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Have a manual resuscitation bag with a face mask and oxygen readily available at the client’s bedside.Have reintubation equipment at bedside.Suction the oropharynx and trachea.Deflate the cuff on the endotracheal tube, and remove the tube during peak inspiration.Following extubation, monitor for signs of respiratory distress or airway obstruction, such as ineffective cough, dyspnea, and stridor.Assess SpO2 and vital signs every 5 min.Encourage coughing, deep breathing, and use of the incentive spirometer.Reposition the client to promote mobility of secretions.Older adult clients have decreased respiratory muscle strength and chest wall compliance, whichmakes them more susceptible to aspiration, atelectasis, and pulmonary infections. Older adult clients require more frequent position changes to promote mobility of secretions.Long term may have stress ulcers, fluid retention (Hyponatremia) due to decreased cardiac out, hypotense(Illness Mgmt) Hepatitis and Cirrhosis: Priority Finding to ReportALT: Expected reference range 4 to 36 units/LAST: Expected reference range 0 to 35 units/LALP: Expected reference range 30 to 120 units/LHepatitis CM:Elevated ALT AST and maybe ALPFailure to take personal precautions with blood and body fluidInfluenza-like manifestationsoFatigueoDecreased appetite with nauseaoAbdominal painoJoint painPHYSICAL ASSESSMENT FINDINGSFeverVomitingDark-colored urineClay-colored stoolJaundiceCirrhosis:Elevated ALT AST and ALP Bilirubin, NH2, Decreased Serum protein, Serum albumin, RBC, Hb, Hct, plateletsCM:
FatigueWeight loss, abdominal pain, distentionPruritus (severe itching of skin)Confusion or difficulty thinking (due to the buildup of waste products in the blood and brain thatthe liver is unable to get rid of)Personality and mentation changes, emotional lability, euphoria, depressionCognitive changesAltered sleep/wake patternGastroesophageal bleeding (enlarged esophageal veins [varices] develop and burst, causing vomiting and passing of blood in bowel movements) or portal hypertensive gastropathy, which isbleeding of gastric mucosaSplenomegaly caused from backup of blood into the spleen, which can cause thrombocytopenia and platelet destructionAscites (bloating or swelling due to fluid buildup in abdomen and legs)Jaundice (yellowing of skin) and icterus (yellowing of the eyes) from decreased excretion of bilirubin, resulting in an increase of circulating bilirubin levelsPetechiae (round, pinpoint, red-purple lesions), ecchymoses (large yellow and purple-blue bruises), nosebleeds, hematemesis, melena (decreased synthesis of prothrombin, deteriorating hepatic function)Palmar erythema (redness, warmth of the palms of the hands)Spider angiomas (red lesions, vascular in nature with branches radiating on the nose, cheeks, upper thorax, shoulders)Dependent peripheral edema of extremities and sacrum Asterixis (liver flapping tremor): coarse