Acid Reflux

In: Science

Submitted By phatkat1725
Words 281
Pages 2
D.Z., a 65-year-old man, is admitted to a medical floor for exacerbation of his chronic obstructive pulmonary disease (COPD; emphysema). He has a past medical history (PMH) of hypertension (HTN), which has been well controlled by enalapril (Vasotec) for the past 6 years, and a diagnosis (Dx) of pneumonia yearly for the past 3 years. He appears as a cachectic man who is experiencing difficulty breathing at rest. He reports cough productive of thick yellow-green sputum. D.Z. seems irritable and anxious when he tells you that he has been a 2-pack-a-day smoker for 38 years. He complains of (C/O) sleeping poorly and lately feels tired most of the time. His vital signs (VS) are 162/84, 124, 36, 102°F, Sao2 88%. His admitting diagnosis is chronic emphysema with an acute exacerbation, etiology to be determined. His admitting orders are as follows: diet as tolerated; out of bed with assistance; oxygen (O2) to maintain Sao2 of 90%; maintenance IV of D5W at 50 ml/hr; intake and output (I&O); arterial blood gases (ABGs) in am; CBC with differential, basic metabolic panel (BMP), and theophylline (Theo-Dur) level on admission; chest x-ray (CXR) q24h; prednisone 60 mg/day PO; doxycycline 100 mg PO q12h × 10 days, azithromycin 500 mg IV piggyback (IVPB) q24h ×2 days then 500 mg PO × 7 days; theophylline 300 mg PO bid; heparin 5000 units SC q12h; albuterol 2.5 mg (0.5 ml) in 3 ml normal saline (NS) and ipratropium 500 mg by nebulizer q4-6h; enalapril 10 mg PO q am.
1. Identify at least three measures you could try to improve…...

Similar Documents

Acid Rain

...Acid Rain --------- Acid Rain is caused by pollution containing sulfur dioxide, nitrogen oxide, and ozone ( SOý, NOx, and Oý ) is released into the air. These chemicals are absorbed into clouds and results in Acid Presipitation ( Acid Rain, Acid Snow, Acid Hail, Acid Sleet ). When the chemicals aren't absorbed into clouds, they can drift for miles and fall to the ground, resulting in Acid Deposition, or dry deposition. When Acid Rain falls into water it is mixed in with the normal water and causes the pH of the entire body to be raised. Measurments on the pH ( potential Hydrogen ) scale, rise exponentialy, thus, a lake with a pH of 4 is ten times as acidic as a lake with a pH of 5, and a lake with a pH of 3 is 100 times as acidic, After many rain falls of Acid rain, the pH of a normal lake ( 5.8 ) to 4. Acid Rain has been known to reach the acidicy of pH 2, ( battery acid has a pH if 1 ) this is a drastic change, as normal rain is average pH 5.2. Acid Rain can dissolve limestone and chalk, and corrodes outdoor structures. Statues and monuments that are left unprotected can fall victim to the unpredjudiced destruction of acid rain. Acid Rain reacts to different types of soil and rocks in two ways. 1) Acid rain will dissolve alkaline rocks and soil, or will neutralize the alkalinity. 2) Acid rain will increase the acidicy of already acidic rocks and soil, such as......

Words: 395 - Pages: 2

Acid Base

...Acids taste sour, are corrosive to metals, change litmus (a dye extracted from lichens) red, and become less acidic when mixed with bases. Bases feel slippery, change litmus blue, and become less basic when mixed with acids. While Boyle and others tried to explain why acids and bases behave the way they do, the first reasonable definition of acids and bases would not be proposed until 200 years later. In the late 1800s, the Swedish scientist Svante Arrhenius proposed that water can dissolve many compounds by separating them into their individual ions. Arrhenius suggested that acids are compounds that contain hydrogen and can dissolve in water to release hydrogen ions into solution. For example, hydrochloric acid (HCl) dissolves in water as follows: HCl | H2O | H+(aq) |  +  | Cl-(aq) | Arrhenius defined bases as substances that dissolve in water to release hydroxide ions (OH-) into solution. For example, a typical base according to the Arrhenius definition is sodium hydroxide (NaOH): NaOH | H2O    | Na+(aq) |  +  | OH-(aq) | The Arrhenius definition of acids and bases explains a number of things. Arrhenius's theory explains why all acids have similar properties to each other (and, conversely, why all bases are similar): because all acids release H+ into solution (and all bases release OH-). The Arrhenius definition also explains Boyle's observation that acids and bases counteract each other. This idea, that a base can make an acid weaker, and vice versa, is called......

Words: 392 - Pages: 2

Acid Reflux

...Acid Reflux: New ways to treat an old issue Stacy C. Darracott NS304 Professor Linda Flowers Park University For my position paper I plan to discuss the several techniques used in treating acid reflux. Since the majority of the population suffers from some form of Acid Reflux, myself included, I thought that this would be a great opportunity to do some research on the different treatments, and find out exactly why and what causes it. My paper will take a closer look at the non-pharmaceutical approaches that are surgical in nature or homeopathic in nature. Lastly, my paper will not only help the reader to understand what acid reflux is exactly, but will help to inform them as well as myself, to the every changing techniques and practices of physicians who are trying to help those who suffer from acid reflux, a better a ray of choices when discussing their treatment plans. Gastro esophageal reflux disease is a consequence of the failure of the normal anti reflux barrier to protect against frequent and abnormal amounts of gastro esophageal reflux. It is the gastric contents moving effortlessly from the stomach to the esophagus. It is a normal physiologic process that occurs multiple times each day especially after large meals. Possible factors determining whether reflux occurs include abdominal straining, presence of hiatal hernia and degree of esophageal shortening and duration of transient lower esophageal sphincter relaxations. Pregnancy also increases......

Words: 1531 - Pages: 7

Amino Acids

...Amino Acids Amino acids are the building blocks of proteins. They band together in chains to form the stuff from which life is born. This is a two-step process: first, they get together and form peptides or polypeptides, and it is from these groupings that proteins are made. A total of 20 different kinds of amino acids form proteins, with the types involved determining the shape of the proteins formed. Commonly recognized ones include glutamine, glycine, phenylalanine, tryptophan, and valine. Three of those — phenylalanine, tryptophan, and valine — are essential amino acids for humans; the others are isoleucine, leucine, lysine,methionine, and threonine. This type cannot be synthesized by the body, so they must be ingested through food. One of the best-known essential amino acids is tryptophan, which performs several critical functions for people. It helps induce normal sleep; helps reduce anxiety, depression, and artery spasm risk; and helps produce a stronger immune system. Tryptophan is perhaps most well-known for its role in producing serotonin, which is what gets all the press at Thanksgiving time for putting people to sleep after the big holiday feast. Amino acids make up 75% of the human body. They are essential to nearly every bodily function, and every chemical reaction that takes place in the body depends on them and the proteins that they build. The essential amino acids must be ingested every day. Failure to get enough of even one of them can result......

Words: 294 - Pages: 2

Preparation of the Grignard Reagent and Benzoic Acid

...#36 and 36b Preparation of the Grignard Reagent and Benzoic Acid Purpose- In this experiment we learned to prepare a Grignard reagent, phenyl magnesium bromide, which we then converted to a carboxylic acid. Procedure & Observations- First we started by setting up our apparatus for Grignard reactions. We started by making sure all glassware was completely dried as a Grignard reaction would not occur if water is present. We used a 100ml round bottom flask for our solution and placed it on a hot plate to control the heating process. We then weighed out 0.4920g of magnesium turnings and placed it into the round bottom flask. We also measured out 2.1ml of bromobenzene into a 50ml flask and got a weight of 3.0557g. We then added 10ml of ether to the 2.1ml of bromobenzene and pipetted half into the round bottom flask. The other half was then added to the separatory funnel along with an additional 7ml of ether. From here we began heating the mixture until boiling started to occur. Once the reaction started to begin we got an instant brownish color change. We also ended up using a drop from another group’s reaction to help move along the process. Once this happened we began slowly adding the remaining bromobenzene over a five minute period. Once it had all been added we added an additional 1ml of ether to rinse the funnel. We then heated under gentle reflux till all the magnesium had dissolved. After this we......

Words: 1392 - Pages: 6

Acid Rain

...Acid Rain – Save the Environment Acid rain, or any other form of precipitation with high nitric and sulfuric acid levels is when the precipitation has a lower pH than natural unpolluted rainwater, 5.5 (National Geographic). Acid rain is the result of combustion of fossil fuels which releases acid chemicals into the air (Wysession, Michael). It is a problem in the world since it effects natural and man-made environments as well as other factors in negative ways. The unpolluted water that rains down on us is always slightly acidic with a pH of around 5.6. This is because the rainwater from the clouds react with the CO2 (Carbon Dioxide) that is in the air. It is in the air due to that we convert the oxygen that we inhale into CO2 inside of our bodies, which we later exhale. This results in a solution called Carbonic Acid. (Wysession, Michael) Water | + | Carbon Dioxide | | Carbonic Acid | H20 | + | CO2 | | H2CO3 | Rain counts as acid rain when it goes below the unpolluted rain pH, 5.6. The acidity of acid rain can be as low as 2.7 on the pH scale depending on the ratio of chemical acids and unpolluted rainwater. However, the usual pH of acid rain is around 4.0 which is more than 10 times more acidic than unpolluted rainwater. (Wysession, Michael) Acid rain can be caused by natural sources such as volcanoes. However, the main cause of acid rain is when the acidic chemicals sulfur dioxide (SO2) and nitrogen oxides (NOX) are released into the air by the combustion......

Words: 2323 - Pages: 10

Fatty Acid

...Eur. J. Lipid Sci. Technol. 104 (2002) 785–791 William E. Neff, Fred Eller, Kathleen Warner 785 Composition of oils extracted from potato chips by supercritical fluid extraction* To determine effects of two extraction procedures on oil compositions, tocopherols, monoacylglycerol, diacylglycerol, triacylglycerol, free fatty acids, polymers and polar components were determined in oils after extraction from potato chips by either supercritical carbon dioxide or hexane. Potato chips were fried in cottonseed oil or low linolenic acid soybean oil and sampled after 1, 10 and 20 h of oil use. Both extraction methods recovered comparable amounts of oil from the potato chips. Compositions of triacylglycerol and non-triacylglycerol components including tocopherols, monomer, polymer, monoacylglycerol, diacylglycerol were similar for samples of chips fried in either oil except for the δ-tocopherol data for potato chips fried in the low linolenic acid soybean oil used for 10 h of frying. There were some differences between the composition of low linolenic acid soybean oil extracted from the potato chips compared to the fryer oil at the 20 h sampling time. These results showed that the supercritical carbon dioxide extraction gave similar results to hexane extraction in yield and composition of oils from potato chips. Keywords: Supercritical fluid extraction, oil composition, tocopherols, cottonseed oil, low linolenic soybean oil, frying, fried food. National Center for......

Words: 5477 - Pages: 22

Acid Rain

... Grade 7 St. Albert The Great Acid Rain Acid rain is rain that has been made acidic by certain pollutants in the air. Acid rain is a type of acid deposition, which can appear in many forms. Wet deposition is rain, sleet, snow, or fog that has become more acidic than normal. Dry deposition is another form of acid deposition, and this is when gases and dust particles become acidic. Acid rain occurs when sulfur dioxide and nitrogen oxides are released into the air where they rise and mix with water, oxygen and other chemicals. Sulfur dioxide and nitrogen oxides dissolve very easily in water and can travel great distances to combine with the moisture in the air. The way that acid rain damages plants is very subtle.Over time, the acidic water alters the pH of the soil where your plants are growing, binding and dissolving vital minerals and carrying them away. Acid rain also falls directly on aquatic habitats. Most lakes and streams have a pH between 6 and 8, although some lakes are naturally acidic even without the effects of acid rain. Acid rain primarily affects sensitive bodies of water, which are located in watersheds whose soils have a limited ability to neutralize acidic compounds. Acid rain can cause serious problems for many different animals and humans ......

Words: 290 - Pages: 2

Nucleic Acids

...CHAPTER 9: NUCLEIC ACIDS 9.1 Levels of Structure in Nucleic Acids  Primary (1o) Structure – order of bases in the polynucleotide sequence  Secondary (2o) Structure – 3D conformation of backbone  Tertiary (3o) Structure – supercoiling of the molecule  Quaternary (4o) Structure – interaction between DNA & proteins  Two principle types of nucleic acids - DNA (deoxyribonucleic acid) - RNA (ribonucleic acid) How do DNA and RNA differ?  Ribosomes: polypeptide-generating machinery of the cell  Tobacco mosaic virus: nucleic acid strand winds through a cylinder of coat-protein subunits 9.2 The Covalent Structure of Polynucleotides  Nucleotides: monomers of nucleic acids 1. Nitrogenous base 2. Sugar 3. Phosphoric acid residue  Order of nucleic acids of DNA contains the information necessary to produce the correct amino acid sequence in the cell’s proteins What are the structures and components of the nucleotides?  Nucleic acid bases (nucleobases): one or two-ring nitrogenous aromatic compound - Pyrimidines – single-ring aromatic compounds  Cytosine – DNA & RNA  Thymine – substitute for Uracil in DNA (sometimes in RNA)  Uracil – RNA only - Purines – double-ring aromatic compounds  Adenine – DNA & RNA  Guanine – DNA & RNA  Methylation can modify bases  Nucleoside - base + sugar covalently bonded - lacks phosphate group - base forms a glycosidic linkage with sugar  Ribonucleoside: β-D-ribose  Deoxyribonucleoside: β-D-deoxyribose  The......

Words: 2444 - Pages: 10

Ascorbic Acid

...Ascorbic acid is one of the important water soluble vitamins. It is essential for collagen, carnitine and neurotransmitters biosynthesis. Most plants and animals synthesize ascorbic acid for their own requirement. However, apes and humans can not synthesize ascorbic acid due to lack of an enzyme gulonolactone oxidase. Hence, ascorbic acid has to be supplemented mainly through fruits, vegetables and tablets. The current US recommended daily allowance (RDA) for ascorbic acid ranges between 100–120 mg/per day for adults. Many health benefits have been attributed to ascorbic acid such as antioxidant, anti-atherogenic, anti-carcinogenic, immunomodulator and prevents cold etc. However, lately the health benefits of ascorbic acid has been the subject of debate and controversies viz., Danger of mega doses of ascorbic acid? Does ascorbic acid act as a antioxidant or pro-oxidant ? Does ascorbic acid cause cancer or may interfere with cancer therapy? However, the Panel on dietary antioxidants and related compounds stated that the in vivo data do not clearly show a relationship between excess ascorbic acid intake and kidney stone formation, pro-oxidant effects, excess iron absorption. A number of clinical and epidemiological studies on anti-carcinogenic effects of ascorbic acid in humans did not show any conclusive beneficial effects on various types of cancer except gastric cancer. Recently, a few derivatives of ascorbic acid were tested on cancer cells, among them ascorbic acid esters......

Words: 321 - Pages: 2

Acid Rain

...Acid rain is defined according to the Dictionary as any form of precipitation whether it is snow, rain or sleet that has a high concentration of acid forming contaminates that come from coal smoke and chemical manufacturing that release sulfuric and nitric oxides. These such contaminates are released into the earth’s atmosphere and combine with water vapor. Acid rain is very harmful to the earth’s environment. In 1963 acid rain was discovered in the White Mountains of New Hampshire at the Hubbard Brook Experimental Forest. At this experimental site they found that the PH level was 3.7 from the rain water collected, that means that it was 80 times more of an acidic level than what would be found in normal water. Some of causes of acid rain are both man made and some that are natural in nature. The causes of acid rain that are manmade are caused by the burning of fossil fuels such as coal. These fossil fuels are burned to generate electricity that powers our homes. When these fossil fuels are the winds pick up the sulfuric and nitric oxide contaminates over large areas of land and fall back to the surface as acid rain. The way that acid rain is found naturally is through the eruption of volcanoes, fires and vegetation that is rotting through decomposition which produce sulfur dioxide and lighting that produces nitrogen dioxide. The effect that acid rain has on the forest life can be absolutely devastating by making trees and other plant life more likely......

Words: 449 - Pages: 2

Acids and Alkalis

... removes nail polish | 5.5 Acids and Alkalis Properties of Acids 1. Acids – sour taste 2. Turns blue litmus paper red 3. pH <7 4. corrosive 腐蚀性 5. react with metals hydrogen gas Example : Hydrochloric acid + Zinc Zinc chloride + Hydrogen | 6. Uses of Acids: a) Hydrochloric acid – clean metals, make dyes b) Citric acid – juices c) Formic acid – coagulate latex d) Benzoic acid/Acetic acid – preserve food e) Tartaric acid – bake cakes, soft drinks f) Acetic acid – vinegar g) Nitric acid – fertilizers, explosives h) Ascorbic acid – Vitamin C tablets i) Sulphuric acid – electrolytes in car batteries, fire extinguisher Properties of Alkalis 1. Alkalis – bitter taste, soapy feeling 2. Turns red litmus paper blue 3. pH >7 4. corrosive 腐蚀性 5. react with ammonium salts ammonia gas Example : Sodium hydroxide + Ammonium chloride Ammonia gas + Sodium chloride + Water | 6. Uses of Alkalis: a) Sodium hydroxide / Potassium hydroxide – soaps b) Calcium oxide – cement, slaked lime c) Ammonium hydroxide – prevent coagulation of latex d) Magnesium hydroxide – toothpaste, milk of magnesia Neutralisation 1. | Acid + Alkali Salt + Water (Neutralisation) | Example 1 : Hydrochloric acid (Acid) + Sodium Hydroxide (Alkali) Sodium chloride (Salt) + Water | Example 2 : Sulphuric acid (Acid) + Magnesium Hydroxide......

Words: 798 - Pages: 4

Acid Rain

...ACID RAIN Acid rain is a mixture of deposited material, both wet and dry, coming from the atmosphere containing excessive amount of nitric acid and sulfuric acids. The rain is acidic in nature because of the presence of pollutants coming from the smoke from the cars and industries. Acid rain can occur in form of rain, snow, fog or dry material that settle to earth. The level of Acidity is determined by calculating the pH level in the water drops. Normal rainwater is slightly acidic. The pH level of normal rainwater ranges between 5.3 and 6.0. The normal rainwater is acidic because the carbon dioxide and water react with each other and form carbonic acid. Carbonic acid is a very weak acid. When the pH level of rainwater falls below this range, it becomes acid rain (conserveegergyfuture.com, 2013). Acid rain affects plants directly and decreases the quality of soil and reduced fertility of the soil. The adverse effects of acid rain are severe where there is more concentration of sulfur dioxide and nitrogen oxide (science.opposingviews, 2015). Acid rain has many negative effects, on lakes, streams, wetlands, and other aquatic environments. The primary reason for acid rains is air pollution. Acid rain is caused by large amount of pollutants it can be minimized by conserving energy and reducing pollution. I believe if we do not take preventive measures for acid rains future generation may face severe consequences (environment.nationalgeographic, 2015). Sulfur and Nitrogen are...

Words: 1679 - Pages: 7

Lipoic Acid

...Lipoic acid, or more technically alpha-lipoic acid, is an increasingly recognized dietary supplement that has demonstrated a variety of beneficial effects. Lipoic acid occurs naturally in small amounts in the body where it is involved in a variety of processes but is primarily important in aerobic metabolism and various enzymatic actions. Lipoic acid is known to be involved in the energy-producing processes in cells. Lipoic acid is found in many foods, including liver, kidney, and heart meat and in broccoli, spinach, beets, yeast, yams, carrots, and potatoes. Scientists discovered lipoic acid in the 1950s, but the importance of this compound and its critical role as an antioxidant in the body was not defined until 1988. Lipoic acid is readily converted in the body to another compound called dihydrolipoic acid. Dihydrolipoic acid, or R-Dihydrolipoic acid, is the reduced form of lipoic acid that has more immediate effects than lipoic acid and has even more significant antioxidant effects than lipoic acid. Both of these antioxidants are particularly effective in destroying free radicals known as peroxynitrite radicals. These damaging compounds contain both oxygen and nitrogen and have been implicated in the development of chronic inflammation, nervous system diseases, pulmonary diseases, and arteriosclerosis. Lipoic acid acts as an antioxidant in the body and has been shown to have protective effects against nerve damage in diabetics, among other beneficial effects. Lipoic......

Words: 2729 - Pages: 11

Acid Bases

...Outcome I Acids and Bases Define acid and base using Arrhenius, Bronsted-Lowry, and Lewis definitions. Classify common items as acid or base by their characteristics such as taste, reaction with indicators, etc. Calculate the pH and pOH of solutions and use pH to classify them as acids or bases Perform titration calculations using pH, pOH and molarities Definitions: Acid Base Arrhenius model Brønsted-Lowry model Conjugate Acid Conjugate Base Conjugate acid-base pair Amphoteric Lewis model Hydronium Strong acid Stron base Weak acid Weak base Ion product constant for water pH pOH Logarithm Neutralization reaction Salt Titrant Equivalence point End point Titration Indicator  Questions and Calculations 1) a.What is Kw? b. What is the concentration of H3O+ in pure water? c. What is the concentration of OH- in pure water? d. What are the properties of a neutral solution? 2) Identify each of these as an acid, a base, both or neither | |Acid |Base |Both |Neither | |Fe | | | | X | |NaOH | | | | | |H2SO4 | ...

Words: 600 - Pages: 3