Fifth Day Of Hospitalization Research Articles

Changing attitudes toward splenic trauma

The emergency physician and the trauma specialist have begun to use new diagnostic and therapeutic techniques when dealing with splenic injuries and blunt abdominal trauma. These techniques of abdominal computed tomography (CT) and nonsurgical management represent a quite different approach from the long-standing modalities of peritoneal lavage and splenectomy. These newer methods are less invasive, but whether they represent an improvement in patient care is subject to question. Recently, a patient who had sustained blunt abdominal trauma following a motor vehicle accident was admitted to our institution. He did not get the routine peritoneal lavage. Instead, in the “new” fashion, the patient received a CT scan of the abdomen and was observed in our Special Care Unit. He did well for several days, and then, on the fifth day of hospitalization, his hematocrit fell to 24% and his systolic pressure decreased to 90 mm Hg. We rushed the patient to the operating suite, and while there we found 1,500 ml of blood in his peritoneal cavity. His spleen was bleeding freely. By the conclusion of the procedure, the patient had received ten units of packed cells, four units of fresh-frozen plasma, and large volumes of crystalloid. A splenectomy was performed. Although this case is anecdotal, it illustrates the potential for catastrophe when dealing with splenic rupture and the fact that CT scans can be technically difficult to interpret. Although some free blood had been noted on this patient’s CT scan pre-operatively, the extent of his splenic injury had not been appreciated. Another recent admission to our medical center in

Acute renal failure after acetaminophen overdose: Report of two cases

Two cases of acute tubular necrosis without hepatic failure following acetaminophen overdose are reported. A 19-year-old Caucasian woman ingested 100 500-mg capsules of acetaminophen. She was admitted to a hospital 68 hours after ingestion, and serum acetaminophen concentration 70 hours after ingestion was 3 microgram/ml. Liver-function test results were markedly elevated, and urinalysis was abnormal on admission. Liver function improved over the next five days, but the patient's renal function deteriorated. Her condition initially was diagnosed as prerenal azotemia, but was later consistent with acute tubular necrosis. Hemodialysis was begun on the fifth day of hospitalization. On the eleventh hospital day, the patient's renal function began to improve, and she was subsequently discharged. In the second case, a 19-year-old Spanish-American woman ingested 30 500-mg capsules of acetaminophen. She was seen in an emergency room 16 hours after the ingestion; her serum acetaminophen concentration was 32 microgram/ml 19 hours after ingestion. Oral acetylcysteine therapy was begun, and liver-function test results were elevated and peaked on the third hospital day. Renal function began to decline on the fifth hospital day; her condition was consistent with acute tubular necrosis. She was hemodialyzed once, and her renal function improved on the tenth hospital day. She was subsequently discharged. It is concluded that acute renal failure without prior hepatic failure may occur after acetaminophen overdose.

Anxiety Levels of Hospitalized Psychiatric Patients Throughout Total Hospitalization

ABSTRACT The purpose of this study was to determine the trend of anxiety levels of psychiatric patients throughout a short-term hospitalizaron. The sample included patients hospitalized in a 27bed psychiatric unit at a University-affiliated hospital. The average hospitalization was ten days. Fifteen patients were randomly selected over a two-month period. There were no limitations as to age, sex, diagnosis, previous hospitalizations or socioeconomic status. Patients who were too disturbed to complete the test forms were not included in the study. The IPAT 8-Parallel-Form Anxiety Battery was administered at daily intervals. Form A was given within 24 hours after admission. Forms B through G were administered, one per day, over the next six days. Form H was withheld until the patient had been informed of his discharge plans. On the average, three days elapsed between the administration of Forms G and the final form, Form H. A Friedman Analysis of Variance indicated that the changes in anxiety levels over time approached statistical significance. A Wilcoxan Signed-Ranks Test showed that some mean scores fluctuated significantly from the initial mean anxiety level. The results supported the observation that anxiety tends to be high at admission and upon notification of discharge. The results also identified a third peak at approximately the fifth day of hospitalization. Implications for nursing care were discussed. The trends in anxiety fluctuation may provide a basis for prediction of periods of particular stress for patients that should have implications for nursing care. Patterns of anxiety fluctuations during a short-term hospitalization period provide areas for further research, some of which were discussed in the report.

What Communication Means to Patients

views were conducted, and the fifth day of hospitalization was the mean date of interviewing. All interviews were recorded verbatim and had a mean length of one hour. It is our thesis that communication had two primary meanings for the hospitalized patients: the securing of information, and interpersonal contact. The securing of information seemed to serve instrumental functions, while interpersonal contact had both instrumental and expressive functions. Expressive refers to action concerned with direct gratification, while instrumental refers to actions

What Communication Means to Patients

views were conducted, and the fifth day of hospitalization was the mean date of interviewing. All interviews were recorded verbatim and had a mean length of one hour. It is our thesis that communication had two primary meanings for the hospitalized patients: the securing of information, and interpersonal contact. The securing of information seemed to serve instrumental functions, while interpersonal contact had both instrumental and expressive functions. Expressive refers to action concerned with direct gratification, while instrumental refers to actions

Terramycin in treatment of pneumonias of childhood: A report of ten cases

CASE 1.--J. B., a 4-month-old Negro male, entered the hospital Feb. 3, 1950, with a toxic appearance but a normal temperature. X-ray confirmed a diagnosis of bilateral bronchopneumonia. The blood cultures were all negative, but the nose and throat cultures revealed pneumococci group B and staphylococci. He was given 1.8 Gin. daily (300 mg. every four hours) of terramycin orally. All clinical and roentgenographic signs of illness disappeared by the fifth day of hospitalization.