Ackley, B.J., Ladwig, G.B., Flynn-Makic, M.B., Martinez-Kratz, M.R., & Zanotti, M. (2020). Desired Outcome: Within 2 hours of nursing interventions, the patient will demonstrate improved gas exchange as evidenced by heart rate and oxygen saturation within normal range. Which action by the nurse is the most appropriate? Encourage pursed lip breathing and deep breathing exercises. Desired Outcome: Within 1 hour of nursing interventions, the patient will demonstrate improved gas exchange as evidenced by oxygen saturation greater than 90%. Youll breathe in supplemental oxygen through a nasal cannula or a mask. numerous Copyright 2023 StudeerSnel B.V., Keizersgracht 424, 1016 GC Amsterdam, KVK: 56829787, BTW: NL852321363B01, Biological Science (Freeman Scott; Quillin Kim; Allison Lizabeth), The Methodology of the Social Sciences (Max Weber), Campbell Biology (Jane B. Reece; Lisa A. Urry; Michael L. Cain; Steven A. Wasserman; Peter V. Minorsky), Forecasting, Time Series, and Regression (Richard T. O'Connell; Anne B. Koehler), Psychology (David G. Myers; C. Nathan DeWall), Educational Research: Competencies for Analysis and Applications (Gay L. R.; Mills Geoffrey E.; Airasian Peter W.), Brunner and Suddarth's Textbook of Medical-Surgical Nursing (Janice L. Hinkle; Kerry H. Cheever), Give Me Liberty! For post-pneumonectomy patients, position the patient with good lung down, which means positioning on the non-operative side. Impaired gas exchange r/t alveolar-capillary membrane changes AEB chest x-ray suggesting possible area of consolidation in the right lower lobe Acute Confusion r/t situational crisis AEB restlessness, irritability, and agitation. However, my patient had normal vital signs, no complaint of pain, and no lab test except a positive strep test. dyspnea, smoking 20 Respiratory System Crackles in all lung fields Diminished Impaired gas exchange related to smoking as evidenced by dyspnea, crackles all lung fields, and oxygen . Subjective Data: Pt family member tells you that the patient has been sleeping constantly for 2 weeks. See our full, Important Disclosure: Please keep in mind that these care plans are listed for, Click to share on Facebook (Opens in new window), Click to share on Twitter (Opens in new window), Click to share on Pinterest (Opens in new window), Click to share on Reddit (Opens in new window), Click to share on LinkedIn (Opens in new window), Click to share on WhatsApp (Opens in new window), Click to share on Pocket (Opens in new window), Click to share on Telegram (Opens in new window), Click to share on Skype (Opens in new window), IV Drug Use Complications & Dangers: (Endocarditis, Infection, Infectious Diseases). OUTCOMES Prepare to administer fluid bolus as ordered. Overall, treatment for COPD with impaired gas exchange focuses on reducing symptoms and slowing disease progression. Mean NRS-11 values for itch went down from 5.14 2.08 (day 1) to 2.30 2.14 (day 6). Impaired gas exchange in COPD can cause symptoms like shortness of breath, coughing, and fatigue. s erm In 2 days, the patient will Patient verbalizes understanding of oxygen and other therapeutic interventions. Clinical, physiologic, and radiographic factors contributing to development of hypoxemia in moderate to severe COPD: A cohort study. Refer the patient to a chest physiotherapist. RECOGNIZE/ANALYZE CUES Davis Company. Likewise, education will help the patient to be aware of specific things to avoid at home in terms of food or drink and why these should be avoided. Two of the most common conditions that fall under the umbrella of COPD are emphysema and chronic bronchitis. Whatnursing care plan bookdo you recommend helping you develop a nursing care plan? Registered Nurse, Free Care Plans, Free NCLEX Review, Nurse Salary, and much more. If you want to view a video tutorial on how to construct a care plan in nursing school, please view the video below. Mechanisms of abnormal gas exchange are grouped into four categories hypoventilation, shunting, ventilation-blood flow imbalance, and limitations . This will reduce hypoxemia resulting in improved oxygen saturation and reduce dyspnea. Altered Vital signs. It is also imperative that the nurse assesses the individuals airway and breathing status immediately and prioritizes this above any other nursing intervention. Changes in behavior and mental status can be early signs of impaired gas exchange. The patient has labored, tachypneic, breathing. Impaired gas exchange related to inadequate surfactant levels and immaturity of pulmonary system Planning and Expected Outcomes : - The infant will suffer minimal respiratory distress syndrome, with reduced work of breathing and no morbidity. Heart failure is a chronic, progressive condition. Manage Settings By using any content on this website, you agree never to hold us legally liable for damages, harm, loss, or misinformation. To reduce the risk of drying out the lungs. Impaired Gas Exchange Diagnoses: Chronic Bronchitis (COPD) Problem Identified: Impaired Gas exchange Nursing Diagnoses: Impaired Gas Exchange r/t altered oxygen supplyobstruction. Therefore, that becomes the priority for the patient and the nurse should begin by improving his oxygen saturation and breathing status. Care Plans are often developed in different formats. Objective Data Physical Assessment General condition: awake, weak looking, on mild-cardiorespiratory distress. To enable to patient to receive more information and specialized care in the removal of thick lung secretions and enabling of improved gas exchange. Impaired gas exchange occurs due to alveolar-capillary membrane changes, such as fluid shifts and fluid collection into interstitial space and alveoli. Pt states she has been coughing up greenish to brownish sputum that is thick. acute respiratory distress syndrome (ARDS), Hydronephrosis Nursing Diagnosis and Care Plan, Psychosocial Nursing Diagnosis and Nursing Care Plan, Abnormal arterial blood gases (ABG) results hypoxia and/or hypercapnia, Abnormal respiratory rate, depth, and rhythm, Cyanosis bluish discoloration of the skin especially in neonates, Medical conditions that involve the collapse or alteration in the alveoli including, Medical conditions that cause reduced hemoglobin levels including bleeding disorders, lung cancer, and ongoing chemotherapy for, Age the total pulmonary blood flow in older people is lower than younger ones, Prolonged immobility as in trauma patients and those with neuromuscular disorders, Patients who have undergone chest or upper abdominal surgery. In a physical assessment, a patient with impaired gas exchange may present with one or more of the following; Confusion, irritability, or impending sense of doom are also potential signs of impaired gas exchange. diagnosis-problem). years, immobility, Ongoing ASSESSMENTS: (verbs associated with Subjective Data: 1. A continuous pulse oximeter allows for close monitoring of the patients oxygen status and evaluation of interventions. To avoid abdominal distention and diaphragm elevation which can lead to a decrease in lung capacity. 2 This promotes NURSING DIAGNOSIS Impaired gas exchange in COPD can cause symptoms like shortness of breath, coughing, and fatigue. Get, Researchers say the 5-questionnaire screening tool called CAPTURE can help diagnose people with treatable COPD, although not all experts agree, Here are five pieces of advice to maintain optimal lung health and breathing capacity, from staying far away from cigarettes to adopting a consistent. Monitor vital signs for oxygen saturation and changes in heart rate, blood pressure, or cardiac rhythm. Reversal agents will diminish the respiratory depression caused by opiates. document.getElementById("ak_js_1").setAttribute("value",(new Date()).getTime()); This site uses Akismet to reduce spam. Copyright 2022 SimpleNursing.com. Client mentions that he is starting to experience shortness of breath and has a hard time taking a deep breath Client states he feels lightheaded while in bed and has a constant headache. Assess the patients vital signs, especially the respiratory rate and depth. What are the causes of impaired gas exchange? When you breathe in these irritants over a long period of time, they can damage your lung tissue. Anticipate the need for intubation and mechanical ventilation. Anna began writing extra materials to help her BSN and LVN students with their studies and writing nursing care plans. Desired Outcome: The patient will have improved oxygenation and will not show any signs of respiratory distress. Respiratory effectiveness can be affected by chronic conditions that affect the lungs like chronic obstructive pulmonary disorder. assessment and Click here to see a full list of Nursing Diagnoses related to Congestive Heart Failure (CHF). Your lungs are vital for providing your body with fresh oxygen while ridding it of carbon dioxide. In addition to her hospital and trauma center experience, Shelly has also worked in post-acute, long-term, and outpatient settings. consumption. A. Monitor the chest drainage system of post-lobectomy or lung resection patient. Encourage the patient to cough to expectorate any sputum. It can happen for several reasons, such as hyperventilation. Presence of pulmonary congestion, pulmonary edema and collection of secretions can all result in impaired gas exchange. EVALUATE PATIENT Impaired gas exchange is a disruption of the oxygen and carbon dioxide exchange in the lung tissues. auscultation. THE EFFECTIVENESS OF Encourage adequate Often, metabolic compensatory changes occur, however during pulmonary edema, hypoxemia can be severe and may require immediate interventions. To enable to patient to receive more information and specialized care in enabling of improved gas exchange. Participants expire into a GaSampler test kit (QuinTron, Milwaukee, WI [QT] 00892,) and 30cc of breath will be extracted from the sample holding bag with a leur-lock syringe (QT02741) with 1-way stopcock (QT01727-V). The most important part of the care plan is the content, as that is the foundation on which you will base your care. restful environment. He has a known history of hypertension and heart failure. Hypercapnia: What Is It and How Is It Treated? oxygenation. Some of our partners may process your data as a part of their legitimate business interest without asking for consent. Agarwal AK, et al. Using the nursing risk for impaired gas exchange care note can help alleviate clients symptoms of impaired gas exchange and prevent life-threatening complications. by gravity. Learn more about how to interpret your FEV1 reading. Increased heart rate and decreased oxygen saturation can be expected in the vital signs of a patient with impaired gas exchange. Low ABG level . All rights reserved. The patients airway is protected and he is able to breathe on his own. Nursing Diagnosis: Impaired Gas Exchange related to altered oxygen supply secondary to lung cancer as evidenced by shortness of breath, wheeze upon auscultation, hypercapnia, cyanosis of the lips, oxygen saturation of 80%, restlessness, and changes in mentation. A 63 year old female presents to the ER with complaints of shortness of breath on excretion and atypical chest pain. Client is free of symptoms of respiratory distress, Client participates in treatment regimen within level of ability and situation, stabilized fluid volume with balanced intake and output, Unlabored respirations at 12-20 breaths/min, Electrolytes: sudden fluid shifts may lead to sodium and potassium imbalance/deficiency, Engage in diaphragmatic and pursed lip breathing techniques. Read theprivacy policyandterms and conditions. Based on these analyses, implemented on a Field Programmable Gate Array, we will interrupt the test exactly when the dominating elementary mechanisms . He was only on one medication,ampicillian. CRITICAL CARE NURSING CARE PLANS. The consent submitted will only be used for data processing originating from this website. Decreasing oxygen saturation levels mean hypoxia. This helps counteract the effects of hypoxemia by delivering oxygen directly into your lungs. This can result in hypoventilation and stasis of secretions with subsequent impaired gas exchange, Prevent complications such as collapsed airway, Provide information about disease/prognosis, therapy needs, and prevention of recurrences, Auscultate breath sounds, noting crackles and wheezes, Measures to facilitate removal of pulmonary secretions such as suction, postural drainage, percussion and vibration, Consultation with appropriate health care providers if signs and symptoms worsen, Instructions on copying such as effective coughing, deep breathing, Diaphragmatic breathing technique to promote greater movement of the diaphragm and decreased use of accessory muscles, pursed lip-breathing technique to cause mild resistance to exhalation, which creates positive pressure in airways. Her experience spans almost 30 years in nursing, starting as an LVN in 1993. Pursed lip breathing and deep breathing exercises also prevents atelectasis or lung collapse. By accessing any content on this site or its related media channels, you agree never to hold us liable for damages, harm, loss, or misinformation. Patient exhibited dyspnea on ambulation from stretcher to bed. Left-sided heart failure is also known as Congestive Heart Failure (CHF). Breath sounds can help determine or confirm the cause of impaired gas exchange. Advertisementsif(typeof ez_ad_units != 'undefined'){ez_ad_units.push([[300,250],'nurseship_com-large-mobile-banner-1','ezslot_4',662,'0','0'])};__ez_fad_position('div-gpt-ad-nurseship_com-large-mobile-banner-1-0');When assessing this patient, the nurse will want to remember ABCs (airway, breathing, circulation) of care. Assess the lungs for decreased ventilation and adventitious lung sounds. 2 part Risk Diagnosis, GENERATE SOLUTIONS Healthline has strict sourcing guidelines and relies on peer-reviewed studies, academic research institutions, and medical associations. Bronchodilators increase the delivery of oxygen by means of improving the dilation of small airways. Fluid resuscitation will treat the underlying cause of the impaired gas exchange and improve oxygenation status. What are nursing care plans? Breath sounds expansion and What are the symptoms of impaired gas exchange and COPD? problems. We and our partners use cookies to Store and/or access information on a device. Central cyanosis involving the mucosa may indicate further reduction of oxygen levels. Thieme. These include things like heart disease, pulmonary hypertension, and lung cancer. Feelings of anxiousness can increase respiratory rate and cause difficulty breathing and should be avoided if possible. IMPAIRED GAS EXCHANGE/SHORTNESS OF BREATH Subjective Data: Allergies: _____ Chief complaint: _____ Onset:_____ q New Onset Chronicq q Recurrence Severity of attack: Scale: (1-10)_____ Precipitating Factors: q Cold air Exercise Chemicalsq Respiratory infectionq Emotional situationsAir pollutants q q q . Injection Gone Wrong: Can You Spot The Mistakes? The patient is a current smoker and has been since she was 19 years old. When you breathe in, your lungs expand and air enters through your nose and mouth. Enter the email address you signed up with and we'll email you a reset link. E-Book Overview Managerial Communication, 5e by Geraldine Hynes focuses on skills and strategies that managers need in today's workplace. She is a clinical instructor for LVN and BSN students and a Emergency Room RN / Critical Care Transport Nurse. Administer 2 liters per minute of oxygen through a nasal cannula as ordered. St. Louis, MO: Elsevier. Assess the patients vital signs and characteristics of respirations at least every 4 hours. Urinary Tract Infection Nursing Diagnosis & Care Plan, Impaired Skin Integrity Nursing Diagnosis & Care Plan, Assess for lung sounds for indications of atelectasis. Nursing-Diagnosis: Impaired gas exchange related to the destruction of alveolar walls. (relevant medical orders, comfort This is because COPD is associated with progressive damage to the alveoli and airways. Nursing Diagnosis: Impaired Gas Exchange related to altered oxygen supply secondary to emphysema as evidenced by shortness of breath, wheeze upon auscultation, phlegm, oxygen saturation of 82%, restlessness, and reduced activity tolerance. If you have COPD with impaired gas exchange you may need to be treated with supplemental oxygen as well as other COPD treatments. As a nurse, you will either follow doctors' orders for nursing interventions or develop them yourself using evidence-based practice guidelines. Pt states she has felt bad since Monday and today is Friday. Head elevation and semi-Fowlers position help improve the expansion of the lungs, enabling the patient to breathe more effectively. Buy on Amazon, Gulanick, M., & Myers, J. L. (2017). Fluid normally resides in the pleural space and acts as a lubricant for the pleural membranes to slide across one another when we breathe. Herdman, T., Kamitsuru, S. & Lopes, C. (2021). INTERVENTIONS AND SATISFY Acute Respiratory Distress Syndrome (ARDS), Nursing Diagnosis: Impaired Gas Exchange related to chest trauma secondary to ARDS as evidenced by shortness of breath, fast and labored breathing, cyanosis of skin, rapid pulse, oxygen saturation of 78%, restlessness, and reduced activity tolerance. positioning Pt family member tells you that the patient has been sleeping constantly for 2 weeks. (Symptoms) Verbalizes difficulty breathing Complains of feeling fatigued Reports a long history of tobacco use Reports having a cold for several weeks Objective Data: assessment, diagnostic tests, and lab values. He reports over the past 3 days his shortness of breath, particularly with activity, has increased significantly. Gas Exchange . The main assessment findings the nurse should be aware of for this patient begin with his vital signs, all of which are listed are abnormal. Impaired Gas exchange. B. Impaired gas exchange: Accuracy of defining characteristics in children with acute respiratory infection. According to the Centers for Disease Control and Prevention (CDC), about 15.7 million people in the United States, or about 6.4 percent of the population, have COPD, making it the fourth leading cause of death in the United States in 2018. Oxygenation and ventilation may need to be supported mechanically. changes in 2. Client demonstrates adequate ventilation and oxygenation of tissue evidenced by ABGs and oximetry. Methods:This is a prospective observational study in very preterm infants. Lab and Diagnostic work shows: WBC 30,000 and chest x-ray preliminary results show possible bilateral lower lobe pneumonia. What is the treatment for impaired gas exchange and COPD? Impaired gas exchange can result from any condition that compromises a patients airway, blood flow, or respiratory effectiveness. Pathophysiology Impaired gas exchange is the state in which there is an excess or deficit in oxygenation or in the elimination of carbon dioxide at the level of the alveolocapillary membrane. Bipap ordered with the following settings Ipap 20, Epap 8, Oxygen Percentage 30%, Rate 12. To increase the oxygen level and achieve an SpO2 value within the target range. To improve the delivery of oxygen in the airways and to reduce shortness of breath and risk for airway collapse. Abnormal objective data BP:140/80mmHg PR: 102bpm RR:24cpm T:37.7C Use of accessory muscles, restless and irritable Three-part diagnostic statement Impaired gas exchange related to hypoxia as evidenced by the use of accessory muscles, respiratory rate of 24 cpm and BP of 140/80. During history collection from pt, pt becomes short of breath and has to stop talking to catch her breath. We and our partners use cookies to Store and/or access information on a device. Our website services, content, and products are for informational purposes only. Impaired gas exchange related to alveolar-capillary membrane changes D (The related to factor of alveolar-capillary membrane changes is accurately written because it is a patient response to the disease process of pneumonia that the nurse can treat. Hypoxemia and impaired CO 2 clearance are characteristics of acute respiratory distress syndrome (ARDS) (1-3).Abundant literature has explored the mechanisms of gas exchange abnormalities in ARDS. -Pt will be place on 2L O2 by nasal cannula per MD order for O2 saturation of less than 90%.-The nurse will demonstrate and verbalize how to use the incentive spirometer for effective oxygenation and airway clearance. Important Disclosure: Please keep in mind that these care plans are listed for Example/Educational purposes only, and some of these treatments may change over time. Oxygen and carbon dioxide are exchanged across the alveolar-capillary barrier in a passive manner, depending on both gases concentrations. low partial pressure of oxygen in arterial blood, Neuromuscular conditions that cause fixation or weakening of the diaphragm, Assess cardiac function such as blood pressure and heart rate, Assess use of central nervous system depressants, Inspect dependent body areas for edema with and without pitting, Pitting edema is generally obvious only after 10lbs weight gain, Pulmonary edema may develop more rapidly, and immediate intervention is necessary, Use of central nervous system depressants may cause depression of respiratory center and cough reflex. Injection Gone Wrong: Can You Spot The Mistakes? The client's physical assessment. Assist the patient to assume semi-Fowlers position. Assessments, Administering, When ventilation occurs but perfusion fails, the imbalance and impairment of gas exchange occur. Powers KA, et al. be within normal In CHF, the heart is either unable to contract completely or fill completely during relaxation. Nursing Diagnosis: Impaired gas exchange related to decreased ventilation secondary to opioid use as evidenced by respiratory rate of 6 respirations per minute, oxygen saturation 70%, and extreme lethargy. oxygen needs and Post fall alert (Subjective/Objective Data THE NURSE TO REEVALUATE Oxygen from the air moves through the walls of the alveoli and enters into the bloodstream via tiny blood vessels called. Objective Data: By my observation, I found that my patient has altered oxygen level . Restlessness, which may be triggered by conditions that change the respiratory state, presented high specificity in a determination study conducted by Pascoal (2015). The client's self-reports. NY Times Paywall - Case Analysis with questions and their answers. Decreased activity tolerance related to imbalance between oxygen supply and demand as evidenced by dyspnea, tachypnea, tachycardia, decreased oxygen saturation, and fatigue. The patient is to be admitted to the hospital for Acute Exacerbation of Congestive Heart Failure (CHF). C. Patient will have Wow, I give up! Interventions are classified into the following seven domains: family, behavioral, physiological, complex physiological, community, safety, and health system interventions. #shorts #anatomy. The APGAR Score is an acronym that denotes specific areas of assessment that must be evaluated between the first and fifth minutes of life. Abnormal Impaired Gas Exchange related to decreased lung compliance and altered level of consciousness as evidence by dyspnea on exertion, decreased oxygen content, decreased oxygen saturation, and increased PCO2. Some mechanisms behind impaired gas exchange in COPD can include one or a combination of the following: When gas exchange is impaired, you cannot effectively get enough oxygen or rid your body of carbon dioxide. Chronic obstructive pulmonary disease. This can be due to a compromised respiratory system or due to [] Effective chest drainage helps the remaining lung segments to re-expand successfully. To view the purposes they believe they have legitimate interest for, or to object to this data processing use the vendor list link below. Good lung down position helps the patient achieve maximum oxygenation and enhanced blood flow to the remaining lung. Auscultate the lungs and monitor for abnormal breath sounds. This process is called gas exchange. In doing this, it will help to remove additional fluid thereby improving his oxygen and breathing capability further. The data is expected to improve slightly to 51.9. Weight Mass Student - Answers for gizmo wieght and mass description. MAKE A CHANGE IN THE Ackley, B. J., Ladwig, G. B., Makic, M. B., Martinez-Kratz, M. R., & Zanotti, M. (2020). To improve cardiac contractility by discharge. Impaired gas exchange related to fluid overload as evidenced by labored, tachypneic breathing, decreased oxygen saturation, crackles in lung fields, pitting edema, congestion on chest x-ray. Proper diagnosis is important for coming out with the right nursing care plan for pneumonia. The nurse is evaluating the plan of care and notes that none of the goals have been met for the client with impaired gas exchange. During this process, oxygen enters the bloodstream while carbon dioxide is removed. It is vital to monitor patients admitted with congestive heart failure closely. The patient is excessively sleepy and falls asleep easily even with stimuli. Ventilation is improved if the airway remains patent through frequent positioning. The patient has a history of obstruction sleep apnea. Decrease in blood pressure to patients baseline (ideally <120/80), Improved contractility by decreasing excess fluid, improvement in breathing status, and stabilization of vital signs, Decreased oxygen saturation (83% at room air), Patients activity level will return to baseline. synonyms) ASSESSMENTS ALLOW Assess respirations for rate and quality, as well as use of accessory muscles. -The nurse will teach the patient 4 benefits of wearing a CPAP machine at home when she sleeps. St. Louis, MO: Elsevier. Doenges, M.E., Moorhouse, M.F., & Murr, A.C. (2019). Nursing Diagnosis: Impaired gas exchange related to alveolar-capillary membrane changes secondary to COPD as evidenced by oxygen saturation 79%, heart rate 112 bpm, and patient reports of dyspnea. Chair/bedrest will limit the bodys oxygen demand beyond the usual requirements. teaching pertinent to diagnosis), EVIDENCE Cross), Chemistry: The Central Science (Theodore E. Brown; H. Eugene H LeMay; Bruce E. Bursten; Catherine Murphy; Patrick Woodward), Final Exam Study Guide - Lecture notes all, Exam 2 study concepts (most likely on exam), Ariel-pnguide - Good notes for nursing studying work, Perspectives in the Social Sciences (SCS100), Introductory Human Physiology (PHYSO 101), United States History, 1550 - 1877 (HIST 117), RN-BSN HOLISTIC HEALTH ASSESSMENT ACROSS THE LIFESPAN (NURS3315), advanced placement United States history (APUSH191), Expanding Family and Community (Nurs 306), Professional Application in Service Learning I (LDR-461), Advanced Anatomy & Physiology for Health Professions (NUR 4904), Principles Of Environmental Science (ENV 100), Operating Systems 2 (proctored course) (CS 3307), Comparative Programming Languages (CS 4402), Business Core Capstone: An Integrated Application (D083), PSY HW#3 - Homework on habituation, secure and insecure attachment and the stage theory, Request for Approval to Conduct Research rev2017 Final c626 t2. Close monitoring of types of food and drinks is also important. 2023 nurseship.com. Diseases that affect the ability for blood to carry oxygen can also result in impaired gas exchange. To increase activity level to patients baseline prior to discharge. Early intervention is recommended to prevent total decompensation. Ncp on anemia - 2022 - S NURSING DIAGNOSIS SUBJECTIVE DATA OBJECTIVE DATA GOAL & PLANNING - Studocu 2022 s.no nursing diagnosis subjective data objective data goal planning implimentation rationale impaired gas exchange related to decreased hemoglobin level Skip to document Ask an Expert Sign inRegister Sign inRegister Home Ask an ExpertNew Meanwhile, chronic bronchitis involves long-term inflammation of the airways. Anti-pyretic drugs aim to reduce the bodys temperature levels. Buy on Amazon. VS: HR 85, BP 130/82, Temp 98.6, RR irregular 19.
Alex Hawke Ruby Princess,
Accident On Northway Yesterday,
Brookhurst Park Baseball Field,
Steven Coleman Obituary,
Bite Beauty Glace Dupe,
Articles I