Extra Flashcards
(215 cards)
1
Q
Nephrotic syndrome
A
Nephrotic syndrome is a collection of symptoms resulting from various causes of glomerular injury. Below are the 4 classic manifestations of nephrotic syndrome:
Massive proteinuria – caused by increased glomerular permeability
Hypoalbuminemia – resulting from excess protein loss in the urine
Edema – specifically periorbital and peripheral edema and ascites; caused by low serum protein and albumin as fluid is pulled into interstitial spaces and body cavities
Hyperlipidemia – related to increased compensatory protein and lipid production by the liver
2
Q
Asthma & Ibuprofen
A
Two groups of commonly used drugs, nonsteroidal anti-inflammatory drugs and beta-adrenergic antagonists (beta blockers), have the potential to cause problems for clients with asthma.
Ibuprofen (Motrin) and aspirin are common over-the-counter anti-inflammatory drugs that are effective in relieving pain, discomfort, and fever. About 10%-20% of asthmatics are sensitive to these medications and can experience severe bronchospasm after ingestion. This is prevalent in clients with nasal polyposis.
3
Q
Blood pressure
A
89mmhg of lower = shock
180mmHg or higher = Hypertensive crisis
4
Q
MAP
A
Mean arterial pressure
60mmHg or high = good tissue perfusion
5
Q
Temp
A
103 or higher
39 or higher
Med emergency
below 95 or 35 Hypothermia
6
Q
Spo2
A
93% or higher = normal
88-92% normal for COPD and Sleep Apnea
7
Q
Heart sound s3
A
heart after s2
Normal in CHF, Not normal in MI
8
Q
Heart sound s4
A
fluid overload (normal for pregnant women)
9
Q
Autonomy
A
freedom of choice, self determination
Autonomy is the right to make decisions for oneself (eg, informed consent). Although having an advance directive is an example of autonomy, requiring one violates this principle. The client has a right to refuse even if the nurse believes it is in the client’s best interest.
When a diagnosis is withheld, even if due to the nurse’s or family’s good intentions, it violates the principle of autonomy.
10
Q
Justice
A
fairness, equal treatment
The principle of justice refers to treating all clients fairly (ie, without bias). Veracity is telling the truth as a fundamental part of building a trusting relationship.
11
Q
Fidelity
A
faithfulness to commitments, following through
Fidelity is exhibiting loyalty and fulfilling commitments made to oneself and others. It includes meeting the expected responsibilities of professional nursing practice and provides the basis of accountability (taking responsibility for one’s actions)
12
Q
Beneficence
A
doing good
Beneficence means to do good (eg, implementing interventions to promote the client’s well-being).
13
Q
Nonmaleficence
A
do no harm
…relates to protecting clients from danger when they are unable to do so themselves due to a mental/physical condition (eg, children, client with Alzheimer disease) and from a nurse who is impaired (Option 5).
14
Q
Veracity
A
truthfulness
Ethical principles guide the nurse in making appropriate decisions and acting accordingly. They speak to the essence but not to the specifics of the law.
15
Q
NEVER DELEGATE
A
Teaching
Assessment
Admissions (post-op or direct)
Education
16
Q
Hemodynamic Monitoring: Arterial Line (red)
A
Catheter typically radial or femoral artery
Continuous blood pressure
ABG blood draws (must be an RN)
17
Q
Hemodynamic Monitoring:
Central Venous Pressure
A
Sensor via central line catheter Sits in a venae cavae Good indicator of preload and pressure from the right side of the heart Often used in heart failure Expected CVP = 6-8 Elevated (worsening heart failure) Decreased (hypovolemia)
18
Q
Hemodynamic Monitoring:
Pulmonary Pressure / Pulmonary Wedge Pressure
A
Sensor via Swan-Ganz catheter
Sits in the pulmonary artery
Good indicator of pulmonary hypertension
Can inflate balloon for pulmonary wedge pressure
Never inflate for prolonged periods of time
Never remove specialized syringe to inflate
19
Q
Right sided heart failure
A
Edema (peripheral, dependent, generalized), JVD (what comes before the failing chamber) - Fluid backing up into SVC / IVC • Elevated CVP (critical care) - catheter above the right atria (6-8) — Pressure from right side of the heart — Worsening of R-side failure • Pulmonary Wedge Pressure (PWP) — Inflated balloon in the pulmonary artery — Also displays possible left-sided failure
20
Q
Left sided heart failure
A
Fatigue, decreased Cardiac Output (CO), reduced circulation, perfusion, Shortness of Breath (SOB) • Pulmonary edema — Fluid backing up — Auscultation (crackles)
21
Q
Echo
A
• Ultrasound (US) of the heart ( Ejection Fraction) • External procedure • TEE (transesophageal echo) - bariatric — 2L NS / sedate Diagnostic for HF, valvular disease, structural heart disease
22
Q
Endocarditis
A
- Inflammation of the inner layer of the heart
* Commonly affects the valves
23
Q
Cardiac Tamponade
A
- Narrowing pulse pressure
- Muffled heart sounds
- Pulsus parodoxus
- Tachycardia
- SOB
24
Q
Aortic Aneurysms
A
- Thoracic or abdominal
- Palpable pulsing mass
- Rupture may manifest with radiating back pain
- Rupture is a medical emergency
25
Marfan Syndrome
• Abnormal weakening of the vessel lining
• Aneurysms are common
• Patients tend to be abnormally tall and thin
with long fingers
• Aortic dissection is a risk
26
Shocks
• Decreased perfusion to vital organs and tissues
— Kidneys are the first organ to fail decreased urine output
— Dangerous decrease in BP
• Fluids, vasopressors, and treat the underlying condition
27
Cardiogenic
• Decreased cardiac output due to poor heart functioning
— MI, HF, Cardiomyopathy
• Positive Inotropic Agents (Dobutamine, Dopamine, etc.)
• Intra-aortic Balloon Pump
28
Hemorrhagic / Hypovolemic
* Loss of blood mass severe hypotension
| * Stop the bleeding or loss of fluid (burns)
29
Neurogenic
* CNS damage
* Loss of blood pressure due to CNS trauma
* Loss of all tone in the vessels vasodilation
30
Anaphylactic
* Allergic response
* Epi-pens / antihistamine / diphenhydramine
* Vasodilation due to allergy
31
Septic
• Due to sepsis (severe infection)
— antibiotics
• Acute Respiratory Distress (ARDS) is a common complication
• Vasodilation
32
Adenosine
For: Supraventricular
Tachycardia (SVT)
```
- (give as fast as you can,
lift the arm, and it will cause the heart
to arrest; the hope is to revert back to
normal sinus rhythm)
—look at monitor
—look at patient (symptomatic versus
nonsymptomatic)
—blood pressure
• cardioversion (synchronized
```
33
Addisonian Crisis
```
med. emergency)
Pathophysiology
• Cortisol levels fall dangerously low
• Often triggered by infection or stress
Signs and Symptoms
• N/V, abdominal pain
• Fever
• Chills
• Skin rash
• Hypotension
Interventions
• Immediate cortisol administration
```
34
Addison’s Disease
Down, Down, Down, Up, Down
Na, HTN, blood vol, K, Gluc
```
Pathophysiology
• Adrenal Insufficiency
• Hypocortisolism / Hypoadrenalism
Signs and Symptoms
• Fatigue / weakness
• Weight loss / anorexia
• Increased pigmentation of skin
• Hypotension / hypoglycemia
• Salt cravings
• Painful muscles / joints
• Norovirus, Diarrhea
• Inability to cope with stress / intolerance to cold
Interventions
• Lifelong cortisol replacement
```
35
Cushing’s Syndrome
Up, Up, Up, Down, Up
Na, HTN, blood vol, K, Gluc
```
Pathophysiology
• Elevated cortisol levels (hypercortisolism)
• Often caused by overuse of steroid medications
Signs and Symptoms
• Weight gain / central obesity (abdominal)
• Moon face
• Thinning skin bruises easily
• Fatigue / muscle weakness
• Depression / anxiety
• Hypertension
• Increased urination / thirst
Interventions
• Stop the steroid medication
• Removal of the adrenal glands
```
36
Hyperparathyroidism
Pathophysiology
• Excessive release of parathyroid hormone
• Hypercalcemia caused by the body pulling calcium
from the bones
Signs and Symptoms
• CNS issues (irritability, fatigue, confusion)
• Kidney stones
• Osteopenia/porosis fractures
Interventions
• Pharmacological (calcitonin, biphosphonates)
• Resection of the parathyroid
37
Hypoparathyroidism
```
Pathophysiology
• Decreased production of parathyroid hormone
• Leads to Hypocalcemia
• Common complication post-thyroidectomy
Signs and Symptoms
• Muscle Tetany / Cramping
• Paresthesias
• Chvostek’s sign / Trousseau’s sign
Interventions
• Pharmacological (calcitriol, vitamin D,
calcium gluconate)
• Decrease intake of phosphorus
```
38
Hyperthyroidism
```
Pathophysiology
• Elevated release of thyroid hormones
Signs and Symptoms
• Everything will speed up (metabolism)
• Weight loss
• Heat intolerance
Interventions
• Pharmacology (methimazole, propylthiouracil, iodine)
• Radioactive iodine
• Thyroidectomy
Complications
• Thyroid Storm
— Severe symptoms of hyperthyroidism
```
39
Hypothyroidism
```
Pathophysiology
• Decreased production of thyroid hormones
Signs and Symptoms
• Fatigue
• Cold intolerance
• Weight gain
• Muscle weakness
Interventions
• Lifelong hormone replacement (levothyroxine)
Complications
• Myxedema coma
```
40
Radioactive Iodine Uptake Test:
• Give a small amount of radioactive iodine.
• Later measure how much is in the thyroid
to determine thyroid problems, specifically
hyperthyroidism.
41
Hashimoto’s Thyroiditis
• Autoimmune disorder leading to underactivity
of the thyroid gland (hypothyroidism)
• More common in women
• Hypothyroidism signs and symptoms
• May be caused by high intake of selenium
or iodine
42
Graves’ Disease
```
Pathophysiology
• Autoimmune disorder leading to overactivity
of the thyroid gland (hyperthyroidism)
• More common in women over 20
Signs and Symptoms
• Similar to hyperthyroidism
• Exophthalmos (bulging eyeballs)
Interventions
• Similar to hyperthyroidism
• Immunomodulators
• Steroids
```
43
Goiter
```
Pathophysiology
• Enlarged thyroid
— Lack of iodine in the diet
— Tumor or nodules on thyroid
• Enlarged lymph node
Signs and Symptoms
• Visible enlargement and ability to palpate
• May be benign or toxic
• Dizziness when raising arms above head
Interventions
• Monitoring
• Surgical
Complications
• Dysphagia
• Respiratory distress
```
44
Diabetic Ketoacidosis (DKA)
Pathophysiology
• When the body does not have enough glucose
or does not have enough insulin to get glucose into
cells for energy, the body begins breaking down fat
for energy, creating ketones which are toxic.
Causes
• Uncontrolled Type 1 DM
• Stress on the body and not enough glucose or
insulin in circulation leading to ketone production.
```
Signs and Symptoms
• Polydipsia and Polyuria
• SOB and fruit-scented breath
• N/V, weakness and confusion
• Kussmaul Breathing
— Fast and deep
Diagnostic Testing:
• Glucose level > 600
• Ketones in urine
Interventions
• F&E replacement to combat dehydration
• Insulin.
```
45
```
Hyperosmolar Hyperglycemic
Nonketotic Syndrome (HHNS)
```
```
Pathophysiology
• When there is a high glucose level in the body,
kidneys remove that glucose.
• When removing glucose, body also removes
water causing dehydration and hyperosmolarity
Causes
• Eventually, due to dehydration, the kidneys
cannot release any more glucose leading
to hyperglycemia
• More prevalent in Type 2 DM
• Takes weeks to develop
• Commonly affects older people (decreased
thirst mechanism)
• Can be caused by illness or infection
• Long standing dehydration
• DM not being managed properly
Signs and Symptoms
• Sugar levels above 600
• Polyuria and Polydipsia
• Hot and dry (may see fever)
• Sleepy and confused
• May lead to seizures, coma, and death
Interventions
• Fluids and insulin
• K+ may be given
```
46
Foot Ulcers / Infection
```
• Decreased sensation
due to arterial insufficiency
• Wet-to-dry dressing for open wounds
— Place a wet or moist dressing on the wound
and do not remove until the dressing is dry.
• Prevention is key
— Keep the feet clean and dry
— Daily inspections
— Use of lotion to prevent cracking
of the skin
— Wear cotton socks and tight fitting shoes
— Careful not to clip toenails too close
```
47
Glycosated Hemoglobin (A1C)
• Gives a 3 month outlook on glucose management
of your patient
• Glucose regulation, diet, exercise
• The higher the A1C, the more unregulated
the glucose in the patient. A higher level
of intervention will be likely.
• Begins with diet and exercise, than oral
antidiabetic agents, than insulin replacement
48
Mixing Insulins:
1. Inject air into long acting insulin (NPH)
2. Inject air into short acting insulin (Regular)
3. Aspirate short acting insulin (R)
4. Aspirate long acting insulin (N)
Draw R before N (RN)
Regular before NPH
Clear before Cloudy
Never shake insulin
Keep it refrigerated
49
Diabetes Insipidus
```
Cause
• Lack of Antidiuretic Hormone (ADH)
Signs and Symptoms
• Frequent Urination
• Dehydration Hypovolemia Hypotension Dizziness
• Rebound Tachycardia
• Hyperosmolar blood - becomes concentrated
Interventions
• Vasopressin
```
50
```
Syndrome of Inappropriate
Antidiuretic Hormone (SIADH)
```
```
Cause
• Too much Antidiuretic Hormone (ADH)
Signs and Symptoms
• Decreased urine output
• Fluid retention hypervolemia hypertension
• Hypoosmolar blood - becomes dilute
— hyponatremia
Interventions
• Water restriction (ice chips)
• Diuretics
• Vasopressin Antagonist
```
51
Diabetes Insipidus
Excessive urine output and thirst, dehydration, weakness, administer pitressin
```
Cause
• Lack of Antidiuretic Hormone (ADH)
Signs and Symptoms
• Frequent Urination
• Dehydration Hypovolemia Hypotension Dizziness
• Rebound Tachycardia
• Hyperosmolar blood - becomes concentrated
Interventions
• Vasopressin
```
52
```
Syndrome of Inappropriate
Antidiuretic Hormone (SIADH)
```
Change in LOC, decrased deep tendon reflexes, tachycardia, N,V,A, HA, administer Declomycin, Diuretics
```
Cause
• Too much Antidiuretic Hormone (ADH)
Signs and Symptoms
• Decreased urine output
• Fluid retention hypervolemia hypertension
• Hypoosmolar blood - becomes dilute
— hyponatremia
Interventions
• Water restriction (ice chips)
• Diuretics
• Vasopressin Antagonist
```
53
Grey Turner’s Sign
Bruising of the flank
| • Indicative of pancreatic necrosis with retroperitoneal or intra-abdominal bleeding
54
Charcot’s Triad
→ Abdominal pain
→ Fever
→ Jaundice
55
Cholangitis
```
• Pathophysiology
— Infection of the common bile duct
— Medical Emergency
• Causes
— Gallstone obstruction
```
```
• Signs and Symptoms
— Charcot’s Triad
→ Abdominal pain
→ Fever
→ Jaundice
• Diagnostic Testing
— ERCP to identify
— Blood Culture to determine bacteria
• Interventions
— ERCP with lithotripsy to break up stones
```
56
Tube Feedings
```
• Feedings have 24 hour shelf life
• Assessing residual and effectiveness of the feedings
— 50% or more residual being aspirated
→ discard the residual
→ half the rate of the pump
— 50% or less residual
→ push it back in
→ keep the rate
• Confirmation
— RN
→ Aspirate content (note color, clear is not good)
→ Push air, auscultate for bubbling
→ Gold-Standard is always XR
— Feedings can not begin until confirmation by XR
→ Risk for pushing food into the lungs causing
pneumonia and death
```
57
Peritonitis
```
• Causes
— Peritoneal Dialysis
— Rupture of organs
• Signs and Symptoms
— Abdominal pain and distention
— Rigid / Board-like Abdomen
• Treatment
— Surgical abdominal washout
— Antibiotics
• Complications
— Sepsis
```
58
Disseminated Intravascular Coagulation (DIC)
```
Pathophysiology
• Minor trauma causing platelets to be used up
• May be a complication of sepsis
Signs and Symptoms
• Abnormal Bleeding - Oozing from the IV sites
– May present with complaints of wetness
on the arm or inspection of dried
or blood around the IV
• Prolonged aPTT and PT
Interventions
• Treat the underlying problem
• Platelets and FFP
```
59
Vaccinations
Immunology
Humoral Immunity - antibodies or immunoglobulins, at birth
Acquired Immunity - learned by infection or vaccination
Cell-Mediated Immunity- B and T cells
• SCID (severe combined immunodeficiency)
• HIV/AIDS
Herd Immunity - indirect protection when the majority of a population is vaccinated
• 95% needed to enjoy the benefit of herd immunity
Hepatitis A (2 rounds)
Hepatitis B (3 rounds)
Varicella (chickenpox) / Herpes Zoster (shingles)
• Virus reactivates in the ganglia (nerves) → severe pain → rash forms
TDAP (Tetanus, Diphtheria, Pertussis) - q5 years
Hib (influenzae) - q1 year
• Attenuated virus (alive)
• Will my child receive the immunization today even if they’re sick?
– No, the child will receive the shot when they come back in for their next visit.
• Injection reactions
– Small fever
– Pain at injection site
• Allergy alert
– Eggs
Human Papillomavirus
• Boys and girls
• Prevents cervical, oropharyngeal, anal cancers
Pneumococcal ( q5 years )
• High risk populations (elderly and immunocompromised)
Meningococcal (q3-5 years)
• High risk populations (elderly and immunocompromised)
• People living in tight quarters
• Dorms (college)
• Service members (military)
MMR (Measles, Mumps, Rubella)
60
Systemic Lupus Erythma
Pathophysiology
• Systemic disease affecting multiple
organs (heart, lungs, skin, liver, kidneys,
nervous system)
• Commonly affects African Americans and women
Signs and Symptoms
• Systemic Inflammation
• Pericarditis
• Butterfly rash, photosensitivity, fatigue
Interventions
• Steroids, Immunomodulators
61
Aplastic Anemia
Production issue — bone marrow is not producing enough
Red Blood Cells (RBC’s)
• Treat with epoetin alfa
• Renal failure / chemo - radiation to bone marrow
Hemolytic Anemia
Destruction issue — the RBC’s are being lysed/sliced
• Bilirubin is released from the hemoglobin when it is destroyed
• Hemolytic jaundice versus physiological jaundice (liver)
62
Sickle Cell Anemia
The RBC’s coagulate together when they are not oxygenated
because they sickle
• Most common in African American women
• Sickle cell crisis (coagulate in joints and block blood flow)
— causes pain
• First nursing intervention is always fluids and then treat pain
63
Pernicious Anemia
Deficiency of B12 (cobalamin)
• Sore, red tongue
• Easy bruising
• Intrinsic factor (made inside the stomach) is needed to absorb
B12 into the body
• Subtotal gastrectomy or total gastrectomy
— intrinsic factor is no longer produced
64
Iron Deficiency
• Common in intestinal disorders
• Supplements (take with orange juice to aid in absorption)
• Injections (if oral supplements cannot be tolerated)
— refer to Iron (Ferrous Sulfate) in the Pharmacology Overview
• Foods that are high in iron
— leafy greens, meats
65
Chlamydia
* Bacterial
| * Discharge / dysuria
66
Genital herpes
* Viral
* Lesions (sores) ---> painful
* Herpes Simplex (Cold Sores)
67
Urinalysis / Dipstick Test
| • Specific Gravity
```
(1.005-1.035)
— Higher more concentrated (dehydrated)
— Lower more dilute (well hydrated)
• Color
— Straw-colored → acute kidney injury
— Amber-colored → dehydration
— Clear → well hydrated and healthy
• Bacteriuria
• Calciuria
• Urine K
• Proteinuria
• Ketonuria
• Hematuria
• Glucose
```
68
Gonorrhea
• Bacterial
• Discharge / dysuria
• In women, if left untreated may cause
complications
69
• Pelvic Inflammatory Disease (PID)
— May lead to infertility
| — Lower abdominal pain
70
Trichomoniasis
* Parasite infects the vaginalis
| * Discharge
71
Syphilis
• Bacterial
• Primary , Secondary , Tertiary (infects the brain,
dementia
• Painless sore → Chancre
72
Compound (open)
* Risk for fat embolism
* Fat embolism becomes pulmonary embolism.
* Risk for infection
73
Comminuted
* Crush injury
* Multiple small pieces of bone
* Surgery with rod placement may be needed.
74
Spinal -
decompress the spine
75
RN Considerations for traction
• Assess skin and pinsites for skin breakdown,infection
• Neurovascular checks
– Monitor pulses, sensation, movement,
color, etc.
• DO NOT touch any piece of the traction
• Turn the patient per physician orders – Q2hr specific orders required
– Logroll if needed
• Isometric exercises to prevent muscle atrophy – Flexion and relaxation of a muscle without movement
76
Skeletal -
pins, screws, wires
77
Bryant’s -
pediatrics for hip or femur
78
Skin (Buck’s) -
common in lower extremites
79
Spiral
* Often the result of child abuse.
| * Confirm the story matches the injury
80
Rhabdomyolysis
Pathophysiology – Rapid breakdown of muscle (skeletal)
– Crush injury – Medications (statins) – May be fatal if left untreated
• Signs and Symptoms – Extreme quick onset pain
– Kidney Failure
→ Myoglobinuria (brownish color)
```
• Diagnostics
– Labs
→ Creatine Kinase
→ D-Dimer
→ Hyperkalemia
– Urinalysis
• Interventions
– IV Fluids
– Treat the S&S
```
81
Compartment Syndrome
Build up of pressure in the third-space around the artery
Pressure eventually occludes the artery causing distal loss of blood flow
Crush injury, Casts, Burns
Can lead to death (MEDICAL EMERGENCY)
Signs and Symptoms – Loss of distal pulses (dorsalis pedis, posterior tibial) – Extreme pain – Swelling in the extremity
• Interventions – Faciotomy
→ Incision into the muscle /facia to release the pressure – Remove the cast
82
Burns
```
Pathophysiology
– 30% or more is a MEDICAL EMERGENCY
– Third spacing of fluid
– Destruction of cells leads to release
of potassium
• Signs and Symptoms
– Hypovolemia → Hypotension
– Shock (circulatory collapse)
– Hyperkalemia
– PVC’s
– ECG changes
```
```
• Interventions
– Monitor vitals and heart rhythm
– Fluid resuscitation
– Lactated Ringers
– Albumin
– Expected outcome or an improvement
will show adequate urine output.
```
83
Traumatic Brain Injury
```
• Pathophysiology
— Concussion
— Coup contrecoup Injury (whiplash)
— Shaken baby syndrome
— Intracranial hemorrhage (leads to stroke)
— Brain herniation (will lead to brain death)
• Signs and Symptoms
— Signs and symptoms are presented
below in ICP and Glasgow Coma Scale
assessments.
```
84
• Intracranial Pressure (ICP)
```
— ICP monitoring
→ Normal = 5-15mmHg
— Pupillary dilation
→ PERRLA
→ Blown pupils (unilateral or bilateral)
— Level of consciousness
→ Glasgow Coma Scale (decrease in)
— Headache, nausea, vomiting
— Cushing’s Triad
→ Apnea, bradycardia, widening pulse
pressure (systolic minus diastolic)
→ Emergency (call HCP/MD)
```
85
— Partial Seizures
→ Singular part of the brain
86
— Generalized Seizures
→ Both hemispheres
87
— Absence Seizure
→ Loss of consciousness
→ Person appears awake
→ Seconds to minutes
88
— Tonic-Clonic (grand mal) Seizure
→ Convulsions
→ Muscle spasms
→ Relaxing (clonic)
89
— Status epilepticus
→ Seizure followed by another seizure
90
— Status epilepticus
→ Seizure followed by another seizure
91
Retinal Detachment
• Pathophysiology
— Medical Emergency (loss of sensory organ)
→ Potential loss of vision
```
• Signs and Symptoms
— Flash of light
— Veil or “curtains” pulled over the visual field
• Interventions
— Surgery
→ Vitrectomy / Retinopexy
```
```
— Place the patient on the side
of the detachment for
positioning post-op.
— Post-op does not mean out of
the woods; it is often the
priority of a question still
```
due to risk.
92
Peds Vitals
Heart Rate
• Higher at birth and lowers during childhood
• Starts at 100-160 BPM
Respiratory Rate
• Higher at birth and lowers during childhood
• Starts at 40-60
```
Blood Pressure
• Lower at birth and elevates during childhood
• Starts at 70/40 to 90/60
Temperature
• Does not change based on age
```
93
2 - 3 months
* Hold the neck up
* May reduce SIDS risk
* Cross eyes disappears
* Grasp reflex
* Smiling
94
6 months
* Teething (start with rice cereal)
* Start with rice cereal
* Moro reflex (startle) disappears
* Sits upright with support
* Can roll over
95
9 - 12 months
• May introduce cows milk at one year of age
(enzyme present)
• Object permanence
— Object exists even if it may not be seen
— Peek-a-boo
• An object exists even if it may not be seen.
• Peek-a-boo
• Babinski reflex (fanning of toes) disappears
• Monosyllabic words (mama, dada)
• Can grasp and pull something
• Cannot push or build
• Stands with support
96
14-16 months
* 2-3 word sentences
* Push-pull toy appropriate
* Walking alone
97
24 Months
• If not walking, a developmental delay (refer to
physical therapy)
• If not talking (mute), a developmental delay
(refer to speech therapy)
• Begin potty training if the child is ready
(vocalizes needs is a good start)
• Builds 6 block tower
98
Fontanelles
• Posterior fontanelle
— Closes at 2-3 months
• Anterior fontanelle
— Closes at 18 months
• If the child is mobile and the fontanells have
not closed, safety is of concern. It is common
to place the child in a helmet.
• Sunken fontanelle shows dehydration
• Bulging fontanel is normal during crying, but
not at rest; may indicate ICP issues
99
Fontanelles
• Posterior fontanelle
— Closes at 2-3 months
• Anterior fontanelle
— Closes at 18 months
• If the child is mobile and the fontanells have
not closed, safety is of concern. It is common
to place the child in a helmet.
• Sunken fontanelle shows dehydration
• Bulging fontanel is normal during crying, but
not at rest; may indicate ICP issues
100
APGAR
Appearance (color all pink, Pink and blue, Blue / Pale)
Pulse (>100, <100, Absent)
Grimace (cough, Grimace, no response)
Activity (flexed, flaccid, limp)
Respiration (strong cry, Weak cry, Absent)
101
Airborne
Measles
Chickenpox / Varicella
Herpes Zoster / Shingles
TB
Negative pressure
102
No pee, No K
Do not give K without adequate urine output
103
Air Embolism
S &S: Chest pain, difficulty breathing, tachycardia, pale / cyanotic, sense of impending doom
Left side and lower head of bed
104
Prolapsed cord
knee-chest postion or trendelenburg
105
Hypovolemia
increased temp, rapid / weak pulse, increase resp, hypotension, anxiety, urine specific gravity > 1.030
106
HyperVolemia
bounding pulse, SOB, dyspnea, Rares / crackes, peripheral edema, HTN, urine specific gravity > 1.010
107
Neuroleptic Malignant Syndrome
Hyperpyrexia - Increased temp
Stiff - Increased mucles tone
Sweaty - Diaphoresis
BP, Pulse, Increased Resp,
108
Tetralogy of Fallot
Think DROP
Defect, septal
Ventricular Septal Defect
• Shunting of blood from side to side
causing poor blood oxygenation
Right Ventricular hypertrophy
• May lead to cardiomyopathy in the infant
Overriding aorts
• Systemic blood pressure affects
• Stronger pulse in one side of the body
versus the other
Pulmonary stenosis
• Narrowing of the pulmonary vasculature
• Leads to pulmonary hypertension
Signs and Symptoms
— Cyanosis
— Heart Failure
— Failure-to-thrive
```
• Interventions
— Tet Spell
→ Knee-to-chest positioning
(helps oxygenation)
— Surgery
→ Typically performed in infancy
→ May require additional surgeries
→ May cause valvular issues later in life
```
109
Autonomic Dysreflexia
Elevated head of bed
loosen constrictive clothing
assess for bladder distention and bowel impaction
administer antihypertensive meds
110
Cogentin
Parkinson and extrapyramidal effects of other drugs
111
VEAL CHOP
Variable - Cord compression (Left side / trendelenberg)
Early - Head
Accels - Okay
Late - Placental (Left side)
```
Accelerations (FHR increasing)
— Good and normal
• Early Decels (FHR decreasing)
— Decel occurs at the same time
as the contraction
— Normal / head compression
during labor
• Variable Decel
— Decel occurs randomly with no
correlation to the contraction
— Cord compression during labor
— Interventions
→ Turn the mother
to the left side
```
```
• Late Decel
— Decels occur after the contraction
— Uteroplacental insufficiency
→ Worst decel
— Interventions
→ Turn the mother to the left side
→ Start oxygen
→ IV fluids
→ C-section may be needed
• If there are no accelerations or decels
— usually a sign of stillbirth
```
112
Ventilator Alarms
| HOLD
High - Obstruction (secretion, Kink, Coughs)
| Low - Disconnected (Leak,)
113
ICP
Increased BP
Decreased Pulse
Decreased Resp
114
Shock
Decreased BP
Increased Pulse
Increased Resp
115
Cord Prolapsed
Apply sterile saline gauze to prevent drying of the cord and to minimize infection
116
Cord Prolapsed
Apply sterile saline gauze to prevent drying of the cord and to minimize infection
117
Antidotes
```
Heparin - Protamine Sulfate
Coumadin - Vitamin K
Ammonia - Lactulose
Acetaminophen - Acetylcysteine
Iron - Deferoxamine
Alcohol - Librium
```
118
Atropine
ATropine = To cause Tachy
| Tx: symptomatic Bradycardia
119
Amiodarone
Tx Vtach and VFib
120
Alteplase
Breaks down clots
121
Adenosine
ADenosine
Decrease HR
SVT
122
Dopamine
Increases BP
123
Milrinone
Given for Heart Failure
| Vasodilates
124
Aminocaproic Acid
Aids in clotting
| Prevent hemorrhage
125
Malignant Hyperthermia
```
• Pathophysiology
— Medical Emergency
— Caused by general anesthesia
and other medications
— Overactive stress on skeletal muscle
• Signs and Symptoms
— Hyperthermia (103 degrees or higher)
— Tachycardia
— Tachypnea
• Interventions
— Pharmacological (dantrolene)
```
126
Schizophrenia
• Signs and Symptoms
– Disorganized thinking
→ 1 +2 = cat
```
Positive Affective
→ Delusions (thoughts)
→ Hallucinations (sensory)
– Risk for commands to the person
(homicide, suicide)
```
Negative
→ Depression, social withdrawal,
flatness of mood
Paranoid
Catatonic
→ When moving this patient, be sure
to put them back in the position
you found them in.
127
Delirium
```
Pathophysiology
– Acute reversible
– Temporary loss of cognition typically
due to an underlying medical cause
→ UTI in the elderly
→ Hypoxia
→ Renal failure
→ Hepatic Encephalopathy / Hepatic Coma
→ Alcohol withdrawal
```
```
• Signs and Symptoms
– Temporary loss of cognition typically
due to an underlying medical cause
– Alert but loss of orientation
• Interventions
– Treat the underlying cause
and the delirium will resolve
```
128
Delirium Tremens (Alcohol Withdrawal)
```
• Pathophysiology
– Chronic alcohol abuse
– Abrupt stop in use
• Signs and Symptoms
– Shaking, diaphoresis, nausea
– Hallucinations
– Hyperthermia and seizures
→ MEDICAL EMERGENCY
```
```
• Interventions
– Benzodiazepines
– Remove stimuli
– Fluids
– Trend blood alcohol content
```
129
Benzodiazepine Overdose / Toxicity
```
• Pathophysiology
– Fat soluble medication
→ Absorbs into the adipose tissue
and can lead to dangerous build-up
→ Obese patients and the elderly
are specifically at risk
• Signs and Symptoms
– Loss of cognition (delirium)
– Respiratory depression / CNS depression
– COMA
```
```
• Interventions
– Strict monitoring
(Glascow Coma Scale, Vitals)
– Titration off benzos
– Antidote - flumenezil
```
130
Sudden Infant Death Syndrome (SIDS)
```
• Leading cause of death in infancy
• Aspiration and suffocation cause
• Sleep Safety
• Sleep on back
— Nothing in the crib (no toys, no bottles,
stuffed animals, etc.)
— No second-hand smoke
• Bereavement support to parents
```
131
Relieving Anxiety in Children
```
• Infant
— Parents
— Swaddling
— Sucrose orally
• Toddler / Preschooler
— Distraction
• School-Age
— Education
→ Doll
→ Displaying procedure
```
```
and/or equipment (allow them to
touch things that are safe)
— Visualize the environment as a child
• Adolescent
— Maintain freedom
— Maintain privacy
```
132
Hydrocephalus
• Pathophysiology
— Abnormal collection of fluid in the cranium
— Common in infants with neural tube defects
• Signs and Symptoms
— Bulging fontanelle
— Can lead to brain damage if not treated early
• Interventions
— Ventriculoperitoneal shunt
→ Drains the fluid (CSF)
to the abdomen
→ Post-Op
```
— Monitor for increased ICP
• High pitched cry
• Bulging fontanelle
• Blown pupils
• Irritability
```
133
Cleft Lip Palate
• Opening in the lip and/or the palate (roof) of
the mouth
• Surgically Corrected
— Pre-Op
→ Sucking (feeding) ability is of concern
(partial occlusion of the nipple
only needed)
→ Upright sitting during feedings
→ More frequent burping
— Post-Op
→ Prone with the head to the side
(facilitates drainage)
→ Sterile normal saline to clean
the suture lining
```
→ Elbow restraints (keep the baby
from touching the suture)
→ Logan Bow (holds the lip together)
→ Feeding by bulb syringe into
the cheek (no sucking yet)
```
134
Talipes Equinovarus
Clubfoot
| • Multiple casts used to correct the deformity after surgery
135
Reye’s Syndrome
```
• Pathophysiology
— Begins with chickenpox, flu,
and other viral infections
— Concurrent administration of aspirin
with the virus
• Signs and Symptoms
— Affects the liver and brain
• Interventions
— AVOID aspirin
```
136
Kawasaki’s Disease
```
• Pathophysiology
— Autoimmune disorder
— Inflammation of the vessels (vasculitis)
— Typical in young children (5 y.o.)
• Signs and Symptoms
— Irritability (may last up to 6 months)
— Fever
— Swollen red tongue
— Infection
• Interventions
— Corticosteroids
— Cyclosporin
— Intravenous immunoglobulins (IVIG)
```
137
Hirschsprung’s Disease
```
• Pathophysiology
— Genetic
— Poor or no nervous system innervation
to the GI tract
— Leads to poor peristalsis
• Signs and Symptoms
— Failure to pass meconium in the first
24 hours after birth
— Constipation
→ May lead to obstruction
and further complications
• Interventions
— Surgery
→ Resection of the dysfunctional
```
part of the intestine
→ Temporary colostomy
→ Reanastamosis of the intestine
138
Lead Poisoning
```
• Pathophysiology
— Children playing outside and not washing
hands. Lead is ingested typically.
— Lead may exist in:
→ Soil
→ Paint
→ Water
• Signs and Symptoms
— Elevated blood lead levels
— Abdominal pain
— Behavioral changes
— Confusion
— Can lead to brain damage
• Interventions
— Chelation therapy
→ Oral (succimer)
→ IV
```
139
Wilms Tumor
• Do not palpate the abdomen
| hypertensive crisis
140
Duchenne Muscular Dystrophy
```
• Pathophysiology
— X-linked recessive disorder
— Affects boys more than girls
— No cure
• Signs and Symptoms
— Progressive loss of muscle function
— Gain and loss of milestones
— Gower’s sign
→ Climbing up the legs
to standing position
• Interventions
— Assistive devices
→ Braces
→ Wheelchair
— Respiratory aid
→ Loss of diaphragm
```
141
Tonsillitis
```
• Pathophysiology
— Inflammation of the tonsils
— Typically from infection
• Signs and Symptoms
— Visual enlargement (+1,+2, etc.)
— Airway crisis
→ Drooling
```
• Interventions
— Tonsillectomy
→ Bleeding risk (drooling blood,
frequent swallowing)
142
Child Abuse
```
Types with Assessment
• Neglect
— Failure to provide the child with basic life
needs (food, shelter, medical care, etc.)
• Physical
— Failure to thrive
— Abnormal injuries
→ Bruising in multiple stages of healing
→ Bruising in abnormal patterns
(straight lines, circles)
— Changes or mismatching stories
— Not reacting to pain
```
```
• Emotional
— Behavior problems (acting out, withdrawal,
low self-esteem, etc.)
— Psychiatric problems
• Sexual
— Swollen genitals
— Inappropriate behavior in school age children
→ Normal in toddlers and adolescents
```
• Interventions
— If abuse is suspected, call police
or authorities
143
Salpingitis
Inflammation / Infection of the fallopian tubes
144
Fibroids
any type of cyst will increase the risk for cancer
outside of cyclic changes means something is going wrong (cancer)
Fibroids - uterus - increase the risk of cancer
Polycystic ovarian - increases the risk of cancer
Fibroid
Cystic
Increase the risk of cancer
145
GTPAL History Assessment
Gravidity
— Number of times pregnant
— Nulligravida (never), Primigravida (first), Multigravida (many)
• Term
— Term births (36-40 weeks)
• Parity
— Number of pregnancies carried to term (viability - 23 weeks)
— Nullipara (never), Primipara (first or one), Multipara (many)
Nx Tip
Multiparous women have much quicker stages of labor. Be aware of quick assessments for women closing in on 6cm or more.
This may be the priority.
• Abortion
— Pregnancies lost due to abortion or miscarriage (spontaneous abortion)
• Living
— Living children
146
Naegele’s Rule
Calculating pregnancy due dates
Last menstrual period (LMP) + 1 year - 3 months + 7 days
• Ex. LMP at April 11th
— April 11th + 1 year - 3 months + 7 days = January 18th
147
Ectopic Pregnancy
— Pregnancy outside of the uterus
— Risk factors
```
• Signs and Symptoms
— Lower abdominal pain
— Vaginal bleeding
— Fever
— Rupture (MEDICAL EMERGENCY)
→ Hypotension (shock)
→ Tachycardia
```
```
• Interventions
— Prior to emergency
→ Induced miscarriage (methotrexate)
— Post emergency
→ Surgery (stop the bleeding)
```
148
Presumptive
Amenorrhea
Nausea / Vomiting
Quickening
Urinary Frequency
149
Probable
Goodell’s Sign
Hegar’s Sign
Chadwick’s Sign
Positive Pregnancy test
150
Positive
Audible fetal heart sounds
Leopold Maneuvers
Ultrasound Visualization
151
Uterine Growth
```
• 2nd and 3rd Trimester majority growth
— 1lbs a week
Prenatal Diet
• Increase 500 calories per day
• Increase unsaturated fatty acids
```
152
Pregnancy Test
• Tests for Human Chorionic Gonadotropin (HcG)
• Blue (positive)
• Also used to assess for testicular cancer in men
Bimanual / Two-hand Exam
• Evaluation of the womb by entering the vaginal
space
• NOT an RN assessment
• Potential pregnancy confirmation
153
Hyperemesis Gravidarum
```
• Pathophysiology
— Not morning sickness (morning sickness
is typically only in the 1st trimester)
• Signs and Symptoms
— Severe nausea and vomiting
— Weight loss
— Dehydration
• Interventions
— Rehydrate
— Pharmacology
→ Anti-nausea
— IV Fluids
```
154
Non-Stress Test
• Tests for fetal wellbeing during pregnancy
• Assesses fetal accelerations
— Reactive / Normal → Good
— Non-reactive / Abnormal → Bad
155
Stress Test
```
• Tests for fetal ability to handle labor
— Administration of oxytocin
• Assesses fetal heart rate when term
— Positive → Bad
— Negative → Good
```
156
TORCH Infections
```
→ Toxoplasmosis (cats)
→ Other (syphilis)
→ Rubella
→ CMV
→ Herpes
```
157
```
1st Trimester
Teratogenic Issues (Congenital Abnormalities)
```
```
Neural tube defects (folic acid
requirements)
• Fetal Alcohol Syndrome
— Baby presents with similar
issues to Down syndrome
• Vertical Transmission
(mother to child)
— TORCH Infections
→ Toxoplasmosis (cats)
→ Other (syphilis)
→ Rubella
→ CMV
→ Herpes
```
158
```
2nd Trimester
Teratogenic Issues (Congenital Abnormalities)
```
Medications could affect growth
• Oligohydramnios may start
• Ultrasound used to monitor
growth
159
```
3rd Trimester
Teratogenic Issues (Congenital Abnormalities)
```
```
Cocaine abuse
— May lead to preterm labor
— Tox Screen on the Baby
→ Positive
→ call the authorities
(child abuse)
— Seclude the baby
with minimal
stimulation and
swaddle for comfort
→ Negative
→ get social work involved
— May lead to small for gestation
age (SGA) baby
→ Glucose regulation issues
(hypoglycemia)
```
160
Preeclampsia
— Typically a problem in the third trimester
— If left untreated, may lead to eclampsia
and potentially death
• Signs and Symptoms
— Hypertension (blurred vision, headache)
— Proteinuria
— Edema (feet, face, hands)
→ A certain level of ankle edema
is normal in late pregnancy
→ Pitting edema is a far greater sign
```
• Interventions
— Bedrest
— Pharmacological
→ Antihypertensives
→ Magnesium sulfate (prevent seizures)
```
```
Nx Tip
Preeclampsia may lead to HELLP (acronym) syndrome.
• Hemolysis
• Elevated liver enzymes
• Low platelet count
```
161
HELLP (acronym) syndrome.
* Hemolysis
* Elevated liver enzymes
* Low platelet count
162
Placenta previa / Placenta accreta
— Abnormal implantation of the placenta
→ Partial previa (incomplete cover
of the cervix)
→ Total previa (complete cover
```
of the cervix)
— Riskier
• Signs and Symptoms
— Painless bright red bleeding
• Interventions
— Provider will attempt to deliver the baby first
— C-section may be needed
```
163
Abruptio placentae
```
— Placenta tearing away from the uterine lining
• Signs and Symptoms
— Rigid boardlike abdomen
— Painful bleeding
• Interventions
— Crash c-section
Nx Tip
Baby has 5 min to survive without oxygen from mom
```
164
Caesarean Section
• Surgical operation with spinal block anesthesia
• 999 mL of blood loss or less is ok
(1L or more = hemorrhage)
• Subsequent pregnancies and labors are more
likely to need another c-section, but it is not
fact. Vaginal birth may be possible if dictated
by a higher license.
• Adhesions (internal scar tissue)
may complicate recovery
165
Vaginal Birth
• 499 mL of blood loss or less is ok
(500mL or more = hemorrhage)
• Shoulder dystocia risk (shoulder gets stuck)
166
Spinal Block (C Section) / Epidural (Vaginal)
```
• Typically a 30min procedure to administer
• HYPOTENSION risk
— Assess blood pressure
• Blocks pain and function from
the injection site down
• Women will lose bladder function
— Assess for urinary retention
(can worsen postpartum bleeding)
— Palpate the bladder / bladder scanner
→ One order for a straight cath is
commonly applied to postpartum
women orders from the HCP
• Affects the newborn (lower apgar)
```
167
Frank Breech
• Legs up
168
Footling Breech
• One foot first
169
Complete Breech
• Indian style position
170
The First Stage of Labor
| •
```
Longest stage
— Help progress by ambulation
• Dilation (0-6 cm)
• Effacement (thinning of) (0-100%)
• Station (descent) (+1 to +4)
```
171
Nitrazine test (pH of the fluid)
→ Blue → positive
| → Green → negative
172
Bishop scores
dictate if induction of labor will likely work. The
| higher the score the more successful induction is likely to be.
173
Good Labor
* 2-3 minutes apart
| * 45 seconds in length
174
The Third Stage of Labor
• Delivery of the placenta (afterbirth)
• Involution of the uterus (clamping down)
— Poor involution may lead to bleeding
175
The Fourth Stage of Labor
```
• Period of recovery after birth
• Some resources do not account for
a fourth stage of labor
• Refer to postpartum considerations
down below
```
176
The Second Stage of Labor
* The delivery of the infant
| * Contractions become stronger and more frequent
177
Uterine Involution
* The uterus returns to normal size
* 2 days postpartum - umbilicus
* 2 fingerbreadths per day after
178
Lochia
Nx Tip
• Cloudy, foul smelling, or purulent discharge is likely an infection
— Refer to HCP / MD
Rubra
• Red - Sanguineous
• Up to 5 days
Serosa
• Pink/Brownish -
Serosanguineous
• 5 to 7 days
Alba
• White/Yellow/
Clear - Serous
• After 7 days
179
Postpartum Depression
* More chronic / long-term
| * Later after birth (2 weeks)
180
Postpartum Blues
* Earlier after birth
| * More acute and mild
181
Guthrie Test (heel prick)
• Tests for genetic condition, but ESPECIALLY
phenylketonuria
• Mandated by law in the U.S.
• Performed when the below apply:
— Minimum post 48 hours after birth
— Have fed for a minimum of 48-72 hours
— Not near discharge, otherwise a urine test will
be performed by a pediatrician 2 weeks later
182
Vernix Caseosa
• Present (normal) in full term babies
• Lubricating for birth, protecting after birth
— Aids in temperature regulation
— The vernix is not washed away first unless
the mother has HIV.
183
Conduction
• Heat loss when in contact with
a cold surface
• Warm objects that will touch the newborn
184
Convection
* Heat loss when the body is exposed to air
| * Keep newborn wrapped
185
Evaporation
* Heat loss when wet and exposed to air
| * Dry the newborn
186
Radiation
• Heat loss from the body to other objects
• Cover objects of heat loss on the body
— Cap on the head
187
Hemolytic Disease of the Newborn
| / Erythroblastosis fetalis
```
• Pathophysiology
— Rh factor incompatibility
— Mother is Rh negative, father is Rh positive
— Mother forms antibodies against the Rh RBC’s
— Mother attacks babies RBC’s
• Signs and Symptoms
— Positive Coomb’s test
→ Tests for the body attacking the RBC’s
→ Agglutination (clumping or clotting)
(positive test)
→ No agglutination (negative test)
— Direct umbilical blood collection
→ Hemoglobin levels
→ Bilirubin levels (elevates when RBC’s
```
are destroyed)
— Jaundice
188
Umbilical Cord Care
```
• Clean and dry cord is best
• Soap and water is best to clean
• DO NOT tuck the stump into the diaper
(infection risk)
• No tub baths until the cord falls off
• Typically falls off between 7-14 days
```
189
Periods of Reactivity
• Times of alertness of the newborn after birth
• Periods where the baby is awake and needs to
be FED.
• Newborns sleep a great deal; feeding is the
priority if everyone is medically ok.
• Periods of NOT eating greater than 4 hours for
a newborn is very BAD.
190
Circumcision
• Advocate for anesthesia for the neonate
• Post-procedural bleeding
— Apply pressure (direct or by diaper)
— Apply petroleum to the penis
(do not want skin sticking to the diaper)
• NO tub baths
• Yellowish exudate normal during healing
process (2-4 days)
191
What can kill/harm your patient the quickest?
Loss of Life
• ABC
• Airway trumps breathing
trumps circulation
Loss of Limb
• Distal blood flow loss (no
distal pulse)
• Compartment Syndrome
```
Loss of Sensory Organ
• Vision changes (loss)
• Hearing / Balance
changes (loss)
• Retinal Detachment
```
192
```
Pressure Ulcers (Decubitus)
Stage I
```
* Non-blanchable redness (erythema)
| * Superficial (intact integumentary system)
193
```
Pressure Ulcers (Decubitus)
Stage II
```
• Red
• Broken through the epidermis
• Risk for infection
— Hydrocolloid dressing needed
194
```
Pressure Ulcers (Decubitus)
Stage III
```
* Yellowish (adipose tissue)
* Partial thickness (through the dermis)
* Consult wound care (debridement needed)
* Wet to dry dressing until they come
195
```
Pressure Ulcers (Decubitus)
Stage IV
```
* Bone / Muscle
* Full thickness
* Consult wound care (debridement needed)
* Wet to dry dressing until they come
196
```
Pressure Ulcers (Decubitus)
Unstageable
```
• Black
• Unable to see what is underneath
• Consult wound care (debridement needed)
Nx Tip
A wet to dry dressing is when you pack a wound with wet
gauze and wait until it is dry. Repeat until wound care shows up.
All wounds are open to air when in the process of healing.
197
Prophylaxis to prevent Ulcers
```
• Q2 turns
— Every two hours is strict, anything greater than that is wrong.
• Never massage bony prominences
— Causes more pressure when the problem in the first place is pressure
• Specialty rotation beds
— Used for Stage III and Stage IV
• Range-of-motion (ROM)
• Heel cushions
```
198
Standard / Universal Precautions
```
• Wear gloves
• Risk for bodily fluid exposure
• Bloodborne illnesses
— Ebola, Hep B, Hep C, HIV
• Anthrax
— Inhaled by a white powder
— NOT communicable
```
199
Contact Precautions
GLOVE AND GOWN
```
• C. Diff
— Hand wash with soap and water
— Caused by overuse of antibiotics
— Severe (foul-smelling) diarrhea
• VRE
• MRSA
• Gastroenteritis (viral)
• Rabies
• Croup
— Caused by the diphtheria virus
— Barking cough, stridor
— Minor - treat with antiinflammatories
— Severe - treat with epinephrine
• Rubella
```
```
• Rotavirus
• Norwalk Virus
• Hep A.
— Enteric precautions (similar to contact,
on occasion only gloves are needed)
• Impetigo
— Honey-crusted lesions on mucous membranes
(occasionally the back)
— Common in pediatric population
• Lice/Scabies
• Respiratory Syncytial Virus (RSV)
— Contact unless a productive cough exists
(then droplet)
• Conjunctivitis (pink eye)
```
200
Droplet Precautions
```
Gloves, Mask, Gown, Goggles
Epiglottitis
• Influenza
• Meningococcal
• Meningitis
```
* Mumps
* Streptococcus
* Rubella (German Measles)
* Sepsis
201
Airborne Precautions
```
Procedure / Surgical Mask ( N95 for TB)
Gloves / Gown / Goggles / Mask / Face Shield
• Consider if splashing or contact is
expected with the patient
Negative Airflow Room
```
```
Herpes zoster (shingles)
• Varicella zoster (chickenpox)
— 7 day incubation period (isolate)
• Measles (rubeola)
— Fever, irritability
— Pain upon chewing
• Sudden Acute Respiratory Syndrome
```
202
Skin Mantoux Test
```
1. PPD (purified protein derivative) /
• Intradermal injection (15 degree) → bleb
• Assess induration not erythema
• 1mm → negative immune response
• 5mm → positive immune response (do not
confuse this with active TB)
— they were exposed to TB at some point
in their lives
— they have antibodies against TB, so those
antibodies are attacking the PPD
• 10mm → immunocompromised (chemo, AIDS)
```
203
Quantiferon Gold Test / TB Bacilii Test
(blood tests)
• Blood draw
• Negative → no TB
• Positive → positive immune response (patient has
had TB in the past or currently has it, send more
x-ray)
204
Chest X-Ray TB
• Negative → Latent TB → Treated outpatient with
long-term antibiotics
• Positive (shows infiltrations) → Active TB →
inpatient isolated in negative airflow NOW!
Start on antibiotic therapy
2-3 clear x-rays before discharge or a negative TB
bacilii test
After discharge, they continue on their long-term
treatment
205
Removing Personal Protective Equipment
| PPE
• What part of the body is most contaminated?
(hands)
• Remove from most contaminated to least
• Gloves → Gown → Wash Hands → Mask → Goggles
→ Wash Hand
206
Other Infection Routes
```
• Yersinia pestis (Rats and fleas)
— Cause of bubonic plague
• Shigella (undercooked food)
— Similar to salmonella
• Yellow Fever (mosquito)
• Lyme Disease (mosquito)
• Brucellosis (uncooked meat, unpasteurized milk)
• Typhoid Fever (contaminated food and water)
• Pinworm (ingestion, fecal-oral route)
— Place tape on the anus during sleep
to diagnose
• Legionnaires’ Disease (stale contaminated water)
— Fountains and old ponds
— Cholera (contaminated water
```
207
Prevention
Primary Prevention
• Prevent the problem from ever existing in the first place
• Vaccinations, condoms, exercise and diet in younger populations (not elderly)
Secondary Prevention
• Screenings (mammography, colonoscopy, PSA blood levels)
Tertiary Prevention
• Prevent the progression of a disease process
— Post MI aspirin use
208
Semi-Fowler’s
The NEURO happy place
— ICP issues or brain trauma
• Sometimes correct for respiratory as well
— Really bad ascites leading to dyspnea
209
High Fowler’s
The RESPIRATORY happy place
• Tripod position refers to a patient leaning
forward to assist in breathing
210
Supine
```
Spinal Injuries
• Post-procedure CNS puncture
— Lumbar puncture (spinal tap)
• Dorsal recumbent refers to mostly supine
with a pillow under the head
```
211
Prone
Meningocele, myelomeningoele, spina bifida
• ARDs
• Post-op Cleft Palate Repair Baby
— Facilitates excretions
212
Sims
Enema, suppository, rectal temp
• Pregnant women
• Sim’s and left side common for
rectal anything
213
Trendelenburg
```
Shock (get preload back)
• Pre-term labor
• Prolapsed cord in labor
• Trendelenburg and to the left
— Air embolism
```
214
Left side lying
Women with variable or late decels
• Dumping syndrome
• Facilitates bowel movements
• GERD
215
Right side lying
Post liver biopsy
• Aids in movement of food into the intestines
— Gastric emptying
