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Friday, September 21, 2007

Supplements For Theoretical Foundations

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Supplements For Theoretical Foundation Slideshow Transcript

Slide 1: SUPPLEMENTS FOR THEORETICAL FOUNDATIONS SAFE AND EFFECTIVE CARE ENVIRONMENT HEALTH PROMOTION AND MAINTENANCE FUNDAMENTAL CONCEPTS REDUCTION OF RISK POTENTIAL THERAPIES AND PROCEDURES

Slide 2: MANAGEMENT OF CARE COMPETENCE,CONFIDENTIALITY AND  PRIVACY ADVOCACY AND ACCOUNTABILITY  RESPECTFUL CARE AND  RESPONSIBILITY PROTECTED RELATIONSHIP AND  PROMOTION OF PUBLIC HEALTH ETHICAL STANDARDS OF CARE 

Slide 3: INFORMED CONSENT CAPACITY AND COMPETENCE  INCLUDES EXPLANATION OF  BENEFITS, EXPECTED  RESULTS,ALTERNATIVES AND RISK VOLUNTARY  INFORMATION UNDERSTOOD  CANNOT SIGN IF UNDER ALCOHOL OR  PREMEDICATED

Slide 4: Which statement about consent is not accurate: It includes explanation of benefits and  disadvantages It states that consent cannot be withdrawn  anytime It requires a competent adult who can make  voluntary choices Married minors and pregnant minors can sign  own consent for treatment

Slide 5: MANAGED CARE WORK ALLOCATION  PATIENT NEEDS AND CONDITIONS  ABILITIES OF STAFF  CONTINUITY OF CARE  KNOWLEDGE OF STAFF AND QUALIFICATIONS\\  RIGHT TASK- FUNCTION , ACTIVITY ,  DECISION…….INFORMATION , SUPERVISION , FOLLOW-UP DON’T DELEGATE ASSESSMENT,TEACHING  EVALUATION,PLANNING

Slide 6: DELEGATION BUILDS TRUST  EMPOWERS OTHERS  TEACHES AN MOTIVATES  TEAMWORK DEVELOPS  ENHANCE COMMUNICATION  RAPID PRODUCTIVITY AND RAISED  SKILL

Slide 7: WHICH OF THE FOLLOWING IS NOT TRUE ABOUT MANAGED CARE? In delegation , responsibility is transferred, accountability  is shared Responsibility is determined by Nurse practice acts,  standards of care, job description and policy statement In delegating identify variables nevertheless this would  not change authority and responsibility Delegate to the lowest person on heirarchy that has the  required skills and abilities who is allowed to do the task legally and according to the organization

Slide 8: Example: “ feed client if coherent and awake, if confused do not feed and notify me asap. IN PLANNING FOR STAFFING ALWAYS TAKE INTO CONSIDERATION CAPACITY / ABILITY OF THE STAFF.

Slide 9: SCOPE  R.N.- PLANNING AND HEALTH TEACHING  LICENSURE REQUIREMENTS  ASSESSMENT AND EVALUATION  NEED FOR KNOWLEDGE AND SKILL  LPN/LVN-  STABLE PATIENTS  STANDARD UNCHANGING PROCEDURES  SIMPLE MONITORING AND IMPLEMENTATION  SEQUENCED/PREDICTABLE OUTCOMES  STATE PRACTICE ACT INCLUSION  UAP-DIRECT PATIENT CARE ACTIVITY AND  STANDARD OPERATING UNCHANGING PROCEDURES

Slide 10: INCIDENT REPORTS SEQUENCE-UNEXPECTED OR UNPLANNED  OCCURENCE RISK MANAGER  SITUATIONS-STATEMENT OF FACTS AND  PATIENT PHYSICAL RESPONSE ACTUAL AND POTENTIAL-REPORT WITHIN 24  HOURS-INVESTIGATION OF REFERRING TEAM MANAGEMENT(RISK MANAGER)

Slide 11: In writing an incident report the nurse manager should state the following guidelines on charting except Don’t include words such as error or  inappropriate Don’t include judgemental statements  Only actual risks should be reported within 24  hours to the risk manager Documentation of clients status should be  continuous

Slide 12: RESTRAINTS LIABLE FOR FALSE IMPRISONMENT  LAST RESORT  INFORMED CONSENT(PROXY)  ALTERNATIVE MEASURES FIRST  BENEFITS> RISKS  LENGTH OF TIME AND CIRCUMSTANCES  SPECIFIED ENSURE SAFETY – CIRCULATION  CHECKS,SKIN CARE, ROM AND REMOVE Q2H

Slide 13: RESTRAINTS IS USED FOR: THE PURPOSE OF DISCIPLINE  COMFORT AND CONVENIENCE OF PROVIDER  REQUIRED TO TREAT MEDICAL SYMPTOMS  MEASURE USED TO CONTROL BEHAVIOR  PREVENT BREACH IN SAFE AND EFFECTIVE  DELIVERY OF MEDICAL THERAPY. ENSURE SAFETY OF OTHER PATIENTS  MEDIUM OF LIMIT SETTING AND PROVISION  OF EXTERNAL CONTROLS

Slide 14: COMPLAINTS COMPROMISE / COLLABORATIVE  AGREEMENT LISTEN ATTENTIVELY  EXPLAIN SCOPES AND LIMITATIONS  ASK AND RELAY EXPECTED  SOLUTIONS AND TERMS NON-DEFENSIVE 

Slide 15: A CLIENT WHO IS ABOUT TO BE BATHED BY A NURSE STATES;”You are too young to know how to do this, get me someone who knows what they are doing”.the nurse best response is: We do this procedure daily, I have done this  several times, tell me what are you afraid of? I can see you are upset , can we talk about it?  You’re concerns show you are upset, we will talk  about this after I have demonstrated the procedure. Can you be more specific about you’re  concerns?

Slide 16: Health teaching C-CONSIDER SUPPORT SYSTEMS /  COMPLIANCE H- olds MOTIVATION AND INSIGHT  A- ALLOW FEEDBACK  N-NEEDS MET AND ASSURED  G- GOALS AND PRIORITIES SET w/ pnt.  E- EMPATHETIC AND ENSURES  COLLABORATION

Slide 17: Patient Education Type of learning: Cognitive Psychomotor Affective Patients motivation –PRIORITY FACTORS – DURATION , COMPLEXITY AND SIDE EFFECTS Discharge planning  Begins with first encounter Functional level considered  Referrals and preferrences  Compromised plan

Slide 18: WHAT IS THE BEST GAUGE THAT THE CLIENT UNDERSTANDS DISCHARGE TEACHING? PATIENT VERBALIZES INTEREST  PATIENT ASKS QUESTIONS RELATED TO  ADAPTATION TO NEEDED CHANGE IN BEHAVIOR ACCURATE DEMONSTRATION OF PROCEDURE  PLANS FOR PRACTICE SESSIONS RELATED TO  HEALTH CARE SUGGESTIONS TAUGHT BY THE R.N.

Slide 19: SAFETY AND INFECTION CONTROL pg.27-49 UNIVERSAL PRECAUTIONS  STANDARD PRECAUTIONS – BARRIER  COMMUNICABLE DISEASE CONCEPTS  CLINICAL MANIFESTATIONS-  INITIAL,PATHOGNOMONIC/OUTSTANDING  DIAGNOSTIC TESTS AND ETIOLOGY  CARE ESSENTIALS AND IMPLICATIONS MANAGEMENT  SEQUELAE 

Slide 20: category-specific isolation strict- prevents transmission of highly contagious or  virulent infections spread by air or direct contact(diptheria and chickenpox) Contact-prevents transmission of highly transmissible  infections spread by close or direct contact to skin and mucous membranes that do not warrant strict precautions respiratory – prevents trans mission of infectious  diseases over short distances through air droplets(measles, meningitis,mumps, pneumonia and H. Influenza) airborne  droplet 

Slide 21: enteric precautions – prevents transmission of  infections by direct or indirect contact with feces(oral-fecal)( cholera,infectious diarrhea , hepa A , infectious AGE) AFB isolation-prevents spread of pulmonary  tuberculosis( laryngeal TB) drainage and secretion precautions- prevents  transmission by direct or indirect contact with purulent material or drainage from an infected body site(abcess, burn infection,and infected wound)

Slide 22: Universal blood and body fluid precautions-  prevents contact with pathogens transmitted by direct/indirect contact with infective blood or body fluids containing blood( AIDS, HEPA- B,SYPHILIS) care of severely immunocompromised clients-  protects client with lowered immunity and resistance from acquiring infectious organism( LEUKEMIA, LYMPHOMA, APLASTIC ANEMIA)

Slide 23: WHICH OF THE FOLLOWING IS AN INCORRECT STATEMENT MADE BY THE STUDENT NURSE ABOUT INFECTION CONTROL HANDWASHING IS THE SINGLE MOST  EFFECTIVE WAY OF PREVENTING THE SPREAD OF INFECTION AUTOCLAVING KILLS ALL PATHOGENIC  MICROORGANISMS INCLUDING SPORES AUTOCLAVED ITEMS IS CONSIDERED STERILE  UNTIL 6 MOS. ONLY THE SKIN CAN NEVER BE STERILE 

Slide 24: THE FOLLOWING PATIENTS ARE INCLUDED IN REVERSE ISOLATION PRECAUTIONS EXCEPT: BURN PATIENTS  PATIENTS WITH APLASTIC ANEMIA  PATIENT WHO ARE ON STEROID THERAPY  PATIENTS WHO ARE ON CHEMOTHERAPY  PATIENTS WHO ARE ON RADIATION THERAPY  PATIENTS WITH LEUKEMIA  PATIENTS WITH LYMPHOMA 

Slide 25: POISONING CHILD PROOF  REFER - POISON CONTROL CENTER  IDENTIFY AND BRING AGENT  SECURE SAFETY AND ABC’S  INDUCE VOMITING W/ IPECAC  STOP/DELAY ABSORPTION W/  WATER/MILK/ACTIVATED CHARCOAL

Slide 26: THE NURSE SHOULD INTERVENE IF A MOTHER OF A VICTIM OF POISONING VERBALIZES TO DO THE FOLLOWING: PLANS TO INDUCE VOMITING FOR PATIENT  WITH ASPIRIN POISONING PLANS TO INDUCE VOMITING WHEN SHE IS  CERTAIN THAT HER CHILD’S GAG REFLEX AND LOC ARE INTACT WILL NOT GIVE IPECAC IF CHILD IS  EXHIBITING NARROWED PULSE PRESSURE WILL WAIT FOR THE SEIZURE TO END  BEFORE ADMINISTERING IPECAC

Slide 27: CONTRAINDICATIONS OF IPECAC / INDUCTION OF VOMITING SEIZURE  SUBNORMAL LOC AND GAG REFLEX  SUBSTANCE CORROSIVE/PETROLEUM  DISTILATE SHOCK-SEVERE 

Slide 28: DISASTER PLANNING TRIAGE-GREATEST GOOD FOR THE  GREATEST NUMBER OF PEOPLE PRINCIPLES- ABCD , MASLOWS  RED-UNSTABLE – IMMEDIATE CARE  YELLOW- STABLE – CAN WAIT 30-60 MIN  GREEN –STABLE- CAN WAIT LONGER  BLACK- UNSTABLE – FATAL, LAST SEEN  DOA – SUPPORTIVE COMFORT MEASURES 

Slide 29: DURING FIRE WHICH SET OF PATIENTS WILL THE NURSE MOBILIZE FIRST AMBULATORY  BEDRIDDEN  CRITICAL  TERMINAL 

Slide 30: WHICH STEP IN FIRE MANAGEMENT COMES LAST? ALARM  CONTAIN  MOBILIZE  EXTINGUISH 

Slide 31: PREVENTION AND EARLY DETECTION OF DISEASE

Slide 32: Medical Asepsis/ Clean Technique Principles:   Pathogens move through spaces or air current  Pathogens are transferred from one surface to  another whenever objects touch.  Hand washing removes microorganism   Pathogens are released into the air on droplet nuclei  when person speaks, breaths, and sneeze.  Pathogens are transferred by virtue of gravity  Pathogens move slowly on dry surface but very  quickly through moisture.

Slide 33: Surgical Asepsis/ Sterile Technique Areas of the body considered sterile are:  Blood stream o  Spinal Fluid o  Peritoneal Cavity o  Urinary Tract o  Muscles o  Bones o  Chamber of the Eyes o 

Slide 34: Sterile object remains sterile when touched by  another sterile object Sterile objects or fields, which falls out of  the range of vision or below one’s waist, are considered contaminated. Sterile items become contaminated when  they come in contact with microorganism transported through the air. When sterile object/ field come in contact  with another surface, it becomes contaminated.  Fluids flows in the direction of gravity.  The edges of the sterile field are considered  unsterile

Slide 35: Isolation Practices  Strict Isolation- prevents transmission of highly  communicable disease by contact and airborne transmission Respiratory isolation- prevents transmission by  droplet Enteric precaution- prevents transmission through  ingestion  Wound and skin precaution- prevents cross-infection  by direct contact with wounds and contaminated articles Discharge precaution- prevent cross-infection by  secretions-contaminated articles Blood precaution- prevent transmission by contact with  blood or items contaminated with blood

Slide 36: GROWTH AND DEVELOPMENT DEVELOPMENTAL TASKS---MILESTONES ----  DELAYS(FIXATIONS/LAG) IQ = MA / CA X 100  JUDGEMENT , COMPREHENSION AND LISTENING  DDST – BIRTH TO 6 YEARS  PERSONAL SOCIAL, FINE , GROSS MOTOR AND  LANGUAGE SKILL AREAS

Slide 37: HEALTH SCREENING OB – GYNE / REPRODUCTIVE TESTS  UTZ-5 WKS CONFIRM PREGNANCY AND AOG  AMNIOCENTESIS – 16 WKS-DETECT GENETIC DISORDERS –  30 WEEKS – L/S RATIO ( 2-4 WKS RESULT)(EMPTY Bladder) OCT – (28 WKS)FHR DECELERATIONS – IV OXYTOCIN 15-20  MIN----3 CONTRACTIONS OBTAINED WITHIN 10 MINUTES- REACTIVE NST – FHR ACCELERATIONS (32-34 WKS) – 2-MORE FHR  ACCELERATION OF 15BPM/MORE LASTING 15 SECS -20 MINS. AND RETURN OF FHR TO NORMAL/BASELINE – REACTIVE DOPTONE- 12 WEEKS (18 – 20 WKS-AUSCULTATION)  AFPT-FETAL SERUM CHON , -DETECT NEURAL TUBE  DEFECTS – 16-18 WKS CHORIONIC VILLI SAMPLING –FETAL ABNORMALITIES- 10-12  WKS

Slide 38: NEWBORN/INFANT HEALTH SCREENING PKU – GUTHRINE BLOOD TEST-EAT  CHON FOR 2 DAYS MIN.(PHEONISTICS – DIAPER) SICKLE CELL DISEASE –ABNORMALLY  SHAPED Hg , ELISA AND WESTERN BLOT  CARRIER SCREENING FOR CYSTIC  FIBROSIS AND SWEAT CHLORIDE TEST

Slide 39: SCHOOL AGE HEARING AND VISION TESTS  ALLEN PICTURE CARDS   SNELLEN CHART-20/40 AT TODDLER AND 20/20 AT SCHOOL AGE  WEBER’S-SENSORINEURAL AND CONDUCTIVE  RINNE’S- CONDUCTIVE  DENTAL EXAM – STARTS AT 2 YEARS

Slide 40: ADOLESCENT PPD – INDURATION – 72 HOURS  BSE – (18-20 YRS.) POST  MENSTRATION/MONTHLY TSE – MONTHLY (18-20 YRS)  PELVIC EXAM WITH PAP SMEAR – IF  SEXUALLY ACTIVE OR 18 Y.O. ANNUALLY

Slide 41: IN TEACHING AN ADOLESCENT PROPER BSE TECHNIQUE THE NURSE SHOULD INSTRUCT THE CLIENT TO PERFORM BSE IN THE FOLLOWING POSITIONS EXCEPT: STANDING WITH ARMS ON THE HIPS FACING  THE MIRROR LYING DOWN WITH PILLOW UNDER THE  SHOULDERS ARMS AT THE BACK OF THE HEAD RAISE THE ARM OF THE SIDE TO EXAMINED  ABOVE THE HEAD POSITION THE ARMS WITH THE BODY IN  ANATOMICAL POSITION

Slide 42: ADULT/ELDERLY HPN , DM, HEARING AND VISION  PROSTATE –ANNUALLY@40  Ca CHECK-UPS-Q3Y-20YO ; QY – 40 YO  SIGMOIDOSCOPY- > 50 Y.O. =Q3-5 YRS  FECAL OCCULT BLOOD TEST- > 50 =  ANNUALLY DIGITAL RECTAL EXAM - > 40 Y.O. = YEARLY  PELVIC EXAM – 18-40 Y.O. =PERFORMED Q 1 – 3  YEARS WITH PAP TEST MAMMOGRAM – 35-39 = BASELINE  40-49 = Q2Y 50 AND OLDER = QYEAR

Slide 43: BP SCREENING(mmHg) SYSTOLIC DIASTOLIC FOLLOW-UP < 130 <85 2 YEARS 130-139 85-89 1 YEAR 140-159 90-99 2 MOS. 160-179 100-109 EVALUATE AND REFER 1 MOS. 180-209 110-119 1 WEEK >210 120 IMMEDIATELY

Slide 44: UPON INITIAL ASSESSMENT THE PATIENT HAS A BLOOD PRESSURE OF 170/90 mmHg. WHAT IS THE FOLLOW-UP REFERRAL FOR THIS PATIENT? REFER AFTER 1 WEEK  EVALUATE AND REFER FOR FOLLOW-  UP AFTER 2 WEEKS EVALUATE AND REFER FOR FOLLOW-  UP IN 2 MONTHS EVALUATE AND REFER FOR FOLLOW-  UP IN 1 MONTH

Slide 45: IMMUNITY pg 127-130 CONTRAINDICATIONS:  SEVERE FEBRILE ILLNESS  LIVE VIRUSES C/I FOR IMMUNOCOMPROMISED  ALLERGIES  RECENTLY ACQUIRED PASSIVE IMMUNITY(BLOOD  TRANSFUSION AND IMMUNOGLOBULINS) if child –no evidence of immunization <7 y.o.  Give DPT,TOPV,TINE  4-6 WKS LATER MMR  1 MONTH AFTER DPT AND TOPV  REPEATED IN ANOTHER MONTH  AGAIN IN 10-16 MOS.  CAN GIVE DPT,MMR,TOPV, AND TINE  SIMULTANEOUSLY

Slide 46: TD- 2 DOSES 4-8 WKS APART;3RD DOSE 6-12  MOS;BOOSTER AT 10 YRS FO LIFE OPV/IPV – 2 DOSES AT 4-8 WKS APART ; 3RD  DOSE 2 -12 MOS AFTER 2ND(OPV NOT USED IN US) MMR-ONE DOSE – 12 MOS  VARICELLA – TWO DOSES 4-8 WEEKS APART  STARTS AT 12 MOS. HEPA B – 3 DOSES;2ND 1-2 MOS AFTER;3RD 4-6 MS  AFTER PPV- ONE DOSE ;IF 65 AND RECEIVED >  5YEARS – ADMINISTER INFLUENZA –ANNUALLY EACH FALL 

Slide 47: ALLERGY CONTRAINDICATIONS EGGS – INFLUENZA , MMR  NEOMYCIN – VARICELLA,IPV,MMR  YEAST – HEPA-B  GELATIN – VARICELLA  PREGNANCY C/I: MMR AND VARICELLA  IMMUNOSUPPRESSED; VARICELLA  WITH Ig or BT PREVIOUS 3-11 MOS – MMR AND  VARICELLA

Slide 48: CONSIDERATIONS- IMMUNIZATION DPT - IM – ANTERIOR OR LATERAL THIGH  FEVER AND SWELLING 24-48 H POTENTIAL  SERIOUS-CONVULSIONS,HYPERPYREXIA,LOC AND  SCREAMING MMR – SC – ANTERIOR OR LATERAL THIGH  RASH, FEVER ARTHRITIS-10DAYS-2 WKS  TRIVALENT OPV – PO  PPD-ID- 4-6/11-16YRS.OLD IN HIGH  PREVALENCE AREAS – EVALUATED 48-72 HOURS

Slide 49: A PATIENT WITH HIV-AIDS IS POSITIVE FOR PPD WHEN THERE IS: PRESENCE OF INDURATION OF 10 MM  PRESENCE OF INDURATION OF 15 MM  PRESENCE OF INDURATION OF 5 MM  WHEAL FORMATION OF 10MM OR  VESCICULAR PROLIFERATION

Slide 50: PHYSICAL ASSESSMENT TEACHING OPPURTUNITY  INSPECTION –VISUALLY  PALPATION-WARM HANDS  DORSUM OF FINGERS FOR TEMP  PERCUSSION-DIRECT,INDIRECT,BLUNT  RESONANCE-MODERATE LOW PITCHED CLEAR  HOLLOW(LUNG) HYPERRESONANCE-OVERINFLATED(EMPHYSEMA)  TYMPANY-HIGH PITCHED,LOUD DRUMLIKE(BOWEL)  DULL-SOFT MUFFLED,DENSE FLUID FILLED TISSUE(LIVER)  FLAT – SOFT HIGH PITCHED,VERY DENSE TISSUE-  (MUSCLE/BONE) AUSCULTATION-DIAPHRAGM-  HIGH PITCHED(LUNG,BOWEL,HEART); BELL – SOFT LOW  PITCHED(HEART MURMURS)

Slide 51: VITAL SIGNS TEMPERATURE:  ORAL – 98.6 ‘F / 37 ‘C   RECTAL – 99.6 ‘F / 37.6’C  AXILLARY – 97.6’F / 36.5’C

Slide 52: Body Temperature   The balance between heat produce by the  body and heat loss from the body  Types of body temperature   Core temperature- deep tissue temperature  of the body  Surface temperature- temperature of the  skin, subcutaneous tissue, and fats  The normal core body temperature is  between 36.7°C (98.7°F)- 37°C (98.6°F).  The thermoregulation center of the body is  the hypothalamus

Slide 53:  Types of fever:   Constant- temperature is constantly  high  Intermittent- the temperature  fluctuates between periods of fever and periods of normal temperature  Relapsing- increase in temperature  alternated with 1 or 2 days normal temperature Remittent fever- the temperature fluctuates o with in a wide range over 24 hours period but remains above normal temperature

Slide 54:  Routes of Temperature –Taking   Oral  Most accessible and most convenient o  Temperature is taken in 2-3 minutes time o  15 minutes before taking the oral o  temperature, don’t allow the client to take hot or cold foods and fluids  Rectal  Most accurate measurement o  Thermometer is inserted 0.5-1.5 inches o  Temperature is taken in 2 two minutes o  time. 

Slide 55: Axillary  The most non-invasive and the most safest o  Temperature is taken in 5-9 minutes time o   If the body temperature declines suddenly,  it is termed as crisis and this indicates hypothalamic disturbances; while if there is a gradual decline of fever, we term that as lysis that indicates normal functioning of the hypothalamus  Antipyretic is the drug of choice for patients  with fever

Slide 56: Pulse   It is the wave of blood created by the  contraction of the left ventricle  Pulse rate is regulated by the  autonomic nervous system (ANS)  The normal pulse rate of an adult  ranges from 60-100 beats per minute  Pulse amplitute describes the quality  of the pulse in terms of its fullness

Slide 57: Number Definition  Description  0 absent no pulsation  1 thready not easily felt  2 weak stronger than  thready 3 normal easily felt  4 bounding stronger  pulsation

Slide 58:  Pulse deficit is the difference between  the apical pulse and radial puls  Pulse rate vary in different age levels:   1 year old- 80-180 beats per min  (BPM)  2 years old- 80-140 BPM   6 years old- 75-120 BPM   10 years old – 50-90 BPM   Adult - 60-100   When palpating for the pulse, use two  to three finger tips. Don’t use the thumb

Slide 59: Pulse sites and reasons for use:   Temporal- used when radical pulse is not accessible  Carotid- used for infants, in cases of cardiac arrest, to  determine the circulation of the brain  Apical- routinely used for infants and children up to three years  old; to determine discrepancies with radial pulse; used in conjunction with some medications.  Brachial- used to measure blood pressure; during cardiac  arrests of infants  Radial- readily accessible and routinely used   Femoral- used in cases of cardiac arrest, infants children,  determine the circulation of the legs  Popliteal- to determine circulation of the lower leg and the site  for the measurement of BP in the lower extremities  Posterior Tibial- to assess for the circulation of the foot   Pedal- to assess for the circulation of the foot 

Slide 60: Respiration   It is the act of breathing: breathing in  (Inhalation), breathing out (Exhalation)  Types of Respiration:   External Respiration- exchanges of  gasses (oxygen and Carbon Dioxide) that happens in the alveoli of the lungs Internal Respiration- exchange of gasses  that happens in the cell

Slide 61: Types of breathing:   Costal (thoracic) breathing-involves the movement of the chest  Diaphragmatic (abdominal)- involves the movement  of the abdomen  The medulla oblongata is the primary respiratory  center of the body  There are three(3) processes involved in respiration   Ventilation- the movement of gasses in and out of  the lungs  Diffusion- exchange of gasses from an area of  greater pressure to an area of lower pressure. It occurs at the alveolo-capillary membrane.  Perfusion- movement of blood for transport of  gasses, nutrients, and metabolic wastes products  Normal adult breathes 16-20 times per minute 

Slide 62: Blood Pressure   It is the pressure exerted by the blood in the arteries   Normal adult’s BP is 120/80   Systolic Pressure is the pressure resulting from the  contraction of the ventricles  Diastolic pressure is the pressure when the ventricles  are at rest. (Normal: 60-90 mm Hg)  Pulse pressure is the difference between the systolic  and diastolic pressure (Normal: 30-40)  Hypertension – abnormally high blood pressure over  140/90 mm Hg for at least two consecutive readings  Hypotension- abnormally low blood pressure, systolic  pressure below 100mm Hg  Postural/ orthostatic hypotension is a sudden drop in  blood pressure caused by a sudden changed in position

Slide 63:  If the BP cuff is too small for a patient, the  BP reading may result to false high measurement; if the BP cuff is too big for a patient, the BP reading may result I false low measurement  Women usually have lower BP than men   The series of sounds that the nurse listens  during BP reading is called Korotkoff sounds  In assessing the BP, use the bell-shaped  diaphragm of the stetoscope since BP is a low frequency sound Always read the lower meniscus of the mercury  of the BP apparatus at eye level to prevent error

Slide 65: NORMAL VITAL SIGNS NEWBORN=30 – 50 / MIN; 120 – 140 / MIN; 60/40 – 80/50 mmHg 1 – 4 YEARS=20 – 40 / MIN; 80 – 140 /MIN;  90/60 – 99/65 mmHg 5 – 12 YEARS=15 – 25 / MIN; 70 – 115 / MIN;  100/56 – 110/60 mmHg ADULT=12 – 20 / MIN;60 – 100 / MIN ; 90 / 60 –  140 / 90 mmHg

Slide 66: BREATHING PATTERNS CHEYNE STOKES – PERIODIC BREATHING  CHARACTERIZED BY RHYTMIC WAXING AND WANING DYSPNEA - LABORED PAINFUL BREATHING  HYPERVENTILATION – ABNORMALLY RAPID DEEP  PROLONGED BREATHING KUSSMAULS – AIR HUNGER , MARKED INCREASE IN  DEPTH AND RATE TACHYPNEA – FAST SHALLOW BREATHING  PARADOXICAL – FLAIL CHEST , DEFLATES DURING  INHALATION BIOT’S – SHALLOW BREATHS INTERRUPTED BY  APNEA

Slide 67: NORMAL FINDINGS PULSE PRESSURE – 30-40 mmHg  Intracranial pressure – 10 mmHg  PULSE DEFICIT – MINIMAL(3-5 ACCEPTABLE)  IDEAL BODY WEIGHT –  MALES -106 LBS FOR 1ST 5FT THEN ADD 6LBS/INCH  FEMALE – 100LBS FOR 1ST 5 FT THEN ADD  5LBS/INCH ADD OR SUBTRACT 10% DEPENDING ON BODY  FRAME. OBESE AND UNDERWEIGHT IF DEVIATION IS >  20%

Slide 68: SKIN SCARS,BRUISES AND LESIONS  CHECK COLOR  EDEMA – GRADING  0-NO EDEMA  1-BARELY DETECTABLE  2-INDENTATION<5MM  3-INDENTATION 5-10MM  4-INDENTATION >10MM  PRESSURE SORE –GRADING  1-NONBLANCHABLE ERYTHEMA  2-EPIDERMIS,PARTIAL THICKNESS  3-FULL DERMIS AND SQ  4- SUPPORTING TISSUES AND BONES  TURGOR-PINCH SKIN TENTED 3 SECS NORMAL(ELDERLY-  OVER STERNUM)

Slide 69: skin lesions  macule  patches  papule  plaque  nodule  tumor  vescicle  bullae  pus

Slide 70: HAIR AND NAILS HIRSUTISM-EXCESS  ALOPECIA-THINNING  SHAPE – NORMALANGLE OF NAIL BED-  160’; CLUBBING ANGLE > 180 DUE TO PROLONGED DECREASED OXYGENATION BLANCHING =< 3 SECS-NORMAL 

Slide 71: HEAD SYMMETRY, SIZE AND SHAPE  CRANIAL NERVE ASSESSMENTS  OPTIC-SNELLEN  OCULOMOTOR- PERRLA  TRIGEMINAL – BITE DOWN AND STROKES WITH  COTTON FACIAL – FACIAL MOVEMENT AND TASTE  ACCOUSTIC – HEARING AND BALANCE(WATCH  TICK TEST,OTOSCOPIC EXAMS AND POSTURE TESTS) GLOSSOPHARYGEAL-GAG AND SWALLOW  VAGUS- SWALLOWING AND SPEAKING 

Slide 72: EYES PTOSIS-DROOPING OF THE UPPER EYELID  ASTIGMATISM – UNEVEN CURVATURE OF CORNEA  LEADING TO REFRACTION ERRORS NYSTAGMUS- ABNORMAL, INVOLUNTARY EYE  MOVEMENTS STRABISMUS-ASSYMETRICAL LIGHT EFLECTION ON  EACH CORNEA RED REFLEX FROM RETINA-NORMAL  COVER UNCOVER TEST – DET.EYE ALIGNMENT  SNELLEN – FAR DISTANCE VISION/VISUAL ACUITY  IOP-TONOMETRY TESTS INDENTATION(6-12) 

Slide 73: EARS PINNA BACK-UP-ADULT;DOWN-BACK-CHILD  RINNE TEST – COMPARES AIR CONDUCTION  WITH BONE CONDUCTION,VIBRATING FORK PLACED ON THE MASTOID IF SOUND NO LONGER HEARD POSITIONED IN FRONT OF EAR CANNAL. SHOULD HEAR A SOUND= 2:1 ; AIR CONDUCTION > THAN BONE CONDUCTION ;= POSITIVE RINNE ASSESS CONDUCTIVE HEARING LOSS 

Slide 74: EARS WEBER – SENSORINEURAL AND CONDUCTIVE  HEARING LOSS FORK PLACED MIDDLE OF FORE HEAD,SHOULD  BE HEARD EQUALLY=WEBER NEGATIVE IF NOT EQUAL=SENSORINEURAL HEARING LOSS.  SOUND HEARD BETTER IN THE IMPAIRED  EAR=BONE CONDUCTIVE HEARING LOSS, IF VICE VERSA = SENSORINEURAL DISTURBANCE

Slide 75: NECK,MOUTH AND PHARYNX TEETH-32  TONSILS – NO TPC , + GAG REFLEX  CERVICAL LYMPH NODES=<1CM  CAROTID – PALPATE THRILL,LISTEN  BRUIT JUGULAR VEINS – NOT DISTENDED  TRACHEA-MIDLINE 

Slide 76: THORAX AND LUNGS APL DIAMETER-1:2 – 5:7  1:1 = BARREL CHEST  TACTILE FREMITUS NORMAL-  BRONCHOPHONY,EGOPHONY AND WHISPERED PECTORILOQUY-CONSOLIDATION OF LUNGS BREATH SOUNDS  VESICULAR – SOFT-LOW PITCHED BREEZY SOUNDS –  PERIPHERAL LUNG SURFACES BRONCHOVESCICULAR-HARSH SOUNDS-MAINSTREAM  BRONCHI BRONCHIAL- LOUD COARSE - TRACHEA  ADVENTITIOUS BREATH SOUNDS  RALES-FINE SHORT,CRACKLING OR HIGH PITCHED  SOUNDS-INSPIRATION RHONCHI-CONTINOUS LOW PITCHED COARSEGURGLING  HARSH SNORING BEST HEARD ON EXHALATION WHEEZES- SQUEAKY SOUNDS HEARD – EXHALATION  STRIDOR – HARSH , MUSICAL SQUEAK HEARD UPON  INHALATION FRICTION RUB-GRATING , CREAKING SOUNDS, FIZZ LIKE  VIBRATIONS – BOTH INHALATION AND EXHALATION

Slide 77: HEART SOUNDS AORTIC AND PULMONIC VALVE AREAS- 2ND  ICS, R AND L RESPECTIVEY ERBS POINT 3RD ICS  TRICUSPID AREA-4TH / 5TH ICS  MITRAL AREA – 5TH ICS , LEFT MCL  PMI-5TH ICS MCL –(INFANTS-LATERAL TO LEFT  NIPPLE-4TH ICS) S1LUBB-CLOSURE OFAV VALVES  S2DUBB-CLOSURE OF SEMILUNAR VALVES  MURMURS , GALLOP-ABNORMAL HEART  SOUNDS

Slide 78: PERIPHERAL VASCULAR SYSTEM ASSESS  PAIN,PALLOR,PARALYSIS,PARESTHESIAS AND PULSES. ASSESS HOMAN’S SIGN  PULSE DEFICIT 

Slide 79: BREASTS START – UPPER OUTER CLOCKWISE  ASSESS FOR SIZE,SHAPE,SYMMETRY  AND NODES

Slide 80: ABDOMEN DORSAL RECUMBENT  INSPECT,AUSCULTATE,PERCUSS AND PALPATE  BOWEL SOUNDS-HIGH PITCHED GURGLES  HEARD AT 5 – 20 SECOND INTERVALS( 5- 25/MIN NORMAL) IF NOT HEARD IN 1 MINUTE STAY FOR 3 -5  MINS. MORE. SEQUENCE IS CLOCKWISE FROM RLQ HYPOACTIVE < 3  HYPERACTIVE =CONTINOUS,LOUD,FREQUENT  TINKLING SOUND – BOWEL OBSTRUCTION 

Slide 81: ABDOMEN REBOUND TENDERNESS-  INFLAMMATION OF PERITONEUM KIDNEYS- DORSAL LUMBAR AREA –  COSTOVERTEBRAL ANGLE KIDNEY PUNCH TEST 

Slide 82: MUSCULOSKELETAL SYSTEM MUSCLE TONE AND STRENGTH  0=COMPLETE PARALYSIS  1=10%-NO MOVEMENT CONTRACTION OF MUSCLE  PALPABLE/VISIBLE 2=25% - FULL MOVEMENT AGAINST GRAVITY WITH  SUPPORT 3=50% - NORMAL MOVEMENT AGAINST GRAVITY  4= 75%- NORMAL MOVEMENT AGAINST GRAVITY WITH  MINIMAL RESISTANCE 5=100%-NORMAL FULL MOVEMENT WITH FULL RESISTANCE  JOINT MOVEMENTS-CREPITUS=GRATING SOUNDS  ARE ABNORMAL FASCICULATION ABNORMAL CONTRACTIONS AND  SHORTENING OF MUSCLE FIBERS TREMOR-INVOLUNTARY TREMBLING  TEST FOR ROM AND ASSESS FOR  ATROPHY/HYPERTROPHY/CONTRACTURES

Slide 83: NEUROLOGIC TESTS MENTAL STATUS-  LANGUAGE-CEREBRAL CORTEX-APHASIA  ORIENTATION(TIME,PLACE,PERSON)(CONFUSION)  MEMORY- IMMEDIATE RECALL, RECENT MEMORY AND  REMOTE MEMORY ATTENTION SPAN AND CALCULATION  JUDGEMENT – EXPLAIN/INTERPRET / PERSONAL VIEWS  PERCEPTION – SENSORY ANALYSIS AND INTEGRATION  CEREBELLAR FUNCTION- COORDINATION , POINT  TO POINT TOUCHING,ALTERNATING MOVEMENTS,GAIT CRANIAL NERVE FUNCTIONS  SENSORY FUNCTION(e.g. PROPRIOCEPTION-  POSITION SENSE- RHOMBERG’S TEST)

Slide 84: NEUROLOGIC TESTS DEEP TENDON REFLEX  0-NO REFLEX   +1 – MINIMAL ACTIVITY(HYPOACTIVE)  +2 – NORMAL RESPONSE  +3 – MORE ACTIVE THAN NORMAL  +4 – MAXIMUM ACTIVITY ( HYPERACTIVE) PRESENCE OF INFANTILE  REFLEXES(BABINSKI) IN AN ADULT SIGNIFIES CNS PATHOLOGY

Slide 85: LEVEL OF CONSCIOUSNESS GLASGOW COMA SCALE=15 POINTS, 7 COMA  EYE OPENING  SPONTANEOUS=4  TO VERBAL COMMAND=3  TO PAIN=2  NO RESPONSE=1  MOTOR RESPONSE  TO VERBAL COMMAND=6  TO PAINFUL STIMULI/LOCALIZES PAIN=5  FLEXES AND WITHDRAWS=4  DECORTICATE=3  DECEREBRATE=2  NO RESPONSE=1  VERBAL RESPONSE  ORIENTED,CONVERSES=5  DISORIENTED,CONVERSES=4  USES INAPPROPRIATE WORDS=3  USES INCOMPREHENSIBLE SOUNDS=2  NO RESPONSE=1 

Slide 86: ASSESSING MOTOR FUNCTION WALKING GAITS  ROMBERGS TEST- STAND FEET TOGETHER ARMS  RESTING AT THE SIDES,EYES OPEN THEN CLOSED. NEG. ROMBERG – MAY SWAY BUT KEEPS BALANCE. SENSORY ATAXIA-CANNOT BALANCE EYES SHUT  CEREBELLAR ATAXIA-CANNOT BALANCE EYES SHUT OR  EPON HEEL-TOE WALKING AND VICE VERSA  FINGER TO NOSE TEST AND OTHER SENSORY  FUNCTION TEST (ONE AND TWO POINT DISCRIMINATION) EXTINCTION PHENOMENON-SYMMETRICAL AREAS  ARE TOUCHED BUT SENSATION ON ONE SIDE CANNOT BE FELT INDICATES LESIONS OF SENSORY CORTEX

Slide 87: GENITALIA , ANUS AND RECTUM ASSESS APPEARANCE AND ORIFICES AND INGUINAL  LYMPH NODES INSPECT CERVICAL OS AND VAGINA-SPECULUM  DEVIATIONS  CYSTOCELE, RECTOCELE,ENTEROCELE  HYPO AND EPISPADIAS-URETHRAL OPENING DISPLACED  HERNIAS-DIRECT,INDIRECT , FEMORAL  INSTRUCT PNT TO BEAR DOWN-PALPABLE BULGE  DIGITAL RECTAL EXAM –INSPECTION AND  PALPATION –POSITION BOTH=SIM’S , FEMALES – LITHOTOMY;MALES =STAND AND BEND FORWARD PROSTATE GLAND-4 CM ;CERVIX = 2-3 CM  HEMORRHOIDS =DILATED VEINS 

Slide 88: ADDITIONAL SUPPLEMENTALS NORMAL VALUES - PG 25  SIGNIFICANCE OF DIAGNOSTICS AND  LABORATORY EXAMS –PG 26 HISTORY SIGNIFICANCE – PG.28  INITIAL MANIFESTATIONS PG 29-30  UNIVERSAL PRECAUTIONS PG48-51  THE REST IN “ must knows” AND  COMPARISONS OF SIGNS AND SYMPTOMS

Slide 89: MOBILITY AND IMMOBILITY POSTURE AND BODY ALIGNMENT-ERECT  JOINT MOVEMENTS=RANGE OF MOTION  CONNECTIVE TISSUE  BONE TO BONE-LIGAMENT  BONE TO MUSCLE – TENDON  COVERS BONES/JOINTS - CARTILAGE  TYPES OF JOINT  SYNARTHROSES(CARTILAGENOUS)  DIARTHROSES( SYNOVIAL)  AMPIARTHROSES(FIBROUS) 

Slide 90: ERGONOMICS-BODY POSITIONING AND MECHANICS PRIORITY-ASSESS PERSONAL CAPACITY 1ST  USE PROTECTIVE DEVICES/ TRANSFER AIDS  CHANGE POSITION SLOWLY-ORTHOSTATIC  HYPOTENSION(DANGLE LEGS FIRST) PIVOT ON THE STRONGER SIDE,MOVE PNT  TOWARDS STRONGER SIDE USE LARGER MUSCLES OF THE BODY AND FACE THE  DIRECTION OF THE MOVEMENT PULL SHEETS ARE BETTER METHOD THAN SLIDING  ALWAYS MOBILZE MAXIMUM MANPOWER/HAVE AN  ASSISTANT STANDING BY. ROCK FROM FRONT TO BACK/VICE VERSA.WIDE  BASE OF SUPPORT, WEIGHT NEAR MIDLINE OF THE BODY.USE APPROPRIATE TRANSFER AND AMBULATION AIDS. (TRAPEZE, HOYER LIFT, SLIDE BOARD, DRAW SHEET AND TRANSFER BELT

Slide 91: Body Mechanics   It is the efficient, coordinated, and safe use  of the body to produce motion and maintain balance during activity. Principles of Body Mechanics  When the line of gravity passes through the base support, 4. balance is maintained and stability can be maintained with the least amount of effort. A wider base support increases stability of the body. 5. When then center of gravity is close to the base of support, a 6. person and an object is more stable. Enlarging the base of support in the direction of force to be 7. applied maintains stability with minimal effort. Tightening the abdominal muscles upward and contracting the 8. gluteal muscle downward requires less energy to move something and the less likelihood of musculoskeletal injury.

Slide 92: Synchronize use of muscle groups’ decreases muscle fatigue. 2. Objects can be moved easily on a flat surface rather than on an 3. inclined surface against gravity. It is easier to lift when the larger leg muscles are used, rather 4. than using the smaller back muscles. The lesser friction when moving objects facilitates motion. 5. It is better to pull than to push because pulling creates lesser 6. friction, hence movement.  In lifting and moving objects, the body’s weight must be used to 8. assist. Alternate rest periods with periods of muscle exertion may be 9. used to prevent muscle fatigue. Greater force is required to move a heavy object. 

Slide 93: THERAPEUTIC EXERCISES PASSIVE ROM-RETENTION OF ROM AND  MAINTENANCE OF CIRCULATION ASSISTIVE- INCREASES MOTION , MAINTAINS  MUSCLE TONE ACTIVE – MAINTAINS MOBILITY OF THE  JOINT AND MAINTAINS MUSCLE STRENGTH RESISTIVE – INCREASES MUSCLE POWER  ISOMETRICS- MAINTENANCE OF STRENGTH  AND PREVENTS MUSCULAR ATROPHY

Slide 94: DANGERS OF IMMOBILITY DECUBITUS ULCER-OSTEOMYELITIS  OSTEOPOROSIS-PATHOLOGICAL FRACTURES AND  RENAL CALCULI INCREASED CARDIAC WORKLOAD- TACHYCARDIA  CONTRACTURES- DEFORMITIES  THROMBUS FORMATION-PULMONARY EMBOLISM  ORTHOSTATIC HYPOTENSION-  WEAKNESS,FAINTNESS AND DIZZINESS RESPIRATORY STASIS – HYPOSTATIC PNEUMONIA  CONSTIPATION – FECAL IMPACTION  URINARY STASIS-URINARY RETENTION  NEGATIVE NITROGEN BALANCE-WEIGHT  LOSS/DEBILITATION

Slide 95: A COMPLICATION OF IMMOBILITY IN WHICH THE BLOOD VESSELS FAIL TO IMMEDIATELY ACCOMMODATE TO THE CHANGES IN POSITION LEADING TO DIZZINESS,FAINTNESS AND WEAKNESS. THE NURSE KNOWS THAT THIS IS DUE TO: VENOUS STASIS IN THE LOWER EXTREMITIES  VENOUS POOLING OF BLOOD IN THE LEGS  INCREASED VASOCONSTRICTION OF THE  PERIPHERAL BLOOD VESSELS ACTIVATION OF THE PARASYMPATHETIC  NERVOUS SYSTEM

Slide 96: SPECIFIC THERAPEUTIC POSITION HIGH FOWLERS-60-90’  FOWLER-45-60’  SEMI-FOWLERS-30-45’  LOW-FOWLERS-15-30’  SUPINE  DORSAL RECUMBENT  LITHOTOMY  TRENDELENBURG  SIMS LATERAL  MODIFIED TRENDELENBURG  PRONE  KNEE-CHEST  SIDE-LATERAL  ORTHOPNEIC 

Slide 97: FOR PATIENTS POST SUBTOTAL GASTRECTOMY WHICH POSITION SHOULD THE NURSE PLACE THE CLIENT IN AFTER MEALS? UPRIGHT POSITION  LEFT SIDELYING POSITION  HIGH FOWLERS POSITION  DORSAL RECUMBENT POSITION 

Slide 98: ASSISTIVE DEVICES CRUTCHES  CRUTCH HEIGHT-  STANDING ;2 -3 (1-2 INCHES)FINGERS BELOW AXILLA OR  SUPINE ;MEASURE FROM THE ANTERIOR FOLD OF THE AXILLA TO THE HEEL OF THE FOOT AND ADD 2.5 CM TEACH MUSCLE STRENGTHENING EXERCISES  PRIOR TO AMBULATION.WEIGHT ON THE HAND GRIP (TO AVOID CRUTCH PALSY) ELBOWS SHOULD BE FLEXED 20-30’ AND  CRUTCHES SHOULD BE KEPT 6 INCHES LATERALLY AND 6 INCHES TO THE FRONT=TRIPOD POSITION(8-10 INCHES-OK) INSTRUCT CLIENT TO MAINTAIN AN ERECT  POSTURE

Slide 99: CRUTCH WALKING GAITS  FOUR POINT-SLOW SAFE-WEIGHT BEARING  ALLOWED FOR BOTH LEGS TWO POINT- FASTER SAFE-WEIGHT BEARING  ALLOWED FOR BOTH LEGS THREE-POINT-NON WEIGHT BEARING OF ONE  LEG SWINGTO/SWINGTHROUGH-PARTIAL WEIGHT  BEARING ALLOWED FOR BOTH LEGS GETTING INTO A CHAIR –BOTH CRUCHES TO THE  WEAK SIDE , STRONGER ARM HOLDS THE ARMREST GOING UP AND DOWN THE STAIRS- GOOD GOES  UP 1ST AND BAD GOES DOWN 1ST.

Slide 100: WALKER- PROVIDES STABILITY AND BALANCE  MOVE WALKER AHEAD 15 CM  (6INCHES-8-10 INCHES)WHILE WEIGHT IS BORNE BY BOTH LEGS.THEN ALTERNATE WEIGHT BEARING ASSISTED BY THE ARMS ELBOWS SHOULD BE FLEXED-20-30’  IF ONE LEG IS WEAKER MOVE THAT  LEG TOGETHER WITH THE WALKER

Slide 101: CANE  HOLD CANE ON THE STRONGER SIDE  FLEX ELBOW 30’ AND TIP OF CANE 15 CM  LATERAL TO THE SIDE OF THE 5TH TOE. ADVANCE CANE AND AFFECTED LEG  ,WEIGHT ON CANE WHEN MOVING THE GOOD LEG BUT FOR MAXIMUM SUPPORT ADVANCE CANE  1 FEET ,MOVE AFFECTED LEG THEN THE STRONGER LEG GOING UP AND DOWN THE STAIRS –SAME  WITH CRUTCHES

Slide 102: IN TRANSFERRING A HEMIPLEGIC CLIENT WITH RIGHT HEMISPHERE LESION FROM BED TO THE WHEELCHAIR, THE NURSE SHOULD POSITION THE WHEELCHAIR: ON THE RIGHT SIDE 90’ FROM THE BED  ON THE LEFT SIDE PERPENDICULAR  TO THE BED ON THE LEFT SIDE 45’ FROM THE BED  ON THE AFFECTED SIDE 

Slide 103: TRACTIONS TRAPEZE BAR OVER HEAD  REQUIRES FREE HANGING WEIGHTS  ANALGESIC GIVEN TO RELIEVE PAIN  CHECK PATIENTS CIRCULATION( 5p’S)  TEMPERATURE MONITORING  INFECTION PREVENTION  OUTPUT AND INTAKE MONITORING  Nutrition needs  Skin must be frquently checked 

Slide 104: TYPES OF TRACTIONS SKIN TRACTION  SKELETAL TRACTION  BUCKS   BRYANTS  RUSSELS  CRUTCHFIELD TONGS  PELVIC  HALO VEST

Slide 105: NUTRITION PREMATURE INFANTS-LESS  THAN37WKS/2,500G-100-200 CAL/KG/DAY AND HIGHER Na,Ca AND CHON FULL TERM-120 CAL/KG/DAY  PREGNANCY + 300CAL/DAY  LACTATION+ 500CAL/DAY 

Slide 106: ENTERAL FEEDINGS CONDITIONS  PREOPERATIVE NEED FOR NUTRITIONAL SUPPORT  GI PROBLEMS  ONCOLOGY THERAPY  ALCOHOLISM,CHRONIC DEPRESSION AND EATING  DISORDERS HEAD,NECK DISORDERS OR SURGERY  COMPLICATIONS  ASPIRATIONTUBE DISPLACEMENT  CRAMPING,VOMITING,DIARRHEA  HYPEROSMOLAR NONKETOTIC COMA/GLUCOSE  INTOLERANCE

Slide 107: TOTAL PARENTERAL NUTRITION TYPES OF SOLUTIONS  TPN-AMINO ACID-DEXTROSE- 2-3 L /24H – FINE BACTERIAL  FILTER USED TNA-TOTAL NUTRIENT ADMIXTURE- AMINO ACID,  DEXTROSE AND LIPIDS-1 LITER /24 HOURS – NO FILTER PERIPHERAL=NO >10% DEXTROSE AND 2 WKS ONLY  CENTRAL – INCOMPATIBLE WITH MEDS AND BLOOD  IF SINGLE LUMEN USED ATRIAL-HICKMAN/BIOVAC AND GROSHONG-  HUBBER NEEDLE USED TO ACCESS PORT THROUGH SKIN

Slide 108: TPN INITIAL RATE OF INFUSION 50 ML/HR THEN 100-  125/HR. COMPLICATIONS-HYPEROSMOLAR COMA, SEPSIS,  PNEUMOTHORAX FAST RATE=HYPEROSMOLAR  STATE(HEADACHE,NAUSEA,MALAISE,FEVER,CHILLS) SLOWED RATE=REBOUND HYPOGLYCEMIA  X-RAY CONFIRMS PLACEMENT ATTACH TO PUMP  IV TUBING AND FILTER CHANGED Q24 HOURS  ALLOW SOLUTION TO WARM IMMEDIATELY BEFORE  USE IF NO SOLUTION USE DEXTROSE 10% W SOLUTION  CHECK DAILY CBG,WEIGHT,TEMP. I AND O ,  CHECK 3X A WEEK BUN, ELECT,  ONCE A WEEK – LFT’S, CBC, SERUM ALBUMIN AND PT,PTT 

Slide 109: OSTOMIES PERMANENT/TEMPORARY  STOMA RED AND SLIGHT BLEEDING WHEN  TOUCHEDBURNING SENSATION UNDER FACEPLATE INDICATES SKIN BREAKDOWN,REFER ABDL DISTENTION/DISCOMFORT, KARAYA POWDER(DEC.IRRITATION),  CHARCOAL/BISMUTH CARBONATE-DEODORIZER APPLIANCE CAN LAST 7 DAYS BUT CHANGE Q48-72H  AND 24-48H IFPERIOSTOMAL SKIN ERYTHEMATOUS, ERODED ILEOSTOMY-LIQUID,CONSTANT,IRRITATING TO THE  SKIN,APPLIANCE CONTINOUS,MINIMAL ODOR COLOSTOMY-FORMED , CAN BE IRRIGATED 300-  500ML AND REGULATED,MAY NOT HAVE TO WEAR AN APPLIANCE

Slide 110: URINARY ELIMINATION BUN – 10-20 MG/DL  CREA – 0.7 – 1.4 MG/DL  24 HOUR URINE PRODUCTION-1000-  1500CC ANURIA<100ML/24H  OLIGURIA< 400 ML/24H  POLYURIA > 2000 ML/24H 

Slide 111: KEGELS –STRENGTHEN MUSCLES OF THE  PELVIC FLOOR-TIGHTEN FOR 3 SECS THEN RELAX FOR 3 SECS PERFORM LYING DOWN, SITTING AND STANDING FOR TOTAL OF 45 BLADDER RETRAINING  INTERMITTENT CATHETERIZATION AFTER  ATTEMPTING TO VOID Q 2-3H, TIME INCREASES GRADUALLY BUT NO MORE THAN 8 HOURS BLADDER TRAINING – DRINK A MEASURED  AMOUNT Q2H THEN ATTEMP TO VOID 30 MINS LATER-TIME GRADUALLY INCREASED TRIGGERING TECHNIQUES-CREDES MANEUVER  AND VALSALVA CLAMP INDWELLING CATH BEFORE REMOVAL.  THEN DUE TO VOID 3-4 HOURS AFTER REMOVAL

Slide 112: 4 HOURS AFTER FOLEY CATHETER REMOVAL THE PATIENT STILL HASN’T VOIDED. THE NURSE IS EFFICIENT IF SHE DID WHICH OF THE FOLLOWING NURSING ACTIONS FIRST? PREPARE FOR STRAIGHT CATHETER  INSERTION ASK THE PATIENT INCREASE ORAL  FLUID INTAKE POUR WARM WATER OVER PERENIUM  OR TURN ON FAUCET. INSPECT THE PATIENTS SYMPHYSIS  PUBIS

Slide 113: HEMODIALYSIS DONE 3-5 HOURS – 2-3 TIMES A WEEK  AV FISTULA-NO BP,VENIPUNCTURE OR  CONSTRICTIONS PALPATE FOR A THRILL AND LISTEN FOR  BRUIT Q8H MONITOR FOR HEMORRHAGE  DISEQUILIBRIUM  SYNDROME,HEPATITIS,HEMORRHAGE,MUSCL E CRAMPS,AIR EMBOLISM AND SEPSIS- COMPLICATIONS

Slide 114: PERITONEAL DIALYSIS TENCKOFF,GORE-TEX CATHETER  WEIGH BEFORE AND AFTER, WARM DIALYSATE  CHON LOSS, INFECTION, -PERITONITIS(CLOUDY  OUTFLOW,BLEEDING) , FEVER , ABDL TENDERNESS AND N & V PREVENT CONSTIPATION BY INCREASING FIBER IN  DIET,MAINTAIN STERILE PROCEDURE,FOR PROBLEMS WITH OUT FLOW –REPOSITION TYPES:  CAPD(4-6H INDWELLING),  AUTOMATED 30MINS EXCHANGES,  INTERMITTENT- 4X A WEEK – 10H/DAY,  CONTINOUS – 1 DAY INDWELLING 

Slide 115: COMFORT AND PAIN Pain  The noxious stimilation of threatened or  actual tissue damage (Geach, 1987) Whatever the experiencing person says it  is, existing whenever he or she says it does (McCaferry, 1979) It is highly subjective and individual and  that is one of the body’s defense mechanism indicating that there is a problem. It is protective as it gives warning or signal  for tissue injury

Slide 116: Classifications of Pain  Superficial Pain- in the surface of the skin Radiating Pain- pain that extends in the surrounding  tissues  Somatic Pain- pain that occurs in the muscles, joints,  and bones Visceral pain- pain that occurs internally (abdominal  cavity and thoracic cavity)  Referred pain- pain that is felt on the other part of the  body other than the source of injury  Intractable pain- pain that is resistant to intervention   Psychogenic Pain- emotional pains  Intermittent pain- pain that stops and recurs again  and again.  Phantom pain- pain is felt in the absence of a part of  the body causing the pain.

Slide 117: Assessment of Pain  Precipitating Factors- “ What triggers the  pain or makes it worse?”  Quality of Pain- “Tell me what the pain feels  like”  Alleviating Factors- “What measures relieve  your pain”  Meaning of pain- “ How do you interpret the  pain?”  Pattern   Location Pain- “Where is your pain”  Periodicity- “How long have you felt the pain  sensation

Slide 118: PREOP CARE INFANT-DISTRACT  TODDLER-ALLOW REGRESSION AND  INVOLVE PARENTS,CONSISTENT CAREGIVER PRE-SCHOOL-LET CHILD HANDLE  EQUIPMENT,EXPRESSION OF FEELINGS THROUGH PLAY DEMOFAMILIAR SORROUNDINGS SCHOOL AGE- EXPLAIN SIMPLY AND ALLOW  CHOICES ADOLESCENTS- INVOLVE AND POINT OUT  STRENGTHS AND BENEFITS,EXPECT RESISTANCE

Slide 119: PREOP CHECKLIST  CONSENT  HEALTH TEACHING (SPEC. POST OP PROCEDURES)  LAB TESTS,ECG,X-RAY  SKIN PREP  BOWEL PREP  IV’S  NPO  PREOP MEDS,SEDATION AND ANTIBIOTICS  REMOVAL OF DENTURES,NAILPOLISH AND  JEWELRY NUTRITION-TPN OR ENTERAL FEEDINGS PREOP 

Slide 120: WHICH OF THE FOLLOWING INTERVENTIONS BY THE NURSE CARING FOR A PATIENT WHO IS SCHEDULED TO HAVE EXPLORATORY LAPAROTOMY IN 8 HOURS IS CORRECT? PLACING THE PATIENT ON NPO 4 HOURS  PRIOR TO THE TEST AND REMOVING JEWELRY,DENTURES AND NAIL POLISH. INSERTING AN 18G IV CATHETER  CONNECTED TO PNSS OPPOSITE THE ARM WITH A 22 G IV CATHETER CONNECTED TO A TPN SOLUTION. TEACH THE PATIENT DEEP BREATHING  EXERCISES AND EXPLAIN THE PROCEDURE TO BE DONE ON THE PATIENT INCLUDING RISKS AND BENEFITS. HAVE THE PATIENT SIGN THE CONSENT  AFTER EXPLAINING THE CONSEQUENCES AND RISKS AS WELL AS THE BENEFITS.

Slide 121: INTRAOP- MAINTAIN SURGICAL ASEPSIS, MONITOR CLIENT STATUS,, APPROPRIATE GROUNDING DEVICES, FLUID BALANCE AND SPONGE/INSTRUMENT COUNT SCRUB NURSE – HANDLES EQUIPMENT , MATERIALS TO THJE SURGEON, SPONGE AND INSTRUMENT COUNT ( STERILE) CIRCULATING NURSE- ENSURES ADEQUACY OF SUPPLIES, SKIN PREP , DOCUMENTATION , HANDLES STERILE EQUIPMENTS BY FORCEPS

Slide 122: POST OP POST OP- MONITOR VS  Q15X4;Q30X2;Q1HX2 THEN PRN  MONITOR I AND O , K LEVEL , CVP, BOWEL SOUNDS,  BREATH SOUNDS AND LOC RESPIRATORY PHYSIOTHERAPY,TCBD  INCENTIVE SPIROMETRY-20 SECS INHALATION  ENCOURAGE AMBULATION  REFER IF UNABLE TO VOID IN 8 HOURS  APPLY TED HOSE AND PNEUMATIC COMPRESSION  DEVICE,CHECK FOR HOMAN’S SIGN

Slide 123: WOUNDS  NOTE DRESSING AND INCISION  FEVER 1-2 DAYS POST OP-ATELECTASIS/  DEHYDRATION 3-7 DAYS – INFECTION  UPPER GI TUBES-GASTRIC DECOMPRESSION  LOWER GI TUBES – BOWEL DECOMPRESSION  WOUND HEALING BY 1ST INTENTION-  SUTURED AND APPROXIMATED ; 3RD INTENTION-NOT CLOSED,W/ PURPOSE EX: DRAINS WOUND HEALING BY 2ND INTENTION-  INCREASED INCIDENCE OF INFECTION , INCREASED SCARRING AND LONGER HEALING TIME

Slide 124: POST-OP COMPLICATIONS SHOCK  PARALYTIC ILEUS  ATELECTASIS AND PNEUMONIA - 2ND DAY  EMBOLISM- 2ND DAY  WOUND INFECTION-3-5D  DEHISCENCE AND EVISCERATION-5-6D  PSYCHOSIS  CARDIOVASCULAR COMPROMISE  URINARY RETENTION-8-12H  URINARY INFECTION -5-8 D  DVT-6-14 DAYS-1 YEAR 

Slide 125: anesthesia Halothane-respiratory and cardiovascular depression-  monitor VS, open IV site-ABC’s prevent aspiration Nitrous Oxide- Hypotension and nausea and vomiting-  adequate O2 IV thiopental Na- decreased BP , respiratory depression,  laryngospasm- ABC spinal and saddle – hypotension and HA- increased OFI  conduction block/epidural block- hypotension and  respiratory depression-HA not experienced local – excitability and hypersensitivity;no epinephrine  on fingers

Slide 126: WHICH OF THE FOLLOWING STATEMENTS IS NOT TRUE REGARDING POST OPERATIVE COMPLICATIONS OBESITY OR MALNUTRITION INCREASES THE  INCIDENCE OF POST-OPERATIVE COMPLICATIONS THE MAIN PURPOSE OF PRE-OPERATIVE  TEACHING IS TO PREVENT POST-OP COMPLICATIONS high pitched tympany is abnormal in the abdominal  quadrants put on TED or pneumatic compresion devices to  prevent venous stasis notify physician if unable to void in 10 hours  1st dressing should be done by RN 



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