Final Study Guide change in body or mind structure
*Public health nurses - political action (meals on
wheels),
*Use nursing expertise and knowledge from
public health to promote health and prevent
illness in public health groups
*work towards insuring a healthy environment
*Refer homeless person to a shelter
*community is people, place. Function
*the community nurse assesses the needs of all
family members
*Primary interventions - immunizations, safety
and injury/violence, exclusion from school,
health ed, diet and nutrition, exercise and
physical activity, illness prevention
*Secondary intervention - screening, referral,
counseling, treatment
*Tertiary prevention - prevent recurrence of
acute problems, prevent complications, foster
adjustment to chronic illness, handicapping
conditions, address learning disabilities, sustain
school based health services
*stress in a work place - effort needs reward and
balance
*work place primary prevention - health
promotion, illness prevention, injury prevention,
violence prevention (reporting procedure)
*work place secondary prevention - screening
and survelliance, treat existing conditions,
emergency care
*work place tertiary prevention- prevents the
spread of communicable diseases, prevents
recurrence of Acute health problems, prevents
complication of chronic conditions, assess fitness
to return to work
*To be a basic need it must….meeting it restores
health, one feels something is missing if need is
unmet, its presence helps prevent illness or
signals health
*deficiency needs must be met! Esteem needs,
belonging needs, safety needs physiological
needs
*maslow in order - physiological, safety,
belonging, esteem, self actualization
*Love and belonging the nurse addresses this
need when she establishes the nurse pt
relationship based on understanding and trust.
Nurse accomplishes this through care planning.
Involve family in care plan
*Qualities of self actualization- acceptance of
self and others, respect for all people, ability to
discriminate between good and evil
*Health is a state of complete physical mental
and social wellbeing. Not meerly the absence of
disease or infirmity
*Disease - med term verifying pathological
*Illness - response of person to disease, level of
functioning is changed
*Internal factors effecting health and illness -
developmental stage, intellectual background,
perception of functioning, emotional factors,
spiritual factors
*External - family practices, socio economical
factors, cultural background
*Dimensions - physical (age, developmental
level, race gender), emotional (long term stress
affects the body systems, anxiety affects health
habits), intellectual (Cognitive abilities,
educational background, past experience),
environmental (Housing, sanitation, climate,
pollution of air, food, water), sociocultural,
(health belief practices are strongly influenced
by a persons economic level, lifestyle, family
and culture) ,spiritual (beliefs and values)
*Self concept influences a persons perception of
health and illness
*6 types of risk factors - age, genetics,
physiological, environmental, health habits,
lifestyle
*After menopause women are more likely to
develop cardiovascular disease
*A family hx of CA or diabetes predisposes a
person to developing the disease
*Illness behavior is when a ill clients perception
of illness will result in unique behaviors
*Stage 1 - experiencing symptoms - if symptoms
continue pt goes into stage 2
*Stage 2 - Assuming the sick role - pt seeks
validation from dr. gives up normal activities
and assumes sick role
*Stage 3 - Assuming a dependent role - if serious
pt enters hospital for tx, pt response to care
depends on - seriousness of illness, degree of
fear, loss of roles, support of others, previous
experiences w/ illness care
*Stage 4 - Achieving recovery and rehabilitation
- begins in hospital, concludes at home, resumes
normal activities and responsibilities
*Support health - sleep 6to8 hrs a night, eat
breakfast, eat reg meals, maintain ideal body
weight, using alcohol moderation if at all, not
smoking, maintaining positive mental health and
self concept.
*older - east a diet low in fat & salt, check bp
regularly and walk 30 minutes a week
*Disuse syndrome - risk for deterioration of
body systems b.c of prescribed or unavoidable
muscoskeletal inactivity.
*Adverse effects on body systems are specific,
predictable and preventable - all body systems
are relater and interdependent.
*lft ventrical feeds blood to entire body
*Circulatory - increased…HR, CO, Stroke
volume.
*venous stasis - static blood, leg muscles are not
being used they no longer assist in returning
blood to the heart  blood flow in slowed down,
congested, pooled. This causes decreased O2
intake
*Dependent edema - anything below the heart,
Supine position causes sacral edema and heel
edema
* edemawhen low levels of protein in blood
reduces osmosis that normally helps with
circulation of body fluids, on venous end of
capillary bed, decreased protein reduces the
return of fluid to vascular system, fluid is
retained in tissues
*Protienthe only nutrient that contains
nitrogenessential to the bodys tissue building
and repair processesgreater output of
nitrogenous wastes in proportion to intake of
protein, person is in negative nitrogen balance.
*fluid from upper part of bile goes around
impaction and appears as diarrhea,
*Muscle tonus allows normal posture, keeps
from collapsing
*Muscle tone is maintained by daily activity
*Within 2 months of immobility muscle is
reduced to half its original size(atrophy)
*if joit are not moved muscle fibers become
infiltrated with fibrous tissue shorten and
joints become fixed into an abnormal angle
called contractures, very painfull
*Osterblasts that make up the bony matrix need
stress and strain of weight bearing and strain on
the bones by the muscles to function well
*Bones become porous, brittle and lose strenght
b/c they have lost their rigidity - disuse
osteroporosis and are more prone to pathological
fractures
*Immobility prone to urinary retention, statisis
of urine, loss of bladder tone and uti’s
*Kidney stones/renal calculi can plug or obstruct
any aea in renal system, especially small urinary
pathways, normal acidic ph below 6.0 and
contains enough citric acid to prevent
precipitation of calcium people w/ high levels of
calcium in urine will have a alkaline urine.
Microorganisms thrive in alkaline urine
*Citrus juices irritates the bladder, cranberry
juices are good for uti’s
*Apnea is the cessation of breathing for 10
seconds or more during sleep, decreases o2 level
in blood
*Narcolepsy - chronic incurable dysfunction of
REM sleep, falls asleep at inappropriate times
*Cataplexy - sudden loss of muscle control
occurring during extreme and intense emotions
such as laughter or anger
*Parasomnias - occur DURING sleep but usually
do not produce insomnia or excessive sleepiness,
sleep walking, sleep terrors, nightmares, grinding
of teeth, bed wetting
*EEG, EOG, EMG - diagnostic testing used in
measurement of sleep
*Many OTC’s to promote rest and sleep contain
alcohol or antihistamines, alcohol disrupts REM
sleep, antihistamines increase bp, both cause
poor coordination and memory changes and
exacerbation of chronic illness
*Hypnotics induce sleep, interfere with nerve
impulses in the brain, have a depressant action
on the CNS, cause fatigue, hangover effect,
dizziness and ataxia, dry mouth, physical and
emotional dependency, DNT TAKE WITH
ALCOHOL!! CAN LEAD TO DEATH!!
*Benzodiazepines - relieve anxiety, anxiolytics,
tranquilizers, halcion, restoril
*Botanical healing - Valerian, interacts with
alcohol, cns depressants, no use with pt who
have hepatic impairment, no use in pregnant or
breast feeding. Monitor bp, hr, sleep patterns,
liver function tests; Melatonin is a biotanical
healing therapy, - regulates sleep patterns, used
for treating insomnia,
BED REST
* Respiratory system Decreased
activityDecreased O2 needs  Decreased
respiratory volume  Pooling and stasis of
respiratory secretions  Pneumonia  Tissue
hypoxia
*Circulatory system  Decreased activity 
Increased workload on heart  Decreased blood
perfusion  orthostatic hypotension 
Thrombus formation  tissue hypoxia
*Psychosocial Aspects  Decreased activity 
Reduced social contacts and stimuli  Reduced
problem solving ability  Decreased coping
ability  decreased time orientation
*Gastrointestinal system decreased activity
lessened energy expenditure Anorexia
Lessened food intake constipation
*Renal System decreased activity Increased
kidney perfusion renal calculi urinary tract
infection bladder retention
*Integumentary system sustained pressure on
body parts tissue hyposia and necrosis
decubitus ulcers
*Musculoskeletal system decreased activity
muscle wasting fibrosis of joints muscle
atrophy joint contractures loss of motor
function
*Eye - check color, edema, too much fluid
indicant of CHF, pupils should be black
*ptosis - drooping of eyelid can occur in
myasymia gravis and stroke pt.
*entropion - inward turning of eyelid
*ectropion - outward turning of eyelid
*decreased pupid response is indicant of
blindness
*Normal eye assessment - uniform red reflex,
clear yellow optic nerve disc, reddish retina,
light red arteries, dar red veings
*Abnormal - cloudiness of lense, changes in the
blood vessels, changes in color and surface
characteristice
*Any deviations in occular motor movements are
indicant of cranial nerve damage 3,4, 7
*Pupil constricts closer things
*Pupil idalates further things
*widespread eyes  downs syndrome
*slanted eyes  mental retardation
*downward slant  doesn’t indicate abnormality
*Keyhole shaped pupil  congential
abnormalities
*spots are indicant of downs syndrome
*Infants  visual tracking
* 9 or 10  snellen chard
* 3 to 5 yrs  20/40 vision
*6 and up  20/30 vision
*Myopia nearsightnedness distant objects
appear blurred
*Hyperopia  close items are blurred far
sightedness
*Presbyopia loss of accommodiation
associated with age, difficult focusing on near
objects
*Astigmatism irregular corneal curvature,
*Aphakia no near vision only vision in the
middle of eye, crystalline lens is absent
* Cataracts above 60 with rubella, long term,
corticosteriod use, opacity within the crystalline
lense, creaste the appearance of white pupil,
diabetics develop it earlier
*Cataract removal  NOP 6 to 8 hrs, Miotics
given to lower intraocular pressure, facilitate
aqueous humor to flow, Mydriatecs - 45 minutes
to work, 4 hrs to wear off, make pupil dialate,
cyclopedias - atropine sulfate, paralyzes the
muscles of accommodation
*cataract post op  home shortly after,
antibiotic and corticosteriod drops, avoid
activites that incdreas IOP, final glasses
prescription when eyes are fully recovered, no
bending or stretching,
*ear drops - over 3 yrs old up and back
*ear drops - under 3 yrs down and back
*corner of the eye should be equal to the top of
the ear
*Ottis media - daycare, pacifires, congenital
abnormalities, male, recent upper respiratory
infections, cigarette smoke, allergies, fam hx of
ear aches
*Ottis media - middle ear infection - treated w/
abx amoxicillin, delayed 48 to 72 hrs. constant
Tylenol q4 hrs whether needed or not
*ottis media w/ effusion is the most common
cause of long term hearing loss
*Menieres disease - most common balance
disorder, between 30-60 yrs. Low pitched
tinnitus, drop attacks, treated w/ vasodilators,
diuretics, antihistamines
*Labryinthitis - rare balance disorder, infection
enters from the meninges, middle ear, or blood
stream, systagmus, sensor neural hearing loss,
toxic episodes are associated with AOM, vertgo,
nausea vomiting
* Acoustic neuronal - balance disorder, benign
tumor, early diagnosis, unilateral tinittis,
progressive, sensor neural hearing loss, mild
intermittent vertigo, dx by ct ro mri, surgically
removed
*Presbycusis - progressive hearing loss as a
resuld of aging, hear sound but dnt understand
speech
*Uvula - helps prevent aspiration
*Glottis - opening between vocal cords
*epiglottis - prevents aspirations
*Check for symmetry nodes should be small
slightly movable and non tender
*Resp assessment of kids - nose breathers,
tongue larger, lung capacity, smallest at cricoid,
smaller airway, barrel chest, diaphramic breather,
pliable ribs, airway smallest at the opening,
retraction is a negative sign
*Head control - 2/3 months of age
*Candidiasis - yeast fungus (thrush) do not
scrape off easily, common with steriod inhaler
users, trx - topical fungal agents, no eating or
drinking for 20 minutes after used, analgesics,
mouth washes lido Cain based, bland diet, soft
foods, yogurt, clean mouth with warm water and
salt.
*Epistaxis - bloody nose, forward lean, pinch
nose, stay calm, anterior bleed caused by drug
use, diresct pressure to nose 10 to 15 minutes,
ice on the nape of the neck, on nose and chew on
ice, this vasodialates, cotton ball or gauze to the
nostril, no NSAIDS b/c they promote bleeding
*Pharyngitits - rapid strep 20 minutes, culture
24-48 hours, could have yellow patches, sore
throat, difficulty swallowing, fever, maliase,
cough, increased WBC, droplet precautions, lasts
1-5 days
*Croup syndrome - croupy cough
*Epiglottis - cannot swollow, looks worse than
they sound, drool, sitting upright leaning forward
with mouth open, restless and frightful, coraking
on inspiration, retractions, rapidly progressive,
preceded by a sore throat, haemophilus
influenza, cheery red epiglottis, do not touch the
pt
*Laryngitis - common in older children and
adolescents, hoarse, treat symptoms, take child
outside to open airways
*Laryngotracheobronchitis LTB - same signs and
symptoms as epiglottis but also a low grade fever
and a high pitched strider wine with breathing -
slow onset, crowing sount, occurs at night, may
progress to hypoxic state, slight temp, uri’s
frequently precede, inspiratory stridor, retraction,
restlessness
* Antitussives - suppress cough reflex, work on
cough centers of the medulla in the brain take 15
- minutes to work and last 3-6 hrs
*Expectorants - loosen up secretions so they can
be coughed out, mixed w/ an antihistimine or
decongestant
*Decongestant - produce nasovasal constriction
to shrink nasal mucous membranes
*Anti fungals - yeast nistatin, flagil diflucan
*Cough suppressant doesn’t work for a 3 year
old
*Constipation is caused by improper diet, lack of
exercise, slow metabolism, neurological
conditions, antichilinergics, diuretics, iron
supplements, opiods, intestional obstruction
(tumor)
*Diarrhea associated with digestion, absorption,
and secretion in the gastrointestinal tract
*when a continous oozing of diarrhea stool
occurs suspect inpaction
*Osmotic - laxative - can cause
hypermagnesmia, excess lacunose
*Reddish brown urine caused by excretion of
phenolphthalein (ex lax, correctol, senna and
cascara (senokot)
*bulk formation stimulates peristalisis and is
safe for people w/o other systemic problems
*Antidiarrheal are used to slow intestinal
motility
*Opiates - type of antidiarrheals - lomotil added
to discourage abuse, Loperamide has no atropine
added, can cause dizziness, dry mouth,weakness,
blurred vision, urine retention, respiratory
depression.
*Immodium causes less cns depression b/c drug
does not cross blood brain barrier
*Pt with severe hepatic impairment should not
use drugs containing diphenoxylate (lamotil) or
liveried
*absorbants work by coting the wall of the GI
tract and absorbing bacteria or toxins that cause
diarrhea
*Motion sickness is the leading cause of nausea
and vomiting, Dramamine inhibits vestibular
stimulation in acoustic area of ear which is
concerned with equilibrium and motion sickness
*UTI - organisms that most frequently cause
UIT’s are normally found in the gastrointestinal
tract, Escherichia coli (e coli ) most common
causative pathogen.
*Retained urine becomes more alkaline, and is
an ideal site for microorganism growth or
bladder infection, positioning also cause it,
dorsal recumbent or prone,
*UTI symptoms - dysuria, fever, chills, nuasea,
vomiting, malaise, cystitis, hematuria, cloudy
urine, bacteriuria can spread to the kidneys and
lead to bacterium known as uro sepsis - this is an
infection that has invaded the blood flow
(stream)
*Pyelonephritis - bacterial infection in kidney,
chronic pyelonephritis most commonly occurs
when urine refluxes from bladder back into the
ureters at the vesicouretal junction, bacteri move
via reflux into kidney tissue and trigger
inflammatory response, as a result filtration,
reabsorption and secretion are impaired and renal
function is reduced.
*Urinalysis done - WBC, WBC’s, RBC, protein,
C and S clean cat,
*can assess with a xray of the kidneys, ureters,
and bladder
*Guomerulonephrititis develops 1-3 weeks after
an infection of the throat or skin, due to
nephrotoxic strains of group A beta hemolytic,
streptococci
*blood is filtered at the glamorous
* protein should not be in urine but should be in
blood
*Dermatitis - inflammation of the skin long term
irritation can cause skin to become thickened
leathery and dark in color
*Allergic dermatitis - repetitive skin contact with
an irritant, memory cells form an antigen to the
irratant and with the next exposure a sensitized
person reacts
*Atopic dermatitis - Exzema, chronic skin
disorder characterized by exacerbations and
remissions, causes unknown, occurs most often
in warm moist areas of the body, symmetric dry
skin eruptions common in antecubital and
popliteal spaces as well as face, scaly reddish
brown papules and plaques that ooze and crust,
tx oatmeal bath, mild soap, emollient lotions,
creams that contain fatty substances, steriod
cream, oral antihistamines, avoid triggering
factors, dietary management, no eggs, cows
milk, fish, corn, citrus, nuts, chocolate, during
the first year of life
* Seborrheic dermatitis - inflammatory disorder
of skin involving scalp, eyebrows, eyelids, ear
canals, nasolabial folds, maxillae and trunk
Linked to with overgrown of iityrosporum yeast,
yellow/white, plaques with greasy scales and
crusts, usually prurutic
*Psoriasis - involves excessively rapid turnover
of epidermal cells, characterized by raised,
reddened, round plaques, covered by silvery
white scales most commonly found on scalp,
extensor surfaces of arms, legs elbows kneew
and sacrum, can cause yellow brown
discoloration of nails, nails may separate from
nailbed, no cure but control is possible
* skin alterations nursing diagnosis - impaired
skin integrity, disturbed body image,
*Ringworm - Capitits (scalp), Corporis (body),
Versicolor (chest back and arms, no pigment on
lesions), Cruris (jock itch), pedis (athletes foot)
most common type
*Scabies - contagious skin condition caused by
the mites sarcopted scabies, lesions, transmitted
by close personal contact, visible brownish greay
threadlike lines end in a pinpoint vesicle, papule
or nodule, scabicides
*Lymes disease - tick bites cause it, bullseye
rash first stage may also have flu like symptoms,
second stage joint pain occurs, neurological
complications, cardiac complications, 3rd stage
large joints become involved arthritits
progresses, trx with antiviotic therapy
*inflammation is always present with infection
but infection is not always present with
Inflammation
*inflammatory response bone marrow releases
increased numbers of immature Europhiles into
circulations calls a shift to the left
* Local response - redness, heat, pain, swelling
and loss of function
*Systemic manifestations - leukocytosis with a
shift to the left, malaise, nausea and anorexia,
increased pulse and respirations which follow the
rise in metabolism that accompanies fever
*Primary intention healing - margins neatly
approximated 3 phases take place 1st - initial 3 -5
days approximation of incision edges, migration
of epithelial cells, clot serving as meshwork for
starting capillary growth 2nd - Granulation
5days-4weeks migration of fibroblasts, secretion
of collagen, abundance of capillary buds,
fragility of wound, 3rd stage - scar contracture 7
days to several weeks - remodeling of collagen,
strengthening of scar
*secondary intention - wounds from trauma,
ulcerations, and infection, lg. amounts of
exudates present, there can be wide irregular
margins that are not approximated, greater
inflammatory action, primary incision may
become infected reopen and healing by
secondary intention takes place, granulation take
place from the wound edges inward and from the
bottom of the wound upward intil the defect is
filled.
*Tertiary Intention - delayed primary intention,
contaminated wound is left open and sutured
closed after the infection is controlled, results in
a larger and deeper scar than primary or
secondary intention
*wounds are either, superficial, partial thickness,
or full thickness
*Hamorragic, sanguineous - small amount
expected after surgery or trauma, large amounts
indicate hemorrhage - bright red or bloody
*Serosanguineous - blood tinged yellow or pink,
expected 48 to 72 hours after injury or trauma,
sudden increase may brecede wound dehiscence
*Serous - thin, clear, yellow, expected for up to 1
week after trauma or surgery
*Purulent - thin cloudy, foul-smelling, may be
thick if filled with dead cells, usually indicated
infetions, may drain suddenly from an abcess
*RICE - soft tissue injury - Rest, Ice,
compression, elevation
* Client with an incission - should e assessed q 4
hrs, erythematic should not extend beyond a half
inch from the incision. Incision should be well
approximated
*Bebridement- betadine, dakins solutions,
hydrogen peroxide, and hibiclens used with
cautions, can damage new epithelium of healing
tissue never used in a clean granulating wound
*Autolytic debridement - used in open wounds
with necrotic de bris and no infection
*Stage I deep tissue injury - in tact skin with
nonblanchable redness
*Stage II - partial thickness loss of dermis - a
shallow crater, pink or red, not a skin tear, break
through skin, no slough, appears like a blister
*Stage III - full thickness tissue loss - all the way
through dermis, not exposed bone, may have
undermining and tunneling, tendon or muscle,
slough may be present but doesn’t obscue to
depth of the wound
*Stage IV - Full tissue loss with exposed bone
tendon or muscle, slough and or echar may be
present and undermining and tunneling is present
*Unstageable - full thickness tissue loss in which
the base of the ulcer is covered by slough in the
bed of the wound and you cannot tell how deep it
is
* measure using centimeters with the greatest
length and width perpendicular to each other
*Eschar and Slough are bad signs
*Granulation and epitheliazation are good signs
*Eschar - leathery black dark brown, material
necrotic devitalized tissures, leave on the heels
*Slough - necrotic tissue in the process of
separating from viable portions of the body
*Granulations - Tissue pink red moist contains
new blood vessels collegen, fibroblasts and
inflammatory cells
*Epithelialization - stage in which the epithelial
cells migrate across the surface of the wound,
color ranges from ground glass to pink
*wounds heal from the inside out
*use a dressing pack and instruments to pack a
wound
*vitals q 4 hrs
*keep skin dry
*Avoid donut type rings
*reposition q 2 hrs
*wheel chair bound person should be repositions
q 15 minutes
*Ulcer wounds should be clensed initially and at
each dressing change, moist wound healing and
prevents disruption of the newly formed
granulation
*keep wound bed moist and surrounding skin
dry
*4-15 lbs per square inch 30 ml syringe with 19
guage angiocatheter
* Wet to dry dressing should never be used on a
clean granulating pressure ulcer
*attend to most contaminated ulcer last
*Protien copper and zinc help with healing
*Vitamin C enhances the absorption of iron
*Iron supplements - drink plenty of water, expect
stools to be black, occasional nausea, vomiting,
diarrhea possible, Iron is given Z track method
* high intake of milk can cause iron deficiency
* shillings test evaluates the body’s ability to
absorb ingested vit b12 from the gi tract
*incompatibility can result in reaction itching,
chills, fever to body systems failure and death
*use y tubing for blood transfussion - one side
for blood other for isotonic saline,
* dextrose solution or LR should not be used it
causes hemolytic
*VS taken prior to transfusion to establish
baseline, then vs. taken q 15 minutes after stand
and end
*if not given within 30 minutes returned to blood
bank, (risk of bacterial growth)
*Blood given slowly 2ml/min
*whole blood 2 hours, plasma 15-30 minutes
*transfussions should not take more than 4 hours
*Hemolytic - most serious reaction - breakdown
of RBC’s result in incompatibility, massive
clumping of RBC’sdestruction
*Febrile - most common, sensitivity to
something in blood, causing fever, chills, muscle
pain, Tylenol is given before transfusion for
prevention, no asparin
*Allergic - mild and severe classification,
sensitivity to proteins in plasma, mile is flushing
of skin, itching, severe anaphylactic - SOB
wheezing shock, death
*Circulatory overload - administered faster than
circulation can accommodate, cough, sob,
headache, increased bp, increased pulse
*sepsis - contaminated with bacteria - high fever
*transfusion related lung injury - reaction
between antibodies in blood and pt leukocytes
can cause sob and decreased o2 stats.
*agism is negative attitudes towards old people
and is damaging to the self esteem of elderly
*short term memory loss goes first
*When assessing the nurse should function on
the pt’s functional age
*elderly desired outcome is functional
independence in a safe environment
*dull information to 4th to 7th grade level
*Deliruim occurs in 18 to 38 percent of older
hospitalized adults. Disorganized thinking,
trouble concentrating, lasts 7-10 days and has a
rapid onset
*Provide consistant caregivers to prevent
confusion
*always know these interactions - drug to drug,
drug to food, drug to disease and the absorption
and distribution
*Erikson -
*(Infant) Trust vs Mistrust
Needs maximum comfort with minimal
uncertainty to trust himself/herself, others, and
the environment
* (toddler) Autonomy vs Shame and Doubt
Works to master physical environment while
maintaining self-esteem
*(preschool) Initiative vs Guilt, Begins to
initiate, not imitate, activities; develops
conscience and sexual identity
*(School-Age Child) Industry vs Inferiority
Tries to develop a sense of self-worth by refining
skills
*(adolescence) Identity vs Role Confusion
Tries integrating many roles (child, sibling,
student, athlete, worker) into a self-image under
role model and peer pressure
*(Young Adult) Intimacy vs Isolation
Learns to make personal commitment to another
as spouse, parent or partner
*(Middle-Age Adult) Generativity vs Stagnation
Seeks satisfaction through productivity in career,
family, and civic interests
*(Older Adult) Integrity vs Despair
Reviews life accomplishments, deals with loss
and preparation for death
* separation anxiety is worst from the ages of
12-36 months
*Pain - brows lowered, forehead bulged between
brows, eye sightly closed, cheecks raised, nose
broadened and bulging
*Provide preschool age w/ a doll and medical
equipment this will allow the child to engage in
therapuetic play reducing anxiety while in the
hospital.
*Elderly have marginal immune function causing
susceptibility to pathologic conditions. Lower
immune system.
*humeral responses are in response to
bacteria,extra cellular viruses, respiratory
pathogens, gastrointestinal pathogens
*Cellular responses are in response to fungus,
viruses intracellular, chronic infection agents,
tumor cells
*systemic anaphylaxis - dyspnea, decreased bp,
bronchole, constriction, gi and bladder smooth
muscle contraction, shock, death within minutes.
Allergen gets into the blood stream and is treated
with epinephrine
*Allergic rhinitis (hay fever) - triggers reaction
in nasal mucosa, watery exudate from nose eyes
upper respiratory tract, coughing, sneezing,
lacrimation, mucosal swelling with airway
obstruction, itchy eyes nose throat and mouth
*Asthma - due to inhaled airborn allergens,
*Athsma - dyspnea, wheezing, coughing,
tightness in the chest, thick sputum
*Atopic dermatitis - red skin rash, strong
hereditary predisposition.
*Serum sickness - urinary, angioedema, fever,
muscle soreness, maliase, joint pain,
polyarthritis, nephritis
Treated with aspirit, anti histamines, severe
reactions when renal neurology changes are
present --corticosteriods
*delayed type IV hypersensitivity - raised areas,
lage number of macrophages at the reaction site,
average of 24 hours to manifest after repeated
exposure, exp. Poison ivy, meatals, makeup
*Family history of allergies is the strongest risk
factor
*Treat,emts - treat symptoms - antihistimines,
diphehydramine, Nasal decongestants,
corticosteriods (make things smaller), inhaled
corticosteriods are not immediately effective
*Inhaled corticosteriods - coughing, pharyngeal
irritation, coughing, dry mouth, oral fungal
infections, systemic effects are reare because of
the low doses used for infalation therapy
*Emergency surgery within hrs, life threatening
*Urgent - soon within a week
*Required - necessary, essential, such as back
pain
*Elective - planned, scheduled for pt’s
convenience, face lift etc
*major - major risks, hazards, time consuming
*minor - simple, uncomplicated, fewer risks,
mole removal
*Diagnostic - determine presence extent of
pathology
*Exploratory - type of diagnostic, examination to
determine nature/extent
*Curative - elimination or repair of pathology
*Ablative - a part is removed abnormal tissue
destroyed
*Reconstructive - repair a defect
*Constructive - making something that did not
previously exist
*obesity increases the chance of awound
dehiscence
*smokers should be encouraged to quit smoking
6 weeks before procedure
*Alcoholics have poor healing, poor nutritional
status, anestisia is an additional stress to liver
*Fever expected immediately post operative for
about 24 hours after that it is indicant of
infection
*hepatic (liver disease) bleed ing is
compromised
*HG and Hct - 02
*Electrolytes - hydration
*creatinine - kidney function
*bleeding time and coagulation - risk for
bleeding?
*ECG - hx of heart disease
*Chest x ray - pneunomnia
*Cough and deep breaths prevent pneumonia
*Informed consent is good for 30 days
*Pt must be off sedation for @ least 4 hrs before
they can sign informed consent
*as a nurse you witness the pt signature only. U
do not witness that they understand the
procedure.
*cath a pt if they havent voided in the last 6-8
hrs before surgery
*unrestricted environment - preop holding area,
PACU, dressing area, staff wears scrubs, may
have pt visitors, hospital staff
*Semi restricted - limited to OR personnel only
includes anesthesia, lounges, wor/supply/storage
areas. OR attire (scrubs, hats, shoes
*Restricted - operating room suite and scrub
areas, surgical team and anesthesia or attire
(scrubs, hats, shoes, mask). Limit contamination
risks.
*circulatory nurses assess and identifying is
there primary responsibilities.
*Nurses monitor and assess pt, assess chart for
completeness, monitor start iv’s pre-op meds,
provide safety and emotional support
*Circulating nurse - RN, checks equipment,
meets patient in pre op holding area, checks
chart and pt, assist anesthesia prn, assist
transferring positioning patient, counts, master of
all, does time out
*Scrub nurse - surgical sterile setup of
equipment/field - draping pt, accurate count of
sponges, needles, and instruments, 1 before and
2 after surgery, maintain sterile field, handing
items to surgeon and assistant, medications on
the field
*Anesthesia decides what can and cannot be
done with the pt. has final say.
*General Anesthesia - pt is unconscious, muscles
are relaxed, no gag reflex, mechanical airway in
place,
*Regional - produces loss of sensation in only
one region of the body and does not result in loss
of consciousness(major advantage). Blocks
nerves in this order, touch, pain, motor, pressure,
proprioceptive, (sensory nerve endings). Types
of regional anesthesia: sinal epidural caudal,
nerve block
*Spinal - hurt a little bit, injected into
subarachnoid space, used for surgery involving
the lower half of the body, autonomic nerve
fibers and are affected first and are last to
recover, technique of choice for elderly, does not
require empty stomach, respiratory arrest ,
heatache, meningitis
*Epidural - injected into epidural space,
procedures involving the lower half of the body,
does not require an empty stomach, dosage can
be changed throughout procedure, low incidence
of post procedural headache, risks are respiratory
arerest, headache, meningitits (same risks as
spinal)
*Caudal - variations of epidural, commonly used
with OB patients
*Nerve block - targets a specific region, injects
into or around a specific nerve, provides intra
postoperative analgesia, treatment of chronic
pain
*Bier Block - iv ansesthetic injected after the
extremity is exsanguination is accomplished,
give a bloodless field. Turnicate can only be on
for one hour,
*Sedation - type of anesthesia that induces an
altered state of consciousness that minimizes
pain and discomfort by administering a
combination of opiods and sedatives
intravenously, used for outpatient procedures, it
allows the pt to maintain reflexes, independently
maintain a patient airway, maintain
cardiovascular function, respond to verbal
commands and physical stimulation, common
side effects; venous thrombosis, phlebitits,
confusion, drowsiness, hypotension, advantage
for the pt: reduces fear, elevation of pain
threshold, maintains consciosness and protective
reflexes, quick return to normal activities
* Local - anesthtic that is given to induce the
absense of sensation in small area of the body
without the loss of sonsciousness, topical, sub q,
intra q
* Anticholinergic - causes dry mouth, blocks
secretions,
*Belladonna Alkaloids - metabolized in the liver,
*Atropine - decreases oral and resp secretions,
*Scopolamine - drug of choice for motion
sickness
*Narcotic Analgesic - pain relief without loss of
*agonist - binds to receptor and stimulates
receptors function
*antagonist - prevents receptor stimulation,
prevents or reverses action of narcotic, used in
drug overdoses
*Pure narcotics - morphine sulfate, codeine
sulfate
*Synthetic - fetanyl, hesperidins
*Demerol is one of the most common narcotics
used as preoperative medications, is generally
given IM 30-90 minutes before surgery
*pupils constrict with narcotics
*Non narcotic analgesics - Salcylates, Para
aminophenol derivatives, Nsaids
*salcylates (aspirin) inhibit prostaglandin
synthesis, side effects - gi distress such as
burning feeling, due to mucosal irritation,
interferes with blood clotting resulting in
bleeding, tinnitus, do not use with anticoagulant,
in child swith viral infection, can cause reyes
syndrome a potentially fatal disease
*Para-aminophenol derivatives (acetaminophen/
Tylenol) - thought to inhibit prostaglandin
synthesis,
*Nsaids - nonsteriodal anti inflammatory drugs *Nitrofurantoin - often combined with
(ibuprofen, advil, orudis). Anti-inflammatory sulfonamides - Primarily UTI, antacids interfere
properties, thought to inhibit prostaglandin with absorption, rust/brown urine, hepatoxicity,
synthesis, decreases inflammatory action is equal steven johnsons syndrome, do not crush, do not
to that of aspirin, gi disturbances most common, drive, increase fluid intake, esp. cranberry juice,
interact with oral anticoagulants and anti plums, proteins, prunes, and vitamin C, take with
hypertensives food
*Bensodiazepines - location of drug action and *Vancomycin - vancocin “big guns” Red neck
mechanism of action not clear but is believed to or red man syndrome, hypotension r/t being
depress the CNS Relaxes pt befoe surgery can administered to quickly, check serum drug
cause dependence, dry mouth, fatigue, muscle levels, check peak and trough
weakness, n/v and hangover effect *Cepholosporins - increase yogurt intake finish
*barbituates - habit forming all, risk for bleeding, alcohol intolerance
* acidic environment kills micro organisms *Macrolides - (erythromycin azithromycin) ,
*protiens help fight pt susceptibility to micro don’t mix with warfarin theophylline, diflucine
organisms take antacide 2 hrs before and after
*MRSA and VRE are the most common *Tetracyclines - broad spectrim - milk products
sosocomial infection and antacids prevent absorption, decrease the
*Biohazard is anything pourable, peel able or effects of oral contraceptives, digoxin absorption
dripable is leading to toxicity, photosensitivity, stomatitis
*droplet precautions - flu, mumps, spread *Aminoglycosides, will not work if you don’t
thought droplets, door open, people who enter keep at a working level, monitor peaks and
room must wear mask, meningococcal troughs (gentamicin)
meningitits
*Contact precautions - mrsa, vre, d diff, scabies,
door open, gloves when entering, do not share
equipment
*Airborne - chicken pox, measles, tb, neg.
pressure room, door closed, susceptible persons
hould not enter isf other are available
*Most effective public health precautions
*Vaccines are the most important finding of the
century
*Vaccines must not be injected subQ
*Older adult - decreased…cough reflex, elastic
recoil of the lungs, activity of the cilia, sphincter
control, renal blood flow, skin elasticity,
epidermis thickness, cell replacement rate,
vascular supply; Increased….bladder
obstruction, dryness of skin, Other….abnormal
swallowing reflexes, incomplete emptying of the
bladder
*Gram stain should be neg. no growth found
*Neutrophils increase in acute infection
*Lymphocyes increase in viral bacterial
infection, monocytes increase is protozoan
infections, esinophylis increased in parastic
infection
*Lincosamide (clindamycin, cleocin) - take with
food, high incidence of anaphylactic shock,
incompatable with aminophline, dilantin,
bartiturates, ampicillin
*Sulfonamide (bactrim) - increased
hypoglycemia, increased anticoagulation, Renal
failure, Stevens johnsons syndrome, icrease fluid
intake, avoid during third trimester