Professional Documents
Culture Documents
TRIAGE-GREATEST
TRIAGE-GREATEST GOOD FOR THE GREATEST NUMBER OF PEOPLE
PRINCIPLES- ABCD , MASLOWS
RESTRAINTS-NOT
RESTRAINTS-NOT INSTITUTED FOR THE PURPOSE OF CONVENIENCE AND AS A
TREATMENT OF MEDICAL SYMPTOMS(FALSE IMPRISONMENT)
BOTH PHYSICAL AND CHEMICAL
INFORMED CONSENT-DURATION REQUIRED NOT PRN
ALTERNATIVE MEASURES FIRST
REMOVE Q2h for skin care and ROM
DONE TO PREVENT HARM OR INJURY OR COMPLICATION IF PNT. DISORIENTED (SAFETY)
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
INCIDENT REPORTS
INCIDENT REPORTS-STATEMENT OF FACTS AND PATIENT’S PHYSICAL RESPONSE FROM
UNEXPECTED OCCURRENCE THAT (COULD/) AFFECT THE CLIENT----SEQUENCE, W/IN 24
HOURS---RISK MANAGER—COMPR. SITUATIONS
NO-REFERENCE , INAPPROPRIATE TERMS OR WORDS, JUDEGMENTAL STATEMENTS, -----
-MONITORING AND DOCUMENTATION
A.M.A.
NOT SYNONYMOUS WITH HAMA WHICH IS RELEASING THE HOSPITAL FROM ANY
LIABILITY AFTER DEPARTURE( THE FORMER MEANS REFUSING A TREATMENT OR
THERAPY)
ASCERTAIN
NOTIFY
Offer assistance
TELEPHONE ORDERS-
ORDERS- REPEAT ORDER TO THE AP AND LET HIM SIGN WITHIN 24 HOURS
INFORMED CONSENT
AGGREED UPON
FACTS KNOWN
TREATMENT
EXPLANATION
RISK UNDERSTOOD
CONSENT CONSIDERATIONS
OB , STD,REHAB ,BLOOD DON.
( MINOR CAN GIVE)
ER, LIFE THREATENING(IMPLIED)
MENTALLY ILL(INCAPABLE)
IMMUNIZATIONS CONSIDERATIONS
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
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
Allergy Considerations:
0-2 SENSORIMOTOR
REFLEXES
IMITATIVE REPETITIVE BEHAVIOR
SENSE OF OBJECT PERMANENCE AND SELF SEPARATE FROM ENVT.
TRIAL AND ERROR RESULTS IN PROBLEM SOLVING
2-7Y PRE-OPERATIONAL
SELF-CENTERED,EGOCENTRIC
CANNOT CONCEPTUALIZE OTHER’S VIEW
ANIMISTIC THINKING
IMAGINARY PLAYMATE – SYMBOLIC MENTAL REPRESENTATION – CREATIVITY
2-4 PRE-CONCEPTUAL (PRE-LOGICAL)
4-7 INTUITIVE (UNDERSTANDING OF ROLES)
7-12Y CONCRETE OPERATIONAL
LOGICAL CONCRETE THOUGHT
INDUCTIVE RESAONING (SPECIFIC TO GENERAL)
CAN RELATE ,PROBLEM SOLVING ABILITY
REASONING AND SELF-REGULATION
12-ABOVE FORMAL OPERATIONAL THOUGHT
Abstract thinking
Separation of fantasy and fact
Reality oriented
Deductive reasoning
Apply scientific method
PRE-CONVENTIONAL (0-6)
PUNISHMENT AND OBEDIENCE
OBEDIENCE TO RULES TO AVOID PUNISHMENT
CONVENTIONAL ( 6-12 )
MUTUAL INTERPERSONAL EXPECTATIONS,RELATIONSHIPS AND CONFORMITY
SOCIAL SYSTEM AND CONSCIENCE MAINTENANCE
BEING GOOD IS IMPORTANT SELF RESPECT OR CONSCIENCE
POST –CONVENTIONAL (12 – 18 Y)
PRIOR RIGHT OR SOCIAL CONTRACT
UNIVERSAL ETHICAL PRINCIPLE
ABIDE FOR COMMON GOOD
RATIONAL PERSON-VALIDITY OF PRINCIPLES-AND BECOME COMMITTED TO THEM
INNER CONTROL OF BEHAVIOR UNDERSTANDING THE EQUALITY OF HUMAN RIGHTS
AND DIGNITY OF HUMAN BEINGS AS INDIVIDUALS
Universal Precautions
Strict Isolation-highly
Isolation-highly transmissible diseases by direct contact and airborne routes of transmission
Private room,gowns, mask , gloves, handwashing,double bagged techniques for soiled articles
Diptheria(pharyngeal),Herpes Zoster, Varicella , Pneumonia( S.Aureus , Strep,group A)
Respiratory Isolation-droplet
Isolation-droplet transmission(3 feet)
Private rom,patient w/ same organism,mask,handwashing,labelled plastic bags for soiled articles
H. influenza, measles, mumps, N. Meningitidis
Tuberculosis/ AFB isolation-suspected
isolation-suspected / active TB
Private room with negative pressureventilation so that air room is vented outside, mask, handwashing,
bronchoscopy and dental examination postponed until 2 weeks of antibiotic therapy
Tuberculosis
Contact Isolation – infectious disseases or multiple resistant microorganisms that are spread by direct contact
or close contact
Private room , mask gown , gloves
diptheria( cutaneous), Herpes simplex, MRSA , Pediculosis , Scabies , Syphilis
Enteric Precautions – infectious diseases transmitted through direct or indirect contact with infected feces.
Handwashing , gloves , gowns worn only when handling contaminated objects with feces
Aseptic meningitis, AGE , Hepa A , Typhoid fever, diarrhea (CDT )
Drainage / Secretions precautions – patients with wound drainage or infected wounds
Gloves, gowns indicated if clothing is likely to be contaminated
Burns
Universal Blood and Body fluids precautions – blood borne , body fluids pathogens ( blood , semen , vaginal
secretions , CSF , synovial fluid , pleural fluid , peritoneal fluid , pericardial fluid , amniotic fluid and tissues.
Gloves , mask, protective eyegears, gown , contaminated needles not recapped and sharps in puncture
resistant containers
Aids , Hepatitis B and C , STD’s
Reversed isolation
Patient is protected from pathogens and nosocomial infections by instituting reversed transmission
precautions
Burns and open wounds, patients with artificial airway , immunocompromised patients – leukemia , AIDS ,
steroid therapy , radiation or cancer chemotherapy , medication effect of leukopenia or agranulocytosis
ANXIETY
MILD – SLIGHT AROUSAL AND INCREASED PERCEPTION
MODERATE-INC. TENSION AND SELECTIVE INATT.
SEVERE – DEC. PERCEPTION AND FOCUSSED ENERGY
PANIC – OVERPOWERING AND LOSS OF CONTROL
IQ = MA / CA X 100
JUDGEMENT , COMPREHENSION AND LISTENING
DDST – BIRTH TO 6 YEARS
PERSONAL SOCIAL, FINE , GROSS MOTOR AND LANGUAGE SKILL AREAS
HEALTH SCREENING
TRANSCULTURAL CONCEPTS
HINDU – REINCARNATION , AUTOPSY , ORGAN DONATION, CREMATION
ISLAM – NO TO ORGAN DONATION , CREMATION AND AUTOPSY …..CONFESS AND TURN
TO MECCA
JUDAISM – WASHED
NATIVE AMERICAN – NOT TO AUTOPSY
BUDDIST – OK – EUTHANASIA AND WITH LAST RITES
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