ACUTE LARYNGOTRACHEOBRONCHITIS LTB (Croup) ¢ Slow Onset. * Commonly Occurs Before Age 5 © Barking Cough ¢ “Crowing Sounds” © URL's Frequently Precede LTB * Restlessness * Supra-sternal © Ingpiratory Stridor © Occurs at Night in Fall and Winter Retractions ¢ TRespiratory Rate © May Progress to Hypoxic State © May Have Slight Temperature (<102")TURP (Iransurethral Resection of the Prostate) * Continuous or intermittent Bladder Irrigation (C.B.|.) (Usually DC'd after 24 houre, if No Clots). “uy Oe * Close observation of drainage system- (T Bladder Distention causes Pain & Bleeding). * Maintain Catheter Patency * Bladder Spasms * Pain Control: Analgesics & | Activity first 24 houre. * Avoid otraining with BMs. T Fiber diet & Laxatives. * Complications: + Hemorrhage - Bleeding should gradually | ta light pink in 24 hrs. * Urinary Incontinence - Kegal Exercioeo * Infections = T Fluide *# Prevertt Deep Vein Thrombosis + Sequential compression stockings * Discourage sitting for prolonged periods @Nursing Education Consultant, In.POST MASTECTOMY NURSING CARE + Elevate affected side with distal joint higher than proxima joint. * No BR, injections or venipunctures on affected side, Watch for S & & of edema on affected arm. + Lymphedema can occur any time after axillary node disection. * Flexion and extension exercises of the hand in recovery. * Abduction and external rotation arm exercises after wound has healed. * Assess dressing for drainage. * Assess wound drain for amount: and color. © Provide privacy when patient looks at incision, *c) iotherapy, Radiation therapy. * Monitor for Complications ~ hemorrhage, hematoma, lymphedema, infection, pootmastectomy pain syndrome, * Feychological concerns: Altered body image Altered sexuality ton Conauttante In Fear of disease outcome Nursing EauSUICIDE PRECAUTIONS SECURE ROOM: ~ Windows Locked - Breakproof Glass & Mirrors - Plastic Flatware - Cords - Phone - Extension - Equipment - Curtains - Belts/Shoelaces/Drawstring Pants - Matches or Cigarettes - Sharps/Razors PATIENT CARE: - Frequent Observation... Preferably1to1 - Staff Communication — Constant Risk Assessment/Documentation - Develop Therapeutic Relationship - Written Behavior Contract with Pt. - Restraints as Necessary - Medications - Monitor and Restrict Visitors OG SySCHIZOPHRENIA - Illogical Thinking - Auditory Hallucinations & Impaired Judgment - Delusions — Persecutory or Grandiose - Lows of Ego Boundaries - Hypersensitivity to Sound, Sight & Smell - Inability to Trust - Difficulty Relating to Others - Bizarre Behavior - Indifferent - Aloof - Love/Hate Feelings - Feelings of: ) - Behavior — Disorganized, Rejection (gate Motor Agitation, - Negativism - Religiosity - Lack of Social Awareness Lack of Self-Respect Catatonic Loneliness, Hopelessness - Retreat to Speech Incoherent Fantasy World & Rambling - Autiom - Disorganized Thinking BB etisrsin Education Conouleants, icRecent Difficulties / Alterations In: Relationships In Patient’s Own Words - Why le He Seeking Help? + Ueual level of functioning ee es eee eS Behavior a Ferceptions Z Cognitive abilities a tFeelings OF: Depression Anxlety Hopelessnese Being overwhelmed Suspiciousness Confusion | Name icity & Cultural lmpications = Marital Status #6 Ages Children = # &. Ages Siblings + Living Arrangements + Occupation Education Religious Affiliations Sphritual Needs 5 Previous illness / Hospitalization Education - highest grade completed Childhood Caregiver Physical Abuse ? Parents Substance Uce/ Abuset J Occupational background pation eee How long employed What joe Social patterns: Friend - importance __ Somatic Changes | Ss Constipation ‘Ageibacen Usual day bo Diarrhea ey Use OF Drugs Sowal Fatgerns E insormia pores mana te ae Lonely Etegt on family ore > Weight Lort aN a Incereste & Abilities pias Happy Family Physical eae aa srenie Rebellious Or Feychosocial Problems $Gives pleasure = Nausea Who? Substance abuse - Meds Nausea ubetance abuse - Mede mi What: problem? i [Yomiting Howitt aftccked Bare, Drug use problems meade the family Seraes coping wiethods @Nuesing Education Consutante, fo.MENTAL REWARD ATION = a Repetition Reinforcement Routine Repetition Reinforcement Routine Repetition Reinforcement R R R R R R R R Ryao ea aac) ue [oa NN oy OL REAL STIMULI MISINTERPRETED... FALSE FIXED BELIEF.EATING DISORDERS Views self as fat — regardless of weight Intenge fear of becoming fat Anxious about losing control Weight is¥85% of normal Feels powerless Associated with obsessive compulsive disorder BULIMIA Recurrent binge eating followed by self-induced vomiting, misuse oF laxatives and enemas Depressed mood following binge eating T Anxiety and compulsivity PICA Fersietent eating of non-nutritive food and non-food substances Food — cornstarch, baking powder, coffee grounds Non-food — clay, soils, laundry starch paint chips More common in children, pregnant women, individuals with autism or cognitive Impairment, patients in chronic renal failure. Influenced by cultural background. Associated with Iron and zinc deficiency. FB onursng Eavcation Constanta neDatety Precautions Remove harmful objects Clase observation Encourage expression Norejudgmental support Kind pleasant ntbresved approach Frequent contact ticipation ns ont ~ Activities Assist in decision making Westen contract = ee ieeunsir Self-Esteem Cognitive Suicidal preoccupation Crying Poverty of ideae Negative view - Self = World - Future Prevent constipation Encourage exerciee Maintain hygienic Mood Dysphoric Depressive Despair [Intereat in pleasure Feychomotor =] Agitation “Gad Persone Scale or [= (genden)t ¢ malos At Risk retardation of movement Ago 419 Adolescente & elderly Fatigue Depression Recent. crisis - stress - loos {Appetite Previous euicide attem) Slotarce sues, Canstipation Chronic or painful tiness Step veturbarees Frevious suicide attempts ETOH (alcohol) abuse Rational thinking impaired ftir i Sante pan a Ea Hallucinating @Nuroing Education Consultant, ne Sicknese (chronic)BIPOLAR DISORDER MANIC * Onset between 18-30 yrs old * Mood: Elevated Expansive Irritable * Speech: Loud-Rapid Punning Poor Judgment. Clanging Vulgar ©? Wr. loss * Grandiose delusions * Distracted * Hyperactive «1 Need for sleep * Inappropriate Dress # Flight of ideas DEPRESSIVE * Previous manic episodes * Feelings of Worthlessness Guilt Hopelessness + TAnger & Irritability eLinterest in pleasure * Negative views * Fatigue & | Energy © LAppetite * Constipation * Insomnia etLibido * Suicidal preoccupation * May be agitated or have movement retardation cy BBB chars education Conus incBASIC COMPONENTS OF A PSYCH ASSESSMENT Why is Patient Ethnicity Seeking help? 3 Mattel Statue Recent Difficutties ay Living Arrangements Relevant Family History & Creda bon f Feelings of - Depression o Education Anxiety Cultural implications [eee cence Religious & Spiritual Suspiciousness: Beliefs/Affiiations Being Overwhelmed Somatic Changes Previous liness: and Hospitalizations Chilahood Growth and Adolescence eco Patterns Brug We E\ Social Patterns - Family ‘S\\ BFrienas Physical, Emotional Sonal Freterence(Practice| of Setual Abuse Interests. Substance Use & Abuee| Family PhysicalJudgment Affect Memory Cognition Orientation BB enierstg Education Consultant icALTERATIONS OF BODY IMAGE IMPACT / SHOCK / DENIA\ Despair Digcouragement Withd a DEPRESSION Insomnia Refusal to participate in self-care Sadness R Refusal to discuss change or lose +Self Esteem Hostile / Irritable GRIEF Normal reaction to loos Regression can and does occur Provide safe environment for : expression of feelings Acceptance and Adaption Common Ini patients who have Active participant in therapy / care experienced mastectomy, ampu- D i Feber aABteatece Aerated CA cna Con ae surgery, or spinal cord injury HG onarsingtarcoton constantALCOHOL WITHDRAWAL DELIRIUM “Delirium Tremens (DTs)” Begin DT9 After Hospitalization, Surgery or Procedure.EAR DROPS ADMINISTRATION Adult Pull ear back and up for Older Children and Adults Pull ear down and back for Infants and Childrent3 yrs. Child OoSTROKE (Brain Attack, CVA) © Headache * Mental Changes ~ Confusion - Disorientation - Memory impairment © Aphasia (,24.¢%,) ete * Resp Probleme (4 Neuromuscular Contrel) # bough / Swallow Reflex * Agnosia (tierctacen) # Incontinence * Seizures * Hemiparesia or Hemiplegia © Emotional Lability * Vigual Changeo (Homorymous Hemiamopsia) * Diplopia, Ptosis, and Lose of Corneal Reflex * Vomiting * Spatial-Ferceptual Defects (CVA Right Hemisphere) * Hypertension * Apraxia (tlearnea Movements) 4 i iDIAGNOSTICS Neuro Exam, CT Sear, MRI ‘Angiography Intea-Artieral Digital Subtraction “Angegrapy (B5A) nocranial Doppler (TCD) iltrasoncaraphy ur, ticox Monitoring SEPNURSING GOALS | * Airway - Oxygenation o$icr * Nutrition + Preserve Function ° Rehabilitation * Safety + Education ‘#Right-Sided Weaknees eAphasia LEFT HEMISPHERE & PUPILLARY ABNORMALITIES] Typically Larger on the Side Opposite the Lesion * Conjugate Deviation (Looks toward lesion) * Homonyrigus Hemisnopsia BZwey e Temporary Vein ae Tiere orsparese ‘Vertigo & Conk * Typeally Last Lees = Hypotonia “® Hypertonia 1 Spatial-Rerceptual Defects, © Aprania © Lose of Voluntary Movement On One Sie eb Neuromusculer Control Reape 2 Swallow - Cough © Bladder - Bowels © Communication Probleme * Emotional Lability impaired Judgement and Memory * Atherosclerosie * Thrombosie * Emboligm * Cerebral Hemorrhage (Tissue DamagerTraura) RIGHT HEMISPHERE *Left-Sided Weakness ° Spatial-Ferceptual Deficita (Vulnerable to Accidents) Bi ottursing Edvcatim ConsultantPARKINSON’S DISEASE © Onget usually gradual, after age 50. (Slowly progressive) * Mask-Like, Blank Expression > * Stooped Fosture © Pill Rolling Tremors 4 * Possible Mental Deterioration * Depression * Has Familial Incidence: More Common in Men * Shuffiing, Propulsive Gait ques ‘@Nureing Education Consultants, lnc.INCREASED INTRACRANIAL PRESSURE © Changes in LOC ¢ Headache = Flattening of Affect "JOrientation & Attention ¢ Seizures "Coma * Impaired Seneory & Motor Function ° Eyes - ; * Fapilledema ¢ Changes in Vital Signs: Cushing’s Triad = Systolic BP “Widering Pulse Freseure” * Pupillary Changes * Impaired Eye Movement: *UPulse ¢ Fosturing * Irregular Resp Pattern " Decerebrate "Decorticate ¢ Vomiting "Flaccia * Not Preceded by Nausea "May be Projectile ° Decreased Motor Function * Changes in Speech = Change in Motor Ability *" Fosturing ©lnfants: ° Bulging Fontanels °Cranial Suture Separation et Head Circumference BBB cturcing Eekication Concuttants, in High Pitched CryINCREASED INTRACRANIAL PRESSURE (IICP) - CUSHING’S TRIAD (Symptoms OF ICP Are Opposite OF Shock) * ICP * * Shock « t Systolic B/P Vere ¥ Pulse t Pulse ‘ Respirations t Respirations(2a scl Scan MRI ‘ * PET, EEG, Angiography) *LiGOx Brain Tissue xygenation Catheter * Transcranial Doppler Studios TP + Evokod Potential Studios \t intracranial Blood Vol. Cerebral Hemorrhage tesr Sale Toxine Cerebral Edema lechomic Cells Dilated Cerebral Arteries PCO “‘Acidotic State # Secondary to Initial Damage # Brain Tumor * Closed Head Injury ured Blood Vessels Ruy os (TTS) holon mange in L * Thrombosis & lechemia uching’s Tad ‘\s Hyarocephalue ° Pupillary Changes ‘y e * Fafledema Fs \cP Monitoring Ventriculostomy) + Cerebral Orggerattion Mon torr (LICOX) 1 Sipertone aire Ve # Medleateg= Osmotic Dretios Corncosterode Artioctaure Drage ‘->Infants_ * Bulging Fontanels * Cranial Suture Separation « THead Circumference * High Pitched Cry * Ingert Urinary i Catheter Avoid Straining ‘Sensory & Motor leacache *Vomizrg TGR Occurs With Tin The Size OF intracranial Contents (pale DR sore Prcesvone © Airway Fatency SF From Ears/Nose? leurov's *FCO2 OK? * Prevent Aspiration "© Hemniation erebral Perfusion * Diabetes Ineipidue * Som-Fowlers Minimum Suctioning § Guice Envkormens, ° Explain Neuro 's During BM * Charge Rosition Slowly * Ventilator? * Provent Eye Damage * ypceurage Fears ROM ¢ Maigean Hoaration ‘Light Sedativea for santa Realty * Presoure Ulcer Prevention sgitation Orientation * Avoid Extreme Hip Flexion * 2 Coughing, Sneezing, or Valesiva Manewer i andioace * Maintain Nutritional Needs - Enteral or Parenteral Feedings Gk te Unconscious « Assess Motor Responses and Movement * Giascow Coma Scale # TSize infant's Head * Work Thru FeelingsFAST RECOGNITION OF A STROKECRANIAL NERVE MNEMONIC S = Sensory Olfactory Optic Oculomotor Trochlear Trigeminal Abducens Facial Acoustic Gloseopharyngeal Vague Nerve Spinal Hypogloseal ZOAA000 BEB onireing Education Coneuttants, ni rrr TO445000 M = Motor On Old Olympus Towering Tope A Finn And German Viewed Some Hops B= Both 3 6 M M B M 5 & B 8 M M Some Say Marry Money But My Brother Says Bad Business Marry MoneyBELL’S PALSY Forehead Not Wrinkled Eyeball Rolls Up Eyelid Does Not Close Flat Nasgolabial Fold Paralysis of Lower Face Etiology: Possible reactivation of herpes vesicles in and around the ear will proceed facial paralysis. Treatment: * Corticosteroids ° Antivirale e Full Recovery by Most Patients in 6 Months, Especially if Treatment is Started ImmediatelyABNORMAL POSTURINGNURSING CARE FOR SPRAINS AND STRAINS R Rest Ice C Compression E ElevationThickened Synovial Al Membranes 4 Inflammation Synovitia| rN Ot Stages Sprannus +> Cartilage Destruction Fibrous —p Fibrous tissue ‘Ankylosia * which evolves into scar tissue «Ayan aa pala 2. ASSESSMENT. NSAIDS, Cox2 Inhibitors * Disease Modifying Antirneumatic Drugs (DMARDs) Af Flaqueni, Methotrexate, Enbrel, Remicade * Heat /Colt Applcacions + Bilateral joint involvement © Detontity roventing Dovicoe + Joint stitfness, pain, limitation of movement # Prysical Therapy * Morning stiffness lasting >thr * Fain increases with movement «@Serum —emm) + Commonly affects joints of hands and fingers Rheumatod Factor # Extraarticular symptoms + Teor ‘Rheumatoid nodules (located on extensor oT C-Reactive Protein surface of joints) Poatthe Antinulear * Sjdigrar's syndrome (decreased tearing, ‘Antibody dry mouth, photosensitivity) **Felty oyndrome (oplenomegaly, blood dyscraciae) BS ohiirsing Education Coeutcant heI can't sit up straight and | got this pillow Doing pretty good — between my legs! can’t crose my legs or stand too long — got to keep JOINT REPLACEMENTS MAIN COURSE me Crrar nee) Nm Knee — CPM, neutral ear DT aCe Cay do not bend hip 7 96° 008 2* post op day Incision careAsoose Extremity For ‘Color ‘T Tolerance To Meds —+ Prevent: Oversedation * LV Rate Avoid CHF fronn pee ue ae - ae Imntblity compicatons " Contractures baat Disorientation ies Seen, Gre Frobleme + Thrombophlebitio Safety —> Side Ralls ana Prevent Falls: Poor Nutrition Constipation - Fluid & eotrolyte Imbalance, Foor Healing Motor Function Pain, Muscle Spas * Circulatory Compromice ¢ Infection immobility Complications * Embol Delayed Union - Non Union # Avazcular at Emcolism Necrosis ‘Nerve and Vascular Injury TAge + Treat cooxisting medical cisorcers Cardiac problems Peripheral Vascular Disease Neurologic disorders TFemale Buckle Tractipn SiMe ose to Relieve Spasmo Para * Presence up t0 24-48 Hours TaN] Wsiian Revcvon Charge Chronic Condition Depend itor 42 Hrs nad Nici Sos coraiaan & ame + Use Asdtion Pilon Beowoon Leg ¢ Tat, Muscle Spagme, Tolge Steep Benue Acted Leg onortaned oe ‘» Adduction of Affected Leg Sutyery = Exercice When OF Estemal Rotation v * Ghent teaching, Self Care Fremenion * Deformity Along Lateral ental Foation # Avoid Extreme Hip Flexion pace, pera ins - Screws - Plates) + Prevent External Rotation is Displaces Prosthctice, ate ae + Ecchymosio HG Ovirsing Education Conoltanta neZOrAQNFAH CARE OF PATIENT IN TRACTION Extremit Temperature 2 Infection Ropes Hang Freely Alignment Circulation Check (5 F’s) Type & Location of Fracture Increase Fluid Intake Overhead Trapeze No Weights On Pea Or Floorfe. 134 oe eS %. CARE OF ys Rs eo © * Elevate Residual Limb The First 24 Hre * Prevent Contracture Of * Promote Good The Joint Avove Amputation Circulation * Discuss Phantom Limb Pain In Extremity * Analgesics * Promote Comfort * Evaluate Healing * Compression Dressing To Prevent Edema * Discourage Semi-Fower’s Position In Patient With AKA To Prevent PATIENTS WITH Contractures Of The Hip * Observe For La AMPUTATIONS gS "29+ Aosese For Skin Breakdown * Wash, Rinse & Dry Residual Limb Daily 2 * Do Not Apply Anything To Residual Lim KO AlcoholmempDries Lotions Skin Too Som oy) * Encourage Patient To Wear Prosthesis When He Gets Up & All Day To Prevent Residual Limb Swelling «Teach Patient that Leather and Metal Farts of Prosthesis | Should Not Get Wet * Promote Optimum Level of MobilityTRACHEAL - ESOPHAGEAL FISTULA (3C*) C- Choking C- Coughing C ° Cyanosis BB ottreing Education Conouttant inSTAGES OF LABOR (Stage of Cervical Dilation) Begins with onset of regular contractions and ends with complete dilation Latent—> Active—> Transitional -Firet Stage - en) (ee (Stage of Expulsion) Begins with complete cervical dilation and ende with delivery of fetus. y - Second Stage - (Placental Stage) Begins immediately after fetus ie born and ende when the placenta io delivered. - Third Stage - (Maternal Homeostatic Stabilization Stage) Beging after the delivery of the placenta and continues for one to four hours after delivery. = Fourth Stage -PRENATAL CARE Presum Foriods N&V Sears Urination Breast Changes Quickening Probable OPG Tet Enlarged Abdomen Hegar's Sign Softening of Uterus Chadwick's Sign Bluish Vagina Goodel's Sign Softening of the Cervical Lip Ballottement - Fetus Rebounds Braxton-Hicks Contractions Fositive FHR Fetal Movement ~Visible + Felt By Examiner Fetal Sonography RH@or . VORURPR CBC UA Hepatitis B Screen 18. Skin Teot HY Screen Glucose Screening Lab Test? | 7-10 Days After Conception Radloreceptor Asoay (RRA) Radioimmunoassay (RIA) Enzyme Linkes Immunosorbent Aeeay (ELISA) History & Physical Ciaiiais > x Obstetric History Schedule Prenatal Visits Vitals Fara’ Gravida uA Weight: L G Height of Fundus FHRPOSTPARTUM ASSESSMENT Mev» c Breasts Uterus Bowels Bladder Lochia Episiotomy/Laceration/ C-Section IncisionPHYSIOLOGIC CHANGES Sesisttnsiiti Ta ee cca *T Need for H.0- os * Tidal Volume ites IN PREGNANCY ‘Meg Sten" fh # T Lumbosacral Curve * Altered Center of Gravity © Duck Wading Gait. #1 Breast Size * Heaviness, Tingling * Darkening of Nipple * Colostrum { Blood Volume ~ 40-50% * THR 10-19 beateimn #1 Cardiac Palpitations + Slight @BEnurgerent * Murmurs Pregnancy GingMile * Poeuscanomia tae ~ Ptyaliom Gastric Keidiny NY, Heartburn # [Tone & Motilty of Smooth Muscles lcmorrhcide & Constipation Lemptying of the gallbladcer Estrogen Influence ‘# Smooth Muscle Hypertrophy lyperplasia of Lining hick White Secretion ~ Loukorrh: ecrequerey *T Biba tone 1 [Reval noshold for Sugar 2 Glomerular eteraton ‘arical Sottering ~ Goodall's Sign Mucus Piug Color of Mucosa © T Skin Pigmentation Facial Mask — Chioaoma re Vulgario ty Bonel Metabolc Rate ermatitis fascular Spider Novi TFacachyroia Actiy © ABD - Stretch Marke ~ Striae Gravidsrum Linea Nigra Produces FEM, LM, Thyrotropin Aarenoseopin & Prolactin @Nursig EAication Consultants, ncNON-STRESS TEST 3 Negatives in a row to interpret results of non-stress test N Non-Reactive N Non-Stress is N Not Good BH eisring Education Conetantn aHE ary t ge Sleeps 16-20 hours a day the first 2 weeks, General Characterietice: ree ff W810 52cm ae Circulatory System: Blood Aow from uel vessels & plecenta stops Clogure OF at orth fe Ductus Arterceus SFeramen Ovele * » Dictus Venza. + Pulmonary Circulation ransitory Murmurs Hands & Fact = Ph ectee res: 6 Heat Rate 120 10160 Beataltin RO? \ Sj Temp Heat Loss Due To: Evaporatior Persie from ont ign Lung Maturation <" 26th Week Gectation Convection - Body heat to cool air flow. Pe de uatocten Rak Conduction - Body heat to blankets, atc. Aelia 38th Weok Gestation Radiation - Heat lose to cool temps, © Reap fore «| 02 Consumption t Utilization of Glucose (Hypoglycemia < 45mgis) ‘& Brown Fat Need for Calories tRivk Metabolic Acidosio 1 Surfactant Production e 3.400 grams (Average) or Tle. Bor: Usually to 10% wt, lose tot fow days. Regained within 10-14 days ieadt > Molding 3 Elongated as Caput Succedaneum>Edema > Measurement >33,cm. to 35 om (15-14 in.). Circumference x (ised w2to em than oo) > Fontanels » Bulging? or Sunker? Extremes in Size May Indicate mi Microcephaly, Hydrocephaly or ICF_ 9 * Umbilical Cord = 2 Arteries & 1 Vein Obeain cord blood sample ery oom. Lung Function after BS onersng eacation consitanta in Within the Tet minute of birch “lous Busty Cry “Ne Byspnea 26 Retlactlons Roep Rate 30-60 / Min Kaphragmatic & Abcominal Muscle ised lose BreathorSS HIGH RISK NEWBORN TEMPERATURE NURSING INTERVE} ITIONS BR Minimize Cold Stress. ! PK Maintain Skin Temp. 36.1°- 36.7°C (96.8°-97.7°F) Continuously Monitor Ternp, We Prevent Rapid Warming or Cooling Pe Use A Cap To Prevent Heat Loss From Head. RESP FUNCTION ¥ Position T 02 - Semiprone/Side Lying. Maintain Resp Tract Fatency. ee ee We Stimulate > Remind to Breathe. 4K Monitor For Hypoglycemia. $ Monitor O2 Therapy. # Assess Tolerance Of Oral Or Tube Feedings. $® Access Resp Effort. $#X Monitor Hydration Closely. © Grunting WE Assess For Gastric Residual, Bowel Sounds, * Nasal Flaring Change In Stool Pattern, Abdominal Girth. * Cyanosis Monitor Weight Gain Or Loss. © Apnea iri Eascaton Conon isHELLP Syndrome (Preeclampsia with Liver Involvement) Hemolysis Elevated Liver Function Tests Low Platelet CountEVALUATION OF EPISIOTOMY HEALING Redness Edema Ecchymosis Discharge, Drainage >UMMA ApproximationDEVELOPMENTAL DYSPLASIA OF THE HIP lAsymetrical gluteal and thigh folds. Affected side) Shortening of leg. on Conoutantes he FB owThreatened + inevitable * Incomplete * Complete ° Miseed AB + Recurrent Control Hemorrhage Vaginal Bleeding or Concealed Hemorrhage Painese Bright Red Bleeding During Mild to Severe 28 &3" Trimester Abdominal Pain Has Presumptwe Signe: Of Pregnancy High hCG levels Passage of Vesicles Fiyperemesio Gravidarur Kaa) s Proteinuria TBP i> Faeries. ‘Aniniotic Fluid Index (AFI) >24-25om Watch Galt Intske Develops 3” Trimester in Diabetica 180 Complications — Abruptio Placenta, Fost Partal HemorrhageCLEFT LIP - POST OP CARE C Choking L Lie on Back E Evaluate Airway F Feed Slowly T Teaching L Larger Nipple Opening ; I Incidence t Males P Prevent Crust Formation Prevent Aspiration BEB on uroing eaicotion concuivants, ineASSESSMENT TESTS FOR FETAL WELL-BEING * BIOPHYSICAL PROFILE * Choice for Follow Up Fetal Evaluations Fetal Breathing Movements - 4 episode of 30 2ec, in 3O min B. Fetal Tone - At leaet | epicode of extremity extension and flexion C. Body Mavemert - 3 episodes over 30 min BIOPHYSICAL TESTS * Daily Fetal Movement: Count: (DFMC) * Ultrazongraphy * Biophysical Frofile (BP?) D. Amniotic Fluid Volume - MRI At least 1 pocket measure 20m BIOCHEMICAL TESTS in 2 perpendicular planes E. Non-Strese Test - Reactive - FHR T with activity. Each hae a possible score of 2 Max Score =10 ©) * Amniocentesio * Chorionic Villus Sampling (CVS) * Percutaneous Umbilical Blood Sampling (FUBS) ‘* Maternal Serum Alpha-Fetoprotein (MSAFP) © Indirect Coombs Test Nursing Education Conuitants IneHEPATITIS A & E Hepatitis with avowel... Comes from the bowel.Fil onursing Education Concur in HEPATIC ENCEPHALOPATHY HEPATIC COMA @ Changes in LOC * Progressive Confusion * Stuporous os © Impaired Thinking & Judgment Se Neuromuscular Disturbances eAsterixis _,, “Liver Flap” 8 Hyperreflexia “ ¢ Fetor Hepaticus Problem Td By: * Constipation e * Infection Treatment * Administer Vancomycin * Hypovolemia & Lactulose * Hypokalemia (LK) Aa a ates * Gl Bleeding © Promote Diet Tin © Ovioi Carbohydrates Opioid Meds & Adequate FluideCIRRHOSIS: LATER CLINICAL MANIFESTATIONS |_ Changes in Mental Responsiveness & Memory Jaundice Spider Angiomas Face - Neck - Shoulders Esophageal Varices Anemia, Leukopenia —— Thrombocytopenia Coagulation Disorders iN Super heial Veins Visible In Abdominal Wall “Caput Medueae” Palmar Erythema Ascites Hepatomegaly Splenomegaly Sexual Characteristics Changes Gynecomastia Hirsutism Edema Feripheral Neuropathy BEB ONursing Education Consultants, Inc. FI ueeCHOLECYSTITIS Jaundice Fever & Leukocytosis Nausea & Vomiting Anorexia Pain @ Right Upper Quad . . . oF Right Shdulder Abdominal Distention * May Radiate To Back wleraaseein Dae Feeling of Fullness Breath Fat Intolerance CMe @tising EAcaton Constr InPREVENTION OF INFECTION + Safe Injection Practices * Use a Single Dose Syringe re and Needle 1 Time and Discard * Do NOT Recap a * Hand Needle Hygiene * Discard in Sharpe Container . We *DoNOT Force a covet Syringe into Barriere a Full Sharps (28 Wdicaved) Container ip ° Give © Mas! * Do NOT Place a Syringe and Needle — © Eye Shield ‘own in your pocket on bedside table * Consider ALL Body Fluids to be Contaminated. AD J ona meal tray % Clean Up Spills of Body Fluids Immediately, * Avoid Contaminating Then Cleanse Area with the Outside of Germicidal Solution. nursing Education Consultant, ine Specimen Containers.INFECTIOUS MONONUCLEOSIS “Mono” Known ae thi « Fatigue, Decreased Energy * Sore Throat (severe) * Tonsil Enlarged and Reddened — ote “es wise gt Transmission: Most common in young people 425 yrs old Predominantly tranemitted via ealiva, ° Headache ° Fever « Treatment: - Rest - Throat Soothing Measures Cause: Epstein Barr Virus (EBV) © Skin Rash © Swollen Lymph Glands © Fain in LUQ— Splenomegaly * Loss of Appetite - Low Energy / |mpact Activity - Gradual TActivity - Course is Self-limiting - Acetaminophen / Ibuprofen FEB oNrina Education Concuranta heHUMAN IMMUNODEFICIENCY VIRUS (HIV) INFECTION Transmisei Stealer pexual intercourse Early Chronic Infection © Cortact with Blood and Blood Praducts ‘* HIV infection to development of ‘AIDS ~ average M1 years *# Symptom ~ fatigue, headache, lymphadenopathy, low grade fever «© Normal CD4* Cell count *thoreased infections Intermediate Chronic Infection '* CD4* T-Cell court b 260-600 cello ‘Increased viral load ‘Perinatal - during pregnancy, delvery, or breastfeeding Sereening * Enzyme inmuncassay (EIA) at 3 wks, 6 wis, mo after exposure “= Rapid HIV Anbody Testing ~ tests for antigens, not antibodies, if positive, nead follow-up with EIA, andlor Antibody/Antigen teot ‘Seroconversion — development of HIV specific antibodies * Window Period ~ may be 2 months between infection ara detection of antboaies (CHV positive) Acquited Immunodeficiency Disease ‘Syndrome — (AIDS) presence of at least: one or more: © D4 Teall count 4 200 caloful (compromised immune syoters) * Opportunistic infections — Fungal ~ Candiaiasie, Preumocystisfroveci preumoria (PCP) Viral ~ Gytomagalovirus (CMY) Bacterial ~ Mycobacterium tuberculesis, pneumonia Protazoal — Toxoplasmosis of brain, intestine Cancer ‘Increased infection, earlier symptoms more severe Late Chronic infection | "= Diagnose of AIDS Treatment: ‘© Antiretroviral therapy (ART) begins with confirmation of HIV Goal Decrease viral load © Maintain of t CD4° T-Cell count: * Delay onset of HIV related Invasive conical pt ‘symptoms Kaposi's sarcoma = eae * Prevent or delay opportunistic Lymphoma Y RP eye infections ‘© Wasting Syndrome © AIDS Dementia Complex. TES on urcing eavcavion ConsultantsBLOOD TRANSFUSION REACTION Febrl i Hemolytic Transfusion *Chille * Fever * Headache Reaction: * Flushing © Tachycardia *T Anxiety + TAnxiety + Low Back Fain + Hypotension * Tachycardia + Fever and Chills Allergi jon: ld: * Hives ¢ Fruritus * Facial Fluehing + Chest Fain Severe: * Tachypnea * Shortness + Hemogiobinuria of Breath + May Have Immediate Onset * Bronchospasm © Anxiety ge Nursing Implications: * Stop Transfusion and notify Physician «Change IV tubing at hub and begin NS + Treat symptoms if present 02, fluids, epinephrine * Check vital signs every 15 minutes * Recheck crossmatch record with unit and send blood bag/tubing to the lab * Obtain blood sample * Obtain urine sample for hemoglobinuria * Monitor fluid/electrolyte balance + Evaluate serum calcium levelo THB ovursing Eascation Comouttanta, te.BLOOD ADMINISTRATION * Determine Fatient’e * Allergies + Check Crossmatch © Previous Transfusion Record With Reactione 2 Nurses: *AB0-Group ss m 5 © 8H Type % Administer Within 30 Minutes of SR aaa Receiving From Blood Bank 1D Blood Bana * Hospital # * Expiration Date * Do NOT Warm Unless * Never Add ANY Meds to Blood Products Risk of Hypothermic Response THEN Only By Specific * Verify Patient’ Blood Warming Equipment. ° Check she D's Order * Check labels on blood bag & 4% Infuse Each Unit Over blood bank transfusion record 2-4 Hours BUT * Baseline vitals - (Then per policy) No Longer Than 4 Houre * #18G or #20G gauge needle Normal saline IV solution * Blood administration set with filter * Severe reactions most likely first 15 min & first 50ce * Blood tubing shauld be changed after 4 hours SUN a cli CSeaacg€tlureing Education Consultant, inc,- Pain Over Area - Presence of a Cause - Abdominal Guarding - Abd Distention - Fever (>100 °F) ~ Anoreria “N&V - TPulse ater - }Bowel Sounds Z - Dehydration ~ Shock Feritoneal Aspiration 0d Feritoneoscopy Ultracound Identify Cause Antibiotics & Antiemetics IV Fluids 5 JAbad Distention he. ass, Surgery to Close Electrolyte Replacement Ferforation Feristalsis->¢ Bowel Sounds 1&0 'S & S Dehydration - Hypovolemia with Knees Flexed Quiet Environment.PEPTIC ULCER DISEASE (PUD ~ 7h, “S, wn >. © Streed +H. pylori * Alcohol * Weight Loss © Smoking ‘© Acid - Normal or * Gastritie Hyposecretion © Pain Ye - 1 hr After Meals * Vomiting * Eating may — * Most Common reo * Well Nourished Shock | * Fain 2-SHre Cushina’s ve Brain After Meals g * Food May 4 Fain Murcia Eevoation Consultants IneCROHN’S DISEASE * Occurs Teens to Mid-30s © Second Feak After Age GO © @ Autoimmune Factors * Nausea & Vomiting * Severe Diarrhea * Low Grade Fever * Infrequent Rectal Bleeding ° Weight Loss * Severe Malabsorption © Abdominal Fain and Distention © Tenderness in RLQ * Complications * © Ferineal Abscesseo * Intestinal Fistulas « Feritonitio * Later S & S's * Hypoxia 3 * Rapid, Shallow * Drowsiness, Dizziness, i Respirations Disorientation : el BP * Muscle Weakness, j Hyperreflexia 2 © Skin/Mucoga Pale to ° Causes: 2 Syanorl’ f AD\ Respiratory Depression E (Anesthesia, * Headache Overdose, tICP) , Airway Obstruction * Hyperkalemia +Alveolar Capillary Diffusion (Pheumonia, . COPD, ARDS, PE) © Dysrhythmias 1 (Tk)METABOLIC ALKALOSIS * Confusion * Dizzy, T Irritability ¢ Dysrhythmias N , Vomiting, (Tachycardia from +K*) ane Diarrhea * Compensatory Hypoventilation © TAnxiety, Seizures ° Cgulece HCOs (Antacids, _ Le © Tremors, Muscle Cramps, bicarbonate) Tingling of Fingers & Toes SH (NG Suctioning, (tserum Ca**) Prolonged Vomiting, Hypercortigolism) HB ones tsscaton ConstanceMETABOLIC ACIDOSIS © Headache « tMuscle Tone, 4Reflexes (Confusion, TDroweiness) «LBP ¢ Hyperkalemia * Kussmaul ‘P Respirations ‘Compensatory ) * Muscle Twitching Hoporertl att ¢ Causes: ° Warm THY Producti s Too much H*(acid) hE Flushed Too little Bicarb Geeaston a iryetabollom) +H Elimination (Vasodilation) (renal failure) HCO. Production (dehydration, liver * Nausea, ¥ailure) Vomiting THCOs Elimination (diarrhea, fistulas) BE or rsingEaicaton Constance@hrsng Education Concent, a Adapted from Dolores Graceffa, RN, MSACID BASE MNEMONIC B#e ep (ROME) Respiratory Opposite pH t PCO, 1 Alkalosis pH | PCO; ft Acidosis Metabolic Equal pH t HCO, F Alkalosis pH | HCO, | AcidosisTRIANGLE OF DIABETES MANAGEMENT EXERCISE Glucose Monitoring MEDICATION ~ DIETMETABOLIC SYNDROME - SYNDROME X Avoid the X Factor Leads to: Diabetes, Stroke and Heart Disease. Fasting BS 2110 mg/l or on Diabetic Medo fen E 6 Os. BMI > 25 Kain (Body Mage Index) IBW t 20% (Ideal Body Weight) Taking Lipid Medication Triglycerides > 150 mg/al HDL < 40 mg/dl" HDL < 35 ma/alQHYPOTHYROIDISM Intolerance to Cold Receding Hairline Facial & Eyelid Edema 7 Dull-Blank Expression Hair Li ? eatin Generalized Edema pay Thick Tongue - Lethargy/Fatigue } Slow Speech Dry Skin . ia Anorexia {Carnes Brittle Naile Muscle Aches & Hair & Weakness Constipation Menstrual Disturbances Late Clinical Manifestations Subniormal Temp Bradycardia Weight Gain +Loc Thickened Skin Cardiac ComplicationsUmMma--aA HYPOGLYCEMIA Tachycardia Irritable Restless Excessive Hunger Diaphoresis DepressionHYPERTHYROIDISM Bulging Eyeg® AS Fine, Straight Hair a Dyspnea on Exertion f a Weight Loss Muscle Wasting Menstrual Changes (Amenorrhea)DIABETES MELLITUS - TYPE 1 SIGNS & SYMPTOMS: Polyuria Urination Polydipsia Mhirst Polyphagia Hunger FW ontursing education Consultants, inc. © Weight Loss ° Fatigue of Frequency of Infections ¢ Rapid Onset elnsulin == Dependent ° Familial Tendency ° Feak Incidence From 10 to 15 Years+ B noun Produced ; © Most Often Before Age 15 . eeutncene neale eaiewa © Was Called Juvenile Diabet * Ketoacidosia Not Common Pads iagebandes + Adults p40 Most Ofzen «Familial & Lifelong * Was Called Adult Onset Diabetes 1 Je Familial xs z Se + May Need —S== Insulin Gestational + Dug Pregnancy * Goes Anay 5 Pregnancy ‘May Noe Reaceur May Have Big, Baby Trick or poz Mature Onset. * Impalred Insulin Production + Keteacidosia Not Common Diabetes of” S Strong Family 1X of ype 2 the Young (MODY) * Game Characteriotlce ae Type 2 “Lor @ Insulin” Secretion Type 1 & 2 aie \yphagia Reps Insulin Folyuria = Hypoaticeria Fatigue * Semogyi Eft porty Contra * Allergic Reaction Diabetes _ Wet WE. * Diabet Ketonciaosi (Tye 1) Eye Probims = Wh 4 nyse revere = Slow Qnoet a ee Ng -hetotic Coma ("ype : Flu & Eectro¥te Imbalance ; Rapid Onset Long Term * Angiopatiy Sutin G2 126 mg/al contiemed by repeat “ferret Vaccine Gpliraen —«PRGRRE pia rr sa + Retinopathy Diet ual oF cose & 200 mala + eymy * Nephropathy insulin Need with t Exercise a i 6 RR RE EOLA REE * Neuropathy 4Glucose Fluctuation wo he ‘glicose 2 200 mafal during * Infections Oral Glucose Tolerance Test (OG™) | eNersin Education Conatant in SeaDIABETES INSIPIDUS (DI (ve Se @& , BE decrease the ies or Pruteary ‘Bianiatony in mor fark 5 1 2 Central DI (neurogenic) Treatment: Vasopressin DDAVPCUSHING’S SYNDROME Corticosteroid Excess Personality Changes Hyperalycemia Moon Face CNS Irritability T Susceptibility . ; to Infection NA* & Fluid Retention (Edema) Thin Extremities Males: eneconaetl/ 4 Fat Deposits on Face | and Back of Stovaen f/ Gl Distress -TAcid Amenorrhea, Hireutism | Thin Skin +— Purple Striae Bruises & Fetechiae Osteoporosis FB ONervirg Eavcation Corman neBLOOD SUGAR MNEMONIC HOT & DRY = SUGAR HIGH COLD & CLAMMY = NEED SOME CANDY FB onsrsing Education Consultants IeADRENAL GLAND HORMONES S Sugar (Glucocorticoids) S Salt (Mineralcorticoids) S Sex (Androgens) BiB 6rursngEaiction ConnitaraADDISON’S DISEASE Adrenocortical Insufficiency Depression Bronze ep Pigmentation of Skin. — Hypoglycemia a 2)— Fostural Tachycardia Hypotension G| Disturbances — Weight Loss, Weakness, Anorexia Fatique Adrenal Crisis: Profound Fatigue Dehydration Vascular Collapse (HBP) Serum NA* TSerum KY eere RVISORY COM ag MAND oeSTEPS IN THE NURSING PROCESS A Delicious PIE: AnApple PIE: Assessment Assessment Diagnosis Analysio Planning Planning Amplementation Implementation Evaluation EvaluationPRE OP CHECKLIST DAY OF SURGERY Wo Hospital Gown W Allergy Band 7 \D Bana o Preoperative Education Completed wv Informed Consent Signed NPO — Bowel Pr A NPO- Bowel Prep wv Dentures, Eyeglasseo, Hearing Aids, Contacts — Wo Skin Prep - Shower Left in Place or Removed or Bath in Anti- | microbial Soap ov Makeup and Nail Polish Removed a Documentation / Checklist of W Vital Signs Before Tranafer Valuable ona w Fre Op Lab Work on Chart S Woided orto'tiansior Surgeon Notified of Abnormal Values vo Medications wv Pre Op Meds — Given and Charted History MAR on Chart W Side Ralls After Pre Op EHR/EMR up-to-date Bed in Low Position Fgh Alert Meds Noted Nursing Education Conaurtants In.u e jf o 2 é eo S. ° xo te t o oe | Ms ah oad V6 94 Hee Early Ambulation WFluid 8 Rate Adequate Hydration Electrolytes GI Drainage Renal Function ‘ Lab Values Nutrition & A "Olaesicg Antiemetics soe "um. ce a Sug gf 4% 20 0h rey, Oh gf & ei Reapiratory 5, é S piratory Din, Function Ba, Bowel Sounds Check NFO Status NG Tube? Encourage Fluids ‘Assess Fluld Tolerance Progressive Diet Monitor for Flatue or BM Assess Output ey o “a BB rong Eaacation Conca Ic+ Should Vola Within G-6 Hre Foot Op *Falpable Bladder «Frequent, Small Amount icing *Pain Suprapubic Area chennai hohe Fever * Wet Breath Sounds * Asymmetrical Chest Movement: * Productive Cough * Hypoxia Tachycardia * Leukoaytosis eco "Redness +Vosre + Chest Fain ee +Purulent Drainage + Dyspnea + Weak Pulse se + TResp Rate "Cool Clammy “Tachycardia Tachycardia “Reotlese *Leukoeytosis “tAriety "TBlecing Diaphoresio + Thirst + sOrientation — te “Blood Gas Changes *Separation of Incision + Evidence of Bowel Through Incision + Tain + Nausea & Vorniting * Abd Distention RESPIRATORY a “No Stool or Flatue 10. Sate & 420, “Nausea *4Breath Sounds “Yomiting + Asymmetrical Chest Movement *Abd Distention + Tachycardia * Abd Tenderness + TRestlessneso lurcing Eaucoton Consultants icEvaluate Reet General Assesoment ‘Affective Behavior Yerval Behavior BP & Reopirations Ariety Nursing DX Alteration in comfort: Fear Plan ———> Implement Cutaneous Stimulation i Distraction Relaxation Techniques z beaes** * Rel = ean” Nursing Education GonoultantaGhroric heath probleme Age Currentdriae © Weight Allergies Suacaltceiwes interview Cone Sat Catheterization ‘Religion Significant others Faychological needs 3. Medications Nursing Avseoement Lab studies Injections Infusions Dressing changes rine patient nfo 2. Evaluate paviert's +e Breathing Wao Dr. gues patient explanation jarring Uereiepeters stared by: De, Patient & Witness Fain Meds bir? agile (Nurse may witness) * Equipment 4. Dont overstelm. Signed prior to Pre-Op med «NFO Policy NB baeive any remains permaners part | gy Wachart # Leg Exercises ape @Nursing Education Coeattants, incMASLOW’S HIEARCHY OF BASIC HUMAN NEEDS | feel on top of the world , fed and a a rested ~ | = 3 ESvS Respiratory Status Assessment [ Color Fluid Intake Special Equipment. Dressing ide King Position Airway until gag refiex OK Fosition rep runcton ‘Suction (PRN) Cough/Deep Breathe 02& O2Gats neato ? Mechanical Support re “ereath Soundk" Prevent. Aspiration Speak Caimly Oren cia Fluid Status Quiet Atmosphere sychological Li Body Alignment Equilibrium Blood Loss? Explain Actions, W Rave Last to Go ber iste ks 4 Electrolyte Levels Awake Patient returns: Hydration Dressings OF +o room if: neiolonal Area Branage = Drainage? NG Tube x = Record output’ Nav? erasing Eciceton Coneutarta nc. from drainsDEHISCENCE / EVISCERATION Dehigcence Separation or splitting open of layers of a surgical wound Evisceration Extrusion of viscera or intestine through a surgical wound TB on eringEavcaton Cooutonta be,Informed consent signed Record vital signs prior to transfer Remove jewelry and valuables Remove nail polish arid makeup Dentures, eye glasses, heating aide — removed or left in place? NFO - tine patient began Bath/shower in antimicrobial soap Family aware of surgical waiting area ive teachin — Appropriate to developmental age ~ Preoperative routines Belamrenen tren conser orm len pryical preparation = cttoceNEO Discuss procedures immediately prior to Sanopbrt and wat co peck WOR —Fostoperative routines Reeplratory care ~ coughing, turning Leg exercises to increase venous return ‘Activity ~ out of bed, ambulation Pain control Fluids and nutrition Nursing Considerations General cit ag y ev azz & ‘Geren nal —Resmsemoreo pont or rag Concer = ends ier ~ Protect area of Learsation Respiratory depression & ~ Monitor return of sensation Patent airway Vomiina, prevent aepration Rotum of consciousness Hydration ta prevent $B Urinary output BiB ovine cascaton conse eCHARTING BODY FLUIDS “Coach” C Consistency Ti: How The Fatient is Tolerating It.CARE OF THE CHRONICALLY ILL CHILD 3X Decline in mortality rate increases in number of children with special health care needs. rn F hile’ ( Maximize independence while minimizing ‘Pr Fecue on chide elie AN atsooa oR age. $x Family Centered Care: ‘Aseeoe family response to lncoe Involve famiy in care asi fay procs ‘arowen ard develogman Y Promote, Maintain, or Restore Health. ¢ Most Common Chronic Childhood Conditions — 2 1, Reapiratory (Asthma) aa ip 2. Specch and Bensory 5 impairments jrinne da actuate 3, Merital and Nervous $< Hospitalization — Baie Wer aNde card tr ae ares ers & maintain routines * Respect family's expertise in care of child * Be attentive to parents’ or caregiver's input are conferences for planning & eharing mutual concerns ‘# Encourage independence and self-care Nursing Education Conoutants, neRIGHT SIDED® FAILURE (Cor Pulmonale) © May be secondary to chronic pulmonary ° Fatigue a problems (COPD) eT Feripheral Venous Pressure Distended Jugular i Veing ° Ascites © Anorexia & Complaints of © Enlarged p Liver & Spleen Gl Distress (Hepatosplenomegaly) § WelgntiGain * Dependent Edema tsa eanseniconucwasi ncPRELOAD AND AFTERLOAD Afterload: Resistance left ventricle must overcome to circulate blood Pressure from volume of blood in ventricles at end of diastole (end diastolic pressure) Increased in: Increased in: Hypertension Hypervolermia Vasoconstriction Regurgitation of cyiten TAfterload = cardiac valves Heart Failure fT Cardiac workload FB onsrving Caicaton on- Reduces number of pathogens - Referred to as “Clean technique” - Used in administration of: Medications Enemas Tube feedings Daily hygiene Hand Hygiene is number 4 MEDICAL ASEPSIS~ - Eliminates all pathogens - Referred to as “Oterile technique” - Used in: Dressing changes Catheterizations Surgical Procedures SURGICAL ASEPSIS- MYOCARDIAL INFARCTION (MI) - - CORONARY OCCLUSION - - Pain: - - eS udelan Onset HEART ATIACK Substernal Crushing Tightness Severe Unrelieved by Nitro May Radiate To: Back Neck Jaw/Tooth = Dyspnea Shoulder - Syncope (LBP) Arm - Nausea - Vomiting - Extreme Weakness THO, IV Meds - Diaphoresis Monitor ~ Denial is Dietary Restrictions Common a INA‘ Cholesterol, -T Pulse " 1 Caffeine PCI? Surgery? Pacemaker? ~ Changes in ST segmentLEFT SIDED Y FAILURE * Paroxysmal Nocturnal Dyspnea Qa © Restlessness * Elevated Pulmonary as - Capillary Wedge wa > * Confusion Pressure * Orthopnea * Pulmonary Congestion - Cough 3 * Tachycardia - Crackles - Wheezes Exertional - Blood-Tinged Dyspnea Sputum * Fatigue ~ Tachypnea © CyanosisLDL/HDL Want LOW (J 100mg/al) = or it will lower you into the ground. Low Deneity Liproprotein Want HIGH (fT 40mg/dl) = for patient to feel healthy. High Deneity Liproprotein BEB orurcing eavcoron conounante neTo Calculate Heart Rate: Count the number of “R” waves in 6 seconds. (6 large blocks X's 10 = 1 min rate) = Wwe@ peretie MHEMONE W_DEFECTS MNEMONICCONGENITAL® DEFECTS 4Pulmonary Blood Flow lam doing the Cyanotic Squat. Example: Tetralogy of Fallot Tricuspid Atresia Squatting Cyanosis Clubbing Syncope cation Coneutant, beCONGENITALW DEFECTS Tt Pulmonary Blood Flow hot blue, just. O (tired all the Example: Patent Ductus Arteriosus (PDA) Atrial Septal Defect (ASD) Ventricular Septal Defect (VSD) * T Fatigue * Murmur * TRisk Endocarditis * CHF * Growth Retardation BRS ote rsing Faction Constants,CONGENITAL & DEFECT SYMPTOMS eT Pulse @ T Respirations wy Retarded Growth Dyspnea, Orthopnea Y Fatigue ¥uRICARDIAC ELECTROPHYSIOLOGY ‘ORS ~, | |COMPLEX Se of rhc Conduction of impulee through the bundle oF HiS to Purkinje fiers causingAUSCULTATING “ttle alrone HEART SOUNDS \7Z APE Tricuspid — FO verte —Mla nNDose Ordered Oty of Sol = Dose on Hana YF Sel Maximum safe dose based on child's weight = Sate dose / Kg x Child's wt, in Kg ‘Amt, to infuse Hour rate Amt to infuee Dene inher el A oe Infusion time i = # of hours Total mle ‘xe Minutes mi / Hour. ae = mi oo rnin = mil xgtt factor =gt /pnin BRB onroing Education Conauitanta ncCan the patient follow directions? Can the patlent swallow? (intothe Blood) __ (Just below skin) ume ad) teem? Pe TB Testing Inritatin Rectal 9 gP Locals Se ner Sublingual Sassi, Nacal Eyes Ears * Medication * Dose To Prove Leaking Pe Administer only = paso weal ee Stang of hem Pe Be familiar Desires response HO OF) seromay Su0-O Tleoue + Route with med or Nepitaers ieou i copa Fla ites F Document: mede ety precautions ee P evaluate ec totlen’s condzion cuppostones ed compat array S ° ee y Aileralee * Aseptic technique * Hand hygiene after removing gloves & between patients Emulelone Spine ’o Review med administration if seus Glient is to do by himself oEhere * ugpnsonsHEPARIN & COUMADIN LAB TESTS HEPARIN + PTT = 10 LETTERS COUMADIN + PT = 10 LETTERS Wow, this is a good way to remember which lab goes with which medication.ATROPINE OVERDOSE Hot as a Hare (decreased sweating = temperature) Mad asa taro Fe (confusion, delirium) Red as a Beet (flushed face) Dry as a Bone (decreased secretions, thirsty)