Theoretical Foundations Bullets

8/3/2019 Theoretical Foundations Bullets

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STOP/DELAY ABSORPTION W/STOP/DELAY ABSORPTION W/ WATER/MILK/ACTIVATED CHARCOALWATER/MILK/ACTIVATED CHARCOAL

CONTRAINDICATIONS OF IPECAC /CONTRAINDICATIONS OF IPECAC / INDUCTION OF VOMITINGINDUCTION OF VOMITING

SEIZURESEIZURE

SUBNORMAL LOC AND GAG REFLEXSUBNORMAL LOC AND GAG REFLEX

SUBSTANCE CORROSIVE/PETROLEUMSUBSTANCE CORROSIVE/PETROLEUM DISTILATEDISTILATESHOCK-SEVERESHOCK-SEVERE

DISASTER PLANNINGDISASTER PLANNING

TRIAGE-GREATEST GOOD FOR THETRIAGE-GREATEST GOOD FOR THE GREATEST NUMBER OF PEOPLEGREATEST NUMBER OF PEOPLE

PRINCIPLES- ABCD , MASLOWSPRINCIPLES- ABCD , MASLOWS

RED-UNSTABLE – IMMEDIATE CARERED-UNSTABLE – IMMEDIATE CARE

YELLOW- STABLE – CAN WAIT 30-60 MINYELLOW- STABLE – CAN WAIT 30-60 MIN

GREEN –STABLE- CAN WAIT LONGERGREEN –STABLE- CAN WAIT LONGER

BLACK- UNSTABLE – FATAL, LAST SEENBLACK- UNSTABLE – FATAL, LAST SEEN

DOA – SUPPORTIVE COMFORT MEASURESDOA – SUPPORTIVE COMFORT MEASURES

DURING FIRE WHICH SET OF PATIENTS WILLDURING FIRE WHICH SET OF PATIENTS WILL THE NURSE MOBILIZE FIRSTTHE NURSE MOBILIZE FIRST

AMBULATORYAMBULATORY

BEDRIDDENBEDRIDDEN

CRITICALCRITICALTERMINALTERMINAL

WHICH STEP IN FIRE MANAGEMENT COMESWHICH STEP IN FIRE MANAGEMENT COMES LAST?LAST?

ALARMALARM

CONTAINCONTAIN

MOBILIZEMOBILIZE

EXTINGUISHEXTINGUISH

PREVENTION AND EARLY DETECTION OFPREVENTION AND EARLY DETECTION OF

DISEASEDISEASEGROWTH AND DEVELOPMENTGROWTH AND DEVELOPMENT

DEVELOPMENTAL TASKS---MILESTONESDEVELOPMENTAL TASKS---MILESTONES ----DELAYS(FIXATIONS/LAG)----DELAYS(FIXATIONS/LAG)

IQ = MA / CA X 100IQ = MA / CA X 100

JUDGEMENT , COMPREHENSION ANDJUDGEMENT , COMPREHENSION AND LISTENINGLISTENING

DDST – BIRTH TO 6 YEARSDDST – BIRTH TO 6 YEARS

PERSONAL SOCIAL, FINE , GROSSPERSONAL SOCIAL, FINE , GROSS MOTOR AND LANGUAGE SKILL AREASMOTOR AND LANGUAGE SKILL AREAS

HEALTH SCREENINGHEALTH SCREENING

OB – GYNE / REPRODUCTIVE TESTSOB – GYNE / REPRODUCTIVE TESTSUTZ-5 WKS CONFIRM PREGNANCY ANDUTZ-5 WKS CONFIRM PREGNANCY AND

AOGAOG

AMNIOCENTESIS – 16 WKS-DETECTAMNIOCENTESIS – 16 WKS-DETECT GENETIC DISORDERS – 30 WEEKS –GENETIC DISORDERS – 30 WEEKS – L/S RATIO ( 2-4 WKS RESULT)(EMPTYL/S RATIO ( 2-4 WKS RESULT)(EMPTY Bladder)Bladder)

OCT – (28 WKS)FHR DECELERATIONS –OCT – (28 WKS)FHR DECELERATIONS – IV OXYTOCIN 15-20 MIN----3IV OXYTOCIN 15-20 MIN----3

CONTRACTIONS OBTAINED WITHIN 10CONTRACTIONS OBTAINED WITHIN 10 MINUTES- REACTIVEMINUTES- REACTIVE

NST – FHR ACCELERATIONS (32-34 WKS)NST – FHR ACCELERATIONS (32-34 WKS) – 2-MORE FHR ACCELERATION OF – 2-MORE FHR ACCELERATION OF 15BPM/MORE LASTING 15 SECS -2015BPM/MORE LASTING 15 SECS -20 MINS. AND RETURN OF FHR TOMINS. AND RETURN OF FHR TO NORMAL/BASELINE – REACTIVENORMAL/BASELINE – REACTIVE

DOPTONE- 12 WEEKS (18 – 20 WKS-DOPTONE- 12 WEEKS (18 – 20 WKS-AUSCULTATION)AUSCULTATION)AFPT-FETAL SERUM CHON , -DETECTAFPT-FETAL SERUM CHON , -DETECT

NEURAL TUBE DEFECTS – 16-18 WKSNEURAL TUBE DEFECTS – 16-18 WKS

CHORIONIC VILLI SAMPLING –FETALCHORIONIC VILLI SAMPLING –FETAL ABNORMALITIES- 10-12 WKSABNORMALITIES- 10-12 WKS

NEWBORN/INFANT HEALTH SCREENINGNEWBORN/INFANT HEALTH SCREENING

PKU – GUTHRINE BLOOD TEST-EAT CHONPKU – GUTHRINE BLOOD TEST-EAT CHON FOR 2 DAYS MIN.(PHEONISTICS –FOR 2 DAYS MIN.(PHEONISTICS – DIAPER)DIAPER)

SICKLE CELL DISEASE –ABNORMALLYSICKLE CELL DISEASE –ABNORMALLY SHAPED Hg ,SHAPED Hg ,

ELISA AND WESTERN BLOTELISA AND WESTERN BLOT

CARRIER SCREENING FOR CYSTICCARRIER SCREENING FOR CYSTIC FIBROSIS AND SWEAT CHLORIDE TESTFIBROSIS AND SWEAT CHLORIDE TEST

SCHOOL AGESCHOOL AGE

HEARING AND VISION TESTSHEARING AND VISION TESTS

ALLEN PICTURE CARDSALLEN PICTURE CARDS

SNELLEN CHART-20/40 AT TODDLERSNELLEN CHART-20/40 AT TODDLER AND 20/20 AT SCHOOL AGEAND 20/20 AT SCHOOL AGE

WEBER’S-SENSORINEURAL ANDWEBER’S-SENSORINEURAL AND CONDUCTIVECONDUCTIVE

RINNE’S- CONDUCTIVERINNE’S- CONDUCTIVEDENTAL EXAM – STARTS AT 2 YEARSDENTAL EXAM – STARTS AT 2 YEARS

ADOLESCENTADOLESCENTPPD – INDURATION – 72 HOURSPPD – INDURATION – 72 HOURS

BSE – (18-20 YRS.) POSTBSE – (18-20 YRS.) POST MENSTRATION/MONTHLYMENSTRATION/MONTHLY

TSE – MONTHLY (18-20 YRS)TSE – MONTHLY (18-20 YRS)

PELVIC EXAM WITH PAP SMEAR – IFPELVIC EXAM WITH PAP SMEAR – IF SEXUALLY ACTIVE OR 18 Y.O. ANNUALLYSEXUALLY ACTIVE OR 18 Y.O. ANNUALLY

ADULT/ELDERLYADULT/ELDERLY

HPN , DM, HEARING AND VISIONHPN , DM, HEARING AND VISIONPROSTATE –ANNUALLY@40PROSTATE –ANNUALLY@40

Ca CHECK-UPS-Q3Y-20YO ; QY – 40 YOCa CHECK-UPS-Q3Y-20YO ; QY – 40 YO

SIGMOIDOSCOPY- > 50 Y.O. =Q3-5 YRSSIGMOIDOSCOPY- > 50 Y.O. =Q3-5 YRS

FECAL OCCULT BLOOD TEST- > 50 =FECAL OCCULT BLOOD TEST- > 50 = ANNUALLYANNUALLY

DIGITAL RECTAL EXAM - > 40 Y.O. = YEARLYDIGITAL RECTAL EXAM - > 40 Y.O. = YEARLY

PELVIC EXAM – 18-40 Y.O. =PERFORMED Q 1PELVIC EXAM – 18-40 Y.O. =PERFORMED Q 1 – 3 YEARS WITH PAP TEST – 3 YEARS WITH PAP TEST

MAMMOGRAM –MAMMOGRAM – 35-39 = BASELINE35-39 = BASELINE

40-49 = Q2Y40-49 = Q2Y



50 AND50 AND OLDER = QYEAROLDER = QYEAR

IMMUNITY pg 127-130IMMUNITY pg 127-130

CONTRAINDICATIONS:CONTRAINDICATIONS:

SEVERE FEBRILE ILLNESSSEVERE FEBRILE ILLNESS

LIVE VIRUSES C/I FORLIVE VIRUSES C/I FOR

IMMUNOCOMPROMISEDIMMUNOCOMPROMISEDALLERGIESALLERGIESRECENTLY ACQUIRED PASSIVERECENTLY ACQUIRED PASSIVE

IMMUNITY(BLOOD TRANSFUSION ANDIMMUNITY(BLOOD TRANSFUSION AND IMMUNOGLOBULINS)IMMUNOGLOBULINS)

if child –no evidence of immunization <7 y.o.if child –no evidence of immunization <7 y.o.Give DPT,TOPV,TINEGive DPT,TOPV,TINE

4-6 WKS LATER MMR4-6 WKS LATER MMR

1 MONTH AFTER DPT AND TOPV1 MONTH AFTER DPT AND TOPV

REPEATED IN ANOTHER MONTHREPEATED IN ANOTHER MONTH

AGAIN IN 10-16 MOS.AGAIN IN 10-16 MOS.

CAN GIVE DPT,MMR,TOPV, AND TINECAN GIVE DPT,MMR,TOPV, AND TINE SIMULTANEOUSLYSIMULTANEOUSLY

TD- 2 DOSES 4-8 WKS APART;3TD- 2 DOSES 4-8 WKS APART;3RDRD DOSE 6-12DOSE 6-12 MOS;BOOSTER AT 10 YRS FO LIFEMOS;BOOSTER AT 10 YRS FO LIFE

OPV/IPV – 2 DOSES AT 4-8 WKS APART ; 3OPV/IPV – 2 DOSES AT 4-8 WKS APART ; 3RDRD

DOSE 2 -12 MOS AFTER 2DOSE 2 -12 MOS AFTER 2NDND(OPV NOT(OPV NOT USED IN US)USED IN US)

MMR-ONE DOSE – 12 MOSMMR-ONE DOSE – 12 MOS

VARICELLA – TWO DOSES 4-8 WEEKS APARTVARICELLA – TWO DOSES 4-8 WEEKS APART STARTS AT 12 MOS.STARTS AT 12 MOS.

HEPA B – 3 DOSES;2HEPA B – 3 DOSES;2NDND 1-2 MOS AFTER;31-2 MOS AFTER;3RDRD 4-4-6 MS AFTER6 MS AFTER

PPV- ONE DOSE ;IF 65 AND RECEIVED >PPV- ONE DOSE ;IF 65 AND RECEIVED > 5YEARS – ADMINISTER5YEARS – ADMINISTER

INFLUENZA –ANNUALLY EACH FALLINFLUENZA –ANNUALLY EACH FALL

ALLERGY CONTRAINDICATIONSALLERGY CONTRAINDICATIONS

EGGS – INFLUENZA , MMREGGS – INFLUENZA , MMR

NEOMYCIN – VARICELLA,IPV,MMRNEOMYCIN – VARICELLA,IPV,MMRYEAST – HEPA-BYEAST – HEPA-B

GELATIN – VARICELLAGELATIN – VARICELLA

PREGNANCY C/I: MMR AND VARICELLAPREGNANCY C/I: MMR AND VARICELLA

IMMUNOSUPPRESSED; VARICELLAIMMUNOSUPPRESSED; VARICELLA

WITH Ig or BT PREVIOUS 3-11 MOS – MMRWITH Ig or BT PREVIOUS 3-11 MOS – MMR AND VARICELLAAND VARICELLA

CONSIDERATIONS-IMMUNIZATIONCONSIDERATIONS-IMMUNIZATION

DPT - IM – ANTERIOR OR LATERAL THIGHDPT - IM – ANTERIOR OR LATERAL THIGH

FEVER AND SWELLING 24-48 HFEVER AND SWELLING 24-48 H POTENTIALPOTENTIAL

SERIOUS-SERIOUS-

CONVULSIONS,HYPERPYREXIA,LOCCONVULSIONS,HYPERPYREXIA,LOC AND SCREAMINGAND SCREAMING

MMR – SC – ANTERIOR OR LATERAL THIGHMMR – SC – ANTERIOR OR LATERAL THIGH

RASH, FEVER ARTHRITIS-10DAYS-2 WKSRASH, FEVER ARTHRITIS-10DAYS-2 WKS

TRIVALENT OPV – POTRIVALENT OPV – PO

PPD-ID- 4-6/11-16YRS.OLD IN HIGHPPD-ID- 4-6/11-16YRS.OLD IN HIGH PREVALENCE AREAS – EVALUATED 48-72PREVALENCE AREAS – EVALUATED 48-72 HOURSHOURS

PHYSICAL ASSESSMENTPHYSICAL ASSESSMENT

TEACHING OPPURTUNITYTEACHING OPPURTUNITY

INSPECTION –VISUALLYINSPECTION –VISUALLY

PALPATION-WARM HANDSPALPATION-WARM HANDS

DORSUM OF FINGERS FOR TEMPDORSUM OF FINGERS FOR TEMP

PERCUSSION-DIRECT,INDIRECT,BLUNTPERCUSSION-DIRECT,INDIRECT,BLUNT

RESONANCE-MODERATE LOW PITCHEDRESONANCE-MODERATE LOW PITCHED

CLEAR HOLLOW(LUNG)CLEAR HOLLOW(LUNG)HYPERRESONANCE-HYPERRESONANCE-OVERINFLATED(EMPHYSEMA)OVERINFLATED(EMPHYSEMA)

TYMPANY-HIGH PITCHED,LOUDTYMPANY-HIGH PITCHED,LOUD DRUMLIKE(BOWEL)DRUMLIKE(BOWEL)

DULL-SOFT MUFFLED,DENSE FLUIDDULL-SOFT MUFFLED,DENSE FLUID FILLED TISSUE(LIVER)FILLED TISSUE(LIVER)

FLAT – SOFT HIGH PITCHED,VERYFLAT – SOFT HIGH PITCHED,VERY DENSE TISSUE-(MUSCLE/BONE)DENSE TISSUE-(MUSCLE/BONE)

AUSCULTATIONAUSCULTATION

DIAPHRAGM-HIGHDIAPHRAGM-HIGH

PITCHED(LUNG,BOWEL,HEART);PITCHED(LUNG,BOWEL,HEART);

BELL – SOFT LOWBELL – SOFT LOW

PITCHED(HEART MURMURS)PITCHED(HEART MURMURS)

VITAL SIGNSVITAL SIGNSTEMPERATURE:TEMPERATURE:

ORAL – 98.6 ‘F / 37 ‘CORAL – 98.6 ‘F / 37 ‘C

RECTAL – 99.6 ‘F / 37.6’CRECTAL – 99.6 ‘F / 37.6’C

AXILLARY – 97.6’F / 36.5’CAXILLARY – 97.6’F / 36.5’C

NORMAL VITAL SIGNSNORMAL VITAL SIGNS

NEWBORN=30 – 50 / MIN; 120 – 140 / MIN;NEWBORN=30 – 50 / MIN; 120 – 140 / MIN; 60/40 – 80/50 mmHg60/40 – 80/50 mmHg

1 – 4 YEARS=20 – 40 / MIN; 80 – 140 /MIN;1 – 4 YEARS=20 – 40 / MIN; 80 – 140 /MIN; 90/60 – 99/65 mmHg90/60 – 99/65 mmHg

5 – 12 YEARS=15 – 25 / MIN; 70 – 115 / MIN;5 – 12 YEARS=15 – 25 / MIN; 70 – 115 / MIN;

100/56 – 110/60 mmHg100/56 – 110/60 mmHg

ADULT=12 – 20 / MIN;60 – 100 / MIN ; 90 / 60 –ADULT=12 – 20 / MIN;60 – 100 / MIN ; 90 / 60 –

140 / 90 mmHg140 / 90 mmHg

BREATHING PATTERNSBREATHING PATTERNS

CHEYNE STOKES – PERIODIC BREATHINGCHEYNE STOKES – PERIODIC BREATHING CHARACTERIZED BY RHYTMIC WAXINGCHARACTERIZED BY RHYTMIC WAXING AND WANINGAND WANING

DYSPNEA - LABORED PAINFUL BREATHINGDYSPNEA - LABORED PAINFUL BREATHING

HYPERVENTILATION – ABNORMALLY RAPIDHYPERVENTILATION – ABNORMALLY RAPID DEEP PROLONGED BREATHINGDEEP PROLONGED BREATHING

KUSSMAULS – AIR HUNGER , MARKEDKUSSMAULS – AIR HUNGER , MARKED INCREASE IN DEPTH AND RATEINCREASE IN DEPTH AND RATE

TACHYPNEA – FAST SHALLOW BREATHINGTACHYPNEA – FAST SHALLOW BREATHING

PARADOXICAL – FLAIL CHEST , DEFLATESPARADOXICAL – FLAIL CHEST , DEFLATES DURING INHALATIONDURING INHALATION

BIOT’S – SHALLOW BREATHS INTERRUPTEDBIOT’S – SHALLOW BREATHS INTERRUPTED BY APNEABY APNEA

NORMAL FINDINGSNORMAL FINDINGS

PULSE PRESSURE – 30-40 mmHgPULSE PRESSURE – 30-40 mmHg

Intracranial pressure – 10 mmHgIntracranial pressure – 10 mmHg

PULSE DEFICIT – MINIMAL(3-5 ACCEPTABLE)PULSE DEFICIT – MINIMAL(3-5 ACCEPTABLE)



IDEAL BODY WEIGHT –IDEAL BODY WEIGHT –

MALES -106 LBS FOR 1MALES -106 LBS FOR 1STST 5FT THEN ADD5FT THEN ADD 6LBS/INCH6LBS/INCH

FEMALE – 100LBS FOR 1FEMALE – 100LBS FOR 1STST 5 FT THEN5 FT THEN ADD 5LBS/INCHADD 5LBS/INCH

ADD OR SUBTRACT 10% DEPENDING ONADD OR SUBTRACT 10% DEPENDING ON

BODY FRAME.BODY FRAME.OBESE AND UNDERWEIGHT IFOBESE AND UNDERWEIGHT IF DEVIATION IS > 20%DEVIATION IS > 20%

SKINSKIN

SCARS,BRUISES ANDSCARS,BRUISES AND LESIONSLESIONS

CHECK COLORCHECK COLOR

EDEMA – GRADINGEDEMA – GRADING

0-NO EDEMA0-NO EDEMA

1-BARELY DETECTABLE1-BARELY DETECTABLE

2-INDENTATION<5MM2-INDENTATION<5MM

3-INDENTATION 5-10MM3-INDENTATION 5-10MM

4-INDENTATION >10MM4-INDENTATION >10MM

PRESSURE SORE –GRADINGPRESSURE SORE –GRADING

1-NONBLANCHABLE ERYTHEMA1-NONBLANCHABLE ERYTHEMA

2-EPIDERMIS,PARTIAL THICKNESS2-EPIDERMIS,PARTIAL THICKNESS

3-FULL DERMIS AND SQ3-FULL DERMIS AND SQ4- SUPPORTING TISSUES AND BONES4- SUPPORTING TISSUES AND BONES

TURGOR-PINCH SKIN TENTED 3 SECSTURGOR-PINCH SKIN TENTED 3 SECS NORMAL(ELDERLY-OVER STERNUM)NORMAL(ELDERLY-OVER STERNUM)

HAIR AND NAILSHAIR AND NAILS

HIRSUTISM-EXCESSHIRSUTISM-EXCESS

ALOPECIA-THINNINGALOPECIA-THINNING

SHAPE – NORMALANGLE OF NAIL BED-160’;SHAPE – NORMALANGLE OF NAIL BED-160’; CLUBBING ANGLE > 180 DUE TOCLUBBING ANGLE > 180 DUE TO PROLONGED DECREASED OXYGENATIONPROLONGED DECREASED OXYGENATION

BLANCHING =< 3 SECS-NORMALBLANCHING =< 3 SECS-NORMAL

HEADHEADSYMMETRY, SIZE AND SHAPESYMMETRY, SIZE AND SHAPE

CRANIAL NERVE ASSESSMENTSCRANIAL NERVE ASSESSMENTS

OPTIC-SNELLENOPTIC-SNELLENOCULOMOTOR- PERRLAOCULOMOTOR- PERRLA

TRIGEMINAL – BITE DOWN ANDTRIGEMINAL – BITE DOWN AND STROKES WITH COTTONSTROKES WITH COTTON

FACIAL – FACIAL MOVEMENT ANDFACIAL – FACIAL MOVEMENT AND TASTETASTE

ACCOUSTIC – HEARING ANDACCOUSTIC – HEARING AND BALANCE(WATCH TICKBALANCE(WATCH TICK TEST,OTOSCOPIC EXAMS ANDTEST,OTOSCOPIC EXAMS AND POSTURE TESTS)POSTURE TESTS)

GLOSSOPHARYGEAL-GAG ANDGLOSSOPHARYGEAL-GAG AND SWALLOWSWALLOW

VAGUS- SWALLOWING AND SPEAKINGVAGUS- SWALLOWING AND SPEAKING

EYESEYES

PTOSIS-DROOPING OF THE UPPER EYELIDPTOSIS-DROOPING OF THE UPPER EYELID

ASTIGMATISM – UNEVEN CURVATURE OFASTIGMATISM – UNEVEN CURVATURE OF CORNEA LEADING TO REFRACTIONCORNEA LEADING TO REFRACTION ERRORSERRORS

NYSTAGMUS- ABNORMAL, INVOLUNTARYNYSTAGMUS- ABNORMAL, INVOLUNTARY EYE MOVEMENTSEYE MOVEMENTS

STRABISMUS-ASSYMETRICAL LIGHTSTRABISMUS-ASSYMETRICAL LIGHT EFLECTION ON EACH CORNEAEFLECTION ON EACH CORNEA

RED REFLEX FROM RETINA-NORMALRED REFLEX FROM RETINA-NORMAL

COVER UNCOVER TEST – DET.EYECOVER UNCOVER TEST – DET.EYE ALIGNMENTALIGNMENT

SNELLEN – FAR DISTANCE VISION/VISUALSNELLEN – FAR DISTANCE VISION/VISUAL ACUITYACUITY

IOP-TONOMETRY TESTS INDENTATION(6-12)IOP-TONOMETRY TESTS INDENTATION(6-12)

EARSEARS

PINNA BACK-UP-ADULT;DOWN-BACK-CHILDPINNA BACK-UP-ADULT;DOWN-BACK-CHILDRINNE TEST – COMPARES AIR CONDUCTIONRINNE TEST – COMPARES AIR CONDUCTION WITH BONE CONDUCTION,VIBRATINGWITH BONE CONDUCTION,VIBRATING FORK PLACED ON THE MASTOID IFFORK PLACED ON THE MASTOID IF SOUND NO LONGER HEARD POSITIONEDSOUND NO LONGER HEARD POSITIONED IN FRONT OF EAR CANNAL. SHOULDIN FRONT OF EAR CANNAL. SHOULD HEAR A SOUND= 2:1 ; AIR CONDUCTION >HEAR A SOUND= 2:1 ; AIR CONDUCTION > THAN BONE CONDUCTION ;= POSITIVETHAN BONE CONDUCTION ;= POSITIVE RINNERINNE

ASSESS CONDUCTIVE HEARING LOSSASSESS CONDUCTIVE HEARING LOSS

EARSEARS

WEBER – SENSORINEURAL ANDWEBER – SENSORINEURAL AND CONDUCTIVE HEARING LOSSCONDUCTIVE HEARING LOSS

FORK PLACED MIDDLE OF FOREFORK PLACED MIDDLE OF FORE HEAD,SHOULD BE HEARDHEAD,SHOULD BE HEARD

EQUALLY=WEBER NEGATIVEEQUALLY=WEBER NEGATIVEIF NOT EQUAL=SENSORINEURALIF NOT EQUAL=SENSORINEURAL

HEARING LOSS.HEARING LOSS.

SOUND HEARD BETTER IN THESOUND HEARD BETTER IN THE IMPAIRED EAR=BONE CONDUCTIVEIMPAIRED EAR=BONE CONDUCTIVE HEARING LOSS, IF VICE VERSA =HEARING LOSS, IF VICE VERSA = SENSORINEURAL DISTURBANCESENSORINEURAL DISTURBANCE

NECK,MOUTH AND PHARYNXNECK,MOUTH AND PHARYNXTEETH-32TEETH-32

TONSILS – NO TPC , + GAG REFLEXTONSILS – NO TPC , + GAG REFLEX

CERVICAL LYMPH NODES=<1CMCERVICAL LYMPH NODES=<1CM

CAROTID – PALPATE THRILL,LISTEN BRUITCAROTID – PALPATE THRILL,LISTEN BRUITJUGULAR VEINS – NOT DISTENDEDJUGULAR VEINS – NOT DISTENDED

TRACHEA-MIDLINETRACHEA-MIDLINE

THORAX AND LUNGSTHORAX AND LUNGS

APL DIAMETER-1:2 – 5:7APL DIAMETER-1:2 – 5:7

1:1 = BARREL CHEST1:1 = BARREL CHEST

TACTILE FREMITUS NORMAL-TACTILE FREMITUS NORMAL-

BRONCHOPHONY,EGOPHONY ANDBRONCHOPHONY,EGOPHONY AND WHISPERED PECTORILOQUY-WHISPERED PECTORILOQUY-

CONSOLIDATION OF LUNGSCONSOLIDATION OF LUNGS

BREATH SOUNDSBREATH SOUNDS

VESICULAR – SOFT-LOW PITCHEDVESICULAR – SOFT-LOW PITCHED BREEZY SOUNDS –PERIPHERALBREEZY SOUNDS –PERIPHERAL LUNG SURFACESLUNG SURFACES

BRONCHOVESCICULAR-HARSHBRONCHOVESCICULAR-HARSH SOUNDS-MAINSTREAM BRONCHISOUNDS-MAINSTREAM BRONCHI

BRONCHIAL- LOUD COARSE - TRACHEABRONCHIAL- LOUD COARSE - TRACHEA

ADVENTITIOUS BREATH SOUNDSADVENTITIOUS BREATH SOUNDS

RALES-FINE SHORT,CRACKLING ORRALES-FINE SHORT,CRACKLING OR HIGH PITCHED SOUNDS-INSPIRATIONHIGH PITCHED SOUNDS-INSPIRATION

RHONCHI-CONTINOUS LOW PITCHEDRHONCHI-CONTINOUS LOW PITCHED COARSEGURGLING HARSH SNORINGCOARSEGURGLING HARSH SNORING BEST HEARD ON EXHALATIONBEST HEARD ON EXHALATION

WHEEZES- SQUEAKY SOUNDS HEARD –WHEEZES- SQUEAKY SOUNDS HEARD – EXHALATIONEXHALATION

STRIDOR – HARSH , MUSICAL SQUEAKSTRIDOR – HARSH , MUSICAL SQUEAK HEARD UPON INHALATIONHEARD UPON INHALATION





ORIENTED,CONVERSES=5ORIENTED,CONVERSES=5

DISORIENTED,CONVERSES=4DISORIENTED,CONVERSES=4

USES INAPPROPRIATE WORDS=3USES INAPPROPRIATE WORDS=3

USES INCOMPREHENSIBLEUSES INCOMPREHENSIBLE SOUNDS=2SOUNDS=2

NO RESPONSE=1NO RESPONSE=1

ASSESSING MOTOR FUNCTIONASSESSING MOTOR FUNCTIONWALKING GAITSWALKING GAITSROMBERGS TEST- STAND FEET TOGETHERROMBERGS TEST- STAND FEET TOGETHER

ARMS RESTING AT THE SIDES,EYESARMS RESTING AT THE SIDES,EYES OPEN THEN CLOSED. NEG. ROMBERG –OPEN THEN CLOSED. NEG. ROMBERG – MAY SWAY BUT KEEPS BALANCE.MAY SWAY BUT KEEPS BALANCE.SENSORY ATAXIA-CANNOT BALANCESENSORY ATAXIA-CANNOT BALANCE

EYES SHUTEYES SHUT

CEREBELLAR ATAXIA-CANNOT BALANCECEREBELLAR ATAXIA-CANNOT BALANCE EYES SHUT OR EPONEYES SHUT OR EPON

HEEL-TOE WALKING AND VICE VERSAHEEL-TOE WALKING AND VICE VERSA

FINGER TO NOSE TEST AND OTHERFINGER TO NOSE TEST AND OTHER SENSORY FUNCTION TEST (ONE ANDSENSORY FUNCTION TEST (ONE AND TWO POINT DISCRIMINATION)TWO POINT DISCRIMINATION)

EXTINCTION PHENOMENON-SYMMETRICALEXTINCTION PHENOMENON-SYMMETRICAL

AREAS ARE TOUCHED BUT SENSATIONAREAS ARE TOUCHED BUT SENSATION ON ONE SIDE CANNOT BE FELTON ONE SIDE CANNOT BE FELT INDICATES LESIONS OF SENSORYINDICATES LESIONS OF SENSORY CORTEXCORTEX

GENITALIA , ANUS AND RECTUMGENITALIA , ANUS AND RECTUM

ASSESS APPEARANCE AND ORIFICES ANDASSESS APPEARANCE AND ORIFICES AND INGUINAL LYMPH NODESINGUINAL LYMPH NODES

INSPECT CERVICAL OS AND VAGINA-INSPECT CERVICAL OS AND VAGINA-

SPECULUMSPECULUMDEVIATIONSDEVIATIONS

CYSTOCELE, RECTOCELE,ENTEROCELECYSTOCELE, RECTOCELE,ENTEROCELE

HYPO AND EPISPADIAS-URETHRALHYPO AND EPISPADIAS-URETHRAL OPENING DISPLACEDOPENING DISPLACED

HERNIAS-DIRECT,INDIRECT , FEMORALHERNIAS-DIRECT,INDIRECT , FEMORAL

INSTRUCT PNT TO BEAR DOWN-INSTRUCT PNT TO BEAR DOWN-

PALPABLE BULGEPALPABLE BULGEDIGITAL RECTAL EXAM –INSPECTION ANDDIGITAL RECTAL EXAM –INSPECTION AND

PALPATION –POSITION BOTH=SIM’S ,PALPATION –POSITION BOTH=SIM’S , FEMALES – LITHOTOMY;MALES =STANDFEMALES – LITHOTOMY;MALES =STAND AND BEND FORWARDAND BEND FORWARD

PROSTATE GLAND-4 CM ;CERVIX = 2-3 CMPROSTATE GLAND-4 CM ;CERVIX = 2-3 CM

HEMORRHOIDS =DILATED VEINSHEMORRHOIDS =DILATED VEINS

MOBILITY AND IMMOBILITYMOBILITY AND IMMOBILITY

ERGONOMICS-BODY POSITIONING ANDERGONOMICS-BODY POSITIONING AND MECHANICSMECHANICS

PRIORITY-ASSESS PERSONAL CAPACITY 1PRIORITY-ASSESS PERSONAL CAPACITY 1STST USE PROTECTIVE DEVICES/ TRANSFER AIDSUSE PROTECTIVE DEVICES/ TRANSFER AIDS

CHANGE POSITION SLOWLY-ORTHOSTATICCHANGE POSITION SLOWLY-ORTHOSTATIC HYPOTENSION(DANGLE LEGS FIRST)HYPOTENSION(DANGLE LEGS FIRST)

PIVOT ON THE STRONGER SIDE,MOVE PNTPIVOT ON THE STRONGER SIDE,MOVE PNT TOWARDS STRONGER SIDETOWARDS STRONGER SIDE

USE LARGER MUSCLES OF THE BODY ANDUSE LARGER MUSCLES OF THE BODY AND FACE THE DIRECTION OF THEFACE THE DIRECTION OF THE MOVEMENTMOVEMENT

PULL SHEETS ARE BETTER METHOD THANPULL SHEETS ARE BETTER METHOD THAN SLIDINGSLIDING

ALWAYS MOBILZE MAXIMUMALWAYS MOBILZE MAXIMUM MANPOWER/HAVE AN ASSISTANTMANPOWER/HAVE AN ASSISTANT STANDING BY.STANDING BY.

ROCK FROM FRONT TO BACK/VICEROCK FROM FRONT TO BACK/VICE VERSA.WIDE BASE OF SUPPORT,VERSA.WIDE BASE OF SUPPORT, WEIGHT NEAR MIDLINE OF THEWEIGHT NEAR MIDLINE OF THE BODY.USE APPROPRIATE TRANSFERBODY.USE APPROPRIATE TRANSFER

AND AMBULATION AIDS. (TRAPEZE,AND AMBULATION AIDS. (TRAPEZE, HOYER LIFT, SLIDE BOARD, DRAW SHEETHOYER LIFT, SLIDE BOARD, DRAW SHEET AND TRANSFER BELTAND TRANSFER BELT

THERAPEUTIC EXERCISESTHERAPEUTIC EXERCISES

PASSIVE ROM-RETENTION OF ROM ANDPASSIVE ROM-RETENTION OF ROM AND MAINTENANCE OF CIRCULATIONMAINTENANCE OF CIRCULATION

ASSISTIVE- INCREASES MOTION ,ASSISTIVE- INCREASES MOTION , MAINTAINS MUSCLE TONEMAINTAINS MUSCLE TONE

ACTIVE – MAINTAINS MOBILITY OF THEACTIVE – MAINTAINS MOBILITY OF THE JOINT AND MAINTAINS MUSCLEJOINT AND MAINTAINS MUSCLE STRENGTHSTRENGTH

RESISTIVE – INCREASES MUSCLE POWERRESISTIVE – INCREASES MUSCLE POWER

ISOMETRICS- MAINTENANCE OF STRENGTHISOMETRICS- MAINTENANCE OF STRENGTH AND PREVENTS MUSCULAR ATROPHYAND PREVENTS MUSCULAR ATROPHY

DANGERS OF IMMOBILITYDANGERS OF IMMOBILITYDECUBITUS ULCER-OSTEOMYELITISDECUBITUS ULCER-OSTEOMYELITIS

OSTEOPOROSIS-PATHOLOGICALOSTEOPOROSIS-PATHOLOGICAL FRACTURES AND RENAL CALCULIFRACTURES AND RENAL CALCULI

INCREASED CARDIAC WORKLOAD-INCREASED CARDIAC WORKLOAD- TACHYCARDIATACHYCARDIA

CONTRACTURES- DEFORMITIESCONTRACTURES- DEFORMITIES

THROMBUS FORMATION-PULMONARYTHROMBUS FORMATION-PULMONARY EMBOLISMEMBOLISM

ORTHOSTATIC HYPOTENSION-ORTHOSTATIC HYPOTENSION-

WEAKNESS,FAINTNESS AND DIZZINESSWEAKNESS,FAINTNESS AND DIZZINESS

RESPIRATORY STASIS – HYPOSTATICRESPIRATORY STASIS – HYPOSTATIC PNEUMONIAPNEUMONIA

CONSTIPATION – FECAL IMPACTIONCONSTIPATION – FECAL IMPACTION

URINARY STASIS-URINARY RETENTIONURINARY STASIS-URINARY RETENTION

NEGATIVE NITROGEN BALANCE-WEIGHTNEGATIVE NITROGEN BALANCE-WEIGHT LOSS/DEBILITATIONLOSS/DEBILITATION

ASSISTIVE DEVICESASSISTIVE DEVICES

CRUTCHESCRUTCHES

CRUTCH HEIGHT-CRUTCH HEIGHT-

STANDING ;2 -3 (1-2STANDING ;2 -3 (1-2 INCHES)FINGERS BELOW AXILLAINCHES)FINGERS BELOW AXILLA OR SUPINE ;MEASURE FROM THEOR SUPINE ;MEASURE FROM THE ANTERIOR FOLD OF THE AXILLAANTERIOR FOLD OF THE AXILLA TO THE HEEL OF THE FOOT ANDTO THE HEEL OF THE FOOT AND ADD 2.5 CMADD 2.5 CM

TEACH MUSCLE STRENGTHENINGTEACH MUSCLE STRENGTHENING EXERCISES PRIOR TOEXERCISES PRIOR TO

AMBULATION.WEIGHT ON THE HANDAMBULATION.WEIGHT ON THE HAND GRIP (TO AVOID CRUTCH PALSY)GRIP (TO AVOID CRUTCH PALSY)

ELBOWS SHOULD BE FLEXED 20-30’ ANDELBOWS SHOULD BE FLEXED 20-30’ AND CRUTCHES SHOULD BE KEPT 6CRUTCHES SHOULD BE KEPT 6 INCHES LATERALLY AND 6 INCHES TOINCHES LATERALLY AND 6 INCHES TO THE FRONT=TRIPOD POSITION(8-10THE FRONT=TRIPOD POSITION(8-10 INCHES-OK)INCHES-OK)

INSTRUCT CLIENT TO MAINTAIN ANINSTRUCT CLIENT TO MAINTAIN AN ERECT POSTUREERECT POSTURE



CRUTCH WALKING GAITSCRUTCH WALKING GAITS

FOUR POINT-SLOW SAFE-WEIGHTFOUR POINT-SLOW SAFE-WEIGHT BEARING ALLOWED FOR BOTH LEGSBEARING ALLOWED FOR BOTH LEGS

TWO POINT- FASTER SAFE-WEIGHTTWO POINT- FASTER SAFE-WEIGHT BEARING ALLOWED FOR BOTH LEGSBEARING ALLOWED FOR BOTH LEGS

THREE-POINT-NON WEIGHT BEARINGTHREE-POINT-NON WEIGHT BEARING

OF ONE LEGOF ONE LEGSWINGTO/SWINGTHROUGH-PARTIALSWINGTO/SWINGTHROUGH-PARTIAL WEIGHT BEARING ALLOWED FORWEIGHT BEARING ALLOWED FOR BOTH LEGSBOTH LEGS

GETTING INTO A CHAIR –BOTHGETTING INTO A CHAIR –BOTH CRUCHES TO THE WEAK SIDE ,CRUCHES TO THE WEAK SIDE , STRONGER ARM HOLDS THESTRONGER ARM HOLDS THE ARMRESTARMREST

GOING UP AND DOWN THE STAIRS-GOING UP AND DOWN THE STAIRS- GOOD GOES UP 1GOOD GOES UP 1STST AND BAD GOESAND BAD GOES DOWN 1DOWN 1STST..

WALKERWALKER--

PROVIDES STABILITY AND BALANCEPROVIDES STABILITY AND BALANCE

MOVE WALKER AHEAD 15 CM (6INCHES-8-10MOVE WALKER AHEAD 15 CM (6INCHES-8-10 INCHES)WHILE WEIGHT IS BORNE BYINCHES)WHILE WEIGHT IS BORNE BY BOTH LEGS.THEN ALTERNATE WEIGHTBOTH LEGS.THEN ALTERNATE WEIGHT BEARING ASSISTED BY THE ARMSBEARING ASSISTED BY THE ARMS

ELBOWS SHOULD BE FLEXED-20-30’ELBOWS SHOULD BE FLEXED-20-30’

IF ONE LEG IS WEAKER MOVE THAT LEGIF ONE LEG IS WEAKER MOVE THAT LEG TOGETHER WITH THE WALKERTOGETHER WITH THE WALKER

CANECANE

HOLD CANE ON THE STRONGER SIDEHOLD CANE ON THE STRONGER SIDE

FLEX ELBOW 30’ AND TIP OF CANE 15 CMFLEX ELBOW 30’ AND TIP OF CANE 15 CM LATERAL TO THE SIDE OF THE 5LATERAL TO THE SIDE OF THE 5THTH TOE.TOE.

ADVANCE CANE AND AFFECTED LEGADVANCE CANE AND AFFECTED LEG ,WEIGHT ON CANE WHEN MOVING THE,WEIGHT ON CANE WHEN MOVING THE

GOOD LEGGOOD LEGBUT FOR MAXIMUM SUPPORT ADVANCEBUT FOR MAXIMUM SUPPORT ADVANCE

CANE 1 FEET ,MOVE AFFECTED LEGCANE 1 FEET ,MOVE AFFECTED LEG THEN THE STRONGER LEGTHEN THE STRONGER LEG

GOING UP AND DOWN THE STAIRS –SAMEGOING UP AND DOWN THE STAIRS –SAME WITH CRUTCHESWITH CRUTCHES

NUTRITIONNUTRITION

PREMATURE INFANTS-LESSPREMATURE INFANTS-LESS THAN37WKS/2,500G-100-200 CAL/KG/DAYTHAN37WKS/2,500G-100-200 CAL/KG/DAY AND HIGHER Na,Ca AND CHONAND HIGHER Na,Ca AND CHON

FULL TERM-120 CAL/KG/DAYFULL TERM-120 CAL/KG/DAY

PREGNANCY + 300CAL/DAYPREGNANCY + 300CAL/DAY

LACTATION+ 500CAL/DAYLACTATION+ 500CAL/DAY

ENTERAL FEEDINGSENTERAL FEEDINGSCONDITIONSCONDITIONS

PREOPERATIVE NEED FORPREOPERATIVE NEED FOR NUTRITIONAL SUPPORTNUTRITIONAL SUPPORT

GI PROBLEMSGI PROBLEMSONCOLOGY THERAPYONCOLOGY THERAPY

ALCOHOLISM,CHRONIC DEPRESSIONALCOHOLISM,CHRONIC DEPRESSION AND EATING DISORDERSAND EATING DISORDERS

HEAD,NECK DISORDERS OR SURGERYHEAD,NECK DISORDERS OR SURGERY

COMPLICATIONSCOMPLICATIONS

ASPIRATIONTUBE DISPLACEMENTASPIRATIONTUBE DISPLACEMENT

CRAMPING,VOMITING,DIARRHEACRAMPING,VOMITING,DIARRHEA

HYPEROSMOLAR NONKETOTICHYPEROSMOLAR NONKETOTIC COMA/GLUCOSE INTOLERANCECOMA/GLUCOSE INTOLERANCE

TOTAL PARENTERAL NUTRITIONTOTAL PARENTERAL NUTRITION

TYPES OF SOLUTIONSTYPES OF SOLUTIONS

TPN-AMINO ACID-DEXTROSE- 2-3 L /24HTPN-AMINO ACID-DEXTROSE- 2-3 L /24H – FINE BACTERIAL FILTER USED – FINE BACTERIAL FILTER USEDTNA-TOTAL NUTRIENT ADMIXTURE-TNA-TOTAL NUTRIENT ADMIXTURE-

AMINO ACID, DEXTROSE AND LIPIDS-1AMINO ACID, DEXTROSE AND LIPIDS-1 LITER /24 HOURS – NO FILTERLITER /24 HOURS – NO FILTER

PERIPHERAL=NO >10% DEXTROSE AND 2PERIPHERAL=NO >10% DEXTROSE AND 2 WKS ONLYWKS ONLY

CENTRAL – INCOMPATIBLE WITH MEDS ANDCENTRAL – INCOMPATIBLE WITH MEDS AND BLOOD IF SINGLE LUMEN USEDBLOOD IF SINGLE LUMEN USED

ATRIAL-HICKMAN/BIOVAC AND GROSHONG-ATRIAL-HICKMAN/BIOVAC AND GROSHONG- HUBBER NEEDLE USED TO ACCESSHUBBER NEEDLE USED TO ACCESS PORT THROUGH SKINPORT THROUGH SKIN

TPNTPN

INITIAL RATE OF INFUSION 50 ML/HR THENINITIAL RATE OF INFUSION 50 ML/HR THEN 100-125/HR.100-125/HR.

COMPLICATIONS-HYPEROSMOLAR COMA,COMPLICATIONS-HYPEROSMOLAR COMA, SEPSIS, PNEUMOTHORAXSEPSIS, PNEUMOTHORAX

FAST RATE=HYPEROSMOLARFAST RATE=HYPEROSMOLAR STATE(HEADACHE,NAUSEA,MALAISE,STATE(HEADACHE,NAUSEA,MALAISE,

FEVER,CHILLS)FEVER,CHILLS)

SLOWED RATE=REBOUNDSLOWED RATE=REBOUND HYPOGLYCEMIAHYPOGLYCEMIA

X-RAY CONFIRMS PLACEMENT ATTACH TOX-RAY CONFIRMS PLACEMENT ATTACH TO PUMPPUMP

IV TUBING AND FILTER CHANGED Q24IV TUBING AND FILTER CHANGED Q24 HOURSHOURS

ALLOW SOLUTION TO WARM IMMEDIATELYALLOW SOLUTION TO WARM IMMEDIATELY BEFORE USEBEFORE USE

IF NO SOLUTION USE DEXTROSE 10% WIF NO SOLUTION USE DEXTROSE 10% W SOLUTIONSOLUTION

CHECK DAILY CBG,WEIGHT,TEMP. I ANDCHECK DAILY CBG,WEIGHT,TEMP. I AND O ,O ,

CHECK 3X A WEEK BUN, ELECT,CHECK 3X A WEEK BUN, ELECT,

ONCE A WEEK – LFT’S, CBC, SERUMONCE A WEEK – LFT’S, CBC, SERUM ALBUMIN AND PT,PTTALBUMIN AND PT,PTT

OSTOMIESOSTOMIES

PERMANENT/TEMPORARYPERMANENT/TEMPORARY

STOMA RED AND SLIGHT BLEEDING WHENSTOMA RED AND SLIGHT BLEEDING WHEN TOUCHEDBURNING SENSATION UNDERTOUCHEDBURNING SENSATION UNDER FACEPLATE INDICATES SKINFACEPLATE INDICATES SKIN BREAKDOWN,REFER ABDLBREAKDOWN,REFER ABDL DISTENTION/DISCOMFORT,DISTENTION/DISCOMFORT,

KARAYA POWDER(DEC.IRRITATION),KARAYA POWDER(DEC.IRRITATION), CHARCOAL/BISMUTH CARBONATE-CHARCOAL/BISMUTH CARBONATE-

DEODORIZERDEODORIZER

APPLIANCE CAN LAST 7 DAYS BUT CHANGEAPPLIANCE CAN LAST 7 DAYS BUT CHANGE Q48-72H AND 24-48H IFPERIOSTOMALQ48-72H AND 24-48H IFPERIOSTOMAL SKIN ERYTHEMATOUS, ERODEDSKIN ERYTHEMATOUS, ERODED

ILEOSTOMY-LIQUID,CONSTANT,IRRITATINGILEOSTOMY-LIQUID,CONSTANT,IRRITATING TO THE SKIN,APPLIANCETO THE SKIN,APPLIANCE CONTINOUS,MINIMAL ODORCONTINOUS,MINIMAL ODOR



COLOSTOMY-FORMED , CAN BE IRRIGATEDCOLOSTOMY-FORMED , CAN BE IRRIGATED 300-500ML AND REGULATED,MAY NOT300-500ML AND REGULATED,MAY NOT HAVE TO WEAR AN APPLIANCEHAVE TO WEAR AN APPLIANCE

URINARY ELIMINATIONURINARY ELIMINATION

BUN – 10-20 MG/DLBUN – 10-20 MG/DL

CREA – 0.7 – 1.4 MG/DLCREA – 0.7 – 1.4 MG/DL

24 HOUR URINE PRODUCTION-1000-1500CC24 HOUR URINE PRODUCTION-1000-1500CC

ANURIA<100ML/24HANURIA<100ML/24HOLIGURIA< 400 ML/24HOLIGURIA< 400 ML/24H

POLYURIA > 2000 ML/24HPOLYURIA > 2000 ML/24H

KEGELS –STRENGTHEN MUSCLES OF THEKEGELS –STRENGTHEN MUSCLES OF THE PELVIC FLOOR-TIGHTEN FOR 3 SECSPELVIC FLOOR-TIGHTEN FOR 3 SECS THEN RELAX FOR 3 SECS PERFORMTHEN RELAX FOR 3 SECS PERFORM LYING DOWN, SITTING AND STANDINGLYING DOWN, SITTING AND STANDING FOR TOTAL OF 45FOR TOTAL OF 45

BLADDER RETRAININGBLADDER RETRAINING

INTERMITTENT CATHETERIZATIONINTERMITTENT CATHETERIZATION AFTER ATTEMPTING TO VOID Q 2-3H,AFTER ATTEMPTING TO VOID Q 2-3H, TIME INCREASES GRADUALLY BUTTIME INCREASES GRADUALLY BUT NO MORE THAN 8 HOURSNO MORE THAN 8 HOURS

BLADDER TRAINING – DRINK ABLADDER TRAINING – DRINK A MEASURED AMOUNT Q2H THENMEASURED AMOUNT Q2H THEN ATTEMP TO VOID 30 MINS LATER-ATTEMP TO VOID 30 MINS LATER-

TIME GRADUALLY INCREASEDTIME GRADUALLY INCREASED

TRIGGERING TECHNIQUES-CREDESTRIGGERING TECHNIQUES-CREDES MANEUVER AND VALSALVAMANEUVER AND VALSALVA

CLAMP INDWELLING CATH BEFORECLAMP INDWELLING CATH BEFORE REMOVAL. THEN DUE TO VOID 3-4REMOVAL. THEN DUE TO VOID 3-4 HOURS AFETR REMOVALHOURS AFETR REMOVAL

HEMODIALYSISHEMODIALYSIS

DONE 3-5 HOURS – 2-3 TIMES A WEEKDONE 3-5 HOURS – 2-3 TIMES A WEEK

AV FISTULA-NO BP,VENIPUNCTURE ORAV FISTULA-NO BP,VENIPUNCTURE OR CONSTRICTIONSCONSTRICTIONS

PALPATE FOR A THRILL AND LISTEN FORPALPATE FOR A THRILL AND LISTEN FOR

BRUIT Q8HBRUIT Q8HMONITOR FOR HEMORRHAGEMONITOR FOR HEMORRHAGE

DISEQUILIBRIUMDISEQUILIBRIUM SYNDROME,HEPATITIS,HEMORRHAGE,MSYNDROME,HEPATITIS,HEMORRHAGE,M

USCLE CRAMPS,AIR EMBOLISM ANDUSCLE CRAMPS,AIR EMBOLISM AND SEPSIS-COMPLICATIONSSEPSIS-COMPLICATIONS

PERITONEAL DIALYSISPERITONEAL DIALYSIS

TENCKOFF,GORE-TEX CATHETERTENCKOFF,GORE-TEX CATHETER

WEIGH BEFORE AND AFTER, WARMWEIGH BEFORE AND AFTER, WARM DIALYSATEDIALYSATE

CHON LOSS, INFECTION,CHON LOSS, INFECTION, -PERITONITIS(CLOUDY-PERITONITIS(CLOUDY OUTFLOW,BLEEDING) , FEVER , ABDLOUTFLOW,BLEEDING) , FEVER , ABDL TENDERNESS AND N & VTENDERNESS AND N & V

PREVENT CONSTIPATION BY INCREASINGPREVENT CONSTIPATION BY INCREASING FIBER IN DIET,MAINTAIN STERILEFIBER IN DIET,MAINTAIN STERILE PROCEDURE,FOR PROBLEMS WITH OUTPROCEDURE,FOR PROBLEMS WITH OUT FLOW –REPOSITIONFLOW –REPOSITION

TYPES: CAPD(4-6HTYPES: CAPD(4-6H INDWELLING),AUTOMATED 30MINSINDWELLING),AUTOMATED 30MINS EXCHANGES, INTERMITTENT- 4X A WEEKEXCHANGES, INTERMITTENT- 4X A WEEK

– 10H/DAY, CONTINOUS – 1 DAY – 10H/DAY, CONTINOUS – 1 DAY INDWELLINGINDWELLING

PREOP CAREPREOP CARE

INFANT-DISTRACTINFANT-DISTRACT

TODDLER-ALLOW REGRESSION ANDTODDLER-ALLOW REGRESSION AND INVOLVE PARENTS,CONSISTENTINVOLVE PARENTS,CONSISTENT CAREGIVERCAREGIVER

PRE-SCHOOL-LET CHILD HANDLEPRE-SCHOOL-LET CHILD HANDLE EQUIPMENT,EXPRESSION OF FEELINGSEQUIPMENT,EXPRESSION OF FEELINGS THROUGH PLAY DEMOFAMILIARTHROUGH PLAY DEMOFAMILIAR

SORROUNDINGSSORROUNDINGSSCHOOL AGE- EXPLAIN SIMPLY AND ALLOWSCHOOL AGE- EXPLAIN SIMPLY AND ALLOW CHOICESCHOICES

ADOLESCENTS- INVOLVE AND POINT OUTADOLESCENTS- INVOLVE AND POINT OUT STRENGTHS AND BENEFITS,EXPECTSTRENGTHS AND BENEFITS,EXPECT RESISTANCERESISTANCE

PREOP CHECKLISTPREOP CHECKLIST

CONSENTCONSENT

HEALTH TEACHING (SPEC. POST OPHEALTH TEACHING (SPEC. POST OP PROCEDURES)PROCEDURES)

LAB TESTS,ECG,X-RAYLAB TESTS,ECG,X-RAY

SKIN PREPSKIN PREP

BOWEL PREPBOWEL PREP

IV’SIV’S

NPONPOPREOP MEDS,SEDATION ANDPREOP MEDS,SEDATION AND

ANTIBIOTICSANTIBIOTICS

REMOVAL OF DENTURES,NAILPOLISHREMOVAL OF DENTURES,NAILPOLISH AND JEWELRYAND JEWELRY

NUTRITION-TPN OR ENTERAL FEEDINGSNUTRITION-TPN OR ENTERAL FEEDINGS PREOPPREOP

INTRAOP- MAINTAIN SURGICAL ASEPSIS,INTRAOP- MAINTAIN SURGICAL ASEPSIS, MONITOR CLIENT STATUS,,MONITOR CLIENT STATUS,,

APPROPRIATE GROUNDING DEVICES,APPROPRIATE GROUNDING DEVICES, FLUID BALANCE ANDFLUID BALANCE AND

SPONGE/INSTRUMENT COUNTSPONGE/INSTRUMENT COUNT

POST OP- MONITOR VSPOST OP- MONITOR VSQ15X4;Q30X2;Q1HX2 THEN PRNQ15X4;Q30X2;Q1HX2 THEN PRN

MONITOR I AND O , K LEVEL , CVP, BOWELMONITOR I AND O , K LEVEL , CVP, BOWEL

SOUNDS, BREATH SOUNDS AND LOCSOUNDS, BREATH SOUNDS AND LOCRESPIRATORY PHYSIOTHERAPY,TCBDRESPIRATORY PHYSIOTHERAPY,TCBD

INCENTIVE SPIROMETRY-20 SECSINCENTIVE SPIROMETRY-20 SECS INHALATIONINHALATION

ENCOURAGE AMBUALTIONENCOURAGE AMBUALTION

REFER IF UNABLE TO VOID IN 8 HOURSREFER IF UNABLE TO VOID IN 8 HOURS

APPLY TED HOSE AND PNEUMATICAPPLY TED HOSE AND PNEUMATIC COMPRESSION DEVICE,CHECK FORCOMPRESSION DEVICE,CHECK FOR HOMAN’S SIGNHOMAN’S SIGN

WOUNDSWOUNDS

NOTE DRESSING AND INCISIONNOTE DRESSING AND INCISION

FEVER 1-2 DAYS POST OP-ATELECTASIS/FEVER 1-2 DAYS POST OP-ATELECTASIS/ DEHYDRATIONDEHYDRATION

3-7 DAYS – INFECTION3-7 DAYS – INFECTION

UPPER GI TUBES-GASTRICUPPER GI TUBES-GASTRIC DECOMPRESSIONDECOMPRESSION

LOWER GI TUBES – BOWELLOWER GI TUBES – BOWEL DECOMPRESSIONDECOMPRESSION

WOUND HEALING BY 1WOUND HEALING BY 1STST INTENTION-INTENTION-

SUTURED AND APPROXIMATED ; 3SUTURED AND APPROXIMATED ; 3RDRD

INTENTION-NOT CLOSED,W/ PURPOSEINTENTION-NOT CLOSED,W/ PURPOSE EX: DRAINSEX: DRAINS



WOUND HEALING BY 2WOUND HEALING BY 2NDND INTENTION-INTENTION-

INCREASED INCIDENCE OF INFECTION ,INCREASED INCIDENCE OF INFECTION , INCREASED SCARRING AND LONGERINCREASED SCARRING AND LONGER HEALING TIMEHEALING TIME

POST-OP COMPLICATIONSPOST-OP COMPLICATIONS

SHOCKSHOCK

PARALYTIC ILEUSPARALYTIC ILEUS

ATELECTASIS AND PNEUMONIA - 2ND DAYATELECTASIS AND PNEUMONIA - 2ND DAYEMBOLISM- 2ND DAYEMBOLISM- 2ND DAYWOUND INFECTION-3-5DWOUND INFECTION-3-5D

DEHISCENCE AND EVISCERATION-5-6DDEHISCENCE AND EVISCERATION-5-6D

PSYCHOSISPSYCHOSIS

CARDIOVASCULAR COMPROMISE-CARDIOVASCULAR COMPROMISE-URINARY RETENTION-8-12HURINARY RETENTION-8-12H

URINARY INFECTION -5-8 DURINARY INFECTION -5-8 D

DVT-6-14 DAYS-1 YEARDVT-6-14 DAYS-1 YEAR

Documents

Theoretical Foundations Bullets