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-inherent in the concept of informed consent and in advance directives
- personal power
- power exercised over oneself
Cortisol -produced by adrenal cortex
Is a anti-inflammatory substance that slows the release of histamine, protects the body from the effects of excessive or prolonged inflammation
Box 13-1 pg 180
Rubella (German Measles)
Anything you are normally vaccinated against
Food borne illnesses
Medical = clean technique, limiting the spread of micro's as much as possible.
Surgical = sterile technique, eliminating micro's from any object that comes in contact with a pt.
Washing hands in between tasks and procedures on a pt can prevent cross-contamination
Washing hands before and after gloving and in between pt care
-Flowers/potted plants avoided due to reservoir for bacterial growth
-No fresh fruits/veggies if WBC low
-Visitors need good hand hygiene
-May need private room, aseptic techniques
-Monitor s/s infection q2-4h
-only canned or cooked foods
Pt's should wear 100% cotton clothes to prevent static electricity to reduce risk of fire.
You can prevent pressure build up in ears by swallowing
No smoking several hours before and after procedure to decrease lung irritation.
-Keep a/c ducts clean so that air being blown does not become a mode of transfer for fungi spores
-Clean infectious spills 1:10 part bleach
1. First line of defense (humoral) antigen binds to a B-lymphcytes
2. Antibodies are produced for that specific antigen.
3. Antibodies seek out (stick to) & bind w/specific antigens.
4. The circulating antigen-antibody complexes are targeted & destroyed by phagocytes (neutros and phagos)
5.Antibodies continuously replenish and the chemical is then triggered immediately, IgG
Anti-chlorinergic receptor agonist
Testing ID for specific allergens. After they are id'd the pt may be desensitized by having small amounts of the allergen injected into them. Desensitizing is aimed at increasing tolerance to the offending allergen and decreasing the severity of the response.
Emergency situation that needs rapid intervention. The most common cause of anaphylaxis is the use of antimicrobials, like penicillin.
Respiratory function, establish airway, admin 02,
IV epi, aminophylline, Benadryl, corticosteroids.
IV fluids, respirations, heart rate, color, O2 sat, until pt is fully recovered.
-decrease laxative use
-eat fresh fruits/veggies/whole grain cereals
-Malnutrition and anemia due to the loss of the basic bowel process
-bicarbonates are lost with severe dehydration.
-Monitor potency of tube suction, make sure set at ordered level
-if tube is not draining reposition pt, gently rotate the tube or pull out.
**IF PT HAS HAD GASTRIC SURGERY ***DO NOT** REPOSITION TUBE***, just move pt.
Occurs with rapid feedings of concentrated formulas.
S/S: cold sweat, abdominal distention, dizziness, weakness, rapid pulse, nausea, vomiting, diarrhea.
-Catheter insertion must be sterile technique
-Monitor s/s of infection
-Monitor flow rate
-Monitor blood glucose and check for hyperglycemia
-bypasses the intestines
-label TPN lines
-DO NOT USE Tpn CATHETER FOR MEDICATION ADMINISTRATION
-TCDB (turn-cough-deep breath)
-splinting the incision area decreases pain by supporting the muscles therefore allowing better lung expansion
Assist w/oral hygiene before and after meals
Teach proper oral care
make sure dentures fit properly
refer to dental care if needed
-Head should be slightly forward
Tilting the head back not only makes it more difficult to eat but also increases the risk of aspiration.
Pt's who have stents placed in esophagus should be told how to reduce risk of regurgitation of stomach contents.
-Eat only small meals
-Remain upright several hours after eating
-Avoid laying flat
-HOB at 30 degrees at all times
Foods and fluids should not be taken w/I 2-3 hours before bed.
Eating at bedtime encourages reflux.
-pulse and pressure w/I pt's norms
-moist mucous membranes
-equal input and output
-no s/s of fever
-normal WBC count
Early signs of shock: weakness, tachycardia, and pallor.
-Roll pt flat on back
-if you suspect hemorrhage, notify RN or Dr immediately while continuing to monitor vitals.
-antidiarrheal (except severe colitis)
-antibiotic agents (sulfa's, cipro)
-iron supps and B12
increase fluid intake.
high vitamin C
development of pressure ulcers
>14 lower risk
<14 higher risk
will not blanch
Partial thickness loss of dermis
Full thickness loss of dermis
Fat may be visible
bone tendon or muscle not exposed
-full thickness loss of tissue
-bone tendon or muscle will be exposed.
long term constipation causes fecal impaction,
hard or putty like feces in colon
may have watery stools, cramps, a feeling of fullness, abd distention.
fluids and fiber
offer a commode or bedpan q 2hrs
adjust based on pt patterns
gravity assists with flow to bladder, when pt lying urine pools and Increases risk for UTI
urinary system works best while upright,
Albumin and its function
Coagulation factors in the liver
Glycogen that is broken down into glucose for use when needed=Glycogenolysis
Liver converts/breaks down by products of the metabolism in the body.
scaring of the liver.
2 elements liver synthesizes to aid in coagulation,
Prothrombin is a blood clotting protein.
-Pneumothorax caused by puncture of lung.=restlessness tachypnea
-hemmorage=tachycardia, hypotension, restlessness
Keep pt on Right side for 2 hours
Light or clay colored stool
-med to high protein
-mod to low fat
monitor for pneumonia
turn cough and deep breath.
hepatitis pt at risk
at least 3000cc of fluid unless contraindicated
If edema increased abd girth, increased B/P indicate fluid overload ? intake
-H2O and sodium can be restricted
-cathartics (diuretics) and abx for hepatic encephalopathy
portal vein delivers blood from intestines to the liver.
high pressure causes collateral vessels to develop.
form in the esophagus, anterior abd wall and rectum
distended or engorged vessels in esophagus
pt should avoid irritants= ATOH, coarse foods, lifting coughing or straining,
the tube must be cut and removed by trained person
a manual pump is placed under the skin to remove fluid from peritoneum
cholecystectomy post op diet
Alpha cells produce and secrete glucogon
Beta cells produce and secrete insulin.
Delta cells produce somatostatin
signs and symptoms of bleeding and shift of fluid reduce volume restlessness
Hypotension is a late sign of blood loss
bed rest allows liver to heal
turn cough deep breath
turn every 2 hours
monitor skin for breakdown
dark concentrated urine
will have increased sodium and decreased water in body
people with high potassium should limit what foods
-drink with water to prevent GI irritation.
-monitor heart for cardiac dysrhythmias
-monitor I and O's
hyperchloremia leads to
binds to sodium and potassium
a hyperventilating pt
will go into
-random movement of particles in all directions
-particles naturally move from low to high concentration
elevated levels of hemoglobin, hematocrit
Abnormally high K
Sx= arrhythmias dysrhythmias.
- caused by vomiting and diarrhea and sweating
anorexia abd distention muscle pn N/V/D dysthymias
-start at age 30
drug therapy for pt's with RA
NSAID's are preferred
glucocorticoids are avoided because of side effect
educate and support
stay up for 30min after
take on empty stomach
take with 6-8 oz of water.
Disease modifying anti-rheumatics drugs
apply moist warm compress before activities,
pt will be limited for ADL
don't cross legs
don't tie shoes
don't flex hips >90 deg
keep pillow between legs
sit rather than stand
maintain proper posture and body alignment
stay on top of pain
take meds on time don't skip a dose
for pt c connective tissue disorders
if NSAID's upset the stomach
stenosis of the esophagus
raise the head of bed and small frequent meals
oral and genital ulcers
pain with sexual activity
causes sexual dysfunction
verify time of last pain med
decreases risk of a med being given to soon
monitor for bleeding
check dressings and report changes to RN
impaired gas exchange
removes diseased tissue or correct defects
ablation= removal of tissue
over 70 have increased risk for surgical complications
malnourished pt at risk for poor wound healing
need additional time to recover from anesthesia,
med remains longer in adipose tissue
history and present illness
past medical history
dehiscence and evisceration
adequate resp and circulation
absent of complications
gag reflex is present
a solution that is greater that 300mEq
has more of the solvent
D5 1/2 NS
every hour to ensure proper rate of infusion
to monitor condition and complications
should be diluted
never given in line
Observe site for redness swelling and pain
put on clean gloves
place a 2x2 dressing over site
chart findings and action
is not a sterile procedure clean only
gloves protect nurse from body fluids
common distraction helps keep pt from messing with site
maintain lines out of site
fluids go into tissue around IV site
stop IV and contact MD to restart at another site .
drugs that are toxic to tissues
signs and symptoms of fluid overload
lung sound associated with fluid overload
post void catheterization
monitor for post void residual less than 50ml is normal
more than 50ml is abnormal needs evaluation
used for C&S testing ordered to assess infection
cloudy urine means
presence of sediment or WBC's
done to check for BUN and creatinine
as well as glucose and calcium
encourage to delay voiding
toileting schedule encouraged to void every 2-3 hours
pt should be praised for using toilet
external urine collection device
removed periodically to clean and replace
Document that the pt has a pessary
involuntary loss of urine
avoid coffee tea cola
pt voids inappropriately because of inability to get to the toilet or manage mechanics of toileting
R/T confusion immobility or barriers in the environment
incontinence due to meds
maintain a 1500-3000mL of fluid unless contraindicated
raw fruits and veggies
bannanas, rice bread potatoes cheese yogurt oatmeal
medical Tx of fecal overflow
pelvic floor exercises and biofeedback
surgical intervention may be needed to repair anal sphincter
common side effects of lasix?
signs of of hypokalemia, also for HTN,
what is mastery?
-the end result of coping strategies, problems solved competently, family functions healthily