Chapters 13-16

Medical Math

• Medical math is essential for accurate medication administration, diagnostic testing, and treatment planning.

• Errors in calculations can lead to serious patient harm, emphasizing the importance of accuracy.

Arithmetic

• Addition, subtraction, multiplication, and division.

• Example: Calculate total fluid intake for a patient

Fractions

• Understanding parts of a whole.

• Simplifying fractions and converting between mixed numbers and improper fractions.

• Example: Administering half a dose of medication (1/2 or 0.5).

Decimals

• Place value understanding and rounding.

• Converting between fractions and decimals.

Percentages

• Calculating percentages for solutions or concentration.

1. Ratios and Proportions:

• Used to express relationships and solve dosage calculations.

Metric System Units of Measurement

• Length: Meter (m), centimeter (cm), millimeter (mm).

• Volume: Liter (L), milliliter (mL).

• Weight: Kilogram (kg), gram (g), milligram (mg), microgram (mcg).

1. Metric System Conversions:

• Length:

  • 1 meter = 100 centimeters = 1000 millimeters.

• Volume:

  • 1 liter = 1000 milliliters.

• Weight:

  • 1 kilogram = 1000 grams = 1,000,000 milligrams.

Household System Common Units

• Teaspoons (tsp), tablespoons (tbsp), cups, pints, quarts.

Household System Conversions

• 1 teaspoon = 5 milliliters.

• 1 tablespoon = 15 milliliters.

• 1 cup = 240 milliliters.

Military Time

1. 24-Hour Clock:

   • Used in health care to avoid confusion between AM and PM.

   • Example: 1:00 PM = 1300 hours; 11:00 PM = 2300 hours.

Dosage Formula

• D (Desired dose) ÷ H (Dose on hand) × Q (Quantity of dose form) = Amount to administer.

1. Pediatric Dosages:

• Often calculated based on weight.

1. IV Flow Rates:

• Formula: Volume (mL) ÷ Time (minutes) × Drop Factor (gtt/mL) = Flow Rate (gtt/min).

1. Medication Administration:

• Ensure correct calculations for oral, intravenous, and intramuscular medications.

1. Patient Monitoring:

• Calculate and interpret fluid intake and output.

1. Diagnostic Testing:

• Use appropriate units and calculations for lab results and imaging studies.

Safety in Health Care

• Safety in health care ensures the protection of patients, staff, and visitors.

• Adherence to safety protocols reduces accidents, injuries, and exposure to hazards.

Body Mechanics

• Body mechanics involves the coordinated use of muscles, bones, and joints to perform movements efficiently and safely.

Key Principles of Body Mechanics

• Maintain a broad base of support: Feet shoulder-width apart.

• Bend from the hips and knees, not the waist.

• Use the strongest muscles (legs) for lifting.

• Hold objects close to the body.

• Avoid twisting the spine; turn the entire body instead.

• Push or pull objects rather than lift them when possible.

Benefits of Body Mechanics

• Prevents musculoskeletal injuries.

• Reduces fatigue and strain.

• Ensures patient and worker safety.

Preventing Environmental Accidents

• Keep hallways and work areas free of clutter.

• Use wet floor signs to warn of slippery surfaces.

• Ensure adequate lighting in all areas.

1. Handling Equipment:

• Regularly inspect and maintain medical devices.

• Follow manufacturer guidelines for safe use.

• Report malfunctioning equipment immediately.

1. Patient Safety:

• Verify patient identity before procedures or medication administration.

• Ensure proper use of side rails, restraints, and call lights.

1. Standard Precautions for Infection Control

• Assume all blood and bodily fluids are infectious.

• Use personal protective equipment (PPE) such as gloves, masks, and gowns.

1. Hand Hygiene:

• Wash hands for at least 20 seconds with soap and water.

• Use alcohol-based hand sanitizer if soap and water are unavailable.

1. Material Safety Data Sheets (MSDS):

• Provide detailed information about chemicals used in the workplace.

• Include instructions for handling, storage, and first aid.

1. Disposal of Hazardous Waste:

• Follow regulations for segregating and disposing of infectious waste, sharps, and chemicals.

• Use puncture-resistant containers for needles and other sharps.

1. Disaster Plans:

• Familiarize yourself with facility-specific protocols for natural disasters, chemical spills, and mass casualty events.

• Participate in regular emergency drills.

1. Evacuation Procedures:

• Assist patients with mobility limitations first.

• Follow designated evacuation routes and assembly points

1. First Aid Training:

Learn basic first aid and CPR techniques to respond effectively in emergencies.

Workplace Violence Prevention

• Workplace violence includes physical assaults, verbal abuse, and threatening behavior.

1. Role of OSHA:

• Establishes and enforces safety standards in the workplace.

• Conducts inspections to ensure compliance.

1. Employer Responsibilities:

• Provide safety training and equipment to employees.

• Maintain a safe and hazard-free work environment.

1. Employee Rights:

• Access to information about workplace hazards.

• Right to report unsafe conditions without fear of retaliation.

Infection Control

• Infection control involves practices and procedures to prevent the spread of infections in health care settings.

• Protects patients, health care workers, and the community.

Microorganisms

• Small living organisms that are invisible to the naked eye.

• Found everywhere, including on and inside the human body.

1. Types of Microorganisms:

Bacteria, viruses, fungi, protozoa, helminths

Bacteria

• Single-celled organisms.

• Can be beneficial (gut flora) or pathogenic (cause diseases like strep throat).

Viruses

• Smallest microorganisms.

• Require a host to reproduce.

Fungi

• Plant-like organisms.

• Cause conditions like athlete’s foot and yeast infections.

Protozoa

• Single-celled animals found in contaminated water.

• Helminths:

• Parasitic worms.

Chain of Infection

Infectious Agent, Reservoir, Portal of exit, mode of transmission, portal of entry, susceptible host

Infectious Agent

• Pathogen causing the disease.

Reservoir

Place where the pathogen lives (e.g., humans, animals, surfaces)

Portal of Exit

• Path by which the pathogen leaves the reservoir (e.g., respiratory droplets, blood).

Mode of Transmission

How the pathogen spreads

Portal of Entry

Path by which the pathogen enters a new host

Susceptible Host

• Individual at risk of infection.

1. Breaking the Chain of Infection

Hand hygiene, sterilization, proper disposal of waste, and vaccinations.

Aseptic Techniques

• Methods used to maintain cleanliness and prevent contamination.

1. Personal Protective Equipment (PPE):

• Gloves, masks, eye protection, and gowns.

• Use PPE as required by the task and level of exposure.

1. Hand Hygiene:

• Wash hands with soap and water for at least 20 seconds.

• Use hand sanitizer if hands are not visibly soiled.

1. Airborne Precautions:

• Used for diseases spread through the air (e.g., tuberculosis, measles).

• Patients placed in negative pressure rooms.

• Health care workers wear N95 respirators.

1. Droplet Precautions:

• Used for diseases spread by large droplets (e.g., influenza, pertussis).

• Masks required for close contact.

1. Contact Precautions:

• Used for diseases spread by direct or indirect contact (e.g., MRSA, C. difficile).

• Gloves and gowns required.

Sterilization

• Destroys all microorganisms, including spores.

• Methods include autoclaving and chemical sterilants.

1. Disinfection:

• Eliminates most pathogens but not all spores.

• Common disinfectants include bleach and alcohol-based solutions.

1. Antiseptics:

• Applied to living tissues to reduce microbial growth (e.g., iodine, alcohol wipes).

Bloodborne Pathogens

1. Examples:

   • Hepatitis B (HBV), Hepatitis C (HCV), and Human Immunodeficiency Virus (HIV).

2. Prevention:

   • Follow standard precautions.

   • Dispose of sharps in puncture-resistant containers.

   • Use gloves when handling bodily fluids.

1. Biohazard Disposal:

• Use labeled containers for contaminated materials.

• Separate infectious waste from general waste.

1. Sharps Disposal:

• Place needles and other sharp objects in designated sharps containers.

• Do not overfill containers to avoid injuries.

Vital Signs

• Vital signs are critical indicators of a patient’s health status.

• They include temperature, pulse, respiration, and blood pressure.

• Pain is often considered the "fifth vital sign."

Temperature

• Measures the balance between heat produced and heat lost by the body.

Normal Ranges of Temperature

• Oral: 97.6°F - 99.6°F (36.5°C - 37.5°C).

• Rectal: 98.6°F - 100.6°F (37°C - 38.1°C).

• Axillary: 96.6°F - 98.6°F (35.9°C - 37°C).

• Tympanic: Similar to oral.

• Temporal: 97.2°F - 100.1°F (36.2°C - 37.8°C).

1. Methods of Temperature Measurement

• Oral, rectal, axillary, tympanic (ear), and temporal (forehead).

• Rectal is the most accurate; axillary is the least accurate.

1. Factors Affecting Temperature:

• Age, environment, activity level, time of day, and illness.

1. Abnormal Temperatures:

• Hypothermia: Below 95°F (35°C).

Hyperthermia/Fever: Above 100.4°F (38°C).

Pulse

• The pressure of the blood against the walls of an artery as the heart beats.

1. Common Pulse Sites:

• Radial: Wrist.

• Carotid: Neck.

• Brachial: Inside the elbow.

Apical: Over the heart, using a stethoscope.

1. Normal Pulse Ranges:

• Adults: 60-100 beats per minute (bpm).

• Children: 70-120 bpm.

• Infants: 100-160 bpm.

Characteristics of Pulse:

• Rate: Number of beats per minute.

• Rhythm: Regularity of beats (regular or irregular).

• Volume: Strength of the pulse (strong, weak, thready).

1. Abnormalities:

• Tachycardia: Pulse over 100 bpm.

• Bradycardia: Pulse under 60 bpm.

Respirations

• The process of taking in oxygen and expelling carbon dioxide.

1. Normal Respiration Ranges:

• Adults: 12-20 breaths per minute.

• Children: 16-30 breaths per minute.

• Infants: 30-50 breaths per minute.

1. Characteristics of Respirations:

• Rate: Number of breaths per minute.

• Rhythm: Regularity of breaths (regular or irregular).

• Depth: Volume of air exchanged (shallow or deep).

1. Respiratory Abnormalities:

• Dyspnea: Difficult breathing.

• Apnea: Absence of breathing.

• Tachypnea: Rapid breathing (>20 breaths per minute).

• Bradypnea: Slow breathing (<12 breaths per minute).

Blood Pressure

• The force of blood against the walls of the arteries during heart activity.

1. Components of BP

• Systolic Pressure: Pressure during heart contraction (top number).

• Diastolic Pressure: Pressure during heart relaxation (bottom number)

1. Normal BP Ranges:

• Systolic: 90-120 mmHg.

• Diastolic: 60-80 mmHg.

• Normal: 120/80 mmHg.

1. Abnormal Blood Pressure:

• Hypertension: High blood pressure (140/90 mmHg or above).

• Hypotension: Low blood pressure (below 90/60 mmHg).

1. Measuring Blood Pressure:

• Use a sphygmomanometer and stethoscope.

• Ensure the patient is seated or lying down with the arm at heart level.

Assessing pain

• Numeric pain scale (0-10).

• Wong-Baker FACES scale for nonverbal patients.

1. Pain Characteristics:

• Location, intensity, duration, and type (sharp, dull, burning).

Importance of pain as a vital sign

• Provides insight into the patient’s condition and guides treatment.

Documentation of Vital Signs

• Record values accurately and immediately.

• Note any abnormalities and report to the supervising health care professional.

Age affecting vitals

• Younger individuals tend to have higher pulse and respiration rates.

Activity levels affecting vitals

• Exercise increases heart rate and respiratory rate temporarily.

Medications affecting vitals

• Some drugs can elevate or depress vital signs.

Environment affecting vitals

• Hot or cold surroundings affect body temperature and respiratory rate.