NPTEFF-- Non/Other Systems Bootcamp

Hickman catheter

location

--insertion through cephalic or internal jugalar vein

use

--long term drug admininstration

--chemo, antibiotics

Swanz-Ganz catheter

location

--soft flexible catheter inserted through vein (usually jugular or femoral) and reaching the pulmonary artery

use

--monitors pulmonary artery pressure and heart function

Arterial line

location

--inserted into artery and attached to monitoring system

use

--measure blood pressure and ABGs

Central venous pressure catheter

location

--indwelling venous catheter with a manometer

use

--measures pressure in right atrium or SVC, right ventricle function, and circulating blood volume

cautions with lines and tubes

--chest tube, catheter, IV line, arterial line, femoral line

chest tube

--positive pressure is contraindicated, if dislodged have pt exhale and plaze gauze or gloved hand over and call nurse

catheter

--hang below level of bladder, don't empty if output is monitored, alert staff if overfilled

IV line

--arm should not be held above head for extended periods

arterial line

--if dislodged, apply firm pressure and alert nursing staff

femoral line

--avoid repetitive hip flexion more than 45 deg

CPR guidelines

1. Check environment/scene for safety

2. Activate emergency response and get AED if available

• If a child or infant and unwitnessed collapse give CPR x 2 min then activate emergency/get AED

• If a second rescuer, second person activates/gets AED, begin CPR immediately, use AED when available

3. Compression-ventilation ratio

--Adults: 30:2, 100-120 bpm, 1 breath per 6 seconds

--Children 30:2 for one rescuer, 15:2 if two rescuers, 100-120 bpm, 1 breath per 2-3

seconds

4. Compression depth and hand placement

--Adults: 2 inches, 2 hands on lower sternum

--Child/infant: 1/3 AP chest diameter

(2 inch in child, 1.5 inch in infant), 1 hand in small child, 2 fingers in infant center of chest

5. Limit chest compression interruptions to <10 seconds

contact precautions

lice, scabies, impetigo, uncontrolled diarrhea, HepA, HepB, dermatitis, rota virus, MRSA, VISSA, VRE, clostridium

hand washing, gloves, and gown

private room without negative air flow

minimize transport, pt washes hands if they leave room

droplet precautions

mumps (rubella), streptococcus a, mengingitism pneumonia, influenza, pertussis

hand washing, gloves, and mask w/in 3ft of pt

--contact precautions only when skin lesions present

private room without negative air flow

minimize patient transport, pt wears mask if leaving room

airborne precautions

(MTV) measles, tuberculosis, varicella, SARS, herpes zoster, chickenpox, small pox

hand washing with gloves, gown, and N95 mask

private room with negative air flow, keep door closed

minimize patient transport, pt wears mask if leaving room

types of data

parametric (measurable quantity)

--interval: equal intervals, no true zero

IE: MCAT score, credit score, IQ score

--ratio: equal intervals, but has a true zero (zero is an actual zero value)

IE: ROM values, weight, height, time value

nonparametric data (NO measure, quality)

--nominal: different categories, no zero, no order/rank, no intervals

IE: sex, ethnicity, blood type, eye color

--ordinal: categories which are ordered/ranked but interval is not measurable or equal

IE: MMT grades, low vs middle vs high income status, level of agreement, political status

meaning of reliability

reliability

--refers to if the test can be accurately repeated or reproduced

types of reliability

intra rater

--accuracy of repeated measurements taken by the same tester

inter rater

--accuracy of repeated measurements taken by different testers

test retest

--same test repeated on same individual at different time

meaning of validity

how well an instrument measures what it is intended to measure

IE: goniometer has strong validity for measuring ROM but weak validity for measuring balance

pretest-posttest research design

1. study sample that has random assignment into

--experimental group OR control group

2. pre test measure/observation taken

3. application of independent variable

--experimental intervention OR no intervention/placebo

4. post test measure/observation taken

wheelchair measurements: seat height

how to measure

-- heel to popliteal fold (plus 2 inches)

average measure

-- 19.5-20.5 inches

wheelchair measurements: seat depth

how to measure

-- posterior buttock along lateral thigh to popliteal fold (minus 2 inches) (along lateral length of femur)

average measure

-- 16 inches

wheelchair measurements: seat width

how to measure

-- widest aspect of buttocks/thighs (plus 1.5-2.0 inches)

average measure

-- 18 inches

wheelchair measurements: back height

how to measure

-- chair seat to axilla (minus 4 inches) (consider any seat cushions and add thickness to final value)

average measure

-- 16 inches

wheelchair measurements: armrest height

how to measure

-- seat of chair to olecranon (plus 1 inch) (consider cushion thickness)

average measure

-- 9 inches

wheelchair axel positioning

normal axel positioning (axel of back wheels)

--in line with shoulder or slightly posterior

for bariatric patients (obese pts)

--move rear wheel axel anterior

for bilateral transfemoral amputee patients

--move rear wheel axel behind pts shoulders

--amputations cause more COM to move posterior in chair so need to compensate with further posterior axel

wherever weight is moving-- thats the direction axel moves

wheelchair propulsion: propulsion phase

apply a smooth, continuous push on the push rims, extending arms forward

--this motion propels the wheelchair

wheelchair propulsion: recovery phase

after the push, release the push rims and bring hands back to starting position

--ready for the next push

wheelchair propulsion: turns

pull one wheel backward and other wheel forward

turn right

--push L wheel forward and R wheel backward

turn left

--push R wheel forward and L wheel backward

wheelchair propulsion: wheelie

patient places hands back on hand rims, then push rims forward abruptly and forcefully

wheelchair propulsion: ascending curb

Ascending curb:

-- Lift the front casters onto the curb by performing a small wheelie

-- Push forward on the push rims to lift the

rear wheels onto the curb

wheelchair propulsion: descending curb

Descending curb:

-- Perform a wheelie and descend with rear

wheels off the curb followed by castor

wheels

OR

-- Descend backwards: Allow the rear wheels

to slowly roll off the curb, followed by the

castor wheels

assistive devices: standard crutches (axillary crutches)

Standard Crutches (Axillary Crutches)

-- Axilla space of approx. 2 inches

-- Crutch is approx. 2 inches lateral and 4-6 inches anterior to the patient’s toe of the shoe

-- Elbow flexion approx. 20-25 degrees when grasping handpiece

assistive devices: forearm crutches (lofstrand crutches)

Forearm Crutches (Lofstrand Crutches)

-- Top of forearm cuff is just distal to elbow, approx. 1.0-1.5 inches below olecranon process

-- Crutch is approx. 2 inches lateral and 4-6 inches anterior to the patient’s toe of the shoe

-- Elbow flexion approx. 20-25 degrees

assistive devices: cane

Cane

-- Always goes on the opposite side

-- Cane is approx. 2 inches lateral and 4-6 inches anterior to the patient’s toe of the shoe

-- Elbow flexion approx. 20-25 degrees

-- Ascending = Good foot goes up first, followed by bad foot and cane

-- Descending = Bad foot and cane first, followed by good foot

therapist positioning: level ground ambulation

Stand behind and slightly toward the patient’s affected lower extremity

Therapist’s hand should be nearest to the patient to grasp under the back of the gait belt with forearm supinated

Therapist should move forward in step/in sync with the patient; PT’s forward foot moves with the assistive device

therapist positioning: stair navigation

Ascending positioning

-- Therapist should be positioned posterolateral (to the patient’s weak side)

-- Grasp the gait belt with one hand; be prepared to use your other hand to control the trunk

-- Advance your feet up one step after the patient has advanced one step, but maintain your feet in an anteroposterior position

Descending positioning

-- Therapist should be positioned anterolateral (to the patient’s weak side)

-- Grasp the gait belt with one hand

-- Do not allow the patient to develop momentum when descending the stairs.

for BOTH: PTs feet should be on two separate stairs to maximize stability if pt falls

assistive device stability (MOST to LEAST stable)

terms to use

--axillary crutches

--single point cane

--parallel bars

--quad cane

--forearm crutches

--walker

--hemi walker

1. Parallel bars

2. Walker

3. Hemi walker

4. Axillary crutches

5. Forearm crutches

6. Quad cane

7. Single point cane

lifts and transfers: 3 person lift

Used to transfer a patient from a stretcher to a bed or treatment plinth

lifts and transfers: 2 person lift

Used to transfer patients of different heights or surfaces or transferring to the floor.

lifts and transfers: dependent squat pivot transfer

Used to transfer a patient who cannot stand independently but can bear some weight through the trunk and lower extremities.

lifts and transfers: hydraulic lift

Used for dependent transfers when the patient is obese, there is only one therapist available to assist with the transfer or patient is totally dependent

ramps and slopes: standard measures

32 inches for doorway

36 inches for hallway (no turning required)

1:12 ratio for stair/ramp (7in is one stair)

--1 inch of stair for 12inch ramp

wooden floors

Metabolic syndrome (definition and criteria for dx)

consists of signs and symptoms that are risk factors and are strongly linked to type 2 diabetes, cardiovascular disease, and stroke.

A diagnosis is made if 3 or more are present:

Waist circumference

-- > 40 inches in men or > 35 inches in women

Fasting Plasma Glucose

-- > 100 mg/dL

Blood Pressure Systolic

--130 mmHg (or higher) and/or diastolic BP = 85 mmHg (or higher) (stage 1 HTN)

High Density Lipoprotein (HDL)

-- < 40 mg/dL in men or < 50 mg/dL in women

--HDLs are good so they should be high in healthy adults

Triglycerides

--150 mg/dL or higher

WEIGHHT

--weight expanded

--impaired glucose

--hypertension

--HDLs

--triglycerides

Hypothalamus-- regulation

responsible for regulation of ANS

sends signals to anterior and posterior pituitary glands

Anterior pituitary gland-- regulation

ACTH

--to adrenal cortex

--which releases cortisol and aldosterone

TSH

--to thyroid gland

--which releases T3 and T4

FSH, LH

--to ovaries and testes

--which releases estrogen, progesterone, testosterone

GH

--to bones and tissues

--promotes growth and metabolism

Prolactin

--milk production in breasts

what does cortisol stimulate?

regulates stress, glucose, regulates BP, anti-inflammatory

what does aldosterone stimulate?

retains sodium and water

excretes potassium (kicks out K)

Posterior pituitary gland-- regulation

ADH aka Vasopressin

--regulates water and mineral balance, water retention

Oxytocin

--stimulates uterine contractions during birth, skin to skin contact

Thyroid gland-- regulation

produces hormones that act to control the rate at which cells burn the fuel from food

Parathyroid gland-- regulation

regulate calcium and phosphate metabolism

Adrenal gland-- regulation

produces corticosteroids that will regulate water and sodium balance, the body's response to stress, the immune system, and metabolism

Addison's disease

Adrenal insufficiency

--decreased cortisol and aldosterone

--decreased BP, dehydration

--hyperkalemia

--decreased glucose

--weight loss, anorexia, GI issues

--general weakness

--intolerance to cold and stress

--anxiety and depression

bronze pigmented skin

aDDisons

DD-- double decreased

little Ms. Addisons

Cushing's disease

Overactive adrenal gland

--elavated cortisol and aldosterone

--increased BP and water retention

--hypokalemia

--increased glucose

--weight gain, round moon face

--proximal muscle weakness and atrophy

--intolerance to heat

--osteoporosis

red, ruddy appearance

Cushings is cushy and chubby

Cushing's disease vs Cushing's syndrome

Cushing's disease

--pituitary issue with more ACTH secretion

--stimulates adrenal gland and more cortisol released

Cushing's syndrome

--adrenal gland tumor

--secretes more cortisol leading to drug toxicity

symptoms common for both

Hyperthyroidism (Grave's disease)

increased T3 and T4, low TSH

--increased HR

--low BP

--high BMR (metabolism)

--heat intolerance

--restlessness, insomnia

--hyperreflexia

--diarrhea

--increased perspiration

--weight loss and increased appetite

--silky skin, moist palms

increased glucose absorption into body (less in blood)

graves like death valley (hot in arizona)

Hypothyroidism (Hashimoto's disease)

decreased T3 and T4, high TSH

--decreased HR

--high BP

--low BMR (metabolism)

--cold intolerance

--sleepy

--proximal muscle weakness

--delayed reflex response

--constipation

--decreased perspiration

--weight gain and decreased appetite

--dry skin and hair, brittle nails

decreased glucose absorption into body (more in blood)

Hyperparathyroidism

high calcium in blood and low phosphate

--can demineralize bone; low density

--glove and stocking sensory loss

osteopenia, peptic ulcers, kidney stones, renal insufficiency, fatigue, depression, confusion

hypercalcemia causes short QT interval

Hypoparathyroidism

low calcium and high phosphorus

--muscle cramps

--fingers and mouth sensory loss

convulsions, cardiac arrhythmias, muscle twitching, muscle cramps/spasms, tetany, fatigue, weakness

hypocalcemia causes prolonged QT interval

Type 1 Diabetes Mellitus (DM)

Pancreas produces no insulin → insulin dependent DM

Diagnosed mostly at childhood, but can be any age

Symptoms:

--Polyphagia, weight loss, ketoacidosis, polyuria, polydipsia, blurred vision and dehydration

ketoacidosis is a medical emergency (body excessively uses fat instead of glucose for energy; acetone fruity breath)

Type 2 Diabetes Mellitus (DM)

Body's resistance to insulin → insulin resistant DM

Occurs secondary to other dysfunctions

Symptoms:

--Similar to Type 1 with rare occurrence of ketoacidosis

fasting blood glucose level

> 126 mg/dL

random blood glucose level

measured at any time

> 200 mg/dL

hemoglobin A1C (HbA1c) level

avg glucose level over span of 3mo

> 6%

normal is 4-6%

immediate insulin needed over 10%

Hypoglycemia

glucose < 70 mg/dL

--pallor, sweating

--shakiness

--poor concentration

--tachycardia

--dizziness, faint

--excessive hunger

Hyperglycemia

glucose > 300 mg/dL

--weakness

--dry mouth

--frequent urination

--dull senses, confusion

--diminished reflexes

--excessive thirst

exercise and diabetes (do's and dont's)

--avoid extreme temps

--do not exercise at peak of insulin (2-4 hrs)

(bc exercise increases insulin in general so there will be excessive insulin causing low blood sugar and hypoglycemia)

--provide initial carb snack

-exercise in morning

exercise and diabetes (FITT principle)

-- 3-7 days per week

-- 11-13 RPE (can go up to 17)

-- at least 150 min/week

-- moderate intensity

blood glucose levels for exercise

100 - 250 = safest

70 - 99 = carb snack

< 70 or > 300 = contraindication

> 250 = assess for ketoacidosis

(if ketones then NO, if no ketones then proceed with caution)

stress incontinence (definition and treatment)

Involuntary leakage of urine during cough, sneezing, or exertion. Can be seen postpartum, pelvic floor muscle weakness.

treatment

--strengthen pelvic floor muscles

urge incontinence (definition and treatment)

Involuntary contraction of the detrusor muscle with a strong desire to void (urgency). Can be seen with infections, Parkinson's disease, UMN lesions.

treatment

--treat infections; voiding schedule

overflow incontinence (definition and treatment)

Incontinence caused by an acontractile or underactive detrusor muscle. Bladder is

overdistended, can not empty completely, and urine dribbles or leaks out. Can be seen with benign prostatic hyperplasia, DM.

treatment

--behavior mods like double voiding, meds, catheter

functional incontinence (definition and treatment)

Incontinence due to mobility, dexterity, or cognitive deficits. Can be seen with dementia, lower extremity weakness.

treatment

--clear clutter, improve accessibility to bathroom, prompt voiding

Benign prostatic hyperplasia

hypertrophy of the prostate glands causing narrowing of the urethra resulting in an increase in urinary retention and dilation of urinary bladder

pregnancy-- MSK changes

weight gain 25-35lbs

postural changes

--forward head, kyphosis, increased lordosis, anterior pelvic tilt

--postural stress continues postpartum d/t lifting and carrying baby

treatment

--postural education, stretching tight muscles, strengthening weak muscles

--pelvic stabilizations, pelvic tilts

pregnancy-- CVP changes

BP is LOW in 1st and 2nd trimester

--increases in 3rd trimester

supine lying can cause compression of IVC and decreases CO

--STOP after 1st trimester (or else will cause supine hypotensive syndrome

resting HR increases 10-20 bpm

--work of breathing increases

left side lying is considered the best

--decreases compression to IVC ansd maximizes CO

--also decreases GERD as internal organs are relaxes

--improves maternal and fetal circulation

HR does not proportionally increase with exercises

pregnancy-- metabolic rate, heat production, and fasting blood glucose levels

metabolic rate and heat production

--increases

normal fasting blood glucose levels

--decrease

preeclampsia

Pregnancy-induced acute hypertension after the 20th week of pregnancy

Presentation

--increase in protein in urine, hyperreflexia, edema, headache, sudden weight gain seen

Diagnosis confirmed

--a blood pressure reading more than 140/90 mmHg

--second abnormal blood pressure reading four hours after the first confirms the diagnosis

It is an emergency!

gestational diabetes

a form of diabetes mellitus that occurs during some pregnancies ONLY

--lowered production of insulin and blood glucose increase

--after birth, levels become normal

eclampsia

NOT during pregnancy

seen after birth

--more severe than preclampsia

characterized by seizures

ectopic pregnancy

when fertilized egg is not implanted in the uterus

--it is anywhere else in uterine cavity; usually in fallopian tubes

--not safe, needs to be terminated

--bterm-72leeding occurs

pregnancy-- contraindicated to exercise

heart disease with unstable hemodynamics

RLD

incompetent cervix

--early dilation of cervix before full term

vaginal bleeding

placenta previa

--after 26 weeks

--placenta located where it may detach before delivery

preclampsia or pregnancy-induced HTN

rupture of membranes

--loss of amniotic fluid before labor

premature labor

--labor beginning before 37th week of pregnancy

uncontrolled maternal T1 DM

severe anemia

pregnancy-- treatment for diastasis recti

> 2 cm

--abdominal bracinjg and head lift

--progress >>> bracing, head lift, and posterior pelvic tilt

> 4 cm abdominal bracing and breathing exercises

gastroesophageal reflux disease (GERD)

backflow of contents of the stomach into the esophagus, often resulting from abnormal function of the lower esophageal sphincter, causing burning pain in the esophagus

s/s

--heart burn after eating/lying down

--dysphagia

--hoarseness of voice

--atypical pain of head and neck

complications

--aspiration pneumonia, asthma

--esophagitis

GERD treatment

Maintain upright positions

Eat meals at least 3-4 hours before sleep

AVOID supine: tends to straighten the esophagus

Sleep on the LEFT side preventing nocturnal reflex

Exercise must be completed 2-3 hours after eating or before meals

AVOID spicy, chocolate, and fatty food

Drugs

--Antacids

--H2 receptor blockers

--Proton pump inhibitors

pain referral locations

--mid back, scapula

--shoulder

--pelvic, low back, sacrum

mid back; scapula

--esophagus, gallbladder, stomach, pancreas, kidney

shoulder

left shoulder

--heart, diaphragm, spleen, tail of pancreas

right shoulder

--gallbladder, liver, head of pancreas

pelvic; low back; sacrum

--colon, appendix, pelvic viscera, prostate

Pancoast tumor (and referral location)

upper lung tumor

--pain referred om C8-T2 nerve distribution

--mimics TOS

--pain on top of shoulder, ipsiL shoulder

typical pain patterns-- quadrants

Right Upper Quadrant (RUQ)

--head of pancreas

--gallbladder pathology

--liver pathology (hepatic)

--peptic ulcer

**good luck harry potter (gall, liver, head, peptic)

Right Lower Quadrant (RLQ)

--appendix

--crohn's disease

**air conditioning (appendix, crohn's)

Left Lower Quadrant (LLQ)

--diverticulitis

--ulcerative colitis

--IBS

**DUI (diverticulitis, UC, IBS)

Left Upper Quadrant (LUQ)

--tail of pancreas

--spleen pathology

**don't be stupid, kid (diaphragm, body/tail pancreas, spleen, L kidney)

Good luck Harry Potter,

Don't be stupid kid

and get a DUI

Go home and use air conditioning

RUQ, LUQ, LLQ, RLQ

**looks like "C" if looking at own chest

what is a hernia and its referred pain?

--hiatal, femoral, inguinal, umbilical

hernia is a condition where part of an organ is displaced and protrudes through the wall of the cavity containing it

Hiatal hernia causes shoulder pain

--similar symptoms to which

condition? GERD

Femoral hernia causes

--lateral pelvic wall pain and groin pain

Inguinal hernia causes

--groin pain

Umbilical hernia causes

--pain around umbilical ring in the mid to lower

abdomen

what are the contraindications after hernia repair

AVOID for the first 6 weeks

--stretching anterior structures

--increasing intraabdominal pressure

what is cholecystitis?

Blockage or impaction of gallstones in the cystic duct resulting in inflammation of the gallbladder

pain in RUQ radiating to R should and R scapula

--nausea, vomiting, low grade fever

--pain increases with eating fatty food

SPECIAL TEST

-Murphy's sign

what is Murphy's sign?

palpating near R subcostal margin as patient takes deep breath

if pain and tenderness increases during inspiration, the test is POSITIVE

what are peptic ulcers?

--definition, pain referral, characteristics, and types

open lesions in digestive system that cause pain

pain is burning, cramping in epigastric area

--can refer to R shoulder

characteristics

--coffee ground vomit (both)

--dark tarry stools (common of duodenal ulcers)

2 types

--gastric ulcers (stomach)

--duodenal ulcers

Gastric (stomach) ulcers vs Duodenal ulcers?

Gastric ulcers (stomach)

--lesions in stomach caused by chronic use of NSAIDS, stress, anxiety, or H pylori bacteria

--pain increases with presence of food d/t acid secretion, pain after eating

-pain relieved with antacids or medically treating infection

Duodenal ulcers

--lesions in duodenum causes mainly by H pylori infection

--pain increases with absence of food, midnight pain

--pain relieved by medically treating the infection

Inflammatory Bowel Disease (IBD)

Chronic inflammation of the gastrointestinal tract

more severe than IBS

2 types

--Ulcerative colitis (LLQ)

--Crohn's disease (RLQ)

Ulcerative colitis vs Crohn's disease?

Ulcerative colitis (L for Left, LLQ)

--only in large intestine and rectum

--continuous lesions

--s/s rectal pain, bleeding, bloody diarrhea with mucus/pus, fecal urgency, weight loss, LBP

Crohn's disease (R for Right, RLQ)

--occurs anywhere in GI tract

--skip lesions (not continuous in tract)

--s/s abdominal pain, weight loss, joint arthritis, pain relieved by passing gas

Inflammatory Bowel Syndrome (IBS)

spastic, nervous and irritable colon

causes

--emotional stress, anxiety, high fat, lactose foods

symptoms

--pain relieved by defecation

--sharp pains in morning or after eating

--nausea, vomiting, bloating, foul breath, diarrhea

--symptoms disappear while sleeping

--ribbon like stool

LLQ pain

treatment

--stress reduction

--dietary changes

--exercise

what is appendicitis?

inflammation of the appendix

--progression can lead to swollen infected appendix

symptoms

--pain in RLQ

--pain comes in waves then becomes steady

--anorexia, nausea, vomiting, elevated temperature, leukocytosis, fever

SPECIAL TESTS

--McBurney's point is tender to palpate

--Rovsing sign for pain migration

--Blumberg's sign for rebound tenderness

what is McBurney's point?

tender area at RLQ when palpating RLQ (appendicitis)

what is Rovsing's sign?

RLQ pain upon palpation of LLQ (appendicitis)

what is Blumberg's sign?

increased pain and rebound at RLQ over McBurney's point (appendicitis)

other tests for appendicitis?

--hop sign, psoas sign, obturator sign, Markle sign, pinch-an-inch test

hop sign

--hop on R leg causes RLQ pain

psoas sign

--hip in extension causes RLQ pain

obturator sign

--hip in IR causes RLQ pain

Markle sign

--heel drop or lowering heel from a heel raise causes RLQ pain

pinch-an-inch test

--pinch skin at RLQ; RLQ pain is (+) for appendicitis

--pinch skin at LLQ, LLQ pain is (+) for diverticulitis

seizures-- recognition and best immediate response

recognition

--sudden unresponsiveness or LOC

--muscle jerking or twitching

--muscle stiffening or loss of muscle tone

--incontinence

response

--remove any nearby objects that are sharp or can cause injury

--turn person to sidelying

--note amount of seizure time (if more than 5 min call EMS)

--dont hold person down or place objects in mouth

concussions-- recognition and best immediate response

recognition

--HA

--nausea

--balance issues

--fatigue

--blurred vision

--sensitivity to light or noise

--numbness / tingling

--cognitive, emotional deficits

response

--stop activity immediately if playing sports

--monitor symptoms

--consult healthcare professional promptly

when to seek EMS

--LOC

--repeated vomiting

--severe HA

--seizures

--unequal pupil size

--prolonged confusion

--weakness or numbness

dehydration-- recognition and best immediate response

recognition

--mild: thirst and dry mouth/lips

--mod: very dry mouth, cracked lips, HA, sunken eyes, postural hypotension

severe: rapid and weak pulse, confusion, lethargy, rapid breathing, seizures, inability to cry or urinate

response

--monitor s/s and prevent worsening

--drinking water

--if nauseous, drink small sips

--severe cases may need IV fluids

heat exhaustion vs heat stoke

heat exhaustion

--lots of sweating

--can have nausea, HA, rapid breathing, slightly elevated temp

--can be unconscious

--pupils normal

heat stroke

--no sweating

--can have nausea, HA

--very elevated temp (106 to 110 deg F)

--unconscious and convulsions

--pupils contract then dilate