CUMULATIVE

Emergency assessment

ABCDE

Airway

Breathing

Circulation

Disability (LOC, pupils, movementx)

Exposure

comprehensive assessment

health hx + physical assess

head-to-toe

upon admission

focused assessment

more in depth

most important technique for infection prevention

hand hygiene

standard precautions

• hand hygiene

• PPE w/ infectious material

• disinfect material/ instruments

• sharp safety

  • transmission precaution

transmission precaution

• source control

• social distancing

• resp hygiene/ cough tech

• appropriate patient placement

standard precaution goal

all waste + contact is potentially infectous

prevent transmission w/ body fluid contact + blood born

wash hands when

• visibly soiled

• after caring with person w/ infectious diarrhea

  • C.diff / B. anthracis

inspection

general survey

physical characteristics, behavior, odors

electronic record advantages

• enter data quickly

• interpersonal data input database for interpersonal communication

• legible and time dated. helps identify trends

• automated clinical surveillance tools (alerts to data that indicates problems)

high risk errors documentation

• inadequate admission assess

• failing to record

  • pertinent health or drug information

  • changes in pt condition

  • prior treatment event

• failure to notify HCP

• failure to follow policy

temperature

36.5-37

>39.5 <35!!!

pulse, resp, o2

60-100; 10-12; 92%

low BP; norm is <120/80

<90 SBP

nociplastic pain

pain w/o identifiable cause

nervous system modification can lead to a phenomenon called ________________________, by which peripheral nociceptors are sensitized to neuropathic pain stimuli.

peripheral sensitization

Result of inflammatory process that creates hypersensitivity to touch or pressure

Peripheral sensitization:

Enhanced response to pain stimulus produced by prolonged pain production

Windup:

(FLACC) scale

Face, Legs, Activity, Cry, Consolability

2m -7y

Central sensitization:

Excitatory process involving spinal nerves produced by continued pain stimuli that can persist even after peripheral stimulation is no longer present

Untreated or undertreated acute pain may lead to chronic pain syndromes, ____________

such as complex regional pain syndrome (CRPS),

Continued painful assault on the peripheral nerves results in transfer of the pain stimulus to the central nervous system.

CRPS

visceral pain

crampy or gnawing

somatic pain

sharp

cutaneous

burning or sharp, such as with a partial-thickness burn

numeric pain scale

0/10/ NPI

7y<

Visual analog scale

line with NPI

cognitive alert but verbally impaired

Mc GIll Pain Questionnaire

verbal descriptors, VAS, present pain intensity rating w/ numbers and words

Brief pain inventory

chronic pain

worst/least pain in past 24, average pain, pain right now

body diagram

functional assess w/ ADL + mood and social

efficacy of pain meds

Pain, Enjoyment, and General activity (PEG)

BPI but shorter

pain on average

how many times pain has interfered with life/ general activity

clinically aligned pain assess (CAPA)

comfort

change in pain

pain control

functioning (ADL)

sleep

FACES

3y<

language communication problem

cal/g

fat 9cal/ g ; protein + carb: 4cal/g

Of the 22 required amino acids, the body can manufacture __ of them from nonprotein dietary sources (nonessential proteins). __ essential amino acids must be obtained through dietary sources.

14; 8

phospholipid

emulsifiers

transport fat soluble across membrane

Vit B (folate)

metabolism + cell synthesis

Vit B12

DNA synthesis, RBC, myelin

vit C

iron absorption

trust vs mistrust

stage I: infant

when uncomfy, caregiver helps

self-efficacy

autonomy vs shame and doubt

II: toddlers

potty train; will learn how to become independent and caregivers will help them distinguish from what is right from wrong

initiative vs guilt

III: preschooler

self-efficancy; actively making plans, setting goals, and performing tasks to feel important. If this is not met, child will have low-self esteem

industry vs inferiority

stage IV: school age

preparing the child to become a worker (integrate to society);

the more time in this stage, the less influence parents have.

School and teachers culture( goals, failures) influence the outcome of child. If not met, child will feel inadequate

identity vs role confusion

stage V: adolescent

group identity, how they appeal to others.

identity and occupational exploration

intimacy vs isolation

stage VI: early adult

fusing their identity to others; not only sexual unions, but close friendships; if not, isolation

generative vs stagnation

stage VII: middle adult

focusing on guiding the next generation; if they have nothing to offer, the stagnation occurs

ego integrity vs despair

stage VIII: late adult

if come to term with their life choices and if not it can lead to despair

Geriatric depression scale

life satisfaction, drop of interests, if happy/mood, memory problems,

National Standards for Culturally and Linguistically Appropriate Services (CLAS) in Health Care

principle standard: care that correlates w/ diverse needs for all

governance, leadership, workforce:

1. advance government and leadership that promote CLAS

2. educate to promote CLAS

communication/ language assist

1. language assist for no cost

2. inform of language services

3. no use of minors as interpreters

4. easy to understand media in commonly used languages

engagement, continuous improvement, accountability

1. establish CLAS goals, ongoing assessments, collect data, plan to implement services, and partner w/ community, communicate results to public

chronic hypoxia

clubbing of nails

ABCDE (skin)

Asymmetry

Border irregular

color variety

diameter >6mm

evolution

acne

inflammation of sebaceous glands

comedones, papule, pustule, cyst

wartz

flesh colored warts

by viruses

rough w/o scale

cellulitis

bacterial infection of deep skin tissue

swelling, redness, warmth, tender/pain

impetigo

Staphy aureus or group A strep

vesicle or bullae → honey- colored crust

herpes simplex

cold sores

group vesicles on erythematous base

mouth, genital, and skin

measles

rubeola (virus)

pinkish, erythematous macules and papules from face to caudal spread

pityriasis rosea

viral herald patch: large oval hyperpigmented lesion w/ fine scale

Christmas tree pattern

rubella

german measles (vaccine)

pink macular and papular rash

roseola

viral

rash appears as fever resolves

discrete macules and papules

candida

fungus in skin folds

satellite pustules with erythematous macules

tinea corporis

ringworm

erythema, pruritic, annular lesion w/ raised border and central clearing

tinea versicolor

by normal skin flora

hypopigmented patchy lesions

upper chest/ back, proximal extremities

_________ are not usually palpable (neck)

thyroid/ parathyroid

unilateral bulging in thryoid

goiter, cyst, or tumor

anterior approach

tilt head slightly back

located thyroid and cricoid cartilage

thyroid crisis

hypermetabolism: tachycardia/pnea, n/v, diarrhea, abd pain, hyperkinesis, fever

hyperthyroid

weight loss, anxiety, palpitation, tachycard, heat intolerance, diaphoresis, muscle weakness

brisk reflex, moist/warm skin

→ thyroid storm

hypothyroid

fatigue, anorexia, weight gain, coarse/brittle hair, cold intolerance

slow speech, cold/dry skin, bradycard, delayed reflex

ptosis

drooping of eyelid

stroke

eye teaching

• eye exam Q2y (DM Q1y)

• impact of screen time on vision

• protective eyewear in occupational

• sunlight exposure → cataracts/ conjunctival disorder (sunglasses)

• DM control → diabetic retinopathy, cataracts, glaucoma

The ______ refers to what in the environment is visible when the eye fixates on a stationary object.

visual field

static visual field

gross differences in all 4 quadrants

ask them to look at your eyes and put fingers in each quadrant

kinetic visual fields

gross peripheral boundaries

move fingers to periphery until pt becomes aware of target

cataract s/s

halos in eyes

diabetic retinopathy s/s

blind spots

macular degeneration s/s

tunneling in visual field

glaucoma s/s

loss of periphery

CN II

optic nerve: visual acuity/ field

CN III

oculomotor: EOMs, PERRLA, eyelid

cardinal gaze

CN IV

trochlear

cardinal fields of gaze

CN VI

abducens: laterally

cardinal fields of gaze

CN I

olfactory

CN V

trigeminal

chewing + face sensation

clench teeth and ask for pain (trigeminal neuroglia)

CN VII

facial

facial expression

CN VIII

Vestibulocochlear

Hearing + balence

CN IX

Glossopharyngeal

motor

gagging and swallowing

CN X

Vagus

pharynx+ larynx sensation + Swallowing

CN XI

accessory

shoulder shrugging, head rotation

CN XII

Hypoglossal

tongue movement and speech

ear function

hearing

vestibular function: proprioception and equilibrium

conductive hearing loss

when external and middle ear is disrupted

BC x2 AC

cholesteatoma

abnormal growth of cells in middle ear

sensorineural hearing loss

SNHL

inner ear to auditory cortex

presbycusis

sensorineural loss from gradual degeneration of nerves and sensory hair cells of Corti

tinnitus

ringing w/o external sound

meriere disease

vertigo w/ severe n/v and hearing loss

24hr of exacerbations w/ period of remission

otalgia

otitis externa/media

severe pain → relief + drainage = rupture TM

otosclerosis

slow fusion of ossicles

ear infection prevention

• cleaning external ear

• risk factors:

  • cigarette smoke

  • propping baby bottles

  • bottle feeding in supine position

  • day care

epitaxis

nose bleed

most common in kiesselbach plexus