Foundations exam 2

PPE for TB

airborne, N95 mask or HEPA respirator, negative pressure room, full face mask if splashing/ spraying possible

PPE for measles

airborne, N95 mask or HEPA respirator, negative pressure room, full face mask if splashing/ spraying possible

PPE for VRE

contact, gloves, gown,

PPE for MRSA

contact, gloves, gown

PPE for SARS COV 1 and influenza

droplet, mask

1) Incubation

(hours) pt may not feel ill but WBC count might be elevated. The transmissibility of the disease is low but possible.

2) Prodromal

(day 1-2) early clinical manifestations: Fever, aches, poor appetite, malaise. The patient is highly infectious at this time.

3) Acute illness

when the reaction is most severe and specific manifestations occur. Still highly infectious.

4) Decline

pathogenic load is being fought off and symptoms are decreasing. Less infectious at this time.

5) Convalescence

patient returns to the previous or new state of health.

Direct

when microorganisms (such as herpes simplex virus [HSV]) move directly from the infected person to another person

Indirect

Occurs when microorganisms are directly moved from the infected person to another person with having a contaminated object or person between these two.

Droplet transmission

occurs when infectious droplets from a client travel through the air and come in contact with the mucosa of a host. Ex- Sneezing, coughing, singing, and talking transmit influenza virus and Bordetella pertussis.

Airborne

Occurs when small particles move into the airspace of another person. - smaller, travels longer distance

Vehicle

Transmission of infectious agents to various individuals through a common source, such as contaminated food or water.

Vector- Borne

Transmission of infectious agents through animals, such as an insect or rodent.

Electrolytes

minerals in the body that conduct electrical charges. Labs- Basic Metabolic Panel (BMP) and Comprehensive Metabolic Panel (CMP). responsible for- maintaining the balance of water in the body, balancing the blood pH (acid-base) level, moving nutrients into the cells, moving wastes out of the cells, maintaining proper function of the body's muscles, heart, nerves, and brain. Presents- hypovolemia, dehydration, tachycardia, tachypnea, confusion, headache, kidney stones, and numerous other medical complications.

Potassium (K+)

major cation of Intracellular fluid (ICF), regulates conduction of cardia

Lasix(furosemide) and spironolactone

Use- treat edema, increases pee, hypo(electrolytes) disorders, hypotension, monitor weight, I/O

Glucose levels

66-100

Calcium levels

9-10.5

Sodium levels

136-145

Potassium levels

3.5-5.0

Magnesium levels

1.3-2.1

BUN levels

5-20 Kidney function

Creatinine levels

0.8-1.2 Kidney function

Sodium (Na+)

major cation in extracellular fluid (E C F), regulates fluid / blood volume, stimulates nerve impulses (Na/K+ pump), works with Ca+ to maintain muscle contractions. Kidney reabsorbs.

Potassium (K+)

major cation of Intracellular fluid (ICF), regulates conduction of cardiac rhythm, transmits electrical impulses throughout the body (Na/K+ pump), assists with acid-base balance. Kidneys eliminate

Calcium (Ca+)

most abundant electrolyte, regulates bone health, neuromuscular function (Contraction), and blood clotting.

Magnesium (Mg+)

I C F; bone; many cellular functions, Alcoholism leads to low levels

Phosphate (phosphorous)

I C F anion, bound with calcium in teeth and bones; inverse relationship.

Hypomagnesemia (cause + TX risk)

Cause- chronic alcoholism, malabsorption, diabetic ketoacidosis, prolonged gastric suction. TX risk- flushing, diaphoresis, decreased LOC, and respiratory depression. Do not push it too fast, make sure you confirm drip rates.

Hypermagnesemia S/S

diarrhea, neuromuscular weakness, flaccid paralysis, respiratory arrest, hypotension, bradycardia.

​​Hypovolemia

loss of fluid/ electrolytes from ECF. S/S- dry skin, dry mucous membranes, non-elastic skin turgor, weak and thready pulse, decreased urine output\>increase in urine specific gravity, blood pressure (hypotension), increased heart rate (tachycardia), rise in temperature (hyperthermia), weight loss. TX- isotonic solutions, push fluids, assess and maintain sodium balance, IV Isotonic fluids/blood transfusion, identify cause.

Hypervolemia

This involves excessive retention of sodium and water in the ECF. Fluid volume excess can result from excessive salt intake, disease affecting kidney or liver function, or poor pumping action of the heart. The retained sodium increases osmotic pressure in the ECF. This pressure pulls fluid from the cells into the ECF. S/S- elevated blood pressure, bounding pulse, bradycardia, pale, cool skin, edema/ascites, crackles. TX- restrict fluids, administer diuretics. assess kidney and heart function, restrict sodium.

hypotonic solution

correct cellular dehydration. Never give hypotonic solutions to patients at risk for increased ICP because they can cause/exacerbate cerebral edema!

hypertonic fluids

help stabilize blood pressure, increase urine output, and reduce edema.

Metabolic acidosis S/Ss

DKA, diarrhea (poop out all of your base), renal failure (retaining too much acid)

Metabolic Alkalosis S/S

vomiting, NGT Suction

Respiratory Acidosis S/S

Loooooow and Slooooow RR (acidooooooosis), sleep apnea, head trauma, post- op, pneumonia (bad gas exchange)m COPD or Asthma attack, Drugs - CNS depressant (opioid overdose), Alcohol intox, Benzodiazepines

Respiratory Alkalosis S/S

FAST RR/ hyperventilation (paper bag to slow down breathing), Panic Attack (blow off CO2) .

Intracellular fluid

contained within the cells. Essential for cell function and metabolism.

Extracellular fluid (ECF)

outside the cells. ECF carries water, electrolytes, nutrients, and oxygen to the cells and removes the waste products of cellular metabolism. ECF accounts for 20% of body weight. ECF exists in three main locations in the body:

Interstitial fluid

lies in the spaces between the body cells. Excess fluid within the interstitial space is called edema.

Intravascular fluid

is the plasma within the blood. Its main function is to transport blood cells. The space within the vascular system including within the chambers of the heart, the arteries, and veins.

Transcellular fluid

includes specialized fluids, such as cerebrospinal, pleural, peritoneal, and synovial fluid; and digestive juices

Third spacing

Certain conditions cause fluid to move into an area that makes it physiologically unavailable (no use for body, out of place), such as into the peritoneal space (in ascites), the pericardial space (with pericardial effusion), or into the vesicles (blisters) with a burn wound. This type of fluid movement is known as third spacing because fluid is literally trapped in a third compartment—not within interstitial (cells) or the intravascular spaces (blood vessels).

Infants and small children rehydration

​​vomiting/ diarrhea can rapidly dehydrate, kidneys not as efficient, swallowing should be assessed prior to oral rehydration, start at 5mL q5-10 min and slowly increase to 50mL/kg over 4hrs. 100mL/kg for moderate dehydration

Older adults rehydration

diminished thirst response, decreased kidney function, offer high fluid foods, frequently offer small amounts of fluid.

ABG/ pH

7.35- 7.45

ABG/ PaCO2

35-45 mmHg

ABG/ HCO3-

21-28 mEq/L

cutaneous/superficial pain

hot object/paper cut, significant and short term

Deep somatic

ligaments, tendons, nerve, blood vessels, bones localized, achy/tender (fracture)

Visceral pain

abdominal cavity, cranium, thorax, not local, tight, pressure, crampy

radiating/referred pain

distant from origin site (heart attack: pain in L arm, back, and jaw)

Radiating pain

starts at origin and extends

Phantom pain

removed limb

Psychogenic pain

from the mind, no physical cause, can be just as severe

Nociceptive pain

can be somatic or visceral, pain receptor responds to stimulus

Neuropathic

injury to nerves, pain signal with no stimulus

Intractable pain

chronic and resistant, multiple methods of pain relief

Presbycusis

age related hearing loss

Anosmia

inability to smell anything

Aphasia

a disorder that affects a clients ability to articulate and understand speech and written language due to damage in the brain

Myopia

nearsightedness, inability to see far away

Hyperopia

farsightedness, inability to see up close

Presbyopia

old eyes, middle adulthood, gradually decreased ability to see near objects

Astigmatism

irregular curvature of the lens, blurred vision at certain points

Cataracts

blurred vision, sensitivity to glare, clouding of the lens, develops slowly, may start in one eye, trouble with ADLs

Glaucoma

increased intraocular pressure, loss of peripheral vision, irreversible, optic nerve compression

Macular degeneration

loss of central vision, number one cause of vision loss in \>65

Diabetic retinopathy

damage of blood vessels in retina, asymptomatic in early stages, can lead to blindness, slowed with control of blood glucose, BP, and cholesterol

Sensorineural hearing loss

most prevalent type of hearing loss, alteration in inner ear, auditory nerve, or hearing center of the brain (presbycusis or ototoxicity)

Ototoxicity

caused by medications, dysfunction of the cochlea or vestibule, tinnitus, dizziness, impaired balance

Conductive hearing loss

alteration in middle ear, blocks sound waves before they hit the cochlea of the inner ear (otitis media or otosclerosis)

Otitis media

inflammation or increased fluid in middle ear

Otosclerosis

abnormal bone growth in the ear

Hypersensitivity

unable to wear clothing with zipper or long sleeves

Defensiveness

hug, wearing clothes, wind to skin

Hyposensitivity

unable to feel extreme temperature or pain

Peripheral neuropathy

nerves in CNS damaged, numbness, pain and weakness in extremities

Diabetic neuropathy

high blood sugar, triglycerides cause damage to nerves and small blood vessels that supply blood to nerves

Idiopathic neuropathy

unknown nerve damage

Hypogeusia

decreased ability to taste

Ageusia

inability to taste

Dysgeusia

salty, rancid, or metallic taste

Hyposmia

reduction to smell

Parosmia

distortion to smell, was pleasant now not

Phantosmia

perception of odor that is not there

For clients who have hearing loss

sit and face client, avoid covering your mouth while speaking, encourage use of hearing devices, speak slowly and clearly, try lowering vocal pitch before increasing volume, use brief sentences with simple words, write down what clients do not understand, minimize background noises, asl for a sign-language interpreter if necessary, do not shout

For clients who have vision loss

call clients by name before approaching to avoid startling them, identify yourself, stay w/in clients visual field if they have partial vision loss, give specific info about the location of items or areas of the building, explain interventions before touching clients, before leaving inform clients of you departure, carefully appraise clients clothing and suggest changes if soiled of torn, make a radio tv or cd plates or digital audio available, describe the arrangement of food on tay before leaving room

For patients who have aphasia

greet clients and call by name, only 1 person speaks at a time, speak clearly and slowly using short sentences and simple words, do not shout, pause between statements to allow time for clients to understand, check for comprehension, tell clients when you don't understand them, ask questions that require simple answers, reinforce verbal with nonverbal communication, allow plenty of time for clients to respond, use methods speech therapists implement (picture chart) to improve communication, acknowledge any frustration in communication

For clients who are disoriented

call clients by name and identify yourself, maintain eye contact at eye level, use brief simple sentences, ask 1 question at a time, avoid lengthy conversation, provide for adequate sleep and pain management, encourage clients to verbalize feelings ab sensoriperceptual loss, print clients to time persons place and situation (clock, calendar w date), provide and use assistive devices, provide care clients cannot perform, assess clients level of satisfaction w family and friends support

Sensory deprivation

large print material, audiobooks, amplify phones, pleasant atoms, wearing hearing aids or glasses, communicate frequently, flowers, pets, pictures, material engagement (crosswords)

Sensory overload

private room, reduce lights and noise, orientation clues, stress reduction, manage pain, schedule sleep

Anticholinergics

dilate pupil and reduce accommodation, blurred vision, and photophobia

Prevention of pressure ulcer

avoid skin trauma, provide supportive devices, maintain skin hygiene, encourage proper nutrition

Stage 1 pressure ulcer

intact skin with nonblanchable redness of localized area usually bony prominence

Stage 2 pressure ulcer

loss of dermis, shallow open ulcer, red pink wound or open ruptured serum filled