Adults 2 midterm

How to treat recurrent gonoconnal urethritis

High dose IM Ceftriaxone

• Do sensitivity testing on patients who persistenly test positive

What populations are recommended to get HPV Vaccine (Gardasil 9)

All 11-12 year olds

-can start at age 9 up to 26

What is ART Therapy

Combination of medications used to control and supress HIV replicaiton

• decrease viral load

• maintain / increase CD4 count

• Prevent HIV related symptoms

• delay disease progression

• prevent HIV transmission

Populations that benefit form HIV PrEP

Individuals at high risk for HIV, including those with HIV-positive partners or multiple sexual partners.

• PrEP with ART can greatly decrease risk of infection with exposure to HIV

How to prevent antibiotic resistance

• Take full course of antibiotics

• Priotize good hygiene

• Avoid unnecessary antibiotic use

  • Use antibiotics only when prescribed by a healthcare professional.

What is antibiotic stewardship

Advocating for only using antibiotics when necessary

Type 1 hypersensitivity

Anaphylatic reactions

-genetic predisposition

-most common type 1 is Hay Fever (allergic rhinitis)

Type 2 hypersensitivity

Hemolytic transfusion reactions

Good Pasture syndromes

Type 3 hypersensitivity

Causes tissue damage in immune-complex reactions

• local or systemic

• immediate or delayed

• associated with autoimmune disorders

Type 4 hypersensitivity

• delayed hypersenstitivty

• cell-mediated (24-48 hours)

  • tissue damage

Management of Anaphylaxis

The treatment of severe allergic reactions that may include epinephrine administration, oxygen, and intravenous fluids.

Does Inflammation mean something is infected?

NO

What lab values indicate aplastic anemia

Decrease Hgb, WBC, and platelets

Signs/ Symptoms of low hemoglobin

may include fatigue, weakness, pale skin (pallor), and shortness of breath.

Signs/ Symptoms of low platelets

may include easy bruising, prolonged bleeding, and petechiae.

Signs/ Symptoms of low neutrophils

Include increased risk of infections, fever, and fatigue.

Signs/ Symptoms of low WBC

Infection??

Immune thrombocytopenia purpura (ITP)

Most common acquired thrombocytopenia

Abnormal destruction of circulating platelets

Interprofessional care for Immune Thrombocytopenia Purpa (ITP)

Immunosupressive therapy

Splenectomy

Thrombotic thrombocytopenia purpura (TTP)

uncommon syndrome with variety of features that are not always present

associated with enhanced aggregation of platelets that form into microthrombi

Thrombotic thrombocytopenia purpura (TTP) INterprofessional care

treat underlying disorder or remove cause

Plasmapheresis to reverse platelet consumption

Rituximab

Caplacizumab

Heparin-induced thrombocytopenia (HIT)

Associate with heparin use

Life Threatening

platelet destruction adnd vascular endothelial injury

5-14 days after heparin therapy

platelets drop by over 50%

Heparin-induced thrombocytopenia (HIT) Interprofessional care

Stop all heparin including heparin flushes

Drugs (Argatroban, Fondaparinux, Bivalirubin)

Start Warfarin

Remove severe clots

Main clincal problem of Thrombocytopenia

impaired issue perfusion

Treatment for megoblastic anemia

vitamin replacemenet therapy (1-5 mg/day PO) (folic acid or B12)

Treatment of severe hemolytic anemia 

Maintence of renal function

Blood transfusions

Corticosteriods

Immunsupressants

What is hypovolemia

Fluid volume deficits

Caused by: abnormal loss of body fluids, inadequate fluid intake, plasma to interstitial fluid shift

Manifestations of hypovolemia

Slower capillary refill

confusion

postural hypotension / increase pule and RR,

decrease urine output

Is dehydrationt he same as hypovolemia

Dehydration is loss of pure water without corresponding loss of sodium

Hypovolemia is loss of blood voluem (water and electrolytes)

Isotonic IV fluid

same osmolaity as cell interior

0.9% NaCl

Lactated Ringers

D5W

Hypotonic IV fluid

Fluid with less solutes then inside the cell

0.45% NaCl

0.33% NaCl

0.2% NaCl

2.5% Dextrose water

Hypertonic IV fluid

Fluids with less solutes then inside the cell

3% NaCl

5% NaCl

>5% Dextros in water

D10W

Metabolic Acidosis

decrease pH

and low HCO3-

• by excess production of H

• poor elimination of H

• Poor production of Bicarbonate

• over elmination of Bicarbonate

Manifestations of Metabolic acidosis

headache

decrease BP

hyperkalemia

warm/ flush skin

N/V/ Diarrhea

Changes in LOC

Kussmaul Respiration

Metabolic Alkolosis

Increase in pH

high HCO3-

Increase in basic components

decrease in acidic components

Metabolic Alkolosis manifestations

Restlessness followed by lethargy

Dysryhthmias (tachycardia)

Compensary hypoventilation

Confusion

N/V/ Diarrhea

Tremors, muscle cramps, tingling fingers/toes

Hypokalemia

Respiratory Acidosis

decrease in pH (hypoventilation)

high PaCO2

Resiratory Acidosis Manifestations

Hypoventilations → hypoxia

rapid/ shallow breath

low BP with vasodialtion

dyspnea

headache

hyperkalemia

dysrthymias

drowsiness, dizzy, disorientation

muscle weakness, hyperfelxia

Respiratory Alkolosis

Increase in pH

low PaCO2

Repiratory Alkolosis Manifestaitons

Seizures

Deep, Rapid Breathing,

Hyperventilation

Tachycardia

low/ norm BP

hypokalemia

numbness and tingling extremities

lethargy and confusioin

light headness

N/V

Signs/ Symptoms of Electrolyte imbalance

muscle cramps

weakness

lethargy/ fatigue

headache

numbness/tingline

Causes of electrolyte imbalances

including dehydration, certain medications, and underlying medical conditions

How to correct a sodium imbalance

drink fluids, restrict Na intake, replace, avoid alcohol

Effects on Potassium eith use of diuretics

lose K+ > hypokalemia

Septic shock signs/ Symptoms

LOW BP

HIGH HR, Temp, RR

calmly, confused, SOB,

increased coagulation and inflammation

low tissue perfusion

vasodilation and maldistribution of blood flow

Primary goal of Shock treatment

Correction of decreased tissue perfusion

Preventing sepsis and shock

Monitor fluid balance to prevent hypovolemic shock

Maintain good hand hygiene

preventive measures for wounds/ injuries

Risk factors for shock

Older adults

Those immunocompromised

Those w/ chronic illness

Surgery/ Trauma patients

When/ why to use insulin in shock patients

Treat hyperglycemia (<180 in shock pt)

reduce inflammation

w/ hemorrhagic shock > improves heart function

Treating hypovolemia and evaluating effective treatment

stop the loss of fluid and restore the circulating volume

(3:1) 3 mL of isotonic crystalloid fluid for every 1mL of blood loss

monitor fluid balance

Treating anaphylactic shock

Epinephrine

( diphenhydramine, histamine receptor blocker)

Maintain airway

Volume expansion

IV corticosteroids if significant hypotension persists

SIRS prevention measures

aggressive infection control to lower the risk

• strict asepsis and assess for invasive line

• early recognition and interventions

aggressive surgery to remove necrosis

aggressive pulmonary management

• early mobilization

Maintain tissue oxygenation

Acute kidney Injury risk factors - Prerenal

factors that reduce systemic circulation causing redcution in renal blood flow leading to oliguria

Sever dehydration

heart failure

decreased CO

Acute kidney Injury risk factors - Intrarenal

cause direct damage to kidney tissue

prolonged ischemia

nephrotoxins

hemoglobin released from hemolyzed RBC

Myoglobin released from necrotic muscle

kidney diseases

Acute tubular necrosis

Acute kidney Injury risk factors -- Postrenal

Mechanical obstruction of the outflow leads to urine reflux into the renal pelvis, impair kidney function

BPH

prostate cancer

calculi

trauma

extrarenal tumors

monitor kidney function in acute kidney injury

Watch weight and I&O

BUN (elevated)

Creatinine (elevation)

urine output (decreased)

Electrolyte imbalances in AKI

decreased sodium

increased potassium

increased phosphorus

decreased calcium

Complications of CKD

Metabolic disturbances

electrolyte and acid-base imbalances

Metabolic acidosis

Anemia

Infection

CV disease

HTN

Dysrthmias

Kussmauls respirations

GI problems

CNS Depression

peripheral neuropathy

mineral/bone disorder

Hemodialysis

3 or 4 hours 3x week

rapid blood flow and access to large blood vessels

Arteriovenous fistula and grafts

Temporary vascular access

AV fistula management

NO BP, venipuncture or IV lines

feel for thrill

hear bruit

Peritoneal Dialysis complication

Exit site infection

Peritonitis

Hernias

Lower back problems

Bleeding

Pulmonary complications

Protein loss

Hemodialysis complications

Hypotension

Muscle cramps

loss of blood

Hepatitis

Safe discharge Perioperative Care

Conscious/ Awake

Vital signs stable

Activity

Respirations

O2 sat >92%

Circulation

Allergies to assess prior to surgery

antibiotics, blood products, anesthetics and latex

MAC sedation

Monitored Anesthesia Care

• diagnostic or therapeutic procedures in/out of the OR

• Varying levels of sedation, analgesia, and anxiolysis

• Must be administered by an ACP

Roles of surgical team members

Preioperative nurse - PreOp, OR, pt advocate during surgery, PACU

Scrub nurse -(sterile) follows the designated surgical hand antisepsis

Circulating nurse- unsterile, keeps documentation

LPN/VN sureg tech - fill role of circulating or scrub nurse

Surgeon - performs surgery

Surgeon’s assistant - asisst… duh

Registered nurse first assistant (RNFA)

Anesthesia care provider (ACP)- admin anesthetic agents

Management of post- operative hypothermia

passive warming

active warming

O2 therapy

Opiods

Dantrolene

Meticulous asepsis

coughing/ deep breathing

Management of Allergic Rhinitis

identify and. avoid triggers

reduce inflammation and symptoms

corticosteroids/ antihistamines/ immunotherapy

pt education

drug alerts

Teaching about total laryngectomy

Remove the larynx

lose their natural voice

will require other methods or communications

Teaching about radical neck dissection

remove the lymph nodes and surrounding tissue in the neck to remove the cancer

can affect the appearance and function of the neck > shoulder weakness

Management of Epistaxis

sit, lean forward

direct pressure lower part of the nose 5-15 min

Nasal Fractures manifestations

deformity, nosebleed, pain, crepitus, swelling, difficulty breathing through the nose, ecchymosis

Management of Bacterial Pneumonia

treat with antibiotics

monitor breathing

monitor oxygen

Evaluating effective treatment of pneumonia

No signs of hypoxemia

normal breathing problems

clear breath sounds

Normal chest x-ray

normal WBC count

No complications

Initiating and discontinuing precautions for TB

airborne precautions- N95

Negative pressure room

infectious for the first 2 weeks after treatment starts

Most are treated as an outpatients

Teaching on prevention of spread

monthly sputum cultures ( 2 in a row (-) means noninfectious)

Strategies for improving medication compliance for TB

Directly Observed Therapy (DOT)

watch the pt take the med and swallow it

Preventing Environmental Lung Disease

PPE: mask, ventilation system, no smoking

Follow OSHA/ NIOSH guidelines

Educational/ Discharge teaching for Lung Transplant patients

adhere to medications

Watch for rejection: (within 1st year) fever, dyspnea, dry cough, O2 desaturation

prevent/ treat complications- infection

self-care, medication management, contacting transplant team, pulmonary hygiene, rehab

Reducing the spread of Pertusis

droplet precautions (mask)

Prophylactic antibiotics for close contacts

infectious immediately through 3rd week after s/s onset or until 5 days after antibiotics

Signs/ Symptoms of Pulmonary Embolism

Dyspnea, mild-moderate hypoxemia

tachypnea/ tachycardia

cough chest pain

crackles/ wheezing

fever

syncope

Pulmonic heart sounds

SEVERE:

Changes in mental status

hypotension

feeling of impending doom

cardiorespiratory arrest/death

Treating Respiratory Failure

O2 therapy

Frequent ABG

support breathing

treat underlying cause

What is PEEP and how does it work?

Positive end-expiratory pressure (PEEP)

Ventilation technique applies positive pressure to the airway at the end of exhalation

Prevents the alveoli from collapsing

improves oxygenation, making breathing more efficient

Preventing Ventilator-Associated Pneumonia (VAP)

strict sterile aseptic technique for suction

Good hand hygiene

Elevate HOB 30 - 45 degrees

daily oral care (CHG)

daily readiness for extubation

stress ulcer prophylaxis

Venous thromboembolism prophylaxis