Draw all specimens for cultures prior to starting treatment
Appendicitis
Inflammation of the appendix.
Review of Anatomy
Digestive System
Primary Organs
Secondary Organs (accessory organs)
The organs of the digestive system are separated into the primary organs and the secondary or accessory organs.
They work together to ensure proper digestion and absorption of nutrients.
The primary organs:
Mouth
Pharynx
Esophagus
Stomach
Small intestine
Large intestine
Rectum
Anal canal
The primary organs form a tube, open at both ends, called the gastrointestinal or GI tract.
Food that enters the tract isdigested, its nutrients are absorbed, and the undigested residue is eliminated from the body as waste material called feces.
The accessory organs:
Teeth
Salivary glands
Tongue
Liver
Gallbladder
Pancreas
Appendix
The accessory organs assist in the mechanical or chemical breakdown of ingested food.
The appendix, although classified as an accessory organ of digestion and physically attached to the digestive tube, is not functionally important in the digestive process.
Inflammation of the appendix is called appendicitis and can be a serious clinical condition and often requires surgery.
Diagnosis can be difficult needs to be diagnosed quickly.
Diagnostic Studies
CBC with differential
What is the CBC going to show? Mild to moderately elevated WBC.
Urinalysis
UA is only done to rule out other problems.
Abdominal x-ray examination
Intravenous (IV) pyelogram
Abdominal computed tomography scan
Abdominal ultrasound
Physical Assessment
Pain in the RLQ
McBurney’s point (halfway between umbilicus and right iliac crest)
Presence of rebound tenderness
RLQ guarding
Abdominal rigidity
Muscle spasms
Tachycardia
Low-grade fever
Acute appendicitis with perforation
Increasing, generalized pain
Fever, greater than 100.7
Generalized abdominal rigidity
Flexed knees
Causes what or at risk for developing? Peritonitis.
May need antibiotics and fluid prior to surgery.
Interventions & Rationales
Pain Medication
Slow, diaphragmatic breathing.
Positioning
Collaborative Interventions
Non-pharmacologic
Pharmacologic
Surgical
Antibiotics
If suspected of appendicitis, maintain NPO status in anticipation of surgery. Establish IV access with a larger gauge needle, ex. 18 gauge.
Pain is pt concern. Treat pain. Fluids.
Act quickly to prevent complications.
Laparotomy is usually the surgical procedure done. However, may need to open if complications
Treated postop for pain control and given IV antibiotics
Evaluation
Vital signs
Absence of chills
Abdomen (Pre and Post op)
Bowel sounds post-surgical
Post-op pain controlled.
Cellulitis
Disease Process: Infection leads to inflammation.
Infection can lead to cellulitis.
Cellulitis is an infection of the subcu.
Risk Factors
Skin break
PAD
Diabetes
Weakened immune function
Past instance(s) of cellulitis
Obesity
Assessment
History:
Draw a circle with a sharpie around the infected area to note any increase in cellulitis.
Need to know where the cellulitis started. Any previous exposures or injuries.
Full head-to-toe physical, looking for open or inflamed areas.
CBC, wound cultures.
Physical:
Look for hot, tender, erythematous, and edematous area with diffuse borders.
Chills, fever, and malaise.
Labs/Diagnostics
History
Nursing Interventions/Evaluations
Interventions:
ABX
Affected limb
Pain control
Monitor
Evaluations (Positive Outcomes):
Opposite
Teach dosing schedule and to take all of the antibiotics. Advise patients if outpatient, of the adverse reactions associated with cellulitis.
May require hospitalization and IV antibiotics.
Adverse reactions Know allergies
NI – elevate affected limb, monitor for swelling and measures to prevent or decrease swelling. Increased swelling = increased pain. Sensitivity to lower extremities may be present and may need a bed cradle to help while in the bed with covers.
Monitor for lymphatic streaking.
Use sharpie to mark infection.
Osteomyelitis
Pathophysiology
Risk Factors
Indirect entry (hematogenous)
Children
Older adults
Debilitation
Hx of skin infections
Hemodialysis
Sickle cell disease
IV drug use
Direct entry
Open wounds
Diabetes
Vascular disease
Indirect – body’s reaction. Starts in or carried by the blood.
Occurs in children <17 and older adults.
Assessment
Subjective
History
Surgery
Nutrition
Activity
Objective
General
Integumentary
Musculoskeletal
Clinical Manifestations
Acute Osteomyelitis
Local:
Bone pain
Swelling
Tenderness
Warmth
Limited movement
Systemic:
Fever, chills, night sweats
Nausea
Malaise
Chronic Osteomyelitis
Local:
Bone pain
Swelling
Warmth
Acute is constant bone pain that worsens with activity and is unrelieved with rest,
Chronic is an infection that last more than one month
Nursing Interventions
Handling of limbs
Wound care
Body alignment
Nonpharmacologic techniques
Activities of daily living
Passive and active range-of-motion
Bed rest for acute
Assess pain
Handle with care.
Collaborative Interventions
Antibiotic Therapy
Analgesics
PT/OT
Nursing Process: Evaluation
Pain
Body temperature
Improvement
Compliance
Complications
Vancomycin is abx of choice.
Peak (30 minutes after dose) and trough (30 minutes before dose). Important to maintain level medication in blood stream.
Is there improvement.
Draw a circle around the reddened area to note any spreading of the infection.
Otitis Media
Acute OM
Common with Upper Respiratory Infection
Bacterial and viral infections
Fluid secreted from the Eustachian tube
OM - Affects tympanum, ossicles, and the space of the middle ear
OM with effusion – inflammation of the middle ear with a collection of fluid in middle ear space.
Clinical indicators for acute OM include:
Adult
Children
Children are at a higher risk due to short, straight, flat eustachian tubes.
Correlation to Immunity Concept
Compromised
Antecedents
Attribute Deficits
Negative Consequences
Otitis Media Exemplar Correlation to Immunity Concept
Interrelated Concepts
Tissue Integrity
Comfort
Functional ability (hearing)
Thermoregulation
Risk Factors for Otitis Media
Gender
Age – more common in first 24 months of life. Rarely happens after 7 years old.
Lifestyle behaviors – propping bottle and going to bed with bottle, exposure to smoke
Other illnesses/conditions
Early detection and treatment is needed secondary to infection may spread to other organs; 1st place is heart.
Assessment
Comprehensive history
Physical/psychological clinical manifestations
rubbing or pulling on ears
crying
lethargy
bulging yellow or red tympanic membranes
purulent material in middle ear or drainage from external canal
limited or no tympanic movement
lymphadenopathy in face and neck
temperature 100.7 to as high as 104 degrees
hearing and speech delays if otitis media becomes chronic
Hematogenous spread from primary infection somewhere else
Community acquired pneumonia – got in the world
Hospital acquired pneumonia – 48 hours or longer after admission to hospital
Aspiration – abnormal entry of foreign object from mouth or stomach into the lungs. Unconscious patients are at high risk.
Necrotizing - rare complication of bacterial lung infection, usually secondary to Staph
Opportunistic – pneumonia in immunocompromised patients – such as pneumocystis jiroveci (PJP) (carinii)or cytomeglavisus (CMV)
Complications
Pleurisy
Pleural effusion
Atelectasis
Pleurisy – inflammation of the pleura
Effusion – a fluid in the pleural space. In most cases it is sterile and reabsorbed but may require aspiration removal by thoracentesis.
Atelectasis - complete or partial collapse of lung or section (lobe) of the lung.
Risk Factors
Geriatric
Nursing home resident
Decreased cough reflex
Decreased immune function
Decreased LOC
Feeding tube
Upper respiratory infection
Assessment
History
Physical
Labs/Diagnostics
What are three common symptoms of hypoxemia?
Restlessness, confusion and agitation
Also tachycardia, tachypnea, slight diaphoresis, and mild hypertension.
Assessment
History
Physical
Labs/Diagnostics
Xray – shows patterns characteristic of the infecting pathogen and it is important
CBC – yes or no
ABG (arterial blood gas) or VBG (venous blood gas)
Sputum C&S
Plan
Breathing – incentive spirometer
Diagnostics
No complications
Implementation & Evaluation
Antibiotics, nutritional therapy – may see weight loss
Interventions (Inc. Collaborative)
RN
Collaborative
Teaching Interventions
Trauma-Sprain
Key Points for Trauma-Sprain
Sprains commonly involve the finger, wrist, knee, and ankle joints
The ankle is the most frequently injured joint
Sprains are classified according to the degree of ligament damage:
First degree
Second degree
Third degree
1st – tears in only a few fibers, mild tenderness and minimal swelling
2nd –partial disruption of the involved tissue, with more swelling and tenderness
3rd – complete tear of the ligament with moderate to severe swelling
Clinical indicators:
Blood vessels
WBCs
Blood flow
inflammatory response
Edema
Warmth and redness
Increased nerve sensitivity and pain
Decreased mobility of the joint
Treatment for sprains depends on degree of ligament damage
First-degree
Second-degree
Third-degree
Correlation to Immunity Concept
Antecedent
Attribute deficit
Negative consequences
Interrelated Concepts
Tissue integrity
Comfort
Mobility
Functional ability
Nursing Process for Trauma-Sprain
Assessment
Comprehensive history
Review of risk factors
Etiology of current injury
Previous injury
Current medications
Diagnostic Tests
X-ray
CT scan
MRI
Nursing Interventions
Primary Prevention
Secondary Prevention
Tertiary Prevention
Critical Skills
Collaborative Interventions
Pharmacologic
Non-pharmacologic
RICE
Surgical
Evaluation
Pain
Understanding of teaching.
Demonstration of assistive devices
Lifestyle modifications
Urinary Tract Infection
Disease Process
Definition
Infection of urinary system
E coli and Candida albicans most common
Urinary tract is sterile a change in any of defense mechanisms can cause UTI
Class as complicated (normal urinary system) and uncomplicated *(when patient has a problem)
Lower uti symptoms (LUTS)
CAUTI Anatomy and terms
Class: Upper vs. Lower UTI
Pathophysiology
Risk Factors
Gender – female more than male
Age – the older the more incidences
Other illnesses/conditions
Lifestyle behaviors
Assessment
History
Physical
Labs/Diagnostics
Midstream Clean Catch – know what this is and steps to obtain Midstream
Clean urethral opening
Void
Plan
Relief from Lower UTI’s.
Sulfa abx – increase fluids and watch for GI symptoms
Early treatment is needed to prevent developing upper UTI.
Prevention of recurrence.
Nitrofurantoin (Macrodantin) – used for chronic UTIs
Implementation & Evaluation
Interventions (Inc. Collaborative)
Nursing Collaborative
Evaluation (Positive Outcomes)
Immunizations (Vaccines)
Types of Immunity r/t Immunizations
Active immunity - exposed to disease and build antibodies in response, ex. flu vaccine, varicella. This is either in the form of having the disease and forming antibodies from that or getting the modulated disease and forming antibodies
Passive immunity - antibodies acquired by receiving the antibodies – baby from nursing mother and/or receiving the antibodies such as IgG injections
Immune response
Vaccine Preventable Diseases
At risk populations
Role of immunizations
Vaccines Available
Vaccines for bacterial infections
Diphtheria
Tetanus
Pertussis
Haemophilus influenza B (Hib)
Pneumococcal conjugate
Meningitis
Vaccines Available
Measles
Mumps
Rubella
Varicella
Polio
HPV
Hepatitis A
Hepatitis B
Rotovirus
Influenza
Shingles
COVID-19
Vaccines for Active Immunity
Inactivated or killed vaccines
Attenuated or live vaccines
Toxoids
Recombinant vaccines
Conjugate vaccines
Boosters
Antibodies for Passive Immunity
Maternal antibodies
Immunoglobulins
Antivenoms
Knowledge and Concerns
Safety
Risk for adverse effects
Multiple vaccines at once
Monitoring by CDC
Necessity
Protection
Contraindications
Age
Immunosuppression
Allergies
Pregnancy
History of seizures
Certain recent medications
Acute illness
Reasons for withholding vaccines come in two varieties: precautions and actual contraindications . A precaution is when a person might be at increased risk for complications if he or she is vaccinated. A decision is made by the physician to immunize or not based on the relative benefit to the person weighed against the possible risks. A contraindication is a situation when a person should not be given the immunization.
Allergic reactions to the vaccine itself or to certain antibiotics, gelatin, and chicken or eggs are contraindications for specific vaccines if the reaction was one of anaphylaxis. For less severe allergic reactions it is a precaution.
Immunoglobulin infusion in the past six months or blood transfusion in the last year are contraindications because either case may result in failure of the person to develop immunity.
A severely immunosuppressed person or a pregnant individual are not given live virus vaccines (contraindicated). Specific protocols exist for immunizing children with cancer for varicella. Children with AIDS who are only mildly immunosuppressed can be vaccinated.
NOTE: Mild illness, low-grade fever, or recent exposure to an infection are not contraindications. Local reactions to previous immunizations or a family history of adverse response are also not contraindications.
The Vaccine Information Statement
Determine what information these statements provides
Record Keeping
Informed consent
What is the reason a nurse must obtained informed consent?