Medical Nursing Week 1

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Gia_bella
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170118
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Medical Nursing Week 1
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2012-10-09 17:17:01
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Medical Nursing Week
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Medical Nursing Class Notes week 1
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  1. ECM
    External Cardia Massage
  2. ICM
    Internal Cardiac Massage
  3. Hypovolemia
    basically means low blood volume
  4. Asystole
    Complete absence of QRS lines
  5. Ventricular Fibrillation
    complete lack of unrecognizable P waves and QRS- T complexes
  6. Sinus bradycardia
    is a rhythm in which fewer than the normal number of impulses arise from the sinoatrial (SA) node
  7. Sinoatrial node   (SA node)
    Acting as the heart's natural pacemaker
  8. Sinus Tachycardia
    Fast heartbeat (tachycardia) that occurs because of overly rapid firing by the sinoatrial node
  9. Ventricular Tachycardia
    is a rapid heartbeat that starts in the ventricles
  10. Signalment
    • Age,
    • Breed
    • sex, Neutered? Spayed?
  11. Questions of history
    • cheif complaint
    • Vomitting- GI tract
    • Diarrhea- GI tract
    • Eating
    • Changed diet
    • Previous illness, surgery
    • medication
  12. Current health status
    • Vaccine history
    • Indoor. outdoor
    • other pets
    • diet
    • toxin exposure, medication laying around
  13. Vitals
    • TPR + weight
    • weight
    • Temp
    • pulse
    • respiration
    • mucous membrane
    • capillar refill time
  14. capillary refill time
    • less than 3 seconds
    • show blood pressure
  15. Techniques
    • Inspection
    • palpation
    • percussion
    • auscultation
  16. S.O.A.P
    • subjective
    • objective
    • assessment
    • plan
  17. Behavior and Mentation
    • B.A.R   Bright Alert Responsive
    • Q.A.R Quiet Alert Responsive
    • Depressed
    • Neuro
    • Stupor
  18. temp of a dog
    • 102.5
    • >103.5 febrile (pyrexia)
    • < 99 degree hypothermia
  19. alopecia
    Hair loss
  20. pruitis
    Itching
  21. Skin Lesions
    • Scabs
    • Masses
  22. Erythema
    • Redness
    • Inflammation
  23. Seborrhea
    • Oiliness
    • Scabs

    Fleas and Ticks
  24. Epiphora
    Tearing
  25. Falconi syndrome-
    is a condition where the tubules of the kidneys do not function properly.
  26. Porforin is where
    in the tears
  27. Nystagmus-
    Jerky oscillation of the eye
  28. Anisocoria-
    unequal pupils
  29. otitis externa
    (ear infection)
  30. Respiration system
    Types of lung sounds
    • 1. Bronchial Sounds – Trachea and larynx
    • 2.Vesicular Sounds – Lungs and Alveoli
  31. Pleural effusion-
    is excess fluid that accumulates between the two pleural layers, the fluid-filled space that surrounds the lungs.
  32. Normal respiration rates
    • A.  Dog – 16-24 breaths per min.
    • B.  Cat – 16-30 breaths per minute
  33. Mucous Membrane color
    Sepsis or Warm Shock-
    Brick Red
  34. Normal heart Rates for dogs
                                  cats
    • 70-180 beats per minute
    • 160-240 beat per minute
  35. Mucous membrane
    Pale to white-
    anemia or poor perfusion
  36. mucous membrane
    cyanotic
    blue (lack of Oxygen)
  37. Icteric
    Jaundice or liver disorder
  38. mucous membrane
    Brown
    methemoglobinemia (acetomenophin toxicity)
  39. Mucous Membrane
    Petechia
    coagulopathy (clotting) or bleeding disorder, bruising
  40. Ascultate Heart
    Left 3rd intercostal space
    Pulmonic Valve
  41. Ascultate Heart
    Left 4th intercostal space
    Aorta
  42. Ascultate Heart
    Left 5th intercostal space
    • 1. Ventral to Sternum
    • Mitral Valve
  43. Ascultate Heart
    Right 4th intercostal space
    Tricuspid Valve
  44. Pulse deficit
    Heart beat not the same as femoral pulse
  45. upper Gastrointestinal
    esophagus, stomach, and duodenum
  46. Lower GI Tract
    • Small Intestine:
    • Large Intestine:
    • Cecum:
    • Colon: absorb water, but it also contains bacteria that produce beneficial vitamins like Vitamin K.
    • Rectum
    • Anus
  47. nephropathy
    A disease of the kidney. Also called renopathy
  48. hydronephrosis
    swelling of the kidneys when urine flow is obstructed
  49. Gastrointestinal System
    teeth
    • calculus or loose teeth
    • gingivitus- Redness and swollen gums
  50. Gastrointestinal System
    Tongue
    symetrical- XII Hypoglossal Nerve
  51. Gastrointestinal System
    Tongue
    Swallow reflex
    • 1. IX- Glosspharyngeal Nerve
    • 2. X-Vargus
    • 3. XI- Accessary
  52. Gastrointestinal System
    Excessive Salivation
    • 1. Facial Paralysis
    •  VII - Facial
  53. Gastrointestinal System
    Palpate Abdomen
    • A. Distended Stomach
    • 1. Bloat
    • B. Large Liver Spleen
    • C. Pendulus
    • 1. Fluid
    • D. Acute Abdomen
    • 1.Pain
  54. Gastrointestinal System
    Anus
    • Anul sacs
    • Rectal
    • 1. symmetrical prostate
    • 2. Fecal appearance
  55. Reproductive
    Male
    Female
    • Male- Tesicles
    • Cryptorchid
    • Female-
    • Vulvar Discharge -Possible pyometra if intact female
    • Mammary Glands- breast Tumors
  56. Reproductive
    Lymph Nodes
    • Should be small and symmetrical
    • Neck- Mandibular
    • Prescapular
    • Axillary
    • Behind knee cap- Inguinal popliteal
  57. Musculoskeletal
    • Limping
    • Muscle atrophy
    •   Symmetry
    • Flexing and extension
    •   Shows dysplasia and arthritis
  58. Nervous System
    Ataxia- Uncoordinated Gait
    Mentation- Mental depression or stupor
    Symmetrical pupils
       Nystagmus
    • Conscious proprioception (CP) of 4 legs
    • Spinal pain
    • Anal and tail tone
    • Sciatic and patellar reflexes
  59. Body Conditioning score
    • 1. Cachexia- Emaciated
    • a. Generally referred to emaciated 2nd to Cancer
    • b. Symptoms 
    •      1. Weakness, lethargy, anorexia, muslce atrophy, wasting and pysical debilitation, edema, and anemia.
    • 1-5 or 1-9
  60. Hospital Patient Care
    Observation
    Daily
    Eating, drinking, Vomiting?, diarrhea?, coughing?, sneezing?
  61. Hospital Patient Care
    Feeding
    • NPO- Nothing per os (nothing Orally)
    • Diet Types
    • Heart disease- Low sodium = H/D
    • Diabetes- No Sugar = W/D
    • Kidney or liver- low protein = K/D and L/D
    • Gastrointestinal- Bland Diet = I/D or D/D
    • Puppies, kittens, or pregnancy- high protein = P/D or A/D
  62. Hospital Patient Care
    Sanitation
    • Note on record if urinating, deficating or vomiting before cleaning
    • 1. Bloody urine
    •      cystitis
    • 2. Feces
    •    a. Black tarey -melena indicated blood (upper GI Bleed)
    •   b. Blood with mucous- colitis (lower GI Bleed)
    •   c. Diarrhea
    • 3. Vomit or regurgitation
    •      a. Food
    •      b. Yellow- bile empty stomach
    •      c. Bloody- GI ulcer, hematemesis, hematokesia
    •      d. Saliva and flem- couching, cardia and respiratory
    • B. Clean Cages, bowls, and towels with disinfectant
    •      a. Rocal, Parvosal, Bleach
  63. hospital Patient Care
    Vital Signs
    • A. Minimum Daily TPR
    • B. Hypothermia (cold)
    •    1. heated cage or incubator
    •    2. HEated pads or bottles
    •    3. Temperature <99
  64. hospital Patient Care
    Recumbent Patients- Paralyzed or can't move
    • A. Decubital ulcers (bed sores)
    •    1. Due to pressure points
    •    2. Paralyzed or recumbent patients that cannot stand
    •    3. Keep cages padded with frequent bedding changes
    • B. Urine scald or rash
    •    1. Not changing bedding, patient laying in urine and feces
    • C. Turn every 2 hours from side to side to sternum,  to prevent pneumonia, pressure sores and edema
  65. Hospital Patient Care
    Treatment Care
    • IV catheters
    •   1. Check daily for patency, flush with heparnized saline every 4-6 hours to prevent clotting
    •   2. check leg and foot for swelling, pain, redness, cellulitis or edema around the elbow or joint
    •     a. Infection
    •     b. Blown Catheter- SQ fluids
    • 3. IV catheters should not be left in any longer than 3 days (3-5) in practice
    • 4. Jugular Catheters should not stay in any longer that 5 days (5-7 in Practice)
  66. Hospital Patient Care
    Urinary Cathers
    • A. Check to see if flowing (patent) and not obstructed
    • B. Flush catheter with 0.9% Nacl
    • C. Record urination volume and color
    • D. Closed system (attache to bag)
    • E. e-collar
  67. Hospital Patient Care
    Sutures
    • 1. Check suture site daily for discharge and inflammation
    • 2. Infection is seen within 3-4 days post surgery
    •     a. Swelling
    •     b. Erythema
    •     c. Pain
    •     d. Fever
    •    e. Discharge
    • 3. Dehiscence-incision and suture break down
    • 4. E-collar to prevent self-trauma
  68. Hospital Patient Care
    Bandages
    • 1. Check bandage daily for wetness from urine or feces
    •      a. Causes tissue scalding and ulceration
    • 2. E-collar to prevent chewing
    • 3. Check toes for swelling and loss of circulation (cold)
    • 4. Wrap bandages in plastic bog to revent wetness
  69. Hospital Patient Care
    Intravenous Fluids
    • 1. Moniter fluids for correct rate and volume
    • 2. Check for correct fluid type and additives (spikes)
    • 3. Ivac machine is set up correctly for rate and volume
    • 4. Should not exceeed 90 ml/kg/hr (pulmonary edema)
  70. Hospital Patient Care
    Drains
    • 1. Penrose- check daily for draining, clean and flush
    •   a. Abscess
    •   b. Seroma
    •    c. Drain removal 2-3 days
    •   d. warm compress tid for 3-5 min
  71. Hospital Patient Care
    Oxygen- 4 minutes of hypoxia can cause brain damage
    • 1. Nasal oxygen
    •    a. Flow rate 1-3 liters
    • 2. Tracheostomy tube
    •     a. Suction and clean out every 4-6 hours
    •        1. Mucous blocks breathing
    •    Monitor patient over heating and humidity in oxygen cage
    • 4. Ventilator
    •    a. Make sure set up correctly
  72. Hospital Patient Care
    Chest Tubes
    • 1. Risk pneumothorax and infection (pyothorax)
    • 2. Suction tubes
    •     a. Make sure 3 way stop cock is closed to prevent air   entering the checst cavity
    • 3. Heimlich chest valve
  73. Catheter Types
    Peripheral Catheters- most common
    • cephalic vein
    • 72 hours max placement
  74. Catheter types
    Central IV lines
    • Catheter inserted into large veins as the superior and inferior vena cava and right atrium
    • Used for hypertonic fluid administration as Total parenteral nutrition (TPN), partial parenteral nutrition (PPN), chemotherapy and frequent blood withdrawals-DKA
    • Primarily used for Dialysis or Central Venous pressure (CVP)
    • Double or triple lumen
    •   1. Catheter has multipe parallel compartments              (Lumens)
  75. Catheter Types
    Central Venous Lines
    • Catheters placed into peripheral (jugular, saphenous or femoral) and advanced towards the heart or vena cava
    • Used for TPN, PPN, chemotherapy, blood withdrawels,
    • Double or triple lumen
  76. Catheter Types
    Peripherally inserted central catheter (PICC Lines)
    • PICC lines placed in peripheral veins with Seldinger technique and guide wires.
    • Used for long term intravenous use as TPN, PPN, blood withdraws, chemotherapy
  77. Catheter Types
    Implantable Ports (port-a-cath)
    • Central Venous line that does not have an external connection, instead a reservoir port covered with silicone.
    • Can be left in place for years
    • Able to give IV medications in the port
    • surgically implanted inder the skin
  78. Catheter care
    Make sure all catheters are flushed with heparnized saline solution. (prevent clotting)

    • All central line catheters not in use or when animals go home with catheters should be heparin locked.
    •    a. 0.1 ml heparin +0.9 ml Saline (1:10), then lock with volume directed on size on catheter insert
    •    b. normal heparin flush (5 units heparin/ml)
  79. Catheter Complications
    • 1. Cellulitis- connective tissue infection and inflammation
    • 2. Phlebitis- vein infection and inflammation
    • 3. Sepsis- body inflammation and infection
    • 4. Extravasation- fluid leaking into tissue from catheter out  of vein
    • Hemorrage- bleeding
    • Hematoma- bruising
    • Air embolism- air in the blood vessels

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