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- male 13.5-18dg/dL
- female 12-16dg/dL
cracking sound from joints rubbing together
Complication of joint replacement
- PE or fat embolus
- usually at day 5 post op
- OOB asap....sequentials/Teds, heparin, ROM
- Discharge teaching of S/S of this
After surgery what are the fevers from??
- Day 1-2 respiratory infection
- Day 2-4 UTI
- Day 5- Wound infection
What's normal temp in the elderly?
What are respirations like in the elderly? 85+
fast and shallow
Why are elderly at risk for dehydration?
- decreased skin elasticity and turgor
- decreased thirst, perspiration and body fluids
Why are elderly at risk for malnutrition?
- decrease taste sensation
- decreased gastric acid and motility
- impaired absorption, reduced saliva
Who's the prevelance of pain twice as high in? Elderly or young adult?
Elderly are in pain more often than anybody....but have a higher pain threshold
Why are psychoactive drugs more potent in the elderly?
cuz the brain receptors are more sensitive....which causes psychoactive drugs to be MORE POTENT
Primary, Secondary and Tertiery in community health
- Primary-prevention(immun/stay healthy)
- Secondary-what to do when they are already sick
- Tertiary-take all meds and prevent reoccurrence
Morbidity vs. mortality
- morbidity-incidence of disease
- mortality-number of deaths in a given period of time
Gate control theory
a pain stim opens a neurological gate, allowing pain stimulus to proceed thru the nervous system to the brain and creat the sensation of pain. It also considers the emotional component of pain.
What explains why pain is perceived differently from person to person?
S/S of pain
- increased BP and HR
pain that is crampy and gnawing....may be referred pain
sharp pain from skin, muscles, bones and joints
- caused by injury to nerve fibers in the PNS or CNS
- numbing, burning, shooting, stabbing
Example of neurpathic pain
phantom limb or diabetic neuropathy
- aka coanalgesics....they add pain relief, but are not classified as pain meds
- (antidepressants, muscle relaxers)
helps to decrease addition potential
What needs to be kept available for patient using a PCA?
Cells and hypertonic and hypotonic dehydration
- hypertonic=cell shrinkage
- hypotonic=cell swelling
VS for dehydration
- Decreased BP
- Increased HR/RR and depth and Temp
sodium and water reabsorption
water to be reabsorbed
accumulation of fluid in all body tissues
IV for hyponatremia
0.9% NS(Sodium Chloride)
If a patient has hypernatremia....what med might they get?
Primary prevention for TB
- ID high risk people and get them vaccinated
- people in close contact with infected should wear a mask
Secondary prevention for TB
teach infected persons they must take prescription till it's done
Tertiary prevention for TB
- Dont spend time in a stuffy enclosed room with anyone with active TB
- Wear a mask if you do
- help infected to take all meds till gone
Side effects of INH
- hepatitis/liver issues
- Renal problems
Rifampin side effects
- orange body fluids
- less effect BCP
Pyrazinamide side effects
renal and liver issues...hepatitis
Ethambutol side effects
droopy upper lid of eye
cyst caused by obstruction in the ducts of the sebaceous glands
inflammtion of eye lid
keratitis....and treatment for
- inflammation of cornea
- wear an eye patch and use atropine drops
S/S of cataracts
- blurred vision/hazy
- NO PAIN
Surgery for cataracts
- extracapsular extraction....only done when effects ADL's
- Contents of lens removed, but posterior capsule is left in tact for attachment of intraocular lens
Patient teaching after extracapsular extraction...cataract surgery
Dont do anything to increase IOP...no straining, leaning over, valsalva or coughing
- increased IOP
- it impairs vision and causes damage to the optic nerve.
- Can cause blindness
Open angle glaucoma
when aqueous humor is prevented from draining due to changes in the trabecular meshowrk, canal of schlemm and adjacent canals....causing IOP
S/S or open angle glaucoma
- foggy and blurred vision
- tired eyes
- Gradual decrease in PERIPHERAL vision
Treatment of Open angle glaucoma
What's a medication contraindicated with glaucoma?
ATROPINE-causes pupils to dialate
surgery for glaucoma
- laser surgery that creates a fistula so aqueous humor can be absorbed
Close ended glaucoma
sudden build up of IOP (1/2 to 1 hr) due to a complete blockage of the filtering angle caused by a bunching up of the iris
What can cause CLosed angle glaucoma?
S/S of closed angle glaucoma
- Excruciating pain
- blurred vision with halos around light
Red eye and moderately dilated and non reactive pupil
treatment for closed angle glaucoma
medical emergency...if not treated will be blind
Peripheral iredectomy-remove portion of iris leaving ahole for aqueous humor to get out
S/S of retinal detachment
- flashing lights or floating spots
- curtain drawn over the eye
NO PAIN OR EYE REDNESS
Treatment for retinal detachment
eye patch in hopes for the retina to go back in place prior to surgery
- Scleral Buckling
- sclera is shortened allowing for contact with choroid and retina
What do you monitor during a nose bleed?
Odd interventions for epitaxis
- monitor CBC, PT/APTT
- IV FLUIDS for increased blood loss
BMI of 25 and it doesnt necessarily mean excessive body fat (muscle, bone...)
BMI of 30....related to excessive amount of body FAT
What should calories come from in our diet?
complex carbs and proteins
Serving of vegetables/fruit
- size of a womans fist or a baseball
- 1/2 cup
Serving of meat
- size of your palm or a deck of cards
- 3-5 oz
A serving of cheese?
size of a thumb or 6 die
What should be on my plate?
- 2/3 plant source foods
- 1/3 animal protein
- blocks fat absorption and digestion
- side effects-abdominal cramps
- loose stool
- vitamin deficiency
- anal leakage
- appetite suppressant and increases metabolic rate
- side effects: increase BP, HR
- constipation and insomnia
Where is food dumped when you've had gastric bypass?
directly in to the jejunum
HOB for NG tube...
- High fowlers
- low to mid fowlers
2 ways to check placement of NG tube
- X ray and aspirate fluid (should be >4...acidic. make sure you calculate amount of aspirate)
- add 20-30 mL of air and auscultate
Prior to feeding a pt with NG tube what do I do?
check for residual (>200)
When feeding a person with NG tube what do I do prior and after feeding?
- flush with 20-30mL of WATER
- RECORD INTAKE
Where do you feel pain if you have gallbladder issues?
acute onset and has a higher fever than the other 100-104
What causes jaundice?
obstruction of bile channels causing an increase in concentration of billirubin in the blood
S/S of Icteric phase of Hepatitis
- elevated billirubin
- Dark amber/foamy urine
- clay colored stools
Which hepatitis can become chronic?
- alcohol intake and increased physical exertion
What can chronic active hepatitis cause?
liver damage...hepatic necrosis and cirrhosis
Which hepatitis cause liver cancer?
B and C
treats Hep C
do a pregnancy test prior to giving
Precautions for Hepatitis A and E
Standard and contact....gown and gloves, private toilet, bag and label contaminated linens, isolate tools
Precautions for Hepatitis, B, C, D and G
- Standard...wash hands
- watch for cuts on self and mucous membranes
Pt teaching for pt with Hep BCDG
- avoid sex till LFT are normal, then use condom
- teach friends/family how to be safe and not isolate pt
- no sharing of razors, tooth brushes
- repeat blood tests often
Prophylaxis for Hepatitis A
Prophylaxis for Hepatitis B
Recombicax....e injections in deltoid
Kubler-Ross stages of grief
Whats an example of bargaining?
go to get accupuncture
Delayed grief response
stuck in denial; go on after a major loss as if nothing has happened
impeded grief reaction
suddenly stop grieving....instead shop a lot, work alot, drugs, alcohol
Chronic /Patholigic grief
normal patterns that persist for very long periods of time
self destructive behaviors....suicide
Death...what goes firs? Last
respirations first and hearings last
Breathing pattern for dying
cheyne stokes and agonal
Left CVA effects
- Right side....
- analytical thinking
- math skills
- receptive and expressive language
Which side of the brain causes problems with agnosia, alexia, agraphia?
Left side CVA
Rt CVA effects
- left side....
- visual/spatial awareness and proprioception
- altered perception of deficits (overestimation of abilities)
- Poor judgement and impulse control
Which side of the brain CVA causes problem with neglect syndrome?
Rt side CVA
Glascow coma scale looks at...
- if patient opens eyes
- has normal verbal responses...can converse
- obeys commands with motor responses
Meds for embolic CVA
- anticoagulant...prevents development of additional emboli
- aspirin, heparin, lovenox, warfarin
Meds for thrombolytic CVA pt
- antiplatelets....prevents extension of the CVA
Clot buster medication
What drug is given to a patient with a CVA and develops seizures
- dilantin, Neurontin
Blood tests for Warfarin
- Heparin-PTT and APTT
Normal temp is...
apical minus radial
gradual increase in rate and depth followed by apnea
rapid, deep, gasping
gasping, irregular and infrequent breathing
How far do you stick enema in?
how high do you hold it?
- 3-4 inches toward umbillicus
- 18 inches above rectum
What do you put in an enema for a child/infant?
- it is advanced till you get urine....then-
- female advance to more inches
- male advance to the hub
How often do you change a catheter?
What do you do if your catheter is clogged?
pinch off and flush with 50mL of NS
How often do you change an IV?
How often do you change a TPN tube?
21-23 gauge and 1-1.5 inches long
25-27 gauge and 1/2 to 5/8 inches long
26-27 gauge and 3/8-5/8 inches
When do you replace a ostomy bag?
every 3-7 days or when it starts to detach from the skin
When a person has a colostomy what are they at risk for?
Which skin cancer can metastasize?
squamous cells....look for it on lip and ears
How often do you apply sun screen?
what is a large mole?
how often do you examine the skin?
- every 2 hours
- larger than 5 cm
- every month