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Purpose of grounding electrical equipment
- Low resistance pathway to point zero voltage
- Need three wire cords, the third ground wire prevents the dangerous buildup of voltage that can occur on the metal frames of some electrical equipment
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RACE
- Rescue
- Alert
- Contain
- Evacuate
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MSDS (Material Safety Data Sheet)
Document that contains information on the potential health effects of exposure to chemicals
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HIPPA
Health Insurance Portability and Accountability Act
Protects medical records strictly confidential and health insurance and billing information
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What to find in Admission Sheet in medical record
- Next of Kin
- Physician
- Initial Diagnosis
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What to find in Physicians Orders in medical record
Prescription and Orders
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What to find in Progress Sheet in medical record
Recent medial statues
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What to find in Specialized Therapy Records and Progress Notes in medical record
Specialist Referrals
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What to find in Vital Sighs Graphic Sheet in medical record
Vital Signs
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What to find in Laboratory Sheet in medical record
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Organs more sensible to electrical shock
- Can cause ventricular fibrillation (the heart)
- Diaphragm dysfunction and death
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Is oxygen flammable or compostable
Oxygen is not flammable but can greatly accelerate rate of combustion
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Techniques used to clarify patients responses (when asking to repeat themselves)
Begin with admission of misunderstanding, Request clarification
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Elements of the POMR
(Problem Oriented Medical Records)
- Parts:
- 1. Database
- 2. Problem list
- 3. The plan
- 4. Progress notes
- Database - Contains routine information about the patient
- Problem List - Something that interferes with a patients physical or psychological health or ability to function
- The Plan:
- Progress Notes: Contain findings of subjective and objective data
- * Often refereed as SOAP
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How to fix charting error
A single line should be drawn though the mistake and the word "error" printed above it
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SOAP
- Subjective: (Patient Complain) " I can't breath"
- Objective: (Results of labs & exams) Awake, alert, orientated to time, place and person. vital sighs
- Assessment: (What is the problem) Retained mucus and possible infection
- Plan:(How is problem going to be treated) Treatment every 2hrs, continue to monitor lung sounds after and before each treatment
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How many people die of HAI
(Hospital Care Associated Infections)
1.7 million HAI's accounting got 99,000 deaths
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Contact
- Staphylococcus
- Pseudomonas aeruginosa
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Droplet
- Meningitis Pneumonia
- Influenza
- Steptococcal Pneumonia
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Cleaning blood spills know the dilution for bleach
1:10
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Amount of time to wash hands
Least 15 sec
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Introduce yourself in Social Space
4-12 feet
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Interview Personal Space
2-4 feet
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Pedal Edema
- Swelling of the lower extremities
- Occurs with heart failure
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Pitting Edema
When indentation mark is left on the skin
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Weeping Edema
Small fluid leak occurs at the point where pressure is applied
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Tripod
- The sitting position that emphysema patients use when they are in trouble
- Sitting upright while bracing elbows on the table
- Severe pulmonary hyperinflation
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Systolic
- Normal:120
- Range: 90-140 mmHg
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Diastolic
- Normal:80
- Range: 60-90 mmhg
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Vocal Fremitus
the vibration created by the vocal cords during speech
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Tactile Fremitus
Vibrations are felt on the chest wall
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Fremitus
- Reduced in obese and overly muscular patients
- To Asses repeat "99"
- ↑ Pneumonia & Atelectasis
- ↓ Emphysema & Pleural Effusion
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Pulse Pressure
30 - 40 mmHg
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Wheezes
- Rapid airflow though obstructed airways
- Expiratory
- Seen: Asthma & CHF
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Stridor
- Rapid airflow though obstructed upper airway
- Monophonic
- Seen: Croup, Epiglottis & Postextubation
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Coarse Crackles
- Excess airway secretions moving though airways
- Coarse, Inspiratory & Expiratory
- Seen: Severe Pneumonia, Bronchitis
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Fine Crackles
- Sudden opening of Peripheral airways
- Fine, Late inspiratory
- Seen: Atelectasis, Fibrosis, Pulmonary Edema
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Capillary refill time
- 2 sec or less
- Bad perfusion
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Least expensive method for the production of commercial O2
Fractional Distillation
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O2 purity standard for FDA
99%
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O2 cannot be stored as a liquid at room temperature
It reverses to its gaseous state
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Who is responsible for structured components for the central piping system in hospitals
NFPA
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Patient with nasal cannula, at what litter would you set bubblier
4 L/min
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If you have a patient in 2 or 3 liters and are complaining that their nose is dry wha would you do
Add humidification
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Goals of providing humidity therapy
- Maintain normal physiological conditions in the lower airway
- Add water to add water vapor to a dry gas
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Indications for using warm humidification
Anything that bypasses the upper airway
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Why wouldn't you want to use warm humidification aerosol
- Tracheal burns
- Hypovolemia
- Excess condensation
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What can be caused by using gas flow exceeding 4L
- Immediate heat & Water loss
- ↑ mucus secretions
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What type of humidifiers are used in a clinical /hospital setting
Bubbler, Passover, Wick and HME
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Unheated bubblers are used for what systems
- Nasal Cannula
- (Do not connect mask to bubbler)
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Highest flow that would be used on a bubbler humidifier
10L/min
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HMEs work
- With own breath
- "Artificial Nose"
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HMEs are used to do what
Humidify and warm
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Reasons why you would put a patient on O2 therapy
- Relieve hypoxemia
- Minimize cardiopulmonary workload
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Indications for O2 therapy
- Documented hypoxemia
- PaO2 < 60 & SaO2 <90% room air
- Severe trauma
- MI
- Post surgical
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When determining need for O2 therapy what to asses
- Patient severity
- Age
- Alertness
- Mouth or Nose breathers
- Minute Ventilation
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Patients with Chronic Hypercapnia if their are placed on high levels of FiO2 what would happen
Patient would stop breathing
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What would happen if air entrapment mask becomes obstructed with anything
FiO2 Increases
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