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NPN 135 FINAL 5/6/13


Different layers of the Skin Epidermis: top layer Dermis: 2nd layer nerves glands Subcutaneous: 3rd layer fatty tissue
Communicable Disease transmitted directly or indirectly to others
Infection invasion & multiplication of microorganism in body tissues, pathogen replicating in or outside of body
Inflammation localized protective response brought on by trauma or injury to tissue
Endemic disease that is always present in a local area
Epidemic disease/illness occurs in higher than normal numbers at the same time in same area
Pandemic disease/illness world wide
Colonization organism is present but not causing any illness
Fomite object that may become contaminated with pathogens and serve in their transmission (objects)
Chain of Infection 1.Infectious agent (source) bacteria, fungi, parasites, virus (how it starts) 2.Reservoirs resting place for it to grow 3.Portal of Exit how it gets out 4.Modes of Transmission how its spread 5.Portal of Entry how it enters 6.Susceptible Hosts
Stages of Infection 1.Incubation 2.Communicable 3.Prodromial 4.Illness 5.Convalescent
Vaccines at Birth HepB
Vaccines at 2 months HepB(1-2mos), DTaP, PCV, Hib, Polio, RV
Vaccines at 4 months DTaP, PCV, Hib, Polio, RV
Vaccines at 6 months HepB(6-18mos), DTaP, PCV, Hib, Polio(6-18mos), RV
Vaccines at 12 months MMR(12-15mos), PCV(12-15mos), Hib(12-15mos), Varicella(12-15mos), HepA(12-23mos)
Vaccines at 15 months DTaP (15-18mos)
Vaccines 4-6 years of age DTaP, IPV, MMR, Varicella
What's the minimal age for Influenza vaccine and how often can you receieve the vaccine? 6 months, yearly
Measles Rubeola, virus, fever, weak, photophobia, Koplick's spots (red,bluish-white center spots) inside mouth, Rash begins on face and spreads downward.
Mumps inflammation of the salavory glands, virus, unilateral/bilateral edema & tenderness of glands, loss of appetite
Rubella German Measles, virus, like measles but milder, swollen lymph nodes, fever, headache, cough, pale red/pink rash begins on face, moves downward
Fifth Disease Virus, F, HA, Sore throat, Rash appears in 3 different stages, 1st-slapped cheek, paleness around mouth, 2nd-rash upper extremities spreads to trunk & thighs, 3rd-overheating returns rash
Roseola 6th disease, virus, sudden persistant fever, rash appears rose-pink starts on trunk, spreads to rest of the body
Polio infantile paraylsis, virus, progresses quickly, muscle spasms, stiff neck & trunk, spreads to limbs, leads to paralysis
Scarlet Fever Scarlatina, bacteria, abrupt F, V, HA, rash all over body sand paper texture, worse in folds of body, nonblanchable. White-strawberry tongue, throat and tonsils swollen
Pertusis "Whooping Cough" bacteria, URI with 2 stages: 1.Proximal-dry hacking cough followed by inspiration making whooping noise, happens at nightm, cough so hard vomits, 2.Convalescent-decrease in coughing/whooping cough
Reye's Syndrome Aspirin use in children, viral infection, leads to neurological failure - liver, GI, brain shuts down. Had virus took aspirin, causing N/V, leathergic, cerebral edema, intracranal pressure, seizures, change in mental status
Hand, Foot, Mouth Disease Virus, fever, blister like erruptions in/around mouth, hands, feet, poor appetite, sore throat
infectious Mononucleosis Mono, Virus, direct contact with blood, or infected saliva, 4-6 weeks to grow, lasts up to 4 months, F, sore throat, fatigue, complications of enlarged liver or spleen
Gonorrhea bacteria, sexual contact, women unsymptomatic, green-yellow discharge, edema of infected area, abd pain & distention, muscle rejiggitary, woman have to have 3 negative cultures to be considered cured.
Herpes Genitalis virus, sexual contact and direct contact with legions, inhibits viral replication Zovirax, shortens duration of virus Famvir, Valtrax, Teach abstain from sex when lesions are active
Chlamydia "Silent disease" b/c no symptoms, complications of PID, infertility /sterility, bacteria, white/clear discharge, burning, urinary frequency
Syphillis the great imitator, S/S are similar to other diseases. Primary stage papul develops at site of entry, sloughs off, chancre, heals secondary stage, flu like symptoms, copper-penny spots on palm of hands, bottom of feet. Tertiary stage creates tumors
HPV human papillomavirus, genital warts, califlower warts, flesh color painless, may cause Cervical cancer. Medical Treatment of topical chemicals, laser therapy, freezing/chriotherapy
Vaginitis 4 different types Bacterial vaginosis-bacteria Yeast infection-fungus overproduction Trichomoniasis- bacteria Atrophic Vaginitis-caused by menopause
Pelvic Inflammatory Disease PID, prolonged strep & staph infections, STD's untreated, severe abd pain, bleeding after sex, N,V, weakness
Rhinitis most common communicable disease, virus, inflammation of nasal and nasal accessories
Influenza the Flu, virus types A&B- seasonal epidemics tpye C-mmilder S/S, complications pneamonia or dehydration, antivirals taken within 2 days of S/S, Tamiflu and Relenza stop virus replicating
Rabies severe viral infection, direct contact of saliva, n/v/f/ha twitching around area of bite, as progresses aggitation, aggressive, irritable, bizarre/abnormal thoughts, confusion, muscle spasms, abnormal posturing, becomes fatal
Pediculosis LICE 3 main types: head,body,pubic lice; egg/nit lives on scalp hatch in week, Nymph young louse, very active, Adult mate live about 1 month. lice live 3-4 days on objects without feeding. Nix Rid
Scabies contagious disease of skin, burrowing into epidermis living and reproducing. cannot live more thsn 24 hours without human blood. S/S- short wavy greyish-white lines found in creases/skin folds. Scabicide Kwell or Eurax
Chicken Pox Varicella, virus, direct contact of secfretions of respiratory or from rash, fluid filled red based vesicles will rupture, ooze, crust over. When crusted over not contagious anymore.
Herpes Zoster Shingles, have to have had some form of chicken pox virus, laid dorment at base of nerve, and reactivated. small clear red spots following track of nerve of the inflammed nerve path. Common places trunk, neck, face. Vaccines for 60 years and older
MRSA Methicillin Resistant Staphylacoccus Aureus. baterica resistant to certain antibiotics,not taking antibiotics as prescribed. 2 types: Hospital acquired, Community Acquired. MRSA can live on fomites several wks, puss filled boil looks like spider bite
Conjuctivitis PINK EYE, inflammation/infection of conjuctiva that lines the eye lid and part of eye. viral/bacterial infeection, Bacterial=drainage thick yellow-greenish, Viral=watery mucousy drainage
Dermatitis 2 types contact & atopic; inflammatory condition that can occur anytime from allergens
Contact Dermatitis occurs when substance/chemical comes in contact with skin & is absorbed in skin. Mus have had prior exposure. Detergents, soaps, chemicals, latex, plants
Atopic Dermatitis Infantile Eczema, inheredited allergen/food allergy. hydrate the skin, tepid/luke warm bath, followed by inclusive cream lock in moisture
Urticaria Hives/Wheals; cannot be cured, but controlled, will outgrow. Allergic reaction to drugs, food, animals, stress, chemicals. Epi Pe on hand, removal of trigger, luke warm baths
4 types of fungal infections Tinea capitis (ring worm of scalp) Tinea corporis (ring worm of the body) Tinea cruris (jock itch) Tinea Pedis (athlete's foot)
Tinea Capitis lesions that are round with pustule on scalp can cause baldness Wood lamp test positive if turns blue
Tinea Corporis Round lesions may be clear in center pustels around edges with scaling, looks like a ring. Wood lamp test positive if turns blue
Tinea Cruris brownish-reddish lesions extending from the groin area (inflammed/irritated)
Tinea Pedis fissures and vesicles around the toes
Acne a papilo-puscular skin erruption, antibiotics to treat severe cases, make worse diet, stress, hormones, fatty foods, acne develops when oil glands are blocked
Psoriasis chronic non-infectious skin condition, triggers: stress, meds, injury to skin, red scaling patches caused by skin growing much faster than normal, common sites: elbows/knees. Vitamin D promotes healing natural sunlight
Decubitus Ulcer pressure ulcer, bed sore, any type of injury that is caused by unrelieved pressure from fristion, shearing, usually over bony prominence.
Stages of Ulcer Stage I: skin red nonblanchable Stage II: skin cracked, blistered, partial skin thickness loss Stage III: skin gone, underlying tissue damaged, full thickness loss Stage IV: muscle or bone is exposed & damaged
Cellulitis an inflammation or infection of the skin that is caused by strep or influenzae (adults bacteria, virus in children) looks like pitted orange can become septic if enters bloodstream.
Impetigo highly contagious skin infection, thick drainage, which is honey colored crusted over, commonly seen on facce, butt, extremities.
Salmonella commonly effects children under 5, improperly prepared food, injest bacteria, abd pain, diarrhea=water, greenish/brown, foul slimy
Samonellolosis food borne found in unpasterized dairy products, untreated meat, eggs uncooked
E-Coli produced in body, when enters urinary tract, produces powerful toxin that causes severe illness & improper preparing food. Severe Diarrhea watery progresses to bloody, v, abd pain, no fever,
Botulism bacteria forms spores, found in soil. 3 types: Food borne(ingested bacteria), Wound (bacteria enters wound), and Infant (ingested by honey). Adults can only recieve anti-toxin. promote motility (l,axative)
C. Difficile C Diff, bacteria, can live on fomites for weeks-months, powerful toxin that attcks intestional lining, watery diarrhea least 3 times days for more than 2 days, foul odor, abd distention, severe cases: Diarrhea up to 15 times a day, blood in stool/pus
Lyme Disease deer ticks, rash at site of bite, "bullseye" appearance, fatigue, chills, ha, muscle/joint pain
Rocky Mountain Spotted Fever F,N,V,HA, joint pain, rash on wrists, ankles, forearms, then becomes more spread out,
West Nile Virus stagnent water, mosquito, most times never know you have it, others ha, body aches, N,V, rash, severe cases: ensephalytis, meningitis, neurological impairment
Anthrax bacteria, spore forming, bioterrism, 3 types: cutaneous (enters wound/skin immediate response) Inhalation(takes 10 days) Gastrointestinal (eating 1-7 days)
Smallpox virus, direct/indriect of prolonged body fluids, bioterrorism, rash on tongue & mouth, starts on face, spreads down, small raised red, become vessicles filled with opaque white fluid (dipped in like belly-buttons) rash becomes hard like BB's, rash scabs
Peri-Operative Nursing time surrounding and during surgery
Pre-Op begins w/ decision of surgery & ends w/ transfer of pt on opating table. 1.educate 2.ensure tests are completed 3.reinforce explanations & instructions from Dr. 4.educate on recovery 5.carry out pre-op interview 6.meds, iv, verify pt, consent form
Intraoperative begin pt is transferred to operating table & ends with admission to PACU, provide for safety, maintain sterile, ensure proper function of equipment, provide specific instruments,documentation, monitoring
Post-Op Begin with admission to PACU & ends with follo up eval in clinical setting. Focus on ABC's monitoring, assess effects for meds, any complications, pain relief, promoting recovery, pre-op teaching, focus on follow up care
Anastomosis surgical joining of 2 ducts or blood vessels to allow flow from one or another
-ectomy surgical removal
Lysis destruction or disolution of (removing something)
-orrhaphy surgerical repair
-oscopy direct visualization of/by scope
-ostomy opening that is made to allow passage of drainage
-otomy opening into
-pexy fixation of
-plasty plastic surgery
Classifactions for Surgery; 3 ways to classify 1. Seriousness of Surgery 2. Urgency 3. Purpose
Difference between major and minor Surgery major-extensive alteration of a body part minor-minimal alteration in body parts
Difference between urgent, elective, & emergency surgery emergency= requires immediate attention, urgent= requires prompt attention necessary for health, keep additional problems from occuring. elective= performed per pt's choice
Purposes of Surgery Diagnostic=confirm diagnosis(Biopsy) Ablation=removal of diseased body part (amputation) Palliative=relieves/reduces symptoms/not cure Reconstructive=restores function Transplant=replace organs Constructive=restores function result of congenital anam
Surgery Settings inpatient-admitted fr surgery (major surgery) one day/same day/ambulatory-admitted & discharged same day outpatient-patient not hospitalized short stay unit-pt's stay does not exceed 24 hours
Factors Influencing Surger Outcome (ABCDE) A-allergies B-bleeding C-corticosteroid use D-Diabetes E-Emboli (blood clots)
Normal levels for ABG's pH= 7.35-7.45 PaO2= 80-100 mmHg PaCO2= 35-45 mmHg O2Sat= >95%
Normal Levels for Blood Studies Hgb= 12-18 g/dl Hct= 37-52% ProTime= 11-12.5 seconds PTT= 30-40 seconds
Abnormal CBC's may reflect what? Infection increase WBC's Malnutriention & Anemia decreased Hct & Hgb Impaired immune function
Serum Electrolyte Analysis evaluate electrolytes & fluid status, may need to replace fluids before surgery
Coagulation Study Pro Time, PTT, platelet count; telss us if pt is at risk for hemorrohage, or thrombus formation
Serum Creatinine & BUN assess renal function
Urine Analysis assess color, pH, gravity, can detect protein, glucose, ketones, and blood in urine
Chest X-ray reflections codition of heart & lungs, telss us how tolerate seditives & anasthetics
EKG/ECG electrocardigram, gives electrical activity of heart
Blood type & cross matching blood type of pt, Rh factor, and compatiability with donor blood
Fasting Blood Glucose detects presence of diabetes
3 elements to Consent Form 1. Surgeon must tell pt EVERYTHING about surgery 2. Consent form must be signed before meds by nurse 3. Must be signed voluntarily can be withdrawn at any time! Nurses Role: witness & obtain signature
Pre-op teaching on Physical Activities to decrease post-op complications Deep Breathing-prevents pneamonia & blood clotting Coughing-moves secretion Incentive Spirometry-inhaling increases lungs function Leg exercises-venous return Turning-q2hrs promote venous return ambulate Ted Hose
Regional Anesthesia blocks transmission of nerve impulses to & from a specific area of body, remains conscious
Spinal Anesthesia lumbar puncture into space around spinal cord, epideral
4 main goals in PACU provide care until recovery of anesthesia, provide care until orientated, until stable vital signs, show no evidence of bleeding/other complications
Areas of Assesment in Post-Op care vitals, resperatory status, cardiovascular status, CNS, Fluid status, Inscission, Pain, N/V, Equipment functioning,
Primary Objective in Pre-Op Care Maintain Patent Airway
Signs of Airway Obstruction lax muscules of tongue (#1 cause), choking, noisy irregular respirations, decrease 02 sat, cynosis of skin
How can nurses prevent respiratory complications? Positioning Deep Breathing Coughing Incentive Spirometer Turning q2hrs Early Ambulation
Benefits of Early Ambulation INCREASES THE FOLLOWING: rate & depth of breathing, mental alterness, urinary elimination, peristalisis, metabolism, circulation
Types of Surgical Wound Drainage Sanguineous-bright red, inital drainage w/in few hours Serosanguineous-pink Serous-pale yellow
Wound Complications Infection-becomes red, warm, tneder, swelling, Fever, elevated WBC's Dehiscence-sudden bursting open of wound Evisceration-protrusion of internal organ through surgical wound
Treatment for Evisceration Emergency, notify MD immediately, place in low fowlers, knees flexed, cover wound with sterile warm dressing
3 phases of wound healing Primary Intention-apparoximated minimal scarring Secondary Intention- repair time, scarring, risk of infection greater, skin edges are not close together Tertiary Intention- delayed primary intention, leave wound open after infection is controlled
3 major concepts that must be present for oxygenation Ventilation Diffusion Perfusion
Natural Changes in the Respiratory System with Aging Decrease in elasticity in lungs, weakened repiratory muscles, thickening of aveoli membrane, dryer membranes, decreased function of cilia, increased risk for infection
Obstruction of the Airway common cause of respiratory insufficency, caused by foreign objects, tongue, thickened secretions. Patrial obstruction air sitll moving through recieving o2, complete obstruction no air movement
Hypoxia low oxygen, inadequate amount of oxygen in tissue & cells, S/S: restlessness, confusion, fatigue, unable to concentrate, SOA, dyspnea
Altered Breathing Patterns tachypnea, bradypnea, hypervenilation, hypoventilation, apnea, cheyne stokes, Kussmaul's
Cardinal S/S Associated with Respiratory Cough Sputum Production Dyspnea Hemoptysis Chest Pain Wheezing Orthopnea
Normal Lung Sounds Bronchial- heardover upper part of sternum short breathing in, long breathing out Vesicular-located outside of lungs, long breathing in, short breathing out Bronchovesicular-heard on center of chest, loud breathing in and out and equal
Crackles (rales) brief not continous, breathing in, crackling or bubbling sound, sounds like hair being rbbed inbetween fingers. caused by fluid mucus or pus in airway
Fine Crackles like crackles, high pitched, sibilant crackling at end of inspiration
Medium crackles like crackles, medium pitched, more sororous moisture sound during mid inspiration
Coarse Crackles like crackles, loud, bubbly sound heard early inspriation
Sonorous Wheezes (rhonchi) Deep running sound loud, low, coarse sound like a snore, heard at any point with breathing
Sibilant Wheezes (wheezes) High-pitched musical, whistle-like, sound duing inspriation/expiration, may vary from one minute to he next, cuased by narrow airway
Pleural Friction Rub Dry creaking grating low pitched sound during breathing in and out, caused by pleura rubbing together
Stridor loud crowing noise, do not need a stethoscope to hear, caused by airway obstruction
Ineffective Airway Clearance inability to clear secretions or obstructions from the respiratory tract. cause= nonproductive cough, increased secretions
Ineffective Breathing Patterns inspiration/expiration that does not provide adequate ventilation. change in normal breathing patterns
Impaired Gas Exchange Access/Deficit in oxygenation and or carbon dioxide. Diffusion not taking place.
Activity Intolerance State in whic an individual has insufficent physchological/psychological energy to complete daily physical activities, too weak to move, can't breath
Altered Nutrition less than body requires not able to breath can't eat as well
Anxiety not able to breath, worried
Lung Scan determining patency of pulmonary airways and anormalities in ventilation. Dye injected (ask if allergy to shellfish).
Pulminary Function Study determine impaired lung function, function of pt with long term COPD, evaluate response to therapy, pre-op lung evaluation.
Direct Visualization 2 purposes, diagnostic-picture of any abnormalities & therapeutic-bronchial washings to remove excessive scretions or foreign objects
Sputum collection secretions of lungs, morning best time to collect, 15 ml of sputum needed, always rinse before collection, before antibiotics get sputum
Blood samples CBC & ABG's, performed at bedside, hold pressure at least 5 mintues, 10 minutes if on blood thinners
Thoracentesis insertion of a large bore needle, removal of fluid that may threaten safety or comfort of pt, inject meds into pleural space, no more than 1300ml in 30 minutes
Lung Biopsy tissues/secretions/cells of lungs.
Asthma trachieal & bronchial response to stimuli reaction to stimuli, inflammation from mucus, can improve on own or need medical attention. Extrinsic factors (outisde, perfume, wax, spray, bleach) or Intrinsic factors (Respiratory Tract Infection, GERD).
3 mechanisms involved in acute Asthma Attacks 1.Recurrent reversible obstruction of Airflow, muslces around bronchioles tighten & narrow airway 2.Increased capillary permiability mucus production increases 3.Inflammatory response Mast Cells react b/c ahe been invaded by asthma triggers
Mild Asthma dyspnea, wheezing, fatigue, weakness
Acute Asthma Attack usually at night, tachypnea, tachycardia, anxious, sweating, chest tightness, ough, expiratory wheezing, nasal flaring
Status Asthamaticus nt responding to usual treatment, damage to airways, airways cannot repair themselves
Asthma Nursing Interventions Admin prescribed meds, cool air, pursed lip breathing (inhale count 2, exhale through pursed lips count 4), Give O2 as prescribed
Croup acute viral disease of childhood, sufficative feeling marked by residnt cough, most common in children 3mos to 3yrs, virus, Hoarseness, Stridor, Tachypnea, Cough (bark)
Epiglotitis flap guarding airway, bacterial infecion, can close off airway, caused by flu virus type B, F, muffled voice, drooling, progressive Resp distress, anxiety, fear, artifical airway
Signs of Hypoxia Restlessness and Tachycardia
RSV Respiratory Syncytical Virus, lower rsp infection, children less than 4, Jan-March, mild cold like symptoms, sore throat, ear infection, F, cough, runny nose, (severe) airway obstuction, retractions, nasal flaring, tachypnea, dyspnea
High Risk group for RSV 2-6 months, immunocomprimised chldren, Congential heat disease patients, chronic lung disease, low soci-economic status, exposure to smoke, daycare, infants not breastfeeding
Interventions for RSV Handwashing teaching, isolate children from respiatory infections, avoid 2nd hand smoke, droplet & contact precaution
Cystic Fibrosis CF, genetic inherited by 2 paents carrying both gene>(autosomal recessive) effects respiratory and GI, mucus begins to collect in airways and organ ducts, ineffective airway clearance, becomes infection, pulmonary hypertension, pulmonary obstruction
in newborns first sign of CF Meconium Illeus, obstruction of bowels
typical S/S of CF stool=fatty, froathy foul stools growth failure, protruded, emaciated, rectal prolapse, bleeding disorders, bruising, skin transparent, chronic cough, respiratory symptoms, wheezing, sputum production, barrel chest
Diagnostic Tests For CF Family inheritence, Chronic pulomary, pancreotic enzymes, sweat test; sweat inducer places on forearm, then bag placed to catch sweat, sweat tested(+ if sweat is greater than 60 meq/L of chloride is present) Chest XRay
SIDS sudden infant death syndrome, crib death, no knon case, occurs during sleep without any warning, no S/S, cold weather months, mainly Jan
Reducing SIDS place on back to sleep, patient education before discharge, firm mattress, do not over heat, no smoking, good prenatal care, breast feed, proper immunization schedule
Nursing care for SIDS expressions: fear, shock, mad, never ask questions that point blame, provide support, support groups, teaching, risk factors, education
Created by: nbuchanan0006
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