1100 Test 2

The interaction between the pathogen microorganism, the environment and the host is defined as

infectious disease process

Communicable Disease

infectious disease that are transmitted by contact from a source to a susceptible host

Parameters of growth

* Weight, length & height are used to monitor growth * head circumference indicates brain growth * Eruption of teeth also follows a sequential pattern *Growth spurts

Physical growth: New Born Weight

* average weight 7.5 *loses 10% of weight in first week *Regains birthweight by 10-14 days *Triple their birth weight by 1 year

NewBorn Head circucumference

* Average newborn head circumference is 14 inches * Increases rapidly in 1st 6 months *Average 4 inch gain from birth to 1year

Safety: What nurses can do to prevent childhood injury

* Model safe practices in the home, workplace, & community *Eucation parents and children through safety guideness to reduce needle injuries *Collaborate wiht other healthcare provideres to promote safety

Viruses

1. Viruses attach to receptor (Spike) on cell 2. Virus breaks down cell membrane (fusion) 3.Virus enters cell 4. Falls apart release DNA & enzymes it brought in 5. Viral RNA/DNA goes to cell nucleus. Hijacks normal cell function so that cell makes more virus 6. Cell makes DNA, viiral enzymes package it into many more viruses. They burst out of cell (budding) and go on to infect other cells

Hypothalamus

main regulator for temperature Regulates through hormonal control Thermoreceptors and a negative feedback system

Mobility is essential for

physical growth and development

Bacteria produce disease in two general ways

some bacteria destory living cells and tissues of the infected organism directly, while some cause tissue damage when they provoke a response from the immune system other bacteria release toxins (poison) that interrfere with the normal activity of the host

non communicable disease

they are caused by factors other than living pathogens mostly brought about by internal factors cannot pass one to another transmission is absent

Pelvic

Range from relatively minor to life threatening May cause serious intraabdominal injury Treatment from bedrest to fixator devices Prone to get a paralytic ileus

Intake

Intake can occur either through the mouth, a tube, or IV. Liquids by mouth: Juice, H20, Ice chips Broths, Milk, Ice cream Ensure semi-liquid pudding doesn't count

The Daily Value

The Daily Value for total carbohydrate is 300 g per day. This is based on a 2,000 calorie diet — your Daily Value may be higher or lower depending on your calorie needs.

Cause of cellulitis

one or more types of bacteria that enter the body by a break or cut in the skin streptococcus and staphylococcus are the two most common bacteria that cause cellulitis

Tissues are

organized groups of cells with common functions

Body system defenses

organs

deposition of new bone by

osteoblasts (ossification)

Bone remodeling is the removal of old bone by

osteoclasts (resorption)

A mother tells the nurse that she will visit her 2 year old son tomorrow around noon. The child asks for his mother, What would be the nurses best response?

your mom will be here after lunch

Prevention of Communicable Disease

*Good site planning *Provision of Basic Clinical Services *Provision of appropriate shelter *Clean Water Supply *Sanitation *Vaccination against specific diseases * Regular and Sufficient food supplly *Control Vectors

Causes

Acute lumbosacral strain, instability of the lumbosacral bony mechanism, osteoarthritis of the lumbosacral vertebrae, degenerative disc disease, herniation of an intervertebral disc

Hypertonic fluids

Excessive amount of concentrated solution Cell shrinks Osmosis inside of the cell switch to higher concentration Types of solutions 3% saline 5% saline 5% dextrose in 0.9% saline 5% dextrose in LR 10% dextrose in saline

Strain

Excessive stretching of a muscle, its fascial sheath, or a tendon

Stage 8 Integrity vs. despair

Have I lived a full life Late adulthood Lasting outcomes:Renunciation and wisdom

Risk factors for altered thermoregulation

Impaired Cognition Pre-Existing Health Conditions Surgical Procedures Nutritional Status

Dietary Data

24-hour recall method Food diaries/calorie counts Food frequency record Diet history

OVerwieght BMI

25.0 or more

colorectal cancer

2nd most common cancer in the U.S. males; 3rd in females More common after age 50; Colonoscopies should begin at this age, then every 10 years unless there is an identified high risk. Early detection and treatment=5 year survival rate of 90%. Over the age of 55=yearly digital rectal exam with fecal occult blood testing. Risk factors: genetics; diet; smoking. All begin as adenomatous polyps and are adenocarcinomas Metastasis to the liver, stomach, duodenum, small intestine, pancreas, spleen, GI tract and abdominal wall may occur. Metastasis occurs directly or through the lymph nodes CBC to assess for anemia; CT; PETA Scan; Colonoscopy CEA or carcinoembryonic antigen is a tumor marker that can be detected in the blood of patients with colorectal cancer. CEA levels are used to estimate prognosis, monitor treatment and detect cancer reoccurrence

Pre op

Comorbidities Muscle spasm and pain control

Heat production

Continual production through metabolic activity Food consumption, hormone levels, and physical activity

Stage I Sensorimotor period

Coordination of sensory input & motor responses; development of object premenence Age: Birth-2 years

Droplet Precautions

Hand Hygiene Mask

The osmolality of the fluid surrounding cells affects them

Isotonic Hypotonic Hypertonic

Treatment

Limitation of extremes of spinal movement Wear brace, corset, or belt Local heat or ice, massage, traction, and transcutaneous electrical nerve stimulation (TENS) NSAIDs, short-term use of oral corticosteroids, opioid analgesics, muscle relaxants, antiseizure drugs, antidepressants Epidural corticosteroid injections may reduce inflammation and relieve acute pain Surgery

Wound Assessment

Location Size Shape Color Odor drainage

Venous Thrombus Forms

Lower extremities and pelvis are highly susceptible to thrombus formation after a fracture Patients with limited mobility, venous stasis is more of a threat

What does endotoxin do?

Opens up aterial wall and fluid leaks into interstitial tissue secretion of cytokines fever BBB inflammation

Secondary Prevention

Screening Malignant hyperthermia

Bacterial Infections

Study slide 11 infection

Output

Urine Emesis Liquid Stool ileostomy Wound (wound vac, jp drain, chest tubes)

Supplements

Vitamin D and calcium Bisphosphonates

Mobility is defined as

a "state or quality of being mobile or movable"

Development

a continous, orderly series of conditions that leads to activities, new motives for activities, and patterns of behavior Learning and maturation

Pathologic fracture

a spontaneous fracture at the site of a diseased bone

Phase 1 activation

a stimulus i.e., hormone, drug, vitamin, physical stressor, injury activates the bone to form osteoclasts

Athropods-mice& lice

abies- the mite burrows under the skin and lays its eggs in the dermal layer Transmitted from person to person Can live on sheets or clothing for 2 days Lice- infect head, body and pubic hair. Lay eggs along th hair shaft Transmitted by personal contact, clothing, bedding, and shared hair products or items

Oblique fracture

across and down the bone

Transverse Fracture

across the bone shaft at a right angle to the longitudinal axis

Range of motion

active- they move themselvees passive- you move limb for them

When to perform hand hygiene

before patient contact before aseptic task after body fluid exposure risk after patient contact after contact with patient surroundings

Inspection

begins when the client walks anywhere—to the bathroom, down the hall, into the room

phase ii resorption

bone is resorbed into the blood stream to create a cavity

Osteoclasts participate in

bone remodeling by assisting in the breakdown of bone tissue

How to calculate body mass index

calculation using persons weight and height BMI=kg/m2 kilogram is a persons weight in kilograms and m2 is their height meters squared weight (pounds)X703 divided by height (covert into inches) squared Example: a patient weghs 200 pounds and is 5'10" 200 x 703 divided by 4,900 (70 X70) equals 28.7

Tetanus in soil

can infect the host but cannot be transmitted to another human. It is an infectious disease (preventable), but is not a communicable disease

Droplets

can remain suspended in the air for hours

Infectious Disease

caused by pathogens invading the host, colonizing and stimulating the inflammatory repsonse to produce host symptoms

Epithelial Cells

cells cover almost the entire internal and external surfaces. Protect other body tissues and organs Nerves in the epithelial cells alert for safety Pain Temperature changes Touch Two layers Epidermis Dermis

Impaired

describes a state in which a person has a limitation in physical movement but is not immobile

The Development of a 2 year old child is characterized by

engaging parallel play

Greenstick fracture

incomplete fracture

Acute

: Sudden change and definite difference in BM consistency & regularity. Must consider cause if worsening/persistent: tumor or obstruction

TOO BIG? BMI 95%

High risk of Type II diabetes Obesity related disorders

Hyperkalemia

High serum potassium caused by Impaired renal excretion Shift from ICF to ECF Massive intake Most common in renal failure

Components of Nutritional Assessment

History taking Dietary, medical, socioeconomic data Physical assessments Anthropometric and clinical data Laboratory data Protein status, body vitamin, mineral, and trace element status

Ongoing Care

Hospitalization averages 3 or 4 days then require care in a subacute rehabilitation unit, at a skilled nursing facility for 6 weeks, or in an acute rehabilitation facility for a few weeks Will still need pain management, monitoring for infection, and prevention of VTE Exercises to restore strength and tone in the quadriceps and muscles around the hip for many months after surgery Physical Therapy

Infection

Open fractures have a high incidence of infection Consider how the injury may have been contaminated Can lead to chronic osteomyelitis Require aggressive surgical debridement May use a antibiotic solution or antibiotic beads May need IV antibiotics

Analgesics and muscle relaxants

Opioids NSAIDs Aspirin

Pharmacotherapy Interventions

Oral Steroids Immunosuppressant chemotherapy

short bowel syndrome

SBS occurs when the small intestine or colon has been resected or shortened. [Crohn disease, tumors, trauma, gastric bypass surgery, etc.] Severity of symptoms is dependent on the amount of bowel that was removed or bypassed. Manifestations: malabsorption of water, nutrients, vitamins and minerals, that may need supplementation.

SEPSIS STEPS SIRS CRITERIA

SIRS:temp.100.4 <96.8 RR>20 HR >90 WBC>12,000 <4,000 > 10% bands PCo2 <32 MMHG SEPSIS= 2 SIRS + Confirmed or suspected infection SEVER SEPSIS= Sepsis + signs of end organ damage hypotension (SBP <90) Lactate >4 mm SEPTIC SHOCK: Severe sepsis with persistant: signs of end organ damage hypotension (SBP <90) Lactate >4 mm

Which is a good characteristic of psychosocial development of school age children

feeling of inferiority or lack of worth can be derived from children themselves or the environment Is eager to develop skills and participate in activities. Gains satisfaction from successful independent behaviors. Peer group formation is beginning. Initiative associated with pre-schoolers. Teenagers have motivation from extrinsic rather than intrinsic sources.

Systemic Manifestations

fever, night sweats, chills, restlessness, nausea, and malaise, drainage from cutaneous sinus tracts or the fracture site

Colles Fracture

fracture of the distal radius Swelling and deformity Reduction and may need fixation devices

Fever is an

important defense mechanism

Spiral Fracture

in a spiral direction along the bone shaft

Stress fracture

in normal or abnormal bone that is subject to repeated stress

Prolonged activity produces lactic acid and muscle fatigue,

inactivity causes atrophy

Fomites

inanimate objects involved in the spread of disease doorknobs cell phones uniforms stethoscopes

Each muscle (there are 350 of them!) is made up of

millions of individual fibers

Proximodistal pattern (inward to outward)

motor control of arms comes before hands

Complete proteins

Complete protein contain all of the essential amino acids in adequate amounts.

Intracelluar Fluid

Prevalent cation is K+ Prevalent anion is PO43-

Adolescents

have an increase in apocrine glands which leads to oily skin and acne.

Osmosis

" Movement of water across a semipermeable membrane that separates compartments with different concentrations of particles." Lesser concentration outside and higher concentration inside of the cell

Physical Growth Newborn Height

* Average height is 20 inches at birth *Grows faster in length in the 1st 6 months than 2nd 6 months *length has increased 50% in the first 12 months

additional costs per patient in hospital

$10,375

for central line associated blood stream infections/case

$45,814/ case

Hopsital acquired infections are associated with

$96-147 billion direct and indirect care in acute care setting

Osteoblasts synthesize organic bone (collagen)

) and are the basic bone-forming cells

Developmental children are vulnerable to injury for the following reasons:

* curious & explore their surroundings *driven to test and master new skills *attempt activities without thinking about them *Assert themselves and challenge rules *strong desire for peer approval

Fistula

- a tunnel or tract with openings into anal canal to the perianal skin. Rarely, can open to bladder and peritoneal cavity. Most occur spontaneously, after an abscess , or are related to Crohn disease. Symptoms of drainage and pus. Surgical treatment: fistulotomy: opening of the fistula to allow healing from inside out [healing by secondary intention

hernia

- defect or weakness of the abdominal wall where the abdominal contents protrude out of the abdominal cavity and form a sac. Caused by trauma, surgery, or increased intra-abdominal pressure [obesity, wt. lifting, tumors]. When pressure is decreased, contents usually return into the abdominal cavity. Nonsurgical treatment: manual reduction. Binder or truss. Activity/lifting education. Surgical: if contents become strangulated, blood supply is cut off. Tissue necrosis. Herniorrhaphy required where defect is closed

fissure

- ulcers occur when internal anal sphincter becomes denuded or abraded causing pain and bleeding. Common causes are childbirth, irritating diarrhea, habitual cathartic use, anal sex. Non-surgical treatment: high fiber diet, meds: psyllium, stool softeners. Surgical: internal sphincterotomy

Mechanism of Medications

1. impair cell wall synthesis causing lysis and cell destruction 2.inhibits protein synthesis, impairing microbial function 3. altering cell membrane permeability causing intracellular leakage 4. inhibit synethesis of nucleic acids 5. inhibits cell metabolism and growth

What are vitamins called?

13 vitamins that the body absolutely needs: vitamins A, C, D, E, K, and the B vitamins (thiamine, riboflavin, niacin, pantothenic acid, biotin, vitamin B-6, vitamin B-12 and folate)

Head circumference by 1 yr

17-18

Average BMI

18.5-24.9 * applies to most 18-65 year olds

Infection

1st stage: colonization pathogen invades body and begins to multiply * Innate response (general) 1st line of defense--intact skin and mucous membranes * Phagocytosis--can be overwhelmed by too many pathogens or toxins Adaptive response (specific) * recognizes specific pathogens and destroys * imprints on them so future exposure response is fast and specific

Hyperkalemia: manifestations

Cardiac dysrhythmias Cramping leg pain Weak or paralyzed skeletal muscles Abdominal cramping or diarrhea

A bedridden client loses muscle strength at a rate of

3% from baseline per day

Fractures

A break in the bone Usually from traumatic injuries Some fractures are secondary to a disease process such as cancer or osteoporosis Classified as open or closed Or classified as complete or incomplete Or identified according to the direction of the fracture line Linear, oblique, transverse, longitudinal, spiral Or displaced or nondisplaced

Infants double wt at

4-6 months triple weight by birth

Hip Fracture

95% result from a fall in the older adult Fracture of the proximal (upper) third of the femur, which extends 5 cm below the lesser trochanter

constipation

: < 2 bowel movements per week Causes: lack of activity highly refined diet low in fiber inadequate fluid intake medications (many classes) psychogenic causes (increased sympathetic stimulation) metabolic disorders muscle strength deterioration (CVA, spinal paralysis, muscular sclerosis, ALS) Chronic laxative and enema use S/S: less bowel movements than usual for client, flatus, hard/dry stools, abd. pain, anorexia, nausea, straining to defecate, liquid incontinence around hard stool

Ericksons psychosocial theory

8 stages

fecal impactio/obstipation

: Patient cannot expel fecal mass. In obstipation, impaction cannot be removed digitally and surgery/procedure may be necessary

Heat loss

: Radiation, convection, conduction, vasodilation, evaporation, reduced muscle activity, and increased respiratory rate

Side effects of vitamins

A (retinol, retinal, retinoic acid): Nausea, vomiting, headache, dizziness, blurred vision, clumsiness, birth defects, liver problems, possible risk of osteoporosis. Client may be at greater risk of these effects if they drink high amounts of alcohol have liver problems, high cholesterol levels or don't get enough protein. D (calciferol): Nausea, vomiting, poor appetite, constipation, weakness, weight loss, confusion, heart rhythm problems, deposits of calcium and phosphate in soft tissues. If the client is taking blood thinners, vitamin E or vitamin K may affect the dose B-3 (niacin): flushing, redness of the skin, upset stomach. B-6 (pyridoxine, pyridoxal, and pyridoxamine): Nerve damage to the limbs, which may cause numbness, trouble walking, and pain. C (ascorbic acid): Upset stomach, kidney stones, increased iron absorption. Folic Acid (folate): High levels may, especially in older adults, hide signs of B-12 deficiency, a condition that can cause nerve damage

Laminectomy

A common, surgical procedure which involves surgical excision to remove the protruding disc

Osteomyelitis

A severe infection of the bone, bone marrow, and surrounding soft tis Invades by indirect or direct entry Microorganisms grow and pressure increases because bone can not exand This increasing pressure eventually leads to ischemia and vascular compromise The infection spreads through the bone cortex and marrow cavity, causing cortical devascularization and necrosis Bone death occurs as a result of ischemia

Inserting and Maintaining a Nasogastric Tube Purposes Decompression, enteral feeding, compression, and lavage Categories of nasogastric (NG) tubes Fine- or small-bore for medication administration and enteral feedings Large-bore (12-French and above) for gastric decompression or removal of gastric secretions Clean technique Maintaining patency

A patient's condition or situation sometimes requires special interventions to decompress the GI tract. Such conditions include surgery, obstruction of the GI tract often caused by tumors, trauma to the GI tract, and conditions in which peristalsis is absent. A nasogastric (NG) tube is a pliable hollow tube that is inserted through the patient's nasopharynx into the stomach. There are two main categories of NG tubes: Fine- or small-bore tubes and large-bore tubes. Small-bore tubes are frequently used for medication administration and enteral feedings. Large-bore tubes, 12-Fr and above, are usually used for gastric decompression or removal of gastric secretions. NG tube insertion does not require sterile technique. Clean technique is used. The procedure is uncomfortable. The patient experiences a burning sensation as the tube passes through the sensitive nasal mucosa. When it reaches the back of the pharynx, the patient sometimes begins to gag. Help the patient relax to make tube insertion easier. Some institutions allow the use of Xylocaine jelly or atomized lidocaine when inserting the tube because it decreases patient discomfort during the procedure. After you insert the tube, you need to maintain its patency. Sometimes the tip of the tubing rests against the stomach wall or the tube becomes blocked with thick secretions. Flushing the tube regularly using a catheter tipped syringe filled with normal saline or warm water helps to prevent blockage of the tube. If an NG tube does not drain properly after flushing, reposition it by advancing or withdrawing it slightly. Any change in tube position requires you to verify its placement in the patient's GI tract.

Radiofrequency discal nucleoplasty (coblation nucleoplasty)

A radiofrequency probe is inserted into the disc that generates energy that breaks the bonds of the gel in the nucleus pulposus, reduces pressure on the disc and surrounding nerve roots

Hemiarthroplasty or Total Joint Replacement by a Posterior Approach

A repaired with (incision posterior to the midline of the greater trochanter down the femoral shaft)

Artifical disc replacement surgery

An artificial disc has a high-density core sandwiched between two cobalt-chromium endplates, after the damaged disc is removed, this device is surgically placed in the spine (usually through a small incision below the umbilicus)

Transmission of infectious agents within a healthcare setting requires three elements:

A source or (reservoir) of infectious agents A susceptible host with a portal of entry receptive to the agent A mode of transmission for the agent

Rotator Cuff Injury

A tear caused by a gradual, degenerative process due to aging, repetitive stress or blunt trauma Causes shoulder weakness, pain, and decreased ROM Confirmed by a MRI Partial tear or cuff inflammation treated conservatively RICE, NSAIDs, corticosteroid and physical therapy Surgical repair may be needed If the tear is extensive, part of the acromion removed (acromioplasty) Immobilize to limit shoulder movement, however avoid a "frozen" shoulder (arthrofibrosis) Physical therapy begins the first postoperative day, weight restrictions for lifting, full recovery may take 6 months

Treatment

Acute pain NSAIDs and muscle relaxants Massage and back manipulation, acupuncture Application of cold and hot compresses Severe pain may require a brief course of corticosteroids or opioid analgesics May need a brief period (1 to 2 days) of rest but should avoid prolonged bed rest, most patients do better if they continue their regular activities but avoid lifting, bending, twisting, and prolonged sitting Symptoms generally improve within 2 weeks

Nursing Diagnoses

Acute pain related to inflammatory process secondary to infection Ineffective health maintenance related to lack of knowledge regarding long-term management of osteomyelitis Impaired physical mobility related to pain, immobilization devices, and weight-bearing limitations

opioid induced constipation

Affects 40% of clients treated for chronic pain with opioids gastric emptying peristalsis fluid reabsorption sphincter tone Morphine, oxy, codeine Fentanyl and methadon

Nursing implemenation: Eliminate oral and parenteral K intake

Increase elimination of K (diuretics, dialysis, Kayexalate) Insulin Cardiac monitor Follow lab values closely

Enemas Cleansing enemas Tap water Normal saline Hypertonic solutions Soapsuds Oil retention Others types of enemas Carminative and Kayexalate

An enema is the instillation of a solution into the rectum and sigmoid colon. The primary reason for an enema is to promote defecation by stimulating peristalsis. The volume of fluid instilled breaks up the fecal mass stretches the rectal wall and initiates the defecation reflex. Enemas are also a vehicle for medications that exert a local effect on rectal mucosa. Enemas are most commonly used for the immediate relief of constipation, emptying the bowel before diagnostic tests or surgery and beginning a program of bowel training. Cleansing enemas promote the complete evacuation of feces from the colon. They act by stimulating peristalsis through the infusion of a large volume of solution or through local irritation of the mucosa of the colon. They include tap water, normal saline, soapsuds solution, and low-volume hypertonic saline. Each solution has a different osmotic effect, influencing the movement of fluids between the colon and interstitial spaces beyond the intestinal wall. Infants and children receive only normal saline because they are at greater risk for fluid imbalance. Tap water is hypotonic and exerts an osmotic pressure lower than fluid in interstitial spaces. After infusion into the colon, tap water escapes from the bowel lumen into interstitial spaces. The net movement of water is low. The infused volume stimulates defecation before large amounts of water leave the bowel. Use caution if ordered to repeat tap-water enemas because water toxicity or circulatory overload could develop if the body absorbs large amounts of water. Physiologically, normal saline is the safest solution to use because it exerts the same osmotic pressure as fluids in interstitial spaces surrounding the bowel. The volume of infused saline stimulates peristalsis. Giving saline enemas lessens the danger of excess fluid absorption. Hypertonic solutions infused into the bowel exert osmotic pressure that pulls fluids out of interstitial spaces. The colon fills with fluid and the resultant distention promotes defecation. Patients unable to tolerate large volumes of fluid benefit most from this type of enema, which is by design low volume. This type of enema is contraindicated for patients who are dehydrated and young infants. A hypertonic solution of 120 to 180 mL (4 to 6 ounces) is usually effective. The commercially prepared Fleet enema is the most common. You add soapsuds to tap water or saline to create the effect of intestinal irritation to stimulate peristalsis. Use only pure castile soap that comes in a liquid form that is included in most soapsuds enema kits. Use soapsuds enemas with caution in pregnant women and older adults because they could cause electrolyte imbalance or damage to the intestinal mucosa. The health care provider sometimes orders a high or low cleansing enema. The terms high and low refer to the height from which, and hence the pressure with which, the fluid is delivered. High enemas cleanse more of the colon. After the enema is infused, ask the patient to turn from the left lateral to the dorsal recumbent, over to the right lateral position. The position change ensures that fluid reaches the large intestine. A low enema cleanses only the rectum and sigmoid colon. Oil-retention enemas lubricate the feces in the rectum and colon. The feces absorb the oil and become softer and easier to pass. To enhance action of the oil, the patient retains the enema for several hours if possible. Carminative enemas provide relief from gaseous distention. They improve the ability to pass flatus. An example of a carminative enema is MGW solution, which contains 30 mL of magnesium, 60 mL of glycerin, and 90 mL of water. Medicated enemas contain drugs. An example is sodium polystyrene sulfonate (Kayexalate), used to treat patients with dangerously high serum potassium levels. This drug contains a resin that exchanges sodium ions for potassium ions in the large intestine. Another medicated enema is neomycin solution, an antibiotic used to reduce bacteria in the colon before bowel surgery. An enema containing steroid medication may be used for acute inflammation in the lower colon. [Shown is Figure 47-14: Prepackaged enema container with rectal tip.]

Focuses on maintaining proper alignment of the spine until healed

After lumbar fusion, place pillows under the patient's thighs when supine and between the legs when in the side-lying position

Risk factors

Age Related Factors Individual risk factors Underlying Health Conditions Poor perfusion Malnutrition Obesity Fluid excess/deficit Immobility Immunosuppressed Genetics Skin Cancer Risk Dermal Ulcers

urinary retention

An accumulation of urine due to the inability of the bladder to empty

Bones

Acts as the structural foundation for the body Supports and protects tissues and internal organs Provides attachment sites for muscles and ligaments Storages calcium Makes red blood cells within the bone marrow Require ongoing maintenance and intermittent repair Remodeling requires adequate nutrition, hormonal regulation, and blood supply

An individual's general health status has significant influence on mobility

Acute illness or injury Debilitating chronic conditions End-of-life conditions Specific mobility impairment issues (neurologic, musculoskeletal or a combination of both)

About half of all American adults—117 million individuals—have one or more preventable chronic diseases, many of which are related to poor eating and physical activity patterns."

About half of all American adults—117 million individuals—have one or more preventable chronic diseases, many of which are related to poor quality eating patterns and physical inactivity. These include cardiovascular disease, high blood pressure, type 2 diabetes, some cancers, and poor bone health. More than two-thirds of adults and nearly one-third of children and youth are overweight or obese. These high rates of overweight and obesity and chronic disease have persisted for more than two decades and come not only with increased health risks, but also at high cost. In 2008, the medical costs associated with obesity were estimated to be $147 billion. In 2012, the total estimated cost of diagnosed diabetes was $245 billion, including $176 billion in direct medical costs and $69 billion in decreased productivity

Administer antipyretics

Acetaminophen Non-steroidal anti-inflammatory drugs Control shivering *Meperidine

Treatment

Aggressive, prolonged IV antibiotic therapy Cultures or a bone biopsy before initiating antibiotics (culture and sensitivity) If antibiotic therapy is delayed, surgical debridement and decompression are often needed IV antibiotic therapy is started in the hospital and continued at home for weeks or as long as 3 to 6 months Surgical removal of the poorly perfused tissue Acrylic bead chains containing antibiotics may also be implanted to help combat the infection. After debridement, a suction wound vac may be applied Often protected with casts or braces

Loss of Perfusion

All tissue requires oxygenation The skin is very tolerant of temporary lack of oxygenation In shock the body's normal physiologic process is to shunt blood away from non vital areas to the heart and the brain. The body can tolerate it for a short amount of time, however, prolonged lack of oxygenation can lead to tissue necrosis. Ex: pressure ulcers, loss of digits

Immoblity

Although immobility is typically considered a negative state, there are times when immobility or immobilization is therapeutic For example, providing rest, recovery, and comfort

Leg Fracture Tibial

Although the bone doesn't have a muscle covering the front, it takes a strong force to fracture Symptoms are pain, swelling, deformity Treatment - immobilization, fixation devices, assess CMS and postop complications

Stage 4: Industry vs. Inferiority

Am I competent or am I worthless 6 years-puberty Lasting outcomes:Method & Competence

Stage 3:Initiative vs. Guilt

Am I good or am I bad fourth-sixth years Lasting outcomes: Direction and purpose

Disuse syndrome

Another term for "decondition" First proposed more than 30 years ago by Bortz, describes the predictable adverse effect on body tissues and functions associated with sedentary lifestyle and inactivity Characterized, as defined by Bortz, included cardiovascular vulnerability, obesity, musculoskeletal fragility, depression, and premature aging

Who gets cellulitis

Are elderly. Have swollen legs (for various reasons) or are overweight or obese. Have previously had an episode of cellulitis. Have a weak immune system - for example, if you take steroids or chemotherapy. Are pregnant. Have poorly controlled diabetes. Are an intravenous drug user. Have severe eczema or other skin conditions that cause cracks in the skin, like athlete's foot.

Minerals.

Are inorganic substances that are not made by living things. Minerals are found naturally in soil and water and are absorbed by plants, which are then eaten by people and other animals. Examples of minerals are iron, calcium, and potassium. People obtain minerals from both the plant and animal products they eat and they become part of the body.

Incomplete proteins

Are missing, or do not have enough of, one or more of the essential amino acids, making the protein imbalanced.

Neurovascular assessment

Application of a cast or constrictive dressing, poor positioning, and physiologic responses to the traumatic injury can cause nerve or vascular damage, usually distal to the injury Color, temperature, capillary refill, peripheral pulses, edema, peripheral sensation, motor function, compare both extremities to obtain an accurate assessment Pallor or a cool-to-cold extremity below the injury could indicate arterial insufficiency A warm, cyanotic extremity could indicate poor venous return A diminished or absent pulse distal to the injury can indicate vascular dysfunction and insufficiency Partial or full loss of sensation (paresis or paralysis) may be a late sign of neurovascular damage. Instruct patients to immediately report any changes in sensation or the ability to move the digits in the affected extremity

Cast care

Apply ice directly over fracture site for first 24 hr (avoid getting cast wet by keeping ice in plastic bag) Don't shove objects inside cast to scratch skin, use hair dryer on cool setting for itching inside the cast Check with HCP before getting fiberglass cast wet Should not have numbness and tingling distal of cast Elevate or keep supported for first 48 hours Should not have swelling associated with pain and discoloration of toes or fingers Report sores or foul odor under cast Move fingers and toes often Pain that is not controlled is a concern Follow up with HCP

Dislocations

Requires prompt attention Considered an orthopedic emergency The longer the joint remains unreduced, the greater the possibility of avascular necrosis and compartment syndrome

Facial Fractures

Assess for cervical spine injury and patent airway May be simple or may involve loss of tissue and bone May also be therapeutically performed to correct malocclusion Surgery includes immobilization, usually by wiring the jaws or use screws and plates Care focuses on a patent airway, oral hygiene, communication, pain management, adequate nutrition Immediate postoperative period concerns are airway obstruction and aspiration of vomit Patient cannot open the jaws Observe for signs of respiratory distress (e.g., dyspnea; alterations in rate, quality, and depth of respirations) After surgery place the patient on the side with the head slightly elevated immediately

Role of UAP

Assist with passive ROM of adjacent joints and active ROM exercises of unaffected limb Notify RN about complaints of pain, tingling, or decreased sensation in the affected extremity

Normal temperature values for an adult

Average temperature range: 36° to 38° C (96.8° to 100.4° F) Average oral/tympanic: 37° C (98.6° F) Average rectal: 37.5° C (99.5° F) Axillary: 36.5° C (97.7° F) *Note there are age related differences for a "normal" temperature*

Wheres the Fat? mono & polyunsaturated

Avocados Fish (such as such as herring, mackerel, salmon, trout, and tuna) Mayonnaise and oil-based salad dressings Nuts and seeds Olives Soft margarines (liquid, tub, and spray)

Diagnostic Study

Biopsy to identify the causative microorganism Blood and wound cultures WBC count, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP) Xrays are not helpful initially because osteomyelitis usually does not appear for weeks after clinical symptoms CT scan and MRI are more helpful in assessing the extent of infection Radionuclide bone scans (nuclear medicine )are helpful in diagnosis and will show the area of infection

Clinical management Secondary

Osteoporosis screening Women age 65 years Younger women who have increased fracture risk USPSTF concludes that evidence is insufficient to recommend screening for men Mobility and fall risk assessment screening

infection

Bacterial infection (Clostridium difficile, Salmonella, Ercheria coli) & parasitic (Giardiasis, round worms)

Lumbar region most affected

Bears most of the weight of the body Is the most flexible region of the spinal column Contains nerve roots that are at risk for injury or disease Has a naturally poor biomechanical structure

Decreased Temperature

Blood vessels constrict, heat is trapped in deeper tissues, sweat glands become less active,skeletal musces contract, causing shivering

Increased temperature

Blood vessels dilate, giving flushed appearance,sweat glands become more active

Calucalation and fluid gain or loss

Body weight change is an excellent indicator of overall fluid volume loss or gain We measure fluid gain or loss in pounds

Fats

Fat is found in foods from both plants and animals Saturated fat Unsaturated fat

What is needed to be mobile

Bones Joints Articular cartilage Tendons and ligaments Skeletal muscle Mechanics of muscle contraction Then, need an intact neurologic system to communicated to and from the brain

Musculoskeletal System II

Bony structures with their joints are held together by ligaments Bony structures with muscles are held together by tendons Bony structures are cushioned by cartilage Most joints have synovial membrane lining the cavity Bursea develop in spaces between tendons, ligaments, and bones for ease in motion Tendons & ligaments have a relatively poor blood supply

Immobility is psychological and leads to

Boredom Depression Feelings of helplessness/hopelessness Grieving Anxiety Anger Disturbed body imag

Act of urination

Brain structures influence bladder function. Voiding: Bladder contraction + urethral sphincter and pelvic floor muscle relaxation 1. Bladder wall stretching signals micturition center. 2. Impulses from the micturition center in the brain respond to or ignore this urge, thus making urination under voluntary control. 3. When a person is ready to void, the central nervous system sends a message to the micturition centers, the external sphincter relaxes and the bladder empties.

Assistive devices

Canes, crutches, walkers, wheelchairs and prostheses Can cause injury if not used correctly Movement of patients Transfer mats, slings, and lifts Now let's practice

Temperature Conversion

C=(F-32)x 5/9 (use if you know Farhenheit temp) F=(9/5 X C)+ 32 (use if you know celsius temp)

Nutrients of Public Health Concern

Calcium- low calcium leads to osteoporosis Iron (of concern for young children, pregnant women, and women capable of becoming pregnant) Folic Acid- lack of folic acid is implicated in neural tube defects Vitamin D- lack of vitamin D causes rickets Vitamin C- lack of vitamin C causes scurvy

Stage 2: Autonomy vs. Shame & Doubt

Can I do things myself or must I always rely on others? Second & third years Lasting outcomes: Self control and will power

Surgical Interventions and Immobilization

Can be either curative or palliative Will emphasize when discussing mobility problems

Carpal Tunnel Syndrome

Caused by compression of the median nerve, which enters the hand at the wrist through the narrow carpal tunnel

Type of patients who need hypertonic solution

Cells are swollen Helps excrete fluid off brain Hyponatremia Pulls sodium back into intervascular system

Directional patterns of growth

Cephalocaudal pattern (head to toe) Proximodistal pattern(inward to outward)

Antivirals

Certain antivirals treat certain viral infections so proper identification is essential. Antivirals help prevent viruses from reproducing. Antivirals inhibit a viruses development as opposed to destroying it. Antivirals treat Herpes Simplex, Hepatitis B, Influenza, and Pharyngitis. Medications: Tamiflu, Acyclovir, Interferon

Role of LPN

Check color, temperature, capillary refill, distal pulses Mark circumference of any drainage on the cast Monitor skin integrity around cast and at traction pin sites Pad cast edges and traction connections to prevent skin irritation Monitor pain and administer prescribed analgesics; notify RN if pain persists

Fever is assocated with different phrases

Chill phase Plateau Febrile episode

inflammation

Chron's disease, Inflammatory bowel disease, Appendicitis, Peritonitis, Ileus, Diverticulitis

malabsorption

Chron's disease, inflammatory bowel disease, Celiac disease, Lactose intolerance

Celiac disease

Chronic, immune mediated disorder of impaired fat absorption. Occurs when gluten proteins bond with mucosal proteins causing immune overreaction by WBCs and t-Cell response Gluten, or wheat, can also cause a true allergy. Actual disease is rare, but some clients with colon disorders, other immune disorders, autism find symptomatic relief when gluten is removed from diet. Symptoms: bloating, cramping, diarrhea, anemia, malnutrition, muscle wasting Diagnosis: History, endoscopic tissue biopsy Related foods: Wheat, barley, rye, oats processed with wheat, malt, licorice, pretzels, soy & teriyaki sauces, cake flour, cocoa and instant tea mixes. Many sauces, prepared foods and soups, and even medications contain wheat as filler. Read all labels. Treatment: Education and gluten-free diet

Environment Cathartics and laxatives Cathartics have a stronger and more rapid effect on the intestines than laxatives Suppositories may act more quickly than oral medications Antidiarrheal agents Opiates used with caut

Chronically ill and hospitalized patients are not always able to maintain privacy during defecation. In a hospital or extended care setting, patients sometimes share bathroom facilities with a roommate. In addition, chronic illness may limit a patient's mobility and activity tolerance and require the use of a bedpan or bedside commode. The sights, sounds and odors associated with sharing toilet facilities or using bedpans are often embarrassing. This embarrassment often causes patients to ignore the urge to defecate, which leads to constipation and discomfort. Be sensitive to patients' elimination needs and intervene to help them maintain as normal bowel elimination habits as possible. Laxatives and cathartics have the short-term action of emptying the bowel. These agents are also used to cleanse the bowel for patients undergoing GI tests and abdominal surgery. Although the terms laxative and cathartic are often used interchangeably, cathartics generally have a stronger and more rapid effect on the intestines. Although patients usually take medications orally, laxatives prepared as suppositories may act more quickly because of their stimulant effect on the rectal mucosa. Give the suppository shortly before the patient's usual time to defecate or immediately after a meal. Laxatives are classified by the method by which the agent promotes defecation. Clients should not be taking laxatives as a method to regulate bowel movements as in the future it will decrease the client's ability to regulate normal elimination. Fruit, fiber, and exercise help prevent constipation. Frequency of bowel movements varies between people. Normal bowel movements occur three times daily to three times a week. Antidiarrheal agents decrease intestinal muscle tone to slow the passage of feces. As a result, the body absorbs more water through the intestinal walls. The most commonly used antidiarrheal agents are loperamide and diphenoxylate with atropine. Codeine or tincture of opium may be used for management of chronic severe diarrhea in patients with diseases such as Crohn's disease, ulcerative colitis, and acquired immunodeficiency syndrome (AIDS). Antidiarrheal agents that contain opiates must be used with caution because opiates are habit forming.

Diverticulitis

Collection forms hard mass (fecalith). Can cause ischemia ulceration, abscess, fistulas obstruction perforation S/S: Mild to severe LLQ pain. NVD. May have palpable mass, tenderness to palpation and distention to inspection. Tx: Acute: IV/PO fluids and antibiotics. Rest bowel and progress diet. Surgery prn.

diverticulosis

Colon not smooth, villi and wells throughout Pockets form, usually high pressure areas. Are asymptomatic until Diverticula (the pocket) can become inflamed or irritated or infected as undigested food with bacteria trapped. Change in bowel habits. Mild to severe abd. pain or tenderness (usually over LLQ). Treat: High Fiber Diet Increase H2O, Exercise Acetaminophen, preferred. NSAIDs may increase risk of flare.

Incomplete+ Incomplete= complementary

Complementary proteins are two or more incomplete protein sources that, when eaten in combination (at the same meal or during the same day), compensate for each other's lack of amino acids.

Venous Thromolism

Compression gradient stockings (antiembolism hose) or using sequential compression devices Move fingers and toes and perform ROM exercises on the unaffected side

Signs and symptoms of Dehydration

Concentrated urine osmolity Skin tugor Dizziness (blood pressure) Tachycardia Muscle cramping

Management of ACL

Conservative treatment for an intact injury is RICE, NSAIDs, crutches, immobilize or hinged knee brace Reconstructive surgery if sustained severe injury to the ACL and meniscus The torn ACL tissue is removed and replaced with autologous or allograft tissue ROM is encouraged soon after surgery The knee is placed in a hinged brace or immobilizer Rehabilitation with physical therapy is critical, with progressive weight bearing determined by the degree of surgical repair Physical functioning may take 6 to 8 months

Many factors influence the process of bowel elimination. Knowledge of these factors helps to anticipate measures required to maintain a normal elimination pattern. Age influences bowel elimination. Infants have a smaller stomach capacity, less secretion of digestive enzymes, and more rapid intestinal peristalsis. The ability to control defecation does not occur until 2 to 3 years of age. Adolescents experience rapid growth and increased metabolic rate. There is also rapid growth of the large intestine and increased secretion of gastric acids to digest food fibers and act as a bactericide against swallowed organisms. Older adults may have decreased chewing ability. Peristalsis declines and esophageal emptying slows. This impairs absorption by the intestinal mucosa. Muscle tone in the perineal floor and anal sphincter weakens, and may cause difficulty in controlling defecation. Regular daily food intake helps maintain a regular pattern of peristalsis in the colon. Fiber in the diet provides the bulk in the fecal material. Bulk-forming foods help remove the fats and waste products from the body. Some foods may also produce gas, which distends the intestinal walls and increases colonic motility. While individual fluid needs vary with the person, a fluid intake of 3 L per day for men and 2.2 L per day for women is recommended. Fluid liquefies intestinal contents by absorbing into the fiber from the diet and creating a larger, softer stool mass. This increases peristalsis and promotes movement of stool through the colon. Physical activity promotes peristalsis. Prolonged emotional stress impairs the function of almost all body systems. During emotional stress, the digestive process is accelerated and peristalsis is increased. Personal elimination habits influence bowel function. A busy work schedule sometimes prevents the individual from responding appropriately to the urge to defecate, disrupting regular habits and causing possible alterations such as constipation. Squatting is the normal position during defecation. For the patient immobilized in bed, defecation is often difficult. If the patient's condition permits, raise the head of the bed to assist the patient to a more normal sitting position on a bedpan, enhancing the ability to defecate. A number of conditions such as hemorrhoids, rectal surgery, anal fissures (which are painful linear splits in the perianal area), and abdominal surgery result in discomfort. In these instances, the patient often suppresses the urge to defecate to avoid pain, contributing to the development of constipation. As pregnancy advances, the size of the fetus increases and pressure is exerted on the rectum. A temporary obstruction created by the fetus impairs passage of feces. Slowing of peristalsis during the third trimester often leads to constipation. A pregnant woman's frequent straining during defecation or delivery may result in formation of hemorrhoids. General anesthetic agents used during surgery cause temporary cessation of peristalsis. The patient who receives a local or regional anesthetic is less at risk for elimination alterations because this type of anesthesia generally affects bowel activity minimally or not at all. Any surgery that involves direct manipulation of the bowel temporarily stops peristalsis. This condition, called an ileus, usually lasts about 24 to 48 hours. If the patient remains inactive or is unable to eat after surgery, return of normal bowel elimination is further delayed. Many medications prescribed for acute and chronic conditions have secondary effects on the patient's bowel elimination patterns. Some medications are used primarily for their action on the bowel and will promote defecation such as laxatives or cathartics or control diarrhea. Diagnostic examinations involving visualization of GI structures often require a prescribed bowel preparation (e.g., laxatives, and/or enemas) to ensure that the bowel is empty. Usually, the patient cannot eat or drink several hours before examinations such as an endoscopy, colonoscopy, or other testing that requires visualization of the GI tract. Following the diagnostic procedure, changes in elimination such as increased gas or loose stools often occur until the patient resumes a normal eating pattern.

Constipation is a symptom, not a disease, and there are many possible causes. Improper diet, reduced fluid intake, lack of exercise and certain medications can cause constipation. When intestinal motility slows, the fecal mass becomes exposed over time to the intestinal walls and most of the fecal water content is absorbed. Little water is left to soften and lubricate the stool. Constipation is a significant source of discomfort and the nurse should assess the need for intervention before the defecation becomes painful or the stool is impacted. Fecal impaction results from unrelieved constipation. In cases of severe impaction, the mass extends up into the sigmoid colon. If not resolved or removed, severe impaction can result in intestinal obstruction. Patients who are debilitated, confused, or unconscious are most at risk for impaction. The nurse should suspect an impaction when a continuous oozing of liquid stool occurs. The liquid portion of feces located higher in the colon seeps around the impacted mass. Diarrhea is an increase in the number of stools and the passage of liquid, unformed feces. Intestinal contents pass through the small and large intestine too quickly to allow for the usual absorption of fluid and nutrients. Irritation within the colon results in increased mucus secretion. As a result, feces become watery and the patient may have difficulty controlling the urge to defecate. Excess loss of colonic fluid can result in dehydration with fluid and electrolyte or acid-base imbalances if the fluid is not replaced. Meticulous skin care and containment of fecal drainage is necessary to prevent skin breakdown. Some causes of diarrhea include Clostridium difficile, communicable foodborne pathogens, surgeries or diagnostic testing of the lower GI tract, and food intolerances. If a client has had an acute episode of diarrhea of undiagnosed origin and is experiencing dehydration and perianal excoriation, the following actions are helpful...maintain a strict record of intake and output, encourage fluid replacement with high electrolyte content and assume the diarrhea is infectious & initiate standard precautions. Fecal incontinence is the inability to control passage of feces and gas from the anus. Many conditions cause fecal incontinence or diarrhea and it is important to identify precipitating conditions and refer to health care providers for medication management. Hemorrhoids are dilated, engorged veins in the lining of the rectum and can be either external or internal. Increased venous pressure from straining at defecation, pregnancy, heart failure, and chronic liver disease causes hemorrhoids

fluid volume imbalances: nursing care

Correct the underlying cause and replace water and electrolytes Orally Blood products Balanced IV solutions

Trauma

Could be either intentional or unintentional Could involve anything from a superficial laceration to a deep gun shot wound

Thermal or Radiation

Could include everything from a sunburn to a deep tissue burn Symptoms from redness or inflammation caused by the vasoconstriction to deep tissue loss. Experience fluid shifts which leads to edema Fibroblasts produce collagen and elastin ( which are proteins) to restore some structure and elasticity. Macrophages remove the bacteria to clean the wound. New vascular networks form which helps new epithelial cells to grow and cover the wound from the edges to the center

Hypovolemia

Deficient fluid volume Decreased cardiac output Risk for impaired oral mucous membranes Potential complication: Hypovolemic shock

Stage 2: Preopreation period

Development of symbolic thought marked by irreversibility, centration, and egocentrism Age:2-7 years

Risk forpoor nutritional status

Developmental factors Gender State of health Alcohol abuse Medications Megadoses of nutrient supplements

Nursing implementation hypervolemia

Daily weights I & O Laboratory findings Cardiovascular care

Disectomy

Decompress the nerve root by removal of the damaged portion which helps maintain bony stability of the spine

Complications in Mobility: Respiratory

Decreased lung expansion Atelectasis Pooling of respiratory secretions

Food intake

Decreased: anorexia (lack of appetite) Increased: Obesity (BMI ≥30)

Fluids for rehydration

Detect clues to ECF volume deficit and excess by inspection of the skin. Examine the skin for turgor and mobility. Normally a fold of skin, when pinched, will readily move and, on release, will rapidly return to its former position. Skin areas over the sternum, abdomen, and anterior forearm are the usual sites for evaluation of tissue turgor. Decreased skin turgor is less predictive of fluid deficit in older persons because of the loss of tissue elasticity. In mild fluid deficits, the skin may appear warm, dry, and wrinkled. These signs may be difficult to evaluate in the older adult because the patient's skin may be normally dry, wrinkled, and nonelastic. In more severe deficits, the skin may be cool and moist if there is vasoconstriction to compensate for the decreased fluid volume. Oral mucous membranes may be dry and the tongue furrowed with fluid volume deficit. Edematous skin may feel cool because of fluid accumulation and a decrease in blood flow secondary to the pressure of the fluid. The fluid can stretch the skin, causing it to feel taut and hard. Assess edema by pressing with a thumb or forefinger over the edematous area. A grading scale is used to standardize the description if an indentation (ranging from 1+ [slight edema; 2-mm indentation] to 4+ [pitting edema; 8-mm indentation]) remains when pressure is released. Good skin care is a priority for patients with fluid imbalances.

uc & cd therapy

Diet s, exercise, quit smoking, no NSAIDS Corticosteroids (methylprednisolone, prednisolone) Anti-inflammatory: 5-aminosalicytic acids [5 ASAs] sulfasalazine (Azulfidine) mesalamine, olsalamine [lack sulfa]. Inhibits pro-inflammatory cytokines & mediators. Biologics [affects immune system; anti-inflammatory] 6-mercaptopurine (6-MP, Purinethol) adalimumab (Humira) azathioprine (Imuran) cyclosporine

Factors to Assess for Nutritional Status

Dietary data Medical and socioeconomic data Anthropometric data Clinical data Biochemical data The study of human body measurement for use in anthropological classification and comparison.

Fluid and electrolyte iimbalance

Directly caused by illness or disease (burns or heart failure) Result of therapeutic measures (colonoscopy preparation, diuretics) Emesis, hemorrhage, drainage through tubes or fistulas These abnormal output routes don't have physiological regulatory mechanisms

Consequences of hyper and hypovolemia

Disruptions of fluid and electrolyte balance have different physiological consequences, depending on the type of imbalance. Concentration imbalances can interfere with perfusion and oxygenation. Osmolality imbalances impair cerebral function and concentration imbalances impair neurolmuscular function."

Nursing Diagnoses

Disturbed body image related to loss of body part and impaired mobility Impaired skin integrity related to immobility and improperly fitted prosthesis Chronic pain related to phantom limb sensation or residual limb pain Impaired physical mobility related to amputation of lower limb

urinary diversion

Diversion of urine to external source

EVP

Do Physical Activity Exercises Decrease Sport Injuries? Clinical Question Among physically active adults and adolescents (P), what is the effect of stretching, strength training, and proprioception exercises (I) versus control group (C) on acute and overuse sport injuries (O)? 25 RCTs of adults and adolescents (n = 26,610) with acute and overuse sport injuries (n = 3464) Intervention was physical activity exercises including strength training, stretching, and/or proprioception exercises that improve joint mobility

Implementation to prevent dislocation

Don't allow for more than 90 degrees of flexion, adduction across the midline Crossing of legs and ankles, internal rotation of hip Many daily activities may reproduce these positions Putting on shoes and socks Crossing the legs or feet while seated Assuming the side-lying position incorrectly Standing up or sitting down while the hip is flexed more than 90 degrees relative to the chair Sitting on low seats, especially low toilet seats Teach the patient to avoid these activities until the soft tissue capsule around the hip has healed enough to stabilize the prosthesis (usually at least 6 weeks)

implementation

During planning integrate the knowledge from assessment and information about available resources and therapies to develop an individualized plan of care. Match the patient's needs with clinical and professional standards recommended in the literature. Building a relationship of trust with patients is important because the implementation of care involves interaction of a very personal nature. The plan of care for urinary elimination alterations must include realistic and individualized goals along with relevant outcomes. The nurse and the patient need to collaborate in setting goals and outcomes and, ultimately, in choosing nursing interventions. A general goal is often normal urinary elimination; but sometimes the individual goal differs, depending on the problem. The goals are short or long term. Make sure that goals are reasonably achievable and relevant to the patient's situation. It is important to establish priorities of care based on the patient's immediate physical and safety needs, patient expectations and readiness to perform some self-care activities. Establish a relationship with the patient that allows discussion and intervention. While you are collaborating with the patient, priorities become apparent, enhancing patient understanding of all the goals. When a patient has multiple nursing diagnoses, it is important to recognize the primary health problem and its influence on other problems. When planning individualized care it is essential to utilize the expertise of the health care team and incorporate them into the plan. For example, when planning care for a patient with urge urinary incontinence incorporate the expertise of continence nurse specialist to assist the patient in learning techniques to inhibit the urinary urge, strengthen pelvic floor muscles and learn fluid and food modifications; the occupational therapist to assist the patient in learning efficient and safe toilet transfers; the physical therapist to help with strengthening exercises of the lower extremities; and the social worker to facilitate obtaining assistive devices in the home that are covered by insurance. The family is included in planning when applicable, especially when a primary caregiver is identified. When a patient requires an indwelling urinary catheter due to acute illness and a need to measure accurate urinary output, the nurse is a key member of the team, monitoring patient progress and ensuring the catheter is removed in a timely manner. Your active and thoughtful role in planning these interventions will result in the patient's progress toward improved urinary elimination. Pelvic floor exercises, also known as Kegel exercises, improve the strength of the pelvic floor muscles and consist of repetitive contractions of muscle groups. These exercises have demonstrated effectiveness in treating stress incontinence, overactive bladders, and mixed causes of urinary incontinence. The application of adult diapers, catheterization of the client or administering Bethanechol will not address decreased pelvic muscle tone.

Nursing care

Early mobility! Factors that cause delayed mobility Excessive sedation or delirium Morbid obesity Multiple invasive devices Fragmented care Availability of adequate equipment Time constraints Adequate number of staff Concerns for patient safety

Hypernatremia

Elevated serum sodium occurring with inadequate water intake, excess water loss or sodium gain Causes hyperosmolality leading to cellular dehydration Primary protection is thirst from hypothalamus

Professional nursing behaviors

Emphasize that you are on the same side Celebrate successes Have empathy

Get mobile

Encourage and make a plan for cough and deep breathing and incentive spirometer Prevents stasis pneumonia Encourage flexion and extension of the foot Promotes venous blood return and prevent venous stasis Use a trapeze bar over the bed Range-of-motion (ROM) - active and passive Promotes circulation and to minimize complications to the joints Don't force the joints past the point of resistance

Enema administration Sterile technique is unnecessary. Wear gloves. Explain the procedure, positioning, precautions to avoid discomfort, and length of time necessary to retain the solution before defecation. Digital removal of stool Use if enemas fail to remove an impaction. Last resort in managing severe constipation.

Enemas are available in commercially packaged, disposable units or with reusable equipment prepared before use. Sterile technique is unnecessary because the colon normally contains bacteria. However, wear gloves to prevent the transmission of fecal microorganisms. Explain the procedure, including the position to assume, precautions to take to avoid discomfort, and length of time necessary to retain the solution before defecation. If the patient needs to take the enema at home, explain the procedure to a family member. Giving an enema to a patient who is unable to contract the external sphincter poses difficulties. Give the enema with the patient positioned on the bedpan. Giving the enema with the patient sitting on the toilet is unsafe because the position of the rectal tubing could injure the rectal wall. For a patient with an impaction, the fecal mass is sometimes too large to pass voluntarily. If a digital rectal exam reveals a hard stool mass in the rectum, it may be necessary to manually remove it by breaking it up and bringing out a section at a time. Digital removal should be the last resort in the management of severe constipation, but may be necessary if the fecal is too large to pass through the anal canal. The procedure is very uncomfortable for the patient. Excess rectal manipulation causes irritation to the mucosa, bleeding, and stimulation of the vagus nerve, which could results in a reflex slowing of the heart rate.

Follow principles of surgical and medical asepsis as indicated Identify patients at risk for latex allergies Identify patients with allergies to povidone-iodine (Betadine). Provide alternatives such as chlorhexidine.

Ensuring patient safety is an essential role of the professional nurse. To ensure patient safety, communicate clearly with members of the health care team, assess and incorporate a patient's priorities of care and preferences, and use the best evidence when making decisions about your patient's care. When performing the skills in this chapter, remember the following points to ensure safe, individualized care: Follow principles of surgical and medical asepsis as indicated when performing catheterizations, handling urine specimens, or helping patients with their toileting needs. Identify patients at risk for latex allergies (i.e., patient history of hay fever; asthma; and allergies to certain foods such as bananas, grapes, apricots, kiwi fruit, and hazelnuts). Identify patients with allergies to povidone-iodine (Betadine). Provide alternatives such as chlorhexidine.

Instruct patients who self-administer enemas to use the side-lying position. If a patient has cardiac disease or is taking cardiac or hypertensive medication, obtain a pulse rate, because manipulation of rectal tissue stimulates the vagus nerve and sometimes causes a sudden decline in pulse rate.

Ensuring patient safety is an essential role of the professional nurse. To ensure patient safety, communicate clearly with members of the health care team, assess and incorporate the patient's priorities of care and preferences and use the best evidence when making decisions about your patient's care. When performing the skills in this chapter, remember the following points to ensure safe, individualized, patient care: Instruct patients who self-administer enemas to use the side-lying position. Tell them not to self-administer an enema while sitting on the toilet because this position results in the rectal tubing, causing friction that could injure the rectal wall. If a patient has cardiac disease or is taking cardiac or hypertensive medication, obtain a pulse rate, because manipulation of rectal tissue stimulates the vagus nerve and sometimes causes a sudden decline in pulse rate, which increases the patient's risk of fainting while on the bedpan, bedside commode, or toilet. Ensuring patient safety is an essential role of the professional nurse. To ensure patient safety, communicate clearly with members of the health care team, assess and incorporate the patient's priorities of care and preferences and use the best evidence when making decisions about your patient's care. When performing the skills in this chapter, remember the following points to ensure safe, individualized, patient care: Instruct patients who self-administer enemas to use the side-lying position. Tell them not to self-administer an enema while sitting on the toilet because this position results in the rectal tubing, causing friction that could injure the rectal wall. If a patient has cardiac disease or is taking cardiac or hypertensive medication, obtain a pulse rate, because manipulation of rectal tissue stimulates the vagus nerve and sometimes causes a sudden decline in pulse rate, which increases the patient's risk of fainting while on the bedpan, bedside commode, or toilet.

Isotonic

Equal concentration of solution Inside = outside Balanced body Won't upset intercellular fluids Types of Fluids .09% saline 5% dextrose 0.225% lactated

Hypervolemia

Excess fluid volume Impaired gas exchange Risk for impaired skin integrity Activity intolerance Disturbed body image Potential complications: Pulmonary edema, ascites

Symptoms of hip fracture

External rotation, muscle spasm, shortening of the affected extremity, severe pain and tenderness

To little? BMI 5%

Failure to thrive Nutritional disorders Neglect

transmission

Fecal-Oral Increased Incidence: Poor handwashing Age, personal hygiene, barrier loss, immunosuppression, gastric Poor food handling motility. Poor refrigeration Food exposed to flies Contaminated H2O Increased Prevalence: Traveling, daycare centers, clinics, dental clinics, schools, subacute care facilities, hospitals. Raw meat. Unpasteurized milk products. Animal/pet contact. Recent antibiotic use.

Things not to do for fracture

Flex hip greater than 90 degrees (e.g., sitting in low chairs or toilet seats) Adduct hip (i.e., bring legs together at knees) Internally rotate hip (i.e., turn toward planted foot on affected side) Cross legs at knees or ankles Twist to reach behind Put on own shoes or stockings without adaptive device Sit on chairs without arms. The arms of chairs will help the patient rise to a standing position

Insensible Loss

Flushes = 10mls Through skin & lungs: 600 ml/day Intake> Output Convert ounces to milliliters Conversion formula oz x 30 = m

2015-2020 Dietary Guidelines for Americans:The Guidelines

Follow a healthy eating pattern across the lifespan. All food and beverage choices matter. Choose a healthy eating pattern at an appropriate calorie level to help achieve and maintain a healthy body weight, support nutrient adequacy, and reduce the risk of chronic disease. Focus on variety, nutrient density, and amount. To meet nutrient needs within calorie limits, choose a variety of nutrient-dense foods across and within all food groups in recommended amounts. Limit calories from added sugars and saturated fats and reduce sodium intake. Consume an eating pattern low in added sugars, saturated fats, and sodium. Cut back on foods and beverages higher in these components to amounts that fit within healthy eating patterns. Shift to healthier food and beverage choices. Choose nutrient-dense foods and beverages across and within all food groups in place of less healthy choices. Consider cultural and personal preferences to make these shifts easier to accomplish and maintain. Support healthy eating patterns for all. Everyone has a role in helping to create and support healthy eating patterns in multiple settings nationwide, from home to school to work to communities.

Meeting People Where They Are: Contextual Factors and Healthy Eating Patterns

Food Access Household Food Insecurity Acculturation

Assessing mobility

Gait and body posture Joints and range of movement Muscles Posture Symmetry of extremities Gait Spine Comparisons between right and left Strength

lactase deficiency

Genetic, secondarily from Celiac disease. Effects 100% Asians, Native Americans; 70% African Americans; 20% Caucasians Lactase is an enzyme that breaks down lactose, found in milk products. A deficiency of lactase causes malabsorption of lactose. Symptoms: Bloating, diarrhea, flatus, pain after consuming milk products Treatment: Education. Avoid milk products without lactate additive. Use lactase enzyme OTC products Active culture yogurts May require calcium supplements www.celiacsupportgroup.org

infectious diarrheal causes

Giardia c-diff Salmonella

Parasitic Protozoan Infections

Giardia for example A parasite lies in or on the host, gets it's food and water at the host's expense, encroaches on normal flora These diseases are prevented by good handwashing (after diaper changing, etc) and proper food preparation

planning

Goals and outcomes Set realistic and individualized goals along with relevant outcomes Collaborate with the patient Setting priorities Patient's immediate physical and safety needs Patient expectations and readiness to perform some self-care activities Teamwork and collaboration

Factors influencing urination

Growth and development Sociocultural factors Psychological factors Personal habits Fluid intake Pathological conditions Surgical procedures Medications Diagnostic Examinations

Developmental Considerations

Growth: infancy, adolescence, pregnancy, and lactation increase nutritional needs Activity increases nutritional needs. Age-related changes in metabolism and body composition Nutritional needs level off in adulthood. Fewer calories required in adulthood because of decrease in BMR.

Airborne Precautions

Hand Hygiene Negative Pressure room n-95 Respirator mask

Contact Precautions

Hand Hygiene Gown Gloves

Leg fractures Femoral Shaft

High energy fracture Blood loss (up to 1.5L) Symptoms include pain, marked deformity, shortening of the leg inability to move the hip or knee Treatment - traction, fixation (intramedullary rod), monitor for postop complications

Chronic

Has functional cause that impedes BM passage (meds, diet, dehydration) Psychogenic root: postponing defecation use of laxatives for perceived constipation self-treats Over time: micro bleeding, dehydration, vitamin deficiency, rectal/perineal irritation

Goals are

Have adequate relief from the underlying health problem Have satisfactory pain management Reach maximum rehabilitation potential (with the use of a prosthesis, if indicated) Cope with the body image changes Make satisfying lifestyle adjustments

Growth refers to

Height Weight Head Circumference BMI

Malignant Hyperthermia

Hereditary condition that causes excessive heat production when exposed to certain anesthetic gases and succinylcholine

Primary Prevention

Hygiene Nutrition Sun exposure Burn prevention Prevention of pressure sores

Type of patients who need hypotonic fluids

Hyperglycemia Hyperosmolaria

Hypothermia

Hypo=Low What temperature is considered hypothermic? What clinical manifestations would be anticipated?

Treatment of Repetitive Strain Injury

Identification of the precipitating activity Modification of equipment or activity Pain management, including heat or cold application and NSAIDs Rest Physical therapy for strengthening and conditioning exercises Lifestyle changes

Fever Treatment

Identify the underlying cause and treat underlying cause

Urinary diversions Incontinent diversions Changing a pouch Gently cleanse the skin surrounding the stoma Measure the stoma and cut the opening in the pouch Remove the adhesive backing and apply the pouch Press firmly into place over the stoma. Observe the appearance of the stoma and surrounding skin. Continent diversions Orthopic neobladder

Immediately after surgery, the patient with an incontinent urinary diversion must wear a pouch to collect the effluent (drainage). The pouch will keep the patient clean and dry, protect the skin from damage and provide a barrier against odor. The pouch should be changed every 4 to 6 days. Each pouch may be connected to a bedside drainage bag for use at night. When changing a pouch, gently cleanse the skin surrounding the stoma with warm tap water using a washcloth and pat dry. Measure the stoma and cut the opening in the pouch. Then apply the pouch after removing the protective backing from the adhesive surface. Press firmly into place over the stoma. Observe the appearance of the stoma and surrounding skin. The stoma is normally red and moist and is located in the right lower quadrant of the abdomen. It is important for the patient to have the correct type and fit of an ostomy pouch. A specialty ostomy nurse is an essential resource when selecting the right appliance so that the pouch fits snugly against the skin's surface around the stoma preventing damaging leakage of urine. Patients with continent urinary diversions do not have to wear an external pouch. However, if the patient has a continent urinary reservoir, the patient must be taught how to intermittently catheterize the pouch. Patients will need to be able and willing to do this four to six times a day for the rest of their lives. After creation of an orthoptic neobladder, patients will have frequent episodes of incontinence until the neobladder slowly stretches and the urinary sphincter is strong enough to contain the urine. To achieve continence, the patient will need to follow a bladder-training schedule and perform pelvic muscle exercises. The postoperative care of patients having continent urinary diversions varies widely with the surgical techniques used and it is important to learn the surgeon's preferred routine or health care facility's procedures before caring for these patients.

Cerebral Spinal fluid leakage is possible

Immediately report leakage of CSF on the dressing or if the patient complains of severe headache CSF appears as clear or slightly yellow drainage on the dressing. It has a high glucose concentration and is positive for glucose when tested with a dipstick Note the amount, color, and characteristics of drainage

Nursing Diagnoses to Consider

Impaired physical mobility related to loss of integrity of bone structures, movement of bone fragments, and prescribed movement restrictions Risk for peripheral neurovascular dysfunction related to vascular insufficiency and nerve compression secondary to edema and/or mechanical compression by traction, splints, or casts Acute pain related to edema, movement of bone fragments, and muscle spasms Readiness for enhanced self-health management

You need more water when

In hot climates More physically active Running a fever Having diarrhea or vomiting

Physical Movement

Includes gross simple movements, fine complex movements, and coordination Involves coordination of musculoskeletal and nervous systems Also adequate oxygenation, perfusion, and cognition, adequate energy, adequate muscle strength, underlying skeletal stability, joint function, and neuromuscular

Clinical manifestations of fever

Increased metabolic rate Increased HR Increased RR Can lead to cellular hypoxia, myocardial hypoxia, and dehydration We will discuss the treatment more in depth later in class! How does fever differ from hyperthermia?

Stages of infection

Incubation period- no symptoms Prodromal period-mild and generalized symptoms (fever, weakness, headache) Invasive Stage-symptoms specific to disease Decline Stage-symptoms subside Convalescence-no symptoms, health returns to normal

NOrmal temperature values in the pediatric patient

Infant-35.5-37.5 C (95.9-99.5) Body temperature regulation varies in children until they reach puberty Nonshivering thermogenesis

Infants, children, adolescents

Infants have thinner skin, it is more permeable, and they have decreased subcutaneous tissue. More susceptible to fluid loss Texture is smooth and dry

Systemic inflammatory repsonse

Infarction infection Tissue Injury = Stress response, which leads to systemic inflammatory response local cytokine melanocortin peptides systemic inflammatory repsose=TNFa melanocortin peptides=MC3/4R=inflammatory reponse

nursing knowledge base

Infection control and hygiene Growth and development Psychosocial considerations

Chain of Infection

Infectious Agent -Bacteria -Viruses -Fungi

Anti inflammatory agents

Inflammation is common sequela of mobility issues Corticosteroids and nonsteroidal anti-inflammatory drugs (NSAIDs) Immunomodulators

Three phases of wound healing

Inflammatory 3-5 days Clots form at site of injury and platelets release growth factors which leads to the healing process. Granulation New vessels and collagen structures are formed > very vascular pink wound bed WBC's remove the debris Maturation Collagen fibers remodels and scars Could continue for months

Treatment for meniscus

Initial care RICE, NSAIDs, immobilize Once acute pain has decreased, physical therapy begins regain knee flexion and muscle strength to assist in returning to full function Surgical repair or excision of part of the meniscus (meniscectomy) may be necessary Meniscal surgery is performed by arthroscopy NSAIDs or other analgesics Immobilize Rehabilitation starts soon after surgery, including quadriceps and hamstring strengthening exercises and ROM

Surgery

Initially immobilized by Buck's traction but needs surgery which provides for a much quicker recovery The type of surgery depends on the location and severity Repair with internal fixation devices (e.g., hip compression screw, intramedullary devices Replacement of the femoral head with a prosthesis Total hip replacement (involves both the femur and acetabulum

Immunity =

Innate immuity (nonspecific, immediate onset) acquired immunity (specific, delay onset)= Cellular response (T cell activiation) & Humoral response (antibodies production)

TO DO

Inspect daily for signs of skin irritation, especially redness, abrasion, and odor Pay particular attention to areas prone to pressure Discontinue use of the prosthesis if irritation develops Wash thoroughly each night with warm water and bacteriostatic soap Expose the residual limb to air for 20 min Do not use lotions, alcohol, powders, or oil Wear only a residual limb sock supplied by the prosthetist Change residual limb sock daily Perform ROM to all joints daily. Perform general strengthening exercises Do not elevate residual limb on a pillow

Stage 1 pressure ulcer

Intact skin nonblancheable redness

Factors that support resistance to infection

Intact skin and mucous membranes a hostile environment created by acidic body secretions (GI, GU, Vaginal) Antimicrobial factors in saliva, tears, and prostatic fluid Resperiatory defenses: humidification cough reflex, alveolar macrophages necessary and adaptive immune responses proper nutrition with glycemic control modify factors that reduce immunity: smoking, ETOH, drugs, unportected sex

Optimal Balance =

Intake and absorption of fluid and electrolytes matches the output of fluid and electrolytes. Osmolality/electrolyte concentrations in body compartments are within normal range

Extracellular fluid volume imbalances

Interprofessional Care Remove fluid without changing electrolyte composition or osmolality of ECF Diuretics Fluid restriction Restriction of sodium intake to treat ascites or pleural effusion

urinary incontinence

Involuntary leakage of urine

Diarrhea

Is a symptom 8 - 9 liters of fluid normally enter intestine daily from mostly endogenous sources. 1-2 liters not absorbed by sm. intestine enter colon, is reabsorbed, leaving 100-200Gm. stool output. Acute diarrhea: >3 watery stools/daily for 14 days. Persistent diarrhea: > 14 days Chronic diarrhea: > 1 month Most acute diarrhea is self limited, usually caused by viruses, bacteria, and parasites. Globally, major cause of morbidity and mortality. Cholera most voluminous and deadly. Non-infectious causes: IBD, IBS, colorectal cancer, ischemic bowel, food allergies, large ingestion of poorly absorbed sugars (lactulose), acute ETOH, and meds.

Stage 1: Trust vs. Mistrust

Is my world predictable and supportive First year of life Lasting outcomes: Drive & Hope

Function of isonitc fluids

Isotonic fluids increase cell volume without a fluid shift

Why is water important

Keep your temperature normal Lubricate and cushion joints Protect your spinal cord and other sensitive tissues Get rid of wastes through urination, perspiration, and bowel movements

Risk factors

Lack of muscle tone, excess body weight, stress, poor posture, cigarette smoking, pregnancy, prior compression fracture of the spine, spinal problems since birth, and a family history of back pain Jobs that require repetitive heavy lifting, vibration and extended periods of sitting

Bacteria

Normally present on skin surface and cause no harm A break in the skin gives the bacteria a point of entry and the bacteria can cause either a superficial or deep tissue infection Impetigo (superficial) Cellulitis ( deep tissue

Acute Low back pain

Lasts 4 weeks or less often caused by hyperflexion due to heavy lifting, overuse of back muscles during yard work, a sports injury, or a sudden jolt as in a motor vehicle crash Often symptoms do not appear at the time of usually start having pain within 24 hours because of a gradual increase in pressure on the nerve from an intervertebral disc and/or associated edema Symptoms may range from muscle ache to shooting or stabbing pain, limited flexibility or ROM, or an inability to stand upright

Prevention Dos

Lasts 4 weeks or less often caused by hyperflexion due to heavy lifting, overuse of back muscles during yard work, a sports injury, or a sudden jolt as in a motor vehicle crash Often symptoms do not appear at the time of usually start having pain within 24 hours because of a gradual increase in pressure on the nerve from an intervertebral disc and/or associated edema Symptoms may range from muscle ache to shooting or stabbing pain, limited flexibility or ROM, or an inability to stand upright

Prevention Donts

Lean forward without bending knees Lift anything above level of elbows Stand unmoving for prolonged time Sleep on abdomen or on back or side with legs out straight Exercise without consulting HCP if having severe pain Exceed prescribed amount and type of exercises without consulting HCP Smoke or use tobacco products

reccommended drugs

Lubiprostone (Amitiza) increases fluid secretion into bowel Naloxegol (Movantik) antagonizes morphine-induced delay in transit times (Narcan, naloxone)

Carbohydrates

Main source of fuel for the brain, muscles, RBC, WBC production and renal cell function Main sources of CHO- Plant foods, milk

Why are CHO important

Main sources of calories Primary energy source Sugars used to sweeten, preserve, and improve the functional attributes of food Sugar alcohols Dietary fiber

Normal Physiiology

Maintenance of homeostasis Composition of fluids and electrolytes kept within narrow limits Water content varies with age, gender, and fat content

Factors Affecting Basal Metabolic Rate

Males have a higher BMR due to larger muscle mass BMR is about 1 cal/kg of body weight per hour for men BMR is about 0.9 cal/kg of body weight per hour for women Factors that increase BMR Growth, infections, fever, emotional tension, extreme environmental temperatures, elevated levels of certain hormones Factors that decrease BMR Aging, prolonged fasting, and sleep

Acute Osteomyelitis

Means an initial infection or an infection of less than 1 month

Meniscus Injury

Menisci are crescent-shaped fibrocartilage in the knee Happens when a rotational stress at the knee in varying degrees of flexion and the foot is planted or fixed A blow to the knee can cause shearing of the meniscus between the femoral condyles and tibial plateau, resulting in a torn meniscus Can have degenerative tears Usually little to no edema because most of the cartilage is avascular Localized tenderness and pain The knee is unstable and the knee "gives way" or "pop" Quadriceps atrophy Arthritis may occur from repeated injury

Stage 4 Formal Operational Period

Mental operations applied to abstract ideas; logical systematic thinking Age: 11-adulthood

Drug Resistant Organism Infections and Colonizations MDROS

Methicillin-Resistant Staphyloccocus Aues (MRSA) Vancomycin Resistant Enterococcus (VRE) Extended Spectrum Beta Lactamase (ESBL) Multi-Drug Resistant Tuberculosis

Normal Flora

Microorganisms Maintain a sensitive balance with other microorganisms to prevent infection. Any factor that disrupts this balance places a person at increased risk for acquiring a disease.

Strain managment

Mild sprains are also usually self-limiting, with full function returning within 3 to 6 weeks Severe strains may require surgical repair of the muscle, tendon or surrounding fascia

Sprain managment

Mild sprains are usually self-limiting, with full function returning within 3 to 6 weeks X-rays to rule out a fracture You don't see soft tissue injuries on xray Can result in a avulsion fracture Depending on the degree of injury to the ligament, the joint may sublux or dislocate If the bones are not realigned immediately (reduction), neurovascular injury can result

Scope

Mobility is a continuum from full mobility to partial mobility and complete immobility Mobility and immobility may refer to a particular part of the body (micro) Or can refer to the entire body (macro) A change in mobility may be temporary

ICU hypertonic solution

Monitor Closely Hard on veins Fluid shifting to vascular system back up to heart /lungs Can lead to fluid overload and pulmonary edema

Role of LPN

Monitor color, temperature, capillary refill, and pulses of affected limb and immediately inform RN of significant changes Administer muscle relaxants, pain meds Reinforce teaching

Stable Vertebral Fracture

More lumbar injuries and are stable if no involvement with the spinal ligaments Pain, internal swelling that can press on nerve roots Always consider spinal involvement Compression fractures - vertebroplasty or balloon kyphoplasty Vertebroplasty - injection of bone cement into a fractured vertebral, then hardens, the cement stabilizes the vertebra and prevents further compression Balloon kyphoplasty involves first inserting a balloon into the vertebral body and then inflating it Immobilize - different braces, Halo for cervical

Fast Facts

Most Americans exceed the recommended limits for added sugars and do not get the recommended amounts of dietary fiber in the diet. Diets lower in added sugars and higher in dietary fiber and nutrient-dense* foods and beverages can reduce the risk of cardiovascular disease. The Dietary Guidelines for Americans recommends consuming less than 10% of calories per day from added sugars and at least half of total grains as whole grains, and limiting the intake of refined grains and products made with refined grains.

Mechanisms Controlling Fluid and Electrolyte Movement osmosis

Movement of water "down" concentration gradient From a region of low solute concentration to one of high solute concentration Across a semipermeable membrane

large bowel obstruction

Much rarer than small bowel obstruction. Usually occurs in sigmoid section and colon cancer usual cause. Obstruction can be caused by inflammatory bowel disease, diverticulitis, and fecal impaction Any obstruction can cause necrosis and severe dilation and distention above obstruction. Gangrene, peritonitis, and perforation can occur. Patient may exhibit S/S of sepsis, metabolic acidosis, hypokalemia. High-pitched tinkling bowel sounds above obstruction, abd. pain, distention, and tenderness Is an acute medical condition. Requires immediate x-ray/CT to determine if colon is perforated. Treatment: Mechanical decompression with NG. Surgical repair/resection is required for complete large bowel obstruction

Four types:

Muscle Neural Connective Epithelial

Get Mobile

Need a mobility plan Can start with simple actions like positioning, turning, continuous lateral rotation therapy (CLRT) Then progress to range-of-motion exercise, head elevation, tilt table, chair position, dangling, and ambulation Set number of times during the day and how long

Woman of child bearing years

Need foods high in heme-iron and/or consume iron-rich plant foods or iron-fortified foods with an iron-absorption enhancer, such as foods high in vitamin C If a client may become pregnant or is in the first trimester of pregnancy, they need adequate synthetic folic acid daily (from fortified foods or supplements) in addition to food forms of folate from a varied diet

Hypotonic

Not a lot of H2O molecule or solute Shift into the cell Cell swells up/rupture Cell lysis - deplete Low or lower concentration of solution Types of Fluid 0.45% saline 0.22% ¼ saline 0.33% saline

Dermal Ulcers

Non blanchable erythema 2. Partial Thickness 3. full Thickness 4. Full thickness with exposed bone, muscle 5 unstageable

nursing diagnoses

Nursing diagnoses common to patients with urinary elimination problems: Functional urinary incontinence Stress urinary incontinence Urge urinary incontinence Risk for infection Toileting self-care deficit Impaired skin integrity Impaired urinary elimination Urinary retention

lab & diagnostic testing

Nursing responsibilities before testing: Ensure a signed consent is completed. Assess the patient for any allergies. Administer bowel-cleansing agents as ordered. Ensure that the patient adheres to the appropriate pretest diet or nothing by mouth (NPO). Responsibilities after testing include: Assessing I&O Assessing voiding and urine Encouraging fluid intake

Six classes of Nutrients

Nutrients that supply energy Carbohydrates 4 calories per gram Proteins 4 calories per gram Fats 9 calories per gram Nutrients that regulate body processes Vitamins Minerals Water

Antibiotic associated diarrhea

Occurs as a result of a disruption of the normal intestinal flora ratio and amount. Some normally occurring flora 'over-proliferate'. Gut becomes host for pathogens. 1. It can affect digestion, absorption of nutrients, hydration. 2. It can allow pathogens to flourish and produce toxins causing watery stool . 3. Clostridium difficile is a common pathogen that leads to gastroenteritis. It is contagious and requires isolation precautions when caring for these patients. Newest significant cause of HAI and sepsis Frequent pan-system effects; high morbidity & mortality Treated with Drugs: metronidazole (Flagyl) and vancomycin Large initial stool sample. Must have 3 stools samples free of c.diff to come out of isolation. Risk factors: antibiotic use, Proton-pump-inhibitors, repeated enemas, prolonged NG tube, GI surgery

Secondary Would Healing

Occurs when wounds have distant edges and granulation tissue gradually fills the gap to close EX: pressure ulcer

At risk populations for immobility

Older adult Alterations in health Orthopedic injury Congenital deformities Neurologic disorders Strokes Head injury Spinal injury or deformities Nutritional deficiencies Cardiopulmonary conditions End-stage cancer Genetics

Vitamin D

Older adults, persons with dark skin, persons exposed to insufficient ultraviolet band radiation (such as sunlight), need extra vitamin D from vitamin D-fortified foods and/or supplements.

surgical nursing considerations

Pain control and repositioning. Inspect for hemorrhage and infection. Lifestyle and dietary education. PROTECT PRIVACY. These are very personal surgical areas. Patients require reassurance and likely a bit of humor.

Chronic Low Back pain

Pain lasts more than 3 months or involves a repeated incapacitating episode Often progressive, and the cause can be difficult to determine Causes include degenerative discs, osteoporosis, weakness from the scar tissue, chronic strain on lower back muscles, congenital spine problems Spinal stenosis is a narrowing of the spinal canal A common cause of chronic low back pain Can be caused by acquired or inherited conditions A common acquired cause is osteoarthritis which narrow the space around the spinal canal and nerve roots leading to compression and inflammation causing pain, weakness, and numbness Other acquired conditions that may cause spinal stenosis include rheumatoid arthritis, spinal tumors, Paget's disease, and traumatic damage to the vertebral column Inherited conditions are congenital spinal stenosis and scoliosis

most common symptoms

Pain, nausea, vomiting, diarrhea Secondary symptoms: Abdominal tenderness, bloating, flatus Change in stool consistency, shape, color, blood Fatigue, weakness, dizziness, signs of dehydration Change in skin color and turgor Fever, tachycardia, tachypnea, blood pressure changes

Hypoactive, sparse sounds....slow peristalsis, no bowel sounds...? No peristalsis > Increased sounds after meals and with diarrhea > Hear above obstruction as bowel trying to push through blockage > Aorta runs along abdominal cavity > WHOOSING SOUNDS

Palpation of the abdominal quadrant that results in pain, may indicate where an abnormality might be. Right lower quadrant pain may suspicious for appendicitis. But the internal organs often 'refer' pain to other areas of the body. Frequently, clients complain of shoulder pain in acute cholecystitis (gallbladder disease). Disease specific clinical signs: Cullen Sign, McBurney's Sign

Antiparasitics

Parasites are unicellular protozoa many are the paths for disease many parasitic medications are toxic and cause seizures Plaquenil to treat lupus and rheumatoid arthritis Flagyl

Diagnostic Testing

Patch testing Cultures Biopsy Woods lamp

Innate Immunity

Pathogen invasion >Bacteria >Viruses 1st line of defense: skin Ciliated cells Lysozyme Coughing Vomiting 2nd line of defense: Blood clot Mast cell Cytokines Leukocytes

Break theChain What is infection control?

Patient to worker visitor patient Visitor to worker visitor patient worker to worker visitor patient

Opoids such as morphine IV 24 to 48 hours

Patient-controlled analgesia (PCA) allows maintenance of optimal analgesic Once the patient receives oral fluids, PCA is discontinued and oral drugs such as acetaminophen with codeine, hydrocodone, or oxycodone (Percocet) Diazepam (Valium) may be prescribed for muscle relaxation Assess and document pain intensity and pain management effectiveness

Role of Rn

Perform neurovascular assessment and signs of compartment syndrome Monitor cast during drying for denting or flattening Teach about cast care and complications of casting, ROM exercises, traction and correct body positioning Assess and develop a plan for complications associated with immobility or fracture (e.g., wound infection, constipation, VTE, renal calculi, atelectasis

Exercise therapy

Performed by nurses or physical therapists in acute care, community-based, and home care settings The goal is rehabilitative or preventive Created based on patient needs A team approach

Assessment of skin

Personal history is very important Inspect the skin from head to toe Palpate any lesions or masses noted.

Factors Affecting food habits

Physiologic and physical factors: stage of development, state of health, medications Physical, sociocultural, and psychosocial factors influencing food choices Economics, culture, religion, tradition, education, politics, social status, food ideology

Internal Fixation

Pins, plates, intramedullary rods, metal and bioabsorbable screws Are surgically inserted to realign and maintain position of bony fragments These metal devices are biologically inert and made from stainless steel, vitallium, or titanium So the body does not reject it Proper alignment and bone healing are evaluated regularly by x-rays Patient is at risk for post surgery complications Long term, device may want to push out threw the skin

Abscess

Pockets of infection by any number of bacterium that often begin formation in the anal crypt. Pain is the primary symptom. Surgical: Incision & Drainage, as antibiotics are rarely effective because of area

UAP

Position casted extremity above heart, apply ice to cast as directed by RN Maintain body position and integrity of traction, assist with ROM exercises Notify RN about complaints of pain or CMS concerns

When positioning a patient, it is important to prevent muscle strain and discomfort. Never try to lift a patient onto a bedpan. Never place a patient on a bedpan and then leave with the bed flat unless activity restrictions demand it. This forces the patient to hyperextend the back to lift the hips onto the pan. The proper position for the patient on a bedpan is with the head of the bed elevated 30 to 45 degrees. When patients are immobile or it is unsafe to allow them to raise their hips, it is safest for the caregiver and the patient to roll them onto the bedpan. Always wear gloves when handling a bedpan. [Shown at top is Figure 47-10: Improper positioning of patient on bedpan.] [Shown at bottom is Figure 47-11: Proper position reduces patient's back strain

Positioning on bedpan (Cont.) Prevent muscle strain and discomfort Elevate head of the bed 30 to 45 degrees Wear gloves when handling bedpans

Type of patients who need isotonic fluids

Post-Surgical Trauma patients with blood-loss GI bleeds Vomiting Diarrhea

Care

PostOp Spinal Fusion Healing time is prolonged compared with a laminectomy, activity limitations may longer A rigid thoracic-lumbar-sacral orthosis [TLSO] or chairback brace is often used Cervical Spine Assess for spinal cord edema such as respiratory distress and upper extremities weakness Immobilized in a soft or hard cervical collar Donor Site Bandaged with a pressure dressing to prevent excessive bleeding. If the donor site is the fibula, frequent neurovascular assessment of the extremity After spinal fusion Teach proper body mechanics and avoid sitting or standing for prolonged periods Encourage activities that include walking, lying down, and shifting weight from one foot to the other when standing Instruct the patient on any lifting restrictions after spinal surgery No bending or stooping or twisting movement

Extracellular Fluid

Prevalent cation is Na+ Prevalent anion is Cl-

catheterization

Preventing catheter associated infection Catheter irrigations and instillations

Insure proper body alignment

Prevents injury to extremities and joints and pulmonary complications Pillows and wedges are commonly used to support the body alignment Repositioned at least once every 2 hours Prevents skin breakdown especially over bony prominences Skin should be kept clean, dry and protected to prevent Monitored and assess for evidence of adequate circulation

What is goal treatment of malignant hyperthermia

Primary and Secondary Prevention Screening is key for these clients Life-threatening

Removal of indwelling catheters Alternatives to catheterization Suprapubic catheters External catheters

Prompt removal of an indwelling catheter after no longer needed is a key intervention that has proven to decrease the incidence and prevalence of HAUTI (hospital-acquired urinary tract infections) and is one of the "never events" identified by the Centers for Medicare and Medicaid Services (CMS). All patients should have their voiding monitored after catheter removal for at least 24 to 48 hours by using a voiding record or bladder diary. The bladder diary should record the time and amount of each voiding, including any incontinence. A bladder scanner can be used to monitor bladder functioning by measuring postvoid residual. The first few times a patient voids after catheter removal may be accompanied by some discomfort, but continued complaints of painful urination indicate possible infection. Abdominal pain and distention, a sensation of incomplete emptying, incontinence, constant dribbling of urine, and voiding in very small amounts can indicate inadequate bladder emptying requiring intervention. The risk of urinary tract infection increases with the use of an indwelling catheter. Symptoms of infection can develop two to three or more days after catheter removal. Patients need to be informed of the risk for infection, prevention measures, and signs and symptoms that need to be reported to the nurse and health care provider. To avoid the risks associated with urethral catheters, two alternative are available for urinary drainage. A suprapubic catheter is a urinary drainage tube inserted surgically into the bladder through the abdominal wall above the symphysis pubis. The external catheter, also called a condom catheter or penile sheath, is a soft, pliable condom-like sheath that fits over the penis providing a safe and noninvasive way to contain urine. For men who cannot be fitted for a condom-type external catheter there are other externally applied catheters. One type attaches to the glans penis using hydrocolloid strips staying in place for multiple days and allows intermittent/straight catheterization. Another option available is a reusable condom like device that is held in place by specially designed underwear. [Shown is Figure 46-15: A, Placement of suprapubic catheter above the symphysis pubis B, suprapubic catheter without a dressing.]

Bones

Protects vital organs Provides storage space for minerals Calcium and phosphorus Produces red and white blood cells Hematopoietic tissue Resorbs itself & Reforms itself The internal and external growth and remodeling of bone are ongoing processes

The Dietary Guidelines for Americans: What It Is, What It Is Not

Provide evidence-based recommendations about the components of a healthy and nutritionally adequate diet Focus on disease prevention rather than disease treatment Inform Federal food, nutrition, and health policies and programs

Joints

Provide stability to bones and allow skeletal movement Mobility is impacted by the degree of joint freedom Allow for skeletal positioning to carry out the desired action Some of the most common problems associated with mobility stem from joint pain and/or changes in joint function

Musculoskeletal System

Provides the stability and mobility necessary for physical activity Physical performance requires bone, muscles, and joints to function smoothly and effortlessly Main line of defense against external forces Numerous disease processes affect this system including metabolic disorders Disorders can also arise from the neurologic system

Ideal Body Weight

Rule of thumb method Adult females 100 pounds( for first 5 feet) then± 5 pounds for every inch over that. Adult males 106 pounds ( for first 5 feet) then ±6 pounds for every inch after

Mild Injury for Strains and Sprains

RICE Rest Limit movement - immobilize in severe injuries After 48 hours encourage movement Ice Apply ice no more than 20 to 30 minutes at a time Avoid applying ice directly to the skin Introduce heat after 48 hours Compression Usually an ace wrap - wrap the bandage starting distally If numbness or tingling - then to tight Elevation Above the heart NSAIDs may also be helpful

Lesions

Range from benign growths to malignant tumors Skin cancer is one of the most common Melanoma Basal cell Squamous cell

Scope

Ranges from intact to some level of disrupted surface. Disrupted ranges from superficial or partial thickness of the epidermis to deep/full thickness of the dermis and deep tissues.

Complications in Mobility: CV

Reduced cardiac capacity Decreased cardiac output Orthostatic hypotension Venous stasis Deep vein thrombosis

Complications in Mobility: GI

Reduced peristaltic motility Constipation

Complications in Mobility:Musculoskeletal

Reduction in muscle mass and atrophy Contracture of joints Bone demineralization

Primary Prevention

Reduction of risk Client education Environmental Control Physical Activity

Chronic Osteomylitis

Refers to a bone infection that lasts longer than 1 month or an infection that has failed to respond to initial antibiotic treatment May be a persistent problem (a result of inadequate acute treatment) or a process of exacerbations and remissions Symptoms are constant bone pain, swelling and warmth at the infection site Over time, tissue turns to scar tissue. The avascular scar tissue provides an ideal site for continued microorganism growth because it cannot be penetrated by antibiotics

Role of RN

Registered Nurse (RN) Administer IV antibiotics, pain meds, teach about antibiotic side effects and length of treatment, signs and symptoms of worsening infection, and use of hyperbaric O2 if order Assess for signs of worsening infection, neurovascular status

Care of ostomies Pouching ostomies Nutritional considerations Psychological Considerations

Regular elimination patterns should begin before a patient goes home or to an extended care facility. It is important to remember that you initiate ostomy care and bowel retraining in acute care settings. However, because these are long-term care needs, teaching is usually continued in restorative care or home settings. An individual with an ostomy wears a pouch to collect effluent or output from the stoma. The pouches are odor proof and have a protective skin barrier surrounding the stoma. Empty the pouch when it is one-third to one-half full. Change the pouching system approximately every 3 to 7 days, depending upon the patient's individual needs. Assess the stoma color. It should be pink or red. The skin should be observed at each pouch change for signs of irritation or skin breakdown. Skin protection is important because of the effluent has digestive enzymes which may cause irritant dermatitis if there is leakage on to the peristomal skin. Other peristomal skin problems are fungal rashes, folliculitis, or ulcerations and should be referred to an ostomy care nurse. Although this practice is not as common due to improved odor-proof pouches, some patients irrigate their sigmoid colostomies to regulate colon emptying. This process takes about an hour a day to complete, but usually means that the patient can wear only a mini pouch afterward to absorb mucus from the stoma and contain gas. Specific equipment designed for ostomies is used that has a silicone cone attached by plastic tubing to a bag that will hold the irrigation fluid which is usually warm water. Follow the routine that the patient has established for this care. Occasionally, a patient with a colostomy who has constipation will have an irrigation or enema ordered. The equipment that is designed specifically for the irrigation should be used rather than an enema administration set use by patients without a stoma. An ostomy requires a pouch to collect fecal material. An effective pouching system protects the skin, contains fecal material, remains odor free, and is comfortable and inconspicuous. A person wearing a pouch needs to feel secure enough to participate in any activity. A pouching system consists of a pouch and skin barrier. Pouches come in one- and two-piece systems and may be flat or convex. Some pouches have the opening precut by the manufacturer; others require the stoma opening to be custom cut to the patient's specific stoma size. Newer pouches have an integrated closure and older ones use a clip to close the pouch. One of the first skills to teach a patient with a new ostomy is how to open and close the pouch. After surgery it may take a few days for patients with new ostomies to feel their appetite has returned to normal. Small servings of soft foods may be more appetizing as it would be for any patient who has had an abdominal surgery. Patients with colostomies have no diet restrictions. Patients with ileostomies will digest their food completely but will lose both fluid and salt through their stoma and will need to be sure to replace this to avoid dehydration. After ostomy surgery, patients face a variety of anxieties and concerns, from learning how to manage their stoma to coping with conflicts of self-esteem, body image, and sexuality. Provide emotional support before and after surgery. Important factors affecting adjustment to the stoma include the ability to successfully assume care of the ostomy including emptying the pouch and changing the pouching system so that unexpected odor and leakage of stool does not occur. Inability to resume self-care may cause a loss of self-esteem. The Wound, Ostomy and Continence Nurses Society (http://www.wocn.org) provides information and helps patients locate a wound, ostomy, and continence nurse (WOCN). Consider referral to local ostomy groups such as those affiliated with the United Ostomy Associations of America at http://www.uoaa.org. [Shown is Figure 47-12: Ostomy pouches and skin barriers. A, SenSura® one-piece pouch with Velcro closure. B, SenSura® two-piece pouching system with separate skin barrier and attachable pouch. NOTE: Skin barriers need to be custom cut according to stoma size. (Courtesy Coloplast, Minneapolis, Minn.)]

Clinical management Primary

Regular physical activity Nutrition Especially during growth cycles Calcium in older adults Ideal body weight Protects joins and the back Adequate rest Prevent injury and trauma Fall prevention

Pre OP Amputation

Reinforce why the amputation is needed, proposed prosthesis, and rehab plan Teach the type of postsurgical dressings to be applied, and type of prosthesis to be used Reinforce the need for muscle strength Discuss types of positioning If a compression bandage is to be used, instruct about its purpose and how applied Tell the patient that the amputated limb may feel like it is still present after surgery This phenomenon, termed phantom limb sensation

Compartment Syndrome Treatment

Relieve the pressure Cut the cast [bivalve] or dressing loosened, reducing traction weight Pulselessness and paralysis are late signs, the limb may require amputation if pressure progresses to this state Damaged muscle cells release myoglobin in the blood causing the kidneys to become obstructed Rhabdomyolysis - common sign is dark reddish brown urine Surgical decompression (fasciotomy) Cut of the fascia on each side of the compartment to release pressure, then leave open until event has subsided

Complications in Mobility: GU

Renal calculi Urinary stasis Infection

Nursing implemenation

Respiratory care Patient safety Skin care

Heatstroke

Restore normothermia Identify and treat Primary and Secondary Prevention

uti

Results from catheterization or procedure

Heatstroke

Results from exposure to extreme heat Body temperature of > 40 C (104 F) Usually due to physical exertion in extreme heat with poor ventilation Characterized by alteration in mental status, increased body temperature, hot, dry skin, delirium, nausea, muscle cramps, Can be fatal

Repetitive Strain Injury

Results from prolonged force or repetitive movements and awkward postures Other names - repetitive trauma disorder, nontraumatic musculoskeletal injury, overuse syndrome (sports medicine), regional musculoskeletal disorder and work-related musculoskeletal disorder Causing tiny tears that become inflamed No specific diagnostic tests exist and diagnosis is often difficult Results in pain, weakness, numbness, or impaired motor function

NANDAS cont.

Risk for electrolyte imbalance Risk for fluid volume deficit Risk for injury Potential complication: Seizures and coma

NANDAS

Risk for electrolyte imbalance Risk for activity intolerance Risk for injury Potential complication: dysrhythmias

Viruses invade the mucosa and offer bacterial cells entry points. That is how a viral cold becomes a bacterial infection like bacterial type pneumonias. Viral pneumonia is caused by widespread viral infection. These people will be treated with antibiotics because of their high risk of developing a committant bacterial pneumonia

STUDY SLIDE 16 INFECTION

Prevention is a key element in these diseases: mosquito/tick born infections prevented through use of DEET, outdoor precautions (long sleeves), pet and human immunization (Rabies) and pet flea/tick pesticides

STUDY SLIDE 17 INFECTION

These diseases are prevented by keeping the skin intact (handwashing, shoes outdoors), clean water, proper handling and cooking of food, and pet worming treatments

STUDY SLIDE 18 infection

Stage 6: Intimacy vs. Isolation

Shall I live my life with another or live alone Early Adulthood Lasting outcomes: Affiliation and love

ostomies

Sigmoid colostomy Transverse colostomy Ileostomy Loop colostomy End colostomy

Throughout the life span

Significant changes happen as a function of growth and development The appendicular skeleton grows faster than the axial skeleton Bones change in composition, grow in length and diameter, and undergo changes in rotation and alignment

Inflammation

Signs of local inflammation and infection are identical. Vascular and cellular responses Exudates (serous, sanguineous, or purulent) Tissue repair

Two types of carbohydrates

Simple CHO- Monosaccharides (glucose, dextrose, fructose) Disaccharides (sucrose, lactose, maltose) Complex CHO- polysaccharides Starches, cereal grains, cornmeal, oats, barley

Why Less Condom Use?

Substance Use Disorders Multiple Partners/ New dating Patterns In 2015, Georgia ranked 5th in the U.S. in report of new HIV infections: 2, 381 of the 39,393 people (CDC, 2015).

Older Adults

Skin becomes thinner and has decreased strength, moisture and elasticity Decreased underlying support tissue leads to sagging Decreased perception of pain Hair and nail growth decreases Decrease in sebaceous glands leas to dry, flaky skin

Secondary Prevention

Skin cancer screenings ( melanoma) ABCDE

Nephrostomy tubes

Small tubes tunneled through the skin into the renal pelvis Placed to drain the renal pelvis when the ureter is obstructed

ibs

Spastic bowel' or mucous colitis Characterized by abd. distention, pain, diarrhea, constipation, or both. Caused by increased motor reactivity from altered CNS regulation in the colon responding to non-organic stimuli: food, hormones, STRESS [psychological & physiological

Results of EBP

Sport injuries were not prevented by stretching before or after the sport activity Strength training and/or proprioception exercises showed a positive effect in reducing sport injuries Strength training reduced sports injuries by 30% with overuse injuries decreased by almost 50% A trend was noted for strength training to have a greater preventive effect against injury compared to proprioception training

Piagets Cognitive Theory

Stage 1: Sensorimotor period Stage:2 Preoperational period Stage: 3 Concrete operational period Stage: 4 Formal Operational period

chrons disease

Starts as an ulcer type lesion of the mucosa and submucosa. Progressively extends through all mucosa to form cobblestone, transmural lesions. Affects all GI tract, mouth to anus. Lesions are not continuous; skip through GI tract. Chronic and relapsing Persistent diarrhea Cramping & pain right lower quadrant N&V if stomach & small intestine lesions Fistulas, abscess, obstruction common; folate and Vitamin D deficiencies Treatment: anti-inflammatory:5-aminosalicytic acid (sulfasalazine [Azulfidine], mesalamine, olsalamine [lack sulfa]. Inhibits proinflammatory cytokines & mediators. Corticosteroids (methylprednisolone, prednisolone) Immunosuppressants when not responding to initial therapy: Mercaptopurine [6-MP, Purinethol], azathioprine [Imuran], cyclosporine Biologics: chimeric monoclonal antibody: infliximab [Remicade] Surgery to repair segment if necessary, as lesions will reappear along GI tract

ulcerative colitis

Starts in mucosa and submucosa anal canal and progresses continuously upward to sigmoid and the rest of the large bowel Mucosa appears granular, dull, uniform Chronic and intermittent 5 - 30 stools/day with mucus and blood Cramping & pain in left lower quadrant gross blood in stool common (hematochezia); affects other organs [eye: uveitis; joints: arthritis; inflammation & scarring of bile ducts sclerosing cholangitis]; Iron deficiency Treatment: anti-inflammatory:5-aminosalicytic acid (sulfasalazine [Azulfidine];mesalamine, olsalamine [lack sulfa]. Inihibit proinflammatory cytokines & mediators corticosteroids (methylprednisolone, prednisolone); Surgery (colectomy & partial colectomy) with ostomies. Removal of entire colon to permanently clear disease.

Amputation

Starts with peripheral neuropathy that progresses to ulcers and gangrene Vascular tests such as arteriography, Doppler studies, and venography show circulation health AEA, BEA, AKA, BKA

Gerentology considerations

Structural changes in kidneys decrease ability to conserve water Hormonal changes include a decrease in renin and aldosterone Loss of subcutaneous tissue leads to increased moisture lost

Routine Colorectal cancer Promotion of normal defecation Sitting position Privacy Positioning on bedpan

Successful nursing interventions improve the patients' and family members' understanding of bowel elimination. One of the most important habits to teach regarding bowel habits is to take time for defecation. Advise the patient to begin establishing a routine during a time when defecation is most likely to occur, usually an hour after a meal. When diagnosed early, colorectal cancer can be treated and eliminated. Following the guidelines for prevention and knowing the early symptoms and seeking medical help if these symptoms occur is the most effective way to prevent death from this disease. African Americans have the highest rates of cancer and highest death rates from cancer of any racial or ethnic group. There is a lower rate of colorectal cancer screening among African Americans but this disparity is decreasing. A number of interventions stimulate the defecation reflex, affect the character of feces, or increase peristalsis to help patients evacuate bowel contents normally and without discomfort. Assist patients who have difficulty sitting because of muscular weakness and mobility problems. Elevated seats require patients to use less effort to sit or stand. Patients restricted to bed use bedpans for defecation. Two types of bedpans are available. The regular bedpan, made of plastic, has a curved smooth upper end and a sharper-edged lower end and is about 5 cm (2 inches) deep. The smaller fracture pan, designed for patients with lower-extremity fractures, has a shallow upper end about 2.5 cm (1 inch) deep. The shallow end of the pan fits under the buttocks toward the sacrum; the deeper end, which has a handle, goes just under the upper thighs. The pan needs to be high enough so feces enter it. [Shown is Figure 47-9: Types of bedpans. From left, Regular bedpan and fracture bedpan.]

Types of carbohydrates

Sugars Sugar alcohols Starches Dietary fiber

Where are CHO found?

Sugars Sugar alcohols Starches Dietary fiber

Compartment Syndrome

Swelling causes increased pressure within a limited space (muscle compartment) Restrictive casts, dressings, splints can cause this as well Interferes with circulation and compresses on nerves leading to ischemia, dysfunction and cellular death Assess for the 6 Ps Pain out of proportion to the injury Increasing pressure in the compartment Paresthesia (numbness and tingling) Pallor, coolness, and loss of normal color of the extremity Paralysis or loss of function Pulselessness (diminished or absent peripheral pulses

FES

Symptoms within 24 to 48 hours after injury chest pain, tachypnea, cyanosis, dyspnea, apprehension, tachycardia, decreased O2, restlessness, confusion These symptoms are caused by poor oxygen exchange

Fat embolism Syndrome

Systemic fat globules from fractures that are distributed into tissues, lungs, and other organs after a traumatic skeletal injury contributory factor in mortality associated with fractures

Signs and Symptoms of Maligant hyperthermia

Tachypnea, tachycardia, unstable blood pressure Muscle rigidity Increased potassium levels and carbon dioxide Hypermetabolic state Administer Dantrolene Sodium

Nursing Inter ventions

Teaching nutritional information Monitoring nutritional status Stimulating appetite Assisting with eating Providing oral nutrition Providing long-term nutritional support

bowel diversions

Temporary or permanent artificial opening in the abdominal wall Stoma Surgical opening in the ileum or colon Ileostomy or colostomy

Proteins

The Daily Value for protein is 50 g per day. This is based on a 2,000 calorie diet — your Daily Value may be higher or lower depending on your calorie needs.

Why are vitamins important?

The body uses vitamins for a variety of biological processes, including growth, digestion, and nerve function.

Through the patient's eyes The patient or caregiver determines which therapies were the most effective Patient outcomes Develop a therapeutic relationship Evaluate a patient's level of knowledge Determine the extent to which the patient accomplishes normal defecation Ask the patient to describe changes in diet, fluid intake, and activity to promote bowel health

The effectiveness of care depends on success in meeting the expected outcomes of self-care. Optimally, the patient will be able to have regular, pain-free defecation of soft-formed stools. The patient or caregiver is the only one who is able to determine if the bowel elimination problems have been relieved and which therapies were the most effective If the nurse establishes a therapeutic relationship with the patient, the patient feels comfortable in discussing the intimate details often associated with bowel elimination. Patients are less embarrassed as nurses help them with elimination needs. Patients relate feelings of comfort and freedom from pain as elimination needs are met within the limits of their condition and treatment. Evaluate a patient's level of knowledge regarding establishing a normal elimination pattern, caring for an ostomy and promoting skin integrity. Also determine the extent to which the patient accomplishes normal defecation. Ask the patient to describe changes in diet, fluid intake, and activity to promote bowel health. Ask the following questions when the patient's expected outcome has not been achieved: Do you use medications such as laxatives or enemas to help you defecate? How often? What barriers are preventing you from eating a diet high in fiber and participating in regular exercise? How much fluid do you drink in a typical day? What types of fluids do you normally drink? What challenges do you encounter when you change your ostomy pouch?

Remodeling & Repairing

The entire process takes 3-4 months Remodeling can repair microscopic bone injuries For large injuries, the process is the same as with soft tissue injuries except the final result is bone The final step for all bone injuries is remodeling

Low Back Pain

The is most often due to a musculoskeletal problem It may be experienced as localized or diffuse It may be radicular or referred Radicular pain is caused by irritation of a nerve root, radiates or moves along a nerve distribution. Sciatica is an example Referred pain is felt in the lower back, but the source of the pain is another location (e.g., kidneys, lower abdomen)

Care after amputation

The most common and debilitating contracture is hip flexion To prevent have patients avoid sitting in a chair for more than 1 hour with hips flexed or having pillows under the surgical extremity Patients should lie on their abdomen for 30 minutes 3 or 4 times each day and position the hip in extension Proper bandaging ensures the residual limb is shaped and molded for eventual prosthesis fitting Compression bandage are applied immediately after surgery to support soft tissues, reduce edema, hasten healing, minimize pain, promote residual limb shrinkage and maturation Wear bandage at all times except during physical therapy and bathing

Anterior Crucate ligament (ACL)

The most commonly injured knee ligament, usually noncontact when the athlete pivots, lands from a jump, or slows down when running Report coming down on the knee, twisting, and hearing a pop, followed by acute knee pain and swelling The knee may feel unstable Can result in a partial tear, a complete tear, or an avulsion (tearing away) from the bones that form the knee

Muscles

The most important difference is control can be voluntary or involuntary Optimal skeletal muscle function depends on the following five factors Nerve impulses reaching the muscle Muscle fibers' response to nerve stimulus Proprioception Mechanical load Joint mobility

Communicable Disease

They are caused by attack of pathogens The diseases are brought about by external factors infectious diseases can pass from diseased person to healthy person infection occurs through direct contact and other mediums

Through the patient's eyes Assess the patient's self-image, social interactions, sexuality, and emotional status Patient outcomes Use the expected outcomes developed during planning to determine whether interventions were effective Evaluate for changes in the patient's voiding pattern and/or presence of symptoms Evaluate patient/caregiver compliance with the plan

The patient is the best source of evaluation of outcomes and responses to nursing care. Include patients in the planning of nursing care and revision of the plan of care based upon their perception of the plan's success. It is important to remember that urinary problems impact the patient not only physically but emotionally, psychologically, spiritually, and socially. Carefully assess the patient's self-image, social interactions, sexuality, and emotional status as impacted by the urinary problem. To evaluate the care plan use the expected outcomes developed during planning to determine whether interventions were effective. This evaluation process is dynamic. Information gathered is used to modify the plan of care to meet expected outcomes. Evaluate for changes in the patient's voiding pattern and/or presence of symptoms such as dysuria, urinary retention, and urinary incontinence. If a behavioral plan is in effect, evaluate patient/caregiver compliance with the plan such as toileting according to the schedule or the number of incontinent episodes. Actual outcomes are compared with expected outcomes to determine success or partial success in achieving those outcomes. Evaluation of an intervention may take place within a day or two or it may take weeks or months to fully evaluate effectiveness. Evaluate initial compliance with dietary changes, understanding of instructions for pelvic muscle exercise, or effectiveness of antibiotic treatment for UTI in 1 to 2 days. Evaluation of the effectiveness of pelvic muscle exercises in decreasing urgency and incontinence will need to be weeks or months after therapy is started. Continuous evaluation, when possible, allows you to determine progress toward goals, encourage compliance, and revise the diagnosis and/or plan as needed.

Bowel training Maintenance of proper fluid and food intake Promotion of regular exercise Management of the patient with fecal incontinence or diarrhea Maintenance of skin integrity

The patient with chronic constipation or fecal incontinence secondary to cognitive impairment may benefit from bowel training, also called habit training. The training program involves setting up a daily routine. By attempting to defecate at the same time each day and using measures that promote defecation, the patient may have a normal defecation pattern. In choosing a diet for promoting normal elimination, consider the frequency of defecation, characteristics of feces, and types of foods that impair or promote defecation. A well-balanced diet with whole grains, legumes, fresh fruits and vegetables eaten regularly promotes normal elimination. Fiber adds bulk to the stool, eliminates excess fluids and promotes more frequent and regular movements. With increasing fiber it is important to drink enough fluids. When the patient has diarrhea, low residue foods, such as white rice, potatoes, bread, bananas, and cooked cereals, are recommended until the diarrhea is controlled. If the patient cannot tolerate foods or liquids orally, intravenous therapy with electrolyte replacement is necessary. A daily exercise program helps prevent elimination problems. Walking, riding a stationary bicycle, or swimming stimulates peristalsis. It is recommended by the American Heart Association and the Centers for Disease Control that adults get at least 150 minutes of exercise each week. For a patient temporarily immobilized, attempt ambulation as soon as possible. In the management of the patient with fecal incontinence or diarrhea, a fecal collector may be applied around the anal opening if the skin is intact. Fecal management systems are available for short-term use with high-volume diarrhea. They are intended for use primarily in acute care settings. The patient with diarrhea, fecal incontinence, or an ileostomy is at risk for skin breakdown when fecal contents remain on the skin. Liquid stool usually contains digestive enzymes that can cause rapid skin breakdown. Irritation from repeated wiping with toilet tissue or frequent ostomy pouch changes further irritates the skin. Meticulous perianal skin care and frequent removal of fecal drainage is necessary to prevent skin breakdown. Cleansing with a no-rinse cleanser and application of a barrier ointment should be done after each episode of diarrhea. If the patient is incontinent, the patient must have be checked frequently and have an immediate change of absorbent products in addition to thorough, but gentle skin cleansing. Patients with ostomies may be unaware of the skin irritation under their ostomy wafer or think that this is a normal part of having an ostomy. Education about skin breakdown and management of it if it does occur is an important role for the ostomy nurse.

Joints

The place where two bones end Joints are classified by the degree of movement that they allow The most common joint is one that has synovial fluid Has a synovial membrane, which secretes thick synovial fluid to lubricate and reduce friction

Immunologic Reactions

The skin gives us a visible indicator of an allergic response Redness, rash, hives Many agents: soaps, detergents, cleaning products, fragrances and metals Some common skin disruptions are thought to be the results of chronic immune response ( Psoriasis) A severe hypersensitivity response can cause extensive tissue sloughing

Spinal Fusion

The spine is stabilized by creating a fusion of adjacent vertebrae with a bone graft, or prosthetic device

Post op Amputation

The usual postop complications - What are those? What is your assessment actions and why? Immediate postoperative prosthesis - potential for hemorrhage Notify the surgeon immediately Have a surgical tourniquet available for emergency use Delayed prosthetic best choice for amputations above the knee or below the elbow, older adults, infection Not all patients are candidates for prostheses Mirror therapy reduces phantom limb sensation and pain in some patients The mirror is thought to provide visual information to the brain Yet, it is unknown why looking in the mirror decreases phantom limb sensation and pain

How much water do I need?

The vast majority of healthy people adequately meet their daily hydration needs by letting thirst be their guide. The Food and Nutrition Board does not specify exact requirements for water, but sets general recommendations for women at approximately 2.7 liters (91 ounces) of total water -- from all beverages and foods -- each day, and men an average of approximately 3.7 liters (125 ounces daily) of total water. Reference

Hypothermia treatment

Therapeutic versus Accidental Restore normal temperature Prevention of Complications What are some of the complications? Which populations are at risk for hypothermia and why? Rewarming measures Sometimes a controlled rate Warmed blankets, IV solutions, Cardiopulmonary bypass Primary Prevention in the form of education, appropriate clothing, limit exposure

Medications Antimuscarinics: treat urgency, frequency, nocturia and urgency UI Bethanechol: treat urinary retention Tamsulosin and silodosin: relax smooth muscle Finasteride and dutasteride: shrink the prostate Antibiotics: treat urinary tract infections Be familiar with the medications and indications for all medications your patient is taking.

There are a small number of medications used to treat urgency, frequency, nocturia, and urgency UI. Antimuscarinics include darifenacin, oxybutynin, solifenacin, fesoterodine, tolterodine, and trospium and one that is not an antimuscarinic, mirabegron. The most common adverse effects of the antimuscarinics are dry mouth, constipation, and blurred vision. In some cases, these medications can cause a change in mental status in older adults. Urinary retention is sometimes treated with bethanechol, and men with outlet obstruction due to an enlarged prostate are treated with agents that relax the smooth muscle of the prostatic urethra, such as tamsulosin and silodosin, and agents that shrink the prostate, such as finasteride and dutasteride. You should be familiar with the medications and indications for all medications your patient is taking. When newly started on an antimuscarinic, you should monitor the patient for effectiveness watching for a decrease in symptoms such as urgency, frequency, and urgency UI episodes. A bladder diary is one of the best ways to do this. In addition, you should regularly assess the patient for side effects such as constipation by monitoring the bowel movement record. Watch for a decrease in bowel movement frequency, straining at bowel movements and changes in stool consistency. Urinary tract infections are treated with antibiotics. Patient with painful urination, are sometimes prescribed urinary analgesics that act on the urethral and bladder mucosa (e.g., phenazopyridine). Patients taking drugs with phenazopyridine need to be aware that their urine will be orange. They must drink large amounts of fluids to prevent toxicity from the sulfonamides and maintain optimal flow through the urinary system.

Continuing and restorative care Lifestyle changes Pelvic floor muscle training Bladder retraining Toileting schedules Intermittent catheterization Skin care

There are techniques that can improve control over bladder emptying and restore some degree of urinary continence. These techniques are commonly referred to as behavioral therapy and are considered first- line treatment for stress, urge, and mixed incontinence. They include lifestyle changes, pelvic floor muscle training (PFMT), bladder retraining, and a variety of toileting schedules In some cases, when the bladder does not empty, patients or caregivers learn to intermittently catheterize. Whenever there is a risk for urine leakage, skin care is an essential component of the plan of care. Adequate urine containment and skin protection promotes patient comfort and dignity. Teach patients about foods and fluids that cause bladder irritation and increase symptoms such as frequency, urgency, and incontinence. Teach patients to avoid common irritants such as artificial sweeteners, spicy foods, citrus products, and especially caffeine. Encourage patients with edema to elevate the feet for a minimum of a few hours in the afternoon to help diminish nighttime voiding frequency. Pelvic floor muscle training (PFMT) involves teaching patients how to identify and contract the pelvic floor muscles in a structured exercise program. This exercise program is commonly called "Kegel" exercises and is based upon therapy first developed by obstetrician gynecologist Dr. Arnold Kegel in the 1940s. The exercises work by increasing the pressure within the urethra by strengthening the pelvic floor muscles and by inhibiting unwanted bladder contractions. In bladder retraining, patients are taught about their bladder and techniques to suppress urgency. They are given a schedule of toileting based upon their diary of voiding and leaking and a schedule is designed to slowly increase the interval between voiding. Patients are taught to inhibit the urge to void by taking slow and deep breaths to relax, perform five to six quick strong pelvic muscle exercises (flicks) in quick succession followed by distracting attention from bladder sensations. When the urge to void becomes less severe or subsides, only then should the patient start their trip to the bathroom. Timed voiding or scheduled toileting is toileting based upon a fixed schedule, not the patient's urge to void. The schedule maybe set by a time interval, every two to three hours or at times of day such as before and after meals. Habit training is a toileting schedule based upon the patient's usual voiding pattern. Using a bladder diary, the usual times a patient voids are identified. It is at these times that the patient is then toileted. Prompted voiding is a program of toileting designed for patients with mild or moderately cognitive impairment. Patients are toileted based upon their usual voiding pattern. Caregivers ask the patient if they are wet or dry, give positive feedback for dryness, prompt the patient to toilet, and reward the patient for desired behavior. Some patients experience chronic inability to completely empty the bladder due to neuromuscular damage. To minimize the risk of urinary tract infection, patients or caregivers are taught to catheterize the bladder. In institutions and catheterization in any setting by a health care provider, intermittent catheterization should follow the principles of asepsis as discussed earlier in the chapter. Teach patients and caregivers about the importance of adequate fluid intake, signs of infection, and their individualized catheterization schedule. The goal for intermittent catheterization is drainage of 400 mL of urine with the schedule is individualized to meet this goal. Key components for incontinence associated dermatitis prevention and treatment include gentle skin cleansing with a no-rinse pH-balanced cleanser, using a skin moisturizer, and application of a moisture-barrier product. In some cases, patients may develop a topical fungal infection that requires treatment with a steroid/antifungal cream or ointment. [Shown is Figure 46-16: Pelvic floor muscles. (From Lewis S, et al: Medical-surgical nursing: assessment and management of clinical problems, ed 9, St Louis, 2014, Mosby.)]

Summary

Thermoregulation is an intricate process based on negative feedback and the hypothalamus Age and certain comorbidities influence the management of body temperature The main goal of temperature management is to restore normothermia and homeostasis Maintain fluid/electrolyte balance Assessment and history and physical are key to care of these clients

When there is a disruption in the skin other body functions are effected

Thermoregulation is ineffective Elimination can be affected because of fluid losses Fluid and electrolyzed are unbalanced r/t the fluid shifts Protection- with disruptions the body is open to possible injuries Safety- the skin keeps our other organs safe Comfort- damage to the skin can be painful Body image- scarring from disruptions can cause body image issues

Infections and Infestations

These are the result of a bacteria, virus or fungus Live arthropods burrow under the skin, or attach themselves to hair follicles

Interspinous process decompression system (X-Stop

This titanium device fits onto a mount that is placed on vertebrae in the lower back which works by lifting vertebrae off the pinched nerve

Fungus

Those that cause superficial infections live on dead cells of the epidermis Candida Albicans and other Candida species thrive in a warm, moist environment of the skin and mucus membranes. Very common to experience after antibiotic therapy EX: Thrush, Yeast infections

nursing process assessment

Through the patient's eyes Nursing history What a patient describes as normal or abnormal is often different from factors and conditions that tend to promote normal elimination. Identifying normal and abnormal patterns, habits, and the patient's perception of normal and abnormal with regard to bowel elimination allows you to accurately determine a patient's problems

Dietary fat has more than twice the calories per gram as either carbohydrate or protein, so calories from fat can add up quickly. Saturated and trans fats can raise the levels of total cholesterol and low-density lipoprotein (LDL or "bad") cholesterol in the blood - which, in turn, can increase the risk of developing cardiovascular disease. Cardiovascular disease is the leading cause of death in both men and women in the U.S. The Dietary Guidelines for Americans recommends consuming less than 10% of calories per day from saturated fat by replacing it with monounsaturated and polyunsaturated fats. The guidelines also recommend keeping the intake of trans fat as low as possible by limiting foods containing partially hydrogenated oils (a source of artificial trans fat).

To reduce the risk of developing chronic diseases, while maintaining adequate intake of important nutrients, follow these ranges for total fat intake: Adults (ages 19 years and older): 20-35% of calories from fat Older children and adolescents (ages 4 to 18 years): 25-35% of calories from fat Young children (ages 1 to 3 years): 30-40% of calories from fat The Daily Value for total fat is per day. (5 teaspoons) This is based on a 2,000 calorie diet — your Daily Value may be higher or lower depending on your calorie needs.

Six major areas of tissue injury

Trauma Loss of perfusion Immunologic reaction Infections and/or infestations Thermal or radiation Lesions

TREATMENT FES

Treatment is supportive depending what organ was effected Prevention is key Careful immobilization and handling of a long bone fractures

Things to do for hip fracture

Use an elevated toilet seat Place chair inside shower or tub and remain seated while washing Use pillow between legs for first 6 wk after surgery when lying on nonoperative side or when supine Keep hip in neutral, straight position when sitting, walking, or lying Notify surgeon immediately if severe pain, deformity, or loss of function occurs Discuss personal risk factors for prosthetic joint infection with surgeon and dentist before dental work.

Skeletal Traction

Used for longer periods than skin traction Can be use for contractures and congenital hip dysplasia as well as fractures A surgeon inserts a pin or wire into the bone, and weights are attached to align and immobilize the injured body part Weights range from 5 to 45 lbs Too much weight can result in delayed union or nonunion The major complications of skeletal traction are infection at the pin insertion site and the effects of prolonged immobility

Skin Traction

Used for short-term treatment (48 to 72 hours) until skeletal traction or surgery is possible Tape, boots, or splints are applied directly to the skin, primarily to help diminish muscle spasms in the injured extremity Traction weights are usually limited to 5 to 10 lb Weights should ALWAYS be free moving A Buck's traction boot is a type of skin traction used preoperatively for hip fractures to reduce muscle spasms Pelvic or cervical skin traction may require heavier weights applied intermittently Regular assessment of the skin, especially over pressure points every 2 - 4 hours because pressure points and skin breakdown may develop quickly

Bone Morphogenic Protein

Used to stimulate bone growth of the graft in spinal fusions A dissolvable sponge soaked with BMP is implanted into the spine The protein on the sponge stimulates the body's cells to produce bone

External Fixator

Uses pins inserted into the bone and attached to external rods to stabilize the fracture Can be used to apply traction or to compress fracture fragments and immobilize reduced fragments Attached directly to the bones by percutaneous transfixing pins or wires Indicated primarily for complex fractures with extensive soft tissue damage, correction of congenital defects, nonunion or malunion and limb lengthening Often used in an attempt to a salvage extremity A long-term process, ongoing assessment for pin loosening and infection is critical Teach meticulous pin care and signs of infection

gastroenteritis

Usually a general term for inflammatory responseof ANY part of GI tract caused by virus or bacterial infection. Caused by the viruses and bacteria discussed with diarrhea. Treat Symptoms Treat Cause and Symptoms

Preterm or Newborn hypothermia

Usually due to environmental exposure Recommended to keep axillary temp > 36.5 C (97.8 F) Swaddling, cap/hat, clothing or radiant warmer may be needed Recall why is the infant at risk for hypothermia?

With aging

Vertebra thin causing shortening of the spinal column and compression Bone density decreases and becomes brittle (particularly in females) Cartilage becomes rigid and fragile, and there is a loss of resilience and elasticity of ligaments Muscle mass and tone reduce significantly

Post op

Vital signs, I&O, respiratory function and encourage deep breathing and coughing, pain medication, observe the dressing and incision for signs of bleeding and infection, neurovascular assessment

Vitamins

Vitamins are essential nutrients that contribute to a healthy life. A provider may recommend that you take them: for certain health problems if you eat a vegetarian or vegan diet if you are pregnant or breastfeeding

Two types of vitamins:

Water-soluble vitamins are easily absorbed by the body, which doesn't store large amounts. The kidneys remove those vitamins that are not needed. Fat-soluble vitamins are absorbed into the body with the use of bile acids, which are fluids used to absorb fat. The body stores these for use as needed.

Getting the conversation started

What's your family's favorite dinner? Who does the grocery shopping in your home? Who cooks? What are some of your family's favorite food routines & traditions? When you're thirsty, what kind of drink do you reach for? Does eating healthier seem hard or unrealistic? If there are barriers, find out what they are and suggest some workarounds.

Goals and outcomes Incorporate elimination habits or routines Reinforce routines that promote health Consider preexisting concerns Setting priorities Patients often have multiple diagnoses Teamwork and collaboration

When planning care, synthesize information from multiple resources. Help patients establish goals and outcomes by incorporating their elimination habits or routines as much as possible and reinforcing the routines that promote health. In addition, consider preexisting health concerns. The overall goal of returning the patient to a normal bowel elimination pattern includes the following outcomes: Patient establishes a regular defecation schedule. Patient is able to list proper fluid and food intake needed to soften stool and promote regular bowel elimination. Patient implements a regular exercise program. Patient reports daily passage of soft, formed brown stool. Patient does not report straining or discomfort associated with defecation. The nurse and patient work together closely to plan effective interventions. A realistic time frame to establish a normal defecation pattern for one patient is sometimes very different for another. When patients are disabled or debilitated by illness, you need to include the family in the plan of care. Patient and family teaching is an important part of the care plan. Other health team members such as dietitians and wound, ostomy, and continence nurses (WOCNs) are often valuable resources. You coordinate activities of the multidisciplinary health care team. Certain tasks, such as assisting patients onto the bedpan or bedside commode, are appropriate to delegate to nursing assistive personnel (NAP). Many of the diagnostic tests for evaluation of the GI system are performed by nonnursing personnel. Maintain ongoing communication with these caregivers will ensure that you provide safe and effective patient-centered care and address the patient's needs, wants and concerns.

Traction Care

When traction is used to treat fractures, the forces are usually exerted on the distal bone fragment to align it with the proximal fragment Fracture alignment depends on the correct positioning and alignment of the patient while the traction forces remain constant For extremity traction to be effective, forces must be pulling in the opposite direction (countertraction) Countertraction may can supplied by the patient's weight or by weights pulling in the opposite direction Traction must be maintained continuously Keep the weights off the floor and moves freely through pulleys Assess for CMS, pain, infection

Stage 5 Identity versus confusion

Who am I and where a m I going Adolescence Lasting outcomes: Devotion and fidelity

Stage 7 Generative vs. self absorption

Will I produce something of real value Middle adulthood Lasting outcomes:Production and care

Primary Wound Healing

Wound edges are well approximated Heals more rapidly EX: Surgical incision, or a simple laceration

Diagnostic Test

X-ray Computed tomography Magnetic resonance imaging Myelogram Arthrography (arthrogram) Bone mineral density Bone scan

Growth

an increase in the physical size of a whole or any of its parts or an increase in number and size of cells can be measure easily and accurately

If a pathogen invades the body and and the conditions are favorable for it to mulitply and cause injurious effects or disease, the resulting condition is called

an infection

Once ingested spores pass through stomach

and germinate in small intestine

HPV Vaccine

all kids age 11-12 should begin the 3 dose series woman can be vaccinated until age 26 men can be vaccinated until age 21

MRSA

all skin infections are now considered MRSA...no penicillin tx Causitive agent: Staphylococcus aureus Transmission:contact HX: on rise since 1960s 60% in ICU First community acquired in 1998, tripled since then Prevention: good hand washing athletes should avoid sharing personal equipment and towels & wash down all equipment Hospital acquired: pneumonia-from ventilators skin and soft tissues Treatment: Vancomycin IV Community acquired: mostly skin infections Incise, drain, & culture wound with with sensitivities no antibioitcs unless severe disease if needed:clindamycin, tetracycline or septra

pilondial cyst

an acute abscess or draining sinus in the sadrococcygeal area with an underlying cyst. Generally asymptomatic unless acutely infected. Surgical treatment: Acute care: I&D to relieve symptoms. However, that does not remove the capsule of the cyst. A cystectomy will be performed later or the cyst will recur and may cause recurrent infections

For each agonist muscle group contracting, there is an

antagonist muscle group relaxing

A father tells the nurse that his child is filling up the house with collections, like seashells bottle caps, baseball cards, and pennies. The nurse needs to recognize that the child is developing

concrete operation thinking sorting, ordering are characteristics of concrete operational thinking

Standard precautions

consider all body fluids as potentially infectious use proper precatuions at all times Standard precautions include: hand hygiene, gloves, mask, eye protection, gown, safe injection practices, proper cleaning of equipment, proper handling of soiled linen, and proper patient room placement. Image: Image: Stover, P. (2017). Infectious disease-Slide 27. Unpublished document, Georgia Highlands College.

Local manifestations

constant bone pain that worsens with activity and is unrelieved by rest, swelling, tenderness, and warmth at the infection site, restricted movement

Surgery is generally performed if the patient is in

constant pain and/or has a persistent neurologic deficit Intradiscal electrothermoplasty (IDET) - a heated wire is threaded through a needle and into the disc to destroy the nerve fibers that have invaded the disc The heat also melts the annulus fibrosus, causing generation of new reinforcing proteins in the fibers

Endemic

constant presence in a geographical area found in a certain place, region, or specific race, and is on going

elimination dysfunction

constipation, diarrhea, gastroenteritis, Irritable Bowel Syndrome

Open Reduction is the

correction of bone alignment through a surgical incision It usually includes internal fixation of the fracture with wires, screws, pins, plates, intramedullary rods, or nails Type and location of the fracture, patient age, and concurrent disease may influence the decision to use open reduction Risks are complications associated with surgery ORIF facilitates early ambulation and decreases the risk of complications related to prolonged immobility

Humeral Shaft

displacement of the humeral shaft Can have radial nerve injury or brachial artery injury Treatment depends on fracture, sling and swathe

Virus

everal are known to disrupt skin Verruca- warts most common on the hands and feet Genitalia- caused by HSV-2 Face- HSV-1 ( fever blisters

Epidemic

exceeds usual frequency in geographical area diasease thats widespread outbreak of a disease that attacks many people and spread through several communities

Pandemic

global epidemic when an epidemic spreads throughout the world

MDRO (multi drug resistant organism)

gonorrhea, salmonella, enterococcus, pseudomonas

Prevention measures for c-diff

hand washing is most important dont use contaminated equipment implement invasive procedures only when necessary change iv sites, tubes, & medication bags regularly

Cephalocaudal (head to toe)

head grows fastest, then trunk, then legs

Temperature regulation is influenced by factors such as

heat loss, heat conservation, and heat production.

hemmorhoids

hemorrhoidal veins that under pressure become weak and distended and form varicosities. Nonsurgical treatment: high fiber diet, lifting/exercise education, BP control, meds: psyllium, stool softeners, anesthetics and astringents [Preparation H, Nupercaine]. Surgical: hemorrhoidectomy

Concunvtivitis

inflammation of the conjuncttiva, which is the clear membrane covering the sclera(white part of eye) and interior lining of eyelinds causes the eyes blood vessels to dilate, resulting in reddish appearance

A sprain

injury to the ligaments surrounding a joint

Antifungals

interfere with ctyoplasmic membrane of the fungus antifungals are used to treat candidiasis (yeast), tinea, ringworm, endocartitis, pulmonary & UTIS Medication: Diflucan, amphotoricin

Deconditioned

is used to describe a loss of physical fitness examples: Athlete Not a physically active person Bedridden

Conjunctivitis cont

it usually starts in one eye and spreads to the other in a aday or two can affect one eye more than the other incubation period varies depending if it is bacterial or viral viral infection: from 12 hours to 3 days later, symptoms will appear bacterial infection: symptoms display 1-3 days after transmission

Adults muscles do not change until

late in life

Nosocomial infections ( Hospital acquired infections) #3 cause of US Death

manifest within 48 hours of hospital admission immunocompromised patients are at higher risk prevention is highest measure of control many organisms are resistant to antibiotics

Osteocytes are

mature bone cells

Stage 3 Concrete operational period

mental operations applied to concrete events; mastery of conservation, hiearchial classification Age: 7-11 years

Our environment is full of microogranisms (microscopic organisms) referred to as

microbes (bacteria, fungi, protozoa, and viruses)

Childrens muscles mature as their

neurological system matures

phase iii formation

new bone (osteoblasts) is layed down into the cavity

Closed Reduction

nonsurgical, manual realignment of bone fragments to their previous anatomic position Closed reduction is usually performed while the patient is under local or general anesthesia. Traction, casting, splints, or braces may be used after reduction

Palpation

noting any heat, tenderness, swelling, crepitus, resistance

over 95% weight on a growth chart =

obesity

Clostrdium difficile

occurs in about 20% of patients linked to 14,000 American deaths each year patients may develop associated diseases such as: * pseudomembrane colitis *toxic megacolon *sepsis *ulcerative colitis *perforation of colon

Tetriatary wound healing

occurs when wound is sutured closed much later More scarring EX: wound must remain open until infection/contamination is resolved

An action potential causes the contraction of

of all or nothing

Too little,, too big can be the first sign

of congenitial disease

low back pain is the leading cause

of job related disability

Muscles They require a constant supply of

oxygen, ATP, & protein

Endotoxins

part of outer portion of cell wall gram negative bacteria' they are liberated when bacteria die and cell wall breaks apart lipid

Microbes that are capable of causing disease is caused

pathogens/infectious or causitive agent

Heat convservation

peripheral vasoconstriction

Late Treatment

surgery to release the carpal ligament or open the surrounding tissue in the carpal tunnel

Toxins

poisonous substances produced by microorganisms

Thermoregulation

process of maintaining the core body temperature at a nearly constant value

Exotoxins

produced inside mostly gram positive bacteria secreted or released following lysis into surrounding medium

The treatment of infectious diseases consist of two steps:

reduce the effects of the disease (symptoms) kill microbes that cause disease

Tinea

refers to a group of diseases caused by fungi in specific sites Tinea capitis- head Tinea pedis- feet

Immoblity

refers to an inability to move

toxemia

refers to the presence of toxins in the blood

after 1 year

regeneration becomes impaired

The body responds to acute stress

release of stress hormones (epinephrine & norepinephrine) These hormones triger flight orfight response Actue stressor= Response from adrenal glands= Increase in epinephrine, norepinephrine, & teststerone= Decreased appetite and food intake & Increase blood pressure blood fats heart rate decrease blood flow to kidneys, skin, and digestive systems

Immunity

resistance to pathogens

Infection at its worse

sepsis

Muscle Contraction starts when a motor unit responds to a

single nerve stimuli

Older adults lose 30% of muscle and bulk strength

starting around age 50(lost at age 70) regenerative function remains unchanged

Colonization

state of microorganism living in or on a body without causing disease--even after your infection is cleared up, and you do not experience any symptoms, you may still carry MRSA

Tissue integrity is defined as the

state of structurally intact and physiologically functioning epithelial tissues.

Early Treatment

stop the repetitive motion and get assistive devices, NSAIDS

Phagocytosis

study slide 10 on powerpoint infection

Shock can develop

systems become increasingly dysfunctional occurs faster in pediatrics and ederly, immunocompromised, significant comcominant illnesses, profound injury Decompinsated SBP <90mmHG or age appropriate

Toxigenicity

the ability to produce toxins

Immunity

the bodies resistance to invading agents Adaptive response: *Antigen/antibody reaction to pathogens or toxins * active: (long term) natural exposure vaccines both lead to imprinting *Passive (short term) Serum-immune globulin during pregnancy

Impaired tissue integrity most closely related

to epithelial tissues

Highest incidence of amputation due to

to peripheral vascular disease (PVD), atherosclerosis, and vascular changes related to diabetes mellitus

Common reservoir for c-diff

toilet washroom toothbrush mugs utensils patients contaminated hands

mechanical dysfunction

tumors, polyps, fistulas, hernias, diverticulosis

how does c diff spread

via fecal-oral route and can survive for years outside of gut

Intervertebral Disc disease

volves the deterioration, herniation, or other dysfunction of the intervertebral discs Can affect the cervical, thoracic, and lumbar spine Aging causes loss of fluid in the intervertebral discs Discs lose their elasticity, flexibility, and shock-absorbing abilities This condition is a normal process The center of the discs become thinner, starts to dry out and shrink This limits the disc's ability to distribute pressure between vertebrae The pressure is then transferred to the strong outside portion, causing progressive destruction When the disc is damaged, it can seep (herniate) through a torn or stretched annulus The herniated disc (slipped disc), spinal disc bulges outward between the vertebrae Herniated discs can press against these nerves causing radiating pain, numbness, tingling, and diminished strength and/or range of motion

Prophylactic anticoagulant drugs are ordered

warfarin (Coumadin) low-molecular-weight heparin (LMWH) (e.g., enoxaparin [Lovenox], dalteparin [Fragmin]) a factor Xa inhibitor (fondaparinux [Arixtra], rivaroxaban [Xarelto], apixaban [Eliquis])

Indications for hand hygiene

when hands are visibly contaminated, soiled & dirty wash with

Measuring Head circumference

widest circumference, avoiding ears

Comminuted fracture

with more than two fragments

Classic normals: newborn weight & head circumference

weight 7.5 lbs head circumference 14

Formation of procallus

within days

new bone (osteoblasts) is layed down into the cavity

within hours

Callus formation

within weeks

Remodeling

years—can be up to 4 years in some cases

Symptoms of Caprel Tunnel

ymptoms include weakness, pain, numbness, or impaired sensation the of the median nerve