Exam 2

Stages of Alcohol Withdrawal: 2

(8-10 hours) disorientation, illusions, nightmares, hallucinations. psychosis benzodiazepines lorazepam or librium can be given orally or IV and tapered over the following 5-7 days.

Stages of Alcohol Withdrawal: 4

(3 days after abstinence): Initial and continuing delirium tremens manifested by confusion, severe psychomotor activity, agitation, sleeplessness, delusions hallucinations, and tachycardia. oral diazepam may be used for symptomatic relief of acute agitation, tremor, impending or acute DTs, and hallucinations. librium may keep your pt out of danger. however once delirium appears, IV lorazepam is used to treat these severe symptoms dehydration is corrected by iv fluids previous med:renal disease, pneumonia, etc.

Management of OM

Antibiotic/ Drug of choice /Oral amoxicillin (80-90mg/kg/day, divided into 2 doses) Manage other symptoms such as fever and pain- ibuprofen, Tylenol lying on affected side might help reduce pain and drain ear. if ear draining, clean with sterile cotton swabs coupled with topical antibiotic treatment. Recurrent infections Chronic complication—hearing loss; can affect speech and delay in development. speech therapy. complete dose of antibiotics. allergies related to.

health care- acquired pneumonia

is an older adult has chronic lung disease has presence of gram negative colonization of mouth, throat, stomach has altered level of consciousness has had a recent aspiration event has presence of endotracheal, tracheostomy, or nasogastric tube has poor nutritional status has reduced immunity (from disease or drug therapy) uses drugs that increase gastric ph (histamine h2 blockers, acids) or alkaline tube feedings is currently receiving mechanical ventilation (VAP)

1. NGN Item Type: Extended Multiple Response Which of the following complications will the nurse anticipate when caring for this infant? bronchiolitis

is it associated to disease process? is it normal with disease process? if yes, don't circle resp failure dehydration fatifue hypoxemia apnea

ASSESSMENT OF CHILD ABUSE- bruising areas

normal- elbow, knee, skin suspicious- back, buttocks, back of thigh, back of calves. ears- esp if pinch marks involving both sides of ear eyes- black esp if bilateral triangle of safety (ears, side of face, and neck, top of shoulders): accidental injuries in this area are unusual. remember: concerns are raised by injuries on both sides of the body injuries to soft tissue injuries with particular patterns any injury that doesn't fit explanation delays in presentation untreated injuries

early evidence of resp complications strep

notify provider: earache resp faster than 50-60b/m fever over 101F listlessness crying increased irritability with or without fever persistent cough for 2 or more days wheezing refusal to eat restlessness and sleep pattern disturbance

community acquired pneumonia

older adult has never receive pneumoccal vaccination or received it more than 5 years ago did not receive the flu vaccine in previous year has chronic health problem or other coexisting condition that reduces immunity has recently been exposed to respiratory viral or flu infection use tobacco or alcohol or is exposed to high amounts of secondhand smoke

Key Features of Anaphylaxis clinical criteria 3 (don't need to memorize)

onset within minutes to hours of hypotension with systolic blood pressure lower than 90 mm Hg or 30% lower than the pts baseline systolic pressure

Key Features of Anaphylaxis clinical criteria 1 (don't need to memorize)

onset within minutes to hours of skin or mucous membrane problems involving swollen lips, tongue, soft palate, uvula; wide spread hives, pruritus, or flushing along with any of these onset new symptoms: respiratory distress or infectiveness, dyspnea, bronchospasm, wheezes, stridor, hypoxia, cyanosis, peek expiratory rate flow lower than pts usual rate, hypotension or any indication of reduced perfusion resulting in organ dysfunction: loss of consciousness, incontinence, hypotonia, absent deep tendon reflexes

capnography

35-45 mm hg

PARTIAL (FOCAL) SEIZURES:CLASSES

COMPLEX PARTIAL SIMPLE PARTIAL

Stages of Alcohol Withdrawal: 3

(12 to 24 hours after abstinence): generalized and tonic-clonic seizures. diazepam IV is commonly given.

Screening Tools for Alcohol Use Disorder:•Alcohol Use Disorder Identification Test (AUDIT) - Table 22.4

Identifies hazardous alcohol use or alcohol use disorder.

GENERALIZED SEIZURES: TYPES

TONIC-CLONIC TONIC CLONIC MYOCLONIC ATONIC

infectious and know what the bacterial is

use antibiotics

unclassified epilepsy

no identifiable cause, no reason why occurred.

generalized epilepsy

affects both hemispheres of the brain

types of epilepsy

generalized focal unclassified

CLONIC

lasts several minutes and causes muscle contraction and relaxation.

Screening versus Diagnosis TB

**we do screening every year** Tuberculin (Mantoux) test—PPD given intradermally in forearm -Induration of 10 mm or greater diameter = positive for exposure 48-72 hours after -Elderly and immunocompromised is 5 mm= if possible, site is reevaluated in 72 hours because false negative readings occur more often after only 48 hours. look at sides red raised- exposed to TB, only exposed. positive ppd and no symptoms- not active TB. latent instead. might decide to do it again, could be a false positive or chest x ray for bacteria lying dormant in lungs. coughing, weight loss, fatigue. symptoms of disease- active TB. classic symptoms. isolate before we go any further. diagnosis- pt telling u symptoms we need to isolate (n95 mask, negative pressure room) before we go further then make a confirm diagnosis. no PPD skin test at this point. QuantiFERON-TB (blood test) - a positive result means the person is infected with T, but does not indicate if the infection is latent or active. *Positive results do not confirm disease*

Asthma: Nursing Assessment (Noticing) Respiratory

*Feeling of chest tightness- goes with SOB, wheezing, cough. expected* Shortness of breath Prolonged exhalation Retractions Tachypnea Dry cough or productive Wheezing, rhonchi Nasal flaring Hypoxia Silent chest *don't confuse chest tightness with chest pain*

STATUS EPILEPTICUS TREATMENT

*IV push lorazepam is drug of choice for treating status epilepticus* Lorazepam (Ativan) IV push- usually given 4mg over a 2 minute period, procedure may be repeated until a total of 8mg is reached. *OR* Diazepam- rectal gel may be used instead. Phenytoin (Dilantin) IV *nursing safety priority* don't give at no more than 50mg/min using an infusion pump. -Loading dose: is given and oral doses are administered as a follow up after the emergency is resolved. -Compatible fluid: if drug is ivpb into an existing iv line, use only normal saline before and after administration. -ECG: can cause cardiac complications. -Serum drug levels: 10-20mcg/ml checked every 6-12hrs after the loading dose then 2 weeks after oral phenytoin is started. more than 30mg/ml is considered an indicator of drug toxicity. *OR* fosphenytoin (Cerebyx) IV- alternative to phenytoin. compatible with most iv solutions. fewer cardiac complications and can be given in IV dextrose solution. if given iv, infuse no more than a rate of 150PE/min. doctor may give this instead of dilantin.

NURSING CARE *DURING* A TONIC-CLONIC SEIZURE

*Protect the pt from injury* don't force anything into the pt's mouth FIRST *turn the pt to the side to Prevent aspiration and keep airway clear.* remove any objects that might inure the pt suction oral secretions if possible without force loosen any restrictive clothing the pt is wearing do not restrain or try to stop the pt's movement; guide movements if necessary. don't pick up pt. observe during: pupil size or anything occurred incontinent episode or lip biting *Documentation: record the time the seizure began and ended*

NURSING CARE *AFTER* A TONIC-CLONIC SEIZURE

*take the pt's Vital signs* look at respiratory rate, o2 sat. if o2 sat at 96% put them on o2 *perform Neurologic checks* orientation, may not remember see how long they return to baseline. *Prevent aspiration- keep the pt at his side* *Rest- allow the pt to rest* body has been thru a lot *Documentation- how often the seizures occur: date, time, duration of seizure. whether more than one type of seizure occurs*

Treatment for C.J. is started immediately. Select the initial interventions that you would anticipate to be implemented for a severe, but not life-threatening, exacerbation of asthma. 1.Oxygen by mask to keep SpO2 at 92% 2.Endotracheal intubation and mechanical ventilation 3.Albuterol by nebulizer q20min for 3 treatments 4.PEFR (peak expiratory flow rate) q20min 5.Insertion of IV catheter and IV fluids for hydration 6.Administration of IV sodium bicarbonate

1,3,5

Your 52-year-old next-door neighbor comes to your house and tells you that he woke up an hour ago with swollen lips and swelling of his lower face. He tells you that in the past hour his tongue also has become swollen, making it difficult for him to speak clearly. He is supposed to leave in 2 hours for the airport for a week-long business trip. When you ask him whether this has ever happened to him before, he says "No," and wonders if he is "coming down with something." When you ask him which medications he has taken today, he tells you that he took his usual 81 mg of aspirin and his usual lisinopril 10 mg on arising this morning. He asks whether he should just take diphenhydramine (Benadryl) and head for the airport. 1. Noticing: What should your first assessment be? Provide a rationale for your answer. 2. Interpreting: Do you think he has angioedema or anaphylaxis? Explain your choice. 3. Are either of his usual medications associated with this type of response? 4. Responding: Should you advise him to take the diphenhydramine and go on his trip as planned? Why or why not? 5. Responding: What should your next action be?

1. airway not closed, giving meds and monitoring 24 hours over night to see what's happening (hospitalized). 4. no go to ER to check it out.

1.You read in his medical record that Allen has posttraumatic stress disorder (PTSD). What are common causes of PTSD, and what is the most likely cause of Allen's condition? 2.Which symptom(s) of PTSD did Allen most likely experience? 3.What other symptoms are related to PTSD in adults?

1. ambush, military trauma. 2. flash back 3. depression, anxiety, heart palpitations, muscle tensing, avoiding reminder activities.

acceptable vital signs for adults respirations

12-20 breaths per min, deep and regular

Treatment Plan:STAGES 1, 2, & 3

1: safe environment- predictable environment. stop from self destructive behaviors and educate. 2: reduce emotions- control emotions by expressing work thru memories. 3: develop coping skills- learn how to cope on day to day basis. self awareness, social skills training, need healthy support system.

Treatment for acute epiglottis

1st*majority of providers will intubate before doing anything for them because of chance of pt gotten frightened and going into resp failure *Diagnosis-lateral neck x-ray (thumb print- thats the shape of it) if negative for this then it's something else ( if child can remain in parents lap) Keep emergency respiratory equipment at bedside -Endotracheal Intubation-airway protection is priority if needed No tongue blade or inspection of throat; back of throat would be red if could see Keep suction(oral) at bedside (drooling can't control secretions) don't want them to aspirate Antibiotics (*Ceftriaxone/cefotaxime and vancomycin) intravenously (once diagnosis made) then oral (7-10 days, finish entire dose) will see a big improvement once 24hr dosage Corticosteroids (for inflammatory process, to decrease inflammation.) given IV. Humified oxygen (if not intubated, adding moisture to it in the air) IV fluids given *nutrition(feeding) not a priority right now* most definitive way to determine: lab/ blood cultures before antibiotics droplet precautions for 24 hours with the initiation of antibiotic therapy continuous monitoring of respiratory status(pulse ox, blood gases if intubated)

infant vaccine

2,4,6 month shots. can get more than one injection, sometimes 3 so even more painful. IM, vastas lateralis. 5/8" needle children develop deltoid and if big enough, can inject there. until then we stay in the leg.

acute epiglottis(table) Medical emergency

2-5 years old but varies bacterial rapidly progressive symptoms: dysphagia, stridor, aggravated with supine, drooling(due to obstruction), high fever, toxic appearance (ill looking), rapid pulse, respirations treatment: airway protection, possible intubation, tracheotomy, humidified oxygen, corticosteroids, fluids, antibiotics, reassurance. *even with vaccine, still see breakthrough cases*

copd oxygen

2/3L

Stages of Alcohol Withdrawal: 1

6-8 hours after abstinence from alcohol): mild tremors, nausea, anxiety, rapid heart rate, increased blood pressure, diaphoresis. *shakes or the jitters* tremors classic sign. benzo (Librium) anxiety and hand tremor help

acceptable vital signs for adults pulse

60-100 beats per minute, strong regular

Alcohol Intoxication: What ETOH level is considered intoxicated?

80mg/dl or 100mg/dl; 0.08 to 0.10 g/dl - two ways to be expressed. 80- 4 beverages 100- 5 beverages

STATUS EPILEPTICUS

A state of constant seizure or condition when seizures recur in rapid succession without return to consciousness between seizures Any seizure lasting > 5 minutes or repeated seizures (clusters) over the course of 30 minutes. Neurologic emergency Can occur with any type of seizure *seizures lasting longer than 10 minutes can cause death* push Ativan IV PRN to prevent turning to S.E.; should stop it from lasting 5 minutes.

Influenza Manifestations

Abrupt onset—~ 7 days: chills, fever, myalgia, headache, cough, sore throat, fatigue, watery nasal discharge. adults- contagious 24 hours before symptoms occur and up to 5 days after they begin. infection with flu strain B- leads to nausea, vomiting, diarrhea. feel fatigued 1-2weeks after acute episode is resolved. Complications: pneumonia, ear or sinus infections, death; Older adults—weak and lethargic, can lead to pneumonia or death. winter months. health care workers highest risk. monitor for dehydration, high risk for pneumonia, protection-nutrition, avoid people with flu. flu vaccine every season.

Short acting beta2 agonist for asthma

Albuterol (Proventil, Ventolin)- teach patient to carry drug at all times because it can stop or reduce life threatening bronchoconstriction. Levalbuterol- teach patient to monitor heart rate because excessive use causes tachycardia and other systemic symptoms. when taking any of these drugs with other inhaled drugs, teach pt to use them at least 5 min before the other inhaled drugs to allow bronchodilation effect to increase penetration of other inhaled drugs. teach pt correct technique for using MDI or DPI to ensure the drug reaches site of action.

Alone with Adam, you say, "You know, my little brother falls off his skateboard a lot. What kind of board do you have?" Adam looks panicky at the question for a moment, then shrugs and says, "I don't know." You try again, "Jason has one of those ones with a ninja painted on it. Do you have that kind?" "I don't know," Adam says. "Maybe?"

Alone for a moment with Adam's parents, which secondary question is least appropriate to ask at this time? A.How do you discipline Adam? B.Who helps you take care of his special needs? C.What about Adam's behavior bothers you the most? D.What did you do to this child? *answer= D.What did you do to this child? may leave with child and can't be put in safe environment.

Allergic Rhinitis

Also known as hay fever Triggered mostly by reaction to airborne allergens(inhaled from environment) History Physical assessment/clinical manifestations •Rhinorrhea, stuffy nose, itchy, watery eyes •Clear mucus •Postnasal drip, dry, scratchy throat and pharyngitis •Pain/headache to cheeks and gums ENT and allergist.

Sudden infant death syndrome (SIDS) 0-1yrs old

American Academy of Pediatrics Back to Sleep Campaign to reduce the risk of SIDS recommendations •Place the infant in a supine position while sleeping •No co-sleeping or prone sleeping •Remove pillows, blankets, and moldable mattresses •Encourage breastfeeding, use pacifier when sleeping Grief counseling •No investigative questions by the nurse •Allow family to hold infant and discuss the feelings openly should have quiet, calm, time to say goodbye. accompany to car or arrange for someone to take them home. debriefing session assist parent in working through feelings to prevent martial disruption in addition to loss of child nurse can encourage expression of emotion by asking about crying, feeling sad, etc. help explore coping skills report suspected abuse but don't confront them.

Angioedema

Angioedema is a severe type I hypersensitivity reaction that involves the blood vessels and all layers of the skin, mucous membranes, and subcutaneous tissues in the affected area seek med attention asap, soon as starting to swell make sure airway not compromised. High in clients taking ACE Inhibitors ("prils") and NSAIDs(know names) Physical Assessment: Deep, firm swelling: Face, lips, tongue, and neck Can lead to airway obstruction Anxiety- impending doom. will look totally different. African American at higher risk. but anybody can experience from ACE inhibitors can experience a problem after long term use of ACE inhibitors

Interventions for Pneumonia

Antibiotics -Broad spectrum: Rocephin, *Levaquin, and Zosyn* Oxygen Therapy- delivered by nasal cannula or mask unless hypoxemia doesn't improve with these devices. 2-3/L, etc depending on their pulse ox to keep them above 92% Adequate hydration (IV fluids and electrolytes) want pt to have productive cough. to rid of. Incentive spirometer- used to improve inspiration muscle action to prevent or reverse atelectasis (alveolar collapse). sit up if possible. hold breath 2-4seconds before exhaling. teach pt to perform 5-10 breathes per session every hour while awake. sucking like a straw, trying to get sections out by coughing. Bronchodilators nebulizers- beta 2 agonists, when bronchospasm present. IV steroids- used with acute pneumonia when inflammation and airway swelling are present. Expectorants- guaifenesin. Prevention: >65 years or chronic health problems (immunocompromised: HIV, cancer, autoimmune, meds for cancer chemo drug, taking biologic agents) to receive pneumococcal vaccine PCV13 and PPSV23 Influenza vaccine seasonally drink 2L/day every pt not hospitalized IM injection in clinic, then oral. want pt to have productive cough IV/oral hydration get pt out of bed, may be fatigued. turn cough deep breath- immobilized pt can do this.

Aspiration

At risk: tube feeding, unconscious, poor swallowing, neurologic injury Prevention: -Elevate HOB -Turn patient to side when vomiting -Prevention of stimulation of gag reflex with suctioning or other procedures -Assessment, proper administration of tube feeding -Rehabilitation for speech therapy for swallowing -Avoid thin liquids with swallowing problems Tuck chin to chest - NO STRAWSSSS! *coughing first sign.*

Alcohol Withdrawal Treatment

Benzodiazepines: •chlordiazepoxide (Librium) •Diazepam (Valium) •Lorazepam (Ativan) Hydration- increase intake, small frequent meals

*stabilized pt and home care:* COPD

Breathing techniques (Chart 30-10) Flutter valve- looks like end of old pipe. ball inside, pt uses it and creates a vibration. breaks up secretions. any person with secretions (pneumonia). replaces chest physiology. Positioning- pt remain in upright position with head of bed elevated can help alleviate dyspnea by increasing chest expansion and keeping the diaphragm in the proper position to contract. 1-2 hour periods 2-3times a day. semi-high fowlers. a lot like tripod position (sitting up leaning forward, arms for support). Coughing- can improve gas exhange by helping increase airflow in the larger airways. cough arising in the morning and bedtime. cough procedure is repeated at least twice. Nutrition- drink at least 2 L/day

Drug Therapy: Inhalers and Nebulizers

Bronchodilators - relaxes smooth muscles aiding in bronchospasms Short acting beta2 agonist(Albuterol (Proventil, Ventolin) and Levalbuterol (Xopenex) Long acting beta2 agonist-preventive daily use (Salmeterol (Serevent) Cholinergic antagonists -bronchodilation and decreased pulmonary secretions (Short acting- Ipratropium (Atrovent) ) Long acting (Tiotropium (Spiriva)) Anti-inflammatories Corticosteroids IV quicker Fluticasone (Ellipta) long acting, Prednisone *Methylprednisolone* oral steroid dexamethasone (sc) oral- home IV- for pts who can't breathe bc quicker.

NURSING INTERVENTIONS FOR INTIMATE PARTNER ABUSE

Careful documentation using body maps, photos: any bruises we see, size and color. tell them come back in 2 days for pictures of bruises (shows better). rape case- come in and get kit immediately. Report to law enforcement Teach about inevitability of cycle of violence, that no one deserves battering. it will not get better. If danger of injury present, advise use of shelter or safe house. Encourage to develop a safety plan (Box 28.5) I will have important numbers available to kids and myself. I can tell so and so about the violence and ask them to call the police if they hear suspicious noises come from my home. if I leave my home I can go 4 places. I can leave extra money, car keys, clothes, ad copies of documents with so and so. if I leave I will bring (check list). to ensure safety I will open my own savings account rehearse my escape route with a support person and review my safety plan.

Acute Laryngotracheobronchitis

Caused by a virus, slow progressive onset, after upper respiratory infection ex. after child had cold (or thought had) for couple days, may start the 3rd night. Low grade fever Stridor, cough sounding like a seal Brassy cough, hoarseness treated at home until respiratory issues (or depression) cause problems (stridor with resting or sleeping) Respiratory depression starts with nasal flaring, intercostal retractions, tachypnea, hypoxia

Acute Epiglottitis

Caused by bacteria H. influenzae, rapid onset, Prevention HIB vaccine (usually 3 doses when young) Recognize Cues: Fever up to 104 Stridor, voice is muffled, froglike sounds on inspiration, (no hoarseness- not affecting larynx) Rapid breathing, Accessory muscle involvement Sitting forward; Not wanting to lie down; tripod position, restless because feel like they can't breathe Tongue protruding, difficulty swallowing, Drooling, Sore throat -painful -poor feeding

Type I: Rapid Hypersensitivity Reactions (atopic allergy)

Caused by increased production of immunoglobulin E (IgE) antibody class •triggering histamine Types of Reactions •Hay fever or Allergic Rhinitis •Allergic asthma •Anaphylaxis •Angioedema Allergens contracted by: •Inhalation (pollens, spores, animal dander, dust, grass, ragweed) •Ingestion (foods, food additives, drugs) •Injection (bee venom, drugs, biologic substances) •Contraction (latex, pollens, foods, environmental proteins) *spring months, areas you live in that you'll come in contact with, trip environment.*

sexual abuse of children

Characteristics of abusers: males, step dads, dads. abuse older child, jobs that involves girls and boys (coach). usually has high school education. Characteristic of victims-sexual behavior, masturbation, sexual promiscuity, nightmares, somatic complaints, feelings of guilt, depression, anxiety, suicide, aggression, chronic low self esteem, chronic pain, obesity, substance misuse, self mutilation, ptsd. girls, boys. boys don't report so mental issues develop Initiation & Perpetuation: relationship with child trying to gain trust. may be scared to say something or their fault. incest among siblings are common.

Croup Syndrome (Table 21.1)

Characterized by hoarseness, barking cough, inspiratory stridor, and varying degrees of respiratory distress from swelling or obstruction cough like: seal, frog. with URI- associated with these 3 below: Affect larynx, trachea, and bronchi

PTSD

Characterized by intense emotional reactions after exposure to a traumatic event. physical, emotional, loss of someone unexpectedly, etc.

Drug Therapy & Teaching 1 TB

Combination drug therapy with strict adherence: -Isoniazid -Rifampin -Pyrazinamide -Ethambutol after 2-3weeks after starting drugs, we do 1st sputum sample. negative results-compliant with meds. 3 Negative sputum culture = no longer infectious, may return to former activities. come back every week, consecutive. if a positive have to start over. Directly observed therapy (DOT) for noncompliance- bedaquiline (targets multi drug resistant TB) should be give DOT.

Epilepsy

Condition in which a person has spontaneously recurring seizures caused by underlying chronic condition. it can be caused by an 1 abnormality in the electrical neuronal activity, an 2 imbalance of neurotransmitters, especially GABA; or a combo of both.

Screening for Contraindications and Precautions

Contraindications for vaccine administration: Known severe allergic reaction, such as anaphylaxis Moderate or severe febrile illness (need temp) Recently acquired passive immunity (blood transfusion, immunoglobulin, or maternal)- immune system down, getting blood from someone else, recognize as foreign and will try to fix it. Has a condition called Guillain-Barre' Syndrome(viral infection that attacks neurological system and causes paralysis of the lower extremities)- flu vaccine Pregnant (no live vaccines) Age, conditions (past medical history)

Asthma: Home Prevention: Take Action

Control and prevent episodes-Improve air flow and gas exchange *asthma is best controlled when the pt is an active partner in the plan* Self-management education-Personal asthma action plan. guided self-care, patients can coo-manage this disease, increasing symptom-free periods and decreasing number and severity of attacks. self care requires extensive education for the patient to be able to self assess resp status, self manage, and know when to consult provider. Drug therapy Control therapy drugs (used daily, prevent from occurring and maintain gas exchange) Reliever drugs (used to stop an attack once it has started) Bronchodilators and Anti-inflammatory agents (reduce inflammation) inhalers: MDI, DPI, SMI oral corticosteroid nebulizer. Exercise and activity- regularly is recommended to maintain cardiac health, strengthen muscles, and promote gas exchange/perfusion. adjust routine as needed. some may need an inhaled SABA before beginning activity. for others, environment may be needed (changing from out door skating in cold to indoor skating); continue to exercise but take short acting inhaler prior to avoid what's causing problem.

acute LTB (table)

infant or child younger than 5 years old viral slowly progressive symptoms: URI, stridor, brassy cough, hoarseness, dyspnea, restlessness, irritability, low grade fever, nontoxic appearance treatment: humidified mist if needed, corticosteroids, fluids, reassurance, nebulizer epinephrine (possible short term improvement), heliox: moderate to severe croup

acceptable heart rates

infant- 120-160 toddler- 90-140 preschooler- 80-110 school age-kid- 75-100 adolescent- 60-90 adult- 60-100

infants and toddlers after vaccine

infants- cry, irritable, fussy, won't suck bottle toddlers- tired, clingy, sleepy may see some swelling in legs- normal as well. tell parents this upfront. give some ibuprofen and acetaminophen for the pain. cool packs on the site.

acute epiglottis causes

ingestion of caustic agents smoke inhalation foreign bodies H. influenzae

anaphylaxis bronchospasms

inhaled beta adrenergic agonist such as metaproterenol or albuterol via high flow nebulizer every 2-4 hours.

manifestations of RSV

initial: rhinorrhea, pharyngitis, coughing, sneezing, wheezing, possible ear or eye drainage, intermittent fever with progression: increased coughing and wheezing, fever, tachypnea, retractions, refusal to eat, copious secretions severe illness: tachypnea, greater than 70 b/m, listlessness, apneic spells, altered air exchange (retractions, crackles), diminished breath sounds

TB Risk Factors

Homeless (older adults) Residents of inner-city neighborhoods Foreign-born persons Living or working in institutions (includes health care workers- increased exposure) IV injecting drug users or alcohol Poverty, poor access to health care Immunosuppression- reduced immunity or HIV disease. frequent contact with untreated infected person. living in crowd areas (long term facilities, prisons, homeless shelters mental health facilities) lower socioeconomic groups not spread by kissing or touching

Evaluation

Does the patient cooperate with treatment? Is the patient able to verbalize motivation toward alternative adaptive coping strategies to substitute for substance abuse? Has nutritional status been restored? are they compliant? group therapy? is it helping? how do they look? skin color may be improved.

Anaphylaxis: Common Agents to cause Anaphylaxis

Drugs Antibiotics (penicillin, vancomycin, etc.) Angiotensin-converting enzyme (ACE) inhibitors Chemotherapy Whole blood (check compatibility for pt. sit with pt first for 15 min after giving vitals) looking for anaphylaxis to occur Opiates Contrast media Foods Shellfish Peanuts Berries Bananas Other Latex Fire ants Mold ex: bee sting, but now im feeling lightheaded.

Anti-inflammatories for asthma

Corticosteroids Fluticasone (Ellipta) long acting- teach pt to use drug daily. even when no symptoms are present, because maximum effectiveness requires continued use for 48-72 hours and depends on regular use. Prednisone- teach pt about expected side effects bc knowing which side effects to expect may reduce anxiety when they appear teach pt to avoid anyone who has URI because drug reduces all protective inflammatory responses, increasing risk of infection teach pt to avoid activities that lead to injury bc blood vessels become more fragile leading to bruising and petechiae. teach pt to take drug with food to help reduce side effect of GI ulcers teach pt not to suddenly stop taking the drug for any reason. bc drug suppresses adrenal production of corticosteroids which are essential for life

Assessment of Pneumonia

Cough Fever, chills Dyspnea, tachypnea *Pleuritic chest pain- can describe it as this* Green, yellow, or rust-colored sputum Confusion or stupor Fine or coarse crackles Bronchial breath sounds- absent or diminished increased resp rate/dyspnea hypoxemia body aches Gram stain, culture and sensitivity of sputum- responsible organism is sometimes not often identified. CBC- obtained to assess for elevated WBC count, which is expected except in older adults. ABGs- in severely ill pts may be assessed to determine baseline arterial oxygen and carbon dioxide levels and to help identify a need for supplemental oxygen. Blood cultures- performed to determine whether the organism has entered the bloodstream. Chest x-ray- *DIAGNOSIS* most common test for pneumonia but may not show changes until 2 or more days after symptoms present. appears as an area of increased density. Pulse oximetry- assess for hypoxemia. listen to lungs.

DIAGNOSTIC TESTS

Electroencephalogram (EEG)- monitor electrical activity of the brain. CT scan- images of the brain. ex: tumor, cysts, bleeding on the brain. MRI- detect tumor or abnormalities with blood vessels. SPECT/PET scan- blood flow of oxygen in brain. Laboratory studies- CBC, labs, liver, kidney, dehydration, drug levels. anything too high/too low can contribute to seizures.

pneumonia

Excess fluid in lungs resulting from inflammation triggered by infectious organisms, inhalation of irritants -Community-acquired pneumonia -Hospital-acquired/healthcare required pneumonia -Aspiration pneumonia Risk factors and Prevention -Table 28-1 and Chart: Preventing Pneumonia (listed below) immobilized pt, elderly ,neurological (muscle wasting/weakening), difficulty swallowing pt at risk. want all pts up and moving so immobility a risk. vap- higher risk for secretions avoid large crowds, avoid people who are sick, get vaccines pneumococcal along with flu vaccine.

Recalling the father's behavior and some common perpetrator and victim characteristics, which might you cite as the most likely indication that the father is possibly a perpetrator? A.His description of his family's needs B.His insistence on being the one to provide financial information C.His disdain for skateboards D.His description of his son's learning disability

D. His description of his son's learning disability he said trouble thinking straight on good day and in class for mildly retards.

Correcting the underlying cause for Metabolic Acidosis (not really exam content)

DKA—give insulin drip, IV fluids, oxygen, K+ if low Diarrhea- antidiarrheal medications and hydration Sepsis- antibiotics and rehydration ; wait and let the bicarb naturally do it. IV hydration with isotonic or hypotonic solution *Bicarbonate is only given if the levels from body producing are low* end stage renal disease- dialysis to receive bicarb. kidney pt bicarb by mouth daily or iv if having acidosis.

What to chart...

Date Vaccine name (dose #) *Manufacturer, Lot number*, and expiration date Site and route (left vastus lateralis, IM) Edition date of vaccine information sheet (VIS) given to family Name of the person giving the vaccine can determine if batch of vaccine is bad or something may have been wrong if all pts developing certain symptoms.

Drug Therapy allergic rhinitis

Decongestants- (vasoconstrict)reducing amount of fluid. BP can elevate because causing vasoconstriction. history of hypotension don't use bc can elevate BP Sudafed Antihistamines(it's what's being released)- drowsiness, sedation; see how it works on pt. Zyrtec, Claritin, Benadryl Corticosteroids Flonase (inhaler) Mast cell stabilizers (after others don't work) Singulair Desensitization therapy - "Allergy shots" (if still not getting relief) *no first gen antihistamines for older adults*

ASSESSMENT OF CHILD ABUSE

Detailed history Thorough physical examination- bruises Observe caregiver-child interaction Attempt to interview the child away from caregiver "What happens when you do something wrong Provide support when abuse is revealed -Informed the child that reporting of abuse is mandatory and what will happen afterwards -Use child's vocabulary when discussing body parts explain so they understand -Avoid leading statements -Reassure that abuse is not their fault develop safe and therapeutic milieu -Determine immediate need for safety No false accusations. don't criticize or judge.

Case #2 Mr. M reports he stopped using the substance approximately 7 days ago. Last night he started having "terrible dreams" and difficulty sleeping. Mr. M is also experiencing diaphoresis, headache, abdominal pain, no appetite, shakiness, irritability, and strong cravings for the drug. Blood pressure, 140/92, pulse 122 beats/minute, and temperature, 101o F. He denies tobacco or other drug use, and reports having a glass of wine or champagne once or twice a year for special occasions.

Diagnosis: cannabis withdrawal Treatment:group therapy, individual therapy anti anxiety (Xanax) benzo

Case # 4 Mrs. B is unconscious with shallow breathing and pinpoint pupils. Respirations 6 breaths/minute. Blood pressure 80/52 mmHg, pulse 48 beats/minute, and temperature 94o F.

Diagnosis: opioid overdose Treatment: narcan (IM, SUBQ, IV, Intranasal) mechanical vent IM, SUBQ- 2-5min IV- 1-2min

Case #3 Ms. J is barefooted, and she is experiencing diaphoresis, heart palpitations, blurred vision, and tremors. Her pupils are dilated, and gait is unsteady. Blood pressure 146/90, pulse 128 beats/ minutes, and temperature, 98.9o F. She tells you the following story: "A few hours ago I was at the Metallica concert and got to thinking that James (lead singer) was talking to me in my head. He told me not to leave the stadium, so I didn't. Everyone else left, my ride left, but I just couldn't. Then I got here somehow. I remember thinking I wouldn't get through and would really lose my mind, especially when that pay phone I was using started melting in my hand. I felt I had to talk really fast before it melted. I really don't remember much of the concert or anything from this morning. I do remember that I had trouble getting to my feet to walk up the stairs to my seat. I remember we all passed around something and the next thing I knew, I started feeling really restless. I just couldn't sit still. I was jumpy, nervous, and sick to my stomach. My heart was racing and I was sweating, even though it wasn't very warm out. I was high and really got into the people and the whole scene. The scenery was fantastic and I could actually see the sounds— there were waves and triangles dancing in front of my eyes to the music. Then it got scary. Things got blurry and faces started looking mean and ugly. That's when I started hearing James in my head telling me not to leave the stadium. Then I was all alone and called for help."

Diagnosis:LSD intoxication Treatment: talk her down, reassure her that it is just effects of the drug. halodol- antipsych med benzo- valium

Case #1 Mr. C is disoriented, anxious, and irritable. Speech is difficult to understand. He has an unsteady gait and rapid involuntary eye movements. Blood pressure, 180/102 mmHg, pulse 144 beats/minute, and temperature 103.2o F. Mr. C begins to yell and pound on the walls of the hospital room, attempts to assault anyone who comes near him.

Diagnosis:PCP intoxication Supportive care Treatment: benzo (Ativan, valium, librium) cooling blankets, elevated temp restraints (assault anyone can be talked down)

Drugs to Treat Alcohol Use Disorder (Table 22.6)

Disulfiram (Antabuse) Naltrexone (ReVia) Acamprosate (Campral) Thiamine supplements

Active TB

Exposed developed disease immediately or latent TB disease became active because of weakened immune disease can spread to others Symptoms: coughs, laughs, sneezes, whistles, sings, infected respiratory droplets become airborne and may be inhaled by others. Patient with active symptoms are considered contagious until test results are returned -Isolate don't have to be hospitalized, often because of complications: severe fatigue, weight loss, can't function, dehydration, sepsis, etc. confirm with positive sputum culture, bacteria with symptoms.

Latent TB

Exposed not active disease No symptoms: lasts for years or decades before clinical symptoms develop. an infected person is not contagious to others until symptoms of disease occur. No transmission Treatment, must be compliant to adhere to month long prescriptions

Drug Therapy & Teaching 2 TB

Exposure- undergo TB testing. Transmission- teach pt to cover mouth and nose with a tissue when coughing or sneezing, to place used tissue in plastic bags, to wear a mask when in contact with crowds, and to use social distancing until drugs suppress infection. Sputum specimens- 2-4 weeks once drug therapy is initiated.

Correcting the underlying cause for Respiratory Alkalosis

Fear, anxiety—anxiety reduction, antidepressants Excessive mechanical ventilation—check settings: to control breathing if they can't do it. Oxygen therapy, rebreathing techniques: Teach stress relieving techniques and identify causes of anxiety tell them to take a deep breath and coach them slow them down stay with pt

ASSESSMENT OF SEIZURE: RECOGNIZE CUES

Gather information about the seizure- question pt or family about how many seizures the pt has had, how long they last, any pattern of occurrence. ask them to describe the seizures the pt has had. ask about the presence of an aura before seizures begin. Medical history-question whether the pt is taking prescribed drugs or herbs or has had head trauma or high fever. ask about med conditions such as previous stroke or hypertension. heart disease, fall, is it normal or new? History of substance abuse- assess any alcohol and or illicit drug history. *if the seizure is a new symptom, ask the pt and family if any loss of consciousness or brain injury has occurred in both the recent and distant past. often pts may have had a head or brain injury sufficient to cause a loss of consciousness but may not remember this at the time of the seizure, esp if it was during their childhood.

Risk Factors and Triggers of Asthma

Genetic factors Environment (allergens, air pollutants, pollen)- cold air, dry air, fine airborne particles. smoke, smoking, fireplaces, 2nd hand smoke. aerosol spray. Exercise- inhaling in cold air. Medication- aspirin, other NSAIDS Stress- job, coping mechanisms GERD- symptoms at night. regurgitating, can get into airways cause irritation. upper respiratory illness *anything they bring in can create this, depends on person and what they're sensitive to.

Acute Streptococcal Pharyngitis

Group A beta-hemolytic streptococci (GABHS) Diagnostic evaluation -Rapid antigen testing -Culture Manifestations/treatment regimen -*Sore throat*, headache, *fever*, exudate Risk for serious sequelae -Acute rheumatic fever -Acute glomerulonephritis: kidneys -Scarlet fever -scaletina- rash; babies may stop feeding or start screaming and fine red rash Nursing care management -Education on comfort -Transmission antibiotics used to treat because bacterial. strep untreated- may have open heart surgery to have valves replaced.

Influenza Diagnostic Studies

H & P, prevalence in community- usually based on the pt's reported symptoms Rapid influenza diagnostic tests (RIDTs)- common but has high false negative rates, and the pt should be treated if flu is suspected even if RIDT is negative. cultures are recommended only in specific situations.

Recommended Vaccines

Hepatitis A and hepatitis B *Diphtheria, tetanus, pertussis (DTP)* Polio (IPV) Rotovirus Measles, *mumps* , rubella (MMR) Varicella *Haemophilus influenzae type B (HIB)* *Pneumococcal (PCV13 and PPSV23)* *Influenza (annually) (Live attenuated influenza or recombinant)*

Complications of COPD

Hypoxemia Acidosis Respiratory infections (pneumonia)- fever, sputum(colorful) Cardiac failure, especially cor pulmonale: right sided heart failure, trying to push blood into damaged lungs that are damaged, overworking. -Right sided heart failure: edema lower extremities abdomen jugular veins anywhere outside of lungs, Jvd, give diuretic like lasix(furosemide) at home by mouth. Cardiac dysrhythmias: -Atrial fibrillation: top part of heart trying to start when it shouldn't. blood lingers and causes clotting. risk for pulmonary embolism. anticoagulants like Coumadin (warfarin). Polycythemia- increased RBCs. pink, reddish undertones. Respiratory failure -Oxygen: PaO2 >80mmHg -Carbon dioxide: PaCO2 <45mmHg

Emergency Care Of the Patient with Anaphylaxis

Immediately assess the respiratory status, airway, and oxygen saturation of patients who show any symptom of an allergic reaction. • Call the Rapid Response Team. • Ensure that intubation and tracheotomy equipment is ready. • Apply oxygen using a high-flow, nonrebreather mask at 90% to 100%. • Immediately discontinue the IV drug or infusing solution of a patient having an anaphylactic reaction to that drug or solution. Do not discontinue the IV, but change the IV tubing and hang normal saline. • If the patient does not have an IV, start one immediately and infuse normal saline. • Be prepared to administer epinephrine IM. Repeat drug as needed every 5 to 15 minutes until the patient responds. • Keep the head of the bed elevated about 10 degrees if hypotension is present(no 10 or supine- CHF, pt who can't breathe.); if blood pressure is normal, elevate the head of the bed to 45 degrees or higher to improve ventilation. • Raise the feet and legs. • Stay with the patient. • Reassure the patient that the appropriate interventions are being instituted. -ask someone to get code carts.

Acute Care: Interventions Take Action asthma

Improve airway clearance and gas exchange Focused Assessment- not focused on head to toe rn, once stabilized will do it and health history. Oxygen- supplemental oxygen by mask to nasal cannula is often used during acute asthma attack. high delivery flow may be needed when bronchospasm are severe and limited flow of oxygen through bronchiole tubes. Medications- bronchodilators, short acting albuterol. corticosteroids IV help with inflammatory process. Position and breathing- next to pt, coaching, into nose out of mouth. semi fowlers to high fowlers. meds (bronchodilator, short acting) over oxygen bc if closed off (inflamed) oxygen can't get in. breathing treatment connected to oxygen in hospital

Chronic Obstructive Pulmonary Disease (COPD): chronic bronchitis

Inflammation of bronchi and bronchioles caused by chronic exposure to irritants (esp cigarette smoke) affects only airways. irritants trigger: inflammation, vasodilation, mucosal edema, congestion, bronchospasm. Production of large amounts of thick mucus, bronchial walls thicken and impair airflow. the increased mucus provides a breeding ground for organisms and leads to chronic infection. paO2 levels decreases (hypoxemia), PaCO2 levels increase (resp acidosis)

Asthma

Inflammation of the mucous membranes lining the airways. how do we treat inflammation. Causing bronchoconstriction (narrows airway), mucus production and edema leading to decreased airflow and gas exchange

Chronic Obstructive Pulmonary Disease (COPD): Emphysema

Loss of lung elasticity and hyperinflation of lung, changes result in dyspnea with reduced gas exchange and the need for an increased respiratory rate. Air trapping and overstretching and enlargement of alveoli, collapse of small, these changes greatly increase the work of breathing and interfere with airflow to the lungs. airways (bronchioles) give pt a lot of oxygen, it stays there and co2 stays also. like collecting.

SEIZURE PRECAUTIONS: TAKE ACTION

Oxygen, Suction equipment, airway, IV access- with an airway readily available. if the pt doesn't have an iv access, insert a saline lock esp if he is at significant risk for generalized tonic clonic seizures. the saline lock provides ready access if iv drug therapy myst be given to stop the seizure *nursing safety priority* Side rails up and padded-maintain safety. good to have check facility protocol because 4 sides can be restraints so at least have one side rail could help is if pt at risk for falls. *padded tongue blades should not be at bedside and should never be inserted into the pt's mouth bc the jaw may clench down soon as the seizure begins* critically ill and older pt- post-octal phase: check airway, get out secretions, go into assessment mode. oxygen, suction.

ANTIEPILEPTIC DRUGS (AEDS): PATIENT TEACHING

Maintain effectiveness & therapeutic drug levels- teach its to take their drug on time. go to all schedule appts and get blood work done. too high-toxicity. too low- not working. Sensitivity of drug- if this occurs, tell them they will need to have blood levels of this drug checked frequently to adjust the dose. in some cases anti seizure effects of drugs can decline and lead to an increase in seizures. pts need to keep their scheduled lab appts to check serum drug levels bc of this. can change, growth and weight may have to increase dose. Drug-drug interaction with phenytoin (Dilantin)- SHOULD not be given with Warfarin. take accurate history. Report adverse effects- document and report to the health care provider. abnormal. yellowing of skin, eyes, GI upsets. anything out of normal, may need to be changed. Drug-food interaction- citrus fruits, such as grapefruit juice.

interventions for older adult abuse

Mandatory reporting: give privacy because may be abuser; be honest if have to report and next steps. Respite care: can also be used with kids. nursing home/center. give caregiver a break several days, weekend, afternoon. social workers oversees if pt needs to be removed from home.

TB disease diagnostic

Manifestation of signs/symptoms Chest X-ray- used to detect active TB or old, healed lesions. calcifications indicate old, healed lesions. caseation and inflammation may be seen if disease active. Sputum smear for acid-fast bacillus- confirms diagnosis and is used to evaluate treatment effectiveness. enhanced cultures take up to 4 weeks for valid result. cultures are usually negative after 3 months of effective treatment. Definitive: Sputum culture of M. tuberculosis

SELF-MANAGEMENT OF SEIZURES

Medication information- know name, dose, time of admin, actions to take if side effects occur, importance of taking prescribed drug and not missing a dose, what to do if dose missed or cannot be taken. Medic-alert bracelet- indicating epilepsy. someone may read and know how to treat. Follow-up appointments- with neurological or PCP as directed. levels need to constantly need to be checked. Management of seizure activity-be sure a family member knows how to help you in the event of a seizure and knows when your PCP or emergency services should be called. Driving & operating machinery- investigate and follow state laws. jobs cannot discriminate. in LA, must be 6 months seizure free. Alcohol & fatigue- avoid these. cannot mix AED and alcohol. fatigue, too much candy, too much stress can cause break thru seizure. Community resources- may not have funds but need meds, social worker help. understand the importance of having blood drawn for therapeutic or toxic levels as requested do not take any drug, OTC, without asking PCP

home care

Monitor for dehydration: may have crying with no tears, dry mucous membranes, sunken fontanel -Observe frequency of voiding -Counting the number of wet diapers 6 diapers/24 hours Output amount -1 ml/kg/hr for weight of <30 kg -30 ml per hour for >30kg

COPD Exacerbations

Monitor respiratory status Q2 hours and prn Oxygen to keep O2 sats 88% or higher BIPAP (Non-invasive ventilation)- using during sleep if have apnea. removes co2. helps control breathing. can have on when they come into emergency room not just during sleep. no teaching while pt can't breathe. they won't pay attention and need all of their energy. fluids help thin secretions.

Alcohol Use Disorder Systemic Effects

Neurological: LOC, sedation Cardiovascular: heart failure, swelling in lower extremities. Gastrointestinal Pancreas Liver Complete Blood Count Cancer

CAGE questionnaire

Not useful in determining risky drinking. Quick indicator of candidacy for standardized interview for alcohol use disorder.

Status Asthmaticus: Treatment

Oxygen keep sats above 92 immediately given to reverse condition: Inhaled nebulizers short acting B2 agonists- if albuterol isn't working Systemic corticosteroid Epinephrine nebulizer or injection- started with albuterol but wasn't working so used this IV access for fluids magnesium sulfate (may also be used although the practice is controversial) prep for emergency intubation -Sudden absence of wheezing and decreased oxygen saturation- indicates complete airway obstruction and requires a tracheotomy. call rapid response team. Frequent ABGs, electrolytes may need mechanical vent.

Improving ventilation and oxygenation for Respiratory Acidosis

Oxygen therapy, ventilator, positioning, breathing techniques Bronchodilators (breathing treatments) Assessing breathing and respiration status hourly Abnormal signs—wheezing, use of accessory muscles, cyanosis

Asthma: Nursing Assessment (Noticing) Integumentary

Pallor Cyanosis

child abuse: predisposing factors

Parental characteristics (Box 28.1): history of abuse, neglect, emotional deprivation as a child; family authoritarianism; low self esteem, feeling worthless, depression; poor coping skills; social isolation; involvement in crisis situation; unrealistic expectations of child behavior; frequent use of harsh punishment; history of severe MI (schizophrenia); violent temper outburst; expects child to satisfy need for love support reassurance; projection of blame onto the child for parents troubles; inability to seek help from others; perception of the child as bad or evil; history of drug alcohol misuse; feeling little or no control over life; low tolerance for frustration; poor impulse control Characteristics of the child: premature because lack of bonding, children with disabilities. Environmental characteristics: poverty, unemployment.

Seizures

Paroxysmal, uncontrolled electrical discharge of neurons in brain, interrupting normal function. may result in change in level of consciousness, motor/sensory ability, and/or behavior. a single seizure can have no known reason. some seizures are caused by a pathological condition of the brain, such as a tumor: in this case once the underlying problem is treated, the pt is often asymptomatic.

Peak Flow Meters

Peak Expiratory Flow Meters measure the maximum flow velocity during forced exhalation Green- asthma well-controlled Yellow- asthma is getting worse or poorly controlled Red Zone- Your asthma is severe. It requires emergency care. do again when not sick record number. 3 times back to back to determine personal best.

ASSESSING FOR INTIMATE PARTNER ABUSE

Physical Signs: strangulation, bruising, bleeding head/face, crying spells. Ask patient about cause of injury: - victims explanation of injury: red flag if it doesn't make sense. - nonverbal responses Ask patient about safety at home: how do you respond to conflict?

PTSD in Children:Signs/Symptoms

Play/Socialization- that includes aspects of traumatic event, social withdrawal, and negative emotions such as fear, anger, guilt, horror, sadness, shame, confusion. may not be engaged or want to interact. Emotions/Behavior- may blame themselves for the event. may feel detachment, enstrangement from others, diminished interests or participation in activities. irritability, aggressive, destructive behavior, problems concentrating, hyper vigilance. very emotional, angry, act out, self destruct. Sleep- sleep disturbances, nightmares.

Care and Use of Automatic Epinephrine Injectors

Prevention is best Medical alert bracelet Notify health care personnel about specific allergies Carry anaphylaxis kit or epinephrine injector Medical records should prominently display list of specific allergens Precautionary measures if drug or agent must be used despite history of allergic reaction can control (lisinopril)- just stop med. cannot control (eating,bees)- epi-pen Can inject through clothing Has expiration date Kids should know how to use, normally would be with the school nurse (epi pen)

Status Asthmaticus:Assessment and Complications

Severe, life-threatening, acute episode of airway obstruction Intensifies once it begins, often does not respond to common therapy Can develop pneumothorax-sudden chest pain and SOB (lung collapses, chest tube is placed) chest x-ray(to confirm)-chest tube(treatment) Cardiac or respiratory arrest- can lead to death. intubate (numbers depends on if intubate. look at trends) Prepare for emergency intubation

influenza management

Prevention: Vaccine Inactivated or live attenuated Takes 2 weeks for antibody production Symptom relief and prevent secondary infection: rest, increase fluid intake, antipyretic, analgesia Antivirals: shorten duration of symptoms and reduce risk of complications -Oseltamivir (Tamiflu) 24-48 hours of symptoms other antivirals- zanamivir, peramivir. not a cure or antibiotic, but reduces the symptoms saline gargles- throat pain antihistamines- reduce rhinorrhea looking for signs of pneumonia, and getting fluids in for dehydration. body aches- Tylenol, ibuprofen. can alternate in between. also helps with temperature control. rest important at this time. don't try to push through and go to work ad pass it to everyone.

TB disease Clinical manifestations (Isolate)

Progressive fatigue Lethargy Nausea Anorexia Weight loss irregular menses Low-grade fever, night sweats Cough, mucopurulent (mucus and pus) sputum, blood streaks (hemoptysis) sometimes blood tinged. crackles increased transmissions of spoken or whispered sounds localized wheezing

COPD Clinical Manifestations

Prolonged expiratory phase Wheezes Decreased breath sounds ↑ Anterior-posterior diameter (barrel chest) Tripod position Pursed lip breathing Dyspnea Cough Sputum production Chronic fatigue Weight loss May experience chest tightness with activity Cyanosis to blue-tinged, dusky appearance CO2- abnormal and out of range. clubbing of fingers. body trying to rid of co2, trying to push thru. activity intolerance years of problems with copd. resp failure with copd

Nursing Interventions for Substance Abuse

Provide a safe environment- first line intervention Promote rest and sleep- first line intervention. Decrease environmental stimuli- withdrawal experiencing anxiety Provide nutritional support- gradually reintroduce food and hydration. eat small frequent meals, increase water fluid intake. vitamins. weight them and add protein into diet. Support self-care- gradually reintroduce healthy hygiene to improve self esteem. Observe behavior frequently: make very clear with pt. check vitals. Explore thoughts and feelings- therapeutic relationship develops here. Assess and identify coping skills- understanding of current coping skills along with id of new skills provide tools to test in a safe setting. assistance in goal setting helps a pt see beyond the current situation and instills hope. nurses admin meds and provide ongoing assessment of their efficacy and side effects after admin. nurses need to monitor vital signs frequently since an increase in pule, BP, and body temp are clear signs of withdrawal. the goal is to keep the pt safe and comfy and stay ahead of withdrawal so pt doesn't suffer.

Diagnostic Examinations

Pulmonary function tests: most accurate for measuring airflow in asthma. how we measure asthma but not while having attack. Peak expiratory flow rates (PEFR) speed exhaling Forced vital capacity (FVC) Forced expiratory volume (FEV1) *decrease in PEFR, FEV1: of 15-20% below the expected value for age, gender, and size is common for the patient with asthma.* ABGs Initially decrease in CO2 (as the pt increases breathing rate and depth) and later increase in CO2 (as does the end-tidal carbon dioxide level, indicating CO2 retention. Sputum collection Skin testing (for allergy) all asthmas aren't related to allergies.

Nola, a 10-week-old, is brought to the emergency room with 3 days of rhinorrhea, congestion, and cough. Mother feels that the infant needs help in breathing and states he has been unable to breast feed all day. Infant is exclusively breastfed. Older sibling is at home with respiratory illness as well. The nurse observes mild intercostal retractions, restless and head bobbing. Wheezing in both lungs and congested cough. Vital Signs: Temperature: 99.2 °F, Heart rate: 178 beats/min, Respirations: 65 breaths/min and Oxygen saturation: 92% on room air

RSV/Bronchiolitis- wheezing congested cough tachycardia restlessness

Bronchiolitis and RSV

Respiratory syncytial virus (RSV) causes mucus and exudate to fill the lining of bronchi and bronchioles very contagious. test for it, stay home. stay away from other kids. swab for it.

Asthma: Nursing Assessment (Noticing) Neurologic

Restlessness Anxiety Difficulty sleeping Unable to speak a few words drowsy lethargic *CNS under attack- lacking oxygen, or too much co2.

Treatment for Respiratory Alkalosis

Results from hyperventilation (releasing co2) ex. panic anxiety Assessment: tachypnea, inability to concentrate

Metabolic Alkalosis (not really exam content)

Results from ingesting to much bases (antacids, bicarbonate), blood transfusion, nasogastric suctioning, vomiting, diuretics, laxatives losing acid when suctioning leading to MA. Assessment: Symptoms of hypocalcemia and hypokalemia

Treatment for Metabolic Acidosis (not really exam content)

Results from: DKA(not enough insulin), starvation, kidney failure, excessive intake of acids, diarrhea Assessment: Kussmaul respirations, warm, flushed dry skin, confusion

Treatment for Respiratory Acidosis

Results from: hypoventilation slow breathing, low respiratory rate (<12). low breathing- drug use/substance abuse (heroin person on street not breathing-give narcan). asthma, COPD. Assessment: confusion, coma, tachycardia, variable respirations, pale to cyanotic and dry skin

Family Education

Risks of contracting vaccine-preventable diseases Benefits of immunization Common adverse reactions: Chills, fever, muscle aches and pains, rash, itching Drowsiness, prolonged or unusual crying, not feeding/eating Pain & tenderness at the injection site Palpable lump Treatment of adverse reactions: Increase fluid intake, rest Acetaminophen administer 45 minutes prior to vaccines and age-appropriate dosages and intervals thereafter Warm or cool compress on site Return visit- tell when next vaccine prescribed.

Long acting beta2 agonist for asthma

Salmeterol (Serevent)- teach pt to not use these drugs as a reliever drugs because they have a slow onset of action and do not relieve acute symptoms. teach pt to correct technique for using MDI or DPI to ensure that the drug reaches site of action.

Drugs for Adult PTSD

Sertraline (Zoloft) Paroxetine (Paxil) go to this if others doesn't work: Phenelzine (Nardil) treats depression, anxiety, sleep, concentration.

Cholinergic antagonists for asthma

Short acting- Ipratropium (Atrovent) Long acting Tiotropium (Spiriva) if pt use any of these as a reliever drug, teach to carry it at all times because it can stop or reduce life threatening. for drugs delivered by MDI, teach pt to shake the inhaler well before using because the drug separate easily teach pt to increase daily fluid intake because can cause mouth dryness teach pt to observe for and report blurred vision, eye pain, headache, nausea, palpitations, tremors, and inability to sleep as these are systemic symptoms of overdose and require intervention teach pt correct technique for using MDI or DPI to ensure drug reaches site of action

Interventions Angioedema

Stop the drug or allergen (whatever is the cause) ensure adequate airway. if in IV, immediately stop the IV infusion Monitor for respiratory distress, stridor and ability to swallow -Oxygen -Intubation if needed or tracheostomy Corticosteroids, diphenhydramine, epinephrine (can be systemic injection). GIVEN IV, may get all 3. look and see if pt can speak, drooling. antibiotics can cause this. once drug therapy is stopped and IV access remains, the pt is closely monitored for 2-6 hours.

Teach Family to Monitor for Respiratory Depression

Stridor at rest Tachycardia Tachypnea that decreases Substernal and intercostal retractions Flaring Nares Increased restlessness- first sign Cyanosis- last sign parent can see pattern. if increased or decreased ex was breathing 12 now its at 6.

key factors of asthma

Symptoms: Daytime symptoms of wheezing, dyspnea, coughing present more than twice weekly Waking from night sleep with symptoms of wheezing, dyspnea, coughing Relieved (rescue) drug needed more than twice weekly Number of times per week activity was limited or stopped by symptoms controlled- none of these partly controlled 1-2 of these uncontrolled- 3-4 of these a person with asthma should be controlled *more symptomatic if rescue inhaler doesn't solve problem, then we need to do a little more*

INTIMATE PARTNER CYCLE OF VIOLENCE (FIG 28.2)

Tension-building stage Acute battering stage Honeymoon stage married couples, couples. women most commonly victims.

PTSD in Adults: Signs/Symptoms

Terror in stomach, GI upset. Heart Palpitations Muscle tensing Anxiety Depression Flashbacks

Isoniazid for TB

instruct pt to avoid antacids and to take the drug on an empty stomach (1 hour before or 2 hours after meals) to prevent slowing of drug absorption in the GI tract teach pt to take a daily vitamin that contains Bcomplex vitamins while on this drug. bc drug can deplete the body of this vitamin remind pts to avoid alcoholic beverages while on this drug. bc liver damaging effects are potentiated tell pt to report darkening of urine, yellow appearance to skin or whites of eyes and increased tendency to bruise or bleed. signs of liver toxicity or failure.

Ethambutol for TB

instruct pt to report any changes in vision, reduced color vision, blurred vision, reduced visual fields, immediately report to PCP remind pt to avoid alcoholic beverages ask pt if they ever had gout bc the drug increases uric acid formation and will make gout worse. instruct pt to drink at least 8 ounces of water when taking this tablet and to increase fluid intake.

Opioid Use Disorder: Intoxication versus Withdrawal Symptoms (Box 22.1)

intoxication: bradycardia, hypotension, hypothermia, sedation, mitosis (pinpoint pupils), hyperkinesis (slowed movement), slurred speech, head nodding, euphoria, analgesia, calmness withdrawal:tachycardia, hypertension, hyperthermia, insomnia, mydriasis (enlarged pupils), hyperreflexia, diaphoresis, piloerection(goosebumps), increased respiratory rate, lacrimation, yawning, rhinorrhea, muscle spasms, abdominal cramps, nausea, vomiting, diarrhea, bone and muscle pain, anxiety

Interventions angioedema continued

intubation- if airway is compromised. creates an area, so much swelling can't breathe on own. presence of stridor and inability of pt to swallow. ex:outside of swelling, stroke: may start with intubation but go to tracheostomy for longterm use. tracheostomy- sometimes swelling is so bad can't intubate, so do a tracheostomy. beyond swelling so get airway. discontinued when pt can breathe easily around tube.

RSV recommendations

breastfeeding, avoid passive smoking, and promote preventive measures: hand washing and admin Synagis to high risk infants.

acceptable range of respiratory rate

newborn- 30-60 infant (6months)- 30-50 toddler(2 years)- 25-32 child- 20-30 adolescent- 16-20 adult- 12-20

green zone

no cough, wheeze, tightness, SOB during day/night. can do usual activities. daily meds 2 or 4 puffs take 5 min before exercise

OLDER ADULT ABUSE

poor mental or physical health: ex Alzheimers disease, non ambulatory. dependent or perpetrator: no land of independency female, older than 75 years, white, living with a relative: more commonly here elderly father cared for by daughter he abused as a child elderly woman cared for by a husband who has abused her in the past: may still abuse her in his older age.

common presenting problems of victim of abuse (book): any setting

signs of stress due to family violence: emotional, behavioral, school, or sleep probs and increase in aggressive behavior injuries in a pregnant woman recurrent visits for injuries attributed to being accident prone

Acute Care Management for LTB with Stridor

Therapeutic management: Airway/Intubation if needed Oxygen with mask or flow by, Heliox (even vapotherm used) Steroids, IV fluids Decrease anxiety due to potential for respiratory obstruction main treatment: Nebulized racemic epinephrine q 20-30 min. for mucosal edema (epinephrine will constrict. 1 dose good, but can repeat it. monitor for several hours after.)helps with swelling. the peak effect is observed within 2 hours and additional doses may be administered every 20-30min as needed. observed for 2 to 4 hours for any visible signs of respiratory distress. usually not an admission trying to constrict not dilate

Interventions for Child with PTSD (Box 16.1)

Therapeutic relationship- establish trust and safety Explore feelings- use developmentally appropriate language Relaxation techniques- teach techniques before trauma exploration to restore sense of control over thoughts and feelings. coloring pages, painting. Identify and cope with feelings- help child id and cope with feelings thru the use of art and play to promote expression. Involve & assist family- in one on ones, unless they cause the trauma. Grief process- educate child and parent, ab response as well. assist parents in solving their own emotional distress about the trauma. separated from family or the situation. Coordinate with social work- for protections as indicated. our BFFs meds are not wanted for kids, UNLESS they have something like ADHD as well, will get adderall to antidepressant.

GENERALIZED SEIZURE: TONIC-CLONIC

Tonic phase Clonic phase Post-ictal phase

Risk factors in Adults

Traumatic events Serious injury to self/others Military trauma: prisoner of war, being taken hostage Natural disaster: floods, tornadoes, earthquakes Human disaster: automobile, airline, train accidents EMS workers bc exposed to all of this.

Metabolic Alkalosis: treatment (not really exam content)

Treatment is aimed at the cause GI losses: antiemetic Fluid and electrolyte are replaced PO or IV Monitor serum electrolyte levels closely

Otitis Media

Usually follows a respiratory infection caused by RSV and influenza Risk factors: bottle propping, day care, smoking in home, breast feeding is better. not up to date on immunizations. Diagnostic Evaluation -Tympanic membrane infected: Purulent discolored, bulging, yellow to reddened membrane pneumococcal vaccine to reduce incidence

Risk Factors in Children

Victims of abuse- abused by parent. Poverty- receiving increased attention and place minority children at greater risk for trauma stress. Non-nurturing environment- suffer neurological consequences that are long lasting and difficult to remediate. left alone In home, parent strict, parent using substance abuse, seeing mom and dad fight.

Nutritional therapy COPD

Weight loss and malnutrition are common. -Pressure on diaphragm from a full stomach causes dyspnea. -Difficulty breathing while eating leads to inadequate consumption. To decrease dyspnea and conserve energy -Rest at least 30 minutes before eating. -Use bronchodilator prophylactically before meals. High-calorie, high-protein diet is recommended. rest between activities ADLs included (bathing, eating, etc) promote self independence, assistance prn smaller meals no beverages between eating (get in nutrients first) fluids outside of meals *Avoid* -Foods that require a great deal of chewing -Exercises and treatments 1 hour before and after eating -Gas-forming foods

ANTIEPILEPTIC DRUGS (AEDS): BOX 39.2

What is the goal of drug therapy? to achieve control of the type of seizure that the pt has, stop it. want pt to experience minimal to no toxic effects. What labs should be monitored? CBC, liver enzymes, therapeutic drug levels if high at risk for toxicity, if low not effective enough Why is frequent oral care important? can cause permanent gingival damage-overgrowth. daily mouth care won't be a chronic problem.

Arterial blood gases (ABGs) are drawn on C.J. Since this is early in her attack, which result would you expect to find? a.Respiratory alkalosis b.Respiratory acidosis c.Metabolic acidosis d.Metabolic alkalosis

a. hyperventilating, pushing out co2. if it was continuing with no treatment- resp acidosis. always look at abg results can go from alkalosis to acidosis

You are called to the patient's room by the patient's spouse when the patient experiences a seizure. Upon finding the patient in a clonic reaction, what do you think you should do first?

a.Turn the patient to the side. b.Start oxygen by mask at 6 L/min. c.Restrain the patient's arms and legs to prevent injury. d.Record the time sequence of the patient's movements and responses as they occur. *answer=turn pt to side. safety 1st. 2nd you would record

Tension-building stage

abuser- edgy, has minor explosions. may become verbally abusive; minor hitting, slapping, and other incidents begin. victim- feels tense and afraid, like walking on eggshells, feels helpless becomes compliant, accepts blame.

Honeymoon stage

abuser- loving behavior, such as bringing flowers, gifts, sorry, makes promises to change. victim- trusting, hoping for change, wants to believe partners promises

reducing risk of OM

sitting, holding infant upright for feedings maintaining routine immunizations, and exclusively breastfeeding until at least 6 months. avoid: propping bottles while child supine no smoking known allergens

COPD causes

smoking, occupational hazards, genetic history. seeing pt often-hypoxia and hypercapnia.

Elijah, a 2-year-old boy, is brought to the emergency department at 11pm for evaluation of cough, respiratory distress, and irritability. Elijah is a previously well child who developed a runny nose 3 days ago. All routine immunizations were up to date. The nurse documents the following: clear rhinorrhea, inspiratory stridor, suprasternal retractions, hoarse cry, dry brassy cough, and swallow without difficulty. Vital sign: Temperature 99.7º F (37.6º C), Pulse 162 beats/minute, Respiration 44 breaths/minute, Oxygen saturation 98% on room air

acute LTB- hoarse cry dry brassy cough (typical sign of croup) vitals getting abnormal for age

focal epilepsy

affects only one hemisphere of the brain

D.T. is an 88-year-old woman who lives alone with limited range of motion. She has been feeling weaker over past 2 days. Last night became confused and disoriented. Her housekeeper notified her daughter, who brought D.T. to the clinic. She reports coughing up mucus over the past 3 days. uShe has a history of mild heart failure that is treated medically but has no other significant health disorders. She last saw her health care provider 4 months ago. 1.What provided information is relevant? 2.What assessment do you want to obtain? 3.What cues support the diagnosis of pneumonia? 4.What diagnostic tests would you expect the nurse practitioner in the clinic to order?

age, limited rom confused, disoriented coughing up mucus (color/consistency) listen to lungs, count respirations, pulse ox, chest x ray

respiratory system

air through mouth and nose vitals tell us a lot about someone. resp rate controls amount of oxygen we pull in. resp rate increases- anxiety, exercise, need more oxygen which is why it's increasing. activity intolerance (sick person)- more oxygen needed, can't tolerate. reason why we let them sit down before we begin. can be temporary. if congested result to mouth breathing. epiglottis is protector to close off of trachea. to prevent aspiration. hoarseness- somewhere near the voicebox when talking about stridor crackles, describe these things to them. tell pt what to look for.

TB

airborne transmitted. particles can linger in the air for hours. cough sneeze sing, releases it into air. from there we have problems with it.

Thiamine supplements

alcohol interferes with vitamin B absorption

Alcohol Use Disorder: Unfolding Case Study Gary, a 49-year-old man, was admitted to the acute care unit 6 hours ago with alcohol intoxication. His current vital signs are: blood pressure 154/90 mm Hg, P 110 bpm, R 20, and temperature 100.2; he has a slight tremor in his hands, and he appears anxious. He complains of a headache and appears flushed. Gary denies that he has an alcohol problem but later admits to drinking approximately a fifth of vodka daily for the past 2 months. He reports that he was drinking vodka just before his admission to the ED. He admits to having had seizures while withdrawing from alcohol in the past.

alcohol withdrawal

Cardiovascular-alcohol use disorder systemic effects

alcoholic cardiomyopathy. direct toxic effects of alcohol can weaken and thin the muscles of the heart, leading to enlargement and eventual heart failure. symptoms of alcoholic cardiomyopathy are similar to other types of heart failure, including fatigue, shortness of breath, and edema of the legs and feet.

liver-alcohol use disorder systemic effects

alcoholic hepatitis- produces highly toxic chemicals. excessive alcohol over extended period of time may result in diseased and inflamed liver. occurs in minority of heavy users. genetic factors such as how the body processes alcohol, other liver disorders (hepC), malnutrition, being female increase risk of this disorder. symptoms: appetite changes, dry mouth, weight loss, nausea, vomiting, pain swelling of abdomen, jaundice, fever, confusion, fatigue. cirrhosis of the liver- healthy liver replaced by scar tissue. eventually the liver can no longer function properly bc scar tissue blocks the flow of blood thru the liver. this slows the processing of nutrients, hormones, drugs, naturally produced toxins. symptoms: easy bleeding and bruising, pruritus, jaundice, ascites, leg edema, weight loss, confusion, spider like blood vessels on skin (petechiae), testicular atrophy. liver transplant may be necessary, low salt diets will reduce ascites.

partially compensated

all outside of normal range

Secondline antibiotics for OM

amoxicillin/clavulanate, azithromycin, cephalosporins (cefdinir, cefuroxime, cefpodoxime)

TONIC

an abrupt increase in muscle tone, loss of consciousness, and autonomic changes lasting from 30 seconds to several minutes.

anaphylaxis- drug used despite a history of allergic reactions

start IV, place intubation equipment and trach set at bedside. pt often premeditated with Benadryl or corticosteroid.

Pyrazinamide for TB

ask pt if they ever had gout instruct pt to drink at least 8 ounces of water when taking this tablet and to increase fluid intake. teach pt to wear protective clothing, hat, sunscreen when going outdoors in sunlight remind pts to avoid alcoholic drinks tell pt to report darkening of urine, a yellow appearance to skin or whites of eyes and increased tendency to bruise or bleed. signs of liver toxicity or failure.

acceptable vital signs for adults temperature

average range: 36 to 38 C (96.8 to 100.4F) average oral/tympanic: 37C (98.6F) average rectal: 37.5 (99.5F) axillary: 36.5C (97.7F)

self management of asthma

avoid potential environmental triggers (smoke, fireplaces, dust, mold, weather changes of warm to cold) avoid drugs that trigger asthma (aspirin, NSAIDS, beta blockers) avoid food that has been prepped with MSG or metabisulfite if you have exercise induced asthma, use your reliever bronchodilator inhaler 30 mins before exercise to prevent or reduce bronchospasm be sure that you know proper technique and correct sequence when you use meter dose inhalers get adequate rest and sleep reduce stress and anxiety; learn relaxation techniques; adopt coping mechanisms that have worked in the past wash all bedding with hot water to destroy dust mites seek immediate attention if: gray or blue fingertips or lips, difficulty breathing walking talking, retractions of the neck chest or ribs, nasal flaring, failure of drugs to control worsening symptoms.

preventing aspiration while swallowing

avoid serving meals when pt is fatigued. provide smaller and more frequent meals. provide adequate time do not hurry the pt. closely supervise the self feeding pt. keep suctioning equipment close at hand and turned on. avoid water and other thin liquids as well as use of straws. thicken all liquids including water. thin liquids may be permitted after a swallowing evaluation by a slp. avoid foods that generate thin liquids during chewing process, fruits. position pt in most upright position possible. when possible, completely deflated tube cuff during meals. suction after cuff deflation to clear airway and allow comfort during meals. feed each bite or encourage pt to take each bite slowly. encourage pt to dry swallow after each bite.. to clear residue from throat. avoid consecutive swallows of liquids. provide controlled small volumes of liquids, using spoon. tell pt to tuck chin down and move forehead forward while swallowing. allow pt to indicate when ready for next bite. if coughing occurs, stop feeding until pt indicates airway is clear. assess resp rate, ease of swallowing, pulse ox, HR during feeding.

Which nursing activity would be your highest priority at this point? a.Obtaining a detailed health history b.Obtaining C.J's pulse oximetry reading c.Obtaining C.J's blood pressure d.Administering oxygen via nasal cannula

b.

COPD with respiratory failure scenario (Responding) Donald Jones was admitted to the emergency room complaining of increased shortness of breath than usual and coughing up green phlegm. He was very drowsy and was diagnosed as having pneumonia with an exacerbation of chronic obstructive pulmonary disease (COPD). His arterial blood gas results are pH 7.21; PaCO2 95 mmHg; PaO2 53 mmHg; HCO3 34 mmHg Background information: Mr. Jones has had a number of COPD exacerbations and his quality of life was diminished. He uses home oxygen 2L/16hrs per day After treatment with nebulizers, IV steroids and controlled oxygen via venturi mask, Mr. Jones was not responding and became unresponsive with labored respirations at 48 breaths/min What should be considered a priority for Mr. Jones treatment?

bipap. give oxygen and remove co2. couldn't breathe fast and retain co2.

common presenting problems of victim of abuse (book): emergency department

bleeding injuries, esp to head and face internal injuries, concussions, perforated eardrum, ab injuries, severe bruising, eye injuries, strangulation marks on neck back injuries broken or fractured jaw, arms, pelvis, ribs, clavicle, legs burns from cigarettes, appliances, scalding liquids, acids psych trauma. anxiety, attacks of hyperventilation, heart palpitations, severe crying spells, suicidal tendencies. miscarriage

kids acute LTB

blow by mist because want to be held and sit upright.

bring child to ER after vaccine IF allergic reactions

breaks out in hives, swelling in face and mouth, high temp, difficulty breathing bring to ER.

MYOCLONIC

causes brief jerking or stiffening of the extremities that may occur singly or in groups. lasting just a few seconds, the contractions may be symmetric (both sides) or asymmetric (one side).

tonic phase

causes stiffening or rigidity of the muscles, particularly of the arms and legs and immediate loss of consciousness. 10-20 seconds. can fall also.

infectious process

change colored and/or thick exudate, more pain, bold redness to areas

Gary's wife stayed home from a planned night out with her friends to pour all the alcohol in his apartment down the drain. What type of behavior is evident?

codependence- alter life to do what person can do themselves.

strep interventions

comfort: compresses, gargles (if old enough), change tooth brush after bacterial illness. liquid or chewable forms of meds. encourage intake of ice chips, flavored ice pops, cool liquids. topical cream to reduce pain- lmx4 lidocaine 4% over injection site for 30 min before injection. infectious until 24 hours on antibiotic therapy, can return to school. change toothbrush during this period too. wash ortho equip throughly avoid close contact with pt, no sharing towels and food/drink items.

oral steroids anaphylaxis

continued after anaphylaxis(under control) at lower doses to prevent the late recurrence of symptoms.

GI Type 1

cramping ab pain nausea vomiting diarrhea

Naltrexone (ReVia)

decreases the pleasure of drinking. uses-withdrawal, relapse prevention, decreases pleasurable feelings and cravings implications- oral or long acting (once a month) inject form. nausea usually goes away after 1st month; headache, sedation. pain at injection site, pt needs to be free 10 days before initiation of meds.

COPD breathing techniques

diaphragmatic or abdominal breathing: lie on back with knees bent. if can't: sit in chair. place hands or book on abdomen to create resistance begin breathing from abdomen while keeping chest still. you can tell if doing correctly if hands or book rises and falls correctly. pursed lip breathing: close mouth and breathe through nose. purse lips as you would to whistle. breathe out slowly through mouth without puffing cheeks. spend at least twice the mouth of time it took you to breathe in use abdominal muscles to squeeze out every bit of air you can remember to use pursed lip breathing during any physical activity. always inhale before beginning the activity and exhale while performing it. never hold your breath.

COPD Exacerbations treatment

difficulty breathing esp with activity Short-acting bronchodilators Corticosteroids Antibiotics- pneumonia or chronic bronchitis ; a lot of exudate normally turns into an infection. Mucolytics- thin the thick secretions making them easier to cough up and expel. Guaifenesin oral. mucinex. get rid of bronchitis side. need fluids with encourage fluids! Supplemental oxygen therapy- keep sats 88% some pts can't get to 92%. depends on pt and what parameters for them.

Gary is being discharged with a prescription for disulfiram (Antabuse) to help maintain a medical aversion to alcohol. What patient teaching about this medication should the nurse provide?

drinks on it will throw up. no alcohol, mouthwash, anything containing alcohol. may have vomiting, nausea, confusion, flushed.

Jacob, a 5-year-old boy, developed sore throat and fever over the course of a day. By evening his temperature was 104 F (40°C), and he had developed low pitched inspiratory stridor. On arrival at the emergency room, he was quiet, flushed and frightened-looking and preferred a sitting posture, leaning forward. He would not speak but was drooling.

epiglottitis- tripod position (sitting forward, leaning forward) drooling

Patient-Centered Collaborative Care allergic rhinitis

esinophils impacted- lets us know more than allergic problem is occurring Allergy testing: skin pricks usually back Skin:*swelling, itching*- allergic to. Oral food Food diary: certain colors first, start with veggies gradually introduce foods. some kids can be allergic to milk- keep all milk products away from child and see if symptoms get better. Interventions: avoidance therapy: wear mask(something out doors) because you know you're inhaling this in Environmental changes Air-conditioning, air-cleaning units- changing filters Cloth drapes Upholstered furniture Carpeting- changing out purifiers in home Pet interventions: may have to rid of pets because symptoms just that bad. or send to grandma's house while we visit from afar.

Gastrointestinal- alcohol use disorder systemic effects

esophagitis: inflammation of the esophagus is a direct result of toxic effects of alcohol. the vomiting related to alcohol overuse contributes. (esophageal varices) veins at risk for bursting due to heavy drinking. gastritis: as a toxin, alcohol irritates the stomach lining. nausea, vomiting., loss of appetite, belching, bloating. damage to stomach lining- ulcers, bleeding.

Asthma: Nursing Assessment (Noticing) Musculoskeletal

exercise intolerance- severely SOB or gasping for air

post-ictal phase

fatigue, acute confusion, and lethargy may last up to 1 hour after the seizure. may not remember having the seizure. exhausted. needs rest, muscles may be sore, may sleep several hours after.

respiratory assessment

first thing we do is observe. we use our senses observe how they're kept; what we hear/smell sweating in a cool atmosphere? something is going on. gasping for air, mouth opened. toxic appearance (ill-looking), skin color, expression of face.

Otitis Media Clinical manifestations

foul odor from ear, drainage, pain. acute otitis media: follows an upper respiratory tract infection, otalgia (earache), fever (may or not be present), purulent discharge (otorrhea-may or not be present) infants and very young kids: crying fussiness, restlessness, irritability, esp on lying down. tendency to rub, hold, or pull affected ear. rolling head side to side. difficulty comforting child. loss of appetite, refusal to feed. older kids: crying or verbalizing feelings of discomfort, irritability, lethargy, loss of appetite chronic otitis media: hearing loss, difficulty communicating, feeling of fullness, tinnitus, vertigo may be present.

parent education of croup (acute LTB)

frequent reassurance (calm manner), explain treatment, educate regarding what they can do to make child more comfy, monitor for worsening of symptoms, continue humidity, adequate hydration, nourishment.

yellow zone

getting worse cough, wheeze, tightness, or SOB or waking at night due to asthma or can do some activities but not all usual 1st- add quick relief med and keep taking green zone med (number of puffs or nebulizer once). repeat every __ min up to maximum of __ doses if symptoms turn to green zone after 1 hour of above treatment: continue monitoring or if symptoms do not return to green zone after 1 hour: take quick relief med, number of puffs or nebulizer add oral steroid mg per day for 3-10 days call doctor before/within hours after taking oral steroid.

Screening for Alcohol Abuse CAGE questionnaire

have you ever felt you needed to cut down on your drinking? are people annoyed by your drinking? have you ever felt guilty about your drinking? have you ever had a drink in the morning (eye opener)? *a score of 2 or more is significant, although a score of 1 requires further assessment.*

neurologic- Type 1

headache, dizziness, paresthesia, feeling of impending doom.

1. NGN Item Type: Enhanced Hot Spot Highlight or place a check mark next to the assessment findings that require follow-up by the nurse.

heart rate 178 respirations 65 mild intercostal retractions restlessness and head bobbing intermittent wheezing in both lungs unable to stay latched to breast cap refill 4 seconds extremity pulse +2

respiratory Type 1

hoarseness, coughing, sensation of narrowed airway wheezing, stridor, dyspnea tachypnea, resp arrest

allergic rhinitis supportive therapy

humidification nasal irrigation applying hot wet packs over sinus area can increase comfort and help prevent spread of infection. rest and fluid intake important. sleep with head of bed elevated avoid cigarette smoking

cardiovascular Type 1

hypotension dysrhythmias tachycardia cardiac arrest

ear wicks

if ear wicks or lightly rolled sterile gauze packs are placed in ear after surgical treatment. keep dry, during shampoo and baths. cleanse and apply moisture barriers (pro shield plus, zinc oxide-based products, or petrolatum jelly vaseline, an prevent skin irritation.

vaccine

if vaccine updated can avoid bacterial infection: epiglottis can develop epiglottis if don't have HIB vaccine we still see break through cases.

early signs of impending airway obstruction acute LTB

increased pulse and respiratory rate. substernal, suprasternal, intercostal retractions, flaring nares, increased restlessness.

2. NGN Item Type: Extended Drag and Drop Use an X to indicate whether the nursing actions below are Indicated (appropriate or necessary), Contraindicated (could be harmful), or Nonessential (makes no difference or not necessary) for the infant's care during hospitalization. bronchiolitis

indicated- monitor resp rate ever 2 hours, utilize normal saline drops during suctioning, provide oxygen for o2 sat less than 90% contraindicated- nasopharyngeal for q4hrs, admin formula in leu of breastmilk nonessential- review chest x ray, provide education regarding nasal suctioning.

preventing pneumonia

know your risk for pneumonia (older than 65, have chronic health problem(esp respiratory problem), or have limited mobility and are confined to a bed or chair during waking hours. have annual flu vaccination after discussing appropriate timing of immunization with your PCP discuss pneumococcal vaccine with PCP and have the vaccination as recommended. avoid crowded public areas during flu seasons if you have mobility problem, cough, turn, move about as much as possible, perform deep breathing exercises. if you are using resp equipment at home, clean equipment as you have been instructed by manufacturer. avoid indoor pollutants such as dust, second hand smoke, aerosols if you don't smoke, vape, use tobacco in any form, do not start if you smoke, vape, seek professional help on how to stop or at least decrease your habit. get enough rest and sleep on daily basis. eat healthy, balanced diet drink at least 3L (quarts) of nonalcoholic fluids each day (unless fluid restrictions are needed bc of another health problem)

TONIC-CLONIC

last about 2-5 minutes begins with a tonic phase that causes stiffening or rigidity of the muscles, particularly of the arms and legs, and immediate loss of consciousness. clonic or rhythmic jerking (clonus) of all extremities follow. the pt may bite his tongue and become incontinent of urine or feces. fatigue, acute confusion, and lethargy may last up to an hour after seizure

CBC-alcohol use disorder systemic effects

leukopenia- when liver is damaged, alcoholism may cause low WBC due to diatomic deficiencies and low protein intake. indicates infection and disease. symptoms: peridontitis, gingivitis, fatigue, weakness, fever, ab pain. improved nutrition and alcohol cessation are indicated for this condition. thrombocytopenia- complication of liver cirrhosis, low platelet count. symptoms: excessive bruising (purpura), petechiae(lower legs), prolonged bleeding from cuts. platelet count begins to rise within 2-5days of abstaining from alcohol.

major objective in medical management of acute LTB

maintaining airway and providing for adequate respiratory exchange

cancer-alcohol use disorder systemic effects

major risk factor for head and neck cancers esp head and neck, esophagus, oral cavity, pharynx, larynx. alcohol use- liver, breast, colorectal cancers.

Pharmacologic Interventions—Strep

make sure not allergic good in 24 hours. can go back to school, considered uncontagious Penicillin Oral -Needs 10-day treatment to decrease risk of rheumatic fever and glomerulonephritis post strep -Issues with medication compliance IM: Penicillin G (if don think they will be compliant with oral dose) NEVER IV!! -Resolves compliance issue (one injection) -Painful injection -Penicillin G procaine is less painful injection -CANNOT give penicillin G by IV route Erythromycin (azithromycin, clarithromycin) if penicillin allergy Other antibiotics (oral cephalosporins, clindamycin, amoxicillin with clavulanic acid

Disulfiram (Antabuse)

makes drinking painful. uses: maintenance, relapse prevention, aversion therapy. implications: physical effects when alcohol is used. intense nausea and vomiting, headache, diaphoresis, flushed skin, dyspnea, confusion. avoid all alcohol and sub such as cough syrup ad mouthwash containing alcohol.

nursing care if children

mandatory reporting- record and obtain info protect the child- make sure removing from situation. support the child- not treating child as victim. support the family plan for discharge: if going to foster care, may not be easy to leave. let them feel how they feel. make sure they understand process and why can't return home. foster family should visit while child is in the hospital first.

Recurrent infections: OM

may be given another round of antibiotics. Tympanostomy tube placement (stays in 6 months- 1 year, will come (fall) out.) multiple ear infections (more than 2). show parent what it looks like, so when it comes out and know it is normal (still notify provider). may do it again years later if it didn't work or was not successful. helps with fluid build up. adenoidectomy (avoid water in ear) avoid contaminated water into ear (lake, river). cotton balls while bathing.

complex partial

may cause loss of consciousness (syncope) or black out for 1-3 minutes. characteristic automatisms may occur in absence seizures. the pt is unaware of the environment and may wander at the start of the seizure. in the period after the seizure, he or she may have amnesia because the area of the brain affected is the is the temporal lobe, complex seizures are often called psychomotor seizures or temporal seizures.

asthma

may meet pt with any of the symptoms. mild- coughing, wheezing not all time, able to do activities moderate- wheezing, sob walking to car, using inhaler some more severe- sob at rest. wheezing more. can't do any activities. one sentence catching their breathe life threatening- can't say one word.

mother

may need info about discontinuation of lactation if was breastfeeding

acceptable vital signs for adults pulse OX

more than or equal to 95%

bronchiolitis

most common infectious disease of lower airways maximum obstruction impact at bronchiolar level usually kids 2-12months old; rare after 2 years old peak:6 months old causes: viruses, RSV symptoms: labored resp, poor feeding, cough, tachypnea, retractions and flaring nares, increased nasal mucus, wheezing, may have fever treatment: supplemental oxygen if o2 sat less than or equal to 90%; bronchodilators (optional); suction nasopharynx; ensure adequate fluid intake; maintain adequate oxygenation

LTB: Home Care for Mild (no stridor at rest)

nasal congestion: Cool air mist to soothes inflamed mucosal lining and reduce respiratory discomfort, IF doesn't have humidifier: in room with steam (shower area, but not in shower), drive around with windows down, open fridge for cool air, taking them outside at night, taking to basement or garage. Nasal saline drops OTC Suctioning of the nasal passage with bulb syringes (before feedings and at bedtime) Treat fever and pain- ibuprofen and Tylenol (according to weight) Encourage fluid intake to prevent dehydration (baby won't take normal intake, tell parents this) Oral steroids (dexamethasone)- help with inflam. process, IV or IM may be given to kids who are unable to tolerate oral dosing. monitor for dehydration and respiratory depression. encourage fun stuff: star shaped jello, popsicles

TB drugs

need to be compliant (can get people to monitor and give meds) teach liver affected. AST/LST elevated. risk for bleeding yellow changes of skin. avoid alcohol.

Key Features of Anaphylaxis clinical criteria 2 (don't need to memorize)

onset within minutes to hours of two or more of these symptoms after a pt has been exposed to potential allergen: - skin or mucous membranes problems involving swollen lips, tongue, soft palate, uvula, wide spread hives, pruritus, flushing -resp distress or ineffectiveness as evidenced by dyspnea, bronchospasm, wheezes, stridor, hypoxia, cyanosis, peak expiratory rate flow lower than the pts usual -hypotension or any indication of reduced perfusion resulting in organ dysfunction such as loss of consciousness, incontinence, hypotonia, or absent deep tendon reflexes - persistent GI probs such as nausea, vomiting, cramping, ab pain

substance abuse

opioid use disorder: heroin. chronic relapsing disorder. difficult impairments, alter life, bad situations. hallucinogens: synthetic or manmade(mushroom, plants) psychosis, hallucinations, mood/anxiety disorders, flashbacks

Ally, a 3-year-old girl, comes into the provider's office with complaints of ear pain, a low-grade fever of 37.2° C (99° F), irritability, rhinitis, cough, difficulty sleeping, and poor appetite over the past 3 days. On inspection, the provider notes a bulging, reddened, tympanic membrane.

otitis media- bulging, redden, tympanic membrane ear pain

Normal ABG Values

pH 7.35-7.45 PaO2 (oxygen) 80-100 mmHg PCO2 (carbon dioxide) 35-45 mmHg HCO3 (bicarb) 22-26 meQ/L SaO2 (O2 sat) 95-100%

C.J.'s condition stabilizes, and she is admitted to the respiratory unit. She is ordered to receive albuterol nebulization treatments q2hr and prn, methylprednisolone 60 mg IV q6hr, and oxygen per nasal cannula at 4 L/min. Arterial blood gases are drawn on O2 at 4 L/min 1 hour after she is admitted. The results are pH 7.36, PaO2 70 mm Hg, PaCO2 44 mm Hg, HCO3 24 mEq/L, SaO2 92%. Based on these results, you should?

pa02-70 hypoxia fix problem monitor her pulse ox, giving meds (steroids; albuterol q6hrs) status asthmaticus

uncompensated

paco2 or hco3 in range, only one of these can be normal. other is abnormal.

pancreas-alcohol use disorder systemic effects

pancreatitis: prolonged and hazardous drinking may result in pancreatic damage. excessive drinking usually more than 5 years result in acute attach of pancreatitis (abdominal pain, nausea, vomiting). withdrawal in the early stages will reverse the condition. chronic condition results in malnutrition, weight loss, diabetes. withdrawal of alcohol in chronic condition may reduce inflammatory episodes and allow for better control of diabetes.

common presenting problems of victim of abuse (book): ambulatory care settings

perforated eardrum, twisted or stiff neck, shoulder muscles, headache depression, stress related conditions (insomnia, violent nightmares, anxiety, extreme fatigue, eczema, loss of hair) talk of having problems with husband or son, describing person as jealous impulsive or alcohol/substance abuse user repeated visits with new complaints bruises of various ages and specific shapes (fingers, belt)

Neurological- alcohol use disorder systemic effects

peripheral neuropathy: chronic alcoholism leads to nutritional deficiencies (thiamine), pins and needles in the lower extremities are a common symptom of peripheral neuropathy; other symptoms include numbness, muscle weakness, sensitivity to touch, and burning, discontinuation of alcohol will prevent further deterioration. alcoholic neuropathy: binge drinking may cause sudden acute alcoholic myopathy with muscle weakness and myonecrosis. chronic alcohol myopathy gradually develops, recovery is possible if alcohol is avoided but the time of recovery varies from rapid (days to weeks) with the acute form to lengthy (weeks to months) with chronic form.

fully compensated

ph in range. others not.

ASSESSMENT FOR OLDER ADULT ABUSE

physical/nonverbal signs: chronic pain, insomnia, hyperventilation, gynecological problems. signs of neglect: Poor hygiene, breakdown of skin, malnutrition, dehydration, underdosing or overdosing of medications. home assessment can tell you a lot. observe interaction with caregiver: we can ask info. do: conduct interview in private, be direct honest and professional, use language pt understands, ask pt to clarify words not understood, be understanding and attentive, inform pt if u must make referral to children's or adult protective services and explain process, assess safety and help reduce ganger at discharge don't: try to prove abuse by accusations or demands, display horror shock anger of the perpetrator or situation, place blame and make judgments, allow pt to feel at fault or in trouble, probe or press for answers the pt is not willing to give, conduct the interview with a group of interviewers.

Respiratory depression

starts with nasal flaring, intercostal retractions, tachypnea (breathing faster than should be), hypoxia, head bobbing

Care and Use of Automatic Epinephrine Injectors (book)

practice assembly of injection device with a non-drug containing training device provided thru the injection device manufacturer keep device with you at all times when needed, inject the drug into the top of your thigh, slightly to the outside, holding the device so needle enters straight down. you can inject right thru pants, avoid seams and pockets where fabric is thicker. use device when any symptom of anaphylaxis is present and before you call 911. it is better to use the drug when it is not needed than to not use it when it is needed whenever you need to use the device, get to the nearest hospital for monitoring for at least the next 4-6 hours. have at least 2 drug filed devices on hand incase more than one dose is needed protect the device from light and avoid temperature extremes carry device in case provided keep safety cap in place until you are ready to use the device. check for: expiration date if close to expiring or has expired obtain a replacement. drug clarity if drug discolored obtain replacement. security of cap if loose or accidentally comes off obtain replacement.

allergic to penicillin

probably allergic to cephalosporins

Adults with PTSD What medications are appropriate for Allen?

probably already have bc of PTSD history. SSRIs: 1st line drugs zoloft paxil nardil

skin Type 1

pruiritis angioedema erythema urticaria

SURGICAL MANAGEMENT:VAGAL NERVE STIMULATION

pt's who cannot be managed effectively with drug therapy may be candidates. VNS has been successful for its with epilepsy and is sometimes referred to as the pace maker for the Brain.VNS may be performed for control of continuous simple or complex partial seizures. pts with generalized seizures are not candidates for surgery bc VNS may result in severe neurological deficits. the procedure takes 2 hours with pt under general anesthesia. the stimulator is activated by a doctor 2 weeks after surgery. observe for complications after the procedure such as hoarseness, cough, dyspnea, neck pain, or dysphagia. teach pt to avoid MRIs, microwaves, shortwave radios, ultrasound diathermy (physical therapy heat treatment)

Because of her age and altered mentation, the health care provider admits her to the hospital for treatment. On admission, D.T. has bronchial breath sounds with diminished sounds of the left lower lobe; O2 saturation is 87%. uWhat is your priority of care for D.T.?

put her on oxygen start low go high supportive care- fever,

otitis media color indicator

reddish, orange, yellow.

inflammatory process

redness, change in color, swelling, pain, discomfort, clear exudate

simple partial

remains conscious throughout the episode. reports an aura before the seizure takes place. this may consist of deja vu, perception of an offensive smell, or sudden onset of pain. during the seizure, the pt may have one sided movement of an extremity, experience unusual sensations, or have autonomic symptoms/ autonomic changes include a change in heart rate, skin flushing, and epigastric discomfort.

angioedema management

requires at least a brief hospitalization

Laboratory Assessment copd

resp acidosis- ABG values (hypoxemia and hypercapnia) Sputum samples- for acute resp infection. treated on the basis of symptoms and common bacterial organisms in the community. CBC- helps confirm presence of infection. Hemoglobin and hematocrit- determine polycythemia Serum electrolytes- examined bc acidosis can change electrolyte values. not getting in foods and nutrients they need. Chest x-ray- rules out other lung diseases and to check progress of pts with resp infections or chronic disease. with hyperinflation with widely spaced robes and flattened diaphragm. anatomy of obstruction and pneumonia. Pulmonary function test- airflow rates and lung volume measurements help distinguish airway disease(obstructive diseases) from interstitial lung disease.

Acamprosate (Campral)

restores the chemical balance in the alcoholic brain uses: relapse prevention- implications: begin taking on the 5th day of abstinence from alcohol. tablets are taken 3 times a day. side effects- diarrhea, gi upset, appetite loss, dizziness, anxiety, difficulty sleeping. contraindicated to renal impairment pts.

clonic phase

rhythmic jerking of all extremities follows.the pt may bite his tongue and become incontinent of urine or feces. 30-40 seconds. cyanosis (resolves on its own), saliva production (drool).

antihistamines (diphenhydramine) for anaphylaxis

second line drugs and given IV or IM for angioedema or urticaria.

asthma teaching

sending home: avoid smoking, smoke. teach ab locations what they're high risk for. teach ab short acting bronchodilators prior to, or do inside exercise when cold. different meds for pain and aching teach coping mechanisms teach sitting elevated with pillows no food/drink 3 hours before bedtime

RSV admitted pts

separate room or grouped with other RSV kids. contact/standard precautions, some institutes do droplet precautions as well. proper handwashing isolation procedures nurses caring for RSV patient should not be assigned to other kids. nurse avoid touching nasal mucosa or conjunctiva.

C.J., a 20-year-old female college student, is admitted to the emergency department (ED) with a severe asthma attack after engaging in a tennis match. She is accompanied by her tennis partner, who drove her to the ED. On an initial assessment you see that she is sitting in an upright position, using her accessory muscles to breathe. She appears restless and anxious. Her vital signs are T 98.4°F (36.9°C), HR 128 beats/min, R 34/min, BP 160/82. Auscultation indicates faint wheezing on inspiration and expiration, and her expirations are prolonged. Hyperresonance is noted upon percussion. C.J. manages to tell you that she has a long history of asthma but that this is the worst attack she has ever experienced. She cannot identify any triggers that she may be sensitive to and has never been tested for allergens. She does not smoke or use alcohol. She had been using a bronchodilator metered-dose inhaler about once a day but has misplaced it. She also has a peak flow meter but has never used it.

severe- respirations and HR elevated. retractions. hypoxia. trigger- exercise induced - didn't have bronchodilator bc misplaced - how was the environment and weather

autoimmune disorders

should get vaccine before other people because at risk for infections. NO live vaccines have to be in well condition. no type of exacerbation pt has concern, direct to physician.

A 62-year-old woman is in the emergency department (ED) and is being treated for pneumonia. Cefazolin sodium, 2 g, is ordered to be given intravenous piggyback (IVPB) every 8 hours for 24 hours. She needs to receive her first dose in the ED. The nurse assesses for allergies, and the patient reports "no known drug allergies" (NKDA). Vital signs: BP 136/84, P 88, R 12, T 98.8° F. uThirty minutes after the medication was started, the patient calls the nurse and reports "itching all over" and difficulty breathing. The nurse notes facial edema and audible wheezing. The patient's skin is red with large, swollen blotches over her arms, trunk, and back. Her systolic blood pressure is 118/78, pulse 108, and respirations 24. The IVPB antibiotic bag has infused about three-fourths of the dose. 1.What is the first action by the nurse? 2.What medications and by what route should the nurse expect the provider to prescribe? 3.What reassessment would you do to see if the treatment is therapeutic?

stop what's causing the problem get airway and call rapid response team

common cold

stuffy nose. can give vaccine... UNLESS a lot of disease processes and come with common cold, may want to wait.

status epilepticus common causes

sudden withdrawal from antiepileptic drugs, infection, acute alcohol or drug withdrawal, head trauma, cerebral edema, metabolic disturbances. if you miss first dose, take it then wait 4 hours for the second dose.

Bronchiolitis and RSV: take action

supportive care because viral,may have to be supported in ICU. *no antibiotics* *NO chest physiology anymore* Oxygen to maintain above 90% Hi flow oxygen (Vapotherm): heat, warmth for humidity. Fluid intake by IV versus small sips- mobilize secretions. Nasal suctioning(bulb syringe) Nasopharyngeal not as much (could puncture lungs so not advised every 4 hours, but can be done) Admission for respiratory distress or dehydration poor feeder bc can't breathe- 5-10ml whatever we can get in (fluids) using med syringe every 10 minutes *Prevention of RSV: premature and high risk; hand washing, droplet and contact isolation* nasogastric fluids- if can't tolerate oral fluids and IV hard to establish monitor pulse ox and iv/ng fluids, monitor for fever

viral

supportive care. NO antibiotics can lead to more bacterial infections (ex. person with covid have pneumonia)

myringotomy

surgical incision of ear drum, may be necessary for sever pain. drain infected middle ear

Respiratory Alterations

sweating- clammy skin, nasal flaring, retractions, tensed stomach muscles, blue-gray tone under eyes and around lips.

blood pressure

systolic <120 mm hg diastolic <80 mm hg pulse pressure: 30 to 50 mm hg

Asthma: Nursing Assessment (Noticing) Cardiovascular

tachycardia

Asthma Action Plan

tailored to meet the patient's personal triggers, asthma symptoms, drug responses. - the prescribed daily controller drug schedule and prescribed reliever drug directions - patient specific daily asthma control assessment questions - directions for adjusting the daily controller drug schedule - when to contact the primary health care provider (in addition to regularly scheduled visits) - emergency actions to take when asthma is not responding to controller and reliever drugs. teach patients to keep a symptom and intervention diary to learn specific triggers of asthma, early cues for impending attacks, and personal response to drugs. stress importance of proper use of his or her personal asthma action plan for any severity of asthma.

prevention and early intervention critical for Anaphylaxis

teach pt with a history of allergic reactions to avoid known allergens whenever possible, wear medical alert bracelet, and to alert health care personnel about specific allergies. carry bee sting kit.

Acute battering stage

tension becomes unbearable. the victim may provoke an incident to get it over with. the victim may try to cover up injury or may look for help.

ATONIC

the pt has a sudden loss of muscle tone, lasting for seconds, followed by postictal (after the seizure) confusion. in most cases, these seizures cause the pt to fall, which may result in injury. this type of seizure tends to be most resistant to drug therapy.

point of criteria

to distinguish anaphylaxis from angioedema

causes of seizures

tumor, stroke, metabolic disorders, acute alcohol withdrawal, heart disorder. can be seizure free once treated.

Sudden Infant Death Syndrome: Prevention

use firm sleep surface, such as a mattress in a safety approved crib covered by a fitted sheet. do not use pillows, blankets, sheepskins, or crib bumpers anywhere in your babies sleep area keep soft objects, toys, loose bedding out of your babies sleep area do not smoke or let anyone smoke around your baby make sure nothing covers your babies head always place your baby on his or her back to sleep, for naps and at night dress your baby in light sleep clothing, such as one piece sleeper and do not use a blanket. baby should not sleep in adult bed, on a couch, or on a chair alone, with you, or with anyone else. teach before having child. immunizations, no smoking

red zone

very SOB or quick relief med have not helped. cannot do usual activities or symptoms are same or worse after 24 hours in yellow zone. take this med quick relief number of puffs for nebulizer oral steroid mg then call doctor now. go to hospital or call ambulance if: still in red after 15 min and you have not reached your doctor.

Rifampin for TB

warn pts to expect an orange reddish staining of skin and urine and all other secretions; also soft contact lenses will become permanently stained instruct sexually active women using oral contraceptives to use additional method while taking this drug and for 1 month after stopping. remind pt to avoid alcohol beverages. tell pt to report darkening of urine, a yellow appearance to skin or whites of eyes and increased tendency to bruise or bleed. signs of liver toxicity or failure. ask pt about all other drug in use.

prevention flu

washing hands frequently staying home from school,work use tissue when sneezing,coughing dispose tissue properly social distancing sneeze in upper sleeve rather than hand

COPD appearance

with severe COPD: thin, with loss of muscle mass in the extremities although neck may be enlarged. slow moving or stooped orthopedic or tripod position(sitting forward, arms held forward) dyspnea becomes severe, activity intolerance (may be so great that bathing and general grooming are neglected) changes in chest size and fatigue. rapid shallow respirations and may have abnormal breathing pattern use accessory muscles:abdomen/neck acute exacerbation- resp rate high as 40-50b/m and requires immediate med attention resp movement is jerky and appears uncoordinated wheezing barrel chest chronic bronchitis- cyanotic or blue tinged dusky appearance excessive sputum prod. swelling of feet and ankles late stage emphysema- pallor or cyanosis, underweight

Clinical Institute Withdrawal Assessment (CIWA-Ar)

withdrawal from alcohol. treat based on score. 8 or more: requires intervention from us; start something PRN med. reassess within next hour and fill out again. 0-7: we're fine