Safety & Infection Control (427-453)

Accident Prevention: 2 Mos & 4 Mos & 6 Mos & 9 Mos

-2 MOS: don't hold infant while smoking or drinking hot liquid. set water heated at 120-130F. test bath water temp w/ inner aspect of wrist before immersing infant. -4 MOS: keep small objects out of infant's reach. don't use teething biscuits. teach older sibs not to give small things. -6 MOS: child-proof home, esp kitchen & broom. use safety gates, drawer safety latches, plug filters. keep poison control # on phone. -9 MOS: use nonskid rugs, socks w/ nonskid strips. keep wastebaskets covered. pad sharp edges. never lead unattended near water. don't use electrical appliances near water.

Accident Prevention: 3-6, 6-11

-3-6: Use helmet. feet should touch the ground when sitting on bike seat. don't eat things from outside (mushrooms). look both ways. if ht or wt above forward-facing limit, use belt-positioning booster seat until seat belt fits properly. -6-11: obey traffic signals on bike. refelctors. light clothing. look for sports team divided by size and maturation not age. use protective equip.

Hepatitis Diagnosis

-Acute inflammatory disease of liver resulting in cell damage from liver cell degeneration and necrosis. -Nursing dx: fatigue, impaired phys mobility, impaired liver func, acute pain, deficient knowledge,

Accident Prevention: Ado/Adult

-Ado: teach appropriate ways to deal w/ anger and threats. safety for swimming & diving. seat belts. hazards of drinking & driving. -adult: seat belts. responsible behavior r/t STIs & alcohol related accidents. suicide prevention. handgun control & safety. motorcycle helmet use. smoke and CO detector use. fire extinguisher use.

Accident Prevention: Elderly

-At risk for injuries: muscle weakness, changes in balance, gait abnormalities, slowed reaction time, use of meds, chronic medical conds (parkinsons). changes in vision, hearing smelling -remove throw rugs, door thresholds. smooth/nonslip floors. clear pathways of furniture. solid chair w/ armrest -good lighting. raised toiler. grab bar. cordless phone.

Emergency Care for client w/ poisoning

-BLS: resp - intubate if comotose, seizing or no gag reflex. freq blood gases. circulation - IV fluids. maintain F&E balance. cardiac mon - essential for comotose child and w/ tricyclic antidepressant or phenothiazine ingestion. -gastric lavage & aspiration: client intubated, positioned head down and on left side. large oro/nasoGT inserted & repeated irrigations of NS instilled until clear. not more than 10ml/kg. must be done w/n 60 min -Activated charcoal: absorbs compounds, forming a non-absorbable complex. 5-10 g for each g of toxin. give w/n 30 minutes of ingestion and after emetic. mix w/ water to make a syrup. given PO or via GT. -Hasten elimination: diuretics: for substances eliminated by kidneys. chelation - heavy metals are not readily eliminated by body. progressive build up - toxicity. a chelating agent binds w/ heavy metal, forming a complex that can be elimanted by kidneys, peritoneal hemodyalsis. -prevent recurrence

Lead Tox RX

-Chelating agent - promotes lead excretion in urine & stool (dimercaprol, calcium disodium, disodium, EDTA); succimer, deferoxamine. -maintain hydration -ID sources of lead & institute deleading procedures. -ed about supervising for pica

Hazardous materials causing immediate threat to life: client treated then decontaminated.

-Chlorine -Cyanide -Ammonia -Phosgene -Hydrogen Sulfide -Organophosphate insecticides -nitrogen dioxide -cancer causing potential: client decontaminated then treated: polychlorinated biphenyls.

Accident Prevention: 1-3

-Don't use toys w/ small pieces. supervise near water. -hold hand when walking across street. -encourage child to sit when eating. -secure all meds in locked area. -turn pot handles toward back of stove. -cover all electrical outlets. -use rear-facing car seat until child reaches ht and wt. allowed by car safety seat manufactures. after 2 yrs or has outgrown rear car seat, use forward facing car seat w/ harness as long as possible.

AIDS: C. neofromans - severe debilitating meningitis

-Fever, h/a, blurred vision -n/v -stiff neck, mental status changes, seizures

Acetaminophen Poisoning ASMT

-First 2 hours: n/v, sweating, pallor, hypothermia, slow-weak pulse. -latent period (1-1.5 days) when sx abate -if no rx - hepatic involvement occurs (may last up to 1 wk) w/ RUQ pain, jaundice, confusion, stupor, coagulation abnormalities -dx tests: serum acetaminophen levels at least 4 hrs after ingestion. liver funct tests & kidney func (change is a late sign) -diagnosis: tox begins at 150mg/kg. major risk is hepatic necrosis

Hepatitis: Plan/Implementation

-Frequent rest periods. contact precautions if diapers or incontinent. If Hep A contact precautions. everyone else - standard precautions. -diet: low in fact, high cals, carbs, protein. no alcohol -For pruritis: calamine, shore clean nails, antihistamines -meds: Vit K, Antivirals (interferon & Lamivudine). post exposure Hep B vaccine -Teaching: avoid alcohol and potentially hepatotoxic prescription (aspirin, sedatives). balance rest & activity. techniques to prevent spread. cannot donate blood! note and report recurrence of s/sx.

AIDS: P. jiroveci (P. carinii) Pneomnia

-Gradually worsening chest tightness & SOB -Persistent dry nonproductive cough, rales -Dyspnea & Tachypnea -Low grade/high fever -Progressive hypoxemia & cyanosis

Hep E

-High risk: persons living in underdeveloped countries -inc: 15-64 days -trans: oral-fecal contaminated water -resembles hep A. does not become chronic. usually seen in young adults. seen in travelers from Asia, Africa, Mexico

Acetaminophen poisoning Planning/Implementation

-Induce vomiting -N-Acetylcysteine - specific antidote. most effective in 8-10 hours. must be given w/n 24 hrs. given PO q 4 hrs x 72 hrs or IV for 3 doses. -maintain hydration, monitor output -monitor livery & kidney function

Aspirin Planning/Implementation

-Induce vomiting. initiate gastric lavage w/ activated char -mon VS and labs -maintain IV hydration & electrolyte replacement. mon I&O, skin turgor, fontanels, urine SG -reduce temp, tepid water baths or hypothermia blankets; prone to seizures -Vitamin K if needed for bleeding disorder. quaiac of vomitus/stools. -IV sodium bicarb enhances excretion

Lead Toxicity Symptoms (plumbism)

-Irritability, sleepiness, n/v, and pain, poor app, constipation, dec activity, inc ICP (seizures, motor dysfunction) -env: flaking, lead-based paint (primary source). crumbling plaster, odor of lead-based gasoline, pottery w/ lead glaze, lead solder in pipes -dx tests: Blood lead level less than or equal to 9mcg/dL is normal. check erythrocyte protoporhyrin (EP) level. CBC - anemia. X-rays (long bone/GI): may show radiopaque material, "lead lines".

TB Diagnose

-Mycobacterium tuberculosis. acid-fast gram-positive bacillus transmitted by airborne droplets. bacillus multiplies in bronchi or alveloi = pneomonitis. may lie dormant for many years and be reactivated in periods of stress -RF; close contact w/ TB. immunocomp. IV drug abuser. persons who live in institutions. lower SES. immigrants from countries w/ high prevalence (Latin American, Southeast Asia, Africa) -incidence increasing in immigrant populations, poverty areas, elderly, alcoholics, drug abusers, persons w/ AIDS

Hazardous Materials

-OSHA mandates acceptable levels of exposure to chemicals. -dose: amt of substance inhaled, ingested, absorbed thru skin/eyes -when there's a prob during transportation of chemical materials, info is provided from a central source, advises rescue & health care workers about the substance, its effect, and how to treat the exposure.

AIDS: Dx tests/precautions

-Positive HIV antibody on enzyme-linked immunosorbent assay (ELISA) and confirmed by Western blot assay or indirect immunoflourescence assay (IFA). Viral Load Testing (CD4 to CD8 ratio, antigen assays). RIPA. CBC reveals luekopenia w/ serious lymphopenia, anemia, thrombocytopenia. -avoid IV drug use (needle-sharing) -precautions regarding sexual patterns (sex ed, condoms, avoid multiple partners). use standard precautions.

Lyme Plan/Implementation

-Prevention: cover exposed areas in wooded areas. check. -Nursing: give abx for 3-4 wks: doxycycline, ceftriazone, azithromycin during stage 1. administed IV PCN during later stages.

Scarlet Fever 2-4 days

-Prodromal: high fever w/ vomiting, chills, malaise, followed by enlarged tonsils covered w/ exudate, strawberry tongue. -sx: rash (red tiny lesions - generalized then desquamate. rash appears w/n 24 hrs. -group A beta-hemolytic streptococci. -droplet precautions for 24 hrs after start of antibx -ensure compliance w/ antibx. bedrest during febrile phase. analgesics for sore throat. encourage fluids, soft diet. administer penicillin or erythromycin.

Chickenpox (Varicella). incubation 13-17 days.

-Prodromal: slight fever, malaise, anorexia -Pruritic rash: macule then papule, then vesicle. lymphadenopathy, inc temp -Airborne precautions. direct contact. contaminated object -isolation until all vesicles crusted. communicable from 2 days before rash. -avoid aspirin (reye's). use Tylenol. -Calamine lotion/baking soda baths for itching

Pertussis (whooping cough). 5-21 days. usually 10.

-Prodromal: upper resp infection for 1-2 wks -sx: severe cough w/ high-pitched whooping sound, esp at night. lasts 4-6 wks. vomiting. -transmission: direct contact, droplet, contaminated articles. -hospitalization for infants, bedrest. hydration. -comp: pneumonia, wt. loss, dehydration, hemorrhage, hernia, airway obstruction. -maintain high humidity, rest. suction, oxygen. -Erthromycin & pertussis immune globulin

Anthrax Cuteaneous

-SX: 1-7 days: itching w/ small papule or vesicle. 2 days after lesion formation: enlarged painless lesion w/ necrotic center. 7-10 days after lesion formation: black eschar forms. sloughs after 12th day. -trans: Skin contact 1-7 days. no person-person trans. high risk: exposure to animal hides, vets, personnel who handle contam materials, military -Standard precautions. but wear gloves, gown and resp protection when decontaminating. decontam surfaces w/ bleach (one-part household bleach to 9-parts water). administer oral fluoroquinolones for post-exposure prophylaxis. administer doxy, erythomycin, and cipro

Syphilis

-Stage 1: painless chancre. disappears w/n 4 wks -stage 2: copper-colored rash on palms/soles. low grade fever. -Stage 3: cardiac & CNS dysfunction -dx: VDRL, RPR, FTA-ABS, MHA-TP -trans: mucous membrane or skin; congenital; kissing; sexual contact. 10-90 days -rx: PCN G IM. or erthyomycin for 10-15 days. ceftriazone & tetracyclines for non pregnant females. retest for cure. abstinence until rx complete. reportable dz

Lyme ASMT

-Stage 1: rash develops w/n 2-30 days. concentric ring. bulls eye. lesion enlarges quickly. regional lymphadenopathy. flu like sx (Malaise, fever, h/a, myalgia, stiff neck, arthralgia, conjunctivitis) w/n one to several mos. lasts 7-10 days and may reoccur -Stage 2: develops w/n 1-6 mos if untreated. cardiac conduction defects. neuro disorder: facial paralysis, not permanent. -Stage 3: arthralgias, enlarged/inflamed joints occur w/n one to several mos after initial infection. chronic fatigue, cognitive disorders. may persist for several years.

Aspirin Poisoning SX

-Tinnitus, nausea, sweating, dizziness, h/a -change in mental status -inc temp, hyperventilation (resp alkalosis) -later, metabolic acidosis, and resp acidosis, bleeding, and hypovolemia

Aspirin poisoning diagnosis

-Toxicity begins at doses of 150-200 mg/kg; 4 grams may be fatal to a child. -altered acid-base balance (resp alk) d/t inc RR -inc metabolism causes greater O2 consumption, CO2 & heat production -met acidosis results in hypokalemia, dehydration, and kidney failure. -may result in dec prothrombin formation & dec platelet aggregation, causing bleeding.

AIDS: Candida Albicans stomatitis or esophagitis

-changes in taste sensation. -difficulty swallowing -retrosternal pain -white exudate & inflammation of mouth & back of throat

Accident Prevention: Newborn

-dont smoke. inc risk of URTI -don't leave unattended in high place or strapped unsafely -use rear-facing car seat -furniture - free of lead based paint -crib slats should be no further apart then 2 3/8 inch. tight fitting mattress and bumper pads. -on back after eating & for sleeping

DROPLET PRECAUTIONS

-droplets larger than 5 microns -involves contact of conjunctiva or mucous membranes of nose/mouth. coughing, sneezing, talking, suctioning -Private room or client w/ same infetion. -wear mask if in close contact -maintain 3 ft separation. door can remain open. -mask on client if being transported. -Diptheria, phemonia, memningitis, H. INfluenza type B, mumps, pertussis

AIDS - CMV - significant factor in morbidity & mortality

-fever, malaise -wt. loss, fatigue -lymphadenopathy -retinochoroiditis characterized by inf & hemorrhage -visual impairment -colitis, encephalitis, pneumonitis -adrenalitis, hepatitis, disseminated infection

Tonsillitis (streptococcal)

-fever, white exudate on tonsils. -positive culture GpA strep -antibx -teach parents serious potential comps: rheumatic fever, glomerulonephritis.

Delta or Hep D (HDV)

-high risk: drug addicts, concurrent HBV infection -inc: 15-46 days -trans: co-infets w/ hep B. closer personal contact. parenteral transmission. -dx test: HD Ag in serum

Toxic Hepatitis

-high risk: elderly, drug-induced (INH, diuretics, tetracylcine, carbon tetachloride, Tylenol, ETOH). Alcohol -trans: noninfectious inflammation of liver -removal of causitive substance. check LOC. encourage fluids.

Hep B (HBV)

-high risk: immigrants from areas of HBV endemicity. drug addicts, fetuses from infected mom. homosexual men. client on dialysis. male prisoners. transfusion recipients. health care workers -inc: 48-180 days -trans: blood & bodily fluids. parenteral drug abuse. sexual contact. hemodialysis. accidental contaminated needle exposure. maternal-fetal route -dx: hep b surface antigen, anti-HBc, anti-HBe -rx: hep B vaccine (deptavax0B, Recombivax HB) -Hep B immune globulin (HBiG) postexposure. interferon alpha - 2b; lamivudir -chronic carriers: freq potential for chronicity 5-10% -comp: cirrhosis, liver cancer

Hep C (HCV)

-high risk: persons receiving freq blood transfusions, international travelers, hemophilia clients -inc: 14-180 days -trans: contact w/ blood & bodily fluids. IV drug users -may be asx. -comp: liver cancer, cirrhosis. -great potential for chronicity

Hep A (HAV)

-high risk: young children, institutions, international travelers to developing countries -inc: 15-50 days -trans: common in fall, early winter. fecal-oral. shellfish from contaminated water. poor sanitation. contaminated food handlers. oral-anal sexual activity -survives on hands. dx: culture stool and detected in serum before onset of dz. prevention - improved sanitation, hep A vaccine. -treated w/ gamma globulin early post exposure. n -no preparation of food.

AIDS High Risk Groups

-homosexual/bisexual men, esp w/ multiple partners -IV drug abusers -Hemophiliacs via contaminated blood products -blood transfusion recipients prior to 1985. -heterosexual partners of infected persons -children of infected women/in utero or at birth

Mantoux Test (PPD)

-intradermally in the forearm. -read in 48-72 hours. measure induration ( palpable, hardened palpation) -results: >15mm = positive for person w/ no RF. does not mean disease is active, just indicates exposure. -10-14.9 mm: induration for clients @ risk (recent immigrants, injection drug users, children less than 4) -3.5-9.9mm: clients w/ AIDS, immunocompromised, transplant clients.

Mono 4-6 wks

-malaise, fever, enlarged lymph nodes, sore throat, flulike aches, low-grade temp. -highest incidence: 15-30 yrs old -advise fam to avoid contact w/ saliva (cups, silverware) for 3 mos. -rx: rest, good nutrition. avoid strenuous exercise (prevent splenic rupture) -comps: encephalitis, spleen rupture.

Mumps 14-21 days

-malaise, h/a, fever, parotid gland swelling, -isolation before & after appearance of swelling -soft, bland diet -comps: deafness, meningitis, encephalitis, sterility.

Chlamydia

-men: dysuria, freq urination, watery discharge -women- may be asx. thick discharge w/ acrid odor, pelvic pain, yellow discharge. painful menses -dx: direct exam of cells. enzyme linked ELISA -trans: MM, sexual contact. 1-3 wks. -notify contacts. may cause sterility. rx w/ azithromycin, doxy, erthyomycin

Lyme Diagnose

-multisystem infection transmitted to humans by tick bite. -most common in summer mos

CONTACT PRECAUTIONS

-needed w/ client care activities that require skin-skin contact (turning, bathing) -private room or someone w/ same infection. -clean, non-sterile gloves for client contact. -wear gown when entering room if clothing will have contact with client, env surfaces, or if client is incontinent, has diarrhea, ileostomy, colostomy, or wound drainage -MRSA, herpes, herpes zoster, C diff, RSV, pediculosis, scabies, rotavirus, hepatitis A

AIDS Nursing Care

-no cure. antiviral agents (zidovudine, aciclovir) -rx specific to presenting cond (kaposi sarcoma - local radiation, single agent/combo chemo. fungal inf: nystatin & swallow, amphotercin B w/ or w/o flucytosine. viral: acyclovir, ganciclovir) -contact precautions in addition to standard -nutrition: high protein, high cals -maintain confidentiality! comfort measures. provide support. minimize social isolation.

Genital Herpes (HSV-2:

-painful vesicular genital lesions. difficulty voiding. recurrence in times of stress, infection, menses. -dx: direct exam of cells. HSV antibodies -trans: mucous membranes or skin. congenital. virus can survive on towels. 3-14 days. -rx: Acyclovir (not cure). sitz bath. emotional support. local meds. client must notify sexual contacts. mon pap smears on regular basis (inc incidence of cervical CA). precautions about vaginal delivery.

AIRBORNE PRECAUTIONS

-pathogens smaller than 5 microns. -private room w/ neg air pressure (6-12 air changes per house). N-95 HEPA filter. TB - wear fit-test resp mask -no other client w/ diff organism in room -place mask on client if being transported. -Measles (rubeloa), TB, Varicella, Shingles

Rubeola 10-20 days

-prodromal: fever/malaise then cough & Koplik's spots on buccal mucosa. -sx: erythematous maculopapular rash w/ face 1st affected. turns brown after 3 days when sx subside. -isolation until 5th day. maintain bedrest during 1st 3-4 days. airborne & seizure precautions. -antipyretics, dim lights, humidifier -keep skin clean, maintain hydration.

Rubella (german measles). 14021 days.

-prodromal: none in children. low fever/sore throat in ado -sx: maculopapular rash 1st on face then on rest of body. sx subside first day after rash. -contact precautions & Droplet precautions -isolate from potentially preg women! -comfort: antipyretics & analgesics (no aspirin!) -rare comp: arthritis, encephalitis -risk of fetal deformity (congenital - contact precautions for 1 yr or until child has neg swabs after 3 mos)

Diptheria (2-5 days)

-prodromal: resembles common cold -sx: low-grade fever, hoarsness, malaise, pharyngeal lymphadenitis, white/gray pharyngeal membrane -trans: direct contact w/ carrier, infected client articles -contact & droplet precautions until 2 negative nose & throat cultures -complete bed rest. look for resp. distress/obstruction. humidification, suctioning, trach prn. severe cases lead to sepsis & death. Give antitoxin therapy!

Kaposi's Sarcoma - most common malignancy

-small purplish-brown, nonpainful, nonpruritis palpable lesions occuring on any part of the body. -most common on skin -dx by biopsy

Pneumonic Plague

-sx: 2-4 days after exposure: fever, productive cough, containg infectious particles, chest pain, hemotypsis, bronchopneumonia, rapid shock, death. -trans: aerosolized inhalation, 1-3 days, person-person trans occurs thru large aerosol droplets. -droplets precautions until 72 hrs after abx. place in private room. give abx: streptomycin, cipro, doxy. -decontam: dont agitate clothes.

Anthrax Inhalation

-sx: Initial - sore throat, mild fever, muscle aches, malaise followed by possible brief improvement. 2-3 days later - abrupt onset of resp failure, shock, fever, hemorrhagic meningitis. -trans: aerosolized spores. 1-7 days, up to 60 days. no person-person trans. -standard precautions. vent support if needed. IV and PO cipro & doxy

Botulism

-sx: drooping eyelids, weakened jaw clench, dyshphagia, blurred vision, symmetric descending weakness, 12-72 hrs after exposure resp dysfunction. may cause death. -trans: contaminated food (12-36 hrs). aerosol inhalation (24-72 hrs). no person-person trans. -standard precautions. contact health dept and CDC if suspicion. supportive care.

Bubonic Plague

-sx: fever, h/a, general illness, painful, swollen regional leymph nodes (bubo). develops into septicemia and pneumonic plague. -trans: infected rodent to man by infected fleas. 2-8 days. -standard precautions for rx of bubo. droplet precautions for plague pneumonia. administer abx. apply insecticides to kill fleas and control rat population.

Small Pox

-sx: occur in 10-17 days. fever, myalgia, synchronous onset of rash that is most prominent on face and extremities (palms & soles included). rash scabs over in 1-2 wks. -trans: airborne & droplet exposure. contact w/ skin lesions. client infectious until scabs separate (about 3 wks). -airborne, contact, and standard precautions place in private room w/ door closed. monitored neg air pressure (6-12 air exchanges per hour). -decontam items contam in infectious lesions using contact precautions. single case is considered a public health emergency. if exposed, give vaccine w/n 3 days of contact. vaccine doesnt give lifelong immunity.

Gonorrhea

-sx: thick discharge from vagina or urethra. freq asx in females. if female has sx: purulent discharge, dysuria, dyspareunia. male sx - painful urination, yellow-green discharge -dx: culture of discharge from cervix/urethra. pos results for other STD dx tests -trans: MM or skin, congenital, vaginal, orogenital, anogenital, sexual activity. 2-7 days -IM cefriaxone 1 time and PO doxycillin BID for 1 wk; azithromycin. IM aqueous PCN w/ PO probenecid PO azithromycin or doxy is used to treat chlmaydia which coexists in 45% of cases. spectinomycin if allergy to ceftriaxone. mon for PID

AIDS Diagnosis

-syndrome distinguished by serious deficits in cellular immune function assoc w/ pos HIV virus. evidenced clinically by development of opportunistic infections, enteric pathogens, and malignancies. -trans: contaminated blood or bodily fluids, sharing IV drug needles, sexual contact, transplacental & possibly thru breast milk. -time from exposure to sx manifestation may be prolonged: 10-12 years

Lead Tox Diagnosis

1. child - practice of pica. children absorb more than adults. paint chips taste sweet. 2. pathology: lead is slowly excreted by kidneys & GI tract. stored in inert form in long bones. -hematology: blocks formation of hgb, leading to microcytic anemia (initial sign) and inc EP -renal: toxic to kidney tubules, allowing abnormal excretion of protein, glucose, aa, phosphates -CNS-increases membrane permeability, resulting in fluid shifts into brain tissue, cell ischemia, and destruction causing neurological and ID w/ low-dose exposure. w/ high-dose exposure, intellectual delay, convulsions, and death (lead encephalopathy)

Decontamination Procedure

1. client walks, wheels, or placed on clean stretcher covered in plastic. transported over protected floor. 2. decontam. shower w/ HCP wearing PPE 3. remove clothing and place in hazard bag 4. valuables - dif bag - decontam later! 5. Wash w/ soap & water. esp body orifices & hairy areas 6. shampoo hair....irrigate wounds...waste water collected in container. 7. if exposed to radiation - scanned w/ detector meter 8. remove floor covering. place in hazard bag. 9. health care workers remove and bag protective clothing 10. after shower. put on clean clothes. steps on clean floor 11. medical eval then started.

instructions for accidental poisoning

1. know sx: change in child's appearance/behavior. presence of unusual substance on mouth, hands, play area. burns, blisters and/or suspicious odor around child's mouth. open/empty containers in child's possession. 2. initiate steps to stop exposure 3. call poison control center. they will advise for rx 4. Syrup of Ipecac no longer recomen. dispose properly! 5. dont give emetic or anything w/ HCP aproval 6. save substance, vomitus, stool, urine 7. induce vomiting only if PCC or HCP says to (contraind - danger of aspiration. petroleum distillate. strong corrosive) 8. water may be used to dilute toxin. dont give too much cause it will accelerate gastric emptying and speed drug absorption. milk may delay vomiting. do not attempt to neutralize a strong acid/alkali n/c this may cause heat-producing reaction. there are only a few specific antidotes. no universal one.

Hepatitis ASMT

Fatigue, jaundice (icterus), yellow sclera, anorexia, RUQ pain & tenderness, malaise. clay colored stools, tea-colored urine. pruritis, accumulation of bile salts under the skin. liver function studies ( elevated AST, ALT, Alkaline Phosphatase (ALP), bilirubin). Prolonged PT. percutaneous liver bopsiy. antibodies to specific virus (ex: anti-HAV)

TB Plan/Implementation

Notify State Health Dept. evaluation of contacts. -Isoniazid prophylaxis - not reco for ppl greater than 35 who are at low risk b/c of inc risk of assoc toxic hepatitis. get 6-9 mos therapy w/ isonizid -Chemo: to prevent development of resistant strains two or three meds are used. usually a 6 or 9 mos regimen w/ isoniazid and rifampin. ethambutol and streptomycin may be used initially. -isolation for 2-4 wks (or 3 neg cx) after therapy started. -Cover mouth & nose. tissues in plastic bag. mask in crowds. avoid exposure to dust & silicone. handwashing. take full course of abx. encourage return to clinic for sputum smears. good nutrition (inc iron, protein, Vit B & C)

TB ASMT

Progressive fatigue, nausea, anorexia, wt. loss, irregular menses, low-grade fevers over a period of time, night sweats, irritability, cough w/ mucopurulent sputum (occasionally streaked w/ blood), chest tightness, dull aching chest, dyspnea. -dx: Skin testing. sputum smear for acid-fast bacilli (induce by respiratory therapy in am & pm - not specific to TB). chest x-ray on positive PPD to detect old and new lesions. tubercles may be seen in lungs. QuantiFERON-TB Gold; results w/n 24 hours.

Multiple Puncture Test (Tine)

Read test in 48-72 hours. -vesicle formation = positive reaction. -screening test only -questionable or positive reactions verified by Mantoux test.

Condylomata acuminata (genital warts)

initially single, small papillary lesion spreads into large cauliflower like cluster on perineum and/or penis, vagina. may be itching/burning. -dx: direct exam. biopsy. HPV. -trans: majority d/t HPV. MM, sexual contact. congenital. 1-3 mos. -curettage, cryotherapy w/ liquid nitrogen or podophyllin resin. kerotolytic agents. avoid intimate sexual contact until lesions are healed. strong assoc w/ incidence of genital dysplasia and cervical CA. atypical, pigmented persistent warts should be biopsied. notify contacts!

ergonomics

the study of interaction of human body w/ use of mechanical and electrical machines. hazard ex: repetitive actions leading to carpal tunnel syndrome.