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NPN 135 FINAL 5/6/13
HEALTH DEVIATIONS FINAL ON 05/06/2013
| Term | Definition |
|---|---|
| Different layers of the Skin | Epidermis: top layer Dermis: 2nd layer nerves glands Subcutaneous: 3rd layer fatty tissue |
| Communicable Disease | transmitted directly or indirectly to others |
| Infection | invasion & multiplication of microorganism in body tissues, pathogen replicating in or outside of body |
| Inflammation | localized protective response brought on by trauma or injury to tissue |
| Endemic | disease that is always present in a local area |
| Epidemic | disease/illness occurs in higher than normal numbers at the same time in same area |
| Pandemic | disease/illness world wide |
| Colonization | organism is present but not causing any illness |
| Fomite | object that may become contaminated with pathogens and serve in their transmission (objects) |
| Chain of Infection | 1.Infectious agent (source) bacteria, fungi, parasites, virus (how it starts) 2.Reservoirs resting place for it to grow 3.Portal of Exit how it gets out 4.Modes of Transmission how its spread 5.Portal of Entry how it enters 6.Susceptible Hosts |
| Stages of Infection | 1.Incubation 2.Communicable 3.Prodromial 4.Illness 5.Convalescent |
| Vaccines at Birth | HepB |
| Vaccines at 2 months | HepB(1-2mos), DTaP, PCV, Hib, Polio, RV |
| Vaccines at 4 months | DTaP, PCV, Hib, Polio, RV |
| Vaccines at 6 months | HepB(6-18mos), DTaP, PCV, Hib, Polio(6-18mos), RV |
| Vaccines at 12 months | MMR(12-15mos), PCV(12-15mos), Hib(12-15mos), Varicella(12-15mos), HepA(12-23mos) |
| Vaccines at 15 months | DTaP (15-18mos) |
| Vaccines 4-6 years of age | DTaP, IPV, MMR, Varicella |
| What's the minimal age for Influenza vaccine and how often can you receieve the vaccine? | 6 months, yearly |
| Measles | Rubeola, virus, fever, weak, photophobia, Koplick's spots (red,bluish-white center spots) inside mouth, Rash begins on face and spreads downward. |
| Mumps | inflammation of the salavory glands, virus, unilateral/bilateral edema & tenderness of glands, loss of appetite |
| Rubella | German Measles, virus, like measles but milder, swollen lymph nodes, fever, headache, cough, pale red/pink rash begins on face, moves downward |
| Fifth Disease | Virus, F, HA, Sore throat, Rash appears in 3 different stages, 1st-slapped cheek, paleness around mouth, 2nd-rash upper extremities spreads to trunk & thighs, 3rd-overheating returns rash |
| Roseola | 6th disease, virus, sudden persistant fever, rash appears rose-pink starts on trunk, spreads to rest of the body |
| Polio | infantile paraylsis, virus, progresses quickly, muscle spasms, stiff neck & trunk, spreads to limbs, leads to paralysis |
| Scarlet Fever | Scarlatina, bacteria, abrupt F, V, HA, rash all over body sand paper texture, worse in folds of body, nonblanchable. White-strawberry tongue, throat and tonsils swollen |
| Pertusis | "Whooping Cough" bacteria, URI with 2 stages: 1.Proximal-dry hacking cough followed by inspiration making whooping noise, happens at nightm, cough so hard vomits, 2.Convalescent-decrease in coughing/whooping cough |
| Reye's Syndrome | Aspirin use in children, viral infection, leads to neurological failure - liver, GI, brain shuts down. Had virus took aspirin, causing N/V, leathergic, cerebral edema, intracranal pressure, seizures, change in mental status |
| Hand, Foot, Mouth Disease | Virus, fever, blister like erruptions in/around mouth, hands, feet, poor appetite, sore throat |
| infectious Mononucleosis | Mono, Virus, direct contact with blood, or infected saliva, 4-6 weeks to grow, lasts up to 4 months, F, sore throat, fatigue, complications of enlarged liver or spleen |
| Gonorrhea | bacteria, sexual contact, women unsymptomatic, green-yellow discharge, edema of infected area, abd pain & distention, muscle rejiggitary, woman have to have 3 negative cultures to be considered cured. |
| Herpes Genitalis | virus, sexual contact and direct contact with legions, inhibits viral replication Zovirax, shortens duration of virus Famvir, Valtrax, Teach abstain from sex when lesions are active |
| Chlamydia | "Silent disease" b/c no symptoms, complications of PID, infertility /sterility, bacteria, white/clear discharge, burning, urinary frequency |
| Syphillis | the great imitator, S/S are similar to other diseases. Primary stage papul develops at site of entry, sloughs off, chancre, heals secondary stage, flu like symptoms, copper-penny spots on palm of hands, bottom of feet. Tertiary stage creates tumors |
| HPV | human papillomavirus, genital warts, califlower warts, flesh color painless, may cause Cervical cancer. Medical Treatment of topical chemicals, laser therapy, freezing/chriotherapy |
| Vaginitis | 4 different types Bacterial vaginosis-bacteria Yeast infection-fungus overproduction Trichomoniasis- bacteria Atrophic Vaginitis-caused by menopause |
| Pelvic Inflammatory Disease | PID, prolonged strep & staph infections, STD's untreated, severe abd pain, bleeding after sex, N,V, weakness |
| Rhinitis | most common communicable disease, virus, inflammation of nasal and nasal accessories |
| Influenza | the Flu, virus types A&B- seasonal epidemics tpye C-mmilder S/S, complications pneamonia or dehydration, antivirals taken within 2 days of S/S, Tamiflu and Relenza stop virus replicating |
| Rabies | severe viral infection, direct contact of saliva, n/v/f/ha twitching around area of bite, as progresses aggitation, aggressive, irritable, bizarre/abnormal thoughts, confusion, muscle spasms, abnormal posturing, becomes fatal |
| Pediculosis | LICE 3 main types: head,body,pubic lice; egg/nit lives on scalp hatch in week, Nymph young louse, very active, Adult mate live about 1 month. lice live 3-4 days on objects without feeding. Nix Rid |
| Scabies | contagious disease of skin, burrowing into epidermis living and reproducing. cannot live more thsn 24 hours without human blood. S/S- short wavy greyish-white lines found in creases/skin folds. Scabicide Kwell or Eurax |
| Chicken Pox | Varicella, virus, direct contact of secfretions of respiratory or from rash, fluid filled red based vesicles will rupture, ooze, crust over. When crusted over not contagious anymore. |
| Herpes Zoster | Shingles, have to have had some form of chicken pox virus, laid dorment at base of nerve, and reactivated. small clear red spots following track of nerve of the inflammed nerve path. Common places trunk, neck, face. Vaccines for 60 years and older |
| MRSA | Methicillin Resistant Staphylacoccus Aureus. baterica resistant to certain antibiotics,not taking antibiotics as prescribed. 2 types: Hospital acquired, Community Acquired. MRSA can live on fomites several wks, puss filled boil looks like spider bite |
| Conjuctivitis | PINK EYE, inflammation/infection of conjuctiva that lines the eye lid and part of eye. viral/bacterial infeection, Bacterial=drainage thick yellow-greenish, Viral=watery mucousy drainage |
| Dermatitis | 2 types contact & atopic; inflammatory condition that can occur anytime from allergens |
| Contact Dermatitis | occurs when substance/chemical comes in contact with skin & is absorbed in skin. Mus have had prior exposure. Detergents, soaps, chemicals, latex, plants |
| Atopic Dermatitis | Infantile Eczema, inheredited allergen/food allergy. hydrate the skin, tepid/luke warm bath, followed by inclusive cream lock in moisture |
| Urticaria | Hives/Wheals; cannot be cured, but controlled, will outgrow. Allergic reaction to drugs, food, animals, stress, chemicals. Epi Pe on hand, removal of trigger, luke warm baths |
| 4 types of fungal infections | Tinea capitis (ring worm of scalp) Tinea corporis (ring worm of the body) Tinea cruris (jock itch) Tinea Pedis (athlete's foot) |
| Tinea Capitis | lesions that are round with pustule on scalp can cause baldness Wood lamp test positive if turns blue |
| Tinea Corporis | Round lesions may be clear in center pustels around edges with scaling, looks like a ring. Wood lamp test positive if turns blue |
| Tinea Cruris | brownish-reddish lesions extending from the groin area (inflammed/irritated) |
| Tinea Pedis | fissures and vesicles around the toes |
| Acne | a papilo-puscular skin erruption, antibiotics to treat severe cases, make worse diet, stress, hormones, fatty foods, acne develops when oil glands are blocked |
| Psoriasis | chronic non-infectious skin condition, triggers: stress, meds, injury to skin, red scaling patches caused by skin growing much faster than normal, common sites: elbows/knees. Vitamin D promotes healing natural sunlight |
| Decubitus Ulcer | pressure ulcer, bed sore, any type of injury that is caused by unrelieved pressure from fristion, shearing, usually over bony prominence. |
| Stages of Ulcer | Stage I: skin red nonblanchable Stage II: skin cracked, blistered, partial skin thickness loss Stage III: skin gone, underlying tissue damaged, full thickness loss Stage IV: muscle or bone is exposed & damaged |
| Cellulitis | an inflammation or infection of the skin that is caused by strep or influenzae (adults bacteria, virus in children) looks like pitted orange can become septic if enters bloodstream. |
| Impetigo | highly contagious skin infection, thick drainage, which is honey colored crusted over, commonly seen on facce, butt, extremities. |
| Salmonella | commonly effects children under 5, improperly prepared food, injest bacteria, abd pain, diarrhea=water, greenish/brown, foul slimy |
| Samonellolosis | food borne found in unpasterized dairy products, untreated meat, eggs uncooked |
| E-Coli | produced in body, when enters urinary tract, produces powerful toxin that causes severe illness & improper preparing food. Severe Diarrhea watery progresses to bloody, v, abd pain, no fever, |
| Botulism | bacteria forms spores, found in soil. 3 types: Food borne(ingested bacteria), Wound (bacteria enters wound), and Infant (ingested by honey). Adults can only recieve anti-toxin. promote motility (l,axative) |
| C. Difficile | C Diff, bacteria, can live on fomites for weeks-months, powerful toxin that attcks intestional lining, watery diarrhea least 3 times days for more than 2 days, foul odor, abd distention, severe cases: Diarrhea up to 15 times a day, blood in stool/pus |
| Lyme Disease | deer ticks, rash at site of bite, "bullseye" appearance, fatigue, chills, ha, muscle/joint pain |
| Rocky Mountain Spotted Fever | F,N,V,HA, joint pain, rash on wrists, ankles, forearms, then becomes more spread out, |
| West Nile Virus | stagnent water, mosquito, most times never know you have it, others ha, body aches, N,V, rash, severe cases: ensephalytis, meningitis, neurological impairment |
| Anthrax | bacteria, spore forming, bioterrism, 3 types: cutaneous (enters wound/skin immediate response) Inhalation(takes 10 days) Gastrointestinal (eating 1-7 days) |
| Smallpox | virus, direct/indriect of prolonged body fluids, bioterrorism, rash on tongue & mouth, starts on face, spreads down, small raised red, become vessicles filled with opaque white fluid (dipped in like belly-buttons) rash becomes hard like BB's, rash scabs |
| Peri-Operative Nursing | time surrounding and during surgery |
| Pre-Op | begins w/ decision of surgery & ends w/ transfer of pt on opating table. 1.educate 2.ensure tests are completed 3.reinforce explanations & instructions from Dr. 4.educate on recovery 5.carry out pre-op interview 6.meds, iv, verify pt, consent form |
| Intraoperative | begin pt is transferred to operating table & ends with admission to PACU, provide for safety, maintain sterile, ensure proper function of equipment, provide specific instruments,documentation, monitoring |
| Post-Op | Begin with admission to PACU & ends with follo up eval in clinical setting. Focus on ABC's monitoring, assess effects for meds, any complications, pain relief, promoting recovery, pre-op teaching, focus on follow up care |
| Anastomosis | surgical joining of 2 ducts or blood vessels to allow flow from one or another |
| -ectomy | surgical removal |
| Lysis | destruction or disolution of (removing something) |
| -orrhaphy | surgerical repair |
| -oscopy | direct visualization of/by scope |
| -ostomy | opening that is made to allow passage of drainage |
| -otomy | opening into |
| -pexy | fixation of |
| -plasty | plastic surgery |
| Classifactions for Surgery; 3 ways to classify | 1. Seriousness of Surgery 2. Urgency 3. Purpose |
| Difference between major and minor Surgery | major-extensive alteration of a body part minor-minimal alteration in body parts |
| Difference between urgent, elective, & emergency surgery | emergency= requires immediate attention, urgent= requires prompt attention necessary for health, keep additional problems from occuring. elective= performed per pt's choice |
| Purposes of Surgery | Diagnostic=confirm diagnosis(Biopsy) Ablation=removal of diseased body part (amputation) Palliative=relieves/reduces symptoms/not cure Reconstructive=restores function Transplant=replace organs Constructive=restores function result of congenital anam |
| Surgery Settings | inpatient-admitted fr surgery (major surgery) one day/same day/ambulatory-admitted & discharged same day outpatient-patient not hospitalized short stay unit-pt's stay does not exceed 24 hours |
| Factors Influencing Surger Outcome (ABCDE) | A-allergies B-bleeding C-corticosteroid use D-Diabetes E-Emboli (blood clots) |
| Normal levels for ABG's | pH= 7.35-7.45 PaO2= 80-100 mmHg PaCO2= 35-45 mmHg O2Sat= >95% |
| Normal Levels for Blood Studies | Hgb= 12-18 g/dl Hct= 37-52% ProTime= 11-12.5 seconds PTT= 30-40 seconds |
| Abnormal CBC's may reflect what? | Infection increase WBC's Malnutriention & Anemia decreased Hct & Hgb Impaired immune function |
| Serum Electrolyte Analysis | evaluate electrolytes & fluid status, may need to replace fluids before surgery |
| Coagulation Study | Pro Time, PTT, platelet count; telss us if pt is at risk for hemorrohage, or thrombus formation |
| Serum Creatinine & BUN | assess renal function |
| Urine Analysis | assess color, pH, gravity, can detect protein, glucose, ketones, and blood in urine |
| Chest X-ray | reflections codition of heart & lungs, telss us how tolerate seditives & anasthetics |
| EKG/ECG | electrocardigram, gives electrical activity of heart |
| Blood type & cross matching | blood type of pt, Rh factor, and compatiability with donor blood |
| Fasting Blood Glucose | detects presence of diabetes |
| 3 elements to Consent Form | 1. Surgeon must tell pt EVERYTHING about surgery 2. Consent form must be signed before meds by nurse 3. Must be signed voluntarily can be withdrawn at any time! Nurses Role: witness & obtain signature |
| Pre-op teaching on Physical Activities to decrease post-op complications | Deep Breathing-prevents pneamonia & blood clotting Coughing-moves secretion Incentive Spirometry-inhaling increases lungs function Leg exercises-venous return Turning-q2hrs promote venous return ambulate Ted Hose |
| Regional Anesthesia | blocks transmission of nerve impulses to & from a specific area of body, remains conscious |
| Spinal Anesthesia | lumbar puncture into space around spinal cord, epideral |
| 4 main goals in PACU | provide care until recovery of anesthesia, provide care until orientated, until stable vital signs, show no evidence of bleeding/other complications |
| Areas of Assesment in Post-Op care | vitals, resperatory status, cardiovascular status, CNS, Fluid status, Inscission, Pain, N/V, Equipment functioning, |
| Primary Objective in Pre-Op Care | Maintain Patent Airway |
| Signs of Airway Obstruction | lax muscules of tongue (#1 cause), choking, noisy irregular respirations, decrease 02 sat, cynosis of skin |
| How can nurses prevent respiratory complications? | Positioning Deep Breathing Coughing Incentive Spirometer Turning q2hrs Early Ambulation |
| Benefits of Early Ambulation | INCREASES THE FOLLOWING: rate & depth of breathing, mental alterness, urinary elimination, peristalisis, metabolism, circulation |
| Types of Surgical Wound Drainage | Sanguineous-bright red, inital drainage w/in few hours Serosanguineous-pink Serous-pale yellow |
| Wound Complications | Infection-becomes red, warm, tneder, swelling, Fever, elevated WBC's Dehiscence-sudden bursting open of wound Evisceration-protrusion of internal organ through surgical wound |
| Treatment for Evisceration | Emergency, notify MD immediately, place in low fowlers, knees flexed, cover wound with sterile warm dressing |
| 3 phases of wound healing | Primary Intention-apparoximated minimal scarring Secondary Intention- repair time, scarring, risk of infection greater, skin edges are not close together Tertiary Intention- delayed primary intention, leave wound open after infection is controlled |
| 3 major concepts that must be present for oxygenation | Ventilation Diffusion Perfusion |
| Natural Changes in the Respiratory System with Aging | Decrease in elasticity in lungs, weakened repiratory muscles, thickening of aveoli membrane, dryer membranes, decreased function of cilia, increased risk for infection |
| Obstruction of the Airway | common cause of respiratory insufficency, caused by foreign objects, tongue, thickened secretions. Patrial obstruction air sitll moving through recieving o2, complete obstruction no air movement |
| Hypoxia | low oxygen, inadequate amount of oxygen in tissue & cells, S/S: restlessness, confusion, fatigue, unable to concentrate, SOA, dyspnea |
| Altered Breathing Patterns | tachypnea, bradypnea, hypervenilation, hypoventilation, apnea, cheyne stokes, Kussmaul's |
| Cardinal S/S Associated with Respiratory | Cough Sputum Production Dyspnea Hemoptysis Chest Pain Wheezing Orthopnea |
| Normal Lung Sounds | Bronchial- heardover upper part of sternum short breathing in, long breathing out Vesicular-located outside of lungs, long breathing in, short breathing out Bronchovesicular-heard on center of chest, loud breathing in and out and equal |
| Crackles (rales) | brief not continous, breathing in, crackling or bubbling sound, sounds like hair being rbbed inbetween fingers. caused by fluid mucus or pus in airway |
| Fine Crackles | like crackles, high pitched, sibilant crackling at end of inspiration |
| Medium crackles | like crackles, medium pitched, more sororous moisture sound during mid inspiration |
| Coarse Crackles | like crackles, loud, bubbly sound heard early inspriation |
| Sonorous Wheezes (rhonchi) | Deep running sound loud, low, coarse sound like a snore, heard at any point with breathing |
| Sibilant Wheezes (wheezes) | High-pitched musical, whistle-like, sound duing inspriation/expiration, may vary from one minute to he next, cuased by narrow airway |
| Pleural Friction Rub | Dry creaking grating low pitched sound during breathing in and out, caused by pleura rubbing together |
| Stridor | loud crowing noise, do not need a stethoscope to hear, caused by airway obstruction |
| Ineffective Airway Clearance | inability to clear secretions or obstructions from the respiratory tract. cause= nonproductive cough, increased secretions |
| Ineffective Breathing Patterns | inspiration/expiration that does not provide adequate ventilation. change in normal breathing patterns |
| Impaired Gas Exchange | Access/Deficit in oxygenation and or carbon dioxide. Diffusion not taking place. |
| Activity Intolerance | State in whic an individual has insufficent physchological/psychological energy to complete daily physical activities, too weak to move, can't breath |
| Altered Nutrition less than body requires | not able to breath can't eat as well |
| Anxiety | not able to breath, worried |
| Lung Scan | determining patency of pulmonary airways and anormalities in ventilation. Dye injected (ask if allergy to shellfish). |
| Pulminary Function Study | determine impaired lung function, function of pt with long term COPD, evaluate response to therapy, pre-op lung evaluation. |
| Direct Visualization | 2 purposes, diagnostic-picture of any abnormalities & therapeutic-bronchial washings to remove excessive scretions or foreign objects |
| Sputum collection | secretions of lungs, morning best time to collect, 15 ml of sputum needed, always rinse before collection, before antibiotics get sputum |
| Blood samples | CBC & ABG's, performed at bedside, hold pressure at least 5 mintues, 10 minutes if on blood thinners |
| Thoracentesis | insertion of a large bore needle, removal of fluid that may threaten safety or comfort of pt, inject meds into pleural space, no more than 1300ml in 30 minutes |
| Lung Biopsy | tissues/secretions/cells of lungs. |
| Asthma | trachieal & bronchial response to stimuli reaction to stimuli, inflammation from mucus, can improve on own or need medical attention. Extrinsic factors (outisde, perfume, wax, spray, bleach) or Intrinsic factors (Respiratory Tract Infection, GERD). |
| 3 mechanisms involved in acute Asthma Attacks | 1.Recurrent reversible obstruction of Airflow, muslces around bronchioles tighten & narrow airway 2.Increased capillary permiability mucus production increases 3.Inflammatory response Mast Cells react b/c ahe been invaded by asthma triggers |
| Mild Asthma | dyspnea, wheezing, fatigue, weakness |
| Acute Asthma Attack | usually at night, tachypnea, tachycardia, anxious, sweating, chest tightness, ough, expiratory wheezing, nasal flaring |
| Status Asthamaticus | nt responding to usual treatment, damage to airways, airways cannot repair themselves |
| Asthma Nursing Interventions | Admin prescribed meds, cool air, pursed lip breathing (inhale count 2, exhale through pursed lips count 4), Give O2 as prescribed |
| Croup | acute viral disease of childhood, sufficative feeling marked by residnt cough, most common in children 3mos to 3yrs, virus, Hoarseness, Stridor, Tachypnea, Cough (bark) |
| Epiglotitis | flap guarding airway, bacterial infecion, can close off airway, caused by flu virus type B, F, muffled voice, drooling, progressive Resp distress, anxiety, fear, artifical airway |
| Signs of Hypoxia | Restlessness and Tachycardia |
| RSV | Respiratory Syncytical Virus, lower rsp infection, children less than 4, Jan-March, mild cold like symptoms, sore throat, ear infection, F, cough, runny nose, (severe) airway obstuction, retractions, nasal flaring, tachypnea, dyspnea |
| High Risk group for RSV | 2-6 months, immunocomprimised chldren, Congential heat disease patients, chronic lung disease, low soci-economic status, exposure to smoke, daycare, infants not breastfeeding |
| Interventions for RSV | Handwashing teaching, isolate children from respiatory infections, avoid 2nd hand smoke, droplet & contact precaution |
| Cystic Fibrosis | CF, genetic inherited by 2 paents carrying both gene>(autosomal recessive) effects respiratory and GI, mucus begins to collect in airways and organ ducts, ineffective airway clearance, becomes infection, pulmonary hypertension, pulmonary obstruction |
| in newborns first sign of CF | Meconium Illeus, obstruction of bowels |
| typical S/S of CF | stool=fatty, froathy foul stools growth failure, protruded, emaciated, rectal prolapse, bleeding disorders, bruising, skin transparent, chronic cough, respiratory symptoms, wheezing, sputum production, barrel chest |
| Diagnostic Tests For CF | Family inheritence, Chronic pulomary, pancreotic enzymes, sweat test; sweat inducer places on forearm, then bag placed to catch sweat, sweat tested(+ if sweat is greater than 60 meq/L of chloride is present) Chest XRay |
| SIDS | sudden infant death syndrome, crib death, no knon case, occurs during sleep without any warning, no S/S, cold weather months, mainly Jan |
| Reducing SIDS | place on back to sleep, patient education before discharge, firm mattress, do not over heat, no smoking, good prenatal care, breast feed, proper immunization schedule |
| Nursing care for SIDS | expressions: fear, shock, mad, never ask questions that point blame, provide support, support groups, teaching, risk factors, education |
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