FON: Standard Precautions

Standard Precautions: Tier 1

• Perform hand hygiene before and after care and when soiled; most important way to prevent infection
• Use personal protective equipment (PPE) if touching, spilling, or splashing of blood or body fluids is likely; use gloves, gowns, mask, goggles, shields, aprons, head and foot protection
• Discard disposable items in fluid-impermeable bag and contaminated
• Do not recap used needles; dispose in sharps container
•  Hold linen away from body; place in impermeable bag in a covered hamper; do not let hampers overflow
• Place lab specimens in a leak-proof transport bag without contaminating the outside; label with biohazard sticker and patient information
• Institute procedure for accidental exposure: Wash area, report to supervisor, receive emergency care, seek referral for follow-up
• Receive hepatitis B vaccine
• Assign patient to private room if hygiene practices are unacceptable
• Avoid eating, drinking, touching eyes, applying makeup in patient area.

Transition-Based Precautions: Tier 2

AIRBORNE

■ Used for microorganisms that spread through air (droplet nuclei 5 m) [e.g., TB, measles, chicken pox])

■ Private room; negative air pressure room; door closed; high-efficiency disposable mask (replace when moist) or particulate respirator (e.g., for TB); transport patient with mask, teach to dispose soiled tissues in fluid impervious bag at bedside

DROPLET

■ Used for microorganisms spread by large-particle droplets (droplet nuclei 5 m, (e.g., pneumonia [streptococcal, mycoplasmal, meningococcal], rubella, mumps, influenza, adenovirus)

■ Private room if available or cohort pts, mask when within 3ft of pt, door open, mask for pt when transporting, teach to dispose soiled tissues in fluid-impervious bag at bedside

CONTACT

■ Used for organisms spread by direct or indirect contact; methicillinresistant S. aureus (MRSA), vancomycin-resistant enterococcus (VRE), vancomycin intermediate-resistant S. aureus (VISA); enteric pathogens (e.g., E. coli, C. difficile), herpes simplex, pediculosis, hepatitis A and E, varicella zoster, respiratory syncytial virus

■ Private room or cohort pts; gowns, gloves over-gown cuffs; dedicate equipment

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Medical and Surgical Nursing Review Bullets

Medical and Surgical Nursing Review Bullets

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Common Cardiac Drugs

Common Cardiac Drugs
Drugs	Main effects	Mechanism	Sites of action
abciximab	anticoagulant stops platelet activation	monoclonal antibody to fibrinogen receptors	platelets
amiloride (combination with frusemide is frumil)	potassium sparing diuretic	plasmalemma sodium & chloride channels	kidney (distal tubules)
amiodarone	class III anti-arrhythmic	prolongs action potential duration	myocardium
aspirin	anticoagulant stops platelet activation	COX inhibitor, blocks TXA2 synthesis	platelets
atropine (sometimes used to stop vagus bradycardia)	parasympatholytic, increases heart rate	blocks muscarinic AcCh receptors	pacemaker cells (sino-atrial node)
captopril	reduces arterial blood pressure	ACE inhibitor	relaxes vascular smooth muscle
clopidogrel	anticoagulant stops platelet activation	blocks ADP receptor	platelets
digitalis and ouabain	increase cardiac contractility, delay AV node triggering	block Na / K ATPase raising intracellular sodium, then calcium	all tissues, but the Na/Ca exchanger is mainly in heart
dipyridamole (often used for X-ray imaging)	coronary vasodilation	inhibition of adenosine uptake	coronary vasculature
furosemide	diuretic	plasmalemma sodium & chloride channels	kidney (loop of Henle)
isoprenaline (and other adrenaline analogues)	increase cardiac contractility	beta agonist raises cyclic AMP	many tissues
losartan	reduces arterial blood pressure	angiotensin AT1 receptor blockade	relaxes vascular smooth muscle
lovastatin	reduces blood cholesterol levels	HMG-CoA reductase inhibitor	liver
morphine	pain relief (mainly)	opiate receptors	brain
nitroglycerine (and many other organic nitrates)	reduce cardiac work load	metabolised to NO	relaxes vascular smooth muscle
propranolol	reduces cardiac contractility, class II anti-arrhythmic	beta blocker lowers cyclic AMP	many tissues
quinidine, novocaine,lidocaine and other local anaesthetics	class I anti-arrhythmics	delay recovery of sarcolemma sodium channels after AP	myocardium
spironolactone (usually added to other diuretics)	reduces diuretic potassium losses	aldosterone antagonist	kidney (distal tubules)
urokinase (streptokinase is cheaper but antigenic)	dissolves blood clots (fibrinolytic)	activates plasminogen to plasmin (protease)	blood clots
verapamil, nifedipine and other dihydropyridines	reduce cardiac work load, class IV anti-arrhythmic	block sarcolemma calcium channels	myocardium; relax vascular smooth muscle
warfarin	anticoagulant vit. K antagonist	blocks g-carboxy glutamate synthesis	liver

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Lecture Notes: Physical Assessment

Physical Assessment Handouts

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Lecture Notes: Nursing Process

Nursing Process Handouts

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Nursing Review: Vital Signs

Vital Signs

 Ø  Temperature (NV 36 – 37.5 C)

ü  Elderly people are at risk of hypothermia

ü  Hard work or strenuous exercise can increase body temperature

ü  Oral: most accessible 2-3 mins. * 15 minutes interval after ingestion of hot or cold drinks

ü  Rectal: most accurate 2-3 mins.

ü  Axillary: most safest 6-9 mins.

Ø  Pulse (NV 60-100 bpm)

   ü  Wave of blood created by contraction of the left ventricle of the heart

   ü  Radial: best site for adult

   ü  Brachial: best site for children

   ü  Apical: best site for 3 years old below

Ø  Respiration (NV 12/16-20)

Normal Breath Sound

Vesicular	Soft, low pitch	Lung periphery
Broncho-vesicular	Medium pitch	Larger airway blowing
Bronchial	Loud, high pitch	Trachea

Abnormal Breath Sound

Crackles	Dependent lobes	Random, sudden reinflation of alveoli fluids
Rhonchi	Trachea, bronchi	Fluids, mucus
Wheezes	All lung fields	Severely narrowed bronchus
Pleural Friction Rub	Lateral lung field	Inflamed Pleura

Ø  Blood Pressure (NV 120/80 mm/hg)

  ü  This is the force exerted by the blood against a vessel wall

  ü  The pressure rises with age.

  ü  A rest of 30 minutes is indicated before the blood pressure can be readily assessed 

             after stressful activity.

  ü  Interval of 30 minutes is needed after smoking or drinking caffeine.

  ü  After menopause, women generally have higher blood pressures than before.

  ü  Pressure is usually lowest early in the morning, when the metabolic rate is lowest, 

             then rises throughout the day and peaks in the late afternoon or early evening

Common Errors in Blood Pressure Assessment

Errors	Effect
Bladder cuff too narrow	Erroneously high
Bladder cuff too wide	Erroneously low
Arm unsupported	Erroneously high
Insufficient rest before the assessment	Erroneously high
Repeating assessment too quickly	Erroneously high
Cuff wrapped too loosely or unevenly	Erroneously low
Deflating cuff too quickly	Erroneously low systolic and high diastolic reading
Deflating cuff too slowly	Erroneously high diastolic reading
Failure to use the same arm consistently	Inconsistent measurements
Arm above level of the heart	Erroneously low
Assessing immediately after a meal or while client smokes	Erroneously high
Failure to identify auscultatory gap pressure	Erroneously low systolic pressure and erroneously low diastolic

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