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Sunday, December 6, 2015

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

Friday, August 14, 2015

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

Thursday, January 8, 2015

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