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Nov7 simulated 1& 2

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november 7, 2010 rationale for peak simulated 1 & 2

november 7, 2010 rationale for peak simulated 1 & 2

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  • 1. GOOD AFTERNOON!!!!
  • 2. Clean-Catch (Midstream) Specimen • perennial area is washed Mild antiseptic/liquid soap • midstream urine is collected 30 ml • avoid collecting initial & last few drops • send specimen laboratory or within 2 hours Collecting Urine Specimens
  • 3. Sterile Specimen from Indwelling Catheter a. From a closed system Method – clamp drainage tubing about 4” below junction of drainage tubing and catheter for 10-30 minutes – Clean specimen collection port with alcohol or antiseptic solution – Collect 3-10 ml of urine with a sterile syringe – For self-sealing catheter, insert needle slowly at 450 angle taking care not to puncture the other side of the tubing Collecting Urine Specimens b. Open-System Method -Place line saver under tubing at junction of catheter and drainage tubing -Disinfect the junction before and after the collection -Hold the disconnected tube (catheter and drainage tubing) 1.5-2 inches from each other -Do not allow the catheter tip to touch container
  • 4. 24-Hour Urine Collection. • Urine passed in a 24-hour period is collected • Measures the amount of certain chemicals the kidneys clean from the body. • To see if too little or too much urine is produced. • Decide on the day and time-usually started in the morning • Discard the first voided urine • Collect all the subsequent urine passed • At the 24th hour, collect the last sample • Urine should be kept cool, refrigerated • Specimen sent to the laboratory within 2 hours after collection Collecting Urine Specimens
  • 5. Intravenous pyelogram(IVP) Visualization of the Urinary system Kidney Urethers Bladders Aka Intravenous pyelography (IVP). Urography. Pyelography.
  • 6. Intravenous pyelogram(IVP)
  • 7. Intravenous pyelogram(IVP) detect problems:  kidney stones  enlarged prostate  tumors in the kUB  surgery on the urinary tract
  • 8. Intravenous pyelogram(IVP)  Preparation: Enema( aperients) 24 hours NPO 6 – 8 hours Remove : jewelry, dentures, eye glasses and any metal objects or clothing  Patient wears cotton examination gown.  Bladder emptied immediately before examination.  Site: median cubital vein : 20 gauge
  • 9. point of comparison… - inflammation of Renal Pelvis/ Renal Parenchyma - s/sx: cystitis s/sx pain: flank pain – T12 & L3 Costovertebral Tenderness Fever: High CYSTITIS PYELONEPRHRITIS - inflammation of the Urinary Bladder - s/sx: Dysuria Freqyuency Urgency Noctoria Pyuria : cloudy.foul odor Pain : suprapubic/hypogastric Fever: Low Grade
  • 10.  Furniture:  sturdy & stable straight back  seat firm should be NO lower shallow than the knee height  sofas & chairs - 17 inches off the ground  heavy rocking chair with arm rest  clear plastic chair protector for upholstered chairs Parkinson’s Disease
  • 11. Low purine diet…… - indicated for gout, uric acid kidney stones and uric acid retention - purpose is to decrease the amount of purine FOODS: AVOID organ meats, fish, lobsters dried peas and beans, nuts, oatmeal, whole wheat
  • 12.  GABHS  Inflammation of kidney  Periorbital Puffy eyes  Hematuria(tea colored)  Hallmark sings/Classics sign Hypertension  Plasmapheresis  Diuretics  Steroids  Autoimmune  Increase glomerolar permeability  Hallmark sings/Classics sign - Protienuria - Edema - Hypercholeteremia  Plasma Expanders  Diuretics  Streroids Glomerulo- nephritis Nephrotic Sydrome
  • 13. OLDCART METHOD O- onset of pain L- location of pain D- duration of pain C- characteristic of pain A- aggravating factors R –radiation of pain T- treatment PQRST mnemonics P- provoked ( what brought about pain) Q- quality of pain R- region or radiation of pain S- severity T- timing MNEMONIC S FOR PAIN ASSESSME NT
  • 14. Pulmonary Wedge Pressure aka: Pulmonary capillary wedge pressure (PCWP) Pulmonary artery occlusion pressure ( PAOP)  Catheter Swan-Ganz  Indication - Diagnose the severity of left ventricular failure - Check if Left Ventricle is over stretched, under stretched or appropriately stretched - Quantify the degree of mitral valve stenosis - Physician can calculate the dose of diuretic drugs - Evaluating pulmonary hypertension - diagnosis of acute respiratory distress syndrome
  • 15. Pulmonary Wedge Pressure aka: Pulmonary capillary wedge pressure (PCWP) Pulmonary artery occlusion pressure ( PAOP)  Catheter Swan-Ganz  Indication - Diagnose the severity of left ventricular failure - Check if Left Ventricle is over stretched, under stretched or appropriately stretched - Quantify the degree of mitral valve stenosis - Physician can calculate the dose of diuretic drugs - Evaluating pulmonary hypertension - diagnosis of acute respiratory distress syndrome
  • 16. skeletal traction
  • 17. Thomas splint
  • 18.  Dribbling, Difficulty starting urine stream  Retention  Inability to void after alcohol & cold exposure  Frequency  Urgency  Small less forceful urine  Nocturia  Elevated WBC, and BUN  Prostate specific antigen (PSA)
  • 19.  ASYMPTOMATIC for 5 or more years after  Early symptoms resemble a FLULIKE illness  MALIGNANCIES: Kaposi’s sarcoma, skin cancer  laboratory tests - Enzyme-linked immunosorbent assay (ELISA) - Western Blot - Rapid HIV tests (30 minutestest)
  • 20. Pregnancy Induced Hypertension Types BP Proteinuria Edema Other S/Sx Mild 140/90 (increase of 30/15) 1+ to 2+ Slight in upper extermities Wt gain 2nd tri 2 lbs/week 3rd tri 1 lb/week Severe 160/110 3 to 4 + Pulmonary Peripheral Edema Epigastric Pain Hepatic Dysfunction Oliguria<500ml/24 Eclampsia up 4+ -same- CONVULSION COMA
  • 21. Anorexia Nervosa Bulimia Nervosa 15% loss of BW BMI<17.5 kg/m Strict dieters Indulges in strenous exercises Pre-occupation with foods Amenorrhea for 3 cycles  binge-purge Russel’s sign Teeth missing lower incisors Abusive of laxative, enema, diuretics Rectal bleeding/constipation Do’s •Small frequent feedings •Monitor I&O, weight gain •Stay with client during meal or atleast 1 hr after •Accompany to the Don’ts •Express feeling of shock/disgust •Don’t compare with others •Don’t allow long time meals (set 30 mins. meal time)
  • 22. Spina Bifida
  • 23. IV Therapy Phlebitis Inflammatory response to damage to the intimal layer of the vein caused by mechanical or physiochemical forces. S/sx of infection A palpable venous cord indicates advanced stage of phlebitis. When identified, remove the PIV . Phlebitis Scale 0 = No Symptoms 1 = Erythema 2 = Pain 3 = Streak Formation, venous cord 4 = Purulent Drainage, palpable venous cord Infiltration Inadvertant administration of medication or solution into tissue surrounding the vein. It’s called Extravasion if vesicant medication is administered into the surrounding tissue. Infiltration: Most commonly identified complication of PIV therapy with a reported incidence of 23% to 78%. . Infiltration Scale 0 = No Symptoms 1 = Some Edema, Cool 2 = 1-6 inch Edema, Cool, Pain 3 = > 6 inch edema, pain, numb 4 = Pitting Edema, Circulatory impairment The difference between Phlebitis and Infiltration
  • 24. …just remember this rADiAtIoN SaFeTy - Label potentially radioactive material - Limit time spent near the source 30 mins/day - Distance from the source 6 feet away - Shield Device Lead Apron - Room Private Room - Dislodge Implant 1. Long handle forceps 2. place in lead lined container 3. report
  • 25. Nerve Injury Paralysis/Effects C1 to C5 Paralysis of muscles used for breathing and of all arm and leg muscles; usually fatal. C5 to C6 Legs paralyzed; slight ability to flex arms. C5: Weakness - shoulder abduction (raising the arm). C6: Weakness: elbow flexion, wrist extension. C6 to C7 Paralysis of legs and part of wrists and hands; shoulder movement and elbow bending are relatively preserved. Weakness: shoulder abduction. C7: Weakness in elbow extension, wrist flexion C8 to T1 Legs and trunk paralyzed; eyelids droop; loss of sweating on the forehead (Horner's syndrome); arms relatively normal; hands paralyzed. C8: Weakness in thumb extension, wrist ulnar deviation (rotate away from the thumb) T2 to T4 Legs and trunk paralyzed; loss of feeling below nipples. T5 to T8 Legs and lower trunk paralyzed; loss of feeling below the rib cage. T9 to T11 Legs paralyzed; loss of feeling below umbilicus (belly button). T12 to L1 Paralysis and loss of feeling below the groin. L2 to L5 Different patterns of leg weakness and numbness. S1 to S2 Different patterns of leg weakness and numbness S3 to S5 Loss of bladder and bowel control; numbness in the perineum.
  • 26. Bronchial Hygiene Therapy (BHT)
  • 27. Chest physiotherapy  includes postural drainage, chest percussion and vibration, and breathing exercises  to remove bronchial secretions, improve ventilation, and increase the efficiency of the respiratory muscles  Postural drainage uses specific positions that allow the force of gravity to assist in the removal of bronchial secretions; before meals and at bedtime; remain in each position for 10 to 15 minutes
  • 28. Chest physiotherapy  Percussion is carried out by cupping the hands and lightly striking the chest wall; 3 to 5 minutes; percussion over chest drainage tubes, the sternum, spine, liver, kidneys, spleen, or breasts is avoided  Vibration is the technique of applying manual compression and tremor to the chest wall during the exhalation phase of respiration; helps to increase the velocity of the air expired from the small airways, thus freeing the mucus.
  • 29. …tractions & pins
  • 30. BMI vs Weight to Height Table
  • 31. BMI  Imperial BMI Formula The imperial bmi formula accepts weight measurements in pounds & height measurements in either inches or feet. 1 foot = 12 inches inches² = inches * inches  Metric Imperial BMI Formula The metric bmi formula accepts weight measurements in kilograms & height measurements in either cm's or meters. 1 meter = 100cms meters² = meters * meters Imperial BMI ( lbs/inches² ) = (weight in pounds * 703 ) height in inches² Metric BMI ( kg/m² ) = weight in kilograms height in meters²
  • 32. Enteral Nutrition  provides liquefied feeding into the gastrointestinal tract via a tube  for patient who have a functioning GI tract but cannot ingest food by MOUTH  Feeding tubes: - short-term: nasogastric tube - long-term: esophagostomy, gastrostomy, enterostomy tube
  • 33. Enteral Nutrition Nasogastric Route Nasoduodenal Route Nasojejunal Route Esophagostomy Route Gastrostomy Route Jejunostomy Route
  • 34. Nasogastric Tube  Insertion: - NEX - High Fowler’s position - Sips of water and advance tube as client swallows - Do not force the tube!  Confirm placement of NGT  Monitor and record residual volume q4h by aspirating stomach content with a syringe. A residual volume of >100-150 ml indicates delayed gastric emptying. Notify MD.  During and after feeding keep HOB 30 degrees to prevent aspiration; For continuous feedings, keep the patient in a semi-Fowler’s position at all times  Flush/Irrigate tube feeding with 30-60ml of water q4h during continuous feeding, before and after each intermittent feeding, before and after administering meds, after each time you check residual volume  Feeding set changed q24h.  Bag rinsed q4h.  Medications: ◦ Liquid medications should be diluted with water ◦ Mixing medications with the feeding should be avoided ◦ Avoid diluting capsules in water ◦ She should consult with the pharmacist to coordinate timing of meds
  • 35. Digital Rectal Exam
  • 36. Hodgkin’s Disease
  • 37. Glasgow Coma Scale
  • 38. Points for quick thinking… Natremias D hypErnatremia hydration hypOnatremia verload I was taught that kalemias do the same as the prefix except for heart rate and urine output. EX: HYPERkalemia: bradycardia, oliguria, restlessness,diarrhea, hyperglycemia,hyperreflexia, increased BP, peaked T waves HYPOkalemia: tachycardia, polyuria, constipation, hypoglycemia Calcemias do the opposite of the prefix EX: HYPOcalcemia causes neuromuscular irritability
  • 39. ……any question?