Sterilization is the eradication of all forms of microbial life including endospores which are the most resistant.
Disinfection is the reduction of vegetative pathogens which are non-endospore forming.
CATEGORIES OF STERILIZATION:
1. Critical - instruments which comes in contact with the bones
2. Semi-critical - instruments which comes in contant with soft tissues
3. Non-critical - instruments which comes in contact with intact skin
4. Single-use/Disposable - should be discarded every after patient
METHODS OF STERILIZATION:
1. Autoclave - superheated steam under pressure with time
- 240 degrees F, 15-20 pounds per square inch (pressure)
- uses distilled water
2. Chemclave - same as autoclave but uses chemical vapor instead of distilled water
- 270 degrees F, 15-20 pounds per square inch (pressure)
3. Dry-heat sterilization - used if the instruments will rust in the autoclave
- instruments should be properly washed and dried first before putting into the machine
COPD - chronic obstructive pulmonary disease
- irreversible respiratory disease which involves abnormal inflammatory response of the airways to noxious particles
- chronic bronchitis and emphysema
*Chronic bronchitis - presence of cough and production of phlegm for at least 3 months of each 2 consecutive years
* Emphysema - destruction of walls due to abnormal overdistention of alveoli
Bronchial asthma - onset is during childhood and is reversible as one gets older or through treatment
- involves hypermucosal edema
Pneumonia - usually caused by streptococcus pneumoniae; inflammation of the lung parenchyma
- sudden, onset shaking/chills
- rapidly rising fever
- pleuritic chest pain
- dyspnea, orthopnea
Tuberculosis - caused by mycobacterium tuberculi and mostly affects the lung parenchyma
- night sweats
- on/off fever
- pleauritic chest pain
- cough
- dyspnea
- hemoptysis
mantoux test/purified protein derivative - confirmatory test; 10 mm induration
Nursing intervention (usually for all resp diseases):
- fowler's position - lung expansion
- promote oxygenation - 2-4 L/min (if more than 50% of the concentration and given for an extended period like more than 48 hours, O2 toxicity might occur)
- deep breathing exercises
- chest physiotherapy
- increased fluid intake
Pulmonary Hypertension - systolic pulmonary artery pressure exceeds 30 mmhg/mean pulmonary artery pressure exceeds 25 mmhg
- mimic symptoms of R sided heart failure
Pulmonary embolism - there is an obstruction due to ischemia somewhere in the branches of the pulmonary artery
Angina pectoris - episodes/paroxysms of pain occurs in the anterior chest which lasts for 3-5 mins
- may be due to ischemia
Myocardial infarction - the areas of the myocardial cells have been permanently damaged, so the myocardium receives reduced oxygenated blood
- crushing, tight chest pain which radiates on the neck, jaw, arms lasting for longer period which cannot be relieved by rest/meds
- diaphoresis
- restlessness
- anxiety
- dyspnea
Nursing intervention:
- high fowler's position
- oxygenation
- feet should not be dangling, should either be dependent on bed or on floor
- avoid constricting clothing
Meds:
Nitroglycerine - decreases oxygen demand of the heart, decreases ischemia and pain
- can be given up to 3 times only
- burning sensation under tongue - drug potency
Beta blockers/calcium channel blockers - decreaser heart rate/contractility
Morphine - analgesic
Cardiac arrest - when the heart ceases to function producing inefficient pulse and blood flow
- conciousness, BP, pulse will be lost
- respiratory gasping may occur
- dilatation of the eyes may occur within 45 seconds
Basic life support is an emergency procedure that consists of recognizing signs of cardiac or respiratory arrest or both, and giving proper CPR to maintain breathing and circulation of the patient until patient recovers or advanced life support arrives
Advanced cardiac life support is also like basic life support but it uses special equipments to prolong life
Do not start CPR when:
- patient has a tag of DNR (Do not resuscitate)
- no biological effect, signs of death are evident (rigor mortis, decapitation, etc.)
- in infants: less than 28 weeks of gestation, anencephaly, less than 20 gms
Stop CPR when:
- signs of recovery has been executed by the victim
- turning over to another rescuer.medical personnel
- operator/rescuer is exhausted
- physician assumes responsibility (do CPR, declares death)
Steps:
1. Survey the scene.
2. Assess the patient. Hey, hey, hey are you ok? Activate EMS.
3. Check for obstruction.
4. If no obstruction seen, check for breathing: (1001-1005)
5: Not breathing, give 2 rescue breaths and observe for rising of the chest.
6. Check for pulse (1001-1010), carotid artery (if infant: brachial artery)
7. If no pulse, start CPR. 30 compressions: 2 rescue breaths; 5 cycles
8. Check again for pulse and breathing (1001-1010)
9. If breathing and pulse is restored, put in side lying position until EMS arrives.
Diabetes Mellitus - occurs when the person has high blood sugar level either due to insufficient production of insulin, or the body resists insulin.
DM type I
- juvenile type: onset is 30 y/o or younger
- insulin dependent DM: Beta cells of the islets of langerhans in the pancreas do not produce insulin
- treated by insulin:
*rapid acting - onset is from 30 mins - 1 hour
- actrapid, humulin R
*intermediate acting - onset is from 2 hr - 3hours
- humulin N, semilente
*long-acting - onset is from 4-5 hours
- ultralente, monotard
DM type 2
- maturity onset is 40 y/o and above
- non-insulin dependent DM: beta cells of the islets of langerhans in the pancreas produces insulin but the body resists it.
- treated by OHA (oral hypoglycemic agents)
*sulfonylareas: metformin, glucophage
Normal blood sugar level - 80-120 mg/dl
Hypoglycemia - low blood sugar level
causes: ommission of meals, overdose of insulin, strenuous activity
signs: tremors, cold clammy skin, hunger pangs, restlessness
tx: fruit juice (orange), candy, dextrose 50%
Hyperglycemia - high blood sugar level
causes: stress, surgery, overdose of insulin, overeating
signs: polyphagia (excessive starvation), polyuria (excessive urination), polydipsia (excessive thirst), kussmaul's breathing, fruity odor breath
tx: insulin, NSS + insulin
*Somogyi phenomenon - occurs when the patient took long-acting insulin at night and didn't eat any snack before going to bed. The blood sugar level will be lowered down while he/she is asleep. The body responds to this by releasing hormones to release glucose. The next morning the patient will have a high blood sugar level
*Dawn's phenomenon - usually at night hormones are released to trigger to liver to release glucose. If there is not enough insulin, the patient will suffer from hyperglycemia the next day
Shock - when there in inadequate blood and oxygen being delivered in the body
kinds:
1. hypovolemic shock - excessive blood/fluid has been lost
2. anaphylactic - due to allergy
3. septic shock - massive vascular collapse secondary to gm - infection
4. cardiogenic chock - when the heart functions inefficiently
nursing intervention: trendelenburg position to promote venous return and treat underlying cause
Post-op complications:
1. Hemorrhage - must be referred immediately for possible blood transfusion or return to OR for wound exploration
2. Post-op fever - might be due to infection
3. Infection - must be treated immediately with antibiotics
4. Atelectasis - may be due to airway obstruction because of broncial secretions. pre and post op physiotherapy should be done
5. deep vein thrombosis - poor blood supply. thrombolytics
6. delayed wound healing - wound dehiscense - may be due to extensive suture tension, malnutrition, poor blood supply. should put sterile gauze on wound and return to the doctor immediately
IV therapy:
- for patients with fluid and electrolyte imbalance
- cannot take food and fluids by mouth
- for emergency medications
- for pre and post op surgery and is NPO
- for critically ill patients
1. Verify order for IV therapy
2. explain procedure to the patient
3. prepare equipments: IV solution already with IV tubings, micropore, cotton, band-aid, IV catheter (g.18-19: BT and for surgery; g.20-22: adult; g.22-24:child)
4. find the best vein possible. straight and visible
5. ask the patient to make fist. taut the skin from where the vein is located
6. insert the IV catheter
7. observe for quick blood return
8. withdraw the stylet needle and advance the IV catheter
9. secure in place
10. connect the IV line and start the drip
11. document
Blood transfusion - transferring blood and blood-based products from one circulatory system to another.
1. Verify order for BT
2. Get patient's consent form
3. check for blood's compatibility
- cross matching has been done
- patient's name and name on the blood bag is the same
- expiration date
4. check patient's VS to obtain baseline VS
5. prepare equipments: NSS, blood unit, y-tubing administration set with filter, g.18-19 IV catheter
6. gently invert the blood bag to mix the plasma with the RBC
7. attach the blood bag to the y-port and slowly start the drip (2-5 ml for 15 mins)
8. stay with the patient to determine any hemolytic reactions
9. check the patient's VS: every 5 min for 15 min, every 15 min for 30 mins, every 30 mins for 1 hour, then every hour
10. then increase the rate. should be consumed within 4 hours otherwise blood will deteriorate
11. after blood has been transfused, start the NSS
12. dispose bag properly
13. document
Chicken pox - varicella virus
- can be transmitted through resp. route
- after 2 weeks, vesicles will appear on the skin
- crusts and scabs will be formed during the latter stage
- *Reye's syndrome - common complication
- has a higher incidence if aspirin is taken to reduce fever
- brain dysfunction occurs
Shingles - recurrence of chicken pox
- herpes zoster
- usually on the lower back
- may cause paralysis
- acyclovir is the medication of treatment
Herpes simplex - human herpes simplex virus 1 and 2
HSV 1:
- usually occurs in the oral mucosa
- cold/fever blisters
- latent on trigeminal nerve ganglia (bet. face and neck)
HSV 2:
- through sexual contact
- latent on sacral base ganglia
- both can be triggered by overexposure to UV rays, stress, and hormonal imbalance
Measles
- rubeola
- macular rash
- koplik spots (sign) - tiny red patches with white central specks on the buccal cavity
German measles
- rubella
- milder than measles
droplet - less than 1 m
airborne - more than 1 m
Hepatitis - any inflammtory disease on the liver
Hepa A - fecal oral route. contaminated food
Hepa B, D, E - sexual contact, infected blood transfusions
Hepa C - same as all
HIV - human immunodeficiency virus
AIDS - acquired immunodeficieny syndrome, latent stage
- can be transferred by sexual contact, blood transfusion, tranpslancental, breast milk, infected needles
Glasgow coma scale - objective measure used to describe patient's level of consciousness through eye opening, verbal and motor response. perfect score is 15
Eye opening:
4 - spontaneous eye opening
3 - by request
2 - to painful stimuli
1 - no response
Verbal response
5 - oriented to people, time, place
4 - engages in conversation but confused in content (disoriented)
3 - words are spoken but conversation not sustained (inappropriate)
2 - groans, evoked on pain
1 - no response
Motor response
6 - obeys command
5 - localizes painful stimuli
4 - flexion withdrawal, cannot localize pain
3 - decorticate (abnormal flexion)
2 - decerebrate (abnormal extension)'
1 - no response
walang tinginan yan.. haha sana isalba ako neto bukas! goodluck myself! I go girl!
