Theories of personality development Psychosexual Psychosocial Cognitive Developmental tasks Moral Interpersonal
Libido – inner drive Parts of body –focus of gratification Unsuccesful resolution - fixation Structures of personality
Freuds psychosexual theory
Id – pleasure principle-instinct Ego – controls action and perception –reality principle Superego – moral behavior - conscience
0-18 m0s ;oral – mouth – trust and discriminating 18 mos. – 3 years ; anal – bowels – holding on or letting go
Negativism and toilet training age
3 -6 years phallic ; genitals –exploration and discovery ( inc. sexual tension)
Gender identification and genital awareness Oedipus and Electra complex // Castration anxiety and penis envy
6-12 years –latency (quiet stage) sexual energy diverted to play. Institution of superego…control of instinctual impulses 12 – young adult – genital ; reawakening of sexual drives – relationships
Sexual maturation Sexual identity ,ability to love and work
LOGICAL CONCRETE THOUGHT INDUCTIVE RESAONING (SPECIFIC TO GENERAL) CAN RELATE ,PROBLEM SOLVING ABILITY REASONING AND SELF-REGULATION
7-12Y CONCRETE OPERATIONAL
Abstract thinking Separation of fantasy and fact Reality oriented Deductive reasoning Apply scientific method
12-ABOVE FORMAL OPERATIONAL THOUGHT
Havighurst Developmental Tasks
Baby to early childhood
Right from wrong and Conscience
Late childhood
Physical skills,wholesome attitude,social roles Conscience morality and values
Fundamental skills in academics Personal independence
Adolescence
Sexual social roles Relationships Independence and ideology
Early adulthood
Career Selecting a mate Finding Civic or social responsibility Achieving Civic or social responsibility Adjusting to changes Satisfactory career performance Adjusting to aging parents Adjusting to parental roles
Middle age
Old age
Adjusting to changes Establishing satisfactory living arrangements and affiliations
Kohlberg – MORAL DEVELOPMENT/ THINKING/ JUDGEMENT
PRE-CONVENTIONAL (0-6)
PUNISHMENT AND OBEDIENCE OBEDIENCE TO RULES TO AVOID PUNISHMENT MUTUAL INTERPERSONAL EXPECTATIONS,RELATIONSHIPS AND CONFORMITY
CONVENTIONAL ( 6-12 )
SOCIAL SYSTEM AND CONSCIENCE MAINTENANCE BEING GOOD IS IMPORTANT SELF RESPECT OR CONSCIENCE
POST –CONVENTIONAL (12 – 18 Y) PRIOR RIGHT OR SOCIAL CONTRACT UNIVERSAL ETHICAL PRINCIPLE ABIDE FOR COMMON GOOD RATIONAL PERSON-VALIDITY OF PRINCIPLES-AND BECOME COMMITTED TO THEM INNER CONTROL OF BEHAVIOR UNDERSTANDING THE EQUALITY OF HUMAN RIGHTS AND DIGNITY OF HUMAN BEINGS AS INDIVIDUALS
INTERPERSONAL THEORY
NEED FOR SECURITY-INFANT LEARNS TO RELY ON OTHERS TO GRATIFY NEEDS AND SATISFY WISHES, DEVELOPS A SENSE OF BASIC TRUST, SECURITY AND SELF WORTH WHEN THIS OCCURS
SULLIVANS
INFANCY
CHILD LEARNS TO COMMUNICATE NEEDS THROUGH USE OF WORDS AND ACCEPTANCE OF DELAYED GRATIFICATION AND INTERFERENCE OF WISH FULFILLMENT
TODDLERHOOD / EARLY CHILDHOOD
DEVELOPMENT OF BODY IMAGE AND SELF-PERCEPTION ORGANIZES AND USES EXPERIENCES IN TERMS OF APPROVAL AND DISAPPROVAL RECEIVED BEGINS USING SELCTIVE INATTENTION AND DISASSOCIATES THOSE EXPERIENCES THAT CAUSE PHYSICAL OR EMOTIONAL DISCOMFORT AND PAIN
PRE-SCHOOL
THE PERIOD OF LEARNING TO FORM SATISFYING RELATIONSHIPS WITH PEERS-USES COMPETITION,COMPROMISE AND COOPERATION THE PRE-ADOLESCENT LEARNS TO RELATE TO PEERS OF THE SAME SEX
SCHOOL AGE
LEARNS INDEPENDENCE AND HOW TO ESTABLISH SATISFACTORY RELATIONSHIPS WITH MEMBERS OF THE OPPOSITE SEX
ADOLESCENCE
BECOMES ECONOMICALLY, INTELLECTUALLY AND EMOTIONALLY SELF SUFICIENT
YOUNG ADULTHOOD LATER ADULTHOOD SENESCENCE
LEARNS TO BE INTERDEPENDENT AND ASSUMES RESPONSIBILITY FOR OTHERS
DEVELOPS AN ACCEPTANCE OF RESPONSIBILITY FOR WHAT LIFE IS AND WAS AND OF ITS PLACE IN THE FLOW OF HISTORY
FORMATION OF PERSONALITY CERTAIN GOALS MUST BE ACCOMPLISHED, IF THIS GOALS ARE NOT ACCOMPLISHED AT A CERTAIN STAGE,….PERSONALITY WILL BE WEAKENED….
FACTORS IN EACH STAGE PERSISTS AS A PERMANENT PART OF PERSONALITY…. EACH STAGE HAS MAJOR TRAUMAS AND FRUSTRATIONS THAT MUST BE OVERCOME …….SUCCESSFUL RESOLUTION OF CONFLICTS ASSOCIATED WITH EACH STAGE IS ESSENTIAL TO DEVELOPMENT…..UNRESOLVED CONFLICTS REMAIN IN THE UNCONSCIOUS AND MAY, AT TIMES, RESULT IN MALADAPTIVE BEHAVIOR
PREVENTION AND EARLY DETECTION OF DISEASE
DEVELOPMENTAL TASKS---MILESTONES ---DELAYS(FIXATIONS/LAG)
GROWTH AND DEVELOPMENT
IQ = MA / CA X 100
JUDGEMENT , COMPREHENSION AND LISTENING
DDST – BIRTH TO 6 YEARS
PERSONAL SOCIAL, FINE , GROSS MOTOR AND LANGUAGE SKILL AREAS
PKU – GUTHRINE BLOOD TEST-EAT CHON FOR 2 DAYS MIN.(PHEONISTICS – DIAPER) SICKLE CELL DISEASE –ABNORMALLY SHAPED Hg , ELISA AND WESTERN BLOT CARRIER SCREENING FOR CYSTIC FIBROSIS AND SWEAT CHLORIDE TEST
HEARING AND VISION TESTS
SCHOOL AGE
ALLEN PICTURE CARDS SNELLEN CHART-20/40 AT TODDLER AND 20/20 AT SCHOOL AGE WEBER’S-SENSORINEURAL AND CONDUCTIVE RINNE’S- CONDUCTIVE DENTAL EXAM – STARTS AT 2 YEARS
PPD – INDURATION – 72 HOURS BSE – (18-20 YRS.) POST MENSTRATION/MONTHLY TSE – MONTHLY (18-20 YRS) PELVIC EXAM WITH PAP SMEAR – IF SEXUALLY ACTIVE OR 18 Y.O. ANNUALLY
ADOLESCENT
HPN , DM, HEARING AND VISION PROSTATE –ANNUALLY@40 Ca CHECK-UPS-Q3Y-20YO ; QY – 40 YO SIGMOIDOSCOPY- > 50 Y.O. =Q3-5 YRS FECAL OCCULT BLOOD TEST- > 50 = ANNUALLY DIGITAL RECTAL EXAM - > 40 Y.O. = YEARLY PELVIC EXAM – 18-40 Y.O. =PERFORMED Q 1 – 3 YEARS WITH PAP TEST MAMMOGRAM – 35-39 = BASELINE
ADULT/ELDERLY
40-49 = Q2Y 50 AND OLDER = QYEAR
CONTRAINDICATIONS:
BP SCREENING(mmHg) IMMUNITY pg 127-130
SEVERE FEBRILE ILLNESS LIVE VIRUSES C/I FOR IMMUNOCOMPROMISED ALLERGIES RECENTLY ACQUIRED PASSIVE IMMUNITY(BLOOD TRANSFUSION AND IMMUNOGLOBULINS) Give DPT,TOPV,TINE 4-6 WKS LATER MMR 1 MONTH AFTER DPT AND TOPV REPEATED IN ANOTHER MONTH AGAIN IN 10-16 MOS.
if child –no evidence of immunization <7 y.o.
CAN GIVE DPT,MMR,TOPV, AND TINE SIMULTANEOUSLY
TD- 2 DOSES 4-8 WKS APART;3RD DOSE 6-12 MOS;BOOSTER AT 10 YRS FO LIFE RD OPV/IPV – 2 DOSES AT 4-8 WKS APART ; 3 DOSE 2 -12 MOS ND AFTER 2 (OPV NOT USED IN US) MMR-ONE DOSE – 12 MOS VARICELLA – TWO DOSES 4-8 WEEKS APART STARTS AT 12 MOS. ND HEPA B – 3 DOSES;2 1-2 MOS AFTER;3RD 4-6 MS AFTER PPV- ONE DOSE ;IF 65 AND RECEIVED > 5YEARS – ADMINISTER INFLUENZA –ANNUALLY EACH FALL
MALES -106 LBS FOR 1ST 5FT THEN ADD 6LBS/INCH ST FEMALE – 100LBS FOR 1 5 FT THEN ADD 5LBS/INCH ADD OR SUBTRACT 10% DEPENDING ON BODY FRAME. OBESE AND UNDERWEIGHT IF DEVIATION IS > 20%
SCARS,BRUISES AND LESIONS CHECK COLOR EDEMA – GRADING
SHAPE – NORMALANGLE OF NAIL BED-160’; CLUBBING ANGLE > 180 DUE TO PROLONGED DECREASED OXYGENATION BLANCHING =< 3 SECS-NORMAL
SYMMETRY, SIZE AND SHAPE CRANIAL NERVE ASSESSMENTS
HEAD
OPTIC-SNELLEN OCULOMOTOR- PERRLA TRIGEMINAL – BITE DOWN AND STROKES WITH COTTON FACIAL – FACIAL MOVEMENT AND TASTE ACCOUSTIC – HEARING AND BALANCE(WATCH TICK TEST,OTOSCOPIC EXAMS AND POSTURE TESTS) GLOSSOPHARYGEAL-GAG AND SWALLOW VAGUS- SWALLOWING AND SPEAKING
PTOSIS-DROOPING OF THE UPPER EYELID ASTIGMATISM – UNEVEN CURVATURE OF CORNEA LEADING TO REFRACTION ERRORS NYSTAGMUS- ABNORMAL, INVOLUNTARY EYE MOVEMENTS STRABISMUS-ASSYMETRICAL LIGHT EFLECTION ON EACH CORNEA RED REFLEX FROM RETINA-NORMAL COVER UNCOVER TEST – DET.EYE ALIGNMENT SNELLEN – FAR DISTANCE VISION/VISUAL ACUITY IOP-TONOMETRY TESTS INDENTATION(6-12)
EYES
PINNA BACK-UP-ADULT;DOWN-BACK-CHILD RINNE TEST – COMPARES AIR CONDUCTION WITH BONE CONDUCTION,VIBRATING FORK PLACED ON THE MASTOID IF SOUND NO LONGER HEARD POSITIONED IN FRONT OF EAR CANNAL. SHOULD HEAR A SOUND= 2:1 ; AIR CONDUCTION > THAN BONE CONDUCTION ;= POSITIVE RINNE
EARS
ASSESS CONDUCTIVE HEARING LOSS
WEBER – SENSORINEURAL AND CONDUCTIVE HEARING LOSS
EARS
FORK PLACED MIDDLE OF FORE HEAD,SHOULD BE HEARD EQUALLY=WEBER NEGATIVE IF NOT EQUAL=SENSORINEURAL HEARING LOSS. SOUND HEARD BETTER IN THE IMPAIRED EAR=BONE CONDUCTIVE HEARING LOSS, IF VICE VERSA = SENSORINEURAL DISTURBANCE
START – UPPER OUTER CLOCKWISE ASSESS FOR SIZE,SHAPE,SYMMETRY AND NODES
BREASTS
DORSAL RECUMBENT INSPECT,AUSCULTATE,PERCUSS AND PALPATE BOWEL SOUNDS-HIGH PITCHED GURGLES HEARD AT 5 – 20 SECOND INTERVALS( 5-25/MIN NORMAL) IF NOT HEARD IN 1 MINUTE STAY FOR 3 -5 MINS. MORE. SEQUENCE IS CLOCKWISE FROM RLQ
REBOUND TENDERNESS- INFLAMMATION OF PERITONEUM
ABDOMEN
KIDNEYS- DORSAL LUMBAR AREA – COSTOVERTEBRAL ANGLE KIDNEY PUNCH TEST
MUSCLE TONE AND STRENGTH
MUSCULOSKELETAL SYSTEM
0=COMPLETE PARALYSIS 1=10%-NO MOVEMENT CONTRACTION OF MUSCLE PALPABLE/VISIBLE 2=25% - FULL MOVEMENT AGAINST GRAVITY WITH SUPPORT 3=50% - NORMAL MOVEMENT AGAINST GRAVITY 4= 75%- NORMAL MOVEMENT AGAINST GRAVITY WITH MINIMAL RESISTANCE 5=100%-NORMAL FULL MOVEMENT WITH FULL RESISTANCE
JOINT MOVEMENTS-CREPITUS=GRATING SOUNDS ARE ABNORMAL FASCICULATION ABNORMAL CONTRACTIONS AND SHORTENING OF MUSCLE FIBERS TREMOR-INVOLUNTARY TREMBLING TEST FOR ROM AND ASSESS FOR ATROPHY/HYPERTROPHY/CONTRACTURES
MENTAL STATUS
NEUROLOGIC TESTS
LANGUAGE-CEREBRAL CORTEX-APHASIA ORIENTATION(TIME,PLACE,PERSON)(CONFUSION) MEMORY- IMMEDIATE RECALL, RECENT MEMORY AND REMOTE MEMORY ATTENTION SPAN AND CALCULATION JUDGEMENT – EXPLAIN/INTERPRET / PERSONAL VIEWS PERCEPTION – SENSORY ANALYSIS AND INTEGRATION
CEREBELLAR FUNCTION- COORDINATION , POINT TO POINT TOUCHING,ALTERNATING MOVEMENTS,GAIT CRANIAL NERVE FUNCTIONS SENSORY FUNCTION(e.g. PROPRIOCEPTION-POSITION SENSERHOMBERG’S TEST)
DEEP TENDON REFLEX
NEUROLOGIC TESTS
0-NO REFLEX +1 – MINIMAL ACTIVITY(HYPOACTIVE) +2 – NORMAL RESPONSE +3 – MORE ACTIVE THAN NORMAL +4 – MAXIMUM ACTIVITY ( HYPERACTIVE)
PRESENCE OF INFANTILE REFLEXES(BABINSKI) IN AN ADULT SIGNIFIES CNS PATHOLOGY
GLASGOW COMA SCALE=15 POINTS, 7 COMA
LEVEL OF CONSCIOUSNESS
EYE OPENING
SPONTANEOUS=4 TO VERBAL COMMAND=3 TO PAIN=2 NO RESPONSE=1
MOTOR RESPONSE
TO VERBAL COMMAND=6 TO PAINFUL STIMULI/LOCALIZES PAIN=5 FLEXES AND WITHDRAWS=4 DECORTICATE=3 DECEREBRATE=2 NO RESPONSE=1
HEEL-TOE WALKING AND VICE VERSA FINGER TO NOSE TEST AND OTHER SENSORY FUNCTION TEST (ONE AND TWO POINT DISCRIMINATION) EXTINCTION PHENOMENON-SYMMETRICAL AREAS ARE TOUCHED BUT SENSATION ON ONE SIDE CANNOT BE FELT INDICATES LESIONS OF SENSORY CORTEX
ASSESS APPEARANCE AND ORIFICES AND INGUINAL LYMPH NODES INSPECT CERVICAL OS AND VAGINA-SPECULUM DEVIATIONS
GENITALIA , ANUS AND RECTUM
CYSTOCELE, RECTOCELE,ENTEROCELE HYPO AND EPISPADIAS-URETHRAL OPENING DISPLACED HERNIAS-DIRECT,INDIRECT , FEMORAL INSTRUCT PNT TO BEAR DOWN-PALPABLE BULGE
DIGITAL RECTAL EXAM –INSPECTION AND PALPATION –POSITION BOTH=SIM’S , FEMALES – LITHOTOMY;MALES =STAND AND BEND FORWARD PROSTATE GLAND-4 CM ;CERVIX = 2-3 CM HEMORRHOIDS =DILATED VEINS
SELF CONCEPT – COLLECTION OF FEELING BELIEFS ABOUT ONE’S SELF SELF ESTEEM – CONFIDENCE IN ONE’S ABILITIES AND JUDGEMENT
STRESS , ANXIETY AND CRISIS SELF- AWARENESS
ASSERTIVENESS + SELF - EVALUATION
GAS – ALARM-RESISTANCE-EXHAUSTION COPING AND STRESS MANAGEMENT
STRESS
ANXIETY
MILD – SLIGHT AROUSAL AND INCREASED PERCEPTION MODERATE-INC. TENSION AND SELECTIVE INATT. SEVERE – DEC. PERCEPTION AND FOCUSSED ENERGY PANIC – OVERPOWERING AND LOSS OF CONTROL
GRIEF AND LOSS Loss is a universal experience that occurs throughout life span Grief is a form of sorrow involving feelings, thoughts, and behaviors caused by bereavement Responses to loss are strongly influenced by one’s cultural background The grief process involves a sequence of affective, cognitive, and psychological states as a person responds to, and finally accepts a loss. Responses to loss and patterns of coping with loss are developed early in life.
Stages of Grieving (Kubler-Ross) Denial- refuses to believe that the loss has occurred Anger- the individual resists the loss and may “act out” feelings. Bargaining- the individual attempts to make a deal in an attempt to postpone the reality of loss. Depression- overwhelming feeling of loneliness and withdrawal from others Acceptance- the individual comes to terms with loss, or impending loss, psychological reactions to loss to the loss cease, and the interaction to other people resumed.
DEATH CONCEPTS
LOSS ,GRIEVING AND DEATH
1-5Y.O – IMMOBILITY AND INACTIVITY Wishes and unrelated action responsible for action 5-10 – final but can be avoided 9-12 – understands own mortality and fears death 12 – 18 – fears and fantasizes avoidance 18-45 – increased attitude awareness 45-65 – accepts mortality Above 65 – multiple meanings, encounters and fears
D – SUPPORTIVE
KUBLER ROSS – STAGES OF GRIEF
A- PROVIDE STRUCTURE AND CONTINUITY B – LISTEN AND ENCOURAGE D- ALLOW EXPRESSION AND PROVIDE FOR SAFETY A- ENCOURAGE PARTICIPATION
6 MOS – 2 YEARS PROVISION OF DIGNIFIED PAIN FREE DEATH( QUEST. ANSWERED AND EMT. SUPPORT) DNR- COMFORT AND HYGIENE NEEDS ON-GOING CURE GOALS ----- COMFORT GOALS
CONCEPTS
HINDU – REINCARNATION , AUTOPSY , ORGAN DONATION, CREMATION ISLAM – NO TO ORGAN DONATION , CREMATION AND AUTOPSY …..CONFESS AND TURN TO MECCA JUDAISM – WASHED NATIVE AMERICAN – NOT TO AUTOPSY BUDDIST – OK – EUTHANASIA AND WITH LAST RITES
CONCEPTS
SAFETY AND INFECTION CONTROL
NON – SPECIFIC AND SPECIFIC CHAIN OF INFECTION
PROTECTING HEALTH
UNIVERSAL PRECAUTION PRINCIPLES OF SURGICAL ASEPSIS INFECTION CONTROL MEASURES ISOLATION – CATEGORY SPECIFIC AND DISEASE SPECIFIC MEDICAL AND SURGICAL ASEPSIS
Strict Isolation-highly transmissible diseases by direct contact and airborne routes of transmission
Private rom,patient w/ same organism,mask,handwashing,labelled plastic bags for soiled articles
H. influenza, measles, mumps, N. Meningitidis
Tuberculosis/ AFB isolation-suspected / active TB
Universal Precautions
Private room with negative pressureventilation so that air room is vented outside, mask, handwashing, bronchoscopy and dental examination postponed until 2 weeks of antibiotic therapy
Tuberculosis
Contact Isolation – infectious disseases or multiple resistant microorganisms that are spread by direct contact or close contact
Enteric Precautions – infectious diseases transmitted through direct or indirect contact with infected feces.
Handwashing , gloves , gowns worn only when handling contaminated objects with feces
Aseptic meningitis, AGE , Hepa A , Typhoid fever, diarrhea (CDT )
Drainage / Secretions precautions – patients with wound drainage or infected wounds
Universal Precautions
Gloves, gowns indicated if clothing is likely to be contaminated
Burns
Universal Blood and Body fluids precautions – blood borne , body fluids pathogens ( blood , semen , vaginal secretions , CSF , synovial fluid , pleural fluid , peritoneal fluid , pericardial fluid , amniotic fluid and tissues.
Universal Precautions
Gloves , mask, protective eyegears, gown , contaminated needles not recapped and sharps in puncture resistant containers
Aids , Hepatitis B and C , STD’s
Patient is protected from pathogens and nosocomial infections by instituting reversed transmission precautions
Reverse Isolation
Burns and open wounds, patients with artificial airway , immunocompromised patients – leukemia , AIDS , steroid therapy , radiation or cancer chemotherapy , medication effect of leukopenia or agranulocytosis
Infectious agents- pathogens (bacteria, fungi, virus, protozoa) Reservoirs- sources or places for growth of the pathogens ReservoirsPortal of Exit and Entry- provides the way for the pathogen to leave one host and enter Entryanother host Modes of transmission- vehicles of transmission of the pathogens transmissionSusceptible Host- a carrier capable of supporting and transmitting microorganism Host
Body Defenses Against Infection
Normal Flora
Intact Skin Saliva and Mucus Membrane Cilia of the Upper Respiratory Tract Infection Inflammatory process Immune Response
Medical Asepsis/ Clean Technique Principles: Pathogens move through spaces or air current Pathogens are transferred from one surface to another whenever objects touch. Hand washing removes microorganism Pathogens are released into the air on droplet nuclei when person speaks, breaths, and sneeze. Pathogens are transferred by virtue of gravity Pathogens move slowly on dry surface but very quickly through moisture.
Surgical Asepsis/ Sterile Technique Areas of the body considered sterile are:
Blood stream Spinal Fluid Peritoneal Cavity Urinary Tract Muscles Bones Chamber of the Eyes
Sterile object remains sterile when touched by another sterile object Sterile objects or fields, which falls out of the range of vision or below one’s waist, are considered contaminated. Sterile items become contaminated when they come in contact with microorganism transported through the air. When sterile object/ field come in contact with another surface, it becomes contaminated. Fluids flows in the direction of gravity. The edges of the sterile field are considered unsterile.
Isolation Practices Strict Isolation- prevents transmission of highly communicable disease by contact and airborne transmission Respiratory isolation- prevents transmission by droplet Enteric precaution- prevents transmission through ingestion Wound and skin precaution- prevents cross-infection by direct contact with wounds and contaminated articles Discharge precaution- prevent cross-infection by secretions-contaminated articles Blood precaution- prevent transmission by contact with blood or items contaminated with blood
PQRST AND QUEST PHARMACOLOGICAL Tx PAIN GATEWAY CONTROL THEORY PLAN AND PREVENT INJURY/HARM PROVIDE ALTERNATIVE MEASURES PROPHYLACTIC/PREVENTIVE PCA PREFERENCE AND PARTICIPATION
COMFORT AND PAIN *COMFORT AND PAIN
Pain The noxious stimilation of threatened or actual tissue damage (Geach, 1987) Whatever the experiencing person says it is, existing whenever he or she says it does (McCaferry, 1979) It is highly subjective and individual and that is one of the body’s defense mechanism indicating that there is a problem. It is protective as it gives warning or signal for tissue injury
Assessment of Pain Precipitating Factors- “ What triggers the pain or makes it worse?” Quality of Pain- “Tell me what the pain feels like” Alleviating Factors- “What measures relieve your pain” Meaning of pain- “ How do you interpret the pain?”
Pattern Location Pain- “Where is your pain” Periodicity- “How long have you felt the pain sensation?”
REM – DREAM PARADOXICAL SLEEP PRIMARY AND SECONDARY SLEEP DISORDERS
REST AND SLEEP *REST AND SLEEP
RESTFUL ENVT. RITUALS RELAXATION RELEVANT MEDS AND RELATED THERAPY & NON PHARMACOLOGIC Tx RECORD ASSESSMENTS AND HISTORY
Stages of Sleep: Non-Rapid Eye Movement (NREM)- for body restoration
Very Light Sleep- drowsy, and readily awakened Light Sleep- Heart and respiratory rate decreases and the body temperature gradually falls. PNS domination- Difficult to arouse Deep Sleep- Decrease metabolism and very difficult to arouse
Rapid Eye movement (REM)- increase synthetic processes of the brain Paradoxical Sleep Dream state of the sleep Close to wakefulness but difficult to arouse
Common Sleep Disorders Insomia- sleeplessness Hypersomia- Excessive sleep at day time Narcolepsy- Sleep attack Parasomias
Somnambolism- sleep walking Soliloqy- Sleep talking Bruxism- clenching and grinding of teeth Night Terrors- bad dreams Nocturnal Erections- wet dreams
Nocturnal Enuresis - BEDWETTING
SAFETY
Rest is the diminished state of activity Sleep is a state of decreased perception and reaction to the environment There are theories of sleep:
Active theory- there are parts of the brain that inhibit other brain parts Passive theory- the reticular activating system of the brain fatigues and becomes depressed, thus sleeps occurs
TRIAGE DISASTER MANAGEMENT -=A,B,C
*SAFETY
P REVENT ABSORPTION O FF AND OUT I DENTIFY S UPPORT AND SUPPLY ANTIDOTE O NGOING MONITORING N OTIFY
POISONING
CHILD PROOF REFER - POISON CONTROL CENTER IDENTIFY AND BRING AGENT SECURE SAFETY AND ABC’S INDUCE VOMITING W/ IPECAC STOP/DELAY ABSORPTION W/ WATER/MILK/ACTIVATED CHARCOAL THE NURSE SHOULD INTERVENE IF A MOTHER OF A VICTIM OF POISONING VERBALIZES TO DO THE FOLLOWING:
PLANS TO INDUCE VOMITING FOR PATIENT WITH ASPIRIN POISONING
PLANS TO INDUCE VOMITING WHEN SHE IS CERTAIN THAT HER CHILD’S GAG REFLEX AND LOC ARE INTACT WILL NOT GIVE IPECAC IF CHILD IS EXHIBITING NARROWED PULSE PRESSURE WILL WAIT FOR THE SEIZURE TO END BEFORE ADMINISTERING IPECAC
SEIZURE SUBNORMAL LOC AND GAG REFLEX SUBSTANCE CORROSIVE/PETROLEUM DISTILATE SHOCK-SEVERE
CONTRAINDICATIONS OF IPECAC / INDUCTION OF VOMITING
TRIAGE-GREATEST GOOD FOR THE GREATEST NUMBER OF PEOPLE PRINCIPLES- ABCD , MASLOWS
DISASTER PLANNING
RED-UNSTABLE – IMMEDIATE CARE YELLOW- STABLE – CAN WAIT 30-60 MIN GREEN –STABLE- CAN WAIT LONGER BLACK- UNSTABLE – FATAL, LAST SEEN DOA – SUPPORTIVE COMFORT MEASURES
AMBULATORY BEDRIDDEN CRITICAL TERMINAL
DURING FIRE WHICH SET OF PATIENTS WILL THE NURSE MOBILIZE FIRST
ALARM CONTAIN MOBILIZE EXTINGUISH
WHICH STEP IN FIRE MANAGEMENT COMES LAST?
READ ENSURE SUPERVISION LOCK AVOID TRANSFERING TEACH AND EDUCATE MANAGEMENT IPECAC ACTIVATED CHARCOAL H2O OR MILK NA SO4 SPECIFIC ANTIDOTE OR ANTAGONIST
POISONING
CHILD PROOF REFER - POISON CONTROL CENTER IDENTIFY AND BRING AGENT SECURE SAFETY AND ABC’S INDUCE VOMITING W/ IPECAC STOP/DELAY ABSORPTION W/ WATER/MILK/ACTIVATED CHARCOAL
FALLS(RAT) RISK ASSESSMENT TOOL
ALTERATION IN SENSATION AND PERCEPTION AWARENESS LEVEL ABILITY TO COMMUNICATE ALTERED GAIT AND POSTURE AMBULATION NEEDS ANXIETY AND EMOTIONAL STATE ASSOCIATED INJURY AND DISEASE ACCESS(LIFESTYLE)
L IGHTING L OWER BED POSITION L OCATE GRAB BARS AND CALL BELL S UFFICIENT ORIENTATION S IDERAILS S UPERVISE AND ORIENT
PREVENTION OF FALLS
ASSIST FREQUENTLY ASSIGN HEALTH CARE PROCEDURES IN PAIRS AREA SUPERVISION ADIMINISTRATION ADJUSTMENTS ALLOW ROCKER CHAIR AND FREQUENT WALKS APPLY PILLOW,WEDGE , PADS AND PROPER POSITIONING ALLEVIATE AGITATION ASSESS AND MONITOR
RESTRAINTS
RESTRAINTS-(HALF BOW KNOT/CLOVE HITCH,SQUARE OR REEF KNOT)
LIMB MUMMY ELBOW MITT OR HAND JACKET BELT OR SAFETY STRAP
CONTROL IMMEDIATE SITUATION OUT OF AREA MAINTAIN CALM BE FIRM AND SET LIMITS ALTERNATIVE TO RESTRAINTS,ASSESS AND ASSIST TRY POSITIVE CONSEQUENCES
CONFUSED AND COMBATIVE
INFANT BATHING COMPLETE ADULT BED BATH TUB BATH THERAPEUTIC
HYGIENE *HYGIENE AND COMFORT
SALINE OATMEAL CORNSTARCH NACHO3 KMnO4
PERINEAL / GENITAL CARE FOOT AND NAIL CARE HAIR CARE ORAL CARE BEDMAKING
HYGIENE AND COMFORT
PRESSURE ULCER
GRADING PREVENTION TREATMENT
ERGONOMICS
ACTIVITY AND EXERCISE *ACTIVITY AND EXERCISE
TYPES AND PRINCIPLES
ROM AND ISOMETRICS
PROBLEMS OF IMMOBILITY AND NURSING INTERVENTIONS
ACTIVITY ORDERS
POSITIONING MOVING AND LIFTING
*MOBILITY AND IMMOBILTY
AMBULATION AMBULATION AIDS
TRANSFERS TRANSFER AIDS
PASSIVE ROM-RETENTION OF ROM AND MAINTENANCE OF CIRCULATION ASSISTIVE- INCREASES MOTION , MAINTAINS MUSCLE TONE ACTIVE – MAINTAINS MOBILITY OF THE JOINT AND MAINTAINS MUSCLE STRENGTH RESISTIVE – INCREASES MUSCLE POWER ISOMETRICS- MAINTENANCE OF STRENGTH AND PREVENTS MUSCULAR ATROPHY
GLAUCOMA(POST OP) – AFFECTED SIDE HEMORROIDECTOMY – SIDE LYING HIATAL HERNIA- UPRIGHT HIP SURGERY – LEGS IN ABDUCTION LAMINECTOMY – BACK AS STRAIGHT AS POSSIBLE LIVER BIOPSY – RIGHT SIDE LYING LOBECTOMY – SEMI FOWLERS POST LP – FLAT MASTECTOMY – ELEVATE EXTREMITY ON PILLOW MYELOGRAM – WATER BASED DYE – ELEVATE THE HEAD --- OIL BASED DYE - FLAT
POSITIONING FOR SPECIAL CONDITIONS
POSTURAL DRAINAGE – LUNG SEGMENT – UPPERMOST POSITION PROLAPSED CORD – KNEE-CHEST PULMONARY EDEMA – FOWLERS PYLORIC STENOSIS – RIGHT SIDE LYING RADIUM IMPLANT – FLAT ON BED RETINAL DETACHMENT – AFFECTED SIDE TOWARDS THE BED
PRIORITY-ASSESS PERSONAL CAPACITY 1ST USE PROTECTIVE DEVICES/ TRANSFER AIDS CHANGE POSITION SLOWLY-ORTHOSTATIC HYPOTENSION(DANGLE LEGS FIRST) PIVOT ON THE STRONGER SIDE,MOVE PNT TOWARDS STRONGER SIDE USE LARGER MUSCLES OF THE BODY AND FACE THE DIRECTION OF THE MOVEMENT PULL SHEETS ARE BETTER METHOD THAN SLIDING ALWAYS MOBILZE MAXIMUM MANPOWER/HAVE AN ASSISTANT STANDING BY. ROCK FROM FRONT TO BACK/VICE VERSA.WIDE BASE OF SUPPORT, WEIGHT NEAR MIDLINE OF THE BODY.USE APPROPRIATE TRANSFER AND AMBULATION AIDS. (TRAPEZE, HOYER LIFT, SLIDE BOARD, DRAW SHEET AND TRANSFER BELT
STANDING ;2 -3 (1-2 INCHES)FINGERS BELOW AXILLA OR SUPINE ;MEASURE FROM THE ANTERIOR FOLD OF THE AXILLA TO THE HEEL OF THE FOOT AND ADD 2.5 CM
TEACH MUSCLE STRENGTHENING EXERCISES PRIOR TO AMBULATION.WEIGHT ON THE HAND GRIP (TO AVOID CRUTCH PALSY) ELBOWS SHOULD BE FLEXED 20-30’ AND CRUTCHES SHOULD BE KEPT 6 INCHES LATERALLY AND 6 INCHES TO THE FRONT=TRIPOD POSITION(810 INCHES-OK) INSTRUCT CLIENT TO MAINTAIN AN ERECT POSTURE
CRUTCH WALKING GAITS
FOUR POINT-SLOW SAFE-WEIGHT BEARING ALLOWED FOR BOTH LEGS TWO POINT- FASTER SAFE-WEIGHT BEARING ALLOWED FOR BOTH LEGS THREE-POINT-NON WEIGHT BEARING OF ONE LEG SWINGTO/SWINGTHROUGH-PARTIAL WEIGHT BEARING ALLOWED FOR BOTH LEGS GETTING INTO A CHAIR –BOTH CRUCHES TO THE WEAK SIDE , STRONGER ARM HOLDS THE ARMREST ST GOING UP AND DOWN THE STAIRS- GOOD GOES UP 1 AND BAD GOES ST DOWN 1 .
WALKERPROVIDES STABILITY AND BALANCE MOVE WALKER AHEAD 15 CM (6INCHES-8-10 INCHES)WHILE WEIGHT IS BORNE BY BOTH LEGS.THEN ALTERNATE WEIGHT BEARING ASSISTED BY THE ARMS ELBOWS SHOULD BE FLEXED-20-30’ IF ONE LEG IS WEAKER MOVE THAT LEG TOGETHER WITH THE WALKER
CANE HOLD CANE ON THE STRONGER SIDE FLEX ELBOW 30’ AND TIP OF CANE 15 CM LATERAL TO THE SIDE OF THE 5TH TOE. ADVANCE CANE AND AFFECTED LEG ,WEIGHT ON CANE WHEN MOVING THE GOOD LEG BUT FOR MAXIMUM SUPPORT ADVANCE CANE 1 FEET ,MOVE AFFECTED LEG THEN THE STRONGER LEG GOING UP AND DOWN THE STAIRS –SAME WITH CRUTCHES
PREMATURE INFANTS-LESS THAN37WKS/2,500G-100-200 CAL/KG/DAY AND HIGHER Na,Ca AND CHON FULL TERM-120 CAL/KG/DAY PREGNANCY + 300CAL/DAY LACTATION+ 500CAL/DAY
*NUTRITION *NUTRITION
CONDITIONS
ENTERAL FEEDINGS
PREOPERATIVE NEED FOR NUTRITIONAL SUPPORT GI PROBLEMS ONCOLOGY THERAPY ALCOHOLISM,CHRONIC DEPRESSION AND EATING DISORDERS HEAD,NECK DISORDERS OR SURGERY ASPIRATIONTUBE DISPLACEMENT CRAMPING,VOMITING,DIARRHEA HYPEROSMOLAR NONKETOTIC COMA/GLUCOSE INTOLERANCE
COMPLICATIONS
SPECIFIC NUTRIENT MODIFICATION CALORIC MODIFICATION CONSISTENCY
NUTRITION
SPECIAL DIETS FOR SPECIFIC DISEASES DIETARY MODIFICATIONS FOR SPECIAL CONDITIONS
AGE – CLEAR LIQUID AGN – LOW NA , LOW CHON ADDISON’S – HIGH NA , LOW K ANEMIA , PERNICIOUS – HIGH CHON , VIT. B. ANEMIA SICKLE CELL – HIGH FLUID GOUT – PURINE RESTRICTED ADHD AND BIPOLAR – FINGER FOODS BURN – HIGH CAL. HIGH CHON CELIAC – GLUTEIN FREE CHOLECYSTITIS – HIGH CHON, HIGH CARB, LOW FAT CHF – LOW NA , LOW CHOL. CROHNS – HIGH CHON AND CHO, LOW FAT
THERAPEUTIC DIET FOR SPECIFIC CONDITIONS
CYSTIC FIBROSIS – HIGH CAL., HIGH NA LITHIASIS----ACID ASH FOR ALK. STONES------ALK. ASH FOR ACID STONES DECUBITUS ULCERS – HIGH CHON , HIGH VIT C DIARRHEA – HIGH K AND NA DUMPING SYNDROME – HIGH FAT, HIGH CHON,DRY HEPATIC ENCEPHALOPATHY-LOW CHON HEPATITIS – HIGH CHON,HIGH CAL.
THERAPEUTIC DIET FOR SPECIFIC CONDITIONS
HIRSPRUNGS – LOW RESIDUE, HIGH CHON AND CHO CIRRHOSIS – LOW CHON MENIERE’S LOW NA MI AND HPN – LOW CHOL.,FATS,NA HYPERTHYROIDISM- HIGH CAL. AND CHON HYPOTHYROIDISM – LOW CAL. , LOW CHOL, LOW SAT. FAT
NEPHROTIC SYNDROME – LOW NA, HIGH CHON , HIGH CAL. HYPERPARATHYROIDISM – LOW CALCIUM HYPOPARATHYROIDISM – HIGH CA, LOW PHOSPHORUS OSTEOPOROSIS – HIGH CALCIUM AND HIGH VIT. D PANCREATITIS – LOW FAT PUD – HIGH FAT, HIGH CARB. LOW CHON PKU – LOW CHON / PHENYLALANINE PIH – HIGH CHON
THERAPEUTIC DIET FOR SPECIFIC CONDITIONS
RENAL FAILURE (ACUTE) – LOW CHON,HIGH CARB
THERAPEUTIC DIET FOR SPECIFIC CONDITIONS
LOW NA (OLIGURIC PHASE) HIGH CHON , HIGH CAL AND RESTRICTED FLUID (DIURETIC PHASE
RENAL FAILURE (Chronic) – LOW CHON , LOW NA , LOW K
TYPES OF SOLUTIONS
TOTAL PARENTERAL NUTRITION
TPN-AMINO ACID-DEXTROSE- 2-3 L /24H – FINE BACTERIAL FILTER USED TNA-TOTAL NUTRIENT ADMIXTURE- AMINO ACID, DEXTROSE AND LIPIDS-1 LITER /24 HOURS – NO FILTER
PERIPHERAL=NO >10% DEXTROSE AND 2 WKS ONLY CENTRAL – INCOMPATIBLE WITH MEDS AND BLOOD IF SINGLE LUMEN USED ATRIAL-HICKMAN/BIOVAC AND GROSHONG- HUBBER NEEDLE USED TO ACCESS PORT THROUGH SKIN
INITIAL RATE OF INFUSION 50 ML/HR THEN 100-125/HR. COMPLICATIONS-HYPEROSMOLAR COMA, SEPSIS, PNEUMOTHORAX
TPN
FAST RATE=HYPEROSMOLAR STATE(HEADACHE,NAUSEA,MALAISE,FEVER,CHILLS) SLOWED RATE=REBOUND HYPOGLYCEMIA
X-RAY CONFIRMS PLACEMENT ATTACH TO PUMP
IV TUBING AND FILTER CHANGED Q24 HOURS ALLOW SOLUTION TO WARM IMMEDIATELY BEFORE USE IF NO SOLUTION USE DEXTROSE 10% W SOLUTION
CHECK DAILY CBG,WEIGHT,TEMP. I AND O , CHECK 3X A WEEK BUN, ELECT, ONCE A WEEK – LFT’S, CBC, SERUM ALBUMIN AND PT,PTT
ENEMA
They act by distending the intestines that increases peristalsis and expulsion of feces and flatus. Enemas serve the following purpose:
Relief of constipation Relief of flatulence Lowers down body temperature Evacuates feces in preparation for diagnostic procedures Administration of medications
Take note of the general principles of Enema: Tube: lubricate and insert 3-4 inches Position: adult- left lateral; infants and children- dorsal recumbent
ENEMA
Administration- administer the enema in a minimum of 15 minutes duration. Conatainer’s Height- 12 inches above the rectum Temperature- 42°C or less
PERMANENT/TEMPORARY STOMA RED AND SLIGHT BLEEDING WHEN TOUCHEDBURNING SENSATION UNDER FACEPLATE INDICATES SKIN BREAKDOWN,REFER ABDL DISTENTION/DISCOMFORT, KARAYA POWDER(DEC.IRRITATION), CHARCOAL/BISMUTH CARBONATEDEODORIZER APPLIANCE CAN LAST 7 DAYS BUT CHANGE Q48-72H AND 24-48H IFPERIOSTOMAL SKIN ERYTHEMATOUS, ERODED ILEOSTOMY-LIQUID,CONSTANT,IRRITATING TO THE SKIN,APPLIANCE CONTINOUS,MINIMAL ODOR COLOSTOMY-FORMED , CAN BE IRRIGATED 300-500ML AND REGULATED,MAY NOT HAVE TO WEAR AN APPLIANCE
OSTOMIES
BLADDER TRAINING
URINARY ELIMATION
LABS AND DIAGNOSTIC TESTS CONDITIONS CATHETERIZATION AND IRRIGATIONS
KEGELS –STRENGTHEN MUSCLES OF THE PELVIC FLOOR-TIGHTEN FOR 3 SECS THEN RELAX FOR 3 SECS PERFORM LYING DOWN, SITTING AND STANDING FOR TOTAL OF 45 BLADDER RETRAINING
INTERMITTENT CATHETERIZATION AFTER ATTEMPTING TO VOID Q 2-3H, TIME INCREASES GRADUALLY BUT NO MORE THAN 8 HOURS BLADDER TRAINING – DRINK A MEASURED AMOUNT Q2H THEN ATTEMP TO VOID 30 MINS LATER-TIME GRADUALLY INCREASED TRIGGERING TECHNIQUES-CREDES MANEUVER AND VALSALVA CLAMP INDWELLING CATH BEFORE REMOVAL. THEN DUE TO VOID 3-4 HOURS AFETR REMOVAL
DONE 3-5 HOURS – 2-3 TIMES A WEEK AV FISTULA-NO BP,VENIPUNCTURE OR CONSTRICTIONS PALPATE FOR A THRILL AND LISTEN FOR BRUIT Q8H MONITOR FOR HEMORRHAGE DISEQUILIBRIUM SYNDROME,HEPATITIS,HEMORRHAGE,MUSCLE CRAMPS,AIR EMBOLISM AND SEPSIS-COMPLICATIONS
HEMODIALYSIS
TENCKOFF,GORE-TEX CATHETER WEIGH BEFORE AND AFTER, WARM DIALYSATE CHON LOSS, INFECTION, -PERITONITIS(CLOUDY OUTFLOW,BLEEDING) , FEVER , ABDL TENDERNESS AND N & V PREVENT CONSTIPATION BY INCREASING FIBER IN DIET,MAINTAIN STERILE PROCEDURE,FOR PROBLEMS WITH OUT FLOW –REPOSITION TYPES: CAPD(4-6H INDWELLING),AUTOMATED 30MINS EXCHANGES, INTERMITTENT- 4X A WEEK – 10H/DAY, CONTINOUS – 1 DAY INDWELLING
PERITONEAL DIALYSIS
OXYGENATION
PULMONARY FUNCTION TESTS DIAGNOSTIC LABORATORIES(ABG, SPUTUM CS AND THROAT CULTURE) VISUALIZATION AUSCULTATION
OXYGENATION
OXYGEN DELIVERY EQUIPMENT CHEST PHYSIOTHERAPY ARTIFICIAL AIRWAYS THORACOCENTESIS,THORACOSTOMY.TRACHEOSTOMY AND ET INTUBATION SUCTIONING CHEST TUBES AND DRAINAGE SYSTEMS
CHEST PHYSIOTHERAPY
TURNING COUGHING DEEP BREATHING POSTURAL DRAINANGE PERCUSSION AND VIBRATION INCENTIVE SPIROMETRY SUCTIONING TRACHEOSTOMY CARE OXYGEN THERAPY VENTILATOR CARE AND MANAGEMENT
Chest Physiotherapy It is the combination of percussion, vibration, and postural drainage Percussion is done for 1-2 minutes. If the patient has tenacious secretions, this can be performed for 3-5 minutes Vibration is done during 5 exhalations Postural drainage is done for 15-20 minutes usually performed 3-4 times a day. Instruct the client to increase fluid intake to liquefy secretions This procedure should not be performed in clients who are pregnant, with chest injuries, dizzy, with pulmonary embolism and abdominal surgery. This procedure is done before meal or 90 minutes after a meal
Oxygen Therapy Indicated to clients who needs additional oxygen, those clients who have reduced lung diffusion of oxygen through the respiratory membrane, heart failure leading to inadequate transport of oxygen. Humidify the oxygen first before you administer. Check for bubbles in the humidifier to promote adequate flow of oxygen Check for kinks in the tubing Position: semi-fowlers/ high fowlers position Place cautionary readings: “NO smoking: Oxygen is in used” Instruct the client not to use woolen blankets as this may create static electricity
incentive spirometry – hold 2-6 sec; 4-5 times/H (TO MAXIMIZE RESP.&MOBILIZE SECRETIONS endotracheal tube- reposition Q8H; cuff 20 mm Hg, humidification and aerosol, deflate cuff occasionaly visualization –
X ray Lung Scxan – 20-40mins isotopes in body for 8 H laryngoscopy Bronchoscopy Thoracentesis- consent, VS and baseline X-ray + post Procedural
tie new trache tie before removing the old tie to prevent accidental dislodgement.ALLOW 2 FINGERS TO BE INSERTED UNDER TIE use precut gauze and perform care OD at least. soak iiner cannula in antiseptic soak with hydrogen peroxide, rinse well suction prn, oral care prn(PROCEDURE DONE q8h AND PRN)
Suctioning PURPOSE: To obtain sputum sample. NURSING ALERT:
ASSESS BREATH SOUNDS
Hyperoxygenate the patient before and after the procedure. Apply intermittent suction on withdrawal of the catheter. Do not suction the patient for more than 15 seconds. IDEAL 10 SECS
Thoracentesis PURPOSE: Aspiration of fluid and /or air from the pleural space. space. NURSING ALERT: Check the consent. Position: Sitting on the side of the bed with feet on a chair, leaning over a bedside table. If the patient unable to sit, the patient may lie in his/her side with hands on the side resting on opposite shoulder. Instruct the patient not to cough, breath deeply or move during the procedure. After the procedure: Position the patient on the unaffected side/puncture site up. Check for bleeding at the puncture site and monitor the respiratory function. Notify the physician if signs of pneumothorax, air embolism and pulmonary edema occur.
INFANT-DISTRACT TODDLER-ALLOW REGRESSION AND INVOLVE PARENTS,CONSISTENT CAREGIVER PRE-SCHOOL-LET CHILD HANDLE EQUIPMENT,EXPRESSION OF FEELINGS THROUGH PLAY DEMOFAMILIAR SORROUNDINGS SCHOOL AGE- EXPLAIN SIMPLY AND ALLOW CHOICES ADOLESCENTS- INVOLVE AND POINT OUT STRENGTHS AND BENEFITS,EXPECT RESISTANCE
*PERI-OPERATIVE NURSING PREOP CARE
PREOP CHECKLIST
CONSENT HEALTH TEACHING (SPEC. POST OP PROCEDURES) LAB TESTS,ECG,X-RAY SKIN PREP BOWEL PREP IV’S NPO PREOP MEDS,SEDATION AND ANTIBIOTICS REMOVAL OF DENTURES,NAILPOLISH AND JEWELRY NUTRITION-TPN OR ENTERAL FEEDINGS PREOP
INTRAOP- MAINTAIN SURGICAL ASEPSIS, MONITOR CLIENT STATUS,, APPROPRIATE GROUNDING DEVICES, FLUID BALANCE AND SPONGE/INSTRUMENT COUNT POST OP- MONITOR VS Q15X4;Q30X2;Q1HX2 THEN PRN MONITOR I AND O , K LEVEL , CVP, BOWEL SOUNDS, BREATH SOUNDS AND LOC RESPIRATORY PHYSIOTHERAPY,TCBD INCENTIVE SPIROMETRY-20 SECS INHALATION ENCOURAGE AMBUALTION REFER IF UNABLE TO VOID IN 8 HOURS APPLY TED HOSE AND PNEUMATIC COMPRESSION DEVICE,CHECK FOR HOMAN’S SIGN
WOUNDS NOTE DRESSING AND INCISION FEVER 1-2 DAYS POST OP-ATELECTASIS/ DEHYDRATION 3-7 DAYS – INFECTION UPPER GI TUBES-GASTRIC DECOMPRESSION LOWER GI TUBES – BOWEL DECOMPRESSION ST WOUND HEALING BY 1 INTENTION-SUTURED AND APPROXIMATED ; 3RD INTENTION-NOT CLOSED,W/ PURPOSE EX: DRAINS ND WOUND HEALING BY 2 INTENTION-INCREASED INCIDENCE OF INFECTION , INCREASED SCARRING AND LONGER HEALING TIME
SHOCK PARALYTIC ILEUS ATELECTASIS AND PNEUMONIA - 2ND DAY EMBOLISM- 2ND DAY WOUND INFECTION-3-5D DEHISCENCE AND EVISCERATION-5-6D PSYCHOSIS CARDIOVASCULAR COMPROMISEURINARY RETENTION-8-12H URINARY INFECTION -5-8 D DVT-6-14 DAYS-1 YEAR