nov7 - simulated 1& 2

8/8/2019 Nov7 - Simulated 1& 2

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GOODAFTERNOON!!!!



Clean-Catch (Midstream) Specimen

perennial area is washed

Mild antiseptic/liquid soap

midstream ur ine is collected 30 ml

avoid collecting initial & last f e w dr ops

send specimen laboratory or within 2 hour s

Collecting Urine Specimens



Ster ile Specimen f r om Indwelling Catheter

a. Fr om a closed system Method

² clamp drainage tubing about 4µbelow junction of drainage tubing and

catheter for 10-30 minutes ² Clean specimen collection port with

alcohol or antiseptic solution

² Collect 3-10 ml of urine with asterile syringe

² For self-sealing catheter, insert needle

slowly at 450 angle taking care not topuncture the other side of the tubing

Collecting Urine SpecimensCollecting Urine Specimens

b. Open-System Method

-Place line saver under tubing at

junction of catheter and drainagetubing

-Disinfect the junction before andafter the collection

-Hold the disconnected tube(catheter and drainage tubing)

1.5-2 inches from each other

-Do not allow the catheter tip totouch container



24-Hour Ur ine Collection.

Ur ine passed in a 24-hour per iod is collected

Measures the amount of certain chemicals the kidneys clean f r om the body.

To see if too little or too much ur ine is pr oduced. Decide on the day and time-usually started in the

morning

Discar d the fir st voided ur ine

Collect all the subsequent ur ine passed

At the 24th hour, collect the last sample Ur ine should be k ept cool, ref r igerated

Specimen sent to the laboratory within 2 hour s af ter collection

Collecting Urine Specimens



IntravenousIntravenous pyelogrampyelogram(IVP)(IVP)

Visualization of the Urinary system

K idney

Urethers

Bladders

Aka

Intravenous pyelography (IVP).

Urography.Pyelography.




ydetect problems:

kidney stones enlarged prostate

tumors in the kUB

surgery on the urinary tract




y Preparation:

Enema( aperients) 24 hours

NPO 6

² 8 hoursRemove : jewelry, dentures, eye glasses and any

metal objects or clothing

y Patient wears cotton examination gown.

y Bladder emptied immediately before examination.

y Site: median cubital vein : 20 gauge



point of comparison«point of comparison«

- inflammation of RenalPelvis/ Renal Parenchyma

- s/sx:

cystitis s/sx

pain: flank pain ² T12 & L3

Costovertebral TendernessFever: High

CYSTITIS PYELONEPRHRITIS

- inflammation of theUrinary Bladder

- s/sx:

Dysuria

Freqyuency

Urgency

NoctoriaPyuria : cloudy.foul odor

Pain : suprapubic/hypogastric

Fever: Low Grade



y 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



LowLow purinepurine diet««diet««

- indicated for gout, ur ic acid kidney stones and ur ic acid retention

- pur pose is to decrease the amount of pur ine

FOODS:

AVOID organ meats, fish, lobster s dr iedpeas and beans, nuts, oatmeal, whole wheat



GABHS

Inflammation of kidney

Periorbital Puffy eyes

Hematuria(tea colored) Hallmark sings/Classics sign

Hypertension

Plasmapheresis

Diuretics

Steroids

Autoimmune

Increase glomerolar

permeability

Hallmark sings/Classicssign

- Protienuria

- Edema

- Hypercholeteremia

Plasma Expanders Diuretics

Streroids

Glomerulo-

nephritis

Nephrotic

Sydrome



OLDCART METHOD

O- onset of pain

L- location of pain

D- duration of pain

C- characteristic of pain

A- aggravating factors

R ²radiation of pain

T- treatment

PQRST mnemonics

P- provoked ( what brought

about pain)

Q- quality of painR- region or radiation of

pain

S- severity

T- timing

MNEMONICS

FOR PAIN

ASSESSMENT



Pulmonary Wedge PressurePulmonary Wedge Pressureak a:ak a:Pulmonary capillary wedge pressurePulmonary capillary wedge pressure (PCWP)(PCWP)

Pulmonary artery occlusion pressurePulmonary artery occlusion pressure ( PAOP)( PAOP)

y Catheter Swan-Ganz

y 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

Normal PAWP : 8-12 mmHg

Above 20 mmHg : Acute Pulmonary edema



sk eletal tractionsk eletal traction



Thomas splint



y Dribbling, Difficulty starting urine stream

y Retention

y Inability to void after alcohol & cold

exposurey Frequency

y Urgency

y Small less forceful urine

y Nocturia

y Elevated WBC, and BUN

y Prostate specific antigen (PSA)



y ASYMPTOMATIC for 5 or more years after

y Early symptoms resemble a FLULIK E illness

y MALIGNANCIES: Kaposi·s sarcoma, skin cancer

y laboratory tests

- Enzyme-linked immunosorbent assay (ELISA)- Western Blot

- Rapid HIV tests (30 minutestest)



Pregnancy Induced HypertensionPregnancy Induced Hypertension

TypesTypes BPBP ProteinuriaProteinuria EdemaEdema Other S/Other S/SxSx

MildMild140/90140/90

(increase(increaseof 30/15)of 30/15)

1+ to 2+1+ to 2+Slight inSlight in

upperupperextermitiesextermities

Wt gainWt gain

22ndnd tri 2 lbs/weektri 2 lbs/week33rdrd tri 1 lb/weektri 1 lb/week

SevereSevere160/110160/110

3 to 4 +3 to 4 +PulmonaryPulmonaryPeripheralPeripheral

EdemaEdema

EpigastricEpigastric PainPain

Hepatic DysfunctionHepatic Dysfunction

OliguriaOliguria<500ml/24<500ml/24

Eclam psiaEclam psia

upup 4+4+--samesame-- CONVULSIONCONVULSION

COMACOMA



Anorexia Nervosa Bulimia Nervosa

15% loss of BW

BMI<17.5 kg/mStrict 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 bathroom

Don·ts

Express feeling of

shock/disgust

Don·t compare with others

Don·t allow long time meals

(set 30 mins. meal time)



SpinaSpina BifidaBifida



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 isadministered 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



«just remember this«just remember this

r ADiAtIoN 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 forceps2. place in lead lined container

3. report



Nerve

Injury

Paralysis/Eff ects

C1 to C5 Paralysis of muscles used for breathing and of all arm and leg muscles;

usually f atal.

C5 to C6Legs paralyzed; slight ability to f lex arms.C5: Weak ness - shoulder abduction (raising the arm).

C6: Weak ness: elbow f lexion, wr ist extension.

C6 to C7

Paralysis of legs and part of wr ists and hands; shoulder movement and

elbow bending are relatively preserved.

Weak ness: shoulder abduction.

C7: Weak ness in elbow extension, wr ist f lexionC8 to T1 Legs and tr unk paralyzed; eyelids dr oop; loss of sweating on the forehead

(Horner's syndr ome); arms relatively normal; hands paralyzed.

C8: Weak ness in thumb extension, wr ist ulnar deviation (r otate a way f r om the

thumb)

T2 to T4 Legs and tr unk paralyzed; loss of f eeling below nipples.

T5 to T8 Legs and lower tr unk paralyzed; loss of f eeling below the r ib cage.

T9 to T11 Legs paralyzed; loss of f eeling below umbilicus (belly button).

T12 to L1 Paralysis and loss of f eeling below the gr oin.

L2 to L5 Diff erent patterns of leg weak ness and numbness.

S1 to S2 Diff erent patterns of leg weak ness and numbness

S3 to S5 Loss of bladder and bowel contr ol; numbness in the per ineum.



Br onchial Hygiene Therapy (BHT)Br onchial Hygiene Therapy (BHT)



Chest physiotherapy

y Percussion is carried out by cupping the hands and

lightly str iking the chest wall; 3 to 5 minutes;

percussion over chest drainage tubes, the sternum,

spine, liver, kidneys, spleen, or breasts is avoided

y Vibration is the technique of applying manual

compression and tremor to the chest wall during

the exhalation phase of respiration; helps toincrease the velocity of the air expired from the

small airways, thus freeing the mucus.



«tractions & pins«tractions & pins



BMI BMI vsvs Weight to Height TableWeight to Height Table



BMIBMI

y Imper ial BMI Formula

The imperial bmi formula accepts weight measurements in pounds& height measurements in either inches or feet.1 foot = 12 inchesinches² = inches * inches

y Metr ic Imper ial BMI Formula

The metric bmi formula accepts weight measurements inkilograms & height measurements in either cm's or meters.

1 meter = 100cmsmeters² = meters * meters

Imperial BMI ( lbs/inches ) = (weight in pounds * 703 )height in inches

Metric BMI ( kg/m ) = weight in kilograms

height in meters



EnteralEnteral Nutr itionNutr ition

y pr ovides liquefied f eeding into the

gastr ointestinal tract via a tube

y for patient who have a functioning GI tract but cannot

ingest food by MOUTH

y Feeding tubes:

- short-term: nasogastric tube

- long-term: esophagostomy, gastrostomy,

enterostomy tube



Enteral Nutr itionEnteral Nutr ition

Nasogastric Route Nasoduodenal Route

Nasojejunal Route Esophagostomy Route

Gastrostomy Route Jejunostomy Route



Nasogastr ic Tubey Insertion:

- NEX

- High Fowler·s position- Sips of water and advance tube as client swallows- Do not force the tube!

y Confirm placement of NGTy Monitor and recor d residual volume q4h by aspirating stomach content

with a syr inge.A residual volume of >100-150 ml indicates delayedgastr ic emptying. Notif y MD.

y Dur ing and af ter f eeding k eep HOB 30 degrees to prevent aspiration;For continuous f eedings, k eep the patient in a semi-Fowler·s position at all times

y Flush/Irr igate tube f eeding with 30-60ml of water q4h dur ing continuousf eeding, before and af ter each intermittent f eeding, before and af ter administer ing meds, af ter each time you check residual volume

y Feeding set changed q24h. y Bag r insed q4h.y Medications:

Liquid medications should be diluted with water

Mixing medications with the f eeding should be avoided

Avoid diluting capsules in water

She should consult with the pharmacist to coor dinate timing of meds



Digital Rectal ExamDigital Rectal Exam



Hodgkin·s DiseaseHodgkin·s Disease



Glasgow Coma ScaleGlasgow Coma Scale



Points for quick thinking«Points for quick thinking«Natremias

DhypErnatremiahydration

hypOnatremiaverload

I was taught that k alemias do the same as the prefix except for heartrate and ur ine 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



««any question?««any question?

nov7 - simulated 1& 2

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