Health Safety Study Sheet

Health Safety Study Sheet


Measurements:

• 5mL/teaspoon
• 3teaspoon/tablespoon
• 15mL/tablespoon

Stages of Pressure Ulcers: (Taylors, pgs 933-34)

• 1= red
• 2= partial
• 3= full
• 4= eschar, black

RYB Wound Classification: (Taylors, pg 939)

• R= Red= Protect
• Y= Yellow= Cleanse
• B= Black= Debride

Poison Control:

• attempt to identify poison before calling poison control center
• liquid drainer is alkaline, do not use ipecac bc it may cause further burning if it comes in contact with esophagus for a second time
• battery acid is acidic and will cause more trauma on the way back up
• gasoline, grease, and oily substances cause respiratory distress and the risk for aspiration is very high
• insecticide should be expelled to avoid absorption so emesis is indicated 

Sensory Deprivation:

• pg 1579, 1583-85 Taylors
• results when a person experiences inout or input that is monotonous, unpatterned, or meaningless
• Risk for sensory deprivation includes:
• environment with decreased or monotonous stimuli
• institutionalized patients
• small living area at home
• bed rest
• isolation
• Impaired ability to receive stimuli
• impaired vision or hearing
• bandages or casts that interfere with vision or tactile stimulation
• affective disorders
• Inability to process environmental stimuli
• spinal cord injuries
• confused
• taking drugs that affect CNS

Sensory Overload:

• Taylor's pg 1579
• person experiences so much sensory stimuli that  the brain s unable to respond meaningfully or ignore the stimuli
• Pts at risk:
• acute or chronically ill
• patients in pain
• pts with intrusive monitoring equipment
• pts in critical care setting
• pts with disturbances or nervous system
• Nurisng Interventions:
• provide consistent predictable pattern of stimuli to help pt develop sense of control
• offer simple explanations before procedures
• establish a schedule
• speak calmly
• explore what stimuli are more sidtressing
• do not sensory deprivation
• identify and eliminate culturally inappropriate stimuli
• orient pt to time and place
• decrease environmental noise
• encourage pt to participate in care
• Signs:
• reduced attention span
• disorganized visual and motor coordination
• disorientation 
• confusion

Types of Immunity (Kee, Pharmacology, pg 502):

• Active Immunity
• is the production of antibodies in the body in response to natural or artificial antigens
• Passive Immunity
• an individual receives antibodies against a particular pathogen from another source
• Natural Immunity
• genetically determined in specific populations
• Acquired Immunity
• occurs from exposure to to an antigen or from passive injection of immunoglobulins
• Vaccination provides active, artificial immunity
• Infection provides active, natural immunity
• Maternal to fetal provides natural, passive immunity
• Transfer by injection provides passive, artificial immunity

Bed Safety:

• It is more important for a bed to be closer to the ground than to have the bed rails up when preventing falls
• Patients can still climb over bed rails

Assessing Risk for Falls:

• risk for gal must be documented as part of the nursing process
• fall risk must be documented because it is part of the nursing process that requires recognition and documentation of fall risks
• after the risk for falling is documented, one can begin to chose safety devices

Restraints:

• should be tied in half-bow knot for quick release
• to protect circulation, restraints should not be snug
• a nurse can independently implement orders for restraints
• they should be assessed every 30 minutes and real eased every two to four hours
• they should be removed as soon as they are no longer needed
• they should not be tied to bed rails

Stages of the Nursing Process

• Assessing:
• collection, validation, communication of data
• establish database
• history
• physical assessment
• review record
• validate data
• communicate data
• Diagnosing:
• analysis of pt data to identify patient strengths and health problems that nursing intervention can prevent or resolve
• interpret and analyze data
• identify strengths and weaknesses
• develop list of diagnoses
•  Planning:
• specify outcomes to reduce , prevent, or resolve, problem
• specify nursing interventions
• Implememting:
• Carrying out the plan of care
• carry out care
• document care
• assist pt to achieve desired outcome
• promote wellness
• prevent disease
• restore health
• promote pt change
• Evaluating
• Measurig the extent to which pt has achieved goals specified in plan
• revise plan if necessary
• continue, modify, or terminate nursing care

Timing of Assessments:

• Initial Assessment
• happens once and is done
• Ongoing Assessment
• happens repeatedly to determine specific problem
• Emergency Assessment
• focuses on life threatening problems
• Time Lapsed Assessment
• compares clients current status to baseline data obtained previously at an earlier date

Physical Examination of Abdomen:

• Observation
• Auscultation
• Percussion
• Palpation

 Stress:

• Maladaptive Response
• smoking
• Developmental crisis:
• occurrence at a predictable stage in someones life
• Coping Mechanism
• innate or habitual reaction to a specific problem or situation
• Risk factor
• something that predisposes someone to a problem
• Prolonged stress
• increases demands on adrenal glands to secrete stress hormones and they can become enlarged
• cortisone production increases
• stomach lining may become irritated
• Structuring
• controlling a situation to keep a threat from occurring
• Self Discipline
• using self talk to convert strength
• Stressors activate the sympathetic nervous system
• epi and norepi are released
• pupils dilate
• heart rate increases
• respirations increase in rate and depth
• blood pressure is elevated
• blod sugar increases due to glucocorticoids being released
• mouth is dry

Maslow's Hierarchy of Needs:

• Taylors pgs 55-59, 72, 1495
• Level 1: Physiologic Needs
• breathing, circulation, temp, food, fluids, elimination, movement
• Level 2: Safety and Security
• housing, community, climate
• Level 3: Love and Belonging
• relationships, communication, support systems
• Level 4: Self Esteem
• fear, sadness, loneliness, happiness, accepting self
• Level 5: Self Actualization
• thinking, learning, decision making, values, beliefs, fulfillment, helping others

Defense Mechanisms:

• Taylors pgs 362, 1527
• Compensation
• person attempts to overcome a perceived weakness by emphasizing a more desirable trait or overachieving in a more comfortable area
• ex: student who has difficulty in academics may excel at sports
• Denial
• person refuses to acknowledge the presence of a condition that is disturbing
• ex: ager finding lump in breast, pt does not seek treatment
• Displacement
• transfers or displaces and emotional reaction from one object or person to another object or person
• ex: person angry with co worker kicks chair
• Introjection
• person incorporates qualities of values of another person into his or her own ego structure. Important during childhood. 
• ex: child adopts parents value of education by telling sibling to go to school
• Projection
• persons thoughts or impulses are attributes to someone else
• Rationalization
• behavior justification
• Reaction Formation
• person develops conscious attitude and behavior patterns that are opposite to what he or she would really like to do
• kid has crush but is mean to that person instead
• Regression
• person returns to earlier method of behavior
• soiling diapers
• Repression
• person voluntarily excludes an anxiety producing event from conscious awareness
• ex: don't remember doing something bad
• Sublimation
• person subsitutes a socially acceptable goal for one whose normal channel of expression is blocked
• ex: individual who is aggressive becomes star football player
• Undoing
• act or communication used to negate a previous act or communication

Drains:

• inserted near wound to promote drainage, thereby reducing the risk of abscess formation and promoting wound healing
• assess the amount, color, odor, and consistency of wound drainage
• the amount and color depend on the wound location and size
• asses drainage on wound, bandages, in drainage bottles

When Implementing Wound Care/Cleaning:

1. Review medical orders for care
2. Gather necessary supplies and bring to bedside
3. Perform hand hygiene and put on PPE, if indicated
4. Identify Patient
5. Close curtain or door for privacy and explain what you are going to do

Prevention:

• Primary Prevention
• focused on promotion and encourage healthy lifestyles and prevent illness
• Secondary Prevention
• focuses on early detection and prompt prevention
• Tertiary Prevention
• restoration and rehabilitation to promote optimal functioning

If a patient does not recognize a med you are giving that they normally take, verify the physicians order that they have the right med ordered.

Ear Drop Administration:

• Adult: pull pinna up and back
• Children: pull pinna down and back

Intramuscular Injections: (Taylor's 751-755, 795-799)

• Preferred Sites
• Infant: vastus lateralis
• Toddlers and Children: vastus lateralis, deltoid
• Adults: ventrogluteal , deltoid
• Intramuscular Needle Injection Length:
• Vastus lateralis: 5/8" to 1"
• Deltoid (children): 5/8" - 1.25"
• Deltoid (adults): 5/8" to 1.5"
• Ventrogluteal (adults): 1.5"
• Inject medication slowly: 10 seconds per 1mL
• Z-track technique: ensures medication does not leak back along the needle
• massage of the site is not recommended but applying pressure is ok

Medication Serum Concentration:

• Highest concentration: when absorption of the drug decreases, when last bit is absorbed
• when excretion of the drug begins, the levels start to fall
• the half life is the time it takes for excretion to lower the serum medication's level by half

Intradermal Injections:

• must be short and fine
• 25, 26, or 27 gauge needle

Sedatives:

• note respiratory rate prior to administration
• a full stomach is not always necessary but can help with nausea 
• should not adversely affect pt weight
• alcohol may enhance the affects

Hearing Aids:

• batteries may last a few days to weeks depending on the type of battery, frequency of use, and power of the aid
• a constant whistling sound means the battery is functioning 
• avoid heat and moisture to keep from damaging the device

Teen agers to best on group learning situations so they can feel acceptance from peers.

Phases of Wound Healing (Taylor's pg 923-24):

• Hemostasis:
• vessels first constrict and clotting begins
• then vessels dilate and capillary permeability increases to allow plasma and blood components to leak into the injured area forming an exudate
• increased perfusion rests in heat and swelling
• platelets release substances that tell other cells to migrate to the area to help heal
• Inflammatory Phase:
• lasts 4-6 days
• leukocytes and macrophages move to wound
• leukocytes arrive first and ingest bacteria and cellular debris
• macrophages arrive ~24hrs later and ingest debris and secrete growth factors necessary for repair
• acute inflammation is characterized by redness, heat, swelling, pain , and loss of function
• Proliferation Phase:
• regenerative phase
• can last for weeks
• formation of granulation tissue (highly vascular, red, bleeds easily)
• Maturation Phase:
• 3 weeks after injury continuing for months or years
• To promote wound healing a diet with plenty of protein for tissue repair
• Suppuration is the formation of pus by bacteria in an infected wound and would indicate an infection is developing
• Granulation tissue is part of the normal healing process for a wound that has not been sutured closed

Skin Lesions:

• Circumscribed, Flat, Nonpalpable Change in Skin Color
• Macule
• freckle, petichiae
• <1 cm="" comment-1cm--="" nbsp="">
• Patch
• vitiligo
• > 1cm
• Palpable, Elevated Solid Masses
• Papule
• mole
• < 0.5 cm 
• Plaque
• coalesced papules
• Nodule
• firmer than papule
• wart
• Tumor
• mass & > 2cm
• lipoma
• Wheal
• irregular, superficial area of localized edema
• hives, mosquito bite
• Circumscribed, Superficial skin Elevations Formed by Free Fluid in  Cavity Within the Skin Layers
• Vesicle
• filled with serous fluid
• herpes simplex
• Bulla
• filled with serous fluid
• & > 0.5 cm
• 2nd degree burn
• Pustlule
• filled with pus
• acne, impetigo

Heat/Cold Therapy:

• Heat is applied to promote vasodilation and increase cellular nutrition
• Cold therapy is applied to slow nerve conduction to decrease pain, inflammation, and ease muscle spasms

Asepsis:

• Surgical asepsis refers to being free of all microbes that cannot be eliminated by hand washing alone.
• Handwashing is a form of medical asepsis
• Isoporpyl alcohol can inhibit growth of organisms but does not sterilize
• In surgical asepsis, forceps must be held with the tips below the handles so that fluid does not run onto the handle and become contaminated by the hands
• If you come into contact with a patient's blood: clean the exposed area with soap and water to reduce the number of pathogens and prevent infection. This is the first action taken.

Hormones:

• Corticosteroids decrease and inhibit inflammation
• Endorphins act on peripheral nervous system reduce pain
• Epinephrine is an adrenal hormone used to treat anaphylaxis, acute bronchial spasms, and other allergic reactions
• Histamine is part of the inflammatory response released when tissue injury occurs

Vitamins and Wound Healing

• Vitamin A is helpful only if the patient is on steroids
• Vitamin C is needed for the synthesis of collagen material that is generated with wound healing
• Vitamin D does not have a particular role in wound healing but is important when bones are injured
• Vitamin K is needed for blood clotting

Radiation:

• Radon accounts for over 50% of humans exposure to radiation
• There is not enough evidence to make a direct relationship between natural radiation and illness

Fire Safety:

• Water will not extinguish  grease fire. It may cause the grease to splash, further spreading the fire
• Carbon dioxide extinguishers are for use on liquid or electrical fires. They are not effective over large areas because the gas disperses quickly
• Water is most appropriate for a paper fire
• A fire retardant blanket is best at smothering a fire, denying it air and access to combustible materials. It is appropriate for any fire

Preschool Communicable Diseases Safety:

• The best way to protect preschoolers from communicable diseases is by immunization

Review of Sympathetic Nervous System Stimulation:

• invoke flight or fight response system
• causes release of adrenocortical hormones, including the glucocorticoids, that increase blood sugar
• respiratory rate is increases
• the heart rate is increased

General Adaptation Syndrome:

• biochemical model of stress
• Three stages:
• alarm reaction
• increase in energy levels, heater rate, resp rate, CO, BP, mental alertness
• stage of resistance
• body attempts to adapt to stressor
• vitals, hormone levels, energy production returns to normal
• if damage to the body is too great, the adaptive mechanisms fail
• stage of exhaustion
• results when adaptive mechanisms are exhausted
• without defense against stressor body will either rest and return to normal or reach total exhaustion and die

Local Adptation Syndrome:

• localized response of the body to stress
• involves only a specific body part, such as a tissue or organ, and not the entire body
• primarily a short term homeostatic adaptive response

Effects of Drug Administration:

• Therapeutic Effect: the desired effect of the medication
• Cumulative Effect: when the body cannot metabolize one dose of the drug before the next dose is administered resulting in an increased amount of the drug in the body
• Idiosyncratic Effect: any abnormal or peculiar response- different from expected response
• Side Effect: predictable effect of a med other than the anticipated, therapeutic effect, such as nausea

Factors that Modify Drug Response:

• Absortion:
• A major variable in absorption is the route of administration. Oral absorption takes place as drugs move away from the GI tract to body fluids. Any GI disturbance (vomiting, diarrhea) will affect absorption
• Distribution:
• Protein binding is a major modifier of drug distribution in the body.
• The blood brain barrie allows only lipid soluble drugs to cross
• Metabolism:
• Many factors influence metabolism
• Age, weight, and liver function can all affect metabolism
• Infants have immature kidney and liver function
• Older clients often have decreased liver function due to aging
• Excretion:
•  the main route of excretion is via the kidney
• decrease in function leads to decreased excretion of drugs
• bile, feces, respiration, saliva, and sweat are also routes for excretion
• Age:
• Infants and older persons are more sensitive to drugs
• Older persons may be more sensitive to barbiturates and CNS depressants
• Infants dosage is based on weight in kg
• Weight:
• persons of higher weight may need higher dosage
• lower weight may need lower dosage
• Toxicity:
• refers to the first adverse symptoms that occur at a particular dose.
• toxicity is more prevalent is persons with liver or renal impairment and in older and younger persons
• Pharmacogenetics
• refers to study of interrelation of heredity on drug response
• up to 95% of drug effects are associated with genetic variability
• Route of Administration:
• drugs delivered by IV act more rapidly than those administered by mouth
• Time of Administration
• presence or absence of food in the stomach
• Emotional factors
• suggestive comments about the drug and its effects
• Preexisting disease state
• liver, kidney, hear, circulatory disease
• Drug History
• past use of current or different drugs can reduce or intensify current effect f drug
• Tolerance:
• ability of a client to respond to a particular dose of a certain drug may diminish after days or weeks
• Cumulative effect:
• occurs when a drug is being metabolized or excreted more slowly then it is being administered

Applying Ointment into child'e eye:

• eye should be washed in direction of inner cathus to outer cathus to avoid forcing foreign material into the  nasolacrimal duct
• the first bead of ointment is considered contaminated and discarded
• no portion of the eye should be touched when administering eye drops or ointment to avoid damage to eye and contamination of applicator
• wiping the applicator tip with a tissue after administering the med increases risk for contamination

Different Types of Wound Gauze:

• hydrocolloid dressings have an inner absorbent layer that forms a moist gel over the wound and promotes granulation
• dry or moist gauze is used to wick drainage
• moist to dry is commonly used to remove necrotic tissue

Lab Values in Relation to Infection, Inflammation, and Wounds

• Eosinophils increase in cases of allergic reactions and stress response
• Erythrocyte sedimentation rate is increased when inflammation is present. This is not the same as an elevated production of erythrocytes as in chronic hypoxia or polycythemia 
• Monocytes in crease in response infection but are not helpful in differentiating between bacterial and other infections
• Neutrophils increase specifically to prevent or limit bacterial infection. Their presence is a key indicator of a bacterial infection.
• Decreased albumin: less than 3.2 is risk for development of ulcer
• Prealbumin less than 19
• Lymphocyte less than1800
• Hemoglobin A1C greater than 8
• Glucose greater than 120
• decreased hemoglobin normal in older adult

Examples of Wound Dressings/Products (Taylors, pg 945):

• Transparant films:
• allow exchange of O2 between wound and environment
• self adhesive
• protect against contamination
• prevent loss of wound fluid
• maintian moist wound environment
• facilitate autolytic debridement
• no absorption of drainage
• allow for visualization of wound
• may remain in place for 24 to 72 hours 
• used with stage 1pressure ulcers
• Hydrocolloid Dressings:
• limit exchange of O2 between wound and environment
• minimal absorption of drainage
• maintains a moist environment
• self adhesive
• provides cushioning
• facilitate autolytic debridement
• protect against contamination
• may be left in place for 3-7 days
• Hydrogels:
• maintain moist environment
• minimal absorption of drainage
• do not adherer to wound
• reduce pain
• require a secondary dressing to secure
• Alginates:
• used for packing for deep wounds and for infected wounds
• requires secondary dressing for securing
• 1-3 days
• Foams:
• provides absorption, protection, insulation, and debridement
• conforms to uneven wound surfaces
• Collagens
• absorbant

Complete Medication Prescription:

• name of med
• dosage
• route
• frequency

Health Illness Continuum:

• high level of health at one end
• death at other
• views health as a constantly changing state
• teaching can be done at any time

Leavell and Clark:

• agent-host-environment model of health and illness
• used for examining the cause of disease in an individual
• environmental factor or stressor must be present for illness to occur

Health Belief Model, Rosenstock, 1974:

• concerned with what people perceive, or believe, to be true about themselves in relation to their health
• model is based on three components:
• percieved susceptability to a disease
• perceived seriousness of a disease
• perceived benefits of action

Health Promotion Model, Pender:

• developed to illustrate how people interact with their environment as they pursue health
• a person with high self esteem is more likely to choose healthy behaviors
• a person with low self esteem is more likely to make poor health choices

Random:

• scored tablets can be broken into halves of quartered
• enteric coated and sustained release delay absorption until capsule has reached small intestine; should not be crushed or cut
• 1 grain = 60 mg
• 3ml per intramuscular
• 1ml per subq
• insulin is given in units via insulin pen/syringe and should not be measure in any other type of syringe
• whenever an IV rate is increased, monitor pt for increased, resp rate, heart rate, and lung congestion- signs of fluid overload
•