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Essential information for healthcare professionals on insulin therapy and medication management for diabetes patients. Topics include assessing peak action times for various insulins, monitoring blood sugar levels before, during, and after exercise, foot care instructions, sick day management, and complications such as lipoatrophy and lipohypertrophy. Additionally, it covers various medications and their considerations, including digoxin, warfarin, methylphenidate, ethambutol, and hydroxyurea.
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“Keep them breathing, keep them safe” Prioritization Techniques ● Prioritize systemic vs. local (life before limb) ● Prioritize acute before chronic ● Prioritize actual before potential future problems ● Prioritize according to Maslow’s- physiological needs before psychosocial (acute safety can take priority- ATI) ● Recognize and respond to trends vs. transient findings (recognizing a gradual deterioration) ● Recognize signs of emergencies and complications vs. “expected client findings” ● Apply clinical knowledge to procedural standards to determine the priority action- recognizing that the timing of administration of antidiabetic and antimicrobial medications is more important than administration of some other medications How to tackle- WHO DO YOU SEE FIRST- questions: ● Who is your most stable patient? ELIMINATE ANSWER ● Who is your most stable patient (of the 3 remaining)? ELIMINATE ANSWER ● Who is your most unstable patient (of the 2 remaining)? Airway? Breathing? Circulation? SELECT ANSWER Transmission-Based Precautions AIRBORNE MTV M- measles T- TB V- Varicella (chicken pox), varicella zoster (disseminated shingles)
M- multidrug resistant organism (MRSA) R- respiratory infection S- skin infections (localized herpes zoster) W- wound infections E- enteric infection → clostridium difficile E- eye infection → conjunctivitis (Also, Hep A) *A nurse with localized herpes zoster CAN care for patients as long as the patients are NOT immunocompromised and the lesions are covered!
Current CDC guidelines indicate that rapid implementation of standard, contact, and airborne precautions are needed for any client suspected of having SARS—in order to protect other clients and healthcare workers Skin Infections VCHIPS V- varicella zoster C- cutaneous diphtheria H- herpes simplex I- impetigo P- pediculosis S- scabies Impetigo - caused by Staph and Strep, untreated can cause acute glomerulonephritis (periorbital edema—indicates poststreptococcal glomerulonephritis) Order of PPE Application ● Gown ● Mask ● Goggles/face shield ● Gloves Order of PPE Removal ● Gloves ● Goggles/face shield ● Gown ● Mask Because the hands of health care workers are the most common means of transmission of infection from one client to another, the most effective method of preventing the spread of infection is to make supplies for hand hygiene readily available for staff to use. Because the respiratory manifestations associated with the avian influenza are potentially life threatening, the nurse’s initial action should be to start oxygen therapy! ● S/S: SOB, diarrhea, abdominal pain, epistaxis ● Institute airborne and contact precautions
According to the CDC, catheter associated UTIs are the most common health care-acquired infection in the US—primary CDC recommendations include avoiding the use of indwelling catheters and the removal of catheters as soon as possible!
Women in Labor with non-reassuring FHR- (S/S: late decels, decreased variability, fetal bradycardia, etc.) ● Turn mother on LEFT side (and give O2, stop Pitocin, increase IV fluids)
Tube Feeding w/ Decreased LOC ● Head of bead ELEVATED (to prevent aspiration) and position patient on RIGHT side (promotes gastric emptying) Postural Drainage ● Lung segment to be drained should be in the uppermost position to allow gravity to work During Epidural/Lumbar Puncture ● Side-lying (“C” curved spine)- lateral recumbent/fetal position Post Lumbar Puncture (LP) – (and also oil-based myelogram) ● Patient lies in flat supine (to prevent CSF leak and headache) for 2-3 hours ● Sterile dressing applied ● Frequent neuro checks Thoracentesis ● Position patient with arms on pillow over bed table or lying on side ● NO MORE THAN 1000cc at one time ● Post- check blood pressure, auscultate bilateral breath sounds, check for leakage, sterile dressing Patient with Heat Stroke ● Lie flat with legs elevated Hemorrhagic Stroke ● HOB elevated 30 degrees to reduce ICP and facilitate venous drainage Ischemic Stroke ● HOB flat (supine) During Continuous Bladder Irrigation (CBI) - catheter is taped to thigh ● Leg should remain straight to prevent pulling on catheter Post Myringotomy - surgical incision in eardrum to relieve pressure and drain fluid (tubes) ● Position on side of affected ear after surgery (allows
● Pain that is not relieved by prescription pain medication may signal hemorrhage, infection or increased ocular pressure Infant with Spina Bifida ● Position prone (on abdomen) to prevent sac from rupturing Buck’s Traction (skin traction) ● Elevate foot of bed for counter-traction Post Total Hip Replacement ● DON’T sleep on affected/operative side ● DON’T flex hip more than 45-60 degrees ● DON’T elevate HOB more than 45 degrees ● Maintain hip abduction by separating thighs with a pillow ● NO adduction or internal rotation Prolapsed Cord ● Knee-chest or Trendelenburg (goal is to prevent pressure on cord) Vena Cava Syndrome (pregnant women) ● Position woman on her left side (relieves pressure off vena cava from fetus)—knees flexed (blood return) o Mother may present with hypotension Infant with Cleft Lip ● Position on back or in an infant seat to prevent trauma to suture line ● While feeding, hold in upright position
Infant with Cleft Palate ● Prone
● On bed rest while implant is in place *(Common NCLEX TOPIC) Autonomic Dysreflexia/Hyperreflexia (S/S: pounding H/A, profuse sweating, nasal congestion, goose flesh, bradycardia, HTN) ● Place patient in sitting position- HIGH FOWLER’S (elevate HOB- FIRST ACTION)— decreases venous return ● Check for kinks in foley catheter tubing Spinal Cord Injury ● Immobilize on spine board ● Head in neutral position ● Immobilize with padded C-collar ● Maintain traction and alignment of head manually ● Log roll client and do not allow to twist or bend Shock ● Bed rest with extremities elevated 20 degrees, knees straight, head slightly elevated (modified Trendelenburg) Head Injury ● Elevate HOB 30 degrees to decrease ICP Peritoneal Dialysis when Outflow is Inadequate ● Turn patient from side to side BEFORE checking for kinks in tubing (according to Kaplan) Nasogastric Tube ● Elevate HOB 30 degrees to prevent aspiration ● Maintain elevation for continuous feeding or 1 hour after intermittent feedings Cardiac Catheterization ● Keep site extended (usually involves femoral artery) Post-thyroidectomy ● Semi-Fowler’s position, prevent neck flexion/hyperextension (support head, neck and shoulders) ● Trach at bedside ● Monitor respiratory status every hour
Post-Bronchoscopy
● Position in Semi-Fowler’s with arm (affected side) elevated
o This facilitates removal of fluid through gravity and enhances circulation
Prior to liver biopsy it is important to check lab results for PT time (vascular organ) Liver biopsy - (prior) administer Vitamin K, NPO at midnight, teach patient that he will be asked to hold breath for 5-10 sec, supine position with upper arms elevated Morphine is contraindicated in pancreatitis— it causes spasm of the Sphincter of Oddi— Demerol is the pain medication of choice! *After pain relief, it is important to cough and deep breathe in pancreatitis—because fluid is pushing up in the diaphragm *With chronic pancreatitis, pancreatic enzymes are given with meals Diabetes Mellitus- pancreatic disorder resulting in insufficient or lack of insulin production leading to elevated blood sugar ● Type I (insulin dependent)- immune disorder, body attacks insulin producing beta cells with resulting Ketosis (result of ketones in blood due to gluconeogenesis from fat) o Excessive thirst and weight loss are characteristic of T1DM ● Type II (insulin resistant)- beta cells do not produce enough insulin or body becomes resistant ● NCLEX Points o Assessment ▪ 3 P’s ● Polyuria (excessive urination), polydipsia (extreme thirst), polyphagia (excessive hunger) ▪ Elevated blood sugar ▪ Blurred vision ▪ Elevated HbA1C ▪ Poor wound healing ▪ Neuropathy ▪ Inadequate circulation ▪ End organ damage is a major concern due to damage to vessels ● Coronary artery disease