TOXIC SHOCK SYNDROME

 Caused by toxin by strains of the

bacterium Staphylococcus Aureus
 Frequently associated with menstruating
women
 Other risk factors: chronic vaginal
infection, pelvic infection, lung abscess,
surgical wound, infection, soft tissue
infection, postpartum and gynecologic
infections, use of IV drugs, tampons
 Recurrence rate: 20%
 Clinical Manifestations: sudden fever,
chills, malaise and muscle pain
 Vomiting, diarrhea
 Hypotension
 Red, macular rash similar to sunburn
often occurs ( appearing in the torso)
 Medical Management: directed primarily
at controlling the infection with antibiotics
and restoring circulating blood volume
 Complications: DIC, septic shock
TRACHEOSTOMY

 Performed to bypass an upper airway

obstruction
 Allow removal of tracheobronchial
secretions
 Long term use of mechanical ventilation
 Prevent aspiration
 To replace endotracheal tube
 A Tracheal Button is a rigid cannula that can be placed into
the tracheostomy stoma after removal of a tracheostomy
tube.
 The button does not extend into the tracheal lumen.
 The tracheal button requires a mature stomal tract, and is
generally used as a long-term solution for people with
obstructive sleep apnea, which cannot be treated by other
means.
 It is generally kept closed during the day to be unobtrusive,
and opened at night to eliminate sleep apnea.
 Since the tube does not extend far into the airway itself
(like a standard tracheotomy tube), it is easy to breath and
talk normally with the device in place.
 It does not need to be opened during the day, since there is
no fixed airway obstruction, as in laryngotracheal stenosis.
In sleep apnea, the blockage is due to dynamic collapse of
the soft tissue of the throat during the muscle relaxation
that accompanies sleep.
How Does PD Clean the
Blood?
 Diffusion
 passage of particles in
solution across a semi-
permeable membrane
from an area of
greater concentration
to an area of lower
concentration
 continues until
equilibration is
achieved
How Does PD Clean the
Blood?
 Osmosis
 movement of
water from an area
of low
concentration to
an area of high
concentration
THE PERITONEUM

semi-permeable sac
lining the abdominal
cavity and covering
the abdominal
organs
 Inhibits presynaptic
uptake of NT
norepinephrine and
serotonin;
anticholinergic action @
CNS and peripheral
receptors
 SE: sedation, dry mouth,
blurred vision,
photosensitivity,
orthostatic hypotension,
urinary retention
 6 RIGHTS OF MEDICATION
ADMINISTRATION

 Right medication
 Right dosage
 Right route of administration
 Right time
 Right client
 Right charting
 Tamoxifen

 orally active selective

estrogen receptor modulator
(SERM) which is used in the
treatment of breast cancer
 acts as an antagonist so that
transcription of estrogen-
responsive genes is inhibited
 USES: infertility
gynecomastia
retroperitoneal fibrosis
Tamoxifen

 SE: endometrial cancer

rapid increase in
triglyceride
thromboembolism
fatty liver
prevents osteoporosis
COMPLICATIONS OF PERIPHERAL I.V.
THERAPY
 INFILTRATION
Causes: dislodged needle or obstruction of
fluid flow
S/Sx: edema, blanching of skin, discomfort at
site, cooler skin temperature
Preventive Nursing Mgt: Use the smallest
gauge of needle possible; use an armboard;
check frequently for coolness of skin around
site, check IV flow rate q 2 hours
Nursing Intervention: D/C IV; apply cold
compress if within first 30 mins. Then apply
warm moist heat to increase absorption of
fluid
 PHLEBITIS
Causes: overuse of vein, irritating infusion
solutions or meds, catheter in vein for too
long, use of large-gauge catheter
S/Sx: tenderness, pain along the course of the
vein, edema, redness at insertion site, red
streak along course of vein, extremity with
IV feels warmer than other extremity
Preventive Nursing Mgt : Change IV site q 72
hrs, use large veins, stabilize cannula, dilute
meds adequately & infused at prescribed
rates, choose the smallest-gauge catheter
possible to administer solutions
Nursing Intervention: apply warm compresses
 HYPOSPADIAS
 Urethral opening is located behind the
glans penis or along the penile shaft

 S/Sx: visualization of defect, ventral

curvature of the penis, urine does not
come out the end of the penis

 Tx: surgery by 6-18 months

 PRESCHOOLER DIET
 Food jags are common; may refuse to eat
anything except one food at each meal.
 Continues to refuse casseroles and mixed
food items.
 Finger foods remain popular.
 Do not bribe child to eat or tell him or her
to “clean your plate.” Serve smaller portions;
if insufficient amounts are not eaten during
mealtimes, eliminate snacks.
 Recognize that refusing to eat is a way to
attract attention.
FUNCTIONAL ASSESSMENT STAGING
OF ALZHEIMER’S DISEASE ( FAST)

 STAGE 1  Capable of self-care

 STAGE 2  Complains of
forgetting, inability
to locate objects.
Subjective work
difficulties. Capable
of self care
 STAGE 3  Decreased ability in
a demanding work
setting is evident to
peers. May have
difficulty traveling
to new areas.
Capable of self-care
regarding ADL.
 STAGE 4  Decreased ability to
perform complex
tasks. Partial self-
care; needs
supervision and
assistance.
 STAGE 5  Requires assistance
selecting attire.
May need to be
coaxed to bathe;
fear of bathing may
develop.
 STAGE 6  Decreased ability to
put on clothing
properly & perform
personal hygiene
measures.
Urinary/fecal
incontinence.
Possible seizure
Sundowner’s
syndrome
 STAGE 7  Vocabulary reduced
to few words, then
to just one word.
Loss of ambulatory
ability , ability to
sit, ability to smile
and eventually to
hold up head
MENIERE’S DISEASE
 Chronic disease involving the inner ear
causing the triad – vertigo, hearing loss
and tinnitus
 Unknown cause
 Fluid distention of the endolymphatic
spaces of the labyrinth destroys
cochlear hair cells
 Usually unilateral
MENIERE’S DISEASE

 Sudden motion of the head may

precipitate attack
 Caloric test
 Vestibular suppressant
 Streptomycin
 Surgery: endolymphatic sac
decompression; labyrinthectomy
 Caloric stimulation is a test which uses
differences in temperature to diagnose
ear nerve damage.
 This test stimulates the inner ear and
nearby nerves by delivering cold and
warm water to the ear canal at different
times.
 When cold water enters the ear, it should
cause rapid, side-to-side eye movements
called nystagmus. The eyes should move
away from the cold water and slowly
back.
 Next, warm water is placed into the ear.
The eyes should now move towards the
warm water then slowly away.
 Patches called electrodes, placed around
the eyes, detect the movements. A
computer records all the results.
 Do not eat a heavy meal before the test.
Avoid caffeine, alcohol, allergy
medications, and sedatives at least 24
hours prior to the test, as these can affect
the results.
This test may be recommended if you
have:
 Dizziness or vertigo
 Hearing loss that may be due to certain
antibiotics
 Certain types of anemia
 Possible psychological causes of vertigo
 Abnormal results mean there may be
damage to the nerve of the inner ear,
which controls balance. If the rapid, side-
to-side eye movements do not occur
even after ice cold water is given,
permanent damage to the nerve has
probably occurred.
TPN
 An IV method of providing highly
concentrated nutrients and vitamins to
a client who is unable to get those
nutrients from food taken by mouth.
 Peripheral/central administration
 Solutions maybe refrigerated:
administer @ room temperature
 @ constant flow rate
 Serum blood glucose level @ regular
basis (4-6 hrs)
 Infusion initiated and discontinued on
gradual basis
 If TPN temporarily unavailable, give
D10W or 20%
 Use filters
 Clients allergic to egg should not be
given lipid solution
 COMPLICATIONS: hyperglycemia
hyperosmolar
coma
septicemia
air embolus
 Peripherally inserted
central catheter It’s a
non-tunneled external
catheter
 Small flexible
catheter inserted into
a peripheral vein then
threaded so that its
tip is positioned in a
central location
 Best suited for
treatments lasting
from several weeks to
6 months requiring
frequent access to
veins
 The PICC line
should be flushed
(rinsed) with10 cc’s
(1 cc = 1 millilitre)
of saline solution
and then 5 cc’s
heparin (an agent
that prevents
clotting) daily and
after each use
Double Lumen HickmanTM and BroviacTM Catheter
 Nurses have a duty to advocate for the
patient through the organizational chain
of command when they believe that the
physician is unresponsive to concerns
about the patient’s condition or is making
inappropriate patient care decisions.
 The chain of command is a specific
course of action involving administrative
and clinical lines of authority established
to ensure effective conflict resolution in
patient care situations and is mostly
applicable in emergency situations.
 Courts have held that nurses have a duty
to question a physician’s order if it is not
consistent with standard medical
practice.
 This could be interpreted to mean that
nurses must know when a physician’s
action or inaction jeopardizes a patient’s
safety and well-being. This places a
significant responsibility on the nurse.
Examples of clinical situations include:
 The dose of a medication is excessive or
inadequate.
 IV fluid orders are incomplete or inconsistent.
 The nurse is concerned about fetal heart rate
monitoring in a patient in labor.
 The postoperative laparoscopic
cholecystectomy patient begins having
symptoms of an acute abdominal process.
 The patient has widely divergent intake versus
urinary output.
 The patient is allergic to the medication the
physician orders.
Documenting This Process
In the unfortunate instance when physician
actions are not appropriate and the chain of
command is invoked, the nurse must document
the events as they occur. Important principles
include:
 Record events and observations in the
patient’s medical record in an objective and
clear manner.
 Document the specific facts, and carefully
record the time of each entry as accurately as
possible.
 Avoid fingerpointing and personal attacks on
the physician.
PANCREATIN
 PANCREATIC
ENZYMES
 Replacement
enzyme to aid in
digestion of starch,
protein and fat
 SE: GI upset and
irritation of mucus
membranes
 Maybe given before,
during or within 1
hour after meals
DEEP TENDON REFLEX
 Biceps

1. Place your right thumb on the patient’s right

biceps tendon
2. Rest the patient’s forearm on your left hand
and strike your thumb with the pointed end of
the hammer head. Hold the hammer loosely so
it pivots in your hand when it is moved with a
wrist action
3. Strike your thumb with the least amount of
pressure needed to elicit the reflex.
cont

 Triceps

1. Have the patient hang his arm freely while you

support it with your non-dominant hand.
2. With the elbow flexed, strike the tendon
directly using the pointed end of hammer

 Brachioradialis

1. Strike the forearm with the hammer about 2.5

cm above the wrist over the radius.
2. Be sure the forearm is supported and relaxed.
 Quadriceps

1. Have the patient sitting with his legs hanging

over the edge of the table or lying down while
you support the legs at the knee.
2. Strike the tendon just below the patella.

 Achilles

1. Support the foot in dorsiflexed position.

2. Tap the Achilles tendon with the hammer head.
 ARTERIO-VENOUS FISTULA

An artery is connected to an adjacent vein to provide a

large volume of blood.