Lorma Colleges Nursing Clinical Teaching Plan for Gastroenteritis

Lorma Colleges College of Nursing Carlatan, City of San Fernando, La Union
LECTURETTES AND QUIZZES
LORMA COLLEGES, College Of Nursing Clinical Teaching Plan for CHO ER/OPD
Lorma Colleges College of Nursing Carlatan, City of San Fernando, La Union BURNS BURN is an injury resulting from exposure to heat, chemicals, radiation or electric current. Different Types of Burn, Causative Agents and their Priority Treatment TYPE Thermal CAUSATIVE AGENT Open flame Steam Hot liquids (water, grease, tar, metal) Acids Strong alkalis Organic Compounds Direct current Alternating current Lightning Solar (Ultraviolet) X-rays Radioactive agents PRIORITY TREATMENT Extinguish flame (stop, drop and roll) Flush with cool water Consult fire department Neutralize or dilute chemicals Remove clothing Consult Poison Control Center Disconnect source of current Initiate CPR if necessary Move to area of safety Consult electrical experts Shield the skin appropriately Limit time of exposure Move the client away from the radiation source Consult a radiation expert
Chemical
Electrical
Radiation
Classification of Burn and their Clinical Findings Classification First Degree Second Degree (painful) Third Degree (painless) Fourth Degree Depth Epidermis involvement Superficial dermis (Papillary layer) Deep dermis (Reticular layer) Epidermis, dermis, hypodermis, bones and muscles Clinical Findings Erythema, significant pain, lack of blisters Blister, clear fluid, pain Whiter appearance, fixed red-staining, no blanching Charred, leathery, thrombus blood vessel, insensate
TREATMENT/MANAGEMENT Nursing Management: 1. 2. 3. 4. Fluid replacement through IV administration Administer 100% humidified oxygen by face mask Administer analgesics and anti-microbial agents as ordered If the clients immunization status is in doubt, Tetanus Toxoid is given IM
Medical Management: 1. ESCHAROTOMY it is being performed to prevent arterial occlusion, release tension and permit unobstructed arterial blood flow. 2. SURGICAL DEBRIDEMENT the process of excising the wound to the level of fascia or sequentially removing thin slices of the burn wound to the level of viable tissue 3. AUTOGRAFTING skin is removed from healthy tissue of the burn-injured client and applied to the burn wound Source: Principles of Medical Surgical Nursing, 4th Edition, Vol 1, pp 486-512.
Lorma Colleges College of Nursing Carlatan, City of San Fernando, La Union POST-TEST ON BURNS Direction: Choose the best answer. Write the letter of your answer in CAPITAL letter before the number. No erasures. No superimpositions. 1. Third degree burn is described by which of the following statements? a. Destruction of the epidermis and dermis b. It has a moist appearance, with blisters c. Destruction of the subcutaneous layer d. It appears charred 2. During the shock phase of burns, the following are manifested by the client EXCEPT: a. Hypovolemia, increased hematocrit b. Diuresis c. Hyperkalemia, hyponatremia d. Fluid shifts from IVC to ISC 3. The primary cause of dehydration during the first 48 hours of burns is: a. Increased insensible losses b. Shifting of plasma c. Fluid loss through blister formation d. Actual fluid destruction by the burning process 4. Which of the following acid-base imbalances occur due to excessive loss of sodium? a. Metabolic acidosis
b. Metabolic alkalosis c. Respiratory acidosis d. Respiratory alkalosis 5. Which of the following should be given highest priority in a client with burns? a. Initiation of fluid replacement b. Securing an airway c. Initiation of TPN d. Prevention of infection 6. The drug of choice for burn clients because it penetrates eschar is: a. Silver nitrate b. Silver sulfadiazine c. Mafenide acetate d. Povidone iodine 7. The stress ulcer that develops in burns is: a. Curlings ulcer b. Cushings ulcer c. Duodenal ulcer d. Gastric ulcer 8. After 48 hours post-burns, which of the following is not an expected manifestation of the client?
a. Polyuria b. Hypokalemia c. Metabolic alkalosis d. Hyponatremia 9. To relieve pain, the following are appropriate nursing measures EXCEPT: a. Avoid draft b. Morphine sulfate per IV
c. Use bed cradle d. Hydrotherapy with cold water 10. Which of the following skin graft is obtained from another human being? a. Autograft b. Syngeneic graft c. Homograft/Allograft d. Heterograft/Xenograft
Lorma Colleges College of Nursing Carlatan, City of San Fernando, La Union GASTROENTERITIS Gastroenteritis - (also known as gastric flu, stomach flu, and stomach virus, although unrelated to influenza) is marked by severe inflammation of the gastrointestinal tract involving both the stomach and small intestine resulting in acute diarrhea and vomiting. It can be transferred by contact with contaminated food and water. The inflammation is caused most often by an infection from certain viruses or less often by bacteria, their toxins (e.g. SEB), parasites, or an adverse reaction to something in the diet or medication. At least 50% of cases of gastroenteritis resulting from foodborne illness are caused by norovirus. Another 20% of cases, and the majority of severe cases in children, are due to rotavirus. Other significant viral agents include adenovirus and astrovirus. Causes: Bacterial Salmonella Shigella Staphylococcus Campylobacter jejuni Clostridium Escherichia coli Yersinia Vibrio cholera Improperly prepared food Consumption of improperly prepared foods or contaminated water Travel or residence in areas of poor sanitation Common for river swimmers during times of rain Viral Reheated meat dishes Seafood Dairy Bakery products Pseudomembranous colitis- cause of diarrhea Rotavirus Norovirus Adenovirus Astovirus
Risk factors: -
LORMA COLLEGES, College of Nursing Clinical Teaching Plan for CHO ER/ OPD
Diagnosis: a. Complete medical history and physical examination b. Fecalysis- if there is presence of blood in the stool c. Complete blood count d. Kidney function tests Signs and symptoms: Stomach pain or spasms Diarrhea Nausea and vomiting Dehydration Fever Abnormal flatulence Abdominal cramps Bloody stool ( infection by amoeba) Heartburn
Prevention: Lifestyle Good hand washing Avoidance of potentially contaminated food or drink Vaccination Rotavirus vaccine Treatment: Replacement of fluid loss Oral rehydration therapy Metoclopramide and ondansetron Antibiotics Metronidazole or vancomycin Antispasmostics- Butylscopolamine Probiotics- Zinc Complications: Diarrhea Reactive arthritis
Reference:Lemone and Burke Medical Surgical Nursing
Lorma Colleges College of Nursing Carlatan, City of San Fernando, La Union POST TEST ON GASTROENTERITIS Direction: Choose the best answer. Write the letter of your answer in CAPITAL letter before the number. No erasures. No superimpositions. 1.Which of the following would be an important assessment finding for an 8-month-old infant admitted with severe diarrhea? a. Absent bowel sounds b. Pale yellow urine c. Normal skin integrity d. Depressed anterior fontanel 2. Which of the following would be the best activity for the nurse to include in the plan of care for an infant experiencing severe diarrhea? a. Monitoring the total 8-hour formula intake. b. Weighing the infant each day. c. Checking the anterior fontanel every shift. d. Monitoring abdominal skin turgor every shift. 3. Which of the following nursing diagnoses as would be appropriate for the nurse to identify as a priority diagnosis for an infant just admitted to the hospital with a diagnosis of gastroenteritis? a. Pain related to repeated episodes of vomiting. b. Deficient fluid volume related to excessive losses from severe diarrhea. c. Impaired parenting related to infants loos of fluid. d. Impaired urinary elimination related to increased fluid intake feeding pattern. 4. Which of the following would the nurse include when teaching the father of an infant just admitted with gastroenteritis about initial treatment for the infant? a. The infant will receive no liquids by mouth. b. Intravenous antibiotics will be started. c. The infant will be placed in a mist tent. d. An iron-fortified formula will be used. 5. The nurse teaches the father of an infant hospitalized with gastroenteritis about the next step of treatment plan once the infants condition has been controlled. The nurse would determine that the father understands when he explains that which the following will occur with his infant? a. The infant will receive clear liquids for a period of time. b. Formula and juice will be offered. c. Blood will be drawn daily to test for anemia. d. The infant will be allowed to go to the play room. 6. The mother of a toddler who has just been admitted with severe dehydration secondary to gastroenteritis says that she cannot stay with her child because she has taken she cannot stay with her child because she has to take care of her other children at home. Which of the responses by the nurse would be most appropriate? a. You really shouldnt leave right now. Your child is very sick. b. I understand, but feel free to visit or call anytime to see how your child is doing.
c. It really isnt necessary to stay with your child. Well take very good care of him. d. Can you find someone to stay with your children? Your child needs you here. 7. A child is admitted to the pediatric unit with the diagnosis of severe gastroenteritis. Which of the following would be most appropriate for the nurse to do? a. Institute standard precautions. b. Place the child in a semiprivate room. c. Use regular eating utensils. d. Single-bag all linens. 8. The physician orders intravenous fluid replacement therapy with potassium chloride to be added for a child with severe gastroenteritis. Before adding, the potassium chloride to the intravenous fluid, which of the following assessments would be most important? a. Ability to void b. Passage of stool today c. Baseline electrocardiogram d. Serum calcium level
9. The child is started on a soft diet after having been on clear liquids following an episode of severe gastroenteritis. When helping the mother choose foods for her child, which of the following foods would be most appropriate? a. Muffins and eggs b. Bananas and rice cereal c. Bran cereal and a bagel d. Pancakes and sausage 10. On a home visit following discharge from the hospital after treatment for severe gastroenteritis, the mother tells the nurse that her toddler answers No! and is difficult to manage. After discussing this further with the mother, the nurse explains that the childs behaviour is most probably the result of which of the following? a. Beginning leadership skills b. Inherited personality traits c. Expression of individuality d. Usual lack of interest in everything
Lorma Colleges College of Nursing Carlatan, City of San Fernando, La Union HYPERTENSION HYPERTENSION -excess pressure in the arterial portion of systemic circulation Pathophysiology: Decrease renal perfusion Juxtaglomerular Release of renin Angiotensinogen Angiotensin I Angiotensin II Na and H20 retention Aldosterone Increase BP Primary hypertension -aka essential hypertension -persistent elevated systemic blood pressure -has no identified cause Secondary hypertension -elevated blood pressure resulting from an identifiable underlying process -causes: kidney disease, coarctation of aorta, endocrine disorders, neurologic disorders, drug use and pregnancy Manifestations: Headache Elevated blood pressure Patient may be asymptomatic Risk factors: Non-modifiable- family history, age, gender, ethnic group Modifiable- stress, obesity, diet, excessive alcohol
Medical management: 1. Alpha-adrenergic blockers 2. Angiotensin-converting enzyme (ACE) inhibitors 3. Angiotensin II receptor blockers (ARBS) 4. Beta-adrenergic blocking agents 5. Calcium channel blockers 6. Centrally acting sympatholytics 7. Vasodilators 8. Diuretics
Nursing management: 1. Reducing sodium intake 2. Maintaining adequate potassium and calcium intakes 3. Reducing total and saturated fat intake 4. Regular exercise 5. Stress reduction 6. Smoking cessation 7. Alcohol limitation 8. Caffeine restriction
STAGES Normal Pre-hypertension Stage 1 Stage 2 Stage 3 Stage 4
SYSTOLIC Less than 120 120 - 139 systolic 140 - 159 systolic 160 - 179 systolic 180 - 209 systolic Greater than 210
DIASTOLIC Less than 80 80 - 89 diastolic 90 - 99 diastolic 100 - 109 diastolic 110 - 119 diastolic Greater than 120
Reference: : Lemone and Burke Medical Surgical Nursing
Lorma Colleges College of Nursing Carlatan, City of San Fernando, La Union POST TEST ON HYPERTENSION Direction: Choose the best answer. Write the letter of your answer in CAPITAL letter before the number. No erasures. No superimpositions. 1.A potential blood donor whose blood pressure is found to average 180/106 on two different readings tells the nurse, I dont understand how it could be so high- I feel just fine. The appropriate response by the nurse is: a. This is probably just a false reading due to white coat syndrome. Dont worry about it. b. It is unusual that you are not having some symptoms such as severe headaches and nosebleeds. c. Having blood pressure often has few or no symptoms; that is why it is called the silent killer. d. You probably should have your blood pressure rechecked in 3 months or so and then follow up with your primary care provider if it is still high. 2. The nurse has just completed a teaching session regarding the risk factors for hypertension for a 45-year old male client. The nurse asks the client to verbalize the modifiable risk factors of the disease. Which of the following is the correct response? a. Cholesterol, menopause, obesity b. Heredity, smoking, diabetes c. Cholesterol, obesity, smoking d. Hypertension, gender, obesity 3. Captopril may be administered to a client with hypertension because it acts as a: a. Vasodilator b. Angiotensin-converting enzyme (ACE) inhibitors c. Angiotensin II receptor blockers (ARBS) d. Beta-adrenergic blocking agents 4. Furosemide is administered IV to a client with hypertension. How soon after administration should the nurse begin to see evidence of the drugs desired effect? a. 30-60 minutes b. 6-8 hours c. 5-10 minutes d. 2-4 hours 5. Dietary approaches to managing hypertension focus on the following except: a. Restricting sodium intake b. Maintaining potassium c. Reducing saturated fat d. Eat a diet rich in fruits and vegetables 6. Appropriate nursing diagnoses for hypertension are all of the following but one: a. Ineffective Health Maintenance b. Risk for Noncompliance c. Imbalanced Nutrition: Less than Body Requirements
d. Excess Fluid Volume 7. A 28-year-old obese woman presents to her doctors office with persistent headache and malaise. She is otherwise healthy. Blood pressure measured in the office is 190/110mmHg. Serum electrolytes demonstrate hypokalemia and metabolic alkalosis with normal kidney function. Urinalysis reveals no proteinuria, cylinduria, or casts. A secondary cause of hypertension is considered. Renal ultrasound shows normal echogenicity, with the right kidney 12.0 cm and the left kidney 10.5 cm in length. Doppler examination is technically limited by her obesity. A renal angiogram reveals significant stenosis of the left renal artery due to fibromuscular dysplasia. What is the best management option for his patient at this point? a. Perform renal artery bypass b. Serial ultrasonography to assess kidney size c. Perform percutaneous angioplasty of the stenotic lesion d. Start an angiotensin-converting enzyme inhibitor and titrate to control blood pressure 8. A 76-year-old man with a past history of non-insulin-dependent diabetes mellitus and hypertension is seen in the office. His blood pressure is 140/85 mmHg, and he has mild renal insufficiency. Urinalysis reveals 2+ protein on dipstick but no cylinduria. Blood pressure medications include hydrochlorothiazide and atenolol. What antihypertensive agent will best control blood pressure and preserve renal function in this patient? a. Amlodipine b. Furosemide c. Lisinopril
d. Verapamil 9. A 4-year-old girl is brought to her pediatricians office with lower extremity weakness and inability to walk. She is afebrile, but her blood pressure is 130/80 mmHg. Routine serum chemistries show profound hypokalemia and metabolic alkalosis. Hypokalemia is the suspected cause of her lower extremity weakness. Further history reveals that the child ate an entire candy dish of aunthentic black licorice at her grandmothers house. What hormone caused the syndrome with which this child presents? a. Aldosterone b. Cortisol c. Dihydrotestosterone d. Progesterone 10. A 35-year-old healthy man is referred for hypertension. His blood pressure is 190/105mmHg and laboratory tests show hypokalemia and metabolic alkalosis with normal renal function. Given his age, there is concern for secondary causes of hypertension. The plasma rennin activity level is low, the plasma aldosterone concentration is high and the PAC:PRA ratio is 45. After 3 days of oral salt loading, the patient collects a 24-hour urine sample that reveals an elevated aldosterone concentration. What is the next step in the workup of his patients hypertension? a. Bilateral renal vein sampling b. Captopril renal scan c. CT scan of the abdomen d. Renal artery angiogram
Lorma Colleges College of Nursing Carlatan, City of San Fernando, La Union DENGUE Dengue is fast emerging pandemic-prone viral disease in many parts of the world. Dengue flourishes in urban poor areas, suburbs and the countryside but also affects more affluent neighbourhoods in tropical and subtropical countries.
Dengue is transmitted by the bite of an Aedes mosquito infected with any one of the four dengue viruses. It occurs in tropical and sub-tropical areas of the world.. Dengue fever is a febrile illness that affects infants, young children and adults. Mosquitoes generally acquire the virus while feeding on the blood of an infected person. After virus incubation for eight to 10 days, an infected mosquito is capable, during probing and blood feeding, of transmitting the virus for the rest of its life. Infected female mosquitoes may also transmit the virus to their offspring by transovarial (via the eggs) transmission, but the role of this in sustaining transmission of the virus to humans has not yet been defined. Infected humans are the main carriers and multipliers of the virus, serving as a source of the virus for uninfected mosquitoes. The virus circulates in the blood of infected humans for two to seven days, at approximately the same time that they have a fever; Aedes mosquitoes may acquire the virus when they feed on an individual during this period. Some studies have shown that monkeys in some parts of the world play a similar role in transmission. It can also spread via the blood of an infected person. Symptoms usually appear 314 days after the infective bite.
DHF is a syndrome due to the dengue virus that tends to affect children under 10 years of age, causing abdominal pain, hemorrhage and circulatory collapse. DHF starts abruptly with high continuous fever, headache, facial flush and respiratory and intestinal symptoms such as sore throat, cough, nausea, vomiting, and abdominal pain. The fever usually continues for two to seven days and can be as high as 41C, possibly with convulsions and other complications. In moderate DHF cases, all signs and symptoms abate after the fever subsides. In severe cases, the patient's condition may suddenly deteriorate after a few days of fever; the temperature drops, followed by signs of circulatory failure, and the patient may rapidly go into a critical state of shock. Shock occurs after 2 to 6 days with sudden collapse, cool clammy extremities, weak thready pulse, and blueness around the mouth. There is bleeding with easy bruising, blood spots in the skin (petechiae), spitting up blood (hematemesis), blood in the stool (melena), bleeding gums and nosebleeds (epistaxis).
Transmission Aedes aegypti, the transmitter of the disease, is a day-biting mosquito which lays eggs in clear and stagnant water found in flower vases, cans, rain barrels, old rubber tires, etc. The adult mosquitoes rest in dark places of the house. The full life cycle of dengue fever virus involves the role of mosquito as a transmitter (or vector) and humans as the main victim and source of infection. Signs and Symptoms Sudden onset of high fever which may last 2 to 7 days. Joint & muscle pain and pain behind the eyes. Weakness Skin rashes - maculopapular rash or red tiny spots on the skin called petechiae Nosebleeding when fever starts to subside Abdominal pain Vomiting of coffee-colored matter Dark-colored stools
Diagnostic Test Tourniquet Test A presumptive test which is positive in the presence of more than 20 petechiae within an each square after 5 minutes of tests. Complete Blood Count Nursing Management Symptomatic and supportive relief Fluids Paracetamol (no ASPIRIN) as ordered Fresh whole blood transfusion is ordered if thrombocytopenia and platelet declines Prevention and Control For nose bleeding, hyperextend the neck to prevent aspiration Assist in management of Shock Provide warmth Monitor Vital signs
Cover water drums and water pails at all times to prevent mosquitoes from breeding. Replace water in flower vases once a week. Clean all water containers once a week. Scrub the sides well to remove eggs of mosquitoes sticking to the sides. Clean gutters of leaves and debris so that rain water will not collect as breeding places of mosquitoes. Old tires used as roof support should be punctured or cut to avoid accumulation of water. Collect and dispose all unusable tin cans, jars, bottles and other items that can collect and hold water.
Reference: Nursingcrib.com
Lorma Colleges College of Nursing Carlatan, City of San Fernando, La Union POST TEST ON DENGUE Direction: Give what is being asked. No erasures. 1. Give the name of the mosquito responsible for the transmission of dengue virus.
2-4. Give at least 3 symptoms of Dengue
5-7. Give at least 3 ways to prevent dengue
8. The signs and symptoms of dengue typically occur after how many days?
9-10. Give at least two signs of shock
Lorma Colleges College of Nursing Carlatan, City of San Fernando, La Union BITES BITES Any bite requires medical attention. Deep bites can cause serious wounds, severe bleeding, and tissue damage, while all animal bites can cause infection. Puncture wounds from teeth carry infection deep into the tissue, while scratches are also an infection risk. The human bite is among the most infectious. INJECTED POISONS: STINGING INSECTS A person may have an extreme sensitivity to the venoms of the Hymenoptera (bees, hornets, yellow jackets, fire ants, and wasps). Venom allergy is thought to be an IgE-mediated reaction, and it constitutes an acute emergency. Although stings in any area of the body can trigger anaphylaxis, stings of the head and neck are especially serious. Clinical manifestations range from: generalized urticaria itching malaise anxiety due to laryngeal edema to severe bronchospasm shock death Generally, the shorter the time between the sting and the onset of severe symptoms, the worse the prognosis. Management Stinger removal if the bite is from a bee, because the venom is associated with sacs around the barb of the stinger itself. Wound care with soap and water is sufficient for stings.
Scratching is avoided because it results in a histamine response. Ice application reduces swelling and also decreases venom absorption. An oral antihistamine and analgesic will decrease the itching and pain. In the case of an anaphylactic or severe allergic response, epinephrine (aqueous) is injected subcutaneously (not intravenously), and the injection site is massaged to hasten absorption. The patient is assessed for signs and symptoms of anaphylactic reaction and treated as necessary (see previous discussion and also Chap. 15). Desensitization therapy should be given to people who have had systemic or significant local reactions. Patient and family education is an important measure in preventing exposure to stinging insects.
SNAKE BITES Venomous (poisonous) snakes cause 7000 to 8000 bites in the United States each year and result in 12 to 15 deaths. Children between the ages of 1 and 9 years are the most likely victims. The greatest number of bites occurs through the daylight hours into early evening during summer months. The most frequent poisonous snakebite occurs from pit vipers. The most common site is the upper extremity. Of these bites, only 20% to 25% result in envenomation (injection of a poisonous material by sting, spine, bite, or other means). Venomous snake bites are medical emergencies (Moon & Galvan, 2000).
Management Initial first aid at the site of the snake bite includes: having the victim lie down removing constrictive items such as rings providing warmth cleansing the wound covering the wound with a light sterile dressing immobilizing the injured body part below the level of the heart. Ice or a tourniquet is not applied Initial evaluation in the ED is performed quickly and includes information about the following: Whether the snake was venomous or nonvenomous; if the snake is dead, it should be transported to the ED with the patient for identification Where and when the bite occurred and the circumstances of the bite
Sequence of events, signs and symptoms (fang punctures, pain, edema, and erythema of the bite and nearby tissues) Severity of poisonous effects Vital signs Circumference of the bitten extremity or area at several points; the circumference of the extremity that was bitten is compared with the circumference of the opposite extremity Laboratory data (complete blood count, urinalysis, and clotting studies)
Generally, ice, tourniquets, heparin, and corticosteroids are not used during the acute stage. Corticosteroids are contraindicated in the first 6 to 8 hours after the bite, because they may depress antibody production and hinder the action of antivenin (antitoxin manufactured from the snake venom and used to treat snake bites). Parenteral fluids may be used to treat hypotension. If vasopressors are used to treat hypotension, their use should be short-term. DOG BITES Almost 75 million dogs live in the United States, and since many victims of dog bites dont seek medical care or report the attack, it may be that the U.S. Center for Disease Control and Prevention (CDC)s estimate of 4.5 million dog bites each year in the U.S. may be too low. Approximately 880,000 dog bite victims seek emergency medical care at hospitals in the U.S. every year. Dogs have rounded teeth, and it is the pressure exerted by their jaws that can cause significant damage to the tissues under the skin, including bones, muscles, tendons, blood vessels, and nerves. More than 30,000 victims of dog bites undergo reconstructive surgery each year, and 15-20 people die of dog bites yearly. MANAGEMENT 1. Stay Safe. Secure the dog or the victim. Move one away from the other. If the dogs owner is around, instruct him or her to secure the dog. If not, move the victim to a safe location. Dogs may bite because their territory is threatened. Dont start any treatment until there is a reasonable expectation that the dog wont attack again. 2. If you are not the victim, practice universal precautions and wear personal protective equipment if available. 3. Control any bleeding by following the appropriate steps. Avoid using a tourniquet unless there is severe bleeding that cannot be controlled any other way. 4. Once the bleeding is controlled, clean the wound with soap and warm water. Do not be afraid to clean inside the wound. Be sure to rinse all the soap away, or it will cause irritation later.
5. Cover the wound with a clean, dry dressing. You can put antibiotic ointment on the wound before covering. Watch for signs of infection: Redness Swelling Heat Weeping pus 6. Always call a physician to determine if you should be seen. Some dog bites need antibiotics, particularly if they are deep puncture wounds. Additionally, many municipalities have regulations for reporting dog bites and monitoring the dogs, and that is often initiated by contact with a doctor. 7. Any unidentified dog runs the risk of carrying rabies. If the dog cannot be identified and the owner cannot show proof of rabies vaccination, the victim must seek medical attention. Rabies is always fatal to humans if not treated. 8. The wound may need stitches. If the edges of a laceration are unable to touch, or if there are any avulsions, the wound will need emergency medical attention. Wounds on the face or hands should be seen by a physician because of the likelihood of scarring and loss of function.
Reference: First Aid Handbook by Dr. Lipscombe and Dr. Kerwin-Nye
Lorma Colleges College of Nursing Carlatan, City of San Fernando, La Union POST TEST ON BITES Direction: Give what is being asked. No erasures. 1. 2. 3. 4. 5. 6. 7. It is the injection of a poisonous material by sting, spine, bite, or other means. It is the antitoxin manufactured from the snake venom and used to treat snake bites. The therapy that should be given to people who have had systemic or significant local reactions in sting bites The drug used to decrease the itching sting bites. The drug used to decrease the pain sting bites. It is also called generalized itchiness. A drug that is contraindicated in the first 6 to 8 hours after the snake bite because they may depress antibody production and hinder the action of antivenin. 8. In the case of an anaphylactic or severe allergic response in sting bite, epinephrine (aqueous) is injected ________, and the injection site is massaged to hasten absorption. 9. The type of virus will be transferred to you if you are bitten with a rabid dog. 10. The common type of phobia that a patient experience when he/she is bitten by a dog. It is defined as the fear of water. ANSWERS:
Lorma Colleges College of Nursing Carlatan, City of San Fernando, La Union POISONING POISONING A poison is any substance that, when ingested, inhaled, absorbed, applied to the skin, or produced within the body in relatively small amounts, injures the body by its chemical action. Poisoning from inhalation and ingestion of toxic materials, both intentional and unintentional, constitutes a major health hazard and an emergency situation. Emergency treatment is initiated with the following goals: To remove or inactivate the poison before it is absorbed To provide supportive care in maintaining vital organ systems To administer a specific antidote to neutralize a specific poison To implement treatment that hastens the elimination of the absorbed poison
TYPES: INHALED POISONS: CARBON MONOXIDE POISONING Carbon monoxide poisoning may occur as a result of industrial or household incidents or attempted suicide. It is implicated in more deaths than any other toxin except alcohol. Carbon monoxide exerts its toxic effect by binding to circulating haemoglobin and thereby reducing the oxygen-carrying capacity of the blood. Signs and symptoms include: Headache muscular weakness palpitation dizziness confusion which can progress rapidly to coma ** Skin color, which can range from pink or cherry-red to cyanotic and pale, is not a reliable sign.
** Pulse oximetry is also not valid, because the haemoglobin is well saturated. It is not saturated with oxygen, but the pulse oximeter reads the saturation as such and presents the false impression that the patient is well oxygenated and in no danger. Exposure to carbon monoxide requires immediate treatment. Management Goals of management are to reverse cerebral and myocardial hypoxia and to hasten elimination of carbon monoxide. Whenever a patient inhales a poison, the following general measures apply: Carry the patient to fresh air immediately; open all doors and windows. Loosen all tight clothing. Initiate cardiopulmonary resuscitation if required; administer oxygen. Prevent chilling; wrap the patient in blankets. Keep the patient as quiet as possible. Do not give alcohol in any form
When unintentional carbon monoxide poisoning occurs, the health department should be contacted, so that the dwelling or building in question can be inspected. A psychiatric consultation is warranted if poisoning was determined to be a suicide attempt.
SKIN CONTAMINATION POISONING (CHEMICAL BURNS) Skin contamination injuries from exposure to chemicals are challenging because of the large number of offending agents with diverse actions and metabolic effects. The severity of a chemical burn is determined by the mechanism of action, the penetrating strength and concentration, and the amount and duration of exposure of the skin to the chemical. Signs and Symptoms: History of exposures. Liquid or powder on the skin Burns. Itching, irritation. Redness, rashes, blisters.
Management The skin should be drenched immediately with running water from a shower, hose, or faucet. Patients clothing is being removed. The skin of health care personnel assisting the patient should be appropriately protected if the burn is extensive or if the agent is significantly toxic or is still present. Prolonged lavage with generous amounts of tepid water is important. In the meantime, attempts to determine the identity and characteristics of the chemical agent are necessary for future treatment. FOOD POISONING Food poisoning is a sudden illness that occurs after ingestion of contaminated food or drink. Signs and Symptoms: N&V Stomach cramps Diarrhea Fever Aches and pains Signs of shock Symptoms of toxic poisoning are dizziness, slurred speech and difficulty breathing and swallowing. Management Determining the source and type of food poisoning Food, gastric contents, vomitus, serum, and feces are collected for examination. The patients respirations, blood pressure, sensorium, CVP (if indicated), and muscular activity are monitored closely. Fluid and electrolyte balance is also an important area to assess. Weight and serum electrolyte levels are obtained for future comparisons. An antiemetic medication is administered parenterally as prescribed if the patient cannot tolerate fluids or medications by mouth. For mild nausea, the patient is encouraged to take sips of weak tea, carbonated drinks, or tap water. After nausea and vomiting subside, clear liquids are usually prescribed for 12 to 24 hours, and the diet is gradually progressed to a low-residue, bland diet. Reference: First Aid Handbook by Dr. Lipscombe and Dr. Kerwin-Nye
Lorma Colleges College of Nursing Carlatan, City of San Fernando, La Union POST TEST ON POISONING Direction: Choose the best answer. Write the letter of your answer in CAPITAL letter before the number. No erasures. No superimpositions. 1. While conducting a medication inventory, the ER nurse of a pediatric hospital checks to ensure that syrup of ipecac is readily available. This action is based on the nurses knowledge that this drug is used primarily to accomplish which of the following? a. Induce vomiting b. Promote diuresis c. Control seizure activity d. Stimulate the heart 2. A toddler is brought to the emergency room after ingesting an undetermined amount of drain cleaner. The nurse would expect to prepare to assist with which of the following first? a. Administering an emetic b. Performing a tracheostomy c. Performing gastric lavage d. Inserting an indwelling (Foley) catheter 3. After the acute stage following an ingestion of drain cleaner by a child, the nurse would be alert for the development of which of the following as a likely complication? a. Tracheal stenosis b. Tracheal varices c. Esophageal strictures
d. Esophageal diverticula 4. A child presents to the emergency room with the history of ingesting a large amount of acetaminophen. For which of the following would the nurse assess? a. Hypertension b. Frequent urination c. Right upper quadrant pain d. Headache 5. When developing the plan of care for a toddler who has taken an acetaminophen overdose, which of the following would the nurse expect to include as a part of the initial treatment? a. Frequent blood level determinations b. Gastric lavage c. Tracheostomy d. Electrocardiogram 6. While assessing a preschooler brought by her parents to the emergency department after ingestion of kerosene, the nurse would be alert for which of the following? a. Uremia b. Hepatitis c. Carditis d. Pneumonitis
7. Which of the following statements by the mother of an 18month-old would indicate to the nurse that the child needs laboratory testing for lead levels? a. My child does not always wash after playing outside b. My child drinks 2cups of milk everyday c. My child has more temper tantrums than other kids d. My child is smaller than other kids of the same age 8. When teaching the mother of a toddler diagnosed with lead poisoning, which of the following would the nurse include as the most serious complication if the condition goes untreated? a. Cirrhosis of the liver b. Stunted growth rate c. Neurologic deficits d. Heart failure
9. When teaching a mother about measures to prevent lead poisoning in her children, which of the following would the nurse include as the most effective preventive measure? a. Condemning of old housing developments b. Educating the public on common sources of lead c. Educating the public on the importance of good nutrition d. Keeping pregnant women out of old homes that are being remodelled 10. Which of the following would be the nurses best response to a mother who asks about the outcome for her child with lead poisoning? a. Many children suffer brain damage from lead poisoning b. Many of its effects require the child to receive special schooling c. Most children with lead poisoning experience problems with the law d. Most effects of lead poisoning are reversible if diagnosed early
Lorma Colleges College of Nursing Carlatan, City of San Fernando, La Union URTI Respiratory System Provides the cells of the body with oxygen and eliminates Carbon Dioxide, formed as a waste product of the cellular metabolism The respiratory system is separated into two separate chapters; the Upper Respiratory System (nose, pharynx, larynx and trachea) and the Lower Respiratory System (lungs)
Upper Respiratory System A. NOSE external opening of the respiratory system B. SINUSES - Lighten the skull - Assists in speech - Produces mucus that drains into the nasal cavities to help trap debris C. PHARYNX - Serves as a passageway for both air and food D. LARYNX - Provides an airway and routes air and food into the proper passageway - Contains the vocal cords necessary for voice production E. TRACHEA - Begins at the inferior larynx and descends anteriorly to the esophagus to enter the mediastinum where it divides to become the right and left primary bronchi of the lungs Lower Respiratory System LUNGS - Apex: lies below the clavicle
Base: rests on the diaphragm Left Lung: composed of 2 lobes with 8 bronchial segments Right Lung: composed of 3 lobes with 10 bronchial segments UPPER RESPIRATORY TRACT INFECTIONS
RHINITIS - Inflammation of the nasal cavities Types of Rhinitis: A. Acute Viral Rhinitis - Commonly known as common cold - Most common human disease - Highly contagious B. Chronic Rhinitis - Includes: o Allergic Rhinitis Hay Fever; results from a sensitivity reaction to allergens o Vasomotor Rhinitis etiology is unknown o Atrophic Rhinitis characterized by changes in the mucous membrane of the nasal cavities Causes: Strains of virus (rhinovirus, adenovirus, parainfluenza viruses, coronaviruses and respiratory sycncytial virus) Risk Factors: Persons working in schools Manifestations: - Nasal mucous membranes appear red (erythematous) and swollen (boggy) - Nasal congestion
Clear, watery secretions leading to coryza Profuse nasal discharge Sneezing Coughing Sore throat Systemic manifestations includes: low- grade fever, headache, malaise, and muscle aches
Diagnostic Procedures: - History and physical assessment - WBC count - Cultures of purulent discharge may also be obtained Management Adequate rest Maintaining fluid intake Avoiding chilling Instructing client to cover the mouth and nose with tissue when coughing or sneezing, and to dispose properly Instruct client to avoid crowds Administer prescribed decongestants, nasal sprays, analgesics and antihistamines Warm salt water gargles and throat lozenges may also help to relieve sore throat Complementary therapies may include herbal remedies such as Echinacea and garlic Dietary supplements such as vitamin C and zinc may also help to reduce severity and duration of URI Aromatherapy Complications: - Serious bacterial infections such as sinusitis and otitis media
INFLUENZA - Highly contagious viral respiratory disease Causes: - Strain of influenza virus (influenza A virus, influenza B virus, and influenza C virus) Risk Factors: - Older adults and people with chronic heart or pulmonary disease Manifestations: - Respiratory: coryza, cough initially dry becoming productive, substernal burning, sore throat - Systemic: Fever and chills, malaise, muscle aches, fatigue Diagnostic Procedures: Chest X-ray WBC count
Management: - Prevention may include immunization of influenza vaccine and administration of antiviral drugs such as amantidine or rimantadine used as prophylaxis - Analgesics or NSAIDS - Antitussives and antibiotics - Pace activities to provide periods of rest - Maintaining adequate hydration - Proper hygiene measures Complications: Exacerbation of COPD Pneumonia
Sinusitis Otitis Media
SINUSITIS - Inflammation of the mucous membrane of the sinuses Causes: - Staphylococci and Streptococci infection (S. Pneumonia, Haemophilus influenza) Risk Factors: - Suppressed immune system - Immunosuppressive drugs - HIV infection Manifestations: - Pain - Headache - Fever - Malaise - Nasal congestion - Bad breath - Purulent nasal discharges - Tenderness across the infected sinuses Diagnostic Procedures: - Health history - Physical examination - WBC and differential count - Cultures of sinus drainage
Sinus X-ray CT Scan MRI
Management: - Antibiotic therapy directed at the usual organism causing sinusitis - If sinusitis does not respond to treatment with oral antibiotics, hospitalization and intravenous therapy may be required - Oral or topical decongestants may also be prescribe - Aromatherapy - Maintaining liberal fluid intake - Application of warm, moist packs to the area of pain - Sleeping with the head of bed elevated Complications: - Local: orbital cellulitis, subperiosteal abscess, orbital abscess, cavernous sinus thrombosis, mucocele, osteomyelitis - Intracranial: meningitis, epidural and subdural abscess, brain abscess, venous sinus thrombosis
Reference: Lemone and Burke Medical Surgical Nursing
Lorma Colleges College of Nursing Carlatan, City of San Fernando, La Union POST TEST ON URTI Direction: Choose the best answer. Write the letter of your answer in CAPITAL letter before the number. No erasures. No superimpositions. 1. A client with allergic rhinitis is instructed on the correct technique for using an intranasal inhaler. Which of the following statements would demonstrate to the nurse that the client understands the instructions? a. I should limit the use of the inhaler to early morning and bedtime use b. It is important to not shake the canister because that can damage the spray device c. I should hold one nostril closed while I insert the spray into the other nostril d. the inhaler tip is inserted into the nostril and pointed toward the inside nostril wall 2. Which of the following would be an expected outcome for a client recovering from an upper respiratory tract infection? a. The client maintains a fluid intake of 800 ml every 24 hours b. The client experience chills only once a day c. The client coughs productively without chest discomfort d. The client experience less nasal obstruction and discharge 3. The nurse teaches the client how to instill nasal drops. Which of the following techniques is correct? a. The client uses sterile technique when handling the dropper b. The client blows the nose gently before instilling drops c. The client uses a new dropper for each installation d. The client sits in a semi fowlers position with the head tilted forward after administration of the drops 4. A client with acute sinusitis is examined in an ambulatory clinic. The nurse can anticipate the use of which of the following medications in the clients treatment plan? a. Antibiotics b. Antihistamine c. Bronchodilators d. Oral corticosteroids 5. The nurse should include which of the following instructions in the teaching plan for a client with chronic sinusitis? a. Avoid the use of caffeinated beverages b. Perform postural drainage everyday c. Take hot showers twice daily d. Report a temperature of 102 F (38.9C or higher)
6. Which of the following individuals would the nurse consider to have the highest priority for receiving an influenza vaccination? a. A 60 yr old man with a hiatal hernia b. A 36 yr old woman with three children c. A 50 yr old woman caring for a spouse with cancer d. A 60 yr old woman with osteoarthritis 7. A client with allergic rhinitis ask the nurse what he should do to decrease his symptoms. Which of the following instruction would be appropriate for the nurse to give the client? a. Use your nasal decongestant spray regularly to help clear your nasal passages b. Ask the doctor for antibiotics. Antibiotics will help decrease the secretion c. it is important to increase your activity. A daily brisk walk will help promote drainage d. keep a diary of when your symptoms occur. This can help you identify what precipitates your attack. 8. An elderly client has been ill with a flu, experiencing headache, fever, and chills. After three days, she develops a cough productive of yellow sputum. The nurse auscultates her lungs and hears a diffuse crackles. How would the nurse best interpret this assessment findings?
a. It is likely that the client is developing a secondary bacterial pneumonia b. Assessment findings are consistent with influenza and are to be expected. c. The client is getting dehydrated and needs to increase her fluid intake to decrease secretions. d. The client has not been taking her decongestant and bronchodilators as prescribed 9. Guaifenesin 300mg four times a day has been ordered as an expectorant. The dosage strength of liquid is 200mg per 5ml. how many milliliters should the nurse administer for each dose? a. 5.0 ml b. 7.5 ml c. 9.5 ml d. 10.0 ml 10. Pseudoephedrine (Sudafed) has been ordered as a nasal decongestant. Which of the following is a possible side effect of this drug? a. Constipation b. Bradycardia c. Diplopia d. Restlessness

Lorma Colleges Nursing Clinical Teaching Plan for Gastroenteritis

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Lorma Colleges College of Nursing Carlatan, City of San Fernando, La Union

LECTURETTES AND QUIZZES

Reference:Lemone and Burke Medical Surgical Nursing

STAGES Normal Pre-hypertension Stage 1 Stage 2 Stage 3 Stage 4

Reference: : Lemone and Burke Medical Surgical Nursing

2-4. Give at least 3 symptoms of Dengue

5-7. Give at least 3 ways to prevent dengue

9-10. Give at least two signs of shock

Reference: First Aid Handbook by Dr. Lipscombe and Dr. Kerwin-Nye

Sinusitis Otitis Media

Sinus X-ray CT Scan MRI

Reference: Lemone and Burke Medical Surgical Nursing

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