update 100% guaranteed
Do not delegate What you can EAT E-evaluate A-assess T-teach
Addison's & CushingsAddison's = down down down up down
Cushings= up up up down up
hypo/hypernatremia, hypo/hypertension, blood volume, hypo/hyperkalemia, hypo/hyperglycemia
Better peripheral perfusion? EleVate Veins, DAngle Arteries
APGAR Appearance (all pink, pink and blue, blue (pale)
Pulse (>100, <100, absent)
Grimace (cough, grimace, no response)
Activity (flexed, flaccid, limp)
Respirations (strong cry, weak cry, absent)
Airborne precautions MTV or My chicken hez tb measles, chickenpox (varicella) Herpes
zoster/shingles TB
Airborne precautions protective equip private room, neg pressure with 6-12 air
exchanges/hr mask & respirator N95 for TB
Droplet precautions spiderman! sepsis, scarlet fever, streptococcal pharyngitis, parvovirus,
pneumonia, pertussis,
influenza,
diptheria,
epiglottitis,
rubella,
mumps, meningitis, mycoplasma or meningeal pneumonia, adeNovirus
(Private room and mask)
,Contact precaution MRS WHISE
protect visitors & caregivers when 3 ft of the pt.
Multidrug-resistant organisms
RSV, Shigella, Wound infections, Herpes simplex, Impetigo, Scabies, Enteric diseases caused by
micro-organisms (C diff),
Gloves and gowns worn by the caregivers and visitors
Disposal of infectious dressing material into a single, nonporous bag without touching the
outside of the bag
PMGG= Private room/ share same illness, mask, gown and gloves
Skin infection VCHIPS
Varicella zoster
Cutaneous diptheria
Herpes simplez
Impetigo
Peduculosis
Scabies
Air or Pulmonary Embolism S/S chest pain, dyspnea, tachycardia, pale/cyanotic, sense of
impending doom. (turn pt to LEFT side and LOWER the head of bed.)
Woman in labor (un-reassuring FHR) (late decels, decreased variability, fetal bradycardia,
etc) Turn pt on Left side, give O2, stop pitocin, Increase IV fluids!
Tube feeding with decreased LOC Pt on Right side (promotes emptying of the stomach) Head
of bed elevated (prevent aspiration)
After lumbar puncture and oil based myelogram pt is flat SUPINE (prevent headache and
leaking of CSF)
Pt with heat stroke flat with legs elevated
during Continuous Bladder Irrigation (CBI) catheter is taped to the thigh. leg must be kept
straight.
After Myringotomy position on the side of AFFECTED ear, allows drainage.
After Cateract surgerypt sleep on UNAFFECTED side with a night shield for 1-4 weeks
after Thyroidectomy low or semi-fowler's position, support head, neck and shoulders.
Infant with Spina Bifida Prone so that sac does not rupture
Buck's Traction (skin) elevate foot of bed for counter traction
, After total hip replacement don't sleep on side of surgery, don't flex hip more than 45-60
degress, don't elevate Head Of Bed more than 45 degrees. Maintain hip abduction by separating
thighs with pillows.
Prolapsed cordKnee to chest or Trendelenburg
oxygen 8 to 10 L
Cleft Lip position on back or in infant seat to prevent trauma to the suture line. while
feeding hold in upright position.
To prevent dumping syndrome (post operative ulcer/stomach surgeries) eat in reclining
position. Lie down after meals for 20-30 min. also restrict fluids during meals, low CHO and
fiber diet. small, frequent meals.
AKA (above knee amputation) elevate for first 24 hours on pillow. position prone daily to
maintain hip extension.
BKA (below knee amputation) foot of bed elevated for first 24 hours. position prone to
provide hip extension.
detached retina area of detachment should be in the dependent position
administration of enema pt should be left side lying (Sim's) with knee flexed.
After supratentorial surgery (incision behind hairline on forhead) elevate HOB 30-40 degrees
After infratentorial surgery (incision at the nape of neck) position pt flat and lateral on either
side.
During internal radiation on bed rest while implant in place
Autonomic Dysreflexia/Hyperreflexia S/S pounding headache, profuse sweating, nasal
congestion, chills, bradycardia, hypertension. Place client in sitting position (elevate HOB)
FIRST!
Shock bedrest with extremities elevated 20 degrees. knees straight, head slightly elevated
(modified Trendelenberg)
Head Injury elevate HOB 30 degrees to decrease ICP
Peritoneal Dialysis (when outflow is inadequate) turn pt from side to side BEFORE checking
for kinks in tubing
Lumbar Puncture After the procedure, the pt should be supine for 4-12 hours as prescribed.
Myesthenia Gravis worsens with exercise and improves with rest