Module 2-F (3) Flashcards
Poison Exposure
Children at risk- Small size/weight, curiosity, lack of fear, evolving mobility. 1-5 High risk. School age- accidental/exposure. Adolescent- purposeful
Types of poisonings- Ingestion
most common
Types of poisonings-Ocular
getting a forgien substance in eyes
Types of poisonings-Dermal exposure
skin/pores
Types of poisonings-Inhalation
breathing in
Types of poisonings-Parenteral exposure
IV
Types of poisonings-Envenomation
venom injection-snake
Common Sources of Poisonings
plants, household and personal care products, cleaners, meds, carbon monoxide, lead, psychopharmocological drugs, alcohol
Therapeutic Management
Obtaining information
Common Sources of Poisonings
plants, household and personal care products, cleaners, meds, carbon monoxide, lead, psychopharmocological drugs, alcohol
Therapeutic Management
Obtaining information
Gastric Lavage
Over a 1/2 hr period. Not used w/ corosive substances.
Therapeutic Management
remove dermal/occular toxins (eye wash), dilute ingested toxins.(never induce vomiting)
Gastric Lavage
Over a 1/2 hr period. Not used w/ corosive substances.
Activated Characoal
1 hr or less- binds to the substance and absorbs its effects. (stimulant to counteract constipation)
Lead poisoning
paint/gas/water/soil. poor nutrition increases the effects of lead poisoning., Homes prior to 1960s
Clinical Manisfestations
CNS, Hemapoietic (RBC’s effected), GI , Skeletal, Renal (ARF)
Lead poisoning
paint/gas/water/soi. poor nutrition increases theeffects of lead posioning., Homes prior to 1960
Clinical Manisfestations
CNS, Hemapoietic (RBC’s effected), GI , Skeletal, Renal (ARF)
Clinical Manisfestatio.ns-serum level 10
harmful
Clinical Manisfestations-serum level 10-15
frequent screenings
Treatment-lead
Chelation- ridding the environment of lead products
Clinical Manisfestations-serum level 20 ^
possible removal and treatment
Treatment-lead
Chelation- ridding the environment of lead products
Physical restraints-
Bed rails x 4 (except if a pt requests it), Geri-chair, Wrist/ankle,waist restraints.
Restraint indications- Legal implications
require an MD order, emergency. Manufacturers directions, check and release according to the policy. (checking skin integrity, pulses)
Restraint indications- legal guidelines
Physiologic- danger of suffocation. Aspiration- Bipap/Cpap- NEVER restrained. Pressure ulcers, contractures.
Alternative methods to restraints.
Determine behavior pattern, pain relief, rule out causes for agitation, assess VS/meds, involve the family, reduce stimulation
Restraint indications- legal guidelines
Physiologic- danger of suffocation. Aspiration- Bipap/Cpap- NEVER restrained. Pressure ulcers, contractures.
Alternative methods to restraints.
Determine behavior pattern, pain relief, rule out causes for agitation, assess VS/meds, involve the family, reduce stimulation
Alternative methods to restraints.
distractions and calm voice, night lights, alarm system, walking barriers, side rails. Place patient close to the Nurisng station, Toilet Q 2 hrs
RACE
Rescue, Alarm,Contain, Extinguish/Evacuate
Accident free environment
Falls- don’t leave infant unattended, eliminate slippery surfaces, good lighting, clutter free, shoes, handrails, bed/call bell.
Patient Abuse/Maltreatment Assessment
Emotional / Physical Abuse, Neglect, sexual exploitation, shaken baby syndrome, Munchausen Syndrome by Proxy, Elder.
Munchausen syndrome by proxy
Illness fabricated or induced in another person. Most often the mother who fabricates or causes an illness in a child to gain attention from healthcare providers.
Risk factors for child abuse
Dysfunction (usually the biggest factor), multigenerational (both parents), socioeconomic, characteristics. (below 5y/o with a developmental delay, physical delay.
Etiology of Child abuse (characteristics
under 5 y/o, physical abnormalities, developmentally delayed, difficult temperament
Risk factors for Elder abuse
^ 80 y/o, Woman, need assistance.(personal care/financial) 1-10 cases actually reported.
Sexual Abuse
Usually 6-9 y/o at onset, 3:1 female to male ratio, incest, molestation, pedefelia, child porn.
Clinical Manisfestations (Physical indicators)
unexplained bruises, burns (soles, palms, buttocks), fractures in various stages of healing, inadequate weight gain, poor hygiene, bald pathces, inappropriate clothing for the season, STD’s
Clinical Manisfestations (Behavioral factors)
Woriness w/ adult contact, apprehension, fear, aggression, stealing food, inconsistent schooling, habit disorders, learning disorders, ( SUICIDAL, PROMISCUITY, EATING)
Clinical Manisfestations (Focused assessment)
Excellent documentation, thorough physical assessment,height/weight gain, emotional state, family support system, non-judgemental in questioning.
RN role in child abuse
Be sure the stories match (biggest indicator) , story matches the injury, know what you are walking in to, Nurses have a DUTY to REPORT
Infection Cycle
6 Components- Infectious agent, Resovoir, Portal of exit, Means of Transmission, Portal of entry, Susceptible host
Breaking the chain of Infection
Medical asepsis, RN responsibility, protection from microorganisms, immunizations, isolation
Factors and Risk of infection
Increased risk- (newborn/elderly, poor health/nutrition, stress, invasive/indwelling med devices.
Focus on the older adult
Common infections- Pneumonia (decrwased reflex in cough, due to cilia), UTI (anatomical changes, incomplete bladder emptying, decreased sphincter tone), Skin (elastiscity, vascular)
Nosocomial Infections (hospital acquired infections)
Not present at the time of hospitalization, 80% from Foley’s,
Exogenous infection
other people
Endogenous infection
organism person harbors
Iatrogenic infection
Result of a treatment or procedure (diagnostic)
Antibiotic resistant pathogens(MRSA)
Methacilin resistant Staphylococcus aureus. “cillin” drugs will not work in treating MRSA
Antibiotic resistant pathogens(VRE)
Vancomycin resistant Enterococcus- Vanco resistant
Antibiotic resistant pathogens
Hand washing is the most effective prevention
Medical asepsis
Clean technique- wask hands frequently, soiled items away from you, avoid bodily fluids, avoid raising dust, clean least soiled to most soiled.
Medical asepsis
dispose in to appropriate containers, pour directly into the drain, sterilize items, good personal grooming, follow guidelines
Surgical asepsis
Sterile to sterile only, open packs away from you, avoid spilling any solution on cloth or paper, wet in considered contaminated, above waist, avoid reaching over a sterile field, never turn back on sterile field, sterile only to break the skin, dry, sterile forceps only, edge is contaminated.
Medical asepsis
Clean technique- wask hands frequently, soiled items away from you, avoid bodily fluids, avoid raising dust, clean least soiled to most soiled.
Medical asepsis
dispose in to appropriate containers, pour directly into the drain, sterilize items, good personal grooming, follow guidelines
Psychological needs during isolation
rejection, guilt, unclean, undesirable, sensory deprivation, avoided and punished. ( need education, empahasize the reasoning) Emotional support, discontinue as soon as safe, Children have special needs( diversional activities, play dress up, young may feel punished)
CDC Guidelines
Standard precautions (wearing gloves) all hospitalized persons, blood and all bodily fluids, secretions, excretions.
CDC Guidelines
Transmission based precautions (airborne (TB), droplet(FLU- 3 ft or less), contact (CDiff)
Psychological needs during isolation
rejection, guilt, unclean, undesirable, sensory deprivation, avoided and punished. ( need education, empahasize the reasoning)
