1. Patient Care Review

2. Vital Signs and Oxygen

3. Homeostasis Mechanisms that function to maintain homeostasis:
Heartbeat
Blood pressure
Body temperature
Respiratory rate
Electrolyte balance

4. Vital signs Body temperature Pulse rate Blood pressure
Respiratory rate
Assessment of mental alertness

5. Vital signs Can be assessed quickly Physiological indicators
Reveal first clue to response to treatment

6. Body temperature
Measure of the degree of heat of the deep tissue of the human body.
Mean body temp. = 98.6 degrees F (370 C)
Daily variation of 1 – 2 degrees F
Body temp must be maintained despite extremes in environment.

8. Body temperature Oral Axillary Tympanic Rectal
Under tongue; time depends on type of thermometer
Axillary
High between upper arm and torso for 5 to 10 min
Tympanic
Electronic thermometer in ear – 3 secs
Rectal
Rectal thermometer placed for 2.5 – 5 min

9. Body temperature Hyperthermia – fever Hypothermia – not common
and cellular Prolonged hyperthermia can lead to serious complications damage.
Hypothermia – not common

10. Respiratory rate Normal respirations are silent and effortless
Measured in breaths per minute
Normal is 12 – 20 per minute
Children are increased and newborns are high – 30 to 60 per minute.

11. Respiratory rate
When assessing respiratory rate, check the rate, depth and pattern to obtain the overall impression of the function of the respiratory system.
Tachypnea – fast resp. rates
Bradypnea – slow resp. rates
Apnea – absence of spontaneous ventilation – very dangerous!

13. Pulse
Pulse can be palpated at superficially located arteries, usually:
Radial, at the side of the wrist
Brachial artery
Carotid artery

14. Pulse
Pulse rates indicate how fast the heart is beating and is recorded in beats per min.
Should be measured for a full minute to be accurate
Use fingers, not thumb to check.
Resting pulse rates for adults are 60 to 100 per min.
Children are 70 to 120 per min.

15. Pulse
Pulse oximeter is a device used to assess the hemoglobin oxygen saturation of the blood and displays pulse as well.
It is placed on a finger, toe earlobe, temple, nose or forehead.

16. Pulse Tachycardia – increased pulse rate
Bradycardia – decrease in heart rate
If no pulse can be felt at the wrist, check the carotid and call for help.
Irregularities should be reported as they can be life threatening.

18. Pulse oximeter

19. Blood pressure
Is the measure of the force exerted by blood on the arterial walls during contraction and relaxation of the heart.
There is always some pressure, and as the heart contracts, there is more pressure.
Constant pressure is the diastolic and peak pressure is systolic.

20. Blood pressure
Sphygmomanometer and stethoscope is used to measure blood pressure.
The cuff is placed on the upper arm midway between elbow and shoulder.
Inflate the cuff which stops the systolic pressure
Place stethoscope over the brachial artery, slowly deflate the cuff.

21. Blood pressure Blood flow returns and can be heard
The first sound of flow is the systolic pressure
When the sound can no longer be heard, the diastolic pressure is reached.
BP is measured in mm of mercury (mm Hg) with systolic over diastolic.

22. Blood pressure
Normal BP in adult range from 95 to 140 mm Hg over 60 to 90 mm Hg
Pressures are usually recorded with the patient in the sitting position and the arm at the level of the heart.
Variations in position ( and arm ) can cause differences.

23. Blood pressure Hypertension Hypotension Bp above 140/90 Is common
Causes increased workload on the heart
Hypotension
BP less than 95/60.
OK unless there are symptoms
Patients in shock are usually hypotensive and need immediate care

25. Oxygen
Is a colorless, odorless, tasteless gas that is critical in efficient cellular metabolism.
Is not flammable, but supports combustion
Constitutes 21% of atmospheric gases
Need for oxygen becomes critical when the internal environment of the body is not consistent
When levels become too low, homeostasis is compromised.

26. Oxygen Hypoxemia Hypoxia
To compensate for hypoxia, respiratory rates, depth of breathing, blood pressure, heart rates increase.

27. Oxygen Oxygen devices: Nasal cannula Masks Tent and hood Ventilators
Portable oxygen cylinder

33. Various tubes and lines
Endotracheal tubes is used to manage respiratory complications
Can be inserted via nose or mouth but also via tracheostomy
Nasotracheal is usually used for anesthesia

37. Various tubes and lines
Thoracostomy tubes (chest tubes) are used to drain the intrapleural space and mediastinum
Are inserted through the chest wall

38. Various tubes and lines
Central venous lines (CV) are catheters that are inserted into a large vein.
Used to administer drugs and nutrition
Also used to manage fluid volume, serve as conduit for blood analysis and monitor cardiac pressure.
Groshong is one of the common ones used.

39. Infection Control

40. Pathogens
Bacteria
Viruses
Fungi
Protozoan parasites

41. Bacteria Microscopic, single celled organisms.
Common bacterial infection:
Streptococcal pharyngitis
Bacterial pneumonia
Food poisoning

42. Viruses Simpler in form to bacteria Cannot live outside a living cell
Common viral diseases:
Common cold
Mononucleosis
warts

43. Fungi Macroscopic – mushrooms Microscopic – yeasts and molds
Common fungal infection:
Ringworm
Athletes foot
Systemic fungal infections can be fatal

44. Protozoan parasites Protozoa are unicellular organisms Can ingest food
Common:
Trichomonas vaginalis
malaria

45. Infectious disease Encounter Entry Spread Multiplication Damage
Outcome

46. Chain of infection 1876 – germ theory Host Infectious microorganism
Mode of transport
reservoir

47. Nosocomial infections
Hospital acquired conditions
Iatrogenic – infection which is result of intervention by physician
Patients are more sensitive to infection.
Especially sensitive patients are those with compromised immune systems – cancer patients.

48. Cross infection Hospital environment Medical personnel Patient
Bloodborne pathogens
Invasive procedures

49. Environmental control of infection
Chemical
Disinfectants – chlorine, iodine
Physical
Sterilization: autoclave
Barriers: gloves, gowns masks
Handwashing
Most important thing we can do

50. Standard precautions Handwashing Gloving Personal protective equipment
Needle recapping
Biospills

51. Transmission – based precautions
Airborne
Droplet
Contact

52. Asepsis
Freedom from infection
Medical
Surgical
sterilization

53. Medical emergencies

54. General priorities Ensure open airway Control bleeding
Prevent or treat shock
Attend to wounds or fractures
Provide emotional support
Reevaluate appropriately

55. Emergency Cart

56. Shock
Hypovolemic
Cardiogenic
Neurogenic
Vasogenic

57. Anaphylactic shock A type of vasogenic shock
Allergic reaction to iodinated contrast media

58. Diabetic crisis Hypoglycemia – excessive insulin present
Hungry, weak and shaky
Glucose tablets or some form of carbs
Hyperglycemia – excessive sugar in the blood
Excessive thirst and urination, rapid and deep breathing
Needs insulin. Get help

59. Respiratory distress Asthma Choking Wheezing
Assist into sitting position
Keep patient calm
Get help, if necessary
Choking
Heimlich maneuver

60. Cardiac arrest
Perform CPR

61. Cerebrovascular accident
Paralysis
Slurred speech
Extreme dizziness
Loss of vision
Loss of consciousness
Get help

62. Nausea and vomiting
Patient to breathe slowly and deeply through their mouths.
If patient vomits, position patient so that there is no aspiration

63. Epistaxis
Patient to lean forward and pinch the affected nostril

64. Vertigo and Syncope Lie patient down and elevate feet
Loosen tight clothing
Moist cloth on forehead

65. Seizures Do not restrain patient Make sure he cannot hurt himself
DO NOT place your hand in patient’s mouth.
Move to floor and away from objects
Place pillow under head
After seizure check that airway is open.

66. Falls Try to minimize the fall without hurting yourself
Get emergency care, if necessary
Fill out accident report

67. Wounds Hemorrhage Burns Dehiscence pressure Maintain sterile field
Cover with sterile dressing and get help