DO NOT delegate what you can EAT!

DO NOT delegate what you can EAT!E - evaluate A - assess T – teach

Addison’s= Everything is DOWN except Potassium… Mineral corticoids are given in Addison’s disease.Hyponatremia, hypotension, decreased blood volume, hyperkalemia, hypoglycemia

Cushing’s= Everything is UP except Potassium Hypernatremia, hypertension, increased blood vol, hypokalemia, hyperglycemia

No Pee, no K (do not give potassium without adequate urine output)

EleVate Veins DAngle Arteries ….for better perfusion

A= appearance (color all pink, pink and blue, blue [pale]) P= pulse (>100, < 100, absent) G= grimace (cough, grimace, no response) A= activity (flexed, flaccid, limp) R= respirations (strong cry, weak cry, absent)

TRANSMISSION-BASED PRECAUTIONS:

AIRBORNE

Measles Chicken Pox/Varicella Hez - Herpes Zoster/Shingles TB

TB… N95 MASK

SARS Private Room - negative pressure, Exchange air 6-12 hrs. - DOOR CLOSED Mask, N95 for TB Gloves Gown Hand washing Disposable supplies

DROPLET

Think of SPIDERMAN!S - sepsis S - scarlet fever S - streptococcal pharyngitis P - parvovirus B19 P - pneumonia P - pertussis I - influenza D - Diphtheria (pharyngeal) E - epiglottitis R - rubella M - mumps M - meningitis M - mycoplasma or meningeal pneumonia An - Adenovirus Private Room Cohort Mask – Pt wears mask when leaving the room Disposable supplies

CONTACT PRECAUTION

MRS.WEE

M - multidrug resistant organism R - respiratory infection S - skin infections * W - wound infxn E - enteric infxn - clostridium difficile E - eye infxn – conjunctivitis

SKIN INFECTIONS VCHIPS

V - varicella zoster C - Cutaneous diphtheria H - herpes simplex I - impetigo P - pediculosis S – scabies Private Room- Door Open Gloves Gown ONLY worn when in Direct Contact Disposable supplies

• Air/Pulmonary Embolism (S&S: chest pain, difficulty breathing, tachycardia, pale/cyanotic, sense of

impending doom) --> turn pt. to left side and lower the head of the bed.

• Woman in Labor w/ Un-reassuring FHR (late decels, decreased variability, fetal bradycardia, etc.) -->

turn on left side (and give O2, stop Pitocin, increase IV fluids)

• Tube Feeding w/ Decreased LOC --> position pt. on right side (promotes emptying of the stomach)

with the HOB elevated (to prevent aspiration)

• During Epidural Puncture --> side-lying

• After Lumbar Puncture (and also oil-based Myelogram)--> pt. lies in flat supine (to prevent headache

and leaking of CSF)

• Pt w/ Heat Stroke --> lie flat w/ legs elevated

• During Continuous Bladder Irrigation (CBI) --> catheter is taped to thigh so leg should be kept straight.

No other positioning restrictions.

• After Myringotomy --> position on side of affected ear after surgery (allows drainage of secretions)

• After Cataract Surgery --> pt. will sleep on unaffected side with a night shield for 1-4 weeks.

• After Thyroidectomy --> low or semi-Fowler's, support head, neck and shoulders.

• Infant w/ Spina Bifida --> position prone (on abdomen) so that sac does not rupture

• Buck's Traction (skin traction) --> elevate foot of bed for counter-traction

• After Total Hip Replacement --> don't sleep on operated side,

don't flex hip more than 45- 60 degrees, don't elevate HOB more than 45 degrees. Hip abduction by separating thighs with pillows.

• Prolapsed Cord --> knee-chest position or Trendelenburg

• Infant w/ Cleft Lip --> position on back or in infant seat to prevent trauma to 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 minutes (also restrict fluids during meals, low CHO and fiber diet, small frequent meals)

• Above Knee Amputation --> elevate for first 24 hours on pillow, position prone daily to provide for

hip extension.

• Below Knee Amputation --> foot of bed elevated for first 24 hours, position prone daily to provide for

hip extension.

• Detached Retina --> area of detachment should be in the dependent position

• Administration of Enema --> left side-lying (Sim's) with knee flexed

• After Supratentorial Surgery (incision behind hairline) --> elevate HOB 30-45 degrees

• After Infratentorial Surgery (incision at 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,

goose flesh, bradycardia, hypertension) --> place client in sitting position (elevate HOB) first before any other implementation.

• Shock --> bed rest with extremities elevated 20 degrees, knees straight, head slightly elevated

(modified Trendelenburg)

• Head Injury --> elevate HOB 30 degrees to decrease intracranial pressure

• Peritoneal Dialysis when Outflow is Inadequate --> turn pt. from side to side BEFORE checking for

kinks in tubing

• Lumbar puncture => AFTER the procedure, the client should be placed in the supine position for 4 to

12 hrs. as prescribed.

Demerol for pancreatitis, NOT morphine sulfate Morphine is contraindicated in Pancreatitis. It causes spasm of the Sphincter of Oddi. Therefore Demerol should be given.

Myasthenia Gravis: worsens with exercise and improves with rest.

Myasthenia Crisis: a positive reaction to Tensilon--will improve symptoms

Cholinergic Crisis: caused by excessive medication-stop med-giving Tensilon

Head injury medication: Mannitol (osmotic diuretic)-crystallizes at room temp so ALWAYS use filter needle

Prior to a liver biopsy it’s important to be aware of the lab result for prothrombin time (10-13 seconds)

Diarrhea)= metabolic acidosis Vomitus)=metabolic alkalosis