gut (yellow) chromic gut (brown) Non-absorbable – become encapsulated by tissue and remains unless removed (removed 7 days after) silk (light blue) nylon (green) cotton (pink) Prolene (royal blue) Mersilenne (Turquoise) Vicryl (purple) Dacron (orange) SYSTEMIC LUPUS ERYTHEMATOSUS (SLE) Autoimmune S/SX: Fatigue Arthritis Sensitivity to sunlight Butterfly rash Management: NO CURE GOAL: controlling symptoms steroids TELEPHONE ORDER Only RN’s may receive telephone orders The order should be countersigned by the physician within 24 hours TENSILON TEST edrophonium chloride (Tensilon) IV evaluation of muscle strength USE: To diagnose myasthenia gravis At bedside: resuscitation equipment atropine sulfate on bedside for possible CHOLINERGIC CRISIS neostigmine for possible MYASTHENIC CRISIS Results: (+) diagnosis = improvement on muscle function after administration of drug (-) diagnosis = muscle fasciculations occur as a result of the drug TETRALOGY OF FALLOT 4 Defects: Pulmonic Stenosis Right Ventricular Hypertrophy Ventricular Septal Defect Overridding of the Aorta Tet spells – severe cyanosis Position: Knee-chest/ Squatting*** Sign Machine-like murmurs Clubbing of fingers Cyanosis Management: Surgery: Blalock Taussig procedure  shunting of the subclavian artery and pulmonary artery THORACENTESIS Purpose: To remove excess fluid or air to ease breathing POSITION: sitting leaning forward over a pillow Chest X-ray identifies best insertion site Within the first 30 minutes, not more than 1000 mL should be removed AVOID: coughing , deep breathing AFTER: Unaffected side with head elevation of 30o for at least 30 minutes THYROIDECTOMY: Complications Bleeding – Feeling of fullness at incision site soiled dressing at nape area, sandbag Accidental removal of parathyroid – Hypocalcemia – classic sign tetany Calcium gluconate, slowly administer- to prevent arrhythmia Laryngospasm – DOB, SOB tracheostomy at bedside, suction Accidental damage of the laryngeal nerve – Hoarseness of voice Encourage patient to talk post op asap to determine laryngeal nerve damage Thyroid storm – Fever, Irritability, Agitation, restlessness, Tachycardia beta blockers
2- Expose the thigh 3- palpate the pulse 4- wrap the BP cuff Common mistakes FALSE-LOW FALSE-HIGH Bladder of cuff too wide Bladder of cuff narrow Arm above heart level Arm below heart level Deflating cuff too slowly Inflating too slowly Smoking, caffeine and exercise for the last 30 minutes KOROTKOFF PHASES Phase 1 – a sharp thump  determines the systole Phase 2 – a blowing or whooshing sound (increasing sound) Phase 3 – a crisp, intense tapping (loud tapping) Phase 4 – a softer blowing sound that fades (muffled sound) Phase 5 – Silence  determines the diastole eg BP – 104/100/90 (Phases I/ IV/ V) TEMPERATURE ORAL – accessible and convenient S – Smoking* N – Newborn O – Oral surgery U – Ulceration/injury to the mouth T – Tremors/convulsions H – Hot/cold foods & fluids just ingested  wait for 15 to 30 minutes before taking temperature AXILLARY – Safe and non-invasive A – Axillary injury X – eXercise/activity I – Inadequate circulation L – Laging basa (moist pits) A – bathing RECTAL – Reliable measurement (Inconvenient and more unpleasant) R – Rectal disease/diarrhea I – Immunosuppressed C – Clotting disorders T – Turning to the side is difficult H – Hemorrhoids U – Undergone rectal surgery M – Myocardial infarction TYMPANIC – Readily accessible, reflects the core temperature, very fast 9 Risk of injuring the membrane) E – Evident cerumen A – An ear infection is present R – Reading may vary between left and right measurement – the wave of blood created by the contraction of the left ventricle. Wait for 10 to 15 minutes if he client has been physically active. Use 2 or 3 middle fingertips lightly over the site. Doppler ultrasound stethoscope (DUS): transducer probe (gel may be applied) and stethoscope headset; when using a DUS, hold the probe lightly over the pulse site. Apical pulse 7 old and above – located at the 5th ICS LMCL 7 years old – located at the 4th ICS LMCL PULSE SITES Infants, palpable: brachial and femoral Allens test: radial CPR, infants: brachial CPR, adults: carotid