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DO NOT DELEGATE WHAT YOU CAN EAT!

Evaluate

Assess

Teach

Don’t delegate Unstable patients

Initial Assessment, Teaching, IV drips, Evaluations only RN

AIRBORNE TRANSMISSION-BASED PRECAUTIONS: MTV

Measles

TB

Varicella-Chicken Pox/Herpes Zoster-Shingles

Private Room: Negative pressure with 6-12 air exchanges/hr

Mask: N95 for TB

DROPLET TRANSMISSION-BASED PRECAUTIONS: Think of SPIDERMAN!

Sepsis

Scarlet fever

Streptococcal Pharyngitis (Streptococcus group A/ Strep Throat): Can Lead to Glomerulonephritis & Rheumatic

Parvovirus B19 Fever.

Pneumonia

Pertussis

Influenza/ Haemophilus influenza type B

Diphtheria (Pharyngeal): Serious bacterial infection.

Epiglottitis: Medial Emergency! No Throat Inspection.

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Rubella/ German measles

Mumps

Meningitis/ Neisseria Meningitidis

Mycoplasma/ Meningeal Pneumonia

An - Adenovirus

Private Room or Cohort Surgical mask PRN for Procedures

Mask 3ft Distance

CONTACT PRECAUTION TRANSMISSION-BASED PRECAUTIONS: MRS.WEE

Multidrug resistant organism/ MRSA/ VRE

Respiratory infection

Skin infections

Wound infection

Enteric infection - Clostridium Difficile

Eye infection – Conjunctivitis

*MRSA - Contact precaution ONLY. Use Chlorhexidine Wipe!

*VRSA - Contact & Airborne precaution (Private room, door closed, negative pressure)

*SARS (Severe Acute Resp Syndrome) Airborne & Contact (just like Varicella)

SKIN INFECTIONS- VCHIPS- CONTACT

Varicella Zoster

Cutaneous Diphtheria (Bacteria Infection in the Wound)

Herpes Simplex

Impetigo (Bacterial Skin Infection)

Pediculosis (Lice)

Scabies (Itchy Skin condition. Burrowing Trail of the Scabies Mite)

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Middle East Respiratory Syndrome (MERS): Viral respiratory illness caused by Coronavirus (MERS-CoV).

S/S: Fever, Cough, SOB, and Death. The Incubation Period is 5-6 days but can range from 2-14 days.

CDC: Standard (Gloves), Contact (Gown), Eye Protection (Goggles), Airborne Precautions (N95)

Negative room: Negative disease (TB, Disseminated Herpes Zoster)

Positive room: Protect the Patient (HIV, Cancer)

Addison’s= hyponatremia, hypotension, decreased blood vol, hypoglycemia, hyperKalemia, HyperCalcemia.

Cushing’s= HyperNatremia, HyperTension, Incr. Blood Vol, HyperGlycemia, hypokalemia, hypocalcemia.

Managing Stress in a patient with Adrenal Insufficiency (Addison’s) is paramount, because if the Adrenal

glands are stressed further it could result in Addisonian Crisis.

Addison’s: Remember BP is the most Important assessment parameter, as it causes Severe Hypotension.

Addison’s: (need to "add" hormone): Hypoglycemia, Dark pigmentation, Decr. Resistance to Stress, fractures,

Alopecia, Weight Loss, GI distress. Vitiligo. Mood swings (Normal)

Need to Report S/S of Infection/ Fever (Addisonian Crisis)

Tx: Mineral Corticoids.

Addisonian Crisis: Hypoglycemia, Confusion, n/v, Abd Pain, Extreme Weakness, Dehydration, Decr. BP.

Cushings: (have extra "Cushion" of Hormones): Hyperglycemia, prone to Infection, Muscle Wasting,

Weakness, Edema, HTN, Hirsutism, Moonfaced/Buffalo Hump

Cause: Excessive production of Corticotropin (Hyperplasia of the Adrenal Cortex) & Cortisol-secreting

Adrenal Tumor.

Prednisone Toxicity: Cushing’s syndrome- Buffalo Hump, Moon face, Hyperglycemia, Hypertension.

Acetaminophen: 10-20. Max 4000mg per day.

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Acetaminophen Poisoning: Possible Liver Failure for about 4 days. Close observation required.

Tx: (Antidote) n-AcetylCysteine/Mucomyst

AcetylSalicyclic Acid (ASA): Metabolic Acidosis.

S/S: Tinnitus, Coffee Ground Emesis (Old Blood), Black tarry stools (Melena), Bruising, Tachycardia,

Hypotension, GI Ulcers.

Tx: Activated Charcoal, then IV Na+

 Carbonate.

Acromegaly: Coarse Facial feature. Assess Cardiac Problems (eg. S3, S4).

Acute Respiratory Distress Syndrome (ARDS):

The 1st Sign is Incr. Respirations. Later comes Dyspnea, Retractions, Air Hunger, Cyanosis.

Cardinal sign is Hypoxemia (Low O2 level in tissues).

Refractory Hypoxemia is the hallmark of ARDS, a progressive form of acute respiratory failure that has a high

Mortality rate. It can develop following a Pulmonary Insult (eg, aspiration, pneumonia, toxic inhalation) or

nonpulmonary insult (eg, sepsis, multiple blood transfusions, trauma) to the Lung.

The Inability to improve Oxygenation With Incr. in O2 concentration.

The insult triggers a Massive Inflammatory response that causes the lung tissue to release inflammatory

mediators (leukotrienes, proteases) that cause damage to the alveolar-capillary (A-C) membrane. As a result of

the damage, the A-C membrane becomes more permeable, and intravascular fluid then leaks into the alveolar

space, resulting in a Noncardiogenic Pulmonary Edema.

The lungs become Stiff and Noncompliant, which makes Ventilation and Oxygenation less than optimal and

results in increased work of breathing, tachypnea and alkalosis, atelectasis, and refractory hypoxemia.

ARDS (fluids in alveoli), DIC (Disseminated Intravascular Coagulation) are always Secondary to something

else (another disease process). – Impaired Gas Exchange.

PreOxygenated with 100% O2, and Suction should be applied for no more than 10 seconds to prevent

hypoxia. The nurse must wait 1-2 minutes between passes to ventilate to prevent hypoxia.

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