fundamentals of nursing notes pdf

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Introduction

Nursing  -   Derived → latin word

* Nursing is a unique function of Nurse
* It provide care to ill as well as healthy
ill → Curative &  Rehabilitative

healthy → Preventing &  Promotive

Nursing symbol - Lamp

First Researcher in Nursing:- Florence Nightingale
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Florence Nightingale:

1. Born :- 12 May 1820. Place :- Italy
2. When Florence Nightingale 3l year old. She started a nursing training course.
3. 1853 : She completed a nursing training course.
4. 1860 : She started Nursing Training Institute at Sent Thomas Hospital, Londan. Now This Hospital known as King Institute
5.  Death :- 13 Aug. 1910.
6. Place :- 10th South Street London
7. Pioneer of Modern Nursing → Florence Nightingale
8. First Researcher in Nursing → Florence Nightingale

International Nurses Day:- 12 May

Health :- Defined by WHO - 7 April 1948 (Geneva)

• A state of complete Physical, mental, social (Harmonious R/S.) & spiritual well being (To believe in Supernatural power) & not merely the absence of disease or infirmity (Disability).

Disease:- (Anything away from health)

Infirmity (Disability/Divyang) - Differently Abled.

World health day :-April, 7

History taking & Physical examination

• A Process of data collection Information collection.

The Following data should be collected:-

(1) Demographic data/Identification data.

• Age (To calculate the medication) gender, race, religion (To know cultural practice) & occupation (To know Occupational hazards).

The following may be Occupational hazards:--
Inorganic 

1. Coal-Anthracosis 
2. Silica - Silicosis 
3. Asbestos - Asbestosis (Cancer lung) Hey 
4. Iron - Siderosis 

Organic

1. Cane Sugar - Baggy
2. Cotton - Byssinosis
3. Tobacco - Tabacosis
4. grain - Farmers lungs
5. Coal miner's - Black lung

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(2) Chief Complaint :

• It should be Written in chronological order. First manifestation Should be written on top.

(3) History of present Illness

• O - Origin
• L- Location
• D - Duration
• C - Character/Course
• A - Aggravating factor
• T - Treatment triad
• S-Severity

(4) History of past Illness

(5) Family history

• (Pictogram) Family tree (Pedigree chart)

(6) Personal fistory

6.a . Immunization Status

• For pregnant women
• TT-I (as early as possible after the confirmation of pregnancy)
• TT-II (One month after first dose)
• Dose: 0.5 ml - I.M.

MMR :- Contraindicated in HIV
Rotavirus- Only Inactivated Influenza/polio vaccin
Varicella zoster:- I.M. allowed after 1 year
After MMR vaccination advice the woman not to be pregnant for the upcoming 1-3 month.
Hep. B. Vaccine - 0, 1, 6 month, No booster dose if titer level is > 10 MIU/ml.
Post exposure prophylaxis for non vaccinated Victims. (Hep B :-Dose of Immunoglobulin.)
Anti-D :- Gamma globulin to the mother 300ug. following delivery in Rh negative mothers within 72 hours

6.b School history

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6.c Menses history:

• Normal Menstrual Pattern
• Menstruation Period duration
• During menstruation changes in body temperature :- 0.5-1.0°F temp
• During Ovulation changes in body temperature :- First 10.5-1.0°F temp. than 0.5-1.0°F temperature.
• Oligomenorrhea:- (long interval b/w menses) > 35 day.
• Menorrhagia:- (Excessive/prolonged bleeding) > 7 days +> 80ml
• Metrorrhagia:- (Irregular bleeding/bleeding b/w menses)
• Spotting/breakthrough bleeding Ex-Uterine fibroid.
• Endometriosis:- Growth of endometrial tissue outside the uterus.
• Amenorrhea:- Absence of Menstrual Cycle.

(7) Socio Economic Status.

• Type of house & sanitation

(8) Physical Examination

• Physical examination of body is done by four technique

8.a Inspection
8.b Palpation
8.c Percussion
8.d Auscultation

8.a Inspection :- (Commonest)
By gross eye examination.
By microscopic (Instrument)
Exp.:-

• Culdoscopy:- To visualized pouch of Top douglas (pouch between uterus & rectum)
• Colposcope :- Visulization of vegina and cirvix
• Laryngoscope :- Laryngeal Examination
• Bronchoscopy :- Bronchioles Examination
• Arthroscopy :- A joint usually knee.
• Vascular Endoscopy :- Arterial & Vascular lumen
• Choledoscopy: - CBD (Common bile duct)
• Laparoscopy :- Abdominal organs
• Choledolithiotomy :- Common bile ductIncision (Stone renove)

8.b Palpation :- It is Sense of touch ( a technique of Touch )

• Palpate the Location, Size, Shape (Olive mass in pyloric stenosis)
• Assess the Temperature by dorsal surface of hand.

Q.If oral temperature is 98.6°F then Rectal temperature is.
Ans. 99.6°F :- Increase by 1°F/0.5°C if Rectal, 97.6 F :- Decrease by 1°F/0.5°C if Axillary
Most accurate temperature - Rectal (< 6 year of age).

8.c Percussion :-Art to produce sound
Palpate to produce vibration.
Tapping the client's skin & body organs.
Percussion is Dull over liver & spleen. (Normal) 

Scoring of deep tendon reflex-

• 0:- No response
• 1+:- Sluggish or diminished
• 2+ :- Active or expected response.
• 3+:- Slightly hyperactive, more brisk than normal, not necessarily pathologic.
• 4+ :- Brisk, hyperactive 7 Intermittent clonus associated disease.

Normal lung sound :- Resonance sound
Emphysema:- Hyper resonance sound.

Liver :-Dull sound
Thigh :- Flat sound

Stomach - drum like sound

8.d Auscultation :

• Listening of Sound with equipment Stethoscope or another instrument.

B.P. :-Korsakoff's of Sound.
NG tube :- Whooshing Sound.
PDA:- murmur
Dub :- Closure of semilunar valve. (S2)
Lub:- Closure of A.V. Valve (S1.)

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Order of physical Examination

• Inspection→ palpation → percussion →auscultation

In abdominal assessment Technique - Less interference to more interference

• Inspection→ auscultation →percussion→palpation.

Various test and terms of physical Examination

Turgor test - Pinch a large fold of skin & assess ability to return, poor turgor occurs in severe dehydration & extreme weight loss.

Snellen eye chart (20/20 feet) - For vision.

Confrontation/Perimetry test :- For peripheral vision. (Donder's Test)

Ishihara chart :- For colour vision.

When auscultating breath sounds, instruct the client to breathe through the mouth & monitor the client dizziness

•  Abnormal lung sound called Adventitious sound
• Murmur :-(Gentle, blowing or swishing noise sound of heart)
• Rales or Crackles (Medium & Fine) In pneumonia
• Coarse crackles :- In pulmonary edema
• Wheezing - In asthma High pitched, during expiration.
• Rhonchi (Called sonorous wheeze) Chronic bronchitis, low pitched, loud snoring During expiration.
• Pleural friction rub :-In pleurisy, Coarse rubbing sound Throughout Inspiration & expiration.

Auscultate cach carotid artery for bruit
↓
(Blowing, swishing sound)

Bowel sound :- 

• Heard first in Right lower quadrant
• High pitched gurgling sound occurs irregularly for 5 to 30 times a minute. (Normal)
• Hyperactive Bowel sound :- Borborygmus sound (due to increased peristalsis).

Kernig's sign :- +ve (In meningitis). →Client Flex leg at hip & knee & reports pain in Vertebral column when leg is extended.

Brudzinski Sign +ve - The client Passively Flex the hip & knee in response to neck flexion & reports pain in the vertebral column.

Decorticate posture -The client's arms (upper) are Flexed & held tightly to the sides of the body & the legs are extended & internally rotated.

Decerebrate posture -The client rigidiy extends the arms with pronated forearms & plantar flexion of the feet.

Disinfection, Sterilization & Biomedical Waste Management

Sepsis :- Infection - Invasion of Pathogens

Asepsis :- Free from pathogenic organisms.

Portal of Entry :- The routes are -

• Respiratory
• GIT
• Skin
• Genitourinary

Septicemia :- Blood Stream Infection.

Aseptic techniques :- Procedures used for asepsis maintenance.
Clean/Medical  

• Body sterile & environment Contaminated
• Maintain=wards, casualties, Immunization Room, Hemodialysis
• For Injection, Vital sign. 
• Bed making 
• Hand Washing -40-60 seconds minutes.
• Flow of running water-Elbow to palm 

Sterile/Surgical

• environment sterile & body contaminited
• Maintain=OT. ICU Critical care areas,
  
• For deep vein/arterial Catheterization
• For Urinary catheterization
• Hand Washing 3 to 5 minute But first case hand wash 10 minute
• Flow of running water-Palm to elbow
• Hand Washing : From less contaminated to more

Elements of hand washing

• Soap :- Emulsification (decrease surface tension)
• Friction :-Heat production kills pathogens. it is most important Element
• Water
• Time

Steps of hand washing :- According to WHO
(1) Palm to Palm
(2) Palm to dorsal/Back.
(3) Interlacing fingers
(4) Knuckles.
(5) Rotation of thumb.
(6) Tip of fingers
(7) Wrist

Disinfection
Meaning :- Killing pathogenic microbes
Types :- There are two types Disinfection

1. Concurrent -Ongoing
2.  Terminal- After discharge/death/ Transfer/Refer.

Antiseptic :- Prevent growth of microorganisms.
Bacteriostatic :- ↓ growth the bacteria.
Autoclaving :- Best method of sterilization in hospital.
Radiation :- Best method of sterilization at commercial level.(Garruma-Irradiated).

Sterilization

Meaning :- Process of killing of all king of microorganism (Pathogenic, Non-pathogenic, spores).

Types:
(1) Physical Sterilization

• Sun light. (Most cheaper) (U.V. Rays)
• Heat

Heat

1. Dry - Flaming (Lab Slides) Burning.
2.  Moist

moist Less than 100°C Pasteurization (Milk) 

1. Holder (63°C for 30 minutes)
2. Flash (72°C/20 Sec. Methed)

moist at 100°C -Boiling

moist greater than 100°C -  Autoclaving

Autoclaving :- 121°C/15 Lb/15-20 minutes ( 30 min )

S.S. Drum :-(Stainless steel) All Instrument put in this for autoclaving

• 30 minuten for wrapped articles.
• 20 minuten for opened articles.

CSSD :- Central Sterilization & Supply department

• Drum window/ lids should be open, when going to CSSD.
• Close lids when coming back.
• Sharp instruments should not be sterilized by boiling because it decreases their sharpness.
• Once drum is opened than All the set of articles are used within 24 hours
• If drum is not opened than all the set of articles are used within 7 days

(2) Chemical/Cold Sterilization

• Disinfectant :- Chemical agents used for cold sterilization

The following disinfectants are used in Hospital
A . Cidex- 2% or 2.45% Glutaraldehyde

• note-Metals are not sterilized by chemicals because there is risk of staining of metals.
• Items to be disinfected
• Endoscope
• Humidifiers
• Nebulizer Tubings.

B. Phenol (5%) :- Carbolic acid - used for carbolization.

• It is available In Crystal form.

Q. Prepare 5% Carbolic acid, 1000 ml for carbolization of bed
Ans.
What we want x Quantity / What we have

5 x 1000/100 = 50 ml (Phenol).
= 950 ml (Water).
Ratio of water & phenol is 950 : 50

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C. Sodium hypochlorite :- (strong disinfectant)

• Trade name: Polar
• Used concentration : 1%
• HIV +ve Instrument, blood, tubing. is disinfected by 1% Sodium hypochlorite.
• Available in: 5% & 10% solution

Q: Prepare 500 ml sodium hypochlorite solution 1%
Ans. 1%x 500/500 = 100 ml hypochlorite

= 400 ml Water

The efficacy of the prepared solution is only for 8 hours.

D. Savlon :- 5%

E. Spirit :- 70% Alcohol-Skin surface disinfectant / Thermometer clean.

F. KmnO4, - Potassium permanganate.

• 1:5000 to 1:10,000.
• Used for mouthwash.
• Used for Sitz Bath

G.  Acriflavine 1%

H. Hydrogen peroxide (1:8) - Mouth wash.

I. Gentian violet 1%
Principle of Cold Sterilization :- Coagulation of Protein.

3. Gaseous Sterilization
Fumigation - In O.T.
(Produce formalin gas)
      ⇓
Formaldehyde + KmnO4,

FOR 12 Hours :- Close O.T.

New Concept :- Foggers - (Fogging) - O.T. Sterilize use of Echo Shield For 30 Minute Duration.
For 30 minute :- Waiting time.
Total :- 1 hours. (Case can be taken after 1 hour)


Exercises :- After sterilization the following can be used up to
Name 
(1) Cheatle forceps Life Span→   24 hour, In OT - 1 shift.

(2) Humidifier Life Span→ 24 hour.

(3) Ventilator tubing Life Span→ 3 days.

(4) S.S. Drum Life Span→ 3 days

(5) I.V. Cannula In hand Life Span→   3 days (Change on 4th day).

(6) Gauze/bandage Life Span→ 3 days.

(7) Packed material Life Span→ 1 year.

(8) Thermometer Life Span→ Single use.

(9) Stethoscope Life Span→ Single use.

(10) Nebulizer mask Life Span→ Single use.

(11) Nebulizer tubing Life Span→ One Shift.

(12) Oxygen tubing Life Span→ 24 hour.

(13) Sutures wrapped in paper Life Span→ 1 month. (4 weeks).

Bio Medical Waste Management
Meaning - Waste material R/T patient Care.

Biomedical waste management Act →In 1998 (pass) & Revised in 2003
Categories :- 10 categories of BMW According to WHO
Sources :
1. Direct bedside
2. Causality
3. Laboratory
4. OT
5. OPD

Objectives:

• To prevent cross Infection.
• To prevent Nosocomial Infection.
• To decrease HCAI (Health care associated Infection)
• E.Coli - Common Cause of Infection in hospital
• Catheterization is most common procedure of HCAI India HCAI rate = 0.8 to 8% HCAI of ICU - 25%
• Common HCAI - UTI- E.Coli (Common Cause)
• Second common HCAI in Hospital - (Pseudomonas)
• Second common HCAI in community-Pneumococcus

Steps of BMW Management

(1) Generation :- Production of BMW

• Doctors & Paramedical staff are responsible for it

(2) Segregation :- Separation of waste.

• A person who is generator is responsible for segregation of

(3) Storage :- BMW Should not be stored beyond

• 48 hours (In ward = 24 hrs. in hospital = 48 hrs.)

(4) Transport :- It should be transported within 48 hours of generation

(5) Disposal of waste

Categories of BMW bags

• Red → Plastic waste
• Yellow → Infectious waste
• Blue → Sharp
• Black →General waste

(For Infectious Waste always Label :- Biohazard label.)
If plastic burns - Produce carcinogenic gases.
Dioxine :- Lethal to human body
Mutilation :- A process of alter the shape to prevent recycling

• Cutting of Hub of syringe
• Burning the tip of Infectious Needle.
• Chemotherapy needle should not mutilate because metal particle enter in respiratory system & cause cancer

Segregation is the responsibility of doctors & paramedicals (waste generators).
Q.: For how much time hospital waste can be put in hospital ?
A. 24 hour - In wards.
B.. 48 hour - In hospital.

Universal precautions

• Used by healthcare providers, to prevent cross Infection.
• Efficiency :- 3 hours.

(1) Hand Washing
(2) Gloves
(3) Gown
(4) Mask
(5) Goggles
(6) Cap
(7) Shoe cover/slippers.

Universal precautions always depends upon nature of disease & nature of procedure.

Exercises:-
Q. During bed making.
Ans. Mask - Occupied bed.

• Gloves - (Close bed)
• Gown - Infectious patient

Q.: During taking vital signs - None.

Q.: During dressing of wounds → Gloves, Gown.

• Burn wound → Gloves, Gown, masks.

Q.: Recording & Writing -- None.

Q.: Care of T.B. patient - mask.

• Intubation of T.B. patient - All needed.

Q.: During I.V. Injection - Gloves.

Q.: During Catheterization → Gloves. (Sterile)

• No touch technique not remove wrapper

Q.: During sitz bath - None.

Q.: During bed bath :- Gloves.

Q.: Weight measurement - None.

note → Hand washing is must in All kind of procedures

Q.: Which is not an universal precaution used by nursing staff.
A. Mask
B. Hand washing 
C. Cough etiquettes
D. Gown
ANSWER: C
Q: Pulse of T.B. patient taken then - Mask.

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Nursing Process

It is a systematic, scientific process, Have 5 steps

1. Assessment
2. Nsg Diagnosis
3. Planning
4. Implantation
5. Evaluation

1. Nursing Assessment

• Head to toe/ Cephalocaudal/ Crown heel assessment.
• Newborn assessment - Keep newborn warm during examination.

Assess the vital sign :newborn

Pulse :- Resting 120-160 BPM, Crying upto 180

The sequence of taking is Respiration, Pulse, Temperature & B.P (Less interference to more interference)
newborn

• Length :-45-55cm (18-22 inch).
• Weight :- 2500-4000gm. (5.5-8.75 lb).
• Head circumference :- 33-35cm.
• Head - 1/4 of body length, 1/5 of body weight (adult).
•  Chest circumference:- 30-32 cm

(Difference between HC & CC should be 3 cm)

• If HC & CC more than 3 cm = macrocephaly
• If HC & CC Less than 3 cm = microcephaly

Moulding - Overlapping of critical bons Spontaneously Disappear 72 hour after birth

Caput Succedaneum 

• Edema of soft tissue Over bone 
• Crosses suture line 
• Subside within few days (24 hours) 

Cephalohematoma

• Swelling caused by bleeding into area b/w Bone & periosteum
• Don't cross suture line.
• Absorbed within 6 week

Both Caput Succedaneum & Cephalohematoma does not require any intervention
these subsides spontaneously.

• Assess for Down Syndrome (trisomy 21.) -Single creases associated with Down Syndrome. ( normal two creases )
• Nasal flaring is an indication of respiratory distress.
• Seesaw respiratory pattern. (fall & rise of chest & abdomen don't occur togetherly).
• Billard scale :- Assessment of Gestational age
• Brande scale :- Assessment of Decubitus ulcer
• Glasgow Coma Scale:- Assessment of consciousness
• Eye movement, Verbal, Motor activity
• Minimum = 3
• Maximum = 15 
• Coma =  7 & Below 7

APGAR score -Assessment of Newborn-should be taken on 1 & 5 minute interval after birth.
Minimum=0
Maximum = 10

CAGE :- To assess/detect the severity of alcoholics. Eye opener drunker. > 2 - Indicate alcohol.

Nipple oedematous & often milky secretion (witch milk secretion)
Vernix caseosa (Responsible for evaporative loss of heat) presence of entire body in preterm newborn but is more prominent b/w folds closer to arm, may be absent after 42 weeks of gestation
Milia :- Small white sebaceous glands appear on the forehead, nose, skin.
Skin - Dry peeling skin-Post mature baby 

Dark red colour:- (plethoric) - premature baby
Acrocyanosis :- Peripheral cyanosis of hands & feet is normal in the first few hours after birth & may be noted Intermittently for the next 7-10 days.

Harlequin sign :-Deep pink or red colour develops over one side of the newborn body while the other side remains pale or normal colour Indicate shunting of blood that occurs with a cardiac problem or may indicate sepsis.

Umbilical cord - Have A2, V2, upto 4 month of fetal life. after birth A2, V1, (A2, V1, is after 16 week) 

If A1,V1, :- Renal agenesis. ( Absence of fibroelastic cartilage in ear also indicate renal agenesis) 

Umbilical cord

• 40 cm length (30-100cm).
•  1-5cm Diameter.
• The right vein disappeared by 4 month.
• Battledore - Cord at margins.
• Velamentous - Cord at membrane.
• Small thin cord associated with poor fetal cord.

GIT Assessment

• Abdominal depression:- Diaphragmatic hernia.
• Abdominal Distension:- Obstruction /mass / sepsis.
• Abdominal Sound :- present in first hour after birth.
• Postpartum constipation may occur, c impaired bowel movement.
• Soft formed stool - by 2nd & 3rd postpartum day.

Genitai Assessment :- 

• Pseudomenstruation (Bleeding through vagina due to withdrawal of maternal hormone estrogen).
• First voiding- Should occur in 24 hour.
• Anus :- First stool meconium should pass with in first 24 hour.

Skeletal System

•  Normal length 45cm, Shape-little finger, Lumberpuncture:- Adult site- L3-L4, child- L4-L5 
• Assess for hair tuft's & dimples along a spinal column (Indicate possible opening & NTD).
• A degree of hypotonicity & hypertonicity may indicate CNS damage.

(A) Congenital dysplasia of hip joint

• Allis sign/Gallaui sign :- Shortening of limb on affected side.
• + ve ortolani sign :- Abduction/Clicking Sound.
• + ve Barlow sign :- (Femoral head out of acetabulum)
• + ve Trendelenburg sign.
• Greater trochanter is prominent.
• Marked lordosis & waddling Gait.

(B) Congenital Club Foot :

• Talipes Varus :- Inversion/bending inward.
• Talipes Valgus :- Eversion/bending outward.
• Talipes Equina :- Plantar flexion-toe is lower than heel.
• Talipes Calcaneus :- Dorsiflexion - toes are higher than heel
• Talipes equinovarus :- most common
• Talipes equino valgus
• Talipes calcaneal varus
• Talipes calcaneovalgus

(c) Idiopathic Scoliosis -

3 dimensional/Spinal deformity that usually involves lateral curvature, spinal rotation.

• + ve adam's test :- Asymmetry of Ribs & flanks is noted when a child is forward at waist & Hangs the arms down the feet.
• Lordosis (Swayback) - Ted lumbar curvature.
• Kyphosis (Hunchback)- Exaggeration of posterior curvature of thoracic spine.
• Scoliosis - lateral spinal curvature

Assess for

• Pyloric Stenosis :- mass - Olive shape-right side to umbilicus :- wave - Lt. to Rt.
• Renal tumor/Nephroblastoma :- Don't palpate
• Epispadias :- Urethral opening at dorsal surface.
• Hypospadias - Urethral opening at Ventral surface.
• Cryptorchidism Undescended testes. Blum ele descon onlayn
• Blue colour of fingers - Raynaud's phenomenon,
• Ischemia + pain + ulcer => Burger's/ Smokers disease

2. Nursing Diagnosis

Meaning - Response of body to the disease
Example :- Altered nutritional status R/t to loss of appetite.
• Qualifier's (increase/decrease/risk/altered)
• Diagnostic labeled.

3. Nursing Planning
It is setting the goal
Goal may be short term or long term.
Goal should be SMART

• S - Specific
• M - Measurable
• A - Achievable
• R - Relevant
• T - Time bounded

4. Intervention/implementation

• It is putting the plan into action.

5. Evaluation

• It is determined to what extent the stated objectives have been achieved. 
• Then decide to terminate or recycle the plan or modify the plan. 
• Process ends with the discharge of the patient.
• Discharge planning starts at the time of admission.

Bed

(1)Closed bed :- For newly admitted clients.
(2) Open bed :- Patient already is in bed but capable to move out
(3) Occupied bed :- Patient completely in bed, not able to move out.
(4) Cardiac bed :-For asthma Patient or for cardiac or respiratory problems.
                ↓
Upper end elevated & patient have support over cardiac table.

(5) Amputation:- lower half cradle bed. (Painprevention)
(6) Blanket/Cradle bed :- Burn patient, Oedematus & painful patient Kidney patient, Rheumatoid arthritis

Supporting devices

• Sand bags :- To immobilise body parts.
• Bed pan :- For defecation.
• Urinals - For urination
• Macintosh :- To prevent soiling of bedsheet, from shoulder to knee joint, put below 37 cm of head of bed.
• Call bell :- For assistance
•  Bed :- 78x38x28cm. (Length, width, height)
• Hospital bed sheet :- 108 x 76 cm.
• IV. Pole :- 18-24 inch.
• Drawsheet :- To prevent skin irritation, 21cm.
• B/w 2 Bed Distance - 6 feet

Vital Signs - Also called cardinal signs that reflects the body’s physiologic status.

1. Temperature :- It is a difference between heat production & heat loss Measured in Centigrade or F

• normal range are 37 degree C or 98.6 degree F
• Fever when body temp. more than 37.2 degree C called fever.
• In -Increased temperatur – Vasodilatation & sweating and hence decreased temp.
• In-decreased temperature - vaso constriction shivering

1. Radiation- Radiation is the transfer of heat b/w two object without physical contact.

• Greatest heat loss up to 80%(60-80%) 

2.conduction- conduction is the transfer of heat from one object to another with direct contact
3. Convection – it is transfer of heat away by air movement Eg- electric fan
4. Evaporation – it is the transfer of heat when substance change their medium Eg- Solid→ Liquid → Gas    22% heat loss

• 1 Kcal - 4.184KJ 
• Thermogenesis- production of heat
• Heat metabolism organ = liver
• Thermoregulation center = hypothalamus
• By Metabolism=Anabolism+ Catabolism
• Anabolism = synthesis
• Catabolism = break down

Fever-

• Fever- Work act as defense mechanism : in our body

1. Constant fever →stimulate the WBC→ phagocytosis → kill  bacteria 

2. Fever also fight viral infection by stimulation “interferone “ which is a viral fighting substance.

3. FUO- Fever of unknown origin

Hyperthermia –Body temp.continue elevation & not heat loss mech.

S/S- Excessive thirst ( Early Sign )
Classification –

•  Low Pyrexia- 99-100 degree F
•  Moderate pyrexia -100-103 degree F
•  High pyrexia -103-105 degree F
• Hyper pyrexia- >105 degree F

Hypothermia-
▪ Body unable to heat production
▪ Continue heat loss.
Sign-  Uncontrolled shivering

⧫ If 34 C से body temp कम जा रहा है तो BP. heart & respiratory problem should be occur .
Classification-

1. Mild – 34-36.9 C
2. Moderate – 30-33.9 C
3. Severe-<30C

Type of fever-

1. Hectic or Swinging fever- जब Temp. के max. और mini. Time के बीच बहुत ज्यादा difference हो जाये. per 24 hour count होता है

2 inverse fever -Normally - Evening temp > morning. temp.
⧫ But in inverse- Fever –Mng temp > Evg. Temp.

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3.Crisis -Two type (high temp. वाले fever का कुछ समय बाद कम हो जाना)
A) True crisis- in this Temp. decrease & Pt.Condition is improve.
B) False crisis- in this Temp. decrease but also condition of patient is not improve .this is medical emergency.

4. Lysis-( Zig-Zag manner).
In this zig-zag manner temp.is lysis.
5.Constant fever- (2C or 3.6F) इसमें Temp. 38 degree C से ऊपर बना रहता है लेककन Mng & evg temp decrease (2 degree c) से अधधक अांतर नही पाया जाता

6. Remitent Fever- [Spikes(spiky hair) & falls fever]
In this fever mng.&evg. Temp. difference is more than 2-3 C but in evg. Time does not return to normal condition.

⧫ Intermittent or quotidian fever- in this Temp. is decrease & return to normal acceptable range with in 24 hour.
⧫ Opposite of constent fever- Remitant fever

⧫ Rectal thermometer insertion point-
- Adult -3.5 cm( 1.5 inch)
- Infant-1.2 cm (0.5 inch)
- Direction – introduction into rectum towards the umbilicus.

Temperature-

Axilla- 97.6 F (5 min)
Oral 98.6 F (2min)
Rectal – 99.6 F(3min)

⧫ Thermometer-
(A)  Tymponic membrane thermometer- (Core temperature)
▪ Most accurate method (2.5 sec)
▪ 1/3 part insert.
▪ Most reliable method – Rectal method

(B)  Mercury (Hg)-
▪ Boling point 35.7 C
▪ Freezing point 39 F
Mercury is 13.5 time heavier than water.
✓ If client take hot & cold liquid & cigratte smoke wt.for 20 mins for measuring temp.

Heat loss by Radiation – Maximum heat loss up to 80% Conduction
Convection Evaporation
Normal tem – 37 c or 98.6 F.
37.2 c – indicate- fever

Types of body tem.

• Core tem – Oral, Rectum
• Surface – Axilla

Specific dynamic action of food(SDA)- it is the Stimulating Capacity of food to produce energy 

•  SDA of Protein - 30% (Highest)
• Mixed food - 12%
• Fat - 4%
• Carbohydrates- 5-6%

Heat production

• 1gm fat :- 9 Kcal - 38KJ.- Highest source of energy. most dense source of energy
• 1gm carbohydrate :- 4 KČal.-17KJ-→ Most readily available
• 1gm protein :- 4 Kcal.-17KJ.

2. Respiration- is the exchange of O2 and CO2 b/w the atmosphere and body

Respiration= Inspiration + Expiration

• Respiratory organ - lungs.
• Respiration - 16-20 respiration per min
• Tachypnoea = >24 respiration /min
• Bradypnoea - < 10 respiration /min
• Hyperpnoea :- Deep respiration
• External respiration :- Process of Inhaling & exhaling air & diffusion of gases between alveoli & capillaries.
• Internal respiration :- Process of exchange of gases between capillaries & cells

Phases of Respiration :

• Inhalation - 25Sec.
• Exhalation 30 SEC.

Normal Respiration :- Eupnea
Absence of Respiration :- Apnea
Sound:-

 Normal Noiseless & Rhythmatic
Wheezing :- Asthma- COPD,


Crackles :- TB pneumonia.
Ronchi :- Pneumonia & T.B.
Pleural friction Rub :- Pleurisy.
Cheyne stoke respiration :- Rhythmic with periods of apnea.
Kussmaul Respiration :- Respiration rate are abnormal, deep, Irregular i.e. DKA
Cyanosis :- Bluish discolouration of skin
 Anoxia/Hypoxia :-O2↓, at tissue.
Hypoxemia :- O2↓, at blood. Methods of detection of hypoxaemia.

(1) ABG analysis (most accurate)
(2) Pulse oximeter :- O2 saturation in blood (96 -99%) 100% when patient is on ventilator

Ventilatator modes :

• Time cycle :- (Pediatric, neonate).
• Volume cycle
• Pressure mode

High pressure alarm 

• Wheezing - Bronchospasm 
• ↑Secretion  
• Obstructed tube 
• Tube biting. 
• ET tube displaced

Low pressure alarm.

• Disconnection or leak in Ventilator or tubings
•  Stop spontaneous Breathing

Complication :- Hypotension
Pneumonia :- Crepitus (Subcutaneous emphysema).

Respiration center- Medulla oblangeta (Upper pons, Lower pons)

Pneumotonic center- (upper pons of m.o.)

Apneustic center- ( Lower pons of m.o.)

3. Blood pressure

• Definition :- Pressure of blood against blood vessels.
• Systolic :-During contraction of ventricle
• Diastolic :-During relaxation of ventricle
• B.P = 120/80 mm Hg. 16/11 Kpa
• Hypertension :- >140/90 mm Hg.
• B.P=C.O.x PR (CO = SVx HR)
• B.P. = SVx HR xPR (PR :- Resistance against the blood flow).
• SV = 70 ml HR = 72 bpm
• C.O. = 5 ltr
• Pulse pressure = Systolic blood pressure - Diastolic blood pressure
• Normal pulse pressure is 40mm Hg

Pulsus paradoxus :- Systolic B.P. decreases more than 10 mm of Hg during Inspiration.

Orthostatic hypotension :- B.P↓ when Position Changed. it decreases when person sits from supine or when stand from sitting,
BP decreases :- Supine /lying → Sitting → Standing

Orthopnoea→ Classic Symptom of left side heart failure. (Difficulty in breathing when lying.)

Q. A orthopneic patient comes to the hospital with a position given 
ans-semifowler

Q.: Position given to Hypovolemic patient
Ans. Trendelenburg.

B.P. measurement:

• Instrument :- Sphygmomanometer
• Site :- Above antecubital fossa (2-3 cm Above) :- Take Brachial pulse

Special consideration r/t with blood pressure-

1. If bladder cuff too wide/ loose - False low reading

2. If bladder cuff to narrow /short /tight - False high reading

3. If the arm low the heart level - False ,high reading

4. If the arm above heart level - False, low reading

Normal B.P reading in thigh are higher than upper extremity

B.P. measure in thigh are lower than bronchial pressure indicates arterial disorder.

B.P. नापते time korotkoff  नामक sound सुनाई देता है

Admission of patient 
Patient :- A person who is not healthy.

Client :- A person participates in health care services.

Customer :- Avail the services & pay for it.

Admission :- Allowing a client to stay in hospital./ offer the bed.

Admission may be :

1. Routine admission
2. Emergency admission.

Requirements for admission of a client

• Basic Informations :- Name, age, religion, address

Collection of Specimen
 
Urine Sample

• Midstream sample.
• Morning-bed time

Type : -

Single sample/ (100-120 ml urine) - At room temp.

1. One time sample -No need of preservatives 

• If delay in sending, keep in refrigerator 
• Try to send immediately in Labs 

2. 24 hour Sample
Add preservative Boric acid Chloroform HCI

24 hour urine collection: VMA Test /RFT

• First collected urine should be discard
• Collect for next 24 hour

Analysis of urine sample

Normal characteristics :

(1) PH - 4.6 to 8 (Acidic to alkaline)

(2) Specific gravity - 1.016 to 1.025

(Specific gravity is the Concentration/Dissolve particles)

H2O ↑ → Specific G↓

H2O ↓ → S.G.↑

Exercises :- Specific gravity of urine

i) In brun - ↑

ii). Cardiac failure - ↑

iïi). Diabetes Insipidus - ↓

iv). Diabetes mallitus. - ↑

v. Overhydration -↓

vi. Dehydration - ↑

vii. Renal failure - ↓ Initially - Electrolyte not reabsorb.

(3) Composition of urine :

96% - H2O

2% - urea

2% - uric acid, electrolyte, creatinine, chloride, phosphate, sulphate, oxalate

(4) Volume - 1500ml.

Polyurea - Increases volume - DM & D.I.

Severe oliguria < 100 ml

Oliguria - < 400ml/day - Kidney failure

Anuria < 50 ml/day or Absence of urination.


(5) Urine Colour-Amber colour.

           ↓

Due to the presence of urobilinogen.

Bone marrow → RBC.
 ↓
Hb.
 ↓
(Heme) fe + Globin (Protein) - Utilise by body for growth.
 ↓
Biliverdin  
   ↓
Converts in to Bilirubin, in presence of Biliverdin Reductase
  ↓
Conjugated bilirubin. (IN LIVER) Water soluble (Mono & Di glucuronic acid).
  ↓
Blood
↓
GIT
↓                           ↓
Urobilinogen      Stercobilin.
↓                             ↓
Urine                   Stool.
↓                             ↓
Amber colour.      Pale brown colour.

Pale/yellow color of urine - Normal.

(i) Green colour urine :- Bile pigment ↑se.

(ii) Red colour urine :- Hematuria (Bleeding. RBC)

Drug: Pyridium

(iii) Orange colour :- Rifampicin drug (Anti T.B. drug)

(iv) Turbid :- Pus in urine.

(v) Whitish/Chyluria - Milky whitish urine.

• Filariasis, Due to ↑ed fat.

Hemoptysis - Blood in sputum.

Hematemesis - Blood in vomiting,

Malena - Blood in stool

(6) Odour- Aromatic (Normal)

In diabetes mellitus & In DKA

Fruity odour :- Acetone present in urine.(Rothera's test.)

Urine test in Laboratory:

(1) Proteinuria - Hot & Cold test
         ↓
Protein in urine :- In Nephrotic Syndrome. Hypoalbuminemia

Q.: Hot & cold test is used to detect.
A. Amino acid in urine By product of protein breakdown.
B. Globulin in urine - Immunoglobulin use, 
C. Albumin in urine
D. All of above
ANSWER: C

(2) Glycosuria :-Glucose in urine

Benedict's Test -

1. Blue liquid c̅ no deposit - Absence of sugar Green liquid c̅ no deposit - Approximately 1% sugar.
2. Green liquid c̅ yellow deposit - Approximately 2% sugar.
3. Colourless liquid c̅ orange deposit - Approximately 3% sugar.
4. Brick red :- 5% or above. DM

(3) Ketone bodies:- Rothera's test/(+ve) purple ring.

Nitroprusside test. (Na- Nitroprusside used for test)

(4) Bile pigment :- Smith test → Green colour +ve.

(5) Bile salt :- Hey's test.

Sterile technique of urine sample
Catheterization

• In Menstrual Cycle
• In UTI , In unconsciousness patient
• Catheterization: Sterile technique
• By close technique.

Stool Specimen

indication
GIT Infection.
Parasitic Infection.
Infectious disease- cholera, Typhoid

Characteristics
Normai : -

• Semisolid
• Smell :- Pungent due to present of skeleton
• Brownish colour

Clay colored stool :- In biliary obstruction (Stercobilin absent).

White stool :-Due to barium diet Intestire.

Red stool :- Malena

Watery stool + mucus + blood - Dysentery.

Rice water stool :- Cholera

Pea soup stool :- Typhoid (Salmonella typhi. Step Ladder pattern fever.)
Widal test (Confirmatory test)

Tarry Red colour stool. :- In upper GI bleeding.

Black, bloody :- Colon cancer

Ribbon shaped stool :- Hirnshprung's disease,

Megacolon (Intestinal obstruction)
↓
Postganglionic nerve fiber Absent. (Aganglionic colon).

Jelly stool :- Intussusception

Q.: Fresh red colour-Lower GI bleeding.
Ans. (In colon cancer)

Watery Stool :- Diarrhoea (3-4 time)

Q.: When Diarrhoea condition persist for a longer time → Metabolic acidosis.


Q.: Typhoid Infected clothing should be dip in which
-Solution [Phenol = 5% Carbolic acid.

More high fiber diet = Dumping syndrome, characterized by lightheadedness, fainting.

less fiber diet :- Cancer.

Constipation :- Difficulty in passing stool or Absence of stool

Obstipation :- Stool retention in intestine for a longer interval

Achalasia :- Decrease movement of oesophagus

 Food stay in stomach :- 3-4 hours
Maximum retain :- Fat.
In fiber diet :- Within 1/2 hours stomach empty
↓
If high fiber diet is taken then Dumping syndrome may occurs. It is characterized by Hyperosmolarity Water from blood enters in to intestine & causes Rapid heartbeat Hypovolemia, Dehydration. Sweating, abdominal pain, Nausea.

Sputum Sample

Requirement:- 15 ml

Colourless secretion of respiratory tract.

Abnormal findings of sputum are:

(1) Yellow - Pus present

(2) Red - Blood in sputum (Hemoptysis).

(3) Black - Carbon pigment, Smoking, pollution

(4) Green - Bronchiectasis. (Dilatation/widening of Respiratory bronchioles. )

(5) Rusty - Pneumonia.

(6) Brown - Gangrene of lungs.

Q.: In Sputum Acid fast bacilli (AFB) + ve, Then which therapy should be started

Ans. DOTs therapy

• AFB:- Mycobacterium tuberculosis.
• 24 March :- International T.B. day.

side effect of DOTS

• Vision problem :- Ethambutol.
• Neuritis :- Isoniazid
• Give (Bit B6/ Pyridoxine) to overcome the neuritis side effect of DOTS

Q. Eosinophils present in sputum -- Asthma

(Allergic) - IgE↑se.

Collection of sputum :

(1) Time - Early morning, before brushing & breakfast

Mouthwash by plain water may be allowed

(2) Technique- Deep coughing - Deep breath & then Cough.

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Vomitus Sample

In G.I. Infection & abnormalities.

Vomiting
1. Projectile (forcefully) - CNS Infection , Pyloric stenosis, Hydrocephalus

2. Non projectile -Nauseated , Travelling, Indigestion

Haematemesis : - Blood in vomiting,

Light brown vomiting - HCI breakdown Hb.

Green :- Presence of bile (Bile Stained vomiting)
   ↓
In duodenal atresia.

Alkaline PH of vomit :-Induce by lower G.I.T.

Acid (HCI) comes out then in body :- Metabolic alkalosis

Q.: Severe prolonged & Continue vomiting may lead
Ans. Metabolic Alkalosis.

Hyperemesis Gravidarum - severe vomiting In pregnancy

Blood Sample

Blood Sample-  (3-5 ml)

1. Venous blood -Routine Investigation 
2. Arterial blood-For ABG analysis (Arterial Blood gas)

3. Capillary blood required for 

- Glucose test

- Malaria Slide

- Rapid HIV test

- In pregnancy

- For blood grouping

- Hb estimation

Cannula :

Colour Size -Less Size, more diameter.

Orange-   14G Dialysis.- 240ml/min

Syringe :- Barrel, Piston, Hub.
2ml, 5 ml, 10ml, 50ml

Spirit :- Disinfection of skin before taking sample (70% Alcohol)

Single stroke technique for cleaning of skin.
Don't recap the needle after taking blood sample

Technique for recap - Single Scoop technique.

Don't bend needle, Mutilate needle.

Biopsy :- Specimen from living body. Preserve 10% formalin

Autopsy :- Sample from dead tissue.In postpartum

Comfort & Positioning

• To ensure comfort.
• To minimize bed sore.
• To prevent complications.
• To give medication.
• To do procedures.

Exercises:

Postioning in the following procedures

TPR :- Supine/Dorsal

B.P. :- Supine/Sitting (In pregnancy strictly in supine position) :- leg separate - Knee flexed.

Catheterization :- Female = Dorsal recumbent, Male = supine with leg abducted

Enema :- Left lateral

Pelvic surgery :- Trendelenberg.

Deep respiration - Fowler's position.

Rectal temperature : - left lateral.

Sigmoidoscopy :- Knee chest position.

Position change to prevent bed sore :- 2 hourly.

Type of positions

(1) Supine :- Person lies on the back.

(Dorsal) - For physical assessment
 • Inspection
 • Palpation :- Pulse, Abdomen liver palpate.
• Auscultation (Sound listen).
 • Obstetrical Examination of abdomen.

• Recumbent (Fundal length).

(2) Dorsal recumbent :- Knee flexed, leg separate.

• For catheterization , Vaginal examination

(3) Fowler position/Sitting position.

• Cardiac cr Respiratory Problem.

N.G. tube insert-High fowler - 80°-90°

N.G. tube feeding-Semi- Fowler - 450-60°

low fowler - 30°

[Thyroidectomy, mastectomy]

Cardiac position :- Rest forward on cardiac tabel.

Fowler position :- Rest backward , not leaning.

GERD'S :- Reverse trendelenburg position.

• To promote gastric emptying.
• To prevent esophageal refluxes.

4. Side lying :- Lateral position

• To relieve supine hypotension in pregnancy.

Right lateral 

• After liver biopsy.  
• After feeding a child.

Left lateral

• during liver biopsy
• Enema
• Rectal temperature
• Suppositories
• Vaginal /vulval examination

Hemorrhoidectomy :- Lateral (Side lying) - to prevent pain & bleeding.

Q.: Rectal temperature of a patient is 38°C, then axillary temp is

Ans. 37°C.

• Rectal thermometer - Short & flat bulb.
• Semi Prone/Forward sidelying.

(5) Sim's position :- Lateral + prone.

• Same Indication as left lateral.
• Modified Sim's :- Cord prolapse.

(6) Standing position:-Physical Examination (Height)


Q.: A newborn length is measured in which position

Ans. Supine

NOTE-45 cm 

• - Umbilical cord
• - Phototheray distance
• - Spinal cord - Evacuated Enema can height
• - length of newborn

(7) Knee Chest position

Cyanotic heart disease.
(TOF) - Cyanotic Spells (Tet's spells).
Shunt in TOF:- Blalock Taussig Shunt = Subclavian & pulmonary artery

• Waterston shunt :- P.A. & Ascending Aorta.
• Pott's shunt :- P.A. & Descending Aorta

• Cord prolapse.
• Sigmoidoscopy
• Postpartum exercise.
• Rectal examination

(8) Trendelenburg position:- Elevate the lower part of the body at almost 30 degree angle.

• If burn of face & head.
• Elevate the head end to prevent edema.
• Legs are elevated
• Head end is lower.o
. Indication - Burn severe dehydration
• Shock (hypovolemia)
• Cord prolapse
• Pelvic surgery (lower abdominal surgery).
•Appendicitis.
• Abruptio placenta. Post partum haemorhage.

(9) Prone Position - Lying on abdomen.

• NTD (Spina bifida).
• Post - anaesthesia.

(10) Lithotomy

• Delivery/labour (eutocia)
• Vaginal/vulvar exa.

Exercises:- Write the Position in the following situition

Q.: After seizure

• Lateral
• Supine with head turn to side.

Q.: A Patient is on the procedure of thoracentesis

Ans. Fowler

(Sitting) = Semi fowler position (Due to the principle of gravity).

Q.: A Pt. is on abdominal tapping procedure

Ans. Semi fowler's position

Oxygenation :- fowler's position.
Epistaxis :- Sitting c̅ head flexed & nose pinching
N.G. Insertion :- High fowler c̅ sip's of H20 for Swallowing
N.G. Feed :- Semi fowler's

Newborn Resuscitation

Restoration of vital signs

(1) Position - Supino with neck extension,

(2) Tactile Stimulation :- Stroking,

Heel too big too :- 1 finger stroke gently,

(3) Free flow oxygen :- Bag & mask.

Suction :- Oral first, then nasal,

• Pinch Suction catheter during Exertions
• (To prevent injury from -ve pressure)
• Remove catheter by rotating movement.

Administer Humidified air

Humidifier should be changed after 24 hour,

Humidifier should be disinfect in

• Glutaraldehyde (2%)
• Sodium hypochlorite (1%) .

Don't Top-up humidifier
Humidifiers fill up to 2/3.

Oxygen toxicity
RLF (Retro lanteral fibroplasia)
Combustion-fire
Atelectasis - Collapse of alveoli 

(4) CPR

1 Minute :- 100 compression, 30 Respiration

Depress sternum :- 1.5 inch

Lower 1/3 of Sternum should be depressed. It is marked by an imaginary line drawn between both nipples, & provides the compression below this line.
(5) Endotracheal Intubation.
position- Supine c̅ neck extended.
(6) Life Saving drags. :

• Adrenaline (Dilution: 1:10,000)
• Dopamine.

Comfort of patient

• Noise :- Normal 85db.
• Ear Frequency :-20-20,000 Hz
• Room temperature :-- 20-22°C
• Humidity: - 40-60%
• Exchange of air :- 15-45 feet/min.
• Noise in ward :- 25-35 decibel.
• Pressure :- Negative pressure (In case of communicable disease, Infectious disease, need Isolation) Eg:- T.B.

Comfort devices :

(1) Bed - Complete =Cot+bed sheet + another sheet.

• Metallic-78 x 38 x 28 inch

(2) Mattress :- Dunlop fibres

Air/water mattress :- For thin & obese patient.

(3) Bed sheet :- 6 Folded

• Metered corner
• Wrinkle free :- To prevent bed sore.

(4) Mackintosh :- To prevent soiling of bed sheets.

• From shoulder to hips.

(5) Bedspread :- Counterpan = To cover the bed.

• In closed bed
• To prevent dust.

Orthopneic position :- Leaning forward & sitting.

(6) Cradle :- To prevent the pressure of top sheets& blankets.

Used in :
Burn
Rheumatoid arthritis
Kidney failure (edema)
In open fracture.

(7) Pillow
(8) Locker
(9) Call bel :- In case of any assistance :- for safe and security (2nd level of maslow's theory)
(10) Cardiac table :- To provide cardiac position.
(11) Sand bags :- To immobilise body parts.
(12) Air cushion :- To prevent bed sore.
(13) Foot rest :- To prevent foot drop (Plantar flexion)
(14) Bed blocks - To elevate any part of bed. (foot or head end).
(15) Urinal:- For urination
(16) Bedpan - For defecation

Diet

1. Therapeutic Diet :-Diet specifically used to treat a particular deficiency or treat the disease

2.Clear liquid diet :-Transparent & liquid at body temperature.

• Given in :- Dehydration, gastroenteritis, pancreatitis.
• It is a deficit in energy (Calories) & nutrients.
• Dairy product & fruit juice

3. Full liquid diet :-Opaque & liquid at body temperature.

• Deficit in energy & nutrients.

4. Mechanically altered diet :-Altered texture of food for minimum chewing.

• Given to pt :-Dental problem, dysphagia, surgery of head or neck

 5. Soft diet :- For difficulty in chewing & swallowing.

6. Low residue, low fiber diet :-In ↓ed G.I. motility In Inflammatory bowel disease, obstruction of GIT.

• Diarrhoea & GI problems.

7. High residue, high fiber diet : In constipation, irritable bowel syndrome, diverticulosis.

• Fruit, vegetables & whole grain products.

8. Fat restricted diet :

• In steatorrhoea, flatulence, diarrhoea due to high fatly diet, malabsorption disorder, pancreatitis, gall bladder disease , GERD.

9. Liver cirrhosis patient :-High thiamine (Vit B1) diet is given eg-Pork.

• High calorie, high protein diet 
• HIV, AIDS, COPD, burn, stress, cancer, wound healing

10. Carbohydrate consistent diet :

• In D.M, hypoglycemia, hyperglycemia & obesity.

11. Sodium restricted diet :-Summer squash (Fruit & vegetables)

• In HTN, heart failure, renal disease, cardiac & liver disease.

12. Protein restricted diet :-In renal & liver disease. Especially Failure cases.

• Limit milk, meat, bread
• Give less protein diet to provide essential amino acids.

13. Renal diet :- for ARF & CRF

• Controlled amount of all electrolytes, Na+, protein & fat & fiber.
• Dialysis restricts fluid in most patients.

14. Potassium modified diet :

• Low potassium diet :- In hyperkalemia, In impaired renal function, hypoaldosteronism, Addison's disease, ACE Inhibitor drugs, Immunosuppressive drugs, potassium sparing diuretics.

15. High K Diet : In hypokalemia.

• In renal tubular acidosis, GI losses Diarrhoea, Vomiting, Intracellular shift, K+ wasting diuretics, antibiotics Hyperaldosteronism, Cushing syndrome, exogenous corticosteroids.

16. Low purine diet :

• In gout, Kidney stone (Uric acid, 2.5-8mg/dl)

17. Vegetarian diet

• Orange & dark green leafy vegetables have iron.
• Iron absorption given Vitamin C should be given with it.

BM   = Weight(Kg) divaid by Height(M2)

Enteral nutrition

• Provide liquified food into GIT via tube.
• In client c̅ swallowing problem, burn, major trauma, severe malnutrition.
• If lactose (milk) Intolerance; give lactose free formula diet.

Parenteral Nutrition

Total PN (TPN) or Hyperalimentation.

Given by central or peripheral veins.

Subclavian, internal jugular vein used for <4 weeks

If More than 4 weeks: Peripherally inserted central venous catheter.

By peripheral vein, Isotonic or mildly hypertonic solution is given
If hypertonic feed gives - Sclerosis, phlebitis, swelling occurs.


Form of nutrients should be given in TPN

1. Carbohydrates should be given in form of Dextrose

2. Fat should be given in form of emulsified fat

3. Protein should be given in the form of Amino acids.


Carbohydrate : -

• Conc. 5 do 70% of glucose.
• Give 3.4 Kcal/g.
• Provide 60-70% of Calorie needs.

Protein :

• Amino acid given, conc" 3.5 to 20%.
• Give 4 Kcal/g.

Fat Emulsion (Lipids) :

• Provide 30% of Calorie.
• Prepaned from Soyabean, Sunflower & emulsified c̅ egg yolk.

People showing allergy c̅ egg yolk, do not give.

Glucose Intolerant person-Give fat emulsion.

If adverse Reaction of lipid (sign-Chest pain, back pain, Chills, cyanosis, Dyspnoea)

Stop Infusien & then notify the physician.

PN administer within 24 hours after preparation & Refrigerate. Remove from the refrigerator before 1/2 or 1 hour.

Insulin adds c̅ Infusion to control glucose level. Because high glucose is present in PN,

Heparin is added to prevent fibrous clot formation on the catheter tip.

Not discontinue PN abruptly because it may cause hypoglycemia, so I flow rate gradually.


Complication of PN

(1) Air Embolism

Also Complication of IV Infusion

Due to disconnected or open catheter

Air enters during IV tubing changing.

S/S:- Chest pain, dysproca, loud churning sound on auscultation, Rapid weak pulse.


Priority action :

(1) Clamp catheter

(2) Position left side lying c̅ trendelenburg (to trap air in right heart)

(3) Notify physician.

(4) Give O2

For IV tubing & Cap change-Instruct client for valsalva maneuver.

Turn head to the opposite side of I.V. intention It Tse Intrathoracic venous pressure

Take a deep breath, hold & bear down.


(2) Hyperglycemia :

Weakness, kussmaul Respiration, thrist, Polyuria.


Priority :

(1) Notify the physician

(2) Infusion rate (40-60 ml/hr)

(3) Give Insulin.


(3) Refeeding Syndrome :-

 In severely malnourished client, c̅ PN rapid drop in K+, magnesium & phosphate

serum level.

(4) Hyperkalemia :

Bounding pulse, crackles, Jugular vein distension, weight gain

Priority :

(1) Slower or Stop IV Infusion,

(2) Restrict fluid

Rapid weight gain indicate abnormality:


(5) Hypoglycemia :

Shakiness, weakness, < 70 mg/dl.

Priority :

(1) Administer IV dextrose (10% )

(2) Notify physician


(6) Infection :

Use strict aseptic technique because PN contains high glucose; medium for bacterial growth.

Monitor temperature & Redness at catheter site.

Priority :

(1) Notify the physician

(2) Remove catheter, tube & send to laboratory for culture of microbes

(3) Take blood culture.

(4) Give Antibiotics


(7) Pneumothorax :

Due to improper catheter placement.

Take chest X-Ray before giving PN.

Priority :- Notify physician.


Intravenous therapy

In haemorrhage & severe hypovolemia administer colloids (plasma expanders)

Eg :- Dextran, Albumin is given, because it Tes Intravascular volume by pulling fluid from Interstitial space.

With I.V. Cannula Infiltration is common.

In a needle catheter ; it can cause catheter embolism.

Catheter Gauze ↑es then diameter Ves.

For emergency fluid administration, administration of blood products & anesthetics, -14, 16, 18, 19 Gauze used.

For peripheral fat infusion-20, 21 gauze.

For standard & clear 1. V. fluid --22, 24 gauze.

For Pt with very small vein - 24, 25 gauze.


IV tubing :- ..

Fluids can't flow unless it is vented.

Macrodrip = 10-20 gtt/mi drop factor =15

Used for adult

Microdrip = 60 gtt/ml, drop factor =60

In a pediatric client.

Filter:- 0.22 um filter

1.2 um-To give lipid & albumin

Change the tubing every 24 to 72 hours.

Nacl (NS) Interchangeable terms. Before giving medicine IV. 1-2 ml NS is used to clean & then give medicine & also flush 1-2 ml NS to maintain patency


IV site selection :

(1) Vein in hand, forearm & antecubital fossa are suitable

(2) In adult => Not use legs & feet vein, because risk of thrombus formation & pooling of drug in

venous return area.

(3) In the Infant Scalp & feet vein.

(4) Use distal site first for Infusion,

(If vein rupture, Infiltration occurs & proximal vein can be used for next puncture)

If antecubital vein Infiltrates, then lower veins of same arm can't be used for punctane.

(5) Avoid taking B.P. on arm receiving I.V. Infusion.

(6) Avoid IV site :

• Edematous extremity.
• Mastectomy side arm.
• Arm that is weak, traumatized, paralysed.
• AV fistula or shunt for dialysis.
• Infected skin area.

(7) In adults the best site is the forearm because bones support it.

Change venipuncture site - every 48 to 72 hours.

Change I V dressing - every day.

Change I V tubing - every 24 to 72 hours.

Administer solution -with in 24 hours, not beyond this period because bacterial growth may occurs in fluid.


Priority Nsg action in Inserting 1.V. line :

(1) Check physician prescription, determine size & type of infusion, explain procedure to patient. (2) Select vein.
(3) Clean skin (Inner to outer circular motion).


Priority for removing IV Line :

(1) Check physician prescription, explain procedure to client, ask to hold arm until needle removal.

(2) Turn off I. V. tubing clamp & remove dressing.

(3) Apply light pressure on site & remove catheter.

(4) Apply pressure for 2-3 minute.

(5) Inspect the site for redness, drainage, swelling.

(6) Document procedure,

A patient of congestive heart failure; Do Not give saline solution - It incrise fluid retention & worsens CHF


Complications of I.V. therapy :

(1) Air Embolism

(2) Catheter embolism :- Occur due to breakage of catheter tip during insertion or removal.

S/S :- B.P., pain in vein, weak & rapid pulse, cyanosis of nail beds, loss of consciousness. 

Intervention :

(A) Place a tourniquet proximally of I.V. site.

(B) Notify the physician Immediately.

(C) Circulatory/Fluid overload

Priority :

(a) Slow the infusion rate.

(b) Give an upright position.

S/S :- Coughing, Rapid breathing, dyspnoea, crackles.


(3)Electrolyte Imbalance : -

Place a red medication sticker if KCl is given. Ringer lactate contain K+, so not give to client c̅ renal failure.

(4) Hematoma :

S/S :- Ecchymosis, swelling, painful lump.

Action :- Elevate extremity & Apply pressure & Ice.

(5) Infection

(6) Infiltration (Extravasation) :

S/S :- Edema, pale, coolness at site.

Prevention :-(1) Avoid Venipuncture over the area of Flexion.

Priority :- (1) Remove I.V. device Immediately.

(2) Elevate extremity & apply compress.

Don't rub infiltrate sites, c can cause hematoma.

C/M :- Reddened, warm, painful, edematous proximal to I.V. site Insertion.

(7) Phlebitis :- Inflammation of vein

Priority:-(i) Remove I.V. device Immediately.

(2) Restart in the opposite extremity.


Central Venous Catheter

Catheter position determined by radiography after Insertion

Give trendelenburg or supine position, ask to perform valsalva maneuver to T pressure central vein

Patency is maintained by flushing c̅ heparin. NS Solution

In PICC (Peripherally inserted central catheter) bleeding occurs upto 24 hour, but not after period & phlebitis may occur.


Epidural Catheter-In epidural space

Aspiration before giving medication, if I miele fluid (CSF) or blood returns, notify physicians anesthesiologist immediately, because catheter in subarachnoid space or blood vessel.


Contraindication :

Skeletal or spinal abnormalities.

Bleeding disorders

Use of anticoagulants.

Multiple abscesses & Sepsis.

If any medication added to I.V. bag- Rotate agitate bag gently.

A severe hypotensive & unresponsive client 5% dextrose in RL (Hypertonic Solution) be it draw fluid from cells & Tes Intravascular fluid

Discharge of patient

A permission given to patients to leave the hospital.

MLC :- Medico legal case

ABSCONDED :- Left hospital without Information.

LAMA:- Left Against medical advice.

Leaving the hospital after notifying the staff.

Discharge planning starts at the time of admission.

Patient should be Informed in advance (on the day or previous day) for discharge

. Q.: Responsibility of nurse during discharge
Ans. Health talk

Mercy Killing (Euthnasia)

• Active :- Death by removing assistance devices
• like - Ventilator or O2
• Passive :- Giving lethal dose.
• Eg :- High dose anaesthesia.

Medication

Medicine 

• Substance used for Desired 
• effect/favourable outcome 
• Favourable Unfavourable.
• Eg :- PCM 

Drug

• Substance that alter the normal functioning.
• ex.-Heroine, cocaine, caffeine.

All medicines are drugs but not all drugs are medicine.

Categories of Drugs

Astringent→ Contraction of tissue & arrest discharge
Analgesic → Pain relief
Antipyretic→ Fever ↓se
Antipruritic → To prevent Itching
Antitussive →Cough Suppressant ( ↓se)- Cough
Antiemetic →Suppress Vomiting

Inotropes → Cardiac contractility ↑se.

Chronotropic →Increase Heart Rate

Mydriatics→ Pupil dilation - fundus Exam. of eye.(i.e.Atropine)

Miotic→ Pupil constriction (Pilocarpine)
Antifungal → Prevent growth of fungus.

Antihypertensive→ ↓B.P.

Purgative→ Constipation release, increases peristalsis.

Cathartics→ To ↑es evacuation of bowel

Anthelmintics→ Against parasites

Antiseptic →Prevent growth of pathogens

Antibacterial→ Bacteria Killing (Antibiotics)

Diuretics→ ↑es urine output

Antacids →Neutralise HCL

Emollients→ Smoothening of fecal matter

Lanotropics→ Candiac contraction

Sedatives →To relieve anxiety (relaxation)

Antipsychotics→ Against Schizophrenia (Mental Illness treatment)

Antianxiety → To relieve anxiety.

Antimani →To relieve manic psychosis.

Bronchodilator→ Dilater bronchioles.

Antispasmodics→ To ↓se spasmodic pain/spasm

Sialagogue ↑se saliva secretion

Gastric tonic/ ↑se tone, function, appetite of Stomach

Hydrogogues →Produce copious watery

Cholagogues→ ↑es bile secretion

Caustics →Substance destructive to living tissue

Diaphoretics→ ↑es sweating

Demulcents →Soften, soothe & protect mucus memb.

Emmenagogues →Stimulate menstrual discharge

Stypics →Agent checks haemorrhage

Vesicants→ Blistering agent

Antidote →Counteract the drugs/poisión

Synergistics →Affect total outcome due to 2 combined drugs

Important symbols :

O.D→ Once a day

B.D → Twice a day.

T.D.S. → Thrice a day

Q6H → 4h time a day. (Every 6 hourly)

Stat → At once (Immediate)

P.r.n. → When required

S.O.S. → Emergency

H.S. → At night

A.C. → Before meal

P.C. → After meal

H → Hour

Q → Every

A.M→ Before noon

P.M → After noon

Att die→ Alternate days

O.N. → Each night

T.O → Telephonic orde

Rx→ Prescription.

С.М. → Tomorrow morning

Rep. → Repeat

Q.: Which drug should not be given h.s. = Diuretics.

Q.: Maximum absorption of drugs occurs if given.

Ans. A.C. (Before meal).

If a drug causes gastric Irritation (so give P.C.).

Q.: A drug is prescribed as Q4H How many doses Will the nurse give to the patient ?

Ans. 6

Measurements

1CC = 1ml

1 Dram = 4gram

= 4ml (cc)

= 1 teaspoonful

= 60 grain song

1 ounce = 30 gm

= 8 teaspoonful

= 480 grain

= 8 dram

= 30ml (cc)

1 Litre = 1000 ml

= 400 Ounces

= 2pint (1 PINT = 500 ML)

= 1 quart

1 Gram = 15 grain

Infusion Time =Total Volume to be infused / ML IN hour infused

1 kg = 2.2 lbs (pound) = 1000 gm.

1 Tablespoon = 4 dram= 15 ml= 3 tsf

1 glassful = 200ml

1 teaspoonful = 4-5ml

1 ml = 60drops.(Pediatric)

1 ml=15 drops(adult)

 1 grain (gr) = 60-65 mg.

cup = 30ml

 1/50grain = 0.4 mg 

1 pint - 500ml

1 Kg - 2.2 lbs Medicine 

1 lbs - 480 gm.

1 glass -- 200 ml.

1 Teaspoon 4-5 ml

1 Tablespoon = 15 ml (3 teaspoon).

1 Insulin Syringe = 1 ml (40 unit).

1 foot = 12” (30 cm).


Calculation

Drug, Doses & fluid :

1. Fluid (Drop/min) - Total Volume(ml)xDrop factor divaid byTime in min.

Diop Factor = gtt (Drop) ÷  min. = 60 ÷ 60= 1 gtt/min

Drop factor -60(For paediatric)

Drop factor = 15 

Q.: A pt. is Infused 2 pint of DNS in 3 hours, calculate the drop/min

Ans.= 1000x15 ÷ 8x60 = 31.25

Murphy set :- Paediatric drip set.

Murphy sign :- Gallbladder disease (+ve sign) Palpation, Cessation of deep inspiration.

Q.: Administer 200 ml N.S. in 10 hours in a 3 month old baby

Ans. 200x60 ÷   10x60  = 20Drop/min.

NS = 0.9%, Isotonic fluid.

Categories of Fluid available in Hospitals


Calculation of Drug doses in children

Hypotonic = N.S. (0.45%)
NOTE-

• Hartman Sign :-Small amount bleeding at implantation time.
• Hartmann's Solution :- RL
• Hartman's Pouch :- Gallbladder
• Hartmann's Procedure :- End Colostomy

Formulas used in calculation

(1) Young's formula :- (1 to 12 year of children).

ChildDose=Age of Child In Years x Adult Dose divaid byAge(years) +12


(2) If child is < 1 year of age (Fried's formula)

= Age of Childin month x Adult Dose divaid by 150

(3) Clark's formula - (on basis of weight)

Child Dose= Wt.in pond x Adult Dose divaid by 150

(4) On basis of body surface area

B.S.A= Kg/M2

Q:You have to prepare 1% molar solution 200 ml, from 5% solution, calculate the amount.

Ans. =- 100 x 200 ÷5

= What we want x quantity ÷What we have

= 40ml polar, 160ml water.

Q: Calculate the doses of tablet pcm for a 2 year old child

2 x 500÷2+12 = 71mg. PCM

Q: Calculate the doses of the tab. PCM for a child weighing 4 Kg.

Ans. = 8.8x500÷1500=29.3mg.

Q.: 400 ml of N.S. is to be infused in 2 hours, calculate drops.

Ans. 400÷2 x 15÷60 =50drop/min.

Q.: 3 Its normal saline is Infused in a day to 5 year old child, whose body weight is 13 Kg. Calculate drops/Minute.

Ans. = 3000x60÷24x60 =125drop/min.

Q.: Gentanıycin 2 ml = 80 mg., administer 20mg in a child of 2% age.

Ans. 0.5ml.

Q.: HIV +ve patient's blood spills on floor, clean by which technique ?

=By 1% Sodium hypochlorite,

= Firstly reduce diameter :- By tissue paper / gauze
For Absorb
  ↓
(15-20 min) Na-hypochlorite...
↓
Clean By gloved hand
↓
discard gauze in Yellow bag

Routes of medication

1. Oral route

Most common route - Oral (Enteral)

2. Intramuscular route

I.M. - Intramuscular - 90°

Doses :- 3ml

Muscle site-Deltoid (T.T.)

Gluteal

Vastus lateralis (In child)

Side effect :- Irritation of tissue (sc)

Z-track technique :- To prevent Irritation or Inflammation of subcutaneous tissue.

Z-track technique :- Stretch skin, puncture needle site & leave the skin,

Purpose :- To prevent medication comes back in subcutaneous tissue.
↓
To prevent Inflammation & Irritation.

Drugs:

Dextran, discardgauze, Iron Injections

Don't massage site

Remove needle after 10sec.


Vaccine :

(a) I.M. Route: -DPT, T.T , D.T, Hepatitis B.

Pentavalent :-DPT, Hib., Hep.B.

(b)  Sub-cutanceous or Hypo-dermal

Angle of needle insertion: 45° .

(1) Measles Vaccine, MMR Vaccine => 9 month

(2) Insulin

(3) Erythropoietin Inj.

(4) Heparin


(c) Intradermal :- 15°

(1) BCG Vaccine - For T.B.

(2) Drug Sensitivity test - Mantoux test (PPD Doses 0.1ml)

Purified protein derivative

Leukemia -> 5 mm (HIV pt. T.B. +ve)

Lab. worker > 10 mm (In Contact with others)

> 15mm (not in contact then T.B. +ve).

= Reading (48-72 hours). 

(d ) Intra osseous :- In Bone.

(e ) Intra thecal/Intra spinal :- Spinal cord.

(f) Topical :- On body surface.

(g) Instillation :- In body orifice, In liquid form

(h) Insertion :- In body orifice In Solid from

(i) Insufflation :- In body orifice, In Powder from

(j) Induction :- Apply on Skin 7 friction.


HOT & COLD Applications

Principle :

Conduction

Convection

Evaporation

Radiation


Hot application 

Vasodilation -↑ peripheral circulation. -Muscular Relaxation -Promote healing 

Contraindication :

• In Kidney pt.
• In Neuro pt.
• In heart pt
• In acute Inflammatory Condition, hot application is strictly prohibited. 
• In acute appendicitis don't use Hot application (B'coz it can rupture ) 
• In tooth abscess

Cold application

Vasoconstriction- ↓ Peripheral circulation

Used to prevent necrosis, because it decreases demand of tissues

 To put dead body at freezing point to prevent pathogen growth & to prevent degeneration ofTissue.

Contraindication :

•  In shock & Collapse
•  In edema.
•  Impaired circulation
•  D.M., Arteriosclerosis,
•  In shivering pt.
• In muscle spasm

Hot Application

1. Dry 
2.  Moist

1. Dry heat application: = 120° - 149°F

• Short wave diathermy :- Sunlight
• Hot water bottle
• Lamp & bulb.
• Radiation
• Electric Cradle heating pads.
• Phototherapy
• Blankets
• Aquathermia pad

Note :- Dry hot application temperature is always more than moist hot application temperature B-coz dry appliances does not comes in direct contact to body

Moist - may cause burning at high temp.


Moist heat application

Moist hot application temperature = 110 - 1150F

General-Bathing

Local -Hot compression (Fomentation)

(1) Simple fomentation :- Woolen cloth (not cotton cloth)

(2) Medicated :- Stupes, Poultices (Turpentine)

(3) Paraffin bath :-(In arthritis patient) :- To ↓es pain

15-30ml Mineral oil adds 1 pound of paraffin wax.
To decrease stiffness of joint

(4) Sitz bath-Temperature :- 110-115°F.

• Solution used :- KmnO4,(1:5,000,- Boric acid (may used) (1 dram to 1 pint) Eusol solution.

Indication :- 

• Hemorrhoids
• Episiotomy :- First 24 hours apply ice packs
• Dysmenorrhoea
• Perineal surgery

Hot water bottle :- Not fill full (fill only 3/4)

• Temp = 120° - 149°F (48.80-65°C)
• Provide Hot water bottle to the patient with urination problem (not passing urine)
• Rationale - Because It relaxes muscles.
• Another method :- Open tap water.

Q.: A patient is on antibiotic therapy for longer duration which vitamin deficiency?

Ans. Vit K :- Bcoz prolonged antibiotic therapy Kill normal flora essential for vit K synthesis.

Q.: Ideal duration of hot application.

20-40 minute (20minute-In sitz bath.)

Interval = 1 hour

Secondary effect produces when duration more & Interval less
Like - Vasoconstriction
Secondary effects are Just opposite effect to primary.


Cold Application :-Duration=20-40 minute, Interval=1 hour

Secondary effect = Vasodilation.
1. dry

• Ice cap 
• Ice collar 
• Ice packs 
• Ice cradle 
• Ice Leg
• Chemical (Cold pack)

Moist

• Cold Sponging -(65-90°F)
•  Cold bath
•  Cold blankets
• Tepid Sponging-(85° - 100°F)

Elimination

1. Stool 
2.  Urine

1. Stool -Problems related to fecal elimination :

• Constipation
• Obstipation
• Fecal Impaction-(Due to pancreatic juice, the stool becomes sticky).

Methods to relieve the problems :

1. Suppositories

2. Enema (Clysis)

3. Enteroclysis (Colonic Irrigation)

Fluid requirement = 2-3 Lt

Enema

1. Evacuated (18”) hight 45 cm

Fluid amount: 250-1000 ml 100-120ml
Temperature of fluid: 105-110 F

100°F (Children) 

2. Retained enema -hight 18-20cm ,98.6F

Fluid amount: 100-120ml

Insertion of tube-3-4" (Adult) 1-1/2" (Child)
Position: Left lateral position
Advice to take deep breath during the procedure (Panting breathing)

Types :

Simple 

• (Soap + H20 enema)
• -500-1000ml (Adult) 
• -250-500ml (Child) 
• < 250 ml(infant)

 Clod enema-In hyperpyrexia

Medicated enema are

1. Oil enema

• Used oil: Olive oil

2. Purgative enema/cathartic
Purpose: To 1 peristalsis
To releive constipation
→ It cause irritant mucosa

3. Carminativel antispasmodic enema
Purpose :- To relieve flatulence/Tympanites.
Use : - Turpentine

4. Astringent enema
Purpose: - To relieve Inflammation (Colitis) of colon
Crohn's disease :- Intestinals Inflammation.
Cohn's disease :- Hyperaldosteronism, Nat & H2O retention BP ↑se.

5. Anthelmintic

Exercises :

Q.: A patient is suffering from Tympanites what kind of enema a nurse should give?
Ans. Carminative enema.

Q.: Position of evacuated enema

Ans. Left lateral, Due to anatomical structure. [with gravity] of sigmoid colon remains at lower level of anus in left lateral postion.

Retained enema :- Fluid retain in body.

• Height :- 18-20cm
• Amount of fluid: 100-120ml
• Temp :- Equal to body temp.
• Slow Administration by murphy drip set

Answer the following questions

Q.: The liquid used for fogging. (O.T. Sterilize)

. Ans. Echo sheild.

Q: For defecation, position should be?

Ans. Squatting position.

Q: Cyanotic spells of TOF pt ,Nurse action?

Ans. Knee chest position. = O2, Administration.(Priority)

Q.: Dose of PPD

Ans. = 0.1ml, ID.

= Purified protein derivative

= Mountouxe test for T.B.

=> 5mm (HIV, Leukemia)

Q.: Route of measles - Subcutaneous (0.5ml).

Ans. 9 Month.

Q.: Why Z technique Use for I.M. Inj?

Ans. To prevent backflow of drug in SC tissue & prevent Irritation of tissue.

Q.: Osmotic pressure of plasma is bcoz of

Ans. Albumin protein

Q.: Catheterization of female pt. position.

Ans. Dorsal recumbent.

Q.: Temp of sitz bath - 110-115°F.

Q.: Duration of Tepid sponging - 20-40 minute.

Q.: Phagocytes of bone - Osteoclast

Q.: Shape of hepatocytes => Hexagonal.

Q.: Green colour of sputum- Bronchiectasis

Q.: White colour stool - Barium dye Inject.

Q.: White Milky urine :- Chyluria - Filariasis

Q.: Complication of hyperemesis - Metabolic Alkalosis.

Q.: Step Ladder pattern of fever - Typhoid.

Q: Pyridoxine (Vit B) is a drug that is used to minimise [peripheral neuritis] Complication of Isoniazid.


Stages of Death

There are 5 stages of death

1. Denial - Refuse.

2. Anger

3. Bargaining - Compromising with the cause with real condition.

4. Depression

5. Acceptance

Last sense to disappear in dying person is helly

Clinical sign of death => Fixed dilated pupil, Not responding to reflex.

Stiffening of muscles Firstly from Jaw. Rigor mortis :- Rigidness of body. (Disappear after 5-6 hours.)

If the dead body is stored placed in deep freezing.

Rational-Pathogens growth not occur, so to prevent autolysis of body

Live body in deep freezing -To ↓se metabolism & 02 requirement

Sample from dead body => Autopsy.

Pastoral Care :- To meet the spiritual need

Q: If the body is HIV +ve how body packing is done?

Ans. Pack the body in plastic bag Grey

Radial pulses first disappear in death.

Q.: Orifices of body plug Cotton ball, Why?

Ans. To prevent body discharge from coming outside.

Q.: The role of a nurse with caregivers of dying patient is

Empathetic - Involved in the situation completely.

Sympathetic - Accept Feeling, but self control,Leader, Motivator

Q.: For oral hygiene of a client a nurse is needed.

Ans. 1 Teaspoon of NaCl & 1/2 pint of water the quantity taken by nurse

(1) 5mg NaCl + 500ml water 1 pint

Q.: Dysentery = Blood & mucus present with Diarrhoea.
Ans. Left lateral

Q.: The application of Ice bag for fever patient is based on
Ans. Conduction

Q.: Secondary effect of coid App.
Ans. Vasodilation.

Q.: Painful micturition = Dysuria.

Abnormal cell size = Dystrophy.

Dysphasia - Speech difficulty

Dysphagia :- Swallowing difficulty

Dysmenorrhoea :- Painful M.C.

Dysrhythmia :- Abnormal rhythm of heart

Discharge :- Give permission to pt. to leave hospital

Sinus Rhythm :- Normal rhythm

Glycosuria - Presence of sugar in urine.

Benedict test (Glucose oxidase test).

incrise specific gravity of urine.

Rothera's test = Ketone in urine.

(Na Nitroprusside).

Smith test = Bile pigment.

Hey's test- Bile salt.

Sputum sample = 15ml.

Blood sample = 3-5ml.



Q.: 12 May 1820 - Birth Horace Night angle.

Ans. 13 Aug 1910 - Death. In Italy.

Q.: A System of family centered care to a dying patient - Hospice care.


(1) Palliative :- To relieve signs & symptoms.

(4) Rehabilitative:- Restoration of optimal functioning.

Foot rest :- To prevent foot drop.

Invasion of microorganism/pathogen in a host - Infection.

Duration of HCAI is -- 48hour.

Q.: Destruction of all pathogenic organisms

Ans. Disinfection.

Q.: Destruction of all kinds of pathogens

. Ans. Sterilization.

Q.: Asepsis - Freedom from pathogens.

Q.: Sepsis - Infection.

Q.: Bacteriostatic - Stop growth of transmitting

disease. (microorganism)

Q; Separation of an Infected person from non an infected person, is called Isolation

Ans. Quarantine. → Upto Incubation period of a disease, a person is put under custody/observation.
Disinfection
Isolation
Sterilization.

Q.: Isolation room press. - Negative pressure.

Q.: The natural power of body to with stand the toxins or the organism of a disease.
Ans. Immunity - Resistance of body.

Q.: Autoclaving - 121°C temp,15lb- pressure, 15-20 min - Duration.

Q.: Total cessation of breathing - Apnoea.

Q.: Chenye stroke respiration. Ans. Polypnoea with pause. Tachypnoea. Rate & Rhythm increse.

Hypoxia – lack of O2 in tissue.

Hypoxemia - lack of O2 in blood.

Q.: Anorexia - loss of appetite

. Q.: 1 ounce - 25 gm, 30ml.

Q.: I.M. - 90°. - Vastus lateralis (In child)


Blood transfusion

• Test :- ABO/Rh.
• Bag strength: 450ml

Test for :

• HIV/Hepatitis/Syphilis (VDRL)
• After removal from freeze, adininister within 30min.
• After removal wait for 15min.
• Administration complete within 4 hours to preven Infection
• Transfusion of clotting factor - Cryoprecipitate
• FFP - Plasma
• Platelet
• Packed RBC.
• Whole blood - Slowly administer. WBC.
• Check vitals just after administration & monitor pt for 30 minutes.
• Rx" sign - Dyspnoea, chest pain, Iteching, Redness Shock
• Glucose & Rb. (Dextrose) - taking before B.T., then not use this, always prefer new I.V. line.

Normal Value

Heamoglobin :-at birth 18gm%

Adult male — 14-16gm%

Adult female — 12-14gm%

RBC/erythrocyte :-4.5-6.5 million/mm2 of blood

TLC:-WBC/Leukocyte :- 4-11000/mm3 of blood

Platelet Thrombocyte :- 1.5-3.5 lac/mm2 of blood

DLC :- 

• Neutrophiles - 40-70% 
• Eosinophiles -1-6% -7 konum
• Basophiles-0-1% Lymphocyte - 20-40%
• Monocyte - 2-10%

PCV (Packed Cell Volume) -

• Male - 38-55%
• Female - 35-45%

ESR (Erythrocyte sedimentation rate) :

• Male - 0-15 mm/1st hours
• Female - 0-20 mm

B.T. :- 2-7 minute
C.T. :- 4-9 minute

P.T. (Prothrombin time):- 9-11 Second

BUN :- 15-45 gm/dl

Total bilirubin :

• Conjugated - 0-0.3 mg/dl
• unConjugated - 0.1-1 mg/dl

Uric Acid :-2.5-8 mg/dl

Total protein :- 5.5-8 mg/dl

Administration of blood products

Autologous donation :- Donation of client's own blood before procedure.

Blood Salvage :- Autologous donation that inyo suctioning blood from body cavities, joint sp,

Compatibility :- Matching of blood.

1. Fresh frozen plasma :- To † clotting factor lever blood or for volume expansion

2. Packed RBC transfusion :- To replace RBC

1 unit is Infused b/w 2 & 4 hours.

1 unit les 1g/dl Hb. & hematocrit by 2%to 3%

Washed RBC (depleted in plasma, platelet & history of a leukocytes) prescribe for patient c̅ allergic transfusion

3. Platelet :

To treat thrombocytopenia.

Infused rapidly after taking from blood bank, within 15-30 minute

4. Fresh frozen plasma :

Change of frozen solid to liquid by gradual warming

Infused c̅ in 2 hours

Rh & ABO compatibility is required,

Effectiveness is determined by clotting studies, prothrombin time, partial thromboplastin time, Universal donor => O - ve

Universal Recipient = AB+ve

5. Cryoprecipitates :

Prepared from fresh frozen plasma, stored for 1 year.

1 unit administered in 15-30 minute.

Used to replace clotting factors, specially factor VIII & fibrinogen.

6. WBC :- Administer in sepsis & neutropenic patient.

1unit : 400 ml; give in 1 hour.


Nursing consideration while transfusing

If a large volume of blood, infused rapidly via a central venous catheter; it can cause cardiac dysrhythmia.

No solution other than NS is added

Never add medication into blood transfusion.

Nurses should assess vital sign & lung sound before transfusion

Take Informed consent before transfusion.

If temperature clevated, before beginning transfusion notify physician,

18-19 gauze needle is required for maximum flow rate of blood products

 Storage of blood is usually 35 days.

Acetaminophen & Diphenhydramine is given if history of adverse Reaction.

Stay c̅ client for first 15 minute to notice any

transfusion Rx".

Sign of Immediate transfusion Rx"_

• Chills & diaphoresis.

• Ache

Rashes, hives, itching, swelling.

Sign of Rx"in unconscious client

Weak pulse, hypotension, fever, brady & tachycardia

Oliguria & Anuria, Visible hemoglobinuria.
Delayed transfusion Rx":-Days to years after.

Fever, mild jaundice, ved hematocrit level.

• Iron overload.

Priority Action in patient c transfusion Reaction :

(1) Stop transfusion Immediately.

(2) Change I V tubing down to I.V. site & Keep

I.V. line open 7 Ns. (0.9%)

(3) Stay c̅ client & check vital signs (Every 5 min.)

(4) Give emergency medication.

Antihistamine, Corticosteroids.

(5) Take urine sample.

(6) Return the blood bag, tubing to the blood bank.


Iron overload :

Due to repeated transfusion in anemia & thrombocytopenia.

S/S :-Diarrhoea, Vomiting, hypotension.

T/t :- Give Deferoxamine (IV & SC) to remove accumulated Iron..

Urine turn red after giving this drug, duc to Iron excretion


Diseases because of blood transfusion -

1. Hepatitis C, transmits most commonly by transfusion

S/S :- Anorexia, nausea, vomiting, dark urine, jaundice.

Occurs within 4-6 week after transfusion. Others :- Hep. B, HIV, herpes , Ebstein-Barr

Virus, malaria etc.

2. Hypocalcemia -

Occurs when citrate transfuses in blood, it blinds c̅ ca+ & excreted.

S/S :- Hyperactive reflex, paresthesia, tetany, muscle cramp, +ve trousseau's sign & + ve

chvostek's sign.

Action :-(1) Slow transfusion & notify physician.

3. Hyperkalemia :

Stored blood liberate K+ through hemolysis.

So give fresh blood to the client to prevent risk of hyperkalemia.

S/S :- Paresthesia, weakness, abdominal cramp, diarrhoea, dysrhythmia

 Action :- Slow transfusion & notify physician.

CSF:- Normal Finding

Cell Count :- Erythrocyte :- Ab.

WBC/Leukocyte - 0.2/mm2

Sugar (Glucose) - 50-80 mg/dl

Chlorides - 700-760 mg/dl

Protein contain - 15-45 mg/dl


Clotting Factor

I. Fibrinogen Factor

II. Prothrombin Factor

III. Thrombin Factor

IV. Calcium Factor

V. Labile Factor

VI. Sno blood clotting Factor

VII. Stable Factor

VIII. Antihemophilic Factor-A

IX. Christmas/Antihemophilic Factor-B

X. Stuart Factor

XI. Plasma tissue thromboplastin/Antihemophilic Factor

XII. Hagmar Factor

XIII. Fibrin stabilizing Factor

Albright syndrome :- Abnormal development of bone and excessive pigmentation of skin

Apert's syndrome :- Congenital disorder of webbing of finger.

Marble size stool :- Irritable bowel syndrome

FIT:- . (Fecal immunochemical test/occult blood detection):- Test use for detection the HB percent in stool

→ Use for colon cancer

NG Tube length :- 76 cm

Neso intestine tube :- 120 cm Length

Size :- 8-12 French

Bernstein test :- Test use for GERD

Endotracheal Tube Placement :- T4-T5 (Just above carena)

TIPS (Transjugular intrahepatic portosystemic shunt)

:- Shunt use in Hepatic cirrhosis

Laennec's cirrhosis :- cirrhosis due to alcohol

Drug of choice in myasthenia gravis :- Neostigmine bromide

Temperature increase after delivery :-100.4°F Normal up to 24 hrs.-Relege dehydration effect of baby

Tape test - Pinworm

Acetaminophen (thylone) :

Antidots + N-Acetylcysteine (mucomyst)

Erythrocyte protoporphyrin test :- test to detect leadpoision 

Care of the older client-During ageing
Decreased perception.
Increased blood pressure but susceptibility to postural hypotension
Respiratory rate usually remains unchanged.
Increased constipation tendency & dehydration.
Loss of hearing ability :- Low pitched tones are heard more easily.
Long term memory not disturbed.
Decreased GFR
Confusion is a common sign of infection in older adults, especially Infection in the urinary tract.
Acute change in Mental status in older clients is a common sign of adurese Rx" Reaction to medication. (Mostly in UTI)
Individual who are at more risk for abuse include those are dependent booz of their immobility or altered mental status
Any suicide threat from on older client should be taken seriously.

Important point :
ABHR :- Primary mode of hand hygiene in 24 health case setting
Change-vere puncture site in 72-96 hours.
I.V. tubing 72 hour
Don't let an IV beg or bottle of solutions hang for more than 24 hours to diminish for potential for bacterial contamination & possibly sepsis.
Before adding medication to the solution, swabs access ports with 70% alcohol and equally alternative solutions.

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