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Risk Reducation & Infection Control

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olanjones's version from 2017-10-03 18:36

Eyes

Question Answer
Care for artificial eyeremove daily for cleansing (mild detergent & H2O), dry & store in water or contact-lens solution, remove before general surgery
Retinopathy of prematurity (babies)expert eye exam for <36wks or 2000g @birth, ↓O2, cont. monitor PO2 (SaO2 should be 95-100), Vit E, ↓light & stimulation
Detached retinabedrest (no forward bend/excessive movement), area of detachment should be in dependent position, no hair-washing x 1 wk, avoid strenuous activity x 3 months
Cataracts (post-op)avoid heavy lifting, use eye drops in affected eye, night-shield, sleep on unaffected side, protect from bright lights/water
Glaucomaavoid tight clothing, ↓external stimuli, avoid heavy lifting/straining, avoid mydriatics (Atropine), 5 DANGER SIGNS – brow arching, halos around lights, blurry vision, ↓peripheral vision, HA/eye pain
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Ears

Question Answer
Post-opreinforce dressing, don’t change, avoid noseblowing/sneezing/coughing, watch for facial nerve damage/infection/vertigo or tinnitus, position on unaffected side, do not apply any pressure if surgery is on internal ear-notify HCP immediately
Otitis mediaadminister abx/antihistamines/nasal decongestants, ventilator tubes, myringotomy, tympanoplasty, bedrest if ↑temp, position on affected ear to promote drainage
Meniere’sadmin antihistamine/antiemetic/antivertigo/diuretics, bedrest in acute phase, protection when ambulating, ↓sodium, avoid caffeine/nicotine/ alcohol, may have decompression w/shunt or total labryinthectomy
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Metabolic alterations

Question Answer
PKUmilk substitute for infants (Lofenalac), ↓protein diet (no meat, dairy, eggs, nutrasweet)
renal failure↑calorie, ↓protein (as allowed by kidney function)
hepatobiliary↓fat, ↑protein, vitamins
cystic fibrosispancreatic enzymes, ↑protein, ↑calorie
atherosclerosis↓saturated fat, ↓cholesterol, meds given before meals
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Pre-op

Question Answer
ChecklistInformed consent, labs/imaging/EKG, skin prep, bowel prep, IV, NPO, pre-meds, removal of jewelry/dentures/nail polish, nutrition (may need PN or tube feeding pre-op)
Supplement affecting coagulationechinacea, garlic, gingko, ginseng, kava, St. John’s wort
Age appropriate teachingtoddler = simple directions; preschool/school-age = play w/equipment; adolescent = expect resistance
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Post-op Complications

Question Answer
Shocktreat cause, O2, IV fluids
Embolism(2nd postop day) O2, anticoag, IV fluids
Paralytic ileusNG suction, IV fluids, decompression
dehiscence/eviscerationlow Fowlers, no coughing, NPO, notify provider, cover w/ sterile saline dressing (wax paper if at home)
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Therapeutic procedures

Question Answer
Suctioningwall suction set between 80-120 mm Hg
Trach cuffcheck pressure q 8hrs, maintain at <25 cm/H2O
Chest tubesif suction is to be used fill suction control chamber w/ sterile H2O to the 20cm mark
Central venous pressurenormal reading 4-12 mmHg; instruct client to hold breath on insertion & withdrawal to prevent air embolism
NG Levin/Salem pumpcheck residual before intermittent feeding & q 4hrs for cont. feeding; instill 15-30 mL of saline/H2O before & after each dose of meds & feeding, q 46 hrs w/ cont. feeding, & when feeding is discontinued; 30-50 mL saline for irrigation
Enemahold irrigation set @ 12-18 inches for high enema, 3 inches for low; insert tube no more than 3-4 inches for adult, 2-3 for child, 1-1.5 for infant; retain 5-10 mins
Self-cath (client teaching)done every 4-6 hrs, clean technique (not sterile), remove 350-400 mL each time, use catheter for 2-4 wks then discard, store in sandwich sized bag or clean container, never store wet or in antiseptic solution, drink 250 ml at 2 hour intervals or ↑2L at regular intervals
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Infection Control

Question Answer
Standard precautionsapply to contact with blood, body fluids, non-intact skin, & mucous membranes from all clients
Airborneprivate room, monitored negative air pressure, keep door closed, must wear N-95 HEPA filter – measles, TB, chicken pox, disseminated zoster
Dropletcontact of conjunctiva or mucous membranes of nose/mouth (sneezing, coughing, talking, suctioning, bronchoscopy), private room or w/ same infection, maintain 3 ft special separation from infected client/visitors (mask if closer than 3 ft), door may remain open – diphtheria, pneumonia, meningitis, influenza, rubella, mumps, pertussis
Contactclients that require skin-to-skin contact or w/ contact with contaminated object in room, private room or w/ same infection, clean, non-sterile gloves, gown if clothing will have contact w/ potential containment, remove PPE prior to leaving room, dedicated equipment to room – MRSA, herpes simplex, localized herpes zoster, C-diff, RSV, pediculosis, scabies, rotavirus, hepatitis A
Private roompoor hygiene habits, contaminates environment, can’t assist in maintaining infection control precautions (peds, AMS)
Shared roomconsider epidemiology and mode of transmission of infecting organism
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Name that precaution!

Question Answer
Measlesairborne
TBairborne
chicken poxairborne
rubella, mumps, pertussisdroplet
MRSA/CdiffContact
herpes simplex, localized herpes zostercontact
N-95 HEPA filterairborne
Door can remain open, mask if within 3 feet of clientdroplet
Toxic shock syndromestandard precautions
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Name that precaution!

Question Answer
Private room, monitored negative air pressure, keep door closedairborne
Must wear N-95 HEPA filterairborne
DiptheriaDroplet
Pneumonia, InfluenzaDroplet, contact of conjuctiva or mucous membranes of nose/mouth
Can put these clients in private room or with clients that have same infectiondroplet
meningitisdroplet
disseminated zosterairborne
scabies or pediculosiscontact
RSVcontact
Hepatitis Acontact
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