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Airborne: MTV
Measles
TB
Varicella (Chicken Pox/Herpes Zoster-Shingles)
Droplet: SPIDERMAN - Erythrocytes (RBC): 4.5-5.0 million/L
Sepsis - Leucocytes (WBC): 4,500-11,000 cells/mm3 (Neutropenia
Scarlet fever <1000/mm3 / Severe neutropenia: <500/mm3)
Streptococcal pharyngitis - Neutrophils: 1800-7800 cells/mm3
Parvovirus B19 - Lymphocytes: 1000-4800 cells/mm3
Pneumonia - Potassium: 3.5-5.0 mEq/L
Pertussis - Sodium: 135-145 mEq/L
Influenza - Chloride: 98-107 mEq/L
Diphtheria (pharyngeal) - Phosphate: 2.5-4.5 mg/dL
Epiglottitis - Magnesium: 1.6-2.6 mg/dL
Rubella - Phosphorus: 2.7-4.5 mg/dL
Mumps - Calcium: 8.6-10 mg/dL
Meningitis - Digoxin: 0.8—2.0 ng/ml
Mycoplasma or meningeal pneumonia - Lithium: 0.8—1.5 mEq/L
A(n)denovirus - Phenytoin: 10—20 mcg/dL
- Theophylline (Aminophylline): 10—20 mcg/dL
Contact: MRS.WEE
Multidrug resistant organisms Varicella zoster ABG VALUES & EVALUATION
Respiratory infection Cutaneous diphtheria
Skin infections (*VCHIPS) Herpes simplex - pH: 7.35—7.45 ROME
Wound infection Impetigo - HCO3: 24—26 mEq/L Respiratory – Opposite
Enteric infection (C. difficile) Pediculosis - CO2: 35—45 mEq/L Metabolic – Equal
Eye infection (conjunctivitis) Scabies - PaO2: 80%—100%
- SaO2: >95%
LABORATORY VALUES
HYPOMAGNESEMIA
ELECTROCARDIOGRAM (EKG)
TORCH INFECTIONS
Toxoplasmosis They cause the
Other (Hepatitis, Syphilis, HIV) worst damage
Rubella during the 1st
Cytomegalovirus trimester.
Herpes simplex
APGAR
Appearance
Pulse
Grimace
Activity
Respiration
Score interventions:
8-10: no intervention required expect to support newborn’s
spontaneous efforts.
4-7: stimulate; rub newborn’s back; administer oxygen, rescore
at specific intervals.
0-3: requires full resuscitation; rescore at specific intervals.
FONTANELS COMPARTMENT SYNDROME
- Anterior: closes between 12-18 months of age. - It occurs when excessive pressure builds up inside an enclosed
- Posterior: closes between birth-2/3 months of age. muscle space in the body.
- It usually results from bleeding or swelling after an injury.
SIGNS OF A POSSIBLE HEART DEFECT (CORBIN) - The dangerously high pressure in compartment syndrome
Color: bluish skin or extremities. impedes the flow of blood to and from the affected tissues.
O2: low pulse oximetry percentage.
Rhythm: abnormal heart rate. Causes:
Breathing: heavy or labored. - Trauma, especially when it results in shock.
Increase in sweat, especially on the forehead. - Abdominal surgery, particularly liver transplant.
Nursing: trouble feeding and breathing at the same time or - Burns
poor appetite. - Sepsis.
- Severe ascites or abdominal bleeding.
IMMUNIZATIONS SCHEDULE - Pelvic fracture.
- Vigorous eccentric abdominal exercises (i.e. sit-ups on a back
Birth HepB extension machine in weight rooms).
*Vitamin K
2, 4, 6 months DTaP Five Ps of fractures and compartment syndrome:
DIHHPR (diaper) IPV (6-18 months) Pain.
HepB (2 & 4 months) Pallor.
Hib Pulselessness.
PCV Paresthesia.
Rotavirus Polar (cold).
*6 months: influenza
yearly FIVE Fs OF GALLBLADDER DISEASE:
12-15 months Hib Fair.
Harry V. Potter, MD Varicella Fat.
PCV Forty y/o.
MMR Five pregnancies.
DTaP (15-18 months) Flatulent.
*HepA (12-23 months: 2 *But it can occur in all ages and both sexes.
doses w/ at least a 4 week
interval) ADDISON’S & CUSHING’S DISEASE
4-6 y/o IPV
I did my vaccines DTaP Addison’s Cushing’s
MMR Down Hyponatremia Up Hypernatremia
Varicella Down Hypotension Up Hypertension
11-12 y/o DTaP Down Hypovolemia Up Hypervolemia
Don’t have money HPV
Up Hyperkalemia Down Hypokalemia
here Meningococcal
HPV (1st: 11-12 y/o;2 Down Hypoglycemia Up Hyperglycemia
months after 1st; 6 months
after 1st / up to age 26) Signs & Symptoms
Adult Influenza yearly
Don’t HIT the adult TDaP q 10 years Addison’s Cushing’s
Elderly Herpes Zoster (60 y/o) Dark pigmentation Prone to infection
Don’t break your HIP Influenza yearly resistance to stress Muscle wasting
Pneumonvax-23 Fractures Weakness
Alopecia Edema
Weight loss Hypertension
SAFETY PRINCIPLES REGARDING TOYS
GI distress Hirsutism
- No small toys for children under age 4 y/o.
Moonface/Buffalo hump
- No metal (dycast) toys if O2 is in use (sparks).
- Beware of fomites (they harbor bacteria - stuffed animal is a Need to ADD hormone Have extra CUSHION of hormones
fomite).
- For a child 9 months, do not pick any of the answers with the Treatment:
words: build, make, construct, sort, stack. - Addison’s: Na intake; medications include mineral corticoids.
- Cushing’s: Na intake; observe for signs of infection.
Addison’s extra: - Thoracentesis: sitting on the side of the bed and leaning over
Managing stress is paramount, because if the adrenal the table (during procedure); affected side up (after
glands are stressed further it could result in Addisonian procedure).
crisis. - Spina bifida: position infant on prone so that sac does not
Blood pressure is the most important assessment rupture.
parameter, as it causes severe hypotension. - Buck’s traction: elevate foot of bed for counter-traction.
- Post total hip replacement: don’t sleep on operated side,
Addisonian crisis: nausea & vomiting, confusion, abdominal don’t flex hip more than 45-60º and don’t elevate HOB more
pain, extreme weakness, hypoglycemia, dehydration, than 45º; maintain hip abduction by separating thighs with
hypotension. pillows.
- Prolapsed umbilical cord: knee-chest position or
*Neutropenic patients should not receive vaccines, fresh fruits, Trendelenburg.
or flowers. - Cleft-lip: position on back or in infant seat to prevent trauma
to the suture line; while feeding, hold in upright position.
TREATMENT FOR SPIDER BITES/BLEEDING (RICE) - Cleft-palate: prone.
Rest. - Hemorrhoidectomy: assist to lateral position.
Ice. - Hiatal hernia: upright position.
Compression. - Preventing Dumping syndrome: eat in reclining position, lie
Elevate extremity. down after meals for 20-30min (also restrict fluids during
meals, low fiber diet, and small frequent meals).
TREATMENT FOR SICKLE CELL CRISES (HHOP) - Enema administration: position patient in left-side lying (Sim’s
Heat. position) with knees flexed.
Hydration. - Post supratentorial surgery (incision behind hairline): elevate
Oxygen. HOB 30-45º.
Pain medications. - Post infratentorial surgery (incision at nape of neck): position
patient flat and lateral on either side.
POSITIONING PATIENTS - Increased ICP: high Fowler’s.
- Asthma: orthopneic position where patient is sitting up and - Laminectomy: back as straight as possible; log roll to move
bent forward with arms supported on a table or chair arms. and sand bag on sides.
- Post bronchoscopy: flat on bed with head hyperextended. - Spinal cord injury: immobilize on spine board, with head in
- Cerebral aneurysm: high Fowler’s. neutral position; immobilize head with padded C-collar,
- Hemorrhagic stroke: HOB elevated 30º to reduce ICP and maintain traction and alignment of head manually; log roll
facilitate venous drainage. patient and do not allow patient to twist or bend.
- Ischemic stroke: HOB flat. - Liver biopsy: right side lying with pillow or small towel under
- Cardiac catheterization: keep site extended. puncture site for at least 3h.
- Epistaxis: lean forward. - Paracentesis: flat on bed or sitting.
- Above knee amputation: elevate for first 24h on pillow, - Intestinal tubes: place patient on right side to facilitate
position on prone daily for hip extension. passage into duodenum.
- Below knee amputation: foot of bed elevated for first 24h, - Nasogastric tubes: elevate HOB 30º to prevent aspiration.
position prone daily for hip extension. Maintain elevation for continuous feeding or 1h after
- Tube feeding for patients with decreased LOC: position intermittent feedings.
patient on right side to promote emptying of the stomach with - Pelvic exam: lithotomy position.
HOB elevated to prevent aspiration. - Rectal exam: knee-chest position, Sim’s, or dorsal recumbent.
- Air/Pulmonary embolism: turn patient to left side and lower - During internal radiation: patient should be on bed rest while
HOB. implant is in place.
- Postural drainage: lung segment to be drained should be in - Autonomic dysreflexia: place patient in sitting position
the uppermost position to allow gravity to work. (elevate HOB) first before any other implementation.
- Post lumbar puncture: patient should lie flat in supine to - Shock: bed rest with extremities elevated 20º, knees straight,
prevent headache and leaking of CSF. head slightly elevated (modified Trendelenburg).
- Continuous Bladder Irrigation (CBI): catheter should be taped - Head injury: elevate HOB 30º to decrease intracranial
to thigh so legs should be kept straight. pressure.
- After myringotomy: position on the side of affected ear after - Peritoneal dialysis when outflow is inadequate: turn patient
surgery (allows drainage of secretion). side to side before checking for kinks in the tubing.
- Post cataract surgery: patient will sleep on unaffected side - Myelogram:
with a night shield for 1-4 weeks. - Water-based dye: semi-Fowler’s for at least 8h.
- Detached retina: area of detachment should be in the - Oil-based dye: flat on bed for at least 6-8h to prevent
dependent position. leakage of CSF.
- Post thyroidectomy: low or semi- Fowler’s, support head, - Air dye: Trendelenburg.
neck and shoulders.
STAIRS WITH CANE/CRUTCHES: INCENTIVE SPIROMETRY STEPS
“Up with the good, down with the bad” 1. Sit upright.
- Going up: “good” leg first, crutches, “bad” leg. 2. Exhale.
- Going down: crutches with “bad” leg, then “good” leg. 3. Insert mouthpiece.
4. Inhale for 3 seconds.
LEAD POISONING S/S (ABCDEFG): 5. Hold for 10 seconds.
Anemia.
Basophilic stripping. ELEVATED INTRACRANIAL PRESSURE & SHOCK
Colicky pain.
Diarrhea. ICP SHOCK
Encephalopathy. Blood pressure
Foot drop. Heart rate
Gum (lead line).
Respiratory rate
NEUROLEPTIC MALIGNANT SYNDROME (FEVER):
Fever. DIABETIC KETOACIDOSIS TREATMENT (KING UFC)
Encephalopathy. K+.
Vitals unstable. Insulin.
Elevated enzymes (CPK). Nasogastric tube: if comatose.
Rigidity of muscles. Glucose: once serum levels drop.
Urea: monitoring.
DIABETES INSIPIDUS SIADH Fluids: crystalloids.
Creatinine: monitor and catheterize.
- Low ADH, low water in - High ADH, water
body. intoxication.
VERTEBRAL INJURIES
- Polyuria. - Oliguria.
- Hypernatremia. - Hyponatremia. Vertebrae Effect
- High hemoglobin, - Low serum
C3 and Unable to care for self, life-sustaining
hematocrit and serum osmolality.
above ventilator is essential.
osmolality from - Weight gain.
dehydration. - Risk: seizures. May use a lightweight wheelchair; feed
- Risk: hypovolemic - TX: fluid restriction. at C6 self with devices; write and care for self;
shock. transfer from chair to bed.
- TX: DDAVP (ADH). Can dress legs; minimal assistance needed;
at C7 independence in wheelchair; can drive car
ANTICHOLINERGIC SIDE EFFECTS with hand controls.
"Know the ABCD'S of anticholinergic side effects" Some independence from wheelchair;
at T1-T4
Anorexia. long-leg braces for standing exercises.
Blurry vision. at L3-L4 May use crutches or canes for ambulation.
Constipation/Confusion.
Dry Mouth. BRAIN STRUCTURES AND THEIR FUNCTIONS
Sedation/Stasis of urine.
CLOZAPINE:
- A significant associated toxic risk is blood dyscrasia.
DIGOXIN:
- Assess pulses for a full minute, if less than 60 bpm hold dose.
- Check digitalis and potassium levels.