Summary for Test 1

* Procedure : Elimiminate source Barrier to transmission Monitor/Evaluate

CH4 Infection Control

HAI–5% of all patients Nosocomial : 25% Respiratory Infections  HIV,TB, Hepatitis B

Signs of Infection= Fever/Diaphoresis/↑WBC/Tachycardia/ Hyperventilation /Cough,Mucus
Pain

Source (Human + Objects) Rsp.) LVN : the greatest potential of spreading infection

Clearing, Washing

Pasteurization

Disinfection
Low – Acetic acid (White vinegar PH=2.0 ~3.0)
High – Glutaraldehyde (20 min), chlorine bleach

Sterilization

Gas – Best for heat sensitive equipment, Low temp, timeconsuming
EtO (Etylene Oxide) – Colorless, Toxic

Steam – for heat stable equipments, High temp
Rapid, reliable, inexpensive, effecient

Host : Immunization, Isolation

Most common way to break the route : Washing hand, Glove , and Isolation
Route

Contact : Direct / Indirect – Formite HIV, Hep. A / Hep B, C

Droplet : 3 ft , > 5μ SARS (Severe Acute Respiratory Symdrome)

Airborne : < 5μ TB


Handwashing

Globe - Body fluids, mucus membrane Avian Bird Influenza

Mask (N95) – Splash or spray SARS – Contact, droplet,

Gown - during procedure

CH 15 Patient Assessment

The process of interviewing and examining the patient for the signs and symptoms of disease
and the effect of treatment

Two key source of patient data : Medical history + Physical examination

1. Medical History : CC HPI PMI demographic data, Occupational, Environmental, Social
2. Physical examination
* Primary Resp signs and symptoms : Cought – Dry, Loose/Productive , Acute , Chronic
Sputum- Amount, Viscosity, Color, Odor
Dyspnea, Chest pain, Fever , Hemoptysis
( Hematemecis )
* Level of consciousness = Confused, Delirious, Lethargic, Obtunded, Stuporous, Comatose
* Vital signs = Body temp
Pulse rate
R.R.
B.P.
Accessary muscles, Color/Skin, JVD, Clubbing, Capillary refill
1) Inspection = Thoracic configuration + Breathing patterns
AP diameter Tachypnea, Bradypnea, Dyspnea, Apnea,
Kyphosis Pursed lips, Cheyne Stroke, Kussmauls Orthopnea
Scoliosis Platypnes
2) Palpation : Chest movement (symmetry ?), Trachea (Middle ?), Tactile and Vocal fremitus
3) Percussion : Hyperresonance  hyperinflated  COPD (asthma)
* Pneumothorax
4) Auscultation
Normal breath sound = Vesticular, Bronchvesticular, Tracheal sound
Adventitious Lung Sound (ALS) = Rhonchi Crakles Wheezes Stirdor

Four critical life functions = Ventilation , Oxygenation , Circulation , Perfusion
CH 37 Storage and delivery of Medical Gas
Oxygen - Green
Helium – Brown  Severe asthma treatment
Heliox  Severe large airway obstruction
Nitrous Oxygen (N2O) - Light Blue : Anestheic agent Nitric Oxide(NO) – Dilate Pulmonary
Carbon dioxide – Gray blood vessel  Infant
Compressed air – Yellow
Nitrogen – Black

20.95 : 78.1 in air DISS



Duration = Contents / Flow = Pressure * Factors / Flow

Regulating flow
Reducing valve : ↓ Pressure
Flowmeter : Control gas flow
1) Flow restrictor
2) Boudon gauge - Press
3) Thorpe tube - Flow

Regulator = Pressure + Flowcontrol


Zone valve : Shut off the gas in emergency



NFPA :
CGA: Manufacture & distribution (Label, Color code)



CH 16 Clinical Lab data


4-6 mill/cu mm
↑Polycythemia , ↓Anemia ( blood loss)
Hemorrhage (Bleeding,출혈)

Blood = Blood plasma + Formed elements ( RBC + WBC + Platelet )
↑Leukocytosis, ↓ Leukopenia
5-10,000 per cu mm

Hb : 12-16 g/dl
Hct (Hematocrit ) = % of RBCs in whole blood

Blood chemistry test

Na+ Hyper : due to dehydration


K+ Hyper : Kidney failure HYPO : Vomitting


Cl- Hyper : Diarrhea


HCO3- Hyper :alkalosis
Hypo : acidosis