gut (yellow) chromic gut (brown) Non-absorbable become encapsulated by tissue and remains unless removed (removed 7 days after) – silk (light blue) nylon (green) cotton (pink) Prolene (royal blue) Mersilenne (Turquoise) Vicryl (purple) Dacron (orange) SYSTEMIC LUPUS ERYTHEMATOSUS (SLE) Autoimmune S/SX: Fatigue Arthritis Sensitivity to sunlight Butterfly rash Management: NO CURE GOAL: controlling symptoms steroids TELEPHONE ORDER Only RN’s may receive telephone orders The order should be countersigned by the physician within 24 hours TENSILON TEST edrophonium chloride (Tensilon) IV evaluation of muscle strength USE: To diagnose myasthenia gravis At bedside: resuscitation equipment atropine sulfate on bedside for possible CHOLINERGIC CRISIS neostigmine for possible MYASTHENIC CRISIS Results: (+) diagnosis = improvement on muscle function after administration of drug (-) diagnosis = muscle fasciculations occur as a result of the drug TETRALOGY OF FALLOT 4 Defects: Pulmonic Stenosis Right Ventricular Hypertrophy Ventricular Septal Defect Overridding of the Aorta Tet spells severe cyanosis – Position: Knee-chest/ Squatting*** Sign Machine-like murmurs Clubbing of fingers Cyanosis Management: Surgery: Blalock Taussig procedure shunting of the subclavian artery and pulmonary artery  THORACENTESIS Purpose: To remove excess fluid or air to ease breathing POSITION: sitting leaning forward over a pillow Chest X-ray identifies best insertion site Within the first 30 minutes, not more than 1000 mL should be removed AVOID: coughing , deep breathing AFTER: Unaffected side with head elevation of 30o for at least 30 minutes THYROIDECTOMY: Complications Bleeding Feeling of fullness at incision site – soiled dressing at nape area, sandbag Accidental removal of parathyroid Hypocalcemia classic sign tetany – – Calcium gluconate, slowly administer- to prevent arrhythmia Laryngospasm DOB, SOB – tracheostomy at bedside, suction Accidental damage of the laryngeal nerve Hoarseness of voice – Encourage patient to talk post op asap to determine laryngeal nerve damage Thyroid storm Fever, Irritability, Agitation, restlessness, Tachycardia – beta blockers
gut (yellow) chromic gut (brown) Non-absorbable – become encapsulated by tissue and remains unless removed (removed 7 days after) silk (light blue) nylon (green) cotton (pink) Prolene (royal blue) Mersilenne (Turquoise) Vicryl (purple) Dacron (orange) SYSTEMIC LUPUS ERYTHEMATOSUS (SLE) Autoimmune S/SX: Fatigue Arthritis Sensitivity to sunlight Butterfly rash Management: NO CURE GOAL: controlling symptoms steroids TELEPHONE ORDER Only RN’s may receive telephone orders The order should be countersigned by the physician within 24 hours TENSILON TEST edrophonium chloride (Tensilon) IV evaluation of muscle strength USE: To diagnose myasthenia gravis At bedside: resuscitation equipment atropine sulfate on bedside for possible CHOLINERGIC CRISIS neostigmine for possible MYASTHENIC CRISIS Results: (+) diagnosis = improvement on muscle function after administration of drug (-) diagnosis = muscle fasciculations occur as a result of the drug TETRALOGY OF FALLOT 4 Defects: Pulmonic Stenosis Right Ventricular Hypertrophy Ventricular Septal Defect Overridding of the Aorta Tet spells – severe cyanosis Position: Knee-chest/ Squatting*** Sign Machine-like murmurs Clubbing of fingers Cyanosis Management: Surgery: Blalock Taussig procedure  shunting of the subclavian artery and pulmonary artery THORACENTESIS Purpose: To remove excess fluid or air to ease breathing POSITION: sitting leaning forward over a pillow Chest X-ray identifies best insertion site Within the first 30 minutes, not more than 1000 mL should be removed AVOID: coughing , deep breathing AFTER: Unaffected side with head elevation of 30o for at least 30 minutes THYROIDECTOMY: Complications Bleeding – Feeling of fullness at incision site soiled dressing at nape area, sandbag Accidental removal of parathyroid – Hypocalcemia – classic sign tetany Calcium gluconate, slowly administer- to prevent arrhythmia Laryngospasm – DOB, SOB tracheostomy at bedside, suction Accidental damage of the laryngeal nerve – Hoarseness of voice Encourage patient to talk post op asap to determine laryngeal nerve damage Thyroid storm – Fever, Irritability, Agitation, restlessness, Tachycardia beta blockers
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