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Patient Management Exam #2 (Nursing considerations for common diseases…
Patient Management Exam #2
Nursing considerations for common diseases
Renal Faliure
Diabetes
Hyperthyroidism
FLUTD
Arthritis
Obesity
Hepatic Faliure
Diarrhea
Bandaging
Why?
Support: reduce pain and swelling.
Protection: from infection, self mutilation, hold dressings in place, protect IV catheter.
Pressure: to arrest hemorrhage, reduce swelling.
Immobilization: Restrict movement of joint or soft tissue injuries. Reduce pain levels. Provide comfort. Reduce dislocation.
Layers
Primary Layer:
Wound dressing (provides optimal healing condition. E.g. swab, parrafin gauze
Secondary Layer:
Padding & absorption. E.g cotton wool. Consolidation of secondary layer.
Tertiary Layer:
Protective- protection from contamination. Vetrap and Elastoplast.
Principles of Bandaging
Tight but not constricting. Overlap previous layer by 50%. Wrap distal to proximal. Toes covered to inhibit oedema. Stirrups for limbs to reduce slipping of bandage.
Dentistry
Tooth Sections
Enamel:
Hardest tissue in the body. A thin layer of enamel covers the crown. Is translucent and becomes brittle if chipped.
Dentine:
Hard, dense bony tissue forming the bulk of a tooth. Found below the enamel.
Pulp/Endodontium:
Center part of the tooh made up of living connective tissue and cells called counterblasts. Has blood vessels, lymphatics and nerves (via the root apex).
Gingiva:
The gums- soft tissue that covers the peridontium.
Alveolar Bone:
Thickended ridge of bone that contains the tooth sockets on jaw bones that hold teeth.
Periodontal Ligament:
Connective tissue fibers that attach a tooth the alveolar bone.
Cementum:
Hard calcified tissue, assists in supporting the tooth and in root repair.
Periodontal Disease
Infection & inflammation of the periodontium (tissues that surround the and support the teeth.) Begins when bacteria in the mouth form a substance called
plaque
that sticks to the surface of the teeth. Minerals in the saliva harden plaque into
tartar
, which is firmly attached to the teeth. Tartar above the gum line is not a problem itself.
The Real Problem
-
The true issue occurs when plaque and tartar spread under the gum line. Bacteria under the gum line secrete toxins which contribute to damage of the supporting tissue around the tooth . Overwhelmed WBCs release chemicals that actually assist in the further damage of the surrounding tissue when there is a server build up of plaque and tartar.
Gingivitis:
Inflammation, irritation & reddening of the gingiva.
Result of poor oral hygiene.
Symptoms include: gums that are swollen, puffy, receding, are sometimes tender and bleed easily.
Treatment:
preventing the issue is the best possible cos of
action. This can be achieved by promoting oral hygiene.
Perdontitis will require professional dental cleaning, which include a thorough oral examination, polishing and scaling.
Perionditis:
- Loss of tissue and bone around the tooth.
Dog Formula:
28 temporary teeth
42 Permanent
4 Quadrants:
Right Upper Permanent
(RU)
; Left Upper Permanent
(LU)
; Left Lower Permanent
(LL)
; Right Lower Permanent
(RL)
.
I3C1P4M2
I3C1P4M3
Cat Formula:
26 Temporary
30 Permanent
4 Quadrants:
Right Upper Permanent
(RU)
; Left Upper Permanent
(LU)
; Left Lower Permanent
(LL)
; Right Lower Permanent
(RL)
.
I3C1P3M1
I3C1P2M1
https://docs.google.com/document/d/1EqOynko2HilvWHaaugz5ABXHdt3ocihGH4hPayc4OdE/edit
Dentistry Tools:
Calculus Forceps:
Removes heavy calculus
Elevators:
break periodontal ligament
.
Scalers:
Remove plaque and debris.
Mirror:
Improves visibility.
Curettes:
Removes debris.
Probes:
Measure depth of gingival sulcus. Determines the presence of periodontal disease.
Explorers: (Periodontal, McCall, Explorer.) Explore enamel. Tactile exam of the sub-gingival surface.
Emergencies
Classification of Triage
:
Class 1:
Catastrophic. Life threatening. Requires immediate attention.
Class 2:
Very servere, critical. Requires attention from minutes to one hour.
Class 3:
Serious, urgent. Requires attention within a few hours.
Class 4:
Less serious, still requires attention within 24 hours.
Symptoms of Shock:
Early Stages of Shock: Heavy panting. Rapid HR. MM brick red.
Later Stages of Shock: Pale MM, Drop in temp. Feet and legs are cold. Non- responsive. Un-conscious. Weak or absent pulse.
Types of Emergencies:
Cardiovascular
Respiratory
Neurological
Urinary/
Reproductive
Environmental
Abdominal Disorders
C
ool
R
abbits
N
ever
U
se
R
isky
E
xits
A
broad.
Basic 1st Aid Guidelines:
Wounds
Inflammatory:
Process begins immediately. Very weak during this stage. This phase lasts 2-5 days. Clot formation, vasocontriction, swelling, redness and pain occur during this time, and macrophages and neutrophils are released by the immune system to combat infection. This is the period where you must clean up necrotic tissue and debris from the wound.
Proliferative (repair):
Wound strength increases. Granulation provides a protective barrier against infection. This phase overlaps with the inflammatory phase as it starts at 2-3 days, but continues over several weeks. The wound contracts and forms granulated tissue and new blood vessels. Invasion of fibroblasts occur at this phase. **
Maturation:
Strongest stage, but will never be as strong as normal tissue. Occurs 3 weeks after the injury and continues for months or years. Collagen remodelling stage. Collagen fibres along the tension lines. scare tissues form.
I.P.M.
Inflammatory:
3-5 days.
Proliferative:
2-3 days. Continues over several weeks.
Maturation:
3 weeks. Continues over months or even years.
Classifications:
Clean: No inflammation or signs of infection. A wound made under aseptic conditions. E.g surgical wounds that do not enter the hollow viscus.
Clean-Contaminated: No inflammation. No unusual contamination. A naturally occuring wound with minor contamination. E.g surgical wound in which the hollow viscus is entered.
Contaminated- Acute. non- purlent. inflammation present. Open traumatic wound. e.g Open fresh wounds, accidental wounds. Surgical wounds with major break in aseptic technique.
Dirty/Infected- Inflammation present. Purulent discharge present. Necrosis of wound is evident & debris may be substantially present. E.g Old traumatic wounds or an infected wound or perforated viscera. High bacterial count. One million bacteria or organisms per gram of tissue.
Can Caring-Cats Carry Dog-Infants*
Clean:
surgical wound. no inflamation or swelling.
Clean-contaminated:
Naturally occuring wound with no inflammation and no unusual infection.
Contaminated:
Acute. Non purulent. Inflammation present. Open traumatic wound.
Dirty/Infected:
Inflammation present. Purulent discharge. Necrosis of wound. Debris.
Causes:
Incision. Graze. Burn. Bite. Scratch. Laceration. Puncture. De-gloving.
Closure:
Primary Closure-
Surgical wounds, held with sutures or staples.
Delayed Primary Closure
- For wounds older than 6 hours with some contamination. Treated as open woudn for 2-3 days to allow drainage and elimination of infection, then wound is surgically closed.
Secondary closure or third healing intention-
For wounds older than 8 hours, or for infected necrotic tissue. Wound is closed by the granulation surface, or by excision of the granulation tissue and primary closure.
Second intention healing-
For wounds older than 6 or 8 hours, or for infected, necrotic wounds. The wound is to heal by granulation. Long heal time. New tissue is weak, has scars, lack of mobility and poor cosmetic result.
Please Don't Threaten Sally:
-
Primary Closure:
Surgical wounds. Suturs and staples.
-
Delayed Primary Closure:
Wounds older than 6 hours, some contamination. 2-3 days to allow drainage and elimination of infection, then surgically closed.
Third Intention Healing:
Wounds older than 8 hours. Wound is closed by granulation surface, or by exicision of the granulation tissue and primary closure.
Second Intention Healing:
For wounds older than 6-8 hours. Heals by granulation of tissue. Long heal time.
First Aid
Basic Emergency Box Set- Up:
IV Catheters. Bandaging Materials. IV Fluids. ECG. Oxygen. Crash Cart. Emetics. Absorbents. Cathartics. Stomach Tubes. Therapeutic Agents.
Stages of Healing