Charting: using AIR

24/12/2009

Uses the mnemonic AIR

  1. Assessment
  2. Intervention
  3. Response
  • synthesizes events
  • avoids information repetition of information found elsewhere in the patient health record

Assessment:

  • Summarizes physical findings
  • begin by specifying each issue addressed in  care
  • focus on needs assessment
  • focus on trend documentation

Intervention

  • Summarize actions taken
  • Summarize notification and response of other team members to assessments and data
  • include condensed care plan
  • include plans for further patient monitoring

Response

  • Summarize outcome of intervention
  • Summarize patient response to care
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Brain Tumors

23/12/2009

 

Localized intracranial space occupying lesions.

  • Tumors usually grow as a spherical mass or diffuse and infiltrate tissue

 

Tumor Effects

  • occur from the compression and infiltration of tissue
  • increased intracranial pressure
  • cerebral edema
  • seizure activity
  • focal neurologic signs
  • hydrocephalus
  • altered pituitary function

 

Effects of Neoplasm depend on the region of the brain occupied by the tumor:

Primary tumors: originate from cells and structures within the brain

Secondary (metastatic) tumors: develop from structures outside the brain

  • occur in 20-40% of all patients with cancer
  • brain tumors rarely metastasize outside the CNS
  • metastasis origin
  1. lungs
  2. breast
  3. lower GI tract
  4. pancreas
  5. kidneys
  6. skin

 

Etiology:

Glial and Meningeal tumors: linked to ionizing radiation exposure

Incidence

  •  in adults – higher incidence in the fifth, sixth and seventh decades
  •  higher incidence in men than women
  •  Adult brain tumors originate most often originate from glial cells (forming the supportive structures of the spinal cord and CNS)

MRI of Brain tumor:


Hip Joint Replacement

22/12/2009

 

Indications for Orthopedic Surgical interventions

  1. unstabilized fracture
  2. deformity
  3. joint disease
  4. necrotic or infarcted tissue
  5. tumors

 

Indications for Joint Replacement

 

  1. severe joint pain
  2. severe disability
  3. osteoarthritis
  4. rheumatoid arthritis
  5. trauma
  6. congenital deformity
  7. femoral neck fractures where blood supply has been disrupted

 

Joint Implant Types

 

  1. Metal and high-density polyethylene components
  • implants are usually cemented in place with polymethacrylate (PMMA)
  • PMMA is a bone binding agent that has similar properties to bone
  • Loosening of prosthesis is the main reason for prosthesis failure

bone ingrowth on right:

 2. Press-fit ingrowth prosthesis

  • porous-coated and cementless
  • bone grows into the implant

 

Pre-operative considerations: organ functioning

  1. Cardiovascular
  2. Respiratory
  3. Renal
  4. Hepatic

 

Risk factors for DVT and Pulmonary embolism

  1. age
  2. obesity
  3. preoperative leg edema
  4. DVT Hx
  5. Varicose Veins

 

Post-operative complications

 

  1. hip prosthesis dislocation
  2. excessive wound drainage
  3. thromboembolism
  4. infection
  5. heel pressure ulcers
  6. heterotrophic ossification = bone growth in the periprosthetic space
  7. avascular osseous necrosis
  8. loosening of the prosthesis

 

Martin, Glenn and Porth, Carol, Mattson. 2009. Pathophysiology Concepts of Altered Health States. 8th ed. Lippincott Williams and Wilkins. Philadelphia


Neurotmesis

21/12/2009

A type of nerve damage where both the nerve and the nerve sheath are damaged. Only partial recovery may occur.


Pedicle Screw

19/12/2009

Used to stabilize the vertebra after laminectomy or during spinal fusion.


Flu Symptoms

18/12/2009

Symptoms of Flu

 

Seasonal Flu H1N1 Flu
All types of flu can cause:

  • Fever
  • Coughing and/or sore throat
  • Runny or stuffy nose
  • Headaches and/or body aches
  • Chills
  • Fatigue
Same as seasonal flu, but symptoms may be more severe.

  • Fever
  • Coughing and/or sore throat
  • Runny or stuffy nose
  • Headaches and/or body aches
  • Chills
  • Fatigue

In addition to the above symptoms, a number of H1N1 flu cases reported:

  • Vomiting
  • Diarrhea

 


The Subcutaneous Butterfly

17/12/2009

The subcutaneous tissue lies between the skin (epidermis and dermis) and the underlying muscle; it is made up of loose connective tissue and varying amounts of fat.  It also contains cutaneous nerves, small lymph vessels and blood vessels.

 Subcutaneous treatment can be given when treatment is not suitable to be given orally. Subcutaneous treatment can be given in preference to intramuscular medication.

Subcutaneous treatment can be given in preference to intravenous treatment.

medication may be given several times a day into the same site.

The most frequently used sites include

  • Abdomen and chest wall (avoiding the umbilical area)
  • Thighs: upper and lateral aspects
  • Buttocks
  • Upper arms: upper and outer aspects

Subcutaneous injections

  • 1-2mls can be injected as a bolus into a site.

Subcutaneous infusions

  • The abdomen is frequently chosen for infusion of larger volumes.  However, many individuals do not like the thought of having needles in their abdomen.
  • Erythema and swelling at the site of infusion

http://www.ich.ucl.ac.uk/clinical_information/clinical_guidelines/cpg_guideline_00154