measuring rectal temperature

Wash hands.

Shake the rectal thermometer below 35 ° C.

Insert thermometer into thermometer sheath.

Apply lubricant to bulb end of thermometer.

Open up the diaper to expose genital area.

Wear gloves if necessary. With non-dominant hand holds on the feet to stabilize the infant in position while insert thermometer about 0.5-1 inch into the anus as guarded by the dominant hand.

Hold thermometer in place for 3 minutes

Remove thermometer gently.

Dress up the infant.

Discard thermometer sheath.

Read thermometer reading at eye level.

Wash hands.

baby bathing

Planning
- perform hand hygiene, gather all necessary and appropriate equipment
- prepare basin with water and check the water temperature (around 38 degree of celsius) with elbow or liquid crystal thermometer

Implementation
- remove baby's clothing except diaper, cover baby with towel/blanket
- with football hold position, wash the infant's head in circular motion using shampoo and rinse
(洗頭時掩耳)
- dry hair and remove diaper
- immerse the infant in the tub of water, hold infant securely with one hand positioned behind neck and upper back (suppose BB head 在左邊，left wrist behind the neck), grasping the opposite upper arm (左手夾實BB左上臂近shoulder); wash infant's body with the other hand
- change hand to well support the infant before lean the infant forward to wash the back (雙手夾住BB，即右手按心口，然後將BB翻轉，即俯臥而BB頭向右邊，洗背時右手support chin)
- carefully remove infant from water, with one hand supporting head and neck of the baby and the other hand supporting buttocks and legs.
- pad dry and dress up with diaper and gown,, wrap with blanket

assess for general condition of infant during and after bathing

bottle feeding

Planning
- perform hand hygiene; gather all necessary and appropriate equipment
- arrange a chair for feeding and wrap the baby with shawl (a piece of fabric worn by women over the shoulders or head or wrapped around a baby) to keep warm

Implementation
- (pour milk powder and warm water into the bottle)
- assemble the teat (嬰兒奶瓶上的橡皮奶頭) onto the bottle without contamination; use a pair of forceps if needed
- test the milk temperature on the inner aspect of wrist before feeding the baby
- sit in a comfortable chair and to cuddle (hug) baby securely with baby's head slightly upward before feeding
- place small towel under the baby's chin and touch the corner of the mouth with teat to allow rooting of the infant for the teat
- place teat on top of the tongue
- tilt the bottle at an angle to keep the teat and the neck of the bottle full of the milk
- burp (noisily release air from the stomach through the mouth) the infant halfway through with the infant in sitting position and after feeding
- clean off dribbled milk around baby's mouth, chin
- check diaper and placing the baby back in crib (嬰兒床) in lateral position

(change napkin before feeding?)

Post-op (C5)

SpO2/TPR(vital signs) Q1H
Patient-controlled analgesia (morphine)
(respiratory distress)
bradycardia
blood pressure drops?
drowsiness?
constipation
chest drain

Pre-op (C5)

NPO (Nil per oral) 6-8 hrs
vital signs
withhold insulin
H'stix (blood glucose) stat (immediately)
+/- Fleet enema
shower
consult anesthesia (doctor)
draw blood
- complete blood count
- random glucose
clotting factor
consent form
ECG
X-ray
renal function test
liver function test
cardiac enzyme
troponin (CK-MB)

apical (rate) position

apex of the heart

It lies behind the 5th left intercostal space,
8-9 cm from the mid-sternal line, slightly medial to the mid-clavicular line

luer fit

The Luer taper is a standardized system of small-scale fluid fittings used for making leak-free connections between a male-taper fitting and its mating female part on medical and laboratory instruments, including hypodermic syringe tips and needles or stopcocks and needles.

(en.wikipedia.org0

abbreviation

TDW: touch down walking
CTLS: cervical, thoracic, lumbar, sacral
I&D: incision and drainage
D/C: discharge
MRI: magnetic resonance imaging
PLT: platelet count
WCC: white cell count
AFB: acid-fast bacillus
CVC: central venous catheter
LMWH: low molecular weight heparin

CRL

Crown-rump length (CRL) is the measurement of the length of human embryos and fetuses from the top of the head (crown) to the bottom of the buttocks (rump). It is typically determined from ultrasound imagery and can be used to estimate gestational age.

(google.com)

gravida/para

Gravida indicates the number of times the woman has been pregnant, regardless of whether these pregnancies were carried to term. A current pregnancy, if any, is included in this count.

Parity, or "para" indicates the number of >20-week births (including viable and non-viable; i.e., stillbirths). Pregnancies consisting of multiples, such as twins or triplets, count as one birth for the purpose of this notation.

(en.wikipedia.org)

e.g. G2P1

entonox

nitrous oxide and oxygen

techniques in OBS

court respiratory rate

then, measure apical rate

prevent crying

X napkin over cord

HBsAg

This tests for the presence of virus. A "positive" or "reactive" HBsAg test result means that the person is infected with the hepatitis B virus, which can be an "acute" or a "chronic" infection. Infected people can pass the virus on to others through their blood and infected bodily fluids.

(hepb.org)

eclampsia and pre-eclampsia

Eclampsia is the onset of seizures (convulsions) in a women with preeclampsia. Preeclampsia is a disorder of pregnancy in which there is high blood pressure and either large amounts of protein in the urine or other organ dysfunction. Onset may be before, during, after delivery.

(en.wikipedia.org)

meconium stained liquor

http://www.patient.co.uk/doctor/meconium-stained-liquor

惡露 (lochia)

http://www.fhs.gov.hk/tc_chi/health_info/faq/women_health/PN2_2_2.html

non-stress test

http://americanpregnancy.org/prenatal-testing/non-stress-test/

empathy is better than sympathy

http://www.diffen.com/difference/Empathy_vs_Sympathy

work distribution

clinical : management
nursing officer 7:3
ward manager 3:7

Mediastinal shift

Mediastinal shift a shifting or moving of the tissues and organs that comprise the mediastinum (heart, great vessels, trachea, and esophagus) to one side of the chest cavity … This can produce compression of the other lung and kinking or twisting of one or more of the great blood vessels, which in turn seriously impairs blood flow to and from the heart.

(medical-dictionary.thefreedictionary.com)

abbreviation

IMP: impression
?: suspected
EDTA: ethylenediaminetetraacetic acid
TPN: total parenteral nutrition
BCG vaccine: Bacillus Calmette–Guérin
HBAg: hepatitis B antigen
GDM: gestational diabetes mellitus
NAD: no abnormality detected
C/S: Caesarean section
AF: artificial feeding
A/N depression: antenatal
GBS: Group B streptococcus
BE: breast engorgement
PPS: postpartum sterilization
IVF: In vitro fertilization
MROP: manual removal of placenta
ARM: artificial rupture of membrane
EA: epidural anesthesia
PET: preeclampsia toxemia
PP: placenta previa
LMP: last menstrual period
OSCAR: One-stop clinic for Assessment of Risk (for Fetal Anomalies)
EDC: expected date of confinement
GIGT: gestational impaired glucose tolerance
PROM: prelabor rupture of membrane
PPP: please prepare patient
FHHR: fetal heart heard regular

TA

tricuspid annuloplasty: surgical reconstruction of an incompetent cardiac valve

TME

Total mesorectal excision is a common procedure used in the treatment of colorectal cancer in which a significant length of the bowel around the tumor is removed.

(emedicine.medscape.com)

UIP

Usual interstitial pneumonia (UIP) is a form of lung disease characterized by progressive scarring of both lungs. The scarring (fibrosis) involves the supporting framework (interstitium) of the lung.

(en.wikipedia.org)

CRP

C-reactive protein (CRP) is an acute phase reactant, a protein made by the liver and released into the bloodstream within a few hours after tissue injury, the start of an infection, or other cause of inflammation.

(google.com)

ESR

ESR stands for erythrocyte sedimentation rate. It is commonly called a "sed rate." It is a test that indirectly measures how much inflammation is in the body. A blood sample is needed.

(google.com)

Nebulizer

In medicine, a nebulizer (or nebuliser) is a drug delivery device used to administer medication in the form of a mist inhaled into the lungs. Nebulizers are commonly used for the treatment of cystic fibrosis, asthma, COPD and other respiratory diseases.

(google.com)

regular nebulised normal saline helps to loosen tenacious secretions

(patient.co.uk)

identify drug allergy

ID bracelet
MAR (medical administration record)
head of bed
ask patient

porridge

It is a dish made by boiling ground, crushed, or chopped cereal in water, milk, or both, with optional flavourings, usually served hot in a bowl or dish.

(en.wikipedia.org)

thoracotomy

It is an incision into the pleural space of the chest.

(google.com)

dizzy vs drowsy

dizzy: 頭暈目眩
drowsy: 昏昏欲睡

pleural effusion

it is excess fluid that accumulates in the pleural cavity
(en.wikipedia.org)

triflow

incentive spirometer

Pleurodesis

Pleurodesis is a medical procedure in which the pleural space is artificially obliterated. It involves the adhesion of the two pleurae.

(source: en.wikipedia.org)

induces inflammation
stops NSAID (non-steroidal anti-inflammatory drug)

Opsite spray

Opsite spray is a transparent and quick drying film
the film helps to provide protection for dry minor surgical and surface wounds
(source: smith-nephew.com)

ECG

PR: SA node>electricity>ventricular muscle
QRS: depolarization
T: repolarization

morphine overdose

respiratory depression

digoxin

apical rate > 60 bpm

accountability

if you are accountable to go for something that you do, you are responsible for it and must be prepared to justify your actions to that person

Hartmann's solution

Hartmann's solution or compound sodium lactate (CSL) is a crystalloid solution that is most closely isotonic with blood and intended for intravenous administration.

(source: google.com)

napkin changing

head of bed has to be flatten before changing napkin to prevent shearing force and pressure sore

病房生存之道

identity
safety (patient/staff)
documentation

pain assessment

pain score
R: rest
M: movement (按wound cough/舉手)

TPP

時地人

Paul's tube

urine for test

Cica-care dressing

It is a self-adhesive gel sheet that helps improve the appearance of the majority of red, dark or raised scars.
(source: smith-nephew.com)

blood pressure monitoring

emotion/pain/temperature/smoking (nicotine)

BP readings can be inaccurate if the cuff does not fit properly

or the patient has just exercised (some drinking)

blood pressure monitor should be same level with the heart of patient

brachial artery: medial, anterior (palm up), antecubital area

record whether the patient was lying, sitting or standing at the time the reading was obtained

(in case of orthostatic hypotension)

assist the patient into a comfortable, quiet, restful position for 5-10 minutes

remove patient's clothing from the arm

Colchicine S/E

diarrhea
(GI upset)

abbreviation

TEE: transesophageal echocardiogram
PVR: pulmonary valve replacement
EF: ejection fraction
SVC: superior vena cava
C/D: chest drain
ACEI: angiotensin-converting-enzyme inhibitor
PPI: proton-pump inhibitor
PTC: percutaneous transhepatic cholangiography
PTCA: percutaneous transluminal coronary angioplasty
ETT: endotracheal tube
INR: international normalized ratio
SR: sinus rhythm
ICS: intercostal space
AVR: aortic valve replacement
VSD: ventricular septal defect
RUZ: right upper zone
PTB: pulmonary tuberculosis
PCA: patient-controlled analgesia
VATS: video-assisted thoracoscopic surgery
CABG: coronary artery bypass graft
FEV1: forced expiratory volume in the first second
PEF: peak expiratory flow
CSU: catheterized specimen urine
NC: nasal cannula
PEEP: positive end-expiratory pressure
MCHC: mean corpuscular hemoglobin concentration
MDW: multidisciplinary day ward
SBE: subacute bacterial endocarditis
HDA: higher disability allowance
MCT diet: medium-chain triglyceride diet
OGD: oesophago-gastro-duodenoscopy
MV: mitral valve
AMI: acute myocardial infarction
PND: paroxysmal nocturnal dyspnoea
DVT: deep vein thrombosis
ASD: atrial septal defect

topical cream for burn

silver sulfadiazine

ARV injection time

Day 0 3 7 14

anticholinergic

blocking the passage of impulses through the parasympathetic nerves

hemoglobin level

male: 14-18 g/dL
female: 12-16 g/dL

OLD CARTS

characterization of pain:

onset
location
duration

characteristics
aggravating factors
relieving factors
(radiation)
timing
severity

abbreviation

EMW: emergency medical ward
ARV: anti-rabies vaccine
DAMA: discharge against medical advice
KUB: kidneys, ureters, and bladder X-ray

IMI amount

deltoid: 1 mL
ventrogluteal: 2.5 mL

point of care testing

The driving notion behind POCT is to bring the test conveniently and immediately to the patient. This increases the likelihood that the patient, physician, and care team will receive the results quicker, which allows for immediate clinical management decisions to be made.

(source: google.com)

OCD

obsessive: thought
compulsive: behavior

亞氏保加症

may lack inborn social skills
dislike any change in routines
appear to lack empathy
avoid eye contact or stare at others
have unusual facial expression or postures
preoccupied with only one or few interests

mood vs affect

Affect is the experience of feeling an emotion while mood is a state of emotion.

Affect is usually short-lived while mood can last for hours or days.

Mood can be a state of affect, where it may have no specific cause.

(source: www.differencebetween.net)

abbreviation

AH: auditory hallucination
MHS: mental health service
EPS: extrapyramidal syndrome
ECT: electroconvulsive therapy
NGASR: The Nurses' Global Assessment of Suicidal Risk
PCP: personalized care program
SO: suicidal observation

meaning of mental terms

delusion: a persistent false psychotic belief regarding the self or persons or objects outside the self that is maintained despite indisputable evidence to the contrary.

insight: the act or result of apprehending the inner nature of things or of seeing intuitively.

stupor: a condition of greatly dulled or completely suspended sense or sensibility.

blunt affect: reduced responsiveness

anergia: lack of energy

(peculiar involuntary movement)

bradykinesia: slowness

avolition: passive apathetic social withdraw

alogia: lack of spontaneous conversation

RAST blood test

A RAST test, or radioallergosorbent test, is a type of blood test used to test for allergies.
While RAST tests are expensive, and not considered as accurate as food challenges,
they are considered a very safe way to test food allergies

2D1S

2d1s q8h

= one pint (500ml) of fluid per 8 hours, arranged as one pint of NS for every 2 pint of D5 given

= thus it's 1.5L / day

(by obecalp)

FiO2

stands for fractional inspired oxygen
it is the amount of oxygen (in percentage form) in the air that the person is breathing

24 hour urine test

discard the first stream of urine of patient passed
urine passed during bowel motion should also be collected
complete the test by passing the last stream of urine at exactly the same time
female patient do not collect their urine during menstruation

aphasic

失語症

abbreviation

IVIg: intravenous immunoglobulin
AVSD: atrioventricular septal defect
HFMD: hand-foot-mouth disease
AML: acute myeloid leukemia
NPA: nasopharyngeal aspiration
CMV: cytomegalovirus
CF: cystic fibrosis
FSNF: full strength normal formula
LP: lumbar puncture
SLE: systemic lupus erythematosus
DAT: diet as tolerated
AR: apical rate
NIPV: non-invasive positive pressure ventilation
BiPAP: bilevel positive airway pressure

pedi age

1 mth to 18 yrs old

disinfection vs sterilization

http://www.diffen.com/difference/Disinfect_vs_Sterilize

eye surgery

For GA case, using the small size of tegaderm to cover the non-operative eye (X ventimask)
For LA case, using green gauze to cover the non-operative eye and put on the ventimask with 2L medical air (4L medical air intra-operation)

BSS

A balanced salt solution (BSS) is a solution made to a physiological pH and salt concentration. Solutions most commonly include sodium, potassium, calcium, magnesium, and chloride.

(en.wikipedia.org)

diathermy

it is the use of high frequency electric current to induce heat
used to either cut or destroy tissue or to produce coagulation...
current has no effect on muscles
can interfere with pacemaker function

monopolar diathermy
bipolar diathermy

layers around brain

skin of scalp
periosteum
bone of skull
Dura mater
arachnoid
(subarachnoid space)
Pia mater

Bair Hugger

forced-air warming
prevent hypothermia

Cidex

disinfection of endoscope

standard precaution

apply to blood;
all body fluids, secretions, and excretions except sweat;
non-intact skin and mucous membrane

tourniquet

止血帶
not more than 2 hours

Mallampati score

predict case of intubation
www.uphs.upenn.edu/ppmc_emergency/PPMC%20Bookmarks/Airway%20Sedation/Airway.pdf

ASA

ASA physical status classification system

www.asahq.org/resources/clinical-information/asa-physical-status-classification-system

suture

#5 (heavy braided suture for orthopedics)
#11-0 (fine monofilament suture for ophthalmics)

abbreviation

PACU: post-anesthetic care unit
MCA: middle cerebral artery
SA: spinal anesthesia
PSF: posterior spinal fusion
K+G: kidney dish and gallipot
PID: prolapsed inter-vertebral disc
EUA: examination under anesthesia
PHACO: phacoemulsification
ERM: epiretinal membrane
IOL: intraocular lens
BSS: balanced salt solution

Duoderm gel

filler for dry cavity wounds to provide a moist wound healing environment
aids autolytic debridement

SIADH

hypersecretion of antidiuretic hormone

tool to prevent pressure ulcer

heel protector

analgesic balm

冬青膏

INR and warfarin

the normal range for the INR is 0.8–1.2. Clinicians desiring therapeutic anticoagulation may aim for a higher INR - in many cases ranging from 2-3 - using anticoagulants such as warfarin

(en.wikipedia.org)

walk with patients

一點 自由行
二點 伴我行
三點 三人行
四點 不宜行 (pad slide)

D/S supp

Dulcolax suppository

sarcoma

Soft tissue sarcomas can develop from soft tissues like fat, muscle, nerves, fibrous tissues, blood vessels, or deep skin tissues.

(source: cancer.org)

back slab

slab of plaster on one side of the limb

should be used to allow for swelling

(source: oscestop.com)

ankylosing spondylitis

It is a long-term disease that involves inflammation of joints between spinal bones, and the joints between spine and pelvis.
These joints become swollen and inflammed.
Over time, the affected spinal bones join together.

RICE

rest
ice
compression
elevation

for sprain, strain or bruise

Coban

a self-adherent elastic wrap that functions like a tape,
but sticks only to itself

protect primary dressings

abbreviation

SCD: sequential compression device
AVN: avascular necrosis
CRF: chronic renal failure
CHF: congestive heart failure
OCD: obsessive-compulsive disorder
CEA: carcinoembryonic antigen
PSA: prostate specific antigen
AFP: alpha-fetoprotein
CAPD: continuous ambulatory peritoneal dialysis
ENT: ears, nose and throat
FEES: fiberoptic endoscopic evaluation of swallowing
CGAT: community geriatric assessment team
PVRU: post void residual urine

documentation

subjective
objective finding
(care+treatment)
evaluation

Influenza and droplet precaution

(資料來源: http://www.chp.gov.hk/tc/content/9/24/29.html)

……流感病毒會不時衍生新品種。每年，流感病毒抗原漂移的出現（輕微改變）會產生新病毒品種。該輕微變異會導致季節性流感，這也解釋了為何須要每年重新研製流感疫苗。

當流感病毒的表面抗原出現抗原轉移（重大改變）時，就會產生能造成流感大流行的病毒品種。人類對這種病毒的抵抗力有限，甚至沒有抵抗力，令新病毒比季節性流感傳播得更迅速及廣泛。……

病徵

健康的人患上季節性流感後，通常會於二至七天內自行痊癒。病徵包括發燒、咳嗽、喉嚨痛、流鼻水、肌肉痛、疲倦和頭痛；亦可能出現嘔吐和腹瀉等。

咳嗽多是嚴重和持續時間較長，但發燒和其他病徵一般會在五至七天內自行減退。然而，免疫力較低的人士或長者一旦染上流感，可以是嚴重的疾病，並且可能會出現支氣管炎或肺炎等併發症，甚至死亡。

傳播途徑

流感病毒主要透過由患者咳嗽、打噴嚏或說話時產生的飛沫傳播，亦可透過直接接觸患者的分泌物而傳播。

潛伏期

一般約為一至四天。

傳染期

患者可在病發前約一天至病發後五至七天內感染他人。而幼兒或免疫功能嚴重受損人士的傳染期甚至會更長。

治理方法

• 充足休息和多喝水
• 若出現流感病徵，切勿上班或上學。如果病徵持續或惡化，應立即求診
• 抗生素是治療細菌感染而非病毒感染的藥物，服用抗生素不能治愈流感或加快痊癒
• 抗病毒劑能減輕病情和縮短患病時間，但必須經由醫生處方才可服用

預防方法

季節性流感疫苗接種

……

個人衞生

• 使用梘液和清水以正確方法洗手
• 當雙手沒有明顯污垢時，可用含70% 至 80% 酒精搓手液潔淨雙手
• 打噴嚏或咳嗽時應掩著口鼻
• 將染污的紙巾棄置於有蓋垃圾箱內
• 打噴嚏或咳嗽後應徹底洗手
• 如出現呼吸道感染病徵，應佩戴口罩

環境衞生

• 保持室內空氣流通

在流感高峰期，避免前往人多擠逼或空氣流通欠佳的公眾地方；高危人士在這些地方逗留時可考慮佩戴外科口罩。

Droplet precautions are intended to prevent transmission of pathogens spread through close respiratory or mucous membrane contact with respiratory secretions. Because these pathogens do not remain infectious over long distances in a healthcare facility, special air handling and ventilation are not required to prevent droplet transmission...A single patient room is preferred if available...Spatial separation of > 3 feet and drawing the curtain between patient beds is especially important for patients in multi-bed rooms with infections transmitted by the droplet route. Healthcare personnel wear a mask for close contact with infectious patient; the mask is generally donned upon room entry. Patients on droplet precautions who must be transported outside of the room should wear a mask if tolerated and follow respiratory hygiene/cough etiquette.

(en.wikipedia.org)