DI

STANCELEARNI
NGCENTRE

AHMADUBELLOUNI
VERS
ITY

ZARI
A,NI
GERI
A

COURS
EMATERI
AL

F
OR

Co
urs
eCo
de&Ti
tl
e:NURS51
1:I
NTENS
IVECARENURS
ING

Ba
che
loro
fNur
si
ngS
cie
nce(
BNS
c)

Pr
ogr
ammeTi
tl
e:Ba
che
loro
fNur
si
ngS
cie
nce(
BNS
c)

1
 ACKNOWLEDGEMENTS

Wea
ckn
owl
edg
eth
eus
eoft
heCo
urs
ewa
reo
fth
eNa
tio
nal
Ope
nUn
ive
rsi
tyo
fNi
ger
iaa
sth
e

p
rima
ryr
eso
urc
e.I
nte
rna
lre
vie
wer
sint
heAh
mad
uBe
ll
oUn
ive
rsi
tywh
oex
ten
siv
elyr
evi
ewe
dan
d

e
nha
nce
dth
ema
ter
ial
hav
ebe
end
ulyl
i
ste
dasme
mbe
rso
fth
eCo
urs
ewa
red
eve
lop
men
tte
am.

Re
vis
edBy
:Sa
li
hu,
A.Ko
mbo

COPYRI
GHTPAGE

2
©201
8Ah
mad
uBe
ll
oUn
ive
rsi
ty(
ABU)Za
ria
,Ni
ger
ia

Al
lri
ght
sre
ser
ved
.Nop
arto
fth
isp
ubl
i
cat
io
nma
yber
epr
oduc
edi
nan
yfo
rmo
rbya
nyme
ans
,

e
lec
tro
nic
,me
cha
nic
al,
pho
toc
opy
ing
,re
cor
din
g,o
rot
her
wis
ewi
tho
utt
hep
rio
rpe
rmi
ssi
ono
fth
e

Ah
mad
uBe
ll
oUn
ive
rsi
ty
,Za
ria
,Ni
ger
ia.

F
irs
tpub
li
she
d2020i
nNi
ger
ia.

I
SBN:

Ah
mad
uBe
ll
oUn
ive
rsi
tye
-Le
arn
ingp
roj
ect
,

Ah
mad
uBe
ll
oUn
ive
rsi
ty

Za
ria
,Ni
ger
ia.

Te
l:+23
4

E-
mai
l
:

3
 COURS
EWRI
TERS
/DEVELOPMENTTEAM

(
ifOERr
eso
urc
e)

S
ali
hu,
A.Ko
mbo ABUS
ubj
ectMa
tte
rRe
vie
wer

Ad
eye
moAd
ekun
leABULa
ngua
geRe
vie
wer

ABUI
nst
ruc
ti
ona
lDe
sig
ner
s/Gr
aph
ics

S
ani
,M.
SABUEd
ito
r

4
 CONTENTS

Co
nte
nts

COURS
EINF
ORMATI
ON 7

COURS
EINTRODUCTI
ONANDDES
CRI
PTI
ON 7

COURS
EPREREQUI
SI
TES 8

COURS
ELEARNI
NGRES
OURCES 8

COURS
EOBJ
ECTI
VESANDOUTCOMES 9

ACTI
VITI
ESTOMEETCOURS
EOBJ
ECTI
VES 9

TI
ME(
TOCOMPLETES
YLABUS
/COURS
E) 9

GRADI
NGCRI
TERI
AANDS
CALE 9

LI
NKSTOOPENEDUCATI
ONRES
OURCES 1
1

Ot
hers
our
cesf
oro
pene
duc
ati
onr
eso
urc
es 1
1

ABUDLCACADEMI
CCALENDAR/
PLANNER 1
3

COURS
ESTRUCTUREANDOUTLI
NE 1
4

MODULE1 1
9

S
tud
ySe
ssi
on1&2:I
nfe
cti
onCo
ntr
oli
nth
eIn
ten
siv
eNur
si
ngCa
reUn
it. 1
9

S
tud
ySe
ssi
on3&4:Ps
ych
oso
cia
lIs
sue
sinI
nte
nsi
veNur
si
ngCa
reI
:St
res
sor
sinI
nte
nsi
veCa
re. 1
9

MODULE2…………………………………………………………………………………………………………………………………….
.
..
..
19

S
tud
ySe
ssi
on1&2:Ps
ych
oso
cia
lIs
sue
sinI
nte
nsi
veNur
si
ngCa
reI
I:S
tre
sso
rsi
nIn
ten
siv
eCa
re. 1
9

S
tud
ySe
ssi
on3&4:Tr
auma
. 1
9

5
S
tan
dar
dPr
eca
uti
ons 21

Ha
ndHy
gie
ne 22

Pe
rso
nal
Pro
tec
ti
veEq
uip
men
t 23

Re
spi
rat
oryHy
gie
ne/
Coug
hEt
iq
uet
te 24

S
har
psS
afe
ty 25

S
afeI
nje
cti
onPr
act
ic
es 26

S
ter
il
is
ati
ona
ndDi
si
nfe
cti
ono
fPa
tie
nt-
Car
eIt
emsa
ndDe
vic
es 27

En
vir
onme
nta
lIn
fec
ti
onPr
eve
nti
ona
ndCo
ntr
ol 29

Ke
yPo
int
s 3
5

Ne
worUp
dat
edRe
comme
nda
tio
ns 3
6

MODULE3
:In
tro
duc
ti
ont
oIn
ten
siv
eCa
reNur
si
ng 90

S
tud
ySe
ssi
on1&2:Nut
ri
ti
on. 90

S
tud
ySe
ssi
on3&4:Pa
tie
ntsUn
der
goi
ngTr
ans
pla
nta
tio
nI. 90

S
tud
ySe
ssi
on5:Pa
tie
ntsUn
der
goi
ngTr
ans
pla
nta
tio
nII
. 90

XI
II
.Gl
oss
ary

COURS
EINF
ORMATI
ON

Co
urs
eCo
de:
NURS51
1

6
Co
urs
eTi
tl
e:I
nte
nsi
veCa
reNur
si
ng

Cr
edi
tUn
its
:2

Ye
aro
fSt
udy
:500L

S
eme
ste
r:F
irs
t

COURS
EINTRODUCTI
ONANDDES
CRI
PTI
ON

I
ntr
oduc
ti
on:

NURS51
1:I
nte
nsi
veCa
reNur
si
ngi
sac
our
set
hati
ntr
oduc
est
hel
ear
nert
ova
rio
usme
tho
dsa
nd

a
ppr
oac
hesi
nIn
ten
siv
eNur
si
ngCa
re.Th
isc
our
sewi
l
lde
vel
opi
nyo
uth
ekn
owl
edg
ean
dsk
il
ls

r
equi
redt
ome
ett
hev
ary
ingn
eed
sofy
ourp
ati
ent
sint
heI
nte
nsi
veCa
res
ett
ing
.

Th
isCo
urs
eGui
det
el
lsy
oub
ri
ef
lywh
att
hec
our
sei
sal
lab
out
,wh
atc
our
sema
ter
ial
syo
uwi
l
lbe

us
inga
ndh
owy
ouc
anwo
rky
ourwa
yth
roug
hth
esema
ter
ial
s.I
tal
sog
ive
syo
uso
meg
uid
anc
eon

y
oura
ssi
gnme
ntsa
ndf
orumd
isc
uss
ion
swh
ichy
oua
ree
nco
ura
gedt
ocr
eat
eti
met
oat
ten
dan
dfo
r

y
out
obea
nac
ti
vep
art
ic
ipa
nt.Th
eCo
urs
eco
nsi
st
sofi
nfe
cti
onc
ont
roli
nth
ein
ten
siv
enur
si
ng

c
arel
i
mit
s,p
syc
hos
oci
ali
ssue
sini
nte
nsi
ven
urs
ing
,tr
auma
,nut
ri
ti
ona
ndp
ati
ent
sun
der
goi
ng

t
ran
spl
ant
ati
on.

De
scr
ipt
io
n:

Th
eco
urs
eai
msa
tpr
ovi
di
ngt
hel
ear
ner
swi
tha
nin
-de
pthun
der
sta
ndi
ngo
fth
eba
sic
sofI
nte
nsi
ve

Nur
si
ngCa
re,
whi
chi
ssy
ste
micc
ove
rag
eofI
nte
nsi
veNur
si
ngCa
reo
fPa
tie
nts
.

COURS
EPREREQUI
SI
TES

Yo
ush
oul
dno
tet
hata
lth
oug
hth
isc
our
seh
asn
osub
jec
tpr
ere
qui
si
te
,yo
uar
eex
pec
tedt
oha
ve:

1
.Sa
tis
fac
tor
yle
vel
ofEn
gli
shp
rof
ic
ien
cy

2.Ba
sicc
omp
ute
rop
era
tio
nsp
rof
ic
ien
cy

7
 3
.On
li
nei
nte
rac
ti
onp
rof
ic
ien
cy

4.We
b2.
0an
dso
cia
lme
diai
nte
rac
ti
ves
kil
l
s

5.Pa
sse
dal
lme
dic
al-
sur
gi
cal
Nur
si
ngI
,I
I,
II
Ian
dIV

COURS
ELEARNI
NGRES
OURCES

Co
urs
eTe
xtb
ook
s

Wa
lsh
,M.
(2005)
.Wa
tso
ns’
sCl
i
nic
alNur
si
nga
ndRe
lat
edS
cie
nce
s,6
thEd
.

Lo
ndo
n:Ba
il
li
ereTi
nda
ll
.

Bu
rki
tt
,H.
G.,
Qiuc
k,C.
R.G.
andGa
tt,
D.(
1996
).Es
sent
ialS
urg
ery
,2n
dEd
.

Ed
inb
urg
h:Ch
urc
hil
lLi
vi
ngs
ton
e.

Le
nna
rd,
J.E.
(1992)
.APo
sit
iv
eAp
pro
acht
oNut
ri
ti
ona
sTr
eat
ment
.Lo
ndo
n:

Ki
ng’
sFun
dCe
ntr
e.

He
lma
n,C.
(1990)
.Cul
tur
e,He
alt
handI
ll
nes
s,2n
dEd
.Ox
for
d:But
ter
wor
th-

He
ine
man
n.

Hi
nch
il
if
f,S
.M.
,Mo
nta
gue
,S.
E.a
ndWa
tso
n,R.
(1996
).Phy
sio
log
yfo
rNur
si
ng

Pr
act
ic
e.Lo
ndo
n:Ba
il
li
areTi
nda
ll
.

Ro
ber
tso
n,G.
(1999)
.'
In
div
idua
l’
sPe
rce
pti
ono
fth
eirq
ual
i
tyo
fli
fef
ol
lo
win
ga

Li
vert
ran
spl
ant
:Ane
xpl
ora
tor
yst
udy
'.J
our
nalo
fAd
vanc
edNur
si
ng.
30(
2):
497-
505.

8
Na
ido
o,J
.(1
994)
.He
alt
hPr
omo
ti
on.
Lon
don
:Ba
il
la
ireTi
nda
ll
.

i
. Co
urs
eJo
urn
als

i
i
. Ot
herRe
sour
ces

COURS
EOBJ
ECTI
VEANDOUTCOMES

Ons
ucc
ess
ful
comp
let
io
noft
hec
our
se,
yous
houl
dbea
blet
o:

De
scr
ibeh
owi
nfe
cti
onc
anb
eco
ntr
oll
edi
nth
eIn
ten
siv
eNur
si
ngCa
reun
it.

Di
scus
sth
eps
ych
oso
cia
lis
sue
sinI
nte
nsi
veNur
si
ngCa
re.

Ex
pla
int
hec
onc
epto
ftr
aumai
nre
lat
io
ntoI
nte
nsi
veNur
si
ng.

De
scr
ibet
her
ela
tio
nsh
ipb
etwe
enn
utr
it
io
nan
dIn
ten
siv
eNur
si
ngCa
re.

En
ume
rat
eva
rio
usp
ati
ent
sun
der
goi
ngt
ran
spl
ant
ati
on.

ACTI
VITI
ESTOMEETCOURS
EOBJ
ECTI
VES

S
pec
if
ic
all
y,t
hisc
our
ses
hal
lco
mpr
is
eoft
hef
ol
lo
win
gac
ti
vi
ti
es:

1
. S
tud
yin
gco
urs
ewa
re

2. Li
st
eni
ngt
oco
urs
eaud
ios

3
. Wa
tch
ingr
ele
van
tco
urs
evi
deo
s

4. F
iel
dac
ti
vi
ti
es,i
ndus
tri
ala
tta
chme
nto
rin
ter
nsh
ip,l
abo
rat
oryo
rst
udi
owo
rk

(
whi
che
veri
sap
pli
cab
le)

5. Co
urs
eas
sig
nme
nts(
ind
ivi
dua
lan
dgr
oup
)

6
. F
orumd
isc
uss
ionp
art
ic
ipa
tio
n

7. Tut
ori
al
s(o
pti
ona
l)

8. S
eme
ste
rex
ami
nat
io
ns(
CBTa
nde
ssa
y-b
ase
d).

9
TI
ME(
TOCOMPLETES
YLLABUS
/COURS
E)

Toc
opewi
tht
hisc
our
se,
youwo
uldb
eex
pec
tedt
oco
mmi
tami
ni
mumo
f2h
our
sinawe
ekf
ort
he

Co
urs
e.

GRADI
NGCRI
TERI
AANDS
CALE

Gr
adi
ngCr
it
eri
a

A. F
orma
tiv
eas
ses
sme
nt

Gr
ade
swi
l
lbea
war
dedb
ase
dont
hef
ol
lo
win
g:

I
ndi
vi
dua
las
sig
nme
nts
/te
st(
CA1
,2e
tc) 20

Gr
oupa
ssi
gnme
nts(
GCA1
,2e
tc) 1
0

Di
scus
sio
ns/
Qui
zze
s/Outo
fcl
asse
nga
geme
ntse
tc 1
0

B.S
umma
tiv
eas
ses
sme
nt(
Seme
ste
rex
ami
nat
io
n)

CBT-
bas
ed 3
0

Es
say
-ba
sed 3
0

TOTAL 1
00%

C.Gr
adi
ngS
cal
e(a
sap
pro
pri
atef
ort
hec
our
se)
:

A=70–1
00

B=6
0–6
9

C=50–59

D=45–49

F=0–44

D.F
eed
bac
k

Co
urs
ewa
re-
bas
ed:

1
.In
-te
xtq
ues
ti
onsa
nda
nswe
rs(
ans
wer
spr
ece
din
gre
fer
enc
es)

1
0
 2.
Sel
f-
ass
ess
men
tque
sti
onsa
nda
nswe
rs(
ans
wer
spr
ece
din
gre
fer
enc
es)

Tut
or-
bas
ed:

1
.Di
scus
sio
nfo
rumt
uto
rin
put

2.
Gra
dedc
ont
inuo
usa
sse
ssme
nts

S
tud
ent
-ba
sed
:

1
.On
li
nep
rog
rammea
sse
ssme
nt(
admi
ni
st
rat
io
n,l
ear
nin
gre
sour
ce,
dep
loy
men
t,a
nd

a
sse
ssme
nt)
.

LI
NKSTOOPENEDUCATI
ONRES
OURCES

OS
SWa
tchp
rov
ide
sti
psf
ors
ele
cti
nga
nop
en-
sour
ce,
orf
orp
roc
uri
ngf
reeo
rop
ens
oft
war
e.

S
cho
olF
org
ean
dSo
urc
eFo
rgea
reg
oodp
lac
est
ofi
nd,
cre
ate
,an
dpub
li
sho
pens
oft
war
e.

S
our
ceF
org
e,f
oro
ne,
hasmi
l
li
onso
fdo
wnl
oad
sea
chd
ay.

Op
enS
our
ceEd
uca
tio
nFo
und
ati
ona
ndOp
enS
our
ceI
ni
ti
ati
ve,
ando
the
ror
gan
isa
tio
nsl
i
ke

t
hes
e,h
elpd
iss
emi
nat
ekn
owl
edg
e.

Cr
eat
iv
eCo
mmo
nsh
ass
eve
ral
ope
npr
oje
ctsf
romKh
anAc
ade
myt
oCur
ri
kiwh
eret
eac
her
san
d

p
are
ntsc
anf
inde
duc
ati
ona
lma
ter
ial
sfo
rch
il
dre
norl
ear
nab
outCr
eat
iv
eCo
mmo
nsl
i
cen
ses
.Al
so,

t
heyr
ece
ntl
yla
unc
hedt
heS
cho
olo
fOp
ent
hato
ffe
rsc
our
seso
nth
eme
ani
ng,
app
li
cat
io
n,a
nd

i
mpa
cto
f"o
pen
nes
s."

Nume
rouso
peno
rop
ene
duc
ati
ona
lre
sour
ced
ata
bas
esa
nds
ear
che
ngi
nese
xis
t.S
omee
xamp
les

i
ncl
ude
:

 OEDb
:ov
er1
0,000f
reec
our
sesf
romun
ive
rsi
ti
esa
swe
lla
sre
vie
wso
fco
ll
ege
san
dra
nki
ngso
f

c
oll
eged
egr
eep
rog
ramme
s

1
1
 Op
enTa
pes
try
:ov
er1
00,
000o
penl
i
cen
sedo
nli
nel
ear
nin
gre
sour
cesf
ora
nac
ade
mica
ndg
ene
ral

a
udi
enc
e

 OERCo
mmo
ns:o
ver40,
000o
pene
duc
ati
ona
lre
sour
cesf
rome
leme
nta
rys
cho
olt
hro
ught
ohi
ghe
r

e
duc
ati
on;ma
nyo
fth
eel
eme
nta
ry,
mid
dle
,an
dhi
ghs
cho
olr
eso
urc
esa
rea
li
gne
dtot
heCo
mmo
n

Co
reS
tat
eSt
and
ard
s

 Op
enCo
nte
nt:ab
log
,de
fi
ni
ti
on,
andg
ameo
fop
ens
our
cea
swe
lla
saf
ri
end
lys
ear
che
ngi
nef
or

o
pene
duc
ati
ona
lre
sour
cesf
romMI
T,S
tan
for
d,a
ndo
the
run
ive
rsi
ti
eswi
ths
ubj
ecta
ndd
esc
ri
pt
io
n

l
i
sti
ngs

 Ac
ade
micEa
rth
:ov
er1
,500v
ide
ole
ctur
esf
romMI
T,S
tan
for
d,Be
rke
ley
,Ha
rva
rd,
Pri
nce
ton
,an
d

Ya
le

 J
ISC:J
oin
tIn
for
mat
io
nSy
ste
msCo
mmi
tt
eewo
rkso
nbe
hal
fofUKh
igh
ere
duc
ati
ona
ndi
sin
vol
ved

i
nma
nyo
penr
eso
urc
esa
ndo
penp
roj
ect
sin
clud
ingd
igi
ti
si
ngBr
it
is
hne
wsp
ape
rsf
rom1
620-
1900!

Ot
hers
our
cesf
oro
pene
duc
ati
onr
eso
urc
es

Un
ive
rsi
ti
es

 Th
eUn
ive
rsi
tyo
fCa
mbr
idg
e'sg
uid
eonOp
enEd
uca
tio
nal
Res
our
cesf
orTe
ach
erEd
uca
tio
n(ORBI
T)

 Op
enLe
arnf
romOp
enUn
ive
rsi
tyi
nth
eUK

Gl
oba
l

 Un
esc
o'ss
ear
cha
bleo
pend
ata
bas
eisap
ort
alt
owo
rld
wid
eco
urs
esa
ndr
ese
arc
hin
iti
ati
ves

1
2
 Af
ri
canVi
rt
ual
Uni
ver
si
ty(
htt
p:
//o
er.
avu.
org
/)h
asn
ume
rousmo
dul
eso
nsub
jec
tsi
nEn
gli
sh,

F
ren
ch,
andPo
rtug
ues
e

 h
ttp
s:/
/co
de.
goo
gle
.co
m/p
/co
urs
e-b
uil
der
/isGo
ogl
e'
sop
en-
sour
ces
oft
war
eth
ati
sde
sig
nedt
ole
t

a
nyo
nec
rea
teo
nli
nee
duc
ati
onc
our
ses

 Gl
oba
lVo
ice
s(h
ttp
://
glo
bal
voi
ces
onl
i
ne.
org
/)i
sani
nte
rna
tio
nal
commun
ityo
fbl
ogg
erswh
ore
por
t

o
nbl
ogsa
ndc
it
iz
enme
diaf
roma
roun
dth
ewo
rld
,in
clud
ingo
nop
ens
our
cea
ndo
pene
duc
ati
ona
l

r
eso
urc
es

I
ndi
vi
dua
ls(
whi
chi
ncl
udeOERs
)

 Li
bra
ria
nCh
ick
:ev
ery
thi
ngf
romb
ook
stoq
uiz
zesa
ndv
ide
osh
ere
,in
clud
esd
ire
cto
rie
sono
pen

s
our
cea
ndo
pene
duc
ati
ona
lre
sour
ces

 K-
12Te
chTo
ols
:OERs
,fr
oma
rtt
osp
eci
ale
duc
ati
on

 We
b2.
0:Co
olTo
olsf
orS
cho
ols
:aud
ioa
ndv
ide
oto
ols

 We
b2.
0Gur
u:a
nima
tio
nan
dva
rio
usc
oll
ect
io
nso
ffr
eeo
pens
our
ces
oft
war
e

Li
veb
ind
ers
:se
arc
h,c
rea
te,
oro
rga
nis
edi
gi
tal
inf
orma
tio
nbi
nde
rsb
yag
e,g
rad
e,o
rsub
jec
t(wh
yre
-

i
nve
ntt
hewh
eel
?)

1
3
 ABUDLCACADEMI
CCALENDAR/
PLANNER

PERI
OD

S
eme
ste
r S
eme
ste
r1 S
eme
ste
r2 S
eme
ste
r3

Ac
ti
vi
ty J
AN F
EB MAR APR MAY J
UN J
UL AUG S
EPT OCT NOV DEC

Re
gis
tra
tio
n

Re
sump
ti
on

La
teRe
gis
tn.

F
aci
l
ita
tio
n

Re
vis
ion
/

Co
nso
li
dat
io
n

S
eme
ste
r

Ex
ami
nat
io
n

N.
B.: -Al
lSe
ssi
onsc
omme
ncei
nJa
nua
ry

-1We
ekb
rea
kbe
twe
enS
eme
ste
rsa
nd6We
eksv
oca
tio
nate
ndo
fas
ess
ion
.

-S
eme
ste
r3i
sOPTI
ONAL(
Fas
t-t
rac
kin
g,ma
kin
gupc
arr
y-o
ver
s&d
efe
rme
nts
)

1
4
 COURS
ESTRUCTUREANDOUTLI
NE

Co
urs
eSt
ruc
tur
e

WEEK MODULE S
TUDYS
ESS
ION ACTI
VITY
/
DAYS

1
.Re
adCo
urs
ewa
ref
ort
hec
orr
esp
ond
ingS
tud
ySe
ssi
on.

2.Vi
ewt
heVi
deo
(s)o
nth
isS
tud
ySe
ssi
on

3
.Li
st
ent
oth
eAud
ioo
nth
isS
tud
ySe
ssi
on
S
tud
ySe
ssi
on1
4.Vi
ewa
nyo
the
rVi
deo
/Yo
uTub
e
&2:
Da
y1 (
htt
ps:
//www.
yout
ube
.co
m/wa
tch
?v=6
p72A485GTY)

Ti
tl
e:I
nfe
cti
on 5.Vi
ewr
efe
rre
dOER(
add
res
s/s
it
e??
???
?)

Co
ntr
oli
nth
e 6
.Vi
ewr
efe
rre
dAn
ima
tio
n(h
ttp
s:/
/www.
yout
ube
.co
m/wa
tch
?v=h
00Eb
gZn
Va4)

I
nte
nsi
ve 7.Re
adCh
apt
er/
pag
eofS
tan
dar
d/r
ele
van
tte
xt.

Nur
si
ngCa
re 8.An
yad
dit
io
nal
stud
yma
ter
ial

Un
it. 9.An
youto
fCl
assAc
ti
vi
ty

1
.Re
adCo
urs
ewa
ref
ort
hec
orr
esp
ond
ingS
tud
ySe
ssi
on.

1
5
 2.Vi
ewt
heVi
deo
(s)o
nth
isS
tud
ySe
ssi
on

3
.Li
st
ent
oth
eAud
ioo
nth
isS
tud
ySe
ssi
on
Da
y2 S
tud
ySe
ssi
on3
4.Vi
ewa
nyo
the
rVi
deo
/Yo
uTub
e
&4
S
TUDY
(
htt
ps:
//www.
nur
se.
com/
blo
g/2008/
03/
24/
nur
ses
-he
lp-
kee
p-p
ati
ent
s-f
rom-
Ti
tl
e:
MODULE1
, e
xpe
rie
nci
ng-
the
-ni
ght
mar
e-t
hat
-i
s-
pts
d/)
Ps
ych
oso
cia
l
5.Vi
ewr
efe
rre
dOER
I
ssu
esi
n
(
htt
ps:
//www.
whh
s.c
om/
Ser
vi
ces
/Cl
i
nic
al-
Ser
vic
es/
Int
ens
ive
-Ca
re/
Int
ens
ive
-
I
nte
nsi
ve
Ca
re-
Pat
ie
nt-
and
-Fa
mil
y-
Sup
por
t-
Ser
vi
ce.
asp
x)
Nur
si
ngCa
reI
:
6
.Vi
ewr
efe
rre
dAn
ima
tio
n(Ad
dre
ss/
Sit
)
S
tre
sso
rsi
n
7.Re
adCh
apt
er/
pag
eofS
tan
dar
d/r
ele
van
tte
xt.
I
nte
nsi
veCa
re.
8.An
yad
dit
io
nal
stud
yma
ter
ial

9.An
youto
fCl
assAc
ti
vi
ty

1
.Re
adCo
urs
ewa
ref
ort
hec
orr
esp
ond
ingS
tud
ySe
ssi
on.
MODULE2
2.Vi
ewt
heVi
deo
(s)o
nth
isS
tud
ySe
ssi
on

3
.Li
st
ent
oth
eAud
ioo
nth
isS
tud
ySe
ssi
on
Da
y3 S
tud
ySe
ssi
on1
4.Vi
ewa
nyo
the
rVi
deo
/Yo
uTub
e(a
ddr
ess
/si
te
&2

1
6
 Ti
tl
e: h
ttp
s:/
/ps
ych
sce
neh
ub.
com/
psy
chi
nsi
ght
s/me
nta
l-
hea
lth
-ch
all
eng
es-

Ps
ych
oso
cia
l h
eal
thc
are
-wo
rke
rs-
dur
ing
-co
vid
-19-
pan
demi
c-
man
age
men
t-s
tra
teg
ies
/)

I
ssu
esi
n 5.Vi
ewr
efe
rre
dOER(
add
res
s/s
it
e

I
nte
nsi
ve h
ttp
s:/
/www.
ncb
i.
nl
m.n
ih.
gov
/pmc
/ar
ti
cl
es/
PMC41
00421
/)

Nur
si
ngCa
reI
I: 6
.Vi
ewr
efe
rre
dAn
ima
tio
n(Ad
dre
ss/
Sit
e)

S
tre
sso
rsi
n 7.Re
adCh
apt
er/
pag
eofS
tan
dar
d/r
ele
van
tte
xt.

I
nte
nsi
veCa
re. 8.An
yad
dit
io
nal
stud
yma
ter
ial

9.An
youto
fCl
assAc
ti
vi
ty

1
.Re
adCo
urs
ewa
ref
ort
hec
orr
esp
ond
ingS
tud
ySe
ssi
on.

2.Vi
ewt
heVi
deo
(s)o
nth
isS
tud
ySe
ssi
on

3
.Li
st
ent
oth
eAud
ioo
nth
isS
tud
ySe
ssi
on
Da
y4 S
tud
ySe
ssi
on3
4.Vi
ewa
nyo
the
rVi
deo
/Yo
uTub
e(a
ddr
ess
/si
te
&4
h
ttp
s:/
/www.
yout
ube
.co
m/wa
tch
?v=4f
wFk
yvPz
qw)

Ti
tl
e:Tr
auma
. 5.Vi
ewr
efe
rre
dOER(
add
res
s/s
it
e

h
ttp
s:/
/www.
hea
lth
li
ne.
com/
hea
lth
/tr
auma
tic
-ev
ent
s)

6
.Vi
ewr
efe
rre
dAn
ima
tio
n(Ad
dre
ss/
Sit
e)

1
7
 7.Re
adCh
apt
er/
pag
eofS
tan
dar
d/r
ele
van
tte
xt.

8.An
yad
dit
io
nal
stud
yma
ter
ial

9.An
youto
fCl
assAc
ti
vi
ty

1
.Re
adCo
urs
ewa
ref
ort
hec
orr
esp
ond
ingS
tud
ySe
ssi
on.

2.Vi
ewt
heVi
deo
(s)o
nth
isS
tud
ySe
ssi
on
S
tud
ySe
ssi
on1
3
.Li
st
ent
oth
eAud
ioo
nth
isS
tud
ySe
ssi
on
&2
Da
y5
4.Vi
ewa
nyo
the
rVi
deo
/Yo
uTub
e(a
ddr
ess
/si
te
Ti
tl
e:Nut
ri
ti
on.
h
ttp
s:/
/www.
yout
ube
.co
m/wa
tch
?v=Y59e
zRTJ
ixs
)

5.Vi
ewr
efe
rre
dOER(
add
res
s/s
it
e

h
ttp
s:/
/www.
wfs
ahq
.or
g/c
omp
one
nts
/co
m_v
ir
tua
l_l
i
bra
ry/
med
ia/
cdd
bf82d
14

54c
5898f
62e
7056
550e
7d7-
60-
Nut
ri
ti
on-
in-
ICU.
pdf
)

6
.Vi
ewr
efe
rre
dAn
ima
tio
n(Ad
dre
ss/
Sit
e)

S
TUDY 7.Re
adCh
apt
er/
pag
eofS
tan
dar
d/r
ele
van
tte
xt.

8.An
yad
dit
io
nal
stud
yma
ter
ial
MODULE3
9.An
youto
fCl
assAc
ti
vi
ty

1
.Re
adCo
urs
ewa
ref
ort
hec
orr
esp
ond
ingS
tud
ySe
ssi
on.

1
8
 S
tud
ySe
ssi
on3 2.Vi
ewt
heVi
deo
(s)o
nth
isS
tud
ySe
ssi
on

&4 3
.Li
st
ent
oth
eAud
ioo
nth
isS
tud
ySe
ssi
on
Da
y6
4.Vi
ewa
nyo
the
rVi
deo
/Yo
uTub
e(a
ddr
ess
/si
te
Ti
tl
e:Pa
tie
nts
h
ttp
s:/
/www.
org
and
ono
r.g
ov/
abo
ut/
pro
ces
s/t
ran
spl
ant
-pr
oce
ss.
html
)
Un
der
goi
ng
5.Vi
ewr
efe
rre
dOER(
add
res
s/s
it
e
Tr
ans
pla
nta
tio
nI
h
ttp
s:/
/www.
who
.i
nt/
tra
nsp
lan
tat
io
n/o
rga
n/e
n/)

6
.Vi
ewr
efe
rre
dAn
ima
tio
n(Ad
dre
ss/
Sit
e)

7.Re
adCh
apt
er/
pag
eofS
tan
dar
d/r
ele
van
tte
xt.

8.An
yad
dit
io
nal
stud
yma
ter
ial

9.An
youto
fCl
assAc
ti
vi
ty

1
.Re
adCo
urs
ewa
ref
ort
hec
orr
esp
ond
ingS
tud
ySe
ssi
on.

2.Vi
ewt
heVi
deo
(s)o
nth
isS
tud
ySe
ssi
on

3
.Li
st
ent
oth
eAud
ioo
nth
isS
tud
ySe
ssi
on
S
tud
ySe
ssi
on5
4.Vi
ewa
nyo
the
rVi
deo
/Yo
uTub
e

Da
y7 Ti
tl
e: Pa
tie
nts Pa
tie
nts
(
htt
ps:
//www.
don
ors
1.o
rg/
pat
ie
nts
/re
sour
ces
-fo
r-t
ran
spl
ant
-pa
tie
nts
/)

Un
der
goi
ng 5.Vi
ewr
efe
rre
dOER(
add
res
s/s
it
e

Tr
ans
pla
nta
tio
n

1
9
 h
ttp
s:/
/www.
med
ica
lne
wst
oda
y.c
om/
art
ic
les
/3256
31)

6
.Vi
ewr
efe
rre
dAn
ima
tio
n(Ad
dre
ss/
Sit
e)

7.Re
adCh
apt
er/
pag
eofS
tan
dar
d/r
ele
van
tte
xt.

8.An
yad
dit
io
nal
stud
yma
ter
ial

9.An
youto
fCl
assAc
ti
vi
ty

We
ek1
3 REVI
SI
ON/
TUTORI
ALS(
On-
Camp
uso
rOn
li
ne)&CONS
OLI
DATI
ONWEEK

We
eks1
4& S
EMES
TEREXAMI
NATI
ON

1
5

20
 S
TUDYMODULES

MODULE1
:

S
tud
ySe
ssi
on1&2:I
nfe
cti
onCo
ntr
oli
nth
eIn
ten
siv
eNur
si
ngCa
reUn
it.

S
tud
ySe
ssi
on3&4:Ps
ych
oso
cia
lIs
sue
sinI
nte
nsi
veNur
si
ngCa
reI
:St
res
sor
sinI
nte
nsi
veCa
re.

MODULE2:

S
tud
ySe
ssi
on1&2:Ps
ych
oso
cia
lIs
sue
sinI
nte
nsi
veNur
si
ngCa
reI
I:S
tre
sso
rsi
nIn
ten
siv
eCa
re.

S
tud
ySe
ssi
on4&4:Tr
auma
.

MODULE3
:

S
tud
ySe
ssi
on1&2:Nut
ri
ti
on.

S
tud
ySe
ssi
on3&4:Pa
tie
ntsUn
der
goi
ngTr
ans
pla
nta
tio
nI.

S
tud
ySe
ssi
on5:Pa
tie
ntsUn
der
goi
ngTr
ans
pla
nta
tio
nII
.

1
2.0S
TUDYMODULES

21
MODULE1

Co
nte
nts
:

S
tud
ySe
ssi
on1&2:I
nfe
cti
onCo
ntr
oli
nth
eIn
ten
siv
eNur
si
ngCa
reUn
it.

S
tud
ySe
ssi
on3&4:Ps
ych
oso
cia
lIs
sue
sinI
nte
nsi
veNur
si
ngCa
reI
:St
res
sor
sinI
nte
nsi
veCa
re.

S
TUDYS
ESS
ION1&2

I
nfe
cti
onCo
ntr
oli
nth
eIn
ten
siv
eNur
si
ngCa
reUn
it

S
ect
io
nan
dSub
sec
ti
onHe
adi
ngs
:

I
ntr
oduc
ti
on

1
.0Le
arn
ingOut
come
s

2.
0Ma
inCo
nte
nts

2.
1No
soc
omi
ali
nfe
cti
on

2.
2:Ce
ntr
esf
orDi
sea
seCo
ntr
olRe
comme
nda
tio
n–Un
ive
rsa
lPr
eca
uti
ons

2.
3:I
sol
ati
onPr
oce
dur
es

2.
4:S
pec
ial
con
sid
era
tio
n

3
.0Tu
torMa
rke
dAs
sig
nme
nts(
Ind
ivi
dua
lorG
rou
pas
sig
nme
nts
)

4.
0St
udyS
ess
ionS
umma
rya
ndCo
ncl
usi
on

5.
0Se
lf
-As
ses
sme
ntQue
sti
ons

6
.0Ad
dit
io
nal
Act
iv
it
ie
s(Vi
deo
s,An
ima
tio
ns&Outo
fCl
assAc
ti
vi
ti
es)

7.
0Re
fer
enc
es/
Fur
the
rRe
adi
ngs
.

I
ntr
odu
cti
on:

Ani
ndi
vi
dua
lint
heI
nte
nsi
veCa
ree
nvi
ron
men
tisa
tco
nst
antr
is
kfo
rac
qui
ri
ngan
oso
comi
al

i
nfe
cti
on.Va
rio
usf
act
orsl
eadt
oth
ise
nha
nce
dsus
cep
ti
bi
li
tyi
ncl
udi
ng(
1)d
ecr
eas
edb
ody

d
efe
nce
sfr
omi
l
lne
ss,
immun
osup
pre
ssi
ona
lte
reds
kini
nte
gri
ty
,ors
tre
ss;(
2)i
ncr
eas
ese
xpo
sur
e

22
t
oth
enume
rousi
nte
rve
nti
onsr
equi
reds
ucha
smul
ti
pl
ean
tib
iot
ic
s,s
uct
io
nin
g,e
tc.
;(3
)th
eus
eof

i
nva
siv
ede
vic
esf
are
swi
thh
eal
i
ng.Un
for
tun
ate
ly,t
hemo
stf
req
uen
tso
urc
eofc
ont
ami
nat
io
nis

c
ros
s-i
nfe
cti
onb
yhe
alt
hca
rep
rov
ide
rs.Nur
sesh
avev
eryf
req
uen
tin
ter
act
io
nswi
thp
ati
ent
san
d

mus
tta
ker
esp
ons
ibi
l
ityf
orap
ort
io
noft
hes
ecr
oss
-co
nta
min
ati
ons
.No
soc
omi
ali
nfe
cti
ons

c
omp
li
cat
eho
spi
tal
i
sat
io
nan
din
cre
aset
hel
eng
tho
fst
ay.Al
tho
ughun
ive
rsa
lpr
eca
uti
onsh
ave

i
mpr
ove
dba
sici
nfe
cti
onc
ont
rol
pra
cti
ces
,th
eya
red
esi
gne
dtop
rot
ectt
heh
eal
thc
arep
rov
ide
r,n
ot

t
hep
ati
ent
.Nur
sesmus
tco
nti
nuet
obev
erya
ggr
ess
ivei
nco
ntr
oll
i
ngc
ros
s-c
ont
ami
nat
io
nto

p
rot
ectt
hei
nte
nsi
vel
yil
lpa
tie
nt.Th
emo
ste
ffe
cti
vewa
yist
owa
shh
and
sbe
for
ean
daf
tere
ver
y

p
ati
entc
ont
act
,wh
eth
ero
rno
tgl
ove
sar
ewo
rn.I
nth
isun
it,b
asi
cin
fec
ti
onc
ont
roli
ssue
sar
e

d
isc
uss
edt
opr
ote
ctb
otht
hep
ati
enta
ndt
hen
urs
efr
omi
nfe
cti
ousd
ise
ase
.

1
.0S
tud
ySe
ssi
onL
ear
nin
gOu
tco
mes

Af
ters
tud
yin
gth
iss
ess
ion
,Ie
xpe
cty
out
obea
blet
o:

1
.Ex
pla
inmo
nomi
ali
nfe
cti
on.

2.
Sta
tet
het
ype
soft
ran
smi
ssi
onso
fno
soc
omi
ali
nfe
cti
ons
.

3
.De
scr
ibet
heun
ive
rsa
lpr
eca
uti
ons

4.
Dis
cus
sth
enur
si
ngi
nte
rve
nti
onsf
ori
nfe
cti
onc
ont
rol
.

2.
0Ma
inCo
nte
nts

2.
1No
soc
omi
ali
nfe
cti
on

De
fi
ni
ti
on:I
sde
fi
neda
sani
nfe
cti
ona
cqui
redi
nth
eho
spi
tal
.In
fec
ti
ousd
ise
aset
ran
smi
tt
ed

d
ire
ctl
yfr
omi
nfe
cte
dpe
rso
ntos
usc
ept
ib
lep
ers
on.I
nfe
cti
ousd
ise
aset
ran
smi
tt
edi
ndi
rec
tl
yfr
om

23
i
nfe
cte
dpe
rso
ntos
usc
ept
ib
lep
ers
onb
yac
arr
ier(
i.
e.
,nur
se,p
hys
ici
an,a
ndo
the
rhe
alt
hca
re

wo
rke
rs)
.No
rma
lfl
orat
hati
nva
desa
ndc
olo
nis
eso
the
rsy
ste
msi
nth
esa
mep
ers
on.No
rma
ll
y

n
on-
pat
hog
eni
cor
gan
ismsi
nva
dea
ndc
olo
nis
esus
cep
ti
bl
epa
tie
nts
.In
fec
ti
onsp
ass
edf
roma
n

i
nfe
cte
dmo
the
rtoh
ern
ewb
orn
.

2.
1.
1Ex
ten
t

1
.5%-
7%o
fpa
tie
ntsa
dmi
tt
edt
oag
ene
ral
hos
pit
ala
cqui
ren
oso
comi
ali
nfe
cti
on.

2.
App
rox
ima
tel
y25%o
fal
lno
soc
omi
ali
nfe
cti
onso
ccurwi
thi
nth
eIn
ten
siv
eCa
reUn
it(
ICU)
.

3
.Asma
nya
son
e-t
hir
dofa
llI
CUa
dmi
ssi
onswi
l
lex
per
ien
cean
oso
comi
ali
nfe
cti
on.

A-Co
mmo
nsi
te
s(i
nde
cre
asi
ngo
rde
roff
req
uen
cy)

1
.Ur
ina
ryt
rac
t.

2.
Sur
gic
alwo
und
s.

3
.Lo
werr
esp
ira
tor
ytr
act
.

4.
Blo
od(
pri
mar
yba
cte
remi
as)
.

5.
Ski
ns.

B-Co
mmo
npa
tho
gen
s

1
.Es
che
ric
hiac
oli
.

2.
Pse
udo
mon
asa
erug
ino
sa.

3En
ter
oco
cci
.

4S
tap
hyl
oco
ccusa
ure
us.

C-Ri
skf
act
ors

1
.Imp
air
edh
ostd
efe
nce
sfr
ome
ffe
ctso
fin
ten
siv
eil
l
nes
s.

2.
Dis
eas
e-a
lte
redi
mmun
efun
cti
on(
i.
e.
,di
abe
tes
,ci
rr
hos
is,
ren
alf
ail
ure
,ma
li
gna
ncy
).

24
3
.Immun
osup
pre
ssi
on(
i.
e.
,or
gant
ran
spl
ant
ati
on,
cor
ti
cos
ter
oidt
her
apy
).

4.
Pro
lon
geda
ndf
req
uen
tex
pos
uret
opa
tho
gen
s,r
esi
st
anto
rga
nis
msi
npa
rti
cul
ari
nth
e

I
nte
nsi
veCa
reUn
it.

5.
Inv
asi
ved
evi
ces
.

6
.Po
orn
utr
it
io
nal
sta
tus
.

2.
1.
2Nur
si
ngi
nte
rve
nti
onsf
ori
nfe
cti
onc
ont
rol

A-1
.Ge
ner
alg
uid
eli
nes

a
.Wa
shh
and
sbe
for
eco
nta
ctwi
thp
ati
ent
stop
rev
entc
ros
s-i
nfe
cti
ona
nda
fte
rre
mov
ingg
lov
es,

s
inc
ele
aksa
ndt
ear
sar
eno
tal
way
sap
par
enta
ndwr
is
tsma
ybec
ont
ami
nat
ed.

b
.Ad
her
etou
niv
ers
alp
rec
aut
io
ns.

c
.Ad
her
etoi
sol
ati
onp
roc
edur
esi
nsug
ges
tedc
ate
gor
ies
.

B-Ce
ntr
esf
orDi
sea
sesCo
ntr
olRe
comme
nda
tio
ns:Un
ive
rsa
lPr
eca
uti
ons

S
tand
ardPr
eca
uti
ons

S
tan
dar
dPr
eca
uti
onsa
ret
hemi
ni
mum i
nfe
cti
onp
rev
ent
io
npr
act
ic
est
hata
ppl
ytoa
llp
ati
ent
s

c
are
,re
gar
dle
sso
fsus
pec
tedo
rco
nfi
rme
din
fec
ti
ons
tat
uso
fth
epa
tie
nt,i
nan
yse
tti
ngwh
ere

h
eal
thc
arei
sde
li
ver
ed.Th
esep
rac
ti
cesa
red
esi
gne
dtob
othp
rot
ectDHCPa
ndp
rev
entDHCP

f
roms
pre
adi
ngi
nfe
cti
onsa
mon
gpa
tie
nts
.St
and
ardPr
eca
uti
onsi
ncl
ude–

1
.Ha
ndh
ygi
ene
.

2.Us
eofp
ers
ona
lpr
ote
cti
vee
qui
pme
nt(
e.g
.,g
lov
es,
mas
ks,
eye
wea
r).

3
.Re
spi
rat
oryh
ygi
ene
/co
ughe
ti
que
tte
.

4.S
har
pss
afe
ty(
eng
ine
eri
nga
ndwo
rkp
rac
ti
cec
ont
rol
s)
.

5.S
afei
nj
ect
io
npr
act
ic
es(
i.
e.
,t
hea
sep
ti
cte
chn
iquef
orp
are
nte
ral
med
ica
tio
ns)
.

6
.St
eri
l
ein
str
ume
ntsa
ndd
evi
ces
.

7
.Cl
eana
ndd
isi
nfe
cte
den
vir
onme
nta
lsur
fac
es.

25
Ea
che
leme
nto
fSt
and
ardPr
eca
uti
onsi
sde
scr
ib
edi
nth
efo
ll
owi
ngs
ect
io
ns.Ed
uca
tio
nan
d

t
rai
ni
nga
rec
ri
ti
cale
leme
ntso
fSt
and
ardPr
eca
uti
onsb
eca
uset
heyh
elpDHCPma
kea
ppr
opr
iat
e

d
eci
si
onsa
ndc
omp
lywi
thr
eco
mme
nde
dpr
act
ic
es.

Wh
enS
tan
dar
dPr
eca
uti
onsa
lon
eca
nno
tpr
eve
ntt
ran
smi
ssi
on,t
heya
res
upp
leme
nte
dwi
th

Tr
ans
mis
sio
n-Ba
sedPr
eca
uti
ons
.Th
iss
eco
ndt
ie
rofi
nfe
cti
onp
rev
ent
io
nisus
edwh
enp
ati
ent
s

h
aved
ise
ase
sth
atc
ans
pre
adt
hro
ughc
ont
act
,dr
opl
eto
rai
rbo
rner
out
es(
e.g
.,s
kinc
ont
act
,

s
nee
zin
g,c
oug
hin
g)a
nda
rea
lwa
ysus
edi
nad
dit
io
ntoS
tan
dar
dPr
eca
uti
ons
.De
nta
lse
tti
ngsa
re

n
ott
ypi
cal
l
yde
sig
nedt
oca
rryo
uta
llo
fth
eTr
ans
mis
sio
n-Ba
sedPr
eca
uti
ons(
e.g
.,Ai
rbo
rne

Pr
eca
uti
onsf
orp
ati
ent
s wi
ths
usp
ect
edt
ube
rcul
osi
s,me
asl
es,o
rch
ick
enp
ox)t
hata
re

r
eco
mme
nde
dfo
rho
spi
tala
ndo
the
ramb
ula
tor
yca
res
ett
ing
s.Pa
tie
nts
,ho
wev
er,d
ono
tus
ual
l
y

s
eekr
out
ined
ent
alo
utp
ati
entc
arewh
ena
cut
elyi
l
lwi
thd
ise
ase
sre
qui
ri
ngTr
ans
mis
sio
n-Ba
sed

Pr
eca
uti
ons
.No
net
hel
ess
,DHCPs
houl
dde
vel
opa
ndc
arr
youts
yst
emsf
ore
arl
yde
tec
ti
ona
nd

ma
nag
eme
nto
fpo
ten
tia
ll
yin
fec
ti
ousp
ati
ent
sati
ni
ti
alp
oin
tso
fen
tryt
oth
ede
nta
lse
tti
ng.Tot
he

e
xte
ntp
oss
ibl
e,t
hisi
ncl
ude
sre
sch
edul
i
ngn
on-
urg
entd
ent
alc
areun
tilt
hep
ati
enti
snol
ong
er

i
nfe
cti
ouso
rre
fer
ralt
oad
ent
als
ett
ingwi
tha
ppr
opr
iat
ein
fec
ti
onp
rev
ent
io
npr
eca
uti
onswh
en

ur
gen
tde
nta
ltr
eat
men
tisn
eed
ed.

Ha
ndHy
gie
ne

Th
isi
sth
emo
sti
mpo
rta
ntme
asur
etop
rev
entt
hes
pre
ado
fin
fec
ti
onsa
mon
gpa
tie
ntsa
ndDHCP.

Ed
uca
tio
nan
dtr
ain
ingp
rog
ramme
ssh
oul
dth
oro
ugh
lya
ddr
essi
ndi
cat
io
nsa
ndt
ech
niq
uesf
or

26
h
andh
ygi
enep
rac
ti
cesb
efo
rep
erf
ormi
ngr
out
inea
ndo
ral
sur
gic
alp
roc
edur
es.

F
orr
out
ined
ent
ale
xami
nat
io
nsa
ndn
ons
urg
ica
lpr
oce
dur
es,us
e wa
tera
ndp
lai
nso
ap

(
han
dwa
shi
ng)o
ran
timi
cr
obi
als
oap(
han
dan
tis
eps
is)s
pec
if
icf
orh
eal
thc
ares
ett
ing
sorus
ean

a
lco
hol
-b
ase
dha
ndr
ub.Al
tho
ugha
lco
hol
-b
ase
dha
ndr
ubsa
ree
ffe
cti
vef
orh
andh
ygi
enei
n

h
eal
thc
ares
ett
ing
s,s
oapa
ndwa
ters
houl
dbeus
edwh
enh
and
sar
evi
si
bl
yso
il
ed(
e.g
.,d
irt
,bl
ood
,

b
odyf
lui
ds)
.Fo
rsur
gic
alp
roc
edur
es,
per
for
m as
urg
ica
lha
nds
crubb
efo
rep
utt
ingo
nst
eri
l
e

s
urg
eon
’sg
lov
es.F
ora
llt
ype
sofh
andh
ygi
enep
rod
uct
s,f
ol
lo
wth
epr
oduc
tma
nuf
act
ure
r’
sla
bel

f
ori
nst
ruc
ti
ons
.Co
mpl
eteg
uid
anc
eonh
owa
ndwh
enh
andh
ygi
enes
houl
dbep
erf
orme
d,i
ncl
udi
ng

r
eco
mme
nda
tio
nsr
ega
rdi
ngs
urg
ica
lha
nda
nti
sep
sisa
nda
rti
fi
ci
aln
ail
s,c
anb
efo
undi
n

t
heGui
del
i
nef
orHa
ndHy
gie
nei
nHe
alt
h-Ca
reS
ett
ing
spd
fic
on[
PDF–494KB]
.

Ke
yHa
ndHy
gie
nef
orDe
nta
lSe
tti
ngs

1
.Pe
rfo
rmh
andh
ygi
ene–

a
.Wh
enh
and
sar
evi
si
bl
yso
il
ed.

b
.Af
terb
are
han
dedt
ouc
hin
gofi
nst
rume
nts
,eq
uip
men
t,ma
ter
ial
s,a
ndo
the
rob
jec
tsl
i
kel
yto

b
eco
nta
min
ate
dbyb
loo
d,s
ali
va,
orr
esp
ir
ato
rys
ecr
eti
ons
.

c
.Be
for
ean
daf
tert
rea
tin
gea
chp
ati
ent
.

d
.Be
for
eput
ti
ngo
ngl
ove
san
dag
aini
mme
dia
tel
yaf
terr
emo
vin
ggl
ove
s.

2.Us
eso
apa
ndwa
terwh
enh
and
sar
evi
si
bl
yso
il
ed(
e.g
.,b
loo
d,b
odyf
lui
ds)
;ot
her
wis
e,a
n

a
lco
hol
-b
ase
dha
ndr
ubma
ybeus
ed.

De
fi
ni
ti
onf
rom 2003CDCDe
nta
lGui
del
i
nes– Or
als
urg
ica
lpr
oce
dur
esi
nvo
lvet
hei
nci
si
on,

e
xci
si
on,
orr
efl
ect
io
noft
is
suet
hate
xpo
sest
hen
orma
ll
yst
eri
l
ear
easo
fth
eor
alc
avi
ty
.Ex
amp
les

27
i
ncl
udeb
iop
sy,p
eri
odo
nta
lsur
ger
y,a
pic
als
urg
ery
,imp
lan
tsur
ger
y,a
nds
urg
ica
lex
tra
cti
onso
f

t
eet
h(e
.g.
,re
mov
alo
fer
upt
edo
rno
ner
upt
edt
oot
hre
qui
ri
nge
lev
ati
ono
fth
emuc
ope
rio
ste
alf
lap
,

r
emo
val
ofb
oneo
rse
cti
ono
fto
oth
,an
dsut
uri
ngi
fne
ede
d).

Pe
rso
nal
Pro
tec
ti
veEq
uip
men
t

Pe
rso
nalp
rot
ect
iv
eeq
uip
men
t(PPE)r
efe
rst
owe
ara
blee
qui
pme
ntt
hati
sde
sig
nedt
opr
ote
ct

DHCPf
rome
xpo
sur
etoo
rco
nta
ctwi
thi
nfe
cti
ousa
gen
ts.
PPEt
hati
sap
pro
pri
atef
orv
ari
oust
ype
s

o
fpa
tie
nti
nte
rac
ti
onsa
nde
ffe
cti
vel
yco
ver
spe
rso
nalc
lot
hin
gan
dsk
inl
i
kel
ytob
eso
il
edwi
th

b
loo
d,s
ali
va,o
rot
herp
ote
nti
al
lyi
nfe
cti
ousma
ter
ial
s(OPI
M)s
houl
dbea
vai
l
abl
e.Th
esei
ncl
ude

g
lov
es,n
osema
sks
,pr
ote
cti
vee
yewe
ar,f
aces
hie
lds
,an
dpr
ote
cti
vec
lot
hin
g(e
.g.
,re
usa
bleo
r

d
isp
osa
bleg
own
,ja
cke
t,l
abo
rat
oryc
oat
).Ex
amp
leso
fth
eap
pro
pri
ateus
eofPPEf
ora
dhe
ren
cet
o

S
tan
dar
dPr
eca
uti
onsi
ncl
ude–

 Us
eofg
lov
esi
nsi
tua
tio
nsi
nvo
lvi
ngp
oss
ibl
eco
nta
ctwi
thb
loo
dorb
odyf
lui
ds,muc
ous

me
mbr
ane
s,n
on-
int
acts
kin(
e.g
.,e
xpo
seds
kint
hati
sch
app
ed,
abr
ade
d,o
rwi
thd
erma
tit
is
)or

OPI
M.

 Us
eofp
rot
ect
iv
ecl
ot
hin
gtop
rot
ects
kina
ndc
lot
hin
gdur
ingp
roc
edur
eso
rac
ti
vi
ti
eswh
ere

c
ont
actwi
thb
loo
dorb
odyf
lui
dsi
san
tic
ipa
ted
.

 Us
eofmo
uth
,no
se,a
nde
yep
rot
ect
io
ndur
ingp
roc
edur
est
hata
rel
i
kel
ytog
ene
rat
esp
las
hes

o
rsp
ray
sofb
loo
doro
the
rbo
dyf
lui
ds.

DHCPs
houl
dbet
rai
nedt
ose
lec
tan
dputo
nap
pro
pri
atePPEa
ndr
emo
vePPEs
oth
att
hec
han
ce

o
fsk
ino
rcl
oth
ingc
ont
ami
nat
io
nisr
educ
ed.Ha
ndh
ygi
enei
sal
way
sth
efi
nals
tepa
fte
rre
mov
ing

a
ndd
isp
osi
ngo
fPPE.
Tra
ini
ngs
houl
dal
sos
tre
ssp
rev
ent
ingf
urt
hers
pre
ado
fco
nta
min
ati
onwh
il
e

we
ari
ngPPEb
y:

 Ke
epi
ngh
and
sawa
yfr
omt
hef
ace
.

28
 Li
mit
ings
urf
ace
sto
uch
ed.

 Re
mov
ingPPEwh
enl
eav
ingwo
rka
rea
s.

 Pe
rfo
rmi
ngh
andh
ygi
ene
.

Th
eap
pli
cat
io
nofS
tan
dar
dPr
eca
uti
onsa
ndg
uid
anc
eona
ppr
opr
iat
ese
lec
ti
ona
nda
nex
amp
leo
f

p
utt
ingo
nan
dre
mov
alo
fpe
rso
nalp
rot
ect
iv
eeq
uip
men
tisd
esc
ri
bedi
nde
tai
lint
he2007

Gui
del
i
nef
orI
sol
ati
onPr
eca
uti
onsp
dfi
con[
PDF–1
.4MB]
.

Ke
yRe
comme
nda
tio
nsf
orPe
rso
nal
Pro
tec
ti
veEq
uip
men
t(PPE)i
nDe
nta
lSe
tti
ngs

1
.Pr
ovi
des
uff
ic
ien
tan
dap
pro
pri
atePPEa
nde
nsur
eiti
sac
ces
sib
let
oDHCP.

2.Ed
uca
tea
llDHCPo
npr
ope
rse
lec
ti
ona
ndus
eofPPE.

3
.We
arg
lov
eswh
ene
vert
her
eisp
ote
nti
alf
orc
ont
actwi
thb
loo
d,b
odyf
lui
ds,muc
ous

me
mbr
ane
s,n
on-
int
acts
kino
rco
nta
min
ate
deq
uip
men
t.

a
.Don
otwe
art
hes
amep
airo
fgl
ove
sfo
rth
eca
reo
fmo
ret
hano
nep
ati
ent
.

b
.Don
otwa
shg
lov
es.
Glo
vess
houl
dno
tber
eus
ed.

c
.Pe
rfo
rmh
andh
ygi
enei
mme
dia
tel
yaf
terr
emo
vin
ggl
ove
s.

4.We
arp
rot
ect
iv
ecl
ot
hin
gth
atc
ove
rst
hes
kina
ndp
ers
ona
lcl
oth
ingd
uri
ngp
roc
edur
eso
r

a
cti
vi
ti
eswh
erec
ont
actwi
thb
loo
d,s
ali
va,
orOPI
Misa
nti
ci
pat
ed.

5.We
armo
uth
,no
se,
ande
yep
rot
ect
io
ndur
ingp
roc
edur
est
hata
rel
i
kel
ytog
ene
rat
esp
las
heso
r

s
pat
ter
ingo
fbl
oodo
rot
herb
odyf
lui
ds.

6
.Re
mov
ePPEb
efo
rel
eav
ingt
hewo
rka
rea
.

Re
spi
rat
oryHy
gie
ne/
Coug
hEt
iq
uet
te

Re
spi
rat
oryh
ygi
ene
/co
ughe
ti
que
ttei
nfe
cti
onp
rev
ent
io
nme
asur
esa
red
esi
gne
dtol
i
mitt
he

29
t
ran
smi
ssi
ono
fre
spi
rat
oryp
ath
oge
nss
pre
adb
ydr
opl
eto
rai
rbo
rner
out
es.Th
est
rat
egi
est
arg
et

p
rima
ril
ypa
tie
ntsa
ndi
ndi
vi
dua
lsa
cco
mpa
nyi
ngp
ati
ent
stot
hed
ent
als
ett
ingwh
omi
ghth
ave

un
dia
gno
sedt
ran
smi
ssi
bl
ere
spi
rat
oryi
nfe
cti
ons
,buta
lsoa
ppl
ytoa
nyo
ne(
inc
lud
ingDHCP)wi
th

s
ign
sofi
l
lne
ssi
ncl
udi
ngc
oug
h,c
ong
est
io
n,r
unn
yno
se,o
rin
cre
ase
dpr
oduc
ti
ono
fre
spi
rat
ory

s
ecr
eti
ons
.

DHCPs
houl
dbee
duc
ate
donp
rev
ent
ingt
hes
pre
ado
fre
spi
rat
oryp
ath
oge
nswh
eni
nco
nta
ctwi
th

s
ymp
toma
ticp
ers
ons
.Re
spi
rat
oryh
ygi
ene
/co
ughe
ti
que
tteme
asur
eswe
rea
dde
dtoS
tan
dar
d

Pr
eca
uti
onsi
n2007.Ad
dit
io
nali
nfo
rma
tio
nre
lat
edt
ore
spi
rat
oryh
ygi
ene
/co
ughe
ti
que
ttec
anb
e

f
oun
dint
he2007Gui
del
i
nef
orI
sol
ati
onPr
eca
uti
onsp
dfi
con
[PDF–1
.4MB]Re
comme
nda
tio
ns

f
or p
rev
ent
ing t
he s
pre
ad o
f i
nfl
uen
za a
re a
vai
l
abl
e

a
t:h
ttp
s:/
/www.
cdc
.go
v/f
lu/
pro
fes
sio
nal
s/i
nfe
cti
onc
ont
rol
/.

Ke
yRe
comme
nda
tio
nsf
orRe
spi
rat
oryHy
gie
ne/
Coug
hEt
iq
uet
tei
nDe
nta
lSe
tti
ngs

1
.Imp
leme
ntme
asur
est
oco
nta
inr
esp
ir
ato
rys
ecr
eti
onsi
npa
tie
ntsa
nda
cco
mpa
nyi
ng

i
ndi
vi
dua
lswh
oha
ves
ign
san
dsy
mpt
omso
far
esp
ira
tor
yin
fec
ti
on,b
egi
nni
nga
tth
epo
into
f

e
ntr
ytot
hef
aci
l
itya
ndc
ont
inui
ngt
hro
ugh
outt
hev
isi
t.

a
.Po
sts
ign
sate
ntr
anc
eswi
thi
nst
ruc
ti
onst
opa
tie
ntswi
ths
ymp
tomso
fre
spi
rat
oryi
nfe
cti
on

t
o:

3
0
 i
.Co
vert
hei
rmo
uth
s/n
ose
swh
enc
oug
hin
gors
nee
zin
g.

i
i
.Us
ean
ddi
spo
seo
fti
ssue
s.

i
i
i.Pe
rfo
rmh
andh
ygi
enea
fte
rha
ndsh
aveb
eeni
nco
nta
ctwi
thr
esp
ira
tor
y

s
ecr
eti
ons
.

b
.Pr
ovi
det
is
sue
san
dno
-to
uchr
ece
pta
cle
sfo
rdi
spo
sal
oft
is
sue
s.

c
.Pr
ovi
der
eso
urc
esf
orp
erf
ormi
ngh
andh
ygi
enei
norn
earwa
iti
nga
rea
s.

d
.Of
ferma
skst
oco
ugh
ingp
ati
ent
san
dot
hers
ymp
toma
ticp
ers
onswh
ent
heye
nte
rth
e

d
ent
als
ett
ing
.

e
.Pr
ovi
des
pac
ean
den
cour
agep
ers
onswi
ths
ymp
tomso
fre
spi
rat
oryi
nfe
cti
onst
osi
tasf
ar

a
wayf
romo
the
rsa
spo
ssi
bl
e.I
fav
ail
abl
e,f
aci
l
iti
esma
ywi
sht
opl
acet
hes
epa
tie
ntsi
na

s
epa
rat
ear
eawh
il
ewa
iti
ngf
orc
are
.

2.Ed
uca
teDHCPo
nth
eimp
ort
anc
eofi
nfe
cti
onp
rev
ent
io
nme
asur
est
oco
nta
inr
esp
ira
tor
y

s
ecr
eti
onst
opr
eve
ntt
hes
pre
ado
fre
spi
rat
oryp
ath
oge
nswh
ene
xami
ni
nga
ndc
ari
ngf
or

p
ati
ent
swi
ths
ign
san
dsy
mpt
omso
far
esp
ir
ato
ryi
nfe
cti
on.

S
har
psS
afe
ty

Mo
stp
erc
uta
neo
usi
nj
uri
es(
e.g
.,n
eed
les
ti
ck,
cutwi
thas
har
pob
jec
t)a
mon
gDHCPi
nvo
lveb
urs
,

n
eed
les
,an
dot
hers
har
pin
str
ume
nts
.Imp
leme
nta
tio
noft
heOS
HA Bl
oodb
orn
ePa
tho
gen
s

S
tan
dar
dha
she
lpe
dtop
rot
ectDHCPf
romb
loo
dex
pos
urea
nds
har
psi
nj
uri
es.Ho
wev
er,s
har
ps

i
nj
uri
esc
ont
inuet
ooc
cura
ndp
oset
her
is
kofb
loo
dbo
rnep
ath
oge
ntr
ans
mis
sio
ntoDHCPa
nd

p
ati
ent
s.Mo
ste
xpo
sur
esi
nde
nti
st
rya
rep
rev
ent
abl
e;t
her
efo
re,
eac
hde
nta
lpr
act
ic
esh
oul
dha
ve

p
oli
ci
esa
ndp
roc
edur
esa
vai
l
abl
ead
dre
ssi
ngs
har
pss
afe
ty.DHCPs
houl
dbea
war
eoft
her
is
kof

3
1
i
nj
urywh
ene
vers
har
psa
ree
xpo
sed
.Wh
enus
ingo
rwo
rki
nga
roun
dsh
arpd
evi
ces
,DHCPs
houl
d

t
akep
rec
aut
io
ns,
aswe
lla
sth
emo
men
tso
fth
ecl
ean
up,
andt
hed
isp
osa
l.

En
gin
eer
inga
ndwo
rkp
rac
ti
cec
ont
rol
sar
eth
epr
ima
ryme
tho
dst
ore
duc
eex
pos
uret
obl
ooda
nd

OPI
Mfr
oms
har
pin
str
ume
ntsa
ndn
eed
les
.Wh
ene
verp
oss
ibl
e,e
ngi
nee
rin
gco
ntr
olss
hou
ldb
e

us
eda
sth
epr
ima
ryme
tho
dtor
educ
eex
pos
ure
stob
loo
dbo
rnep
ath
oge
ns.En
gin
eer
ingc
ont
rol
s

r
emo
veo
ris
ola
teah
aza
rdi
nth
ewo
rkp
lac
ean
dar
efr
eque
ntl
yte
chn
olo
gy-
bas
ed(
e.g
.,s
elf
-

s
hea
thi
nga
nae
sth
eti
cne
edl
es,
saf
etys
cal
pel
s,a
ndn
eed
lel
essI
Vpo
rts
).Emp
loy
erss
houl
din
vol
ve

t
hos
eDHCP wh
oar
edi
rec
tl
yre
spo
nsi
bl
efo
rpa
tie
ntc
are(
e.g
.,d
ent
is
ts,h
ygi
eni
st
s,d
ent
al

a
ssi
st
ant
s)i
nid
ent
if
yi
ng,
eva
lua
tin
gan
dse
lec
ti
ngd
evi
ceswi
the
ngi
nee
reds
afe
tyf
eat
ure
satl
eas
t

a
nnua
ll
yan
dast
heyb
eco
mea
vai
l
abl
e.Ot
here
xamp
leso
fen
gin
eer
ingc
ont
rol
sin
clud
esh
arp
s

c
ont
ain
ersa
ndn
eed
ler
eca
ppi
ngd
evi
ces
.

Wh
ene
ngi
nee
rin
gco
ntr
olsa
ren
ota
vai
l
abl
eora
ppr
opr
iat
e,wo
rk-
pra
cti
cec
ont
rol
ssh
oul
dbeus
ed.

Wo
rk-
pra
cti
cec
ont
rol
sar
ebe
hav
iour
-ba
seda
nda
rei
nte
nde
dtor
educ
eth
eri
sko
fbl
oode
xpo
sur
e

b
ych
ang
ingt
hewa
yDHCPp
erf
ormt
ask
s,s
ucha
sus
ingao
ne-
han
deds
coo
pte
chn
iquef
or

r
eca
ppi
ngn
eed
lesb
etwe
enus
esa
ndb
efo
red
isp
osa
l.Ot
herwo
rk-
pra
cti
cec
ont
rol
sin
clud
eno
t

b
end
ingo
rbr
eak
ingn
eed
lesb
efo
red
isp
osa
l,n
otp
ass
ingas
yri
ngewi
tha
nun
she
ath
edn
eed
leb
y

h
and
,re
mov
ingb
ursb
efo
red
isa
sse
mbl
i
ngt
heh
andp
iec
efr
omt
hed
ent
alun
it,a
ndus
ing

i
nst
rume
ntsi
npl
aceo
ffi
nge
rsf
ort
is
suer
etr
act
io
norp
alp
ati
ond
uri
ngs
utur
inga
nda
dmi
ni
st
rat
io
n

o
fan
aes
the
sia
.

Al
lus
edd
isp
osa
bles
yri
nge
san
dne
edl
es,s
cal
pelb
lad
es,a
ndo
the
rsh
arpi
te
mss
houl
dbep
lac
ed

i
nap
pro
pri
atep
unc
tur
e-r
esi
st
antc
ont
ain
ersl
oca
tedc
los
etot
hea
reawh
eret
heya
reus
ed.S
har
ps

c
ont
ain
erss
houl
dbed
isp
ose
dofa
cco
rdi
ngt
ost
atea
ndl
oca
lre
gul
ate
dme
dic
alwa
ster
ule
s.

F
ormo
rei
nfo
rma
tio
nab
outs
har
pss
afe
ty,
seet
heGui
del
i
nesf
orI
nfe
cti
onCo
ntr
oli
nDe
nta
lHe
alt
h

3
2
-
Car
eSe
tti
ngs
—2003p
dfi
con
[PDF–1
.21MB]
,th
eCDCWo
rkb
ookf
orDe
sig
nin
g,I
mpl
eme
nti
ng,

a
ndEv
alua
tin
gaS
har
psI
njur
yPr
eve
nti
onPr
ogr
amme
,an
dth
eCDCS
amp
leS
cre
eni
nga
ndDe
vic
e

Ev
alua
tio
nFo
rmsf
orDe
nti
st
ry.

Ke
yRe
comme
nda
tio
nsf
orS
HARPSS
AFETYi
nDe
nta
lSe
tti
ngs

1
.Co
nsi
ders
har
pit
ems(
e.g
.,n
eed
les
,sc
ale
rs,
bur
s,l
abk
niv
es,
andwi
res
)th
ata
rec
ont
ami
nat
ed

wi
thp
ati
entb
loo
dan
dsa
li
vaa
spo
ten
tia
ll
yin
fec
ti
vea
nde
sta
bli
she
ngi
nee
rin
gco
ntr
olsa
nd

wo
rkp
rac
ti
cest
opr
eve
nti
nj
uri
es.

2.Don
otr
eca
pus
edn
eed
lesb
yus
ingb
othh
and
san
dan
yot
hert
ech
niq
uet
hati
nvo
lve
sdi
rec
ti
ng

t
hep
oin
tofan
eed
let
owa
rda
nyp
arto
fth
ebo
dy.

3
.Us
eei
the
rao
ne-
han
deds
coo
pte
chn
iqueo
rame
cha
nic
ald
evi
ced
esi
gne
dfo
rho
ldi
ngt
he

n
eed
lec
apwh
enr
eca
ppi
ngn
eed
les(
e.g
.,b
etwe
enmul
ti
pl
ein
jec
ti
onsa
ndb
efo
rer
emo
vin
gfr
om

an
on-
di
spo
sab
lea
spi
rat
ings
yri
nge
).

4.Pl
aceus
edd
isp
osa
bles
yri
nge
san
dne
edl
es,s
cal
pelb
lad
es,a
ndo
the
rsh
arpi
te
msi
n

a
ppr
opr
iat
epun
ctur
e-r
esi
st
antc
ont
ain
ersl
oca
teda
scl
osea
spo
ssi
bl
etot
hea
reawh
eret
he

i
te
msa
reus
ed.

S
afeI
nje
cti
onPr
act
ic
es

S
afei
nj
ect
io
npr
act
ic
esa
rei
nte
nde
dtop
rev
entt
ran
smi
ssi
ono
fin
fec
ti
ousd
ise
ase
sbe
twe
eno
ne

p
ati
enta
nda
not
her
,orb
etwe
enap
ati
enta
ndDHCPd
uri
ngp
rep
ara
tio
nan
dad
min
ist
rat
io
nof

p
are
nte
ral(
e.g
.,i
ntr
ave
nouso
rin
tra
mus
cul
ari
nj
ect
io
n)me
dic
ati
ons
.Sa
fei
nj
ect
io
npr
act
ic
esa
rea

s
eto
fme
asur
es,DHCPs
houl
dfo
ll
owt
ope
rfo
rmi
nj
ect
io
nsi
nth
esa
fes
tpo
ssi
bl
ema
nne
rfo
rth
e

p
rot
ect
io
nofp
ati
ent
s.DHCPmo
stf
req
uen
tlyh
and
lep
are
nte
ralme
dic
ati
onswh
ena
dmi
ni
st
eri
ng

l
oca
lan
aes
the
sia
,dur
ingwh
ichn
eed
lesa
ndc
art
ri
dge
sco
nta
ini
ngl
oca
lan
aes
the
ti
csa
reus
edf
or

o
nep
ati
ento
nlya
ndt
hed
ent
alc
art
ri
dges
yri
ngei
scl
ean
eda
ndh
eats
ter
il
is
edb
etwe
enp
ati
ent
s.

3
3
Ot
hers
afep
rac
ti
cesd
esc
ri
bedh
erep
ri
mar
il
yap
plyt
oth
eus
eofp
are
nte
ralme
dic
ati
onsc
omb
ine
d

wi
thf
lui
din
fus
ions
yst
ems
,suc
hasf
orp
ati
ent
sun
der
goi
ngc
ons
cio
uss
eda
tio
n.Un
saf
epr
act
ic
es

t
hath
avel
edt
opa
tie
nth
armi
ncl
ude1
)us
eofas
ing
les
yri
nge–wi
tho
rwi
tho
utt
hes
amen
eed
le

–t
oad
min
ist
erme
dic
ati
ont
omul
ti
pl
epa
tie
nts
,2)r
ein
ser
ti
ono
faus
eds
yri
nge–wi
tho
rwi
tho
ut

t
hes
amen
eed
le– i
ntoame
dic
ati
onv
ialo
rso
lut
io
nco
nta
ine
r(e
.g.
,sa
li
neb
ag)t
oob
tai
n

a
ddi
ti
ona
lme
dic
ati
onf
oras
ing
lep
ati
enta
ndt
henus
ingt
hatv
ialo
rso
lut
io
nco
nta
ine
rfo
r

s
ubs
eque
ntp
ati
ent
s,a
nd3
)pr
epa
rat
io
nofme
dic
ati
onsi
npr
oxi
mit
ytoc
ont
ami
nat
eds
upp
li
eso
r

e
qui
pme
nt.

S
afei
nj
ect
io
npr
act
ic
eswe
rec
ove
redi
nth
eSp
eci
alCo
nsi
der
ati
onss
ect
io
n(As
ept
icTe
chn
iquef
or

Pa
ren
ter
alMe
dic
ati
ons
)oft
he2003CDCd
ent
alg
uid
eli
nes
.Ho
wev
er,b
eca
useo
fre
por
tso
f

t
ran
smi
ssi
ono
fin
fec
ti
ousd
ise
ase
sbyi
nap
pro
pri
ateh
and
li
ngo
fin
jec
tab
leme
dic
ati
ons
,CDCn
ow

c
ons
ide
rss
afei
nj
ect
io
npr
act
ic
est
obeaf
orma
lel
eme
nto
fSt
and
ardPr
eca
uti
ons
.Co
mpl
ete

g
uid
anc
eons
afei
nj
ect
io
npr
act
ic
esc
anb
efo
undi
nth
e2007 Gui
del
i
nef
orI
sol
ati
on

Pr
eca
uti
onsp
dfi
con
[PDF– 1
.4MB]
.Ad
dit
io
nalma
ter
ial
s,i
ncl
udi
ngal
i
sto
ffr
eque
ntl
yas
ked

q
ues
ti
onsf
romp
rov
ide
rsa
ndap
ati
entn
oti
fi
cat
io
nto
olk
it,a
rea
lsoa
vai
l
abl
e.Th
eOn
e&On
ly

Ca
mpa
igni
sap
ubl
i
che
alt
hef
for
ttoe
li
min
ateun
saf
eme
dic
ali
nj
ect
io
ns.Th
eca
mpa
igni
sle
dby

CDCa
ndt
heS
afeI
nje
cti
onPr
act
ic
esCo
ali
ti
on(
SIPC)
.Tol
ear
nmo
rea
bouts
afei
nj
ect
io
npr
act
ic
es

a
nda
cce
sst
rai
ni
ngv
ide
osa
ndr
eso
urc
es,
ple
asev
isi
t

h
ttp
://
www.
one
and
onl
yca
mpa
ign
.or
g/e
xte
rna
lic
on.

Ke
yRe
comme
nda
tio
nsf
orS
AFEI
NJECTI
ONPRACTI
CESi
nDe
nta
lSe
tti
ngs

1
.Pr
epa
rei
nj
ect
io
nsus
inga
nas
ept
ict
ech
niq
uei
nac
lea
nar
ea.

2.Di
si
nfe
ctt
her
ubb
ers
ept
umo
name
dic
ati
onv
ial
wit
hal
coh
olb
efo
rep
ier
ci
ng.

3
.Don
otus
ene
edl
eso
rsy
ri
nge
sfo
rmo
ret
hano
nep
ati
ent(
thi
sin
clud
esma
nuf
act
ure
dpr
efi
l
led

s
yri
nge
san
dot
herd
evi
cess
ucha
sin
sul
i
npe
ns)
.

3
4
4.Me
dic
ati
onc
ont
ain
ers(
si
ngl
ean
dmul
ti
dos
evi
al
s,a
mpul
es,
andb
ags
)ar
een
ter
edwi
than
ew

n
eed
lea
ndn
ews
yri
nge
,ev
enwh
eno
bta
ini
nga
ddi
ti
ona
ldo
sesf
ort
hes
amep
ati
ent
.

5.Us
esi
ngl
e-
dos
evi
al
sfo
rpa
ren
ter
alme
dic
ati
onswh
enp
oss
ibl
e.

6
.Don
otus
esi
ngl
e-
dos
e(s
ing
le-
use
)me
dic
ati
onv
ial
s,a
mpul
es,a
ndb
agso
rbo
ttl
eso
f

i
ntr
ave
nouss
olut
io
nfo
rmo
ret
hano
nep
ati
ent
.

7
.Don
otc
omb
inet
hel
ef
tov
erc
ont
ent
sofs
ing
le-
usev
ial
sfo
rla
terus
e.

8.Th
efo
ll
owi
nga
ppl
yifmul
ti
dos
evi
al
sar
eus
ed–

a
.De
dic
atemul
ti
dos
evi
al
stoas
ing
lep
ati
entwh
ene
verp
oss
ibl
e.

b
.Ifmul
ti
dos
evi
al
swi
l
lbeus
edf
ormo
ret
hano
nep
ati
ent
,th
eys
houl
dber
est
ri
ct
edt
oa

c
ent
ral
i
sedme
dic
ati
ona
reaa
nds
houl
dno
ten
tert
hei
mme
dia
tep
ati
entt
rea
tme
nta
rea

(
e.g
.,d
ent
alo
per
ato
ry)t
opr
eve
nti
nad
ver
ten
tco
nta
min
ati
on.

c
.Ifamul
ti
dos
evi
ale
nte
rst
hei
mme
dia
tep
ati
entt
rea
tme
nta
rea
,its
houl
dbed
edi
cat
edf
or

s
ing
le-
pat
ie
ntus
ean
ddi
sca
rde
dimme
dia
tel
yaf
terus
e.

d
.Da
te mul
ti
dos
evi
al
swh
enf
ir
sto
pen
eda
ndd
isc
ard wi
thi
n 28 d
ays
,un
les
sth
e

ma
nuf
act
ure
rsp
eci
fi
esas
hor
tero
rlo
nge
rda
tef
ort
hato
pen
edv
ial
.

9.Don
otus
efl
ui
din
fus
iono
rad
min
ist
rat
io
nse
ts(
e.g
.,I
Vba
gs,t
ubi
ngs
,co
nne
cti
ons
)fo
rmo
re

t
hano
nep
ati
ent
.

S
ter
il
is
ati
ona
ndDi
si
nfe
cti
ono
fPa
tie
nt-
Car
eIt
emsa
ndDe
vic
es

I
nst
rume
ntp
roc
ess
ingr
equi
resmul
ti
pl
est
epsus
ings
pec
ial
i
sede
qui
pme
nt.Ea
chd
ent
alp
rac
ti
ce

s
houl
dha
vep
oli
ci
esa
ndp
roc
edur
esi
npl
acef
orc
ont
ain
ing
,tr
ans
por
ti
ng,a
ndh
and
li
ng

3
5
i
nst
rume
ntsa
nde
qui
pme
ntt
hatma
ybec
ont
ami
nat
edwi
thb
loo
dorb
odyf
lui
ds.Ma
nuf
act
ure
r’
s

i
nst
ruc
ti
onsf
orr
epr
oce
ssi
ngr
eus
abl
ede
nta
lin
str
ume
ntsa
nde
qui
pme
nts
houl
dber
ead
il
y

a
vai
l
abl
e–i
dea
ll
yino
rne
art
her
epr
oce
ssi
nga
rea
.Mo
sts
ing
le-
used
evi
cesa
rel
abe
ll
edb
yth
e

ma
nuf
act
ure
rfo
rsi
ngl
e-
usea
ndd
ono
tha
ver
epr
oce
ssi
ngi
nst
ruc
ti
ons
.Us
esi
ngl
e-
used
evi
cesf
or

o
nep
ati
ento
nlya
ndd
isp
oseo
fth
ema
ppr
opr
iat
ely
.

Cl
ean
ing
,di
si
nfe
cti
ona
nds
ter
il
is
ati
ono
fde
nta
leq
uip
men
tsh
oul
dbea
ssi
gne
dtoDHCPwi
th

t
rai
ni
ngi
nth
ere
qui
redr
epr
oce
ssi
ngs
tep
stoe
nsur
ere
pro
ces
sin
gre
sul
tsi
nad
evi
cet
hatc
anb
e

s
afe
lyus
edf
orp
ati
entc
are
.Tr
ain
ings
houl
dal
soi
ncl
udet
hea
ppr
opr
iat
eus
eofPPEn
ece
ssa
ry

f
ort
hes
afeh
and
li
ngo
fco
nta
min
ate
deq
uip
men
t.

Pa
tie
nt-
car
eit
ems(
e.g
.,d
ent
ali
nst
rume
nts
,de
vic
es,a
nde
qui
pme
nt)a
rec
ate
gor
is
eda
scr
it
ic
al,

s
emi
cr
it
ic
al,o
rno
ncr
it
ic
al,d
epe
ndi
ngo
nth
epo
ten
tia
lri
skf
ori
nfe
cti
ona
sso
cia
tedwi
tht
hei
r

i
nte
nde
dus
e.

 Cr
it
ic
ali
te
ms,s
ucha
ssur
gi
cali
nst
rume
ntsa
ndp
eri
odo
nta
lsc
ale
rs,a
ret
hos
eus
edt
o

p
ene
tra
tes
oftt
is
sueo
rbo
ne.Th
eyh
avet
heg
rea
tes
tri
sko
ftr
ans
mit
ti
ngi
nfe
cti
ona
nds
houl
d

a
lwa
ysb
est
eri
l
ise
dus
ingh
eat
.

 S
emi
cr
it
ic
ali
te
ms(
e.g
.,mo
uthmi
rr
ors
,ama
lga
mco
nde
nse
rs,
reus
abl
ede
nta
limp
res
sio
ntr
ays
)

a
ret
hos
eth
atc
omei
nco
nta
ctwi
thmuc
ousme
mbr
ane
sorn
on-
int
acts
kin(
e.g
.,e
xpo
seds
kin

t
hati
sch
app
ed,a
bra
ded
,orh
asd
erma
tit
is
).Th
esei
te
msh
aveal
owe
rri
sko
ftr
ans
mis
sio
n.

Be
caus
eth
ema
jor
it
yofs
emi
cr
it
ic
ali
te
msi
nde
nti
st
rya
reh
eat
-t
ole
ran
t,t
heys
houl
dal
sob
e

s
ter
il
is
edus
ingh
eat
.Ifas
emi
cr
it
ic
ali
te
mish
eat
-se
nsi
ti
ve,
DHCPs
houl
dre
pla
cei
twi
thah
eat

-
tol
era
nto
rdi
spo
sab
lea
lte
rna
tiv
e.I
fno
nea
rea
vai
l
abl
e,i
tsh
oul
d,a
tami
ni
mum,
bep
roc
ess
ed

us
ingh
igh
-le
vel
dis
inf
ect
io
n.

No
te:De
nta
lha
ndp
iec
esa
nda
sso
cia
teda
tta
chme
nts
,in
clud
ingl
ow-
spe
edmo
tor
san
dre
usa
ble

3
6
p
rop
hyl
axi
san
gle
s,s
houl
dal
way
sbeh
eats
ter
il
is
edb
etwe
enp
ati
ent
san
dno
thi
gh-
le
vel
ors
urf
ace

d
isi
nfe
cte
d.Al
tho
ught
hes
ede
vic
esa
rec
ons
ide
reds
emi
cr
it
ic
al,s
tud
iesh
aves
hownt
hatt
hei
r

i
nte
rna
lsur
fac
esc
anb
eco
mec
ont
ami
nat
edwi
thp
ati
entma
ter
ial
sdur
ingus
e.I
fth
esed
evi
cesa
re

n
otp
rop
erl
ycl
ean
eda
ndh
eats
ter
il
is
ed,t
hen
extp
ati
entma
ybee
xpo
sedt
opo
ten
tia
ll
yin
fec
ti
ous

ma
ter
ial
s.

Di
gi
talr
adi
ogr
aph
yse
nso
rsa
rea
lsoc
ons
ide
reds
emi
cr
it
ic
ala
nds
houl
dbep
rot
ect
edwi
thaF
ood

a
ndDr
ugAd
min
ist
rat
io
n(F
DA)
-cl
ear
edb
arr
iert
ore
duc
eco
nta
min
ati
ond
uri
ngus
e,f
ol
lo
wedb
y

c
lea
nin
gan
dhe
at-
ste
ril
i
sat
io
norh
igh
-le
veld
isi
nfe
cti
onb
etwe
enp
ati
ent
s.I
fth
eit
emc
ann
ot

t
ole
rat
eth
esep
roc
edur
est
hen
,atami
ni
mum,p
rot
ectwi
tha
nFDA-
cl
ear
edb
arr
ier
.Ina
ddi
ti
on,

c
lea
nan
ddi
si
nfe
ctwi
tha
n En
vir
onme
nta
lPr
ote
cti
on Ag
enc
y(EPA)
-r
egi
st
ere
dho
spi
tal

d
isi
nfe
cta
ntwi
thi
nte
rme
dia
te-
le
vel(
i.
e.
,tub
erc
ulo
cid
alc
lai
m)a
cti
vi
tyb
etwe
enp
ati
ent
s.Be
caus
e

t
hes
eit
emsv
aryb
yma
nuf
act
ure
ran
dth
eira
bil
i
tyt
obes
ter
il
is
edo
rhi
gh-
le
veld
isi
nfe
cte
dal
so

v
ary
,re
fert
oma
nuf
act
ure
rin
str
uct
io
nsf
orr
epr
oce
ssi
ng.

 No
ncr
it
ic
alp
ati
ent
-ca
rei
te
ms(
e.g
.,r
adi
ogr
aphh
ead
/co
ne,b
loo
dpr
ess
urec
uff
,fa
ceb
ow)a
re

t
hos
eth
ato
nlyc
ont
acti
nta
cts
kin
.Th
esei
te
msp
oset
hel
eas
tri
sko
ftr
ans
mis
sio
nofi
nfe
cti
on.

I
nth
ema
jor
it
yofc
ase
s,c
lea
nin
g,o
rifv
isi
bl
yso
il
ed,c
lea
nin
gfo
ll
owe
dbyd
isi
nfe
cti
onwi
tha
n

EPA-
reg
ist
ere
dho
spi
tald
isi
nfe
cta
nti
sad
equa
te.Pr
ote
cti
ngt
hes
esur
fac
eswi
thd
isp
osa
ble

b
arr
ier
smi
ghtb
eap
ref
err
eda
lte
rna
tiv
e.

Cl
ean
ingt
ore
mov
ede
bri
san
dor
gan
icc
ont
ami
nat
io
nfr
omi
nst
rume
ntss
houl
dal
way
soc
cur

b
efo
red
isi
nfe
cti
ono
rst
eri
l
isa
tio
n.I
fbl
ood
,sa
li
va,
ando
the
rco
nta
min
ati
ona
ren
otr
emo
ved
,th
ese

ma
ter
ial
sca
nsh
iel
dmi
cr
oor
gan
ismsa
ndp
ote
nti
al
lyc
omp
romi
set
hed
isi
nfe
cti
ono
rst
eri
l
isa
tio
n

p
roc
ess
.Aut
oma
tedc
lea
nin
geq
uip
men
t(e
.g.
,ul
tr
aso
nicc
lea
ner
,wa
she
r-d
isi
nfe
cto
r)s
houl
dbe

us
edt
ore
mov
ede
bri
stoi
mpr
ovec
lea
nin
gef
fec
ti
ven
essa
ndd
ecr
eas
ewo
rke
rex
pos
uret
obl
ood
.

Af
terc
lea
nin
g,d
rie
din
str
ume
ntss
houl
dbei
nsp
ect
ed,
wra
ppe
d,p
ack
age
d,o
rpl
ace
din
toc
ont
ain
er

3
7
s
yst
emsb
efo
reh
eats
ter
il
is
ati
on.Pa
cka
gess
houl
dbel
abe
ll
edt
osh
owt
hes
ter
il
is
erus
ed,t
he

c
ycl
eorl
oadn
umb
er,t
hed
ateo
fst
eri
l
isa
tio
n,a
nd,i
fap
pli
cab
le,t
hee
xpi
rat
io
nda
te.Th
is

i
nfo
rma
tio
nca
nhe
lpi
nre
tri
evi
ngp
roc
ess
edi
te
ms i
nth
eev
ento
fani
nst
rume
nt

p
roc
ess
ing
/st
eri
l
isa
tio
nfa
il
ure
.

Th
eab
il
it
yofas
ter
il
is
ert
ore
achc
ond
iti
onsn
ece
ssa
ryt
oac
hie
ves
ter
il
is
ati
ons
houl
dbemo
nit
ore
d

us
ingac
omb
ina
tio
nofb
iol
ogi
cal
,me
cha
nic
al,a
ndc
hemi
cali
ndi
cat
ors
.Bi
ol
ogi
cali
ndi
cat
ors
,or

s
por
ete
sts
,ar
eth
emo
sta
cce
pte
dme
tho
dfo
rmo
nit
ori
ngt
hes
ter
il
is
ati
onp
roc
essb
eca
uset
hey

a
sse
sst
hes
ter
il
is
ati
onp
roc
essd
ire
ctl
ybyk
il
li
ngk
nownh
igh
lyr
esi
st
antmi
cr
oor
gan
isms(
e.g
.,

Ge
oba
cil
l
uso
rBa
cil
l
uss
pec
ies
).As
por
ete
sts
houl
dbeus
eda
tle
astwe
ekl
ytomo
nit
ors
ter
il
is
ers
.

Ho
wev
er,b
eca
uses
por
ete
stsa
reo
nlyp
erf
orme
dpe
rio
dic
all
y(e
.g.
,on
ceawe
ek,o
ncead
ay)a
nd

t
her
esul
tsa
reus
ual
l
yno
tob
tai
nedi
mme
dia
tel
y,me
cha
nic
ala
ndc
hemi
calmo
nit
ori
ngs
houl
dal
so

b
epe
rfo
rme
d.

Me
cha
nic
ala
ndc
hemi
cali
ndi
cat
orsd
ono
tgua
ran
tees
ter
il
is
ati
on;h
owe
ver
,th
eyh
elpd
ete
ct

p
roc
edur
ale
rro
rsa
nde
qui
pme
ntma
lfun
cti
ons
.Me
cha
nic
almo
nit
ori
ngi
nvo
lve
sch
eck
ingt
he

s
ter
il
is
erg
aug
es,c
omp
ute
rdi
spl
ays
,orp
ri
nto
uts
;an
ddo
cume
nti
ngt
hes
ter
il
is
ati
onp
res
sur
e,

t
emp
era
tur
e,a
nde
xpo
sur
eti
mei
nth
est
eri
l
isa
tio
nre
cor
ds.S
inc
eth
esep
ara
met
ersc
anb
e

o
bse
rve
ddur
ingt
hes
ter
il
is
ati
onc
ycl
e,t
hismi
ghtb
eth
efi
rs
tin
dic
ati
ono
fap
rob
lem.

Ch
emi
calmo
nit
ori
ngus
ess
ens
it
iv
ech
emi
cal
sth
atc
han
gec
olo
urwh
ene
xpo
sedt
ohi
gh

t
emp
era
tur
eso
rco
mbi
nat
io
nso
fti
mea
ndt
emp
era
tur
e.Ex
amp
lesi
ncl
udec
hemi
cal
ind
ica
tort
ape
s,

s
tri
pso
rta
bs,a
nds
pec
ialma
rki
ngso
npa
cka
gin
gma
ter
ial
s.Ch
emi
calmo
nit
ori
ngr
esul
tsa
re

o
bta
ine
dimme
dia
tel
yfo
ll
owi
ngt
hes
ter
il
is
ati
onc
ycl
ean
dth
ere
for
eca
npr
ovi
demo
ret
ime
ly

i
nfo
rma
tio
nab
outt
hes
ter
il
is
ati
onc
ycl
eth
anas
por
ete
st.Ac
hemi
cali
ndi
cat
ors
houl
dbeus
ed

i
nsi
dee
ver
ypa
cka
get
ove
rif
yth
att
hes
ter
il
is
inga
gen
t(e
.g.
,st
eam)h
asp
ene
tra
tedt
hep
ack
age

a
ndr
eac
hedt
hei
nst
rume
ntsi
nsi
de.I
fth
ein
ter
nalc
hemi
cali
ndi
cat
ori
sno
tvi
si
bl
efr
omt
he

3
8
o
uts
ideo
fth
epa
cka
ge,a
nex
ter
nali
ndi
cat
ors
houl
dal
sob
eus
ed.Ex
ter
nali
ndi
cat
orsc
anb
e

i
nsp
ect
edi
mme
dia
tel
ywh
enr
emo
vin
gpa
cka
gesf
romt
hes
ter
il
is
er.I
fth
eap
pro
pri
atec
olo
ur

c
han
ged
idn
oto
ccur
,don
otus
eth
ein
str
ume
nts
.Ch
emi
cali
ndi
cat
orsa
lsoh
elpt
odi
ff
ere
nti
ate

b
etwe
enp
roc
ess
eda
ndun
pro
ces
sedi
te
ms,e
li
min
ati
ngt
hep
oss
ibi
l
ityo
fus
ingi
nst
rume
ntst
hat

h
aven
otb
eens
ter
il
is
ed.

No
te:A s
ing
le-
par
ame
teri
nte
rna
lch
emi
cali
ndi
cat
orp
rov
ide
sin
for
mat
io
nre
gar
din
gon
lyo
ne

s
ter
il
is
ati
onp
ara
met
er(
e.g
.,t
imeo
rte
mpe
rat
ure
).Mul
ti
par
ame
teri
nte
rna
lch
emi
cal
ind
ica
tor
sar
e

d
esi
gne
dtor
eac
tto≥2p
ara
met
ers(
e.g
.,t
imea
ndt
emp
era
tur
e;o
rti
me,t
emp
era
tur
e,a
ndt
he

p
res
enc
eofs
tea
m)a
ndc
anp
rov
ideamo
rer
eli
abl
ein
dic
ati
ont
hats
ter
il
is
ati
onc
ond
iti
onsh
ave

b
eenme
t.

S
ter
il
is
ati
on mo
nit
ori
ng(
e.g
.,b
iol
ogi
cal
,me
cha
nic
al,c
hemi
calmo
nit
ori
ng)a
nde
qui
pme
nt

ma
int
ena
ncer
eco
rdsa
rei
mpo
rta
ntc
omp
one
ntso
fad
ent
ali
nfe
cti
onp
rev
ent
io
npr
ogr
amme
.

Ma
int
ain
inga
ccur
ater
eco
rdse
nsur
esc
ycl
epa
rame
ter
sha
veb
een me
tan
des
tab
li
she
s

a
cco
unt
abi
l
ity
.Ina
ddi
ti
on,i
fth
erei
sap
rob
lem wi
thas
ter
il
is
er(
e.g
.,un
cha
nge
dch
emi
cal

i
ndi
cat
or,p
osi
ti
ves
por
ete
st)
,do
cume
nta
tio
nhe
lpst
ode
ter
min
eifa
nin
str
ume
ntr
eca
lli
s

n
ece
ssa
ry.

I
dea
ll
y,s
ter
il
ein
str
ume
ntsa
nds
upp
li
ess
houl
dbes
tor
edi
nco
ver
edo
rcl
ose
dca
bin
ets
.Wr
app
ed

p
ack
age
sofs
ter
il
is
edi
nst
rume
ntss
houl
dbei
nsp
ect
edb
efo
reo
pen
inga
ndus
etoe
nsur
eth
e

p
ack
agi
ngma
ter
ialh
asn
otb
eenc
omp
romi
sed(
e.g
.,we
t,t
orn
,pun
ctur
ed)d
uri
ngs
tor
age
.Th
e

c
ont
ent
sofa
nyc
omp
romi
sedp
ack
ssh
oul
dber
epr
oce
sse
d(i
.
e.,c
lea
ned
,pa
cka
ged
,an
dhe
at-

s
ter
il
is
eda
gai
n)b
efo
reus
eonap
ati
ent
.

Re
comme
nda
tio
nsf
ort
hec
lea
nin
g,d
isi
nfe
cti
on,
ands
ter
il
is
ati
ono
fde
nta
leq
uip
men
tca
nbef
oun
d

i
nth
eGui
del
i
nesf
orI
nfe
cti
onCo
ntr
oli
nDe
nta
lHe
alt
h-Ca
reS
ett
ing
s—2003p
dfi
con
[PDF–1
.21

3
9
MB]
.Re
comme
nda
tio
nsf
ort
hec
lea
nin
g,d
isi
nfe
cti
on,a
nds
ter
il
is
ati
ono
fme
dic
ale
qui
pme
nta
re

a
vai
l
abl
e i
n t
heGui
del
i
ne f
or Di
si
nfe
cti
on a
nd S
ter
il
is
ati
on i
n

He
alt
hca
reF
aci
l
iti
esp
dfi
con
[PDF–1MB](
ava
il
abl
e

a
t:www.
cdc
.go
v/i
nfe
cti
onc
ont
rol
/pd
f/g
uid
eli
nes
/di
si
nfe
cti
on-
gui
del
i
nes
.pd
fpd
fic
on[
PDF–1MB]
).

F
DA r
egul
ati
ons o
n r
epr
oce
ssi
ng o
f s
ing
le-
use d
evi
ces a
re a
vai
l
abl
e

a
t:h
ttp
s:/
/www.
fda
.go
v/d
own
loa
ds/
Med
ica
lDe
vic
es/
Dev
ice
Reg
ula
tio
nan
dGui
dan
ce/
Gui
dan
ceDo
cu

me
nts
/uc
m07
1441
.pd
fpd
fic
on[
PDF–554KB]
ext
ern
ali
con
.

Ke
yRe
comme
nda
tio
nsf
orS
TERI
LIS
ATI
ONANDDI
SI
NFECTI
ONOFPATI
ENT-
CAREDEVI
CESi
n

De
nta
lSe
tti
ngs

1
.Cl
eana
ndr
epr
oce
ss(
dis
inf
ecto
rst
eri
l
ise
)re
usa
bled
ent
ale
qui
pme
nta
ppr
opr
iat
elyb
efo
reus
e

o
nan
oth
erp
ati
ent
.

2.Cl
eana
ndr
epr
oce
ssr
eus
abl
ede
nta
leq
uip
men
tac
cor
din
gtoma
nuf
act
ure
rin
str
uct
io
ns.I
fth
e

ma
nuf
act
ure
rdo
esn
otp
rov
ides
uchi
nst
ruc
ti
ons
,th
ede
vic
ema
yno
tbes
uit
abl
efo
rmul
ti
-

p
ati
entus
e.

a
.Ha
vema
nuf
act
ure
rin
str
uct
io
nsf
orr
epr
oce
ssi
ngr
eus
abl
ede
nta
lin
str
ume
nts
/eq
uip
men
t

r
ead
il
yav
ail
abl
e,i
dea
ll
yino
rne
art
her
epr
oce
ssi
nga
rea
.

3
.As
sig
nre
spo
nsi
bi
li
ti
esf
orr
epr
oce
ssi
ngo
fde
nta
leq
uip
men
ttoDHCPwi
tha
ppr
opr
iat
etr
ain
ing
.

4.We
ara
ppr
opr
iat
ePPEwh
enh
and
li
nga
ndr
epr
oce
ssi
ngc
ont
ami
nat
edp
ati
ente
qui
pme
nt.

5.Us
eme
cha
nic
al,c
hemi
cal
,an
dbi
ol
ogi
calmo
nit
orsa
cco
rdi
ngt
oma
nuf
act
ure
rin
str
uct
io
nst
o

e
nsur
eth
eef
fec
ti
ven
esso
fth
est
eri
l
isa
tio
npr
oce
ss.Ma
int
ains
ter
il
is
ati
onr
eco
rdsf
ol
lo
win
g

s
tat
ean
dlo
cal
reg
ula
tio
ns.

En
vir
onme
nta
lIn
fec
ti
onPr
eve
nti
ona
ndCo
ntr
ol

40
Po
li
ci
esa
ndp
roc
edur
esf
orr
out
inec
lea
nin
gan
ddi
si
nfe
cti
ono
fen
vir
onme
nta
lsur
fac
ess
houl
dbe

i
ncl
ude
dasp
arto
fth
ein
fec
ti
onp
rev
ent
io
npl
an.Cl
ean
ingr
emo
vesl
arg
enumb
erso
f

mi
cr
oor
gan
ismsf
roms
urf
ace
san
dsh
oul
dal
way
spr
ece
ded
isi
nfe
cti
on.Di
si
nfe
cti
oni
sge
ner
all
ya

l
ess
-l
et
halp
roc
esso
fmi
cr
obi
ali
nac
ti
vat
io
n(c
omp
are
dwi
ths
ter
il
is
ati
on)t
hate
li
min
ate
svi
rt
ual
l
y

a
llr
eco
gni
sedp
ath
oge
nicmi
cr
oor
gan
ismsb
utn
otn
ece
ssa
ril
yal
lmi
cr
obi
alf
orms(
e.g
.,b
act
eri
al

s
por
es)
.

Emp
has
isf
orc
lea
nin
gan
ddi
si
nfe
cti
ons
houl
dbep
lac
edo
nsur
fac
est
hata
remo
stl
i
kel
yto

b
eco
mec
ont
ami
nat
edwi
thp
ath
oge
ns,
inc
lud
ingc
li
ni
calc
ont
acts
urf
ace
s(e
.g.
,fr
eque
ntl
yto
uch
ed

s
urf
ace
ssuc
hasl
i
ghth
and
les
,br
ack
ett
ray
s,s
wit
che
sond
ent
alun
its
,co
mput
ere
qui
pme
nt)i
n

t
hep
ati
ent
-ca
rea
rea
.Wh
ent
hes
esur
fac
esa
ret
ouc
hed
,mi
cr
oor
gan
ismsc
anb
etr
ans
fer
redt
o

o
the
rsur
fac
es,i
nst
rume
ntso
rth
eno
se,mo
uth
,ore
yeso
fDHCPo
rpa
tie
nts
.Al
tho
ughh
and

h
ygi
enei
sth
eke
ytomi
ni
mis
ingt
hes
pre
ado
fmi
cr
oor
gan
isms
,cl
i
nic
alc
ont
acts
urf
ace
ssh
oul
dbe

b
arr
ierp
rot
ect
edo
rcl
ean
eda
ndd
isi
nfe
cte
dbe
twe
enp
ati
ent
s.EPA-
reg
ist
ere
dho
spi
tal

d
isi
nfe
cta
ntso
rde
ter
gen
ts/
dis
inf
ect
ant
swi
thl
abe
lcl
ai
msf
orus
einh
eal
thc
ares
ett
ing
ssh
oul
dbe

us
edf
ord
isi
nfe
cti
on.Di
si
nfe
cta
ntp
rod
uct
ssh
oul
dno
tbeus
eda
scl
ean
ersun
les
sth
ela
bel

i
ndi
cat
est
hep
rod
ucti
ssui
tab
lef
ors
uchus
e.DHCPs
houl
dfo
ll
owma
nuf
act
ure
rre
comme
nda
tio
ns

f
orus
eofp
rod
uct
sse
lec
tedf
orc
lea
nin
gan
ddi
si
nfe
cti
on(
e.g
.,a
moun
t,d
il
uti
on,
con
tac
tti
me,
saf
e

us
e,a
ndd
isp
osa
l).F
aci
l
ityp
oli
ci
esa
ndp
roc
edur
ess
houl
dal
soa
ddr
essp
romp
tan
dap
pro
pri
ate

c
lea
nin
gan
dde
con
tami
nat
io
nofs
pil
l
sofb
loo
doro
the
rpo
ten
tia
ll
yin
fec
ti
ousma
ter
ial
s.

Ho
use
kee
pin
gsur
fac
es,(
e.g
.,f
lo
ors
,wa
ll
s,s
ink
s)c
arr
yle
ssr
is
kofd
ise
aset
ran
smi
ssi
ont
han

c
li
ni
calc
ont
acts
urf
ace
san
dca
nbec
lea
nedwi
ths
oapa
ndwa
tero
rcl
ean
eda
ndd
isi
nfe
cte
dif

v
isi
bl
yco
nta
min
ate
dwi
thb
loo
d.

Ad
dit
io
nalg
uid
anc
efo
rth
ecl
ean
inga
ndd
isi
nfe
cti
ono
fen
vir
onme
nta
lsur
fac
es–i
ncl
udi
ngf
or

c
lea
nin
gbl
oodo
rbo
dys
ubs
tan
ces
pil
l
s–i
sav
ail
abl
eint
heGui
del
i
nesf
orEn
vir
onme
nta
lIn
fec
ti
on

41
Co
ntr
oli
nHe
alt
h-Ca
reF
aci
l
iti
esp
dfi
con
[PDF– 1MB]a
ndt
heGui
del
i
nef
orDi
si
nfe
cti
ona
nd

S
ter
il
is
ati
oni
nHe
alt
hca
reF
aci
l
iti
esp
dfi
con
[PDF–1MB]
.

Ke
yRe
comme
nda
tio
nsf
orENVI
RONMENTALI
NFECTI
ONPREVENTI
ONANDCONTROLi
nDe
nta
l

S
ett
ing
s

1
.Es
tab
li
shp
oli
ci
esa
ndp
roc
edur
esf
orr
out
inec
lea
nin
gan
ddi
si
nfe
cti
ono
fen
vir
onme
nta
l

s
urf
ace
sind
ent
alh
eal
thc
ares
ett
ing
s.

a
.Us
esur
fac
eba
rri
erst
opr
ote
ctc
li
ni
calc
ont
acts
urf
ace
s,p
art
ic
ula
rlyt
hos
eth
ata
red
iff
ic
ult

t
ocl
ean(
e.g
.,s
wit
che
sond
ent
alc
hai
rs
,co
mput
ere
qui
pme
nt)a
ndc
han
ges
urf
aceb
arr
ier
s

b
etwe
enp
ati
ent
s.

b
.Cl
eana
ndd
isi
nfe
ctc
li
ni
calc
ont
acts
urf
ace
sth
ata
ren
otb
arr
ier
-pr
ote
cte
dwi
tha
nEPA-

r
egi
st
ere
dho
spi
tald
isi
nfe
cta
nta
fte
rea
chp
ati
ent
.Us
eani
nte
rme
dia
te-
le
veld
isi
nfe
cta
nt(
i.
e.
,

t
ube
rcul
oci
dal
cla
im)i
fvi
si
bl
yco
nta
min
ate
dwi
thb
loo
d.

2.S
ele
ctEPA-
reg
ist
ere
ddi
si
nfe
cta
ntso
rde
ter
gen
ts/
dis
inf
ect
ant
swi
thl
abe
lcl
ai
msf
orus
ein

h
eal
thc
ares
ett
ing
s.

3
.Fo
ll
owma
nuf
act
ure
rin
str
uct
io
nsf
orus
eofc
lea
ner
san
dEPA-
reg
ist
ere
ddi
si
nfe
cta
nts(
e.g
.,

a
moun
t,d
il
uti
on,
con
tac
tti
me,
saf
eus
e,d
isp
osa
l).

C-I
ntr
ave
nous(
IV)Ca
the
ter
s

a
.Wa
sha
ndg
lov
eha
ndsb
efo
rev
eni
pun
ctur
e.

b
.Us
ean
tis
ept
icp
rep
ara
tio
nbe
for
eve
nip
unc
tur
e

c
.Us
est
eri
l
ene
edl
esf
orI
Vin
fus
ion
s

d
.Se
cur
eca
the
tera
nda
ppl
yas
ter
il
edr
ess
ing

e
.In
spe
ctc
ath
ete
rsi
ted
ail
y.

42
f
.In
ser
tne
wca
nnul
aev
ery48-
72h
our
s

g
.Ch
ang
edr
ess
inga
ndp
oss
ibl
yap
plya
nti
bi
ot
ico
int
men
tev
ery48h
our
sorf
ol
lo
win
gnur
si
ng

p
rac
ti
ceg
uid
eli
nes
.

h
.Ch
ang
eIVt
ubi
nge
ver
y48h
our
san
daf
terb
loo
dpr
oduc
torl
i
pide
mul
si
oni
nfus
ion
s.

I
n-t
extQue
sti
on

I
den
tif
yri
skf
act
orso
fNo
soc
omi
ali
nfe
cti
on

An
swe
r:

1
.Imp
air
edh
ostd
efe
nce
sfr
ome
ffe
ctso
fin
ten
siv
eil
l
nes
s

2.
Dis
eas
e-a
lte
redi
mmun
efun
cti
on(
i.
e.d
iab
ete
s,c
ir
rho
sis
,re
nal
fai
l
ure
,ma
li
gna
ncy
)

3
.Immun
osup
pre
ssi
on(
i.
e.
,or
gant
ran
spl
ant
ati
on,
cor
ti
cos
ter
oidt
her
apy
)

4.
Pro
lon
geda
ndf
req
uen
tex
pos
uret
opa
tho
gen
s,r
esi
st
anto
rga
nis
msi
npa
rti
cul
ari
nth
e

I
nte
nsi
veCa
reUn
it

5.
Inv
asi
ved
evi
ces

6
.Po
orn
utr
it
io
nal
sta
tus

2.
1.
3Ve
nti
l
ato
rs

a
.Us
est
eri
l
e,d
isi
nfe
cte
dord
isp
osa
blemo
uth
pie
ces(
tub
ing
,ca
nnul
a)

b
.Re
pla
cec
ir
cui
tr
yev
ery24-
48h
our
s

c
.Re
mov
efl
ui
dbui
l
d-upi
nth
etub
ing

d
.Ch
ang
e,s
ter
il
eord
isi
nfe
cta
ero
sol
-p
rod
uci
nge
qui
pme
nte
ver
y24h
our
san
dbe
twe
enp
ati
ent
s.

e
.Us
est
eri
l
eso
lut
io
nsi
nfl
ui
dre
ser
voi
rs
;di
sca
rdun
use
dpo
rti
onsa
fte
r24h
our
s.

f
.Us
est
eri
l
eca
the
tera
nds
ter
il
egl
ove
swh
eno
nei
ssu
cti
oni
ngi
fano
penc
ath
ete
rsy
ste
misus
ed.

43
g
.Ch
ang
esuc
ti
onc
ath
ete
raf
tere
achus
e.I
fcl
ose
dtr
ach
eal
suc
ti
oni
nga
ppa
rat
usus
ed,
cha
nge

t
hee
nti
res
etupe
ver
y24h
our
s.

2.
1.
4Wa
steDi
spo
sal

a
.Re
comme
nda
tio
n’sb
ase
dont
heo
ccup
ati
ona
lsa
fet
yan
dhe
alt
had
min
ist
rat
io
n’sBl
oodBo
rne

Pa
tho
gens
tan
dar
d

A-I
.Sh
arp
s

Don
otr
eca
p,b
endo
rbr
eakd
isp
osa
blen
eed
les
;ifr
eca
ppi
ngi
sun
avo
ida
ble
,pl
acet
hec
apo
nfl
at

s
urf
acea
ndt
hre
adn
eed
lesi
ntot
hec
apus
ingo
nlyo
neh
and
.

Don
otr
emo
ven
eed
lesf
romd
isp
osa
lsy
ri
nge
s

Pl
acec
ont
ami
nat
edd
isp
osa
lsh
arp
sinac
ont
ain
ers
pec
if
ic
all
yde
sig
nedf
ors
har
psd
isp
osa
l

i
mme
dia
tel
yaf
terus
e.

Pl
acec
ont
ami
nat
edr
eus
abl
esh
arp
sinap
unc
tur
e-r
esi
st
ant
,l
eak
-pr
oof(
ons
ide
san
dbo
tto
m),

c
olo
ur-
cod
edo
rla
bel
l
edc
ont
ain
er.

Co
nta
ine
rsf
orc
ont
ami
nat
eds
har
psmus
tbee
asi
l
yac
ces
sib
le,
sta
ndup
rig
htt
hro
ugh
outus
e,a
nd

r
epl
ace
dbe
for
eal
l
owe
dtoo
ver
fi
ll
.

Cl
osec
ont
ain
erso
fco
nta
min
ate
dsh
arp
sbe
for
ere
mov
ingo
rre
pla
cin
g

I
fle
aki
ngo
ccur
sori
spo
ssi
bl
e,p
lac
eth
eco
nta
ine
rwi
thi
nas
eco
nda
ryc
ont
ain
ert
hati
scl
osa
ble

l
eak
-pr
oofa
ndc
olo
urc
ode
d.

B-I
I.S
pec
ime
nsa
ndo
the
rre
gul
ate
dwa
ste

We
arg
lov
eswh
eno
nei
sha
ndl
i
ngs
pec
ime
nsa
nda
llwa
stema
ter
ial
s.

Pl
acei
nco
nta
ine
rst
hata
rec
los
abl
ele
ak-
pro
of,
col
ourc
ode
dorl
abe
ll
ed,
andc
ont
aina
llc
ont
ent
s

wi
tho
utl
eak
ageo
rpr
olus
ion
.

C-Co
nta
min
ate
dla
und
ry

a
.We
arg
lov
esa
nda
nyo
the
rap
pro
pri
atep
ers
ona
lpr
ote
cti
vewe
arwh
eno
nei
sha
ndl
i
ng

c
ont
ami
nat
edl
aun
dry
.

44
b
.Ha
ndl
easi
nfr
eque
ntl
yasp
oss
ibl
e

c
.Ba
gorc
ont
aina
tth
esi
teo
fus
e

d
.Don
otr
ins
eors
orta
tth
esi
teo
fus
e

e
.Pl
acewe
tla
und
ryi
nco
nta
ine
rst
hatp
rev
ents
oak
ingt
hro
ugh

f
.Us
ela
bel
l
edo
rco
lour
-co
dedb
ags
.

I
n-t
extQue
sti
on

Ho
wof
tend
oyo
ure
pla
cec
ir
cui
tr
yiname
cha
nic
alv
ent
il
ato
r?

An
swe
r

Ev
ery24-
48h
our
s

2.
2.I
sol
ati
onPr
oce
dur
es

A.
Pur
pos
e:t
opr
eve
ntt
het
ran
smi
ssi
ono
fmi
cr
oor
gan
ismsa
mon
gpa
tie
ntsp
ers
onn
ela
ndv
isi
to
rs

B.
Uni
ver
sal
blo
oda
ndb
odyf
lui
dpr
eca
uti
ons
:in1
987t
heCe
ntr
esf
orDi
sea
seCo
ntr
ol(
CDC)

p
ubl
i
she
dgui
del
i
nest
opr
eve
ntt
het
ran
smi
ssi
ono
fth
ehuma
nimmun
ode
fi
ci
enc
yvi
rus(
HIV)a
nd

o
the
rbl
oodb
orn
epa
tho
gen
s.Th
eseun
ive
rsa
lpr
eca
uti
ons

(
htt
ps:
//wo
nde
r.c
dc.
gov
/wo
nde
r/p
rev
gui
d/p
000041
9/p
000041
9.a
sp#h
ead
002005000000000)

a
ret
obeus
edc
ons
ist
ent
lyb
yal
lpe
rso
nne
lwh
oco
mei
nco
nta
ctwi
thb
loo
dan
dbo
dyf
lui
ds,

r
ega
rdl
esso
fpa
tie
nth
ist
ory
/di
agn
osi
s.

C.
Oth
eri
sol
ati
onc
ate
gor
ies
:In
sti
tut
io
nsus
ual
l
yde
vel
opt
hei
ris
ola
tio
nca
teg
ori
es,
andt
hey

s
houl
dbef
ol
lo
wedc
ont
ent
ly
.

2.
2.1S
pec
ial
con
sid
era
tio
n

Tub
A. erc
ulo
sis1
.De
fi
ni
ti
on:Tub
erc
ulo
sis(
TB)i
sani
nfe
cti
ousd
ise
asec
aus
edb
yth
etub
erc
le

b
aci
l
lus
,My
cob
act
eri
umt
ube
rcul
osi
s.Pa
tho
log
icc
har
act
eri
st
ic
sin
clud
ein
fla
tio
nar
yin
fil
tr
ati
ons
,

f
orma
tio
noft
ube
rcl
es,
cas
eat
io
n,n
ecr
osi
s,a
bsc
ess
,fi
bro
sis
,an
dca
lci
fi
cat
io
n.I
nfe
cti
onma
yoc
cur

i
nth
ere
spi
rat
orys
yst
em(
mos
tco
mmo
n),
GIa
ndg
eni
to
uri
nar
ytr
act
s,b
one
s,j
oi
st
,ne
rvo
uss
yst
em,

45
l
ymp
hno
desa
nds
kin
.Th
ein
cid
enc
eofTBh
asi
ncr
eas
edi
nre
cen
tye
ars
,an
dth
eeme
rge
nceo
f

r
esi
st
ants
tra
insh
aveb
eeni
den
tif
ie
d.TBo
ccur
sins
eve
ral
sta
gesa
sde
scr
ibe
dbe
low.

A-S
tag
e

i
.Pr
ima
ryTBi
nfe
cti
oni
sch
ara
cte
ris
edb
yth
epr
ese
nceo
ftub
erc
ulo
siso
rga
nis
msi
nth
eho
stt
hat

mul
ti
pl
ie
san
dcr
eat
ein
fla
mma
tor
yle
sio
ns.
Thi
sph
asei
sge
ner
all
ywi
tho
utc
li
ni
cal
symp
toms

i
i
.Th
ela
ten
tph
asei
sth
eti
meb
etwe
ent
hep
ri
mar
yin
fec
ti
ona
ndt
hed
eve
lop
men
tofa
cti
ve

d
ise
ase
.Th
isp
eri
odi
sva
ria
ble(
upt
o50y
ear
s)d
epe
ndi
ngup
ont
heh
ost
’si
mmun
esy
ste
m;a
cti
ve

TBc
ano
ccura
tan
yti
mea
fte
rex
pos
ure
,us
ual
l
ywh
ent
hep
ati
enti
sun
ders
tre
sso
rot
her
wis
e

i
mmun
oco
mpr
omi
sed
.Al
tho
ught
hep
ati
enti
sno
tco
nta
gio
usi
nth
ela
ten
tpe
rio
d,t
her
ewi
l
lbea

p
osi
ti
veTBs
kint
estr
eac
ti
oni
fth
epa
tie
nti
sno
timmun
osup
pre
sse
d.

B-i
i
i.TB(
act
iv
eTB)i
sch
ara
cte
ris
edb
ypa
tho
log
ica
ndf
unc
ti
ona
lsy
mpt
omsi
ndi
cat
ingt
he

d
est
ruc
ti
ono
fho
stt
is
sueb
ymy
cob
act
eri
um.
Thes
kint
esta
ndc
hes
tra
dio
gra
pha
rep
osi
ti
ve.

Tr
ans
mis
sio
ntoo
the
rsc
ano
ccur
.

1
.Tr
ans
mis
sio
n/c
ommun
ica
bil
i
ty:I
nha
lat
io
nofd
rie
ddr
opl
etn
ucl
eie
achc
ont
ain
ingas
ing
le

t
ube
rcl
eba
cil
l
i’
s,d
rop
letn
ucl
eia
red
isp
ell
edf
romt
hep
ati
entt
hro
ughc
oug
hin
g,s
nee
zin
g,l
aug
hin
g

a
nds
ing
ing
.In
ges
ti
ono
rsk
inp
ene
tra
tio
n,a
lth
oug
hra
re.
Commun
ica
blef
ora
slo
nga
sba
cil
l
iar
ein

s
put
um;ma
ybey
ear
sfo
rso
me.

2.
Inc
uba
tio
n:4-
12we
eksa
fte
rex
pos
ure

An
yti
med
ise
asei
sth
ela
ten
tst
age

C-3
.Ri
skf
act
ors

a
.Cl
osec
ont
actwi
thap
ers
onwi
thi
nfe
cti
ousTB,
esp
eci
al
lyi
fth
epe
rso
nisa
thi
ghr
is
kfo
ran
y

i
nfe
cti
on.

b
.HI
Vin
fec
ti
on

c
.Me
dic
alc
ond
iti
onsk
nownt
oin
cre
aset
her
is
kofa
cti
veTB(
i.
e.
,i
mmun
osup
pre
ssi
on,
dia
bet
es,

l
euk
aemi
a,a
ndHo
dgk
in’
sdi
sea
se)

46
d
.Me
dic
all
y,un
der
ser
ved
,lo
w-i
nco
mep
opul
ati
ons

e
.Fo
rei
gn-
bor
npe
rso
nfr
omac
oun
trywi
thah
ighi
nci
den
ceo
fTBo
rli
vi
ngi
nar
easwi
thah
igh

i
nci
den
ceo
fimmi
gra
tio
nfr
oms
uchc
oun
tri
es.

f
.Ch
ron
ici
l
lne
ss

g
.Ma
lno
uri
shme
nt.

h
.Be
ingar
esi
den
tofal
ong
-te
rmc
aref
aci
l
ity(
eld
erl
y,i
nca
rce
rat
edme
nta
ll
yil
l
)

i
.Al
coh
ola
ddi
ct
io
norus
ero
fHI
Vdr
ugs

j
.Wo
rki
ngwi
ths
il
ic
oneo
ras
bes
tos

I
n-t
extQue
sti
on

S
tat
ethep
urp
oseo
fthei
sol
ati
onp
roc
edur
e

An
swe
r

Th
epur
pos
eist
opr
eve
ntt
het
ran
smi
ssi
ono
fmi
cr
oor
gan
ismsa
mon
gpa
tie
nts
,pe
rso
nne
lan
d

v
isi
to
rs

2.
2.2Po
st-
exp
osur
epr
eca
uti
ons

a
.Sk
int
est
:On
ceTBb
aci
l
lie
nte
rth
ebo
dy,
ant
ib
odi
esa
reus
ual
l
ypr
oduc
edt
hatr
esul
tinap
osi
ti
ve

s
kint
estwi
thi
n2-
3we
eks
;do
esn
oti
ndi
cat
eac
ti
ved
ise
ase
;iti
spo
ssi
bl
etoh
aveTBi
nfe
cti
on

wi
than
ega
tiv
esk
int
est
.

b
.Ch
estx
-ra
y:ma
ysh
owc
alc
if
ic
ati
ona
tin
fec
ti
onss
it
e;p
oss
ibl
epl
eur
ale
ffus
ion

c
.Co
ll
abo
rat
ewi
tho
ccup
ati
ona
lhe
alt
htoe
val
uat
eth
ene
edf
orp
rev
ent
ati
vet
rea
tme
nti
fex
pos
ure

t
oTBi
sre
ali
sedo
ran
ewi
nfe
cti
ond
eve
lop
s.

d
.Mul
ti
pl
ere
sis
tan
tst
rai
nso
fTBr
equi
redt
rea
tme
ntwi
tht
woo
rmo
red
rug
s.

A-Nur
si
ngi
nte
rve
nti
onsf
ori
nfe
cti
onc
ont
rol

a
.Ac
id-
fas
tba
cil
l
i(AF
B)s
put
ums
mea
rso
nap
ati
entwi
thp
ulmo
nar
ysy
mpt
omswh
oar
eatr
is
k

47
f
orTB

b
.AF
Bis
ola
tio
nun
til
sput
ums
mea
rre
sul
tsa
reun
kno
wn

c
.AF
B(s
pec
ial
res
pir
ato
ry)i
sol
ati
onf
orp
ati
ent
swi
tha
cti
vei
nfe
cti
on)

d
.AF
Bis
ola
tio
nma
ybed
isc
ont
inue
daf
tert
hep
ati
entd
emo
nst
rat
ese
vid
enc
eofr
esp
ons
est
o

t
her
apys
ucha
sde
cre
ase
dco
ugh
,de
cre
ase
dma
ximumd
ail
yte
mpe
rat
ure
,re
sol
uti
ono
fni
ght

s
wea
t,a
ndi
mpr
ove
dge
ner
alh
eal
thwi
thi
ncr
eas
eda
ppe
ti
tea
ndwe
igh
tga
in;us
ual
l
y,i
mpr
ove
men
t

i
sse
ena
fte
rap
pro
xima
tel
y2we
ekso
fco
nti
nuo
usa
nti
bi
ot
ict
her
apy
.

e
.Se
cre
ti
onp
rec
aut
io
nont
hep
ati
entwi
the
xte
rna
lTBl
esi
ons

f
.Sk
int
esto
ncl
osec
ont
act
sofi
nfe
cti
onsTBp
ati
entwh
odo
esn
oth
avead
ocume
nte
dhi
st
oryo
f

p
osi
ti
vet
estr
esul
ts

g
.Ne
gat
iv
epr
ess
urer
oomun
til
the
rei
snoo
rga
nis
mons
mea
r

h
.Ob
ser
vedi
nge
sti
ono
fTBme
dic
ati
ons

i
.Te
achp
ati
entt
oco
vern
osea
ndmo
uthwh
il
eco
ugh
ing
,we
arma
skp
rop
erl
ywh
eno
uto
fth
e

r
oom,
li
mite
xcur
si
onf
romt
her
oom,
andt
akeme
dic
ati
onsa
ppr
opr
iat
elya
ndc
omp
let
e

me
dic
ati
onsc
our
se

j
.Re
por
tne
wca
seso
fTBt
opub
li
che
alt
hde
par
tme
nt

k
.Ma
skp
ati
entwh
eni
ntr
ans
ito
uto
fth
ero
om.

l
.TBs
kint
est
ingo
fnur
sesup
one
mpl
oyme
nta
nde
ver
y6-
12mo
nth
sde
pen
din
gont
hep
rev
ale
nce

o
fTBi
nth
eun
it

m.
Che
str
adi
ogr
aphf
orn
urs
eswi
thad
ocume
nte
dhi
st
oryo
fpo
sit
iv
esk
int
estf
ort
hea
cti
ve

d
ise
asea
temp
loy
men
tan
dye
arl
yth
ere
aft
er

B-HI
Van
dac
qui
redi
mmun
ede
fi
ci
enc
ysy
ndr
ome(
AIDS
)

1
.De
fi
ni
ti
on:I
nfe
cti
onwi
thHI
Visc
har
act
eri
sedb
ygr
adua
lan
dac
cel
era
tin
gde
str
uct
io
noft
he

i
mmun
esy
ste
m.Th
isd
ege
ner
ati
ono
ccur
sinf
iv
eph
ase
san
dre
sul
tsi
nAI
DS.
Cri
te
riaf
or

d
iag
nos
ingAI
DSh
aveb
eene
sta
bli
she
dbyt
heCDC.
Forad
iag
nos
iso
fAI
DS,
apa
tie
ntmus
tha
ve

48
e
it
heraT4l
ymp
hoc
ytec
ell
coun
tle
sst
han200/
mm3o
rce
rta
inAI
DSi
ndi
cat
orc
ond
iti
ons
.

a
.Fi
vep
has
eso
fin
fec
ti
on(
2)(
tr
ans
mis
sio
nma
yoc
curd
uri
ngg
all
pha
ses
).

i
.i
nfe
cti
on;n
ode
tec
tab
lea
nti
bod
iesl
andn
osy
mpt
oms

i
i
.Se
con
d(a
lsoc
all
eda
cut
epr
ima
ryHI
Vin
fec
ti
on)
:la
sts1
-2we
eks
;an
tib
odi
esma
ybed
ete
cte
d;

f
lul
i
kes
ymp
toms
,sk
inr
ash

i
i
i.Th
ird(
als
oca
ll
eda
symp
toma
ticHI
Vin
fec
ti
on)
:la
sts1
-15o
rmo
rey
ear
s;a
nti
bod
iesa
re

d
ete
cta
ble
;nos
ymp
toms

i
v.F
our
th:
las
tsupt
o3y
ear
s;a
lth
oug
hsy
mpt
oma
tic
,do
esn
otme
etCDCc
ri
te
riaf
orAI
DS

d
iag
nos
is;a
nti
bod
iesa
red
ete
cta
ble
;sy
mpt
omsi
ncl
udef
eve
r,n
igh
tswe
ats
,di
arr
hoe
a,we
igh
tlo
ss,

f
ati
gue
,ne
uro
pat
hy,
lymp
had
eno
pat
hy,
ora
lle
sio
ns,
andc
ogn
iti
ves
lowi
ng

v
.Fi
ft
h(AI
DS)
:va
ria
blel
eng
th,
mays
urv
ive1
-5y
ear
sfo
rmf
ir
sti
ncl
udes
eve
reo
ppo
rtun
ist
ic

i
nfe
cti
ons
,tumo
ursi
nan
ybo
dys
yst
em,
andn
eur
olo
gicd
efi
ci
ts

C-2.
Tra
nsmi
ssi
on/
Commun
ica
bil
i
ty

a
.Co
nta
ctwi
thc
ont
ami
nat
edb
loo
d(n
eed
le-
sti
ck,
tra
nsf
usi
on,
ando
pens
kinwo
und
s,o
cul
ara
nd

o
ral
muc
ousme
mbr
ane
s)

b
.Or
al,
ana
l,v
agi
nal
int
erc
our
se

c
.Pe
rin
ata
l(t
ran
spl
ace
nta
l,e
xpo
sur
etoi
nfe
cte
dbl
ooda
tbi
rt
h,b
rea
stmi
l
k)

d
.Co
mmun
ica
blef
romt
hep
res
enc
eofHI
Vins
eraun
til
dea
th

2.
2.3I
ncub
ati
on

a
.Va
ria
ble
:Ti
mef
orme
xpo
sur
etos
ero
con
ver
si
oni
s4we
ekst
o6mo
nth
s,a
ndt
imef
rom

s
ymp
toma
tici
mmun
esup
pre
ssi
ont
oAI
DSc
anb
e20y
ear
s

A-Ri
skf
act
ors

a
.Ri
sko
fHI
Vtr
ans
mis
sio
nwi
that
ypi
cal
nee
dles
ti
ckf
roma
nHI
V-p
osi
ti
ves
our
cei
s0.
4%(
3)

b
.In
div
idua
lsp
art
ic
ipa
tin
ginun
pro
tec
teds
exua
lac
ti
vi
ti
eswi
thHI
V-p
osi
ti
vep
ers
ons

c
.Mul
ti
pl
ese
xpa
rtn
ers

49
d
.IVd
rugus
e

e
.Pe
rso
nsr
ece
ivi
ngb
loo
d

f
.Pe
rso
nswi
thh
aemo
phi
l
iao
rco
agul
ati
ond
iso
rde
rs

g
.In
fan
tbo
rnt
oHI
V-p
osi
ti
vemo
the
r

h
.ob
tai
nHI
Vse
rol
ogya
tba
sel
i
ne(
exp
osur
e),
6we
eks
,3mo
nth
s,a
nd6mo
nth
s(a
lsoa
t12

mo
nth
sifz
ido
vud
inet
her
apyi
ni
ti
ate
dass
ero
con
ver
si
oni
sde
lay
edb
yth
era
py)
.

B-Nur
si
ngi
nte
rve
nti
onsf
ori
nfe
cti
onc
ont
rol

a
.Un
ive
rsa
lpr
eca
uti
ons
.

b
.We
aran
osema
sk,
pro
tec
ti
vee
yewe
ar,
apr
on,
andg
lov
eswh
ena
tri
skf
ors
pla
shc
ont
ami
nat
io
n.

c
.Fo
ll
ows
ter
il
is
ati
onp
roc
edur
esf
orv
ent
il
ato
rs.

d
.Cl
eanc
ont
ami
nat
eds
urf
ace
san
deq
uip
men
twi
thd
isi
nfe
cta
nt.

e
.Fl
ushmuc
ousme
mbr
ane
swi
thwa
teri
fco
nta
ctwi
thb
loo
doro
the
rin
fec
ti
ousma
ter
ial
occ
urs
.

f
.Don
ote
at,
dri
nk,
ora
ppl
yma
keupo
rco
nta
ctl
ensi
nar
easwh
erei
nfe
cti
ousma
ter
ial
sar
e

p
res
ent
.

g
.Re
por
tne
wca
seso
fAI
DSt
oth
ePub
li
cHe
alt
hDe
par
tme
nt;HI
Vre
por
ti
ngv
ari
esb
yst
ate
.

Po
st-
exp
osur
epr
oph
yla
xis(
PEP)

Ke
yPo
int
s

 Po
st-
exp
osur
epr
oph
yla
xis(
PEP)me
anst
aki
ngHI
Vme
dic
ine
swi
thi
n72h
our
saf
tera

p
oss
ibl
eex
pos
uret
oHI
Vtop
rev
entHI
Vin
fec
ti
on.

 PEPs
houl
dbeus
edo
nlyi
neme
rge
nci
es.
Iti
sno
tme
antf
orr
egul
arus
ebyp
eop
lewh
oma
y

b
eex
pos
edt
oHI
Vfr
eque
ntl
y.

 PEPmus
tbes
tar
tedwi
thi
n72h
our
s(3d
ays
)af
terap
oss
ibl
eex
pos
uret
oHI
V.Th
eso
one
r

PEPi
sst
art
eda
fte
rap
oss
ibl
eHI
Vex
pos
ure
,th
ebe
tte
r.

 I
fyo
uar
epr
esc
ri
bedPEP,
youwi
l
lta
keHI
Vme
dic
ine
sev
eryd
ayf
or28d
ays
.

50
C-He
pat
it
isBv
irus

1
.De
fi
ni
ti
on:I
nfe
cti
onwi
tht
heh
epa
tit
isBv
ir
us(
HBV)c
aus
esd
ama
gei
nth
eli
veri
ncl
udi
ng

i
nfl
amma
tio
n,mo
non
ucl
earc
ell
inf
il
tr
ati
oni
nth
epa
ren
chy
maa
ndp
ort
ald
uct
s,h
epa
ticc
ell

n
ecr
osi
s,t
hep
rol
i
fer
ati
ono
fKup
ffe
rce
ll
,an
dce
ll
ul
arc
oll
aps
e.Bi
l
irub
ine
xcr
eti
onb
eco
mes

i
mpa
ire
dre
sul
ti
ngi
nja
und
ice
.In
fec
ti
onwi
thHBVc
anb
eac
uteo
rch
ron
ic,
andc
li
ni
cal
sev
eri
ty

ma
yra
ngef
roms
ubc
li
ni
cal
inf
ect
io
ntoa
cut
eful
min
ati
ngd
ise
ase
.

I
n-t
extQue
sti
on

Thef
ir
stnur
si
ngi
nte
rve
nti
onf
ori
nfe
cti
onc
ont
roli
s?

An
swe
rUn
ive
rsa
lpr
eca
uti
ons

2.
3.Tr
ans
mis
sio
n/Co
mmun
ica
bil
i
ty.

a
.Co
nta
ctwi
thi
nfe
cti
ousb
loo
dth
roug
hne
edl
est
ic
ks,
tra
nsf
usi
ons
,op
ens
kinwo
und
s,o
rmuc
osa

o
fey
ean
dmo
uth
;co
nta
ctwi
the
nvi
ron
men
tal
sur
fac
esc
ont
ain
ingc
ont
ami
nat
edb
loo
d.HBVv
irus

c
ans
urv
ive1we
eko
rlo
nge
rons
urf
ace

b
.Se
xua
lco
nta
ct(
sal
i
va,
seme
n,v
agi
nal
sec
ret
io
ns)

c
.Pe
rin
ata
l(t
ran
spl
ace
nta
lore
xpo
sur
etoi
nfe
cte
dma
ter
nal
blo
oda
tbi
rt
h)

d
.Co
mmun
ica
bled
uri
ngi
ncub
ati
ona
ndt
hro
ugh
outt
hec
li
ni
cal
cour
seo
fdi
sea
se;c
arr
iers
tat
e

(
inf
ect
io
us)ma
ype
rsi
stf
ory
ear
s

2.
3.
1In
cub
ati
onp
eri
od:45-
180d
ays
,av
era
ge6
0-90d
ays

A-Ri
skf
act
ors

a
.Ma
leh
omo
sex
ual
act
iv
it
y

b
.Fe
mal
epr
ost
it
uti
on

c
.He
ter
ose
xua
lre
lat
io
nswi
thmul
ti
pl
ese
xpa
rtn
ers

51
d
.IVd
rugus
e

e
.He
mod
ial
ysi
s

f
.Af
ore
ignp
ers
onf
roma
rea
swi
thh
ighHBVr
ate
s

g
.Bl
oodc
ont
acti
nth
ehe
alt
hca
ree
nvi
ron
men
t

B-Po
st-
exp
osur
epr
eca
uti
ons

a
.Re
por
timme
dia
tel
ytoo
ccup
ati
ona
lore
mpl
oye
ehe
alt
hfo
rfo
ll
owupt
rea
tme
nt

b
.Fo
ll
owp
ost
-ex
pos
urei
mmun
opr
oph
yla
xisg
uid
eli
nesr
eco
mme
nde
dbyCDCf
orp
erc
uta
neo
us

(
nee
dles
ti
ck,
lac
era
tio
n,b
it
e)o
rpe
rmuc
osa
l(o
cul
ar,
muc
ousme
mbr
ane
)ex
pos
uref
oun
din

h
epa
tit
isBi
mmun
egl
obul
i
n(HBI
G)ma
yber
eco
mme
nde
d.

c
.Fo
ll
ows
ero
log
icma
rke
rs:b
loo
din
fec
ti
ousi
fpo
sit
iv
ehe
pat
it
isBs
urf
acea
nti
gen(
HBs
Ag)o
ccur
s

wi
thp
res
enti
nfe
cti
ono
rca
rri
ers
tat
e;p
osi
ti
veh
epa
tit
isBea
nti
gen(
HBe
Ag)i
sas
soc
iat
edwi
th

p
rog
res
sio
nfr
oma
cti
veh
epa
tit
ist
och
ron
ich
epa
tit
isa
ndr
epr
ese
ntsah
igh
lyi
nfe
cti
ouss
tat
e.

d
.Cl
eanc
ont
ami
nat
eds
urf
ace
san
deq
uip
men
twi
thd
isi
nfe
cta
nt.

e
.Don
ote
at,
dri
nk,
ora
ppl
yma
keupo
rco
nta
ctl
ens
esi
nar
easwh
erei
nfe
cti
ousma
ter
ial
sar
e

p
res
ent
.

f
.Re
por
tne
wca
sest
oPub
li
cHe
alt
hDe
par
tme
nt.

Po
st-
exp
osur
ePr
oph
yla
xis

Ne
worUp
dat
edRe
comme
nda
tio
ns

Th
efo
ll
owi
ngr
eco
mme
nda
tio
nsa
ren
ewo
rup
dat
ed:

 un
ive
rsa
lhe
pat
it
isB(
Hep
B)v
acc
ina
tio
nwi
thi
n24h
our
sofb
irt
hfo
rme
dic
all
yst
abl
e

i
nfa
ntswe
igh
ing≥2,
000g
rams
;

 t
est
ingHBs
Ag-
pos
it
iv
epr
egn
antwo
menf
orh
epa
tit
isBv
irusd
eox
yri
bon
ucl
ei
cac
id(
HBV

DNA)
;

 p
ost
vac
cin
ati
ons
ero
log
ict
est
ingf
ori
nfa
ntswh
osemo
the
r’
sHBs
Ags
tat
usr
ema
ins

un
kno
wni
nde
fi
ni
te
ly(
e.g
.,wh
enap
are
nto
rpe
rso
nwi
thl
awf
ulc
ust
odys
urr
end
ersa
n

52
 i
nfa
ntc
onf
ide
nti
al
lys
hor
tl
yaf
terb
ir
th)
;

 s
ing
le-
dos
ere
vac
cin
ati
onf
ori
nfa
ntsb
ornt
oHBs
Ag-
pos
it
iv
ewo
menn
otr
esp
ond
ingt
oth
e

i
ni
ti
alv
acc
ines
eri
es;

 v
acc
ina
tio
nfo
rpe
rso
nswi
thc
hro
nicl
i
verd
ise
ase(
inc
lud
ing
,butn
otl
i
mit
edt
o,t
hos
ewi
th

h
epa
tit
isCv
irus[
HCV]i
nfe
cti
on,
cir
rho
sis
,fa
ttyl
i
verd
ise
ase
,al
coh
oli
cli
verd
ise
ase
,

a
uto
immun
ehe
pat
it
is
,an
dana
lan
inea
min
otr
ans
fer
ase[
ALT]o
ras
par
tat
e

a
min
otr
ans
fer
ase[
AST]l
eve
lgr
eat
ert
hant
wic
eth
eup
perl
i
mito
fno
rma
l);a
nd

 r
emo
val
ofp
ermi
ssi
vel
ang
uag
efo
rde
lay
ingt
heb
irt
hdo
seun
til
aft
erh
osp
it
ald
isc
har
ge.

Th
isr
epo
rta
lsob
rie
fl
ysumma
ris
esAme
ric
anAs
soc
iat
io
nfo
rth
eSt
udyo
fLi
verDi
sea
ses(
AAS
LD)

g
uid
eli
nesf
orma
ter
nal
ant
iv
ir
alt
her
apyt
ore
duc
epe
rin
ata
lHBVt
ran
smi
ssi
on,
pub
li
she
d

p
rev
ious
ly.
Rec
omme
nda
tio
nsf
romt
heI
nfe
cti
ousDi
sea
sesS
oci
et
yofAme
ric
a(I
DSA)r
ega
rdi
ng

v
acc
ina
tio
noft
hei
mmun
oco
mpr
omi
sedh
osta
rep
ubl
i
she
dse
par
ate
ly.

Af
tert
he24Ho
urWi
ndo
wan
dNoAc
ces
stoPEP

I
fyo
uar
eun
abl
etor
ece
ivePEPwi
thi
nth
ere
comme
nde
dti
mef
rame
,yo
ush
oul
dst
il
lvi
si
ta

h
eal
thc
arep
rov
ide
rtor
ece
ivet
rea
tme
nta
sso
ona
spo
ssi
bl
e.Th
eCDCe
sti
mat
est
hatt
rea
tme
nt

ma
ybee
ffe
cti
vea
tpr
eve
nti
ngi
nfe
cti
oni
fgi
venupt
o7d
aysa
fte
rth
ein
iti
ale
xpo
sur
e,b
utn
ot

e
noug
hre
sea
rchh
asb
eend
onet
oco
nfi
rmh
owe
ffe
cti
vePEPi
sifg
ive
naf
tert
hatt
ime
li
ne.Th
e

e
arl
i
erPEPi
sre
cei
ved
,th
emo
rel
i
kel
yiti
stob
eef
fec
ti
ve.

Th
eWo
rldHe
alt
hOr
gan
isa
tio
nal
sor
eco
mme
ndst
hats
tan
dar
dfi
rs
t-a
idb
eap
pli
edi
mme
dia
tel
yto

a
llc
utsa
ndwo
und
sth
atma
yha
veb
eene
xpo
sedt
oin
fec
tedb
loo
d.Th
est
and
ardf
ir
sta
idi
ncl
ude
s

1
)le
tti
ngt
hewo
undb
lee
dfr
eel
yan
d;2)wa
shi
ngt
hewo
undi
mme
dia
tel
ywi
ths
oap
,ge
l,o
rha
nd-

c
lea
nin
gso
lut
io
n.Bes
uret
otr
eatt
hewo
undg
ent
ly
,an
ddon
otus
eha
rshs
olut
io
nso
rso
apswh
en

c
lea
nin
gth
ear
ea.
WHOa
lsop
rov
ide
sin
str
uct
io
nso
nho
wtop
rop
erl
ycl
ean
see
yes
,th
emo
uth
,an
d

un
bro
kens
kina
fte
rpo
ten
tia
lex
pos
ure
.
53
I
fyo
ube
li
evet
haty
ouwe
ree
xpo
sedt
ohe
pat
it
isBa
ndn
eve
rre
cei
vedPEP,y
ous
houl
dbet
est
ed

t
okn
owy
ourh
epa
tit
isBs
tat
us.I
tta
kesupt
o9we
eksf
ort
heh
epa
tit
isBv
irust
osh
owi
nth
e

b
loo
dst
rea
m.Th
ere
for
e,i
tisi
mpo
rta
ntt
oge
tte
ste
dfo
rth
ehe
pat
it
isB3
-pa
nelb
loo
dte
st(
HBs
Ag,

HBc
Ab,
HBs
Ab)a
tle
ast9we
eksa
fte
rth
eex
pos
uret
ode
ter
min
eify
ouh
aveb
eeni
nfe
cte
d.I
fyo
u

r
ema
inun
inf
ect
eda
fte
rth
atp
eri
oda
nda
reHBs
Abn
ega
tiv
e,t
hec
omp
let
io
noft
heh
epa
tit
isB

v
acc
ines
eri
esi
sst
ron
glyr
eco
mme
nde
d.

C-Cy
tome
gal
ovi
rus

1
.De
fi
ni
ti
on:Cy
tome
gal
ovi
rus(
CMV)i
same
mbe
roft
heh
erp
esv
irusg
roup
.CMVt
ypi
cal
l
y

p
rod
uce
sana
symp
toma
ticmo
non
ucl
eos
is-
ty
pei
nfe
cti
oni
nad
ult
s.I
tre
mai
nsl
ate
nti
nbo
dyt
is
sue

a
ndma
ypr
oduc
ere
cur
ren
tin
fec
ti
ons
.Co
nge
nit
ala
nda
cqui
redCMVi
nfe
cti
onsi
nne
wbo
rnsc
an

l
eadt
oir
rev
ers
ibl
ece
ntr
aln
erv
ouss
yst
emd
ama
ge.
Inf
ect
io
nsi
nth
eimmun
oco
mpr
omi
sedp
ati
ent

ma
yle
adt
opn
eumo
nit
is
,he
mol
yt
ica
nae
mia
,he
pat
it
is
,an
dpe
ric
ard
iti
s.

2.
3.
2Tr
ans
mis
sio
n/Co
mmun
ica
bil
i
ty

a
.Co
nge
nit
al:CMVc
ros
sest
hep
lac
ent
aan
dca
nca
uses
eve
rec
ong
eni
tal
ano
mal
i
es.

b
.Pr
ena
tal
:CMVi
spr
ese
nti
nth
ece
rvi
cal
sec
ret
io
nso
fmo
the
rswi
thp
rima
ryi
nfe
cti
ono
r

r
eac
ti
vat
io
nofl
ate
nti
nfe
cti
on;l
ong
-te
rme
ffe
ctso
nne
uro
log
icd
eve
lop
men
tofb
abya
reun
kno
wn.

c
.Bl
oodt
ran
sfus
ion
s

d
.Or
gant
ran
spl
ant
ati
ons

e
.Cl
osea
ndp
rol
ong
edc
ont
actwi
thi
nfe
cte
dbo
dys
ecr
eti
ons(
CMVi
sfo
undi
nal
lbo
dys
ecr
eti
ons
)

f
.Se
xua
lco
nta
cta
ndk
iss
ing

g
.Co
mmun
ica
blef
ora
slo
nga
sth
evi
rusi
sex
cre
tedi
nsa
li
vaa
ndur
ine
;ma
ybemo
nth
stoy
ear
s

A-I
ncub
ati
on

a
.Un
kno
wn,
est
ima
tedt
obe3
-8we
eksf
ol
lo
win
gtr
ans
fus
ion
,3-
12we
eksi
nth
ene
ona
tef
ol
lo
win
g

p
eri
nat
ale
xpo
sur
e

54
B-Ri
skf
act
ors

a
.Immun
osup
pre
ssi
on(
HIV,
tra
nsp
lan
tat
io
ns)

b
.Ch
ron
ici
l
lne
ss

c
.Fe
tusa
ndn
eon
ate
.

Po
ste
xpo
sur
epr
eca
uti
onsa
.Ifp
reg
nan
tori
mmun
oco
mpr
omi
sed
,no
ti
fyap
hys
ici
ani
fex
pos
urei
s

s
usp
ect
ed.

C-Nur
si
ngi
nte
rve
nti
onsf
ori
nfe
cti
onc
ont
rol

a
.Un
ive
rsa
lpr
eca
uti
on.

b
.CMVi
sas
pec
ial
con
cer
ntop
reg
nan
tnur
ses
.

Al
tho
ughun
ive
rsa
lpr
eca
uti
onss
houl
dbee
ffe
cti
vea
gai
nstt
ran
smi
ssi
on,
thed
ang
ert
oth
eun
bor
n

f
etusma
ypr
omp
tth
enur
set
ore
que
str
eas
sig
nme
nt.

I
n-t
extQue
sti
on

Wh
ata
ret
hef
ir
sta
nds
eco
nda
cti
ono
npo
st-
exp
osur
etoHBV?

An
swe
r

a
.Re
por
timme
dia
tel
ytoo
ccup
ati
ona
lore
mpl
oye
ehe
alt
hfo
rFo
ll
owupt
rea
tme
nt

b
.Fo
ll
owp
ost
-ex
pos
urei
mmun
o-p
rop
hyl
axi
sgui
del
i
nesr
eco
mme
nde
dbyCDCf
orp
erc
uta
neo
us

(
nee
dles
ti
ck,
lac
era
tio
n,b
it
e)o
rpe
rmuc
osa
l(o
cul
ar,
muc
ousme
mbr
ane
)ex
pos
uref
oun
din

h
epa
tit
isBi
mmun
egl
obul
i
n(HBI
G)ma
yber
eco
mme
nde
d.

2.
3.
3An
tib
iot
ic
-re
sis
tan
tor
gan
isms

1
.De
fi
ni
ti
on:o
rga
nis
mst
hata
rer
esi
st
antt
omul
ti
pl
ean
tib
iot
ic
s.Ex
amp
lesi
ncl
udeS
tap
hyl
oco
ccus

a
ure
usr
esi
st
anc
etome
thi
ci
ll
i
n(MRS
A),
oxa
cil
l
in,
naf
ci
ll
i
n,c
eph
alo
spo
rin
s,e
ryt
hro
myc
in,

c
li
nda
myc
in,
tet
rac
ycl
i
ne,
ora
min
ogl
yco
sid
esa
ndv
anc
omy
cin
-re
sis
tan
ten
ter
oco
cci
(VREC)
.

55
I
nfe
cti
onwi
thr
esi
st
anto
rga
nis
msi
nani
nte
nsi
vel
yil
lpa
tie
nto
fte
nle
adst
osy
ste
mic

i
nfl
amma
tor
yre
spo
nses
ynd
romewi
thmul
ti
pl
eor
ganf
ail
urea
ndd
eat
hasar
esul
t.

2.
Tra
nsmi
ssi
on/
Commun
ica
bil
i
tya
.Di
rec
tco
nta
ctwi
thc
ont
ami
nat
edh
and
s(i
e,f
roms
put
umo
r

d
res
sin
gch
ang
es)
.MRS
Aca
nbec
arr
iedo
nco
nta
min
ate
dbo
dys
urf
ace
s(h
and
s,wr
is
ts,
nos
e)f
or

mo
ret
han3h
our
saf
teri
noc
ula
tio
nb.
Commun
ica
blef
ort
het
imeo
fin
fec
ti
ono
rco
lon
isa
tio
n

3
.In
cub
ati
ona
.Va
rie
swi
the
acho
rga
nis
m

4.
Ris
kfa
cto
rsa
.Nume
rousa
ndp
rol
ong
eda
nti
bi
ot
ict
her
api
esb
.Pr
olo
nge
dho
spi
tal
i
sat
io
nc.
Bur
n

i
nj
uryd
.Su
rgi
cal
pro
ced
uree
.Tr
auma
ticwo
und
s

5.
Pos
tex
pos
urep
rec
aut
io
nsa
.No
nek
nown

A-Nur
si
ngi
nte
rve
nti
onsf
ori
nfe
cti
onc
ont
rol

a
.Ha
ndwa
shi
ngb
efo
rea
nda
fte
rev
eryp
ati
entc
ont
act

b
.Co
nta
cti
sol
ati
on(
gown
san
dgl
ove
swh
eni
nco
nta
ctwi
thp
ati
ento
rpa
tie
nt’
sen
vir
onme
nt)f
or

t
hed
ura
tio
nofh
osp
it
ali
sat
io
ntop
rev
entn
oso
comi
als
pre
ado
fin
fec
ti
onc
.Pr
iva
ter
oom,
org
roup

s
imi
l
arr
esi
st
antp
ati
ent
sto
get
herd
.Co
ll
abo
rat
ewi
thp
hys
ici
an/
sta
fft
oco
ntr
ola
nti
bi
ot
ict
her
apy
.

e
.Di
si
nfe
cts
urf
ace
sob
jec
tsr
egul
arl
y.

B-Ep
ide
mio
log
ica
ll
ysi
gni
fi
can
tor
gan
isms

1
.De
fi
ni
ti
on:Ma
nymi
cr
oor
gan
ismsc
aus
eno
soc
omi
ali
nfe
cti
onsi
nth
eho
spi
tal
i
sedp
ati
enta
sa

r
esul
tofc
ros
s-c
ont
ami
nat
io
n.Pr
ote
cti
ono
fth
epa
tie
ntc
anb
eac
hie
vedt
hro
ughme
ti
cul
oush
and

wa
shi
nga
ndb
asi
cin
fec
ti
onc
ont
rolme
asur
es.Ho
wev
er,t
her
ear
eaf
ewn
orma
ll
yno
npa
tho
gen
ic

mi
cr
oor
gan
ismst
hatma
yca
used
ise
asei
nth
eco
mpr
omi
sedI
nte
nsi
veCa
rep
ati
ent
.Th
ese

o
rga
nis
msa
reo
fte
nfo
undi
nwa
ters
our
cess
ucha
sfl
owe
rar
ran
geme
ntsa
ndt
apwa
teri
nma
ny

a
rea
soft
hec
oun
try
.Ex
amp
leso
fco
mmo
nlyd
ete
cte
dor
gan
ismsi
ncl
udep
seud
omo
nasa
nd

Ac
ine
tob
act
er,a
ndc
ont
ami
nat
io
nwi
tht
hes
eor
gan
ismsma
yca
usep
neumo
niao
rce
ntr
all
i
ne

s
eps
is.

56
 2.Tr
ans
mis
sio
n/Co
mmun
ica
bil
i
tya
.Di
rec
tco
nta
ctwi
thc
ont
ami
nat
edh
and
sori
te
mse
xpo
sedt
o

t
apwa
ter(
i.
e.
,ve
nti
l
ati
onb
ag(
Amb
u-b
ag)o
rsu
cti
ona
ppa
rat
usr
ins
edi
nta
pwa
ter
)b.

Co
mmun
ica
blee
acht
imee
xpo
sur
eoc
cur
s

3
.In
cub
ati
ona
.No
nsp
eci
fi
c

4.
Ris
kfa
cto
rsa
.Wo
und
sb.
Cen
tra
lve
nousc
ath
ete
rc.
Art
if
ic
ial
air
way(
i.
e.
,en
do-o
rna
sot
rac
hea
l

a
irwa
yort
rac
heo
tomy
)

C-Po
ste
xpo
sur
epr
oph
yla
xisa
.No
nek
nown

Nur
si
ngi
nte
rve
nti
onsf
ori
nfe
cti
onc
ont
rol

a
.un
ive
rsa
lpr
eca
uti
ons

b
.Wa
shh
andb
efo
rea
nda
fte
rma
nip
ula
tin
gIVl
i
neso
rre
spi
rat
orya
nds
uct
io
nap
par
atus
.

c
.Us
est
eri
l
ewa
tert
ofl
ushs
uct
io
nca
the
ter
san
dtor
ins
eal
lai
rwa
yap
par
atus(
i.
e.
,ve
nti
l
ati
on

b
ago
rsuc
ti
ona
ppa
rat
us)
;ne
verr
ins
epa
tie
nti
te
msi
nta
pwa
ter

d
.Ne
verd
oat
rac
heo
tomya
reawi
thg
auz
eso
ake
dint
apwa
ter
,us
est
eri
l
esa
li
newa
tero
nly
.

e
.Ne
vera
ll
owt
apwa
tert
oco
mei
nco
nta
ctwi
thI
Vca
the
teri
nse
rti
ons
it
es

f
.Av
oidh
and
li
ngc
ent
ral
ven
ousc
ath
ete
rsun
les
sne
ces
sar
y.

g
.Don
ota
ll
owf
res
hfl
owe
rso
rpo
tte
dpl
ant
sint
hep
ati
ent
’sr
oom,
sin
cet
heyma
yha
rbo
ur

mi
cr
oor
gan
ismsi
nth
ewa
tero
rso
il
.

S
ARS
-COV-
2POS
T-EXPOS
UREPROPHYLAXI
S(PEP)

Po
st-
Exp
osur
ePr
oph
yla
xis

 Th
e Pa
nel
rec
omme
ndsa
gai
nstt
he us
eofh
ydr
oxy
chl
oro
qui
nef
orS
ARS
-Co
V-2p
ost
-ex
pos
ure

p
rop
hyl
axi
s(PEP)(
AI)
.

57
 Th
ePa
nel
rec
omme
ndsa
gai
nstt
heus
eofo
the
rdr
ugsf
orS
ARS
-Co
V-2PEP,e
xce
pti
nac
li
ni
cal

t
ri
al(
AII
I)
.

Ra
tio
nal
e

S
eve
ral
ran
domi
sedc
ont
rol
l
edt
ri
al
sha
vee
val
uat
edt
heus
eofh
ydr
oxy
chl
oro
qui
nef
orS
ARS
-Co
V-2

PEP.No
neo
fth
eses
tud
iesh
asr
epo
rte
dan
yev
ide
nceo
fef
fi
cac
y,a
nda
lls
howe
dah
igh
er

f
req
uen
cyo
fad
ver
see
ven
tsa
mon
gpa
rti
ci
pan
tswh
ore
cei
vedh
ydr
oxy
chl
oro
qui
net
hana
mon
g

c
ont
rol
par
ti
ci
pan
ts.
Ther
esul
tso
fso
meo
fth
eses
tud
iesa
red
esc
ri
bedb
elo
w.

S
eve
rala
gen
ts(
e.g
.,a
nti
-S
ARS
-Co
V-2 mo
noc
lon
ala
nti
bod
ies
,hy
per
immun
ega
mma
glo
bul
i
n,

c
onv
ale
sce
ntp
las
ma,i
ver
mec
ti
n,i
nte
rfe
ron
s,t
eno
fov
irwi
tho
rwi
tho
ute
mtr
ic
it
abi
ne,v
it
ami
nD)

a
rec
urr
ent
lyb
ein
gin
ves
ti
gat
edf
orS
ARS
-Co
V-2PEP.Th
ela
tes
tcl
i
nic
alt
ri
al
sfo
rSARS
-Co
V-2PEP

c
anb
efo
un tCl
da i
nic
alTr
ial
s.
gov
.

Cl
i
nic
alTr
ial
Dat
a

Bo
thc
hlo
roq
uin
ean
dhy
dro
xyc
hlo
roq
uin
eha
vei
nvi
tr
oac
ti
vi
tya
gai
nsts
eve
rea
cut
ere
spi
rat
ory

s
ynd
rome
-as
soc
iat
edc
oro
nav
ir
us(
SARS
-Co
V)a
ndS
ARS
-Co
V-2.As
mal
lco
hor
tst
udywi
tho
uta

c
ont
rolg
roup s
ugg
est
edt
hath
ydr
oxy
chl
oro
qui
ne mi
ghtr
educ
eth
eri
sko
fSARS
-Co
V-2

t
ran
smi
ssi
ont
ocl
osec
ont
act
s.

3
.0Tu
torMa
rke
dAs
sig
nme
nts(
Ind
ivi
dua
lorG
rou
p)

Di
scus
sva
rio
usp
rec
aut
io
nsan
urs
eina
nin
ten
siv
eca
reun
its
houl
dta
ket
opr
eve
ntn
oso
comi
al

i
nfe
cti
onsi
nhe
rwa
rd.

4.
0Co
ncl
usi
on/
Summa
ry

No
soc
omi
ali
nfe
cti
onsc
omp
li
cat
eth
eho
spi
tal
i
sat
io
nofp
ati
ent
san
din
cre
aset
hel
eng
tho
fst
ay

wi
tha
dve
rsee
ffe
ctso
nth
epa
tie
nts
,fa
mil
i
esa
nds
oci
et
yatl
arg
eev
ent
heh
osp
it
alwo
rke
rss
oit

s
houl
dbet
hec
onc
erno
fal
lho
spi
tal
wor
ker
stop
rev
entn
oso
comi
ali
nfe
cti
onsa
tev
erys
tag
eint
he

58
h
osp
it
al.

Th
iss
tud
yse
ssi
onh
asl
ook
eda
tin
fec
ti
onc
ont
roli
nth
eIn
ten
siv
eCa
reUn
it(
nos
oco
mia
l

i
nfe
cti
ons
),t
het
ype
soft
ran
smi
ssi
ons
,co
mmo
npa
tho
gen
s,r
is
kfa
cto
rs,n
urs
ingi
nte
rve
nti
onsf
or

i
nfe
cti
onc
ont
rol
,un
ive
rsa
lpr
eca
uti
ons
,is
ola
tio
npr
oce
dur
esa
nds
pec
ialc
ons
ide
rat
io
nsf
ors
ome

s
pec
if
ici
nfe
cti
ons
.Nod
oub
tat
hor
oug
hun
der
sta
ndi
ngo
fth
eun
itwi
l
las
sis
tth
enur
set
opr
eve
nt

n
oso
comi
ali
nfe
cti
onst
her
ebya
voi
di
ngc
omp
li
cat
io
nso
nin
div
idua
lpa
ten
ts

5.
0Se
lf
-As
ses
sme
ntQue
sti
ons

S
elf
-As
ses
sme
ntQu
est
io
n

I
den
tif
yte
n(1
0)n
urs
ingi
nte
rve
nti
onsa
ndr
ati
ona
let
owa
rdst
hep
rev
ent
io
nofNo
soc
omi
al

i
nfe
cti
oni
nth
eIn
ten
siv
eCa
reUn
it.

6
.0Ad
dit
io
nal
Act
iv
it
ie
s(Vi
deo
s,An
ima
tio
ns&Outo
fCl
assAc
ti
vi
ti
es)e
.g.

a
.Vi
si
tYo
uTu
bea
dd(
htt
ps:
//www.
yout
ube
.co
m/wa
tch
?v=6
p72A485GTY.
Wat
cht
hev
ide
o&

s
umma
ris
eiti
n1p
ara
gra
ph

b
.Vi
ewt
hea
nima
tio
nona
dd/
sit
ean
dcr
it
iq
uei
tint
hed
isc
uss
ionf
orum

c
.Ta
keawa
lka
nde
nga
gea
ny3s
tud
ent
son;I
n2p
ara
gra
phss
umma
ris
eth
eiro
pin
iono
f

t
hed
isc
uss
edt
opi
c.e
tc.

7.
0Re
fer
enc
es/
Fur
the
rRe
adi
ngs

Ce
ntr
esf
orDi
sea
seCo
ntr
ol.
(1987)Re
comme
nda
tio
nsf
orPr
eve
nti
ono
fHI
VTr
ans
mis
sio
nin

He
alt
h-Ca
reS
ett
ing
s.Mo
rb.
Mor
tal
.Wk
ly.
Rep
.36(
upp
l.
2S)
:6S
,

Gr
ime
s,D.
(1991
)In
fec
ti
ousDi
sea
se.
St.
Loui
s:Mo
sby
-Ye
arBo
ok,
1991
.

Ba
rtl
ett
.J.
(1993
)po
cke
tbo
oko
fIn
fec
ti
ousDi
sea
seTh
era
py.
Bal
ti
mor
e:Wi
l
li
ams&Wi
l
kin
s,P.
166
.

59
h
ttp
s:/
/www.
cdc
.go
v/o
ral
hea
lth
/in
fec
ti
onc
ont
rol
/summa
ry-
inf
ect
io
n-p
rev
ent
io
n-

p
rac
ti
ces
/st
and
ard
-pr
eca
uti
ons
.ht
ml

h
ttp
s:/
/www.
hep
b.o
rg/
blo
g/e
xpo
sed
-he
p-b
-st
eps
-ta
ke-
pre
ven
t-i
nfe
cti
on/

6
0
 S
TUDYS
ESS
ION3
&4

Ps
ych
oso
cia
lis
sue
sinI
nte
nsi
veNur
si
ngCa
re1
:St
res
sor
sinI
nte
nsi
veCa
re

S
ect
io
nan
dSub
sec
ti
onHe
adi
ngs
:

I
ntr
oduc
ti
on

1
.0Le
arn
ingOut
come
s

2,
0Ma
inCo
nte
nts

2.
1–De
fi
ni
ti
on

2.
2–Ae
ti
ol
ogy

2.
3–As
ses
sme
nt

2.
4–S
tre
ssMa
nag
eme
ntS
tra
teg
ies

8.
0Tu
torMa
rke
dAs
sig
nme
nts(
Ind
ivi
dua
lorG
rou
pas
sig
nme
nts
)

9.
0St
udyS
ess
ionS
umma
rya
ndCo
ncl
usi
on

1
0.0 S
elf
-As
ses
sme
ntQu
est
io
ns

1
1.0 Ad
dit
io
nal
Act
iv
it
ie
s(Vi
deo
s,An
ima
tio
ns&Outo
fCl
assAc
ti
vi
ti
es)

7.
0Re
fer
enc
es/
Fur
the
rRe
adi
ngs

I
ntr
odu
cti
on:

Ph
ysi
cala
nde
mot
io
nalc
ri
ses
,suf
fer
ing
,an
dsi
gni
fi
can
tdi
st
res
soc
curd
ail
yint
heI
nte
nsi
veCa
re

e
nvi
ron
men
t.Th
est
res
sofb
ein
gin
ten
siv
eil
l
,orwa
tch
ingas
ign
ifi
can
tot
herb
ein
ten
siv
elyi
l
l,

g
rea
tlyi
nfl
uen
cesa
nin
div
idua
l’
sps
ych
olo
gic
als
tat
ean
demo
ti
ona
lre
spo
nse
spe
rso
nal
i
ty

s
truc
tur
einc
onj
unc
ti
onwi
tht
hen
atur
eoft
hei
l
lne
ssi
nte
rac
ttod
ete
rmi
newh
atc
opi
ngs
tra
teg
ies

a
nin
div
idua
lwi
l
lus
etoma
nag
ean
dde
cre
ases
tre
ss.
Int
ens
iveCa
ren
urs
eso
fte
ndi
sco
vert
hata
n

i
ndi
vi
dua
l’
san
xie
tya
nd/
orc
opi
ngs
tra
teg
iesa
reh
ind
erh
iso
rhe
rhe
alt
han
dre
cov
eryawe
ll

a
sth
ehe
alt
hca
rep
rov
ide
rab
il
it
ytod
eli
vere
ffe
cti
vec
are
.Un
der
sta
ndi
ngt
hes
pec
if
ics
tre
sso
rsi
n

I
nte
nsi
veCa
rea
ndt
hei
rimp
acto
nth
epa
tie
nt,f
ami
l
y,a
ndn
urs
ings
taf
fiso
fth
eut
mos
t

6
1
i
mpo
rta
ncei
nth
ede
li
ver
yofh
oli
st
icn
urs
ingc
arewh
il
eth
eba
lan
cei
sma
int
ain
edi
nth
e

h
eal
thc
arep
rov
ide
r’
sli
fe
.

Th
eco
mmo
npr
ese
nta
tio
noft
hed
yin
gpa
tie
nti
nIn
ten
siv
eCa
rei
sas
ign
ifi
can
tst
res
sor

t
hati
mpa
cto
nal
loft
hes
een
vir
onme
ntsa
nd,t
her
efo
re,i
sad
dre
sse
dinh
isd
isc
uss
iono
f

p
syc
hos
oci
ali
ssue
s.I
npa
rti
cul
ar,
thep
rov
oca
tiv
ena
tur
eofs
uic
idec
anp
rod
ucei
nte
nsee
mot
io
nal

r
esp
ons
esi
nth
ecl
i
ent
,hi
sorh
erf
ami
l
y,a
ndt
heh
eal
thc
aret
eam.Th
eca
reo
fth
esui
ci
dalp
ati
ent

i
ssp
eci
fi
cal
l
yad
dre
sse
dtop
rov
idet
heI
nte
nsi
veCa
ren
urs
ewi
thc
onc
ret
esk
il
lsa
ndi
nde
pen
den
t

n
urs
ings
tra
teg
iest
obeus
edi
nco
njun
cti
onwi
ths
uic
idea
fte
rma
thc
aref
ort
hec
li
enta
nds
elf
-c
are

s
tra
teg
iesf
ort
heh
eal
thc
arep
rov
ide
rs.

1
.0S
tud
ySe
ssi
onL
ear
nin
gOu
tco
mes

Af
ters
tud
yin
gth
iss
ess
ion
,Ie
xpe
cty
out
obea
blet
o:

1
.Ex
pla
ins
tre
sso
rsi
nIn
ten
siv
eCa
re

2.
Dis
cus
sth
eimp
acto
fst
res
sonp
ati
ent
,fa
mil
yan
dnur
si
ng

3
.De
scr
ibeg
ene
ral
ada
pta
tio
nsy
ndr
ome

4.
Dis
cus
sst
res
sma
nag
eme
nts
tra
teg
iesf
orp
ati
entf
ami
l
yan
dho
spi
tal
Wor
ker
s.

2.
0St
res
sor
sinI
nte
nsi
veCa
re:I
mpa
cto
nPa
tie
nt,
Fami
l
y,a
ndNur
si
ng

2.
1De
fi
ni
ti
on

S
tre
ssi
sac
omp
lexp
syc
hob
iol
ogi
calr
esp
ons
etot
hed
ema
ndso
fas
tre
sso
r.As
tre
sso
risa
ny

i
nte
rna
lore
xte
rna
lde
man
d(s
)th
ate
xce
edt
hea
vai
l
abl
ere
sour
ceso
f

t
hei
ndi
vi
dua
l.S
tre
ssi
sre
pre
sen
tedi
nav
ari
et
yofr
esp
ons
esma
nif
est
eda
nxi
et
y,

a
nge
r,e
mot
io
nalt
ens
ion
,fr
ust
rat
io
n,a
nin
abi
l
ityt
oad
jus
ttoas
it
uat
io
n,o
rdi
ff
ic
ult
ywi
th

j
udg
men
tan
dde
cis
ionma
kin
gab
il
it
ie
s.

As
tre
sso
rca
nbeat
emp
ora
ry,
con
tin
ual
,orr
ecur
ren
tex
per
ien
ce.
Rec
urr
enta
nd/
or

6
2
c
ont
inua
lst
res
sre
spo
nse
sca
npr
oduc
eps
ych
olo
gic
ala
nd/
orp
hys
iol
ogi
cal
exh
aus
ti
on.S
tre
ssi
s

h
eal
thywh
eni
tpr
oduc
ess
ti
mul
ati
ona
nda
ler
tne
ss,c
ont
ri
but
est
ope
rso
nalg
rowt
han
d

d
eve
lop
men
t,a
nda
ssi
st
sani
ndi
vi
dua
linme
eti
ngp
ers
ona
lps
ych
oph
ysi
ol
ogi
caln
eed
s.Ho
wev
er,

wh
ens
tre
ssb
eco
mes“
dis
tre
ssf
ul”t
oth
ein
div
idua
l,i
tca
ncr
eat
efe
eli
ngso
fhe
lpl
ess
nes
s,a
pat
hy,

a
ndf
ati
gue
,in
ter
fer
ingwi
tho
pti
malf
unc
ti
oni
nga
nde
ven
tua
ll
yco
ntr
ibut
ingt
oth
ede
vel
opme
nto
f

i
l
lne
ss.

2.
1.
1Et
io
log
y

A.
Gen
era
lad
apt
ati
ons
ynd
rome

B.
Str
ess
orso
nin
ten
siv
eil
lpa
tie
nts

1
.Ph
ysi
cal
str
ess
ors
:

a
.Pa
in

b
.Sl
eepd
epr
iva
tio
n

c
.Tr
eat
men
tsi
dee
ffe
cts

2.
Psy
cho
log
ica
lst
res
sor
ssuc
hasf
ear
,la
cko
fco
ntr
ol,
cro
wdi
ng,
dep
ers
ona
li
sat
io
n,d
epr
ess
ion

a
ndl
oss

3
.Se
nso
rys
tre
sso
rs:s
ucha
sno
ise
,li
ght
ing
,te
chn
olo
gic
alo
ver
loa
dan
dla
cko
f

e
nvi
ron
men
tal
cue
s(l
acko
fout
si
dee
nvi
ron
men
tst
imu
lat
io
n)

A-
Str
ess
orso
nfa
mil
i
eso
fth
ein
ten
siv
elyi
l
l

1
.Lo
sso
fa‘
hea
lth
y’p
ers
ont
oani
nte
nsi
vel
yil
lpa
tie
nt

2.
Pot
ent
ial
dea
tho
fap
ati
ent

3
.Se
par
ati
onf
romp
ati
ent

4.
Rec
urr
enc
eofwo
nil
l
nes
s.

5.
Fin
anc
ial
ins
ecur
it
y

6
.Ch
ang
ingf
ami
l
yro
les
/re
spo
nsi
bi
li
ti
es

7.
Str
ang
ean
dov
erwh
elmi
ngh
osp
it
ale
nvi
ron
men
t

6
3
8.
Unc
ert
ain
ty

B-
Str
ess
orso
fIn
ten
siv
eCa
ren
urs
ing

1
.En
vir
onme
nt

a
.Cr
owd
edwo
rks
pac
e

b
.No
isye
nvi
ron
men
t

c
.Sh
iftr
ota
tio
n

d
.In
ade
qua
tee
qui
pme
nt/
per
son
nel

2.
Int
erp
ers
ona
l(wo
rk)r
ela
tio
nsh
ips

a
.Co
mmun
ica
tio
nba
rri
ers
/la
cko
fco
mmun
ica
tio
n

b
.La
cko
faut
hor
it
y

c
.La
cko
fre
war
d

d
.Ne
gat
iv
efe
edb
ack

e
.Nur
se/
phy
sic
ianr
ela
tio
nsh
ipd
if
fi
cul
ti
es

f
.Pa
tie
nt/
fami
l
yre
lat
io
ns

g
.In
exp
eri
enc
edp
eer
s

h
.Po
ten
tia
lag
gre
ssi
on/
vio
len
cei
nth
ewo
rkp
lac
e

3
.Kn
owl
edg
ele
vel

a
.Co
nst
antt
ech
nol
ogi
cad
van
ces

b
.Co
mpl
i
cat
ede
ver
-ch
ang
inge
qui
pme
nt/
dev
ice
s

4.
Pat
ie
ntc
are

a
.Cr
is
is-
lad
ene
nvi
ron
men
t

b
.Co
nti
nua
lex
pos
uret
olo
ss

c
.Th
ese
rio
usn
esso
fth
epa
tie
nt’
sco
ndi
ti
on

5.
Pro
fes
sio
nal
i
sm

a
.Do
wns
izi
nge
ffe
cti
nIn
ten
siv
eCa
reun
its

6
4
b
.Fe
eli
ngso
fin
ade
qua
cy

C-
ASS
ESS
MENT

A.
Ass
ess
men
tofl
i
fea
ndc
opi
ngr
esp
ons
es

1
.As
ses
sli
fee
ven
tsa
nds
tre
sso
rso
vert
hel
ast1
2mo
nth
s

a
.Us
eho
lme
sandr
ahes
tre
sss
cal
e

S
oci
alRe
adj
ust
men
tRa
tin
gsc
alet
oob
tai
nty
pesa
ndd
egr
eeso
fcumul
ati
ves
tre
sst
hati
ndi
vi
dua
ls

h
avee
xpe
rie
nce
dov
ert
hel
asty
ear
.

2.
Ass
essh
owt
hei
ndi
vi
dua
lha
sco
pedwi
tht
hes
est
res
sor
s

a
.Pr
obl
em-
foc
use
dco
pin
g

b
.Emo
ti
on-
foc
use
dco
pin
g

2.
1.
2As
ses
sme
nto
fps
ych
oph
ysi
ol
ogi
cal
res
pon
set
ost
res
sor
s

1
.Be
hav
ior
alr
esp
ons
es

a
.An
ger

b
.De
fen
siv
ene
ss

c
.“I
nte
nsi
ven
ess
,”i
ncr
eas
edc
ri
ti
ci
smo
fot
her
s

d
.Ea
sil
yup
set

e
.Emo
ti
ona
l/p
ron
etoo
utb
urs
ts

f
.Ir
ri
tab
il
it
y

g
.Mo
odf
luc
tua
tio
ns

h
.Ri
gi
dth
ink
ing

i
.Sa
d

j
.Se
eksc
ons
tan
tre
ass
ura
nce

k
.Wi
thd
rawn

l
.Te
arf
ul

6
5
A-
2.Ph
ysi
cal
res
pon
ses

a
.Co
gni
ti
ved
ist
urb
anc
es

b
.Ea
tin
gdi
st
urb
anc
esuc
hasa
nor
exi
aoro
ver
eat
ing

c
.Ga
str
oin
tes
ti
nal
(GI
)di
st
urb
anc
es

d
.He
ada
che

e
.In
cre
ase
dvul
ner
abi
l
ityt
oil
l
nes
sori
nj
ury

f
.We
igh
tfl
uct
uat
io
ns

g
.Sl
eepd
ist
urb
anc
es

h
.Sy
mpa
the
ti
cne
rvo
uss
yst
ema
cti
vat
io
n

B-
3.Ki
net
icr
esp
ons
es

a
.Ag
it
ati
on

b
.An
xie
ty

c
.Fa
tig
ue

d
.Fr
ust
rat
io
n

e
.Re
stl
ess
nes
s

f
.Tr
emo
rs

C-
4.F
unc
ti
oni
ng/
Pro
duc
ti
vi
ty

a
.Ac
cid
entp
ron
ene
ss

b
.De
cre
ase
din
ter
esti
nwo
rk

c
.De
cre
ase
dpr
oduc
ti
vi
ty

d
.Se
nseo
fbe
ingo
ver
whe
lme
d

6
6
I
n-t
extQue
sti
on

Li
stt
hev
ari
ousp
oss
ibl
ere
spo
nse
stot
hes
tre
sso
rint
heI
nte
nsi
veCa
reUn
it

An
swe
r:

Re
spo
nse
sin
clud
e:

Be
hav
iour
alr
esp
ons
es

Ph
ysi
cal
res
pon
ses

Ki
net
icr
esp
ons
es

F
unc
ti
oni
ng/
Pro
duc
ti
vi
ty

2.
1.
3As
ses
sme
nto
fpr
ese
ntc
opi
ngme
asur
es

A-
1.Ac
ti
vi
ty

a
.Ho
bbi
es

b
.Ph
ysi
cal
exe
rci
se

2.
Che
mic
alme
dia
tio
n

a
.St
imul
ant
s

i
.Ca
ffe
ine

i
iNi
cot
ine

i
i
i.I
l
li
ci
tdr
ugs

b
.De
pre
ssa
nts

i
.Al
coh
ol

i
i
.Pr
esc
ri
pt
io
nme
dic
ati
ons

i
i
i.An
xio
lyt
ic
s(a
nti
anx
iet
yme
dic
ati
on)

i
v.S
lee
pin
gme
dic
ati
on

v
.Pa
inme
dic
ati
on

6
7
B-
3.Co
mmun
ica
tio
n

a
.Di
scus
sio
nofp
rob
lems
/co
nfl
i
ctswi
thf
ami
l
y,f
ri
end
s,c
oll
eag
ues

b
.Pr
obl
em-
sol
vi
ng

C-
4.Es
cap
eme
cha
nis
ms

a
.Av
oid
anc
e

b
.Ab
sen
tee
ism,
notv
isi
ti
ng

c
.Al
coh
ol

d
.Dr
ugst
ore
lax

I
n-t
extQue
sti
on

I
nth
eAs
ses
sme
nto
fth
epr
ese
nceo
fco
pin
gme
asur
es,
ide
nti
fyt
hee
leme
nto
fes
cap
eme
cha
nis
m.

An
swe
r

a
.Av
oid
anc
e

b
.Ab
sen
tee
ism,
notv
isi
ti
ng

c
.Al
coh
ol

d
.Dr
ugst
ore
lax

2.
25.
Min
d/Bo
dyt
ech
niq
ues

a
.Gui
dedi
mag
ery

b
.Me
dit
ati
on

c
.Pr
ogr
ess
ivee
ati
ngb
eha
vio
ur

d
.Se
lf
-hy
pno
sis

6
.Nut
ri
ti
on

a
.Co
mpul
si
vee
ati
ngb
eha
vio
ur

b
.Ba
lan
cede
ati
ngh
abi
ts

2.
3.S
tre
ssma
nag
eme
nts
tra
teg
iesf
orp
ati
ent
,fa
mil
y,a
nds
taf
fme
mbe
rs.

6
8
A.
Inf
ect
iv
ein
div
idua
lco
pin
gre
lat
edt
oth
ein
abi
l
ityt
oma
nag
est
res
sef
fec
ti
vel
y

1
.Pr
obl
em:An
ger
,ag
it
ati
on,
hos
ti
li
ty
,an
demo
ti
ona
lin
sta
bil
i
ty

2.
Int
erv
ent
io
n

a
.In
iti
atear
ela
tio
nsh
ipwi
tht
hep
ati
ent
,fa
mil
yme
mbe
r,o
rst
affp
ers
ons

b
.Pa
tie
nt/
fami
l
yte
ach
ing

i
.As
ser
ti
vec
ommun
ica
tio
n

i
i
.Es
tab
li
shr
eal
i
sti
cex
pec
tat
io
nsa
ndg
oal
s

i
i
i.Re
lax
ati
ont
ech
niq
ues

c
.As
sis
tpa
tie
nt/
fami
l
yins
ett
ingr
eas
ona
ble
,ac
hie
vab
lel
i
fes
tyl
ego
als

d
.En
cour
agep
ati
ent
/f
ami
l
ytop
lanf
orc
han
gesi
nli
fe(
pro
perd
iete
xer
ci
se)

2.
33.
Des
ir
edo
utc
ome
s

a
.Id
ent
if
yan
dac
kno
wle
dges
our
ceso
fst
res
s

b
.Id
ent
if
yan
dus
esk
il
ls
,kn
owl
edg
e,a
nda
bil
i
tie
stoc
opewi
ths
tre
ss

c
.Noe
vid
enc
eofs
elf
-de
str
uct
iv
ebe
hav
iour

2.
3.
1B.
Pot
ent
ial
fea
rre
lat
edt
oli
fe
-th
rea
ten
ingi
l
lne
ss

1
.Pr
obl
em:a
nxi
et
y,a
git
ati
on,
fea
r,p
ani
c

2.
Int
erv
ent
io
n

a
.Ob
ser
vep
ati
ent
/f
ami
l
yfo
rsi
gnso
ffe
ar

i
.I
ncr
eas
eda
git
ati
on

i
i
.In
cre
ase
dhe
artr
ate
,re
spi
rat
io
n,b
loo
dpr
ess
ure

i
i
i.Di
aph
ore
sis

i
v.Pa
nic

v
.Pup
ild
il
ati
on

b
.Sh
area
ndc
lar
if
yyo
uro
bse
rva
tio
nso
fph
ysi
cal
symp
tomswi
th

6
9
t
hep
ati
ent
/f
ami
l
y.

c
.Re
mai
nwi
thp
ati
ent
/f
ami
l
ydur
ingp
eri
odso
ffe
ar

d
.As
sis
tth
epa
tie
nti
nid
ent
if
yi
ngt
hes
our
ceo
ffe
ar.

e
.Ex
pla
ina
llt
est
s,p
roc
edu
res
,an
dex
pec
tat
io
nst
opa
tie
nta
ndf
ami
l
y.

f
.Co
nsul
tat
io
nan
dco
ll
abo
rat
io
nwi
thme
dic
alp
syc
hia
tryt
ode
ter
min
eth
eap
pro
pri
ate
nes
sof

p
syc
hop
har
mac
olo
gici
nte
rve
nti
on

g
.Us
eme
nta
lhe
alt
hcl
i
nic
als
pec
ial
i
stst
oas
sis
tind
eve
lop
ingp
lan
tst
o

ma
nag
epa
tie
nt,
fami
l
yan
dst
affme
mbe
rco
nfl
i
ctso
rst
rai
nth
atma
y

d
eve
lop
.

A-
3.De
sir
edo
utc
ome
s

a
.Di
min
isha
ndc
ont
rol
fea
r

b
.Us
ehe
alt
h-e
nha
nci
ngc
opi
ngs
kil
l
smo
ree
ffe
cti
vel
yan
dfr
eque
ntl
y

c
.Ve
rba
li
sat
io
noff
ear
sre
lat
edt
oli
fe
-th
rea
ten
ingi
l
lne
ss

B-
C.Po
ten
tia
lal
ter
ati
oni
nfa
mil
ypr
oce
ssr
ela
tedt
oli
fe
-th
rea
ten
ingi
l
lne
ss.

1
.Pr
obl
em:f
ami
l
ydi
sr
upt
io
n,e
mot
io
nal
out
bur
st,
dis
tan
cin
goff
ami
l
y

2.
Int
erv
ent
io
n

a
.As
ses
sfa
mil
yre
act
io
nst
oth
isc
ri
si
s

b
.Di
scus
swi
tht
hep
ati
enta
ndf
ami
l
yme
mbe
rst
hei
mpa
cto
fth
ecr
is
is

c
.As
ses
s

i
.Ab
il
it
ytoa
dap
t

i
i
.An
tic
ipa
tor
ygr
iev
ing

i
i
i.Ex
pec
tat
io
nsf
orf
ami
l
yme
mbe
rs

i
v.Ne
gat
iv
ere
act
io
ns

v
.Ro
lea
dju
stme
nts

d
.Co
nsi
derr
efe
rra
lfo
rfa
mil
yme
mbe
rst
osup
por
ti
vet
her
apyo
r

70
s
pir
it
ual
coun
sel
l
ing

e
.Fa
cil
i
tat
eac
ces
stot
hep
ati
entf
orf
ami
l
yme
mbe
rs

C-3
.De
sir
eout
come

a
.Co
nta
inme
nta
ndr
educ
ti
ono
fcr
is
isa
nds
tre
sss
ymp
tomst
hat

c
ont
ri
but
etoi
nef
fec
ti
vec
opi
ng

b
.Ef
fec
ti
vef
ami
l
ypr
obl
em-
sol
vi
ng

c
.Pa
tie
nta
ndf
ami
l
yca
ndi
scus
spr
obl
emsa
ndc
onc
ern
s.

I
n-t
extQue
sti
on

Wha
tist
heut
mos
tai
moff
ami
l
ycr
is
isr
eso
lut
io
n?

An
swe
r

Ef
fec
ti
vef
ami
l
ypr
obl
ems
olv
ingb
eca
uset
hel
i
fec
ri
si
swi
l
lne
verc
eas
etoe
xis
t.

2.
3.
2D.
Hig
hri
skf
orv
iol
enc
eduet
oth
est
res
sofl
i
fe-
thr
eat
eni
ngi
l
lne
sso
npa
tie
nta
nd

f
ami
l
y

1
.Pr
obl
em:a
nge
r,h
ost
il
it
yve
rba
lin
timi
dat
io
n,p
hys
ica
las
saul
t

A-
2.I
nte
rve
nti
ons

a
.As
ses
san
ddo
cume
ntd
egr
eeo
fan
ger
/ag
it
ati
onp
res
enti
npa
tie
nta
ndf
ami
l
y.

i
.Ac
cus
ato
rys
tat
eme
nt

i
i
.An
ger

i
i
i.F
ear

i
v.Di
st
rus
t

v
.Fi
stc
len
chi
ng

v
i.Pa
cin
g

v
ii
.Swe
ari
ng

v
ii
i.
Scr
eami
ng

71
i
x.S
hout
ing

x
.Th
eve
rba
lth
rea
tofv
iol
enc
e

x
i.S
tat
eme
nte
xpr
ess
ingl
osso
fco
ntr
ol

B-b
.De
ter
min
e“r
eas
on:f
ora
ngr
y/a
git
ate
dre
spo
nse
sbyp
ati
ento
rfa
mil
y

c
.Di
scus
sme
tho
dst
oma
nag
ean
gerwi
tho
utl
osso
fbe
hav
iourc
ont
rol

C-d
.En
cour
agep
ati
ent
/f
ami
l
ytoe
xpr
essa
nge
r,f
rus
tra
tio
n,o
run
mete
xpe
cta
tio
ns.

e
.In
str
uctp
ati
ent
/f
ami
l
yinr
ela
xat
io
nte
chn
ique
san
dpr
act
ic
ewi
tht
hem.

f
.Co
ll
abo
rat
ewi
thp
hys
ica
lth
era
py/
occ
upa
tio
nal
the
rap
yre
gar
din
gpa
tie
nt’
sin
cre
ase
dle
vel
of

p
hys
ica
lag
it
ati
ont
ofa
cil
i
tat
eat
her
ape
uti
cre
lea
seo
fte
nsi
on.
Thi
swi
l
lco
ntr
ibut
etoi
mpr
ove
d

f
unc
ti
ona
lca
pac
it
y.

2.
3.
3Ma
int
aina
tle
asta
nar
m’sl
eng
thf
roma
nex
tre
mel
yag
it
ate
dpo
ten
tia
l

v
iol
entp
ati
ento
rfa
mil
yme
mbe
r.

h
.At
temp
tve
rba
len
gag
eme
nta
ndd
e-e
sca
lat
io
noft
hea
git
ate
dpa
tie
nt

i
.Ta
lkwi
tht
hep
ati
ent
/f
ami
l
yinal
owv
oic
e;s
howc
onc
erna
ndr
esp
ect
.

j
.As
sur
eth
epa
tie
nt/
fami
l
yth
aty
oui
nte
ndt
ohe
lpt
hem.

k
.Ma
kec
ert
ainy
ouh
avea
nex
ita
vai
l
abl
einc
aset
hev
iol
enc
eoft
hep
ati
ent
/f
ami
l
yes
cal
ate
s

A-l
.Us
ere
str
ic
ti
ve/
res
tra
ini
ngme
cha
nis
mfo
rth
epr
ote
cti
ono
fth
epa
tie
nt:mo
nit
ort
hep
ati
ent

e
ver
y15mi
nut
est
oas
sur
ehi
sorh
ers
afe
ty.

m.
Exp
lai
ntof
ami
l
yme
mbe
rst
her
eas
onf
orus
ingr
est
ri
ct
iv
e/r
est
rai
ni
ngd
evi
ces
.

B-n
.Co
ll
abo
rat
ewi
ths
ecur
it
yof
fi
cer
(s)t
ofa
cil
i
tat
eth
esa
fee
xis
ten
ceo
fth
efa
mil
yifi
tbe
come
s

n
ece
ssa
ryt
oha
vet
hemr
emo
ved
.

72
o
.Di
rec
tl
yob
ser
vea
ndmo
nit
orap
ote
nti
al
lyv
iol
entf
ami
l
yme
mbe
rwh
oisv
isi
ti
nga
nin
ten
siv
eil
l

p
ati
ent(
esp
eci
al
lyi
fth
ereh
asb
eenah
ist
oryo
ffa
mil
y/i
nte
rpe
rso
nal
vio
len
ce)

C-De
sir
edo
utc
ome

a
.Th
epa
tie
ntwi
l
lno
tha
rms
elf
,fa
mil
yme
mbe
r,o
rst
aff
.

b
.Fa
mil
yme
mbe
rswi
l
lre
mai
nsa
fea
ndn
on-
thr
eat
eni
ngt
owa
rdst
hep
ati
entwh
oisi
nte
nsi
vel
yil
l
.

c
.Fa
mil
yme
mbe
rswi
l
lno
tus
eth
rea
ten
ingb
eha
vio
uro
rvi
ol
enc
e

t
owa
rds
taf
f.

I
n-t
extQue
sti
on

I
ntheus
eofr
est
ri
ct
iv
e/r
est
rai
ni
ngme
cha
nis
msf
ort
hep
rot
ect
io
nofaPa
tie
nt,
howo
fte
nist
he

p
ati
entt
obemo
nit
or?

An
swe
r

Ev
ery1
5mi
nut
est
oas
sur
ehi
sorh
ers
afe
ty.

6
.0Tu
torMa
rke
dAs
sig
nme
nts(
Ind
ivi
dua
lorG
rou
p)

Di
scu
ssa
sse
ssme
nto
fanI
nte
nsi
veCa
ren
urs
ewh
oise
xpe
ri
enc
ingj
obs
tre
sso
rs

An
swe
r

AS
SES
SMENT

Th
eun
der
-l
is
teds
hal
lse
rvea
sag
uid
e

A.
Ass
ess
men
tofl
i
fea
ndc
opi
ngr
esp
ons
es

1
.As
ses
sli
fee
ven
tsa
nds
tre
sso
rso
vert
hel
ast1
2mo
nth
s

a
.Us
eHo
lme
san
dRa
heS
oci
alRe
adj
ust
men
tRa
tin
gsc
alet
oob
tai
nty
pesa
nd

d
egr
eeo
fcumul
ati
ves
tre
sst
hata
nin
div
idua
lha
sex
per
ien
cedo
vert
hel
asty
ear
.

2.
Ass
essh
owa
nin
div
idua
lha
sco
pedwi
tht
hes
est
res
sor
s

a
.Pr
obl
em-
foc
use
dco
pin
g

b
.Emo
ti
on-
foc
use
dco
pin
g

73
7.
0Co
ncl
usi
on/
Summa
ry

S
tre
ssc
anb
eat
emp
ora
ry/
con
tin
ual
orr
ecur
ren
tex
per
ien
ce.
Rec
urr
enta
ndo
rco
nti
nua
lst
res
s

r
esp
ons
esc
anp
rod
ucep
syc
hol
ogi
cal
ando
rph
ysi
ol
ogi
cex
haus
ti
ona
lth
oug
hst
res
sish
eal
thy

wh
eni
tpr
oduc
ess
ti
mul
ati
nga
nda
ler
tne
ss,
con
tri
but
est
ope
rso
nal
gro
wtha
ndd
eve
lop
men
tan
d

a
ssi
sta
nin
div
idua
linme
eti
ngp
ers
ona
lps
ych
oph
ysi
ol
ogi
cal
nee
ds,
whe
nitb
eco
mesd
ist
res
sful
to

t
hei
ndi
vi
dua
litc
anc
rea
teaf
eel
i
ngo
fhe
lpl
ess
,ap
ath
yan
dfa
tig
ue,
int
erf
eri
ngwi
tho
pti
mal

f
unc
ti
oni
nga
nde
ven
tua
lco
ntr
ib
uti
ont
oth
ede
vel
opme
nto
fil
l
nes
s.Th
isun
ith
ase
xpo
sedl
ear
ner
s

t
owh
ats
tre
ssi
s,h
ows
tre
ssc
oul
dbeh
eal
thya
ndun
hea
lth
y,g
ene
ral
ada
pta
tio
nsy
ndr
ome
,ca
use
s

o
fth
est
res
sora
ndt
hei
mpa
cto
fst
res
sor
sonp
ati
ent
,fa
mil
yan
dnur
si
ng.

8.
0Se
lf
-As
ses
sme
ntQue
sti
ons

9.
0De
scr
ibet
hea
vai
l
abl
eme
anso
fco
pin
gwi
ths
tre
sso
rso
fap
rof
ess
ion
aln
urs
e

wo
rki
nga
tth
eIn
ten
siv
eCa
reUn
ito
fyo
urh
osp
it
al.

S
elf
-As
ses
sme
ntQu
est
io
ns(
Sho
uldc
orr
esp
ondt
oth
eNoo
fSe
ssi
onL
ear
nin
gOu
tco
mes
&ea
ch

s
hou
ldr
el
at
etot
hec
orr
esp
ond
ingL
ear
nin
gOu
tco
me)

6
.0Ad
dit
io
nal
Act
iv
it
ie
s(Vi
deo
s,An
ima
tio
ns&Outo
fCl
assAc
ti
vi
ti
es)e
.g.

a
.Vi
si
tYo
uTu
bea
dd.
Wat
cht
hev
ide
o&s
umma
ris
eiti
n1p
ara
gra
ph

b
.Vi
ewt
hea
nima
tio
nona
dd/
sit
e??
???
??a
ndc
ri
ti
quei
tint
hed
isc
uss
ionf
orum

c
.Ta
keawa
lka
nde
nga
gea
ny3s
tud
ent
son?
???
???
???
?;I
n2p
ara
gra
phss
umma
ris
eth
eir

o
pin
iono
fth
edi
scus
sedt
opi
c.e
tc.

1
2.0 Re
fer
enc
es/
Fur
the
rRe
adi
ngs

Ce
ntr
esf
orDi
sea
seCo
ntr
ol.
(1987)Re
comme
nda
tio
nsf
orp
rev
ent
io
nofHI
V

t
ran
smi
ssi
oni
nhe
alt
h-c
ares
ett
ing
.Mo
rb,
Mor
tal
.Wk
ly.
Rep
.36
(sup
pl.
2S)
:6s
.

74
Gr
ime
s,D.
(1991
)In
fec
ti
onDi
sea
se.
St.
Loui
s:Mo
sby
-Ye
arBo
ok,
1991

Ba
rtl
et,
J.(
1993
)Po
cke
tbo
oko
fIn
fec
ti
onsDi
sea
seTh
era
py.
Bal
ti
mor
e:Wi
l
li
ams&Wi
l
kin
s.p
.16
6

Do
ole
y,S
.eta
lGui
del
i
nesf
orp
rev
ent
ingt
het
ran
smi
ssi
ono
ftub
erc
ulo
sisi
nhe
alt
hca
res
ett
ing
s,

wi
ths
pec
ial
Foc
uso
nHI
VRe
lat
edi
ssue
s.Mo
rb.
Mor
tal
.Wk
ly.
Rep
.39:
Rep
.39RR.
17.

Ce
ntr
esf
orDi
sea
seCo
ntr
ol.
(1991
)He
pat
it
isBVi
rus
:Ac
omp
res
siv
est
rat
egyf
ore
li
min
ati
ng

t
ran
smi
ssi
oni
nth
eUn
ite
dSt
ate
sth
roug
hun
ive
rsa
lch
il
dho
odv
acc
ina
tio
n.Re
comme
nda
tio
nso
f

t
hei
mmun
isa
tio
npr
act
ic
ead
vis
oryc
ommi
tt
ee.
Mor
bMo
rta
lWk
lyRe
p40:
9.

75
 MODULETWO

S
TUDYS
ESS
ION1&2

PS
YCHOS
OCI
ALI
SSUESI
NINTENS
IVENURS
INGCAREI
I

S
ect
io
nan
dSub
sec
ti
onHe
adi
ngs
:

I
ntr
oduc
ti
on

1
.0Le
arn
ingOut
come
s

2.
0Ma
inCo
nte
nts

2.
1-Th
eSui
ci
dal
Pat
enti
nth
eIn
ten
siv
eCa
reEn
vir
onme
nt

2.
2-De
ath
/Dy
ing

1
3.0 Tu
torMa
rke
dAs
sig
nme
nts(
Ind
ivi
dua
lorG
rou
pas
sig
nme
nts
)

1
4.0 S
tud
ySe
ssi
onS
umma
rya
ndCo
ncl
usi
on

1
5.0 S
elf
-As
ses
sme
ntQu
est
io
ns

1
6.0 Ad
dit
io
nal
Act
iv
it
ie
s(Vi
deo
s,An
ima
tio
ns&Outo
fCl
assAc
ti
vi
ti
es)

7.
0Re
fer
enc
es/
Fur
the
rRe
adi
ngs

I
ntr
odu
cti
on:

I
nth
epr
evi
ouss
tud
yse
ssi
on,
wel
ook
eda
tst
res
sor
sint
heI
nte
nsi
veCa
re,
wha
tst
res
sis
,ca
use
s

o
fst
res
sor
s,t
ype
sofs
tre
sso
rs,t
hei
mpa
cto
fth
est
res
soro
nth
epa
tie
nt,f
ami
l
yan
dnur
si
ng,we

a
lsoe
xpl
ore
dst
res
sma
nag
eme
nts
tra
teg
iesf
orp
ati
ent
,fa
mil
yan
dnur
ses
.Th
iss
tud
yse
ssi
onwi
l
l

l
ooki
ntos
omes
pec
if
icc
ase
sli
keas
uic
ida
lpa
tie
nti
nth
eIn
ten
siv
eCa
ree
nvi
ron
men
tan
ddy
ing

p
ati
ento
rde
ath
.

1
.0S
tud
ySe
ssi
onL
ear
nin
gOu
tco
mes

Af
ters
tud
yin
gth
iss
ess
ion
,Ie
xpe
cty
out
obea
blet
o:

1
.Ex
pla
int
hec
onc
epto
f“s
uic
ide
’

2.Di
scus
sth
eva
rio
ust
heo
ret
ic
ale
xpl
ana
tio
nont
hei
ssue
sofs
uic
ide

76
 3
.Li
stv
ari
ouswa
yso
fas
ses
sin
gsui
ci
de

4.Di
scus
sth
epr
oce
sso
fdy
ing

5.En
ume
rat
eas
ses
sme
nto
fad
yin
gpa
tie
nt

6
.Ex
pla
int
hen
urs
ingr
esp
ons
ibi
l
iti
eso
fad
yin
gpa
tie
nt.

2.
0Ma
inCo
nte
nts

2.
1Th
eSui
ci
dal
Pat
ie
nti
nth
eIn
ten
siv
eCa
reEn
vir
onme
nt

De
fi
ni
ti
on:S
uic
idei
sth
eac
tofv
olun
tar
il
yan
din
ten
tio
nal
l
yta
kin
gon
e’so
wnl
i
fe.

S
uic
idec
anb
eac
comp
li
she
dinwa
yst
hatr
ang
efr
oma
cti
vet
opa
ssi
ve,
acut
etoc
hro
nica
nd

c
ons
cio
usl
ytoun
con
sci
ous
lyd
ete
rmi
nes
elf
-de
str
uct
iv
ebe
hav
iour
sth
atr
esul
tatt
hee
ndo
fli
fe
.

S
uic
idema
ybeme
tho
dic
all
ypl
ann
edo
rco
mmi
tt
edo
nani
mpul
se.

Th
erec
anb
etwod
ist
inc
tpr
ese
nta
tio
nso
fsui
ci
dal
beh
avi
our
:th
eac
ti
vel
ysui
ci
dal
pat
ie
nta
ndt
he

p
ote
nti
al
lys
uic
ida
lpa
tie
nt.
Howe
ver
,po
ten
tia
ll
ysui
ci
dal
beh
avi
ourc
anq
uic
klyp
rog
res
stoa
cti
vel
y

s
uic
ida
lbe
hav
iour
.Pr
ese
ntl
ysui
ci
dei
sth
efi
ft
hma
jorc
aus
eofd
eat
hint
heUn
ite
dSt
ate
s.

2.
1.
1Et
io
log
y:S
eve
ral
the
ore
ti
cal
exp
lan
ati
onsa
rea
ddr
ess
ingt
hei
ssue
sofs
uic
ide
.Th
ese

t
heo
rie
sin
clud
eps
ych
oph
ysi
ol
ogi
cal
,ps
ych
ody
nami
c,a
ndp
syc
hos
oci
alc
onc
ept
ual
i
sat
io
ns.

A-I
nth
eca
teg
oryo
fps
ych
oph
ysi
ol
ogi
cals
tud
ies
,th
ereh
aveb
eens
eve
ralc
orr
ela
tesr
epo
rte
dwi
th

s
uic
ide
.Inr
evi
ew,l
eth
ala
tte
mpt
san
dsuc
ces
sfuls
uic
ide
ste
ndt
obea
sso
cia
tedwi
thad
ecr
eas
e

i
nth
ene
uro
tra
nsmi
tt
ers
ero
ton
ini
nth
ebr
ain
,inc
onj
unc
ti
onwi
thad
ecr
eas
eini
tsp
rima
ry

me
tab
oli
te
,5-
hyd
rox
yin
dol
eac
etr
ica
cid
,int
hec
ere
bro
spi
nalf
lui
d.Ad
dit
io
nal
l
y,t
her
ati
oof

n
ore
pin
eph
rin
etoe
pin
eph
rin
eisd
ecr
eas
edi
nth
eur
ineo
fin
div
idua
lswh
oha
vea
tte
mpt
eds
uic
ide

wh
il
eco
rti
cot
rop
hin
-re
lea
sin
gfa
cto
rs(
CRF
)isd
emo
nst
rat
edt
obeh
ype
-se
cre
ted
.Th
esef
ind
ing
s

s
ugg
estt
hep
res
enc
eofh
ype
rac
ti
vi
tyi
nth
ehy
pot
hal
ami
c-
pi
tui
tar
y-a
dre
nal
axi
sins
uic
ida
lpa
tie
nts
.

An
oth
ers
ign
ifi
can
tbi
och
emi
calf
ind
ingi
sth
ede
xame
tha
son
esup
pre
ssi
ont
est(
DST)
,wh
ich

d
emo
nst
rat
esh
ighr
ate
sofn
on-
sup
pre
ssi
ona
mon
gth
osewh
oat
temp
tors
ucc
eedi
nsui
ci
de.

B-
Thep
syc
hod
yna
micmo
delo
fsui
ci
def
ocus
eso
nth
ein
div
idua
l,s
pec
if
ic
all
yhi
sorh
erp
ers
ona
li
ty

77
d
eve
lop
men
tan
dab
il
it
ytob
ala
nceb
etwe
ent
wob
asi
cin
sti
nct
s-t
hewi
l
ltol
i
vea
ndt
hewi
l
ltod
ie.

S
omet
heo
ris
tch
ara
cte
ris
ess
uic
ida
lin
div
idua
lsa
s

n
arc
iss
ist
ica
nda
tte
mpt
ingt
oha
rmo
rhur
tot
her
sbyd
est
roy
ingt
hems
elv
es.
Oth
er

t
heo
ris
tsp
rop
oset
hatun
ders
uff
ic
ien
tdi
st
res
san
dco
nfl
i
ct,
thewi
sht
odi
ede
fea
ts

t
hewi
sht
oli
ve.

C-
Fi
nal
l
y,t
hep
syc
hos
oci
alf
rame
wor
kofs
uic
ideb
eha
vio
ure
xpl
ore
sth
efa
cto
rst
hati
nfl
uen
cet
he

r
ela
tio
nsh
ipb
etwe
ent
hei
ndi
vi
dua
lan
dhi
sorh
ers
oci
ocul
tur
als
yst
em.Th
eps
ych
oso
cia
l

p
ers
pec
ti
vea
tte
mpt
stop
rov
ideme
ani
ngt
oth
eri
si
ngs
tat
is
ti
cofs
uic
idei
nth
eUn
ite
dSt
ate
s.A

s
pec
if
icf
ind
ingi
sth
ati
ndi
vi
dua
lswh
ore
pea
tsui
ci
dea
tte
mpt
ste
ndt
oha
veh
ist
ori
eso
fth
emo
re

f
req
uen
tep
iso
des
,be
gin
nin
gata
nea
rli
era
ge.Th
eye
xpe
rie
ncemo
rep
owe
rle
ssn
essa
nds
uff
er

mo
ref
eel
i
ngso
fex
ter
nal
l
ydi
rec
tedh
ost
il
it
y.

I
nre
ali
ty
,th
eps
ych
oph
ysi
ol
ogi
cal
,ps
ych
ody
nami
c,a
ndp
syc
hos
oci
alf
act
orsi
nte
rac
t

i
nco
mpl
exs
yst
ems
.Th
ere
for
e,mul
ti
pl
ein
ter
act
iv
eet
io
log
iesa
rei
nvo
lve
din

p
rod
uci
ngs
uic
ida
lbe
hav
iou
r.

2.
1.
2As
ses
sme
nto
fsui
ci
dal
pat
ie
nt

A-Me
nta
lst
atusa
sse
ssme
nt

1
.Be
hav
ioura
ndg
ene
ral
app
ear
anc
e

a
.Ve
rba
li
sesd
ire
cts
tat
eme
ntss
ucha
s,“
Iwa
ntt
odi
e,
”wi
shIwe
red
ead
,”t
hev
oic
esa
ret
ell
i
ng

met
ohur
t/k
il
lmy
sel
f”

b
.Ma
kesi
ndi
rec
tst
ate
men
tab
out“
notb
ein
ghe
rea
nymo
re,
”th
eywi
l
lmi
ssme
,”Ik
nowt
hep
ain

wi
l
lbeo
vers
oon
”

c
.As
kab
outs
uic
ideme
tho
ds

d
.Hi
desme
dic
ati
ont
oin
ges
tal
ter

e
.Sh
owsa
git
ati
on

78
f
.Ne
gle
ctsp
ers
ona
lhy
gie
nea
nda
ppe
ara
nce

2.
Foc
use
dsui
ci
dea
sse
ssme
nt

a
.Ad
ire
cte
din
ter
vie
wwi
thaf
ocus
eds
uic
idea
sse
ssme
ntmus
tbec
omp
let
edb
y

ap
syc
hia
tri
c/me
nta
lhe
alt
hpr
ofe
ssi
ona
lbe
for
ede
cre
asi
ngt
hel
eve
lofo
bse
rva
tio
n,t
ran
sfe
rri
ng

t
hep
ati
entf
romt
heI
nte
nsi
veCa
reUn
it,
ord
isc
har
gi
ngt
hep
ati
entf
ortt
heh
osp
it
al.

b
.Fo
cus
eds
uic
idea
sse
nti
ncl
ude
sth
efo
ll
owi
ngq
ues
ti
ons
:

i
.Ha
vey
oue
verf
el
tde
pre
sse
dfo
rse
ver
ald
aysa
tat
ime
?

i
i
.Dur
ingt
hist
ime
,ha
vey
oue
verh
adt
houg
htso
fki
l
li
ngy
our
sel
f?

i
i
i.Wh
end
idt
hes
eth
oug
htso
ccur
?

i
v.Wh
atd
idy
out
hin
kab
outd
oin
gtoy
our
sel
f?

v
.Di
dyo
uac
tony
ourt
houg
hts
?

B-
Foc
use
dsui
ci
dea
sse
ssme
ntc
ont
inue
d.

v
i.Ho
wof
tenh
avet
hes
eth
oug
htso
ccur
red
?

v
ii
.Wh
eni
sth
ela
stt
imey
ouh
adt
hes
eth
oug
hts
?

v
ii
i.
Hav
eyo
urt
houg
htse
veri
ncl
ude
dha
rmi
ngs
ome
onee
lsei
nad
dit
io
nto

y
our
sel
f?

i
x.Ho
wof
tenh
ast
hato
ccur
red
?

x
.Wh
ath
avey
out
houg
hta
boutd
oin
gtot
heo
the
rpe
rso
ns?

x
ii
.Wh
end
oest
hist
houg
hto
ccur
?

x
ii
i.
Rec
ent
ly
,wh
ats
pec
if
ic
all
yha
vey
out
houg
hta
boutd
oin
gtoy
our
sel
f?

x
iv.
Hav
eyo
uta
kena
nys
tept
owa
rdsa
cqui
ri
ngt
heme
ans(
gun
,pi
l
ls)o
fsui
ci
de?

Doy
oup
res
ent
lyh
aveawe
apo
n(g
un)a
tho
me?Wh
ato
the
req
uip
men
tbul
l
ets
,ro
pe,
pil
l
sar
est
il
l

i
nyo
urh
ome
?

x
v.Ha
vey
out
houg
hta
boutwh
eny
ouwo
uldd
oth
is?

x
vi.
Hav
eyo
uth
oug
hta
boutwh
ate
ffe
cty
ourd
eat
hwo
uldh
aveo
nyo
urf
ri
end
san
dot
her
s?

79
x
vii
i
.Yo
uso
unda
mbi
val
ento
run
sur
eab
outt
hes
epl
ans
.Wh
ata
res
omeo
fth
ere
aso
nst
hath
ave

k
epty
ouf
romo
nth
emt
husf
ar?

C-
Foc
use
das
ses
sme
ntc
ont
inue
d

x
ix.
Mor
esp
eci
fi
cal
l
y,wh
ata
rey
ourf
eel
i
ngsa
boutr
eli
gi
on,
sui
ci
de,
andGo
d?

x
x.Wh
ata
rey
out
houg
hta
boutr
esp
ons
ibi
l
iti
esf
ory
ourf
ami
l
yan
dch
il
dre
nify
ouk
il
lyo
urs
elf
?

x
xi.
Wha
tar
eyo
urt
houg
htsa
bouto
the
rre
aso
nsf
orl
i
vin
gan
dst
ayi
nga
li
ve?

x
xii
.Wh
ath
elpwo
uldma
kei
tea
sie
rfo
ryo
utoc
opewi
thy
ourc
urr
entt
houg
htsa
ndp
lan
s?

x
xii
i
.Ha
vey
ouma
dea
nyp
lan
sfo
ryo
urp
oss
ess
ion
sort
oco
mmun
ica
tewi
thp
eop
lea
fte
ryo
ur

d
eat
hsuc
hasan
oteo
rawi
l
l?

x
xiv
.Ho
wdo
est
alk
inga
boutt
hisma
key
ouf
eel
?

I
n-t
extQue
sti
on

S
tat
eth
atp
ath
olo
gyo
fsuc
ces
sful
sui
ci
dal
att
emp
t

An
swe
r:

S
ucc
ess
ful
sui
ci
dest
endt
obea
sso
cia
tedwi
thad
ecr
eas
eint
hen
eur
otr
ans
mit
ters
ero
ton
ini
nth
e

b
rai
n,i
nco
njun
cti
onwi
thad
ecr
eas
eini
tsp
ri
mar
yme
tab
oli
te
,5-
hyd
rox
yin
dol
eac
etr
ica
cid
,int
he

c
ere
bro
spi
nal
flui
d.

2.
1.
3Mo
od/
emo
ti
ona
lre
spo
nse
s/c
opi
ng

a
.De
pre
ssi
oni
sama
jorr
is
kfo
ral
lag
egr
oup
s.

b
.Ho
pel
ess
nes
sismo
rep
red
ict
iv
eofs
uic
idet
hand
epr
ess
ion
.

c
.In
div
idua
lswi
thp
ers
ona
li
tyd
iso
rde
rsh
avea
nin
cre
ase
dra
teo
fsui
ci
de.

d
.Un
rel
i
eve
dan
xie
tyd
iso
rde
r,p
art
ic
ula
rlyp
aind
iso
rde
r

e
.Ex
ces
siv
egui
l
tan
dse
lf
-bl
ame

f
.Lo
wse
lf
-es
tee
m

80
g
.Ch
emi
cal
abus
e

A-Th
oug
hts
,be
li
ef
s,a
ndp
erc
ept
io
ns

a
.Ch
aot
ic
,di
sor
gan
ise
d,a
ndo
r/i
rr
ati
ona
lth
ink
ing

b
.De
lus
ion
sfp
ers
ecut
io
n

c
.Ha
ll
uci
nat
io
nse
spe
cia
ll
yco
mma
ndh
all
uci
nat
io
ns,
tel
l
ingt
hep
ati
entt
oco
mmi
tsui
ci
de

d
.Po
orj
udg
men
t

e
.Po
ori
mpul
sec
ont
rol

B-I
nte
rpe
rso
nal
rel
ati
ons
hip
s

a
.Re
cen
tlo
sso
fsi
gni
fi
can
tot
her
(s)t
hro
ughd
eat
h,d
ivo
rce
,se
par
ati
ons

b
.Cumul
ati
vel
oss
esi
nal
i
mit
edt
imef
rame

c
.So
cia
lis
ola
tio
nan
dwi
thd
rawa
l

d
.Re
cen
tps
ych
oth
era
pyt
ermi
nat
io
n/i
nte
rrup
ti
ono
fps
ych
iat
ri
ctr
eat
men
t.

e
.Av
ail
abi
l
it
yofs
oci
als
upp
ort
.

C-Ph
ysi
cal
il
ln
ess

a
.Ch
ron
ic,
deb
il
it
ati
ng,
ter
min
al,
ort
rauma
tici
l
lne
ss

b
.Ch
ron
icp
ain

c
.Re
cen
t,c
ata
str
oph
icl
osso
fph
ysi
cal
fun
cti
ons

I
n-t
extQue
sti
on

Wh
il
eco
nduc
ti
ngaf
ocus
eda
sse
ssme
nto
nin
ter
per
son
alr
ela
tio
nsh
ipso
nas
uic
idea
tte
mpt
,wh
at

i
sth
efi
rs
tit
emt
oas
ses
s?

An
swe
r

Th
ere
cen
tlo
sso
fsi
gni
fi
can
tot
her
(s)t
hro
ughd
eat
h,d
ivo
rce
,se
par
ati
ons

2.
2.Ph
ysi
cal
exa
min
ati
on

2.
2.1-1
.Le
velo
ftr
eat
mentr
equi
red

81
a
.Fi
rs
tai
d,e
mer
gen
cyd
epa
rtme
ntc
are

b
.Ho
spi
tal
admi
ssi
on,
rout
inec
are

c
.In
ten
siv
eCa
re,
agg
res
siv
ete
chn
olo
gict
rea
tme
nt

A-2.
Age
nto
rme
tho
dus
ed

a
.In
ges
ti
on(
ove
rdo
se)
,cut
ti
ng,
sta
bbi
ng

b
.Dr
own
ing
,as
phy
xia
tio
n,s
elf
-st
ran
gul
ati
on

c
.Jump
ing
,sh
oot
ing

3
.In
jur
y/Le
sio
n/To
xic
it
y

a
.Mi
ni
mal

b
.Mo
der
ate

c
.Se
ver
e

B-4.
Phy
sic
alf
unc
ti
onr
eco
ver
y

a
.Go
od:c
omp
let
ere
cov
eryp
red
ict
ed

b
.Fa
ir:r
eco
ver
yex
pec
tedo
vert
ime

c
.Po
or:r
esi
dua
lde
fi
ci
tse
xpe
cte
d

d
.No
tre
ver
si
bl
e:n
ore
cov
erye
xce
pte
d

C-5.
Sys
tema
sse
ssme
ntd
uri
ngt
heI
nte
nsi
veCa
rep
has
e

a
.Ca
rdi
ova
scul
ars
yst
em:Mo
nit
orf
orh
emo
dyn
ami
cin
sta
bil
i
tyd
uet
oca
rdi
ova
scul
ard
isr
upt
io
ns

f
romo
ver
dos
eord
ire
ctt
rauma
tici
nj
ury
.

b
.Re
spi
rat
orys
yst
em:Mo
nit
orr
esp
ir
ato
ryf
unc
ti
onf
orp
oss
ibl
eas
pir
ati
on,
res
pir
ato
ryf
ail
ured
ue

t
ome
dic
ati
ono
ver
dos
e,i
nge
sti
ono
fto
xicc
hemi
cal
s,o
ras
phy
xia
tio
n.

c
.Mus
cul
osk
ele
tal
sys
tem:
Ass
essf
unc
ti
ona
lal
ter
ati
onsd
uet
otr
auma
tici
nj
uri
esf
rommo
tor

v
ehi
cl
ecr
ash
es,
jump
ing
,st
abb
ing
,org
uns
hotwo
und
s.

d
.Ne
uro
log
ica
l:As
ses
sce
ntr
ala
ndp
eri
phe
ral
ner
vouss
yst
emf
unc
ti
onr
ela
tedt
oat
temp
ted

82
s
uic
ide
;mo
nit
ord
egr
eeo
fimp
air
edc
ons
cio
usn
ess
.

i
.Noi
mpa
irme
ntd
emo
nst
rat
ed

i
i
.Co
nfus
ion

i
i
i.S
tup
oro
us

i
v.Co
mat
ose

I
n-t
extQue
sti
on

Ne
uro
log
ica
las
ses
sme
nti
nph
ysi
cal
ass
ess
men
tme
ans

An
swe
r

Ne
uro
log
ica
l:As
ses
sce
ntr
ala
ndp
eri
phe
ral
ner
vouss
yst
emf
unc
ti
onr
ela
tedt
oat
temp
teds
uic
ide
;

mo
nit
ord
egr
eeo
fimp
air
edc
ons
cio
usn
ess
.

2.
2.2Di
agn
ost
icp
ara
met
ers

1
.Co
mpr
ehe
nsi
ves
eruma
ndur
inet
oxi
col
ogys
cre
en:I
fth
ech
ose
nme
tho
dofs
uic
idei
s

me
dic
ati
ono
ver
dos
eort
oxi
cch
emi
cal
ing
est
io
n,c
omp
reh
ens
ives
erum/
uri
net
oxi
col
ogys
cre
ens

a
ren
ece
ssa
ryt
oob
tai
nba
sel
i
ned
atat
opl
anme
dic
al/
nur
si
ngc
ared
uri
ngt
hei
nte
nsi
ve

i
l
lne
ssPh
ase
.

2.
Hemo
glo
bin
/He
mat
ocr
iti
sne
ces
sar
ytoa
sse
sst
hed
egr
eeo
fhe
mat
olo
gics
tab
il
it
y,e
spe
cia
ll
y

wh
ent
hec
hos
enme
tho
disc
utt
ings
tab
bin
g,o
rjump
ing
,wh
ichh
asp
rod
uce
dsi
gni
fi
can
tly

o
ver
/co
veti
nj
uri
esa
ndp
ote
nti
alb
loo
dlo
ss.

3
.Ar
ter
ial
blo
odg
ase
s:Mo
nit
orf
ora
cid
osi
spHl
ess7.
35,
car
box
yhe
mog
lob
ind
uet
oac
arb
on

mo
nox
idep
ois
oni
ng

4.
Uri
nal
ysi
s:My
ogl
obi
nur
iama
yex
istd
uet
omus
cled
esc
ri
pt
io
n(r
hab
domy
oly
sis
)fr
omt
oxi
c

c
hemi
cal
ing
est
io
norf
ormr
ema
ini
ngi
nac
onf
ine
dpo
sit
io
naf
tera
nov
erd
ose

A-I
V.Pa
tie
nt/
fami
l
yma
nag
eme
nt

A.
Inp
lan
nin
gco
mpr
ehe
nsi
vec
arei
nth
epa
tie
ntwh
osc
urv
iest
hes
uic
idea
tte
mpt
,th
enur
se

n
eed
stous
eth
efo
ll
owi
ngq
ues
ti
ont
odi
rec
tca
re:

83
1
.Ist
hep
ati
enta
cti
vel
ysui
ci
dal
?

2.
Wha
tist
hed
egr
eeo
fle
tha
li
tyo
fth
epl
an?

3
.Do
est
hep
ati
entn
eedt
obei
nap
rot
ect
ede
nvi
ron
men
t?d
oesh
eors
hen
eedt
obemo
nit
ore
d

c
los
elyun
til
apr
ote
cti
vee
nvi
ron
men
tisa
rra
nge
d?

4.
Wha
tist
hel
eve
lofc
ommi
tme
ntf
romt
hep
ati
ent
’ss
upp
orts
yst
em?

B-B.
Pot
ent
ial
fors
elf
-di
rec
tedv
iol
enc
ere
lat
edt
osui
ci
dal
ide
ati
ona
ndp
oori
mpul
sec
ont
rol

1
.Pr
obl
em:S
elf
-ha
rm,
sel
f-
inj
ury

2.
Int
erv
ent
io
n

a
.As
ses
scur
ren
tsui
ci
der
is
k

b
.Se
ekc
ons
ult
ati
onwi
thme
dic
alp
syc
hia
tri
cse
rvi
cest
ode
ter
min
eth
ele
vel
ofs
uic
ida
li
ty

c
.Imp
leme
nta
ppr
opr
iat
ele
vel
ofo
bse
rva
tio
n/p
rec
aut
io
n;1
:1i
fne
ces
sar
y(i
nac
cor
dan
cewi
th

h
osp
it
alp
oli
cy)
.

d
.No
ti
fya
lla
ppr
opr
iat
est
affi
fap
ati
enti
spl
ace
dons
uic
idep
rec
aut
io
ns.
e
.Ac
kno
wle
dgef
eel
i
ngsa
nde
xpl
ai
npr
eca
uti
ons
;in
for
mth
epa
tie
ntt
hats
taf
fme
mbe
rswi
l
l

p
rot
ectt
hemun
til
the
yca
nre
sis
timp
uls
es.

f
.Pr
ovi
deas
afep
hys
ica
lan
d;i
nte
rpe
rso
nal
env
ir
onme
ntb
ase
donl
eve
lofs
uic
ider
is
k.

g
.Don
otp
romi
sea
bso
lut
eco
nfi
den
tia
li
tya
boutp
ert
ine
nti
nfo
rma
tio
nth
ati
simp
ort
antf
ort
he

e
nti
reh
eal
tht
eamt
okn
owi
npl
ann
inga
ndd
eli
ver
ingc
are
.

C-
Sel
fdi
rec
tedv
iol
enc
eco
nti
nue
d

h
.Do
cume
nta
llp
ati
ent
/f
ami
l
yco
nta
ctsa
ndp
lan
nin
g:i
ncl
udea
sse
ssme
nto
fri
ska
ndp
lanwi
th

s
pec
if
icr
est
ri
ct
io
ns,
theme
tho
dan
dfr
eque
ncyo
fob
ser
vat
io
n,a
nds
taf
fre
spo
nsi
bi
li
tyf
or

o
bse
rva
tio
nan
des
cor
tifg
oin
gouto
fth
eun
itf
ord
iag
nos
ti
cpr
oce
dur
es.

i
.Ar
ran
gec
ons
ult
ati
ona
ndc
oll
abo
rat
io
nwi
thp
syc
hia
tri
c/me
nta
lhe
alt
hsp
eci
al
is
tsa
nds
oci
al

wo
rke
rst
ofa
cil
i
tat
eco
mpr
ehe
nsi
vep
syc
hos
oci
ala
sse
ssme
nta
nde
ffe
cti
vep
lanc
are
.

j
.Tr
ans
fert
ops
ych
iat
ri
cse
rvi
ceswh
ent
hep
ati
enti
sme
dic
all
yst
abl
e.

84
2.
2.3De
sir
edo
utc
ome

a
.Pa
tie
ntr
ema
inss
afe
.

b
.Pa
tie
ntd
oes
n’ta
cto
nsui
ci
dal
imp
uls
eswh
il
einh
osp
it
al.

c
.Pa
tie
nt/
fami
l
yve
rba
li
sest
houg
hts
,fe
eli
ngso
fas
uic
idea
tte
mpt
.

A-I
nef
fec
ti
vef
ami
l
yco
ping
:co
mpr
omi
sedd
uet
oco
mpl
ete
dsui
ci
deo
fap
ati
ent
.

1
.Pr
obl
em:d
eat
hofap
ati
enti
nanI
nte
nsi
veCa
ree
nvi
ron
men
tre
lat
edt
osuc
ces
sful
sui
ci
de.

2.
Int
erv
ent
io
n

a
.Pr
ovi
dea
nop
por
tun
ityf
ort
hef
ami
l
ytod
isc
usst
hed
eat
hoft
hep
ati
ent

b
.En
cour
agec
ons
ult
ati
ona
ndus
eofp
syc
hia
tri
cme
nta
lhe
alt
hsp
eci
al
is
tst
oas
ses
san
das
sis
tth
e

f
ami
l
yinc
opi
ngwi
thl
ossa
ndd
eal
i
ngwi
tht
hei
mpa
cto
fsuc
ces
sful
sui
ci
de.

c
.Al
l
owf
ami
l
yme
mbe
rst
oex
pre
ssf
eel
i
ngs(
esp
eci
al
lya
nge
r)t
owa
rdt
hep
ati
entf
ora
ban
don
ing

t
hem:a
ll
owt
hef
ami
l
ytod
isc
usst
hei
rfe
eli
ngsa
boutn
otb
ein
gab
let
opr
eve
ntt
hes
uic
idef
rom

o
ccur
ri
ng.

B-e
.Re
fert
osur
viv
orso
fsui
ci
deg
roup
ssuc
hast
hef
ol
lo
win
g:

S
urv
ivo
rso
fsui
ci
de(
SOS
)

Lo
vin
gOut
rea
cht
oSur
viv
orso
fSui
ci
de(
LOS
S)

S
tri
vi
ngToRe
achEv
eryS
urv
ivo
rofS
uic
ide(
STRES
S)

C-V.
Pat
ie
ntt
eac
hinga
ndho
mehe
alt
hco
nsi
der
ati
ons

A.
Pat
ie
nts
urv
ive
sas
uic
idea
tte
mpt

1
.Co
nfi
rmp
ati
enth
asb
eenc
lea
redb
yme
dic
alp
syc
hia
tri
cse
rvi
ces
.

2.
Ass
ure
dth
atp
ati
ent
/f
ami
l
y(i
fdi
sch
arg
edf
romI
nte
nsi
veCa
reUn
it)h
aso
utp
ati
ent

r
efe
rra
lap
poi
ntme
ntb
efo
rel
eav
ingun
its
.

3
.En
sur
eth
atb
othp
ati
enta
ndf
ami
l
yha
vewr
it
teni
nst
ruc
ti
onsc
onc
ern
ingh
owt
oob
tai
n

e
mer
gen
cya
ssi
st
anc
eifs
uic
ida
limp
uls
esr
etur
n.

85
4.
Rev
iewwi
thp
ati
ent
/f
ami
l
yin
dic
ati
onso
fex
ace
rba
tio
nofs
uic
ida
li
ty

B.
Pat
ie
ntd
iesf
romas
ucc
ess
ful
sui
ci
de

1
.Bea
vai
l
abl
etof
ami
l
yme
mbe
rsa
ndp
rov
idec
ommun
itys
upp
orti
nfo
rma
tio
naf
tert
heyr
etu
rn

h
ome
.

2.
Enc
our
aget
hes
urv
ivo
r(s
)toa
tte
nda
ndp
art
ic
ipa
tei
nas
upp
ortg
roup
.

3
.Re
vie
wwi
ths
urv
ivo
rst
hei
mpo
rta
nceo
ffo
ll
owupwi
thme
nta
lhe
alt
hco
nsul
tat
io
ntoe
ffe
cti
vel
y

ma
nag
eps
ych
olo
gict
rauma
,sh
ock
,an
dgr
ief
.

2.
3.DEATH/
DYI
NG

I
.De
fi
ni
ti
on

De
athi
sani
nev
it
abl
eev
ente
ver
yli
vi
ngb
ein
gfa
ces
.Dy
ingi
sap
roc
ess
,wh
ichc
an

o
ccurs
udd
enl
yoro
vert
imea
ndi
nvo
lvet
hed
yin
gpe
rso
ns,
fami
l
yme
mbe
rs,

f
ri
end
,co
ll
eag
uesa
ndt
heh
eal
thc
arep
rov
ide
rswo
rki
ngwi
tht
hep
ati
ent
.

De
atho
fth
ebo
dya
sawh
olei
skn
owna
sso
mat
icd
eat
h.Wh
enc
ess
ati
ono
fvi
tal

o
rga
nss
ucha
sth
ehe
art
,l
ung
,an
dbr
aino
ccur
s,c
ell
ul
ard
eat
hpr
oce
edsi
nar
api
d

t
hro
ughun
eve
nma
nne
r.Th
isd
own
war
dsp
ir
alo
ffun
cti
onp
roc
edur
esc
ell
ul
ar

d
eat
hth
roug
hth
een
tir
eor
gan
ism.
Thec
ess
ati
ono
ffun
cti
onc
anb
esp
eci
fi
edf
ore
achi
ndi
vi
dua
l.

Un
der
sta
ndi
ngt
hec
omp
lexp
hys
iol
ogi
cin
ter
rel
ati
ons
hip
sbe
twe
enc
elld
eat
h,s
oma
ticd
eat
han
d

t
hef
ail
ureo
fvi
talo
rga
sm,i
sani
nte
gra
lbuto
nlyi
ni
ti
als
tepi
nde
vel
opi
ngn
urs
ingc
aref
ort
he

d
yin
gpa
tie
nta
ndh
iso
rhe
rfa
mil
ykn
owl
edg
ean
dat
ten
tio
ntot
heun
der
ly
ingp
hys
iol
ogi
cch
ang
e

d
uri
ngt
hed
yin
gpr
oce
ssc
anf
aci
l
ita
tet
heh
eal
thc
arep
rov
ide
r’
sab
il
it
ytoa
ll
evi
atep
ain
,

d
isc
omf
ort
,an
dsuf
fer
ing
,imp
rov
ingt
heo
ver
all
qua
li
tyo
fre
mai
ni
ngl
i
fea
ndmi
ni
mis
ingt
he

n
ega
tiv
eef
fec
tso
fth
edy
ingp
roc
esso
nfa
mil
yme
mbe
rs.

2.
3.
1II
.Pr
oce
sso
fdy
ing

Dur
ingt
hel
asth
our
sofl
i
fe,
the
rea
ret
hre
eimp
ort
anta
spe
ctso
fth
edy
ingp
roc
ess
:th
e

86
d
eat
hwa
tch,
thed
eat
hsc
ene
,an
dtef
h i
nald
eat
h.Th
ede
athwa
tchmus
tbef
aci
l
ita
tedb
yth
e

h
eal
thc
arep
rov
ide
rsc
ari
ngf
ort
hep
ati
enta
ndf
ami
l
yme
mbe
rs.

Ph
ysi
ol
ogi
cco
ntr
oli
sac
hie
vedb
yag
gre
ssi
vep
ainc
ont
rol
/ma
nag
eme
nt,
sle
epp
romo
ti
ona
ndr
eli
ef

o
fan
xie
tya
ndr
est
le
ssn
esswh
il
epr
omo
ti
ngo
ver
all
comf
ortf
ort
hep
ati
enta
ndf
ami
l
yme
mbe
rs.
It

i
sofp
rima
ryc
onc
ernt
ohe
alt
hca
rep
rov
ide
rs,
fami
l
yme
mbe
rs,
dea
thwa
tchc
anl
astf
orh
our
s

wh
il
eth
ede
aths
cen
eist
ypi
cal
l
ybr
iefa
ndt
ermi
nat
esa
tth
eti
meo
fth
epa
tie
nt’
sac
tua
l

p
hys
iol
ogi
cde
atha
ndwi
tht
her
it
ual
ofp
ron
oun
cin
gth
ede
atho
fth
epa
tie
ntmuc
hti
met
he

f
ami
l
yme
mbe
rsa
remo
sti
nti
mat
elyi
nvo
lve
dint
hisf
ina
las
pec
toft
hed
eat
hpr
oce
ss.

S
eve
ral
exp
ect
edd
eat
hpa
tte
rnsd
esc
ri
bedwh
ent
hep
ati
enti
sex
pec
tedt
odi
ean
dinwh
att
ypeo
f

p
red
ict
abl
ema
nne
r.He
alt
hca
rep
rov
ide
rsc
ana
sse
sswh
enap
ati
entwi
l
ldi
ean
d,t
her
efo
re,
can

a
ppr
opr
iat
elyp
lant
hei
rnur
si
ngc
are
.De
athp
att
ern
sca
nbed
eli
nea
tedi
nth
efo
ll
owi
ng

f
iv
eca
teg
ori
es:(
1)t
oos
udd
end
eat
h,(
2)f
luc
tua
tin
gpa
tte
rni
n(3
)ce
rta
ind
eat
hwi
thi
nak
nown

t
ime
,(4)c
ert
aind
eat
hwi
thi
nanun
kno
wnt
ime
,an
d(5)l
i
nge
rin
g.

A-I
II
.As
ses
sme
nto
fth
eDy
ing

A.
Pat
ter
nofp
ati
ent
’si
l
lne
ss

1
.Wh
ata
ret
heme
dic
ald
iag
nos
es?

2.
Whe
nan
dho
wwa
sth
e“b
adn
ews
”gi
ven
?Ho
wof
tena
ndr
ece
nt?

3
.Wh
ode
li
ver
edt
he“
badn
ews
”an
dho
wwa
sitd
one
?

4.
Wha
tdot
hep
ati
enta
ndf
ami
l
yun
der
sta
nda
boutt
hei
l
lne
ss?

5.
Ist
hep
ati
ents
ti
ll
act
iv
elyp
art
ic
ipa
tin
gind
eci
si
onsa
ndt
rea
tme
nt?

6
.Do
est
hep
ati
enta
ckn
owl
edg
eph
ysi
cal
li
mit
san
d/o
rsy
mpt
omst
hata
rer
ela
tedt
oil
l
nes
san
d

t
rea
tme
nt?

B-A.
Sta
geso
fdy
ingt
raj
ect
ory

1
.Ac
utep
has
e:b
egi
nswh
ent
hep
ati
enti
ni
ti
al
lyl
ear
nst
hatd
eat
hisap
oss
ibi
l
ity
.

2.
Chr
oni
cli
vi
ng-
dyi
ngf
unc
ti
ona
lst
atus
,an
din
cre
asei
nde
pen
den
ce.
Thi
sis

87
ap
eri
odo
fre
mis
sio
ns;h
owe
ver
,th
ege
ner
alt
raj
ect
oryi
sad
own
war
dsp
ira
l.

3
.Te
rmi
nal
pha
se:c
har
act
eri
sedb
yge
ner
ali
sedp
hys
ica
lex
haus
ti
on.
Thep
ati
enti
sex
per
ien
cin
g

h
isl
asth
osp
it
ali
sat
io
n.

C-B.
Cop
inga
sse
ssme
nt

1
.Ist
hep
ati
ent
/f
ami
l
yawa
reo
fth
ete
rmi
nal
”di
agn
osi
s?

2.
Howa
ret
hep
ati
enta
ndf
ami
l
yco
pin
g/wh
ats
pec
if
icb
eha
vio
urso
rde
fen
ceme
cha
nis
msa
re

b
ein
gus
edb
yth
epa
tie
nta
ndf
ami
l
y?

3
.Wh
atd
egr
eeo
fag
it
ati
ono
ran
geri
spr
ese
nti
nth
epa
tie
nt?

4.
Wha
tfe
arse
xis
tun
kno
wn,
lon
eli
nes
s,s
orr
ow,
los
sofb
odi
l
yfun
cti
on,
los
sofs
elf
-c
ont
rol
,

p
ain
/suf
fer
ing
,lo
sso
fse
lf
-i
den
tit
y/s
elf
-wo
rth
,re
gre
ssi
on?

5.
Howmuc
hco
ntr
old
oest
hep
ati
enth
aveo
verd
eci
si
onsi
nth
ere
mai
ni
ngd
ays
?

6
.Ist
hep
ati
ent
/f
ami
l
yre
que
sti
ngs
taf
fme
mbe
rst
obei
nth
ero
om?

7.
Ist
hep
ati
ent
/f
ami
l
yre
str
ic
ti
onv
isi
to
rs

2.
3.
2C.
Pai
nas
ses
sme
nto
fth
eDy
ing

1
.De
gre
eofp
aine
xpe
rie
nce
d

2.
Wha
tdo
est
hep
ati
entr
epo
rtr
educ
est
hep
ain
?Wh
ati
ncr
eas
est
hep
ain

3
.Wh
atma
kest
hep
ati
ent
’sc
omf
ort
abl
e?

4.
Wha
tist
hep
ati
ent
’sa
tti
tud
e

D.
Spi
ri
tua
lan
dcul
tur
ala
sse
ssme
nt

1
.Wh
ath
ome
sdo
est
hep
ati
enth
ave
?

2.
Whoa
ret
hes
pir
it
ual
pro
fes
sio
nal
simp
ort
antt
oth
epa
tie
nt?

3
.Wh
ati
sth
epa
tie
nt’
san
dfa
mil
y’
scul
tur
alv
iewo
fde
ath
?

4.
Wha
tsp
eci
fi
cri
tua
lsa
ren
ece
ssa
ryo
rimp
ort
ant
?

E.
Ass
ess
men
tofd
eat
hpr
epa
rat
io
ns

88
1
.Wh
ata
ret
he“
tas
ks”t
hatt
hep
ati
enta
ndf
ami
l
yst
il
lne
edt
oac
comp
li
sh?

2.
Wha
tpr
epa
rat
io
nsf
ord
yin
gha
sth
epa
tie
ntma
de?(
the
sei
ncl
udewi
l
ls,

f
une
ral
arr
ang
eme
nts
,li
vi
ngwi
l
l,f
ina
lme
ssa
ges
).

A-3
.Whe
red
oest
hep
ati
entwa
ntt
odi
e

F
.As
ses
sme
nto
fpa
stl
oss
esi
nli
fe

G.
Ass
ess
men
tofaf
ami
l
yco
pin
g

1
.Ist
hef
ami
l
yca
pab
leo
fca
rry
ingo
utt
hep
ati
ent
’swi
she
s?

2.
Doe
sth
efa
mil
yne
eda
ddi
ti
ona
lsup
por
ttoma
ked
eci
si
onswh
ent
hep
ati
enti
sun
abl
etod
oso
?

B-I
V.Pa
tie
nt/
fami
l
yma
nag
eme
nt/
Nur
si
ngDi
agno
sis

A.
Sel
f-
car
ede
fi
ci
tre
lat
edt
oth
ete
rmi
nal
pha
seo
fin
ten
siv
eil
l
nes
s

1
.Pr
obl
em:i
ncr
eas
edd
epe
nde
ncef
orp
hys
ica
lca
red
uet
oin
ten
siv
eil
l
nes
swi
tht
hea
cti
ved
yin
g

p
roc
ess
.

2.
Int
erv
ent
io
ns:Ph
ysi
cal
car
eoft
hed
yin
gpa
tie
nti
ncl
udea
tte
nti
ont
oth
efo
ll
owi
nga
spe
cto
f

n
urs
ingc
are

a
.El
i
min
ati
on:k
eept
hei
nco
nti
nen
tpa
tie
ntc
lea
n,d
ry,
ando
dour
-f
ree
,an
das
ses
sfo
rimp
act
io
n;

t
hen
urs
e’sa
tti
tud
ewh
end
eal
i
ngwi
tht
hei
nco
nti
nen
tpa
tie
ntma
yco
mmun
ica
ter
eje
cti
ono
r

p
rot
ect
iv
eca
re.

b
.Ha
ir:c
are
dfo
rha
irh
asag
rea
tin
flue
nceo
nse
lf
-i
mag
ean
dse
lf
-es
tee
m.

c
.Muc
ousme
mbr
ane
s:y
oun
eedt
oke
ept
hen
ose
,mo
uth
,an
dey
emo
ista
ndc
lea
n;us
eof

l
ubr
ic
ant
san
dmo
uth
was
hesi
sde
sir
abl
e

d
.Nut
ri
ti
ona
ndh
ydr
ati
on:s
mal
l
,fr
eque
ntf
eed
ingo
ffa
vour
it
efo
odsa
rel
i
kel
ytob
eac
cep
ted
;ic
e

c
hip
soff
avo
uri
tes
oftd
rin
ksn
eedt
obea
vai
l
abl
eco
nst
ant
lyi
fth
epa
tie
nti
sca
pab
leo
fnut
ri
ti
ona
l

i
nta
ke.

e
.Po
sit
io
nin
g:f
req
uen
tpo
sit
io
nin
gisn
ece
ssa
ryt
opr
ote
ctt
hep
ati
entf
roms
kinb
rea
kdo
wna
ndt
o

e
nsur
eth
att
hea
irwa
yisn
otp
art
ial
l
yorc
omp
let
elyo
bst
ruc
ted
.

89
f
.Sk
in:s
kins
houl
dbec
lea
n;l
oti
ons
houl
dbea
ppl
i
edt
opr
ovi
demo
ist
urea
ndp
res
sur
ear
eas

s
houl
dbep
rot
ect
edf
roms
kinb
rea
kdo
wna
ndd
ecub
it
usf
orma
tio
n.Ma
ssa
get
her
apyc
anb
eus
ed

f
ors
kina
ndmus
clei
nte
gri
ty
,aswe
lla
spa
inma
nag
eme
nta
ndr
ela
xat
io
nst
rat
egy
.

3
.De
sir
edo
utc
ome
:top
rov
idep
hys
ica
lca
rea
ndma
int
ainh
ygi
enea
ndc
onf
ormf
ort
hep
ati
ent
.

C-B.
Pai
nre
lat
edt
ophy
sio
log
ica
lte
rat
io
nsd
uet
ote
rmi
nalp
has
eofi
nte
nsi
vei
l
lne
ss.

1
.Pr
obl
em:f
ear
,pr
oce
dur
ali
nto
ler
anc
e,e
mot
io
nal
dis
tre
ssa
nxi
et
y

2.
Int
erv
ent
io
n

a
.Us
eme
dic
ati
ons(
bot
han
alg
esi
can
dan
tia
nxi
et
yag
ent
swh
ena
ppr
opr
iat
e)i
nad
equa
ted
ose
sto

p
rov
idep
ainr
eli
ef
.

b
.Co
nsul
tat
io
nwi
thc
li
ni
cal
soc
ial
i
stsi
npa
inma
nag
eme
ntt
oes
tab
li
sha
nef
fec
ti
ver
egi
men
.

c
.Ut
il
is
eal
ter
nat
iv
eme
asur
ess
ucha
shy
pno
sis
,gui
dedi
mag
ery
,ma
ssa
ge,
anda
cup
unc
tur
al

p
res
sur
eth
era
pya
sad
jun
ctso
fpa
inme
dic
ati
on.
(Atas
tag
eofd
yin
g,i
tisn
ota
ppr
opr
iat
eto

a
tte
mpti
mag
eryo
rhy
pno
sisi
fth
epa
tie
nth
asn
ota
lre
adyus
edt
hem)
.

3
.De
sir
edo
utc
ome

a
.Pa
tie
nta
ndf
ami
l
yre
por
tora
ckn
owl
edg
epa
inr
eli
ef

b
.Pa
tie
ntc
anp
art
ic
ipa
tei
nhi
sorh
erc
arewi
thi
nth
ere
str
ic
ti
ono
fhi
sph
ysi
cal
con
dit
io
n.

c
.Ab
sen
ceo
ford
imi
ni
she
dle
vel
ofa
git
ati
on.

I
n-t
extQue
sti
on

Wh
ata
ret
hea
lte
rna
tiv
eme
asur
est
opa
inma
nag
eme
nti
nad
yin
gpa
tie
nt?

An
swe
r

Ut
il
is
esuc
hash
ypn
osi
s,g
uid
edi
mag
ery
,ma
ssa
ge,
anda
cup
unc
tur
alp
res
sur
eth
era
pyc
ans
erv
e

a
sad
jun
ctso
fpa
inme
dic
ati
on.

2.
3.
3C.
Anx
iet
yre
lat
edt
oimp
end
ingd
eat
hdet
ohe
lpl
ess
nes
s,l
osso
fco
ntr
ol,
anda
ban
don
men
t

90
1
.Pr
obl
em:F
ear
(s)a
nxi
et
y,i
nef
fec
ti
ve,
cop
ing
,in
cre
ase
dsy
mpa
the
ti
cne
rvo
uss
yst
emr
esp
ons
es

2.
Int
erv
ent
io
ns:Emo
ti
ona
lca
reo
fth
edy
ingp
ati
enta
ndh
iso
rhe
rfa
mil
y

a
.Sp
endt
imed
ail
ywi
thp
ati
ent
scr
eat
inga
nac
cep
ti
nga
tmo
sph
ere

b
.Li
st
enr
ath
ert
hant
alka
ll
owf
ort
hee
xpr
ess
iono
ffe
eli
ngs

c
.Al
l
owa
nds
upp
ortt
hep
ati
ent
sownd
eci
si
onma
kin
gre
gar
din
gpl
ann
ingt
imeo
fca
re,
vis
it
ors

a
ndc
ont
inue
dtr
eat
men
t.

d
.Us
eto
uchwh
ent
hep
ati
enti
ndi
cat
est
hro
ughv
erb
alo
rno
nve
rba
lbe
hav
iour(
cry
ing
,re
lat
ings
ad

s
tor
ies
)th
ati
tisn
eed
ed.

e
.Me
etwi
thf
ami
l
yan
dsi
gni
fi
can
tot
her
stoa
nswe
rque
sti
ons
,li
st
ent
ofe
eli
ngs
,pr
ovi
de

i
nfo
rma
tio
n,a
ndg
ives
upp
ort
.

f
.Al
l
owa
smuc
hti
mea
sth
epa
tie
ntn
eed
swi
thf
ami
l
yan
dsi
gni
fi
can
tot
her
s.

g
.Ma
kea
ppr
opr
iat
ere
fer
ral
s,b
ase
dont
hep
ati
entwi
she
stos
oci
alwo
rke
rs,
psy
chi
atr
icc
li
ni
cal

s
pec
ial
i
sts
,la
wye
rs,
min
ist
ers
,pr
ies
ts,
orr
abb
i.

h
.Ai
dth
epa
tie
nti
nco
mpl
eti
ngun
fin
ish
edb
usi
nes
s.

i
.I
fth
epa
tie
nti
sno
tab
let
obead
eci
si
on-
mak
er,
ass
istaf
ami
l
yme
mbe
rinma
kin
gde
cis
ion
s.

j
.Us
ean
xio
usl
yme
dic
ati
oni
nco
njun
cti
onwi
thr
ela
xat
io
nst
rat
egi
est
oma
nag
ean
xie
ty.

k
.Ex
pla
ina
llt
est
san
dpr
oce
dur
est
opa
tie
nta
ndf
ami
l
y.Al
so,
inc
lud
ewh
att
hep
ati
enti
sex
pec
ted

t
odod
uri
ngt
hep
roc
ess
.

A-3
.De
sir
edo
utc
ome
s:Pa
tie
nta
ndf
ami
l
ydot
hef
ol
lo
win
g;

a
.Co
mfo
rta
nde
xpr
essf
ear
s

b
.Ex
pre
ssf
eel
i
ngs

c
.Us
esup
por
tse
rvi
ceso
ffe
redt
oth
em

d
.De
mon
str
atead
imi
ni
she
dle
vel
ofd
eat
h-r
ela
teda
nxi
et
y

e
.Co
mpl
etep
rep
ara
tio
nsf
ord
eat
h

D.
Ant
ic
ipa
tor
ygr
iev
ingr
ela
tedt
opo
ten
tia
llo
sso
fsi
gni
fi
can
tot
herd
eat
hofs
elf

91
1
.Pr
obl
ems
:Co
gni
ti
vec
han
ges
,be
hav
iour
alc
han
ges
,al
ter
edf
eel
i
ngs
,so
mat
ics
ymp
toms

2.
Int
erv
ent
io
ns

a
.De
ter
min
ewh
ati
skn
owno
rfe
are
dab
outt
hep
ote
nti
all
oss

b
.En
cour
ageo
pend
isc
uss
iono
ffe
arsa
ndc
onc
ern
s

c
.Id
ent
if
yan
dva
li
dat
eth
eimp
acto
fpr
evi
ouse
xpe
rie
nce
swi
thl
oss
.

d
.Av
oide
it
herr
ein
for
ci
ngd
eni
alo
rca
usi
ngap
rema
tur
edi
sr
upt
io
noft
he

d
eni
alp
roc
essd
uri
ngt
hee
arl
yst
ageo
fsh
ocka
ndd
isb
eli
ef
.

e
.In
sti
l
lho
pesf
ort
hea
bil
i
tie
sofp
ati
enta
ndf
ami
l
ytoc
opewi
thl
oss
.

f
.Id
ent
if
yth
ene
edf
ori
nfo
rma
tio
noft
hep
ati
enta
ndf
ami
l
y.

g
.Pr
ovi
def
ami
l
ywi
tho
ngo
ing
,ho
nes
tfo
rma
tio
nco
nce
rni
ngp
ati
ent
’
s

h
.Fa
cil
i
tat
eco
mmun
ica
tio
n(wh
enp
oss
ibl
e)b
etwe
enp
ati
enta
nds
ign
ifi
can
tot
her
s.

i
.Co
nsul
tbe
rea
veme
nto
rme
nta
lhe
alt
hsp
eci
al
is
tsa
ndp
ast
ora
lse
rvi
cest
oas
sis
tins
upp
ort
ing

t
hep
ati
enta
ndf
ami
l
yme
mbe
rs.

j
.En
cour
agi
ngf
ami
l
yme
mbe
rst
oma
int
aint
hei
rse
lf
-c
are

k
.Id
ent
if
yan
yin
dic
ati
onso
fdy
sfun
cti
ona
lgr
iev
ing(
sui
ci
dal
ide
ati
on/
int
ent
,pa
tho
log
icd
eni
al
,

un
con
tro
ll
edb
eha
vio
urs
ucha
svi
ol
enc
e).

B-3
.De
sir
edo
utc
ome

a
.Pa
tie
nta
ndf
ami
l
ywi
l
lex
pre
sst
houg
htsa
ndf
eel
i
nga
boutt
hea
nti
ci
pat
edl
oss
.

b
.Pa
tie
nta
ndf
ami
l
yca
nma
kea
nin
for
medd
eci
si
onr
ela
tedt
oth
ean
tic
ipa
tedl
oss
.

c
.Fa
mil
yme
mbe
rsma
int
ainc
ons
truc
ti
ver
ela
tio
nsh
ips

d
.An‘
app
rop
ria
te’
dea
thi
sac
hie
ved
,wh
ichme
etst
hef
ol
lo
win
gex
pec
tat
io
ns:

i
.Co
nfl
i
ctr
edu
cti
on

i
i
.Re
inf
orc
eme
nto
fsi
gni
fi
can
tre
lat
io
nsh
ips

i
i
i.Be
hav
iouri
sina
li
gnme
ntwi
tht
hep
ati
ent
’si
dea
lsa
ndv
alue
s

i
v.Ba
sici
nst
inc
tsa
ndwi
she
sar
ere
ali
sed
.

92
V.
Int
erv
ent
io
nso
fhe
alt
hca
rep
rov
ide
rst
afft
oma
nag
eth
eimp
acto
fdi
sen
fra
nch
ise
dgr
ief

A.
Act
iv
elyp
art
ic
ipa
tei
nst
affme
eti
ngsa
nds
upp
ortg
roupme
eti
ngswi
thme
nta
lhe
alt
hnur
se

s
pec
ial
i
stst
oex
plo
ren
urs
ings
taf
fme
mbe
rs’
fee
li
ngsa
boutd
yin
gpa
tie
nts
.

B.
Cle
arl
yco
mmun
ica
te,
dur
ingr
epo
rtt
imea
ndi
nte
amme
eti
ngse
xac
tl
y

h
ate
hpa
tie
nta
ndf
ami
l
ykn
ow,
wit
hsp
eci
fi
cdi
scus
sio
nsa
boutt
hel
eve
lofc
ared
eci
si
onst
hat

h
avet
ran
spi
red

C.
Usee
thi
csc
ommi
tt
eec
ons
ult
ati
onsf
orh
eal
thc
are
,pa
tie
nt,
and
/orf
ami
l
yco
nfl
i
ctss
urr
oun
din
g

ad
iff
ic
ultd
eat
hev
ent
.

D.
Usep
erc
ons
ult
ati
ont
ova
li
dat
epe
rso
nal
fee
li
ngso
flo
ss.

E.
Usep
ers
ona
lme
nta
lhe
alt
hco
nsul
tat
io
ntoa
ssi
sti
nth
eid
ent
if
ic
ati
ona
ndma
nag
eme
nto
f

d
ise
nfr
anc
his
edg
rie
f.

C-VI
.Pa
tie
nta
ndf
ami
l
yte
achi
nga
ndho
mehe
alt
hco
nsi
der
ati
ons

A.
Imme
dia
te“
pos
t-l
oss
”emo
ti
ona
lca
ref
orf
ami
l
yme
mbe
rs

1
.Re
vie
wca
rep
rov
ide
dtot
hep
ati
ent
.

2.
Det
ermi
nei
ffa
mil
yme
mbe
rswo
uldl
i
ket
ose
eth
epa
tie
ntb
efo
rel
eav
ingt
heh
osp
it
al.

3
.Co
nsul
tat
io
nwi
thas
pir
it
ual
lea
der
,so
cia
lwo
rke
r,o
rme
nta
lhe
alt
hcl
i
nic
als
pec
ial
i
stma
ybe

n
ece
ssa
ryi
fgr
iefr
esp
ons
esa
rei
nte
nsea
ndt
hef
ami
l
yex
hib
it
sin
eff
ect
iv
eco
pin
gwi
thl
oss
.

4.
Pro
vid
ere
fer
ral
tob
ere
ave
men
tth
era
pis
t

5.
Arr
ang
eame
nta
lhe
alt
hcl
i
nic
als
pec
ial
i
stF
oll
owupa
fte
r24h
our
stod
ete
rmi
net
hel
eve
lof

c
opi
ng.

6
.Pr
ovi
der
efe
rra
ltos
upp
ortg
roup
.

B.
Pat
ie
ntl
eav
ingI
nte
nsi
veCa
reUn
itt
obec
are
dfo
rath
omewi
thh
ight
ech
nol
ogy
-as
sig
ned

n
urs
ingc
are

1
.In
str
uctp
ati
enta
ndf
ami
l
yonwh
att
oex
pec
tco
nce
rni
ngi
l
lne
sst
raj
ect
ory
.

2.
Arr
ang
eaf
ami
l
yme
mbe
rto“
sle
epo
ver
”int
heI
nte
nsi
veCa
reUn
itt
ofa
cil
i
tat
efa
mil
yme
mbe
rs

93
k
nowl
edg
ean
dsk
il
li
nca
rin
gfo
rpa
tie
nts

3
.Ar
ran
geme
ntr
efe
rra
lan
dco
nsul
tat
io
ntod
isc
har
gep
lan
nin
gte
amme
mbe
rst
ofa
cil
i
tat
ea

s
moo
tht
ran
sit
io
ntot
heh
omec
ares
ett
ing
.

4.
Enc
our
agef
ami
l
yme
mbe
rst
opa
rti
ci
pat
einc
oun
sel
l
ingi
fho
spi
cet
oho
mec
arep
rog
rammeh
as

a
cce
sst
oame
nta
lhe
alt
hsp
eci
al
is
ttoe
xpl
oret
hei
mpa
cto
faf
ami
l
yme
mbe
rdy
inga
tho
me.

I
n-t
extQue
sti
on

Li
stt
hre
e(3
)in
str
uct
io
n nf
so a
mil
yte
achi
nga
ndho
mehe
alt
hco
nsi
der
ati
ons

An
swe
r

1
.In
str
uctp
ati
enta
ndf
ami
l
yonwh
att
oex
pec
tco
nce
rni
ngi
l
lne
sst
raj
ect
ory
.

2.
Arr
ang
eaf
ami
l
yme
mbe
rto“
sle
epo
ver
”int
heI
nte
nsi
veCa
reUn
itt
ofa
cil
i
tat
efa
mil
yme
mbe
rs

k
nowl
edg
ean
dsk
il
li
nca
rin
gfo
rpa
tie
nts
.

3
.En
cour
agef
ami
l
yme
mbe
rst
opa
rti
ci
pat
einc
oun
sel
l
ingi
fho
spi
cet
oho
mec
arep
rog
rammeh
as

a
cce
sst
oame
nta
lhe
alt
hsp
eci
al
is
ttoe
xpl
oret
hei
mpa
cto
faf
ami
l
yme
mbe
rdy
inga
tho
me.

1
0.0 Tu
torMa
rke
dAs
sig
nme
nts(
Ind
ivi
dua
lorG
rou
p)

Wh
yisas
uic
ida
lat
temp
tont
hei
ncr
eas
eind
eve
lop
ingc
oun
tri
est
oda
y?

1
1.0 Co
ncl
usi
on/
Summa
ry

S
inc
eiti
sth
epr
ima
ryr
esp
ons
ibi
l
ityo
fan
urs
etor
est
oreh
eal
tha
ndr
eha
bil
i
tat
ehi
she
r

c
li
ent
/pa
tie
nt,
soi
nth
eco
urs
eofma
nag
ingas
uic
ida
lpa
tie
nt,
theo
nusl
i
eso
nth
enur
set
oen
sur
e

t
hath
erp
ati
entr
ema
inss
afe
,do
esn
ota
cto
nsui
ci
dal
imp
uls
eswh
il
eun
derh
erc
area
ndt
hatt
he

p
ati
ento
rfa
mil
yve
rba
li
sest
houg
hto
rfe
eli
ngo
fas
uic
idea
tte
mpt
.

I
nth
iss
tud
yse
ssi
on,
youh
avel
ear
ntwh
ats
uic
idei
s,h
owt
oas
ses
sap
ati
enta
tte
mpt
ings
uic
ide

a
ndh
owt
oma
nag
eas
uic
ida
lpa
tie
nte
ffe
cti
vel
y.Th
edy
ingp
ati
entwa
sal
sol
ook
eda
t,

94
a
sse
ssme
nto
fdy
ingp
ati
entma
nag
eme
nto
fdy
ingp
ati
enta
ndt
hed
eadi
ncl
udi
ngn
urs
es

r
esp
ons
ibi
l
it
ie
sto
war
dst
hed
eadg
ri
eve
dfa
mil
i
es.

5.
0Se
lf
-As
ses
sme
ntQue
sti
ons

a
.Gr
iev
edma
nag
eme
nti
ses
sen
tia
lton
urs
ingp
rac
ti
ce.
Why
?

b
.Di
scus
sth
ere
spo
nsi
bi
li
ti
eso
fap
rof
ess
ion
aln
urs
etot
hed
yin
gpa
tie
nta
ndh
isf
ami
l
y.

6
.0Ad
dit
io
nal
Act
iv
it
ie
s(Vi
deo
s,An
ima
tio
ns&Outo
fCl
assAc
ti
vi
ti
es)e
.g.

a
.Vi
si
tYo
uTu
bea
dd.
Wat
cht
hev
ide
o&s
umma
ris
eiti
n1p
ara
gra
ph

b
.Vi
ewt
hea
nima
tio
nona
dd/
sit
ean
dcr
it
iq
uei
tint
hed
isc
uss
ionf
orum

c
.Ta
keawa
lka
nde
nga
gea
ny3s
tud
ent
son?
???
???
???
?;I
n2p
ara
gra
phss
umma
ris
eth
eir

o
pin
iono
fth
edi
scus
sedt
opi
c.e
tc.

7.
0Re
fer
enc
es/
Fur
the
rRe
adi
ngs

Ba
rba
ra,
S.J
.(1
989)
.Ps
ych
iat
ri
cMe
nta
lHe
alt
hNur
si
ng,
2ndEd
.Lo
ndo
n:J
.P.

Li
ppi
nCOHCo
mpa
ny.

El
har
t,D.
,Fi
rs
ich
,S.
C;Gr
agg
,SH.
andRe
es,
O.M.
(1978)S
cie
nti
fi
cPr
inc
ipl
esi
n

Nur
si
ng,
Sai
ntLo
uis
:Th
eC.
VMo
sbyCo
mpa
ny.

Wo
ods
,S.
LFr
oel
i
che
r,E.
S.
SHa
lpe
nny
,C.
J.a
ndMo
tze
r,S
.U(
1995)Ca
rdi
ac

Nur
si
ng3
rdEd
.J.
PLi
ppi
nCOHCo
mpa
ny.

95
96
 S
TUDYS
ESS
ION3&4

TRAUMA

S
ect
io
nan
dSub
sec
ti
onHe
adi
ngs
:

I
ntr
oduc
ti
on

1
.0Le
arn
ingOut
come
s

2,
0Ma
inCo
nte
nts

2.
1-De
fi
ni
ti
ono
ftr
auma

2.
2-Ca
use
soft
rauma
tici
nj
uri
es

2.
3Nur
si
ngp
roc
esso
ftr
auma
tici
nj
uri
es

2.
4Se
ver
it
yca
teg
ori
eso
ftr
auma

2.
5:S
pec
if
ice
xtr
emi
tyi
nj
uri
es

2.
6Di
sch
arg
epl
ann
ingf
ort
het
raumap
ati
ent

3
.0Tu
torMa
rke
dAs
sig
nme
nts(
Ind
ivi
dua
lorG
rou
pas
sig
nme
nts
)

4.
0St
udyS
ess
ionS
umma
rya
ndCo
ncl
usi
on

5.
0Se
lf
-As
ses
sme
ntQue
sti
ons

6
.0Ad
dit
io
nal
Act
iv
it
ie
s(Vi
deo
s,An
ima
tio
ns&Outo
fCl
assAc
ti
vi
ti
es)

7.
0Re
fer
enc
es/
Fur
the
rRe
adi
ngs

I
ntr
odu
cti
on:

Th
iss
tud
yse
ssi
oni
slo
oki
nga
ttr
aumawh
ichi
sth
eph
ysi
cali
nj
uryc
aus
edb
yin
ten
tio
nala
nd

un
int
ent
io
nalf
orc
ese
xer
tedo
nth
ebo
dy.Di
sab
il
it
ie
san
dde
ath
sre
cor
dedf
romt
raumac
ann
otb
e

e
sti
mat
ede
spe
cia
ll
yind
eve
lop
ingc
oun
tri
eswh
erer
eco
rdk
eep
ingi
sin
ade
qua
te.Th
isun
itwi
l
l

e
xpo
set
her
ead
ert
ova
rio
uswa
yst
raumai
sca
use
d,p
rev
ent
io
nan
dma
nag
eme
nto
fva
rio
usc
ase
s

o
ftr
auma
.

97
1
.0S
tud
ySe
ssi
onL
ear
nin
gOu
tco
mes

Af
ters
tud
yin
gth
iss
ess
ion
,Ie
xpe
cty
out
obea
blet
o:

1
.Ex
pla
int
hec
aus
eso
ftr
auma

2.
Dis
cus
sth
enur
si
ngma
nag
eme
nto
fva
rio
usi
nj
uri
ess
ust
ain
edb
ypa
tie
nts

3
.Ex
pla
ins
pec
if
ice
xtr
emi
tyi
nj
uri
esa
ndt
hei
rma
nag
eme
nt.

4.
Des
cri
bet
hed
isc
har
gep
roc
edur
eofat
raumap
ati
ent
.

2.
0Ma
inCo
nte
nts

1
.De
fi
ni
ti
on:Tr
aumai
sth
eph
ysi
cali
nj
uryc
aus
edb
yin
ten
tio
nala
ndun
int
ent
io
nalf
orc
ese
xer
ted

o
nth
ebo
dy.Tr
auma
tici
nj
uri
esk
il
l150,
000Ame
ric
ansy
ear
lya
ndl
eav
e60mi
l
li
oni
nj
ure
dan
d

3
00,
000p
erma
nen
tlyd
isa
ble
d.

Tr
aumai
sth
eel
udi
ngc
aus
eofd
eat
hinp
ers
ons45y
ear
sol
dory
oun
gera
ndi
sra
nke
dast
he

f
our
thma
jorc
aus
eofd
eat
hina
lla
geg
roup
s.Th
etr
imo
dal
dea
th

d
ist
ri
but
io
nil
l
ust
rat
est
hre
epe
akso
fde
atha
fte
rin
jur
y.

A.Pe
ak1
:50%o
fde
atho
ccur
sint
hef
ir
stf
ewmi
nut
esa
fte
rani
nj
uryr
esul
ti
ngf
romama
ssi
ve

h
eado
rth
ora
cici
nj
ury
,hi
ghs
pin
alc
ordd
ama
ge,l
arg
eve
sse
ltr
ans
act
io
n(a
ort
ic
),a
nd

e
xsa
ngui
nat
io
n.

B.Pe
ak2:
30-
35% o
fde
atho
ccur1
-3h
our
saf
tera
nin
jur
yre
sul
ti
ngf
romh
emo
tho
raxo
r

p
neumo
tho
rax
;sub
dur
alo
rep
idur
alh
ema
tomah
ypo
vol
emi
csh
ocks
eco
nda
ryt
oanun
con
tro
ll
ed

h
aemo
rrh
ageo
fth
eli
ver
,sp
lee
n,f
emur
;orp
elv
icf
rac
tur
es.

C.p
eak3
:10% o
fth
ede
athd
ayo
fth
e we
eka
fte
rani
nj
urya
sa r
esul
tofs
eps
is,

mul
ti
sys
temo
rga
nfa
il
ure
,an
dse
con
dar
yef
fec
tso
ftr
auma
.

Th
etr
aumac
ont
inuumo
fca
reb
egi
nsa
tth
eev
ento
fin
jur
yan
den
dswi
thf
ull
rec
ove
ry,
temp
ora
ry

o
rpe
rma
nen
tdi
sab
il
it
y,o
rde
ath
.In
ter
ven
tio
nsb
ytr
ain
edp
reh
osp
it
al,me
dic
ala
ndn
urs
ing

p
ers
onn
el’
sca
nimp
actat
raumap
ati
ent
;out
come
san
dpo
ten
tia
ll
yfa
tal
comp
li
cat
io
ns.

98
2.
1II
.Ca
use
s:Me
cha
nis
mofi
nj
ury
:

Po
ten
tia
lin
jur
iesa
nds
eco
nda
ryc
omp
li
cat
io
nsc
anb
epr
edi
ct
edb
ykn
owi
ngt
heme
cha
nis
mof

i
nj
ury
.Th
eex
ten
tan
dna
tur
eofi
nj
uryd
epe
ndo
nth
ety
peo
ffo
rcea
ppl
i
eda
ndt
heb
ody
’sr
esp
ons
e

t
oth
eap
pli
ede
ner
gy.
Tra
uma
tici
nj
uri
esa
reg
ene
ral
l
ydi
vi
dedi
ntob
lun
tan
dpe
net
rat
inga
ssa
ult
s.

Co
mpr
ess
ion
,Cr
ush
ing
,sh
ear
ing
,ac
cel
era
tio
nan
dde
cel
era
tio
nfo
rce
sca
nda
mag
epr
ote
cti
ve

t
is
sue
s,b
one
s,o
rga
ns,
andmus
cles
truc
tur
es.
Blun
ttr
aumac
anb
emo
rel
i
fe-
thr
eat
eni
ngt
han

p
ene
tra
tin
gtr
aumab
eca
useo
fth
epo
ten
tia
lfo
rin
jur
iest
ogoun
rec
ogn
ise
dan
dun
dia
gno
sed
.

Bu
rnsa
rea
lsoc
ons
ide
redt
rauma
tici
nj
uri
es.

2.
1.
1A.
Blun
ttr
aumap
att
ern
sofi
nj
ury
.

Th
eca
useo
fin
jur
yinp
ene
tra
tin
gtr
aumai
sth
een
erg
yfo
rme
dan
dtr
ans
mit
tedb
yth
epe
net
rat
ing

i
nst
rume
nti
ntot
hes
urr
oun
din
gti
ssue
s.Or
gan
sco
mmo
nlyp
unc
tur
edi
ncl
udet
hel
i
ver
,sma
ll

i
nte
sti
nes
,va
scul
ars
truc
tur
es,
ands
ple
en.
Int
est
ina
lpe
net
rat
ingd
ama
geh
ass
ign
ifi
can
tmo
rta
li
ty

d
uet
oco
mpl
i
cat
io
nsf
romf
aec
alc
ont
ami
nat
io
n.Th
ein
jur
iesd
epe
ndo
nth
esi
teo
fimp
act
,th
e

p
osi
ti
ono
fth
eas
sai
l
ant(
ang
leo
fpe
net
rat
io
n),
andt
het
ypeo
fin
str
ume
ntus
ed.

1
.Mo
torv
ehi
cl
eac
cid
ent
s:Th
esea
cci
den
tsa
ret
hel
ead
ingc
aus
eofd
eat
hfo
rAme
ric
ansb
etwe
en

t
hea
geso
f1a
nd3
4ye
ars
.

a
.He
ad/
on/
rea
r-e
ndc
oll
i
sio
ns:I
njur
ieso
fth
eao
rti
car
ch,
li
ver
,sp
lee
n,d
iap
hra
gm,
kid
ney
,an
d

b
owe
lsc
aus
ingt
ear
san
dru
ptur
esl
ace
rat
io
nst
oth
efa
ce,
chi
n,o
rmo
utha
nte
rio
rne
ckb
rus
hin
g;

a
ndi
nj
uri
est
oth
ech
esto
rab
dome
nwi
tha
nun
der
ly
ingc
ard
iacc
ont
usi
on.
Ther
eari
mpa
ctc
an

r
esul
tinh
ype
rex
ten
sio
noft
hen
eck
,co
mmo
nlyr
efe
rre
dtoa
s“wh
ipl
ash
.

b
.La
ter
ali
mpa
ct(
“T-
bon
e”i
mpa
ct)
:Imp
acto
nth
edr
iv
er’
ssi
dewi
l
lpo
ten
tia
tel
ef
t-
si
dedf
rac
tur
es

a
nds
ple
nici
nj
ury
.Imp
acto
nth
epa
sse
nge
r’
ssi
dema
yca
user
igh
t-s
ide
din
jur
iesa
ndl
i
ver

i
nvo
lve
men
t.Ma
yha
veac
ont
ral
ate
ral
inj
uryo
fth
ehe
ad,
nec
ksp
ine
,sp
ine
,ch
esta
bdo
men
.

c
.Ro
ll
ove
r/e
jec
ti
on:Hi
ghp
rob
abi
l
ityo
fmul
ti
sys
temi
nj
uri
es

d
.Fr
onts
eatp
ass
eng
er.
nos
afe
tyb
elt
:In
jur
esi
ncl
udef
rac
tur
e/d
isl
oca
tio
noft
hea
nkl
e,k
nee
,

99
f
emur
,po
ste
rio
rdi
sl
oca
tio
noft
hea
cet
abul
um:c
omp
res
sio
nin
jur
ieso
fth
eab
dome
n,c
hes
t,h
ead
,

n
eck
,an
dma
xil
l
ofa
cia
lre
gio
n.

e
.Li
mit
edus
eofs
afe
tyd
evi
ces
:Sh
oul
derh
arn
essa
lon
eca
nle
adt
obr
ush
ing
,se
ver
ela
cer
ati
ons
,

r
ibf
rac
tur
es,
andn
ecki
nj
uri
es.
Lapb
eltus
eon
lyc
anc
aus
efa
cia
l,n
eck
,ch
est
,l
umb
ars
pin
e,a
nd

b
lad
deri
nj
ure
s.Al
apb
eltwo
ret
ooh
ighc
aus
ess
ofta
bdo
min
ali
nj
urya
ndt
hor
aco
lumb
ara
nd

s
pin
ali
nj
uri
es.

A-
2.Mo
tor
cyc
lea
ndb
icy
clec
ras
hes
:

He
ado
n,l
ate
ral
imp
act
,ej
ect
io
n,a
ndl
ayi
ngt
heb
iked
ownc
ommo
nlyr
esul
tinf
rac
tur
est
oth
e

s
kul
l
,ne
ck,
rib
s,o
rex
tre
mit
ie
s;a
vul
si
ons
,ab
ras
ion
;an
d“r
oadr
ash
.”He
adi
nj
uryi
sth
eca
useo
f

75%o
fmo
tor
cyc
led
eat
hs.
Hea
din
jur
iesa
rer
educ
edwi
thp
rot
ect
iv
ehe
lme
tus
e.

3
.Pe
des
tri
anv
sve
hic
le:c
los
edo
rop
enf
rac
tur
eofl
owe
rex
tre
mit
ie
sin
clud
inga
nkl
e,p
ate
ll
a,t
ib
ia,

f
ib
ula
,fe
mur
,pe
lvi
s,h
eadt
hor
aci
c,a
bdo
min
ala
nds
pin
ali
nj
ure
s.

4.
Fal
l
sorj
ump
s:I
nge
ner
al,
ina
nyf
all
gre
ate
rth
anf
eet
,sus
pec
tin
ter
nal
inj
uri
es.
Spi
nal
and

b
rai
nin
jur
y,b
il
ate
ral
ske
let
alf
rac
tur
eso
fth
eca
lca
neu
s’s(
hee
lbo
ne)
,lo
were
xtr
emi
ti
es,
lon
g

b
one
san
dpe
lvi
s;v
ert
ic
als
hea
ran
dco
mpr
ess
ionf
rac
tur
e.

Ax
ial
loa
din
g(f
orc
eap
pli
edup
war
dord
own
war
dwi
tho
utb
end
ing
)oft
hec
erv
ica
lve
rte
bra
lan
d

l
umb
ars
pin
ema
yre
sul
tinb
urs
tfr
act
ure
s,c
omp
res
sio
nfr
act
ure
s,d
isl
oca
tio
ns,
ord
iske
xtr
usi
on,

d
eta
chme
nto
fth
ora
cica
ort
aan
dso
li
dor
gan
ssuc
hast
hel
i
vero
rsp
lee
n,o
rCo
ll
esf
rac
tur
e.

Ba
ckwa
rdsf
all
son
tot
heo
cci
putc
aus
ehi
gh-
mor
tal
i
tys
kul
lfr
act
ure
s.

5.
Agg
rav
ate
das
saul
ts
:st
oma
chp
erf
ora
tio
n,d
iap
hra
gma
ticl
ace
rat
io
nan
doe
sop
hag
alr
upt
ure
,

l
ace
rat
edl
i
vero
rsp
lee
n,o
rac
utes
ubd
ura
lhe
mat
oma
.

6
.Gun
sho
two
und
:Ti
ssuec
ell
smo
vef
orwa
rda
ndl
ate
ral
fro
mth
esi
tec
aus
ingt
is
suec
omp
res
sio
n

a
nds
tre
tch
ingi
nap
roc
essc
all
edc
iva
tio
n.Th
ere
sul
tist
is
sue
,bo
nea
ndo
rga
nde
str
uct
io
nfr
om

b
urn
ing
,ex
pan
din
gga
ses
.Bul
l
ete
ntr
y,e
xitwo
und
sar
ela
rge
rth
ane
ntr
ywo
und
san
dha
vef
ray
ed

e
dge
s.Ea
cht
is
suewo
unda
ndt
rac
toft
heb
ull
ett
raj
ect
orys
houl
dbec
ons
ide
redc
are
ful
l
y.

1
00
7.
Imp
ale
men
t/s
tabwo
und
:Imp
ale
dob
jec
tss
houl
don
lyb
eex
plo
reda
ndr
emo
vedi
nth
eop
era
tin
g

r
oom.
Dia
phr
agma
tict
hor
aci
cin
jur
ies(
bel
owt
hef
our
thi
nte
rco
sta
lss
pac
e)ma
yin
vol
ves
truc
tur
es

i
nth
eab
dome
n.1
:4p
eop
les
ust
ain
ingp
ene
tra
tin
gab
domi
nal
inj
uri
esh
avea
sso
cia
tedc
hes
t

i
nj
uri
esEx
ten
siv
ein
ter
nal
dama
gema
yre
sul
tfr
omwe
apo
nmo
veme
nt.

B-
II
I.Nur
si
ngp
roc
ess
:Bo
dil
yre
spo
nset
otr
auma
:Ea
cht
rauma
tis
edp
ati
enti
ncur
sva
ryi
ng

d
isr
upt
io
nsi
nth
ehe
mod
yna
mic
,immun
olo
gic
,an
dme
tab
oli
csy
ste
mso
fth
ebo
dy.
Imp
rov
ed

s
urv
iva
bil
i
tyo
ftr
aumap
ati
ent
sisa
cco
mpl
i
she
dbye
arl
yan
dag
gre
ssi
vema
nag
eme
nto
fbl
eed
ing
,

a
irwa
yco
mpl
i
cat
io
nsa
ndi
nfe
cti
ousc
omp
li
cat
io
nan
dbyt
hea
ssur
anc
eofa
deq
uat
enut
ri
ti
ona
l

i
nta
ke.

A.
Hemo
dyn
ami
cre
spo
nse
:Tr
aumaa
ndi
nj
urya
ret
hemo
stc
ommo
nca
use
sofl
i
fe-
thr
eat
eni
ng

h
aemo
rrh
ageo
rhy
pot
ens
ive
ssh
ocks
tat
es.
Hae
mor
rha
ge(
acut
ebl
eed
ing
)ma
ybeo
bvi
ouso
r

o
ccul
t.Th
eex
ten
tofi
nj
urya
nds
umo
flo
stb
loo
dco
rre
lat
eswi
thf
ours
tag
eso
fsh
ock
.

C-
1.As
ses
sme
nto
fTr
auma
tis
edPa
tie
nt/
Nur
si
ngDi
agn
osi
s

a
.Si
gna
nds
ymp
toms(
fora70k
gpe
rso
n)

i
.Mi
l
dha
emo
rrh
age
-upt
o15% o
fbl
oodv
olume(
750mL)
:sl
i
ghth
ypo
ten
siv
eduet
olo
wbl
ood

v
olume
;ta
chy
car
dia>1
00b
eat
s/mi
nut
est
oin
cre
asec
ard
iaco
utp
ut;c
ool
,pa
les
kin
;an
xie
ty;

d
il
ate
dpu
pil
s;c
api
l
lar
yre
fi
ll(
>2 s
eco
nds
);f
lui
dsh
ift
s;s
ymp
ath
eti
cre
spo
nse
s;r
ele
aseo
f

n
ore
pin
eph
rin
ean
dep
ine
phr
ineh
ormo
nes
,al
lino
rde
rtoi
ncr
eas
eca
rdi
aco
utp
ut.Re
spo
nset
o

f
lui
d r
esus
cit
ati
on.
ii
. Mo
der
ate h
aemo
rrh
age
-up 25% o
fbl
ood v
olume (
1250 mL)
:

mo
der
ateh
ypo
ten
sio
n(>90mm Hgs
yst
oli
c)
;hy
pox
iad
uet
omi
nut
e);t
ach
ypn
ea;c
ool
,pa
les
kin
;

c
api
l
lar
yre
fi
llp
oor
;le
tha
rgy
;we
akn
ess
;de
cre
ase
dur
ineo
utp
ut(
25mL/
hour
)ve
nousr
etur
n

d
ecr
eas
e;“
loo
kba
d.”Re
spo
ndt
ofl
ui
dre
sus
cit
ati
on.

i
i
i.S
eve
reh
aemo
rrh
age
-upt
o35%o
fbl
oodv
olume(
1800mL)
:mo
der
atet
ose
ver
ehy
pot
ens
ion

(
60-
90 mm Hgs
yst
ol
ic
);h
ypo
xia
;ta
chy
car
dia(
>120 b
eat
s/mi
n);c
old
;cy
ano
sis
;ag
it
ati
on;

c
onf
usi
on;d
ecr
eas
edur
ineo
utp
ut(
<15mL/
hour
);s
hun
tin
gtoc
oreo
rga
ns(
bra
in,h
ear
t,k
idn
eys
),

1
01
me
tab
oli
cdy
sfun
cti
on.Re
fra
cto
ryt
ocr
yst
all
oi
dfl
ui
dsr
esus
cit
ati
on.Li
kel
yton
eedb
loo
dtr
ans

f
unc
ti
ona
nds
urg
eryt
oco
rre
ctt
heun
der
ly
ingp
rob
lem

i
v.Ex
tre
meh
aemo
rrh
age
-upt
o50%o
fbl
oodv
olume(
2500mL)
:pr
ofo
undh
ypo
ten
sio
n(<6
0

mmHgs
yst
oli
c)
,se
ver
ehy
pox
ia,
bra
dyc
ard
iawi
thd
ecr
eas
edp
uls
epr
ess
ure
s,s
kinc
olda
nd

mo
ttl
ed,
oli
gur
iaun
con
sci
ous
;ma
yre
sul
tini
rr
eve
rsi
bl
ece
lla
ndo
rga
nde
ath
.Ex
san
gui
nat
io
nan
d

c
ir
cul
ato
ryf
ail
urel
eadt
oca
rdi
aca
rre
st.

2.
1.
2b.
Dia
gno
sti
cte
sts
.

i
.Se
rum

Tr
aumal
abo
rat
oryp
rot
oco
l:us
edf
ormo
stp
ati
ent
swi
ths
eve
ret
rauma
.In
clud
esc
omp
let
ebl
ood

c
oun
t,c
hemi
st
ry,
coa
gul
ati
ons
tud
ies
,ar
ter
ial
blo
odg
ase
s(ABG)t
oxi
col
ogys
cre
en,
li
verf
unc
ti
on

t
est(
LFT)
,amy
las
e,ur
inea
nal
ysi
s,a
ndb
loo
dte
stf
ort
ypea
ndc
ros
sma
tch
.

Co
mpl
et
ebl
oodc
oun
t:Us
eda
sani
ndi
cat
oro
fth
ese
ver
it
yofb
loo
dlo
ss,
nee
dfo
rbl
oodt
ran
sfus
ion
,

a
nda
sse
ssme
nto
fon
goi
ngb
loo
dlo
ss(
bas
edo
npr
ogr
ess
ive
lyd
ecr
eas
ingh
aemo
glo
bina
nd

h
ema
toc
ri
t)
,an
dpr
ovi
desb
ase
li
nev
alue
sfo
rwh
iteb
loo
dce
ll
s,a
ndp
lat
ele
ts

Ch
emi
st
ry:Pr
ovi
desd
ataf
ora
sse
ssme
nto
fel
ect
rol
yt
esi
mba
lan
ces
,pa
rti
cul
arl
yimp
ort
anti
n

c
ase
sofh
ypo
vol
emi
aan
dde
hyd
rat
io
n.Al
soh
elp
ful
toe
val
uat
ere
nal
fun
cti
onb
ase
donb
loo
dur
ea

n
itr
oge
n(BUN)a
ndc
rea
tin
inev
alue
s.

Co
agul
ati
ons
tud
ies
:mo
stc
ommo
nlyus
eda
ret
hep
rot
hro
mbi
nti
mea
ndp
art
ial
thr
omb
opl
ast
in

t
ime
.Itma
ybea
lte
redi
nca
seso
fse
ver
ein
jur
yorwh
enc
oag
ulo
pat
hyd
eve
lop
s

ABG:I
mpo
rta
ntf
ort
hea
sse
ssme
nto
fre
spi
rat
oryd
ysf
unc
ti
on,
hyp
oxe
mia
,hy
per
car
bia
,an
d

me
tab
oli
corr
esp
ira
tor
yac
id-
bas
eimb
ala
nce
s.

To
xic
olo
gy:us
eful
fort
hea
sse
ssme
nto
fal
coh
oli
nto
xic
ati
ona
ndp
res
enc
eofi
l
li
ci
tdr
ugs
,an
yof

wh
ichma
yca
usea
lte
rat
io
nsi
nth
epa
tie
ntme
nta
lst
atus
.

LF
T:F
req
uen
tlyus
eda
sane
arl
yin
dic
ato
rofl
i
veri
nj
ury
.Al
soh
elp
ful
toa
sse
ssf
ort
hep
res
enc
eof

1
02
c
hro
nicl
i
verd
ise
ase
.

Amy
las
e:I
ndi
cat
oro
fpa
ncr
eat
ici
nj
ury
.Ma
yal
sob
eel
eva
tedi
nca
seso
fse
ver
epe
rit
oni
ti
s.

A-
ii
.Ur
ine

Ur
inea
nal
ysi
s:Th
epr
ese
nceo
fre
dbl
oodc
ell
sint
heur
inema
ysug
ges
tre
nal
orur
oge
nit
al

t
rauma
.Ina
ddi
ti
on,
theur
inec
anb
eus
edf
ort
oxi
col
ogys
cre
ena
nda
sse
ssme
nto
fth
ead
equa
cy

o
fre
nal
fun
cti
on.
Con
cen
tra
tedur
inewi
thh
ighs
pec
if
icg
rav
it
yisc
ommo
nlys
eenwi
thh
ypo
vol
emi
a

a
ndd
ehy
dra
tio
n.

B-
ii
i
.Ot
her

Pl
ai
nra
dio
gra
phi
c:Co
mmo
nlyo
rde
redx
-ra
ysi
nal
lpa
ten
twi
ths
eve
reb
lun
ttr
aumai
ncl
ude
:th
ree

-
vi
ewc
erv
ica
lsp
inex
-ra
ysa
nte
rio
r-p
ost
eri
orv
iewso
fth
ech
esta
ndp
elv
is.

Co
nsi
dera
dmi
ni
st
rat
io
nofv
aso
act
iv
edr
ugs
,bute
nsur
eth
atf
lui
dre
ple
ti
onsc
omp
let
edb
efo
re

i
ni
ti
ati
ng.

Mo
nit
ora
ndma
int
ainur
ineo
utp
ut(
UOP)g
rea
tert
han50mLh
our(
mus
tbeg
rea
tert
han1mL/
kg

p
erh
ourf
orc
hil
dre
n).
Ifmy
ogl
obi
nisp
res
enti
nur
inef
roms
eve
remus
cleo
rbur
nsi
nj
ury
,ma
int
ain

UOPg
rea
tert
han1
00mL/
hourt
oav
oidn
eph
rot
oxi
ci
ty
.

As
ses
spul
sesa
nds
kint
emp
era
tur
eev
eryh
our
.

Co
mpl
et
ene
uro
log
ice
xamse
ver
y1-
4ho
urst
oas
ses
sce
reb
ral
per
fus
ion
.

Mo
nit
orc
hemi
st
ryl
abwo
rkt
oas
ses
sre
nal
fun
cti
on(
BUN,
cre
ati
ni
ne)a
ndLF
T.F
ell
ows
eri
al

h
aemo
glo
bin
/he
mat
ocr
ite
lec
tro
lyt
eimb
ala
nce
s.

C-
ii
i
.De
sir
edo
utc
ome

Ad
equa
teo
xyg
enp
erf
usi
ono
fti
ssue
san
dor
gan
sase
vid
enc
edb
yno
rma
lme
nta
tio
n,UOPg
rea
ter

t
han50mL/
hour
,no
rma
lre
nal
ande
lec
tro
lyt
ela
bva
lue
s.

1
03
Bl
eed
ingc
ont
rol
l
edwi
tha
ppr
opr
iat
ewo
undma
nag
eme
nto
rop
era
tiv
ein
ter
ven
tio
n.Re
memb
er

t
hath
aemo
rrh
agef
roms
oil
org
ans(
suc
hast
hel
i
vera
nds
ple
en)c
anb
ese
lf
-l
imi
te
dift
hee
xte
nt

o
fth
ein
jur
yisn
ots
eve
re.

Ar
ter
ial
pre
ssur
e,c
ard
iaco
utp
uto
xyg
ens
atur
ati
on,
andc
ent
ral
ven
ousp
res
sur
ere
tur
nto

b
ase
li
ne.

Vi
tal
sig
nst
ono
rma
lra
nge
.

S
hoc
kan
dfl
ui
dvo
lumeo
ver
loa
dar
eav
oid
ede
vid
enc
ebyc
lea
rlun
gfi
el
dsa
nda
bse
nceo
foe
dema
.

I
n-t
extQue
sti
on

De
fi
neTr
auma

An
swe
r:

Tr
aumai
sth
eph
ysi
cal
inj
uryc
aus
edb
yin
ten
tio
nal
andun
int
ent
io
nal
for
cese
xer
tedo
nth
ebo
dy.

2.
1.
3b.
Anx
iet
y-
rel
ate
dtoa
nac
uted
ecr
eas
eofh
eal
ths
tat
usa
nda
ctua
lth
rea
tofd
eat
h.

i
.Pr
obl
em:F
earo
fdy
ing
,re
stl
ess
nes
stoc
omp
act
nes
s,h
ope
les
sne
ss,
res
ist
anc
etot
rea
tme
nt.

i
i
.In
ter
ven
tio
ns

 I
mme
dia
ten
urs
inga
cti
onst
ore
ver
set
rauma
tics
hoc
kde
sce
nt,

 En
sur
epa
tie
nth
asa
deq
uat
epa
inme
dic
ati
onc
ove
rag
e.Pa
tie
ntswh
oar
eil
l
ici
tdr
ugsma
y

r
equi
rel
arg
edo
seso
fpa
inme
dic
ati
ons

 Li
st
ent
oth
epa
tie
nt

 Ta
lkt
oth
epa
tie
nta
ndf
ami
l
y;e
xpl
ai
nin
ter
ven
tio
nan
dpr
ovi
dei
nfo
rma
tio
nasa
ppr
opr
iat
e.

 Ma
int
ainah
ope
ful
out
loo
k.

 Al
l
owf
ami
l
yan
dpa
tie
ntp
ri
vat
eti
me

 En
cour
agef
ami
l
yme
mbe
rst
ore
mai
ncl
oseb
yasa
ppr
opr
iat
e.

 Bep
rep
are
dtor
epe
ati
nst
ruc
ti
onsma
nyt
ime
s.

 Ad
min
ist
era
nti
anx
iet
yme
dic
ati
onsa
sne
ede
d

1
04
  Ac
cur
ate
lya
sse
ssa
lco
hol
andi
l
li
ci
tdr
ugus
epr
iort
oth
etr
auma
.

 Al
coh
olwi
thd
rawa
lwi
l
lca
uses
eve
rea
nxi
et
yan
dsh
oul
dbea
voi
dedwi
tha
ppr
opr
iat
e

p
rop
hyl
act
ict
rea
tme
nt:l
ora
zep
ama
ndo
xaz
epa
m.

 Co
nsul
tps
ych
olo
gis
ts,
soc
ial
wor
ker
s,a
ndc
ler
gyp
ers
onn
el’
sasn
eed
ed.

A-
ii
i
.De
sir
edo
utc
ome

 Pa
tie
nta
blet
ofo
ll
owt
hec
omma
nd,
ver
bal
i
sef
eel
i
ngsa
ndc
omp
lai
nts
,an
dma
ke

a
ppr
opr
iat
ehe
alt
hca
rea
ndr
eco
ver
yde
cis
ion
s.

 Pa
tie
ntsa
ndf
ami
l
yme
mbe
rsf
eel
sup
por
teda
ndc
are
dfo
rbyt
het
raumat
eam.

 Th
epa
tie
nt’
sst
ateo
fpa
ina
nda
nxi
et
yre
li
eve
d.

B.
Immun
olo
gicr
esp
ons
e:Ea
rlyr
eco
gni
ti
ono
fan
yfo
rmo
fin
fec
ti
oni
nth
etr
aumap
ati
enti
s

e
sse
nti
alt
oav
oidb
act
ere
mia
,se
psi
san
dmul
ti
sys
temo
rga
nfa
il
ure
.Th
iswi
l
lre
duc
emo
rbi
di
tya
nd

s
avel
i
ves
.In
cre
ase
dba
cte
ria
lpr
oli
fe
rat
io
nan
dco
lon
isa
tio
nma
yac
ti
vat
eac
utei
nfl
amma
tor
y,

c
hemi
cal
,an
dce
ll
ul
arr
esp
ons
es.

Co
mmo
nso
urc
eso
fin
fec
ti
oni
ncl
udewo
unda
nde
xte
nde
dpr
ess
ures
it
es;r
esp
ira
tor
yan
dur
ina
ry

t
rac
ts;a
ndt
heg
ast
roi
nte
sti
nal
sys
tem,
all
ofwh
ichc
anl
eadt
oba
cte
remi
a.Ot
herp
ote
nti
al

s
our
cesi
ncl
udeb
act
eri
atr
ans
loc
ati
onf
romt
heg
ast
roi
nte
sti
nal
tra
ct;s
inusi
nfe
cti
ons
;to
oth
,br
ain
,

a
bdo
min
al/
per
ine
ala
bsc
ess
;or
gana
ndt
is
suei
nfe
cti
onso
fth
ehe
artl
i
nin
g,c
olo
n,

p
anc
rea
s,g
all
bl
add
er,
pro
sta
te,
app
end
ix,
ore
ars
;an
din
dwe
ll
in
gca
the
ter
san
dli
nes
.

B-1
.As
ses
sme
nt

a
.Si
gnsa
nds
ymp
toms

i
.Sy
ste
mici
nfe
cti
on:S
usp
ects
eps
isi
fth
erei
sac
han
gei
nth
ecl
i
nic
alp
ict
urei
ncl
udi
ngc
hil
l
s

f
ol
lo
wedb
yfe
vero
rhy
pot
her
mia
,ta
chy
car
dia
,ta
chy
pne
a,o
li
gur
ia,
mal
ai
se,
con
fus
ion
,

h
emo
dyn
ami
cch
ang
es,
andl
euk
ocy
tos
is(
inc
rea
sedl
euk
ocy
tes
:wh
itec
ell
sin
cre
ase
).

i
i
.Lo
cal
i
sedi
nfe
cti
on:Re
dne
ss,
ten
der
nes
s,wa
rmt
h,s
wel
l
ing
,pur
ule
ntd
rai
nag
efr
omt
hei
nj
ury

s
it
e,a
ndd
ysf
unc
ti
on

1
05
b
.Di
agn
ost
ict
est
s

i
.Se
rum

 S
erum:Lo
wpl
ate
letc
oun
t;wh
iteb
loo
dce
llc
oun
tan
ddi
ff
ere
nti
alf
luc
tua
tio
nsa
nd

i
ncr
eas
es(
>10%)o
fba
nds(
occ
urswi
thl
euk
ocy
tos
is)
;la
cta
te;mus
tob
tai
nbl
oodc
ult
ure
s

(
fora
sse
ssme
nto
fba
cte
rae
miaa
nds
eps
is)
.

 ABG:a
cid
osi
s

 Ur
ina
lys
isc
ult
urea
nds
ens
it
iv
it
y

 BUN:i
ncr
eas
e:c
rea
tin
inec
lea
ran
ce:d
ecr
eas
es

 Co
agul
ati
ons
tud
ies
:di
sse
min
ate
din
tra
vas
cul
arc
oag
ula
tio
nma
yde
vel
opf
roms
eps
is

 Li
verf
unc
ti
ont
esta
ndb
il
ir
ubi
n:ma
ybee
lev
ate
dina
cal
cul
ousc
hol
ecy
sti
ti
s.

C-
ii
.Cul
tur
es:a
lwa
yso
bta
inp
ri
ort
odr
ugt
her
apyo
rac
han
gei
nan
tib
iot
ict
her
apy
.Do
cume
nta
nd

s
pec
if
ydr
ugsa
dmi
ni
st
ere
dth
roug
houtt
her
egi
men
;be
dsi
deb
ron
cho
sco
pyc
ult
ure
s.

 Ae
rob
ica
nda
nae
rob
icc
ult
ure
soft
hewo
unds
it
ean
ddr
ain
ages
it
es

 Bl
oodc
ult
ure
s;at
ota
loft
wos
etso
bta
ine
dfr
omd
iff
ere
nts
it
esa
nda
tti
mes
.

 S
put
um;Gr
ams
tai
nan
dcul
tur
e

 Lumb
arp
unc
tur
e

i
i
i.Ra
dio
gra
phs

 Ch
est
,ab
domi
nal
,ors
inusx
-ra
ys

 Ul
tr
aso
undo
rCTs
can
.

I
n-t
extQue
sti
on

I
ntr
aumaa
sse
ssme
nto
fBl
oodur
eaNi
tr
oge
n(BUNa
ndc
rea
tini
ne)
,wha
tiss
een?

An
swe
r

 BUN:i
ncr
eas
e

 Cr
eat
ini
nec
lea
ran
ce:d
ecr
eas
es

1
06
2.
2.2.
Pat
ie
ntma
nag
eme
nt

a
.Po
ten
tia
lfo
rin
fec
ti
onr
ela
tedt
odi
sr
upt
io
nofn
orma
lde
fen
ceme
cha
nis
ms.

i
.Pr
obl
em:c
ir
cul
ato
rys
hoc
kst
ate
,hy
pox
emi
a,p
neumo
nia
,se
psi
san
dsy
ste
mic

i
nfl
amma
tor
yre
spo
nse
ssy
ndr
ome
.

i
i
.In
ter
ven
tio
n

Re
sus
cit
ati
onp
has
e

 Us
est
ri
cta
sep
ti
can
dst
eri
l
ete
chn
ique
sdur
ingp
roc
edur
es.

 Us
eun
ive
rsa
lpr
eca
uti
onsd
uri
ngt
hec
areo
fop
enwo
und
s.

 Ex
erc
isee
xce
ll
enth
and
-wa
shi
ngs
kil
l
s.

 I
nst
it
utei
nfe
cti
onc
ont
rol
andi
sol
ati
onp
rec
aut
io
ns

 Co
mpl
et
edr
ess
ingc
han
geso
npe
rip
her
ala
ndc
ent
ral
li
nesa
cco
rdi
ngt
oin
sti
tut
io
nal
pol
i
cy.

 Ch
ang
ein
tra
ven
ousc
ath
ete
rsi
te
sac
cor
din
gtoi
nst
it
uti
ona
lpo
li
cy

 As
ses
sin
tra
ven
ouss
it
ese
ver
ysh
iftf
orr
edn
esso
rsi
gno
fin
fec
ti
on;d
isc
usswi
th

p
hys
ici
anst
hen
eedt
och
ang
ein
fec
tedc
ent
ral
li
nes
;imme
dia
tel
ydi
sco
nti
nue
dan
y

i
nfe
cte
dpe
rip
her
all
i
nesa
nds
tar
tne
win
tra
ven
ousl
i
nesi
nan
oth
ers
it
e.

2.
2.1I
nte
rve
nti
onc
ont
inue
d

 Di
sco
nti
nuea
lli
nva
siv
ede
vic
esa
sso
ona
spo
ssi
bl
e.

 I
fth
ecl
ose
dsuc
ti
ons
yst
emus
ed,
cha
nget
hes
yst
eme
ver
y24h
our
s;us
ecl
ose
dsuc
ti
oni
f

t
hep
ati
enti
ntub
ate
dev
ery24h
our
s.

 Af
terwo
undc
ult
ure
sar
eob
tai
ned
,el
i
min
atet
hep
oss
ibi
l
ityo
fin
fec
ti
onsc
ont
ami
nat
io
n

wi
the
arl
ytr
eat
men
tso
fir
ri
gat
io
n,d
ebr
ide
men
t,a
nds
urg
ica
lin
ter
ven
tio
nifn
eed
ed

 Ad
min
ist
eri
ntr
ave
nousa
nti
bi
ot
ic
sasp
res
cri
bed

I
nte
nsi
veCa
rePh
ase

 Mo
nit
orf
ore
arl
ysi
gnso
fse
psi
san
dsy
ste
mici
nfl
amma
tor
yre
spo
nse
ssy
ndr
ome

 Do
cume
nta
ndt
ren
dqua
nti
tya
ndq
ual
i
tyo
fwo
undd
rai
nag
e.

1
07
  De
bri
den
ecr
oti
cti
ssue
swi
thl
oca
lwo
und
sca
rea
ndf
req
uen
tdr
ess
ingc
han
ges
.

 Ad
min
ist
era
nti
bi
ot
ic
sjud
ici
ous
lyt
oma
int
aina
deq
uat
ele
vel
sint
heb
loo
d;mo
nit
ord
rug

i
nco
mpa
tib
il
it
ie
scl
ose
ly.

 Pr
eve
ntp
ulmo
nar
yin
fec
ti
onsb
yre
pos
it
io
nin
gpa
tie
ntsa
nda
ssi
st
ingi
nan
douto
fbe
d

f
req
uen
tly
,co
mpl
et
ingc
hes
tph
ysi
cal
the
rap
y,us
ings
ter
il
esuc
ti
oni
ngt
ech
niq
ues
,an
d

c
han
gin
gve
nti
l
ato
ryt
ubi
nga
ndc
los
eds
uct
io
npe
rin
sti
tut
io
nal
pol
i
cy.

 De
cre
asee
xpo
sur
eton
oso
comi
alo
rga
nis
msb
yus
ingb
asi
cin
fec
ti
onc
ont
rol
tec
hni
que
s.

 En
sur
ead
equa
ten
utr
it
io
nal
sup
por
t:o
ral
,en
ter
al,
orp
are
nte
ral
;ob
tai
nda
il
ywe
igh
ts.

 Ma
int
ains
kini
nte
gri
ty
:Po
sit
io
nan
dtur
nev
ery2h
our
s,p
rov
ideap
res
sur
e-r
eli
evi
ngs
lee
p

s
urf
ace
,ba
thep
ati
entus
ingmi
l
dso
apa
ndwa
rmwa
ter
,pr
ote
cts
kinf
romur
inea
ndf
aec
al

e
xpo
sur
e.

 Tr
ans
fert
oth
ein
ter
med
iat
eca
reun
ita
sso
ona
spo
ssi
bl
etod
ecr
eas
eth
efr
eque
ncyo
f

n
oso
comi
ale
xpo
sur
efo
undi
nth
eIn
ten
siv
eCa
reUn
it.

A-
ii
i
.De
sir
edo
utc
ome

 Ab
sen
ceo
fsi
gnsa
nds
ymp
tomso
fin
fec
ti
on.

 Bl
ood
,ur
ine
,sp
utum,
andwo
undc
ult
ure
sar
ene
gat
iv
e

 Pr
eve
nti
ono
fno
soc
omi
ali
nfe
cti
on

a
.Al
ter
edt
is
sue
spe
rfus
ionr
ela
tedt
oth
ehy
per
dyn
ami
cst
ateo
fse
pti
csh
ocka
nds
eps
is

i
.Pr
obl
em:c
ata
bol
i
cme
tab
oli
c;i
nef
fec
ti
vewo
undh
eal
i
ng;d
imi
ni
she
dce
reb
ral
,co
ron
ary
,an
d

o
rga
nbl
oodf
lo
w.

B-
ii
.I
nte
rve
nti
on:

 At
temp
ti
ngt
oid
ent
if
yth
eso
urc
eofi
nfe
cti
ous
;ob
tai
nur
ine
,se
rum,
sput
um,
andwo
und

c
ult
ure
s

 Pr
ovi
dep
ulmo
nar
ysup
por
t:o
xyg
en,
ven
til
ati
ona
ndp
osi
ti
vea
nde
xpi
rat
oryp
res
sur
e,

1
08
 c
ons
tan
tre
pos
it
io
nin
gwi
tht
heh
eado
fbe
dupa
sne
ces
sar
y.

 Co
rre
ctf
lui
dvo
lumed
efi
ci
tswi
thc
rys
tal
l
oid
.Ad
min
ist
erf
lui
ds(
lac
tat
edRi
nge
r’
sso
lut
io
n

o
rno
rma
lsa
li
ne)t
oma
int
ains
yst
oli
cbl
oodp
res
sur
egr
eat
ert
han90mmHgUOPg
rea
ter

t
han50Ml
/ho
ur.

 Tr
ans
fus
eco
ll
oi
ds(
blo
odp
rod
uct
s)a
cco
rdi
ngt
oha
emo
glo
bin
/he
mat
ocr
itr
esul
ttoi
mpr
ove

o
xyg
en-
car
ryi
ngc
apa
cit
y.

 Ad
min
ist
erv
aso
pre
sso
rs,
buto
nlya
fte
rth
efl
ui
dvo
lumeh
asb
eenr
epl
ace
d,t
oma
int
ain

a
deq
uat
ebl
oodp
res
sur
e.

 S
ter
oidus
etod
ecr
eas
eca
pil
l
aryl
eaki
sco
ntr
ove
rsi
ala
ndi
sno
tre
comme
nde
dint
rau
ma

p
ati
ent
satp
res
ent
.

 Mo
nit
ora
rte
ria
lpr
ess
ure
,ce
ntr
alv
eno
usp
res
sur
e,p
ulmo
nar
yar
ter
ypr
ess
ure
,an
dABGs
;if

c
han
geso
ccur
,di
scus
sth
epl
ano
fca
rewi
tht
hep
hys
ici
an.

 Mo
nit
orBUNa
ndc
rea
tin
inet
oas
ses
sre
nal
fun
cti
oni
nga
ndr
eco
gni
sest
hen
eedf
or

d
ial
ysi
s.

 Mo
nit
oro
rie
nta
tio
nan
dme
nta
lfun
cti
oni
ngt
ode
ter
min
ece
reb
ral
per
fus
ion
.

 Pr
ovi
dea
deq
uat
enut
ri
ti
ona
lsup
por
t:c
alc
ula
tet
oac
coun
tfo
rin
cre
asec
alo
ricr
equi
reme
nt

c
aus
edb
yth
ehy
per
dyn
ami
cst
ate
.

 Mo
nit
ora
ndd
ocume
nti
nta
kea
ndo
utp
ut.

C-
ii
i
.De
sir
edo
utc
ome

 F
lui
dvo
lumeo
ver
loa
disp
rev
ent
eda
sev
ide
nceb
yno
rma
lce
ntr
alv
eno
usa
ndp
ulmo
nar
y

a
rte
ryp
res
sur
es.

 Ox
yge
nat
io
nofb
loo
disa
deq
uat
eade
vid
enc
ebyp
uls
eox
yge
nat
io
ngr
eat
ert
han94%a
nd

n
orma
lABG.

 Or
ganp
erf
usi
onur
ineOut
put
,pa
lpa
blep
uls
es,
war
mdr
ysk
in,
nor
mal
LFT.

2.
2.2c
.Hy
per
the
rmi
are
lat
edt
oth
ein
fla
mma
tor
ypr
oce
ss,
hyp
er-
met
abo
li
cst
ate
,orc
ir
cul
ati
ng

1
09
p
yro
gen
ic.

i
.Pr
obl
em:I
ncr
eas
eme
tab
oli
cre
qui
reme
nts
.

i
i
.In
ter
ven
tio
n

 I
den
tif
yin
fec
ti
ouss
our
cesa
ndo
rga
nis
msb
yob
tai
ni
ngur
ines
erum,
sput
um,
andwo
und

c
ult
ure
s.

 Do
cume
nta
ndt
ren
dco
ret
emp
era
tur
ese
ver
yho
urf
ori
nef
fec
ti
vet
her
mor
egul
ati
on.

 Mo
nit
orh
ear
tra
te;f
eve
riso
fte
nas
soc
iat
edwi
tht
ach
yca
rdi
a.

 I
ffe
bri
l
ead
min
ist
era
nti
pyr
eti
cdr
ugt
her
apy
,aso
rde
red

 Af
tert
hep
ati
enth
asr
eac
hedma
ximumt
emp
era
tur
eas
sis
twi
thc
ool
i
ngt
ech
niq
ues
:co
ol

r
oom,
max
imi
sea
irf
lo
w,p
rov
idec
ool
wat
erb
ath
,pr
ovi
ded
ryc
lot
hin
g.

 As
sis
twi
ths
urg
ica
ldr
ain
ageo
fex
uda
tiv
ele
sio
nsa
nda
bsc
ess
es.

 Mi
ni
mis
ein
vas
ivet
her
api
es;d
isc
ont
inuei
nva
siv
eli
nesa
ndt
ube
sass
oona
spo
ssi
bl
e.

 Ad
min
ist
ers
yst
emi
can
tib
iot
ic
sba
sedo
nsus
pec
tedp
ath
oge
ns,
cul
tur
ere
sul
tsa
ndt
he

o
rga
nis
m’sa
nti
bi
ot
ics
ens
it
iv
it
y,a
sor
der
ed.

 Mo
nit
orc
alo
rici
nta
ket
oen
sur
eth
atn
utr
it
io
nme
etsi
ncr
eas
edme
tab
oli
cde
man
ds.

A-
ii
i
.De
sir
edo
utc
ome

 Re
sto
rat
io
nton
orma
lco
reb
odyt
emp
era
tur
e(3
70C)

 Ca
lor
ici
nta
kes
uff
ic
ien
ttome
etd
ema
nds

 He
artr
ater
etur
nst
oba
sel
i
ne.

A.Me
tab
oli
cre
spo
nse
s:I
njur
eda
ndi
nte
nsi
vel
yil
lpa
tie
ntse
xpe
rie
nci
ngv
ary
ings
tre
ssl
eve
lst
hat

c
ant
ri
gge
rth
ebr
eak
downo
fca
rbo
hyd
rat
e,p
rot
ei
nan
dfa
t(c
ata
bol
i
cst
ate
).I
ncr
eas
eds
tre
ssa
nd

e
ner
gyd
ema
ndsd
uet
oin
jur
yan
dde
cre
asei
nta
keo
fli
fe
-sus
tai
ni
ngn
utr
ien
tsn
ece
ssi
tat
ea

n
utr
it
io
nala
sse
ssme
nta
ndr
epl
eni
shme
ntwi
thi
n48-
72h
our
spo
sti
nj
ury
.Hy
per
met
abo
li
cst
ate
s

i
ncr
eas
eox
yge
nde
man
dan
dco
nsump
ti
ona
swe
lla
sba
sale
ner
gyn
eed
s.I
fnut
ri
ent
sar
eno
t

r
ead
il
yav
ail
abl
e,t
her
ewi
l
lbead
ela
yinwo
undh
eal
i
ng,
comp
romi
seo
fth
eimmun
ere
spo
nse
,an
d

1
10
l
osso
fen
erg
yre
ser
vesa
ndmus
cle
sma
ss.Th
eke
ytot
hep
rev
ent
io
nofme
tab
oli
cde
fi
ci
enc
iesi
s

e
arl
ynut
ri
ti
ona
lsup
por
twi
tha
deq
uat
epr
ote
ina
ndc
alo
rie
s.

B-
1.As
ses
sme
nt

a
.Si
gnsa
nds
ymp
toms

i
.Oe
dema

i
i
.We
igh
tlo
ss,
fatl
oss
,an
dmus
clewa
sti
ng

i
i
i.F
ati
gue
sea
sil
y

i
v.Pul
mon
aryi
nsuf
fi
ci
enc
yan
din
abi
l
ityt
owe
an

v
.Op
por
tun
ist
ici
nfe
cti
ons
.

b
.Di
agn
ost
ict
est
s

i
.Se
rum

 Bl
oodv
olumed
efi
ci
enc
ieso
fso
dium,
pot
ass
ium,
ser
uma
lbumi
n,t
ran
sfe
rri
n,p
re-
alb
umi
n,

l
owt
ota
lly
mph
ocy
tec
oun
t,c
rea
tin
ine
,gl
uco
sema
gne
sium,
pho
sph
orusa
ndt
rac
e

e
leme
nts

i
i
.Ur
ine

 Ur
ina
lys
is:me
asur
esn
itr
oge
nan
dgl
yco
sur
ia.

C-
2.Pa
tie
ntma
nag
eme
nt

a
.Al
ter
ati
onsi
nnut
ri
ti
on,
les
sth
anb
odyr
equi
reme
nts
,re
lat
edt
oin
cre
ase
dme
tab
oli
cde
man
d.

i
.Pr
obl
em:i
nsul
i
nre
sis
tan
ce,
pro
tei
nde
ple
ti
on,
mal
nut
ri
ti
on,
imp
air
edwo
undh
eal
i
ng,
inc
rea
sed

i
nfe
cti
onsa
ndo
rga
ndy
sfun
cti
on,
neg
ati
ven
itr
oge
nba
lan
ce(
uri
nen
itr
oge
nlo
ssd
uet
oin
cre
ase
d

p
rot
ei
nca
tab
oli
sm)
.

i
i
i.I
nte
rve
nti
ons

Nut
ri
ti
ona
las
ses
sme
nta
nde
arl
ysup
por
ti
ves
tra
teg
iesa
rer
equi
redt
ore
ple
nis
hst
ore
sof

c
arb
ohy
dra
tes
,pr
ote
insa
ndf
atswi
tho
ral
int
ake
,tub
efe
eli
ngs(
ent
era
l),
ors
ter
il
ein
tra
ven
ous

1
11
(
par
ent
era
l)a
dmi
ni
st
rat
io
n.

 Ea
rlyc
ons
ult
ati
onwi
thad
iet
ic
ian

 Ca
lcul
atec
alo
ricr
equi
reme
ntsa
ndmo
nit
ord
ail
ywe
igh
ts.
Mus
tes
ti
mat
eBa
sal
Ene
rgy

Ex
pen
dit
urea
ndmul
ti
pl
yby1
.5t
oob
tai
nca
lor
icr
equi
reme
ntd
uri
ngr
eco
ver
yfr
oms
eve
re

i
nj
ury
.

 Ma
int
aina
ccur
atec
alo
riec
oun
ts

 Ob
tai
na24-
hourur
ines
amp
leo
nceawe
ekt
omo
nit
orf
orc
rea
tin
inec
lea
ran
cea
nd

n
itr
oge
nba
lan
ce.

 Wh
eni
ni
ti
ati
ngp
are
nte
ral
nut
ri
ti
ono
bta
inf
ing
er-
sti
ckb
loo
dsug
arsf
req
uen
tly
.

 Ad
min
ist
eri
nsul
i
n,p
ota
ssi
um,
mul
ti
vi
tami
n,t
rac
emi
ner
als
,an
dot
hern
utr
it
io
nal
adj
unc
ts

a
sne
ede
d.

 Mo
nit
ori
nputa
ndo
utp
utf
req
uen
tly
.

 I
for
aln
utr
it
io
nal
sup
ple
men
tso
rde
reds
pac
ead
min
ist
rat
io
nsot
hatp
ati
ent
sar
ehun
grya
t

me
alt
ime
.Ad
dfl
avo
urst
oen
ter
alf
ormul
as(
suc
hass
tra
wbe
rryo
rch
oco
lat
esy
rup
).

 I
fth
epa
tie
ntc
ane
at,
enc
our
agef
ami
l
yme
mbe
rst
obr
ingf
avo
uri
tef
ood
stos
ti
mul
ate

c
alo
rici
nta
ke

 Mo
nit
orf
ord
iar
rho
ea.

2.
2.3i
i
i.De
sir
edo
utc
ome

 Th
epa
tie
ntc
ons
ume
smi
ni
mal
dai
l
yre
qui
reme
ntsa
ndv
it
ami
ns.
Mus
ten
sur
ead
equa
te

i
nta
keo
fpr
ote
ins
,ca
rbo
hyd
rat
esa
ndf
atso
nad
ietp
lan
.

 Ad
equ
atewo
undh
eal
i
ng

 F
lui
dan
del
ect
rol
yt
eba
lan
cen
orma
l

 Po
sit
iv
eni
tr
oge
nba
lan
ce

 We
igh
tga
in

 Re
tur
nton
orma
lba
sal
met
abo
li
smn
eed
:1500-
1800c
alo
rie
spe
rda
y(6
300-
756
0J/
day
)

1
12
 o
r1c
alo
rie
/kgp
erh
our(
4.2J
/kgp
erh
our
).

 Re
tur
ntoan
orma
ldi
eta
sso
ona
spo
ssi
bl
e

 Re
tur
nofa
ppe
ti
te

I
V.S
eve
rit
yca
teg
ori
eso
ftr
auma
.Pe
net
rat
ingi
nj
uri
esc
aus
ingt
ran
sac
ti
ono
rse
ver
ela
cer
ati
onst
o

h
eav
il
yva
scul
ari
seda
rea
sorv
it
alo
rga
nsa
rel
i
fe-
thr
eat
eni
ngi
nj
uri
es,
mul
ti
sys
temi
nj
uri
esh
ave

v
ary
ingd
egr
eeso
fsh
ock
.Bur
nsv
aryd
epe
ndi
ngup
ont
hei
nte
nsi
tyo
fhe
ata
nda
moun
toft
imeo
f

b
odys
urf
acec
ont
actwi
tht
heh
eats
our
ce.
Blo
odl
ossa
ndh
ypo
ten
sio
nva
ryd
epe
ndi
ngup
ont
he

t
imet
ode
fi
ni
ti
vei
nte
rve
nti
on(
dir
ectp
res
sur
e,a
deq
uat
efl
ui
dre
pla
ceme
nta
nds
urg
ica
lpr
oce
dur
e).

A-A.
Lif
e-t
hre
ate
nin
g:I
njur
iesi
nco
mpa
tib
lewi
thl
i
fei
nvo
lve
dma
ssi
vec
rus
hin
gin
jur
iest
ovi
tal

s
truc
tur
esi
nth
ech
est
,ab
dome
n,p
elv
is,
hea
dorn
eck
.

1
.In
jur
ies

a
.Di
sr
upt
io
nso
fox
yge
nex
cha
ngeo
rlun
gpr
oce
ss,
air
wayo
bst
ruc
ti
ono
rre
spi
rat
oryi
nsuf
fi
ci
ent
;

o
peno
rte
nsi
onp
neumo
tho
rax
,ma
ssi
veh
emo
tho
rax
,fl
ai
lch
esta
ndp
ulmo
nar
yco
ntus
ion
,tr
ach
eal

d
isr
upt
io
n;a
nda
irwa
yin
hal
ati
oni
nj
ury
.

b
.Di
sr
upt
io
nso
fci
rc
ula
tor
yst
atuso
ror
ganp
roc
ess
:gr
eatv
ess
elo
rar
ter
ial

d
isr
upt
io
nss
ucha
sao
rti
ctr
ans
act
io
norr
upt
ure
,in
tima
ldi
sr
upt
io
n,o
rpe
ric
ard
ial
tamp
ona
de.

c
.Di
sr
upt
io
nofn
eur
olo
gics
tat
us:l
osso
fsy
mpa
the
ti
cto
ne,
unc
ons
cio
usn
ess
,hi
ghc
ordi
nj
uri
es,

i
ntr
ace
reb
ral
hae
mor
rha
ge,
bra
ins
temc
omp
res
sio
n,o
rhe
mis
phe
ricd
ama
ge.

d
.Di
sr
upt
io
nso
fbo
nec
ont
inui
tyo
rva
scul
arp
roc
ess
:or
tho
pae
dici
nj
uri
ess
ucha
spe
lvi
ccr
usha
nd

e
xtr
emi
tya
mput
ati
ons
.

B-2.
Comp
li
cat
io
ns

a
.Ap
neao
rhy
pox
ia:a
nox
ia;ma
ybei
mme
dia
tel
yfa
tal

b
.Se
ver
ehy
pot
ens
ion
,Se
ver
esh
ock
,ore
xsa
ngui
nat
io
ns.

c
.Is
che
mia(
mus
cle
s,t
is
sue
,an
dbr
ain
.

d
.Ad
ultr
esp
ira
tor
ydi
st
res
ssy
ndr
ome
.

1
13
e
.As
pir
ati
ono
rno
soc
omi
alp
neumo
nia

f
.Se
psi
san
dsy
ste
mici
nfl
amma
tor
yre
spo
nses
ynd
rome

g
.Co
agul
opa
thi
es(
fr
eque
ntl
yduet
ohy
pot
her
mia
.

h
.Br
aind
eat
h

i
.Ca
rdi
aca
rre
st.

C-B.
Pot
ent
ial
l
yli
fe
-th
rea
ten
ing

1
.In
jur
ies

a
.Di
sr
upt
io
nso
fex
cha
ngeo
rlun
gpr
oce
ss:r
esp
ir
ato
ryi
nsuf
fi
ci
enc
y;p
neumo
tho
rax
,pul
mon
ary

c
ont
usi
onswi
tho
rwi
tho
utf
lai
lse
gme
nt,
tra
che
obr
onc
hia
ldi
sr
upt
io
nan
dtr
auma
ticd
iap
hra
gma
tic

r
upt
ure

b
.Di
sr
upt
io
nso
fci
rc
ula
tor
yst
atuso
ror
gans
yst
ems
:he
mod
yna
micc
omp
romi
sesp
oss
ibl
yduet
o

c
ard
iacc
ont
usi
on,
abd
omi
nal
org
ani
nj
uri
es(
li
vera
nds
ple
enmo
stc
ommo
n),
oes
oph
aga
l

d
isr
upt
io
n,o
rev
isc
era
tio
ns.

c
.Di
sr
upt
io
nso
fne
uro
log
ica
lst
atus
:al
ter
edl
eve
lofc
ons
cio
usn
ess
,br
aina
nox
ia,
cer
ebr
alo
ede
ma,

i
ncr
eas
edi
ntr
acr
ani
alp
res
sur
e,p
ara
lys
is,
orl
osso
fse
nsa
tio
npo
ssi
bl
yduet
ohe
ado
rsp
ina
l

t
raumao
rde
glo
vin
gin
jur
y.

d
.Di
sr
upt
io
nofb
onec
ont
inui
tyo
rva
scul
arp
roc
ess
:ar
ter
ial
ori
nti
mal
dis
rup
ti
on,
ope
norc
los
ed

mul
ti
pl
efr
act
ure
sord
isl
oca
tio
n,f
rai
lch
est
,fi
rs
tri
bfr
act
urewi
thp
oss
ibl
eun
der
ly
ings
ubc
lav
ian

a
rte
ryi
nj
ury
,bl
untc
hes
tora
bdo
min
alt
rauma
,cr
ush
edp
elv
ist
woo
rmo
rep
rox
ima
llo
ng-
bon
e

f
rac
tur
es,
max
il
lo
fac
ial
tra
uma
,ort
rauma
tica
mput
ati
ons
.

I
n-t
extQue
sti
on

Wh
ati
sth
ein
iti
alp
has
eint
hema
nag
eme
nto
fap
ati
entwi
tht
rauma
?

An
swe
r

Re
sus
cit
ati
onp
has
e

1
14
2.
3.2.
Comp
li
cat
io
ns

a
.Hy
pot
ens
iono
roc
cul
tbl
eed
ing

b
.Se
ver
eme
dic
alp
rob
lemsi
nduc
edb
yth
etr
auma
tice
ven
t(i
.
e,my
oca
rdi
al

i
nfa
rct
io
n).

c
.Br
aind
eat
h

d
.Se
pti
cemi
a

e
.Ne
rvei
nj
ury(
phr
eni
c,l
ary
nge
al,
vag
us,
bra
chi
alp
lex
us)
.

f
.Va
scul
arp
rob
lems
:de
epv
eint
hro
mbo
sis
,ar
ter
iov
eno
usf
is
tul
a,p
seud
oan
eur
ysm.

g
.Pul
mon
aryo
rfa
temb
oli

h
.Di
sse
min
ate
din
tra
vas
cul
arc
oag
ula
tio
n.

i
.Lo
sso
fal
amb

2.
3.
1C.
Non
-li
fe
-th
rea
ten
ing
:So
med
rama
tici
nj
uri
esma
ylo
oke
xtr
eme
lys
eve
rea
nds
eemt
o

wa
rra
nti
mme
dia
tei
nte
rve
nti
on;h
owe
ver
,th
eyma
yno
tbel
i
fe-
thr
eat
eni
ng(
suc
haso
rbi
tal
blo
w-

o
utf
rac
tur
es)
.Al
way
sad
dre
ssb
asi
can
dad
van
cedl
i
fes
upp
ortn
eed
sbe
for
epr
oce
edi
ng.

1
.In
jur
ies

a
.Di
sr
upt
io
nso
flun
gpr
oce
sse
s:l
ungc
ont
usi
ono
rsi
mpl
ehe
mot
hor
axo
rpn
eumo
tho
rax
.

b
.Di
sr
upt
io
nso
fbo
nec
ont
inui
tyo
rva
scul
arc
omp
romi
se:o
rth
opa
edi
cin
jur
y,d
igi
tal
amp
uta
tio
ns,

s
imp
lef
rac
tur
es,
sur
fac
etr
auma
,orp
eri
phe
ral
vas
cul
ari
nj
uryc
.di
sr
upt
io
nso
fme
nta
lhe
alt
h:

p
syc
hol
ogi
core
mot
io
nal
pro
ble
msi
nduc
edb
yat
rauma
tica
cci
den
t.

2.
Comp
li
cat
io
ns

a
.Vo
lkma
n’sc
ont
rac
tur
es(
con
tra
ctur
esr
esul
ti
ngf
romi
nj
uryt
oth
ebl
oods
upp
lyt
oth
ata
rea
).

b
.Co
mpa
rtme
nts
ynd
rome(
dama
gec
aus
edb
yis
che
mias
eco
nda
ryt
oin
cre
asec
omp
art
men
t

p
res
sur
e).

c
.In
app
rop
ria
teb
eha
vio
urt
hre
ate
nin
gin
jur
ytot
hems
elv
eso
rso
meo
nee
lse
.

1
15
A-V.
Spe
cif
ice
xtr
emi
tyi
nj
uri
es

A.
Fra
ctur
es

1
.De
fi
ni
ti
on:No
rma
lbo
nec
ont
inui
tyi
sdi
sr
upt
eda
ndu
sua
ll
yin
vol
vesaz
oneo
fin
jur
yin
clud
ing

s
oft
-t
is
sues
truc
tur
es.
Fra
ctur
esa
red
esc
ri
beda
cco
rdi
ngt
oth
eth
reef
ol
lo
win
gcl
ass
if
ic
ati
ons
:

a
.An
ato
mics
it
e:e
pip
hys
eal
(he
ado
fal
ongb
one
),me
tap
hys
eal
(wi
ders
haf
t,g
rowt
hzo
ne)
,

d
iap
hys
eal
(sh
afto
fth
elo
ngb
one
),o
rin
tra
art
ic
ula
r(j
oi
nt)
.Ad
iap
hys
eal
fra
ctur
eca
nbef
urt
her

d
esc
ri
beda
sdi
st
al,
med
ia,
orap
rox
ima
lth
irdo
fth
esh
aft
.

b
.Ty
peo
fdi
spl
ace
men
t:c
los
ed(
si
mpl
e),
ope
n(c
ommi
nut
ed)
,co
mpl
etei
nco
mpl
ete
,co
mpr
ess
ion
,

d
isp
lac
ed,
gre
ens
ti
ck(
twi
st
ing
),i
mpa
cti
ng,
oro
ver
ri
di
ng.

c
.Pl
aneo
ffr
act
ure
:li
nea
r,l
ong
it
ude
,ob
li
que
,sp
ir
al,
ort
rav
ers
e

2.
Eti
ol
ogy
:Th
eme
cha
nis
mofi
nj
urya
ndt
hee
xte
nta
ndd
ura
tio
nofa
nen
erg
yso
urc
eimp
act
ing

t
hes
pec
if
icb
odyr
egi
onf
ore
cas
tin
jur
iest
osur
fac
eti
ssue
san
dbo
ne.

B-3
.Nur
si
ngp
roc
ess
.

a
.As
ses
sme
nt:I
mpo
rta
ntd
atai
ncl
udep
re-
hos
pit
ale
xtr
ic
ati
ont
ime
,immo
bil
i
sat
io
nte
chn
ique
s,

r
esus
cit
ati
ves
tab
il
is
ati
onme
asur
es,
andme
cha
nis
mofi
nj
uryc
ommo
dit
ie
s(mo
torv
ehi
cl
e

a
cci
den
ts(
mos
tco
mmo
n),
eje
cti
onf
romav
ehi
cl
e,f
all
,cr
ush
/co
mpr
ess
ioni
nj
uri
es,
vio
len
t

a
ssa
ult
s,i
ndus
tri
al
).Ex
ami
nea
nyp
hot
ogr
aph
yac
comp
any
ingc
har
t.

i
.Si
gna
nds
ymp
toms

Pr
ima
rys
urv
ey(
air
way
,br
eat
hin
g,c
ir
cul
ati
on,
dis
abi
l
it
y(n
eur
olo
gics
tat
us)
,an
d

e
xpo
sur
e/e
nvi
ron
men
tal
con
tro
l(p
rev
enth
ypo
the
rmi
a)i
sex
ecut
edf
ir
st.

Es
ti
mat
edb
loo
dlo
ss

S
eco
nda
ry-
sur
veyo
rth
opa
edi
cas
ses
sme
nt

F
rac
tur
ean
das
soc
iat
edi
nj
uri
es

i
i
.Di
agn
ost
ict
est

1
16
Ra
dio
gra
phso
fal
lfr
act
ure
ssh
oul
din
clud
ean
ter
ior
-po
ste
rio
ran
dla
ter
alv
iewsi
nor
dert
o

mul
ti
pl
ean
gle
soft
hei
nj
urya
ndd
ete
rmi
net
hee
xte
nto
fdi
sr
upt
io
n.Ob
li
quea
ndc
omp
ari
sonv
iews

o
fth
eun
aff
ect
ede
xtr
emi
tya
ndf
il
mso
fjo
inta
bov
ean
dbe
lowt
hei
nj
uryma
yal
sob
ene
ces
sar
y.

Ar
ter
iog
ram/
ang
iog
rap
hy:Us
edwh
env
asc
ula
rin
vol
veme
nti
ssus
pec
ted
.

Ma
gne
ti
cre
son
anc
eima
ger
y:i
den
tif
ie
sso
ft-
ti
ssuei
nj
uryd
iski
nvo
lve
men
tofs
pin
ali
nj
uri
es,

l
i
game
nto
usi
nj
uri
es.

CTs
can
san
dmy
elo
gra
mst
oid
ent
if
yfr
act
ure
sun
det
ect
edb
ypl
ai
nfi
l
ms,
doc
ume
ntt
hea
moun
tof

d
isl
oca
tio
n,c
onf
ir
mth
eamo
unto
fco
mmun
ica
tio
nan
dst
abi
l
ityo
fth
efr
act
ure
.

Ur
eth
rog
ram/
cys
tog
rami
den
tif
ydi
sr
upt
io
noft
heur
eth
ral
sys
temb
ybo
nyd
isp
lac
eme
nts
eco
nda
ry

t
oimp
act

S
erum

Tr
aumal
abo
rat
oryp
rot
oco
l(s
eeHe
mod
yna
micr
esp
ons
e,)

Ha
emo
glo
bina
ndh
ema
toc
ri
tfo
rbl
oodl
oss

Ch
emi
st
ri
esf
orf
lui
dba
lan
ce;mo
nit
orsf
orad
ecr
eas
eofs
erumc
alc
ium,
mag
nes
ium,
and

p
hos
pha
te

Ty
pea
ndc
ros
sma
tcht
opr
epa
redf
orp
oss
ibl
etr
ans
fus
ion
.

Co
agul
ati
ons
tud
iesf
orh
aemo
rrh
agep
ote
nti
al

Ur
ina
lys
isf
ort
oxi
col
ogys
cre
ena
ndmy
ogl
obi
n;a
deq
uat
eout
put
=0.
5-1
.0mL/
kgp
erh
ourur
ine

o
utp
utf
ora
nad
ult

ABGo
rpul
seo
xime
tryme
asur
eme
ntp
ref
err
ed

C-b
.Pa
tie
ntma
nag
eme
nt

i
.I
mpa
ire
dph
ysi
cal
mob
il
it
yre
lat
edt
oimmo
bil
i
sat
io
nde
vic
esa
ndp
ain

Pr
obl
em:I
nte
rfe
reswi
tha
bil
i
tyt
ope
rfo
rma
cti
vi
ti
eso
fda
il
yli
vi
ng,
pot
ent
iat
est
hed
eve
lop
men
tof

d
eepv
eint
hro
mbo
sis
,co
nst
ip
ati
on/
il
eus
,pr
ess
ureul
cer
s,f
lui
dan
del
ect
rol
yt
eab
nor
mal
i
tie
s,f
oot

1
17
d
rop
,an
dpn
eumo
nia

I
nte
rve
nti
on:Th
ere
sus
cit
ati
onp
has
e

Ea
rlyi
nte
rve
nti
oni
npr
e-h
osp
it
ala
nde
mer
gen
cyd
epa
rtme
nt(
fi
rs
t24h
our
s).
Urg
ents
urg
ica
l

i
nte
rve
nti
onb
yano
rth
opa
edi
csur
geo
nca
nre
duc
eth
eex
ten
tofe
xtr
emi
tyd
isa
bil
i
ty.

I
mme
dia
tei
mmo
bil
i
sat
io
nan
dre
duc
ti
on/
rea
li
gnme
nto
fbo
nyi
nj
urywi
thi
n8h
our
s.I
mmo
bil
i
se

j
oi
nta
bov
ean
dbe
lowt
hei
nj
ury
.Co
nsi
dert
heus
eofaPn
euma
ticAn
tis
hoc
kGa
rme
nt(
PAS
G)t
o

t
emp
ora
ril
yimmo
bil
i
sep
elv
iso
rfe
murf
rac
tur
ean
dta
mpo
nad
epe
lvi
cha
emo
rrh
age
.Ho
wev
er,
the

c
li
ni
ci
anmus
tmo
nit
orh
idd
ene
xte
rna
lbl
eed
ingun
dert
hePAS
G.Th
ePAS
Gsh
oul
dno
tbeus
edi
n

p
ati
ent
s

wi
thc
ong
est
iv
ehe
artf
ail
ureo
rpr
egn
antp
ati
ent
s.

Ap
plyi
nsul
ate
dic
e,s
pli
nt,
ande
lev
atee
xtr
emi
tya
bov
eth
ele
vel
oft
heh
ear
ttor
educ
eswe
ll
in
g

a
ndp
ain
.

Co
nti
nuer
eva
lua
tio
noft
hec
ir
cul
ato
rya
ndn
eur
ova
scu
lars
tat
uso
fth
ein
jur
ede
xtr
emi
ty
.As
ses
s

p
uls
es(
pal
pab
lea
ndDo
ppl
er)a
nds
kint
emp
era
tur
e.Ob
ser
vec
omp
art
men
tsy
ndr
ome
.Th
e

p
res
enc
eofap
uls
ese
xtr
emi
ty
,pa
ll
oro
fth
esk
in,
par
est
hes
iaa
ndp
aina
reh
igh
lys
ugg
est
iv
eof

c
omp
art
men
tsy
ndr
ome
.

Mo
nit
orsf
ore
xte
rna
lbl
eed
ing

As
sis
tint
emp
ora
ryf
rac
tur
ere
duc
ti
onme
asur
es.

Pr
ovi
dep
aina
nda
nxi
et
yre
li
efwi
ths
hor
t-
act
ing
,IVa
nal
ges
ica
nda
nxi
ol
yt
ic
saf
tern
eur
olo
gic

e
xami
nat
io
nan
dde
ter
min
ati
ono
fas
soc
iat
io
nin
jur
ies
.En
sur
eth
atp
ainme
dic
ati
onsh
aveb
een

a
dmi
ni
st
ere
dbe
for
efr
act
urer
educ
ti
on.

I
nte
rve
nti
on:I
nte
nsi
veCa
rep
has
e

En
sur
eth
atp
uls
esa
rep
res
entd
ist
alt
oth
eimmo
bil
i
sat
io
nsi
te

Av
oidma
nip
ula
tio
nofi
nj
ury

Ap
plys
ter
il
edr
ess
inga
ndc
omp
let
edr
ess
ingc
han
gest
owo
und
san
dimmo
bil
i
sat
io
npi
nsi
te
sas

1
18
o
rde
red

Pul
mon
aryma
nag
eme
nt:En
cour
aget
hep
ati
entt
oge
touto
fbe
dass
oona
spo
ssi
bl
e.I
nst
ruc
tor

a
ssi
stp
ati
entt
otur
n,c
oug
han
dco
mpl
eted
eep
-br
eat
hin
gex
erc
ise
sors
pir
ome
trye
ver
y2h
our
s

a
nda
sne
ede
d.

Co
nsul
tph
ysi
cal
the
rap
yan
doc
cup
ati
ont
her
apya
sso
ona
spo
ssi
bl
e.

Re
vie
wal
l
owa
blep
osi
ti
oni
ngo
uto
fbe
dwi
tht
hep
ati
ent
.Us
epa
ddi
ngt
opr
ess
urep
oin
t.Ma
int
ain

c
lea
n,d
rys
kins
urf
ace
.

F
rac
tur
ere
ali
gnme
ntma
nag
eme
nt:a
ppr
opr
iat
elyut
il
is
ean
dma
int
aint
rac
ti
ond
evi
ces
,st
eri
l
e

c
lea
nsi
ngo
fpi
nsi
te
,ci
rc
ula
tor
yan
dne
uro
vas
cul
arl
i
mbr
eas
ses
sme
nt

I
ni
ti
ater
eha
bil
i
tat
iv
eex
erc
isee
arl
y.En
cour
aget
hep
ati
entt
opa
rti
ci
pat
eac
ti
vel
yinp
ass
iver
ang
e

o
fmo
ti
one
xer
ci
sesi
ncl
udi
ngp
lan
tarf
le
xio
nan
ddo
rsi
fl
exi
ono
ffe
et.
Con
sid
erus
ingaf
oots
pli
nt

t
opr
eve
ntf
ootd
rop
.

I
nst
ruc
tpa
tie
ntt
oas
ses
spa
ino
nas
cal
eof0-
10a
ndd
ocume
nte
ver
y2h
our
sora
fte
ran
ypa
in-

r
eli
evi
ngi
nte
rve
nti
ons
;pr
ovi
dep
ainr
eli
efa
sap
pro
pri
ate
.

Pr
ovi
ded
ist
rac
ti
onss
ucha
smo
vie
s,mus
ic,
game
s,a
ndr
ead
ingma
ter
ial
s.

De
sir
edo
utc
ome

S
kini
nte
gri
tyd
isr
upt
io
npr
eve
nte
d

F
urt
herd
ama
gep
rev
ent
ed

Pa
tie
ntr
epo
rtp
ainr
eli
ved

Re
sto
redmo
bil
i
tyt
oop
ti
mal
,l
eve
l,h
eal
i
ngo
ffr
act
urewi
tho
utma
lun
ion

Th
epa
tie
ntv
erb
ali
sesun
der
sta
ndi
nga
nda
ssi
st
swi
thc
arep
roc
edur
es,
ada
pti
ved
evi
cesa
nd

e
xer
ci
ses
.

i
i
.Po
ten
tia
lfo
rin
fec
ti
onr
ela
tedt
oco
nta
min
ant
sofo
penf
rac
tur
esa
nds
oft
-t
is
sue
sin
jur
y

Pr
obl
em:No
soc
omi
ali
nfe
cti
on,
slo
wedh
eal
i
ngp
roc
ess
,se
psi
s,t
eta
nus
,ga
sga
ngr
ene
,an
d

o
ste
omy
eli
ti
s

1
19
I
nte
rve
nti
on(
res
usc
it
ati
vep
has
e)

Ob
tai
nae
rob
ica
nda
nae
rob
icwo
undc
ult
ure
sbe
for
eir
ri
gat
io
n.

Us
ewe
tsa
li
ned
res
sin
gone
xpo
sedt
is
sue
.Av
oidi
odi
ne-
bas
eds
olut
io
nduet
oti
ssuei
rr
it
ati
ona
nd

d
ela
yedwo
undh
eal
i
ng.

Pr
ovi
dei
rr
iga
tio
nan
dco
nta
min
antd
ebr
ide
men
twi
thac
opi
ousa
moun
tofs
ali
ne.
Thi
spr
oce
dur
e

ma
ybed
onei
nth
eop
era
tin
gro
om.

Us
est
eri
l
ete
chn
iqued
il
ig
ent
lyt
oav
oidf
urt
herc
ont
ami
nat
io
n

Ad
min
ist
era
ppr
opr
iat
ebr
oad
-sp
ect
ruma
nti
bi
ot
ic
stoc
ove
rsus
pec
tedo
rga
nis
ms.
Bes
uret
o

a
dmi
ni
st
ero
nti
met
oma
int
aina
nad
equa
tel
eve
linb
loo
d.

Ad
min
ist
ert
eta
nust
oxo
idi
mmun
isa
tio
norb
oos
tert
opr
eve
ntt
eta
nus
.

I
nte
rve
nti
on(
Int
ens
iveCa
rep
has
e)

Mo
nit
orf
ort
hes
igno
fin
fec
ti
on:e
ryt
hema
,oe
dema
,pa
in,
woun
ddr
ain
age
,fe
ver
,ch
il
ls
,ch
ang
es

i
nvi
tal
sig
ns

Ad
min
ist
era
nti
bi
ot
ic
saso
rde
red
;gi
veo
nti
met
oma
int
aina
deq
uat
ele
vel
sint
heb
loo
d

Us
est
eri
l
ete
chn
iqued
uri
ngd
res
sin
gch
ang
esa
ndp
in-
si
tec
are
;wa
shh
and
sbe
for
ees
pec
ial
l
yat

s
kin
/de
vic
esc
ont
act

Ob
ser
vef
ort
hes
igno
fos
teo
mye
li
ti
s,c
ommo
ntoo
penf
rac
tur
esa
ndma
rke
dco
nta
min
ati
on:
low-

g
rad
efe
ver
,swe
ll
in
g,t
end
ern
ess
,pa
ina
tth
esi
te
,an
dpur
ule
ntd
rai
nag
e.

Ob
ser
vef
ors
ign
san
dsy
mpt
omso
fga
sga
ngr
ene
:pa
in,
swe
ll
in
g,c
olo
urc
han
gesi
nth
ezo
neo
f

i
nj
ury
,pur
ule
ntd
rai
nag
e,h
emo
rrh
agi
cbul
l
ae(
bli
st
ers
),t
ach
yca
rdi
a,f
eve
r,a
lte
reds
ens
ori
um.

Pr
ovi
dea
deq
uat
ehy
dra
tio
nan
dnut
ri
ti
on

Ap
plya
nti
mic
rob
ial
top
ica
lag
ent
saso
rde
red

I
nst
ruc
tpa
tie
nth
owt
oma
int
ainc
lea
nwo
unds
it
es

I
nst
ruc
tpa
tie
ntt
oin
for
mth
enur
sei
fne
wpa
ina
tsi
teo
ccur
s.

De
sir
edo
utc
ome

1
20
Ab
sen
ceo
fin
fec
ti
one
vid
enc
edb
yno
rmo
the
rmi
a,wh
iteb
loo
dce
llc
oun
tsl
esst
han1
5,00mm3

n
ega
tiv
ewo
uldc
ult
ure
s,a
bse
nceo
ffo
ul-
sme
ll
in
gdr
ain
age
.

Re
sol
uti
ono
fin
fec
ti
ona
ndi
den
tif
ie
dor
gan
ismt
rea
tedwi
tha
nti
bi
ot
ic
spr
omp
tl
y

Go
ods
kinc
olo
urt
emp
era
tur
e

Ab
sen
ceo
fswe
ll
in
g

Th
epa
tie
ntd
emo
nst
rat
esa
sep
ti
cwo
ulds
elf
-c
are

2.
3.
2ii
i
.Po
ten
tia
lfo
rimp
air
edg
ase
xch
ang
ere
lat
edt
opul
mon
aryo
ccl
usi
onc
aus
edb
ypul
mon
ary

e
mbo
lus
/fa
temb
olusf
romf
atg
lob
uler
ele
ases
eco
nda
ryt
oma
nip
ula
tio
noff
rac
tur
eorf
rom

p
rol
ong
edi
mmo
bil
i
ty.

Pr
obl
em:a
cut
ehy
pox
iaf
romp
ulmo
nar
yar
ter
yoc
clus
ion
.

I
nte
rve
nti
ons

Mo
nit
orf
ort
hes
igno
fre
spi
rat
oryd
ist
res
s(d
ysp
nea
,ta
chy
pno
ea)
;pr
ovi
dev
ent
il
ato
rys
upp
orta
s

n
eed
ed;a
ssi
stwi
thi
ntub
ati
ona
sne
ede
d

Ob
tai
nvi
tal
sig
nse
ver
y4h
our
s;o
bta
int
emp
era
tur
eev
eryh
ouri
ffe
verd
eve
lop
s.

As
ses
sfo
rpe
tec
hia
eonc
hes
t,a
xil
l
aea
ndc
onj
unc
ti
ve.
Not
if
yph
ysi
ci
ani
fpr
ese
nt

Mo
nit
orABGd
ataa
nda
rte
ria
lox
yge
nsa
tur
ati
ong
rea
tert
han94%:ma
ken
eed
edv
ent
il
ati
on

c
han
ges
.

As
ses
sbr
eat
hso
unde
ver
y4h
our
stoe
nsur
ead
equa
teg
ase
xch
ang
eina
lll
obe
s.

Mo
nit
orf
ort
hro
mbo
cyt
ope
nia(
pla
tel
etl
eve
l<1
50,
000-250,
000/
mm3
).

As
ses
sne
uro
log
ics
tat
use
ver
yho
urd
uet
oth
epo
ten
tia
lfo
rce
reb
ral
isc
hemi
a

Li
mitmo
veme
nto
ffr
act
uret
oav
oidmo
bil
i
sat
io
noff
at

De
sir
edo
utc
ome

No
rma
lga
sex
cha
ngee
vid
enc
ebyn
orma
lre
spi
rat
ory
,ar
ter
ial
oxy
gent
ens
iong
rea
tert
han80mm

Hg
,ar
ter
ial
car
bond
iox
ide
sle
sst
han45mmHg
,ar
ter
ial
oxy
gens
atur
ati
ong
rea
tert
han94%,

1
21
a
rte
ria
lbl
oodp
H7.
35-
7.45.

Re
stl
ess
nes
sse
con
dar
ytod
ysp
neai
sdi
min
ish
ed

A-B.
Tra
uma
tica
mput
ati
ons

1
.De
fi
ni
ti
on:S
eve
rep
art
sca
nbel
i
fe-
thr
eat
eni
ng,
butb
lee
din
gisus
ual
l
ywe
llma
nag
edwi
thd
ire
ct

p
res
sur
etowo
undo
rst
ump
.Amp
uta
tio
nsa
rec
las
sif
ie
dast
rauma
tic
,pa
rti
al
,co
mpl
ete
,

i
nco
mpl
ete
,ors
urg
ica
l.De
scr
ip
ti
vet
ype
sin
clud
eth
efo
ll
owi
ng.

a
.Cuto
rgui
l
lot
ine
:we
ll
-de
fi
nedwo
unde
dge
san
dlo
cal
i
sedd
ama
get
oso
ftt
is
sue
,ve
sse
l,a
nd

n
erv
es

b
.Cr
ushwo
und
:di
ff
uses
oft
-t
is
sued
ama
gei
nvo
lvi
nga
rte
ria
lin
tima
l

c
.Av
uls
ivea
mput
ati
on:t
ear
ingt
ost
ret
chi
ngo
fti
ssuewi
thn
erv
ean
dva
scul
atur
eto
rna
wayf
rom

i
nj
urys
it
e;d
egl
ovi
ng(
she
ari
ng)i
nj
ury
.

2.
Eti
ol
ogy

a
.Mo
stc
ommo
nca
useo
fup
per
-ex
tre
mit
yamp
uta
tio
nisamo
torv
ehi
cl
eac
cid
ent
,th
enf
armi
ng

a
cci
den
ts,
ind
ust
ry-
rel
ate
dcr
ushi
nj
uri
es,
andv
iol
enta
ssa
ult
s.

b
.ot
herme
cha
nis
msi
ncl
udes
aws
,kn
ive
s,h
atc
het
san
dla
wnmo
wer
s.

c
.Co
mmo
nsi
te
sofa
mput
ati
oni
ncl
uded
igi
ts(
fi
nge
rsa
ndt
oes
):h
and
;fo
rea
rm;a
rm;e
ar;n
ose
;

p
eni
s;t
ran
sme
tat
ars
al;a
ndb
elo
w,t
hro
ugha
nda
bov
eth
ekn
ee.

3
.Nur
si
ngp
roc
ess

a
.As
ses
sme
nt

i
.Si
gna
nds
ymp
toms

De
cre
ases
yst
ol
icb
loo
dpr
ess
ure(
<90mmHg
)ife
xte
nsi
veb
lee
din
gati
nj
uryc
aus
esh
ypo
vol
emi
a

De
cre
ase
dUOP(
<30mL/
hour
)fr
omh
ypo
vol
emi
a.

I
ncr
eas
edh
ear
tra
tef
romh
ypo
vol
emi
a

Di
min
ish
edme
nta
tio
nre
lat
edd
ecr
eas
ece
reb
rap
erf
usi
on

i
i
.Di
agn
ost
ict
est
s

1
22
X-
ray
sofb
otht
hes
tumpa
nda
mput
ate
dpa
rtt
ode
ter
min
eth
epr
ese
nceo
faf
ore
ignb
ody

Tr
aumal
abo
rat
oryp
rot
oco
l:s
amea
sme
nti
one
dun
derh
emo
dyn
ami
cre
spo
nse
.

c
.Pa
tie
ntma
nag
eme
nt

i
.Ac
tua
lfl
ui
dvo
lumed
efi
ci
tre
lat
edt
obl
oodl
oss

Pr
obl
em:p
oss
ibl
eti
ssueo
ror
gand
est
ruc
ti
onf
romd
ecr
eas
edp
erf
usi
on.

I
nte
rve
nti
on(
res
usc
it
ati
onp
has
e)

Ad
dre
ssl
i
fe-
thr
eat
eni
ngi
nj
uri
esf
ir
st,
byp
ri
mar
yan
dse
con
dar
yas
ses
sme
nt.

De
ter
min
eth
eme
cha
nis
mofi
nj
uryt
oco
nsi
der
edp
oss
ibl
eco
nta
min
ati
ona
tth
est
umps
it
e.

Co
ntr
olh
aemo
rrh
agewi
thd
ire
ctp
res
sur
ean
dsa
li
ne-
moi
st
ene
ddr
ess
ing
;el
eva
tea
ndi
mmo
bil
i
se

s
tump
;av
oidt
our
niq
uet
,si
ncec
ir
cul
ati
onc
anb
eco
mpr
omi
sedf
urt
her
.

Mo
nit
orh
aemo
glo
bina
ndh
ema
toc
ri
t,
admi
ni
st
erb
loo
dpr
oduc
tsi
fne
ces
sar
y.

F
req
uen
tch
eck
sofv
it
als
ign
san
dne
uro
log
ics
tat
us.

Es
ti
mat
eda
ctua
lbl
oodl
ossa
sout
li
nedi
nHe
mod
yna
micr
esp
ons
e.

Ad
min
ist
erwa
rne
din
tra
ven
ousf
lui
dan
dbl
oodp
rod
uct
s

F
lui
dre
pla
ceme
ntwi
tht
wol
arg
e-b
orei
ntr
ave
nousc
ath
ete
rsi
nanun
aff
ect
edl
i
mbwi
thl
act
ate
d

Ri
nge
r’
sso
lut
io
n

Ad
min
ist
ero
xyg
enb
yfa
cema
sk

I
nse
rtaF
ole
yca
the
tert
omo
nit
orh
our
lyUOP.
Mai
nta
ina
tle
ast50mL/
hourd
uri
ngt
he

r
esus
cit
ati
onp
has
e

Pr
ovi
des
tump
,amp
uta
tedp
art
,an
dre
imp
lan
tat
io
nca
re.

I
nte
rve
nti
on:I
nte
nsi
veCa
rep
has
e

Mo
nit
orc
ent
ral
ven
ousp
res
sur
e,p
ulmo
nar
yar
ter
ywe
dgep
res
sur
e,a
ndo
the
rhe
mod
yna
micd
ata
.

Mo
nit
ori
nta
kea
ndo
utp
utme
asur
eme
nts

Co
nsul
tps
ych
iat
ryt
oad
dre
ssb
odyi
mag
eco
nce
rns
,se
nso
ry,
cha
nge
s.

Us
eas
ept
ict
ech
niq
uewh
enc
omp
let
ingd
res
sin
gch
ang
es;a
sse
sss
it
eca
ref
ull
yfo
ras
igno
f

1
23
i
nfe
cti
on(
red
nes
s,s
wel
l
ing
,pa
in,
orp
urul
entd
rai
nag
e).

De
sir
edo
utc
ome

Vi
tal
sig
nswi
thi
nno
rma
lli
mit
s

La
bda
tar
efl
ecta
deq
uat
eha
emo
glo
bina
ndh
ema
toc
ri
tle
vel
s

F
urt
herb
lee
din
gpr
eve
nte
d.

B-i
i
.Po
ten
tia
lfo
rin
fec
ti
ono
fst
ump

Pr
obl
em:Lo
cal
i
sedi
nfe
cti
onc
aus
esp
aina
ndh
ast
hep
ote
nti
alf
ors
yst
emi
cin
fec
ti
on

I
nte
rve
nti
on

De
bri
dea
ndi
rr
iga
tewo
undt
hor
oug
hly
;re
mov
eal
lne
cro
ti
cti
ssue
sma
yre
qui
rea
nop
era
tin
gro
om.

Pr
eve
nto
ede
mab
yus
ingn
onr
ig
ids
ter
il
edr
ess
inga
ppl
i
cat
io
nco
nsul
tph
ysi
cal
the
rap
yan
d

o
ccup
ati
ona
lth
era
pyt
ose
lec
tap
pro
pri
ates
tumpwr
app
ing
.

Ad
min
ist
ert
eta
nusi
mmun
isa
tio
nan
dan
tib
iot
ic
saso
rde
red

Us
est
ri
cth
and
was
hin
gan
dst
eri
l
ete
chn
ique
.

I
mme
dia
tel
yco
nsul
tano
rth
opa
edi
csur
geo
n

S
upp
ortp
art
ial
amp
uta
tio
nbyi
mmo
bil
i
sin
gth
ear
ea

De
sir
edo
utc
ome

Ab
sen
ceo
fin
fec
ti
on

Wo
undh
eal
i
ng

i
i
i.I
mpa
ire
dph
ysi
cal
mob
il
it
yre
lat
edt
opa
ina
ndc
ont
rac
tur
es

Pr
obl
em:Lo
sso
fli
mb,
dys
fun
cti
ona
lamb
ula
tio
n.Al
ter
edb
ala
nce
,co
ord
ina
tio
nde
fi
ci
tco
ntr
act
ure
,

a
lte
rat
io
niss
ens
oryf
unc
ti
on.

I
nte
rve
nti
on

Pr
ovi
dep
res
cri
bes
kin
car
eoft
hes
tump

Co
nsul
tph
ysi
cal
the
rap
yea
rly

En
cour
agea
nda
ssi
stwi
tht
hei
some
tri
cex
erc
iseo
fin
vol
vede
xtr
emi
tywi
thr
epe
ti
ti
on.
Abo
vet
he

1
24
k
neea
mput
ati
on;a
voi
dhi
pfl
exi
ona
nda
bduc
ti
on;d
ono
tel
eva
tes
tumpo
npi
l
lows
.

Re
pos
it
io
npa
tie
nta
nds
tumpf
req
uen
tly

S
tumpwr
app
ingwi
the
las
ti
cfa
bri
cba
nda
ge:a
lwa
yswr
apd
ist
alt
opr
oxi
mal
top
rev
ents
wel
l
ing
,

a
nds
hri
nka
nds
hap
est
umpo
fpr
ost
het
ic
s.

En
cour
ager
ang
e-o
f-mo
ti
one
xer
ci
set
oin
cre
asemus
cles
tre
ngt
han
dfl
exi
bi
li
ty
.

Pr
ovi
des
uff
ic
ien
tpa
inc
ont
rol
wit
hana
nal
ges
ict
oen
sur
eco
mpl
ace
ncewi
the
xer
ci
ses

I
nst
ruc
tfa
mil
yinp
hys
ica
lth
era
pya
ssi
st
antr
olea
ndp
ati
ent
’
sne
edf
orf
unc
ti
ona
lac
ti
vi
ti
es

De
sir
edo
utc
ome

Ab
sen
ceo
fco
ntr
act
ure
s

Op
ti
mal
ran
geo
fmo
ti
on

Pa
inc
ont
rol
l
ed.

i
v.Di
st
urb
anc
einb
odyi
mag
ean
dse
lf
-c
onc
eptr
ela
tedt
odi
sf
ig
ure
men
t.

Pr
obl
em:Lo
sso
fli
mbo
rpa
rt,
powe
rle
ssn
ess
,an
ger
,fe
ar,
dep
res
sio
n,un
wil
l
ing
nes
stoa
cce
ptl
oss

o
rvi
ews
tump

I
nte
rve
nti
on

Co
nsi
derp
hys
iol
ogi
cco
nsu
lta
tio
n.

Di
scus
swi
tht
hep
ati
entf
eel
i
ngo
flo
ssa
ndt
hen
orma
lgr
iefc
ycl
e.Pr
ovi
deas
upp
ort
iv
e

e
nvi
ron
men
ttoa
ssi
sti
nth
egr
iev
ingp
roc
ess
.

Al
l
owt
hep
ati
entt
oma
kea
sma
nyc
hoi
cesa
spo
ssi
bl
e(f
ood
,ro
uti
nen
aps
)tog
ainas
ens
eof

c
ont
rol
.

Di
scus
spl
ano
fca
rer
ela
tedt
opr
ost
hes
isf
it
ti
ng.

En
cour
aget
hep
ati
entt
opa
rti
ci
pat
eint
hep
lano
fca
rea
ndd
eci
si
onma
kin
g.

De
sir
edo
utc
ome
.

Th
epa
tie
nte
xemp
li
fi
eda
deq
uat
eco
pin
gme
cha
nis
ms.

Th
epa
tie
nti
sac
ti
vel
yin
vol
vedi
nth
ere
hab
il
it
ati
vep
has
e.

1
25
C-C.
Comp
art
ments
ynd
rome
.

1
.De
fi
ni
ti
on:Ac
omp
li
cat
io
nofo
rth
opa
edi
ctr
aumawh
enan
erv
e,t
end
onv
ess
elo
rmus
clei
s

c
ons
tri
ct
edwi
thi
nac
los
eds
pac
eth
ati
ssur
roun
dedb
yme
mbr
ane
sth
atd
ono
tst
ret
ch.Ma
yal
so

r
esul
tfr
oma
cut
ear
ter
ialo
ccl
usi
on.Re
str
ic
tedc
ir
cul
ati
ont
omi
cr
ova
scul
atur
ech
ang
esc
aus
es

i
sch
emi
aofn
erv
ean
dmus
cle(
Vol
kma
nn’
sis
che
micc
ont
rac
tur
e)

2.Et
io
log
y:Co
mpa
rtme
nts
ynd
romei
saf
unc
ti
ono
fti
mea
ndp
res
sur
e.I
ncr
eas
edd
ura
tio
nof

s
tre
sso
ran
dpr
ess
urep
rod
uces
ymp
toms
.In
ter
nalp
res
sur
eisf
romb
lee
din
goro
ede
ma,e
xte
rna
l

p
res
sur
efr
omr
est
ri
ct
iv
ede
vic
ess
ucha
sca
sts
,orp
rol
ong
edi
nfl
ati
ono
fth
ePAS
G.I
njur
iesa
tri
sk

o
fde
vel
opi
ngc
omp
art
men
tsy
ndr
omei
ncl
udec
los
edf
rac
tur
esa
cco
mpa
nie
dbyt
is
suec
ont
usi
on

a
ndb
oned
isp
lac
eme
nt,c
omp
res
sio
n/c
rus
hin
jur
ies
,op
enf
rac
tur
e,a
rte
ria
lin
jur
iesf
romg
uns
hot

wo
und
s,a
ndb
urn
s.

I
n-t
extQue
sti
on

Wh
ati
sco
mpa
rtme
nts
ynd
rome
?

An
swe
r

Ac
omp
li
cat
io
nofo
rth
opa
edi
ctr
aumawh
enan
erv
e,t
end
onv
ess
elo
rmus
clei
sco
nst
ri
ct
edwi
thi
n

ac
los
eds
pac
eth
ati
ssur
roun
dedb
yme
mbr
ane
sth
atd
ono
tst
ret
ch.

2.
3.
33.
Nur
si
ngp
roc
ess
.

a
.As
ses
sme
nt

i
.Si
gna
nds
ymp
toms
:Th
epr
ese
nceo
fal
loft
hef
ol
lo
win
gde
not
esv
erya
dva
nce
dis
che
miaf
rom

c
omp
art
men
tsy
ndr
ome
.

Pa
in:r
ela
tedomus
clei
sch
emi
a

Pa
ll
or:s
kinc
olo
urc
han
gesr
ela
tedt
ola
cko
fbl
oods
upp
lyt
oth
ear
ea.

Pul
ses
:ma
ybed
imi
ni
she
dora
bse
ntr
ela
tedt
oar
ter
ial
inf
lo
wco
mpr
ess
ion
.

1
26
Pa
res
the
siao
fth
eaf
fec
teda
read
uet
ose
nso
ryn
erv
eis
che
mia
.

Pa
ral
ysi
s:d
uet
ois
che
miao
fmo
torn
erv
es

i
i
.Di
agn
ost
ict
est
s.

S
erum:my
ogl
obi
nma
ybep
res
enti
fmus
clen
ecr
osi
sha
soc
cur
red
.

Ur
ine
:my
ogl
obi
npr
ese
nti
fmus
clen
ecr
osi
sha
soc
cur
red

Ot
her
:in
tra
-co
mpa
rtme
nta
lpr
ess
ureme
asur
eme
ntswi
thmo
nit
ori
ngd
evi
cest
ome
asur
eth
ein
tra

-
comp
art
men
tal
pre
ssur
eatt
hei
nj
urys
it
e.

Ap
res
sur
ele
sst
han20mmHg
:no
rma
l

Pr
ess
ure20-
30mmHg
:is
che
micd
ama
gea
ndi
mme
dia
ten
eedf
orp
res
sur
ere
duc
ti
on.
art
eri
al

b
loo
dfl
owi
sno
tus
ual
l
yob
str
uct
edb
yco
mpa
rtme
ntp
res
sur
eof3
0-6
0mmHg
.Di
st
alp
uls
esma
y

s
ti
ll
bep
alp
ate
d.

b
.Pa
tie
ntma
nag
eme
nt

i
.Po
ten
tia
lfo
rde
cre
ase
dti
ssue
spe
rfus
iona
ndn
eur
ova
scul
arc
omp
romi
ser
ela
tedt
oin
cre
ase
d

c
omp
art
men
tpr
ess
ure
.

Pr
obl
em:p
ain
,oe
dema
,pa
rae
sth
esi
a,my
ogl
obi
nur
ia,
nec
ros
is

I
nte
rve
nti
ons
.

As
cer
tai
nti
meo
fin
jur
yan
dti
mes
inc
eon
seto
fsy
mpt
oms
;da
mag
eca
noc
curwi
thi
nth
efi
rs
tfe
w

h
our
saf
teri
nj
ury
,ma
ypr
ese
nto
nad
mis
sio
ntot
hee
mer
gen
cyr
oom.

I
den
tif
ysi
tea
ndme
cha
nis
mofi
nj
ury

S
usp
ecta
sso
cia
tedi
nj
uri
es:s
oft
-t
is
sue
sco
ntus
ion
,he
mat
oma
s,f
rac
tur
eord
isl
oca
tio
ns.

As
ses
san
dmo
nit
orf
orp
ain
,pa
ll
or,
pul
se,
par
est
hes
ia,
andp
ara
lys
is(
“t
hef
iv
ePs
”)

I
nve
sti
gat
epa
inc
omp
lai
ntso
fth
rob
bin
gdi
spr
opo
rti
ona
lpa
ina
tin
jur
ysi
teun
rel
i
eve
dbya
nal
ges
ic

d
rug
san
din
cre
ase
dinr
esp
ons
etop
ass
ives
tre
tcho
fth
emus
cle
.

Ex
ami
nef
ir
mne
sso
rte
nse
nes
soft
hec
omp
art
men
tbyc
omp
act
ingwi
th

i
nj
uri
ese
xtr
emi
ty

1
27
Ob
ser
vep
all
ora
ndc
api
l
lar
yre
fi
ll
del
ayd
ist
alt
oth
eco
mpa
rtme
nt.

I
den
tif
ypa
res
the
siao
rlo
sso
fse
nsa
tio
n.Th
esea
rea
les
ign
sin
dic
ati
ngp
res
sur
eont
hen
erv
es

a
ndma
yma
nif
esta
snumb
nes
san
dti
ngl
i
ng.

Ex
ami
newi
tht
wo-
poi
ntd
isc
ri
min
ati
on,
sha
rpa
ndd
ull
touc
h.

As
ses
sfo
rth
eli
mit
edo
rwe
akmo
tora
bil
i
tyo
fex
tre
mit
ybe
caus
eofp
ain

f
romt
hep
res
sur
e.

As
ses
spul
sesd
ist
alt
oth
ein
jur
y.Ch
eckp
uls
eswi
thp
alp
abl
ean
dDo
ppl
erme
tho
dev
ery1
-2

h
our
s:i
fdi
min
ish
ed,
lat
esi
gna
ndi
rr
eve
rsi
bl
e,p
res
enc
eofp
uls
esd
oesn
otr
uleo
utc
omp
art
men
t

s
ynd
rome
.Th
eme
cha
nis
mofi
nj
urya
nda
cco
mpa
nyi
ngs
ign
san
dsy
mpt
omsa
ret
hek
eyt
o

d
ete
cti
on.

Ma
int
aint
hee
xtr
emi
tya
the
artl
eve
ltod
ecr
eas
eswe
ll
in
g,y
etma
int
ainp
erf
usi
on.

Re
lea
sec
ons
tri
ct
iv
ede
vic
ess
ucha
sca
stso
rti
ghtd
res
sin
gs

Mo
nit
ora
ndr
eco
rdt
ren
dsi
npa
tie
nt’
spa
inp
att
ern
san
def
fec
tso
fme
dic
ati
on.

Tr
endc
omp
art
men
tpr
ess
urea
ndn
oti
fyt
hep
hys
ici
ano
fri
si
ngp
res
sur
esi
ndi
cat
ingc
omp
art
men
t

s
ynd
rome
;me
asur
eci
rc
umf
ere
nceo
fex
tre
mit
y.

Pr
epa
rep
ati
ento
fop
era
tin
gro
omwh
ens
urg
ica
lde
comp
res
sio
noft
hec
omp
art
men
tfa
sci
ash
eat
h

b
yfa
sci
ot
omyi
sre
qui
red
.

I
nte
rve
nti
on(
pos
t-f
asc
iot
omy
)

As
ses
sne
uro
vas
cul
ars
tat
ush
our
ly
,th
epa
tte
rno
fre
spo
nse
stoi
nte
rve
nti
ona
ndc
ont
inue
dli
mb

a
sse
ssme
nt(
cruc
ial
top
rev
entf
urt
herd
isa
bil
i
ty)
.Fa
sci
ot
omys
houl
dimme
dia
tel
yre
tur
npul
se.

Mo
nit
orf
ors
kini
nfe
cti
on,
ass
uri
ngs
ter
il
it
yoff
asc
iot
omys
it
esa
nd

we
t-t
o-we
t(o
pent
is
sue
)orwe
t-t
o-d
rys
ter
il
esa
li
ned
res
sin
gasa
ppr
opr
iat
e.

Mo
nit
orf
orb
lee
din
g

Mo
nit
orc
li
ni
cal
sig
nso
fin
cre
asi
ngc
omp
art
men
tpr
ess
ured
uet
omo
bil
i
sat
io
n,p
ers
ist
ento
ede
ma,

1
28
o
rve
nousl
eak
ing
.

As
sis
twi
thc
omp
art
men
tsy
ndr
omeme
asur
eme
nts

Ex
pec
tde
lay
edp
rima
ryo
rse
con
dar
ysk
inc
los
urewi
thg
raf
tsa
fte
rswe
ll
in
gha
sre
ced
ed.

De
sir
edo
utc
ome

I
ncr
eas
eda
rte
ria
lbl
oodf
lo
wan
dimp
rov
edv
eno
usr
etur
ntot
hei
nj
ure
dar
ea.

I
ntr
a-c
omp
art
men
tal
pre
ssur
ele
sst
han20mmHg
.

Pr
eve
nti
ono
fne
uro
mus
cul
ard
ete
rio
rat
io
nan
dir
rev
ers
ibl
ese
que
lae
.

Ab
sen
ceo
fsi
gnso
fin
fec
ti
ont
ofa
sci
ot
omys
it
es

S
king
raf
the
alsp
rop
erl
y.

A-i
i
.Imp
air
edp
hys
ica
lmo
bil
i
tyr
ela
tedt
opa
in,
pre
ssur
ean
dfa
sci
ot
omy

i
nci
si
ons

Pr
obl
em:De
cre
ase
dex
tre
mit
yfun
cti
on,
wea
kmo
torr
esp
ons
es,
andf
earo
fpa
in

I
nte
rve
nti
on

Ea
rlyi
nte
rve
nti
ont
ore
li
evep
res
sur
ean
dsub
seq
uen
tde
str
uct
io
ntot
hemi
cr
ova
scul
atur
e.

I
ni
ti
ater
ang
e-o
f-mo
ti
one
xer
ci
see
arl
y

I
den
tif
ypr
ess
urep
oin
tsa
ndp
ada
ppr
opr
iat
elyt
oav
oidp
res
sur
eso
res
.

En
sur
esuf
fi
ci
entp
ainc
ont
rol
toi
mpr
ovec
omp
li
anc
ewi
the
xer
ci
ses
.

De
sir
edo
utc
ome

F
ull
ran
geo
fmo
ti
ono
fth
ein
jur
ede
xtr
emi
ty

F
unc
ti
ona
lab
il
it
ytoc
omp
let
eac
ti
vi
sto
fda
il
yli
vi
ng

Pr
eve
nti
ono
fco
ntr
act
ure
s

Th
epa
tie
ntp
art
ic
ipa
tesi
nre
hab
il
it
ati
vep
has
es.

B-VI
.Di
sch
arg
epl
ann
ingf
ort
het
raumap
ati
ent

A.
Pat
ie
nt,
car
eta
ker
,an
dfa
mil
yha
veb
eenp
rov
ide
dan
dun
der
sta
nda
llwr
it
ten

d
isc
har
gei
nst
ruc
ti
ons
.

1
29
1
.Al
lque
sti
onsa
nswe
red

2.
Und
ers
tan
din
gofa
ppr
opr
iat
elo
cat
io
nst
ore
tur
nst
oco
nti
nueh
eal
thc
are

n
eed
s.

3
.Kn
owl
edg
eofn
ame
san
dte
lep
hon
enumb
erso
fpe
rso
nne
ltoc
all
fora
nan
swe
rtoq
ues
ti
ons
.

B.
Homeh
eal
thc
area
gen
cya
ndr
eha
bil
i
tat
io
nar
ran
geme
ntsa
rec
omp
let
epr
iort
odi
sch
arg
e.

1
.Ho
mee
nvi
ron
men
tco
nduc
ivet
ore
cov
ery
,es
pec
ial
l
yfo
rel
der
lya
ndc
hal
l
eng
edp
opul
ati
ons
.

2.
Homea
sse
ssme
ntf
orr
unn
ingwa
ter
,el
ect
ri
ci
ty
,cl
ean
li
nes
s,a
ndc
are
-ta
kers
upp
ort
.

3
.Nut
ri
ti
ona
lre
qui
reme
ntsn
eeda
ndh
eal
thyf
ood
sid
ent
if
ie
d.

C.
Pat
ie
nta
ndc
are
tak
erun
der
sta
nda
ndd
emo
nst
rat
ewo
undc
are
.

I
nfe
cti
onp
rev
ent
io
nte
chn
ique
s

Ha
ndwa
shi
ngt
ech
niq
ue

un
der
sta
ndi
ngo
fsi
gnsa
nds
ymp
tomso
fin
fec
ti
on

Un
der
sta
ndi
ngo
fst
eri
l
eve
rsuse
nvi
ron
men
t

Re
cog
nit
io
nofs
ign
san
dsy
mpt
omso
fwo
undi
nfe
cti
on.

B.
Pat
ie
nta
ndc
are
tak
erun
der
sta
ndc
aus
esa
ndt
rea
tme
nto
fpa
in

1
.Di
st
inc
ti
ono
fpa
int
ype
s:a
cut
epa
in(
comp
res
sio
n,t
ear
ing
,cr
amp
ing
,oe
dema
)an
dch
ron
icp
ain

(
pha
nto
mli
mbp
ain
,in
cor
rec
tjo
ini
ngo
fbo
nef
rac
tur
es)
.

2.
Kno
wle
dgeo
fme
dic
ati
ona
ppr
opr
iat
efo
rty
peso
fpa
in.

3
.Mo
bil
i
tya
ndr
ang
e-o
f-mo
ti
one
xer
ci
see
nco
ura
geda
sap
pro
pri
ate

4.
Pro
perus
eofc
rut
che
sorme
cha
nis
meq
uip
men
t

C-C.
Pat
ie
nta
ndf
ami
l
yof
fer
edas
upp
ortg
roup

a
.Co
uns
ell
i
ngf
orb
odyi
mag
ech
ang
eso
rab
use(
vi
ct
imsa
ndt
hei
r

a
bus
ers
).

b
.Sub
sta
ncea
bus
eco
uns
ell
i
ng

c
.sp
iri
tua
lsup
por
tgr
oup
s

1
30
d
.Fi
nan
cia
lco
uns
ell
i
ng

e
.Le
gal
gui
dan
ce(
li
vi
ngwi
l
ls,
powe
rofa
tto
rne
y,o
rga
ndo
nat
io
n).

f
.Ps
ych
olo
gic
alc
oun
sel
l
ingo
fan
xie
ty,
dep
res
sio
nsui
ci
dal
ten
den
cie
s.

g
.Re
tur
ntowo
rka
sso
ona
spo
ssi
bl
een
cour
age
d.

D.
Pre
scr
ipt
io
nfi
l
leda
ndi
nst
ruc
ti
one
xpl
ai
ned

a
.Me
dic
ati
ons
idee
ffe
ctsa
ndc
ont
rac
ti
ons

b
.Do
sag
e,r
out
e,a
ndr
egul
ari
tyo
fad
min
ist
rat
io
n

E.
Tra
uma
-pr
eve
nti
one
duc
ati
ona
ndb
eha
vio
urmo
dif
ic
ati
on

a
.St
res
sma
nag
eme
ntf
orp
ati
enta
ndc
are
tak
er

b
.Se
atb
elt
s,c
hil
dsa
fet
yse
at,
andh
elme
tus
e.

c
.Pe
des
tri
ana
ndb
icy
clet
raf
fi
csa
fet
y

d
.Ed
uca
tio
nab
outg
unsa
ndk
niv
esa
ndv
iol
enc
eav
oid
anc
est
rat
egi
es

e
.Ed
uca
tio
nab
outd
rin
kin
g,d
riv
inga
ndd
rug
sav
oid
anc
est
rat
egi
es

F
.Fo
ll
ow-
upa
ppo
int
men
tsa
rema
dea
nde
xpl
ai
nedt
oth
efa
mil
y

a
.De
ter
min
eho
wth
epa
tie
ntwi
l
lre
tur
ntot
hec
li
ni
c

b
.Fa
cil
i
tat
ear
ran
geme
ntst
oas
sur
ear
etur
ntot
hec
li
ni
c.

I
n-t
extQue
sti
on

I
den
tif
ie
dsi
gnsa
nds
ymp
tomst
hatc
onn
ote
sve
rya
dva
nce
dis
che
miaf
romc
omp
art
men
t

s
ynd
rome
.

An
swe
r

Pa
in,
Pal
l
or,
Pul
ses
,Pa
res
the
siaPa
ral
ysi
s.

3 Tu
torMa
rke
dAs
sig
nme
nts(
Ind
ivi
dua
lorG
rou
p)

Ex
pla
inv
ari
ousc
aus
eso
ftr
auma
tici
nj
uri
esa
ndd
isc
usst
hep
rev
ent
io
nofe
ach

c
aus
eid
ent
if
ie
d.

1
31
 Que
sti
on

S
elfAs
ses
sme
ntQue
sti
on

Di
scus
str
auma
-pr
eve
nti
one
duc
ati
ona
ndb
eha
vio
urmo
dif
ic
ati
ona
ndaf
ol
lo
w-upa
ppo
int
men
tto

t
hef
ami
l
yofat
rauma
tis
edp
ati
ent
.

An
swe
r

E.
Tra
uma
-pr
eve
nti
one
duc
ati
ona
ndb
eha
vio
urmo
dif
ic
ati
on

a
.St
res
sma
nag
eme
ntf
orp
ati
enta
ndc
are
tak
er

b
.Se
atb
elt
,ch
il
dsa
fet
yse
at,
andh
elme
tus
e.

c
.Pe
des
tri
ana
ndb
icy
clet
raf
fi
csa
fet
y

d
.Ed
uca
tio
nab
outg
unsa
ndk
niv
esa
ndv
iol
enc
eav
oid
anc
est
rat
egi
es

e
.Ed
uca
tio
nab
outd
rin
kin
g,d
riv
inga
ndd
rug
sav
oid
anc
est
rat
egi
es

F
.Fo
ll
ow-
upa
ppo
int
men
tsa
rema
dea
nde
xpl
ai
nedt
ofa
mil
y

a
.De
ter
min
eho
wth
epa
tie
ntwi
l
lre
tur
ntoc
li
ni
c

b
.Fa
cil
i
tat
ear
ran
geme
ntst
oas
sur
ear
etur
ntot
hec
li
ni
c.

4 Co
ncl
usi
on/
Summa
ry

Zo
ne-
Smi
thi
nHe
braa
ndKuh
n(1
996
)st
ate
dth
att
rauma
tici
nj
uri
esk
il
lne
arl
y

1
50,
000Ame
ric
ansay
eara
ndl
eav
es6
0mi
l
li
oni
nj
ure
dan
d300,
000p
erma
nen
tly

d
isa
ble
dFi
gur
esi
nde
vel
opi
ngc
oun
tri
esa
ren
otr
ead
il
yav
ail
abl
e.Nod
oub
t

t
rauma
tici
nj
uri
esa
rea
tana
lar
min
gra
tei
nde
vel
opi
ngc
oun
tri
esTh
eun
ith
asl
ook
edi
ntot
he

c
onc
epto
ftr
auma
,ae
ti
ol
ogy
,th
enur
si
ngp
roc
esso
ftr
auma
tici
nj
uri
es,
pre
caut
io
ns,
ass
ess
men
t,

s
pec
if
ice
xtr
emi
tyi
nj
uri
esa
ndt
hei
rnur
si
ngma
nag
eme
nta
ndf
ina
ll
yth
edi
sch
arg
e

p
roc
edur
e/p
rep
ara
tio
nfo
rth
etr
aumap
ati
ent
.Iti
sex
pec
tedt
haty
ouh
avel
ear
ntg
rea
tlya
ndt
his

k
nowl
edg
ewi
l
lbe
tte
ryo
urq
ual
i
tat
iv
eca
ret
oyo
urp
ati
ent
s.

1
32
5 S
elf
-As
ses
sme
ntQue
sti
ons

6
.0Ad
dit
io
nal
Act
iv
it
ie
s(Vi
deo
s,An
ima
tio
ns&Outo
fCl
assAc
ti
vi
ti
es)e
.g.

a
.Vi
si
tYo
uTu
bea
dd?
???
???
???
???
???
.Wa
tcht
hev
ide
o&s
umma
ris
eiti
n1p
ara
gra
ph

b
.Vi
ewt
hea
nima
tio
nona
dd/
sit
e??
???
??a
ndc
ri
ti
quei
tint
hed
isc
uss
ionf
orum

c
.Ta
keawa
lka
nde
nga
gea
ny3s
tud
ent
son?
???
???
???
?;I
n2p
ara
gra
phss
umma
ris
eth
eir

o
pin
iono
fth
edi
scus
sedt
opi
c.e
tc.

1
7.0 Re
fer
enc
es/
Fur
the
rRe
adi
ngs

Ame
ric
anCo
ll
egeo
fSur
geo
nsCo
mmi
tt
eeo
nTr
auma
.(1
993
)Ad
van
cedTr
auma

Li
feS
upp
ortI
nst
ruc
torMa
nua
l(5t
hed
).Ch
oco
g:Ame
ric
anCo
ll
egeo
fSur
geo
ns.
Pp.
11,
21.

Tr
unk
ey,
D.(
1982)Th
eVa
lueo
fTr
aumaCe
ntr
es.
AmCo
llS
urgBul
l67:
5.

Na
tio
nal
Saf
etyCo
unc
il
.(1
987)Ac
cid
entF
act
s(1
987e
d).
Chi
cag
o,1
987.

Cr
eel
,J.
H.(
1988)I
nJECa
mpb
ell
(ED)
,Ba
sicTr
aumaL
ifeS
upp
ortAd
van
ced

Pr
eho
spi
tal
Car
e(2n
ded
)En
gle
woo
dCl
i
ffs
,NJ
:Pr
ent
ic
e-Ha
ll
,1988.
P.1
3.

Yo
ung
,an
dHA,
Sch
imd
ekHH.
(1982)Co
mpl
i
cat
io
nsa
cco
mpa
nyi
ngOc
cip
it
al

S
kul
lfr
act
ure
s.JTr
auma22:
914,
1982.

Va
nor
e,ML.
(1992)Mo
dul
e2.
InEWBa
ley
e,S
ATTur
cke(
eds
)A,

Co
mpr
ehe
nsi
veCur
ri
cul
umf
orTr
aumaNur
si
ng.
Bos
ton
:Jo
nesa
ndBa
rtl
ett
,p.
19.

Ly
erl
y,HK,
(1987)Th
eHa
ndb
ooko
fSur
gi
cal
Int
ens
iveCa
re:Pr
act
ic
eoft
he

S
urg
eryRe
sid
enta
tth
eDuk
eUn
ive
rsi
tyMe
dic
alCe
ntr
e.Ch
ica
go:Ye
arBo
ok,

1
33
 S
TUDYMODULES3

MODULE2:I
ntr
oduc
ti
ont
oIn
ten
siv
eCa
reNur
si
ng

Co
nte
nts
:

S
tud
ySe
ssi
on1
&2:Nut
ri
ti
on.

S
tud
ySe
ssi
on3&4:Pa
tie
ntsUn
der
goi
ngTr
ans
pla
nta
tio
nI.

S
tud
ySe
ssi
on5:Pa
tie
ntsUn
der
goi
ngTr
ans
pla
nta
tio
nII
.

S
TUDYS
ESS
ION1

S
ect
io
nan
dSub
sec
ti
onHe
adi
ngs
:

I
ntr
oduc
ti
on

1
.0Le
arn
ingOut
come
s

2,
0Ma
inCo
nte
nts

2.
1-De
fi
ni
ti
ono
fma
ras
mus
,an
dkwa
shi
ork
or

2.
2-Re
spo
nset
oin
ten
siv
eil
l
nes
san
din
jur
y

2.
3-Nur
si
nga
sse
ssme
nto
fnut
ri
ti
ona
lne
eds

2.
4-Pa
tie
ntma
nag
eme
nt.

3
.0Tu
torMa
rke
dAs
sig
nme
nts(
Ind
ivi
dua
lorG
rou
pas
sig
nme
nts
)

4.
0St
udyS
ess
ionS
umma
rya
ndCo
ncl
usi
on

5.
0Se
lf
-As
ses
sme
ntQue
sti
ons

6
.0Ad
dit
io
nal
Act
iv
it
ie
s(Vi
deo
s,An
ima
tio
ns&Outo
fCl
assAc
ti
vi
ti
es)

1
34
7.
0Re
fer
enc
es/
Fur
the
rRe
adi
ngs

I
ntr
odu
cti
on:

Th
ela
sts
tud
yse
ssi
onl
ook
eda
ttr
auma
tici
nj
uri
esa
tva
rio
usl
eve
lsa
ndi
nth
ema
nag
eme
nto
f

I
nte
nsi
veCa
rep
ati
ent
snut
ri
ti
oni
spe
rti
nen
ttos
urv
iva
lan
dins
it
uat
io
nswh
erema
lnut
ri
ti
ons
ets

i
nth
esur
viv
alr
ateo
fth
epa
tie
nti
sgr
oss
lya
ffe
cte
dasa
lre
ady
.Ho
spi
tal
i
sedp
ati
ent
sar
eath
igh

r
is
kfo
rth
ede
vel
opme
nto
fma
lnut
ri
ti
ons
omes
ugg
estt
hata
sma
nya
s50% o
fho
spi
tal
i
sed

p
ati
ent
sha
ved
ocume
nte
d mo
der
atet
ose
ver
epr
ote
in-
cal
ori
e ma
lnut
ri
ti
onp
rot
ei
n-c
alo
rie

ma
lnut
ri
ti
oni
sas
soc
iat
edwi
thi
ncr
eas
edmo
rbi
di
tya
ndmo
rta
li
ty
.Ast
hemo
stc
ommo
nfo
rmo
f

ma
lnut
ri
ti
oni
nth
eho
spi
tals
ett
ing
,iti
sch
ara
cte
ris
edb
yde
cre
ase
dle
vel
sofv
isc
era
lan
dso
mat
ic

p
rot
ei
nsa
swe
lla
sde
ple
tedf
ats
tor
esa
ndmus
clewa
sti
ng.

1
.0S
tud
ySe
ssi
onL
ear
nin
gOu
tco
mes

Af
ters
tud
yin
gth
iss
ess
ion
,Ie
xpe
cty
out
obea
blet
o:

1
-De
fi
nema
ras
mus
,kwa
shi
ork
ora
ndmi
xedk
was
hio
rko
ran
dma
ras
mus
.

2-Ex
pla
ine
bba
ndf
lo
wph
ase
sofr
esp
ons
est
oin
ten
siv
eil
l
nes
san
din
jur
y.

3
-Di
scus
snur
si
nga
sse
ssme
nto
fnut
ri
ti
on.

4-De
scr
iben
urs
ingma
nag
eme
nto
fma
lno
uri
she
dpa
tie
nts
.

2.
0Ma
inCo
nte
nts

2.
1De
fi
ni
ti
on

A.
Mar
asmus
:In
ade
qua
tec
alo
riei
nta
ker
esul
tind
ecr
eas
edf
ats
tor
esa
ndd
epl
ete
dmus
clema
ss;

mo
stc
ommo
nint
hemo
der
ate
lys
tre
sse
dpa
tie
nt.

B.
Kwa
shi
ork
or:I
nad
equa
tes
upp
lyo
fami
noa
cid
stos
upp
ortp
rot
ei
nsy
nth
esi
s;r
esul
tind
ecr
eas
ed

l
eve
lso
fpl
asma
,an
aemi
a,i
mpa
ire
dimmun
ere
spo
nse
san
doe
dema
.

C.
Mix
edk
was
hio
rko
r/ma
ras
mus(
pro
tei
n-c
alo
riema
lnut
ri
ti
on)
:Ch
ara
cte
ris
ed

1
35
b
ysk
ele
tal
mus
cle
,de
cre
ase
dfa
tst
ore
s,a
ndd
epl
ete
dvi
sce
rap
rot
ei
ns;d
efi
ci
tsi
nen
erg
yan
d

p
rot
ei
nar
emo
stc
ommo
nins
eve
rel
yst
res
sedp
ati
ent
swh
oar
eca
tab
oli
c.

Re
spo
nse
stoI
nte
nsi
veI
ll
nes
san
dIn
jur
y

Th
ere
spo
nse
stoi
nte
nsi
vei
l
lne
ssa
ndi
nj
urya
rec
har
act
eri
sedb
ytwod
ist
inc
tph
ase
s:

e
bba
ndf
lo
wph
ase
s.

B.
Ebbp
has
e:Th
ego
ali
stoma
int
ainb
loo
dfl
owa
ndo
xyg
ena
tio
nofv
it
alo
rga
nss
hor
tdur
ati
on;

c
har
act
eri
st
ic
sin
clud
eth
efo
ll
owi
ng:

1
.De
cre
ase
dca
rdi
aco
utp
ut

2.
Dec
rea
sedc
oret
emp
era
tur
e

3
.De
cre
ase
dox
yge
nco
nsump
ti
on

4.
Inc
rea
sedl
eve
lso
fca
tec
hol
ami
ne,
gluc
ago
ns

5.
Dec
rea
sedi
nsul
i
n

6
.In
cre
ase
dse
rumg
luc
osel
eve
l

7.
Hep
ati
cgl
uco
sep
rod
uct
io
nno
rma
l

C.
Flo
wph
ase
:Th
ego
ali
stop
rov
idef
uel
foro
rga
nfun
cti
ona
ndt
is
suer
epa
ir’
spe
ake
lev
ati
ons

o
ccur5-
10d
aysa
fte
rin
jur
y;c
har
act
eri
st
ic
sin
clud
eth
efo
ll
owi
ng:

1
.In
cre
ase
dca
rdi
aco
utp
ut

2.
Inc
rea
sedc
oret
emp
era
tur
e

3
.In
cre
ase
dox
yge
nco
nsump
ti
on

4.
Inc
rea
sedl
eve
lso
fca
tec
hol
ami
neg
luc
ago
ns

5.
Nor
mal
ori
ncr
eas
edi
nsul
i
n

6
.Se
rumg
luc
osen
orma
lori
ncr
eas
ed

7.
Hep
ati
cgl
uco
sep
rod
uct
io
nma
rke
dlye
lev
ate
d

8.
Hyp
erme
tab
oli
sma
ndh
ype
rca
tab
oli
sm

b
.Fl
owp
has
eisme
dia
tedb
yco
unt
er-
reg
ula
tor
yho
rmo
nes(
cor
ti
sol
,gl
uca
gon
s,c
ate
cho
lami
nes
,

1
36
g
rowt
hho
rmo
nes
)an
dcy
tok
ine
s(i
nte
rle
uki
n-1
tumo
rne
cro
sisf
act
or,
int
erf
ero
n).

c
.Al
ter
ati
onsi
nsub
str
ateme
tab
oli
smo
ccurd
uri
ngt
hef
lo
wph
ase

i
.Ca
rbo
hyd
rat
eme
tab
oli
sm

-I
ncr
eas
edh
epa
ticg
luc
osep
rod
uct
io
n

-I
ncr
eas
edg
luc
osec
ons
ump
ti
onb
ywo
und
s,c
ell
soft
her
eti
cul
oen
dot
hel
i
als
yst
em,
inf
lamma
tor
y

t
is
sue
.

-Th
ein
cre
ase
dgl
uco
sep
rod
uct
io
nisn
otr
educ
edwi
the
xog
eno
usg
luc
osea
dmi
ni
st
rat
io
n.

-I
nsul
i
nre
sis
tan
cer
esul
tsi
nhy
per
gly
cemi
a

i
i
.Fa
tme
tab
oli
sm

Br
eak
downo
ffa
tfr
oma
dip
oset
is
sues
tor
es

I
ncr
eas
ele
vel
soff
reef
att
yac
ids

F
att
yac
idso
xid
ise
dfo
rfue
lorr
ecy
cle
dba
ckt
ope
rip
her
alt
is
sue
s

i
i
i.Pr
ote
inme
tab
oli
sm

Ac
cel
era
teb
rea
kdo
wno
fsk
ele
tal
mus
cle

Th
eli
verut
il
i
sesa
min
oac
idsf
roms
kel
eta
lmus
clec
ata
bol
i
smt
osy
nth
esi
sea
cut
e-p
has
e-r
eac
tan
t

p
rot
ei
n,wh
ichs
upp
ort
simmun
efun
cti
ona
ndwo
undh
eal
i
ng

I
ncr
eas
edc
ata
bol
i
smo
fsk
ele
tal
mus
cler
esul
tsi
nne
gat
iv
eni
tr
oge
nba
lan
ce.

2.
1.
1Nur
si
ngAs
ses
sme
nt

G.
Ass
ess
men
t:wi
thi
n24h
our
soft
hep
ati
enti
sst
abi
l
ise
d

H.
Sig
nan
dsy
mpt
oms

1
.Ge
ner
ala
ppe
ara
nce

a
.De
ple
ti
ono
fmus
cle
san
dfa
tst
ore
s

i
.Te
mpo
ral
was
hin
g

i
i
.Ob
vio
ust
is
sue
sea
sti
nga
roun
dbo
nyp
romi
nen
cess
ucha
sri
bsi
l
iacc
res
t,

s
cap
ula

1
37
b
.Ed
ema
-se
ver
ehy
poa
lbumi
nemi
adi
sr
upt
son
cot
icp
res
sur
ean
dma
yca
usef
lui
dtol
eakf
rom

v
asc
ula
rsp
acei
ntos
urr
oun
din
gti
ssue
s

c
.Sk
int
ext
ure
-dr
yne
sso
rsc
ale
sca
nbes
eco
nda
ryt
oes
sen
tia
lfa
ttya
cide
ffi
ci
enc
y.

d
.Sk
int
urg
or-
ind
ica
tio
nofh
ydr
ati
ons
tat
us

e
.Te
eth
.Mo
uth
,an
dgums
-po
orc
ond
iti
on,
ble
edi
ngma
yin
dic
atev
it
ami
n

d
efi
ci
enc
y.

f
.Co
ndi
ti
ono
fha
ira
ndn
ail
s-
hai
rlo
ssi
sas
soc
iat
edwi
thz
incd
efi
ci
enc
y.

2.
Mus
cles
tre
ngt
h

a
.De
cre
ase
dab
il
it
ytoa
ssi
sti
ntur
nin
gort
ran
sfe
rri
ngf
romb
edt
och
air

b
.Re
duc
edh
ad-
gra
spi
ngs
tre
ngt
h

3
.Ca
rdi
ac

a
.He
mod
yna
mica
sse
ssme
nt–b
loo
dpr
ess
ure
,ce
ntr
alv
eno
usp
res
sur
e,

p
ulmo
nar
yar
ter
ypr
ess
ure(
PAP)
,pul
mon
arya
rte
rywe
dgep
res
sur
e(PAWP)
,

c
ard
iaco
utp
ut

i
.As
ses
sfo
rin
dic
ati
onso
fov
erh
ydr
ati
ono
run
derh
ydr
ati
on.

i
i
.De
cre
ase
dbl
oodp
res
sur
e,d
ecr
eas
edc
ard
iaco
utp
utma
ypr
ecl
udee
nte
ral
fee
din
gbe
caus
e

i
nad
equa
teb
loo
dfl
owt
oth
ein
tes
ti
newi
l
lno
tsup
por
tdi
ges
ti
ona
ndc
oul
dca
usei
nte
sti
nal

i
sch
emi
a.

b
.Id
ent
if
yth
ene
edf
orf
lui
dre
str
ic
ti
ons

4.
Res
pir
ato
ry

a
.Re
spi
rat
oryr
ate
,ti
dal
vol
ume
,ca
pac
it
y,mi
nut
eve
nti
l
ati
on

i
.De
cre
ase
ddi
aph
rag
mmu
scl
ema
sswi
l
lin
cre
aset
ida
lvo
lumed
ecr
eas
evi
tal
cap
aci
ty
,in
cre
ase

r
esp
ira
tor
yra
tea
ndmi
nut
eve
nti
l
ati
on.

i
i
.Ov
erf
eed
ingn
onp
rot
ei
nca
lor
ieswi
l
lin
cre
aseCO2p
rod
uct
io
n.

4.
Ren
al

1
38
a
.Ur
ineo
utp
ut-a
sse
ssq
uan
tit
yan
dqua
li
tyo
fur
ineo
utp
ut

i
.De
cre
aseur
ineo
utp
ut

i
i
.Fl
ui
dov
erl
oad

i
i
i.De
cre
ase
dcr
eat
ini
nec
lea
ran
ce

b
.El
ect
rol
yt
es,
blo
odur
ean
itr
oge
n,c
rea
tin
ine

i
.Ac
cumul
ati
ono
fur
eai
nbl
ood
:Th
iswi
l
lri
sei
nth
ehy
perc
ata
bol
i
cpa
tie
nta
ssk
ele
tal
mus
clei
s

mo
bil
i
sed
.Ita
lsor
is
esd
uri
ngp
rot
ei
nad
min
ist
rat
io
nwi
tho
utd
ial
ysi
s.

i
i
.In
cre
ase
dpo
tas
sium,
mag
nes
ium,
andp
hos
pho
rus

i
i
i.I
ncr
eas
edc
rea
tin
inei
ndi
cat
eswo
rse
nin
gre
nal
fun
cti
on.

d
.Ty
pea
ndf
req
uen
cyo
fdi
al
ect
ict
her
apy

i
.Di
al
ysi
sisac
ata
bol
i
cth
era
pya
ndc
ont
ri
but
est
opr
ote
ind
epl
eti
on.

i
i
.Co
nti
nuo
usa
rte
rio
ven
oush
emo
fi
lt
rat
io
ndi
al
ysi
sorp
eri
to
nea
ldi
al
ysi
sis

as
ign
ifi
can
tso
urc
eofn
on-
pro
tei
nca
lor
ies
.

5.
Gas
tro
int
est
ina
l

a
.Qua
nti
fyo
utp
utf
roma
nyt
ube
sac
ces
sin
gth
eGa
str
o-I
nte
sti
nal
Tra
ct

i
.Fl
ui
d/e
lec
tro
lyt
ede
ple
ti
onc
ano
ccurwi
the
xce
ssi
vel
oss
esf
romt
heGa
str
o-I
nte
sti
nal
Tra
ct.

b
.Me
asur
eab
domi
nal
dis
ten
tio
n.

c
.St
ool
out
put
-qua
nti
fyt
hea
moun
t,d
esc
ri
bet
hec
ons
ist
enc
y

i
.Ex
ces
siv
est
ool
orf
is
tul
alo
sse
sco
nta
inas
ign
ifi
can
tamo
unto
fme
asur
abl
eni
tr
oge
n.

d
.Aus
cul
tat
io
nofb
owe
lso
und
s–l
eas
tus
eful
inf
orma
tio
nan
dab
sen
ceo
fbo
wel
soun
dsd
oesn
ot

me
anGa
str
o-I
nte
sti
nal
Tra
cti
sno
nfun
cti
ona
l.

A-C.
Ant
hro
pome
tri
cda
ta

1
.Ad
mis
sio
nwe
igh
tan
dhe
igh
t

a
.Ev
alua
tet
hed
egr
eeo
fwe
igh
tlo
ss;g
rea
tert
han1
0%i
ssi
gni
fi
can
t.

2.
Cal
cul
ateI
dea
lBo
dyWe
igh
t(I
BW)

1
39
a
.Me
n:I
BW=1
06I
bfo
rfi
rs
t5f
t;6
Ibf
ore
acha
ddi
ti
ona
lin

b
.Wo
men
:IBW=1
00I
bfo
rfi
rs
t5f
t;5I
bfo
rea
cha
ddi
ti
ona
lin

c
.Ca
lcu
lat
e%I
BW(
Tab
le4.
1)[
1]

S
eve
rema
lnut
ri
ti
onl
esst
han70%o
fIBW

Mo
der
atema
lnut
ri
ti
on70-
80%o
fIBW

Mi
l
dma
lnut
ri
ti
on80-
90%o
fIBW

e
.Sk
inf
ol
dme
asur
esa
rel
essr
eli
abl
edur
inga
cut
epe
rio
dso
fst
res
s.

D.
Met
abo
li
cas
ses
sme
nt

1
.Vi
sce
ral
pro
tei
nst
atus
-ca
tab
oli
cil
l
nes
sre
sul
tsi
nde
ple
ti
ono
fal
bumi
n,-p
re-
alb
umi
n,a
nd

t
ran
sfe
rri
ngb
eca
useo
fad
ecr
eas
edp
rod
uct
io
noft
hes
epr
ote
inst
osup
por
tth
ein
cre
ase
d

s
ynt
hes
iso
fac
ute
-ph
ase
-re
act
antp
rot
ei
ns.

a
.Al
bumi
n-l
ongh
alf
-l
if
e(21d
ays
)li
mit
sit
sus
eful
nes
sasama
rke
rofn
utr
it
io
nal
def
ic
it
;ho
wev
er,

i
tisag
oodi
ndi
cat
oro
fth
ese
ver
it
yofi
nte
nsi
vei
l
lne
ss.

Th
efl
ui
dst
atuswi
l
laf
fec
tse
rumme
asur
es:Ov
erh
ydr
ati
onr
esul
tsi
nde
cre
ase
dal
bumi
n,un
der

h
ydr
ati
onr
esul
tsi
nel
eva
tedv
alue
s.

b
.Pr
eal
bumi
n-as
hor
terh
alf
-l
if
eisa
ppr
oxi
mat
ely8-
10d
ays
.Le
vel
sap
pea
r

l
owwh
eni
rons
tor
esa
rel
ows
ucha
swi
thma
ssi
veh
aemo
rrh
age
.

2.
Mea
sur
eso
fimmun
efun
cti
on–t
ota
lly
mph
ocy
tec
oun
tan
dsk
ina
nti
gent
est
ing

a
.Le
ssr
eli
abl
eme
asur
eofn
utr
it
io
nal
sta
tusi
nth
ein
ten
siv
elyi
l
lbe
caus
eimp
air
ed

i
mmun
oco
mpe
ten
cer
esul
tsi
nst
res
s,t
rauma
,an
dma
nyc
hro
nicd
ise
ase
s

3
.En
erg
yex
pen
dit
ure
-to
tal
exp
end
itur
eisus
ual
l
yin
cre
ase
dinp
rop
ort
io
ntot
hes
eve
rit
yofi
nj
ury

a
nds
tre
ss.

a
.Es
ti
mat
ingMe
tab
oli
cRa
te:Ha
rri
s-
Ben
edi
cte
qua
tio
n(BMR)

i
.Eq
uat
io
npr
edi
ct
sba
sal
met
abo
li
cra
te.

i
i
.Eq
uat
io
nun
der
est
ima
tesn
eed
sdur
ingi
nte
nsi
vei
l
lne
ssa
ndo
ver
est
ima
tese
ner
gyn
eed
sin

1
40
p
ati
ent
swh
oar
einb
arb
it
ura
tec
oma
.

i
i
i.Pr
edi
ct
iv
eeq
uat
io
nsa
ret
ypi
cal
l
ymul
ti
pl
ie
dbys
tre
ssf
act
orst
ode
fi
net
het
ota
lda
il
yno
npr
ote
in

c
alo
riep
res
cri
pt
io
n.

d
.Me
asur
ingr
est
inge
ner
gye
xpe
ndi
tur
e(REE)
:in
dir
ectc
alo
rime
try

i
.Me
asur
eso
xyg
enc
ons
ump
ti
ona
ndCO2p
rod
uct
io
n

i
i
.Re
qui
resap
ort
abl
eme
tab
oli
cca
rt

i
i
i.Mo
sta
ccur
atewa
ytod
ete
rmi
nee
ner
gye
xpe
ndi
tur
e;g
rea
tert
han1
2%

r
efl
ect
shy
per
bol
i
sm

4.
Nit
rog
enb
ala
nce

a
.Ni
tr
oge
nba
lan
ce=n
itr
oge
n-n
itr
oge
nout
put
.

b
.Co
ll
ect24-
hourur
ineur
ean
itr
oge
nan
dcr
eat
ini
ne.

c
.Ne
gat
iv
eni
tr
oge
nba
lan
cei
sch
ara
cte
ris
ti
cofa
cut
eil
l
nes
s.

5.
Ser
umc
hemi
st
ryme
asur
e:El
ect
rol
yt
es–s
eruml
eve
lsf
luc
tua
ter
api
dl
ydur
ing

p
eri
odso
fac
utei
l
lne
ss.

a
.Po
tas
sium,
mag
nes
ium,
-ph
osp
hor
us–s
eruml
eve
lsd
ropi
nre
spo
nset
oag
gre
ssi
ver
efe
edi
ng

b
eca
usep
ota
ssi
uma
ndp
hos
pho
rusi
onsa
red
riv
eni
ntot
hec
ell
tos
upp
orta
nab
oli
sm.

b
.Bl
oodur
ean
itr
oge
nan
dcr
eat
ini
ne-i
ncr
eas
esma
yre
fl
ecth
ydr
ati
ons
tat
usa
nds
ign
alwo
rse
nin
g

r
ena
lfun
cti
on.

c
.Se
rumg
luc
ose
-hy
per
gly
cemi
a(>200mg
/dl
)ch
ara
cte
ris
ti
cfe
atur
edur
ings
eve
res
tre
ss

d
.Se
rumt
ri
gl
yce
rid
e-h
ype
rtr
ig
lyc
eri
demi
ama
yre
fl
ectd
ecr
eas
ecl
ear
anc
eofl
i
pid

e
.He
mog
lob
in/
hema
toc
ri
t-
ana
emi
aisc
ommo
nwi
thp
rot
ei
n-c
alo
riema
lnut
ri
ti
on.

B-Pa
tie
ntma
nag
eme
nt

A.
Alt
era
tio
ninn
utr
it
io
n/me
tab
oli
cst
atusr
ela
tedt
ohy
per
met
abo
li
sma
ndh
ype
rca
tab
oli
sm

c
aus
edb
yth
ere
spo
nset
ose
ver
est
res
s/a
cut
eil
l
nes
s.

1
.Pr
obl
em:we
igh
tlo
ss,
neg
ati
ven
itr
oge
nba
lan
ce,
del
aye
dwo
undh
eal
i
ng

1
41
2.
Int
erv
ent
io
n

a
.Nut
ri
ti
ona
lsup
por
tin
dic
ate
dift
hep
ati
entwo
uldb
eta
kin
gno
thi
ngo
ral
l
yfo
rmo
ret
han5d
ays
.

b
.De
ter
min
een
erg
yne
eds

i
.Ca
lor
icn
eed
sar
eba
sedo
nth
ego
alsf
orf
ats
tor
es/
bod
ywe
igh
t.

We
igh
tga
in:(
res
ti
nge
ner
gye
xpe
ndi
tur
e[REE]x
1.5)–n
otr
eco
mme
nde
ddur
ingi
nte
nsi
vei
l
lne
ss

We
igh
tma
int
ena
nce
.(REEx
1.2)

We
igh
tlo
ss:(
REEx0.
8-1
.0)
-nol
esst
han800n
onp
rot
ei
nkc
al/
d

i
i
.Es
ti
mat
edn
eed
sdur
ingi
nte
nsi
vei
l
lne
ss

We
igh
tma
int
ena
nce=3
5-40k
cal
/kgb
odywe
igh
tpe
rda
y

Us
eid
eal
bod
ywe
igh
tift
hep
ati
enti
smo
rbi
dl
yob
ese
.

C-e
.De
ter
min
epr
ote
inn
eed
s.

i
.Pr
ote
inr
epl
eti
oni
sus
ual
l
yre
qui
redf
orh
igh
lyc
ata
bol
i
cpa
ten
s.

i
i
.2.
0g/
kgb
odywe
igh
tpe
rda
y

i
i
i.Me
asur
eni
tr
oge
nba
lan
cewe
ekl
y.

3
.De
sir
edo
utc
ome

a
.Me
etg
oal
sfo
rfa
tst
ore
san
dbo
dywe
igh
t.

b
.Re
duc
ene
tne
gat
iv
eni
tr
oge
nba
lan
ce.

i
.Di
ff
ic
ultt
oac
hie
vep
osi
ti
ven
itr
oge
nba
lan
ced
uri
ngp
eri
odso
fex
tre
mec
ata
bol
i
sm

c
.De
cre
asemo
rbi
di
tya
ndmo
rta
li
ty

B.
Nut
ri
ti
ona
lde
fi
ci
tre
lat
edt
oth
ein
abi
l
ityt
ous
eGIt
rac
tdur
ingt
hep
eri
odo
fhy
perc
ata
bol
i
sm

a
ndh
ype
rme
tab
oli
sms
eco
nda
ryt
ose
ver
ehe
mod
yna
mici
nst
abi
l
ity(
red
uce
dbl
oodf
lo
wtot
he

i
nte
sti
ne)
;di
sr
upt
io
noft
hec
ont
inui
tyo
fth
eGIt
rac
tbe
caus
eofo
bst
ruc
ti
on,
fi
st
ula
,ori
l
eus
;

d
ecr
eas
eda
bso
rpt
io
nca
use
dbyGIb
lee
din
g,a
cut
epa
ncr
eat
it
is
,ori
ntr
act
abl
edi
arr
hoe
a.

1
.Pr
obl
em:p
ote
nti
alwe
igh
tlo
ss,
neg
ati
ven
itr
oge
nba
lan
ce,
del
aye
dwo
undh
eal
i
ng,
inc
rea
sed

mo
rbi
di
tya
ndmo
rta
li
ty

1
42
2.
Int
erv
ent
io
n:t
ota
lpa
ren
ter
aln
utr
it
io
n(TPN)

a
.En
erg
y-s
upp
ly–d
ext
ros
e(l
g=3
.4k
cal

i
.Pr
ovi
de6
0-70%o
fto
tal
non
pro
tei
nca
lor
ien
eed
s

i
i
.Don
ote
xce
ed7d
ext
ros
e/k
gbo
dywe
igh
tpe
rda
y.

i
i
i.Mi
ni
mal
req
uir
eme
nti
s200g
/d(
700k
cal
).

i
v.De
xtr
oses
olut
io
nsa
vai
l
abl
einac
onc
ent
rat
io
nra
ngi
ngf
rom5%t
o70%

b
.En
erg
ysup
ply
-li
pi
d(l
g=9k
cal
)

i
.Pr
ovi
de3
0-40%o
fto
tal
non
pro
tei
nca
lor
icn
eed
s.

i
i
.Don
ote
xce
ed2.
5gf
at/
kgb
odywe
igh
tpe
rda
y.

i
i
i.Li
pi
dso
lut
io
nsa
vai
l
abl
ein1
0%o
r20%c
onc
ent
rat
io
ns

c
.Pr
ote
ins
upp
ly

i
.St
and
arda
min
oac
idf
ormul
asc
ont
ainami
xofe
sse
nti
ala
ndn
one
sse
nti
ala
min
oac
ids
.

i
i
.Ami
noa
cids
olut
io
nsa
vai
l
abl
einc
onc
ent
rat
io
nsr
ang
ingf
rom8.
5%t
o14%

2.
1.
2Mi
norTo
pic
s

A-d
.El
ect
rol
yt
es

i
.Ad
del
ect
rol
yt
est
oto
tal
par
ent
era
lnut
ri
ti
on(
TPN)r
egi
mend
ail
yfo
rma
int
ena
nce

S
odi
um–70-1
00mEq
/d

Po
tas
sium–70-1
00mEq
/d

Ch
lor
ide–80-1
20mEq
/d

Ma
gne
sium–1
5-20mEq
/d

Ph
osp
hor
us–20-
30mmo
l/d

Ca
lci
um-
10-20mEq
/d

Ac
eta
te–06
0mEq
/d

Da
il
yad
jus
tme
ntsb
ase
dond
ail
yla
bor
ato
ryv
alue
s

f
.Vi
tami
ns

1
43
i
.Ad
dad
ail
ypa
ren
ter
alv
it
ami
nsup
ple
men
ttoTPN

i
i
.1mgv
it
ami
nKa
dde
dtoTPNf
orma
int
ena
nce

i
i
i.1
0mgv
it
ami
n1.
Mx3d
aysf
orr
epl
eti
oni
fth
erea
rec
lot
ti
nga
bno
rma
li
ti
es

i
v.Ad
dit
io
nal
thi
ami
ne,
fol
ate
,vi
tami
nB1
2wi
tha
lco
hol
abus
e

g
.Tr
acte
leme
nts

i
.Ad
dda
il
ypa
ren
ter
alt
rac
eel
eme
ntmi
xtoTPN.

i
i
.St
and
ards
olut
io
nco
nta
insz
inc
,co
ppe
r,ma
nga
nes
e,c
hro
miuma
nds
ele
nium.

i
i
i.Ad
dit
io
nal
zin
cre
qui
redd
uri
nga
cut
eca
tab
oli
cst
res
s

i
v.Re
duc
eco
ppe
ran
dma
nga
nes
eint
hes
ett
ingo
fbi
l
iar
y

h
.Ad
min
ist
rat
io
nte
chn
ique
s

i
.De
li
ver
yre
qui
resc
ent
ral
acc
essb
eca
useo
fth
ein
cre
ase
dos
mol
ari
tyo
fth
eTPNs
olut
io
ns.

Ma
yus
eex
ist
ingl
i
nest
hath
aveb
eenp
rop
erl
yma
int
ain
ed

F
emo
ral
cat
het
ersc
anb
eus
ed.

Pr
oxi
mal
por
tso
fhe
mod
yna
micmo
nit
ori
ngl
i
nesc
anb
eus
ed.

I
ni
ti
ateTPNa
tgo
al:n
ora
tio
nal
etos
lowl
yta
per
ings
olut
io
ns.

Ch
eckb
loo
dgl
uco
see
ver
y6h
our
sfo
r48h
our
san
dth
en,
ifs
tab
le,

d
ail
y.

Mo
nit
ors
erumma
gne
sium,
cal
ci
um,
pot
ass
iumd
ail
yfo
r3d
ays
,th
ene
ver
y3d
ays
.

Di
sco
nti
nua
tio
nofTPN:Nor
ati
ona
les
upp
ort
ingt
hen
eedt
osl
owl
yta
perd
ownTPNs
olut
io
ns

b
efo
red
isc
ont
inui
ng.

i
.Pr
eve
ntp
ote
nti
alc
omp
li
cat
io
nso
fTPN

j
.Me
tab
oli
cco
mpl
i
cat
io
ns:

(
1)h
ype
rgl
yce
mia
:mo
nit
orb
loo
dgl
uco
sea
nd

a
djus
tgl
uco
sec
alo
rie
sac
cor
din
gly
,ad
dsh
ort
-ac
ti
ngi
nsul
i
ntoTPNt
oke
eps
uga
rle
ss200g
/dL,

i
ncr
eas
eamo
unto
fno
npr
ote
inc
alo
rie
spr
ovi
deda
sfa
t;

1
44
(
2)h
ype
rtr
igl
yce
rid
emi
a:mo
nit
orb
ase
li
nes
erumt
ri
gl
yce
rid
es,
red
ucel
i
pidc
alo
rie
sift
ri
gl
yce
rid
e

l
eve
ltoa
sse
ssc
lea
ran
ce;

(
3)h
ype
rca
pni
a:a
voi
dov
erf
eed
ingt
opr
eve
nti
ncr
eas
edc
arb
ohy
dra
tep
rod
uct
io
n;

(
4)h
epa
ticd
ysf
unc
ti
on:a
voi
dov
erf
eed
ing
,ex
pec
tmi
l
dtr
ans
ien
tel
eva
tio
nsi
ntr
ans
ami
nas
ean
d

a
lka
li
nep
hos
pha
test
hatp
eakwi
thi
n10-
15d
ayso
fst
ari
ng

TPN,
mon
ito
rli
verf
unc
ti
ont
est
swe
ekl
y.

B-3
.De
sir
edo
utc
ome

a
.Go
alsf
orwe
igh
t/f
ats
tor
esme
t

b
.Re
duc
edn
etn
ega
tiv
eni
tr
oge
nba
lan
ce

c
.In
cre
ase
dvi
sce
ral
pro
tei
nle
vel
s(p
rea
lbmi
n,a
lbumi
n,t
ran
sfe
rri
ng)

d
,Se
rume
lec
tro
lyt
ele
vel
swi
thi
nno
rma
lli
mit
s

C.
Nui
ri
ti
ona
lde
fi
ci
tre
lat
edt
oth
ein
abi
l
ityt
oea
tan
dme
etr
equi
reme
ntsd
uri
ngp
eri
odso
f

h
ype
rme
tab
oli
sma
ndh
ype
rca
tab
oli
sms
eco
nda
ryt
oup
perGIt
rac
tob
str
uct
io
n,i
l
eus
,fi
st
ula
;

p
anc
rea
tit
is
;ri
sko
fas
pir
ati
on;d
ecr
eas
edp
har
yng
eal
ref
le
xeso
rde
pre
sse
dme
nta
lst
atus

1
.Pr
obl
em:p
ote
nti
alf
orwe
igh
tlo
ss,
neg
ati
ven
itr
oge
nba
lan
ce,
del
aye
dwo
undh
eal
th,
and

i
ncr
eas
edmo
rbi
di
tya
ndmo
rta
li
ty

2.
Int
erv
ent
io
n:i
ni
ti
atee
nte
ral
fee
din
g

a
.De
ter
min
ewh
erei
nth
eGIt
rac
ttof
eed
:st
oma
cho
rsma
lli
nte
sti
ne

i
.Ga
str
ici
l
eusc
ommo
nins
eve
reh
eadi
nj
ury
,af
tere
xte
nsi
vea
bdo
min
als
urg
ery
,an
ddur
ing

s
eve
res
eps
is

i
i
.De
lay
edg
ast
ri
c,e
mpt
yi
ngc
ano
ccurf
romp
har
mac
olo
gici
nte
rve
nti
ono
risa
sso
cia
tedwi
th

c
hro
nici
l
lne
sss
ucha
sdi
abe
tes
.

i
i
i.Po
stp
ylo
rice
nte
ral
fee
din
gwi
l
lre
duc
eth
eri
sko
ffe
edi
ng-
rel
ate
das
pir
ati
on.

b
.Se
lec
ten
ter
ala
cce
ssd
evi
ce(
Tab
le4.
2)

1
45
i
.De
ter
min
eife
nte
ral
fee
din
gwi
l
lbes
hor
t-
ter
m(<.
1mo
nth
)orl
ong
-te
rm(
>1mo
nth
).

i
i
.Pe
rma
nen
ten
ter
ala
cce
ssi
sin
dic
ate
diff
orc
edf
eed
ingi
sne
ces
sar
il
ygr
eat
ert
han1mo
nth
.

c
.Se
lec
ten
ter
alf
ormul
a

i
.St
and
ardp
oly
mer
icf
ormul
a–c
ont
ain
s1k
cal
/mLa
ndi
s70-
80%f
reewa
ter
.

Mo
stc
ont
aina
ppr
oxi
mat
el
y40go
fpr
ote
inp
erl
i
trea
nda
rei
ndi
cat
edf
ormo
der
ate
lys
tre
sse
d

p
ati
ent
s.

i
i
.Ca
lor
ic
all
yde
nsef
ormul
a-c
ont
ain
s1.
5-2.
0kc
al/
mLa
ndi
s60-
70%f
reewa
ter
.

Us
einf
lui
d-
res
tri
ct
edp
ati
ent
s.

i
i
i.Hi
gh-
pro
tei
nfo
rmul
a-c
ont
ain
sgr
eat
ert
han50-
60go
fpr
ote
inp
erl
i
trea
ndi
sin
dic
ate
dfo
rhi
ghl
y

c
ata
bol
i
cpa
tie
nts
.

i
v.En
ter
alf
ormul
a-l
i
mit
eda
ppl
i
cat
io
nbutma
ybeo
fus
einp
anc
rea
tit
iso
rma
lab
sor
pti
on

s
ynd
rome
s

v
.En
ter
alf
ormul
asc
ont
ainv
it
ami
ns,
tra
cee
leme
nts
.

d
.Ad
min
ist
rat
io
nte
chn
ique
s

i
.I
nte
rmi
tt
entf
eed
ing
:En
ter
alf
eed
ingi
sad
min
ist
rat
edv
iag
rav
it
ydr
ipe
ver
y4-
6ho
urs
.Th
is

d
eli
ver
yme
tho
diso
nlyf
ori
ntr
aga
str
icf
eed
ing
.Ea
chf
eed
ings
houl
d

i
. i
nfus
eov
er3
0-6
0mi
nut
es.
Eac
hin
ter
mit
ten
tfe
edi
ngs
houl
dno
tex
cee
d480mL.

I
ntr
oduc
efe
edi
nga
t120mLe
ver
y4h
our
san
dad
van
cea
sto
ler
ate
dtog
oal
reg
ime
n.

Mo
nit
ort
ole
ran
cet
oth
efe
edi
ngr
egi
men

Ch
eckg
ast
ri
cre
sid
ual
sbe
for
eea
chf
eed
ing
:Ho
ldi
fre
sid
ual
isg
rea
tert
han1
50mL.

As
ses
sfo
rna
use
avo
mit
ingo
rbl
oat
ing
-ma
yin
dic
ateg
ast
ri
cmo
ti
li
tyi
ssl
owe
d

i
i
.Co
nti
nuo
usf
eed
ingc
anb
ede
li
ver
edi
ntot
hes
toma
cho
rsma
lli
nte
sti
ne.
Sta
rtf
eed
inga
tar
ate

o
f30-
50mL/
han
dad
van
cei
nin
cre
men
tso
f(3
0mLun
til
theh
our
lyr
ater
eac
hest
heg
oal
.

F
eed
ing
sin
tot
hes
mal
li
nte
sti
nemus
tbec
ont
inuo
usv
iaap
umpt
opr
eve
ntd
iar
rho
ea.

Mo
nit
ort
ole
ran
cet
oth
ere
gime
n

1
46
Ch
eckg
ast
ri
cre
sid
ual
sev
ery4h
our
s.

Mo
nit
ora
bdo
min
alg
irt
h-h
oldf
eed
ingf
ori
ncr
eas
eda
bdo
min
ald
ist
ent
io
n.

Mo
nit
orf
orn
aus
eaa
ndv
omi
ti
ng-
mayi
ndi
cat
etub
eti
pha
smi
gra
tedf
roms
mal
li
nte
sti
net
o

s
toma
ch.

Mo
nit
orf
ord
iar
rho
ea:Rul
eouti
nfe
cti
ousc
aus
es,
dil
uteh
ype
rto
nicme
dic
ati
onst
hata
red
eli
ver
ed

v
iat
hef
eed
ingt
ubewi
thwa
ter
,an
dtr
eatwi
tht
her
out
inea
dmi
ni
st
rat
io
nofa
nti
di
arr
hoe
al.

f
.Pr
eve
ntc
omp
li
cat
io
nso
fen
ter
alf
eed
ing

i
.Ov
erh
ydr
ati
on:s
ele
cte
nte
ral
for
mul
ast
hata
rec
alo
ric
all
yde
nset
hatc
ont
ainl
essf
reewa
ter
.

i
i
.De
hyd
rat
io
n:d
il
utet
hee
nte
ral
for
mul
awi
thwa
tert
ome
etc
alc
ula
tedd
ail
yfl
ui
dre
qui
reme
nts
.

i
i
i.As
pir
ati
on:k
eeph
eado
fth
ebe
del
eva
ted3
0-45d
egr
ees
,us
eco
lour
inga
gen
t

t
ode
tec
tfe
edi
ngi
ntr
ach
eal
asp
ir
ate
,us
ePHt
est
ing
,ad
min
ist
ere
nte
ral
fee
din
gpo
stp
ylo
ric
all
y,

us
eon
lys
mal
l
-bo
ren
aso
gas
tri
ctub
es.

i
v.Di
arr
hoe
a:e
xcl
udea
nd/o
rtr
acto
the
rca
use
sofd
iar
rho
ea;c
ons
ide
rfi
bref
ormul
afo
rse
ver
e

d
iar
rho
eac
aus
edb
yama
lab
sor
pti
ons
ynd
rome
;co
nsi
dera
nel
eme
nta
lorp
ept
ide
-ba
sedf
ormul
a.

v
.Ad
min
ist
ersl
ope
rami
de

v
i.F
eed
ingt
ubeb
loc
kag
e;a
voi
dme
dic
ati
ona
dmi
ni
st
rat
io
nifp
oss
ibl
e;i
fnoo
the
rro
utea
vai
l
abl
e,

us
eli
qui
dme
dic
ati
onso
rth
oro
ugh
lyc
rus
hedp
il
ls
;fl
ui
dtub
eev
ery3
-4h
our
swi
thwa
rmwa
ter

d
uri
ngc
ont
inu
ousf
eed
inga
ndb
efo
rea
nda
fte
rea
chi
nte
rmi
tt
entf
eed
ing
.

C-3
.De
sir
edo
utc
ome

a
.Me
etg
oal
sfo
rwe
igh
t/f
ats
tor
es.

b
.Re
duc
ene
tne
gat
iv
eni
tr
oge
nba
lan
ce.

c
.Re
duc
emo
rbi
di
tya
ndmo
rta
li
ty
.

d
.Mi
ni
mis
eco
mpl
i
cat
io
nso
fen
ter
alf
eed
ing
.

D.
Alt
era
tio
nsi
nfl
ui
dan
del
ect
rol
yt
est
atusr
ela
tedt
oth
eimp
air
men
tofo
rga
nfun
cti
on(
ren
al,

l
i
ver
,ca
rdi
ac,
res
pir
ato
ry)c
omp
li
cat
ingt
hed
eli
ver
yofn
utr
it
io
nal
goa
ls.

1
47
1
.Pr
obl
em:De
ter
ior
ati
ngo
rga
nfun
cti
oni
mpa
irsc
lea
ran
ce/
tol
era
nceo
fca
lor
ies
,pr
ote
in,
fl
ui
dan
d

e
lec
tro
lyt
esr
esul
ti
ngi
nfl
ui
dov
erl
oad
,ab
nor
mal
ser
ume
lec
tro
lyt
es,
inc
rea
sedBUN,
inc
rea
sed

CO2p
rod
uct
io
n.

2.
Int
erv
ent
io
n:Ad
jus
tnut
ri
entp
res
cri
pt
io
ntoa
cco
untf
orwo
rse
nin
gor
ganf
unc
ti
on.

a
.Re
nal

i
.Pr
ote
inp
res
cri
pt
io
n:De
cre
aset
het
ota
lamo
unto
fst
and
arda
min
oac
ids(
1.4g
/kgp
er

we
igh
t)i
fdi
al
ysi
sisi
nef
fec
ti
veo
rco
ntr
ain
dic
ate
d.

i
i
.Ke
epb
loo
dur
ean
itr
oge
n(BUN)l
esst
han1
00g
/dL.

i
i
i.S
pec
ial
i
sedr
ena
lfo
rmul
as(
ess
ent
ial
ami
noa
cid
s)a
reo
nlyi
ndi
cat
edi
npa
tie
ntswh
oca
nno
tbe

d
ial
yse
d.Th
eef
fi
cac
yoft
hes
esp
eci
al
is
edf
ormul
asi
sco
ntr
ove
rsi
al
.

i
v.Ma
xima
ll
yco
nce
ntr
atea
lln
utr
ien
tso
lut
io
ns

v
.Re
str
ic
t/d
ele
tema
gne
sium,
pot
ass
ium,
andp
hos
pho
rus
.

v
i.Pr
ovi
dea
ddi
ti
ona
lac
eta
te.

v
ii
.Ca
lcul
atec
alo
ricc
ont
ri
but
io
nofd
ial
yt
ict
her
api
ess
ucha
sCAVHDa
ndp
eri
to
nea
ldi
al
ysi
s.

b
.He
pat
ic

i
.Pr
ote
inp
res
cri
pt
io
n:S
lowl
yin
tro
duc
est
and
arda
min
oac
ids
olut
io
ns(
0.8-
1g/
kgp
erwe
igh
t)a
nd

a
dva
ncea
sto
ler
ate
d,mo
nit
ori
ngf
orwo
rse
nin
gen
cep
hal
opa
thy
.

i
i
.Re
str
ic
the
pat
icf
ormul
as(
bra
nch
ed-
cha
ina
min
oac
idf
ormul
a)f
orp
ati
ent
swi
thwo
rse
nin
g

e
nce
pha
lop
ath
ywh
oar
eun
res
pon
siv
etome
dic
alt
her
apy
.

i
i
i.Pr
ovi
dea
tle
ast1
50-
200go
fgl
uco
se/
d

i
v.Re
str
ic
tfl
ui
dan
dso
dium

v
.Sup
ple
men
tvi
tami
nK1mgd
ail
y,mo
nit
orc
lot
ti
ngs
tud
ies

v
i.De
let
eco
ppe
ran
dma
nga
nes
e

c
.Re
spi
rat
ory

i
.Av
oido
ver
fee
din
gpa
tie
nts(
>150%o
fme
asur
ede
ner
gye
xpe
ndi
tur
e).

1
48
i
i
.Se
lec
ta50:
50mi
xofg
luc
osea
ndf
att
ome
etd
ail
yno
npr
ote
inc
alo
rie

r
equi
reme
nts
.

I
n-t
extQue
sti
on

Wh
ens
houl
dami
noa
cida
dmi
ni
st
rat
io
n,b
ere
duc
edi
nre
lat
io
ntor
ena
limp
air
men
t?

An
swe
r:De
cre
aset
het
ota
lamo
unto
fst
and
arda
min
oac
ids(
1.4g
/kgp
erwe
igh
t)i
fdi
al
ysi
sis

i
nef
fec
ti
veo
rco
ntr
ain
dic
ate
d.

4.
0Tu
torMa
rke
dAs
sig
nme
nts(
Ind
ivi
dua
lorG
rou
p)

(
a)Wi
ths
pec
if
ich
ead
ing
s,d
if
fer
ent
iat
ebe
twe
enMa
ras
musa
ndKwa
shi
ork
or.

(
b)Wh
ata
ret
hev
ari
ousme
asur
esi
nth
eas
ses
sme
nto
fnut
ri
ti
on?

5.
0Co
ncl
usi
on/
Summa
ry

Th
ere
lev
anc
eofa
deq
uat
enut
ri
ti
ont
oth
esur
vi
val
oft
hep
ati
enti
nIn
ten
siv
eCa
rec
ann
otb
e

un
der
min
eds
oth
enur
sewi
l
lne
edt
opa
yho
li
st
ica
tte
nti
ont
oth
epa
tie
ntr
ece
ivi
ngn
urs
ingc
are

un
derh
er.
Then
urs
emus
tbek
nowl
edg
eab
lei
nth
isa
reat
obea
blet
oas
sis
tth
epa
tie
nt;s
hemus
t

b
eab
let
oma
kea
deq
uat
ejud
gme
ntwi
tht
hea
sse
ssme
nta
lre
adyd
onei
nor
dern
ott
oputt
he

p
ati
enti
nfur
the
rda
nge
r.

I
nth
isun
it,
youh
avel
ear
nta
boutma
ras
musk
was
hio
rko
ran
dth
emi
xed
,re
spo
nset
oin
ten
siv
e

i
l
lne
ssa
ndi
nj
uryb
yth
epa
tie
nts
,nur
si
nga
sse
ssme
nto
fnut
ri
ti
ona
ndma
nag
eme
nto
fnut
ri
ti
ono
f

v
ari
ousp
ati
ent
s.I
tise
xpe
cte
dth
att
hek
nowl
edg
eac
qui
redi
nth
isun
itwi
l
lbe
tte
ryo
urn
urs
ing

c
areo
fyo
urp
ati
ent
satv
ari
ousl
eve
ls.

6
.0S
elf
-As
ses
sme
ntQue
sti
on

Br
ief
lyc
omme
nto
nth
enut
ri
ti
ona
las
ses
sme
nto
fth
epa
tie
ntwi
tha
nin
ten
siv
e

i
l
lne
ss.

1
49
 An
swe
r

Nur
si
ngAs
ses
sme
nt

.
Ass
ess
men
t:wi
thi
n24h
our
soft
hep
ati
entb
ein
gst
abi
l
ise
d

.
Sig
nan
dsy
mpt
oms

1
.Ge
ner
ala
ppe
ara
nce

a
.De
ple
ti
ono
fmus
cle
san
dfa
tst
ore
s

i
.Te
mpo
ral
was
hin
g

i
i
.Ob
vio
ust
is
sue
sea
sti
nga
roun
dbo
nyp
romi
nen
cess
ucha
sri
bsi
l
iacc
res
t,s
cap
ula

b
.Ed
ema
-se
ver
ehy
poa
lbumi
nemi
adi
sr
upt
son
cot
icp
res
sur
ean
dma
yca
usef
lui
dtol
eak

f
romv
asc
ula
rsp
acei
ntos
urr
oun
din
gti
ssue
s

c
.Sk
int
ext
ure
-dr
yne
sso
rsc
ale
sca
nbes
eco
nda
ryt
oes
sen
tia
lfa
ttya
cide
ffi
ci
enc
y.

d
.Sk
int
urg
or-
ind
ica
tio
nofh
ydr
ati
ons
tat
us

e
.Te
eth
.Mo
uth
,an
dgums
-po
orc
ond
iti
on,
ble
edi
ngma
yin
dic
ateav
it
ami
nde
fi
ci
enc
y.

f
.Co
ndi
ti
ono
fha
ira
ndn
ail
s-
hai
rlo
ssi
sas
soc
iat
edwi
thz
incd
efi
ci
enc
y.

6
.0Ad
dit
io
nal
Act
iv
it
ie
s(Vi
deo
s,An
ima
tio
ns&Outo
fCl
assAc
ti
vi
ti
es)e
.g.

1
50
a
.Vi
si
tYo
uTu
bea
dd?
???
???
???
???
???
.Wa
tcht
hev
ide
o&s
umma
ris
eiti
n1p
ara
gra
ph

b
.Vi
ewt
hea
nima
tio
nona
dd/
sit
e??
???
??a
ndc
ri
ti
quei
tint
hed
isc
uss
ionf
orum

c
.Ta
keawa
lka
nde
nga
gea
ny3s
tud
ent
son?
???
???
???
?;I
n2p
ara
gra
phss
umma
ris
eth
eir

o
pin
iono
fth
edi
scus
sedt
opi
c.e
tc.

8.
0Re
fer
enc
es/
Fur
the
rRe
adi
ngs

7.
0Re
fer
enc
e

Ac
ker
man
;M.
H.,
Eva
ns,
N.J
.an
dEc
klun
d,M.
M.(
1994)S
yst
emi
cIn
fla
mma
tor
y

r
esp
ons
esy
ndr
ome
,se
psi
s,a
ndn
utr
it
io
nal
sup
por
t.Cr
it
.Ca
reNur
s.Cl
i
n.N.
Am.

6
:321
,

Yo
ung
,an
dHA,
Sch
imd
ekHH.
(1982)Co
mpl
i
cat
io
nsa
cco
mpa
nyi
ngOc
cip
it
al

S
kul
lfr
act
ure
s.JTr
auma22:
914,
1982.

Va
nor
e,ML.
(1992)Mo
dul
e2.
InEWBa
ley
e,S
ATTur
cke(
eds
)A,
Comp
reh
ens
iveCur
ri
cul
umf
or

Tr
aumaNur
si
ng.
Bos
ton
:Jo
nesa
ndBa
rtl
ett
,p.
19.

Ly
erl
y,HK,
(1987)Th
eHa
ndb
ooko
fSur
gi
cal
Int
ens
iveCa
re:Pr
act
ic
eoft
he

S
urg
eryRe
sid
enta
tth
eDuk
eUn
ive
rsi
tyMe
dic
alCe
ntr
e.Ch
ica
go:Ye
arBo
ok,

1
51
1
52
 S
TUDYS
ESS
ION3&4

Pa
tie
ntsUn
der
goi
ngTr
ans
pla
nta
tio
nI

S
ect
io
nan
dSub
sec
ti
onHe
adi
ngs
:

I
ntr
oduc
ti
on

1
.0Le
arn
ingOut
come
s

2,
0Ma
inCo
nte
nts

2.
1-De
fi
ni
ti
ono
fOr
ganTr
ans
pla
nta
tio
n

2.
2-Ty
peso
fOr
ganTr
ans
pla
nta
tio
n

2.
3-Cr
it
eri
afo
rma
tch
ingd
ono
ran
dre
cip
ien
t

2.
4-Or
gant
ran
spl
antI
mmun
olo
gy

2.
5-Nur
si
ngPr
oce
sso
fPa
tie
ntsun
der
goi
ngo
rga
ntr
ans
pla
nta
tio
n

1
8.0 Tu
torMa
rke
dAs
sig
nme
nts(
Ind
ivi
dua
lorG
rou
pas
sig
nme
nts
)

1
9.0 S
tud
ySe
ssi
onS
umma
rya
ndCo
ncl
usi
on

20.
0 S
elf
-As
ses
sme
ntQu
est
io
ns

21
.0 Ad
dit
io
nal
Act
iv
it
ie
s(Vi
deo
s,An
ima
tio
ns&Outo
fCl
assAc
ti
vi
ti
es)

7.
0Re
fer
enc
es/
Fur
the
rRe
adi
ngs

I
ntr
odu
cti
on:

Th
iss
tud
yse
ssi
oni
sonp
ati
ent
s’un
der
goi
ngt
ran
spl
ant
ati
on,wh
att
hec
onc
epto
for
gan

t
ran
spl
ant
ati
oni
sal
lab
out
,ty
peso
fgr
aft
san
dor
gant
ran
spl
ant
s,c
ri
te
riaf
orma
tch
ingd
ono
ran
d

r
eci
pi
ent
,or
gant
ran
spl
anti
mmun
olo
gya
ndn
urs
ingp
roc
essa
ppr
oac
hofp
ati
ent
sun
der
goi
ng

v
ari
ouso
rga
ntr
ans
pla
nta
tio
ns.Th
esub
jec
tofo
rga
ntr
ans
pla
nta
tio
nwi
l
lco
nti
nuei
nth
ene
xtun
it

f
orb
ett
erc
ove
rag
e.

1
.0S
tud
ySe
ssi
onL
ear
nin
gOu
tco
mes

Af
ters
tud
yin
gth
iss
ess
ion
,Ie
xpe
cty
out
obea
blet
o:

1
.De
fi
neo
rga
ntr
ans
pla
nta
tio
n

1
53
2.
Sta
tet
het
ype
sofg
raf
tsa
ndo
rga
ntr
ans
pla
nta
tio
n

3
.Li
stt
hec
ri
te
riaf
orma
tch
ingd
ono
ran
dre
cip
ien
t.

4.
Des
cri
bet
hen
urs
ingp
roc
esso
for
gant
ran
spl
ant
ati
on

5
.Ex
pla
ino
rga
ntr
ans
pla
nti
mmun
olo
gy.

2.
0Ma
inCo
nte
nts

De
fi
ni
ti
on

A.
Org
ant
ran
spl
ant
ati
oni
sth
epr
oce
sso
ftr
ans
fer
ri
ngaf
unc
ti
oni
ngo
rga
nfr
omo
nep
ers
ont
o

a
not
hert
ore
pla
cean
onf
unc
ti
ona
l,d
ise
ase
dor
gan
.Or
gant
ran
spl
ant
ati
onh
asb
eco
met
he

t
rea
tme
nto
fch
oic
efo
ren
d-s
tag
eor
gand
ise
ase
.Th
edo
nat
edo
rga
nisc
all
edag
raf
t.Or
gan

t
ran
spl
antp
ati
ent
smo
stl
i
kel
ytor
equi
reI
nte
nsi
veCa
rei
nte
rve
nti
oni
ncl
udet
hos
ere
cei
vi
ngh
ear
t,

l
ung
,he
art
-l
ung
,li
ver
,pa
ncr
eas
,is
letc
ell
s,k
idn
ey-
pan
cre
as,
andb
onema
rro
wtr
ans
pla
nts
.

Di
scus
sio
nsp
ert
ine
ntt
oea
cha
rei
ncl
ude
dint
hiss
ess
ion
.

B.
Typ
eso
fgr
aft
s

Th
erea
ret
hre
ety
peso
fgr
aft
s.Th
esea
re:

1
.Is
ogr
aft
:Ag
raf
ttr
ans
pla
nte
din
toa
nid
ent
ic
alh
ist
ori
cal
his
toc
omp
ati
bl
ere
cip
ien
t(e
.g.
Twi
n

s
ibl
i
ng)
.

2.
All
ogr
aft
:Ag
raf
ttr
ans
pla
nte
din
tot
her
eci
pi
ento
fth
esa
mes
pec
iesb
utn
ota
not
her(
e.g
.Sk
in

t
ran
spl
ant
).

3
.Aut
ogr
aft
:Ag
raf
ttr
ans
pla
nte
dfr
omo
nea
reao
fth
ere
cip
ien
t’
sbo
dyt
oan
oth
er(
e.g
.sk
in

t
ran
spl
ant
).

C.
Typ
eso
for
gant
ran
spl
ant
s

Th
erea
ref
ourt
ype
sofo
rga
ntr
ans
pla
nts
.

1
.Ca
dav
eri
c:Th
edo
nori
sge
net
ic
all
ydi
ff
ere
ntf
romt
her
eci
pi
ent
,an
dth
edo
norh
asb
een

p
ron
oun
cedb
rai
nde
adb
uti
sme
dic
all
ysup
por
tedt
oma
int
aino
rga
npe
rfus
ion
.

2.
Syn
gen
eic
:Th
eor
gand
ono
rsal
i
vin
g,b
loo
d-r
ela
tedi
ndi
vi
dua
lwi
tha
nid
ent
ic
alg
ene
ti
cma
tch

1
54
3
.Aut
olo
gous
:Th
egr
afti
s“s
elf
”do
nat
ed.

4.
All
oge
nei
c:Th
eor
gani
sdo
nat
edf
romag
ene
ti
cal
l
ydi
ff
ere
ntl
i
vin
gdo
nor
.

2.
1D.
Cri
te
riaf
orma
tch
ingd
ono
ran
dre
cip
ien
t

Th
erea
rep
rot
oco
lso
rin
sti
tut
io
nal
i
sat
io
nva
ria
tio
nsi
nth
eap
pli
cat
io
nso
fth
eset
ran
spl
ant
ati
on

c
ri
te
ria
;ins
omec
ent
res
,tr
ans
pla
nta
tio
nisc
ont
rai
ndi
cat
edi
nap
ati
entwh
oma
ybec
ons
ide
red

e
li
gi
bl
efo
rtr
ans
pla
nta
tio
nel
sewh
ere
.

1
.Huma
nle
uko
cyt
ean
tig
en(
HLA)ma
tch
:Mo
ree
mph
asi
sedi
nbo
nema
rro
wtr
ans
pla
nt(
BMT)
.

2.
ABOc
omp
ati
bi
li
ty
:Al
lma
joro
rga
ntr
ans
pla
ntse
xce
ptBMT,
isl
etc
ell
s

3
.Mi
xedl
ymp
hoc
ytec
oun
t:Do
newi
thl
i
vin
gre
lat
edd
ono
rsa
ndwh
ene
vere
lsep
oss
ibl
e.Po
sit
iv
e

mi
xedl
ymp
hoc
yter
eac
ti
onp
red
ict
sin
cre
ase
din
cid
enc
eofr
eje
cti
on.

4.
equi
val
entd
ono
r/r
eci
pi
ento
rga
nsi
ze

5.
noa
cti
vei
nfe
cti
onsi
ndo
noro
rre
cip
ien
t(p
art
ic
ula
rlyh
uma
nimmun
ode
fi
ci
enc
yvi
rusi
nfe
cti
on

o
rhe
pat
it
is
).

6
.Do
norc
ri
te
ria(
ide
al,
butn
ota
ppl
i
edun
ifo
rml
yina
llt
ran
spl
antc
ent
res
)

i
.Noh
ist
oryo
fin
tra
ven
ous(
IV)d
rugus
e

i
i
.Co
ret
emp
era
tur
egr
eat
ert
han3
20F
.

i
i
i.La
bor
ato
ryt
est
swi
thi
nno
rma
lli
mit
s

i
v.Noh
ist
oryo
fme
tas
tas
isi
ngc
anc
er,
exc
eptb
asa
lce
llc
arc
ino
mao
rani
sol
ate
dbr
aint
umo
ur.

v
.Fo
rca
rdi
act
ran
spl
ant
,ad
ono
rmus
tha
vean
orma
l12-
le
ade
lec
tro
car
dio
gra
m,e
cho
car
dio
gra
m,

c
rea
tin
eph
osp
hok
ina
se,
andc
rea
tin
eph
osp
hok
ina
seMBi
soe
nzy
me

v
i.F
orl
i
vert
ran
spl
ant
ati
on,
nor
mal
tra
nsa
min
ase
sar
ere
qui
red
.

I
I.Or
gant
ran
spl
antI
mmun
olo
gy

A.HLA(
huma
nle
uko
cyt
ean
tig
ens
)ma
tch
ing

HLAma
tch
ingi
sus
edt
oma
tchp
ati
ent
san
ddo
nor
sfo
rbl
oodo
rma
rro
wtr
ans
pla
nts
.If2p
eop
le

1
55
s
har
eth
esa
meHLAt
ype
,th
eya
rec
ons
ide
reda'
mat
ch'
.I
t'
smuc
hmo
rec
omp
li
cat
edt
hanb
loo
d

t
ypi
ng.

1
.Al
lpe
rso
nsh
avet
hei
rowng
ene
ti
cun
ive
rsa
lpr
oduc
tco
dec
all
edt
heHLA,
whi
chd
ist
ing
uis
hes

t
hei
rbo
dyc
ell
sfr
omf
ore
ignc
ell
s.

2.
HLAsa
rep
rot
ei
nso
nth
eout
si
deo
fce
ll
sth
atd
ist
ing
uis
hani
ndi
vi
dua
l’
sce
ll
sfr
omo
the
rce
ll
s.

3
.Th
isUn
ive
rsa
lPr
oduc
tCo
dei
sus
edt
oma
tcht
hed
ono
ran
dre
cip
ien
tasc
los
elya
spo
ssi
bl
eto

p
rev
entr
eje
cti
onb
yth
ere
cip
ien
t.

4.
HLAsa
red
ivi
dedi
ntoc
las
sIo
rma
jora
nti
gen
s(A,
B,C)a
ndc
las
sIIo
rmi
nora
nti
gen
s(D,
DP,

DQ,
DR)
.

a
.No
rma
limmun
ere
spo
nseo
ffo
rei
gnHLA.

b
.Cl
assI
Ian
tig
enss
ti
mul
ateh
elp
erTc
ell
s.

c
.He
lpe
rTc
ell
sst
imul
ateBc
ell
stop
rod
ucea
nti
bod
iesa
gai
nstc
las
sIa
nti
gen
sonf
ore
ignt
is
sue
.

B.
HILAt
ypi
ng

1
.Us
edt
oma
tchd
ono
r/r
eci
pi
entf
ort
her
educ
edl
i
kel
i
hoo
dofr
eje
cti
on

2.
Tis
suet
ypi
ngf
orc
las
sIa
nti
gen
s.

3
.Mi
xedLy
mph
ocy
teCul
tur
e(MLC)i
sus
edt
ode
tec
tcl
assI
Ian
tig
enswi
thl
i
vin
gdo
nor
s.I
tta
kes

d
ayst
oob
tai
nth
eser
esul
ts
,butwh
ene
vert
imep
ermi
tso
rifmul
ti
pl
edo
nor
sar
eav
ail
abl
e,t
he

p
ote
nti
ald
ono
rwh
oha
sth
elo
wes
tMLCr
esp
ons
eist
hep
ref
err
edd
ono
r.Th
eor
eti
cal
l
y,ah
igh
ly

p
osi
ti
ver
eac
ti
oni
ndi
cat
esa
nin
cre
ase
dri
sko
fpo
org
raf
tsur
viv
al;h
owe
ver
,th
epr
edi
ct
iv
eva
lueo
f

t
heMLCi
nso
li
dor
gant
ran
spl
ant
ssuc
hask
idn
eyt
ran
spl
ant
ati
oni
sun
kno
wn.

2.
1.
1

I
II
.Nur
si
ngp
roc
ess
:as
ses
sme
nt

A.
Sig
nsa
nds
ymp
tomso
fen
gra
ftme
nti
ncl
udet
her
etur
nofn
orma
lor
ganf
unc
ti
on.

B.
Sig
nsa
nds
ymp
tomso
fre
jec
ti
on

1
.De
fi
ni
ti
on:Ani
mmun
ere
spo
nsea
gai
nstt
ran
spl
ant
edt
is
sue
;of
tenb
othh
umo
ral
andc
ell
ul
ar

1
56
me
dia
ted

2.
Hyp
era
cut
ere
jec
ti
on

a
.Oc
cur
swi
thi
nmi
nut
es.

b
.Ch
ara
cte
ris
edb
yth
ere
cip
ien
t’
san
tib
odi
esa
dhe
rin
gtot
hev
asc
ula
ren
dot
hel
i
umo
fth
egr
aft
,

t
ri
gge
rin
gco
mpl
eme
nt,
andc
lot
ti
ng.

c
.Si
gnsa
nds
ymp
toms
:Ra
pid
,wi
des
pre
adv
asc
ula
rth
romb
osi
sca
use
sse
ver
egr
aftn
ecr
osi
san
d

o
rga
nfa
il
ure
.

d
.Noc
ura
tiv
etr
eat
men
tex
cep
tre
tra
nsp
lan
tat
io
n.

3
.Ac
uter
eje
cti
on

a
.Oc
cur
sho
urst
oda
ysf
ol
lo
win
gtr
ans
pla
nta
tio
n.

b
.An
tig
enso
nth
ere
cip
ien
t’
sma
cro
pha
gesp
roc
esst
hea
nti
gen
sont
het
ran
spl
ant
edo
rga
n.Th
eB

a
ndTl
ymp
hoc
yte
sbe
comes
ens
it
is
edt
oth
esea
nti
gen
san
dtr
igg
erh
umo
ral
andc
ell
ul
ar

r
esp
ons
esc
aus
ingi
nj
uryt
oth
egr
aft
.Cy
tot
oxi
cTc
ell
sca
usel
yse
san
ddi
rec
tin
jur
ytot
heg
raf
t;

l
ymp
hok
ine
spr
oduc
eac
ti
vat
edTc
ell
sth
ate
nha
nceg
raf
tre
jec
ti
on.

c
.Si
gnsa
nds
ymp
toms
:Pa
in,
ten
der
nes
sov
erg
raf
tsi
te
,de
cre
asi
ngg
raf
tfun
cti
on,
fev
er,
mal
ai
se.

d
.Tr
eat
men
twi
thi
mmun
osup
pre
ssi
veme
dic
ati
ons
.

4.
Chr
oni
cre
jec
ti
on

a
.Oc
cur
smo
nth
stoy
ear
saf
tert
ran
spl
ant
ati
on.

b
.In
vol
vest
hemi
norh
ist
oco
mpa
tib
il
it
yan
tig
ens
.

c
.Re
sul
tsi
nth
epr
oli
fe
rat
io
nofe
ndo
the
li
ala
ndmo
non
ucl
earc
ell
swi
thn
arr
owi
ngo
fth
eva
scul
ar

a
rte
ria
lbe
dint
heg
raf
tan
dot
hero
rga
ns.

d
.Si
gnsa
nds
ymp
toms
;Gr
adua
llo
sso
fgr
aftf
unc
ti
on

e
.Re
jec
ti
ons
ign
san
dsy
mpt
omsa
reun
iquet
oor
gant
ran
spl
ant
s.

A-C.
Ini
ti
alp
ostt
ran
spl
anta
sse
ssme
ntsa
reun
ifo
rmwh
eth
ers
oli
dor
gans
urg
ica
lpr
oce
dur
eor

BMT.

1
57
1
.Imme
dia
tep
ost
ope
rat
iv
eca
re(
exc
eptBMT,
isl
etc
ell
s)
.

a
.Imme
dia
temo
nit
ori
ngf
ors
ign
sorh
ype
rac
uter
eje
cti
onb
yth
romb
osi
soro
rga
n.

b
.Ro
uti
nec
ard
iop
ulmo
nar
yIn
ten
siv
eCa
remo
nit
ori
ngb
ase
donl
eng
tho
fan
aes
the
sia
,fl
ui
dsl
ost
,

t
hec
omp
lex
it
yofo
rga
nre
sec
ti
on,
orp
ri
orme
dic
alh
ist
ory
.Ma
nyo
fth
esemo
nit
ori
ngp
ara
met
ers

a
ren
otn
eed
edwi
thr
out
inek
idn
eyt
ran
spl
ant
ati
on.

k
.Ca
rdi
acmo
nit
ori
ng

i
i
.Ox
yge
nsa
tur
ati
onmo
nit
ori
nga
nda
rte
ria
lbl
oodg
asa
nal
ysi
s.

i
i
i.Va
scul
arv
olumea
sse
ssme
nts
:Bl
oodp
res
sur
e,c
ent
ral
ven
ousp
res
sur
e,we
igh
t,i
nta
kea
nd

o
utp
ut.

i
v.Bl
oodc
hemi
st
rymo
nit
ori
ng.

v
.He
mat
olo
gymo
nit
ori
ng.

c
.Pr
ese
nceo
fpa
in.

d
.Mo
nit
ori
ngo
fin
cis
iona
ndd
rai
nsi
te
sfr
ome
xce
sso
rab
nor
mal
dra
ina
ge,
sig
nal
l
inga
lte
red

v
asc
ula
rin
teg
rit
yorr
eje
cti
ons
ymp
toms
.

e
.Br
eat
hes
oun
ds,
lun
gex
pan
sio
n,a
bil
i
tyt
oco
ugh
,an
dde
epb
rea
thi
ngs
ign
all
i
nga
tel
ect
asi
sor

e
arl
ypn
eumo
nia
.

f
.Te
mpe
rat
uremo
nit
ori
ngt
ode
tec
tpo
ten
tia
lin
fec
ti
on.
Oth
ers
ymp
tomso
fin
fec
ti
ona
ren
ot

us
ual
l
yap
pre
cia
bled
uet
oimmun
osup
pre
ssi
vet
her
apy

B-I
VNur
si
ngp
roc
ess
:pl
ann
ing

A.
Pot
ent
ial
alt
era
tio
nint
is
suep
erf
usi
on

1
.Pr
obl
em:I
nth
epo
stt
ran
spl
antp
eri
odf
ai
lur
etoe
ngr
aftl
ead
stoi
sch
emi
aan
ddy
sfun
cti
ono
fth
e

e
ngr
aft
edo
rga
n.S
ymp
tomso
ffa
il
uret
oen
gra
fta
rep
art
ic
ula
rtoe
acht
ypeo
ftr
ans
pla
nt;h
owe
ver
,

s
omen
urs
ingc
arei
sun
ive
rsa
lfo
ral
ltr
ans
pla
ntp
ati
ent
sex
per
ien
cin
gpo
ten
tia
lre
jec
ti
on.
Alt
ere
d

t
is
suep
erf
usi
on

i
nth
epo
stt
ran
spl
antp
eri
oda
lsoma
ybec
aus
edb
yre
duc
edp
erf
usi
ono
fth
egr
aft
,soc
are
ful

1
58
e
val
uat
io
nofg
raf
tci
rc
ula
tio
nise
sse
nti
al
.

2.
Eti
ol
ogy
:Hy
per
acut
e,a
cut
e,o
rch
ron
ict
ran
spl
antr
eje
cti
onp
hen
ome
naa
ret
heus
ual
caus
e;

h
owe
ver
,in
ade
qua
tev
asc
ula
rva
lueo
rpo
sto
per
ati
ves
hoc
kma
yal
sop
rod
ucei
sch
emi
cgr
aft

s
ymp
toms
.

3
.In
ter
ven
tio
ns

a
.Mo
nit
ore
ngr
aft
edo
rga
n’sf
unc
ti
onc
are
ful
l
y,e
spe
cia
ll
ydur
ingt
hef
ir
st2we
ekswh
ens
eve
re

r
efe
cti
onp
hen
ome
noni
smo
stc
ommo
n.

b
.Ad
min
ist
era
nti
rej
ect
io
nme
dic
ati
ons(
immun
osup
pre
ssi
ves
)aso
rde
redRe
gime
nsa
ndd
ose
s

v
aryg
rea
tlya
mon
gor
gan
s,t
ype
soft
ran
spl
ant
,an
dtr
ans
pla
ntc
ent
res
.

c
.Ad
min
ist
erI
Vfl
ui
ds,
blo
odc
omp
one
nts
,orv
aso
pre
sso
rsa
sor
der
edt
oma
int
ainv
asc
ula
rvo
lume

a
nda
deq
uat
epe
rfus
iono
fth
een
gra
fte
dor
gan
.Th
esp
eci
fi
cgo
alme
ansa
rte
ria
lpr
ess
ure(
MAP)

d
iff
erswi
thv
ari
oust
ype
soft
ran
spl
ant
s.Th
eli
te
rat
urer
epo
rtsg
oal
MAPsf
orm6
0to75mmHg
.

4.
Des
ir
edo
utc
ome
:no
rma
lgr
aftf
unc
ti
ond
emo
nst
rat
edb
yno
rma
li
sat
io
nofo
rga
nfun
cti
on,
and

n
orma
lme
nta
lst
atus
.

B.
Pot
ent
ial
fori
nfe
cti
on

1
.Pr
obl
em:Pa
tie
ntswh
oha
veun
der
gon
eor
gant
ran
spl
ant
ati
onmus
tbeg
ive
n

i
mmun
osup
pre
ssi
veme
dic
ati
onst
opr
eve
ntg
raf
tre
jec
ti
on,
butt
hemo
sts
eri
ousa
dve
rsee
ffe
cto
f

t
hes
edr
ugsi
sth
epo
ten
tia
lfo
rin
fec
ti
ona
ddi
ti
ona
lri
sksf
ori
nfe
cti
ona
rea
sso
cia
tedwi
tht
he

s
urg
ica
lpr
oce
dur
ead
min
ist
rat
io
nofa
nae
sth
eti
cag
ent
s,a
ndi
nva
siv
eth
era
py(
eg,
Fol
eyc
ath
ete
rs,

c
ent
ral
ven
ousc
ath
ete
rs)r
equi
redt
oen
sur
ere
cov
ery
.

2.
Eti
ol
ogy
:Pa
tie
ntsun
der
goi
ngo
rga
ntr
ans
pla
nta
tio
nar
epr
onet
oin
fec
ti
ond
uet
o

i
mmun
osup
pre
ssi
veme
dic
ati
onsus
edt
opr
eve
ntr
eje
cti
on,
exp
osur
eton
oso
comi
ali
nfe
cti
onsi
n

t
heI
nte
nsi
veCa
reUn
it(
ICU)
,an
dma
nyb
rea
ksi
nth
eba
rri
erd
efe
nce(
ie,
dur
ingt
he

o
per
ati
vep
roc
edur
e;wi
thI
Vli
nes
,ca
the
ter
s,a
ndd
rai
ns)
.Th
ead
min
ist
rat
io
nofb
roa
d-s
pec
trum

a
nti
bi
ot
ic
sil
l
sun
des
ir
abl
emi
cr
obe
sbuta
lsod
est
roy
sno
rma
lfl
oraa
nde
nco
ura
gest
heg
rowt
hof

1
59
r
esi
st
antmi
cr
oor
gan
isms
.

C-3
.In
ter
ven
tio
ns

a
.Pr
ote
ctf
rome
nvi
ron
men
tal
inf
ect
io
nri
sks(
e.g
.,s
ter
il
ete
chn
ique
;av
oida
ssi
gnme
ntswi
th

p
ati
ent
sha
vin
gre
sis
tan
tin
fec
ti
ons
;cl
eanmul
ti
-p
ati
ente
qui
pme
ntb
efo
reus
e).

b
.Ma
int
ainme
ti
cul
oush
ygi
eneo
fth
epa
tie
nt(
inc
lud
ingd
ent
alc
are
,fr
eque
ntc
lea
nsi
ng,
ands
hee
t

c
han
ges
).

c
.Co
nsi
derc
are
ful
l
yth
ene
edf
ori
nva
siv
eli
nes
,re
ali
si
ngi
nfe
cti
onr
is
ks.

d
.Av
oidun
nec
ess
aryi
nva
siv
epr
oce
dur
ess
ucha
sin
tra
mus
cul
ari
nj
ect
io
nso
rna
sog
ast
ri
ctub
es.

At
temp
ttoma
int
ainb
arr
ierd
efe
ncewh
ene
verp
oss
ibl
e.

e
.Me
asur
ebo
dyt
emp
era
tur
eatl
eas
ton
cee
ver
y2t
o4h
our
sHy
per
the
rmi
ama
ybet
heo
nly

s
ymp
tomo
fin
fec
ti
oni
nth
eimmun
osup
pre
sse
dpa
tie
nt.

f
.Imp
leme
nti
nst
it
uti
ona
l“i
mmun
osup
pre
ssi
vep
rec
aut
io
ns,
”suc
hasd
ail
ydr
ess
ingc
han
ges
,us
e

a
nti
mic
rob
ial
soa
p,o
rot
herun
iqueme
asur
es.

g
.Ob
tai
nbo
dyf
lui
dcul
tur
esa
sor
der
edwi
thf
ebr
il
eep
iso
deso
rasas
urv
eil
l
anc
eme
asur
e.

h
.Ad
min
ist
era
nti
bi
ot
ic
saso
rde
reda
ndmo
nit
orme
dic
ati
onl
eve
ls,
rep
ort
ingn
ewf
eve
rso
r

a
bno
rma
lse
ruma
nti
bi
ot
icl
eve
ls.

4.
Des
ir
edo
utc
ome

a
.Pa
tie
nti
sfe
bri
l
e

b
.Noc
ult
ure
sar
epo
sit
iv
efo
rmi
cr
obe
s.

c
.No
rma
lle
uko
cyt
eco
unta
ndd
if
fer
ent
ial
.

d
.Nowo
undd
rai
nag
e.

C.
Alt
era
tio
ninc
omf
ort
,po
sto
per
ati
vep
ain

1
.Pr
obl
em:Mo
sts
oli
dor
gant
ran
spl
ant
s(k
idn
ey,
kid
ney
-pa
ncr
eas
,pa
ncr
eas
,li
ver
,he
art
,l
ung
,an
d

h
ear
t-
lun
g)r
equi
reama
jors
urg
ica
lpr
oce
dur
ein
vol
vi
ngr
ese
cti
ona
nda
nas
tomo
siso
rth
e

e
ngr
aft
edo
rga
n.Mo
stp
ati
ent
sre
qui
real
arg
ech
esto
rab
domi
nal
inc
isi
ont
hatp
rod
uce
s

1
60
c
ons
ide
rab
lep
ost
ope
rat
iv
edi
sco
mfo
rt.

2.
Eti
ol
ogy
:Pa
ini
sca
use
dbye
xte
nsi
vet
is
sued
ama
ger
equi
redd
uri
ngt
hes
urg
ica
lpr
oce
dur
ean
d

i
sen
han
cedwi
thi
mmo
bil
i
tyd
uri
ngap
rol
ong
eds
urg
ica
lpr
oce
dur
e.I
nte
nsi
veCa
rer
out
ine
s(e
g,

we
igh
ts,
dre
ssi
ngc
han
ges
),p
ulmo
nar
yhy
gie
neme
asur
es,
andi
ndwe
ll
in
gli
nese
xac
erb
atet
his

d
isc
omf
ort
.

2.
1.
23.
Int
erv
ent
io
ns

a
.As
ses
spa
tie
nt’
spe
rce
pti
ono
fco
mfo
rta
tle
aste
ver
ysh
iftus
ingaq
uan
tit
ati
ves
cal
eth
at

r
efl
ect
swh
ent
hed
isc
omf
orti
swo
rseo
rre
li
eve
dbyi
nte
rve
nti
ons(
eg,

v
isua
lan
alo
gues
cal
es)
.

b
.Ad
min
ist
erp
aina
nds
eda
tin
gme
dic
ati
onst
ore
laxt
hep
ati
enta
ndt
ode
cre
aseo
xyg
en

c
ons
ump
ti
on,
whi
chma
yco
ntr
ib
utet
oce
ll
ul
arh
ypo
xia
.

c
.Pr
eme
dic
atet
hep
ati
entwi
tha
nal
ges
icsp
ri
ort
oco
ugh
inga
ndd
eepb
rea
thi
ngo
rea
rly

a
mbul
ati
on.

d
.Mo
nit
orf
orc
ommo
nad
ver
see
ffe
ctso
fan
alg
esi
cs(
esp
eci
al
lyo
pia
tes
);h
ypo
ven
til
ati
on,

e
xce
ssi
ves
lee
pin
ess
,ha
ll
uci
nat
io
nsc
onf
usi
on,
con
sti
pat
io
n,

ur
ina
ryr
ete
nti
on,
naus
ea,
hea
dac
he,
lowe
rdi
ast
oli
cbl
oodp
res
sur
e,o
rit
chi
ng.

e
.Aug
men
tph
arma
col
ogi
cag
ent
swi
tho
the
rco
mfo
rtme
asur
ess
ucha
spo
sit
io
nin
g,p
il
lo
ws,
or

r
ela
xat
io
nex
erc
ise
s.

4.
Des
ir
edo
utc
ome

a
.Pa
tie
ntd
eni
esd
isc
omf
ort
.

b
.Pa
tie
ntv
erb
ali
sesr
eli
efo
fdi
sco
mfo
rtwi
tho
rde
reda
nal
ges
ics
.

c
.Ab
sen
ceo
fan
alg
esi
cad
ver
see
ffe
cts
.

d
.Pa
tie
ntc
anp
erf
ormmo
bil
i
tya
ndb
rea
thi
nge
xer
ci
sesa
sre
qui
red
.

D.
Pot
ent
ial
alt
era
tio
ning
ase
xch
ang
e

1
61
1
.Pr
obl
em:Pa
tie
ntsun
der
goi
ngt
ran
spl
ant
ingo
fte
nre
qui
rea
ssi
st
anc
ewi
thv
ent
il
ati
ona
nd

o
xyg
ena
tio
n.

2.
Eti
ol
ogy
:Pr
olo
nge
dan
aes
the
sia
,wh
ichi
sco
mmo
nwi
ths
omet
ran
spl
ants
urg
eri
es,
red
uce
d

i
nde
pen
den
tve
nti
l
ati
ona
ndd
ecr
eas
esv
it
alc
apa
cit
y,wh
ichc
ani
mpa
irg
ase
xch
ang
e.Ma
ny

p
ati
ent
sal
soh
avec
omp
lexp
ost
ope
rat
iv
eco
urs
eswi
thl
arg
ech
esto
rab
domi
nal
inc
isi
onsa
nd

l
i
mit
edp
hys
ica
lac
ti
vi
ty
,wh
ichc
ont
ri
but
etot
hisp
rob
lema
ndt
her
efo
rec
omp
romi
seg
ase
xch
ang
e.

La
st,
immun
osup
pre
ssi
vet
her
apya
dmi
ni
st
ere
dtop
ati
ent
stop
rev
entg
raf
tre
jec
ti
onp
red
isp
ose
s

p
ati
ent
stot
her
is
kofi
nfe
cti
ousl
ungp
roc
ess
eswh
enh
ypo
ven
til
ati
ona
nda
tel
ect
asi
soc
cur
.

A-3
.In
ter
ven
tio
ns.

a
.Pl
acet
hep
ati
enti
nhi
ghF
owl
er’
sorr
eve
rseTr
end
ele
nur
g’
spo
sit
io
ntop
rov
idema
xima
l

v
ent
il
ati
ona
ndo
xyg
ena
tio
n.

b
.En
cour
agec
oug
hin
gan
dde
epb
rea
thi
ngp
ost
ope
rat
iv
ely
.

c
.Ea
rlya
mbul
ati
onp
ost
-t
ran
spl
ant
.

d
.As
ses
sre
spi
rat
oryr
ate
,qua
li
ty
,an
dbr
eat
hso
undf
req
uen
tlyi
nth
eea
rlyp
ost
-t
ran
spl
antp
eri
od.

e
.Mo
nit
orf
lui
dst
atusa
ndc
ard
iov
asc
ula
rto
ler
anc
etof
lui
dst
oas
ses
sfo
rhy
per
vol
emi
aorh
ear
t

f
ail
ure
,wh
ichc
ont
ri
but
edt
oal
ter
edo
xyg
ena
tio
n.

f
.As
ses
sar
ter
ial
blo
odg
ase
s,o
xyg
ens
atur
ati
on,
andc
apn
ogr
aph
yasn
eed
edf
ori
ndi
cat
io
nso
f

r
esp
ira
tor
yde
comp
ens
ati
on.

g
.As
ses
san
dma
nag
epa
int
opr
omo
tema
xima
lre
spi
rat
orye
ffo
rta
ndmi
ni
mal
med
ica
tio
n-

i
ndu
cedr
esp
ira
tor
ysup
pre
ssi
on.

h
.As
ses
ssp
utum,
bre
aths
oun
ds,
ands
put
umc
ult
ure
saso
rde
red
.

i
.Mo
nit
ors
put
um,
bre
aths
oun
dsa
ndt
emp
era
tur
efo
rev
ide
nceo
fpul
mon
aryi
nfe
cti
ons
.

j
.Ch
ang
ere
spi
rat
oryc
aree
qui
pme
ntd
ail
ytop
rev
enti
nfe
cti
on.

k
.Tur
npa
tie
nte
ver
y2t
o4h
our
stoe
nsur
ead
equa
tev
ent
il
ati
on

a
ndc
ir
cul
ati
ont
hro
ugh
outb
othl
ung
s.

1
62
4.
Des
ir
edo
utc
ome

a
.Ar
ter
ial
oxy
gens
atur
ati
on(
Sao
2)g
rea
tert
han90%

b
.Ar
ter
ial
oxy
gent
ens
ion(
pao
2)i
sgr
eat
ert
han6
0mmHgb
yar
ter
ial
blo
odg
asa
nal
ysi
s.

c
.Pa
tie
nti
saf
ebr
il
e.

d
.Pa
tie
nth
asmi
ni
mal
cle
ars
put
um.

e
.Pa
tie
nt’
sch
estx
-ra
yisc
lea
r,wi
tho
uti
nfi
l
tra
tes
.

B-E.
Alt
ere
dsk
ini
nte
gri
ty

5.
Pro
ble
m:Pa
tie
ntsun
der
goi
ngt
ran
spl
ant
ati
onh
avep
rol
ong
edi
l
lne
sse
san
dre
cov
eryp
eri
odst
hat

a
lte
rmo
bil
i
tya
ndn
utr
it
io
n,b
otho
fwh
ichi
nfl
uen
ces
kini
nte
gri
ty
.Al
ter
edr
esi
st
anc
etoi
nfe
cti
onf
rom

i
mmun
osup
pre
ssa
ntme
dic
ati
ona
lsoc
ont
ri
but
est
oth
eri
sko
fal
ter
eds
kini
nte
gri
tya
ndi
tss
ubs
eque
nt

i
nfe
cti
ousc
omp
li
cat
io
ns.

6
.Et
io
log
y:Th
eet
io
log
ieso
fal
ter
eds
kini
nte
gri
tyc
ove
rab
roa
dra
ngeo
fpr
obl
emsr
ela
tedt
o

i
nte
nsi
vei
l
lne
ssa
ndt
het
ran
spl
antp
roc
essi
ts
elf
.Sur
gic
alwo
und
sar
eof
tenl
arg
e,i
nvo
lves
eve
ral

ma
jormus
cleg
roup
s(e
xce
ptr
out
inek
idn
eyt
ran
spl
ant
),a
nda
rea
cco
mpa
nie
dbymul
ti
pl
edr
ain
s

t
hatma
yca
uses
kine
xco
ria
tio
n:mo
res
ubt
lec
aus
esi
ncl
udec
oex
ist
ingi
mmun
esup
pre
ssi
on.

Mul
ti
pl
eIn
tra
ven
ousl
i
nesa
ndc
ath
ete
rsa
ren
ece
ssa
ryf
ori
mme
dia
tep
ost
ope
rat
iv
eca
rea
nd

mo
nit
ori
ng,
butt
heyc
ont
ri
but
etot
hep
rob
lemo
fal
ter
eds
kini
nte
gri
ty
.Th
epr
olo
nge
dre
cup
era
tiv
e

p
eri
odf
ormo
stp
ati
ent
sma
ypr
edi
spo
set
hemt
oimmo
bil
i
tyo
ral
ter
edn
utr
it
io
n,wh
ichi
nhi
bi
ts

wo
undh
eal
i
nga
ndi
ncr
eas
est
her
is
kofi
ntr
aop
era
tiv
eori
nci
si
ona
lin
fec
ti
on.

C-7.
Int
erv
ent
io
ns

a
.As
ses
ssk
ine
ver
ysh
iftf
orb
rea
ksi
nin
teg
ri
ty
,ev
ide
nceo
fpr
ess
ure
,orp
oorwo
undh
eal
i
ng.

At
temp
ttoo
bse
rvec
ath
ete
rsi
te
sev
erys
hif
t.

b
.Ad
min
ist
ers
kinl
ot
io
ntoma
int
ains
kini
nte
gri
ty
.

c
.Ch
ang
est
eri
l
edr
ess
ing
sda
il
y.Bec
ert
aint
hatwo
uldd
rai
nsd
ono
tle
akn
ont
hes
kin
.

1
63
d
.Us
epa
pert
ape
,hy
poa
ll
erg
eni
cta
pe,
Duo
der
m(Co
nva
Tec
,Br
is
tol
May
ers
-Sq
uib
b,Pr
inc
eto
n,NJ
),

o
rot
hers
kinp
rep
ara
tio
npr
oduc
tsi
fne
ces
sar
ytop
rev
ent

s
kil
lbr
eak
down
.

e
.Pe
rfo
rmap
ass
iveo
rac
ti
ver
ang
eofmo
ti
ont
oen
han
cec
ir
cul
ati
ona
ndj
oi
ntmo
bil
i
ty.

f
.Pe
rfo
rma
sse
ssme
nta
ndc
ult
ure
sofe
ver
yca
the
ters
it
ewo
uldb
rea
kins
kini
nte
gri
tya
ndo
rif
ic
e

wi
tht
emp
era
tur
esp
ike
.

g
.At
temp
ttok
eepa
lls
kins
urf
ace
scl
eana
ndd
ry.
Moi
st
,da
rka
rea
sar
eli
kel
ytoe
nha
nce

mi
cr
obi
alg
rowt
h.F
ung
als
kini
nfe
cti
onsa
rec
ommo
nini
mmun
oco
mpr
omi
sedh
ost
s.Us
eto
pic
al

a
nti
mic
rob
ial
age
ntsa
sor
der
edf
ors
kil
li
nfe
cti
ons
.Re
cog
nis
eth
ats
kine
xco
ria
tio
nsma
ybe

i
nfe
cti
ous
,an
difo
rde
red
,us
ean
tif
ung
alp
owe
rins
kil
lfo
lds
.

i
.I
fth
epa
tie
nti
simmo
bil
i
sedf
ora
nex
ten
dedp
eri
od,
obt
ains
pli
ntso
fex
tre
mit
ie
stop
rev
ent

c
ont
rac
tur
es.

4.
Des
ir
edo
utc
ome

f
.Wo
undh
eal
swi
tho
utc
omp
li
cat
io
ns(
inf
ect
io
n,d
ehi
sce
nce
,an
dev
isc
era
tio
n).

g
.Nop
res
sur
ebr
eak
downa
rea
soc
cur
.

h
.Noe
vid
enc
eofi
nfe
cti
ona
tsut
ures
it
eori
nva
siv
eIVl
i
nesa
ndc
ath
ete
rs.

F
.Al
ter
edn
utr
it
io
n,l
esst
hanr
equi
reme
nts

1
.Pr
obl
em:Th
epr
olo
nge
dho
spi
tal
i
sat
io
nan
dre
cov
eryp
roc
essi
ntr
ans
pla
nta
tio
nfr
eque
ntl
y

i
nte
rfe
reswi
tha
deq
uat
enut
ri
ti
on.

2.Et
io
log
y:Dur
ingt
ran
spl
ant
ati
on,a l
ongs
urg
ica
lpr
oce
dur
e,p
rol
ong
edr
eco
ver
ype
rio
d,

d
isr
upt
io
nsi
nba
rri
eri
nte
gri
tya
ndi
mmun
osup
pre
ssi
onc
ont
ri
but
etoac
li
ni
cals
it
uat
io
ninwh
ich

t
hep
ati
enti
sun
abl
etome
eth
iso
rhe
rme
tab
oli
cde
man
ds.Ev
enwi
thi
ni
ti
alp
are
nte
ral

s
upp
leme
nta
tio
n,f
ol
lo
wedb
yen
ter
als
upp
leme
nta
tio
nca
lor
ica
ndn
utr
ien
tne
edso
fte
nar
eno
t

f
ull
yme
tdur
ingt
hep
ost
tr
ans
pla
ntp
eri
od.
Comp
li
cat
io
nsi
nth
ist
imea
cce
ntua
tet
hisp
rob
lem.

3
.In
ter
ven
tio
ns.

1
64
a
.Ma
int
aini
nta
kea
ndo
utp
utr
eco
rdsa
tle
aste
ver
ysh
ift
.

b
.We
ighd
ail
y.

c
.Ob
tai
nnut
ri
ti
onc
ons
ult
ati
ono
nal
ltr
ans
pla
ntp
ati
ent
s.

d
.Ast
hed
ietp
rog
res
ses
,mo
nit
orc
alo
riec
oun
tsa
ndn
utr
it
io
nin
tak
e.

e
.En
cour
agev
it
ami
nsup
ple
men
tat
io
nast
hep
ati
ent
’sc
ond
iti
oni
mpr
ove
s

4.
Des
ir
edo
utc
ome

a
.Pa
tie
nts
howsl
esst
han1
0%we
igh
tlo
ssi
nth
eimme
dia
tep
ost
-t
ran
spl
antp
eri
od.

b
.Ma
int
ainac
alo
rici
nta
kema
tch
ingt
hea
sse
sse
dne
eds

I
n-t
extQue
sti
on

I
npo
st-
tr
ans
pla
nt,
wha
tpo
sit
io
nsh
oul
dth
epa
tie
ntb
epl
acea
ndr
ati
ona
le?

An
swe
r:

Pl
acet
hep
ati
enti
nhi
ghF
owl
er’
sorr
eve
rseTr
end
ele
nur
g’
spo
sit
io
ntop
rov
idema
xima
l

v
ent
il
ati
ona
ndo
xyg
ena
tio
n.

3
.0Tu
torMa
rke
dAs
sig
nme
nts(
Ind
ivi
dua
lorG
rou
p)

Di
scus
ssp
eci
alp
rec
aut
io
nsn
eed
edi
nth
ema
nag
eme
nto
fap
ati
entun
der
goi
ngo
rga
ntr
ans
pla
nts
.

4.
0Co
ncl
usi
on/
Summa
ry

F
oro
rga
ntr
ans
pla
nta
tio
ntob
esuc
ces
sful
,al
lth
ing
sbe
inge
qua
lad
equa
tep
rep
ara
tio
nofd
ono
r

a
ndr
eci
pi
entmus
tbema
deb
yal
lhe
alt
hwo
rke
rsi
nvo
lve
dore
lsei
twi
l
lbeal
abo
uri
nfut
il
it
yan
d

awa
steo
fre
sour
ces
.Iti
simp
ort
antt
hata
llp
art
ie
sin
vol
vedmus
tbek
nowl
edg
eab
lea
nda
cti
ve

p
art
ic
ipa
ntsi
nth
eca
reo
fth
eses
pec
ial
cas
ess
oth
atg
oodr
esul
tsc
anb
eat
tai
ned
.

Th
ele
arn
ersh
aveg
onet
hro
ught
hef
ol
lo
win
gint
hisun
it,
i.
e.t
heme
ani
ngo
for
gant
ran
spl
ant
ati
on,

t
ype
sofg
raf
tsa
ndo
rga
ntr
ans
pla
ntsf
orma
tch
ingd
ono
ran
dre
cip
ien
t,o
rga
ntr
ans
pla
nt

i
mmun
olo
gya
ndn
urs
ingp
roc
esso
fma
nag
eme
nto
fap
ati
entun
der
goi
ngo
rga
ntr
ans
pla
nta
tio
n.I
t

1
65
i
sas
sume
dth
aty
ouh
avel
ear
nts
ogr
eatt
hatt
hek
nowl
edg
ewi
l
lbe
tte
ryo
urn
urs
ingc
areo
f

p
ati
ent
sun
der
goi
ngo
rga
ntr
ans
pla
nta
tio
n.Yo
uwi
l
lle
arnf
urt
heri
nth
ene
xtun
it-
spe
cif
ico
rga
n

t
ran
spl
ant
ati
ona
ndi
tsma
nag
eme
nt.

5.
0Se
lf
-As
ses
sme
ntQue
sti
ons

Hi
ghl
i
ghtwh
atma
kesp
ati
ent
sun
der
goi
ngt
ran
spl
ant
spr
onet
oin
fec
ti
on.

S
elf
-As
ses
sme
ntQu
est
io
ns

Pa
tie
ntsun
der
goi
ngo
rga
ntr
ans
pla
nta
tio
nar
epr
onet
oin
fec
ti
ond
uet
oimmun
osup
pre
ssi
ve

me
dic
ati
onsus
edt
opr
eve
ntr
eje
cti
on,
exp
osur
eton
oso
comi
ali
nfe
cti
onsi
nth
eIn
ten
siv
e

Ca
reUn
it(
ICU)
,an
dma
nyb
rea
ksi
nth
eba
rri
erd
efe
nce(
ie,
dur
ingt
heo
per
ati
vep
roc
edur
e;

wi
thI
Vli
nes
,ca
the
ter
s,a
ndd
rai
ns)
.

6
.0Ad
dit
io
nal
Act
iv
it
ie
s(Vi
deo
s,An
ima
tio
ns&Outo
fCl
assAc
ti
vi
ti
es)e
.g.

a
.Vi
si
tYo
uTu
bea
dd?
???
???
???
???
???
.Wa
tcht
hev
ide
o&s
umma
ris
eiti
n1p
ara
gra
ph

b
.Vi
ewt
hea
nima
tio
nona
dd/
sit
e??
???
??a
ndc
ri
ti
quei
tint
hed
isc
uss
ionf
orum

c
.Ta
keawa
lka
nde
nga
gea
ny3s
tud
ent
son?
???
???
???
?;I
n2p
ara
gra
phss
umma
ris
eth
eir

o
pin
iono
fth
edi
scus
sedt
opi
c.e
tc.

7.
0Re
fer
enc
es/
Fur
the
rRe
adi
ngs

Ci
vet
ta,
Y.M;Ya
ylo
r,R.
Wan
dKi
rb
y,R.
R(1
988)I
nte
nsi
veCa
re.
Phi
l
ade
lph
ia:

Y.
P.Li
ppi
nco
ttCo
mpa
ny

He
bra
,J.
andd
Kuh
n,M.
A(1
996
)Ma
nua
lofI
nte
nsi
veCa
reNur
si
ng,
NewYo
rk:

Li
tt
le,
Bro
wna
ndCo
mpa
ny.

Yo
ung
,an
dHA,
Sch
imd
ekHH.
(1982)Co
mpl
i
cat
io
nsa
cco
mpa
nyi
ngOc
cip
it
al

1
66
S
kul
lfr
act
ure
s.JTr
auma22:
914,
1982.

Va
nor
e,ML.
(1992)Mo
dul
e2.
InEWBa
ley
e,S
ATTur
cke(
eds
)A,
Comp
reh
ens
iveCur
ri
cul
umf
or

Tr
aumaNur
si
ng.
Bos
ton
:Jo
nesa
ndBa
rtl
ett
,p.
19.

Ly
erl
y,HK,
(1987)Th
eHa
ndb
ooko
fSur
gi
cal
Int
ens
iveCa
re:Pr
act
ic
eoft
he

S
urg
eryRe
sid
enta
tth
eDuk
eUn
ive
rsi
tyMe
dic
alCe
ntr
e.Ch
ica
go:Ye
arBo
ok,

1
67
 S
TUDYS
ESS
ION5

Pa
tie
ntsUn
der
goi
ngTr
ans
pla
nta
tio
nII

S
ect
io
nan
dSub
sec
ti
onHe
adi
ngs
:

I
ntr
oduc
ti
on

1
.0Le
arn
ingOut
come
s

2.
0Ma
inCo
nte
nts

2.
1Nur
si
ngPr
oce
ssOv
erv
iew

2.
2He
artt
ran
spl
ant
ati
on

2.
3Lun
g

2.
4Li
ver

2.
5Ki
dne
y-p
anc
rea
s

2.
6Bo
nema
rro
w

2.
7Immun
osup
pre
ssi
vea
gen
ts.

22.
0 Tu
torMa
rke
dAs
sig
nme
nts(
Ind
ivi
dua
lorG
rou
pas
sig
nme
nts
)

23
.0 S
tud
ySe
ssi
onS
umma
rya
ndCo
ncl
usi
on

24.
0 S
elf
-As
ses
sme
ntQu
est
io
ns

25.
0 Ad
dit
io
nal
Act
iv
it
ie
s(Vi
deo
s,An
ima
tio
ns&Outo
fCl
assAc
ti
vi
ti
es)

7.
0Re
fer
enc
es/
Fur
the
rRe
adi
ngs

I
ntr
odu
cti
on:

Th
iss
tud
yse
ssi
oni
sac
ont
inua
tio
noft
hep
rev
iousun
itl
ook
inga
tth
epa
tie
ntsun
der
goi
ngo
rga
n

t
ran
spl
ant
ati
on.I
nth
epr
emi
seun
it,weh
adl
ook
eda
tth
eco
nce
pto
for
gant
ran
spl
ant
ati
on,t
ype
s

o
fgr
aft
san
dor
gant
ran
spl
ant
ati
oni
nte
nsi
vef
ord
ono
ran
dre
cip
ien
t,o
rga
npr
oce
sso
fpa
tie
nts

un
der
goi
ngo
rga
ntr
ans
pla
nta
tio
n.

Th
iss
tud
yse
ssi
onwi
l
llo
oki
ntos
pec
if
icc
ase
sofo
rga
ntr
ans
pla
nta
tio
nsuc
hast
heh
ear
t,l
i
ver
,

1
68
l
ung
,an
dki
dne
y-p
anc
rea
s,b
onen
arr
owa
ndi
mmun
osu
ppr
ess
ivea
gen
ts.
Hap
pyr
ead
ing

1
.0S
tud
ySe
ssi
onL
ear
nin
gOu
tco
mes

Af
ters
tud
yin
gth
iss
ess
ion
,Ie
xpe
cty
out
obea
blet
o:

1
.Li
sta
tle
astf
ouro
rga
nst
hatc
anb
etr
ans
pla
nte
d.

2.Di
scus
sth
enur
si
ngc
areo
fpa
tie
ntsun
der
goi
ngh
ear
t,l
ung
,li
ver
,an
dki
dne
y-p
anc
rea
sor

b
onema
rro
wtr
ans
pla
nta
tio
n

3
.Ex
pla
int
her
ele
van
ceo
fimmun
osup
pre
ssi
vea
gen
ts.

2.
0Ma
inCo
nte
nts

Nur
si
ngp
roc
ess
:Ov
erv
iew

A.
Hea
rtt
ran
spl
ant
ati
on

B.
Lun
gtr
ans
pla
nta
tio
n

C.
Liv
ert
ran
spl
ant
ati
on

D.
Kid
ney
-pa
ncr
east
ran
spl
ant
ati
on

E.
Bon
ema
rro
wtr
ans
pla
nta
tio
n

F
.Immun
osup
pre
ssi
vea
gen
ts

1
69
1
70
1
71
1
72
1
73
2.
1

2.
1.
1

1
74
1
75
a
.

I
ntus
sus
cep
ti
ono
fdo
norb
ron
chi
int
oth
ere
cip
ien
t,b
ron
chi
wit
hano
ver
lapo
fon
etot
wo

c
art
il
agi
nousr
ing
s.Th
isr
educ
esi
sch
emi
aoft
hea
nas
tamo
sis
.

A-Ea
rlyc
omp
li
cat
io
ns

Ac
uter
eje
cti
on S
ign
s/s
ymp
toms

Tr
eat
ment 1
.Lo
w-g
rad
efe
ver
.(>99.
40F
)

I
mmun
osup
pre
ssi
ve 2.
Gen
era
lMa
lai
se

t
her
apy 3
.Ta
chy
car
dia

1
76
 4.
Sho
rtn
esso
fbr
eat
h,d
ysp
neao
nex
ert
io
n

5.
Coug
h

6
.Sa
o2d
imi
ni
she
dfr
omb
ase
li
ne,
par
ti
cul
arl
ywi
th

e
xer
ci
ses(
>3%

7.
Dec
rea
sedPa
02o
rin
cre
ase
dPa
02

8.
10%d
ecr
eas
einF
VCa
ndF
EV

9.
Per
ihi
l
ari
nfi
l
tra
teo
nch
estx
-ra
y

1
0.S
li
ghti
ncr
eas
einWBCc
oun
t

S
urg
ica
lco
mpl
i
cat
io
ns

Tr
eat
men
t:Ba
sedo
nSi
gns
/sy
mpt
oms

Pr
ese
nti
ng 1
.Bl
eed
inga
tth
ean
ast
omo
ti
csi
te

Co
mpl
i
cat
io
n 2.
Pul
mon
aryh
ype
rte
nsi
on

3
.At
el
ect
asi
s

4.
Pne
umo
nia

Ea
rlyc
omp
li
cat
io
nsOf
tent
heo
rga
nist
ran
sfe
rre
dfr
om(
con
t.)v
irusi
nfe
cti
oni
sco
mmo
nint
his

i
nfe
cti
ono
fth
egr
aftt
ran
spl
ant
,i
fcy
tome
gal
ovi
russ
tat
ust
rea
tme
nt:s
tat
ush
asn
otb
eenus
eda
s

t
ran
spl
anta
nti
mic
rob
ial
the
rap
ycr
it
eri
a;i
nfe
cti
ona
ndr
eje
cti
ons
ymp
tomsa
red
iff
ic
ultt
o

d
ist
ing
uis
hinl
ungt
ran
spl
ant
s.

S
ign
s/s
ymp
tomsa
red
iff
ic
ultt
odi
st
ing
uis
hinl
ungt
ran
spl
ant

S
ign
/sy
mpt
oms
.

1
.Br
eat
hso
und
sona
usc
ult
ati
onr
eve
alc
oar
ses
oun
ds

g
urg
les
,cr
ack
les
,an
dwh
eez
es.

2.
Dec
rea
sePa
02r
spi
rat
orya
cid
osi
s

3
.Pe
rsi
st
entp
ulmo
nar
yoe
dema

4.
fev
er

1
77
5.
Dec
rea
seF
VCF
EV

6
.in
cre
ase
dpul
mon
arya
rte
ryp
res
sur
es

7.
alt
era
tio
nins
put
umq
uan
tit
y,c
olo
ur,
oro
dour

Bl
eed
ingS
igns
/sy
mpt
oms

Tr
eat
men
t:p
osi
ti
ve 1
.He
mop
tos
is

Pr
ess
urev
ent
il
ati
on 2.
Cra
ckl
eso
naus
cul
tat
on

Bl
oodc
omp
one
nt 3
.Pa
tch
ypul
mon
aryi
nfi
l
tra
teso
nx-
ray

Th
era
py 4.
Hyp
oxe
mia

B-La
tec
omp
li
cat
io
ns

Ch
ron
icr
eje
cti
onS
ymp
tomss
amea
sfo
rac
uter
eje
cti
on,
butd
eve
lopmo
re

Tr
eat
men
t: S
lowl
ybr
onc
hio
li
ti
sob
li
te
rat
io
nsma
yoc
cura
sal
atec
omp
li
cat
io
nas
soc
iat
edwi
th

c
hro
nic
-ch
ara
cte
ris
edI
mmu
nos
upp
res
sio
nbyaf
ib
rot
ici
nfl
amma
tor
ypr
oce
ssc
aus
inga

p
rog
res
siv
ere
duc
ti
oni
npul
mon
aryc
omp
li
anc
esa
ndv
it
alc
apa
cit
y.

Ly
mph
opr
oli
fe
rat
iv
eSi
gns
/sy
mpt
oms

1
.Ly
mph
ade
mop
ath
ydi
sea
se

Tr
eat
men
t

2.
Ext
remel
euk
ocy
tos
is,
inc
lud
ingWBCb
las
ts

An
tin
eop
las
ti
cst
her
apy3
.Mul
ti
sys
temo
rga
ndy
sfun
cti
ond
isc
har
ge/
homeh
eal
th1
.Th
ela
rge

wo
undma
yre
qui
rec
omp
lexh
omec
are
;sur
gi
cal
cli
psa
rer
emo
veda
bout4we
eksp
ost
op

3
.Si
gnsa
nds
ymp
tomso
fre
jec
ti
ons
houl
dber
epo
rte
dtot
hec
oor
din
ato
rase
arl
yasp
oss
ibl
e

a
.Ac
ti
vi
tys
houl
dbeg
rad
ual
l
yin
cre
ase
d

b
.Amb
ula
tio
nofa
ppr
oxi
mat
ely1mi
l
e/wh
il
ema
int
ain
inga
nox
yge
nsa
tur
ati
ona
bov
e90%i
sth
e

g
oal
fort
hes
eco
ndt
oth
irdp
ost
ope
rat
iv
ewe
ek.

c
.Pa
tie
ntmus
tus
eah
and
hel
dpe
rime
tert
ome
asur
ePVCa
ndF
EVr
esul
tre
cor
dedd
ail
yif

1
78
p
ulmo
nar
yfun
cti
ond
ecr
eas
es.

>1
0%,
thep
hys
ica
lorc
oor
din
ato
rsh
oul
dben
oti
fi
ed.

d
.Lun
gfun
cti
oni
smo
nit
ore
dpe
rio
dic
all
y(a
boute
ver
y3mo
nth
s)t
hro
ughp
ulmo
nar
yfun
cti
on

l
abo
rat
orys
pir
ome
tert
est
s.

e
.Pe
rio
dicb
ron
chi
alb
iop
sie
svi
abr
onc
hos
cop
ytoa
sse
ssf
orr
eje
cti
on.

2.
Pat
ie
ntsa
rer
efe
rre
dtoap
ulmo
nar
yre
hab
il
it
ati
ngp
rog
rammet
hatr
equi
resag
rad
ual
inc
rea
se

i
nae
rob
ice
xer
ci
sea
boutt
hre
eti
mesawe
ekf
ora
bout3mo
nth
saf
tert
ran
spl
ant
,l
ik
elyt
oin
clud
e

wa
li
ng,
bic
ycl
i
ng,
upp
erb
odye
rgo
met
er,
andp
hys
ica
lth
era
pyf
ors
tre
ngt
hen
ing

4.
Fol
l
ow-
upl
abo
rat
oryt
est
ingi
ncl
ude
son
cet
oth
reet
ime
swe
ekl
ych
emi
st
ry,
pan
elc
omp
let
e

b
loo
dco
unt
.

C-I
ndi
cat
io
n

1
.En
d-s
tag
eli
verd
ise
ase(
alc
oho
l-
rel
ate
d,me
tab
oli
cdi
st
urb
anc
e,h
epa
tit
is
)

2.
<1y
eare
xpe
cte
dsur
viv
al

3
.Ag
e1-
70y
ear
s

4.
Hep
ato
mawi
tho
utme
tas
tas
is

5.
Evi
den
ceo
fal
coh
olr
eha
bil
i
tat
io
n

6
.Bi
l
irub
inc
onc
ent
rat
io
ns>1
0mg
/dl
,se
ruma
lbumi
n<2.
5mg
/dL,
andp
rot
hro
mbi
nti
me.
5

s
eco
ndsb
eyo
ndt
hec
ont
rol

7.
Rec
urr
entv
ari
cea
lbl
eed
ingd
esp
it
esc
ler
oth
era
py

8.
Asc
it
esr
efr
act
oryt
ome
dic
alt
her
apy

Co
ntr
ain
dic
ati
ons

1
.Ac
ti
vei
nfe
cti
onss
ucha
sth
ehuma
nimmun
ode
fi
ci
enc
yvi
rus

2.
Sev
erec
ard
iop
ulmo
nar
ydy
sfun
cti
on

3
.Ad
van
cedc
hro
nicr
ena
lin
suf
fi
ci
enc
yduet
ohe
pat
icd
ise
ase

4.
Anya
cti
vee
xtr
ahe
pat
icma
li
gna
nci
es.

1
79
Pr
oce
ss

1
.Or
tho
tro
picl
i
vert
ran
spl
ant
ati
ond
ise
ase
dli
veri
sre
mov
eda
ndr
epl
ace
dwi
tht
hed
ono
r'
sli
ver

2.
Het
ero
top
icl
i
vert
ran
spl
ant
ati
ond
ise
asel
i
verr
ema
insi
npl
ace
,an
dth
edo
nat
edl
i
veri
sgr
aft
ed

i
npl
ace(
per
for
medl
esso
fte
n)

3
.Twot
ype
sofb
il
ia
rya
nas
tomo
ses

a
.Ch
ole
doc
hod
edun
oto
my-
pre
fer
edme
tho
dofd
ono
rco
mmo
nduc
tan
ast
omo
sist
ore
cip
ien
t

c
ommo
nduc
t.

b
.Ro
ux-
enYc
hol
edo
cho
jej
uno
sto
my-
use
dwh
ent
hec
ommo
nbi
l
educ
tsa
red
ise
ase
d,i
nvo
lve
d

d
ono
rco
mmo
nbi
l
educ
tbe
inga
nas
tomo
sedt
oth
ere
cip
ien
t’
sje
jun
um.

4.
Cad
ave
rli
ver
sar
epa
rti
al
lyr
ese
cte
dfo
rsma
ll
-f
rame
dre
cip
ien
tsa
ndc
hil
dre
n

5.
Liv
ingr
ela
tedd
ono
r“c
ut-
downl
i
ver
s’a
reus
edo
nch
il
dre
noro
the
rsa
sal
aste
ffo
rta
t

t
ran
spl
ant
ati
on.

2.
1.
2Ea
rlyc
omp
li
cat
io
n

A-

Ac
uter
eje
cti
on S
ign
s/s
ymp
toms

Tr
eat
men
t: 1
.Hy
pot
ens
iona
fte
r

I
mmun
osup
pre
ssi
veDi
ast
oli
can
dme
ana
rte
ria
l

p
res
sur
eswi
l
lbel
ow

Ag
ent
s 2F
eve
rorp
rol
ong
edp
ost
ope
rat
iv
ehy
pot
her
mia

3
.De
cre
ase
dbi
l
edr
ain
ageo
rve
ryl
i
ghto
rda
rkmud
dy-

c
olo
ure
dbi
l
edr
ain
age

4.
Ser
uma
lbumi
n2mg
/dLmo
ret
han72h
our
s

p
ost
ope
rat
iv
ely

5.
Cla
yco
lour
eds
too
lsf
ol
lo
win
gT-
tub
e

i
nte
rna
li
sat
io
n

1
80
 6
.In
cre
ase
dse
rumb
il
ir
ubi
nan
dhe
pat
ict
ran
sami
nas
es

7.
Rig
htup
perq
uad
ran
tte
nde
rne
sso
rpa
in.

Ea
rlyCo
mpl
i
cat
io
ns 8.
Dar
kte
a-c
olo
ure
dur
ines
eco
nda
ryt
oin
cre
ase
dur
ina
ry

b
il
ir
ubi
n

9.
Sud
den
,se
ver
ehy
per
gly
cemi
aorh
ypo
gly
cemi
amo
ret
han

72h
our
spo
sto
per
ati
vel
y

1
0.F
ati
gue

1
1.Un
cor
rec
tab
lec
oag
ulo
pat
hie
s(d
esp
it
eco
nti
nuo
us

r
epl
ace
men
tth
era
py,
vit
ami
nKs
upp
leme
nta
tio
n)wi
tho
r

wi
tho
uto
ver
tbl
eed
ing

S
urg
ica
lco
mpl
i
cat
io
ns S
ign
/sy
mpt
oms

Tr
eat
men
t:c
orr
ect 1
.Hy
pot
hemi
abe
yon
d

Un
der
ly
ingc
aus
eac
tua
lsi
gna
lre
jec
ti
on;ma
yber
ela
tedt
o

t
ran
sfun
cti
ont
her
apyi
nth
eop
era
tin
gro
om

2.
Pul
mon
aryi
nsuf
fi
ci
enc
yord
iff
ic
ult
yin

d
isc
ont
inua
tio
nofme
cha
nic
alv
ent
il
ati
on-
pro
ble
mwo
rse
ned

i
fli
vert
end
ern
ess
,as
cit
es,
oro
the
rsi
gnso
fac
uter
eje
cti
on

a
rep
res
ent

B- Cl
oth
inga
bno
rma
li
ti
esS
ign
/sy
mpt
oms

Tr
eat
men
t:s
upp
orto
f 1
.Ov
erb
lee
din
g

Co
agul
ati
onun
til
nor
mal 2.
Occ
ultb
loo
dins
too
l,ur
ine
,

c
lot
hin
gre
tur
nse
mes
is/
nas
oga
str
icd
rai
nag
e

3
.Pe
tec
hia
e

4.
Eas
ybr
uis
ing

5.
Gumb
lee
din
g(o
ozi
ng)

1
81
 3
.In
abi
l
ityt
oac
hie
veh
emo
sta
sisa
fte
rin
jur
yor

b
rea
kin
/ba
rri
er(
Eg,
ven
ipun
ctur
e)

4.
Ble
edi
nga
roun
dex
ist
ingl
i
neso
rol
dpun
ctur
esi
te
s

5.
Fla
nk/
bac
kmo
ttl
i
nga
ndt
ig
htn
esss
ign
al

b
lee
din
gfr
oma
nas
tomo
sis

El
ect
rol
yt
ean
dac
id S
ign
/sy
mpt
oms

Ba
sea
bno
rma
li
ti
es 1
.In
iti
alh
ype
rgl
yce
mias
houl
dre
sol
vewi
thi
n72h
our
s

Tr
eat
men
t:p
are
nte
ral 2Ea
rlyp
ost
ope
rat
iv
epe
rio
dss
howsh
ypo
kal
emi
a,b
utf
or

e
lec
tro
lyt
eno
rma
li
sesi
n24-
72h
our
s

S
upp
ort

Di
st
urb
anc
e 3
.Al
kal
osi
sbo
thr
esp
ira
tor
yan
dme
tab
oli
c

Re
nal
ins
uff
ic
ien
cy S
ign
/sy
mpt
oms

F
romi
ncr
eas
ed 1
.Ol
i
gur
ia

He
pat
ore
nal
pre
ssur
e 2.
Con
cen
tra
tedur
inewi
the
lev
ate
dur
ina
ryb
il
ir
ubi
n

Tr
eat
men
t:ma
int
ain 3
.In
cre
ase
dbl
oodur
ean
itr
oge
nan
dcr
eat
ini
ne

Re
nal
per
fus
iona
nd 4.
Alt
ere
dcl
ear
anc
eofme
dic
ati
onsa
nti
bi
ot
ic
s,s
eda
tiv
es,

Mi
ni
mis
ere
nal
ins
ult
sna
rco
ti
cs,
neur
omus
cul
arb
loc
kin
g

a
gen
ts

Hy
pot
ens
ionf
rom S
ign
s/s
ymp
toms

Va
sod
il
ati
onr
ela
ted 1
.Lo
wdi
ast
oli
cBP

Toa
bno
rma
lli
verf
unc
ti
on 3
.Ful
l
,bo
und
ingp
uls
es

Tr
eat
men
t:Pr
ovi
deI
V

F
lui
dsa
ndv
aso
pre
sso
r

Ag
ent
stos
upp
ort

1
82
Pe
rfus
ionp
res
sur
e

I
nfe
cti
ono
fth
egr
aft S
ign
/sy
mpt
oms

Tr
eat
men
t: 1
.Fe
ver

An
timi
cr
obi
alt
her
apy 2.
Wor
sen
ingc
oag
ulo
pat
hei
s

3
.Un
con
tro
ll
abl
ehy
pog
lyc
emi
aorh
ype
rgl
yce
mia

La
tec
omp
li
cat
io
ns

Ch
ron
icr
eje
cti
on S
ign
/sy
mpt
oms

Tr
eat
men
t: 1
.Pe
rsi
st
entJ
aun
dic
e

I
mmun
osup
pre
ssi
ve 2.
Somn
ole
nce
,co
nfus
ion
,co
ma,
sei
zur
es,
ast
eri
xi
s,o
rot
her

s
ymp
tomso
fammo
nial
eve
ls.

3
.El
eva
teds
eruma
mmo
nial
eve
ls

4.
Flui
dre
ten
tio
n(e
spe
cia
ll
yas
cit
es)

5.
Per
si
st
entp
leur
ale
ffus
ion
s

6
.He
pat
ore
nal
syn
dro
mei
sth
epr
ogr
ess
iver
ena
lfa
il
ure

t
hato
ccur
ssi
mul
tan
eous
lywi
thwo
rse
nin
ghe
pat
icf
unc
ti
on

7.
Per
si
st
entr
esp
ira
tor
yan
dme
tab
oli
cal
kal
osi
sGVHD

ma
nif
est
sasn
aus
ea,
vomi
ti
ngd
iar
rho
ea.

GVHD Do
nori
mmun
oco
mpe
ten
tTl
ymp
hoc
yte
sac
comp
anyt
he

d
ono
r'
sli
vera
ndr
eco
gni
set
her
eci
pi
ent
'
sti
ssue
sasf
ore
ign

I
mmun
osup
pre
ssi
veTh
esec
ell
sat
temp
ttod
est
royt
hes
elf
-

t
is
sue
s.Th
emo
stf
req
uen
tlyt
arg
ete
dor
gan
sint
his

s
ynd
romeo
fli
vert
ran
spl
ant
ati
ona
ret
heGl
tra
ct,
ski
n,a
nd

l
ung
s

S
ign
/sy
mpt
oms

1
.Fr
eque
ntl
ywa
ter
ydi
arr
hoe
acl
ayc
olo
ure
dfo
ulo
douro
fst
ool
sco
mmo
nma
nif
est
ati
ons
.

1
83
2.
Enl
arg
eda
ndt
end
erl
i
verb
utma
ybemi
st
ake
nfo
rot
her
sco
mpl
i
cat
io
ns.

3
.Sk
int
hic
ken
ed,
prur
it
icl
ose
sth
eab
il
it
ytos
wea
t,l
i
kel
ytob
eco
mei
nfe
cte
d.

Ly
mph
oro
li
fe
rat
iv
e S
ign
/sy
mpt
oms

Di
sor
der
s 1
.Ly
mph
ade
nop
ath
y

Tr
eat
men
t: 2.
Ext
remel
euk
ocy
tos
is,
inc
lud
ingWBCb
las
ts

An
tin
eop
ati
cst
her
apy 3
.Mul
ti
sys
temo
rga
ndy
sfun
cti
on

Di
sch
arg
e/h
omeh
eal
th 1
.Mul
ti
pl
ewo
unds
it
esma
yre
qui
re

Co
mpl
exd
res
sin
gch
ang
es

2.
Arr
ang
efo
rho
mec
aren
urs
est
oas
sis
t

wo
undc
are

3
.Te
achp
ati
enta
ndf
ami
l
yT-
tub
eca
reun
til

i
nte
rna
li
sat
io
nco
mpl
ete
d

4.
Ale
rtp
ati
enta
ndf
ami
l
ytos
ign
san
dsy
mpt
omso
f

r
eje
cti
on

5.
Immun
osup
pre
ssi
oni
sfo
rli
fer
ena
lfa
il
urewi
the
vid
enc
e

o
fot
hers
yst
emsi
nvo
lve
men
t

I
ndi
cat
io
ns 1
.En
d-s
tag
epa
ncr
eat
icd
ise
aseo
rtr
auma

r
esul
ti
ngi
nin
sul
i
n-d
epe
nde
ntd
iab
ete
s

2.
Chr
oni
cre
nal
fai
l
urewi
the
vid
enc
eofo
the
rs

s
yst
emi
nvo
lve
men
t

El
i
gib
il
it
y 1
.In
sul
i
n-d
epe
nde
ntd
iab
ete
s

2.
Comp
li
cat
io
nso
fdi
abe
tesa
remo
res
eri
oust
han

r
is
kofs
urg
erya
nimmun
osup
pre
ssi
on

3
.Ne
phr
opa
thy(
forc
omb
ine
dpa
ncr
eas
-ki
dne
y

t
ran
spl
ant
)

1
84
 4.
Unc
ont
rol
l
edh
ype
rgl
yce
mia

5.
Sev
eren
eur
opa
thy
.

Co
ntr
ain
dic
ati
on 1
.Pr
ese
nceo
fpe
net
rat
inga
bdo
min
al

wo
und
s

2.
Bur
ns>1
5%o
fbo
dy

3
.Hy
per
ten
sio
n(un
les
sint
hep
res
enc
eof

e
nd-
sta
ger
ena
ldi
sea
se)

4.
His
tor
yofh
uma
nimmun
ode
fi
ci
enc
y

v
ir
usi
nfe
cti
onso
rme
tas
tas
isi
ngma
li
gna
ncy

5.
Sev
erei
nca
pac
it
ati
ngn
eur
opa
thi
es(
eg,

e
spe
cia
ll
yaut
ono
micn
eur
opa
thi
esc
aus
ing

d
ysr
hyt
hmi
as)

6
.In
ope
rab
lep
eri
phe
ral
vas
cul
aro
rca
rdi
ova
scul
ar

d
ise
ase

Pr
oce
ss 1
.Ki
dne
y-p
anc
rea
sest
ran
spl
ant
ati
on

a
.Mo
stc
ommo
nty
peo
fpa
ncr
east
ran
spl
ant

b
.Bo
tho
rga
nsc
omef
romt
hes
amed
ono
ror

ak
idn
eyi
str
ans
pla
nte
dwi
thi
n6mo
nth
stoay
ear

f
ol
lo
win
gth
epa
ncr
east
ran
spl
ant

c
.Is
letc
ell
sar
eimp
lan
tedt
hro
ught
hep
ort
alv
ein

o
fth
epa
tie
nt.

d
.Pr
obl
emsi
ncl
udei
sol
ati
ono
fen
oug
his
letc
ell
s

a
ndg
rea
terr
is
kofi
nfe
cti
ousc
omp
li
cat
io
nsi
n

p
ati
ent
sre
cei
vi
ngi
mmun
osup
pre
ssi
vet
her
apy

f
roma
nea
rli
erk
idn
eyt
ran
spl
ant
.

1
85
3
.Se
gme
nta
lpa
ncr
east
ran
spl
ant
ati
on

a
.Sl
i
vin
gre
lat
edd
ono
rpr
ovi
dest
hes
egme
nta
l

p
anc
rea
s

b
.Re
mai
nsun
deri
nve
sti
gat
io
nre
gar
din
g

r
is
k/b
ene
fi
tra
tio

4.
Who
le-
org
anp
anc
rea
str
ans
pla
nta
tio
n

a
.In
dic
ate
dfo
rnour
emi
cdi
abe
teswh
oha
ven
otp
eev
ish
lyr
ece
ive
dak
idn
eyt
ran
spl
ant

b
.Re
mai
nsun
deri
nve
sti
gat
io
nre
gar
din
gri
sk/
ben
efi
tra
tio

5.
Thed
ono
rki
dne
yist
ran
spl
ant
edi
ntot
hel
ef
til
i
acf
oss
aan
dan
ast
omo
sedt
oth
ere
cip
ien
t’
s

b
lad
der

6
.Th
edo
norp
anc
rea
sist
ran
spl
ant
edi
ntot
her
ig
hti
l
iacf
oss
aan
dan
ast
omo
sedv
iat
hep
anc
rea
tic

d
uod
eno
cyt
oto
mya
ppr
oac
h;t
her
efo
re,
thee
xoc
ri
nes
ecr
eti
ond
rai
nst
hro
ught
heb
lad
der
.Th
e

e
xis
ti
ngp
anc
rea
soft
heh
ostc
ont
inue
sot
here
xoc
ri
nef
unc
ti
onsv
iat
heGa
str
o-I
nte
sti
nal
tra
ct.

C-Ea
rlyc
omp
li
cat
io
ns

Ac
uter
eje
cti
on S
ign
s/s
ymp
toms
:re
nal

Tr
eat
men
t: 1
.In
cre
ase
dcr
eat
ini
ne

I
mmun
osup
pre
ssi
ve 2.
Inc
rea
sedb
loo
dur
ean
itr
oge
n

Ag
ent
s 3
.De
cre
ase
dur
ina
ryo
utp
ut

4.
Hyp
ert
ens
ion

5.
Inc
rea
sedwe
igh
t

6
.Gr
aftt
end
ern
ess

7.
Fev
er

8.
Coa
gul
opa
the
sis

S
ign
s/s
ymp
toms
:pa
ncr
eat
ic

1
.De
cre
ase
dur
ina
rya
myl
ase(
pre
ced
esg
luc
ose

1
86
 c
han
ges
)

2.
Gra
ftt
end
ern
ess

3
.Hy
per
gly
cemi
a

4.
Fev
er

S
urg
ica
lco
mpl
i
cat
io
ns 1
.Pa
ncr
eat
icd
uet
osur
gic
alma
nip
ula
tio
n;

ma
nif
est
ed

Tr
eat
men
t: s
pec
if
ict
oep
iga
str
icd
isc
omf
ort
,i
ncr
eas
eds
erum

a
myl
asea
ndl
i
pas
e,p
rob
lemc
lay
-co
lour
eds
too
ls,

f
att
y-
foo
din
tol
era
nce
s

2.
Deh
ydr
ati
ond
etoh
ype
rgl
yce
mico
smo
ti
cdi
ure
sis

p
ost
ope
rat
iv
elyun
til
gluc
osen
orma
li
ses

I
nfe
cti
ono
fth
egr
aft 1
.Ne
phr
it
ish
era
lde
dyf
lan
korb
ack

Tr
eat
men
tdi
sco
mfo
rt,
ten
der
nes
satt
hei
nci
si
on

s
it
e,f
eve
r

An
timi
cr
obi
alt
her
apy 2.
Uri
nar
ytr
acti
nfe
cti
on(
eg,
ure
thr
it
is
,

c
yst
it
is
)co
mmo
noc
cur
ren
cewi
ths
ymp
tomss
ucha
sur
ina
ry

ur
gen
cy,

ur
ina
ryf
req
uen
cy,
dys
uri
a,h
ema
tur
iaGr
aftt
hro
mbo
sis

Oc
clus
iono
fgr
aftv
ess
ell
ead
stoa
cut
egr
aftp
ain
,si
gns

Tr
eat
men
t: i
ncr
eas
ean
dsy
mpt
omso
fac
utea
bdo
min
ale
ven
t,o
li
gur
iac
ir
cul
ati
ngb
loo
d

h
ema
tur
iav
olumeo
rad
min
ist
err
ena
ldo
sed
opa
min
etoi
ncr
eas
e

g
lome
rul
arf
il
tr
ati
onr
ate
.

La
tec
omp
li
cat
io
ns

1
.El
eva
tedt
emp
era
tur
e

2.
Wei
ghtg
aino
f2-
31b
/d

1
87
3Hy
per
ten
sio
n

4.
Pai
nan
dte
nde
rne
sso
vert
heg
raf
tsi
te

5.
Hyp
erg
lyc
emi
a

Tr
eat
men
t

I
mmun
osup
pre
ssi
vea
gen
ts

=l
ymp
hor
oli
fe
rat
iv
edi
sor
der

S
ign
/sy
mpt
oms

1
.Ly
mph
ade
nop
ath
y

2.
Ext
remel
euk
ocy
tos
is,
inc
lud
ingWBC

b
las
ts

1
.Mul
ti
sys
temo
rga
ndy
sfun
cti
on

Tr
eat
men
tsa
nti
neo
pla
sti
csa
gen
ts/
dis
cha
rge
/ho
meh
eal
th

1
.Re
tur
nton
orma
ldi
abe
ti
cpr
eca
uti
ons
,be
caus
eal
tho
ughh
ype
rgl
yce
miama
yber
eso
lve
dwi
th

t
het
ran
spl
ant
,ot
here
ffe
ctso
fth
edi
sea
sema
yst
il
lma
nif
est
.

2.Ad
vis
epa
tie
ntt
oco
nti
nuet
est
ingb
loo
dsug
arss
eve
ralt
ime
sad
ayf
ormo
nth
saf
tert
ran
spl
ant
;

h
ype
rgl
yce
miama
ybea
nea
rlys
ymp
tomo
fre
jec
ti
on.
Ifb
loo
dsug
arsa
re>200mg
/dL,
thep
ati
ent

i
sad
vis
edtc
all
theh
eal
thc
aret
eam

3
.Immun
osup
pre
ssi
vema
ybef
orl
i
fe,
alt
houg
hdo
sesa
ret
ape
redd
rama
tic
all
yaf
ter

s
eve
ral
wit
hou
tre
jec
ti
ons
ymp
toms

4.
Pat
ie
nts
houl
dse
lf
-mo
nit
orf
orf
lui
dre
ten
tio
nan
dli
mitf
lui
din
tak
eifn
ece
ssa
ry

5.
Adv
isep
ati
entt
ota
keb
ica
rbo
nat
eta
ble
tsa
sor
der
eda
sar
epl
ace
men
tfo
rno
rma
lki
dne
y

b
uff
eri
ng.

De
fi
ni
ti
on

Ad
min
ist
rat
io
nofav
eryh
ighd
oseo
fCh
emo
the
rap
yre
sul
ti
ngi
nse
ver
e

my
elo
sup
pre
ssi
on,
whi
chr
equi
resb
onema
rro
wtr
ans
pla
nta
tio
nasar
esc
ueme
asur
e.

1
88
Ty
pes

1
.Aut
olo
gous

a
.Bo
nema
rro
wth
ati
s‘s
elfd
ona
ted
”

b
.On
lyp
eRf
orme
dfo
rma
li
gna
ntd
ise
ase
swh
il
eth
epa
ten
tisi
nre
mis
sio
n

c
.Di
sea
sesi
ncl
udel
ymp
homa
san
dso
li
dtumo
urss
ucha
sEwi
ng’
ssa
rco
maa
nd

Ho
dgk
in'
sdi
sea
se

d
.Of
tenp
erf
orme
dwi
thp
rog
eni
to
rce
ll
s,wh
icha
reg
ene
rat
edb
yhi
ghd
osec
hemo
the
rap
yan
d

o
bta
ine
dfr
omt
hep
ati
entv
iap
her
esi
spr
iort
oth
ebo
nema
rro
wtr
ans
pla
nt.

e
.So
mec
ent
resp
urg
eth
ema
rro
w,i
.
e.t
rea
titwi
thc
hemo
the
rap
ypr
iort
ore
tra
nsp
lan
tat
io
n

f
.Do
esn
otr
equi
reHLAt
ypi
ngo
rmi
xedl
ymp
hoc
ytec
ult
ure
.

2.
All
of
eni
c-
onema
rro
wth
ati
sdo
nat
edf
roma
not
herl
i
vin
gdo
nor
.

a
.re
qui
resHLAt
ypi
nga
ndmi
l
dly
mph
ocy
tec
ult
ure

b
.Do
esn
otr
equi
reABOc
omp
ati
bi
li
tyb
uti
spr
efe
rre
d

c
.Ma
ybef
rome
it
herar
ela
tedo
run
rel
ate
ddo
nor

d
.Pe
rfo
rme
dfo
rma
li
gna
nta
ndn
onma
li
gna
ntd
iso
rde
rss
ucha
sac
utemy
elo
gen
ousl
euk
aemi
a,

a
cut
ely
mph
ocy
ti
cle
uka
emi
a,c
hro
nicmy
elo
gen
ousl
euk
aemi
a,a
pla
sti
can
aemi
a,my
elo
dys
pla
sti
c

s
ynd
romeo
rmul
ti
pl
emy
elo
ma

3
.Sy
nge
nei
c

a
.bo
nema
rro
wdo
nat
edf
romal
i
vin
gid
ent
ic
alt
win

b
.Us
ual
l
yal
l
owsf
ort
hec
los
etma
tchr
ega
rdi
ngHLAt
ypi
nga
ndmi
xedl
ymp
hoc
ytec
ult
uret
het
ype

o
fbo
nema
rro
wtr
ans
pla
nta
tio
nch
ose
nde
pen
dso
nth
ety
pea
nde
xte
nto
fdi
sea
se,
HLAma
tch
ing

d
ona
tio
ncr
it
eri
aav
ail
abi
l
ity
,aswe
llt
hed
ono
rme
eti
ngd
ona
tio
nsc
ri
te
ria

I
ndi
cat
io
ns

1
.He
mat
olo
gicma
li
gna
nci
es-
le
uka
emi
a,l
ymp
homa
,mul
ti
pl
emy
elo
ma,
Ewi
ngs
arc
oma

2.
Non
hema
tol
ogi
cma
li
gna
nt(
sol
i
dtumo
urs
)suc
hasb
rea
st,
sma
llc
ell
lun
gca
nce
rov
ari
ana
nd

1
89
c
hil
dho
odb
rai
ntumo
urt
est
ic
ula
r.

3
.me
tab
oli
can
dge
net
icd
iso
rde
rss
ucha
sse
ver
eco
mbi
nedi
mmun
ede
fi
ci
enc
ysy
ndr
ome
,ap
las
ti
c

a
nae
mia

El
i
gib
il
it
y

1
.De
fi
nedi
ndi
cat
or

2.
Pat
ie
ntmus
tbei
nre
mis
sio
n

3
.Ad
equa
tef
ina
nci
ala
nds
oci
alr
eso
urc
es

4.
Goo
dor
ganf
unc
ti
on

Co
ntr
ain
dic
ati
on

1
.El
eva
tedc
rea
tin
ine

2.
Dec
rea
sedp
ulmo
nar
yfun
cti
ont
est
s

3
.De
cre
ase
dmy
oca
rdi
aej
ect
io
nfr
act
io
n

4.
Age>6
5ye
ars

5.
Inc
rea
sedt
ran
sami
nas
es

6
.Co
ntr
ain
dic
ati
onsa
rev
ari
abl
ese
con
dar
ytor
ese
arc
hpr
oto
col
s.

Pr
oce
ss

Aut
olo
gousma
rro
wtr
ans
pla
nta
tio
nfo
rce
rta
inma
li
gna
nci
es,at
heo
ris
edd
oser
esp
ons
esr
ela
tio
n

s
tat
est
hatv
eryh
ighd
oset
her
apywi
l
lab
lat
eth
ema
li
gna
ncy
.Dur
ingt
hel
i
fe-
thr
eat
eni
ng

my
elo
sup
pre
ss,t
heb
onema
rro
wisi
nfus
edwi
thI
Van
dse
edst
hro
ugh
outt
hep
ati
ent
’
sbo
dy.Th
is

p
rov
ide
sth
epa
tie
ntwi
thf
unc
ti
oni
ngb
onema
rro
wce
ll
s.Th
epa
tie
nti
sre
qui
redt
obei
nsr
emi
ssi
on

f
ort
heb
onema
rro
wtr
ans
pla
nts
.Th
emo
stf
req
uen
tch
emo
the
rap
eut
ica
gen
tsus
eda
rea
lky
lat
ing
.

1
.Ad
oub
le-
lume
npe
rma
nen
tve
nousa
cce
ssd
evi
ce(
VAD)
,eg
.Hi
ckma
nisp
lac
ed

2.
Thep
ati
entr
ece
ive
shi
ghd
osec
hemo
the
rap
yan
dma
rro
wst
imul
ati
ngf
act
orsf
ol
lo
wedb
y

p
her
esi
sofc
ir
cul
ati
ngma
rro
wst
emc
ell
sifi
ndi
cat
ed

1
90
3
.Bo
nema
rro
wha
rve
sti
spe
rfo
rme
d

4.
Bon
ema
rro
wce
ll
sar
epur
geda
ndt
rea
tedt
ode
str
oyma
li
gna
ntc
ell
sifi
ndi
cat
ed.

5.
Hig
hdo
sec
hemo
the
rap
yan
dorTBIa
rea
dmi
ni
st
ere
d

6
.Ond
ay0t
hep
ati
enti
sre
inf
use
dwi
tht
heb
onema
rro
w

7.
Thep
ati
entwa
itsf
ort
heWBCc
oun
ttor
etur
n(>1
000)wi
tha
nANC>500c
ell
s/mm3
).

Al
l
oge
nei
cma
rro
wtr
ans
pla
ntTh
ist
ran
spl
antr
equi
rest
ota
lde
str
uct
io
noft
heh
ostma
rro
wwi
th

h
ighd
osec
hemo
the
rap
yan
d/o
rra
dia
tio
nth
era
pya
ndi
sfo
ll
owe
dwi
thi
nfus
ionma
rro
wth
ath
as

b
eenh
arv
est
edf
roma
not
her

p
ers
ons(
thed
ono
r)d
uri
nga
nop
era
tiv
epr
oce
dur
e.

Th
ein
fus
edma
rro
wmi
gra
test
oth
eho
stb
onema
rro
wan
den
gra
fts

1
.On
ema
rro
wha
rve
sta
ndp
lac
eme
nto
fad
oub
le-
lume
nHi
ckma
n

2.
Hig
hdo
sec
hemo
the
rap
y(TBIi
sin
dic
ate
d)

3
.Bo
nema
rro
wisp
urg
edf
romd
ono
r

4.
Hig
h-d
osec
hemo
the
rap
yisa
dmi
ni
st
ere
d

5.
Ond
ay0b
onema
rro
wre
inf
usi
onp
erf
orme
d

6
.Pa
tie
ntwa
itsf
ort
heWBCc
oun
ttor
etur
n(>1
000wi
tan
dANC>500c
ell
smm3
).Ra
tio
nal
e;

Dur
ingt
heb
onema
rro
wtr
ans
pla
nt,
thep
ri
mar
yco
nce
rni
sen
gra
ftme
nto
fth
ebo
nema
rro
wce
ll
s

a
ndp
rev
ent
io
nofi
nfe
cti
on.

Ea
rlyc
omp
li
cat
io
ns

Ac
uter
eje
cti
on:a
cut
eGVHD

1
.Oc
cur
spr
ima
ril
yina
ll
oge
nei
ctr
ans
pla
nt,
esp
eci
al
lyu
nre
lat
edt
ran
spl
anti
smi
ni
mal
wit
h

s
yng
eni
ctr
ans
pla
nt

Tr
eat
men
t:

2.
Def
ini
ti
on:Tl
ymp
hoc
yte
sfr
omd
ono
rbo
nema
rro
wre
cog
nis
eno
nse
lfs
urf
acea
nti
gen
son

v
ari
ouso
rga
ns(
fr
eque
ntl
ysk
in)
,GLt
rac
t,t
hel
i
veri
nth
ere
cip
ien
tan
dmo
unti
mmun
ede
str
uct
io
n

1
91
o
fth
oseo
rga
ns.
Acut
eGVHDo
ccur
swi
thi
nth
efi
rs
t100d
aysf
ol
lo
win
gbo
nema
rro
wtr
ans
pla
nt

3
.Si
gn/
symp
toms

a
.Ma
cul
opa
pua
lrr
ashv
ary
ingi
nin
vol
veme
ntf
rom<25%o
fth
ebo
dyt
oge
ner
ali
sede
ryt
hro
der
ma

wi
tht
heb
ull
ousf
orma
tio
nan
dde
squa
mat
io
n;r
asho
fte
nbe
gin
sons
ole
soff
eeta
rms
,sh
oul
der
,or

t
run
k

b
.GVHDo
fth
eli
vera
ppe
arsa
sane
lev
ate
dal
kal
i
nep
hos
pha
te,
ele
vat
edb
il
ir
ubi
nja
und
ice
,

h
epa
tome
gal
y,r
igh
tup
perq
uad
ran
tte
nde
rne
ss.

c
.GVHDo
fth
ein
tes
ti
nal
tra
ctus
ual
l
yin
clud
edi
arr
hoe
a>500mL/
dse
ver
eab
domi
nal
pai
nwi
tho
r

mo
uthc
arep
rac
ti
cea
ndp
rop
hyl
act
ic

a
nti
mic
rob
ial
sar
egi
ven
.

Ha
emo
rrh
age

1
.Bo
nema
rro
wsup
pre
ssi
ona
ffe
ctsp
lat
ele
tsa
lmo
sti
mme
dia
tel
y

2.
Lowp
lat
ele
tco
unte
xac
erb
ate
sbl
eed
ings
ymp
tomss
upp
ortt
end
enc
yfr
ommuc
osi
ti
sorGVHD.

3
.He
pat
icd
ise
ase(
GVHDo
rVOD)e
xac
erb
ate
sth
ete
nde
ncyt
obl
eed
.

4.
Sig
nsa
nds
ymp
tomso
ccu
lto
rov
ertb
lee
din
gab
nor
mal
pla
tel
etc
oun
t,a
ndc
oag
ula
tio
nte
sts

5.
Dia
gno
sis
:cl
i
nic
als
ymp
tomsa
ndl
abo
rat
oryt
est
s

h
epa
ticVOD

1
.De
fi
ni
ti
on:f
ib
rousg
ran
ula
tio
nofv
ess
elsi
nth
eli
vera
sac
ons
eque
nceo
fan
tin
eop
las
ti
c

c
hemo
the
rap
yan
dra
dia
tio
nth
era
pyc
aus
esc
omp
ri
sedc
ir
cul
ati
ont
hro
ught
hel
i
vera
ndp
ort
al

h
ype
rte
nsi
on

2.
Sig
n/s
ymp
toms

a
.On
seti
sbe
twe
end
ays8a
nd1
5po
st-
tr
ans
pla
nt.
May
bel
ate
raut
olo
gousb
onet
ran
spl
ant
,an
d

ma
yea
rli
eri
fpa
tie
nth
eav
il
ypr
etr
eat
edwi
tha
lky
lat
inga
gen
ts

b
.Th
efi
rs
tsy
mpt
omsus
ual
l
yri
ghtup
perq
uad
ran
tab
domi
nal
ten
der
nes
swi
thh
epa
tome
gal
y

c
.Fl
ui
dre
ten
tio
nan
dwe
igh
tga
ina
lsoo
ccure
arl
y

1
92
d
.Di
ff
ere
nti
ate
dfr
omGVHDo
fth
eli
verb
yth
efa
ctt
hati
sol
ate
dhy
per
bil
i
rub
ine
miao
ccur
sfi
rs
t

a
ndt
ran
sami
nas
eel
eva
tio
ndo
esn
oto
ccurun
til
lat
er

3
.Di
agn
osi
s:l
i
verb
iop
syc
onf
ir
mcl
i
nic
als
usp
ici
on

I
n-t
extQue
sti
on

Ad
min
ist
rat
io
nofav
eryh
ighd
oseo
fCh
emo
the
rap
yre
sul
ti
ngi
nse
ver
emy
elo
sup
pre
ssi
on,
whi
ch

r
equi
resb
onema
rro
wtr
ans
pla
nta
tio
nasar
esc
ueme
asur
e.Wh
icha
reo
fth
edi
ff
ere
ntt
ype
,

i
den
tif
yth
em.

An
swe
r:Th
eyi
ncl
ude
:

1
.Aut
olo
gous

2.
All
oge
nic

3
.Sy
nge
nei
c

2.
1.
3

A-F
ail
uret
oen
gra
ft

1
.De
fi
ni
ti
on:I
fen
gra
ftme
ntwi
thb
onema
rro
wre
cov
eryh
asn
oto
ccur
redb
yap
pro
xima
tel
y6-
10we
eks

d
epe
ndso
nani
nst
it
uti
ona
lno
rmt
hati
sba
sedo
nco
ndi
ti
oni
ngd
rug
sus
eda
ndme
tho
dofp
rep
ari
ng

ma
rro
wpr
iort
ore
inf
usi
on)
:fa
il
uret
oen
gra
ftb
onema
rro
wre
sul
tsi
nfun
cti
ona
lap
las
ti
can
aemi
a.

2.
Sig
n/s
ymp
tomso
fan
aemi
a,b
lee
din
gan
din
fec
ti
ons

3
.Di
agn
osi
s-
bon
ema
rro
wbi
ops
y

1
93
4.
Tre
atme
nt

a
.Ma
rro
wst
imul
ati
onwi
ths
ynt
het
ice
ryt
hro
poi
et
int
oen
han
ceRBCg
rowt
h;g
ran
ulo
cyt
eco
lon
y-

s
ti
mul
ati
ngf
act
or(
fi
lg
ras
ti
m)t
ohe
nceWBCg
rowt
h;a
ndf
ol
ate
,B1
2,s
ter
oid
stoe
nha
ncep
lat
ele
ts

g
rowt
h

b
.Sup
por
ti
vec
arewi
thb
loo
dco
mpo
nen
ttr
ans
fus
ion
s

c
.Ifa
uto
log
ousma
rro
wtr
ans
pla
nt,
aba
ckupma
rro
wha
sus
ual
l
ybe
enf
roz
enb
utn
ott
rea
teda
s

e
xte
nsi
vel
y;r
ein
fus
iono
fba
ckupma
rro
wma
yha
vei
ncr
eas
edr
is
kofma
li
gna
ncyr
ecur
ren
ce.

d
.An
oth
erma
tch
edt
ran
spl
anti
spe
rfo
rme
dass
oona
spo
ssi
bl
e;i
fno
nei
sav
ail
abl
e,HLA

un
mat
che
dtr
ans
pla
ntma
ybep
erf
orme
d.

La
tec
omp
li
cat
io
n:Ch
ron
icGVHD

1
.Pr
oce
sss
imi
l
art
oac
uted
ise
aseb
utp
roc
edur
esc
oll
age
nsub
sta
ncewi
thf
ib
ros
is

2.
Org
ansi
nvo
lve
dus
ual
l
yin
clud
esk
in,
Glt
rac
t,a
ndl
i
ver

a
.Ch
ron
ict
hic
ken
eds
kin
,po
ors
wea
tin
g,t
ear
ingo
rot
hern
orma
lex
cre
ti
ons

b
.Di
arr
hoe
awi
tho
rwi
tho
utGl
ble
edi
ngma
yoc
cur

c
.El
eva
tedt
ran
sami
nas
eso
ccurts
ign
all
i
veri
nvo
lve
men
t

3
.Br
onc
hio
li
ti
sob
li
te
ran
sinas
ett
ingo
fpo
st-
tr
ans
pla
nti
sth
oug
htt
obeama
nif
est
ati
ono
fch
ron
ic

GVHDo
flun
ga.
Obs
truc
ti
ves
ymp
tomso
npul
mon
aryf
unc
ti
ont
est(
dec
ree
dfun
cti
ona
lre
sid
ual

c
apa
cit
y,i
ncr
eas
edd
iff
usi
onl
ungc
apa
cit
yofC02)

b
.Pul
mon
aryh
ype
rte
nsi
onma
yac
comp
anyr
esp
ir
ato
rys
ymp
toms

c
.Ra
pid
lyp
rog
res
siv
elun
gfa
il
ureo
ccur
sde
spi
tec
ort
ic
ost
ero
idt
her
apy

B-Di
sch
arg
e/h
omeh
eal
th;Co
nsi
der
ati
ons

1
.Mo
stp
ati
ent
sdon
oth
aven
orma
limmun
efun
cti
ond
esp
it
eth
ere
tur
nofWBCc
oun
t;i
nfe
cti
ous

p
rev
ent
io
npr
eca
uti
onsa
ree
sse
nti
al

2.
Blo
odp
rod
ucts
upp
orti
sof
tenr
equi
redf
ors
eve
ral
mon
thsa
fte
rdi
sch
arg
e

3
.Al
li
mmun
eme
mor
yise
li
min
ate
dwi
tha
ll
oge
nei
cbo
nema
rro
wtr
ans
pla
nt;p
ati
entmus
tla
ter

1
94
(
aft
er2y
ear
s)b
eimmun
ise
dag
ain
stc
hil
dho
odi
l
lne
ss,
hep
ati
ti
s,a
ndp
neumo
coc
cus
;th
ere
for
e,

t
hep
ati
ents
houl
dav
oide
xpo
sur
edur
ingt
hatp
eri
od

4.
Aft
era
nal
l
oge
nei
cbo
nema
rro
wtr
ans
pla
nt,
thes
eco
ndd
ropi
nbl
oodc
oun
toc
cur
sbe
twe
en

d
ays50a
nd70

5.
Immun
osup
pre
ssi
vea
gen
tswi
l
lbet
ape
reda
ndd
isc
ont
inue
daf
ters
eve
ral
yea
rswi
tho
ut

r
eje
cti
ons
ymp
toms

6
.Fr
eque
ntb
loo
dco
unt
s,c
hemi
st
ryt
est
s,a
ndb
onema
rro
wbi
ops
iesa
rep
erf
orme
dtoe
val
uat
eth
e

s
ucc
esso
fth
eBMTa
ndt
hea
deq
uat
een
gra
fte
dma
rro
w.

1
95
C-

I
n-t
extQue
sti
on

S
tat
eth
eimme
dia
tei
mpl
i
cat
io
noff
ai
lur
etoe
ngr
aft

An
swe
r

1
96
f
ail
uret
oen
gra
ftb
onema
rro
wre
sul
tsi
nfun
cti
ona
lap
las
ti
can
aemi
a.

3
.0Tu
torMa
rke
dAs
sig
nme
nts(
Ind
ivi
dua
lorG
rou
p)

Wh
ati
sth
ere
lev
anc
eofi
mmun
osup
pre
ssi
vea
gen
tsi
nth
ema
nag
eme
nto
for
gant
ran
spl
ant

p
ati
ent
s?

4.
0Co
ncl
usi
on/
Summa
ry

Av
astn
umb
ero
fpa
tie
ntsh
aveb
ene
fi
tt
edf
romv
ari
ouso
rga
ntr
ans
lat
io
nsa
llt
heh
eal
thp
ers
onn
el

i
nvo
lve
dmus
tbek
een
lyi
nte
res
tedi
nwh
att
heya
red
oin
gan
dbeb
ett
ers
kil
ful
sot
hatmo
re

s
ucc
ess
esc
anb
eac
hie
vedi
nth
isd
ire
cti
on.
Nod
oub
tor
gant
ran
spl
ant
ati
oni
sab
rea
kth
roug
h

t
oda
yint
heh
eal
ths
ect
or.

I
nth
iss
tud
yse
ssi
on,
weh
aves
tud
ieds
omes
pec
if
icc
ase
sofo
rga
ntr
ans
pla
nta
tio
nss
ucha
she
art
,

l
i
ver
,lun
g,k
idn
ey-
pan
cre
asa
ndb
onema
rro
w;wea
lsol
ook
eda
timmun
osup
pre
ssi
vea
gen
tst
hat

c
ane
it
herma
keo
rma
rth
esuc
ces
sofo
rga
ntr
ans
pla
nta
tio
nifn
otus
eds
kil
l
ful
l
y.Id
oho
pet
hat

t
hek
nowl
edg
eac
qui
redi
nth
ela
stt
woun
itswi
l
lbe
tte
ryo
urn
urs
ingma
nag
eme
nto
fpa
tie
nts
.

5.
0Se
lf
-As
ses
sme
ntQue
sti
on

Di
scus
sth
emo
dal
i
tie
sfo
rma
nag
ingf
ai
lur
etoe
ngr
aft

S
elf
-As
ses
sme
ntQu
est
io
ns

Th
eli
neo
fma
nag
eme
nta
rea
sfo
ll
ows
:

a
.Ma
rro
wst
imul
ati
onwi
ths
ynt
het
ice
ryt
hro
poi
et
int
oen
han
ceRBCg
rowt
h;g
ran
ulo
cyt
e

c
olo
ny-
sti
mul
ati
ngf
act
or(
fi
lg
ras
ti
m)t
ohe
nceWBCg
rowt
h;a
ndf
ol
ate
,B1
2,s
ter
oid
sto

e
nha
ncep
lat
ele
tsg
rowt
h

b
.Sup
por
ti
vec
arewi
thb
loo
dco
mpo
nen
ttr
ans
fus
ion
s

c
.Ifa
uto
log
ousma
rro
wtr
ans
pla
nt,
aba
ckupma
rro
wha
sus
ual
l
ybe
enf
roz
enb
utn
ott
rea
ted

1
97
a
sex
ten
siv
ely
;re
inf
usi
ono
fba
ckupma
rro
wma
yha
vei
ncr
eas
edr
is
kofma
li
gna
ncy

r
ecu
rre
nce
.

d
.An
oth
erma
tch
edt
ran
spl
anti
spe
rfo
rme
dass
oona
spo
ssi
bl
e;i
fno
nei
sav
ail
abl
e,HLA

un
mat
che
dtr
ans
pla
ntma
ybep
erf
orme
d.

6
.0Ad
dit
io
nal
Act
iv
it
ie
s(Vi
deo
s,An
ima
tio
ns&Outo
fCl
assAc
ti
vi
ti
es)e
.g.

a
.Vi
si
tYo
uTu
bea
dd?
???
???
???
???
???
.Wa
tcht
hev
ide
o&s
umma
ris
eiti
n1p
ara
gra
ph

b
.Vi
ewt
hea
nima
tio
nona
dd/
sit
e??
???
??a
ndc
ri
ti
quei
tint
hed
isc
uss
ionf
orum

c
.Ta
keawa
lka
nde
nga
gea
ny3s
tud
ent
son?
???
???
???
?;I
n2p
ara
gra
phss
umma
ris
eth
eir

o
pin
iono
fth
edi
scus
sedt
opi
c.e
tc.

7.
0Re
fer
enc
es/
Fur
the
rRe
adi
ngs

Da
nov
it
chG.
(1992)Ha
ndb
ooko
fKi
dne
yTr
ans
pla
nta
tio
n,Bo
sto
n:Li
tt
leBr
own
,

P.
324.

Yo
ung
,an
dHA,
Sch
imd
ekHH.
(1982)Co
mpl
i
cat
io
nsa
cco
mpa
nyi
ngOc
cip
it
al

S
kul
lfr
act
ure
s.JTr
auma22:
914,
1982.

Va
nor
e,ML.
(1992)Mo
dul
e2.
InEWBa
ley
e,S
ATTur
cke(
eds
)A,
Comp
reh
ens
iveCur
ri
cul
umf
or

Tr
aumaNur
si
ng.
Bos
ton
:Jo
nesa
ndBa
rtl
ett
,p.
19.

Ly
erl
y,HK,
(1987)Th
eHa
ndb
ooko
fSur
gi
cal
Int
ens
iveCa
re:Pr
act
ic
eoft
he

S
urg
eryRe
sid
enta
tth
eDuk
eUn
ive
rsi
tyMe
dic
alCe
ntr
e.Ch
ica
go:Ye
arBo
ok,

1
98