Chapter 7 Review for Test

Chapter 22 Antihypertensive Drugs Hypertension Defined (JNC-8) Pharmacology Overview 7 main categories of drugs to treat HTN Adrenergic drugs (old friend) Angiotensin-converting enzyme (ACE) inhibitors Angiotensin II receptor blockers (ARBs) Calcium channel blockers (CCBs) Diuretics Vasodilators Direct renin inhibitors A. Adrenergic Drugs: 5 Subcategories and where they act A1. Adrenergic neuron blockers (central and peripheral)- we won’t talk about this A2. Alpha1 receptor blockers (peripheral) A3. Alpha2 receptor agonists (central) A4. Beta receptor blockers (peripheral) A5. Combined α and β receptor blockers (peripheral) A2. Peripherally Acting Adrenergic DrugAlpha1 Blockers (we’ve met these) Doxazosin, prazosin, alfuzosin Block alpha1-receptors which causes BP to decrease Reduces peripheral vascular resistance and BP by dilating both arterial and venous blood vessels Main Use: benign prostatic hyperplasia (BPH) Alpha1 Blockers REMEMBER Tamsulosin (Flomax)* is an α1 blocker BUT *Tamsulosin is not used to control BP, just for BPH. A3. Centrally Acting Adrenergic DrugsAlpha 2 agonist Clonidine and methyldopa 1- Stimulate alpha2-adrenergic receptors. in the brain Decreases sympathetic outflow from the CNS which decreases NE production 2. Stimulate alpha2-adrenergic receptors in kidneys remember alpha 2 opposes alpha 1 Dilates peripheral blood vessels → lowers peripheral resistance → Results in decreased BP So ….Clonidine (Catapres) Used primarily for its ability to decrease blood pressure in an urgent setting Also use in opioid withdrawal as previously discussed Oral (multiple times a day), and topical patch formulations Do not stop abruptly as it may lead to rebound hypertension In reality, Clonidine and methyldopa Not prescribed as first-line home antiHTN drugs High incidence of unwanted adverse effects: orthostatic hypotension, fatigue, and dizziness MIGHT be uses as adjunct drugs after other drugs have failed, in conjunction with other antiHTN such as diuretics A4. Adrenergic Drugs Selective Beta 1 Blockers Metoprolol, Atenolol Reduction of HR through β1 receptor blockade (remember adrenergic blocking of this receptor???) HR results in BP Cause reduced secretion of renin = BP A4. Adrenergic Drugs Selective Beta1 Blockers Nebivolol (Bystolic) Uses: hypertension and HF Action: blocks β1 receptors and produces vasodilatation, which results in a decrease in SVR High doses loses selectivity and blocks both β1 and β2 Less sexual dysfunction All BB- Do not stop abruptly; must be tapered over 1 to 2 weeks A4. Adrenergic Drugs NONSelective Beta Blockers Propranolol Acts equally on β1 and β2 Other uses include situational anxiety associated with public speaking, test taking As mentioned on previous slide, nebivolol at high doses becomes beta nonselective A5. Dual-Action Adrenergic Drugs α1 and β Receptor Blockers Dual antihypertensive effects of reduction in heart rate (beta1 receptor blockade) and vasodilation (alpha1 receptor blockade) Examples are carvedilol (common) and labetalol (not as common) A5. Dual-Action Adrenergic Drugs α1 and β Receptor Blockers Carvedilol (Coreg) Widely used drug that is well tolerated Uses: HTN, mild to moderate HF in conjunction with digoxin, diuretics, and ACE inhibitors Contraindications: severe bradycardia or unstable HF, bronchospastic conditions such as asthma, and various cardiac conduction problems Adrenergic Drugs Indications - HTN But also for Glaucoma (topical) BPH: doxazosin, prazosin, and terazosin (2 for 1) Management of severe HF when used with cardiac glycosides and diuretics Contraindications Acute HF- have to stabilize first MOAIs- yeah doesn’t everything interact with MAOIs? Peptic ulcers Severe liver/kidney disease Asthma (with beta blockers) Adrenergic Drugs: Adverse Effects Orthostatic hypotension 1st-dose syncope Rebound hypertension with abrupt discontinuation Most common: Dry mouth, drowsiness, constipation, sedation Interactions- always check for specific drug interactions Can cause additive CNS depression with alcohol, benzodiazepines, opioids Question #1 When administering an alpha-adrenergic drug for hypertension, it is most important for the nurse to assess the patient for the development of what response? Hypotension Hyperkalemia Oliguria Respiratory distress Answer A Hypotension This is a key point in patient education These drugs have strong vasodilating properties and may cause severe hypotension, especially at the beginning of therapy. B. Angiotensin-Converting Enzyme Inhibitorsaka ACE Inhibitors or ACEi Large group of safe and effective drugs Currently are 10 ACEi Often used as first-line drugs for HF and hypertension May be combined with a thiazide diuretic, loop diuretic, or Calcium Channel Blocker (CCB) You need to understand the basics ACE Inhibitors: Review RAAS ACE converts angiotensin I, formed through the action of renin, to angiotensin II Angiotensin 2 is a potent vasoconstrictor and also induces aldosterone secretion by the adrenal glands Aldosterone stimulates sodium resorption (H20 follows Na Both act to raise BP which causes kidneys to reduce renin production ACEi= Great drug to treat HTN BUT contraindicated in pregnancy (2nd,3rd trimester due to fetal renal damage) and breastfeeding first few weeks after birth B. ACE Inhibitors - PRIL Lisinopril (Prinivil) super common, often the 1st drug Enalapril (Vasotec) also common Captopril (Capoten) great if liver disease present Benazepril (Lotensin) Fosinopril (Monopril) Perindopril (Aceon) Quinapril (Accupril) Ramipril (Altace) Trandolapril (Mavik) Primary Effects of the ACE Inhibitors Prevent Na (and H2O) resorption by inhibiting aldosterone secretion (volume reduction) (GO BACK TO RAAS DIAGRAM) blood volume decreases work of the heart preload, or the left ventricular end-diastolic volume which is important in HF ACE SUMMARY OF ACTIVITY 1) Prevent vasoconstriction caused by angiotensin 2 (2) Prevent aldosterone secretion  less sodium and water resorption Cardioprotective Effects of ACEi They slow progression of left ventricular hypertrophy (ventricular remodeling) after MI so considered cardioprotective ACE inhibitors have been shown to decrease morbidity and mortality in patients with HF Renal Protective Effects of ACEi ACE inhibitors: reduce glomerular filtration pressure by volume reduction Cardiovascular drug of choice for patients with diabetes since it helps protect kidneys by reducing pressure. Sometimes used low dose for kidney protection with DM without HTN B. ACEi Enalapril (Vasotec) Only ACEi available in both oral and IV Enalapril IV does not require cardiac monitoring Oral enalapril: prodrug (metabolized in liver) Improves patient’s chances of survival after an MI Reduces the incidence of HF B. ACEi Captopril (Capoten) Uses: prevention of ventricular remodeling after MI; reduce the risk of HF after MI Shortest half-life Must be administered multiple times throughout the day so this limits its use Not a prodrug so good for patient with liver disease Question #2 A patient with diabetes has a new prescription for the ACE inhibitor lisinopril. She questions this order because her provider has never told her that she has hypertension. What is the best explanation for this order? The doctor knows best The patient is confused This medication has cardioprotective properties This medication has a protective effect on the kidneys for patients with diabetes Answer D ACE inhibitors have been shown to have a protective effect on the kidneys because they reduce glomerular filtration pressure. This property makes them the cardiovascular drug of choice for patients with diabetes. Question #3 A patient with a history of pancreatitis and cirrhosis is also being treated for hypertension. Which drug will most likely be ordered for this patient? Clonidine Prazosin Diltiazem Captopril Answer D Captopril Captopril is not a prodrug; therefore, it does not need to be metabolized by the liver to be effective. This is an advantage in patients with liver disease. ACE Inhibitors: Adverse Effects *Dry, nonproductive cough, which reverses when therapy is stopped. This is a class effect Dizziness- Note: First-dose hypotensive effect may occur Headache & Fatigue Possible hyperkalemia ** Angioedema: rare but potentially fatal Not safe in pregnancy-are contraindicated during the second and third trimesters of pregnancy because of increased risk of fetal renal damage C. Angiotensin II Receptor Blockers(ARB) Considered an alternative to ACEi Less likely to cause a dry cough and hyper K+ that is common with ACE inhibitors Angiotensin II Receptor Blockers: Mechanism of Action Go back to RAAS diagram! ARBs affect primarily 2 places 1. Vascular smooth muscle - blocks vasoconstriction 2. Adrenal gland -Selectively blocks the binding of Ang 2 to certain Ang 2 receptors inhibiting secretion of aldosterone Lowers volume retention and BP Angiotensin II Receptor Blockers -ARTAN Losartan (Cozaar)- very common Eprosartan (Teveten) Valsartan (Diovan) Irbesartan (Avapro) Candesartan (Atacand) Olmesartan (Benicar) Telmisartan (Micardis) Azilsartan (Edarbi) C. ARB Losartan (Cozaar) Beneficial in patients with HTN and HF Used with caution in patients with kidney or liver dysfunction and in patients with renal artery stenosis ***Not safe for breastfeeding women and should not be used in pregnancy (Cat C 1st trimester, Cat D 2nd-3rd trimester), potential fetal toxicity Appear to be equally effective for the treatment of hypertension and well tolerated ARBs less likely to cause cough and hyperK+ but can still happen Evidence that ARBs are associated with lower mortality after MI than ACE inhibitors Never take ACEi and ARBs at the same time* 5. Calcium Channel Blockers (CCB) Primary use: HTN, angina, some dysrhythmias Cause smooth muscle relaxation by blocking the binding of calcium to its receptors, preventing muscle contraction Results in: Relaxed blood vessels to the heart Decreased peripheral smooth muscle tone Decreased SVResistance Decreased BP E. Diuretics First-line antiHTN in JNC 8 guidelines Decreases fluid volume The results from diuresis: preload, Peripheral resistance Overall effect  Decreased workload of the heart and decreased BP Thiazide diuretics are the most commonly used diuretics for HTN Ie hydrochlorothiazide (HCTZ), chlorthalidone We will discuss diuretics further in the chapter on diuretics F. Vasodilators Directly relax arterial or venous smooth muscle (or both) Results in: Decreased SVR Decreased afterload Peripheral vasodilation Indicated for treatment of HTN May be used in combination with other drugs F. Vasodilators Hydralazine (Apresoline) Orally: routine cases of essential hypertension Injectable: hypertensive emergencies BiDil: specifically indicated as an adjunct for treatment of HF in African-American patients F. Vasodilators Sodium Nitroprusside (Nitropress) *Sodium nitroprusside and IV diazoxide are reserved for the management of hypertensive emergencies. Contraindications: severe HF, known inadequate cerebral perfusion (especially during neurosurgical procedures) F. Vasodilators Adverse Effects Hydralazine: dizziness, headache, tachycardia, edema, dyspnea, N/V/D, vitamin B6 deficiency, rash Sodium nitroprusside: hypotension, bradycardia, decreased platelet aggregation, rash G. Direct Renin Inhibitors Aliskirin (Tekturna) Blocks the RAS pathway at the point of activation. Inhibiting renin production prevents the downstream production of Ang II (potent vasoconstrictor) Adverse effects: N/V, severe hypotension, hyponatremia, hyperkalemia… Contraindicated in patients with DM taking ACEi or ARB Miscellaneous Antihypertensives Eplerenone (Inspra) Newer class of drugs called selective aldosterone blockers (remember RAAS?) Reduces BP by blocking the actions of aldosterone at its corresponding receptors in the kidney, heart, blood vessels, and brain Indications: routine treatment of hypertension and for post-MI HF Contraindicated if serum potassium levels are high (above 5.6 mEq/L) A Special Form of HTNTreatment of Pulmonary Hypertension Sildenafil and Tadalafil Commonly used for erectile dysfunction Used for pulmonary hypertension but with different trade names Sildenafil: Revatio* (Viagra for ED) Tadalafil: Adcirca* (Cialis for ED)

Electrostatics The section of CBSE Class 12 Physics electrostatic potential and capacitance notes mainly deals with the in-depth analysis of electromagnetic phenomena when they are not performing any movements. Additionally, it is divided into ten further sub-topics to study the companion processes of reaching the state. These are - 1. Electric charge In this section of Physics ch 2 Class 12 notes, you get to learn about the basic features of electric charge and its expression in Physics. Along with its basics, the sections help to understand the full potential of charge. Different aspects of Charge included in Class 12 Physics Chapter 2 notes are - Definition Type: Positive and Negative Charge Unit and dimensional formula Point Charge Properties of Charge Comparison of Charge and Mass Methods of Charging Electroscope 2. Coulomb's Law Force is created when charges of opposite signs attract each other, and they repulse if the signs are the same. Coulomb's law tries to define this phenomenon through a mathematical formula, explicitly mentioned in Physics Class 12 notes Chapter 2. Moreover, there is key information about the variation of the constant k and its effect on a medium. Coulomb's law's vector form and the principle of superimposition are also explained in ch 2 Physics Class 12 notes. (Image will be uploaded soon) 3. Electric Field As stated in Class 12 Physics Chapter 2 notes, every positively or negatively charged particle has their respective electric fields. It feels a force at the time of interaction which might be attraction or repulsion. As it arises from electric charge, it is crucial to know about its different parts like - Electric field intensity Relation between electric force and electric field Super imposition of electric field Point charge Continuous charge distributions Properties of Electric Field Lines Motion of Charged Particles in an Electric field Learning more about the electric field from electric potential and capacitance notes Class 12 helps a student to get a grasp of upcoming chapters. 4. Electric Potential Energy When energy helps a charge to move from an electric field, it is known as the Electric Potential Energy. This section of electrostatic chapter Class 12 notes requires a student to study the Electron volt (eV), and the potential energy that an n number of charges can hold. 5. Electric Potential This section of Class 12 Physics Chapter 2 notes focuses on in-depth learning of Electric Potential or Voltage. Basically, it defines the potential movement of energy. 6. Relation between Electric Field and Potential Apart from knowing more about the relationship between the two values, Physics Class 12 Chapter 2 notes also discuss equipotential surfaces. 7. Electric Dipole Essentially, 'Dipoles' are two opposite points of charge represented with q and –q, with their distance between each other being 2a. Electric Dipoles are crucial in your study of Physics Class 12 Chapter 2 notes to learn more about electric fields and their potential. Additionally, Class 12 Physics Chapter 2 notes focus on the influence of electric dipoles on a uniform electric field mainly through Force and Torque, Work, and Potential Energy. In the last part of Electrostatics, further focus is on using the formulas to their fullest potential. It includes subsections of Electric Field, Electric Potential Energy, Electric Potential, and Electric Dipole. In the notes for electrostatic potential and capacitance, you will find proper solutions accompanied by clear and crisp diagrams for better understanding. 8. Gauss's Law Apart from just discussing the Gauss's Law, in Physics Class 12 ch 2 notes there is a thorough explanation of its properties and applications. The Gauss' Law states that net electric flux passing through a hypothetical closed surface is equal to the net electric charge present within the same closed surface. Being a broad part of the whole chapter, you may need to spend a little more time on it. Moving forward, it starts discussing the properties of conductors in relation to Gauss's Law. The Class 12 Physics notes Chapter 2 perfectly defines the journey to Gauss' Law from Coulomb's Law. Here is the Gauss's Law present in the Class 12 Physics ch 2 notes, (image will be uploaded soon) 9. Capacitors There is a dedicated section about Capacitors in the Class 12 Physics Chapter 2 notes elucidating its functions and importance as storage of potential electric energy. After explaining the structure of a capacitor, it points out the different types, parallel plate, spherical and cylindrical. The section of Chapter 2 notes of Physics Class 12 is further divided into subheads like: Properties of an ideal battery Grouping of capacitors Simple circuits (Series and Parallel) Dielectric Van de Graaff generator Combination of drops Charge distribution method Wheatstone Bridge-based circuit Extended Wheatstone Bridge Infinite network of capacitors Redistribution of charge between two capacitors Vedantu prepares the Class 12 Physics Chapter 2 notes with help from subject matter experts. In the PDF, you get a comprehensive idea of the topic along with potential answers to the most asked questions. Furthermore, the detailed explanation on each section and subsections are written in a simple language allows a student to ace their exams with wholesome knowledge. These Physics Chapter 2 Class 12 notes are going to be one of the best supplementary study materials besides a student’s textbooks. Visit the Vedantu website or download the app to get your hands on all important notes! Important Questions A charge of 4 × 10–8C is uniformly distributed on the surface of a spherical conductor, having a radius of 15 cm. Determine the electric field just outside this sphere at a point that is 15 cm from the centre of this sphere. Determine the capacitance given that the distance between the two plates has been reduced by half and the parallel plate capacitor holds a capacitance of 20 pF (where 1pF = 10-12 F) having air between the two plates. What will be the total capacitance of a combination where three capacitors, each having a capacitance of 20 pF, are connected in series. A square having a side of 10 cm has a 500 µC charge at its centre. Determine the work done to move a charge of 10 µC between two points that are diagonally opposite each other on the square. At an equatorial point, what will be the electrostatic potential because of an electric dipole? Calculate the work done to move a test charge, q, through a length of 1 cm along the equatorial axis of an electric dipole? Polarisation A capacitor has its plates enclosed in a medium that can be filled by insulating substances. A net dipole moment is then induced by an electric field in the dielectric. This event causes the field in an opposite direction. Equipotential Surface An equipotential surface is a type of surface where the potential always has a constant value. If considered as a point charge, the concentric spheres that are centred at a particular area of this charge are basically equipotential surfaces. Advantages of Vedantu's Revision Notes: A Comprehensive Resource for Effective Learning There are several reasons why one may refer to Vedantu's revision notes for studying a subject like Electrostatic Potential and Capacitance. Here are some key points: Comprehensive Coverage: Vedantu's revision notes provide a comprehensive coverage of the entire topic, ensuring that all important concepts and subtopics are included. Concise and Organized: The notes are designed to be concise, focusing on the key points and core ideas. They are organized in a structured manner, making it easy for students to navigate and revise the content. Simplified Explanation: The revision notes offer simplified explanations of complex concepts, making them more accessible and easier to understand. This helps students grasp the material more effectively. Key Formulas and Equations: The notes highlight the key formulas and equations relevant to the topic, ensuring that students have a clear understanding of the mathematical aspects of Electrostatic Potential and Capacitance. Examples and Illustrations: Vedantu's revision notes often include examples and illustrations that help clarify concepts and provide practical applications, enabling students to better relate theory to real-world scenarios. Quick Recap: The revision notes serve as a quick recap of the important points, allowing students to review the material efficiently before exams or assessments. Exam-Oriented Approach: Vedantu's revision notes are designed with an exam-oriented approach, focusing on the topics and concepts that are frequently asked in examinations. This helps students prepare effectively and increase their chances of scoring well. Accessible Anytime: Vedantu's revision notes are easily accessible online, allowing students to study at their convenience and revise the material anytime, anywhere.

Chapter 7 Review for S12

Chapter 7 - Review Data and Decision Making *Glow bus due at midnight, name and student number: answer questions using content in class People have created wonderful things for centuries, and management Management can be traced as far back as 500 bc when the ancient Sumerians used written records to improve government and business activities Why is it important to lean from the past Not to repeat our mistakes Classical management approaches Scientific management Administrative Principles Bureaucratic organisation Behavioural Management Approaches Follett’s Organizations as communities The Hawthorne studies Maslow’s theory of human needs Mcgregor’s Theory x and Theory Y Argyris Personality and organisation Modern Management foundations Organises as systems Contingency thinking Quality management Quantitative and analysis and tools Evidence-based management Contributions Frederick Taylor - Father of Scientific management He noticed that workers often did their jobs with wasted motions and without a constant approach. His resulted in inefficiency and low performance He believed the problem could be fixed if workers were taught to do their jobs in the best ways and ten were helped and guided by supervisors Four guiding principles of scientific management Rules of motion, standardized work and proper working conditions Select workers with the right abilities Train workers and give them incentives Support workers by planning and smoothing the way as they do their work Frank and Lillian Gilbreth Pioneered use of motitono studies as a management tool In one famous case, the gilbreaths cut down the number of motions used by bricklayers adn tripled their productivity Contributions from scientific management Make results-based compensation a performance incentive Carefully design jobs with efficient work methods Carefully select workers with the ability to perform the job Trian workers to execute activities to the best of their abilities Train supervisors to support workers so they can perform jobs to the best of their abilities Classical Management Adiminstative principle (Henro Fayol) 1919, after a career in French industry, Henri F published “adminisration Industrielle et Generale” (General and industrial management) in which we out like his views on the management of organiztion and workers Rules and duties in management Foresight - to complete a plan of action for the future Organization - To provide and mobilize resources to implement the plan Common- to lead, select and evaluate workers to get the best work toward the plan Coordination- to fit diverse efforts together and ensure information is shared and problems solved Control- to make sure things happen according to plan and to take necessary corrective action Classical management Bureacratic organiztion (Max Weber) Max weber (Bureaucrativ organization) - late 19th century German political economist who had a major impact in the fields of management and sociology Bureaucratic Organization An ideal, intentionally rational adn very efficient form of organization Based on the principles of logic, order and legitimate authority Characteristics of BO Clear division of labour Clear hierarchy of authority Formal rules and procedure Impersonality Careers based on merit What are some disadvantages of bureaucracy Takes a long time for problems to become solved bec there are procedures and there is a chain of people in command Having the power Rules have to follow Excessive paperwork or “red tape” Slowness in handling problems Rigidity in the face of shifting needs Resistance to change Employee apathy Behavioural Management Approaches (focus on understanding the elements that affect human behaviour in organisations) Follett’s Organizations as communites Mary park follett contributed to the transition from classical thinking inot behavioural management Groups and human cooperation Groups allow individuales too combine their talents for a greater good Organizations are cooperating “communites” of managers adn workers Managers job is to help people copperate and achive an integration of goals and intrests Forward-looking managment insight: Making every emploee an owner creates a sense of collective responsibility Prescursor of employrr ownership, profit sharing and gain sharing Buniess problems invovle a varity of inter realted factors Prescursor of systems thinking Private profits realtive to public good Precursor of managerial ethics and social respinsibility Hawthorne studies Took place at western electric chicago plan, a tran led by Harvards Elton Mayo set out to learn how econmic incentives and workplace conditions affected workers output Maing objective Intial study examined how ecomoin incentives adn physical conditions affected worker output (productivity) No consistent relationship found During experientmetn they had 2 groups The expertiant groups (impoved wokring ocnditions ) The control group ( no changes to original working conidtions) No consitant relationship found, perfomance in both groups increased even after removing incentives Social setting and human relations Concluded New “social setting” led workers to do good job Good “Human relations” = higher productivity The contect - The Great Depression (1929-1940) Employee attitudes and groups processes Osme thinsf satisifed some workers but not others People resticited output to adhere to groups norms (Avoid layoffs) Lessons from he hawthrone stufirs Social and human concerns are keys to prductivity Hawthrone effect - People who are singled out for special attention perform as expected Maslow’s Theory of human needs Human needs The work of psychologist Abraham Maslow in the area if human “needs,” also has had a major impact in the behavioual apporach to management Maslow’s hierarchy of human needs Self actualization needs Higherst level: need foe self fulfillment to grow and use abilites to fullest and most creative extent Esteem needs Needs fro esteem in eyes of others need for respect, prestige, recognition; need for self esteem, personal sense of competence, mastery Social needs Need for love, affection, sense of belongingness in ones relationship either other people Safett needs Need for security, protection and stability in teh events of day to day life Physiological needs Most basic of all human needs: need for biological maintence; food, water and phydical well being Principles Defict principle: A satidifed need is not a motivator of behaviour Progress principles: A need becomes a motivator once the preceding lower-level need is satisfied Both principles cease to operate at self actulilzation level McGregor’s Theories Thepry x assumes that workers; Dislike work Lack ambition Are irresponsible Resist change Prefer to be led Theoyry y assumes that workers are Willing to work Willing to accept responsibility Capable of self control Capable of self direction Imaginative and creative According to McGregor, Managers create: Self fulfilling prophecies Implications of Theory x and y Theory x managers: Create situations where workers become dependent, passive and reluctant Theory y managers create situations where workers respond with initiative and high performance Central to notions of empowerment and self management Argyris’s theory of adult personality Classical management principles and practices inhibit worker maturation and are inconsistent with the mature adult personality Management practices should accommodate the mature personality: Increasing task responsibility Increasing task variety Using participative decision making Modern Management Foundation Quantitative analysis and Tools Analytics: the use of large data bases and mathematics to solve problems and make informed decision using systematic analysis Organization as systems System Collection of interrelated parts that function together to achieve a common purpose Subsystem A smaller component of a larger system Open systems Organisations that interact with their environment Contingency thinking Tires to maths managerial responses with problem (situation) No “one best way” to manage The “appropriate way to to manage depends on the situations Quality management Qality anc competitive advantafe are linked Total quality managment (TQM) Comprehensive approach to contiou impovment on teh entire organization ISO certification Gloval quality management standards Refine and upgrade quality to meet ISO requirments Evidednce Based Managment Making management decision on “hard facts” about what really works

7.012 Employee Health The Center provides a safe working environment for all employees through a collaborative effort with them and the organization’s infection control program to identify infectious conditions that may put staff, patients and visitors at risk. Health evaluations, immunity testing for measles, mumps rubella and chickenpox, tuberculosis screening and immunity testing for hepatitis B and if not immune either signs declination form or accepts 3 dose vaccine series. (Rrefer to the Employee and Occupational Health Section policy Chapter 3.21) It is the center’s policy to monitor Health Care Associated Infections (HAI) in patients and personnel working in the Center as part of its ongoing program in Infection Prevention and Control. Staff should be encouraged to stay home when they have signs and symptoms of an infectious disease. If a staff develops signs and symptoms while at work, the person of other personnel and patients who may have been exposed to a staff member with a communicable disease should be taken into consideration. Patients and personnel can be told that they were exposed to a certain disease without disclosing the index case’s identity. In addition we work together to provide an annual influenza vaccination program that includes all staff who have patient contact, and licensed independent practitioners. Environmental Rounds - Environmental rounds are performed daily by assigned staff members, ie. “safety officer”. Feedback on opportunities for improvement is given to the Infection Control Coordinator and QAPI committee and then reported to the board Education – Employee education includes: General information about infections Techniques for prevention, surveillance, investigation and control Review of policies and procedures related to infection control: (See attachment B, policy and procedure reference list) Employee health practices; refer to Administration 3.16 Orientation and Training Offer of Hepatitis B vaccination & post exposure evaluations Annual TB skin testing Provides access to influenza vaccinations. Educates staff and licensed independent practitioners about influenza vaccination; non-vaccine infection control measures (such as the use of Droplet Precautions); and diagnosis, transmission, and potential impact of influenza. Annually evaluates vaccination participation and non-participation in the influenza immunization program and reports to Department of Health.

7.015 Hand Hygiene: Practice observation of hand hygiene compliance via the use of a hand hygiene survey tool to be reviewed quarterly at the QAPI committee. (Chapter 10.14 Handwashing & Surgical Antisepsis) Continue infection control education through ongoing orientation to center staff routinely and annual mandatory in-service. Continue to promote hand hygiene awareness for patients and staff by means of educational materials placed throughout the center which references the CDC/WHO guidelines. Needle-stick Injuries: (Refer to Exposure Control Plan) Use of designated safety engineered needles for injections (safety glide needles for injection and autoguard IV catheters) and blood draw. New employee and annual clinical competency for injections will be provided to all staff. The staff will be trained yearly on OSHA, blood borne pathogens and PPE. 7.016 Hand Hygiene Quality in the ASCs: based on AORN (Association of periOperative Registered Nurses) Standards and guidelines Policy: All ASC staff, including physicians, nurses, and other healthcare workers, are required to perform hand hygiene before and after any direct contact with patients, before and after any procedure, and after any contact with potentially contaminated items or surfaces. Hand hygiene must be performed using either an alcohol-based hand rub or soap and water. The alcohol-based hand rub must contain at least 60% alcohol. Staff members must ensure that their hands are free of debris and visible dirt before performing hand hygiene. Hand hygiene must be performed for a minimum of 20 seconds, and hands must be dried thoroughly after washing. Staff members must be trained on proper hand hygiene techniques and will be educated on a regular basis to ensure compliance with this policy. All staff members must comply with this policy and demonstrate compliance during inspections by ASC management and regulatory agencies. Any staff member who fails to comply with this policy will be subject to disciplinary action. ASC management will monitor compliance with this policy through regular inspections and audits and will take appropriate action to address any noncompliance issues. The ASC will maintain records of staff compliance with this policy as part of its infection control program. The ASC will review and update this policy on an annual basis or more frequently as needed to ensure that it remains current with the latest guidelines and standards for hand hygiene quality.

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