Download Patient-Focused Care Practices at your Facility

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Forms & Tools
The following pages contain practical tools for implementing
patient-focused care practices at your facility.
CAUTI
FAQs about Catheter-Associated Urinary Tract Infection . . . . . . .79
Surgical Fire Safety
Surgical Safety Team Communication . . . . . . . . . . . . . . . . . . . . .80
Universal Protocol and Fire Risk Assessment . . . . . . . . . .81
Extinguishing a Surgical Fire . . . . . . . . . . . . . . . . . . . . . . . . . . . . .84
Preventing Surgical Fires . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .85
H1N1 (Swine Flu)
H1N1 Patient Handout (English) . . . . . . . . . . . . . . . . . . . . . . . . . .87
H1N1 Patient Handout (Spanish) . . . . . . . . . . . . . . . . . . . . . . . . .89
78 The OR Connection
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CAUTI-Patient Handout
FAQs
Forms & Tools
about
“Catheter-Associated
system, which includes the bladder (which stores the urine) and the kidneys (which filter the blood to make urine). Germs (for example, bacteria
or yeasts) do not normally live in these areas; but if germs are introduced,
If you have a urinary catheter, germs can travel along the catheter and
ca
What is a urinary catheter?
A urinary catheter is a thin tube placed in the bladder to drain urine.
Urine drains through the tube into a bag that collects the urine. A urinary
catheter may be used:
• If you are not able to urinate on your own
• To measure the amount of urine that you make, for example, during
intensive care
•
• During some tests of the kidneys and bladder
o Catheters are put in only when necessary and they are removed as
soon as possible.
o Only properly trained persons insert catheters using sterile (“clean”)
technique.
o The skin in the area where the catheter will be inserted is cleaned
be
• External catheters in men (these look like condoms and are placed over
the penis rather than into the penis)
•
aw
Catheter care
o Healthcare providers clean their hands by washing them with soap
and wa
touching your catheter.
If you do not see your providers clean their hands,
please ask them to do so.
-
urinary tr
o The catheter is secured to the leg to prevent pulling on the catheter.
germs tha
-
there. Germs can enter the urinary tract when the catheter is being put in
or while the catheter remains in the bladder.
• Burning or pain in the lower abdomen (that is, below the stomach)
• Fever
•
problems
•
So
emoval or change of the catheter. Your doctor will deterWhat are some of the things that hospitals are doing to prevent catheter-
ac
Co-sponsored by:
o Keep the bag lower than the bladder to prevent urine from backflowing to the bladder.
o Empty the bag regularly. The drainage spout should not touch anything while emptying the bag.
if I have a catheter?
•
• Always keep your urine bag below the level of your bladder.
• Do not tug or pull on the tubing.
• Do not twist or kink the catheter tubing.
•
What do I need to do when I go home from the hospital?
• If you will be going home with a catheter, your doctor or nurse should
explain everything you need to know about taking care of the catheter.
Make sure you understand how to care for it before you leave the
hospital.
•
as burning or pain in the lower abdomen, fever, or an increase in the
• Before you go home, make sure you know who to contact if you have
ques
Surgeon leads
Anesthesia leads
80 The OR Connection
Team members are encouraged
to speak up when any problems
are noted.
Monitors applied and functioning
Anesthesia equipment and medical
check complete
Special airway equipment
Antibiotic prophylaxis ordered/
initiated (60min)
•
Team verbally agrees or corrects discrepancies
OR staff reviews
• Sterility/equipment/irrigation
solutions
• Fire Risk Assessment score
given or N/A
• IV access/fluids/blood products
• Specific patient concerns
• Antibiotic
• ASA
Anesthesia reviews
•
Surgeon confirms with OR team:
Patient name, procedure
• Operative side & site/mark visible
• Correct positioning (patient/table)
• Relevant images available/labelled?
• Implants available?
• Specimen collection
• Length of case/critical steps
•
Based on the WHO Surgical Safety Checklist, http://www.who.int/patientsafety/safesurgery/en
© World Health Organization 2008 All rights reserved.
Info from circulator/OR staff.
Info from surgeon.
Info from anesthesia provider.
•
Anesthesia reviews
Transfer to ____/oxygen needed
Counts complete (instrument, sponge,
needle)
Nurse confirms with OR team:
Procedure name?
• Specimen(s)/labelling?
• Estimated blood loss?
• Any equipment/pick list issues?
• Postop concerns?
• Wound packing/dressing?
•
Circulator leads
Circulator confirms items with surgeon / OR
team before patient leaves OR.
Forms & Tools
6:48 PM
Introductions: All team members
Please state name and role
Surgeon arrives: Team introductions begin
followed by confirmation of items and anticipated critical steps.
Anesthesia: We are going to go over a checklist
to provide the safest possible care.
BEFORE PATIENT LEAVES ROOM
12/28/09
Patient/staff has confirmed:
Identification (name/DOB)
• Procedure
• Side/site
• Allergies
Consent verifies procedure?
Consent for blood or blood refusal?
Site/side is initialed?
OR equipment available/working?
Surgeon present in facility?
BEFORE SKIN INCISION
BEFORE INDUCTION OF ANESTHESIA
Surgical Safety Team Communication
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Surgical Safety Team Communication
Prep &
Holding
Unit Doing
Procedure
21020 S(36590)(0307)C
Initials
Signature/Title
Print Name
Time:________O#4 FIRE RISK ASSESSMENT
Initial:_______
FIRE RISK ASSESSMENT
Time Out: Time:_________
Initial:_______
Initial:_______
Initials
Signature/Title
Initial:_______
(see side 2 for specifics)
SCORE 1 or 2: ‰ Initiate Routine Protocol
SCORE 3:
‰ Initiate High Risk Fire Protocol
Procedure site or incision above the xiphoid
Open oxygen source (face mask/ nasal cannula)
Ignition source (cautery, laser, fiberoptic light source)
3
rd
2 Time Out: Time:_________
nd
1st Time Out: Time:_________
0 (NO)
0 (NO)
1 (Yes)
1 (Yes)
OR – Universal Protocol
Print Name
______
Total Score:
0 (NO)
1 (Yes)
The entire procedure team has performed a Time Out and all members
have verbally agreed.
2nd
3rd
Time out included the verification of:
1st
Correct patient identity
Agreement on procedure to be done
Correct site and side
Diagnostic study confirmation of site and side
Availability of implants
Availability of special equipment
Universal Protocol and Fire Risk Assessment
Initial:________________
Side marked by:
‰ Patient ‰ Family member (Relationship):____________ ‰ Healthcare Provider
C After verification has been completed, the patient if able, will write “Yes” with a
permanent marker on or as near the site as possible:
‰ RIGHT ____________________ ‰ LEFT ___________________
COMPONENT # 2 SITE MARKING (If required)
Name and date of birth confirmed **
Patient/Decision maker verbalizes planned procedure
Schedule confirms planned procedure
Consent confirms planned procedure **
History and Physical confirms planned procedure
Diagnostic Study confirms planned procedure
Progress Record/Consult confirms planned procedure
Site marking required (go to Component 2)
Site marking not required
Date/Time:
Initial:
Sending
Unit
COMPONENT # 3 TIME OUT
6:48 PM
Mark all that apply
** indicates required field
COMPONENT # 1 VERIFICATION PROCESS
Date of Procedure
_____________
Side 1
12/28/09
_____________________________________________________________________
_____________________________________________________________________
Planned Procedure: ___________________________________________________
OPFRM
(MNDPK(
UNIVERSAL PROTOCOL AND
FIRE RISK ASSESSMENT
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Aligning practice with policy to improve patient care 81
The caregiver (RN/LPN, anesthesia provider, surgeon, resident, PA) beginning the verification process will initiate the form.
When care of the patient is transferred to a new care area, the new care giver will complete the appropriate columns and initial.
Mark (¥) only the boxes that indicate the method reviewed to confirm the planned procedure.
Resolve discrepancies identified through the verification process prior to moving the patient to the procedure area or prior to the initiation of the bedside
procedure/anesthesia regional block.
82 The OR Connection
Time out is completed prior to the start of the procedure and a designated person (circulating RN, assisting RN or tech) will complete the section and initial.
Mark (¥) only the boxes that indicate the components confirmed.
An additional Time Out is documented for a second procedure.
In the event that the physician performing the procedure leaves the patient or repositions the patient after the Time Out process has occurred, the Time
Out process is repeated and documented.
FIRE RISK ASSESSMENT
x Routine Protocol
1. FUEL:
A. When an alcohol based solution is used, use minimal amount of solution and allow sufficient time for fumes to dissipate before draping. Observe
drying time (minimum 3 minutes). Do not drape patient until flammable prep is fully dry.
B. Do not allow pooling of any prep solution (including under the patient).
C. Remove bowls of volatile solution from sterile filed as soon as possible after use.
D. Utilize standard draping procedure
2. IGNITION SOURCE:
A. Protect all heat sources when not in use. (cautery pencil holster, laser in stand by mode etc.)
B. Activate heat source only when active tip is in line of sight.
C. De-activate heat sources before tip leaves surgical site.
D. Check all electrical equipment before use.
x High Risk Protocol (includes all of routine protocol)
A. Use appropriate draping techniques to minimize O2 concentration (i.e., tenting, incise drape).
B. Electrical Surgical Unit (ESU) setting should be minimized
C. Encourage use of wet sponges.
D. Basin of sterile saline and bulb syringe available for suppression purposes only.
E. Anesthesia Care Provider considerations:
x A syringe full of saline will be available, in reach of the anesthesia care provider, for procedures within the oral cavity.
x Documentation of oxygen concentration/flows. Use of “MAC Circuit” for oxygen administration.
A.
B.
C.
D.
COMPONENT #3 TIMEOUT
Purpose: To conduct a final verification of the correct patient, procedure, site and implants, if applicable.
Document site marking for patients having surgical/invasive procedures involving laterality or digits. (Patients having surgical/invasive procedures involving
level(s) (i.e. spine or ribs) will have level(s) marked by the Licensed Independent Practitioner (LIP) performing the procedure or identified by the LIP using
radiographic techniques during the procedure.)
Forms & Tools
6:49 PM
A.
12/28/09
COMPONENT #2 SITE MARKING
Purpose: To clearly identify the intended site of incision or insertion.
A.
B.
C.
D.
Side 2
COMPONENT # 1 VERIFICATION PROCESS
Purpose: To outline the process for identifying the correct person, correct procedure, and correct site for surgical and invasive procedures with involvement of
the patient or decision maker when possible.
UNIVERSAL PROTOCOL AND FIRE RISK ASSESSMENT
(For Operating Room and Non-Operating Room Settings)
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Universal Protocol and Fire Risk Assessment
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Medline is a registered trademark of Medline Industries, Inc.
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Extinguishing a Surgical Fire
EMERGENCY PROCEDURE
EXTINGUISHING A SURGICAL FIRE
Fighting Fires ON the Surgical Patient
Review before every surgical procedure.
In the Event of Fire on the Patient:
1. Stop the flow of all airway gases to the patient.
2. Immediately remove the burning materials and have another team member extinguish them.
If needed, use a CO2 fire extinguisher to put out a fire on the patient.
3. Care for the patient:
—Resume patient ventilation.
—Control bleeding.
—Evacuate the patient if the room is dangerous from smoke or fire.
—Examine the patient for injuries and treat accordingly.
4. If the fire is not quickly controlled:
—Notify other operating room staff and the fire department that a fire has occurred.
—Isolate the room to contain smoke and fire.
Save involved materials and devices for later investigation.
Extinguishing Airway Fires
Review before every surgical intubation.
MS09445_1
At the First Sign of an Airway or Breathing Circuit Fire, Immediately and Rapidly:
1. Remove the tracheal tube, and have another team member extinguish it. Remove cuff-protective
devices and any segments of burned tube that may remain smoldering in the airway.
2. Stop the flow of all gases to the airway.
3. Pour saline or water into the airway.
4. Care for the patient:
—Reestablish the airway, and resume ventilating with air until you are certain that nothing is left
burning in the airway, then switch to 100% oxygen.
—Examine the airway to determine the extent of damage, and treat the patient accordingly.
Save involved materials and devices for later investigation.
Source: New Clinical Guide to Surgical Fire Prevention. Health Devices 2009 Oct;38(10):330. ©2009 ECRI Institute
More information on surgical fire prevention is available at: www.ecri.org/surgical_fires
84 The OR Connection
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Preventing Surgical Fires
Forms & Tools
ONLY YOU CAN PREVENT SURGICAL FIRES
Surgical Team Communication Is Essential
The applicability of these recommendations must be considered individually for each patient.
At the Start of Each Surgery:
X
Enriched O2 and N2O atmospheres can vastly increase flammability of drapes, plastics, and hair. Be aware of possible
O2 enrichment under the drapes near the surgical site and in the fenestration, especially during
head/face/neck/upper-chest surgery.
X
Do not apply drapes until all flammable preps have fully dried; soak up spilled or pooled agent.
X
Fiberoptic light sources can start fires: Complete all cable connections before activating the source. Place the source in
standby mode when disconnecting cables.
X
Moisten sponges to make them ignition resistant in oropharyngeal and pulmonary surgery.
During Head, Face, Neck, and Upper-Chest Surgery:
X
Use only air for open delivery to the face if the patient can maintain a safe blood O2 saturation without supplemental O2.
X
If the patient cannot maintain a safe blood O2 saturation without extra O2, secure the airway with a laryngeal mask
airway or tracheal tube.
Exceptions: Where patient verbal responses may be required during surgery (e.g., carotid artery surgery, neurosurgery,
pacemaker insertion) and where open O2 delivery is required to keep the patient safe:
— At all times, deliver the minimum O2 concentration necessary for adequate oxygenation.
— Begin with a 30% delivered O2 concentration and increase as necessary.
— For unavoidable open O2 delivery above 30%, deliver 5 to 10 L/min of air under drapes to wash out excess O2.
— Stop supplemental O2 at least one minute before and during use of electrosurgery, electrocautery, or laser, if
possible. Surgical team communication is essential for this recommendation.
— Use an adherent incise drape, if possible, to help isolate the incision from possible O2-enriched atmospheres
beneath the drapes.
— Keep fenestration towel edges as far from the incision as possible.
— Arrange drapes to minimize O2 buildup underneath.
— Coat head hair and facial hair (e.g., eyebrows, beard, moustache) within the fenestration with water-soluble surgical
lubricating jelly to make it nonflammable.
— For coagulation, use bipolar electrosurgery, not monopolar electrosurgery.
During Oropharyngeal Surgery (e.g., tonsillectomy):
X
X
Scavenge deep within the oropharynx with a metal suction cannula to catch leaking O2 and N2O.
Moisten gauze or sponges and keep them moist, including those used with uncuffed tracheal tubes.
During Tracheostomy:
X
Do not use electrosurgery to cut into the trachea.
During Bronchoscopic Surgery:
X
If the patient requires supplemental O2, keep the delivered O2 below 30%. Use inhalation/exhalation gas monitoring
(e.g., with an O2 analyzer) to confirm the proper concentration.
When Using Electrosurgery, Electrocautery, or Laser:
X
The surgeon should be made aware of open O2 use. Surgical team
discussion about preventive measures before use of electrosurgery,
electrocautery, and laser is indicated.
X
Activate the unit only when the active tip is in view (especially if looking
through a microscope or endoscope).
X
Deactivate the unit before the tip leaves the surgical site.
X
Place electrosurgical electrodes in a holster or another location off the
patient when not in active use (i.e., when not needed within the next few
moments).
X
Place lasers in standby mode when not in active use.
X
Do not place rubber catheter sleeves over electrosurgical electrodes.
Developed in collaboration with the
Anesthesia Patient Safety Foundation.
Source: New Clinical Guide to Surgical Fire Prevention. Health Devices 2009 Oct;38(10):319. ©2009 ECRI Institute
More information on surgical fire prevention, including a downloadable copy of this poster, is available at www.ecri.org/surgical_fires
®
MS09445_2
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Forms & Tools
H1N1 Patient Handout
H1N1 (Swine Flu)
What is H1N1 flu?
H1N1 influenza, or swine flu, is a respiratory
illness caused by type A influenza viruses. This
virus was originally referred to as “swine flu”
because it was thought to be very similar to flu
viruses that normally occur in pigs (swine) in
North America. H1N1 flu was first detected in
people in the United States in April 2009.
How does H1N1 flu spread?
H1N1 flu is contagious and is spreading between people. This virus may be transmitted in similar ways that other flu viruses
spread, through coughing or sneezing. A person may be able to infect another person one day before symptoms develop and
for seven or more days (longer for children) after becoming sick. It is possible that someone may become infected by touching
something with the virus on it and then touching his mouth or nose. Eating pork does not cause swine influenza.
What are the symptoms of H1N1 flu?
The symptoms of H1N1 flu include fever, cough, sore throat, runny or stuffy nose, body
aches, headache, chills and fatigue. Diarrhea and vomiting may also be associated with
H1N1 flu. Most people with the virus have recovered without needing treatment, but
hospitalizations and deaths have occurred.
H1N1 Symptoms
• Headache
• Fever
• Fatigue
What should I do if I think I have H1N1 flu?
If you have flu symptoms, stay home and avoid contact with other people to avoid
spreading your illness. It is recommended that you stay home for at least 24 hours after
your fever is gone, or if possible, until your cough is gone. If you have severe illness or
you are at high risk for flu complications, contact your health care provider.
He or she will determine whether testing or treatment is needed.
• Chills
Seek emergency medical care for any of the following warning signs:
• Body aches
• Runny or
stuffy nose
• Sore throat
• Cough
In children:
In adults:
•
•
•
•
•
•
• Difficulty breathing
or shortness of breath
• Pain or pressure in the chest or abdomen
• Sudden dizziness
• Confusion
• Severe or persistent vomiting
• Flu-like symptoms improve but then return with
fever and worse cough
Fast breathing or trouble breathing
Bluish skin color
Not drinking enough fluids
Not waking up or not interacting
Being so irritable that the child does not want to be held
Flu-like symptoms improve but then return with
fever and worse cough
• Severe or persistent vomiting
Page 1
Text courtesy of NursingCenter.com.
Images courtesy of Anatomical Chart Company.
Lippincott Williams & Wilkins | Wolters Kluwer Health Businesses.
nursingcenter.com
anatomical.com
5mcc.com
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H1N1 Patient Handout
How is H1N1 flu treated?
The CDC recommends the use of oseltamivir (brand
name Tamiflu) or zanamivir (brand name Relenza) to
treat and/or prevent swine influenza. These antiviral
medications may also prevent serious complications.
For treatment, antiviral drugs work best if started
within 2 days of symptoms.
What can I do to prevent H1N1 flu?
You can reduce your risk of contracting and spreading swine influenza
and other influenza viruses by:
• Coughing or sneezing into
your arm; avoiding close
contact with people who have
respiratory symptoms such as
coughing or sneezing
• Not touching your eyes, nose, or
mouth because this is how germs
get into your body
• Staying home when you're sick
and getting as much rest
as possible
• Keeping surfaces and objects
(especially tables, counters, doorknobs, toys) that can be exposed
to the virus clean
• Washing your hands often
with soap and water for
15-20 seconds; using
alcohol-based hand cleansers
is also acceptable
• Practicing other good health habits,
including getting plenty of sleep,
staying active, drinking plenty of
fluids, and eating healthy foods
Lisa Morris Bonsall, MSN, RN, CRNP
Page 2
Text courtesy of NursingCenter.com.
Images courtesy of Anatomical Chart Company.
Lippincott Williams & Wilkins | Wolters Kluwer Health Businesses.
88 The OR Connection
Check with your healthcare
provider to see if the
H1N1 vaccine is right for you.
nursingcenter.com
anatomical.com
5mcc.com
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Forms & Tools
H1N1 Español por los Pacientes
Virus de la influenza A subtipo H1N1
(anteriormente llamado de la «gripe porcina»)
¿Qué es la gripe por H1N1?
La gripe por H1N1, originalmente llamada
«gripe porcina», es la enfermedad respiratoria que
causa la infección por el virus de la influenza A
subtipo H1N1. A este virus originalmente se le llamó
virus de la «gripe porcina» puesto que se pensó que
era muy similar a los virus que causan gripe en los
cerdos (porcinos) en Norteamérica. El virus de la influenza
A subtipo H1N1 fue detectado por primera vez en humanos
en los Estados Unidos de Norteamérica en abril del 2009.
¿Cómo se propaga la gripe por H1N1?
La gripe por H1N1 es contagiosa y se propaga de persona a persona. El virus puede propagarse de manera similar a otros
virus de la gripe; a través de la tos o de los estornudos. Una persona puede infectar a otra un día antes de presentar síntomas
y durante siete o más días (más tiempo en los niños) después de haber enfermado. Existe la posibilidad de que una persona se
infecte al tocar una superficie contaminada con el virus si esta persona luego se pone las manos sobre la boca o nariz. Comer
carne de cerdo no causa gripe por H1N1.
¿Cuáles son los síntomas de la gripe por H1N1?
Los síntomas de la gripe por H1N1 incluyen fiebre, tos, dolor de garganta, nariz con
mucosidad o tupida; dolor en el cuerpo, dolor de cabeza, escalofríos y fatiga. La mayoría
de las personas que han tenido el virus se han recuperado sin necesitar tratamiento, pero
ha habido otras que han necesitado hospitalización, y también otras que han muerto.
Síntomas de A(H1N1)
• Dolor de cabeza
• Fiebre
• Fatiga
¿Qué debo hacer si pienso que tengo gripe por H1N1?
Si usted piensa que tiene síntomas de gripe quédese en casa y evite entrar en contacto con
otras personas para no propagar la enfermedad. Es recomendable quedarse en casa por lo
menos durante 24 horas después de que le haya pasado la fiebre, o si es posible, después
de que le haya pasado la tos. Si está gravemente enfermo, o si pertenece a un grupo de alto
riesgo para desarrollar complicaciones, entre en contacto con su proveedor de atención
médica. Él determinará si es necesario que le hagan análisis o que tome tratamiento.
• Escalofríos
• Nariz con
mucosidad o tupida
• Dolor de garganta
• Tos
• Dolores corporales
Busque atención médica de urgencias si presenta cualquiera de los
siguientes signos (señas) de alarma:
En niños:
En adultos:
•
•
•
•
•
•
• Dificultad para respirar o sensación de «falta de aire»
• Dolor o sensación de presión en el pecho o en
el abdomen
• Mareo súbito
• Confusión
• Vómito intenso o persistente
• Los síntomas como de gripe mejoran pero luego
reaparecen con fiebre y tos más fuerte.
Respiración acelerada o dificultad para respirar
Tonalidad morada en la piel
No está tomando suficientes líquidos
No se despierta o no responde a las acciones
Está tan irritable que no quiere que lo alcen
Los síntomas como de gripe mejoran pero
luego reaparecen con fiebre y tos más fuerte.
• Vómito intenso o persistente
Página1
Texto por cortesía del centro NursingCenter.com.
Imágenes por cortesía de Anatomical Chart Company.
Lippincott Williams & Wilkins | Wolters Kluwer Health Businesses.
nursingcenter.com
anatomical.com
5mcc.com
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H1N1 Español por los Pacientes
¿Cómo es el tratamiento para la gripe por A(H1N1)?
Los Centros para el Control y la Prevención de Enfermedades de los EE. UU.
(CDC) recomiendan el uso de oseltamivir (nombre de marca Tamiflu) o de
zanamivir (nombre de marca Relenza) para el tratamiento y la infección,
o solamente para prevenir la infección por el virus de la influenza
A(H1N1). Estos medicamentos antivíricos también pueden prevenir
complicaciones graves. Para el tratamiento, los medicamentos antivíricos
funcionan mejor si se comienzan a usar en un lapso de dos días después
de que comienzan los síntomas.
¿Qué puedo hacer para prevenir la gripe por A(H1N1)?
Usted puede disminuir su riesgo de contraer gripe por A(H1N1) y de propagar
otros virus de la influenza de la siguiente manera:
• Tosiendo o estornudando sobre
su brazo y evitando el contacto
cercano con personas que
presentan síntomas respiratorios
tales como tos o estornudos.
• No tocándose los ojos, nariz o
boca, pues ésta es la manera
como los gérmenes llegan hasta
nuestro cuerpo.
• Quedándose en casa cuando está
enfermo y descansando el mayor
tiempo que pueda.
• Manteniendo limpias las superficies
y objetos (especialmente mesas,
mesones, cerraduras de puertas)
que puedan estar expuestos al virus.
• Lavándose las manos con
frecuencia con agua y jabón
durante 15 a 20 segundos o
usando un limpiador para las
manos con base en alcohol.
• Practicando otros hábitos saludables;
incluso dormir bastante, mantenerse
activo, tomar líquidos en cantidad y
comer alimentos saludables.
Escrito por Lisa Morris Bonsall, MSN, RN, CRNP
Traducido por Marcela D. Pinilla, M.H.E., M.T. (ASCP)
Página 2
Texto por cortesía del centro NursingCenter.com.
Imágenes por cortesía de Anatomical Chart Company.
Lippincott Williams & Wilkins | Wolters Kluwer Health Businesses.
90 The OR Connection
Verifique con su proveedor
de atención médica para
determinar si la vacuna
contra el virus de la
influenza A(H1N1) es
adecuada para usted.
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