1003 6-12 Flashcards
(36 cards)
what are the measurement of cardiac function?
- Pulse rate and strength
- Blood pressure
- Temperature
- Electrocardiogram (ECG)
- Echocardiogram (Echo)
- Pulmonary artery catheter
- Continuous cardiac output monitoring
- Stress tests
describe the coronary blood flow
Coronary ischemia occurs when blood flow is reduced thus there is an imbalance between supply and demand
Conditions that cause ischemia; • Coronary artery disease
• Blood clot
• Coronary artery spasm
describe mechanical system
- Systole: Contraction of myocardium
- Diastole: Relaxation of myocardium
- Stroke volume: Amount of blood ejected with each heartbeat
- Cardiac output (CO): Amount of blood pumped by each ventricle in 1 minute
- CO = SV x HR
• Normal 4-8 L/min
• Cardiac index: CO divided by body surface area
• Normal 2.8-4.2 L/min/m2
what is cardiac cycle
- Cardiac cycle refers to all events associated with blood flow through the heart
- Systole – contraction of heart muscle • Diastole – relaxation of heart muscle
what are the factors affecting strike volume
Preload – amount ventricles are stretched by contained blood
• Afterload – back pressure exerted by blood in the large arteries leaving the heart
• Contractility – cardiac cell contractile force
what is blood pressure
Average blood pressure in
aorta
describe the level of blood pressure determined by 5 factors
- Cardiac output – dependant on stroke volume (SV). Stroke volume is the amount of blood (in millilitres) pumped from the heat with each beat
- Vascular resistance – the resistance to blood flow thorough the arteries ie the pressure required to push the blood through
- Volume of circulating blood – if increased this increases the BP
- Viscosity – increased thickness of the blood makes it harder to pump
- Elasticity of the blood wall – thick and rigid blood vessels make it harder to push blood through
describe the conduction system in order
The Conduction System • Dedicated areas and tracts of nervous tissue throughout cardiac tissue • Sino-Atrial Node • Internodal Pathways • Atrio-Ventricular Node • Atrio-ventricular Bundle (of His) • Bundle Branches • Purkinje Fibres
what is the ECG
PQRS T wave on an ECG Three major waves of electric signals appear on the ECG. Each one shows a different part of the heartbeat.
• The first wave is called the P wave. It records the electrical activity of the atria.
• The second and largest wave, the QRS wave, records the electrical activity of the ventricles.
• The third wave is the T wave. It records the heart’s return to the resting state.
what is the goal of neurological assessment
To standardise clinical observations, always conduct a set of neurological observations with the oncoming nurse to minimise subjectivity
Monitor progress, a neuro patient often deteriorates slowly, and an accurate neuro assessment can identify a deterioration very early
Provide a guide to estimate a patient’s prognosis
what AVPU scale in SAGO chart ?
A- alert
V- rousable by voice
P- rousable by pain
U- unresponsive
what is Glasgow coma scale
- Widely used tool to assess level of consciousness
- Provides a standardised approach to assessment of level of consciousness
- A common language for healthcare workers, although consistency in scoring between staff can be unreliable
- Consistency in use essential; Can be less than reliable if staff not trained to use the scale
- Score can be used to measure and trend neurological dysfunction, and as a basis for decisions of clinical management
- Used in conjunction with measurement of other parameters of cerebral function
what is the 3 parameters in Glasgow scale
- eye opening
Spontaneous;
Speech;
Painful stimuli (central pain first then peripheral if no response);
No response;
*May not be able to open eyes after brain surgery due to periorbital oedema
2. verbal Orientated - 3 orientation questions (e.g. time, place, person); Confused; Inappropriate speech, Incomprehensible sound (e.g. moaning); No verbal response
- motor
Obeys commands (e.g. stick out your tongue);
Localises to pain (e.g. pushes your hand away);
Withdrawal (e.g. patient tries to move away);
Flexion or extension; No response
describe about pupil and reaction to light
- Inspect both eyes for pupil size and symmetry
- Left and right pupils should be equal in size
- Patients with normal neurology demonstrate a brisk and consensual pupillary reaction to light.
- Reacts ‘+’ if there is a brisk constriction of the pupil.
• Sluggish ‘SL’ if the pupil takes longer to constrict.
• No reaction ‘–’ if the pupil is non- reactive and has not changed in size.
• Closed ‘c’ – if both are eyes are closed and unable to open due to gross orbital swelling
describe Limb assessment: Motor and sensory function
- A key element of neurological assessment
• Limb power should be present in all major and minor joints.
• Diminished function may indicate a lesion in the central or peripheral nervous system. - Ask the patient to flex each knee one at a time and get the person to try and straighten the leg or push against resistance applied by you.
- Assess bilateral equality of muscle strength in the arms and legs.
- Note any neurologic deficit such as weakness in one limb.
describe Neurovascular Assessment
- Assessment of the peripheral circulation and the peripheral neurologic integrity.
- Neurovascular impairment is usually caused by pressure on the nerve or altered vascular supply to the extremity.
- Neurovascular assessment is comparative – always assess the unaffected limb to establish a baseline, prior to assessing the affected limb.
when do we need it?
- fractures
- surgery to limb or joints
- bums
- crush injuries
- application of traction, cast, splints or any constrictive dress to limbs
- trauma an extremity
frequency?
- As per documented medical orders
- Hourly for 8 hours then; Second hourly for 24 hours then; Fourth hourly up to 60 hours (therefore from 24 hours to 60 hours)
- Increased frequency to half hourly if deficit identified
- Determined by condition of the patient at any given time and/or related procedural protocols
explain about movement and sensation
- ActiveMovement=abletovoluntarily extend and flex an extremity, digit.
- PassiveMovement= parent/nurse/doctor is able to extend and flex an extremity, digit
- Patientsshouldbeabletodemonstrate active movement of an extremity
- Increased pain on passive extension or flexion of fingers or toes this may indicate compartment syndrome
explain about palpating pulse
- Pulses are palpated to sense the movement or flow of blood through the peripheral vessels
- Specify which pulses are palpable, i.e. dorsalis pedis and posterior tibialis for lower limbs and radial pulse for upper limbs
- Assess the pulse (grade it as strong, weak or absent).
- Record the pulse distal to injury and/or surgical site.
what is compartment syndrome
Is an increase of pressure within a muscle compartment, there is an increase of interstitial pressure within the osseofascial compartments.
• If the pressure is not relieved, necrosis of the soft tissues will occur, leading to permanent contracture deformities
• Causes capillary perfusion to be reduced below a level necessary for tissue viability, and is classified as:
• Acute/Crush
• Chronic/Exertional
reasons?
• Decreased compartment size • Restrictive dressings
• Splints
• Casts
- Increased compartment content • Bleeding
- Edema
what are the Assessment 6 P’s?
Assessment 6 P’s
• Pain: not relieved by simple analgesics (nonnarcotic) and excessive pain on passive extension and flexion of extremity . Narcotics can mask pain from compartment syndrome. This should not preclude appropriate analgesia but rather indicate a need for a higher index of suspicion.•
• Paresthesia : abnormal sensations eg, numbness, tingling of extremity
• Pressure: skin is tight and shiny, pressure in muscle compartment is greater
then 30-40mmHg ( pressures are measured in theatres)
• Pallor : can indicate an arterial injury, is a late sign
• Paralysis : caused by prolonged nerve compression or muscle damage, is a late sign
• Pulselessness : Can indicate death of a tissue, check general colour of the extremity
what is metabolism
-the sum of all energy transformation that occur in the body to maintain life
- energy protection
-
what is thermodynamics
The thermal energy.
- energy is not like being created or destroyed
- energy can change from on form to another
- HEAT is a form of energy
what is heat
thermal energy transported from on site to another
- cause of transfer: themperature between 2 sites
- heat moves from warmer to cooler sites
temperature is the measurement of average heat or thermal energy
explain the thermoregulation overview
- thermal input (core and skin)
- comparator (CNS: hypothalamus, spinal cord)
- error detector (pre optic anterior hypothalamus= POAH)
- output controller
- output (vosomoiton, sweating, shivering)
- negative feedback mechanism go back to 1
