Complete Flashcards

Question

What does V/Q stand for?

Answer 1

Ventilation/Perfusion Ratio

Answer 2

Tuberculosis

Answer 3

Bicarbonate

Answer 4

Peak Expiratory Flow Rate

Answer 5

Continuous Positive Airway Pressure

Answer 6

Ejection Fraction

Answer 7

Acute Kidney Injury

Answer 8

Cerebrovascular Accident

Answer 9

Acute Renal Failure

Answer 10

Hypertension

Answer 11

Ischaemic Heart Disease

Answer 12

Coronary Artery Disease

Answer 13

Myocardial Infarction

Answer 14

Unstable Angina Pectoris

Answer 15

ST-Elevation myocardial infarction

Answer 16

Atrial Fibrillation

Answer 17

Coronary Heart Disease

Answer 18

Non-ST-Elevation myocardial infarction

Answer 19

Heart Failure

Answer 20

Cardiovascular disease

Answer 21

Peripheral Vascular Disease

Answer 22

Transient Ischaemic Attack

Answer 23

Unstable Angina

Answer 24

Chronic kidney disease

Answer 25

Acute Coronary Syndrome

Answer 26

Chronic renal failure

Answer 27

Level of Consciousness

Answer 28

Intracranial pressure

Answer 29

Cerebrovascular accident

Answer 30

Cerebral perfusion pressure

Answer 31

Traumatic brain injury

Answer 32

Spinal Cord injury

Answer 33

Spinal Cord Blood Flow

Answer 34

Mean Arterial Pressure

Answer 35

Subarachoid Haemorrhage

Answer 36

Blood Brain Barrier

Answer 37

Cerebrospinal Fluid

Answer 38

A localised damage to the skin and underlying soft tissue thats usually, but not always, over a body prominence

Answer 39

External medical devices, these wounds are then referred to as medical device-related pressure injurys (MDRPIs)

Answer 40

Yes. Although the anatomy of mucous membrane sites isn't consistent with pressure injury staging guidelines. For this reason, pressure injuries to mucous membranes can't be staged using the pressure injury staging system.

Answer 41

1. From endotracheal tubes 2. From nasogastric tube stabilisers

Answer 42

When layers of tissue move in opposite, parallel directions, resulting in stretching, occluding or the tearing of blood vessels and disruption of blood flow to the affected area.

Answer 43

Tissue ischemia and tissue death

Answer 44

It can take several days for the tissue damage to 'surface' and show itself, typically by changes in colour, temperature, and texture

Answer 45

The NPUAP staging system

Answer 46

No, once a pressure injury is characterised i.e "S3PI", it is always that, it can either be a healing S3PI or a non-healing S3PI. If a wound is worsening it can be restaged.

Answer 47

Hospital-acquired pressure injuries

Answer 48

Higher mortality rate, longer length of stay, and a higher chance of readmission + increased cost of care.

Answer 49

Presence of fluid in the wound Colour of the area Type of tissue exposed or directly palpable.

Answer 50

Turning and repositioning the patient frequently Padding bony prominences (pillow between knees ect) Keeping the elevation of the head at 30 degrees Ensuring the surface the patient is on allows them to move side to side Floating the heels off the mattress Promoting PH-balances skin cleansers followed by moisturisers and protectants Containing fecal and urinary incontinence to the best we can (pads) Optimising patients nutritional status Provide a pressure redistribution mattress and chair pad for those at high risk Assess for tissue breakdown Collaborate with the MDT to optimize care interventions.

Answer 51

S - Surfaces and Devices S - Skin inspection K- Keep moving I - Incontinence and moisture N - Nutrition and hydration

Answer 52

Can happen anywhere but Heels, sacrum and ankles are more common

Answer 53

Carried out regularly (identify any discolouration, change in temperature, swelling and any pain or discomfort) Pressure mapping can be used to identify the intensity of pressure Too much bedding can cause pressure and make sure the chair they are using is the chair (sit with knees at a 90 degree angle) Watch where the feet of tall people are, as the feet might be touching the end and cause pressure

Answer 54

When moving a client in bed, bring their knees up so there feet are braced on the bed before lifting the head of the bed, so their heels don’t slide along the sheets and cause friction and also help reduce pressure on the sacrum and heels.

Answer 55

Having a mobility plan in place helps ensure care is received to meet a person’s needs The plan should include a repositioning schedule, or walking schedule, aides and people required Shower and toilet chairs can lead to pressure damage

Answer 56

Incontinence products such as pads, ensure they are changed if full prior to position change as they increase the risk of pressure and skin damage Someone who experiences incontinence is 40% more likely to sustain a pressure injury Ensure incontinence products are the right size and shape for the person

Answer 57

Nutrition plays a major part in maintaining optimum skin health. Malnutrition screening and observing what, and the quantity of food and drink taken, and a regular weight check is vital for pressure injury prevention Overweight people are also at risk. Research suggests in the over 65 age group, as many as 40% are malnourished

Answer 58

4 stages Stage 1 Stage 2 Stage 3 Stage 4

Answer 59

Skin is intact with an area of nonblanchable erythema, Meaning when you press on the reddened area, it doesn’t turn white or become pale Stage one doesn’t describe the layer of tissue that has been impacted, only that localised skin is intact, red and doesn’t blanch

Answer 60

Partial skin loss with exposed dermis A wound that is pink or red in colour, consisting of moist, viable tissue Alternatively, stage 2 pressure injuries can present as an intact or ruptured fluid-filled blister

Answer 61

Stages 1 and 2

Answer 62

Deep tissue pressure injuries can present as a blood-filled blister or they may have epidermal separation and a darkened wound bed. A deep tissue pressure injury can progress to an unstable wound. When this happens, the wound is recategorised as an unstageable pressure injury

Answer 63

Localised areas that: Have intact or non-intact skin Don’t blanch Are deep red, purple or maroon in colour

Answer 64

A physical, sensory, neurological, psychiatric, intellectual, or other form that is something an individual has.

Answer 65

The process which happens when one group of people create barriers by designing a world for only their way of living, taking no account of the impairments other people have

Answer 66

Its used by people with impairments that may be going from home/care facility to a hospital, its used to communicate the needs of that individual and allows the nurse to provide individualised care to that patient.

Answer 67

Find out about their condition, take the time to find out how to meet their needs, and involve the person with the impairment in planning their care.

Answer 68

Cerebral palsy, depression, and down syndrome.

Answer 69

1. Asking the patient about any factors that might affect their ability to preform ADLs or post-hospital recommendations when they are back home. - Then asking this patient about their preferences for accomodating their needs. 2. Observe the patient preforming manual tasks independently and without coaching before discharge 3. Follow up with the patient shortly after their discharge to determine whether they are successfully preforming self-care activities and to identify any questions or problems.

Answer 70

- A condition than can be treated and managed, however NOT cured - A condition that is ‘non-communicable disease’ meaning you can’t catch it

Answer 71

- Autoimmune conditions like diabetes, rheumatoid arthritis - Chrons disease - not autoimmune however does affect the immune system - inflammatory bowel condition - Cardiovascular disease - Cancers - Respiratory disease - Mental Illness - Chronic Pain - Chronic Kidney disease - Dementia - COPD (Chronic Obstructive Pulmonary Disease)

Answer 72

Therefore Long term conditions are conditions that cannot be cured, however can be managed. An acute illness if treated correctly can be cured. Patients with Long Term conditions can still be admitted to hospital with acute exacerbations of their long term condition. For example Chronic Obstructive Pulmonary Disease (COPD) - acute exacerbation (change in cough or sputum), or heart failure - acute exacerbation

Answer 73

- Reduce disease progression - improve their quality of life (QOL) - Increase the patients understanding of their ‘triggers’ - when they need to get medical help and from where - Reduce readmission to hospital-reduce costs to health system

Answer 74

- “Chronic illness is the leading cause of morbidity, mortality and inequitable health outcomes in NZ” - “Reducing the impact of long term conditions is a priority of the NZ health system. Service funders and providers need to be more flexible, innovative and able to measure the difference they are making for their populations. This high-level approach is people/whānau focused, not disease specific.”

Answer 75

Progressive, chronic disease characterised by irreversible airway obstruction, hindering expiratory flow Umbrella term encompassing emphysema, chronic bronchitis and other conditions Each has their own pathophysiology but all contribute to airway inflammation initiated by a noxious irritant

Answer 76

Lung disease which makes it harder for clients to breathe out. The Alveoli are damaged making it harder for effective gas exchange to occur as the air sacs enlarge, Emphysema causes big baggy alveoli (increased volume) so pressure drops – this makes it hard for CO2 to be expelled

Answer 77

- Tobacco smoking (Cigarettes, pipes, cannabis, second hand smoke) - Indoor pollutants (Biomass fuel used for cooking and heating (wood and coal) most common in developing countries) - Outdoor pollutants (Occupational dusts/chemicals, Particulate matter, ozone, sulpha dioxide, nitrogen dioxide, carbon monoxide, and lead (industrialised areas) forest bush fires, agricultural burning, transport - Genetics, history of respiratory infections

Answer 78

It is a ventilatory strategy frequently adopted spontaneously for patients with COPD to relieve dyspnoea (difficultly breathing): it helps to counteract gas trapping. It generates an increased pressure in the airways to allow for expiration (airflow will move from an area of high to low pressure)

Answer 79

Pursed lip breathing works by moving oxygen into your lungs and carbon dioxide out of your lungs. This technique helps to keep airways open longer so that you can remove the air that is trapped in your lungs by slowing down your breathing rate and relieving shortness of breath Emphysema causes big baggy alveoli (increased volume) so pressure drops – this makes it hard for CO2 to be expelled. Pursed lip breathing generates increased pressure so that intraluminal pressure exceeds atmospheric pressure and the breath can flow out of the lungs more easily. It is to aid expiration and decrease WOB (work of breathing).

Answer 80

Rheumatic fever may develop if strep throat or scarlet fever infections are not treated properly or after strep skin infections. Rheumatic fever is thought to be caused by a response of the body’s immune system. The immune system responds to the earlier strep throat or scarlet fever infection and causes a generalised inflammatory response. Strep throat is caused by the bacteria Group A Streptococcus. If rheumatic fever is not treated promptly, rheumatic heart disease may occur. Rheumatic heart disease weakens the valves between the chambers of the heart. Severe rheumatic heart disease can require heart surgery and result in death.

Answer 81

Rheumatic fever is not a long term condition. Getting a precise diagnosis soon after symptoms show up can prevent the disease from causing permanent damage and can develop into rheumatic heart disease - Rheumatic Heart Disease is a long term condition

Answer 82

Although anyone can get Rheumatic fever, It is more common in school aged children (age 5-15), Māori and Pacific children. Rheumatic fever is very rare in children younger than 3 years old and adults. Infectious illnesses, including group A strep, tend to spread wherever large groups of people gather. Crowded conditions can increase the risk of getting strep throat or scarlet fever, and thus rheumatic fever if they are not treated properly. These settings include: - Schools - Day-care centres - Military training facilities Someone who had rheumatic fever in the past is more likely to get rheumatic fever again if they get strep throat or scarlet fever again

Answer 83

1. Primary Prevention 2. Reduce disease progression 3. Empower patients/whānau

Answer 84

Screening - like cardiovascular disease risk assessment, Smear, Well man check, Mammography, vaccinations. Importance of education for primary prevention

Answer 85

If there are early warning signs of type 2 diabetes, then lifestyle changes can be put into place for example to reverse the high levels of HbA1c back to within normal

Answer 86

Therapeutic relationship Acknowledge their challenges, include family Understand the patients ‘motivators’ Collaborative care approach, education and support. Look at barriers for the patient Use a interpersonal approach, use GP, notes, ect Show compassion and empathy Empower the patient Provide patient with as much knowledge about the condition as possible (education) Support strategies that work for them

Answer 87

If patient is admitted with an acute exacerbation of their LTC, the following is important:- Discharge planning starts as soon as possible following admission All the correct services are alerted to the admission and kept updated of possible discharge date- INTERPROFESSIONAL COLLABORATION Community services are restarted on patient discharge.

Answer 88

Glasgow Coma Scale

Answer 89

A: Alcohol E: Epilepsy I: Insulin O: Opium U: Uraemia T: Tumour I: Injury P: Psychiatric S: Sepsis S: Stroke These are some common causes of altered consciousness

Answer 90

Delirium, cardiac/neurological/muscular-skeletal condition, side-effects from medications, balance/strength/mobility, poor eyesight, poor memory, and incontinence/urinary urgency.

Answer 91

Alertness/wakefulness: the appearance of wakefulness Alertness/cognition: content of cognitive mental functions.

Answer 92

Eye opening

Answer 93

Observe the patient before speaking to them. (If their eyes are open, or they open as you approach score a 4 - spontaneous) Next, talk to the patient with a normal voice, say their name or ask them to open their eyes. (If they open their eyes - score a 3 for speech) If this fails speak louder or shout. Not touching the pt. (If the patient opens their eyes score a 3 - to speech)

Answer 94

Next, touch or shake the patient (if the patient opens their eyes score 2 - to pain) If this fails, use noxious stimuli. Explain to the patient and family what you are going to do and why, apply a peripheral painful stimulus (applying pressure with barrel of pen to the lateral outer aspect of the second or third interpharangeal joint, gradual pressure 10-15 secs) If the patient opens their eyes score 2 - pain. If this fails and the patient has still not opened their eyes score 1 - none. Note: if the patients eyes are closed due to facial injurys or swelling document "C" and a score cannot be assigned for this category.

Answer 95

Wernickes speech centre which in in the temporal lobe and on broca's speech centre in the frontal lobe.

Answer 96

First ask the patient the following questions: 'Who are you', 'Where are you', and 'Why are you here' + 'What is the current month' and 'What is the current season'. - don't use closed questions. If the patient answers all of these correctly, score 5 - orientated. If the patient answers one or more of the above questions wrongly but is able to talk in sentences, score 4 - confused. (Orientation to time is often lost first) If the patient tries to respond to the questions but is unable to talk in full sentences and uses random words or repeats the same phrase or work, score 3 If you hear no intelligible words - score 2. If the patient doesn't produce any sounds - score 1. Note: if the patient is unable to respond verbally due to an endotracheal tube, document 'T'

Answer 97

1st. Ask the patient to obey at least two simple commands Examples: Lift your arms up, hold up your thumb, stick out your tongue. If the patient follows the command, score 6 - obeys commands If this fails move on. Observe the patient, are they trying to pull their O2 supply ect moving their hand above chin level. This would be 'localising to pain' - score a 5. If both of these are not present we move to applying a painful stimulus. Firstly explain to the patient what you are going to do and why. Apply supra-orbital pressure gradually for 30 seconds, then try the trapezius squeeze for up to 30 seconds. If the patient try's to locate the stimulus in an attempt to remove the source of pain, score 5 - localises to pain (note: the patient must bring arm above chin level and across bodys midline). If the patient flexes their arm towards the source of pain but fails to localise or remove it, score 4 - withdrawal from pain/normal flexion. If the patient flexes the arm at the elbow and rotates wrist in response to pain, score 3 - abnormal flexion. If the patient straightens the arm at elbow and rotates it inwards with legs extending and the feet plantar-flexed, score 2 - extension. If no movement is observed, score 1 - none.

Answer 98

1. Listen to the patients family's concerns 2. When communicating a GCS score, state each component of score not just total 3. Ensure the same staff member carries out all observations during shift 4. at shift handover, observations should be done together with nurse leaving and nurse arriving 5. Ask for second opinion when in doubt 6. Mark dots not lines on chart 7. A drop of one point in motor response is of clinical significance and must be reported to the medical team immediately 8. During the night shift, do not assume the patient is asleep and omit assessment 9. Clarify with the team the freq of the GCS obs and how long these should be continued for.

Answer 99

Apply pressure above the eye gradually for a maximum of 30 seconds. This targets the trigeminal nerve (cranial nerve V), and is contraindicated by orbital damage, skull fracture and glaucoma. This method is also risky for patients with reduced awareness due to potential sudden movement that may cause injury to their eyes.

Answer 100

Apply pressure by grasping approximately 3cm of the muscle between the thumb and forefingers and twisting for up to 30seconds. This targets the spinal accessory nerve and is documented as the most suitable method. Especially in the presence of orbital damage, skull fracture or glaucoma. Although this method could be difficult on a large or obese patient.

Answer 101

These methods cause prolonged discomfort and damage

Answer 102

Irreversible and devastating consequences

Answer 103

Sp02, RR, Pa02 (ABG), colour

Answer 104

should include correct administration and use of oxygen delivery devices

Answer 105

toxicity with prolonged exposure to high 02 concentrations; decreased affinity of Hb for C02 in C02 retainers (haldane effect)

Answer 106

oxygen therapy devices should not be used near an open flame due to its high combustibility

Answer 107

oxygen therapy improves effective cellular oxygenation. it acts to restore normal cellular activity at the mitochondrial level and reduce metabolic acidosis

Answer 108

oxygen is largely inhaled into the alveoli and diffused into the capillary bed. oxygen combines with haemoglobin, with a small amount being dissolved in the plasma. oxygen is metabolised in the tissues almost entirely in the mitochondria, where oxidase enzymes reduce the oxygen in the formation of adenosine triphosphate (ATP). excretion of oxygen metabolites (C02 and H20) is via the lung renal system

Answer 109

treatment of hypoxaemia by increasing alveolar oxygen tension. The aim is achieve a normal or near normal oxygen saturation for an individual patient

Answer 110

bronchodilator - relief of symptoms during maintenance treatment of asthma and COPD; prevention of treatment of exercise/allergen induced bronchospasm

Answer 111

peak flow measurements before and after administration can help determine effectiveness

Answer 112

what common side effects to expect appropriate delivery of inhaler (including spacer, mouth care) asthma and COPD action plan

Answer 113

tachycardia, headache, nervous tension, fine hand tremor, hypotension hyper/hypokalemia (which may cause weakness, fatigue, tremors, muscle spasm)

Answer 114

caution with CVD, diabetes and HTN inhaler may contain lactose

Answer 115

salbutamol is a B2- adrenergic agonist and stimulates B2 adrenergic receptors. binding to these receptors in the lungs results in relaxation of bronchial smooth muscles

Answer 116

onset by inhalation is rapid (5-15 min) peak effect reached in 1-2 hours metabolised in liver and excreted in kidneys

Answer 117

Chest Pain/Angina

Answer 118

Sit down, Stand up slowly

Answer 119

Flushing, Headache, Dizziness, Dry mouth (rare)

Answer 120

VIAGRA, ETOH (ethanol), HR <50

Answer 121

Antagonises NO receptors = relaxes smooth muscle. Dilates veins and arteries. Reduces BP

Answer 122

Sublingual, dermal, rapidly metabolised short duration

Answer 123

Morphine Sulfate (IV), Oxynorm, Sevredol, MS Contin

Answer 124

Analgesia/sedation

Answer 125

RR, BP, HR

Answer 126

Careful mobilising. Avoid ethanol and other opiates

Answer 127

Sedation, Dizziness, Nausea, constipation, hallucinations

Answer 128

Respiration rate, depression, severe asthma, acute abdomen pain, traumatic brain injury (TBI)

Answer 129

Opioid mu-receptor antagonist. Targets CNS opiate receptors. Depresses CNS, RR, GI. Vasodilation

Answer 130

Oral, IM, IV, Per rectum. Short half life

Answer 131

- Less than normal levels of 02 in the body tissues

Answer 132

less than normal levels of 02 in the blood Pa02 <80mmHg (<60mmHg significant hypoxaemia)

Answer 133

- Greater than normal levels of C02 - PaC02 > 45mmHg

Answer 134

- Less than normal levels of C02 - PaC02 < 35mmHg

Answer 135

75-100mmHg

Answer 136

75-100mmHg

Answer 137

1. Changes in the colour of your skin 2. Confusion 3. Restlessness 4. Anxiety 5. Increased heart rate 6. Increased respiration rate 7. Shortness of breath 8. Sweating 9. Wheezing 10. Use of Accessory muscles 11. Flaring of nostrils or pursed lips 12. Decreased oxygen saturation levels

Answer 138

1. Frequent chest infections 2. Persistent wheezing 3. Persistent chesty cough which can be dry or with sputum 4. Difficulty breathing 5. Dyspnea 6. Decreased energy levels 7. Tightness of the chest 8. Swelling in the lower extermities

Answer 139

Adequate Ventilation and Perfusion

Answer 140

When blood flow can be redirected from poorly ventilate alveolus (one air sac) to a well-ventilated alveolus through vasoconstriction

Answer 141

Poor perfusion and a well ventilated alveolus

Answer 142

Poor ventilation AND Poor perfusion (no air moving through the lungs)

Answer 143

Mechanical Functional

Answer 144

- Structural damage - Airway obstruction - Medication

Answer 145

- Nervous system (spinal injury high up, anything that impacts the nerve pathways) - Intercostal Muscles - Diaphragm (injury which impacts taking a deep breath to expel CO2 effectively, or on inspiration with the intake of O2) - Abdominal muscles (Pushing diaphragm out to push the air out)

Answer 146

- Physiological and foreign objects (asthma, mucous)

Answer 147

CNS Depressants (Alcohol, benzodiazepines, sedatives. Anything which effects the respiration rate)

Answer 148

- Cardiac Compromise (Poor venous return) - Pulmonary Embolism (Block off blood vessels and lungs - ventilated but not perfused) - Tumour (blockage which effects perfusion) - Hb (Haemoglobin) (Not enough Haemogolbin = not enough red blood cells to carry enough oxygen as Haemogolbin has 4 oxygen particles) - Infection (pus, anything in the lungs which block the perfusion in the lungs) - COPD - Compliance (the ability for the lungs to inflate and recoil) - Resistance - Surface area (hold the alveolus open, if you lose this, the alveoli might collapse more easily as the surface area will be reduced - smoking)

Answer 149

- Inflammation of Bronchial walls causing epithelial oedema = decrease air entry, decrease gas exchange - Exudate in lower airways causing obstruction to air flow = decrease air entry, decrease gas exchange - Exudate in alveoli causing increased diffusion distance = decrease gas exchange - Inflammation in alveolar wall causing increased diffusion distance = decreased gas exchange

Answer 150

- Partial or complete obstruction to pulmonary artery (could be a clot and partially close off the artery) causing reduced blood flow = decreased gas exchange - Ineffective functioning alveoli (from exudate or oedema) causing vasoconstriction of surrounding pulmonary capillaries = further decrease gas exchange

Answer 151

- Tachypnoea/bradypnoea (fast and slow breathing) - Orthopnoea (have trouble breathing lying down, but can breathe normally when sitting up heart not pumping efficiently) - Dyspnoea (subjective feeling of breathing, reporting they are struggling to breath) - Rhythm and depth (are they breathing in a normal rhythm? Gasping? Breathing shallow?)

Answer 152

- Wheeze - Crackles - Stridor (usually on inspiration, sounds like a barking type sound. Inflammation or obstruction of the airway) - Reduced Air entry - Cough

Answer 153

- Sternocleidomastoid - Scalenes - Trapezius - Pectoralis minor/major - Abdominals (on expiration)

Answer 154

- Upright - Tripod (leaning forward, supporting upper body with hands on knees/similar) - Chest symmetry

Answer 155

a group of cells that have similar structure and that function together as a unit.

Answer 156

Hypoxaemia. We can assess and use interventions to prevent this from going to hypoxia hence preventing cell death

Answer 157

Hyperventillation. Taking in too much O2, and not being able to balance this with CO2

Answer 158

Often caused secondary to Hypoxaemia. Which is caused by any condition that reduces the amount of oxygen in your blood or restricts blood flow can cause hypoxia. People living with heart or lung diseases such as COPD, emphysema or asthma, are at an increased risk for hypoxia

Answer 159

ventilation-perfusion (V/Q) mismatch, diffusion impairment, hypoventilation, low environmental oxygen and right-to-left shunting.

Answer 160

Ventilation-perfusion mismatch is mismatched distribution of ventilation (airflow) and perfusion (blood flow)

Answer 161

Ventilation-perfusion (V/Q) mismatch occurs when either the ventilation (airflow) or perfusion (blood flow) in the lungs is impaired, preventing the lungs from optimally delivering oxygen to the blood

Answer 162

ventilation/perfusion ratio

Answer 163

Vasoconstriction is the narrowing (constriction) of blood vessels by small muscles in their walls. When blood vessels constrict, blood flow is slowed or blocked

Answer 164

a small air-containing compartment of the lungs in which the bronchioles terminate and from which respiratory gases are exchanged with the pulmonary capillaries.

Answer 165

A tiny branch of air tubes in the lungs

Answer 166

- Diaphoresis (excessive sweating) different to normal sweating, clammy al over dripping in sweat and they feel cold. increased metabolic effort. hypocapnia - Hypoxia (less than normal level of 02 in the cells - Respiratory rate - Gasping associated with running out of breath, RR starts to drop and they start gasping, rhythm changes too) - Accessory muscle Need to intervene quickly or they can go into respiratory arrest

Answer 167

can be measured but a degree of subjectivity depending on how it is calculated

Answer 168

- accessory muscle use nasal flaring/ pursed lip breathing - speaking long/short sentences, single words only, not speaking - intercostal indrawing

Answer 169

- measurement of maximal forced exhaled air flow (L/min) - baseline and to measure effectiveness of interventions - useful for people with asthma - used to keep an eye on maximal force

Answer 170

- CXR (chest X-ray) - spirometry - CT/MRI - ABG (arterial blood gas)

Answer 171

patency is it open and is it fully open, partial obstruction? - is the airway patent - partial obstruction- snoring, stridor, you can hear something - complete obstruction- silence, no extra sounds - under threat? - what your assessing for, patency, expecting to find the airway patent, or patent and concern that it is under threat. possible cause of obstruction - tongue - vomit - epiglottis - uvulitis - secretions - inflammation - neurological impairment - foreign body

Answer 172

In doing this we are increasing ventilation hence increasing gas exchange in the lungs.

Answer 173

Respiratory rate Breath sounds Accessory muscles Positioning Neurological changes Skin Sputum

Answer 174

Tachypnoea/bradypnoea Orthopnoea Dyspnoea and Rhythm & Depth

Answer 175

abnormally rapid breathing.

Answer 176

abnormally slow breathing.

Answer 177

Orthopnea is the sensation of breathlessness that affects a person when they are lying down and subsides in other positions, such as standing or sitting up.

Answer 178

difficult or laboured breathing that is self reported by the patient

Answer 179

Cyanosis is the blue tinging of the skin so assess capillary refill of peripherals.

Answer 180

Peak flow is a simple measurement of how quickly you can blow air out of your lungs. Normal adult peak flow scores range between around 400 and 700 litres per minute

Answer 181

as a baseline and to measure the effectiveness of interventions (useful for diagnosing asthma)

Answer 182

Anxiety Agitation Confusion Drowsiness Pain

Answer 183

Diaphoresis Pallor Cyanosis Flushing

Answer 184

Colour Odour Haemoptysis

Answer 185

Positioning: - maintaining head and neck alignment (chin tilt/jaw thrust) - Consider elevating head of bed/side positioning in OSA - Recovery position Clear secretions: - Encourage airway clearance with coughing - Consider suctioning (Yankeur/suction catheter) - Promote hydration to thin secretions for expectoration

Answer 186

General appearance: Work of breathing Rate, depth and pattern Accessory muscle use Nasal flaring/pursed lips Cough Colour Skin moisture Positioning: Supine/erect Tripod Pillows to support Level of activity: What is your patient doing? Chest: AP measurement Symmetry Paradox Drains? Supplemental oxygen use: Nasal cannula Airvo (humidified O2) CPAP/BiPAP machine Posterior chest auscultation: Air entry Quality of breath sounds Wheeze Crackles Adventitious sounds Percussion: Resonance Hyper resonance Dullness

Answer 187

Positioning: Sit the patient upright Support with pillows if required Mobilise as able Regular turns/repositioning Cough techniques: Huff coughing Incentive spirometry Deep breathing Administer prescribed medications: Bronchodilators (inhalers with spacer Oxygen Physiotherapy referral: Education Loosen secretions Secretions: Promote hydration to thin secretions Consider humidification of O2 Anxiety reduction: Education and reassurance to reduce respiratory effort and SNS response

Answer 188

General appearance: Skin colour -Flushed -Cyanotic Temperature -Raised (core) -Peripherally cool Capillary refill time Diaphoresis Heart rate: Tachycardia/bradycardia Rhythm (regular/irregular) Quality (weak/bounding) Blood pressure: Hypertension Normotension Hypotension Renal function: Urine output eGFR Fluid balance

Answer 189

Hydration: Oral Intravenous fluid as prescribed Administer prescribed medication: Consider DVT prophylaxis Mobilising: Foot pedalling Frequent mobilisation as able Regular repositioning

Answer 190

Level of consciousness: AVPU Orientated to time, person & place? Restlessness/agitation (hypoxaemia) Anxiety: Breathlessness Fear of dying Dyspnoea Increased work of breathing Mood SNS response Pain: COLDSPA Pleuritic pain will contribute to alveolar hypoventilation (decreasing gas exchange) Opioid analgesia causing ↓ RR and LOC

Answer 191

Pain management: Select appropriate analgesia Administer analgesia as prescribed Anxiety reduction to reduce SNS response: Patient education Communication of plan Involve family/whānau Not “reassure patient” – what does this mean?!

Answer 192

Patient risk assessment: Falls Braden Smoking Past medical/surgical history: Previous respiratory issues (COLDSPA) Medications Drug reactions Allergies Early Warning Score: Trends Action required?

Answer 193

Occupation (hazards) Living situation Family/whānau supports Self-management of health issues Alcohol and drug use Cultural needs Spiritual needs

Answer 194

An acute or chronic condition in which the heart doesn’t pump blood as well as it should resulting in congestion (CHF) of blood backing up and unable to meet the demands of the body - The heart’s inability to consistently pump enough blood to organs and tissues - Cardiac output is insufficient to meet the metabolic demands of the body and accommodate venous return - Occurs from either a structural or functional abnormality of the heart - The resulting decreased blood supply to body impairs organs and tissue function - The dominant feature is inadequate tissue perfusion

Answer 195

Valve problem/dysfunction, ventricle thickness, rigidity

Answer 196

Following a MI, cardiomyopathy, CAD (coronary artery disease)

Answer 197

Stroke Volume x Heart Rate (3.5-5L/min)

Answer 198

Amount of blood pumped out per heartbeat

Answer 199

(Volume) amount of ventricular stretch at the end of diastole. The greater the stretch the stronger the contraction (Starling’s Law)

Answer 200

(Pressure) resistance to the ejection of blood from the ventricle

Answer 201

- The ejection fraction (EF) is the amount of blood that is pumped out of the left ventricle (LV) with each heartbeat - A decreased EF = decreased amount of blood being pumped out = decreased perfusion - It is measured in percentages - Normal range is 55-70% - An EF of 40% or less indicates HF - Calculated from an echocardiogram

Answer 202

- Shortened to HFrEF which stands for Heart Failure reduced Ejection Fraction - Pumping problem of the heart - Inability of the Left ventricle to contract effectively ( Ventricles can’t pump hard enough during systole )

Answer 203

- Shortened to HFpEF which stands for Heart failure Preserved ejection fraction - It is a relaxing problem - Inability of the Left ventricle to relax and fill effectively ( Not enough blood fills into ventricles during diastole )

Answer 204

Systole = The ventricles eject blood (pump) Diastolic = The ventricles fill with blood (relax)

Answer 205

- The right ventricle cannot eject sufficient amounts of blood - blood backs up in the venous system and may result in: - Peripheral Oedema - Weight gain but anorexia/nausea may be present - Hepatomegaly/Splenomegaly - Liver is the last place to send blood back to the heart - Ascites - Jugular vein distention - The blood can back up to the rest of the body via the right atrium and manifest as oedema, legs/ankles/feet, sacrum/penis (dependent areas) around the eyes, organ oedema (Could experience Anorexia, GI distress, Weight loss, signs related to liver function impairments)

Answer 206

- The left ventricle cannot pump blood effectively to the systemic circulation. The blood backs up in the pulmonary system so the pulmonary venous pressure increases in: - Decrease EF - Pulmonary congestion/oedema with dyspnoea - Cough - Crackles - Impaired oxygen exchange - LHF is the most common form (from left ventricular dysfunction). Blood cannot get out and around the body, so it backs up in the lungs via the left atrium and pulmonary vein - It causes pulmonary congestion and oedema in the lungs (cough with frothy sputum, Cyanosis and signs of hypoxia, orthopnea)

Answer 207

1. MI or cardiac dysfunction/structural abnormality impairs ability of L) ventricle to fill with or eject blood 2. Poor ventricular function/myocardial damage leads to decreased stroke volume and cardiac output 3. Leads to a neurohormonal response 4. Either sympathetic system is activated to increase cardiac workload, or RAAS pathway is activated 5. Results in vasoconstriction and sodium + fluid retention 6. Further stress on the ventricular wall and remodelling leads to heart failure

Answer 208

Pale, grey, SOBOE, orthopnea (unable to lie flat and breathe), nocturia (increased urination overnight due to lying flat and kidneys being well perfused), oedema, confusion, tachycardia, hypotensive, dry cough, dyspnoea, weak pulse, tachypnoea, fatigue, anxiety, ECG abnormalities, palpitations, restlessness, hypoxaemia, moist cough, diaphoresis, cyanosis, dizzy, light-headed, nausea, weight-gain, SOB, crackles on auscultation, ascites, exercise intolerance

Answer 209

- Ischaemia - Myocardial infarction (elevated Troponin) - Valve disease - Cardiomyopathy - Pericarditis - Fluid overload (renal failure, Intravenous fluid (IVF)) - Hypertension - Smoking - Type 2 Diabetes

Answer 210

a test of the action of the heart using ultrasound waves to produce a visual display, for the diagnosis or monitoring of heart disease.

Answer 211

Left ventricular ejection fraction (LVEF) Ejection fraction typically refers to the left side of the heart. It shows how much oxygen-rich blood is pumped out of the left ventricle to most of the body's organs with each contraction.

Answer 212

LHF usually develops first then RHF because the left ventricle pumps blood throughout the body.

Answer 213

Troponin I These are proteins that are released when the heart muscle has been damaged, such as occurs with a heart attack

Answer 214

In heart valve disease, one or more of the valves in your heart doesn't work properly.

Answer 215

Cardiomyopathy is a disease of the heart muscle that makes it harder for the heart to pump blood to the rest of the body.

Answer 216

Pericarditis is swelling and irritation of the thin, saclike tissue surrounding the heart (pericardium). Pericarditis often causes sharp chest pain.

Answer 217

Dyspnoea (difficult or laboured breathing) Orthopnoea (Discomfort when breathing while lying down flat) Paroxysmal nocturnal dysponea (a sensation of shortness of breath that awakens the patient) Pulmonary congestion - cough, crackle, wheeze

Answer 218

Baroreceptors in the aortic and carotid arteries sense a drop in the BP The sympathetic nervous system (SNS) releases adrenaline and noradrenaline Low cardiac output and vasoconstriction results in decreased renal perfusion → renin is released by the kidneys This initiates the renin angiotensin aldosterone system (RAAS)

Answer 219

SNS activation results in: ↑ Heart rate and ↑ contractility which ↑ blood pressure Neuro-hormonal activation results in: ↑ blood volume (related to aldosterone & ADH secretion) which ↑ preload angiotensin II ↓ vascular capacity which ↑afterload

Answer 220

Pathophysiological process: ↓ blood & O2 supply to body (pump failing) SNS & RAAS response helps… but ultimately harms Signs and symptoms: Shortness of breath Orthopnoea/nocturia Oedema - peripheral/pulmonary Exercise intolerance Fatigue Weight ↑ Attempts to ↑cardiac output to ↑O2 delivery: tachypnoea tachycardia (risk of arrhythmias

Answer 221

Right as RV is failing to pump the blood forward to the lungs, backing up in the body via the RA

Answer 222

Left as LV is failing to pump the blood forward to the body, is backing up in the lungs via the LA

Answer 223

Treat the underlying cause if possible Aim to increase cardiac function and decrease myocardial workload – beta blockers Prevent harmful neuroendocrine responses, e.g.. SNS, RAAS, ventricular remodelling – ACE inhibitors.

Answer 224

ACUTE i.e. post surgery fluid overload – common in the elderly – correct the cause with diuretics and it goes away CHRONIC i.e. r/t myocardial dysfunction caused by IHD, cardiomyopathy, HTN or valvular disease/disorders

Answer 225

Damage to the myocardium esp LV – is a piece of steak – ineffective pumping. Depending on the extent of the infarction that would affect the severity of the HF

Answer 226

Heart failure is commonly caused by IHD It is common in the elderly – one of the main reasons for admission to hospital The pathological processes that underpin heart failure result in decreased contraction, decreased filling or both.

Answer 227

Statements of: c/p, heavy weight, indigestion, SOB, SOBOE, Increased HR (to pump more oxygen around body) BP low Ability to speak ECG Oxygen saturations and/or ABG Cyanosis/colour/diaphoresis Sounds (gurgling/snoring/apnoea) Agitation/confusion Anxiety Dyspnoea

Answer 228

Rapid Ax, Posterior Chest Ax, Peripheral vascular Ax, Apical pulse – PMI, if sond displaced then eg of ventricular hypertrophy.

Answer 229

The vein acts as a barometer to measure fluid in the right atrium Raised JVP indicates fluid overload Common in right sided heart failure.

Answer 230

- Remove waste products from the body by turning them into urine - Remove drugs from the body - Balance the body's fluids - Release hormones that regulate blood pressure (renin, erythropoietin) - Produce an active form of vitamin D that promotes strong, healthy bones - Control the production of red blood cells - Electrolyte Regulation WWETBED.

Answer 231

Glomerular filtration rate (GFR) is the amount of blood that passes through the glomeruli each minute The normal blood flow through the kidneys is 105-125 mls/min →99% is reabsorbed resulting in 1- 1.5L of urine per 24 hours

Answer 232

Pre-renal: Adequate perfusion pressure (renal blood flow) and oxygenation of kidneys. If there isn’t enough pressure in the system then urine output will decrease. The kidneys may be functioning fine but if the system isn’t functioning well Renal: The kidney units must be functioning properly i.e. no damage to the structures in the kidney such as tubules, glomerular Post-renal: There must be no obstruction to urine flow

Answer 233

Low Urine output. 100-400ml/day (an early warning sign related to poor urine output)

Answer 234

Lack of urine production. A late warning sign related to poor urine output. <100ml/day

Answer 235

Acute kidney injury (AKI)occurs when the kidneys are unable to remove the body's metabolic waste or perform their seven regulatory functions, in particular, Maintenance of BP and electrolyte regulation. These metabolic wastes build up in the body and GFR falls as the disease progresses

Answer 236

Pre-Renal Causes: (Low cardiac output, low BP, severe vomiting) Intrarenal (Intrinsic) causes (Damage to renal tissue, nephrotoxins, NSAIDS (Non-steroidal anti-inflammatory drugs) Post-renal causes (Obstruction (kidney stones), renal calculi)

Answer 237

Initiating phase hours = days Oliguric phase = 10 - 14 days Diuretic phase Recovery phase = 3 - 12 months

Answer 238

- Fluid balance chart (FBC) - Daily weigh (1kg of weight = 1L retained fluid) - Skin integrity - Vital signs → EWS - Capillary refill time (CRT) - Palpate and/or scan the bladder - Bloods – GFR, electrolytes, CBC - Ability to manage ADLs

Answer 239

Haemodialysis Peritoneal dialysis

Answer 240

A machine removes blood from your body, filters it through a dialyser (artificial kidney) and returns the cleaned blood to your body. This 3- to 5-hour process may take place in a hospital or a dialysis centre three times a week.

Answer 241

During peritoneal dialysis, a cleansing fluid flows through a catheter into part of your abdomen. The lining of your abdomen (peritoneum) acts as a filter and removes waste products from your blood. After a set period of time, the fluid with the filtered waste products flows out of your abdomen and is discarded.

Answer 242

Need a fully functioning myocardium and kidneys

Answer 243

Diabetes Hypertension Smoking Obesity Ethnicity Gender men>women Age - kidney function decreases with age Specific conditions – glomerulonephritis

Answer 244

Built up waste in the kidneys which the body wants to get rid of

Answer 245

Maintain adequate nutrition Fluid restriction Promote activity & rest as tolerated Provide skin care Provide education on condition & complications Provide culturally appropriate care Psychological/emotional l support Support for smoking cessation

Answer 246

Treatment is aimed at slowing the progression of the disease Smoking cessation Adequate BGL control at least two alcohol free days per week Reduce systolic BP by reducing the BMI moderate physical activity reducing salt intake

Answer 247

Care with medications due to ↓renal function (e.g. ↓GFR & ↓nephrons) Reduced organ function due to the normal ageing proccess Co-existing conditions (e.g. diabetes, HF) Polypharmacy Dehydration (& hypotension) are poorly tolerated (care with diuretics) as is fluid overload Older people are less able to maintain homeostasis due to cellular ageing

Answer 248

AKI tends to cause sudden, severe symptoms that are easily recognised, while CKD symptoms develop slowly and are easily mistaken for other conditions. While AKI can usually be reversed by resolving the underlying cause, CKD is not reversible and need to be managed to preserve the function of the kidneys. AKI is often associated with medications such as morphine and ibuprofen

Answer 249

- Alcohol - Epilepsy - Insulin - Opiates - Uraemia - Tumour - Injury - Psychiatric - Stroke - Sepsis (AEIOU TIPSS)

Answer 250

Occurs when there is an imbalance inside the cranium, following brain injury or other medical conditions that cause an increase in pressure inside the skull.

Answer 251

Brain tissue, blood volume and cerebrospinal fluid (CSF)

Answer 252

A rise in ICP greater than cerebral perfusion pressure, (CPP), results in reduced blood flow to the brain as vessels are squashed from the pressure Reduced blood flow = reduced oxygen and glucose delivery which results cerebral ischaemia.

Answer 253

States that the sum of volumes of brain, cerebrospinal fluid (CSF) and intracerebral blood is constant An increase in one should cause a reciprocal decrease in either one or both remaining two

Answer 254

- Rise in ICP greater than CPP causes reduced blood flow to the brain. Reduced blood flow means less O2/glucose delivery to tissue causing cerebral ischaemia. - Cerebral ischaemia stimulates a sympathetic response (adrenaline release to increase BP & HR) in order to increase blood flow and therefore O2 delivery - Parasympathetic response initiated by increase BP is detected by baroreceptors. This results in an attempt to reduce BP by decreeasing HR - Ongoing increased BP causes further rise in ICP and further restriction of blood flow. A switch of aerobic cellular respiration to anaerobic respiration results in decreased ATP production for cellular function (cerebral ischaemia) - Breakdown of Na+/K+ pump causes water to enter the cell, resulting in cell death. As cerebral oedema worsens, the brainstem is compressed causing irregular respirations before death is imminent

Answer 255

Confusion Drowsiness Headache Forgetfulness Limb weakness Nausea Photophobia Diplopia Oval pupils (from round) Impaired extra-ocular movement

Answer 256

Projectile vomiting Seizures Fixed and dilated pupil/s Loss of gag reflex Abnormal flexion/extension of upper and lower limbs Hypertension (widening pulse pressure) Bradycardia Irregular respiratory pattern

Answer 257

Drowsiness Lethargy Dizziness

Answer 258

Slurred (dysarthria) Delayed Word finding difficulty (expressive/receptive dysphasia) No speech (aphasia)

Answer 259

Mild/mod/severe weakness Hemiplegia (one sided arm/leg/face weakness) Sensation changes Swallowing difficulties (dysphagia) Uncoordinated

Answer 260

Disinhibition Personality change Emotional

Answer 261

Unequal Sluggish Oval Pinpoint

Answer 262

Poor memory Inability to sequence Change in comprehension Confusion

Answer 263

Oxygen and glucose - when body is resting brain uses 20-25% of oxygen & glucose Blood flow - interruption causes irreversible damage within 3-8 minutes Electrical conduction - relay and process information

Answer 264

A way of maintaining brain blood flow despite changes in cerebral perfusion pressure (the pressure required to deliver adequate oxygen and glucose) Once cerebral perfusion pressure (CPP) is outside the range of 60-160mmHg, autoregulation is lost If autoregulation is lost, the brain relies on mean arterial pressure (MAP) to maintain it’s blood supply This means that if there is injury to the brain and a patient’s blood pressure is too low, there is not enough pressure to drive the blood around the brain ↓ oxygen ↓ glucose = brain tissue hypoxia and death

Answer 265

Nervous system assessment -Cranial nerves (CNI – XII) -Spinal nerves (C1-8, T1-12, L1-5, S1-5, Co1) --Reflexes --Sensation --Strength Coordination and balance Gait Mini mental state examination (MMSE) Speech and language

Answer 266

Computerised tomography (CT) Magnetic resonance imaging (MRI) Carotid ultrasound/Doppler (measures cerebral blood flow) EEG – electroencephalograms (electrical activity in brain) Cerebral angiography: identify responsible blood vessel Lumbar puncture for CSF analysis (can also be sampled from ventricles)

Answer 267

Antiemetics May provide nausea relief Antipyretics Reduce metabolic activity Diuretics Control fluid balance Corticosteroids Reduce cerebral oedema Antiepileptics Control of neurotransmitters Thrombolytics Fast dissolution of blood clots Antiplatelets Prevents platelets from sticking together and clumping Analgesics Reduce SNS activity and reduce ICP Skeletal muscle relaxants Ease contractures Anti-parkinson Increase dopamine/reduce acetylcholine activity to improve motor coordination Faecal Softeners Prevent straining and increasing ICP Antibiotics Reduce systemic inflammation and cerebral oedema Antiarrhythmics Improve cardiac output and cerebral perfusion Antihypertensives Prevent secondary cerebral ischaemia through raised ICP

Answer 268

Rapidly developing clinical signs of focal (or global in case of coma) disturbance of cerebral function Lasting more than 24 hours or leading to death

Answer 269

Hypertension, Age, Drugs/alcohol, Females have an increased risk due to Oestrogen, Inactivity, Obesity, Diabetes, High cholesterol

Answer 270

Trouble walking, trouble speaking and/or understanding, one-sided weakness or paralysis Motor deficits (mobility, swallowing, gag reflex, respiratory) Communication (speaking, aphasia) Intellectual function (memory, judgement) Affect (trouble controlling emotions

Answer 271

Maintain head of bed 30 degrees: to facilitate jugular venous drainage and help reduce intracranial pressure Maintain systolic blood pressure within prescribed parameters (often < 180mmHg): to reduce the potential for further bleeding or ischaemic changes Continuous neurological observations: to help identify deterioration to initiate timely intervention and treatment Ensure correct positioning of paralysed limbs: to prevent contractures and maximise function for rehabilitation Ensure patient is kept NBM until swallow is assessed by Speech and Language Therapist: to prevent aspiration of oral fluid and food Administer prescribed aspirin orally or enterally: to impede clotting and prevent further ischaemia Turn the patient regularly: to maintain skin integrity and prevent pressure injury if the patient cannot move themselves

Answer 272

Ischaemic and Haemorrhagic

Answer 273

Cerebral embolism is a blood clot or debris formed elsewhere in the body which travels to the brain. If it cannot pass through the lumen it will occlude the vessel, interrupting blood flow causing tissue ischaemia.

Answer 274

Cerebral thrombosis is a narrowing of the cerebral arteries caused by plaque build-up. A clot then forms on the plaque, occluding the vessel lumen and restricting blood flow to an area of the brain. Tissue ischaemia results if not thrombolysed.

Answer 275

A burst blood vessel will cause blood to leak into brain tissue and surrounding structures, causing a rise in intracranial pressure and damage to brain tissue

Answer 276

Ischaemic Cascade Disrupted blood flow Anaerobic respiration Lactic Acid Insufficient ATP Ion imbalance Increase in intracellular calcium Increased Glutamate Vasoconstriction Enlarged area of infarction into penumbra* Cell membrane and proteins break down Formation of free radicals Protein production decreased Cell injury and death

Answer 277

Ruptured vessel Explosive eruption of blood from vessel into surrounding brain tissue and structure Haematoma develops Exposure of brain to blood, an increase in intracranial pressure caused by sudden entry of blood into the tissue, and secondary ischaemia result from reduced blood flow/perfusion Ion imbalance Mismatch between blood flow and metabolic demand Breakdown of sodium/potassium pump maintaining cellular function Anaerobic respiration to produce ATP Increased production of lactic acid Cell death Altered pH Cell membrane and proteins break down Formation of free radicals Cell injury and death

Answer 278

Coma Breathing problems, spontaneous changes in blood pressure and heart rate Nausea and vomiting

Answer 279

Ataxia, dysarthria, incoordination, nystagmus

Answer 280

Paralysed left side Special perceptual deficits Quick, impulsive behavioural style Memory deficits Short attention span, impulsive (safety concerns), impaired judgement (tends to minimise problems), impaired time concepts

Answer 281

Paralysed right side Speech and language deficits Slow, cautious behavioural style Memory deficits Aware of deficits (more prone to anxiety, depression), impaired comprehension r/t language/mathematics

Answer 282

A temporary focal loss of neurological function caused by ischaemia (less than 24hrs) Most resolve within 1-2 hours Result from inadequate blood flow to brain from partial or complete occlusion of an artery

Answer 283

Mechanical disruption to the structure & function of the spinal cord & spinal nerve pathways. Can be a traumatic or non traumatic injury

Answer 284

Damage to the spinal cord resulting from a traumatic event, fall or accident usually occurs from a fracture and/or dislocation of the spine. May also be the result of penetrating injuries from: displaced bony fragments penetrating the spinal cord and/or the spinal nerves. bullets or weapons.

Answer 285

Vascular disorders, tumours, infections or haematomas causing cord compression

Answer 286

Transient concussion (reversible) Contusion (bruising) Laceration (cut to the cord) Compression (Squashed) Transection (irreversible, cut through the cord)

Answer 287

Symptomsdepend ondegree of paralysis & potential for rehabilitation depends on the level of lesion Paralysis from below level of injury Loss of reflexes Loss of bowel, bladder and sexual function Muscle spasm Inability to control body temperature Loss of bone density High risk of pressure injury

Answer 288

Microscopic haemorrhages occurs in the central grey matter and pia matter Tissue volume is increased, causing compression and necrosis Oedema occurs in the white matter, causing impaired circulation throughout spinal cord The haemorrhage and oedema obstruct blood flow and lead to further ischaemic areas Leads to functional impairment which may be temporary or long term

Answer 289

Encourage independence but assist with ADLS Assist with bowel/bladder cares Prompt pressure area cares Regular position changes Ensure environment is clutter free Provide education surrounding rehab

Answer 290

Ischaemia Hypoxia Oedema Inflammatory Process

Answer 291

Voluntary movement Sensation of pain, temperature, pressure & proprioception Bowel and bladder function Loss of reflexes

Answer 292

C5-Elbow flexion L2-hip flexion C6-wrist extension L3-knee extension C7-elbow extension L4-ankle dorsiflexion C8-finger flexion L5-toe extension T1-finger abduction S1-ankle plantar flexion

Answer 293

Spinal Shock Neurogenic Shock Autonomic Dysreflexia

Answer 294

Areflexia (sudden depression reflex activity) < level injury Muscles paralysed, flaccid and without sensation below level of injury Bowel and bladder function lost Gastric stasis Paralytic ileus

Answer 295

Loss of autonomic control leads to: - ↓ BP, ↓ HR - Peripheral venous pooling - Priapism - Loss of temperature control - Lack of perspiration below level of injury

Answer 296

Occurs after spinal shock has resolved in persons with SCI above T6. Stimulus causes sympathetic nerves to become overactive inhibitory nerves from brain travelling down spinal cord serve to moderate all spinal cord reflexes thus if someone taps your knee - your leg kicks. This is a spinal reflex Simple response to painful stimulus makes your body react with reflexive sympathetic response at spinal cord level as well as increasing B/P. Normal circumstances inhibitory nerves from brain moderate response.

Answer 297

Urinary retention Over distended bladder or bowel Pressure ulcers Kidney stones Ingrown toenail

Answer 298

Noxious stimulus (distended bladder, constipation etc.) Signals transmitted to spinal cord to initiate SN activation (> HR, > BP - vasoconstriction, > RR) HTN stimulates baroreceptors in carotid bodies. Brain initiates PN activity to reduce BP by slowing HR (bradycardia) Signals to reverse SN activity sent from brain via spinal cord to vasodilate blood vessels, slow HR. This occurs ABOVE SCI level Signals can’t pass BELOW level of injury. If noxious stimulus continues, ascending signals continue to initiate SN activity Results in increasing HTN (associated headache, blurred vision) bradycardia, vasodilation ABOVE SCI level and vasoconstriction BELOW

Answer 299

HTN (>20mmHg Pt baseline) bradycardia Headaches Blurred vision Facial flushing Diaphoresis above level of injury Anxiety and restlessness

Answer 300

Put the person into sitting position 90◦ to help lower the BP Loosen clothing Assess for the probable cause and remove Continue to assess vital signs (Q2-3min BP) Administer GTN as prescribed if SBP > 150mmHg (short acting anti-hypertensive medications only)

Answer 301

- Vital signs - Preop checklist guiding document for before patient goes to surgery - NBM status nil by mouth status (have to have fasted 6 hours before surgery) - Medications (what they can and cant have, blood thinners is a no) - Consent - Weight and height (if necessary, necessary for anastatic/medications) (important for appropriate dosing of medication, especially for anastatic) - Specific physical assessments (how well they are physically will determine how well they will do during surgery) - Neurovascular - Neurological (GCS/ PERRLA/ limb strength) - Respiratory / cardiovascular - Wound assessment - Pain (acute/chronic) (all patients will have some sort of pain, especially with acute patients, chronic pain with other injuries like back injuries, both can occur together if someone has chronic pain they will also have acute pain after surgery)

Answer 302

- medical/surgical/family history - blood tests/ scans/x-rays - nutritional/ fluid status - drugs (OTC/recreational) alcohol use - respiratory status - cardiovascular status - hepatic/ renal function - past and current medication use - endocrine function - allergies - psychosocial factors - cultural beliefs - spiritual beliefs

Answer 303

- Airway- regular observations (patient has just had anastatic important) - Vitals (EWS score) (determined by EWS but also by protocol on how often you check them) - Pain (checking in on pain is very important!!! Patients will have pain, well managed pain shouldn’t turn into chronic pain) - AVPU - Orientation to time place person (TPP) (medications can make you hallucinate, you can be alert but confused, ) - Nausea and vomiting (anastatic can make you feel sick after, antinausea medication given after surgery they may need more, are you feeling sick at all) - Wound check for strikethrough (though the dressing) (wound checking important bleeding)

Answer 304

- May be general or specific to type of surgery - Highest incidence of post-op complications is between 1-3 days post op - Neish things depending on what type of surgery Immediate complications - Hemorrhage, atelectasis, shock, low urine output Early complications - Pain, acute confusion syndrome, nausea and vomiting, fever, secondary hemorrhage (bleeding later one days after surgery). DVT, paralytic ileus (ileus of the small intestine stops working, asking if they have passed wind, which determines there is peristalsis), AKI Later complications - Bowel obstruction due to adhesions, infection, incisional hernia (hernia that is caused by them having to cut through stomach muscle), keloid scar formation (extra scar tissue)

Answer 305

Pre operative (starts from admission, what risks specifically do they have) - Pre-assessment clinic - Fitness/risk assessment - Addressing comorbidities Continue/stop relevant medication

Answer 306

Intra operative - Correct timely antibiotics - Cardiovascular optimization (having a close focus on patients cardiovascular status, by monitoring and adequate fluids) - Specific drugs (I.e. anti-emetics)

Answer 307

Post operative - Enhanced recovery programs (don’t keep patients resting in bed, breathing optimized, walking around, prevents pressure injury, blood flow) - Analgesia ( - Early mobilization Regular post op ward rounds regularly being seen by surgical team)

Answer 308

Hazards of surgery for the elderly are proportion to - The number and severity of co-existing health conditions - The nature and duration of the surgery The older patient has less physiological reserves than a younger person - Lower cardiac reserve - Decreased renal/hepatic function - Decreased gastrointestinal function - Sensory limitations - Dehydration, constipation, malnutrition may be evident

Answer 309

Obesity increases the risk and severity of complications During surgery, fatty tissues are especially susceptible to infection - Wound dehiscence, deep vein thrombosis when supine, increasing the risk of hypoventilation and postoperative pulmonary complications - Physical characteristics of short thick necks, large tongues, recessed chins associated with an increased oxygen demand and decreased pulmonary reserves- impedes intubation - Difficulties associated with positioning, bariatric equipment required

Answer 310

A condition of equilibrium (stability or balance) in the body’s internal environment It is dynamic Constant fluctuations of both the internal and external environment Internal conditions usually vary within a very narrow range (pH blood 7.35-7.45) Core body Temp BP/HR/RR BGL

Answer 311

Stimulus: Any disruption to a controlled condition Receptor/sensor: Monitors the environment and responds to a stimulus Control centre: Determines set-point/range to be maintained. Analyses input and determines appropriate response (output). Effector: Muscles or glands which bring about a response or effect.

Answer 312

Inhibitory, therefore negates a change Prevent sudden severe changes within the body; reverses or negates original stimulus Once equilibrium is achieved the response is reduced and the process “shut off” More common

Answer 313

Do not help to maintain equilibrium Do not oppose a change in internal environment Enhance and amplifies the effector so the response continues at a faster rate Only stops when stimulus removed Less common

Answer 314

What Is Disease? Disease is any failure of normal physiological function that leads to negative symptoms. While disease is often a result of infection or injury, most diseases involve the disruption of normal homeostasis. Any disease process can lead to an imbalance of HOMEOSTASIS this imbalance is what we see in signs and symptoms.

Answer 315

Effective receptors Effective brain function--. control centre Effective major organs Skin / Musculoskeletal/ Lungs/ Heart/ kidneys/ Liver/Pancreas An adequate blood volume More cardiac specific Effective blood vessels An effective cardiac pump Effective kidney function

Answer 316

Baroreceptors- pressure Chemoreceptors-gases/chemical substances Mechanoreceptors- stretch Nociceptors- pain Photoreceptors-light Thermoreceptors- temperature

Answer 317

The signs and symptoms we see are the result of the body’s way of maintaining HOMEOSTASIS Therefore normal vital signs=normal homeostasis Abnormal vital signs=a change in homeostasis, due to an acute situation or chronic disease process

Answer 318

Hyperglycaemia Severe fatigue Polyuria Polydipsia Ketones in urine/pear breath Increase RR

Answer 319

pH of blood normal range for homeostasis is : 7.35-7.45 -> slightly alkaline Discuss chronically high CO2 -> COPD patient may have a ‘normal’ mild respiratory acidosis….. They have a chronic lung disease that is irreversible/ progressive and incurable

Answer 320

Bleeding after a surgical procedure. The hemorrhage may occur immediately after the surgery or be delayed. It need not be restricted to the surgical wound.

Answer 321

Hypovolemic shock is an emergency condition in which severe blood or other fluid loss makes the heart unable to pump enough blood to the body. This type of shock can cause many organs to stop working.

Answer 322

Warfarin and aspirin

Answer 323

Hypotension rt loss of blood volume Tachycardia rt heart compensation for reduced CO Grey pallor rt less blood to skin as blood being directed to heart Excess haemorrhage (inc bleeding)

Answer 324

Increased myocardial 02 demand and decreased myocardial 02 supply

Answer 325

Open the artery and keep it open

Answer 326

GTN, morphine, and aspirin

Answer 327

RR under 12, altered level of consciousness, and hypotension

Answer 328

An antiplatelet

Answer 329

To lower total cholesterol / low-density lipid levels

Answer 330

Diuretics, statins and beta blockers

Answer 331

Slow the HR, lower the BP and reduce the force of contraction.

Answer 332

Promote vasodilation and diuresis, decreasing the workload of the heart.

Answer 333

Increase sodium and water excretion by the kidneys

Answer 334

A. Bronchospasm, increased mucous production and narrowing of the airways

Answer 335

B. Cancer cells moving from their original location to other sites

Answer 336

C. Nausea and vomiting

Answer 337

B. The damage was probably in the left side of his cerebrum probably in the frontal area

Answer 338

C. Damage to the arterial walls

Answer 339

A. Dyspnea, Orthopnea, and cough

Answer 340

An infectious microorganism reaches the alveoli, macrophages become overwhelmed and they signal neutrophils, the neutrophils will engulf the alveoli producing a fibrin rich exudate. This exudate fills infected and neighbouring alveoli causing alveoli to stick together and decrease ventilation. The oedema in the alveoli also increase diffusion distance for gases, impairing gas exchange.

Answer 341

Assess the patient’s airway through seeing if they are able to speak full sentences, and while doing so watching for WOB and use of accessory muscles Posterior chest assessment, assessing for dullness on percussion of the lung fields (indicating lung consolidation) Posterior chest assessment, assessing for bronchial breath sounds on auscultation (Can indicate consolidation)

Answer 342

Teach the huff coughing technique to mobilize secretions and expand their lungs to promote ventilation and perfusion. Encourage fluid intake of 2-3L to thin secretions in the airways and alveoli to aid in the removal of secretions and promote effective gas exchange Positioning - place the pt in the high fowler’s position as this aids in lung expansion and coughing up of secretions.

Answer 343

Posterior chest assessment, resonance over the lung fields during percussion Posterior chest assessment, mostly vesicular sounds heard over the lung fields without adventitious sounds during ascultation

Answer 344

Keep diet low in sodium and reduce fluids to 2L and under Reduce alcohol, cholesterol and caffeine intake Reduce levels of stress Exercise regularly Smoking cessation

Answer 345

I would apologise that this occurred and ensure the pillows for this patients head were a blue colour to indicate these were for the head and and inform other staff to please keep these pillows at the top of the bed only to ensure the head is respected. Use white pillows for the body. As per tikanga policy

Answer 346

DVT’s are caused by 3 main factors described as Virchows triad. These are stasis of blood flow, hyper coagulability, Endothelial injury. You can be more predisposed to these 3 factors if you are older, pregnant, or have had a long period of immobility. A DVT is a formation of a clot in the deep veins. It is a type of VTE (venous thrombo embolism), blood stasis leads to the formation of a DVT as blood in the peripheral veins will start to clot together due to lack of mobility, hypercoagubility will increase hemostasis of blood in the peripheral veins increasing blood clotting and endothelial damage will causing blood clotting in order to ‘heal’ the damage. This is a result of the platelets in the blood and exacerbated by WBC’s.

Answer 347

This can lead to autonomic dysreflexia as the kinked indwelling catheter can cause bladder distension causing a stimulus in the lower body that the body overreacts to. This will cause symptoms such as HTN, a pale, cool and clammy tone to the lower skin, and flushed upper skin, nausea and vomiting, headache, pupil constriction, and bradycardia. This is unique to spinal patients, particularly those with a spinal injury at T6 or above.

Answer 348

GTN to relax smooth muscle, and dilate veins and arteries Morphine (analgesia) to depress the CNS hence reduce pain and promote vasodilation Aspirin (antiplatelet) to impede clotting

Answer 349

Statins work to decrease total cholesterol levels which is a risk factor for atherosclerosis. Statins also slow down the progression of disease so they can help delay symptoms such as angina (chest discomfort or breathlessness)

Answer 350

Ace inhibitors to promote vasodilation and diuresis by decreasing afterload and preload hence decreasing workload of the heart Beta blockers to slow conduction (HR) and lessen the force of contraction to reduce myocardial workload Diuretics to provide relief of clinical symptoms of fluid overload.

Answer 351

Coronary artery disease (CAD), also called ischaemic heart disease, happens when the major blood vessels in the heart get narrow and stiff. It can cause myocardial infarction and angina.

Answer 352

Rheumatic fever starts with a sore throat that is known as ‘strep throat’ – a throat infection caused by a bacteria called Group A Streptococcus. This is an autoimmune disease. It happens when your immune system makes a mistake and attacks other parts of your body, as well as the strep throat germs. This can cause inflammation and oedema in the heart, joints (elbows and knees), brain and skin

Answer 353

Anxiety. Fatigue. Lightheadedness or dizziness. Sweating. Fainting (syncope) or near fainting.

Answer 354

that the sum of volumes of brain, CSF, and intracranial blood is constant. An increase in one should cause a decrease in one or both of the remaining two.

Answer 355

Any condition that affects the structure and function of the heart and blood vessels

Answer 356

Coronary Artery Disease (CAD) - Angina, myocardial infarction Cerebrovascular disease (CVD) Peripheral vascular disease (PVD) Heart Failure (HF) Hypertension Rheumatic Heart Disease Congenital Heart Disease

Answer 357

Autoimmune disease that results from a Group A Streptococcus (GAS) infection in the throat Is linked to poor housing conditions, overcrowding, socioeconomic deprivation, barriers to primary health care access and a lack of treatment for strep throat Is largely unseen in the developed world but NZ has one of the highest rates in the world - mainly in the North Island If untreated, it may develop into rheumatic heart disease and go on to damage the heart - valve/s may need to be replaced 92% of all cases of rheumatic fever affect Māori and pacific island children and young people (aged 4-19)

Answer 358

The term is given to heart problems caused by narrowed heart arteries. When arteries are narrowed, less blood and oxygen reach the heart muscle. Ischemia occurs when there is insufficient blood flow and blood volume to supply the O2 needs of the myocardium

Answer 359

Usually atherosclerosis

Answer 360

Symptom of reversible myocardial ischaemia Usually predictable and manageable Occurs due to a stable lesion/plaque in the coronary artery A type of chest pain caused by reduced blood flow to the heart (often described as squeezing, pressure, heaviness, tightness or pain in the chest)

Answer 361

Ineffective myocardial oxygen perfusion -Myocardial oxygen demand is greater than oxygen supply -At risk of heart muscle damage/necrosis -Damaged muscle behaves ineffectively -At risk of arrhythmia (damaged muscle does not convey impulses well) -May lead to cardiac arrest

Answer 362

-Results from sustained ischaemia or sudden complete blockage of the coronary artery from plaques (atherosclerosis). -If the plaques rupture, you can have a heart attack (myocardial infarction) -Myocardial tissue distal to the obstruction dies -Can be partial thickness (NSTEMI) or full thickness (transmural) (STEMI) -Life-threatening -Complications include: Cardiogenic shock, heart failure, ventricular fibrillation (VF) which can lead to death

Answer 363

-Non-ST-Elevation Myocardial Infarction (NSTEMI) involves partial thickness myocardial wall damage -ST-Elevation Myocardial Infarction (STEMI) involves full thickness myocardial wall damage (with/without necrosis)

Answer 364

Stemi: -Full thickness damage to the myocardium (transmural) -Sudden complete blockage of a coronary artery -ST segment evaluation on an -ECG -No need to wait for bloods -ECG finding is definitive NSTEMI: -Partial thickness damage to the myocardium -Partial blockage of a coronary artery -Not visible on an ECG -Need bloods for cardiac biomarkers to diagnose

Answer 365

-Group of clinical symptoms that are consistent with acute myocardial ischaemia. Unless interventions are applied promptly ACS can result in myocardial death -ACS is the term for an imbalance of 02 supply and demand. The underlying pathophysiology is atherosclerosis which can lead to plaque rupture and thrombus formation

Answer 366

Unstable angina (UA), Non—ST-segment elevation myocardial infarction (NSTEMI), ST-segment elevation myocardial infarction (STEMI)

Answer 367

Pale, grey, confused, tachycardic, hypotensive, hypertensive, chest pain, dyspnoea, weak thready pulse, feeling of impending doom, think it’s indigestion, feel like an elephant on their chest, tachypnoeic, fatigue, anxiety, ECG abnormalities, pain radiating across the chest, down the left arm, into the jaw, into the back, palpitations, restlessness, tightness in chest, hypoxaemia, diaphoresis, cyanosis, dizzy, light-headed, nausea

Answer 368

In absence of O2, cell function will deteriorate: -Ischaemia: Lack of O2 -Injury: Potentially reversible damage -Infarction: Necrosis - permanent damage

Answer 369

History (chest pain and related symptoms) 12 Lead ECG (ST elevation height and area of the heart) Blood tests Other Diagnostic Investigations that may be Untaken Include:: Coronary angiogram +/- Angioplasty Echocardiography (ECHO) Transoesophageal Echocardiography Exercise tolerance test (ETT) Electrophysiological studies (EPS) Chest X-Ray

Answer 370

Troponin T and I - Cardiac specific enzymes Cardiac enzymes: Creatinine kinase (CK-MB) - mainly in cardiac muscle, myoglobin - cardiac and skeletal muscle Electrolytes - K+, NA+, important for electrical conduction and kidney function Complete blood count (CBC) Lipid Profile - fasting Brain Naturide Peptide (BNP)

Answer 371

Group of clinical symptoms that are consistent with acute myocardial ischaemia. Unless interventions are applied promptly ACS can result in myocardial death ACS is the term for an imbalance of O2 supply & demand. The underlying pathophysiology is atherosclerosis which can lead to plaque rupture and thrombus formation Unstable Angina Pectoris STEMI Non-STEMI

Answer 372

Exercise/ Exertion ↑ HR, ↑ CO, ↑ myocardial O2 demand Extremes of temperature Vasoconstriction ↑resistance vasodilation ↓venous return Eating a heavy meal ↑ parasympathetic stimulation – blood diverted to the GI system Emotions/stress ↑ HR, ↑ CO, ↑ myocardial O2 demand Effects of drugs Can ↑ or ↓ HR, BP

Answer 373

Follow the Heart Foundation Angina Action Plan (copy on Moodle) Percutaneous Coronary Intervention (PCI) – the gold standard (watch the YouTube clip on Moodle) Thrombolysis - fibrinolytic therapy (dissolves clots) - Alteplase / Metalyse - Streptokinase - Tissue plasminogen activator (TPA)

Answer 374

Heart attack is a MI Results from a blocked coronary artery This prevents oxygen-rich blood from reaching the myocardium Without oxygen the myocardial cells begin to die A circulation problem Cardiac arrest a sudden, cessation of the heart’s functioning Triggered by electrical malfunction in the heart that causes an arrhythmia (irregular heart beat) Disrupts the pumping action An electrical problem

Answer 375

OPEN THE ARTERY AND KEEP IT OPEN Increase oxygen supply to the myocardium → give nitrates and consider O2 if SaO2 < 93% Relieve pain, reduce O2 demand & signs of ischaemia Preserve viable myocytes Relieve obstruction: - Manage thrombus to reperfuse the artery & minimise permanent damage

Answer 376

Aspirin Metoprolol Atorvastatin Cilazapril GTN spray

Answer 377

Normal Sinus Rhythm Arrhythmias Asystole Atrial Fibrillation

Answer 378

Ventricular Tachycardia (VT) Ventricular Fibrillation (VF)

Answer 379

Ventricular Tachycardia (VT) is characterised by an absence of P waves as the ventricles have taken over - QRS complex is wide and fast There is initially a pulse, but VT can progress onto no palpable pulse (no cardiac output) = cardiac arrest (needs defibrillation) This is a life-threatening rhythm

Answer 380

Ventricular fibrillation (VF) is characterised by rapid disorganised contraction of the ventricles = life-threatening rhythm - needs defibrillating immediately!! No discernible atrial or ventricular activity No palpable pulse (no cardiac output) or respirations = cardiac arrest VF is the most common arrhythmia in patients with cardiac arrest - can be because of myocardial infarction (MI)

Answer 381

Easiest rhythm to memorise Complete absence of electrical activity - straight line on the monitor No QRS complexes - no cardiac output Cessation of the heart’s functioning

Answer 382

Atrial Fibrillation (AF) - completely disorganised atrial electrical activity Impulses arise from the SA node and other sites in the atria Conduction through the AV node is irregular and usually fast There are no P waves and it is irregular Instead of a P wave - it has uneven fibrillary lines (F waves) before the QRS complex

Answer 383

Older age Male gender Obesity Hypertension Excessive alcohol intake Heart Failure

Answer 384

SOB Fatigue Palpitations Chest pain Haemodynamic instability (abnormal or unstable blood pressure)

Answer 385

Depends on the cause, severity of symptoms and the pattern Get the rate down – Beta Blockers Control the rhythm – medication or cardioversion Anticoagulation due to the risk of thromboembolism

Answer 386

A diagnostic tool used to help identify pathological changes associated with Acute coronary syndromes (ACS) such as a myocardial infarction (MI) Detects the heart’s electrical activity through electrodes attached to the skin and relays them as waveforms for interpretation on graph paper 10 physical leads to attach to the patient showing 12 different views of the heart

Answer 387

1. On the 4th intercostal space r of sternum 2. L of sternum 3. between 2 and 4 4. 5th IS mid clav 5. level with 4 at l ant axillary line 6. level with 5 at mid axil line (mid pit)

Answer 388

V1 should go on the right side of the sternum, where the sternum meets the rib V2 should go on the left side of the sternum, where the sternum meets the rib V4 goes on the mid-clavicular line on the 5th intercostal space V3 goes in the middle of V2 and V4 V5 goes horizontally to V4 on the anterior axillary line which is furthest to the front of the side of the chest wall V6 goes in the mid axillary line which is on the side, vertical to the armpit One electrode on each arm Leg electrodes go somewhere down on the calves or thighs which depends on what kind of access you have to the patient’s lower extremities

Answer 389

Coup = direct impact Contrecoup = secondary damage away from injury site

Answer 390

Diffuse axonal injury(brain stem, closed head injury)coma, mortality 33-50%

Answer 391

Insufficient oxygen and glucose supply to brain tissue

Answer 392

Smoke inhalation Carbon monoxide poisoning Cardiac arrest Strangulation Drowning Drug overdose Traumatic birth Stroke Electrocution

Answer 393

Brain Suffers traumatic injury Brain swelling or bleeding increased intracranial volume Rigid cranium allows no room for expansion of contents so intracranial pressure increases Pressure on blood vessels within the brain causes blood flow to the brain to slow Cerebral hypoxia and ischaemia occur Intracranial pressure continues to rise. Brain may herniate. Cerebral blood flow ceases

Answer 394

Loss of consciousness Interruption of normal breathing Interruption of cardiac function Fixed dilated pupils

Answer 395

Bleeding, trauma, perforation, obstruction Inflammation, infections, infestations Tumours; benign and malignant Congenital disorders Circulatory and nervous system faults Ageing High levels of stress and anxiety Irregular eating habits Low fibre and water intake Low levels daily exercise Congenital /genetic influences

Answer 396

Change in appetite *Weight gain or loss *Dysphagia *Intolerance to certain foods *Nausea and vomiting Change in bowel habits Abdominal pain Flatus These are sometimes ignored, not recognised by patients or treated by over the counter (OTC) medications

Answer 397

Gall bladder inflammation Associated with: A mixture of particulate solids precipitated from bile. Consists of cholesterol crystals, calcium bilirubinate pigment, and other calcium salts. Gallstones (may be asymptomatic) Incidence higher in females >40yrs Acute cholecystitis: Pain + rigidity of upper abdomen pain radiates to mid sternum or right shoulder region Associated with nausea and vomiting. If the common bile duct becomes obstructed = jaundice (yellow tinge to the skin associated with itchiness)

Answer 398

Colonic disorders e.g. volvulus, irritable bowel syndrome (IBS), diverticular disease Drug induced e.g. antacids, barium sulphate, laxative abuse, opioids, antidepressants. Opioid induced constipation is a significant issue for post surgical patients. Management includes regular aperients(prescribed) avoiding use of other constipating medications. Mobilisation and fluids.(Brown, Edwards, Seaton & Buckley,2015 pg. 65) Systemic disorders e.g. diabetes, spinal cord lesions, stroke Pregnancy

Answer 399

Results from kinking or occlusion by faecalith.(hardened mass of faecal matter) Pain periumbilical progressing to RT lower quadrant at McBurney’s point Rebound tenderness on palpation Low grade fever/nausea vomiting Complications Peritonitis or localised abscess can occur within 24 hours after onset of pain

Answer 400

Results from functional disorder of intestinal motility Symptoms are present for at least 3 days a month Chronic intermittent & recurrent abdominal pain Irregular bowel habit Diarrhoea, constipation, abdominal distension, flatulence, bloating Continual defecation urge, urgency, feeling of incomplete evacuation

Answer 401

Crohn’s disease: Common in young adults and adolescents. More common in women and older population (50-80 years).(Farrell,M (2017 p 1011) Subacute ,chronic inflammation of all layers of colon(transmural) Oedema and thickening progressing to ulceration of mucosa Skip lesions separated by normal tissue Scar tissue and formation of granulomas interfere with normal colon function

Answer 402

More common in Caucasian and people of Jewish descent. Peak incidence between 30-50 years 5% patients may go on to develop colon cancer. (Farrell,M ,2017, p 1013) Affects superficial mucosa rectum and colon Multiple ulcerations, desquamation of epithelium, Abscesses form infiltrating submucosa layers Bowel narrows, shortens presence of fistulas

Answer 403

Common for both conditions: Abdominal pain – usually mild – moderate (Crohn’s) onset in right lower quadrant Diarrhoea Bloody stools (more likely with UC) Weight loss (Crohn’s) Fever (UC during acute attacks. Common with Chron’s) Fatigue Malabsorption

Answer 404

Crohn's disease and Ulcerative colitis

Answer 405

Rest the bowel, control inflammation, combat infection, correct malnutrition, alleviate stress, symptomatic relief Medications Surgery – 75% of Crohns require surgical intervention either stricturoplasty or resection +/- temp ostomy or ileostomy Nutritional therapy - according to triggers, malnutrition etc +/- TPN Some people with IBD suffer extra-intestinal manifestations of disease including arthritis, ankylosing spondylitis, eye inflammation and skin lesions thought to be cause by circulation products of inflammation triggering inflammation in other areas.

Answer 406

Latin word - rolled up, twisted Twisting of part of intestine around itself = obstruction Frequently in colon, but can occur in stomach and small bowel Can lead to: gangrene, obstruction, perforation, peritonitis & death

Answer 407

Gender ↑males Age > 55 Family history, familial adenomatous polyposis (FAP) Colorectal polyps Inflammatory bowel disease (IBD) Obesity Smoking Excess alcohol consumption High fat diet Low fibre diet

Answer 408

Biopsy from colonoscopy – histology report and mass visualised CEA( carcinoembryonic antigen) elevated readings. Abnormal blood results Mass visualised on CT scan Palpable mass felt during abdominal examination. AFTER DIAGNOSIS Staging /classification of colorectal cancer dictates the management. Surgery required to remove tumour and part of bowel e.g. hemicolectomy. Abdominal-perineal resection. Laparoscopic colectomy. May require chemotherapy , radiotherapy, biological and targeted therapy.

Answer 409

Partial removal of the colon or removal of the entire colon is one of the most common forms of colorectal surgery The name of the procedure describes the extent of the surgery e.g. hemicolectomy - part of the ascending or descending colon

Answer 410

Removal of diseased area of bowel and length of normal bowel either side of it. Removal of any potentially diseased areas. Two ends of healthy bowel are anastomosed (joined together by stitching or stapling the ends together). Wound closed with clips or stitches. Commonly performed laparoscopically or may start this way and proceed to open surgery. +/- stoma / ostomy (ileostomy, transverse, sigmoid) Temporary – loop, double barrelled, Hartman's pouch Permanent – rectal

Answer 411

Haemodynamic stability Pain Control Fluid & electrolyte balance Number & appearance stools Bristol Stool Chart Wound care Nutrition status Skin integrity Education -Identifies coping patterns -Lifestyle modification Rest versus exercise Knowledge of disease Signs & symptoms to prevent complications

Answer 412

An ostomy is a surgical opening that connects an organ or underlying structure directly to the skin. There are different types of ostomies created for different purposes to maintain normal body function. They are named after the organ or structure they connect to. e.g. Tracheostomy is an opening through the neck connecting the trachea allowing the patient to breathe.

Answer 413

A stoma (Greek word for mouth or opening). The end of the organ or structure on the skin surface.

Answer 414

Part of the colon is brought through the surface of the skin through an opening on to the abdomen. The output from a stoma is related to the location of the stoma. Normal bowel habits can be generated with colostomies. Stools are formed if the stoma is functioning correctly. They are they are usually active from as frequently as twice a day to as infrequently as second daily. Usually located on the transverse or descending colon. May be permanent or temporary (reversible).

Answer 415

UROSTOMY - Permanent diversion of the urinary tract involving a stoma. Common indications include: bladder cancer, urinary incontinence, congenital abnormalities, interstitial cystitis. ILEAL CONDUIT- most common type of urostomy the ureter is implanted into a segment of the ileum that is led out through the abdominal wall. The loop of ileum is a passageway for the urine to pass (sometimes the sigmoid colon is used). UTEROSTOMY - More common in paediatrics the ureter is brought to surface of the abdomen creating the stoma on the surface

Answer 416

Techniques used: Terminal or end formation (Colostomy or Ileostomy) Following a bowel resection. The section of bowel that remains attached to the upper GI tract is brought out onto the abdominal surface. The stoma is created by folding the intestine back onto itself and suturing the end to the abdomen. The other end of the colon is either removed or over sewn. It may be temporary Specific Indications: Colostomy - cancer sigmoid colon, inflammatory bowel disease, diverticulitis, trauma, volvulus, May be created to rest a portion of bowel. Ileostomy - When removal of the colon is required, most commonly for inflammatory bowel disease.

Answer 417

Management: Physical: Manage pain, Replace fluid & electrolytes Administer prescribed medications e.g. antibiotics, Physically prep the patient for surgery (may require bowel prep) Psychological & emotional support: Listen to the patients/ family whānau concerns provide a safe environment and offer opportunities for discussion. Identify the patients support systems Offer a visit from a person who has a stoma Offer to be present when the stoma is first viewed

Answer 418

What to expect post op What to expect for pain management What to expect with bowel/bladder function Introduce the patient to the types of appliances and how to fit them. How to clean their stoma Diet changes that they may have to make

Answer 419

Colour (beware of the dusky stoma) should be red / pink Output type, colour, consistency Shape, (spout & size) Note changes in size particularly if it increases in size Surrounding skin condition of skin, redness, ulceration etc If rod or bridge is in place Note the position of the rod and if it is holding the stoma in place Sutures loose, detached, signs of infection

Answer 420

Ongoing assessment for post op complications/ report changes Stoma Nurse specialist consult Medical team review if problems develop Good skin care Appliance review Stoma output, medication and diet review Assess and manage fluid and electrolyte balance Education and support) Listen to the patient regarding their feelings about their altered body image Support groups

Answer 421

A respiratory condition whereby the airway may tighten, partially close, swell and make more mucus when faced with certain triggers. this causes difficulty breathing.

Answer 422

is thought to be caused by a combination of genetic and environmental factors. this included - exercise- induced asthma, can worsen when air is cold or dry - occupational asthma, triggered by workplace irritants such as chemicals, fumes, gases or dust - allergy-induced asthma, triggered by airborne substances such as pollen, smoke, tobacco, pet fur.

Answer 423

an inflammatory response is triggered by allergens= mucous secretion that occludes small airways and causes bronchial hyperreactivity airway inflammation = swelling or oedema of the membranes that line the bronchi and bronchioles mast cells, when activated, release chemical called mediators which cause inflammatory response, leading to an increased blood flow and movement of white blood cells to the area and bronchoconstriction. alveoli in areas distal to airway obstruction become hyper-inflated air trapping within the alveoli causes increased pressure that decreases alveolar perfusion causing a ventilation/ perfusion (V/Q) mismatch. this will initially cause hypoxaemia and eventually cause hypercapnia leading to asthma symptoms.

Answer 424

bronchodilators through nebuliser or spacer administer 02 as prescribed sit patient upright reassurance education mobilise/ rest as tolerated monitor sputum. posterior chest peak flow

Answer 425

A group of lung diseases that block airflow and make it difficult to breathe. Emphysema Chronic Bronchitis

Answer 426

SOBE increased RR decreased SP02 increased HR fever chills Wheeze Crackles on inspiration Cough dullness on percussion chronic cough fatigue sputum production increased frequency of chest infections tripod positioning clammy skin/ diaphoresis dizziness

Answer 427

encourage fluids to moisten secretions position upright to maximise air entry educate breathing techniques. pursed lip breathing, exhalation of c02 bronchodilators ABS

Answer 428

tobacco smoke/ air pollution causes inflammation of the airway epithelium, which leads to infiltration of inflammatory cells and release of cytokines, which can cause systemic effects (muscle weakening and loss) this can lead to continuous bronchial irritation and inflammation - chronic bronchitis (bronchial oedema, hypersecretion of mucus, bacteria; colonisation of airways or breakdown in lung elastic tissue - Emphysema (destruction of alveolar septa and loss of elastic recoil of bronchial walls) both of which can result in - airway obstruction, air trapping, loss of surface area for gas exchange, frequent exacerbations (infection, bronchospasm), Evident by Dyspnea, cough, hypoxemia, hypercapnia or pulmonia.

Answer 429

SOBE increased RR decreased SP02 increased HR fever chills Wheeze Crackles on inspiration Cough dullness on percussion

Answer 430

acute infection of the lung parenchyma

Answer 431

administer ABs encourage fluid intake, IV fluids encourage coughing technique position upright cooling cares educate good hand hygiene.

Answer 432

1. bacteria invades spaced between cells and alveoli 2. inflammatory response + alveolar macrophages try to control infection 3. fluid and mucus buildup in lungs 4. impaired gas exchange and circulation 5. ventilation exceeds pulmonary perfusion (V/Q) mismatch.

Answer 433

influenza is an acute inflammation of nasopharynx, trachea and bronchioles with congestion, oedema and the possibility of necrosis of respiratory structures.

Answer 434

fever cough sore throat runny/ stuffy nose body aches headaches chills upset stomach

Answer 435

1. virus enters the respiratory tract attaching to epithelial cells 2. enters host cell and uses host DNA to replicate the disease 3. new viral spores are released from host cell 4. destruction/ desquamation of trachea and bronchi means on basal layer of epithelium remains 5. damage to epithelial cell wall causes oedema and possibly haemorrhage of submucosa leading to cell death 6. necrotic cells may undergo phagocytosis by macrophages, recruiting neutrophils 7. results in alveolar wall oedema causing ineffective gas exchange.

Answer 436

there are age groups more susceptible to influenza including - elderly - young children and pregnant women - adults and children with chronic disorders of pulmonary and or circulatory systems - those living in nursing homes or long term care.

Answer 437

administer bronchodilators encourage fluids cooling cares educate hand hygiene prevention (immunisation)

Answer 438

is a blockage in one of the pulmonary arteries in the lungs

Answer 439

SOB chest pain cough increased HR or palpitations decreased SP02

Answer 440

a pulmonary embolism is caused by blood clots that travel from the legs, or rarey other parts of the body. (DVT deep vein thrombosis) risk factors include - conditions and disorders that blood clotting as a result of venous stasis - decreased mobility - hypercoagulability - pregnancy and injury to endothelial cells that line vessel - no matter the source, a blood clot becomes an embolus when all or part of it breaks away from the site of formation into the bloodstream

Answer 441

administer anticoagulants encourage regular mobilisation and position changes reassure and educate about PE treatment options administer 02 as required.

Answer 442

increases myocardial oxygen demand and decreased myocardial oxygen delivery results in ineffective myocardial oxygen perfusion

Answer 443

can range from no symptoms, to chest pain, to a heart attack.

Answer 444

1. atherosclerosis leads to heart damage and necrosis of the myocardium 2. heart damage leads to cardiac arrest/ arrhythmias.

Answer 445

coronary artery disease (CAD) is the most common type of heart disease and happens with the arteries that supply blood to the heart muscle (coronary artery) become hardened and narrowed. - A gradual blockage can result in angina. - A sudden or severe blockage can result in heart attack or cardiac arrest. Risk factors - HTN - smoking - diabetes - high fat and cholesterol diet

Answer 446

lifestyle changes, medications, angioplasty and surgery. physical exercise, smoking cessation, weight loss, low fat diet GTN spray medications - statin (decreased liver’s production of harmful cholesterol) - blood thinners (helps prevent blood clots from forming, dissolves old ones) - beta blockers (slows heart rate and decreases blood pressure) - calcium channel blockers (relaxes blood vessels) - heart medications (helps reduce chest pain or pressure caused by blockage in arteries of heart) coronary stent - tube placed in the arteries of the heart to keep them open coronary angioplasty - unblocking an artery by inflating a balloon inside it. A stent may also be inserted to hold artery open coronary artery bypass surgery.

Answer 447

the build up of fats, cholesterol and other substances in and on the artery walls.

Answer 448

Atherosclerosis often has no symptoms until a plaque ruptures or the build up is severe enough to block blood flow. - chest pain. - SOB - Fatigue - tightening of the chest

Answer 449

1. an irritant is present, e.g. lipids, high blood pressure, toxins, diabetes. 2. damage occurs to the endothelium by the irritant- a crack of fissure is formed. 3. LDL cholesterol deposits accumulate in the artery wall known as fatty streaks 4. LDL oxidases and sends signals to the immune system and monocytes (WBC) arrive 5. monocytes convert to macrophages and consume the cholesterol 6. macrophages fill up on cholesterol and die = foam cells 7. formation of foam cells = release of cytokines 8. smooth muscle cells migrate into expanding fatty plaque forming a lipid cap 9. smooth muscle cells also deposit calcium into the fatty plaque, hardening it and causing bulging into the artery lumen 10. blood flow is decreased(resistance increased)and compliance is reduced (less flexibility) 11. ongoing inflammation= plaque rupture, thermogenic material inside cap is exposed= arriving platelets from a thrombus 12. a thrombus is formed and occludes the artery causing ischemia or infarction

Answer 450

high blood pressure high cholesterol high triglycerides smoking and or sources or tobacco insulin resistance, obesity or diabetes inflammation from diseases such as arthritis, lupus or infections or inflammation of unknown cause.

Answer 451

is the heart’s inability to consistently pump enough blood to organs and tissues.

Answer 452

1. MI or cardiac dysfunction / structural abnormality impairs ability of the left ventricle to fill with or eject blood 2. poor ventricular function/ myocardial damage leads to decreased stroke volume and cardiac output 3. leads to a neurohormonal response 4. either sympathetic system activated to increase cardiac workload or RAAS cc c pathways activated 5. results in vasoconstriction and sodium + fluid retention 6. further stress on the ventricular wall and remodeling leads to heart failure.

Answer 453

commonly caused by IHD (decreased contraction, ventricular filling or both). more common among the elderly. can be caused by AF, HTN, diabetes smoking, drinking excessively , HIV and some cytotoxic drugs.

Answer 454

ensure daily weights start FBC and fluid restrictions educate on healthy eating and exercise furosemide?

Answer 455

progressive irreversible loss of kidney function and decreased GFR for at least three months. can lead to AKI, interventions aim to prevent AKI

Answer 456

Nausea Vomiting Loss of appetite Fatigue and weakness Sleep problems Urinating more or less Decreased mental sharpness Muscle cramps Swelling of feet and ankles Dry, itchy skin High blood pressure (hypertension) that's difficult to control Shortness of breath, if fluid builds up in the lungs Chest pain, if fluid builds up around the lining of the heart

Answer 457

At the early stages people have no symptoms: Diabetes Hypertension Smoking Obesity Ethnicity Gender men>women Age - kidney function decreases with age Specific conditions – glomerulonephritis

Answer 458

Nursing interventions: Maintain adequate nutrition Fluid restriction Promote activity & rest as tolerated Provide skin care Provide education on condition & complications Provide culturally appropriate care Psychological/emotional l support Support for smoking cessation

Answer 459

Acute kidney injury (AKI)occurs when the kidneys are unable to remove the body's metabolic waste or perform their seven regulatory functions – in particular, for cardiac week - maintenance of BP and electrolyte regulation

Answer 460

passing less urine (pee) than usual very concentrated urine, or urine looking yellow/brown/red in colour loss of appetite nausea or vomiting fatigue and short of breath feeling confused, anxious and restless, or sleepy swelling of legs or other body parts pain in abdomen or lower back.

Answer 461

Assessments: Fluid balance chart (FBC) Daily weigh (1kg of weight = 1L retained fluid) Skin integrity Vital signs → EWS Capillary refill time (CRT) Palpate and/or scan the bladder Bloods – GFR, electrolytes, CBC Ability to manage ADLs

Answer 462

throbbing pain in 1 leg (rarely both legs), usually in the calf or thigh, when walking or standing up swelling in 1 leg (rarely both legs) warm skin around the painful area red or darkened skin around the painful area – this may be harder to see on brown or black skin swollen veins that are hard or sore when you touch them

Answer 463

DVT (deep vein thrombosis) is a blood clot in a vein, usually in the leg.

Answer 464

Deep venous thrombosis usually begins in venous valve cusps. Thrombi consist of thrombin, fibrin, and red blood cells with relatively few platelets (red thrombi); without treatment, thrombi may propagate proximally or travel to the lungs. 1. Decreased or mechanically altered blood flow 2. Trauma to blood vessels stimulates the clotting cascade 3. Platelets aggregate at the site, especially where venous statis is present 4. Platelets and Fibrin form the initial clot 5. Decreased blood flow leads to decreased oxygenation and increase in hematocrit (increase in RBC in the blood volume) 6. RBC are trapped in the fibrin meshwork 7. Clot may completely occlude blood vessel or embolus may travel to other parts of the body (lungs or brain).

Answer 465

Virchow's Triad distills the multitude of risk factors for DVT into three basic elements favouring thrombus formation: venous stasis, vascular injury and hyper coagulability. Clinical, biochemical, and radiological tests are used to increase the sensitivity and specificity for diagnosing DVT.

Answer 466

The condition where the motor activity of the bowel is impaired, usually without the presence of a physical obstruction.

Answer 467

Abdominal bloating, abdominal distension, Gas, Constipation, Nausea and vomiting, dehydration.

Answer 468

Paralytic ileus occurs when the muscle contractions that move food through your intestines (peristalsis) are temporarily paralyzed. 1. SNS activated intra operatively and bowel motility inhibited 2. Increase in cytokines and inflammatory mediators decrease bowel motility 3. Peristalsis slows then stops 4. This leads to decreased movement of faecal matter through the bowel

Answer 469

Loss of consciousness from several minutes to hours Persistant headache or headache that worsens Repeated vomiting or nausea Convulsions or seizures Dilation of one or both pupils Clear fluids draining from nose and ears Inability to awaken from sleep

Answer 470

Traumatic brain injury occurs when a traumatic event causes that brain to move rapidly within the skull, leading to damage. Damage of neuronal tissues associated with TBI fall into two categories: Primary injury, which is directly caused by mechanical forces during initial insult; and secondary injury, which refers to further tissue and cellular damages following primary insult.

Answer 471

Brain dysfunction caused by an outside force, usually a violent blow to the head.

Answer 472

Motor deficits – most obvious – include: mobility, respiratory function, swallowing and speech, gag reflex, self care abilities Hemiplegia (paralysis) / hemiparesis (weakness) Ataxia = altered coordination of movement & posture (cannot coordinate movement – lost sense of where body part is located, staggering/abnormal walking movements) Dysphagia = altered swallow Communication – Speech = aphasia (inability to use or comprehend words), expressive & receptive dysphasia – depending on area affected these will differ eg – damage to Wernickes area – may have fluent aphasia – faulty understanding of written or spoken words, might produce a string of words with no meaning (word salad), or damage to Brocca area – non fluent – inability to properly form words (know what they want to say but cannot speak the words) Intellectual Function – Both memory and judgement may be impaired, L side damage more likely to result in memory problems, R side tends to mean pt is impulsive Spatial perceptual - more common with R side – patients may deny their illness or their body parts. Neglect of one side of body (may be made worse by homonymous hemianopia) , spatial orientation – can’t judge distances, agnosia – cant recognise an object by sight, touch or hearing, and apraxia – inability to carry out learned sequential movements on command Affect - may have trouble controlling emotions, responses may be exaggerated or unpredictable, depression an issue, frustration, lability Focus in on terminology Hemianopia / diplopia Memory – short & long term affected, low attention & concentration, altered judgement & abstract thought Emotional lability Elimination – symptoms more often temporary than permanent but need to consider functional incontinence (resulting from cognitive, functional or environmental factors)

Answer 473

Ischaemic cascade: - disrupted blood flow - Anaerobic respiration - Lactic acid - Insufficient ATP Ion imbalance: - Increase in intracellular calcium - Increase Glutamate - Vasoconstriction Enlarged area of infarction into penumbra: - Cell membrane and proteins break down - Formation of free radicals - Proteins production decreased - Cell injury and death

Answer 474

Ruptured vessel: - Explosive eruption of blood from vessel into surrounding brain tissue and structure - Haematoma develops - Exposure of brain to blood, an increase in intracranial pressure caused by sudden entry of blood into the tissue, and secondary ischaemia result from reduced blood flow/perfusion. ion imbalance: - Mismatch between blood flow and metabolic demand - Breakdown of sodium/potassium pump maintaining cellular function - Anaerobic respiration to produce ATP - Increased production of lactic acid Cell death: Altered pH Cell membrane and proteins break down - Formation of free radicals - Cell injury and death

Answer 475

Modifiable contributing factors: - High cholesterol - diabetes - Obesity - Inactivity - Smoking and ETOH - Hypertension Non-modifiable contributing factors: Age More common in over 55-year-olds Gender Women have a higher incidence of stroke than men Ethnicity NZ Maori have a greater incidence than non-Maori Greater incidence in South Asian and African/Caribbean population Genetics Small vessel disease in approx. 7% of stroke in young adults

Answer 476

Nursing interventions: Maintain head of bed 30◦ to facilitate jugular venous drainage and help reduce intracranial pressure Maintain systolic blood pressure within prescribed parameters (often < 180mmHg) to reduce the potential for further bleeding or ischaemic changes Continuous neurological observations to help identify deterioration to initiate timely intervention and treatment Ensure correct positioning of paralysed limbs to prevent contractures and maximise function for rehabilitation Ensure patient is kept NBM until swallow is assessed by Speech and Language Therapist to prevent aspiration of oral fluid and food Administer prescribed aspirin orally or enterally to impede clotting and prevent further ischaemia Turn the patient regularly to maintain skin integrity and prevent pressure injury if the patient cannot move themselves

Answer 477

A spinal cord injury (SCI) is damage to the tight bundle of cells and nerves that sends and receives signals from the brain to and from the rest of the body.

Answer 478

HTN (>20mmHg pt baseline) - Bradycardia Headaches Blurred vision Facial Flushing Diaphoresis above level of injury Anxiety and restlessness.

Answer 479

1. Noxious stimulus (distended bladder, constipation etc.) 2. Signals transmitted to spinal cord to initiate SN activation (> HR, > BP - vasoconstriction, > RR) 3. HTN stimulates baroreceptors in carotid bodies. Brain initiates PN activity to reduce BP by slowing HR (bradycardia) 4. Signals to reverse SN activity sent from brain via spinal cord to vasodilate blood vessels, slow HR. This occurs ABOVE SCI level 5. Signals cant pass BELOW level of injury. if noxious stimulus continues, ascending signals continue to initiate SN activity. 6. Results in increasing HTN (associated headache, blurred vision) bradycardia, vasodilation ABOVE SCI level and vasoconstriction BELOW.

Answer 480

Transient concussion (reversible) Contusion - Bursed Laceration- Cut to cord Compression - Squashed cord Transection (irreversible) - cut straight through spinal cord

Answer 481

Interventions: Put the person into sitting position 90◦ to help lower the BP Loosen clothing Assess for the probable cause and remove Continue to assess vital signs (Q2-3min BP) Administer GTN as prescribed if SBP > 150mmHg (short acting anti-hypertensive medications only)

Answer 482

A painful and dangerous condition caused by pressure build-up from internal bleeding or swelling of tissues. The pressure decreases blood flow, depriving muscles and nerves of required nourishment. Occurs in long bone fractures.

Answer 483

Bulging or visible swelling of the muscle. Feeling like the muscle is fuller, swollen or somehow larger than normal. Numbness. Muscle pain that is stronger than you’d expect from the injury. Severe pain when you stretch the muscle. Tightness in the muscle. Tingling or burning sensation in or under your skin, called paresthesias.

Answer 484

Fluid enters a fixed volume compartment (eg from bleeding) Increase in tissue and venous pressure This pressure exceeds capillary perfusion pressure Capillaries collapse Muscle and nerve ischemia occurs OR… External compression (eg plaster cast) Decrease in size of compartment Increase in intracompartment pressure and decrease in arteriolar pressure Leads to muscle and nerve ischemia

Answer 485

Acute compartment syndrome can also occur after injuries without bone fractures, including: Crush injuries Burns Overly tight bandaging Prolonged compression of a limb during a period of unconsciousness Surgery to blood vessels of an arm or leg A blood clot in a blood vessel in an arm or leg Extremely vigorous exercise, especially eccentric movements (extension under pressure)

Answer 486

Pain, Pallor (pale appearance), pulselessness, paresthesia (burning or prickling sensation), poikilothermia (temperature control).

Answer 487

Autonomic dysreflexia is an abnormal, overreaction of the involuntary (autonomic) nervous system to stimulation. The most common cause of Autonomic dysreflexia is spinal cord injuries.

Answer 488

Hypertension Bradycardia Sweating Flushing Pupillary constriction Nasal congestion Pale cool skin Piloerection (goose bumps)

Answer 489

ingrown toenail, constipation intense pain, kinked catheter, distended bladder, urinary tract infection, pressure injury

Answer 490

1. Strong discomfort/pain stimulus sending signal into spinal cord via intact peripheral nerves below T6 lesion 2. CNS senses this input as it travels up the spinal cord evoking a massive Peripheral sympathetic response through spinal reflexes and sends the Sympathetic Nervous System signals and vessels vasoconstrict below the level of the T6 injury 3. Vessels continue to constrict as they are trying to send signals to the brain - peripheral artery hypertension occurs 4. Brain detects hypertensive crisis through baroreceptors in carotid and aortic arch but CAN’T get the signal to relax vessels and decrease blood pressure into the lower extremities because the spinal cord is severed 5. Brain attempts two maneuverers to halt hypertensive crisis May... 6. Attempts to Shut down sympathetic surge by sending descending inhibitory impulses Impulses unable to travel to most sympathetic outflow areas due to spinal cord injury at T6 or above OR.... 6. Attempts to decrease peripheral BP by slowing Heart Rate through an intact vagus (parasympathetic) nerve Compensatory bradycardia is inadequate, and hypertension continues 7. Sympathetic nerves prevail below level of spinal injury and parasympathetic nerves prevail above level of injury causing vasodilation above the level of injury (T6) and Vasoconstriction below T6 injury causes increase BP and the vagus nerve causes bradycardia. 8. Reflex hypertension eases with removal of noxious stimulus

Answer 491

A myocardial infarction (commonly called a heart attack) is an extremely dangerous condition that happens because of a lack of blood flow to your heart muscle. The lack of blood flow can occur because of many different factors but is usually related to a blockage in one or more of your heart’s arteries. Without blood flow, the affected heart muscle will begin to die. If blood flow isn’t restored quickly, a heart attack can cause permanent heart damage and death.

Answer 492

Chest pain (angina). This can be mild and feel like discomfort or heaviness, or it can be severe and feel like crushing pain. It may start in your chest and spread (or radiate) to other areas like your left arm (or both arms), shoulder, neck, jaw, back or down toward your waist. Shortness of breath or trouble breathing. Fatigue. Trouble sleeping (insomnia). Nausea or stomach discomfort. Heart attacks can often be mistaken for indigestion or heartburn. Heart palpitations. Anxiety or a feeling of “impending doom.” Sweating. Feeling lightheaded, dizzy or passing out.

Answer 493

myocardial infarction is usually due to thrombotic occlusion of a coronary vessel caused by rupture of a vulnerable plaque. Ischemia induces profound metabolic and ionic perturbations in the affected myocardium and causes rapid depression of systolic function. Prolonged myocardial ischemia activates a "wavefront" of cardiomyocyte death that extends from the subendocardium to the subepicardium. Mitochondrial alterations are prominently involved in apoptosis and necrosis of cardiomyocytes in the infarcted heart.

Answer 494

Coronary artery spasm. Rare medical conditions: An example of this would be any disease that causes unusual narrowing of blood vessels. Trauma: This includes tears or ruptures in the coronary arteries. Obstruction that came from somewhere else in your body: A blood clot or air bubble (embolism) that gets trapped in a coronary artery. Electrolyte imbalance. Eating disorders: Over time, these can damage your heart and ultimately result in a heart attack. Takotsubo or stress cardiomyopathy. Anomalous coronary arteries (a congenital heart defect you’re born with where the coronary arteries are in different positions than normal in your body. Compression of these causes a heart attack).

Answer 495

Interventions: Supplemental oxygen Medications Education

Answer 496

a type of chest pain caused by reduced blood flow to the heart

Answer 497

Discomfort, heaviness or tightness of the chest which may spread to the back, shoulders, neck or jaw. Other people describe it as a dull ache Discomfort in the arm, neck or jaw with no chest discomfort The discomfort can range from mild or dull to severe.

Answer 498

Angina is usually caused by coronary artery disease (also called atherosclerosis), which is the build-up of plaque in the walls of your arteries

Answer 499

Almost invariably, angina is associated with significant obstruction of at least one major coronary artery. Oxygen demands not met. Normally, the myocardium extracts a large amount of oxygen from the coronary circulation to meet its continuous demands. Increased demand. When there is an increase in demand, flow through the coronary arteries needs to be increased. Ischemia. When there is blockage in a coronary artery, flow cannot be increased, and ischemia results which may lead to necrosis or myocardial infarction. Schematic Diagram for Angina Pectoris via Scribd.

Answer 500

Partial or complete collapse of a lobe or the entire lung, common post op complication.

Answer 501

Atelectasis often causes no symptoms on its own, though some underlying conditions that lead to atelectasis (like COPD) can cause symptoms. However symptoms that may be experienced are: Trouble breathing/shortness of breath (dyspnea). Coughing. Chest pain. Rapid breathing (tachypnea). Skin and lips turning blue. Increased HR Decreased O2 Decreased chest expansion on one or both sides

Answer 502

Reduced ventilation or blockage Obstruction of air to and from alveoli Trapped air absorbed into bloodstream, blockage stops further air entering alveoli Area of lung becomes airless Lung collapse Respiratory distress

Answer 503

Reduced Alveolar ventilation due to compression or absorption Trapped 02 is absorbed in the blood stream No further 02 is absorbed because of blockage Alveoli collapse leading to acute respiratory distress

Answer 504

Intervention: Deep breathing exercises - DBE aim to allow as much oxygen in as possible to increase lung expansion and remove any sputum that may be present. DBE can re-expand the lung tissue such as alveoli that are unable to be inflated correctly during atelectasis. Nursing actions to prevent atelectasis: 1. Spirometer is used to help the lungs to strengthen by encourage deep, full breaths. The pt aims to breathe in slowly and hold their breath for as long as comfortable. this device should be used at least 10 times every hour to promote recovery. 2. Administer bronchodilators 3. Have pt sitting upright to increase lung expansion and gas exchange 4. Education on breathing techniques and importance of coughing to excrete mucous.

Answer 505

There are two types of meningitis, Bacterial and viral. Bacterial- the entry of bacteria into the cerebrospinal fluid (CSF) and bacterial growth in this compartment leading to inflammation within the CSF and the adjacent brain tissue. Viral - Once the virus has replicated and caused dysfunction within the immune system, it is able to cross the BBB (Blood-brain barrier) where it enters the cerebrospinal fluid

Answer 506

Not having completed childhood vaccinations, Children under the age of 5 years and adults over 50 years, living in overcrowded houses and co morbidities.

Answer 507

Infants and children- Fever, crying, unsettled, irritable, vomiting, sleeping, harder to wake, reluctant to walk, rash Teens and adults- Fever, Headache, vomiting, sleeping, confusion, delirious, Unconscious, joint pain, aching muscles, stiff neck, photophobia, rash.

Answer 508

An opening on the abdomen. connected to either the digestive system or urinary system to allow waste to divert out of the body.

Answer 509

Colostomy: Opening from the large intestine through the abdomen. can be temporary or permanent. can be located in ascending, transverse, descending, or sigmoid. Ileostomy: opening in the abdomen wall located on the right lower abdomen, at the end of the ileum. Urostomy: opening in the abdominal wall. re- directs urines away from the bladder thats diseased or injured.

Answer 510

Pouches needs to be changed every 3-7 days but the pouch needs to be emptied regularly every day to decrease the risk of infections. it can take the stoma a few days to work correctly therefore, slowly introduce foods.

Answer 511

Is there fluid in the wound? If so, what type? - An intact or ruptured fluid-filled blister corresponds to a stage 2 pressure injury - An intact or ruptured blood-filled blister corresponds to a deep tissue pressure injury

Answer 512

What colour is the wound? Reddened, intact tissue that doesn’t blanch indicates stage 1 pressure injury Pink or red tissue that’s moist and superficial indicates stage 2 pressure injury Dark red, purple, or maroon tissue with or without the overlying skin indicates a deep tissue pressure injury

Answer 513

- What tissues do you see or feel in the wound bed? - Slough or eschar obscuring the wound bed so that you can’t determine the level of tissue destruction is an unstageable pressure injury - If adipose tissue is visible in the wound (globular, yellow appearance and/or granulation tissue) then you know it is a stage 3 pressure injury - Any wound with the deeper tissues exposed or palpable (fascia, muscle, ligament, tendon, cartilage or bone) is a stage 4 pressure injury

Answer 514

Tools Frameworks Processes Policies Procedures Best Practice Guidelines

Answer 515

A - Assess D - Nursing Diagnoses (Identify actual problems and potential problems) P - Plan care and undertake I - Intervention (intervene in their care for a better outcome for the patient - sitting them up 90 degrees to increase lung expansion and better breathing) E - Evaluate care

Answer 516

Psychosocial Patients account of their history/presentation Vital signs Systems review Subjective (questioning) and objective (physical examination) data Medications Discharge planning and ongoing care Education and health promotion needs Discharge considerations Assessment summary

Answer 517

C - Character (describe…) O - Onset (When did it begin?) L - Location (where is it? Does it radiate?) D - Duration (How long does it last? Does it recur?) S - Severity (How bad is it?) P - Pattern (What makes it better or worse?) A - Associated Factors (What other symptoms occur with it? How does it affect you and every day life?)

Answer 518

Eye Opening Response: 4 - Spontaneous 3 - To Sound 2 - To Pain 1 - Non Coma: no eye opening Best Verbal: 5 - Response/Orientation 4 - Confused 3 - Inappropriate words 2 - Incomprehensible sounds 1 - None Best Motor Response: 6 - Obeys Commands 5 - Localises to stimulus/pain 4 - Withdraws from painful stimulus (flexion) 3 - Abnormal flexion in response to pain (decorticate rigidity) 2 - Abnormal extension in response to pain (decerebrate rigidity) 1 - Flaccid/no response

Answer 519

The Glasgow Coma Scale is a clinical scale used to reliably measure a person’s level of consciousness after a brain injury. The GCS assesses a person based on their ability to perform eye movements, speak, and move their body.

Answer 520

A - Alert - The patient is lucid and fully responsive, can answer your questions, can see what you’re doing V - Voice - The patient responds to your voice, but may be drowsy, keeps their eyes closed and may not speak coherently P - Pain - The patient is not alert and does not respond to your voice, but a painful stimulus. EG, shaking the shoulders or possibly pinching an war lobe, elicits a response U - Unresponsive - The patient is unresponsive to any of the above. They are unconscious (anything other than A, then perform a GCS)

Answer 521

Tool used for handover of information clearly and concisely: I - Identify S - Situation B - Background A - Assessment R - Request/Recommendations

Answer 522

Correct the Immediate and Life-threatening problems Treat the cause Prevent further attacks/episodes/complications

Answer 523

Approved Generic name and drug group or category Monitoring requirements Patient education Common adverse effects and how to detect them Significant drug interactions, contra-indications and precautions Pharmacodynamics mechanism and site of action Pharmacokinetics particular parameters and concerns to be aware of

Answer 524

DVT is formed when red blood cells, fibrin and platelets bind together and create a clot. Increased numbers of fibrin and blood cells build up behind the thrombus and attach to it increasing the size of the clot

Answer 525

Administer asprin as prescribed to reduce the ability of the blood to clot and so the blood flows easier through narrowed arteries Administer oxygen as prescribed to keep Sp02 levels within target and to increase oxygen levels Reassurance to decrease the SNS response and therefore decrease HR Educate around stress and relaxation techniques. Stress causes a persistent increase in cortisol levels, which is linked to cardiac function as well as increase adrenaline levels which increases HR and RR.

Answer 526

A Maintain bed rest to reduce risk of thrombus dislodging Administer anticoagulants to breakdown clot and prevent further clot formation Elevate legs above heart to reduce stasis and decrease swelling Apply TED stockings as prescribed as compression stocking enhance circulation by providing a graduated pressure on the leg to help return the venous blood to the heart

Answer 527

- Anxiety - Agitation - Confusion - Drowsiness - Pain

Answer 528

- Diaphoresis - Pallor - Cyanosis (blue tinge, think about peripheral (capillary refit test.) Looking around the lip, face and sternum) - Flushing - Digital clubbing

Answer 529

- Short-acting (SABAs) = relieve the effects - Long-acting (LABA) = controllers

Answer 530

- Provide relief for 4-6 hours - Rapid onset of action - 5-10 mins - Can be used in an acute asthma attack (usually blue inhalers)

Answer 531

- Long duration of action (12hrs) - Slow onset of action - Not to be used to relieve acute symptoms

Answer 532

- Potent anti-inflammatory agents - Given via inhalation route greatly reduced systemic adverse effects - EG. Fluticasone (Flixotide), Beclomethasone (Beclazone) - Reduce the hyper-responsiveness of the bronchial smooth muscle to irritants

Answer 533

- INHALER: Pushes out a pre-measured spray of asthma medicine - SPACER: A spacer is a specially designed plastic tube for use with an inhaler. A spacer used with a puffer delivers more medication into the lungs than using a puffer on it’s own - NEBULISER: A machine that converts liquid medication into a fine mist, which is inhaled through a mask or mouthpiece

Answer 534

Hypercapnia (Greater than normal levels of C02) and Hypoxaemia (Less than normal levels of 02 in the blood)

Answer 535

- Tachypnoea (Increased Respiratory rate) to “blow off” excess CO2 - Use of accessory muscles to increase chest expansion and help with forced exhalation to expel CO2 and recruit 02

Answer 536

- Tachypnoea once PO2 < 60mmHg to recruit more 02 - Activation of sympathetic nervous system response (increase Heart rate, Blood pressure) to increase 02 circulation to tissues - Peripheral vasoconstriction (poor peripheral perfusion) to prevent O2 for vital organs

Answer 537

The reversal of Hypoxaemia and Hypoxia

Answer 538

- NASAL PRONGS: - Used when low to medium concentration of 02 is required - Greater than 4L/min may dry out nasal mucosa - Useful when the patient is eating and cannot use a face mask - SIMPLE FACE MASK (may also be called a Hudson Mask): - Inspired oxygen concentration varies with litre flow, rate and depth of reparations - There are other types of masks I.e. patient disease-specific

Answer 539

- Decreased respiratory rate - Increase in depth of respirations - Increase tissue oxygenation (mucous membranes, not just Sp02) - Decrease work of breathing/accessory muscle use - Decrease work of myocardium in patients with cardiac disease - Increased Sp02 levels

Answer 540

When your kidneys are damaged, they produce less erythropoietin (EPO), a hormone that signals your bone marrow—the spongy tissue inside most of your bones—to make red blood cells. With less EPO, your body makes fewer red blood cells, and less oxygen is delivered to your organs and tissues

Answer 541

- Prior heart attack, high blood pressure and coronary artery disease can lead to heart failure and impacts the ability to efficiently pump blood to the rest of the body - As a result, the heart may beat faster and the left ventricle may increase in size becoming an even less effective pump - When the kidneys sense the reduced blood flow, they attempt to compensate by retaining more water and salt - This excess fluid retention often causes congestion in tissues and results in swelling and an increased strain on the weakened heart - The progressive effect of the heart failing to properly circulate blood and congestion due to fluid retention is known as congestive heart failure

Answer 542

Related to fluid excess. As the heart starts to fail, renal perfusion falls. The kidneys respond by increasing the production of renin, leading to more aldosterone production, which is consequently followed by sodium and water retention with less urine production with these products and try and maintain/increase BP

Answer 543

- Blob-like structure called Glomerulus | - Long Stringy structure called Tubule

Answer 544

- The glomerulus works like a sift to only allow specific ingredients such as vitamins and minerals to pass into the tubule - The tubule detects whether any of those ingredients are needed in the body, if they are needed, they are reabsorbed in amounts the body needs so they can circulate in the blood again. The tubules also sense compounds that the body doesn’t need (urea, left over from the breakdown of proteins) and redirect them as urine, transporting it out of the kidneys via 2 ureters

Answer 545

Loss of elasticity in arterial vessels

Answer 546

D. Intermittent claudication due to peripheral ischaemia

Answer 547

A. A blockage of a coronary artery

Answer 548

D. Commence daily weighs

Answer 549

A. An arryrhythmia

Answer 550

B. Undertake an assessment using the rapid assessment framework

Answer 551

A. ask the patient to describe the character of the stools and any associated symptoms

Answer 552

D. vital signs and the early warning score

Answer 553

A. impaired peristalsis

Answer 554

A. Restlessness

Answer 555

C. Empyema

Answer 556

D. Impaired tissue perfusion

Answer 557

D. Baroreceptors in the aortic arch and carotid body

Answer 558

A. Release of aldosterone, which increases serum osmolarity, causing release of antidiuretic hormone (ADH)

Answer 559

D. crackles in the right and left lobes with productive green sputum.

Answer 560

A. respiratory rate

Answer 561

A. aspiration.

Answer 562

A. Stop the infusion and seek assistance immediately.

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