NRSG258 - part 2

Question 1

Pre-op medications

Answer 1

sedation, prophylactic medication, anti-anxiety, regular medications

Question 2

Intra-op medications

Answer 2

anaesthetics, sedation, muscle relaxation, pain relief, prophylactic medication

Question 3

post-op medications

Answer 3

analgesics, antibiotics, laxatives

Question 4

Consent

Answer 4

Voluntary
Specific
Informed
Legal capacity

Question 5

Withdrawal of consent

Answer 5

Consent can be withdrawn at any time if the patient has legal capacity•Patient can refuse to continue with a procedure even if it means physical injury or death•The law about consent involves understanding

Question 6

Factors Affecting Legal Capacity

Answer 6

Unconscious

Has an intellectual disability such as dementia or brain injury (This may depends on degree)

An emergency

A child

Question 7

Threshold Test of Capacity

Answer 7

must be able to understand the nature, effect and treatment, voluntarily given and can communicate the decision to another person

Question 8

Consent - Other factors that may affect capacity:

Answer 8

Severe pain
opioids
being under the influence of illegal drugs or alcohol language barriers

Question 9

Emergency Treatment

Answer 9

the health professional may provide reasonable treatment to ‘save life’ or ‘prevent serious injury or death’ for both adults and children‘

Where a patient is unconscious or is incapable of consenting the common law will deem a consent for the treatment given provided that it was necessary, reasonable and given in good faith’.

Question 10

Age of consent (NSW)

Answer 10

14

Question 11

Power of Attorney

Answer 11

A legal document where a person over 18 years and of sound mind is appointed by you to make limited or total financial decisions on your behalf e.g. manage shares, pay bills

General POA ends if you lose legal capacity

Organised with a solicitor

Question 12

Enduring/Medical POA

Answer 12

A legal document where you appoint someone to make decisions for you if you lose capacity

Can be medical or finances or both

You can revoke this at any time as long as long as you have legal capacity

Witnesses must sign all POAs

Organisedwith a solicitor

Question 13

The Coroner

Answer 13

An official who investigates cause of death, health and safety issues related to the death or actions required to prevent similar deaths

Question 14

Deaths ‘reportable’ to the Coroner

Answer 14

Unexpected; violent or unnatural (homicide or suicide); due accident or injury (drowning, MVA, fire)

Occurred during or following a health-related procedure where the doctor would not have expected the death. While under or as a result of an anaesthetic

Death certificate has not been signed as cause of death unclear

Death that occurs within 24hrs of presentation to hospital or 24 post any surgery

Or if the person:
Had not been attended by a doctor in the last six months
Is of unknown identity
Died in custody
Was in or temporarily absent from a mental health facility

Question 15

Nurse’s Role in a Reportable Death

Answer 15

Awareness of the documentation required to certify death and how to prepare the body.

Minimum interference with the body all tubing left in the patent

Needles taped down

Drains are placed in appropriate containers and kept with the body

Person cannot be washed

Family can visit but must be supervised

Question 16

Clinical documentation

Answer 16

Contain the date and time

Be brief, accurate, complete, legible, objective

Only use accepted medical abbreviations and correct medical terminology

Signed – (print your surname) and identify your role (student nurse; R.N.)

Must be in English.

Notes should be factual and objective

Observations including frequency and changes; medications; pain management; wound; fluid status; nutrition status; adverse events; deterioration/ improvement; tests and procedures;

Verbs –states, denies, complained of, requested…

Specific statements

Objective statements

Maintain confidentiality

Question 17

Documentation - Structure

Answer 17

A – Airway
Respiratory – Airway + Breathing
B – Breathing
CVS - Circulation
C –Circulation
CNS -Disability
D –Disability
GIT –Diet/ Bowels
E – Exposure
Renal – Fluids in and out
F –Fluids/Full set vital signs)
Integumentary – Exposure
G –Glucose/ Give comfort measures
General/Social
H –Head to toe assessment

Question 18

What is the common (lay) name for the Zygoma

Answer 18

cheekbone

Question 19

A&P and pathophysiology # zygoma

Answer 19

Articulates the frontal, maxillary and temporal bones as a result Zygomatico maxillary fractures can cause significant impairment to function and appearance of the midface and orbit.

The ZMC is an important buttress for the face, provides the prominence of the cheek, and determines the midface width with the zygomatic arch.

Forms the lateral walls and floors of the orbits •Often associated with orbital #

It is the second most common facial fracture, and it is often a challenge to adequately repair these fractures with a high potential for complications.

Question 20

Discharge planning and transfer of care - IDEAL

Answer 20

Begins on admission

Should be specific to the patient and their needs (IDEAL

)Include– patient and family (with consent)

Discuss– home, medications, problems, warning signs, follow-up appointments

Educate– patient’s condition in plain language

Assess– how well education from doctors & nurses has been

Listen– and respect patient’s goals, preferences, concerns

Question 21

Management of open facial #

Answer 21

• Spinal precautions
• Assess for airway obstruction -dysphonia
• Adequate ventilation and oxygenation
• Control bleeding with direct pressure
• Control epistaxis with direct pressure (Avoid blowing nose)
• Prophylactic antibiotics
• Monitor LOC and pain
• fractures may be treated by performing a closed reduction (resetting the broken bone or bones without surgery) or an open reduction (surgery that requires an incision to reposition the fractured bones).
• For a complex fracture with multiple broken bones, reconstructive surgery is required.
• The type of treatment will depend on the location and extent of the injury.
• The aim of treatment for facial fractures is to restore the normal appearance and function of the injured areas.
• Life-threatening conditions, such as blockage of the airways, cardiovascular problems, or brain or nervous system injuries, must be treated immediately.

Question 22

PACU – patient monitoring

Answer 22

• Receive handover from anaesthetist and assess patient’s condition
• Ensure patient can maintain airway and breathe spontaneously
• Observe/report/manage immediate post-op complications
• Normalise temperature
• Monitor, report and record intake as well as output e.g. drips, drains, etc.
• Assess and manage pain, alertness, distress, nausea/vomiting
• Undertake relevant observations e.g. colostomy, flap, limb, neurological
• Answer questions and provide reassurance
• Determine when patient is ready to transfer to ward

Question 23

Types of wound closure

Answer 23

• Primary intention
• Secondary intention
• Tertiary Intention

Question 24

Primary intention

Answer 24

Edges of wound brought together e.g. surgical incision

Question 25

Secondary intention

Answer 25

• Spontaneous healing

* Wound left open to epithelialise and contract e.g. infected/contaminated wounds or dehisced surgical wounds

Question 26

Tertiary Intention

Answer 26

• Delayed primary closure

* Wound left open and surgical closure when wound is clean

Question 27

Clinical handover - ISBAR

Answer 27

I   
Identify patient (3 identifiers) , you and your role

S
State immediate clinical situation (diagnosis/reason for admission/current issues)

B
Provide relevant background/medical history

A
Identify assessments and needsList most important and recent observations

R

• Outline any nursing/medical plans (where you are up to with this/what needs to be done)
• Identify timeframes and transition of careUse patient records to cross-check information
• Ensure documentation of all findings or changes of condition
• Ensure comprehension, acknowledgement and acceptance of responsibility for the patient by the clinician receiving handover