Nursing the person with deteriorating health (Powerpoint)

What are you looking for when assessing someone’s airway?
Look- Obstruction, nostril flaring, accessory muscles, cyanosis; Listen- Airway noises; Feel- Breathe
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List 3 things when assessing circulation?
Look - LOC, HR, CRT, colour, urine output, ECG/cardiac monitoring; Listen- BP; Feel- Temp, pulse
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Discuss 2 reasons why critical outreach was introduced to clinical practice?
The Comprehensive critical care review (2000) found that there was a need to recognised the deteriorating patient and appropriately manage them, it also highlighted problems with poor communication and recognised delays in treating them
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Discuss the main purpose of critical outreach teams?
Reduce ICU admissions through earl intervention and treatment, enable discharge from critical care wards to general wards, share knowledge and skills with ward based staff (Comprehensive Critical Care Review, 2000)
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What are the levels of care?
Level 0 - General ward care; Level 1 - Risk of deterioration or recent step down; Level 2 - Single organ failure or stepping down; Level 3 - Multi organ failure and respiratory support; Critical care w/o walls - All nurses with critical care knowledg
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What are you looking for when assessing someone’s breathing?
Look - Resps, chest rising (bilaterally), swelling, patterns (seesaw etc), sats; Listen- oscillation, (wheeze, stridor, ronchi) Feel- tracheal deviation, percussion
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What is the equation for MAP?
*123* 1(SBP) + 2(DBP) ÷ 3 = MAP
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Why is mean arterial pressure important?
Mean arterial pressure is significant because it measures the pressure necessary for adequate perfusion of the organs of the body.
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List 3 things when assessing Disability?
conscious level (AVPU + C), Pupil reaction (PEARL - Pupils are equal, round, reactive to light), blood glucose.
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List 3 things when assessing Exposure?
Top to toe assessment - Rashes, signs of trauma, swelling, temperature and colour, full history and review notes/investigations
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What does SBAR stand for?
Situation, Background, Assessment, Recommendation
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What did the comprehensive critical care review (2000) find?
The review found that the deteriorating patient was not always recognised efficiently and managed resulting in delays in treating them, it also highlighted problems with poor communication and identifies the need for levels of care to be introduced
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What did the National Patient Safety Agency (NPSA, 2007) find?
Patient deterioration is not recognised, effectively managed, communication and documentation was poor, lack of experience, more consultant presence needed evening/nights
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What did the National Confidential Enquiry into Patient Outcome and Death (NCEPOD, 2005) find?
Variables that lead to poor patient outcomes - Tailoring oxygen therapy, Maintaining a patients airway and breathing,Maintaining adequate fluid balance
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What observations are recorded on a NEWS Score?
respiratory rate, oxygen saturations, blood pressure, pulse rate, level of consciousness, Temperature
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What are the changes on the NEWS 2?
Follow A-E sequence, Show parameters, SPO2 scale for patients with altered sats range 88-92%, c added to ACVPU, sepsis flag,
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What are the 4 layers of the heart?
Endocardium, Myocardium, Epicardium, Pericardium.
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What is the cardiac cycle?
Cardiac cycle refers to all events associated with blood flow through the heart, Systole – contraction of heart muscle, Diastole – relaxation of heart muscle
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What is ischaemia?
Supply of oxygen to myocardial cells temporarily insufficient to meet demand, No permanent damage, as long as balance is restored quickly.
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What is Infarction?
Caused by prolonged cessation of oxygenated blood supply to myocardial cells, Irreversible damage to cells within 20 minutes
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What are the 3 conditions associated with ACS?
Unstable angina, NSTEMI, Stemi
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What is troponin and why is it measured,
Troponin is an enzyme that can indicate damage to cardiac cells
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What are the two forms of treatment for MI?
Chemical - Thrombolysis / Mechanical - PPCI
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Munro Kellie hypothesis
The skull is a rigid compartment containing three components: brain, blood, and cerebrospinal fluid,- it states that all volume components are constant and in a state of equilibrium
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What is ICP?
Brain tissue = 83% of volume within skull, Cerebral blood volume = 8%, CSF = 9%, The pressure these exerts within the skull equates as the intracranial pressure, An ICP of greater than 20mmHg is regarded as raised.
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Cerebral Perfusion Pressure
Blood (pressure) flowing into the brain (MAP), competing with pressure coming down from the brain (ICP) = Cerebral Perfusion pressure (CPP) (Normal = 70-90mmHg)
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What is asthma
Asthma is a long-term condition that results in inflammation and narrowing of the airways, muscle is hypertrophied, Characterised by periodic acute episodes of acute narrowing of the airways - bronchospasm
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Advantages of witness resus?
Opportunity to say goodbye, able to see that there is everything been done, non dying alone, positive affect on grieving process.
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Disadvantages of witness resus?
traumatic event, possible repercussions (complaints, legal action), families may try to interfere, team may feel uncomfortable and under pressure to carry on, patient confidentiality and dignity, adequate space, may cause relatives to faint
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What is the correct procedure to ensure effective witness resus?
relatives to be chaperoned at all times, made aware off who else is in the room and their roles, prepare them before entering, inform them of their right to leave at any time and address elephant in room, may be upsetting, what they may see, hear etc
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Which bottle comes first in blood cultures ?
Aerobic first as there will be air in the needle.
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Whats does the acronym SCENE stand for in pre hospital care?
Safety – PPE, environment•Casualties – Numbers? Triage?•Events – MOI, predicted injury pattern?•Needs – drugs, specialists, other agencies?•Equipment
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What are the 3 points that make up the trauma tired of death?
Coagulopathy, Metabolic acidosis, Hypothermia
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What is AKI?
Acute Kidney Injury is characterised by a rapid reduction in kidney function resulting in a failure to maintain fluid, electrolyte and acid base balance homeostasis”
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What are the M's to prevent AKI?
Monitor Patient, Maintain circulation, Minimise kidney insult, Manage acute illness
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What are the Non-Pharmacological Techniques to manage delirium
assess environment (lighting, noise, orientation, personalisation, temperature) ADL's (dehystraion, constipation, nutrition) Butterfly scheme? involve relatives carers,
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What are the Pharmacological Techniques to manage delirium
analgesia (pain management), only to be used after non-pharm techniques, 0.5-1mg Haleperidol, 0.5mg-1mg lorazepam
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Frank and starling law of the heart
the stroke volume of the heart increases in response to an increase in the volume of blood in the ventricles, before contraction (the end diastolic volume)
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what is lactate and indicator of? and what is normal
Lactate – indicates adequacy of tissue perfusion and/or anaerobic respiration, Should be 2mmol per litre or less
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What is hypovolaemic shock and how is it treated simply?
Hypovolaemic shock is caused by a reduction in volume – treat that rapidly and support with fluids and oxygen as appropriate
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What is cardiogenic shock and how is it treated simply?
Cardiogenic shock is caused by pump failure – treat that rapidly and support with nitrates, diuretics and inotropes as appropriate
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what are crystalloids?
Crystalloids contain small molecules that flow easily across semipermeable membranes, allowing for transfer from the bloodstream into the cells and body tissues increasing fluid volume interstitial & intravascular space. Electrolytes can be added
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what are colloids
Colloids contain larger molecules that do not pass across diffusional barriers as readily as crystalloids, therefore remaining intravascular spaces and enhance plasma volume greater then crystalloids. more expensive but smaller amount needed
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what is sepsis?
sepsis is a life-threatening condition that arises when the body’s response to infection injures its own tissues,
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what are the 3 specific signs of anaphylaxis?
Acute onset of illness, skin and/or mucosal changes, life-threatening Airway and/or Breathing and/or Circulation problems
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what are the 3 types of anaphylaxis reactions
Uniphasic - quick onset, rapid decline, symptoms disappear after treatmeant and don't return; Bi-phasic - mild -serves symptoms at start, may disappear and then return with increasing bp & breathing problems; Protracted anaphylaxis - can last days
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what is the dose of adrenaline given during anaphylaxis?
Dose in adults: 0.5 mg = 1:1000, 0.5 ml. can be repeated if no response to 1st dose (5 minutes later). (best administer IM)
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what are the second line treatments for anaphylaxis?
02, iv fluid, Salbutamol, Anti-histmine and steroids
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Other cards in this set

Card 2


List 3 things when assessing circulation?


Look - LOC, HR, CRT, colour, urine output, ECG/cardiac monitoring; Listen- BP; Feel- Temp, pulse

Card 3


Discuss 2 reasons why critical outreach was introduced to clinical practice?


Preview of the front of card 3

Card 4


Discuss the main purpose of critical outreach teams?


Preview of the front of card 4

Card 5


What are the levels of care?


Preview of the front of card 5
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