A-E, ABG, consent Flashcards

Question

Discuss respiratory compensation

Answer 1

* If a metabolic acidosis develops the change is sensed by chemoreceptors centrally in the medulla oblongata and peripherally in the carotid bodies. * The body responds by increasing depth and rate of respiration therefore increasing the excretion of CO2 to try to keep the pH constant. * The classic example of this is ‘Kussmaul breathing’ the deep sighing pattern of respiration seen in severe acidosis including diabetic ketoacidosis. **Here you will see a low pH and a low pCO2 which would be described as a metabolic acidosis with partial respiratory compensation (partial as a normal pH has not been reached).**

Answer 2

* In response to a respiratory acidosis, for example in CO2 retention secondary to COPD, the kidneys will start to retain more HCO3 in order to correct the pH. * **Here you would see a low normal pH with a high CO2 and high bicarbonate.** * This process takes place over days. * It is important to ensure that the compensation that you see is appropriate, i.e. as you would expect. If not then you should start to think about mixed acid base disorders.

Answer 3

1. State that this is an arterial blood gas sample (rather than venous). 2. State the patients name and outline history/pertinent examination findings. 3. State the time the sample was taken and how much oxygen the patient was on at the time. 4. Present your findings: e.g. this showed type one respiratory failure with a p02 of 7 5. Present any abnormal findings or important negatives from the rest of the values. 6. A one line summary of your findings

Answer 4

Minor procedures e.g. venepuncture, physical examination, small wound closure, ECG etc

Answer 5

Record the consent discussion in the patient's notes

Answer 6

Treatment can be provided without consent provided it is immediately necessary to save their life or to prevent serious deterioration

Answer 7

Given voluntarily and freely without pressure or undue influence being exerted to accept or refuse treatment. The person must be appropriately informed and have capacity to consent

Answer 8

Consent may only be provided by the patient, someone authorised to do so under a Lasting Power of Attorney, or someone who has the authority to make treatment decisions, such as a court appointed deputy in England and Wales, or a guardian with welfare powers in Scotland. No one else can make a decision on behalf of an adult who has capacity

Answer 9

The use or threat of using force to make a person do something they are resisting, the restriction of liberty of movement whether or not the person resists

Answer 10

* The person using it believes it is necessary to prevent harm to the person lacking capacity * The restraint used is a proportionate response to the likelihood and seriousness of harm * The action does not conflict with a previous decision made by an attorney

Answer 11

If the patient might have capacity, but assessment is not possible immediately, then restraint may be used lawfully in certain emergency circumstances (as a last resort)

Answer 12

The Bolam test is a test that can be carried out to ascertain whether a doctor or other medical professional has breached their duty of care to a patient. states that if a doctor reaches the standard of a responsible body of medical opinion, they are not negligent. If a person falls below the appropriate standard and is negligent they are failing to do what a reasonable person would do

Answer 13

* Basically outlines that when providing consent for anything, patients need to be told all of the risks and not just those the doctor sees as necessary to inform of - this is because the person experiencing the procedure or intervention or treatment may be significant to the patient but not significant to the doctor. * Material risk is a risk that is deemed to be of significance by an individual patient rather than by a body of doctors. In order to discover what may concern a patient, it is imperative that a doctor endeavours to find out what matters to each patient. “A material risk is one that a reasonable person in the patient’s position is likely to attach significance to, or if the doctor is or should reasonably be aware that their patient would be likely to attach significance to it.” * As a result, it is advisable to inform the patient of all significant possible and/or unavoidable risks however unlikely, the potential benefits of treatment, the risks of procedural failure, details of alternatives to that particular treatment, and the risks incurred by doing nothing.

Answer 14

If competent, they must still receive the basic information required in order to give valid consent. Such information is likely to include whether the procedure is invasive, what level of pain they might experience, what can be done to minimise this, and if it involves any serious risks. Patient refusal to know in detail about the proposed treatment should be carefully documented in the patient’s notes

Answer 15

If they are deemed to be competent * Competency does not just relate to age and maturity of the child but also to the specific treatment * At 16 children are generally presumed to have capacity to give consent * Parents cannot override competent consent given by a child * If parents are trying to override competent refusal of a child then legal advice should be sought

A-E, ABG, consent Flashcards

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