How can Asprin affect a wound?
It can inhibit tensile strength of skin and prolong healing time.
What is pain?
Pain is the conscious awareness or recognition of a nociceptive stimulus
List the four types of pain
- Acute pain
- Chronic pain
- Somatic pain
- Neuropathic pain
Falls and the consequences in the elderly population are becoming increasingly common. what interventions would you put in place to minimise the risk for an elderly patient in hospital?
The following interventions would be done:
- falls risk assessment and plan
- non slip socks
- mini mental exam
- call bell within reach
- aids and equipment nearby (e.g- glasses, walking aid, urinal, hearing aids)
- lower the bed to the ground
- supervised mobilisation
- PCA “guard”supervision” if confused
- medication review
- place patient near nurses station
With regards to skin traction, explain why the traction force is applied over a wide area and why it is applied distal to the fracture?
Traction is applied over a wide area to evenly distribute pulling force. It is applied distal to maintain a pulling force on the ‘end” of the bone.
List the integumentary conditions that are influenced by genetic factors
- Albinism
- eczema
- Hypohidrotic ectoderm all displagia
- incontinentia pigmenti
- neurofibromatosis elasticum
- psoriasis
Why is documentation so important?
- to identify reason for admission, care already received and doctors orders
- to facilitate communication between all members of the multidisciplinary healthcare team
- to ensure other health professionals are well informed
- to ensure continuity of care of your patient
- to enable effective ongoing care of your patient
Name 3 different types of oxygen delivery systems
- Face mask (Hudson mask)
- Venturi mask – for COPD patients
- Non rebreather mask – stops exhaled gas from returning
- Nasal prongs
- Nurses can prescribe and administer O2 to patients
• False, we cannot prescribe however we are able to administer oxygen in an emergency.
Discuss the principles of good pain management in the care of acute pain.
- Pain is subjective- only the patient can describe it
- Working out any obstacles determine to combat
- Nurses have the responsibility to assess pain – pain scale , using the P,Q,R, S, T approach = provoking (what makes it better or worse),quality (what does it feel like), radiation (does your pain radiate), severity (pain intensity=1-10),time (when did it first start)
- Multimodal effect = using analgesic ladder to combat pain
- Non-pharmalogical comfort measures= music, TV, cold pack, heat pack
When is consent required from a patient and who can consent for a patient?
Consent to treatment is the principal that a person must give their permission before they receive any type of medical treatment or examination. This must be done on the basis of a preliminary explanation either verbally or written. Consent should be from the patient or guardian if under age or those in which are acting on their behalf (power of attorney).
If unconscious consent is informed consent is surpassed in these situations.
b) Explain the signs and symptoms of compartment syndrome
• Pain-persistent, progressive and out of proportion to the injury
• Pallor- the limbs may be pale
• Pulselessness- pulse absent or diminished
• Paraesthesia- nerves become ischaemic
• Paresis- feelings of weakness in limb or it’s extremities
Remember your 5 P’s
Describe the features of a person who has decerebrate posturing.
The pt lies in rigid extension with arms internally rotated at the shoulders, elbows, knees and hips extended and fingers, ankles and toes flexed.
Describe the features of a person who has decorticate posturing.
A unilateral or bilateral postural change, consisting of the upper extremities flexed and adducted and the lower extremities in rigid extension
- Describe the nursing care of a patient with a bowel obstruction. Where possible provide rationales for your interventions/actions.
- Pain & symptom management – provide medication if required
- Fluid balance monitoring
- Monitor for signs and symptoms of deterioration
- Administration of IV fluid, electrolytes and antibiotics
- Insertion of a nasogastric tube – nil by mouth
- Treatment of nausea and vomiting
- Radiograph or ultrasound required
- Prepare for surgery (if required
Discuss the differences between ischemic and haemorrhagic stroke.
- Ischaemic stroke= sudden blockage or occlusion of cerebrovascular blood flow
- Haemorrhagic stroke= rupture of a blood vessel within the brain.
The acronym RICE is used in nursing. Explain what this means and to whom you would apply it
RICE is used for the treatment of strains and sprains.
R-rest – prevent additions injury and promotes healing
I-ice-moist/dry cold applied intermittently for 20-30 min
C-compression- controls bleeding, reduces oedema and provides support for injured tissue
E-elevation- controls the swelling
Describe the risk factors and the principles of prevention for the development of pressure ulcers.
- Surgery (THR, back injury) and bed bound for to long, immobile (quadriplegic)
- Turn or moving pt 2hrly
- Dry sheets
- Compression mattress
- Wedges, booties,
- Creams
- Brandon and Norton scale
- Describe the management and nursing care of a patient with a suspected CVA?
- They need to get a scan to determine type of CVA= ischaemic or Haemorrhagic stroke.
- ECG/CT scan
- find out as much information as possible / medical history
- Start an antithrombotics/anti platelets = aspirin, clopidogrel
- Monitor BP
- Medication management- antiarrthymics, antihypertensives
- Normal obs
Discuss when a nasogastric tube may be required and the rationale for aspiration of the tube
A nasogastric tube may be required for:
• Short term administration of medications of feedings - infants
• To treat an obstruction
• To remove fluid and gas from the upper GI tract
The rationale for aspirating the tube is to be able to identify and confirm the position of the NGT and rule out the possibility of respiratory tract placement.
Why is it important that the patient cease taking aspirin and NSAIDs prior to surgery?
• Can cause excessive bleeding as aspirin is a blood thinner
Why is nutritional support an important consideration when caring for a patient with an ileostomy?
• Patients are at risk of malabsorption due to the inability to absorb nutrients from food prior to expulsion
List 4 signs that someone may not be tolerating enteric feeding?
- Respiratory distress
- Nausea, vomiting, diarrhoea
- GORD
- Abdominal distention
- Blood sugars/ glucose fluctuations
What is aspiration pneumonia? Why are stroke patients at increased risk? What can be done to reduce the risk of aspiration pneumonia?
- Aspiration pneumonia is an inflammation of the lungs and bronchial tubes caused by the inhalation of oropharyngeal or gastric content.
- Stroke patients are more at risk due to the attribution of dysphagia.
- To reduce risks of aspiration happening stroke patients should be made NPO till a swallow assessment has been performed. Enteral tube feeding may be required if the patient fails to meet their nutritional need orally. Modifying food and fluid textures to promote safe oral intake. Sitting the patient up and using modified equipment to help prevent complications from arising. pH measurement should be performed routinely. Measurement of exposed tube length and should be checked often especially after coughing or vomitting.
