SDLP

Question 1

1. Why are observations and documentation important elements of nursing care in the acute care patient?

Answer 1

• Identify reasons for admission and care already received
• Ensure all health professionals are well informed
• Legal issues
• Effective and holistic care

Question 2

2. Why do we do observations in acute care patients?

Answer 2

• to identify possible problems and to assess the overall status of the patient

Question 3

3. Why is it important to know the normal limits of TPR, BP and 02 sats?

Answer 3

• it establishes a baseline for further comparison
• what is normal for one is not necessarily normal for another
• knowing patients normal limits allows you to identify possible problems

Question 4

4. What do we do with the results when we have recorded them?

Answer 4

Report and document them and then pass them onto the attending doctor

Question 5

5. What are the main causes of mortality and morbidity among Australian adults?

Answer 5

Chronic disease and disability – ie cardiovascular disease and diabetes

Question 6

6. What are some of the legal issues you have heard of regarding documentation in nursing?

Answer 6

Only state the facts – objective data and not too much subjective unless it is actually stated by the patient.
Do not try and white out an error – use correct procedure to fix an error

Question 7

7. Nursing diagnoses mostly differ from medical diagnoses in that they are:
   a. dependent upon medical diagnoses for the direction of appropriate interventions.
   b. primarily concerned with caring, while medical diagnoses are primarily concerned with curing.
   c. primarily concerned with human response, while medical diagnoses are primarily concerned with pathology.
   d. primarily concerned with psychosocial parameters, while medical diagnoses are primarily concerned with physiologic parameters.

Answer 7

a. dependent upon medical diagnoses for the direction of appropriate interventions.

Question 8

1. What does the term negligence mean in nursing?

Answer 8

Negligence is a tort – it is behaviour that results in unintended harm

Question 9

2. In relation to negligence what is highlighted in the ANMC code of conduct and how does this relate to your nursing practice?

Answer 9

o Nurses practice in a safe and competent manner
o Nurses practice in accordance with the standards of the profession
o Nurses practice and conduct themselves in accordance with the laws relevant to the practice

Question 10

3. When do we need to gain consent from our patients?

Answer 10

• Whenever you are about to perform anything on a patient that invades their personal space.
• When patient is going to surgery

Question 11

4. What does duty of care mean?

Answer 11

Duty of care is your responsibility as a nurse to provide the best care available to your patients in the safest and most professional way

Question 12

5. What is quantitative research?

Answer 12

Quantitative research is research based on social phenomena by using statistical, mathematical or numerical data. It uses a variety of subject areas, measurements and data collection

Question 13

6. What is Quantitative analysis?

Answer 13

Qualitative analysis is analysis of data and research. Aims at understanding behaviour through the use of mathematical and statistical modelling, measurement and research

Question 14

What are the most common condition in patients in which an intermittent catheter would be used a nursing intervention

Answer 14

Intermittent catheter is a treatment of choice in patients who cannot empty the bladder successfully themselves – ie neurological, multiple sclerosis and spinal cord injuries.
It provides periodic drainage of urine form the bladder

Nursing diagnosis - urinary retention related to nuerologic impairment

Question 15

How do you create a sterile field?

Answer 15

A sterile field is created by proper hand hygiene procedures and the use of personal protective equipment

Question 16

1. What are some of the reasons for nasogastric intubation in your patients?

Answer 16

o Access route for the administration of fluids. Drugs and / or nutrients
o To allow drainage of the contents of the stomach
o To allow removal of air from the stomach
o To diagnose disorders

Question 17

2. What type of patients would you expect to see having nasogastric intubation and why?

Answer 17

Post-surgery – gastric or oesophageal surgery
Adults – primarily to remove fluid and gas from the upper GI tract
Short term administration of medications or feeding

Question 18

What are the potential complications of enteral feeding and what can you do as a nurse to prevent these for occuring?

Answer 18

Long term use – can be complicated by reflux of gastric contents up into the oesophagus with overflow, into the airway. To avoid this, they are best inserted at the time of surgery or before surgery to ensure accuracy

Question 19

4. Describe the nursing responsibilities and patient teaching in medication administration for Gastroesophageal reflux (GERD), Gastritis and Peptic Ulcer Disease?

Answer 19

GERD – Improving patient nutritional and physical condition / promoting weight gain
GASTRITIS – Reducing anxiety, promoting optimal nutrition, promoting fluid balance, relieving pain, teaching patients self care
PEPTIC ULCER DISEASE – Pharmacologic therapy, stress reduction dn rest, smoking cessation, dietary modification, surgical management, follow up care

Question 20

You are asked to provide pre and post operative information to a patient having a hiatus hernia repair and the family. What information would you give, what anatomical models would you use and what drawings would you do for the patient to better illustrate the information you are providing?

Answer 20

PRE – OP – Nutritional advice – weight loss, avoid bending, sleeping well supported, cease smoking
POST OP – Change in diet and promotion of a healthy lifestyle / medication management

Question 21

Acute pancreatitis is particularly painful. What is happening to induce such pain? What interventions would you be implementing to diminish symptoms? Which medications would be used and how would they be administered? What advice can you give to patients being discharged from hospital?

Answer 21

acute pancreatic is caused by auto digestion of the pancreas.
Pancreatic ducts become blocked, accompanied by hyper secretion of the exocrine enzymes of the pancreas.
Severe abdominal pain
Adequate pain management is essential – parenteral opioids, insulin, continuous infusions in critically ill / oral feedings are withheld.
AT DISCHARGE – advise patient that a prolonged period is needed to regain strength. Reinstructions need to be given. Education on self-care / community nurse referral

Question 22

1. Describe the nursing care of a person with a bowel obstruction.

Answer 22

o Monitoring for signs and symptoms of deterioration
o Fluid balance monitoring
o Administration of IV fluids and electrolytes
o Pain and symptom management
o Nasogastric tubing

Question 23

2. An ileus may occur post operatively. What is an ileus and how would you know if a patient has one?

Answer 23

An ileus is a painful obstruction of the ileum or other part of the intestine.  A patient would present with:
•	Nausea and vomiting
•	Stomach cramps
•	Bloating
•	Lack of bowel movements

Question 24

3. Following bowel surgery large amounts of fluid sequester in the bowel for a period of time. What are the nursing responsibilities in this situation and what would you be monitoring?

Answer 24

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Question 25

4. Diarrhoea and constipation can occur for a number of reasons. Review these and then discuss the medications which might be helpful? What information would you provide to the client regarding other actions that may be useful?

Answer 25

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Question 26

5. “Golitely” and such like preparations are given preoperatively to patients about to undergo procedures where good visualisation of the bowel is required or where bowel emptying and cleanliness is important. What is this substance and how is it administered? What advice would you give to the client at home or what nursing actions would be appropriate for an inpatient?

Answer 26

Golitely is a glycol electrolyte solution which is given to patients beginning at noon the day before a colonoscopy, or in any procedure where a good visualisation of the bowel is required. The patient ingests the solution orally, within 3 to 4 hours, and must maintain a clear fluid diet during that time. It is also important that the patient limits fibre intake 72 hours before the procedure, so that the colon can be fully cleansed. Patients are advised to stay at home or close to the toilet when they commence this solution, as it requires frequent bowel movements. They are also required to keep up their fluid intake. Known side effects of the solution are nausea, bloating, cramps or abdominal fullness, fluid and electrolyte imbalance and hypothermia

Question 27

1. Why is it easier to swallow food than water? What are the essential steps in carrying out a swallowing assessment

Answer 27

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Question 28

2. For patients with cognitive impairments it is more effective to communicate using one step rather than two step questioning and or/instructions. Explain the difference and give examples.

Answer 28

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Question 29

3. Which muscles are recruited for micturition and how do they work?

Answer 29

Micturition is urination or voiding. It normally occurs approx. 6-8 times in a 24 hour period. It is activated by the micturition reflex arc within the sympathetic and parasympathetic nervous systems, which cause a coordinated sequence of events. The pelvic nerve firstly stimulates the bladder to contract, resulting in complete relaxation of the striated urethral sphincter and followed by a fall in urethral pressure, contraction of the detrusor muscle, opening of the vesicle neck and proximal urethra, and flow of urine

Question 30

4. Describe the trajectory of deterioration if signs and symptoms of rising intracranial pressure are missed and there is a failure to act? What is the Monro-Kellie Hypothesis?

Answer 30

The combination of headache, papilloedema and vomiting is generally considered indicative of raised intracranial pressure (ICP), although there is no consistent relation between the severity of symptoms and the degree of hypertension. If they are missed it would cause respiratory failure and heart failure as these systems are controlled by the medulla. The Monro-Kellie hypothesis states that because of the limited space for expansion within the skill, an increase in any of the components requires a change in the volume of one or both of the others. As the brain tissue has limited space to change compensation typically is accompanied by displacing or shifting CSF, increasing the absorption of CSF or decreasing cerebral blood volume

Question 31

5. Describe how you would assess neurological functioning using the Glasgow coma scale?

Answer 31

The Glasgow coma scale is a neurological assessment tool developed in 1974. It was devised to ascertain altered states of consciousness. It has 3 parameters: o Best eye response o Best verbal response o Best motor response Scores are calculated in each category to add up to 15. Obviously a score close to 15 would indicate good neurological functioning, whereas a score of 7 to less would be of concern, and a score of 3 or less would indicate severe problems

Question 32

An 84 year old woman had an internal fixation for her fractured hip. She complains that her elastic stockings feel tight and hot and asks you to remove them. How would you respond to this request? What is the rationale for your action?

Answer 32

Elastic stockings are used to prevent Deep vein thrombosis, which is the most common complication post-surgery, particularly in the elderly or those at risk of developing thromboembolism. It is important that the patient keeps the stocking on, however nurses need to monitor the patient 2-4 hours and ensure the stocking is fitted correctly. The stocking also needs to be removed twice daily and care provided. The nurse needs to also ensure increased fluids are taken, as well as ankle and foot exercises to prevent DVT

Question 33

1. With regard to skin traction, explain why the traction force (i) is applied over a wide area and (ii) applied distal to the fracture.

Answer 33

Skin traction is used to control muscle spasms and to immobilise an area before surgery. Skin traction is accomplished by using a weight to pull on skin extensions or on a foam boot attached to the skin. The amount of weight applied must not exceed the tolerance of the skin. Whenever traction is applied, counteraction must be used to achieve effective traction. Counteraction is the force acting in the opposite direction

Question 34

2. The acronym RICE is used in nursing. Explain what this means and who would be the likely candidates to receive it.

Answer 34

``` Treatment of contusions, strains and sprains consist of resting and elevating the affected part, applying cold, and using a compression bandage. The acronym RICER is useful in remembering treatment interventions: R – Rest I – Ice C-Compression E-Elevation R-Referral ```

Question 35

3. 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?

Answer 35

In the hospital setting, it is important to do our utmost to ensure the safety of our patients, particularly the elderly who are at a greater risk of falls. Measures can include: o Guide rails in their beds o Ensure call bell is accessible at all times o Bed to be lowered to the lowest level possible o Alarm mattress on beds o Use of hip protectors

Question 36

Explain why bladder and bowel function and care is different for patients with spinal cord injury compared to the population at large. What is the routine bladder and bowel care of patients with spinal cord injury?

Answer 36

Immediately after a spinal cord injury, the urinary bladder becomes atonic and cannot contract by reflex activity – which results in urinary retention. As the patient has no sensation of bladder distention, overstretching of the bladder and detrusor muscle may occur, delaying the return of bladder function. Immediately after a spinal cord injury, a paralytic ileus usually develops due to neurogenic paralysis of the bowel, therefore, a nasogastric tube is often required to relieve distention and prevent aspiration. Bowel activity usually returns within the first week

Question 37

1. Describe the stages of wound healing.

Answer 37

Surgical wound healing occurs in 3 phases: • Inflammatory phase –1-4 days, when blood clotting forms, and wound becomes fluid filled. Debris of damaged tissue and blood clot are phagocystosed. • Proliferative phase – 5-20 days – collagen produced. Granulation tissue forms. Wound tensile strength increases • Maturation phase – 21 days to months or even years – fibroblasts leave wound. Tensile strength increases. Collagen fibres reorganise and tighten to reduce scar size

Question 38

Compare and contrast healing by primary intention and healing by secondary intention?

Answer 38

First intention, or primary healing – wounds made aseptically; with a minimum of tissue destruction, and with approximation of wound edges heal with little tissue reaction by first intention. Second intention occurs in infected wound, traumatic wounds, or in wounds in which the edges have been poorly approximated previously healing occur by a process of granulation, and eventual re-epithelialisation and wound contracture

Question 39

Why are specific infection control procedures required when MRSA +ve patients are hospitalised. Why are limited antibiotics available for MRSA +ve patients? Identify the usual dose of Vancomycin, route of administration, precautions and side-effects.

Answer 39

MRSA is highly virulent, so steps must be taken to prevent its spread. Patients with MRSA are isolated in a private room, and contact precautions (gown, mask, glove, and antibacterial soap) are used. The number of people in contact with affected patients in minimised, and appropriate precautions must be taken when transporting these patients within or between facilities. Therapy for MRSA has been limited to penicillin formulations or vancomycin in combination with an aminoglycoside eg gentamicin

Question 40

You are in hospital and unable to sleep and you hear the nurses at nurses station being loud and talking about you saying that you are always whinging about the pain, one of them says” I know the type all they want is the drugs” How would this make you feel?

Answer 40

This is terrible and should never happen. Nurses should not judge – nurses do not have an opinion, and if they do, they keep it to themselves. Whatever you may think or feel about a patient is insignificant and should not be said.

Question 41

Why is pre-op Education & discharge planning important?

Answer 41

Pre –op education is crucial, as it prepares the patient in the best possible way for surgery. Explaining what is to be expected and what is involved, alleviates a lot of patient anxiety and also reduces a lot of post op complications. More often these days, day surgery is popular, so it is important that patients are well educated in how to look after themselves after the operation – and especially after discharge.

Question 42

When are the anti-embolic stockings applied?

Answer 42

Anti-embolic stockings are used on patients who are at a high risk of DVT. IT is a precautionary method and help with the circulation during surgery. They are used often post surgery to alleviate the risk of thromboembolism.

Question 43

When is the consent form signed?

Answer 43

The consent form needs to be signed before the patient is given any pre-operative medication, as this can distort patients thought patterns some times. The surgeon should be responsible for getting the patient to sign the form, and the form would be taken with the patient to the operating room

Question 44

# Define the following surgical procedures, and Identify specific pre-operative preparation for each. Colonoscopy

Answer 44

Computer stimulated endoluminal perspective of the air-filled distended colon using conventional spiral or helical CT scanning. This procedure is valuable as a diagnostic aid and screening device. Specific pre op preparation should include ensuring the stomach is completely empty, as per the pre-op instruction.

Question 45

# Define the following surgical procedures, and Identify specific pre-operative preparation for each. Total Hip Replacement

Answer 45

A total hip replacement is the replacement of a severely damaged hip with an artificial joint. Specific pre-op instructions include the awareness of pain, and also extensive education of what to expect

Question 46

# Define the following terms: Appendicectomy

Answer 46

An appendicectomy is the surgical removal of the appendix. It is usually performed as soon as possible to decrease the risk of perforation

Question 47

# Define the following terms: Gastrectomy

Answer 47

A gastrectomy is a partial or full surgical removal of the stomach

Question 48

# Define the following terms: Arthroscopy

Answer 48

Arthroscopy is the examination of the inside of a joint, such as the knee, using a special illuminating instrument inserted through a small incision or 'portal’

Question 49

# Define the following terms: Mastectomy

Answer 49

Is the medical term for the surgical removal of 1 or 2 of the breasts, usually due to breast cancer?

Question 50

# Define the following terms: Rhinoplasty

Answer 50

a nose job, is a plastic surgery procedure for correcting and reconstructing the form, restoring the functions, and aesthetically enhancing the nose, by resolving nasal trauma, congenital defect, respiratory impediment, and a failed primary rhinoplasty

Question 51

# Define the following terms: Salpingectomy

Answer 51

The severing or surgical removal of a fallopian tube

Question 52

Define the following terms: | Laparotomy

Answer 52

a surgical incision through the abdominal wall made to allow investigation of an abdominal organ or diagnosis of an abdominal disorder