What is the structured approach to patient assessment?
- Prepare
- Safety
- Primary Assessment
- Secondary Assessment
- Focused Assessment
What is the purpose of the PRIMARY assessment?
- Identifies and prioritises life threatening injuries and/or conditions
- the life threatening injury and/or illnes is immediately treated prior to continuing
- ongoing reassessment
What is the purpose of the SECONDARY assessment?
- only done after primary survey is completed and resuscitation is complete
- is a systematic process to ensure the detection of ALL injuries/concerns
- complete head-to-toe examination in a systematic approach
Name all the components of the PRIMARY assessment.
- Danger
- Response
- Send for help
- Airway
- Breathing
- Circulation
- Disability
- Exposure
Name all the components of the SECONDARY assessment.
- Freezing
- Get vitals
- History
- Inspect back
- Document
What is the purpose of a FOCUSED assessment?
- detailed assessment f the symptom/effecte body system
- only the area related to the problem is assessed
- includes a symptom analysis
Name two indicators for haemodynamic monitoring.
- provides sensitive indicators of deterioration in the pt’s condition
- aids in understanding disease process
- facilitates decision making/used to guide therapy
Name the most commonly used venous access points for central venous cathetarisation… in order.
Mwahahahaaa…
- subclavian
- internal jugular
- external jugular
- femoral (rare)
What is haemodynamic monitoring?
Haemodynamic monitoring is the ability to real time monitor and measure pressures within the cardiovascular system. This includes:
- central venous pressure (CVP)
- arterial blood pressure
What are the complications associated with CVC insertion?
In your own time, look up the appropriate nursing management for each.
- risk for incorrect placement at insertion
- increased risk for sepsis
- potential for embolus
- unused lumens can become blocked
What is arterial catheterisation? Name the two common access points.
Arterial catheterisation is the insertion of an arterial line directly into the an artery, allowing accurate measurements and monitoring of blood pressure.
Common access points:
- radial artery
- femoral artery
Name four complications associated with arterial cathetar insertion.
In your own time, look up the nursing management for each.
- dampened wave form
- loss of wave form
- haemorrhage
- emboli
- infection
- inadvertant drug administration
- ischemia
What are the “general rules” with arterial cathetars?
- must not be any air in the line
- NEVER INJECT into an arterial line
- arterial lines must always be transduced to a monitor
- calibrate the system to atmospheric pressure
- alarm parameters should be set and on AT ALL TIMES
