week 3

Question 1

What does AVPU stand for?

Answer 1

Alert
Verbal
Pain
Unresponsive

Question 2

What can increase HR and RR?

Answer 2

• Compensated shock
• Infection
• Stress

Question 3

What can decrease RR?

Answer 3

• Medications (e.g. racemic)

- Exhaustion

Question 4

What can cause decreased HR?

Answer 4

• Hypoxia

- End stage shock

Question 5

What is angina?

Answer 5

• Symptom of coronary artery disease
• Chest pain due to lack of blood supply and oxygen to the heart
• Pain often spreads to shoulders, arm, neck and jaw

Question 6

What does angina feel like?

Answer 6

• Squeezing
• Pressure
• Heaviness
• Tightness
• Pain in the chest
• Can be sudden or recur over time

Question 7

How can angina be treated?

Answer 7

Depending on severity, can be treated by lifestyle changes, medication, angioplasty or surgery

Question 8

What is atherosclerosis?

Answer 8

Build up of plaque

Question 9

What is arteriosclerosis?

Answer 9

Thickening of walls of arteries

Question 10

What is chronic stable angina?

Answer 10

• Same pattern of onset, duration, intensity of symptoms
• Pain lasts 5-15 mins
• Usually predictable - provoked by exertion
• Relieved by rest or GTN

Question 11

What is unstable angina?

Answer 11

• New in onset, occurs at rest (or with minimal exertion), has a worsening pattern
• Other symptoms: SOB, fatigue, indigestion, anxiety
• Not relived with GTN
• Unpredictable
• Associated with plaque rupture exposing a thrombus
• MEDICAL EMERGENCY

Question 12

What is acute coronary syndrome (ACS)?

Answer 12

The name given to three types of CAD that are associated with sudden plaque rupture: UA, N-STEMI, STEMI
Unstable angina (partial occlusion) , Non elevated-ST Elevated MI (partial occlusion), ST Elevated MI (total occlusion).

Question 13

How does the patient with acute coronary syndrome present?

Answer 13

	Pale and clammy 
	Chest pain/ Dyspnoea 
	Nausea and vomiting
	Hypotensive
	Pulmonary oedema
	Collapse, sweating

Question 14

Which acute coronary syndrome has a elevated ST segment?

Answer 14

STEMI

Question 15

Which acute coronary syndrome doesn’t have a elevated ST segment but has elevated cardiac enzymes?

Answer 15

N-STEMI

Question 16

Which acute coronary syndrome doesn’t have a elevated ST segment and doesn’t have elevated cardiac enzymes?

Answer 16

Unstable angina

Question 17

What are complications of MI?

Answer 17

• Arrhythmias - atrial fibrillations, ectopic beats ( premature, irregular beats), heart failure, cardiogenic shock, pulmonary oedema, acute respiratory failure
• Cardiac arrest- only VF and VT are shock able. Asystole and PEA provide CPR and adrenaline

Question 18

What are diagnostic studies for MI?

Answer 18

Lab Tests 
•	(lipid profile)- high cholesterol 
•	Serum cardiac markers (Trop T, CK)
Medical Imaging
•	12-lead ECG
•	Cardiac catheterisation + coronary angiography
•	Chest x-ray
•	Echocardiogram (heart ultrasound)

Question 19

What are acute nursing interventions for cardiac problems?

Answer 19

1. Pain assessment and relief – IV access
2. Ongoing monitoring & assessment, cardiac monitoring, frequent vitals
3. Rest and comfort; positioning (sit upright), bed rest, limited activity for 12-24 hours
4. Alleviation of stress and anxiety
5. Understanding patients emotional and behavioural reactions – life defining event - loss, grief, depression
   Oxygen therapy; drug therapy: GTN and aspirin;

MDT CARE
• Rapid diagnosis and treatment extremely important
• Clinical decision making re treatment, pharmacology, surgical management (PCI, CABG)

Question 20

How to reperfuse STEMIs with thrombolysis?

Answer 20

• dissolve thrombus (streptokinase)

* percutaneous catheter infusion (PCI)- allows stent insertion

Question 21

What is surgical revascularisation - CABG?

Answer 21

coronary artery bypass graft- adding vessels/veins, to bypass the obstructed part of the artery

Question 22

What are nursing interventions for acute heart failure:pulmonary oedema?

Answer 22

• C-XRAY
• Monitoring
• Treat cause
• Positioning
• Oxygen therapy– nasal prong, high flow, CPAP/BiPAP
• Drug therapy (cardiac Mx and anxiety Mx; intravenous)
• Daily weight
• Rest
• Regular assessment
• Combine physical, psychosocial and relational needs with each care encounter

Question 23

What is heart failure?

Answer 23

sometimes known as congestive heart failure, occurs when your heart muscle doesn’t pump blood as well as it should.

Question 24

What are the types of heart failure?

Answer 24

Right-sided heart failure. (Back-ups in the area that collects “used” blood)
Left-sided heart failure. (Failure to properly pump out blood to the body)
Congestive heart failure. (Fluid backs up into the lungs and tissues)

Question 25

What is DKA?

Answer 25

serious complication of type 1 diabetes and, much less commonly, of type 2 diabetes. DKA happens when your blood sugar is very high and acidic substances called ketones build up to dangerous levels in your body

Question 26

What are the three clinical features of DKA?

Answer 26

 Hyperglycaemia- polyuria, polydipsia, polyphagia  Dehydration and electrolyte loss- Nausea/vom, LOC,  Acidosis - increased work of breathing and rate (Kussmual respirations), pale and clammy, cold,

Question 27

What is HHNS (Hyperglycaemic hyperosmolar non-ketotic syndrome)?

Answer 27

Condition resulting from very high blood glucose levels. Can affect both types of diabetics, yet it usually occurs amongst people with T2DM

Question 28

What are nursing assessments and interventions for DKA?

Answer 28

 Treating hyperglycaemia – insulin infusion  Correcting dehydration- fluid infusion  Correcting electrolyte loss- Do not add to the first litre of fluid infused  Correcting acidosis Monitoring of vital signs, LOC, ECG, O2 saturations, urine output – 1/24 Monitor FBC 1/24

Question 29

What are signs of hypokalaemia?

Answer 29

``` Low blood levels of Potassium  Fatigue  Muscle weakness, leg cramps, soft, flabby muscles  Nausea and vomiting, paralytic ileus  Paraesthesia, decreased reflexes  Weak, irregular pulse  Polyuria  Hyperglycaemia  ECG changes: ST segment depression, flattened T wave, presence of U wave, Ventricular arrhythmias, bradycardia ```

Question 30

What are the three categories of AKI causes?

Answer 30

prerenal, intrarenal and postrenal

Question 31

What are prerenal causes of AKI?

Answer 31

Hypovlaemia decreased cardiac output vasodilation decresased renovascular blood flow

Question 32

What are intrarenal causes of AKI?

Answer 32

Nephrotoxic injury- antibiotics, contrst | interstitial nephritis

Question 33

What are postrenal causes of AKI?

Answer 33

``` benign prostatic hyperplagia bladder cancer neuromuscular disorders- affect bladder function prostate cancer spinal cord disease strictures- narrowing of vessels trauma ```

Question 34

What does RIFLE mean?

Answer 34

``` Risk- GFR < 75% Injury - GFR < 50% Failure - GFR < 25% Loss- complete loss of function End-stage kidney disease ```

Question 35

What is nursing management for AKI?

Answer 35

 Treat precipitating cause  Fluid restriction (600 mls + previous 24 hours loss) Fluid and electrolyte balance  Nutritional therapy (enteral nutrition)  Measures to lower potassium- lower potassium levels (insulin and dextrose)  Calcium supplements  Dialysis - Haemodialysis, Peritoneal  Monitor vital signs  Urine assessment  Respiratory assessment  Skin assessment  Prevent infection  Monitor fatigue and potential anxiety  Monitor of complications – arrhythmias, infection

Question 36

What are the different types of dialysis?

Answer 36

Peritoneal | haemodialysis