Deteriorating Patient Management

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Questions and Answers

What are the early signs of patient deterioration that healthcare providers should recognize?

Vital signs changes, altered mental status, and difficulty breathing.

What is the purpose of performing a MetCall in patient management?

A MetCall is initiated to summon a team for urgent medical assistance when a patient's condition deteriorates.

List two common signs and symptoms of pulmonary embolism.

Shortness of breath (SOB) and chest pain.

What is thoracentesis and when is it indicated?

Thoracentesis is an invasive procedure to remove excess fluid or air from the pleural space, indicated for conditions like pneumothorax or pleural effusion. Signup and view all the answers

What is the role of underwater seal drainage (UWSD) in patient care?

UWSD is used to manage pleural space issues by allowing air or fluid to escape while preventing backflow. Signup and view all the answers

Describe the purpose of suctioning in airway management.

Suctioning clears secretions from the airway to maintain patency and facilitate breathing. Signup and view all the answers

What complications can arise from a haemothorax?

Shortness of breath, chest pain, hypoxemia, and hypotension. Signup and view all the answers

What is colostomy and its purpose?

Colostomy involves bringing part of the large intestine through the abdominal wall to create a stoma for waste elimination. Signup and view all the answers

What are the key assessments to perform when checking a stoma?

Check the stoma for working (amount, colour, smell), flatulence, consistency of faecal matter, and signs of infection. Signup and view all the answers

What nursing care should be provided for a patient with a nasogastric tube (NGT)?

Verify NGT position, regularly flush the tube, perform oral care, and secure the NGT. Signup and view all the answers

What is myocardial infarction and its common signs and symptoms?

Myocardial infarction occurs when blood flow to part of the heart muscle is blocked, causing damage; symptoms include chest pain, SOB, fatigue, lightheadedness, and sweating. Signup and view all the answers

Describe the appropriate position for a patient after an appendectomy and its rationale.

The patient should be in a semi-fowlers position to reduce abdominal tension and discomfort. Signup and view all the answers

What is the purpose of a coronary angiogram?

To visualize the inside of coronary arteries and assess for blockages or abnormalities. Signup and view all the answers

What signs indicate ventricular fibrillation?

Signs include syncope, no pulse, and potentially seizures. Signup and view all the answers

What is a common indication for using a nasogastric tube?

Indications include gastric obstruction, enteral feeding for those unable to eat by mouth, and removal of gastric contents. Signup and view all the answers

What is the difference between atrial fibrillation and atrial flutter in terms of heart rhythm?

Atrial fibrillation shows no P-wave and has irregular rhythm, while atrial flutter has a regular QRS with distinct flutter waves. Signup and view all the answers

Study Notes

Deteriorating Patient Management

Recognize early signs: vital signs (VS), altered mental status, difficulty breathing.
Perform initial assessment using the ABCDE approach: Airway, Breathing, Circulation, Disability, Exposure.
Activate MetCall for urgent medical assistance.
Administer oxygen therapy, IV fluids, and medications as needed.
Keep family updated on patient's status.

Respiratory System Disorders

Pulmonary Embolism: Thrombus obstruction in the pulmonary artery, leading to right heart strain. Symptoms include shortness of breath (SOB), chest pain, cough, tachypnea, and tachycardia.
Pleural Effusion: Fluid accumulation in the pleural space. Symptoms include SOB, chest pain, dry cough, decreased breath sounds, and hypoxia.
Acute Pulmonary Oedema: Excess fluid in the lungs. Symptoms include SOB, cough, tachypnea, crackles, and frothy sputum.
Pneumothorax: Air accumulation in the pleural space. Symptoms include SOB, chest pain, hypoxemia, and tachypnea.
Haemothorax: Blood accumulation in the pleural space. Symptoms include SOB, chest pain, hypoxemia, and hypotension.
Hemopneumothorax: Combination of air and blood in the pleural space. Symptoms include SOB, chest pain, hypoxemia, hypotension, and tachycardia.
Thoracentesis: Invasive procedure to remove fluid or air from the pleural space for conditions like pneumothorax and hemothorax.

UWSD (Under Water Seal Drainage) Nursing Care

Inspect and palpate the insertion site for subcutaneous emphysema, infection, swelling, and check dressing integrity.
Monitor suction presence and amount in cmH2O (typically 105-160).
Assess for air leaks and observe bubbling in the water seal chamber.
Check for swinging motion in the water column of the water seal chamber.
Document drainage volume on fluid balance chart at 1200 and 2400 hours or hourly for large volumes.
Ensure chest X-ray is performed to confirm intercostal catheter placement and daily X-rays while the catheter remains in place.

Emergency Airway Management

Artificial Airways: Oropharyngeal airway (Guedel), nasopharyngeal airway, endotracheal tube.
Suctioning Equipment: Yankauer suction tip, suction catheters for oropharyngeal, nasopharyngeal, and endotracheal use.

GI System

Colostomy: Surgical procedure bringing part of the large intestine through the abdominal wall to form a stoma.
- Stoma care includes assessing working condition (amount, color, smell), checking for flatulence and faecal consistency, ensuring stoma bag fits well, monitoring for signs of infection, and documenting care per shift.
NGT (Nasogastric Tube) Indications:
- Gastric obstruction, enteral feeding for dysphagia patients, administering medication, removing gastric contents, preventing aspiration.
NGT Nursing Care: Verify tube position (via X-ray, notation of tube length, auscultation), regularly flush the tube to maintain patency, provide oral care, and secure NGT properly.

Surgical Nursing Care: Appendectomy

Position patient in semi-Fowler's to reduce abdominal tension.
Monitor vital signs and assess pain levels; administer medications as necessary.
Conduct wound or skin assessments to check for infections.
Provide discharge education.

Cardiac Conditions

Myocardial Infarction: Blocked blood flow to heart muscle leads to damage. Symptoms include chest pain, SOB, fatigue, lightheadedness, and sweating.
Cardiac Arrhythmias: Irregular heart rhythms caused by faulty electrical impulses. Symptoms include chest pain, palpitations, fatigue, and lightheadedness.
- Atrial Fibrillation: Rapid irregular heartbeats from atria; lacks P-wave.
- Atrial Flutter: Regular rapid heartbeats from atria; characterized by regular QRS complexes.
- Ventricular Tachycardia: Rapid heartbeat from ventricles; lacks P-wave, has wide QRS.
- Ventricular Fibrillation: Rapid, irregular heartbeat; no P-wave or QRS complexes.
Cardiac Procedures:
- Coronary Angiogram: Visualizes coronary arteries to assess blockages.
- Coronary Angioplasty: Opens narrowed arteries to improve blood flow.
- Coronary Artery Bypass Grafting (CABG): Creates new pathways around blocked arteries.
- Cardioversion: Restores normal heart rhythm for abnormal heartbeats.

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Description

This quiz focuses on the recognition and management of deteriorating patients, highlighting critical early signs like vital signs, altered mental status, and difficulty in breathing. It also covers initial assessments such as the ABCDE approach and essential interventions like oxygen therapy and IV fluids. Understanding conditions like pulmonary embolism and pleural effusion is crucial for effective patient care.