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EXAM PREP: EXAM PREP: WEEK 1: INTRODUCTION TO PRE AND POST PROCEDURAL CARE LEARNING OUTCOMES: 1. Explain and demonstrate the role of the nurse related to pre- and post-procedural assessment and management using the nursing process....

EXAM PREP: EXAM PREP: WEEK 1: INTRODUCTION TO PRE AND POST PROCEDURAL CARE LEARNING OUTCOMES: 1. Explain and demonstrate the role of the nurse related to pre- and post-procedural assessment and management using the nursing process. 1. 1. Explain and demonstrate the role of the nurse related to pre- and post-procedural assessment and management using the nursing process. Aspects of safe preparation for a procedure: it is important to ensure that patient and the procedure are identified constantly throughout the entirety of the procedure pre and post operatively. ensure the procedure matches the patient and ensure to use the correct terminology. there are 3 stages of procedural care (pre, intra and post); PREPROCEDURE CARE: Preparation Physical Social Emotional Education Consent = fully informed: procedure, risks and alternatives, free and voluntary and has legal capacity to consent On the day of the procedure it is the nurses responsibility to ensure that the patient is ready and prepared for their operation, this is to ensure that they are in their optimal state for their procedure PREOPERATIVE PREPARATION: vital signs fasting - this helps to prevent the risk of aspiration from occurring during anaesthesia skin preparation bowel preparation EXAM PREP: 1  appropriate theatre attire preoperative medications Post operative monitoring will be determined based on the; type of surgery that was conducted, the anaesthetic type and whether the patient is inpatient/Day surgery 1. Explain and demonstrate the role of the nurse in relation to therapeutic and professional communication. 1. 1. Explain and demonstrate the role of the nurse in relation to therapeutic and professional communication. Ensuring that health professionals use the correct terminology to ensure that the procedure matches the patient (many types of suffixes or prefixes are used to relate to a certain operation or procedure done) Ensuring the patient is fully aware of the procedure or operation that they are about to receive, this helps to make sure that consent is still present for the elected procedure. Providing patient comfort to ensure that the patient is comfortable and is not worrying about the procedure about to completed. 1. Prepare, perform, and document peri-operative procedures and spinal precautions. Prepare, perform, and document peri-operative procedures and spinal precautions. 1. Explain and demonstrate the role of the nurse in the management of patient symptoms, function, and minimising risk in a peri-operative setting. Explain and demonstrate the role of the nurse in the management of patient symptoms, function, and minimising risk in a peri-operative setting. Monitoring of vital signs Ensuring that patient is aware of any complications that might have affected the outcome of the procedure WEEK 2: ASSESSMENT AND MANAGEMENT OF THE PATIENT WITH ALTERED BREATHING LEARNING OUTCOMES: Explain and demonstrate the role of the nurse in relation to the principles of respiratory assessment and management using the nursing process. Making sure that you appropriately measure Resp Rate as this is one of the main vital signs to look for when a patient starts to deteriorate Checking Sp02 levels to ensure that there is adequate oxygenation - take this into account to whether or not you need to do any further assessments When attempting to manage a patient with a respiratory problem: EXAM PREP: 2  How are we going to optimise gas flow sit them up support them well with pillows do a pain assessment Cadell airways for incubation, tracheotomy tubes if patient is unable to support their own airway Administration of therapeutic substances to increase oxygenation oxygen (not a drug) when starting a patient on oxygen it is important to ensure that you pick the right device or way of administration to ensure the maximum benefit, also talking to the patient to let them know why they require oxygen and how they will benefit from it. other medications; broncho-dilaters or salbutamol given through a nebulizer Mobilise pulmonary secretions - if secretions are present this can impede respiratory functions appropriate positioning chest physiotherapy using a Yankee sucker or y catheter ensuring adequate hydration Explain and demonstrate the role of the nurse in relation to chest physiotherapy. Providing appropriate chest physiotherapy education related to deep breathing and coughing to patients pre- and post-surgery. Using knowledge of the mechanics of breathing to identify body positions that will allow optimal air entry into the lungs of patients being cared for. Work in collaboration with physiotherapists to provide appropriate and effective chest physiotherapy. Assist and motivate patients when prescribed a chest physiotherapy regime. Deep breathing exercise Deep breathing preferential ventilates bases of lungs - which are usually bypassed is the patients breathing is dysfunctional deep breathes assist in increasing total lung capacity - ultimately creates more effective cough and huff - assists in preventing airway collapse of exhalation and moving secretions centrally EXAM PREP: 3  Adding an inspiratory hold (eg hold for 3 seconds) can assist with collateral ventilation of the alveoli - assists with the expansion of the alveoli to increase diffusion prompt patient to breathe in and try to expand their tummy - to assist with ventilating the bases palpate their tummy to assist with this Deep breathing is best done standing up or in a 90-degree angle, for more efficient ventilation, supine means their lungs/breathing are not working properly Recognise requirements of escalation of care and basic life support algorithm WEEK 3: LEARNING OUTCOMES: Describe pharmacological and non-pharmacological principles of acute pain management. Prior to administering analgesia, what are some of the principles for the care of a person experiencing pain you should consider? assess the pain treat the contributing factors (pathology) individualise the person's analgesic therapy choose the least invasive route for administration Keep the person in control of their own analgesia as much as possible titrate the doses to provide maximal pain relief with minimal side effects Can you identify three complementary/ alternative therapies as non- pharmacological interventions for pain you would feel confident to provide? relaxation, mindfulness, imagery, biofeedback providing education psychotherapy, cognitive behavioural therapy, structured report and hypnosis Cutaneous stimulation (hot and cold therapy) transcutaneous electrical nerve stimulation Acupuncture and acupressure 1. Explain and demonstrate the role of the nurse and patient in relation to the principles of acute pain management using the nursing process. Providing parenteral medication (IM and SC) EXAM PREP: 4  Purpose Angle of (Rate of insertion absorption, Maximum Type of (used for a type of tissue Site Needle size volume to be Injection person of receiving injected average muscle medication, and fat mass) when it is used) injects medication Injection site is between the the abdomen, Subcutaneous dermis and at or under the 25-gauge, muscle; belly button, 1.5cm needle 0.5-1 mL 45 Degrees absorbed also the arm (varies by size slowly; (front and of the person typically used back) and the for insulin and thigh anticoagulants Deltoid muscle of the arm. The the gauge and deltoid muscle used to length of the is the site most promote rapid needle are well-developed typically used medication selected on the adults: 4mL in a for vaccines.... absorption and basis of the large muscle; Intramuscular Vastus lateralis to provide an medication infants and muscle of the alternative volume and small children: 90 Degrees thigh.... route when viscosity and 0.5-1mL; older Ventrogluteal medication is the person's children and muscle of the irritating to body size adults; 1-2mL hip.... subcutaneous - typically, a Dorsogluteal tissue 22–25-gauge muscles of the needle buttocks. Angle of injection: WEEK 4: LEARNING OUTCOMES: 1. Explain the pathophysiology of fluid and electrolyte imbalance 1. 1. Explain the pathophysiology of fluid and electrolyte imbalance FLUID AND ELECTROLYTES EXAM PREP: 5  Parenteral Fluids confirm the type and amount of IV solution by reading the prescribing practitioner’s order in the medical record. IV solutions are sterile and packaged in plastic bags or glass containers. Solutions that are incompatible with plastic are dispensed in glass containers Plastic IV solution bags collapse under atmospheric pressure to allow the solution to enter the infusion set IV solutions are usually packaged in quantities ranging from 50-1000 mL. crystalloids, electrolyte solutions with the potential to form crystals, are used to replace concurrent losses of water, carbohydrates and electrolytes. Sodium chloride and compound sodium lactate are commonly used crystalloid solutions. There are three main types of parenteral fluids that are classified in accord with the tonicity of the fluid relative to normal blood plasma. An osmolar solution can be hypotonic, isotonic or hypertonic. The type of solution is prescribed based on the person’s diagnosis and the goal of therapy. Hypotonic fluid (hypo-osmolar, less than 290 mmol/L) lowers osmotic pressure and causes fluid to move into the cells; if fluid is infused beyond the person’s tolerance, water intoxication may present Isotonic Fluid (iso-osmolar, 290 mmol/L) increases ECF volume; if fluid is infused beyond the person’s tolerance, cardiac overload may result Hypertonic fluid (hyperosmolar, greater than 290, mmol/l) increases the osmotic pressure of the blood plasma, drawing fluid from the cells; if fluid is infused beyond the person’s tolerance, cellular dehydration may result. EXAM PREP: 6  1. Explain the pathophysiology of fluid and electrolyte imbalance Explain the pathophysiology of fluid and electrolyte imbalance an electrolyte is a compound that ionizes when dissolved in a solvent such as water There are two types of electrolytes: Cations; positively charged (sodium) Anions; negatively charged (chloride) There are six main electrolytes: sodium (predominant electrolyte) extracellular 135-145 mmol ECF fluid volume Nerve impulses Regulate acid-balance: potassium chloride extracellular 96-110 mmol Gastric secretions Regulate acid-base balance: calcium Extracellular 2.1-2.6 mmol EXAM PREP: 7  Nerve impluses Muscle contractions Blood clotting Bone and teeth formation: magnesium phosphorus MECHANISMS TO MOVE FLUID INCLUDE: osmosis diffusion filtration active transport KEY SIGNS OF FLUID LOSE INCLUDE: thirst dry mucous membranes sunken eyes Reduced skin turgor weak rapid pulse Low BP- postural hypotension reduced urine output (below 30mls per hour) STRATERGIES TO CORRECT IMBALANCES: oral rehydration or restriction IV therapy Electrolyte replacement Medications to alter fluid levels such as diuretics Diet management 1. Describe the principles of fluid and electrolyte management 1. 1. Describe the principles of fluid and electrolyte management too much fluid and the body become overloaded, the excess fluid moves from the vascular space (extracellular space) and into the interstitial space. EXAM PREP: 8  when fluid moves into the lungs it’s known as pulmonary edema and in the brain ceriable Edema both conditions can be life threatening conditions A drug class known as diuretics are often prescribed to aid the secretion of excess fluid 1. Explain and demonstrate the role of the nurse in relation to altered fluid and electrolyte status using the nursing process 1. 1. Explain and demonstrate the role of the nurse in relation to altered fluid and electrolyte status using the nursing process When giving fluid it is important to look at these clinical factors; -full clinical history -signs and symptoms -physical assessment -Blood pathology including; Urea and electrolytes Full blood count arterial blood gas Parathyroid hormone (for Ca2+ imbalance) -the continuous monitoring of vital signs -regular assessment of the insertion site (VIPS) can help to locate local injections and systemic injections 1. Prepare, perform and document parenteral fluid and electrolyte administration 1. 1. Prepare, perform and document parenteral fluid and electrolyte administration Wound Assessment and management COMPLEX WOUNDS: What specific data will you collect when assessing a wound? Type of wound; is it an internal or external cause internal can be from allergies, impaired circulation or injection External included cuts, abrasions and surgery surgical can be delineated further into 4 types whether the wound is acute or chronic (after 4 weeks) Type of healing; primary - the wound is clean EXAM PREP: 9  secondary - tissue loss tertiary - the wound is open What are some factors that hinder wound healing? the phases need to occur in the correct order for proper healing to occur local factors; systemic factors position of the wound dehiscence risk or wound infection systemically, consider increasing age, malnutrition, nutritional deficiencies, smoking, obesity, immune disorders, stress, anaemia, immobility, shock Diabetes and complications, including delayed wound healing There are a number of forms of diabetes, the most common being diabetes mellitus, a chronic condition where people experience chronically high levels of glucose in the blood. Diabetes mellitus (DM) can be further classified into three main types: Type 1, type 2, and gestational diabetes. TYPE 1 Diabetes TYPE 2 Diabetes insulin resistance, and the All insulin producing cells of the progressive loss of insulin Pathophysiology pancreas are destroyed by a production by cells of the pancreas chronic autoimmune condition (Beta cells) Can occur at any age, however most frequently in childhood and adolescence. Onset abrupt in children, may be slower in More frequently in older adults but is Usual onset of symptoms adults. If not diagnosed and increasing in young adults and treated, high glucose and ketone adolescents levels as well as dehydration may lead to diabetic ketoacidosis Excess thirst, increased urination, Excessive thirst and urination, tired, lethargic, hungry, slow healing Symptoms leading to unexplained weight loss, wounds and cuts, blurred vision, diagnosis weakness and fatigue, blurred gradually putting on weight (or losing vision it), mood swings, headaches, dizzy Long term neuropathy, retinopathy, Neuropathy, retinopathy, symptoms/complications nephropathy nephropathy EXAM PREP: 10  Lifestyle modifications (diet, exercise) oral anti hypoglycaemics may be added class at a time, insulin Mangement Insulin may be added to address developing illness and increasing BGL’s with time Insulin deficient or resistant the body is not able to produce insulin may be required as the illness (does insulin have to be insulin at all. it is required to be progresses provided) provided Type 1: 5-10% of diagnosed cases of diabetes can occur at any age, however most frequently in childhood and adolescence. all insulin producing cells of the pancreas are destroyed by a chronic autoimmune condition the body is not able to produce insulin at all determined by genetics modifying external factors will not prevent or delay the onset of type 1 DM Type 1 diabetes symptoms Unexplained weight loss: When the body is unable to extract energy from food, it will instead break down muscle and fat. Energy is lost through glycosuria. Ketonuria: Ketones in the urine indicate excess ketones in the blood, which are excreted in the urine. In the absence of insulin, fat is broken down and converted to ketones in the liver. Ketones are released into the bloodstream and excreted in the urine, and in high amounts lead to ketosis and potentially ketoacidosis. Diabetic ketoacidosis frequently occurs at the onset of type 1 diabetes and if the person is unwell or insulin is missed, and can be fatal if not treated. Type 2: 87% of all diabetes cases more frequently in older adults but is increasing in young adults and adolescents insulin resistance, and the progressive loss of insulin production by cells of the pancreas (beta cells) more common in people who tend to store fat around the abdomen Gestational diabetes- similar to type 2 but occurs only in pregnancy 2-10% of cases elevated blood glucose levels occurs for the first time in pregnancy. EXAM PREP: 11  pancreas is not producing enough insulin, or the insulin produced is not effective. usually occurs for first time in the second or third trimester resolves after birth but increases the risk of diabetes in later life for both the mother and child. Some long-term complications of DM: microvascular conditions – where the small blood vessels of the nerves, eyes and kidneys are damaged due to persistent high blood glucose levels (neuropathy, retinopathy, nephropathy). macrovascular complications – high blood glucose levels over time, effect the large blood vessels including coronary arteries (heart attack), brain (stroke), and the legs and feet (peripheral vascular disease). Common symptoms of both type 1 and type 2 diabetes Hunger and fatigue: Lack of insulin or resistance to insulin means glucose can’t be used effectively by the body, causing hunger and tiredness. Insulin aids the transport of glucose from blood to muscles; insufficient or ineffective insulin leaves the muscles without an energy source and thus a feeling of tiredness ensues. Hunger is triggered by the body seeking extra energy sources but unfortunately eating more without the aid of insulin to transport the food to the muscles just escalates the blood glucose level. Urinating more and being thirsty: The kidneys excrete excessive glucose - and water and electrolytes are lost through osmotic diuresis. This, in turn, increases thirst, then fluid consumption increases, which further increases urination. Dry mouth and itchy skin: An effect of dehydration from excessive urination. Longer term symptoms of both type 1 and type 2 diabetes include: Yeast infections: Yeast feeds on glucose. Infections can grow in folds of skin including between fingers and toes, under breasts and the genital area. Slow-healing cuts and sores: High blood glucose affects blood flow and also the haemoglobin’s ability to carry oxygen. Over time diabetes may cause damage to the nerves that also impedes wound healing. Pain and numbness in feet and legs: Caused by nerve damage. If the diagnosis of type 2 diabetes is delayed, diabetes complications may already be present at the time of diagnosis. INSULIN AND GLUCAGON BALANCE: insulin lowers blood sugar levels in three ways; 1. it enhances the transport of glucose from the blood and into body cells, particularly into muscle and fat cells EXAM PREP: 12  2. it inhibits the breakdown of glycogen into glucose 3. it inhibits the conversion of amino acids or fats into glucose Glucagon is an amino acid peptide and has a pretty big effect on the body in raising blood glucose levels Glucagon mainly targets the liver as this is one of the major storage sites for glycogen Introduction to post-operative gastrointestinal complications 1. What are some of the most common complications of gastrointestinal surgery? Ileus surgical wound dishisence psuedo obstruction perforation of the bowel anastomic leak 1. What is a post operative ileus? When is an ileus more likely to occur? bowel = sleepy (bowel paralysis) can cause obstructions to occur within the intestines after surgery (usually when the bowel is touched during a surgical operation - this is because the intestines are very sensitive and not normally touched. 1. Can you identify and explain some of the roles of the registered nurse in relation to the care of a person who has undergone a gastrointestinal surgery? GIT Nursing assessment skin; dehaydration, pallor, jaudice, brusing, itching Eyes: sunken, yellow, pale Mouth: lips, tongue, gums, teeth weight vitals: BP, Temp, HR, RR, pain score Diet: changes, altered bowel patterns, food intolerances medical/surgical history, medication history, social/personal history Prescence or absence of: - nausea -dypepsia (indigestion) -dysphagia (difficulty swollowing) abdo pain: COLDSPA EXAM PREP: 13  - Bowel sounds - haematemesis (blood in vomit) - diarrhea onset: duration, frequency, stool chart, excavting or relieving factors - constipation - melaena (black tarry stool from bleeding in upper GIT - palpable lumps: sit, onset and characteristics NURSING CARE OF GI SYSTEM: observations: vitals signs are monitored Nutrition of hydration; Strict FBC, adequate hydration, oral hydration, when permitted a balanced nutritional intake Elimination: observe nature, course, characteristics, output chart, stool samples Pain relief: pain assessment, maximise comfort Preparation for investigations: e.g colonoscopy and laparoscopy require fasting GI surgery Investigation: Laparoscopy Excision: Appendectomy Repair: Hernia Transplantation: Liver Disorders of GIT Cancers: colorectal cancer is the 2nd most common in AUS Peptic ulcer disease: break or ulcer in the mucosal lining, damages the lining by excess acid secretion Inflammatory Bowel disease: e.g chrons, ulcerative colitis and diverticilitis appendictis Colostomy is the surgical resection of the bowel to divert faecal contents, it is an ostomy of the colon. Hartmann’s procedure is temporary colostomy Wound and Chest infections SURGICAL WOUND INFECTIONS: What are some obvious signs of wound infection? redness (erythema) EXAM PREP: 14  swelling fever drainage -clear -Yellow murky -Green Pain Foul odour no healing POST-OPERATIVE CHEST INFECTIONS: What is pneumonia ? infection presents within the alveoli - causing the alveoli to become inflamed, creating fluid which is sitting within the alveoli. this prohibits maximal oxygen uptake and thus decreases gas exchange within the lungs causing dyspnea. How the post op patient you will be caring for may develop pneumonia which patients are most at risk? Role of the nurse in AMR stewardships is the careful use of antimicrobials this includes: the role of the nurse includes: Medication rights are followed (medication dose, time, route and patient) appropiate tests are taken before antibiotics are commenced check if the patient has any allergies recorded Ask what they are being used for to avoid miscommunication Ask if the pt can switch from IV to oral antibiotics if they are eating and drinking Asking about the duration Discuss the importance of using them as prescribed Help ppts and families understand the importance of avoiding unnecessary antibiotics Avoid spraying antibiotics into the air when mixing and dispose of waste correctly ensuring that the patient finishes the whole course of antibiotics to prevent the risk of microbial resistance. EXAM PREP: 15