NURS2040 Professional Practice 4 (PP4) Week 6 PDF

NURS2040 Professional Practice 4 (PP4) Course Coordinators/Lecturers Dr Benjamin Hay & Marie Fielding Week 6 ACKNOWLEDGEMENT OF COUNTRY The University of Notre Dame Australia is proud to acknowledge the traditional owners and custodians of this land upon which our Universit...

NURS2040 Professional Practice 4 (PP4) Course Coordinators/Lecturers Dr Benjamin Hay & Marie Fielding Week 6 ACKNOWLEDGEMENT OF COUNTRY The University of Notre Dame Australia is proud to acknowledge the traditional owners and custodians of this land upon which our University sits. The University acknowledges that the Fremantle Campus is located on Wadjuk Country, the Broome Campus on Yawuru Country and the Sydney Campus on Cadigal Country. Course Updates Assessments: reminder- see course outline Ass 1 -Mid sem –completed – marks back in 2 weeks – if deferred (3 days to submit docs- watch emails) Ass 2- Med+Safe (Hurdle task 1)– after study week break in week 7 tutorial-2nd attempt following weeks –Week 8 and if needed-3rd and final week 9 Ass 4- CSE –IDC insertion (Hurdle task 3)– -1st practice week 5, 7, 8 and then assessment in week 9/10 –watch BB emailed announcements for more info and sign-up links Ass 5- Final semester test- week 10-tutorials Weekly plans- updates Study break week - 2nd September (practice with med+safe) Week 7- (Broome students study week) and med calcs assessment in tutorials Week 8 –STS event with SOP- Monday 0830-0930 in Zoom –compulsory attendance Week 9 – pre-recorded lecture (WA public holiday) and no tutorial in week 9 –self directed Week 10-end sem assessment and CSE’s if applicable -2nd attempts Week 11- SGG for OT placement students – see emails Objectives Revise cardiac physiology, cardiac perfusion, & monitoring Explore nursing management of potential cardiovascular postoperative complications. Discuss indications and measurement of Central Venous Pressure (CVP) and Jugular Venous Pressure (JVP) in practice. Discuss complex perfusion dysfunction and nursing management for patients with heart failure. Discuss medical and surgical cardiovascular interventions with nursing considerations Discuss a congenital Paediatric cardiovascular issue. Discuss safe transfusion practice, patient indications, and management Pre-reading: Pre-reading: Ch65- Ch 38-pg 974-975 PACU, Post Blood transfusion op care & complications Ch 31 (revision) 630-636- cardiac and vessels assessment Ch54 (revision) circulation pg1494-1509  Week 6: Lecture overview Week 1 introduced the perioperative journey, which includes three phases: 1. Preoperative (week 1) 2. Intraoperative (week 2) 3. Postoperative (this week and following weeks with systems e.g. cardiovascular postoperative complications and care) Today’s session focuses on the postoperative phase and cardiovascular system, and considers: – Revision of cardiac anatomy and physiology – Nursing management of potential postoperative cardiovascular complications. – Minimally invasive cardiac procedures, measurement of CVP/JVP – Cardiomyopathy and Heart failure. – Common congenital cardiac conditions. – Management of blood transfusions 5 Lecture – Week 5 | NURS2040 - Professional Practice 4 Cardiac physiology-CO Revision What is Cardiac Output (CO)? The amount of blood the heart pumps through the circulatory system in a minute. What is Stroke Volume? The amount of blood put out by the left ventricle of the heart in one contraction. CO = SV x HR Heart rate: Influenced by autonomic nervous system (e.g. ‘Fight or flight’); blood pressure; hormones (thyroid); and medications. Heart rates >150bpm cause inadequate filling time (diastole) thus a HR increases CO; HR, whilst negative chronotropes contractility whilst negative inotropic drugs 50% of people). High risk of severe impairment & arrhythmias-heart blocks and bradycardias  ECG monitoring highlights cardiac rhythm and arrhythmias & ischemic episodes Central venous pressure reflects the pressure in the central veins measured in the thoracic cavity. Fluctuates with respiration. Arterial Pressure monitoring provides a continuous [accurate] measurement of blood pressure and can be used for sampling arterial blood gases (ABG) Pulse Oximetry monitors oxygenation What are these?: ETCO2 ; PAP; AWP; FiO2; TV (ml)...  The heart is located in the mediastinum Is a hollow muscular structure pumping 4-5 litres Theory to practice- of blood per minute. Is the size of a clenched fist post op cardiac Heart covering and walls: patients Pericardium Epicardium Myocardium Endocardium Heart chambers and valves Sternal wires Epicardial pacing wire Automated internal defibrillator- AICD (with leads in endocardium) Discuss indications and measurement of Central Venous Pressure (CVP) and Jugular Venous Pressure (JVP) in practice. Why measure CVP: CVP is used to assess adequacy of blood volume and is an indicator of right ventricular preload. CVP also reflects the limit to venous return and informs about right ventricular function. CVP measurements may be helpful to support and guide fluid management CVP measurement Measured through a central line and measures right atrial pressure https://litfl.com/cvp-measurement/ There are no valves between the right atria and the superior vena cava so the pressure measured at the tip of the catheter is a measure of right atrial pressure Right atrial pressure is an indirect measurement of right ventricular preload Helps to assess cardiac function and venous return to the heart Measuring CVP: Fluid filled tubing connected to a transducer is attached to the distal lumen of the central line. Measure from the phlebostatic axis (4th intercostal space mid axillary line). Temporarily cease fluids being administered through the lumen for measurement. Ensure reading occurs at end expiration. Recommence fluids. Document – normal CVP reading can be between 0-8cm H20, abnormal e.g. cardiac tamponade could be 12cm H20 Jugular Venous Pressure (JVP): Noninvasive evaluation of central venous pressure (CVP) can be achieved by assessing the Jugular Venous Pressure (JVP) Elevated CVP will present clinically as a pulsation of the internal jugular vein when a patient is inclined at 45 degrees; however, it can be noted in an upright patient in severe cases. Elevated JVP readings can indicate heart failure and fluid overload needing diuresis  Postoperative cardiovascular complications: risk factors Surgical factors: Patient factors: Duration of surgery. Presence of diabetes Type of anaesthesia. History of transient ischaemic attack (TIA) Episodes of hypotension within the operative Acute MI procedure. Angina Site of surgery: thoracic, orthopaedic, vascular Ischaemic disease procedure or surgery as a result of trauma. Congestive heart failure Emergency surgery. Elevated BP (particularly SBP over 180mmHg) Blood transfusions / excessive fluid administration Low haematocrit and Hb Elevated creatinine Evidence of ischaemia in ECGs Older / senior patients. Obese / bariatric patients. Current smoker. Increased ASA score or poor functional status. Cardiac booklet to help patients understand their hospital stay and surgery: (SCGH sample) https://www.scgh.health.wa.gov.au/~/media/HSPs/NMHS/Hospitals/ SCGH/Documents/Services/Cardiothoracic/CARDIAC_SURGERY_PATI My heart booklet –risk factors and surgical procedure explanations for patients: ENT_INFORMATION_BOOKLET.pdf https://www.heartfoundation.org.au/ Lecture – Week 4 | NURS2040 - Professional Practice 4 11  Explore nursing management of potential cardiovascular postoperative complications. Hypovolaemia: Hypovolaemic shock: Inadequate circulating blood volume Inadequate tissue perfusion resulting from markedly reduced Causes: Fluid deficit, haemorrhage circulating blood volume Signs: Tachycardia, decreased urine output, decreased blood Causes: Severe hypovolaemia from fluid deficit or haemorrhage pressure Signs: Rapid weak pulse, dyspnoea, tachypnoea; restlessness and Preventative management: Early detection of signs; fluid anxiety; urine output less than 30 mL/hr; decreased blood pressure; and/or blood replacement cool, clammy skin, thirst, pallor Preventative management: Maintain blood volume through adequate Haemorrhage: fluid replacement, prevent haemorrhage; early detection of signs Internal or External bleeding Causes: Disruption of sutures, insecure sutures, insecure ligation of blood vessels Signs: Overt bleeding (dressings saturated with bright blood; bright, free-flowing blood in drains or chest tubes), increased pain, increasing abdominal girth, swelling or bruising around incision Preventative management: Early detection of signs Ch 38-pg 974-975 Critical thinking- PACU, Post op care 1. Note the importance of periop education from week 1- deep breathing and coughing, moving safely post op, TEDS, Post op care & complications and expectations…links to safety and reducing complications Explore nursing management of potential cardiovascular postoperative complications. Thrombophlebitis: Embolus: Inflammation of the veins, usually of the legs and associated with a Foreign body or clot that has moved from its site of blood clot formation to another area of the body (e.g. the lungs, Causes: Slowed venous blood flow due to immobility or prolonged heart or brain) sitting; trauma to vein, resulting in inflammation and increased blood Causes: Venous or arterial thrombus; broken intravenous coagulability catheter, fat or amniotic fluid Signs: Aching, cramping pain; affected area is swollen, red and hot to Signs: In venous system, usually becomes a pulmonary touch; vein feels hard; discomfort in calf when foot is dorsiflexed or embolus (see pulmonary embolism); signs of arterial when the person walks (Homans’ sign) emboli may depend on the location Preventative management: Early ambulation, leg exercises, Preventative management: Turning, ambulation, leg antiembolic stockings, SCDs, adequate fluid intake exercises, SCDs; careful maintenance of IV catheters Thrombus: Blood clot attached to wall of vein or artery (most commonly the leg veins) Causes: As for thrombophlebitis for venous thrombi; disruption or *Measuring limb girth with tape may inflammation of arterial wall for arterial thrombi provide additional data to the degree of swelling-note the markings for the Signs: Venous: same as thrombophlebitis Arterial: pain and pallor of same spot each time affected extremity; decreased or absent peripheral pulses Preventative management: Venous: same as thrombophlebitis Arterial: maintain prescribed position; early detection of detection of signs Ch 38-pg 974-975 PACU, Post op care Critical thinking- 1. What specific post op nursing observations are important to detect & complications some of the above complications?  Explore nursing management of potential cardiovascular postoperative complications. Cardiac tamponade is a clinical syndrome caused by the accumulation of fluid in the pericardial space, resulting in reduced ventricular filling and subsequent hemodynamic compromise. The condition is a medical emergency, the complication of which include profound shock, multi organ failure and death. Signs: Tachypnea Tachycardia Elevated jugular venous pressure (JVP) and CVP Confusion Decreased urine output Hypotension Peripheral cyanosis Management: Urgent medical review Drainage/evacuation of fluid from pericardial space (see video) Emergency open heart surgery for cardiac tamponade video (graphic) https://www.youtube.com/watch?v=ogmEHG8qSzQ Cardiovascular disease in Australia Heart Foundation. (2023). Heart Foundation. (2023). Minimally invasive procedures Australian Institute of Health and Welfare. (2023). Heart, stroke and vascular disease: Australian facts: In 2020-21, common procedures performed in hospital for CVD were: https://www.aihw.gov.au/reports/heart-stroke-vascular-diseases/hsvd-facts/contents/about Echocardiography (49,000) pacemaker insertion (19,900). Coronary angiography (146,000), Percutaneous valve replacement (TAVI) or repair (12,000). https://www.heartfoundation.org.au/Bundles/ Percutaneous coronary intervention (48,000), Your-heart/Conditions/FP-ACS-Guidelines Lecture – Week 4 | NURS2040 - Professional Practice 4 15  Medical and surgical cardiovascular interventions and nursing considerations Interventional cardiology Coronary angiogram. Coronary artery stent insertion for CAD/STEMI (PTCA) Rotablation. A) A thrombotic occlusion of the right coronary B) Right coronary artery is opened, and blood Pacemaker insertion. artery is noted (arrows). flow restored following angioplasty and placement of a 4 mm stent Percutaneous valve replacement. Shaffer, Rose, Lewis’s Medical-Surgical Nursing ANZ, Copyright © 2020 Copyright 2020 Elsevier Australia Placement of a coronary artery stent. Rotablation Rotational atherectomy involves navigating a A. A) The stent is positioned at the site of the lesion. catheter fitted with a Rotablator device (diamond coated burr) through the site of the B. B) The balloon is inflated,expanding the stent. The blockage, where it gently pulverizes the balloon is then deflated and removed. blockage into tiny particles that can pass safely through the bloodstream (particles smaller C. C) The implanted stent is left in place. than red blood cells). http://www.scvc.com.au/rotational-atherectomy.html Nursing care considerations: Most hospital sites include clinical pathways and care guides for staff for specific care for intervention (see samples in BB) e.g. ACS pathway, or suspected chest pain; Coronary angiogram clinical pathway; VTE risk assessment Risks: Ineffective tissue perfusion- decreased O2 to capillary level Decreased CO- not meeting demands Activity intolerance- to meet ADLS Goals: Improve tissue perfusion Restore cardiac output Interventions: Promote circulation – cardiac rehab post surgery/diagnosis; positioning important-leg exercises, care with legs elevated can improve or worsen condition –e.g. heart failure; sit in high fowler to decrease preload and pulmonary congestion, monitor FBC-strict for HF patients if fluid restriction Medications- nitrates, Ca Channel blockers, ACE inhibitors, beta blockers, Inotropes, vasodilators, aspirin, diuretics Preventing venous stasis- TEDS, sequential compression devices, low molecular weight heparin Close monitoring for deterioration e.g. post op care post PTCA Valves: What are the causes of valve disease? Congenital Around 9 in every 1,00 live births are affected Infective endocarditis by congenital heart disease Acute infective (AIHW, 2020) endocarditis Conditions stretching and distorting the heart valves Sub acute infective Hypertension endocarditis Heart failure Aortic atherosclerosis Other Myocardial infarction Autoimmune disorder Rheumatic fever Marfan syndrome Strep bacteria Metabolic disorder Cause damage/scarring of valves (aortic and Radiation therapy to the mitral) Symptoms may appear years later after thorax for cancer recovery from rheumatic fever Surgical options: Valve repair – Surgical procedure of choice – Lower mortality – May not restore total valve function Valve replacement – Mechanical (artificial) – Biological (tissue) Discuss complex perfusion dysfunction and nursing management for patients with heart failure. Cardiomyopathy (CMP) CMP is a group of diseases that directly affect myocardial structure or function Primary or secondary Dilated, hypertrophic or restrictive Can lead to cardiomegaly and HF Dilated CMP Ischaemia (IHD), idiopathic and a 20% incidence of genetic Management options and nursing care: inheritance patterns. Treatment of underlying cause Autoimmune process and alcoholic CMP are also implicated. Nitrates Characterised by diffuse inflammation and rapid degeneration of the myocardial fibres. Beta adrenergic blockers antiarrhythmics Results in ventricular dilation, impaired systolic function, atrial ACE inhibitiors enlargement and left ventricular stasis of blood. Hypertrophic CMP Diuretics Massive ventricular hypertrophy Ventricular assist device Rapid, forceful contraction of left ventricle Implantable cardioverter/defibrillator Impaired relaxation (diastole) Surgical – Heart Transplantation End result is impaired ventricular filling as ventricle becomes non- compliant, leading to diastolic dysfunction Restrictive CMP Impaired filling during diastole but systolic filling is unchanged Fibrosis, hypertrophy and infiltration produce stiffness of the ventricle wall and loss of compliance Characterised by fatigue, exercise intolerance, dyspnoea-These symptoms occur because the heart cannot increase its CO by increasing heart rate without further compromising ventricular filling https://www.heartfoundation.org.au/bundles/your- heart/what-is-cardiomyopathy  Discuss complex perfusion dysfunction and nursing management for patients with heart failure. Heart failure: An abnormal clinical syndrome involving inadequate cardiac pumping/filling. Insufficient blood supply/oxygen to tissues. Used to be called congestive heart failure (CHF). Causes- anything that interferes with mechanisms that regulate cardiac output (CO). Risk factors: Hypertension, CAD Left side heart failure: Most common form Results from left ventricular dysfunction Blood backs up into left atrium and pulmonary veins Increased pulmonary pressure causes fluid leakage → pulmonary congestion and oedema Heart unable to pump oxygen-rich blood from the lungs to the left atrium. Causes blood to back up through the left atrium and into the pulmonary veins. Increased pulmonary pressure causes fluid extravasation from the pulmonary capillary bed into the interstitium and then to alveoli. Manifested as pulmonary congestion and oedema. Right-sided Heart Failure: Right ventricular dysfunction Blood backs up into the right atrium and venous circulation: Jugular venous distension. Hepatomegaly, splenomegaly. Vascular congestion of GI tract. Peripheral oedema. Most commonly caused by left-sided HF May result from acute conditions (RV infarction, PE) and from cor pulmonale Occurs due to left sided heart failure Backup of blood into the right atrium and venous circulation Venous congestion in the systemic circulation results in: Jugular venous distension, Pre-reading: hepatomegaly, splenomegaly, vascular congestion of the gastrointestinal tract, & peripheral Ch 31 (revision) 630-636- oedema cardiac and vessels assessment Heart failure and video Ch54 (revision) pg1494-1509 https://www.heartfoundation.org.au/Bundles/Your- heart/heart-failure https://www.instagram.com/doc_wakeup/?hl=en  Discuss complex perfusion dysfunction and nursing management for patients with heart failure. Management of heart failure: Main treatment goals: Treat the underlying cause and contributing factors Medications: Maximise CO Provide treatment to alleviate symptoms Diuretics Improve ventricular function RAAS inhibitors Improve quality of life – ACE inhibitors Preserve target organ function – Angiotensin II receptor blockers Improve mortality and morbidity. – Aldosterone antagonists Oxygen therapy β-adrenergic blockers Relieve dyspnoea and fatigue Vasodilators Physical and emotional rest Conserve energy and decrease oxygen needs – Nitrates Structured exercise program Positive inotropic agents Biventricular pacing/cardiac – Digitalis (be alert for digitalis toxicity) IABP and VADs as bridge or destination therapy for stage IV HF https://www.amboss.com/us/knowledge/renin- angiotensin-aldosterone-system-inhibitors/ Nutritional therapy: Low-sodium diet Recommend the Dietary Approaches to Stop Hypertension (DASH) diet Sodium is usually restricted to 2 g/day If fluid restriction is required, < 2 L/day. Daily weights Pre-reading: Ch 31 (revision) 630-636-cardiac and vessels assessment https://www.heartfoundation.org.au/Bundles/Your- Ch54 (revision) pg1494-1509 heart/Conditions/Heart-failure-clinical-guidelines Congenital paediatric cardiac conditions Tetralogy of Fallot. Transposition of great arteries. Coarctation of the aorta https://www.heartfoundation.org.au/Bundles/ Your-heart/congenital-heart-conditions Lecture – Week 4 | NURS2040 - Professional Practice 4  Discuss safe transfusion practice, patient indications, and management Blood transfusion indications: Blood loss (trauma, surgery, haemorrhage) Blood products: Severe anaemia Packed red blood cells (RBC)= removed plasma from whole blood, increases O2 carrying capacity without excess fluid (blood loss post Replacement of fluid and protein op, anaemia). Can be stored for 10 days, WCC removed (causes Restoration of oncotic pressure reactions), infused at 1 unit over 1-3 hours but must be completed Replacement essential clotting factors within 4.5 hours after removal from fridge Plasma or Fresh frozen plasma (FFP)= Liquid part of blood and Blood grouping and matching: restores fluid and proteins in intravascular space; contains clotting Recipient to donor –blood is a living tissue –considered factors but needs to be given quickly after thawing as proteins can break down. Infused over 30mins, should be of the same blood type ‘transplantation’-risk of fatal transfusion reaction-strict Platelets= separated out of plasma and used for clotting abnormalities process required and tissue repair. Administered over 30-60mins with specific blood Blood groups= A, B, O, and AB, and rhesus (Rh) factor +/- transfusion set –not standard IV line. ve (85% of pop’n has antibodies on their RBC= Rh +ve) Serum albumin= large molecule protein to increase oncotic pressure Blood of one group incompatible with another group in intravascular space= fluid to shift from interstitial space to and mismatches (group and Rh) causes haemolytic intravascular space to help correct hypovolaemia. Can be in 4% or reactions. Type O –ve can give to all (no antigens) 20% volumes. Autologous blood can be given long before patient going Cryoprecipitate= plasma containing Factor VIII (8) and other clotting factors; only small amounts (10-15ml) administered in a vial over 30- for surgery and given back to them during/after 60mins –expensive- one vial was $12k! Blood Products & Their Uses-Youtube video https://www.youtube.com/watch?v=hYfwQYuhNuo Pre-reading: Ch65- Blood transfusion RBC- O-=Universal donor AB+=Universal receiver Understanding Blood Types & Potential Complications-Youtube video https://www.youtube.com/watch?v= 0f2U3DDo8Xs  Discuss safe transfusion practice, patient indications, and management Before requesting issue of a blood product or collecting the blood product, clinical staff must check the following: The prescription has been satisfactorily completed, and a valid, informed consent has been obtained and the indication for transfusion has been documented in the patient’s health-care record The patient has been assessed, including baseline vital signs, to determine whether it is appropriate to undertake the transfusion at the planned time IV access is appropriate 18–20G or larger and patent, and all necessary equipment is available and in working order (e.g. infusion pumps, Blood IV set or blood warmers) Appropriately trained and competent staff are available for the duration of the transfusion, including two staff to perform the blood product and patient identity checks at the patient’s side-blood is not spiked/started until all checks completed Pre-reading: Ch65- The patient is available to proceed with transfusion; for example, the patient is not scheduled for a procedure. Blood transfusion Once a unit of blood is removed from the blood fridge, transfusion must: Commence within 30 minutes. Be completed within 4 hours. Normal saline is used to prime the line- isotonic and doesn’t affect RBC (no lysis or clumping) Transfusion reactions usually occur in first 15mins- start infusion slowly and remain with patient for 15- 30mins to observe- vital signs= 15/60mins Check and follow hospital policies WAHealth Patient blood management tools and Medical management of massive haemorrhage- resources- periop bleeding risk assessments and blood product selection and options more; Paeds resources… https://first10em.com/massive-hemorrhage-the- https://www.health.wa.gov.au/Articles/N_R/Patie clinical-approach/#google_vignette nt-Blood-Management-tools-templates-and- resources NSQHS Blood Management Standard The Blood Management Standard aims to improve outcomes for patients by identifying risks and using strategies that optimise and conserve a patient's own blood, as well as ensuring that any blood and blood products that patients receive are safe and appropriate. https://www.safetyandquality.gov.au/standards/nsqhs-standards/blood- management-standard iTransfuse app for mobiles: https://www.lifeblood.com.au/health- professionals/learn/itransfuse-app National blood authority Australia: https://blood.gov.au/single-unit- transfusion  Reactions - refer to hosp clinical practice guidelines Clinical Signs Nursing Intervention Haemolytic Reaction:  (incompatibility) Stop transfusion and ring for  Febrile, chills, headache, SOB, Chest pain, RMO! Monitor obs and FBC, urinalysis. Check Tachycardia, hypotension blood pack and paperwork for discrepancies. Send remaining blood and lines to lab. Infuse NaCl with new lines. CALL MET if meets criteria. Document! (incident report, Progress notes) Allergic Reaction:  STOP TRANSFUSION  Itching, urticarial rash, wheezing (mild)  Keep IV line open with normal saline  Severe- dyspnoea, chest pain, circulatory  Check blood pack label and patient collapse, cardiac arrest. identification labels are correct i.e. correct unit has been given to correct patient.  NOTIFY RMO  Severe- Administer CPR if needed, administer medications or oxygen as ordered.  Reactions - refer to hosp clinical practice guidelines Clinical Signs Nursing Intervention Febrile Reaction: (incompatibility) Stop transfusion and Febrile, chills, warm, flushed skin, ring for RMO! Give antipyretics as headache, anxiety, muscle pain. ordered. Keep the vein open with normal saline. Fluid overload/circulatory overload: Stop transfusion Dyspnoea, chest pain, anxiety, Notify medical staff-frequent obs, check diaphoresis, blood tinged sputum, fine medication chart for frusemide to be crackles on auscultation of the chest given between units, FBC, nursing care as per fluid overload Tutorial and labs (week 6) Lab: Please review the free elearning resource on ‘blood safe’ and complete for your portfolios/CV: https://learn.bloodsafelearning.org.au/course/details/ctp Tutorials: Download PDF ‘Chapter 7- Caring for a person with a cardiac condition-Scenario 1=ischaemic chest pain; & Scenario 2=heart failure’ from Clinical Reasoning text prior to session. Download PDF ‘Chapter 9-Caring for a patient receiving blood component therapies-Scenario 1=Red blood cells; & Scenario 2= Platelets and Fresh Frozen Plasma (FFP) https://ebookcentral.proquest.com/lib/unda/detail.action? pq-origsite=primo&docID=30031152 Access chapter answer guide in ‘Essential Information’ folder in BB to check your working out Students can work through the purple case studies this week if keen and as an another option from the links in BB. Case studies include patient case studies for CCF, CABG, and chest pain management  References (1/2) Australian College of Perioperative Nurses. (2023). Nursing Roles. https://www.acorn.org.au/nursing-roles Brown, D., Edwards, H., Seaton, L., Buckley, T. (2015). Lewis’s medical-surgical nursing; assessment and management of clinical problems (5th edition). Elsevier. Broyles, B., Reiss, B., Evans, M., McKenzie, G.,Pleunik, S., Page, R. (2017). Pharmacology in nursing, Australian and New Zealand (2nd ed.). South Melbourne, Vic: Cengage Learning Australia. Clinical Excellence Commission. (2023). Sentinel Events reporting. https://www.cec.health.nsw.gov.au/Review- incidents/Biannual-Incident-Report/sentinel-events Hamlin, L., Davies, M., Richardson-Tench, M. & Sutherland-Fraser, S. (Eds). (2016). Perioperative nursing: an introduction (2nded.).Elsevier NSW Health The Pre-Procedure Preparation Toolkit 2007. Retrieved from http://www0.health.nsw.gov.au/policies/gl/2007/pdf/GL2007_018.pdf Rothrock,J.C. (2007). Alexanser’s Care of the patient in surgery. (13th ed). The Australian College of Operating Room Nurses, (2014). ACORN standards for perioperative nursing, 2014-2015. Adelaide South Australia: the Australian College of Operating Room Nurses Ltd. Abreu, E., & Potter, D. (2001). Recommendations for renovating an operating theater at an emergency obstetric care facility. International Journal of Gynecology & Obstetrics, 75, 287-294. https://doi.org/10.1016/S0020-7292(01)00527-6 Lecture – Week 2 | NURS2040 - Professional Practice 4 30 References (2/2) Images: Abreu, E., & Potter, D. (2001). Correct traffic flow in and out of the operating theatre. In Recommendations for renovating an operating theater at an emergency obstetric care facility. International Journal of Gynecology & Obstetrics, 75, 287-294. https://doi.org/10.1016/S0020-7292(01)00527-6 Anaesthesia image: https://image.slidesharecdn.com/historyofanaesthesia-160111060823/95/history-of-anaesthesia-8-638.jpg?cb=1452493273 Local anaesthetic - https://openi.nlm.nih.gov/imgs/512/319/4553273/PMC4553273_cios-7-275-g002.png?keywords=anesthesia Deviated septum: https://www.columbiadoctors.org/health-library/multimedia/deviated-nasal-septum/ Epidural - http://medicineworld.org/images/blogs/1-2009/epidurals-10621.jpg Eye block - https://s3.amazonaws.com/classconnection/984/flashcards/7530984/jpg/peri_vs_retro-152EB370BE5462FA6DB.jpg Blachial plexus - https://s-media-cache-ak0.pinimg.com/originals/8e/7c/95/8e7c95b1b91a230876d772d63d7b0ac4.jpg Femoral block : http://ee_ce_img.s3.amazonaws.com/cache/ce_img/media/remote/ce_img/https_ee_channel_images.s3.amazonaws.com/article- figures/8979/article-g03_400_273.jpg Dermatomes: https://s-media-cache-ak0.pinimg.com/originals/c2/f6/11/c2f611ca51001dd574ee6174db0c7f8e.jpg Laryngectomy image:http://1.bp.blogspot.com/-zgXt1p4sFQc/TiZd7-aY6OI/AAAAAAAAB3U/v5yIJaS1wC0/s1600/Slide+7+- +Pre_Post+Lary+Illustr.+no+logo%255B2%255D.jpg Lap thyroidectomy image: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3689381/bin/12262_2012_494_Fig1_HTML.jpg Radical neck dissection image retrieved from : https://www.cedars-sinai.edu/Patients/Programs-and-Services/Head-and-Neck-Cancer-Center/Treatment/Neck- Dissection.aspx Lecture – Week 2 | NURS2040 - Professional Practice 4 31 Any Questions?