Nursing Practice CVS_Consolidation Aug2024.pdf

NUR1125: Consolidation and Revision for CVS Nursing Practice This session covers ONLY the NP component © Copyright National University of Singapore. All Rights Reserved.  Exam Details NUR1125 PPNP1 CA Digital Assessment 30 MCQs (Closed book) 8th Oct 2...

NUR1125: Consolidation and Revision for CVS Nursing Practice This session covers ONLY the NP component © Copyright National University of Singapore. All Rights Reserved.  Exam Details NUR1125 PPNP1 CA Digital Assessment 30 MCQs (Closed book) 8th Oct 2024,TUES Venue: MPSH 1A Time: 17:30 – 18:15 (45 minutes) Please be at the venue at least 30 mins before: 17:00 © © Copyright CopyrightNational National University University of of Singapore. Singapore.All All Rights Rights Reserved. Reserved. Revision Plan for Nursing Practice Question and answer CA Briefing Week 7 Saturday (5th Self Directed Revision October 2024, 10am) To Week 5 address any questions Tues 10 Sept 2024 students have for CA (only CVS topics) © Copyright National University of Singapore. All Rights Reserved. Syllabus to will be included in Continuous Assessment Haematology Anemia © Copyright National University of Singapore. All Rights Reserved. Example 1 Mr A was admitted to the hospital for an elective Percutaneous Coronary A) Inflammation of a vein at an Intervention (PCI) via femoral artery. On the 2nd day of post PCI, Mr A’s body early stage. temperature was found to be elevated to 39.0 degree Celsius. He complained B) Inflammation of a vein at a of chills. Nurse Tina examined Mr A’s arm and noticed the following: medium stage. C) An allergic reaction to the contrast media used during the Percutaneous Coronary Intervention. D) Inflammation of a vein just below the skin's surface, which results from a blood clot. Mr A also complained of pain when Nurse Mary palpated along with the IV cannula site. The venous cord is palpable, and some hardness is felt surrounding the IV cannula site. Nurse Mary immediately removed the IV cannula. Which of the following is the MOST likely condition is Mr A suffering from? © Copyright National University of Singapore. All Rights Reserved. © Copyright National University of Singapore. All Rights Reserved. Example 1 Mr A was admitted to the hospital for an elective Percutaneous Coronary A) Inflammation of a vein at an Intervention (PCI) via femoral artery. On the 2nd day of post PCI, Mr A’s body early stage. temperature was found to be elevated to 39.0 degree Celsius. He complained B) Inflammation of a vein at a of chills. Nurse Tina examined Mr A’s arm and noticed the following: medium stage. C) An allergic reaction to the contrast media used during the Percutaneous Coronary Intervention. D) Inflammation of a vein just below the skin's surface, which results from a blood clot. Mr A also complained of pain when Nurse Mary palpated along with the IV cannula site. The venous cord is palpable, and some hardness is felt surrounding the IV cannula site. Nurse Mary immediately removed the IV cannula. Which of the following is the MOST likely condition is Mr A suffering from? © Copyright National University of Singapore. All Rights Reserved. Example 2 INJECTIONS –IV, IM, SC, IT, IP, CONTINUOUS INFUSION DISCHARGE DATE MEDICATIONS DR’S SIGN MCR DISCONTINUED PHARMACY MEDICATION S DURATI DATE DR’S SIGN √ ON IV Sodium Chloride 0.9% 500 LFP 12345G (today) mls and IV Dextrose 5% 500 mls over 24 hours 2 How can the nurse maintain sterility while administering intravenous. fluid to Mr Joe? A. Replace IV peripheral cannula every 24 hours B. Replace IV peripheral cannula every 48 hours C. Replace fluid administration set every 24 hours D. Scrub the distal end of the IV administration set (key part) 10 times © Copyright National University of Singapore. All Rights Reserved. Example 2 INJECTIONS –IV, IM, SC, IT, IP, CONTINUOUS INFUSION DISCHARGE DATE MEDICATIONS DR’S SIGN MCR DISCONTINUED PHARMACY MEDICATION S DURATI DATE DR’S SIGN √ ON IV Sodium Chloride 0.9% 500 LFP 12345G (today) mls and IV Dextrose 5% 500 mls over 24 hours 2. How can the nurse maintain sterility while administering intravenous fluid to Mr Joe? A. Replace IV peripheral cannula every 24 hours B. Replace IV peripheral cannula every 48 hours C. Replace fluid administration set every 24 hours D. Replace fluid administration set every 72 hours © Copyright National University of Singapore. All Rights Reserved. Example 2 INJECTIONS –IV, IM, SC, IT, IP, CONTINUOUS INFUSION DISCHARGE DATE MEDICATIONS DR’S SIGN MCR DISCONTINUED PHARMACY MEDICATION S DURATI DATE DR’S SIGN √ ON IV Sodium Chloride 0.9% 500 LFP 12345G (today) mls and IV Dextrose 5% 500 mls over 24 hours 2 How can the nurse maintain sterility while administering intravenous. fluid to Mr Joe? A. Replace IV peripheral cannula every 24 hours B. Replace IV peripheral cannula every 48 hours C. Replace fluid administration set every 24 hours D. Scrub the distal end of the IV administration set (key part) 10 times © Copyright National University of Singapore. All Rights Reserved. Cardiovascular: Revise the following OSMOSIS Lab Guide Tut Keynotes © Copyright National University of Singapore. All Rights Reserved.  ABCDE assessment framework. Look Visible obstruction in the mouth or Nil or not mentioned in case study A upper airway AIRWAY Listen Noisy Breathing (e.g. gurgling or Nil or not mentioned in case study 1 stridor) Feel Passage of air at the mouth and nose NAD Look Rate/rhythm/depth of respiration RR 26 breaths/min B Cyanosis of lips and tongue Cyanotic lips BREATHIN Use of accessory muscles (+) use of accessory muscles G Listen Oxygen saturation Auscultate lung sounds 90% (room air) Crackles heard in bilateral bases 2 Feel Bilateral lung expansion Not examined Look Extremities for skin colour Pale, Cyanotic extremities, cold skin C Monitor urine output Not mentioned in case study CIRCULATI ON Listen Feel Manual BP by auscultation Pulse rate, rhythm and depth 130/90 mmHg 100 beats/ min (elevated) ECG rhythm (regular); depth (not mentioned) 3 Extremities for cool and clammy Cold skin, diaphoretic Capillary refill time Not mentioned in case study Assess level of consciousness Conscious D Examine pupillary reaction and size Not mentioned in case study DISABILIT Monitor blood glucose level Not mentioned in case study Y Assess for pain Crushing chest pain Measure body temperature 37.5 degree Celsius E Examine dressing sites, drainage Not mentioned in case study EXPOSUR systems and invasive line (e.g. E infection) Assess skin (e.g. wound or rash) NAD © Copyright National University of Singapore. All Rights Reserved. Group 4: What are the monitoring strategies and nursing management required for Mr Lee to monitor his cardiac status and to ensure adequate cardiac tissue perfusion? Cardiac Monitoring Cardiac monitor provides continuous record of Mr Lee’s heart rhythms. It has three or five attachable leads. The leads must be placed in the correct position to obtain a reliable ECG trace. How does it differ from a 12-lead ECG? © Copyright National University of Singapore. All Rights Reserved.  3-lead system 5-lead system 12-lead system Singapore: uses IEC color code Selecting the monitoring lead - Choices for a 3-lead system include leads I, II, and III - Choices for a 5-lead system include leads I, II, III, aVR, aVL, aVF, and V. - In most cases, the clinician will choose lead II, which produces the most upright ECG complex. © Copyright National University of Singapore. All Rights Reserved.  3. Restore Lumen 2. Limit thrombus 1. Balance Myocardial Patency: Angioplasty, 01 formation: Antiplatelet Supply and Demand Stent Placement, or and Anticoagulant Oxygen: Aim SPO2 94-98% Coronary Artery Bypass (or 88-92% if at risk of *Dual Antiplatelet For all STEMI patients hypercapnic resp failure Therapy (interfere with - with ischemic symptoms of the binding of platelets): less than 12 hours duration *Nitroglycerin: 0.3-0.6mg SL Aspirin + - severe HF or cardiogenic shock every 5 minutes for a total irrespective of the durations of of 3 doses Clopidogrel OR symptoms Ticagrelor For patients who have *Beta Blockers: Reduce blood contraindications to fibrinolytic *Anticoagulant (interfere therapy pressure, open up veins and artery to improve blood flow with the proteins in your Within 90 minutes (Door to device *Lipid management (eg: Statin) blood that are involved time) with the coagulation If PCI is unavailable, thrombolytic *Calcium Channel Blockers: process): Example: therapy should be administered allow blood vessels to relax and 30 minutes of patient’s arrival to open Enoxaparin emergency department © Copyright National University of Singapore. All Rights Reserved. * Use of medication will be further discussed at Pharm Tutorial Post-PCI Education © Copyright National University of Singapore. All Rights Reserved. Post-PCI Education © Copyright National University of Singapore. All Rights Reserved. Group 3: What are the immediate monitoring strategies and nursing management required for Mr Lee in the management of the excessive fluid in his lungs? © Copyright National University of Singapore. All Rights Reserved. Group 3: What are the immediate monitoring strategies and nursing management required for Mr Lee in the management of the excessive fluid in his lungs? Patient Education on dietary and fluid recommendations © Copyright National University of Singapore. All Rights Reserved. Group 3: What are the immediate monitoring strategies and nursing management required for Mr Lee in the management of the excessive fluid in his lungs? 1.3 kg © Copyright National University of Singapore. All Rights Reserved. NP Lab © Copyright National University of Singapore. All Rights Reserved. NP Lab © Copyright National University of Singapore. All Rights Reserved. NP Lab © Copyright National University of Singapore. All Rights Reserved. © Copyright National University of Singapore. All Rights Reserved. © Copyright National University of Singapore. All Rights Reserved. © Copyright National University of Singapore. All Rights Reserved. CVS Practice Qns (Osmosis) © Copyright National University of Singapore. All Rights Reserved. CVS Practice Qns (CREATIVE AI) Link to use this telesimulation platform - CREATIVE AI (with username and password) will be released to you by Week 6. Check CANVAS for updates © Copyright National University of Singapore. All Rights Reserved. Other Matters © Copyright National University of Singapore. All Rights Reserved. Questions and Answers Thank You and Best Wishes © Copyright National University of Singapore. All Rights Reserved.