1003 6-12 Flashcards
what are the measurement of cardiac function?
- Pulse rate and strength
- Blood pressure
- Temperature
- Electrocardiogram (ECG)
- Echocardiogram (Echo)
- Pulmonary artery catheter
- Continuous cardiac output monitoring
- Stress tests
describe the coronary blood flow
Coronary ischemia occurs when blood flow is reduced thus there is an imbalance between supply and demand
Conditions that cause ischemia; • Coronary artery disease
• Blood clot
• Coronary artery spasm
describe mechanical system
- Systole: Contraction of myocardium
- Diastole: Relaxation of myocardium
- Stroke volume: Amount of blood ejected with each heartbeat
- Cardiac output (CO): Amount of blood pumped by each ventricle in 1 minute
- CO = SV x HR
• Normal 4-8 L/min
• Cardiac index: CO divided by body surface area
• Normal 2.8-4.2 L/min/m2
what is cardiac cycle
- Cardiac cycle refers to all events associated with blood flow through the heart
- Systole – contraction of heart muscle • Diastole – relaxation of heart muscle
what are the factors affecting strike volume
Preload – amount ventricles are stretched by contained blood
• Afterload – back pressure exerted by blood in the large arteries leaving the heart
• Contractility – cardiac cell contractile force
what is blood pressure
Average blood pressure in
aorta
describe the level of blood pressure determined by 5 factors
- Cardiac output – dependant on stroke volume (SV). Stroke volume is the amount of blood (in millilitres) pumped from the heat with each beat
- Vascular resistance – the resistance to blood flow thorough the arteries ie the pressure required to push the blood through
- Volume of circulating blood – if increased this increases the BP
- Viscosity – increased thickness of the blood makes it harder to pump
- Elasticity of the blood wall – thick and rigid blood vessels make it harder to push blood through
describe the conduction system in order
The Conduction System • Dedicated areas and tracts of nervous tissue throughout cardiac tissue • Sino-Atrial Node • Internodal Pathways • Atrio-Ventricular Node • Atrio-ventricular Bundle (of His) • Bundle Branches • Purkinje Fibres
what is the ECG
PQRS T wave on an ECG Three major waves of electric signals appear on the ECG. Each one shows a different part of the heartbeat.
• The first wave is called the P wave. It records the electrical activity of the atria.
• The second and largest wave, the QRS wave, records the electrical activity of the ventricles.
• The third wave is the T wave. It records the heart’s return to the resting state.
what is the goal of neurological assessment
To standardise clinical observations, always conduct a set of neurological observations with the oncoming nurse to minimise subjectivity
Monitor progress, a neuro patient often deteriorates slowly, and an accurate neuro assessment can identify a deterioration very early
Provide a guide to estimate a patient’s prognosis
what AVPU scale in SAGO chart ?
A- alert
V- rousable by voice
P- rousable by pain
U- unresponsive
what is Glasgow coma scale
- Widely used tool to assess level of consciousness
- Provides a standardised approach to assessment of level of consciousness
- A common language for healthcare workers, although consistency in scoring between staff can be unreliable
- Consistency in use essential; Can be less than reliable if staff not trained to use the scale
- Score can be used to measure and trend neurological dysfunction, and as a basis for decisions of clinical management
- Used in conjunction with measurement of other parameters of cerebral function
what is the 3 parameters in Glasgow scale
- eye opening
Spontaneous;
Speech;
Painful stimuli (central pain first then peripheral if no response);
No response;
*May not be able to open eyes after brain surgery due to periorbital oedema
2. verbal Orientated - 3 orientation questions (e.g. time, place, person); Confused; Inappropriate speech, Incomprehensible sound (e.g. moaning); No verbal response
- motor
Obeys commands (e.g. stick out your tongue);
Localises to pain (e.g. pushes your hand away);
Withdrawal (e.g. patient tries to move away);
Flexion or extension; No response
describe about pupil and reaction to light
- Inspect both eyes for pupil size and symmetry
- Left and right pupils should be equal in size
- Patients with normal neurology demonstrate a brisk and consensual pupillary reaction to light.
- Reacts ‘+’ if there is a brisk constriction of the pupil.
• Sluggish ‘SL’ if the pupil takes longer to constrict.
• No reaction ‘–’ if the pupil is non- reactive and has not changed in size.
• Closed ‘c’ – if both are eyes are closed and unable to open due to gross orbital swelling
describe Limb assessment: Motor and sensory function
- A key element of neurological assessment
• Limb power should be present in all major and minor joints.
• Diminished function may indicate a lesion in the central or peripheral nervous system. - Ask the patient to flex each knee one at a time and get the person to try and straighten the leg or push against resistance applied by you.
- Assess bilateral equality of muscle strength in the arms and legs.
- Note any neurologic deficit such as weakness in one limb.
describe Neurovascular Assessment
- Assessment of the peripheral circulation and the peripheral neurologic integrity.
- Neurovascular impairment is usually caused by pressure on the nerve or altered vascular supply to the extremity.
- Neurovascular assessment is comparative – always assess the unaffected limb to establish a baseline, prior to assessing the affected limb.
when do we need it?
- fractures
- surgery to limb or joints
- bums
- crush injuries
- application of traction, cast, splints or any constrictive dress to limbs
- trauma an extremity
frequency?
- As per documented medical orders
- Hourly for 8 hours then; Second hourly for 24 hours then; Fourth hourly up to 60 hours (therefore from 24 hours to 60 hours)
- Increased frequency to half hourly if deficit identified
- Determined by condition of the patient at any given time and/or related procedural protocols
explain about movement and sensation
- ActiveMovement=abletovoluntarily extend and flex an extremity, digit.
- PassiveMovement= parent/nurse/doctor is able to extend and flex an extremity, digit
- Patientsshouldbeabletodemonstrate active movement of an extremity
- Increased pain on passive extension or flexion of fingers or toes this may indicate compartment syndrome
explain about palpating pulse
- Pulses are palpated to sense the movement or flow of blood through the peripheral vessels
- Specify which pulses are palpable, i.e. dorsalis pedis and posterior tibialis for lower limbs and radial pulse for upper limbs
- Assess the pulse (grade it as strong, weak or absent).
- Record the pulse distal to injury and/or surgical site.
what is compartment syndrome
Is an increase of pressure within a muscle compartment, there is an increase of interstitial pressure within the osseofascial compartments.
• If the pressure is not relieved, necrosis of the soft tissues will occur, leading to permanent contracture deformities
• Causes capillary perfusion to be reduced below a level necessary for tissue viability, and is classified as:
• Acute/Crush
• Chronic/Exertional
reasons?
• Decreased compartment size • Restrictive dressings
• Splints
• Casts
- Increased compartment content • Bleeding
- Edema
what are the Assessment 6 P’s?
Assessment 6 P’s
• Pain: not relieved by simple analgesics (nonnarcotic) and excessive pain on passive extension and flexion of extremity . Narcotics can mask pain from compartment syndrome. This should not preclude appropriate analgesia but rather indicate a need for a higher index of suspicion.•
• Paresthesia : abnormal sensations eg, numbness, tingling of extremity
• Pressure: skin is tight and shiny, pressure in muscle compartment is greater
then 30-40mmHg ( pressures are measured in theatres)
• Pallor : can indicate an arterial injury, is a late sign
• Paralysis : caused by prolonged nerve compression or muscle damage, is a late sign
• Pulselessness : Can indicate death of a tissue, check general colour of the extremity
what is metabolism
-the sum of all energy transformation that occur in the body to maintain life
- energy protection
-
what is thermodynamics
The thermal energy.
- energy is not like being created or destroyed
- energy can change from on form to another
- HEAT is a form of energy
what is heat
thermal energy transported from on site to another
- cause of transfer: themperature between 2 sites
- heat moves from warmer to cooler sites
temperature is the measurement of average heat or thermal energy
explain the thermoregulation overview
- thermal input (core and skin)
- comparator (CNS: hypothalamus, spinal cord)
- error detector (pre optic anterior hypothalamus= POAH)
- output controller
- output (vosomoiton, sweating, shivering)
- negative feedback mechanism go back to 1
what is the Basic life support
when patient is unresponsive DRABCD -danger -responsive -open airway -normal breathing -start CPR -attach defibrillator (AED)
what’s the Fluid balance charts for
to calculate input and output
- positive or negative balance
what do we use to assess acid/base balance?
pH scale
how to gather data?
using SOAPIER
- subjective- heath history
- objective - physical examination
- assesment- what’s going on
- plan
- intervention
- evaluate
- re-evaulate
what is physical assessment skill
- to gather baseline data about patient
- confirm the problem
- inspection: observation, 5 assessment
- palpation
- percussion
- auscultation
what is Non verbal communication skills useful skills
- S (Sit at an angle to the patient) • U (Uncross legs and arms) • R (Relax) • E (Eye contact) • T (Touch) • Y (Your intuition)
what is direct and indirect measurement?
Levels of measurement
measurement (direct)
- clinical Dara such as BP,
measurement of constructs or phenomena (indirect)
- abstract idea
- Nominal scale
-categories : gender - ordinal scale
- Ordered Categories e.g. rank in class depending on grades or weight
categories, pain scales - interval scale
-No absolute zero eg BMI - ration level
- Has an absolute zero eg no weight gain in kilos or growth in cm’s because there is an absolute zero
what is reality and validity?
Reliability
Does it measure something consistently?
– How do I know that the test, the scale, the instrument works every time I use it?
– Represents the consistency of measure obtained
Validity
Does it measure what it is supposed to?
– How do I know that the test, scale or instrument I use measures what it is supposed to?
– Extent to which an instrument reflects the true measure being observed
what does shock mean?
(heart shock etc)
and what are the cause?
- shock is one of body’s most important alarm bells, signalling that the health of the entire body is at risk.
- The immediate cause is inadequate tissue perfusion or the inability of the body to keep pace with tissue demand for oxygen
-Acute, widespread process of impaired tissue perfusion
– derangement in
» cellular (function/structure)
» metabolic (rate and function, needs not met) » Haemodynamics
maybe result in cellular dysfunction, multiple organ dysfunction (failure) and death:
Impairedoxygenuse
» Delivery (eg excessive vasodilation or vasoconstriction, decreased blood volume, acidosis effect on O2 carrying capacity of blood ect)
» Excessive consumption (pyrexia)
– Impairedglucoseuse
» Impaired delivery
» Increased metabolism
» Uptake disruption due to vasoactive toxins, kinins or histamine
» Stress response
what kind of shock there are?
- Hypovolaemia
- Cardiogenic
-Distributive (fluid shifts within the body) » Septic
» Anaphylactic » Neurogenic
describe about heart sounds
Systolic
– following opening of aortic valve (vibration sound) and
closure of tricuspid & mitral valves
– first heart sound (S1) » long and low in pitch » feel a pulse (carotid)
Diastole
– closure of aortic and pulmonary valves
» rapid snap
– second heart sound (S2)
3rd heart sound (S3) not normally present
– rumbling of blood into already full ventricle
in assessment approaches, where the A-G assessment belong to?
primary
- Crucial first element in every patient encounter • Structured & systematic • A-G approach • Allows identification of threats to immediate health
Secondary? • More focussed, in depth • Systematic, logical and organised • Head to toe • Body systems - pain assessment
