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258 revision part two Flashcards

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1
Q

what is assessed under E in an A-E assessment?

A

Exposure:

  1. body temperature
  2. skin integrity
  3. signs of pressure injury
  4. wounds, dressings or drains, invasive lines
  5. ability to transfer and mobilise
  6. bowel movements
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2
Q

what is assessed under D in an A-E assessment?

A

Disability:

  1. level of consciousness
  2. speech
  3. pain
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3
Q

what is assessed under C in an A-E assessment?

A

Circulation:

  1. pulse rate and rhythm
  2. blood pressure
  3. urine output
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4
Q

what is assessed under B in an A-E assessment?

A

Breathing:

  1. respiratory rate
  2. work of breathing
  3. oxygen saturation
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5
Q

what are macronutrients and micronutrients?

A

macronutrients - proteins, fats, carbs

micronutrients - vitamins and minerals

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6
Q

how is excess glucose stored?

A

converted to glycogen and stored in the liver and muscles or converted into fat and stored in adipose tissue

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7
Q

what is cholesterol used for in the body?

A

cell membranes, steroid hormones, bile

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8
Q

what is nitrogen balance?

A 
when nitrogen (protein) intake is equal to nitrogen (protein) output. no nitrogen, no amino acids.
it's widely considered to be the primary goal of nutritional support, and is closely associated with improved patient outcomes.
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9
Q

what is nitrogen essential for?

A

wound healing; growth, repair and maintenance of tissues

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10
Q

how much nitrogen does a body have and how much can we stand to lose?

A

only about 1000g. loss of a third of this can lead to death. loss of 10g/day for 10 days = loss of 2.5kg muscle

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11
Q

what causes loss of nitrogen from the body?

A 
fever
trauma
burns
major surgery
infection/sepsis
malnutrition/starvation
physical/emotional stress
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12
Q

what % of the body is water?

A

about 50 - 60%

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13
Q

what medical conditions alter the amount of fluids required?

A

renal/cardiac failure = less fluids

diarrhoea/fever/vomiting/burns = more fluids

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14
Q

effects of vitamin deficiencies?

A 
vit C- scurvy
vit D - rickets
vit B 12 - megaloblastic anaemia
vit K - bleeding
folic acid - spina bifida
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15
Q

which vitamins are fat soluble and wouldn’t be absorbed in a totally fat-free diet?

A

A, D, E, K

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16
Q

what BMIs mean:

A

BMI < 18.5 - underweight
BMI > 25 overweight
BMI > 30 obese
BMI > 40 morbidly obese

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17
Q

what are the two types of nutritional support (feeding) if you can’t eat?

A

enteral - NG tube, gastrostomy (PEG), jejunostomy tube

parental - via veins

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18
Q

when would enteral nutritional support be used?

A

if GI tract functional but patient has dysphagia/aphagia

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19
Q

advantages of enteral nutritional support over parenteral?

A

maintains digestive and liver functions ie motility
maintains insulin/glucagon ratios
maintains GIT organisms

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20
Q

potential complications of enteral nutritional support

A 
misplaced tube
aspiration
dumping syndrome
perforated oesophagus
perforation of brain
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21
Q

when would parenteral nutritional support be used?

A

when GI tract non-functional or when increased metabolic demand for nutrition (burns, shock)

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22
Q

potential complications of parenteral feeding?

A 
pneumothorax from insertion of CVC
infection from high glucose + portal of entry
hyper/hypoglycaemia
protein overload
electrolyte imbalance
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23
Q

what are the major fluid compartments in the body?

A

intracellular fluid (two thirds of total water) and extracellular fluid (one third)

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24
Q

how is the extracellular fluid further divided?

A

interstitial fluid (80% of the ECF) and plasma (20% of the ECF)

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25
Q

how much plasma volume does a textbook male have?

A

3 litres

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26
Q

what is osmolarity?

A

the number of ions in a solution

27
Q

what does increased serum osmolarity mean?

A

an increase in concentrations in solutes in the blood - this means the patient is dehydrated and may need fluid replacement

28
Q

what is tonicity?

A

the relative concentration of solutes in two fluids, aka the ability of an extracellular solution to make water move into or out of a cell by osmosis

29
Q

what is an isotonic solution?

A

ICF and ECF have same number of ions - no net movement into or out of cells (normal saline 0.9%NaCl)

30
Q

what is a hypertonic solution?

A

more ions in the ECF - water is drawn out of cells, cells lyse (10% dextrose)

31
Q

what is a hypotonic solution?

A

ECF has fewer ions, so water is drawn into cells and they swell and burst (0.25% NaCl)

32
Q

when might you use a hypertonic solution?

A

in the case of cerebral oedema, it can reduce swelling in the brain by drawing water out of brain cells (you might use mannitol)

33
Q

explain link between hypertonicity and diabetes

A

hyperglycaemia = increased blood osmolarity = water drawn out of cells (cellular dehydration)
when there is some much glucose in blood it can’t be transported back out of the nephrons (transporters full), it’s excreted in urine and will take water with it = polyuria and glycosuria. this will lead to polydipsia and dehydration

34
Q

what is an example of hypotonicity in illness?

A

water intoxication - can lead to cerebral oedema, confusion, coma, death

35
Q

signs and symptoms of dehydration?

A 
dry mouth
thirst
tachypnoea
tachycardia
confusion  
low BP (BP is maintained at first as water moves from ICF to ISF to plasma)
36
Q

signs and symptoms of fluid overload?

A 
full, bounding pulse
distended jugular veins
high BP
oedema
pulmonary oedema
37
Q

what is an appropriate level of fluid for most patients to meet fluid maintenance requirements?

A

about 30ml/kg/day (1 - 1.5 ml per kg per hour)

38
Q

what is ascites?

A

fluid collecting in the abdomen

39
Q

main ions inside cells?

A

potassium, magnesium, proteins

40
Q

main ions outside cells?

A

sodium, chloride, bicarbonate

41
Q

how is the water/sodium regulated in the body?

A

not enough water in blood - ADH, aldosterone cause water to be reabsorbed in kidneys, BP increases
too much water - ADH and aldosterone inhibited, urine becomes more dilute

42
Q

names for too much/too little sodium, calcium, potassium?

A

hyper or hypo -natremia, -calcemia, -kalemia

43
Q

two signs of hypercalcemia?

A

trousseau’s sign, chvostek’s sign

44
Q

where is ADH produced and stored?

A

produced in hypothalamus, stored in posterior pituitary

45
Q

when is ADH released?

A

in response to increased osmolarity of blood as detected by osmoreceptors in the hypothalamus

46
Q

where is alsosterone produced?

A

adrenal cortex

47
Q

how does aldosterone work?

A

aldosterone loves sodium - cause sodium to be reabsorbed, and therefore water

48
Q

what controls the release of aldosterone?

A

regulated by
RAAS system
ACTH (adrenocorticotropic hormone) released by the anterior pituitary
circulating levels: when sodium is low or potassium high in circulation

49
Q

which hormones affect fluid balance?

A

ADH, aldosterone, RAAS, ANP and BNP

50
Q

examples of crystalloids

A

fluids with small particles/solutes: hartmann’s, sodium chloride 0.9%, 5% dextrose, plasma-lyte

51
Q

is 5% dextrose hypertonic or isotonic?

A

isotonic in the bag, hypotonic in the body (so it’s a good fluid for dehydration. also used for hypoglycaemia/ insulin shock)

52
Q

another name for Hartmann’s?

A

CSL (compound sodium lactate)

53
Q

examples of colloids?

A

whole blood/packed cells, fresh frozen plasma, albumin

54
Q

disadvantages of colloids?

A

they can lead to oedema

they can cause allergic reactions/anaphylaxis

55
Q

The location of the apex of the heart in a four (4) year old child is the:

A

4th intercostal space to the left of the midclavicular line

56
Q

where are the adenoids found?

A

back of the nose

57
Q

where are the tonsils found?

A

back of the throat

58
Q

signs and symptoms of tonsillitis

A
  1. swelling of tonsils
  2. redness to tonsils
  3. yellow or white coating to tonsils
  4. snoring/ difficulty breathing
  5. fever
  6. recurrent ear infections
59
Q

common treatments for tonsillitis?

A
  1. throat cultures
  2. xray to visualise size of adenoids
  3. blood test (?infection)
  4. surgery
60
Q

how much is the risk of nausea and vomiting increased by in a T+A post-op?

A

30 - 40%

61
Q

most common complications post-op for T+A?

A

nausea and vomiting

hypoxia from respiratory complications

62
Q

other potential complications post-op for T+As?

A
  1. cardiac complications - usually only in pts with cardiac anomalies
  2. shivering, agitation, delirium - more common with newer anaesthetic agents ie sevoflurance
  3. urinary retention (from anaesthetic drugs
63
Q

how can you reduce post-op spasms in throat following T+As?

A

chew gum, adequate cool fluids

nursing cards (13 decks)

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