COMPLICATIONS OF HOSPITAL ADMISSION

Question 1

Pressure Injuries - risk factors

Answer 1

Risk Factors

• Tissue susceptibility
  
  • Nutritional status
  • Age – very young or very old
  • Tissue oxygenation / perfusion
  • Chronicity
  • Skin integrity and temperature
  • Moisture
• Mechanical load (pressure / friction / shear)
  
  • Magnitude and duration
  • Mobility and sensory limitation

Question 2

Falls - Consequences

Answer 2

• Fracture, closed head injury, laceration, pain,
• Disability secondary to injury
• Fear / limitation of activity / cycle of decreased function
• Death

Question 3

Healthcare Associated Infection - entails

Answer 3

• Unnecessary pain and suffering
• Increased length of stay
• Increased cost of delivering health care

Question 4

Healthcare Associated Infection - Prevention

Answer 4

Prevention

Eliminate

• Prompt management of spills
• Disposal of sharps
• Telehealth

Substitution

• Replace difficult to clean equipment
• Oral medication instead of IV

Isolation

• Single patient rooms
• Manage surgical or clinical lists

Engineering

• Ventilation / air quality / plumbing

Question 5

Venous Thromboembolism

Answer 5

Deep Vein Thrombosis (DVT)

• A clot that develops in a deep vein, usually in a leg

Pulmonary embolism

• Develops when a DVT clot mobilises from the vein wall
• Travels to the lungs, and resulting in a partial or complete blockage to blood
  flow

Risk Factors

• Age
• Excess body weight
• Cancer and some autoimmune disorders
• Conditions with increased blood clotting
• Pregnancy and post partum women

Symptoms

• Pain in the leg
• Pain often starts in the calf and can feel like cramping or soreness.
• Red or discoloured skin on the leg
• A feeling of warmth in the affected leg
• Swelling of the affected foot, ankle or leg

Diagnosis

• Ultrasound of the affected vein
• D-Dimer blood test (measures enzyme in the blood that is present when active clotting occurs
• MRI or angiogram

Prevention

Medical

• Anti-coagulation medication
• Clexane, heparin, enoxaparin, aspirin

Mechanical

• Anti-embolic stockings
• Intermittent pressure calf pumps
• Keep the patients mobile!

Question 6

Delerium

Answer 6

A sudden change in thinking or behaviour

• Often caused by changes in health
  
  • Infection
  • Medication changes

Symptoms

• Confusion / forgetfulness
• Lack of orientation to time / place / person
• Inability to concentrate
• Changes in sleeping patterns
• Scared / upset / irritable / anger / depression
• Hallucinations
• Incontinence

Risk factors

• > 65 years, or >45 years in ATSI people
• Multiple medications / recent changes to medications
• Recent surgery
• Depression
• Poor eyesight and/or hearing loss
• Very sick or frail
• Cognitive impairment, including dementia, intellectual disability or brain injury
• Patients who have had delirium before

Treatment

• Diagnosing and treating underlying infection
• Nutrition
• Changing medications
• Keeping mobile

Question 7

Osteomyelitis

Answer 7

• Bone infection
• Often caused by non-healing wounds of overlying skin
• may spread from other parts of the body
• Usually staphylococcus aureus
• Treatment with long turn IVABs

Question 8

ISOBAR

Answer 8

Intervention - 3 pt ID (name, DOB, UMRN)

Situation - diagnosis, progress

Observation - patient observations

Background - patients history

Assessment - treatments undertaken, progress, physio specific problems

Recommendation - the plan going forward