Everything RDP content Flashcards
(116 cards)
1
Q
Explain asthma
A
Asthma is a common condition caused by narrowing of the small air passages in the lungs. The narrowing happens when air passages become swollen and inflamed, causing more mucus to be produced. In addition, the muscle bands around the air passages become tighter. These changes make it harder for air to get in and out of the lungs, and cause wheeze, cough and problems with breathing.
Asthma is a chronic inflammatory disease of the airways characterized by reversible airways obstruction and bronchospasm.
Exacerbations in children are often precipitated by a viral infection.
Asthma increases the risk of fatal anaphylaxis
2
Q
Paediatric respiratory rate for 5 yer old (Rosies age)
A
20-30
3
Q
examination of severity of asthma
A
Wheeze is not a good marker of severity.
The most important parameters in the assessment of the severity of acute childhood asthma are:
general appearance/mental state and;
work of breathing (accessory muscle use, recession)
Initial SpO2 in air, heart rate and ability to talk are helpful but less reliable additional features.
Tachycardia can be a sign of severity but is also a side effect of beta agonists such as salbutamol.
Wheeze intensity, pulsus paradoxus, and peak expiratory flow rate are NOT reliable. A silent chest with no wheeze may herald imminent respiratory collapse.
Asymmetry on auscultation is often found due to mucous plugging, but warrants consideration of foreign body.
Children with respiratory distress should have minimal handling.
4
Q
what is a spacer?
A
5
Q
Ventilation
Perfusion
Diffusion
A
6
Q
explain the gas Gas exchange process
A
7
Q
what is fio2
A
Fraction of inspired oxygen 78% made of nitrogen, room air 21%, flow rate can change the fio2 in the air, type of device used can also change the fio2
8
Q
oxygenation definition
A
Oxygenation definition: uptake and delivery of oxygen for energy metabolism
9
Q
Normal lungs sounds?
A
vesicular is the normal 7th and 8th ribs or bronchial vesicular
10
Q
types of respiratory failure
A
Type 1 respiratory failure occurs when the respiratory system cannot adequately provide oxygen to the body, leading to hypoxemia. Examples include pneumonia, pe. Treatment, giving supplemental oxygen, positioning
Type 2 respiratory failure occurs when the respiratory system cannot sufficiently remove carbon dioxide from the body, leading to hypercapnia. Examples: neurological disorder (MS), Copd, head and neck injury, APO, drug induced. Treatment CPAP because it opens the alveoli which increases the exchange of cases
11
Q
Temperature effects o2 consumption
A
if someone is pyrexia they need more oxygen, if they are septic the body demands more (Explain why)
12
Q
respiratory drive?
A
in normal patients: high levels of carbon dioxide, in copd is low level of oxygen
13
Q
copd?
A
COPD covers three conditions: emphysema, bronchitis and asthma.
Know the pathophysiology of COPD
14
Q
APO
A
APO – fluid overload of the lungs, could be caused too much iv fluids or CCF, left ventricular failure causes APO because its connected to the lungs. Symptoms: SOB, pink frothy sputum, hypertension, tachycardic
Treatments: CPAP helps with apo and it forces the fluid out, could also use diuretics, or dialysis . gtn
APO but hypotensive don’t give diuretics because they could arrest so you give inotropes (aramine to get blood pressure up first without giving to much fluid)
Diagnosis: To confirm APO chest xray, but you do a respiratory assessment first and will hear loads of crackles.
15
Q
Reliever vs preventor
A
preventor is daily to opens alveoli to stop broncho restriction whilst reliever is potent bronchodilator to relieve acute symptoms.
16
Q
Diagnosis of asthma
A
lung function test, respiratory lung function test, history.
17
Q
normal urine output?
A
0.5ml per kg – for example if an adult is 80kg you would want 40mls per hour
1-2ml per kg for a child
No urine output for 6 hrs needs to be flagged
18
Q
normal blood volume?
A
Blood volume – 80-90mls of blood per kg in paediatrics so they can compensate for more blood loss than adults as they have more blood volume per kg
Blood volume – 65-70mls of blood per kg in adults
19
Q
differences of children anatomy in relation to breathing to adults
A
Anatomy of children’s ribs is they are more horizontal than adults and adults ribs go round the lungs so children can’t get as good of an expansion in their breath.
Children also have smaller airways
Children are mouth breaths and have bigger tounges, more soft tissue, smaller pharynx
20
Q
crystalloid vs colloid
A
Crystalloid: small molecule so it can pass through
Colloid: large molecules that you cant see through such as blood, albumin, platelets
21
Q
hypertonic
A
22
Q
isotonic
A
23
Q
hypotonic
A
24
Q
morphine use and mechanism of action
A
Morphine is an opioid medicine prescribed for severe pain when other pain-relief medicines are not effective or cannot be used. Interact with opioid receptors and produce analgesia. hyperpolarization of interneurons and depressing the release of transmitters associated with transmission of pain.
25
Intercostal catheter (ICC) and underwater suction/dry suction thoracic drainage unit (UWSD). What are they and what are they used for?
26
Focused cardiovascular assessment explained including landmarks?
27
Focused respiratory assessment explained including landmarks?
28
Focused neurological assessment explained including landmarks?
29
Focused abdominal assessment explained including landmarks?
30
Types of artificial airways?
31
CPAP and BIPAP explain?
32
tracheostomy
33
Central venous catheters (CVCs) what are types of central lines and what are they used for?
34
Revise fluids and electrolytes
35
basic ecg interpretation
36
Types of nutriontional support
TPN, nasogastric feeding, PEG feeding
37
explain nasogastric insertion and management?
38
explain compartment syndrome
Compartment syndrome is a painful build-up of pressure around your muscles. Causing pressure in your vessels. Will complain of extreme pain as the pressure build up causing lack of oxygen to blood vessels, killing the veins and arteries. Treatment is fasciotomy - procedure in which the fascia is cut to relieve pressure in the muscle compartment, is used to treat people with acute or chronic compartment syndrome.
39
explain third spacing
occurs when too much fluid moves from the intravascular space (blood vessels) into the interstitial or “third” space—the nonfunctional area between cells. This can cause potentially serious problems such as edema, reduced cardiac output, and hypotension.
40
explain pneumothorax
41
explain haemothorax
42
what is the AVPU assessment and who is it used for?
43
what is the HAT assessment and what is it used for
Hypotension systolic bp less than 100
Altered mental status
Tachypnea rr 22/min
44
sepsis vs infection
Sepsis vs infection: Sepsis occurs when your body's immune system starts to send infection-fighting chemicals throughout your body rather than just to the infection itself. These chemicals cause inflammation and start to attack the healthy tissues. Your body is no longer fighting the infection, it's fighting itself.
Sepsis you’re at risk of organ dysfunction
Lactate can indicate tissue hypoxia so its an indicator of sepsis
Anyone that have had surgery are at risk of sepsis same with babies and elderly
45
sepsis vs septic shock
Difference between septic shock and sepsis: septic shock is when their blood pressure drops so low causing damage to organs whilst sepsis occurs when your immune system has an extreme reaction to an infection
46
hypotension treatment
Fluids:
hartmans for the electrolytes
albumin if its very low then crystolloids
can also use quick acting aramine or noradrenaline
47
high temperature treatment
high temperature treatment
paracetamol after lfts
cooling them down – ice packs
Rigor – shivering but when you have a high temperature, so don’t take off blankets because they will shiver more and there temperature will go up even more
48
explain taking blood cultures for treatment of sepsis
Blood cultures from 2 sites as the results are more systemic and give a better more accurate reading , blood cultures are done before antibiotics to make sure you don’t mask the problem and give the specifically needed antibiotic
49
Intracellular extracellular etc
50
PQRST ecg
P – atrial depolarisation
QRS – ventricular depolarisation
T – Ventricular repolarisation
51
Indications for iv therapy
52
Different ecg readings and indications (study)
When you’ve had an enlarged Q wave it shows a previous AMI
give more!!!
53
troponins
protein that are released when there is death/insult or injury in or to the heart
Serial troponins: 6 hourly
54
explain 2, 3 and AVF inferior AMI etc
need to answer
fact: we don’t normally give GTN to inferior because we have less pre load so we couldn’t have the volume due to the vasodilated. So there would be not enough load to contract
55
explain angina and unstable angina
chest pain to due a partial or complete blockage such a plaque build up or thrombus causing an insufficient amount of blood getting to the heart
Stable: when you exercise it causes vasoconstriction then the partial blockage has less room for the blood to go through causing the chest pain on exertion. So it is resolvable as when the vessels dilate again it feels better
Unstable: complete blockage in the vessels causing chest pain even at rest and vasodilating doesn’t resolve the issue as the vessel is completely blocked.
56
Digoxin:
Aspirin:
Metoprolol:
Frusemide:
Statin:
Metformin:
Anginine:
Digoxin: don’t give if the heart rate is below 60
Aspirin:
Metoprolol:
Frusemide:
Statin:
Metformin:
Anginine:
57
Angio treatment
PCI – they like people to have it within 90 minutes. Insertion into the heart to get rid of the blockage
If no PCI facilities they go for fibrinolytic therapy (blood thinner) streptokinase, amylase, alteplase
58
alteplase
Alteplase is a fibrinolytic agent; it also is referred to as tissue plasminogen activator (tPA). Alteplase converts plasminogen to the proteolytic enzyme plasmin, which lyses fibrin as well as fibrinogen.
Alteplase know everything – 0.9mg per kg is the correct dose, maximum dose of 90mg
Alteplase monitoring:
Signs of bleeding such as at the surgical sites, haematuria, haematomas
Neuro obs
Vital signs
– every 15 mins for the first hour
- Every 30 mins for 2hours
- 1 hrly for 4 hours
- 2hrly for 4 hours
- 4 hours post
59
CABGS
Coronary artery bypass grafting (CABG), also called heart bypass surgery, is a medical procedure to improve blood flow to the heart. It may be needed when the arteries supplying blood to the heart, called coronary arteries, are narrowed or blocked
60
Cardiac tamponade
is a medical emergency that takes place when abnormal amounts of fluid accumulate in the pericardial sac compressing the heart and leading to a decrease in cardiac output and shock
61
Rapid atrial fibrillation
need to explain
amiodarone mixed with 5% dextrose and then beta blockers
62
Renal failure and the types
63
AMI explained
64
pancreatitis
The pathophysiology of acute pancreatitis is based on the premature activation of the enzymes zymogen and trypsinogen, resulting in local pancreatic destruction and activation of the inflammatory cascade, which causes the systemic inflammatory response syndrome (SIRS) often associated with acute pancreatitis.
The 2 most common causes of pancreatitis are gallstones and heavy alcohol consumption
Bloods for suspected pancretitis: FBC, LFT, U and E’s, CRP, Serum lipase, Serum amylase
65
role of the pancreas
The pancreas has dual roles - it is an organ of the digestive system and of the endocrine system. The exocrine pancreas produces enzymes that help to digest food, particularly protein. The endocrine pancreas makes the hormone insulin, which helps to control blood sugar levels
66
the spleen
The spleen controls the level of white, red blood cells and platlets
67
CAGE score: alcohol scale
Cut down, annoyed, guilty and eye opener
68
Hepatic encephalopathy:
This is a condition that happens when your liver is too diseased or damaged to properly process ammonia, leading to a buildup of ammonia in your blood that travels to your brain. It can cause confusion, disorientation and coma. It can sometimes be fatal.
Lactulose binds to ammonia and removes it from the system
KNOW what lactulose it is and how it works^^^^
69
lactulose
Lactulose is used to treat constipation
70
frusemide
Furosemide is a potent loop diuretic that works to increase the excretion of Na+ and water by the kidneys by inhibiting their reabsorption from the proximal and distal tubules, as well as the loop of Henle. It works directly acts on the cells of the nephron and indirectly modifies the content of the renal filtrate.
71
Refeeding syndrome
is a potentially fatal condition, caused by rapid initiation of refeeding after a period of undernutrition. It is characterised by hypophosphataemia, associated with fluid and electrolyte shifts and metabolic and clinical complications.
72
first and second line of defence
First line of defence is the skin, mucous
Second line of defence is neutrophils
73
Acute Myeloid Leukaemia
A type of cancer of the blood and bone marrow with excess immature white blood cells.
AML progresses rapidly, with myeloid cells interfering with the production of normal white blood cells, red blood cells and platelets.
Symptoms include fatigue, recurrent infections and bruising easily.
Treatments include chemotherapy, other drug therapy and stem-cell transplants.
74
What is neutropenia
Neutropenia is not a disease. It is a condition in which you have a low number of neutrophils (white blood cells).
75
S.I.R.S criteria: systemic inflammatory response syndrome
Body temperature over 38
Heart rate greater than 90 beats/minute.
Respiratory rate greater than 20/22 breaths/minute
White cell count below 4
76
C. diff
also known as Clostridioides difficile or C. difficile) is a germ (bacterium) that causes diarrhea and colitis (an inflammation of the colon
77
Nadir
is a term that basically means low point. When a person with cancer reaches their “nadir” following each chemotherapy cycle, it means that the person's blood cell counts are the lowest they will be during that treatment cycle. Each chemotherapy treatment comes with a nadir period. Within 10-14 days.
78
platelets
Their primary function is to prevent and stop bleeding. If a blood vessel is damaged, the body sends signals to platelets which cause them to travel to the injured area. Once the platelets arrive at the site, they clump together to form a clot that helps stop bleeding. A normal platelet count in adults ranges from 150,000 to 450,000 platelets per microliter of blood
When you have a low platelet count, you may have trouble stopping bleeding. Bleeding can happen inside your body, underneath your skin, or from the surface of your skin. You may not have serious bleeding until your platelet count is very low
79
Heparin
Heparin injection is an anticoagulant. It is used to decrease the clotting ability of the blood and help prevent harmful clots from forming in blood vessels. This medicine is sometimes called a blood thinner, although it does not actually thin the blood.
80
Brain is made up of: Monroe – Kellie theory
1. Blood 10%
2. CSF 10%
3. Brain 80 %
Monro-Kellie doctrine, or hypothesis, is that the sum of volumes of brain, CSF, and intracranial blood is constant. An increase in one should cause a decrease in one or both of the remaining two.
81
Hydrocephalus
is the buildup of fluid in cavities called ventricles deep within the brain. The excess fluid increases the size of the ventricles and puts pressure on the brain. Cerebrospinal fluid usually flows through the ventricles and bathes the brain and spinal column.
82
Cerebral perfusion pressure (CPP)
is the net pressure gradient that drives oxygen delivery to cerebral tissue. Calculated by (CPP = MAP − ICP). And its normal range is 60-80
Map of 80 – icp 20 = 60 so that’s good
If map is 60 you want it up as then it would equal 40 so you could give noradrenaline to get the MAP up by increasing blood pressure
83
seizure management
Time started and duration
Airway management guedal
Aura of the seizure
Triggers
Clonazepam
Safety measure
Post ictal state – 5/30mins
84
ramipril
Ramipril is an angiotensin-converting enzyme (ACE) inhibitor and is utilized for multiple indications, including hypertension and prevention of heart failure progression following a myocardial infarction
85
1 unit of blood is
250mls
86
Metaraminol
Metaraminol is the vasoconstrictor of choice for the short-term management of acute hypotension along with fluids such as albumin and can be administered by peripheral intravenous catheter. If low blood pressure persists despite adequate fluid resuscitation, it is usual practice to switch to a noradrenaline infusion once central access is available.
87
Acute kidney injury
condition of acute loss of function of the kidneys resulting in disruption of fluid and electrolytes and accumulation of waste.
Can have acute on chronic kidney injury
88
measuring urine output in adults
0.5 per kg per hour of urine
89
Hypovolaemia
Low blood volume
90
With bleeding we get
Decreased circulating volume – decreased pre load – decreased cardiac output – decreased blood pressure
91
pre renal
intra renal
post renal
Pre renal – hypotension
Intra renal – meds/nephrotoxic, contrast (whats the gfr is the question they ask before a scan)
Post renal – obstructions such as prostate, bph, tumours
92
Discuss the differences between delirium, dementia in the older person
Delirium is an abrupt onset of reduced orientation to the environment in contrast to dementia, a gradual neurodegenerative process leading to the disturbance in the core features, and attention is affected much later in the disease course.
93
What is elder abuse and what forms can it take
financial, psychological. Sexual, verbal, neglect, physical
94
Considerations do nurses need to take into account with elderly patients
Cognitive decline, memory impairments, behavioural issues
Polypharmacy
AF, coronary artery disease risk
Lung function declined
Bowel issues, decreased urine output, UTIs, prostate issues in men, haemorrhoids
Risk of type 2 diabetes, lower temperature
Mobility decline, increased falls risk
Skin more fragile (increased risk of infections), wound healing decline
95
Cardiogenic shock
(due to heart problems) – heart has ischemia causing insufficient contraction so not enough blood and therefore oxygen getting to the body causing inadequate supply and then the body goes into shock. Causes: heart attack, ischemia disease, pericarditis
Treatment:
96
Hypovolemic shock
Hypovolaemic shock: life-threatening condition that occurs when the body is not getting enough blood flow. With bleeding we get: Decreased circulating volume – decreased pre load – decreased cardiac output – decreased blood pressure
MORE.
97
Anaphylactic shock
(caused by allergic reaction)
Anaphylaxis causes the immune system to release a flood of chemicals that can cause you to go into shock — blood pressure drops suddenly and the airways narrow, blocking breathing.
Increases vascular permeability and vasodilation leading to hypo perfusion of tissues the body responds to these changed increasing heart rate and contractability. Prostaglandin D functions as a bronchoconstrictor, coronary vasoconstrictor and peripheral vasodilation
Low urine output
Causes: reactions to medications
Treated with adrenaline (vasoconstrictor) and antihistamines
98
Septic shock
(due to infections)
Gram negative bacteria is the most common cause of sepsis
99
Neurogenic shock
(caused by damage to the nervous system): Neurogenic shock is a critical condition that results from the dysregulation of the autonomic nervous system following spinal cord injury, especially in the cervical and upper thoracic vertebrae above the T6 level, as a result of traumatic events
Because of spinal cord injury the messages of fight, flight or freeze so tachycardia doesn’t show as a symptom, bradycardia, cyanose
Treatment: fluid rescuitation and vasopressors for the hypotension
Atropine for bradycardia
Surgery for spinal cord injury
100
Pathophysiology of shock
The fundamental defect in shock is reduced perfusion of vital tissues. Once perfusion declines and oxygen delivery to cells is inadequate for aerobic metabolism, cells shift to anaerobic metabolism with increased production of carbon dioxide and elevated blood lactate levels.
101
symptoms of shock
Anxiety or agitation/restlessness
Bluish lips and fingernails
Chest pain
Confusion
Dizziness, lightheadedness, or faintness
Pale, cool, clammy skin
Low or no urine output
Profuse sweating, moist skin
Rapid but weak pulse
Shallow breathing
Being unconscious (unresponsive)
102
treatment of shock
Oxygen
Short acting aramine if hypotensive
Fluids such as albumin whilst waiting for blood to come and to create space for the vasoconstrictor
Then long acting vasoconstrictor such as noradrenaline if needed
Treat the underlying cause of the shock eg diahrrea causing dehydration (shock) treat diahrrea will treat the shock
103
Ketones present in the urine for which complications
from starvation and diabetes
104
What are some indications for chest drainage and UWSD
105
ventilation, diffusion and perfusion
106
what do you need for a tracheostomy?
107
GTN what is it and how does it work?
Glyceryl trinitrate, an organic nitrate, is a vasodilator. Its principal pharmacological action is the relaxation of vascular smooth muscle. Glyceryl trinitrate produces a dose related dilation of both arterial and venous beds.
108
Endone
is an opioid. It is used to relieve strong pain when other pain relievers such as paracetamol (for example Panadol®, Panamax®) and anti-inflammatories (for example Brufen®, Voltaren®) are not effective enough. Has the same mechanism of action as other opioids: binding to a receptor, inhibition of adenylyl-cyclase and hyperpolarisation of neurons, and decreased excitability
109
metformin
mechanism of action: The centre of metformin's mechanism of action is the alteration of the energy metabolism of the cell. Metformin exerts its prevailing, glucose-lowering effect by inhibiting hepatic gluconeogenesis and opposing the action of glucagon.
Used for: Metformin is used to control blood glucose (sugar) levels in people who have type 2 diabetes.
110
Morphine Sulphate
Morphine is a full opioid agonist and is relatively selective for the mu-opioid receptor, although it can bind to other opioid receptors at higher doses. The principal therapeutic action of morphine is analgesia.
111
Paracetamol
Paracetamol is a type of weaker analgesia for pain. It is thought to produce analgesia through a central inhibition of prostaglandin synthesis.
112
Aspirin
aspirin is non-steroid anti-inflammatory drugs (NSAIDs) inhibit the activity of the enzyme now called cyclooxygenase (COX) which leads to the formation of prostaglandins (PGs) that cause inflammation, swelling, pain and fever. And is used for heart conditions because spirin slows the blood's clotting action by reducing the clumping of platelets. Platelets are cells that clump together and help to form blood clots. Aspirin keeps platelets from clumping together, thus helping to prevent or reduce blood clots.
113
Clonazepam
Clonazepam is a benzodiazepine drug used for the acute treatment of panic disorder, epilepsy, and nonconvulsive status epilepticus. It's primary mode of action is to facilitate GABAergic transmission in the brain by a direct effect on benzodiazepine receptors.
114
Celecoxib
Celecoxib is a nonsteroidal anti-inflammatory drug (NSAID) used to treat mild to moderate pain and help relieve symptoms of arthritis. selective inhibition of cyclooxygenase-2 (COX-2), responsible for prostaglandin synthesis, an integral part of the pain and inflammation pathway.
115
Ondansetron
Ondansetron is in a class of medications called serotonin 5-HT3 receptor antagonists. It works by blocking the action of serotonin, a natural substance that may cause nausea and vomiting
116
Pantoprazole
is a type of medicine called a proton pump inhibitor (PPI). Proton pumps are enzymes in the lining of your stomach that help it make acid to digest your food. Pantoprazole prevents proton pumps from working properly. This reduces the amount of acid the stomach makes. Pantoprazole reduces the amount of acid your stomach makes. It's used for heartburn, acid reflux and gastro-oesophageal reflux disease (GORD) – GORD is when you keep getting acid reflux. It's also taken to prevent and treat stomach ulcers.
