Extra Flashcards
How to test for MRSA
3 swabs
mouth, nose then groin
CRE bacteria
Group of bacteria resistant to carbapenem class of antibiotics. These abx are used to treat severe infections.
Test- sample of faeces and rectal swab
Falls assessment
FRAT
Timed up and go
Turn 180 degrees
Tinneti test
Central line insertion sites
Internal jugular vien
Subclavian vein
Femoral vein
Indications for central line
Administering IV medication
Fluid balance monitoring using central venous pressure
Complications of a central line
Haemothorax
Pneumothorax
Haematoma
Arterial puncture
Arterial line insertion site
Radial artery
Ulnar artery
Brachial artery
Axillary artery
Posterior tibial artery
Femoral artery
Dorsalis pedis artery
Indications of an arterial line
Continuous direct BP monitoring
Frequent blood sampling
Complications of an arterial line
Artery occlusion
Haemaoma/bleeding
Infection, air emboli
Nice guidelines for end of life care
- Recognition
- Communication
- Shared decision making
- Maintain hydration
- Pharmacology
- Validated behavioural pain chart
Neurogenic shock
Loss of control over dilation and contraction of blood vessels causing a drastically lowered BP
Causes: injury to the brain or spinal cord
Components of 4AT
Test for delirium
Alertness
AMT 4 (Age, DOB, place, year)
Attention
Acute change/fluctuating course
CAM
Acute confusion with fluctuating pattern
Inattention
Disorganised speech
Altered level of consciousness
How to prevent falls
Exercise >2hrs a week, >6 months
Multifactorial falls prevention (MFFP)- Medication or fixing medical causes, getting rid of home hazards, physio
Time up and go test
Time it takes for a person to stand up from a seated position, walk three meters, turn around, and return to seated position in the chair. Normal < 10 seconds. 11-20 seconds is within normal limits for elderly.
Turn 180 test
Does it take them more than 4 steps to turn 180 degrees
Tinneti’s test
Stand, turn 360 degrees, sit
Walk few metres slowly, turn around and walk back quickly
Sit back down
QALY
Quality-adjusted life years; weigh each year of life by perceived quality from 0 to 1. Uses ADLs, freedom from pain and freedom from mental disturbance
years x quality of life score
1 QALY costs: £20,000- £30,000
End of life QALY: £50,000
QALY
Quality-adjusted life years; weigh each year of life by perceived quality from 0 to 1. Uses ADLs, freedom from pain and freedom from mental disturbance
years x quality of life score
1 QALY costs: £20,000- £30,000
End of life QALY: £50,000
Saline vs hartmans
- Saline preferred if hypocholeramic
- Hartmans is the most like plasma but dont give if hyponatraemic
Composition of saline
Na+ 154
Cl- 154
308 mosm/l
Composition of 5% dextrose
Glucose- 50g
mosm/l- 154
Composition of Hartmanns solution
Na+- 131
Cl- 111
K+ 5
HCO3- 29
Calcium 2
mosm/l 270
Red flags for sepsis
- Objective evidence of new or altered mental state
- Systolic BP <90 mmHg or drop of >40 from normal
- Heart rate >130 per minute
- Respiratory rate >25 per minute
- Needs O2 to keep SpO2 >92% (88% in COPD)
- Non blanching rash/ mottled/ ashen/ cyanotic
- Recent chemotherapy
- Not passed urine in 18 hours (<0.5ml/kg/hr if catheterised)
Amber flags for sepsis
- Relatives concerned about mental status
- Acute deterioration in functional ability
- Immunosuppressed
- Trauma/ surgery/ procedure in the last 8 weeks
- Respiratory rate 21-24
- Systolic Bp 91-100 mmHg
- Heart rate 91-130 or new dysrhythmia
- Temperature <36
- Clinical signs of wound infection
NEWS score: respiration rate
3: <8 or >25
2: 21-24
1: 9-11
0: 12-20
NEWS score: O2 score scale 1
3: <91
2: 92-93
1: 94-95
0: <96
NEWS score: O2 scale 2
3: <83 and >97 on oxygen
2: 84-85 and 95-96 on oxygen
1: 86-87 and 93-94 on oxygen
0 88-92 or <93 on air
NEWS score oxygen requirement
Oxygen: 2 points
NEWS score: systolic blood pressure
3: <90 or >220
2: 91-100
1: 101-110
0: 111-219
NEWS score: pulse per minute
3: <40 or >131
2: 111-130
1: 41-50 or 91-110
0: 51-90
News score: Consciousness
3- CVPU
NEWS score: temperature
3: <35
2: >39.1
1: 35.1-36 or 38.1-39
0: 36.1-38
MUST score BMI
> 20= 0
18.5-20= 1
<18.5= 2
MUST score weight loss
Unplanned weight loss in the past 3-6 months
<5%= 0
5-10%= 1
>10%= 2
MUST scores
1= medium risk, observe in hospital weekly, in a care home monthly, in the community every 2-3 months
2 or more= high risk. Monitor weekly in hospital, and monthly in the care home and community
The incident reporting cycle
Incident occurs
Take immediate action
Inform the person in charge
Take further immediate action
Complete an incident form
Incident review and feedback
Classification and grading of the incident
Inclusion of incidents in the trust reporting system
Definition of dehydration
1% or greater loss of body mass due to fluid loss where the body has less water than it needs to function properly
The initialsymptoms of dehydration
Impaired cognitive function
Reduced physical performance
Headaches
Fatigue
Sunken eyes
Dry, less elastic skin
The more serious effects of dehydration
Circulating blood volume decreases= hypotensions, tachycardia, weak/thready pulse, cold peripheries, oliguria, then organ failure and death
Symptoms of fluid excess
Fatigue, dyspnoea and pitting oedema
The 3 stages of assessing fluid balance
Clinical assessment
Review of fluid balance charts
Review of blood chemistry
Bloods: Na (increased), K, Cl, HCO3 and blood urea
Gold standard for dehydration: plasma osmolarity
What plasma osmolarity is the threshold for dehydration
> 300 mOsm/kg
Shock
Acute circulatory failure or inappropriately distributed tissue perfusion resulting in generalised cellular hypoxia and/or inability for cells to use oxygen.
Explain the process of septic shock
Bacterial toxin induces expression of NO-producing enzyme iNOS causing overproduction of NO resulting in vasodilation and decreased BP
What type of shock does blood pooling in anaphylaxis cause
Disruptive shock
How does anaphylaxis cause shock
Excessive immune response
Overproduction of histamine
Increased Ca in cells
Increased production of NO by cNOS enzymes
Increased cGMP causing decreased BP.
Redistribution of blood leads to blood pooling and decreased arterial pressure
What indicates hypovolaemia
SBP<100, HR>90, cap refill >2s, RR >20 and NEWS >5
What kind of response does a NEWS of 8 require
Emergency response (response team must include staff with critical care skills, including airway management
Role of central line
Allows multiple and greater volumes of IV fluids to be given, allows blood to be drawn easily, can measure central venous BP and can be used to measure fluid volume status (can be used for dialysis, fluid resuscitation and when patients need many blood samples or long term IV therapy or for caustic medications eg. chemo)
What is enhanced recovery
An evidence-based approach that helps people recover more quickly after having major surgery. Research has shown that the earlier a person gets out of bed and starts walking, eating and drinking after having an operation, the shorter their recovery time will be
Riglers sign
Double wall on the bowel on AXR, air in the abdomen
What treatment is needed in bowel obstruction
Decompression- NJ or endoscope i.e. top or bottom
Why might sigmoid volvulus need resection
They can be recurrent
What part of the bowel distends and burst quickest
Caecum- as its more spherical
What does large bowel distention, abrupt cut off anf loss of features on AXR mean
Lead piping i.e. toxic megacolon
