TPP Program Flashcards
Please tell me about your clinical skills, personal attributes and qualifications that would benefit ED?
Attributes; good to be clear, hence reflected recently asking colleges, always looking to better oneself…
- time management skills; the patient load on stroke and surgical and how these types of nursing differ. (10 patients)
- team player
- compassionate and emphatic nurse
- keen to learn and be part of the team; will try anything e.g. up skilling
Qualifications; ALS, Bachelor of Nursing, Cert 3, UNI CLUBS - Managerial roles, venipuncture,
Clinical skills; A-G, patient Hx, secondary assessments e.g. stroke, give subcut / IM / IV e.g. use to be an immunized, work as part of a team e.g. rapids, understand SPOK and CERS, falls risk
Your patient develops chest pain; becomes Hot and sweaty, SOB, what do you do
Notify senior staff members / CERS / Rapid etc.
- ECG + show doctor
- Vitals
- focused assessment; PQRST.
- Pt. HX ; is this normal? angina vs STEMI
- Oxygen? Are they maintaining above 95%
The doctor may ask for; Asprin / GTN (can nurse initiate), or Morphine.
- IV Access; they may want bloods eg. trop, FBC, electrolytes as this can cause cardiac issues.
- Arrest; bring trolly (forward thinking), commence BLS then Adv LS.
- Reassure pt.
- documentation
Pt. becomes tachy and breathless what do you do?
Recognize that this is urgent and could be life-treating. we are a team, ask for help - do not manage alone. may need to seek advice and assistance.
- CERS / RAPID + get extra hands for scribe
- A-G and focused assessment if relevant
- ECG
- Oxygen if not maintaining
- Do they look symptomatic; pail, grey, cool, and altered mental status (CGS) as all key indicators of deterioration. AVPU
- IV Access
- vitals
- medications / fluids
- may need interventions outside your scope and hence move to resus if in ED etc.
- document !! debiref
Cardiac arrest question. Your patient goes into cardiac arrest
Early CPR and defib are the only things that can save this person …. get on the chest early.
Basic life support
D - danger, check for anything dangerous
R - check the patients responsiveness
S - send for help. press the arrest button, dial 2222. yell out.
A - look in the mouth and check nothing is blocking the airway
B - Breathing, put your hand on the chest and look / listen / feel for 10 seconds
C - compressions; place hands on chest and start
D - defib pads attached as soon as possible and defib if shockable, dump if not shockable.
ALS
Continue compressions
Oxygen away
All others away
Charging
Hands off
Evaluate rythym
Defib / dump
You are asked to perform a procedure that you are unfamiliar with, what do you do?
Take it as an opportunity to learn, and politely decline to complete it by yourself. Perhaps the CNS or educator can teach you. Maybe there is a learning package?
If it is outside the Scope let staff know you are not comfortable.
Be willing and eager to learn
Asking for help and prioritising care questions: you get a new patient into your care that needs IVAB and fluids, a patient who is going to OT and needs a chest list. and a patient who is hypotensive? What do you do?
Although pt. flow through the unit is very important and not breaching 24 hours etc. pt. should be proritised according to their clinical needs.
- 1st is hypotensive pt. as this had the postentional to deteriorate further ….
- ask for help / may not be able to manage in a timely manner by yourself
- delegate
- communicate with in charge and collegeues.
liquid spill; what do you do?
As do not know what the liquid is, I would not just wipe it up.
- try and find out what the liquid is
- put up signs e.g. wet floor
- page for cleaner
EXAMPLE : cytoxotic / infection cleaner
accompany to bedside question - your patient is prescribed morphine and the senior checks with you but says “you’ll be right to give this I need to go?” What do you do?
- as per medication rights …..
- S8
- Please come with me to the bed side, I do not feel comfortable
- I would prefer you came with me
- I do not feel comfortable doing this alone
- If doesn’t come discuss with manager immediently
CORE Values question
Collaboration - working collaboratively means getting in and getting more work done quicker. MDT - stroke. working up a patient in ED. Makes for lighter work + opinions can have new ways of thinking
Openness - need to be open with our patients. this fosters trust. open disclosure but also acknowledge DOC. Especially in ED, do not want them to feel mistrusted or distressed. MH example. being honest.
Respect - families, patients, hospitals, and colleges. e.g legal obligation as well as moral to respect wishes such as NOK. example - body lanague. be kind
Empowerment - give patients education to allow for management of their own health conditions. they are not an illness, they are fighting an illness. e.g teaching them to use crushers, bgl or how to tell if they deteriorate.
how do we keep our patients safe
OMS
FRAMP
CIWAH
once identify risk act - e.g falls / lower bed / non-sip socks call bell / document / tell collegues.
hydromorph of 20mg
resolving conflict question ; how do you resolve a conflict with a colleague
try and resolve without disrupting the department
take on feedback
could be legit
managing conflict policy
if cant resolve go to managers
your patient is septic what do you do?
follow the sepsis pathway
- antibiotics + fluid resus in 1st hour
- bloods, including lactate + cultures
- VBG
watch for deteroatuoin;
- tachycardia
- hypotension
- febrile
- increased lactate
think about causes + immunicopmorised
- Chemo / HIV
- IDC
-PPM
- Recent surgery
PPE + INFECTION CONTROL (ESBL)
- isolation
- PPE
- Signs
- hand washing ; 5 moments
- singage
- education for pt. fam and visitors
How do you work in a stressful environment
- debrief
- friends and fam
- MH
- gym
