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Acute > W1: MC > Flashcards

W1: MC Flashcards

1
Q

Define Acute Care

A

Short-term, specialised care provided in a hospital setting to restore & maintain health

Examples include: ICU, ED, neurological, respiratory, maternity, paeds & aged care

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2
Q

The acute cardiorespiratory team includes patients who are:

A
  • Pre/postoperative
  • Have respiratory disease eg COPD, cystic fibrosis, etc
  • Are in the ICU/HDU (acute trauma, post-surgical or medical respiratory dysfunction eg haemodynamically unstable)
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3
Q

What is the aim of an acute assessment?

A
  • Seek information eg from medical chart, nursing staff, relatives or carers, ward rounds, medical chart review
  • Ask questions
  • Do our assessment
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4
Q

Who is weight bearing status particularly important for/who determines it?

A

Particularly important for people who have had orthopaedic procedures or fractures & determined by surgical team

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5
Q

Define the following weight bearing status:

  • NWB: non-weght bearing
  • Partial weight bearing
  • Touch weight bearing
  • Weight bear as tolerated
A
  • NWB: 0%
  • PWB - 50%
  • TWB: light touch only for balance
  • WBAT: as much as needed/no restriction
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6
Q

What is important to address prior to conducting a subjective assessment?

A
  • Introduce yourself /state why you are there
  • Obtain consent
  • Determine if patient is oriented to time and place
  • Start with open ended questions
  • Allow the patient to discuss what problems are important to them at the time
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7
Q

What is included in a subjective assessment?

A

History of presenting condition
Past medical history
Medications
Home environment
Mobility & function

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8
Q

What special questions should be covered?

CSD WHS HC

A

Cough
Sputum
Dyspnea
Wheeze
Hemoptysis
Smoking history
Home oxygen
Chest pain

Particularly for respiratory presentations what else should be covered:
- Pain
- Falls
- Previous physio intervention

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9
Q

What is a cough?

What should you ask a patient about their cough?

What should you assess in a cough?

A

A protective reflex that rids the airways of secretions, particulate matter or foreign bodies (can be chronic or acute)

Baseline (do they normally have a cough) & do they cough up sputum

Strength, sound quality (eg dry or moist) & secretion clearance (productive or non-productive)

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10
Q

Healthy adults produce up to how much sputum?

A

100mL of tracheoronchial secretions each day

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11
Q

What should you ask a patient about their sputum?

A

Baseline (do they normally cough-up sputum)
The colour (can indicate disease severity)
Volume: how much can they cough up?
Viscosity: how thick are the secretions? Do they need interventions to do so eg nebuliser or can they do it independently

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12
Q

Saliva: description

A

Clear watery fluid

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13
Q

Mucoid: description & causes

A

Description: Opalescent or white
Cause: Chronic bronchitis without infection, asthma

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14
Q

Mucopurulente: description & causes

A

Description: Slightly discoloured, but not frank pus
Cause: bronchiectasis, cystic fibrosis or pneumonia

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15
Q

Purulent: description & causes

A

Thick viscous
- Yellow
- Dark green/brown
- Rusty
- Red currant jelly

Causes: haemophilius, pseudomonas, pneumoccus, mycoplasma & kiebsiella (bacterial infection)

NOTE:
The term “purulent” describes a type of discharge or fluid that contains pus. Pus is a thick, viscous fluid that results from the body’s inflammatory response to infection. It’s typically yellow, green, or brownish, depending on the type of infection and the specific bacteria involved.

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16
Q

Frothy: description & causes

A

Pink or white
Cause: pulmonary oedema

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17
Q

Hameoptysis: description & causes

A

Description: ranging from blood specks to frank blood, old blood (dark brown) - essentially involves coughing up blood

Causes: Infection (tuberculosis, bronchiectasis), infarction/cardiac disease, carcinoma, vasculitis (damage to blood vessels), trauma & coagulation disorders.

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18
Q

Black: description & causes

A

black specks in mucoid secretions
Causes: smoke inhalation (fires, tobacco, heroin), coal dust

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19
Q

Definition of shortness of breath (ie dyspnoea)

A

Defined as an uncomfortable and abnormal awareness of breathing

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20
Q

True or false: shortness of breath is pathological if it occurs disproportionate to actiivty/conditions

A

True

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21
Q

What should you ask a patient about their SOB?

A

Onset (what causes the SOB?), duration, aggravating and easing factors and quantify the level of breathlessness

22
Q

What scale is used to quantify dyspnoea?

A

The modified borg dyspnoea scale

23
Q

Define a wheeze and what does it indicate?

A

A whistly sound caused by narrowing of the airways during expiration. Typically indicates an airway obstruction

24
Q

What may an obstruction in a wheeze be due to?

A

Bronchospasm (asthma), oedema (heart failure), sputum or foreign bodies

25
Q

What do the different types of wheezes indicate?

A

High pitched wheeze = near total obstruction

Fixed monophonic wheeze = single obstructed airway

Polyphonic wheezes (multiple) = widespread narrowing

Localised wheeze = sputum retention

26
Q

What should you ask a patient about their wheeze?

A

Baseline
Duration
Aggravating and easing factors

27
Q

What is haemoptysis?

A

Presence of blood in sputum

28
Q

What is frank vs isolated haemoptysis?

A

Frank = significant amounts of blood. Can be life threatening and may require bronchial artery embolisation/surgery.

Isolated (tinged or streaked) = May be the initial sign of bronchogenic carcinoma

29
Q

True or false: patients with chronic infective lung diseases may suffer from recurrent haemoptysis?

A

True

30
Q

What is the relationship between smoking and cancer?

A

Linear

31
Q

What should you determine regarding smoking for a patient?

A

Work out their pack year smoking Hx (packs/day x years smoked)

Need to ask about: history ie have they ever smoked?, duration, amount, cessation

32
Q

Vaping: studies have suggested…

What should you ask about?

A

Multiple pro-inflammatory effects on the respiratory system increased airway resistance, impaired response to infection and impaired mucociliary clearance

Device & frequency

33
Q

Home oxygen supplementation
- Prescribed by?
- Must not have been smoking for?
- Need to ask patient about?

A
  • Respiratory specialist
  • 4 weeks
  • Time, dosage, etc
34
Q

Where does chest pain generally originate from?

A
  • Musculoskeletal, cardiac, pleural or tracheal inflammation
35
Q

Chest pain: what is stable angina?

A

Discomfort that comes on with activity and dissipates with rest

36
Q

Chest pain: what is unstable angina?

A

Discomfort that comes on with increasing activity that does not abate with rest?

37
Q

Chest pain: myocardial infarction: define

A

Chest pain where areas of the lung experience death due to inadequate oxygen supply.

38
Q

What should you ask a chest pain patient about?

A

Onset (how long have they had it, have they had it previously?) & location (where is the pain - is it localised or referred?

39
Q

Major signs of heart attacks in women vs men

A

Women: chest pain, nausea, pain or discomfort in jaw/neck/back, pain or discomfort in the arm/shoulder & shortness of breath

Men: Chest pain, pain or discomfort in arm/shoulder & SOB

Difference: men don’t have nausea and pain in the jaw/neck/back

40
Q

In a bed side assessment what observations are made

A

Note: step 1 of a bed side assessment is observation.

Includes identifying potential hazards, patients position & appearance, interaction with the environment, equipment and patient monitoring

41
Q

What are the vital signs?

A

Respiratory rate
Heart rate
Blood pressure
Temperature
Oxygen saturation
Consciousness

42
Q

Respiratory rate (Vital signs)
- What is it?
- Normal
- Other classifications

A
  • Number of breaths a person breaths per minute
  • 12-20 breaths/minute
  • Tachypnoea: rapid breathing & bradypnoea: slow breathing
43
Q

Heart rate (pulse rate) - Vital signs
- What is it?
- Normal
- Other classifications

A
  • How many times the heart beats per minute
  • 60-100bpm (adults)
  • Tachycardia (>100bpm ie fast heart rate), Bradycardia (<60bpm ie slow heart rate)
44
Q

Blood pressure (vital sign)
- What is it?
- Normal
- Other classifications

A
  • Indicates the pressure of the blood moving through the arteries as the heart pumps blood throughout the body
  • 120/80 or 130/85
  • Hypertension (>140/90): increase in blood pressure which may mean your heart is working hard to deliver oxygenated blood to key organs
  • Hypotension (<90/60): decrease in blood pressure which may mean the pumping pressure of the heart is not sufficient to deliver key organs with oxygenated blood
45
Q

Temperature (vital sign)
- What is it?
- Normal
- Other classifications

A
  • A measure of how well the body can make and remove heat
  • 36.5-37.2
  • Hypothermia (< 35 degrees), hyperthermia/fever (high temp - may indicate infection)
46
Q

O2 sat (Vital sign)
- What is it?
- How is it measured
- Normal
- Severe level?

A
  • Provides an indication of the amount of 02 in a patients blood. Measured with pulse oximetry
  • 95-100%
  • <90% is very severe and requires urgent medical review
47
Q

Consciousness (Vital sign)
- What is it?
- how is it assessed?

A
  • Indication of neurological function
  • Assessed with ACVPU or glasgow coma scale
48
Q

Consciousness (vital sign): ACVPU - What is it?

A
  • Alert: is the person awake and responsive?
  • Confusion: can they answer simple questions or are they confused and disoriented?
  • Voice: do they response to voice, either verbally or physically?
  • Pain: do they respond to physical stimulus
  • Unresponsive: is the person unconscious

**ANYTHING less than an A is a problem. Seek medical help

49
Q

Consciousness (vital sign): Glasgow Coma Scale. What are the 3 behaviours? What is the best response/comatose client or totally unresponsive classified as?

A
  • Eye opening, best verbal response, best motor response
  • Best response = 15, comatose client = 8 or less and totally unresponsive is less than 3
50
Q

Ideally where should vital signs fall within?

A

The white part of the graph. Yellow is a warning ie increased concern, doctor should come review, and red = deteriorating

51
Q

What is included in an objective assessment?

A

Active/passive ROM
Muscle length
Muscle strength
Neurological assessment
Functional eg bed mobility, sit to stand, stairs, walking, etc

**Required to determine level of assistance required, need for any equipment, treatment goals, provide recommendations to nursing/allied health & to plan for discharge

Acute (14 decks)

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