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Acute Care One > Week 1-2 > Flashcards

Week 1-2 Flashcards

1
Q

Why are observations, documentation important elements of nursing care?

A
  • To identify reasons for admission
  • Facilitate communication between health professionals
  • Enable effective and ongoing care of patients
  • To assess the patients well-being
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2
Q

Why do observations get done in acute patients?

A
  • To ensure patient are keeping stable
  • Monitor their health status
  • Establish if the patient is deteriorating
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3
Q

Why is it important to know therapeutic limits of vital signs?

A
  • To identify any abnormalities in results

- To determine if further investigation is required

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4
Q

What is the requirement once results are received?

A
  • Received results
  • Document finding in patient file/cart
  • If urgent pass to the heath professional once documented
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5
Q

what are the main causes of mortality and morbidity?

A
  • Heart disease - associated with lifestyle factors
  • Stroke- associated with lifestyle factors
  • Cancer
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6
Q

What legality requirements for documentation?

A
  • Use black pen
  • Clear/Legible writing
  • Correct mistakes appropriately (line through and initial, start again)
  • No abbreviations
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7
Q

What is the difference from medical and nursing diagnosis?

A
  • Depending upon medical diagnosis for the direction of appropriate interventions
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8
Q

What is ADPIE?

A
  • Assessment
  • Diagnosis
  • Planning
  • Implementation
  • Evaluation
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9
Q

What is acute nursing care?

A
  • Involves provision of individualised of chronically ill patients
  • Transferrable generalised care through specialised skills
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10
Q

What are some Medical/Surgical acute care patients disorders?

A
  • Respiratory
  • Integumentary
  • CVA/Neurological conditions
  • Immunological
  • Pre/Postoperative care
  • Musculoskeletal
  • Lower/Upper GI
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11
Q

What are the 3 levels of nursing enquiry?

A
  • Critical engagement ie reflection
  • Collaborative ongoing evaluation ie clinical audits
  • Advanced nursing knowledge i.e. ongoing education/PHD
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12
Q

What is qualitative?

A

Deeper understanding of patient/health professional experience

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13
Q

What is quantitative?

A

measurement of specific variables

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14
Q

What are the 3 components of evidence based practice?

A
  • Best practice
  • Patient values
  • Clinical expertise
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15
Q

What does color Purple mean?

A
  • MET CALL/ CODE BLUE- meets criteria fro this
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16
Q

What does colour Pinky/Red mean?

A
  • Patient requires medical review
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17
Q

What does colour Orange mean?

A
  • Requires Senior nurse review
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18
Q

What does colour Yellow mean?

A
  • Increase patients surveillance/frequent OBS
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19
Q

What is the importance of Integumentary System?

A
  • To protect organs and the bodies function
20
Q

Why do we use Aseptic Technique?

A
  • To minimise the and protect the body from microorganisms
21
Q

What are some of Vascular skin lesions?

A
  • Petechiae: round, red, purple molecule 1-2mm
  • Ecchymosis: round, black, yellow, green, Irregular macular lesions larger than petechiae.
  • Cherry Angioma: round, red/purple- located on trunk/extremities
  • Spider Angioma: Red- artery lesions, face,neck, arms, trunk. Associated with liver disease, pregnancy, bit B deficiency.
  • Telangiectasia: Spider like/ bluish/red colour
22
Q

What are the bacterial skin infections?

A
  • Impetigo
23
Q

What are the 2 types of carcinomas?

A
  • Basal cell

- Squamos cell carcinoma

24
Q

What are the 3 components or wound healing?

A
  • Haemostasis Phase
  • Inflammation Phase
  • Reconstruction Phase
  • Maturation Phase
25
Q

What is Basal Cell Carcinoma?

A
  • Uncontrolled growths of in the skins epidermis
  • Waxy nodule appearance
  • Pearl borders rolled/translucant
26
Q

What are the differences between primary intention and secondary intention of healing?

A

Primary intention is a surgical opening and cell and tissue loss is kept to a minimum. The wound is sutured or stapled closed.
Secondary intention is a surgical opening that is left open. Excessive cell and tissue loss occurs, Left open to heal.

27
Q

What are the types of viral infection?

A
  • Herpes Zoster/simplex
28
Q

What types of fungal infections are there?

A
  • Tinea
  • Ringworm
  • Thrush (candida)
29
Q

What are the types of skin tumours

A
  • Benign

- Malignant

30
Q

What are the 4 types of melanomas?

A
  • Superficial Spreading
  • Nodular Melanoma
  • Lentigo-Maligna
  • Acral Lentiginous
31
Q

What is Squamous Cell Carcinoma?

A
  • Involves mucous membranes
  • Rough/scaly texture
  • Metastasise via blood/lymphatic system
32
Q

What are 3 types of burns?

A
  • Superficial
  • Partial Thickness
  • Full thickness
33
Q

Whats Stage 1 burns?

A
  • Superficial effecting epidermis of skin
  • Pressure related alteration
  • Skin still intact
34
Q

Whats Stage 2 burns?

A
  • Partial thickness skin loss involving epidermis & dermis of skin
  • Presents as abrasion, blister
35
Q

Whats Stage 3 burns?

A
  • Full thickness skin loss damage necrosis subcutaneous tissue, muscle/bone
  • Presents deep crater
  • Exudate presents
36
Q

What is stage 4 burns?

A
  • Full-thickness skin loss
  • Extensive obstruction, tissue necrosis, damage to muscle, bone structures
  • Dermis, subcutaneous tissue destroyed
  • High risk infection rate
37
Q

What are the classifications of wounds?

A
  • Acute
  • Chronic
  • Damage
  • Stages
  • Color
38
Q

What are the purpose of dressings?

A
  • Provide protection
  • Reduce microorganism
  • Reduce patient discomfort
  • Improve healing
  • Reduce further trauma
39
Q

What colour is black for a wound?

A
  • Necrotic tissue
40
Q

What colour is yellow for a wound?

A

Moist, sloughy wound

41
Q

What colour is green for a wound?

A

Moist, sloughy, green discharge (infection)

42
Q

What colour is red for a wound?

A

Healthy, granulating wound

43
Q

What colour is pink for a wound?

A

Epithelialising wound

44
Q

What is rule of nines?

A
  • Fast/convenient estimation of total body area

- Divided into areas of 9%

45
Q

Name types of dressings used for burns?

A
  • Anti-microbial-
  • Hydrocoloids
  • Alginate dressing- clotter
  • Paraffin gauze-
  • Silver-

Acute Care One (5 decks)

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