Week 3 Flashcards
What percentage of live births result in a Ventricular Septal Defect?
25%
Identify the symptoms of Cardiac Failure in Infants
- Poor feeding
- Failure to thrive
- Fatigue
- Tachypnoea
- Tachycardia
- Hepatomegaly
- Sweating
Talk through the common treatment pathway for VSD
- Full PEWS observation in line with Trust observation and monitoring policy
- Administration of medication
- Accurate fluid balance monitoring
- Liaison with MDT ( Cardiac Liaison Team & X-Ray / Echo )
- Family Centered Care
Identify the Guiding Principles of Treatment for VSD
- Surgery
- Diuretics’
- Fluid Restriction
- Beta Blockers
- Ibuprofen / Indomethacin
- Prostaglandins ( keep some ducts open )
- Transplant
- Varies from case to case
What is a Ventricular Septal Defect?
- `It is a common form of congenital heart disease
- It occurs when there’s a hole between the two ventricles
Identify the causes of Ventricular Septal Defect
- Congenital
What are Milrinone Drains?
- Used for short - term treatment of heart failure
- Works by increasing the strength of the heart beat & relaxing certain blood vessels to increase the amount of blood that is pumped from the heart
- Can help reduce: shortness of breath, tiredness
What are Mediastinal Drains?
- They are inserted as standard postoperative practice following cardiac surgery to assist the clearance of blood from the pericardial space.
What are Cardiac Catheters?
- A procedure where a catheter is guided through a blood vessel into the heart to diagnose or treat certain heart conditions.
Give an overview of how Milrinone works
- Phosphodiesterase Inhibitor
- Positive inotrope
- Increase the contractibility of the heart
- Vasodilators = Reduced SVR
- PBE activity = Reduced cAMP level
What are the possible side effects of Milrinone?
COMMON: - Arrhythmia - Headaches - Hypotension UNCOMMON: - Angina Pectoris - Chest Pain - Hypokalemia - Tremor RARE: - Anaphylactic Shock - Bronchospasm
What is an ECG?
- Electrocardiography
- It is the measurement of electrical activity in the heart, interpreting the diagnosis of complex arrhythmias and myocardial ischemia
Discuss the 6 Stage System involved in Cardiac Monitoring
- Is there any electrical activity?
- What is the ventricular ( QRS ) rate?
- Is the QRS rhythm regular or irregular?
- Is atrial activity present?
- Is atrial activity related to ventricular activity and if so, how?
Talk me through Seizure Resus
- Attach the Defibrillator as soon as it is available and Analyse the Rhythm (pause CPR for <5seconds during rhythm analysis)
- Decide if the Rhythm is Shockable or Non- Shockable
- Continue CPR immediately
- If Shockable immediately initiate hands on charging
- Pause only to deliver the shock (ensure no one is touching the patient)
- If Non-shockable continue CPR
- Analyse the Rhythm every two minutes
- During each cycle consider which drugs are required
- During each cycle consider reversible causes and relevant interventions
How do you treat a NON-SHOCKABLE RHYTHM ( asystole / PEA ) ?
- Administer IV adrenaline 1mg immediately
- Once administered adrenaline is repeated every 3 - 5 minutes
How do you treat a SHOCKABLE RHYTHM ( ventricle fibrillation, pulseless ventricle tachycardia ) ?
- If three shocks fail, administer
- 1mg IV adrenaline & 300mg IV Amiodarone, once administered adrenaline is repeated every 3-5 minutes
Talk through the AED Procedure Sequence
- Check for risks to the victim, any bystanders, and yourself.
- Assess the victim to be unresponsive and not breathing normally.
- Send someone for the AED and to call for an ambulance (prehospital settings) or crash team (in hospital settings).
- Start Cardio-Pulmonary Resuscitation (CPR) unless AED is immediately available with easy access to the patient’s chest (COVID-19 guidance state that CPR can only be performed once level 3 PPE has been donned).
- Switch on the AED and attach the AED pads.
- Follow the AED voice prompts.
- Ensure CPR is stopped and that nobody touches the victim whilst the rhythm is being analysed.
- Safely deliver a shock to the victim.
- Resume CPR immediately, as guided by the voice prompts, starting with chest compressions
- Minimise interruptions in chest compression
- Continue as directed by voice / visual prompts until advanced help arrives
How does Milrinone help to restore blood pressure?
It is a medication used to increase the heart’s contractility and decrease Pulmonary Vascular Resistance and so tends to lower arterial blood pressure.
Identify possible health issues that may occur in individuals who have Down’s Syndrome
- Heart Problems
- Blood Disorders
- Vision & Hearing
- Thyroid
- Constipation
- Toilet Training
- Coeliac Disease
- Breathing ( Nasal Congestion )
- Infections
- Teeth ( often come through later )
- Arthritis
- Neck Instability
What is PDA?
- Patent Ductus Arteriosus
- It is a heart defect which is a result of the connection between the aorta and the pulmonary artery does not close
What are the signs & symptoms of PDA?
- Continuous Murmur
- Tachycardia
- Bound Peripheral Pulses
- Tachypnoea
- Poor Feeding & Poor Weight Gain
- Sweating whilst feeding
Walk through the first aid procedure for seizures
- Assess danger ( safety is priority )
- Shout / call for help
- Only move the individual if they are in danger or move objects that may cause the individual to hurt themselves.
- Note the time ( it is important to note how long seizures last for )
- Gently support the individual’s head or place something soft underneath, such as: a jumper
- Loosen any tight clothing ( alleviate restrictions )
- Prevent crowding
- DO NOT hold them down, allow the seizure to happen
- DO NOT put any objects in their mouth, they will not swallow their tongue, and this may cause trauma.
( IMMEDIATELY POST SEIZURE ) - Check for signs of life ( A – B – C ) for 10 seconds, start CPR if no signs of life
- If not fully conscious place them in recovery position, ensuring patent airway
- If possible, wipe face and over any incontinence
- Keep NBM until fully conscious, avoid aspiration
- Stay with them
Identify the 7 different types of seizures
- Focal Aware Seizures
- Focal Impaired Awareness Seizures
- Focal To Bilateral Tonic Clonic Seizures
- Absence Seizures
- Tonic & Atonic Seizures
- Myoclonic Seizures
- Tonic Clonic & Clonic Seizures
Define Focal Aware Seizures
- the individual is conscious and usually know that the seizure is happening
- it could be an unusual smell or taste, twitching of an arm, strange rising feeling in the stomach etc
Define Focal Impaired Awareness Seizures
- they affect more of the brain and consciousness is affected, may be confused or not know what is happening.
- the individual may wonder around, behave strangely, pick up objects or make chewing movements.
- can last a couple seconds or a few minutes
Define Focal To Bilateral Tonic Clonic Seizures
- sometimes affects both sides of the brain.
- it usually warns them that a tonic Clonic seizures may follow
Define Absence Seizures
the person becomes unconscious for a short time, they may look blank and stare, not responding to what is happening around them
Define Tonic & Atonic Seizures
Tonic: person’s muscles become stiff, falling if they stood
Atonic: person’s muscles suddenly relax and become floppy - usually falling forwards
Define Myoclonic Seizures
- Muscle Jerking
- The seizures involve jerking of a limb or part of a limb
Define Tonic Clonic & Clonic Seizures
- the person goes stiff ( tonic ) and usually falls to the ground, shaking or jerking ( clonic )
- breathing can be affected, they can go pale or blue, particularly around their mouth
- they might bite their tongue
Define Status Epilepticus
- Is when a seizure lasts longer than 5 minutes.
- Is when seizures occur one after another without recovery in the interim.
- Can happen in any type of seizures.
- Can be convulsive or non-convulsive.
- Can be very dangerous and can increase the risk of death.
Identify the risk factors for Dementia
- Age ( 10 - 30% prevalence in over 65% )
- Sex ( more common in females )
- Brain Injury ( TBI leads to increased risk
- Osteoarthritis
- Lifestyle / Modifiable Factors
( smoking / hypertension / diabetes / mental health / diet )
Identify the barriers to Incontinence
- Learning/cognitive disability
- Mobility
- Ability to communicate
- Environmental factors
- Clothing
- Anxiety
- Attitudes
What can incontinence be caused by?
- Urinary tract infections (UTI)
- Constipation
- Medications
- Alcohol, Nicotine, and caffeine
- Abdominal Surgery
- Pregnancy and childbirth
- Excess weight
- Prostate Complications (In Men)
- Functional incontinence (caused by physical or psychological inhibiting factors)
Identify possible questions to determine your patient’s continence
- How often the person goes to the toilet to urinate and whether this is a change to their normal routine
- Current or previous medical history (including pregnancy and urine infections)
- Possibility of physical or sexual abuse, including FGM (female genital mutilation)
- A rough estimate of the amount of urine passed
- If there is leakage of urine
- Information about diet and fluid intake
- Any medications being taken (both prescribed and over the counter)
- Lifestyle factors, including recreational drugs, alcohol, smoking and weight
- Ability – for example, whether the person can feed, dress and bathe on their own
- Mobility – physical or environmental factors
- Capacity – does the person recognise the need to go to the toilet or do they forget where the toilet is?
What are the RCPCH Growth Charts?
- The Roya College Of Pediatrics & Child Health
- They allow healthcare professionals to plot and measure child growth, allowing for comparisons with healthy children of the same age and gender
What is The Care Act 2014?
- It requires local authorities to ensure the provision or arrangement of services, facilities or resources to help prevent, delay or reduce the development of needs for care and support.
What is the main principle of The care Act 2014?
- to help to improve people’s independence and wellbeing and for care providers and givers to promote a person-centred approach to the care and support they provide.
What is the Transition Assessment identified in The Care Act 2014?
It is an assessment that takes place in the transition from children’s to adult services
What is the DESC Framework?
Describe
Express
Specify
Consequences
What is the purpose of DESC Framework?
To develop assertiveness in communication
