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168.362 > Week Three > Flashcards

Week Three Flashcards

1
Q

What is family centred care?

A
  • Recognises family as constant in child’s life
  • Systems must support, respect, encourage and enhance the family’s strength and competence
  • Needs of family must be addressed
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2
Q

What are stressors of hospitalisation?

A

Separation anxiety:
- Protest phase (Crying and screaming; clinging to the parent)
- Despair phase (Crying stops; evidence of depression)
- Detachment (denial) phase (Resignation but not contentment; superficial adjustment;
May seriously affect attachment to the parent after separation)

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3
Q

What are infants needs when there is a loss of control?

A
  • Trust
  • Consistent living caregivers
  • Daily routines
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4
Q

What are preschoolers needs when there is a loss of control?

A
  • Egocentric and magical thinking is typical of this age
  • May view illness or hospitalisation as punishment for misdeeds
  • Preoperational thought
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5
Q

What are school-age children’s needs when there is a loss of control?

A
  • Striving for independence and productivity
  • Fears of death, abandonment, permanent injury
  • Boredom
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6
Q

What are adolescents needs when there is a loss of control?

A
  • Struggle for independence and liberation
  • Separation from the peer group
  • May respond with anger and frustration
  • Need for information about their condition
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7
Q

How to normalise the hospital environment?

A
  • Maintain the child’s routine, if possible
  • Time structuring
  • Self-care (age appropriate)
  • Schoolwork
  • Friends and visitors
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8
Q

What are normal values of a child from birth to one week?

A

Respiratory rate - 30-60
Pulse rate - 100-160
Systolic BP - 50-70

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9
Q

What are normal values of a child from one week to six weeks?

A

Respiratory rate - 30-60
Pulse rate - 100-160
Systolic BP - 70-95

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10
Q

What are normal values of a child at six months?

A

Respiratory rate - 25-40
Pulse rate - 90-120
Systolic BP - 80-100

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11
Q

What are normal values of a child at one year?

A

Respiratory rate - 20-30
Pulse rate - 90-120
Systolic BP - 80-100

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12
Q

What are normal values of a child at three years?

A

Respiratory rate - 20-30
Pulse rate - 80-120
Systolic BP - 80-110

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13
Q

What are normal values of a child at six years?

A

Respiratory rate - 18-25
Pulse rate - 70-110
Systolic BP - 80-110

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14
Q

What are normal values of a child at ten years?

A

Respiratory rate - 15-20
Pulse rate - 60-90
Systolic BP - 90-120

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15
Q

What should you consider for vital sign values for children?

A
  • Patients normal should always be considered
  • HR, BP and RR will increase during fever and stress
  • RR on infants count for 60 seconds
  • In clinically decompensating child BP last to change
  • Bradycardia in children ominous sign, usually from hypoxia - act quickly
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16
Q

How to communicate with children and their families?

A
  • Listening to the parent - are they concerned
  • Parental involvement
  • Developmental age of language development
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17
Q

How to prepare for procedures?

A
  • Goal is to decrease anxiety, promote cooperation, and support coping skills
  • Psychological preparation (Age-specific guidelines for preparation; Based on developmental characteristics)
  • Establish trust and provide support
  • Parental presence and support
  • Explanation to the child
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18
Q

How to perform procedures?

A
  • Use of the treatment room for procedures
  • Expect success
  • Involve the child
  • Provide distraction
  • Encourage expression of feelings
  • Provide positive support
  • Use of play in procedures
  • Prepare the family
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19
Q

What immunity do infants younger than 3 months have?

A

Maternal antibodies offer protection

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20
Q

What infection rate do infants age 3 to 6 months have?

A

An increasing rate of infection

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21
Q

What is there a high rate of in toddlers and preschoolers?

A

High rate of viral infections

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22
Q

What is there an increase of in children older than 5 years?

A

An increase in GABHS and Mycoplasma pneumoniae infections

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23
Q

How does immunity change as children grow older?

A
  • Immunity increases with age
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24
Q

How is size different in children?

A
  • Diameter of airways is smaller
  • Distance between structures is shorter, allowing organisms to rapidly move down
  • Short and open eustachian tubes
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25
Q

What are types of respiratory dysfunction in children?

A
  • Croup syndromes
  • Bronchitis
  • Bronchiolitis
  • Asthma
  • Epiglottitis
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26
Q

What are clinical manifestations of respiratory infections in children?

A
  • Vary with age

- Generalised signs and symptoms and local manifestations differ in young children

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27
Q

What are clinical signs of respiratory infections?

A
  • Fever
  • Anorexia, vomiting, diarrhea, abdominal pain
  • Cough, sore throat, nasal blockage or discharge
  • Respiratory sounds
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28
Q

What are nursing interventions for respiratory infections?

A
  • Ease the respiratory effort
  • Manage fever
  • Promote rest and comfort
  • Control infection
  • Promote hydration and nutrition
  • Provide family support and teaching
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29
Q

What is croup syndromes characterised by?

A
  • Hoarseness
  • Barking cough
  • Inspiratory stridor
  • Varying degrees of respiratory distress
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30
Q

What does croup syndromes affect?

A
  • Larynx
  • Trachea
  • Bronchi
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31
Q

What is croup syndromes particularly problematic for infants and small children?

A

Due to smaller diameter of airways

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32
Q

What are principles of nursing care for a child with croup?

A
  • Observe from a distance
  • Reassure parents
  • Minimal interaction
  • Minimal intervention
  • Adrenaline nebuliser if severe
  • Stay calm
  • Hydrate
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33
Q

What are clinical manifestations of acute epiglottitis?

A
  • Sore throat
  • Pain
  • Tripod positioning
  • Retractions
  • Inspiratory stridor
  • Mild hypoxia
  • Distress
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34
Q

What is therapeutic management for acute epiglottitis?

A
  • Potential for respiratory obstruction
  • A presumptive diagnosis of epiglottitis constitutes an emergency
  • Should not be examined until anaesthetist present as immediate intubation or tracheostomy may be indicated for airway obstruction
  • Keep patient calm, comfortable and minimise any distress
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35
Q

How to prevent acute epiglottitis?

A

Haemophilus influenzae type b (Hib) vaccine

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36
Q

What are characteristics of bronchiolitis?

A
  • Acute viral infection - bronchiolar level
  • Rare in children over 2 years
  • Respiratory syncytial virus (RSV)
  • Spread by hand to eye, nose and other mucus membranes
  • Causes childhood pneumonia as well
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37
Q

What are characteristics of a mild disease in children?

A

Behaviour - Normal
Respiratory rate - Normal-mild tachypnoea
Use of accessory muscles - Nil to mild chest retraction
Oxygen saturation/oxygen requirement - O2 saturations greater than 92% (room air)
Apnoeic episodes - None
Feeding - Normal

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38
Q

What do children need to have when having IV fluids administered?

A

Burette

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39
Q

What are characteristics of a moderate disease in children?

A

Behaviour - Some intermittent irritability
Respiratory rate - Increased
Use of accessory muscles - Moderate chest wall retractions, tracheal tug, nasal flaring
Oxygen saturation/oxygen requirement - O2 saturations 90-92% (room air)
Apnoeic episodes - May have brief apnoea
Feeding - May have difficulty or reduced feeding

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40
Q

What are characteristics of a severe disease in children?

A

Behaviour - Increased irritability and/or lethargy; fatigue
Respiratory rate - Marked increase or decrease
Use of accessory muscles - Marked chest wall retractions, marked tracheal tug, marked nasal flaring
Oxygen saturation/oxygen requirement - O2 saturations less than 90% (room air); hypoxemia may not be corrected by O2
Apnoeic episodes - May have increasingly frequent or prolong apnoea
Feeding - Reluctant or unable to feed

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41
Q

What are characteristics of febrile convulsions/seizures in children?

A
  • Affects 4% of children
  • Most occurs 6 months to 3 year
  • Boys affected twice as often as girls
  • Most febrile seizures generalised, last < 5 minutes
  • 30% to 30% of children have one occurrence
  • Cause uncertain
  • > 38.8c and occurs during temperature rise
  • Accompany illness: otitis media, respiratory infections
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42
Q

What is nursing management for children having febrile convulsions/seizures?

A
  • Stay calm
  • Think safety
  • Call for help
  • If lasting > 5 minutes - Dr consultation
  • Observe and examine for origin of fever
  • Parental support and education
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43
Q

How to ease respiratory effort?

A
  • Positioning
  • Oxygen
  • Hydration
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44
Q

What age group is croup common in?

A

6 months to 3 years

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45
Q

What to inspect in children’s appearance ?

A
  • Abnormal tone
  • Decreased interactiveness
  • Decreased consolability
  • Abnormal look/gaze
  • Abnormal speech/cry
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46
Q

What are key assessments when caring for children?

A
  • Health history
  • Nutrition
  • Family structure
  • Physical
  • Developmental
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47
Q

What to inspect in children’s work of breathing ?

A
  • Abnormal sounds
  • Abnormal position
  • Retractions
  • Flaring
  • Apnea/gasping
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48
Q

What to inspect in children’s circulation to skin?

A
  • Pallor
  • Mottling
  • Cyanosis
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49
Q

What are ABCs of critical paediatric illnesses?

A

Absent airway, breathing or circulation

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50
Q

What are ABCs of unstable paediatric illnesses?

A

Compromised airway, breathing or circulation

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51
Q

What are ABCs of potentially unstable paediatric illnesses?

A

Normal airway, breathing, and circulation but significant mechanism of injury or illness

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52
Q

What are ABCs of stable paediatric illnesses?

A

Normal airway, breathing and circulation. No significant mechanism of injury or illness

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53
Q

What does CUPS stand for for paediatric illnesses?

A

Critical
Unstable
Potentially unstable
Stable

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54
Q

What to assess for the paediatric assessment triangle?

A
  • Appearance
  • Work of breathing
  • Circulation
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55
Q

What does AVPU stand for?

A

Alert
Verbal
Pain
Unresponsive

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56
Q

What can increase HR and RR?

A
  • Compensated shock
  • Infection
  • Stress
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57
Q

What can decrease RR?

A
  • Medications (e.g. racemic)

- Exhaustion

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58
Q

What can cause decreased HR?

A
  • Hypoxia

- End stage shock

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59
Q

What is angina?

A
  • Symptom of coronary artery disease
  • Chest pain due to lack of blood supply and oxygen to the heart
  • Pain often spreads to shoulders, arm, neck and jaw
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60
Q

What does angina feel like?

A
  • Squeezing
  • Pressure
  • Heaviness
  • Tightness
  • Pain in the chest
  • Can be sudden or recur over time
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61
Q

How can angina be treated?

A

Depending on severity, can be treated by lifestyle changes, medication, angioplasty or surgery

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62
Q

What is atherosclerosis?

A

Build up of plaque

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63
Q

What is arteriosclerosis?

A

Thickening of walls of arteries

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64
Q

What is chronic stable angina?

A
  • Same pattern of onset, duration, intensity of symptoms
  • Pain lasts 5-15 mins
  • Usually predictable - provoked by exertion
  • Relieved by rest or GTN
65
Q

What is unstable angina?

A
  • New in onset, occurs at rest (or with minimal exertion), has a worsening pattern
  • Other symptoms: SOB, fatigue, indigestion, anxiety
  • Not relived with GTN
  • Unpredictable
  • Associated with plaque rupture exposing a thrombus
  • Medical emergency
66
Q

What is acute coronary syndrome (ACS)?

A

The name given to three types of CAD that are associated with sudden plaque rupture:

  • UA
  • N-STEMI
  • STEMI
67
Q

What are modifiable risk factors of CAD?

A
  • Elevated serum lipids
  • HTM
  • Tobacco use
  • Sedentary lifestyle
  • Obesity
  • DM
  • Metabolic syndrome
  • Stress
  • Homocysteine levels
68
Q

What are non-modifiable risk factors of CAD?

A
  • Age
  • Gender
  • Ethnicity
  • Family history and genetics
69
Q

How does the patient with acute coronary syndrome present?

A
  • Collapse
  • Sweating
  • Pallor
  • Chest pain
  • Dyspnoea
  • Nausea and vomiting
  • Pale and clammy
  • Pulmonary oedema
  • Hypotension
  • Bradycardia/tachycardia
70
Q

Which acute coronary syndrome has a elevated ST segment?

71
Q

Which acute coronary syndrome doesn’t have a elevated ST segment but has elevated cardiac enzymes?

72
Q

Which acute coronary syndrome doesn’t have a elevated ST segment and doesn’t have elevated cardiac enzymes?

A

Unstable angina pectoris

73
Q

What are complications of MI?

A
  • Arrythmias (AF – atrial fibrillations, ectopic beats)
  • Cardiac arrest
  • Heart failure
  • Cardiogenic shock
  • Pulmonary oedema
  • Acute respiratory failure
74
Q

What are diagnostic studies for MI?

A 
Lab Tests:
- Lipid profile
- Serum cardiac markers (Trop T)
Medical Imaging:
- 12-lead ECG
- Cardiac catheterisation + coronary angiography
- Chest x-ray
- Echocardiogram
- Exercise stress testing
75
Q

What are acute nursing interventions for cardiac problems?

A
  • Pain
  • Ongoing monitoring an assessment
  • Rest and comfort
  • Anxiety
  • Emotional and behavioural reactions
76
Q

What is multidisciplinary care for cardiac problems?

A
  • Rapid diagnosis and treatment extremely important

- Best practice treatment

77
Q

How to reperfuse STEMIs with thrombolysis?

A
  • Stop the infarction process by dissolving thrombus and reperfusing myocardium
  • Treatment if no PCI available in timely manner (ie within 120 mins; goal within 30mins of arrival to facility without cardiac catheterisation facility)
  • Within 6 hours ideally otherwise mortality reduced by 25%
78
Q

What is surgical revascularisation - CABG?

A

The restoration of perfusion to a body part or organ that has suffered ischemia mainly by vascular bypass and angioplasty

79
Q

What are nursing interventions for acute heart failure:pulmonary oedema?

A
  • C-XRAY
  • Monitoring
  • Treat cause
  • Positioning
  • Oxygen therapy
  • Drug therapy (cardiac Mx and anxiety Mx; intravenous)
  • Daily weight
  • Rest
  • Regular assessment
  • Combine physical, psychosocial and relational needs with each care encounter
80
Q

How to provide patient education for cardiac problems?

A
  • Needs to occur at every stage of the hospitalisation and recovery
  • Patient must be aware of the need to learn
  • Timing important - initially in crisis - shock, disbelief
  • Simple, brief language
  • Learning what to expect provides sense of control
  • Use evidence-based teaching guides
81
Q

What are nursing assessments for cardiac pain?

A
  • Pain assessment
  • Vital signs
  • Precipitating factors
  • Skin
  • ECG
  • Blood work
  • Medication
  • Pt history/cardiac history
  • Perfusion
  • Auscultation
82
Q

What is a MI?

A
  • Occlusion of coronary artery for greater than 4-6 hours

- Irreversible cell death

83
Q

What are characteristics of unstable angina?

A
  • No change in ECG but possible ST depression and T wave depression
  • No change in biomarkers
84
Q

What are characteristics of a NSTEMI?

A
  • No ST elevation or Q waves
  • Can have ST depression or T wave inversion
  • Change in biomarkers
85
Q

What are characteristics of a STEMI?

A
  • ST elevation and presence of Q wave

- Change in biomarkers

86
Q

What is emergency care for MI (MONATAS)?

A
  • Morphine
  • Oxygen
  • Nitrates
  • Aspirin
  • Thrombolytics
  • Anticoagulants
  • Stool softener
87
Q

How to administer nitrates?

A
  • 1-2 sprays at 0 min
  • Check blood pressure
  • 1-2 sprays five minutes later
  • Check blood pressure
  • 1-2 sprays five minutes
88
Q

When should you not give GTN?

A

If systolic blood pressure is below 100

89
Q

What are manifestations of heart failure?

A
  • Breathlessness
  • Tachycardia
  • Hypotension
  • Anxiety
  • Fatigue
90
Q

What is heart failure?

A
  • Linked to cardiovascular disease (HTN, CAD, and MI)
  • A chronic condition that worsens over time
  • No predictable course
91
Q

What are the types of heart failure?

A
  • LVF (left sided heart failure)
  • RVF (right sided heart failure)
  • Bilateral heart failure
92
Q

What is normal ejection fraction?

93
Q

When if heart failure end stage?

A
  • Confirmed diagnosis
  • Ejection fraction less than 20%
  • Not a candidate for device therapy or surgery
  • BNP greater than maximal therapy
  • Persistent NYHA class III-IV symptoms
  • Multiple comorbidities which influence initiating heart failure
  • Inability to optimise
94
Q

If a patient is complaining of chest pain what should you do as a nurse?

A
  • Get help
  • Pain assessment
  • Vital signs
  • ECG
  • Skin
95
Q

What is DKA?

A
  • Absent of insulin

- Leads to disorders of metabolism of carbohydrate, protein and fat

96
Q

What are the three clinical features of DKA?

A
  • Hyperglycaemia
  • Dehydration and electrolyte loss
  • Acidosis
97
Q

What is HHNS (Hyperglycaemic hyperosmolar non-ketotic syndrome)?

A

Lack of effective insulin leads to hyperosmolarity and hyperglycaemia which causes osmotic diuresis, resulting in water and electrolyte losses

98
Q

What are characteristics of DKA?

A
  • Patients affected - Type 1 diabetes
  • Precipitating event
  • Omission of insulin; physiological stress
  • Onset - Rapid (<24h)
  • BGL - >13.9 mmol/L
  • Arterial pH - <7.3
  • Serum and urine ketones - Present
  • Serum Osmolality - 300 -350 mmol/L
  • Plasma bicarbonate - <15 mmol/L
  • Urea and Creatinine level - Elevated
  • Mortality rate - <5%
99
Q

What are characteristics of HHNS?

A
  • Patients affected - Type 2 diabetes
  • Precipitating event
  • Physiological stress
  • Onset - Slower (several days)
  • BGL - >33.3 mmol/L
  • Arterial pH - Normal
  • Serum and urine ketones - Absent
  • Serum Osmolality - >350mmol
  • Plasma bicarbonate - Normal
  • Urea and Creatinine level - Elevated
  • Mortality rate - 10%-40%
100
Q

What are precipitating factors of DKA?

A
  • Increased amounts of stress hormone
  • New diabetics
  • Management errors in insulin doses
  • Deliberate omission of insulin by patient
  • Erratic compliance with insulin and eating
  • Recreational drug use/ alcohol binges
101
Q

What are signs and symptoms of DKA?

A
  • Fatigue, headache
  • Polyurina
  • Polydipsia
  • Polyhagia
  • Nausea and vomiting
  • Abdominal pain
  • Dehydration
  • Kussmaul respirations
  • Acetone on breath
  • Decreased LOC
102
Q

What are nursing assessments and interventions for DKA?

A
  • Rapid ABC and determine LOC
  • Number 18 IV leur
  • Venous ABGs, FBC, U and E’s
  • CBG and CBK
  • Dehydration assessment
  • Signs of hypokalemia
  • Potential for hypovolemic shock
  • Signs of infection
  • ECG, SPo2, urine output
103
Q

What are signs of hypokalaemia?

A
  • Fatigue
  • Muscle weakness, leg cramps, soft, flabby muscles
  • Nausea and vomiting, paralytic ileus
  • Paraesthesia, decreased reflexes
  • Weak, irregular pulse
  • Polyuria
  • Hyperglycaemia
  • ECG changes: inverted T wave
104
Q

What is collaborative management for DKA?

A
  • Treating hyperglycaemia
  • Correcting dehydration and hypovolemia
  • Correcting electrolyte loss
  • Correcting acidosis
  • Identify and correct the precipitating cause
105
Q

What are nursing interventions for DKA?

A

Monitoring of:

  • Vital signs
  • LOC
  • ECG
  • O2 saturations
  • Urine output – 1/24
  • FBC 1/24
  • Serum glucose and potassium
106
Q

How to provide rehydration therapy for DKA patients?

A
  • 1L 0.9% saline over 1 hour
  • 1L over 1-2 hours
  • 2 L over 4 hours
  • 1L every 4-6 hours
  • Switch to 5-10% glucose over next 8 hours once BGL <15mmol/L
  • Continue with saline in addition to glucose if patient remains volume depleted
107
Q

How to administer insulin for fluid management of patients with DKA?

A
  • 50 units actrapid in 50ml NaCl in syringe driver for IV infusion
  • Start 6 unit/hour
  • Laboratory venous BGL should be checked 2/24
108
Q

How to replace potassium in patients with DKA?

A
  • Do not add to the first litre of fluid infused
  • Establish K+ level
  • Monitor K+ every 2 hours
109
Q

What is the rate of potassium chloride to be added to each litre of fluid for different serum potassium levels?

A
  • > 5.5 - Nil recheck in 2 hours
  • 3.5-5.5 - 20 mmol/L
  • 3.0 -3.4 - 40 mmol/L
  • <3.0 - Higher rates of potassium should be administered in ICU
110
Q

How to prevent DKA and what are sick day rules?

A
  • Sugar free cough mixtures
  • Seek prompt medical treatment – antibotics/ paracetamol
  • If unable to eat normally – carbohydrates should be replaced with cereals, soups or liquid carbs
  • Drink plenty of sugar-free liquids
  • If vomiting – seek medical attention
  • Insulin should be continues even if not eating
  • It is likely that insulin doses will need to increased during illness
  • BGL should be checked more regularly (4x/day)
111
Q

What are characteristics of AKI?

A
  • Rapid onset and loss of kidney function
  • Accompanied by rise in serum creatinine and/or reduction in urine output
  • Potentially reversible
  • High mortality rate
  • Usually affects people with life threatening conditions
  • Commonly follows severe, prolonged hypotension or hypovolaemia or exposure to nephrotoxic agent
112
Q

What is the process of DKA?

A
  • No glucose in cells to be used as source of energy
  • Liver starts converting glycogen to glucose
  • Body starts breaking down fat (lypolysis)
  • Ketones (acid by products) produced
  • Increased ketones and glucose in blood and ketones in urine (ketonuria)
  • Metabolic acidosis
  • Osmotic diuresis
113
Q

What are the three categories of AKI causes?

A
  • Prerenal
  • Intrarenal
  • Postrenal
114
Q

What are prerenal causes of AKI?

A
  • Hypovolaemia
  • Decreased cardiac output
  • Acute haemorrhage
  • Decreased peripheral vascular resistance
  • Decreased renovascular blood flow
115
Q

What are intrarenal causes of AKI?

A
  • Nephrotoxic injury
  • Interstitial nephritis
  • Other – acute tubular necrosis
  • SLE and myoglobin
116
Q

What are postrenal causes of AKI?

A
  • Benign prostatic hyperplasia
  • Bladder cancer
  • Calculi formation
  • Neuromuscular disorders
  • Prostate cancer
  • Spinal cord disease
  • Strictures
  • Trauma
117
Q

What is acute tubular necrosis (intrarenal)?

A
  • Nephrotoxic or ischemic injury that damages renal tubular epithelium
  • ATN most common cause of intrarenal failure especially in hospitalized patients.
  • Damage to cellular structure
118
Q

What can damage to cellular structure in acute tubular necrosis cause?

A
  • Prevents normal concentration of urine
  • Filtration of wastes
  • Regulation of acid-base, electrolyte and water balance
119
Q

What does RIFLE mean?

A
  • Risk
  • Injury
  • Failure
  • Loss
  • ESRD
120
Q

What is criteria for risk in RIFLE?

A

Increased creatine x 1.5 or GFR decrease > 25%

121
Q

What is criteria for injury in RIFLE?

A

Increased creatine x 2 or GFR decrease > 50%

122
Q

What is criteria for failure in RIFLE?

A

Increased creatine x 3 or GFR decrease > 75% or creatine > 4mg per 100ml (acute rise of > 0.5 mg per 100 ml dl)

123
Q

What is criteria for loss in RIFLE?

A

Persistent ARF = complete loss of renal function > 4 weeks

124
Q

What is criteria for ESRD in RIFLE?

A

End stage renal disease

125
Q

What is multidisciplinary care for AKI?

A
  • Treat precipitating cause
  • Fluid restriction (600 mls + previous 24 hours loss)
  • Nutritional therapy (enteral nutrition)
  • Measures to lower potassium
  • Calcium supplements
  • Dialysis
126
Q

What is nursing management for AKI?

A
  • Monitor vital signs
  • Fluid and electrolyte balance
  • Urine assessment
  • Respiratory assessment
  • Skin assessment
  • Prevent infection
  • Monitor fatigue and potential anxiety
  • Monitor of complications - arrhythmias, infection
127
Q

What are the general principles of dialysis?

A
  • Diffusion
  • Osmosis
  • Ultrafiltration
128
Q

What lab monitoring do you complete on a DKA patient as a baseline?

A
  • Glucose
  • NA+, KCL and urea
  • Creatine
  • Bicarbonate
  • Arterial gas
129
Q

What lab monitoring do you complete on a DKA patient after 2 hours?

A
  • Glucose
  • NA+, KCL and urea
  • Bicarbonate
  • Arterial gas
130
Q

What lab monitoring do you complete on a DKA patient after 6 hours?

A
  • Glucose
  • NA+, KCL and urea
  • Bicarbonate
131
Q

What lab monitoring do you complete on a DKA patient after 12 hours?

A
  • Glucose
  • NA+, KCL and urea
  • Creatine
  • Bicarbonate
132
Q

What lab monitoring do you complete on a DKA patient after 24 hours?

A
  • Glucose
  • NA+, KCL and urea
  • Creatine
  • Bicarbonate
133
Q

What are signs of hyperkalaemia?

A
  • Elevated T wave

- Blood work

134
Q

What is the rate of insulin infusion?

A

Start 0.1 units/kg/hour intravenous insulin infusion

135
Q

When should insulin infusion be stopped?

A

When insulin and ketone levels are normal

136
Q

How do you stop insulin infuson?

A

Lower infusion and administer sub cut injection of insulin. Titrate this slowly and continue hourly monitoring

137
Q

What is the range for normal potassium?

A

3.5-5.2 mmol/L

138
Q

What are risk factors for AKI?

A
  • Diabetes
  • Over 75 years
  • Hypertension
  • Heart and liver failure
  • Sepsis
  • Nephrotoxic drugs
139
Q

What are examples of nephrotoxic drugs?

A
  • Gentamicin
  • Vancomycin
  • MI contrast
140
Q

What are the phases of AKI?

A
  • Initial or onset phase
  • Oliguric or maintenance phase
  • Diuretic
  • Recovery
141
Q

What is TPN mean?

A

Total parental nutrition

142
Q

What is PPN mean?

A

Peripheral parental nutrition

143
Q

What does TPN and PPN do?

A

They directly administer nutrients into the circulatory system

144
Q

What are the different types of dialysis?

A
  • Peritoneal dialysis
  • Haemodialysis dialysis
  • Continuous renal replacement therapy (CRRT)
145
Q

What are the phases of peritoneal dialysis?

A
  • Instill (glucose fluid administered)
  • Dwell (from 30 minutes to 8 hours)
  • Drain (ideally straw colour and translucent)
146
Q

What do you look for in a drained bag of peritoneal dialysate?

A
  • Colour
  • Clarity
  • Mucous shreds
  • Weight
147
Q

What is RH factor?

A
  • The D antigen

- A protein found on RBC’s surface

148
Q

What does “-“ve D antigen mean?

149
Q

What does “+”ve D antigen mean?

150
Q

What are the different types of blood products?

A
  • Whole blood
  • Red blood cells
  • Platelets
  • Fresh frozen plasma (FFP)
  • Albumin
151
Q

What does prothrombinex do?

A

Reserve blood thinners

152
Q

What is a group and hold?

A
  • Check patient details
  • Check historical information on patient such as previous blood group, previous transfusion and obstetric history
  • ABO and RhD typing of recipient’s red cells
  • Antibody screen to detect antibodies in recipient’s plasma
  • Identification of red cell antibodies (performed if positive antibody) screen detected
153
Q

What is a cross match?

A
  • Serological crossmatch of the patient’s plasma versus donor red cells
  • Once pre-transfusion testing is completed blood can be issued to the ward or operating theatre
  • Detects incompatibility between a patient and donor blood chosen for transfusion
  • The units compatible are labelled specifically for the patient
  • The blood bank holds the units and releases them immediately upon request
154
Q

How to manage blood transfusion before the blood arrives?

A
  • Know why your patient requires a transfusion
  • Prepare and talk to your patient
  • Ensure that the patient has a valid sample for “group and screen” in the Blood Bank
  • Ensure written, informed consent has been obtained
  • Ensure blood is prescribed and prescription signed by the Medical Practitioner
  • Prepare your equipment
  • IV line primed with 0.9%NaCL only
  • Min 20G leur, 18G preferable
  • Send for the blood (using appropriate forms and systems)
155
Q

How to manage blood transfusion when the blood arrives?

A
  • Take the unit, prescription and consent to the bedside, and check all of this with another RN - 2 person check
  • Ask the patient to identify themselves – full name and DOB while checking the patients wristband and details on swing label on the blood bag
  • Both nurses check the unit number, component, unit group that has been provided by the blood bank with details on swing label on the blood bag
  • Check expiry date on unit
  • Spike the unit and prime the line - always use a line with a 170-200micron filter or add a 170-200 micron filter onto the giving set
  • Set up line - you may use an infusion pump
  • You have 30 minutes in which to begin the infusion
156
Q

What are observations necessary for a blood transfusion?

A
  • Baseline temp, pulse, respiration and manual blood pressure - document
  • Remain with your patient for the first 15mins of the transfusion
  • Repeat all vital signs within 15 min of commencement - document
  • Depending on patients condition and hospital policy, vital signs are monitored and recorded every 30mins, 1 hourly or 2 hourly
  • Always take and document observations at the end of every unit
  • Read and be familiar with the hospital blood policies prior to transfusing the patient
157
Q

What are adverse effects of blood transfusions?

A
  • Febrile Non-Haemolytic Transfusion Reaction
  • Allergic reaction
  • Anaphylactic reaction
  • Hypotensive reaction
  • Acute Haemolytic Transfusion Reaction
  • Bacterial sepsis
  • T.A.C.O. – Transfusion Associated Circulatory Overload
158
Q

What are the rights for blood transfusions?

A
  • Right patient
  • Right component
  • Right time

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