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| 🇬🇧 | 🇬🇧 |
| What is first line treatment of hypertension | ACE inhibitors |
| What is the mode of action of ACE inhibitors? | Works in the RAAS system - ACE inhibitors works in the lungs by inhibiting the conversion of angiotensin I to angiotensin II which Reduces vasoconstriction and Decreases aldosterone secretion from the adrenal gland = loss of fluid and sodium in the urine |
| Side effects of ACE inhibitors? | GI upset, persistent dry cough, dizziness, anemia, hyperkalaemia, hyponatraemia, angioedema |
| What is the mode of action of calcium channel blockers? | Inhibit the movement of calcium ions across cell membranes of myocardium and arterial muscle cells (stops action potential- block heart muscle cell contraction, Depresses myocardial contractility, Relaxes and dilates arteries Decreases BP and venous return |
| Nursing considerations for ACE inhibitors? | *Take 1 hour before or 2 hours after food *Teratogenic * Warn patient to avoid dehydration and excessive perspiration as it may lead to a greater fall in BP, increasing the risk of fainting, therefore patient should maintain hydration within prescribed limits *BP is recorded every 15 minutes for 1 hour after the initial dose and, if a hypotensive response occurs, place the patient in a supine position *NSAIDS react with medications |
| Side effects of calcium channel blockers? | Peripheral oedema, skin flushing, rash, liver damage, heart block |
| Nursing considerations for calcium channel blockers? | *No grapefruit (increases serum levels) *Good oral hygiene - risk of gingiva hyperplasia *Swallow whole -dont crush or chew *Monitor blood pressure and pulse |
| What is the mode of action of thiazide diuretics? | Inhibit reabsorption of sodium and chloride at the beginning of the distal convoluted tubule which promotes excretion of water and sodium resulting in increased urinary volume |
| Side effects of thiazide diuretics? | • GI irritation • Thirst • Polyuria • Electrolyte imbalances (hyponatremia and hypokalaemia). • Postural hypotension |
| Nursing considerations of diuretics? | *Monitor for dehydration *Monitor renal function and electrolytes *take in the morning due to polyuria |
| What is the mode of action for Angiotensin 2 receptor blockers? | Works in RAAS. Selectively binds to ACE 2 receptors sites in vascular smooth muscle and adrenal cortex. Blocks vasoconstriction and release of aldosterone which decreases blood pressure. |
| Side effects of ARBs? | Hypotension, dizziness, syncope, dry mouth, resp tract infections |
| Nursing considerations of ARBs? | *Assess blood pressure and pulse routinely *Monitor potassium levels - hyperkalemia *Teratogenic - can cross placenta *Falls risk due to hypotension *Avoid potassium substitutes |
| What is the mode of action for beta blockers? | Beta 1 adrenergic receptor blocker – blocks receptor sites in the myocardium preventing epinephrine from binding to receptors causing decrease heart rate, contractility and cardiac output and reduce the release of renin |
| What are the side effects of beta blockers? | Gi upset, dizziness, bradycardia, cold extremities, CNS effects |
| Nursing considerations for beta blockers? | • Withheld less than 60bpm • advise to change positions slowly to prevent orthostatic hypotension * monitor blood glucose |
| What class is digoxin from? | Cardiac glycoside |
| What is digoxin used for? | Heart failure and atrial fiblliration |
| What is the mode of action of digoxin? | Inhibition of the sodium pump increases intracellular sodium and increases the calcium level in the myocardial cells causing an increased contractile force of the heart. indirect effect : Stimulates parasympathetic nz via vagus nerve- leading to sinoatrial (SA) and atrioventricular (AV) node effects that decrease the heart rate |
| Nursing considerations for digoxin? | *Not to be used in pregnancy *Pulse for 1 min before administering; hold dose if pulse < 60 *Retake pulse in 1 hr. If adult pulse remains < 60 hold drug and notify prescriber *Educate patient on signs of toxicity and – rehiterate the importance of blood tests *Avoid meds with meals- delays aborbtion |
| Mode of action of GTN? | Provide a source of nitric oxide which mediates relaxation of smooth muscle - widening blood vessels, letting more blood and oxygen reach your heart. This reduces strain on your heart, making it easier for your heart to pump blood. |
| Side effects of GTN? | Headache Dizziness Hypotension nausea/vomitting |
| What are the symptom of right sided hear failure? | Distended, pulsating neck vein (sit patient upright- more noticeable) Peripheral oedema – weight gain, swollen ankles/feet Hepatomegaly and splenomegaly(enlarged speen) (enlarged liver – size and weight due to fluid in abdomen Ascites (abdo fluid) Anorexia and GI upset Dyspnoea |
| What are 4 factors that cause cardiac arrest? | *Myocardial infarction *hypovolemic shock(decreased volume of blood) * Hypoxia *Trauma |
| What are signs of cardiac arrest? | *chest pain *SOB *fatigue *anxiety-impending sense of doom |
| How are deteriorating patients managed in hospital? | *MET call *EWS score *emergency bells *Resuss trolley and defib |
| What does CPR stand for? | Cardio pulmonary resuscitation |
| What does CPR do for the heart? | Chest compressions increase intrathoracic pressure and apply direct compression of the heart |
| Why do children most likely go into cardiac arrest? | Because they are deprived of oxygen |
| What are the shockable rhythms? | Ventricular fibrillation & ventricular tachycardia |
| What are the non shockable rhythms? | Asystole & pulseless electrical activity |
| How much adrenaline is administered for anaphylaxis? | 0.3-0.5mL 1:1000 - Intramuscular into vastus lateral(side of thigh) |
| What is the goal from post resuscitation treatment? | *assess ABCDE *treat causes *12 lead ECG *re-evaluate oxygenation and ventilation *temperature control |
| Risk factors associated with anesthesia? | *Type of procedure *Age *Diabetes - impaired healing, electrolyte balance *Cardiac/resp disease *Cognitive/renal/hepatic function |
| What info is gathered in pre-op assessment to identify risk factors? | *Medical history *Medications *Physical disabilities *Surgical/anesthetic history - PONV |
| What other things are considered in the pre-op assessment? | *Cultural considerations *Emotional status *Baseline obs *Patient education *Post op support |
| What are the triad of medications used in general anesthetic? | Hypnotic, analgesic and muscle relaxant |
| What are the three phases of GA? | Induction, maintenece, emergence |
| What are some physiological changes in surgery due to positioning? | Skin - risk of pressure/sheer injuries or temp Resp system - Less room for lungs to expand – abdominal area shifts upwards – reduces inspiration and expiration Cardiovascular system - risk of DVT- anesthesia causes peripheral dilation lowers BP and causes blood to pool in areas |
| Why is thermal support important intraoperatively? | Risk of hypothermia - agents provide vasodilation causing heat loss |
| Identify and explain two medications that are risk factors intraoperatively ? | Anticoagulants - alter normal clotting factors - risk of hemorrhaging. Discontinue at 48 hours before surgery Antihypertensive - beta-blockers and calcium channel blockers, interact with anesthetic agents to cause bradycardia, hypotension and impaired circulation |
| What is the aim of post op care? | Oxygenation circulation of blood comfort nutrition and fluids elimination movement and exercise hygiene psychological support protection and safety |
| What the goal of oxygenation in post op care? | Assessment is also made of colour and breathing to observe for the signs of any respiratory tract complications. Mucus secretions can accumulate, leading to pneumonia, bronchitis or atelectasis. |
| What is the goal of circulation of blood in post op care? | Risk of DVT and pulmonary embolus. During this period deep breathing, coughing and, if possible, leg exercises and early ambulation are encouraged |
| What is the goal of elimination in post op care? | It is important to observe urinary output on an ongoing basis. If retention of urine or inadequate emptying of the bladder occurs, it may be necessary for the individual to have a urinary catheter inserted |
| What is the goal of comfort in post op care? | Assume a semi-upright position. This position promotes adequate lung expansion, and assists urinary or wound drainage by gravity |
| What is the effects of pain in the post-op patient? | • Enhances surgical stress response • Causes tachycardia & hypertension • O2 demand increases • Respiratory function compromised • Reduced ability to mobilise |
| What is the nursing management of a post op hemorrhage? | *Assess vital signs - cognition *Check wound dressing *Check estimated blood loss *Pain assessment *Blood tests (FBC + hemoglobin |
| What is the nursing management of hypotention/shock? | *IV fluids, blood products *position patient flat *Assess causes |
| What is the nursing management of a post-op CVA? | Assessment of hemiparesis, facial drooping, speech, orientation, LOC |
| What is the nursing management of post-op urinary retention? | Usually normal after surgery - should pass urine within 6 hours *monitor fluid balance *encourage fluid intake *sit upright position for gravity *monitor weight *sound of running water *warm shower *bladder scan if nor successful *possible catheter |
| What is the nursing management for post op delirium? | *check underlying causes - medications, dehydration, electrolyte imbalance *delirium assessment *close monitoring *re-orientate patient *falls risk *Promote safe environment |
| What is the nursing management of a post op pulmonary embolism? | Vital signs anticoagulant if needed mobilization TED stockings - calf pumps |
| What is the nursing management of hypoventilation? | *monitor resp rate, depth and effort *check medication history *Sit patient upright *assess pain - remove restricting dressings *administer o2 if decreased o2 sats |
| What is the nursing management of post-op constipation? | *Encourage fluids(kiwi crush) *mobility *manual evacuation *laxatives |
| What does hypersensitivity mean? | An excessive or abnormal sensitivity to a substance. A person who is hypersensitive to a certain drug will often suffer a severe allergic reaction |
| What is hypersensitivity type 1? | Also known as allergic reaction - Immediate reaction – IgE mediated response Occurs within minutes of exposure |
| What is the physiological effects of anaphylaxis? | Vasodilation - hypotension bronchoconstriction - reduced breathing - cyanosis increased heart rate fluid shift - reduced blood volume increased capillary permeability - swelling |
| Signs of anaphylaxis? | *Swelling of the eyes and face *noisy breathing - wheeze or stridor *red raised rash *hypotension *tachycardia *stomach pain *loss of consciousness |
| What is the treatment of anaphylaxis? | Adrenaline,O2, IV access, fluid replacement, antihistamines, hydrocortisone |
| Why is adrenaline given in anaphylaxis? | Prevents (or relieves) –laryngeal oedema, circulatory collapse, release of histamine and other mediators Provides bronchodilation (SYMPATHETIC) |
| How much adrenaline is used in anaphylaxis? | 0.5mLs - 1:1000 |
| What is HIV? | Type of retrovirus that attacks CD4 T helper cells which help the body fight off infections - therefore making a person with HIV more vulnerable to other infections (dendritic cells present virus to T cells) |
| What is a retrovirus? | A type of virus that inserts a copy of its RNA into the DNA of a host cell - hijaks host cell and causes it to die and the retrovirus will move into surrounding cells |
| What are the symptoms of HIV? | Flu like symptoms develop 2-4 weeks after exposure As the virus replicates patient remains symptom free as the body makes antibodies to try fight the infection further progression means the CD4 cell count is less than 200 which leads to aids defining conditions |
| What are aids defining conditions? | Classified as being directly associated with advanced HIV infection - presence of AIDS |
| What is the mode of action of NNRTIs (non-nucleoside reverse transcriptase inhibitors? | Binds to and blocks HIV reverse transcriptase enzyme to prevent replication |
| What is the mode of action of integrase strand transfer inhibitors (INSTIs)? | Inhibits the strand transfer step of retroviral DNA integration which is essential for HIV replication. |
| What is the mode of action of protease inhibitors? | Inhibits the action of protease enzyme preventing replication |
| What is the mode of action of the biologic medication 'infliximab? | Binds to tumor necrosis factor inhibiting the inflammatory cascade which suppresses chronic inflammation and immune response activation. (TNF is high with autoimmune diseases ) |
| How do DMARDs work | Work to slowly modify autoimmune diseases by suppressing immune and inflammatory response - inhibit T & B cells |
| Why are injections used to administer medication? | *Faster absorption time *Patients who are unable to swallow *Some meds are poorly absorbed in the GI tract *Patients who have fluid restrictions |
| Length of a needle is dependent on? | IM or S/C Site Muscle mass Subcutaneous fat |
| Importance of subcut injections? | *Used for small volumes of medications *slow absorption time - not as many blood vessels *risk of lipohypertrophy - |
| Importance of intramuscular injections? | In the muscle layer Suitable for larger volumes than subcutaneous sites Faster absorption |
| Potential complications of IM injections? | *Pain *Bleeding *Injury to nerves or blood vessels *Abscess |
| Common sites for IM injection? | Deltoid Vastus lateralis – Side of thigh Rectus femoris – Not commonly used - front of thigh Ventrogluteal - side of hip Dorsogluteal - upper outer glute - not recommended due to sciatic nerve injury |
| What is the pathophysiology of lymphedema? | Collection of fluid that collects in the interstitial spaces of the arm or leg due to a blockage in the lymphatic system. |
| What causes lymphedema? | *Removal of lymph nodes *Damage from cancer treatment *Trauma *Genetics |
| Signs and symptoms of lymphedema? | *Swelling in affected limb *Soreness *Weakness |
| What are some things to consider post mastectomy with node removal ? | *Physiotherapy - exercise - to help with drainage *Compression bandage |
| Things to avoid after surgery to reduce risk of lymphedema? | *Injections/blood tests on the affected area - local inflammatory response *Vigorous lifting *Sunburn *Tight clothing on area |
| Education around post surgery to reduce risk of lymphedema? | *Elevate arm when possible *healthy diet *prevent trauma *maintain skin care |
| What is Lymphadenopathy? | Enlarged swollen lymph nodes |
| What causes Lymphadenopathy? | Usually infection - elevated white blood cells |
| Tonsillitis is a cause of Lymphadenopathy, what are symptoms? | *sore throat *swollen enlarged tonsils *fever *difficulty swallowing |
| What is Non-Hodgkin's lymphoma ? | Cancer of the lymphocytes in the lymphatic system without the presence of reed Sternberg cells - more common |
| What is Hodgkin's lymphoma? | Cancer of the lymphocytes WITH the presence of reed Sternberg cells |
| What is the symptoms of malignant lymphomas? | *Enlarged lymph nodes *night sweats *fever *weight loss *fatigue |
| Nursing considerations for lymphomas? | *Patient education *Psychological support *identify barriers |
| Treatment of lymphomas? | Dependent on severity chemotherapy - most common radiation immunotherapy stem cell transplant |
| Side effects of lymphoma treatment? | Chemo can damage bone marrow Anaemia (low hemoglobin) can cause shortness of breath, tachycardia, or fatigue Thrombocytopenia (low platelet count) puts patients at risk of bleeding or bruise Neutropenia (low white blood cell count) puts the patient at increased risk of infection Nausea and vomiting |
| What are some factors that hinder wound healing? | Age - impaired venous return + decreased Langerhans cells genetics predisposing medical conditions (diabetes, renal disease) stress - affects immune system Nutrition- malnutrition will affect wound healing such as a protein deficiency Smoking- causes vasoconstriction which reduces the amount of oxygen available to the cells |
| What is a chronic wound? | A wound that has remained unhealed for more than 4 - 6 weeks- pressure sore, diabetic wound, post-op wound |
| What is involved in the examination part of HEIDI? | Assess the peri-wound - measurement, infection, edema, pulse(circulation) |
| What is the goal of moisture in a wound? | Goal is to maintain moisture - not to dry or too wet - dressings correct this |