| how does motion sickness trigger vomitting? | Disturbances of the semi-circular canals or the vestibule will send electrical signals to the vestibular nuclei in the brain to stimulate histamine and muscarinic receptors via the vestibular/cochlea nerve (VIII- 8) , signal gets passed on to the CTZ then to the vomiting centre to trigger vomiting reflex |
| How does cerebral stimulation work to induce vomitting? (smells, sight, pain) | Stimuli are processed through the higher brain centre (cerebral cortex) and electrical impulses are sent to the vomiting centre via stimulation of the muscarinic receptors |
| how does gastric stimulation trigger the vomitting reflex? | Gastric epithelial lining consists of rugae containing microscopic gastric pits – lined by cells called. The enterochromaffin (EC) cell is an enteroendocrine cell subtype the cells that Release serotonin in response to cytotoxic agents - Stimulates serotonin receptors on Vagus nerve to bring sensations to the vomiting centre to trigger the vomiting reflex |
| what are the indicators of increased lilkihood of PONV? | Female
Non smoker( protective mechanism)
Use of post op opioids
History of PONV |
| What are the 3 phases of chemotherapy induced nausea and vomitting? | • Acute – occurring within a few minutes to hours
• Delayed – occurring 24 hours after drug administration.
• Anticipatory – occurring before drug administration, a conditioned response (psychological response – negative experiences to chemo drugs) |
| what are the causation theories in nausea and vomitting during pregnancy? | increased amount of hormones
protective mechanism to protect the embryo from harmful substances |
| what is the nursing management of caring for someone experiencing nausea and vomitting? | Prevention of nausea and vomiting if possible (goal of care – prevent before it happens)
Must be managed if it is affecting nutrient and fluid intake or if it delays essential treatments
Assess the cause
Administer medications by a route that is likely to be effective
Minimise the distressing experience of nausea and vomiting |
| what is Ondansetron - 5HT3 Serotonin receptor antagonists used for and its mode of action? | chemo and post op nausea and vomitting - It reduces the vomiting reflex by blocking serotonin at 5HT3 receptors both peripherally in the gastro-intestinal tract and centrally in the chemoreceptor trigger zone |
| what are the common side effects of ondansetron? | headache and constipation |
| what is cyclizine - Histamine – H1 receptor antagonists used for and its mode of action? | motion sickness - blocks the action of histamine and mucuranic receptors reducing the stimulation of the CTZ |
| what are the side effects of cyclizine ? | anti muscuranic – drowsiness , dry mouth , constipation |
| what is the mode of action of metoclopramide - dopamine 2 receptor antagonist? | It stimulates gastrointestinal peristalsis (accelerating gastric emptying and intestinal transit time), lowers oesophageal sphincter pressure, and antagonises dopamine receptors in the chemoreceptor trigger zone. |
| what are the side effects of metoclopramide? | Extra pyramidal –
drowsiness
nausea
bowel disturbances |
| nursing management of nausea and vomitting? | assess the cause
give appropriate antiemetic
remove bad smells
maintain fluid intake
position patient upright during and after eating
oral hygiene |
| implications of non management of nausea and vomitting ? | Exhaustion
Ability to manage pain (pain threshold decreases)
Surgical implications – wound site rupture(severe vomiting can rupture sutures – increase in abdominal pressure)
distress |
| diagnostic criteria for major depressive disorder? | 5 more more depressive symptoms ongoing for more than 2 weeks that doesnt get better - The symptoms cause significant distress or impairment in social,work, family |
| nursing considerations for depression? | Develop a therapeutic rapport
Encourage client to express feelings
encourage goal setting
Structure the day – gently support client to become involved in regular brief social and recreational activities
Encourage regular meals and activities of daily living (sleep, exercise and mindfulness). |
| difference between bipolar 1 and 2? | Bipolar 1 : A person with bipolar 1 disorder may or may not have a major depressive episode. The symptoms of a manic episode may be so severe that you require hospital care.
Bipolar 2 : involves a major depressive episode lasting at least two weeks and at least one hypomanic episode (a period that’s less severe than a full-blown manic episode). |
| what is mania in bipolar disorder? | persistently elevated mood, which may be one of elation or irritability;
increased activity;
and poor judgement |
| what is hypomania in bipolar disorder? | Mild form of mania – less severe
no psychotic episodes
• No significant impairment in social or occupational function |
| what are some symptoms of a manic episode? | racing thoughts
decreased need for sleep
increased activity
exaggerated sense of self confidence
loss of touch with reality |
| nursing considerations for manic episode? | Safety – prevent person from hurting themselves or others.
Provide a low-stimulus environment – quiet rooms with limited activities or stimuli
set boundaries and simple instructions - do not argue |
| Interventions and treatment for mood disorders? | Recovery Planning (awareness of triggers)
Lifestyle medicine (exercise, diet, sleep)
Talking therapies
CBT Cognitive behaviour therapy
Music, Art therapy
Mindfulness/relaxation techniques
Antidepressant/Mood stabilsing medication |
| causation theories of mood disorders? | Hormonal factors – excess cortisol
Genetic links
trauma
neurochemical - monoamine hypothesis
stress during pregnancy and after birth |
| what are the four classes of anti depressants? | SSRIs (e.g. fluoxetine or citalopram),
SNRIs serotonin and noradrenaline reuptake inhibitors (e.g. venlafaxine )
TCA tricyclic antidepressants (e.g. amitriptyline) and
Monoamine oxidase inhibitors (MAOIs) (phenelzine) |
| what is the mode of action of SSRI'S - sertraline? | inhibit the reuptake of serotonin at the pre synaptic cleft making it more available in the synapse |
| side effects of SSRIS? | headache
weight gain
insomnia
sexual dysfunction
excessive sweats |
| nursing considerations for anti depressents? | suicide risk
serotonin syndrome - educate patient
will not immediately work - takes time to see therapeutic effect
need to ween off medication - educate on discontinuation syndrome
must not be used with other anti depressents |
| mode of action of serotonin noradrenaline reuptake inhibitor? | inhibits the reuptake of serotonin and noradrenaline at the pre-synaptic cleft making it more available in the synapse |
| mode of action of TCA tricyclic antidepressants (e.g. amitriptyline ? | Inhibits reuptake of serotonin and noradrenaline by blocking the serotonin transporter and the norepinephrine transporter enhancing neurotransmission |
| what is the mode of action of monoamine oxidase inhibitors? | Used when other medication hasn’t worked. Inhibits the action of monoamine oxidase which is responsible for the breakdowns of amines. This increases the concentration of neurotransmitters across the synapse. |
| what are the effects of serotonin syndrome? | tachycardia
hyperthermia
tremors
confusion |
| what are the effects of discontinuation sydrome? | imbalance
flu like symptoms
anxiety
electric shocks in the brain |
| what is the mode of action of lithium? | Lithium displaces K+ & Na+, possibly Ca+2 to occupy sites
making it harder for the action potential to be relayed through neurons - Inhibits excitatory neurotransmitters such as dopamine and glutamate and promotes GABA-mediated neurotransmission |
| side effects of lithium? | GI effects: nausea, vomiting, diarrhoea, dyspepsia, weight loss or weight gain
CNS changes: lethargy, sedation, tremor |
| nursing considerations for lithium? | monitor for lithium toxicity
• Be careful with dehydration- hydration is important to balance the extra salts
daily blood tests to monitor serum levels |
| why is a neurological assessment needed? | As part of an initial assessment to establish baseline recordings
Determine changes
Deterioration
Stability
Improvement |
| What might affect LOC? | hypoxia
intracranial pressure
sedating drugs
electrolyte imbalances |
| late signs of raised ICP? | hemiparesis
raised blood pressure
sweating
seizures |
| Whats involved with a neurological assessment? | level of consciousness
motor function
pupillary function
respiratory function
vital signs |
| why is assessing pupil movement important ? | If the eyes move together into all six fields, extraocular movements are intact |
| what is Cushing's triad a sign of? | raised ICP - Increased systolic BP
Decreased heart rate
Irregular/ decreased respiration |
| what is the glascow coma scale ? | used to assess a wide variety of conditions where consciousness levels are in question
Assesses:
Eye responses : Scores1- 4
Verbal response: Scores1 -5
Best motor response : Scores1-6 |
| observations when a patient is on a PCA - patient controlled analgesia? | Normal Post Operative vital sign checks
Pain Intensity rest/movement
Level of Consciousness
Respiration rate
regular checks |
| how to opioids work with nociception? | Transmission phase of Nociception help stop transmission from the periphery to the spinal cord
Perception phase by altering the limbic system (important in terms of perception)
Modulation phase by helping in the activation of the descending inhibitory pathways that then modulate transmission in the spinal cord. |
| side effects of opioids? | Respiratory depression (major concern)
Nausea and vomiting (common) antiemetics charted too
Constipation (can lead to bowel obstruction)
sedation
hypotension - falls risk |
| what is some patient teaching around PCA use? | Educate the patient pre op or pre use about how the PCA works
Explain that the is very effective as analgesia maintenance once pain is well controlled.
It is always best to teach the patient to push for pain relief before the pain is severe.
Patients need reassurance that the PCA has safety mechanisms such as the total hourly dose that mean ‘overdose’ is unlikely
Only the patient can press their button ie not for relatives and friends to push |
| possible problems with PCA analgesia? | need to have cognitive awareness to use, physical dexterity to use, and need to know if the patient is opioid naïve
There may be equipment problems
Prescription errors |
| what is an epidural? | method of pain relief and anesthetic injected into the epidural space around the spinal cord - Local anesthetics and Opioids: Morphine, Fentanyl |
| nursing considerations for an epidura? | BP, P, Temp post op observations for the organisation ie ½ hrly for 2 hours, 1 hrly four hours, then 2 , 4 hrly
Resp rate 1/24 for 24 hours
Pain assessment
Dermatome levels: 2hrly-4hrly, or if there is a change in rate of the epidural infusion |
| complications of epidural? | tubing and pumps need to be clearly marked
displacement of catheter
infection
urinary retention - numb bladder
resp depression |
| what are nerve blocks? | Long-acting local anesthetics, such as bupivacaine or ropivacaine
Nerve blocks interrupt all afferent and efferent transmission to the area
Interrupt transduction and transmission - inhibit action potential |
| possible complications of nerve blocks? | LA Systemic toxicity is a potential complication
haematoma is another potential complication of RS block secondary to vascular injury during needle or catheter placement
nerve injury
allergic reaction
Infection
Increased risk of falls with some blocks ie a femoral nerve block |
| what is the mode of action of opioids? | binds to opiate receptors in the brain resulting in inhibition of the ascending pain pathways thus altering the perception and response to pain |
| what is pychosis? | A cluster of symptoms comprising one or more of the following:
Hallucinations
Delusions
Disorganised thoughts and behaviour
disconnection from reality |
| Psychosis can occur as a result of brain injury, disease, substance exposure/ ingestion, or as a symptom of mental distress. True or false? | True |
| what is schizophrenia? | A mental disorder that effects perception, thoughts and behavior - characterized by phsycosis episodes |
| what are the causation theories of schizophrenia? | Diathesis Stress Model (predisposition of vulnerability and stress)
Childhood Trauma
Genetics
Prenatal Factors
Dopamine Hypothesis (increased dopamine
Drug use ( recreational drug use – cocaine, cannabis etc . Triggers psychotic disorders with underlining predispositions |
| what are the three stages of schizophrenia? | prodromal, acute, residual |
| the prodromal phase can often go on for 2 years - what are three symptoms? | Worsening of usual work or school performance
Worsening intellectual and organisational functioning
Social withdrawal |
| what are the positive symptoms of schizophrenia? | Hallucinations (mainly auditory)
Delusional thinking
Disorganised or bizarre behaviour,
movement disorders - catatonia |
| what are the negative symptoms of schizophrenia? | Anhedonia (lack of feelings)
Blunt affect (lack of expression)
Avolition (lack of motivation)
Poverty of speech/thought
Social withdrawal
Insomnia |
| what is schizoaffective disorder? | thought disorder that includes both psychotic features and mood symptoms |
| what are some impacts of phycosis? | impacting on the person’s sense of self, experience of life and the world, and relationships. |
| nursing considerations for physcosis? | mental state exam - BATOMI
gain rapport and trust
engage person to reality orientated activities involving connection and contact
explore impacts of both negative and positive symptoms
focus on recovery - acknowledge their views and needs
encourage person to understand meaning of their phycosis |
| what is the mode of action of typical antipsychotics (haloperidole)? | Block D2 receptors in brain reducing dopaminergic transmission - usually treat positive symptoms |
| what are the side effects for typical antipsychotics? | can cause extra pyramidal symptoms
sedation
postural hypotension
sexual dysfunction |
| what is the mode of action of Atypical antipsychotics? | block D2 and serotonin receptors reducing transmission - works well for positive and negative symptoms - balances serotonin - dopamine |
| what are the side effects of Atypical antipsychotics (Risperidone)? | hypertension
postural hypotension
metabolic disorders
sedation
risk of neuroleptic malignant syndrome in all antipsychotics |
| clozapine is a Atypical antipsychotic, what are some important factors about this drug? | used for treatment-resistant people who dont respond to other meds
Advice patient of flu like symptoms (fever and sore throat)
risk of Agranulocytosis (low WBC)
Blood tests weekly for first 18 weeks and then 4 weekly (FBC; looking for drop in baseline WBC or absolute neutrophil count (ANC) |
| what are extra pyramidal symptoms (ADPT) | Akathisia – restlessness
Dystonia – involuntary facial movement
Pseudo-parkinsonisms – symptoms of Parkinson's disease induced by medication: Rigidity, tremor, shuffling gait
Tardive Dyskinesia – involuntary movements of the tongue, lip smacking/chewing/sucking, face & limbs |
| what is the meaning of intellectual disability? | problems with mental abilities such as learning, problem solving, judgement)
adaptive functioning (activities of daily life such as communication and independent living) |
| How is ID diagnosed? | long process, requires input from different health professionals -
Family History e.g. some chromosomal micro-deletions can occur in family members e.g., 15q11.2 microdeletion
Alcohol, drug misuse/abuse e.g. Fetal alcohol syndrome [FAS] (common cause of ID
Detailed history e.g. seizure disorders, attentional difficulties, sleep disturbances, behavioral disorders
MRI/CT
IQ test |
| what may a diagnoses of ID support for the child and family? | Access to information about the symptoms
Obtain information about what can be done to help the child
Determine specifically where and how to help the child
funding |
| What are the types of intellectual disabilities? | trisomy 21 (downs syndrome)
fetal alcohol spectrum disorder
autism |
| what are the characteristics of downs? | Short stature
ID
Language is delayed
Short and long-term memory is affected
Heart defects, GI defects, visual and hearing defects |
| how is downs diagnosed? | prenatal screening
• Chorionic villus sampling (CVS) (invasive – sample of tissue from placenta
• Amniocentesis – sample of amniotic fluid containing foetal tissues from the amniotic sac surrounding foetus |
| what is fetal alcohol spectrum disorder? | Ethanol and its metabolite acetaldehyde can alter fetal development by disrupting cellular differentiation and growth, disrupting DNA and protein synthesis and inhibiting cell migration |
| what are the poor life outcomes associated with FASD? | At increased risk of child abuse and neglect
Poor educational outcomes
Mental health and substance abuse issues |
| how is early identification achieved in intellectual disabilities? | comprehensive developmental checks (e.g. plunket, B4 school checks) so deviations from normal development are recognised
addressing parental concerns about their child’s development
prompt referral and access to diagnostic services
Treatment: MDT approach to providing specific therapies |
| What can cause ID? | Trauma – before and after birth
Alcohol
Infection
Environment
Chromosome abnormalities
Metabolic issues
Substance abuse |
| Nursing considerations for ID? | Person centered approach that promotes client participation and provides opportunities to make choices
Self-determination – support and encouragement
Encouragement and praise – developing independence, self esteem, confidence
think about external support
use non verbal cues |
| Under the Disability Act 2005 people with disabilities are entitled to? | have their needs assessed
• Have individual service statements drawn up, setting out what services they should get
• Access independent complaints and appeals procedures
• Access public buildings and public service employment |
| the vision of the nz disability strategy is to? | New Zealand is a non-disabling society – a place where disabled people have an equal opportunity to achieve their goals and aspirations, and all of New Zealand works together to make this happen |
| The Disability Action Plan 2019-2023 works toward putting the New Zealand Strategy into action. true or false? | true |
| what is a peak flow meter used for? | used for the diagnosis, monitoring and assessment of the severity of respiratory compromise, particularly in patients with asthma
measures forced expiratory volume - peak expiratory flow rate |
| what is allergic rhinitis(hayfever)? | exsposure to an allergen - can be early or late reaction
watery rhinorrhea (runny nose)
nasal obstruction
nasal itching
Sneezing |
| what is asthma? | a chronic inflammatory disorder of the lungs that are hypersensitive with recurrent episodes of wheezing, coughing, tightness of the chest, and shortness of breath, irritable cough |
| what are predisposing factors of asthma? | family history of:
Hypersensitivity
Allergies
atopy,
smoking during pregnancy,
exposure to pollution
past medical history of allergies |
| How does an acute flare up of asthma happen? | of IgE occurs – binds to inflammatory cells
Initiates B-lymphocyte activation
IgE binds to cells and causes release of inflammatory mediators: inflammatory process causing airway inflammation, mucus production (goblet cells), bronchospasm and bronchoconstriction |
| how is asthma diagnosed? | health history
asthma symptom diary
peak flow
spirometry
listen to lungs |
| how is asthma managed? | Accurate diagnosis – pharmalogical treatment
Assess control of symptoms
Pharmacological treatment
Complete an asthma action/management plan
Assess risk of severe exacerbations |
| what is COPD? | chronic obstructive irreversible progressive disease of the lungs |
| COPD is an umbrella term for which conditions? | chronic bronchitis
emphysema
irreversible asthma |
| what is chronic bronchitis? | inflammation causes chronic bronchial secretions and narrowing of the bronchi(main culpurt) -excess secretion of goblet cells causes narrowing of airways |
| what is emphysema? | a permanent destructive enlargement of the airspaces within the lung)break down of walls of alveloli – gas echange is reduced air becomes trapped – permanent |
| what is irreversible asthma? | poorly controlled childhood asthma, multiple acute exacerbations = remodeling, structural and chronic inflammatory changes cause partial or no reversibility in lung function |
| what are the predisposing factors for COPD? | smoking
pollution
chemical exposure
childhood asthma thats uncontrolled |
| symptoms of chronic bronchitis? | Productive cough
Wheezing and/or rhonchi, are universal features
Progressive dyspnea on exertion
Repeated purulent respiratory infections |
| non pharmalogical interventions for COPD? | smoking cessation
low exercise - maintain lung function
pulmonary rehabilitation
immunization - prevent infections
management plan |
| what is tuberculosis? | controlled under the tuberculosis act - requires notification
serious airborne infectious disease caused by mycobacterium reaching alveoli and replicates killing off immune cells |
| what are the symptoms of active TB? | Unexplained weight loss
Loss of appetite
Night sweats
Fever
Fatigue
Chills
Respiratory – cough, hemoptysis(coughing up blood), chest pain |
| what is pneumonia ? | acute respiratory infection causes by bacteria -white blood cells and bacteria accumulate - Alveoli fill with exudate/pus and may become solid |
| risk factors for developing pneumonia? | *other lung diseases
*reduced immune system
*cold damp housing
*medications - immunosuppressive, corticosteroids
*older age and young children |
| complications of pneumonia? | Bacteremia – bacteria can enter blood stream – comes systemic
Sepsis – immune cells kick
Acute respiratory distress syndrome (ARDS) requiring mechanical ventilation Pleural effusion -
Lung abscess or empyema –abscess in brain or lung |
| symptoms of pneumonia in adults? | Cough
Fever (>37.8°C)
Tachypnoea
Tachycardia
Dyspnoea
Sputum production |
| symptoms of pneumonia in children? | Increased respiratory effort:
In-drawing
Rib recession
Accessory muscle use
Grunting (usually bad sign
Irritability, grumpy
Fatigued
Difficulty feeding - infants
Dyspnoea
stridor or wheeze
Unsettled or complain of pain |
| how is pneumonia diagnosed? | clinical symptoms
chest xray
sputum culture and sensitivity
chest sounds
pulse ox |
| what is the rationale for providing o2? | prevention of cellular hypoxia cause by hypoxemia (low PaO2) and prevention of potentially irreversible damage to vital organs |
| what are the clinical goals of o2 therapy? | Treat hypoxemia
Decrease workload of breathing
Decrease myocardial workload |
| high concentration of o2 can lead to hyperoxia (toxicity) what are the symptoms? | visual changes e.g tunnel vision
Tinnitus
Nausea
twitching(especially of the face)
behavioural changes |
| what are the types of o2 thereapy? | high concentration (not dependent on pts respiratory effort) and low concentration (is dependent on respiratory effort) , long term o2 therapy |
| what is the treatment for allergic rhinitis? | oral anti histamines
topical nasal spray |
| what is the mode of action of short and long acting beta 2 agonists? | binds to B 2 adrenergic receptors on the bronchial smooth muscle promoting • relaxing bronchial smooth muscle
• stabilising mast cell membranes
• inhibiting mast cell mediators |
| what is the mode of action of Short acting anti-cholinergic ? | inhibits acetylcholine at muscarinic receptors in bronchial smooth muscle
• causing bronchodilation via relaxation of smooth muscle
• Causes reduction of the viscous mucus associated with COPD |
| what is the mode of action of glucocorticosteroids? | decreases airway inflammation and bronchial reactivity by reducing inflammatory mediator production and secretion (e.g. cytokines, histamine), and inhibiting the response of inflammatory cells. |
| what is the mode of action of anti histamines? | Blocks action of H1 histamine receptors to prevent mast cells from exploding |
| What is the APGAR assessment for new borns right after birth ? | usually done at 1 minute old then again at 5 mins old - checks babys appearance, pulse, grimace, activity and respiration |
| what is a guthrie test (heel prick)for new borns? | heel prick test done within 48-72 hours on a blood spot card- tests for cystic fibrosis, hypothyroidism, amino acids |
| what assessments are done for new borns? | APGAR assessment
Guthrie heel prick test
reflexes - indicate how well the NS is developing and functions
well child/tamariki ora check - takes over from midwife |
| what do well child checks provide? | Vision and hearing checks, growth and development assessments
Advice on Breastfeeding and infant nutrition, immunisation, preventing SUDI, childhood illness, parenting for child age and stage, safety and injury prevention
Support for smoking cessation, family violence screening, referrals and provision of additional supports |
| what is the pediatric assessment triangle used to assess? | Appearance: Muscle tone, consolability, spontaneous movements, speech or cry, distress level
Work of Breathing: effort, Respiratory distress, abnormal airway sounds
Circulation to skin: Skin color, such as pale, mottled, cyanotic, or flushed, bleeding, sweating |
| children are sensitive to injury, infections and toxins - as part of a neurovascular assessment what should you assess? | Cerebral function ) balance , gait, coordination
Cerebellar function
Modified GCS and AVPU
Pupils (PERL) – assess light response,
Check pain levels |
| in regards to the traffic light system (NICE guidelines) for identifying cause of fever what needs to be ruled out? | Meningococcal disease and bacterial meningitis
Herpes simplex encephalitis
Pneumonia
System for identifying illness under 5 who present with a fever |
| what are the potential | reduced level of conciousness
reduced skin turgor
tachypnoea
pale/cyanosis skin color
temp above 38 degrees |
| What are ACES? | Adverse childhood experiences - physical and emotional abuse, neglect, caregiver mental illness and household violence |
| what is toxic stress? | prolonged frequent exposure to trauma/ACES. can lead to long term effects mentally and physically |
| what can ACES have long term effects on ? | Obesity, diabetes, heart disease, behaviours (smoking, drug use, suicide), lack of life achievement |
| Why do nurses need to know about ACES? | Raising awareness
Advocacy
Support screening
Provide interventions
Collaborate with other health professionals |
| What helps ACES? | Safe, stable, and nurturing relationships.
The presence of protective adults makes it possible for a young child to adapt to stress in healthy ways that facilitate growth and healthy development.
Resiliency: help parents and children to build the skills they need to buffer stress. (E.g., mastery of a skill, being part of a community.) |
| what is perfusion dependent on? | blood volume, vascular resistance, and cardiac output |
| what are the assessments of hypertension? | Urinalysis - haematuria and proteinuria(protein in urine) – damage done to kidneys
Blood tests - creatinine and eGFR, electrolytes, HbA1c, lipid profile (aspects of cholesterol- high risk CD), BUN, FBC/CBC(aneamia) LFTs – chedk kidney function , electrolytes – kidney and cardiac dysfunction
Ophthalmoscopy examination of the fundus( structures of the eye – small vessels of eye damage or changes to vascular system of eye
An ECG (check overall function – ventricular hypertrophy
ambulatory monitoring |
| complications of hyperlipidemia? | Atherosclerosis – narrow and block arteries can cause thrombis/clot if rupture
Angina -
Myocardial Infarction
Stroke |
| angina is due to ? | transient myocardial ischaemia(lack of perfusion of heart disease |
| angina signs and symptoms? | Chest pain described as tight, dull, heavy or crushing
Pain may radiate to the arms, neck, jaw or back
Pain occurs during physical activity or emotional stress and relieved by rest
Patient may have associated breathlessness, nausea, dizziness |
| diagnosis of angina? | comprehensive history
ECG stress test
coronary angiogram
physical assessment of pain
blood tests |
| diagnosis of stemi MI? complete occlusion to coronary artery | Elevation of ST segment on ECG
Elevated Troponin T
- angina symptoms at rest |
| treatment for MI? | • GTN – begin with this – sparys SL
• Aspirin – antiplatelet – 300mg
• IV morphine
• Oxygen if Spo2 <93%ra – below 93 then should give – if pt is not short of breath don’t give it
• Fibrinolysis – used for stemi who cant make hospital within 90 mins. High risk |
| first line treatment for stroke? | Thrombolysis – within 3 hours of symptom onset = Ateplase |
| first line treatment for hemorrhagic stroke? | emergency surgery - clipping or coiling |
| diagnosis for hear failure? | ECG – LVH, LVF (ventricular hypertrophy, arrythmias (sensitive test
Chest X-ray – cardiomegaly, pulmonary oedema (fluid build up , size of heart,
Echocardiogram (gold standard for diagnosis) better quality – looks and quality of ventrcles
Blood Test - Brain Naturiectic Peptide (BNP) |
| treatment of SVT? | Valsalva maneuver
cardioversion = •Adenosine – IV – tramsient AV block – revert back to sinus rhythm
• Synchronised electrical cardioversion: defiblirater – deliver a shock back to normal heart rhythm |
| treatment of AF? | Treatment Aims:
Symptom management
Assessment and management of thromboembolic risk
Pharmacological Treatment:
Beta blockers
Calcium channel blockers (Verapamil or Diltiazem)
Digoxin
Amiodarone
Anticoagulant therapy (warfarin, dabigatran, clopidogrel, rivaroxaban, aspirin |
| nursing considerations for AF? | Early recognition of AF - Manually checking pulses for 1 minute over 50yrs old, monitor cardiac output, vital signs, LOC
Patient education - health literacy, barriers to managing condition, risk of bleeding(anticoagulants) sports, manage bleeding
Self-management plan – need to know what to do if symptoms arrise
Perioperative care for surgical interventions |
