| Explain how the stress response alters glucose metabolisn | Stress triggers the release of catabolic hormones: adrenaline, noradrenaline, glucagon and cortisol. Adrenaline, glucagon and noradrenaline all work synergistically to promote glycogenolysis in the liver, which increases BGL. Cortisol promotes gluconeogenesis, lipolysis, and increases insulin resistance leading to a decrease in cellular uptake of glucose. As a result of all these physiologic changes, the patient may become hyperglycaemic. |
| What is an APTT test? | The activated partial thromboplastin time. It is used to measure the effect of heparin. |
| What is an INR test? | The international normalised ratio, which measures the prothrombin time. It is used to measure the effect of warfarin. |
| What is the target INR for warfarin? | 2-3 |
| What is the target APTT for heparin? | 50-90 seconds |
| What class of drug is dalteparin (Fragmin)? | It is a LWMH |
| What class of drug is enoxaparin (clexane)? | It is a LMWH |
| What class of drug is warfarin (coumadin)? | It is a vitamin K antagonist (anticoagulant) |
| What class of drug do argatroban, bivalirudin (angiomax) and dabigatran (pradaxa) belong to? | They are direct thrombin inhibitors (anticoagulants) |
| What class of drug do apixaban and rivaroxaban belong to? | They are factor xa inhibitors (anticoagulants) |
| What is the antidote for heparin? What is the mechanism, preparation and contraindications | Protamine sulfate. Mechanism: binds to heparin and renders the molecule inert. Preparation: slow IV injection within 3 hours of heparin injection. Contraindications: allergies to protamine or fish. |
| Which has the greater therapeutic index: UFH or LMWH? | LMWH |
| What is the mechanism of warfarin? | Blocks conversion of inactive vitamin K so that clotting factors II, VII, IX and X are not produced in the liver |
| How do you wean a patient off heparin? | Commence on warfarin (coumadin), overlap with heparin for 48 hours before ceasing heparin. |
| What is the mechanism and preparation of UFH? | Mechanism: inhibits factor Xa and thrombin IIa. Given SC or IV but never IM. |
| Why can't you give heparin IM? | There is a significant risk of intramuscular haematoma if given IM. |
| What is the antidote for dagibatran (pradaxa)? What is the mechanism and preparation for this antidote? | Idarucizumab (praxbind). Mechanism: inhibits thrombin. Preparation given IV. |
| Name two antifibrinolytic agents and some common indications for use. | Aminocaproic acid and Tranexamic acid, indicated in preventing blood loss for trauma, epistaxis, surgery and PPH. |
| What is the antidote for warfarin (coumadin)? | Vitamin K |
| What is the effect of St Johns Wort on heparin? | St Johns Wort increases the bleeding effect of warfarin |
| What is involved in an ERAS protocol? | Early enteral feedings, encouraging early ambulation, use of opioid-sparing analgesia, a laproscopic approach to colorectal surgery, aggressive management of PONV, use of prophylactic ABs |
| What is involved in the nursing management of surgical drains? | Measure the output on a FBC, noting the amount, colour and consistency; inspect surrounding skin for signs of infection or excoriation; ensure drain is on the correct suction and that the catheter is patent; report the presence of excessive drainage or unusual clotting to the doctor; change the dressing around the insertion site as required using aseptic technique; remove drain once approved by RMO. |
| What are normal Hb values for the adult male and female? | Male: 140-160g/L; Female: 120-140g/L |
| What blood type is known as the universal donor? | Blood type O |
| What blood type is known as the universal recipient? | Blood type AB |
| What is involved in nursing management of the Pt receiving a blood transfusion? | Check the packed cell order and bag according to the 6 rights; ensure IV access via a large bore catheter (e.g.18G in a cubital vein); flush the line to ensure patent; only administer the blood product using an approved giving set (i.e. one that has a filter that will remove any unwanted clots); record baseline VS; continuously monitor patient for first 15 minutes of infusion for any potential anaphylactic reactions; repeat and record vital signs every 15 minutes until the infusion is complete. |
| What should the nurse do if the Pt has a reaction to a blood tranfusion? | Immediately stop the transfusion and change the line; send the entire bag to the laboratory for investigation; flush line with normal saline TKVO; notify the nurse in charge and doctor ASAP; collect venous blood sample for sepsis screen; collect urine sample to Ax for haemolytic reacions; complete a full riskman / incident report |
| What are the stages of haemostasis in order? | 1. vascular phase; 2. platelet phase (ie primary haemostasis); 3. coagulation phase (ie secondary haemostasis); 4. clot resolution; 5. fibrinolysis |
| What are the nursing priorities for a Pt in fluid overload in order? | 1. administer O2 via N.C. titrated to SpO2 >96%; 2. sit Pt upright in high fowler's; 3. administer diuretics; 4. commence strict FBC; 5. repeat full set of VS and respiratory Ax; 6. manage cause |
| Fine crckles vs coarse crackles | Fine crackles suggest fluid in the small airways & alveloli such as in APO, pneumonia. Coarse crackles suggest fluid in the larger bronchioles such as in bronchitis, infective COPD. |
| Bilateral crackles vs coarse crackles | Bilateral crackles suggest cardiogenic APO. Unilateral crackles suggest atelactasis. |
| Nursing goals for Pt in respiratory distress | RR 12-20; lungs clear to auscultation; pH 7.35-7.45; paO2 80-100mmHg; PaCO2 35-45mmHg; O2 >96%; Pt has a calm affect |
| What obs do you do on a Pt with a PCA every hour? | RR, SpO2, sedation score, PCA attempts, bolus dose given in last hour and the progressive total dose |
| Indications for rapid response / MET call for a Pt on a PCA? | Respiratory rate less than 5 and/or sedation score of 3 |
| What class of drugs are furosemide and bumetanide? | They are loop diuretics |
| What class of drugs are hydrochlorothiazide and chlorothiazide? | They are thiazide diuretics |
| What class of drug is spironolactone (aldactone)? | It is a potassium sparing diuretic |
| What is first spacing? | It is the normal distribution of fluid in the ICF and ECF |
| What is second spacing? | It is the abnormal accuulation of interstitial fluid, i.e. oedema |
| What is third spacing? | it is excess fluid accumulation in the nonfunctional area between cells. Fluid is trapped where it is difficult to move back into the cells or blood vessels such as in ascites, or oedema assciated with burns, trauma and sepsis. |
| What is normal urine specific gravity? | 1.005 - 1.030 |
| What is normal serum sodium level? | 135-145mmol/L |
| What s normal potassium level? | 3.5-5.0mmol/L |
| What is normal calcium level? | 2.1-2.6mmol/L |
| What is the other name for antidiuretic hormone? Where is it produced? | Vasopressin. Produced in the hypothalamus & stored in the pituitary gland. |
| What does the hormone ADH do? | Increase vascoconstriction and H2O reabsorption |
| What does the hormone aldosterone do? | Increase Na reabsorption (which increases H2O reabsorption by osmosis). Produced by adrenal cortex. |
| What does atrial natriuretic peptide do? Where is it produced? | Causes vasodilation and excretion of sodium and H2O. Produced by the heart. |
| Nursing priorities for patients on TPN? | Facilitate: EUCs measured daily, LFTs measured weekly; BGL measured every 6/24; daily weighs |
| What is the part of the brain that is responsible for the initiation of vomiting? | The medulla |
| What is the part of the brain that is responsible for relaying information to the vomiting centre? | The chemoreceptor trigger zone |
| What are some sympathetic changes associated with vomiting? | Tachycardia, tachypnoea, increased sweating |
| Why are NSAIDs best taken with food? | NSAIDs block prostaglandins in the stomach, which lead to an increase in production of gastric acid. If there is no food in the stomach, this can lead to gastric ulcers and bleeding. |
| Paracetamol: adverse effects | gastric upset, skin rash, itching. OD can lead to hepatotoxicity. |
| Paracetamol: containdications | Pt has already taken paracetamol in the last 6 hours or exceeding daily limit (4g); known hypersensitivity to paracetamol; abnormal liver function |
| What class of drugs are ibuprofen (nurofen, advil); diclofenac (voltaren) and celecoxib (celebrex)? | NSAIDs |
| Ibuprofen: adverse effects | Increases risk of MI & CVA; GI upset (ulcer / bleeding); tinnitus; bronchoconstriction; renal failure |
| Aspirin: adverse effects | Gastric irritation / ulcer; bronchoconstriction; renal failure (long-term, high dose); tinnitus (sign of OD); Rey's syndrome (swelling of liver and brain |
| General adverse effects associated with opioids | respiratory depression, bradycardia, euphoria, sedation, pupil constriction, constipation, pruritus (itching), depressed cough reflex, bronchoconstriction & hypotension r/t histamine release |
| Morphine: drug interactions | Alcohol & other depressants; opioid antagonists (e.g. Naloxone); MAOIs with pethidine (can cause serotonin syndrome) |
| Morphine: contraindications & cautions | Head injury, respiratory depression, alcoholism |
| Tramadol: adverse effects | Nausea, seizures (caution in epilepsy) |
| Codeine: uses | Analgesia, cough suppressant, anti-diarrhoeal |
| Codeine: adverse effects | Constipation, addiction, respiratory depression |
| Naloxone: cautions | Will reverse the effects of morphine including analgesia; half-life shorter than morphine so monitor for signs of re-sedation |
| Nursing management of Pt with nausea and vomiting | Place pt in high-folwer's to reduce aspiration risk; provide emesis bag; remove any noxious stimuli (e.g. bed pans); administer anti-emetics, reduce oral intake until nausea is controlled (sips of water or ice chips for comfort only); for Pts with NGT - aspirate tube; listen for bowel sounds and check abdomen for distension (paralytic ileus?); check BGL as dysglycaemia can cause nausea |
| What class of drug is prochlorperazine (stemetil)? | Dopamine antagonist |
| Prochlorperazine: adverse fx | constipation, dry mouth, sleepiness, dizziness, blurred vision, extrapyramidal side effects (tremor, dystonia) |
| Metaclopramide: adverse fx | diarrhoea, sleepiness, restlessness, EPSEs, hypotension |
| What class of drug is metaclopramide (maxalon)? | Dopamine antagonist (i.e. BLOCKS dopamine) |
| Ondansetron: adverse fx | constipation, headache, anxiety, dizziness, reduces effectiveness of tramadol if given together |
| What class of drug is ondansetron (zofran)? | 5-HT3 receptor antagonist |
| What class of drug is hysocine hydrobromide (Kwells)? | Anticholinergic |
| What class of drug is hysocine butylbromide (Buscopan)? | Anticholinergic |
| What is the indication for Kwells? | Motion sickness - blocks ACh receptors in vestibular apparatus which decreases vagal stimulation of the medulla |
| What is the indication for Buscopan? | Abdominal cramps - blocks ACh receptors in smooth muscle of GI tract which reduces spasms |
| What class of drug is promethazine (phenergen)? | Antihistamine |
| What is the indication for promethazine (phenergen)? | N&V associated with inner ear disturbances |
| Promethazine: adverse reactions | drowsiness |
| Name five classes of antimicrobial drugs | Antivirals, antibiotics, antifungals antiprotozoals, antihelminthics (for worms) |
| General adverse reactions for most antimicorbials | Diarrohoa, nausea, vomiting, skin rashes, gives, pruritus, thrush, anaphylaxis, nephrotoxicity |
| Define bactericidal | The drug kills the organism |
| Define bacteriostatic | The drug inhibits the growth of the organism |
| Features of a gram positive organism | Have no outer lipid membrane, appears blue upon staining |
| Features of a gram negative organism | Have an outer lipid membrane, do not stain with blue dye |
| Features of eukaryotes (human cells) | have nucleus and a cell membrane but no cell wall |
| Features of prokaryotes (bacteria) | Do not have a nucleus. Has a cell wall and a cell membrane. |
| Antibiotic vs antibacterial | Antibiotic = substance produced by micro-organisms that inhibits other micro-organisms. Antibacterial = a chemically modified antibiotic or a synthetic drug. |
| Stages of wound healing | 1. Inflammation; 2. Proliferation / epithelialisation / organisation; 3. Regeneration / fibrosis |
| Primary intention healing is... | Closure by a surgical suture / staple. Edges are well approximated. |
| Secondary intention healing is... | Spontaneous healing - the edges aren't approximated. Healing occurs from the base upwards. |
| Tertiary intention healing is... | When the wound is purposefully left open to allow for oedema or infection to resolve, before being closed up by sutures, stapes or adhesive skin closures. Also called "delayed primary closure." |
| What is the nurse's role in preventing antibiotic resistance? | Know the indications for the AB (judicious use); participate in audits; Provide pharmacoeducation to ensure that the Pt and family know how to use the AB correctly according to prescriber's instructions; participate in audits; recognise the causes of AB resistance and take measures to prevent it (e.g. careful preparation of IV drugs); facilitate wound culture testing as required |
| What is a normal paediatric early warning score? | <2 |
| T or F: A four year old's trachea is shorter than an adults? | True |
| When measuring blood pressure in young children, the nurse should ensure that the cuff covers | Two thirds of the upper arm |
| The apex of the heart in a child is located... | in the 4th intercostal space, left of the mid-clavicular line |
| Developmental assessment covers a number of areas, which include...? | fine motor, gross motor, psychosocial, cognitive |
| Centile (percentile) charts are used to indicate trends of weight and height as well as which of the following growth indicators? | Head circumference (measured up to age 2) and BMI |
| Key differences between the paediatric and the adult respiratory system include... | Children's upper airways are: shorter & narrower; they have a small oral cavity with a relatively larger tongue; they have a long floppy epiglottis which is prone to swelling - meaning children air prone to airway obstruction. The bifurcation of the trachea is higher in children and a more acute angle into R&L bronchi - means it is easier for infection to enter the lungs |
| At what age does the GFR in children reach adult values? | By 2 years of age |
| When do children gain bladder control? | By about age 4 |
| What complications might arise as a result of children's kidney's being less mature? | Decreased urinary excretion of drugs = increased risk for drug toxicity. Reduced ability to regulate electrolytes = prone to dehydration and fluid overload. Decreased excretion of H+ and sodium bicarb levels are lower = increased risk for acidosis. |
| T or F: The CV system in children is proportionately larger? | True |
| What is a normal SpO2 reading in children? | 95-98% on RA. It is not necessary to oxygenate children to 100%. |
| T or F: SaO2 readings may indicate early earning signs of hypoxia before cyanosis is seen? | True |
| What is the most likely cause of cardiac arrest in a child? | Prolonged hypoxia / respiratory issues as children tend to have fairly efficient CV systems. |
| Normal paediatric HR values? | Neonates: 100-160; Infants: 90-120; Age 2-5: 95-140; Age 5-12: 80-120; Age12+: 80-100 |
| Normal paediatric SBP values? | Neonates: 60-90; Infants: 80-100; Age 2-5: 80-120; Age 5-12: 90-110; Age12+: 100-120 |
| Normal paediatric RR values? | Neonates: 30-60; Infants: 30-40; Age 2-5: 20-30; Age 5-12: 15-20; Age12+: 12-15 |
| Normal paediatric BV values (ml/kg)? | Neonates: 90; Infants: 80; Age 2-5: 80; Age 5-12: 80; Age12+: 70 |
| Nursing interventions for pain post tonsillectomy? | Apply ice collar around neck if tolerated; give paracetamol via oral liquid; give cold ice block |
| Definitions for paediatric patients | Neonate: birth to 1 month; Infant: 1 month to 1 year; Toddler: 1-3 years; Pre-schooler: 3-5 years; School age: 5-12 years; Adolescence: 12-18 years |
| Indication for a tonsillectomy and adeniodectomy? | Pt has had tonsilitis 7 or more times in a year |
| When can you cease clear fluids before surgery? | 2 hours minimum |
| What are Freud's psychosocial stages of development? | Infancy: Oral; 1-2 yrs: Anal; 3-5 yrs: Phallic; 6-12 years: Latency; 12+ years: Genital |
| What are Erikson's psychosocial stages of development? | Infancy: trust vs mistrust; 1-2 yrs: autonomy vs shame/doubt; 3-5 yrs: initiative vs guilt; 6-12 yrs: industry vs inferiority; 12+ years: identity vs role confusion |
| What are Piaget's cognitive stages of development? | Birth-2 yrs: sensorimotor; 2-7 yrs: preoperational; 7-11 yrs: concrete operational; 12+ years: formal operational |
