Exam prep 2

Describe the external anatomy and protective structures of the spinal cord (include spinal nerves and nerve roots in your description)

The spinal cord is a cylindrical structure encased within the vertebral column and protected by the meninges, cerebrospinal fluid, and bone. It's encased in three meningeal layers (dura, arachnoid, and pia mater), with spinal nerves and nerve roots emerging from its sides. Spinal nerves, which are pairs connecting to the spinal cord segments, transmit signals throughout the body. 

Describe the internal anatomy of the spinal cord and the functions of gray and white matter.

The spinal cord's internal anatomy features gray matter centrally and white matter surrounding it. Gray matter, shaped like a "butterfly," contains cell bodies and dendrites, responsible for processing and integrating information. White matter, located externally, primarily consists of axons covered in myelin, facilitating rapid nerve signal transmission.
Sensory Processing:

Dorsal horns receive sensory input from the body. 

Motor Output:

Ventral horns contain motor neurons that project to muscles. 

Autonomic Control:

Lateral horns, present in the thoracic region, contain neurons involved in autonomic control. 

Map the main somatosensory pathways (include neurons, ascending spinal cord tracts and sensory information conducted in your answer).

Map the main somatic motor pathways (include neurons, descending spinal cord tracts and the skeletal muscles they innervate in your answer).

List health history questions relevant to a neurological assessment. 

To conduct a thorough neurological assessment, health history questions should focus on a patient's past and present neurological concerns, including symptoms, their characteristics, and potential triggers. Additionally, questions about family history, medications, and social history are important for a complete picture.

Outline how to assess the level of consciousness

To assess a patient's level of consciousness (LOC), healthcare professionals use a variety of methods, including the AVPU scale and the Glasgow Coma Scale (GCS). The AVPU scale provides a quick assessment of Alertness, Voice, Pain, and Unresponsiveness. The GCS offers a more detailed assessment, focusing on eye opening, verbal response, and motor response, providing a numerical score reflecting the patient's overall neurological status.

Summarise a pupillary assessment

A pupillary assessment involves evaluating the pupils, the openings in the centre of the iris, for size, shape, symmetry, and response to light. It's a key part of a neurological exam, especially in critically ill or unresponsive patients, as changes in pupil size and reactivity can indicate brain dysfunction.

Recall changes in physiological parameters associated with a neurological injury

Neurological injuries, particularly traumatic brain injuries, can lead to a range of physiological changes affecting memory, attention, and other cognitive functions. These changes can manifest as impaired memory, slowed processing speed, and behavioural alterations.

Identify the purpose and components of a FAST neurological assessment

The FAST (Facial Droop, Arm weakness, Speech difficulty, Time to call for help) assessment is a quick and simple way to identify potential stroke symptoms in an emergency situation. Its purpose is to enable early recognition of stroke signs and encourage prompt medical intervention, which can improve patient outcomes. The components of FAST are: Face (check for one-sided droop), Arms (test for weakness or numbness on one side), Speech (listen for slurred or strange speech), and Time (call 000 immediately).

Discuss the physiology and pathophysiology of pain

Pain, both physiologically and pathologically, is a complex experience involving nociception, which is the detection and transmission of potentially harmful stimuli. Nociception involves transduction, transmission, modulation, and perception of pain signals. Pathological pain, unlike physiological pain, often involves nerve damage or dysfunction, leading to pain in the absence of a stimulus or increased sensitivity to stimuli.

Discuss the assessment of pain in both nursing and midwifery contexts

Pain assessment in nursing involves a comprehensive evaluation of a patient's pain experience, encompassing the patient's verbal and nonverbal cues, as well as factors influencing their perception and coping mechanisms. This assessment guides appropriate pain management and ensures patient comfort and well-being.

List the divisions of the autonomic nervous system and their respective functions

The two divisions of the autonomic nervous system are the sympathetic division and the parasympathetic division. The sympathetic system is associated with the fight-or-flight response, and parasympathetic activity is referred to by the epithet of rest and digest.

Compare the organisation of the autonomic nervous system with that of the somatic nervous system

The autonomic nervous system (ANS) and somatic nervous system (SNS) are both part of the peripheral nervous system (PNS), but they differ in their organization and function. The SNS controls voluntary movements of skeletal muscles, while the ANS regulates involuntary functions like heart rate and digestion. The SNS uses a single motor neuron pathway, while the ANS uses a two-neuron pathway involving a synapse in a ganglion.

Compare sympathetic and parasympathetic motor neurons and map their pathways from the central nervous system to effector tissues

Sympathetic and parasympathetic neurons are part of the autonomic nervous system (ANS), controlling involuntary functions. Sympathetic neurons are associated with the "fight or flight" response, preparing the body for action, while parasympathetic neurons promote "rest and digest" activities, conserving energy. Both systems utilize a two-neuron chain: a preganglionic neuron originating in the CNS and a postganglionic neuron that innervates the effector tissue.

Identify the receptors that bind autonomic neurotransmitters (acetylcholine and noradrenalin) and explain how receptor binding mediates the differential effects of these neurotransmitters

Identify central neurotransmitters and their major effects

List all vital signs and when they should be assessed

Vital signs, including temperature, pulse, respiration, and blood pressure, should be assessed regularly to monitor a patient's overall health. They should be assessed on admission to a hospital, and then at least three times daily for patients without specific contraindications. Additional assessment may be required based on a patient's condition.

Summarise the physiology, determinants, normal ranges, changes in normal ranges, equipment and process for assessing vital signs

Vital signs (temperature, pulse, respiration, blood pressure, and oxygen saturation) reflect fundamental body functions and can indicate health status. Normal ranges vary based on factors like age, fitness, and overall health. Deviations from these ranges can signal medical issues or changes in a person's condition.

• Temperature: Oral or tympanic temperature typically ranges from 97.7°F to 99.1°F (36.5°C to 37.3°C), with an average of 98.6°F (37°C).

• Pulse: Adult pulse rate usually ranges from 60 to 100 beats per minute.

• Respiration: Adult respiratory rate generally ranges from 12 to 20 breaths per minute.

• Blood Pressure: Normal blood pressure in adults is between 90/60 mmHg and 120/80 mmHg.

• Oxygen Saturation: Normal oxygen saturation is typically 95% to 100%.

Discuss common alterations to blood pressure including hypertension, hypotension and postural hypotension

Hypertension (high blood pressure), hypotension (low blood pressure), and postural hypotension (orthostatic hypotension) are common alterations to blood pressure. Hypertension is a condition where blood pressure consistently exceeds the normal range, while hypotension is when blood pressure drops below the normal range. Postural hypotension is a specific type of low blood pressure that occurs when standing up after sitting or lying down.

Describe the process for assessing blood pressure including the Korotkoff sounds

To measure blood pressure using the auscultatory method, a blood pressure cuff and stethoscope are used to listen for Korotkoff sounds. The cuff is inflated to a point above the expected systolic pressure, and then slowly deflated while listening with the stethoscope. The systolic pressure is determined when the first distinct sound is heard, and the diastolic pressure is determined when the sounds completely disappear.

Describe the anatomy of the heart, including the coronary circulation

Atria:

The right atrium receives deoxygenated blood from the body via the superior and inferior vena cavae. The left atrium receives oxygenated blood from the lungs via the pulmonary veins.

Ventricles:

The right ventricle pumps deoxygenated blood to the lungs via the pulmonary artery. The left ventricle pumps oxygenated blood to the body via the aorta.

Heart Valves:

Tricuspid valve: Located between the right atrium and right ventricle.

Pulmonary valve: Located between the right ventricle and pulmonary artery.

Mitral valve (bicuspid valve): Located between the left atrium and left ventricle.

Aortic valve: Located between the left ventricle and aorta.

Coronary arteries:

The two main coronary arteries, the left and right, branch off from the aorta and supply blood to the heart muscle.

Left coronary artery:

Supplies the left side of the heart, including the left ventricle and left atrium. It further divides into the left anterior descending (LAD) artery and the circumflex artery.

Right coronary artery:

Supplies the right side of the heart, including the right ventricle and right atrium, according to Johns Hopkins Medicine.

Coronary veins:

Blood drains from the heart muscle through coronary veins, which eventually drain into the coronary sinus and then into the right atrium.

Coronary sinus:

A large venous structure located on the posterior aspect of the heart that receives the coronary veins.

Describe the unidirectional pathway of blood flow through the heart

The heart functions as a unidirectional pump, ensuring blood flows in one direction through its chambers and valves. This one-way flow is maintained by the heart's four valves, which open and close in synchronization with the heartbeats.

Describe and explain the events of the cardiac cycle

1. Atrial Diastole (relaxation):

All chambers are relaxed, and blood passively flows from the veins into the atria and then into the ventricles through the atrioventricular valves.

2. Atrial Systole (contraction):

The atria contract, pushing the remaining blood into the ventricles.

3. Isovolumetric Ventricular Contraction:

Ventricles contract, but no blood is ejected because the aortic and pulmonary valves are closed.

4. Ventricular Systole (contraction):

Ventricles contract, pushing blood into the aorta and pulmonary artery, forcing open the aortic and pulmonary valves.

5. Ventricular Diastole (relaxation):

Ventricles relax, and the aortic and pulmonary valves close to prevent backflow.

6. Isovolumetric Ventricular Relaxation:

Ventricles relax further, and the atrioventricular valves open, allowing blood to flow from the atria into the ventricles, restarting the cycle.

Examine the intrinsic and extrinsic innervation of the heart and explain their respective functions

The heart is innervated by both intrinsic and extrinsic nerve fibers, each playing a role in regulating cardiac function. The intrinsic nervous system, also known as the intrinsic cardiac nervous system (ICNS), consists of neurons and ganglia located within the heart itself, while the extrinsic innervation includes the autonomic nervous system (sympathetic and parasympathetic).

Define cardiac output and identify the factors that determine cardiac output

Cardiac output (CO) is the volume of blood pumped by the heart per minute. It's calculated by multiplying stroke volume (the amount of blood ejected per heartbeat) by heart rate (heartbeats per minute). The main factors influencing cardiac output are stroke volume, heart rate, preload, afterload, and contractility.

Discuss the components of a comprehensive cardiovascular health assessment

In essence, a comprehensive cardiovascular health assessment is a multifaceted approach to understanding and managing heart health. It involves a combination of patient information, physical examination, diagnostic testing, and a tailored management plan to address individual needs and reduce the risk of cardiovascular disease.

Locate anatomical landmarks in the thorax related to the cardiovascular system

In the thorax, anatomical landmarks associated with the cardiovascular system include the heart, great vessels, and related structures like the pericardium and mediastinum. The heart is located within the middle mediastinum, specifically between the lungs, and is encased by the pericardium. Key landmarks related to the heart include its four borders, valve locations, and the apex, which lies just to the left of the sternum between the fourth and fifth ribs.

Describe normal heart sounds and relate them to the corresponding events in the cardiac cycle

Normal heart sounds, "lub-dub," correspond to the closure of heart valves during the cardiac cycle. S1 (lub) is the sound of the atrioventricular valves (mitral and tricuspid) closing at the beginning of ventricular contraction (systole), while S2 (dub) is the sound of the semilunar valves (aortic and pulmonary) closing at the end of systole, marking the beginning of diastole.

Identify the anatomical location for auscultating heart sounds (S1, S2)

S1, caused by mitral and tricuspid valve closure, is best heard at the left 5th intercostal space at the midclavicular line (apex). S2, resulting from aortic and pulmonary valve closure, is typically heard in the 2nd left intercostal space near the sternal border (pulmonic valve) and 2nd right intercostal space (aortic valve).

Discuss common cardiovascular conditions including hypertension, angina, myocardial infarction, heart failure

Hypertension, angina, myocardial infarction, and heart failure are common cardiovascular conditions that affect the heart and blood vessels. Hypertension is high blood pressure, while angina is chest pain due to reduced blood flow to the heart. Myocardial infarction, or a heart attack, is a serious condition where the heart muscle is damaged due to a blocked artery. Heart failure occurs when the heart cannot pump blood effectively to meet the body's needs.

Describe 5 cardiovascular diagnostic tests

Five common cardiovascular diagnostic tests include: electrocardiogram (ECG), echocardiogram, stress test, coronary angiogram, and blood tests. These tests help doctors diagnose and monitor heart conditions.

Use a fluid balance chart to calculate fluid input, output and fluid balance

To use a fluid balance chart, accurately track fluid intake and output over a 24-hour period and then calculate the balance. Fluid input includes all fluids entering the body, while output includes all fluids leaving the body. The balance is calculated by subtracting total output from total input. 

Compare the structure of arteries, arterioles, capillaries, venules and veins, and relate the structure of each vessel type to its function

Arteries are thick-walled, round blood vessels transporting blood away from the heart under high pressure, while veins are thinner-walled, often flattened vessels returning blood to the heart under low pressure. Arterioles and venules are smaller versions of arteries and veins, respectively, connecting to capillary beds where exchange of substances with tissues occurs. Capillaries, the smallest vessels, have incredibly thin walls, allowing for diffusion of substances between blood and surrounding tissues

Define blood flow, blood pressure, and resistance, and explain the relationship between these factors

Blood flow, blood pressure, and resistance are interconnected cardiovascular factors. Blood flow is the movement of blood through the body, blood pressure is the force exerted by the blood against vessel walls, and resistance is the opposition to that flow. These factors are related because blood pressure drives blood flow, and resistance opposes that flow.

Explain systolic pressure, diastolic pressure, mean arterial pressure, and pulse pressure

Systolic and diastolic pressures represent the peaks and troughs of blood pressure within the arteries during the cardiac cycle. Mean arterial pressure (MAP) is the average pressure throughout the entire cycle, and pulse pressure is the difference between systolic and diastolic pressures.

List and explain the factors that influence blood pressure and describe how blood pressure is regulated

1. Vessel Length:

• As a vessel gets longer, the distance blood needs to travel increases, leading to greater friction and resistance.

• Increased resistance means the heart has to work harder to pump blood through the longer vessels, resulting in higher blood pressure. 

2. Vessel Diameter:

• Smaller vessel diameters increase resistance because there's less space for blood to flow, causing more friction against the vessel walls. 

• Conversely, larger diameters decrease resistance and blood pressure. 

• The body can regulate blood pressure by adjusting vessel diameter through vasoconstriction (narrowing) and vasodilation (widening). 

3. Blood Viscosity:

• Blood viscosity refers to its thickness, and higher viscosity means the blood is thicker and harder to pump. 

• Thicker blood increases resistance, requiring the heart to work harder and elevating blood pressure. 

• Factors like dehydration or increased red blood cell count (hematocrit) can increase blood viscosity. 

Explain the movement of fluid, respiratory gases and nutrients between capillaries, the tissues and back again

As it enters the capillaries, your blood makes contact with tissues and cells. It delivers oxygen and nutrients and removes carbon dioxide and waste. Now low in oxygen, the blood travels through the veins to return to your heart's right atrium, where the circuit starts all over again.

Locate clinically relevant blood vessels

Clinically relevant blood vessels are those whose health and function are crucial for overall well-being. These include major arteries like the aorta and its branches, as well as veins like the vena cava. Specifically, the heart, aorta, and its branches (like the coronary arteries), carotid arteries, and major veins (superior and inferior vena cava) are clinically important.

Identify the components of a respiratory assessment

A comprehensive respiratory assessment typically involves several key components: history taking, inspection, palpation, percussion, auscultation, and potentially, further investigations. This process helps clinicians evaluate a patient's respiratory status and identify any underlying issues.

Identify the landmarks of the chest for auscultating breath sounds

To identify landmarks for auscultating breath sounds, you'll be listening to specific areas of the chest to assess lung sounds. The key landmarks are the anterior, lateral, and posterior chest, with specific areas within these regions that correspond to lung lobes.

Identify normal and abnormal breath sounds

Normal breath sounds, or vesicular sounds, are soft, low-pitched, and primarily heard during inhalation. They are the sounds of air flowing smoothly through the airways. Abnormal breath sounds, also called adventitious breath sounds, can be crackles, wheezes, rhonchi, stridor, or pleural rub, and they indicate potential issues in the lungs or airways.

Describe pulmonary disorders (obstructive and restrictive)

Obstructive diseases make it difficult to exhale, often due to airway narrowing or obstruction. Restrictive diseases limit the lungs' ability to expand fully, reducing their capacity to take in air.

Define the terms: tachypnoea, bradypnoea, dyspnoea, orthopnoea, peripheral cyanosis, central cyanosis, hypoxia and hypoxaemia

• Tachypnoea: Rapid breathing, an abnormally high respiratory rate. It's often shallow. 

• Bradypnoea: Slow breathing, an abnormally low respiratory rate. 

• Dyspnoea: Shortness of breath or difficulty breathing, a subjective sensation of air hunger. 

• Orthopnoea: Difficulty breathing when lying down, which is relieved by sitting up or standing. 

• Peripheral cyanosis: A bluish discoloration of the extremities, particularly the fingers and toes, due to a lack of oxygen in the blood. 

• Central cyanosis: A bluish discoloration of the skin and mucous membranes, usually the face and trunk, due to a lack of oxygen in the blood. 

• Hypoxia: A deficiency of oxygen in the tissues. 

• Hypoxaemia: A deficiency of oxygen in the blood. 

Identify how to administer supplemental oxygen using various devices; including nursing care

1. Nasal Cannula:

• Description: A device that delivers oxygen through two prongs inserted into the nostrils. 

• Flow Rate: Typically 1-6 liters per minute. 

2. Simple Mask:

• Description: A mask that covers the mouth and nose, delivering a higher concentration of oxygen than a nasal cannula. 

• Flow Rate: Typically 5-10 liters per minute. 

3. Non-Rebreather Mask:

• Description: A mask with a reservoir bag that delivers a higher concentration of oxygen than a simple mask. 

• Flow Rate: Typically 10-15 liters per minute. 

Describe the role of chest physiotherapy to maintain adequate oxygenation

Chest physiotherapy plays a crucial role in maintaining adequate oxygenation by improving lung function and facilitating the removal of secretions from the airways. Techniques like percussion, vibration, and postural drainage help loosen mucus, making it easier to expel and improving airflow, ultimately enhancing gas exchange.

Describe the process for performing airway suctioning including risks and nursing and midwifery management

Airway suctioning removes secretions to maintain a clear airway and improve oxygenation. It involves using a suction catheter to remove mucus, blood, or other material from the mouth, nose, or tracheostomy. Proper suctioning requires careful equipment selection, preparation, and procedure execution to minimize risks like hypoxemia and infection.

Describe the components of the respiratory system and relate their structures to their functions

The respiratory system's components, including the nose, mouth, pharynx, larynx, trachea, bronchi, and lungs, are intricately linked to their functions of gas exchange and air conduction. Structures like the nasal cavity and bronchioles, along with the lungs' alveoli, are specifically adapted to facilitate oxygen intake and carbon dioxide expulsion. 

Outline the mechanics of pulmonary ventilation

Pulmonary ventilation, or breathing, involves air moving into and out of the lungs due to pressure differences. Inspiration (inhalation) occurs when the diaphragm and intercostal muscles contract, expanding the chest cavity, decreasing intrapulmonary pressure, and drawing air into the lungs. Expiration (exhalation) is the reverse process, with muscles relaxing, the chest cavity shrinking, increasing intrapulmonary pressure, and forcing air out. 

Describe the factors the influence gas flow/ventilation and describe the disorders that arise when gas flow is impaired

Gas flow and ventilation are influenced by lung compliance, airway resistance, and the force of breathing muscles. Impaired gas flow can lead to various disorders like hypoventilation, ventilation-perfusion (V/Q) mismatch, and right-to-left shunting, resulting in hypoxemia (low blood oxygen) or hypercapnia (high blood CO2).

Describe gas exchange in the lungs and tissues; and how oxygen and carbon dioxide are transported in the blood

Gas exchange, the process of oxygenating the blood and removing carbon dioxide, occurs in the lungs and tissues via diffusion. In the lungs, oxygen moves from the air sacs (alveoli) to the blood, while carbon dioxide moves from the blood to the alveoli. In tissues, oxygen diffuses from the blood to the cells, and carbon dioxide diffuses from the cells to the blood. Oxygen is transported in the blood primarily bound to hemoglobin in red blood cells, while carbon dioxide is transported in several ways, including bound to hemoglobin, dissolved in the plasma, and as bicarbonate ions

Outline the mechanisms that control respiration

Respiration, or breathing, is controlled by a complex interplay of muscles, nerves, and brain centers. Key mechanisms include the respiratory muscles, the nervous system, and the respiratory centers in the brainstem. These work together to ensure sufficient oxygen intake and carbon dioxide removal.

Describe the Australian medication scheduling system including the storage and disposal of medications

The Australian medication scheduling system classifies medicines and poisons based on their risk to public health, influencing how they are sold, stored, and disposed of. The system, known as "scheduling," utilizes ten schedules, with lower-risk medicines generally having fewer restrictions and being available without a prescription. Safe storage and disposal practices are crucial for all scheduled medicines and poisons.

Define relevant terms related to medication administration

Discuss the 8 Rights of medication administration and the role of the nurse and midwife in this process

right patient, right medication, right dose, right route, right time, right documentation, right reason, and right response.

Identify the types and components of a valid medication order

Name of the drug (generic), strength, dose, frequency (including admin time) and route. Patient's name and medical record number in the doctor's own handwriting, with the exception of an approved electronic prescribing tool.

Describe the appropriate response and follow-up to a medication error

• maintain the patients safety.

• inform the appropriate prescriber and seek advice on any action required.

• review the patient's care plan in light of any advice given.

• report the error to the service manager or modern matron.

Use a medication calculation formula to calculate oral medication dosages

Briefly describe the various sources of drugs and how drugs are named

Drugs can originate from various sources, including natural substances like plants and animals, as well as being synthesized in labs.

List the various routes of drug administration and describe the advantages and disadvantages of each

• Intravenous Route.

• Intramuscular Route.

• Subcutaneous Route.

• Rectal Route.

• Vaginal Route.

• Inhaled Route.

Describe pharmacokinetics, including: absorption, distribution, metabolism, excretion, first-pass metabolism, bioavailability

Absorption: Describes how the drug moves from the site of administration to the site of action.

Distribution: Describes the journey of the drug through the bloodstream to various tissues of the body.

Metabolism: Describes the process that breaks down the drug.

Excretion: Describes the removal of the drug from the body.

First- pass metabolism: First-pass effect decreases the active drug's concentration upon reaching systemic circulation or its site of action.

Bioavailability: Bioavailability refers to the extent and rate at which the active moiety (drug or metabolite) enters the systemic circulation, thereby accessing the site of action.

Describe what is meant by the therapeutic range and half life of a drug and why these factors are important in a dosage regime

The therapeutic range of a drug is the dosage range or blood plasma or serum concentration usually expected to achieve the desired therapeutic effect. The half-life of a drug is the time it takes for the amount of a drug's active substance in your body to reduce by half.

Describe pharmacodynamics and list the 4 protein targets (carrier proteins, enzymes, ion channels and receptors) of drugs

Pharmacodynamics refers to the effects of drugs in the body and the mechanism of their action. As a drug travels through the bloodstream, it exhibits a unique affinity for a drug-receptor site, meaning how strongly it binds to the site.

Briefly outline what is meant by adverse drug reactions, drug interactions, hypersensitivity, contraindications and drug transfer

Adverse drug reactions (ADRs) encompass unwanted and harmful effects of drug therapy, including side effects, interactions, and hypersensitivity reactions. Drug interactions occur when one drug alters the effect of another, while hypersensitivity reactions (allergies) are immune-mediated responses that can be unpredictable and severe. Contraindications are specific situations or conditions where a drug should not be used due to the potential for harm. Drug transfer, also known as drug interactions, can occur across different body compartments or between different patients, especially in cases of drug-induced diseases.