Miscellaneous Knowledge

When to give oxygen therapy?

• When sats are below 92%

• Wean off when sats are above 94%

What is the purpose of oxygen therapy

• relieve hypoxemia

• maintain oxygenation to tissues and organs

Nasal cannula considerations

upto 4L/min

High flow nasal cannula considerations

• 15-60L/min

• Provides continous pressure and flow rate can be changed

Simple mask considerations

5-10L/min

Non-rebreather mask considerations

• 10-15L/min

• has reservoir bag that also contains O2

CPAP mask considerations

• continous airway pressure

• Keeps airway open

Venturi mask considerations

• 3-10L/min

• Contains air + O2

• Different coloured valves allow different flow rate and FiO2

What is FiO2

Fraction of inspired oxygen

• RA is 21%

Cancer

A group of diseases characterised by abnormal and unregulated cell growth

Cancer pathology

1. Unwanted cell proliferation: cancer cells don’t respond to normal signals to stop/reduce growth

2. Control of growth signals: cancer cells secrete their own growth signals and/or upregulate growth factor receptors

3. Disables cellular apoptosis: Cancer cells don’t undergo normal self-destruction

4. Restoration of telomeres: normal cells aging leads to progressive shortening of telomeres and cell death, Restoration of telomeres allows cancer cells to divide indefinitly

Malignant tumour chracteristics

• cancerous cells

• rapid, unregulated growth

• lack of cellular differentiation

• absence of normal tissue organisation

• metastisize

General cancer symptoms

• Fatigue

• Pain

• weight loss

• Systematic symptoms from location

Cancer treatments

1. Surgery

2. Radiation

3. Immunotherapy

4. Hormone therapy

5. Chemotherapy

Radiation therapy

ionising radiation destroys DNA and cells, but damage can occur to non cancerous cells.

Radiation therapy side effects

• Redness in skin

• hair loss

• nausea

• vomitting

• fatigue

• reduced blood cell count

Immunotherapy

Manipulation of immune system to stimulate action against cancer cells

Hormone therapy

Inhibits hormone production for hormone dependent cancers e.f. reproductive cancers

Chemotherapy

Use of non-selective cytotoxic drugs to target vital cellular/metabolism processes essential to cell growth/replication. Given in cycles to allow non-cancerous cells recovery time.

Chemotherapy side effects

• fatigue

• nausea

• vomitting

• hair loss

• infertility/sterility

• growth suppression

• impaired wound healing

• reduced blood cell numbers

Complications from treatment

1. immunosuppression

2. Neutropenia

Immunosuppression

When treatment destroys white blood cells increasing risk of infection and resulting in poor wound healing

Neutropenia

Suppression of bone marrow resulting in reduced neutrophil production from chemo drugs. Infections may progressive rapidly without early symptoms, so protective isolation is important.

Febrile neutropenia

medical emergency

Pre-operative considerations

• Medical history

• Medications

• Alcohol/drug intake

• Allergies

• Last food/fluid intake

• metal/surgical inplants

• surgical consent

• Physical prep e.g. bowel prep

Intraoperative considerations

• Safety checklist: Sign in, time out, sign out

• Surgical counts

• Pressure injury assessments

• Local, GA, Sedation, regional e.g. epidural

Side effects of anaethesia

• Memory loss

• confusion

• difficulty passing urine

• N+V

Post-operative considerations

• Level of consciousness

• airway

• vitals

• respiratory status

• pain

Post-operative complications

Hemorrage / hypovolemic shock

• Caused by loss of blood, where HR and vasoconstriction increase to maintain blood pressure

Signs and symptoms of hemorrage/hypovolemic shock

• increased HR

• tachyapnoea

• Decreased BP

• Prolonged cap refill

• Pallor

• oliguria

Treatment for hemorrage / hypovolemic shock

• IV fluids

• Maintain airway

• Control hemorrage

• Oxygen

• Blood transfusion

Components of blood

• Red cells

• Plasma

• Platelets

Why give red cells

• correct anaemia

• Tissue oxygenation

Why give plasma

• Restore hemostasis / blood volume

Why give platelets

• Help clotting through platelet plug/fibrin net

Considerations for giving blood to patients

• valid group and screen

• Prescription

• Informed consent

• Vasuclar access

• Documentation

• 2 RN with seperate checks

• Positive ID (NHI, DOB, full name)

Adverse effects of blood transfusion

• Febrile non-hemolytic transfusion reaction (Temp > 38C)

• Minor allergic reaction

• Moderate allergic reaction

• Anaphylaxis

• Hypotensive reaction (Systolic BP <80 or falls >30)

• Acute hemolytic transfusion reaction (N+V, tachycardia, fever, chills, pain, hypotension)

• Delayed hemolytic transfusion reaction (worsening anaemia, renal failure, hemoglobinuria)

Blood transfusion observations

• Baseline obs

• Full set of Obs at 15 mins (remain in the room)

• Every 60 minutes

• After each unit

Blood transfusion timeframes

• Four hours from issue

ECG placement

V1/V2 = fourth intercostal space

V3 = in between V2/V4

V4 = Nipple line

V5/V6 = same intercostal space as V4

Resuscitation considerations

• Compression-to-ventilation ratio be 30:2 for all ages.

• Chest compressions should be provided at a rate of approximately 100 – 120 /min

• DRSABCD

NZ Resuscitation guidlines

Resuscitation drugs

Shockable drugs

• Adrenaline: 1mg after 2nd shock, then every second loop

• Amiodorone: 300mg after 3rd shock

Non-shockable drugs

• Adrenaline: 1mg immediatly, then every second loop

Pandemic

Exponential disease growth affecting several countries and populations

Epidemic

An unexpected increase in disease specific to a geographical area

What diseases are notifiable

• Measles

• Rubella

• Salmonella

• Campylobacter

• Crytosporidium

• Hepatitis A

• Giardia

• E. coli

• Shigella

• Streptococcal

• Pertussis

What is a notifiable disease

Diseases that are notifiable to the Medical Officer of Health to enable prevention and control. The primary purpose of notification is to enable public health officials to respond quickly and effectively to potential outbreaks, epidemics, and other public health emergencies. 

Who must notify about notifiable diseases

• Health practitioners

• Laboratories

• School principals and childcare centres (in outbreaks)

• Employers (for work-related infectious diseases)

Notifications are made directly to Public Health Units (PHUs) — part of Te Whatu Ora | Health New Zealand.

What are nursing responsibilities in relation to notifiable diseases

• Legal Duty

  • Know which conditions are notifiable.

  • Notify immediately if required (some diseases are urgent, e.g. meningitis, measles).

  • Understand regional PHU protocols.

• Infection Control

  • Implement standard, contact, droplet, or airborne precautions.

  • Use PPE and environmental cleaning practices.

• Patient Communication

  • Inform the patient of their diagnosis with empathy.

  • Educate about preventing transmission.

• Public Health Collaboration

  • Work with PHUs for:

    • Contact tracing

    • Mass immunisation

    • Quarantine or isolation advice

    • Community outbreak response

• Documentation

Key notifiable disease issues

• Underreporting (especially in rural or Māori communities)

• Late notifications delaying outbreak response

• Misinformation or stigma reducing patient disclosure

• Workforce strain during outbreaks (e.g., RSV, norovirus, COVID-19 surges)

Five moments of hand hygiene

• Before touching a patient

• -  Before a procedure

• -  After a procedure or blood/fluid exposure risk

• -  After touching a patient

• -  After touching a patient’s surroundings

Contact precautions

• MDRO, diarrhea

  • -  Risk in direct contact and indirect contact

  • -  Standard precautions and use of PPE

Droplet precautions

• Influenza, RSV

• Risk in coughing, sneezing, or talking

• Used when there is spread through close respiratory or mucus membrane

  contact

• Use of PPE

Airborne precautions

Covid-19, TB

- Risk in droplets or particles suspended in the air

- UseofPPE+N95

Complex precautions

Used when there is more than one mode of transmission e.g. droplet and contact, norovirus

Types of MDRO

MRSA(methicillin-resistantstaphylococcusaureus) § ESBL(extendedspectrumbetalactamase)
VRE(vancomycin-resistantenterococcus)
CPO(carbapenemase-producingorganisms)

Donning PPE

Gown, Mask, Goggles, Gloves

Doffing PPE

Gloves, Gown, Goggles, Mask

Palliative care

Holisitic, person-centred care that aim to not hasten or postpone death but improve quality of life for termianlly ill patients

Considerations when talking to bereaved family

• facilitate open, honest conversations

• Create opportunities for familial input

• Assess level of understanding and amount of knowledge wanted

• Provide options for ongoing care/support

• Support through legal processes

• Ensure awareness of after death processes e.g. funeral arrangements

Euthanasia

Deliberately bringing about the death of a person to end what is considered an intolerable existence

Key considerations for euthanasia

• A health practitioner cannot raise discussion around ‘assisted dying’

• Must determine competence to make an informed decision and can communicate that decision in some way

• A person can change their mind at any time

• Must encourage discussion with family, friends and counsellors

• Must ensure decision is free from pressure

Eligibility criteria for euthanasia

• over 18

• NZ permanent resident or citizen

• Suffering from terminal illness likely to end life in 6 months

• advanced state of irreversible decline

• experiencing unbearable suffering

• competent to make informed decision

Spirituality

The spiritual essense of a person is their life force. It determines who we are, where we come from and where we are going

Grief

the emotional reaction to loss

Types of grief

• Anticipatory grief

• Complicatred grief

• Disenfranchised grief / ambiguous loss

• Delayed grief

Youth sexual health risk factors

• Poor knowledge

• Psychosocial maturity

• Embarrassment recieving sexual health advice

• Lack of easy access to care

What is PRIME nursing

Emergency ‘24hr’ on call practitioner in rural areas (Primary Response in Medical Emergencies)

What is rural nursing

an area of nursing where nurses look after residents of rural communities across the lifespan and respond to a range of health needs through a broad scope of practice

Health outcomes for rural people

• Poorer health outcomes

• Lower life expectancy

• mental health challenges

• Poorer access to health and support services

Service accessiblity issues in rural areas

• Geographic factors: distance, weather

• Inconsistent data coverage: impacting telehealth

• Challenges attracting and maintaining staff (distance to work, hours, lack of cover)

• Inequities between access to primary, secondary and tertiary healthcare because of less local options

• Taking time off to attend appointments becayse of service hours

Airway issues and considerations in an emergency

• Recognise signs and symptoms of airway compromise e.g. cyanosis

• Clear obstructions e.g. suctioning, back blows, chest thrusts

• Secure airway e.g. head tilt, jaw thrust (Infant head should be kept neutral)

• Provide ventilatory support e.g. oxygen therapy

• Monitor vitals

Chocking ANZCOR guidelines

Assess effectiveness of cough

1. effective cough = mild airway obstruction

2. ineffective cough = severe airway obstruction

Mild airway obstruction interventions

• Encourage coughing

• consistent checks

• Send for help

Severe airway obstruction interventions

1. if responsive:

   • send for help

   • 5x back blows, 5x chest thrusts (alternate)

   • For infants face head down across thighs

2. if unresponsive

   • send for help

   • CPR

EWS esculation pathways (yellow)

EWS=1-5

• Increase monitoring

• address pain. fever or distress

EWS esculation pathways (Orange)

EWS=6-7

• discuss with NIC

• HO review

EWS esculation pathways (Red)

EWS=8-9, or any vital sign in red zone

• Registrar review in 20 minutes

EWS esculation pathways (Blue)

EWS=10+, or any vital sign in blue

• Call 777

Hypothermia

Average temp lower than 36 degrees

Signs and symptoms of hypothermia

• confusion

• drowsiness

• loss of consciousness

• shivering

• cyanosis

• cold, pale skin

Hypothermia treatment

• Warm IV fluids

• Heating pads

• Remove wet clothing

Signs and symptoms of shock

• Altered LOC
  cold, clammy skin

• dizziness

• dry mucus membranes

• hypotension

• tachycardia

• oliguria

Sepsis

Microorganism infiltrates blood triggering a systemic inflammatory response that causes severe hypotension and tachycardia

Signs and symptoms of sepsis

• slurred speech

• extreme shivering or fever

• passing no urine

• skin mottled or discoloured

• impending sense of doom

• severe breathlessness

Sepsis 6 treatment

• Blood cultures

• Lactate levels

• anti-biotics

• fluids

• Oxygen

• monitoring urine output

AED pad placement

1. Adults: anterior to lateral

2. Small children/infants: front to back