NUR4032 Exam

What is the nursing process?

ADPIE - Assessment, Diagnosis, Planning, Intervention, Evaluation

What are the benefits of using the nursing process?

Generalisable

Purposeful

Consistency

Identifies priorities

Confidence-Building

Organised framework for critical thinking

Examples of Assessment Tools

Pain, Waterlow, MUST score, GCS, SOCRATES

What is a medical diagnosis?

Is the medical determination of a disease or syndrome

What is a nursing diagnosis?

Is a clinical judgement concerning a human response to health conditions/life processes, or susceptibility to that response, by an individual, caregiver, family, group or community.

What does SMART stand for in terms of planning?

Specific, Measurable, Achievable, Realistic, Timed

What are the 4 principles of person-centred care

Empowering people

Personalisation of care

All treated with dignity, compassion and respect

Coordination of care

Benefits of patient-centred care for the patient

Improved communication

Empowering

Improved patient satisfaction

Better health outcomes

What is mental health?

A state of mental well-being that enables people to cope with the stresses of life, realise abilities, and contribute to their community.

What is a model used for mental health ?

Mental health continuum model

What is a learning disability ?

A lifelong disability that significantly reduces ability to understand information and learn new skills

IQ less than 70

What is autism ?

A lifelong neurodevelopmental condition

Does not impact IQ

What is neurodiversity

Natural variations in how the brain works - can cause difference in processing, learning, behaviour

What is bias ?

Favouring or disliking someone/something due to a prior opinion

Eg preferring people of the same age

What is Prejudice?

A negative judgment or opinion toward someone/something without reason, experience or consideration

What is discrimination?

Unjust or poor treatment of someone, or a group based on differences

What is unconscious bias?

When we make subconscious judgements or decisions based on our experiences, upbringing or interpretations.

What are microaggressions

Verbal and non-verbal exchanges constitute unintentional indirect or subtle discrimination against a marginalised or vulnerable person.

What are microaffirmations

Intentional or unintentional acts that disrupt microaggressions and discriminatory behaviour

What does holistic mean?

Treating the whole person rather than just the symptoms of a disease

What are the 4 components of a holistic assessment?

Physical, Psychological, Social, Spiritual

What is the difference between objective and subjective data?

Objective - The data that is measured through observation, diagnostic testing or physical examination

Subjective - What the patient states

What is a risk assessment?

Identifying risks and taking sensible and proportionate measures

Examples of risk assessments in practice

Manual Handling

Tissue Viability

Nutrition

Falls

Mobility

Suicide Risk

What are the three types of risk assessment ?

Generic, Bespoke, Dynamic

What is a generic risk assessment?

It can be used when activities share the same hazard. IE care delivered to many patients of used in many situations

What is a bespoke risk assessment?

Activity specific, tailor made for a person or situation

What is a dynamic risk assessment?

It is done ad hoc, before or during an activity, and can add to an existing generic or bespoke risk assessment. Allows flexibility for varied circumstances

What is the definition of a fall?

An event which causes a person to, unintentionally, rest on the ground or lower level and is not a result of a major intrinsic event or overwhelming hazard.

What two groups are most at risk of falls?

Children, Older adults

What are the 4 contributing factors of a fall (DAME)

Drugs and Alcohol, age-related problems, and Medical illness, Environmental factors

What are the two types of care plan and the difference?

Individualised care plans - Writing a care plan from scratch

Standardised care plans - EBP, pre-written care plans for people with specific needs or groups of patients

What are 3 advantages and 3 disadvantages of individualised care plans?

Advantages - Focuses on the patient, high-quality individualised care. Improves patient care, guided by a holistic assessment

Disadvantages - time consuming, not evidence based, can be a difficult skill

What are 3 advantages and 3 disadvantages of a standardised care plan?

Advantages - Consistent care, evidence-based, ensures documentation of delivered care, can save time

Disadvantages - Doesn’t always suit all patients, can be used as a tick box exercise, May not be updated appropriately.

What is advance care planning?

People may lack the capacity to make decisions about their care at the EOL. Advance care planning outlines patient’s wishes in case this occurs

What are the 3 layers of the heart - Inner to Outer

Endocardium

Myocardium

Epicardium/Pericardium

What is the myocardium comprised of and how do they facilitate contraction?

Cardiomyocytes - Rich in glycogen and mitochondria meaning energy production is improved

What are the three main coronary arterys?

Left Anterior Descending (LAD)

Left Circumflex Artery (LCX)

Right Coronary Artery (RCA)

What is the function of the LEFT ANTERIOR DESCENDING coronary artery

Supplies blood to the myocardium - located in the epicardium

What is the function of the LEFT CIRCUMFLEX artery ?

Delivers blood to the left atrium, ventricle and sometimes the SA node

What is the function of the RIGHT CORONARY ARTERY

Delivers blood to the right atrium, ventricle and parts of conduction system (SA and AV node)

What are the 5 parts of the cardiac conduction system ?

SA node, AV node, Bundle of His, Left and Right bundle branches, Purkinje fibers

What is the role of the AV node in the cardiac conduction system?

Acts to delay the electrical impulse to ensure the atria has fully ejected blood into the ventricles before ventricular systole (contraction)

What is the role of the purkinje fibres ?

Rapidly transmit electrical impulses from AV bundle to the myocardium of the ventricles allowing coordinated ventricular contraction

What is preload?

The amount of stretch on the myocardial muscle fibres just before contraction - best measure is end-diastolic volume

What is afterload?

The pressure that the heart must work against to eject blood during systole. Proportional to average arterial pressure

As aortic and pulmonary pressure increases the afterload increases retrospectively

What is contracility?

The force which the heart contract is referred to as cardiac contractility

What is cardiac output and the formula?

Measurement of the amount of blood pumped by each ventricle in 1 minute.

CO = HR X SV

What is stroke volume and the formula?

The stroke volume represents the volume of blood ejected from the ventricle with each heartbeat

SV = CO / HR

What structures does the upper respiratory tract contain?

Nasal cavity, Pharynx, Epiglottis, Larynx

What is the role of the bronchial artery and bronchial vein

Bronchial Artery - Carries oxygenated blood from the left ventricle to the lungs

Bronchial Vein - Carries deoxygenated blood from the lungs to the right atrium

What is the role of type 1 and type 2 cells within the alveoli?

Type 1 - Diffuse gases

Type 2 - Repair and secrete lubricant

Which lung has 2 lobes instead of 3 and why?

Left lung - Smaller due to the position of the heart

What are the 2 arteries that make up pulmonary circulation?

Pulmonary and bronchial arteries

Why is the pulmonary artery different from all other artery’s in the body?

the only artery in the body that carries deoxygenated blood

How many alveoli does the average adult have?

500 million

What are the 5 functions of the respiratory system ?

Air preparation - Filtering, warming and humidifying inspired air

Vocalisation - producing speech through vibration of the vocal cords

Olfaction - Detecting smells using olfactory receptors

Protection and defence - protecting respiratory surfaces from dehydration, temperature changes and against inhaled pathogens

RESPIRATION - Extracting O2 from atmosphere and disposing of CO2

What is the formula for aerobic respiration?

Fuel(glucose) + O2 = ATP + CO2 + H20

What are the 4 processes of respiration?

Pulmonary Ventilation

External Respiration

Transport of gases

Internal Respiration

What is pulmonary ventilation?

How air gets in and out of the lungs - breathing ( Inspiration and expiration)

At rest the pressure inside the lungs is equal to atmospheric pressure - pressure changes between the lungs and atmosphere facilitate respiration

What is the difference between external respiration and internal respiration?

External - Movement of O2 and CO2 into and out of the pulmonary circulation

Internal - The exchange of O2 and CO2 between blood and cells

What is boyles law ?

At a fixed temperature, the pressure exerted by a gas is inversely proportional to volume

What happens to the following factors on inspiration?

Diaphragm

Intercostal Muscles

Thoracic cavity

Intrathoracic pressure

Diaphragm contracts

Intercostal muscles contract

Thoracic cavity expands

Intrathoracic pressure decreases

What happens to the following factors on Expiration?

Diaphragm

Intercostal Muscles

Thoracic cavity

Intrathoracic pressure

Diaphragm relaxes

Intercostal muscles relax

Thoracic cavity recoils

Intrathoracic pressure increases

What type of process is A) Inspiration B) Expiration

A) Active

B) Mostly Passive

What is work of breathing?

The energy required to overcome 3 factors impacting lung expansion

• Lung Compliance

• Airway Resistance

• Surface tension in alveoli

What are the three factors impacting lung expansion

Lung compliance

Airway Resistance

Surface Tension in alveoli

What are the volume and capacities associated with the respiratory system?

Tidal lung capacity

Tidal Volume

Minute Volume

What is tidal lung capacity?

Total amount of air lungs can hold W

What is tidal volume?

Measures the amount of air going in and out of lungs in 1 breath

What is minute volume?

Tidal Volume X RR

What two features vary in breathing?

Rate and depth

What is the control centre for breathing?

Medulla Oblongata (Rate)

PONS (Depth and Volume)

What sensors detect changes in regards to control of breathing?

Where are they located?

Chemoreceptors

Central - Medulla Oblongata

Peripheral - Aortic Arch and Carotid Sinus

What is diffusion?

Gas molecules moving from areas of high concentration to low concentration

How is O2 transported?

Attaches to Hb in erythrocytes

Each Hb molecule has 4 subunits, each with an iron ion

O2 attaches to the iron ion, creating oxyhaemoglobin

What is Hypoxaemia?

Low O2% in blood

How is CO2 transported?

Attaches to Hb

When erythrocyte reaches a cell it triggers O2 release allowing CO2 to bind

What is Hypercapnia?

High CO2 in blood

What are the two major muscles of ventilation?

Intercostal and diaphragm

What is the name for the air that remains in the lungs that cannot be exhaled?

Residual volume

What is the purpose of health screening?

To identify people in an apparantly healthy population who are at higher risk of a health problem or a condition so that early intervention can be offered

What are the 3 types of health screening in the UK?

Stratified Screening

Population Screening

Targeted Screening

What are the benefits of health screening?

Reduction of incidence and mortality of conditions

Early intervention

Early Detection

The 3 main methods for evaluating screening programmes?

Randomised Controlled Trials - compare outcomes of those who undergo screening and those who don’t

Time Trend Studies - analyse outcomes of screening for different groups from before and after screening is introduced.

Case Control Studies - compare 2 groups; one with condition concerned with and the other without

What are the ethics of health screening? (4)

> Improve health and wellbeing

> Treat people with respect

> Promote equality and inclusion

> Use public resources fairly and proportionately

What is personal informed choice with regards to health screening ?

How many informed choice principles are there?

A decision made to accept or decline a screening test based on access to accessible, accurate, evidence-based information.

There are 8 informed choice principles

What are health inequalities?

The consequence of wider determinants and how this impacts patients’ health

What are wider determinants?

Social constructs in the world we live in that affect everyone such as air pollution

Factors that impact development in the early year?

Smoking in pregnancy

Birthweight

Breastfeeding

Infant Mortality

Child obesity

What are 3 examples of wider determinants in the UK

Built and natural environment

Education

Income

Employment

Crime

Social Capital

What is social inequality?

Variations in wider determinants

What does the social gradient of health show?

Access to resources, higher income and better education means better overall health

Health inequalities are avoidable. True or False

True

What are the 4 main factors that lead to health inequalities in England ?

Socioeconomic

Geographical

Special Characteristics

Socially excluded groups

When was the Marmot Review Published?

2010

What was the aim of the marmot review?

> Identify evidence for policy relating to health inequalities

> Propose objectives and measures regarding infant mortality and life expectancy expectancy

Marmots findings suggested wider determinants have a cumulative effect ? True or False ?

True

What are three recommendations from the Marmot Review?

Give every child the best start in life

Enable all to maximise capability and have control of their life

Fair employment and good work

Healthy standard of living for all

Create sustainable and health places and communities

Focus on impact and prevention of ill health

What were 3 findings of the Marmot Review 2020

> Life expectancy and overall health has worsened in the most deprived areas

> Health inequalities have overall increased

> Health is declining at a population level

>Poverty increasing

>Reiterated recommendations of the original report