1/1502
Looks like no tags are added yet.
Name | Mastery | Learn | Test | Matching | Spaced |
---|
No study sessions yet.
PQRST pain assessment
P - provocations (what brings pain on),
Q - quality or quantity of pain (how long it lasts),
R - region, radiation,
S - severity,
T - timing (when it started, how long it lasts, does anything cause it)
COLDSPA pain assessment
C - character,
O - onset (when did it begin?),
L - location (where is it?),
D - duration (how long does it last?),
S - severity (how bad is it?),
P - pattern (what makes it better or worse?),
A - associated factors (what makes symptoms occur)
FLACC
Face, Legs, Activity, Cry, Consolability
FLACC pain assessment usage
Used for paediatric patients
FLACC score of 1-3
Indicates mild discomfort
FLACC score of 4-6
Indicates moderate pain
FLACC score of 7-10
Indicates severe discomfort/pain
Integumentary assessment
Assesses rashes, skin turgor, warmth, dryness, colour
Neurological assessment
Assesses AVPU, GCS, behaviour changes, slurred speech, facial drooping/palsy
Cardiovascular assessment
Assesses heart rate and rhythm, blood pressure, swollen legs/arms, skin signs of CVS concern (i.e. cyanosis), peripheral pulses
Respiratory assessment
Assesses work of breathing, accessory muscle use, respiratory rate, equal chest rise and fall
Gastrointestinal assessment
Assesses bowel sounds, bowel movements, abdomen distended, painful/tender abdomen
Genitourinary assessment
Assesses urinary concerns, hydration, urination frequency, pain
Musculoskeletal assessment
Assesses muscle wastage, weakness, mobility issues
A-E assessment
A - airway, B - breathing, C - circulation, D - disability, E - exposure
IPPA approach
I - inspection (what can we see?),
P - palpitation (what can we feel?),
P - percussion (what can we hear through listening and feeling?),
A - auscultation (what can we hear?)
Target range for pH
7.35-7.45
Target range for HC03 (bicarbonate)
22-26mmol/L
Target range for sodium
135-145mmol/L
Target range for potassium
3.5-5.2mmol/L
Target range for Pa02 (partial pressure of oxygen)
70-100mmHg
Target range for PaC02 (partial pressure of carbon dioxide)
35-45mmHg
Characteristics of acids
Hydrogen containing compounds that release H+ ions when dissolved in water. The higher the concentration of H+, the lower the pH = fluid becomes more acidic
Characteristics of bases
Compounds that pick up/bind H+ ions.
Basicity and pH relationship
The lower the concentration of H+, the higher the pH, making the fluid more basic (alkaline).
Most abundant electrolyte in extracellular fluid
Sodium (Na+).
Most abundant electrolyte in intracellular fluid
Potassium (K+).
Impact of sodium on the body
The greatest influence on ECF osmolarity and water level in body fluid
Blood pressure/volume
Cell transportation
Neuronal signaling
Impact of potassium on the body
The greatest influence on ICF osmolarity
Maintains resting cell membrane
Pumping heart and muscles
Controlling acid-base balance
Water and electrolyte balance in the blood
Aldosterone stimulates sodium (Na+) reabsorption/retention and potassium (K+) secretion at the renal tubules.
Acid-base balance in the blood
Achieved through regulating excretion of acid/bases as necessary;
lungs can excrete or conserve acids via ventilation; kidneys can excrete or conserve acids or bases in the urine.
Kidneys role in acid-base maintenance
Bicarbonate is conserved by being reabsorbed while acids are expelled in urine.
Lungs role in acid-base maintenance
Can only regulate acid excretion via ventilation through CO2 excretion
Causes of hypernatremia
Water loss or excessive sodium gain in the ECF leading to an increase in plasma osmolarity which can lead to a fluid shift and cellular dysfunction.
Signs and symptoms of hypernatremia
Increased thirst (polydipsia)
Dry mucus membranes
CNS symptoms (i.e. lethargy, irritability, muscle twitching).
Causes of hyponatremia
Sodium loss or water gain in the ECF, decreasing ECF osmolarity meaning water will move into cells causing them to swell and leads to cellular dysfunction.
Signs and symptoms of hyponatremia
Muscle twitching and weakness,
hypervolemia,
oedema,
decreased urine output,
confusion,
seizures.
Causes of hyperkalemia
Caused by increased intake, cell damage from trauma, burns, hypoxia or acidosis, or decreased renal excretion.
Signs and symptoms of hyperkalemia
Muscle weakness or cramps,
fatigue,
decreased GI motility,
arrhythmias,
ECG changes,
cardiac arrest,
bradycardia.
Causes of hypokalemia
Caused by reduced dietary intake or increased loss of K+ from increased renal secretion.
Signs and symptoms of hypokalemia
Muscle weakness,
arrhythmias,
ECG changes,
cardiac arrest,
respiratory depression,
decreased GI motility.
Causes of respiratory acidosis
Buildup of CO2 in the blood leading to excess H+ from depression of brainstem respiration or failure of ventilation (i.e. pneumonia, COPD, airway resistance).
Signs and symptoms of respiratory acidosis
Headache,
blurred vision,
SOB,
lethargy,
disorientation,
muscle twitching,
convulsions.
Causes of respiratory alkalosis
Lowered H+ in blood from too much CO2 being expelled due to hyperventilation, pain, anxiety, sepsis, fever, or hypoxemia (low oxygen in tissues).
Signs and symptoms of respiratory alkalosis
Dizziness
confusion,
convulsions,
muscle spasms in fingers or toes.
Metabolic acidosis
Increased acid production when too much bicarbonate is excreted from renal loss (i.e. renal failure) or GI loss (i.e. diarrhoea), or increased acid production from ketoacidosis, medications such as Paracetamol or Aspirin, increased lactic acid production, or exposure to certain toxins.
Signs and symptoms of metabolic acidosis
• Headache
• Lethargy
• Confusion
• Coma
• Hyperventilation
• Nausea/vomiting
• Hypotension.
Metabolic alkalosis
Too much hydrogen/acids are lost or too much bicarbonate is retained from GI loss,
increased renal loss (i.e. diuretics, Cushing's syndrome),
dehydration or increased bicarbonate retention from IV solutions.
Signs and symptoms of metabolic alkalosis
• Weakness
• Muscle cramps
• Hyper-reflexia
• Hypoventilation
• Confusion
• Convulsions.
Red blood
Corrects anaemia and oxygenates tissues.
Gold blood
Restores haemostasias, either platelet plug or fibrin net.
Bottles in blood transfusions
Specialised support and replacement, sourced from plasma.
Timeframes for blood administration
• 4 hours from issue
• 4 hours from spiking the bottle
• 3 hours from reconstitution
• 1 hour from issue.
Post administration guidelines after blood transfusion
• Stay with the patient for the first 15 minutes
• TPR (temp, pulse, respiration) every 30 minutes
• BP every hour
• TPR/BP at completion.
Blood pressure regulation
• Blood volume, overall compliance, cardiac output, peripheral resistance
• Parasympathetic NS releases acetylcholine which slows the heart
• Sympathetic NS releases catecholamines, epinephrine and norepinephrine to increase heart rate.
RAAS system regulation of blood pressure
• BP drops and is detected by the renin-angiotensin aldosterone system (RAAS)
• Sympathetic NS stimulates and releases renin • Angiotensinogen is activated by the liver
• Angiotensin 1 is created
• Angiotensin-converting enzyme (ACE) converts angiotensin 1 to angiotensin 2
• Angiotensin 2 constricts vessels and increases blood volume.
Cardiac output regulation
• Changes in stroke volume and heart rate.
Caring for someone with a cardiac event
• ABCs (airways, breathing, circulation)
• Vitals - pain assessment
• Medications (morphine, GTN, aspirin), consider other medications and allergies
• Reassurance.
Focused cardiovascular assessment
• Inspection - jugular veins (?distended), extremities, CAP refill, redness, pitting oedema
• Auscultation - heart sounds, murmurs
• Palpitation - radial, neck, inner knee, pedal, femoral pulses.
Thickest layer of the heart
Myocardium.
Order of blood flow
• Starts in the superior and inferior vena cavae
• Moves to the right atrium • Into the right ventricle
• Blood goes through the pulmonary trunk and enters pulmonary circulation
• Blood reenters the heart through the left atrium
• Moves into the left ventricle
• Enters systemic circulation via the aorta.
Intrinsic conduction system
Sets the basic rhythm of the heart by generating impulses that stimulate the heart to contract.
Cycle of the intrinsic conduction system
• Starts with atrial contraction
• Ventricular contraction closes AV valves and opens semilunar valves
• Semilunar valves then close and the chambers relax
• Blood fills the ventricles.
P-wave on an ECG
Atria depolarization.
QRS complex on an ECG
Ventricle depolarization.
T-wave on an ECG
Ventricle repolarization.
First heart sound (S1)
Sound from mitral and tricuspid valve closing.
Second heart sound (S2)
Sound from the aortic and pulmonic valves closing.
Murmur
Abnormal heart sound of blowing/swishing from blood turbulence.
Grade 1 murmur
Hard to hear.
Grade 2 murmur
Easily heard but faint.
Grade 3 murmur
Easy to hear
Grade 4 murmur
Loud with chest thrill
Grade 5 murmur
Very loud, can hear when corner of the chest piece is lifted off the chest
Grade 6 murmur
Can hear when whole chest piece is lifted off the chest
Angina
Chest pain that occurs when the oxygen demand of the myocardium outweighs the available supply
Causes of angina
Caused by physical exertion or stress
Stable angina
Predictable and resolves with rest or GTN
Unstable angina
Unpredictable and can occur at rest.
Increases in severity, length and/or frequency
Angina treatment
Smoking cessation,
Control HTN,
Improve diet,
Weight loss,
Lower cholesterol,
GTN (nitroglycerine),
Coronary artery disease
Narrowing, stiffening and/or blockage of coronary arteries usually caused by atherosclerosis
Coronary artery disease treatment
Coronary bypass graft (CABG), stents/balloons
Antiplatelets (i.e. aspirin),
Statins (lowers cholesterol),
Beta blockers (lowers HR and BP),
ACE inhibitors (lowers BP)
Blood test indicating myocardial infarction
Increased troponin T
ECG changes indicating myocardial infarction
T wave inversion, ST elevation or depression
Signs and symptoms of myocardial infarction
Prolonged pain or tightness in the chest,
Shoulder, arm, neck, or jaw pain,
Diaphoresis,
Pallor,
Nausea/vomiting,
Anxiety,
SOB,
Fatigue
NSTEMI on ECG
Non S-T elevation,
involves subendocardial infarction (partial occlusion)
STEMI on ECG
Elevation of the S-T segment. Complete and sustained blockage resulting in transmural infarction
Myocardial infarction treatment
Morphine,
Oxygen,
Nitroglycerine,
Aspirin,
Thrombolytics,
Percutaneous coronary intervention (PCI)
Atrial fibrillation
Irregular and typically rapid heart rate that can cause a stroke or PE
Ventricular tachycardia
Abnormal and rapid discharge of electrical signals in the ventricles (150-200 bpm)
Signs and symptoms of ventricular tachycardia
Palpitations,
SOB,
Chest pain,
Dizziness,
Loss of consciousness
Ventricular tachycardia treatment
Can cause cardiac arrest.
Treated with radiofrequency ablation,
implantable cardioverter defibrillator (ICD) or antiarrhythmics (i.e. Sotolol, Amiodarone)
Ventricular fibrillation
Ventricles quiver instead of contracting, caused by lack of cardiac output in ventricles
Ventricular fibrillation treatment
CPR, Defibrillation,
Implantable cardioverter defibrillation (ICD),
Medications (i.e. epinephrine, amiodarone)
Pulmonic stenosis
Narrowing of the pulmonary valve
Causes of pulmonic stenosis
Rubella in mothers,
Rheumatic fever,
Carcinoid syndrome
Signs and symptoms of pulmonic stenosis
Fatigue,
SOB,
Chest pain,
Fainting,
Cyanosis,
Poor appetite,
Abdominal distension
Pulmonic stenosis treatment
Balloon valvuloplasty,
Pulmonary valve replacement
Aortic stenosis
Narrowing of the aortic valve preventing blood from flowing properly
Causes of aortic stenosis
Calcium buildup in the valve cusp, Rheumatic fever, Bicuspid aortic valve (birth defect)