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End of Trimester Exam Notes: Acute Nursing. 2803NRS
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Acute Study GuideCare of Clients with Acute Medical/Surgical Conditions
Primary Survey: Identifies life-threatening issues (ABCDE= Airway, breathing, circulation, disability &
exposure), Vital Signs
Secondary Survey: Brief head to toe assessment. Uses Inspection, palpation, auscultation and percussion
Pre op care: Health history, risk assessment, weight, specific obs e.g BGL, verify content, pt education,
allergy status
Post op care: Post-anaesthesia care unit (PACU)- monitors pt until conscious and stable. Hospital ward:
ongoing monitoring to detect early complication/deterioration. Assessments- general appearance, overall
status, vital signs, airway, circulation, LOC, nausea/vomiting, surgical site/drainage, movement, urine
output/IDC drainage, pain/PCA, IV fluids, other medications, specific obs e.g BGL, neaurovas
Post Op Complications: Shock, DVT, PE, chest infection/pneumonia, infection, abscess formation,
dehiscence, delayed healing, atelectasis (collapsed lung).
Pain Assessment: PQRST. P= What provokes the pain. Q= Quality of pain e.g burning, stabbing, throbbing.
R= Region/Radiation. What is the pain? Does it radiate. S= How severe is the pain? (1-10). T= Timing=
When does the pain occur? When did the pain start
Consideration & contra-indications
- Diabetes medications can’t be given if pt’s is fasting
- Hypertension medications can cause complications with analgesia
- Anticoagulants to be withheld 24 hours before surgery
Nil by mouth complications
- Nausea/Vomiting - Malnutrition - Electrolyte imbalance - Hypoglycaemia
Intravenous Fluids
- For hydration and increasing circulating blood flow
Types: Crystalloid- increase fluid volume in intravascular and interstitial space
Isotonic- normal saline 0.9%, hartmans, ringers lactate
Hypotonic- 0.45% saline, 5% dextrose and D/S solutions
Hypertonic- higher concentrations of glucose and electrolytes
Colloid- increased circulated blood volume
IVC care
- Assess the site: every shift & before and after medication administration.
- Monitor site for signs of infection, extravasation/infiltration. e.g redness (erythema, tracking, heat,
pain/tenderness, oedema, swelling, purulent, discharge, leakage, bleeding
- Ensure dressing is clean & secure.
- Flush cannula before and after giving medications- ensure no residual from previous medication
and clears line of current medications.
Person-centred care: Care that is respectful and responsive to the preferences, needs and values of each
individual person. Dimensions: respect, emotional support, physical comfort, information, communication,
continuity and transition, family/carer involvement and access to care.
1
, Care for clients with acute cardiovascular conditions
ECG: A medical test that detects heart abnormalities by measuring the electrical activity generated by the
heart. 12 leads, produces a graphical representation of the heart’s electrical impulses.
When to do? Pt with chest pain, when assessing pt’s with cardiovascular disease, when assessing for
myocardial ischemia.
Echocardiogram: uses a external transducer to view & record waves that are bounded off the heart. Gives
a view of the direction of blood flow through the chambers of the heart.
Why? For suspected problems with valves or chambers, shortness of breath problems or chest pain. Can
also be used to detect congenital heart defects in unborn babies.
Acute coronary syndrome: A group of signs and symptoms of an acute cardiac event. unstable cardiac
ischemia caused by a sudden blockage of blood flow to an area of the heart. Sever enough to lead to
myocardium death (Myocardial infarction).
Risk factors: Older age (older than 45 for men, 55 for women), high blood pressure, high blood cholesterol,
cigarette smoking, lack of exercise, obesity, diabetes, family history, poor diet
Signs & symptoms: Pain: in arms, chest, back & jaw. Palpitations, dyspnoea, dizziness or syncope (fainting),
feeling dread, fatigue, nausea
Stemi
- Caused by an abrupt & prolonged blocked blood supply. Affects a large area of the heart.
- Causes changes on the ECG as well as in the blood levels of key chemical markers (troponin).
- ST elevation, complete occlusion
Non-Stemi
- ST depression, partial occlusion.
Chest pain treatment: Glyceryl Trinitrate- vasodilates and relaxes blood vessels which reduces strain on
heart. Sublingually works in 1-2 minutes
Coronary heart disease: Caused by impaired blood flow to myocardium. May be asymptomatic or may lead
to angina pectoris, acute coronary syndrome, myocardial infacrtion, arrhythmias, heart failure and even
sudden death.
Myocardial infarction: blood supply to an area of myocardium is blocked completely. If blood supply is not
restored, that part of the myocardium will die. Life-threatening
Hypertension- excessive pressure in the arterial portion of the systemic circulation. It may be the primary
condition or secondary resulting from an underlying condition
Cardiac investigations
- Depends on client’s presentation and condition
- ECG, history and examination, blood test- FBC, hb, electrolytes, cardiac enzymes/troponin,
cholesterol, echocardiogram, angiography, stress test, x-ray, CT, MRI, Pet scans
2
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