Exam (elaborations)
NSB236 WEEK 1 – RECOGNISING THE DETERIORATING PATIENT TEST QUESTIONS AND ANSWERS
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NSB236 WEEK 1 – RECOGNISING THE DETERIORATING PATIENT TEST QUESTIONS AND ANSWERS...
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NSB236 WEEK 1 – RECOGNISING THEDETERIORATING PATIENT TEST QUESTIONS
AND ANSWERS
Why is recognising the deteriorating patient important? - ANSWER
Failure to rescue/recognise clinical deterioration is associated with
increased patient mortality
- Clinical staff frequently lack the clinical skills to identify and interpret
signs and symptoms of clinical deterioration
- Poor communication
- Introduction of modified early warning scores (MEWS) track and trigger
- MET and RRS
What are the most common causes of a MET call? - ANSWER Hypoxia
Hypotension
ALOC
Tachycardia
Tachypnoea
What are the most common underlying causes medical emergency calls
are attributed to? - ANSWER Sepsis
Cardiogenic shock
Pulmonary shock
Arrhythmia
What is important for recognising deterioration? - ANSWER Ability to
critically evaluate assessment findings in the context of the patients
primary condition and co-morbid condition
Understanding of vital signs is paramount
- Normal ranges for vital signs have not been validated
- Consider what is normal in context
What are signs suggestive of sepsis? - ANSWER Temperature >38.3 or
<36
Respiratory rate >20
Heart rate >90
,ALOC or confusion
Hyperglycaemia >7.7
Oliguria (Less than 0.5ml/kg/hr)
What should be assessed with blood pressure? - ANSWER - BP or MAP
is effected by cardiac output and systemic vascular resistance
- Clinical hypotension considered to be 20% decreased in the patients
normal blood pressure or 30mmHg reduction in systolic blood pressure
- Systolic blood pressure less than 100 are difficult to accurately
measure both manually and via electronic devices
- MAP is the perfusion pressure within the arteries during one cardiac
cycle - provides a better indicator of perfusion to organs
— MAP = SBP + (2xDBP)/3
What are the properties of haemodynamic perfusion? - ANSWER Four
cardiovascular properties are necessary to maintain adequate tissue
perfusion for cellular metabolism
- Sufficient CO
- Uncompromised vascular tone
- Sufficient blood volume and blood pressure
- Tissues are able to utilise oxygen
What is pulse pressure? - ANSWER The difference between SBP and
DBP
- PP = SBP-DBP.
- Conceptually proportional to SV
- Low pulse pressure - insufficient preload, heart failure, shock
- Wide pulse pressure - atherosclerosis, hyperthyroidism, raised ICP
Positive Portsmouth sign
- Heart rate should not go above systolic BP (shock state)
What are the haemodynamic aspects of heart rate? - ANSWER
Increased great rate - reduction in time to allow for ventricular filling
Increased heart rate increased myocardial oxygen demand
Heart rates that exceed blood pressure
, Increased heart rate - compensatory process initiated by the
sympathetic nervous system in order to preserve cardiac output (CO -
stroke volume x HR)
What compensation is seen in respiration? - ANSWER Oxygen delivery
depends on
- Cardiac output (optimise with fluid replace of pharmacological agents)
- Available Hb
- Arterial oxygen saturation (SaO2)
Avoid Hypoxaemia >90% PaO2 greater than 60mmHg
The normal metabolic workload of respirations is approximately 6%
Respiratory rate in the 30s leads to six times the metabolic workload to
sustain the respiratory rate
Respirations and respiratory assessments are poorly performed clinically
Respiratory rates
- Mid 20s require clinical interventions
- in the 30s immediate interventions and are not sustainable for a long
period.
What is oxygenation? - ANSWER Cells require oxygen in order to use
as an energy source and production of ATP - preferential aerobic
metabolism
Needs to be 95+ - needs to have a po2 of 80+
Anaerobic metabolism - using fats and proteins for energy results in an
increase in lactic acid and alteration fo cell function
What are signs and symptoms of sepsis? - ANSWER - Fever and/or
rigours
- Hypothermia
- Cough, increased sputum or dyspnoea
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