NSB236 Week 1 - Recognising the deteriorating patient Questions and Correct Answers the Latest Update
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Course
NSB236
Institution
NSB236
Why is recognising the deteriorating patient important?
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 co...
NSB236 Week 1 - Recognising the
deteriorating patient Questions and
Correct Answers the Latest Update
Why is recognising the deteriorating patient important?
✓ 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
✓ 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?
✓ 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?
✓ - 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?
✓ 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?
✓ 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?
✓ 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?
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