Class notes
acute midterm #1 full review of all information/lectures
- Course
- NURS 3073
- Institution
- University Of New Brunswick (UNB )
acute midterm #1 full review of all information/lectures
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NURS3071 Winter 2024Midterm #1
Date: Tuesday, Feb 6th @ 0930
Value: 20% of final grade
Number of Qs:
• Approximately 65-70 questions, 1 bonus Format/Style of Qs:
o Multiple choice (majority of questions)
o Multi-select (note: scored all or nothing) Short answer (fill in the blank)
True/False
o Matching/Ordering
Miscellaneous: Lab Reference Ranges document will be provided, CrowdMark will be used for
MC.
Content: All required resources (readings, videos, lectures) and in-class activities are testable
content.
On midterm:
• Head-to-toe assessment
• ABCDE Assessment
Airway, Breathing, circulation, disability, exposure
AIRWAY BREATHING CIRCULATION DISABILITY EXPOSURE
Partial Inadequate O2= Inadequate LOC, AVPU, Head-toe looking at body
obstruction: hypoxia perfusion= fluid GCS
loud Inadequate imbalances =
Full ventilation= ß organ failure
obstruction: inflation,
silent bronchospasm
Examine: Assess/examine: Examine: Examine: Examine:
- Airway - Rate/rhythm Temp, HR, rhythm, - Blood gluc - Trauma
noise - Depth, SpO2 cap refill, skin,ß - Pain - Bleeds/rash/burns
- Position - Bilateral ÝBP (hypo=sign of - Sedation - Pressure
- Foreign inflation sepsis or bleed) - Neuro ulcers/wounds/scar
body - Cyanosis, - In/outs - Toxicology - Edema/temp/tender
- Fluid lung sounds - Med. Hx.
- Secretion - Emphysema
- JVD (jugular)
- Edema
Intervention: Intervention: Intervention: Intervention: Intervention:
- Open - O2 -repos, Ýfluids, - Antidotes - Identify cause
- Suction - Pneumothorax medication, ECG, - Glucose - Thermomanagement
- Secure therapy transfusion. - Trauma treatment
- O2 - Ventilation
Goal: Goal: Goal: Goal: Goal:
- Patient - Adequate - Stable - Stable - Reveal s/s and
airway oxygen and circulation LOC Thermomanage
ventilation and
gluc.
, • Communication tools
o SBAR: situation, background, assessment, response/recommendation),
o NEWS: national early warning score for CARDIAC ARREST
§ Doesn’t use diastolic BP
• Blood product administration
- Platelets can come in 4 forms:
1) Pathogen reduced pool
2) Pool of 4 units
3) Single donor
4) HLA single donor
- Frozen Plasma comes in 2:
1) Whole blood donor
2) Apheresis donor
Students role:
Cannot: Can:
- Check or sign off blood. - Monitor pt and their v/s.
- Hang or administer. - Teach why they need it.
- Obtain consent. - Prime IV line with 0.9% NaCl
v/s: start, q5min, q15min, q30min, q1h till stop, 2-3x after stopped.
If reaction:
1) STOP transfusion.
2) v/s.
3) verify pt, blood label. Stay w patient.
4) Notify MD and lab.
5) Treat s/s.
• Fluid imbalance
o Fluid compartments (ICF/ECF)
- intracellular fluid: inside cells
- 2/3 of body fluid (muscle mass)
- in skeletal muscles
- HIGH in K+ and PHOSPHATE
- Extracellular fluid: outside of cells
- 1/3 of body fluid
- HIGH in Na, LOW in K.
- includes:
- intravascular fluid (plasma): intravascular space (plasma and blood)
- interstitial fluids (surround cells)
- transcellular fluids (cerebral spinal fluid)
- When a major muscle trauma occurs, cells will burst, K+ (potassium) leaves the cell and
causes an imbalance (edema – fluid needs to shift back)
, - 3rd spacing: moving fluid from 1 space to another (ex: ascites, fluid overload, edema)
o Fluid and electrolyte movement:
1) Passive transport: movement of molecules/ions without energy
a. Diffusion: move solutes from 1 space to another thru a membrane
i. Facilitated diffusion: move solutes from 1 space to another thru a
channel.
b. Osmosis: move fluid from 1 space to another (particles cannot cross
membrane but fluid can.
c. Filtration: moving due to pressure gradient or hydrostatic pressure (hydrostatic
pressure: more pressure on outside of cell).
d. Reabsorption: into intravascular space relies on the ALBUMIN levels (large
molecule for plasma and blood. Increases ability to move fluid into
intravascular space.
2) Active transportation: needs energy.
§ NEEDS ATP
§ Pumps (ex: sodium potassium pump) à salty banana
• Increase K+ Intracellular.
• Decreases K+ extracellular.
• Increase K+ extracellular.
• Decreases K+ Intracellular.
o An electrolyte balancer with pump = active.
o Where Na goes, water flows.
- Increase Na= water to extracellular
- Decrease Na = water to intracellular (cell swells)
o Fluid volume excess & deficit
EXCESS:
- Related to failed compensatory methods.
- Kidneys cannot keep up with demand.
- Increase IV fluids.
- Can lead to heart issues.
- Hypervolemia
- 1kg = 1L excess fluid (daily wgts)
- Fluid overload: SOB, crackles in lungs, Hypertension, edema
DEFICIT: ß Ý
- Rapid diaresis, vomit, diarrhea, DEHYDRATION
- Hypovolemia: ß urine output, ßBP, Ý RR, ßWgt, ßturgor, Ý thirst
• Electrolyte imbalances
o Homeostatic mechanisms:
Kidney 0.5-1L/kg/hr – large role with electrolyte imbalances
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