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NURS3101 Exam With Complete Solutions
Shock - ANSWER Inadequate delivery of O2 to cells Patho of shock - ANSWER - Hypotension
- Circulatory failure
- Insufficient tissue perfusion Compensatory Shock - ANSWER Early stage of shock
- Agitated
- Tachycardic
- Tachypnoea
- Vasoconstriction
- Oliguria <400mL U.O.
- Increased BGL Progressive Shock - ANSWER Compensatory mechanisms begin failing to meet tissue metabolic needs. S & S:
- Low LOC
- Tachyponea
- SOB
- Tachycardic
- Anuria
- Cold peripheries
- Low MAP Refractory Shock - ANSWER Unresponsive to therapy as too much cell death S&S:
- Unconscious
- Anuria
- Kidney failure
- No Map > Hypovolemic Shock - ANSWER Severe blood & fluid loss. Caused by vomitting, diarrhoea and bleeding Cardiogenic Shock - ANSWER Pump failure due to decreased O2, less blood. Causes
- MI -CHF
- Coronary heart disease (CAD) Distributive shock - ANSWER Peripheral vessels get weak and leak into the tissues. E.G sepsis, anaphylatic & neurogenic shock Obstructive shock - ANSWER Impaired filling and or out flow of the heart due to the obstruction of the heart itself Clinical Manifestations of Hypovolemic Shock - ANSWER - Increased HR & PVR
- Cool, pale and clammy
- No oedema
- JVP not raised Clinical Manifestations of Cardiogenic/Obstructive Shock - ANSWER - Rapid HR
- Increased PVR
- Cool and clammy
- Increased JVP
- Pulmonary oedema Clinical Manifestations of Distributive Shock - ANSWER - Increased HR
- Decreased PVR
- Flushed
- JVP not raised
- Decreased HR in neurogenic Potential Complications of Shock - ANSWER - Kidney failure
- Respiratory failure
heart pump the blood
- Antibiotics: treat infections. E.g Vancomycin
- Urine output: circulates volume and renal function (Normal 0.5mL/kg/hr)
- Lactate measurement: progression of treatment. Lactate acidosis results from a deficit in tissue o2 availability
- ABG: to detect the bloodstream pathogens Multiple Organ Dysfunction Syndrome (MODS) - ANSWER 1. Continued auto amplifying massive inflammatory response
- Tissue hypoperfusion
- O2 supply/demand imbalance
- End organ dysfunction disseminated itravascular coagulation (DIC) - ANSWER serious condition that arises as a complication of another disorder, in which widespread, unrestricted microvascular blood clotting occurs; primary symptom is hemorrhage Lactate - ANSWER - Produced in excess by muscle cells, RBC's, brain & other tissues when there is sufficient o
- Primary way of producing energy in the body's cells is disrupted When does the respiratory system start to fail - ANSWER 1-3 days When does the liver start to fail - ANSWER 5-7 days
When does the GIT system start to fail? - ANSWER 10-15 days
When do the kidneys begin to fail? - ANSWER 11-17 days
Sepsis patho - ANSWER Ineffective material that enters systemic circulation leading to decreased tissue perfusion and o2 from WBC's
Characteristics of burns - ANSWER Injury resulting from exposure to heat, chemicals, radiation, cold injuries and electric current
Thermal burns - ANSWER Exposure to dry heat (flames) or moist heat (steam or hot liquids)
Chemical burns - ANSWER Direct skin contact with acids, alkaline agents, toxic compounds
Electrical burns - ANSWER Contact with an electric current lower than <1000v or >
Radiation burns - ANSWER Mediated by energy transferrence
Cold burns - ANSWER Decreased blood flow causes tissue necrosis
Patho of burns - ANSWER Inflammatory reaction leading to rapid oedema formation due to increased microvascular permeability, vasodilation & increased extravascular osmotic activity. Earliest stage of vasodilation and increased venous permeability is due to histamine release
Parkland's formula - ANSWER 3ml Hartmann's x body weight x %TBSA
- 1/2 given in first 8hrs
- 1/2 given in the next 16hrs
Rule of Nine's - ANSWER - Arms, head and neck = 9% each
- Legs, front of torso & back of torso = 18%
- Perineum & palms = 1% each
Airway management of burns - ANSWER Maintain patent airway. Inspect for foreign material. Insert guedel if compromised
Breathing management of burns - ANSWER Administer 100% o2. Expose chest for bilateral and adequate chest movement. Consider CO2 poisoning
- Hypothermia
- Permanent scarring
- Breathing problems (smoke inhalation)
Background pain - ANSWER Constant burning or throbbing sensation. Treat with NSAID's & paracetamol or PCA w/ morphine
Breakthrough pain - ANSWER Sudden increase in pain. Treat with ket, morphine, fetanyl or IV opioid
Procedural pain - ANSWER Prior to commencing a procedure
Epidermal burns - ANSWER Dry, red blances w/ pressure, no blisters. Heals with no scarring
Superficial dermal - ANSWER Pale pink, extremely painful, low risk of scarring
Mid-dermal - ANSWER Dark pink, large blisters, cap refill sluggish. Painful, Mod risk of scarring
Deep-dermal - ANSWER Blotchy red, may blister, no cap refill, increased risk of scarrin
Full-thick burn - ANSWER No blisters, no cap refill. Will scar
Smoke Inhalation - ANSWER Airway or pulmonary injury resulting from the inhalation of toxic products
Patho of smoke inhalation - ANSWER Thermal injury, chemical irritation of the respiratory tract, systemic toxicity due to CO and cyanide = inflammatory response = increased fluid resus volumes, progressive pulmonary dysfunction, prolonged ventilator
days, risk of pneumonia and acute respiratory syndrome
Risk factors for smoke inhalation - ANSWER - Being in an enclosed space for more than 5 minutes
- Experiencing prolonged exposure (bushfire)
- Asthma
- Young children
- Elderly
V:Q mismatch - ANSWER An imbalance in the amount of oxygen received in the alveoli and the amount of blood flowing through the alveolar capillaries
Intubation - ANSWER insertion of a tube into the trachea
Mechanical ventilator - ANSWER a machine used to inflate and deflate the lungs when a person cannot breathe on his own
carbon monoxide poisoning - ANSWER a toxic condition that results from inhaling and absorbing carbon monoxide gas. CO molecules with replace the O
Symptoms of smoke inhalation - ANSWER - Increased RR, worsening hypoxia
- Headache, coma, dec. LOC, vision loss
- Increased HR, C.O. Cardiac failure, arrhythmia, chest pain
Airway management of S.I - ANSWER Maintain patent airway. Look for airway obstructions and listen for upper airway noises. Use a guedel airway to open the airway and remove secretions
Breathing management of S.I. - ANSWER Listen for rapid breathing, shallow breaths, wheezing. Administer 100% O2 via a NRBM
Unintelligble sounds
Motor (GCS) - ANSWER Obeys= Localizing pain= Withdrawal form pain= Flexion to pain= Extension to pain= None=
Cerebral Perfusion Pressure (CPP) - ANSWER MAP-ICP
intra cranial pressure - ANSWER 0-15 mmHg. Growing pressure inside the skull
Taking a hx (neuro assessment) - ANSWER - MOI
- Injury sustained
- S&S
- Treatment provided
Subjective data (Neuro assess) - ANSWER - When it occured?
Objective data (Neuro assess) - ANSWER - Memory
Vital Signs (Neuro assessment) - ANSWER - BGL <10mmOL (brain perfusion requires normal BGL level)
- BP (widening pulse pressure = cushings triad)
- T <37.5 (prevent fever)
- HR (bradycardia)
- RR (irregular breathing - pressure on brain stem)
Assess LOC (neuro assessment) - ANSWER GCS, AVPU
Cushing's triad - ANSWER -Increase in systolic BP -Increase in pulse pressure (systolic and diastolic numbers get further apart) -Decrease in HR -Late sign -Seen with increased ICP -Adverse effect of prednisone
Compensating for raised ICP (Stage 1) - ANSWER Cerebral arteriole autoregulation (vasoconstriction)
Compensating for raised ICP (Stage 2) - ANSWER Monroe-Kellie Doctrine
Monroe-Kellie Doctrine - ANSWER when one content in the skull increases, another must decrease to compensate and maintain normal ICP
Clincal manifestations of ICP - ANSWER - Change in LOC, behavioural changes
- Headache, nausea & vomitting
- Pressure increases when you cough or sneeze
- IDC: understand input and output
Impaired cerebral perfsuion pressure - ANSWER -CT scan
- Check pupillary response every 5 minutes
- GCS every hour
Hypothermic related to drowning - ANSWER - Remove wet clothes
- Warm blankets
- Increase 1 degree per hour (vessels will dilate quickly if increased too much)`
Acute Spinal Injury - ANSWER Degenerative loss of motor, sensory and autonomic function
Spinal Cord A&P - ANSWER - 31 pairs of spinal (8C, 12T, 5L, 5S, 1C)
- Sensory/afferent via dorsal root, motor/efferent via ventral root
- Grey matter (cell body) vs white matter (myelinated axons)
- Meninges
Classification of a SCI - ANSWER - Vertebral level of injury
- Degree - complete/incomplete
- Overall severity - considers level, degree & mechanism
A (Impairment scale) - ANSWER Complete. Non-sensory or motor function is preserved in the sacral segments s4-
B (Impairment scale) - ANSWER Sensory incomplete. Sensory but no motor function is preserved below the neurological level
C (impairment scale) - ANSWER Motor incomplete. Motor function is preserved @ most caudal sacral segments (anal contraction)
D (impairment scale) - ANSWER Motor incomplete. 1/2 of key muscle functions below the lesion having muscle functions >
E (impairment scale) - ANSWER Normal
Functions affected by SCI - ANSWER Reflexes, ventilation, communication, autonomic control, sensorimotor function, skin integrity, bladder/bowel control and sexual function
Can the SC regenerate? - ANSWER No, neurons cannot undergo mitotic division to replace/renew themselves. Some capacity for axonal regrowth in PNS, some in CNS, but much slower and more inefficient
Primary SCI - ANSWER Irreversible damage sustained @ the time of injury. (Direct trauma, compression)
Secondary SCI - ANSWER Evolving injury vascular dysfunction and spreading wave of inflammation = ischemia & oedema
Spinal Shock - ANSWER Transient concussion of SC. "Physiological" rather than anatomical dysfunction. It lasts hours-weeks. Absence of all sensorimotor, autonomic and reflex neurologic activity below level of injury
Neurogenic shocK - ANSWER Haemodynamic changes resulting from a loss of autonomic tone due to SCI. Seen when SCI is above T
Autonomic Dysreflexia - ANSWER - SCI @T6 or above
- Imbalance of the autonomic NS
- Initiated @ the bladder
Pathologic Fracture - ANSWER A break in the bone that is caused by a disease. E.G osteoporosis or cancer
Longitudinal Fracture - ANSWER Occurs parallel to the long axis of the bone. E.G. direct or high impact injury or stress overuse
Spiral Fracture - ANSWER Twisted shaped break that extends around the long axis of the bone. MOI: football injury
Greenstick Fracture - ANSWER One side of the bone is broken, while the other side remains intact. MOI: falling from a height
Simple Fracture - ANSWER The broken bone does not break through the skin
Compound Fracture - ANSWER Broken bone breaks through to the skin. MOI: significant trauma
Oblique Fracture - ANSWER Diagonal or angle break across the bone. MOI: twisting forces
comminuted fracture - ANSWER Bone breaking into 3 or more fragments
Transverse fracture - ANSWER Bone breaks into 2 separate fragments
The healing process - ANSWER 1. Fracture
- Hematoma
- Osteoclasts
- Angiogenesis
- Osteoblasts
- Soft Callous
- Bony (hard)
- Callous
- Reunion/remodelling
Priority managements of open and closed fractures - ANSWER - Splinting: Align the bone and improve blood flow
- Stop the bleeding with a torniquet or possible manual pressure with a pad
- Cover with sterile dressing soaked in saline
- Immunisation - tetanus
- Saline irrigation
- Antibiotics asap <3hrs
- <8hrs to surgery for a better functional outcome - debridement and wound closure
Early complications of fractures - ANSWER - Arterial injury
- Nerve injury
- Compartment syndrome
- DVT
- Fat embolism
Late complications of fractures - ANSWER - Osteomyelitis (infection in the bone)
Compartment syndrome - ANSWER High pressure built up in a group of muscles
- Listen
- Colour and cap refill
- Temp
6 P's of neurovascular assessment - ANSWER Pain Pulse Paralysis Pallor Paresthesia Pressure
Category 1 (Red) - ANSWER - Immediate
- Life threatening conditions
- Cardiac arrrest, <10 RR or GCS <
Category 2 (Orange) - ANSWER - 10 mins
- Time sensitive treatment
- Stridor, HR <50>150, sepsis
Category 3 (Green) - ANSWER - 30 mins
- Potentially life threatening
- Severe pain, mod blood loss, head injury with LOC
Category 4 (Blue) - ANSWER - 60 mins
- Potentially serious
- Mild haemorrhage or swollen joint
Category 5 (White) - ANSWER - 2hrs
- Less urgent
- Minimal pain
- Abrasions
- Lacerations
Mass Disaster Triage (MIMMS) - Command - ANSWER One service has control @ the scene
Safety (MIMMS) - ANSWER Self, scene, survivors
Communication (MIMMS) - ANSWER Early arrangements
Assessment (MIMMS) - ANSWER - Estimate the number and severity of the injured
- Determines the initial health service response to the scene
Triage (MIMMS) - ANSWER - Casualties prioritised
- Repeated @ every stage of evacuation chain
Treatment (MIMMS) - ANSWER Do the most for the most
Transport (MIMMS) - ANSWER - Ambulance
- Commanders responsibility
Acute Behavioural Disturbance - ANSWER Abnormal physiology behaviour E.G. delirium
