Australian Commission on Safety and Quality in Healthcare

Australian Commission on Safety and Quality in Healthcare
Read the ‘Australian Commission on Safety and Quality in Healthcare (2012). National inpatient medication chart user guide’ and answer the following questions. Make sure you provide correctly formatted in text citations for each answer and full references in the reference list. If you use a direct quote ensure you type the text exactly as it appears in the source document, use quotation marks and include a page number.
1. If the ‘Allergies and Adverse Drug Reactions’ (ADR) section of the medication chart is not completed, as a registered nurse what action should you take?
2. Define nurse initiated medicines:
3. Name five medications that (depending upon hospital policy) a nurse could initiate?
4. Examine the order for a regular medication below. Look the medication up. How many errors can you find? Write them down in full sentences.

5. Having discovered problems with the prescription, what would your actions be?
6. You are administering a once daily medication but the doctor has neglected to write the times for administration. It is very important that this patient receives this medication. You know this drug is always given in the morning on an empty stomach, the RMO has been called to an emergency and the breakfast trolley is on its way. What would you do?
7. One of your patients administers their own asthma medication and you write the code ? on the medication chart to indicate that they have self-administered. Why do nurses circle the code letter when documenting non-administration of a medication?
Care Planning and Patient Admission
8. Watch the audiovisual patient vignette available under Subject Documents?Lab 1 on UTSOnline and then complete as many areas as you can on the ‘Emergency Department Assessment form located in your ‘Labs 1-5 Charts and Checklist folder’.
9. Define subjective and objective data regarding health history and physical examination and identify what forms of subjective and objective data were collected in the patient vignette?
10. Please comment on Haidee’s interviewing and communication skills when she was questioning Dr Bennett about alcohol use. What could Haidee have done better here?
Respiratory Revision
11. Briefly explain the following terms.
• Ventilation:
• Compliance:
• Surfactant:
• Diffusion:
• Oxygen toxicity:
• Absorption atelectasis:

12. How is the respiratory rate regulated by the body?

13. Describe and explain the purpose of the following diagnostic studies:

• Haemoglobin:
• Haematocrit:
• ABGs:
• Oximetry:

14. What factors can affect the accuracy of pulse oximetry?

15. List early cues (signs and symptoms) of inadequate oxygenation.
Obstructive Pulmonary Diseases
16. Dr Bennett stated she has emphysema. Emphysema is a chronic obstructive pulmonary disease (COPD). Define COPD:

17. How does cigarette smoking cause COPD?

18. When do the clinical manifestations of COPD typically appear?
19. In the patient vignette Carolyn only put Dr Bennett on 2 L/min of oxygen despite her saturating at 88%. Explain why would she give her such a low flow rate of O2?
administration and use of the National Medication Chart: NPS Medicinewise Professional: http://nps.lamsinternational.com/moodle/

Oxygen Therapy
Device Flow Rate FiO2 Range Nursing Considerations
Nasal cannula

Simple face mask
(Hudson mask)
Non-rebreather mask
Venturi Mask
20. Complete the following table. Insert the in-text reference here: You may need to refer to Brown et al. and Crisp et al.
LABORATORY 2
Nursing the Diabetic Patient
1. In the patient vignette, Dr Bennett asked why she couldn’t have higher doses of oral hypoglycaemics rather than being given insulin injections. After looking up metformin and corticosteroids explain the need for parenteral insulin in this patient at this time?
2. Patient’s blood sugar levels often become unstable when they are admitted to hospital. What are some reasons for this other than corticosteroids?
3. Explain the actions of the following two hormones:
Insulin
Glucagon

4. According to Brown et al. what is a normal blood glucose range? (You still need to reference your answer).
5. Should a diabetic patient’s finger be swabbed with an alcohol wipe before being punctured for a blood glucose level? Why or why not?
6. Complete the table of insulins below comparing the action, time of onset, peak and duration of action. Insert an in-text reference here:
Action Onset Peak Duration
Actrapid
Novorapid
Mixtard 30/70
Protaphane
Lantus

7. Name three sites that can be used for subcutaneous injection:
8. Why is it recommended that a sequence of injections (e.g. insulin) should be given in the same area of the body?
9. Why must insulin be injected? Why are there no oral insulin medications?
10. In regards to insulin administration what is meant by a sliding scale?
11. Why do nurses pinch the skin when giving a subcutaneous injection?
12. What is the maximum volume in millilitres of water-soluble medication that could be injected subcutaneously?
13. What is the best site for subcutaneous injections into very thin patients?
14. Complete the following sentence:
“To ensure the medication reaches the subcutaneous tissue, the nurse follows this rule: if 5cm of tissue can be grasped, the needle should be inserted at a Click here to enter text. degree angle; if 2.5 cm of tissue can be grasped, the needle should be inserted at a Click here to enter text. degree angle” (Crisp & Taylor 2009, p. 781; Crisp et al. 2013, p. 877).
15. What size needle is generally used for subcutaneous injection?
16. How is the length of the needle for giving subcutaneous insulin determined?
17. How do you determine the ‘pack years’ of a smoker?
18. How many pack years does Dr Bennett have?
Extended Learning
To listen to sample lung sounds go to: http://www.wilkes.med.ucla.edu/lungintro.htm
Respiratory Assessment
19. Complete the following table of NORMAL breath sounds. Reference:
Description Location Origin
Vesicular
Bronchovesicular
Bronchial

20. Complete the table of ABNORMAL breath sounds. Reference:
Sound Site Auscultated Cause Character
Crackles Fine:
Medium:
Coarse:
Wheeze

LABORATORY 3
Cardiovascular Assessment
1. When gathering a cardiac history from a patient, what kind of information would you be seeking?
2. When you take a patient’s blood pressure what exactly are you measuring?
3. What is the difference between systolic and diastolic readings?

Read Banerjee et al. (2011) on UTSOnline and answer the following questions. Although the reference citation is given here, you still need to correctly reference all of your answers.
4. Describe how you would undertake a postural blood pressure on a patient?
5. What were the main conclusions the authors drew after examining the available literature on postural blood pressure measuring?
6. In your own words (paraphrase the text), describe why heart rate increases when people stand up after lying down:
7. According to Banerjee et al. (2011) what would a normal change to heart rate be when a person changed from lying supine to standing upright?
8. What does Brown et al. (2008 or 2012) state are normal changes to vital signs during a postural blood pressure?
9. Describe how you would assess capillary refill time. What is this a measurement of? What would you consider a normal result?
Managing Chest Pain
10. PQRST is a pneumonic to assist health professionals in obtaining information from a patient who has pain or discomfort. Complete the table below:
Factor Questions to ask the patient
P Precipitating events
Q Quality of pain
R Radiation of pain
S Severity of pain
T Timing

Click on the link for the Australian Resuscitation Council webpage (link on UTSOnline) ? On the right hand side of the home page, Click on ‘Click here to access ARC guidelines’ ? Guideline 9.2.1 Recognition and first aid management of heart attack. You still need to correctly reference each of your answers.
11. What are the warning signs of a heart attack?
12. Watch the patient vignette on UTSOnline. Which of these signs and symptoms did Mr Lars have? (You do not need to reference this answer).
13. What is the difference between a heart attack and cardiac arrest?

14. Define ‘atypical chest pain’. Which people are more likely to describe atypical chest pain?

15. Look up antianginal agents in Tiziani. Briefly describe the cause of angina pain and the main aims of antianginal medications. You must reference your answer.
16. Look up glyceryl trinitrate tablets in Tiziani . What are the main adverse effects in relation to this drug?

17. Explain the difference between angina and a myocardial infarction?
Rhythm Recognition and Monitoring
18. Looking through Mr Lars old notes you find the following six second strip. Can you identify the rhythm? Hint: It is the most common arrhythmia in Australia and New Zealand occurring in 2% of the general population. What are the ECG characteristics that define this rhythm?

 

 

 

 

 

19. You hook Mr Lars up to a five lead ECG to monitor him. You see there is ST elevation present in leads I and II. You print a new six second strip off lead II. What is the significance of changes to the ST segment?

20. Mr Lar’s chest pain has not abated despite giving 2x 600 micrograms of glyceryl trinitrate, oxygen at 6 L/min and letting him rest for ten minutes. He is diaphoretic and says he’s feeling nauseous and breathless despite the oxygen. Knowing what it signifies, you are worried about the ST elevation. Looking at the criteria on an observation chart in your charts and checklist folder, do you call for a critical review or make a rapid response call? Explain your decision.

21. Mr Lars loses suddenly loses consciousness. You see the following rhythm on the ECG screen. What is the rhythm called? What action should you take?
22. Can you identify what this next rhythm is, and the likely management?
23. Briefly explain the use of serum cardiac markers in the diagnosis of myocardial infarction?

24. Mr Lars’s ECG shows ST elevation in Leads 11, 111, aVF. This represents an inferior wall myocardial infarction. Which coronary artery is involved in an inferior wall myocardial infarction?
LABORATORY 4
Neurological Assessment
1. Following his cardiac arrest Mr Lars has a reduced level of consciousness. The nurse handing over described his Glasgow Coma Scale (GCS) as E2M5V2. Describe Mr Lars condition based on his GCS score (you do not need to reference this answer). Fill in Mr Lars current neurological observations on the neuro chart in your Charts and Checklist Folder, ask your tutor for prompts.
2. Complete the following table of GCS scores (you may abbreviate).

Category of Response Appropriate Stimulus Response Score
Eyes Open • Approach to bedside
• Verbal command
• Pain 4
3
2
1

Best Verbal Response • Verbal questioning with maximum arousal 5
4
3
2
1

Best Motor Response • Verbal command
• Pain 6
5
4
3
2
1
3. If a patient does not open eyes to voice or gentle touch or shaking, then the nurse uses peripheral pain stimulus to elicit a response. What is an appropriate method of applying peripheral pain?
4. How do you assess motor function in a conscious patient?
5. When assessing motor function it is the central nervous system you are assessing. Name three different methods of applying central pain to a patient who is not responding to voice or gentle touch, or making spontaneous movements? (Which method you use in practice will be governed by hospital policy).
6. What is a normal pupillary reaction when light is shone into the eye?

7. Briefly describe each of the following six categories of a normal physical assessment of the nervous system?

• Mental status –
• Function of cranial nerves –
• Motor system –
• Sensory system –
• Reflexes –
• Vital signs –

8. Describe decorticate and decerebrate posturing. What is the significance of these postures?
Oropharyngeal Suctioning, and Oropharyngeal Airways
9. What are the indications for suctioning patient airways?
10. How often should you suction your patient?
11. How does a guedel airway protect your patient’s airway?
12. How do you determine the correct size of guedel airway for your patient? Why is it important to select the correct size?
13. How is a guedel inserted into an adult patient?
14. What are the indications and contra-indications for a nasopharyngeal airway?
Care of IV Cannulas
15. Mr Lars is at risk of infection due to receiving intravenous therapy. On the diagram below from Crisp and Taylor (2009. p. 1048) label the sites where contamination could potentially occur.
Labels:
A.
B.
C.
D.
E.
F.

 

 

 
16. List three ways contamination could be prevented:

17. Identify three complications that may occur at Mr Peter Lars IV cannula site and list the cues (signs and symptoms) of each? Insert reference here.

18. What is the minimum intravenous flow rate to keep a vein patent?
Fluid and Electrolyte Balance
19. Define electrolytes:
20. Complete the following table: Insert reference here.
Cations/Anions Normal Serum Level Function and Regulation
Sodium (Na†)
Potassium (K†)
Calcium (Ca²)
Magnesium (Mg²†)
Chloride (Cl¯)
Bicarbonate (HCO3¯)
Phosphate (PO4³¯)

21. What are the differences between isotonic, hypertonic and hypotonic solutions?
22. Commencing a fluid balance chart is a nurse initiated action. Which patients should routinely have their fluid balance measured?
23. Discuss the accuracy of daily weights to gauge fluid balance compared to fluid balance charts.
24. The Dr has asked you about one of your other patients Anna Fender’s fluid balance but you haven’t yet added it up. Total the fluid balance chart for Anna (don’t forget to add the progressive totals for input and output) in your Charts and Checklist folder. Comment on her fluid balance? (You do not need to reference this answer).
LABORATORY 5
1. What is the definition of acute and chronic pain according to Macintyre et al. (2010)? (You still need to reference your answer).
2. According to Brown et al. (2008 or 2012) what are the five broad areas pain can be classified into? List them and provide a brief explanation of each. Insert reference here.
3. Imagine you are caring for a patient in the ward who has the PRN order below. Using the 1-10 pain scale, you assess your patient and she states that her pain is currently 9/10. However, she was laughing with her visitor and chatting when you saw her a few minutes ago. It is currently five-o-clock in the afternoon; the patient is alert and does not look distressed. The nurse on morning shift administered 2.5 mg of morphine three times but did not record a pain score. Would you administer morphine? If so, how much morphine would you give? Explain your reasoning, referencing appropriately.

4. After reading the pages of Macintyre et al. (2010), define the terms below: (You still need to reference your answer).
• Tolerance –
• Physical dependence –
• Addiction –

5. What are some of the complicating factors of caring for a patient with an addiction disorder, and what are some strategies the nurse could use to overcome them?

6. According to Crisp and Taylor and Crisp et al. there are three types of analgesics. Name them, state their indications and provide an example of each.
7. Referring to Brown et al. Name three routes of analgesic administration that are not oral or parenteral and name an advantage of administering analgesia this way:
8. Briefly discuss two non-drug therapies for pain relief that nurses can initiate?
Neurovascular Observations
9. What are the indications for assessing neurovascular status?
10. How often is neurovascular status assessed?
11. Describe the treatment for compartment syndrome?
Pre and Post-op Nursing Care
12. Read Charlene’s progress notes. Identify and discuss elements of her history that may put her at risk of post-operative complications?
13. Charlene asked why you had to remove her make-up and nail polish as “they’re not operating on her face or hands”. What would you tell her?
14. Charlene has given you her jewellery for safe-keeping. The pieces are not worth much money but she tells you they hold great sentimental value. What are you going to do with her jewellery while she is in the operating theatre?
15. What are the three conditions that need to be met for informed consent?
16. After she has been returned to the ward, how often should you monitor Charlene’s vital signs post-operatively?
17. Charlene weighs 64kg. She has returned from theatre with a urinary catheter insitu. How much urine would you expect it to drain hourly?
18. Patients often have low urine output following surgery. What are some of the contributing factors?
19. What interventions can the nurse initiate to help the surgical patient maintain respiratory function?
20. List what instructions might be included in typical postoperative orders from a surgeon
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