Acute Care 168.362|2023 LATEST UPDATE|GUARANTEED SUCCESS

DKA onset/charecteristics Omission of insulin and physiological stress Occurs in pt's with T1DM with a rapid onset. DKA Physical symptoms Thirst, dry mouth, Nausea, Vomiting, Abdo pain, flushed dry skin, sunken eyes, fever, polyuria, rapid weak pulse, Kussmaul breathing 00:35 01:13 What is Kussmaul breathing? Deep + Laboured breathing pattern DKA lab findings BGL 13.9mmol, Arterial pH 7.3, Serum + Urine Ketones present, plasma bicarbonate 15 mmol/L, Elevated urea + creatinine, serum osmolality 330-350 mmol/L DKA treatment + Monitoring Fluid + Electrolyte replacement therapy. Bolus insulin - Continuous infusion. Iv 150 - 200 ml/h. Vital signs, urine output, BGL, Serum K+, GCS, Fluid overload. Mortality rate 5% HHS characteristics Hyperosmolar hyperglycaemic syndrome. Lack of effective insulin and extracellular fluid loss. Occurs in pt's with T2DM over 60 experiencing physiological stress. HHS symptoms BGL 33.3mmol Absent ketones, Serum osmolality 350 mmol/L, Elevated urea + creatinine, mortality rate 10 - 40%. Polyuria, thirst, warm-dry skin, fever, dry mouth. Hypokalemia + Signs/symptoms Low K+, Fatigue, muscle weakness, nausea, vomiting, weak + irregular pulse, polyuria, hyperglycemia, abnormal ecg - inverted T wave AKI precipitators The rapid onset and loss of kidney function. Caused by: Hypovolemia, prolonged hypotension, nephrotoxic agent, acute tubular necrosis. AKI symptoms Oliguria, Oedema, shortness of breath, confusion and nausea. AKI nursing management Vital signs, fluid + electrolytes, urine assessment, respiratory assessment, skin assessment, prevent infection, monitor fatigue + anxiety. Glomerular filtration rate GFR. How does CAD develop? 1. Chronic endothelial injury 2. Fatty streak 3. Fibrous plaque 4. Complicated lesion Hardening/narrowing of the blood vessels. 01:08 01:13 What are the symptoms of angina? Chest pain due to myocardial ischaemia ABCDEF for treatment of chronic stable angina A - ACE inhibitor, Antiplatelet, antianginal therapy B - Beta-blockers, BP control C - Cholesterol management, Calcium channel blockers D - Diet, Depression screening, Diabetes management. E - Education + Exercise F - Flu vaccination Presentation of ACS/unstable angina Collapse, sweaty, clammy, dyspnoea, chest pain, pulmonary oedema, nausea, vomiting, hypotensive, bradycardia or tachycardia Diagnostic tests for ACS/unstable angina Lipid profiles, 12-lead ECG, Chest X-ray, Echocardiogram, Exercise stress testing, Serum cardiac markers. Nursing management of ACS/unstable angina Pain management, Monitoring + assessment, Rest + comfort, Rapid diagnosis by MDT What is an MI? Myocardial Infarction (heart attack) is a result of prolonged ischaemia causing myocardial cell death. What are the signs/symptoms of MI? Immobilising chest pain, nausea, vomiting, fever, feeling of impending doom, weakness, anxiety, dyspnoea, tachypnoea, cold + clammy skin, diaphoresis, syncope, pericardial friction rub What are the interventions for an MI Assess ABC, Vital signs, ECG, cardiac markers, PCI, Thrombolytic therapy. Medications: GTN, aspirin, morphine, thrombolytics. What is PCI? Percutaneous coronary intervention 1. Cardiac catheterisation to locate blockage 2. Insertion of a stent to expand the artery and increase blood flow. Mortality in MI's decreases by 25% if reperfusion occurs within 6 hours. What is thrombolytic therapy? Used to stop infarction by dissolving thrombi, allows reperfusion, can be performed in clinics where cardiac catheterisation is not possible. What is CABG surgery? Coronary artery bypass graft surgeries are one method of surgical revascularisation. In the surgery an artery most commonly the internal mammary artery IMA, is attached distally to the blockage. Nursing management post-CABG Chest X-ray, O2 therapy, Drug therapy, vital signs, monitoring, rest, daily weight. Describe the biology of cancer? 1. Indiscriminate + continuous proliferation 2. Defect in cell differentiation 3. Genetic link: Malfunctioning Protooncogenes + tumour suppressor genes. 4. Acquired damage to genes: Radiation, carcinogens. What is cancer? 200+ diseases characterised by unregulated + uncontrolled growth of cells. The leading cause of death in NZ. Incidence has increased but mortality decreased. What is the current theory of the stages of cancer disease progression? Initiation: A mutation occurs Promotion: Proliferation of cells, latent period Progression: Increased growth rate, increased invasiveness and metastasis. What is metastasis? the development of secondary malignant growths at a distance from a primary site of cancer. Histological classification of cancer Grade 1: Cells differ slightly from normal + are well differentiated. Grade 2: Increased abnormality + moderately differentiated cells. Grade 3: Cells are v. abnormal + poorly differentiated. Grade 4: Cells are immature + undifferentiated. Cell of origin is difficult to determine. Extent of disease (cancer) classification Stage 0: Cancer in situ Stage 1: Localised tumour growth Stage 2: Limited local growth Stage 3: Local + regional spread Stage 4: Metastasis TNM classification system An international system for determining the extent of metastasis and the level of cell differentiation, two important factors in treatment and prognosis of cancer. T1-4: Ascending degrees in tumour size + involvement. Tis: Tumour in situ N1-4: Ascending degrees of nodal involvement M1-4: Ascending degrees of metastatic involvement.