Acute Nursing Care (NUR 3463 : Acute Care)
4 Aspects of Valid Consent - Voluntary, Specific, Informed, Legal Capacity (18+ no cognitive
impairment)
What are some factors that contirbute to perioperative complications ? - Age: eg elderly have
delayed wound healing.
Lifestyle choices including nutritional status.
Medications
Procedural complications
Environmental/SES
What are some of the risks/issues for a surgical pt with diabetes? - Fasting - monitor BGLs
Best to have surgery in the morning
Effects on wound healing and infection risk
Medication metabolization
Loss of muscle mass - mobilization
What kinds of medications are given preoperativly? - sedation, antibiotics (prophylatic), anti
anxiety, pts regular meds.
What kinds of meds are given in the intraoperative period? - Anaesthics, sedation, muscle
relaxation, pain relief.
What kind of meds are given in the post operative period? - analgesics, laxitives, antibiotics,
antiemetics.
What does the acronym IDEAL stand for in relation to discharge planning? - Include
Discuss
Educate
Assess
Listen
,What is Gilick Competency? - When a child is under legal age for consent but is able to
intellectually about to understand and consent to medical decisions.
What is the role of Power of Attorney ? - POA are not able to make medical decisions. They look
after the pts financials. Only medical power of attorney can make medical decisions on behalf of
the pt.
Documentation structure to follow? A-H (post op) - A- Airway
B - Breathing
C - Circulation
D - Disability
E - Exposure
F - fluids/full vitals
G - Glucose
H - Head to toe assessment
Signs of inflammation - redness, heat, swelling, pain and - or + of function
Pathogenisis of Inflamation - Tissue damage
Mast cells activation: cells release histamine and heparin.
Dilation of blood vessles occur increasing blood flow and vessle permeability.
Clot formation for temp repair ie redness swelling.
Role of histamine in Inflammation - Vasodilation, activates pain receptors to activate
phagocytosis.
Describe the events of phagocytosis. - 1. Phagocyte attaches to pathogen or debris.
2. Phagocyte engulfs pathogen or particles (phagosome)
3. Lysosomes fuse with phagocyte vessle (phagolysosome)
4. lysosomal enzymes digest the particles
5. exocytosis of vesicle removes indigestable matter.
,What are the two most important immunoglobulins involved in immunity? - IgM and IgG
What 2 parts of the CNS control thermoregulation? - Hypothalamus and sympathetic nervous
system
What is hyperthermia and what are the concequences of this condition? - Above 37.5 degrees,
death can occur at over 43 degrees. Heat stroke can occur leading to damage to hypothalamus.
How do you treat hyperthermia? - Slow cooling, and increased h2o and Na losses.
What is malignant hyerthemria? - Is a rare genetic condition that is associated with anesthetics.
What is hypothermia and its concequences? - Core temp below 35 degrees.
Prolonged shivering can lead to decreased glycogen in liver and decreased BGL resulting in
confusion. Hypothalamus doesnt control vasodilation therefore the pt may feel hot. Organs
decrease in function leading to acidosis state and VF.
Pathogenisis of fever - Bacteria toxins and cytokines eg prostaglandins act on hypothalamus to
increase temp set point and head producing mechanisms.
Benefits of fever - Improve immune function by increasing release of cytokines, T and B cells and
phagocytosis. It also acts by decreasing release of nutrients from liver which the bacteria need to
divide. Therefore slowing down infection so that bacteria cannot divide.
Physiological risks of fever - Stress on body, brain damage can occur if fever reaches 41 plus.
Death can occur at 43 plus. Febrile seizures at 39 degrees can occur among children most
commonly.
Definition of Pain - described as an unpleasant sensory and emotional experience associated
with actual or potential tissue damage or described in terms of such damage.
What are the 3 categories of chronic pain? - neuropathic, inflammatory, pathologic
What is the duration of chronic pain? - More than 3 months
, What is the name of the sensory receptor for pain? - Nociceptors
Transmission of pain (4 steps) - 1. Initial injury activates receptors.
2. Transmission of nerve impulses.
3. Transmission of pain via the lateral spinothalmic tracts.
4. Chemicals released leading to change or remodeling in pathway leading to increase in pain
intensity.
Dermatomes - Sensory branches of the spinal cord = 31 nerves. Important during epidurals and
are tested to make sure the diaphragm isn't numbed as this may lead to breathing issues.
Pharmacokenetics aspects - absorption, distribution, metabolism and excretion of drugs into
through and out of the body.
Pharmacodynamics - Looks at how drugs effects the body eg: chemical action, block enzymes,
physical action, acts on receptors.
Agonist Drugs - activates receptors
Antagonist Drugs - blocks receptors
Types of Antipyretic drugs - Non steroidal antinflammatory drugs (NSAIDs) eg: ibuprofen and
aspirin.
Paracetamol
What are the adverse reactions of paracetamol? - Gastric upset
Skin rashes
Hives and itching (urticaria)
Cautions for paracetomol use? - Overdose can occur with hepatotoxicity and renal failure (10 to
15 grams).
4 Aspects of Valid Consent - Voluntary, Specific, Informed, Legal Capacity (18+ no cognitive
impairment)
What are some factors that contirbute to perioperative complications ? - Age: eg elderly have
delayed wound healing.
Lifestyle choices including nutritional status.
Medications
Procedural complications
Environmental/SES
What are some of the risks/issues for a surgical pt with diabetes? - Fasting - monitor BGLs
Best to have surgery in the morning
Effects on wound healing and infection risk
Medication metabolization
Loss of muscle mass - mobilization
What kinds of medications are given preoperativly? - sedation, antibiotics (prophylatic), anti
anxiety, pts regular meds.
What kinds of meds are given in the intraoperative period? - Anaesthics, sedation, muscle
relaxation, pain relief.
What kind of meds are given in the post operative period? - analgesics, laxitives, antibiotics,
antiemetics.
What does the acronym IDEAL stand for in relation to discharge planning? - Include
Discuss
Educate
Assess
Listen
,What is Gilick Competency? - When a child is under legal age for consent but is able to
intellectually about to understand and consent to medical decisions.
What is the role of Power of Attorney ? - POA are not able to make medical decisions. They look
after the pts financials. Only medical power of attorney can make medical decisions on behalf of
the pt.
Documentation structure to follow? A-H (post op) - A- Airway
B - Breathing
C - Circulation
D - Disability
E - Exposure
F - fluids/full vitals
G - Glucose
H - Head to toe assessment
Signs of inflammation - redness, heat, swelling, pain and - or + of function
Pathogenisis of Inflamation - Tissue damage
Mast cells activation: cells release histamine and heparin.
Dilation of blood vessles occur increasing blood flow and vessle permeability.
Clot formation for temp repair ie redness swelling.
Role of histamine in Inflammation - Vasodilation, activates pain receptors to activate
phagocytosis.
Describe the events of phagocytosis. - 1. Phagocyte attaches to pathogen or debris.
2. Phagocyte engulfs pathogen or particles (phagosome)
3. Lysosomes fuse with phagocyte vessle (phagolysosome)
4. lysosomal enzymes digest the particles
5. exocytosis of vesicle removes indigestable matter.
,What are the two most important immunoglobulins involved in immunity? - IgM and IgG
What 2 parts of the CNS control thermoregulation? - Hypothalamus and sympathetic nervous
system
What is hyperthermia and what are the concequences of this condition? - Above 37.5 degrees,
death can occur at over 43 degrees. Heat stroke can occur leading to damage to hypothalamus.
How do you treat hyperthermia? - Slow cooling, and increased h2o and Na losses.
What is malignant hyerthemria? - Is a rare genetic condition that is associated with anesthetics.
What is hypothermia and its concequences? - Core temp below 35 degrees.
Prolonged shivering can lead to decreased glycogen in liver and decreased BGL resulting in
confusion. Hypothalamus doesnt control vasodilation therefore the pt may feel hot. Organs
decrease in function leading to acidosis state and VF.
Pathogenisis of fever - Bacteria toxins and cytokines eg prostaglandins act on hypothalamus to
increase temp set point and head producing mechanisms.
Benefits of fever - Improve immune function by increasing release of cytokines, T and B cells and
phagocytosis. It also acts by decreasing release of nutrients from liver which the bacteria need to
divide. Therefore slowing down infection so that bacteria cannot divide.
Physiological risks of fever - Stress on body, brain damage can occur if fever reaches 41 plus.
Death can occur at 43 plus. Febrile seizures at 39 degrees can occur among children most
commonly.
Definition of Pain - described as an unpleasant sensory and emotional experience associated
with actual or potential tissue damage or described in terms of such damage.
What are the 3 categories of chronic pain? - neuropathic, inflammatory, pathologic
What is the duration of chronic pain? - More than 3 months
, What is the name of the sensory receptor for pain? - Nociceptors
Transmission of pain (4 steps) - 1. Initial injury activates receptors.
2. Transmission of nerve impulses.
3. Transmission of pain via the lateral spinothalmic tracts.
4. Chemicals released leading to change or remodeling in pathway leading to increase in pain
intensity.
Dermatomes - Sensory branches of the spinal cord = 31 nerves. Important during epidurals and
are tested to make sure the diaphragm isn't numbed as this may lead to breathing issues.
Pharmacokenetics aspects - absorption, distribution, metabolism and excretion of drugs into
through and out of the body.
Pharmacodynamics - Looks at how drugs effects the body eg: chemical action, block enzymes,
physical action, acts on receptors.
Agonist Drugs - activates receptors
Antagonist Drugs - blocks receptors
Types of Antipyretic drugs - Non steroidal antinflammatory drugs (NSAIDs) eg: ibuprofen and
aspirin.
Paracetamol
What are the adverse reactions of paracetamol? - Gastric upset
Skin rashes
Hives and itching (urticaria)
Cautions for paracetomol use? - Overdose can occur with hepatotoxicity and renal failure (10 to
15 grams).
