Reference no: EM132229633 , Length: 5000 Words

Question 1. List the common causes of unconsciousness under the following headings:

Blood Oxygenation Problems

Metabolic Problems

Blood Circulation Problems

Central Nervous problems

Question 2. A MET call is used to identify a potentially deteriorating patient. Outline the changes to the patient's condition that may indicate that they are deteriorating and that you need to call a MET call.

Question 3. From the list below, place the appropriate roles that each of the emergency response team may be involved in during an emergency situation.

A. Medical Officer
B. Anaesthetist -
C. Senior RN (ALS)
D. Ward RN / EN

Question 4. List the emergency equipment that must be checked on the resuscitation trolley

Question 5. List the emergency equipment that must be checked at the bedside.

Musculoskeletal

Question 1. Which of the following are common forms of traction?
Circle the correct response:

1. Simple Buck's Traction

2. Manual Traction

3. Plaster of Paris

4. Hamilton Russell Traction

5. Skeletal Traction

6. All of the above

Question 2. What are the indications for traction?

Question 3. What equipment is necessary to apply non-adhesive skin traction?

Question 4. How can counter traction be accomplished in the clinical setting?
Please circle the appropriate response:

• Trendelenberg tilt the foot of the bed upwards

• Raise the head of the bed only

• Raise the foot of the bed only

• Keep the bed flat

Question 5. When applying non-adhesive skin traction should the bandage be applied above the knee?

YES NO
Question 6. If the bandage supplied with the traction kit is soiled can a crepe bandage be substituted?

YES NO
Question 7. When applying the traction apparatus should the footboard be placed very close or against the patient's foot?

YES NO
Question 8. You are caring for a patient with a fracture shaft of femur who is in 6 pounds of non-adhesive skin traction. Describe the necessary nursing observations under the following headings:

Question 9. When skin traction is applied the management of the apparatus is essential to maintain even, balanced traction. Answer the following by choosing the correct response/s:

a. Which of the following aspects should apply to the ropes connecting the traction to the weight bag?

• No weight applied directly onto the ropes

• Ropes free from knots and twists

• Frayed ropes should be discarded & changed

• All of the above

b. Which of the following aspects should apply to the weight bag?

• Weight bag should hang cleanly above the floor
• Water or sand can be used to fill the bag
• No more than 8 pounds should be applied
• If there is a hole in the bag it can be patched up with sleek
• All of the above
c. Which of the following aspects should apply to the pulleys?

• Pulley should run in a straight line from the leg to the bed
• Pulleys should allow the ropes to run freely
• All of the above
d. How frequently should skin traction be removed?
Circle the correct response:

• Once a day
• Once per shift
• Should remain intact
• Every 2 days
e. When applying skin traction what position should the patient be in?

• On their side
• Supine
• Semi upright
• With counter traction applied
f. When applying the bandage to secure skin traction how should it be applied?
Circle the correct response:

• Circular application
• Figure of eight application
• Requires more than one bandage
• Spiral application

Question 10. When attending to neurovascular observations, should they be performed on the affected limb only or should they be performed on both the affected and non-affected limbs? Why?

Question 11. What are the complications associated with the application of traction?

Question 12. Is a medical order required to apply skin traction and should the exact weight to be applied be documented by the Medical Officer?

YES NO

Question 13. The common perineal nerve is close to the surface in certain areas of the lower leg. Which particular areas should be covered with soft padding or avoided when bandaging? Circle the appropriate response/s:

• Malleoli
• Head of the fibula - lateral aspect
• Patella
• All of the above

Question 14. Should the footboard of the traction apparatus always be clear from the foot of the bed?

YES NO

Pre & Post Operative Management

Your patient Mr Smith has been admitted electively to undergo an Open Cholecystectomy for impacted gallstones. You are the nurse that is responsible for admitting the patient and preparing them for theatre.

1. List all the requirements that must be undertaken to ensure that this patient is fully prepared for theatre. There are sub headings to help you to ensure all areas have been completed.

2. Another one of your patients is returning from theatre after having a spinal anaesthetic. What is a spinal anaesthetic and what nursing observations must be undertaken on your patient who has undergone a spinal anaesthetic?

3. What are your responsibilities to prepare the patient environment for your patient returning from theatre?

4. Before bringing your patient back to the ward you must receive handover of your patient from the recovery nurse. What information must you ensure that you receive during this handover?

5. On return to ward (RTW) - your patient is complaining of pain. What post-operative comfort strategies could you consider to provide adequate pain management for your patient?

6. Your patient Mr. Smith has returned from theatre after having the open cholecystectomy under general anesthetic. He will return with the following:

7. List 5 common post-operative complications that you could be expected for Mr Smith in the immediate postoperative period?

8. Define the following surgical terms

A. Local Anaesthetic

B. Spinal Anaesthetic

C. Caudal Block

D. Epidural Analgesia
E. Peripheral Nerve Block

Explain then following surgical terminology

A. Amputation
B. Open reduction
C. Hip replacement
D. Craniotomy
E. Tonsillectomy
F. Appendectomy
G. Laparotomy
H. Hysterectomy
I. Prostatectomy
J. Cataract extraction

9. Outline the signs and symptoms that may indicate internal bleeding in your patient that presents after surgery from a major trauma.

Respiratory
1. Outline the following common respiratory terminology.
• Dyspnoea
• Tachycardia
• Tachypnoea
• Wheeze
• Cyanosis
• Dysphagia
• Pyrexia

2. Your patient suddenly has difficulty breathing and has become short of breath. Outline the important nursing care that you will undertake to assess and manage this patient.

3. Outline the important aspects of oxygen therapy. Include safety aspects and monitoring of your patient.

4. What are the acceptable oxygen flow rates to be used when administering oxygen via the following types of masks?
Nasal prongs: 1 - 4 litres per minute and concentration of oxygen is 24-40%

Hudson Mask: 15 litres per minute

5. What fluid type should be utilised in the humidification systems?
Circle the correct response:

• Sterile Water
• Normal Saline
• Fresh Water
• 5% Dextros

6. When delivering nebulisation therapy to your patients what type of gas flow should the nebuliser mask be connected to?
Circle the correct response:

Patient with no COPD History

• Oxygen
• Air
• Does not matter
Patient with a known COPD History (CO2 Retainer)

• Oxygen
• Air
• Does not matter

7. You are required to administer nebulisation therapy to your patient. What is the best position for administration?
Circle the appropriate response:

Patient position:

• Lateral
• Sitting upright
• Supine
• Semi upright

8. After completion of the nebulisation therapy what should the nurse instruct the patient to perform?

9. Which of the following is an early indicator that a patient's oxygen levels in their blood may be reduced or inadequate?
Circle the correct response:

10. Define the following terms

• Pneumothorax

• Haemothorax

• Empyema

11. Your patient has been admitted to hospital with a suspected pneumothorax. Outline the normal sites for insertion of intercostal catheters in the following situations:

12. After having a chest x-ray performed the pneumothorax has been identified. An ICC has been inserted and connected to an UWSD bottle system. Describe the function of the following components on the underwater seal drainage system under the following headings.

Underwater seal chamber:

Suction control chamber

Drainage chamber

13. What observations must the nurse perform when caring for the patient with an underwater seal drainage bottle? Use the following headings

The Patient

The UWSD & ICC

14. The position that the UWSD system should be kept in an upright position and always below the level of the chest.
TRUE FALSE

15. In what chamber would an air leak be observed?
Circle the correct answer

• Suction control chamber

• Water seal chamber

• Drainage chamber

16. What chamber would you be able to identify a swing?
Circle the correct answer.

• Suction control chamber

• Water seal chamber

• Drainage chamber

17. When assessing the underwater seal system you note that there is NO swing present. What might this indicate?

18. Define the following terms:

19. To commence CPAP therapy in the ward setting is it necessary for the medical officer to prescribe a particular level of PEEP?

YES NO

20. List the 3 common indications for CPAP therapy

21. When would CPAP therapy be contraindicated for a patient?

22. If your patient has labile blood pressure can the application of CPAP therapy further drop their blood pressure?

YES NO

23. Your patient has been admitted with pneumonia. What psychological supports and care could be required due to the impact of their acute respiratory condition?

Neurological

Clinical Scenario 1

Gary is a 45 year old male. He presented to the emergency department after a fall from a first floor window last night. He had been out drinking at a work function and had forgotten his house keys. His wife called an ambulance this morning as Gary was very agitated and appeared to have a weakness in his left arm and leg. She also noticed some blood loss on the pillow from a gash on Gary's head.

Using the headings below, state how you this patient will be managed.

a. What do you think has happened to Gary? What condition may he have sustained?
b. What assessments will you undertake on Gary considering your initial thoughts on his potential condition?
c. You are required to undertake neurological observations. How will you ask the questions to complete a correct Glasgow Coma Scale for Gary and what does this involve? Give examples of your questions.

d. What complications may occur from the injury that Gary presents with?

Clinical Scenario 2
Mr Ken Nyugen is a 56 year old male who has been admitted to the acute medical ward with an ischaemic stroke. He initially presented by ambulance after being found slumped in a chair at home by his daughter. On initial presentation to the emergency department the following assessment data was obtained:
GCS 11/15
PEARL 4 pupils equal and reactive to light
RR 20
BP 210/100
HR 50 Regular
12 lead ECG Right Bundle Branch Block - old
SpO2 92% RA
Course crackles right lower lobe
T 37.5
Left hemiplegia
Aphasia
Dysphagia
Incontinence

a. Detail how you would perform your physical assessment of the client.

b. What is Mr. Nguyen's main risk factor that may have contributed to this CVA?

c. Explain the different causes or types of CVA.

d. What are some of the other risk factors of Stroke?

e. What is dysphagia?

f. What are some indications of dysphagia?

g. Explain the nursing management for Mr. Nguyen in the acute setting? What care interventions will be required?