Reference no: EM132341698

Implement and monitor care for a person with acute health problems - Acute Knowledge Assessment

Read each question carefully, and look at the assessment as frequently as you need. Answers describing nursing actions must be within the NMBA role and scope of the enrolled nurse.

QUESTION 1 - Your patient has acute renal failure and has undergone blood testing including the GFR.

State the four degrees of renal failure and include the physiological changes to kidney function as a percentage. (Include one sentence for each degree).

QUESTION 2 - Your patient has renal calculus, which are classified by location within the renal/urinary system.

a) Define renal calculus (use one to two sentences).

b) State the anatomical location for:

Nephrolithiasis

Ureterolithiasis

Cystolithaiais

c) Explain the dietary changes that may be required for patients suffering renal calculus (use one to two sentences).

QUESTION 3 - Your patient is a 76 year man with a history of constipation, hypertension, and arthritis, He is on regular anti-hypertensives and opioids. He has been admitted with an acute bowel obstruction. Doctors orders include Nil by mouth, administer and monitor IV hydration, administer IV analgesia, bowel movements and insertion of an NGT which is to be placed on straight drainage with 4 hourly aspirations.

Choose three required nursing interventions for this patient and explain why each intervention is required (explain your answer using two or more sentences for each intervention).

QUESTION 4 - Your patient has presented with a suspected appendicitis. Report to the RN the signs or symptoms your patient may have presented to ED with. Explain the reason the patient my be presenting with these signs and symptoms (Minimum three answers, with one sentence per answer required).

QUESTION 5 - Your patient was admitted via ambulance with suspected ruptured cerebral aneurysm. Explain to your patient's family (using appropriate language) the pathophysiology of this condition (use a minimum of one paragraph in your answer).

QUESTION 6 - An 18 year old woman has been admitted to your ward after a generalised seizure and has been diagnosed with epilepsy. Explain to this patient's family, using language the family may understand, the pathophysiology of a seizure (short answer question, minimum two paragraphs are required).

QUESTION 7 - Acute pain can be caused by many factors, conditions, injuries or diseases. Referring to RPH Nursing Practice Standard for pain management:

a) Describe how you would undertake an acute pain assessment (use one paragraph in your answer).

b) Identify different mechanisms of acute pain by completing table below and include at least two pain descriptions and two examples of the types of conditions causing acute pain.

Pain Mechanism	Description	Examples
Somatic Pain
Visceral Pain
Neuropathic pain

QUESTION 8 - Match the correct definition to the following respiratory conditions

i. Pneumothorax

ii. Haemothorax

iii. Pleural effusion

A. Blood in the pleural space causing partial or complete collapse of the lung.

B. Excess serous fluid in the pleural cavity.

C. Air in the pleural space causing complete or partial collapse of the lung.

QUESTION 9 - Complete the table below - describe the pathophysiology and signs and symptoms of acute respiratory disorders, using language the patient may understand (use two to three sentences per disorder).

Disorder	Pathophysiology
Pneumonia
Pulmonary Embolism

QUESTION 10 - You have found taken handover and entered your patient's room and found them unconscious.

a) Explain three potential causes of an acute unconscious state (use one to two sentences for each potential cause in your answer).

It is found that you patient is hypogylcaemic with a BGL of 1.5 mmoL.

b) Explain the nursing intervention required for this patient (use one to two sentences in your answer).

QUESTION 11 - Angina: a) Differentiate between stable angina, unstable angina and Prinzmetal angina. Include the cause of the disorder in your answer (use a minimum of one paragraph for your answer).

b) Explain to your patient the actions they should take if they are experiencing an episode of acute angina at home (50-100 words).

QUESTION 12 - a) Review the attached picture Rule of 9s.jpg and your readings/videos. Explain the 'Rule of 9s' (use two to three sentences to explain your answer).

b) Identify and describe three nursing interventions for a patient suffering from acute burns. Include both physical and psychological impacts that may require nursing intervention. Include a rationale for each intervention (use one to two sentences for each intervention).

QUESTION 13 - Explain the burns classification system. Include a brief description of the classification and the layers of the skin involved (two or more sentences are required for each classification).

QUESTION 14 - Cellulitis is a condition:

A. Caused by a fast spreading infection in the epidermis that infiltrates the subcutaneous layers

B. Caused by a fast spreading infection in the dermis that infiltrates the subcutaneous layers

C. That can include swelling of the lymph nodes draining the area

D. Caused by a slow spreading infection in the dermis that infiltrates the subcutaneous layers

QUESTION 15 - You are caring for a patient with cellulitis

a) Explain the treatments required for both mild and severe cellulitis to your patient.

b) Explain to your patient the potential physical and psychological impact of the condition on their daily living activities. Use one paragraph for each answer. (Using 50-100 words in total).

QUESTION 16 - a) Why is someone with a deep vein thrombosis (DVT) at a higher risk of developing a pulmonary embolism (PE)? (Use a minimum of two sentences in your answer)

B) Describe the three main types of DVT that can be found in the legs (use one paragraph in your answer).

QUESTION 17 - Explain four risk factors that may increase the likelihood of developing a 'venous thromboembolism' such as a pulmonary embolism (using a minimum of one paragraph in your answer).

QUESTION 18 - Explain the physiology of three (3) symptoms and /or clinical signs for a patient with dehydration. (Use at least one sentence to explain each of the three examples required).

QUESTION 19 - You have a patient who has experienced a fall and has been admitted pre-operatively for the management of a fractured neck of femur.

Refer to the Royal Perth policy document on a fractured neck of femur pre-operatively. Describe the nursing interventions for managing a fractured neck of femur, and explain your reasoning. Include a minimum of five nursing interventions (long answer required).

QUESTION 20 - Your patient has fractured their pelvis in three (3) places following a motor vehicle accident. This has been surgically treated with an open reduction and internal fixation and you are responsible for their nursing care post-operatively.

a) Based on your understanding of this patients acute health condition and treatment, identify the impact this will have on the patient's daily living activities in the first day post-op. State three (3) actual or potential changes in the patients daily living activities (nursing problems), and two (2) relevant nursing care actions you would implement for each identified nursing problem. (Use one sentence to describe each actual or potential change and one sentence for each nursing care action).

Actual or Potential Change in the Patients Daily Living Activities	2 Nursing Care Actions to Manage these Nursing Problems
	Nursing Action 1 Nursing Action 2
	Nursing Action 1 Nursing Action 2

b) Your patient has complained of pain, and has a pain score of 7/10. After reviewing the patients charts you identify that paracetamol 1gram was administered one (1) hour ago, and ibuprofen 400mg, two (2) hours ago.

Based on this information, what nursing action will you implement? (use one to two sentences in your answer).

QUESTION 21 - A new patient has been admitted with the diagnosis of internal bleeding following a motor vehicle accident.

a) List three (3) symptoms and/ or clinical signs for a person experiencing internal haemorrhage due to trauma?

b) Describe three (3) nursing observations/assessments you would implement to monitor this patient to identify possible changes in their condition, include in your answer the possible changes which may indicate haemorrhage (one sentence per intervention is required).

QUESTION 22 - You are caring for a patient who has a closed head injury following a sports injury. The doctor is awaiting results from an MRI scan to confirm the final diagnosis of contusion or concussion.

A) Explain the difference between concussion and cerebral contusion. Your answer should include signs & symptoms (Use two paragraphs in your answer).

QUESTION 23 - Your patient is admitted with a myocardial infarction.

A) List three (3) of the most common signs and/ or symptoms a patient could present with for a myocardial infarction? (Three sentences required in your answer).

B) Describe the psychological needs of your patient with this diagnosis, and how you would provide them with psychological support, within your scope of practice (two or more sentences required in your answer).

QUESTION 24 - You are caring for a patient who has been an inpatient for an extended period of time following major surgery. The patient has developed a severe infection, with severe sepsis and is possibly developing septic shock.

A) List 4 (four) signs and / or symptoms of severe sepsis.

B) As a nurse, why is recognising and promptly reporting these changes in the patients condition essential for this patient? (use one to two sentences to explain your answer)

QUESTION 25 - Shock is a life threatening medical emergency, with different causes and types.

A) List and explain four (4) types of shock (use a minimum of four sentences in your answer).

B) What are your first actions for a patient in shock? (use one or more sentences in your answer).

QUESTION 26 - On assessment your patient presents with the following clinical observations post cataract surgery.

• Airway Clear
• Breathing: Respiratory rate of 40
• Circulation: Pulse rate 145
• Systollic B.P of 85
• Urinary output 100mls/hr
• GCS 15/15 and Alert

(The patients baseline observations prior to surgery were RR16, B.P 130/80, Pulse 78, and GCS 15/15).

a) According to in hospital emergency management protocols what action/call do you initiate?

b) Which clinical observations lead you to your decision? (Include MER criteria in your answer, use three sentences in your answer.).

QUESTION 27 - Your patient becomes unresponsive and is not breathing. Use the BLS algorhythm to explain the protocol for managing the patient, include all parts. Long Answer required.

QUESTION 28 - You are caring for a patient day 1 post op with a fractured neck of femur (NOF). You find him on the floor looking pale, clammy and complaining of pain. Refer to the Post-Fall Management Guidelines in WA Healthcare Settings guidelines and describe the immediate first aid you will provide using the immediate post fall procedures. Long answer required.

QUESTION 29 - Give the rationale behind the following pre op nursing actions for a patient undergoing a total hysterectomy via a laparotomy approach? Use one sentence for each rationale.

Action	Rationale/Why?
Fasting
Removal of jewelry
Shave
Observations
Height and Weight

QUESTION 30 - Mrs Wren is undergoing a cataract extraction.

As the nurse caring for this shift, detail the health education you would provide to her about her upcoming procedure? (Use one paragraph in your answer).

QUESTION 31 - What is the frequency of routine post op observations on a patient following an Above knee amputation (AKA)?

15mins for the first hour then stop

15-30mins for 2hrs, 1hrly for 2 hours, 2hrly for 4hrs, 4 hours for 24hrs

What you as the nurse deem appropriate

15-30mins for 2hrs, 1hrly for 1 hour2, 2hrly for 2hrs, 4 hours for 24hrs

QUESTION 32 - You patient is returning to the ward post-op following a Trans- Ureatheral Resection of the Prostate (TURP). Explain the required equipment and reason for use, that you would set up to prepare for the arrival on the ward, of your patient post-op.

Include four items of equipment and their reason for use (minimum four sentences are required ).

QUESTION 33 - Samantha Goodlet is day 2 post-op following surgery for her double mastectomy. She has an indwelling catheter in situ, post-operative pain, wound drainage via two medinorm vacuum drains and her wound dressings remain intact. Today her goals for care include getting out of bed to walk outside her room with the physiotherapist, and then having a shower.

As part of her care for this shift, identify who you will manage her post-operative pain according to the following headings.

a) Assessing and documenting her post-operative pain

b) Non-pharmacological pain relief

c) Pain relief prior to mobilising with the physiotherapist and having a shower

(Use one to two sentences for each answer a, b and c)

QUESTION 34 - While performing post-operative observations on Mrs Jones, following her general anaesthetic she is not waking up as quickly as expected.

a) What might indicate to you that she has not waking up as expected post-op? (Use one to two sentences are required).

b) Which type of observations will you implement to assess her level of consciousness and possible deterioration? (one sentence is required).

c) What is the name of the tools you will use to record your observations and complete the assessment? (one sentence is required).

QUESTION 35 - Postoperatively patients may receive fluid by a variety of different routes.

For each route given, list three (3) nursing observations that an enrolled nurse would perform to monitor fluid balance or ensure safety of the patient receiving fluid via this route.

Preferred   Route	Observations Required (3 for each route)
1. Fluid intake IV
2. Fluid intake CVC
3. Fluid intake TPN
4. Fluid intake Oral
5. Fluid intake NG

QUESTION 36 - On admission Safeh Muhammed has now returned to the ward following her double mastectomy. She is alert, orientated and tolerating light diet and fluids. She has a catheter in situ, post-operative pain, wound drainage, wound dressings and reduced mobility, increasing her risk of complications from acute bed-rest post-op.

Complete the following table to identify observations you would implement post-op to assess her risk or identify symptoms of developing a complication of acute bed-rest during this post-operative period.

Possible complication	Observation/s to Assess Risk or Identify complication
Pressure Injury	List one assessment tool
Deep Vein Thrombosis (DVT)	State at least 2 observations:
Post-operative chest infection	State at least 2 observations:

QUESTION 37 - Mrs Jones nursing care plan states she needs to mobilise on day one post-op. It also requires a re-assessment of her falls risk prior to mobilising.

Why does Mrs Jones require re-assessment using the Fall Risk Assessment and Management Plan Day one post op, when one of these was completed the previous day as part of her patient admission? (Use a minimum of two sentences in your answer).

Access Mrs Jones's fall risk assessment on admission here: sam jones framp.pdf.

QUESTION 38 - You have a patient with a temporary tracheostomy tube inserted. The patient requires suctioning and you have gathered the relevant equipment.

Refer to the RPH policies and procedure guidelines to complete following table and describe the steps for performing tracheostomy suctioning for this patient.

One sentence required per answer.

How do you ensure principles of WHS and infection control are maintained during the procedure?

How do you ensure informed consent and patient co-operation during the procedure?

What do you do if a fenestrated tube is in situ?

How do you check suction is present after connecting the suction catheter?

What action is implemented for patients at risk of post-suctioning hypoxia? (2 actions required)

How/ where is suction created on the suction catheter?

How long is the maximum period for suction to be applied continuously during this procedure?

QUESTION 39 - You are caring for a patient who has had an intercostal catheter (ICC) inserted, that has also been connected to an underwater drainage system (UWSD), without suction. Post insertion of this ICC state how you would perform the nursing interventions required to manage the ICC, drainage tube and the drainage system in the first 24 hours following insertion.

Include dot point descriptions of the nursing interventions required, according to the following table. Must include the required infection control, observations/assessments and documentation. Long Answer required.

NURSING ACTION	HOW TO PERFORM THIS NURSING INTERVENTION
Care of the drainage tube and system and under water seal drain to ensure patency and drainage
Care of the intercostal catheter (ICC) and insertion site

QUESTION 40 - Complete the following table to list nursing actions you can implement as an enrolled nurse to monitor the patient using different medical devices. List three (3) nursing observations for each device.

Medical Device	Nursing Observations to Monitor the Patient When Using Medical device
CPAP (Continuous Positive Airway Pressure)
BiPAP (Bilevel Positive Airway Pressure)
Peripherally Inserted Central Catheter (PICC)

QUESTION 41 - Surgical procedures can be categorised as the surgery either being Elective Surgery or Emergency Surgery. Your patient has been booked for elective surgery.

To assist the patients understanding of the care being implemented, describe how you will explain the difference between elective surgery and emergency surgery to your patient? (Use two paragraphs in your answer)

QUESTION 42 - Patients undergoing surgery require different type of anaesthesia to help with their pain during and after the procedures. Specific nursing interventions are also associated with these types of anaesthetic.

Complete the table below and provide:

a) A description of the anaesthesia used (one sentence for each type is required)

b) List 3 nursing actions you would implement to monitor the patient post-operatively who has been treated with each type of anaesthesia.

Type   of Anaesthesia	Description	Three  Nursing Actions to be Undertaken Post Operatively
General
Local
Spinal
Epidural
Peripheral Nerve Block

QUESTION 43 - Your patient has returned to the ward following surgery for a below knee amputation. The stump has a firm bandaging and a cast in situ when the patient returns to the ward area.

Describe three (2) nursing care actions you will implement for the post-op care of the stump (minimum of two sentences are required).

QUESTION 44 - Your patient has returned to the ward following an open reduction and internal fixation (ORIF) of a fractured left radius.

a) How does this surgical procedure treat the fracture? (one to two sentences are required in your answer).

B) The principles of post-operative care include minimising post-operative swelling in the limb. Explain one nursing action you can implement to reduce swelling in the limb post-op (one sentence are required in your answer).

QUESTION 45 - You are caring for a patient who has had a right total hip replacement. The principles of post-operative nursing care include preventing dislocation of the hip post-op.

Describe three (32) nursing actions you will include in the nursing care plan to reduce the risk of post-op dislocation. (Minimum three sentences is required in your answer).

QUESTION 46 - You are caring for a patient who has had a craniotomy. The post-operative nursing care includes frequent neurological observations.

What is the rationale for these frequent nursing observations? (Use a minimum of two sentences in your answer).

QUESTION 47 - Amy is aged 12 and is booked for a tonsillectomy.

A) What is a tonsillectomy? (one to two sentences required)

B) Describe the nursing action that will be implemented for Amy post-op to reduce the risk of infection, plus clean the throat and promote healing. (one to two sentences required)

QUESTION 48 - What are the principles of nursing for an appendectomy patient postoperatively?

Describe four (4) nursing interventions. (Use four sentences in your answer).

QUESTION 49 - Your patient is booked for an exploratory laparotomy to determine the source of internal bleeding following a motor vehicle accident.

A) What is a laparotomy? (Use one sentence in your answers).

B) What will the surgeon do when the source of the bleeding is located? (Use one sentence in your answer).

C) The post-operative nursing care plan includes orders for nil orally and intravenous fluids. Explain why the patient is on nil orally, and also receiving IV fluids following this surgical procedure (use one sentence for each action).

Nursing Care Action	Rationale for this Nursing Care Action
Nil orally
IV Fluids

QUESTION 50 - You are caring for Samantha Goodlet, a patient who has had a vaginal hysterectomy. Describe four (4) post-operative nursing actions for a patient who has had a vaginal hysterectomy (Uses four sentences in your descriptions)

QUESTION 51 - Mr Ian Knight has returned to your ward following a Transurethral Resection of the Prostrate (TURP). He has a bladder wash-out in progress.

Describe the management of this bladder wash-out (using one paragraph for your answer).

QUESTION 52 - Mrs Wren has had a cataract extraction as a day surgery procedure.

As part of your surgical nursing care you provide discharge advice to the patient. Describe four (4) post- operative instructions you will include in the discharge advice for this patient, following removal of her cataracts (Use one paragraph for your answer).

QUESTION 53 - Define the following surgical terms:

i. Above Knee Amputation

ii. Hysterectomy

iii. Laparotomy

iv. Appendectomy

A. Surgical removal of the bones below the knee

B. Large abdominal incision

C. Removal of the uterus

D. Removal of the appendix

QUESTION 54 - Safeh Mohammed is a 45 year old lady and had a recent diagnosis of breast cancer, she is scheduled for a double mastectomy at 1500hrs today. Samantha is appearing very anxious and teary about the pending operation and her post-operative recovery.

Describe 3 referrals to multi-disciplinary team members the nurse may make, and the rationale for each referral. Use one sentence to describe each referral you will make.

QUESTION 55 - Devise a care plan using the holistic approach to care in the acute care environment including nursing interventions and outcomes.

Safeh Mohammed patient is on the ward for pre-operative preparation for a mastectomy and resconstruction and requires a holistic care plan. Safeh speaks limited English and requires some assistance to understand the surgery and post-op care she will require. She is 45 years old and a devout Muslim and has requested some support to continue her spiritual practices. She is concerned about the ongoing care of her 4 school age children while she is in hospital as her husband works full time. She currently is suffering from migraines due to stress.

Identify 4 nursing problems, and devise at least one nursing intervention for each problem. Include the expected outcomes and remember you are making a plan with an holistic approach.

Attachment:- Acute Knowledge Assignment File.rar