Cardiovascular System Review

The three body systems I am revising and expanding my knowledge on this semester are cardiovascular, respiratory and neurological. These are the systems that are most relevant to what we're learning in classes and on placement. I'm reading three different textbooks for each, and then doing the review questions at the end of the chapter in one of the textbooks. I recently completed Cardiovascular System Anatomy, Physiology, Diseases and Disorders. Here's a summary:

1. Which of the following risk factors are controllable or modifiable?
a. Heredity b. Diet c. Age d. Stress
e. Smoking f. Exercise

2. Which of the following statements are correct in relation to coronary artery disease?
a. It is often called coronary heart disease.
b. Slow, progressive occlusion of arteries often leads to development of collateral arteries that extend into ischaemic tissue, providing some protection against infarction.
c. It will always lead to a myocardial infarction.
d. Diagnosis of CAD is made by evaluating the history, ECG, and angiograms.
e. The disease is commonly due to atherosclerosis.

3. Define the following terms related to haemorrhage:
a. Petechiae – small pinpoint haemorrhages (like varicose veins)
b. Ecchymosis – larger area of purplish colour commonly called a bruise
c. Purpura – spontaneous bleeding into the tissues related to a haemorrhagic disease that may be characterised by both petechiae and ecchymosis.

4. What are the functions of the cardiovascular system?
The most basic function is to pump blood around the body and supply all organs and tissues with freshly oxygenated, nutrient rich blood. Waste products of cell function are removed with the blood as it leaves . The cardiovascular system also transports other vital substances, such as hormones and immune cells.

5. Which signs and symptoms are associated with common cardiovascular system disorders?
Dyspnea (difficulty breathing), fatigue, tachycardia (rapid heart rate), chest pain, pain in the left arm and/or jaw, heart palpitations, sweating, edema in the extremities, nausea, vomiting, cyanosis.

6. Which diagnostic tests are most commonly used to determine the type and/or cause of cardiovascular system disorders?
Auscultation of the chest, blood pressure measurement, ECG, angiogram, blood test, cardiac catheterisation.

7. What symptoms are usually seen in congestive heart failure?
Gradual increase in dyspnea, tachycardia, tachypnea (rapid breathing), neck vein distension, edema in the ankles and lower legs.

8. What is the difference between phlebitis and thrombophlebitis?
Phlebitis is the inflammation of superficial veins and may be caused by injury, obesity, poor circulation, prolonged bed rest, and infection. Thrombophlebitis is the development of a clot in an inflamed vessel. Clots in superficial veins rarely embolise (break loose and travel), but clots in deep veins often do and are a serious concern (deep vein thrombosis).

9. What are the most common signs and symptoms of shock?
Extremely low blood pressure, facial pallor, cool and clammy skin, cyanosis, tachycardia, tachypnea, altered mental status, syncope (fainting), unconsciousness, oliguria (lack of urine).

10. What are some of the changes occurring in the cardiovascular system with age?
The heart muscle loses some of its contractility, causing decreased cardiac output and/or increased heart rate to compensate. Vessels lose elasticity and become more rigid and narrowed. Valves become thick and sclerotic and lose some functioning. Decreased peripheral circulation results in cool and pale extremeties, improper healing, and edema in the legs and feet.

Homework summary

In addition to my placement I've also being doing a lot of study recently. I have to, because it's relevant to what I'm doing on placement, so will help me get more out the experience, and I have assignments and homework tasks due.

Here is everything I've got done in the last 1 - 2 weeks:

Lectures
• Psychiatric Complexities in Acute care settings
• Pain management in the acute care setting
Reading
• Excellence in practice: technology and the registered nurse
• Establishing and maintaining a professional profile
• The theory-practice gap in clinical practice
• Reflective practice for the graduate nurse
• Anatomic and physiologic overview of neurological system – neurons, neurotransmitters, the brain (cerebrum, brain stem, cerebellum), structures protecting the brain, cerebrospinal fluid, cerebral circulation (arteries and veins), blood-brain barrier,
• Neurological Observation
• Professional Learning Outcomes Assignment (1600 words)- this assignment included a cover letter, curriculum vitae, and essay about my learning needs in order to transition confidently from student to graduate nurse. I finished it over the weekend and am handing it in today.

Neuro placement - week 2

I'm about half way through my placement, still have 8 days to go, and am loving it.

This week I've been doing nursing care for an elderly Russian man who speaks very limited English and had come into the ED after having increasing headaches over the last 12 months, and then had some kind of seizure while driving. The did a CT Brain scan and found something looking like this:


Then they did a craniotomy to take a biopsy and it turned out to be Gliobastoma Multiforme, one of the worst kind of brain tumors which has a very grim prognosis - 6 months to a year. After the surgery. A few days after the surgery he went into a coma for about 24 hours. As part of the neurological observations we had to do sternal rubs and press hard on the nail beds to inflict pain (to assess whether the brain is responding to painful stimulus). It leaves a pretty nasty bruise when it is done over and over.

I accompanied him to get an EEG done which measures the electrical activity of the brain. His brain function was normal and they did some other test where they lift up an arm and it flops back down to the bed quickly when let go. However when the arm was lifted and let go close to the face, the arm stopped falling a couple of centimetres from the face, which showed that there was some kind of consciousness there because otherwise they would have hit themselves in the face. The findings were consistent with a psychogenic pseudo coma which is a state mimicking acute unconsciousness with intact self-awareness, due to severe depression, inability to cope, near death experience and a number of other factors. They become 'locked-in' to this state.

As soon as the patient's family left, I decided to check on him and he started waking up! Since then he has been awake and fully conscious and has also said he can remember everything his family were saying to him while he "was asleep" and complained that people kept "pinching and punching" him. So bizaare.

Another patient I had this week had epididmo-orchitis which is inflammation of the testicles, causes by trauma or STD infection. He said he was hit in the balls by a soccer ball. It make the testicle that is inflamed change shape and become really large so they are in a lot of pain and have difficulty walking. He was given IV antibiotics and pain relief.

If you want to see what it actually looks like you can do a google image search. Decided not to put a picture of someone's inflammed testicles on my blog, lol.

Yesterday two males in their 20s were admitted after a single vehicle car crash. Lots of lacerations to the face and body from smashing the windscreen, but no seat belt bruises on either of them. They both said the other one had been driving and they both had illicit drugs in their system. They had neck braces on and were supposed to be lying straight and avoid moving their spine until it could be confirmed that they didn't have any spinal fractures, but they were both completely non compliant and insisted on getting out of bed and taking their neck brace off because it's too tight. Idiots!

Had my first formal feedback from my clinical educator and she thinks I'm doing really well. She said my strengths are: performing nursing care in accordance with recognised standards of practice, seeking additional knowledge when presented with unfamiliar situations, demonstrating increased responsibility and accountability, approaching patient assessments in and organised and structured way, and ensuring my nursing practice is sensitive and supportive to cultural, social and psychological issues. The things I need to develop are my drug knowledge and interpreting supplementary data such as blood test results to help me plan care and interventions for my patients.

Last night I slept for 12 hours to catch up on sleep debt. Today I'm working on an assignment that's worth 40% and due Monday.

Neurosurgery clinical - Day 2

Very long and productive day today. From 9 - 11am I had a lab class in which we did Basic Life Support (CPR) practice and refresher, nasogastric tube insertion, and epidural management. Not all nurses can insert and remove epidurals, you have a gain specific accreditation at least a couple of years into practice. But we will be expected to assist, assess and document.

Then I had a break and spent some time in the library researching for my assignment that I'm currently working on. Reading I did today:
• Australian Nursing and Midwifery Council National Competency Standards for the Registered Nurse
• Continuing Competency Framework
• Managing the Transition from Student to Graduate Nurse
• Becoming a competent, confident, professional practitioner
• Becoming part of a Team
• Managing approaches to nursing care delivery

Following that I had a very interesting shift with some new experiences:
• Neurological observations on a patient with Post Traumatic Amnesia (he was assaulted to the head in a nightclub)
• Neurological observations, full nursing care (hygiene), pressure area care, and drug administration via PEG (directly to the stomach) on an unconscious patient.
• Care of a patient with halo brace, accompanied him to his x-rays and helped him sit up and get out of bed for the first time since his accident.



I didn't get home till 10:30pm. Luckily tomorrow I am on afternoon shift again. But then on Wednesday I have an early start. I don't like late finish then early start because it is impossible to get 8 hours sleep in between. The most I could get would be six hours. If I get home at 10:30 there's no time to wind down afterwards, and I have to be up again at 5:00am to shower, have breakfast, catch the tram and be there again by 6:45. I'm not complaining but I wouldn't like to have to do that on a regular basis. It really messes with your body clock.

3rd year clinical - first shift

I did my shift on Friday even though I'm not 100% better. My clinical educator said it was ok. I was still coughing a bit and felt guilty but I made sure I did hand hygeine all the time and I made it through the shift, and there were actually a few other staff members with what sounded like the same cough as me, so I didn't feel so bad.

I am on the neurotrauma and neurosurgery ward, which has some overflow from the orthopedic ward too. The patient I was mainly looking after was an orthopedic patient - an 80 year old Greek lady with the broken femur who was day 4 post surgery and needed full nursing care for everything. She had a 'pad' which is actually an adult nappy, but they call it a pad because I guess it doesn't sound as bad, and was having diarrhoea. The pad needed changing 3 times during my shift and because even rolling to her side caused a lot of pain, 2 nurses were needed to change it. The smell was so bad. I don't know if I'll ever get used to dealing with faeces, but it's part of the job. I feel sorry for people who are incontinent and it makes me never want to get to that state. All the more reason to keep up my yoga and pilates and try to keep my bowels healthy.

Did my first blood transfusion on her as well (her haemoglobin levels were low after the surgery) which was good after learning all about it last year but not having had a chance to do it yet. Had to educate her first about the reasons using simple language because her English was a bit limited, then get consent, do the baseline assessment and monitor for adverse reactions, as well as set up and start the actual transfusion.

Also did my first drug administration per vagina. Not as bad as it sounds. The tablet comes in a disposable applicator. Just like inserting a Tampax tampon. It was an oestrogen tablet that absorbs at the site of the cervix.



Also removed an IV catheter for the first time. My nurse buddy was very nice and I think we worked well together. She's young and only a couple of years out. I'll be working alongside her for all of next week too. I'm glad I wasn't asked to come in this weekend to make up the shifts I missed, better to have the weekend to recuperate and make up the shifts when I'm fighting fit.

Currently working on my Professional Transitions in Nursing Assignment which is due next Monday. I also have two 2 hour classes next week as well as 5 x 8 hour shifts of clinical, so very very busy this week.

Sick

Sorry for the lack of blog updates. Last week I only had to go into uni for one day. We did a clinical simulation session with a dummy to 'prepare us for clinical' but I'm pretty sure the main purpose was to participate in research study on 'whether clinical simulation actually helps prepare students for clinical placements' that one of our teachers is doing. In my opinion it does not, because it is unrealistic, there is no RN and it's just 5 or 6 students fussing around a dummy with not much idea whether they're doing the right thing. Clinical placement is nothing like that of course.

A week ago I did my first paid nursing shift as a PCA (patient care assistant)! I got called at 5:45am and had to be there at 7am. It was an aged care nursing home and my job was to get the patient's up, dressed and showered and take them to breakfast. Quite a few of them had dementia, urinary and bowel incontinence, or ataxia (unbalanced). So I had to change their nappies, give full assistance with showering and dressing and remind them where they are and what's going on. It was great experience and the other staff were very nice to me. And I got paid! I had another interview for another agency last week as well and got accepted so hopefully that will lead to more work and more variety of experience.

The last two days have been orientation to our wards for clinical placement. We had to do one patient assessment and figure out everything that's going on with them and put together a care plan. I've been studying a lot of new things to do with neurological assessment and diseases and will do some blog posts about them later. I'm really looking forward to getting started on the placement but unfortunately right now I'm sick so today I didn't go in for my shift and I'm going to stay home tomorrow as well. Hopefully I'll be good to go on Friday. I am usually very resilient to coughs and colds that go round, especially in the last three years I've been getting adequate sleep and taking vitamins. However, over the weekend I came into contact with a couple of people that had a very nasty cough and unfortunately I seem to have picked it up. If I have been affected by it, it must be very contagious, so the last thing I would want is to give it to the patients or other students. My clinical coordinator will try to slot me into some other shifts, maybe weekend shifts, in the next three weeks to make up the hours. Just resting, drinking hot tea with honey and lemon, and trying to get a bit of study done, although it's hard to find the mental energy. I've worked a bit on two different assessments in the last 24 so I'm happy with that, but my main focus is getting better.

Complex Care Nursing Week 2

Some things I've covered in this subject this week . . .

Lectures
• The Coronial Process – special lecture from the Coroner

Drugs:
• Clopidogrel – antiplatelet, prevents clotting
• Perhexiline – antiangina, decreases heart’s oxygen demand
• Lignocaine – local anaesthetic injection, but can also be taken orally for heart arrhythmia
• Perindopril – ACE inhibitor, lowers blood pressure
• Frusemide – loop diuretic, lowers blood pressure and reduces oedema (build up of fluid in the tissues)
• Prazosin – blocks alpha-1 receptors which are responsible for the vasoconstrictive action of norepinephrine, which would normally raise blood pressure. By blocking these receptors, prazosin reduces blood pressure.
• Atenolol - is a selective β1 receptor antagonist belonging to the group of beta blockers, works by slowing down the heart and reducing its workload, thus reducing hypertension
• Caltrate - used for relief of the symptoms of indigestion and heartburn. The active ingredient, calcium carbonate, neutralises excess acid produced by the stomach.
• Trimethoprim - antibiotic used for the treatment of urinary tract infections , traveler's diarrhea, respiratory and middle ear infections
• N-Acetyl-Cysteine – mucolytic (mucus dissolving) agent used in respiratory conditions with excessive and/or thick mucus production, such as emphysema, bronchitis, tuberculosis, bronchiectasis, amyloidosis, pneumonia, cystic fibrosis and COPD Chronic Obstructive Pulmonary Disease. It is also used to treat paracetamol overdose.

Labs
• Head to Toe Assessment
• Central Venous Line Management

• Respiratory Assessment
• Tracheostomy care and suctioning


Online Modules
• Chest Drainage 101

Videos
• Oasis Dry Suction Chest Drains Parts 1 - 4
• Atrium’s Ocean Chest Drain Set Up and Operation Parts 1 - 5 – indication for chest drains - http://www.youtube.com/watch?v=Hn0SHGuUVak&feature=related
• Central Venous Catheter Connectors Positive Displacement
• Central Venous Catheter Negative Pressure in Catheter Lumens
• Tracheostomy Care
• Tracheostomy Suctioning
• Intubation and Mechanical Ventillation - http://www.youtube.com/watch?v=V8VIw0fk4X0

Things to look forward to

My first clinical placement this semester starts on March 14 and is for 3 weeks. Found out that I will be on the Neurosurgery and Neurotrauma ward. Head injury, brain damage and brain surgery - very interesting! Haven’t done anything like this before.

From April 16 to May 22 I will not have any classes or clinical placements! That’s FIVE WEEKS off in the middle of the semester! I hope to do lots and lots of paid work during this time, as well as spend plenty of quality time with my family during the Easter period.