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| Question | Answer |
| What is Chronic Renal Failure? | It is either kidney damage or a decrease in kidney glomerular filtration rate of less than 60ml/ mL/ min/ 1.73^2 for 3 or more months. |
| Liverpool Care Pathway | End of life care plan |
| What is the prevalence of CKD in New Zealand? | Māori are 30 times more likely than the national average to suffer from CKD. |
| What are the main causes of CKD in New Zealand? | Diabetes is the main cause with hypertension, polycystic kidneys and smoking following. |
| What are the five stages of renal failure? | 1. Kidney damage with normal or increased GFR. 2. Kidney damage with mild decreased GFR 3. Moderate decreased GFR 4. Severe decreased GFR 5. Kidney failure |
| What are the symptoms of CKD? | There will be a significant rise in creatinine in stage 4-5 with a GFR of less than 30mL. Hyperkalemia or lack of insulin. Metabolic acidosis. Malnutrition. Oedema both pulmonary and peripheral. Anaemia, peripheral neuropathy, decreased libido and fatigue. |
| What are the key goals of management for CKD? | To identify the cause of CKD, reduce progression of kidney disease by treating high blood pressure and albuminuria. Reduce cardiovascular risk, avoid nephrotoxic medications or volume depletion. |
| What is the role of a nurse in CKD management? | Provide smoking cessation, encourage exercise and weight loss, educate on dietary modification, BP monitoring, medication (Fe++, Ca++, ACE inhibitors), assist with dialysis, assess for cardiovascular complications, fluid overload and pain. |
| What is diabetes? | Endocrine disorder marked by an inability to maintain glucose homeostasis. Type 1 - results from autoimmune destruction insulin-secreting cells. Type 2 - results from reduced responsiveness of target cells to insulin; obesity and lack of exercise. |
| What is the pathophysiology of Type 2 Diabetes Mellitus | The body is unable to produce adequate insulin to meet the needs. There is B cell deficiency coupled with peripheral insulin resistance. Peripheral insulin resistance = blood levels of insulin are high there is no hypoglycemia or low blood sugar. This may be due to changes in the insulin receptors that bring about the actions of the insulin. |
| What is insulin resistance? | Insulin resistance refers to when cells of the body such as the muscle, liver and fat cells fail to respond to insulin, even when levels are high. Caused by obesity. |
| What are the complications of diabetes? | Microvascular; Macrovascular; Neuropathy and Hypoglycemia. |
| What is a Diabetes Annual Review? | These consultations are done annually and they give an overview of all aspects of care related to diabetes. The aim is wellness and to prevent complications. It is central to the diabetes program. Used as a time to plan care for the following year. |
| What does the Diabetic Annual Review monitor? | Glycaemic control, lipids, renal function > albumin and creatinine ratio, blood pressure, height and weight, retinal screening, foot assessments, teeth and gums and healthy lifestyle advice. |
| What are the medications for Diabetes? | Hypoglycaemics - metformin, sulphonylureas, glitazones, insulin. Lipid Lowering medication - statin, fibrates Antihypertensives - ACE inhibitors Acarbose, aspirin, analgesics - gabapentin, capsaicin cream and TCA’s |
| Name some interventions for Diabetes | Nutritional therapy, exercise programmes, bg monitoring, hyperglycaemia management, insulin therapy, oral hypoglycaemic drugs, skin surveillance, foot care, medication management, diabetes prevention projects. |
| What is osteoarthritis? | Chronic and progressive musculoskeletal disorder. It is the most common form of joint disease and is characterized by continuous loss of articular cartilage, resulting in joint space in narrowing, pain and ultimately, loss of function. |
| What is the pathophysiology of osteoarthritis? | Osteoarthritis is caused by the biochemical breakdown of articular cartilage in the synovial joints and the entire joint organ, including the subchondral bone and synovian. |
| What causes osteoarthritis? | Primary Osteoarthritis (unknown event) = idiopathic cause, natural aging of the joint and genetic. Secondary O (known) = trauma, mechanical stress, inflammation, joint instability, neurological disorders, skeletal deformities, hematological or endocrine disorders & certain medications. |
| What are the signs and symptoms of osteoarthritis? | Pain, stiffness, swelling, harry potter wand fingers, crepitus, tenderness, loss of flexibility, bone spurs, knee hip spine and hands are the most affected. |
| Name some interventions for osteoarthritis? | Progression can be slowed and pain and disability can be reduced through effective management to improve quality of life. Interventions will depend on the nature and severity of the disease and need to be customized to suit the individual and their needs. |
| What are some non-pharmacological management techniques? | Education, support groups, physiotherapy, occupational therapy, weight loss, exercise, orthotic devices, laser therapy. Acupuncture and nutritional supplements |
| What are some pharmacological management techniques? | Paracetamol, NSAIDS, COX-2 Inhibitors, hormone replacement therapy, proton pump inhibitors, opioid analgesics, psychotropic drugs, topical NSAIDS and topical capsaican. |
| What are some nursing interventions for osteoarthritis? | Provide pt with information and ensure understanding. Educate the patient on exercise - hydrotherapy and its benefits in relation to OA. Discuss support network options with pt, including pain mgt groups, seminars and ensure they have adequate support from family and friends. Encourage regular check ups and self mgt. |
| What is Rheumatoid Arthritis? | Form of inflammatory arthritis and autoimmune diseases. Fluid build up causing inflammation and joint pain, systemic and intermittent. Is the second most common form of arthritis and women are three times more likely to develop RA than men. |
| What are the symptoms of RA? | Fatigue, pain in the joints, swelling of the joints, stiffness in the joints, muscle pain, mild fever, loss of appetite, changes to the skin and nails, anaemia, symptoms may vary. |
| What are some interventions for RA? | Education and counselling. We need to take a self-management support approach. Eg, CBT, Information and referral to surrounding support networks - Arthritis New Zealand. Rest but consider fatigue management. Exercise. Encouraging regular check up with health services. |
| What is Gout? | Attacks of acute inflammatory arthritis. Metabolic disease and there is primary and secondary gout. It’s characterized by urate crystals around the joints and long term can form tophi. |
| What is the pathophysiology of gout? | Essentially, hyperuricemia. |
| What is the cause of gout? | Hyperuricemia >6.8. |
| What is the pharmacological treatment method for acute gout? | First line: NSAIDS eg. Naproxen, ibuprofen, diclofenac Second line: colchicine Third line: corticosteroids - prednisolone. |
| What is the pharmacological treatment to lower urate levels in recurrent gout attacks? | First line: Allopurinol Second line: probenecid Other options: benzbromarone (special authority criteria) |
| What is motor neuron disease? | The progressive loss of the upper and lower motor neurons of the brain and spinal cord, which causes muscle wasting and weakness. There are four types: Amyotrophic lateral sclerosis Progressive bulbar palsy Progressive muscular atrophy Primary lateral sclerosis |
| What is the pathophysiology of MND? | Degeneration occurs in the upper motor neurons of the cerebral cortex, the anterior horn cells of the spinal cord and the motor nuclei of the brain stem and results in multiple failures in nerve impulse transmission. |
| What is an intervention for dysphagia in MND? | Teaching swallowing techniques, exercise and pain relief. |
| What is an intervention for incontinence? | Toileting regimes, bells nearby, preserving their dignity, fluid regime/charts, indwelling catheters - something they might need to incorporate into their regimes. |
| What is an intervention for saliva and mucus in patients with MND? | Oral cares - providing cups to spit, head positioning so they don’t choke on extra saliva. Anti-muscarinic medications (can cause urinary incontinence) |
| What is an intervention for immobility in patients with MND? | Early introduction of mobility aids is recommended to enhance independence and reduce the load on the degenerating muscles. |
| What is the treatment for MND? | Riluzole is the only drug licensed as a treatment drug for MND. The drug is used to suppress glutamate activity. It is not funded for kiwis. The focus for MND patients: Provide comfort and supportive therapies. Retain as much muscle function as possible. |
| What are the supportive measures in MND? | Correct posture in bed and chair. Optimized fluid intake. Massage and physiotherapy for muscle cramps, stiffness and spasms. Repositioning and passive limb movements for relief from pain. Managing oral care. Putting strategies in place for communication due to dysarthria. Addressing anxiety. Sleep therapy. Teach assisted cough technique to caregivers Ensuring adequate nutritional intake due to weight loss from muscle wasting. |
| What are the pharmacological interventions for MND? | NSAIDS for pain. SSRI for depression. Oxygen therapy and noninvasive ventilation for breathlessness and fatigue |
| What are symptom management examples in the care of a patient with MND? | Ranges from pain control, respiratory support, dysphagia management, drooling control, enhanced communication and management of emotional lability. Pain resulting from strain = NSAIDS. Swallowing problems = modified cups, postural changes, fluid thickening and food modification. Dark grape juice to reduce saliva. Coordinate care with family to reduce the traffic through the home. Providing time to support family carers is vital for maintaining effective in home care. Educational information needs to be relevant to achieving immediate care, address specific problems and be inclusive of planning for future care needs. |
| What is MS? | MS is a disease of the CNS neurons. Characterised by demyelination. Cause unknown |
| What is the pathophysiology of MS? | Sensitized T cells enter CNS check for antigens. Slowing down of impulses. Demyelinating disease affecting the nerve fibers in the white matter of the brain, the spinal cord and the optic nerve (a process of acute inflammation causes demyelination to occur). |
| What are the symptoms of MS? | Fatigue. Mental change. Bowel and bladder symptoms. Visual disturbances. Numbness, tingling or pain symptoms. Brain and nerve symptoms. Sexual symptom. Speech and swallowing symptoms |
| What is the treatment of MS? | No cure currently exists for MS. Treatments are used to delay the progression of MS. Manage chronic symptoms, and treat acute exacerbations. Medication. Physiotherapy. Lifestyle factors. Counseling/social support. Alternative treatments. |
| What is the role of the nurse in the care of a patient with MS? | Promotion of physical mobility, exercises, activity and rest. Minimizing effects of immobility. Managing speech and swallowing difficulties. Preventing injury. Enhancing bladder and bowel control. Quality of life. Body image. Nurses can play an important role in community education and advocacy to enhance opportunities and acceptance of MS in the community. Families providing care also need supportive care. |
| What is COPD? | COPD is characterised by progressive airflow obstruction. This is a major cause of chronic morbidity and mortality; and its increasing in prevalence. It umbrellas chronic bronchitis and emphysema. |
| What is the pathophysiology of COPD? | Airway inflammation, mucociliary dysfunction and consequent airway structural changes. COPD is characterised by chronic inflammation of the airways, lung tissues and pulmonary blood vessels as a result of exposure to smoke and chems. |
| What are the signs and symptoms of COPD? | Cough, regular sputum production, shortness of breath, wheeze, chest tightness and sleep disturbance. Fatigue, reduced exercise tolerance and poor appetite. Reduced chest expansion, hyperresonance on percussion, prolonged expiratory phase and possible R HF. |
| What is the goal of care for COPD? | Optimise function, delay the progression, manage the effects and enact terminal care if advanced (inclusive if there is a profound weakness, drowsy for extended periods, disorientated to time with poor attention span and of course, difficulty swallowing medications) |
| What are some nursing interventions for COPD? | Smoking cessation, vaccination, pulmonary rehabilitation, medications and surgery. Support self-management with medication. Provide edu to pt and carer to optimise drug administration and re-assess capability to use devices when needed. Manage exacerbations. |
| What are some nursing interventions for COPD? | Utilise interventions that encourage patient motivation. The relapse cause of COPD means that while symptoms are usually present in some form, care needs will fluctuate. |
| What is the pharmacological treatment for COPD? | First line therapy - bronchodilators. Corticosteroid therapy, muscarinic antagonists, mucolytic medicine. |
| What is oxygen therapy? And who is it indicated for? | Supplemental oxygen; people with COPD need this when their o2 stats are low to prevent hypoxemia and reduces heart strain and dyspoea. |
| What is pulmonary Rehabilitation? | Exercise and nutrition; tailored with their full involvement. Consisting of exercise, diet regimes and education for client and family. Smoking cessation. |
| What is the pathophysiology of Bronchiectasis? | Permanent dilation of the airways. An accumulation of mucus and damage to the cilia. There's a loss of elasticity and structure because there is warmth and moisture. Narrowing of the lumen. |
| What are some nursing interventions ofr Bronchiectasis? | Chest physiotherapy; chest percussions and postural drainage. Exercise and nutrition - exercise helps to loosen the mucus and strengthens muscles involved in breathing. Edu; encouragement to seek prompt med attention; MDT. |
| What is the pathophysiology of Chronic Asthma? | Inflammation and swelling in the airways. Bronchial constriction. Bronchial hyperreactivity - increased mucous production. |
| What are some nursing interventions for Chronic Asthma? | Medication; patient education and ensuring understanding of medication, administration, correct dose, side effects, care of devices, self care. Flu vaccine, regular visits to health professional, lifestyle moderation and smoking cessation. |
| What is ischemic heart disease? | Characterised by reduced blood supply to the heart muscle usually due to narrowing of the coronary arteries as a result of atherosclerosis. |
| What are the signs and symptoms of IHD? | Angina - chest pain, left arm left jaw radiation, back, shoulder, shortness of breath, sweaty and nausea. MI - same, but with vomiting, faint, cold and clammy. Heart muscle dying due to lack of blood to heart muscle caused by atheroma. |
| What are some interventions for IHD? | Lifestyle changes, cardiac rehabilitation, alternative medicine, psychosocial interventions - nutritonal, family support, MH, medcial treatments, surgical interventions, self-management and education. |
| What are some interventions for IHD? | Increase social connectivity, stress reduction techniques, address anxiety and depression. Smoking cessation and encourage physical activity. |
| What is Chronic Heart Failure? | Condition in which the cardiac output is insufficient to the needs of the body. It can be caused by a cardiac disease that compromises ventricular systolic or diastolic function. |
| What are the symptoms and signs of CHF? | SOB when exerted or when lying down. Fatigue and weakness. Swelling in the legs, ankles and feet. Rapid or irregular heart beat, reduced ability to exercise, persistent cough, chest pain, skin changes, nocturia and renal failure. |
| What is the pathophysiology of CHF? | Heart fails to pump and circulate an adequate supply of blood to meet the needs of the body. |
| What are the comorbidities of CHF? | Renal failure, anemia, respiratory conditions, high blood pressure, diabetes, anxiety and metabolic syndrome. |
| How do you manage CHF? | Though taking an MDT approach to CHF management; pharmacological therapy, nurse-led interventions and management through palliative and supportive management |
| What is the pharmacological therapy for CHF? | frusemide; identify underlying cause of it and treat it. |
| What are some nurse-led interventions for CHF? | Holistic review of patients life. Clinical assessment of oedema, fluid intake and output, HR and blood pressure. Long term planning, so things like palliative care, managing symptoms. Education and counselling. |
| What is a Cerebrovascular accident? | A stroke. A group of disorders involving sudden, focal interruptions of cerebral blood flow. |
| What is an ischaemic stroke? | Fatty tissue build upon blood vessel walls. Blood clots form on the fatty tissue which gradually block the artery. |
| What is an haemorrhagic stroke? | Rupturing of the cerebral arteries such as an intracerebral hemorrhage or subarachnoid haemorrhage. Elevated BP may cause a blood vessel to balloon which may result in the vessel bursting. |
| What is a TIA? | Transient Ischemic Attack; brief symptoms. Area of temporarily blocked blood flow. Weak point in blood vessel wall. |
| What manifests as a result of a stroke? | Numbness, weakness, aphasia, confusion, visual disturbances in one or both eyes, vertigo or loss of balance. Impacts on memory, thinking, attention or learning. Inability to recognise parts of own body. Reduced sensory input. Loss of bowel and bladder control. Emotional crisis. |
| What are the risks of having a stroke? | Smoking; diet; type 2 diabetes; low HDl and high LDL; excessive alcohol consumption. |
| What are some comorbidities? | Hyper and hypotension; intercerebral haemorrhage; thrombosis, risk of falls, pressure sores and fever. |
| What are some nursing considerations for strokes? | You wanna focus on stabilisation, investigation and rehabilitation. Core care is what all nurses are working towards; level of consciousness, limb weakeness, oving and handling, ADLS, loss of feeeling, communication, swallowing, incontience and emotions. |
| What is the pharmacological management of strokes? | Thrombolysis; Aspirin. BP lowering. Anticoagulation; warfarin. Cholesterol lowering; simvastatin. |
| What are some nursing-led interventions for strokes? | Encourage self-care; facilitate mobility; teach by breaking activities into small pieces; clutter free environment |
| What is the Chronic Care Model? | People who have long term conditions or who are at risk of developing long term conditions need to essentially develop and continue practicing complex self-management strategies to allow them to live a sweet as g life. People with LT conditions who effectively maintain self-management practices have better clinical outcomes/benefits. |
| What are the key elements of the Chronic Care Model? | 1. Self-management support - provide support and advocacy to pts and fam. SMART goals and follow up. 2. Delivery system design - assure the delivery of self man support is effective and clinically efficient. Consider health lit 3. Decision support - promote clinical care that is consistent with scientific evidence and client preference. 4. Clinical information systems - organize client and population data to facilitate efficient care. |
| What are the stages of the change model? | 1. Pre-contemplation - not even thinking about changing their drinking behaviour - lack of knowledge 2. Contemplation - willing to consider the possibility that they have a problem, and the possibility offers hope for change. 3. Preparation - commitment to change - deciding to stop drinking is the hallmark of this stage of change. Weighed the pros and cons. 4. Action - implementing the plan, public commitment to stop drinking in order to get external confirmation of the plan. 5. Relapse - strong temptation to drink and fail to cop with it successfully - people are armed with a variety of relapse prevention skills. They know where to get the support they need. 6. Maintenance - overt modifications in their lifestyles and are working to prevent relapse. |
| What is the change model? | It is a model that focuses on the decision making of the individual. Often people recycle through the stages or regress to earlier stages from later one. |
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