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The nursing process

311.2 Vet nursing The nursing process and clinical exams

QuestionAnswer
How is the medical model orientated? Disease orientated
How is the nursing process orientated? Patient orientated
What are the steps of the nursing process Assessment->Nursing diagnosis->Planning->Implementation->Evaluation
What is assessment in the nursing process? Establish individual needs of patient, find out info on normal behaviour
What is nursing diagnosis in the nursing process? Find out what the patient needs for the best nursing care
What is planning in the nursing process? Make plans to overcome the nursing problems identified and set goals
What is implementation in the nursing process? Follow the set plan, making sure to record steps on patient sheets
What is evaluation in the nursing process? Make sure the plan is working, that goals are met and the problems have been solved
What are the 3 nursing models? The ability model, The Orem model and The Roper, Logan and Tierney model
Which nursing model has the 10 abilities? The Orpet and Jeffery ability model
What are the 10 abilities? Eat, drink, pee, poo, breathe, body temp, groom, move, sleep and express normal behaviour
Which nursing models take lifespan as a continuous factor? The ability model and the Roper, Logan and Tierney model
Which nursing model includes conception? The Orem model
Which nursing model includes the 8 universal self-care requisites? The Orem model
What are the 8 universal self-care requisites? Breathe, drink, eat, eliminate waste, balance activity and rest, balance social interaction, prevent hazards, behave normally
Which nursing model includes the 12 activities of living? The Roper, Logan and Tierney model
What are the 12 activities of living? Stay safe, communicate, eat and drink, eliminate waste, breathe, groom, body temp, move, work and play, express sexuality, sleep, die
Which nursing model looks at the dependence/independence continuum? The Roper, Logan and Tierney model
What are the 5 factors influencing the activities of living? Biological, Psychological, Sociocultural, Environmental, Politicoeconomic
What are the 5 components of the Roper, Logan and Tierney model? Activities of living, Lifespan, Factors affecting activities, Dependence/independence, Individuality of living
What is one of the most important jobs of the veterinary nurse? Careful observation and assessment of patients
What must vet nurses be able to do? Recognise normal and abnormal appearance and behaviour patterns of those in their care
What does a nursing model provide the nurse with, particularly at the assessment stage? Information on the normal or ideal state of the patient
How does carrying out an assessment impact on the nursing care of the patient? More specific to the patient and ability to not miss out on important info
What is the SOAP method? Subjective, Objective, Assessment, Planning
How should the patient be observed at first? From afar and immediately on their entrance to the surgery
How can we promote normal patient behaviour in practice? Pheromones, animals in best kennels for purpose, nurse consults for socialisation, towels to cover cages, sedation, home visits
What is meant by assessment of patient mentation? How the patient might be feeling, their mental state such as scared, tired, etc.
What are 3 important measures of the body's function? Temperature, pulse and respiration
What are TPR also know as? Clinical parameters
What is useful about TPR? Easy to measure and monitor throughout treatment
Normal temperature range of the dog? 38.3-39.2oC
Normal temperature range of the cat? 38.2-38.6oC
Normal temperature range of the horse? 37.2-38.9oC
Normal temperature range of the rabbit? 38.5-40oC
What is another word for fever? Pyrexia
What might cause pyrexia? Drug reaction, Infection, Neoplasia
What might cause hyperthermia? Hot room, Heat stroke, Stress, Exercise, Seizure activity
What might cause hypothermia? Anaesthesia, Drug reactions, Environment, Illness
What is a diphasic temperature? One which is fluctuating
What colour should the mucus membranes be? Pink, paler in cats
What might a pale MM signify? Poor perfusion, circulatory collapse, haemorrhage, anaemia
What might blue/purple MM signify? Insufficient transport of oxygen to the body tissues. Respiratory obstruction or dyspnoea
What is blue/purple tinged MM also called? Cyanotic
What might yellow MM signify? May be due to liver disease, bile flow obstruction or an increase in RBC destruction. In foals can be due to neonatal isoerytholysis
What is yellow tinged MM also called? Icterus/jaundiced
What might a dark MM signify? Sepsis, fever, congestion, extensive tissue damage or excitement
What might cherry red MM signify? Carbon-monoxide poisoning
What might orange MM signify? Administration of synthetic haemoglobin products
What might chocolate brown MM signify? Paracetamol poisoning in dogs and cats
What is neonatal isoerythrolysis? Incompatibility of blood types between the mare and foal
What are petechiae? Pinpoint red haemorrhages on the mucosa.
What might petechiae signify? Blood clotting disorders such as von Willibrand's or animals poisoned with anti-coagulant rodenticides
What is the CRT? Capillary refill time. The time it takes for full colour to return to the mucosa
What is a normal CRT? 1-2 seconds
What may an increased CRT indicate? Dehydration, Heart failure, Shock, Hypovolaemia
What might a decreased CRT indicate? Severe sepsis or fever
What are the 5 common pulse points in dogs and cats? Sub-lingual, carpal, coccygeal, femoral and dorsal metatarsal
Where is the sub-lingual pulse found? Ventral aspect of the tongue
Where is the carpal pulse found? Palmar aspect of the carpus
Where is the coccygeal pulse found? Proximal ventral aspect of the tail
Where is the femoral pulse found? Medial aspect of the femur
Where is the dorsal metatarsal pulse found? Medial aspect of the tarsus
4 common pulse points in the horse? Ventral ramus of the mandible, Transverse facial artery, Palmar digital arteries, Radial artery
3 important factors to consider when taking the pulse? Pace, rhythm, character
7 reasons for a tachycardia? fever, fear, exercise, pain, hypoxia, hypovolaemia, drug reaction
4 reasons for bradycardia? Unconsciousness, sleep, anaesthesia, very fit
2 reasons for a weak pulse? hypovolaemia, diminished cardiac output
2 reasons for a strong, jerky pulse? Valvular insufficiency, congenital heart defects (patent ductus arteriosus)
On double sided stethoscopes the flat diaphragm is for what? High-frequency sounds such as the heartbeat
On double sided stethoscopes the curved diaphragm is for what? Lower-frequency sounds such as the lungs
Single sided stethoscopes rely on what to change pitch detection? Pressure
Light pressure on a single sided stethoscope will detect what? Low pitched sounds
Firm pressure on a single sided stethoscope will detect what? High pitched sounds
Where should you listen for the optimum heart sounds? Between the 3rd and 6th ribs on the left side
What should the heart rate be for a dog? 70-140bpm
What should the heart rate be for a cat? 100-200bpm
What should the heart rate be for a horse? 30-40bpm
What should the heart rate be for a rabbit? 130-325bpm
Why should respiration be measured first when doing TPR? If patient is not breathing intervention is required. Temp is measured last to stress patient less
What is dyspnoea? Difficulty breathing
What is apnoea? Stop breathing
What is tachypnoea? Fast breathing
What is hypopnoea? Shallow breathing, reduced lung filling
What is bradypnoea? Slow breathing
What is orthopnoea? Dyspnoea that is relieved by adopting an upright position. Extends the head and neck and pushes out the shoulders to give the most space to breath.
What is Cheyne-Sokes respiration? Deep convulsive breaths at infrequent intervals, also called agonal breathing. At death.
What is stridor/stertor? Loud/noisy breathing
What is the normal resp rate for a dog? 10-30rpm
What is the normal resp rate for a cat? 20-30rpm
What is the normal resp rate for a horse? 12-20rpm
What is the normal resp rate for a rabbit? 30-60rpm
What does a blood pressure measurement provide? Info about cardiovascular function. Indirect measurement of cardiac output and tissue blood flow
What is hypotension? Low blood pressure
Why is hypotension bad? Increased glucose demand, O2 demand and cardiac work which leads to tissue and organ damage.
What is systolic BP? Peak pressure. Towards the end of the cardiac cycle when ventricles are contracting.
Normal systolic BP? 90-120 mmHg
What is diastolic BP? Minimum pressure. Beginning of the cardiac cycle as ventricles fill with blood.
Normal diastolic BP? 55-90 mmHg
What is the gold standard method of measuring BP? Direct arterial blood pressure measurement (arterial catheter)
How can the wrong size BP cuff affect the results? Loose cuff- lower readings, Tight cuff- higher readings
Created by: 18000305