(Chronic Illness-long duration, slow progression, unpredictable) Chronic Illness self management- Clear understanding of illness/outcomes, Active engagement

in own disease manag. process, self manag. skills, self efficacy, health literacy. Self Efficacy- belief in the capacity to successfully learn and perform a behaviour. Primary Health Care-Broad spectrum of activities to encourage health and well being. Include primary care, follow up activities for promoting health of the community, protecting from harm and preventing illness. Levels of health prevention- primary- prior to disease, secondary- early detect/tx of disease/limit disability, tertiary- rehab/min. disability. Perioop phase-starts with pt decision to have surg and ends with transfer of pt onto theatre trolley. Preop-teaching to prevent postop complications-Inform pt about awakening in recovery unit, purpose of reg. obs, pain control/comfort measures, import. of turning, coughing, deep breathing. Areas assessed postop- consciousness(gradually aware of surroundings, know where they are and what has happend/patient not rousable/confused. Resp-monitor rate depth chest movt. Breathing unhindered, skin colour pink, signs of cyanosis/poor o2. sit upright ASAP encourage lung expansion/ reduced resp rate, due to analgesia, aware of pts med hx before giving o2. Pulse- Monitor and asses against base line recording, rate, volume, irregularities, be aware of drugs given can affect pulse rate/ increase pulse rate indicate reduced circulating volume due to haemorrhage, arrhythmias-cardiac prob-ecg may be required, bradycardia may indicate reaction to drug/cardiac arrest. BP- monitor/ asses base line, drugs can affect bp, bp should return within pts normal limit/ Hypotension indicate haemorrhage or lack of fluid replacement. low bp may be due to pain and nausea. TEMP- can alter in surg needs monitoring/decrease temp indicates hypothermia, reaction to drugs, warming blankets can be used. Increased temp indicates infection. Emetogenic profiling- Risk factors to consider in the development of PONV- surgical, anaesthetic, patient characteristics, postop PONV= consequences for pt- discomfort, dehydration/electrolyte, anxiety, wound rupture, prolonged recovery time, cost involved in hosp. stay.(important to prevent these occurring post op).

Common postop complic- resp, hypoxaemia, pneumonia, pulm embolism, cardiovascular-DVT, haem. Hypovalaemic shock, arrhythmias. Nutrition and elimin. wound infect. Stages of shock- initial, compensatory, progressive, refractory. Path HTN- Rise in arterial pressure there has to be an increase in CO Pharm/ non pharm intervention- Pending diagnosis management covers medication- newly diag. ACEI(or ARA)/ CA+ channel blocker/low dose thiazide diuretic. manage assoc. cond. e.g diabetes, lipid disorder. lifestyle mod. monitor BP. Acute Coronary syndrome(ACS)- include broad spectrum of clinical presentations, spanning ST elev. MI through to an accelerated pattern of angina w/out evidence of Myonecrosis). Clinical presentations result from MI- Unstable angina, acute MI-ST segment elev. MI (STEMI), Non ST seg. Elev. ACS( NON STEMI). ACS PATH- Athersclerosis, affects coronary artieries, narrowing of arteries, reduces blood supply to myocardial muscle= MI. AGINA-Imbal. of O2 supply/demand. No myocardial muscle damage. ANGINA PECTORISPain/discomfort due to 02 deficiency to myocardium= imbal. between myocardial 02 supply/demand. Divides into 3 cats. stable agina, vasopatic , unstable angina. CHESTPAIN/UNSTABLE ANGINA vs ACUTE MI= unresolved blockage in coronary artery resulting in tissue death=MI. 3 factors for Angina= HR, Myocardial contractility, systolic left ventricular wall tension. STABLE ANGINA- chronic/excertional angina, eps. of predictable chest pain due to exercise/ activity. VASOSPASTIC ANGINA-Variant/ prinzmetals angina, caused by coronary artery spasm, pain free periods for days/weeks, chest pain in clusters during sleep, rest and waking. UNSTABLE ANGINA- unpredictible, pt reposts worsening sympotms, chest pain more severe and prolonged. ECG- Recording of electrical activity of the heart as it undergoes depol./repol to initiate the Heart beat.

ISCHAEMIC CHEST PAIN-Heavy, dull retrosternal. assoc. sympt. SOB, nausea, diaphoresis. Review ECG- ST changes= Ischaemia/infarction. ACUTE MYCARDIAL INFARCTION(AMI)-when coronary blood flow stops for a long period of time, causing myocyte necrosis, necrosis results in MI. NITRATES ( GTN SPRAY/ANGININE)- dilate arteries/veins. thus reducing stress on heart muscle, reducing 02 the heart requires allowing the heart to function longer w/out ischaemia. nitrites relieve angina and prevent angina from occurring. CHEST PAIN ASSESSMENT-Precipitating & Palliative factors, Quality, Region & Radiation, Severity/associated symptoms, Time. HEART FAILURE-Failure of the cardiac muscle to pump sufficient blood to meet the body's metabolic needs/dysfunction of the L. Ventricle STROKE VOLUME (SV) 3 factors- Preload, Myocardial contractility, After load CARDIAC MARKERS- Serum Tropinin Levels, Lactate De Hydrogenase, Creatine Kinase. INTERVENTIONS HF- O2 Therapy, Positioning, Non invasive positive pressure ventilation, fluid restriction. Pharmo interventions HF-Diuretics( Frusemide) Beta Adrenergic Blockers, fish oils, cardiac glycoside, vasodilator therapy CARDIOGENIC SHOCK- Mechanical devices- Intra aortic balloon pumps, L Ventricular assist devices. CORONARY BYPASS POSTOP COMPLICATIONS-Cardiovascular, Respiratory, Renal, GIT, Neuropsychological. RESP. DEFENCE MECHANISM- Particle filt. in nostril, sneezing, mucociliary escalator, coughing. RISK FACTORS CHRONIC RESP. DISEASE-Tobacco, indoor/outdoor polut. allergens. ACUTE BRONCHITIS- Inflam/Infect. of bronchi in LRT, persistent cough. (caused by Rhinovirus influenza). PNEUMONIA-Acute Inflam. of lung parenchyma caused by infect. COPD- chronic obstructions of lung airflor that interferes with normal breathing/ not fully reversible.

COPD-X= Confirm diag. optimise function, prevent deterioration, develop support network/self manage, manage exacerbations. PULMONARY COMPLICATIONS- Acute exacerbations, resp. failure, peptic ulcer, depress/anxiety, cor pulmonae. ASTHMA-chronic inflam. of airways. causes wheezing, SOB, chest tightness, coughing. DIAGNOSIS- based on recurrent /persistent wheeze MANAGEMENT- Brochobialators, Anti Inflam. CYSTIC FIBROSIS-Genetic Disease, DIAG BY- Guthrie test CONFIRMED BY- Sweat test. NOT CURABLE- Exocrine dysfunction. BLOOD LOSS IN PAEDS- critical due to the lower volume of blood per kg. BP SHOCK IN PAEDS- A drop in Bp=Severe shock. usually maintained until then. ARTERIAL BLOOD GAS ANALYSIS-PH 7.35-7.45,Pa02 80-100mmHg, PaC02 35-45, HCO3- 22-28mmol/L, Sa02 95-100%. RESP. Acidosis PH <7.35/PaC02>45, Resp Alkalosis Ph > 7.45 / PaC02 >35, Metabolic Asidosis ph <7.35/HCO3< 22, Metabloic Alkalosis ph >7.45/HC03>26. Non invasive positive press. ventilation- assisted ventilation w/out a endotracheal tube. Trauma- Penetrating trauma-foreign objects, Blunt trauma-injury has no opening in the skin or outside environment. Pneumothorax- Blunt/penetrating injury or other, Haemorthorax-blunt/penetrating injury. MANAGEMENT- Intercostal catheter and connect under water seal drainage system.

FLAIL SEGMENT- two or more ribs # in two or more places, the ribs no longer have a bony attachment to rib cage. Cardiac Tamponade- bleeding from heart into pericardial sac( elastic membrane). INTERVENTION- Pericardiocentesis. ACUTE RESP FAILURE PAEDS- Signs- restlessness, tachypnoea, tachycardia, diaphoresis. Peripheral arterial disease- Progressive narrowing/degeneration of arteries. COMPS- Delayed healing/arterial ulcers amputation. DIAG- Doppler, Ankle Brachial index, Angiography. Manage- Educate, antiplatlet drugs, exercise, diet, surg. Probs- ineffect. peripheral tissure perfus.skin integrity/decreased periph. circulation, acute pain. Venous Thrombo Embolism= DVT- lower exteremties susceptible to DVT after fracture. Virchows Triad risk factors- Venous stasis, Coag. abnormalities, vessel damage. ARISE FROM-Popliteal, femoral, iliac vein thrombosisANTICOAG DRUG- Enoxaparin 40mg daily, Low dose heprin.PE-in pulm arteries, air/fat, DIAG- Pulm. Arteriography Lung perf. scan, ECG changes. Manage- Narcotic analg. for pain O2 therapy, Iv Heprin/fluids. Peripheral vasc. assess. Colour nail beds/skin, sensation, movement, warmth, pulse, oedema. SHOCK- Cardiovasc. syst. fails to perfuse tissue- inadeq. o2 delivery to meet cellular demands. CARDIOGENIC SHOCK- Inability of the heart to pump adequ. blood to tissues and end organs, peristent hypotension/ tissue hypoperfusion (preload) resulting in impaired diastolic filling ege arrhythmias. COMMON CAUSE-AMI. DISTRIBUTIVE SHOCK- Septic/anaphylactic/neurogenic= blood vessel function. SEPTIC SHOCK- Systemic inflamm. response- Primary= Misdistribution blood flow. ANAPHYLACTIC SHOCK- Immediate hypersensitivity reaction, sever antibody-antigen response, IgE med, Non IgE med.

NEOGENIC SHOCK-loss/suppression of sympathetic tone. disrupts SNS. eg spinal cord injury. MANAGEMENT- o2 transport, o2 use, identify case of shock, provide comfort