I am sorry for the lack of posts it’s just that I am only NINE WEEKS off graduating and it’s all been so crazy! I’ve got nine assessments, fifteen days of clinical and five weeks of class standing between now and finishing my Bachelor of Nursing degree. To everyone that is interested in nursing, has just started the degree, or can see the light at the end of the tunnel like myself- keep with it, I promise you will never look back! :)
Sinus pause describes a condition where the SA node fails to generate an electrical impulse for what is generally a brief period of time. In the above example, the initial rate is 88 beats per minute (the first two beats are normal), then there is a 1.8 second sinus pause before the heart resumes, initially at a somewhat slower rate of 52 beats per minute. A related rhythm is SA block which is often hard to distinguish from a sinus pause. In SA block, the SA node creates an impulse, but it is blocked from leaving the SA node. The differences are beyond the scope of this discussion.
Patients who have sinus pauses may complain of missed or skipped beats, flutters, palpitations, hard beats or may feel faint, dizzy or lightheaded or experience a syncopal episode (passing out). Frequent pauses would heighten these symptoms. This is a result of patients actually missing or dropping beats. Obviously, if the heart misses a beat, blood does not flow during that time period resulting in a lack of oxygen or perfusion throughout the body.
Treatment and prognosis depend on the cause and cardiac status of the patient. This condition may be drug induced or it may be a result of cardiac disease. Treatment may involve the use of medications or the use of a temporary or permanent pacemaker.
Weird, I’ve seen a few of these asked on my dash tonight. It is currently sitting at 5.83 but I’ve just finished a semester so once those grades are in it will change.
The Bachelor of Nursing degree takes three years and once you are an RN it’s only another year for the midwifery degree also. It might differ for other places but for Australia it’s that long full-time…
A person’s appearance can provide useful clues into their quality of self-care, lifestyle and daily living skills.
As well as noting what a person is actually doing during the examination, attention should also be paid to behaviours typically described as non-verbal communication. These can reveal much about a person’s emotional state and attitude.
body language and gestures
response to the assessment itself
rapport and social engagement
level of arousal (e.g. calm, agitated)
anxious or aggressive behaviour
psychomotor activity and movement (e.g. hyperactivity, hypoactivity)
unusual features (e.g. tremors, or slowed, repetitive, or involuntary movements)
Mood and affect
It can be useful to conceptualise the relationship between emotional affect and mood as being similar to that between the weather (affect) and the season (mood). Affect refers to immediate expressions of emotion, while mood refers to emotional experience over a more prolonged period of time.
range (e.g. restricted, blunted, flat, expansive)
appropriateness (e.g. appropriate, inappropriate, incongruous)
stability (e.g. stable, labile)
- happiness (eg, ecstatic, elevated, lowered, depressed)
- irritability (e.g. explosive, irritable, calm)
Speech can be a particularly revealing feature of a person’s presentation and should be described behaviourally as well as considering its content (see also section on Thoughts). Unusual speech is sometimes associated with mood and anxiety problems, schizophrenia, and organic pathology.
speech rate (e.g. rapid, pressured, reduced tempo)
volume (e.g. loud, normal, soft)
tonality (e.g. monotonous, tremulous)
quantity (e.g. minimal, voluble)
ease of conversation
This refers to a person’s current capacity to process information and is important because it is often sensitive (though in young people usually secondary) to mental health problems.
level of consciousness (e.g. alert, drowsy, intoxicated, stuporose)
orientation to reality (often expressed in regard to time/place/person - e.g. awareness of the time/day/date, where they are, ability to provide personal details)
memory functioning (including immediate or short-term memory, and memory for recent and remote information or events)
literacy and arithmetic skills
visuospatial processing (e.g. copying a diagram, drawing a bicycle)
attention and concentration (e.g. observations about level of distractibility, or performance on a mentally effortful task – e.g. counting backwards by 7’s from 100)
language (e.g. naming objects, following instructions)
ability to deal with abstract concepts (e.g. describing conceptual similarity between two things).
A person’s thinking is generally evaluated according to their thought content or nature, and thought form or process.
- delusions (rigidly held false beliefs not consistent with the person’s background)
- overvalued ideas (unreasonable belief, e.g. a person with anorexia believing they are overweight)
- depressive thoughts
- self-harm, suicidal, aggressive or homicidal ideation
- obsessions (preoccupying and repetitive thoughts about a feared or catastrophic outcome, often indicated by associated compulsive behaviour)
- anxiety (generalised, i.e. heightened anxiety with no specific referent; or specific, e.g. phobias)
Thought process refers to the formation and coherence of thoughts and is inferred very much through the person’s speech and expression of ideas.
- highly irrelevant comments (loose associations or derailment)
- frequent changes of topic (flight of ideas or tangential thinking)
- excessive vagueness (circumstantial thinking)
- nonsense words (or word salad)
- pressured or halted speech (thought racing or blocking)
Screening for perceptual disturbance is critical for detecting serious mental health problems like psychosis (this is relatively rare in young people, though peak onset is between 19 and 22 years), cases of severe anxiety, and mood disorders. It is also important in trauma or substance abuse. Perceptual disturbances are typically marked and may be disturbing or frightening.
- derealisation (feeling that the world or one’s surroundings are not real)
- depersonalisation (feeling detached from oneself)
- the person perceives things as different to usual, but accepts that they are not real, or that
- things are perceived differently by others
- probably the most widely known form of perceptual disturbance
- hallucinations are indistinguishable by the sufferer from reality
- can affect all sensory modalities, although auditory hallucinations are the most common
- in children it is common to experience self-talk or commentary as an internal “voice”
- command hallucinations (voices telling the person to do something) should be investigated
- important to note the degree of fear and/or distress associated with the hallucinations
Insight & Judgement
Insight and judgement is particularly important in triaging psychiatric presentations and making decisions about safety.
- acknowledgement of a possible mental health problem
- understanding of possible treatment options and ability to comply with these
- ability to identify potentially pathological events (e.g. hallucinations, suicidal impulses)
- refers to a person’s problem-solving ability in a more general sense
- can be evaluated by exploring recent decision-making or by posing a practical dilemma (e.g. what should you do if you see smoke coming out of a house?)
Day 1: 30mL/kg/day
Day 2: 60mL/kg/day
Day 3: 90mL/kg/day
Day 4: 120mL/kg/day
Day 5: 150mL/kg/day
These guidelines are for a well-term baby. Aim for 6 feeds daily.
Oesophageal varices are a common complication of cirrhosis of the liver, occurring in two-thirds to three- quarters of patients with the cirrhosis. These collateral vessels contain little elastic tissue and are quite fragile. They tolerate the high pressure poorly, and the result is distended, tortuous veins that bleed easily. Large varices are more likely to bleed. In addition, because of compromised liver function, there are alterations in normal blood-clotting mechanisms.