1.Public health care

PrimaryHealth Care (PHC) is a pathway that is used to achieve basic healthfor all. PHC serves as a foundation of an effective healthcare systemas it includes the provision of integrated and accessible health careservices (Riegelman,2010).The form of health care service is characterized by a sustainedpartnership between the healthcare delivery systems, patients, andthe entire community.

2.Deadly Ears and community involvement

The‘is a health program in Queensland that raises awareness in mattersregarding ear disease in children. This initiative works withfamilies from indigenous communities by conducting school screeningprograms, as well as, raising their understanding of the impacts ofchronic ear disease. This aspect of empowerment has continued tobuild a strong relationship between the community and the Deadly Earsinitiative, leading to health and educational improvements,especially among Aboriginal children. Additionally, thiscollaboration has led to the change in policy in the health andeducation sector that has focused on the improvement of healthoutcome in the community.

3.Chronic illness management

Aself-management program for an asthmatic 3 year old should involvemonitoring and reporting symptoms to a healthcare provider. A 3yearold with this chronic illness requires self-management support, whichincludes acquiring sufficient information, assisting patient withemotional aspects, teaching the patient some problem solving skills,acquiring disease-specific skills and ensuring ongoing and regularfollow-ups. Much evidence shows that regular follow-ups have thegreatest impact on health outcome, as well as, the provider-patientinteraction.

4.Pre-operative teaching

Pre-operationalteaching is a relevant defense against postoperative complication, asit serves to reduce postoperative pain and anxiety. Teaching patientsundergoing surgery and their families facilitates ensures involvementin all aspects of care, including the patient’s ability to consentto surgery. There are various aspects to pre-operative teachingregardless of the procedure. This may include the provision ofappropriate information and hand written the instruction about thenature of surgery, which may be used as a reference. Other aspectsinclude encouraging patients to fast the night before the operation,as well as, following instructions with respect to taking medication.

5.Pre-operative assessments

Postoperativeassessment is vital as it helps to detect any associated complicationand ensure appropriate care facility is provided to the patient. Someof the areas that require assessment include wound and skinmanagement, temperature, neurological assessment, pressure areas andpain and nausea assessment (Woodhead, 2005). The skin and woundshould be checked regularly as seepage can lead swelling andhemorrhage. Temperature assessment reduces chemical reactions whileneurological assessment is used in detecting consciousness in orderto understand sedation and any complication arising fromunconsciousness.

6.Emetogenic profiling and surgery

Emetogenicprofiling allow through preoperative history before a surgicalprocedure. This method of profiling helps to reduce a patient’srisk factors after surgery. Emotogenic profiling has proven effectivein patients who experience significant nausea and vomiting aftersurgery.

7.Respiratory characteristic

Respiratoryfailure is common in children and can lead to progressive respiratoryillness. Some of the common pediatric respiratory characteristicsthat are associated with the risk of these illnesses in childreninclude narrow airways, immature intercostals and accessory muscles,higher metabolic rate, large adenoids and tongue, as well as, largeocciput in infants (Fraser, Waters, Forster and Brown, 2014). Thepresence of large adenoids increases the risk of airway obstruction,while immature muscle cause early fatigue of the respiratory musclesin infants.

8.Fluid and electrolyte imbalance in young children

Youngchildren and infants are known to be more vulnerable to fluid andelectrolyte imbalance than adults because of their greater need forwater. Children, especially those who are below the age of 5 years,have an immature hypothalamus, which is unable to regulate the bodytemperature and respiratory rate. Since infants lose a greaterpercentage of body fluid, they should have an adequate intake offluid daily.

9.Drop in BP

Septicshock is recognized to occur before hypotension, making it a latesign of decreased blood pressure. According to Loftus (2011)points out that hypotension in children is a late sign of shock thatindicates that the critical decompensate phase has begun. Patientswith a markedly low BP have inadequate pressure to maintain properperfusion of all the vital organs, and may need to have perfusionrestored to normal level immediately.

10.Small amount of blood loss

Smallamounts of blood endanger a pediatric patient because of thesignificant decrease in haemoglobin levels. More so, the change intotal blood volume influences oxygen delivery to the tissues, as wellas, cause a reduction in oxygen supply resulting to the destructionof red blood cell.

11.Chronic stable angina and myocardial infarct pain difference

Chronicstable angina is characterized by chest pain that may increase withduration and frequency. Chronic stable angina pain is described assevere and may last for 10 min. The pain episodes of Myocardial areusually severe than those chronic stable angina and may last longerthan 20 to 20 minutes. The pain does not subside when patient restlike in angina.

12.Precipitating factors

Themajor precipitating factors of angina include emotional stress,sexual activity, disturbing dreams, bathing, drinking and eating coldfoods, and dressing among others.

13.How nitrates work to treat angina

Nitratessuch as NTG are used to treat angina by releasing nitric oxide fromthe cells in the blood vessels lining, in both veins and arteries.This works by dilating blood vessels and decreasing the work of theheart. Thus, nitrates improve angina by decreasing oxygen demand andcoronary blood flow.

14.Cardiac markers

Cardiacmarkers such as troponin and myoglobin have been often associatedwith successful infarct reperfusion. Their great use is to excludecardiac damage in patients with chest pain. In particular, troponinsare also known for increasing plasma in unstable angina, which is anessential criterion for the diagnosis of myocardial infarction.

15.Risk factors for Coronary Artery Disease

Hypertension,diabetes, depression, stroke, obesity and smoking are among thecommon risk factors of coronary artery disease. Patients withcoronary artery disease can be reduced these risk factors by quittingsmoking, for smoker, and a modest reduction in cholesterol anddietary fat. Studies also emphasize on the importance of physicalexercise, recreation and fitness.

16.Nutritional intake for COPD patients

Patientswith COPD require a nutritional intake because weight loss, lack ofappetite and lean body mass can affect the physical energy. Without aproper nutrition intake, COPD patients suffer from an imbalancedlevel of energy intake and may begin to deplete. Furthermore,reduction of the intake in nutritional food may result to a series ofpsychological factors such as fatigue, depression, discomfort andgastric distension (James et al, 2012). To avoid any complicationsand undernourishment, COPD patients need to be routinely screened todetect any changes.

17.Prevention of Contrast induced nephropathy

Contrast-inducednephropathy is a recognized complication whose result for preventivemeasures has proven inconsistent. However, studies suggest thathydration is an intervention that has portrayed great benefit in manyrandomized trials. Another preventive measure include, the infusionof sodium bicarbonate an hour before the procedure has beenidentified as effective. This is essential as it improves theelimination of the contract agent. Also, the maintenance of highurine output has been considered an effective way of preventingcontrast agents from clogging renal tubules and limiting theexposures of toxin in the kidneys.

18.Signs of retroperitoneal bleeding in patient with cardiaccatheterization

Retroperitonealbleeding is rarely obvious until significant blood loss has takenplace. However, patients who have had a retroperitoneal bleed developa significant abdominal discomfort and tachycardia due tointravascular volume depletion, as well as, progressive anemia. Otherforms of common physical signs include pain tingling and back pains.Patients with retroperitoneal bleeding may also develop hypotensionand abdominal distention are hours after characterization procedure.

19.Cystic fibrosis and transition to adult CF team

Trainingprograms are critical when preparing a young adult with cysticfibrosis in their transition to adult health care facilities.Training in young adults is essential and should involve listening tothe young adult’s view during the transitional process. Other wayis to set up appointments for the adult healthcare provider to cometo the pediatric setting, or for the nurse to accompany the teen tothe adult center during their first appointment. Lastly, ensurecommunication between the adult and pediatric care team to facilitatethe success of the transition.

20.Arterial blood pressure

Themean arterial blood pressure for an adult needed to sustain perfusionpressure to vital organs is approximately 60mmHg. However the elderlyand patients with renal artery stenosis may reach higher targets.

21.Blood in the Peritoneal Cavity

Theperitoneal cavity, a stretchable or distensible sac, has the capacityto hold up to five liters of blood. However, a loss of a minimum oftwo liters of blood would cause a measurable variation in thedistension of the stomach. This is extremely crucial in thedetermination of the presence of an internal injury.

22.Shock and absence of low blood pressure

Shockin injured patients is not always because of low blood pressure. Somemanifestations of shock are caused by the changes resulting fromcompensatory efforts. The compensatory mechanism tries to keep anadequate blood flow to vital organs leading to increased heart rate,contractility, as well as, renal retention. As shock progresses, thechanges in the respiratory, renal, and central nervous system becomesmore evident.

23.Compare and contrast cardiogenic, septic and hypovolemic shock

Cardiogenic,Septic and Hypovolemic shock are potentially fatal conditions, whoseearly signs are increased heart rate, respiration and restlessness.Hypovolemic shock, also known as the low volume shock occurs whenlarge amount of blood or plasma is lost. Physical examination revealsdry mucous, flattened neck veins, and loss of skin turgor. The mostcommon cause of hypovolemic shock is trauma, surgery, major bloodloss and massive gastrointestinal hemorrhage. Cardiogenic shockresults from the interference of heart function or cardiac failure. Either or both ventricles fail and cannot adequately eject the enddiastolic volume. Patients suffering from cardiogenic shockdemonstrate a low CO and high systemic vascular resistance. Septicshock occurs when massive infection produces toxins that increasepermeability and vasodilation. Unlike cardiogenic shock, Septic shockIs characterized by high levels of CO and low systemic vascularresistance.

24.Hypovolemic shock treatment

Hypovolemicshock is a life threatening condition that results from acutehypovolemia. The treatment for this condition is symptomatic as it isaimed at correcting imbalances and removing underlying cause. Thisinclude efforts aimed at increasing blood supply to the brain,replacing fluid loss, and identifying bleeding sites in order tocontrol bleeding.

25.Best position for hypovolemic shock patient

Patientswho are in shock should be transported in a spine position andimmobilized on a long board. If a patient with mild hypovolemia isstable, the best position is spine with head of the bed elevated 30to 60 degrees to maintain pulmonary ventilation. On the other hand,if the patient is unstable and hypotensive, the best position issupine and flat. Turning the patient after every 2 hour is said tohelp in improving oxygenation and pulmonary function. However, it isimportant to keep in mind that hypovolemic shock patients should notbe placed in the Trendenburg position because it may aggravate thealready impaired ventilator function, as well as, increaseintracranial pressure in patients with traumatic brain injury.

26.Use of crystalloids versus colloids in the treatment of hypovolemicshock

Thebest treatment of hypovolemic shock continues to be dogged by thecrystalloid-versus-colloid debate, which still remain controversial.However, crystalloids and colloids has long been used in treatmentwith the first choice of treatment being crystalloids. This isbecause crystalloids are inexpensive and move freely and rapidlywithin the intravascular and extra-vascular spaces. On the otherhands, Colloids are an expensive choice compared to crystalloids, butthey stay in the intravascular space longer than crystalloids. Thus,more evidence suggests that colloids are superior to crystalloids asthey have the ability to improve cardiac output and oxygen transport.

27.Crackles onchest auscultationwhen experiencing cardiogenic shock

Cracklesmay be heard at the bases to mid zones on the lungs on pulmonaryauscultation, indicating the presence of pulmonary oedema. Thus, Itis possible to hear crackles when auscultating a patient’s chestduring cardiogenic shock as it is an indication of the leftventricular dysfunction.

28. How positive pressure ventilation assist in pulmonary oedema

Positivepressure ventilation has been used in the management of acuterespiratory failure. Positive pressure ventilation is frequently usedto improve oxygenation in persons with pulmonary oedema by improvingventilation perfusion matching within the lung. The positive pressurehas proven effective as it results to an effect that opens a greaternumber of alveoli that tends to collapse in the presence of alveolaredema fluid. Therefore, instituting positive pressure ventilation inpatients with pulmonary edema usually results in prompt improvementin oxygenation, and at time in cardiac output.

29.Virchow’s triad of risk factors for Deep Vein thrombosisdevelopment

Itis well established that without treatment, a large number ofpatients with Deep Vein thrombosis develop pulmonary embolism, and50% of patients diagnosed with pulmonary embolism have a highshort-term mortality. Some of the well known risk factors includedehydration, obesity, critical care admission, varicose vein withphlebitis, use of hormone replacement therapy, recent pregnancy orchild birth, and dehydration among others. These risk factors affectstasis of blood flow to a lesser degree leading to blood disorder.

30.Types of anticoagulant therapy used to treat DVT and status tests

Therapyused in the treatment of DVT includes heparin or unfractionatedheparin and low molecular-weight heparin therapy. Unfractionatedheparin is a natural occurring anticoagulant, which inhibits plateletfunction. Heparin prevents thrombosis as it is given as asubcutaneous injection, two or three times daily. On the other hand,Low-molecular weight heparins are forms of heparins that have moreselective effects on coagulation. Their biochemical propertiessuggest that they have a longer half-life and less variableanticoagulant response than standard response.


Fraser,J., Waters, D., Forster, E., &amp Brown, N. (2014). Paediatricnursing in Australia: principles for practice.Cambridge: Cambridge University Press.

James,J., Grimble, G. K., &amp Silk, D. B. (2012). Artificialnutrition support in clinical practice(2nd ed.). London: GMM.

Loftus,C. M. (2011). Neurosurgicalemergencies(2nd ed.). New York: Thieme .

Riegelman,R. K. (2010). Publichealth 101: healthy people–healthy populations.Sudbury, Mass.: Jones and Bartlett.

Woodhead,K. (2005). Atextbook of perioperative care.Edinburgh: Elsevier/Churchill Livingstone.