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Nursing (NRSG258 ) Lecture Acute Care Notes

John Marsh
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Australian Catholic University

Acute Care Nursing 1 (NRSG258 )

NRSG 258 Lecture Acute Care Notes

Patient focused and evidence based care.
Clinical reasoning and critical thinking.
IBL tutorials with 80% attendance required with documentation for absences.
Introduction of acute care nursing
Clinical reasoning cycle steps:
Perioperative risk factors:
– Age: Children deteriorate quickly, elderly due to other conditions, wound healing.
– Nutritional status
– medication/ medical history
– Lifestyle choices
– Procedural complications
– Environmental (ie SES, where they live)
Diabetes and Surgery Risks/Issues:
Fasting so blood sugar need to monitored
Best to have surgery in the morning
What type of diabetes
Effect wound healing and risk of infection (immune system)
Effect medication metabolization – Insulin & hypoglycemic meds
Loss of muscle mass – longer to mobilise prost surgery. Prone to wound breakdown – longer
healing time.
Perioperative medications:
Pre: sedation, prophylactic meds (antibiotics), anti anxiety, regular meds
Intra: anaesthetics, sedation, muscle relaxation, pain relief
Post: analgesics, laxatives, antibiotics. Sedentary – more prone to constipation.
Postoperative care:
Monitor every 15 mins
– Alertness
– Hydration (iv fluids)
– Pain, nausea, vomiting
– BP, pulse, temp, output/input ect obs
– Specialist observation eg neurological.
Pain Management:
PCA – patient controlled analgesia.
Non verbal patient, non english speaking assessment of pain can use hicks faces to
demonstrate their pain score also nursing observations of grunting, restlessness and facial
Alternative/complementary therapies: music therapy, massage, aromatherapy, heat/cool pack
and transcutaneous electrical nerve stimulation (TENS).
Discharge planning: IDEAL
(include, discuss, educate, assess, listen):
Assess: coping, home situation social supports
Educate: wound care, pain management, working, potential complications.
Provide: rehabilitation, referrals, letters to GP, take home meds, follow up appointments.
Legal Issues Related to Surgery and Documentation:
For consent to be valid:
– Voluntary
– Specific
– Informed
– Legal capacity (legal age >18, cognitive abilities)
Normally surgeon/register obtains their consent for procedures and the doctor performing the
procedure explains the procedure to the patient.
Advance Care Directives – care they wish to receive if they become unable to consent.
Gilick Competency:
If a child is of and age and is intellectually able to consent they can.
Power of Attorney (POA) can not make medical decisions. Only medical power of attorney is
able to make medical decisions.
Any advice we give patients should be documented in the patient’s record. It is not our role to
explain the surgery, risks benefits ect.
Documentation structure:
A – airway
B – breathing
C – circulation
D – disability
E – exposure
F – fluids/full vitals
G – glucose/give comfort measup



Nursing (NRSG258 ) Lecture Acute Care Notes

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