The Basics
In Anaemia:
Does Vitamin C improves iron absorption when taken with iron- rich foods?
True or False
True
According to UK Sepsis Trust, What is Sepsis?
a) Blood Poisoning
b) Severe Immune Response
c) Severe Infection
b) Severe Immune Response
Sepsis is when our immune system goes overdrive fighting an infection.
Can quickly lead to organ failure and death. Any infection could trigger sepsis.
Preventing infection is the best way to avoiding sepsis
True or False
True
Re: Post Endoscopic Management
Patient had urgent endoscopy showing large oesophageal varices with active bleeding. Band ligation is performed successfully. Apart from monitoring HB/ U&E/ LFT and obs/ fluid balance. What should be your next steps?
Allocated points given to any of the following answers:
1) Continue vasoactive meds for 2-5 days to reduce bleeding.
2) Continue IV ABX for 5-7 days.
3) Monitor complications (rebleeding, aspiration, infection, hepatic encepalopathy)
After the first Gastro Development day topic on Alcohol Withdrawal, what was the collective topic suggested for the 2nd development day?
(Upper) GI Bleed
Definition: What is Acute Kidney Injury?
Acute deterioration in renal function from a patient's baseline.
Acute kidney injury (AKI) occurs when kidneys suddenly lose their ability to filter waste from the blood, developing within hours or days (National Kidney Foundation, 2024).
Which type of anaemia is associated with MCV <80 fL (foot-Lambert)?
Microcytic anaemia
In Anaemia:
What are the 2 main risk during Iron Infusion?
Anaphylaxis
Permanent skin staining
Patients who are on Alcohol Withdrawal Management. How often would you have to reassess patients who has CIWA score >10?
Hourly
How many areas of Link Nurses/HCA do we have in the ward?
21
(anticoagulation, alcohol, blood safety, dementia, deteriorating patients, diabetes, DOLS/ safeguarding, Education, Falls, Fit testing, Infection control, learning disabilities, medical devices, moving and handling, Nutrition, Palliative care, Sepsis/ AKI, Tissue viability, Vascular Access, Tobacco dependency, Telemetry)
What is Sepsis Six
1) Give 0xygen (Aiming sats >94%)
2) Give IV ABX
3) Give Fluid Challenge
4) Take Blood Cultures
5) Take Lactate
6) Measure Urine Output
H Pylori
NSAIDS
Alcohol
Excess production of gastric acid
Can you name 4 clinical signs and symptoms of AKI?
Clinical findings: oliguria/anuria, hypovolaemia signs (dry mucous membranes, tachycardia, hypotension), volume overload signs (hypertension, pulmonary/peripheral oedema), uraemia signs (ecchymosis (bruises), asterixis (flapping tremor), confusion), post-renal obstruction signs (distended bladder).
In Anaemia:
Which of the following nutrients is ALSO required for effective red blood cell synthesis?
a) Vitamin C and Vitamin K
b) Vitamin A and Riboflavin
c) Folate and Vitamin B12
d) Vitamin D and Calcium
c) Folate and Vitamin B12
What 5 weekly audits is the ward required to complete on Mondays?
Hand hygiene
Commode
Venflone
CD check
Catheter
A 58y/o man with a history of alcohol- related liver cirrhosis & alcohol excess is handed over to you during out of hours with vomiting bright red blood. He is hypotensive (BP 80/40) and tachycardic (HR 120). His abdomen is distended. He appears jaundice, lethargic and cool to touch.
Apart from ABCDE approach, IV access, Obs/ fluid monitoring and bloods, what else could be your immediate management?
Allocated points given to any of the answers below:
1) Prepare for urgent OGD (pre- OGD preparation/ checklist, patient/ NOK information). NBM.
2) Outreach/ H@N for OOH
3) Consider Thiamine IV, CIWA & Benzo
Can you name 5 risk factors that could cause or contribute to AKI
chronic kidney disease, heart failure, liver disease, diabetes, previous AKI, oliguria, cognitive impairment, hypovolaemia, nephrotoxic drugs, iodine-based contrast media, urological obstruction, sepsis, age 65+.
A 55F with Congestive Heart Failure is planned for IV iron infusion. Which adjustment is MOST important?
a) Use oral iron instead
b) Infuse slowly and monitor for fluid overload
c) Avoid IV iron completely
d) Give double the standard dose
b) Infuse slowly and monitor for fluid overload
Patient post OGD showing large oesophageal varices with active bleeding. Band ligation is performed successfully.
Plan to continue Terlipressin and IV Pip- Taz.
Apart from bloods (U&E), what 3 other monitoring would you monitor post OGD?
Monitor complications (rebleeding, aspiration, infection, hepatic encepalopathy)
Assess for hepatic decompensation (fluid status, mental state, LFT)
Fluid Balance
What are the three visions of having Gastro Development days?
Peer Support/ Discussions
Empowerment
Revalidation
Name 4 of 6 functions of the Kidneys
Regulating water volume
Acid/ Base balance
Influences Red Blood Cells production
Controls Blood Pressure
Drug Metabolism and Removal of waste products
Endocrine functions: Vit D production
What secondary prophylaxis would you advise to your patient post UGI Bleed?
1) Non- selective beta blocker (Carvidelol/ Propranolol). Target HR 55-60.
2) Ensure repeat outpatient OGD (4- 6/52 for placement of further bands)
3) Alcohol cessation, nutritional support, consideration of liver transplant (strict criteria)
4) Safety net patient: Monitor complications of cirrhosis (ascites, encephalopathy, SBP)
Out of hours admission:
A 58y/o man with a history of alcohol- related liver cirrhosis & alcohol excess is handed over to you during out of hours with vomiting bright red blood. He is hypotensive (BP 80/40) and tachycardic (HR 120). His abdomen is distended. He appears jaundice, lethargic and cool to touch.
You have done their ABCDE approach, IV access inserted with bloods taken and fluids administered (incl. blood).
What else would you do?
Prepare for urgent OGD (pre- OGD preparation/ checklist, patient/ NOK information). NBM.
Outreach/ H@N for OOH
Patients with AKI.
Can you name 4 reasons of 7 when would you escalate to Critical Care Outreach Team?
Anuria or Oliguria
Refractory Hyperkalaemia
Refractory Hypotension
Acidosis (Low Bicarb and High Lactate)
Reduced GCS
Fluid Overload
Clinical Concern " Something not right..."
Every ward has a Profile of Learning Opportunities (POLO) file accessible to all staff in the sisters office. What is the colour of the file?
Purple