1. COPD
a. Diagnostic: Pulmonary function test, chest X-Ray, CT scan, ABG, labs tests, spirometry,
FEV1<70%, increased residual volume, 6 min walk test, CAT, CCQ, echo, sputum
b. Nursing care: monitor breath sounds, elevate HOB, eliminate pollution, pursed lip
breathing, increase fluid intake, turn q2 hrs, influenza vaccine, pneumococcal vaccine,
smoking cessation, O2 ( high or low flow), humidifier, chest , surgical therapy,
percussion/vibration/postural drainage, ABD breathing, Huff cough, nutrition therapy
c. Theophylline: bronchodilator, side effects: headache, nausea, vomiting, muscle tremors,
tachycardia, hypokalemia, phypo/hypercalemia- are signs of toxicity
2. Asthma
a. Assessment: RR, breath sounds, peak flow, O2, wheezing, eczema, hives, HR >120/min,
PEFR ≤40%, RR >30/min, use of accessory muscles, percussion, ABG
b. Management: avoid triggers, premedicate before exercise, IV corticosteroids, anti-IgE
( Xolair), SABAs
c. Lung sounds: wheezing, prolonged expiration, thermoplasty, leukotriene modifiers
3. Pneumonia assessment findings: tachypnea, dyspnea, cough, fever, fine or course crackles,
bronchial breath sounds, egophony
4. Dehydration management: correct underlying cause, blood products, balanced, daily weights, I &
O, labs
5. Calcium imbalance- controlled by parathyroid
a. Hyper-: fatigue, lethargy, weakness, confusion, hallucinations, coma, seizures, polyuria,
dehydration, bone pain, fractures
b. Hypo-: alkalosis, increased calcium loss, dysphagia, positive trousseau or chvostek sign,
cardiac dysrhythmia, tingling of the mouth or extremities
6. Hematological system
a. Pernicious anemia management: prioritize activities, maximize O2, evaluate nutritional
needs, transfusion of packed RBCs, oral iron supplements, treat underlying cause
b. Heparin induced thrombocytopenia: life threatening, response to heparin ( platelet
destruction and vascular endothelial injury), develops 5-10 days after starting heparin,
count drops 50% from baseline, venous thrombosis is a major clinical problem
c. Immune thrombocytopenia purpura ( ITP): most common thrombocytopenia, abnormal
destruction of circulating platelets, primarily an autoimmune disease, acute in children,
chronic in adults, treated with multiple therapies, associated with enhanced aggregation
of platelets , associated with hemolytic-uremic syndrome
d. Normal values
i. WBC:4,000-11,000
ii. RBC:4.7-6.1
iii. HgB: men->13.5-17.5 woman-> 12.0-15.5
iv. Hct: men-> 45-52% woman-> 37-48%
v. Platelets:150,000-450,000
e. Idiopathic aplastic anemia: decrease in all lood cell types, hypocellular bone marrow,
ranges from chronic to critical, rare, usually acquired, autoimmune presumed
, f.Hemolytic anemia: destruction or hemolysis of RBC faster than they can be made,
intrinsic or extrinsic, intrinsic usually inherited, jaundice, enlargement of spleen and
liver, maintenance of renal function is a must
g. Hodgkins lymphoma: malignant, proliferation of abnormal giant and multinucleated
cells, reed-sternburg cells, located in lymph nodes, twice as likely in males, long term
survival rate exceeds 80%, causes unknown, infiltrates lungs spleen or liver eventually,
begins above the diaphragm, nodes remain movable and nontender, painless unless
nodes exert pressure on nerves
i. Symptoms: weight loss, fatigue, fever and chills, tachycardia, night sweats,
alcohol induced pain
ii. Key factors: EBV, genetic predisposition, occupational toxins
h. Sickle cell crisis: autosomal recessive disorder, presence of abnormal Hgb in RBC,
identified in neonatal screening, incurable and often fatal by middle age, RBC stiffen and
enlongate, erythrocytes take a sickle shape due to low O2, most severe, infections are
likely to occur, reversable with reoxygenation, causes a vaso-occlusive crisis, severe
capillary necrosis, life threatening, pain, pallor, prone to cholelithiasis (gallstones),
pneumococcal pneumonia likely to occur, acute chest syndrome (fever, chest pain,
dyspnea, pulmonary infiltrates, cough)
7. Cardiovascular system
a. Aldactone: HTN medication and edema medication, may cause dizziness
lightheadedness nausea or headache
b. Heart failure
i. Management: monitor vitals, supplement O2, higjh fowlers, mechanical
ventilation, ultrafiltration, ventricular assist device, intraaortic balloon pump,
diuretics, vasodilators, morphine, dobutamine, digitalis, ICD, resynchronization,
RAAS ( ace, angiotension II, aldosterone) , Bidil, nitrates, corlanor, beta blockers,
restrict fluid
ii. Diagnostic: echo, ECG, chest x-ray, 6 min walk test, heart cath, BNP, EMP,
cardiopulmonary exercise stress test
c. MVP
i. Unknown cause but normally genetic, most asymptomatic, murmur d/t
regurgitation, severe MR uncommon, treat with beta blockers
ii. Symptoms: dysrhythmias, dizziness, palps, light headedness
iii. Prophylactic antibiotics: if MR present
d. Rheumatic fever]
i. Can cause damage to the valves and heart failure
ii. From strep infections
e. Pericarditis
i. Muffled heart sounds, chest pain, pericardial friction rub
f. Hypertension:
i. Inderal: for HTN, CP, and A Fib
g. PVD ( peripheral vascular disease)
i. Buergers disease: rare, in the arteries and veins of the arms and legs, inflamed
blood vessels, blue or red tint of hands and feet, angio, quit tobacco, surgery
a. Diagnostic: Pulmonary function test, chest X-Ray, CT scan, ABG, labs tests, spirometry,
FEV1<70%, increased residual volume, 6 min walk test, CAT, CCQ, echo, sputum
b. Nursing care: monitor breath sounds, elevate HOB, eliminate pollution, pursed lip
breathing, increase fluid intake, turn q2 hrs, influenza vaccine, pneumococcal vaccine,
smoking cessation, O2 ( high or low flow), humidifier, chest , surgical therapy,
percussion/vibration/postural drainage, ABD breathing, Huff cough, nutrition therapy
c. Theophylline: bronchodilator, side effects: headache, nausea, vomiting, muscle tremors,
tachycardia, hypokalemia, phypo/hypercalemia- are signs of toxicity
2. Asthma
a. Assessment: RR, breath sounds, peak flow, O2, wheezing, eczema, hives, HR >120/min,
PEFR ≤40%, RR >30/min, use of accessory muscles, percussion, ABG
b. Management: avoid triggers, premedicate before exercise, IV corticosteroids, anti-IgE
( Xolair), SABAs
c. Lung sounds: wheezing, prolonged expiration, thermoplasty, leukotriene modifiers
3. Pneumonia assessment findings: tachypnea, dyspnea, cough, fever, fine or course crackles,
bronchial breath sounds, egophony
4. Dehydration management: correct underlying cause, blood products, balanced, daily weights, I &
O, labs
5. Calcium imbalance- controlled by parathyroid
a. Hyper-: fatigue, lethargy, weakness, confusion, hallucinations, coma, seizures, polyuria,
dehydration, bone pain, fractures
b. Hypo-: alkalosis, increased calcium loss, dysphagia, positive trousseau or chvostek sign,
cardiac dysrhythmia, tingling of the mouth or extremities
6. Hematological system
a. Pernicious anemia management: prioritize activities, maximize O2, evaluate nutritional
needs, transfusion of packed RBCs, oral iron supplements, treat underlying cause
b. Heparin induced thrombocytopenia: life threatening, response to heparin ( platelet
destruction and vascular endothelial injury), develops 5-10 days after starting heparin,
count drops 50% from baseline, venous thrombosis is a major clinical problem
c. Immune thrombocytopenia purpura ( ITP): most common thrombocytopenia, abnormal
destruction of circulating platelets, primarily an autoimmune disease, acute in children,
chronic in adults, treated with multiple therapies, associated with enhanced aggregation
of platelets , associated with hemolytic-uremic syndrome
d. Normal values
i. WBC:4,000-11,000
ii. RBC:4.7-6.1
iii. HgB: men->13.5-17.5 woman-> 12.0-15.5
iv. Hct: men-> 45-52% woman-> 37-48%
v. Platelets:150,000-450,000
e. Idiopathic aplastic anemia: decrease in all lood cell types, hypocellular bone marrow,
ranges from chronic to critical, rare, usually acquired, autoimmune presumed
, f.Hemolytic anemia: destruction or hemolysis of RBC faster than they can be made,
intrinsic or extrinsic, intrinsic usually inherited, jaundice, enlargement of spleen and
liver, maintenance of renal function is a must
g. Hodgkins lymphoma: malignant, proliferation of abnormal giant and multinucleated
cells, reed-sternburg cells, located in lymph nodes, twice as likely in males, long term
survival rate exceeds 80%, causes unknown, infiltrates lungs spleen or liver eventually,
begins above the diaphragm, nodes remain movable and nontender, painless unless
nodes exert pressure on nerves
i. Symptoms: weight loss, fatigue, fever and chills, tachycardia, night sweats,
alcohol induced pain
ii. Key factors: EBV, genetic predisposition, occupational toxins
h. Sickle cell crisis: autosomal recessive disorder, presence of abnormal Hgb in RBC,
identified in neonatal screening, incurable and often fatal by middle age, RBC stiffen and
enlongate, erythrocytes take a sickle shape due to low O2, most severe, infections are
likely to occur, reversable with reoxygenation, causes a vaso-occlusive crisis, severe
capillary necrosis, life threatening, pain, pallor, prone to cholelithiasis (gallstones),
pneumococcal pneumonia likely to occur, acute chest syndrome (fever, chest pain,
dyspnea, pulmonary infiltrates, cough)
7. Cardiovascular system
a. Aldactone: HTN medication and edema medication, may cause dizziness
lightheadedness nausea or headache
b. Heart failure
i. Management: monitor vitals, supplement O2, higjh fowlers, mechanical
ventilation, ultrafiltration, ventricular assist device, intraaortic balloon pump,
diuretics, vasodilators, morphine, dobutamine, digitalis, ICD, resynchronization,
RAAS ( ace, angiotension II, aldosterone) , Bidil, nitrates, corlanor, beta blockers,
restrict fluid
ii. Diagnostic: echo, ECG, chest x-ray, 6 min walk test, heart cath, BNP, EMP,
cardiopulmonary exercise stress test
c. MVP
i. Unknown cause but normally genetic, most asymptomatic, murmur d/t
regurgitation, severe MR uncommon, treat with beta blockers
ii. Symptoms: dysrhythmias, dizziness, palps, light headedness
iii. Prophylactic antibiotics: if MR present
d. Rheumatic fever]
i. Can cause damage to the valves and heart failure
ii. From strep infections
e. Pericarditis
i. Muffled heart sounds, chest pain, pericardial friction rub
f. Hypertension:
i. Inderal: for HTN, CP, and A Fib
g. PVD ( peripheral vascular disease)
i. Buergers disease: rare, in the arteries and veins of the arms and legs, inflamed
blood vessels, blue or red tint of hands and feet, angio, quit tobacco, surgery
