PN2 Exam #2 Study Guide-Completed A

PN2 Exam #2 Study Guide ASTHMA • Characterized by exacerbations of acute airway inflammation • Airway obstruction occurs d/t bronchoconstriction, mucous, or inflammation when exposed to trigger Clinical Manifestations: • High pitched, wheezing lung sounds • Cough • SOB • Chest tightness • Worsens at night or when triggers are present Medications: • Short Acting= Albuterol, Proventil, Ventoli • Long Acting= Serevent • Corticosteroids= Serevent, Advair Education: • Avoid triggers • Stop/avoid smoking • Teach which inhaler is rescue Exacerbation Interventions: • Give short-acting beta agonist • IV corticosteroids depending on severity • O2 via nasal cannula • High-fowler’s position • Calm atmosphere Questions: If a pt. is having an asthma attack how would you expect it to affect their VS? • At first RR increased then decreased as attack progresses • Tachycardia 120 • Decreased BP If you give a pt. Albuterol, what type of side effects would you expect to see? • Increased HR • Tremors What are rescue medications for Asthma? • Short-acting beta agonists (Albuterol) EPITAXIS • Nose bleed – d/t trauma, allergies, drug use • Most frequent ED complaint Interventions & Treatment: • Anterior portion of nose = apply direct pressure for 5-10 while leaning forward • Apply silver nitrate • Apply lidocaine/ep with cotton pledge for 5-10 minutes • Nasal packing for 2-5 days • Educate on prevention – Vaseline, humidifiers COPD • Chronic obstructive pulmonary disease – emphysema & chronic bronchitis • Causes= air pollution, occupation, smoking Primary Symptoms: • Cough • Sputum production • DOE – Dyspnea On Exertion Clinical Manifestations: • Wheezes or crackles heard in lungs • Prolonged expiratory phase • Distant heart sounds • Orthopneic position • Barrel chest • Use of accessory muscles • Weight loss (dyspnea with eating) • Late phase= clubbing to nails, right-sided HF, chronic cyanosis Medications: • Avoid frequent use of cough suppressants (antitussives) because coughing is a protective mechanism • Limit narcotic use d/t respiratory depression can worsen hypercapnia • Beta-Adrenergic Agonists: Albuterol, formoterol • Anticholinergics: Atrovent, Spiriva • Corticosteroids: short course only • Methylxanthines: Theophylline (limited) Interventions & Education: • Pursed lipped breathing • Controlled coughing • Controlled O2 therapy (1-2 L) • Low sodium diet • Diaphragmic breathing • Conserve energy • Small frequent meals • Increase fluids • BiPAP RAYNAUD’S DISEASE • Bilateral vasospasms; peripheral artery occlusive disease triggered by cold & stress Clinical Manifestations: • Pain & cyanosis followed by redness and pain (when warmed up) • Pain is intermittent, extremities are numb & cold & may have swelling/ulcerations Education: • Stop smoking • Exercise • Control stress • Avoid extreme temperatures ALLERGIC RHINITIS Prevention: • Remove carpet • Keep pets out of house or out of bedrooms • Wash linens in hot water • Avoid heat & humidity • Avoid feather pillows • Avoid cigarette smoke Medications: • Fexofenadine (Allergra) = non-drowsy • Pseudoephedrine (Sudafed) = non-drowsy • Diphenhydramine (Benadryl) = drowsy CYSTIC FIBROSIS • An inherited, recessive, chronic, progressive, and frequently fatal disease of the body’s exocrine mucus producing glands • Primarily affects the respiratory, digestive, and intestinal systems and pancreas • Each parent passes the recessive gene to a child Possible Complications: • Lung abscesses • Chronic bronchitis • Honeycomb lung • Bronchiectasis • Chronic pancreatitis • Malabsorption • Cor pulmonale Clinical Manifestations: • Apical crackles • Frequent infections • Purulent secretions • Productive cough • Wheezing • Dyspnea • Recurrent infections • Bronchiectasis • Infiltrates • Scarring (CXR) • Increased chest circumference • Hyper-resonance with percussion • Clubbing • Gassiness • Diabetes • Pancreatic insufficiency • Pancreatitis • Meconium ileus • Diarrhea • Abnormal sweat Cl concentrations • Infertility Treatment: • Referral to regional CF center • Focus: clearance and reduction of lower airway secretions, prevention & treatment of respiratory infections, pancreatic enzyme replacement and adequate PO intake, psychosocial support. • Surgery-lung transplant, long wait-list Interventions: • Pancreatic Enzymes (may need replacement) • Bulky, foul-smelling stools (malabsorption) • Give adequate salt • TF/parenteral nutrition • Daily weight • Iron supplements PNEUMONIA • Acute or chronic infection of one or both lungs caused by bacteria or virus Risk Factors: • Increased age • Immunocompromised • Diabetes • CHF • Active malignancies • Chronic diseases (i.e. sickle cell anemia) Clinical Manifestations: • Fever/chills • Productive or dry cough • Tachycardia • Cyanosis • Joint pain/aches • Hypotension • Headache • Mood swings • Anorexia • Pleuritic chest pain • Dyspnea • Crackles in lungs Diagnostics: • CBC • Chest x-ray Treatment: • Antibiotics • Possible O2 • Pneumonia vaccine • Rest & fluids • Incentive spirometer, cough & deep breathing BUERGER’S DISEASE • Occlusive disease mostly in small/medium arteries • Associated with clot formation and fibrosis of vessel wall Cause/Education: • Smoking – especially young male smokers • Stopping smoking will stop disease progression Clinical Manifestations: • Thickened nail beds • Intermittent claudication • Cramps in legs after exercise • Blackish ulcerations on skin • Extreme sensitivity to hot & cold • Pain in digits • Weak/thread peripheral pulses Diagnostics: • Plethysmograph studies of the digits (early stages) • Doppler U/S • Arteriograms - extent of disease process ANEMIA • Low hemoglobin (RBC) level • 1st cause = blood loss/hemorrhage • 2nd cause = decreased RBC production d/t malnutrition, renal disease, or bone marrow suppression • 3rd cause = destruction of RBC/abnormal RBC structure (sickle cell anemia=crescent shaped) Clinical Manifestations: • Fatigue • Weakness • Tachycardia • Hypotension • Hypoxia, SOB • Pallor • Chest pain Diagnostics: • Full CBC • Iron studies & Serum B12 • Haptoglobin & Erythropoietin • Bone Marrow Aspiration Treatment: • Iron replacement PO/IV • Vitamin B12 IM/PO • Folic Acid PO (green leafy veggies, liver, fruits, cereal) • Erythropoietin • RBC infusion • O2 administration (especially in sickle cell) • Hemodynamic & cardiac monitoring TONSILLITIS • History of otitis media, hearing difficulties, sore throat w/ swallowing Clinical Manifestations: • Sore throat, change/loss of voice • Reddened tonsils • Swollen/tender neck lymph nodes • Fever • White/yellow coating on tonsils • Snoring Diagnostics: • Throat culture for group A strep. & bacterial infection • CT if infection present to see if it spread to neck region • Pre-op CBC to assess for anemia/infections Tonsillectomy Education: • Report= signs of hemorrhage, fever, excessive vomiting, unrelieved pain, excessive coughing or swallowing • Drink minimum 8 glasses of water a day • Soft foods for first few days • Avoid smoking & heavy lifting • No gargling – can irritate surgical site AORTIC ANEURYSM • Permanent bulging and stretching of an artery – dilated 2x or greater in size • Most common = Abdominal Aortic Aneurysm (AAA) Risk Factors: • Hypertension = #1 risk • Smoking • Hyperlipidemia AAA Clinical Manifestations: • Nausea/vomiting • Back pain d/t pressure on spinal nerves • Pulsation in upper abdominal midline • Auscultation of a bruit at aneurysm site – DO NOT palpate Thoracic Aorta Clinical Manifestations: • Severe back pain-compression of surrounding tissues • Bronchial obstruction & hoarseness • Dyspnea & dysphasia • Aphonia-r/t pressure on laryngial nerve • Pulsating mass about suprasternal notch Diagnostics: • X-ray to identify the location of the mass • CT scan • Duplex Ultrasonography • Transesophageal Echocardiography - thoracic aneurysms Treatment: • Anti-hypertensives • Anti-anxiety medications • Surgery for aneurysms 6cm or are rapidly growing • Aneurysms 6cm monitor with ultra sound every 6 months HEMOPHILIA • Hereditary bleeding disorder resulting in deficient clotting factors (VII, IX, & X) • Hemophilia A= VII deficient, from mothers to sons • Hemophilia B= Christmas disease, from mothers to sons • Hemophilia C= IX deficient, autosomal recessive • Von Willebrand’s disease Clinical Manifestations: • Joint & muscle pain • Hemorrhages • Bruises easily Complications: • Untreated joint bleeding can cause permanent damage Diagnostics: • Platelet levels • Factor assay tests • Coagulation tests HEART FAILURE • Heart cannot efficiently pump blood throughout the body – heart doesn’t fill with enough blood or pump with enough force • Compensates by increasing HR which dilates ventricles (increased HR = decreased cardiac output) Diastolic HF: • Inability to relax, causes decrease in ventricular filling Systolic HF: • Inability of the ventricles to contract and pump blood adequately • More common – r/t aging d/t stiffness of vasculature Left-Sided HF: • Reduced capacity to pump blood into systemic circulation • Decreased CO and stasis or “backup” of fluid into pulmonary circulation Left-Sided Causes: • Hypertension • Alcoholism • MI • Coronary artery blockage • Hypothyroidism • Heart infection Left-Sided Symptoms: • Dyspnea on exertion • Orthopnea • Cough w/ pink sputum • Crackles, wheezes • Cyanosis • New S3 (ventricle gallop), heart murmur • Pulmonary edema Right-Sided HF: • Reduced capacity to pump blood into pulmonary circulation • Causes stasis or “backup” of fluid in venous circulation Right-Sided Causes: • Pulmonary hypertension • Congenital heart diseases • Heart valve diseases • Chronic lung diseases (COPD, Cystic Fibrosis) • Left HF Right-Sided Symptoms: • JVD • Dependent edema in LE • Abdominal discomfort • Nausea from fluid congestion • Irregular heart rate • Enlarged liver • Weight gain HF Diagnostics: • ECG= thickening of heart muscle and dysrhythmias • ECHO= MAIN test - shows heart enlargement • Decreased cardiac function tests • CXR= heart enlargement • Stress tests • Cardiac Catheterization= identifies degree of HR • MRI= examines heart muscles • BNP= determines the degree of HF HF Interventions: • Goal= decrease heart workload, improve cardiac function & symptoms • Decrease fluid & sodium intake • Elevate HOB, dangle legs • O2 via non-rebreather or mechanical vent • Pulmonary edema= sitting position, high O2, diuretics, intubate CARDIAC/HF MEDICATIONS Diuretics: • HF, HTN, DCM • *Monitor for dehydration, hyponatremia, & hypokalemia Nitrates (have ‘nitr’ in name): • HF • Do not give if pt. has hypotension, tachycardia, or bradycardia • Commonly used for angina • Increase venous capacity Beta Blockers (end in ‘lol’): • HF, HTN, DCM • Decreases HR & BP • Decreases contraction force/workload Calcium-Channel Blockers (most end in ‘dipine’): • HF, HTN • Decreases HR & BP • Vasodilators • Reduces angina • Dilates coronary arteries ACE Inhibitors: • HF, HTN, DCM • Decrease pressure the heart must overcome to eject blood from the heart by interfering with the renin-angiotensin-aldosterone system (RAAS) • Promotes vasodilation Digoxin (Lanoxin): • HF • Cardiac glycoside • Increase heart’s contractility • Increases myocardial cell contraction Vasodilators: • HF, HTN, DCM, Buerger’s Disease, Raynaud’s • Isosorbide • Decrease BP Anticoagulants & Antiplatelet: • HF, DCM, Arteriosclerosis & Atherosclerosis, Thrombophlebitis • Heparin, Lovenox, Coumadin, Aspirin, Plavix • Prevent cardiac events • Not primary tx of HF DILATED CARDIOMYOPATHY (DCM) • Disease of heart muscle resulting in dilated heart chamber (balloon expanding) • Decreases force in heart contraction • Leads to weak & thin heart wall – similar to right & left HF • Associated with CHD, heart valve disease, & HTN Clinical Manifestations: • SOB • Lung congestion • Dependent edema • Fatigue • Palpations • Syncope • Chest pain Diagnostics: • EKG • Cardiac catheter= heart tissue biopsy Medications: • ACE inhibitors • Beta blockers • Diuretics • Anticoagulants • Antiarrhythmics INFECTIVE ENDOCARDITIS • Destructive infection of the heart’s inner lining (endocardium) or the heart valves Etiology/Causes: • Surgery, dental procedures • Artificial heart valve • Rheumatic fever • Congenital heart defects • Heart Valve defects • Streptococcal pharyngitis Clinical Manifestations: • Vague infection findings • Malaise • Anorexia, weight loss • Cough • Back pain • Heart murmurs • Retinal hemorrhages (Roth spots) • Petechiae • Headaches Diagnostics: • *Serial Blood cultures= to identify microorganism • ECHO Treatment: • Long-term IV antibiotics • Possible surgery HYPERTENSION • The harder the heart muscle works the greater the pressure on heart wall • Defined as BP 140/90 on two separate readings, at two different times • Normal BP= 120/80 • Pre-Hypertension= 120/80 - 139/89 • Stage I Hypertension= 140/90 – 159/99 • Stage II Hypertension= 160/100 • Cuff bladder width= 40% of arm circumference • Cuff bladder length= 80%-100% of arm circumference Modifiable Risk Factors: • Sedentary lifestyle • Smoking • Obesity, physical inactivity • Stress • Drug abuse • Caffeine • High-fat diet • Excessive alcohol intake (3+ drinks/day) Non-Modifiable Risk Factors: • Family history • African-American decent • More common in Males until age 55 • Age 65+ Clinical Manifestations: • “Silent Killer” • Fatigue • Dizziness • Angina • Palpitations • Dyspnea • *Headache= most reported s/s – possibly r/t sleep apnea if upon waking • Nocturia Diagnostics: • Used to detect underlying cause • Electrolyte levels • Fasting lipid profile • Creatinine/BUN • Sleep study Interventions: • DASH diet= low fat & cholesterol - high grains, fruits & vegetables • Avoid high sodium= canned foods, animal products PULSE PRESSURE Systolic – Diastolic = Pulse Pressure Example: BP= 120/80, PP= 40 PERIPHERAL ARTERY DISEASE (PAD) • Plaque form on the arterial walls, trapping emboli and causing blood flow to cease distally Risk Factors: • Men 50+ • Postmenopausal women • HTN, hyperlipidemia • Obesity, decreased activity • Smoking • Diabetes • Family history • Stress Clinical Manifestations: • Occurs unilaterally • Skin mottling, ulcerations, black or gangrenous • Muscle atrophy • Shiny skin, sparse hair • Thickened nails • Six P’s (seen in affected extremity) o Pulseless o Pain – often worse at night, accompanied by cramping/fatigue o Pallor o Paresthesia o Paralysis o Poikilothermia (coldness) Interventions/Treatment: • Place extremity in dependent position to decrease pain • Anticoagulants • Percutaneous transluminal angioplasty (PTA)-balloon catheter • Laser-assisted angioplasty and atherectomy • Bypass grafts • Amputation Diagnostics: • Doppler pulses to assess for blood flow • Ankle-brachial index (ABI)= measures ratio of lower to upper extremity BP • Ultrasound • Treat-mill testing • Arterio-angiograms= identify advancement/location of claudication TUBERCULOSIS • Cough lasting 2+ weeks • Weight loss – 3lbs/week considered significant • Fever, night sweats • Weakness • Hemoptysis – progressed stage Medication: • Given in different combinations that are tailored to pt. individual infection • Isoniazid, Rifampin, Pyrazinamide, Ethambutol ARTERIO & ATHERO-SCLEROSIS • Arteriosclerosis: hardening of the small arteries • Atherosclerosis: accumulation of plaque in large arteries Pathophysiology: • An accrual of lipids, calcium, blood, carbohydrates, fibrous tissue located on the intimal layer of the vessel Risk Factors: • Increased age • Men typically develop earlier than women • African & Mexican-American • Hypertension • High cholesterol • Physical inactivity • Stress • Obesity • Tobacco • Diabetes Mellitus Clinical Manifestations: • Hypertension • Heart disease • Prolonged capillary refill • Temp differences in extremities • Cold extremities • Bruits Nursing Assessment: • Bilateral B/P readings • Apical & radial pulse checks • Need gravity to get increased circulation to lower extremities Diagnostics: • Assess cholesterol levels (LDL levels) • Homocystine level 15 indicates risk for CAD/PAD • Coagulation studies • Arteriography • MRI: evaluate extent Interventions: • Diet: 30% or less in saturated fat, cholesterol intake 300 mg/day • Increase exercise • Smoking cessation Medications: • Heparin, Lovenox - clot prevention • Aspirin, Plavix - anti-platelet formation • Cholestyramine - lowers blood cholesterol levels • Simvastatin, Pravastatin, Atorvastatin - lowers LDL levels • Tricor (Fenofibrate) – lowers cholesterol and risk for pancreatitis • Niacin (Vitamin B3) – lowers blood lipids