ATI ASTHMA / ACTIVE LEARNING TEMPLATE System Disorder Study Guide 2023.

ATI ASTHMA / ACTIVE LEARNING TEMPLATE System Disorder Study Guide 2023. Acid-base balance o Maintenance of arterial blood pH between 7.35 and 7.45 through control of hydrogen ion production and elimination o Represents delicate balance between hydrogen ions (acid) and bicarbonate (base) o Largely controlled by lungs and kidneys o Dehydration – o f/v overload – HR/BP increase, lung crackles o f/v deficit o R sided HF – fluid collect in legs/sacral area o L sided HF – o (look at p.128 in iggy) o Acidosis occurs if arterial blood pH level falls below 7.35 ▪ Too many hydrogen ions in the body (respiratory acidosis), or ▪ Too little bicarbonate (metabolic acidosis) o Alkalosis occurs if arterial blood pH level is above 7.45 ▪ Too few hydrogen ions in the body (respiratory alkalosis), or ▪ Too much bicarbonate (metabolic alkalosis) o Altered potassium/chloride affect the heart o Risk factors ▪ Poisoning (e.g., salicylate ingestion) ▪ Medical conditions • COPD • Uncontrolled diabetes mellitus (especially Type I) • Chronic kidney disease o Excessive emesis, diarrhea o Hyperventilation o Electrolyte imbalances (especially potassium) o Physiological Consequences ▪ Compensation • Kidneys’ response • Lungs’ response ▪ Assessment - Patient health history – why here? Med? Past procedures?; Present or recent signs/symptoms; Medications, OTC drugs, supplements; ABG monitoring o Health Promotion Strategies - Living healthy lifestyle; Exercise; Healthy diet; Patients at risk should be monitored o Interventions - Dependent upon the type of imbalance (depends on comorbidities); Treatment of the underlying cause(s); See Chapter 13 o Heart less efficient the harder it works • Cellular regulation o Genetic and physiologic processes that control cellular growth, replication, differentiation, and function to maintain homeostasis o May be normal or impaired o P. 130 o Risk factors - Older age; Smoking ; Poor nutrition; Physical inactivity; Environmental pollutants (air, water, soil); Radiation; Selected medications (e.g., chemotherapy); Genetic predisposition or risk o Physiological Consequences- Benign cell growth; Malignant (cancerous) cell growth o Assessment - Patient, family, and psychosocial histories; Physical examination; Diagnostic testing o Interventions ▪ Primary prevention - Use sunscreen of 30 SPF or above; Minimize exposure to sunlight, UV light; Stop smoking and other tobacco use; Eat low-fat, high-fiber diet; Increase physical activity and exercise; Avoid environmental hazards ▪ Secondary prevention - Screening o Interventions (tertiary) – Surgery; Radiation therapy; Chemotherapy; Hormonal therapy; Targeted therapy; Biologic therapy; Bone marrow or hemapoietic stem cell transplants • Clotting o A complex, multi-step process by which blood forms a protein-based structure (clot) o Platelet aggregation clotting cascade o See Chapter 33 o Risk factors—increased or excessive clotting ▪ Immobility or decreased mobility ▪ Polycythemia ▪ Smoking ▪ Certain chronic health problems o Risk factors—decreased clotting ▪ Chemotherapeutic agents and/or corticosteroids ▪ Cirrhosis of the liver (see bruised/discolored skin) ▪ Rare genetic diseases o Pulmonary embolism (PE) – o Deep vein thrombosis (DVT) – o Physiologic Consequences ▪ Increased clotting: Venous thrombosis ▪ Decreased clotting: Prolonged internal or external bleeding o Assessment ▪ Decreased clotting • Bruising • Petechiae • Occult or frank blood in urine and/or stool • Frank bleeding from gums/nose o Increased risk for clotting ▪ Venous thrombosis (redness, pain, swelling, warmth) ▪ Arterial thrombosis (not observable, but marked by decreased perfusion to distal extremity or internal organ) • Critical rescue o Teach patients with decreased clotting ability to report unusual bleeding or bruising immediately o Teach patients at risk for increased clotting to: ▪ Drink fluids ▪ Avoid crossing legs ▪ Ambulate frequently ▪ Stop smoking ▪ Report redness, pain, swelling, and warmth of lower extremity ▪ Not be constipated ▪ No sharp objects - razors o Interventions ▪ Anticoagulants/antiplatelet drugs ▪ Direct thrombin inhibitors ▪ See Chapter 33 • Cognition o Complex integration of mental processes and intellectual function for reasoning, learning, memory, personality o Inadequate cognition – delirium (acute), dementia (chronic), see ch 4 o Impaired cognition – global cognitive disorders, focal cognitive disorders o Risk factors for impaired cognition – advanced age, Brain trauma at any age, Disease or disorder, Environmental exposure to toxins, Substance use disorder, Genetic disorders, Depression, General anesthesia (especially older adults), Fluid/electrolyte imbalances o Physiologic and psychosocial consequences - Loss of short- and/or long-term memory, Disorientation, Impaired reasoning and decision-making, Impaired language skills, Uncontrollable or inappropriate emotions, Delusions, hallucinations o Assessment – mental status assessment, diagnostic tests, neuropsychomotor or neurocognitive testing o History o Mental status assessment (eg confusion assessment model) o Diagnostic testing o Neuropsychological testing o Health promotion strategies – avoid risk factors, stimulate intellectual part of brain (music lessons, new language, crossword puzzles) o Interventions – safety (orientation to person, place, time; cholinesterase inhibitors for those with dementia; determine underlying cause of delirium) • Comfort o State of physical well-being, pleasure, and absence of pain/stress o Has physical and emotional dimensions o Risk factors – Physical, Emotional, Psychosocial o Physiologic and Psychosocial Consequences - Can result in emotional stress and discomfort; “Fight or flight” activated; Persistent pain, anxiety may develop o Assessment – ask, see ch 5 for pain assessment, investigate underlying cause o Health promotion strategies – anticipate pain and emotional stress, intervene before stressors occur if possible o Interventions – collaborate w/ members of the interprofessional team as needed, implement pain management measures • Elimination o Excretion of waste from the body o Accomplished via GI tract and renal/urinary system o Continence, incontinence, retention o Diarrhea, constipation o Risk factors - Aging (bowel and urine); Neurologic disorders injuries (bowel and urine); Spinal cord injuries (bowel and urine); Excessive laxative use (bowel); GI infections (bowel); Bowel diseases (bowel); BPH (urine); Medications (bowel); GU disorders (urine); Decreased peristalsis (bowel) o Physiologic and psychosocial consequences – tissue integrity damage; depression, anxiety; fluid and electrolyte imbalance; bladder rupture (uncommon); bowel impaction, intestinal obstruction (life threatening) o Assessment - Determine risk factors, underlying causes; Assess perineum and buttocks; Monitor frequency, amount, consistency, and characteristics of urine and stool; Laboratory testing o 1 thing undiagnosed can lead to a TON of problems o Health promotion strategies – adequate nutrition and hydration; high fiber diet; toilet or void promptly; bulk forming agents or stool softeners; exercise o Interventions - Monitor for fluid and electrolyte imbalances (in the patient with diarrhea); Health teaching, stool softeners, bulk-forming agents, mild laxatives (as prescribed) (in the patient with constipation); Frequent toileting, catheterization if needed (in the patient with retention) • Fluid and electrolyte balance o Regulation of body fluid volume, osmolality, and composition; and electrolyte regulation o Filtration, diffusion, osmosis, selective excretion o Fluid imbalances - Dehydration, fluid overload o Electrolyte imbalances - Hypokalemia, hyperkalemia, etc. o Risk factors – acute illness, severe burns, serious injury or trauma, chronic kidney disease, major surgery, poor nutrition intake, older adults o Physiological consequences (all dependent on type) – fluid deficit, fluid excess (overload), electrolyte deficit, electrolyte excess o Assessment – complete health history, assess for risk factors, weight change is best indicator of fluid volume change, laboratory tests o Health promotion strategies – drink adequate fluids (8+ glasses of water daily unless contraindicated), well balanced diet ATI ASTHMA/ACTIVE LEARNING TEMPLATE System Disorder Study Guide. o Interventions – fluid deficit (replace fluids), fluid overload (fluid restriction, diuretics), collaborate w/ interprofessional team members • Gas exchange o Process of oxygen transport to cells, and carbon dioxide transport away from cells o Risk factors - Acute or chronic problems affecting central neurons, normal diaphragm function, adequate skeletal muscle contractility; Aging (loss of pulmonary alveoli elasticity); Lung diseases; Smoking; Environmental pollutant exposure; Prolonged immobility o Physiological consequences - Inadequate transportation of oxygen to body cells and organs; Retention of carbon dioxide; Can lead to cell dysfunction or cell death o Assessment – complete health history; focused respiratory assessment; Breathing effort, oxygen saturation, capillary refill, thoracic expansion, lung sounds; Monitor for cough, sputum, shortness of breath, etc.; Laboratory tests; Diagnostic testing o Health promotion strategies - Infection control measures; Smoking cessation; Immunizations; Exposure awareness (e.g., influenza, TB) o Interventions - Identify and treat underlying cause of impairment; Drug therapy; Coughing and deep breathing; Incentive spirometry; Oxygen therapy; Pulse oximetry • Glucose regulation o Ch 59 • Immunity o Protection from illness or disease o Types - Natural active immunity, Natural passive immunity, Artificial active immunity, Artificial passive immunity o Antibody-mediated immunity o Cell-mediated immunity o Risk factors - Older age, Low socioeconomic groups, Non-immunized adults, Chronic illnesses, Taking chronic drug therapy, Substance abuse disorder, Not practicing a healthy lifestyle, Genetic risk o Physiologic Consequences - Susceptible to multiple types of infection, Allergies or autoimmune reactions, See Chapter 18 o Assessment - Complete health history, Family history, Allergies, medications, environmental exposures, Immunization history, Weight, wound healing, cognition, allergic responses, organ dysfunction, Laboratory assessment o Interventions - Avoid infections, Handwashing, Immunizations, Healthy lifestyle, Avoidance of environmental hazards, Teach infection control methods • Infection o Invasion of pathogens (harmful microbes) into the body that multiply and cause disease or illness o Classifications – Bacteria, Viruses, Fungi, Parasites or protozoa o Risk factors – Immunocompromised, Chronic illnesses, Advanced age, Crowded or unsanitary environment, Consuming contaminated food, water, Impaired tissue integrity, Exposed to highly contagious infections, Stress ATI ASTHMA/ACTIVE LEARNING TEMPLATE System Disorder Study Guide. o Physiologic Consequences – Localized (Cellulitis), Systemic (Increased WBC, Septic shock, See Chapter 34) o Assessment – History; Redness, warmth, pain, swelling, elimination changes; Laboratory testing o Health Promotion Strategies - Primary prevention, Secondary prevention o Interventions - Some infections resolve by themselves, Antimicrobial drug therapy, Fluid and electrolytes, Rest, Nutrition • Inflammation o Syndrome of normal responses to cellular injury, allergy, or invasion by pathogens o Classifications – Acute, Chronic o Risk factors – Everyone, Those at risk for allergy or chronic inflammatory diseases are susceptible to chronic inflammation o Physiologic Consequences – Redness, Warmth, Swelling, Pain or discomfort, Loss of function of affected part of the body o Assessment – History, Assess for local and systemic symptoms, Laboratory tests o Health Promotion Strategies - Avoid injury o Interventions – RICE, Drug therapy • Mobility o Ability of an individual to perform purposeful physical movement of the body o Functional ability o Risk factors - Dysfunction of the musculoskeletal or nervous system, Severe brain or spinal cord injuries, Bedridden or prolonged bedrest o Physiological Consequences - Pressure injuries, Constipation, Muscle atrophy, Pneumonia, Venous thromboembolism, Urinary system calculi o Assessment - Observe patient in their environment, Functional assessment tools, Muscle strength, joint range of motion (ROM) o Health Promotion Strategies - Assess for individuals at risk, Teach ROM, Teach “heel pump”, Drink adequate fluids, Evaluate need for assistive devices, Evaluate need for ambulatory aid o Interventions - Passive ROM, Turn, reposition, Keep skin clean and dry, Promote nutrition and hydration, Encourage deep breathing and coughing exercises, Teach about immobility complications, Collaborate with physical therapist • Nutrition o Process of ingesting and using food and fluids o Proteins, carbohydrates, fats, vitamins, minerals o Poor nutrition status o Malnutrition (generalized or specific) o Risk factors - Older adults, Obesity, Lack of money, Anorexia or bulimia o Physiologic Consequences - Dependent upon status of generalized malnutrition or lack of specific nutrients o Assessment – History, GI symptoms, Height, weight, BMI, Skin, hair, nails, Laboratory testing ATI ASTHMA/ACTIVE LEARNING TEMPLATE System Disorder Study Guide. o Health Promotion Strategies - Healthy lifestyle, Exercise, Adequate nutrients, BMI between 19 and 24.9 kg/m2 o Interventions - Collaborate with interprofessional team to address specific problem; For weight loss or low weight: High-protein oral supplements, enteral supplements, parenteral nutrition; Drug therapy; Surgery (e.g., bariatric); See Chapter 55 • Pain o An unpleasant sensory and emotional experience o Subjective o Types – Acute, Persistent o Mechanism - Nocioceptive, Neuropathic o Risk factors – Anyone, Acute trauma, Chronic diseases o Physiologic and Psychosocial Consequences ▪ One or more sympathetic nervous system signs and symptoms • Acute - “Fight or flight” reaction (Nausea, Vomiting, diaphoresis, Increased blood pressure, respirations, pulse, Dilated pupils) • Persistent - No “fight or flight” reaction; Can lead to anxiety, depression o Assessment – Location, Intensity, Quality, Onset, duration, Aggravating or precipitating factors, Effects on quality of life and daily function, Psychosocial effects o Health Promotion Strategies - Often unavoidable, Avoid high-risk activities o Interventions – Pharmacologic (Opioids, non-opioids), Non-pharmacologic (Depends on patient preferences, Integrative therapies) • Perfusion o Adequate arterial blood flow through peripheral tissues (peripheral perfusion) o Blood pumped by the heart to oxygenate major body organs (central perfusion) o Risk factors – Modifiable (Smoking, Lack of physical activity, Obesity), Non-modifiable (Age, Gender, Family history) o Physiologic Consequences – Peripheral (Lower extremities, Cool, pale, cyanotic distal legs, Skin ulcers, Gangrene), Central (Myocardial infarction, Stroke, Shock) o Assessment – History, Family history, Signs/symptoms of impaired central or peripheral impairment o Health Promotion Strategies - Improve nutrition, Stop smoking, Regular exercise, Screening and monitoring o Interventions - Vasodilating drugs, Surgery • Sensory perception o The ability to perceive and interpret sensory input into one or more meaningful responses o Vision, hearing, smell, taste, touch o Risk factors – Aging, Chronic diseases, Mechanical or chemical trauma, Cranial nerve II or VIII damage, Drug therapy (e.g., ototoxicity), Occupational exposures, Genetic risk o Physiologic Consequences - Physical injury (falls, other accidents), Inability to perform ADLs or ambulate independently, May not be able to solely rely on verbal communication, May not be able to use written communication ATI ASTHMA/ACTIVE LEARNING TEMPLATE System Disorder Study Guide. o Assessment – History, Family history, Determine risk factors, Ask about use of aids (glasses, contacts magnifiers, hearing aids or amplifiers, etc.), Basic assessment of vision and hearing o Health Promotion Strategies – Primary (Avoiding risks (e.g., safety goggles, ear plugs)), Secondary (Screening (e.g., eye examinations)) o Interventions - Drug therapy, Corrective lenses or eye surgery, Hearing aids, Psychosocial support • Sexuality o Complex integration of physiologic, emotional, and social aspects of well-being o Not the same as reproduction or gender identity o May be perceived differently by different individuals o Risk factors – Menopause, Erectile dysfunction or prostate problems o Physiologic and Psychosocial Consequences - Poor self-image and self-concept, Impaired intimacy o Assessment - Ask about perception, Partner(s), Protective measures, History of STIs or sexual problems during intercourse o Health Promotion Strategies - STI screening, Physical examination o Interventions - Drug therapy, Referral to a qualified provider if problem is emotional or psychological • Tissue integrity o Intactness of structure and function of integument and mucous membranes o Intact versus impaired o Degree of tissue damage - Partial-thickness, Full-thickness o Risk factors - Older age, Certain medical conditions (e.g., malnutrition, neurologic disorders, diabetes mellitus, etc.), Pressure injuries (See Chapter 23), o Physiologic Consequences - Localized (cellulitis) or systemic (sepsis) infection, Pain, Difficulty healing o Assessment – History, Current chronic health problems, Medications currently taken, Full skin assessment, Risk assessment tools (e.g., Braden scale), Serum albumin and prealbumin levels o Health Promotion Strategies - Proper hygiene, Proper nutrition, Inspect skin daily, Keep skin clean and dry, Change positions, Use evidence-based screening tools, Protect skin (and eyes) from sun o Interventions - Preventative measures, Adequate diet and nutrition supplements, Drug therapy, Chemical/surgical debridement • QUESTIONS o The nurse is assessing a client who smokes and consumes fast food several times daily. Which assessment finding requires immediate nursing intervention? ▪ Cool, pale feet ▪ Temperature of 99.9° F ▪ Body mass index of 34 ▪ Cat allergy that causes shortness of breath ATI ASTHMA/ACTIVE LEARNING TEMPLATE System Disorder Study Guide. o A client tells the nurse, “I just don’t feel like being sexually intimate with my partner any more.” What is the appropriate nursing response? ▪ “How often do you expect to have sex?” ▪ “Do you not find your partner attractive?” ▪ “Would you consider seeing a mental health professional?” ▪ “Have you experienced pain or difficulty with intercourse?” o The nurse is caring for four clients. Which individual does the nurse identify at highest risk for a cognitive concern? ▪ 29-year-old with the common cold and an ankle fracture ▪ 40-year-old who just received a tetanus immunization after stepping on a rusty nail ▪ 59-year old with diabetes who is meeting with the registered dietician nutritionist (RDN) ▪ 71-year-old who drinks 6 beers daily and had surgery under general anesthesia this morning CHAPTER 26 • Anatomy of the nose and sinuses o NEED to retain patent airway o Interference with the upper airway decreases oxygen concentration • Upper airway obstruction (start at p. 1794) o Pathophysiology Overview ▪ Interruption in airflow through nose, mouth, pharynx, or larynx ▪ Can be life-threatening condition ▪ Early recognition is essential in preventing complications, including respiratory arrest ▪ Causes include tongue edema or occlusion, laryngeal edema, peritonsillar and pharyngeal abscess, head and neck cancer, thick secretions, stroke and cerebral edema, facial tracheal or laryngeal trauma or burns, foreign body aspiration o Assessment – recognize cues ▪ Assess cause of partial or complete obstruction