Complex Final Exam Review
Resp Acidosis, Cancer (cellular)
1A: Infection and Inflammation
Pneumonia
● Clinical Manifestations
○ Fever, chills, flushed face, sweating
○ SOB, difficulty breathing, tachypnea
○ Crackles, wheezes (chest discomfort)
○ Coughing w/ sputum production (yellow, green, thick)
○ Decreased O2 sat (~88%, confusion from hypoxia is most common in older
adults)
● Nursing Interventions/Management of Care
○ Diagnostics
■ Sputum culture and sensitivity before antibiotics (in the morning)
■ CBC w/ diff (elevated WBC)
■ Chest x-ray will show consolidation (fluid build-up in the lungs)
■ ABGs (hypoxemia PaO2 <80)
○ Position in HIGH fowlers (unless contraindicated)
○ TCDB and incentive spirometer 10x/hr
○ Admin O2 (start w/ nasal cannula, monitor skin breakdown)
○ Drink 2-3L/day to thin secretions and promote hydration
○ Increase protein
○ Antibiotics→ Penicillins and Cephalosporins
Tuberculosis
● Clinical Manifestations
○ Persistent cough (longer than 3 weeks)
○ Purulent sputum, blood-tinged
○ Weight loss, appetite loss
○ Night sweats and low-grade fever in the afternoon
○ Fatigue and lethargy
● Nursing Interventions/Management of Care
○ Heated and humidified oxygen
○ PRIORITY→ prevent infection transmission!!
■ Wear N95
■ Negative-airflow room
■ Airborne precautions
■ Pt wear a surgical mask for transport
■ Pt cough into tissues and dispose of in a plastic bag
, ○ Encourage fluid and adequate calories in diet
○ Encourage foods rich in protein, iron, and vitamins B and C
○ TCDB and incentive spirometer
○ After 3 negative sputum cultures, they are no longer carrying the disease ■
Not after a negative mantoux test
○ Get sputum cultures q 2-4 wks
● Pharmacological Interventions
○ Taken for 6-12 months
○ 4 drugs for the first 2 months
○ Then take isoniazid and rifampin for 4 months either daily, 2x a week, or weekly ○
Before starting meds, get baseline liver, vision, and hearing tests
○ Report s/s of hepatotoxicity (jaundice, yellow sclera)
○ Isoniazid
■ Take on an empty stomach
■ Hepatotoxic and neurotoxic (paresthesias of hands and feet, B6 to
prevent neurotoxicity)
■ Liver function test prior to starting
■ No alcohol
○ Rifampin
■ Hepatotoxic
■ Liver function tests before starting
■ Urine and secretions will be orange
○ Pyrazinamide
■ Hepatotoxic
■ Increase fluids
○ Ethambutol
■ Get baseline visual acuity tests and monthly after
■ Report vision changes immediately
■ Do not give to patients younger than 8
Inflammatory Bowel Syndrome (UC/Crohn’s)
● Clinical Manifestations
○ UC→ in the rectum and sigmoid colon, goes in a directional pattern, bottom of
the colon to the anus
■ LLQ ab pain and cramps (high pitched bowel sounds)
■ 15-20 diarrhea/day w/ blood, mucus, or pus
○ Crohn’s→ can affect the whole GI tract, esophagus to anus, has skip lesions
■ RLQ ab pain and cramps
■ 5 diarrhea/day w/ mucus or pus
● Management of Care
○ Vitamin deficiencies→ B12 (IM shot)
○ Assess albumin when assessing nutrition
, ○ Electrolyte imbalances bc dehydration, watch K and Mg
● Health Promotion/Teaching
○ Increased risk of colon cancer due to inflammation
● Nutrition
○ High protein, high calories, LOW FIBER
○ Avoid trigger foods
○ No caffeine or alcohol
○ Take multivitamin w/ iron
○ Small frequent meals
○ Avoid grains, fruit, veg, seeds, beans
● Pharmacological Interventions
○ 5-Aminosalicylic Acid: Anti-Inflammatory
■ Sulfonamides: Sulfasalazine
■ NOT if they have a sulfa allergy
○ Corticosteroids
○ Immunosuppressants
○ Immunomodulators
○ Antidiarrheals
■ Bc hopefully they’ll be able to absorb more nutrients
Gallbladder Disease: Cholelithiasis/Cholecystitis
● Cholelithiasis→ Gallbladder stones
● Cholecystitis→ Inflammation of the gallbladder
● Clinical Manifestations
○ Sharp pain in the RUQ radiating to the right shoulder
○ Rebound tenderness- Blumberg sign
○ Jaundice
○ Steatorrhea (fatty stool)
● Health Promotion/Teaching
○ Low-fat diet rich in HDL (seafood, nuts, olive oil)
○ Regular exercise
○ Don’t smoke
○ Promote weight reduction
● Management of Care
○ Admin analgesics for pain
● Nutrition
○ Low-fat→ reduce dairy, no fried food, chocolate, nuts or gravies
○ High protein
○ Avoid gas-forming foods→ beans, cabbage, broccoli, cauliflower, coffee ○
Fat-soluble vitamins (A , D, E, K) or bile salts
1B: Fluid and Electrolyte and Immunity
, HIV
● Assessment
○ Acute infection→ flu-like symptoms, night sweats, sore throat, rash, nausea,
weakness, fatigue, chills
○ Early chronic infection→ usually asymptomatic and then gets worse
○ w/in the first 6 months of infection, the viral load is very high and then it gets even
higher
○ Late chronic infection→ opportunistic infections
● Diagnostics
○ ELISA→ screening tests for HIV antibodies
○ Western Blot→ if ELISA is positive, western blot confirms result
○ HIV viral load test (CD4)→ determines viral load before beginning treatment
● Management of Care
○ STANDARD precautions (unless bodily fluids involved like an open wound) ○
PRIORITY→ prevent secondary infections!!
■ If they get sick, probs will die
○ Good hygiene and hand washing
○ Avoid crowds and sick ppl (wear mask)
○ Avoid raw and undercooked foods (meats, fish, eggs)
○ No live vaccines get inactivated flu and pneumonia
○ Monitor weight (bc malnourished)
○ Clean blood off surfaces w/ bleach
○ Pts blood, vomit, and feces are contaminated
○ Notify is pregnant
○ Report infection immediately
○ Teach to use condoms/abstinence, don’t share needles/razors/toothbrushes
Systemic Lupus Erythematosus (SLE)
● Autoimmune disorder that causes chronic inflammation and destruction of healthy tissue
● Diagnostics
○ CBC (if messing w/ bones), BMP (if messing w/ kidneys)
○ Immunologic tests
■ Antinuclear antibody (ANA)→ antibodies produced against yourself,
will be positive
■ dsDNA→ very specific for SLE
○ CBC→ pancytopenia (if messing w/ bones)
○ Increased BUN and Creatinine w/ kidney involvement
○ Increased ESR bc inflammation
● Clinical Manifestations
○ Butterfly rash!! (erythematous)
Resp Acidosis, Cancer (cellular)
1A: Infection and Inflammation
Pneumonia
● Clinical Manifestations
○ Fever, chills, flushed face, sweating
○ SOB, difficulty breathing, tachypnea
○ Crackles, wheezes (chest discomfort)
○ Coughing w/ sputum production (yellow, green, thick)
○ Decreased O2 sat (~88%, confusion from hypoxia is most common in older
adults)
● Nursing Interventions/Management of Care
○ Diagnostics
■ Sputum culture and sensitivity before antibiotics (in the morning)
■ CBC w/ diff (elevated WBC)
■ Chest x-ray will show consolidation (fluid build-up in the lungs)
■ ABGs (hypoxemia PaO2 <80)
○ Position in HIGH fowlers (unless contraindicated)
○ TCDB and incentive spirometer 10x/hr
○ Admin O2 (start w/ nasal cannula, monitor skin breakdown)
○ Drink 2-3L/day to thin secretions and promote hydration
○ Increase protein
○ Antibiotics→ Penicillins and Cephalosporins
Tuberculosis
● Clinical Manifestations
○ Persistent cough (longer than 3 weeks)
○ Purulent sputum, blood-tinged
○ Weight loss, appetite loss
○ Night sweats and low-grade fever in the afternoon
○ Fatigue and lethargy
● Nursing Interventions/Management of Care
○ Heated and humidified oxygen
○ PRIORITY→ prevent infection transmission!!
■ Wear N95
■ Negative-airflow room
■ Airborne precautions
■ Pt wear a surgical mask for transport
■ Pt cough into tissues and dispose of in a plastic bag
, ○ Encourage fluid and adequate calories in diet
○ Encourage foods rich in protein, iron, and vitamins B and C
○ TCDB and incentive spirometer
○ After 3 negative sputum cultures, they are no longer carrying the disease ■
Not after a negative mantoux test
○ Get sputum cultures q 2-4 wks
● Pharmacological Interventions
○ Taken for 6-12 months
○ 4 drugs for the first 2 months
○ Then take isoniazid and rifampin for 4 months either daily, 2x a week, or weekly ○
Before starting meds, get baseline liver, vision, and hearing tests
○ Report s/s of hepatotoxicity (jaundice, yellow sclera)
○ Isoniazid
■ Take on an empty stomach
■ Hepatotoxic and neurotoxic (paresthesias of hands and feet, B6 to
prevent neurotoxicity)
■ Liver function test prior to starting
■ No alcohol
○ Rifampin
■ Hepatotoxic
■ Liver function tests before starting
■ Urine and secretions will be orange
○ Pyrazinamide
■ Hepatotoxic
■ Increase fluids
○ Ethambutol
■ Get baseline visual acuity tests and monthly after
■ Report vision changes immediately
■ Do not give to patients younger than 8
Inflammatory Bowel Syndrome (UC/Crohn’s)
● Clinical Manifestations
○ UC→ in the rectum and sigmoid colon, goes in a directional pattern, bottom of
the colon to the anus
■ LLQ ab pain and cramps (high pitched bowel sounds)
■ 15-20 diarrhea/day w/ blood, mucus, or pus
○ Crohn’s→ can affect the whole GI tract, esophagus to anus, has skip lesions
■ RLQ ab pain and cramps
■ 5 diarrhea/day w/ mucus or pus
● Management of Care
○ Vitamin deficiencies→ B12 (IM shot)
○ Assess albumin when assessing nutrition
, ○ Electrolyte imbalances bc dehydration, watch K and Mg
● Health Promotion/Teaching
○ Increased risk of colon cancer due to inflammation
● Nutrition
○ High protein, high calories, LOW FIBER
○ Avoid trigger foods
○ No caffeine or alcohol
○ Take multivitamin w/ iron
○ Small frequent meals
○ Avoid grains, fruit, veg, seeds, beans
● Pharmacological Interventions
○ 5-Aminosalicylic Acid: Anti-Inflammatory
■ Sulfonamides: Sulfasalazine
■ NOT if they have a sulfa allergy
○ Corticosteroids
○ Immunosuppressants
○ Immunomodulators
○ Antidiarrheals
■ Bc hopefully they’ll be able to absorb more nutrients
Gallbladder Disease: Cholelithiasis/Cholecystitis
● Cholelithiasis→ Gallbladder stones
● Cholecystitis→ Inflammation of the gallbladder
● Clinical Manifestations
○ Sharp pain in the RUQ radiating to the right shoulder
○ Rebound tenderness- Blumberg sign
○ Jaundice
○ Steatorrhea (fatty stool)
● Health Promotion/Teaching
○ Low-fat diet rich in HDL (seafood, nuts, olive oil)
○ Regular exercise
○ Don’t smoke
○ Promote weight reduction
● Management of Care
○ Admin analgesics for pain
● Nutrition
○ Low-fat→ reduce dairy, no fried food, chocolate, nuts or gravies
○ High protein
○ Avoid gas-forming foods→ beans, cabbage, broccoli, cauliflower, coffee ○
Fat-soluble vitamins (A , D, E, K) or bile salts
1B: Fluid and Electrolyte and Immunity
, HIV
● Assessment
○ Acute infection→ flu-like symptoms, night sweats, sore throat, rash, nausea,
weakness, fatigue, chills
○ Early chronic infection→ usually asymptomatic and then gets worse
○ w/in the first 6 months of infection, the viral load is very high and then it gets even
higher
○ Late chronic infection→ opportunistic infections
● Diagnostics
○ ELISA→ screening tests for HIV antibodies
○ Western Blot→ if ELISA is positive, western blot confirms result
○ HIV viral load test (CD4)→ determines viral load before beginning treatment
● Management of Care
○ STANDARD precautions (unless bodily fluids involved like an open wound) ○
PRIORITY→ prevent secondary infections!!
■ If they get sick, probs will die
○ Good hygiene and hand washing
○ Avoid crowds and sick ppl (wear mask)
○ Avoid raw and undercooked foods (meats, fish, eggs)
○ No live vaccines get inactivated flu and pneumonia
○ Monitor weight (bc malnourished)
○ Clean blood off surfaces w/ bleach
○ Pts blood, vomit, and feces are contaminated
○ Notify is pregnant
○ Report infection immediately
○ Teach to use condoms/abstinence, don’t share needles/razors/toothbrushes
Systemic Lupus Erythematosus (SLE)
● Autoimmune disorder that causes chronic inflammation and destruction of healthy tissue
● Diagnostics
○ CBC (if messing w/ bones), BMP (if messing w/ kidneys)
○ Immunologic tests
■ Antinuclear antibody (ANA)→ antibodies produced against yourself,
will be positive
■ dsDNA→ very specific for SLE
○ CBC→ pancytopenia (if messing w/ bones)
○ Increased BUN and Creatinine w/ kidney involvement
○ Increased ESR bc inflammation
● Clinical Manifestations
○ Butterfly rash!! (erythematous)
