2800 exam 2 study guide

Asthma

• Definition: Hyperreactive airway disease of bronchioles, characterized by reversible airway constriction. Each attack leads to inflammatory changes, making it reversible unlike COPD.

• Risk Factors/Triggers:

  • Allergies
  • Occupational exposure
  • Viral infections
  • Gastroesophageal reflux disease (GERD, particularly nocturnal asthma)
  • Exercise-induced asthma
  • Air pollutants
  • Allergen inhalation
  • Drugs
  • Food additives
  • Occupational exposure
  • Hormonal changes
  • Stress
  • Exercise
  • Cold, dry air

• Clinical Manifestations (Peak Flow Meters):

  • Measures expiratory volume.
  • Reduced volume in asthma due to respiratory system resistance.
  • Diagnoses and assesses attack severity.
  • Green zone (80-100%): good asthma control.
  • Yellow zone (50-80%): asthma not well controlled, worsening.
  • Red zone (below 50%): severe asthma.

Nursing Assessment & Management (Asthma)

• Interprofessional Management Goal: Achieve and maintain asthma control.
• Medication Management: HCP adjust medications based on symptom severity and patient control level.
• Control Level Determination: Based on medication use, symptoms, and PEFR or FEV1.
• Diagnostic Assessment & Testing:
  • Chest X-ray
  • Blood testing (e.g., IgE)
• Acute Attacks: Management of acute episodes.

Nursing Implementation (Asthma)

• Health Promotion:

  • Teach trigger identification and avoidance.
  • Examples: smoke, pet dander, cold air, aspirin, specific foods, cats.
  • Proper dress during cold weather.
  • Prompt treatment for URIs/sinusitis.
  • Job changes if occupational irritants are involved.
  • Weight loss for obese patients.

• Ambulatory Care:

  • Maximize patient self-management of acute episodes using asthma action plans.
  • Action plans based on patient's PEFR and personal thresholds.
  • Daily PEFR monitoring.
  • Green Zone: use usual medications.
  • Yellow Zone: caution, consider adjusting medications as needed.
  • Red Zone: serious problem, seek emergency care.
  • Beneficial to exercise at tolerated levels.
  • Validated questionnaires for symptom assessment.
  • Address disparities in socioeconomic status and healthcare access affecting asthma control.

COPD

• Definition: Progressive, irreversible obstructive lung disease. Preventable and treatable.

• Risk Factors:

  • Cigarette smoking/toxic gases
  • Infections
  • Asthma
  • Pollution
  • Aging
  • α1-antitrypsin deficiency (AATD)
  • Genetics (higher in White population)
  • More women die from COPD, but men have higher incidence

• Clinical Manifestations:

  • Increased diffusion time across membranes.
  • Chronic intermittent cough
  • Chronic sputum production
  • Dyspnea on exertion
  • Heavy chest
  • Difficulty breathing
  • Increased work of breathing
  • Air trapping
  • Flattened diaphragm
  • Barrel chest
  • Wheezing (may or may not be present)
  • Fatigue
  • Chronic hypoxia leading to pulmonary hypertension, right-sided heart failure.

Interprofessional Care (COPD)

• Management:

  • ABG analysis (pH, pCO2, PO2, HCO3) is critical.

• Gerontologic Considerations:

  • Aging increases COPD risk but cause-and-effect relationship is unclear.

Nursing Management (COPD)

• Overall Goals:

  • Improve protein intake (small frequent meals).
  • Pursed-lip breathing to reduce anxiety.
  • Huff coughing
  • Tripod positioning
  • Diaphragmatic breathing techniques.
  • Teach techniques to minimize air trapping.

• Activity Considerations: Activity intolerance due to consistent low O2 levels.

Cystic Fibrosis

• Definition: Autosomal recessive disorder causing defects in the CFTR gene, which regulates chloride ion transport across epithelial cells. This leads to thick, sticky mucus buildup.

• Clinical Manifestations:

  • Pulmonary wheezing, rhonchi
  • Thick, sticky mucus
  • Sinusitis
  • Nasal polyps
  • Abdominal pain (pancreatitis, cholecystitis)
  • Salty sweat
  • Liver cirrhosis
  • Rectal prolapse
  • Fatigue
  • Clubbing
  • Barrel chest
  • Steatorrhea
  • Abdominal distention

• Complications:

  • Hyperglycemia
  • Infections
  • Nasal polyps
  • Damaged airways
  • Hemoptysis
  • Pneumothorax
  • Respiratory failure
  • Nutritional deficiencies

Nursing Management (Cystic Fibrosis)

• Overall Goals:

  • Dietary adjustments (added salt, increased fats, calories, protein, vitamins A, D, E, and K).
  • Teach hyperglycemia recognition due to pancreatic insufficiency.

• Nursing Implementation (Acute & Ambulatory):

  • Acute: Bronchoconstriction & airway obstruction relief, aggressive CPT, antibiotics, O2 therapy.
  • Ambulatory: Infection treatment, nutritional support, psychosocial support, and aerobic exercise encouragement.

• Adult care: Encourage greater independence in managing care and life goals.

• Genetic Counseling: Include teaching about offspring's risk.

Tuberculosis

• Definition: Active, transmissible, potentially fatal infection.

• Primary TB Infection:

  • Inhaled bacteria trigger inflammatory response.
  • Develops within 2 years of infection.

• Post-Primary TB:

  • TB disease occurring 2 years or more after initial infection.
  • Person is infected and can spread to others.

• Latent TB Infection:

  • TB remains inactive in the body.
  • No symptoms.
  • Not transmissible.
  • Can progress to TB disease.
  • Requires treatment.

• Clinical Manifestations:

  • Night sweats
  • Low-grade fever
  • Weight loss
  • Hemoptysis (blood in sputum)

• Complications:

  • Scarring
  • Residual cavitation (gas-filled pulmonary tissue)
  • Lung damage

• Interprofessional Care: Outpatient care, visitor restrictions.

• Nursing Management & Assessment

• Assessment: Previous TB history, chronic illness, immunosuppressive diseases or medications, social & occupational history, productive cough, night sweats, fever, weight loss, chest pain, abnormal lung sounds, morning sputum collection when productive.

• Testing: Mantoux, QuantiFERON-Gold, chest X-ray.

• Overall Goals: Normal lung function, adherence to treatment, prevention of spread, and no recurrence.

• Nursing Care: Health promotion, ambulatory care: eradicating TB. Adherence to medications, proper hygiene, and CDC reporting.

Gastroesophageal Reflux Disease (GERD)

• Definition: Lower esophageal sphincter (LES) tone problem leading to stomach acid reflux into the esophagus.

• Clinical Manifestations:

  • Heartburn (often worse at night)
  • Chest pain
  • Nausea
  • Bloating
  • Gas
  • Belching
  • Food intolerance
  • Dysphagia (difficulty swallowing)
  • Regurgitation
  • Lump sensation in throat
  • Sleep disruption
  • Chronic cough
  • Asthma exacerbation
  • Laryngitis

• Complications:

  • Esophagitis: Inflammation of the esophagus- dysphagia, odynophagia, retrosternal chest pain.
  • Barrett’s Esophagus: Precancerous change of esophageal cells (from flat to columnar). Increased cancer risk, ablation may be needed. Dysphagia, heartburn, epigastric pain, regurgitation, dyspepsia.

• Lifestyle Modifications: Stop tobacco, alcohol. Small meals, no late-night eating. Avoid milk, red wine. Sleep elevated.

• Patient Teaching: Low-fat diet, small frequent meals, no alcohol, caffeine, smoking cessation, no lying down after eating, loose clothing, sleep elevated, weight loss when needed.

• Nutritional Therapies: High protein, high calorie, high vitamin, low residue, lactose-free diet.

Peptic Ulcer Disease (PUD)

• Definition: Chronic or acute inflammatory erosion of the stomach or duodenum (more common). Caused by hypersecretion of HCl, in effective mucous production, and poor cellular repair.

  • Chronic ulcer: erosion through muscular wall.

• Clinical Manifestations:

  • Epigastric & abdominal pain.
  • Pain between meals (2–3 hours after eating)
  • Intense, burning, gnawing pain.
  • Potential perforation (severe abdominal pain, rigid abdomen, absent bowel sounds, shallow respirations)

• Complications: Perforation.

• Conservative Therapy:

  • PPI’s (omeprazole)
  • H2 receptor antagonists (famotidine)
  • Antibiotic therapy for H. pylori
  • Smoking cessation, alcohol/caffeine reduction.

• Nursing Interventions:

  • Recommend small, frequent, high-protein meals. Avoid milk, red wine, tobacco, alcohol, caffeine). Sleep elevated, no late-night eating.

• Health Promotion:

  • Avoid foods causing distress (acidic foods). Smoking & alcohol reduction. No OTC NSAIDs/Aspirin unless prescribed. Report increased nausea/vomiting, epigastric pain, bloody emesis/tarry stools.

Constipation

• Definition: Fewer than 3 bowel movements per week. Usual is 3 days.

• Risk Factors: Elderly, opioid users.

• Clinical Manifestations:

  • Abdominal distention, tenderness, rigid abdomen.
  • Tympany (gas-filled intestine)
  • Possible impaction (hard stool stuck in sigmoid colon/rectum).

• Interventions/Interprofessional Care:

  • Increase fiber intake (20-30g/day)
  • Increase fluid intake
  • Laxatives (bulk-forming, osmotic, stimulant; use cautiously/sparingly).
  • Increased physical activity.
  • Suppositories (as needed)

• Nutritional Therapy: Increase fiber & fluids.

• Patient Teaching: Normal bowel movements should be smooth, sausage-shaped, and easy to pass.

Inflammatory Bowel Disease (IBD)

• Definition: Autoimmune disorder, unclear etiology. Chronic inflammation of the bowel.

• Ulcerative Colitis (UC): Limited to the large intestine. Continuous inflammation; ulceration penetrates inner lining only. Lower left abdominal bleeding is common

• Crohn's Disease: Can affect any part of the GI tract. Discontinuous (skip lesions) inflammation; ulceration penetrating the entire thickness of the bowel wall. Bleeding not common. Lower right abdominal pain is typical.

• Risk Factors: Geographic location, racial/ethnic background. Family hx is a significant risk factor.

• Clinical Manifestations: Weakness, nausea, abdominal pain, frequent bloody stools, anemia, low-grade fever, dehydrated skin.

• Complications: Malabsorption, diarrhea, pain, hyper active bowels, tenderness, anemia, dehydration, arthritis, uveitis, obstruction, microperforations potentially causing DVT/PE, skin issues. Hemorrhage, stricture, perforation, abscess, fistula, CDI, toxic megacolon (UC).

• Interprofessional Care: Rest the bowel, control inflammation, correct malnutrition, symptomatic relief, improve quality of life.

• Surgeries: Crohn's: resection, lifelong nutritional support (bolus/PN) may be needed. UC: proctocolectomy with ileal pouch-anal anastomosis, or permanent ileostomy.

• Nutritional Therapy: High calorie, Vitamin, protein, low-residue, lactose free.

Urinary Incontinence

• Definition: Involuntary urine loss.

• Stress Incontinence: Urine loss with pressure on the bladder.

• Urge Incontinence: Sudden, strong urge with urine loss.

• Overflow Incontinence: Bladder unable to empty fully (e.g., BPH).

• Reflex Incontinence: Involuntary loss due to reflex action (neurological issues).

• Functional Incontinence: Inability to reach the toilet due to physical or cognitive limitations.

• Risk Factors: Older adults, neurological disorders, mobility issues, pregnancy, menopause.

Benign Prostatic Hyperplasia (BPH)

• Definition: Prostate gland enlargement causing urinary obstruction.

• Risk Factors: Men over 50 years old.

• Clinical Manifestations: Gradual. Nocturia, frequency, urgency, dysuria, bladder pain, incontinence, weakened urine stream, inability to start/control stream, dribbling at end of urination.

• Complications: Kidney failure due to pressure on the ureters. Hydronephrosis.

• Interprofessional Care/Treatment: Restore bladder drainage, relieve symptoms, prevention/treatment of complications.

• Procedure (TURP): Transurethral resection of the prostate.

• Perioperative Goals: Restore urinary drainage, resolve UTI, understand procedure implications, and restoration of urinary control, complete bladder emptying

• Health Promotion: Early detection/treatment of BPH. Avoid bladder irritants (alcohol, caffeine).

• Post operative: Monitor for TURP syndrome (nausea, vomiting, confusion, etc., due to hyponatremia). Drink 2L fluid/day. Digital rectal exams yearly.

Cirrhosis

• Definition: End-stage liver disease; extensive liver cell damage replaced by scar tissue.

• Causes: Hepatitis C, alcoholic liver disease, nonalcoholic fatty liver disease (NAFLD).

• Clinical Manifestations (Early/Late):

  • Early: Fatigue, enlarged liver, normal liver function tests.
  • Late: Jaundice, peripheral edema, ascites.

• Complications: Portal hypertension, esophageal/gastric varices, peripheral edema, ascites, hepatic encephalopathy, hepatorenal syndrome.

• Jaundice: Yellowing of skin and eyes due to bilirubin buildup.

• Spider angiomas: Red center, spreading extensions.

• Hematologic problems: Thrombocytopenia, leukopenia, anemia, coagulation problems (nosebleeds, petechiae, etc.).

• Cirrhosis effect on PT: Prolongs PT.

• Portal hypertension: Increased pressure in the portal vein leading to esophageal varices. Hematemesis. Ascites (fluid accumulation due to portal pressure and lowered albumin).

• Esophageal varices: Abnormal esophageal veins.

• Peripheral edema: Fluid accumulation often associated with ascites.

• Ascites: Fluid accumulation in the abdomen.

• Hepatic encephalopathy: Brain dysfunction. Asterixis (flapping tremor).

• Nutritional recommendations: High protein (unless encephalopathy), alcohol cessation.

Diabetes Mellitus

• Type 1 DM: Insulin deficiency; requires lifelong insulin. Unknown cause but genetics may contribute. Rapid onset.

• Type 2 DM: Insulin resistance; may require insulin. Preventable via lifestyle changes. Gradual onset.

• Clinical Manifestations (Type 1 & 2):

  • Both: Polyuria, polydipsia, polyphagia (increase in urination, thirst, and hunger)
  • Type 1: weight loss, fatigue, infections, rapid onset.
  • Type 2: fatigue, recurrent infections, vaginal yeast infections, slow wound healing, vision problems.

• Complications (Acute/Chronic):

  • Acute: Hyper- and hypoglycemia.
  • Chronic: Angiopathy (blood vessel damage) leading to macrovascular disease (CVD), retinopathy, neuropathy, foot/leg problems, skin complications, infections, anxiety, depression, diminished self-care.

• Hypoglycemia: Low blood sugar. Symptoms: nervousness, tremors, headache, sweating, hunger, potential coma/death. Treatment (if swallow): food/liquid, otherwise glucagon/IV dextrose.

• Hyperglycemia: High blood sugar. Symptoms: Headache, nausea, vomiting, abdominal pain, dizziness, rapid pulse, shallow breathing, acetone breath, potential coma/death. Treatment: IV fluids, insulin, monitor BG, ketones, and potassium.

• Nutritional recommendations: Lewis P. 1299–1301.

• Labs: Monitor Hemoglobin A1C (target <7).

• Diabetic retinopathy: Eye complications from high blood sugar. Prevention: keeping BG in target range. Differentiate sensory vs. autonomic neuropathy.

Hyperthyroidism/Hypothyroidism

• Hyperthyroidism: Excess thyroid hormones (T3 & T4). Symptoms: high HR, diarrhea, tremor, irritability, sweating, muscle wasting, always hot.

• Hypothyroidism: Insufficient thyroid hormones (T3 & T4). Symptoms: low HR, constipation, cold sensitivity, lethargy, slow speech.

• Graves' Disease: Autoimmune stimulation of the thyroid, leading to hyperthyroidism. Enlarged thyroid (goiter). Bug eyes (exophthalmos).

• Goiter: Enlarged thyroid.

• Thyroid Storm: High fever, tachycardia, agitation, psychosis (medical emergency).

• Nursing Interventions (Hyperthyroidism): Monitor for thyroid storm, GI/cardiovascular status, I&O, and weight. Treatment options: antithyroid meds, radioactive iodine, surgery (requiring lifelong hormone replacement).

• Hypothyroidism: Primary (high TSH, low T3, T4); Secondary (low TSH, low T3, T4); Severe: Myxedema coma.

• Myxedema: Severe hypothyroidism, leading to confusion, coma. Often associated with Hashimoto’s thyroiditis (autoimmune attack on the thyroid).

• Nursing Interventions (Hypothyroidism): Administer Levothyroxine, monitor for goiter/symptoms.

Test your knowledge on asthma definitions, triggers, and management strategies. This quiz covers key concepts including the use of peak flow meters and patient management in various scenarios. Ideal for healthcare professionals and students interested in respiratory conditions.