Medical Management of Bronchiectasis and Anemia

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Questions and Answers

What characteristic symptom is commonly associated with bronchiectasis?

Chronic cough with copious purulent sputum (correct)

Constant wheezing without coughing

Rapid shallow breathing with no sputum

Severe chest pain on inspiration

Which of the following is NOT a part of the medical management for bronchiectasis?

Bronchodilators

Strict bed rest (correct)

Antibiotics

Humidification

Which assessment finding is commonly associated with decreasing air flow in bronchiectasis?

Improved lung sounds on auscultation

Increased sputum production (correct)

Decreased respiratory rate

Elevated blood pressure

What is the most common cause of death from infection in the US?

Pneumonia Signup and view all the answers

Which of the following microorganisms is typically associated with bacterial pneumonia?

H. influenzae Signup and view all the answers

What is the purpose of the Schilling test?

To evaluate vitamin B12 absorption Signup and view all the answers

Which nutrient is necessary for the absorption of vitamin B12 in the small intestine?

Intrinsic factor Signup and view all the answers

Which dietary items are recommended for a patient with pernicious anemia?

Liver and organ meats Signup and view all the answers

What describes a significant difference between vitamin B12 deficiency and folic acid deficiency?

Folic acid deficiency causes megaloblastic anemia without neurologic involvement Signup and view all the answers

Which condition is characterized by a deficiency of circulating red blood cells accompanied by leukopenia and thrombocytopenia?

Aplastic anemia Signup and view all the answers

What can potentially cause folic acid deficiency anemia?

Malabsorption disorders Signup and view all the answers

Which of the following is NOT a common cause of aplastic anemia?

Intake of excessive vitamins Signup and view all the answers

What should patients with folic acid deficiency anemia prioritize in their diet?

Soft, bland foods high in folic acid Signup and view all the answers

What is a primary symptom of folic acid deficiency anemia?

Beefy red tongue Signup and view all the answers

What management step should be taken when a client has stomatitis and glossitis?

Promote mouth care before and after meals Signup and view all the answers

What is a common assessment finding in a patient with bronchiectasis?

Chronic cough with copious and purulent sputum Signup and view all the answers

Which of the following conditions can lead to bronchiectasis?

Congenital abnormalities Signup and view all the answers

What does the drainage of purulent material from the bronchi primarily aim to achieve in bronchiectasis management?

Eliminate airway obstruction Signup and view all the answers

During a clinical assessment, sputum collected from a bronchiectasis patient is noted to settle in three distinct layers. What color does the top layer represent?

Frothy and cloudy Signup and view all the answers

What is one of the primary medical management strategies for bronchiectasis?

Antibiotics Signup and view all the answers

What is a clinical manifestation commonly associated with COPD?

Barrel chest Signup and view all the answers

What role does excessive elastase protease play in the effects of tobacco smoke?

It breaks down elastin in alveoli. Signup and view all the answers

Which of the following is NOT a part of the psychosocial assessment for COPD patients?

Presence of dyspnea Signup and view all the answers

What does a Pulmonary Function Test measure in COPD patients?

Lung capacities like vital capacity Signup and view all the answers

Which intervention is essential for airway maintenance in COPD management?

Liquefy secretions Signup and view all the answers

What is a common laboratory finding in COPD patients?

Hypoxemia Signup and view all the answers

Which breathing technique is recommended for cough control in COPD patients?

Controlled coughing Signup and view all the answers

Which of the following is a potential symptom of right-sided heart failure (RSHF) in COPD patients?

Dependent edema Signup and view all the answers

What is a Lobectomy primarily used to treat?

Lung abscesses Signup and view all the answers

What are typical assessment findings of Iron Deficiency Anemia?

Cold sensitivity and reduced energy Signup and view all the answers

Which procedure involves the removal of an entire lung?

Pneumonectomy Signup and view all the answers

What is a primary cause of Iron Deficiency Anemia?

Inadequate intake of iron Signup and view all the answers

What is a key component of nursing management for patients with Iron Deficiency Anemia?

Monitor for signs of abnormal bleeding Signup and view all the answers

What should medical management for Iron Deficiency Anemia include?

Oral iron supplements or blood transfusions Signup and view all the answers

What does a wedge resection entail?

Excision of small nodules or biopsy Signup and view all the answers

What are potential causes of anemia?

Inadequate production, destruction of RBCs, or blood loss Signup and view all the answers

What is a common side effect of diuretics particularly for hypertensive clients with asthma or chronic renal disease?

Hypokalemia Signup and view all the answers

Which class of diuretics is known for preventing sodium and water reabsorption while promoting potassium excretion?

Thiazide diuretics Signup and view all the answers

Which agents lower blood pressure by interfering with the transmembrane flux of calcium ions?

Calcium channel blockers Signup and view all the answers

What defines a fusiform aneurysm?

Localized dilation affecting the entire circumference Signup and view all the answers

Which condition commonly leads to the formation of an aneurysm?

Weakened tunica media Signup and view all the answers

What type of drug is the first-line treatment for hypertensive patients with ischemic heart disease?

Beta blockers Signup and view all the answers

What is the main action of potassium-sparing diuretics?

Inhibit sodium reabsorption in exchange for retaining potassium Signup and view all the answers

Where do aneurysms most commonly occur in the body?

In the abdominal aorta Signup and view all the answers

Study Notes

Disturbances in Oxygenation

Lecture title: Disturbances in Oxygenation
Course: OLFU Level 3, College of Nursing
Reference: OLFU CON NOMB 312 LECTURE

Pericarditis

Inflammation of the pericardium
Associated with:
- Malignant neoplasms
- Idiopathic causes
- Infections (bacteria, viruses, fungi)
- Post-myocardial infarction (Dressler's syndrome) - pericarditis, fever, and pericardial/pleural effusion (1-12 weeks post-MI)
- Postpericardiotomy syndrome
- Systemic connective tissue disease
- Renal failure
Chronic pericardial inflammation causes fibrous thickening of the pericardium ("Chronic Constrictive Pericarditis")
Characterized by a rigid pericardium, resulting in inadequate ventricular filling and heart failure

Assessment of Pericarditis

Pain radiating to neck, shoulder, and back, worsened by inspiration, coughing, and swallowing; relieved by sitting up and leaning forward
Pericardial friction rub (scratchy high pitch sound)
Signs of right-sided heart failure (RSHF)
Echocardiography and CT scan to show pericardial thickening
White blood cell (WBC) count
Atrial fibrillation is also common

Interventions for Pericarditis

Nonsteroidal anti-inflammatory drugs (NSAIDs) for pain
Corticosteroids
Antibiotics
Pericardial drainage (if caused by malignancy)
Radiation or chemotherapy (if caused by malignancy)
Hemodialysis (if caused by uremic pericarditis)
Making the client comfortable with appropriate positioning
Monitoring for complications, specifically pericardial effusion

Pericardial Effusion/Cardiac Tamponade

Accumulation of fluid (blood or other) in the pericardial sac
Puts pressure on the heart, preventing effective pumping
Findings:
- Jugular distention
- Paradoxical pulse (systolic blood pressure drops more on expiration than inspiration)
- Reduced cardiac output
- Muffled heart sounds
- Circulatory collapse
Emergency care: pericardiocentesis

Myocarditis

Causes:
- Viral, bacterial, fungal, and parasitic infections
- Chronic alcohol and cocaine abuse
- Radiation therapy
- Autoimmune disorders
- Bulimia (consumption of ipecac syrup)
Consequences:
- Inflammation, abnormal function, reduced cardiac output, impaired blood circulation, possible congestive heart failure (CHF)
- Due to ischemia, tachycardia, dysrhythmias, cardiomyopathy

Assessment of Myocarditis

Pain, fever, tachycardia
Dysrhythmias, dyspnea
Malaise, fatigue
Anorexia, pale or cyanotic skin
Signs of right-sided heart failure (RSHF)
Increased white blood cell (WBC) count
Elevated C-reactive protein (CRP)
Elevated cardiac enzymes
Abnormal electrocardiogram (ECG)
Abnormal chest radiography
Echocardiography

Interventions for Myocarditis

Treatment of the underlying cause (antibiotic)
Rest (bed rest), sodium-restricted diet
Prescribing cardiotonic drugs (digitalis)
Monitoring of cardiopulmonary status and complications (e.g. CHF, dysrhythmias)
Vital signs (VS)
Daily weight
Intake and output (I&O)
Heart and lung sounds
Pulse oximetry measurements
Cardiac monitoring
Dependent edema evaluation

Rheumatic Fever

A systemic inflammatory disease that develops after an upper respiratory tract infection (URTI) with group A ß-hemolytic streptococci
Rheumatic carditis (rheumatic endocarditis) causes inflammation of the tonsils, pharynx, and larynx
Antibodies mistakenly attack heart, joint, skin, and nervous system tissues, leading to inflammatory debris (vegetations) around valve leaflets

Coronary Artery Disease

Acute coronary syndrome (ACS) describes a group of clinical symptoms that are consistent with acute myocardial ischemia
Ischemia is insufficient blood supply to the myocardium
Atherosclerosis resulting in ischemia
Angina pectoris is the most common clinical manifestation of myocardial ischemia - caused by chemical and mechanical stimulation of sensory afferent nerves inside coronary vessels and myocardium
Types of Angina:
- Stable
- Unstable
- Variant (Prinzmetal's)

Myocardial Infarction

Etiology and Genetic Risk:
- Atherosclerosis
- Nonmodifiable risk factors
- Modifiable risk factors: increased serum cholesterol, smoking, hypertension, impaired glucose tolerance, obesity, physical inactivity, stress
Key Physical Assessment/Clinical Manifestations:
- Angina-substernal chest discomfort, radiating to left arm, precipitated by exertion or stress, relieved by nitroglycerin or rest, lasting <15 minutes, few associated symptoms
- Myocardial Infarction-substernal chest pressure, radiating to the left arm, back, or jaw, occurring without cause, usually in the morning, relieved only by opioids, lasting 30 minutes or more, frequent associated symptoms like nausea, diaphoresis, dyspnea, fear and anxiety, dysrhythmias, fatigue, epigastric distress, and shortness of breath
Interventions:
- Pain management: MONA (morphine, oxygen, nitroglycerin, aspirin)
- Positioning - semifowler's position
- Provide a quiet and calm environment

Chronic Airflow Limitations (CAL)

A group of chronic lung conditions
Includes asthma, chronic bronchitis, emphysema, and bronchiectasis
Conditions characterized by airflow blockage

Bronchial Asthma

Physical assessment findings:
- Audible wheezing and rapid/shallow respirations
- Wheezing is more intense during exhalation
- Dyspnea, cough, accessory muscle use, and barrel chest (especially in chronic severe asthma)
- Cyanosis, low pulse oximetry
- Change in level of consciousness (LOC) and tachycardia due to hypoxemia
Laboratory assessment:
- Arterial blood gas (ABG) tests
- Elevated eosinophil count
- Elevated IgE levels
- Pulmonary function test (PFT)

Bronchitis

Acute bronchitis:
- Usually begins as an upper respiratory tract infection (URTI) caused by viruses or bacteria (e.g., H. influenzae, S. pneumoniae, M. pneumoniae)
- Caused by chemical irritants or air pollutants
Assessment findings: fever, chills, malaise, headache, dry and irritating non-productive cough (initial)
Medical management: bed rest, antipyretics, expectorants, antitussives, fluids, humidifiers, and antibiotics (if needed)
Nursing management:
- Auscultate breath sounds, and monitor VS every 4 hours
- Encourage coughing and deep breathing exercises
- Provide humidity to loosen bronchial secretions
- Change the client's bedding if it's damp
- Offer fluids frequently
- Teach about infection prevention (handwashing, covering mouth/nose when sneezing or coughing), preventing the sharing of eating (food) utensils
Chronic bronchitis:
- Prolonged inflammation in the bronchi with mucus production for at least 3 months each year for 2 years
- Cause: smoking, history of bronchial asthma, respiratory infections, air pollution
- Assessment findings include chronic productive cough with thick white mucus, blood-streaked sputum, and signs of bronchospasm, acute respiratory infections, cyanosis, and possible dyspnea/orthopnea.
Medical management: smoking cessation, fluid intake, diet, use of bronchodilators, corticosteroids, antibiotics, postural drainage, and regular physical therapy.
Nursing management: Focus on educating the client on disease management, including smoking cessation measures, occupational counseling, monitoring of air quality/pollution levels, avoiding triggers of bronchoconstriction and use of inhalers correctly.

Emphysema

A chronic lung disease characterized by the loss of lung elasticity and hyperinflation of the lungs
Most common COPD condition (chronic obstructive pulmonary disease)
Etiology:
- Long-term history of smoking
- Chronic bronchial asthma
- Respiratory infections
- Exposure to air pollutants
Assessment findings: chronic productive cough (white and/or purulent mucus; sometimes blood-streaked), signs of bronchospasm, acute respiratory infections, cyanosis, shortness of breath
The signs and symptoms of COPD may include an increased respiratory rate, use of accessory muscles of respiration, and a barrel-chest appearance (as the lungs overinflate).
Medical management:
- Smoking cessation
- Postural drainage
- Steroid therapy
- Antibiotic therapy

Bronchiectasis

Abnormal and permanent dilation of bronchi and bronchioles
Results from inflammation and destruction of the structural components of the bronchial wall caused by chronic pulmonary infections such as P. aeruginosa and H. influenzae
Assessment findings: chronic cough (copious, purulent, blood-streaked sputum), coughing worsens with position changes, fatigue, weight loss, anorexia, dyspnea, increased size of bronchioles, atelectasis, and possible pulmonary changes
Medical management:
- Drainage of purulent material from bronchi
- Antibiotics
- Bronchodilators
- Mucolytics
- Humidification
- Surgery to remove bronchiectasis (if appropriate for the situation), chest physical therapy and postural drainage

Pneumonia

An inflammatory process affecting the bronchioles and alveoli
Most common cause of death from infection in the U.S. (Smeltzer & Bare, 2004; specific year not listed.)
Causes:
- Bacterial pneumonia
  - S. pneumoniae, P. carinii, S. aureus, K. pneumoniae, P. aeruginosa, H. influenzae
- Atypical pneumonia
  - Mycoplasma pneumonia, Chlamydia pneumoniae, Chlamydia psittaci, Legionella pneumophila, and other infectious agents (e.g., viruses, parasites, fungi)
- Radiation therapy-related pneumonia
  - Damage to normal lung mucosa from radiation therapy
- Chemical ingestion or inhalation-related pneumonia
  - Ingestion or inhalation of chemicals (e.g., kerosene, gasoline, or volatile hydrocarbons)
Pathophysiology:
Inhalation and aspiration of droplets containing microorganisms
Spread from the bloodstream
Inflammation and exudate formation in alveoli
Impairment of gas exchange
Atelectasis and consolidation
Assessment findings: fever, chills, productive cough with rust-colored sputum, chest wall muscle discomfort, general malaise, pain during breathing (patient exhibits shallow breathing), wheeze, crackles, cyanosis, and decreased breath sounds
Medical management:
- Prompt initiation of antibiotic therapy (for bacterial pneumonia)
- Hydration to thin secretions
- Supplemental O2 to alleviate hypoxemia
- Patient needs rest, bronchodilators, analgesics, and antipyretics.
- Fluid and electrolyte replacement due to fever, dehydration, and poor nutrition
- Mechanical ventilation (if needed)

Pleural Effusion

Abnormal collection of fluid between the visceral and parietal pleurae
Causes:
- Pneumonia
- Lung cancer (CA)
- Tuberculosis
- Pulmonary embolism
- Congestive heart failure (CHF)
General Classification:
- Transudative (low protein content, few cells)
  - Hydrothorax - accumulation of water/serous fluid
- Exudative (high protein content, many cells)
  - Pyothorax/Empyema - accumulation of pus
  - Hemothorax - accumulation of blood
  - Chylothorax - accumulation of lymph and lipoproteins
Assessment:
- Fever
- Pain
- Dyspnea
- Dullness over involved area during chest percussion
- Diminished or absent breath sounds
- Friction rub
- Chest X-ray or CT scan may show fluid accumulation
Medical management:
- Correct the underlying cause
- Antibiotics
- Analgesics
- Cardiotonic drugs (to manage CHF, if present)
- Thoracentesis – removal of fluid from the pleural space
- Possible surgery
Nursing management:
- Thorough explanation of the procedure
- Positioning the client on the unaffected side (1 hour)
- Monitoring for complications such as respiratory distress (dyspnea, tachypnea or hypotension).

Fractured Ribs/Sternum

Common injury from hard fall or blow to the chest (e.g., car accidents)
Sharp end of broken rib may tear lung or thoracic blood vessels
Flail chest- complication of fractured ribs (2 or more adjacent ribs fractured in more than 1 place). Results in free-floating rib segments, impacting normal breathing in a paradoxical way (inward on inspiration and outwards on expiration)
- Paradoxic chest movement leads to reduced gas exchange, decreased lung compliance, retained airway secretions, atelectasis and hypoxemia
Medical Management:
- Immobilization with rib belt or elastic bandage.
- Analgesics (codeine, regional nerve block)
- Support ventilation and clear lung secretions
- Antibiotics if infection suspected
- ET intubation and mechanical ventilation (if appropriate)
Nursing Management:
- Applying the immobilization device
- Instruct client on deep breathing exercises
- Assess and monitor for respiratory distress, infections, and pain.

Pneumothorax/Hemothorax

Pneumothorax- air in the pleural space causing partial or complete lung collapse
- Types: spontaneous pneumothorax • Open pneumothorax • Tension pneumothorax
Hemothorax- blood in the pleural space frequently occurs with open pneumothorax, resulting in heompneumothorax.
Assessment findings: Pain, dyspnea, diminished/absent breath sounds, respiratory excursion on affected side, hyper-resonance on percussion, tracheal shift (tension pneumothorax), and weak, rapid pulse, anxiety, diaphoresis.
Diagnostic tests: Chest X-ray to determine the area and degree of pneumothorax, and ABG analysis.
Nursing Interventions:
- Provide nursing care for ET tube clients (suction secretions, blood, and vomitus.)
- Monitor mechanical ventilation.
- Assist with thoracentesis/CTT placement and provide proper nursing care.

Lung Resections

Procedures for removing parts or all of a lung due to conditions like bronchiectasis, bronchogenic carcinoma, emphysematous blebs, lung abscesses.
Types of procedures: Lobectomy, pneumonectomy, segmentectomy/segmental resection, wedge resection.

Hematologic Disorders

Deficiencies of red blood cells (RBCs) and hemoglobin (Hgb) resulting in anemia are grouped under Hematologic Disorders.
Anemia results from:
- Blood loss
- Inadequate or abnormal production of RBCs
- Destruction of RBCs

Iron Deficiency Anemia

Microcytic, hypochromic anemia due to inadequate iron intake or malabsorption in the GI tract, leading to reduced production of hemoglobin
Assessment findings: decreased energy, cold sensitivity, fatigue, heart rate even at rest, decreased complete blood count (CBC), decreased hemoglobin (Hgb), reduced hematocrit (Hct) and serum iron; blood smear reveals microcytic and hypochromic RBCs
Medical management: Determine the underlying cause. Provide dietary changes to increase iron content. Provide iron supplements (oral or intravenous/parental)
Nursing management: Monitor for signs and symptoms of abnormal bleeding. Provide adequate rest. Provide explanation on the diagnostic tests.
Foods high in iron:
- Liver, especially pork and lamb
- Red meat, organ meats, and kidney beans
- Whole-wheat breads & cereals
- Leafy green vegetables
- Carrots, egg yolks, and raisins

Pernicious Anemia

Caused by a deficiency of intrinsic factor, from the gastric mucosa interfering with the absorption of B12
Assessment findings: usually seen in older people (defective intrinsic factor leading to B12 deficient), stomatitis, glossitis (beefy red tongue), pallor, fatigue, difficulty of exercise, severe cases associated with jaundice, irritability, confusion, numbness, and tingling, difficulty with gait.
Diagnostic findings: Client's history, symptoms, blood and bone marrow (BM) studies, microscopic exam, and Schilling test (to assess B12 absorption)
Medical management: Vitamin B₁₂ (IM) injections for maintenance
Nursing management: Dietary instruction (high Vitamin B₁₂ foods), avoid irritating foods like coarse or spicy foods, soft-bristled toothbrush and nonirritating mouthwashes. Bed rest when/if necessary

Folic Acid Deficiency Anemia

Related to the lack of folic acid preventing DNA synthesis, resulting in abnormal development of RBCs
Assessment findings: severe fatigue, sore and beefy red tongue, dyspnea, nausea, anorexia, headaches, lightheadedness
Diagnosis: measurement of serum Folate
Treatment: Oral and parenteral folic acid supplements and a balanced diet
Nursing management: Encourage consumption of foods rich in folate (liver, organ meats, dried beans, nuts, green leafy vegetables, citrus fruits, and brewer's yeast)
Additional nursing care: Oral hygiene, adequate rest

Aplastic Anemia

A disorder caused by the failure of bone marrow to produce blood cells
Characterized by pancytopenia, a decrease in red blood cells, white blood cells, and platelets
Causes:
- Exposure to toxins (drugs, chemicals)
- Ionizing radiation
- Autoimmune conditions
Assessment findings: weakness, fatigue, frequent infections, unusual bleeding, petechiae/ecchymoses, and splenomegaly
Medical management: Blood transfusions, antibiotics, corticosteroids (if autoimmune), stem cell transplantation for treatment and/or offending agents
Nursing management: Monitoring for signs/symptoms of bleeding, and implementing blood transfusions and medications, high-protein, high-vitamin diet, isolation procedures, and promoting oral hygiene.

Hemolytic Anemia

Caused by the accelerated premature destruction of red blood cells (RBCs)
Assessment findings: varied symptoms depending on severity and onset: dyspnea, pallor, fatigue, jaundice, chills, fever, precordial pain, abdominal pain, nausea, diarrhea, melena and hematuria, splenomegaly and hepatomegaly
Medical management: Identify and/or treat the underlying cause if applicable (e.g., transfusion reactions, infections.), corticosteroids (if applicable), and spleen removal (if needed)
Nursing management: Monitor for signs of hypoxia (confusion), cyanosis, shortness of breath, tachycardia, and palpitations

Hemostasis/Blood Clotting

The sequential process of blood clotting (hemostasis) involves platelet aggregation, blood clotting cascade, and formation of fibrin clot.

Idiopathic Thrombocytopenic Purpura (ITP)

Antibody-mediated destruction of platelets, causing a clotting problem
Assessment Findings: petechial rashes, ecchymosis (bruises), mucosal bleeding, anemia from blood loss, intracranial stroke (in severe cases)
Diagnostic Findings: Platelet count, megakaryocyte count in bone marrow, and presence of antiplatelet antibodies
Medical Management: Treatment of underlying condition, protection from trauma, corticosteroids, and platelet transfusion (not routinely)
Nursing Management: Bleeding control, prevention of bruising, providing support to clients dealing with the physical changes and body image issues

Disseminated Intravascular Coagulation (DIC)

Widespread clotting in small blood vessels throughout the body
Causes: obstetric complications, infections, trauma, and/or cancers
Assessment: Petechiae, Echymoses, mucous membrane bleeding, prolonged bleeding from IV or venipuncture sites, uncontrollable hemorrhage
Medical Management: Treat the underlying cause, blood products, and anticoagulants
Nursing Management: Monitor for bleeding, monitor for signs of organ damage, maintain safety measures relating to bleeding risk.

Blood Vessel Disturbances

Arteriosclerosis: Thickening or hardening of the arterial wall
Atherosclerosis: A type of arteriosclerosis involving plaque formation within the arterial walls, causing vascular damage, inflammation, and fatty streak formation.

Hypertension

New classification (2003) "Normal adult BP":
- <120mmHg systolic
- <80mmHg diastolic
- Prehypertension: 120-139/80-89mmHg
- Stage 1 hypertension: 140-159/90-99mmHg
- Stage 2 hypertension: >160/>100mmHg
Etiology (Primary):
- No known cause
- Associated risk factors
  - Age >60 years
  - Family history
  - Excessive calorie consumption
  - Physical inactivity
  - Excessive alcohol intake
  - Hyperlipidemia
  - African American ethnicity
  - High intake of salt/caffeine; reduced K+, Ca++, Mg++
Secondary: Due to specific disease states and some medications
- Renal vascular & renal parenchymal issues
- Primary aldosteronism
- Pheochromocytoma
- Cushing's syndrome
- Coarctation of aorta
- Brain tumors
Assessment: Review risk factors, check for orthostatic hypotension (fall in BP on standing), monitor for tachycardia, sweating, pallor and other signs/symptoms
Diagnostic assessment: No specific test, but lab tests can assist in assessing possible secondary hypertension (BUN, CREA, RBC, Pus and presence of Renal Disease)
Interventions:
- Lifestyle modifications: Sodium restriction, weight reduction (if applicable), moderation of alcohol, increase exercise
- Drug therapy:
  - Diuretics
  - Calcium-channel blocking agents
  - ACE inhibitors
  - Beta blockers

Aneurysm

A permanent localized dilation of an artery, enlarged to at least 2 times normal diameter
Types:
- Fusiform- diffuse dilation affecting the entire circumference of the artery
- Saccular- an outpouching affecting only a portion of the artery
Etiology:
- Atherosclerosis is the most common cause
- Hypertension
Assessment findings:
- Asymptomatic until rupture
- Steady abdominal/flank/back pain
- Possible symptoms of rupture include hypotension, diaphoresis, mental obtundation, oliguria, and dysrhythmias (S/S of hypovolemic shock).
Diagnostic assessments: X-ray to detect "eggshell" appearance if AAA; CT scan for size and location; Ultrasonography to assess the size and location
Interventions:
- Nonsurgical- Monitor growth and maintain normal BP
- Surgical – Repair or resection of the aneurysm

Peripheral Vascular Disease

Alteration of blood flow through the peripheral arteries and veins.
Peripheral arterial disease (PAD) - chronic partial or total arterial occlusion from systemic atherosclerosis; affects lower extremities.
Assessment findings: intermittent claudication (muscle discomfort/cramping during walking that eventually forces a stopping), rest pain (numbness/burning pain in the toes, feet, and lower leg occurring at rest), decreased/absent peripheral pulses, loss of hair, and other signs of peripheral arterial disease.
Radiographic assessment:
- Arteriography
- Segmental systolic BP measurements with Doppler probe (ankle-brachial index or ABI)
- Exercise tolerance testing
Medical and/or nursing management: exercise (but monitor for any pain), positioning, vasodilation (promoting warm temperature to extremities), drug therapy (antiplatelet agents and hemorheologic agents), percutaneous transluminal angioplasty (PTA), laser-assisted angioplasty, and/or arterial revascularization with bypass procedures (graft procedures)

Buerger's Disease

Occlusive disease affecting small-to-medium-sized arteries and veins, most frequently in the distal extremities
Cause: Unknown, but often associated with smoking.
Assessment findings: intermittent claudication in the arch of the foot, increase cold sensitivity, reduced pulses, peripheral ischemia, ulceration, possible gangrene.
Interventions: Cessation/complete avoidance of tobacco in all forms, maintain warmth and avoid exposure to extreme cold
Management: Similar to PAD

Raynaud's Disease/Phenomenon

Vasospasm that causes blanching and cyanosis of the extremities (mostly fingertips and toes) due to extreme cold or emotional stress
Assessment: blanching, coldness, numbness, pain, and swelling.
Management: Identify and avoid triggers. Drug therapy (e.g., calcium channel blockers). Surgery (lumbar sympathectomy). Health teaching

Veinous Thromboembolism

Thrombus- a blood clot ◦ Endothelial injury (e.g., catheter placement) ◦ Venous stasis (e.g., prolonged bed rest, immobility) ◦ Hypercoagulability (e.g., inherited conditions, certain medications)
Embolus- A blood clot that moves from its origin to another area. ◦ Thrombophlebitis – blood clot with inflammation ◦ Phlebothrombosis – blood clot without inflammation
Deep vein thrombosis (DVT) – occurs in the deep veins of the lower extremities; risk for pulmonary embolism
Assessment findings—calf or groin pain & swelling. Homan's sign is not a reliable test, but a useful method is assessing for localized edema
Medical Management- Anticoagulants are the primary treatment for prevention of clots further enlargement. Thrombolytic Therapy, Warfarin
Nursing Management: Elevate the affected extremity (prevent edema)

Varicose Veins

Dilated and tortuous veins in the legs
Can cause symptoms like pain, swelling, aching heaviness, especially after prolonged standing or sitting
Assessment findings:
- Heaviness/tiredness in the legs, especially after prolonged standing or sitting
- Distended/tortuous veins visible under the skin
- Swollen ankles and/or feet
- Brodie-Trendelenburg test
Medical management:
- Mild cases – exercise, losing weight, wearing support
- Severe cases – surgery (veins tied off above and below incompetent valves or vein removal)
Prevention methods (in general): Avoid prolonged standing, elevate legs, exercise regularly

Burn Injury

Classification of burn injury depth:
- Superficial-epidermal injury only, heals in 3-6 days without complications
- Superficial partial-thickness – involves upper one-third of the dermis, blisters, heals in 10-21 days with possible minor pigment changes
- Deep partial-thickness – involves more than one-third of the dermis, involves blisters, heals in 2 – 8 weeks with scarring
- Full-thickness – involves all layers of the skin including subcutaneous tissue, fat, tendons, bone, and muscle, avascular, and leaves no sensation
Assessment findings: skin color changes, edema, blistering, pain, and possible trauma related to the mechanism of the burn. Use "rule of nines" to calculate total burn surface area (TBSA).
- Inhalation injury check for: intraoral charcoal, singed hairs/eyelashes, hoarseness or brassy cough.
Medical management:
- Initial 1st aid: Prevent further injury and provide respiratory/cardiac support. Administer O2, IV fluids, and pain medication as appropriate/needed.
- Acute Care: Quick assessment of the extent of burn injury to identify any additional trauma. Maintain adequate ventilation (e.g., bronchoscopy, warm, humidified O2, and/or ET, escharotomy/tracheostomy, if necessary)

Oncology

Branch of medicine dealing with the study, detection, treatment, and management of cancer
An oncology nurse specializes in treating and caring for people with cancer.
Cancer is characterized by uncontrolled, purposeless, and damaging growth of cells that structurally and functionally differ greatly from the normal cells.
WARNING SIGNS OF CANCER:
- Changes in blood bowel or bladder habits
- Sores that do not heal
- Unusual or persistent bleeding or discharge
- Thickening or lumps that have persisted
- Indigestion/difficulty swallowing
- Changes to normal mole/warts
- Persistent cough/hoarseness
- Unexplained Anemia
- Unexplained weight loss
Tumor staging: TNM (Tumor, Node, Metastasis) classification system used to determine the stage and extent of the cancer and provide treatment direction
Cancer Management:
- Cure- Complete eradication of malignant disease
- Control- Prolonged survival and containment of growth
- Palliation- Relief of symptoms
SURGICAL MANAGEMENT:
- Local excision of small masses
- Radical excision of large masses to minimize tumor spread
- Prophylactic- removal of non-essential organs/tissues to prevent development of cancer
- Palliative- to lessen pain, improve comfort
- Reconstructive- improving function or desirable cosmetic effect
RADIATION THERAPY
- Use of ionizing radiation to interrupt cellular growth and cause cell death
- Internal radiation (brachytherapy)- needles, seeds, beads, or catheters implanted into body cavities
CHEMOTHERAPY
- Antineoplastic agents are used in an attempt to destroy tumor cells
- Chemotherapy agents are most effective against cells that grow and divide rapidly, but they harm normal cells too.
SIDE EFFECTS:
- Alopecia
- Nausea and Vomiting
- Myelosuppression
- Mucositis

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Test your knowledge on bronchiectasis, its management, and related nutritional deficiencies. This quiz covers key symptoms, diagnostic tests, and dietary recommendations for conditions like pernicious anemia and folic acid deficiency. Prepare to assess your understanding of clinical guidelines in respiratory and hematologic care.