LP1.2

General Information

• This document contains study notes for a nursing exam.
• The content covers various topics related to complex health alterations.
• The notes include questions, answers, diagnoses, interventions, and teaching points for each topic.
• The exam appears to be for an Associate Degree Nursing program.

End-of-Life Care

• Multiple organ dysfunction syndrome (MODS): Insufficient blood flow deprives cells of oxygen, inducing acidosis, hyperkalemia, and tissue ischemia. This leads to the release of toxic metabolites, causing further cell damage and hypoxia.
• Good vs. bad death: A good death prioritizes relief from suffering for the patient, family, and caregivers while respecting patient/family wishes. A bad death involves pain, unmet wishes, isolation, and fear.
• End-of-life goals: Identifying patient needs, managing symptoms, promoting meaningful interactions between the patient and loved ones, and facilitating a peaceful passing.
• Palliative Care: A compassionate and supportive approach for patients and families nearing the end of life, not hastening or postponing death. It involves an interdisciplinary team and other medical treatments may also be used.
• Hospice Care: An interdisciplinary approach aiming for good quality of life and a peaceful death for terminally ill individuals. Comfort care is prioritized.
• End-of-life clinical manifestations: Include changes in the neurosensory system (communication issues, decreased LOC, visual/hearing changes), cardiovascular system (decreased BP, heart rate, and respiratory rate, temperature regulation issues), Gl system (constipation, anorexia, nausea/ vomiting), GU system (decreased urinary output, incontinence), pain management, and respiratory changes.
• End-of-Life Psychosocial Support: Focuses on client/family emotional and spiritual needs. Includes being realistic, encouraging reminiscence, and providing referrals to bereavement specialists.

Musculoskeletal Disorders

• Osteoporosis vs. osteopenia: Osteoporosis is a metabolic bone disease characterized by reduced bone density and increased risk of fractures. Osteopenia is characterized by low bone mass, a precursor to osteoporosis.
• Affected sites: Primary sites include the wrist, hip, and vertebral column.
• Osteoporosis classifications: Primary osteoporosis commonly occurs in postmenopausal women and men over 70. Secondary osteoporosis results from associated medical conditions or long-term drug therapy/immobility.
• Prevention teaching: Adequate calcium intake, avoiding a sedentary lifestyle, daily weight-bearing exercise, limiting alcohol, and quitting smoking.
• Osteoporosis assessment: Physical assessment includes posture inspection, checking for kyphosis, observing for loss of height, pain with movement, and restricted movement.
• Osteoporosis diagnosis: Assessment of bone mineral density (BMD) using DEXA, QCT, or QUS.
• Osteoporosis treatment: Medications like bisphosphonates (alendronate, risedronate), calcitonin, RANKL inhibitors, and parathyroid hormones. Dietary recommendations (calcium, vitamin D, protein) and exercise are crucial.

Osteomalacia

• Definition: Softening of bone tissue due to inadequate calcium and phosphorus mineralization.
• Risk Factors: Malnutrition, poor diets, vitamin D deficiency

Paget's Disease

• Definition: Metabolic disorder where bone is excessively broken down and reformed.
• Affected sites: Skull, spine, pelvis, femur, tibia.
• Clinical manifestations: Bone pain, bowing of long bones, spinal curve changes, enlarged skull, and pathologic fractures.
• Interventions: Aspirin, NSAIDs, calcitonin, bisphosphonates, mithramycin, and physical therapy.

Osteomyelitis

• Definition: Bone infection caused by pathogenic microorganisms.
• Types: Exogenous (external source), endogenous (from bloodstream), contiguous (spread from nearby infection).
• Acute vs. chronic manifestations: Fever, erythema, swelling, tenderness, localized pain (acute). Localized pain, drainage, sinus tract, ulceration (chronic).
• Interventions: Antibiotics, pain control, wound care, and surgical management (sequesrectomy, bone grafts).

Bone Tumors

• Types: Osteochondroma, Chondroma, Osteoid Osteoma, Osteoblastoma, Giant Cell Tumor, Ewing's Sarcoma, Osteosarcoma, Chondrosarcoma.
• Assessments: Pain, swelling, masses, warmth, and neurological/functional assessments.
• Interventions: Pain control, non-surgical and surgical treatments such as curettage and joint repair.

Hand and Foot Disorders

• Carpal Tunnel Syndrome: Median nerve compression in the wrist, causing pain and numbness.
• Dupuytren's Contracture: Palmar fascia thickening causing flexion contracture of the fingers.
• Morton's Neuroma: Digital nerve tumor causing pain and burning sensations.
• Hallux Valgus/Bunion: Lateral deviation of the big toe.
• Hammertoes: Dorsiflexion of the metatarsophalangeal joint.
• Plantar Fasciitis: Inflammation of the plantar fascia (arch of the foot).

Pediatric Disorders

• X-linked disorders: Genetic inheritance via the X chromosome, commonly affecting males. Examples include Duchenne and Becker muscular dystrophies.
• Duchenne Muscular Dystrophy: Early onset, rapid progression, leading to loss of ambulation and death in the mid-20s due to cardiac and respiratory failure.
• Becker Muscular Dystrophy: Slower progression, maintaining ambulation longer.
• Scoliosis: Lateral curvature of the spine. Differentiation from Lordosis (concave curvature) and Kyphosis (front-to-back curvature).

Musculoskeletal Trauma

• Fracture classifications: Complete, incomplete, open (compound), closed (simple), displaced, non-displaced, pathologic, stress, compression.
• Assessment findings: Changes in bone alignment, altered extremity length/shape, pain with movement, numbness/tingling, decreased ROM.
• Bone healing stages: Hematoma formation, granulation tissue, callus formation, osteoblastic proliferation, bone remodeling.
• ORIF vs. external fixation: ORIF (open reduction internal fixation) involves surgery with plates/screws, while external fixation applies external devices for traction, casting, or bracing.

Amputations

• Complications: Hemorrhage, infection, phantom limb pain, immobility or activity limitations, neuroma formation, and flexion contracture.

Acute Compartment Syndrome

• Cause: Increased pressure within a muscle compartment, reducing circulation.
• Clinical manifestations: Sensory/motor deficits, pain, pallor, pulses, edema.
• Emergency care: Rapid diagnosis and fasciotomy to relieve pressure within the affected compartment.

Crush Syndrome

• Cause: Multiple compartment injury leading to edema and reduced tissue perfusion.
• Complications: Hypovolemia, hyperkalemia, rhabdomyolysis (muscle breakdown) leading to acute tubular necrosis.

Fat Embolism/PE

• Cause: Fat embolism usually follows long bone fractures.
• Clinical manifestations: Altered mental status, hypoxia, dyspnea, tachypnea.

Renal Disorders

• Immunologic Renal Disorders: Diseases that damage the glomeruli (proteinuria, hematuria).
• Acute Glomerulonephritis: Infection or disease triggers inflammation and damage to the glomeruli.
• Clinical manifestations: Edema, increased weight, hypertension, fatigue, fluid overload, altered urine output (color, amount, dysuria).
• Interventions: Fluid and sodium restriction, antihypertensive medications, and antibiotics.
• Nephrotic Syndrome: Increased glomerular permeability, leading to protein loss and edema formation.

Polycystic Kidney Disease

• Cause: Inherited disorder causing fluid-filled cysts to develop in the nephrons.
• Clinical manifestations: Flank or abdominal pain, nocturia, abdominal girth increase, constipation, and hematuria.
• Interventions: Pain management (opioids, acetaminophen), fluid intake support, dietary fiber, and regular exercise.
• Chronic Glomerulonephritis: Progressive kidney damage over years causing atrophied kidneys and reduced nephron function

Obstructive Disorders

• Hydronephrosis: Kidney enlargement due to urine accumulation.
• Hydroureter: Ureter enlargement due to obstruction.
• Urethral Stricture: Lower urinary tract obstruction, causing bladder distention.
• Nephrostomy: Catheter placed in the renal pelvis to drain urine
• Pyelonephritis: Upper urinary tract infection with acute or chronic presentation.
• CVA tenderness: Pain or discomfort when the costovertebral angle is percussed.

Renal Trauma

• Minor trauma: Damage to small blood vessels, contusions.
• Major trauma: Extensive bleeding, lacerations.
• Pedicle injuries: Laceration or break in renal artery or vein.

Diabetic Nephropathy

• Cause: Microvascular complication of diabetes, affecting the kidneys.
• Manifestations: Persistent albuminuria (protein in urine).

Acute & Chronic Kidney Disease

• Acute Kidney Injury (AKI): Sudden decrease in renal function due to inadequate perfusion, damage to the kidneys, or urinary obstruction.
• Types of AKI: Prerenal, Intrinsic (intrarenal), Postrenal.
• Labs affected by AKI/CKD: Serum creatinine, blood urea nitrogen (BUN), urine output, urine specific gravity.
• Phases of AKI: Onset, oliguria, diuretic, recovery.
• Nephrotoxic agents: Antibiotics, chemotherapy agents, NSAIDs.
• Chronic Kidney Disease (CKD): Progressive, irreversible kidney injury leading to the loss of nephron function and buildup of waste products.
• CKD Stages: Defined by glomerular filtration rate (GFR) levels.
• Uremic syndrome: Build-up of waste products leading to systemic issues due to kidney failure.

Kidney Replacement Therapy

• Hemodialysis: Blood is filtered through an artificial membrane to remove waste.
• Peritoneal dialysis: Dialysate is instilled into the abdominal cavity to remove waste.
• Complications of dialysis: Dialysis disequilibrium syndrome, and arterial steal syndrome, infections (peritonitis).

Kidney Transplantation

• Candidates and donors: Candidates need to be free from other medical problems; donors are both living and cadaver.

Hyperacute vs. Acute vs. Chronic Rejection

• Hyperacute: Immediate rejection, triggered by pre-existing recipient antibodies against the donor organ.
• Acute: Antibody-mediated or cellular rejection occurring within weeks or months.
• Chronic: Gradual rejection due to inflammation and scarring, occurring over time.

Nutritional needs during different stages, considerations, and treatment of Kidney Disease

• Protein, sodium, potassium, and phosphorus restriction: vary depending on specific stage and lab values to prevent complications. Specific foods to avoid are determined via lab values.
• Dialysis and nutritional needs: Dietary changes may differ based on specific needs during and after dialysis.
• Important labs for monitoring: GFR, sodium, potassium, phosphorus, calcium and more.

Fluid and sodium retention

• Measurements: Daily weight changes and blood pressure monitoring are key.
• Considerations: Fluids and sodium are carefully monitored.

Medication considerations

• Medications: Specific classifications of medications are listed and their functions, precautions and use is described.

Emergency care considerations

• Assessments and interventions: Specific instructions for emergency situations like acute compartment syndrome, are detailed.

Post-procedure/post-surgical care considerations

• Assessments: Specific post operative considerations are included.
• Specific interventions: such as wound care, pain management, and monitoring for complications are outlined.