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• These are your study notes

Pulmonary Embolism

• Pulmonary arteries are blocked by a thrombus, fat, air, or tumor
• Gas exchange is impaired and can cause hemodynamic instability
• Clinical manifestations include dyspnea, chest pain, tachycardia, and cough, hypoxemia, anxiety, and possible hemoptysis.
• Diagnostic tests include ABG analysis, chest x-ray, ECG, D-dimer test, spiral CT scan, and V/Q scan
• Spiral CT scan is the most common diagnostic test
• V/Q scan if CT is contraindicated
• Manage with oxygen therapy and anticoagulation medications
• Anticoagulation medications include heparin, low-molecular-weight heparin, and factor Xa inhibitors
• Fibrinolytic agents may be used for massive PE
• An inferior vena cava (IVC) filter may be needed
• Nursing management involves assessing cardiorespiratory status, administering oxygen and medications, providing emotional support, and educating patients on long-term anticoagulation therapy

Acute Respiratory Failure

• Hypoxemic Respiratory Failure: Oxygenation failure where PaO2 is ≤ 60 mm Hg with ≥ 60% oxygen
• Hypercapnic Respiratory Failure: Ventilatory failure where PaCO2 is > 50 mm Hg and pH is < 7.35
• Causes include respiratory system issues such as pneumonia, ARDS, and COPD
• Cardiac issues such as pulmonary edema and anatomic shunt are causes
• Clinical manifestations include dyspnea, changes in breathing pattern, use of accessory muscles, and changes in mental status
• Tachycardia, dysrhythmias, and changes in blood pressure are clinical manifestations
• Skin may be pale, cool, clammy, or warm and flushed
• Diagnostic tests include arterial blood gas, chest x-ray, and pulse oximetry
• Management includes oxygen therapy, mobilization of secretions, cough/deep breathe, suctioning, humidification, noninvasive or invasive ventilation, and treating the underlying cause
• Nursing management involves assessing for airway patency, breathing effort, and overall respiratory status
• Monitoring of vital signs, ABGs, and pulse oximetry is important
• Provide emotional support and prevent complications

Acute Respiratory Distress Syndrome (ARDS)

• ARDS is a severe form of ARF characterized by damage to the alveolar-capillary membrane
• Leads to decreased surfactant production, atelectasis, and impaired gas exchange
• Inflammatory mediators increase alveolar capillary permeability
• Diagnostic criteria include timing within one week of a known clinical insult, bilateral opacities on chest x-ray, and oxygenation issues.
• Clinical manifestations are similar to ARF, but more severe
• Hypoxemia refractory to oxygen therapy
• Management includes mechanical ventilation with low tidal volume and positive end-expiratory pressure (PEEP)
• Positioning strategies, like prone positioning, and extracorporeal membrane oxygenation (ECMO)
• Complications include cardiovascular such as increased CO, dysrhythmias, and hypotension
• CNS and Psychological complications include delirium and PTSD
• GI complications include hypermetabolic state, paralytic ileus, and GI bleeding
• Hematologic complications include anemia, disseminated intravascular coagulation, and thrombocytopenia
• Renal complications include AKI
• Nursing management is similar to ARF, but more intensive monitoring and care
• Frequent ABG monitoring is necessary
• Analgesia, sedation, and neuromuscular blockade may be needed

Lung Cancer

• Non-small cell lung cancer (NSCLC) is the most common type
• Smoking is the most significant risk factor
• Other risk factors include exposure to secondhand smoke, airborne carcinogens, and chronic lung disease
• Clinical manifestations include cough, hemoptysis, dyspnea, chest pain, hoarseness, and fatigue
• Diagnostic tests include Chest x-ray, CT scan, and MRI
• Sputum cytology and biopsy are diagnostic tests
• Bone scans and scans of the brain, pelvis, and abdomen
• Stages range from 0 to IV based on tumor size, lymph node involvement, and metastasis
• Management includes surgery (lobectomy, pneumonectomy), radiation therapy, chemotherapy, and immunotherapy
• Targeted therapy is a management technique
• Screening includes annual low dose CT for high-risk patients ages 50 to 80 with history of smoking.
• Nursing management involves assessing understanding of disease, treatment, and prognosis
• Provide support, education, and symptom management and smoking cessation counseling

Acute Kidney Injury (AKI)

• Prerenal: Decreased blood flow to the kidneys leading to hypovolemia and heart failure
• Intrarenal: Direct damage to kidney tissue from nephrotoxins and ischemia
• Postrenal: Obstruction of urine flow from stones and BPH
• RIFLE classification includes Risk, Injury, Failure, Loss, and End-stage kidney disease
• Serum creatinine and urine output criteria define the stage of AKI
• Oliguria or anuria, though nonoliguric AKI is also possible
• Changes in urine output and serum creatinine and urinalysis may show casts, RBCs, and WBCs.
• Diagnostic tests include history and physical assessment
• Urinalysis and serum creatinine and BUN are diagnostic tests
• Kidney ultrasound, renal scan or CT scan, and renal biopsy for intrarenal causes
• Management includes treating the underlying cause, fluid restriction, nutritional support, and measures to lower potassium levels
• Calcium supplements or phosphate-binding agents, dialysis, and continuous renal replacement therapy
• Avoid nephrotoxic agents
• Nursing management includes monitoring daily weights, intake/output, and vital signs
• Assess urine for color, specific gravity, glucose, protein, blood, and sediment
• Skin and mouth care and monitoring for electrolyte imbalances

Pyelonephritis

• Infection of the renal parenchyma
• Caused by ascending bacterial infection from the lower urinary tract
• Risk factors include structural abnormalities, pregnancy, and vesicoureteral reflux
• Clinical manifestations include fever/chills, nausea/vomiting, malaise, and flank pain
• Dysuria, urgency, and frequency
• Urinalysis, urine culture and sensitivity, and imaging studies like ultrasound, CT scan, or MRI are diagnostics
• Management includes antibiotics and adequate fluid intake
• Symptom management with NSAIDs or antipyretics and possible hospitalization if severe
• Nursing management includes patient education on antibiotic therapy, fluid intake, and follow-up

Urinary Tract Calculi (Kidney Stones)

• Supersaturation of crystal-forming substances in urine
• Contributing factors include climate, diet, genetics, metabolic factors, and lifestyle
• Dehydration and concentrated urine increase risk
• Urinary pH affects stone formation
• Clinical manifestations include severe, colicky pain in flank, back, abdomen, or groin
• Hematuria and crystalluria, and urinary urgency and frequency
• Noncontrast CT scan or ultrasound, urinalysis, and 24-hour urine collection for measurement of minerals are diagnostics
• Management includes pain management with opioids or NSAIDs
• Alpha-Adrenergic blockers help with stone passage
• Increase fluid intake
• Dietary changes and restrictions depending on stone type, endourologic procedures, extracorporeal shock-wave lithotripsy (ESWL), and open surgical stone removal
• Nursing management includes assessing pain, fluid intake, and urinary symptoms
• Strain all urine to retrieve stones for analysis
• Patient education on diet, hydration, and medications and encourage ambulation

Anemia

• Reduction in the number of red blood cells (RBCs), hemoglobin, or hematocrit
• Leads to decreased oxygen carrying capacity
• Clinical manifestations include fatigue, pallor, tachycardia, dyspnea, and other signs related to tissue hypoxia
• Adequate intake of protein, iron, vitamin B12, folic acid, copper, niacin, and vitamin B5 is necessary for RBC production
• Iron Deficiency Anemia is caused by blood loss, poor iron intake, or poor absorption
• Low Hgb, Hct, serum iron, ferritin and high TIBC

Megaloblastic Anemia

• Caused by cobalamin (vitamin B12) or folic acid deficiency
• Macrocytic RBCs, low serum cobalamin or folate levels
• Treatment with replacement therapy
• Anemia of Chronic Disease is underproduction of RBCs and shortened RBC survival
• Normocytic, normochromic, and hypoproliferative
• Aplastic Anemia involves pancytopenia, low levels of all blood cells.
• Normocytic, normochromic anemia, and low reticulocyte count
• Anemia due to Acute Blood Loss results from hemorrhage or trauma
• Hgb, Hct, and RBC will be decreased
• Treatment focuses on stopping the bleeding, fluid replacement, and possible blood transfusions

Hemolytic Anemia

• Caused by increased destruction of RBCs
• Elevated bilirubin levels, jaundice, high reticulocytes, and abnormal blood smear
• Treatment includes supportive care and addressing the underlying cause
• Sickle Cell Anemia is a genetic disorder caused by a mutation in the beta-globin gene
• Sickled cells cause vaso-occlusion, pain, and organ damage
• Treatment focuses on managing pain crises and preventing complications

Thalassemia

• Genetic defect in globin synthesis
• RBCs are microcytic and hypochromic
• Treatment includes blood transfusions, iron chelation, and HSCT
• Polycythemia Vera is excessive production of RBCs
• Increased blood viscosity and risk for thrombus formation
• Treatment includes phlebotomy, hydration therapy, and myelosuppressive drugs
• Nursing management includes assess knowledge of nutrition, safety, and disease
• Encourage rest, monitor cardiorespiratory response to activity, and aid with ADLS
• Provide education on diet, medications, and potential complications

Human Immunodeficiency Virus (HIV)

• HIV is a retrovirus that causes immunosuppression
• Targets CD4+ T cells, eventual destruction of CD4+ cells and opportunistic diseases develop
• Transmission through infected blood, semen, vaginal secretions, or breast milk
• Acute infection, followed by a period where the HIV antibody test becomes positive
• Symptomatic infection develops with declining CD4 counts and increasing viral load
• AIDS is diagnosed when the CD4 count drops below 200 cells/μL, or if certain opportunistic infections or cancers develop
• Symptoms such as persistent fever, night sweats, diarrhea, headaches, and severe fatigue may occur as the CD4 count declines
• Opportunistic infections
• HIV antibody/antigen tests are diagnostics
• Confirmation with HIV viral load testing and monitoring with CD4 counts and viral load
• Treatment includes Antiretroviral therapy (ART) to suppress viral load, but ART does not cure HIV
• Prevention includes Pre-exposure prophylaxis (PrEP) for high-risk individuals and Post-exposure prophylaxis (nPEP) within 72 hours of exposure
• Safer sexual practices and avoiding sharing drug equipment and regular testing
• Nursing management includes assessment of risk factors
• Patient education on transmission, treatment, and prevention
• Emotional support and counseling

Disseminated Intravascular Coagulation (DIC)

• Life-threatening condition involving widespread activation of the clotting cascade, leading to both thrombosis and hemorrhage
• Caused by an underlying disease or condition
• Risk factors include cancers, hemolytic processes, obstetric conditions, septicemia, shock, and tissue damage
• Clinical manifestations include bleeding, tissue damage, and organ ischemia or infarction
• Prolonged PT, PTT, APTT and decreased fibrinogen and platelets are diagnostics
• Increased D-dimer and presence of schistocytes on peripheral blood smear are diagnostics
• Treat the underlying cause with blood product support
• Blood product support includes platelets, cryoprecipitate, fresh frozen plasma
• Careful monitoring and supportive care
• Nursing management includes minimizing tissue damage
• Protect patient from bleeding sources and administer blood products and medications