Nursing Knowledge Check: Stress, Neurological, Respiratory, and More PDF

Unit #1 - What is stress? Explain the difference between Eustress and Distress. Eustress: Positive stress that can motivate individuals and improve performance.​ Distress: Negative stress that can lead to anxiety, decreased performance, and health problems List some symptoms that the nurse might...

Unit #1 - What is stress? Explain the difference between Eustress and Distress. Eustress: Positive stress that can motivate individuals and improve performance.​ Distress: Negative stress that can lead to anxiety, decreased performance, and health problems List some symptoms that the nurse might see throughout the body when the patient is experiencing prolonged stress. Cardiovascular: Hypertension, tachycardia​ Gastrointestinal: Ulcers, irritable bowel syndrome​ Musculoskeletal: Tension headaches, muscle pain​ Immune System: Decreased immunity, increased susceptibility to infections​ Psychological: Anxiety, depression, irritability Explain General Adaptation Syndrome and its three phases.; Physiological stress responce ​ Alarm Phase: Immediate reaction to stressor; "fight or flight" response. ​ Resistance Phase: The Body attempts to adapt to the stressor. ​ Exhaustion Phase: Prolonged stress leads to depletion of resources, resulting in decreased stress tolerance, fatigue, and health issues. What is Acute Stress Disorder? -​ A short-term condition occurring after a traumatic event, characterized by anxiety, dissociation, and other symptoms lasting from 3 days to 1 month. Explain PTSD and how it can be managed or treated. -​ A long-term condition triggered by experiencing or witnessing a traumatic event. -​ Symptoms include flashbacks, nightmares, severe anxiety, and uncontrollable thoughts about the event -Psychotherapy (e.g., Cognitive Behavioral Therapy) -Medications (e.g., SSRIs) -Support groups What are some of the common medications used for PTSD? Selective Serotonin Reuptake Inhibitors (SSRIs): e.g., Sertraline, Paroxetine​ Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs): e.g., Venlafaxine​ Prazosin: For nightmares and sleep disturbances What is Local Adaptation Syndrome? A localized response of the body to stress, such as inflammation, reflexive pain response, or localized vasoconstriction. Looking at the CNS and PNS compare the physiological reactions to pain. Central Nervous System (CNS): Processes and interprets pain signals.​ Peripheral Nervous System (PNS): Transmits pain signals from the site of injury to the CNS In the area below list the different Objective and Subjective observations regarding pain: Objective- Vital signs (elevated BP, HR), facial expressions, guarding behavior. Subjective- Patient's self-reported pain levels, descriptions of pain quality and intensity. Explain the difference between acute and chronic pain. Acute Pain: Sudden onset, usually sharp, and lasts less than 6 months.​ Chronic Pain: Persistent pain lasting longer than 6 months, often resistant to medical treatments. What does OPQRSTUV stand for? For each letter, give one sample question that you might ask the patient to acquire information about their pain. ​ O: Onset – "When did the pain start?" ​ P: Provocation/Palliation – "What makes it better or worse?" ​ Q: Quality – "What does the pain feel like?" ​ R: Region/Radiation – "Where is the pain? Does it spread?" ​ S: Severity – "How intense is the pain on a scale of 0 to 10?" ​ T: Timing – "Is the pain constant or intermittent?" ​ U: Understanding – "What do you think is causing the pain?" ​ V: Values – "What is your goal for pain relief?"​ List some non-pharmacological interventions the nurse can implement for relieving pain: -​ Heat/cold therapy -​ Massage -​ Relaxation techniques -​ Distraction -​ Acupuncture What are some of the common medications used for pain relief? -​ Non-Opioids: Acetaminophen, NSAIDs -​ Opioids: Morphine, Hydromorphone -​ Adjuvants: Antidepressants, Anticonvulsants What are the Stages of Grief? Give a brief explanation of each. Denial: Refusal to accept reality. Anger: Frustration and questioning. Bargaining: Attempting to negotiate for a different outcome. Depression: Deep sadness and withdrawal. Acceptance: Coming to terms with the loss. How can the nurse help the patient and family who are experiencing grief? -​ Provide empathetic listening. -​ Encourage expression of feelings. -​ Offer resources for counseling and support groups. -​ Respect cultural and individual differences in grieving processes. Unit #2 Outline- Neurological Disorders What is a Cerebral Vascular Accident? A CVA, or stroke, occurs when blood flow to a part of the brain is interrupted, leading to brain cell death Explain the difference between an Ischemic and a Hemorrhagic stroke. Ischemic Stroke: Caused by a blockage in a blood vessel supplying the brain. Hemorrhagic Stroke: Caused by bleeding into or around the brain. What are some of the risk factors for a CVA? Modifiable: Hypertension, smoking, diabetes, high cholesterol, obesity, sedentary lifestyle.​ Non-Modifiable: Age, gender, family history, ethnicity. If a patient were experiencing a CVA what symptoms might you see? -​ Sudden numbness or weakness, especially on one side of the body. -​ Confusion, trouble speaking or understanding. -​ Vision problems. -​ Dizziness, loss of balance or coordination. -​ Severe headache with no known cause. Using the table below list the different symptoms you would see in left vs right brain damage after a CVA. Left Brain Damage Right Brain Damage Right-sided weakness/paralysis Left-sided weakness/paralysis Speech/language problems Spatial-perceptual deficits Slow, cautious behavior Quick, impulsive behavior Memory problems related to Memory problems related to language performance What are some of the diagnostic tests used to determine a CVA? Give a brief explanation of each procedure. -​ CT Scan: Identifies bleeding or infarction. -​ MRI: Provides detailed images of brain tissue. -​ Carotid Ultrasound: Detects narrowing of carotid arteries. -​ Echocardiogram: Checks for heart sources of clots. What are some of the medications used to treat a CVA. Choose one and list its action, onset, peak, duration, and where it is metabolized. tPA (Tissue Plasminogen Activator): Dissolves clots in ischemic stroke. ​ Action: Thrombolytic agent. ​ Onset: Immediate. ​ Peak: Rapid. ​ Duration: Short. ​ Metabolized: Primarily in the liver. Give a brief explanation of what an angioplasty is. A procedure to restore blood flow through the artery by inflating a balloon inside the vessel. What is the purpose of the Glasgow Coma Scale? A scale used to assess consciousness in patients with acute brain injury, evaluating eye, verbal, and motor responses. What are some of the body systems affected after a CVA? List one concern for each system. -​ Neurological: Cognitive deficits, paralysis. -​ Respiratory: Risk of aspiration pneumonia. -​ Musculoskeletal: Muscle weakness, contractures. -​ Urinary: Incontinence or retention. List two possible nursing diagnoses when caring for a patient after a CVA. -Impaired physical mobility related to hemiparesis.​ - Risk for aspiration related to impaired swallowing. What is Multiple Sclerosis, what is happening in the body, and what signs and symptoms might you see? An autoimmune disease where the immune system attacks the myelin sheath of nerve fibers, disrupting communication between the brain and body. Signs and Symptoms: ​ Fatigue ​ Numbness or weakness ​ Vision problems ​ Tremors ​ Coordination issues Medications: ​ Interferon beta-1a: Modulates immune response.​ ○​ Action: Reduces inflammation. ○​ Onset: Variable. ○​ Peak: 3-15 hours. ○​ Duration: Several days. ○​ Metabolized: Liver. List two potential nursing diagnoses when dealing with a patient with MS. -​ Fatigue is related to the disease process. -​ Impaired physical mobility related to muscle weakness. What is ALS? A progressive neurodegenerative disease affecting motor neurons, leading to muscle weakness and atrophy. What is happening in the body, and what signs and symptoms might you see? progressive degeneration and death of motor neurons, the nerve cells that control voluntary muscle movement and breathing ​ Spasticity ​ Difficulty speaking and swallowing ​ Respiratory compromise ​ Muscle cramps What is Parkinson’s Disease. What is happening in the body and what signs and symptoms might you see? Parkinson’s disease happens because dopamine-producing brain cells are dying, leading to impaired control over movement and eventually other body functions. The hallmark signs include tremor, stiffness, slow movements, and balance problems, but it can also cause mental and emotional changes. What are some medications used in the treatment of Parkinson’s? Choose one and list its action, onset, peak, duration, and where it is metabolized. Levodopa-Carbidopa: Increases dopamine levels. ​ Action: Converts to dopamine in the brain. ​ Onset: 30 minutes. ​ Peak: 1-2 hours. ​ Duration: 4-6 hours. ​ Metabolized: Liver. Disorders of the Nervous system are very complex. List all the Interprofessional team members that may be involved in care and give a brief description of their role. Physiotherapist: Assists with mobility and strength. Occupational Therapist: Helps with daily living activities. Speech-Language Pathologist: Addresses communication and swallowing issues. Social Worker: Provides resources and support. Neurologist: Manages neurological care. Unit #3 Outline- Depression, Delirium, Dementia Define Dementia. Dementia refers to a group of cognitive disorders characterized by a progressive decline in memory, thinking, behavior, and the ability to perform daily activities. It is not a normal part of aging but is caused by brain changes that interfere with normal functioning. What is the most common type of Dementia? Alzheimer’s Disease is the most common form of dementia, accounting for 60-80% of cases. It is marked by the accumulation of amyloid plaques and neurofibrillary tangles in the brain, which disrupt communication between neurons and cause neuron death. What are the 8 A’s of Dementia? Amnesia – Memory loss (short-term and long-term) Aphasia – Language difficulties, including problems with speaking, understanding speech, reading, and writing Apraxia – Difficulty with motor planning or executing familiar tasks​ Agnosia – Inability to recognize objects, people, sounds, or smells despite intact sensory function​ Altered Perception – Misinterpreting sensory information, which can cause hallucinations or delusions Apathy – Lack of motivation, interest, or concern about daily activities Anosognosia – Lack of awareness or denial of the condition Attention Deficits – Difficulty focusing or concentrating on tasks For the following stages of Dementia, list the symptoms you may see: Early stage: Symptoms: Mild memory loss, especially with recent events; difficulty finding the right words; occasional disorientation in familiar places; still able to perform most daily activities independently. Middle Stage: Symptoms: Increasing confusion and memory loss; difficulty with routine tasks like dressing, bathing, or eating; noticeable changes in behavior and mood, such as agitation, wandering, and suspicion; need for help with daily activities. Late Stage: Symptoms: Severe memory loss, inability to communicate verbally or nonverbally; loss of motor skills and mobility; complete dependence on caregivers for all activities of daily living; may experience incontinence. Explain Alzheimer’s Disease. Alzheimer's disease is a degenerative brain disorder that leads to memory loss, confusion, and behavioral changes. It is caused by the buildup of amyloid plaques and tau tangles in the brain, which disrupt normal brain function. As the disease progresses, it causes neuronal death and significant brain shrinkage, impairing cognitive abilities. What is Vascular Dementia? What are some factors that increase the risk? Vascular dementia occurs when there is reduced blood flow to the brain due to damage to blood vessels. This can be a result of stroke, hypertension, or other cardiovascular issues. Risk factors for vascular dementia include a history of stroke, heart disease, smoking, high blood pressure, and diabetes. Symptoms may vary depending on the area of the brain affected, but typically include confusion, difficulty with attention and problem-solving, and changes in mood. What is Lewy Body Dementia? What symptoms may be present with this condition? Lewy Body Dementia is characterized by the presence of abnormal protein deposits, called Lewy bodies, in the brain. These deposits affect brain regions that control memory and motor skills. Common symptoms include visual hallucinations, Parkinson-like motor symptoms (tremors, stiffness, and difficulty walking), fluctuating cognitive function, and sleep disturbances. Difficulties in short-term memory, spatial perceptual deficits, and visual hallucinations Explain Frontotemporal Dementia. This type of dementia primarily affects the frontal and temporal lobes of the brain, which control behavior, personality, and language. Symptoms of Frontotemporal Dementia can include marked changes in personality (e.g., impulsivity, inappropriate behavior), poor judgment, and language difficulties (e.g., trouble finding words or speaking clearly). How is a patient diagnosed with Alzheimer’s disease? Through clinical evaluation; -​ Patient history and symptom assessment -​ Cognitive testing -​ Neuroimaging (e.g., MRI or CT scan) to rule out other causes of symptoms -​ Laboratory tests to rule out conditions like thyroid disorders or vitamin deficiencies What medications might be used in the treatment of Dementia? MAIN: Cholinesterase inhibitors (e.g., Donepezil, Rivastigmine): These drugs increase acetylcholine levels in the brain, which can help improve memory and cognitive function in the early stages of Alzheimer’s. Glutamate regulators (e.g., Memantine): This drug helps regulate glutamate, a neurotransmitter involved in learning and memory, to improve symptoms in moderate to severe stages of dementia.​ Antidepressants, antipsychotics, and mood stabilizers may be prescribed to manage behavioral symptoms such as agitation, depression, and aggression. What are some nursing interventions that could be implemented for the patient with Dementia? -​ Ensure safety by minimizing fall risks and securing dangerous areas in the home. -​ Provide cognitive stimulation through activities such as puzzles or reading to promote memory retention. -​ Establish a structured routine to reduce confusion and anxiety. -​ Promote communication through simple, clear language and encourage nonverbal forms of communication if speech is impaired. -​ Support caregivers by offering education and resources to assist in caregiving responsibilities. For each area list some of the causes of Depression: Biological Factors: Genetics, chemical imbalances in the brain (especially serotonin, norepinephrine, and dopamine), and hormonal changes can all contribute to depression. CNS disorders, electrolyte and chemical imbalances, infections, nutritional deficits Pharmacological Factors: Certain medications, such as corticosteroids, beta-blockers, and some antihypertensives, may contribute to depression as a side effect. Alcohol, sedatives, antihypertensives, analgesics. Psychosocial Factors: Stressful life events, trauma, loss, chronic illness, social isolation, and a history of abuse can increase the risk of depression. What criteria need to be met for a diagnosis of Depression to be made? -​ Diagnosis is based on clinical assessment, including a detailed history of symptoms (e.g., persistent sadness, loss of interest in activities, changes in appetite or sleep) -​ Depressed mood -​ Loss of pleasure or interest -​ Weight gain or loss -​ Sleeping difficulties -​ Psychomotor agitation or retardation -​ Fatigue -​ Feeling worthless -​ Inability to concentrate -​ Thoughts of suicide or death The patient needs to express 5 or more of these symptoms for at least two weeks to be considered to have Major Depressive Disorder, but having any two symptoms for a week or more may be a sign of mild to moderate depression. What are some medications that may be used in the treatment of Depression? SSRIs- Selective Serotonin Reuptake Inhibitors: Prozac, Zoloft, Paxil, Celexa SNRIs- Serotonin and Norepinephrine Reuptake Inhibitors: effexor, effexor XR MAOs- Monoamine oxidase inhibitors Tricyclics; interfere with the metabolism of Norepinephrine and Serotonin What are some of the nursing interventions that could be implemented for the patient with Depression? -​ Assess the client for S&S of depression -​ Educate and monitor the client as antidepressants take up to 6 weeks to work  -​ Monitor for effectiveness -​ Educate on specifics related to the medications i.e. MAO inhibitors & food, Prozac & Antihistamines -​ Encourage discussion about fears -​ Educate about counseling/help groups in the area -​ Identify, educate and decrease negative self-talk -​ Reduce environmental anxiety and distress Explain Delirium. Delirium is a worsening or change in a person’s mental state that happens suddenly, over one to two days. The person may become confused or be more confused than usual. Or they may become sleepy and drowsy. Delirium can be distressing to the person and those around them, especially when they don’t know what’s causing these changes. It can develop rapidly and fluctuates throughout the day, often worsening at night (sundowning). What are some causes of delirium? -​ Infection -​ Metabolic disturbances, for example, -​ renal failure -​ Intra-cranial pathology, for example, trauma or tumour; side effects of medication -​ Drug or alcohol withdrawal or postoperative states How is Delirium treated? -​ Nutrition -​ Rest -​ Hydration -​ Comfort What are some nursing interventions that could be implemented for the client experiencing delirium? -​ Ensure a calm environment -​ promote safety -​ assign one-to-one care -​ avoid restraints -​ Use caution with medication Compare the differences between Dementia, Depression, and Delirium.  Characteristic Dementia Depression Delirium Onset Gradual, progressive Insidious- can be Sudden, often sudden acute Course Progressive decline Can be chronic or Fluctuates, often episodic reversible Memory Impaired memory (short Generally intact, but Short-term and long-term) focus on mood memory loss Alertness Normal, unless severe Normal Fluctuating, often reduced Orientation Impaired in later stages Usually intact Often impaired Cognitive Progressive decline Often intact, Severely impaired, Function mood-related fluctuates Treatment Medications, supportive Antidepressants, Address care therapy underlying causes Unit #4 Outline; Respiratory Disorders Explain what is happening within the body when the patient has influenza. ​ The influenza virus infects the upper and lower respiratory tract, leading to inflammation, fever, chills, and muscle aches. ​ It can lead to complications such as pneumonia, especially in elderly or immunocompromised patients. What are the signs and symptoms of influenza? -​ Fever and chills -​ Cough, sore throat -​ Body aches, headaches -​ Fatigue and weakness -​ Runny or stuffy nose -​ Sometimes gastrointestinal symptoms like vomiting or diarrhea Explain what is happening within the body when the patient has pneumonia. -​ Acute inflammation of the lung -​ parenchyma caused by -​ microbial organism What are the signs and symptoms of pneumonia? -​ Chest pain when you breathe or cough -​ Confusion or changes in mental awareness (in adults age 65 and older) -​ Cough, which may produce phlegm -​ Fatigue -​ Fever, sweating and shaking -​ Chills  -​ Lower than normal body temperature (in adults older than age 65 and people with weak immune systems) -​ Nausea, vomiting or diarrhea -​ Shortness of breath What assessments would you make for the patient with pneumonia? -​ Complete patient history -​ Full respiratory assessment -​ Fatigue, weakness, malaise -​ Anorexia, nausea, vomiting -​ Fever, chills -​ Dyspnea, cough (productive or nonproductive), nasal congestion, pain with breathing -​ Chest pain, sore throat, headache, abdominal pain, muscle aches How is pneumonia treated? Pharmacologucal interventions; -​ Antibiotics -​ Antivirals -​ Antifungals -​ Antitussives -​ Analgesics -​ Oxygen therapy What happens in the body when the patient has lung cancer? -​ Abnormal, uncontrolled cell growth in the lungs leads to the formation of tumors that may invade surrounding tissues and spread to other parts of the body (metastasize). -​ It can obstruct airflow, impair gas exchange, and cause symptoms such as coughing, weight loss, and hemoptysis (coughing up blood). What are the signs and symptoms of lung cancer? -​ Persistent cough that worsens over time -​ Hemoptysis (coughing up blood) -​ Shortness of breath -​ Chest pain, especially with deep breathing or coughing -​ Unexplained weight loss and fatigue Is lung cancer treatable? Yes, when early, Develops slowly, often too late once you can see symptoms What are the normal age-related changes to the Respiratory system? -​ Decreased elastic recoil -​ Decreased chest wall compliance -​ Decreased number of functional alveoli -​ Decreased force of cough -​ Decreased cilia function What are some of the common respiratory diseases in the elderly? -​ COPD -​ Asthma -​ Pneumonia -​ Lung cancer -​ Bronchitis What interventions could be implemented to promote respiratory health in older adults? -​ Encourage smoking cessation and offer resources for quitting.  -​ Promote regular physical activity to improve lung function. -​ Ensure proper vaccination (e.g., flu and pneumococcal vaccines). -​ Monitor and manage chronic respiratory conditions like COPD or asthma. COPD is becoming more common in the elderly. What are the causes? -​ Smoking (primary cause) -​ Long-term exposure to environmental pollutants -​ Genetic factors (e.g., alpha-1 antitrypsin deficiency) What is happening within the respiratory system with COPD? -​ Chronic inflammation of the airways and destruction of lung tissue (emphysema) lead to airflow limitation. -​ Increased mucus production and narrowed airways result in coughing, wheezing, and shortness of breath. For the various respiratory diseases/conditions covered in this unit, what are some of the medications the nurse may be giving? Explain the action of each one. ​ Bronchodilators (e.g., Salbutamol) to open the airways ​ Corticosteroids (e.g., Fluticasone) to reduce inflammation ​ Mucolytics (e.g., Acetylcysteine) to thin mucus ​ Antibiotics for bacterial infections, like pneumonia​ Unit #5; Cardiovascular Disorders List some of the Subjective and Objective data that would be collected when performing an assessment on the Cardiovascular status of the patient. Subjective Data -​ Chest pain or discomfort -​ Shortness of breath or difficulty breathing -​ Fatigue or weakness -​ Palpitations (feeling of irregular heartbeats) -​ Dizziness or lightheadedness -​ History of heart disease or related conditions (e.g., hypertension, diabetes) Objective Data -​ Vital signs: blood pressure, heart rate, respiratory rate, temperature -​ Heart sounds: murmur, gallop rhythm, or S3/S4 sounds -​ Peripheral edema (swelling in legs or ankles) -​ Jugular vein distension -​ Lung auscultation for crackles (suggests heart failure) What abnormal findings might the nurse find if there were diseases or complications occurring in the heart? Bounding pulse Irregular heartbeat/pulse Distended neck veins Central Cyanosis Peripheral Cyanosis Splinter Hemorrhages Clubbing of nail beds Varicose veins -​ Hypertension (high blood pressure) 140/90 -​ Tachycardia (rapid heart rate) -​ Bradycardia (slow heart rate) -​ Heart murmurs -​ Peripheral edema If there was a need for further investigation, what are some of the diagnostic studies that may be done to diagnose the problem? -​ Electrocardiogram (ECG): To assess heart rhythm and detect arrhythmias. -​ Blood studies -​ Serum lipids -​ Echocardiogram: To assess heart function and detect abnormalities in heart valves or chambers. -​ Stress Test: To assess how the heart responds to physical activity. -​ Chest X-ray: To check for signs of heart failure or lung disease. -​ Cardiac Catheterization: To assess coronary artery function or blockages. Explain hypertension and list the risk factors. Hypertension is a chronic condition where the blood pressure in the arteries is consistently elevated. 140/90 ​ Family history of hypertension ​ Obesity ​ Physical inactivity ​ Excessive alcohol consumption ​ High sodium intake ​ Age (more common in individuals over 60) What medications might be included in the treatment of hypertension? ANTIHYPERTENSIVES: Diuretics (e.g., Hydrochlorothiazide): Help remove excess sodium and fluid from the body. ACE inhibitors (e.g., Enalapril): Help relax blood vessels and lower blood pressure.​ Beta-blockers (e.g., Metoprolol): Reduce heart rate and blood pressure. Calcium channel blockers (e.g., Amlodipine): Relax blood vessels. What is a myocardial infarction? A myocardial infarction (heart attack) occurs when blood flow to a part of the heart muscle is blocked, leading to tissue damage or death. List the symptoms that may be seen in an MI for both males and females. Males: Chest pain (ranging from a feeling of tightness to extreme pain) Pain or discomfort in one or both arms, the back, neck, jaw or stomach. Shortness of breath Cold sweats  Nausea Females: Chest pain (constant or intermittent) Pain or discomfort in one or both arms, the back, neck, jaw or stomach. Shortness of breath Cold sweat Nausea/vomiting Light-headedness Palpitations Fatigue What is CAD? CAD is the narrowing or blockage of coronary arteries due to atherosclerosis (fatty plaque build-up), reducing blood flow to the heart. What medications might be used in the treatment of CAD? Statins (ie. Atorvastatin/Lipitor) Antiplatelet drugs (ie. Acetylsalicylic acid/ASA – Asprin) Beta Blockers (ie. Metoprolol/Lopressor) Calcium Channel Blockers (ie. Diltiazem/Cadizem) ACE inhibitors (ie. Ramipril/Altace) Nitroglycerin (this is a vasodilator) Anti-Anginals (ie. Nitrates, CCB, Beta Blockers) Explain what is happening to the heart in CHF. CHF is a condition in which the heart is unable to pump blood effectively, leading to fluid accumulation in the body. Below compare the symptoms of left vs right-sided CHF. Left Sided Fatigue Dyspnea Orthopnea Dry, hacking cough Pulmonary Edema Nocturia Paroxysmal nocturnal dyspnea Right Sided Fatigue Dependent Edema  Right upper quadrant pain Anorexia GI Bloating Nausea Explain the difference between Stable and Unstable Angina. Stable Angina: Predictable chest pain that occurs with exertion or stress and resolves with rest or nitroglycerin.​ Unstable Angina: Sudden, unpredictable chest pain that occurs at rest or with minimal exertion and is a medical emergency. What are some of the symptoms of PVD? Changes in the skin, including decreased skin temperature, or thin, brittle, shiny skin on the legs and feet Weak pulses in the legs and the feet Gangrene (dead tissue due to lack of blood flow) Hair loss on the legs Impotence Severe pain when the artery is very narrow or blocked Wounds that won't heal over pressure points, such as heels or ankles Numbness, weakness, or heaviness in muscles Pain (described as burning or aching) at rest, commonly in the toes and at night while lying flat Paleness when the legs are elevated Reddish-blue discoloration of the extremities Restricted mobility write that out as one better list Compare the modifiable vs non-modifiable risks of PVD. Modifiable: Smoking, diabetes, hypertension, high cholesterol, obesity​ Non-modifiable: Age, family history, gender List some nursing interventions for PVD. Assess regularly for areas of warmth, tenderness. Educate the patient to never massage areas of tenderness (this could dislodge an embolus) Administer pain medications for comfort Encourage the client to eliminate the modifiable risk factors where possible. (quit smoking, lose excess weight, exercise) What are some medications used in the treatment of PVD? Anticoagulants Warfarin Inhibits vitamin K-dependent Monitor INR/PT; assess for signs of (Coumadin) clotting factors to prevent bleeding; avoid vitamin K-rich foods; blood clots. consistent dosing.  Beta Bisoprolol Slows heart rate, reduces Monitor HR and BP; watch for bradycardia, Blockers (Zebeta) cardiac workload and BP. fatigue; use caution with respiratory conditions. Antiplatelets Clopidogrel Prevents platelet Monitor for bleeding/bruising; GI irritation (Plavix), Aspirin aggregation to reduce risk possible; use cautiously with other of clots and strokes. anticoagulants. What is heart failure? CHF is a condition in which the heart is unable to pump blood effectively, leading to fluid accumulation in the body. What are some risk factors for heart disease? - high blood pressure, high cholesterol, smoking, diabetes, and obesity Compare left vs right-sided heart failure. LEFT SIDED Fatigue Dyspnea Orthopnea Dry, hacking cough Pulmonary Edema Nocturia Paroxysmal nocturnal dyspnea RIGHT SIDED Fatigue Dependent Edema Right upper quadrant pain Anorexia GI Bloating Nausea What are the symptoms you would see in each? Feature Left-Sided Heart Failure Right-Sided Heart Failure Primary Cause Often caused by left ventricular Often caused by left-sided heart dysfunction (e.g., MI, hypertension, failure, pulmonary hypertension, or aortic stenosis) right ventricular MI Pathophysiology Blood backs up into lungs → Blood backs up into systemic pulmonary congestion circulation → peripheral congestion Main Area Lungs (Pulmonary circulation) Body (Systemic circulation) Affected Key Symptoms - Dyspnea (SOB) - Dependent edema (legs, ankles, - Orthopnea sacrum) - Paroxysmal nocturnal dyspnea - Jugular venous distension (JVD) (PND) - Hepatomegaly (enlarged liver) - Cough (dry, hacking) - Ascites - Crackles/rales - GI symptoms (nausea, anorexia, - Fatigue bloating) - Pulmonary edema - Right upper quadrant pain - Nocturia - Fatigue Complications - Pulmonary edema - Organ congestion - Impaired gas exchange - Liver dysfunction - Malabsorption What are some nursing interventions that could be implemented in CHF? -​ Patient teaching on management of disease: -​ Avoiding risks that may worsen the symptoms of thedisease -​ Watching for early symptom -​ Assessing edematous legs and feet for skin impairment and worsening of edema. -​ Encourage exercise and activity as tolerated for patients with stable HF. -​ Encourage a healthy diet, low in sodium. Involve your team Dietician for help in care planning. What are some medications that you might see as the nurse in the care of CHF? -​ Diuretics -​ Angiotensin Converting Enzyme Inhibitors -​ Neprilysin Inhibitors -​ B-adrenergic blockers -​ Mineral Corticoid Receptor -​ Antagonists -​ Inotropic Medications Class 6 Endocrine Disorders Age related changes; -​ Decreased hormone production and secretion -​ Altered hormone metabolism and biological activity -​ Decreased responsiveness of target tissues to hormones -​ Alterations in circadian rhythms. What are the glands of the endocrine system? -​ Pineal gland -​ Thymus -​ Ovaries -​ Uterus -​ Testicles -​ Hypothalamus -​ Pituitary gland -​ The thyroid and parathyroid gland -​ Pancreas -​ Adrenal glands -​ Kidney Explain the difference between Type 1 and Type 2 diabetes. Type 1 Diabetes: An autoimmune disorder where the body attacks insulin-producing cells in the pancreas, leading to insulin deficiency.​ Type 2 Diabetes: A metabolic disorder where the body becomes resistant to insulin, often linked to obesity and lifestyle factors. What are some modifiable risks for preventing Type 2 diabetes? -​ Lack of physical activity  -​ Poor diet (high in sugars and fats) -​ Overweight or obesity -​ Smoking What is the purpose of insulin in the body? -​ Is the hormone produced by the B cells in the islets of Langerhans of the pancreas. -​ Under normal conditions insulin is continuously released into the bloodstream in small, pulsatile increments, with an increased release when food is ingested. -​ Promotes glucose transport from bloodstream across cell membrane to cytoplasm of cell -​ Decreases glucose in the bloodstream Compare the symptoms of Hyperglycemia vs Hypoglycemia. Hyperglycemia: Increased thirst, frequent urination, blurred vision, fatigue Hypoglycemia: Shaking, sweating, confusion, dizziness, irritability What is gestational diabetes? Gestational diabetes occurs during pregnancy when the body cannot produce enough insulin to meet the increased demands. It typically resolves after childbirth but increases the risk of developing Type 2 diabetes later in life. What are some of the clinical manifestations of Type 1 diabetes? 3 P’s of Diabetes Polyuria (frequent urination) Polydipsia (excessive thirst) Polyphagia (excessive hunger) Weight loss Weakness Fatigue What are some of the clinical manifestations of Type 2 diabetes? Nonspecific symptoms May have classic symptoms of type 1 Fatigue Recurrent infection Recurrent vaginal yeast or monilia infection Prolonged wound healing Visual changes What are some of the different types of insulin that may be used? Exogenous insulin- Insulin from an outside source -​ Rapid-acting analogue (clear): lispro (Humalog), aspart (NovRapid), and glulisine (Apidra) -​ Short-acting (clear): regular -​ Intermediate-acting (cloudy): NPH -​ Extended long-acting: glargine (Lantus), detemir (Levemir) -​ Premixed (cloudy): Regular/NPH 30/70 What is diabetic ketoacidosis? Lack of insulin → glucose can't enter cells → body uses fat for energy Fat breakdown → produces ketones (acidic byproducts) Ketones accumulate in the blood → metabolic acidosis High blood sugar causes osmotic diuresis → dehydration and electrolyte loss List 5 nursing interventions for the diabetic patient. Nursing Intervention Purpose 1. Monitor blood glucose levels To detect hypoglycemia or hyperglycemia early and adjust regularly treatment promptly. 2. Educate on proper insulin/oral med Prevent medication errors; ensure adherence and understanding. use 3. Promote dietary management Maintain stable blood glucose; prevent spikes or crashes. 4. Inspect feet daily for Prevent diabetic foot complications due to neuropathy and poor wounds/ulcers healing. 5. Encourage regular physical activity Improves insulin sensitivity and glucose utilization. For each listed, give some abnormalities that may be seen if a Thyroid disorder were present: System Hyperthyroidism Hypothyroidism Integumentary Warm, moist skin; hair thinning; sweating Dry, coarse skin; brittle hair/nails Cardiovascular Tachycardia, palpitations, ↑ BP Bradycardia, hypotension Musculoskeletal Muscle weakness; tremors Muscle cramps, stiffness, slow movements Neurological Anxiety, restlessness, insomnia Fatigue, depression, slow thinking What are the normal ranges for the following: FBG: 4.0 – 6.0 mmol/L Random BG: 4.0 – 11.0 mmol/L Explain the difference between hyperthyroidism and hypothyroidism. What are the symptoms of seen in each? Hyperthyroidism (High thyroid hormone) ​ Cause: Often Graves' disease, autoimmune ​ Metabolic rate: ↑ (high)  ​ Symptoms: ○​ Weight loss despite increased appetite ○​ Heat intolerance ○​ Nervousness, anxiety, insomnia ○​ Tachycardia, palpitations ○​ Diarrhea ○​ Fine tremors ○​ Exophthalmos (bulging eyes in Graves’) Hypothyroidism (Low thyroid hormone) ​ Cause: Often Hashimoto’s thyroiditis, autoimmune ​ Metabolic rate: ↓ (low) ​ Symptoms: ○​ Weight gain despite poor appetite ○​ Cold intolerance ○​ Depression, fatigue ○​ Bradycardia ○​ Constipation ○​ Dry skin, brittle hair ○​ Menstrual irregularities Class 7 Knowledge Check; Gastrointestinal Disorders List some of the normal age-related changes to the gastrointestinal system. ​ Increased tooth decay ​ Diminished taste ​ Decreased saliva ​ Decreased gag reflex ​ Decreased esophageal motility ​ Decreased HCL ​ Slower stomach emptying ​ Decreased intestinal motility ​ Diminished absorption of vitamins and minerals ​ Mucosa less absorptive ​ Diminished impulses to defecate ​ Decreased muscle tone at the sphincters What are some of the reasons a patient may become dehydrated? ​ Decreased thirst mechanism ​ Fear of incontinence ​ Lack of accessible fluids ​ Inability to drink independently ​ Lack of motivation ​ Altered mood ​ n/v, GI problems What diagnostic tests may be done to diagnose problems with the GI system?  Test Purpose Endoscopy (EGD) Visualize esophagus, stomach, duodenum; detect ulcers, tumors, inflammation Colonoscopy View colon and rectum; screen for cancer, polyps, inflammation Abdominal Ultrasound Detect gallstones, liver disease, masses Barium Swallow / Enema Assess structure and movement of GI tract via X-ray contrast Stool Tests Check for blood, infection (e.g. C. difficile), parasites Liver Function Tests (LFTs) Assess liver health via enzyme levels Amylase/Lipase Evaluate pancreatic inflammation (pancreatitis) CT/MRI Abdomen Detailed imaging for masses, obstructions, inflammation What are some causes of nausea and vomiting? Nausea - nerve endings in stomach & other parts irritated & sends message to vomiting centre in brain (medulla) D/T illness, effects of Cancer tx, stress, pain, GI irritation from food, viruses, meds When considering older adults, what are some immediate concerns if they have nausea/vomiting? ​ Dehydration (risk increases quickly due to less fluid reserve) ​ Electrolyte imbalance (can cause confusion, arrhythmias) ​ Aspiration risk (weakened gag reflex) ​ Malnutrition (reduced appetite, poor absorption) ​ Delayed diagnosis (atypical presentation in elderly) What is GERD? GERD is a chronic condition where stomach acid flows back into the esophagus, causing irritation and heartburn. Stomach acid repeatedly irritates the lining of the esophagus, which can lead to inflammation, ulcers, or Barrett’s esophagus. DT; Weak or relaxed lower esophageal sphincter (LES), Obesity, Certain foods (spicy, fatty, acidic), Smoking, Alcohol What drug classification would be used in the treatment of GERD, and how does it work? Drug Class Examples How It Works  Antacids Tums, Maalox Neutralize stomach acid for quick relief H2 Receptor Blockers Ranitidine, Famotidine Reduce acid production in the stomach Proton Pump Inhibitors Omeprazole, Block acid production more effectively/longer (PPIs) Pantoprazole duration What is a Hiatal Hernia? -​ Defect in wall of diaphragm - protrusion of part of stomach into thoracic cavity -​ D/T decreased muscle strength and tone, obesity, multiple pregnancies, congenital defects S&S- indigestion, belching, substernal/epigastric pain, feelings of pressure after eating, regurgitation, dysphagia, ++ pain after lying down What is Gastritis? ​ Gastritis is inflammation of the stomach lining, acute or chronic. ​ Causes:​ ○​ NSAIDs (e.g. ibuprofen) ○​ Alcohol ○​ H. pylori infection ○​ Stress ○​ Smoking​ What causes constipation? Obstruction- fecal matter unable to move ​ Low fiber intake ​ Dehydration ​ Sedentary lifestyle ​ Medications (e.g., opioids, iron supplements) ​ Ignoring the urge to defecate ​ Neurological disorders ​ Hypothyroidism​ What non-pharmaceutical interventions could the nurse implement to help relieve constipation? 1.​ Encourage increased fluid intake 2.​ Promote high-fiber diet (fruits, vegetables, whole grains) 3.​ Encourage regular physical activity 4.​ Establish routine toileting times 5.​ Educate on avoiding holding in stools 6.​ Abdominal massage (as appropriate)​