Adult Nursing Exam 2 Study Guide PDF

Exam 2 Ch. 15 , 30 +48 , HIV Normal & Abnormal CD4 counts Normal CD4 + T-Cell Count :...

Exam 2 Ch. 15 , 30 +48 , HIV Normal & Abnormal CD4 counts Normal CD4 + T-Cell Count : 800-1200 cells/ML - Immune problems start when CD4 + count = 500 cells/ML - Severe immune suppression when CD4 + count = 200 cells/ML > - Low CD4 count leads to increased risk of opportunistic infections Lab Testing for Antiretroviral Therapy (ART) CD4 + T-cell Count : marker of immune function Viral Load indicates : HIV progression (lower viral load-less active disease * Undetectable viral load does NOT mean virus is eliminated ART Goals : - decrease viral loads -maintain/increase CD4 + T-Cell Counts - prevent symptomsa opportunistic infections - delay disease progression -prevent transmission Health Promotion Prevention Strategies : -safe-sexual practices (abstinence , condoms , non-contact sex) - avoid drug using/sharing needles - proper workplace precautions (no needle recapping , post-exposure prophylaxis Medication Teaching for TB · Medication adherence is critical · Multiple-drug therapy to prevent resistance - Common Meds : Isoniazid (INH) , Rifampin , Ethambutol , Pyrazinamide - Side Effects : · INH : peripheral neuropathy (take vitamin B6) · Rifampin : Orange-colored body fluids · Ethambuto Vision changes : Pyrazinamide hepatotoxicity · : TB Education Latent TB (CTB) asymptomatic : , can progress if untreated Active TB : requires isolation , airborne precautions Importance of medication adherence to prevent drug resistant TB -Follow up w/ monthly sputum cultures - Minimize exposure to others - Factors that could reactivate TB - Notify health dept. Signs & Symptoms of TB Pulmonary TB (develops 2-3 weeks after infection) : -persistant dry cough t progresses to productive cough - fatigue malaise night low-grade fever , , weight loss , sweats , - hemoptysis (blood in sputum) and dyspnea (late-stage Sx) Reading a PPD Test Assess induration (not redness) at 48-72 hours Positive Test Interpretation : - hmm individuals in healthy  - 210mm in high-risk populations (i.. e health care workers - hmm in immunocompromised individuals (i. e. HIV , organ transplant * Once positive positive , will always test need chest X-ray for further diagnosis Precautions w/ Hepatitis Pts. · Standard Precautions Hepatitis BtC bloodborne · : pathogens avoid contact w/ infected blood · No vaccine for Hep. C Hep. D only occurs w/ Hep B infection. Safety Precautions for Hep. · avoid alcohol a hepatotoxic meds · ensure adequate rest & nutrition to support liver regeneration · monitor liver function tests (LFTsI , PT/INR · avoid donating blood if infected Management of Hep. Diet : high carbs , low protein a fat Monitor for liver failure signs (jaundice , ascites , confusion) Hep. B : antiviral therapy (nucleosides , interferon) Hep. C : direct-acting antivirals (no vaccine available Ch. 22 Visual Problems Eye Injuries Determine · mechanism of injury · Assess for chemical exposure - Immediate ocular irrigation · Ensure ABCs (airway breathing, , circulation  Assess · visual acuity Avoid pressure on the eye · Do NOT blow nose · Do NOT attempt treatment (except flushing for chemical exposure) Stabilize · (DO NOT REMOVE foreign objects · cover w/ dry , sterile patch a protective shield · Keep head at 45" elevation · fluids No food or (in case of surgery Blindness & Sighted Guide Technique · Address verbally first stand slightly in front of the person · offer elbow for them to hold your walk slightly ahead while guiding · Describe the env. as you walk Miotic Drugs (For Glaucoma · cause pupillary constriction (miosis · Help drain aqueous humor > - reduces intraocular pressure · May cause decreased vision in dim light · Used the management in of acule angle-closure glaucoma Glaucoma Types Primary Open-Angle Glaucoma (POAG) Cause Most common ; decreased outflow in trabecular like drain) clogged : meshwork a SX : develops Slowly , no early Sx , tunnel vision in late stages Primary Angle-Closure Glaucoma (PACG) Cause : Emergencyi sudden blockage of aqueous humor due to pupil dilation or age-related changes SX : severe eye pain , M/V , halos around lights , blurred vision , red eye Cataracts - opacity (clouding) of the lens Common Causes : aging (Sehile cataracts) , blunt trauma , UV radiation exposure , long-term corticosteroid use, ocular inflamation Sx decrease vision perception glare (especially night gradual in abnormal color at : , , Treatments : - No nonsurgical cure e visual aids (reading glasses , magnifiers , better lighting - Surgical Therapy : - lens removal d intraocular lens implant > - eye drops (NSAIDs mydriatics to dilate pupils cycloplegics to accommodation ( , , paralyze & Post op davle glasses for photophobia, monitor for systemic toxicity : Retinal Detachment SX : Sudden onset , light flashes (photopsia) , floaters or "cobwebs" in Vision , painless but leads to blindness if untreated Risk Factors : aging , severe myopia , eye trauma , cataract surgery , Family Hx Management : - Seele immediate medical evaluation CURGENT -Surgical intervention needed : > - laser or scleral buckling intraocular procedures (90 % Success rate cryopexy , , - Post-op Care : - antibiotic & steroid eye drops , pain control (though usually no pain) , restricted head movement (failure can cause re-detachment! ) Ch. 23 : Auditory Problems Meniere's Disease Cause : Unknown (possibly due to endolymph accumulation in the inner earl Sx : Episodic vertigo (spinning Sensation) tinnitus , (ringing) hearing , loss , aural fullness lear pressure Attacks : -Sudden & severe can last hours to days - occur several times can a year - may cause "drop attacks" (falling due to loss of balance) - SX : N/V , sweating , pallor Nursing Care Post-Op : - quiet , dark room - no sudden movements - assist w/ ambulation - minimize vertigo a maximize safety (lowerd lock bed Pt. Teaching After Ear Surgery - avoid sudden head movements - do not try to out of bed wo assistance get - take meds to reduce dizzines if R - change positions slowly avoid getting head wet -report fever , pain , increase in hearing loss , or drainage - do not or blow the nose (if needed leave open cough , mouth - avoid crowds - avoid high elevations or airplane travel Types of Hearing Loss Conductive Hearing Loss (Outer & Middle Earl Cause sound : transmission problem Characteristics : - speak softly (b/c they hear their own voice loudly hear better in noisy env. - bone conduction better than air conduction Tx underlying treat hearing aids : cause , may help Sensorineural Hearing Loss (Inner ear or CN#) Cause : damage to in her ear or ototoxic drugs Characteristics : - can near sound but cannot understand speech -hearing aids do NOT improve clarity only , make sounds louder may lead to misunderstanding in conversations Hearing Impairement Strategies General Tips : -speak normally a slowly - do NOT overexaggerate facial expressions or overenunciate -use simple sen. A rephrase words if needed -get their attention first! Visual & Env. Adjustments -use hand movements to draw attention -reduce background noise -ensure good lighting - more closer to their better ear - do - not cover your mouth while speaking avoid facial expressions that might be misinterpreted # Lip reading - avoid eating , chewing , or smoking while speaking helps recognize 40 % of spoken words * - maintain eye contact Ch 38. Heart Failure Primary Causes of Heart Failure Coronary Artery Disease : including MI Hypertension including hypertensive : crisis Rheumatic Heart Disease Congenital Heart Defects Pulmonary Hypertension Cardiomyopathy Vival postpartum substance abuse : , , Hyperthyroidism Valvular disorders i e.. mitral stenosis Myocarditis Precipitating causes : Anemia : decreased oxygen supply increases heart workload Infection : increases Oxygen demand Thyrotoxicosis : increased HR & workload Hypothyroidism increased risk for artherosclerosis : Dysrhythmias : decreased CO - increased workload Bacterial Endocarditis increases workload cause valvular disorders may : , Pulmonary Embolism increases : workload to pump blood into lungs Paget's Disease : increases workload due to increased vascular bed Nutritional Deficiencies : decreased cardiac function increases workload Hypervolemia : increased preloada workload Pulmonary Edema Manifestations - cyanotic - anxious , pale , use of accessory muscles tachycardia sputum hypotension - - coold skin Cough w/ frothy , bloody hypertension clammy or - dyspnea , Orthophea , tachypnea crackles + wheezes Chronic Heart Failure Manifestions : - fatigue - dyspnea , Orthophea , paroxysmal nocturnal dyspnea -tachycardia , palpitations - cough - edema - nocturia Left-sided Heart Failure Systolic HF (HFrEF) - inability to pump blood forward - caused impaired contractile function increased afterload , cardiomyopathy, mechanical abnormalities by , or - decreased left Ventricular EJ : Normal = 50-10 % Diastolic HF (HF pEF) - impaired ability of ventricles to relax and fill during diastole -results in decreased strove volume a CO -caused by left ventricular hypertrophy from hypertension aging , , female gender , diabetes , obesity - End Result : same as systolic failure Manifestations paroxysmal : nocturnal dyspnea pulmonary congestation (cough , , crackles , wheezes , blood-tinged sputum tachypnea), , restlessness , confusion , Orthophea tachycardia , exertional , dyspnea fatigue Cyanosis , , Right-Sided Heart Failure Fatigue ↑ peripheral - right Ventricle (RV) fails to pump effectively Manifestations : , venous pressure , ascites , enlarged liver or spleen , - fluid backs up in the venous system distended jugular veins , anorexia , complaints of GI distress , weight gain , edema - fluid moves into tissues a organs - Most Common Cause : left-sided HF > - other causes RV infarction , embolism , or pulmonary pulmonale : Diagnostic Tools - echocardiogram provides : info on EF , heart values , and heart chambers (electrocardiogram) - ECG - Chest X-ray - 6-min walk test - MUGA Scan (multigated acquisition - cardiopulmonary exercise stress test - heart catheterization - EMB (endomyocardial biopsy) - BNP Levels (B-type Natriuretic Peptide) : > - pg/mL := Normal 100 - ElevatedLevels : associated w/ SOB , swelling of legsa abdomen Understanding EKG P wave : represents time for passage of the electrical impulse through the atrium - causes : Atrial depolarization QRS Interval : represents time for depolarization (contraction) of both Ventricles (systole ST Segment : time bit ventricular depolarization & repolarization (diastole T wave : time for ventricular repolarization The Aging Heart Kyphosis : curvature of the spine Cellular : HR ↓ CO reduced exercise Aging , , response to + stress valvular Rigidity : may cause murmurs Orthostatic Hypotension : more common due to decreased baroreceptor sensitivity Ch 69 Musculoskeletal. Rheumatoid Arthritis (RA) Type : chronic , systemic autoimmune disease Characteristics : - inflammation of connective tissue in joints - periods of remission & exacerbation - joints are painful , stiff , warm , tender , I swollen w/ fluid - blood tests show widespread inflammation (often anemia , weight loss , fatigue - X-rays show thin a eroded bones Manifestations : - affects multiple joints symmetrically -systemic Sx (i. e. fatigue , weight loss) - Extra-articular manifestations : nodules , vasculitis , pulmonary issues Osteoarthritis (OA) Type : most common form of joint disease in the U S.. Characteristics : - Slowly progressive non-inflammatory disorder of the joint - pain worsens w/ activity - joint does not feel hot or tender , a does not look red - usually involves one or a few joints - inflammation is rare or short-lived -X-rays show bony growths (i. e. bony Spurs , extra Calcium deposits) Manifestations : - localized to specific joints - involvement asymmetrical joint -morning stiffness clasting less than 30 minutes) crepitus (grating sensation) during joint movement Ambulatory Care for Arthritis Exercise & Activity : Individualized Exercise plans : improve flexibility strength , , a endurance Types of Exercises : - Recreational & Therapeutic Exercise - Gentle ROM Exercises : daily to maintain joint function - Aquatic Exercises : in warm water to reduce joint stress - During Acute Inflammation : limit to one or two reps to prevent exacerbation Joint Protection : Task Modification : less stress on joints EnergyConservation : - Work Simplification Techniques : Short work periods w/ rest breaks - pacing a organizing : avoid repetitive movements li e.. climbing stairs Assistive Devices : - joint protective devices : electric can openers , carts for supplies - occupational therapy : for increased independence wh adaptive tools Dressinga Aids Mobility : - Velcro shoes + front zipper clothing - care or walker Nursing Interventions : Lightweight Splints : to protect & support joints - Removal Reapplication w/ ROM : & As Rx regular exercises Morning Stiffness Management : warm showers/baths , warm towels , warm hand soaks Manifestation of Gout Chronic Gout : - involves multiple joints - visible deposits of sodium urate Crystals called tophi - chronic inflammation may lead to joint deformity a cartilage destruction I can predispose to OA) Uric Acid Complications : - acid lead to stone formation excessive uric may kidney a urinary tracts - Pylonephritis : inflammation of the kidney due to infection Hip Fractures Common in the Elderly : due to decreased bone density + increased fall risk Manifestations external rotation of the muscle severe pain leg spasms , : , Post-surgery Care : DO NOT : - Adduct the hip - Sit in low chairs - cross legs at knees - sit in chairs w/o arms - drive for 4-6 weeks Nursing Priorities : pain relief , prevention of complications , & mobility support Mandibular Fractures Common Cause : therapeutic correction of malocclusion (includes intermaxillary fixation( Nursing Priority : PREVENT ASPIRATION ! - Oral hygiene is crucial to prevent infectiona food debris accumulation -nutritional support using a straw for sustenance (beware of gas a bloating - encourage ambulation & use of bulk-forming laxatives a prone jvice to prevent constipation Complications of Fractures Malunion Nonunion Delayed , , Union : Improper or slow healing Angulation : abnormal bone alignment Myositis Ossificans : bone tissue forms inside muscle Pseudoarthrosis : False joint formation Refracture : fracturing at the same site Infection Compartment Syndrome : increased pressure w/in muscle compartments Fat Embolism Syndrome : fat globules in bloodstream Nursing Management for Fractures Pain Relief Diet : protein Vitamins B D , , , AC for healing Hydration : 2 , 000-3 000 , mL of fluids daily Body Jacket Brace small meals to prevent abdominal distention : Traction : clean pin sites , assess swin condition Cast care : monitor for tightness swelling , , or skin irritation Clinical Manifestation of Lupus Dermatologic Problems : - Vascular skin lesions (commonly in sun-exposed areas 55 % -85 % - Butterfly Rash : occurs in of cases - Discoid lesions - Subacule cutaneous lupus - Oral/Nasopharyngeal vicers - Alopecia Musculoskeletal Problems : - polyarthralgia w/ morning stiffness - arthritis w/ increased rish of bone loss & fracture Cardiopulmonary Problems : - tachypnea cough pleurisy , , - due to fibrosis dysrhythmias of SA & AV nodes Renal Problems : - Mild proteinuria to rapidly progressive glomerulonephritis -scarring a permanent damage leading to end-stage renal disease - effective treatments cytotoxic agents , immunosuppressive : corticosteroids , agents Nervous System Problems : -generalized/focal siezures -peripheral neuropathy - Cognitive dysfunction (disordered thinking memory , deficits , psychiatric disorders Hematologic Problems : - formation of antibodies against blood cells - disorders anemia , Leukopenia , thrombocytopenia , coagulation Infection Risks : - increased susceptibility to infections due to : > - defects in the ability to phagocytize bacteria > - deficiency in antibody production - immunosuppressive effects of anti-inflammatory drugs - Infection is a major cause of death in SLE pts. Care & Drug Therapy for Lupus NSAIDs : for mild arthralgia or arthritis Corticosteroids : for severe cutaneous SLE (start Slow & low Antimalarial Drugs , Steroid-Sparing Drugs , Immunosuppressive Drugs Topical , Agents Nursing Management : Unpredictable Disease Course : affects multiple systems Key Interventions : - monitor weight a intake/output - collect 24-hr urine samples - assess Neurological Status (i.. e Visual problems , seizures, personality changes - provide education on disease nature a emotional support