NUR 319 Exam #1 Study Guide PDF

**NUR 319 Exam \#1 Study Guide** **[Respiratory:]** **[Identify the structures and discuss the anatomy within the chest and thoracis cavity including the pulmonary system.]**\ Intercostal muscles, Diaphragm, Accessory muscles and Abdominal muscles, upper and lower respiratory tract Chest cavity e...

**NUR 319 Exam \#1 Study Guide** **[Respiratory:]** **[Identify the structures and discuss the anatomy within the chest and thoracis cavity including the pulmonary system.]**\ Intercostal muscles, Diaphragm, Accessory muscles and Abdominal muscles, upper and lower respiratory tract Chest cavity encloses the lung protects + gives room for lung to expand Pleura holds around the lung usually fluid or air space, help lung expand in chest cavity without damage **[Discuss the function of the pulmonary system including the 3-step process by which it does it. ]** Main function → gas exchange, aid in fluid and electrolyte changes Ventilation Neurochemical control + mechanic of breathing - respiratory center, central and peripheral chemoreceptors - muscles (major + accessory), lung elasticity, airway resistance, work of breathing Diffusion Gas Transport lung to blood - oxygen + carbon dioxide transport Perfusion blood to tissue - blood flow aka circulation system pulmonary and bronchial circulation - artery AA, artery away - veins VT, veins towards **[List some of the common clinical manifestations that may indicate pulmonary disfunction.]** Dyspnea not breathing Alter breathing pattern hypo or hyper Coughing Sputum (hemoptysis) discharge or mucus Cyanosis / hypoxemia Nail clubbing Chest pain Hypercapnia **[Identify and differentiate different types of dyspnea and include clinical manifestations seen in each. ]** Subjective experience w/ objective data - pt will have subjective experiances unique experiances - nurse will need to get objective data Respiration rate, scale of breathing, O2 stat, ABGs Transient or Chronic happen at a certain time or constant Dyspnea on exertion when moving Orthopnea when sitting Paroxysmal nocturnal dyspnea night Signs and symptoms nasal flaring, using accessory muscle, retraction, chest tightening, coughing, SOB, wheezing, shadow breathing, breathlessness **[Define and differentiate the following:]** Hyperventilation loss of CO2 - hypocapnia, respiratory alkalosis, - caused by anxiety, acute head injury, pain, etc Hypoventilation buildup of CO2 - hypercapnia, respiratory acidosis - caused by neuro or mechanical issues Hypercapnia buildup of CO2 - hyperventilation of alveoli + increased carbon dioxide + respiratory acidosis - Depressants, opioids, head trauma, CNS infection, spinal cord or neuromuscular disorder/injury Hypoxemia reduced PaO2 in blood - High altitude, pulmonary embolism, pulmonary edema Hypoxia not enough O2 in tissue - Hypoxemia **[Differentiate and compare the different disorders of the upper respiratory, and understand symptoms associated with each and what causes those symptoms (could disregard causes, s/s and treatment) ]** Common Cold congestion of everything (nose + throat) - Caused rhinovirus, Bacterial infection  - Symptoms  Swollen mucous, sneezing, congestion, sore throat, cough, low fever, Headaches, weakness, aches  - Treatment  Antibiotics IF 5+ days w/ fever , decongestant  Acute rhinitis inflammation of nasal mucous membrane - Causes Allergies, stress, viral illness  - Symptoms Sneezing, stuffy runny noses, tiredness, fatigue  - Treatment  Antibiotics, decongestants, Fluids   Sinusitis inflammation of sinuses mucous membrane - Causes Viruses, bacteria invading membrane of sinuses  - Symptoms Sneezing, mucous, inflamed/pain in sinuses, stuffy/runny nose, headache, fever  - Treatment  Fluids, irrigation with NS, rest  Acute pharyngitis inflammation of throat - Causes viral infection, step etc. - Symptoms fever, cough, nausea, swollen lymph nodes and tonsils  - Treatment meds, sneezing with mouth open Respiratory infections → infection in the lower respiratory track  - Causes Bacteria, virus, fungal etc going into your lungs  - Symptoms Secretion, runny nose, itchy eyes, inflammation, congestion, cough sneezing  - Treatment  Decongestion, antibiotics, fluids, rest  Symptoms of all - Secretions, excess mucus, runny nose, itchy eyes, inflammation, nasal/chest congestion, sneezing, coughing Treatment of all - Antihistamines, intranasal glucocorticoids, nasal decongestant, expectorants, antitussives, analgesic, fluids, antibiotic **[Identify the action, use and contraindications/ cautions and side effects of the following categories of meds and be able to give examples of each.]** Antitussives → nonopioid (dextromethorphan, benzonatate) and opioid (hydrocodone, codeine)  - Therapeutic effect  Cough treatment - Action of drug  suppress cough reflex - Contradictions   Hypersensitivity, bad for non-chronic productive cough  - Toxic side effects  drowsiness, respiratory depression - Interventions  increase fluids  Expectorant → guaifenesin  - Therapeutic effect Thin mucous secretions = elimination by coughing  - Action of drug  Reducing surface tension, - Contradictions  diabetic, alcohol issues  Mucolytics → acetylcysteine (inhaled) or hypertonic saline  - Therapeutic effect  large amount of secretion, cystic fibrosis, antidote for acetaminophen poisoning  - Action of drug  liquefy mucus or prevention of liver damage - Contradictions  Respiratory insufficiency - Toxic side effects  Bronchospasms, tachycardia - Interventions  strong rotten egg taste, monitor secretions and respiratory status  Decongestants → phenylephrine, ephedrine, naphazoline, pseudoephedrine  - Therapeutic effect  Treat congestion, decrease nonproductive cough - Action of drug  Stimulates alpha1-adrenergic receptors to reduce inflammation - Toxic side effects  restless, rebound congestion Antihistamines → 1^st^-gen diphenhydramine, Promethazine, Dimenhydrinate, 2^nd^ gen Cetirizine, loratadine, Fexofenadine, Intranasal azelastine, Olopatadine - Therapeutic effect  Acute and allergic rhinitis, common cold, sneezing, cough, motion sickness, sleep aid  - Action of drug  Competes with histamine for receptor sites, block H1-receptor sites to prevent secretion and itching, drying out mucus - Contradictions  Narrow glaucoma, urinary retention - Toxic side effects  Sedation, anticholinergic effects  Nasal glucocorticoids  Mometasone, Fluticasone, Triamcinolone, Budesonide - Therapeutic effect  Decrease Inflammation - Action of drug  Decreases inflammation within rhinitis  - Contradictions  hyper-senativity, hypertensions - Toxic side effects  Nosebleeds, headaches/irritation, sore throat, burning in the nose  **[Discuss some nutritional considerations when treating someone for common upper respiratory disorders to help boost immune, build strong respiratory muscles.\ ]**high protein and fiber diet strong respiratory muscles Echinacea helps fighting respiratory infections Elderberry boost immune cells + unblock flu virus ability to spread Garlic antiviral compounds Oregano oil antibiotic + antiviral herb Vitamin D + vitamin C boost immune system **[Discuss the mechanism restrictive vs. Obstructive disorders of the pulmonary system. ]** Restrictive limits volume - Spiration, atelectasis, bronchiectasis, bronchiolitis, pulmonary fibrosis - Decrease in total lung capacity due to fluid or decreased elasticity  - Hard to fully expand lungs  Obstructive limit airflow - Asthma, COPD - Hard to exhale or inhale **[Differentiate (briefly) the different disorders of the lower respiratory including the pathophysiology, etiology and treatment:]** Pneumothorax Air in pleural space - Cause puncturing of lung space - Signs + symptoms cyanosis, chest pain/tightness, coughing, fatigue, fast breathing/heart rate - Treatment observation, needle aspiration, blood patch, surgery Pleural effusion Fluid in pleural space - Cause leaking of fluid from other organs - Signs + symptoms SOB, chest pain, fever, cough - Treatment drain, chest tube Aspiration choking on fluid or solid stuff - Cause something entering your airway - Signs + symptoms cough, horsiness, increased saliva, chewing problems - Treatment swallowing or speech therapy, prevention tactics Atelectasis collapse part or all of lung - Cause complication of surgery, injury, mucus, tumor - Signs + symptoms coughing, chest pain, increased HR, rapid breathing, blue skin/lips - Treatment inhaler, physical activity draining mucus or air Pulmonary Fibrosis damaged and scarring of lung tissue - Cause drugs, genetic disorders, - Signs + symptoms SOB, Dry cough, tiredness, weight loss - Treatment medication, oxygen therapy, transplant Pulmonary edema fluid buildup in the lungs - Cause heart, blood clots, high blood pressure - Signs + symptoms anxiety, SOB, coughing, lightheadedness - Treatment prevention, medication, oxygen treatment Asthma chronic inflammation of airway due to triggers - Cause trigger, genetic - Signs + symptoms coughing, wheezing, SOB, chest tightness - Treatment inhaler, oxygen, nebulizer (COPD- Chronic bronchitis, Emphysema) - Cause smoking, inflammation of bronchi - Signs + symptoms coughing, SOB, wheezing, mucus - Treatment oxygen therapy, ventilation Pneumonia infection of air sacs in lungs - Cause infection, viral or bacterial - Signs + symptoms mucus, SOB, decease appetite, chills, fever - Treatment antibiotics, prevention, Pulmonary Embolism blood clot in lung - Cause heart illness, blood clot - Signs + symptoms SOB, back pain, lightheaded tingling - Treatment surgery , prevention + immediate treatment Pulmonary hypertension hypertension in the lungs - Cause hypertension - Signs + symptoms High BP, chest pain, tiredness, edema - Treatment oxygen therapy , diet and lifestyle changes **[Identify the action, use, contraindications/ cautions and side effects and nursing considerations for the following categories of meds and be able to give examples of each and how/why they are used:]** Bronchodilator agents → beta2-adrenergic agonist  short acting SABAs (rescue) long acting LABAs (maintain) - Therapeutic effect  Relieving bronchospasm, histamine release inhibited, Ciliary motility increased  - Action of drug  Inhaled short acting treatment for bronchospasm and asthma, Oral long acting control of asthma  - Contradictions  Avoid stimulants, bronchodilators before inhaled steroids - Toxic side effects  Tachycardia, Chest pain  Bronchodilator agent Methylxanthines → theophylline  - Therapeutic effect  Bronchodilation, treatment for asthma or COPD - Action of drug Relaxes smooth muscles of bronchi - Toxic side effects  Dysrhythmia, Seizures, hyperglycemia, tachycardia, intestinal bleeding  Bronchodilator agent anticholinergics → Ipratropium bromide (Short-acting), Tiotropium (Long-acting) - Therapeutic effect  Maintaining bronchospasms in COPD, allergen-induced or exercised-induced  - Action of drug  Dilating bronchioles  - Toxic side effects  Anticholinergic effects  - Interventions  Do not swallow  Anti-inflammatory agents: glucocorticoids→ Beclomethasone, Budesonide (inhaled), Prednisone (oral), Hydrocortisone, Methylprednisolone (IV) - Therapeutic effect  Prevention of inflammation  - Action of drug  Suppress airway mucus production, Reduction in airway mucosa  - Toxic side effects  Oral → hyperglycemia, suppression of adrenal gland, Inhaled → hoarseness - Interventions  Rinse mouth, taper dose to avoid adrenal imbalance, Avoid NSAIDs  Anti-inflammatory agent: leukotriene modifiers → zafirlukast, montelukast, zileuton  - Therapeutic effect  Short term treatment of asthma attacks, maintenance of chronic asthma, Used for prophylaxis of exercise-induced bronchospasm  - Action of drug  Reduced inflammatory process, Decreased bronchoconstriction  - Toxic side effects  hepatotoxicity, infection  - Interventions Empty stomach, once daily  Antibiotics → trimethoprim-sulfamethoxazole  - Therapeutic effect Treating chronic bronchitis caused by infections - Action of drug Killing of bacteria cells  - Toxic side effects Renal, hepatic impairment, anemia  - Interventions  Collect sputum first  **[How Does Food Relate to Breathing? List some food choices that would be appropriate for a population with acute or chronic respiratory disorders.]** - Carbohydrates = increases CO2, Fat = least amount of CO2 - Pt encouraged to eat low carb, high protein and fat diet - Eat complex carbs whole-grain, pasta, fruits + vegs - Limit simple carbs sugar, cake, candy etc **[Discuss appropriate patient education associated with eating, energy consumption and nutritional consideration for our patient population with acute or chronic respiratory disorders.]** - Rest before eating, eat early in the morning - Avoid anything that cause gas or bloating - Eat multiple small meal a day - Consider calcium replacement when taking steroids long term **[ABGs and acid-base imbalances ]** **[Normal pH and pH that would indicate an acid-base imbalance.]** - normal range 7.35 to 7.45 - acid under 7.35 - basic over 7.45 **[Determine Acid-Base imbalance from ABG data given\ ]**pH → acid 7.35 to 7.45 base HCO3 → acid 22 to 26 base PaCO2 → base 35 to 45 acid How to do ABG problems 1. Look at the pH for acid or base 2. PaCO2 match = Respiratory 3. HCO3 match = Metabolic **[Systems that help regulate the acid-base balance]** - Respiratory (Lung) and Renal/Kidney **[Identify the 4 acid-base imbalances, symptoms, causes, and treatments for each.]** Metabolic acidosis renal failure - Cause Renal failure cause buildup of acid - Sign + symptoms confusion, increased RR, decreased BP/HR, shock - Treatment bicarbonate med, correct underlying problem Metabolic alkalosis vomiting/NG suctioning - Cause Vomiting or suctioning removes all acid from body - Sign + symptoms low electrolytes, decrease respiration and tachy - Treatment give electrolytes, restore fluids, give chloride Respiratory acidosis ventilation/breathing issue - Cause unable to remove CO2 properly, buildup of O2 - Sign + symptoms increased everything (HR, BP, RR, ICP) - Treatment improve ventilation Respiratory alkalosis Hyperventilation issue - Cause breathing out too much, buildup of CO2 - Sign + symptoms lightheadedness, numbness - Treatment deep breathing **[Musculoskeletal]** **[List the functions of the skeletal muscles]** - Movement, position, stabilize, heat **[Differentiate and give examples of joint classifications.]** - Stability and movement - Synarthrosis Fibrous tissue, just protection, no movement, skull - Amphiarthrosis cartilaginous tissue, limited movement, spine - Diarthrosis synovial joint and cartilaginous tissue, all ROM, normal joints **[Differentiate osteoblasts and osteoclasts]** - Osteoblast form new bones (builds bones) - Osteoclast dissolve old/damaged bones (close out or removes bones) **[Differentiate tendons from ligaments in their structure and function]** Tendons attach muscle to bone - stabilize movement, transferring forces from muscle to bone Ligaments attach bone to bone - stabilize joint by restricting movement **[Compare strain and sprain]**\ Sprain tearing to ligaments, will see bruising Strain overstretching to muscle or tendons, will not see bruising **[Define fracture and differentiate the different classifications of fractures.]** complete vs incomplete full break or partial break open vs close Bone visible through skin or not comminuted Multi-place break linear Straight line without moving bone oblique slanted break occult does not appear in x-ray pathologic disease caused segmented small pieces greenstick corner break impacted bone driven into each other spiral Spiral transverse straight break **[Discuss the possible complications of a fracture]** Inflammation, edema, clotting issues, blood loss Muscle spasm, infection, ischemia, nerve damage, failure to heal, deformity, osteoarthrosis, chronic pain **[Differentiate closed and open reduction]** Close done without exposing the injured bone Open done with exposing the injured bone **[Discuss the treatment for joint injuries (RICE plus)]** Rest, Ice, Compress, elevate **[Discuss the steps of inflammation, Cardinal signs of inflammation and cause for each sign\ ]**steps of inflammation - injury arteriole constriction + vasodilation capillary permeability plasma thicken RBC = warmth + redness biochemical healing cardinal signs of inflammation - Redness increased RBC - Warmth + swelling increased blood flow - Pain + loss of function injury **[Discuss the systemic effects of inflammation and the symptoms attributed. ]** - Risk for cardiovascular, vessel/artery, pneumonia, lung cancer, diabetes - Fever, pallor, CNS changes, swelling, aches **[List the benefits of inflammation]** - Prevent infection - Limits spread of invasion - Tigger clotting - Prepare area for healing - Remove bacteria + dead cells [Differentiate (briefly) the different bone and joint disorders including the pathophysiology, etiology and treatment:] Osteoporosis weaken bones - Cause menopause, low calcium, smoking - Signs and symptoms pain, difficulty walking - Treatment diet, exercise, medication Rickets and Osteomalacia weaken bone and muscles - Cause low vit D. - Signs and symptoms weak, deformed bones, pain, stiffness - Treatment calcium and Vit D. supplements, Paget's overgrowth of bone production - Cause viral infection, cancer etc - Signs and symptoms - Treatment medication, mobility aids Osteomyelitis bone infection - Cause bacteria, viruses, fungi etc - Signs and symptoms bone pain, sweating, fever - Treatment medication for infection Lordosis, Kyphosis, Scoliosis - Cause genetic, poor posture - Signs and symptoms - Lordosis inward curvature of spine - Kyphosis increase front to back curve of spine - Scoliosis sideway curve of spine - Treatment physical therapy Muscular Dystrophy stiffen muscle and makes less flexible - Cause genes, production of poor proteins - Signs and symptoms falling down, weaken muscles + cramps, walking toes + waddles - Treatment PT, OT, medication Fibromyalgia flare up of pain in muscles - Cause unknown - Signs and symptoms musculoskeletal pain + fatigue, digestive problems - Treatment pain med, stretching, sleeping Osteoarthritis damage or decreasing of cartilage in joints - Cause wearing and tearing, old age - Signs and symptoms pain, stiffness, tenderness, swelling - Treatment pain management Rheumatoid arthritis inflammation of lining in your joints - Cause age, inflammation, - Signs and symptoms tender/warmth, stiffness - Treatment mobility aid, medication, heat compress Ankylosing Spondylitis fusing of bones - Cause inflammation - Signs and symptoms stiffness, back pain, fatigue - Treatment slowing progressing of disease, no cure, pain management Bursitis, Synovitis, Tendinitis inflammation of soft tissue in joints and muscles Bursitis → fluid-filled sacs near joints become inflamed  Synovitis → synovial joint becomes inflamed  Tendinitis → tendons becomes inflamed  - Cause inflammation and swelling caused by damage - Signs and symptoms stiffness and pain during movement, swelling - Treatment RICE treatment **[Identify the action, use, contraindications/ cautions and side effects and nursing considerations for the following categories of meds and be able to give examples of each and how/why they are used:]** Alendronate - Therapeutic effect  Paget's disease of bone treatment - Drug action  Inhibit bone resorption  - Toxic side effects  Esophagitis, GI disturbances, musculoskeletal pain, visual disturbances - Interventions  Take med first thing in the morning, empty stomach, sit or ambulate for 30 mins after meds  Calcitonin-salmon - Therapeutic effect  Postmenopausal osteoporosis, Paget's disease, hypercalcemia, cancer  - Drug action  Decreases resorption by inhibiting osteoclast, inhibits tubular resorption to increase renal calcium excretion   - Toxic side effects  Nausea, nasal dryness/irritation - Interventions  Chvostek, trousseau sign, hypocalcemia, bone density, consume calcium and vit. D Calcium citrate and calcium carbonate - Therapeutic effect  Hypocalcemia treatment, deficiencies of parathyroid hormone, vit. D or calcium  - Drug action  Calcium Supplement  - Toxic side effects  Hypercalcemia, muscle weakness, constipation, abdominal pain  - Interventions  Monitor calcium levels  Disease modifying antirheumatic drugs *immunosuppressive* Etanercept, *infliximab, Hydroxychloroquine, Methotrexate, auranofin, sulfasalazine* - Therapeutic effect  Rapid relief of pain and inflammation  - Drug action  Death to rapid replicating cells, immunosuppressive , treat RA   - Toxic side effects  Increase risk of infection, hepatic toxicity, bone marrow  - Interventions  Monitor bone marrow, bleeding, etc  Raloxidene  - Therapeutic effect  Postmenopausal osteoporosis, brotect against breast cancer  - Drug action Decreased bone resorption  - Toxic side effects  Hot flashes, leg cramps  - Interventions  Need high calcium + Vit. D rich foods, monitor bone density, monitor serum calcium **[Discuss gout etiology, signs and symptoms, dietary considerations, education and treatment regimen.]** Gout inflammatory disease of joint, tendons, and other tissues - In the toe - Defective purine metabolism = uric acid accumulation Treatment + drugs - Colicine inhibits migration of leukocytes - Probenecid block reabsorption of uric acid - Allopurinol decrease uric acid production Nursing consideration - Avoid high purine, grapefruit - Monitor lab (CBC) renal + hepatic function - Record fluid output - Take meds with food - Yearly eye exams **[Pain and infection medications ]** **[Identify the action, use, contraindications/ cautions, side effects, and nursing considerations for the following categories of meds and be able to give examples of each and how/why they are used:]** Antibiotics penicillin (Narrow), ampicillin (Broad) - Therapeutic effect treat infection - Drug action destroy cell wall - Side effects contraception disruption, Antibiotics cephalosporin *Cephalexin, Cefazolin, Ceftriaxone, Cefepime* - Therapeutic effect treat infection alternative to penicillin allergies - Drug action beta-lactam antibiotics, - Side effects contraception disruption NSAIDS pain medications 1^st^ gen (COX-1 + COX-2) *Aspirin, Ibuprofen, Ketoprofen, Naproxen, Indomethacin*, *Diclofenac, Ketorolac*, *Meloxicam, Piroxicam,* 2^nd^ gen (COX-1) *celecoxib* - Therapeutic effect decrease pain, inflammation and fever - Drug action - inhibits COX-1to decrease GI protection, platelet aggregation, nephrotoxicity - Inhibit COX-2 to decrease inflammation, fever, pain - Side effects Opioids *Fentanyl, Meperidine, Methadone, Codeine, Oxycodone, Hydromorphone* - Therapeutic effect decrease pain, sedation, bowel relief and cough suppression - Drug action decrease GI mobility, RR decrease, euphoria + sedation - Side effects RR decreasing **[Blood & Hematologic Disorders]** **[List the functions of blood.]** Clotting, defense, transport, regulation **[Function of the bone marrow]** Cell factory, store fat, stem cells **[Discuss some diagnostic tests used to analyze the blood components]** Complete blood count overall health of blood Hemoglobin check for anemia Hematocrit amount of RBC in blood Reticulocyte count assess bone marrow function Chemical analysis determine serum levels of iron, vit. B, folic acid, cholesterol, urea, glucose Bleeding time platelet function test PT and PTT coagulation process Mean corpuscular volume amount of oxygen carrying blood **[Define:]** Anemia low RBC Polycythemia too many RBC Leukocytosis too many WBC Leukopenia low WBC Thrombocytopenia low platelet Pancytopenia low everything WBC, RBC, platelet **[Differentiate (briefly) the different hematologic disorders including the pathophysiology, etiology and treatment:]** Iron deficiency anemia Fe  - Causes  Low Fe in diet  - Symptoms  Brittle nails, smooth/sore tongue, Cracking of the corner of mouth  - Treatments  Increase Fe supplements Anemia of chronic diseases  - Causes  Anemia resulting from other diseases  - Symptoms  Low RBC - Treatments  Supplements, treating underlying disorders  Pernicious anemia → B12  - Causes  Autoimmune disorder resulting in poor B12 absorption  - Symptoms  Paresthesia, poor spatial sense, misshapen RBC  - Treatments  Increasing Vit B12  Aplastic anemia → body is unable to produce enough blood cells  - Causes  Radiation, autoimmune disorders  - Symptoms  Uncontrolled bleeding, infection risk, fatigue  - Treatments  Transfusion, stem cell transplants Sickle cell anemia → misshapen RBC  - Causes  Sickle cell gene - Symptoms  Tissue ischemia, swelling of feet + joints, abdominal pain  - Treatments  Supplements, transplants and transfusions  Polycythemia--polycythemia vera → blood cancer increasing RBC production - Causes  Overproduction of RBC, mutation with blood production  - Primary → increased because of bone marrow - Secondary → increased because of oxygen decreased  - Symptoms  Thicken blood, clotting  - Treatments Blood withdrawal, increasing fluids  Hemophilia → inability to clot properly  - Causes  Inherited disorder  - Symptoms  Excessive bleeding, bruises, blood in urine/stool  - Treatments  Replace missing clotting factor  Von Willebrand disease → bleed more easily than normal  - Causes  gene that decreases von Willebrand factor  - Symptoms  Frequent long lasting bleeding, bruises  - Treatments  Desmopressin, giving von Willebrand factor  Disseminated intravascular coagulation DIC → abnormal blood clotting  - Causes Infection, liver failure, transfusion reactions  - Symptoms  Bleeding, blood clot, SOB  - Treatments  Plasma transfusion  Leukemia → decrease in WBC  - Causes  Genetic, aging, other blood disorders   - Symptoms  Fever, fatigue, losing weight, recurring infections  - Treatments  Chemo, stem cell transplant **[Differentiate the components of blood and the actions of each (briefly)]** Whole blood all blood - Used to increase volume, good for blood replacement Packed red blood cells only RBC, oxygen - Increase RBC, anemia treatment Platelets platelets blood - Increase platelets, for active bleed, bone marrow, chemotherapy Plasma coagulation factors - Active bleed, shock, burns. Coagulation therapy White blood cells WBC - Infection, low WBC Albumin expands circulating blood volume - Hypovolemia, hypoalbuminemia, burns, respiratory issues **[Differentiate universal donor blood vs. universal recipient blood]** Universal donor O- Universal recipient AB+ **[Discuss the nursing considerations for blood transfusions using the nursing process]**\ Assessment  - Baseline laboratory values + vital signs , assess risk for FVE Diagnosis  - Find appropriate reason to why a transfusion is needed  Planning  - Blood transfusion history, verify the prescription, signed consent  - Assess infusion site for patency + infection before giving blood  - Safety checks, right client, right blood type + match  - Know universal precautions for handling and administering  - Do not administer blood products with any other medications  Implementation  - 0.9% sodium chloride solution to administer with blood products   Incase there is a reaction  - Prime IV + blood tubing with a blood filter  - 20-gauge or larger IV catheter,  Change tubing every 2 units  - Begin blood transfusion  within 30min of removal from blood bank refrigeration  - Stop transfusion 4hrs after blood bag left refrigeration - Stay with client + monitor vitals for the first 15-30. Then hourly  Evaluation  - Document correctly, **[Identify the steps of clotting.]** - Step 1 platelets initiate process - Step 2 Fibrin formation of a mesh over the platelet - Step 3 RBCs are trapped in fibrin mesh **[Identify the action, use, contraindications/ cautions and side effects, antidote and nursing considerations for the following categories of meds and be able to give examples of each and how/why they are used:]** Antiplatelets - Therapeutic effect Prevention of thrombosis, myocardial infarction, stroke care - Drug action Stop step 1, Stop Platelet aggression  - Toxic side effects  Hemorrhagic stroke, tinnitus, hearing loss, Bleeding - Interventions Do not give to children with fever or crescent chickenpox  Anticoagulant: Direct thrombin inhibitors → Dabigatran, Desirudin, Bivalirudin, Argatroban  - Therapeutic effect  - Dabigatran → prevents stroke or embolism for Afib, treat and prevent DVT and PE. - Bivalirudin → percutaneous coronary angioplasty or intervention. - Argatroban → prevent or treat thrombosis in clients who cannot take heparin  - Desirudin → for hip replacement surgery to prevent DVT. - Drug action Stop step 2 = Inhibits thrombin from converting fibrinogen into fibrin  - Toxic side effects  Bleeding, stroke - Interventions Assess for stroke, bleeding, use anticoagulant if, Idarucizumab (anticoagulant) Antithrombin  - Therapeutic effect  Prevention of clotting  - Drug action  Inhibits thrombin and prevents coagulation - Toxic side effects  Liver function, bleeding, infusion site reactions  - Interventions Assess for bleeding, sign and symptom of anaphylaxis  Anticoagulants LMWH → Dalteparin, Enoxaparin  - Therapeutic effect Prevent DVT, acute PE after abdominal surgery  - Thin blood → prevention of thrombus formation  - Drug action Stop step 2 and 3 = Inhibits thrombin, inactivates Xa factor  - Toxic side effects Edema, urinary retention, hyperkalemia, bleeding  - Interventions  Base off of weights, No labs to check Assess for signs bleeding Protamine sulfate → antidote  Anticoagulants Xa Inhibitor → rivaroxaban, apixaban, frondaparinux  - Therapeutic effect  Prevention of DVT, acute PE, Reduces the risk of stroke, embolism for afib  - Drug action  Stops step 3 = Blocks clotting factor Xa  - Toxic side effects Bleeding, wound, muscle spasms  - Interventions  No routine coagulation monitoring needed, Assess for bleeding, Use activated prothrombin concentrate → antidote  Anticoagulants Warfarin  - Therapeutic effect  Treatment of venous thrombosis, Tx of AFib, prevention of PE/DVT - Drug action Antagonize Vit. K  - Toxic side effects Hemorrhage, hepatitis - Interventions  Monitor PT levels, INR levels, Give Vit. K → antidote, Oral care  Thrombolytics → tenecteplase, Alteplase  - Therapeutic effect  Treat acute MI, PE, Ischemic stroke  - Drug action Reverse clothing process And Breakdown clot  - Toxic side effects  Bleeding, anaphylaxis, dysrhythmias  - Interventions  Aminocaproic acid → antidote **[Discuss nursing considerations/interventions and teaching when caring for a population using anticoagulants, antiplatelet, and thrombolytics as part of their treatment.]** Monitor/Assess - Mobility, need for assistive devices, fall risk  - Liver function, hepatotoxicity - Fall risk, bleeding risk Education  - Therapeutic effect may take a few days  - Avoid alcohol and other nonprescription meds  - Avoid sitting, must move body   **[Discuss non-pharm and pharm interventions to protect the GI tract for patients while taking anticlotting medications.]** - Eat foods high in protein, Iron and etc  - Avoid eating things that could have a drug-food reaction  Garlic, giniko etc **[List Herbal supplements that must be considered when caring for clients taking anticlotting medications and discuss the concerns of each.]** - With warfarin → Vit. K intake needs to be monitored  - Liver, DGLV, soybean, spinach  - Vit. E can increase bleeding  - Fish Oil can increase bleeding + affect INR  - Ginger, Garlic, Ginkgo biloba, Dong Quai, Feverfew can increase bleeding time