Exam 2 Study Guide PDF

**[Modules 3, 4, 5]** **[COPD]** Patho - Chronic Bronchitis: Smoking, Repeated airway infections - Emphysema: Smoking, chronic exposure to irritants Clinical Manifestations - Leaning forward with hands on knees and tachypnea - Respiratory Acidosis (low pH, High CO2, decreased O2) -...

**[Modules 3, 4, 5]** **[COPD]** Patho - Chronic Bronchitis: Smoking, Repeated airway infections - Emphysema: Smoking, chronic exposure to irritants Clinical Manifestations - Leaning forward with hands on knees and tachypnea - Respiratory Acidosis (low pH, High CO2, decreased O2) - Barrel Chest, small/thin (emphysema) - Overweight, coughing with mucus (Chronic Bronchitis) - Mucopurulent mucus Treatment/ Interventions - Chronic Bronchitis -- monitor for polycythemia (excess blood cells to compensate for lack of 02 to tissues) - Rest, Elevated HOB - VS with pulse ox - give bronchodilators and mucolytics - Cough deep breath exercises/ pulmonary secretion and removal methods. **[Acute Bronchitis:]** Patho: - Viral or nonviral, smoke inhalation, allergic reaction, airway becoming inflamed and narrowed, swelling and mucus production, decreased ciliary function. This is ACUTE Clinical Manifestations: - Cough with RECENT ONSET, symptoms are mild and self-limiting, sore throat, postnasal drip, fever Treatment: - Monitor symptoms as this is likely a recent onset of cough. - Self-limiting, encourage rest, nutrition, and fluids. - May need bronchodilators. **[Abnormal Breathing:]** - **Cheyne Stokes** has a regular cycle of breathing where the rate and depth of breathing increase and then decrease until apnea occurs. Apnea may lengthen. - **Biots** has a period of normal breathing followed by apnea- is irregular (overdose breathing) **[Obesity/ OSA:]** Patho: - BMI \> 30, causes decreased alveolar ventilation (hypoventilation) - Leads to hypoxemia, polycythemia, cor pulmonale Clinical Manifestations: - Loud snoring with no breathing for 10 seconds or longer Treatment/ Interventions: - Low-Fowlers maximizes diaphragmatic chest expansion and decreases hypoventilation. - CPAP/ BiPAP - Education on weight loss **[Ankylosing Spondylitis:]** Patho: - More common in males (3:1) in their 20-30's - Cause unknown. - Transient acute arthritis of peripheral joints - Chronic inflammation at the site of ligamentous insertion into the spine or sacroiliac joints - The respiratory system is affected by limited chest expansion and the formation of pulmonary fibrosis in the upper lobes. Clinical Manifestations: - Low to mid back pain, stiffness Treatment/ Interventions: - No cure, treat symptoms. - PFTs, CXR **[Pleural Effusion:]** Patho: - Collection of fluid or pus in the pleural cavity Clinical Manifestations: - Absent breath sounds - Can be asymptomatic with \< 300ml - SOB - Pleuritic pain Treatment/ Interventions: - Thoracentesis: Position the patient so there is easy access to the effusion. - Education on Using arms to splint the chest for pain **[Pneumonia:]** Patho: - Infection that inflames the alveoli - Mycoplasma, atypical bacteria - Legionnaires- from air mists - Anaerobic- from aspiration - Opportunistic (fungal aspergillus- from old homes and jiroveci -- opportunistic) - Bacterial, viral, community, hospital-acquired, atypical Risks: - Elderly - Multiple comorbidities - on antibiotics/ immunosuppressed Clinical Manifestations: - Bronchial Breath Sounds - Fever, chills, cough, headache Treatment/Interventions: - Sputum Culture: Rinse mouth out then spit. **[Hypersensitivity Pneumonitis:]** - Risk: Restrictive occupational disease, predominantly seen in nonsmokers **[Tension Pneumothorax:]** Patho: - Trauma induced from penetrating or non-penetrating injury. - OR Central line placement, thoracentesis, lung biopsy, ventilator - Results from the buildup of air under pressure in pleural space - Air enters pleural space during inspiration but cannot escape during expiration = lung collapses and ribs spring outward Clinical Manifestations: - Tracheal shift to the Left - Shortness of breath/ dyspnea - Severe Tachycardia, hypotension Treatment/ Intervention: - EMERGENCY - Thoracentesis, chest tube **[Tuberculosis:]** Patho: - Mycobacterium is inhaled and enters the lung. Alveolar macrophages ingest the bacteria and T-cells/ macrophages surround the bacteria creating a granuloma Ghon Tubercle- nodule can become necrotic and has lymph components. Risks: - Immunosuppressed (HIV), tight living quarters Reactivation: - Ghon Tubercle can form in lymph nodes, they release the mycobacterium. The disease can stay latent for several years. Clinical manifestations: - Diaphoresis: soaking the sheets Treatment/ Interventions: - Medications Isoniazid taken with rifampin, pyrazinamide, and ethambutol (B6) daily for 8 weeks. [ ] After Isoniazid will be taken with rifampin for up to 7 months - need liver panels monthly as it is rough on the liver (ALT/ AST) - Avoid tuna, aged cheese, red wine, soy sauce, and yeast. **[PaO2:]** - Normal is \>70 mmHg. - Safe is 45-70 - Dangerous is \< 40 - A big drop = decreased oxygen and ventilation (especially at rest) DANGER **[Hemophilia:]** Patho: - X-linked recessive disorder with deficient factors 8 and 9 creates an abnormal sequence of intrinsic pathway coagulation to form a fibrin clot resulting in bleeding. Clinical Manifestations: - Easy bruising, spontaneous bleeding Treatment/ Interventions: - Tylenol for pain - aPTT normal is around 30-40 but hemophilia would have a high number (like 80ish) **[Von Willebrand Disease:]** Patho: - autosomal dominant disorder that affects factor VIII (8), von Willebrand factor (plasma protein), and platelet dysfunction - It occurs in both males and females - leads to absences of PLT adhesion at injury sites Clinical Manifestations: - Mucosal & GI bleeding, excess bleeding after surgery Treatment/ Interventions: - Labs- - Activated partial thromboplastin (aPTT): - PT - Hgb - PLT **[Immune Thrombocytopenia Purpura (ITP):]** Patho: - Auto-immune inflammation of small vessels causing infiltration of supportive tissues - Abnormal blood vessels due to meds (warfarin) or allergies Clinical Manifestations: - Bruising, heavy menses, petechia, risk for bleeding membranes/ GI/ pulmonary Treatment/ Interventions: - Labs- Platelets (\< 30,000) - Education- - Bleeding risk (meds/ activities) - Pts can learn to live a productive and functioning life with low platelets **[Thrombocytopenia:]** - Decrease in Platelets (\< 150,000). - \< 100K symptoms occur - \< 50K petechia - \< 20K bleeding - Related to chemo - Bone marrow issues can cause a drop in platelet counts because this is the blood cell factory. - Bone marrow cancer would be a situation that would cause a delay in making platelets (dropping the PLT level in the body) **[DVT:]** Patho: - Thrombus in leg Clinical Manifestations: - Edema, tenderness, and inflammation Treatment/ Interventions: - Relieve pain by: - Elevate the leg. - Apply moist heat. - Acetaminophen - Continue Anticoagulant, and avoid exercise. - If too much Heparin: Give protamine Sulfate - Serious Complication: Pulmonary Embolism monitor for SOB **[Raynaud's:]** Patho: - Pathological effects on local nerve functions - This is [extreme vasoconstriction.] - Immune deficiency, trauma, women, smoking, cold temp, emotional stress Clinical Manifestations: - Cyanosis to finger/ toe tips - Pain/ numbness Treatment/ Interventions: - Stop smoking. - Avoid cold temperatures. **[Buerger's:]** Patho: - A RARE inflammatory condition that affects small and medium-sized arteries and veins of the upper and lower extremities, producing varying degrees of obstruction. Associated with smokers. Clinical Manifestations: - Decreased arterial flow Cold, no hair, absent pulses, ulcers. Treatment/ Interventions: - Monitor for decreased pulses. - AMPUTATION **[Venous Insufficiencies/ Obstructions:]** Patho: - R/t heart disease - Valves are incompetent. Clinical Manifestations: - Beefy red tissue opening on the inside / medial part of the ankle - Pain that decreases with ambulation and elevation - Venous stasis ulcer, warm/ tough/ thickened skin, areas of dark pigmentation, aching, cramping, edema - If an obstruction occurs: Edema, increased hydrostatic capillary pressure- Deep Vein Thrombus Treatment/ Interventions: - Education: - WALK TO RELIEVE PAIN - Compression stocking while in bed - Elevate legs above the heart. - Do no cross legs - Exercise and ambulate throughout the day. (20min 4x day) - Keep extremities protected, clean, and dry **[Varicose Veins:]** Patho: - impaired venous return - Standing increased pressure/ pulling - At risk for increased capillary pressure and edema Clinical Manifestations: - aching, heavy discomfort, darkened raised tortuous veins - Venous ulcers may develop Treatment/ Interventions: - Pain relief for varicose veins: Elevated legs above the heart **[Peripheral Vascular Disease:]** Patho: - Wound Cause: Insufficient blood flow to tissue Clinical Manifestations: - Deep, circular, black ulcer on the toe (great), painful, dry, gangrene around proximal joint spaces. No edema **[Chronic Arterial Obstruction:]** Patho: - Related to atherosclerosis making it difficult to allow oxygen to tissues Clinical Manifestations: - Intermittent claudication with activity - Absent pulses - Ulcer on toe Treatment/ Interventions: - REST - Avoid crossing legs. - Angioplasty **[Arteriosclerosis/ Atherosclerosis:]** Patho: - Risk factors: Males, pts with hyperlipidemia, diabetics, smokers - At risk for ischemic stroke, retinal injuries, renal impairment, angina, heart failure Treatment/ Interventions: - Education: - Test the water temperature before getting in the bath- avoid heat- i.e water bottles and heating pads on the extremities (can use on Abd for reflex vasodilation), - keep extremities protected and warm, no cold temps - walk/exercise until there is pain then rest. - keep leg in a neutral position- legs dangling, HOB up, maybe reclined or with feet resting on the floor. - No constriction (crossing legs/ tight clothes/ socks) **[Hypertension:]** Patho - No Cause/ unknown - Many risk factors that are modifiable and non-modifiable - Modifiable: Physical Activity, decreasing blood glucose - Secondary HTN high BP that occurs secondarily to another cause. A screenshot of a medical report Description automatically generated Clinical Manifestations: - Can be asymptomatic Treatment/ Interventions: - Lifestyle modifications: - Decrease smoking and alcohol drinking (less than 1-2 daily), - Exercise 3x a week or up to 150 min a week (30m x5d), - restrict sodium to \< 2g /day, potassium intake 3500-5000 mg/day, - DASH diet- fruits/ veggies, low-fat dairy, decreased saturated fat/ total fat (healthy grains) - maintain body weight BMI of 18.5-24.9 **[Hypertensive Emergency:]** - Diastolic BP \>/= 120 and / or Systolic BP \>/= 180 - End Organ damage = HTN emergency - Risk factor: African American Males **[Smoking:]** - Deteriorates the lining of vessels. - Creates thrombus, increased LDL/ triglycerides, decreased O2 (myocardial), increased vasospasm. **[Orthostatic Hypotension:]** - Response to position change (lying flat to standing) - Drop in systolic BP of over 20 mmHg OR decrease in diastolic BP of 10 mmHg or more in 3 minutes of standing. - Think about the patient lying flat and then standing blood rushes/ pools in the legs and we need that blood evenly distributed so our heart continues to pump oxygenated blood. - The body can increase BP by Increasing cardiac output/ vasoconstriction on peripheral vessels, so blood becomes evenly distributed. **[EKG Strips:]**  Bradycardia- be concerned with hypoxia. Atrial Fibrillation - ACLS Medical Training A-fib- concerned with myocardial hypertrophy. - Also a pulse that is decreased in the radial compared to the apical  ST-Elevation- concerned with myocardial blockage/ occlusion, and pericarditis. 7.4 ECG Patterns and Dysrhythmias -- Nursing Advanced Skills Tachycardia **[ICD Placement:]** - If a patient had an ICD placed and now you hear muffled sounds Cardiac Tamponade **[Becks Triad:]** - Monitor for: - Hypotension, Muffled heart tones, JVD - Cardiac Tamponade **[Circulatory Hypoxia:]** - Decreased cardiac output---may be from an obstruction in an artery or vein. **[Mitral Valve Regurgitation:]** - Loud pansystolic, high-pitched blowing radiating to the axilla **[Mitral Valve Stenosis:]** Patho: - Complication -Right ventricle hypertrophy due to backflow from stenosis which will cause decreased function. - If there is backflow Pulmonary hypertension (Venous), A-fib Clinical Manifestations: - Pulmonary congestion (dyspnea especially with exertion), chest pain, fatigue, hemoptysis, dizziness, asymptomatic - Backflow Dyspnea on exertion due to pulmonary venous hypertension Treatment/ Interventions: **[Aortic Valve Stenosis:]** Patho: - The aortic cusp has calcification creating a narrowing in the valve (stenosis) Clinical Manifestations: - Diminished cardiac output- syncope, fatigue, tiredness, low systolic BP, angina, faint pulses. - Crescendo-decrescendo murmur (S4) Treatment/ Interventions: **[Rheumatic Heart Disease:]** - Causes damage to connective tissue in the heart Damage leads to inflammation/ swelling/ erosions our platelets and fibrin will clump and collect on the valve leaflets just like when there is an injury to a vessel, they try to patch it up. **[Pericarditis:]** Patho: - If pericarditis is chronic There is dysfunction, the sac is destroyed, and the outside of the heart will adhere to the surrounding mediastinal structure. Clinical Manifestations - Chronic Pericarditis: Radiating pain, fever, malaise, exercise intolerance, weakness, fatigue, systemic venous congestion Treatment/ Interventions: - Pain Relief- Upright in a chair leaning forward. **[Heart Failure:]** Patho: - Left Side: - Right ventricle issue/ failure to pump blood to the lungs and then to the left side of the heart. - Increased pulmonary pressure and edema: too much blood in the lungs and the heart must work hard to get it to the body. - Decreased peripheral circulation back to the heart- if there is no blood to pump there is a failure. - Right Side: - Cor Pulmonale: increased resistance to pulmonary arterial flow due to obstructive/restrictive lung issues leads to compensatory right ventricular hypertrophy which can lead to right-sided heart failure. Clinical Manifestations: - Left Side: - Backward Flow dyspnea on exertion, orthopnea, cough, paroxysmal nocturnal dyspnea, cyanosis, basilar crackles - Forward Flow fatigue, oliguria, increased heart rate, faint pulses, restlessness, confusion, anxiety - In general Shortness of breath with exertion (walking up stairs and needing to stop halfway up) - Increased BP to compensate for decreased O2 in myocardial tissues. - Right Side: - Lower extremity edema, JVD, hepatomegaly, ascites, splenomegaly, Increased HR, fatigue, oliguria Treatment/ Interventions: - Monitor for Fluid Overload, strict I/O's - Education: Call the PCP with Worsening swelling/ SOB with activity or rest, gaining more than 5lb in a week and 2 lb in a day **[Angina/ Myocardial Infarction:]** Patho: - Insufficient blood flow causing decreased O2 to myocardial tissues Clinical Manifestations: - Angina CHEST PAIN and shortness of breath. This can be predictable with physical activity as there is increased demand for oxygen and the vessels may have plaque build-up which narrows the vessel and decreases oxygen supply. - Angina Atypical Signs/ Symptoms: Back pain, fatigue, weakness Treatment/ Interventions: - First step take vital signs - Then CXR, EKG, apply O2 - O2 - Nitro - Asa - Morphine - If pt comes in with chest pain but normalizes after 24 hours (Normal CK isoenzyme)- you evaluate for another cause of chest pain that is not MI **[Age-Related Concerns:]** - Late diastole suggestive of S4 Gallop (extra sound) - Increased SBP, ventricular wall thickening, decreased detection of HF (look for SOB, weakness), decreased renal function, diuretics not working creating distention **[Tube Feeding:]** - Assess placement of tube every 4 hours - HOB elevated to 45 degrees. - Change meds from pill form to liquid. - Water flushes are needed **[Blood Donation:]** - Who can donate: - Weight at least 50kg - 17 y/o with consent from a parent - Temp less than 99.6 - SBP 80-180 / DBP 50-100 - Hgb at least 12.5 **[MEDS:]** - Pt with a low HR, dizziness, and nausea - Angiotensin Receptor Blocker- Decreased BP by vasodilation which decreases cardiac workload and helps relieve HF symptoms. Monitor Kidney Function - Beta-blocker- decreases contractility and vasodilation. Avoid with Asthma - Calcium Channel Blocker- given with aortic valve disease and angina due to vascular vasodilation. - Calcium Channel blocker- acts mainly on the heart with cardiac contractility to reduce O2 demand - Antibiotics used for TB, need liver panels monthly as it is rough on the liver (ALT/ AST), taken with rifampin, pyrazinamide, and ethambutol (B6) **[daily for 8 weeks.]** After Isoniazid will be taken with rifampin for up to 7 months - Avoid tuna, aged cheese, red wine, soy sauce, and yeast.