NUR 529 Module 2 PDF

Unit 3. Chapters 7- 8. There are 3 questions from this unit. 24. Chapter 7. Stress and Adaptation- 1. Treatment and Research of Stress Disorders a. The traumatic stress response is the change that occurs in the biochemical stress response system of people who have expe...

Unit 3. Chapters 7- 8. There are 3 questions from this unit. 24. Chapter 7. Stress and Adaptation- 1. Treatment and Research of Stress Disorders a. The traumatic stress response is the change that occurs in the biochemical stress response system of people who have experienced some type of mistreatment as a child so that they are not able to respond effectively to stressors in the future Evidence supports that early intervention can assist such people in developing new and effective coping mechanisms to better manage stress in the future (Cabrera et al., 2020). b. For caregivers, stress can contribute to burnout. Multiple studies have shown that burnout leads to decreased patient satisfaction and increased safety risks c. A study conducted with caregivers of a spouse or family member during the COVID-19 pandemic demonstrated that they reported higher levels of caregiver stress and had poorer self-perceived global health ratings due to the reduction in home and community resources and limited contact with friends and family during the pandemic The following are examples of research that has been done on stress: 1. Geriatric Considerations a. An interpreter may be helpful when bilingual people use their home language when stressed (Eliopoulos, 2022). b. Caregiver stress contributes to abuse of older adults, highlighting the importance of educating about available resources and support systems (Eliopoulos, 2022). c. Role fulfillment is key to stress management in the aging adult. Sharing the need to allow the person to perform roles within limitations is encouraged (Eliopoulos, 2022). d. Stress is twice as common in people aged 50 to 65 than those aged 65 to 80 years (American Institute of Stress, 2023). 2. PEDIATRIC Considerations a. Stress in children can be due to normal developmental issues or atypical events including sickness, violence, or trauma. Resilience (coping skills to effectively deal with stress) will help the child to achieve balance (Kyle & Carman, 2022). b. Infants deal with stress by sucking. Regression back to a pacifier or bottle may occur during times of stress. Praise for age-appropriate behavior is recommended (Kyle & Carman, 2022). c. Comfort measures such as rocking, stroking, cuddling, and holding the child can reduce stress (Kyle & Carman, 2022). d. Children who are left home alone after school may experience a high degree of stress. This may be age-dependent, with children under the age of 11 or 12 experiencing self- care stress and those over the age of 12 feeling safe and confident in staying home alone. Some states have laws to help parents/caregivers make these decisions The Stress Response: Acute vs Chronic Stress & hormonal 1. Acute a. The stress response is a normal, coordinated physiologic system meant to increase the probability of survival, but also designed to be an acute response—turned on when necessary to bring the body back to a stable state and turned off when the challenge to homeostasis abates. b. Under normal circumstances, the neural responses and the hormones that are released during the response do not persist long enough to cause damage to vital tissues. 2. Chronic Stress a. The stress response is designed to be an acute self-limited response in which activation of the ANS and the HPA axis (The hypothalamic-pituitary-adrenal (HPA) axis is a neuroendocrine system that connects stress to physiological responses in the body) is controlled in a negative feedback manner. b. Chronicity and excessive activation of the stress response can result from chronic illnesses and can contribute to the development of long-term health problems. c. Chronic activation of the stress response is an important public health issue from both a health and a cost perspective. d. Stress is linked to a myriad of health disorders, such as diseases of the cardiovascular, gastrointestinal, immune, and neurologic systems, as well as depression, substance use disorder, eating disorders, accidents, and suicide. e. Allostatic load describes the cumulative effects of chronic stress on one’s health. Stress hormones such as cortisol lead to negative effects on the immune, cardiovascular, and metabolic processes leading to inflammation, hypertension, hyperglycemia, and other health problems causing health risks (Cherry, 2022). Increased allostatic load contributes to health disparities in marginalized communities 3. Hormonal Stress: a. Neuroendocrine Responses  b. effects on the body. 25. Chapter 8. Compartmental Distribution of Body Fluids: Edema can be defined as palpable swelling produced by expansion of the interstitial fluid volume. Assessment: daily weight, visual assessment, measurement of the affected part, application of finger pressure to assess for pitting edema. Treatment: directed toward maintaining life when the swelling involves vital structures, correcting or controlling the cause, and preventing tissue injury. Edema of the lower extremities may respond to simple measures such as elevating the feet. Diuretic therapy is commonly used for an increase in ECF volume. Albumin may be administered to raise the plasma colloidal osmotic pressure when the cause of the edema is hypoalbuminemia. Elastic support stockings and sleeves increase interstitial fluid pressure and resistance to outward movement of fluid from the capillary into the tissue spaces. Edema assessment and treatment. 26. Chapter 8. Mechanisms of Acid-Base: Function of the lungs and kidneys in acid-base Regulation.  Respiratory: Control of extracellular co2 by the lungs. Only comes into play when the chemical buffers do not minimize H+ changes. Only about 50 to 75% effective as a buffer system, occurring within minutes and is maximal within 12 to 24 hours. In acting rapidly, it prevents large changes in pH from occurring while waiting for the much more slowly reacting kidneys to respond. Kidneys: Third line of defense in acid-base disturbances and play three major roles. First is through excretion of H+ from fixed acids that result from protein and lipid metabolism. Second is accomplished through the reabsorption of HCO3 that is filtered through the glomerulus, so it’s not lost in the urine. The third is the production of new HCO3 that is released back into the blood Unit 4. Chapters 10- 12. There are 10 questions from this unit. Begins on p. 263. 27. Chapter 10. Infectious Diseases. Diagnosis and Treatment of Infectious Diseases: Detection and Diagnosis of infectious diseases. The diagnosis of an infectious disease requires 2 criteria: the recovery of a probable pathogen or some evidence of its presence from the infected sites of a diseased host and accurate documentation of clinical signs and symptoms compatible with an infectious process. Diagnosis types: Culture: refers to the growth of a microorganism outside of the body, usually on or in artificial growth media such as agar plates or broth. In the case of bacterial pathogen, identification is based on microscopic appearance and gram stain reaction, shape, texture, and color (morphology) of the colonies and by a panel of biochemical reactions that fingerprint salient biochemical characteristics of the organism. Fungi and mycoplasmas are cultured in much the same way as bacteria but with more reliance on microscopic and colonial morphology for identification. Some fungi can take weeks to grow and identify through culture. In the setting of acute infection, it is important that cultures are obtained prior to antibiotic administration. The causative organism cannot be identified by culture in up to 33% of people presenting with sepsis. Serology: indirect means of identifying infectious agents by measuring serum antibodies in the diseased host. A tentative diagnosis can be made if the antibody level, also called the antibody titer, against a specific pathogen rises during the acute phase of the disease and falls during convalescence. Serologic identification of an infectious agent is not as accurate as a culture, but may be a useful adjunct. IgM specific antibodies generally rise and fall during the acute phase of the disease, whereas the synthesis of IgG increases during the acute phase and remains elevated until or beyond resolution. IgM antibodies do not cross the placenta, so if IgM is elevated in a neonate it did not come from mother, it originated in child. Antigen detection incorporates features of culture and serology but reduces to a fraction the time required for diagnosis. This method relies on purified antibodies to detect antigens of infectious agents in specimens obtained from the diseased host. DNA and RNA sequencing: DNA probe hybridization – small fragements of DNA are cut from the genome of a specific pathogen and labeled with compounds that allow detection. Polymerase chain reaction (PCR) – this method incorporates two unique reagents: a specific pair of oligonucleotides called primers and heat-stable DNA polymerase.  28. Chapter 10. Infectious Diseases. Diagnosis and Treatment of Infectious Diseases: General intervention methods used in treatment of infectious diseases. Antimicrobial Agents: can be categorized roughly according to mechanism of anti-infective activity, chemical structure, and target pathogen. Antibacterial agents: antibiotics. Most antibiotics are actually produced by other microorganisms, primarily bacteria and fungi, as by-products of metabolism. Effective only against other prokaryotic organisms. Bactericidal if it causes irreversible and lethal damage to the bacterial pathogen and bacteriostatic if its inhibitory effects on bacterial growth are reversed when the agent is eliminated. Antiviral agents: Viral replication requires the use of eukaryotic host cell enzymes, and the drugs the effectively interrupt viral replication are likely to interfere with host cell production as well. Protease inhibitors are solely for the treatment of HIV, they inhibit an HIV-specific enzyme that is necessary for late maturation events in the virus life cycle. Antifungal agents: The target site of the two most important families of antifungal agents is the cytoplasmic membranes of yeasts or molds. Antiparasitic agents: Treatment of parastitic illness is based on exploiting essential components of the parasites metabolism or cellular anatomy that are not shared by the host. Any relatedness between the target site and the cells of the host increases the likelihood for toxic reactions in the host. Immunotherapy: Involves supplementing or stimulating the hosts immune response so that the spread of a pathogen is limited or reversed. IVIG and cytokines are examples. Surgical Intervention: surgical removal of infected tissues, organs, or limbs. Usually only needed in present day when the infective agent is resistant to all treatments. May be used to hasten the recovery process by providing access to an infected site by antimicrobial agents (drainage of abscess), cleaning the site (debridement), or removing infected organs or tissue (appendectomy). Surgery might be the only means of a complete cure such as endocarditis. 29. Chapter 11. Innate and Adaptive Immunity: Epithelial Barriers. The intact skin is by far the most formidable physical barrier available to infection because of its design. It is comprised of closely packed cells that are organized in multiple layers that are continuously shed. In addition, a protective layer of protein, known as keratin, covers the skin. Sheets of tightly packed epithelial cells line and protect the gastrointestinal, respiratory, and urogenital tracts and physically prevent microorganisms from entering the body. These cells destroy the invading organisms by secreting antimicrobial enzymes, proteins, and peptides. When pathogens are able to breach the epithelial defenses, the innate immune response is initiated by the bodys leukocytes, which recognize common surface receptors present on the invading microorganisms. 30. Chapter 11. Innate and Adaptive Immunity. See p. 261: Infectious disease terminology. Toxins produced by bacteria. Host – any organism capable of supporting the nutritional and physical growth requirements of another Infection – presence and multiplication within a host of another living organism, with subsequent injury to the host Colonization – act of establishing a presence Microflora – Internal and external exposed surfaces of the human body are normally and harmlessly inhabited by a multitude of bacteria Mutualism – interaction in which both the microorganism and the host derive benefits from the interaction Parasitic relationship – only the infecting organism benefits from the relationship and the host either gains nothing or sustains injury from the interaction. Infectious disease – if the host sustains injury or pathologic damage from a microorganism Virulence – disease producing potential Pathogens – microorganisms capable of causing disease Prokaryotes – unicellular organisms, bacteria, lack organized nucleus Plasmids – smaller extrachromosomal pieces of circular DNA that bacteria often harbor (sometimes contain genetic material that increased the virulence or antibiotic resistance) Cytoplasm – contains reproductive and metabolic machinery of the cell Cytoplasmic membrane – flexible lipid membrane 31. Chapter 11. Adaptive Immunity. Passive Immunity. Adaptive immunity: acquired when the host mounts an immune response to an antigen either through the process of vaccination or from environmental exposure. It is called active immunity because it requires the host’s own immune system to develop an immunologic response including the development of memory. Usually long lasting but requires a few days to weeks after a first exposure to sufficiently develop an appropriate immunologic response that culminates in the destruction of the presenting antigen. Passive immunity: Immunity transferred from another source. Most common form of passive immunity is that conferred from mother to fetus. IgG antibodies are transferred to the fetus via the placenta and also after birth in breast milk and colostrum so infants have some degree of protection from infection for 3 to 6 months. Produces only short-term protection that lasts weeks to months. 32. Chapter 11. Pg. 292. Innate and Adaptive Immunity: Immunoglobulins. Primary & secondary immune response. Antibodies are protein molecules are also known as immunoglobulins. Igs are classified into 5 different categories based upon their role in the humoral defense mechanism. The Ig is compromised of four-polypeptide chains with at least 2 identical antigen-binding sites. 33. Chapter 9: Page 317. Describe the emergency care of a client with anaphylaxis. Anaphylaxis is a castastropic, systemic, life-threatening IgE-mediated hypersensitivity reaction associated with the widespread release of histamine into the systemic circulation that produces massive vasodilation, hypotension, arterial hypoxia, and airway edema. Clinical manifestations occur along a continuum in severity and can be graded on a scale of I to IV. Grade I reactions are usually confined to the cutaneous and mucosal tissues manifesting as erythema and urticaria, with or without angioedema. Grade II reactions progress to include moderate multisystem signs such as hypotension, tachycardia, dyspnea, and GI disturbances. Grade III reactions become life threatening because of the development of bronchospasm, cardiac dysrhythmias, and cardiac collapse. Once a hypersensitivity reaction reaches grade IV, cardiac arrest has occurred and management is purely resuscitative in nature. Preventing exposure to potential triggers that cause anaphylaxis is essential. The initial management should focus on withdrawal of the offending allergen, maintenance of a patent airway, establishment of appropriate intravenous access, volume resuscitation, and administration of epinephrine. 34. Chapter 11: Page 279. Innate immunity barriers. Describe innate barriers that help protect humans against pulmonary infections.