N443 Exam Study Guide PDF

N443: Exam 1 Study Guide Pulmonary Embolism ♡♡♡♡ ​ Pathophysiology o​ Blockage of pulmonary arteries by a thrombus, fat, air, or tumor o​ Impairs gas exchange and can cause hemodynamic instability ​ Clinical Manifestations o​ Dyspnea, chest pain, tachycardia, cough...

N443: Exam 1 Study Guide Pulmonary Embolism ♡♡♡♡ ​ Pathophysiology o​ Blockage of pulmonary arteries by a thrombus, fat, air, or tumor o​ Impairs gas exchange and can cause hemodynamic instability ​ Clinical Manifestations o​ Dyspnea, chest pain, tachycardia, cough o​ Hypoxemia, anxiety, and possible hemoptysis ​ Diagnostic Tests o​ ABG analysis, chest x-ray, ECG o​ D-dimer test o​ Spiral CT scan is the most common test (CT PE) o​ V/Q scan if CT is contraindicated ​ Management o​ Oxygen therapy o​ Anticoagulation (heparin, low-molecular-weight heparin, factor Xa inhibitors) o​ Fibrinolytic agents for massive PE o​ Inferior vena cava (IVC) filter may be needed ​ Nursing Management o​ Assess cardiorespiratory status o​ Administer oxygen and medications o​ Provide emotional support o​ Patient education on long-term anticoagulation therapy Acute Respiratory Failure ♡♡♡♡ ​ Types o​ Hypoxemic Respiratory Failure: Oxygenation failure ▪​ PaO2 ≤ 60 mm Hg on ≥ 60% oxygen o​ Hypercapnic Respiratory Failure: Ventilatory failure ▪​ PaCO2 > 50 mm Hg and pH < 7.35 ​ Causes o​ Respiratory system issues (e.g., pneumonia, ARDS, COPD) o​ Cardiac issues (e.g., pulmonary edema, anatomic shunt) ​ Clinical Manifestations 1  o​ Dyspnea, changes in breathing pattern, use of accessory muscles, and changes in mental status o​ Tachycardia, dysrhythmias, changes in blood pressure o​ Skin may be pale, cool, clammy, or warm and flushed ​ Diagnostic Tests o​ Arterial blood gas o​ Chest x-ray o​ Pulse oximetry ​ Management o​ Oxygen therapy o​ Mobilization of secretions o​ Cough/deep breathe o​ Suctioning o​ Humidification o​ Noninvasive or invasive ventilation o​ Treat underlying cause ​ Nursing Management o​ Assess for airway patency, breathing effort, and overall respiratory status o​ Monitor vital signs, ABGs, and pulse oximetry o​ Provide emotional support o​ Prevent complications Acute Respiratory Distress Syndrome (ARDS) ♡♡♡♡ ​ Pathophysiology o​ Severe form of ARF characterized by damage to the alveolar-capillary membrane o​ Leads to decreased surfactant production, atelectasis, and impaired gas exchange o​ Inflammatory mediators increase alveolar capillary permeability ​ Diagnostic Criteria o​ Timing within one week of a known clinical insult o​ Bilateral opacities on chest x-ray that cannot be attributed to volume overload o​ Oxygenation issues ​ Clinical Manifestations o​ Similar to ARF, but more severe 2  o​ Hypoxemia refractory to oxygen therapy ​ Management o​ Mechanical ventilation with low tidal volume o​ Positive end-expiratory pressure (PEEP) o​ Positioning strategies, like prone positioning o​ Extracorporeal membrane oxygenation (ECMO) ​ Complications o​ Cardiovascular: increased CO, dysrhythmias, hypotension o​ CNS and Psychological: delirium, PTSD o​ GI: Hypermetabolic state, paralytic ileus, GI bleeding o​ Hematologic: anemia, disseminated intravascular coagulation, thrombocytopenia o​ Renal: AKI ​ Nursing Management o​ Similar to ARF, but more intensive monitoring and care o​ Frequent ABG monitoring o​ Analgesia, sedation, and neuromuscular blockade may be needed Lung Cancer ♡♡♡♡ ​ Types o​ Non-small cell lung cancer (NSCLC) most common ​ Etiology o​ Smoking is the most significant risk factor o​ Other risk factors include exposure to secondhand smoke, airborne carcinogens, and chronic lung disease ​ Clinical Manifestations o​ Cough, hemoptysis, dyspnea, chest pain, hoarseness, and fatigue ​ Diagnostic Tests o​ Chest x-ray, CT scan, and MRI o​ Sputum cytology, biopsy o​ Bone scans and scans of the brain, pelvis, and abdomen ​ Staging o​ Stages range from 0 to IV based on tumor size, lymph node involvement, and metastasis ​ Management o​ Surgery (lobectomy, pneumonectomy) o​ Radiation therapy 3  o​ Chemotherapy and immunotherapy o​ Targeted therapy ​ Screening o​ Annual low dose CT for high-risk patients (ages 50 to 80 with history of smoking) ​ Nursing Management o​ Assess understanding of disease, treatment, and prognosis o​ Provide support, education, and symptom management o​ Smoking cessation counseling Acute Kidney Injury (AKI) ♡♡♡♡ ​ Causes o​ Prerenal: Decreased blood flow to the kidneys (e.g., hypovolemia, heart failure) o​ Intrarenal: Direct damage to kidney tissue (e.g., nephrotoxins, ischemia) o​ Postrenal: Obstruction of urine flow (e.g., stones, BPH) ​ RIFLE Classification o​ Risk, Injury, Failure, Loss, End-stage kidney disease o​ Uses serum creatinine and urine output criteria to define the stage of AKI ​ Clinical Manifestations o​ Oliguria or anuria, though nonoliguric AKI is also possible o​ Changes in urine output and serum creatinine o​ Urinalysis may show casts, RBCs, and WBCs ​ Diagnostic Tests o​ History and physical assessment o​ Urinalysis and serum creatinine and BUN o​ Kidney ultrasound o​ Renal scan or CT scan o​ Renal biopsy for intrarenal causes ​ Management o​ Treat underlying cause o​ Fluid restriction o​ Nutritional support o​ Measures to lower potassium levels o​ Calcium supplements or phosphate-binding agents 4  o​ Dialysis or continuous renal replacement therapy o​ Avoid nephrotoxic agents ​ Nursing Management o​ Monitor daily weights, intake/output, and vital signs o​ Assess urine for color, specific gravity, glucose, protein, blood, and sediment o​ Skin and mouth care o​ Monitor for electrolyte imbalances Pyelonephritis ♡♡♡♡ ​ Pathophysiology o​ Infection of the renal parenchyma o​ Usually caused by ascending bacterial infection from the lower urinary tract o​ Risk factors include structural abnormalities, pregnancy, and vesicoureteral reflux ​ Clinical Manifestations o​ Fever/chills, nausea/vomiting, malaise, and flank pain o​ Dysuria, urgency, and frequency ​ Diagnostic Tests o​ Urinalysis o​ Urine culture and sensitivity o​ Imaging studies like ultrasound, CT scan, or MRI ​ Management o​ Antibiotics o​ Adequate fluid intake o​ Symptom management with NSAIDs or antipyretics o​ Possible hospitalization if severe ​ Nursing Management o​ Patient education on antibiotic therapy, fluid intake, and follow-up Urinary Tract Calculi (Kidney Stones) ♡♡♡♡ ​ Pathophysiology o​ Supersaturation of crystal-forming substances in urine o​ Contributing factors: climate, diet, genetics, metabolic, and lifestyle o​ Dehydration and concentrated urine increase risk 5  o​ Urinary pH affects stone formation ​ Clinical Manifestations o​ Severe, colicky pain in flank, back, abdomen, or groin o​ Hematuria and crystalluria o​ Urinary urgency and frequency ​ Diagnostic Tests o​ Noncontrast CT scan or ultrasound o​ Urinalysis o​ 24-hour urine collection for measurement of minerals ​ Management o​ Pain management with opioids or NSAIDs o​ α-Adrenergic blockers (e.g., tamsulosin) to help with stone passage o​ Increase fluid intake o​ Dietary changes and restrictions depending on stone type o​ Endourologic procedures (cystoscopy, lithotripsy) o​ Extracorporeal shock-wave lithotripsy (ESWL) o​ Open surgical stone removal ​ Nursing Management o​ Assess pain, fluid intake, and urinary symptoms o​ Strain all urine to retrieve stones for analysis o​ Patient education on diet, hydration, and medications o​ Encourage ambulation Anemia ♡♡♡♡ ​ General Concepts o​ Reduction in the number of red blood cells (RBCs), hemoglobin, or hematocrit o​ Leads to decreased oxygen carrying capacity ​ Clinical Manifestations o​ Fatigue, pallor, tachycardia, dyspnea, and other signs related to tissue hypoxia ​ Nutritional Support o​ Adequate intake of protein, iron, vitamin B12, folic acid, copper, niacin, and vitamin B5 is necessary for RBC production ​ Iron Deficiency Anemia o​ Caused by blood loss, poor iron intake, or poor absorption o​ Low Hgb, Hct, serum iron, ferritin and high TIBC 6  o​ Treatment with oral or parenteral iron supplements and dietary changes ​ Megaloblastic Anemia o​ Caused by cobalamin (vitamin B12) or folic acid deficiency o​ Macrocytic RBCs, low serum cobalamin or folate levels o​ Treatment with replacement therapy ​ Anemia of Chronic Disease o​ Underproduction of RBCs and shortened RBC survival o​ Normocytic, normochromic, and hypoproliferative ​ Aplastic Anemia o​ Pancytopenia, low levels of all blood cells (RBC, WBC, platelets) o​ Normocytic, normochromic anemia, and low reticulocyte count ​ Anemia due to Acute Blood Loss o​ Results from hemorrhage or trauma o​ Hgb, Hct, and RBC will be decreased o​ Treatment focuses on stopping the bleeding, fluid replacement, and possible blood transfusions ​ Hemolytic Anemia o​ Caused by increased destruction of RBCs o​ Elevated bilirubin levels, jaundice, high reticulocytes, and abnormal blood smear o​ Treatment includes supportive care and addressing the underlying cause ​ Sickle Cell Anemia o​ Genetic disorder caused by a mutation in the beta-globin gene o​ Sickled cells cause vaso-occlusion, pain, and organ damage o​ Treatment focuses on managing pain crises and preventing complications ​ Thalassemia o​ Genetic defect in globin synthesis o​ RBCs are microcytic and hypochromic o​ Treatment includes blood transfusions, iron chelation, and HSCT ​ Polycythemia Vera o​ Excessive production of RBCs o​ Increased blood viscosity and risk for thrombus formation o​ Treatment includes phlebotomy, hydration therapy, and myelosuppressive drugs 7  ​ Nursing Management o​ Assess knowledge of nutrition, safety, and disease o​ Encourage rest, monitor cardiorespiratory response to activity, and aid with ADLs o​ Provide education on diet, medications, and potential complications Human Immunodeficiency Virus (HIV) ♡♡♡♡ ​ Pathophysiology o​ HIV is a retrovirus that causes immunosuppression o​ Targets CD4+ T cells, eventual destruction of CD4+ cells o​ Opportunistic diseases develop ​ Transmission o​ Through infected blood, semen, vaginal secretions, or breast milk ​ Progression o​ Acute infection, followed by a period where the HIV antibody test becomes positive o​ Symptomatic infection develops with declining CD4 counts and increasing viral load o​ AIDS is diagnosed when the CD4 count drops below 200 cells/μL, or if certain opportunistic infections or cancers develop ​ Clinical Manifestations o​ Symptoms such as persistent fever, night sweats, diarrhea, headaches, and severe fatigue may occur as the CD4 count declines o​ Opportunistic infections ​ Diagnosis o​ HIV antibody/antigen tests o​ Confirmation with HIV viral load testing o​ Monitoring with CD4 counts and viral load ​ Treatment o​ Antiretroviral therapy (ART) is used to suppress viral load o​ ART does not cure HIV ​ Prevention o​ Pre-exposure prophylaxis (PrEP) for high-risk individuals o​ Post-exposure prophylaxis (nPEP) within 72 hours of exposure 8  o​ Safer sexual practices and avoiding sharing drug equipment o​ Regular testing ​ Nursing Management o​ Assessment of risk factors o​ Patient education on transmission, treatment, and prevention o​ Emotional support and counseling Disseminated Intravascular Coagulation (DIC) ♡♡♡♡ ​ Pathophysiology o​ Life-threatening condition involving widespread activation of the clotting cascade, leading to both thrombosis and hemorrhage o​ Caused by an underlying disease or condition ​ Risk Factors o​ Cancers, hemolytic processes, obstetric conditions, septicemia, shock, and tissue damage ​ Clinical Manifestations o​ Bleeding, tissue damage, and organ ischemia or infarction ​ Diagnostic Tests o​ Prolonged PT, PTT, aPTT o​ Decreased fibrinogen and platelets o​ Increased D-dimer o​ Presence of schistocytes on peripheral blood smear ​ Management o​ Treat the underlying cause o​ Blood product support (platelets, cryoprecipitate, fresh frozen plasma) o​ Careful monitoring and supportive care ​ Nursing Management o​ Minimize tissue damage o​ Protect patient from bleeding sources o​ Blood products and medications 9