Study Guide Exam 1 - Concepts N4 PDF

Study Guide: Oxygenation & Respiratory Disorders I. Infectious Respiratory Problems 1. Croup ​ Signs & Symptoms: Stridor, barking cough, retractions, respiratory distress ​ Management: Cool humidified air, corticosteroids, racemic epinephrine, fluids, keep calm, monitor vital signs 2....

Study Guide: Oxygenation & Respiratory Disorders I. Infectious Respiratory Problems 1. Croup ​ Signs & Symptoms: Stridor, barking cough, retractions, respiratory distress ​ Management: Cool humidified air, corticosteroids, racemic epinephrine, fluids, keep calm, monitor vital signs 2. Epiglottitis ​ Signs & Symptoms: High fever, tripod position, drooling, dysphagia, respiratory distress ​ Management: DO NOT examine throat, emergency intubation, humidified oxygen, IV antibiotics 3. Bronchitis ​ Cause: Viral infection ​ Symptoms: Gradual onset, rhonchi, productive cough, malaise, low-grade fever ​ Management: Rest, fluids, humidification, avoid cough suppressants, antibiotics if bacterial 4. Bronchiolitis (RSV) ​ Cause: Respiratory Syncytial Virus (RSV) ​ Symptoms: Tachypnea, wheezing, crackles, retractions ​ Management: Humidified oxygen, suctioning, hydration, elevate head of bed 5. Pneumonia ​ Types: Community-acquired (CAP), hospital-acquired (HAP), ventilator-associated (VAP) ​ Symptoms: Dyspnea, cough, fever, crackles, diminished breath sounds ​ Management: Oxygen, hydration, incentive spirometer, bronchodilators, antibiotics 6. Influenza & COVID-19 ​ Symptoms: Fever, cough, fatigue, myalgia, SOB, anosmia (COVID-19)  ​ Management: Supportive care, hydration, antivirals (oseltamivir), vaccines, infection control 7. Tuberculosis (TB) ​ Risk Factors: Close contact, crowded living, immunocompromised ​ Diagnosis: PPD skin test, chest X-ray, sputum culture ​ Treatment: Combination therapy (isoniazid, rifampin, ethambutol, pyrazinamide), airborne precautions II. Non-Infectious Respiratory Problems 1. Upper Airway Obstruction ​ Causes: Tongue/laryngeal edema, trauma, abscess, foreign body aspiration ​ Assessment: Stridor, cyanosis, anxiety, hypoxia ​ Management: Airway clearance, bronchoscopy, emergency tracheostomy 2. Obstructive Sleep Apnea (OSA) ​ Risk Factors: Obesity, large uvula, short neck ​ Symptoms: Snoring, daytime sleepiness, morning headaches ​ Management: CPAP, surgery (Uvulopalatopharyngoplasty) 3. Asthma ​ Triggers: Allergens, exercise, NSAIDs, GERD ​ Symptoms: Wheezing, dyspnea, cough, chest tightness ​ Management: ○​ Rescue Medications: Short-acting beta2-agonists (albuterol) ○​ Control Medications: Inhaled corticosteroids (fluticasone), leukotriene modifiers (montelukast) ○​ Emergency: Status asthmaticus requires immediate oxygen, IV steroids, bronchodilators 4. COPD (Chronic Obstructive Pulmonary Disease) ​ Types: ○​ Emphysema: Alveolar damage, air trapping, barrel chest ○​ Chronic Bronchitis: Mucus hypersecretion, chronic cough ​ Symptoms: Dyspnea, productive cough, cyanosis, clubbing ​ Management:  ○​ Medications: Bronchodilators (beta2-agonists, anticholinergics), corticosteroids ○​ Breathing Techniques: Pursed-lip breathing, diaphragmatic breathing ○​ Oxygen Therapy: Maintain SpO2 88-92% 5. Cystic Fibrosis (CF) ​ Cause: Autosomal recessive disorder affecting chloride transport ​ Symptoms: Thick mucus, frequent lung infections, pancreatic insufficiency, malnutrition ​ Management: ○​ Airway Clearance: Chest physiotherapy, postural drainage, mucolytics ○​ Nutrition: High-calorie, high-protein diet, pancreatic enzyme replacement ○​ Infection Prevention: Vaccinations, antibiotics III. Oxygen Therapy & Tracheostomy Care 1. Oxygen Therapy ​ Delivery Methods: ○​ Low-Flow: Nasal cannula (1-6 L/min), simple mask (5-10 L/min) ○​ High-Flow: Venturi mask, high-flow nasal cannula ○​ Noninvasive Ventilation: CPAP, BiPAP ​ Precautions: ○​ Oxygen toxicity (use lowest effective FiO2) ○​ Combustion risk (no smoking, grounded electrical equipment) 2. Tracheostomy Care ​ Indications: Airway obstruction, prolonged ventilation ​ Complications: ○​ Tube obstruction: Thick secretions (prevent with humidification, suctioning) ○​ Accidental decannulation: Keep spare trach tube available ○​ Infection: Sterile suctioning, site cleaning Study Guide: Vascular and Cardiac Conditions I. Vascular Problems in Pregnancy 1. Hypertension in Pregnancy ​ Risk Factors: First pregnancy, family history, age >35, chronic hypertension, obesity, diabetes, multifetal pregnancy ​ Gestational Hypertension: BP >140/90 after 20 weeks, resolves postpartum, no proteinuria 2. Preeclampsia & Eclampsia ​ Pathophysiology: Generalized vasospasm → decreased organ perfusion ​ Symptoms: Hypertension, proteinuria, edema, vision changes, liver dysfunction, headache ​ Management: Magnesium sulfate (prevent seizures), antihypertensives (hydralazine), fetal monitoring ​ HELLP Syndrome: Hemolysis, Elevated Liver enzymes, Low Platelets → medical emergency 3. Chronic Hypertension in Pregnancy ​ Management: Methyldopa, beta-blockers, calcium channel blockers (avoid ACE inhibitors) II. Heart Failure 1. Types of Heart Failure ​ Left-Sided HF: Pulmonary congestion, dyspnea, orthopnea, fatigue ​ Right-Sided HF: Peripheral edema, JVD, ascites, hepatomegaly ​ Systolic HF (HFrEF): EF 40%, poor ventricular filling 2. Compensation Mechanisms ​ SNS Activation: Increased HR, BP → worsens workload ​ RAAS Activation: Fluid retention → increased afterload ​ BNP Release: Vasodilation & diuresis response 3. Management  ​ Medications: ACE inhibitors, ARBs, beta-blockers, diuretics, digoxin ​ Lifestyle Modifications: Sodium restriction, fluid balance, daily weights III. Valvular Heart Disorders 1. Types of Valve Disorders ​ Mitral Stenosis: Pulmonary congestion, diastolic murmur ​ Mitral Regurgitation: Blood backflow, systolic murmur, fatigue ​ Aortic Stenosis: Narrow valve, LV hypertrophy, systolic murmur ​ Aortic Regurgitation: Backflow to LV, widened pulse pressure 2. Treatment ​ Non-Surgical: Beta-blockers, diuretics, ACE inhibitors, anticoagulation ​ Surgical: Valve replacement (mechanical or biological), balloon valvuloplasty IV. Hypertension & Peripheral Vascular Disease 1. Hypertension ​ Essential HTN: No identifiable cause, linked to genetics/lifestyle ​ Secondary HTN: Due to kidney disease, endocrine disorders, medications ​ Hypertensive Crisis: BP >180/120, risk of stroke, treated with IV antihypertensives 2. Peripheral Artery Disease (PAD) ​ Stages: Asymptomatic → Claudication → Rest pain → Necrosis ​ Symptoms: Pain, cool skin, weak pulses, ulcers ​ Management: Exercise, antiplatelets, revascularization 3. Peripheral Venous Disease (PVD) ​ Symptoms: Edema, stasis dermatitis, varicose veins, ulcers ​ Treatment: Compression stockings, leg elevation, wound care V. Congenital Heart Anomalies & Pregnancy 1. Heart Failure in Pregnancy ​ Class I & II: Activity modification, infection prevention ​ Class III & IV: Bed rest, oxygen, fetal monitoring ​ Medications: Heparin, digoxin, diuretics 2. Congenital Heart Defects ​ Acyanotic Defects (Left-to-Right Shunt): ASD, VSD, PDA, Coarctation of the Aorta ​ Cyanotic Defects (Right-to-Left Shunt): Tetralogy of Fallot, Transposition of Great Arteries, Hypoplastic Left Heart ​ Management: Prostaglandin E1 (PDA maintenance), surgical repair, digoxin, diuretics 3. Pediatric Heart Failure ​ Signs: Poor feeding, tachycardia, respiratory distress ​ Treatment: Oxygen (caution in L→R shunt), inotropes (digoxin), diuretics, vasodilators Study Guide: Anemia, Pregnancy, and Neonatal Conditions I. Anemia Overview 1. General Concepts ​ Definition: Decrease in red blood cell (RBC) count, hemoglobin (Hgb), or hematocrit (Hct), leading to reduced oxygen-carrying capacity. ​ Common Symptoms: Fatigue, dyspnea, palpitations, pallor, dizziness, jaundice (in hemolytic anemia). 2. Assessment & Diagnosis ​ History: Family history, medical conditions, diet, medications, menstrual history. ​ Physical Exam: ○​ Skin: Pallor, jaundice, brittle nails. ○​ Cardiac/Respiratory: Tachycardia, murmurs, dyspnea. ○​ Abdomen: Hepatosplenomegaly, GI bleeding signs. ○​ Neurologic: Fatigue, paresthesia (B12 deficiency). ​ Lab Tests:  ○​ CBC: Low RBC, Hgb, Hct. ○​ MCV & MCHC: ​ Microcytic (Low MCV): Iron deficiency, thalassemia. ​ Macrocytic (High MCV): B12 or folic acid deficiency. ​ Normocytic (Normal MCV): Aplastic anemia, acute blood loss. II. Types of Anemia 1. Blood Loss Anemia ​ Acute Hemorrhage: Trauma, GI bleeding, postpartum hemorrhage. ​ Chronic Blood Loss: Heavy menstruation, peptic ulcers, colorectal cancer. ​ Treatment: ○​ Fluid replacement (IV fluids, blood transfusion). ○​ Iron supplementation. 2. Hemolytic Anemias ​ Increased RBC destruction due to intrinsic or extrinsic factors. ​ Signs: Jaundice, splenomegaly, hyperbilirubinemia, dark urine. ​ Types: ○​ Sickle Cell Disease (SCD): ​ Autosomal recessive, Hgb S mutation. ​ Triggers: Hypoxia, dehydration, infection, stress. ​ Complications: Pain crisis, acute chest syndrome, stroke, priapism. ​ Management: Hydration, oxygen, pain control (opioids), hydroxyurea. ○​ Thalassemia: ​ Microcytic, hypochromic anemia due to defective hemoglobin production. ​ Treatment: Blood transfusions, iron chelation therapy. 3. Production Disorders ​ Iron Deficiency Anemia: ○​ Causes: Poor diet, blood loss, pregnancy, malabsorption. ○​ Labs: Low iron, low ferritin, high TIBC. ○​ Treatment: Oral iron (take on empty stomach, vitamin C enhances absorption). ​ Vitamin B12 Deficiency (Pernicious Anemia): ○​ Causes: Lack of intrinsic factor (pernicious anemia), vegan diet, malabsorption. ○​ Symptoms: Neuropathy, glossitis, dementia-like symptoms. ○​ Treatment: B12 injections or oral supplements. ​ Folic Acid Deficiency:  ○​ Causes: Poor diet, pregnancy, alcoholism, drugs (methotrexate). ○​ Complications: Neural tube defects in pregnancy. ○​ Treatment: Folic acid 400 mcg/day (600 mcg in pregnancy). ​ Aplastic Anemia: ○​ Bone marrow failure → pancytopenia (low RBC, WBC, platelets). ○​ Causes: Autoimmune, radiation, drug-induced. ○​ Treatment: Immunosuppressants, bone marrow transplant. III. Pregnancy-Related Blood Disorders 1. Rh Incompatibility & ABO Incompatibility ​ Rh- mother, Rh+ fetus → maternal antibodies attack fetal RBCs in future pregnancies. ​ Prevention: RhoGAM at 28 weeks & postpartum. ​ Complication: Erythroblastosis fetalis → severe anemia, hydrops fetalis. ​ ABO Incompatibility: Occurs if O mother carries an A, B, or AB baby → causes neonatal jaundice. 2. Neonatal Hyperbilirubinemia ​ Causes: Rh/ABO incompatibility, prematurity, hemolysis, breastmilk jaundice. ​ Treatment: ○​ Phototherapy: Converts bilirubin to water-soluble form. ○​ Frequent feeding: Promotes excretion. ○​ Exchange transfusion if severe. IV. Hypertension & Vascular Disorders 1. Hypertension Consequences ​ Organ damage: Stroke, MI, CHF, kidney failure, vision loss. ​ Crisis (BP >180/120): Requires IV antihypertensives. 2. Polycythemia (High RBC) ​ Primary (Polycythemia Vera): Bone marrow overproduction. ​ Secondary: Due to chronic hypoxia (COPD, high altitude). ​ Treatment: ○​ Phlebotomy (remove excess RBCs).  ○​ Hydration (to decrease viscosity). ○​ Aspirin (prevent clotting). V. Key Treatments & Nursing Considerations Condition Treatment Iron Deficiency Iron supplements, diet changes B12 Deficiency B12 injections/oral supplements Folic Acid Deficiency Folic acid supplements Sickle Cell Disease Hydroxyurea, hydration, oxygen, pain control Thalassemia Blood transfusions, iron chelation Aplastic Anemia Bone marrow transplant, immunosuppressants Rh Incompatibility RhoGAM, fetal monitoring Hyperbilirubinemia Phototherapy, hydration Hypertension Lifestyle changes, antihypertensives  Polycythemia Phlebotomy, aspirin, hydration Nursing Exam Study Guide: Congenital Heart Abnormalities I. Overview of Congenital Heart Defects (CHDs) ​ Definition: Structural defects in the heart present at birth, affecting blood flow. ​ Classifications: ○​ Acyanotic Defects: Left-to-right shunting (increased pulmonary blood flow or obstruction). ○​ Cyanotic Defects: Right-to-left shunting (decreased pulmonary blood flow or mixed circulation). II. Acyanotic Heart Defects (Left-to-Right Shunting) 💡 Key Feature: Oxygenated blood is abnormally recirculated back to the lungs, causing pulmonary congestion but not cyanosis. 1. Atrial Septal Defect (ASD) 🔹 Patho: Hole between atria → oxygenated blood flows from left to right atrium.​ 🔹 Symptoms: ​ Often asymptomatic in childhood. ​ Murmur: Systolic ejection murmur at the upper left sternal border. 🔹 ​ Fatigue, SOB, frequent respiratory infections.​ 🔹 Diagnosis: Echo shows defect.​ Treatment: ​ Small ASD may close spontaneously. ​ Larger defects require surgical patch closure or catheter-based closure. 2. Ventricular Septal Defect (VSD) 🔹 Patho: Hole between ventricles → left-to-right shunting increases pulmonary blood flow.​ 🔹 Symptoms: ​ Loud, harsh holosystolic murmur at left lower sternal border. ​ Poor feeding, failure to thrive (FTT). 🔹 ​ Pulmonary hypertension if untreated.​ 🔹 Diagnosis: Echo confirms defect.​ Treatment: ​ Small VSD may close on its own. ​ Large VSD: Surgical closure to prevent heart failure. 3. Patent Ductus Arteriosus (PDA) 🔹 Patho: Failure of the ductus arteriosus to close after birth → left-to-right shunting from aorta 🔹 Symptoms: to pulmonary artery.​ ​ Machinery-like murmur (continuous, systolic & diastolic). ​ Bounding pulses, widened pulse pressure. 🔹 ​ Frequent respiratory infections.​ 🔹 Diagnosis: Echo confirms PDA.​ Treatment: ​ Indomethacin (NSAID) may close PDA in premature infants. ​ Surgical ligation or coil occlusion for larger PDAs. 4. Coarctation of the Aorta (CoA) 🔹 Patho: Narrowing of the aorta → obstructs blood flow to lower body.​ 🔹 Symptoms: ​ High BP in upper extremities, low BP in lower extremities. ​ Weak or absent femoral pulses. 🔹 ​ Cold lower extremities, leg pain.​ 🔹 Diagnosis: BP comparison, Echo, X-ray shows "rib notching".​ Treatment: ​ Balloon angioplasty or surgical repair. III. Cyanotic Heart Defects (Right-to-Left Shunting) 💡 Key Feature: Deoxygenated blood bypasses the lungs, leading to cyanosis (blue discoloration). 1. Tetralogy of Fallot (TOF) 🔹 4 Defects: Pulmonary stenosis, Right Ventricular Hypertrophy, Overriding Aorta, 🔹 Symptoms: Ventricular Septal Defect (VSD).​ ​ Cyanosis (worsens with crying, feeding). ​ Tet Spells (hypercyanotic episodes) → relieved by knee-chest position. 🔹 ​ Boot-shaped heart on X-ray.​ 🔹 Diagnosis: Echo, SpO₂ monitoring.​ Treatment: ​ Surgical correction by 1 year of age. ​ Prostaglandin E1 (PGE1) to keep PDA open until surgery. 2. Transposition of the Great Arteries (TGA) 🔹 Patho: Aorta and pulmonary artery are switched → two separate circulations (deoxygenated 🔹 Symptoms: blood goes to body).​ ​ Severe cyanosis at birth, not improved by oxygen. ​ No murmur or minimal murmur. 🔹 ​ Egg-on-a-string heart on X-ray.​ Treatment: ​ Prostaglandin E1 (PGE1) to keep PDA open. ​ Atrial switch surgery (Mustard or Jatene procedure). 3. Tricuspid Atresia 🔹 Patho: Tricuspid valve missing → no blood flow from right atrium to right ventricle.​ 🔹 Symptoms: ​ Cyanosis, FTT. 🔹 ​ Murmur due to associated VSD/PDA.​ Treatment: ​ PGE1 to maintain PDA. ​ Three-stage surgical repair (Fontan procedure). 4. Hypoplastic Left Heart Syndrome (HLHS) 🔹 Patho: Underdeveloped left ventricle → right ventricle must pump for entire body.​ 🔹 Symptoms: ​ Severe cyanosis & shock when ductus closes.  🔹 ​ Weak pulses, cold extremities.​ Treatment: ​ PGE1 to keep PDA open. ​ Three-stage palliative surgery or heart transplant. IV. Nursing Interventions & Management 1. General Nursing Care ​ Monitor oxygenation & perfusion: Cyanosis, cap refill, clubbing. ​ Monitor fluid status: Risk for heart failure. ​ Optimize nutrition: Increased caloric needs due to high metabolism. ​ Cluster care: Minimize stress to reduce oxygen demand. ​ Parental support & education: Chronic condition management. 2. Medications Medication Indication Prostaglandin E1 (PGE1) Keeps ductus arteriosus open in cyanotic defects (TOF, TGA, HLHS) Indomethacin (NSAID) Closes PDA in preemies Diuretics (Furosemide, Reduces pulmonary congestion in left-to-right shunts Spironolactone) Digoxin Increases contractility in heart failure ACE inhibitors Reduces afterload in left-sided heart failure 3. Surgical Interventions  Procedure Indication Balloon Septostomy TGA (creates ASD to improve mixing) Blalock-Taussig TOF (palliative, increases pulmonary blood flow) Shunt Norwood Procedure HLHS (3-stage repair) Total Repair TOF, TGA, VSD (definitive treatment) V. Key Nursing Exam Points ✅ Recognize cyanotic vs. acyanotic defects.​ ✅ Know the murmur characteristics of each defect.​ ✅ Understand the role of PGE1 vs. Indomethacin.​ ✅ Differentiate Tet Spells from other cyanotic crises.​ ✅ Understand surgical interventions for major defects. 💡 PRO TIP: Mnemonic for Cyanotic Defects ("5 T's") 1️⃣ Tetralogy of Fallot​ 2️⃣ Transposition of Great Arteries​ 3️⃣ Tricuspid Atresia​ 4️⃣ Total Anomalous Pulmonary Venous Return​ 5️⃣ Truncus Arteriosus