Adult Health 1 Exam 3 PDF

Renal System Disorders Function: homeostasis - Regulate, filter, reabsorb, eliminate What is the anatomy of the renal system? - 2 kidney → filters waste - 2 ureter → transport urine to bladder - Bladder → holds urine - Urethra → eliminates What is urine? Urine formation - Filtration...

Renal System Disorders Function: homeostasis - Regulate, filter, reabsorb, eliminate What is the anatomy of the renal system? - 2 kidney → filters waste - 2 ureter → transport urine to bladder - Bladder → holds urine - Urethra → eliminates What is urine? Urine formation - Filtration at glomerulus - Absorption to capillaries - Reabsorption into tubule - Excretion into urine What is in urine? - Unilin, uric acid, urea, ammonia - bacterial toxin, creatine, vit. D - Erythropoietin, ANP hormone What are some diagnostic tests for the renal system? - Blood urea nitrogen - Creatinine, Creatinine clearance, Cystatin C - CT scan of Kidney, Cystometrogram, Cystoscopy - GFR, MRI, Angiogram - Bladder scan/Renal Scan - Biopsy, Urinalysis, Culture - Uroflowmetry What are the assessments for the real system? Physical assessment - Inspection, auscultation, percussion, palpation Questions to ask - Color, odor, amount changes in urine - Voiding habits, pas surgical procedures - Family, personal and current history Genetic disorders - APKD, diabetes, bladder cancer Ange related changes - GFR decreases, blood flow decreases - Renal reserve decreased, poor bladder What are some disorders found in the Urinary tract? Urinary Tract Infection - Colonization → uroepithelial penetration → ascension → pyelonephritis → acute kidney injury - Pathogen will enter urethra moves up the bladder - Bacteria makes biofilm + attack cells in bladder - Infection moves up to kidney, reduce urine - Infection in kidney - Kidney may get damaged if worsen - Risk factors - Glycosaminoglycan (GAG) - Geriatric, poor emptying of bladder - Infection or inflammation - Medical - Indwelling catheter, antibiotic, spermicide - Behavioral - Voiding dysfunction, sexual activity, - Anatomy - Vesicoureteral reflux, female gender, pregnancy - Genetic - Family hx, uroepithelial cell, vaginal mucus - Defenses for UTI - Urine → acidic ph, osmolality, rushing flow - Mucosa → cytokines/chemokines, mucosa, urethra length Pyelonephritis → inflammation of kidney - Acute Pyelonephritis - Bacterial infection of kidney - Risk factors - UTI, pregnancy, obstruction, trauma, kidney stone - Chronic diseases - Chronic pyelonephritis - Inflammation of kidney leading to kidney failure - Risk factors - UTI, kidney issues, HTN, obstruction - Manifestations - Pain or burning sensation when voiding - Increased urgency with urination - Diagnostic test - Urinalysis, gram stain, urine culture - WBC test, intravenous pyelography - Voiding, cystoscopy, manual examination - Treatment - Meds  - Short term antibiotics, IV meds - Surgery - Ureteroplasty - Ureteral reimplantation - Therapies - Homeopathy, aroma, herbal, cranberry juice - Nursing care - Relieve pain, fluids, increase voiding, avoid irritants Urinary calculi → kidney stone - May vary in location - Causes - Supersaturated urine forms crystals that sticks to each other - Calcium, uric acid, struvite, cystine - Risk factors - Low fluids, stasis, UTI, hypercalciuria, hyperparathyroid - 20-60 yrs old equal in male and female - Manifestations - Abdominal pain, blood in urine - Vomiting, fever and chills - Diagnostic test - Urinalysis, chemical analysis - Urine study, uric acid test, CT scan - Cystoscopy, look at calcium and phosphorus serum - Treatment - Increase fluids, cystography, lithotripsy, ureteroscopy, stents - Meds - Opioid analgesics, NSAID, stone passage meds, - Thiazide to decrease calcium and phos - Potassium citrate - Nursing care - Education on decreasing protein and sodium - Avoid purine high foods - Increase fluids, monitor ph, straining for stone passage Urinary reflux → incomplete bladder emptying result in urine backflow to ureter - Causes - Infection of transurethral, hematogenous, direct extension - Manifestations - Dysuria, increased frequency, urgency - Nocturia, pyuria, hematuria, UTI - Shock, back pain - Treatment - Medication and surgery  - Nursing care - Fluids, encourage voiding habits - Body’s defenses - Vesicoureteral junction - During voiding, pressure causes ureter to close Urinary tract tumor → cancer - Tumor growing within bladder prevents urine emptying - Risk factors - Tobacco, age, male, exposure - Manifestations - Blood, frequent painful or painless urination - Diagnostic test - scans - Treatment - Surgery, chemo, immunotherapy Urinary incontinence → inability to hold urine - Risk factors - Pregnancy, menopause, pelvis weakness - Incompetent, urethra, diabetes, storke - Disturbance, medication, lack of care - Types of incontinence - Stress - Urge - Reflex - Overflow - Functional - Iatrogenic - Mixed - Manifestations - Leaking urine, urgency to urinate - Diagnostic test - Urinalysis, culture, ultrasound - Post-void residual, uroflowmetry - Treatment - Medication - Stress is treated with duloxetine, estrogen - Urge is treated with dettol La - Overflow is treated with flomax - Surgeries - Bladder, sphincter, urethral sling, - Nursing care - Teach clients to avoid diuretic, irritants, constipation  - Void regularly, pelvic floor exercise, stop smoking Urinary retention → unable to pee or fully empty bladder - Causes - Mechanical obstruction, fecal impaction, voluntary, inflammation, UTI scarring, surgery, diabetes, drug meds - Manifestations - Firm, distended, incontinence, dull tone on percussion - Diagnostic test - Bladder scan - Treatment - Catheter - Cholinergic meds - Calculi removal - Nursing care - Voiding pattern importance, pain meds - Privacy, bedside commode, bath/show Neurogenic bladder → damage of nervous system linked to bladder function - Types - Spastic - Sensory and voluntary control - Flaccid - Muscle control spinal injury - Manifestations - Urinary incontinence, urinary frequency and urgency - Diagnostic test - Urine culture, urinalysis, bladder scan - Treatment - insert a cath - Medication - Anticholinergic, cholinergic - Surgery - Rhizotomy, urinary diversion, sphincter implant - Nursing care - Encourage fluids, PRN diet change - Void stimulation, empty bladder, meds and decrease risk What is a Urinary diversion? Types - Ileal conduit, bilateral urostomy, continent urinary diversion Complications to know - Wound infection, dehiscence, urinary leakage, obstruction - Hyperchloremic acidosis, stoma damage, renal calculi ileus  - Stenosis, renal deterioration, impaired urination - Impaired skin, body imagine, infection Management of the stoma - Be concerned for - Tumor, infection, UTI, renal calculi, worsten stoma - Post-op care - Pain control, monitor urine volume - color of drainage, vital signs - Throughout care - Irrigate 5-10 mL by MD’s order - Report abnormalities to MD - Wound care + right tools - Inspect for healthy soma (beefy red) - Avoid moisture - Inspect odors, pH < 6.5 - Urine sample as needed Lymphatic System Assessment and Disorders What is in the lymphatic system - Lymph, nodes, spleen, thymus, tonsil, Peyer patch (found in intestines) Assessing the peripheral vascular system - arteries/arterioles, capillaries, veins/venules, lymphatic vessels How do we determine the health of arterial circulation? - Blood flow, peripheral vascular resistance, MAP - Blood viscosity, vessel length/diameter - Sympathetic, renin-angiotensin - Temp, chemical, hormone, diet - Positioning, emotional state, exercise What is the difference between arteriosclerosis vs atherosclerosis? - Arteriosclerosis - Hardening of arteries - Muscle fiber/ endothelial lining - Atherosclerosis - Accumulation of lipid, calcium, blood, carbs and tissues in arteries What are some Lymphatic Disorders? What are some Blood pressure and important terms? - Normal → 100 - Cardiac output - Amount of blood pumped by heart in 1 min - Systemic vascular resistance - Pressure that allow blood flow - Pulse pressure - Systolic-diastlic - Mean arterial pressure - Pressure in arteries to deliver blood What is hypertension and how do we treat it? Hypertension → high blood pressure - Primary hypertension - Unidentified cause, essential hypertension - Secondary hypertension - Identified cause - Causes are usually underlying: kidney, aorta, endocrine, drug - Risk factors - Smoking, diabetes, dyslipidemia, renal function, obesity, inactivity - 55+ yrs old for M, 54+ yrs old for F - Family hx - Organs of concerns - Heart → MI risk - Stroke or TIA - Kidney disease, artery disease - Retinopathy - Diagnosing the disorder - Primary - ECG, UA, blood glucose, K, Cr, Ca, Hct levels - Cholesterol - Secondary - Renal function, UA, CT/MRI. Blood, IVP. Renal test - Follow-up exams - Normal → 2 yrs - Prehypertension → 1 yrs - Stage 1 → 2 months - Stage 2 → ASAP - Assessments - Family hx, risk factors, symptoms of other organs, cardiovascular health - Lifestyle, support/compliance - Gerontologic considerations for treatment - Compliance level, support, education - Treatment - Lifestyle modification  - Weight loss, decrease alcohol/sodium - Regular activity, increase fruit, veg, low fat - DASH diet (veg, fruit, whole grain, low fat) What is a hypertensive crisis? - BP >180/120 - Must be lowered or risk organ damage - Treatment - Reduce 25% in first hr - Reach 160/120 within 6hr - Gradual reduction → unless gradual reduction overtime - Frequent monitoring of BP and heart - Medication - IV vasodilator, sodium nitroprusside, - Nicardipine, enalapril, nitroglycerin What is a hypertensive urgency? - BP is high but no risk for organ damage - Treatment - Monitor BP + cardiovascular - Assess for damage - Medication - Beta-adrenergic blocker, angiotensin-converting - Enzyme inhibitor, alpha2-agonists Hemolytic system Disorders and Assessment What are the functions of blood? - Transport nutrients from GI to body - Transport oxygen from lung to body - Transport waste, hormones, warmth for body - Electrolyte, acid-base balance - Osmotic regulation What are the different types of blood? Hematopoiesis - Blood is developed from bone marrow - Proliferation differentiation change to type of blood Erythrocyte RBC - Small circular disk, 120 day lifespan - Hemoglobin, oxygen Leukocyte WBC - Multiple shapes, 2 different groups - No hemoglobin, defense mechanism What are some lab work and exams important to blood? - CBC → complete blood count - Looks at overall health - Anemia, leukemia, infection - Measures - RBC, WBC, hemoglobin, hematocrit - platelets, volume, weight, amount - CBC with differential - Looks at different types of WBC - Erythrocyte Sedimentation Rate ESR - Looks for inflammation - Bone Marrow Aspiration and Biopsy - Looks at bone marrow to help diagnose progression or treat bone marrow - Anemia, myelodysplastic syndrome, cancer, infections What are some lab work and exams important to heart and peripheral system - Blood pool imaging, cardiac-cath - CXR, CT, MRI, TEE, MRA, ESR - Echocardiogram, electrocardiogram, - Treadmill test, thallium stress test - PET scan, pericardiocentesis - Nuclear persantine, Bone marrow scan Assessment - Subjective data - economic, past hx, habits, nutrition, symptom hx - Physical assessment - Pain, pallor, pulse, paralysis, - paresthesia, peripheral pulse What are peripheral vascular diseases? Manifestations - Intermittent claudication, pain at rest, paresthesia, decrease in peripheral pulse - pallor/Rubor, shiny skin, hairless skin, decoloration, skin breakdown Complication - Gangrene, amputation, rupture of aortic aneurysm, infections, sepsis Risk factors - Diabetes, smoking, hypercholesterolemia, HTN, increase homocysteine Diagnosis - Pressure measurement, stress test, doppler, duplex US, angiography Treatment - Stop smoking, footcare, exercise, decrease in cholesterol, weight loss - Meds - Antiplatelets, decrease in viscosity, parenteral vasodilator, prostaglandins  - Surgical - Endarterectomy, bypass graft Nursing care - Urine output, CVP, pulse, volume - Hematoma formation, possible compartment syndrome What are some Peripheral Vascular Diseases and how do you treat them? Thromboangiitis obliterans (Buerger disease) → inflammation resulting in clots - Risk factors - Smokers, asians - Manifestations - Pain, claudication, ulcer/gangrene - Diagnosing - Hx, physical, doppler, MRI, angiography - Treatment plans - Surgery - Sympathectomy, arterial bypass graft - Nursing care - Circulation, prevent hypoxia, education Raynaud’s Disease → arterial vaso-occlusion in fingertips/toes - Risk factors - Smoking, injury, living in a cold climate - Manifestations - Color change, numbness, tingling, burning pain - Diagnosing - Hx, physical - Treatment plans - Warm hands, diet/exercise - Decreasing stress, no smoking - Avoid injuring self, manage body weight - Meds - Vasodilators, nitroglycerine, calcium channel blocker - Alpha-adrenergic blockers - Nursing care - Prevention of exposure to cold, stress, smoking Acute arterial occlusion → blood clot in arterial - Risk factors - Age, smoking, obesity, sedentary life, history - Manifestations - Tissue ischemia, paresthesia, cyanosis/mottling - paralysis/spasms  - Diagnosing - Looking at S/S, arteriography - Treatment plans - Surgery - Thrombo-endarterctomy - Embolectomy - Meds - Anticoagulation, thrombolytics - Nursing care - Pain, exercise, monitor wounds for healing Thrombophlebitis (venous thrombosis) → blood clot in veins resulting in inflammation - Risk factors - Hospitalization, immobility, cancer, trauma, pregnancy, oral BC - Manifestations - Virchow’s triad - Stasis of blood, decreasing vessel, increasing coagulability - Calf pain, chronic venous insufficiency - Pulmonary embolism, superficial vein thrombosis - Diagnosing - MRI, venous, ultrasounds - Treatment plans - Compressed veins, bedrest, TEDs - Surgery - Thrombectomy, greenfield filter - Meds - NSAIDs, anticoagulant, Thrombolytics - Low-weight heparin - Nursing care - Anticoagulant, pain management, clot care/control Chronic venous insufficiency → decrease venous return overtime - Risk factors - DVT, varicose veins, leg trauma - Manifestations - Edema, discomfort/pain, thin/shiny brown skin - Weeping dermatitis, thick subcutaneous fat, ulcers - Diagnosing - Doppler, trendelenburg test - Treatment plans - Meds → Corticosteroids, zinc oxide, miconazole, clotrimazole - Nursing care - Evaluation of leg Varicose veins → damaged veins - Risk factors - pregnancy/women, aging - Prolonged standing, malformation - Concerns - Venous insufficiency, status ulcers, chronic dermatitis - Manifestations - Aching pain, leg fatigue, heaviness, dilated veins - Discolor skin with ulcers - Diagnosing - Doppler, trendelenburg test - Treatment plans - Surgery - Ligation, stripping, laser/ablation - Treatment - Compression, walking, avoid prolonged sitting, leg elevation - Nursing care - Avoid prolonged standing, compression Lymphadenopathy → inflammation resulting pressure to tissue - Risk factors - - Manifestations - Enlarged lymph nodes - Diagnosing - Lymphangiography - Lymphoscintigraphy - Treatment plans - skin/foot care, antibiotics, diuretics, surgery - Nursing care Peripheral arterial insufficiency → build up of fatty deposit in arteries - Risk factors - Smoking, high BP, diabetes, high cholesterol - Manifestations - Pain at rest, weak pulse, ulcers, color changes - Diagnosing - Assessment → health hx, meds - Treatment plans - Quit tobacco, balanced diet, manage cholesterol - Nursing care - Regular physical activity Cardiovascular system Disorders What is the anatomy of the heart, and how does the heart beat? Anatomy review - 3 layers of the heart - Endocardium - Myocardium - Epicardium - 4 chambers - Heart valves - Systole → pulmonary + aortic valves - Diastole → tricuspid + mitral valves Conduction of the heart - SA node, AV node, Bundle of His, R/L branch, Fibers What are some cardiac terms to know? Depolarization → shift in electric charge allowing for negative charge inside the cell Repolarization → shift in electric charge allowing for positive charge inside the cell Refractory periods → recovery period Cardiac output → liters per minute of blood pumped by the heart Stroke volume → liters of blood pumped out by the left ventricle Preload → degree of ventricular stretch at end of diastole Contractility → heart’s ability to contract Afterload → pressure needed to eject blood Ejection fraction → function of heart ability to eject blood What do you look for in a cardiovascular assessment? - Pulse rate - Speed - Pulse rhythm - Sinus arrhythmia, EKG - Character - Volume, weak/strong, shock, volume, irregularity - Cardiac rate/rhythm - Tachy (fast), Brady (slow), dysrhythmia - Heart sounds - Abnormal, murmur, splitting - Skin - Any changes color, texture, ulcers - Extremities → upper - Cap refill, pulses, vein/arteries - Extremities → lower - Pulses, vein/arteries What are some changes to the cardiovascular effects caused by aging? - Decreased myocardial efficiency - Decreased sinus node, bone marrow - Left ventricle changes - Increased blood pressure - Decreased immune system What are some cardiac disorders and how do we treat them? Heart failure → inability to pump blood to meet needs  - Risk factors - CAD, diabetes, high blood pressure, obesity - Concerns - Systolic dysfunction, diastolic dysfunction - Chronic HTH, CAD, Atherosclerosis, diabetes - Valvular issue - Types of Heart Failures and manifestations - Systolic → weaken heart muscle - Decrease in contraction - Unable to eject blood - Diastolic → stiff heart muscle - Stiff heart muscles - Unable to fill heart - Left-side → lung issue - HTN/CAD, Low O2, oliguria - Pulmonary congestion - S3→ ventricular gallop - Dyspnea, orthopnea, dry cough - Right-side → body issues - Edema, increased weight - JVD, congestion - Diagnosing - Atrial natriuretic factor, brain natriuretic peptide - Serum electrolytes, urinalysis - Liver function, thyroid function test - ABG, CXR, electrocardiography - Treatment plan - Meds - Beta blocker, diuretic, calcium-channel blocker - Digitals, hydralazine, isosorbide, anticoagulants - Statin, NSAIDs - Nursing care - Assessments - Health hx, sleep, activity, mental status - lung sounds, fluids and weight - Med care - Given on time, K+ with thiazide/loop diuretics - Check volumes, glucose, serums, - Avoid sunlight and reactions Fluid Volume Excess → too much fluid in body - Risk factors - Fluid increase, sodium diet, renal and kidney issues - Manifestations - Anxiety, BP changes, abnormal breath sounds, heart problems - Diagnosing - Weight gain, edema, dyspnea - Treatment plans - Diuretics, vasodilators, changing systolic blood pressures - Nursing care - Assessments - Fluid overload, weight - Education for clients - Med, exercise, stress, infection - Diet → low sodium and fluid restriction - Monitor → excess fluid, hypotension, sodium, weight Pulmonary Edema → fluid buildup  - Left ventricle cannot handle overload of blood volume causing pressure to increase and fluid backed up back into the lungs - Risk factors - - Manifestation - Restlessness, anxiety, dyspnea, orthopnea, cool/clammy skin - Cyanosis, weak/rapid pulse, lung congestion - Productive cough, decreased LOC, increased sputum - Diagnosing - CXR, ABG, O2 levels, PAWP - Hemodynamic, pulmonary artery wedge, pressure - Treatment plans - Management - prevention/early detection - Monitor lung sounds, upright patient, dangle legs, decrease stress - Meds - Oxygen → facemask, non rebreather, CPAP, ventilation - Diuretic → furosemide, bumetanide, metolazone - Vasodilator → nitroglycerine, nitroprusside - Other meds → morphine, aminophylline - Nursing care Cardiomyopathy → heart disease - Risk factors - - Types of cardiomyopathy - Dilated → common - Unknown cause, show onset of dysrhythmia - Atrial chamber → size increased - Ventricle chamber → size increased - Decreased muscle - Hypertrophic → decreased left ventricle - Increased O2 demand and contractility - Thicken septum - Decreased ventricle chamber - Left ventricle Hypertrophy - Restrictive → rigid wall impair - Decreased exercise tolerance - Dyspnea - Left ventricle hypertrophy - Manifestation - Impaired CO, heart failure, sudden death, dysrhythmias - Diagnosing - Echocardiogram, ECG, CXR - Hemodynamic, cardiac catheterization - Coronary angiography, myocardial biopsy - Treatment plans - Medications - ACE inhibitor, vasodilator, digitalis - Beta blocker, anticoagulants, antidysrhythmic - Surgery - Cardiac transplant, ventricular assist, removal of extra tissue - Peacemaker, cardioverter-defibrillator - Nursing care - Identity causes, regulate meds, low-sodium/fluid restriction - Exercise Coronary atherosclerosis → necrosis of coronary due to lack of O2 - Inflammation or lipid accumulation in vessels - Necrosis, lack of o2, chest pain, MI, STEMI risk - Risk factors - rupture/erosion of plague, Coronary artery spasm - Vessel obstruction, inflammation of arteries - Nonmodifiable - Family Hx of CAD, Age increased, gender, race - Modifiable - Smoking, diabetes, metabolic, obesity, inactivity, Diet - Types of Atherosclerosis - Angina - Stable → predictable, relieved by rest - Unstable → not relieved by rest - Intractable → incapacitating - Variant → pain at rest, reversed by elevation - Silent → no pain, EKG - Stemi - Semi → complete block - Nonstemi → partial obstruction - Manifestations - Chest pain, episodes of pain/pressure in chest - Due to blood flow, exertion or stress, Dyspnea - pain located in neck, jaw, shoulder, left arm - Diagnosing - ECG, creatine kinase, myoglobin, CXR - Cholesterol serum, troponin, echocardiogram - Coronary angiography, stress test, TEE - Treatment plans - Stop activity + rest, assess vitals, pain, ECG - Monitor BP, HR, meds - Meds - Statins, antiplatelet, anticoagulants, calcium blocker - Beta blocker, ace inhibitor - Nursing care Acute MI - Risk factors - Manifestations - Diagnosing - Cardiac biomarker, cholesterol panel - BNP, coagulation panel, CXR - Assessment - IV, vitals care - 12-lead ECG - Catch lab (PCI) - Treatment plan - Nursing actions What are the cholesterol ranges you should know? - LDL - Optimal 190 - HDL  - High/low risk >60 - Low/high risk - Male