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NR603 Week 3 Case Study Guide, Study Guides, Projects, Research of Nursing

Harvard University Nursing

NR603 Week 3 Case Study GuideNR603 Week 3 Case Study Guide

Typology: Study Guides, Projects, Research

2023/2024

Available from 04/26/2024

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Chapter 8

Functions of the Skin:

•Acts as the first line of defense

•Prevents excess fluid loss

•Controls body temperature

•Active in sensory perception

•Synthesizes vitamin D

Pruritus:

•Itching

oAllergic responses, Type I sensitivity

oChemical irritation caused by insect bites

oParasite infestations

Pruritus Causes:

•Release of histamine in a hypersensitivity response

Effects of Pruritus:

•Redness and itching – inflammation

•Risk of infection due to scratching

Causes of Contact Dermatitis:

•Allergic contact dermatitis

oExposure to an antigen

oSensitization occurs on first exposure

▪Type IV cell-mediated hypersensitivity

oPruritic rash develops at site a few hours after exposure

•Irritant Contact Dermatitis

oInflammatory because of direct exposure

oDoes not involve immune response

oRemoval of irritant

oReduction of inflammation with topical glucocorticoids

Urticaria (hives) Causes:

•Ingestion of substances, release histamine

•Examples: shellfish, drugs, certain fruits

•Result of type I hypersensitivity

Urticaria Effects:

•Eruption of hard, raised erythematous lesion

•Often scattered all over the body

•Highly pruritic

•Check for pharyngeal mucosa and check airway

oAdminister EpiPen or other first aid required

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Chapter 8 Functions of the Skin:

Acts as the first line of defense
Prevents excess fluid loss
Controls body temperature
Active in sensory perception
Synthesizes vitamin D Pruritus:
Itching o Allergic responses, Type I sensitivity o Chemical irritation caused by insect bites o Parasite infestations Pruritus Causes: - Release of histamine in a hypersensitivity response Effects of Pruritus:
Redness and itching – inflammation
Risk of infection due to scratching Causes of Contact Dermatitis:
Allergic contact dermatitis o Exposure to an antigen o Sensitization occurs on first exposure ▪ Type IV cell-mediated hypersensitivity o Pruritic rash develops at site a few hours after exposure
Irritant Contact Dermatitis o Inflammatory because of direct exposure o Does not involve immune response o Removal of irritant o Reduction of inflammation with topical glucocorticoids Urticaria (hives) Causes:
Ingestion of substances, release histamine
Examples: shellfish, drugs, certain fruits
Result of type I hypersensitivity Urticaria Effects:
Eruption of hard, raised erythematous lesion
Often scattered all over the body
Highly pruritic
Check for pharyngeal mucosa and check airway o Administer EpiPen or other first aid required

Psoriasis Causes:

Chronic inflammatory skin disorder o Onset usually in the teenage years o Psoriasis results from abnormal T cell activation
Psoriasis results from abnormal T cell activation o The rate of cellular proliferation is increased o Thickening of the dermis and epidermis Effects of Psoriasis:
A silvery plaque while the base remains erythematous
Lesions on face, scalp, elbows, knees
Itching or burning sensations Treatment of Psoriasis:
Glucocorticoids, tar preparations, antimetabolites Cellulitis (erysipelas):
Infection of the dermis and subcutaneous tissue Cellulitis Causes:
Secondary to an injury
Staphylococcus aureus or streptococcus Effects of Cellulitis:
Frequently in lower trunks and legs
Area becomes red, swollen and painful
Red streaks may develop; running along lymph vessels proximal to infected area Herpes Simplex Type 1:
Oral herpes o Cold sores or fever blisters Effects of HSV-1:
Painful oral ulcer Herpes Simplex Type 2:
Genital herpes Effects of HSV-2:
Genital vesical ulcer Herpes Simplex Virus: - Virus remains latent in sensory ganglia - Recurrence may be triggered by o Common cold, sun exposure, stress

Pediculosis:

Lice
Female lice lays eggs on hair shafts
After hatching, louse bites human host, sucking blood for production of ova
Excoriations result from scratching
Close contact transmission Squamous Cell Carcinoma:
Painless, malignant tumor of the epidermis
Lesions most commonly found on exposed areas of the skin but also in oral cavity o Face and neck o Base of tongue
Tumor gros sloly
Rarely metastasize to distant site Malignant Melanoma:
Highly metastatic form of cancer
Develops in melanocytes o From a nevus (mole)
Often appear as multicolored lesion with irregular border o Grow quickly o Change in shape, size, color and texture o May bleed Treatment of Malignant Melanoma:
Surgical removal and radiation plus chemotherapy ABCD of Melanoma:
Appearance
Border
Color
Diameter
Evaluation Kaposi’s Sarcoma : - Occur in those with AIDS and other immunodeficiency - May affect viscera as well as skin - Malignant cells arise from endothelium in small blood vessels o Purplish macules o Nonpruritic, nonpainful - Immunocompromised patients o Lesions develop rapidly over upper body

Treatment of Kaposi’s Sarcoma:

Combination of radiation, chemotherapy, surgery, biological therapy Diagnostic Tests for Skin Lesions:
Culture and staining
Biopsy
Blood test
Skin testing o Patch or scratch method Chapter Thirteen Functions of the Respiratory System:
Transport oxygen from air to blood o O2 important for cellular metabolism
Removal of CO2 from the blood o CO2 is a waste product from metabolism
Upper respiratory tract o Respiratory mucosa
Lower respiratory tract o Sterile Ventilation:
Process of inspiration and expiration
Air always moves from high pressure area to low pressure area o Inspiration ▪ Moves air from atmosphere to lungs ▪ Atmospheric pressure higher than pressure in alveoli o Expiration ▪ Air moves from lungs into atmosphere ▪ Pressure in alveoli higher than in atmosphere Tidal Volume:
Amount of air entering lungs with each normal breath Residual Volume:
Amount of air remaining in the lungs after forced expiration Vital Capacity:
Maximal amount of air expired following a maximal inspiration Primary Control:
Centers for breathing
Located in the medulla and pons

Sputum:

Normal secretions are relatively thin, clear and colorless or cream color
Abnormal sputum o Yellow-green, thick tenacious mucus, hemoptysis Eupnea:
Normal rate (10-18 inspirations per minute) Tachypnea:
Rapid superficial breathing Bradypnea:
Slow respiratory rate Apnea:
Cessation of breathing Kussmaul Respirations:
Labored respiration or prolonged inspiration or expiration Wheezing or Whistling Sounds:
Obstruction in small airways Stridor:
High-pitched crowing noise
Usually indicates upper airway obstruction Rales:
Light bubbly or crackling sounds with serous secretions Ronchi:
Deeper or harsher sounds from thicker mucous Absence:
Nonaeration or collapse of lungs Dyspnea:
Subjective feeling of discomfort o Feels unable to inhale enough air
Short of breath either on exertion or at rest
Severe dyspnea indicative of respiratory distress o Flaring of nostrils o Use of accessory respiratory muscles o Retraction of muscles between or above ribs Orthopnea:

Dyspnea occurs when lying flat Parxysmal Nocturnal Dyspnea:
Sudden acute type of dyspnea Cyanosis: - Bluish coloring of skin and mucous membranes - Caused by large amounts of unoxygenated hemoglobin in blood Pleural Pain:
Results from inflammation or infection of parietal pleura Friction Rub:
Soft sound produce as the rough membrane against each other
Pleural imflammation Clubbed Fingers:
Result from chronic hypoxia associated with respiratory or cardiovascular disease
Painless, firm, fibrotic enlargement at the end of the digit Hypoxemia:
Inadequate oxygen in blood Hypoxia:
Inadequate oxygen supply to the cells
Fatigue, lethargy or stupor, and muscle weakness
Extreme hypoxia can result in cell death
Result of cerebral hypoxia which stimulates SNS
Compensation mechanisms o Tachycardia and increased blood pressure Acid-Base Imbalance:
Respiratory acidosis due to excessive carbon dioxide
Respiratory alkalosis due to increased RR such as anxiety Cause of Common Cold:
Viral infection Common Cold:
Spread through respiratory droplets, highly contagious
Hand-washing and respiratory hygiene important in prevention Effects of Common Cold:
Mucous membranes of the nose and pharynx are red and swollen
Increase secretion

Exudate contains fibrin and forms a consolidated mass
Exudate produces rusty sputum Pleurisy:
Pleuritic pain Hypoxia - May develop respiratory acidosis Pneumonia Manifestations:
Sudden onset
Systemic signs
Dyspnea, tachypnea, tachycardia – oxygen defecit
Pleural pain
Rales
Productive cough
Confusion or disorientation Tuberculosis:
Caused by mycobacterium tuberculosis
Mycobacterium is acid fast, aerobic, slow growing bacillus Tuberculosis Occurs In:
People living in crowded conditions
Immunodeficiency
Others: HIV infection, homeless area, malnutrition, etc… Primary Tuberculosis Infection:
When organism first enters the lungs Latent Infection:
The individual has been exposed to the bacillus and infected but does not have active disease and is asymptomatic Secondary or Re-Infection of Tuberculosis:
Reactivated – due to decrease host resistance Active TB (primary or secondary):
Organisms multiply, forming large areas of necrosis – cavitation
Cough, positive sputum, radiograph shows cavitation
Cavitation promotes spread to other parts of the lung Signs and Symptoms of Tuberculosis:
Weight loss, low grade fever, night sweat, cough anorexia Tuberculosis Diagnostic Tests:
Skin test results

o Type IV cell mediated hypersensitivity reaction – mantoux test

Active infections o Acid-fast sputum test o Chest x-ray o Sputum culture and sensitivity Cystic Fibrosis:
Inherited (genetic) disorder
Thick secretion, tenacious mucus from the exocrine glands
Primary effects seen in lungs and pancreas Cystic Fibrosis in the Lungs:
Mucus obstructs airflow in bronchioles and small bronchi
Permanent damage to bronchiole walls
Infections are common due to o Stagnant mucus o Commonly caused by pseudomonas aeruginosa and staphylococcus aureus Digestive Tract Cystic Fibrosis:
Meconium ileus in newborns o Small intestine of neonate is blocked by mucous at birth, preventing the excretion of meconium
Blockage of pancreatic and bile ducts o Malabsorption and malnutrition Sweat Glands Cystic Fibrosis:
Sweat has high sodium chloride content
Most conclusive test for diagnosis Signs and Symptoms of Cystic Fibrosis:
Meconium ileus may occur at birth
Salty skin: skin test
Signs of malabsorption: steatorrhea, abdominal distention
Chronic cough and frequent respiratory infections
Failure to meet normal growth milestones Diagnosis of Cystic Fibrosis:
Sweat test
Genetic testing
Stool test o Fat content and trypsin
Radiography, pulmonary function test
Blood gas analysis

Intrinsic Asthma:

Onset during adulthood
Hyperresponsive tissue in airway initiates attack Pathophysiology of Asthma:
Inflammation of the mucosa with edema
Bronchoconstriction
Increased secretion of thick mucous
Changes create obstructed airways, partial or total Signs and Symptoms of Asthma:
Cough, dyspnea, tight chest
Wheezing
Thick or sticky mucous
Hypoxia, tachycardia
Respiratory alkalosis/acidosis
Severe respiratory distress Status Asthmaticus:
Persistent severe attack of asthma
Medical emergency
Does not respond to usual therapy
May be fatal because of hypoxia and acidosis Chronic Obstructive Pulmonary Disease:
Group of chronic respiratory disorders that are characterized by progressive tissue degeneration and obstruction in the airways of the lung o Examples: emphysema and chronic bronchitis
Debilitating conditions that may affect individuals ability to work and function independently
May lead to the development of cor pulmonale
Respiratory failure may occur Emphysema:
Breakdown of alveolar wall o Leads to large, permanently inflated alveolar air spaces
Fibrosis and thickening of the bronchial walls
Progressive difficulty with expiration o Air trapping and increased residual volume o Overinflation of the lungs o Increased anterior-posterior diameter of thorax (barrel chest)
Advanced emphysema and loss of tissue o Pneumothorax o Hypercapnia o Hypoxia o Frequent infections

o Pulmonary hypertension and cor pulmonale Etiology of COPD Emphysema:

Smoking or genetic factors S&S of COPD:
Dyspnea
Hyperventilation with prolonged expiratory phase o Development of barrel chest
Anorexia, fatigue, weight loss
Clubbed fingers Diagnostic Test of COPD:
Chest radiography and pulmonary function tests Chronic Bronchitis:
Significant change in bronchi o Inflammation, obstruction, repeated infection, chronic coughing Etiology of Chronic Bronchitis:
Constant irritation from smoking or exposure to inhaled irritants Signs and Symptoms of Chronic Bronchitis:
Constant productive cough, tachypnea, SOB
Frequent thick and purulent secretions
Hypoxia, cyanosis, hypercapnia – caused by airway obstruction
Polycythemia, weight loss, signs of cor pulmonale possible Restrictive Lung Disorders:
Group of disorders with impaired lung expansion and reduced total lung capacity First Group of Restrictive Lung Disorders:
Abnormality of chest wall – limits or impairs lung expansion o Kyphosis or scoliosis, poliomyelitis, amyotrophic lateral sclerosis, botulism, muscular dystrophy Second Group of Restrictive Lung Disorders:
Diseases affecting the supporting framework of lungs o Idiopathic pulmonary fibrosis, occupational diseases Pulmonary Edema: - Fluid collecting in alveoli and interstitial o Reduces amount of oxygen diffusing into blood o Interferes with lung expansion Etiology of Pulmonary Edema:
Heart failure

Etiology of Pleural Effusion:

Exudative effusions: result from inflammation
Hydrothorax: result from increased hydrostatic pressure or decreased osmotic pressure in blood vessels
Hemothorax: result from trauma, cancer or surgery S&S of Pleural Effusion:
Dyspnea
Chest pain
Increased respiratory and heart rates Pneumothorax:
Air in pleural cavity Closed Pneumothorax:
Air can enter pleural cavity from internal airways – no opening in chest wall Open Pneumothorax:
Atmospheric air enters the pleural cavity through an opening in the chest wall Tension Pneumothorax:
Most serious form of medical emergency
Air entry into pleural cavity on inspiration but hole closes on expiration
Severe hypoxia and respiratory distress develop quickly
Pressure increases on the affected side eventually push the mediastinal contents against the other lung Adult Respiratory Distress Syndrome:
Results from injury to the alveolar wall and capillary membrane o Multitude of predisposing conditions S&S of Adult Respiratory Distress Syndrome:
Marked sign: dyspnea
Restlessness
Rapid, shallow respirations
Increased HR
Combination of respiratory and metabolic acidosis Acute Respiratory Failure: - End result of pulmonary disorders - Severe hypoxia o Pao2 is less than 50 mmHg - Hypercapnia o PaCO2 is greater than 50 mmHg

- Serum pH is decreasing Spirometry:

Pulmonary function test
Tests pulmonary volumes and airflow times Arterial Blood Gas Determination:
Checks oxygen, carbon dioxide, bicarbonate, serum Ph Oximetry:
Measures O2 saturation Exercise Tolerance Testing:
For patients with chronic pulmonary disease Radiography:
Helpful in evaluating tumors and infections Bronchoscopy:
Perform biopsy
Check site of lesion or bleeding Culture and Sensitivity Tests:
Sputum testing for presence of pathogens
Determine antimicrobial sensitivity of pathogen Chapter Ten Circulatory System:
Consists of the cardiovascular system and lymphatic system
Blood vessels Arteries:
Arterioles
Transport blood away from the heart Veins:
Venules
Return blood back to heart Capillaries:
Microcirculation within tissues Systemic Circulation:
Exchange of gases, nutrients and wastes in tissues Pulmonary Circulation:

Can receive: Type O and A Type B:
RBC Antigens: B
Antibodies in plasma: A
Can Receive: Type O and B Type AB:
RBC Antigens: A and B
Antibodies in plasma: None
Can Receive: Type O, A, B, or AB Anemia:
Causes a reduction in oxygen transport
Basic problem is hemoglobin deficit
Oxygen deficit leads to o Less energy production in all cells o Tachycardia and peripheral vasoconstriction – compensation mechanisms General Signs of Anemia:
Fatigue, pallor, dyspnea, tachycardia
Decreased regeneration o Digestive tract becomes inflamed and ulcerated, leading to stomatitis o Inflamed and cracked lips o Dysphasia o Hair and skin may show degeneration changes
Severe anemia may lead to angina or CHF Iron Deficiency Anemia:
Insufficient iron impairs hemoglobin synthesis o Microcytic (small cell), hemochromic (less color) RBCs Iron Deficiency Anemia Etiology:
Dietary intake of iron below minimum requirement
Chronic blood loss
Impaired duodenal absorption of iron
Severe liver disease: iron absorption/storage S&S of Iron Deficiency Anemia:
General signs of anemias o Pallor, fatigue, lethargy, and CNS stimulation (hypoxia)
Spoon shaped and rigid nails, brittle hair
Stomatitis, glossitis, menstrual irregularities, delayed healing

Pernicious Anemia (B12 Deficiency):

Basic problem is lack of intrinsic factor o Intrinsic factor secreted by gastric mucosa, required for intestinal absorption of Vitamin B
Characterized by very large, immature, nucleated erythrocytes
B12 is needed for the function and maintenance of neurons Etiology of B12 Anemia:
Dietary insufficiency
Malabsorption o Chronic gastritis, common in alcoholics and causes atrophy of the gastric mucosa or inflammation condition
Surgery, such as gastrectomy B12 Deficiency Anemia S&S:
General signs of anemia
Tongue is typically enlarged, red, sore and shiny
Digestive discomfort, often with nausea and diarrhea
Feeling of pins and needles, tingling in limbs Aplastic Anemia:
Impairment or failure of bone marrow leading to loss of stem cells and pancytopenia o Pancytopenia: decreased numbers of erythrocytes, leukocytes and platelets in the blood Etiology of Aplastic Anemia:
Myelotoxins: radiation, industrial chemicals, drugs
Others: genetic abnormalities, hepatitis C, SLE, etc… S&S Aplastic Anemia:
Blood counts indicate pancytopenia
Anemia signs
Leukopenia (recurrent infection)
Thrombocytopenia (petechiae) Cause of Sickle Cell Anemia:
Genetic condition o Autosomal recessive disorder o More common in individuals of African Sickle Cell Anemia:
Abnormal hemoglobin
Sickle cell crisis occurs when O2 levels are lowered o Lung infection or dehydration
Sickle-shaped cells have shorter lifespan

NR603 Week 3 Case Study Guide, Study Guides, Projects, Research of Nursing

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