NUR 2571 / NUR2571: Professional Nursing II / PN 2 Exam 2 Study Guide (Latest 2021 / 2022, Study Guides, Projects, Research of Nursing

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NUR2571: Professional Nursing II / PN 2 Exam 2 Study Guide ASTHMA * Characterized by exacerbations of acute airway inflammation « Airway obstruction occurs d/t bronchoconstriction, mucous, or inflammation whenexposed to trigger Clinical Manifestations: « High pitched, wheezing lung sounds * Cough + SOB * Chest tightness + Worsens at night or when triggers are present Medications: « Short Acting= Albuterol, Proventil, Ventoli + Long Acting= Serevent ¢ Corticosteroids= Serevent, Advair Education: + Avoid triggers + Stop/avoid smoking ¢ Teach which inhaler is rescue Exacerbation Interventions: « Give short-acting beta agonist + IV corticosteroids depending on severity * O2 via nasal cannula + High-fowler’s position * Calm atmosphere Questions: If a pt. is having an asthma attack how would you expect it to affect their VS? + At first RR increased then decreased as attack progresses * Tachycardia >120 * Decreased BP If you give a pt. Albuterol, what type of side effects would you expect to see? « Increased HR * Tremors What are rescue medications for Asthma? + Short-acting beta agonists (Albuterol) EPITAXIS « Nose bleed — d/t trauma, allergies, drug use * Most frequent ED complaint Interventions & Treatment: + Anterior portion of nose = apply direct pressure for 5-10 while leaning forward « Apply silver nitrate « Apply lidocaine/ep with cotton pledge for 5-10 minutes « Nasal packing for 2-5 days NUR2571: PROFESSIONAL NURSING II / PN 2 EXAM 2 STUDY GUIDE | + Educate on prevention — Vaseline, humidifiers COPD * Chronic obstructive pulmonary disease -emphysema & chronic bronchitis * Causes= air pollution, occupation, smoking Primary Symptoms: * Cough « Sputum production * DOE -— Dyspnea On Exertion Clinical Manifestations: « Wheezes or crackles heard in lungs ¢ Prolonged expiratory phase « Distant heart sounds * Orthopneic position * Barrel chest « Use of accessory muscles + Weight loss (dyspnea with eating) + Late phase= clubbing to nails, right-sided HF, chronic cyanosis Medications: + Avoid frequent use of cough suppressants (antitussives) because coughing is a protective mechanism « Limit narcotic use d/t respiratory depression can worsen hypercapnia * Beta-Adrenergic Agonists: Albuterol, formoterol + Anticholinergics: Atrovent, Spiriva * Corticosteroids: short course only ¢ Methylxanthines: Theophylline (limited) Interventions & Education: ¢ Pursed lipped breathing * Controlled coughing * Controlled O2 therapy (1-2 L) + Low sodium diet « Diaphragmic breathing * Conserve energy + Small frequent meals * Increase fluids + BiPAP RAYNAUD’S DISEASE ¢ Bilateral vasospasms; peripheral artery occlusive disease triggered by cold &stress Clinical Manifestations: « Pain & cyanosis followed by redness and pain (when warmed up) * Pain is intermittent, extremities are numb & cold & may have swelling/ulcerations Education: + Stop smoking + Exercise NUR2571: PROFESSIONAL NURSING II / PN 2 EXAM 2 STUDY GUIDE | « Daily weight NUR2571: PROFESSIONAL NURSING II / PN 2 EXAM 2 STUDY GUIDE | Iron supplements PNEUM IA Acute or chronic infection of one or both lungs caused by bacteria or virus Risk Factors: Increased age Immunocompromised Diabetes CHF Active malignancies Chronic diseases (i.e. sickle cell anemia) Clinical Manifestations: Fever/chills « Headache Productive or dry cough * Mood swings Tachycardia « Anorexia Cyanosis ¢ Pleuritic chest pain Joint pain/aches * Dyspnea Hypotension * Crackles in lungs Diagnostics: CBC Chest x-ray Treatment: Antibiotics Possible O2 Pneumonia vaccine Rest & fluids Incentive spirometer, cough & deep breathing BUERGER’S DISEASE Occlusive disease mostly in small/medium arteries Associated with clot formation and fibrosis of vessel wall Cause/Education: Smoking — especially young male smokers Stopping smoking will stop disease progression Clinical Manifestations: Thickened nail beds Intermittent claudication Cramps in legs after exercise Blackish ulcerations on skin Extreme sensitivity to hot & cold Pain in digits Weak/thread peripheral pulses Diagnostics: Plethysmograph studies of the digits (early stages) Doppler U/S Arteriograms - extent of disease process NUR2571: PROFESSIONAL NURSING II / PN 2 EXAM 2 STUDY GUIDE | NUR2571: PROFESSIONAL NURSING II / PN 2 EXAM 2 STUDY GUIDE | Avoid smoking & heavy lifting No gargling —can irritate surgical site AORTIC ANEURYSM Permanent bulging and stretching of an artery — dilated 2x or greater in size Most common = Abdominal Aortic Aneurysm (AAA) Risk Factors: Hypertension = #1 risk Smoking Hyperlipidemia AAA Clinical Manifestations: Nausea/vomiting Back pain d/t pressure on spinal nerves Pulsation in upper abdominal midline Auscultation of a bruit at aneurysm site - DO NOT palpate Thoracic Aorta Clinical Manifestations: Severe back pain-compression of surrounding tissues Bronchial obstruction & hoarseness Dyspnea & dysphasia Aphonia-r/t pressure on laryngial nerve Pulsating mass about suprasternal notch Diagnostics: X-ray to identify the location of the mass CT scan Duplex Ultrasonography Transesophageal Echocardiography - thoracic aneurysms Treatment: Anti-hypertensives Anti-anxiety medications Surgery for aneurysms >6cm or are rapidly growing Aneurysms <6cm monitor with ultra sound every 6 months HEMOPHILIA Hereditary bleeding disorder resulting in deficient clotting factors (VIL, IX, & X) Hemophilia A= VII deficient, from mothers to sons Hemophilia B= Christmas disease, from mothers to sons Hemophilia C= IX deficient, autosomal recessive Von Willebrand’s disease Clinical Manifestations: Joint & muscle pain Hemorrhages Bruises easily Complications: Untreated joint bleeding can cause permanent damage Diagnostics: Platelet levels Factor assay tests NUR2571: PROFESSIONAL NURSING II / PN 2 EXAM 2 STUDY GUIDE | * Coagulation tests NUR2571: PROFESSIONAL NURSING II / PN 2 EXAM 2 STUDY GUIDE | HEART FAILURE Heart cannot efficiently pump blood throughout the body — heart doesn’t fill withenough blood or pump with enough force Compensates by increasing HR which dilates ventricles (increased HR = decreased cardiac output) Diastolic HF: Inability to relax, causes decrease in ventricular filling Systolic HF: Inability of the ventricles to contract and pump blood adequately More common — r/t aging d/t stiffness of vasculature Left-Sided HF: Reduced capacity to pump blood into systemic circulation Decreased CO and stasis or “backup” of fluid into pulmonary circulation Left-Sided Causes: ¢ Left-Sided Symptoms: Hypertension + Dyspnea on exertion Alcoholism + Orthopnea MI * Cough w/ pink sputum Coronary artery blockage * Crackles, wheezes Hypothyroidism * Cyanosis Heart infection « New S3 (ventricle gallop), heart murmur *« Pulmonary edema Right-Sided HF: Reduced capacity to pump blood into pulmonary circulation Causes stasis or “backup” of fluid in venous circulation Right-Sided Causes: ¢ Right-Sided Symptoms: Pulmonary hypertension * IVD Congenital heart diseases + Dependent edema in LE Heart valve diseases « Abdominal discomfort Chronic lung diseases (COPD, + Nausea from fluid congestion Cystic Fibrosis) ¢ Irregular heart rate Left HF « Enlarged liver + Weight gain NUR2571: PROFESSIONAL NURSING II / PN 2 EXAM 2 STUDY GUIDE | Isosorbide Decrease BP Anticoagulants & Antiplatelet: HF, DCM, Arteriosclerosis & Atherosclerosis, Thrombophlebitis Heparin, Lovenox, Coumadin, Aspirin, Plavix Prevent cardiac events Not primary tx of HF DILATED CARDIOMYOPATHY (DCM) Disease of heart muscle resulting in dilated heart chamber (balloon expanding) Decreases force in heart contraction Leads to weak & thin heart wall — similar to right & left HF Associated with CHD, heart valve disease, & HTN Clinical Manifestations: SOB Lung congestion Dependent edema Fatigue Palpations Syncope Chest pain Diagnostics: EKG Cardiac catheter= heart tissue biopsy Medications: ACE inhibitors Beta blockers Diuretics Anticoagulants Antiarrhythmics INFECTIVE ENDOCARDITIS Destructive infection of the heart’s inner lining (endocardium) or the heart valves Etiology/Causes: Surgery, dental procedures Artificial heart valve Rheumatic fever NUR2571: PROFESSIONAL NURSING II / PN 2 EXAM 2 STUDY GUIDE | * Congenital heart defects + Heart Valve defects NUR2571: PROFESSIONAL NURSING II / PN 2 EXAM 2 STUDY GUIDE | Streptococcal pharyngitis Clinical Manifestations: Vague infection findings Malaise Anorexia, weight loss Cough Back pain Heart murmurs Retinal hemorrhages (Roth spots) Petechiae Headaches Diagnostics: * Serial Blood cultures= to identify microorganism ECHO Treatment: Long-term IV antibiotics Possible surgery HYPERTENSION The harder the heart muscle works the greater the pressure on heart wall Defined as BP > 140/90 on two separate readings, at two different times Normal BP= 120/80 Pre-Hypertension= 120/80 - 139/89 Stage I Hypertension= 140/90 — 159/99 Stage II Hypertension= > 160/100 Cuff bladder width= 40% of arm circumference Cuff bladder length= 80%-100% of arm circumference Modifiable Risk Factors: Sedentary lifestyle Smoking Obesity, physical inactivity Stress Drug abuse Caffeine High-fat diet Excessive alcohol intake (3+ drinks/day) Non-Modifiable Risk Factors: Family history African-American decent More common in Males until age 55 Age 65+ Clinical Manifestations: “Silent Killer” Fatigue Dizziness Angina Palpitations NUR2571: PROFESSIONAL NURSING II / PN 2 EXAM 2 STUDY GUIDE | + Laser-assisted angioplasty and atherectomy NUR2571: PROFESSIONAL NURSING II / PN 2 EXAM 2 STUDY GUIDE | Bypass grafts Amputation Diagnostics: Doppler pulses to assess for blood flow Ankle-brachial index (ABI)= measures ratio of lower to upper extremity BP Ultrasound Treat-mill testing Arterio-angiograms= identify advancement/location of claudication TUBERCULOSI Cough lasting 2+ weeks Weight loss — 3lbs/week considered significant Fever, night sweats Weakness Hemoptysis — progressed stage Medication: Given in different combinations that are tailored to pt. individual infection Isoniazid, Rifampin, Pyrazinamide, Ethambutol ARTERI ATHERO-SCLEROSI Arteriosclerosis: hardening of the small arteries Atherosclerosis: accumulation of plaque in large arteries Pathophysiology: An accrual of lipids, calcium, blood, carbohydrates, fibrous tissue located on theintimal layer of the vessel Risk Factors: Increased age Men typically develop earlier than women African & Mexican-American Hypertension High cholesterol Physical inactivity Stress Obesity Tobacco Diabetes Mellitus Clinical Manifestations: Hypertension Heart disease Prolonged capillary refill Temp differences in extremities Cold extremities Bruits Nursing Assessment: Bilateral B/P readings Apical & radial pulse checks Need gravity to get increased circulation to lower extremities NUR2571: PROFESSIONAL NURSING II / PN 2 EXAM 2 STUDY GUIDE | « Diagnostics: NUR2571: PROFESSIONAL NURSING II / PN 2 EXAM 2 STUDY GUIDE |