NUR2571 Professional Nursing II PN 2 Exam 2 Study Guide, Exams of Nursing

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NUR2571: PROFESSIONAL NURSING II / PN 2 EXAM 2 STUDY GUIDE | 1 • 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 1 NUR2571: Professional Nursing II / PN 2 Exam 2 Study Guide ASTHMA NUR2571: PROFESSIONAL NURSING II / PN 2 EXAM 2 STUDY GUIDE | 2 • 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 2 NUR2571: PROFESSIONAL NURSING II / PN 2 EXAM 2 STUDY GUIDE | 5 • Daily weight 5 NUR2571: PROFESSIONAL NURSING II / PN 2 EXAM 2 STUDY GUIDE | 6 • Iron supplements • PNEUMONIA • 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 • Productive or dry cough • Tachycardia • Cyanosis • Joint pain/aches • Hypotension • Diagnostics: • CBC • Chest x-ray • Treatment: • Antibiotics • Possible O2 • Pneumonia vaccine • Rest & fluids • Incentive spirometer, cough & deep breathing • BUERGER’S DISEASE • Headache • Mood swings • Anorexia • Pleuritic chest pain • Dyspnea • Crackles in lungs • 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 • 6 NUR2571: PROFESSIONAL NURSING II / PN 2 EXAM 2 STUDY GUIDE | 7 • • 7 NUR2571: PROFESSIONAL NURSING II / PN 2 EXAM 2 STUDY GUIDE | 10 • 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 (VII, 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 10 NUR2571: PROFESSIONAL NURSING II / PN 2 EXAM 2 STUDY GUIDE | 11 • Coagulation tests • 11 NUR2571: PROFESSIONAL NURSING II / PN 2 EXAM 2 STUDY GUIDE | 12 • • • 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: • Hypertension • Alcoholism • MI • Coronary artery blockage • Hypothyroidism • Heart infection • • Right-Sided HF: • Left-Sided Symptoms: • Dyspnea on exertion • Orthopnea • Cough w/ pink sputum • Crackles, wheezes • Cyanosis • New S3 (ventricle gallop), heart murmur • Pulmonary edema • Reduced capacity to pump blood into pulmonary circulation • Causes stasis or “backup” of fluid in venous circulation • Right-Sided Causes: • Pulmonary hypertension • Congenital heart diseases • Heart valve diseases • Chronic lung diseases (COPD, Cystic Fibrosis) • Left HF • • Right-Sided Symptoms: • JVD • Dependent edema in LE • Abdominal discomfort • Nausea from fluid congestion • Irregular heart rate • Enlarged liver • Weight gain 12 NUR2571: PROFESSIONAL NURSING II / PN 2 EXAM 2 STUDY GUIDE | 15 • 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 15 16 • • Congenital heart defects Heart Valve defects NUR2571: PROFESSIONAL NURSING II / PN 2 EXAM 2 STUDY GUIDE | 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 17 NUR2571: PROFESSIONAL NURSING II / PN 2 EXAM 2 STUDY GUIDE | • Laser-assisted angioplasty and atherectomy 20 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 • TUBERCULOSIS • 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 • • ARTERIO & ATHERO-SCLEROSIS • 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 21 NUR2571: PROFESSIONAL NURSING II / PN 2 EXAM 2 STUDY GUIDE | • Diagnostics: 22