Study Guide: Exam 2 Questions and Answers Best Exam Solution RATED A+, Exams of Nursing

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Study Guide: Exam 2 Questions and Answers Best Exam Solution RATED A+ Perfusion: • Infective endocarditis: S&S o Infection of the heart’s inner lining (endocardium) or the heart valves which causes damages and destroy the heart’s endocardium and heart valves o Once in the bloodstream, bacteria travel through the heart and attach to any insult that the heart may already have encountered o Etiology: ▪ IV drug users ▪ Surgery ▪ Dental procedures ▪ Artificial heart valve ▪ Previous endocarditis ▪ Rheumatic fever ▪ Congenital heart defects ▪ Heart Valve defects ▪ Streptococcal pharyngitis o Clinical Manifestations: ▪ Vague infection findings-esp early ▪ Low Blood pressure ▪ Malaise ▪ Fever ▪ Night sweats ▪ Fatigue ▪ Anorexia/Weight loss ▪ Cough ▪ Back pain ▪ Heart murmurs (new or changed) ▪ Retinal hemorrhages (Roth spots) ▪ Janeway lesions (feet) ▪ Oslers’nodes (hands) ▪ Petechiae ▪ Headaches/Reduced concentration ▪ Development of HF (and the s/sx that come with it) ▪ Positive blood cultures ▪ Systemic embolization ▪ Confusion • Right sided HF: o Etiology ▪ Left sided failure ▪ Chronic lung disease ▪ Congenital heart disease ▪ Primary pulmonary HTN ▪ Heart valve disease ▪ Right ventricular MI. o S/Sx: ▪ Increased volume and pressure develop in the venous system = peripheral edema • Left sided HF: o Left ventricle failure starves body of oxygen and nutrients o Causes: ▪ Chronic coronary artery blockage ▪ HTN ▪ Excessive alcohol use ▪ MI ▪ Hypothyroidism ▪ Infection o Formally known as CHF o Acute or Chronic, Mild to severe o Subtypes ▪ Systolic HF:(squeezing) • Reduced EF (EF is the percentage of blood ejected from the heart during systole, as it decreases perfusion diminishes. Normal EF is greater than 50%) results when the heart cannot contract forcefully enough during systole to eject adequate amounts of blood into circulation, decreased stroke volume, low EF, less than 40%, vital organs do not get oxygenated blood ▪ Diastolic HF: (filling/resting phase) • Left ventricle cannot relax adequately during diastole (too stiff to fill). • Inadequate relaxation or stiffening” prevents the ventricle from filling with sufficient blood to ensure adequate output, normal EF o S/Sx ▪ Pulmonary congestion ▪ Pharmacology: • Antiplatelet aggregating agetns: Aspirin, Plavix • HMG-CoA inhibitors (statins): Simvastatin, Pravastatin, Atorvastatin • Fibrates: Tricor • Nicotinic acid: Niacin (integrative health) • Omega-3 ethyl esters (Lovaza) adjunct to diet to lower TGs and increase HDL • PAD: S&S o Disorders that change the natural flow of blood through the arteries/veins of the peripheral circulation o Decreases perfusion to body tissues o Risk Factors ▪ Advancing Age (men over 50, postmenopausal women) ▪ HTN ▪ Hyperlipidemia ▪ Obesity ▪ Smoking ▪ Familial predisposition ▪ DM ▪ Stress ▪ Decreased Activity o Clinical Manifestation by Stage ▪ Stage I: Asymptomatic • No claudication • Bruit or aneurysm • Pedal pulses decreased/absent ▪ Stage II: Claudication • Muscle pain/cramping/burning with exercise, relieved with rest • Reproducible with exercise • “Intermittent claudication” ▪ Stage III: Rest Pain • Pain while resting, awakens pt at night • Pain = numbness/burning, toothache-type pain • Occurs in distal part of the extremity • Relieved by placing the extremity in a dependent position ▪ Stage IV: Necrosis/Gangrene • Ulcers/blackened tissue in the toes/forefoot/heel • Distinctive gangrenous order present ▪ Other • Loss of hair on lower calf/ankle/foot • Dry, scaly, dusky, pail or mottled skin • Thickened toenails • Cold, gray/blue extremity • MVP: S&S • Labs: o Potassium ▪ 3.5-5.5 o LDL/HDL ▪ Bad/Good o Blood glucose ▪ >125 = DM o INR ▪ Monitor with warfarin therapy • Sickle cell: interventions for pain o IV pain medications • Hemophilia A: o Hemophilia A (classic)-Factor VIII deficiency. 80% of cases o Clinical Manifestations/Assessment ▪ Joint/Muscle hemorrhages causing pain ▪ Easy bruising ▪ Prolonged, potentially fatal hemorrhage after trauma/surgery ▪ Hemarthrosis (untreated bleeding into the joint) ▪ Can cause severe limitation of ROM o Diagnostic Tests ▪ Plt levels ▪ Factor assay tests ▪ Coag tests (aPTT, PT) o Treatment/Interventions ▪ Hemophilia treatment center ▪ Monitoring clotting factors levels ▪ Replacement of factor deficiency-Factor VIII or IX concentrates ▪ Blood products-FFP, cyroprecepitates ▪ Assess for bleeding ▪ Safety ▪ Pain control for join pain ▪ Education for patient and family ▪ Psychosocial needs • TB: S&S, meds (INH, Rifampin) o Clinical Manifestations ▪ Clinical symptoms may be absent (esp. latent) ▪ 2 or more weeks of cough, fever, weight loss ▪ Night sweats ▪ Weakness, ▪ Chills ▪ Hemoptysis (with progressive disease) o Diagnostic Tests ▪ Tuberculin Skin Tests (Mantoux, PPD) ▪ Evaluated 48-72 hours after injected ▪ Patients may be positive if: exposed to the Mycobacterium TB, had TB perviously that has been successfully treated, has been immunized for the TB with the BCG vaccine, is sick with TB ▪ T-Spot (serum lab) ▪ CXR ▪ Sputum Culture o Treatment/Interventions ▪ Goal: Prevent further spread to the community ▪ Education: patient and family ▪ Pharmacology-adherence is key: ▪ Isoniazid (INH ▪ Rifampin (RIF ▪ Ethambutol (EMB) ▪ Pyrazinamide (PZA) • Aortic Aneuysm: S&S Gas Exchange: • Meds: o Albuterol-Beta-adrenergic agonists • Mgmt of sleep apnea o Collaborative Care o Sleep study to observe sleep apnea o Completing the STOP-Bang Sleep Apnea Questionnaire (chapter 29) o Mutation in a gene that produces protein responsible for movement of chloride and sodium ions through the cell membrane (cystic fibrosis transmembrane conductance regulator, CFTR). o Clinical Manifestations ▪ Purulent secretions lead to bronchial plugging and inflammation causes bronchial wall thickening over time and airway destruction=bronchial infections ▪ Productive cough ▪ Wheezing ▪ Dyspnea ▪ Recurrent infections ▪ Bronchiectasis ▪ Infiltrates ▪ Scarring (CXR) ▪ Increased chest circumference ▪ Hyperresonance with percussion ▪ Apical crackles o Non-pulmonary ▪ Clubbing ▪ Gassiness ▪ Diabetes ▪ Pancreatic insufficiency ▪ Pancreatitis ▪ Meconium ileus ▪ Diarrhea ▪ Abnormal sweat chloride concentrations ▪ Infertility o Treatment/Interventions ▪ Referral to regional CF center ▪ Focus: clearance and reduction of lower airway secretions, prevention, treatment of resp tract infections, pancreatic enzyme replacement and adequate PO intake, psychosocial support. ▪ Surgery-lung transplant, long wait-list ▪ Nutrition: • Pancreatic Enzymes • Monitor for bulky, foul-smelling stools=malabsorption • Give adequate salt • TF/parenteral nutrition • Daily weight • Pneumothorax: S&S o Collect of air in the pleural cavity-leads to a collapse of all or part of the lung o Etiology ▪ Smoking ▪ Family hx ▪ Trauma ▪ Pulmonary disease o Clinical Manifestations ▪ Sudden onset ▪ Pleuritic chest pain on affected side ▪ Dyspnea ▪ Tachypnea ▪ Tachycardia ▪ Hypotension ▪ Respiratory distress ▪ Air hunger ▪ Tracheal deviation (tension pneumo) ▪ Anxiety o 4 types of Pneumothorax ▪ Spontaneous-occurs suddenly, can be primary or secondary (COPD, asthma) ▪ Traumatic-blunt physical trauma, penetrating and non penetrating (steering wheel post MVA) ▪ Iatrogenic-Procedure complications (bx) ▪ Tension-Pressure of air in the pleural space exceeds the ambient pressure(CPR, lung infection) • Lung cancer: S&S o Cough o Weight Loss