Exam 2- DISEASES Flashcards
asthma
heterogenous disease characterized by a combo of bronchial hyperresponsiveness with reversible expiratory airflow limitation
pathophysiology of asthma
exposure to allergens or irritants triggers the inflammatory cascade involving a variety of inflammatory cells; inflammation leads to bronchoconstriction, hyperresponsiveness, and edema of airways leads to limited airflow
what changes occur to the lungs because of asthma?
fibrosis, smooth muscle, hypertrophy, musuc hypersecretion, angiogenesis
progressive loss of lung function
what are the risk factors from asthma?
genetics, baby’s immune system must be conditioned to function. stress
what are the clinical manifestations of asthma?
wheezing, coughing, dyspnea, and chest tightness
what happens during an acute attack of asthma?
wheezing; initially expiration then with progress both inspiration and expiration
what lung sounds might you hear from asthma?
decreased/absent breath sounds with exhaustion or inability to have enough muscle force for breathing
silent chest
ominous sign; severe airway obstruction or impending respiratory failure; may be life-threatening or need a ventilator
hyperventiliation
increased lung volume from trapped air and limited airflow
abnormal alveolar perfusion and ventilation
hypoxemic, decreased PaCO2, increased pH
what are the complications of asthma?
pneumonia, tension pneumothorax; status asthmaticus; acute respiratory failure
status astmaticus
extreme acute asthma attack that DOES NOT IMPROVE with regular bronchodilators or corticosteroids
what are the symptoms of status asthmaticus?
hypoxia, hypercapnia, acute respiratory failure, chest tightness, short shallow breaths, wheeze/no air movement, cough, sweating, difficulty talking/breathing
what is the emergency treatment for status asthmaticus
intubation and mechanical ventilation; hemodynamic and monitoring; analgesia and sedation; IV magnesium sulfate (works as bronchodilator
what are the diagnostic studies of asthma?
peak expiratory flow rate; peak flow meter; spirometry; chest x-ray; sputum culture and sensitivity
what are the asthma classifications?
all patients should have an asthma action plan for acute attacks and to prevent further attacks
interprofessional care for asthma patient
achieve and control; return to the best possible level of daily functioning
mild-moderate asthma attack interprofessional care
inhaled bronchodilators and oral corticosteroids; monitor vitals; monitor as outpatient unless not responding to treatment; follow up with HCP
severe asthma attack symptoms
alert and oriented but focused on breathing; tachycardia, tachypnea; accessory muscles being used; tripod position; symptoms interfere with ADLs
severe asthma attack treatments
supplemental O2 and oximetry
PaCO2 >60 mmHg or SaO2 >93%
drug therapy of asthma
quick relief or rescue medications; bronchodilators; anti-inflammatory drugs; long-term control medications
what are the priority problems of asthma?
impaired breathing; activity intolerance; anxiety; lack of knowledge
acute bronchitis
self-limiting inflammation of bronchi caused by viruses
what is the diagnosis for bronchitis?
breath sounds- crackles or wheezing on expiration but CXR is normal
what are the triggers of bronchitis?
pollution, chemical inhalation, smoking, chronic sinusitis, and asthma
what are the symptoms of asthma?
cough, clear/purulent sputum, headache, fever, malaise, dyspnea, and chest pain
what are the treatment goals of bronchitis?
symptom relief and prevent pneumonia
cough suppressants, oral fluids, humidifier; throat lozenges, hot tea; bronchodilator inhaler; wear mask to limit allergen exposure; if due to flu, use antivirals; see HCP if patient has fever, dyspnea, or > 4 weeks; avoid irritants and smoking
bordetella pertussis
gram-negative bacteria attached to cilia, releases toxins results in inflammation
what is the diagnosis for pertussis?
nasopharyngeal cultures, polymerase chain reaction (PCR0 of nasopharyngeal secretions (rapid test), or serology testing
what are the manifestation stages of pertussis?
stage 1: (1-2 weeks) low grade fever, runny nose, watery eyes, general malaise, and mild nonproductive v=cough
stage 2: (2-10 weeks) paroxysms of cough
stage 3: (2-3 weeks) less severe cough, weak
what are the hallmark characteristics of pertussis?
uncontrollable, violent cough with “whooping” sound from trying to breathe in air against an obstructed epiglottis
what is the treatment for pertussis?
ATBs
what else is important about pertussis?
contagious from stage 1 until 5 days after taking ATBs; routine and droplet precautions; don’t use cough suppressant, antihistamine results in coughing episode; don’t use corticosteroids or bronchodilators because it is ineffective
chronic obstructive pulmonary disease (COPD)
preventable, treatable, often progressive disease characterized by persistent airflow limitation;
associated with chronic inflammatory response in the airways and lungs primarily caused by cigarette smoking and other noxious particles and gases
what is the pathophysiology of COPD?
characterized by chronic inflammation of airways, lung parenchyma (bronchioles and alveoli) and pulmonary blood vessels;
the defining feature is airflow limitation that is not fully reversible during forced exhalation due to loss of elastic recoil, airflow obstruction due to mucous hypersecretion, mucosal edema, and bronchospasm
what is the disease progression of COPD?
abnormalities in air flow limitation; air trapping; gas exchange; impaired or destroyed lung tissue exists alongside normal tissue
severe disease of COPD
pulmonary hypertension; systemic manifestations
what is the primary process of COPD
inflammation
as air trapping increases, alveolar walls are destroyed resulting in formation of bullae and blebs
what are the main risk factors of COPD?
cigarette smoking and infection
what occurs in the respiratory system from cigarette smoking?
hyperplasia of cells, lost/decreased ciliary activity; abnormal distal dilation and destruction of alveolar walls; precancerous cells developing chronic, enhanced inflammation
passive smoking
decreased pulmonary function; increased respiratory symptoms; increased risk of lung and nasal sinus cancer
what are the clinical manifestations of COPD?
chronic cough, sputum production, dyspnea, chest heaviness/tightness, chest breather, wheezing, fatigue, weight loss/anorexia; prolonged expiratory phase, pursed lip-breathing, barrel- chest, tripod position, peripheral edema, hypoxemia, hypercapnia, increased RBCs, hemoglobin concentrations
what are the complications of COPD exacerbation?
accessory muscle use, cyanosis, unstable BP, right side heart failure, change in mentation, decreased breath sounds
what are the complications of COPD cor pulmonalle?
chronic inflammation and pulmonary vascular changes results in pulmonary hypertension resulting in right side heart failure
right side heart failure
response to constriction of pulmonary vessels in response to the alveolar hypoxia
signs of COPD cor pulmonalle
dyspnea, crackles at base, systolic murmurs, distended neck veins, hepatomegaly, right upper quadrant tenderness, peripheral edema, weigh gain, increased BNP level
treatment for COPD cor pulmonalle
O2, diuretics, anticoagulant therapy
what are the diagnostic studies for COPD?
spirometry
interprofessional care of COPD
most treated as outpatient, evaluate for exposure to environmental/occupational irritants, flu vaccine annual, pneumococcal vaccine (every 5 years)
interprofessional care with O2 treatment for COPD
combustion, CO2 narcosis, O2 toxicity, and infection
pneumonia
acute infection of lung parenchyma (alveoli and bronchi-gas exchange);
associated with significant morbidity and mortality rates
etiology of pneumonia
defense mechanisms of the lungs become incompetent or overwhelmed
what are the 3 ways organisms reach the lungs with pneumonia?
aspiration
inhalation
hematogenous spread
what are the classifications of pneumonia?
community-acquired
hospital-acquired
ventilator-associated
empiric antibiotic therapy
what are the different types of pneumonia?
viral; bacterial; mycoplasma; aspiration; opportunistic
aspiration pneumonia
abnormal entry of oral/gastric material in lower airway
what are the major risk factors of aspiration pneumonia?
decreased LOC, difficulty swallowing, insertion of nasogastric tubes with or without feeding, aspirated material triggers inflammatory response, primary bacteria most common, aspiration of acid reflux causes chemical pneumonitis
what are the clinical manifestations of pneumonia?
cough; fever and chills; dyspnea and tachypnea; pleuritic chest pain; lethargy; accessory muscle gland use; nasal flaring; asymmetric chest movement; tachycardia
what are the complications of pneumonia?
multi-drug resistant; atelectasis; pleurisy; pleural effusion; bacteremia; pneumothorax; acute respiratory failure; lung abscess; empyema; sepsis
what are the diagnostic studies for pnuemonia?
chest x-ray; thoracentesis/bronchoscopy; pulse oximetry; leukocytosis; ABGs; sputum gram-stain, culture, and sensitivity; blood cultures
what is the interprofessional care of pneumonia?
pneumococcal vaccine; prompt treatment with antibiotics; supportive care; viral pneumonia- no definitive treatment
what treatment do you give for bacterial community-acquired pneumonia?
initial empiric therapy; antibiotics
arterial blood gases
measure of O2 compliance against the arterial walls
what are the priority problems for pneumonia?
impaired gas exchange; impaired breathing; fluid imbalance; hyperthermia; activity intolerance
primary tuberculosis
bacteria are inhaled, inflammatory response occurs; if adequate immune response infection doesn’t progress to disease
active tuberculosis
primary (active) TB disease within 2 years of infection; reactivation TB (post-primary)- disease occurs >2 years after primary infection
latent tuberculosis
infected (positive skin test) but not active disease; asymptomatic; noninfectious; may develop active TB later; important to treat to prevent active TB
multidrug-resistant tuberculosis
resistance to two of the most potent first-line anti-TB drugs
what are the two most potent drugs for TB?
isoniazid and rifampin (turns urine orange)
what are the causes for multi-drug resistant TB?
incorrect prescribing; lack of public health case management; nonadherence; lack of funding for education and prevention
what are the diagnostic studies for TB?
tuberculin skin test; bacille-calmett-guerin vaccine; interferon-y release assays-screening tools; chest x-ray; bacteriologic studies
interprofessional care of tuberculosis
infectious for first 2 weeks after starting treatment; aggressive drug therapy (must monitor adherence); airborne isolation (negative pressure room)
what is the drug therapy of pneumonia?
taken between 8 weeks-13 months: isonizad, rifampin, pyrazinamide; ethambutol
what is a major side effect from the drug therapy used for pneumonia?
non-viral hepatitis
allergic rhinitis
inflammation of nasal mucosa due to seasonal or perennial allergen; exposure leads to IgE and inflammation
what are the clinical manifestations of allergic rhinitis?
my allergic reactions; pale, boggy, swollen turbinates
what is the management of allergic rhinitis?
corticosteroids; decongestants; immunotherapy
acute viral rhinopharyngitis
common cold; contagious- airborne droplets or contact; can survive 3 days on inanimate objects
what are the symptoms of acute viral rhinophrayngitis?
runny nose; watery eyes; congestion; sneezing; coughing; sore throat; fever; headache; fatigue
what is the management of acute viral rhinopharyngitis?
symptom relief; monitor/teach to report secondary infection or worsening symptoms
influenza
classified by serotypes; droplet precautions
what are the manifestations of influenza?
abrupt onset- chills, fever, myalgia headache, cough, sore throat, or fatigue
what is the management of infleunza?
vaccine- DON’T GIVE TO SOMEONE WITH AN EGG ALLERGY
sinusitis
inflammation of sinus mucosa results in blockage and accumulated secretions
what are the acute manifestations of sinusitis?
pain/tenderness, purulent drainage, congestion, headaches, fever, malaise, or haitosis
what are the chronic manifestations of sinusitis?
facial/dental pain, congestion, increased damage
what is the management of sinusitis?
symptom relief- decongestants, corticosteroids, analgesics, saline spray/irrigation, rest, and hydration
acute pharyngitis
inflammation of pharyngeal walls; tonsils, palate, uvula
what are the manifestations of acute pharyngitis?
sore throat; red, swollen pharynx
appendicitis
inflammation or infection of the appendix
signs and symptoms of appendicitis
constant dull pain over mcburney’s point; anorexia, nausea, and vomiting; rebound tenderness and abdominal; PSOAS sign; low grade fever; elevated WBC; client side-laying and guarding; constipation and diarrhea
risks for appendicitis
obstruction by fecalith, appendicolith, or foreign bodies or toxins; low fiber diet; high intake of refined carbs; could be caused by nutrition, trauma, and more
treatment for appendicitis
appendectomy; pharamcologic
diagnostic evaluation for appendicitis
leukocyte >10,000mm3; neutrophil >75%; abdominal graphs; ultrasound study; CT scan
complications of appendicitis
perforation; peritonitis
pre-op procedures of appendicitis
NPO; IV fluids; monitor pain; monitor signs of rupture or peritonitis; position right side-laying or low semi-fowler’s for comfort
post-op procedures of appendicitis
monitor temp and incision for infection; NPO until bowel sounds are heard; ruptured appendix results in a penrose drain
discharge and home healthcare instruction for appendicitis
medications; incisions; complications (peritonitis); nutrition
enteral feeding tube
delivery of a nutritional feeding directly into the stomach, duodenum, or jejunum; located in the small bowel
nursing interventions for enteral feeding tube
subsequent placement should be checked by aspirating the stomach contents and measuring pH (1.5-4); provide nose/mouth care; must be checked with x-ray; replace every 4 weeks; check residual (if over 100 mL, hold/stop feeding); place patient in semi-fowler’s for feeding
complications for enteral feeding tube
tube misplacement; diarrhea; constipation
interventions for percutaneous endoscopic gastronomy
assess residual volume every 4/8 hours, if feeding; flush with 30 mL warm water before and after feeding and meds (unless otherwise ordered); maintain semi-fowler’s position 1-2 hours after feeding
LPN assistance with percutaneous endoscopic gastrotomy
flush NG and G tubes; give bolus or continuous feeding for stable patient; give meds through NG/G tube; provide skin care
UAP abilities with percutaneous endoscopic gastrotomy
provide oral care; weigh patient; head of bed at 35-45 degrees; report symptoms; drain and measure output; assess vitals
parenteral nutrition
IV administration of IV solution made up of glucose, insulin, minerals, lipids, electrolytes, and other essential nutrients; used when patient cannot effectively use the GI tract for nutrition
partial/peripheral parenteral nutrition
used when patient can eat but not take in enough nutrients; administered through large distal arm vein or PICC line
total parenteral nutrition
used when patient require intensive nutritional support for an extended time period; delivered through central vein
nursing interventions for parenteral nutrition
maintain strict surgical sepsis for dressing drain (Q72 hours); change tubing and remaining TPN Q24 hours; monitor glucose, electrolytes, and fluid imbalance; use infusion pump; daily weight
safety for parenteral nutrition
solutions are prepared in the pharmacy and are good for 24 hours (always check orders); follow aseptic technique to reduce potential for infection; change filter and IV tubing Q24 hours; check glucose levels and vitals Q4; accurate I&O; assess heart and lungs; mouth care daily
gastritis
inflammation of gastric mucosa; breakdown in gastric mucosal barrier allowing HCl acid and pepsin to diffuse back into mucosa results in tissue edema, disruption of capillary walls with loss of plasma into gastric lumen and possible hemorrhage
causes of gastritis
medications (NSAIDs, ASA, corticosteroids); diet; microorganisms (bacterial, viral/fungal infections); environmental; diseases/disorders; endoscopy, NGT, stress
acute clinical manifestations of gastritis
nausea and vomiting; epigastric tenderness; hemorrhage; anorexia
chronic clinical manifestations of gastritis
asymptomatic; pernicious anemia
diagnostic studies of gastritis
endoscopy; h. pylori test
nursing and interprofessional management of acute gastritis
identify cause; NPO, IV fluids, antiemetics; monitor lab results for electrolyte imbalance; monitor vitals, heme test; PPIs/H2 receptor blockers
nursing and interprofessional management of chronic gastritis
evaluate and eliminate cause; antibiotics for h. pylori; cobalamin for pernicious anemia; lifestyle modifications
GERD
chronic syndrome of mucosal damage due to reflux of stomach acid into lower esophagus; acidic gastric contents overwhelm esophageal defenses, causes irritation and inflammation
primary factor of GERD
incompetent lower esophageal sphincter [LES] (caused by overeating)
clinical manifestations of GERD
heartburn (pyrosis); regurgitation; dyspepsia; respiratory- wheezing, hoarseness, sore throat
diagnostic studies of GERD
upper GI endoscopy; esophagram (barium swallow)’ motility studies
complications of GERD
respiratory and dental erosion
nursing and interprofessional management of GERD
lifestyle modifications (upright after eating, HOB increased on 4-6 inch blocks); drug therapy (proton pump inhibitors, histamine receptor blockers, avoid foods that decrease LES pressure)
hiatal hernia
herniation of part of the stomach into the esophagus through and opening in the diaphragm; weakened muscle in diaphragm and esophagogastric opening (increased intraabdominal pressure)
sliding hernia
part of stomach protrude into the chest; occurs with increased intraabdominal pressure
paraoesophageal hiatal hernia
stomach protrudes up through esophageal hiatus
predispositions of hiatal hernia
obesity, pregnancy, heavy lifting, ascites, tumor, intense physical exertion
clinical manifestations of hiatal hernia
some asymptomatic, heartburn, dyspepsia, regurgitation, respiratory, chest pain
diagnostic studies of hiatal hernia
barium swallowing test and endoscopy
nursing and interprofessional management of hiatal hernia
avoid bearing down; avoid lifting weights/heavy objects; avoid constricting garments
