Stevens-Johnson Syndrome (SJS)/Toxic Epidermal Necrolysis (TEN)
Life-threatening skin reaction, usually triggered by medications. TEN results in more skin loss than SJS.
Patho: Genetic mutation causes the immune system to react abnormally to certain medications (e.g., anticonvulsants, allopurinol, sulfonamides), resulting in destruction of cells in the skin and mucous membranes.
S/S: Fever and flu-like symptoms, followed by painful blistering and peeling of skin which typically begins on the face and chest.
Dx: Skin biopsy.
Tx: Cessation of causative medication, fluid resuscitation, oxygen therapy, mechanical ventilation, corticosteroids, analgesics.
NC: Assist with intubation, maintain patient's body temperature, provide wound care with non-adherent dressings.
Patients should be admitted to a burn unit if possible!
Parasitic Infestations
Pediculosis: Infestation by human lice: pediculosis capitis (head), pediculosis corporis (body), pediculosis pubis (pubic).
- RF: School-age children, head-to-head contact.
- S/S: Pruritus, sleeplessness.
Scabies: Infestation by mites.
- RF: Poor hygiene, crowded living conditions.
- S/S: Intense pruritus, burrows (appear as grayish-white lines, particularly between fingers and palms).
Tx: Pediculocides (e.g., permethrin).
PT: To prevent reinfestation, wash clothing/linens in hot water. Bag linens that cannot be washed in tightly sealed bags for 2 weeks. Check and treat other household members.
Lyme Disease
Tick-transmitted infection caused by the spirochete Borrelia burgdorferi.
Patho: Bite from an infected deer tick causes local infection/inflammation. Left untreated, infection spreads to other organs, resulting in systemic complications.
Prevention: Wear long sleeves, long pants, closed shoes and hat in wooded/grassy areas. Check body for ticks when returning inside.
S/S:
- Stage I (Localized): Erythema migrans (ring-shaped, bullseye lesion), flu-like symptoms (e.g., malaise, fever, muscle/joint pain or stiffness).
- Stage II (Disseminated): Dysrhythmias, dyspnea, palpitations, facial paralysis, nerve pain/numbness.
- Stage III (Late): Arthritis, cognitive impairment.
Dx: Positive ELISA test, confirmed with western blot test.
Tx: Antibiotics (e.g., doxycycline), analgesics (e.g., NSAIDs).
Card 4
Burns: Acute Phase
Nursing Care
Answer
Burns: Acute Phase
Assist with wound healing interventions.
- Debridement: Surgical, chemical, mechanical.
Skin Grafts: Elevate and immobilize graft site. Monitor for infection.
Topical Medications: Silver sulfadiazine, mafenide acetate.
Prevent infection. Provide antibiotics, utilize aseptic technique, restrict visitors. No fresh plants/flowers, no raw foods.
Maintain mobility. Provide active/passive ROM exercises to prevent contractures.
Ensure adequate nutrition. Increase calorie and protein intake. Provide TPN as ordered.
Card 5
Burns: Fluid Resuscitation
Expected Urine Output
Parkland Formula
Laboratory Assessment
Answer
Burns: Fluid Resuscitation
Expected Urine Output: Provide IV fluid resuscitation to maintain a urine output of 0.5 mL/kg/hr in adults (~ 30 - 50 mL/hr) and 0.5 - 1 mL/kg/hr in children.
Parkland Formula: Amount of fluid needed in first 24 hours = 4 mL Lactated Ringer's x patient's weight (kg) x % body burned (using Rule of Nines).
- Administer ½ that amount in first 8 hours.
- Administer ¼ of that amount in second 8 hours.
- Administer ¼ of that amount in third 8 hours.
Laboratory Assessment:
- Fluid Shift (Third Spacing): Hypovolemia, ↑ Hbg/Hct (due to hemoconcentration), hyponatremia, hyperkalemia.
Card 6
Burns: Assessment of Injury
Depth of Injury:
- Burn Characteristics
Answer
Burns: Depth of Injury
Superficial: "First degree." Damage limited to epidermis. Pink/red color, mild edema, no blisters.
Superficial Partial-Thickness: "Second degree." Damage to upper layer of dermis. Pink/red color, mild/moderate edema, blisters, no eschar.
Deep Partial-Thickness: "Second degree." Damage deep into dermis. Red/white color, moderate edema, rare blisters, soft/dry eschar.
Full-Thickness: "Third degree." Damage extends to subcutaneous tissue. Color varies, severe edema, no blisters, hard/inelastic eschar, pain may not be present.
Deep Full-Thickness: "Fourth degree." Damage extends beyond subcutaneous tissue (muscle, tendon, bone). Black, no edema, no blisters, hard/inelastic eschar, no pain.
Card 7
Burns: Assessment of Injury
Estimating Burn Percentage:
- Rule of Nines
Burns: Emergent Phase
Stop the burning process.
Maintain a patent airway, administer oxygen as prescribed, assess for inhalation injury (S/S: singed eyebrows or nasal hair, sooty sputum).
Provide IV fluid resuscitation with a large bore catheter to prevent hypovolemia.
Administer colloids (e.g., albumin) as ordered.
Provide IV opioid analgesics.
Maintain body temperature (i.e., keep the patient warm).
Insert foley catheter to closely monitor urine output.
Keep patient NPO, insert NG tube.
Administer tetanus vaccine (if applicable).
Card 9
Burns
Emergent Phase, Acute Phase, Rehabilitative Phase:
- Timing and Focus of Each Phase
Answer
Burns
Emergent Phase:
- Timing: Begins at the onset of injury, lasts ~ 24 - 48 hours.
- Focus: Maintain airway, provide fluid resuscitation, preserve organ functioning.
Acute Phase:
- Timing: Begins when fluid resuscitation is complete (~ 48 - 72 hours after injury), ends when wound closure is achieved.
- Focus: Infection control, wound healing, nutrition, mobility.
Rehabilitative Phase:
- Timing: Begins with wound closure, ends when the patient achieves maximal function.
- Focus: Psychosocial adjustment, prevention of contractures and scars through reconstructive procedures.
Herpes Zoster (Shingles)
Viral disease caused by reactivation of the varicella zoster virus.
Patho: After a previous varicella infection (chickenpox), the varicella zoster virus remains dormant in the nerve ganglia until it becomes reactivated. Triggers include immunosuppression, infection, stress, fatigue.
S/S:
- Pre-Eruptive Phase: Abnormal skin sensations (e.g., burning), malaise, low-grade fever ~ 48 hours before lesions appear.
- Eruptive Phase: Painful, unilateral vesicular rash that runs along a dermatome, low-grade fever, paresthesia.
Labs/Dx: Clinical presentation, PCR test of vesicle.
Tx: Antiviral medications (e.g., acyclovir), analgesics.
NC: Isolate patient (airborne/contact precautions) until lesions have crusted. Avoid patient contact with individuals who have not had chickenpox and are not vaccinated. Monitor for postherpetic neuralgia (pain that lasts > 1 month after onset).
PT: Prevention with zoster vaccine for adults > 50 years old.
Herpes Simplex Virus (HSV)
Viral infection that causes HSV-1 (typically spread through contact with contaminated saliva) and HSV-2 (spread primarily through sexual contact).
Patho: After infection with the herpes virus, the virus remains dormant in the nerve ganglia and becomes reactivated during times of stress (physical, psychological). Burning, pain, and tingling may precede vesicles.
S/S: Painful vesicular or ulcerative lesions on the mouth/lips for HSV-1 and on the genitals for HSV-2. Fever, malaise.
Labs/Dx: Clinical presentation, type-specific HSV serologic tests.
Tx: No cure. Antiviral medications (topical/systemic) to decrease severity and frequency of outbreaks, analgesics, topical anesthetic agents.
PT: Condom use recommended. Abstain from sexual activity during periods of known active viral shedding (visible lesions).
Candidiasis
Overgrowth of candida fungi in warm/moist environments (e.g., thrush = candida infection in the mouth, yeast infection = vaginal candidiasis).
Patho: Imbalance in local flora allows for overgrowth of C. albicans.
RF: Immunosuppression, antibiotics, inhaled corticosteroids, pregnancy, diabetes.
S/S: Red, irritated skin with itching and burning. White patches in the mouth or throat with oral candidiasis.
Dx: KOH test, clinical examination.
Tx: Antifungals.
PT: Keep skin clean and dry. Wear cotton underwear and avoid tight clothing to prevent vaginal candidiasis. Only take antibiotics as necessary. Rinse mouth after using inhaled corticosteroids.
Bacterial Skin Infections
Folliculitis: Inflammation of a hair follicle.
- S/S: Small erythematous pustule.
- Tx: Usually self-resolving, topical antibiotics.
Furuncle (Boil): Bacterial infection of multiple hair follicles and the adjacent tissue.
- S/S: Larger erythematous, pus-filled nodule.
- Tx: Warm compresses, incision and drainage, antibiotics.
Cellulitis: Infection of the deeper connective tissue.
- S/S: Erythema, warmth, pain, edema, fever, malaise.
- Tx: Systemic antibiotics.
Card 17
Laboratory Studies
Culture and Sensitivity
Tzanck Smear
Potassium Hydroxide (KOH) Test
Answer
Laboratory Studies
Culture and Sensitivity: Used to identify and treat bacterial skin lesions. Get culture (exudate or biopsy) prior to starting antibiotics. Use normal saline to clean wound (vs. antibacterial cleanser) before obtaining culture. Final result takes ~ 3 days.
- Culture identifies the pathogen.
- Sensitivity determines what antibiotic can be used to kill the pathogen.
Tzanck Smear: Used to diagnose viral skin lesions (e.g., herpes infection).
Potassium Hydroxide (KOH) Test: Used to diagnose fungal skin lesions (e.g., tinea infection).
Skin Biopsy: Used to diagnose malignancies. Includes punch, incisional, excisional, and shave biopsies.
Card 18
Pressure Injury
Treatment
Nursing Care
Answer
Pressure Injury
Tx:
- Protective dressings.
- Debridement (surgical, chemical, mechanical) of necrotic tissue.
- Negative pressure wound therapy, hyperbaric oxygen therapy, skin grafts/flaps.
NC:
- Reduce pressure to the area. Use specialty mattress that provides pressure redistribution, and turn/reposition patient frequently (commonly every 2 hours in bed).
- Keep HOB
- Do not massage bony prominences.
- Ensure adequate nutrition, especially protein.
Pressure Injury Staging
Stage 1: Intact skin with non-blanchable erythema (remains red during/immediately after pressing with finger).
Stage 2: Partial thickness skin loss with exposed dermis, red/moist wound bed or serous-filled blister.
Stage 3: Full thickness skin loss with visible adipose tissue.
Stage 4: Full thickness skin loss with exposed muscle, tendon, and/or bone.
Unstageable: Wound base is covered in slough or eschar, so depth of wound is unknown.
DTI: Intact or non-intact skin with non-blanchable purple/maroon discoloration or a blood-filled blister.
Card 20
Pressure Injury
Pathophysiology
Risk Factors
Answer
Pressure Injury
Injury that occurs to the skin and underlying soft tissue due to intense/prolonged pressure to the area. Typically occurs over a bony prominence, but can be caused by a medical device.
Patho: Tissue compression impairs blood flow, which leads to inadequate perfusion and oxygenation. This leads to cell death.
RF: Impaired nutrition, reduced sensation, excess moisture, immobility, impaired oxygenation, friction/shear.
Assess patient's risk for skin breakdown using a risk assessment scale. A score ≤ 14 using the Norton scale, or a score ≤ 18 using the Braden scale indicates ↑ risk of skin breakdown.
Wound Healing
Inflammatory Phase:
- Hemostasis: Vasoconstriction, platelet aggregation, clot formation.
- Inflammation: Vasodilation, phagocytosis of bacteria (e.g., "clean-up"). Timing = 3 - 5 days.
Proliferative Phase:
- Epithelialization: Resurfacing with new skin cells.
Timing = 2 - 3 days for incisional wounds.
- Granulation: Wound fills with scar tissue (collagen produced by fibroblasts). Timing = 2 - 3 weeks for incisional wounds.
- Contraction: Reduction in wound size (open wounds only).
Maturation/Remodeling Phase: Replacement of existing collagen with new, stronger collagen. Timing > 1 year.
Card 22
Wound Healing
Wound Closure
Factors That Delay Wound Healing
Answer
Wound Healing
Wound Closure:
- Primary Intention: Wound closed surgically (e.g., sutures, staples) or well-approximated wound edges (e.g., papercut).
- Secondary Intention: Wound left open to heal through process of granulation, contraction, and epithelialization (e.g., pressure injury).
- Tertiary Intention: Wound left open for debridement and observation, then closed at a later time (e.g., infected traumatic wound).
Factors that Delay Wound Healing: Older age, decreased immune function, impaired nutrition (especially ↓ protein), impaired circulation, smoking, diabetes.
Lung Cancer
Screening
Risk Factors
Signs/Symptoms
Labs/Diagnostics
Treatment
Answer
Lung Cancer
Screening: Annual low-dose CT scans for at-risk population.
RF: Smoking, secondhand smoke, pollution, exposure to asbestos.
S/S: Cough, blood-tinged sputum, chest pain, shortness of breath, hoarseness, weight loss, fatigue, dull chest percussion.
Labs/Dx: CT scan, bronchoscopy with needle biopsy.
Tx: Chemotherapy, targeted therapy, radiation, photodynamic therapy, lobectomy, pneumonectomy.
Card 26
Colorectal Cancer
Screening
Risk Factors
Signs/Symptoms
Labs/Diagnostics
Treatment
Answer
Colorectal Cancer
Screening: Fecal occult blood test (FOBT) annually, colonoscopy every 10 years (or sigmoidoscopy every 5 years) starting at age 50.
RF: Older age, high-fat diet (especially red meat), genetics, smoking, obesity, alcohol, physical inactivity.
S/S: Rectal bleeding, change in bowel color, shape, consistency.
Labs/Dx: Colonoscopy (definitive), positive FOBT, CT/MRI.
Tx: Chemotherapy, radiation, surgery (e.g., colon resection or colectomy with colostomy/ileostomy).
Card 27
Prostate Cancer
Screening
Risk Factors
Signs/Symptoms
Labs/Diagnostics
Treatment
Answer
Prostate Cancer
Screening: Annual PSA test and digital rectal exam (DRE) starting at age 50 (earlier if higher risk).
Take PSA before DRE!
RF: Older age, high-fat diet, race (African Americans), genetics.
S/S: Urinary retention, hesitancy, frequency. Frequent bladder infections, hematuria, nocturia.
Labs/Dx: Elevated PSA (> 4 ng/mL), transrectal ultrasound, biopsy.
Tx: Hormone therapy (e.g., leuprolide), chemotherapy, radiation, prostatectomy, orchiectomy.
Card 28
Breast Cancer
Screening
Risk Factors
Signs/Symptoms
Treatment
Mastectomy Care/Teaching
Answer
Breast Cancer
Screening: Annual mammogram starting at age 40, monthly breast self-examination starting at age 20.
RF: Genetics, early menarche, late menopause, long-term use of oral contraceptives, smoking, hormone replacement therapy (HRT), obesity.
S/S: Firm, non-tender, immobile breast lump. Dimpling or peau d'orange (i.e., orange peel) appearance. Nipple discharge, ulceration, or retraction.
Tx: Hormone therapy (e.g., tamoxifen), chemotherapy, radiation, surgery (e.g., lumpectomy, mastectomy).
Mastectomy Care/Teaching:
- NC: Do not use the arm on the affected side to administer injections, obtain blood, or measure BP.
- PT: Wear sling when ambulating, wear loose clothing, perform arm/hand exercises to prevent edema and increase ROM.
Card 29
Cancer: Female Reproductive System
Endometrial Cancer
Cervical Cancer
Ovarian Cancer
Treatment
Answer
Cancer: Female Reproductive System
Endometrial Cancer: Cancer of the inner uterine lining, often due to prolonged exposure to estrogen without progesterone. Key symptom is postmenopausal bleeding.
Cervical Cancer: Cancer of the cervix, usually caused by the human papillomavirus (HPV). Key symptom is painless vaginal bleeding.
- Prevention: HPV vaccine (3 injections over 6 months).
- Screening: Pap tests every 1 - 3 years, starting 3 years after first sexual intercourse or by age 21.
Ovarian Cancer: Epithelial tumor that grows on the surface of the ovaries and spreads rapidly. Symptoms are vague (e.g., GI disturbances), resulting in low survival rates due to late detection.
Tx: Chemotherapy, internal/external radiation, ablation therapy, surgery (e.g., hysterectomy, salpingectomy, oophorectomy).
Card 30
Cancer: Hematologic System
Leukemia
Lymphoma
Multiple Myeloma
Treatment
Answer
Cancer: Hematologic System
Leukemia: Cancer of the bone marrow, causing overgrowth of cancerous WBCs. This prevents growth of RBCs, platelets, and normal WBCs.
Lymphoma: Solid tumor in the lymphoid tissue (e.g., lymph nodes and spleen), causing overgrowth of lymphocytes.
- Hodgkin's: Reed-Sternberg cells, local/regional.
- Non-Hodgkin's: No Reed-Sternberg cells, disseminated spread.
Multiple Myeloma: Cancer that causes overgrowth of plasma cells in the bone marrow, resulting in excess secretion of antibodies and cytokines. This prevents growth of RBCs, platelets, and normal WBCs.
Tx: Chemotherapy, radiation, targeted therapy, stem cell transplant, bone marrow transplant.
High risk of anemia, thrombocytopenia, and neutropenia!
Card 31
Skin Cancer
ABCDE Skin Assessment
Treatment
Answer
Skin Cancer
ABCDE Skin Assessment: Assessment of skin changes that may indicate the presence of melanoma.
- A = Asymmetry.
- B = Border (irregular).
- C = Color (pigment varies across mole).
- D = Diameter (width > 6 mm, size of a pencil eraser).
- E = Evolving (change in appearance or new bleeding).
Tx: Excision, cryosurgery, topical chemotherapy, Mohs surgery.
Card 32
Skin Cancer
Preventing
Main Types of Skin Cancer
Answer
Skin Cancer
Prevention: Avoid midday sun, wear sunscreen and protective clothing, perform regular skin checks.
Main Types of Skin Cancer:
- Basal Cell Carcinoma: Waxy nodule with pearly borders. Originates in the basal layer (lower part) of the epidermis. Most common type of skin cancer.
- Squamous Cell Carcinoma: Scaly, rough lesion that may crust or bleed. Originates in the upper layer of the epidermis.
- Melanoma: Irregular lesion, various color hues. Originates in the melanocytes (melanin-producing epidermal cells), highly metastatic. Most deadly form of skin cancer.
Card 33
Cancer Complications
Anemia:
- Nursing Care, Patient Teaching
Thrombocytopenia:
- Nursing Care, Patient Teaching
Answer
Cancer Complications
Anemia:
- NC: Monitor for shortness of breath, dizziness, fatigue. Administer epoetin alfa (to ↑ RBC count) and ferrous sulfate as prescribed.
- PT: Ensure sufficient intake of foods rich in iron, folate, and vitamin B12. Allow for extra rest periods.
Thrombocytopenia:
- NC: Monitor for blood in stool, urine, vomit. Avoid IVs and injections when possible. Apply prolonged pressure after blood draws or injections.
- PT: Use electric razor, soft toothbrush. Avoid blowing nose vigorously. Avoid NSAIDs. Prevent falls/injury due to risk of bleeding.
Card 34
Cancer Complications
Preventing Infection:
- Nursing Care, Patient Teaching
Answer
Preventing Infection
NC: Initiate neutropenic precautions (reverse isolation), monitor patient's temperature, restrict visitors who are ill, no fresh flowers/plants, keep dedicated equipment in the patient's room, administer filgrastim as ordered to ↑ WBC count.
PT: Take temperature daily, report temp > 37.8°C (100°F). Perform frequent hand hygiene. Avoid crowds, sick people. Do not consume raw foods. Avoid yard work, gardening. Do not change cat litter box. Wash dishes in hot water (or in a dishwasher). Wash toothbrush in dishwasher daily (or rinse in bleach solution).
Card 35
Cancer Complications
Malnutrition:
- Nursing Care, Patient Teaching
Mucositis:
- Nursing Care, Patient Teaching
Answer
Cancer Complications
Malnutrition:
- NC: Administer antiemetic meds (e.g., ondansetron) and medications to ↑ appetite (e.g., megestrol).
- PT: Avoid drinking liquids with meals. Eat cold or room-temperature foods. Consume a high-calorie, high-protein, nutrient-dense diet. Use supplements if needed.
Mucositis:
- NC: Provide oral care before and after meals.
- PT: Avoid mouthwashes or swabs containing glycerin or alcohol. Rinse mouth with saline solution. Apply topical anesthetic agents as prescribed. Use a soft toothbrush. Eat soft/bland foods (scrambled eggs are a good choice). Avoid spicy, hard, or acidic foods.
Card 36
Cancer Treatment
External Radiation Therapy:
- Patient Teaching
Answer
External Radiation: Patient Teaching
Wash skin over affected area with mild soap and water, gently pat dry.
Skin over target area will be marked (do not remove!).
Do not apply lotions, powders, ointments to irradiated skin unless prescribed.
Wear loose, soft clothing.
Avoid sun or heat exposure to affected area.
Card 37
Cancer Treatment
Chemotherapy, Internal Radiation Therapy:
- Nursing Precautions
Answer
Cancer Treatment: Nursing Precautions
Chemotherapy:
- Use appropriate PPE per facility policy (e.g., chemotherapy gloves/gowns).
- Double-bag linens with impervious bag on outside.
- Follow spill management guidelines, including use of spill kits.
- Double-flush toilets after use. Use splash guard prior to flushing.
Internal Radiation Therapy (Brachytherapy):
- Patient should be kept in a private room with the door closed.
- Cluster care in order to minimize time spent in the patient's room.
- Wear dosimeter badge and lead apron. Avoid turning away from patient.
- Pregnant employees and visitors should not enter the room.
- Visitors must remain > 6 feet away from patient. Limit visits to ≤ 30 min.
- If the implant becomes dislodged, use long-handled tongs to place it in a lead container and then call the provider.
Card 38
Tumor Classification
Tissue Type
Grading
Staging
Answer
Tumor Classification
Tissue Type: Type of tissue in which the cancer originates.
- Carcinoma: Epithelial tissue, including adenocarcinoma (organ or gland) and squamous cell carcinoma (skin).
- Sarcoma: Connective tissue (e.g., bones, tendons, cartilage, muscle).
- Leukemia: Bone marrow.
- Myeloma: Plasma cells in the bone marrow.
- Lymphoma: Lymphatic glands or nodes.
Grading: Similarity of cancer to tissue of origin (grade 1 - 4). Grade 1 = resembles normal cells. Grade 4 = no similarity to tissue of origin.
Staging: Extent of disease using TNM staging.
- T = Tumor (T1 - T4): Size and extent of the main tumor.
- N = Node (N0 - N3): Number of regional lymph nodes involved.
- M = Metastasis (M0, M1): Presence of metastasis. M0 = no metastasis, M1 = metastasis present.
Card 39
Cancer
Signs/Symptoms
Diagnostics
Treatment
Complications
Answer
Cancer
S/S: Unexplained weight loss, fatigue, pain, unusual bleeding, bruising, swelling/lumps in the body, change in bowel/bladder function, persistent cough/hoarseness, skin changes (e.g., non-healing sore).
Dx: Biopsy (definitive), MRI, CT scan, PET scan, ultrasound.
Tx:
- Medications: Chemotherapy to destroy rapidly dividing cells, hormonal therapy, immunotherapy.
- Procedures: Tumor excision, radiation therapy.
Complications: Malnutrition, infection, mucositis, anemia, thrombocytopenia, alopecia.
Card 40
Cancer
Pathophysiology
Risk Factors
Answer
Cancer
Disease characterized by DNA damage that causes abnormal cell growth (i.e., dysplasia) and development.
Patho:
- Initiation: Damage or mutation of DNA leads to excessive cell division due to lack of suppressor gene function and excessive oncogene function.
- Promotion: Mutated cells are exposed to promoters that enhance its growth (e.g., estrogen).
- Progression: Tumor cells acquire additional mutations, which allows the tumor to metastasize and become resistant to therapy.
RF: Older age, genetics, immunosuppression, viruses, tobacco use, sun exposure, high-fat/low-fiber diet.
Card 41
Human Immunodeficiency Virus (HIV)
Diagnostics
AIDS Criteria
Treatment
Patient Teaching
Answer
Human Immunodeficiency Virus (HIV)
Dx: Positive ELISA test, confirmed with western blot test.
AIDS Criteria: CD4+ count
S/S: Kaposi's sarcoma, TB, pneumonia, wasting syndrome, candidiasis of the airways, and other infections.
Tx: Highly active antiretroviral therapy (HAART) consisting of three or more medications used simultaneously to inhibit viral replication.
PT:
Practice safe sex.
Ongoing monitoring of CD4+ counts.
Prevent infection: Hand hygiene, bathe daily with antimicrobial soap, avoid raw foods, don't clean cat litter boxes, avoid crowds and sick people.
Card 42
Human Immunodeficiency Virus (HIV)
Pathophysiology
Risk Factors
Signs/Symptoms
Labs
Answer
Human Immunodeficiency Virus (HIV)
Retrovirus that causes ↓ immunity and ↑ susceptibility to infections.
Patho: Virus enters the body through blood or bodily fluids and targets CD4+ lymphocytes (helper T-cells), causing immunodeficiency, autoimmunity, and neurologic dysfunction.
RF: Unprotected sex, multiple sexual partners, perinatal exposure, IV drug use, health care workers.
S/S: Flu-like symptoms, lymphadenopathy, thrush, weakness, night sweats, fever, weight loss, rash.
Labs: ↓ WBCs, CD4+ count 3.
Systemic Sclerosis (Scleroderma)
Chronic, inflammatory connective tissue disease.
Patho: Autoimmune dysfunction causes: (1) damage and occlusion of blood vessels, and (2) overproduction of collagen, which causes tissues to become inflamed, fibrotic, then sclerotic (hard).
RF: Sex (female), age (30 - 50).
S/S: Joint pain, Raynaud's phenomenon, pitting edema in hands with taut/shiny skin, GI dysfunction (e.g., dysphagia, reflux), arrhythmias and dyspnea due to cardiac/pulmonary fibrosis, malignant hypertension with renal involvement.
Labs/Dx: Positive ANA titer, elevated ESR.
Tx: Supportive, no cure. Immunosuppressants, ACE inhibitors.
PT: Skin moisturization, frequent rest periods. Avoid stress, cold hands/feet (for Raynaud's).
Systemic Lupus Erythematosus (SLE)
Chronic inflammatory disorder of the connective tissue that causes widespread inflammation and tissue damage.
Patho: Autoimmune disorder causes production of antinuclear antibodies (ANA), leading to inflammation and damage to most major body systems (e.g. skin, lungs, kidneys, heart). Characterized by periods of exacerbations and remissions.
Discoid lupus erythematosus (DLE) affects only the skin.
RF: Sex (female), age (20 - 40), race (African American, Asian, Native American).
Card 46
Laboratory Studies
Types of White Blood Cells
Percentage in Circulation
Causes of Increased Levels
Answer
Laboratory Studies
Type of WBC
Percentage in Circulation
Causes of Increased Levels
Neutrophils
40 - 60%
Acute bacterial infections.
Neutrophils are first to neutro'lize the threat!
Lymphocytes
20 - 40%
Chronic bacterial or viral infections.
Monocytes
2 - 8%
Protozoal and viral infections, tuberculosis, chronic inflammation.
Eosinophils
1 - 4%
Allergic reactions or parasitic infections.
Basophils
0.5 - 1%
Allergic reactions or leukemia.
With Basophils, you might need Benadryl!
Most to least prevalent WBCs: Never Let Monkeys Eat Bananas.
Card 47
Laboratory Studies
White Blood Cells (WBCs), Neutrophils, Erythrocyte Sedimentation Rate (ESR), C-Reactive Protein (CRP):
- Expected Ranges
Answer
Laboratory Studies
WBCs: Expected range: 5,000 - 10,000/mm3.
- Leukocytosis: WBCs > 10,000/mm3.
- Leukopenia: WBCs 3.
Neutrophils: Expected range: 2,500 - 8,000/mm3.
- Neutropenia: Neutrophils 3.
"Left shift" (banded/immature neutrophils) indicates the bone marrow can't keep pace with an infection and is releasing immature neutrophils into the blood.
ESR: Expected range:
CRP: Expected range:
Card 48
Infection
Risk Factors
Systemic Infection
Local Infection
Answer
Infection
RF: Compromised immunity, chronic/acute disease, poor hygiene, poor sanitation, crowded living environment, IV drug use, unprotected sex.
Systemic Infection: Infection that is in the bloodstream.
- S/S: Fever, chills, malaise, fatigue, tachypnea, tachycardia.
Local Infection: Infection that only affects one body part or organ.
- S/S: Edema, pain, erythema, warmth in a particular area of the body.
Card 49
Stages of Infection
Incubation Period
Prodromal Stage
Illness Stage
Convalescence
Answer
Stages of Infection
Incubation Period: Time period between the initial entry of a pathogen into the host and the appearance of general S/S. Pathogen multiplies within the host while the host is unaware of the disease.
Prodromal Stage: Appearance of general, non-specific signs/symptoms (e.g., fever, fatigue, malaise).
Illness Stage: Appearance of infection-specific signs/symptoms (e.g., vomiting, cough).
Convalescence: Recovery from infection. Patient generally returns to normal functioning, but permanent damage may remain.
Card 50
Chain of Infection
Illustration
Answer
Chain of Infection
Card 51
Chain of Infection
Infectious Agent
Reservoir
Portal of Exit
Mode of Transmission
Portal of Entry
Susceptible Host
Answer
Chain of Infection
Epidemiologic model that describes the spread of infection/disease.
Infectious Agent: Organism capable of causing infection/disease (e.g., bacteria, viruses, fungi, parasites).
Reservoir: Where the agent lives and multiplies (e.g., humans, animals, soil).
Portal of Exit: The way the agent leaves the reservoir (e.g., nose/mouth, urine, blood).
Mode of Transmission: How the agent goes from the reservoir to the new host. Includes direct contact, droplet, airborne, vehicles (e.g., water, food), or vectors (e.g., mosquitoes, fleas, ticks).
Portal of Entry: How the agent enters the new host. May be the same as the portal of exit.
Susceptible Host: Recipient of infection. Susceptibility influenced by immune status, genetics, age, etc.
Card 52
Immune System Disorders
Hypersensitivity
Autoimmune Reactions
Immunodeficiency
Answer
Immune System Disorders
Hypersensitivity: Exaggerated or inappropriate response upon exposure to an antigen (allergen), resulting in inflammation and destruction of healthy tissue.
Autoimmune Reactions: Body's normal defenses recognize self-antigens as foreign and target them. Caused by genetic, hormonal, and environmental factors.
Immunodeficiency: Absent or depressed immune response due to viral infections, medications, or genetic disorders. Places the patient at higher risk for infection.
Card 53
Acquired Immunity
Active Natural Immunity
Active Artificial Immunity
Passive Natural Immunity
Passive Artificial Immunity
Answer
Acquired Immunity
Active Natural Immunity: Exposure to a pathogen triggers the immune system to produce antibodies.
Active Artificial Immunity: Vaccination triggers the immune system to produce antibodies.
Passive Natural Immunity: Antibodies are passed through the placenta or breastmilk from mom to baby.
Passive Artificial Immunity: Immunoglobulins (i.e., antibodies) are administered to the patient for immediate protection.
Passive immunity protection is immediate, but may only last a few weeks or months. Active immunity can take several weeks to develop, but is long-lasting.
Card 54
Acquired Immunity
Cellular Immunity:
- Initiation, Types of Cells Involved
Answer
Cellular Immunity
Type of immunity provided by sensitized T-lymphocytes.
Initiation of Cellular Immunity: A naïve T cell comes in contact with a MHC-antigen complex and becomes activated. The activated T cell secretes cytokines, which enables the proliferation and activation of:
- Helper/Inducer T Cells (CD4+ cells): Recognize self vs. foreign cells. In response to foreign cells, CD4+ cells release cytokines ("call to arms" for other WBCs).
- Regulatory T Cells: Prevent hypersensitivity (overreaction) of the immune system by releasing cytokines that inhibit the immune system.
- Cytotoxic T Cells (CD8+ cells): Destroy infected, cancerous or damaged cells.
Card 55
Acquired Immunity
Humoral Immunity: Illustration
Answer
Humoral Immunity
Card 56
Acquired Immunity
Humoral Immunity:
- Steps in Humoral Immunity
Answer
Humoral Immunity
Antibody-mediated immunity.
Steps:
- B Cell Activation: Antigen binds to an antibody on a B cell. The B cell engulfs the antigen (i.e., endocytosis) and presents it on the surface of the cell by MHC II proteins.
- B Cell Proliferation: Helper T cell binds to the MHC-antigen complex and releases cytokines, which causes the B cell to divide rapidly into:
- Plasma Cells: Produce and release antibodies against that specific antigen.
- Memory Cells: Become sensitized, but do not function until the next exposure to the same antigen. Upon re-exposure to the same antigen, memory cells mount a rapid and large immune response to the antigen.
- Antibody-Antigen Reaction: Binding of the antibodies to the antigens triggers neutralization or destruction of the antigens.
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Innate Immunity
Stages of Inflammation
Answer
Inflammation
Body's protective reaction to injury, disease, or irritation of the tissues. Immediate and non-specific.
Stages of Inflammation:
- First Stage: Warmth, erythema, edema, decreased function, and/or pain at site of injury.
- Second Stage: WBCs kill the microorganisms. Exudate containing WBCs and dead tissues cells accumulate at the site.
- Third Stage: Damaged tissue is replaced by scar tissue.
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Immune System
Function
Innate Immunity
Acquired Immunity
Answer
Immune System
Function: Protect the body from disease-causing microorganisms.
Innate Immunity: Defense mechanisms in the body that respond immediately to all antigens.
- Includes: Inflammatory response, skin, stomach acid, mucus, phagocytic cells.
Acquired Immunity: Production of antibodies in response to a specific antigen through the action of B and T lymphocytes.
- Includes: Humoral immunity and cellular immunity.
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Human Papillomavirus (HPV)
Prevention
Signs/Symptoms
Diagnostics
Treatment
Patient Teaching
Answer
Human Papillomavirus (HPV)
Most common STI. Certain HPV strains cause anogenital warts (condyloma acuminatum); other HPV strains can lead to cancer. HPV is the primary risk factor for cervical cancer.
Prevention: HPV vaccine prior to first sexual contact, safe sex practices.
S/S: Asymptomatic. Small, white or flesh-colored growths in the anogenital region.
Dx: Clinical examination, pap test.
Tx: No cure for the virus. Wart removal with prescription creams/ointments or cryotherapy (i.e., freezing wart to aid in removal).
PT: Partner notification, safe sex practices. Annual pap tests for women.
Card 60
Syphilis
Stages/Symptoms
Diagnostics
Treatment
Nursing Care
Patient Teaching
Answer
Syphilis
Bacterial infection caused by T. pallidum. Lack of treatment can lead to systemic complications and death.
Stages/Symptoms:
- Primary: Appearance of a non-tender genital chancre (ulcer).
- Secondary: Flu-like symptoms, infectious rash on hands/feet.
- Latent: Lesions heal on their own; no clinical S/S.
- Tertiary (Late): Irreversible neurological/cardiovascular damage.
Dx: Chancre specimen, rapid plasma reagin (RPR) blood test.
Tx: Antibiotics (e.g., penicillin G, doxycycline).
NC: Wear gloves when palpating chancre. Complete disease reporting requirements.
PT: Partner notification and treatment, abstinence during treatment, rescreening.
Pelvic Inflammatory Disease (PID)
Bacterial infections of the upper female genital tract that can lead to infertility, sepsis, or death.
Patho: Sexually transmitted bacteria spread from the vagina to the uterus, fallopian tubes, or ovaries. Most commonly caused by chlamydia or gonorrhea.
S/S: Often asymptomatic. Lower abdominal pain, pelvic pain, menstrual irregularities, dysuria, fever.
Dx: STI testing, rule out other causes.
Tx: Antibiotics, mild analgesics, comfort measures (e.g., heating pad).
PT: Avoid sexual intercourse during treatment, importance of follow-up appointments. Safe sex practices, partner notification and treatment.
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Chlamydia & Gonorrhea
Signs/Symptoms
Diagnostics
Treatment
Nursing Care
Patient Teaching
Answer
Chlamydia & Gonorrhea
Sexually transmitted bacterial infections of the reproductive tract. Left untreated, can cause pelvic inflammatory disease (PID), infertility, preterm labor complications.
S/S: Often asymptomatic. Dysuria, penile/vaginal discharge.
Dx: Urinalysis, swab or tissue culture from the cervical os or male urethra.
Tx: Antibiotics (e.g., azithromycin, doxycycline for chlamydia; cephalosporins for gonorrhea).
NC: Complete disease reporting requirements.
PT: Abstinence during treatment, partner notification and treatment, need for rescreening, safe sex practices.
Card 63
Disorders of the Testes
Hydrocele
Spermatocele
Varicocele
Testicular Torsion
Answer
Disorders of the Testes
Hydrocele: Fluid collection that forms around the testis, causing painless swelling in the testicle. Common in newborns or due to scrotal injury, inflammation.
Spermatocele: Sperm-containing cyst on the epididymis, usually asymptomatic.
Varicocele: Enlarged veins within the scrotum. Can cause infertility by ↑ scrotal temperature.
Testicular Torsion: Twisting of the spermatic cord, inhibiting blood flow to the testicle and causing severe pain and swelling. Immediate surgical repair required.
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Disorders of the Penis
Erectile Dysfunction:
- Causes, Treatment
Priapism:
- Causes, Treatment
Answer
Disorders of the Penis
Erectile Dysfunction (ED): Inability to achieve or maintain an erection.
- Causes:
- Organic ED: Gradual deterioration of function due to vascular or neurological disorders, medications, trauma.
- Psychogenic ED: Sudden onset, follows period of high stress.
- Tx: PDE-5 inhibitors (e.g., sildenafil).
Priapism: Uncontrolled, prolonged painful erection without sexual desire. Complications: circulation impairment and inability to void.
- Causes: Neurological or vascular disorders, medications.
- Tx: Urinary catheterization, cavernous aspiration, vasoconstrictors, surgical intervention.
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Transurethral Resection of the Prostate (TURP)
Indications
Continuous Bladder Irrigation
Post-Op Medications
Patient Teaching
Answer
TURP
Surgery to remove part of the prostate gland through the penis.
Indications: Urinary retention or chronic complications associated with BPH.
Continuous Bladder Irrigation (CBI): Flushing of sterile fluid through a 3-way catheter to prevent/remove blood clots. Goal is to keep irrigation outflow light pink.
- ↑ CBI rate if outflow is bright red or contains clots.
- For catheter obstruction (S/S: bladder spasms, ↓ outflow): turn off CBI, irrigate using large piston syringe.
- It is expected that the patient will feel a continuous need to urinate.
Post-Op Medications: Analgesics, antispasmodics (e.g., oxybutynin), prophylactic antibiotics, stool softeners to prevent straining.
PT: Drink > 2 L of water per day. Avoid caffeine or alcohol (i.e., bladder stimulants). If urine is bloody, stop activity, rest, and increase fluid intake.
Benign Prostatic Hypertrophy (BPH)
Enlarged prostate.
Patho: ↓ Androgen hormones with aging causes enlargement of the prostate. This impairs urine outflow from the bladder, resulting in urinary retention, ↑ risk of infection and reflux into the kidneys.
S/S: Urinary frequency, incontinence, urgency, hesitancy, retention. Post-void dribbling, reduced urinary stream force. Hematuria, nocturia. Frequent urinary tract infections.
Labs/Dx: ↑ PSA (> 4 ng/mL). ↑ WBCs with UTI, ↑ creatinine and BUN with kidney involvement.
Tx:
- Medications: Finasteride, tamsulosin, tadalafil.
- Surgery: Transurethral resection of the prostate (TURP).
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Pelvic Organ Prolapse
Types
Risk Factors
Treatment
Answer
Pelvic Organ Prolapse
One or more pelvic organs fall down or slip out of place and bulge into the vagina.
Types:
- Uterine Prolapse: Pelvic floor muscles and ligaments weaken, causing the uterus to protrude into the vagina.
- Cystocele: Protrusion of the bladder through the anterior vaginal wall, causing urinary frequency, urgency, hesitancy, incontinence.
- Rectocele: Protrusion of the rectum through the posterior vaginal wall, which can cause constipation and hemorrhoids.
RF: Olde age, obesity, childbirth, pelvic surgery, chronic constipation.
Tx: Kegel exercises, vaginal pessaries, intravaginal estrogen, surgical repair.
Menopause
Cessation of menses (no periods for ≥ 12 months).
Patho: Decline in ovarian follicles (and ovulation) results in ↓ estrogen production and cessation of menses. Starts at ~ 50 years old.
S/S: Vasomotor symptoms (e.g., hot flashes, night sweats), urogenital symptoms (e.g., ↓ vaginal secretions), ↓ bone density, psychogenic symptoms (e.g., mood swings, sleep disturbances).
Tx: Hormone therapy (HT). Prevents hot flashes, reduces vaginal tissue atrophy, ↓ risk of bone fractures. ↑ Risk of embolic events (DVT, MI, stroke) and breast cancer.
PT: For patients on HT, quit smoking immediately. Avoid restrictive socks/clothing, avoid sitting for prolonged periods of time. Monitor for symptoms of a DVT, MI, stroke.
Gynecologic Disorders
Menorrhagia: Prolonged or excessive menstrual bleeding. Can result in anemia.
With menorrhagia, you nearly hemorrhage!
Dysmenorrhea: Painful menstruation.
Amenorrhea: Absence of menses. Causes include pregnancy, tumors, endocrine lesions, weight loss, Cushing's syndrome.
Endometriosis: Presence of endometrial tissue outside the uterus. S/S: Pain and dysmenorrhea. Common cause of infertility.
PMS: Varying symptoms (e.g., irritability, depression, breast tenderness, bloating, headache) that occur prior to menstruation.
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Fibrocystic Breast Condition
Pathophysiology
Risk Factors
Signs/Symptoms
Diagnostics
Treatment
Answer
Fibrocystic Breast Condition
Non-cancerous changes in the breast that include the development of fibrotic connective tissue and cysts.
Patho: Hormone imbalance (↑ estrogen and ↓ progesterone), results in hyperproliferation of fibrotic connective tissue.
RF: Estrogen and anti-estrogen treatment, 35 - 50 y/o females.
S/S: Breast pain. Movable, tender, rubber-like cysts (commonly occur bilaterally in the upper-outer quadrants of the breasts).
Dx: Breast ultrasound, mammogram, biopsy.
Tx: Supportive measures (e.g., analgesics, supportive bra, ice/heat, ↓ caffeine intake). Symptoms resolve after menopause due to ↓ estrogen.
Card 71
Reproductive System
Female Screening/Diagnostic Tests:
- Pap Test, Mammogram, BSE
Male Screening/Diagnostic Tests:
- PSA, DRE, TSE
Answer
Screening/Diagnostic Tests
Female Tests:
- Pap Test: Screens for cervical cancer. Every 1 - 3 years, starting at age 21.
- Mammogram: Screens for breast cancer. Annually starting at age 40. Avoid use of deodorant, lotions, or powders in the axillary region prior to mammogram.
- Breast Self Examination (BSE): Monthly (~ 3 - 5 days after period).
Male Tests:
- Prostate Specific Antigen (PSA): Screens for prostate cancer. Annually starting at age 50 (earlier if higher risk). PSA > 4 ng/mL requires further evaluation for prostate cancer or BPH. Take PSA before DRE!
- Digital Rectal Exam (DRE): Screens for prostate cancer. Palpation of the prostate gland through the rectal wall. Abnormal findings: enlarged or hard prostate, irregular shapes/lumps.
- Testicular Self Exam (TSE): Monthly (during/after a shower).
Card 72
Male Reproductive System
Duct System and Sperm Pathway
Answer
Duct System and Sperm Pathway
Immature sperm leave the testes and travel to the epididymis, where they mature and are stored in the "tail" of the epididymis.
When ejaculation occurs, mature sperm are expelled from the epididymis into the vas deferens.
The vas deferens merges with the seminal vesicle to form the ejaculatory duct. Secretions from the seminal vesicle are added to the sperm.
The ejaculatory duct passes through the prostate gland, where alkaline fluid is added to the seminal fluid.
Semen empties into the urethra.
Card 73
Male Reproductive System
Illustration
Answer
Male Reproductive System
Card 74
Male Reproductive System
Key Functions
Internal Genitalia
External Genitalia
Answer
Male Reproductive System
Key Functions: Production of androgens, spermatogenesis.
Internal Genitalia:
- Testes: Composed of seminiferous tubules, site of spermatogenesis and testosterone production.
- Epididymis: Site of sperm maturation and storage.
- Vas Deferens (Ductus Deferens): Muscular tube that delivers sperm to the ejaculatory duct.
- Accessory Glands: Prostate gland, seminal vesicles, bulbourethral glands.
External Genitalia:
- Penis: Consists of the shaft and the glans penis. Allows for urination, intercourse.
- Scrotum: Pouch that protects the testes, epididymis, and vas deferens.
Card 75
Female Reproductive System
Menstrual Cycle Phases
Answer
Menstrual Cycle Phases
Follicular Phase: First day of menses through ovulation. ↑ in FSH stimulates follicular maturation in the ovary. This leads to an ↑ in estrogen and thickening of the endometrium to prepare for potential implantation of a fertilized egg.
Ovulation: Estrogen peaks, leading to a surge in LH and release of an oocyte (i.e., egg).
Luteal Phase: Follicle turns into a "corpus luteum" and releases progesterone, which thickens the lining of the uterus. If pregnancy does not occur, progesterone levels drop and the corpus luteum is reabsorbed.
Card 76
Female Reproductive System
Illustration
Answer
Female Reproductive System
Card 77
Female Reproductive System
Key Functions
Internal Genitalia
External Genitalia
Answer
Female Reproductive System
Key Functions: Reproduction, production of sex hormones.
Internal Genitalia:
- Ovaries: Organs responsible for oogenesis (egg production) and secretion of sex hormones (estrogen, progesterone).
- Fallopian Tubes: Long, slender tubes that allow oocytes to travel from the ovaries into the uterine cavity.
- Uterus: Consists of the corpus (body) and cervix (conduit between the uterine cavity and vagina).
- Layers: Endometrium (lines the uterine cavity), myometrium (middle layer, smooth muscle), and serosa (outermost lining).
- Vagina: Hollow, flexible tube that connects the uterine cervix to the vulvar vestibule.
External Genitalia (Vulva): Labia majora, labia minora, clitoris, vulvar vestibule, urethral meatus, vaginal orifice.
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Kidney Transplant
Indications
Nursing Care
Patient Teaching
Answer
Kidney Transplant
Replacement of a diseased kidney with a healthy kidney from a donor.
Indications: Kidney failure.
NC (Post-Op):
- Monitor urine output. Report urine output
- Monitor bladder irrigation for clots.
- Monitor for S/S of infection.
- Monitor for S/S of organ rejection (e.g., ↓ urine output, fever, pain, weight gain, hypertension, ↑ creatinine, BUN, and WBCs.
PT: No contact sports, monitor for signs of infection and rejection, monitor BP daily. Immunosuppressive medications will need to be taken for the rest of the patient's life.
Dialysis Complications
Hemodialysis Complications:
- Disequilibrium Syndrome: Neurologic deterioration due to cerebral edema and ↑ ICP. S/S: nausea/vomiting, headache, ↓ LOC, seizures, coma, death. Slow dialysis rate for mild symptoms, or discontinue dialysis.
- Hypotension: Slow dialysis rate, lower the head of the bed. Administer IV fluids and colloids as ordered.
Peritoneal Dialysis Complications:
- Peritonitis: Infection in the peritoneum (i.e., membrane lining the abdominal wall). S/S: fever, cloudy outflow, nausea/vomiting, abdominal pain/distension, rebound tenderness.
Card 80
Peritonial Dialysis
Indications
Nursing Care
Answer
Peritonial Dialysis
Instillation and dwelling of a hypertonic dialysate solution in the peritoneal cavity to remove waste products.
Indications: Chronic kidney disease. Best for patients who are independent or have caregiver support at home to safely perform the procedure.
NC:
- Before: Assess weight. Warm dialysate solution. Use sterile technique when accessing catheter insertion site.
- During: Keep outflow lower than patient's abdomen. Monitor the color of outflow. It should be clear and light yellow. Bloody or cloudy outflow indicates possible infection!
For poor inflow/outflow: Check for kinks in tubing, address patient constipation, reposition patient, milk tubing to break up clots.
Card 81
Hemodialysis
Indications
Nursing Care
Answer
Hemodialysis
Procedure where blood is filtered through a dialyzer outside the body. Eliminates excess fluid, electrolytes, and waste products from the body.
Indications: Fluid overload, metabolic acidosis, hyperkalemia, uremia related to acute kidney injury or chronic kidney disease.
NC:
- Before: Ensure patent vascular access (auscultate for bruit, palpate thrill). Obtain vital signs, labs, weight. Hold certain medications until after dialysis (e.g., antihypertensives).
- During: Monitor for hypotension, cramping, nausea/vomiting, bleeding. Administer heparin as ordered to prevent clots.
- After: ↓ BP and weight expected. Compare pre- and post-procedure weight to estimate volume of fluid removed.
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Chronic Kidney Disease (CKD)
Patient Teaching
Answer
CKD: Patient Teaching
Avoid nephrotoxic meds (e.g., NSAIDs) and contrast dye.
Avoid magnesium-containing antacids or laxatives.
Work with a dietician. Restrict fluid, potassium, sodium, phosphorus intake. Protein restricted based on GFR. ↑ Protein needed after dialysis, as protein is lost with each exchange.
AV Fistula: Surgically-created connection between an artery and vein that allows for dialysis access. No BP or blood draws from arm with fistula. Do not carry items or sleep on arm with fistula. For a new fistula, perform hand exercises to mature the fistula.
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Chronic Kidney Disease (CKD)
Stages of CKD
Treatment
Nursing Care
Acute Kidney Injury (AKI)
Pathophysiology:
- Prerenal, Intrarenal, Postrenal AKI
Answer
Acute Kidney Injury (AKI)
Sudden loss of kidney function; usually reversible.
Patho: Three general underlying causes:
- Prerenal AKI: ↓ Blood flow to kidneys due to shock, sepsis, hypovolemia, renal vascular obstruction.
- Intrarenal AKI: Direct damage to the kidneys (e.g., physical trauma, hypoxic injury, chemical injury due to toxins or medications).
- Postrenal AKI: Mechanical obstruction to urine outflow (e.g., stone, tumor, BPH) causes urine to back up into the kidneys, impairing kidney function.
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Urolithiasis
Diagnostics
Treatment
Nursing Care
Patient Teaching
Answer
Urolithiasis
Dx: Non-contrast abdominal and pelvic CT scan, renal ultrasound, X-ray of kidneys, ureters, and bladder (KUB).
Tx:
- Medications: Opioids, NSAIDs, oxybutynin, antiemetics.
- Procedures:
- Lithotripsy: Use of laser or shock-wave energy to break up stones. Hematuria, bruising at lithotripsy site is expected.
- Ureterolithotomy: Extraction of kidney stone.
NC: Monitor I&Os. Strain all urine (save stone for lab analysis).
PT: ↑ Fluid intake (3 L/day) and activity. Modify diet to limit foods according to calculi type (calcium, oxalate, uric acid).
Urolithiasis
Presence of stones (calculi) in the urinary tract. Composed of calcium phosphate, calcium oxalate, or uric acid. Nephrolithiasis = kidney stone.
Patho: Supersaturation of urine due to slow urine flow leads to crystallization and formation of a stone.
RF: Sex (male), damage to urinary tract lining, high acidity or alkalinity of urine, urinary retention, dehydration.
S/S: Severe pain (e.g., flank, back, lower abdominal pain), dysuria, fever, diaphoresis, nausea/vomiting, pallor, tachycardia, tachypnea, oliguria, hematuria.
Card 90
Nephrotic Syndrome
Labs
Diagnostics
Treatment
Nursing Care
Answer
Nephrotic Syndrome
Labs:
- Blood: Hypoalbuminemia, hyperlipidemia.
- Urine: Massive proteinuria (> 2+).
Dx: Ultrasound, renal biopsy.
Tx: Corticosteroids, diuretics, 25% albumin (to ↑ plasma volume and ↓ edema), statins (to ↓ cholesterol).
NC:
- Monitor I&Os, daily weight. Measure abdominal girth daily.
- Fluid restriction. Low sodium, moderate protein diet.
- Prevent skin breakdown due to edema
- Prevent infection due to corticosteroid use.
Nephrotic Syndrome
Kidney disorder that causes massive loss of protein in the urine.
Patho: Immune disorder, disease, or genetic defect damages the glomeruli, causing ↑ glomerular permeability. This allows protein (albumin) to pass in the urine and results in ↓ serum osmotic pressure.
RF: Lupus, diabetes.
S/S: Weight gain, edema (periorbital edema, ascites, peripheral edema), frothy urine (due to excess protein), anorexia.
"Nefrothy" syndrome can cause frothy urine!
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Glomerulonephritis
Labs
Diagnostics
Treatment
Nursing Care
Answer
Glomerulonephritis
Labs:
- Blood: ↑ Creatinine, BUN, WBCs, ESR. ↓ Protein, Hgb. Positive antistreptolysin-O titer.
- Urinalysis: Hematuria, proteinuria, ↑ urine specific gravity.
- Throat Culture: Positive for group A beta-hemolytic streptococcus.
Dx: Renal biopsy.
Tx:
- Medications: Antibiotics for underlying infection, diuretics, antihypertensive medications, corticosteroids (to ↓ inflammation).
- Procedures: Plasmapheresis to filter antibody complexes out of blood, dialysis and/or kidney transplant for chronic glomerulonephritis.
NC: Monitor I&Os, daily weight, labs. ↓ Fluids, sodium, protein.
Pyelonephritis
Bacterial infection in the kidney.
Patho: With acute pyelonephritis, a UTI spreads from the bladder → ureters → kidneys. Chronic pyelonephritis occurs due to a urinary tract defect and/or reflux from the bladder.
RF: BPH, kidney stones, pregnancy, ↑ urine pH, incomplete bladder emptying, chronic disease (e.g., diabetes).
S/S: Costovertebral tenderness, fever, chills, flank/back pain, dysuria, urinary frequency and urgency, cloudy and foul-smelling urine, nausea/vomiting, confusion (in older adults).
Labs/Dx:
- Blood: ↑ WBCs, creatinine, BUN, ESR, CRP.
- Urine: Positive for leukocyte esterase, nitrites, WBCs, bacteria.
Tx: Antibiotics, antipyretics, NSAIDs, opioid analgesics.
Card 96
Urinary Tract Infection (UTI)
Prevention
Answer
Prevention of UTIs
Drink ~ 3 L of fluid per day.
Empty bladder regularly.
Avoid constipation.
Urinate after intercourse.
Cranberry products may ↓ risk of UTIs.
Females should wipe front to back and wear cotton underwear. Avoid bubble baths, sitting in wet bathing suits, and wearing tight clothing.
Uncircumcised males should clean under foreskin.
Urinary Tract Infection (UTI)
Infection in any part of the urinary tract. Most common type is a bladder infection (cystitis).
Patho: Bacteria (usually E. coli) contaminate the periurethral area, then colonize the urethra and migrate to the bladder.
RF: Females (due to shorter urethra, close proximity of urethral meatus to anus), foley catheters, menopause, pregnancy, frequent sexual intercourse, diabetes.
S/S: Abdominal pain, dysuria, urinary frequency and urgency, nausea/vomiting, cloudy urine, foul-smelling urine, confusion (in older adults).
Labs: Urinalysis positive for bacteria, WBCs, hematuria, leukocyte esterase, nitrites.
Tx: Antibiotics, phenazopyridine (bladder analgesic).
Urinary Incontinence
Stress Incontinence: Small urine loss with ↑ abdominal pressure (e.g., sneezing, coughing, laughing). Caused by a weakened pelvic floor.
- RF: Menopause, prior pregnancy/deliveries, obesity, pelvic surgeries, constipation.
- Tx: Kegel exercises, weight reduction, topical estrogen for women, vaginal cones or pessaries.
Urge Incontinence: Inability to reach the bathroom in time due to an overactive detrusor muscle.
- RF: Neurologic disorders (e.g., stroke), bladder irritation.
- Tx: Anticholinergics (e.g., oxybutynin), bladder training, toileting schedule, avoid caffeine and alcohol.
Card 99
Laboratory Studies
Urinalysis:
- Urine Specific Gravity, Normal Findings
Blood Tests:
- Creatinine, Blood Urea Nitrogen (BUN)
Answer
Laboratory Studies
Urinalysis:
- Urine Specific Gravity: Expected range 1.005 - 1.030.
- ↑ Urine Specific Gravity = Concentrated urine.
- ↓ Urine Specific Gravity = Dilute urine.
- Normal Findings: Yellow color, pH of 4.5 - 8. No glucose, ketones, blood, protein, bilirubin, nitrates or leukocyte esterase in urine.
Blood Tests:
- Creatinine: Expected range 0.6 - 1.2 mg/dL. ↑ Levels indicate kidney dysfunction.
- Blood Urea Nitrogen (BUN): Expected range 10 - 20 mg/dL.
↑ Levels can indicate kidney dysfunction OR dehydration.
10 - 20 buns are fine for a cookout!
Card 100
Regulatory Systems
Antidiuretic Hormone (ADH)
Natriuretic Hormones (ANP, BNP)
Answer
Regulatory Systems
ADH:
- ADH is secreted by the posterior pituitary gland in response to ↑ blood osmolarity (i.e., concentrated blood).
- ADH causes the kidneys to ↑ reabsorption of water, which ↑ blood volume and BP.
Natriuretic Hormones:
- Atrial and brain natriuretic peptides (ANP and BNP) are secreted from cardiac muscle cells in response to atrial stretch (due to ↑ blood volume).
- ANP and BNP stimulate diuresis, which ↓ blood volume and BP.
ANP and BNP will make you pee!
Card 101
Regulatory Systems
Renin Angiotensin Aldosterone System (RAAS)
Answer
RAAS
With ↓ renal blood flow (indicating low BP), kidneys secrete renin.
Renin converts angiotensinogen (from liver) to angiotensin I.
Angiotensin-converting enzyme (ACE) (from lungs) converts angiotensin I to angiotensin II.
Angiotensin II causes the following actions, which ↑ BP:
- Vasoconstriction of the afferent arterioles in the nephrons, which ↑ sodium and water reabsorption.
- Release of aldosterone from the adrenal cortex, which causes the kidneys to ↑ reabsorption of sodium and water.
- Vasoconstriction of peripheral blood vessels.
Card 102
Nephron
Illustration
Answer
Nephron
Card 103
Nephron
Key Functions
Answer
Nephron
Functional unit of the kidney, responsible for urine formation. Each nephron consists of a glomerulus, the surrounding Bowman's capsule, and tubular structures.
Key Functions:
- Filtration: Blood enters the glomerulus from the afferent arteriole and is filtered at a rate of ~ 125 mL/min (glomerular filtration rate). Non-filterable components (e.g., proteins) exit via the efferent arteriole.
Afferent Approaches, Efferent Exits.
- Reabsorption and Secretion: Glomerular filtrate then moves through the tubular structures (proximal tubule, loop of Henle, distal convoluted tubule, collecting duct), where water, electrolytes, and other substances are either reabsorbed into circulation or excreted into the urine.
Card 104
Renal System
Key Components: Illustration
Answer
Renal System
Card 105
Renal System
Key Functions
Components
Answer
Renal System
Key Functions:
- Maintain proper fluid volume in the body.
- Regulate electrolyte levels and acid-base balance in the blood.
- Eliminate waste products (e.g., uric acid, urea, ammonia, creatinine) from the body.
- Regulate blood pressure through the release of renin.
- Enable RBC production through the release of erythropoietin.
- Convert vitamin D into its active form, which allows for the absorption of calcium.
Components: Kidneys, ureters, bladder, urethra.
Card 106
Bariatric Surgery
Indications
Nursing Care
Patient Teaching
Answer
Bariatric Surgery
Surgical procedure to reduce gastric capacity or absorption.
Indications: Morbidly obese patients (BMI > 40, or BMI > 35 with other risk factors).
NC (Post-Op): Monitor for dumping syndrome (S/S: abdominal cramping, tachycardia, nausea, diarrhea, diaphoresis).
PT:
- Chew food slowly and completely.
- Eat 6 small meals a day (vs. 3 big meals).
- Do not consume liquids with meals.
- Recline after meals to slow gastric emptying (with dumping syndrome).
- Focus on high-protein foods. Avoid foods high in sugar, fat, carbohydrates.
- Take vitamin/mineral supplements as directed.
Card 107
Cholecystitis
Labs
Diagnostics
Treatment
Nursing Care
Patient Teaching
Answer
Cholecystitis
Labs: ↑ WBCs. ↑ ALP, AST, LDH, bilirubin (with liver involvement). ↑ Amylase and lipase (with pancreas involvement).
Dx: Ultrasound, HIDA scan.
Tx: Analgesics, lithotripsy (shock waves used to break up gallstones), cholecystectomy (surgical removal of the gallbladder).
NC: Monitor for complications (e.g., pancreatitis, peritonitis, perforation).
PT: Low fat diet, avoid gas-causing foods, lose weight (if applicable).
Cholecystitis
Inflammation of the gallbladder.
Patho: Gallstone blocks the cystic duct or common bile duct, obstructing bile flow. This causes chemical irritation/inflammation of the gallbladder, ↓ blood flow, and necrosis.
RF: Cholelithiasis, high-fat diet, sex (female), obesity, age (> 40), genetics.
Female, Fat, Forty+, Family history.
S/S: RUQ pain (may radiate to right shoulder), pain with ingestion of high-fat food, nausea/vomiting, dyspepsia, gas, bloating, jaundice, dark urine, clay-colored stools.
Hepatitis
RF: IV drug use, body piercings, tattoos, high-risk sexual practices, travel to underdeveloped countries, contaminated food/water.
S/S: Fever, lethargy, nausea/vomiting, jaundice, dark-colored urine, clay-colored stools, arthralgia, abdominal pain.
Labs: ↑ ALT, AST, and bilirubin.
Dx: Liver ultrasound, CT/MRI, serological assays, liver biopsy.
Tx: Antiviral medications, supportive treatment.
PT: Encourage Hepatitis A & B vaccines, safe sex practices, safe food preparation (e.g., hand hygiene).
Card 110
Hepatitis
Pathophysiology
Types of Viral Hepatitis
Answer
Hepatitis
Inflammation of the liver.
Patho: Exposure to a causative agent results in liver inflammation, hepatocyte injury and necrosis. Chronic hepatitis can lead to cirrhosis and liver cancer.
Types of Viral Hepatitis:
- Hepatitis A: Acute infection. Fecal/oral transmission (contaminated food/water). Self-resolving, prevention with Hep. A vaccine.
- Hepatitis B: Acute/chronic infection. Blood/body fluids transmission. Prevention with Hep. B vaccine.
- Hepatitis C: Acute/chronic infection. Blood/body fluids transmission.
- Hepatitis D: Acute/chronic infection. Blood/body fluids transmission. Only occurs with a Hep. B infection.
- Hepatitis E: Acute infection. Fecal/oral transmission (contaminated water or undercooked meat).
Hepatitis A and E are transmitted when you EAT (contaminated food/water).
Esophageal Varices
Swollen/fragile blood vessels in the esophagus that can cause life-threatening hemorrhage.
Patho: Blood flow is impaired into the liver (due to cirrhosis, hepatitis), which leads to ↑ pressure in the portal vein (portal hypertension). This causes blood to be pushed into the surrounding blood vessels, including those in the esophagus.
RF: Portal hypertension, portal vein obstruction.
S/S: Hematemesis, hypotension, tachycardia with bleeding.
Labs: ↑ AST, ALT; ↓ Hgb/Hct.
Dx: EGD.
Tx: Blood transfusion (if indicated).
- Medications: Vasoconstrictors, non-selective beta blockers.
- Procedures: Endoscopic sclerotherapy (EST) or band ligation (EBL), balloon tamponade, esophageal stent, transjugular shunt.
Card 112
Paracentesis
Indications
Nursing Care
Answer
Paracentesis
Insertion of a needle through the abdominal wall to remove fluid from the peritoneal cavity.
Indications: Ascites causing respiratory distress.
NC:
- Pre-Procedure: Ensure patient consent has been obtained. Advise patient to empty bladder. Take vital signs, weight. Measure abdominal girth.
- Post-Procedure: Document amount and characteristics of collected fluid. Monitor for hypotension, administer albumin as prescribed. Take vital signs, weight. Measure abdominal girth.
Card 113
Cirrhosis
Labs
Diagnostics
Treatment
Nursing Care
Patient Teaching
Cirrhosis
Extensive degeneration, destruction, and fibrosis (scarring) of the liver.
Patho: Inflammation of the liver results in destruction and replacement of hepatocytes with scar tissue. This impairs blood flow in the liver and ↓ liver function. Causes include chronic alcoholism (i.e., Laennec's cirrhosis), nonalcoholic fatty liver disease, chronic viral hepatitis, toxins/drugs, chronic biliary obstruction.
S/S:
- Early: Fatigue, hepatomegaly, nausea/vomiting, abdominal pain.
- Late: Bleeding/bruising, jaundice, ascites, esophageal varices, portal hypertension, peripheral edema, fetor hepaticus (sweet musty breath smell), asterixis, hepatic encephalopathy, pruritus, petechiae, spider angiomas, palmar erythema, dark urine, clay-colored stool.
Card 115
Pancreatitis
Labs
Diagnostics
Treatment
Nursing Care
Patient Teaching
Answer
Pancreatitis
Labs: ↑ Amylase, lipase, WBCs, glucose, CRP, ESR. ↓ Calcium, magnesium, platelets. ↑ Bilirubin, AST, ALT with biliary dysfunction.
Dx: Ultrasound, CT scan, MRI.
Tx: NPO, then progress to bland/low-fat diet. IV fluids and electrolytes. NG tube with suction for severe cases.
- Medications: Opioid analgesics, antibiotics, antiemetics, insulin, pancreatic enzymes (with meals/snacks).
NC: Monitor for complications (e.g., chronic pancreatitis, pancreatic pseudocyst, type 1 diabetes).
PT: Do not consume alcohol (encourage alcohol recovery program if applicable), low-fat diet, no smoking.
Pancreatitis
Inflammation of the pancreas.
Patho: Pancreatic digestive enzymes are activated prematurely (before reaching the intestines), resulting in autodigestion and fibrosis of the pancreas.
RF: Alcohol abuse, bile tract disease, GI surgery, gallstones, trauma, medication toxicity.
S/S: Severe LUQ or epigastric pain (radiating to the back or left shoulder), worse in supine position or with ingestion of high-fat food. Nausea/vomiting, Cullen's sign (blue/grey discoloration around the umbilicus), Turner's sign (ecchymoses on flanks), ascites, jaundice, tetany.
If you turn your patient on their side, you will see Turner's sign!
Diverticulitis
Inflammation of diverticula (small pouches in the intestine).
Patho: High intraluminal pressure causes diverticula to form in weak spots in the GI wall (i.e., diverticulosis). Undigested food and bacteria accumulate in the diverticula, leading to inflammation and infection (i.e., diverticulitis).
RF: Low-fiber diet, genetics, obesity, smoking, NSAIDs, corticosteroids.
S/S: LLQ abdominal pain (descending, sigmoid colon), bloating, fever, N/V.
Labs: ↑ WBCs, ESR, CRP. ↓ Hgb/Hct with bleeding.
Dx: Barium enema, colonoscopy, CT scan, lower GI series.
Tx: Antibiotics, analgesics.
NC: Monitor for signs of complications (perforation, peritonitis, bleeding, fistula).
PT: NPO or clear liquid diet during exacerbations, then progress to a low-fiber diet. Ongoing, eat a high-fiber diet.
Card 118
Crohn's Disease
Labs
Diagnostics
Treatment
Nursing Care
Patient Teaching
Answer
Crohn's Disease
Labs: ↓ Hct/Hgb (anemia) and albumin; ↑ ESR, CRP and WBCs.
Dx: Colonoscopy, EGD, CT/MRI.
Tx:
- Medications: Aminosalicylates (e.g., sulfasalazine), corticosteroids, biologics (e.g., infliximab), antidiarrheals.
- Surgery: Small bowel resection, colectomy, ileostomy.
NC: Monitor I&Os, electrolytes, CBC levels. Monitor for complications (e.g., peritonitis, intestinal obstruction, fistulas, malnutrition).
PT: Bowel rest (NPO) with TPN during severe exacerbations. Ongoing, consume a high-calorie, low-fiber diet. Eat small frequent meals.
Crohn's Disease
Chronic inflammatory disease that can involve the entire GI tract (most common in the distal small intestine or proximal colon) and all layers of the bowel wall. Characterized by periods of remissions and exacerbations.
Patho: Inflammation leads to the development of patchy ulcerations ("skip lesions") and granulomas in the GI tract. Causes scarring and narrowing of the intestinal lumen, placing patient at risk for fistulas.
RF: Autoimmune disorders, genetics, smoking, NSAID use.
S/S: Diarrhea (5 - 6 loose stools/day), steatorrhea, RLQ pain, weight loss, fever, fatigue.
Card 120
Ulcerative Colitis
Diagnostics
Treatment
Nursing Care
Patient Teaching
Answer
Ulcerative Colitis
Dx: Stool sample, colonoscopy with biopsy.
Tx:
- Medications: Aminosalicylates (e.g., sulfasalazine), corticosteroids, immunosuppressants, antidiarrheals.
- Surgery: Proctocolectomy and ileostomy, fecal microbiota transplant.
NC: Monitor I&Os, electrolytes, CBC levels. Monitor for complications (e.g., peritonitis, sepsis).
PT: NPO during exacerbations. Ongoing, consume a high-calorie, low-fiber diet. Avoid caffeine, alcohol, lactose. Eat smaller, more frequent meals.
Ulcerative Colitis
Chronic inflammatory disease of the colon, characterized by periods of remissions and exacerbations.
Patho: Abnormal immune response causes inflammation in the mucosal layer of the colon, which leads to continuous ulcerations.
RF: Autoimmune disorders, genetics, Jewish descent, stress.
S/S: Diarrhea with blood or pus (10 - 20 liquid stools/day), fever, abdominal pain, fecal urgency, weakness, weight loss, dehydration.
Labs: ↑ WBC, CRP, ESR; ↓ Hgb/Hct (anemia), albumin, potassium, magnesium.
Card 122
Peritonitis
Pathophysiology
Risk Factors
Signs/Symptoms
Diagnostics
Treatment
Nursing Care
Answer
Peritonitis
Inflammation of the peritoneum.
Patho: Peritoneal cavity becomes contaminated by bacteria, resulting in inflammation.
RF: Infection, trauma, peritoneal dialysis. Perforation related to appendicitis, diverticulitis, peptic ulcer disease.
S/S: Rigid, boardlike abdomen, abdominal pain, nausea/vomiting, rebound tenderness, fever, tachycardia, ↓ bowel sounds.
Dx: Abdominal X-ray, CT, ultrasound.
Tx: NPO, NG tube, IV fluids, antibiotics, analgesics.
- Surgery: Repair/removal of perforated organ, intra-abdominal lavage.
NC: Monitor patient closely for sepsis.
Appendicitis
Inflammation of the appendix.
Patho: Opening of the appendix becomes obstructed by a fecalith, tumor, or due to infection. This results in inflammation, ischemia, and bacterial overgrowth.
S/S: RLQ pain (McBurney's point), rebound tenderness, loss of appetite, nausea/vomiting, fever.
Labs/Dx: CT scan, ↑ WBCs.
Tx: NPO. IV fluids, antibiotics.
- Surgery: Laparoscopic or open appendectomy (removal of the appendix).
Complications: Peritonitis, perforation (sudden relief of pain may indicate rupture of the appendix, which is an emergency!).
Card 124
Ostomies
Types of Ostomies
Patient Teaching
Answer
Ostomies
Surgical procedure that reroutes part of the intestine through the abdominal wall, forming a stoma.
Types of Ostomies:
- Ileostomy: Created from the ileum. Stool is loose/watery.
- Colostomy: Created from the large intestine. Stool consistency varies.
- Ascending Colostomy = Liquid stool
- Transverse Colostomy = Semi-solid stool
- Descending/Sigmoid Colostomy = Formed stool
PT:
- Assess stoma regularly. Should be pink/moist. Pale or blue stoma = ischemia.
- Empty bag when it is 1/3 full. Change immediately if leaking!
- Cut opening in skin barrier ≤ ⅛" wider than the measured stoma size to prevent skin damage from contact with ostomy output.
- Chew food thoroughly. Consume low-fiber diet for first 6 - 8 weeks. Avoid foods that cause gas/odor.
Card 125
Intestinal Obstruction
Pathophysiology
Signs/Symptoms
Diagnostics
Treatment
Nursing Care
Answer
Intestinal Obstruction
Complete or partial blockage of the intestines. Potentially life-threatening condition.
Patho:
- Mechanical obstruction: Bowel is physically blocked due to adhesions from surgery, tumor, hernia, or fecal impaction.
- Paralytic Ileus: Decreased/absent peristalsis due to abdominal surgery, electrolyte imbalances, inflammation/infection, intestinal ischemia.
S/S: Abdominal distention and pain, absent bowel sounds distal to obstruction, high-pitched bowel sounds above obstruction.
- Small Bowel: Profuse vomiting (bilious or feculent), obstipation, severe fluid and electrolyte imbalances.
- Large Bowel: Minimal/no vomiting, obstipation or ribbon-like stool, no major fluid and electrolyte imbalances.
Dx: Abdominal CT with contrast.
Tx: NPO, NG tube with suction, IV fluids and electrolytes.
- Surgical: Colon resection, colostomy, lysis of adhesions.
NC: Strict I&Os, monitor electrolytes and acid/base balance.
Abdominal Hernia
Section of intestine protrudes through a weakness in the abdominal muscle wall (e.g., inguinal or umbilical hernia).
Patho: Muscle weakness and/or ↑ intra-abdominal pressure allows for herniation. Risk of bowel strangulation, obstruction, and necrosis.
RF: Obesity, pregnancy, lifting of heavy objects.
S/S: "Lump" or protrusion at affected site. Severe pain and ↓ bowel sounds with strangulation or obstruction.
Dx: Physical examination by provider, CT scan, MRI, ultrasound.
Tx: Truss (belt), surgical repair of hernia, bowel resection for necrosis.
PT (Post-Op): Avoid coughing if possible, splint when coughing/sneezing, avoid heavy lifting and straining.
Irritable Bowel Syndrome (IBS)
Intestinal disorder that causes abdominal pain and changes in bowel movements (in the absence of other diseases).
Patho: Unknown.
RF: Stress, mental health disorders, intestinal bacterial overgrowth, food sensitivities.
S/S: Pain, bloating, diarrhea (IBS-D), constipation (IBS-C), or a combination (IBS-M). Improvement in symptoms upon defecation.
Dx: Symptom review and tracking, diagnostic testing to rule out other diseases (e.g., stool/blood tests), endoscopy.
Tx: Alosetron (IBS-D), lubiprostone (IBS-C).
PT: Keep a food/symptom journal to identify triggers (e.g., milk, alcohol, caffeine, wheat, eggs). ↑ Fiber intake and physical activity, avoid gluten, reduce stress.
Hiatal Hernia
Protrusion of the stomach through the diaphragm into the chest.
Patho: Weakening of the diaphragm or anatomic defect allows the fundus of the stomach to protrude through the esophageal hiatus (opening in the diaphragm where the esophagus passes from the thorax to the abdomen). High risk of gastric strangulation!
S/S: Heartburn, dysphagia, chest pain after meals.
Dx: Upper GI series, EGD.
Tx: GERD medications, fundoplication surgery.
PT: Same teaching as GERD. Post-op: Avoid coughing and straining (use stool softeners).
Dysphagia
Difficulty swallowing.
Patho: Swallowing is impaired by a structural abnormality, or a disorder that impairs the muscles or nerves used for swallowing.
RF: Stroke, head/neck/esophagus injury, GERD, cerebral palsy, Parkinson's disease, cleft palate, dementia, infection, ALS.
S/S: Coughing, clearing of the throat, difficulty eating and/or drinking, food pocketing, aspiration pneumonia.
Dx: Upper GI series (e.g., barium swallow), swallow assessment by speech language pathologist (SLP), EGD.
Tx: Dysphagia diet (e.g., soft/moist food, thickened liquids), feeding tube for severe dysphagia.
NC: ↑ HOB (high-Fowler's).
PT: Tuck chin when swallowing (if recommended by SLP).
Gastrointestinal (GI) Series
Procedure
Preparation
Patient Teaching
Answer
Gastrointestinal (GI) Series
Fluoroscopy imaging test used to identify GI abnormalities (e.g, ulcers, tumors, obstructions). May include upper GI series, small-bowel follow-through, or lower GI series (i.e., barium enema).
Procedure: Patient drinks barium and x-rays are taken as it moves through the GI tract.
Preparation: NPO, no smoking or chewing gum during the 8 hours prior to the procedure. Bowel prep for lower GI series.
PT: ↑ Fluid intake after test to flush out the barium. Stools may be white for several days until barium is cleared out.
Card 137
GI Procedures
Esophagoduodenoscopy (EGD)
Sigmoidoscopy
Colonoscopy
Answer
GI Procedures
EGD: Esophagus, stomach, and duodenum are visualized under moderate sedation.
- Prep: NPO 6 - 8 hours prior to the procedure.
Sigmoidoscopy: Visualizes the anus, rectum, and sigmoid colon. No anesthesia necessary.
- Prep: Clear liquid diet (avoid red or purple liquids), bowel prep (e.g., polyethylene glycol), NPO after midnight.
Colonoscopy: Anus, rectum, sigmoid colon, descending colon, transverse colon, and ascending colon are visualized under moderate sedation.
- Prep: Clear liquid diet (avoid red or purple liquids), bowel prep (e.g., polyethylene glycol), NPO after midnight.
Gallbladder & Biliary Tract
Gallbladder:
- Structure: Pear-shaped, located underneath the liver.
- Functions: Store and concentrate bile from the liver, release bile into the small intestine when fat is ingested.
Biliary Tract and Ducts:
- Bile drains into the cystic duct.
- Cystic duct combines with the common hepatic duct to form the common bile duct.
- Common bile duct combines with the pancreatic duct, before emptying into the duodenum.
Card 140
Liver
Structure
Functions
Answer
Liver
Structure: Two main lobes, each made of lobules (functional units of the liver).
Functions:
- Storage of minerals, fat-soluble vitamins.
- Bile production and secretion.
- Bilirubin (waste product from breakdown of old RBCs) metabolism and secretion.
- Detoxification and excretion of harmful drugs and substances.
- Protein metabolism, including plasma protein synthesis (albumin, clotting factors) and conversion of ammonia to urea.
- Fat metabolism, including cholesterol synthesis and elimination.
- Carbohydrate metabolism (e.g., glycogenolysis and gluconeogenesis).
Card 141
Large Intestine & Pancreas
Structure
Functions
Answer
Large Intestine & Pancreas
Large Intestine:
- Structure (Proximal to Distal): Cecum, ascending colon (on right), transverse colon, descending colon (on left), sigmoid colon, rectum, anal canal.
- Functions: Movement of feces through the colon, absorption of water and electrolytes, defecation.
Pancreas:
- Structure: Head, body, tail.
- Functions:
- Exocrine: Secretion of enzymes into the duodenum that allow for digestion of carbohydrates, fats, and proteins.
- Endocrine: Production of hormones (e.g., insulin, glucagon) that regulate blood glucose levels.
Card 142
Stomach & Small Intestine
Structure
Function
Answer
Stomach & Small Intestine
Stomach:
- Structure (Proximal to Distal): Cardia (esophageal entry), fundus (top), body, pylorus. Pyloric sphincter leads to duodenum.
- Function: Mechanical and chemical digestion. Mixes food with gastric secretions to form chyme, which empties into the small intestine.
Small Intestine:
- Structure (Proximal to Distal): Duodenum, jejunum, ileum.
DJ Ileum plays at the GI club!
- Function: Movement (peristalsis) from the stomach to the large intestine, digestion, absorption.
- Inactivated pancreatic enzymes (amylase, lipase, protease) enter the duodenum at the sphincter of Oddi, where they become activated and digest carbohydrates, fats, protein.
- Bile enters the duodenum at the sphincter of Oddi and emulsifies fat. If the sphincter of Oddi is closed, bile is stored in the gallbladder.
Card 143
Oral Cavity & Esophagus
Components
Function
Answer
Oral Cavity & Esophagus
Oral Cavity:
- Components: Buccal mucosa, lips, tongue, hard palate, soft palate, teeth, salivary glands (parotid, submandibular, and sublingual).
- Functions: Mechanical digestion (i.e., grinding of food into smaller pieces through mastication) and chemical digestion (salivary amylase begins digestion of carbohydrates).
Espohagus:
- Structure: Muscular tube that connects the pharynx (throat) to the stomach. Contains two sphincters:
- Upper Esophageal Sphincter: Protects against reflux of food into the airways, prevents entry of air into the digestive tract.
- Lower Esophageal Sphincter (i.e., Cardiac Sphincter): Prevents reflux of gastric contents into the esophagus.
- Function: Propels the food bolus towards the stomach via peristalsis.
Card 144
Gastrointestinal System
Illustration
Answer
Gastrointestinal System
Card 145
Gastrointestinal System
Functions
Components
Answer
Gastrointestinal System
Functions: Provide essential nutrients to support body functions through digestion, allow for elimination of waste products through defecation.
Components:
- Alimentary Canal: Oral cavity, pharynx, esophagus, stomach, small intestine, large intestine, rectum, anal canal.
- Accessory Organs: Salivary glands, liver, gallbladder, pancreas.
- Peritoneum: Serous membrane that holds the digestive organs in place within the abdominal cavity.
Card 146
Diabetes Mellitus
Chronic Complications
Answer
Diabetes Mellitus: Chronic Complications
Cardiovascular Disease: ↑ Risk for hypertension, MI, stroke.
Neuropathy: Nerve damage, neuropathic pain, foot infections and deformities (e.g., Charcot foot).
Nephropathy: Kidney damage, which can lead to chronic kidney disease (CKD).
Retinopathy: Impaired vision or vision loss.
Gastroparesis: Impaired digestion.
Other Complications: ↑ Risk of infection, tooth decay, gum disease, hearing loss, sexual dysfunction.
Card 147
DKA and HHS
Treatment
Nursing Care
Answer
DKA and HHS
Tx: Address underlying cause (e.g., infection), IV fluid resuscitation, IV insulin, bicarbonate (for severe acidosis).
NC:
- Check blood glucose hourly (goal
- Closely monitor potassium levels.
- Hyperkalemia is often present at admission. Administer calcium gluconate to prevent cardiac dysrhythmias.
- Hypokalemia may occur during treatment of DKA/HHS because insulin causes potassium to move back into cells. Replace potassium as indicated.
Card 148
Hyperglycemic Hyperosmolar State (HHS)
Risk Factors
Signs/Symptoms
Labs
Answer
HHS
Life-threatening condition with VERY high blood glucose levels and severe dehydration. Gradual onset. More common with type 2 DM.
HHS has 2 Hs, and is more common with Type 2 DM.
RF: Older adults, inadequate fluid intake, decreased kidney function, infection, stress.
S/S: 3 Ps (polyuria, polydipsia, polyphagia), dehydration (resulting in hypotension, tachycardia, weakness).
Labs: Blood glucose > 600 mg/dL, NO ketones in blood and urine, NO metabolic acidosis.
DKA
Life-threatening condition with high blood glucose levels and ketones in the blood and urine. Rapid onset. More common with type 1 DM.
RF: Infection, stress/illness, untreated or undiagnosed type I DM, missed insulin dose.
S/S: 3 Ps (polyuria, polydipsia, polyphagia), fruity breath odor, Kussmaul respirations, nausea/vomiting, dehydration (resulting in hypotension, tachycardia, weakness).
Labs: Blood glucose > 300 mg/dL, ketones in blood and urine, metabolic acidosis, hyperkalemia.
The K in DKA will remind you to monitor K!
Card 150
Hypoglycemia: Nursing Care
Conscious Patients
Unconscious Patients
Answer
Hypoglycemia: Nursing Care
Conscious Patients:
- Have the patient consume ~ 15 g of a quickly absorbed carbohydrate (e.g., 4 - 6 fl oz juice/soda, 8 fl oz milk).
- Recheck blood glucose in 15 min. If still
- Once blood glucose is > 70 mg/dL, have the patient consume a snack containing protein and carbohydrates.
Unconscious Patients:
- Administer IM/subcutaneous glucagon or IV dextrose.
- If patient has not regained consciousness in 10 min, repeat.
- Once the patient is conscious (and can swallow safely), have the patient consume a carbohydrate snack.
Hypoglycemia
Blood glucose
Causes: Excess insulin, ↓ food intake, exercise, excess alcohol.
S/S: Hunger, irritability, confusion, diaphoresis, headache, shakiness, blurred vision, pale/cool skin, decreased LOC, seizure/coma.
Cold and clammy...need some candy!
PT: Monitor blood glucose levels with a glucometer. Check levels before, during, and after exercise. Eat regular meals/snacks. Carry a fast-acting carbohydrate (e.g., glucose tablet) with you at all times. When drinking alcohol, consume food at the same time.
Card 152
Diabetes Mellitus: Patient Teaching
Foot Care
Answer
Diabetes Mellitus: Foot Care
See a podiatrist regularly. Get professionally fitted shoes.
Inspect feet daily using a mirror. Check shoes for objects before putting them on.
Apply moisturizer to feet, but not between toes.
Do not go barefoot or wear open-toe shoes. Wear socks that fit well, without uncomfortable seams.
Cut nails straight across, file away sharp corners. Do not use OTC products (e.g., corn/callus removal agents).
Do not use heating pads on feet.
Check water temperature with elbow before stepping into a tub or shower. Do not soak feet.
Card 153
Diabetes Mellitus: Patient Teaching
Insulin Administration
Illness Care
Lifestyle Modifications
Answer
Diabetes Mellitus: Patient Teaching
Insulin Administration: Rotate injection sites to prevent lipohypertrophy.
Illness Care:
- Monitor blood glucose more frequently when sick.
- Do not skip insulin when sick.
- Test urine for ketones.
- Prevent dehydration: drink ~ 3 L of water per day.
- Notify provider if illness lasts more than 1 day, temperature > 38.6 °C, blood glucose > 250 mg/dL, or urine is positive for ketones.
Lifestyle Modifications: For type 2 DM, lose weight, ↑ activity levels. Limit foods high in fat or sugar. Closely monitor carb intake. Reduce stress, stop smoking, limit alcohol intake.
Recognize symptoms of hypoglycemia and hyperglycemia.
Wear a medical ID bracelet.
Diabetes Mellitus (DM)
Type 1 DM, Type 2 DM, Gestational DM:
- Pathophysiology, Risk Factors
Answer
Diabetes Mellitus (DM)
Type 1 DM:
- Patho: Autoimmune dysfunction causes destruction of beta cells in the pancreas, leading to a lack of insulin secretion.
- RF: Family history, age (children, young adults).
Type 2 DM:
- Patho: Insulin resistance and ↓ insulin production develops slowly over time.
- RF: Obesity, hypertension, hyperlipidemia, smoking, genetics, race (African American, American Indian, Hispanic), inactivity.
Gestational DM:
- Patho: Placental hormones counteract insulin, resulting in glucose intolerance during pregnancy.
- RF: Gestational DM during previous pregnancy, obesity, family history of type 2 DM.
Card 156
Hyperparathyroidism
Pathophysiology
Signs/Symptoms
Labs/Diagnostics
Treatment
Nursing Care
Answer
Hyperparathyroidism
Hypersecretion of parathyroid hormone (PTH) by the parathyroid gland.
Patho: Parathyroid adenoma, renal failure or vitamin D deficiency causes overproduction of PTH. This results in ↑ intestinal calcium absorption, ↓ renal excretion of calcium, and ↑ calcium release from the bones.
S/S: Fatigue, muscle weakness, bone deformities/pain, nausea/vomiting, weight loss, constipation, hypertension, kidney stones, dysrhythmias.
Labs/Dx: Hypercalcemia, hypophosphatemia, ↑ PTH.
Tx:
- Medications: Furosemide (↑ Ca excretion), phosphates, calcitonin.
- Surgery: Removal of adenoma, parathyroidectomy.
NC: Implement safety precautions to prevent fractures. Provide low calcium, high phosphorus diet. Encourage ↑ fluid intake.
Card 157
Hypoparathyroidism
Pathophysiology
Signs/Symptoms
Labs/Diagnostics
Treatment
Nursing Care
Answer
Hypoparathyroidism
Hyposecretion of parathyroid hormone (PTH) by the parathyroid gland.
Patho: Damage to parathyroid gland during a thyroidectomy results in hypocalcemia and hyperphosphatemia.
S/S: Muscle cramps, numbness/tingling, positive Chvostek's and Trousseau's signs, tetany/seizures, dysrhythmias.
Labs/Dx: Hypocalcemia, hyperphosphatemia, ↓ PTH.
Tx: Calcium gluconate, calcium/vitamin D supplements, phosphate binders.
NC: Implement seizure precautions. Provide high calcium, low phosphorus diet. Give phosphate binders with meals.
Card 158
Thyroidectomy
Indications
Nursing Care
Patient Teaching
Answer
Thyroidectomy
Surgical removal of part or all of the thyroid gland.
Indications: Thyroid cancer, hyperthyroidism, thyroid nodule.
NC
- Pre-Op: Administer antithyroid drugs, iodine, beta blockers as ordered.
- Post-Op:
- Place patient in semi-Fowler's position.
- Support patient's head and neck (using sandbags, pillows).
- Monitor for bleeding! Assess dressing and behind patient's neck.
- Monitor for signs of hypocalcemia due to parathyroid damage (e.g., numbness/tingling around mouth, muscle twitching, positive Chvostek's or Trousseau's signs). Administer calcium gluconate for hypocalcemia.
PT: Avoid neck flexion/extension.
For a total thyroidectomy, lifelong thyroid replacement is required!
Card 159
Thyroid Storm (Thyrotoxicosis)
Causes
Signs/Symptoms
Treatment
Nursing Care
Answer
Thyroid Storm (Thyrotoxicosis)
Excessively high levels of thyroid hormones. High mortality rate.
Causes: Infection, stress, DKA.
S/S: Severe hypertension, chest pain, dysrhythmias, dyspnea, delirium, fever, nausea/vomiting.
Tx:
- Medications: Beta blockers, anti-thyroid medications, antipyretics.
- Surgery: Thyroidectomy.
NC: Maintain patent airway, monitor for dysrhythmias, administer oxygen, provide IV fluids. Apply cooling blanket to reduce fever.
Card 160
Hyperthyroidism
Signs/Symptoms
Labs/Diagnostics
Treatment
Nursing Care
Answer
Hyperthyroidism
S/S: Tachycardia, hypertension, heat intolerance, exophthalmos, weight loss, insomnia, diarrhea, warm/sweaty skin, anxiety, irritability.
Labs/Dx: ↑ T3/T4, ↓ TSH (in primary hyperthyroidism).
Tx:
- Surgery: Thyroidectomy.
- Medications: Propylthiouracil, iodine solutions, beta blockers, radioactive iodine therapy.
NC:
- ↑ Patient's calories and protein intake.
- Monitor I&Os, weight, vital signs.
- For exophthalmos, tape eyelids closed for sleep and provide eye lubricant.
Card 161
Hyperthyroidism
Pathophysiology
Answer
Hyperthyroidism
Excess thyroid hormones (T3/T4) are released from the thyroid gland, resulting in a hypermetabolic state.
Patho:
- Primary: Grave's disease (most common cause, autoimmune issue) or thyroid nodule results in hypersecretion of T3/T4 from the thyroid gland.
Secondary: Anterior pituitary gland tumor causes ↑ TSH secretion (which ↑ T3/T4 production).
- Tertiary: Hypothalamus dysfunction causes ↑ TRH secretion (which ↑ TSH secretion and ↑ T3/T4 production).
Card 162
Myxedema Coma
Causes
Signs/Symptoms
Treatment
Nursing Care
Answer
Myxedema Coma
Severe, life-threatening hypothyroidism.
Causes: Untreated hypothyroidism, infection, illness, abrupt discontinuation of levothyroxine.
S/S: Hypoxia, ↓ cardiac output, ↓ LOC, bradycardia, hypotension, hypothermia.
Tx: Large doses of IV levothyroxine, treatment of underlying infection/illness.
NC: Maintain patent airway, monitor cardiac rhythm, warm patient. Assist with intubation and mechanical ventilation.
Card 163
Hypothyroidism
Signs/Symptoms
Labs/Diagnostics
Treatment
Nursing Care
Answer
Hypothyroidism
S/S: Hypotension, bradycardia, lethargy, cold intolerance, constipation, weight gain, hair loss, brittle fingernails, depression, cold/dry skin, pallor.
Labs/Dx: ↓ T3/T4, ↑ TSH (with primary hypothyroidism), ↓ TSH (with secondary/tertiary hypothyroidism), anemia.
Tx: Levothyroxine, liothyronine.
NC:
- Encourage frequent rest periods.
- Encourage a low-calorie/high-fiber diet to promote weight loss and prevent constipation.
- Increase room temperature, provide blankets.
Card 164
Hypothyroidism
Pathophysiology
Answer
Hypothyroidism
Inadequate production of thyroid hormones (T3 and T4) by the thyroid gland.
Patho:
- Primary: Hashimoto's disease (most common cause, autoimmune issue), thyroidectomy, or radiation therapy causes thyroid gland injury/damage, leading to ↓ T3/T4 production.
- Secondary: Anterior pituitary gland tumor causes ↓ TSH secretion (which ↓ T3/T4 production).
- Tertiary: Hypothalamic dysfunction causes ↓ TRH secretion (which ↓ TSH secretion and ↓ T3/T4 production).
Card 165
Hyperaldosteronism
Pathophysiology
Signs/Symptoms
Labs
Diagnostics
Treatment
Nursing Care
Answer
Hyperaldosteronism
Hypersecretion of mineralocorticoids from the adrenal cortex.
Patho: Adrenal adenoma or adrenocortical hyperplasia causes ↑ secretion of aldosterone, which results in excessive reabsorption of sodium and water and excess excretion of potassium in the kidneys.
S/S: Hypertension, headache, weakness, paresthesias, tetany.
Labs: Hypokalemia, hypernatremia, ↑ aldosterone.
Dx: Adrenal CT scan.
Tx: Adrenalectomy, spironolactone.
NC: Monitor BP, I&Os, potassium levels. Low-sodium, high potassium diet (prior to surgery).
Pheochromocytoma
Hypersecretion of catecholamines from the adrenal gland.
Patho: Adrenal medulla tumor causes excess release of epinephrine and norepinephrine, which ↑ the sympathetic response in the body.
S/S: Tachycardia, hypertension, diaphoresis, headache, shortness of breath.
Labs/Dx: 24-hour urine test (for vanillylmandelic acid, metanephrine, and catecholamines), clonidine suppression test. CT/MRI of adrenal gland.
Tx:
- Surgery: Tumor excision, adrenalectomy.
- Medications: Antihypertensives until surgery.
Do not palpate abdomen as that can cause a sudden release of catecholamines and trigger severe hypertension!
Card 167
Cushing's Syndrome
Diagnostics
Treatment
Nursing Care
Answer
Cushing's Syndrome
Dx: Dexamethasone suppression test (measures whether ACTH secretion by the pituitary gland can be suppressed). CT, MRI, ultrasound to identify pituitary or adrenal gland tumor.
Tx:
- Surgery: Tumor excision, hypophysectomy, adrenalectomy.
- Medications: Ketoconazole (inhibits cortisol synthesis).
NC:
- Restrict fluid and sodium. Increase intake of potassium, calcium, and protein.
- Monitor for complications (e.g., fluid volume overload, pulmonary edema, GI bleeding).
- Protect patient from infection, skin breakdown, and bone fractures.
Cushing's Syndrome
Endocrine disorder characterized by excess levels of cortisol.
Patho: Pituitary adenoma (Cushing's disease), adrenal tumor, or prolonged steroid administration results in excess cortisol, which causes ↑ glucose levels, protein catabolism, altered fat metabolism, and ↓ immune response.
S/S: Fatigue, weakness, "buffalo hump", "moon face", truncal obesity, weight gain, fluid retention, hypertension, peptic ulcer disease, diabetes, bone pain/fractures, emotional instability, ↑ risk of infection, acne, hirsutism, thin/fragile skin, abdominal striae.
Cushing's will make you look like a cushion (due to fluid retention)!
Labs: ↑ Serum glucose, sodium. ↓ Serum potassium, calcium. ↑ Cortisol levels in saliva.
Card 169
Addisonian Crisis
Causes
Signs/Symptoms
Treatment
Nursing Care
Answer
Addisonian Crisis
Life-threatening disorder caused by adrenal insufficiency.
Causes: Infection, stress, trauma, abrupt discontinuation of corticosteroids in a patient with Addison's disease.
S/S: Weakness, fatigue, severe hypotension, nausea/vomiting, dehydration, dysrhythmias, shock.
Tx: IV glucocorticoids, IV fluids with dextrose, identify/treat underlying cause.
NC: Monitor vital signs, I&Os, weight. Monitor for signs of shock (↓ LOC and urine output). Monitor for dysrhythmias due to hyperkalemia. Provide bed rest and a quiet environment.
Card 170
Adrenocortical Insufficiency
Diagnostics
Treatment
Nursing Care
Patient Teaching
Answer
Adrenocortical Insufficiency
Dx: ACTH stimulation test (differentiates primary and secondary insufficiency).
Tx: Corticosteroids (e.g., hydrocortisone, fludrocortisone). Medications to address hyperkalemia: sodium polystyrene sulfonate, insulin and dextrose, calcium gluconate (cardiac protection), sodium bicarbonate.
NC: Administer fluids, electrolytes as ordered. Provide food, supplemental glucose for hypoglycemia.
PT: Teach patients that corticosteroid doses may need to be ↑ during times of stress/illness.
Adrenocortical Insufficiency
Inadequate secretion of hormones by the adrenal cortex (aldosterone, cortisol, sex hormones).
Patho:
- Primary: Addison's disease (autoimmune disorder) or adrenal gland injury/infection causes partial/complete destruction of the adrenal gland.
- Secondary: Abrupt discontinuation of corticosteroid therapy or hypopituitarism suppresses the hypothalamus-pituitary-adrenal (HPA) axis.
S/S: Weakness, fatigue, weight loss, bronzed skin color, hypotension, dehydration, abdominal pain, nausea/vomiting, salt craving.
Labs: ↓ Serum cortisol, sodium, glucose; ↑ Serum potassium, calcium, BUN.
Card 172
Syndrome of Inappropriate Antidiuretic Hormone (SIADH)
Labs/Diagnostics
Treatment
Nursing Care
Answer
SIADH
Labs/Dx:
- Urine: ↑ Specific gravity (> 1.030), ↑ osmolality, ↑ sodium.
- Blood: ↓ Serum osmolality (
Tx: Diuretics, vasopressin antagonists, hypertonic saline (e.g., 3% NaCl). Address underlying cause of SIADH.
NC: Monitor I&Os, weigh patient daily. Restrict fluids and replace sodium as ordered. Monitor for fluid volume overload, pulmonary edema. Monitor neurologic status and implement seizure precautions due to hyponatremia.
Card 173
Syndrome of Inappropriate Antidiuretic Hormone (SIADH)
Pathophysiology
Signs/Symptoms
Answer
SIADH
Excess release of ADH from the posterior pituitary gland.
Patho: Brain tumor, head injury, meningitis, and/or medications cause excess secretion of ADH, even when plasma osmolality is low. This results in reabsorption of water (but not sodium) in the kidneys.
S/S: Small amounts of concentrated urine, fluid volume excess (e.g., tachycardia, hypertension, crackles, JVD, weight gain), headache, nausea/vomiting, muscle cramping, confusion, seizures.
With SIADH, you are Super Inflated with excess fluid!
Card 174
Diabetes Insipidus
Labs
Diagnostics
Treatment
Nursing Care
Answer
Diabetes Insipidus
Labs:
- Urine: ↓ Specific gravity (
- Blood: ↑ Serum osmolality (> 295 mOsm/L), ↑ sodium.
Dx: Water deprivation test (tests the ability of the kidneys to concentrate urine), vasopressin test (determines if diabetes insipidus is neurogenic or nephrogenic), MRI.
Tx: Vasopressin, desmopressin for neurogenic DI. Thiazide diuretics for nephrogenic DI.
NC: Monitor I&Os, urine specific gravity, daily weight.
Card 175
Diabetes Insipidus
Pathophysiology
Signs/Symptoms
Answer
Diabetes Insipidus
Insufficient ADH released from the posterior pituitary gland (or inadequate kidney response to ADH) results in the kidneys being unable to concentrate urine.
Patho:
- Neurogenic: Hypothalamus or pituitary tumor/injury causes insufficient ADH to be released in response to ↑ blood osmolarity.
- Nephrogenic: Inadequate kidney response to ADH due to kidney disorders or nephrotoxic drugs.
S/S: Large amounts of dilute urine, polydipsia, dehydration, hypotension, anorexia.
Diabetes Insipidus will make you Dry Inside.
Diabetes InSIPidus will make you want to SIP a lot of water.
Growth Hormone Deficiency
Inadequate secretion of growth hormone (GH) from the anterior pituitary gland.
Patho: Genetics, injury/damage to the pituitary gland, or hypothalamus dysfunction causes ↓ secretion of GH. This results in impaired growth, short stature, and maturation delays.
S/S: Short stature (but proportional height and weight), ↓ muscle mass, ↑ fat, delayed puberty.
Labs/Dx: GH stimulation test, bone age scan, CT scan of head.
Tx: GH replacement therapy (e.g., somatropin) administered via subcutaneous injections. Treatment typically stopped when X-ray shows epiphyseal closure.
Card 178
Hypophysectomy
Indications
Nursing Care
Patient Teaching
Answer
Hypophysectomy
Surgical removal of the pituitary gland.
Indications: Pituitary adenomas.
NC (Post-Op): Monitor for signs of CSF leak: "halo sign" in nasal drainage (clear in center, yellow on edges), patient report of sweet-tasting drainage, presence of glucose in nasal drainage, headache.
PT:
- Avoid activities that ↑ ICP: coughing, sneezing, blowing nose, bending at waist, straining during bowel movements (↑ fiber intake).
- Decreased sense of smell expected for ~ 1 month.
- Do not brush teeth for 2 weeks; OK to floss and rinse mouth.
- Lifelong hormone replacement therapy required!
Laboratory Studies
Thyroid Panel:
Lab Value
Expected Range
Triiodothyronine (T3)
70 - 205 ng/dL
Thyroxine (T4)
4 - 12 mcg/dL
Thyroid Stimulating Hormone (TSH)
0.5 - 5.0 mU/L
Blood Glucose:
Lab Value
Expected Range
Fasting Blood Glucose
2 Hour Oral Glucose Tolerance Test
HgbA1C
Card 182
Negative Feedback Loop
Thermostat Analogy
Function in the Body
Answer
Negative Feedback Loop
Mechanism that regulates most endocrine hormones to achieve homeostasis, similar to a thermostat.
Thermostat: Your heater is on, and your thermostat is set at 75 degrees. The heater runs until the temperature gets above 75, and then it turns off. When the temperature drops below 75 degrees again, the heater turns back on.
Function in the Body: If an endocrine gland senses that there is not enough of a hormone circulating in the blood, changes are initiated to increase production of that hormone. If the endocrine gland senses there is too much of a hormone, changes are initiated to decrease production of that hormone.
Card 183
Hormones
Insulin:
- Role in Body, Control Over Release
Glucagon:
- Role in Body, Control Over Release
Answer
Hormones
Insulin: ↓ Blood glucose levels. Insulin allows glucose to leave the bloodstream and enter the cells, where it can be used for energy.
- Release: Rise in blood glucose levels causes insulin to be released from the pancreatic beta cells in the islets of Langerhans.
Glucagon: ↑ Blood glucose levels. Glucagon stimulates glycogenolysis (conversion of glycogen in the liver into glucose), gluconeogenesis (increased production of glucose), and causes adipose tissue to break down fat for energy.
- Release: Low blood glucose levels cause glucagon to be released from the pancreatic alpha cells.
When the glucose is gone, glucagon is released.
Card 184
Hormones
Calcitonin:
- Role in Body, Control Over Release
Parathyroid Hormone:
- Role in Body, Control Over Release
Answer
Hormones
Calcitonin: ↓ Serum calcium levels by ↓ activity of osteoclasts in bones and ↑ excretion of calcium in the kidneys.
- Release: ↑ Blood calcium levels stimulate the release of calcitonin from the thyroid gland.
Calcitonin helps tone down calcium levels in the blood!
Parathyroid Hormone (PTH): ↑ Serum calcium levels by pulling calcium out of the bones and into the bloodstream, ↑ reabsorption of calcium in the kidneys, and ↑ absorption of calcium in the intestines.
- Release: ↓ Blood calcium levels stimulate the release of PTH from the parathyroid gland.
Card 185
Hormones
Epinephrine, Norepinephrine:
- Role in Body, Control Over Release
Answer
Hormones
Epinephrine and Norepinephrine: Catecholamines released in response to acute stress. They prepare the body for the "fight or flight" response, causing vasoconstriction, ↑ HR, ↑ BP, bronchodilation, pupil dilation, ↑ blood flow to the muscles, and ↑ blood glucose levels.
Epinephrine has a stronger effect on the heart. Norepinephrine has a stronger effect on the blood vessels.
- Release: Acute stress causes activation of the sympathetic nervous system (SNS), which activates nerves connected to the adrenal medulla, causing secretion of epinephrine and norepinephrine.
Card 186
Renin Angiotensin Aldosterone System
Renin Angiotensin Aldosterone System (RAAS) Steps
Answer
Renin Angiotensin Aldosterone System
With ↓ renal blood flow (indicating low BP), kidneys secrete renin.
Renin converts angiotensinogen (from liver) to angiotensin I.
Angiotensin-converting enzyme (ACE) (from lungs) converts angiotensin I to angiotensin II.
Angiotensin II causes the following actions, which ↑ BP:
- Vasoconstriction of the afferent arterioles in the nephrons, which ↑ sodium and water reabsorption.
- Release of aldosterone from the adrenal cortex, which causes the kidneys to ↑ reabsorption of sodium and water.
- Vasoconstriction of peripheral blood vessels.
Card 187
Hormones
Antidiuretic Hormone:
- Role in Body, Control Over Release
Aldosterone:
- Role in Body, Control Over Release
Answer
Hormones
Antidiuretic Hormone (ADH): Controls blood pressure and blood volume by regulating reabsorption/excretion of water in the kidneys. Higher levels cause reabsorption of water; lower levels cause excretion of water.
- Release: ADH is secreted from the posterior pituitary gland when body senses low blood volume, low BP, and/or hypernatremia.
Aldosterone (Mineralocorticoid): Aldosterone ↑ blood pressure and blood volume by promoting renal reabsorption of sodium and water and excretion of potassium.
- Release: Controlled by the renin angiotensin aldosterone system (RAAS).
Card 188
Hormones
Oxytocin:
- Role in Body, Control Over Release
Prolactin:
- Role in Body, Control Over Release
Answer
Hormones
Oxytocin: In females, causes contraction of the uterus and promotes lactation. In males, controls production of testosterone and sperm release.
- Release: Controlled through a positive feedback mechanism. In women, oxytocin is released in response to uterine contractions and breastfeeding.
Prolactin: Promotes lactation (primarily). Released from the anterior pituitary gland.
- Release: Levels of prolactin are controlled by levels of dopamine, estrogen, and other hormones in the body.
Card 189
Hormones
Estrogen, Progesterone, Testosterone:
- Role in Body, Pathway that Controls Release
Answer
Hormones
Estrogen: Stimulates development of female sex organs. Regulates the menstrual cycle.
- Pathway: GnRH (hypothalamus) → LH and FSH (anterior pituitary) → estrogen (ovaries).
Progesterone: Regulates the menstrual cycle and plays a key role in the maintenance of pregnancy.
- Pathway: GnRH (hypothalamus) → LH (anterior pituitary) → progesterone (ovaries).
Testosterone (Androgen): Stimulates development of male sex organs and is instrumental in sperm production.
- Pathway: GnRH (hypothalamus) → FSH and LH (anterior pituitary) → sperm and testosterone production (testes).
Card 190
Hormones
Cortisol, Thyroid Hormones, Growth Hormones:
- Role in Body, Pathway that Controls Release
Answer
Hormones
Cortisol (Glucocorticoid): "Stress hormone". Regulates metabolism, immune response, and the body's response to stress. Raises blood glucose levels.
- Pathway: CRH (hypothalamus) → ACTH (anterior pituitary) → Cortisol (adrenal cortex).
Thyroid Hormones (T3/T4): Regulate metabolism, growth and development, heart function, brain function, muscle function, digestion, bone maintenance. T3 is the active form of T4.
- Pathway: TRH (hypothalamus) → TSH (anterior pituitary) → T3/T4 (thyroid gland).
Growth Hormone (GH): Controls growth and metabolism in the body (including protein synthesis). Also called somatotropin.
- Pathway: GHRH (hypothalamus) → GH (anterior pituitary).
Endocrine Organs/Glands
Hypothalamus, Pituitary Gland:
- Hormones Released
Answer
Endocrine Organs/Glands
Organ/Gland
Hormones Released
Hypothalamus
Corticotropin releasing hormone (CRH), Thyroid releasing hormone (TRH), Growth hormone releasing hormone (GHRH), Gonadotropin releasing hormone (GnRH)
That was a Cut Throat game… but Good Game!
Pituitary Gland
Anterior: Thyroid stimulating hormone (TSH), Prolactin, Follicle stimulating hormone (FSH), Luteinizing hormone (LH), Adrenocorticotropic hormone (ACTH), Growth hormone (GH)
TP Flag
Posterior: Antidiuretic hormone (ADH), oxytocin
Card 194
Endocrine System
Key Function
Endocrine Organs/Glands
Answer
Endocrine System
Key Function: Release of hormones (i.e., chemical messengers) from organs/glands in the body. These hormones in turn control many functions in the body, including:
- Growth and development
- Metabolism
- Reproduction
- Electrolyte, acid/base balance
- Response to infection, stress, injury
Endocrine Organs/Glands: Hypothalamus, pituitary gland, adrenal gland, thyroid gland, parathyroid gland, pancreas, ovaries, testes.
Malignant Hyperthermia
Inherited disorder that causes a life-threatening reaction to certain drugs used in general anesthesia (e.g., succinylcholine).
Patho: Anesthetic agent prompts uncontrolled calcium release from the skeletal muscle cells. This leads to sustained muscle contraction and a hypermetabolic state.
S/S: Muscle rigidity, tachycardia, fever, dysrhythmias, tachypnea, hypotension, cyanosis.
Labs: Myoglobinuria (muscle proteins in the urine), metabolic acidosis with ABG.
Tx: Discontinue surgery if possible, administer antidote dantrolene and 100% oxygen. Implement cooling measures (e.g., cold IV fluids, ice packs). Administer sodium bicarbonate for metabolic acidosis.
Card 196
Amputation
Risk Factors
Nursing Care
Patient Teaching
Answer
Amputation
Removal of a limb or digit.
RF: Trauma, infection, peripheral vascular disease.
NC:
- Emergency care for traumatic amputation: Wrap severed extremity in dry sterile gauze, place in sealed bag, submerge bag in ice water.
- Monitor for infection, bleeding.
- Treat phantom limb pain with beta blockers, antiepileptics, antispasmodics, antidepressants.
- Wrap stump in figure-eight pattern to shrink residual limb.
PT: To prevent hip flexion contractures, perform ROM exercises, avoid elevating the stump (except in the first 24 - 48 hrs) and chair sitting > 1 hour. Lie prone for 20 - 30 minutes every 3 - 4 hours.
Card 197
Immobilization Devices
Nursing Care
Answer
Immobilization Devices: Nursing Care
Do not lift or remove weights. Do not let weights rest on floor (should be hanging freely).
Muscle spasms are expected and should be treated with medications (e.g., muscle relaxants), repositioning, heat, or massage. Report unrelieved muscle spasms to the provider.
For halo traction, do not use rods or ring to turn or lift patient. Make sure wrench/screwdriver are attached to the vest to release patient from the device in the event of an emergency.
Provide pin site care as ordered. Monitor for pin loosening and signs of infection (e.g., increased drainage, erythema, skin tenting at pin site). Clean pins using a new cotton tip swab for each pin. Do not remove crusting at pin site.
Traction
Skin Traction: Weights are attached to the patient's skin to immobilize the area and ↓ muscle spasms before surgery, or to reduce a fracture.
- Bryant Traction: Used for hip dysplasia in children.
- Buck's Traction: Used for hip fractures in adults.
- Bryant: Ants are small (like children), but adults have money (Bucks).
Skeletal Traction: Weights are attached to screws/pins inserted into the bone. Used for long bone fractures.
Halo Traction: Metal ring (halo) is attached to the skull with pins to immobilize and protect the cervical spine. Used for cervical spine trauma and spinal deformities.
Card 199
Casts
Nursing Care
Patient Teaching
Answer
Casts
NC:
- Handle plaster casts using your palms (not fingertips, to avoid denting) until the cast is dry.
- Elevate cast above the level of the heart to ↓ swelling.
PT:
- Do not place objects inside cast.
- Blow cool air from a hair dryer under the cast to relieve itching.
- Report the following symptoms to provider: hot spots, ↑ drainage, malodor, ↑ pain.
Fracture Complications
Fat Embolism: Fat globule from the bone marrow travels to the lungs. Most common with long bone and hip fractures.
- S/S: Dyspnea, confusion, tachypnea, tachycardia, petechiae on upper body, decreased SpO2.
- Tx: Supportive care (e.g., bedrest, oxygen, IV fluids).
Compartment Syndrome: ↑ Pressure within the muscle compartment of an extremity. Impairs circulation, causing ischemia.
- S/S: Hard/swollen muscle, intense pain unrelieved by medication and/or pain with passive movement.
- 5Ps: Pain, Paresthesia, Paralysis, Pallor, Pulselessness.
- Tx: Fasciotomy, amputation.
- NC: Avoid use of cold therapies, do not elevate affected limb.
Card 201
Fractures
Nursing Care
Answer
Fractures: Nursing Care
Provide emergency care. Cut off clothing, remove jewelry, control bleeding, immobilize fracture by splinting. Apply ice and elevate extremity to ↓ swelling.
Perform neurovascular checks. Assess pain level, sensation (e.g., numbness, tingling, lack of sensation), skin temperature, skin color, capillary refill, pulses, movement.
Monitor for complications (e.g., osteomyelitis, venous thromboembolism, fat embolism, compartment syndrome).
Fractures
RF: Osteoporosis, Paget's disease, long-term steroid use, trauma, bone cancer, substance abuse.
S/S: Pain, edema, ecchymosis, crepitus, deformity in extremity, muscle spasms.
Dx: X-ray, CT scan, MRI.
Tx:
- Medications: Antibiotics for open fractures, analgesics, muscle relaxants.
- Procedures:
- Closed reduction and immobilization (e.g., splint, cast, traction).
- External fixation (i.e., pins attached to external frame).
- Open reduction and internal fixation (i.e., use of internal pins, plates, and screws).
Card 203
Fractures
Types of Fractures: Illustration
Answer
Fractures
Card 204
Fractures
Fracture Classification
Types of Fractures
Answer
Fractures
Fracture Classification:
- Closed/Simple: Does not break skin surface.
- Open/Compound: Breaks skin surface, ↑ risk of infection.
Types of Fractures:
- Transverse: Occurs perpendicular to the long axis of the bone.
- Impacted (Compression): Two or more bones are crushed together due to loading force.
- Comminuted: Results in two or more pieces.
- Oblique: Occurs at an angle (slanted).
- Spiral: Caused by twisting motion (possible sign of abuse!).
- Greenstick: Partial fracture (only one side is broken).
Gout
Metabolic disease that causes hyperuricemia (↑ uric acid in the blood) and uric acid crystals to be deposited in the joints.
Patho: ↑ Uric acid causes tophi (crystals) to accumulate in connective tissue.
- Primary Gout: Overproduction of uric acid due to a genetic defect in purine metabolism.
- Secondary Gout: Hyperuricemia is caused by another disease (e.g., CKD) or medication (e.g., thiazide diuretics, beta blockers).
S/S: Joint pain, erythema, swelling, tophi in the great toe.
Labs/Dx: ↑ Uric acid levels, synovial fluid examination shows urate crystals, X-ray, CT scan.
Tx: NSAIDs, colchicine for acute gout attacks, allopurinol and/or probenecid for chronic gout, ice packs.
PT: Avoid alcohol, purine-rich foods (e.g., red and organ meat, shellfish, fructose drinks), "starvation" dieting. ↑ Fluid intake. Reduce stress.
Osteomyelitis
Bone infection.
Patho: Infection causes inflammation of the bone tissue. This ↓ blood flow to the bone, resulting in necrosis.
RF: Recent trauma (e.g., open fracture), orthopedic hardware (e.g., artifical joint), bacteremia, pressure injuries, diabetes.
S/S: Bone pain, erythema, edema, fever.
Labs: ↑ WBCs.
Dx: X-ray, MRI, nuclear medicine scan, bone biopsy.
Tx: Long-term antibiotic therapy, surgical debridement of the bone, hyperbaric oxygen therapy.
Paget's Disease
Metabolic disorder that causes bones to be soft, structurally disorganized, and weak. This ↑ the patient's risk for fractures.
Patho: Bone is excessively broken down by osteoclasts and replaced with vascular fibrous tissue and weak, abnormal bone. Cause is unknown.
RF: Older age, European descent, sex (male).
S/S: Usually asymptomatic. Bone pain/stiffness, abnormal spinal curvature, fractures, bowing in long bones.
Labs: ↑ Serum alkaline phosphatase, ↑ urinary hydroxyproline.
Dx: X-ray, CT scan, nuclear medicine scan.
Tx: Analgesics, bisphosphonates, calcitonin.
PT: Gentle exercises to increase mobility.
Osteomalacia
Bone loss due to a vitamin D deficiency. Adult equivalent of rickets.
Patho: Lack of vitamin D ↓ calcium absorption, which triggers parathyroid hormone release. PTH causes a ↓ in phosphorus, which impairs bone mineralization (resulting in "soft bones").
RF: Insufficient sunlight exposure or dietary intake of vitamin D, body disorders that disrupt vitamin D production or absorption (e.g., Crohn's disease, celiac disease), CKD, dark skin.
S/S: Bone pain, muscle weakness, waddling gait, increased falls.
Labs: ↓ Calcium, vitamin D, phosphorus levels. ↑ PTH levels.
Dx: Bone X-rays, DXA scan, bone biopsy.
Tx: Vitamin D, calcium supplementation.
Osteoporosis
Metabolic bone disorder that causes ↓ bone mass, leading to fragile bones and ↑ risk for fractures. Osteopenia is a precursor to osteoporosis.
Patho: Rate of bone resorption by osteoclasts exceeds the rate of bone formation by osteoblasts, which results in ↓ bone density.
RF: Older age, low body weight, calcium or vitamin D deficiency, females, ↓ estrogen (post-menopausal women), smoking, immobility, corticosteroid use, hyperparathyroidism, race (White or Asian), heavy alcohol use.
S/S: Back pain, ↓ height, kyphosis, balance issues, fractures.
Dx: DXA scan.
Tx: Calcitonin, estrogen, raloxifene, alendronate.
PT: ↑ Calcium and vitamin D intake, sun exposure with sunscreen, weight bearing exercise. Prevent falls.
Card 210
Hip and Knee Arthroplasty
Hip Arthroplasty:
- Patient Positioning, Patient Teaching
Knee Arthroplasty:
- Patient Positioning, Patient Teaching
Answer
Hip and Knee Arthroplasty
Hip Arthroplasty:
- Patient Positioning: Place abduction device between patient's legs to prevent joint dislocation, keep heels off bed to prevent pressure injuries. Encourage use of overhead trapeze bar to assist in repositioning.
- PT: Use elevated toilet seat, avoid low chairs, do not cross ankles/legs, do not allow hip flexion > 90°.
Signs of joint dislocation include ↑ hip pain, shortening of affected leg, internal leg rotation.
Knee Arthroplasty:
- Patient Positioning: Do not place pillow under knee (or use knee gatch) in order to prevent flexion contractures. Initiate continuous passive motion (CPM) immediately after surgery if ordered.
- PT: Do not kneel or do deep-knee bends.
Card 211
Arthroplasty
Indications
Contraindications
Nursing Care
Patient Teaching
Answer
Arthroplasty
Surgical replacement of a diseased joint with a prosthetic joint.
Indications: Osteoarthritis, rheumatoid arthritis, trauma, congenital defects.
Contraindications: Advanced osteoporosis, active infection in the body.
NC:
- Pre-Op: Administer epoetin alfa or advise patient to provide an autologous blood donation (several weeks before surgery) to prevent post-op anemia.
- Post-Op: Monitor for S/S of a thromboembolism (e.g., DVT, PE), and other complications (e.g., infection, bleeding, neurovascular compromise). Prevent thromboembolism: Apply sequential compression devices (SCDs) or antiembolic stockings, encourage early ambulation and exercises, administer anticoagulants.
PT: Prophylactic antibiotics may be recommended for high-risk patients prior to dental work or invasive procedures.
Card 212
Osteoarthritis vs. Rheumatoid Arthritis
Key Differences
Answer
Osteoarthritis vs. Rheumatoid Arthritis
Osteoarthritis
Rheumatoid Arthritis
Degenerative disease due to excessive joint "wear and tear".
Inflammatory disease due to autoimmune disorder.
End-of-day pain. Pain with activity, gets better with rest.
Morning pain. Pain after rest/immobility, gets better with activity.
Unilateral, affects specific joints.
NOT symmetrical.
Bilateral, affects ALL joints.
Symmetrical.
Bouchard's and Heberden's nodes, crepitus.
Osteoarthritis causes nOdes that look like Os.
Swan neck and boutonniere deformities, ulnar deviation, ankylosis.
A swan goes to the prom with a boutonniere on to dance. Exercise helps his RA!
Negative rheumatoid factor.
Positive rheumatoid factor
Card 213
Rheumatoid Arthritis
Labs
Diagnostics
Treatment
Nursing Care
Patient Teaching
Answer
Rheumatoid Arthritis
Labs: Positive rheumatoid factor (RF) antibody, positive ANA titer. Elevated WBCs, ESR, CRP.
Dx: X-ray, MRI, arthrocentesis (test for presence of WBCs, RF).
Tx:
- Medications: Immunosuppressants (e.g., prednisone, methotrexate), hydroxychloroquine, NSAIDs, COX-2 inhibitors.
- Procedures: Plasmapheresis (to remove antibodies from blood), total joint arthroplasty, PT/OT.
NC: Monitor for Sjogren's syndrome (S/S: dry eyes, dry mouth, dry vagina), a complication associated with RA.
PT: Take a warm shower to relieve morning stiffness, engage in physical activity to preserve ROM, use assistive devices (e.g., wrist supports), balance activity with rest.
Rheumatoid Arthritis
Chronic, progressive autoimmune disease that causes inflammation, thickening, and deformation of the joints bilaterally and symmetrically. Characterized by periods of exacerbations and remissions.
Patho: Autoantibodies attack the synovium in joints, causing edema, inflammation (synovitis), and subsequent destruction of the articular cartilage and bone. Cause is unknown, possibly related to genetic and environmental factors.
RF: Sex (female), age (20 - 50), family history.
S/S: Bilateral joint pain and swelling, morning stiffness (↑ pain with rest, ↓ pain with activity), ankylosis (joint fixation and deformity), fatigue, swan neck and boutonniere deformities, ulnar deviation, subcutaneous nodules, fever, red sclera, lymphadenopathy.
Osteoarthritis
Progressive degeneration of cartilage in a joint.
Patho: Excessive mechanical stress on weight-bearing joints causes "wear and tear" on articular cartilage and the release of irritative enzymes. These enzymes further erode articular cartilage, leading to localized inflammation, osteophytes (bone spurs), and limited mobility.
RF: Older age, sex (female), obesity, smoking, repetitive stress on joints.
S/S: Joint pain/stiffness (↑ pain with activity, ↓ pain with rest), enlarged joints, crepitus, loss of function, Heberden's nodes (distal interphalangeal joints), Bouchard's nodes (proximal interphalangeal joints).
Heberden's are Higher up on the finger, Bouchard's are Below.
Musculoskeletal Diagnostic Tests
Arthrocentesis: Aspiration of synovial fluid from a joint cavity and/or injection of medications (e.g., corticosteroids).
Arthroscopy: Provides visualization of the internal structure of a joint. Allows for the collection of biopsies and surgical repair of joint structures. Contraindications: infected joint, lack of joint mobility.
Dual X-Ray Absorptiometry (DXA): Measures bone mass, used to diagnose osteoporosis.
Nuclear Medicine Scan: Used to identify fractures, infections, bone cancer. Isotope administered 4 - 6 hours prior to the procedure. Scan may be repeated at 24, 48, 72 hours. Patient should ↑ fluid intake after procedure.
Electromyography (EMG): Used to evaluate muscle/nerve disorders (e.g., muscle weakness). Needles inserted into the muscle and electrical activity is recorded.
Card 218
Synovial Joint
Illustration
Answer
Synovial Joint
Card 219
Synovial Joint
Key Components of a Synovial Joint
Answer
Synovial Joint
Joint Capsule: Surrounds a synovial joint, composed of fibrous connective tissue.
Synovium: Membrane that lines the joint capsule and secretes synovial fluid (provides lubrication, shock absorption).
Joint Cavity: Fluid-filled space where articulating surfaces of the bones contact each other.
Articular Cartilage: Thin layer of hyaline cartilage that covers the surface of each bone (where it articulates with other bones).
Bursae: Small fluid-filled sacs lined with synovial membrane. Prevent friction between bone and other structures.
Card 220
Bones
Hormones That Affect Bone Growth
Answer
Bones
Parathyroid Hormone (PTH): ↑ Levels of calcium in the blood. PTH promotes osteoclast activity, moving calcium from the bone into the bloodstream.
Calcitonin: ↓ Levels of calcium in the blood. Calcitonin ↓ bone resorption by inhibiting osteoclast activity. Opposes the action of PTH.
Calcitonin helps tone down calcium levels in the blood!
Growth Hormone: Regulates bone growth and metabolism. Stimulates osteoblast activity, promoting bone formation.
Cortisol: Small amounts are needed for bone development, but large amounts block bone growth. Glucocorticoids can cause bone loss due to ↓ bone formation and ↑ bone breakdown.
Card 221
Long Bone Components
Illustration
Answer
Long Bone Components
Card 222
Bones
Bone Layers
Long Bone Components
Bone Remodeling
Answer
Bones
Bone Layers:
- Outer Layer: Cortex (dense, compact bone tissue).
- Inner Layer: Medullary cavity (spongy, cancellous bone tissue). Contains bone marrow, where hematopoiesis occurs.
Long Bone Components:
- Diaphysis: Midsection (shaft).
- Epiphysis: Knob-like end.
- Metaphysis: Area where the epiphysis meets the diaphysis. Contains the epiphyseal plate (growth plate) or epiphyseal line.
Bone Remodeling: Continuous process by osteoblasts (bone-forming cells) and osteoclasts (bone-destroying cells). After age 35, bone resorption exceeds bone formation.
OsteoBlast = Bone Building.
OsteoClast = Bone Crushing.
Card 223
Musculoskeletal System
Components
Functions
Answer
Musculoskeletal System
Bones: Provide structural support, protection of organs, blood cell production, storage of minerals/lipids.
- Types of Bones: Long, short, flat, irregular, sesamoid bones.
Joints: Areas where 2 or more bones meet, allow for range of motion.
- Types of Joints: Synarthrodial/synarthrosis (immovable), amphiarthrodial (slightly movable), diarthrodial/synovial (movable).
Skeletal Muscles: Allow for body movement, under voluntary control.
Tendons: Fibrous connective tissue, attach muscles to bones.
Ligaments: Fibrous connective tissue, attach bones to other bones.
Bones Like Bones (L = Ligament).
Meniere's Disease
Inner ear disorder that affects balance and hearing.
Patho: Overproduction or ↓ absorption of endolymphatic fluid results in degeneration of hair cells in the inner ear.
RF: Genetics, infection, ototoxic medications.
S/S: Tinnitus, unilateral sensorineural hearing loss, vertigo, vomiting, balance issues.
Meniere's is making me ears ring!
Dx: Hearing tests, electrocochleography, CT/MRI to rule out tumor.
Tx: No cure, treatment is supportive.
- Medications: Antihistamines, anticholinergics, antiemetics, diuretics.
- Procedures: Labyrinthectomy, endolymphatic decompression.
PT: Avoid caffeine, alcohol, smoking. Restrict salt intake and distribute fluid intake evenly throughout the day.
Retinal Detachment
Separation of the retina from the epithelium.
Patho: Vitreous humor builds up behind the retina, which pushes the retina away from the back of the eye, causing it to detach.
RF: Aging, injury, family history, previous intraocular surgery, ocular tumors.
S/S: Floaters, flashing lights. Sudden, painless sensation of a "curtain" being pulled over the visual field.
Dx: Ophthalmoscopic examination.
Tx: Emergency surgery to repair the detached retina.
Macular Degeneration
Deterioration of the macula, resulting in loss of central vision.
Patho:
- Dry: Macula get thinner with age and tiny clumps of protein (drusen) grow. More common, slower onset.
- Wet: Abnormal blood vessels grow under the retina and leak blood/fluid, causing scarring of the macula. Less common, faster onset.
S/S: Loss of central vision, blurred vision.
Macular degeneration affects the Middle of your vision.
Dx: Ophthalmoscopic examination.
Tx: No cure. Dietary supplements, photodynamic therapy.
PT: Quit smoking, wear sunglasses, make home modifications to ensure safety.
Card 227
Glaucoma
Signs/Symptoms
Diagnostics
Treatment
Answer
Glaucoma
S/S:
- Open Angle: Loss of peripheral vision, mild aching in the eyes, headache.
- Closed Angle: Severe eye pain, severe headache, nausea/vomiting, blurred vision, halos around lights, reddened sclera.
Having Glaucoma is like seeing God (i.e., halos).
Dx: Tonometry to measure IOP (normal range: 10 - 21 mmHg).
Tx:
- Medications: Mannitol (for closed angle glaucoma), acetazolamide, eye drops (e.g., timolol, pilocarpine, travoprost).
- Surgery: Trabeculoplasty, trabeculectomy
Card 228
Glaucoma
Pathophysiology
Risk Factors
Answer
Glaucoma
Eye disorder that causes ↑ IOP and damage to the optic nerve.
Patho:
- Open Angle: Most common. Aqueous humor overproduction or ↓ outflow results in a gradual ↑ in IOP.
- Closed Angle: Less common. Forward displacement of the iris obstructs aqueous humor outflow completely, resulting in a sudden ↑ in IOP.
RF: Aging, genetics, race/ethnicity (African or Asian), diabetes, hypertension.
Cataracts
Lens opacity, impairing vision.
Patho: Proteins in the lens deteriorate and clump together, causing the lens to thicken/harden. This obstructs the passage of light through the lens to the retina.
RF: Aging, family history, systemic disease (e.g., diabetes), trauma.
S/S: Gradual/painless loss of vision, blurred and double vision, sensitivity to glare, halos around lights, white/grey pupil, absent red reflex.
Cataracts = Cloudy lens, Cloudy vision.
Dx: Physical examination, visual acuity test.
Tx: Surgical removal of cataract.
PT (Post-Op):
- Apply eye drops as prescribed, wear sunglasses.
- Avoid ↑ IOP. Don't bend at waist. Avoid sneezing, coughing, blowing nose, lifting ≥ 10 lbs, tight collars, straining with bowel movements.
- Best vision occurs ~ 4 - 6 weeks after surgery.
TBI Complications
Brain Herniation: Downward movement of brain tissue due to cerebral edema.
- S/S: Fixed/dilated pupils, ↓ LOC, abnormal respirations and posturing.
Hemorrhage/Hematoma:
- Epidural Hematoma: Arterial bleeding into the space between the skull and dura mater.
- Subdural Hematoma: Venous bleeding into the space between the dura mater and arachnoid mater.
- Intracerebral Hemorrhage: Accumulation of blood within the brain tissue.
Hydrocephalus: Build-up of fluid in the brain due to impaired reabsorption of CSF or an issue with CSF outflow.
Others: Diabetes Insipidus, SIADH, cerebral salt-wasting syndrome.
Card 231
Traumatic Brain Injury (TBI)
Diagnostics
Treatment
Nursing Care
Patient Teaching
Answer
Traumatic Brain Injury (TBI)
Dx: CT/MRI, neurologic assessment.
Tx:
- Medications: Mannitol to ↓ ICP, hypertonic NaCl to ↓ brain swelling, pentobarbital to induce coma and ↓ metabolic demands, anticonvulsant to prevent/treat seizures, opioid analgesics for pain.
- Procedures: Mechanical ventilation, ICP monitoring, craniectomy to relieve pressure inside the skull.
NC:
- Stabilize the cervical spine, maintain patent airway.
- Monitor vital signs, LOC, EKG.
- Prevent ↑ ICP. Reduce hypercarbia (hyperventilate patient), avoid suctioning and keep HOB = 30° and head midline.
PT: Avoid coughing, blowing nose, extreme neck flexion/extension, restrictive clothing.
Traumatic Brain Injury (TBI)
Disruption of brain functioning due to trauma. Penetrating (object pierces the skull) or non-penetrating (closed head injury).
Patho:
- Primary Injury: Acceleration or deceleration injury results in shearing, injury/destruction of brain tissue, and/or hemorrhage.
- Secondary Injury: Reactive processes that occur after the initial injury (e.g., hypotension, hypoxia, ischemia, cerebral edema) further damage brain tissue.
S/S: Irritability, confusion, ↓ LOC, headache, Cushing's triad (widened pulse pressure, bradycardia, irregular breathing), pupil abnormalities, nausea/vomiting, seizures, abnormal posturing, ataxia, muscle weakness, CSF leakage from nose/ear ("halo" sign on dressing), Battle's sign, periorbital ecchymosis.
TBI: Top (i.e., systolic) hypertension, Bradycardia, Irregular breathing.
Card 233
Cerebrovascular Accident (CVA)
Diagnostics
Treatment
Nursing Care
Answer
Cerebrovascular Accident (CVA)
Dx: CT, MRI, cerebral angiogram.
Tx:
- Ischemic stroke: Thrombolytics (within 3 hours of symptoms), anticoagulants, antiplatelets, embolectomy (surgical removal of clot).
- Hemorrhagic stroke: Antihypertensives, surgical aneurysm repair.
NC:
- Closely monitor patient's BP.
- Implement fall precautions.
- Assess swallowing and gag reflex before allowing patient to eat.
- Thicken liquids, teach patient to tuck chin to chest when swallowing.
- Reposition patient frequently to prevent pressure injuries.
- Teach patient to use scanning technique (turn head from direction of unaffected side to affected side) for homonymous hemianopsia.
Card 234
Cerebrovascular Accident (CVA)
Signs/Symptoms: Left vs. Right Hemisphere
Answer
Cerebrovascular Accident (CVA)
S/S: Unilateral numbness or weakness of the face, arm, or leg. Confusion, trouble speaking or understanding speech, facial drooping, visual disturbances (e.g., diplopia, blurred vision), dizziness, impaired balance, severe headache.
- Left Hemisphere: Affects language/math skills, analytical thinking. Expressive aphasia (inability to speak/understand language), reading and writing difficulty, right-sided hemiparesis (weakness) or hemiplegia (paralysis).
- Right Hemisphere: Affects visual and spatial awareness. Overestimation of abilities, poor judgement and impulse control, left-sided hemiparesis or hemiplegia.
Left = Language. Right = Reckless (i.e., poor judgement).
Cerebrovascular Accident (CVA)
Sudden interruption of blood supply to the brain.
Patho: Reduced blood flow to the brain deprives brain cells of oxygen and nutrients, leading to brain tissue damage/necrosis. Three causes:
- Hemorrhagic: Ruptured artery/aneurysm.
- Thrombotic: Blood clot in a cerebral artery.
- Embolic: Blood clot from another part of the body that travels to the cerebral artery.
RF: Smoking, hypertension, diabetes, AFIB, hyperlipidemia, previous transient ischemic attack (TIA).
A TIA is a temporary blockage of blood flow to the brain. Symptoms last a few minutes up to 24 hours. TIAs may precede a CVA.
Card 236
Myasthenia Gravis
Pathophysiology
Signs/Symptoms
Diagnostics
Treatment
Nursing Care
Answer
Myasthenia Gravis
Autoimmune disorder that causes severe muscle weakness. Characterized by periods of exacerbation and remission.
Patho: Antibodies destroy ACh receptors at the neuromuscular junction (NMJ).
S/S: Muscle weakness (worse with activity, improves with rest), diplopia, dysphagia, shortness of breath, thymus hyperplasia, drooping eyelids.
Dx: Edrophonium (Tensilon) test, electromyography, repetitive nerve stimulation.
Tx:
- Medications: Cholinergics (e.g., pyridostigmine) - monitor for cholinergic crisis, atropine is antidote! Immunosuppressants, immunoglobulins.
- Procedures: Plasmapheresis, thymectomy.
NC: Maintain patent airway. Assist with ambulation. Encourage periods of rest. Provide small, frequent high-calorie meals. Monitor for choking, aspiration. Administer eye drops, tape eyes shut at night (to prevent corenal drying/damage).
Card 237
Guillain-Barre Syndrome (GBS)
Pathophysiology
Signs/Symptoms
Labs/Diagnostics
Treatment
Nursing Care
Answer
Guillain-Barre Syndrome (GBS)
Autoimmune disorder affecting the peripheral nervous system that causes a sudden onset of weakness and paralysis.
Patho: GBS usually follows a respiratory or GI viral infection, leading to autoimmune destruction of the myelin sheath and axons in motor and sensory nerves.
S/S: Tingling in feet/hands, symmetrical weakness, absent DTRs, paralysis. Symptoms begin at the feet and move up.
Labs/Dx: Lumbar puncture (↑ protein in CSF). Abnormal nerve conduction velocity test.
Tx: Plasmapheresis, intravenous immunoglobulin (IVIG).
NC: Maintain patent airway. Monitor for aspiration pneumonia, respiratory failure.
Amyotrophic Lateral Sclerosis (ALS)
Neurodegenerative disease causing progressive muscle weakness. Cognitive function not impacted.
Patho: Exact cause is unknown. Gradual deterioration of the upper and lower motor neurons leads to loss of voluntary movement and muscle control.
RF: Race (white), age (> 40), family history.
S/S: Muscle weakness and atrophy, muscle cramps/twitching, dysphagia, respiratory paralysis (within 3 - 5 years).
Dx: Clinical symptoms, rule out other neurologic disorders.
Tx: No cure. Riluzole slows deterioration of motor neurons.
NC: Maintain patent airway. Monitor for pneumonia, respiratory failure. Coordinate with palliative team.
Multiple Sclerosis
Autoimmune disorder that causes the development of plaques in the white matter of the CNS. Characterized by periods of relapsing and remitting.
Patho: Immune system destruction of the myelin sheath (i.e., demyelination), impairs nerve impulse transmission.
Multiple Sclerosis affects the Myelin Sheath.
RF: Sex (female), age (20 - 40 years old).
S/S: Vision problems (diplopia/nystagmus), muscle spasticity and weakness, hearing loss, balance issues, bladder/bowel dysfunction, cognitive changes, fatigue, emotional changes (e.g., depression), pain, dysphagia.
Labs/Dx: MRI. Lumbar puncture (↑ protein in CSF).
Tx: Corticosteroids for exacerbations, DMARDs/immunosuppressants, interferon-beta medications (to prevent relapses), muscle relaxants.
PT: Avoid triggers that may worsen symptoms (i.e., temperature extremes, stress, fatigue, illness).
Card 240
Autonomic Dysreflexia
Pathophysiology
Signs/Symptoms
Treatment
Nursing Care
Answer
Autonomic Dysreflexia
Life-threatening hypertension following a spinal cord injury (typically at or above T6).
Patho: Stimuli below the level of the SCI (e.g., distended bladder) initiates a sympathetic response, resulting in vasoconstriction and ↑ BP. Parasympathetic nervous system is unable to compensate.
S/S: Extreme hypertension, severe headache, blurred vision, diaphoresis. Flushing above level of injury (due to vasodilation). Cool, pale skin below level of injury (due to vasoconstriction).
Tx: Address underlying cause, antihypertensives.
NC: First priority is to sit the patient up! Notify provider, loosen restrictive clothing, address underlying cause (e.g., distended bladder, fecal impaction). Administer antihypertensives, monitor BP.
Neurogenic Shock
Autonomic dysregulation following a spinal cord injury (typically above T6).
Patho: Spinal cord injury causes the loss of sympathetic nervous system activity, with unopposed parasympathetic response. This leads to instability in HR, BP, and temperature regulation.
S/S: Hypotension, bradycardia, flushed/warm skin.
Tx: IV fluids, vasopressors, atropine.
Card 242
Spinal Cord Injury (SCI)
Nursing Care
Answer
Spinal Cord Injury (SCI)
Stabilize spine, maintain patent airway, monitor vital signs.
Monitor for complications (hemorrhage, neurogenic shock, autonomic dysreflexia).
Provide urinary catheterization. Initiate bowel program (e.g., stool softeners, toileting schedule).
Reposition patient regularly to prevent pressure injuries.
For a patient in halo traction, do not apply pressure to rods. Make sure wrench/screwdriver are attached to the vest to release patient from the device in the event of an emergency.
Level of Injury and Extent of Paralysis
S/S: ↓ Motor function, ↓ sensation, loss of bowel/bladder control, respiratory dysfunction (especially injuries above C4)
- Hypertonia: Result of injury to upper motor neurons. Spastic muscle tone, spastic neurogenic bladder.
- Hypotonia: Result of injury to lower motor neurons. Flaccid muscle tone, flaccid neurogenic bladder.
Spinal shock may occur following a sever SCI. This causes a temporary loss of reflexes and sensation, lack of thermoregulation, and flaccid paralysis below level of injury.
Dx: X-ray, CT, MRI.
Tx:
- Medications: Methylprednisolone (↓ inflammation), analgesics, muscle relaxants.
- Procedures: Immobilization, laminectomy, spinal fusion, therapeutic hypothermia.
Card 244
Spinal Cord Injury (SCI)
Level of Injury and Extent of Paralysis: Illustration
Answer
Spinal Cord Injury (SCI)
Card 245
Spinal Cord Injury (SCI)
Pathophysiology
Answer
Spinal Cord Injury (SCI)
Spinal cord trauma due to hyperextension, hyperflexion, vertical compression, or rotational forces.
Patho: Primary injury is the damage caused directly by the injury. Secondary injury results from hemorrhage and edema that impairs circulation in the spinal cord, resulting in ischemia damage.
- Degree of Injury:
- Complete: Damage results in loss of all innervation below the level of injury.
- Incomplete: Preservation of some function below the level of injury.
- Level of Injury:
- Paraplegia: Result of injury below T1. Paralysis or paresis (weakness) of lower extremities.
- Quadriplegia: Result of injury in the cervical region. Paralysis or paresis of all 4 extremities.
Huntington's Disease
Progressive brain disorder that causes uncontrolled movements, emotional problems, and dementia.
Patho: Autosomal dominant genetic disorder results in degeneration of GABA neurons (inhibitory neurotransmitters) and ↑ dopamine in the cerebral cortex and basal ganglia.
S/S: Chorea (abnormal/excessive involuntary movements), bradykinesia, dysphagia, cognitive issues (dementia, memory loss, poor impulse control), psychiatric issues (depression, mania, personality changes).
Chorea makes you move like you are doing choreography.
Dx: Genetic testing, family history.
Tx: No cure. Symptom management with psychotropic agents and tetrabenazine (for chorea).
Card 247
Alzheimer's Disease
Diagnostics
Treatment
Nursing Care
Home Safety
Answer
Alzheimer's Disease
Dx: Symptom review, cognitive exam, rule out other causes. Definitive diagnosis with brain examination after death.
Tx: Donepezil, memantine, medications to manage symptoms (e.g., antipsychotics, antidepressants, anxiolytics).
NC: Maintain structured environment. Provide short directions, repetition, frequent reorientation. Avoid overstimulation. Provide a single-day calendar. Maintain routine toileting schedule.
Home Safety: Remove scatter rugs. Install door locks (out of sight and patient reach), good lighting (especially over stairs). Mark step edges with colored tape. Remove clutter.
Card 248
Alzheimer's Disease
Pathophysiology
Risk Factors
Signs/Symptoms by Stage
Answer
Alzheimer's Disease
Gradual, irreversible dementia. Results in memory problems, judgement issues, and changes in personality.
Patho: Beta-amyloid deposits and neurofibrillary tangles develop in the brain, disrupting communication between neurons. This leads to neuron death and atrophy of the affected areas.
RF: Older age, family history, cardiovascular disease.
S/S:
- Stage I (Mild): Forgetfulness, short-term memory loss, mild cognitive impairment.
- Stage II (Moderate): Disorientation, agitation, assistance with ADLs necessary, incontinence, wandering.
- Stage III (Severe): Bedridden, verbal/motor skills lost, dysphagia.
Card 249
Parkinson's Disease
Diagnostics
Treatment
Nursing Care
Answer
Parkinson's Disease
Dx: Clinical symptoms, rule out other neurologic diseases.
Tx:
- Medications: Levodopa/carbidopa, benztropine.
- Procedures: Deep brain stimulation.
NC:
- Monitor swallowing and food intake. Provide dysphagia diet as ordered (e.g., thickened liquids). Sit patient upright to eat. Have suction equipment available.
- Encourage exercise and stretching to maintain ROM.
- Assist with ADLs, implement fall precautions.
Meningitis
Inflammation of the meninges (membranes around the brain and spinal cord).
Patho: Infectious organisms enter the CNS through the bloodstream or gain access directly (e.g., trauma).
RF: Crowded living conditions (e.g., dorms), immunosuppression, travel exposure, chronic medical conditions (e.g., diabetes).
Prevention: Hib vaccine (given to infants), meningococcal vaccine (given to teenagers), pneumococcal vaccine.
S/S: Fever, headache, nausea/vomiting, nuchal (neck) rigidity, photophobia, positive Kernig's and Brudzinski's signs, altered mental status, tachycardia, seizures.
Labs/Dx: Lumbar puncture with CSF analysis.
- Bacterial: Cloudy, ↓ glucose, ↑ protein and WBCs, positive gram stain.
- Viral: Clear, slightly ↑ protein and WBCs, negative gram stain.
Card 253
Status Epilepticus
Risk Factors
Treatment
Nursing Care
Answer
Status Epilepticus
Life-threatening condition where a person has a prolonged seizure (> 5 minutes) or fails to regain consciousness in between seizures.
RF: CNS infection, head trauma, drug withdrawal/toxicity.
Tx: Benzodiazepines (e.g., lorazepam), antiepileptics (e.g., phenytoin), barbiturates (e.g., phenobarbital), propofol.
NC: Maintain patent airway and provide oxygen. Administer antiepileptic drugs. Assist with intubation.
Card 254
Seizures
Diagnostics
Treatment
Nursing Care
Answer
Seizures
Dx: EEG to identify origin of seizure.
Tx:
- Medications: Antiepileptics (e.g., phenytoin, valproic acid).
- Procedures: Vagal nerve stimulator, craniotomy to remove brain tissue causing seizures.
NC:
- During Seizure: Lower patient to bed or floor if standing/sitting. Turn patient to the side. Loosen restrictive clothing. Do not put anything in the patient's mouth. Do not restrain patient. Document onset/duration of seizure.
- After Seizure: Check vital signs, neurological status. Reorient patient, implement seizure precautions if not already in place, determine possible trigger.
Card 255
Seizures
Tonic-Clonic
Absence
Myoclonic
Atonic
Answer
Seizures
Tonic Clonic: May be preceded by aura. 3 phases:
- Tonic Phase: Stiffening of muscles, loss of consciousness.
- Clonic Phase: 1 - 2 min of rhythmic jerking of extremities.
- Postictal Phase: Confusion, sleepiness, agitation.
Absence: Loss of consciousness for a few seconds. Resembles "day dreaming". Key features are blank staring, eye fluttering, lip smacking, picking at clothes.
Myoclonic: Brief jerking of extremities.
Atonic: Loss of muscle tone, results in falling. Individual typically remains conscious. Also known as a drop seizure.
Card 256
Seizures
Pathophysiology
Risk Factors
Triggers
Answer
Seizures
Uncontrolled electrical discharge of neurons in the brain. Epilepsy is ≥ 2 unprovoked seizures.
Patho: Disease, injury, or unknown cause results in hyperexcitability of neurons and decreased inhibition of neuron activity.
RF: Fever, cerebral edema, infection (e.g., meningitis), toxin exposure, brain tumor, hypoxia, alcohol/drug withdrawal, fluid and electrolyte imbalances (e.g., hyponatremia).
Triggers: Fatigue, stress, flashing lights, caffeine.
Cluster Headaches
Neurovascular disorder causing severe, sudden head pain that lasts 30 minutes - 2 hours. Happens daily at the same time for months, more common in spring and fall seasons.
Patho: Possibly caused by sudden release of histamine or serotonin at the trigeminal nerve.
S/S: Severe unilateral, non-throbbing headache (typically around the orbital region), facial sweating, nasal congestion, droopy eyelid, excess tearing, agitation, and pacing.
Dx: Patient history, rule out other neurological disorders.
Tx: Oxygen therapy, sumatriptan, ergotamine, verapamil, corticosteroids.
Migraine Headaches
Neurovascular disorder causing unilateral throbbing head pain that persists for 4 - 72 hours. Preceded by aura (visual or sensory disturbance) for 15 - 30% of patients.
Patho: Possible activation of CN V, causing cerebral arterial vasodilation.
RF: Sex (female), family history.
Triggers: Bright/flashing lights, stress, anxiety, menstrual cycle, sleep deprivation, certain foods (e.g., MSG, tyramine, nitrites).
S/S: Unilateral throbbing headache, nausea/vomiting, photophobia, phonophobia, aura.
Dx: Patient history, rule out other neurological disorders.
Tx: NSAIDs (mild migraine), antiemetics, caffeine, sumatriptan or ergotamine for severe migraines.
PT: Avoid triggers, reduce stress levels. Seek dark/quiet environment during migraines.
Card 259
Magnetic Resonance Imaging (MRI)
Procedure
Nursing Care
Answer
Magnetic Resonance Imaging (MRI)
Imaging procedure that uses strong magnetic fields and radio waves to make images of internal structures of the body. Provides better soft tissue contrast than a CT scan.
NC (Pre-Procedure):
- Assess for history of claustrophobia.
- Have patient remove all jewelry.
- Make sure patient does not have any metal implants (e.g., pacemaker, artificial joints, artificial heart valves, IUDs, aneurysm clips).
- Provide earplugs, as MRIs are loud.
Card 260
Lumbar Puncture
Procedure
Nursing Care
Answer
Lumbar Puncture
Cerebral spinal fluid (CSF) sample is taken from the spinal canal for analysis. Used to diagnose infections (e.g., meningitis) and neurological disorders. Usually done between L3/L4 or L4/L5.
NC:
- Pre-Procedure: Position the patient on their side in a fetal position, or stretched over a table while sitting so the back is arched.
- Post-Procedure: Instruct patient to lay flat for several hours and ↑ fluid intake. Monitor for CSF leak, which can cause a severe headache (epidural blood patch may be necessary).
Card 261
Intracranial (ICP) Monitoring
Indications
Normal ICP
Symptoms of Increased ICP
Answer
Intracranial (ICP) Monitoring
Monitoring of ICP through a device surgically inserted into the cranial cavity. High risk of infection.
Indications: Patient in a coma (i.e., Glasgow coma scale of ≤ 8), traumatic brain injury, following some brain surgeries.
Normal ICP: 5 - 15 mmHg.
Symptoms of ↑ ICP:
- Early: Irritability, restlessness, headache.
- Late: ↓ LOC, pupil abnormalities, abnormal breathing patterns (e.g., Cheyne Stokes, Biot's), abnormal posturing (e.g., decorticate, decerebrate).
Card 262
Electroencephalogram (EEG)
Procedure
Nursing Care
Answer
Electroencephalogram (EEG)
Test used to identify seizures, sleep disorders, and other neurological disorders. Electrodes placed on the scalp to record electrical activity in the brain.
NC:
- Pre-Procedure: Instruct patient to wash hair prior to procedure, arrive sleep deprived, avoid stimulants or sedative medications prior to procedure. NPO not needed.
- During Procedure: Hyperventilation or strobe lights may be used to ↑ likelihood of seizure activity.
Card 263
Cerebral Angiogram
Purpose
Nursing Care
Answer
Cerebral Angiogram
Invasive procedure that allows for visualization of cerebral blood vessels. Catheter placed into an artery (e.g., femoral artery) and threaded up to the blood vessels in the brain to assess for blockages or abnormalities.
NC:
- Pre-Procedure: Keep patient NPO 4 - 6 hours. Check for allergy to contrast dye, iodine, shellfish*. Assess kidney function (e.g., creatinine, BUN), assess/mark distal pulses to easily re-check them after the procedure.
- Post-Procedure: Check insertion site for bleeding. Check for blood flow distal to the puncture site (i.e., pulses, capillary refill, temperature, color). Advise patient to keep leg straight for several hours. Encourage ↑ fluid intake.
*Recent evidence suggests that allergies to shellfish do not increase the risk of reaction to IV contrast more than any other allergies, however, for testing purposes defer to your instructor, textbook, and/or facility.
Eye
Outer Layer: Sclera (white fibrous tissue) and cornea (transparent tissue at the front of the eye, allows light to enter the eye).
Middle Layer: Iris (colored portion of eye, controls pupil size), ciliarybody(produces aqueous humor), choroid (main source of blood supply to the retina).
Inner Layer: Retina (contains rods and cones, transmits impulses to the optic nerve).
Path of Light Waves: Light waves → cornea → aqueous humor (fills anterior and posterior chambers) → pupil (opening in center of iris) → lens (focuses light on the retina) → vitreous body (fills vitreous chamber) → retina → CN II → brain (visual cortex in occipital lobe).
Card 268
Autonomic Nervous System
Function
Components
Answer
Autonomic Nervous System
Function: Maintain homeostasis through innervation of smooth muscle, cardiac muscle, and glands.
Components:
- Sympathetic Nervous System: "fight or flight"
- Originates at T1 - L2 in the spinal cord.
- Effects: ↑ Cardiac output, vasoconstriction (↑ BP), bronchodilation, pupil dilation, ↓ secretions/peristalsis.
- Parasympathetic Nervous System: "rest and digest"
- Originates at S2 - S4 in the spinal cord.
- Effects: ↓ Cardiac output, vasodilation (↓ BP), bronchoconstriction, pupil constriction, ↑ secretions/peristalsis.
Card 269
Central Nervous System
Spinal Cord
Meninges
Cerebral Spinal Fluid (CSF)
Answer
Central Nervous System
Spinal Cord: Column of nerve tissue that connects to the brainstem and runs inside the spinal column, ending at L1/L2. Controls mobility, regulates organ function, processes sensory information, transmits signals between the CNS and PNS.
Meninges: Membranes that cover and protect the brain and spinal cord. Three layers (superficial to deep): dura, arachnoid, and pia mater.
- Epidural Space: Between the skull/vertebrae and dura mater (used for epidural analgesia/anesthesia).
- Subdural Space: Between the dura mater and arachnoid mater.
- Subarachnoid Space: Between the arachnoid mater and pia mater (CSF circulates in this space).
CSF: Fluid that surrounds and cushions the CNS. Provides nutrients and eliminates waste products.
Card 270
Cerebrum
Illustration
Answer
Cerebrum
Card 271
Brain
Cerebrum
Cerebellum
Brain Stem
Answer
Brain
Cerebrum: Controls motor, cognitive, sensory function. The cerebrum is split into left and right hemispheres. The right hemisphere controls the left side of the body, and the left hemisphere controls the right side of the body. Each hemisphere contains 4 lobes:
- Frontal: Contains the motor cortex and Broca's area (speech function).
- Parietal: Contains the sensory cortex.
- Occipital: Contains the visual cortex.
- Temporal: Contains the auditory cortex and Wernicke's area (comprehension of verbal/written language).
Cerebellum: Coordinates muscle movements, maintains posture and balance.
Brain Stem: Regulates autonomic functions (e.g., breathing, heart rate, digestion, swallowing), facilitates communication between the cerebrum/cerebellum and the spinal cord.
Card 272
Neuron
Illustration
Answer
Neuron
Card 273
Neuron
Parts of a Neuron
Function of Each Part
Answer
Neuron
Dendrites: Receive signals (i.e., neurotransmitters) from other neurons, convert the signals into electrical impulses.
Soma (Cell Body): Contains the nucleus and controls the cell's activities.
Axon: Carries the electrical impulse down to the axon terminals.
Myelin Sheath: Surrounds and insulates the axon, allowing for faster transmission of the signal.
Axon Terminals: Release neurotransmitters into the synapse to bind with the dendrites of another neuron.
Card 274
Nervous System Cells
Neurons
Neuroglial Cells
Answer
Nervous System Cells
Neurons: Functional units of the nervous system, transmit impulses or "messages". Each neuron produces a neurotransmitter (chemical) that enhances or inhibits the impulse.
- Sensory Neurons (Afferent Neurons): Control sensation and send messages from the PNS to the CNS.
- Motor Neurons (Efferent Neurons): Control mobility and send messages from the CNS to the PNS.
Afferent Approaches the CNS, Efferent Exits the CNS.
Neuroglial Cells: Supportive cells that provide protection, structure, nutrition for neurons.
Card 275
Nervous System
Key Functions
Components
Answer
Nervous System
Key Functions: Mobility, sensation, cognition, many involuntary processes (e.g., breathing).
Components:
- Central Nervous System (CNS):
- Brain (cerebrum, cerebellum, brain stem)
- Spinal cord
- Peripheral Nervous System (PNS):
- 12 Cranial nerves
- 31 Pairs of spinal nerves
- Autonomic nervous system (ANS)
Acquired Coagulation Disorders
ITP: Autoimmune disorder (possibly triggered by a viral infection) causes a ↓ in the lifespan of platelets.
- Labs: ↓ Platelets. ↑ PT, aPTT.
- Tx: Corticosteroids, IVIG (IV immunoglobulin), splenectomy.
HIT: Immune-mediated drug reaction that causes a drop in platelets after heparin treatment.
- Labs: ↓ Platelets, normal PT and aPTT.
- Tx: Stop heparin immediately. Administer alternative anticoagulant (e.g., argatroban), platelet transfusion.
DIC: Disorder where clotting factors and platelets are depleted through formation of thousands of micro-clots in the body. Most common cause is severe sepsis.
- Labs: ↓ Platelets. ↑ PT, aPTT, D-dimer.
- Tx: Platelet/plasma transfusion, heparin.
Genetic Coagulation Disorders
Hemophilia: Rare, inherited bleeding disorder that results in a deficiency of clotting factors. Hemophilia A = Deficiency of factor VIII. Hemophilia B = Deficiency of factor IX.
- Labs: ↑ aPTT. Platelets, PT not affected!
- Tx: Factor replacement.
Von Willebrand's Disease (VWD): Hereditary bleeding disorder that causes deficiency of a clotting factor (VWF) and impaired platelet function. Three major types, type 1 is most common.
- Labs: ↓ VWF, ↓ factor VIII. Platelets, PT, aPTT are typically normal in type 1 VWD.
- Tx: Factor replacement.
Card 278
Coagulation Disorders
Signs/Symptoms
Treatment
Nursing Care
Patient Teaching
Answer
Coagulation Disorders
Impaired clotting due to a deficiency in platelets and/or clotting factors.
S/S: Excessive bleeding/bruising, oozing of blood from incisions, petechiae, tachycardia, hypotension.
Tx: Blood products, fluid volume replacement, oxygen, clotting factor replacement.
NC: Limit venipunctures and IM injections, implement fall precautions.
PT: Use soft-bristled toothbrush, electric razor. Avoid blowing nose forcefully. Seek immediate medical attention following any head trauma.
Polycythemia
Rare blood disease that causes ↑ RBCs.
Patho:
- Primary: Gene mutation causes uncontrolled production of abnormal RBCs. This makes the blood thicker, which ↑ the patient's risk for clots and impairs blood flow. Impaired blood flow leads to ischemia.
- Secondary: Long-term poor oxygenation due to lung or heart disease causes ↑ production of RBCs.
S/S: Plethora (ruddy complexion), nail clubbing, dizziness, fatigue, headache, splenomegaly, hypertension.
Labs/Dx: ↑ RBC and Hbg/Hct, bone marrow biopsy.
Tx: No cure. Pheresis (removal of RBCs), aspirin, hydroxyurea.
Card 280
Sickle Cell Anemia
Types of Sickle Cell Crises
Labs/Diagnostics
Treatment
Nursing Care
Patient Teaching
Answer
Sickle Cell Anemia
Types of Sickle Cell Crises:
- Vaso-Occlusive Crisis: Severe pain, swelling of hands/feet.
- Splenic Sequestration Crisis: Splenomegaly, hypovolemic shock.
- Aplastic Crisis: Severe anemia due to viral infection.
- Acute Chest Syndrome: Dyspnea, fever, cough.
- Hyperhemolytic Crisis: Rapid ↓ in Hgb levels.
Labs/Dx: Sickle turbidity test (detects HbS), hemoglobin electrophoresis.
Tx: Opioid analgesics on a schedule, antibiotics (for infection).
NC: Administer IV fluids, blood products, O2 as ordered.
PT: Adequate fluid intake and rest. Prevent infection (e.g., hand hygiene, avoid crowds).
Sickle Cell Anemia
Genetic disorder that causes chronic anemia, pain, infection, and organ damage.
Patho: Autosomal recessive genetic disorder causes normal hemoglobin (HbA) to be replaced with abnormal sickle hemoglobin (HbS), resulting in RBC sickling. This leads to ↑ blood viscosity, blood flow obstruction, and tissue hypoxia.
RF: Family history, race (African Americans), Middle Eastern descent.
S/S: Pain, fatigue, shortness of breath, pallor, jaundice.
Anemia
Blood disorder causing a deficiency in RBCs or hemoglobin.
Patho: Blood loss, insufficient RBC production, or excess RBC destruction results in ↓ oxygenation to the body's tissues. Causes:
- Blood Loss: GI bleeding (most common), trauma, menorrhagia.
- Iron-Deficiency Anemia: Insufficient intake or poor absorption of iron. Common in children and during pregnancy.
- Vitamin-Deficiency Anemia: Insufficient intake of folic acid or vitamin B12, pernicious anemia (lack of intrinsic factor in the gastric mucosa, which impairs absorption of B12).
- Aplastic Anemia: Bone marrow damage due to cancer, autoimmune disorders, medications (e.g., chemotherapy).
- Hemolytic Anemia: Destruction of RBCs due to genetic disorders, infections, autoimmune disorders, medications.
Card 284
Coronary Artery Bypass Graft (CABG)
Procedure
Nursing Care
Answer
Coronary Artery Bypass Graft (CABG)
Surgery to bypass one or more coronary arteries due to blockage or persistent ischemia, using the patient's own blood vessels (e.g., saphenous vein) or synthetic grafts.
NC (Post-Procedure):
- Monitor patient's BP. Hypertension can cause bleeding from graft. Hypotension can cause collapse of graft.
- Monitor body temperature. Treat hypothermia with rewarming procedures.
- Monitor for bleeding. Notify provider for chest tube drainage > 150 mL/hr.
- Monitor LOC, fluid and electrolyte balance, cardiac rhythm, pain level, neurovascular status of donor site.
- Monitor for complications (e.g., cardiac tamponade).
Card 285
Percutaneous Coronary Intervention (PCI)
Procedure
Nursing Care
Answer
Percutaneous Coronary Intervention (PCI)
Minimally invasive procedure used to open blocked coronary arteries.
Procedure: Catheter with a balloon is threaded through a blood vessel (usually at the femoral artery) up to the blocked coronary artery. Balloon is inflated and a stent is placed to restore blood flow. For a patient with a STEMI, goal is door-to-balloon time ≤ 90 minutes.
NC (Post-Procedure):
- Monitor for bleeding at insertion site.
- Check perfusion to extremity distal to insertion site (e.g., pulses, temperature, color).
- Monitor for complications, including artery dissection and thrombosis (reocclusion of vessel).
Card 286
Myocardial Infarction (MI)
Treatment
Nursing Care
Patient Teaching
Answer
Myocardial Infarction (MI)
Tx:
- Medications: Aspirin, antiplatelet agent (e.g., clopidogrel), thrombolytics, anticoagulants, nitroglycerin, morphine, antihypertensives (e.g., beta blockers, ACE inhibitors), statins.
- Surgery: Percutaneous coronary intervention (PCI), coronary artery bypass graft (CABG), atherectomy (surgical removal of plaque).
NC: Administer oxygen for SpO2 ≤ 90% (as ordered). Monitor for complications (e.g., heart failure, cardiogenic shock).
PT: Participate in cardiac rehabilitation program (i.e., medically supervised program that provides education and training to promote heart health).
Myocardial Infarction (MI)
Sudden blockage of blood flow to the heart.
Patho: Atherosclerosis in the coronary artery and rupture of a plaque leads to formation of a thrombosis (and occlusion of blood flow to the heart).
S/S: Chest pain/discomfort (often radiating to left arm), shortness of breath, diaphoresis, dizziness, tachycardia, anxiety. Women are more likely to have nausea/vomiting, fatigue, and pain in the back or jaw.
Labs: ↑ Cardiac enzymes (e.g., troponin T, troponin I).
Dx: EKG changes (e.g., ST elevation/depression, T wave inversion, abnormal Q wave), cardiac catheterization.
Angina
RF: Older age, family history, smoking, inactivity, heart disease, hypertension, diabetes, obesity.
Dx: EKG, stress test, CT/MRI, echocardiogram, coronary angiogram.
Tx: Nitroglycerin, antihypertensives (e.g., beta blockers, calcium channel blockers), statins, anticoagulants.
PT:
- Nitroglycerin Instructions: For chest pain, stop activity and rest. Take up to 3 tablets. Place 1st under tongue, wait 5 min. If no relief, call 911. Take 2nd, wait 5 min. If no relief, take 3rd.
- Lifestyle Changes: Heart healthy diet, lose weight, ↓ stress, smoking cessation.
Card 289
Angina
Pathophysiology
Types
Angina vs. MI Symptoms
Answer
Angina
Chest pain due to ischemic heart disease.
Patho: Atherosclerosis narrows/blocks coronary artery blood flow, resulting in ↓ oxygen being provided to the heart. Three main types:
- Stable Angina: Occurs with exercise, relieved by rest or nitroglycerin. Consistent pattern for ≥ 2 months.
- Unstable Angina: Occurs with exercise OR at rest. Chest pain ↑ in duration, frequency, or severity over time.
- Variant (Prinzmetal's) Angina: Related to coronary artery spasm, occurs during rest.
Angina vs. MI: Chest pain unrelieved by rest or nitroglycerin, lasting > 30 min is indicative of a MI. MIs can also have other symptoms, such as: shortness of breath, nausea/vomiting, diaphoresis.
Card 290
Shock
Impact of Vital Signs and Hemodynamics
Answer
Shock
Type of Shock
HR
BP
RR
Preload
CO
Afterload
Hypovolemic
↑
↓
↑
↓
↓
↑
Cardiogenic
↑ / ↓
↓
↑
↑
↓
↑
Obstructive
↑
slight ↓
↑
↑
↓
↑
Distributive
↑
↓
↑
↓
↓
↓
Treat shock with appropriate resuscitation (e.g., blood transfusion, normal saline, etc.) prior to initiating treatment with vasopressors (e.g., norephinephrine, dopamine).
Card 291
Shock
Signs/Symptoms
Labs
Treatment
Nursing Care
Answer
Shock
S/S: Hypotension, tachycardia, tachypnea, weak pulses, ↓ urine output. Wheezing, angioedema, and rash with anaphylactic shock.
Labs: ↑ Serum lactate, abnormal ABGs. ↑ Cardiac enzymes with cardiogenic shock. ↓ Hct/Hgb with hypovolemic shock due to blood loss. Positive blood cultures with septic shock.
Tx: Treat underlying cause. Administer IV fluids, blood products, colloids to maintain intravascular volume, vasopressors (e.g., norepinephrine) to maintain tissue perfusion. Antibiotics for septic shock. Epinephrine for anaphylactic shock.
NC: Administer oxygen, maintain patent airway, prepare for intubation, place patient in supine position with legs elevated for hypotension. Monitor VS, LOC, urine output. Monitor for multiple organ dysfunction syndrome (MODS) and disseminated intravascular coagulation (DIC).
Card 292
Shock
Pathophysiology
Types of Shock
Answer
Shock
Life-threatening circulatory failure.
Patho: Insufficient blood flow leads to cellular and tissue hypoxia. Four types:
- Hypovolemic Shock: Blood loss due to trauma or surgery, GI losses (e.g., vomiting/diarrhea), diuresis.
- Cardiogenic Shock: Heart pump failure due to acute MI, HF, valve/structural problem, dysrhythmias.
- Obstructive Shock: Blockage of great vessels or the heart itself (e.g., PE, tension pneumothorax, cardiac tamponade).
- Distributive Shock: Extreme systemic vasodilation. Causes:
- Septic Shock: Dysregulated response to an infection.
- Neurogenic Shock: Loss of sympathetic tone due to brain or spinal cord injury.
- Anaphylactic Shock: Severe allergic reaction.
Varicose Veins
Dilated, tortuous veins (full of twists and turns).
Patho: Pooling of blood in the legs causes the veins to become enlarged/weakened, impairs valve function, and allows blood to flow backwards.
RF: Female, prolonged standing, pregnancy, obesity, family history.
S/S: Distended, rope-like veins in the calves, aching pain and feeling of "heaviness" in legs, edema, pruritus.
Tx: Compression stockings, elevation, sclerotherapy, vein-stripping (removal), radio frequency, laser treatment.
Venous Insufficiency
Veins in the lower extremities do not transport blood back to the heart effectively.
Patho: Valves in the lower legs become damaged due to prolonged venous hypertension or previous blood clot.
RF: Obesity, immobility, pregnancy, history of DVT.
S/S: Edema, aching pain in legs, venous stasis ulcers (heavily draining, around the ankles), brown discoloration of legs (stasis dermatitis).
Tx: Elevate legs to ↑ venous return, apply compression stockings, monitor for complications (e.g., cellulitis).
PT: Avoid sitting/standing still for too long, change positions often. Avoid crossing legs and restrictive pants. Apply compression stockings before getting out of bed in the morning.
Card 295
Venous Thromboembolism (VTE)
Labs/Diagnostics
Treatment
Nursing Care
Answer
Venous Thromboembolism (VTE)
Labs/Dx: Positive D-dimer, venous duplex ultrasound, CT angiogram.
Tx:
- Medications: Anticoagulants (e.g., heparin), thrombin inhibitors (e.g., argatroban), thrombolytics (e.g., alteplase).
- Procedures: Thrombectomy (removal of clot), inferior vena cava filter (prevents new emboli from entering the lungs).
NC:
- DVT: Elevate extremity (no pillow or knee gatch under knee), warm/moist compresses, do not massage limb, apply compression stockings, monitor for S/S of PE.
- PE: Sit patient upright (e.g., high-Fowler's position), administer oxygen as ordered.
Venous Thromboembolism (VTE)
Blood clot that starts in a vein. Two types: deep vein thrombosis (DVT) and pulmonary embolism (PE).
Patho: Thrombus (blood clot) forms in a deep vein (usually the lower leg, thigh, pelvis) due to Virchow's triad (endothelial injury, stasis of blood flow, hypercoagulability). Inflammation occurs around the thrombus, and it breaks loose (becoming an embolus). The embolus travels to the pulmonary artery, causing a pulmonary embolism (PE).
RF: Hip/knee replacement, heart failure, immobility, pregnancy, combined oral contraceptives, family history, race (African Americans).
S/S:
- DVT: Calf/thigh pain, edema, erythema.
- PE: Shortness of breath, dyspnea, anxiety, chest pain with inspiration, tachycardia, tachypnea, hypotension.
Raynaud's
Rare vascular disorder that causes vasospasms in the arterioles/arteries, ↓ blood flow to the extremities.
Patho: Raynaud's Disease (primary Raynaud's) is idiopathic. Raynaud's phenomenon (secondary Raynaud's) occurs due to arterial damage from connective tissue disorders (e.g., lupus, scleroderma).
S/S: Upon exposure to cold or stress, fingers become cyanotic, cold, numb, and painful. After spasm, tissue becomes hyperemic (red) as blood returns to the area.
Dx: Clinical symptoms, ANA titer to identify underlying autoimmune disease.
Tx: Vasodilators (e.g., nifedipine), sympathectomy for severe symptoms.
PT: Avoid cold, wear warm clothing. ↓ Caffeine, stress. Stop smoking.
Buerger's Disease
Inflammatory condition that impairs circulation to the extremities. Progression can lead to tissue death (gangrene) and amputation.
Patho: Chemicals in tobacco cause vasculitis, scarring and occlusion of small/medium blood vessels in the arms/legs.
RF: Smoking, male, 20 - 50 years old.
S/S: Claudication, numbness/tingling, ↓ temp and pulses, cyanosis in extremities.
Dx: Arteriogram (allows for visualization inside the arteries).
Tx: Vasodilators (e.g., calcium channel blockers).
PT: Stop smoking, avoid extreme cold.
Card 299
Aneurysm
Diagnostics
Treatment
Nursing Care
Patient Teaching
Answer
Aneurysm
Dx: CT, ultrasound.
Tx: Prevent rupture of aneurysm!
- Medications: Antihypertensives.
- Surgery: Aneurysm resection or repair.
NC:
- Monitor for S/S of aortic rupture: Sudden onset of severe pain, ↓ pulses distal to rupture, hypovolemic shock (S/S: hypotension, tachycardia, ↓ LOC, oliguria).
- Monitor VS, cardiac rhythm, ABGs, urine output. Report output﹤ 30 mL/hr.
PT: Stop smoking, slowly ↑ physical activity, maintain normal body weight/lipid levels, monitor BP.
Aneurysm
Balloon-like bulge in the arterial wall.
Patho: Congenital disorder, trauma, infection, or disease damages and weakens the arterial wall. Intravascular pressure causes outpouching or dilation of the vessel wall.
RF: White males, ↑ age, atherosclerosis, hypertension, hypercholesterolemia, smoking, Marfan syndrome.
S/S: May be asymptomatic, found during routine tests.
- Abdominal Aortic Aneurysm (AAA): Flank/back pain, pulsating abdominal mass with bruit (do not palpate due to risk for rupture!).
- Thoracic Aortic Aneurysm: Severe back/chest pain, shortness of breath, dysphagia (difficulty swallowing), cough.
Card 301
Peripheral Bypass Graft
Procedure
Nursing Care
Complications
Answer
Peripheral Bypass Graft
Surgery to restore blood flood to the extremity due to PAD. Blood supply is rerouted around the blocked artery in the leg.
NC (Post-Op):
- Closely monitor pedal pulses, capillary refill, skin color and temperature.
- Patient needs to keep leg straight for ~ 24 hrs after surgery.
Complications:
- Graft Occlusion: S/S include pallor, ↓ pedal pulses and temperature, ↑ pain.
- Compartment Syndrome: S/S include numbness, pain with passive movement, edema, taut skin.
Peripheral Arterial Disease (PAD)
Tx:
- Medications: Antiplatelets, statins.
- Surgery: Angioplasty, peripheral bypass graft.
PT:
- Walk until the point of pain, stop and rest, then walk a little more.
- Avoid crossing legs and restrictive clothing.
- Maintain a warm environment, wear socks.
- Avoid cold, stress, caffeine, nicotine (which causes vasoconstriction).
Peripheral Arterial Disease (PAD)
Inadequate blood flow to the lower extremities.
Patho: Atherosclerosis causes partial or total arterial occlusion, depriving the lower extremities of oxygen and nutrients.
RF: Hypertension, diabetes, smoking, obesity, hyperlipidemia.
S/S: Intermittent claudication (ischemic leg pain that ↑ with exertion, ↓ with dangling), cool/shiny skin, pallor with elevation, dependent rubor, delayed capillary refill, ↓ pedal pulses, lack of hair on calves, thick toenails, dry/necrotic eschar on toes, delayed wound healing.
Dx: Ankle-brachial index (ABI), doppler ultrasound.
Card 304
Hypertension
Signs/Symptoms
Diagnostics
Treatment
Nursing Care
Patient Teaching
Answer
Hypertension
S/S: Usually asymptomatic.
Dx: SBP > 130 mmHg or DBP > 80 mmHg (≥ 2 readings taken on separate visits).
Tx: Diuretics, anti-hypertensive agents (e.g., beta blockers, ACE inhibitors).
NC: Monitor for hypertensive crisis (S/S: headache, chest pain, shortness of breath, dizziness).
PT: DASH diet (↑ fruits, veggies, whole grains, low-fat dairy; ↓ salt and fat), weight reduction, stress reduction, smoking cessation, limit alcohol consumption. Take BP regularly at home.
Card 305
Hypertension
Pathophysiology
Risk Factors
Answer
Hypertension
High blood pressure.
Patho: Increased peripheral resistance and/or an increase in cardiac output causes ↑ BP. Over time, hypertension can damage the heart and blood vessels, leading to ↑ risk for atherosclerosis, MI, and stroke. Two types:
- Primary: Most common, idiopathic.
- Secondary: Disease or medication causes ↑ BP.
RF:
- Primary: Family history, ↑ sodium intake, obesity, smoking, stress, hyperlipidemia.
- Secondary: Kidney disease, hyperthyroidism, Cushing's syndrome, pheochromocytoma.
Atherosclerosis
Build-up of plaque on the arterial walls.
Patho: Blood vessel damage causes inflammation and formation of plaques. Plaque deposits can become large enough to narrow the lumen, reducing blood flow. Plaque rupture can lead to formation of a thrombus or embolus, causing an MI or stroke.
RF: Hypertension, aging, immobility, smoking, family history, hypercholesterolemia, diabetes, obesity, stress.
S/S: Hypertension, bruits.
Labs: ↑ LDL and triglycerides.
Dx: Echocardiogram, CT/MRI, stress test, angiography.
Tx: Cholesterol-lowering medications (e.g., statins).
PT: Smoking cessation, weight loss, exercise, heart-healthy diet.
Cardiomyopathy
Disease of the cardiac muscle.
Patho: Heart muscle becomes enlarged, thickened, and/or rigid, which can lead to HF, arrhythmias, pulmonary edema.
Main Types:
- Dilated: Most common. Ventricles enlarge and weaken, starting with the left ventricle, affecting systolic function.
- Hypertrophic: Ventricles and septum enlarge and thicken, affecting diastolic function and obstructing outflow.
- Restrictive: Ventricles become stiff/rigid, restricting filling during diastole.
Cardiac Tamponade
Compression of the heart due to the accumulation of fluid in the pericardial sac.
Patho: Build up of pericardial fluid from an underlying cause (e.g., MI, infection, neoplasm, blunt trauma) compresses the heart, restricting blood flow into the ventricles and reducing cardiac output.
S/S: Hypotension, muffled heart sounds, jugular vein distension, paradoxical pulse (variance of ≥ 10 mmHg in SBP between inspiration and expiration), electrical alternans, dyspnea, fatigue.
Dx: Chest X-ray, echocardiogram.
Tx: Pericardiocentesis (removal of fluid from pericardial sac).
Card 310
Pericarditis
Pathophysiology
Signs/Symptoms
Labs/Diagnostics
Treatment
Nursing Care
Answer
Pericarditis
Inflammation of the pericardium (sac that surrounds the heart).
Patho: Inflammatory response is triggered in response to infection, autoimmune disorder, or trauma.
S/S: Chest pain (worse when supine, relieved by sitting up and leaning forward), friction rub, fever, dysrhythmias, dyspnea.
Labs/Dx: ↑ WBC, EKG showing ST or T spiking, echocardiogram.
Tx:
- Medications: NSAIDs, colchicine, corticosteroids, antibiotics (for bacterial pericarditis).
- Procedures: Pericardiectomy.
NC: Monitor for complications (e.g., cardiac tamponade).
Rheumatic Heart Disease
Heart valve damage caused by rheumatic fever.
Patho: Respiratory infection with group A beta-hemolytic streptococcus bacteria (i.e. strep throat) triggers an autoimmune response (rheumatic fever), which leads to the development of inflammatory lesions (Aschoff bodies) in the heart. These lesions cause damage to the myocardium, pericardium, and heart valves.
S/S: Tachycardia, cardiomegaly, murmur, friction rub, chest pain.
Labs/Dx: Throat culture positive for streptococcal infection, positive ASO titer, echocardiogram.
Tx: Antibiotics, valve repair/replacement.
Infective Endocarditis
Infection of the endocardium (inner layer of the heart).
Patho: Bacteria or fungi adhere to the heart and form vegetative growths on the heart valve or endocardium. This leads to necrosis and possible embolization of the growth.
RF: Congenital heart disease, valvular heart disease, prosthetic valve, IV drug use.
S/S: Fever, flu-like symptoms, murmur, petechiae, splinter hemorrhages (red streaks under nail beds).
Labs/Dx: Positive blood culture, echocardiogram.
Tx: Antibiotics, valve repair/replacement.
Valvular Heart Disease
Cardiac valve dysfunction (aortic, mitral, tricuspid, or pulmonary).
Patho: Damage or defect in a heart valve occurs due to congenital or acquired causes. This leads to stenosis (narrowed opening), prolapse, and/or insufficiency (regurgitation of blood).
RF: Hypertension, older age, smoking, hypercholesterolemia, diabetes, rheumatic heart disease, infective endocarditis.
S/S: Murmurs, extra heart sounds (e.g., S3, S4 sounds), arrhythmias, dyspnea with mitral stenosis or insufficiency.
Dx: Chest X-ray, EKG, echocardiogram.
Tx:
- Medications: Diuretics, digoxin, anticoagulants, antihypertensives.
- Surgery: Balloon valvuloplasty, valve repair, prosthetic valve.
PT: For high-risk patients who receive a prosthetic valve, prophylactic antibiotics may need to be taken before dental work, surgery, or invasive procedures.
Card 314
Heart Failure
Labs
Diagnostics
Treatment
Nursing Care
Answer
Heart Failure
Labs: ↑ hBNP (> 100 pg/mL).
Dx: Echocardiogram (↓ ejection fraction), hemodynamic monitoring (↑ CVP, PAWP; ↓ CO).
Tx: Diuretics, digoxin, beta blockers, ACE inhibitors, angiotensin II blockers, calcium channel blockers, vasodilators, anticoagulants.
NC: Monitor daily weight, I&Os. Sit patient upright (high-Fowler's). Administer oxygen, restrict fluid and sodium intake as ordered. Monitor for complications (e.g., pulmonary edema).
Card 315
Heart Failure
Pathophysiology
Signs/Symptoms
Answer
Heart Failure
Heart muscle does not pump enough blood to meet the body's needs.
Patho: Congenital heart defect or disorder (e.g., coronary heart disease, cardiomyopathy, hypertension, valvular disease) damages or overworks the heart, reducing cardiac output.
S/S:
- Left-Sided HF: Results in pulmonary congestion.
- Key S/S: Dyspnea, crackles, fatigue, pink/frothy sputum.
- Right-Sided HF: Results in systemic congestion.
- Key S/S: Peripheral edema, ascites, jugular vein distention, hepatomegaly.
Left = Lungs. Right = Rest of the body.
Card 316
Pacemakers
Nursing Care
Patient Teaching
Answer
Pacemakers
NC (Post-Op):
- Check insertion site for S/S of infection.
- Provide sling and instruct patient to minimize shoulder movement.
- Assess for hiccups, which may indicate pacemaker is pacing the diaphragm.
PT:
- Carry pacemaker ID, take pulse daily, avoid contact sports.
- No heavy lifting for 2 months.
- Pacemaker will set off airport security detectors.
- MRIs may be contraindicated. Check with provider for compatibility.
- OK to use garage door opener, microwave.
Card 317
Pacemakers
Types of Pacing
Pacemaker Modes
Answer
Pacemakers
Device that provides electrical stimulation of the heart when the natural pacemaker in the heart doesn't maintain proper rhythm.
Indications: Symptomatic bradycardia, AV block
Types of Pacing:
- Atrial Pacing: Used with SA node failure.
- Ventricular Pacing: Used with a complete AV block.
- AV Pacing: Used with SA node failure and a complete AV block.
Pacemaker Modes:
- Asynchronous: Fires at a constant rate regardless of heart's electrical activity.
- Synchronous (Demand Pacemaker): Fires only when the heart's intrinsic rate falls below a certain rate.
Card 318
Cardioversion
Types of Cardioversion
Nursing Care
Answer
Cardioversion
Types of Cardioversion:
- Electrical: Synchronized cardioversion is the use of electrical shocks delivered at the peak of the QRS complex to restore normal heart rhythm. Defibrillation is the use of unsynchronized electrical cardioversion in an emergency situation (e.g., VF, pulseless VT).
- Chemical: Use of medications to restore normal heart rhythm (e.g., adenosine, procainamide).
NC:
- For a scheduled cardioversion, ensure the patient has been on anticoagulation for 4 - 6 weeks prior to procedure.
- Stand clear while electrical shock is delivered.
- After procedure, ensure patent airway, monitor VS, obtain EKG, monitor for S/S of dislodged clot (e.g., PE, stroke, MI).
Card 319
Atrioventricular (AV) Blocks
First-Degree AV Block, Second-Degree Type 1 AV Block, Second-Degree Type 2 AV Block, Third-Degree AV Block:
- Pathophysiology, Treatment
Answer
Atrioventricular (AV) Blocks
First-Degree AV Block: Prolonged impulse conduction time from the atria to the ventricles due to a delay in the AV node.
- Tx: Typically not required, but may progress into a more severe block.
Second-Degree Type 1 AV Block: Progressive ↑ in impulse conduction time between the atria and ventricles until one impulse fails to conduct.
- Tx: Usually temporary and does not require treatment.
Second-Degree Type 2 AV Block: Sudden failure of impulse conduction from the atria to the ventricles without a progressive ↑ in conduction time.
- Tx: Pacemaker.
Third-Degree AV Block: Complete failure of all impulse conduction from the atria to the ventricles.
- Tx: Pacemaker.
Ventricular Dysrhythmias
Premature Ventricular Complex (PVC): Abnormal impulse that originates from the ventricle and occurs early.
- Tx: Antiarrhythmics (for symptomatic PVCs).
Ventricular Tachycardia (VT): Rapid ventricular rhythm > 100 bpm, usually due to ischemic heart disease. VT can often deteriorate into VF.
- Tx: VT with pulse treated with synchronized cardioversion, antiarrhythmics. VT without a pulse requires defibrillation.
Ventricular Fibrillation (VF): Rapid, ineffective quivering of the ventricles.
- Tx: Defibrillation!
Defib VFib!
Asystole: Absence of any ventricular rhythm.
- Tx: CPR.
Atrial Dysrhythmias
Atrial Fibrillation (AFIB): Rapid and disorganized depolarization of the atria, causing the atria to quiver or "fibrillate" instead of fully squeezing. This causes blood to collect in the atria, placing the patient at high risk for clots.
- Tx: Cardioversion, antiarrhythmics, anticoagulants.
Atrial Flutter: Abnormal electrical circuit forms in the atria, causing the atria to depolarize 250 - 350 times/minute.
- Tx: Cardioversion, antiarrhythmics.
Premature Atrial Complex (PAC): Abnormal impulse that originates from the atria and occurs early.
- Tx: Not usually necessary. ↓ Stress, avoid alcohol and caffeine.
Supraventricular Tachycardia (SVT): Abnormally fast HR that originates above (supra = above) the ventricles, typically in the atria.
- Tx: Cardioversion, antiarrhythmics.
Sinus Dysrhythmias
Sinus Tachycardia: Regular cardiac rhythm, heart rate > 100 bpm.
- Causes: Physical activity, anxiety, fever, pain, anemia, medications, compensation for ↓ cardiac output or BP.
- Tx: Treat underlying cause.
Sinus Bradycardia: Regular cardiac rhythm, heart rate
Causes: Excess vagal stimulation, cardiovascular disease/infection, hypoxia, medications.
Tx: Treatment of asymptomatic bradycardia is not necessary. Atropine or pacemaker for symptomatic bradycardia.
Sinus Arrhythmia: Normal variant from normal sinus rhythm where the heart rate increases slightly with inspiration and decreases slightly with expiration.
Causes: Common in children and typically disappears with age.
Tx: Not necessary.
Fluid Volume Excess
Isotonic fluid gain in the extracellular space.
Patho: Excess intake of fluids, inadequate excretion of fluids, or a fluid shift causes excess fluid to accumulate in the intravascular space (hypervolemia) and/or in the interstitial space (edema).
RF: Heart failure, extended use of corticosteroids, kidney dysfunction, cirrhosis, Cushing's syndrome. SIADH causes hypotonic fluid excess.
S/S: Weight gain, edema, tachycardia, tachypnea, hypertension, bounding pulses, dyspnea, crackles, jugular vein distension, ascites.
Labs/Dx: Dilute blood and urine. ↓ Hct,↓ BUN, ↓ serum osmolality, ↓ urine specific gravity.
Tx: Diuretics, removal of fluid from third space (e.g. paracentesis).
NC: Monitor daily weight, I&Os. Sit patient up. Limit fluid and sodium intake, administer O2 as ordered. Protect skin from breakdown. Monitor for complications (e.g., pulmonary edema). Report weight gain of 1 - 2 lbs in 24 hours, or 3 lbs in a week.
Fluid Volume Deficit
Isotonic fluid loss (i.e. water and sodium) from the extracellular space.
Patho: Loss of body fluids, inadequate fluid intake, or a fluid shift to the interstitial space causes hypovolemia. Dehydration is the loss of water without the loss of sodium.
RF: GI losses, hemorrhage, diaphoresis, diuretics. Dehydration RF: Diabetes insipidus, DKA, hyperventilation.
S/S: Hypotension, weak thready pulse, tachycardia, tachypnea, thirst, weakness, prolonged capillary refill time, oliguria, flattened jugular veins, dry mucus membranes, ↓ skin turgor.
Labs/Dx: Concentrated blood and urine. ↑ Hct, ↑ serum osmolality, ↑ BUN, ↑ urine specific gravity, ↑ urine osmolarity.
Tx: Fluid and electrolyte replacement, blood transfusion.
NC: Monitor I&Os, implement fall precautions. Monitor for hypovolemic shock. Notify provider for urine output
Card 331
Coronary Angiogram
Procedure
Nursing Care
Answer
Coronary Angiogram
Invasive procedure used to determine if a patient has a coronary artery blockage or narrowing. Catheter is inserted into the femoral artery and threaded up to the heart. Also known as a "cardiac cath."
NC:
- Pre-Procedure: Keep patient NPO 8 hours prior to procedure. Assess for allergy to contrast dye, iodine, shellfish*. Assess kidney function (BUN, creatinine). Assess/mark distal pulses for easy comparison post-procedure.
- Post-Procedure: Check insertion site for bleeding. Check extremity distal to puncture site for pulses, capillary refill, temperature, color. Take VS every 15 min x 4, then every hour x 4. Patient needs to lie flat for 4 - 6 hours after procedure.
*Recent evidence suggests that allergies to shellfish do not increase the risk of reaction to IV contrast more than any other allergies, however, for testing purposes defer to your instructor, textbook, and/or facility.
Hemodynamic Monitoring
Invasive monitoring used to provide direct measurement of pressures in the heart and great vessels.
CVP: Measures pressure in the vena cava or right atrium, assessing performance of the right side of the heart.
- Expected Range: 2 - 8 mmHg.
PAWP: Measures pressure during occlusion of the pulmonary artery, assessing performance of the left side of the heart.
- Expected Range: 6 - 12 mmHg.
CO: Measures the amount of blood pumped by the heart in one minute.
- Expected Range: 4 - 8 L/min.
Card 333
Cardiac Function
Electrocardiography (EKG)
Echocardiogram
Transesophageal Echocardiogram (TEE)
Answer
Cardiac Function
EKG: Provides a graphic representation of cardiac electrical activity. Used to diagnose dysrhythmias, MIs, electrolyte imbalances, and other disorders affecting heart function.
Echocardiogram: Uses ultrasound waves to visualize cardiac structures (especially the valves) and measure left ventricular ejection fraction (LVEF).
Normal LVEF = 55 - 70%.
TEE: Transducer is placed down the esophagus for a more detailed view of cardiac structures. Typically done under conscious sedation.
Card 334
Electrolytes
Ca, Cl, Mg, P, K, Na:
- Expected Ranges
Laboratory Studies
Lab Value
Expected Range
Activated Partial Thromboplastin Time (aPTT)
30 - 40 seconds
Prothrombin Time (PT)
11 - 12.5 seconds
International Normalized Ratio (INR)
0.8 - 1.1
D-Dimer
Human B-type Natriuretic Peptides (hBNP)
Cardiac Enzymes
Enzymes released in the bloodstream in response to ischemia in the heart. Troponin is most specific!
Cardiac Enzyme
Expected Range
Onset
Duration
CK-MB
0% of total CK
3 - 6 hrs
2 - 3 days
Myoglobin
2 - 3 hrs
24 hrs
Troponin T
2 - 3 hrs
10 - 14 days
Troponin I
2 - 3 hrs
7 - 10 days
Troponin T is elevated for TWO weeks. Troponin I (I looks like roman numeral I) is elevated for ONE week.
Blood Transfusion Reactions
NC: For most types of reactions, stop infusion, infuse 0.9% NaCl through a separate line, notify provider, send blood bag to lab.
Mild Allergic:
- S/S: Itching, flushing, urticaria.
- Tx: Administer diphenhydramine as ordered.
Anaphylactic:
- S/S: Wheezing, dyspnea, hypotension, ↓ O2 saturation.
- Tx: Administer epinephrine and corticosteroids as ordered.
Febrile:
- S/S: Fever, chills, hypotension, tachycardia, tachypnea.
- Tx: Administer antipyretics as ordered.
Card 342
Blood Transfusions
Best Practices for Administration of Blood
Answer
Blood Transfusions
Use 20 gauge or bigger IV catheter (18 gauge preferable).
Confirm patient ID, blood compatibility, expiration time with another RN.
Prime administration set with 0.9% NaCl only.
Do not administer medications through tubing used for blood.
If the transfusion is not initiated within 30 minutes, return blood bag to the blood bank.
Stay with patient for the first 15 minutes to monitor for transfusion reactions.
After obtaining blood products from the blood bank, transfusion must be completed within 4 hours.
Card 343
Blood Transfusions
Blood Type Compatibility
Answer
Blood Transfusions
Blood Type
Can Donate To:
Can Receive:
A+
A+, AB+
A+, A-, O+, O-
B+
B+, AB+
B+, B-, O+, O-
AB+
AB+
All Types
O+
O+, A+, B+, AB+
O+, O-
A-
A+, A-, AB+, AB-
A-, O-
B-
B+, B-, AB+, AB-
B-, O-
AB-
AB+, AB-
AB-, A-, B-, O-
O-
All Types
O-
Card 344
Blood Transfusions
Types of Blood Products
Indications
Infusion Time
Answer
Blood Transfusions
Type of Blood Product
Indications
Infusion Time
Packed RBCs (PRBCs)
Acute blood loss, sickle cell crisis, symptomatic anemia
2 - 4 hours
Fresh-Frozen Plasma (FFP)
Reversal of anticoagulants, thrombotic thrombocytopenic purpura
15 - 30 minutes (within 2 hours of thawing)
Platelets
Thrombocytopenia or inherited/acquired platelet disorders
15 - 30 minutes
Card 345
IV Complications
Fluid Overload:
- Signs/Symptoms, Nursing Care
Infection:
- Signs/Symptoms, Nursing Care
Answer
IV Complications
Fluid Overload: Too much volume is infused into the circulatory system.
- S/S: Shortness of breath, crackles, hypertension, jugular vein distention, tachycardia, edema.
- NC: Raise head of the bed, slow infusion rate, monitor SpO2 and vital signs, administer diuretics as ordered.
Infection: Invasion of microorganisms at the insertion site.
- S/S:
- Local: Pain, warmth, edema, induration (hardness), malodorous drainage.
- Systemic: Fever, chills, malaise, elevated WBCs.
- NC: Discontinue IV, send catheter tip for culture (if requested). Administer antibiotics, analgesics, antipyretics as ordered.
Card 346
IV Complications
Air Embolus:
- Signs/Symptoms, Nursing Care
Thrombosis:
- Signs/Symptoms, Nursing Care
Answer
IV Complications
Air Embolus: Air enters the venous system through the IV catheter.
- S/S: Hypotension, tachycardia, dyspnea, cyanosis.
- NC: Clamp catheter, place patient on left side in Trendelenburg position, administer oxygen, notify provider.
Thrombosis: Vein becomes occluded with a thrombus (i.e., clot).
- S/S: Slowed IV flow, inability to draw blood from central line, swelling/pain at site.
- NC:
- Peripheral IV: Discontinue IV, apply cold compress, elevate extremity.
- Central Lines: Instill thrombolytic agent into catheter and allow to dwell as ordered.
Card 347
IV Complications
Extravasation:
- Signs/Symptoms, Nursing Care
Catheter Embolus:
- Signs/Symptoms, Nursing Care
Answer
IV Complications
Extravasation: Infiltration of an agent that causes tissue damage (i.e., a vesicant).
- S/S: Erythema, pain, edema, blister, slough, ulceration.
- NC: Turn off infusion, aspirate residual drug. Administer antidote as indicated by facility policy before removing IV. Elevate extremity, apply warm/cold compress (depending on solution).
Catheter Embolus: IV catheter fragment in the venous system.
- S/S: Missing catheter tip upon removal of IV, severe pain along the vein, weak/thready pulse, hypotension.
- NC: Place tourniquet high on extremity. Prepare patient for surgery to remove fragment.
Card 348
IV Complications
Phlebitis:
- Signs/Symptoms, Nursing Care
Infiltration:
- Signs/Symptoms, Nursing Care
Answer
IV Complications
Phlebitis: Inflammation of the vein (due to mechanical irritation from IV catheter or pH/osmolality of certain medications).
- S/S: Erythema, pain, warmth, edema, indurated/cordlike vein, red streak.
- NC: Discontinue IV, elevate extremity, apply warm/moist compress, obtain specimen for culture if indicated.
Infiltration: IV fluids or medications leak into the surrounding tissue.
- S/S: Swelling, coolness, dampness, slowed rate of infusion, fluid leaking from IV insertion site.
- NC: Discontinue IV, elevate extremity, warm/cold compress (warm for normal/high pH solutions, cold for low pH solutions).
Intravenous Therapy
Peripheral Venous Catheter: Catheter inserted into a small peripheral vein (e.g., arm, hand).
- Indications: Fluid, medication, blood product administration.
- Types: Short peripheral catheters, midline catheters.
Central Venous Catheter: Catheter that terminates in the superior vena cava, just above the right atrium.
- Indications: Long-term antibiotic therapy, chemotherapy, CVP monitoring, TPN.
- Types: Tunneled and nontunneled central venous catheters, implantable ports, PICC lines.
Blood Clotting
Primary Hemostasis: Vascular injury causes vasoconstriction, platelet aggregation, and formation of a platelet plug (which triggers secondary hemostasis).
Secondary Hemostasis: Clotting factors (I - XIII) activate each other in a clotting cascade.
- Intrinsic Pathway: Activation of clotting factors inside the blood in response to blood vessel damage. Measured as activated partial thromboplastin time (aPTT).
- Extrinsic Pathway: Activation of clotting factors outside the blood in response to trauma to extravascular cells. Measured as prothrombin time (PT).
- Common Pathway: Intrinsic and extrinsic pathways merge into this pathway. Prothrombin is activated into thrombin, which activates fibrinogen into fibrin (clot).
Card 351
Blood Components
Illustration
Answer
Blood Components
Card 352
Blood Components
Plasma
Formed Elements
Answer
Blood Components
Plasma: Contains water, ions, protein (albumin, globulin, fibrinogen, clotting factors), nutrients, wastes, gases.
Formed Elements:
- Red Blood Cells (Erythrocytes): Carry oxygen and remove carbon dioxide.
- White Blood Cells (Leukocytes): Part of the body's immune system; detect and fight off pathogens.
- Platelets (Thrombocytes): Instrumental in the blood clotting process.
Card 353
Blood Pressure
Components
Regulation of Blood Pressure
Answer
Blood Pressure
Force of blood exerted against the arterial walls.
Components:
- Systolic BP (SBP) = Amount of pressure generated against the arterial walls during left ventricular systole (contraction).
- Diastolic BP (DBP) = Amount of pressure generated against the arterial walls during left ventricular diastole (relaxation).
Regulation of BP: Autonomic system controls BP via input from sensory receptors (e.g., baroreceptors, chemoreceptors, stretch receptors) located in blood vessels near the heart.
Card 354
Cardiac Function
Preload
Afterload
Contractility
Left Ventricular Ejection Fraction (LVEF)
Answer
Cardiac Function
Preload: Volume of blood in the ventricles at end of diastole (just prior to contraction). Determines the amount of stretch placed on myocardial fibers.
Afterload: Peripheral resistance the left ventricle must overcome to push blood into systemic circulation.
Contractility: Force of the heart muscle contraction.
LVEF: Percentage of blood leaving the left ventricle each time it contracts. Normal: 55 - 70%.
Card 355
Heart Conduction
Illustration
Answer
Heart Conduction
Card 356
Heart Conduction
Heart Conduction Steps
Answer
Heart Conduction Steps
SA node (sinus node) initiates an electrical impulse, which stimulates the atria to depolarize and contract.
The impulse travels down to the AV node, where there is a delay to allow the blood in the atria to empty into the ventricles.
The impulse then travels to the Bundle of His, then the left and right bundle branches, then to the Purkinje fibers, then to the myocardial contractile cells.
Depolarization of the myocardial contractile cells triggers ventricular contraction.
Card 357
Blood Circulation
Blood Flow Through the Heart
Answer
Blood Flow Through the Heart
The right atrium receives unoxygenated blood from three veins: superior vena cava (SVC), inferior vena cava (IVC), coronary sinus.
Blood passes from the right atrium to the right ventricle through the tricuspid valve.
Blood passes from the right ventricle into the main pulmonary artery via the pulmonic valve.
The pulmonary artery brings the blood to the lungs to become oxygenated. Oxygenated blood leaves the lungs via the pulmonary veins to the left atrium.
Blood passes from the left atrium to the left ventricle via the mitral valve.
Oxygenated blood passes from the left ventricle through the aortic valve into the aorta, where it is distributed throughout the body.
Heart Anatomy
Heart Valves:
- Types of Heart Valves
Answer
Heart Valves
Flaps (leaflets) that control blood flow and prevent blood from flowing backwards.
Types of Valves:
- Tricuspid: Separates the right atrium from the right ventricle.
- TRIcuspid is on the RIght side.
- Mitral (Bicuspid): Separates the left atrium from the left ventricle.
- Pulmonic: Separates the right ventricle from the pulmonary artery.
- Aortic: Separates the left ventricle from the aorta.
Heart Anatomy
Pericardium: Surrounds and protects the heart (peri = around, enclosing).
Heart Wall Layers:
- Epicardium: External layer (epi = upon, above).
- Myocardium: Middle layer (myo = muscle), composed of cardiac muscle (responsible for pumping action of the heart).
- Endocardium: Inner layer (endo = within, inner).
Chambers:
- Right atrium, right ventricle, left atrium, left ventricle.
- Septum separates the left/right sides of the heart.
Card 361
Cardiovascular System
Components
Function
Answer
Cardiovascular System
Components:
- Heart: Muscular pump that pumps ~ 5 L blood/minute and circulates blood through the body. Located within the mediastinum between the lungs, with ⅔ of its mass left of midline.
- Blood Vessels:
- Blood Flow: Heart → Arteries → Arterioles → Capillaries → Venules → Veins → Heart.
- Arteries/Arterioles: Carry blood away from the heart.
Arteries: Carry blood Away from the heart!
-
- Capillaries: Allow for exchange of materials (e.g., O2, CO2) between the blood and tissue cells.
- Veins/Venules: Carry blood towards the heart.
Functions: Supply oxygen and nutrients to tissues/organs, remove metabolic waste.
Card 362
Mechanical Ventilation
Nursing Care
Answer
Mechanical Ventilation
Keep manual resuscitation bag (bag-valve mask) and reintubation equipment (w/ 2 different tube sizes) at bedside.
Regularly assess patient's LOC, vital signs, breath sounds, pulse oximetry, ABGs.
Suction oral and tracheal secretions as needed.
Reposition ET tube every 24 hours to prevent pressure injuries; monitor for skin breakdown.
Provide frequent oral care.
Monitor for complications, including: ventilator-associated pneumonia (VAP), volutrauma (overdistension of alveoli), cardiac compromise (e.g., hypotension).
Keep HOB ≥ 30°.
Card 363
Mechanical Ventilation
Key Ventilator Settings
Answer
Mechanical Ventilation
Respiratory Rate (f): # of breaths/min delivered (usual: 6 - 20).
Tidal Volume (VT): Volume of gas delivered during each breath (usual: 6 - 10 mL/kg).
Inspiratory Flow Rate/Time: Speed of VT delivery (usual: 40 - 80 L/min, over 0.8 - 1.2 seconds).
Pressure Limit: Maximum pressure of VT delivery, usually 10 - 20 cm H2O above peak inspiratory pressure.
FiO2 (Fraction of Inspired Oxygen): O2 concentration of air delivered, usually 21% (room air) - 100%.
I:E Ratio: Duration of inspiration to expiration (usual: 1:2 - 1:1.5).
PEEP (Positive End Expiratory Pressure): Pressure applied at the end of ventilator expirations to distend alveoli and prevent collapse (usual: 5 cm H2O).
Card 364
Mechanical Ventilation
Purpose
Alarms
Answer
Mechanical Ventilation
Purpose: Improve gas exchange and ↓ work of breathing until the cause of respiratory failure (e.g., ARF, ARDS, respiratory fatigue) is corrected.
Alarms:
- Low Pressure Alarm: Disconnection, cuff leak, or tube displacement.
Low pressure alarm = Leak.
- High Pressure Alarm: Pulmonary edema, Pneumothorax, Bronchospasm, Biting, Secretions, Cough, Kink.
2 PB sandwiches can make you SiCK.
Card 365
Acute Respiratory Failure (ARF)
Treatment
Nursing Care
Acute Respiratory Distress Syndrome (ARDs)
Respiratory failure with non-cardiac associated pulmonary edema.
Patho: Systemic inflammatory response leads to alveolar permeability, inflammation, and collapse.
RF: Sepsis, shock, trauma, pneumonia, pancreatitis, inhalation of chemicals or water (with near-drowning).
S/S: Dyspnea, rapid/shallow breathing, tachycardia, substernal retractions, cyanosis/pallor, crackles.
Labs/Dx: ABG, chest X-ray.
Tx: Correct underlying cause, oxygen therapy, mechanical ventilation.
NC: Maintain patent airway, monitor cardiac status (e.g., HR, BP), provide mechanical ventilation care.
Card 368
Chest Tube
Nursing Care
Answer
Chest Tube
Obtain chest X-ray to verify tube position.
Keep an occlusive dressing at the chest tube insertion site.
Assess insertion site for subcutaneous emphysema (S/S: edema, crepitus) and infection.
Only clamp when ordered. Do not "strip" the tube.
Encourage patient to cough, breathe deeply, and use an incentive spirometer to help with lung expansion.
Keep padded clamps, sterile water, sterile gauze at bedside.
If chest tube disconnects from drainage system, place end of tube in sterile water (to maintain water seal).
If chest tube is accidentally removed, place sterile dressing over site, notify provider.
Monitor for complications (e.g., tension pneumothorax).
Card 369
Chest Tube
Chambers
Answer
Chest Tube
Drains fluid, air, or blood from pleural space. Chest tube placed near lung apex for a pneumothorax, and near the base of the lung for a hemothorax or pleural effusion.
Chambers:
- Drainage Collection: Chart amount and color of drainage. Report drainage > 100 mL/hr to the provider.
- Water Seal: Add sterile fluid up to the 2 cm line, check every 2 hours. Chamber must be kept upright and below chest insertion site.
- Tidaling (↑/↓ movement of water) expected.
- Lack of tidaling = lung re-expansion or obstruction.
- Continuous bubbling = air leak.
Seals swim in the tides! Tidaling is expected in the water seal!
- Suction Control: -20 cm H20 common.
- Continuous bubbling expected.
Tension Pneumothorax
Air is trapped in the pleural cavity under positive pressure.
Patho: Air enters the pleural space upon inspiration, but can't escape on expiration. Accumulating pressure causes lung collapse.
RF: Chest tube occlusion, fractured ribs, mechanical ventilation.
S/S: Tracheal deviationtowards unaffected side, absent breath sounds on affected side, respiratory distress, asymmetry of the thorax, hypotension, tachycardia, tachypnea, neck vein distension, pallor, anxiety.
Labs/Dx: Chest X-ray, ABG.
Tx: Immediate insertion of large bore needle into pleural space to remove air and re-expand the lung. Insertion of a chest tube.
Pleural Disorders
Disorders that involve the pleura or pleural cavity.
Patho: Air, fluid, or blood increase tension in the pleural cavity. This can lead to lung collapse. Three types:
- Pneumothorax: Accumulation of air in the pleural space.
- Pleural Effusion: Accumulation of fluid in the pleural space.
- Hemothorax: Accumulation of blood in the pleural space.
S/S: Respiratory distress, reduced/absent breath sounds on the affected side.
Percussion: Hyperresonance with pneumothorax, dullness with pleural effusion and hemothorax.
Dx: Chest X-ray.
Tx: Oxygen therapy.
Medications: Benzodiazepines for anxiety, opioid analgesics for pain.
Procedures: Chest tube to remove air/fluid/blood from pleural space.
Card 372
Pulmonary Embolism (PE)
Nursing Care
Patient Teaching
Answer
Pulmonary Embolism (PE)
NC: Sit patient upright, administer oxygen.
PT:
- Oral anticoagulants (e.g., warfarin, apixaban) are typically initiated concurrently with heparin therapy. Once a therapeutic level of the oral anticoagulant is reached, heparin therapy can be discontinued.
- For warfarin therapy, frequent blood draws are needed to monitor PT/INR levels. Maintain a consistent intake of vitamin K.
- Anticoagulants ↑ the risk of bleeding. Use a soft-bristled toothbrush and an electric razor. Avoid blowing nose forcefully. Seek immediate medical attention following any head trauma.
- Prevent future DVTs: Stop smoking, ↑ mobility, wear compression stockings.
Pulmonary Embolism (PE)
Life-threatening blockage in a lung artery.
Patho: Embolus (e.g., DVT) becomes lodged in pulmonary circulation. Pulmonary vascular occlusion leads to impaired gas exchange.
RF: Immobility, smoking, combined oral contraceptives, obesity, surgery, AFIB, long bone fractures (fat emboli), pregnancy.
S/S: Shortness of breath, anxiety, chest pain with inspiration, tachycardia, tachypnea, hypotension, petechiae (fat embolism), diaphoresis.
Labs: ↑ D-dimer (indicates presence of clot).
Dx: CT angiogram.
Tx:
- Medications: Anticoagulants (e.g., heparin), thrombolytics (e.g., alteplase).
- Surgery: Thrombectomy (removal of clot). Inferior vena cava filter (IVC filter) prevents new emboli from entering the lungs.
Card 374
Tuberculosis (TB)
Treatment
Nursing Care
Answer
Tuberculosis (TB)
Tx: Combination drug therapy of up to 4 antibiotics (e.g., rifampin, isoniazid, pyrazinamide, ethambutol) for 6 - 12 months.
NC:
- Place patient in negative airflow room.
- Wear N95 mask in room. Patient should wear a surgical mask when leaving their room.
- Screen family members for TB.
- Teach patient that sputum samples will be needed every 2 - 4 weeks. Patients are considered not infectious after 3 negative sputum cultures.
Tuberculosis (TB)
Infectious disease in the lungs caused by Mycobacterium tuberculosis.
Patho: Organism is transmitted via aerosolization and attaches to the alveoli. This triggers an immune response, ingestion of the bacilli by macrophages, and formation of granulomas (lesions).
S/S: Cough lasting > 3 weeks, purulent and/or bloody sputum, night sweats, weight loss, lethargy.
Labs/Dx:
- Blood Test: QuantiFERON-TB Gold Plus.
- Mantoux Skin Test: Intradermal injection, read within 48 - 72 hours. Induration of 15 mm = positive result (5 mm for immunocompromised patients, 10 mm for higher risk patients). Past BCG vaccination may produce a false-positive result.
- Acid-fast Bacilli Culture: Use 3 early morning sputum samples.
- Imaging: Chest X-ray.
Card 376
Pneumonia
Pathophysiology
Signs/Symptoms
Labs
Diagnostics
Treatment
Nursing Care
Answer
Pneumonia
Excess fluid in the lungs due to inflammation.
Patho: Infectious organism (e.g., bacterial, viral, fungal) causes fluid collection around the alveoli and thickening of the alveolar walls, leading to impaired gas exchange.
S/S: Fever, shortness of breath, chest pain, cough, dyspnea, confusion (common in older patients!), crackles/wheezes.
Labs: ↑ WBCs, ABG (↓ PaO2, ↑ PaCO2), sputum culture.
Obtain sputum sample BEFORE starting antibiotic therapy.
Dx: Chest X-ray.
Tx: Antibiotics, bronchodilators, oxygen therapy.
NC: Position patient in High-fowler's, administer oxygen as prescribed. Encourage coughing, deep breathing, use of incentive spirometer, ↑ fluids.
Card 377
Influenza
Pathophysiology
Prevention
Signs/Symptoms
Labs/Diagnostics
Treatment
Nursing Care
Answer
Influenza
Highly contagious acute viral respiratory infection.
Patho: Influenza A, B, or C virus is spread primarily through droplets from person-to-person. The virus attaches to epithelial cells in the respiratory tract and replicates.
Prevention: Hand washing, annual vaccination, avoid close contact with infected persons.
S/S: Fever/chills, malaise, muscle aches, headache, rhinorrhea, cough, sore throat.
Labs/Dx: Rapid influenza diagnostic test using nasal/throat swab.
Tx: Saline gargles, rest, ↑ fluid intake.
- Medications: Antiviral agents (take within 48 hrs after the onset of symptoms!), analgesics, antitussives.
NC: Implement droplet precautions.
Upper Respiratory Tract Disorders
Inflammation of nasal mucosa (rhinitis), sinuses (sinusitis), pharynx (pharyngitis), larynx (laryngitis), tonsils (tonsillitis).
Patho: Viral infection, bacterial infection, or allergies cause the release of histamine. This results in local vasodilation, edema.
S/S: Rhinorrhea, sore throat, headache, facial pain, fever, hoarseness, difficulty swallowing.
Labs/Dx: Pharyngeal culture to rule out group A beta-hemolytic streptococcal infection (strep throat), influenza and COVID-19.
Tx: Nasal saline irrigation, steam inhalation.
- Medications: Mucolytics, decongestants, antihistamines, analgesics, antibiotics for bacterial infections.
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Pulmonary Hypertension
Pathophysiology
Risk Factors
Signs/Symptoms
Labs/Diagnostics
Treatment
Nursing Care
Answer
Pulmonary Hypertension
High blood pressure in the lungs.
Patho: ↑ Vascular resistance and narrowing of the arteries in the lungs cause ↑ pressure in the right ventricle, leading to right ventricular enlargement/failure (Cor Pulmonale).
RF: Cardiac defects/disease, pulmonary embolism, lung disease (e.g., COPD).
S/S: Dyspnea, pallor, fatigue, chest pain on exertion, weakness, edema related to right-sided heart failure.
Labs/Dx: Cardiac catheterization, ABG, EKG, PFTs, hemodynamic monitoring (↑ PAP and PAWP).
Tx: Diuretics, digoxin, vasodilators, oxygen therapy.
NC: Fluid restriction for right-sided heart failure. Monitor I&Os and daily weight. Encourage frequent rest periods.
Interstitial Lung Disease
A group of restrictive lung disorders that cause stiff and noncompliant lungs.
Patho: Chronic inflammation of the lungs replaces healthy lung tissue with fibrotic scar tissue.
RF: Environmental inhalants, immune disorders, sarcoidosis.
S/S: Cough, dyspnea, chest discomfort, fatigue, nail clubbing.
Dx: X-ray, lung biopsy, PFTs.
Tx: Oxygen therapy.
- Medications: Corticosteroids (↓ inflammation).
- Procedures: Lung transplant.
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Cystic Fibrosis
Labs/Diagnostics
Treatment
Nursing Care
Answer
Cystic Fibrosis
Labs/Dx: Sweat chloride test, DNA testing, PFTs, stool analysis.
Tx:
- Medications: Bronchodilators, anticholinergics, dornase alfa, antibiotics (for pulmonary infections), pancreatic enzymes (take with meals and snacks).
- Procedures: Chest physiotherapy uses percussion, vibration, postural drainage, and breathing exercises to loosen respiratory secretions. Schedule treatments before meals or 1 - 2 hours after meals to avoid vomiting. Use bronchodilator 30 - 60 minutes before treatment.
NC: Administer oxygen. Encourage ↑ fluids, ↑ protein/calorie diet. Provide supplements (e.g., fat-soluble vitamins A, D, E, K).
Card 382
Cystic Fibrosis
Pathophysiology
Signs/Symptoms
Answer
Cystic Fibrosis
Genetic disorder that severely impairs lung function and causes dysfunction in other organs/tissues that make mucus or sweat.
Patho: Autosomal recessive disorder causes obstruction of NaCl transport within cell membranes, producing secretions with low water content. This results in abnormally thick, sticky mucus that plugs organ ducts (pancreas, lungs, liver, small intestine, reproductive organs) and leads to organ failure.
S/S:
- Respiratory: Wheezing, coughing, dyspnea, mucus plugs, cyanosis, barrel-shaped chest, clubbing, chronic respiratory infections.
- GI: Steatorrhea (fatty, malodorous stools), delayed growth, fat-soluble vitamin deficiency (A, D, E, K).
- Skin: High NaCl content in sweat, saliva, and tears.
COPD
Labs/Dx: ABG (↑ PaCO2, ↓ PaO2), polycythemia (↑ RBCs due to chronic hypoxia), chest X-ray, PFTs.
Tx: Inhaled bronchodilators, anticholinergics, corticosteroids. Mucolytics, systemic corticosteroids for exacerbations, oxygen therapy.
Giving high concentrations of oxygen can cause a patient with COPD to lose their hypoxic drive to breathe.
NC: Place patient in upright position. Administer oxygen as prescribed. Monitor for complications (e.g., right-sided heart failure).
PT: Smoking cessation. Breathing techniques (e.g., abdominal and pursed lip breathing), effective coughing, incentive spirometer. Small frequent meals, ↑ fluids, high calorie/protein diet. Oxygen safety.
COPD
A group of diseases (e.g., emphysema, chronic bronchitis) which cause irreversible airway obstruction.
Patho: Emphysema causes destruction of alveoli, ↓ lung elasticity, hyperinflation, and "air trapping." Bronchitis causes inflammation of the airways and hypersecretion of mucus. These two changes lead to hypoventilation, hypoxemia, and hypercapnia.
RF: Smoking, air pollution, occupational chemicals/dusts, infection.
S/S: Cough, excess sputum, dyspnea, crackles/wheezes, barrel chest, use of accessory muscles, nail clubbing*, cyanosis, hyperresonance (due to trapped air), rapid/shallow respirations, ↓ SpO2, "tripod" positioning.
*Recent evidence suggests that clubbing is not correlated with COPD, however, for testing purposes defer to your instructor, textbook, and/or facility.
Card 385
Status Asthmaticus
Signs/Symptoms
Treatment
Nursing Care
Answer
Status Asthmaticus
Airway obstruction unresponsive to usual therapy. Can lead to pneumothorax and cardiac/respiratory arrest. This is a medical emergency.
S/S: Extremely labored breathing, gasping or inability to speak, anxiety, ↓ LOC, neck vein distension, pulsus paradoxus (↓ in SBP during inspiration), cyanosis.
Tx: Bronchodilators, epinephrine, corticosteroids.
NC: Administer oxygen. Prepare for emergency intubation and mechanical ventilation.
Card 386
Asthma
Treatment
Patient Teaching
Answer
Asthma
Tx: Bronchodilators (control therapy and reliever drugs), anticholinergics, anti-inflammatories, leukotriene antagonists.
PT:
- Monitor asthma using a peak flow meter. Perform 3 times and record highest number (not average).
- Identify and avoid environmental triggers/irritants.
- For exercise-induced asthma, use bronchodilator 30 minutes before exercise.
- Educate patient on the difference between short and long-acting asthma medications, and proper use of a MDI or DPI inhaler.
- Advise patient to always carry an emergency inhaler.
Sleep Apnea
Breathing disruption in sleep that lasts > 10 seconds and occurs ≥ 5 times per hour.
Patho:
- Obstructive: Upper airways become blocked by overly relaxed airway muscles, or by tongue/soft palate.
- Central: The brain doesn't send signals to the muscles that control breathing.
RF: Obesity, large tonsils, neuromuscular or endocrine disorders.
S/S: Persistent daytime sleepiness, irritability.
Dx: Polysomnography, overnight sleep study.
Tx: CPAP (continuous positive airway pressure) or BPAP (bi-level positive airway pressure), adenoidectomy, tonsillectomy.
Card 389
Oxygen Delivery Systems
Nasal Cannula
Simple Face Mask
Partial Rebreather Mask
Non-Rebreather Mask
Aerosol Mask/Face Tent
Venturi Mask
Answer
Oxygen Delivery Systems
Device
Flow Rate
Considerations
Nasal Cannula
1 - 6 L/min
Water-based lubricant may be used in nares to prevent drying.
Simple Face Mask
5 - 8 L/min
Impairs patient's ability to eat, drink, and talk.
Partial Rebreather
10 - 15 L/min
Adjust flow rate to maintain bag 2/3 full.
Non-Rebreather
10 - 15 L/min
Inflate reservoir bag prior to applying.
Aerosol Mask/Face Tent
6 - 15 L/min
Good for patients with facial trauma or burns.
Venturi devices provide the most precise O2 delivery (up to 40%) without intubation. Flow rate is dependent upon the mask to which it is attached.
Card 390
Oxygenation
Hypoxemia and Hypoxia
Early Signs/Symptoms of Hypoxia
Late Signs/Symptoms of Hypoxia
Oxygen Toxicity
Answer
Oxygenation
Hypoxemia is low oxygen content in the arterial blood (
Early S/S of Hypoxia: Restlessness, irritability, abnormal breathing (e.g., use of accessory muscles, nasal flaring, adventitious lung sounds), tachycardia, tachypnea, hypertension, pallor.
Late S/S of Hypoxia: ↓ LOC, ↑ lactic acid (i.e., lactic acidosis), dysrhythmias, bradycardia, bradypnea, hypotension, cyanosis.
Oxygen Toxicity: Exposure to above-normal O2 partial pressures with oxygen therapy.
- S/S: Non-productive cough, nasal congestion, substernal pain, headache, nausea/vomiting, fatigue, sore throat.
Use the lowest O2 liter flow needed to manage hypoxia.
Card 391
Thoracentesis
Procedure
Nursing Care
Answer
Thoracentesis
Insertion of a needle in the posterior chest to aspirate fluid (
NC:
- Pre-Procedure: Sit patient upright with arms supported on pillows or overbed table (i.e., tripod position). Educate patient to not move, talk, or cough during procedure.
- Post-Procedure: Monitor patient for mediastinal shift, pneumothorax, bleeding, hypotension. Chest X-ray if complications are suspected. Encourage deep breaths to expand lungs.
Card 392
Bronchoscopy
Procedure
Nursing Care
Answer
Bronchoscopy
Insertion of a bronchoscope (thin, flexible tube with a light and camera on the end) into the airway to allow for visualization and collection of specimens.
NC:
- Pre-Procedure: Keep patient NPO 4 - 8 hours, prepare patient for sedation.
- Post-Procedure: Ensure patient's gag reflex has returned before allowing patient to eat/drink. Sore/dry throat and blood-tinged sputum are expected. Monitor for pneumothorax, which can occur within 24 hours after procedure.
Card 393
Oxygenation
Arterial Blood Gas (ABG)
Pulse Oximetry (SpO2)
Pulmonary Function Tests (PFTs)
Answer
Oxygenation
ABG: Use of an arterial blood sample to assess acid-base balance, ventilation, and oxygenation of critically ill patients.
- pH: 7.35 - 7.45 (hydrogen ion concentration).
- PaCO2: 35 - 45 mmHg (partial pressure of CO2).
- HCO3: 21 - 28 mEq/L (bicarbonate).
- PaO2: 80 - 100 mmHg (partial pressure of O2).
- SaO2: 95 - 100% (O2 saturation).
SpO2: 95 - 100% (measurement of O2 saturation using pulse oximetry).
Patients with COPD are expected to have SpO2 and SaO2 levels in the low 90s.
PFTs: Evaluates lung function, including lung volume, capacity, and rates of flow.
Card 394
Respiratory System
Ventilation
Diffusion
Perfusion
Answer
Respiratory System
Ventilation: Flow of air into and out of the alveoli.
- Asthma causes bronchoconstriction, which ↓ ventilation.
Diffusion: Exchange of O2 and CO2 between the alveoli and RBCs (in the bloodstream).
- Lung fibrosis increases the alveolar wall thickness, which impairs diffusion.
Perfusion: Exchange of O2 and CO2 between the RBCs and the body tissues.
- Peripheral arterial disease (PAD) restricts blood flow to the extremities, which ↓ perfusion.
Card 395
Respiratory System
Alveoli: Illustration
Answer
Alveoli
Card 396
Respiratory System
Respiratory System Components: Illustration
Answer
Respiratory System
Card 397
Respiratory System
Key Function
Components
Answer
Respiratory System
Key Function: Gas exchange. Provide oxygen (O2) to the body's cells and remove carbon dioxide (CO2) from the body.
Components:
- Upper Airway: Nose, mouth, pharynx, larynx, trachea.
- Function: Warm, humidify, and filter the air.
- Lower Airway: Bronchi (primary, secondary, tertiary), bronchioles, alveolar ducts, alveoli.
- Function: Gas exchange. Alveoli are the functional units for gas exchange.
- Pleura: Membranes that surround and cushion the lungs. The space between the 2 layers is the pleural cavity.