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89 Cards in this Set
- Front
- Back
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Inflammation and its consequences of Asthma |
caused by allergens, results in bronchoconstriction and is usually reversible |
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Inflammation and its consequences of COPD |
caused by cigarette smoke, results in small airway narrowing and alveolar destruction and is irreversible |
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What is, Intermittent, reversible, affects only the airways not alveoli and is caused by inflammation, hyper-responsiveness, airway edema and remodeling |
Asthma |
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3 most common symptoms of asthma |
cough, dyspnea and wheezing |
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Definition of Asthma |
a chronic inflammatory disorder of the airways in susceptible individuals, this inflammation caused recurrent episodes of wheezing, breathlessness, chest tightness and coughing, particularly at night or early in the morning. These episodes are usually associated with widespread but variable airflow obstruction that is often reversible either spontaneously or with treatment |
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Types of Asthma |
Intrinsic, Extrinsic, Mixed |
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Characteristics of Intrinsic Asthma |
Non-allergenic, non-atopic- non-immunologic, triggers include respiratory infection, exercise, dust, cold air, inhalation of fumes, aspirin deranged autonomic nervous control leads to mucosal wall edema, bronchial smooth muscle constriction. |
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Characteristics of Extrinsic Asthma |
Allergenic, atopic, immunologic, triggers include pollens, animal dander, dust, molds. inhaled allergen couples with antibody on mast cell leads to release of slow-reating substance of anaphylaxis, histamine or other mediators leads to mucosal wall edema and bronchial smooth muscle constriction |
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Intermittent Asthma |
symptoms less than 1 time a week at night less than or equal to 2 a month. asymptomatic and normal between attacks. |
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Mild Persistent Asthma |
day symptoms more than once a week but less than once a day attacks may affect activity and night symptoms greater than 2 times a month |
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Moderate persistent asthma |
daily symptoms, attacks affect activity night symptoms more than once a week |
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Severe persistent asthma |
continuous day symptoms, limited physical activity and frequent night symptoms |
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Types of Asthma Drug Therapy |
Relievers = Short acting B2-agonists Controllers = long-acting B2-agonists Preventers = inhaled corticosteroids combinations |
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Complications of Asthma |
Status Asthmaticus, life threatening can lead to respiratory failure 10% require ventilatory assistance and ICU Symptoms: mimic attack but more severe and longer. severe anxiety, fear of suffocation, diaphoresis, PEF decreased, neck vein distention, HTN, Tachycardia, Tachpnea Dysrhythmias Treatment: immediate hospitalization, treatment of hypoxia, fluids, meds and monitoring |
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COPD - Chronic Obstructive Pulmonary Disease Characteristics |
-chronic bronchitis and emphysema contributing factors= smoking, recurrent infections, air pollution, heredity, aging |
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Emphysema |
"Pink Puffers" loss of the lung's elastic recoil, causing the respiratory bronchioles to collapse upon expiration |
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Chronic Bronchitis |
"Blue Bloater" Inflammation and structuralchanges, increased mucus, |
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Panlobar Emphysema |
Destruction of bronchiole, alveolar duct and alveoli, little inflammation, hyper-expanded chest, work on exhalation |
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Centrilobar Emphysema |
Derangement of the V/Q ratios, chronic hypoxemia, hypercapnea, polucuthemia and right sided heart failure |
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COPD Clinical Manifestations |
Chronic cough, sputum productions and dyspnea on exertion, weight loss common, increased number of respiratory infections, in primary emphysema will have "barrel chest" |
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Diagnosis of COPD |
Thourgh H & P, spirometery to evaluate airflow obstruction. FEV1/FVC will be less than 70%, reversibility will be tested, chest x ray, ABGs, Screenign for alpha1-antitrypsin deficiency classified by five stages |
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Medical management of COPD |
smoking cessation to slow progression, may use chantix, wellbutrin, nortiptyline, or clonidine. Bronchodilators- beta agonists, anticholinergics, methyxanthines, combinations, nebulized medications, inhaled and systemic corticosteroids, influenza and pneumococcal vaccines. Oxygen therapy "severe copd" High fat low CHO diet |
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Nursing Management of COPD |
Education, breathing exercises, inspiratory muscle training, activity pacing, self-care activities, physical conditioning, O2 therapy, Nutritional therapy,coping measures |
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Chronic Bronchitis |
Is a disease of the airways, is defined as the presence of cough and sputum production for at least 3 months in each of 2 consecutive years |
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Signs and Symptoms of Chronic Bronchitis |
Dyspnea, fever, tachypnea, productive cough, clear to purulent sputum, pleuritic chest pain, diffuse rhonchi and crackles heard on auscultation, Respiratory acidosis, increased hemoglobin, digital clubbing, cardiac enlargement, leads to right sided heart failure |
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Blue Bloater |
Chronic Bronchitis |
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Pink Puffer |
Emphysema |
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Nursing Management of Bronchitis |
improving airway clearance, smoking cessation, keep room dust free, administer bronchodilators, use postural drainage position, encourage coughin, encourage fluid intake, improve breathing patter, use pursed-lip breathing at intervals and during periods of dyspnea administer antibiotics, improve gas exchange, check ABG's, O2 therapy, inspiratory muscle training, encourage frequent small meals, avoid gas producing foods, monitor weight, exercise as possible with o2 |
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Nutritional Therapy related to COPD |
goal: decrease dyspnea and conserve energy rest at least 30 mins prior to eating, use bronchodilator before meals, select foods that can be prepared in advance, 5-6 small meals daily to avoid bloating, avoid foods that require a great deal of chewing, avoid exercises and treatments 1 hour before and after eating, avoid gas-forming foods, high calorie and high protein diet, supplements, avoid high carbs to prevent increase in CO2 load |
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Primary Pulmonary hypertension (PPH) |
occurs in the absence of other lung disorders cause is unknown. blood vessel constriction with increasing vascular resistance in the lung. The hear fails (cor pulmonale) without treatment death occurs within 2 years |
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Management of PPH |
warfarin therapy, calcium channel blockers, endothelin-receptor antagonists, natural and synthetic prostacyclin agents, digoxin and diuretics O2therapy |
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Cor Pulmonale |
hypertrophy of R side of heart from pulmonary hypertenstion. eventual R side failure. (JVD, hepatomegaly, RUQ tenderness, ascites, epigastric distress, peripheral edema) |
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Interstitial Pulmonary Disease |
affects the alveoli, blood vessels and surrounding support tissue of the lungs rather than the airways. restrictive disease- thickened lung tissue, reduced gas exchange, slow onset of disease, dyspnea most common symptoms |
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Cystic Fibrosis |
Affects the sinuses, lungs, skin, liver, pancreas, intestines and reproductive organs, thick sticky mucus blocks airways, bacterial infections occur often and blood is in muscous |
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Management of CF |
breathing retraining- pursed lip and diaphragmatic, coughing, aerosol-nebulization for meds. percussion, vibration, postural drainage position so gravity helps drainage, percuss and vibrate to help loosen secretions dont do right after meals |
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How to assess the Endocrine System
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Health history, energy level, hand and foot size changes, headaches, urinary changes, heat/cold intolerance, changes in sexual characteristics, personality changes
Physical assessment, appearance including hair distribution, fat distribution, quality of skin, appearance of eyes, size of hands and feet, peripheral edema, facial puffiness, vital signs |
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Diagnostic testing of the endocrine system |
serum levels of hormones, antibody testing, urinary tests to measure by-products, stimulation tests, suppression tests |
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Types of Pituitary Tumors |
Eosinophilic, Basophilic and Chromophobic |
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Eosinophilic Tumors |
may result in gigantism or in acromegaly. may suffer from severe headaches, visual disturbances, decalcification o the bone, endocrine disturbances |
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Basophilic tumors |
may cause cushing's syndrome w/ features of hyperadrenalism, truncal obesity, amenorrhea, osteporsis |
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Chromophobic Tumors |
90% of pituitary tumors, present with lowered BMR, obesity, somnolence, scant hair, low body temp, headaches, visual changes |
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Anterior Pituitary produces these hormones |
Growth hormone, adrenocorticotropic, thyroid stimulating, follicle stimulating, luteinizing, and prolactin |
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Hyper-pituitarism |
often seen in target organs ie: thyroid, adrenals, growth hormone excess, giantism, early childhood, acromegaly adults 30s and 40s |
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Hypo-pituitarism |
rare usually from tumor or trauma, more relevant in pediatric, obstetric populations, often non-specific but may be seen in target organs, |
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Syndrome of Inappropriate Antidiuretic Hormone SIADH |
Excessive ADH secretion, retain fluids and develop a dilutional hyponatremia, often non-endocrine. caused by disorders of the CNS like head injury, surgery tumors, infections, or medications. Management eliminate cause, give diuretics, fluid restriction, I&O, daily weight, lab chemistries. restoration of electrolytes must be gradual |
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Manifestations of SIADH |
excessive thirst urinary specific gravity of 1.001-1.005 |
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Diabetes Insipidus |
deficiency of ADH, Excessive thirst, large volumes of dilute urine, can occur secondary to brain tumors, head trauma, infections of the CNS, and surgical ablation or radiation. Nephrogenic DI- relates to failure of the renal tubules to respond to ADH can be related to hypokalemia, hypercalcemia and to medications |
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Symptoms of Diabetes Insipidus |
uncontrollable thirst, a yearning for ice water, increased urine volume of diluted reaching 2.5 to 15 liters a day. Nocturia, hypotension, tachycardia, poor skin turgor, dry mucous membranes, irritability, decreased cognition, hyperthermia, ataxia, coma |
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Assessment of Thyroid |
inspect gland, observe for goiter, check TSH, serum T3 and T4. T3 resin uptake, radioactive iodine uptake test and thyroid scan |
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Thyroid Scan |
helps determine the location, size, and shape of gland. "Hot" areas = increased function and "cold" areas = decreased function |
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Radioactive iodine uptake test |
measures rate of iodine uptake. hyperthyroidism will exhibit high rate of uptake while hypothroidism will have low uptatke |
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Hyperthyroidism |
Excess T3, T4 or both, more likely in men, iodine deficiency contributes Graves disease |
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Graves Disease |
diffuse toxic goiter, autoimmune, hyperplasia from thyroid stimulatin abs activate production of hormones. remissions/exacerbations can progress to destroy thyroid = hypothyroidism |
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Thyrotoxicosis |
nervousness, irritable, apprehensive, palpitations, heat intolerance, skin flushing, tremors, possibly exophthalmos, increased sensitivity to catecholamines, can occur after irradiation or presence of a tumor |
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Symptoms of Hyperthyroidism |
palpitations, heat intolerance, nervousness, insomnia, breathlessness, increased bowel movements, light/absent menstrual periods, fatigue, tachycardia, trembling hands, weight loss, muscle weakness, warm most skin, hair loss, staring gaze |
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Treatment of Hyperthyroidism |
Block effects, stop over secretion with meds, thyroid ablation with RI, subtotal thyroidectomy, nutrition, Eye care, restful environment |
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Thyroid storm what is it how do you treat it |
is an acute release of thyroid hormones in response to administration of RI. Symptoms include; high fever, tachycardia, delirium, chest pain, dyspnea, papitations, weight loss, diarrhea, abdominal pain. Treat with O2 IV fluids with dextrose, hypothermic measures, steroids to treat shock and adrenal deficiency, iodine to decrease output of T4 beta blockers, PTU or Tapazole impedes formation of thyroid hormone and blocks conversion of T4 to T3 |
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Nursing Management of Hyperthyroidism |
Reassurance r/t emotional reactions, eye care, maintain body temp, adequate caloric intake, manage complications such as dysrthmias and tachycardia, education |
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Hypothyroidism |
insufficient hormone. often from atrophy of thyroid from Graves/ Hashimoto's disease, inadequate TSH, Surgical removal, goitrogens, iodine def areas. if long-standing can lead to Myxedema(coma) |
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Myxedema |
accumulation of mucopolysaccharides in SC and interstitial tissues is the extreme form of hypothyroidism can progress to shock |
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Signs/symptoms of hypothyroidism |
increased weight, constipation, perioribital edema, hoarse voice, slower movements, paresthesias, intolerance to cold, mentrual changes, decreased sweating response, dry coarse and cold skin, hair loss, apathy, brittle nails and hair |
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Management of Hypothyroidism |
thyroid hormone meds, low cal diet, prevent constipation, vital signs, cardiac monitoring, safety |
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Management of Myxedema |
cautious fluid replacement, glucose to restore glycemic levels, avoid rapid overheating to do increased oxygen demands but keep warm, may give levothyroxine IV, modify activity, high fiber foods |
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Hyperparathyroidism symptoms |
depression, poor concentration, memory deficits, muscle weakness, fatigue, weight loss, anemia, anorexia, ectopic calcifications, shortened q-t interval, polyuria, polydipsia, metabolic acidosis, gout, osteopenia, peptic ulcers, pancreatitis, nausea and vomitting |
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Management of hyperparathyroidism |
surgical removal, hydration therapy, increase mobility, fluids, prune juice and stool softeners for constipation watch for s/s of tetany postsurgially as well as cardiac dysrhythmias and hypotension |
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Hypercalcemic Crisis |
seen with levels greater than 15mg/dl, can result in life threatening neurologic, cardiovascular and renal symptoms, treatments include hydration, loop diuretics, phosphate therapy, calcitonin or mithramycin |
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Hypoparathyroidisim |
seen most often following removal of thyroid gland, parathyroid glands or following radical neck surgery. results in increased bone phospate and decreased blood calcium levels. decreased absorption of calcium |
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Symptoms of Hypoparathyroidism |
tingling or burning in fingertips, toes and lips. muscle aches or cramps of legs, feet, abdomen or face. twitching or spasms of muscles especially around mouth, fatigue/ weakness. dry coarse skin, patchy hair loss, brittle nails, anxiety or nervousness, headaches, depression, mood swings, memory loss |
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Diagnosis of Hypoparathyroidism |
low blood CA+ level, low parathyoid hormone level, high blood phosphorus level, low blood magnesium level, ECG, Urine calcium test, x-rays and bone density tests, trousseau's sign, chvostek's sign |
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Management of Hypoparathyroidism |
calcium supplements, vitamin D, diet high in calcium low in phosphorus, lifetime drug therapy, medical alert bracelet, reduce stress, Tetany biggest danger |
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Pheochromocytoma |
usually a benign tumor, originates from the chromaffin cells of the adrenal medulla, usually develops between 40-50, 10% are malignant, may be associated with thyroid carcinoma or parathyroid hyperplasia or tumor |
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Manifestations of Pheochromocytoma |
headache, diaphoresis, palpitations, hypertension, hyperglycemia, tremors, flushing, anxiety, blurred vision, feeling of impending doom. BP's exceeding 250/150 can occur |
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Manifestations of Cushing's Syndrome |
Cataracts, glaucoma, hypertension, HF, Moon face, turnical obesity, buffalo hump, sodium retention, hypokalemia, hyperglycemia, negative nitrogen balance, altered calcium metabolism, osteoporosis, compression fractures, peptic ulcers, pancreatitis, thinning of skin, striae, acne and mood alterations |
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Cushing's |
caused by increased glucocorticoids especially cortisol, usually related to pituitary adenoma more common in women, Associated with 5h's |
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What are the 5 H's |
hypertension, headache, hyperhidrosis, hypermetabolism, hyperglycemia |
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Management of Cusings |
bedrest, elevated HOB, ICU, Nipride, Calcium channel blockers and beta blockers, surgical management, steroid therapy |
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Primary Addison's Disease |
all 3 steroids decreased, autoimmune, part of polyendocrine deficiency syndrome, possible causes are: TB, hemorrhage, infract, infection, AIDS and CA
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Secondary Addison's Disease |
No ACTH, sudden stop of steroids |
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Manifestations of Addison's Disease |
muscle weakness, anorexia, dark pigmentation, hypotension, hypoglycemia, low sodium levels, high postassium levels, gi disturbances, changes in distribution of hair, |
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Addisonian Crisis |
circulatory shock, pallor, apprehension, weak and rapid pulse, rapid breathing, low BP, headache, nausea, abdominal pain and diarrhea, can be brought on by overexertion, exposure to cold, acute infection, decrease in salt intake |
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Types of Hematological Studies |
CBC, PT/INR, PTT, TT, Fibrinogen, D-dimer, Fibrin degradation products, Bone marrow aspiration and biopsy |
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Iron deficiency |
most common type of anemia, common causes are blood loss an diet |
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Hemolytic Anemia- Types |
Sickle cell, thalassemia, hereditary spherocytosis, polythemia, leukopenia, lymphopenia, neutropenia, leukemia |
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Sickle Cell characteristics and management |
inherited disease, pain is most common symptom, managed with bone marrow transplant, transfusions, hydroxyurea, arginine, oxygen, pain management,infection, emotional support, education, monitor for complications |
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Myelodysplastic syndrome MDS |
myeloid stem cells cause dysplasia, can progress to leukemia. treated with bone marrow transplant, transfusions, education and chelation |
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Aplastic anemia |
decreased bone marrow stem cells, treated with bone marrow transplant, immunosuppressives, splenectomy, transfusions |
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Anemia of Renal Failure |
deficiency of erthropoietin, treat with recombinant erthropoietin (epogen) |
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Anemia of Chronic illness |
inflammation, infection, malignancy treat underlying disease |
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Thalassemia |
hereditary, defective hemoglobin chain synthesis, causing abnormal hemoglobin formation. alpha is mild beta can be fatal managed with transfusions, BMT and teaching |
