Respiratory
What are the ABGs the nurse should expect in a patient with COPD?
pH < 7.35
PCO2 > 45 mmHg
HCO3- 22-26 mEq/L
What two laboratory values or diagnostic findings could indicate a myocardial infarction?
EKG- STEMI & Q wave
Labs- troponin & CKMB
Name 3 body systems that are impacted by immobility and how to manage/optimize each as a nurse.
MS- sit on side of bed, help with turns
Skin - turns, decrease friction and sheer
Circulation - SCDs, TED hose (compression stockings)
Respiratory - cough and deep breathe, incentive spirometer
GI - increase fluid intake and fiber
GU - toileting schedule
Stress response - monitor BGs, GI prophylaxis (Pepcid/pantoprazole)
Explain the three main types of aphasia.
Receptive – unable to understand (receive) written or spoken language
Expressive – unable to express themselves (can’t speak or write)
Global- can’t speak or understand language (both of the above forms are present)
A patient had surgery and received dye to view vessels. The patient's estimated blood loss from surgery is 10mL. Soon after surgery, the patient develops an increased creatinine, a GFR of 35, and a decreased BUN/creatinine ratio. Explain what type of acute kidney injury would be of concern.
Intrarenal- use of dye
What are three manifestations seen in someone with hyperglycemia?
Polyuria
Polydipsia
Polyphagia
What are 5 signs and symptoms of anaphylaxis?
Wheezing, stridor, coughing, urticaria, tingling, pruritis, chest tightness, bronchoconstriction, angioedema, difficulty swallowing, sense of fear/panic, hypoxia, dizziness, fainting, decreased LOC, BP can drop causing anaphylactic shock
A client has a condition that allows air to enter the pleural space during inspiration, but the air is unable to exit during expiration.
What term will the nurse use to describe this condition? Why is this condition concerning?
Tension pneumothorax
Lung can't expand and mediastinal contents (aorta, trachea) can shift compromising perfusion and ventilation.
A patient reports chest pain from gardening that was relieved by rest. What is this classified as?
Stable angina
Name 4 immediate effects of the activation of the sympathetic nervous system.
Hypertension, tachycardia, tachypnea, bronchodilation, increased blood glucose levels, vasodilation to skeletal muscle, aldosterone and ADH secreted, decreased GI motility, and decreased urine output.
What pathophysiology is involved with multiple sclerosis?
Demyelination of neurons
Explain two substances that are secreted and work in the renal system to compensate for hypovolemia/hypotension.
Renin secreted by the juxtaglomerular cells- activates the RAAS
ACE secreted by lungs converts angiotensin I to II- vasoconstriction
Aldosterone secreted by adrenal cortex- sodium reabsorption in exchange for potassium or hydrogen
Antidiuretic hormone (ADH) secreted by the posterior pituitary- reabsorption of water in distal convoluted tubules & collecting ducts
What are 2 causes of hypoglycemia?
Injecting too much insulin
Increased exercise
Not eating enough food after taking insulin
Vomiting after taking insulin
What is your priority concern in a patient suffering from a burn?
Fuild resuscitation
A patient who has excess mucus production, difficulty metabolizing the fat-soluble vitamins (A, D, E, and K), frequent respiratory infections, and steatorrhea likely has which condition?
Cystic fibrosis
A patient with a history of IV drug abuse presents with a fever, chills, and a new heart murmur. Which condition should the nurse suspect?
Infective endocarditis
Explain three differences between benign versus malignant neoplasia.
Benign- localized, slow growth, well-differentiated, well-demarcated
Malignant- able to metastasize, erratic growth, poorly differentiated, genetically unstable
What are two different types of cerebral vascular accidents and what test is used to determine which type is occurring?
Hemorrhagic and ischemic
CT scan or MRI
A patient in end stage renal disease will be in metabolic acidosis. Why does this occur?
The kidneys can’t excrete hydrogen ion (an acid).
There is decreased resorption of bicarbonate (base).
A patient has suspected hyperthyroidism. What are the thyroid labs we look at for diagnosis and state whether each will be high or low.
TSH- Decrease
T3- Increase
T4- Increase
During an active inflammatory response, proinflammatory mediators are released.
What labs show active inflammation and what is the purpose of inflammation?
Purpose: Pain, increased capillary permeability, fever, vasodilation, lymphadenopathy bronchospasm (depends on the specific mediator)
Labs: ESR, CRP, leukocytosis, fibrinogen,
(Proinflammatory mediators: TNF-alpha, interleukins, histamine, kinins, prostaglandins, leukotrienes, substance P)
List 4 characteristics a patient with emphysema can present with and the pathophysiology involved.
Decreased oxygen saturation, flattened diaphragm, barrel chest/increased anteroposterior diameter, increased total lung capacity, increased residual volume, pursed lip breathing, clubbed fingers, tripod position, and hyperventilation.
Enzymes destroy the alveolar walls leading to air trapping.
What is the difference between preload and afterload? Give an example of something that causes increased preload and increased afterload.
Preload is the pressure of blood as the ventricles fill; afterload is the force the left ventricle has to overcome to eject blood.
Preload: fluid overload, bradycardia, exercise, SNS stimulation
Afterload: smoking, atherosclerosis, hypertension, aortic stenosis, diabetes mellitus
Name two conditions that cause metabolic acidosis.
Diarrhea- loss of bicarbonate
Diabetic ketoacidosis (DKA)- build up of ketones in the body
Build up of lactic acid
Renal failure- inability to excrete hydrogen ions and inability to make and resorb bicarbonate into the bloodstream
Which neurotransmitter is decreased in Parkinson disease and what are three manifestations?
Dopamine is decreased (so acetylcholine goes unopposed)
Propulsive shuffling gait
Stooped/bent forward posture
Rigid but weak muscles
Mask like face
Dysphagia
Pill rolling fingers/tremors
Difficulty initiating movement
Orthostatic hypotension
Constipation
Urinary dysfunction (urgency, frequency, incontinence)
A patient with hematuria, proteinuria, facial and periorbital edema, and hypertension most likely has which renal disease?
Glomerulonephritis
List three hormones that are imbalanced in Cushing disease; is there too much or too little of the hormones?
Cortisol (sweet)
Aldosterone (salty)
Testosterone (sexy)
Catecholamines (epinephrine & norepinephrine)
All are increased
How do B-cells and T-cells become activated?
What happens to these cells in HIV?
How do you know a patient has progressed to AIDS?
B-cells and T-cells become activated by CD4 cells (helper T-cells). This is the cell that is attacked in HIV.
AIDS diagnosis: Low CD4 count (<200 cells/mm3) & presence of opportunistic infections
Common opportunistic infections: pneumocystis jirovecii, recurring Candida (thrush), tuberculosis, cancer - Kaposi sarcoma.
A patient has chest pain and shortness of breath. The EKG, troponin, and chest x-ray are all negative. The patient's D-dimer is elevated.
What condition should the nurse expect?
Pulmonary embolism
A patient has left-sided heart failure. Recent meals include eating ham, potato chips, corn on the cob with salt and butter, frozen foods, and soup.
What signs and symptoms should the nurse expect to develop in this patient?
Shortness of breath, tachypnea, crackles, and an elevated BNP.
An elderly woman was found lying on the floor in the morning. She says she fell early last night and couldn't get up. She is suspected of having rhabdomyolysis.
Explain the pathophysiology involved and list two manifestations of the condition.
•Caused by a breakdown of skeletal muscle tissue where myoglobin, creatine kinase, & electrolytes leak into plasma and destroy the nephrons
•Myalgia
•Weakness
•Myoglobinuria (tea-colored urine)
•Increased creatine kinase level, hyperkalemia, hyperphosphatemia / hypocalcemia (early), metabolic acidosis
What is the pathophysiology related to Alzheimer’s Disease?
A deficit of acetylcholine and the development of neurofibrillary tangles and amyloid plaques lead to cortical atrophy.
What levels (high or low) should the nurse expect in a patient with acute renal failure for the following?
Creatinine
Glomerular Filtration Rate
Blood pressure
Bicarbonate
Calcium
Phosphorus
Potassium
Creatinine- high
Glomerular filtration rate- low
Blood pressure- high
Bicarbonate- low
Calcium- low
Phosphorus- high
Potassium- high
What is the difference in pathophysiology between diabetes insipidus and syndrome of inappropriate antidiuretic hormone?
What is one way to treat each condition?
Diabetes insipidus – decreased ADH secretion (the client will have increased urine output)
Syndrome of inappropriate antidiuretic hormone- increased ADH (the client will retain fluid in the bloodstream and have decreased urine output)
Diabetes insipidus (DI)- give IV fluid (patient is dehydrated) or antidiuretic hormone (vasopressin)
Remember “DI”, think “Dry Inside”
Syndrome of inappropriate antidiuretic hormone- restrict fluids or give diuretics (patient retains fluid due to excess ADH present)
Remember “SIADH”, think “Soaked Inside”
What are 4 manifestations of sepsis? How do you know if your patient progresses into shock?
Leukocytosis/leukopenia, hyper/hypothermia, tachypnea, tachycardia, know/suspected infection.
Shock: sustained hypoperfusion seen by hypotension and therefore increasing lactic acid, pale, cool/clammy skin