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OSA: Major Risk Factors

Obesity, large neck circumference, male sex, older age, and upper-airway narrowing are major risk factors for obstructive sleep apnea (OSA).

OSA: Patient Characteristics

Classic patient characteristics include loud snoring, witnessed apneic episodes, daytime sleepiness, morning headaches, irritability, and poor concentration.

OSA: Why OSA Is a Problem

OSA causes repeated airway obstruction during sleep, resulting in hypoxemia, hypercapnia, fragmented sleep, daytime fatigue, and increased cardiovascular risk.

OSA: Diagnostic Test

Polysomnography (sleep study) is the definitive diagnostic test for OSA.

OSA: Key Teaching

Teach patients to lose weight if appropriate, avoid alcohol and sedatives before sleep, sleep on the side, elevate the head of the bed, and use CPAP as prescribed.

OSA: Treatment

Treatment includes CPAP, lifestyle changes, positional therapy, weight loss, and sometimes surgery such as UPPP if conservative therapy fails.

Cystic Fibrosis: Why Mucus Is a Problem

In cystic fibrosis, defective chloride transport produces thick, sticky mucus that obstructs airways and ducts, causing infection and poor airway clearance.

Cystic Fibrosis: Nursing Interventions

Key interventions include chest physiotherapy, high-frequency chest wall oscillation vest therapy, huff coughing, hydration, monitoring respiratory status, and administering prescribed antibiotics.

Cystic Fibrosis: Nutrition Teaching

Teach high-calorie, high-protein, high-fat nutrition, pancreatic enzymes before meals and snacks, and fat-soluble vitamin supplementation.

Cystic Fibrosis: Common Respiratory Organism

Pseudomonas aeruginosa is a common chronic lung infection in cystic fibrosis.

Asthma: Typical Presentation

Asthma commonly presents with wheezing, cough, dyspnea, chest tightness, and symptoms that may worsen at night or early morning.

Asthma: Wheezing Severity Pearl

Wheezing does not always reflect severity; a sudden absence of wheezing (silent chest) may mean life-threatening airflow obstruction.

Asthma: Acute Treatment Priority

Acute treatment focuses on bronchodilation, usually with a short-acting beta agonist such as albuterol; a nebulizer is often used during severe acute exacerbations.

Asthma: Steroid Role

Corticosteroids reduce airway inflammation and are controller therapy rather than immediate rescue therapy.

Asthma: Rescue vs Controller

Bronchodilators are rescue medications for acute symptoms; inhaled corticosteroids are controller medications for long-term inflammation control.

Asthma: Ominous Sign

A silent chest is an ominous sign that may indicate impending respiratory failure.

COPD: Typical Patient

A typical COPD patient often has a history of smoking, chronic cough, sputum production, dyspnea, pursed-lip breathing, and barrel chest.

COPD: Appropriate Oxygen Saturation

For many hospitalized COPD patients, an oxygen saturation around 88% to 92% is often targeted to avoid worsening CO2 retention while maintaining oxygenation.

COPD: What to Watch For with Pneumonia

In a COPD patient hospitalized with pneumonia, watch closely for worsening work of breathing, rising CO2, declining mental status, hypoxemia, and ineffective airway clearance.

COPD: Key Nursing Interventions

Use high-Fowler positioning, encourage pursed-lip breathing, monitor oxygenation and respiratory effort, promote airway clearance, and conserve energy.

COPD: Teaching Points

Teach smoking cessation, vaccinations, small frequent meals, energy conservation, pursed-lip breathing, diaphragmatic breathing, and infection prevention.

COPD: Most Important Teaching

Smoking cessation is the single most important teaching point to slow COPD progression.

Interstitial Lung Disease: Common Presentation

Interstitial lung disease often presents with dry cough, progressive shortness of breath, and reduced exercise tolerance.

Sarcoidosis vs Pulmonary Fibrosis: Remission

Sarcoidosis is more likely than idiopathic pulmonary fibrosis to go into remission.

Sarcoidosis vs Pulmonary Fibrosis: Severity

Idiopathic pulmonary fibrosis is generally more severe, progressive, irreversible, and more likely to require lung transplant or palliative care.

Idiopathic Pulmonary Fibrosis: Key Features

Idiopathic pulmonary fibrosis commonly causes dry cough, exertional dyspnea, inspiratory crackles, fatigue, and later clubbing.

ILD: Long-Term Care

Long-term care may include oxygen, pulmonary rehabilitation, energy conservation, symptom management, and palliative discussions for progressive disease.

Tuberculosis: Latent vs Active

Latent TB infection is not infectious; active TB disease is infectious if pulmonary and untreated.

Tuberculosis: Testing

TB can be tested with a tuberculin skin test (PPD), interferon-gamma release assay such as QuantiFERON, sputum AFB smear, sputum culture, and chest x-ray.

Tuberculosis: Gold Standard

Sputum culture is the gold standard for diagnosing active tuberculosis.

Tuberculosis: Precautions

Suspected or confirmed active pulmonary TB requires airborne precautions, a negative-pressure room, and N95 or HEPA masks for staff.

Tuberculosis: Drug Side Effects

TB drugs can cause hepatotoxicity; rifampin can discolor urine, sweat, and tears orange-red.

Tuberculosis: High-Risk Patients

High-risk patients include immunocompromised people, those with HIV, recent close contacts, people living in crowded settings, and those with limited access to healthcare.

Tuberculosis: Medication Teaching

Teach patients to complete the full course of therapy, avoid alcohol, report jaundice or dark urine, and follow directly observed therapy if prescribed.

HIV: Key Lab 1

Viral load measures the amount of circulating HIV and is used to monitor treatment effectiveness.

HIV: Key Lab 2

CD4 count reflects immune function; lower counts mean higher risk for opportunistic infections.

HIV: CD4 Around 500

A CD4 count near 500 suggests immune compromise may be starting, but the risk is not as severe as at lower counts.

HIV: CD4 Below 200

A CD4 count below 200 cells/µL is one criterion for AIDS and indicates high risk for opportunistic infections.

HIV: Biggest Concern

The biggest concern in HIV is opportunistic infection risk due to impaired immune function.

HIV: AIDS Definition

AIDS is diagnosed when CD4 count falls below 200 cells/µL or when certain opportunistic infections or cancers occur.

HIV: ART Goal

The goal of antiretroviral therapy is to reduce viral load to undetectable levels and preserve or improve CD4 count.

HIV: Teaching

Teach lifelong medication adherence, safer sex practices, and the need to report symptoms such as new shortness of breath, vision changes, or altered mental status.

Anemia: Iron Deficiency

Iron-deficiency anemia usually causes low ferritin, low serum iron, high TIBC, fatigue, pallor, and glossitis.

Anemia: B12 Deficiency

Vitamin B12 deficiency may cause macrocytic anemia, paresthesias, gait problems, glossitis, and cognitive changes.

Anemia: Folic Acid Deficiency

Folic acid deficiency causes macrocytic anemia and GI symptoms, but does not usually cause the neurologic deficits seen with B12 deficiency.

Anemia: Aplastic Anemia

Aplastic anemia causes pancytopenia and requires infection and bleeding precautions.

Anemia: Teaching

Teach adequate intake of iron, folate, and B12; iron is better absorbed with vitamin C and may cause black stools and constipation.

Anemia: General Manifestations

Common anemia manifestations include fatigue, dyspnea, palpitations, pallor, and decreased exercise tolerance.

Hemophilia: Classic Finding

The classic finding in hemophilia is delayed bleeding with slow prolonged blood loss, often into joints and muscles.

Hemophilia: Hemarthrosis

Hemarthrosis means bleeding into a joint and is a hallmark complication of hemophilia.

Hemophilia: Nursing Care

Acute bleeding is managed with replacement of the missing factor, direct pressure for external bleeding, and RICE for joint bleeds.

Hemophilia: Teaching

Teach avoidance of contact sports, use of a soft toothbrush, injury prevention, and wearing a medical alert ID.

Thrombocytopenia: Main Concern

Thrombocytopenia increases risk for bleeding, especially when platelet counts are very low.

HIT: What It Is

Heparin-induced thrombocytopenia is an immune reaction to heparin causing platelet drop and dangerous thrombosis.

HIT: Priority Action

If HIT is suspected, stop all heparin immediately and notify the provider.

HIT: Biggest Concern

The biggest concern in HIT is thrombosis, not bleeding.

DIC: Key Principle

If a patient has DIC, the priority is to treat the underlying cause while supporting bleeding and clotting abnormalities.

DIC: Lab Pattern

DIC commonly causes prolonged PT/aPTT, low fibrinogen, low platelets, and elevated D-dimer.

Polycythemia: What It Means

Polycythemia means there are too many red blood cells, causing blood to become thick and increasing clot risk.

Polycythemia: Patient Teaching

Teach hydration, mobility, smoking cessation if relevant, and clot prevention strategies to reduce thrombotic risk.

Scleroderma: CREST

CREST stands for Calcinosis, Raynaud phenomenon, Esophageal dysfunction, Sclerodactyly, and Telangiectasia.

Scleroderma: Key Teaching

Teach protection from cold exposure, skin care, ROM exercises, small frequent meals, and remaining upright after eating to reduce reflux.

Scleroderma: Hallmark Features

Hallmark features include tight shiny skin, Raynaud phenomenon, mask-like facies, and esophageal dysfunction.

Lupus: Hallmark Rash

Systemic lupus erythematosus commonly causes a butterfly rash across the cheeks and nose.

Lupus: Photosensitivity Teaching

Teach patients with lupus to avoid sun exposure and use sunscreen because photosensitivity can trigger flares.

Lupus: Important Labs

ANA is commonly positive in lupus; anti-DNA and anti-Smith are more specific tests.

Lupus: Organ Concern

Monitor for kidney involvement such as proteinuria and decreased urine output, which may signal lupus nephritis.

Sickle Cell Crisis: Common Trigger

A common trigger of sickle cell crisis is deoxygenation, often from infection, dehydration, or other stressors.

Sickle Cell Patho

In low oxygen states, hemoglobin S causes cells to become stiff, sticky, and sickled, leading to hypoxia, ischemia, and pain.

Sickle Cell Reoxygenation Pearl

If sickled cells are reoxygenated early, sickling may be reversible; repeated sickling damages cells and shortens their life span.

Sickle Cell Priority Care

Priority care in vaso-occlusive crisis is oxygenation, hydration, and pain control.

Sickle Cell Acute Chest Syndrome

Acute chest syndrome presents with fever, chest pain, cough, and dyspnea and is a major emergency.

Sickle Cell Prevention Drug

Hydroxyurea helps reduce sickling episodes and vaso-occlusive crises.

Cancer: Primary Prevention

Primary prevention reduces cancer risk before disease develops, such as smoking cessation, sunscreen use, exercise, and vaccines.

Cancer: Secondary Prevention

Secondary prevention aims to detect cancer early through screening and early diagnosis.

Cancer: CAUTION Signs

CAUTION stands for Change in bowel/bladder habits, A sore that does not heal, Unusual bleeding, Thickening or lump, Indigestion, Obvious change in mole, and Nagging cough.

Cancer: Stage 1 vs Stage 4

Stage 1 generally indicates localized early disease; stage 4 indicates distant metastasis.

Hodgkin vs Non-Hodgkin

Hodgkin lymphoma usually spreads in an orderly contiguous pattern; non-Hodgkin lymphoma often spreads in a more non-specific widespread pattern.

Lymphoma: B Symptoms

B symptoms are fever, drenching night sweats, and unexplained weight loss.

Multiple Myeloma: Hallmarks

Multiple myeloma is associated with malignant plasma cells, M proteins, bone pain, fractures, hypercalcemia, renal dysfunction, and anemia.

Multiple Myeloma: Priority

In multiple myeloma, prioritize safety because pathologic fractures are a major risk.

Oncologic Emergencies

Important oncologic emergencies include tumor lysis syndrome, neutropenic fever, spinal cord compression, superior vena cava syndrome, hypercalcemia, and DIC.

Primary vs Secondary Immunodeficiency

Primary immunodeficiencies are usually inherited or congenital; secondary immunodeficiencies are acquired from conditions such as HIV, malnutrition, chemotherapy, corticosteroids, or chronic disease.

Immunodeficiency: Infection Concern

Patients with immunodeficiency may have subtle infection signs, and fever can be the only early clue.

Immunodeficiency: Teaching

Teach infection prevention, food safety, avoiding sick contacts, and prompt reporting of fever.

Open-Angle vs Angle-Closure Glaucoma

Open-angle glaucoma develops slowly and painlessly; angle-closure glaucoma is an acute emergency with sudden pain, nausea, and halos around lights.

Glaucoma: Medication Teaching

Glaucoma medications must be taken lifelong to prevent optic nerve damage.

Wet vs Dry Macular Degeneration

Dry AMD is more common and progresses slowly with drusen; wet AMD is less common but more severe and rapid due to abnormal leaking vessels.

Cataracts: Risk Factors

Cataract risk factors include aging, diabetes, smoking, corticosteroid use, alcohol use, UV exposure, trauma, and infection.

AMD: Hallmark Symptom

Age-related macular degeneration often causes central vision loss and metamorphopsia, where straight lines appear wavy.

Acute Angle-Closure Glaucoma: Symptoms

Sudden severe eye pain, blurred vision, halos, nausea, and vomiting suggest acute angle-closure glaucoma.

Meniere Disease: Symptoms

Meniere disease typically causes episodic vertigo, tinnitus, fluctuating hearing loss, and a sense of ear fullness.

Hearing Aid: First-Time Use

New hearing aid users should start wearing them for short periods in quiet settings and gradually increase wear time.

Hearing Aid: Other Considerations

Teach proper cleaning, battery care, reducing background noise, facing the speaker, and realistic expectations during adjustment.

Cochlear Implant

A cochlear implant bypasses damaged inner ear structures and directly stimulates the auditory nerve.

End of Life: Durable Power of Attorney

A durable power of attorney for healthcare names the person who will make decisions if the patient loses decision-making capacity.

End of Life: Expected Breathing Changes

Expected breathing changes near death can include irregular respirations, periods of apnea, and Cheyne-Stokes breathing.

End of Life: Sensory Changes

Hearing is often thought to be one of the last senses to diminish at end of life.

End of Life: Physical Changes

Common physical changes near death include decreased intake, decreased urine output, cool extremities, altered breathing, and decreased responsiveness.

Hospice vs Palliative Care

Palliative care focuses on comfort and quality of life at any stage of serious illness; hospice is for expected life expectancy of about 6 months or less without curative treatment.