CH1 Final Exam

Asthma

S/s: resp alkalosis!

ABGs: alkalosis early in attack (dec CO2), acidosis (inc CO2) in status asthmaticus

Meds:

• Albuterol = SABA, Rescue!

• Salmeterol = LABA, long-term management

• Anticholinergic: -tropium, relieves and prevents asthma

• Steroids: rinse mouth to avoid thrush

• montelukast: 30min before exercise

Interventions: admin bronchodilator first before steroids

Status Asthmatics: emergency acidosis! Tripod position!

HOW TO USE: remove cap, connect pieces, shake, exhale, place at mouth, push, remove, hold breath, breath out, wait 1 min between puffs

keep record of triggers and allergies and how many times they use!

nasal wash to prevent rebound effect!

COPD

Patho: emphysema and bronchitis (#1 cause is smoking)

S/s: freq resp infection, pursed lip breathing, prolonged expiratory time —> resp acidosis, clubbed fingers, cyanotic

Diagnosis: flattened diaphragm

Labs: inc RBCs due to compensatory mechanism of hypoxia

Meds: same as asthma + mucolytics

NI:

• respiratory acidosis!

• smoking cessation

• diaphragmatic/abdominal breathing (supine)

• pursed lip breathing

• assess of activity intolerance

• inc calories and protein diet, no carbonated drinks or fluids w/ meals

• 02 = 88%-92%

• vibratory and expiratory pressure

• effective coughing

Smoking Cessation

Nicotine Replacement

• gum: pocket in cheek for buccal absorption

• nicotine patches, lozenges (pouches), inhaler, nasal spray

Other Meds

• Varenicline: (partial nicotine agonist) causes vivid dreams and hallucinations

• Bupropion: (anti-depressant) not for ppl w/ seizures

ALL tobacco is bad, NO vapes, NO hookahs

Eat healthy snacks to fulfill urge, hydrate, find support system, and hobbies

Pack Year = average # of packs smoked per/day X # of years smoked

Diabetes

S/s: 3Ps and weight loss

T1DM: leads to increased ketones in the body (DKA) —> Metabolic Acidosis —> Kussmaul’s Resp (Tx: Fluids, Insulin, Electrolyte Replacement like K+)

*monitor for proteinuria = dec kidney function

LABS:

• Fasting = greater than 126 on 2 occasions means DM

• A1C = normal 4-6%, prediabetes 5.7-6.4%, DM greater than 6.5%, uncontrolled 8%

Meds:

• insulin (look at pharm)

• metformin (Biguanides): take with meals, hold 48 hours before/after contrast due to lactic acidosis (oral)

Interventions:

• Foot care: moisturize (not between toes), wear clean socks, cut nails straight across, no heat, don’t cross legs

• Sick days: monitor BG q4h, drink 8-12oz

• Call! if- n/v, large ketones, inc BG after 2 doses of insulin, 101.5 fever for longer than 24 hours

• 15/15 Hypoglycemic rule: 15g of sugar then check in 15 min

Risk of:

• hypertension

• retinopathy

• neuropathy

• alcohol —> hypoglycemic (drink w/ meals)

Effects: Dawn (undertreatment) + Somogyi (overtreatment)

Migraines

Patho: vasodilation in brain = pain

STAGES: prodromal, aura, headache (4-72 hours), postdrome

S/s: with aura (vision), older adults will have aura with no pain, unilateral pulsating pain w/ activity, photo/phonophobia, n/v, fatigue

Meds: Abortive vs. preventive (Botox, beta-blockers) meds

• Sumatriptan: constriction (abortive tx)

• Beta Blockers: prevent migraines, must take every day (preventative tx)

Interventions: pain management, avoid triggers, avoid tyramine

MS

Patho: autoimmune, inflammatory, not fatal (r/e)

immune system attacks the myelin sheath, causing transmission issues

S/s: cognitive decline (more common in women), tinnitus, diplopia, nystagmus, flaccid/spastic bladder, hypoalgesia (reduced sensitivity to pain), tremors, ataxia, vertigo, dysphagia

Dx:

• CSF Tap- elevated protein, WBC, IgG

• MRI- visualize plaques on the brain

• Physical Exam- assess patient’s level of sensation to stimulation

Meds:

• interferon injections: reduce inflammation and immune attacks

• muscle relaxant: Baclofen (GABA Agonist tx muscle spasticity)

• weed

• steroids (prednisone): decreases swelling

• dalfampridine (improve gait)

• dexamethasone (used for relapse)

Interventions:

• avoid Stress, Sickness, Smoking, and Sun (overheating causes exb.)

• promote independence and ADLs

• Gait training

ALS

Patho: fatal (most die in 3-5 years), not autoimmune

S/s: physical decline, fully intact cognition

(due to degeneration of CNS and brain)

• muscle atrophy

• hyperactive reflexes

• fasciculations (twitching in face)

• dysarthria (slurred speech)

• dysphagia

• paralysis of respiratory muscles (leads to death)

Meds:

• riluzole: dec glutamate to slow cell death

• edaravone: dec free radicals and oxidative stress to preserve brain cells

NI:

• EOL planning, assess anxiety levels, palliative & hospice

• Airway management- resp. failure is #1 priority!

• monitor breathing and temperature closely

OSA (obstructive sleep apnea)

Patho: not breathing for greater than 10 seconds 5x/hr

Risks:

• obesity (HTN, MD, CVD)

• large uvula/tonsil/adenoids

• short neck

• male

S/s: respiratory acidosis, snoring, morning headache, daytime sleepiness, nocturia, low libido

Diagnosis: Polysomnography (sleep study)

Meds:

• Modafinil: promotes wakefulness

  • Dafodil = wake up and smell the roses

Interventions:

• change sleep positions

• weight loss

• dec alcohol consumption and no sedatives !!! (caution with opioids)

• BIPAP: more pressure when breath in, less when breath out

• APAP: automatic

• CPAP: continuous

• increased risk of hypertension

Parkinson’s (PD)

Patho: low dopamine (controls movement), high acetylcholine

S/s:

• pill-rolling tremors (1st sign)

• muscle rigidity

• bradykinesia

• postural instability

• dysphagia (aspiration risk)

Diagnosis: brain autopsy

Meds:

• Carbidopa/ Levodopa: C slows breakdown of L (L = converts into dopamine in the brain) *eat carbs w carbidopa

• Ropinirole: SE = orthostatic hypotension

• Benzotropine (anticholinergic to dec aCh) : Tx tremors; SE = dry! OH

• Selegiline: no tyramine foods

Intervention:

• aspiration pneumonia

• freeze gait = 1 step back, 2 forward

• give extra time and promote independence

• high cal, high protein diet

Huntington’s (HD)

Patho: imbalance of dopamine (motor), GABA (calming), glutamate (nerve firing, memory, learning, mood)

Alters mood, personality, and behavior!

dominant inheritance!

S/s: progressive dementia, choreiform movement (walk, speak, reason), immobility kills

Diagnosis: HD gene test

Meds:

• Tetrabenazine: dec choreiform movements; SE = depression

• Antipsychotics: 2nd gen to manage psych s/s like aggression

Intervention:

• Aspiration pneumonia from dysphasia!!

• Prioritize safety (well lit, mattress on floor, lock doors) and encourage independence

• genetic risk —> encourage testing/ counseling

• expressive dysphagia (pt might use white board to talk back, NEVER nurse)

Seizures

abnormal, sudden, excessive, uncontrolled electrical disturbances

Epilepsy = chronic repeated seizures

Interventions;

• safety: turn to side, remove objects, restrictive clothing, no restrains

• airway: suction

• time: greater than 5 min = status epilepticus (MED EMERGENCY)

• meds: -pam 1st (2mg), then -toin

• check BG afterwards, caused by hyperglycemia?

Meds:

• all cause drowsy, ataxia, and depress CNS

• Levetiracetam: monitor CBCs (infection)

• Phenytoin: IV vesicant thru central line

• Divalproex: hepatotoxic, monitor LFTs

Types of seizures

• absence = starring into space

• tonic = stiff

• clonic = repeated jerking

• myoclonic = jerking/twitches

• atonic = dec muscle tone

• tonic-clonic = stiff, jerky, loss of conciousness

Lupus (SLE)

Patho: chronic autoimmune, inflammatory disease

Common COD- CVD and CKD (organ damage/failure)

S/s: butterfly rash!!, joint/muscle pain, swelling, depression, alopecia, pleuritic pain, pericarditis, Raynaud’s

Meds:

• NSAIDs: anti-inflammatory

• Corticosteroids (prednisone): monitor HTN, fluid retention, worsening RF, and hyperglycemia

• Immunomodulators (DMARDs)

• antimalarial: protects synovial lining, dec fever, and fatigue (SE= photophobia)

Interventions:

• monitor kidneys and heart! (limit sodium)

• protect skin from UV, mild protein shampoo

• watch for systemic effects like HTN, edema, UO, BP, fluid retention, circulatory issues (pallor), and cognitive effects

• Risk for infection

• Frequent eye exams

TB

S/s: persistent cough, hemoptysis, night sweats, weight loss, chills/fever

Diagnosis:

• NAA: most accurate TB test, results in 2 hrs

• Sputum culture: confirms diagnosis after 3 cultures

• PDD: measure induration- not redness around

  • doesn’t show exposure vs latent

Meds:

• rifampin: red railed (red urine, contraception doesn’t work)

• Isoniazid: empty stomach, liver toxic

• pyrazinamide: worsens gout, photosensitivity, COMBO med

• ethambutol: damaging to eyes (optic neuritis)

Interventions:

• airborne precautions = priority

  • N-95 mask and negative pressure room

  • Sputum samples every 2-4 weeks

  • 3 negatives on 3 different days = no longer infectious!

• Test family for TB

• follow meds as prescribed!

• promote airway clearance, effective coughing

Allergies

Patho: IgE-mediated allergy cascade triggered by allergens

Allergens: Inhaled, Ingested, Injected, Contraction

S/s: sneezing, runny nose, and red, watery, itchy eyes (can be seasonal)

Allergic-induced asthma = bronchospasm and constriction

Meds:

• Steroids: dec edema in airway and dec secretions

• Antihistamines and Decongestants (monitor rebound)

• Bronchodilators (used before steroids to OPEN)

• Anti-inflammatories

NI:

• urticaria = hives

• Identify and avoid triggers

• No nasal washing = rebound effect

• Complications = Angioedema & Anaphylaxis

HTN

Patho: avg BP is higher than normal; strength of blood pushing on walls

Dx: cannot be diagnosed in a single visit, must be 2+ visits

MAP = Mean Arterial Pressure, indicates organ perfusion

• if, MAP = (2 x DBP + SBP)/ 3 < 60mmHg, then ischemia

PP = Pulse Pressure, indicates health and tone of arterial walls

• PP = SBP - DBP; narrow <40, wide >60

CO = HR x Stroke Volume

Meds:

• ACE (-pril) & ARB(-sartan): monitor for angioedema and hold SBP <100

• CCB (-dipine, -mil, -zem): no grapefruit juice! can worsen HF

• BB (-olol): hold HR <60 and SBP <100

• Diuretics: Loop + Thiazide (monitor hypokalemia and hypomagnesemia), K sparing to dec fluid

• garlic + coenzyme Q10: AE = bleeding and hepatotoxicity

Labs:

• cholesterol and microalbuminuria (monitor proteinuria → HTN damages kidneys)

NI:

• assess BP in BOTH arms and palpate ALL pulses

• commitment to a long-term lifestyle change is most important

  • DASH diet

  • BP tracker

  • monitor caffeine and stress

  • quit smoking + alcohol

  • weight reduction and exercise!

Heart murmurs

Aortic Stenosis: 2nd right ICS, harsh, systolic

Aortic Regurg: 3rd left ICS, high-pitched, blowing, diastolic

Mitral Stenosis: 5th left ICS midclavicular, rumbling, diastolic (DYSPNEA UPON EXERTION due to inc pressure in lungs)

Mitral Regurg: 5th left ICS midclavicular, high-pitched, systolic

Mitral Valve Prolapse: 5th left ICS midclavicular, late systolic murmur

Cardioversion vs Defibrillation

Cardioversion: for pts with fast rhythms like A-fib (shocks R wave)

• Elective procedure- informed consent!

• Pt awake with dec LOC (sedative meds)

• EKG monitor

Defibrillation: for pts who are unconscious with V-fib/tach

• emergency

• no cardiac output

• EKG monitor

failure to pace

no spikes (no electrical signaling from pacemaker)

failure to sense

inappropriate spikes (pacemaker fires wrong)

can’t sense pts intrinsic HR

failure to capture

appropriate spikes w/o cardiac response (no P or QRS wave following spikes)

→ looks likes a flat line with pacemaker spikes

Cardiomyopathies

DILATED: muscle tissue stretched

• fatigue, weakness, HF, dysrhythmias, S3/S4 sounds, cardiomegaly

• Blood sits stagnant → Rx of clots and PE!

• Tx: vasodilators, transplant

HYPERTROPHIC: stiff heart chambers that can’t contract effectively (systole)

• dyspnea, angina, fatigue, syncope, palp, cardiomegaly, S4, HF, death

• Tx: BB to lower workload, MV replacement (DO NOT GIVE Digoxin and Nitroglycerin)

RESTRICTIVE: rigid, fibrosed walls that cannot expand to fill (diastole)

• dypnea, fatigue, RS HF from backed up blood, heart block, emboli, S3/S4, cardiomegaly

• Tx: treat HF and HTN, place pt on exercise restrictions

HF

LEFT-SIDED HF: blood backs into lungs

• cough, crackles, wheezing, blood-tinged sputum, tachypnea, restlessness, confusion, fatigue, cyanosis

RIGHT-SIDED HF: blood backs into rest of body due to pulmonary HTN

• fatigue, ascites, enlarged liver and spleen, distended JV, anorexia, edema (may be secondary to pulmonary problems or LSHF)

CARDIAC OUTPUT = HR X STROKE VOLUME/ 1000

Angina

→ chest pain due to ischemia

• Unstable: occurs at any time, even during rest. due to vasospasm and prolonged atherosclerosis (Tx: nitro)

• Stable: exertional angina due to myocardial ischemia. episodes of pain worse with exercise (Tx: relieved by rest and nitro)

Nitroglycerin: patch, sublingual during exb- 3 tabs, 5 min apart (call ER if not relieved after 1st tab)

CAD

→ usually occurs due to atherosclerosis (plaque build-up and calcification that dec perfusion to heart muscles/tissue)

Rx: #1 MODIFIABLE RX FACTOR IS SMOKING!

Labs + Dx:

• Troponins (indicate heart tissue death) and highly sensitive C-reactive protein (inflammation marker)

• CT or PET- gold standard to assess myocardial perfusion + LV function

• Right Heart Cath: fem vein → IVC→ R atrium→ R ventricle →pulmonary artery (assess lung pressure)

• Left Heart Cath: fem/brachial/radial*→ aorta→ aortic valve→ L ventricle (assess stroke volume, EF)

• Coronary arteriography: same as LHC → aortic arch→ coronary artery

Tx:

• Balloon Angioplasty

• Intracoronary Stent Placement

• BB: monitor for bradycardia, never stop abruptly due to rebound

• CCB: OH precautions

NI:

• For Cath: edu abt conscious sedation, warmth when dye injected, sheath removal can cause bleeding- bedrest + keep extremity straight

• check for metformin use and iodine/shellfish allergy before procedures

• asses baseline neuro/resp/cv/vitals

• contrast is hard on kidneys, so inc fluids for BUN/Cr UO

• assess for hematoma, bleeding, and bruising @ insertion site

PAD

→ atherosclerosis of arteries (Buerger’s disease in smokers)

S/s: numb, necrotic, burning, pain, cyanotic, hair thinning, intermittent claudication, weak pulse, cool skin

assess 6 Ps: pain, pulse, paralysis, pallor, paresthesia, pressure

Labs:

• Doppler-derived max systolic acceleration (ID PAD in pts w DM)

• Ankle-Brachial Index (norm: 0.9-1.3)

Tx:

• Antiplatelets: inc risk of bleeding w/ PAD

• Statins/ACE/ARB: dec cholesterol and BP

• low-fat diet and exercise

• smoking cessation

NI:

• Compartment Syndrome = medical emergency!

• avoid cold temps, caffeine, stress, and crossing legs

• DANGLE legs

PVD

→ narrowing of veins leading to pooling of blood in extremities

S/s: warm, brown extremities, itching skin, standing/sitting pain, edema, dull ache

Assess for VTE, Venous Insufficiency, Varicose veins!

Tx:

• Anticoagulants: to prevent VTE and clots

• Statins: dec cholesterol

• Thrombolytics: dissolve clots

• DVT filter: catches clots and breaks them down (#1 Tx)

• Compression stockings

NI:

• do NOT massage leg- can lossen thrombus and cause PE or Stroke!

• apply warm, moist compresses

• ELEVATE legs for 20 min, 4-5x per/day above the heart

Iron Deficient Anemia

• Nutritional- poor intake/absorption of iron through diet or loss through bleeding

• S/s: Asymptomatic in early stages, then General sx, pallor, glossitis, cheilitis (inflammation of lips)

• Labs: microcytic (small RBCs), hypochromic anemia, (dec MCV, MCH, MCHC), low iron, Hgb, Hct, folate

• Tx: supplemental iron and folic acid

  • Vit C can inc absorption

  • take in between meals

  • edu green/black stools and stained teeth

  • SE= GI, n/c, TOX: Fever, Urticaria (hives)

Pernicious Anemia

• Inability to absorb Vit B12 due to intrinsic or autoimmune problems

• S/s: General sx, parethesia, weakness, loss of sense, balance issues, ataxia, smooth beefy red tongue!

• Not associated with nutrition- FH, GI conditions, LT use of PPI and H2 blockers

• Labs: macrocytic (large RBCs), (inc MCV), abn RBCs outnumber norm, inc folate and cobalamin

• Tx: injections of Vit B12 or intranasal cyanocobalamin for LIFE

  • maintain good nutrition w/ Vit C and folic acid

  • monitor for gastric cancer

  • monthly injection regime for the rest of life

Aplastic Anemia

• Pancytopenia- low bone marrow blood cell production (RBC, WBC, platelets)

• S/s: General sx, fever, infections, neutropenia, bleeding problems from thrombocytopenia

• Caused by chemo, radiation, sulfonamides, anticonvulsants, insecticides, arsenic, OR 70% idiopathic

• Labs: Normocytic (norm MCV, MCH, MCHC), severe dec in all marrow

• Tx: erythropoietin: epoetin alfa or stem cell transplant

  • monitor for inc in BP

  • monitor Hbg + Hct twice per week

  • monitor for stroke if Hgb increases too rapidly (>1g/dL in 2wk)

Folic Acid Deficient Anemia

• Nutritional! dec intake of folic acid

• S/s: slow, insidious onset, weight loss, malnourished

• Poor nutrition, alcoholism, anorexia, malabsorption, pregnancy, infancy, hemodialysis, anticonvulsants, methotrexate, and contraceptives

• Labs: Macrocytic (large RBCs), (Inc MCV), serum folate < 3ng/mL

• Tx: folic acid oral replacement and nutritional intake of folate

  • large doses can mask B12 deficiency!

  • edu pt about urine turning dark yellow

CKD/ESRD

→ progressive, irreversible kidney damage from HTN, CVD, DM, nephrotox drugs

GFR staging to diagnose:

1. >90mL/min (normal)

2. 60- 89mL/min (mild loss of function)

3. 30- 59mL/min (moderate kidney damage)

4. 15- 29mL/min (severe kidney damage)

5. <15mL/min (ESRD)

-Labs: GFR, BUN/Cr (elevated), electrolytes (imbalanced), ABGs (monitor for metabolic acidosis and Kussmaul), H&H, urinalysis (proteinuria), blood osmolarity (high), X-ray to assess bone fractures (Mineral Bone Disease)

-S/s: fluid retention! high BP, edema, crackles, SOB, high ammonia, anemia, muscle cramps (r/t K+), bone fractures, itchy/flaky skin

(If LOW Ca= Trousseau, Chvostek, bone fractures)

-meds:

• Loop and Thiazide diuretics (monitor potassium, not used in ESKD)

• Vitamins and minerals: phosphate binders, folic acid, iron salts, Vit D

• erythropoietin (prescribe when hgb <10g/dL, Hold if above)

• Parathyroid hormone mediator (to slow bone demineralization)

• Anti-hypertensives (ACE/ARB/CCB): inc blood flow and GFR

• Anti-lipidemics (statins): inc perfusion and GFR

• Insulin: lower levels for DM patients (monitor for HYPO)

• AVOID: antacids, magnesium, aluminum, decongestants, phenylephrine, antihistamines

NI:

• daily weights! 1kg of weight gain = 1L of fluid

• monitor for fluid overload (crackles, weight gain, I&O imbalance)

• Nutrition! restrict protein, sodium, phosphorus, and potassium

• adhere to the dialysis schedule and don’t miss a session

CKD/ESRD Exp Findings Terms

• Uremia = urea waste products build up in the blood due to poor kidney function and filtration

• Azotemia = nitro waste buildup in the blood, INC BUN

• Anuria = no urine output

• Uremic Fetor = urine breath

• Stomatitis = inflammation of the mouth

• Halitosis = foul breath

• Metallic Taste = due to inc ammonia

• Polyuria = increased UO (usually early stages)

• Pruritis = itching from uremic frost in sweat

Dialysis

→ Process of removing excess fluid and waste from blood- restores fluid, electrolyte, and AB balance. Tx for CKD

→ Peritoneal Dialysis

• Dialysate is put into the abdomen, triggering waste products to shift out of the bloodstream and into the solution. Then the dialysate is removed.

• Dialysate: hypertonic, glucose solution that pulls fluid

• Sterile procedure! Prevent Peritonitis!

  • S/s: cloudy effluent, fever, abd pain, n/v, rigid/board-like abd, dec BS, dehydration, inc HR/BP

• Flexible schedule, 24-hr Tx (Ambulatory, Cycling [sleep], Intermittent)

• Steps: Inflow (Fill), Dwell (30min- 8hrs), Drain (massage to facilitate)

→ Hemodialysis

• Temporary, life-saving Tx, more efficient than PD (shorter time)

• AV Fistula = do NOT touch/use access for anything other than HD

  • Palpate for bruits/thrills = normal

  • Aseptic technique, non-sterile

• Check effectiveness: weight loss (weigh before and after HD), dec Cr and Potassium, BP control

• Complications: #1 Hemodynamic instability, loss of blood, hepatitis, disequilibrium syndrome (neurological sx), infection, inc risk of bleeding (give heparin and have protamine sulfate on hand for hemorrhage)

• CI: hemodynamic instability, severe vascular disease, bleeding, uncontrolled diabetes

Kidney Transplant

→ Criteria to Receive:

• No other medical issues

• 2-70 years old (70+ is considered on an individual basis)

• HLA = 6, PRA = low %, crossmatch = negative

• pts w/ HIV or HEP B/C are still eligible! (Not AIDS tho)

→ Contraindications for Recipients:

• Advanced cardiac disease

• Metastatic cancer (if cancer, must have remission for 2-5 years)

• Chronic infections

• Alcoholism or drug abuse- poor adherence

• Long-term pulmonary disease

• GI disease like diverticulosis (Tx disease first)

• Uncontrolled DM

→ Pre-op Considerations

• 4–5 day inpatient stay after the procedure

• crossmatch is redone right before surgery to confirm

• assess the urinary system and plan to correct deformities

• Dialysis 24 hours before surgery + Infuse donor blood

• Diet: simple carbs and low protein

• Risk for infection + strict I&Os

→ Post-op Considerations

• Foley- best way to measure UO and relieve urine retention

• Sudden loss of urine = sign of rejection!

• Urine may be pink/bloody + run urinalysis daily

• Monitor electrolyte balance esp. Na and K+

• daily weights! should be no gain

→ Complications

• Rejection: usually 1 temporary acute rejection at the start, inc immunosuppressant

  1. Hyperacute: within 48 hours; remove kidney

     (s/s: INC temp, BP, pain)

  2. Acute: 1 week to weeks; inc immunosuppressant

     (s/s: oliguria, anuria, fever, HTN, tenderness, lethargy, elevated BUN/Cr)

  3. Chronic: gradually over months to years; manage s/s until dialysis is needed

     (s/s: INC BUN/Cr, fluid retention, fatigue, electro imbalance)

• Meds: Immunosuppressant for life + Corticosteroids (Methyl prednisone) to stop inflammation

• Thrombosis and Stenosis: lowers blood flow to kidney (s/s: bruit)

• Infection Rx: strict handwashing and teaching abt flu shot

• Wound Infections: strict aseptic technique and handwashing

UTI/Cystitis & Pyelonephritis

• Uncomplicated: E. Coli infection in healthy, non-pregnant, non-menopausal women

• Intersistal: chronic inflammation due to other disorders

S/s: inc urgency + freq, change in coca, abn/flank pain, bladder distention, nocturia, dysuria, fever, tachypnea, hypotension, OA = Confusion!

Labs:

• Clean Catch Urine

• Urinalysis: leukocyte esterase and nitrates (MUST for Dx!)

• C&S to prescribe antibiotic

Meds:

• Antibx: usually 3-day course of TMP-SMX (Bactrim), Nitrofurantoin, or Fosfomycin

• Analgesics or Antipyretics for comfort (turn urine orange)

• Antispasmodics dec bladder spasm and promote full emptying

• Antifungal (Ampho B) for fungal UTI

NI:

• inc fluids (2-3 L/day) + cranberry juice + AVOID: alc, coffee, OJ

• teach antibiotic adherence

• Teach prevention: safe sex, clean before and after, and correct wiping

• avoid douching and bubble baths

• Pregnant women w/ cystitis require immediate antibiotic therapy to prevent preterm labor

BPH

→ Non-metastasis enlargement of the Prostate

S/s: hesitancy, frequency, nocturia, weak stream, dribbling, retention, distension,

I-PSS high score = BPH

Rx:

• Older adult

• smoking and alcohol abuse

• FH

• DM and CVD

• Obesity, sedentary lifestyle, and western diet

• Testosterone and Androgen supplements

meds + Tx:

• #1 Tamsulosin (SE = OH, syncope, tachycardia)

• 5-alpha reductase inhibitor- Finasteride (SE = ED, low libido, OH)

• TURP (surgical resection): irrigate to prevent blood clots + monitor UO

NI:

• Can cause UTI (retention) and kidney damage from backflow (Hydronephrosis)

• Teach bladder distention prevention

  • dec fluids, no alc, void freq, no antihistamines

Cancer

Benign (encapsulated, localized, dec blood supply) vs. Malignant (non-encapsulated, invasive, metastasis, spreads via fluid pathways)

• AVOID: low fiber, high fat, preserved, cured/smoked meats, nitrates (junk and fast food)

• De-stress and prioritize sleep

• Avoid smoking, tobacco, drinking, tanning beds, and excessive sun exposure

• >30 min of moderate exercise 5x per/wk

Tx:

• Prophylaxis: pt is at risk of tumor development or recurrence

• Curative: expect pt to achieve remission and return to normal life

• Control: uncurable, sx managed for a long time

• Palliative: terminal, encourages comfort and high quality of life only

Chemotherapy Considerations:

• n/v/d, anorexia, alopecia

• hyperuricemia, kidney/liver damage (monitor labs)

• bone marrow suppression (avoid crowds) and mouth sores (stomatitis)

• high Rx of anemia and infection!

• Area around vascular chem site may become red/inflamed = normal

• chem is potent and toxic, wear full PPE and dispose in waste bin!

Radiation Considerations:

• skin touched by radiation therapy will be photosensitive (rx of sunburn)

• no direct sun exposure during Tx for 1 yr

• no soap over radiation site, avoid lotion, powers (sensitive skin!)

• Never face away from pt during rad Tx- lead needs to be between you and pt (properly fitted and coverage of neck)

HIV/AIDS

→ HIV virus enters into bloodstream and hijacks CD4 T-cells

1. Acute (2-4wks): flu-like sx, dec CD4 and inc CD8

2. Chronic Asymp. (>10yrs): >500 cells/mm³, produces cells as HIV kills

3. Chronic Symptomatic (>10yrs): 200-500 CD4 cells/mm³, exb of s/s

4. Late Chronic (end stage): AIDS Dx, <200 cells/mm³ and opportunistic infection

Opportunistic Infections:

• Kaposi’s Sarcoma: cancerous sores/ulcers on entire body

• Wasting Syndrome: malabsorption, extreme weight loss, GI inflam.

• Candida: oral thrush or vaginal yeast infection

• hairy oral leukoplakia: white crust on sides of tongue

• cytomegalovirus

• pneumocystis jirovecii pneumonia

• TB

Rx: (NOT passed through saliva) needlesticks, blood transfusions, sex, perinatal

Dx:

• Antibody-Antigen Test (antibodies detected 21 days post-infection)

  • Positive test does NOT confirm infection

• 4th Gen HIV Assay → HIV Nucleic acid test = HIV Dx

meds: no cure

• Combo antiretroviral therapy (cART)- promote adherance

• GOALS: inc CD4, WBC, and lymphocytes. Dec viral load

• Multi-drug therapy: more effective bc targets in multiple ways and prevents HIV resistance to a single med

• PEP, PREP (Truvada)

NI:

• Exposure: 1. bleed wound 2. wash for 1 min 3. contact employee health for testing and tx

• only standard precautions necessary (glove and hand hygiene)

• monitor every 2-6 months for changes in immunity

• FL Law; 1988 AIDS Act- maintains confidential testing (<18yrs too)

Osteoporosis

→ chronic, progressive metabolic disorder of low bone mass “silent disease”

• Osteomalacia = bone softening due to dec Vit D (stim calcium absorp)

• Osteopenia = precursor to osteoporosis

S/s: reduced height, back pain (worse w/ activity and relieved at rest), restricted movement, kyphosis, fractures

Rx: Asian/Euro, Female, Thin

Dx: DEXA scan: -1 to -2.5 = osteopenia, < -2.5 = osteoporosis

Meds that can cause OP:

• corticosteroids, PPIs, Thiazide Diuretics, heparin, anti-rejection drugs, alcohol usage

Meds to Tx OP:

• Thyroid Hormone (calcitonin): inhibits osteoclast activity

• Os-CAL: inc calcium (inc fluids and monitor for HYPER)

• Bisphosphonates (-dronate): Alendronate (empty stomach and assess for aspirin sensitivity)

NI:

• limit intake of caffeine, alcohol, and carbonated drinks

• Vit D exposure is good for bones (but wear sunscreen)

• Weight-bearing exercise to strengthen bones

• Reduce fall risk at home

• Take calcium and Vit D supplements

• Vit D foods: fish, egg yolk, milk, green veggies, sardines, beans, figs

Osteoarthritis

→ most common degenerative joint disease; progressive deterioration and loss of cartilage in one or more joints (LOSS OF MOBILITY)

Rx: women (2:1), bleeding, joint injuries, weight

S/s: unilateral pain and stiffness, crepitus, bone hypertrophy- usually weight-bearing joints like hands, hips, knees

• Bouchard nodes (proximal) come before Heberden nodes (distal)

• limping gait, joint swelling (inflammation of synovitis)

• vertebral pain that radiates

• changes to esteem, depression, anger, stress

meds:

• acetaminophen, NSAIDS, celecoxib, ibuprofen (for pain)

• muscle relaxants

• opioids

• glucosamine

• topicals

NI:

• Pain management! hot/cold compress and lots of rest

• Avoid excessive flexion to prevent more injury

• CAMS: acupuncture, tai chi, music therapy

• better shoes, weight control

• CBT for mental health

Rheumatoid Arthritis

→ chronic, progressive inflammatory autoimmune disease (affects whole body)

• Synovial Joint damage from inflammation: destroys cartilage and bone

• Can affect organs: heart, lungs, skin, eyes

Rx: onset @ 35yrs, female

S/s: bilateral, symmetric, multiple joints, prolonged morning stiffness, pleuritic pain, myocarditis, anorexia, weight loss, fatigue, paresthesia, pain (Late: anemia, osteoporosis, pericarditis)

Meds:

• Infliximab (DMARDS): slows progression via immunosuppressant

• Glucocorticoids

NI:

• focus on mobility management

• GOAL: slow progression and encourage fine muscle dexterity

• COMPLICATIONS: Sjogren Syndrome (DRY), Osteoporosis, Vasculitis, Felty syndrome (Splenomegaly, Neutropenia, Leukopenia, Thrombopenia)