Exam 1-Adult Health

Aortic Stenosis Manifestations

Valve becomes 1/3 its normal size

Angina

Syncope

Exertional dyspnea

Left ventricular failure

May be asymptomatic

Risk factors for Endocarditis

Intravascular devices

Oral procedures

Respiratory procedures

Procedures involving infected skin

Nursing Management for Endocarditis

Health history/home meds

VS with heart sounds (looking or murmur/sounds)

Joint/muscle pain

VTE Prevention

Early aggressive mobilization

Bed rest should change position Q2

Flex, extend feet, knees, and hips 2-4 hr

Up and in chair

VTE Care

Drug therapy (anticoagulants)

compression stockings

SCDs

Pt care for Chronic Venous Insufficiency

Assess for edema, eczema, venous leg ulcers

Diet/nutrition status

Compression and wound care

Give meds (analgesics, antibiotics)

Evaluate therapy effectiveness

Teach pt manifestations, complications, and treatment

Peripheral Artery Disease Rask factors

HTN

High sodium intake

Smoking

Peripheral artery disease care

Stop smoking

Regular exercise

Body weight management

DASH diet/HTN diet

Glucose control

PT/OT

Foot care

Surgery

Intermittent Claudication

Muscle pain caused by exercise

Due to lactic acid build up

Breathing Abnormalities-Auscultation

No breath sounds

Bronchophony, whispered pectoriloquy

Coarse crackles

Egophony (E-A sound)

Fine crackles

Pleural friction rub

Stridor

Wheezes

Reparatory Diagnostics-Endoscopy

Bronchoscopy

Lung biopsy

Mediastinoscopy

Exercise testing

Pulmonary function tests

Reparatory Diagnostics-Radiology

Chest x-ray

CT

Fluid volume deficit caused by

abnormal fluid loss, inadequate fluid intake, or a shift from plasma to interstitial fluid

Dehydration

Loss of pure water w/o loss of NA

FVD causes

Diabetes

GI loses (V/D)

Hemorrhage

Sweating

Osmotic dieresis

Overuse of dieresis

3rd space fluid shift (burns)

FVD Manifestations

Slow cap refill

Confusion, restlessness

Cold/clammy

Postural hypotension

Increased RR

Seizure, coma

Thirst

Decreased urination

Weakness, dizzy

Weight loss

Fluid Volume Excess caused by

Abnormal fluid retention (HF, renal F), excess intake, shift from interstitial fluid into plasma

FVE causes

Corticosteroids use (long-term)

Cushing’s

HF

Primary polydipsia

Renal F

SIADH

FVE Manifestations

Bounding pulse, increased BP & CVP

Confusion, headache, lethargy

Dyspnea, crackles, pulmonary edema

Edema

JVD

Muscle spasms

Polyuria

S3 heart sounds

Seizures, coma

Weight gain

Post-Op Cardio Problems

Most common: Hypotension, HTN, dysrhythmias

Greater risk: Alt respiratory function, cardio disease history, oldies, critically ill

Fluid retention is common 1-3 days post

Fluid overload can happen if IV given too rapidly

Complications: Hypokalemia, syncope (fainting)

Granulocytes function

Phagocytosis, WBC engulf any unwanted organism, digest, and kill it

Neutrophil most common type

Sickle Cell Crisis Implementation

Usually triggered by low O2 in blood

Due to infection

Diagnosed with blood smear

Sickle Cell nursing management

PAC

Incentive spirometry

Blood Transfusion Nursing Management

Baseline assessment

IV good

Wristband and blood band check

Adjust transfusion rate

Assess for reaction

CNA take VS

Evaluate therapeutic effect

Monitor overload (shortness of breath)

Iron Deficiency Anemia Treatment

Identify underlying cause

Drug therapy

Orals

IM/IV

Nutrition therapy

Packed RBC

Iron Deficiency Anemia Medication SE

GI upset

Stained teeth

Heartburn

C/D

Polycythemia Vera Interventions

Phlebotomy (300-500 ml every few days)

Low dose asprin

Pernicious Anemia Manifestations

Middle age +

Scandinavian and blacks

Tissue hypoxia

Sore, red, beefy, shiny tongue

A/N/V

Muscle weakness

Impaired cognition

HTN Diagnostics/Labs

BP

Fasting BG

History and physical assessment

UA

eGFR

CBC

Lipids

Uric Acid

12-lead ECG

HTN Care/Management

BP monitoring

Nutrition (decrease Na, cholesterol, fat)

Weight management

Stress management

Physical activity

Stop smoking

Decrease alcohol

Drug therapy

Education

HF Diagnostics

History and physical assessment

Determine underlying cause

Chest x-ray

12-lead ECG

2D echo

Nuclear imaging

Cardiac cath

HF Labs

BNP

Serum chem

Cardiac biomarkers

Liver, thyroid, and kidney function

CBC

Lipids

UA

HF Manifestations (Right)

Increase HR

Edema

Murmurs

Increased weight

JVD

R ventricle heaves

Ascites

Hepatomegaly

N/A/bloating

Anxiety/depression

Fatigue

RUQ pain

HF Manifestation (Left)

L ventricle heaves

Increase HR

S3+S4 sounds

Confusion, restless

Dry, hacking cough

Orthopnea

Crackles

Pleural effusion

PMI & LV hypertrophy

Pulsus alternes

Shallow R (32-40)

Paroxysmal nocturnal dyspnea

Frothy pink sputum

Anxiety/depression

Dyspnea

Fatigue/weakness

Nocturia

Paroxysmal nocturnal dyspnea manfestations

Sudden dyspnea that wakes the pr

fluid accumulation in pulmonary vessels entering alveoli while pr is supine

Pt will have panic w/feeling of suffocation and desire to sit/stand