med surg 2 - exam 2

what are the signs & symptoms of COPD?

airflow limitation (destruction of alveoli aka emphysema & small-airway disease aka chronic bronchitis manifesting as cough/sputum production for at least 3 months for 2 consecutive years)

increased work of breathing (accessory muscles, tripod position), SOB, “barrel chest,” hypoxemia, cyanosis, cough & sputum production, anxiety, crackles/wheezing

what is some education for COPD?

breathing techniques (pursed lip breathing keeps airways open longer), pacing of activities, smoking cessation, nutritional needs (small, frequent meals), medication regimen (including proper use of inhalers), vaccine prophylaxis to decrease the risk of exacerbations, exacerbation recognition, coping strategies

what is some education on proper use of inhalers?

remove cap & shake, breath out, place in mouth & press down at start of inhalation, hold breath for 10 seconds then breathe out, wait a minute before repeating, rinse mouth at completion of doses & replace cap

what is chronic bronchitis?

inflammation of bronchi & bronchioles by chronic exposure to smoke & environmental irritants, which causes increased production of mucus cells & thick mucus; walls of bronchi thicken, causing airway obstruction

presence of cough & sputum production for at least 3 months in each of 2 consecutive years

“blue bloater”

what is the best way to prevent COPD?

no cigarette smoking

what are COPD exacerbations?

change in the natural course of the disease evidenced by variation from baseline symptoms (caused by exposure to pollutants)

acute in onset & may indicate need for change in patient management

warning signs include increasing SOB, wheezing, more frequent or severe cough, anxiety, problems with sleep, & decreased appetite

what is some information about bronchodilators?

cornerstone of pharmacological management of COPD

beta2-adrenergic agonists & anticholinergics

give before meals

what are the signs & symptoms of cystic fibrosis?

increased work of breathing, tachypnea, irregular breathing patterns, diaphoresis, nasal flaring, pursed-lip breathing, retractions, use of accessory muscles, persistent cough with thick sputum, wheezing, decreased ability to exercise, repeated lung infections, inflamed nasal passages

GI effects related to accumulation of mucus in the pancreas, which hinders release of pancreatic enzymes (foul-smelling or greasy stools, poor weight gain & growth, intestinal blockage in newborns, severe constipation)

how do you diagnose cystic fibrosis?

labs (sweat chloride test)

what is some education for cystic fibrosis?

airway clearance techniques, use of supplements, avoiding risk factors of exacerbation, genetic testing

what is emphysema?

"pink puffer”

loss of lung elasticity & development of hyperinflation of alveoli

small airways collapse prematurely, causing trapping of air & distention

ineffective exchange of oxygen & carbon dioxide causes hypoxemia, carbon dioxide retention (hypercapnia), & chronic respiratory acidosis

what are the signs & symptoms of obstructive sleep apnea?

loud snoring, snorting, witnessed apnea, gasping during sleep, recurrent waking during sleep, choking, fatigue, irritability, daytime sleepiness

hypoxemia & hypercapnia

15 or more events in an hour are sufficient for diagnosis

what are the signs & symptoms of asthma?

wheezing, dyspnea, coughing, increased sputum, increased respiratory rate after exposure to trigger

chest tightness & tachycardia secondary to decreased oxygenation or anxiety

classic sign of asthma attack is inability to speak in full sentences

what is some education for asthma?

individual asthma action plan, avoidance of risk factors, pursed-lip breathing, peak flow motor, smoking cessation, proper inhaler technique

what is left-sided heart failure?

dysfunction of the left ventricle

weakened contraction results in poor peripheral perfusion & back flow of blood into the lungs

what are the signs & symptoms of left-sided heart failure?

SOB/orthopnea, crackles, pallor, weak pulses, cool temperature in extremities, delayed capillary refill, fatigue, weakness

severe: hypotension, cool extremities, decreased urine output, poor or decreasing mentation, S3 or S4

what is some education for left-sided heart failure?

medication management, maintain activity as tolerated (alternate activity & rest periods), low-salt diet, daily weights, cardiac rehabilitation, s/s of worsening HF

how does one self-manage for heart failure?

patient assumes responsibilities for symptom monitoring, medication adherence, & lifestyle changes

• daily weights (gain indicates fluid retention)

• low-sodium diet

  • preventing cardiac cachexia

what do you manage heart failure with medication?

goals are reduction of risk factors, manipulation of critical components of cardiac output, & control of compensatory mechanisms

ACE inhibitors, ARBs, & arterial vasodilators are used for afterload reduction

ARNIs are used for afterload & preload reduction

venous vasodilators & diuretics are used for preload reduction

beta blockers & I(f) current inhibitors are used for decreasing heart rate & workload

inodilators, inotropes, & cardiac glycosides are used for increased contractility

how do you manage atrial fibrillation with medication?

anticoagulants, initial rate control in new-onset AF, medication to control HR (digoxin, beta blockers, CCBs), rhythm control with antiarrhythmic medications

what is some education for warfarin?

bleeding as a possible complication, vitamin K is the reversal agent, diet & lifestyle

what is some education for slidenafil (Viagra) for a patient with a history of cardiac issues?

increased risk of hypotension with coadministration of nitroglycerin

what is right-sided heart failure?

inability of the right side of the heart to effectively pump blood to the pulmonary vasculature

weakened contraction of the right ventricle results in backflow of blood into the right atrium & venous circulation

what are the signs & symptoms of right-sided heart failure?

JVD, generalized dependent edema, hepatomegaly, ascites

severe: hypotension, cool extremities, decreased urine output, poor or decreasing mentation, S3 or S4

what is some education for right-sided heart failure?

medication management, maintain activity as tolerated (alternate activity & rest periods), low-salt diet, daily weights, cardiac rehabilitation, s/s of worsening HF

what is intermittent claudication?

muscle pain (ache, cramp, numbness, or sense of fatigue) classically in the calf that occurs during exercise & is relieved by a short period of rest

sign of peripheral arterial disease

what is peripheral arterial disease?

obstruction of blood flow through large peripheral arteries causing partial or total arterial occlusion

• obstruction caused by a combination of atherosclerosis, inflammation, stenosis, embolus, & thrombus

deprives lower extremities of oxygen & nutrients, leading to ischemia, necrosis, or cell death

may be asymptomatic or manifest with intermittent claudication or atypical lower extremity pain

what are the signs & symptoms of an aneurysm?

typically cause no symptoms until dissection or rupture

palpable pulsatile mass in the abdomen, spontaneous chest/back/flank pain

what is some education for aneurysms?

s/s, regular screening with pain for patients with marfan’s syndrome, strict treatment regimen, compliance with medication, smoking cessation, maintain a healthy weight, regular exercise, avoid crossing or elevating legs to decrease pressure on aorta & iliac arteries, stress reduction, diagnostic testing & screening recommendations, regular ultrasounds to measure aneurysm’s growth

what data is found on an assessment of a thoracic aneurysm?

constant pain (caused by stretching of aortic tissue & impingement on adjacent structures)

heart failure (ascending aneurysms may cause aortic regurgitation)

dyspnea/cough (respiratory symptoms caused by distortion & obstruction of trachea & aneurysm)

hoarseness of voice/dysphagia (caused by distortion of the phrenic nerve or direct impingement on esophagus)

what data is found on an assessment of an abdominal aneurysm?

pain (occurs in back & abdomen due to impingement on adjacent structures & stretching of aortic tissue)

abdominal throbbing (noticeable, small pulsing mass near navel due to increased aortic pressure)

cyanosis/blood clots (blood can pool in the part of the aorta that is bulging, & a blood clot can develop inside the aneurysm; if it breaks loose, symptoms can result)

what is chronic venous insufficiency?

occurs when your leg veins don’t allow blood to flow back up to your heart; when valves do not flow well this can cause back flow & pooling of blood in the legs

pain, swelling, cramps, skin changes, varicose veins, leg ulcers

how do you manage chronic venous insufficiency?

keep your legs elevated, aspirin, radiofrequency ablation, sclerotherapy, surgery

what is carotid artery disease?

common atherosclerotic vascular disease characterized by vessel wall thickening, plaque formation, & progressive narrowing of the carotid artery

plaque disruption & thrombus formation contribute to progressive narrowing

mild = less than 50%; moderate = 50-69%; severe = 70-99%

what is the ankle brachial index?

compares ankle BP to brachial BP to assess PAD (normally ankle would be greater than brachial)

divide ankle BP by brachial BP

less than 0.9 is diagnostic of PAD

how do you manage a stroke?

prevent complications (VTE prophylaxis, manage BP, control risk factors)

what are some complications of a stroke & how do you prevent them?

weakness or paralysis (risk of contracture) - splinting, passive ROM, PT/OT

what is homonymous hemianopsia?

field loss deficit in the same halves of the visual field of each eye, often resulting from CVA or tumor

what is a venous stasis ulcer?

ulcers that occur around the ankles when there is damage to the valves inside the leg veins

what is some education for venous stasis ulcers?

smoking cessation, losing weight, exercise, elevate legs for a short periods, compression socks

what are some modifiable risk factors for peripheral vascular disease?

injury to arms/legs, CAD, DM, high cholesterol, HTN, obesity, physical inactivity, smoking, infection

what are some nonmodifiable risk factors for peripheral vascular disease?

age greater than 50, history of heart disease, male, postmenopausal female, family history of high cholesterol, HTN, irregular anatomy of muscle or ligaments or peripheral vasculature