Health and Illness Unit 3

What part of the brain is responsible for voluntary motor function?

Frontal lobe

What part of the brain is responsible for equilibrium, coordination, and proprioception?

Cerebellum

What changes occur to the musculoskeletal system with old age?

Thinning vertebral disks, shortening spinal column, kyphosis, decreased bone density

What happens to the cardiovascular system during immobility? (3 changes)

orthostatic hypotension, increased cardiac workload, increased thrombus formation

Nursing interventions for immobility

Passive and active ROM, frequent repositioning, encourage oral fluids, TEDs, SCDs

A nurse is assessing for complications of immobility. Which of the findings should the nurse expect? Select all that apply

Diarrhea

Pressure ulcers

Contractures of extremities

Crackles in the lungs

Polyuria

Pressure ulcers, contractures of extremities, crackles in the lungs

What effects happen to the respiratory system during immobility? (3 changes)

Decreased ventilation, decreased V:Q ratio, stasis of secretions

What part of the body is most sensitive to lack of oxygen?

Brain

Effects of immobility on GI system

decreased peristalsis, constipation, anorexia

What is contractures and when do they form?

Shortening of muscle fibers and begins after 8 hours of immobility

Effects of immobility on integumentary system

Decreased tissue perfusion, pressure ulcers

What does the Braden scale assess?

Risk for pressure injury development. Lower the score the increased risk for injury. Factors include sensory perception, moisture, activity, mobility, nutrition, and friction/shear.

Effects of immobility on urinary system

overflow incontinence, urine stasis, renal calculi, infection

What are the clinical manifestations of inflammation?

Redness, swelling, heat, pain, impaired function

A nurse is assessing a client for a suspected anaphylactic reaction following a CT scan with contrast dye. For which of the following client findings should the nurse intervene?

Urticaria

Stridor

Vomiting

Hypotension

Stridor

What cells are the first to arrive to an inflammatory site?

Neutrophils

Where does histamine come from and what does it do?

Stored and released from mast cells. Causes early vasodilation and increases permeability. Chemically attracts eosinophils

What does bradykinin do?

Dilation of vessels, increases vascular permeability, stimulates histamine release

What does leukotrienes do?

Helps with inflammation and increases mucous. Chemically attracts neutrophils and macrophages

What do mast cells?

increase vasodilation and permeability

What are the stages of inflammation?

Stage 1- vascular and cellular response

• Vascular- initial vasoconstriction at site followed by vasodilation. Increased capillary permeability

• Cellular- movement of leukocytes to cite. Formation of exudate

Stage 2- Exudate production

Stage 3- Reparative stage

What are the types of exudate?

Serous- watery

serosanguinous- pinky

Purulent- puss-like

Hemorrhagic- bloody

What is regeneration?

Tissue replaced from parenchyma (labile tissues)

What is repair?

Process of laying down connective tissue to restore strength and structure of tissues

What is primary healing?

Filled with blood clot, reepithelization and revascularization, and collagen formation

What is secondary healing?

Seen in wounds with unapproximated edges. Heals from the bottom up

What is dehiscence?

Wound pulls apart at suture line

What is evisceration?

Wound opens and organs expel

What is a fistula?

Abnormal passageway

What increase neutrophils a sign of?

Bacterial infection, ischemia

What are increased lymphocytes a sign of?

viral infection

What are increased eosinophils a sign of?

Allergic reaction or parasitic infection

What is SIRS criteria?

Requires 2+ of the following:

• Temp >38 or <36

• Heart rate >90

• RR >20 breaths per minute

• WBC >12,000 or <4,000

• >10% bands

The nurse is evaluating teaching provided to a client with chronic inflammation. Which client statement indicates to the nurse that teaching has been successful?

A. “I limit doing things that aggravate the pain.”

B. “I refrain from physical activity.”

C. “I think it would be best if I got a wheelchair and didn’t walk again.”

D. “I ignore the pain until I can’t stand it anymore.”

A

What is C-reactive protein?

Elevated in response to inflammatory process

<1= low risk for developing CV disease

1-3= average risk of developing CV disease

>3= high risk of developing CV disease

What is erythrocyte sedimentation rate (ESR)?

Lab to detect non-specific inflammation

Higher number indicated inflammation

Normal in 0-15 (men) or 0-20 (women)

The nurse conducts screening for inflammatory diseases with clients of a community health clinic. Which test should the nurse perform?

A. MRI

B. Xray

C. Urine Test

D. Skin Test

D

What is the POLICE acronym for inflammation?

protection and optimal loading, ice, compress, elevate

What is the treatment of anaphylaxis?

Epinephrine. Emergency tracheotomy if severe

What are sources of biogenic stress?

Amphetamines, caffeine

What are the stages of general adaptive syndrome?

Alarm, resistance, exhaustion

What happens during metabolic stress response?

Ebb phase- 24 hours. Metabolic rate is unchanged or decreased.

Flow phase- hypermetabolism with increased O2 and calorie demands

What are the manifestations of Addison’s disease?

Fatigue, weight loss, low BP, low glucose, low Na, High K, high Ca

What are the manifestations of Cushing’s disease?

Obesity, round face, hirsutism, fragile skin, HTN, DM, Low K

What are the functions of epinephrine?

Increases HR, facilitates blood flow to muscles and brain, relaxes smooth muscle, assists with conversion of glycogen to glucose

What are the functions of norepinephrine?

Vasoconstriction, maintaining BP and increasing it in acute stress

What is the most severe and incapacitating form of stress?

PTSD

DSM criteria for schizophrenia

Positive symptoms, at least one per week for one month, progression, condition is distressing/disabling, symptoms cannot be explained by other DSM-5 diagnosis

Lifespan groupings for schizophrenia

Early onset- before 17 years old

Late onset- after 40

Very late onset- after 60

What happens to the brain during schizophrenia?

Increase dopamine in basal ganglia, decreased dopamine in prefrontal cortex, increase in ventricle size, decrease in size of thalamus, prefrontal cortex, and hippocampus

What is an example of a grandiose delusion?

Homeless person believing they are a millionaire

What is an example of a somatic delusion?

Believing their sinuses are filled with worms

What alogia?

Poverty of speech and thoughts

What is avolition?

Lack of motivation

What are the phases of schizophrenia?

Premorbid- nonspecific emotional, cognitive, or motor delays

Prodromal- general symptoms appear

Acute- Positive symptoms develop

Stabilization- occurs 6-18 months after acute phase. Does not have acute phase symptoms

Maintenance- patient returns to functional status

What are the side effects of first generation anti-psychotics?

EPS, tardive dyskinesia, anticholinergic side effects, hyperprolactinemia

Side effects of second generation antipsychotics

Neutropenia, agranulocytosis, weight gain, EPS, NMS

What is EPS?

Abnormal muscle movements caused from too much D2 in nigrostriatal pathway.

What is acute dystonia and how to do we treat it?

Sustained muscle contraction

Treated with Cogentin or benztropine

How do we treat pseudo parkinsonism?

Cogentin or aretane

What is akathisia and how do we treat it?

Inability to sit still

Treat beta blockers (propranolol), parkinson meds, ativan, alprazolam

What is echolalia?

Client repeats words spoken to them