AH final test review

Hematologic/Lymphatic/HIV-AIDS

1. Red Blood Cells (RBC)

  • Function: The primary function of red blood cells (RBCs) is to transport oxygen from the lungs to body tissues and return carbon dioxide from the tissues back to the lungs.

a. Disorders Related to RBC

  • Anemia: A condition characterized by a deficiency of red blood cells or hemoglobin in the blood, leading to decreased oxygen transport capacity.

i. Etiology of Different Types of Anemia

  • Hypovolemic Anemia: Caused by a significant decrease in blood volume due to hemorrhage or fluid loss.

  • Iron-Deficient Anemia: Resulting from inadequate iron intake, absorption, or chronic blood loss.

  • Pernicious Anemia: Caused by the inability to absorb vitamin B12 due to intrinsic factor deficiency leading to impaired red blood cell production.

  • Sickle-Cell Anemia: A hereditary disorder characterized by the production of abnormal hemoglobin (hemoglobin S), leading to the distortion of RBC shape and impaired oxygen transport.

  • Aplastic Anemia: Occurs when the bone marrow fails to produce sufficient amounts of blood cells due to factors like radiation, certain medications, or autoimmune diseases.

ii. Associated Labs & Normal/Abnormal Values

  • Common tests include complete blood count (CBC), reticulocyte count, ferritin levels, and vitamin B12 levels to diagnose and assess the severity of anemia.

  • Normal ranges can vary based on age, sex, and laboratory standards.

iii. Dietary Considerations

  • Key sources of iron: Red meat, poultry, fish, lentils, beans, tofu, and fortified cereals. Vitamin C enhances iron absorption.

iv. Nursing Interventions

  • Monitor hemoglobin and hematocrit levels, assess for symptoms of anemia such as fatigue and weakness, educate on dietary changes, and administer iron supplements or blood transfusions as prescribed.

2. Platelets

a. Function of Platelets

  • Platelets are small cell fragments involved in hemostasis; they aggregate at sites of vascular injury to form blood clots and prevent bleeding.

b. Associated Lab Values

  • Normal platelet count ranges from 150,000 to 450,000/microliter.

c. Disorders Related to Platelets
i. Disseminated Intravascular Coagulation (DIC)

  • A serious condition characterized by the overwhelming activation of the clotting cascade, leading to the formation of clots and subsequently resulting in massive bleeding.

ii. Hemophilia

  • A hereditary disorder caused by the deficiency of clotting factors, leading to excessive bleeding.

iii. Etiology

  • DIC can be triggered by trauma, sepsis, or malignancies, while hemophilia is usually genetically inherited.

d. Nursing Interventions/Nursing Considerations

  • Monitor for signs of bleeding and clotting, ensure proper education on lifestyle adjustments, and manage complications associated with these conditions.

  • Medications for Platelet Functions:

    • Antithrombotic agents: Used to reduce the formation of blood clots.

    • Anticoagulants: Medications like heparin and warfarin that help prevent coagulation.

    • Coagulation Studies: Monitor effectiveness of medications through tests like PT (Prothrombin Time) and INR (International Normalized Ratio) to guide dosing.

e. Antidotes for Medications

  • Antidotes for heparin: Protamine sulfate

  • Antidotes for warfarin: Vitamin K

3. White Blood Cells (WBC)

a. Function of WBC

  • White blood cells are critical components of the immune system, responsible for defending the body against infections and foreign invaders.

b. Normal/Abnormal Labs

  • Normal white blood cell count ranges between 4,500 and 11,000 cells/microliter.

c. Disorders of WBC
i. Disorders

  • Leukemia: A type of cancer affecting blood and bone marrow, leading to the overproduction of abnormal WBCs.

  • Myeloma: Cancer of plasma cells leading to impaired immune response.

  • Lymphoma: Cancer that begins in lymphatic tissues.

ii. Priority Nursing Interventions

  • Monitor WBC counts, educate patients about infection prevention, and administer prescribed treatments.

iii. Priority Nursing Concerns

  • Recognizing signs of infection and managing complications associated with abnormal WBC counts.

4. HIV/AIDS

a. Etiology/Timeline

  • HIV (Human Immunodeficiency Virus) causes AIDS (Acquired Immunodeficiency Syndrome), characterized by a progressive failure of the immune system.

b. Modes of Transmission

  • Transmission occurs mainly through unprotected sexual contact, sharing needles, and from mother to child during birth or breastfeeding.

c. Patient Teaching: Prevention

  • Educate on safe practices, including safe sex, needle exchange programs, and the importance of regular testing.

d. Lab Values - CD4 Count in AIDS

  • Normal CD4 count is typically 500-1600 cells/mm³; a count below 200 cells/mm³ indicates AIDS.

e. Treatments - Anti-Retrovirals

  • Antiretroviral therapy (ART) reduces the viral load and helps maintain immune function.

f. Opportunistic Infections

  • Patients with AIDS are predisposed to infections such as Pneumocystis pneumonia or candidiasis.

g. Patient Teaching Related to Anti-Retroviral Therapy

  • Instruct patients on adherence to medication regimens and monitoring for side effects.

Integumentary & Burns

5. Define/Identify Primary & Secondary Skin Lesions

  • Primary Skin Lesions: Initial, distinctive changes in skin color or texture (e.g., macules, papules).

  • Secondary Skin Lesions: Changes that result from primary lesions (e.g., scales, crusts).

6. Wound Dressings

a. Types & Purposes

  • Dressings such as hydrocolloid, foam, and alginate serve to protect wounds, promote healing, and manage moisture levels.

7. Pressure Injuries

a. Descriptions of Stages

  • Stage I: Non-blanchable erythema of intact skin.

  • Stage II: Partial thickness skin loss involving epidermis, dermis, or both.

  • Stage III: Full thickness skin loss, possibly exposing subcutaneous tissue.

  • Stage IV: Full thickness tissue loss with exposed bone, tendon, or muscle.

8. Inflammatory Skin Disorders

a. Types

  • Contact Dermatitis: Inflammation caused by direct contact with irritants or allergens.

  • Eczema: A chronic condition causing dry, itchy skin.

  • Psoriasis: An autoimmune disorder leading to rapid skin cell turnover and scaly plaques.

i. Etiology

  • Factors such as genetics, allergens, changes in climate, and certain behaviors can trigger these conditions.

ii. Treatment & Nursing Interventions

  • Management may include topical corticosteroids, antihistamines, and patient education on skin care.

9. Infectious Skin Disorders

a. Common Disorders

  • Herpes Simplex Virus (HSV): Causes cold sores or genital herpes.

  • Herpes Zoster: Reactivation of varicella-zoster virus leading to shingles.

  • Impetigo: Bacterial skin infection characterized by honey-colored crusts.

i. Etiology and Clinical Manifestations

  • Each infectious disorder has unique symptoms and transmission vectors, requiring specific treatment approaches.

ii. Treatments - Medications

  • Antiviral medications for HSV, antibiotics for bacterial infections.

b. Fungal Skin Infections
i. Five Most Common Types

  • Tinea pedis (athlete's foot),

  • Tinea cruris (jock itch),

  • Tinea corporis (ringworm),

  • Tinea capitis (scalp ringworm),

  • Tinea unguium (nail fungus).

ii. Treatments for Fungal Skin Infections

  • Topical or systemic antifungal agents based on infection severity.

iii. Nursing Interventions

  • Educate on hygiene practices to minimize recurrence and manage symptoms.

10. Skin Lesions

a. Types

  • Differentiation between cysts (closed sacs of tissue) and keloids (overgrowths of scar tissue).

b. Cancerous Neoplasms
i. Types

  • Basal Cell Carcinoma: The most common skin cancer, arising in the basal cells.

  • Squamous Cell Carcinoma: Cancer of squamous cells, often characterized by scaly patches.

  • Malignant Melanoma: A serious form of skin cancer, originating from melanocytes.

11. Burns

a. Etiology and Manifestations of Malignant Skin Lesions

  • Burns categorized into partial thickness (superficial and deep) and full thickness, based on tissue involvement.

i. Clinical Manifestations

  • Superficial: Redness, swelling, pain without blisters.

  • Deep partial thickness: Red/white skin, blisters, severe pain.

  • Full thickness: White/brown skin without pain due to nerve damage.

ii. Phases and Treatment

  • Emergent Phase: Initial response, fluid resuscitation.

  • Acute Phase: Focus on wound healing and preventing complications.

  • Rehabilitation Phase: Focus on restoring function and the psychosocial aspect of recovery.

iii. Purpose of Debridement

  • Removal of necrotic tissue to promote healing and reduce infection risk.

Gastrointestinal

1. Bariatric Surgeries

a. Complications

  • Dumping Syndrome: A condition occurring post-surgery characterized by rapid gastric emptying and symptoms like nausea and diarrhea.

2. Disorders of Upper GI

a. Hiatal Hernia
i. Clinical Manifestations

  • Symptoms can include heartburn, regurgitation of food, and chest pain.

ii. Therapeutic Interventions

  • Management with lifestyle changes, medications, or surgery if severe.

b. Gastritis
i. Etiology

  • Causes can include infection (H. pylori), anti-inflammatory medications, or excessive alcohol consumption.

c. Peptic Ulcer Disease
i. H. Pylori

  • Causative agent is Helicobacter pylori, leading to ulcers in the stomach and duodenum.

ii. Treatment/Therapeutic Interventions

  • Medications such as proton pump inhibitors (PPIs), antibiotics in cases of H. pylori infection.

3. Disorders of Lower GI

a. Appendicitis
i. Clinical Manifestations

  • Symptoms include right lower quadrant pain, fever, and nausea.

ii. Potential Complications

  • Risk of rupture leading to peritonitis.

b. Diverticulitis
i. Clinical Manifestations

  • Symptoms include abdominal pain, fever, and changes in bowel habits.

ii. Treatments

  • Dietary modifications, antibiotics, and possibly surgery in severe cases.

c. Crohn's Disease and Ulcerative Colitis
i. Etiology, Causative Factors

  • Possible genetic, environmental factors influence the onset.

ii. Clinical Manifestations

  • Symptoms can vary but often include abdominal pain, diarrhea, and weight loss.

iii. Treatments

  • Corticosteroids and immunosuppressive therapies used for management.

d. Abdominal Hernias
i. Types

  • Common types include inguinal, umbilical, and femoral hernias.

ii. Complications of Abdominal Hernias

  • Strangulation can occur, leading to compromised blood supply and requiring emergency intervention.

e. Bowel Obstructions
i. Types

  • Two main types: mechanical (physical blockage) and non-mechanical (paralytic ileus).

ii. Complications of bowel obstructions

  • Can lead to vomiting, dehydration, and perforation of the bowel.

f. Ostomies
i. Types and Patient Teaching

  • Colostomy and ileostomy, with education on care, hygiene, and dietary adjustments for different outputs.

4. Disorders of the Accessory Organs - Liver, Pancreas, Gallbladder

a. Liver
i. Functions of the Liver

  • Metabolizes nutrients, detoxifies harmful substances, and produces bile for digestion.

ii. Associated Lab Tests/Values for Liver

  • Common tests include liver function tests like ALT, AST, bilirubin levels for overall liver health assessment.

b. Hepatitis
i. Types and Causative Factors

  • Includes Hepatitis A (viral, fecal-oral transmission), B (blood and body fluids), C (blood transmission), D, and E.

c. Cirrhosis - End-Stage Chronic Liver Failure
i. Etiology

  • Long-term damage from conditions like chronic alcohol use, viral hepatitis, and fatty liver disease.

ii. Clinical Manifestations

  • Symptoms can be summarized by the acronym CHEAP: Confusion, Hepatomegaly, Edema, Ascites, and Portal Hypertension.

iii. Treatment for Each Symptom of Cirrhosis

  • Management focuses on symptom control, nutritional support, and monitoring for complications.

d. Pancreas
i. Functions of the Pancreas

  • Produces digestive enzymes and hormones including insulin, which is vital for glucose regulation.

ii. Associated Lab Tests/Values for Pancreas

  • Amylase and lipase levels to evaluate pancreatic function and inflammation.

iii. Clinical Manifestations of Pancreatitis

  • Symptoms include severe abdominal pain, nausea, vomiting, and elevated enzymes.

iv. Priority Nursing Interventions of Pancreatitis

  • Maintain NPO status and manage pain appropriately.

e. Gallbladder
i. Cholelithiasis

  • Presence of gallstones leads to potential blockage of bile ducts.

ii. Prevention and Dietary Considerations

  • Educate on low-fat diets to minimize risks of gallstone development.

Renal

1. Urinary Drainage Systems

a. Catheters
i. Appropriate Reasons for Insertion

  • Blockages, urinary retention, or during surgical procedures as indicated.

ii. Nursing Interventions for Catheters

  • Regular monitoring of output, catheter care to prevent infection.

b. Urinary Retention
i. Causes

  • Can result from prostate enlargement, nerve issues, or medications.

ii. Priority Nursing Interventions

  • Assess bladder distension, use of catheter if necessary, and patient education.

c. Urinary Incontinence
i. Differentiate Between Types

  • Urge incontinence, stress incontinence, overflow incontinence, and functional incontinence need differentiated management strategies.

2. Disorders of the Urinary Tract

a. Urinary Tract Infections
i. Clinical Manifestations

  • Symptoms include dysuria, frequency, urgency, and flank pain.

ii. Medical Management/Priority Nursing Interventions

  • Treatment with antibiotics and symptomatic relief strategies.

b. Urethritis
i. Clinical Manifestations

  • Symptoms may present as burning sensation during urination and discharge.

ii. Medical Management/Priority Nursing Interventions

  • Similar approaches as UTI management emphasizing prevention and comfort.

c. Pyelonephritis
i. Etiology

  • Often arises from untreated UTIs, leading to kidney infection characterized by fever, nausea, and flank pain.

ii. Nursing Interventions

  • Encouragement of fluid intake, monitoring vital signs, and administration of antibiotics.

d. Urolithiasis
i. Medical Management

  • Encourage fluid intake, pain management, and potentially surgical intervention for larger stones.

ii. Nursing Interventions

  • Educate on dietary changes to prevent stone recurrence.

e. Acute Glomerulonephritis
i. Etiology - Causative Agent

  • Often follows infections, such as streptococcal infections, leading to inflammation within the kidneys.

ii. Clinical Manifestations

  • Symptoms can include hematuria, proteinuria, and edema.

f. Acute Renal Failure
i. Prerenal, Intrarenal, Postrenal - Examples of Each

  • Prerenal: Due to decreased blood flow (shock).

  • Intrarenal: Damage to kidney tissue from infections or toxins.

  • Postrenal: Due to obstruction (e.g., enlarged prostate).

ii. Four Stages (Phases) and Clinical Manifestations of Each Stage

  1. Initiation Phase: Subtle changes, risk of injury.

  2. Oliguric Phase: Decreased urine output, fluid overload.

  3. Diuretic Phase: Increased urine output but may lose electrolytes.

  4. Recovery Phase: Gradual return to baseline kidney function.

g. Chronic Renal Failure

3. Dialysis

i. Clinical Manifestations

  • Symptoms may include fatigue, weakness, and electrolyte imbalances.

ii. Associated Labs - BUN/Cretinine

  • Elevated BUN and creatinine indicate impaired kidney function.

iii. Electrolyte Abnormalities (Potassium) and Interventions

  • Hyperkalemia can occur; interventions include dietary restrictions and medications to lower potassium levels.

a. Hemodialysis
i. Considerations for Dialysis Access Devices

  • Monitor for infection, ensure proper care of access sites.

ii. Nursing Interventions for Access Devices

  • Assess for patency and signs of complications, educate patients on care protocols.

b. Peritoneal Dialysis
i. Nursing Considerations

  • Monitor fluid balance and ensure proper exchange techniques.

ii. Potential Complications - Most Serious Complication

  • Peritonitis is a serious risk; symptoms include abdominal pain and fever.

4. Kidney Transplant
a. Nursing Considerations/Monitoring

  • Lifelong immunosuppression to prevent rejection, regular monitoring of kidney function and complications.

  • Antirejection: Medications must be adhered to strictly to prevent transplant rejection, typically involving a regimen tailored to the individual patient.