Adult Health Final Exam Review

Cardiac Rhythms and Treatments

• Normal Sinus Rhythm (NSR):
  • Regular rhythm.
  • Heart rate (HR) between 60-100 bpm.
  • P wave present before every QRS complex.
• Sinus Bradycardia:
  • HR less than 60 bpm.
  • Treatment:
    • Atropine.
    • Pacing (if symptomatic).
• Sinus Tachycardia:
  • HR greater than 100 bpm.
  • Treatment:
    • Address the underlying cause (e.g., fever, hypovolemia).
• Atrial Fibrillation (A-Fib):
  • Irregularly irregular rhythm.
  • No distinct P waves.
  • Treatment:
    • Rate control (beta-blockers, calcium channel blockers - CCBs).
    • Anticoagulants.
    • Cardioversion.
• Ventricular Tachycardia (V-Tach):
  • Wide QRS complex.
  • HR greater than 100 bpm.
  • May or may not have a pulse.
  • Treatment:
    • With pulse: Amiodarone, cardioversion.
    • Pulseless: CPR, defibrillation.
• Ventricular Fibrillation (V-Fib):
  • Chaotic rhythm.
  • No pulse.
  • Treatment:
    • CPR.
    • Defibrillation (ASAP).
• Asystole:
  • Flatline; no electrical activity.
  • Treatment:
    • CPR.
    • Epinephrine (not shockable).

Respiratory Acidosis

• Occurs when the lungs are unable to remove sufficient CO2, leading to a low pH and high PaCO2.
• Uncompensated:
  • pH less than 7.35 (pH < 7.35).
  • PaCO2 greater than 45 (PaCO_2 > 45).
• Partially Compensated:
  • pH less than 7.35 (pH < 7.35).
  • PaCO2 greater than 45 (PaCO_2 > 45).
• Fully Compensated:
  • Normal pH (7.35-7.45) (7.35 < pH < 7.45).
  • PaCO2 greater than 45 (PaCO_2 > 45).
• Causes:
  • COPD.
  • Drug overdose.
  • Respiratory depression.
• Treatment:
  • Improve ventilation (BiPAP, oxygen).
  • Reverse opioid.
  • Intubation (if needed).

Pneumothorax

• Air enters the pleural space, causing lung collapse.
• Types:
  • Spontaneous:
    • Tall, thin young males or those with lung disease.
  • Traumatic:
    • Injury, central line insertion.
  • Tension:
    • Life-threatening; causes tracheal deviation.
• Signs and Symptoms (S/S):
  • Sudden dyspnea.
  • Chest pain.
  • Absent breath sounds on the affected side.
  • Tracheal deviation (in tension pneumothorax).
• Treatment:
  • Chest tube insertion.
  • Needle decompression (for tension pneumothorax).

Chest Tubes

• Used to remove air/fluid from the pleural space.
• Chamber Functions:
  • Collection Chamber:
    • Collects fluid.
  • Water Seal Chamber:
    • Allows air to exit, but prevents re-entry.
  • Suction Control:
    • Applies negative pressure.
• Key Observations:
  • Bubbling in the water seal chamber: Indicates an air leak.
  • Tidaling: Normal fluctuation; stops if the lung re-expands or the tube is blocked.
  • No drainage or sudden stop in bubbling: Possible obstruction.
• Nursing Care:
  • Keep below chest level.
  • Don’t strip tubing.
  • If dislodged: Apply sterile dressing, tape on three sides.
  • If disconnected: Submerge the end in sterile water.

Nitroglycerin

• Used for angina and heart failure.
• Mechanism of Action (MOA):
  • Vasodilation, which reduces preload and myocardial oxygen demand.
• Routes:
  • Sublingual, IV, patch, ointment.
• Key Points:
  • Sublingual: Take up to 3 doses, 5 minutes apart; call EMS if no relief after the 1st dose.
• Side Effects:
  • Headache, hypotension, dizziness.
• Contraindications:
  • Sildenafil (Viagra), hypotension.

Myocardial Infarction (MI)

• Definition: Death of heart muscle due to lack of oxygen (from a blocked coronary artery).
• Types:
  • STEMI:
    • Full thickness damage; ST elevation on ECG.
  • NSTEMI:
    • Partial blockage; no ST elevation, but elevated troponin.
• Symptoms:
  • Chest pain (crushing, radiates to jaw/arm).
  • Dyspnea.
  • Nausea.
  • Diaphoresis.
  • Atypical symptoms in women/older adults (fatigue, indigestion).
• Diagnosis:
  • ECG changes (ST elevation, T-wave inversion).
  • Elevated cardiac enzymes (Troponin, CK-MB).
• Treatment:
  • Morphine.
  • Oxygen.
  • Nitroglycerin.
  • Aspirin.
  • Beta-blockers.
  • Anticoagulants
  • PCI (stent), or thrombolytics.
• Nursing Focus:
  • Cardiac monitoring.
  • Assess pain.
  • Monitor for arrhythmias, heart failure.

Upper Respiratory Infection (URI)

• Definition: Infection of the nose, throat, sinuses (common cold, sinusitis, pharyngitis).
• Causes: Viral (most common), sometimes bacterial.
• Symptoms:
  • Cough, sore throat, runny/stuffy nose, sneezing, low-grade fever.
• Treatment:
  • Symptomatic: Fluids, rest, decongestants, throat lozenges.
  • NO antibiotics for viral URIs.
  • If bacterial (strep throat): antibiotics (penicillin, amoxicillin).

Urinary Tract Infection (UTI)

• Definition: Infection anywhere in the urinary tract (bladder, urethra, kidneys).
• Symptoms:
  • Lower UTI (cystitis): dysuria, urgency, frequency, cloudy/foul-smelling urine.
  • Upper UTI (pyelonephritis): fever, chills, flank pain, nausea.
• Diagnosis:
  • Urinalysis: + leukocytes, nitrites, sometimes blood.
  • Urine culture confirms organism.
• Treatment:
  • Antibiotics (Bactrim, nitrofurantoin, ciprofloxacin).
  • Increase fluids.
  • Wipe front to back, void after sex, avoid irritating products.
  • Older adults: May present with confusion, not classic symptoms.

Cardiovascular Risk Factors

• Non-Modifiable:
  • Age.
  • Gender (men and postmenopausal women higher risk).
  • Family history/genetics.
• Modifiable:
  • Hypertension.
  • Smoking.
  • High cholesterol (especially LDL).
  • Diabetes (type 2).
  • Obesity.
  • Sedentary lifestyle.
  • Poor diet.
  • Stress/alcohol.
• Nursing Role:
  • Health teaching: diet (low sodium/saturated fat), exercise, smoking cessation.
  • Monitor BP, lipids, glucose.
  • Encourage medication adherence.

Aneurysms

• Definition: A bulging or dilation of a blood vessel wall, often an artery.
• Types:
  • Abdominal Aortic Aneurysm (AAA): common, silent until rupture.
  • Thoracic Aortic Aneurysm.
  • Cerebral (brain): can cause hemorrhagic stroke if ruptured.
• Symptoms:
  • AAA: pulsating abdominal mass, back/flank pain.
  • Thoracic: chest pain, hoarseness, difficulty swallowing.
  • Rupture: sudden severe pain, hypotension, shock.
• Diagnosis:
  • CT scan, ultrasound, MRI.
• Treatment:
  • Monitor small aneurysms.
  • Surgical repair for large or symptomatic ones.
  • Strict BP control (beta-blockers).
• Nursing Considerations:
  • Don’t palpate suspected AAA.
  • Monitor vitals, especially BP.
  • Post-op: assess circulation, monitor for bleeding.

Thrombolytic Therapy

• Purpose: Dissolves clots (used in strokes, MI, PE).
• Common Drugs: Alteplase (tPA), reteplase, tenecteplase.
• Mechanism: Activates plasminogen → converts to plasmin → breaks down fibrin in clots.
• Indications:
  • Acute STEMI (within 12 hours).
  • Ischemic stroke (within 3-4.5 hours of symptom onset).
  • Massive PE with hemodynamic instability.
• Contraindications (bleeding risk):
  • Recent surgery.
  • Active bleeding.
  • History of hemorrhagic stroke.
  • Severe HTN.
• Nursing Notes:
  • Monitor for bleeding (IV sites, gums, urine, brain).
  • Neuro checks for intracranial bleed.
  • No IM injections.

Cholesterol Medications

• Statins (atorvastatin, simvastatin):
  • Inhibit cholesterol production in the liver.
  • ↓ LDL, ↑ HDL, ↓ triglycerides.
  • Side effects: Myopathy, liver damage.
  • Monitor: LFTs, muscle pain.
• Ezetimibe:
  • Blocks cholesterol absorption in the intestines.
  • Often added to statins.
• Bile Acid Sequestrants (cholestyramine):
  • Bind bile in the gut → forces liver to use cholesterol to make more bile.
  • Side effects: GI issues, interferes with med absorption.
• Fibrates (fenofibrate, gemfibrozil):
  • Lower triglycerides, raise HDL.
  • Risk of gallstones, myopathy (especially with statins).
• PCSK9 Inhibitors (alirocumab, evolocumab):
  • Injectable, for resistant high cholesterol.
  • Very effective LDL lowering.

Percutaneous Coronary Intervention (PCI)

• Definition: A non-surgical procedure used to treat narrowing of the coronary arteries.
• Purpose: Improves blood flow to the heart in patients with CAD or during a heart attack.
• Procedure: A catheter with a balloon is inserted, then inflated to open the artery. Often a stent is placed to keep it open.
• Nursing Considerations:
  • Monitor for bleeding at the insertion site, chest pain, ECG changes, and renal function (due to contrast dye used).

Urecholine

• Class: Cholinergic (parasympathomimetic) agent.
• Action: Stimulates the bladder to contract, helping with urination.
• Uses: Treats urinary retention, particularly after surgery or in neurogenic bladder.
• Side Effects: Hypotension, bradycardia, diarrhea, abdominal cramps.
• Nursing Notes: Monitor vital signs, bowel sounds, and urinary output.
• Contraindicated in asthma, peptic ulcer disease.

Peripheral Artery Disease (PAD)

• Signs & Symptoms:
  • Intermittent claudication (leg pain with activity, relieved by rest).
  • Cool, pale, or shiny skin.
  • Weak or absent pulses in extremities.
  • Ulcers or wounds that don’t heal on feet/toes.
• Treatment:
  • Lifestyle changes: smoking cessation, exercise.
  • Meds: antiplatelets (aspirin, clopidogrel), statins.
  • Procedures: angioplasty, stents, or bypass surgery.
• Nursing Considerations:
  • Promote circulation, educate on foot care, assess for signs of worsening ischemia.

Nitroglycerin - Detailed

• Class: Nitrate; vasodilator.
• Use: Relieves angina (chest pain) by dilating coronary arteries and reducing cardiac workload.
• Routes: Sublingual (SL), IV, transdermal, topical.
• Side Effects: Headache, hypotension, dizziness, flushing.
• Nursing Notes:
  • Monitor BP and pain relief.
  • Instruct patient to take 1 SL tab every 5 minutes (up to 3 total) during chest pain and seek help if no relief.
  • Store SL tabs in original, dark container.

Insulin

• Purpose: Regulates blood glucose levels by allowing cells to take in glucose.
• Types:
  • Rapid-acting (lispro): Onset 15 mins.
  • Short-acting (regular): Onset 30-60 mins.
  • Intermediate (NPH): Onset 1-2 hrs.
  • Long-acting (glargine): Onset 1-2 hrs, no peak.
• Administration: SQ injection or IV (only regular insulin IV).
• Side Effects: Hypoglycemia (shaking, sweating, confusion), lipodystrophy.
• Nursing Notes: Monitor glucose levels, rotate injection sites, and patient education.

Diabetes Type 1 and 2

• Type 1 Diabetes
  • Cause: Autoimmune destruction of pancreatic beta cells (no insulin).
  • Onset: Childhood or adolescence.
  • S/S: Polyuria, polydipsia, polyphagia, weight loss, fatigue.
  • Treatment: Insulin therapy, diet, and exercise.
• Type 2 Diabetes
  • Cause: Insulin resistance and/or decreased insulin production.
  • Onset: Adult (more common).
  • S/S: Often asymptomatic early, fatigue, recurrent infections, blurred vision.
  • Treatment: Oral meds (metformin, sulfonylureas), possibly insulin, lifestyle changes.
• General S/S of Hyperglycemia:
  • Polyuria, polydipsia, blurred vision, fatigue, slow healing wounds.
• General S/S of Hypoglycemia:
  • Sweating, shaking, irritability, confusion, tachycardia.
• Nursing Management:
  • Monitor blood glucose, encourage diet/exercise adherence, teach s/s of hypo/hyperglycemia, medication compliance.

Blood Thinners

• Purpose: Prevent blood clots (DVT, PE, stroke, heart attack).
• Types:
  • Anticoagulants:
    • Slow down clotting.
    • Examples: Warfarin (Coumadin), Heparin, Enoxaparin (Lovenox), Apixaban (Eliquis), Rivaroxaban (Xarelto).
  • Antiplatelets:
    • Prevent platelets from sticking together.
    • Examples: Aspirin, Clopidogrel (Plavix).
• Side Effects: Bleeding, bruising, blood in urine or stool.
• Nursing Considerations:
  • Monitor INR/PT (warfarin) or aPTT (heparin).
  • Avoid high-risk activities.
  • Watch for signs of bleeding.

Tuberculosis (TB)

• Cause: Bacterial infection (Mycobacterium tuberculosis), affects the lungs.
• Transmission: Airborne droplets.
• S/S: Persistent cough (3+ weeks), hemoptysis (bloody sputum), night sweats, weight loss, fatigue, fever.
• Diagnosis: TB skin test (PPD), chest X-ray, sputum culture.
• Treatment: Long-term antibiotics (6–12 months).
  • RIPE Therapy:
    • Rifampin: red/orange body fluids
    • Isoniazid: liver toxicity, neuropathy
    • Pyrazinamide: joint pain
    • Ethambutol: vision problems
• Nursing: Ensure med compliance, airborne precautions, monitor liver function.

Congestive Heart Failure (CHF)

• Definition: The heart can’t pump effectively to meet the body’s needs.
• Causes: CAD, HTN, MI, valve disease.
• S/S:
  • Left-sided: Pulmonary issues—crackles, dyspnea, orthopnea, fatigue.
  • Right-sided: Peripheral edema, JVD, ascites, hepatomegaly.
• Treatment:
  • Medications: ACE inhibitors, beta blockers, diuretics (furosemide), digoxin.
  • Lifestyle: Low-sodium diet, fluid restriction, daily weights, monitor swelling and breathing.
• Nursing: Monitor lung sounds, weight changes, edema, fluid balance, med adherence.

Diabetic Ketoacidosis (DKA)

• Occurs in: Type 1 diabetes (mostly).
• Cause: Severe insulin deficiency → body burns fat → ketone buildup → metabolic acidosis.
• S/S: Fruity breath, Kussmaul respirations (deep, rapid breathing), N/V, abdominal pain, confusion, dehydration, high blood sugar, ketones in urine.
• Treatment: IV insulin, fluids (normal saline), electrolyte replacement (esp. potassium).
• Nursing: Monitor glucose, potassium, ABGs, and mental status.

Heart Failure - Right vs Left

• Left-Sided HF (Think L = Lungs)
  • S/S: Dyspnea, orthopnea, pulmonary congestion: crackles, wheezing, fatigue, cough, decreased O2
• Right-Sided HF (Think R = Rest of body)
  • S/S: Peripheral edema, weight gain, JVD (jugular vein distension), ascites, hepatomegaly

Neuropathy

• Definition: Nerve damage, often due to diabetes.
• Types:
  • Peripheral: Numbness, tingling, burning in hands/feet
  • Autonomic: Affects internal organs (GI, bladder, heart)
• Causes: Diabetes (most common), alcohol, chemo, vitamin B12 deficiency.
• Treatment: Blood sugar control (for diabetics).
• Meds: Gabapentin, pregabalin, duloxetine, pain management, foot care, PT for balance.
• Nursing: Educate on foot care, prevent injury, fall precautions.

Hemodialysis

• Purpose: Filters waste, extra fluid, and toxins from the blood when kidneys fail.
• How it works: Blood is removed, filtered through a dialyzer, and returned to the body.
• Used for: End-stage renal disease (ESRD), severe acute kidney injury.
• Schedule: Typically 3 times/week for several hours.
• Access types:
  • AV fistula (preferred)
  • AV graft
  • Central venous catheter (short-term)
• Nursing care: Assess access site for bruit/thrill. Monitor for hypotension, fatigue, bleeding. Don’t use the arm with the fistula for BP or IVs.

Nephrotoxicity and Ototoxicity

• Nephrotoxicity
  • Definition: Kidney damage from toxins/drugs.
  • Common causes: NSAIDs, aminoglycosides, contrast dye, some chemo drugs.
  • S/S: Decreased urine output, ↑ BUN/creatinine, fluid retention.
  • Prevention: Hydration, avoid unnecessary nephrotoxic drugs.
• Ototoxicity
  • Definition: Damage to the ear/hearing from meds.
  • Common causes: Aminoglycosides (gentamicin), loop diuretics (furosemide), some chemo drugs.
  • S/S: Tinnitus, hearing loss, vertigo.
  • Nursing: Monitor hearing, renal function, and drug levels.

Kidney Stones

• Definition: Hard deposits of minerals/salts in kidneys.
• Causes: Dehydration, high calcium/oxalate diet, genetics.
• S/S: Sudden, severe flank pain; hematuria; nausea/vomiting; dysuria.
• Treatment: Small stones: Fluids, pain meds, strain urine. Large stones: Lithotripsy (shock waves), surgery.
• Prevention: Stay hydrated, dietary changes based on stone type.

AV Graft

• Definition: A synthetic tube connecting an artery to a vein for hemodialysis access.
• Used when: Patient’s own vessels aren’t suitable for a fistula.
• Pros: Can be used sooner than a fistula.
• Cons: Higher infection and clotting risk than fistulas.
• Nursing care: Check for bruit/thrill, don’t use that arm for BP/IVs, monitor for signs of infection or thrombosis.

Acute Kidney Injury (AKI)

• Definition: Sudden loss of kidney function over hours to days.
• Causes:
  • Pre-renal: ↓ blood flow (dehydration, shock)
  • Intra-renal: Direct kidney damage (toxins, drugs)
  • Post-renal: Obstruction (kidney stone, enlarged prostate)
• S/S: ↓ urine output, ↑ BUN/creatinine, fluid overload, electrolyte imbalance.
• Treatment: Fix the cause, fluids or diuretics, electrolyte management, dialysis if severe.
• Nursing: Strict I&O, monitor labs, avoid nephrotoxic meds.

Incentive Spirometers

• Purpose: Prevent atelectasis and pneumonia after surgery or during immobility.
• How to use:
  • Sit upright.
  • Inhale slowly and deeply through the mouthpiece.
  • Hold breath 3-5 seconds.
  • Exhale and rest.
  • Repeat 10 times/hour.
• Nursing: Encourage regular use, especially post-op, and educate on correct technique

Angina

• Definition: Chest pain due to reduced blood flow to the heart muscle.
• Types:
  • Stable angina: Triggered by exertion, relieved by rest or nitroglycerin.
  • Unstable angina: Unpredictable, occurs at rest, may signal an impending heart attack.
  • Prinzmetal (variant): Caused by coronary artery spasms; often at rest.
• S/S: Chest pressure or pain (may radiate to jaw, arm, back), shortness of breath, sweating.
• Treatment:
  • Meds: Nitroglycerin, beta blockers, calcium channel blockers.
  • Lifestyle: Smoking cessation, stress management, diet, exercise.
• Nursing: Monitor vitals, ECG, pain characteristics; educate on nitro use.

Fluid Volume Imbalances

• Fluid Volume Deficit (Dehydration)
  • Causes: Vomiting, diarrhea, bleeding, diuretics, sweating.
  • S/S: Dry mucous membranes, poor skin turgor, hypotension, tachycardia, low urine output, dark urine
  • Treatment: Oral or IV fluids, monitor electrolytes and I&O.
• Fluid Volume Overload
  • Causes: Heart failure, kidney failure, excessive IV fluids.
  • S/S: Edema, weight gain, crackles in lungs, JVD, hypertension, dyspnea, bounding pulses
  • Treatment: Diuretics, fluid/sodium restriction, monitor daily weight and I&O.

Chronic Kidney Disease (CKD)

• Definition: Gradual, irreversible loss of kidney function (over months/years).
• Causes: Diabetes, hypertension, glomerulonephritis
• S/S: Fatigue, edema, anemia, electrolyte imbalances (↑K, ↑phos, ↓Ca), uremia (waste buildup): nausea, confusion, itching
• Stages: 1 (mild) to 5 (ESRD, requires dialysis)
• Treatment: Control underlying cause (BP, diabetes), dialysis if needed, low-protein, low-sodium, low-potassium diet
• Nursing: Monitor labs (BUN/Cr, K, Hgb), manage diet, educate on meds and dialysis.

Deep Vein Thrombosis (DVT)

• Definition: Blood clot in deep vein (usually leg).
• S/S: Swelling, redness, warmth, pain (calf).
• Prevention: Mobility, SCDs, hydration.
• Medications:
  • Heparin (IV or SQ): Fast-acting; Monitor aPTT; Antidote: Protamine sulfate
  • Warfarin (Coumadin): Oral, takes days to work Monitor INR (target 2–3); Avoid vitamin K-rich foods (green leafy veggies); Antidote: Vitamin K
  • DOACs (Apixaban, Rivaroxaban): No routine labs; fewer food interactions
• Client Teaching:
  • Take meds same time daily.
  • Use electric razors/soft toothbrush to prevent bleeding.
  • Report signs of bleeding (gums, stool, urine, bruising).
  • Avoid NSAIDs and alcohol.

Metabolic Alkalosis

• Definition: pH > 7.45 (pH > 7.45), ↑HCO₃ (bicarbonate)
• Causes: Vomiting or NG suction (loss of stomach acid), overuse of antacids, diuretic use (loss of potassium)
• S/S: Confusion, muscle twitching, tingling, hypokalemia signs, slow breathing (compensatory)
• Treatment: Treat the cause (stop vomiting, replace electrolytes), IV fluids, potassium replacement

Electrolyte Imbalances

• Hypernatremia (↑ Sodium)
  • Causes: Dehydration, excessive salt intake
  • S/S: Thirst, confusion, muscle twitching, seizures
  • Treatment: Hypotonic fluids (D5W or 0.45% NS), limit sodium intake
• Hyponatremia (↓ Sodium)
  • Causes: Fluid overload, SIADH, diuretics
  • S/S: Headache, confusion, seizures, nausea
  • Treatment: Fluid restriction, hypertonic saline (3% NaCl for severe)
• Hyperkalemia (↑ Potassium)
  • Causes: Kidney failure, ACE inhibitors, K-sparing diuretics
  • S/S: Muscle cramps, peaked T-waves, arrhythmias
  • Treatment: Calcium gluconate (protects the heart), insulin with glucose (pushes K+ into cells), Kayexalate, diuretics, dialysis
• Hypokalemia (↓ Potassium)
  • Causes: Diuretics, vomiting, diarrhea
  • S/S: Weakness, fatigue, flat T-waves, arrhythmias
  • Treatment: Potassium replacement (oral or IV)
• Hypercalcemia (↑ Calcium)
  • Causes: Hyperparathyroidism, cancer
  • S/S: Bone pain, kidney stones, constipation, lethargy
  • Treatment: IV fluids, bisphosphonates, loop diuretics
• Hypocalcemia (↓ Calcium)
  • Causes: Hypoparathyroidism, low vitamin D
  • S/S: Muscle cramps, Chvostek’s & Trousseau’s signs, seizures
  • Treatment: Calcium supplements (oral or IV), vitamin D
• Hypermagnesemia (↑ Magnesium)
  • Causes: Renal failure, excessive Mg (antacids)
  • S/S: Decreased reflexes, bradycardia, hypotension
  • Treatment: IV calcium, diuretics, dialysis
• Hypomagnesemia (↓ Magnesium)
  • Causes: Alcoholism, diarrhea
  • S/S: Tremors, tetany, seizures, ↑ reflexes
  • Treatment: Magnesium replacement (oral or IV)

Asthma

• Definition: Chronic inflammation of airways causing bronchoconstriction.
• S/S: Wheezing, shortness of breath, coughing, chest tightness.
• Triggers: Allergens, exercise, cold air, stress.
• Treatment:
  • Quick Relief: Albuterol (SABA) – rescue inhaler
  • Long-Term Control: Inhaled corticosteroids (fluticasone) LABAs (salmeterol) Leukotriene modifiers (montelukast) Oral corticosteroids during exacerbations
• Nursing: Monitor respiratory rate, use peak flow meter, educate on inhaler technique

Community-Acquired Pneumonia

• Common pathogens: Streptococcus pneumoniae, Haemophilus influenzae, Mycoplasma pneumoniae
• S/S: Fever, cough, sputum, dyspnea, crackles
• Treatment (based on setting and risk factors):
  • Healthy outpatient: Amoxicillin or Doxycycline
  • With comorbidities or recent antibiotic use: Amoxicillin/clavulanate + macrolide (azithromycin) or fluoroquinolone (levofloxacin)
  • Inpatient: Ceftriaxone + azithromycin, or levofloxacin IV
• Nursing: Encourage fluids, monitor O2, support respiratory function.

Anaphylactic Shock

• Definition: A life-threatening allergic reaction causing airway swelling and cardiovascular collapse.
• Causes: Foods, insect stings, medications
• S/S: Rapid onset: Airway: swelling, wheezing, stridor Skin: hives, flushing Cardiovascular: hypotension, tachycardia
• Treatment: Epinephrine IM (first-line), Oxygen, Antihistamines (diphenhydramine), Steroids (methylprednisolone), IV fluids for BP support
• Nursing: Airway assessment is top priority. Always check allergies.

Cancer Treatment and Side Effects

• Chemotherapy: Targets fast-growing cells (but hits healthy ones too)
• Radiation: Localized treatment to shrink tumors
• Targeted therapy: Blocks specific cancer cell pathways (HER2, EGFR)
• Immunotherapy: Boosts immune system (checkpoint inhibitors like nivolumab)
• Common Side Effects:
  • Chemo: N/V, hair loss, fatigue, low WBCs (neutropenia), mucositis
  • Radiation: Skin irritation, fatigue
  • Immunotherapy: Autoimmune reactions, inflammation
• Nursing care: Monitor labs (CBC, ANC) Infection prevention (neutropenic precautions) Manage nausea, hydration, mouth care Supportive care: pain control, nutrition, emotional support

Tuberculosis (TB) - Detailed

• Cause: Mycobacterium tuberculosis
• Transmission: Airborne droplets
• Isolation: Airborne precautions: Negative pressure room, N95 mask for staff, surgical mask for patient if transport needed
• S/S: Persistent cough (3+ weeks), hemoptysis, night sweats, weight loss, fever
• Diagnosis: TB skin test (PPD), chest X-ray, sputum culture
• Medications (RIPE therapy):
  • Rifampin: Orange/red body fluids, hepatotoxic
  • Isoniazid (INH): Neuropathy (take with vitamin B6), hepatotoxic
  • Pyrazinamide: Joint pain, increased uric acid
  • Ethambutol: Eye problems (optic neuritis, vision changes)
• Duration: Usually 6–12 months
• Nursing: Ensure adherence to meds, monitor liver function, educate on infection control

Hypertension (HTN)

• Definition: Persistent BP > 130/80 mmHg (BP > 130/80 mmHg)
• Risk Factors: Age, family history, obesity, sedentary lifestyle, smoking, high sodium intake, alcohol, stress, diabetes, chronic kidney disease
• Treatment:
  • Lifestyle: Diet (DASH), exercise, weight loss, low sodium
  • Meds: ACE inhibitors (lisinopril) ARBs (losartan) Calcium channel blockers (amlodipine) Diuretics (hydrochlorothiazide)

Hypertension - Stages and Pregnancy

• Stage 1 HTN: Systolic 130–139 OR diastolic 80–89 (130 < Systolic < 139 OR 80 < Diastolic < 89)
  • Usually lifestyle changes first; meds if at high risk
• Pre-eclampsia (Pregnancy-related HTN):
  • After 20 weeks gestation, BP >140/90 (BP > 140/90) + proteinuria or organ damage
  • S/S: Headache, visual changes, swelling, epigastric pain, hyperreflexia
  • Treatment: Monitor BP, fetal status, magnesium sulfate to prevent seizures. Delivery is the only cure
• Hypertensive Crisis: BP >180/120 (BP > 180/120)
  • Can lead to stroke, MI, organ failure.
  • Emergency if symptoms like chest pain, confusion, vision changes.
  • Treatment: IV antihypertensives (labetalol, nitroprusside)

Heart Sounds - Assessment

• Normal:
  • S1 (“lub”): Closure of mitral/tricuspid valves (start of systole)
  • S2 (“dub”): Closure of aortic/pulmonic valves (start of diastole)
• Abnormal:
  • S3: “Ventricular gallop” – heart failure (lub-dub-dub)
  • S4: “Atrial gallop” – stiff ventricle (HTN, MI) (lub-lub-dub)
  • Murmur: Turbulent blood flow (valve issue)
  • Click/rub: Pericarditis = pericardial friction rub (scratchy)

Thyroid Stimulating Hormone (TSH)

• Function: Released by pituitary to stimulate thyroid gland
• Normal Range: 0.5–5.0 mIU/L (0.5 < TSH < 5.0)
• High TSH: Indicates hypothyroidism (thyroid not responding, pituitary increases TSH)
  • S/S: Fatigue, cold intolerance, weight gain, dry skin
  • Treatment: Levothyroxine
• Low TSH: Indicates hyperthyroidism
  • S/S: Weight loss, heat intolerance, anxiety, tachycardia
  • Treatment: Methimazole, radioactive iodine, beta blockers

Kidney Stones