Hypercalcemia (Differential Diagnoses)

Absolutely. Your list is very broad, so the best way to study it is not to memorize every disease. We can turn it into a high-yield nursing reviewer based on: What is it? → What will I see? → What should I assess? → What should I do? → What medications/treatments matter? → What is the priority/emergency? → What should I teach? Below is a condensed master reviewer. I’ll keep it nursing-focused and use simple language. ⸻ 🩺 MEDICAL-SURGICAL NURSING REVIEWER 1. ENDOCRINE SYSTEM Diabetes Mellitus Type 1 Type 2 Main problem Little/no insulin Insulin resistance + progressive insulin deficiency Usually Younger onset, but can occur any age More common in adults Treatment Insulin required Lifestyle + oral/injectable meds ± insulin Major acute problems DKA HHS Signs of hyperglycemia “3 Ps” * Polyuria – urinating frequently * Polydipsia – excessive thirst * Polyphagia – excessive hunger Other: * Fatigue * Blurred vision * Slow wound healing * Recurrent infections Hypoglycemia Think FAST: * F – Feeling shaky * A – Altered behaviour/confusion * S – Sweating * T – Tachycardia Treatment if conscious: 15 g fast carbohydrate → recheck glucose in 15 min → repeat if necessary. Examples: * Glucose tablets * Juice * Regular pop If unconscious/severe: * Glucagon if appropriate * IV dextrose in a healthcare setting DKA Usually associated with Type 1. Think: Hyperglycemia + ketones + metabolic acidosis Signs: * Dehydration * Abdominal pain * Nausea/vomiting * Fruity/acetone breath * Kussmaul respirations * Altered LOC Priority treatment: 1. IV fluids 2. Insulin 3. Monitor/correct electrolytes, especially potassium 4. Monitor glucose and acid-base status HHS Usually Type 2. * Extremely high glucose * Severe dehydration * Altered LOC * Little/no significant ketoacidosis Major nursing priority: fluid replacement and monitoring. Diabetes teaching Remember: * Foot care * Inspect feet daily * Proper footwear * Don’t walk barefoot * Don’t cut corns/calluses yourself * Monitor blood glucose * Know signs of hypo/hyperglycemia * Medication adherence * Sick-day management * Regular eye/kidney/foot assessments ⸻ ❤️ 2. CARDIOVASCULAR SYSTEM Stroke Two major types: * Ischemic → blocked blood vessel * Hemorrhagic → bleeding Recognize stroke: BE FAST B – Balance loss E – Eye/vision changes F – Face drooping A – Arm weakness S – Speech difficulty T – Time to call emergency services Nursing priorities * ABCs * Determine last known well * Neurological assessment * Blood glucose * Prepare for CT/imaging * Swallow assessment before oral food/fluids/medications * Prevent aspiration * Maintain safety Do not give food or water until swallowing is assessed. ⸻ Myocardial Infarction (MI) Think: “Time = muscle.” Common symptoms: * Chest pressure/pain * Radiation to arm/jaw/back * Dyspnea * Diaphoresis * Nausea * Anxiety Some patients, especially older adults and people with diabetes, may have atypical or minimal pain. Nursing priorities * ABCs * ECG * Vital signs * Cardiac monitoring * IV access * Blood work including cardiac biomarkers * Oxygen if hypoxemic/clinically indicated * Administer prescribed medications promptly Common medications: * Aspirin * Nitroglycerin * Antiplatelet drugs * Anticoagulants * Beta blockers * Statins Nitroglycerin Can cause: * Hypotension * Headache * Dizziness Never combine nitrates with PDE-5 inhibitors because of potentially severe hypotension. ⸻ Heart Failure Left-sided Think Lungs * Dyspnea * Crackles * Orthopnea * Pulmonary edema * Pink/frothy sputum in severe pulmonary edema Right-sided Think Body * Peripheral edema * Weight gain * JVD * Hepatomegaly * Ascites Nursing priorities * Daily weight * I&O * Respiratory assessment * Edema assessment * Fluid/sodium management as ordered * Medication adherence Sudden weight gain can indicate fluid retention. Common drugs: * Diuretics * ACE inhibitors/ARBs/ARNI * Beta blockers * Mineralocorticoid antagonists * SGLT2 inhibitors * Digoxin in selected patients Digoxin Watch for: * Bradycardia * Nausea/vomiting * Visual disturbances * Dysrhythmias Low potassium increases risk of digoxin toxicity. ⸻ Peripheral Vascular Disease Arterial Think: “Pain + Pale + Pulseless + Cold” * Cool extremity * Weak pulses * Pale colour * Pain with activity * Poor wound healing Venous Think: “Swollen + Warm + Edema” * Edema * Warm skin * Aching * Venous ulcers often near ankles ⸻ 🩸 3. HEMATOLOGY Anemia Reduced oxygen-carrying capacity. Signs: * Fatigue * Pallor * Weakness * Dyspnea * Tachycardia * Dizziness Iron-deficiency anemia May see: * Low hemoglobin * Low ferritin * Microcytic/hypochromic RBCs Iron teaching: * Take as directed * Vitamin C can improve absorption * Dark stools are common * Constipation can occur * Liquid iron may stain teeth ⸻ Leukemia Cancer of blood-forming tissues. Possible findings: * Infection → abnormal WBC function * Anemia → fatigue/pallor * Bleeding → low platelets * Bone/joint pain Think: Leukemia = infection + anemia + bleeding Nursing priorities: * Infection prevention * Bleeding precautions when indicated * Monitor CBC * Oral care * Avoid unnecessary invasive procedures * Monitor treatment adverse effects ⸻ 🍽️ 4. GASTROINTESTINAL SYSTEM Crohn’s vs Colitis Crohn’s Ulcerative Colitis Can affect anywhere mouth → anus Colon/rectum “Skip lesions” Continuous inflammation Transmural Mainly mucosal Fistulas common Bloody diarrhea common Strictures possible Toxic megacolon risk Crohn’s Watch for: * Diarrhea * Abdominal pain * Weight loss * Malnutrition * Fistulas Ulcerative colitis Watch for: * Bloody diarrhea * Abdominal cramps * Urgency * Risk of toxic megacolon ⸻ Diverticulitis Inflammation/infection of diverticula. Signs: * Usually LLQ abdominal pain * Fever * Change in bowel habits During acute inflammation: * Follow prescribed bowel-rest/diet plan * Monitor pain, fever and abdominal status * Watch for perforation/peritonitis ⸻ Colorectal Cancer Red flags: * Change in bowel habits * Blood in stool * Unexplained weight loss * Iron-deficiency anemia * Abdominal discomfort Important: Screening is important even before symptoms occur. ⸻ Constipation Risk factors: * Opioids * Immobility * Low fluid intake * Low fibre * Some medications Management: * Fluids if not contraindicated * Fibre * Activity * Bowel routine * Appropriate laxatives/stool softeners ⸻ Diarrhea Priority concerns: Fluid + electrolytes + cause Assess: * Frequency * Stool characteristics * Blood * Fever * Abdominal pain * Hydration * Recent antibiotics/travel/exposure ⸻ Peptic Ulcer Disease Major complications: * Bleeding * Perforation * Gastric outlet obstruction Warning signs: * Hematemesis * Melena * Sudden severe abdominal pain * Rigid abdomen Common causes: * H. pylori * NSAIDs ⸻ Appendicitis Classic: * Pain may begin around umbilicus and migrate to RLQ * Fever * Nausea/vomiting * Rebound/guarding may occur Priority Prevent rupture. Avoid: * Laxatives * Enemas * Applying heat to abdomen ⸻ 🚰 5. RENAL SYSTEM UTI Symptoms: * Dysuria * Frequency * Urgency * Suprapubic discomfort If infection reaches kidneys: * Fever * Flank pain * Chills * Nausea/vomiting Nursing * Obtain urine specimen correctly * Culture before antibiotics when ordered/appropriate * Encourage fluids if not contraindicated * Complete antibiotics ⸻ Renal Failure Major problems: Think: * Fluid overload * Electrolyte imbalance * Acid-base imbalance * Uremia * Anemia Possible findings: * Edema * Hypertension * Fatigue * Decreased urine output * Nausea * Confusion Particularly important: Hyperkalemia can cause life-threatening dysrhythmias. ⸻ Dialysis Hemodialysis Blood is filtered through a machine. Assess: * Weight * BP * Fluid status * Access site AV fistula Remember: “Feel + Hear” * Thrill → feel it * Bruit → hear it Protect the access: * No BP on that arm * No blood draws on that arm when avoidable * Don’t compress unnecessarily ⸻ Incontinence Types: Stress → coughing/sneezing Urge → sudden strong urge Overflow → bladder doesn’t empty Functional → can’t get to toilet Mixed → combination Management depends on cause. ⸻ 🫁 6. RESPIRATORY SYSTEM COPD Includes chronic bronchitis and emphysema. Common: * Dyspnea * Chronic cough * Sputum * Wheezing * Reduced exercise tolerance Nursing: * Position upright * Pursed-lip breathing * Energy conservation * Smoking cessation * Oxygen as prescribed * Inhaler technique Don’t automatically assume oxygen should be withheld from COPD patients. Oxygen is prescribed/titrated according to the patient’s clinical status and target saturation. ⸻ Asthma Usually reversible airway obstruction/inflammation. Symptoms: * Wheezing * Cough * Dyspnea * Chest tightness Rescue medication Short-acting bronchodilator, e.g. salbutamol. Controller Often: Inhaled corticosteroid Severe attack Red flags: * Difficulty speaking * Severe respiratory distress * Exhaustion * Altered LOC * Silent chest Silent chest = very serious. ⸻ Pneumonia Signs: * Fever * Cough * Sputum * Dyspnea * Crackles * Pleuritic chest pain Nursing: * Oxygen if needed * Antibiotics if bacterial/ordered * Hydration if appropriate * Mobilization * Cough/deep breathing * Monitor respiratory status ⸻ Lung Cancer Risk factors: * Smoking * Environmental/occupational exposures Symptoms: * Persistent cough * Hemoptysis * Weight loss * Dyspnea * Chest pain ⸻ Tuberculosis Classic: * Persistent cough * Fever * Night sweats * Weight loss * Possible hemoptysis Nursing priority Airborne precautions for suspected/confirmed infectious pulmonary TB according to institutional policy. ⸻ Atelectasis Collapsed alveoli, often after surgery. Prevention: * Deep breathing * Coughing * Incentive spirometry * Early mobilization * Adequate pain control ⸻ Pneumothorax Air in pleural space → lung collapse. Possible: * Sudden dyspnea * Chest pain * Decreased/absent breath sounds Tension pneumothorax Emergency. May cause: * Severe respiratory distress * Hypotension * Distended neck veins * Tracheal deviation * Cardiovascular collapse Requires immediate emergency treatment. ⸻ Hemothorax Blood in pleural space. Think: Respiratory compromise + blood loss. Chest tube may be required. ⸻ 🦴 7. MUSCULOSKELETAL Osteoporosis Loss of bone density. Risk: * Fractures * Vertebral compression * Hip fracture Prevention: * Weight-bearing activity * Calcium/vitamin D as appropriate * Fall prevention * Avoid smoking * Limit excessive alcohol ⸻ Fractures Priority: ABCs → bleeding → neurovascular status Assess the 6 Ps: * Pain * Pallor * Pulselessness * Paresthesia * Paralysis * Poikilothermia/coolness Neurovascular assessment is critical. ⸻ Arthritis Osteoarthritis Think: Wear and tear * Pain with activity * Stiffness * Often affects weight-bearing joints Rheumatoid arthritis Think: Autoimmune * Symmetrical joint involvement * Morning stiffness * Systemic effects ⸻ Scoliosis Abnormal lateral curvature of spine. Assess: * Posture * Shoulder/hip asymmetry * Spinal curvature * Respiratory effects if severe ⸻ Multiple Sclerosis Autoimmune demyelinating disease affecting CNS. Possible: * Weakness * Fatigue * Visual disturbances * Sensory changes * Balance problems * Bladder dysfunction Important nursing concept: Fatigue and heat can worsen symptoms. ⸻ 🦠 8. INFECTION/IMMUNE SYSTEM MRSA Methicillin-resistant Staphylococcus aureus. Key: * Resistant to several antibiotics * Contact precautions may be required * Strict hand hygiene ⸻ VRE Vancomycin-resistant enterococci. Key: * Resistant organism * Contact precautions according to facility policy * Hand hygiene * Environmental cleaning ⸻ C. difficile Often associated with antibiotic exposure. Symptoms: * Frequent watery diarrhea * Abdominal cramping * Fever VERY IMPORTANT Soap and water handwashing is preferred because alcohol-based hand sanitizer does not reliably kill C. difficile spores. Use appropriate contact/spore precautions according to facility policy. ⸻ Influenza * Fever * Cough * Myalgias * Fatigue * Headache Prevention: Annual vaccination + respiratory hygiene. ⸻ Sepsis Think: Infection + organ dysfunction Potential signs: * Fever or hypothermia * Tachycardia * Tachypnea * Altered mental status * Hypotension * Reduced urine output * Elevated lactate Nursing priority Recognize early and escalate rapidly. Expect: * Cultures * Lactate * IV fluids when indicated * Prompt antimicrobials when sepsis is suspected * Source control * Frequent reassessment ⸻ 🔬 9. DIAGNOSTIC TESTS Don’t memorize only the test. For every test ask: 1. Why is it being done? 2. What does it tell me? 3. What does the nurse do before? 4. What does the nurse do after? 5. What complications should I watch for? ⸻ CT Uses X-rays to create detailed cross-sectional images. Contrast may be used. Nursing: * Check allergies/previous contrast reactions * Assess kidney function when appropriate * Follow contrast-specific instructions ⸻ MRI Uses magnetic field. NO metal/unsafe metallic objects. Assess: * Implanted devices * Metal fragments * Claustrophobia ⸻ X-ray Useful for: * Fractures * Chest conditions * Some abdominal problems ⸻ Ultrasound Uses sound waves. Common: * Pregnancy * Abdomen * Pelvis * Blood vessels No ionizing radiation. ⸻ Mammogram Breast imaging for screening/assessment. ⸻ Endoscopy Allows direct visualization of GI tract. Nursing: * Usually NPO beforehand * Sedation may be used * Monitor airway and vital signs afterward * Ensure gag/swallow reflex has returned before oral intake when applicable ⸻ Bronchoscopy Visualizes airways. Post-procedure: * Monitor respiratory status * Watch for bleeding * Keep NPO until protective reflexes return if sedated/topical anesthetic used ⸻ Pulmonary Function Tests Measure lung function. Important for: * Asthma * COPD * Other pulmonary disorders ⸻ 🧪 10. LABORATORY VALUES For exams, know what the lab means, not just the number. CBC Hemoglobin/Hematocrit Think: oxygen-carrying capacity Low → anemia/bleeding/etc. WBC Think: infection/inflammation/immune response Platelets Think: clotting Low → bleeding risk. ⸻ INR Measures effect of warfarin therapy. Higher INR generally = increased anticoagulation and bleeding risk. Monitor for: * Bleeding * Bruising * Hematuria * Melena ⸻ Glucose Think: current blood glucose ⸻ HbA1c Think: “3-month-ish glucose picture.” Used for longer-term diabetes management. ⸻ BUN + Creatinine Think: Kidney function. Creatinine is particularly useful when evaluating renal function. ⸻ GFR Estimates kidney filtration. Lower GFR generally = worse kidney function. ⸻ Electrolytes Sodium Think: water balance + neurological function Potassium Think: heart rhythm Abnormal potassium can cause dangerous dysrhythmias. Calcium Think: bones + muscles + nerves ⸻ Cholesterol LDL “Lousy” cholesterol Higher LDL → increased cardiovascular risk. HDL “Healthy” cholesterol Generally protective. ⸻ Urinalysis Can help identify: * UTI * Protein * Blood * Glucose * Ketones * Kidney problems ⸻ Culture & Sensitivity Culture = What organism? Sensitivity = Which antibiotic is effective? ⸻ 💊 11. PHARMACOLOGY For every medication, memorize: Class → Why given → Major adverse effects → Contraindications/precautions → Nursing assessments → Patient teaching ⸻ Acetaminophen (Tylenol) Used for: * Pain * Fever Major concern: Liver toxicity with excessive dosing. ⸻ NSAIDs Examples: * Ibuprofen * Naproxen Watch for: * GI bleeding * Kidney injury * Fluid retention * Cardiovascular risks ⸻ Morphine Opioid. Watch: * Respiratory depression * Sedation * Hypotension * Constipation * Nausea Antidote for opioid-induced respiratory depression: Naloxone ⸻ Antibiotics Key nursing principle: Complete the prescribed course unless directed otherwise. Watch: * Allergic reactions * Diarrhea * Superinfection * C. difficile ⸻ Warfarin (Coumadin) Anticoagulant. Monitor: INR Major complication: Bleeding Teaching: * Consistent vitamin K intake rather than suddenly changing intake * Drug interactions matter * Report unusual bleeding ⸻ Heparin Anticoagulant. Monitor: * Bleeding * Platelets * aPTT for unfractionated heparin, depending on protocol Major complication: Bleeding Important adverse reaction: HIT – heparin-induced thrombocytopenia ⸻ Insulin Major adverse effect: HYPOGLYCEMIA Know: * Onset * Peak * Duration * Administration technique * Glucose monitoring ⸻ Nitroglycerin Used for angina. Can cause: * Headache * Hypotension * Dizziness Avoid with PDE-5 inhibitors. ⸻ Digoxin Remember: “Slow heart + low potassium = danger.” Monitor: * Apical pulse * Potassium * Signs of toxicity ⸻ Diuretics Example: Furosemide (Lasix) Causes: * Increased urine output * Decreased fluid volume Watch: * BP * Electrolytes * Dehydration * Potassium ⸻ Corticosteroids Example: Prednisone Long-term effects: * Infection risk * Hyperglycemia * Osteoporosis * Fluid retention * Skin changes * Adrenal suppression Do not abruptly stop long-term corticosteroids without medical direction. ⸻ Bronchodilators Example: Salbutamol Can cause: * Tremor * Tachycardia * Nervousness ⸻ Inhaled corticosteroids Important: Rinse mouth after use. Helps prevent oral candidiasis. ⸻ Statins Example: Atorvastatin Used to lower cholesterol. Watch: * Muscle pain/weakness * Liver-related adverse effects ⸻ Stool medications Psyllium Bulk-forming. Requires adequate fluid intake unless contraindicated. Docusate Stool softener. Stimulant laxatives Increase intestinal motility. ⸻ 🧠 12. NEUROLOGICAL Seizure During seizure: Protect, don’t restrain. * Protect from injury * Turn to side if possible * Protect airway * Remove nearby hazards * Don’t put anything in mouth * Time the seizure After: * Assess airway * Vital signs * Neurological status * Document characteristics Status epilepticus Emergency. ⸻ Increased Intracranial Pressure Think: Headache + vomiting + decreased LOC + pupil changes Late sign: Cushing’s triad * Increased BP/widened pulse pressure * Bradycardia * Irregular respirations Nursing: * Elevate head as ordered * Maintain neutral neck alignment * Avoid unnecessary stimulation * Monitor neurological status * Prevent hypoxia/hypercapnia ⸻ Parkinson’s Disease Classic: TRAP T – Tremor R – Rigidity A – Akinesia/bradykinesia P – Postural instability Nursing: * Fall prevention * Mobility support * Medication timing * Swallowing assessment * Nutrition ⸻ Spinal Cord Injury Priority: Airway + breathing + immobilization + neurological assessment Possible complications: * Neurogenic shock * Autonomic dysreflexia * Respiratory compromise * Loss of bowel/bladder control * Pressure injuries Autonomic dysreflexia Usually associated with injuries at/above T6. Signs: * Sudden severe hypertension * Headache * Flushing/sweating above injury * Bradycardia Priority: Sit patient upright and identify/remove the trigger. ⸻ 👁️ 13. SENSORY Cataracts Clouding of lens. Symptoms: * Blurred vision * Glare * Reduced visual acuity Treatment: Surgical removal when significantly affecting vision. ⸻ Glaucoma Optic nerve damage often associated with increased intraocular pressure. Key distinction: Glaucoma → pressure/optic nerve Cataract → cloudy lens Acute angle-closure glaucoma: * Severe eye pain * Headache * Halos * Nausea/vomiting * Red eye Emergency. ⸻ Hearing Loss Conductive Problem with sound transmission through outer/middle ear. Sensorineural Problem involving inner ear/auditory nerve. Communication: * Face patient * Speak clearly * Don’t shout * Reduce background noise * Verify understanding ⸻ 🔥 14. BURNS Think: Airway → Breathing → Circulation Inhalation injury Red flags: * Facial burns * Soot * Singed nasal hairs * Hoarseness * Stridor * Carbonaceous sputum Airway edema can worsen rapidly. ⸻ Burn priorities * Airway * Breathing * Circulation * Fluid resuscitation for significant burns * Pain management * Infection prevention * Temperature control * Nutrition * Wound care ⸻ 15. WOMEN’S & MEN’S HEALTH Menopause Decrease in estrogen. Common: * Hot flashes * Night sweats * Sleep problems * Vaginal dryness * Mood changes Long-term: * Bone loss * Cardiovascular considerations ⸻ Birth Control Know: * Effectiveness * How it is used * Contraindications * STI protection Most hormonal birth control does NOT protect against STIs. Condoms help reduce STI transmission. ⸻ STIs Examples: * Chlamydia * Gonorrhea * Syphilis * HPV * Herpes * HIV Nursing: * Testing * Treatment adherence * Partner notification/treatment when appropriate * Safer sex education * Prevention ⸻ Breast Cancer Warning signs: * New breast lump * Skin changes * Nipple changes/discharge * Axillary lymph node changes Know current screening recommendations and individual risk factors. ⸻ Prostate Cancer Possible: * Urinary hesitancy * Weak stream * Frequency * Hematuria Important: Early prostate cancer may have no symptoms. ⸻ 🚨 16. EMERGENCY NURSING Shock Basic concept: Tissues aren’t receiving enough oxygen/perfusion. Signs: * Tachycardia * Hypotension * Altered LOC * Cool/clammy skin in many shock states * Decreased urine output * Tachypnea Major types Hypovolemic → blood/fluid loss Cardiogenic → pump failure Distributive → vasodilation (e.g., septic/anaphylactic) Obstructive → obstruction to circulation Priority: ABCs + identify/treat cause + restore perfusion. ⸻ Hemorrhage Look for: * Tachycardia * Hypotension * Pallor * Weakness * Decreased LOC * Decreased urine output Priority: Control bleeding + support circulation + escalate. ⸻ Anaphylaxis Severe allergic reaction. Signs: * Airway swelling * Wheezing * Dyspnea * Hypotension * Hives * GI symptoms FIRST-LINE MEDICATION: IM epinephrine Do not delay epinephrine while waiting for other treatments. ⸻ 💧 17. FLUID & ELECTROLYTES Dehydration Signs: * Thirst * Dry mucous membranes * Tachycardia * Hypotension * Poor skin turgor * Decreased urine output * Weight loss ⸻ Fluid overload Signs: * Edema * Crackles * Dyspnea * Weight gain * JVD * Hypertension ⸻ Potassium Hypokalemia Think: Weak + irregular heart Causes: * Diuretics * GI losses Hyperkalemia Think: Dangerous heart rhythm Causes: * Renal failure * Tissue breakdown * Certain medications ⸻ Acid-Base Use: ROME Respiratory = Opposite Metabolic = Equal Examples: Respiratory acidosis CO₂ ↑ → pH ↓ Respiratory alkalosis CO₂ ↓ → pH ↑ Metabolic acidosis HCO₃ ↓ → pH ↓ Metabolic alkalosis HCO₃ ↑ → pH ↑ ⸻ 👶 MATERNAL-CHILD NURSING Prenatal Care Monitor: * Maternal vital signs * Weight * Blood pressure * Urine * Fetal growth * Fetal heart rate * Laboratory screening * Risk factors Important warning signs: * Vaginal bleeding * Severe headache * Visual changes * Severe abdominal pain * Fluid leakage * Decreased fetal movement * Sudden swelling/other signs of hypertensive disorders ⸻ Fetal Development High-yield concept: First trimester → organ formation Second trimester → growth and development Third trimester → maturation and preparation for birth ⸻ Labour Stage 1 Onset of true labour → complete cervical dilation. Stage 2 Complete dilation → birth of baby. Stage 3 Birth of baby → delivery of placenta. Stage 4 Immediate postpartum recovery. ⸻ Apgar At approximately 1 and 5 minutes. A P G A R A – Appearance P – Pulse G – Grimace A – Activity R – Respiration Each scored 0–2. Apgar helps assess newborn adaptation; it does not by itself diagnose asphyxia or determine long-term prognosis. ⸻ Newborn Assessment Assess: * Respiratory effort * Heart rate * Temperature * Colour * Tone * Feeding * Reflexes * Weight * Head circumference * Urine/stool ⸻ Breastfeeding Benefits: * Nutrition * Immune protection * Bonding Signs of effective feeding: * Good latch * Audible swallowing * Appropriate wet/dirty diapers * Expected weight pattern ⸻ 👶 PEDIATRIC NURSING Development General progression: Head → toe Simple → complex Large muscles → fine motor Always consider developmental stage when communicating with children. ⸻ Pediatric Safety Big priorities: * Falls * Choking * Burns * Poisoning * Drowning * Car-seat safety * Medication dosing * Safe sleep Medication principle Pediatric medications are often based on: weight (kg) Always verify calculations and concentrations. ⸻ Pediatric Asthma Same basic principles as adults: * Bronchodilator for acute symptoms * Controller medications for long-term control * Trigger avoidance * Asthma action plan ⸻ RSV Common in infants/young children. Signs: * Rhinorrhea * Cough * Wheezing * Increased work of breathing * Poor feeding Priority: Respiratory assessment and hydration. ⸻ Croup Classic: Barking cough + stridor Often worse at night. Severe respiratory distress requires urgent intervention. ⸻ Cystic Fibrosis Thick secretions affect lungs and GI system. Think: “Thick mucus + lung infections + malabsorption.” Nursing: * Airway clearance * Nutrition * Pancreatic enzymes when prescribed * High-calorie/high-protein nutrition * Infection prevention ⸻ Gastroenteritis Major concern: Dehydration. Assess: * Wet diapers/urine * Mucous membranes * Tears * Capillary refill * Weight * Activity/LOC ⸻ Pyloric Stenosis Classic: Projectile, non-bilious vomiting Often occurs in young infants. Possible: * Hunger after vomiting * Dehydration * Weight loss ⸻ ASD vs VSD ASD Hole between atria. VSD Hole between ventricles. VSD can produce: A significant murmur and increased pulmonary blood flow. ⸻ Sickle Cell Disease Problem: Abnormal hemoglobin → sickled RBCs → vaso-occlusion and hemolysis. Crisis triggers: * Dehydration * Infection * Hypoxia * Stress Management: * Hydration * Oxygen if hypoxemic * Pain management * Treat infection * Rest * Disease-specific therapies ⸻ Meningitis Think: Fever + headache + stiff neck + altered mental status May also have: * Photophobia * Vomiting * Seizures Emergency. Use appropriate isolation precautions according to suspected organism and institutional policy. ⸻ Hydrocephalus Excess CSF. Infants may have: * Increasing head circumference * Bulging fontanelle * Irritability * Poor feeding * “Sunsetting” eyes Older children: * Headache * Vomiting * Visual changes * Altered LOC ⸻ 🧠 MENTAL HEALTH NURSING Therapeutic Communication DO: * Use open-ended questions * Listen * Reflect * Clarify * Validate feelings * Maintain appropriate boundaries DON’T: * Give false reassurance * Judge * Argue * Give excessive advice * Say “everything will be fine” ⸻ Depression Symptoms: * Persistent sadness * Anhedonia * Sleep changes * Appetite changes * Fatigue * Poor concentration * Feelings of worthlessness * Suicidal thoughts Nursing priority: Assess suicide risk directly. ⸻ Bipolar Disorder Mania * Elevated/irritable mood * Increased energy * Decreased need for sleep * Rapid speech * Impulsivity * Grandiosity Nursing: * Reduce stimulation * Maintain safety * Set clear limits * Encourage nutrition/hydration * Administer medications as prescribed ⸻ Schizophrenia Positive symptoms: * Hallucinations * Delusions * Disorganized speech/behaviour Negative symptoms: * Flat affect * Social withdrawal * Reduced motivation Communication Don’t argue with delusions. Instead: Acknowledge the patient’s feelings while presenting reality. ⸻ OCD Obsessions: Intrusive thoughts Compulsions: Repetitive behaviours/mental acts ⸻ Eating Disorders Watch: * Electrolytes * Cardiac rhythm * Nutrition * Weight * Refeeding complications * Psychological safety ⸻ Substance Use Priorities: * Airway/breathing/circulation * Overdose recognition * Withdrawal * Safety * Nonjudgmental communication ⸻ 🧪 HIGH-YIELD DIAGNOSTIC TEST THINKING When you see a test question, ask: “Why are they ordering this?” Examples: CT head after sudden neurological deficit → looking for bleeding/structural abnormalities. MRI → detailed soft tissue/neurological/musculoskeletal imaging. ECG → electrical activity/ischemia/dysrhythmia. Troponin → myocardial injury. HbA1c → long-term glucose control. Creatinine/GFR → kidney function. INR → warfarin effect. Culture and sensitivity → organism + effective antimicrobial. Pulmonary function test → lung function/obstruction/restriction. ⸻ 💊 PHARMACOLOGY MASTER MEMORY MAP Instead of memorizing 100 medications individually, memorize the danger associated with each class: Drug/Class Think Insulin Hypoglycemia Opioids Respiratory depression Warfarin Bleeding + INR Heparin Bleeding + HIT Furosemide Fluid/electrolyte loss Digoxin Bradycardia/toxicity ACE inhibitors Hyperkalemia + cough/angioedema Beta blockers Bradycardia/hypotension Steroids Hyperglycemia + infection NSAIDs GI bleeding + kidney injury Statins Muscle/liver effects Bronchodilators Tachycardia/tremor Inhaled steroids Oral candidiasis Antibiotics Allergy + C. diff ⸻ 🚨 THE “PRIORITY QUESTION” METHOD When you’re stuck on an exam question, ask: 1. Is the airway threatened? If yes → AIRWAY 2. Is breathing compromised? If yes → BREATHING 3. Is circulation/perfusion compromised? If yes → CIRCULATION 4. Is there an acute neurological deterioration? Think neurological emergency. 5. Is there a safety risk? Falls, suicide, aspiration, seizures, etc. 6. Which patient is deteriorating? Unstable beats stable. ⸻ ⭐ TOP THINGS I WOULD MEMORIZE FIRST If you have limited study time, prioritize these: 🚨 Emergencies * Anaphylaxis → IM epinephrine * Stroke → BE FAST + last known well * MI → ECG + rapid intervention * Sepsis → early recognition + rapid treatment * Tension pneumothorax → emergency * Severe hypoglycemia → rapid glucose treatment * Status epilepticus → emergency * Increased ICP → neurological deterioration * Hemorrhage → control bleeding + perfusion * Severe burns → ABCs 💊 Medications * Insulin → hypoglycemia * Morphine → respiratory depression * Warfarin → INR/bleeding * Heparin → bleeding/HIT * Digoxin → pulse/potassium/toxicity * Furosemide → fluid/electrolytes * Nitroglycerin → hypotension + PDE-5 interaction * Steroids → infection/hyperglycemia * Antibiotics → allergy/C. diff * Inhaled steroids → rinse mouth 🧪 Labs * Hb → oxygen carrying * WBC → infection/immune response * Platelets → bleeding/clotting * INR → warfarin * Glucose → current sugar * HbA1c → long-term glucose * Creatinine/GFR → kidney * K⁺ → heart rhythm * Na⁺ → neurological/fluid balance * Culture → organism * Sensitivity → antibiotic choice 🩺 Nursing skills * Infection control * Medication administration * IVs * Oxygen * Suction * Tracheostomy * Chest tubes * Urinary catheter * Wound care * Ostomy care * Vital signs * Neurovascular assessment * Respiratory assessment ⸻ 📚 How I’d recommend studying this huge syllabus Don’t try to study all of these diseases in one sitting. Use system blocks: Day 1: Diabetes + cardiovascular Day 2: Respiratory + renal Day 3: GI + liver Day 4: Hematology + immune/infection Day 5: Neuro + musculoskeletal Day 6: Maternal/newborn Day 7: Pediatrics Day 8: Mental health Day 9: Pharmacology Day 10: Labs + diagnostics + clinical skills Day 11: Emergency/priority questions Day 12: Full mixed practice exam + review weak areas For each condition, make yourself answer only 5 questions: 1. What is happening? 2. What will I assess? 3. What is the biggest complication? 4. What will I do first? 5. What do I teach the patient? That approach will help you think like a nurse rather than memorize isolated facts, which matches the study framework you were given.

Hypovolemia vs Hypervolemia

Hypercalcemia Clinical Overview

Hyperkalemia and Hypokalemia Clinical Notes

Fluid and Electrolytes: Hypervolemia and Hormonal Regulation

PART 6 — Insulins & Hyperkalemia Cocktail

Hyperkalemia Medical Review

1. 90 kg ağırlığında sağlıklı bir erkek hastanın plazma volümü yaklaşık olarak kaç litredir? C) 4.5 L ✅ 2. 70 kg ağırlığındaki sağlıklı yetişkin bir erkekte, interstisyel (dokular arası) sıvı hacmi yaklaşık olarak kaç litredir? A) 10.5 L ✅ 3. Damar sıvısı ile dokular arasındaki sıvı geçişlerinde, aşağıdaki basınç türlerinden hangisi sıvıyı damar dışına (interstisyel alana) doğru iter? C) Kanın hidrostatik basıncı ✅ 4. Sıvı geçişlerinde, suyun düşük yoğunluktaki ortamdan yüksek yoğunluktaki ortama doğru yarı geçirgen bir zardan geçmesine ne ad verilir? A) Ozmoz ✅ 5. Sağlıklı bir insanda normal plazma ozmolaritesi (osmolalite) değer aralığı aşağıdakilerden hangisidir? B) 275-295 mOsm/kg ✅ 6. Plazma proteinlerinin (özellikle Albümin) normal değer aralığı kaç g/dL'dir? C) 6-8 g/dL ✅ 7. Plazma onkotik basıncını damar içinde tutarak ödem oluşumunu engelleyen temel plazma proteini hangisidir? C) Albümin ✅ 8. Aşağıdakilerden hangisi ödem klinik ayırıcı tanısında yer alan fizyopatolojik mekanizmalardan biri değildir? A) Hidrostatik basınç artışı B) Venöz dönüş bozukluğu C) Onkotik basınç artışı ✅ D) Kapiller permeabilite (geçirgenlik) artışı E) Lenfatik drenaj bozukluğu 9. Aşağıdakilerden hangisi hidrostatik basınç artışına bağlı gelişen ödemin klinik özelliklerinden biri değildir? A) Kısa süreli gode (çukur) bırakması B) Özellikle göz kapaklarında belirgin olması ✅ C) Soluk görünümlü olması D) Anazarka tarzında yaygın olması 10. Aşağıdaki venöz dönüş bozukluklarından hangisi fizyopatolojik tutulum yeri bakımından diğerlerinden klinik olarak farklıdır? A) Travma B) Varis C) Dışarıdan bası (tümör vb.) D) Perikardit ✅ E) Tromboflebit 11. Ödem şikayeti ile kliniğe başvuran bir bireyde, etiyolojiyi belirlemek amacıyla aşağıdaki laboratuvar incelemelerinden hangilerine bakılmalıdır? (1. Kan protein düzeyleri, 2. Tam idrar analizi, 3. 24 saatlik gaitada protein kaybı) B) Hepsi ✅ 12. Aşağıdakilerden hangisi vücut sıvılarındaki ana katyonlardan (pozitif yüklü iyon) biri değildir? A) Sodyum (Na^+) B) Potasyum (K^+) C) Klor (Cl^-) ✅ (Anyondur) D) Kalsiyum (Ca^{2+}) E) Magnezyum (Mg^{2+}) 13. Hücre içi (intrasellüler) ve hücre dışı (ekstrasellüler) alanların ana katyonları sırasıyla hangi şıkta doğru verilmiştir? B) Potasyum (K^+) / Sodyum (Na^+) ✅ 14. HCO_3^- (Bikarbonat) iyonunun normal intravasküler (plazma) değeri kaç mEq/L'dir? C) 24 ✅ 15. Sıvı-elektrolit dengesinde hayati öneme sahip olan Na^+/K^+ ATPaz pompasının bir döngüdeki çalışma mekanizması nasıldır? A) 3 Na^+ dışarı pompalanırken, 2 K^+ hücre içine alınır ✅ 16. Vücutta suyun geri emilimini (reabsorbsiyonunu) tübüllerden doğrudan arttırarak su dengesini sağlayan temel hormon hangisidir? D) Antidiüretik Hormon (Vazopresin) ✅ 17. Kadın ve erkek bireyler arasında total vücut suyu oranının farklı olmasının en temel nedeni aşağıdakilerden hangisidir? C) Vücut yağ dokusu oranı farklılığı ✅ (Kadınlarda yağ oranı yüksek olduğunun göstergesidir) 18. Aşağıdakilerden hangisi hücreler arası potasyum (K^+) geçişini (şift) tetikleyerek "hipokalemiye" yol açan durumlardan biri değildir? D) Aşırı laksatif kullanımı ✅ (Hücre içi şift yapmaz; GİS yoluyla K net uzaklaştırır) 19. Hipertonik dehidratasyon tablosunda serum sodyum (Na^+) düzeyinin klinik olarak hangi seviyede olması beklenir? D) > 150 mEq/L ✅ 20. Hipotonik dehidratasyon klinik tablosunda serum sodyum (Na^+) miktarının ne kadar olması tanı kriteridir? C) 130 mEq/L altı ✅ 21. Aşağıdakilerden hangisi total vücut suyu fazlalığı (hipervolemi) sonucunda dilüsyonel hiponatremiye yol açan klinik durumlardan biridir? A) Glukokortikoid eksikliği ✅ 22. Laktatlı Ringer solüsyonu infüzyonu, aşağıdaki klinik tabloların hangisinde laktik asidoz riskinden dolayı kesinlikle kontrendikedir? C) Karaciğer yetmezliği ✅ (Karaciğer laktatı bikarbonata metabolize edemez) 23. Endotelden salgılanan ve "Endothelium Derived Relaxing Factor" (EDRF) olarak , düz kasları gevşeten en güçlü lokal vazodilatatör molekül hangisidir? B) Nitrik Oksit (NO) ✅ 24. Aşağıda B-Tipi Natriüretik Peptidlerin (BNP) etki mekanizmasına yönelik bilgiler yer almaktadır. Yanlış seçeneği işaretleyiniz. A) BNP, miyokardiyal ve atriyal duvar gerilimine bağlı olarak salınan diüretik etkili bir hormondur. B) Böbreklerde ve periferik dolaşımda sodyum (Na^+) atılımını azaltırlar. ✅ (Doğrusu: Sodyum atılımını arttırır) C) Renin salınımını ve kaskadını baskılarlar. D) Aldosteron salınımını azaltarak tuz tutulmasının önüne geçerler. E) Damar düz kaslarında vazodilatasyona neden olurlar. 25. Aşağıdakilerden hangisi endotel hücrelerinden salgılanan veya endotel bağımlı çalışan lokal "vazodilatatör" (damar genişletici) maddelerden biri değildir? A) Nitrik Oksit B) Adenozin C) Anjiyotensin II ✅ (En güçlü vazokonstriktörlerdendir) D) Prostasiklin (PGI_2) 26. Aşağıdakilerden hangisi Nitrik Oksit (NO) salınımını endotelden doğrudan "uyaran" (tetikleyen) durumlardan biri değildir? D) Katekolaminler ✅ (Damarı kasmaya meyillidir, NO salınımını doğrudan uyarmaz) 27. Aşağıdakilerden hangisi endotel dokusunun vücutta üstlendiği fizyolojik görevlerden veya kontrol mekanizmalarından biri değildir? A) Vasküler tonusun ve damar çapının kontrolünün düzenlenmesi B) Kan basıncının sistemik homeostazının ayarlanması C) İnflamatuar hücre göçünün ve lokal inflamasyonun düzenlenmesi D) Hücre içi kohezyonun (bağlılığın) endotel bariyeri dışından düzenlenmesi ✅ E) Koagülasyon (pıhtılaşma) ve antikoagülan dengenin kontrolü 28. Renin-Anjiyotensin-Aldosteron Sisteminde (RAAS) karaciğer kökenli Anjiyotensinojen'den oluşan Anjiyotensin I'i, biyolojik olarak aktif olan Anjiyotensin II'ye dönüştüren ACE enzimi en yoğun olarak hangi organda sentezlenir? C) Akciğer kılcal damar endoteli ✅ 29. Kalp yetmezliği sürecinde devreye giren nöroendokrin (nörohumoral) kompanzasyon mekanizmalarının uzun dönemdeki kronik "olumsuz" sonuçlarından biri değildir? A) Aşırı sıvı, su ve sodyum birikimine bağlı ödem B) Miyokardiyal patolojik hipertrofi ve ventriküler dilatasyon C) Ölümcül aritmiler ve ani kardiyak ölüm sıklığında artış D) Refleks taşikardi ile birlikte ön ve ard yükte net azalma ✅ (Kompanzasyon ard yükü azaltmaz, vazokonstriksiyon ile arttırır) E) Kalp yetersizliği klinik tablosunun progresyonu (kötüleşmesi) 30. Klinik pratik ve acil tıp departmanlarında, sol kalp yetmezliği / konjestif kalp yetmezliği tanısında ve progresyon takibinde serumda düzeyi en güvenilir artış gösteren biyobelirteç hormon hangisidir? B) BNP ✅ 31. Aşağıdakilerden hangisi endotel bağımlı dilatasyon (gevşeme) fonksiyonlarında bozulmaya (endotel disfonksiyonuna) neden olan klinik tablolardan biri değildir? E) Triptofan yüklenmesi ✅ (Doğrusu modellemede Metiyonin yüklenmesidir) 32. Aşağıdakilerden hangisi şok patofizyolojisinin "Kompanse (Erken)" evresinde vücudun gösterdiği sistemik yanıtlardan biridir? D) Vital organ kan akımını korumak için sistemik vazokonstriksiyon gerçekleşmesi ✅ 33. Aşağıdakilerden hangisi hipovolemik şok tablosundaki bir hastadan alınan kan örneğinin laboratuvar analizinde "görülmesi beklenmeyen" (gözlenmeyen) bir bulgudur? B) Serum bikarbonat (HCO3^-) düzeyinde artış ✅ (Bikarbonat tüketilir, düzeyi azalır) 34. Klinik sıvı/şok tedavisine ve agresif resüsitasyona hiçbir şekilde yanıt vermeyen "refrakter şok" hastalarında, arka planda yatan ve gözden kaçabilecek olası nedenlerden biri değildir? E) Anksiyeteye bağlı çocuksu davranış sergileme ✅ 35. Sistemik vazodilatasyon ve ani kapiller geçirgenlik artışı ile, alerjik bir reaksiyon tetiklediği mediyatörlerle ortaya çıkan anafilaktik şokun etiyolojisinde yer almayan durum hangisidir? E) Kardiyak aritmiler ✅ (Kardiyojenik şok nedenidir) 36. Bradikardi (kalp hızında yavaşlama) ve hipotansiyon birlikteliği ile seyreden, sempatik tonus kaybına bağlı gelişen özel şok tipi hangisidir? B) Nörojenik şok ✅ 37. Aterosklerozun patogenezinde, subendotelyal alana geçen makrofajların modifiye/okside LDL'yi kontrolsüz ve sınırsız bir şekilde yutarak "köpük hücresine" (Foam Cell) dönüşmesini sağlayan temel mekanizma hangisidir? A) Makrofaj yüzeyindeki Çöpçü (Scavenger) reseptörlerinde "down-regülasyon" mekanizmasının olmaması ✅ 38. Ateroskleroz sürecinde, monosit ve T lenfositlerin hasarlı damar duvarına tutunmasını ve içeri sızmasını sağlayan endotel kökenli "ilk önemli yapışkan adezyon molekülleri" hangileridir? B) VCAM-1 ve Selektinler (E-Selektin, P-Selektin) ✅ 39. Rüptür (yırtılma) ve akut tromboz riski taşıyan "Hassas (Unstabil) Plak" ile "Kararlı (Stabil) Plak" karşılaştırmasında hangisi hassas plağın özelliklerinden biri değildir? D) Düz kas hücresi ve kollajen içeriğinin çok zengin olması ✅ (Stabil plağın özelliğidir) 40. Sigara kullanımının ateroskleroz ve koroner arter hastalığı patofizyolojisindeki etkilerine yönelik verilen bilgilerden hangisi biyolojik olarak yanlıştır? A) Geri dönüştürülemez (değiştirilemez) majör bir risk faktörüdür. ✅ (Doğrusu: Değiştirilebilir en önemli faktördür) 41. Aşağıdakilerden hangisi hücre zedelenmesinde "Geri Dönüşümsüz (İrreversibl)" aşamaya geçildiğinin kesin bir morfolojik/biyokimyasal göstergesidir? C) Lizozomların parçalanması ve otolitik enzimlerin serbest kalması ✅ 42. Aşağıdakilerden hangisi hücreyi serbest radikallerin hasarından koruyan "Enzimatik Antioksidan" sınıfında yer alan bir moleküldür? C) Katalaz ✅ 43. Aşağıdakilerden hangisi endojen veya eksojen kaynaklı bir "Serbest Radikal" (Reaktif Oksijen Ürünü) moleküldür? C) Çevre kirleticiler (Ozon, NO_2 vb.) ✅ 44. Aşağıdakilerden hangisi hücresel düzeyde "oksidan/hasar yapıcı" ajanlardan biri değildir? A) Süperoksit Dismutaz (SOD) ✅ (Koruyucu antioksidan enzimdir) 45. Aşağıdakilerden hangisi enzimatik antioksidanlar (SOD, Katalaz, Glutatyon Peroksidaz) arasında "yer almayan" koruyucu yapılardan biridir? E) Koenzim Q10 ✅ (Non-enzimatik antioksidandır) 46. Akut inflamasyonun vasküler (damarsal) fazında gerçekleşen olayların doğru mikroskobik sırası hangisidir? B) Geçici vazokonstriksiyon \ Vazodilatasyon \ Kapiller geçirgenlik artışı ✅ 47. Aşağıdakilerden hangisi akut inflamasyonun vasküler fazından ziyade "Hücresel Fazında" yer alan lökositik olaylardan biri değildir? E) Prostaglandin salınımı ✅ (Kimyasal mediyatördür, hücresel eylem değildir) 48. Doku zedelenmesi oluştuktan sonra, inflamasyon alanına ve hasarlı bölgeye kemotaktik uyaranlarla "ilk giden/akut fazı domine eden" fagositer hücre hangisidir? C) Nötrofil ✅ 49. Paraziter enfeksiyonlarda, alerjik cevap mekanizmalarında ve stresle baş etme süreçlerinde rol oynayan hücre savunma elemanı hangisidir? B) Eozinofil ✅ 50. Aşağıdakilerden hangisi inflamatuar süreçlerin lokal veya sistemik nihai sonucunu etkileyen mikrobiyal/konakçı faktörlerden biri değildir? D) Hücrelerin Pinositoza karşı direnç mekanizması ✅ 51. Aşağıdakilerden hangisi inflamasyon sürecinde lökositlerin yaptığı eylemlerden biri "değildir"? A) Ekzositoz ✅ 52. Aşağıdakilerden hangisi inflamasyon sürecinde görev alan ve ilk salınan "vazoaktif amin" grubu mediyatörlerden biridir? D) Histamin ✅ 53. Akut inflamasyon ile Kronik inflamasyon tablolarını birbirinden ayıran patofizyolojik kriterler arasında yer almayan hangisidir? C) Hastada oluşan psikolojik değişiklikler seviyesi ✅ 54. Asit-Fast (ARB) boyanan, damlacık yoluyla bulaşan ve akciğerlerde kazeifikasyon nekrozu içeren granülomlar (Ghon odakları) oluşturan Tüberküloz (Verem) hastalığının en yaygın etkeni hangisidir? E) Mycobacterium tuberculosis ✅ 55. Diabetes Mellitus (Diyabet) klinik tanısının standardizasyonunda altın standart olarak kabul edilen ve 75 gram susuz glukoz yüklemesiyle yapılan laboratuvar testinin adı nedir? C) Oral Glukoz Tolerans Testi (OGTT) ✅ 56. Bir bireye standart 75 gram OGTT yapıldığında, "Bozulmuş Glukoz Toleransı" (IGT / Prediyabet) tanısı koyabilmek için 2. saat plazma glukoz değeri hangi aralıkta saptanmalıdır? B) 140 - 200 mg/dL arası ✅ 57. Kas ve yağ dokusu hücrelerinde, insülin reseptörüne bağından sonra glukozun hücre içine kolaylaştırılmış difüzyonla taşınmasını sağlayan "insüline duyarlı ana taşıyıcı protein" hangisidir? GLUT-4 ✅ 58. Geriye dönük yaklaşık 3 aylık (120 günlük) ortalama eritrosit ömrü boyunca maruz kalınan kan şekeri düzeyini yansıtan laboratuvar tetkiki hangisidir? C) HbA1c (Glikozillenmiş Hemoglobin) ✅ 59. Pankreasın endokrin fonksiyonunda insülin salınım kaskadını "baskılayan/inhibe eden" hormonal veya fizyolojik durum hangisidir? B) Somatostatin ve Ghrelin hormonları ✅ 60. Tarihte diyabet klinik tedavisinde karbonhidratlardan fakir, proteinden zengin diyet modelini ilk öneren bilim insanı kimdir? John Rollo ✅ 61. Mide mukozasında yer alan Antrumdaki G hücrelerinden sentezlenen, paryetal hücreleri doğrudan uyararak Hidrojen iyonu (H^+ / Asit) salgılanmasını tetikleyen majör hormon hangisidir? Gastrin ✅ 62. Kompleman sisteminin "Klasik Yolunun" (Classical Pathway) aktive olabilmesi için ortamda mutlaka bulunması gereken başlatıcı temel faktör hangisidir? B) Antijen-Antikor Kompleksi (IgG veya IgM yapısında) ✅ 63. Kompleman kaskadının hedef patojen hücre zarında silindirik bir delik açarak ozmotik lize (öldürmeye) neden olan "Membran Atak Kompleksi" (MAK) hangi protein diziliminden oluşur? C) C5b - C9 arası kompleman serisi ✅ 64. Kompleman kaskad sisteminde, her üç aktivasyon yolunun (Klasik, Alternatif, Lektin) da birleştiği, eksikliğinde en ağır ve tekrarlayan bakteriyel enfeksiyon tablolarının görüldüğü merkez protein hangisidir? B) Kompleman C3 ✅ 65. Anne sütüyle bebeğe pasif bağışıklık sağlayan, mukoza yüzeylerinde (gözyaşı, tükürük, havayolu sekresyonları) dimerik yapıda bulunarak ilk savunma bariyerini oluşturan antikor (immünglobülin) tipi hangisidir? A) İmmünglobülin A (IgA) ✅ 66. Kemik iliğinde lökosit serisinin aşırı uyarılması sonucu, periferik yaymada lökosit sayısının lösemiyi taklit edecek şekilde 40.000 - 100.000 / mm^3 sınırına fırlamasına ne ad verilir? B) Lökomoid Reaksiyon ✅ 67. Aşağıdakilerden hangisi insan vücudunda gelişen "Otoimmün" patolojilere (bağışıklık sisteminin kendi dokusuna saldırması) örnek bir hastalık değildir? A) Tip 1 Diabetes Mellitus B) Sistemik Lupus Eritematozus (SLE) C) Romatoid Artrit (RA) D) Tip 2 Diabetes Mellitus ✅ (İnsülin direnci ve reseptör defektlidir, otoimmün değildir) 68. Renin, Anjiyotensin, Aldosteron ve Vazopressin (ADH) salgılanma mekanizmalarıyla ilgili verilen RAAS öncüllerinin Doğru (D) / Yanlış (Y) seçeneği hangisidir? ⁠(D)⁠ Renin jukstaglomerüler hücrelerden salgılanır. ⁠(D)⁠ Anjiyotensin I, akciğerde ACE ile Anjiyotensin II'ye dönüşür. ⁠(Y)⁠ Vazopressin (ADH) ön hipofizden salgılanır. (Doğrusu: Arka hipofizden salgılanır) ⁠(Y)⁠ Aldosteron potasyumu tübüllerden geri emer. (Doğrusu: Potasyumu idrarla atar) Doğru Sıralama Seçeneği: D - D - Y - Y ✅ 69. Dehidratasyon durumunda vücudun verdiği hormonal ve homeostatik yanıt öncüllerinin Doğru (D) / Yanlış (Y) analizi hangisidir? ⁠(D)⁠ ADH (Vazopresin) salınımı artar. ⁠(Y)⁠ Aldosteron salınımı baskılanır. (Doğrusu: Tuz ve su tutmak için artar) ⁠(D)⁠ Susama merkezi uyarılır. ⁠(Y)⁠ Tübüllerden Na ve H_2O reabsorbsiyonu engellenir. (Doğrusu: Geri emilim artar) 70. Mide mukozasının korunmasına yönelik verilen öncüllerin Doğru (D Yanlış (Y) ⁠(D)⁠ Prostaglandinler mukus ve bikarbonat salgısını uyararak mideyi korur. ⁠(D)⁠ NSAİİ (Aspirin vb.) ilaçlar prostaglandin sentezini baskılayarak hasarı artırır. ⁠(Y)⁠ Glukokortikoidler (kortizon) mide mukozasını korur. (Doğrusu: Mideyi korumaz, ülser riskini artırır) 71. Natriüretik Peptitlerin (ANP ve BNP) fizyolojisine yönelik verilen Doğru (D) / Yanlış (Y) klinik sıralaması aşağıdakilerden hangisidir? ⁠(D)⁠ Hem ANP hem de BNP kalp duvar gerilimi (volüm yükü) artınca miyosilerden salınır. ⁠(Y)⁠ ANP, kronik ventriküler basınç artışına bağlı transkripsiyonel regülasyonla salınır. (Doğrusu: Akut gerilmeye yanıt verir) ⁠(D)⁠ RAAS aktivasyonu sırasında ANP ve BNP, bu sisteme ters (zıt) düzenleyici görev yaparak sodyum/su dengesini korur. ⁠(Y)⁠ BNP, atriyal basınçtaki akut mikroskobik değişikliklere bağlı kısa patlamalar halinde salınır. (Doğrusu: Kronik süreçlerde ventrikülden salgılanır) 72. KOAH gelişim mekanizmalarına ve hücresel rollere yönelik verilen klinik? ⁠(D)⁠ Oluşan progressif alveol duvar hasarı amfizem tablosuna neden olur. ⁠(D)⁠ Makrofaj ve nötrofillerden salgılanan proteazlar mukus hipersekresyonuna (kronik bronşit) yol açar. ⁠(D)⁠ CD8^+ T lenfositleri fibroblast aktivasyonu ve havayolu fibrozisinde etkilidir. 73. Aşağıdakilerden hangisi ateroskleroz /evrelerinden biri değildir? Cevap: "Endotel hasarı olmadan doğrudan plak vaskülarizasyonu başlaması" ifadesi yanlıştır. Ateroskleroz endotel hasarı ile başlar. 74. Aşağıdakilerden hangisi endotelin antikoagülan (pıhtılaşma engelleyici) görevlerinden biri değildir? Cevap: Tromboksan A2 (TXA2). Çünkü TXA2 pıhtılaşmayı engellemez; aksine trombositleri kümeleştirir ve damarı kasar. 75. Aşağıdaki moleküllerden hangisi lökositlerin endotele yapışmasını sağlayan moleküllerden değildir? Cevap: Kadherin. Kadherinler hücre içi yapısal bağlantılardır, selektin veya integrinler gibi lökosit adezyon görevi üstlenmezler. 76. Endotel hasarı sonucu aşağıdaki lipitlerden hangisi, endotel hasar bölgesine yapışmaz (Aterosklerozdan sorumlu değildir)? Cevap: HDL. Çünkü HDL yüksek yoğunluklu "iyi" kolesteroldür, damar duvarında plak oluşturmaz, tam tersine temizler. 77. Peptik ülser patofizyolojisinde mukoza hasarında / savunmasında rol oynayan faktörlerden hangisi yanlıştır (agresif/koruyucu)? Cevap: Artmış prostaglandin seviyesi yanlıştır. Prostaglandinlerin artması hasar yapmaz, aksine mukozayı korur. 78. Aşağıdakilerden hangisi kalp yetmezliğinin progresyonu (ilerlemesi) süreçlerini gösteren klinik değişimlerden biridir? Cevap: Miyokardiyal hipertrofi ve dilatasyon, arteriyel ve venöz kan akımında değişiklikler, kapiller hidrostatik basınç artışı. 79. Kalp duvar gerilimi artınca salgılanan Natriüretik Peptitlere (ANP ve BNP) yönelik verilen bilgilerden hangisi doğrudur? Cevap: ANP ve BNP'nin her ikisi de kalp duvar gerilimi artınca salgılanır ve RAAS aktivasyonu sırasında antagonist görev yaparak sodyum ve su homeostazisini sağlarlar. 80. Aşağıda Anjiyotensin II'nin etkileri yer almaktadır. Yanlış olanı işaretleyiniz. Cevap: "ADH salınımını baskılar" ifadesi yanlıştır. Anjiyotensin II su tutmak için ADH'ı baskılamaz, aksine salınmasını uyarır. 81. Aşağıdakilerden hangisi endotel bağımlı vazodilatasyonda (gevşemede) bozulmaya (endotel disfonksiyonuna) neden olan durumlardan biri değildir? Cevap: Kısa süreli fizyolojik egzersiz reaksiyonu. Egzersiz damar fonksiyonlarını bozmaz, iyileştirir. 82. Aşağıdakilerden hangisi ödem klinik ayırıcı tanı fizyolojik mekanizmaları için yanlıştır? Cevap: Onkotik basınç artışı ödem yapar ifadesi yanlıştır. Onkotik basıncın artması sıvıyı damarda tutarak ödemi engeller. 83. Aşağıdakilerden hangisi inflamasyon (iltihap) sürecinde yer alan kimyasal tepkilerden/mediatörlerden biri değildir? Cevap: "Sedimantasyon" veya "Kan Rengi" gibi ifadeler doğrudan kimyasal mediatör değildir (laboratuvar/fiziksel bulgudur). Histamin, Serotonin, Prostaglandin ve Komplemen ise gerçek kimyasal mediatörlerdir. 84. Aşağıdaki vitamin yetersizliklerinden hangisi yara iyileşmesini olumsuz etkileyen genel faktörler arasında en kritiktir (kollajen sentezi kofaktörüdür)? Cevap: Vitamin C ✅ 85. Hücre içine glukoz alımını sağlayan insülden bağımsız, karaciğer hepatositleri ve pankreas beta hücrelerinde glukoz sensörü (algılayıcı) olarak çalışan taşıyıcı protein hangisidir? Cevap: GLUT-2 ✅ 86. Tip 1 Diyabet etiyopatogenezinde majör rol oynayan, genetik yatkınlıktan sorumlu tutulan insan lökosit antijeni (HLA) gen lokusları hangileridir? Cevap: HLA-DR3 ve HLA-DR4 ✅ 87. Diyabet hastalarında insülin direnci gelişimini tetikleyen patolojik süreçler arasında yer almayan durum hangisidir? Cevap: Başarılı bariatrik obezite cerrahisi. (Çünkü obezite cerrahisi insülin direncini tetiklemez, aksine düzeltir). 88. Pnömoni patofizyolojisinde alveolar lümenin nötrofil, fibrin ve eritrositlerle tamamen dolduğu, akciğerin makroskobik olarak karaciğer kıvamını aldığı evre hangisidir? Cevap: Kırmızı Hepatizasyon evresi ✅ 89. Sol kalp yetmezliğinde sol ventrikül pompalama gücü azalınca kanın geriye doğru göllenmesi sonucu ilk olarak hangi klinik tablo gelişir? Cevap: Pulmoner ödem (Akciğer ödemi) ve dispne ✅ 90. Akut faz reaktanı olan ve aterosklerotik plak rüptür riskini, damar sertliği derecesini öngörmede klinik olarak yaygın kullanılan karaciğer kaynaklı protein hangisidir? Cevap: C-Reaktif Protein (CRP) ✅ 91. Aşağıdakilerden hangisi hücrelerin patolojik dış etkenler (iskemi, toksin vb.) sonucu kontrollü olmaksızın şişerek patlaması ile karakterize ölüm şeklidir? Cevap: Nekroz ✅ 92. Hücrenin büyüme sinyallerini kendi kendine üretmesi, apoptotik sinyallerden kaçması ve sınırsız çoğalma potansiyeline sahip olması durumuna ne ad verilir? Cevap: Kanseröz Hücre Dönüşümü ✅ 93. Stresör bir ajanla karşılaşıldığında vücutta nöroendokrin olarak ilk uyarılan ana kontrol merkezi neresidir? Cevap: Hipotalamus ✅ 94. Hipotansiyonu olan bir hastada afferent arteriyollerden salgılanarak RAAS kaskadını başlatan böbrek kökenli enzim hangisidir? Cevap: Renin ✅ 95. İltihaplı bölgede lokal olarak kızarıklık (Rubor) ve sıcaklık (Calor) artışına neden olan temel vasküler olay hangisidir? Cevap: Vazodilatasyon ✅ 96. Aşağıdakilerden hangisi yaralanma sonrası dokunun eski orijinal anatomik yapısını ve hücre tipini tamamen kazanması işlemine verilen addır? Cevap: Rejenerasyon ✅ 97. Kronik havayolu inflamasyonu ve parankim hasarı ile giden KOAH klinik tablosunun patogenezinde elastik lifleri parçalayan ana enzim grubu hangisidir? Cevap: Proteazlar (Elastazlar) ✅ 98. Mide parietal hücrelerinden asit salgılanmasını bloke ederek peptik ülser tedavisinde kullanılan mide koruyucu ajanların fizyolojik hedefi hangisidir? Cevap: H^+/K^+ ATPaz Pompası (Proton Pompası) ✅ 99. Aşağıdakilerden hangisi diyabetin üç klasik kardinal klinik semptomundan (3P) biri değildir? Cevap: Polidaktili (Çok parmaklılık anlamına gelir, diyabetle ilgisi yoktur) 100. Hücreler arası potasyumun hücre dışına net çıkışı sonucu plazmada potasyum yükselmesi (Hiperkalemi) durumuna yol açan metabolik dengesizlik hangisidir? Cevap: Asidoz ✅ (Alkaloz hipokalemi yaparken, asidoz hidrojen-potasyum değişimi ile hiperkalemiye yol açar) 101. Bir doku ya da organın kronik uyaranlar veya kan akımı azalması sonucu hücre hacminin ve boyutunun küçülmesine ne ad verilir? Cevap: Atrofi ✅ 102.Hipotonik bir dehidratasyon (serum\ Na^+ < 130\ mEq/L) tablosunda, osmotik basınç dengesindeki değişim nedeniyle sıvı geçişi hangi yöne doğru gerçekleşir? Cevap: Hücre dışından (ekstrasellüler) hücre içine doğru. ✅ (Gerekçe: Hücre dışı sıvı hipotonik hale geldiğinde, su osmotik olarak daha yoğun olan hücre içine girer ve hücreler şişer). 103. [Kardiyovasküler Slaytı / Ses Kaydı Vurgusu] Sol kalp yetmezliğinde pulmoner kapiller hidrostatik basınç artışı sonucu alveollere sızan eritrositleri yutan hemosiderin yüklü makrofajlara ne ad verilir? Cevap: Kalp hatası/yetmezliği hücresi (Heart failure cell) ✅ 104. [Ateroskleroz Slaytı] Aterosklerotik plağın stabilitesini sağlayan, düz kas hücreleri tarafından sentezlenen ve rüptürü engelleyen en önemli fibröz matriks elemanı hangisidir? Cevap: Kollajen ✅ (Gerekçe: Fibröz kepi kalınlaştırarak plağı kararlı hale getirir). 105. [İnflamasyon Slaytı] Akut inflamasyon alanında lökositlerin endotele tutunması sırasında, lökositlerin yüzeyindeki İntegrinler ile endotel yüzeyindeki hangi molekül "sıkı yapışma" (firm adhesion) fazını gerçekleştirir? Cevap: ICAM-1 / VCAM-1 ✅ (Gerekçe: Selektinler yuvarlanmadan, integrin-ICAM/VCAM etkileşimi ise sıkı yapışmadan sorumludur). 106. [Solunum Slaytı] Kronik Bronşit tanısı olan bir hastada, havayollarında mukus hipersekresyonuna neden olan patolojik anatomik değişiklik aşağıdakilerden hangisidir? Cevap: Submukozal bezlerin hiperplazisi ve kadeh (Goblet) hücre sayısının artması ✅ 107. [İmmünoloji PDF'i] Aşağıdakilerden hangisi Tip II hipersensitivite (Sitotoksik tip) mekanizmasıyla gelişen klinik tablolara bir örnektir? Cevap: Kan transfüzyon reaksiyonları ve Rh uyuşmazlığı ✅ (Eritrosit yüzeyindeki antijenlere karşı gelişen antikor bağımlı sitotoksik reaksiyondur). 108. [İmmünoloji PDF'i / Ses Kaydı] Antijen-antikor komplekslerinin dokularda çökmesi ve kompleman aktivasyonuyla karakterize "Tip III Hipersensitivite" reaksiyonuna en tipik klinik örnek hangisidir? Cevap: Sistemik Lupus Eritematozus (SLE) ve Akut Glomerulonefrit ✅ (SLE, sistemik immün kompleks hastalığıdır). 109. [Diyabet Slaytı] İnsülin reseptör sinyal yolağında, IRS fosforilasyonunu bozarak obezite kaynaklı "insülin direncine" neden olan, yağ dokusundan salgılanan proinflamatuar sitokin/adipokin ikilisi hangisidir? Cevap: TNF-Alfa ve İnterlökin-6 (IL-6) ✅ 110. [IBS-EBH Slaytı] Sadece kolonu ve rektumu tutan, mukozada psödopolip (yalancı polip) oluşumu ve kript abseleri ile karakterize İnflamatuar Bağırsak Hastalığı hangisidir? Cevap: Ülseratif Kolit ✅ 111. [Mide/Siroz Slaytı] Siroz patofizyolojisinde, karaciğer disfonksiyonuna bağlı olarak "Amonyak (NH_3)" gazının üreye dönüştürülemeyip beyne geçmesi ve astreksis ile karakterize nörolojik tabloya ne ad verilir? Cevap: Hepatik Ensefalopati ✅ 112. Vaka 1 (Glukoz Metabolizması Analizi): Rutin tetkik sonucunda açlık plazma glukozu 117 mg/dL ve 75 gr glukozla yapılan Oral Glukoz Tolerans Testi'nde (OGTT) 2. saat kan glukozu 120 mg/dL saptanan hastanın tanısıyla ilgili hangisi doğrudur? Çözüm ve Teşhis: Hastanın açlık kan şekeri 100-125 mg/dL sınırında olduğu için bozuktur; ancak 2. saat şekeri 140 mg/dL'nin altında olduğundan glukoz toleransı normaldir. Bu nedenle hastanın tanısı Bozulmuş Açlık Glukozu (BAG / İzole IFG) şeklindedir. 113. Vaka 2 (Ülseratif Kolit Şiddet Analizi): Ülseratif Kolit teşhisi alan hastada lökosit sayısı normal, günde dörtten az dışkılama, dışkıda kan miktarı az/orta, ateş normal, taşikardi yok, anemi hafif ve sedimantasyon hızı 20 mm/saat altında ise Truelove-Witts tablosuna göre hangi seviyededir? Teşhis: Hafif (Mild) Derece Ülseratif Kolit ✅ Sağlıklı yetişkin bir erkekte vücut ağırlığının %60'ı sudur. Kadınlarda yağ oranının daha yüksek, kas oranının düşük olması nedeniyle bu oran %50 civarına düşer. Hücre İçi Sıvı (İCS): Total suyun 2/3'ünü (%40) oluşturur. Ana katyonu Potasyum (K^+), ana anyonları ise fosfat ve proteinlerdir. Hücre Dışı Sıvı (ECS): Total suyun 1/3'ünü (%20) oluşturur. Kendi içinde İnterstisyel Sıvı (%15) ve İntravasküler Sıvı (Plazma) (%5) olarak ikiye ayrılır. Hücre dışı sıvının ana katyonu Sodyum (Na^+), ana anyonları ise Klor (Cl^-) ve Bikarbonat (HCO_3^-)'tır. Plazmada normal HCO_3^- değeri 24 mEq/L'dir. Sıvı Hareketini Düzenleyen Starling Güçleri Kapiller Hidrostatik Basınç: Kanın damar duvarına yaptığı basınçtır. Sıvıyı damar dışına (interstisyel alana) itmeye çalışır. Plazma Onkotik (Kolloid Osmotik) Basıncı: Plazma proteinlerinin (özellikle Albümin) suyu damar içinde tutma gücüdür. Sıvıyı damar içine çekmeye çalışır. Ödem Oluşum Mekanizmaları 1 Kapiller Hidrostatik Basınç Artışı: Venöz dönüş bozukluklarında (kalp yetmezliği, varis, tromboflebit) kan damarda göllenir ve dokuya sızar. Kalp yetmezliğine bağlı ödemler genelde sistemik, simetriktir ve gode bırakır. 2 Plazma Onkotik Basıncının Azalması: Karaciğer sirozunda (albümin sentezi azaldığında) veya nefrotik sendromda (idrarla protein kaybedildiğinde) damarın suyu tutma gücü azalır ve sıvı dokuya kaçar. Albümin 3.5 g/dL altına düşerse ödem başlar. 3 Kapiller Geçirgenlik (Permeabilite) Artışı: İnflamasyon, yanık veya alerjik reaksiyonlarda (histamin etkisiyle) endotel aralıkları açılır; proteinler ve sıvı dokuya sızar (Eksüda karakterinde ödem). 4 Lenfatik Obstrüksiyon (Tıkanıklık): Tümör basısı veya lenf nodu cerrahisi nedeniyle lenfatik drenaj bozulursa dokular arası sıvı drene edilemez ve lokal ödem (lenfödem) gelişir. ÜNİTE 2: Kardiyovasküler Sistem, RAAS Kaskadı, Natriüretik Peptitler ve Şok Sıvı Azaldığında Devreye Giren Sistem: RAAS Vücutta kan hacmi veya kan basıncı düştüğünde böbrekteki jukstaglomerüler hücrelerden Renin salgılanır. 1 Renin, karaciğerde üretilen Anjiyotensinojen'i Anjiyotensin I'e çevirir. 2 Anjiyotensin I, akciğer endotelinde bulunan ACE (Anjiyotensin Dönüştürücü Enzim) ile Anjiyotensin II'ye dönüşür. 3 Anjiyotensin II'nin Etkileri: * Vücudun en güçlü vazokonstriktör (damar daraltıcı) maddelerindendir. Adrenal korteksten Aldosteron salınımını uyarır (tübüllerden sodyum ve su tutulumu ) Hipofiz arka lobundan ADH (Vazopresin) salınımını uyarır (sadece suyun geri emilimini sağlar) Beyindeki susama merkezini uyarır. Sıvı Artığında Devreye Giren Sistem: Natriüretik Peptitler Kalbe gelen sıvı yükü (volüm yükü) arttığında, kalp duvarı gerilir ve buna yanıt olarak natriüretik peptitler salgılanır: ANP (Atriyal Natriüretik Peptid): Atriyumlardan, basınçtaki akut değişikliklere bağlı olarak salınman bir hormondur. BNP (B-Tipi Natriüretik Peptid): Ventriküllerden, kronik basınç ve volüm yüküne bağlı olarak salınır. Kalp yetmezliğinde serumda düzeyi en çok artan biyobelirteç hormondur. Etkileri: RAAS'ı baskılarlar. Böbrekten sodyum ve su atılımını arttırarak (natriürez ve diürez) kan hacmini ve tansiyonu düşürmeye çalışırlar. Şok Patofizyolojisi ve Evreleri Kompanse (Erken) Evre: Kan basıncını korumak için sempatik sistem ve RAAS aktive olur. Hayati olmayan organ yataklarında (cilt, böbrek, GİS) vazokonstriksiyon gerçekleşir; nabız hızlanır (taşikardi). Progresif (İlerleyen) Evre: Kompanzasyon yetersiz kalır. Hücre metabolizması aerobikten anaerobiğe döner. Laktik asit birikir, metabolik asidoz gelişir. Na^+/K^+ pompası bozulur, hücreler şişer. İrreversibl (Geri Dönüşümsüz) Evre: Lizozomlar parçalanır, hücre içi otolitik enzimler salınır ve yaygın hücre/organ ölümü gerçekleşir. Şok İndeksi: Nabız} / \ Sistolik Kan Basıncı} formülüyle hesaplanır. Normal değeri 0.5-0.7 arasındadır. 1.0 ve üzerinde olması masif kan kaybına (%40 üstü) işaret eder. ÜNİTE 3: Akut İnflamasyon Kaskadı, Eksüda-Transüda Farkı ve Yara İyileşmesi Akut İnflamasyon Fazları Vasküler Faz Sıralaması: Hasar anında ilk olarak saniyeler süren geçici vazokonstriksiyon olur. Ardından lokal kan akımını arttırmak için vazodilatasyon gelişir (kızarıklık ve sıcaklık artışı). Son olarak kapiller geçirgenlik artar ve dokuya protein zengin sıvı (Eksüda) sızar (şişlik/ödem). Hücresel Faz Sıralaması: Lökositlerin hasar bölgesine gitme sürecidir. Sıralama: Marginasyon (Döşenme) \ Rolling (Yuvarlanma) \ Sıkı Yapışma \ Diyapedez (Göç) Kemotaksis \ Fagositoz. Bölgeye ilk giden akut hücre Nötrofil'dir. 1. Derece Yara: Sadece epidermisin yüzeyel kaybı ve güneş yanığı benzeri hafif doku hasarı ile karakterizedir. 2. Derece Yara: Epidermisin tamamen elden çıktığı, bül (su toplanması) oluşumuyla karakterize yüzeyel dermal yanıklardır. Keloid: Granülasyon fazında aşırı ve kontrolsüz kollajen birikimi (hipertrofik skar) sonucu oluşan kabarık tümöral doku yapısıdır. ÜNİTE 4: Solunum Sistemi Fizyopatolojisi (Pnömoni, KOAH ve Tüberküloz) Pnömoninin Patofizyolojik Evreleri 1 Konjesyon Evresi: Mikroorganizmaların alveollere ulaşmasıyla başlar, damarlarda genişleme ve bakteri yüklü sıvı birikimi ile karakterizedir. 2 Kırmızı Hepatizasyon Evresi: Alveollerin fibrin, nötrofil ve bol miktarda eritrosit ile dolarak akciğerin makroskobik olarak karaciğer kıvamını aldığı evre. 3 Gri Hepatizasyon Evresi: Eritrositlerin parçalandığı, fibrinli eksüdanın alveolleri doldurmaya devam ettiği evre. 4 Rezolüsyon Evresi: İyileşme fazıdır. Alveollerdeki debrilerin makrofajlar tarafından temizlendiği dönemdir. Klinik Skorlama: Pnömoni hastalarının hayati riskini belirlemede CURB-65 (Confusion, Urea, Respiratory rate, Blood pressure, Age \ge 65) kriterleri kullanılır. KOAH (Kronik Obstrüktif Akciğer Hastalığı) Kaskadı Patofizyoloji: Sigara kullanımı, koruyucu bir anti-proteaz olan Alfa-1 Antitiripsin aktivitesini inhibe eder (azaltır). Buna bağlı olarak makrofaj ve nötrofillerden salgılanan proteaz (elastaz) aktivitesi artar, alveollerdeki elastik lifler yok olur (elastolizis). Amfizem: Terminal bronşiyollerin arkasındaki hava yollarının kalıcı ve anormal genişlemesi/yıkımıdır. Hava hapsi sonucu hastada Fıçı Göğüs görünümü ve Pembe Üfleyen (Pink Puffer) kliniği oluşur. Kronik Bronşit: En az iki yıl üst üste ve bu yılların en az 3 ayı boyunca balgamlı öksürük ile karakterizedir. Histopatolojisinde submukozal bezlerin hiperplazisi ve Goblet hücre artışı izlenir. ÜNİTE 5: Diabetes Mellitus (Diyabet) Patofizyolojisi ve Tanı Kriterleri Hücresel Düzeyde İnsülin Etki Mekanizması ve Direnç İnsülin, tirozin kinaz aktivitesine sahip spesifik İnsülin Reseptörü'ne bağlanır, hücre içinde IRS (İnsülin Reseptör Substratı) proteinleri aktive olur. Bu kaskad, veziküllerde bekleyen GLUT-4 kapılarının membran yüzeyine göç etmesini tetikler. Kas ve yağ dokusu glukoz almak için insüline (GLUT-4'e) bağımlıdır. Karaciğer ve pankreas beta hücreleri ise insülinden bağımsız çalışan GLUT-2 taşıyıcısını bir glukoz sensörü olarak kullanır. Obezitede İnsülin Direnci: Genişleyen yağ dokusundan salgılanan proinflamatuar sitokinler (TNF-Alfa ve IL-6), IRS proteinlerini tirozin yerine serin rezidülerinden fosforilleyerek insülin sinyal yolağını tamamen bloke eder. Tip 1 vs Tip 2 Diabetes Mellitus Ayrımı Tip 1 Diyabet: Otoimmün kökenlidir. Pankreas beta hücreleri tamamen tahrip olmuştur, insülin üretimi yoktur. Ketozise (DKA) yatkınlık çok yüksektir. HLA-DR3 ve HLA-DR4 gen lokusları ile güçlü ilişkisi vardır. Tip 2 Diyabet: İnsülin üretimi vardır ancak insülin direnci ve reseptör defekti baskındır. Genetik yatkınlık (aile öyküsü) Tip 2'de çok daha güçlüdür. Böbrek Şeker Eşiği ve Semptomlar Kan glukoz düzeyi biyolojik böbrek eşiği olan 180 mg/dL sınırını aştığında, tübüllerden geri emilim yetersiz kalır ve idrarda şeker görülür (Glukozüri). Bu durum renal lümende osmotik basınç yaratarak osmotik diüreze, yani diyabetin 3P semptomuna (Poliüri, Polidipsi, Polifaji) yol açar. ÜNİTE 6: İnflamatuar Bağırsak Hastalıkları (EBH) ve İBS Patolojisi Crohn Hastalığı ve Ülseratif Kolit Makroskobik Ayrımı İrritabl Bağırsak Sendromu (İBS) Yapısal veya biyokimyasal bir bozukluk olmaksızın seyreden, visseral hipersensitivite (bağırsakların uyarılara aşırı hassasiyeti) ile karakterize fonksiyonel bir hastalıktır. Tanısında Roma Kriterleri kullanılır. Beslenme tedavisinde gaz ve şişkinliği azaltmak amacıyla Düşük FODMAP diyeti uygulanır. ÜNİTE 7: Karaciğer Sirozu, Portal Hipertansiyon ve Sistemik Sonuçları Karaciğer parankim dokusunun kronik hasar sonucu fibrozis (kollajenleşme) ve rejenere nodüllerle kaplanarak vasküler mimarisinin bozulmasıdır. Organın fonksiyon kaybına bağlı olarak iki ağır sistemik tablo gelişir: 1. Portal Hipertansiyon ve Asit Mekanizması Karaciğer içindeki sinüzoidlerde vasküler direnç arttıkça, portal ven basıncı yükselir (Portal Hipertansiyon). Karın boşluğunda patolojik sıvı birikmesi (Asit) iki ayağın birleşmesiyle tavan yapar: Hidrostatik Ayak: Portal hipertansiyon nedeniyle periton kılcallarındaki hidrostatik basınç artar ve sıvı karın boşluğuna itilir. Onkotik Ayak: Sirozlu karaciğer plazma proteini olan Albümin'i sentezleyemez. Plazma onkotik basıncı düşer ve damar suyu tutamaz. 2. Hepatik Ensefalopati ve Astreksis Mekanizması [Image showing ammonia metabolism pathway from intestine to liver and brain] Normal şartlarda proteinlerin bağırsakta bakterilerce yıkılmasıyla ortaya çıkan toksik Amonyak (NH_3) gazı, portal venle karaciğere gelerek üre döngüsünde zararsız üreye dönüştürülür. Sirozda parankim çalışmadığı için amonyak temizlenemez, kanda birikir ve kan-beyin bariyerini geçerek beyindeki astrositlerde glutamin birikimine ve Serebral Ödeme yol açar. Klinik Yansıması: Hastada bilinç bulanıklığı, kişilik değişiklikleri ve en tipik motor bulgu olan Astreksis (Kuş kanadı sallama titremesi / Flapping Tremor) tablosu ortaya çıkar.

NCLEX Review: Mental Health Disorders Anxiety Disorders Generalized Anxiety Disorder (GAD) Excessive worry lasting 6 months or more Symptoms: Restlessness Muscle tension Fatigue Poor concentration Sleep disturbance Panic Disorder Sudden intense fear with: Chest pain Palpitations Shortness of breath Feeling of doom Nursing: Stay with client Calm environment Short/simple communication Phobias Irrational fear of object/situation Treatment: Exposure therapy CBT SSRIs sometimes used OCD (Obsessive-Compulsive Disorder) Obsessions = intrusive thoughts Compulsions = repetitive behaviors to reduce anxiety Nursing: Do not suddenly stop rituals Set limits gradually Encourage coping skills PTSD Triggered after traumatic event Symptoms: Flashbacks Hypervigilance Nightmares Avoidance Priority: Safety Trauma-informed care Depression Disorders Major Depressive Disorder Symptoms SIGECAPS: Sleep changes Interest loss Guilt Energy low Concentration poor Appetite changes Psychomotor changes Suicidal thoughts Nursing Priorities Suicide assessment Nutrition/hydration Sleep/rest Medication adherence Medications SSRIs Examples: Sertraline Fluoxetine Teachings: Takes weeks to work Do not stop abruptly Watch for serotonin syndrome Serotonin Syndrome Symptoms: Agitation Fever Tremor Hyperreflexia Diarrhea Bipolar Disorder Mania Symptoms Mnemonic: DIG FAST Distractibility Indiscretion Grandiosity Flight of ideas Activity increased Sleep deficit Talkative Nursing Care Reduce stimulation Set firm limits High-calorie finger foods Encourage rest Medications Mood Stabilizers Lithium Anticonvulsants Lithium Toxicity Therapeutic level: 0.6–1.2 mEq/L Toxic signs: Tremor Vomiting Confusion Ataxia Severe diarrhea Important: Maintain sodium/fluid intake Dehydration increases toxicity risk Schizophrenia Spectrum Disorders Positive Symptoms Things added: Hallucinations Delusions Paranoia Disorganized speech Negative Symptoms Things lost: Flat affect Social withdrawal Anhedonia Lack of motivation Hallucination Nursing Response Present reality “I do not hear the voices.” Assess for command hallucinations Delusions Do NOT argue. Respond: “I understand this feels real to you.” Antipsychotics First Generation Haloperidol Risk: EPS Tardive dyskinesia Neuroleptic malignant syndrome (NMS) Second Generation Olanzapine Risperidone Risk: Weight gain Diabetes Metabolic syndrome EPS Symptoms Acute dystonia Akathisia Parkinsonism Tardive dyskinesia Treatment: Benztropine Diphenhydramine Neuroleptic Malignant Syndrome Medical emergency: Fever Rigidity Confusion Elevated CK Personality Disorders Cluster A Odd/eccentric Paranoid Schizoid Schizotypal Cluster B Dramatic/emotional Antisocial Borderline Histrionic Narcissistic Borderline Personality Disorder Fear of abandonment Splitting staff Self-harm risk Nursing: Consistent boundaries Team communication Cluster C Anxious/fearful Avoidant Dependent Obsessive-compulsive personality disorder Eating Disorders Anorexia Nervosa Severe restriction Distorted body image Bradycardia Electrolyte imbalance Priority: Monitor cardiac status Daily weights Observe after meals Bulimia Nervosa Binge/purge behavior Normal weight often seen Complications: Hypokalemia Dental erosion Substance Use Disorders Alcohol Withdrawal Starts within hours after last drinkd

Extravasation, hemorrhagic cystitis, TLS, hypercalcemia of malignancy (Day 3)

HYPERKALEMIA PROTOCOL

Hypocalcemia/Hypercalcemia & Hypomagnesemia/Hypermagnesemia

Hypokalemia/Hyperkalemia & Hyponatremia/Hypernatremia

3.2 Bone Metastases and Hypercalcemia of Malignancy

NUR 204: EXAM 1 COMPLETE STUDY GUIDE SECTION 1: CANCER PATHOPHYSIOLOGY & EPIDEMIOLOGY Cellular Characteristics • Cancer is uncontrolled cell growth caused by genetic damage. • Apoptosis: The body's natural ability to destroy abnormal or cancerous cells. Malignant cells fail to undergo apoptosis. • Angiogenesis: Malignant cells can create their own blood supply for nourishment, making them very difficult to eliminate. • Progression to Malignancy: Hyperplasia (rapid increase in normal cells) → Dysplasia (abnormal cells) → Carcinoma in situ (localized cancerous cells) → Malignancy. Tumor Types & Staging • Primary vs. Secondary: The primary tumor is where the cancer originated. Secondary tumors are the sites of metastasis (e.g., lung cancer that spreads to the liver means the liver contains secondary tumors). • TNM Staging System: o T = Tumor size. o N = Lymph Node involvement. o M = Metastasis (Spread). • Number Staging (0-4): Stage 0 (In situ, abnormal cells haven't spread) to Stage IV (Distant metastasis, spread to distant body parts). Risk Factors & Prevention (Live Lecture Focus) • Modifiable vs. Non-modifiable: Age, genetics (BRCA mutations), and gender are non-modifiable. Smoking, alcohol, obesity, and sedentary lifestyle are modifiable. • Environmental Factors: o Physical: UV light (tanning beds), radiation. o Chemical: Tobacco, alcohol, workplace pesticides/cleaners. o Biological: Viral infections (HPV causes cervical cancer, Hep B/C causes liver cancer), poor diet. • Nurse's Role in Community Screenings: Skin cancer screenings are highly effective for community health fairs because they are non-invasive. Screening Guidelines • Breast: Mammograms starting at age 40 (earlier if high risk). • Colorectal: Colonoscopy every 10 years starting at age 45. • Prostate: PSA blood screening at age 50. • Tumor Markers: PSA (Prostate) and BRCA1/BRCA2 (Breast). SECTION 2: IMPACT OF CANCER & NURSING CARE Physiological Impacts • Pain: Very common, affecting up to 80% of advanced cancer patients. • Infection/Neutropenia: Dangerously low white blood cells. Live Lecture Note: Any spike in temperature (even a low-grade fever like 100.4°F) is a massive red flag for impending sepsis and must be addressed immediately. • GI Issues: Nausea, vomiting, and mucositis (painful mouth inflammation). For mucositis: avoid spicy/acidic foods and use lidocaine rinses. Cognitive & Psychosocial Impacts • Delirium (HIGH YIELD): Acute, sudden confusion. Live Lecture Note: Delirium is reversible. The nurse must treat the underlying cause. Interventions include reorienting the patient, clustering care, avoiding interruptions, and simulating day/night to regulate circadian rhythms (lights on during the day, off at night). • Financial & Psychosocial: Cancer treatments are grueling and expensive, leading to lost employment and depression. Nurses should facilitate early referrals to social workers and case managers. Nursing Safety & Medication Administration • Extravasation Safety: Vesicant chemotherapy drugs can severely damage tissue if they leak outside the vein. Live Lecture Note: If chemo is given via a peripheral IV, the nurse MUST check for blood return every single hour to prevent extravasation. If extravasation occurs: stop the infusion immediately. • Chemotherapy PPE: The nurse must wear proper PPE (e.g., double gloves, chemo gown, face protection) and dispose of chemo materials in designated hazardous waste bins (e.g., yellow bins). • Neutropenic Precautions (Reverse Isolation): Protecting the highly vulnerable patient from the nurse/visitors. Includes strict hand hygiene, no sick visitors, and avoiding crowds. SECTION 3: ONCOLOGIC EMERGENCIES • Spinal Cord Compression: Early signs include back pain, muscle weakness, loss of sensation, and bowel/bladder incontinence. • Brain Metastasis/Increased ICP: Personality changes, seizures, altered speech/balance. • Hypercalcemia: Confusion, severe muscle weakness, arrhythmias, and ECG changes. • Superior Vena Cava (SVC) Syndrome: Tumor compresses the SVC causing facial/neck edema and dyspnea. • Tumor Lysis Syndrome (TLS): Rapid cell death causes severe electrolyte imbalances (hyperkalemia, hyperuricemia). • SIADH: Tumor triggers excessive antidiuretic hormone (ADH), leading to massive water retention, dilutional hyponatremia, and confusion. SECTION 4: SELECTED CANCERS Lymphedema What is it? A frequent cancer treatment complication where fluid builds up in an extremity (typically on one side), causing severe swelling. • Signs & Symptoms: Swelling, a feeling of heaviness, decreased range of motion, and tightness in the skin. • Common complication of: Breast cancer treatments, specifically resulting from lymph node dissection/removal, radiation therapy, or chemotherapy. • Nursing Priorities & Treatment: o Elevate the affected arm above heart level. o Use compression sleeves as prescribed. o Encourage range-of-motion exercises to prevent stiffness. o ABSOLUTE SAFETY RULE: NO blood pressures, NO IVs, and NO blood draws on the affected arm. • Breast Cancer: o Live Lecture Note: Ductal breast cancer is the most common type (originating in the milk ducts). o Signs: Hard mass, nipple retraction, "orange peel" skin (peau d'orange). o Hormone Receptors: If the tumor is estrogen-receptor positive, treatment must avoid estrogen as it will feed the tumor. o Lymphedema Care: Swelling in the arm due to lymph node removal. Rule: No blood pressures, IVs, or blood draws on the affected arm. Elevate the arm and use compression. • Lung Cancer: o Live Lecture Note: Often asymptomatic in the early stages, leading to late diagnosis. o Signs: Chronic cough, hemoptysis (rust-colored/bloody sputum), dyspnea. High risk for brain metastasis. • Colorectal Cancer: o Live Lecture Note: A hallmark sign is "ribbon-like" or pencil-thin stool, caused by a tumor pressing in the rectum and narrowing the passageway. Other signs: rectal bleeding, changes in bowel habits, anemia. • Pancreatic Cancer (HIGH MORTALITY): o Live Lecture Note: High mortality because early symptoms are incredibly vague; usually caught too late. o Whipple Procedure: Surgery that removes the head of the pancreas but leaves a portion behind so the patient retains some insulin secretion. Nursing Priority: You must strictly monitor for manifestations of diabetes (hypo/hyperglycemia) because pancreatic function is deeply impaired. • Skin Cancer: o Types: Basal cell (slow-growing, sun-exposed areas), Squamous cell (more serious), Melanoma (most deadly, highly metastatic). o Melanoma ABCDEs: Asymmetry, Border irregularity, Color variation, Diameter >6mm, Evolving. • Brain Tumors: o Live Lecture Note: Primary brain tumors are typically benign. Malignant brain tumors have usually metastasized from somewhere else. SECTION 5: INFLAMMATION & IMMUNITY BASICS • Acute vs. Chronic Inflammation: Acute is short-term and protective (redness, heat, swelling, pain). Chronic is prolonged, causing tissue damage. Exam Tip: Chronic inflammation heavily increases the risk for cardiovascular disease. • Infection vs. Inflammation: Inflammation does not always mean infection (e.g., sprains, allergies). Systemic infection signs include fever, tachycardia, and confusion. Rule: Always draw a blood culture before starting antibiotics. SECTION 6: AUTOIMMUNE & INFLAMMATORY DISORDERS Detailed Osteoarthritis (OA) (Live Lecture Focus) • Pathophysiology: OA is a degenerative joint disease causing progressive cartilage breakdown. It is characterized by the friction of "bone on bone" as cartilage degenerates, which leads to the formation of bone spurs and bone cysts (fluid-filled cavities). • Key Distinction: There is NO systemic inflammation; OA is localized to the affected joints. • Risk Factors: Natural wear and tear of aging, trauma, joint overuse (e.g., repetitive work or sports), obesity, genetics, and a sedentary lifestyle. • Complications: Because OA causes a lack of mobility and a sedentary lifestyle, patients are at a highly increased risk for cardiovascular disease, diabetes, and obesity. Patients over 65 should also be screened for iron overload (hemochromatosis), which can accelerate the progression of OA. Patients are also at high risk for depression and anxiety due to loss of independence and chronic pain. • Signs & Symptoms: Joint pain, stiffness, crepitus (cracking of the joints), muscle atrophy, and limited range of motion. • Treatment: o Non-surgical first: Physical therapy, exercise (specifically swimming/water exercises to take pressure off the joints), and weight loss. o Medications: Acetaminophen (monitor for liver toxicity), NSAIDs like ibuprofen/naproxen (monitor for kidney toxicity), and cortisone injections into the joint. o Surgical: Joint replacement (e.g., hip or knee). Nursing Priority: Ambulate the patient right away after surgery to prevent complications. Detailed Rheumatoid Arthritis (RA) (Live Lecture Focus) • Pathophysiology: A chronic autoimmune disease where the body's immune system mistakenly attacks the synovial tissue and fluid in the joints. • Risk Factors: Increased age (highest onset in the 60s), genetics, females (especially those who have never given birth), obesity, smoking, and high stress. o Trigger mechanism: Someone with a genetic susceptibility who experiences an external trigger (like an infection or trauma) can kickstart the autoimmune reaction. • Signs & Symptoms: Symmetric joint swelling and pain (usually in the hands and feet), morning stiffness lasting longer than 1 hour, fever, malaise, and weakness. Patients experience flare-ups (severe symptoms) and remissions (no symptoms). • Rheumatoid Nodules: The most common visible manifestation of RA. These are detachable, movable subcutaneous knots or swellings of varying sizes, typically found in the fingers/hands. • Diagnostics: Elevated ESR and C-reactive protein (CRP) indicate inflammation. Positive Rheumatoid Factor (RF) and ANA (anti-nuclear antibody) blood tests. • Medications & Safety: o Treated with DMARDs (Disease-Modifying Antirheumatic Drugs). o Priority: DMARDs suppress the immune system, putting the patient at a severe risk for infection. o Hydroxychloroquine teaching: Long-term use can cause retinal damage and glaucoma leading to blindness; patients MUST see an optometrist regularly for eye exams. Systemic Lupus Erythematosus (SLE): • Multisystem autoimmune disease attacking self-tissues. • Symptoms: Butterfly rash on the face, photosensitivity, joint pain. • Complications: Cardiovascular disease (pericarditis) and kidney failure (lupus nephritis). • Triggers: Teach patients to avoid UV light/sun exposure, severe stress, exhaustion, and infections to prevent flare-ups. Peritonitis (LIFE THREATENING): • Inflammation of the peritoneum (abdomen). • Symptoms: Rigid, board-like abdomen, rebound tenderness. • Complication: Septic shock and death. SECTION 7: HIV / AIDS & HYPERSENSITIVITY HIV/AIDS: • A retrovirus that specifically targets and destroys CD4 T-cells. • Transmission Phase: The virus is most highly infectious during the initial phase when the viral load is the highest. • Opportunistic Infections: When CD4 drops < 200 (AIDS), the patient is at extreme risk for deadly infections like Tuberculosis, Pneumocystis pneumonia (PCP), and Kaposi sarcoma. • PrEP (Pre-Exposure Prophylaxis): Reduces risk of contracting HIV but does NOT replace safe sex practices (condoms). Risk Factors & At-Risk Populations: o Individuals with multiple sexual partners without protection, and those who share IV drug needles. o Substance use (drugs/alcohol) is a major risk factor because it lowers inhibitions, leading to unprotected sex. o Incarcerated populations or those in closed settings (due to sharing needles, self-tattooing, and sexual violence). o Pregnant or lactating women (due to the risk of perinatal transmission). Phases of HIV Progression: 1. Acute Infection Phase: Occurs 2 to 4 weeks after exposure. The risk of transmission is at its absolute highest because the viral load in the blood is massive. Patients exhibit flu-like symptoms (fever, malaise, fatigue). 2. Chronic Infection Phase: Patients are often asymptomatic, meaning they may not even realize they are infected. They can still transmit the virus if their viral load is high enough. This stage can last for a decade or longer. 3. AIDS: If left untreated, HIV progresses to AIDS. Diagnosis is confirmed when the CD4 T-cell count falls below 200. Immune system damage is severe, creating a very high risk for fatality and opportunistic infections (such as Tuberculosis, Kaposi sarcoma, and fungal infections). • PrEP vs. PEP (Crucial Difference): o PrEP (Pre-Exposure Prophylaxis): Medication taken prophylactically to prevent the transmission of HIV to an HIV-negative person. It does NOT replace safe sex practices (condoms must still be used). o PEP (Post-Exposure Prophylaxis): Medication taken after accidental exposure (e.g., a broken condom, a needle stick injury, or sexual assault). It MUST be taken within 72 hours of exposure to be effective. It is taken daily for 28 days and is not meant for regular, ongoing use. Anaphylaxis: • Severe allergic reaction triggering massive histamine release. • Patho: Causes increased capillary permeability, where blood vessels leak fluid into the tissues, leading to profound hypotension and airway edema. • Priority Treatment: Epinephrine IM. • High-Risk Factor: Patients taking Beta-blockers or Alpha-adrenergic blockers are at a high risk of death because these medications reduce the effectiveness of epinephrine, preventing the reversal of the shock. SECTION 8: INFECTIONS & SAFETY PROTOCOLS Meningitis (SAFETY RULE): • Diagnosed via Lumbar Puncture (testing CSF). • Live Lecture Safety Rule: If the patient shows signs of Increased Intracranial Pressure (ICP) (like severe headache, altered mental status), a CT scan of the head MUST be performed BEFORE a lumbar puncture. Performing a lumbar puncture when ICP is high can cause fatal brain herniation. • Risk Groups: College dorm students, unvaccinated individuals. Lumbar Puncture (Live Lecture Safety Rules) • Purpose: To draw out and test the cerebrospinal fluid (CSF) specifically to screen for and confirm a diagnosis of meningitis. • Position: The patient should be laying on their side with their knees pulled to their chest (fetal position) to help open up the spinal column for needle insertion. • Contraindication & Safety Priority: A lumbar puncture is completely contraindicated if the patient has Increased Intracranial Pressure (ICP). o Rule: A CT scan of the head MUST be performed BEFORE a lumbar puncture to rule out increased ICP. Performing a lumbar puncture on a patient with increased ICP can cause fatal brain herniation Sinusitis: • Inflammation of the sinuses causing facial pressure ("like you got punched in the face"), congestion, and post-nasal drip. • Live Lecture Rule: Treat with hydration, nasal irrigation, and steam. AVOID over-the-counter antihistamines and decongestants because they cause rebound inflammation (making symptoms worse when they wear off). Influenza: • FACTS Mnemonic: Fever, Aches, Chills, Tiredness, Sudden onset. High risk for secondary pneumonia in older adults and pregnant women. SECTION 9: MEDICATIONS HIGHLIGHTED IN LIVE LECTURE 1 Your instructor specifically highlighted these medications and their nursing implications during the recorded lectures: 1. Analgesics & Anti-inflammatories • Opioids (Cancer Pain): A major side effect is delayed gastric emptying and severe constipation. Intervention: Administer stool softeners, encourage hydration and mobility. Monitor for decreased respirations and drowsiness (which creates a fall risk). • Acetaminophen (Tylenol): Used for mild OA pain. Warning: Hepatotoxic (toxic to the liver) if too much is given. • Ibuprofen/Naproxen (NSAIDs): Used for OA/RA inflammation. Warning: Nephrotoxic (toxic to the kidneys) and can cause GI bleeding. • Corticosteroids (Cortisone): Can be injected directly into joints for OA inflammation. 2. Neurological & Emergency Medications • Mannitol: An osmotic diuretic used specifically to lower elevated Intracranial Pressure (ICP) in patients with brain tumors. • Phenytoin & Levetiracetam (Keppra): Anti-epileptic medications used to prevent seizures in patients with brain metastasis/tumors. • Epinephrine: The absolute first-line priority treatment for anaphylaxis. Works to constrict blood vessels and open the airway. • Hydroxychloroquine (DMARD): Used for RA and Lupus. Warning: Can cause retinal toxicity. Patients require regular eye exams (every 6 months) and must use photosensitivity precautions. SECTION 10: SAMPLE QUESTIONS & ANSWERS Q1: The client’s cancer is staged as T1, N2, M1 according to the TNM classification system. How would the nurse interpret this staging? A. One tumor that is nonresponsive to treatment with distant metastasis B. Leukemia indicated that is confined to the bone marrow C. A 2-cm tumor with one regional lymph node involved and no distant metastasis D. Small tumor with extension into two lymph nodes and one site of distant metastasis Answer: D. Rationale: T = small primary tumor, N = extension to regional lymph nodes, M = distant metastasis has occurred. Q2: The nurse is assessing an older client at a checkup visit. Which reported change would alert the nurse to the possibility of colon cancer? A. Pencil-thin stool B. Erectile dysfunction C. Reduced urine stream D. Persistent pain in the lower back and legs Answer: A. Rationale: Tumors growing in the colon/rectum compress the passageway, resulting in ribbon-like or pencil-thin stool. Q3: A nurse is performing a cancer screening assessment on several clients. Which of the following findings is a possible manifestation of cancer? (Select all that apply) A. Temperature 36° C (96.8° F) B. Sore that does not heal C. Difficulty swallowing D. Blood in the urine E. Rhinitis Answer: B, C, D. Rationale: Using the CAUTION mnemonic, signs include sores that do not heal, difficulty swallowing, and unusual bleeding/discharge. Q4: A nurse is caring for a client who has breast cancer. The client asks why the treatment plan contains a combination therapy of three different medications. Which of the following responses should the nurse make? (Select all that apply) A. “Combination chemotherapy decreases the risk of medication resistance.” B. “Combination chemotherapy attacks cancer cells at different stages of cell growth.” C. “Combination chemotherapy increases production of platelets.” D. “Combination chemotherapy stimulates the immune system.” Answer: A, B. Rationale: Using multiple chemo drugs reduces drug resistance and attacks the cell at various phases of the cell cycle. Q5: A nurse is caring for a burn client whose calculated 24-hour intravenous fluid requirements are determined to be 5000 mL. What is the total volume (mL) that the nurse should infuse after the first 8 hours of fluid resuscitation has infused? Answer: 2500 mL. Rationale: Standard burn fluid resuscitation protocols require half (50%) of the 24-hour total to be administered in the first 8 hours following the burn injury. Q6: The nurse is caring for a client who has a systemic infection. What is the best method to prevent infection transmission? A. Obtaining an immunization B. Implementing proper hand hygiene C. Wearing gloves D. Managing the client’s fever Answer: B. Rationale: Strict hand hygiene remains the most effective method for preventing the transmission of infectious organisms. Q7: The nurse is assessing a client with systemic lupus erythematosus (SLE). Which of the following laboratory findings should the nurse anticipate? (Select all that apply) A. Positive ANA titer B. Increased hemoglobin C. Pancytopenia D. Urine positive for protein and RBCs Answer: A, C, D. Rationale: SLE causes an autoimmune response (Positive ANA), bone marrow suppression (pancytopenia), and lupus nephritis, which damages the kidneys causing protein and blood to spill into the urine. Q8: A nurse is providing teaching to a client who is to receive a vaccination following a deep puncture wound to the foot. Which information would the nurse include? A. “You will need to receive this vaccination annually.” B. “Your passive immunity will be boosted by receiving this shot.” C. “I am administering this vaccination to help protect you against tetanus.” D. “This immunization requires three separate injections several weeks apart.” Answer: C. Rationale: Tetanus vaccination is indicated for deep puncture wounds. Q9: A nurse is assessing a client who is being treated with interferon alfa-2b for malignant melanoma. The nurse should identify that which of the following findings are adverse effects of this medication? (Select all that apply) A. Tinnitus B. Muscle aches C. Peripheral neuropathy D. Bone loss E. Depression Answer: B, C, E. Rationale: Interferon therapy causes significant flu-like symptoms (muscle aches, chills), peripheral neuropathy, and mood changes including severe depression. Q10: A nurse is reviewing the medical record of a client. Which of the following findings are risk factors for ovarian cancer? (Select all that apply) A. Previous history of endometriosis B. Family history of colon cancer C. First pregnancy at age 24 D. First period at age 14 E. Use of oral contraceptives for 10 years Answer: A, B. Rationale: Endometriosis and a family history of associated cancers (like colon or breast BRCA mutations) increase the risk for ovarian cancer. (Pregnancy and oral contraceptive use typically decrease the risk). Q11: The nurse is caring for a client whose white blood cell count is 6000/mm3. Which differential value would the nurse discuss with the health care provider? A. Eosinophils 700/mm3 (Reference range: 50–400/mm3) B. Monocytes 500/mm3 (Reference range: 100–800/mm3) C

NURS 348 — EXAM 4 STUDY GUIDE Hypertension Definition & Overview • Persistent elevation of BP ≥130/80 mmHg (systolic at/greater than 130 OR diastolic at/greater than 80) on at least 2 separate visits, 2+ weeks apart. • Primary (Essential): No identifiable cause, most common (90–95% of cases). • Secondary: Caused by another condition or adverse effects of medications. Etiology/Pathophysiology • ↑ Peripheral resistance and/or ↑ cardiac output → ↑ blood pressure → When blood vessels get narrower (increased resistance) or the heart pumps more forcefully (increased output), pressure inside the vessels rises “like squeezing a hose while water is running” → Over time, this high pressure damages the vessel walls and heart muscle, increasing the risk for atherosclerosis, heart attack (myocardial infarction), and stroke. • ↑ Increased peripheral resistance (arteriolar constriction) → ↑ afterload → left ventricular hypertrophy → heart failure → The heart pushes against more resistance (afterload), making the heart muscle thicker (hypertrophy). Over time, it becomes weaker and can lead to heart failure. • Kidneys retain sodium and water → ↑ circulating volume → The kidneys hold onto extra salt and water, adding more fluid to the blood. More fluid means higher pressure—like overfilling a water balloon. • Activation of renin–angiotensin–aldosterone system (RAAS) = vasoconstriction + fluid retention. RAAS is like the “blood pressure booster” → When this system turns on, blood vessels tighten and the kidneys save even more salt and water, both of which raise blood pressure. Risk Factors: • Primary: family history, ↑ sodium intake, Obesity (BMI >25), African-American ethnicity, smoking, hyperlipidemia, diabetes mellitus, and stress. • Secondary: kidney disease, Cushing’s, pregnancy, pheochromocytoma, medic (steroids, OCPs). Clinical Manifestations (S/S) • Often asymptomatic (“silent killer”)!!! • Headache, dizziness, fainting, vision changes • Retinal damage on exam (cotton wool spots, papilledema). • Note: if blood pressure reading is elevated then take in both arms; pt legs uncrossed, and arms above heart; correct cuff Diagnostics (Dx)/Labs • Multiple BP readings (both arms, sitting and standing) • ECG → Left-Ventricular hypertrophy. evaluates cardiac function. • Labs → ↑ BUN/creatinine (kidney disease), lipids, glucose, cortisol (Cushing’s) Nursing Care / Nursing Interventions • Monitor pt BP regularly and accurately, check both arms/correct cuff • Put on DASH diet (Dietary Approach to Stop Hypertension) Medications • ⭐️Diuretics (first-line): excess fluids, they need to remove; increase urine • Thiazides (hydrochlorothiazide) inhibits water & sodium reabsorption and increases potassium excretion • Side effects/SE: hypokalemia; monitor potassium(K⁺) levels • Loop (furosemide) decreases sodium reabsorption & increase potassium excretion– SE: hypokalemia; monitor potassium(K⁺) levels • Potassium-sparing (spironolactone) – SE: hyperkalemia; monitor potassium levels. EKG: peaked T waves • Also watch out for muscle weakness, irregular, pulse, and dehydration. • ⭐️Calcium channel blockers (verapamil, amlodipine, and diltiazem) Calcium channel blockers relax and widen blood vessels by preventing calcium from entering muscle cells, leading to lower blood pressure (vasodilation) • SE: constipation; take fiber for verapamil, and all can ↓HR • Avoid grapefruit juice ➡️ toxicity, hypotensive effects Calcium= contract • ⭐️ACE inhibitors (lisinopril, enalapril): prevents angiotensin II → vasodilation • SE: - hypotension; monitor BP and pulse HR -hyperkalemia; monitor potassium levels -erectile dysfunction -⭐️cough linked to angioedema (swollen tissue under the skin around lips, tongue, and glottis); report swelling & discontinue med • ⭐️ARBs (valsartan, losartan): for ACE-intolerant pts from cough/hyperkalemia. ARBs lower blood pressure by blocking angiotensin II from binding to its receptors, preventing vasoconstriction, and reducing fluid retention. • SE: angioedema, heart failure, hyperkalemia • Change position, slowly, report, angioedema, edema, and avoid foods that are high in potassium (bananas, potatoes, apricots, spinach, beans); monitor potassium levels • Aldosterone-receptor antagonists (eplerenone, spironolactone): blocks aldosterone action. • SE: kidney damage, hypertriglyceridemia, hyponatremia, and hyperkalemia; monitor kidney function, triglycerides, sodium, and potassium levels • Avoid Grapefruit juice and St. John’s wort, salt substitutes, and potassium rich foods • ⭐️Beta blockers (metoprolol, atenolol): blocks beta receptors (adrenaline/epinephrine) ➡️reduces heart rate, cardiac output, and blood pressure ↓HR, ↓CO; use cautiously in diabetics • SE: -⭐️erectile dysfunction, -Fatigue, weakness, depression -hypoglycemia • Monitor heart rate (hold if HR is less than 60) and do not suddenly stop taking med (cause rebound hypertension); and don’t give to pts with asthma, airway disease (cause bronchospasms) • Central Alpha-2 agonists (clonidine): calm the nerves that raise blood pressure, letting blood vessels, relax, and BP go down, ↓SNS tone • SE: sedation, orthostatic, hypotension, and sexual dysfunction/impotence • Monitor BP and pulse • Alpha-adrenergic blockers (prazosin, doxazosin): vasodilator= relaxed BP; give at night to avoid first-dose hypotension. Start with low dose. • SE: postural hypotension; make sure patient rises slowly and caution. • Monitor BP 2 hrs after initiation Complications • Hypertensive Crisis: usually when patients do not follow the medication regimen • BP >180/120 → organ damage (encephalopathy, renal failure) • S/S: severe headache, dizziness, blurred vision, confusion, epistaxis • Treat: IV antihypertensives (nitroprusside, nicardipine, labetalol); the goal is to lower BP gradually by 20-25% in first hour. Not less than 140/90. Monitor BP every 5-15 mins Patient Education • Adhere to medication regimen, don’t abruptly stop even when you feel better • Change positions slowly • Encourage DASH diet (low sodium, high fruits/veggies, low-fat dairy) ex: grilled salmon, brown rice, steamed broccoli, and low-fat milk • Avoid high-sodium foods. Consume less than 2.3 g/day • Monitor BP at home • Report signs or symptoms of electrolyte imbalances • Encourage Weight loss, exercise 3x weekly • Encourage Smoking cessation • Encourage Limit alcohol (≤2/day men, ≤1/day women) • Manage stress • Report persistent cough or swelling (ACE inhibitor red flag) Peripheral Venous Disorders(PVD) Patho: problems with veins where Deoxygenated blood can't get back to the heart Oxygenated blood pools in the extremities. The valves are preventing backflow. • Venous Thromboembolism (VTE): blood clot that starts in a vein. -Two types: deep vein thrombosis (DVT) and pulmonary embolism (PE) • Venous insufficiency: Improper functioning of the veins. Veins aren’t able to push back blood to the heart which results in swelling, venous stasis ulcers, or cellulitis. Blood can go down into the veins just fine but cannot come back up. a. VTE ex: Deep Vein Thrombosis (DVT) Pathophysiology • Thrombus (Blood clot) forms in deep veins (usually in legs) → can embolize (travel and block vessel) its way to lungs (PE). • Caused by Virchow’s triad: venous/blood flow stasis, endothelial injury, hypercoagulability. Risk Factors • Surgery (hip, knee, prostate) • Immobility • Heart failure • Pregnancy • Family hx • Oral contraceptives or hormone therapy • Cancer • COVID-19 (elevated D-dimer) • Central venous catheters Clinical Manifestations • Note that clients can be asymptomatic • Calf/groin pain (dull/achy), tenderness, warmth, edema • Unilateral swelling • Shallow, irregular shaped wounds • Too much blood, brown/yellow discoloration • Sudden SOB and sharp chest pain → suspect PE • Positioning: “Elevate Veins”, position up in “V” shape, above heart. Worsens: if dangling, sitting/dangling for long periods of time. Diagnostics • ⭐️Venous duplex ultrasonography = gold standard; it’s an ultrasound of Leg to see blood clot/blood flow through the vessel. • ⭐️D-dimer ↑ = clot breakdown evidence • Venogram/MRI if ultrasound inconclusive Nursing Interventions • Bed rest until anticoagulation started • Elevate leg slightly above heart (no knee gatch). Positioning: “EleVate Veins”, think V as veins are up, to keep the veins open. • Warm compresses • DO NOT massage leg • Compression stockings (after swelling ↓) • Encourage early ambulation when safe • SCDS Medications/Procedures (Anticoagulants) stops blood from clotting, another nurse must be with you • Unfractionated heparin (given IV): prevents clots and growth of existing clot; monitor platelets, and aPTT (how long it takes blood to clot) (1.5–2× normal). Must be given in facility. MUST MONITOR CLOSELY • Antidote: protamine sulfate • Low-molecular-weight heparin (Lovenox/enoxaparin): given SubQ, weight-based, prevention and treatment of DVT, given twice daily, can be used in home setting. Don’t need labs. Monitor for bleeding, and take bleeding precautions (Electric razor, soft toothbrush, environment safety) • Warfarin (Coumadin): oral, inhibits vitamin K clotting factors overlaps; combined with heparin 3–4 days until INR 2–3 (takes awhile to kick in; therapeutic affect) • Antidote: vitamin K • Avoid high vitamin K foods (green leafy veggies) • Monitor PT (range: 11-13.5 secs), INR (must know range: 2–3) • Factor Xa inhibitors (fondaparinux; SubQ) (rivaroxaban, apixaban; oral): Prevents development of Thromboses; transitional medication; initial labs are PT and PTT; not routinely • Direct thrombin inhibitors (dabigatran): directly prevents growth of thrombus Formation, given sub Q ; initiate initial lab values only for PT and APTT. • Antidote: idarucizumab • Thrombolytics (tPA): for massive DVT/PE, directly infused into clot, start within 24hrs- 5 days of clot formation; monitor for bleeding, neuro status, dizziness, headache. Take bleeding precautions, pt must use electric razor and, brush teeth with a soft toothbrush. • Inferior vena cava filter: prevents embolus from reaching lungs (PE), inserted in femoral vein; catches blood clot. Used when pt is unresponsive to other treatments. Monitor: bleeding, hematoma, infection, PE (dyspnea, chest pain, tachycardia). Nursing actions: assess circulation and encourage leg exercises/ambulation early, have patient not sit for too long Anticoagulant Therapy Nurse’s Role • Verify labs,;Double-check with another RN for IV heparin, Assess for bleeding (bruises, gums, stools) and Monitor vitals, mental status (signs of intracranial bleed) Reversal Agents • Heparin → protamine sulfate • Warfarin → vitamin K • Dabigatran → idarucizumab Patient Education • Avoid contact sports • Soft toothbrush, electric razor • Avoid sudden diet changes (vitamin K) Complications (anticoagulants) • ⭐️Pulmonary embolism: sudden dyspnea, chest pain, SOB, anxiety, tachypnea → emergency; sit, patient in high Fowlers, and administer oxygen and anticoagulants • ⭐️Ulcer formation(venous): often formed over the medial malleolus, chronic, hard to heal, can reoccur. Can lead to amputation/death. Neuropathic patients might not feel this. Nursing care: Dressing is left 3–7 days; wound vacuums, diet: high in zinc, protein, iron, and vitamins A and C, debride necrotic tissue so wound can heel. Patient Education(Anticoagulants) • Bleeding precautions (soft toothbrush, electric razor) • Report bruising or black stools • Avoid prolonged sitting/crossing legs • Wear compression stockings b. Venous insufficiency Pathophysiology • Valves and legs are damaged due to prolong venous HTN Our previous blood clot Risk factors: • Sitting/standing in one position for a long period of time • Obesity • Pregnancy • Thrombophlebitis Clinical manifestations: • Status dermatitis(brown discoloration along ankles) • Edema • Stasis ulcers around ankles Labs/DX • D-dimer ↑ = clot breakdown evidence, detects clot Nursing interventions: Elevate legs to increase venous return (20 mins, 4-5/day), position: legs above heart, “Elevate Veins”, Apply stockings, and monitor for cellulitis Patient education: avoid sitting/standing still for too long, change positions often, avoid crossing legs, tight clothing. Apply stockings before getting out of bed in the morning Peripheral Arterial Disease (PAD) : affects blood vessels that carry blood away from the heart; artery carries blood away from heart but has difficulty going down to extremities. Pathophysiology • Atherosclerosis in lower extremities → decreased blood flow to tissues. Risk Factors • Smoking, DM, hypertension, hyperlipidemia, obesity, age, sedentary lifestyle. Clinical Manifestations • Intermittent claudication: leg pain with exercise, relieved by rest; not enough oxygen makes the tissue suffer = pain; ischemia • Pain(sharp) that is only relieved when resting in dependent position • Cool, pale, cyanotic skin • Loss of hair on legs, thick toenails • Weak/absent pedal pulses; dorsalis pedis; Doppler(verify), +1 • Numbness, burning at night • No blood and no edema due to an adequate blood flow • Note: think “A” in PAD as Antarctica, where it’s cold! For cold, pale skin! Diagnostics • ⭐️ABI < 0.9 = PAD; ankle pressure compared to break your pressure; expected finding is 0.9–1.3; less than is PAD • ⭐️Arteriography for visualization of occlusion/decreased arterial flow with contrast injection on a x-ray. Monitor for bleeding, hemorrhage, marked, pedal pulses • Doppler studies → decreased flow in DM patients • ⭐️Exercise tolerance testing → decreased pressure in lower limbs, read the workload of the heart/circulation, and clarification during exercise. May use treadmill or meds (dipyridamole, adenosine). Finding of a BP/pulse waveform = arterial disease. Monitor vitals before, during, and after. Stop test if chest pain or symptoms are severe. Nursing Interventions • Encourage graded exercise until pain, rest, repeat • Avoid elevating legs above heart (impairs flow) • Avoid cold, caffeine, nicotine, tight clothing • Keep extremities warm (no heating pad), they can’t feel • Foot care: inspect daily, no bare feet, toenails straight Medications • Antiplatelets: (aspirin, clopidogrel) reduces blood viscosity and increases blood flow and extremities. Monitor: bleeding, abdominal pain, black, tarry stools. • Statins: (atorvastatin, simvastatin). Relieved manifestations like intermittent claudication. • Pentoxifylline: improves RBC flexibility (claudication). Monitor for bleeding, abdominal pain, black tarry stools. Procedures • Angioplasty (balloon/stent). Opens and helps, maintain the patency of the vessel, however, laser vaporizes atherosclerosis plaque. Monitor for bleeding, vital signs, pulses, cap Refill. As patients rest limbs are straight for 2-6 hrs before ambulation. Anticoagulant/Antiplatelet therapy given 1-3 months after. • Atherectomy rotation, device removes, arterial plaque. Monitor for bleeding and distal pulses. rest limbs are straight for 2-6 hrs. Anticoagulant/Antiplatelet therapy given 1-3 months after. • Arterial revascularization bypass surgery • Used for clients at risk for losing a limb, severe claudication, or limb pain at rest. It reroutes the circulation around the arterial occlusion. • Post-op: ⭐️ maintain adequate circulation in repaired artery, mark pedal/dorsalis pulses(compare both), monitor color/temp, pain, cap refill, blood pressure (HTN= risk for bleeding; Hypotension=clot risk). • Complications: for these notify provider first -graft occlusion: acute blockage of bypass graft within 24 hr(absent pulse, cold foot, increased pain) -compartment syndrome: tissue pressure restricting blood flow; causing ischemia (numbness, tingling, edema, worsening/passive pain) -infection: infection of site (warm, tenderness, elevated, WBC, purulent drainage, use sterile technique) Patient Education • Walk until pain → rest → walk more • Stop smoking • Avoid crossing legs • Diet low in cholesterol and fat Postoperative Care – Peripheral Bypass/Revascularization Priorities • Assess extremity: color, temperature, cap refill, sensation, pulses q15min ×1hr • Mark pedal pulses before surgery • Maintain adequate BP (avoid hypo or hypertension) • Do not flex hip/knee excessively • Encourage ambulation when ordered • Report sudden pain, loss of pulse, pale/cool extremity = graft occlusion Complications • Graft occlusion, Compartment syndrome, Wound infection Arterial vs. Venous Ulcers Feature Arterial Ulcer Venous Ulcer Location Toes, feet, lateral ankle Medial ankle Appearance Pale, dry, round “punched out”, no drainage Irregular, leaky/moist, brown discoloration Pain Severe, worse with elevation Achy, relieved with elevation Skin Cool, shiny Warm, thickened Treatment Improve arterial flow Compression therapy, elevate legs Valvular Heart Disease OVERVIEW Overview • Stenosis = narrowed opening/thickening and hardening • Regurgitation = backflow of blood • Causes: rheumatic fever, degenerative calcification, endocarditis Diagnostics • Chest X-ray → chamber enlargement • ⭐️ECG → hypertrophy • Echo → valve dysfunction • TEE → direct view of valves ⭐️ Medications overview • Diuretics [furosemide, hydrochlorothiazide, spironolactone]: reduce pulmonary congestion, by removing excessive extracellular fluid. Monitor: hypokalemia, eats foods high in potassium, and administer furosemide IV slowly over 1 – 2 minutes. • Afterload–reducing agents [Beta-blockers (-lol); calcium channel blockers (-dipine); ACE inhibitors (-pril); angiotensin–receptor blockers (-artan); vasodilators (hydralazine]): control heart rate, by lessening resistance to contraction. Monitor: hypotension. • Inotropic agents (digoxin): increases contractility, improves cardiac output. Hold medication if pulse rate (abnormal) is less than 60/min or greater than 100/min. Take medication same time every day, avoid combining with antacids (2hrs). Monitor: toxicity such as weakness, confusion, visual changes, low appetite. • Anticoagulants: reduces risk of thrombus. Monitor: stroke, PT, INR, bleeding/bruising. Procedures • Valvuloplasty (balloon dilation) • Valve replacement • Mechanical = lifelong anticoagulants • Tissue = replace every 7–10 years Patient Education • Prophylactic antibiotics before dental procedures • Good oral hygiene • Daily weights • Sodium restriction • Avoid caffeine/alcohol • Report HF signs (weight gain, edema, SOB) • Avoid alcohol, epinephrine, and ephedrine= can cause dysrhythmias THE 4 VALVULAR DISORDERS Mitral Stenosis Etiology/Pathophysiology: Narrowed mitral valve obstructs blood flow from left atrium (LA) → left ventricle (LV), increasing LA pressure and pulmonary congestion → right-sided heart failure. Often caused by rheumatic fever. Clinical Manifestations: Dyspnea on exertion, orthopnea, pitting edema, fatigue, palpitations, hemoptysis, apical diastolic murmur. Risk Factors: Rheumatic heart disease, aging, congenital malformations. Labs/Diagnostics: Echocardiogram (valve narrowing, pressure gradient), ECG (A-fib), chest X-ray (LA enlargement). Medications/Management: • Diuretics [furosemide, hydrochlorothiazide, spironolactone]: reduce pulmonary congestion, by removing excessive extracellular fluid. Monitor: hypokalemia, eats foods high in potassium, and administer furosemide IV slowly over 1 – 2 minutes. • Afterload–reducing agents [Beta-blockers (-lol); calcium channel blockers (-dipine): control heart rate, by lessening resistance to contraction. Monitor: hypotension. • Anticoagulants: reduces risk of thrombus; prevent emboli from A-fib. Monitor: stroke, PT, INR, bleeding/bruising. • Surgical: Balloon valvuloplasty or valve replacement. NCLEX Tip: Rheumatic fever is the most common cause. Mitral Insufficiency Etiology/Pathophysiology: Incomplete closure of mitral valve causes blood to leak back into LA during systole → LV dilation and hypertrophy. Clinical Manifestations: Fatigue, dyspnea, orthopnea, palpitations, holosystolic murmur at apex, pitting edema, S3 sounds Risk Factors: Mitral valve prolapse, rheumatic disease, MI, endocarditis. Labs/Diagnostics: Echocardiogram (regurgitant volume), ECG (A-fib), BNP (HF indicator). Medications/Management: • Beta-blockers (-lol); ACE inhibitors (-pril); ARBS/angiotensin–receptor blockers (-artan): reduce afterload /control heart rate, by lessening resistance to contraction. Monitor: hypotension. • Diuretics [furosemide, hydrochlorothiazide, spironolactone]: manage fluid overload. Monitor: hypokalemia, eats foods high in potassium, and administer furosemide IV slowly over 1 – 2 minutes. • Anticoagulants if A-fib present; reduces risk of thrombus; prevent emboli from A-fib. Monitor: stroke, PT, INR, bleeding/bruising. • Surgery for severe cases. NCLEX Tip: Afterload reduction decreases regurgitant flow. Aortic Stenosis Etiology/Pathophysiology: Narrowed aortic valve → obstructed LV outflow → ↑ LV pressure → hypertrophy → ↓ cardiac output. Clinical Manifestations: Triad: angina, syncope, dyspnea (heart failure); systolic murmur radiating to carotids. Risk Factors: Aging (calcification), congenital bicuspid valve, rheumatic fever. Labs/Diagnostics: Echocardiogram (valve area), ECG (LV hypertrophy), cardiac cath (pressure gradient). Medications/Management: • Avoid nitrates/vasodilators (can cause hypotension). • Use beta-blockers (-lol) cautiously. reduce afterload /control heart rate, by lessening resistance to contraction. Monitor: hypotension. • Surgical aortic valve replacement (definitive). NCLEX Tip: Do not aggressively lower preload; maintain perfusion. Aortic Insufficiency Etiology/Pathophysiology: Incomplete closure of aortic valve → backflow of blood into LV → volume overload → dilation and LV hypertrophy. Clinical Manifestations: Dyspnea, palpitations, fatigue, bounding (“water hammer”) pulse, wide pulse pressure, diastolic murmur. Risk Factors: Rheumatic fever, endocarditis, Marfan syndrome, trauma. Labs/Diagnostics: Echocardiogram (backflow volume), ECG (LV enlargement), chest X-ray (cardiomegaly). Medications/Management: • Calcium channel blockers (-dipine); ACE inhibitors (-pril); vasodilators (hydralazine]): reduce afterload /control heart rate, by lessening resistance to contraction. Monitor: hypotension. • Diuretics for volume management. • Surgical valve replacement when severe. NCLEX Tip: Bounding pulse and wide pulse pressure are hallmark findings. General Nursing & Exam Focus • Best diagnostic test: Echocardiogram (for all). • Monitor for A-fib in mitral disorders. • Valve replacement (mechanical): Lifelong anticoagulation. • Daily weights & fluid balance: Detect early HF. • Positioning: High-Fowler’s for dyspnea, low-sodium diet. Inflammatory Heart Disorders (Endocarditis, Pericarditis, Myocarditis, Rheumatic Carditis) Risk Factors • IV drug use, valve replacement, streptococcal infection, immunosuppression, lower socioeconomic status Pericarditis: inflammation of the pericardium (sac around heart) -RF: heart attack, lupus, rheumatoid arthriti -Clinical manifestations: Chest pain (relieved when leaning forward), coughing, Pericardial friction rub, fever, dysrhythmias, and SOB -Labs/DX: • High WBCs, EKG showing ST or T spiking, echocardiogram (inflamed heart) -Nursing care/Intervention: address pain/inflammation, and monitor for cardiac tamponade, position, patient upright, leaning forward, and monitor ECG - Medications: NSAIDs, corticosteroids, anti antibiotics for bacterial • Ibuprofen/NSAIDs for inflammation (pericarditis). Avoid if patient has peptic ulcer, monitor for G.I. bleeding, platelets, liver/kidney function. Must be taken with food, avoid alcohol. • Corticosteroids (prednisone) for autoimmune causes (pericarditis/myocarditis). Low-dose first, take with food, and patient must not stop abruptly. Monitor BP, glucose, electrolytes, wounds, infection, sudden weight gain. -Complication: cardiac tamponade → muffled heart sounds, paradoxical pulse, JVD, hypotension (Beck’s triad) Myocarditis: inflammation of the myocardium (heart muscle itself) -RF: viral (covid, Coxsackie), fungal, or bacterial infection; autoimmune disorder -Clinical Manifestations: Tachycardia, chest pain, murmur, friction rub, dysrhythmias, peripheral swelling, cardiomegaly. -Labs/Dx: ECG, echocardiogram, high troponin, CK – MB, ESR in CRP for inflammation/injury -Nursing Care/interventions: monitor for heart failure, and dysrhythmia’s, provide rest and activity restriction -Medication: • Amphotericin B for fungal infection (myocarditis/endocarditis). Monitor liver/kidney function for a G.I. upset. • Corticosteroids (prednisone) for autoimmune causes (pericarditis/myocarditis). Low-dose first, take with food, and patient must not stop abruptly. Monitor BP, glucose, electrolytes, wounds, infection, sudden weight gain. Endocarditis: bacterial infection that leaves inflammation of the endocardium (inner layer of the heart); bacterial or fungal Infection of endocardial tissues that leads to necrosis and embolization of growth -RF: congenital/valvular heart disease, prosthetic valve, IV drug use -Clinical Manifestations: janeway lesions, Fever, murmur, petechiae, splinter hemorrhages (red streaks under nail beds), Osler’s nodes -labs/dx: positive blood culture, echocardiogram -nursing interventions/care: administer IV antibiotics, antipyretics for fever, and anticoagulants, patient should use soft toothbrush, and prophylactic antibiotics before dental/invasive procedures -medication: • Penicillin for infection (rheumatic fever/endocarditis). Monitor for allergic reaction, kidney function/electrolytes. • Amphotericin B for fungal infection (myocarditis/endocarditis). Monitor liver/kidney function for a G.I. upset. Rheumatic Carditis/heart disease: infection of endocardium due to complication of rheumatic fever; GABHS triggers, rheumatic fever leading to inflammatory lesions in the heart -RF: children, Follows untreated strep infection -Clinical Manifestations: tachycardia, Fever, rash(trunk/extremities), joint pain, murmur, chest pain, muscle spasms, friction rub -Labs/Dx: throat culture (strep infection), positive ASO titer, echocardiogram -Nursing care/Interventions: administering antibiotics to stop strep infection, and promote rest, monitor for heart failure, and encourage life on prophylactic antibiotics. -Medications: antibiotics, valve replacement/repair • Penicillin for infection (rheumatic fever/endocarditis). Monitor for allergic reaction, kidney function/electrolytes. Nursing Interventions (Overview for Inflammatory disorders) • Monitor for tamponade & HF • Administer antibiotics (penicillin) • Pain relief (NSAIDs for pericarditis) • Bed rest • Emotional support • Auscultate heart sounds; murmur or friction rub • Collab with cardiologist and physical therapists Procedures (Overview for Inflammatory disorders) • Pericardiocentesis for fluid removal, then sent to laboratory; monitor for recurrence of cardiac tamponade. ( pericarditis.) • Valve surgery if damaged Complications (Overview for Inflammatory disorders) • Cardiac tamponade: medical emergency resulted from fluid accumulation in pericardial sac. S/S: dyspnea, dizziness, tightness in chest, restlessness. Administer IV fluids, notify the provider, obtain chest, x-ray or ECG Cardiac Diagnostics & Vascular Access (Ch. 28) Transesophageal Echocardiography (TEE) Provides clear heart images via probe in the esophagus to detect valve disease, thrombi, or heart failure. NPO 4–6 hr, monitor VS, ECG, and sedation; check gag reflex before eating post-procedure; keep HOB 45°. Stress Testing (Exercise or Pharmacologic) Assesses heart’s response to stress for angina, HF, MI, or dysrhythmia. NPO 2–4 hr, avoid caffeine/tobacco, wear comfortable clothes; stop test for chest pain, SOB, dizziness. Post: monitor ECG & BP until stable. Coronary Angiography (Cardiac Catheterization) Identifies coronary artery blockages using contrast dye via femoral, radial, or brachial artery. NPO 4–6 hr, assess renal function, allergies (iodine/shellfish), and hold metformin 48 hr before/after. Post: monitor VS and site for bleeding, hematoma, or thrombosis, keep limb straight, maintain bedrest. Complications: cardiac tamponade (↓BP, JVD, muffled heart sounds), embolism, hematoma, AKI—notify provider. Teach: report chest pain, bleeding, SOB, avoid lifting >10 lb, and take antiplatelets as prescribed if stent placed. Vascular Access Devices (VADs) Provide reliable central access for fluids, meds, TPN, or blood. Verify tip placement via x-ray before use. PICC: up to 12 mo use, insert in basilic/cephalic vein → SVC; no BP/venipuncture in that arm, keep dressing dry. Tunneled Catheter: long-term use, subcutaneous tunnel prevents infection; no dressing once healed. Implanted Port: long-term chemo access; access with Huber needle, flush with heparin after use. Complications: • Phlebitis: redness, pain, warmth—maintain sterile technique. • Occlusion: flush gently with 10 mL syringe; never force. • Mechanical issues: swelling or pain at port site = dislodgement → notify provider

Medical Terminology (Abscess-Hypokalemia)

Hypercalcemia (CMPP)

CMPP: Hypercalcemia