Complex Final Exam

1A: Infection and Inflammation Pneumonia: Inhalation of infectious organisms or aspiration of an irritant  Triggers inflammatory process  Edema and fluid exudate fills the alveoli  Causes alveoli to be unable to expand  Clinical Manifestations: o Chest discomfort (due to coughing) o Fever o Shortness of breath or difficulty breathing o Tachypnea o Yellow-tinged sputum o Cough o Crackles and wheezes o Decreased oxygen saturation (less than 95%)  Nursing Interventions: o Position in high-Fowler’s to maximize ventilation (unless contraindicated) o Use of incentive spirometer to promote deep breathing (Turn, cough, deepbreathe) o Promote adequate nutrition and fluid intake  The increased work of breathing requires additional calories  Increased fluid intake to 2-3 L/day to promote hydration and thinning of secretions o Obtain cultures  Administer antibiotics as prescribed o Administer bronchodilators as prescribed to reduce bronchospasms and reduce irritation  Short-acting beta2 agonists (Albuterol) for rapid relief  Anticholinergic medications (ipratropium)  Methylxanthines (theophylline)  Management of Care: o Frequent hand hygiene and avoid crowds to prevent spread of infection o Promote smoking cessation o Provide rest periods for patients who have dyspnea Tuberculosis: Infectious disease caused by Mycobacterium tuberculosis  Transmitted through aerosolization (airborne route)  Clinical Manifestations: o Purulent sputum (possibly blood-streaked) o Persistent cough lasting longer than 3 weeks o Night sweats o Low-grade fever in the afternoon o Fatigue and lethargy o Weight loss and anorexia  Nursing Interventions/Management of Care: o Airborne Precautions  N95 Mask  Negative airflow room  Gloves o Promote adequate nutrition:  Increase fluid intake to 2-3 L/day  Increase protein, iron, vitamin C, and vitamin B o If transporting patient to another department, place a surgical mask on patient o Sputum samples are needed every 2-4 weeks  Pts are no longer considered contagious after 3 consecutive negative sputum cultures, and may return to work/school o Monitor liver, kidney, vision, and hearing function while taking medications o Apply heated and humidified oxygen as prescribed  Pharmacological Interventions: o Combination therapy of two or more medications for 6-12 months (RIPE)  Rifampin  Will turn urine and other secretions orange (this is harmless)  Report jaundice, pain/swelling of joints, loss of appetite, or malaise  Can interfere with oral contraceptives  Isoniazid  Do not drink alcohol  Report manifestations of hepatotoxicity  Pyrazinamide  Increase fluids to help prevent kidney problems  Report jaundice, pain/swelling of joints, loss of appetite, or malaise  Ethambutol:  Complete baseline vision acuity test  Report vision changes immediately o Emphasize that failure to take the full course of medications can lead to a resistant strain of TB 2 Ulcerative Colitis: Inflammatory bowel disease (IBD) that causes edema and inflammation primarily in the rectum and rectosigmoid colon  Clinical Manifestations: o Left-lower quadrant abdominal pain/cramping  uLcerative coLitis (LLQ) o Diarrhea  Up to 15-20 liquid stools/day (can contain mucus, blood, or pus) o Rectal Bleeding o High-pitched bowel sounds o Abdominal distention, tenderness, and/or firmness upon palpitation o Anorexia, weight loss, fatigue, loss of electrolytes  Management of Care: o Monitor for electrolyte imbalances (especially potassium) o Monitor I&O to assess for dehydration  Health Promotion/Teaching: o Pt will need routine colonoscopies to monitor for colon cancer o Seek emergency care for indications of bowel obstruction or perforation  Fever, severe abdominal pain, vomiting  Nutrition: o Eat high-protein, high-calorie, and low-fiber foods o Small, frequent meals o Assist the patient in identifying foods that trigger manifestations o Avoid caffeine and alcohol o Pt may need monthly vitamin B12 injections Crohn’s Disease: Inflammatory bowel disease (IBD) that causes inflammation and ulceration of the GI tract; All bowel layers can become involved, with sporadic lesions  Clinical Manifestations: o Right-lower quadrant abdominal pain/cramping o Diarrhea  5 loose stools/day with mucus or pus o Steatorrhea (fatty stools) o High-pitched bowel sounds o Abdominal distention, tenderness, and/or firmness upon palpitation o Anorexia, weight loss, fatigue, loss of electrolytes  Management of Care: o Monitor for electrolyte imbalances (especially potassium) o Monitor I&O to assess for dehydration  Health Promotion/Teaching: o Pt. will need routine colonoscopies to monitor for colon cancer o Seek emergency care for indications of bowel obstruction or perforation  Fever, severe abdominal pain, vomiting  Nutrition: o Eat high-protein, high-calorie, and low-fiber foods 3 o Small, frequent meals o Assist the patient in identifying foods that trigger manifestations o Avoid caffeine and alcohol o Pt may need monthly vitamin B12 injections Cholelithiasis/Cholecystitis: Cholelithiasis (gallstones) form and obstruct the cystic and/or common bile ducts  causing bile to back up in the gallbladder  causing inflammation of the gallbladder (cholecystitis)  Clinical Manifestations: o Sharp, RUQ pain  Often radiating to the right shoulder o Intense pain with nausea and vomiting after ingestion of high-fat foods  Evidenced by increased HR, pallor, and diaphoresis o Pain with deep inspiration during right subcostal palpation (Murphy’s sign) o Rebound tenderness (Blumberg’s sign) o Dyspepsia, eructation (belching), and flatulence o Jaundice, clay-colored stools, steatorrhea, dark urine, pruritus o Fever  Health Promotion/Teaching: o Smoking cessation o Lose weight if overweight/obese o Exercise regularly  Management of Care: o Administer analgesics as prescribed for pain  Nutrition: o Low-fat diet, rich in HDL sources  Reduce dairy products  Avoid fried foods, chocolate, nuts, gravies  HDL sources: seafood, nuts, olive oil o Avoid gas-forming foods (beans, cabbage, cauliflower, broccoli) 1B: Fluid and Electrolytes and Immunity Human Immunodeficiency Virus (HIV):  Assessment: o Stage 1 – Progression of HIV Infection:  Manifestations occur within 2-4 weeks of infection (flu-like symptoms, rash, sore throat)  Rapid rise in HIV viral load, decreased CD4+ cells, and increased CD8 cells o Stage 2 – Chronic Asymptomatic Infectious: 4  This stage can be prolonged and asymptomatic  The patient can remain asymptomatic for 10 years or more o Stage 3 – AIDS:  Characterized by life-threatening opportunistic infections (Kaposi’s sarcoma, herpes simplex virus, herpes zoster virus, candidiasis)  Diagnostics: o Enzyme-linked Immunosorbent Assay (ELISA)  Positive result indicates HIV o Supplemental HIV antibody test (Western blot or indirect immunofluorescence assay [IFA])  Positive result o Pts with a positive result from ELISA, Western blot, or IFA should be tested for viral load  If CD4+ is less than 200 means it has progressed to AIDS  Management of Care: o Highly active antiretroviral therapy (ART) – Use of 3-4 HIV medications in combination with other antiretroviral medications to reduce medication resistance, adverse effects, and dosages o Main goals of drug therapy:  Decrease viral load  Maintain/raise CD4+ counts  Delay HIV related symptoms and opportunistic infections Systemic Lupus Erythematosus (SLE): Autoimmune disorder in which an atypical immune response results in chronic inflammation and destruction of healthy tissue; Generally characterized by periods of exacerbations and remissions; Can lead to lupus nephritis (leading cause of death for SLE)