Nutrition's Role in Wound Healing & Inflammation: Alzheimer's, Osteoporosis, & Digestive D, Exercises of Nursing

Download Nutrition's Role in Wound Healing & Inflammation: Alzheimer's, Osteoporosis, & Digestive D and more Exercises Nursing in PDF only on Docsity! 13 MEDSURG chAPTER 13 – fLUID AND ELECTROLYTE: BALANCE AND DISTURBANCE Fluid and electrolyte balance is dependent upon dynamic processes that are crucial for life and homeostasis. Amount and Composition of Body Fluids Approximately 60% of a typical adult’s weight consists of fluid (water and electrolytes) Factors that influence the amount of body fluid: Age, gender, and body fat  Younger people have a higher percentage of body fluid than older people  Men have proportionately more body fluid than women  Obese people have less fluid than those are thin because fat cells contain little water Body fluid is located in 2 fluid compartments  Intracellular space (fluid in the cells) o Approximately 2/3 of body fluid is in the ICF compartment and is located primarily in the skeletal muscle mass  Extracellular space (fluid outside the cells) 13 o Approximately 1/3 of the body fluid is in the ECF compartment. ECF transports electrolytes, it also carries other substances like enzymes and hormones. The ECF compartment is further divided into ▪ Intravascular space (fluid within the blood vessels) contains plasma. Approximately 3L of the average 6 L of BV in adults is made up plasma. The remaining 3 L is made up erythrocytes, leukocytes, and thrombocytes. ▪ Interstitial space: contains the fluid that surrounds the cell. Totals about 11-12 L in an adult. Lymph is an ISF ▪ Transcellular space: the smallest division of the ECF compartment and contains approximately 1 L. Examples: digestive secretions, cerebrospinal, synovial, sweat Body fluid normally moves between the 2 major compartments in an effort to maintain equilibrium between the spaces. Loss of fluid from the body can disrupt this equilibrium. Third-Space fluid shift or third spacing 13 The concentration of solute is greater inside the cell in order to establish a concentration equilibrium.  Net Water Movement: into cell  End Results: cell swells (hemolysis) Electrolyte Active chemicals in body fluids. Cations that carry positive charges and Anions that carry negative charges.  Major cations in body fluid: sodium, potassium, calcium, magnesium, and hydrogen ions  Major anions in body fluid: chloride, bicarbonate, phosphate, sulfate, and proteinate ions Electrolyte Relationships  Inverse: Both electrolytes will go in opposite directions. Think: Fraternal Twins  Similar: Both electrolytes will go in the same direction. Think: Identical Twins 13 Sodium/ Potassium = Inverse Na+ = K+ Magnesium/ Calcium = Similar Mg = Ca+ Magnesium/P otassium = Similar Mg =K+ SODIUM RANGE: 135 – 145 mEq/L GOAL: Maintain blood pressure and blood volume. Maintain fluid balance/ water distribution throughout the body & Regulate by aldosterone Hypernatrem ia – over 145 Causes 13  Overproduction of Aldosterone  An increase intake of Na+ (oral/iv)  GI tube feedings  Hypertonic solutions in excess  Corticosteroids = Na+ excretion decreases  Loss of fluids = too much free salt o Dehydrated, infection, diarrhea  Diabetes insipidus Signs + Symptoms (Big & Bloated)  Flushed skin  Fever  Agitated, confused  Neurologic deficits  Increase fluid retention = EDEMA  Decrease urine output  Dry mouth + skin Interventi ons 1. Restrict sodium intake 2. Patient safety (confused patient) o Call light 13  Confusion/lethargic/trouble concentrating  Decrease DTR  Loss of urine and appetite  Decrease in BP & bowel sounds  Shallow respirations = late sign due to muscle weakness Interventions 1. Watch HR, RR, GI, Renal, Neuro 2. Administer IV hypertonic fluids (hard on veins 3. Restrict fluids/diuretics (risk: fluid overload) 4. Antidiuretic hormone antagonist (for SIADH) o Declomycin = do not give with food 5. Patients on lithium = watch drug levels (decrease in NA+ = increase in lithium” 6. Die t Diet encou rage  Salty foods in moderation 13 POTASSIUM RANGE: 3.5-5.0 mmol/L GOAL: Manage heart + muscle function. Maintain fluid balance + BP. Regulated by kidneys (to maintain potassium balance, the renal system must function because 80% of the potassium is excreted daily leaves the body by way of the kidneys) Hyperkalemia – over 5.0 Causes  ACE Inhibitors (Retain K+)  Spironolactone  NSAIDs  Burns or trauma or sustained tissue damage (K+ explodes out of cells that are lysed)  Addison’s = decrease in aldosterone that regulates K+  IV fluids  Renal impairment (kidney disease or dialysis) Signs + Symptoms (Tight + Contracted)  Irregular heartbeat = ST elevation, peak T wave  Decrease in BP, decreased HR, severe V-fib 13  Respiratory failure  Hyperactive bowel sounds = diarrhea  Brain strain = confusion  Big muscle weakness – cramping, decrease DTR’s tingling, burning, numbness Interventions  IV sodium bicarbonate  IV calcium gluconate “gives the muscles down”  Albuterol  Furosemide/hydrochlorothiazide  Dialysis  Sodium polycystrene sulfonate Diet  No salt substitutes  No fruit  No green leafy veggies Limit o P – potatoes/pork o O – oranges o T – tomatoes o A – avocado 13 3. Watch glucose, Ca+ and Na+ - Ca+, Na+, K+ are inversely related 4. Give oral supplement with food 5. Less than 2.5 = potassium infusion = only IV slowly (watch for infiltration) 6. Hold potassium wasting diuretics – Why? Decrease K+ causes digoxin toxicity K+ sparing diuretics  Spirno actone  Aldactone  Dyazide  Triamtirene  Maxide CALCIUM RANGE: 9-11 GOAL: affects bones, heartbeats, and clotting factors JOB: stabilize neuron excitability and help regulate muscle contraction and relaxation including cardiac muscle 13 Hypocalce mia – under 9.0 Causes  Hypoparathyroidism  Thyroidectomy  Pancreatitis – releases calcium  Loop diuretics, laxatives, long term steroids, phenytoin  Phosphate enemas = increase in Phosphate = decrease in Ca+ & Mg+  GI wounds  Chronic disease – cellac, crohns, CKD  Increase phosphate, decrease vitamin D, decrease magnesium Signs + Symptoms (Wild + Crazy)  Prolonged QT/ST (severe: VTach)  Decreased HR, diminished peripheral pulses, and decreased BP)  Tetany (tingling)  Heart failure  Trousseau sign = arm spasm with BP cuff  Chvostek sign = smile when touching facial nerve 13  Slow clotting factors = bleeding  GI system doing crazy = diarrhea  Laryngospasms, dyspnea, ALOC, seizures, confused Interventions 1. Give food high in calcium 13 MAGNESIUM RANGE: 1.5-2.5 mEq/L GOAL: Muscle relaxation. Maintain immune system, bones, BG JOB: Maintain neuromuscular function. It acts directly on the myoneural junction, variations in the serum level affect neuromuscular irritability and contractility. Hypomagne semia – under 1.5 Causes  Excessive alcohol = stops GI from absorbing Mg+  Fluid loss - NG suction, N/V, Diuretics  Antibiotics (aminoglycosides)  Pregnant momma’s = risk for malnutrition Signs 13 + Symptoms (muscles go wild)  Increase HR, Increase RR (shallow respirations)  Prolonged QT interval  Depressed ST segment, inverted T wave  Tetany  Tremors  Muscular excitability  Dyspnea  Diarrhea  Decrease DTR’s(CLONUS), numbness, tingling  Confusion, insomnia, seizures Interventions 13 1. Assess swallowing (muscles) 2. IV magnesium sulfate 3. Assess respiratory rate 4. Assess reflexes – CLONUS is BAD 5. DIET Hypermagne semia – over 2.5 Causes  Diabetic ketoacidosis  Antacids with Mg+ (TUMS)  Renal failure  Hyperkalemia – Addison’s disease Signs + Symptoms (Too Relaxed) (neurologic depression signs)  Decrease BP, decrease RR, decrease HR  Widened QR’s, prolonged PR interval  Hypoactive bowel sounds  Decrease DTR’s (deep tendon reflexes) (areflexia) or absent  Drowsy , lethar gic 13  Acute respiratory acidosis occurs in emergency situations such as pulmonary edema, and is exhibited by hypoventilation, store too much CO2 and decreased PaCO2 Respiratory alkalosis is a clinical condition in which the arterial pH is greater than 7.45 and the PaCO2 is less than 38 mm Hg. (pH is high & CO2 is low)  Respiratory alkalosis is always caused by hyperventilation, which causes excessive “blowing off” of CO2 and a decrease in the plasma carbonic acid concentration. Mixed Acid-Base Disorders  A normal pH in the presence of changes in the PaCO2 and plasma HCO3 – concentration immediately suggests a mixed disorder, o Example: an example of a mixed disorder is the simultaneous occurrence of metabolic acidosis and respiratory acidosis during respiratory and cardiac arrest.  The only mixed disorder that cannot occur is a mixed respiratory acidosis and alkalosis, because 13 it is impossible to have alveolar hypoventilation and hyperventilation at the same time ABG’s  pH: 7.35 -7.45  PaCO2: 35-45  HCO3: 22-26  PaO2: 75-100mmHg  O2: 95 – 100% ROME R- Respiratory O- Opposite 13 M- Meta bolic E- Equa l Uncompensated = CO2 or HCO3 normal Partially Compensated = Nothing is normal Compensated = pH is normal Hemoglobin  Male: 13-18  Femal e: 12-16 Hemato crit  Male 42-52%  Female: 37-47% 13 BURNS Superficial (First degree burn)  No blisters or scars  Pink or red  May be tender or painful  Only affects top layer (epidermis) Partial Thickness (Second degree burn)  Raw, mottled, red appearance  Skin is moist  May blister or need grafting  Painful, blanching  Shiny, scars left behind  Affects epidermis upper 1/3 dermis 13  2-6 weeks healing time Deep partial thickness (Third degree burn)  Red-waxy white appearance  Reduced pain sensation  Blisters present  Eschar formation  Affects epidermis, all dermis Full thickness (Third degree burn)  Black, brown, yellow, pearly white  Eschar, dry looking = leathery  Blood vessels + bones may be visible  Little to no pain – nerves are destroyed  Affects epidermis, dermis, subcutaneous tissue  May need grafting  Eschar must be removed Nursing Care: Infection Control Burn patients = RISK for intracellular fluid deficit 13 1. PPE: gloves, gown mask, cover hair 2. Ensure patient tetanus hot if 5-10 yrs 3. Watch for temperature loss = shivering keep temperature 85-100F* 4. Pain control – IV route best, not oral 5. Wound care- premedicate o Debridement – remove necrotic tissue o No pillows for the ear or neck. Use rolled towel under shoulder o Watch for webbing RULES OF 9’S AND THE PARKLAND BURN FORMULA The rule of 9’s will help determine if the patient qualifies for referral or transfer to the burn unit  This also helps determine the amount of fluid therapy needed using the parkland burn formula RISK for: Hypovolemic shock (decrease intravascular volume) within 24 hours 13 The intraoperative phase begins when the patient istransferred onto the OR bed and ends with admission tothe PACU. 13  Intraoperative nursing responsibilities involve acting as scrub nurse, circulating nurse, or registered nurse first assistant The postoperative phase begins with the admission of the patient to the PACU and ends with a follow-up evaluation in the clinical setting or home Perioperative Nursing Type of Surgery  Diagnostic: allows to confirm or establishes diagnosis  Corrective: excision or removal of diseased body part  Reconstructive: restore function or appearance to traumatized or malfunctioning tissues  Ablative: removes a diseased body part  Palliative: relieves or reduces pain or symptoms of a disease; it does not sure  Transplant: replaces malfunctioning structures  Cosmetic: performed to improve personal appearance Preoperative nursing care Ensure adequate hydration The goal in the preoperative period is for the patient to be as healthy as possible. Every attempt is made to assess for and address risk factors that may contribute 13 to postoperative complications and delay recover. This provides a peaceful and secure environment, provides information and its related risk factors and the nature of the cerebral artery aneurysm to patient and his or her relatives; teaching and motivating a preoperative patient; prevention of constipation and arterial blood pressure increase  Avoid excessive fasting  Allow fluid intake up until 2 hours before surgery  Replace further losses in those with enterocutaneous fistulas and high output stomas Intraoperative nursing care Maintain fluid balance The intraoperative nursing care includes the surgical team. The intraoperative experience has undergone many changes and advances that make it safer and less disturbing to patients. With these advances, anesthesia and surgery still place the patient at risk for several complications or adverse events.  Avoid excessive fluid therapy during surgery  Used balanced fluid  Use monitoring to guide fluid administration 13 when triggered, causes sustained skeletal muscle contraction. It can lead to severe hyperthermia, left ventricular failure, brain damage, organ failure, disseminated intravascular coagulation (DIC). Cardiac arrest, and death. Usually triggered during or after administration of commonly used general anesthetics 13 Postoperative nursing care Encourage ear ly oral intake The postoperative period extends from the time the patient leaves the operating room until the last follow- up visit with the surgeon. This may be as short as a day or two or as long as several months. During the postoperative period, nursing care focuses on reestablishing the patient’s physiologic equilibrium, alleviating pain, preventing complications, and educating the patient about self-care  Early resumption of oral intake  Stop IV fluids once oral intake established  Aim for a state of zero fluid balance  If oral intake inadequate supplement with IV fluid  If oral intake delayed, consider EN/PN Ongoing postoperative care  Ineffective airway clearance  Ineffective tissue perfusion  Deficient fluid volume  Imbalanced nutrition  Urinary retention 13  Acute pain  Risk for infection Diet:  NPO until return the bowel movement then liquids, soft diet, and finally normal Administration of IV fluids according to: daily requirements. Administration of medications such as: antibiotics, analgesic, or sedatives Wound-Healing Mechanisms First-intention healing  Wounds made aseptically with a minimum of tissue destruction that are properly closed heal with little tissue reaction by first intention (primary union). o Wound edges opposed o Normal healing o Minimal scar Second-intention healing  Second intention healing (granulation) occurs in infected wounds (abscess) or in wounds in which the edges have not been approximated. Excessive loss of tissue o Wound left open 13  Vitamin D: beef, liver, egg yolks, fortified dairy products, sardines, tuna 13  Vitamin E: olive oil, almonds, sunflower seeds, peanut butter, green leafy vegetables  Vitamin K: kale, chard spinach, turnips greens, spring onions, brussels sprout  Vitamin C: citrus, kiwi, tomatoes, peppers, guava, strawberries, pineapple cHAPTER 35 Asessment of immune function Immunity is the body’s specific protective response to a foreign agent or organism. The immune system functions as the body’s defense mechanism against invasion and allows a rapid response to foreign substances in a specific manner. Immune function is affected by a variety of factors, central nervous system integrity, general physical and emotional status, medications, dietary patterns, and the stress of illness, trauma, or surgery. 13 MDROs are microorganisms, predominantly bacteria, that are resistant to one or more classes of antimicrobial agents.  Examples of MDROs o Methicillin-resistant staphylococcus aureus (MRSA) which is spread from one person to the other through direct skin touch or by utilization of the infected personal items such as razor, utensil, and towels. o Vancomycin-resistant enterococcus (VRE) which the infection enters the GI tract ANATOMIC AND PHYSIOLOGIC OVERVIEW Anatomy of the Immune System The immune system is composed of an integrated collection of various cell types, each with a designated function in defending against infection and invasion by other organisms. The molecules and cells participate in specific interactions with immunogenic epitopes (antigenic determinants) present on foreign materials, initiating a series of action in a host, 13 cells that manufacture antibodies. These antibodies are transported into the bloodstream and attempt to disable invaders  Cellular immune response: involves the T lymphocytes, which can turn into killer T cells that can attack the pathogens Cellular Immune Response Major characteristics of the immunoglobulins and Hypersensitivity Types Ty pe I IgE  Appears in serum  Takes part in allergic and some hypersensitivity reactions  Combats parasitic infections  Allergic rhinitis, asthma, anaphylaxis Examples: local and systemic anaphylaxis, seasonal hay fever, food allergies, and drug allergies Type II IgG 13  Appears in serum and tissues (interstitial fluid)  Assumes in major role in bloodborne and tissue infections  Activates the complement system  Enhances phagocytosis  Cross the placenta Or IgM  Appears mostly in intravascular serum  Appears as the first immunoglobulin produced in response to bacterial and viral infections  Activates the complement system Examples: red blood cell destruction after transfusion with mismatched blood types or during hemolytic disease of the newborn Not relevant to essential oils Drug allergy, graves’ disease, anemia Type III IgG/IgM  Immune complex-mediated hypersensitivity 13  Not relevant to essential oils Rheumatoid arthritis, serum sickness, SLE Type IV T cells  Allergic contact dermatitis, type I diabetes mellitus, multiple sclerosis. Graft rejection, chronic asthma  Can happen with essential oils  Cell mediated hypersensitivity IgA  Appears in body fluids (blood, saliva, tears, and breast milk, as wells as pulmonary, gastrointestinal, prostatic, and vaginal secretions  Protects against respiratory, gastrointestinal, and genitourinary infections  Prevents absorption of antigens from food 13  Man ual labor Sympto ms:  Joint pain – HARD + BONY  Bone spurs (Heberden/Bauchard) 13  Stiffness - < 30min; worse at end of the day  Grating + clicking sound  Only join ts NO o Inflammation o Redness o Warmth RHEUMATOID ARTHRITIS The immune system attacks synovium (connective tissue within the joints) that affects mostly wrists, fingers, elbows. (Symmetrical) Can be systemic (fever, anemia) Cause: Unknown – tends to affect woman > men; any age 20-60 Symptoms:  Inflammation!  Stiffness > 30min  Soft, warm joints  Systemi c sx 13 (fever) YES: o Inflammation o Warmth o Redness GOUT Very painful form of arthritis characterized by the formation of uric acid c rystals and severe inflammation The stages of gout progression  STAGE 1 High Uric Acid Levels: uric acid is building upin the blood and starting to form crystals around joints  STAGE 2 Acute Gout: symptoms start to occur, causing a painful gout attack  STAGE 3: Intercritical Gout: periods of remission between gout attacks  STAGE 4 Chronic Gout: gout pain is frequent and tophi form in joints Symptoms:  Intense joint pain (mostly at night)  Swollen joints o Pain o Red o Warm 13  Fish  Walnut & flaxseed  Fruits & vegetables  Whole grains LYME DISEASE An infection caused by the spirochete Borrelia burgdorferi, acquired from a tick bite (ticks live in wooded areas and survive by attaching to a host) infection with the spirochete stimulates inflammatory cytokines and autoimmune mechanisms Symptoms:  Headache  Hearing loss and paralysis of face  Muscle soreness  Erythema migrans (ring shaped rash)  Fever  Fatigue  Nausea & vomiting FIBROMYALGIA A central sensitization syndrome caused by neurobiological abnormalities which act to produce 13 physiological pain and cognitive impairments as well as many other disabling symptoms. Pain in the outer coverings of muscles and tendons Women are nine times more likely to have fibromyalgia than men Risk Factors:  Females 30-50 years  History of rheumatologic conditions, chronic fatigue syndrome, Lyme disease  Deep sleep deprivation Symptoms:  Fatigue  Chest pain, dyspnea  Headaches  Abdominal pain, heartburn, constipation, and diarrhea  Muscle spasms, muscle weakness, and joint pain  Painful periods, pelvic pain, and early menopause HUMAN IMMUNODEFICIENCY VIRUS (HIV) 13 A virus that attacks cells that help the body fight infection Causes Transmitted through the exchange of some infected body fluids  Use of non-sterile syringes and tools  Pregnancy/breastfeeding  Blood transfusion  Organ transplant  Unprotected sex (most common cause) Symptoms  Fever  Frequent Infections  Chills  Headaches  Night sweats  Sore throat  Muscle aches and pains  Joint pain  Fatigue  Swollen lymph nodes 13 the maximal volume of air exhaled from the point of maximal inspiration Signs + Symptoms  Fatigue  Optic neuritis  Dysarthria  Dysphagia  Tinnitus  Weakness  Pain  Incontinence  Diarrhea & constipation  Urinary incontinence CHAPTER 20 ASSESSMENT OF RESPIRATORY FUNCTION The respiratory system is composed of the upper and lower respiratory tracts. Together, the two tracts are responsible for ventilation (movement of air in and out of the airways) 13 The upper respiratory tract warms and filters inspired air so that the lower respiratory tract (the lungs) can accomplish gas exchange or diffusion. Paranasal Sinuses The paranasal sinuses include four pairs of bony cavities. These air spaces are connected by a series of ducts that drain into the nasal cavity. The sinuses are named by their location: frontal, ethmoid, sphenoid, and maxillary. The sinuses are a common site of infection. The prominent function of the sinuses is to serve as a resonating chamber in speech. ASSESSMENT The major signs and symptoms of respiratory disease: Dyspnea  Subjective feeling of difficult or labored breathing, breathlessness, shortness of breath. A multidimensional symptom common to many pulmonary and cardiac disorders, particularly 13 when there is decreased lung compliance or increased airway resistance o Tachypnea: abnormally rapid respirations o Hypoxemia: low blood oxygen level o Orthopnea: shortness of breath when lying flat, relieved by sitting or standing o Stridor: high pitched sound heard usually on inspiration when someone is breathing through a partially blocked upper airway o Wheezing: a high-pitched musical sound that is often the major finding in a patient with bronchoconstriction or airway narrowing. Cough  Is a reflex that protects the lungs from the accumulation of secretions or the inhalation of foreign bodies  If the person is in distress and not able to cough up secretions. Nursing intervention is to increase fluid intake to decrease secretions  Coughing after food intake may indicate aspiration ofmaterial. A swallowing assessment is indicated.  After any procedure, it is important that the patient takes nothing by mouth until the cough reflex returns because the pre-op sedation and local 13  Wheezing is high-pitched, musical sound heard on either expiration (asthma) or inspiration (bronchitis). Major finding in a patient with bronchoconstriction or airway narrowing. Rhonchi are low pitched continuous sounds heard over the lungs in partial airway obstruction Hemoptysis  The expectoration of blood from the respiratory tract. It can present as small to moderate blood- stained sputum (pink frothy sputum) to a large hemorrhage. Causes: o Pulmonary infection o Carcinoma of the lung o Abnormalities of the heart or blood vessels o Pulmonary artery or vein abnormalities o PE or infarction Upper Respiratory Signs + Symptoms  Runny nose  Sneezing  Stuffed nose 13  Itchy eyes  Sore throat  Hoarse voice  Fever  Headaches  Lethargy  Muscle ache Lower Respiratory Signs + Symptoms  Coughing  Wheezing  SOB  Chest pain Abnormal (adventitious) Lung Sounds  Crackles: inspiration, intermittent sounds occurring when air moves through airways that contain fluid o Inflammation or congestion o Pneumonia, congestive heart failure (CHF), bronchitis, COPD  Wheezes: continuous musical sounds heard on expiration and sometimes on inspiration as air 13 passes through airways constricted by swelling, secretions or tumors o Asthma & airway obstruction OBSTRUCTION AND TRAUMA OF THE UPPER RESPIRATORY AIRWAY OBSTRUCTIVE SLEEP APNEA OSA is a disorder characterized by recurrent episodes of upper airway obstruction and a reduction in ventilation. It is defined as cessation of breathing (apnea) during sleep usually cause by repetitive upper airway obstruction. Sleep apnea affects your whole body!  Stroke  Fatigue 13 Acute rhinosinusitis follows a viral URI or cold, such as an unresolved viral or bacterial infection, or an exacerbation of allergic rhinitis. Signs + Symptoms  Purulent nasal drainage  Nasal obstruction  Facial pain pressure If untreated, acute rhinosinusitis may lead to severe complications like osteomyelitis and mucocele (cyst of the paranasal sinuses) Chronic Rhinosinusitis Chronic rhinosinusitis is diagnosed when the patient has experienced 12 weeks or longer of two or more of the following symptoms:  Mucopurulent drainage  Nasal obstruction  Facial pain pressure fullness  Hyposmia (decreased sense of smell) Mechanical obstruction is the ostia of the frontal, maxillary, and anterior ethmoid sinuses (known collectively as the ostiomeatal complex) is the usual cause of CRS and recurrent acute rhinosinusitis. SEASONAL INFLUENZA 13 Also known as the flu; highly contagious acute viral respiratory infection. May be caused by several viruses, usually known as types A, B, and C. Influenza virus types A&B cause the most human illness and the flu season. Influenza A is more contagious and responsible for moderate to severe illness in humans and animals. It has caused every known flu pandemic. Signs + Symptoms  Fever  Headache  Nasal drainage  Sore throat  Coughing 13  Muscle weakness  Diarrhea/vomiting  Joint aches Assess ment 1. Acute onset of fever and muscle aches 2. Headache 3. Fatigue, weakness, anorexia 4. Sore through, cough, rhinorrhea PNEUMONIA An inflammation of the lung parenchyma caused by microorganism, inflames the air sacs (alveoli) in one or both lungs which interferes with the diffusion of oxygen and carbon dioxide. Pneumonia can be classified into community-acquired pneumonia, health care associated pneumonia Community acquired pneumonia is the most common type and often occurs as a complication of influenza Health care associated pneumonia has a high mortality rate is most likely to be resistant to antibiotics 13  Capillaries open and neutrophils come in to fight the bacteria  Macrophages clean up debris once the infection is gone Viral Pneumonia Ex. COVID-19 caused by SARS-CoV-2  Virus enter cells and begin to multiply  The cells are destroyed as viruses burst through  Lymphocytes sense and destroy virus infected cells. Type 2 pneumocytes grow to replace damaged cells ASTHMA A heterogenous disease caused by airway inflammation The underlying pathology is asthma is reversible diffuse airway inflammation that leads to long-term airway narrowing. This narrowing which is exacerbated by various changes in the airway includes bronchoconstriction, airway edema, airway hyperresponsiveness, and airway remodeling. Main medication for asthma attack: albuterol beta-2-agonist Signs + Symptoms 13  Cough  Chest tightness  Wheezing  Dyspnea  Mucous production 13  Poor oxygen saturation PULMONARY TUBERCULOSIS Tuberculosis (TB) is an infectious disease that primarily affects the lung parenchyma. TB spreads from person to person by airborne transmission. An infected person released droplet nuclei though talking, coughing, sneezing, laughing, or singing. TB beings when a susceptible person inhales mycobacteria and becomes infected. The bacteria are transmitted through the airways to the alveoli where they are deposited and begin to multiply. Hepafilter is needed if the patient doesn’t have a negative pressure room Signs + Symptoms  Low-grade fever  Cough  Night sweats  Fatigue  Weight loss  Cough with or without sputum CYSTIC FIBROSIS 13  Chronic bronchitis: the bronchial tubes become inflamed and excessive mucus production occurs as a result from irritants or injury  Emphysema: the air sacs in the lungs are damaged and enlarged, resulting in hyperinflation and breathlessness COPD include diseases that cause airflow obstruction (emphysema & chronic bronchitis) or CF, bronchiectasis, and asthma are classified as chronic pulmonary disorders. COPD can coexist with asthma. Respiratory insufficiency and failure are major life-threatening complications of COPD. Risk Factors  Smoking  Passiv e smoking Signs + Sympto ms  Chronic cough  Sputum production  Dyspnea  Crackles and wheezes 13  Rapid respirations  Hypoxemia  Orthopnea 13  Clubbing  Cya nosis Asses sment 1. Cough 2. Exertional dyspnea 3. Wheezing and crackles 4. Sputum production 5. Weight loss 6. Barrel chest (with emphysema) 7. Use of accessory muscles for breathing 8. Prolonged expiration 9. Orthopnea 10. Cardiac dysrhythmias 11. Congestion and hyperinflation seen on chest x ray 12. ABG levels indicate respiratory acidosis and hypoxemia 13. Pulmonary function tests that demonstrate deceased vital capacity EMPHYSEMA 13  Low flow systems contribute partially to the inspired gas the patient breathes which means that the patient breathes some room air along with the oxygen. These systems do not provide a constant or precise concentration of inspired oxygen  High flow systems provide the total inspired air. Highflow systems are indicated for patients who require aconstant and precise amount of oxygen. Nasal Cannula  Used for low-to-medium concentration of oxygen for which precise accuracy is not essential.  When oxygen is given via cannula, the percentage of oxygen reaching the lungs varies with the depth and rate of respirations  Patients with otherwise normal vital sign (post-op, low SpO2, long-term oxygen therapy)  Flow: 1-6L/min  FiO2: 25 – 40% 13 Nonrebre ather mask  Covers the client’s nose and mouth. Low oxygen delivery system that delivers the highest O2 concentration  FiO2 80% to 95% at flow rates of 10 to 15L/min to keep the reservoir bag 2/3 full during inspiration and expiration Oxygen masks comes in several forms The Venturi Mask  The most reliable and accurate method for delivering precise concentrations of oxygen through noninvasive means. The mask is constructed in a way that allows a constant flow of room air blended with a fixed flow of oxygen  High-flow oxygen delivery system  Controlled oxygen therapy required (patients with exacerbation of COPD)  Flow: 2 – 15L/min 13  FiO2: 24- 60% The Hudson Mask  Higher concentrations required and controlled oxygen. Not necessary (severe asthma, acute left ventricle failure, pneumonia, trauma, severe sepsis) 13  Conductivity  Automaticity Troponin: a cardiac muscle biomarker; measurement is used as an indicator of heart muscle injury Cardiac Output Cardiac output refers to the total amount of blood ejected by one of the ventricles in liters per minute. The cardiac output in a resting adult is 4 to 6 L/min but varies greatly depending on the metabolic needs of the body. Cardiac output is computed by stoke volume x heart rate. Stroke volume is the amount of blood ejected from one of the ventricles per heartbeat. The average resting stroke volume is about 60 to 130 mL Cardiac catherization is when someone is having cardiac symptoms, chest pain. Tube from your femoral artery to look in the coronary artery. To see how block your arteries are. Cardiac shock: when a patient is in v-fib or v- tach Reading EKG’s 13 Depolariza tion = contract Repolariza tion = relax  P-Wave: atrial depolarization  QRS Complex: Ventricle depolarization  T- Wave: Ventricle repolarization For a client to be given a MRI or CT scan and needs a contrast dye, they must have an IV line in place. Aspirin – antiplatelets. it’s going to prevent platelets from sticking. If you don’t prevent these platelets from sticking it can cause chest pain, clots. Inspection Head to toe cardiac clues  Hair: brittle, dry – think poor nutrition, possibly due to cardiac or vascular insufficiency  Eyes: vascular changes may be a result of high BP, raised yellow-orange plaque under eyelids. May indicate chronic serum cholesterol elevation  Lips/tongue: blue tinged? Think: cyanosis: dry? Dehydration 13  Jugular vein: distended when at 45-degree angle? Think: hypervolemia, right-sided heart failure, pericardial tamponade, or constrictive pericarditis  Chest: auscultate if crackles (rales) consider left-sided heart failure. Assess rate, rhythm, and presence of murmurs  Blood pressure: over 135/85 may indicate hypertension  Abdomen: fluid accumulation (ascites) or enlarged, tender liver may indicate right sided heart failure. Pulsating mass may indicate -AAA  Skin: dry, cool – may be from poor nutrition. Blue-tinged indicates cyanosis. Pallor may suggest anemia or decrease circulation  Sacrum: check for edema and pressure areas in immobilized clients  Nails: clubbing may indicate chronic low O2 saturation, as in congenital cardiac or pulmonary disease. Thick nails – poor