Pharm quiz 5

Progesterone

"the pregnancy hormone" In both female and male body Regulates monthly changes of the uterine cycle Promotes breast development In men secreted by adrenal glands, used to make testosterone

Control of Ventilation

-Hypercapnia Carbon dioxide levels in the blood increase Carbon dioxide easily diffuses into CSF Lowers pH and stimulates respiratory center Increased rate and depth of respirations (hyperventilation) Causes respiratory acidosis - nervous system depression -Hypoxemia Marked decrease in oxygen Chemoreceptors respond Important control mechanism in individuals with chronic lung disease - move to hypoxic drive -Hypocapnia Caused by low carbon dioxide concentration (low partial pressure of carbon dioxide) in blood May be caused by hyperventilation Excessive amounts of carbon dioxide expired Causes respiratory alkalosis

Syphillis

A systemic infection that consists of 4 stages Primary stage- painless firm chancre, 3 weeks after exposure, lymphadenopathy, may be asymptomatic Second stage- widespread symmetric rash *palms of hands and soles of feet* general s/s infection- fatigue, malaise, fever Latent stage- persists for years, usually asymptomatic Tertiary syphillis- "gumma" typical lesion- bone, liver, cardiac neurosyphilis Treatment: Long acting penicillin or azithromycin Screening/testing Reportable disease Concerns: Congenital syphilis- if fetus infected after the 4th month may die in utero or have active infection or multiple abnormalities

Anti-inflammatory Drugs

Address the inflammatory component of asthma Classifications Inhaled glucocorticoids also known as Corticosteroids Mast Cell Stabilizers Leukotriene Modifiers *dont stop abruptly-withdrawal

Dysfunctional Uterine Bleeding: treatment

Administration of Progestin Oral contraceptives High doses conjugated estrogens x3 weeks, add progesterone for last 10 days NSAIDS Lysteda Dilation and Curettage (D&C)

Endometriosis

Affects about 5 million women in the US Presence of endometrial tissue outside the uterus on structures such as the ovaries, ligaments, or colon May affect distant sites such as the lungs Local inflammation and pain Can cause adhesions and obstruction Infertility frequently results

Treatment of Acidosis or Alkalosis

Aimed at correcting the underlying cause, replace fluids and electrolytes if needed and correct the pH

Protozoan-Sexually Transmitted Infections Trichomoniasis

Anaerobic flagellated protozoan Asymptomatic in men Subclinical infection in women that flares Affects vagina and urethral mucosa and Bartholins gland Copious yellow foul smelling discharge Treat with metronidazole (Flagyl) Treat sexual partners

A male, age 67, reports taking diphenhydramine (Bena- dryl) for "hay fever." Considering this client's age, the nurse assesses for which of the following findings? 1. Ahistoryofprostateorurinaryconditions 2. Anyrecentweightgain 3. Ahistoryofallergicreactions 4. Ahistoryofpepticulcerdisease

Answer: 1 Rationale: Diphenhydramine (Benadryl) and other anithis- tamines are contraindicated in clients with prostate or low- er urinary tract obstruction because anticholinergic effects may worsen these conditions. Options 2, 3, and 4 are incor- rect. Diphenhydramine (Benadryl) is a common treatment for allergic conditions and has no effects on weight gain or peptic ulcer disease. Cognitive Level: Analyzing. Nursing Process: Assessment. Client Need: Physiological Integrity.

BPH patient education

Avoid caffeine and alcohol intake Avoid medications with anticholinergic properties Antihistamines, TCA's, phenothiazines Avoid alpha-adrenergic agents Decongestants/pseudoephedrine Avoid testosterone and anabolic steroids If symptoms persist despite medication, may turn to surgical intervention TURP

Lobar Pneumonia

Bacterial pneumonia Community-based, often in healthy young adults Usually caused by Streptococcus pneumoniae Infection localized in one or more lobes Inflammation of vascular congestion, exudate forms in the alveoli Exudate contains fibrin and forms a consolidated mass **Exudate produces rusty sputum Adjacent pleurae frequently involved Infection may spread to pleural cavity-empyema Manifestations Sudden onset Systemic signs High fever with chills, fatigue, leukocytosis Dyspnea, tachypnea, tachycardia Pleural pain Rales Productive cough Typical rusty-colored sputum Confusion and disorientation

Dysfunctional Uterine Bleeding

Bleeding occurs on a noncyclic basis, or in abnormal amounts Problem commonly reported by women Often caused by hormonal imbalance between estrogen and progesterone Treated with Hysterectomy, or progesterone HRT Multiple causes: early abortion, pelvic neoplasm, thyroid disorders, pregnancy, infection Amenorrhea: absence of menstruation Dysmenorrhea: painful menstruation Endometriosis: abnormal location of endometrial tissue

5-alpha-reductase inhibitors

Block enzyme in testosterone metabolic pathway and block hormonal signal for prostate growth finasteride (Proscar) Improved urinary function Take several months to work Used in patients who can't tolerate cardiovascular effects of alpha 1 adrenergic blockers Can cause sexual dysfunction

Pulmonary Embolus (PE)

Blood clot or mass that obstructs pulmonary artery or any of its branches Effect of embolus depends on material, size, and location Small pulmonary emboli might be "silent" unless they involve a large area of the lung Large emboli may cause sudden death 90% of pulmonary emboli originate from deep vein thrombosis in legs; are preventable Signs and symptoms Small emboli: transient chest pain, cough, dyspnea Larger emboli: increased chest pain with coughing or deep breathing, tachypnea, and dyspnea develop suddenly Later: hemoptysis and fever Hypoxia: causes anxiety, restlessness, pallor, tachycardia Massive emboli Severe crushing chest pain, low blood pressure, rapid weak pulse, loss of consciousness Prevention Health teaching prior to surgery Antiembolic stockings Exercise to prevent thrombosis Use of anticoagulant drugs Diagnosis Radiography, lung scan, MRI, pulmonary angiography

Which information should the nurse teach the patient who is prescribed a glucocorticoid inhaler? 1Advise the patient to gargle after each administration. 2Instruct the client to use the inhaler on a PRN basis. 3Encourage the patient not to use spacer when using the inhaler. 4Teach the patient to check his or her forced expiratory volume daily.

1Advise the patient to gargle after each administration.

The patient with the flu has been taking Acetylcysteine (Mucomyst), a mucolytic. Which adverse effect should the nurse assess for? 1Bronchospasm 2Nausea 3Fever 4Drowsiness

1Bronchospasm

The patient diagnosed with a massive pulmonary embolus is ordered the thrombolytic streptokinase. The nurse notes on the medication administration record (MAR) that the patient is allergic to the "-mycin" medications, including streptomycin. Which intervention should the nurse implement? 1Call the HCP to report the allergy. 2Administer the medication as ordered. 3Call the pharmacist to substitute a medication. 4Check the bleeding-time laboratory values.

1Call the HCP to report the allergy.Coumadin interferes with production of prothrombin.

The patient diagnosed with the flu is prescribed the cough medication hydrocodone. Which information should the nurse teach the patient regarding this medication? 1Teach the patient to monitor the bowel movement for constipation. 2Driving or operating machinery is all right while taking this medication. 3This medication usually causes insomnia, so plan for the rest periods. 4This medication is more effective when taken with a mucolytic.

1Teach the patient to monitor the bowel movement for constipation.

The patient diagnosed with a PE is receiving intravenous heparin, and the HCP prescribes 5 mg warfarin (Coumadin) orally once a day. Which statement best explains the scientific rational for prescribing these two anticoagulants? 1Coumadin interferes with production of prothrombin. 2It takes 3-5 days to achieve a therapeutic level of Coumadin. 3Heparin is more effective when administered with warfarin. 4Coumadin potentiates the therapeutic action of heparin.

2It takes 3-5 days to achieve a therapeutic level of Coumadin.

The patient who has been using Oxymetazoline (Afrin) nasal spray for several weeks complains to the nurse that the spray no longer seems to work to clear the nasal passages. Which information should the nurse teach? 1Increase the amount of sprays used until the desired effect has been reached. 2This type of medication can cause rebound congestion is used too long. 3Alternate the Afrin with a saline nasal spray every 2 hours. 4Place the Afrin nasal spray in a vaporizer at night for the best results.

2This type of medication can cause rebound congestion is used too long.

Spermatocele

Cyst containing fluid and sperm that develops between the testis and the epididymis outside the tunica vaginalis

Antitussives

Dampen the cough reflex Used for common cold or allergies Liquid syrups should be allowed to coat throat- no water Opioid- raise cough threshold in CNS Codeine, Hydrocodone Schedule III, IV, V Relieve severe cough Non-Opioid- Dextromethorphan- raises cough threshold in CNS Large amounts: Hallucination, slurred speech, dizzy, drowsy, euphoria, resp. depression, ataxia, seizure, coma Benzonatate- numbs stretch receptors in lungs Delsym

Menopause

Decreased estrogen secretion by the ovaries, and results in permanent cessation of menses Hot flashes Night Sweats Irregular menstrual cycles Vaginal dryness & atrophy Stress urinary incontinence Bone mass loss CAD Alzheimer's like dementia

Decongestants

Drugs used to relieve nasal congestion Most are sympathomimetic Oral or intranasal Oral: pseudoephedrine & phenylephrine Alpha-adrenergic activity HTN, CNS stimulation are side effects of oral formulation Oxymetazoline (Afrin) Rebound congestion, Do not use more than 3 days

Other uses for Hormone Therapy

Dysfunctional uterine bleeding Severe menopausal symptoms neoplasms

Erectile Dysfunction Nursing

Education Role of therapy Assessment: CV, and Mood Assess recreational drug use- college students/party drug Never use with Nitrates or Alpha blockers Alphadrenergic blockers= severe hypotension Doxazosyn (Cardura), terazosin (Hytrin) Do not share drug When to seek help: Chest pain, erection >4 hours or painful

TB Treatment

Effective treatment requires monitoring and follow-up and is expensive. TB is becoming an increasingly serious problem: Homelessness and crowding in shelter HIV infection Lack of health care Multi-drug resistant TB

Complications of Alkalosis

Electrolyte imbalance Cardiac arrhythmias Coma

Erectile dysfunction treatment

Enzyme phosphodiesterase-5 (PDE-5) 60%-80% effective Maintain relaxation of smooth muscle and increase blood flow Do not cause erections- enhance them

Hormone Therapies- additional uses

Estrogens: Female hypogonadism Primary ovarian failure Cancer treatment: prostate ca Estrogen/Progestin: Replacement therapy following surgical removal of the ovaries

Vulvovaginal Candidiasis Ph <4.5

Fungal infection d/t Candida White "cottage cheese" discharge Immune deficient conditions After antibiotics Do not need to treat partner unless symptomatic

Bacterial Vaginosis Ph> 4.5

Gardnerella Vaginalis Anaerobic bacteria White/gray vaginal discharge Fish-like odor Can be STD

Asthma - Treatment

General measures Skin tests for allergic reactions Avoidance of triggering factors Good ventilation of environment Swimming and walking Use of maintenance inhalers or drugs Measures for acute attacks Controlled breathing techniques Inhalers Bronchodilators Glucocorticoids - IV Oxygen Measures for status asthmaticus: hospital care if no response to bronchodilator

Intranasal Corticosteroids

Glucocorticoid Preferred drug for perennial allergic rhinitis Decrease secretion of inflammatory mediators, decrease tissue edema, cause mild vasoconstriction. 1-3 weeks for desired response-take in advance of exposure Burning in nose, dry mucosa & epistaxis Spit out extra- don't swallow

Patient education regarding OCP

Goal of therapy Take the pill at the same time each day For ONE missed dose take 2 pills the next day For TWO missed doses take 2 pills X 2 days, a second method of contraception should be used for at least 7 days after restarting the pills For THREE missed doses, the patient should implement other contraceptive precautions until the regimen can be restarted in the next monthly cycle

Chronic Obstructive Pulmonary Disease (COPD)

Group of chronic respiratory disorders Causes irreversible and progressive damage to lungs Debilitating conditions that may affect individual's ability to work May lead to the development of cor pulmonale Respiratory failure may occur Group of chronic respiratory disorders Causes irreversible and progressive damage to lungs Debilitating conditions that may affect individual's ability to work May lead to the development of cor pulmonale Respiratory failure may occur Progressive difficulty with expiration Air trapping and increased residual volume Over inflation of the lungs Fixation of ribs in a respiratory position, increased anterior-posterior diameter of thorax (barrel chest) Flattened diaphragm (on radiographs

Pharmacotherapy: URI/Common Cold

H1- receptor antagonists (antihistamines) Decongestants Antitussives Expectorants

Pharmacotherapy: Allergic Rhinitis

H1- receptor antagonists (antihistamines) Intranasal Corticosteroids Mast Cell Stabilizers Decongestants- Nasal

Regulation of Male Reproductive System

Hormone Regulated- relatively constant levels Hypothalamus- GnRH (gonadotropic hormones) production Pituitary Follicle-stimulating hormone (FSH)- regulates sperm production Leutinizing Hormone (Interstitial cell-stimulating hormone (ICHS)- regulates testosterone production Testes- secrete testosterone Relatively stable, high levels of this androgen throughout adulthood

Regulation of Female Reproductive Syndrome

Hormone regulated Hypothalamus Gonadotropin-releasing hormone (GnRH) Pituitary gland Follicle-stimulating hormone (FSH) Luteinizing hormone (LH) Ovary Estrogen Progesterone Testosterone Complex interactions involving the hypothalamus, anterior pituitary, and the ovary Feedback mechanism involves estrogen and progesterone acting on the anterior pituitary gland to control the release of LH and FSH

Subcutaneous contraceptive implants

Implanon 99% effective Progesterone-only rod Inserted under skin, efficacy x 3 years Norplant (x5 years) used elsewhere, no longer in the US

Metabolic Impact on Acid-Base Balance

In blood the carbonic acid produced from combining CO2 and H2O dissociates as follows: H2CO3 → H+ + HCO3- HCO3- (bicarbonate ion) is regulated by the kidneys Excreting bicarbonate via the urine lowers the blood level, thus making the blood more acidic Retaining bicarbonate via the urine raises the blood level, thus making the blood more alkaline

Estrogen

In both female and male body Produced in ovaries, testes, adrenal glands, brain and adipose tissue Responsible for maturation of female reproductive organs & appearance of secondary sex characteristics Egg development, uterine wall thickening In men, memory, heart health sperm protection Contraindicated for patients with thromboembolic disorders/clotting disorders Contraindicated for patients with estrogen fed tumors- Breast Ca

Allergic Rhinitis

Inflammation of nasal mucosa Characterized by sneezing, watery eyes, and nasal congestion Caused by exposure to antigen (allergen) Allergic reaction causes histamine release Most common causes (allergens): Pollens from weeds, grasses, and trees Mold spores; dust mites; certain foods Animal dander

Chronic Bronchitis

Inflammation, obstruction, repeated infection, chronic coughing twice for 3 months or longer in 2 years History of cigarette smoking or of living in urban or industrial areas Mucosa inflamed and swollen Hypertrophy and hyperplasia of mucus glands Fibrosis and thickening of bronchial wall Low oxygen levels-they retain co2 Severe dyspnea and fatigue Signs and symptoms Constant productive cough Tachypnea and shortness of breath Frequent thick and purulent secretions Cough and rhonchi more severe in the morning Hypoxia, cyanosis, Hypercapnia Due to airway obstruction Polycythemia, weight loss, and signs of cor pulmonale possible As vascular damage and pulmonary hypertension progress Treatment Cessation of smoking and reduction of exposure to irritants Treatment of infection Vaccination for prophylaxis Expectorants Bronchodilators Appropriate chest therapy Including postural drainage and percussion Low-flow oxygen Nutritional supplements

Signs of Acidosis

Lethargy Confusion CNS depression leading to coma Deep rapid respiratory rate - indicates an attempt by the lungs to rid the body of excess acid

Emergency Contraception

Prevention of pregnancy following unprotected intercourse Plan B 2 doses of 0.75mg levonorgestrel 12 hours apart Prevents ovulation, alters endometrium to prevent implantation Will not terminate implanted pregnancy

Hypogonadism

Primary Hypogonadism Testes do not produce enough testosterone Causes: mumps, testicular trauma or inflammation, certain autoimmune disorders Secondary hypogonadism Lack of sufficient FSH and LH secretion from pituitary fail to trigger testosterone production by testes Causes: Cushing's syndrome, thyroid disorders, estrogen-secreting tumors, therapy with GnRH agonists Symptoms: Diminished appearance of secondary sex characteristics Sparse axillary, facial and pubic hair Increased subcutaneous fat Small testicular size Erectile dysfunction Low sperm counts Decreased libido Fatigue Depression Reduced muscle mass

Depo-Provera injections

Progesterone only IM injection Every 3 months Since 1992 No contraindication in breastfeeding mothers

Chronic Asthma Pharmacotherapy

Prophylaxis and treatment for chronic asthma Leukotriene receptor antagonists Block inflammatory responses in presence of stimulus Not effective for treatment of acute attacks Chromolyn sodium prophylactic medication inhalation on a daily basis useful for athletes and sports enthusiasts no value during an acute attack

Classes of Asthma Drugs Bronchodilators

Quick relief medications: Short and intermediate acting Beta 2-adrenergic agonists, anticholinergics and systemic corticosteroids Long-acting medications: Inhailed corticosteroids, mast cell stabilizers, leukotriene modifiers, long-acting beta2 -adrenergic agonists, methylxanthines, and immunomodulators

Asthma

Bronchial obstruction In persons with hypersensitive or hyper responsive airways May occur in childhood or have an adult onset Often family history of allergic conditions Extrinsic asthma Acute episodes triggered by type I hypersensitivity reactions Intrinsic asthma Onset during adulthood Hyper responsive tissue in airway initiates attack. Stimuli include Respiratory infections; stress Exposure to cold, inhalation of irritants Exercise Drugs Pathophysiologic changes of bronchi and bronchioles **Inflammation of the mucosa with edema **Bronchoconstriction Due to contraction of smooth muscle Increased secretion of thick mucus In airways **Changes create obstructed airways, partially or totally. (may lead to complete airway obstruction Intense breathlessness, Dyspnea

Methylxanthines

Bronchodilators, older drugs, closely related to caffeine Prototype medications Theophylline (Theo-dur) Aminophylline Narrow therapeutic margin Significant interactions with numerous other drugs Administered PO or IV Metabolized primarily in the liver **Nursing considerations- Monitor serum drug levels-Theophylline *10-20mcg/ml Limit food and beverages w/xanthine (chocolate, cola, coffee) **Side Effects Nervousness, tremors, dizziness, headache, nausea, vomiting, anorexia, Tachycardia, dysrhythmias, hypotension, seizures circulatory failure, respiratory arrest (serious adverse effects)

Signs of Alkalosis

CNS stimulation Irritability Confusion Slow respiratory rate-body is attempting to retain acid and lower Ph Hyperactive reflexes Convulsions

Expectorants

Reduce thickness/viscosity of bronchial secretions Increases mucous flow, and promotes expectoration Guaifenesin (Mucinex) Few side effects Common ingredient in OTC cold/flu preparations Take with full glass of fluid, & increase fluids during treatment to thin mucous secretions

Benign Prostatic Hypertrophy

Called hypertrophy, is actually hyperplasia of the prostatic tissue with formation of nodules surrounding the urethra Hyperplasia related to imbalance between estrogen and testosterone associated with aging Enlarged gland, incomplete emptying of the bladder due to obstruction, leads to frequent infections Obstruction: distended bladder, dilated ureters, hydronephrosis, and possible renal damage Enlargement of the prostate gland Obstructs urethra The most common benign neoplasm in men Causes difficult urination hesitancy Increased frequency w/small amts of urine Increased urgency Postvoid leakage(dribbling) Nocturia

Acid-base Balance

Regulation of acids and bases is critical to cellular metabolism Unless corrected quickly acidosis or alkalosis can have fatal consequences To maintain homeostasis the ph of most plasma and body fluids must be kept in a narrow range between 7.35 and 7.45.

Selective alpha1 blockers

Relax smooth muscle in prostate gland, bladder neck, & urethra doxazosin (Cardura) terazosin (Hytrin) tamsulosin (Flomax) Side Effects: Reflex tachycardia. Ejaculatory dysfunction w/tamsulosin

Risk factors for UTI

Sexual intercourse Use of diaphragm/spermicide Delayed postcoidal micturition Recent UTI older adults: confusion

Adult Respiratory Distress Syndrome

Signs and symptoms Dyspnea Restlessness Rapid, shallow respiration Increased heart rate Combination of respiratory and metabolic acidosis Non-responder to increasing o2 therapy Treatment Treatment of underlying cause Supportive respiratory therapy

Upper Respiratory Tract Infections :sinitus

Sinusitis Usually bacterial infection Analgesics for headache and pain Course of antibiotics often required to eradicate infection

General Manifestations of Respiratory Disease: sneezing

Sneezing Reflex response to irritation in upper respiratory tract Assists in removing irritant Associated with inflammation or foreign material

General Manifestations of Respiratory Disease: sputum

Sputum Yellowish-green, cloudy, thick mucus Often indication of a bacterial infection Rusty or dark-colored sputum Usually sign of pneumococcal pneumonia Very large amounts of purulent sputum with foul odor May be associated with bronchiectasis Thick, tenacious mucus Asthma or cystic fibrosis; blood-tinged sputum: may result from chronic cough, may also be sign of tumor or tuberculosis Hemoptysis Blood-tinged (bright red) frothy sputum, usually associated with pulmonary edema

Administration of Pulmonary Medications

Swift and efficient mechanism for medication delivery Enormous surface area of bronchioles and alveoli with access to significant blood supply results in rapid onset Types Aerosol Nebulizer DPI (dry powder inhaler) MDI (metered does inhaler)

Nasal Decongestants (nice)

Sympathomimetic amines Mechanism of Action Stimulate A-adrenergic receptors of nasal mucosa, causing vasoconstriction and decreased nasal congestion Less systemic effects than oral preparations A-adrenergic receptor effects Vasoconstriction of arterioles= elevated BP Dilated pupils Intestinal relaxation Bladder sphincter contractions

Beta 2 Adrenergic Agonists

Sympathomimetic, drug of choice for acute bronchospasm Bronchodilators-relax smooth muscle, widening airway No anti-inflammatory properties, combination therapy may be indicated Simply beta agonists, are effective bronchodilators for the management of asthma and other pulmonary diseases. They are first-line drugs for the treatment of acute bronchoconstriction Beta adrenergic agonists are drugs that activate the sympathetic nervous system, which relaxes bronchial smooth muscle resulting in bronchodilation. These medications may act either on beta 1 receptors, which are located in the heart or on beta 2 receptors, which are found in the smooth muscle of the lungs, uterus, and other organs. Beta agonists that activate both beta 1 and beta 2 receptors are called non selective bronchodilators. Beta agonists that activate only the beta 2 receptors are called selective drugs. Industry is move more towards selective drugs because they produce fewer cardiac side effects.

Mast Cell Stabilizers2

Taken on a daily basis Prevents asthma attacks by inhibiting release of histamine Medications Cromolyn (Intal), MDI or nebulizer, intranasal, eye gtts, PO Short half life-inhaled 4-6 /day Nedocromil sodium (Tilade), MDI, eye gtts Side Effects: stinging or burning of nasal mucosa, sneezing, irritation of the throat and nasal congestion, nausea, Anaphylaxis, angioedema, bronchospasm Do not treat acute attacks, maximum benefit may take several weeks Less effective than inhaled glucocorticoids Pregnancy category B, and exhibit no serious toxicity

Torsion of the testis

Testis rotates on the spermatic cord Compresses arteries and veins Ischemia develops, scrotum swells Immediate treatment is required Frequently occurs during puberty Spontaneous and following trauma

Androgens

Testosterone: Essential for maturation of sperm Provide negative feedback system for the continuous control of gonadotropin secretions There is no cyclic hormones in males Effects tissues outside reproductive system as well An anabolic steroid hormone that promotes metabolism and skeletal muscle development Promotes synthesis of erythropoietin

Histamine

Chemical mediator for inflammatory response Neurotransmitter in CNS

Smoking's Influence on the Lung

Cigarette smoke, inflames tissue and inhibits alpha-1 antitrypsin, which allows then the enzyme to digest/dissolve lung tissue

**IMPORTANT WARNING: OCP

Cigarette smoking increases the risk of serious side effects from oral contraceptives, including heart attacks, blood clots, and strokes. This risk is higher for women over 35 years old and heavy smokers (15 or more cigarettes per day). If you take oral contraceptives, you should not smoke

Beta 2 Adrenergic Agonists: Classification

Ultra short Short Acting Intermediate Long Acting Inhaled-produce little systemic effects Oral-longer duration, systemic effects-dysrhythmia, tolerance *Nursing Considerations-palpitations, tachycardia*, dry mouth, nervousness, cough or hyperglycemia Combined LABA/Inhaled Steroid (Advair) Patients should avoid drinking large amounts of caffeine-containing drinks such as tea, coffee, cocoa, and cola Prototype Medications Albuterol (Proventil) Levalbuterol HCl (Xopenex) Salmeterol (Serevent)

Compensation

Uncompensated: pH is abnormal, either PaCO2 or HCO3- is abnormal and the other is normal Partially compensated: pH is abnormal, PaCO2: and HCO3- are both abnormal Fully compensated: pH is normal, PaCO2 and HCO3- are both abnormal

Epispadias

Urethral opening on the dorsal (upper) surface of the penis, proximal to the glans May affect the urinary sphincter Incontinence may result Infections may result from stricture at the opening

Hypospadias

Urethral opening on the ventral (under) surface of the penis If the opening occurs in the proximal section considered more severe May be accompanied by chordee, ventral curvature of the penis

Bronchiectasis

Usually a secondary condition Irreversible abnormal dilation of the medium-sized bronchi (primarily) May be saccular or elongated Arises from recurrent inflammation and infection Leads to obstruction of airways, weakening of muscle and elastic fibers in bronchial walls, or both Infecting organisms Usually mixed, streptococci, staphylococci, pneumococci, H. influenza Signs and symptoms Chronic cough Production of copious amounts of purulent, foul-smelling sputum Treatment Antibiotics Bronchodilators Chest physiotherapy Treatment of primary condition -avoid intebation for as long as possible

Chronic Prostatitis

Usually related to repeated infection by E. Coli Prostate only slightly enlarged, irregular, and firm because fibrosis is more extensive Signs of dysuria, frequency, urgency

Upper Respiratory Tract Infections Influenza (FLU)

Viral infection Three groups of influenza viruses Type A (most prevalent), types B and C Viruses constantly mutate Sudden, acute onset with fever, marked fatigue, aching pain in the body May also cause viral pneumonia Mild case of influenza may be complicated by secondary bacterial pneumonia Commonly, deaths in flu epidemics result from pneumonia Treatment symptomatic and supportive, unless bacterial infection develops secondarily Antiviral drugs: may reduce symptoms and duration, reduces risk to infect others Prevention Respiratory hygiene! Vaccination is recommended for most individuals

Compensatory Mechanisms

The body will attempt to compensate for acidosis or alkalosis, to achieve a normal pH The respiratory system will compensate for metabolic pH shifts: Metabolic acidosis: respiratory rate will increase to "blow off" CO2, thus increasing pH of blood Metabolic alkalosis: respiratory rate will decrease to retain CO2, thus decreasing pH of blood The kidneys will compensate for respiratory pH shifts: Respiratory acidosis: kidneys will retain more bicarbonate, thus increasing pH of blood Respiratory alkalosis: kidneys will excrete more bicarbonate, thus decreasing pH of blood Respiratory compensation is much faster than metabolic Respiratory system can restore a normal pH within minutes Kidneys can restore a normal pH within hours

Female infertility: Failure to Ovulate

The endocrine problem occurs at level of hypothalamus, pituitary or ovary Target treatment at the specific cause Failure to ovulate: Clomiphene (Clomid) stimulates release of LH, results in maturation of follicles and induces ovulation Pituitary issue: treat with GnRH or HMG- increases follicle maturation

Respiratory mucosa

consists of pseudostratified ciliated columnar epithelium which included mucus-secreting goblet cells. The mucous blanket traps foreign particles, and the cilia sweep the mucus and debris up and out of the respiratory tract. This process is called "ciliary escalator" Smoking impairs the function of the cilia, and the irritation caused aby smoke leads to the replacement of ciliated epithelium by squamous cells, thereby removing the protective mechanism.

The upper respiratory tract

is made up of the passageways that conduct air between the atmosphere and the lungs. Air is warmed and moistened by the highly vascular mucosa. Foreign material is filtered out by the mucous secretions and hairs.

Cryptorchidism

maldescent of the testis, normal descent later part of pregnancy Often spontaneous descent occurs during the first year after birth Remain undescended, spermatogenesis is impaired Increased risk of testicular cancer in cryptorchid testes

A client with asthma has a prescription for two inhal- ers, albuterol (Proventil, VoSpire) and beclomethasone (Qvar). How should the nurse instruct this client on the proper use of the inhalers? 1. Usethealbuterolinhaler,andusethebeclomethasone only if symptoms are not relieved. 2. Use the beclomethasone inhaler, and use the albuterol only if symptoms are not relieved. 3. Use the albuterol inhaler, wait 5-10 minutes, then use the beclomethasone inhaler. 4. Use the beclomethasone inhaler, wait 5-10 minutes, then use the albuterol inhaler.

nswer: 3 Rationale: Using a bronchodilating inhaler such as alb- uterol (Proventil, VoSpire) first, then waiting 5-10 min- utes before using an ICS inhaler such as beclomethasone (Qvar), will allow the corticosteroid to reach deeper into the lungs following bronchodilation. Options 1, 2, and 4 are incorrect. The two inhalers have been prescribed together to maximize therapeutic effects. Using the beclomethasone before the albuterol may not allow the drug to reach deeply into the lungs for best effects. Cognitive Level: Applying. Nursing Process: Implementation. Client Need: Physiolog- ical Integrity.

Nasopharynx

posterior wall are located the pharyngeal tonsils or adenoids which is made of lymphoid tissue, another defense against the inhalation of foreign materials. Palatine tonsils or Tonsils located at the posterior portion of the oral cavity. Tonsils Can become enlarged due to infection and can obstruct airflow.

Phosphodiesterase-5 inhibitors

sildenafil (Viagra) vardenafil (Levitra) tadalafil (Cialis) Side Effects: 5-10mm drop in BP= Caution in those taking BP meds Contraindicated in patients taking NITRATES/alpha adrenergic blockers Nasal congestion, headache, facial flushing, dizziness Blurred vision (sidenafil) Priaprism- erection lasting >4 hours

Transdermal Contraceptive Patch

97% effective Monophasic dosing Change every 7 daysx3 weeks Apply shoulder, abdomen, buttocks or torso More expensive than OCP, skin irritation

NuvaRing

99% effective Monophasic combination hormone Insert intravaginally Remove Q3 weeks to allow for menses, then insert a new ring More expensive than OCP

Prostatitis Treatment

Antibiotic therapy if Category 1 or Category 2 Usually CIPRO NSAIDS/anti-inflammatories as well as prophylactic Antibacterials

Complications of Acidosis

Organ dysfunction or failure Shock The kidneys and lungs maintain the balance (proper pH level) of chemicals called acids and bases in the body. Acidosis occurs when acid builds up or when bicarbonate (a base) is lost. Acidosis is classified as either respiratory or metabolic acidosis.

Transport of Oxygen and Carbon Dioxide

Oxygen About 1% of oxygen is dissolved in plasma Most is bound (reversibly) to hemoglobin Binding/release of oxygen to hemoglobin depends on PO2, PCO2, temperature, plasma pH Carbon dioxide Waste product from cellular metabolism About 7% dissolved in plasma About 20% reversibly bound to hemoglobin Most diffuses into red blood cells- Bicarbonate

Factors Influencing Acid-Base Balance

PaCO2 Increased by: hypoventilation (e.g. over sedation, coma) → respiratory acidosis Decreased by: hyperventilation (e.g. anxiety, anemia) → respiratory alkalosis HCO3- Increased by: loss of gastric acid, some diuretics, adrenal tumors → metabolic alkalosis Decreased by: severe diarrhea, kidney disease, untreated diabetes, starvation → metabolic acidosis

Factors Influencing Oxygen Values

PaO2 Increased by oxygen therapy Decreased by hypoventilation, low oxygen in inhaled air, suffocation SaO2 Decreased by severe hypoventilation, low oxygen in inhaled air, suffocation

Progesterone only OCP's "Minipills"

Prevent pregnancy by producing mucus at entrance to uterus & inhibits implantation of fertilized egg Failure rate of 1-4% Higher incidence of menstrual irregularities Amenorrhea, prolonged bleeding, breakthrough spotting Used for patients at high risk for estrogen-related side effects (breast ca, thromboembolic events) Pregnancy category X

Human Chorionic Gonadotropin (hCG) abuse

Placental hormone used by athletes and teens Not an anabolic steroid Resembles LH, which stimulates testosterone production Used to transition off steroids, and to mask use of steroids

Mast Cell Stabilizers

Prevent mast cell break down, result in decreased histamine release Need to use prior to exposure to allergen for best results Nasal spray & eye drops Cromolyn: Intal

The client has been prescribed oxymetazoline (Afrin) nasal spray for seasonal rhinitis. The nurse will provide which of the following instructions? 1. Limituseofthissprayto5daysorless. 2. The drug may be sedating so be cautious with activities requiring alertness. 3. This drug should not be used in conjunction with antihistamines. 4. This is an OTC drug and may be used as needed for congestion.

. Answer: 1 Rationale: Prolonged use of oxymetazoline (Afrin) causes hypersecretion of mucus and worsening nasal congestion, resulting in increased daily use. Options 2, 3, and 4 are in- correct. This medication should not be used for longer than 5 days unless otherwise directed. It may be used with an- tihistamines for symptomatic relief and it is not sedating. Cognitive Level: Applying. Nursing Process: Implementa- tion. Client Need: Physiological Integrity.

Female infertility

3 main causes of female infertility Pelvic infection- PID Physical obstruction of uterine tubes- Endometriosis Lack of ovulation- endocrine issue

Male Infertility

30%-40% of infertility issues related to male reproductive system Can be psychological- must rule out Oligospermia- less than 20 million sperm/ml of ejaculate Azoospermia- complete absence of sperm in ejaculate Causes: Erectile dysfunction, Infections- TB, mumps, STI Treatment goal= increase sperm production Im injections of hCG 3x/week x1 year If unsuccessful, change to menotropins (Pergonal) FSH & LH Antiestrogens tamoxifen/clomiphene used to block negative feedback result increased FSH and LH Estrogen therapy is not very successful. Only 5% of male infertility is related to endocrine problems.

Which information should the nurse discuss with the patient diagnosed with COPD who is prescribed theophylline, a xanthine bronchodilator? 1Instruct the patient to take the medication on an empty stomach. 2Explain that an increased heart rate and irritability are expected side effects. 3Discuss the need to avoid large amounts of caffeine-containing drinks. 4Tell the patient to double the next dose if a dose is missed.

3Discuss the need to avoid large amounts of caffeine-containing drinks.

The patient diagnosed with rule-out DVT is experiencing dyspnea and chest pain on inspiration. On assessment, the nurse finds a respiratory rate of 40. Which medication should the nurse anticipate the HCP to order? 1Warfarin (Coumadin), an oral anticoagulant. 2Enoxaparin (Lovenox), a low-molecular-weight heparin. 3Heparin, an intravenous anticoagulant. 4Ticlopidine (Ticlid), an antiplatelet medication.

3Heparin, an intravenous anticoagulant.

The patient diagnosed with COPD is prescribed methylprednisolone (Solu-Medrol), a glucocorticoid, IVP (IV push). Which laboratory test should the nurse monitor? 1The white blood cell (WBC) count. 2The hemoglobin and hematocrit. 3The blood glucose level. 4The BUN and creatinine.

3The blood glucose level.

Prostatitis

4 types Category 1- acute bacterial Category 2- chronic bacterial Category 3- non-bacterial Category 4- asymptomatic inflammatory prostatitis Closely associated with UTI's in men due to anatomical layout, promotes the spread of infection through the structures Bacterial episodes are considered ascending infection, or inflammation with multiple causes

The male patient diagnosed with chronic obstructive pulmonary disease (COPD) tells the nurse that he as been expectorating "rusty-colored" sputum. Which medication should the nurse anticipate the HCP prescribing? 1Prednisone, a glucocorticoid. 2Habitrol, a transdermal nicotine system. 3Dextromethorphan (Robitussin), and antitussive. 4Ceftriaxone (Rocephin) a cephalosporin.

4Ceftriaxone (Rocephin) a cephalosporin.

The patient diagnosed with arterial hypertension develops a cold. Which information regarding OTC medications should the nurse teach? 1Try to find a medication that will not cause drowsiness. 2OTC medications are not as effective as a prescription. 3OTC medications are more expensive than prescriptions 4Do not take OTC medication unless approved by the HCP

4Do not take OTC medication unless approved by the HCP

The nurse is discharging a patient diagnosed with chronic obstructive pulmonary disease (COPD). Which discharge instructions should the nurse provide regarding the patient's prescription for prednisone, a glucocorticoid? 1Take all the prednisone as ordered until the prescription is empty. 2Take the prednisone on an empty stomach with a full glass of water. 3Stop taking the prednisone if a noticeable weight gain occurs. 4The medication should never be abruptly discontinued.

4The medication should never be abruptly discontinued.

A client has started taking clomiphene (Clomid, Sero- phene) after an infertility work-up and asks the nurse why she is not having in-vitro fertilization. Which of the following nursing statements would be most helpful in explaining the use of clomiphene to the client? 1. Theclient'sdiagnosticwork-upsuggestedthat infrequent ovulation may be the cause for her infertility and clomiphene increases ovulation. 2. In-vitro fertilization is expensive and because clomiphene is less expensive, it is always tried first. 3. Thereislessriskofmultiplebirthswithclomiphene. 4. Theclient'spasthistoryoforalcontraceptiveusehas prevented her from ovulating. Clomiphene is given to stimulate ovulation again in these conditions.

Answer: 1 Rationale: Infertility may result from physical obstruction, pelvic infections, or endocrine-related reasons resulting in lack of ovulation. If a fertility work-up suggests that infre- quent or lack of ovulation is a primary cause, clomiphene may be tried to increase ovulation and is approximately 80% effective for clients with ovulatory-related infertility. Options 2, 3, and 4 are incorrect. Clomiphene will not be therapeutic if the causes of infertility are other than lack of ovulation. The risk of multiple births is higher with ovulatory stimu- lants with approximately 5% resulting in twins. Contracep- tives do not continue to suppress ovulation after they have been discontinued. Cognitive Level: Applying. Nursing Pro- cess: Implementation. Client Need: Physiological Integrity.

A 65-year-old client is prescribed ipratropium (Atrovent) for the treatment of asthma. Which of the following con- ditions should be reported to the health care provider before giving this client the ipratropium? 1. Areportedallergytopeanuts 2. A history of intolerance to albuterol (Proventil, VoSpire) 3. A history of bronchospasms 4. A reported allergy to chocolate

Answer: 1 Rationale: Ipratropium (Atrovent) is contraindicated in pa- tients with hypersensitivity to soya lecithin or related food products such as soybean and peanut. Options 2, 3, and 4 are incorrect. A history of intolerance to albuterol or bron- chospasms are indications for the ipratropium. A history of allergy to chocolate is not a contraindication for this drug. Cognitive Level: Analyzing. Nursing Process: Assessment. Client Need: Physiological Integrity.

The client with erectile dysfunction is being evaluated for the use of sildenafil (Viagra). Which of the following questions should the nurse ask before initiating therapy with sildenafil? 1. "Areyoucurrentlytakingmedicationsforangina?" 2. "Do you have a history of diabetes?" 3. "Have you ever had an allergic reaction to dairy products?" 4. "Haveyoueverbeentreatedformigraineheadaches?"

Answer: 1 Rationale: Life-threatening hypotension is an adverse effect in clients who are taking sildenafil (Viagra) and organic ni- trates. Options 2, 3, and 4 are incorrect. Diabetes, allergies to dairy, or migraines are not contraindications for silde- nafil. Cognitive Level: Applying. Nursing Process: Assess- ment. Client Needs: Physiological Integrity.

The nurse is teaching a client who has a new prescriptionfor testosterone gel. Which of the following instructions should the nurse give to this client? 1. "Avoidexposingwomentothegelortoareasofskin where the gel has been applied." 2. "Report any weight gain over 5 lb (2 kg) in 1 month." 3. "Avoid showering or swimming for at least 12 hours after applying the gel." 4. "Apply the gel to the scrotal and perineal areas daily."

Answer: 1 Rationale: Women and children should avoid contact with the gel or areas of the skin where gel has been applied to avoid drug absorption. Options 2, 3, and 4 are incorrect. A weight gain of 5 lb (2 kg) in 1 week's time should be re- ported but a gain over 1 month may not be significant. The gel should be applied to the chest or upper torso, not to the scrotal or perineal areas. Showering or swimming should be avoided for several hours after gel application to allow for adequate absorption, but there is no need to wait a full 12 hours before these activities. Cognitive Level: Applying. Nursing Process: Implementation. Client Need: Physiolog- ical Integrity.

A client is given a prescription for finasteride (Proscar) for treatment of benign prostatic hyperplasia. Essential teaching for this client includes which of the following? (Select all that apply.) 1. Fulltherapeuticeffectsmaytake3to6months. 2. Hairlossormale-patternbaldnessmaybeanadverse effect. 3. Thedrugshouldnotbehandledbypregnantwomen, especially if it is crushed. 4. Blooddonationshouldnotoccurwhiletakingthisdrug. 5. Reportanyweightgainofover5lb(2kg)in1week's time.

Answer: 1, 3, 4 Rationale: Enlarged prostatic tissue will decrease over a pe- riod of 3 to 6 months. The drug is teratogenic and should not be handled by pregnant women. Blood donation should not occur while taking finasteride because the blood may be given to a woman. Options 2 and 5 are incorrect. Finasteride in lower doses is given under the trade name "Propecia" for treatment of baldness. There is a concern for edema and weight gain when alpha-blocking drugs are used to treat BPH but finasteride (Proscar) is a 5-alpha reductase inhibitor, not an alpha-blocker, and edema and weight gain are not associated with its use. Cognitive Level: Analyzing. Nursing Process: Implementation. Client Need: Physiologi- cal Integrity.

Which of the following clients would have a higher risk for adverse effects from estradiol and norethindrone (Ortho-Novum)? (Select all that apply.) 1. An 18-year-old with a history of depression 2. A 16-year-old with chronic acne 3. A 33-year-old with obesity per her BMI 4. A 24-year-old who smokes one pack of cigarettes per day 5. A 41-year-old who has delivered two healthy children

Answer: 1, 4 Rationale: Women who smoke have a greater risk of adverse cardiovascular effects and the FDA has issued a black box warning about these effects. A previous history of depres- sion is a relative contraindication because oral contracep- tives may worsen depression in some women. The use of OCs should be evaluated by the health care provider in this situation. Options 2, 3, and 5 are incorrect. OCs sometimes are prescribed as an off-label treatment for acne. Obesity alone is not a contraindication for OCs, nor is age. Women over 35 who smoke have a greater risk of cardiovascular ad- verse effects. Cognitive Level: Analyzing. Nursing Process: Assessment. Client Need: Physiological Integrity

A client is receiving treatment for asthma with albuterol (Proventil, VoSpire). The nurse teaches the client that while serious adverse effects are uncommon, the follow- ing may occur. (Select all that apply.) 1. Tachycardia 2. Sedation 3. Temporarydyspnea 4. Nervousness 5. Headache

Answer: 1, 4, 5 Rationale: Tachycardia, nervousness, and headache may occur with the use of albuterol (Proventil, VoSpire) inhalers. Options 2 and 3 are incorrect. Sedation and dyspnea are not adverse ef- fects of albuterol. Cognitive Level: Applying. Nursing Process: Implementation. Client Need: Physiological Integrity.

A client is interested in taking levonorgestrel and estra- diol (Seasonique) and asks how it is taken. Which expla- nation by the nurse is correct? 1. "Seasoniqueistakenyear-roundwithoutabreakand without a period." 2. "Seasonique is taken for 84 days and then followed by 7 days of a lower dose contained in the same package." 3. "Seasonique is a vaginal ring that is inserted monthly." 4. "Seasonique is taken for 2 months then off for 1 month using regular oral contraceptives."

Answer: 2 Rationale: Seasonique is taken for 84 consecutive days, fol- lowed by 7 days of a lower dose that is contained in the same pill pack. Options 1, 3, and 4 are incorrect. None of these explanations are correct for Seasonique. Cognitive Level: Analyzing. Nursing Process: Implementation. Client Need: Physiological Integrity.

A client has been prescribed fluticasone (Flonase) to use with oxymetazoline (Afrin). How should the client be taught to use these drugs? 1. Usethefluticasonefirst,thentheoxymetazolineafter waiting 5 minutes. 2. Use the oxymetazoline first, then the fluticasone after waiting 5 minutes. 3. The drugs may be used in either order. 4. The fluticasone should be used only if the oxymetazoline fails to relieve the nasal congestion.

Answer: 2 Rationale: The oxymetazoline (Afrin) should be used first, followed by the fluticasone (Flonase) in 5 to 10 minutes. When a decongestant and corticosteroid nasal spray are used together, the decongestant spray should be used first to allow time for the nasal passages to open, allowing the corticosteroid to reach deeper into the nasal passages. Op- tions 1, 3, and 4 are incorrect. The drugs are ordered in combination for better control of nasal rhinitis. The oxy- metazoline should not be used for over 5 days unless other- wise directed. Cognitive Level: Applying. Nursing Process: Implementation. Client Need: Physiological Integrity.

Which of the following nursing assessments would be appropriate for the client who is receiving testosterone? (Select all that apply.) 1. Monitor for a decrease in hematocrit (Hct). 2. Assessforsignsoffluidretention. 3. Assessforincreasedmusclemassandstrength. 4. Checkforblooddyscrasias. 5. Assessformusclewasting.

Answer: 2, 3 Rationale: A side effect of testosterone therapy is fluid re- tention. Testosterone is also used to increase muscle mass and strength. Options 1, 4, and 5 are incorrect. The hema- tocrit may increase with the use of testosterone, because it promotes the synthesis of erythropoietin. Muscle wasting should not occur and blood dyscrasias are not common with the use of testosterone. Cognitive Level: Analyzing. Nursing Process: Assessment. Client Need: Physiological Integrity.

Which of the following drugs is most immediately helpful in treating a severe acute asthma attack? 1. Beclomethasone(Qvar) 2. Zileuton(ZyfloCR) 3. Albuterol(Proventil,Ventolin) 4. Salmeterol(Serevent)

Answer: 3 Rationale: Beta-adrenergic drugs such as albuterol (Proven- til, Ventolin) are most often used for rapid bronchodila- tion. Options 1, 2, and 4 are incorrect. Corticosteroids such as beclomethasone, leukotriene modifiers such as zileuton, and long-acting beta agonists such as salmeterol may be used for maintenance therapy to prevent or control asth- ma attacks but do not act quickly enough for acute attacks. Cognitive Level: Applying. Nursing Process: Implementa- tion. Client Need: Physiological Integrity.

A client who received a prescription for zafirlukast (Ac- colate) returns to his provider's office after three days, complaining that "the drug is not working." She reports mild but continued dyspnea and has had to maintain consistent use of her bronchodilator inhaler, pirbuterol (Maxair). What does the nurse suspect is the cause of the failure of the zafirlukast? 1. Theclientisnottakingthedrugcorrectly. 2. The client is not responding to the drug and will need tobe switched to another formulation. 3. The drug has not had sufficient time of use to have full effects. 4. Thepirbuterolinhalerisinteractingwiththezafirlukast.

Answer: 3 Rationale: Leukotriene modifiers such as zafirlukast (Acco- late) take up to 1 week or longer to develop full effects. The client should continue to use her bronchodilator as needed while the drug reaches full therapeutic effects. If no change in effects is noted after 7-10 days, the therapy should be re-evaluated. Options 1, 2, and 4 are incorrect. Because the drug is taken orally, the client should be self-administering the zafirlukast correctly. More time is needed before deter- mining whether the drug will have full effects, and it is of- ten used as an adjunct to bronchodilation therapy. Cogni- tive Level: Analyzing. Nursing Process: Evaluation. Client Need: Physiological Integrity.

A woman consults the nurse about Plan B (levonorg- estrel) after unprotected intercourse that occurred 2 days before. Which of the following instructions will the nurse give to this client? 1. "Youmustwait7daysbeforetakingthepillsforPlanB to be effective." 2. "Plan B is effective only within 24 hours of unprotected intercourse." 3. "You will take one pill of Plan B at first, followed by another pill 12 hours later." 4. "YouwillneedtoobtainaprescriptionforPlanB."

Answer: 3 Rationale: Plan B (levonorgestrel) is administered by taking one pill, followed by another pill 12 hours later. Options 1, 2, and 4 are incorrect. Plan B should be taken within 120 hours after unprotected intercourse. After 7 days it is ineffective in preventing pregnancy. It is available OTC to women older than 17 after age verification by a pharmacist, and a prescrip- tion is not required. Cognitive Level: Applying. Nursing Pro- cess: Implementation. Client Need: Physiological Integrity.

Which of the following is the best advice that the nurse can give a client with viral rhinitis who intends to pur- chase an OTC combination cold remedy? 1. "Dosagesintheseremediesprovideprecisedosingfor each symptom that you are experiencing." 2. "These drugs are best used in conjunction with an antibiotic." 3. "Itissafertouseasingle-drugpreparationifyouare experiencing only one symptom." 4. "Sincethesedrugsareavailableoverthecounter,itis safe to use any of them as long as needed."

Answer: 3 Rationale: Single-symptom OTC preparations are preferred over multiuse preparations to avoid additional drugs that are not needed for symptom relief and to decrease risk of addi- tional adverse effects. Options 1, 2, and 4 are incorrect. Dos- ing of any OTC preparation is carefully calculated to provide precise dosing for age and symptoms. Antibiotics may be re- quired for serious infections, but for common symptoms OTC remedies are recognized as safe and effective; however, they should not be used indefinitely without consultation with a health care provider. Cognitive Level: Application. Nursing Process: Implementation. Client Need: Physiological Integrity.

Urinary Tract Infections

Asymptomatic Bacteriuria urine cultures No symptoms Uncomplicated UTI + urine culture Symptomatic: Dysuria, Frequency, Urgency, Suprapubic discomfort No structural or functional GU abnormality Complicated UTI + Urine culture Symptoms: all of UTI plus Fever, Chills, Flank Pain GU abnormalities Abdominal Pain

The nurse is teaching a client about the use of tadalafil (Cialis). What will the nurse teach him about the effects of tadalafil? 1. Itshouldalwaysresultinapenileerectionwithin 10 minutes. 2. It may heighten female sexual response. 3. It is not effective if sexual dysfunction is caused by psychological conditions. 4. Itwillresultinlessintensesensationwithprolongeduse.

Answer: 3 Rationale: Tadalafil (Cialis) and other similar drugs are not effective if the erectile dysfunction is psychological in nature. Options 1, 2, and 4 are incorrect. Tadalafil will not height- en sexual response in females. It does not cause decreased sensations over time and it enhances, rather than causes, an erection. Cognitive Level: Applying. Nursing Process: Im- plementation. Client Need: Physiological Integrity.

A client has a prescription for fluticasone (Flonase). Place the instructions that follow in the order in which the nurse will instruct the client to use the drug. 1. Instillonespraydirectedhighintothenasalcavity. 2. Clearthenosebyblowing. 3. Primetheinhalerpriortofirstuse. 4. Spitoutanyexcessliquidthatdrainsintothemouth.

Answer: 3, 2, 1, 4 Rationale: When an intranasal inhaler is used, the device should be primed prior to the first use; the nasal passages should be cleared by blowing; the drug should be instilled by spray directed high into the nasal passages; and any liq- uid that drains into the mouth should be spit out. Cognitive Level: Applying. Nursing Process: Implementation. Client Need: Health Promotion and Maintenance.

A client with a history of BPH is complaining of feeling like he "cannot empty his bladder." He has been taking finasteride (Proscar) for the past 9 months. What should the nurse advise this client to do? 1. Continue to take the drug to achieve full therapeutic effects. 2. Discuss the use of a low-dose diuretic with the health care provider. 3. Decreasetheintakeofcoffee,tea,andalcohol. 4. ReturntothehealthcareproviderforPSAlaboratory studies and a prostate exam.

Answer: 4 Rationale: Finasteride promotes shrinking of enlarged prostates and helps restore urinary function with full thera- peutic effects obtained within 6 to 12 months. Because this client reports a sudden increase in urinary symptoms after taking the drug for 9 months, he should be evaluated by the health care provider for prostate cancer screening. Options 1, 2, and 3 are incorrect. Continuing to take the dose, or a low-dose diuretic, with the onset of new symptoms would not be appropriate. Decreasing bladder irritants such as coffee, tea, and alcohol may help overall but do not explain the sudden increase in symptoms. Cognitive Level: Analyz- ing. Nursing Process: Implementation. Client Need: Physi- ological Integrity.

A 43-year-old client is receiving medroxyprogesterone (Depo-Provera) for treatment of dysfunctional uterine bleeding. Because of related adverse effects, which of the following may indicate a potential adverse effect? 1. Breakthroughbleedingbetweenperiods 2. Insomniaordifficultyfallingasleep 3. Eye,mouth,orvaginaldryness 4. Jointpainorpainonambulation

Answer: 4 Rationale: Medroxyprogesterone (Depo-Provera) carries a black box warning about the risk of decreased bone density that may occur over time. Joint or bone pain, or pain on ambulation, should be assessed as a sign of this potential adverse effect. Options 1, 2, and 3 are incorrect. Medroxy- progesterone may cause spotting between menstrual peri- ods but is usually not an adverse effect of concern unless it increases. Insomnia or dryness of the eyes, mouth, or va- gina are not effects associated with medroxyprogesterone. Cognitive Level: Analyzing. Nursing Process: Evaluation. Client Need: Physiological Integrity.

A client has been using a fluticasone (Flovent) inhaler as a component of his asthma therapy. He returns to his health care provider's office complaining of a sore mouth. On inspection, the nurse notices white patches in the client's mouth. What is a possible explanation for these findings? 1. Theclienthasbeenconsuminghotbeveragesafterthe use of the inhaler. 2. Theclienthaslimitedhisfluidintake,resultingindry mouth. 3. Theresidueoftheinhalerpropellantiscoatingthe inside of the mouth. 4. Theclienthasdevelopedthrushasaresultofthe fluticasone.

Answer: 4 Rationale: The client likely has developed a thrush (Can- dida) infection of the mouth secondary to the use of the corticosteroid inhaler. After the use of ICS inhalers such as fluticasone (Flovent), clients should be taught to rinse the mouth and spit out the residue. Drinking fluids will also prevent irritation, ulcerations, and thrush infections of the throat. Options 1, 2, and 3 are incorrect. Drinking hot liquids should be managed carefully but will not increase the incidence of adverse effects due to the inhaler. Fluids in general should be increased but dry mouth should not re- sult in white patches. The propellant should not be remain- ing in the client's mouth after rinsing, eating, or drinking. Cognitive Level: Analyzing. Nursing Process: Evaluation. Client Need: Physiological Integrity.

The nurse is teaching a client about the use of dextro- methorphan with guaifenesin (Robitussin-DM) syrup for a cough accompanied by thick mucus. Which instruction should be included in the client's teaching? 1. "Liesupinefor30minutesaftertakingtheliquid." 2. "Drinkminimalfluidstoavoidstimulatingthecough reflex." 3. "Takethedrugwithfoodforbestresults." 4. "Avoiddrinkingfluidsimmediatelyafterthesyrupbut increase overall fluid intake throughout the day."

Answer: 4 Rationale: The syrup base of dextromethorphan will help to soothe throat irritation and fluids should be avoided im- mediately following administration. Overall fluid intake should be increased throughout the day. Options 1, 2, and 3 are incorrect. The client does not need to remain supine af- ter taking this drug, take the drug with food, or avoid fluid intake. Cognitive Level: Applying. Nursing Process: Imple- mentation. Client Need: Physiological Integrity.

The female patient is being admitted to a medical unit with a diagnosis of pneumonia. Which intervention would the nurse implement? Rank in order of performance. 1Start an intravenous access line. 2Administer the IVPB antibiotic. 3Teach to notify the nurse of any vaginal itching. 4Obtain sputum and blood cultures. 5Place an identity band on the patient.

Answer: 5, 4, 1, 2, 3

Anticholinergics

Anticholinergics are alternative bronchodilators. Work by blocking the parasympathetic system which produces similar effects as sympathetic nervous system—bronchodilation. Common anticholinergics Ipratropium bromide (Atrovent) (COPD+ asthma) Tiotropium (Spiriva)(COPD) Atrovent more common medication prescribed for COPD and asthma Combining w/beta-adrenergic agonist produces greater bronchodilator effects and longer duration. (ie. Combivent-albuterol and atrovent) Spiriva is a newer anticholinergic approved for COPD Side Effects-dry mouth, gastrointestinal distress and headache, dry mouth, bad taste, anxiety, urinary retention. Paradoxical bronchospasm, *Pharyngitis Nursing Considerations- Monitor client's condition Respiratory and heart rate prior to and after administration History- narrow angle glaucoma, renal disorders and urinary bladder neck obstruction, caution w/elderly -Rinse and spit after use

Abnormal Breathing Patterns

Apnea: cessation of breathing Dyspnea: difficult or labored breathing Tachypnea: excessively rapid respirations Bradypnea: abnormal slowness of respirations Orthopnea: difficulty breathing when lying down Paroxysmal nocturnal dyspnea (PND): occurs suddenly at night, usually 1-2 hours after falling asleep Kussmaul respirations: deep and labored breathing pattern Cheyne Stokes respirations: progressively deeper and sometimes faster breathing followed by a gradual decrease that results in a temporary stop, apnea

Acute Bacterial Prostatitis

Ascending infection (progresses up the urethra) Primarily caused by E. coli, but sometimes Pseudomonas, Proteus, or Strep. Faecalis See in older men with BPH Young men with UTIs due to coliform bacteria from the intestines In association with STDs such as Gonorrhea With instrumentation such as catheterization Process of confirming the source of infection may be painful and spread the infection, bacteremia Symptoms: Tender, swollen, boggy, soft prostate gland Urine with large quantities of microorganisms, pus, and leukocytes Signs of dysuria, frequency, and urgency May be inflammation of epididymis or testes as well Fever, chills, low back pain, pain in lower abdomen Obstruction of urinary flow in severe cases

General Manifestations of Respiratory Disease: others

Breathing patterns and characteristics Labored respiration or prolonged inspiration or expiration Often associated with obstruction of airways Adventitious lung sounds Pleural Pain: results from inflammation or infection of parietal pleura Dyspnea: subjective feeling of discomfort, may be caused by increased carbon dioxide or hypoxemia, often noted on exertion such as climbing stairs Severe dyspnea indicative of respiratory distress Flaring of nostrils Use of accessory respiratory muscles Retraction of muscles between or above the ribs Cyanosis: bluish coloring of skin and mucous membranes caused by large amounts of unoxygenated hemoglobin in the blood ABG changes Hypoxemia: inadequat4e oxygen in blood Hypercapnea: increased carbon dioxide in blood Friction rub: soft sound produced as rough, inflamed, or scarred pleural move against each other Clubbed digits: results from chronic hypoxia associated with respiratory or cardiovascular disease Painless, firm, fibrotic enlargement at the end of the digit

Condylomata Acuminata

Caused by human papillomavirus (HPV) DNA virus Incubates up to 6 months May be asymptomatic Treatment: cryotherapy, surgery, lazer removal HPV vaccination

Female infertility: Endometriosis

Common cause of infertility Causes pain, dysfunctional bleeding and dysmenorrhea Painful intercourse

Upper Respiratory Tract Infections: Common Cold

Common cold (infectious rhinitis) Viral infection More than 200 possible causative agents Spread through respiratory droplets Irritation of cells causes histamine release Hand-washing and respiratory hygiene important in prevention Symptomatic treatment: OTC cold medicine, only treat the symptoms you are having, do not over medicate Secondary bacterial infections may occur Usually caused by streptococci Purulent exudate, systemic signs - i.e., fever

Vaginitis/Vaginosis

Conditions where the normal balance of flora in vagina is altered, or where there is a pathogen which causes symptoms Normal healthy vaginal flora: Lactobacillus Acidophillus gm+ bacteria keeps Ph of vagina acidic

Asthma - Signs and Symptoms

Cough, marked dyspnea, tight feeling in chest Wheezing Rapid and labored breathing Expulsion of thick or sticky mucus Tachycardia Might include pulsus paradoxus Pulse differs on inspiration and expiration Hypoxia Respiratory alkalosis Initially due to hyperventilation Respiratory acidosis Due to air trapping Severe respiratory distress Hypoventilation leads to hypoxemia and respiratory acidosis Respiratory failure Indicated by decreasing responsiveness, cyanosis Status asthmaticus Persistent severe attack of asthma Does not respond to usual therapy Medical emergency! May be fatal due to severe hypoxia and acidosis Hospitalization required

General Manifestations of Respiratory Disease: coughing

Coughing Irritation due to nasal discharge Inflammation or foreign material in lower respiratory tract Due to inhaled irritants

HRT- considerations

Counsel patient regarding undesirable adverse effects of estrogen use before implementing therapy. Female: Hirsutism, loss of hair, deepening voice Male: Secondary female characteristics- higher voice, lack of body hair, increased breast size, impotence Reversible, may subside with adjusted dose or discontinuation of estrogen therapy

COPD- Emphysema

Destruction of alveolar walls and septae Leads to large, permanently inflated alveolar air spaces Classified by specific location of changes Contributing factors Genetic deficiency: alpha-antitrypsin Genetic tendency Cigarette smoking Pathogenic bacteria Breakdown of alveolar wall results in Loss of surface area for gas exchange Loss of pulmonary capillaries Loss of elastic fibers Altered ventilation-perfusion ratio Decreased support for other structures Fibrosis Narrowed airways Weakened walls Interference with passive expiratory airflow Signs and symptoms Dyspnea Occurs first on exertion Hyperventilation with prolonged expiratory phase Development of "barrel chest" Anorexia and fatigue Weight loss Clubbed fingers Diagnostic tests Chest radiograph and pulmonary function testsAdvanced emphysema and loss of tissue Adjacent damaged alveoli coalesce, forming large air spaces Pneumothorax Occurs when pleural membrane surrounding large blebs ruptures Hypercapnia becomes marked Hypoxia becomes driving force of respiration Frequent infections Pulmonary hypertension and cor pulmonale may develop in late stageTreatment Avoidance of respiratory irritants Immunization against influenza and pneumonia Pulmonary rehabilitation Appropriate breathing techniques Adequate nutrition and hydration Improves energy levels, resistance to infection Bronchodilators, antibiotics, oxygen therapy as condition advances Lung reduction surgery

Bronchopneumonia

Diffuse pattern of infection in both lungs Several species of microorganisms may be the cause Inflammatory exudate forms in alveoli Onset tends to be insidious Moderate fever, cough, rales Productive cough with purulent sputum-usually yellow or green Antibacterial treatment

Varicocele

Dilated vein in the spermatic cord usually on the left Develops after puberty Results from lack of valves in the veins permitting backflow of blood and increased pressure in the vines Painful and tender, leads to infertility, impaired blood flow to the testes, and decreased spermatogenesis

Mucolytics

Directly loosens thick bronchial secretions Breaks down the chemical structure of mucus molecules Acetylcysteine (Mucomyst) Inhalation route only By prescription only CF, chronic bronchitis Can trigger bronchospasm Smells like rotten eggs

Tuberculosis

Etiology Mycobacterium tuberculosis transmitted by oral droplets from persons with active infection Occurs more frequently with People living in crowded conditions, immunodeficiency, malnutrition, alcoholism, conditions of war, chronic disease, HIV infection Usual cause M. tuberculosis Somewhat resistant to drying and many disinfectants Can survive in dried sputum for weeks Destroyed by ultraviolet light, heat, alcohol, glutaraldehyde, formaldehyde Normal neutrophil response does not occur Cell-mediated immunity normally protection Primarily affects lungs; other organs may be invaded, too Primary infection When organism first enters the lungs Engulfed by macrophages - local inflammation If cell-mediated immunity is inadequate: Mycobacteria reproduce and begin to destroy lung tissue This form of disease is contagious! If cell-mediated immunity is adequate: Some bacilli migrate to lymph nodes - granuloma - formation of tubercle (contains live bacilli) - walled off and calcifying Tubercle may be visible on chest radiograph. Bacilli may remain viable in a dormant stage for years. Individual's resistance and immune responses high - bacilli remain walled off Primary or latent infection - individual has been exposed, infected, but does not have disease and is asymptomatic Individual cannot transmit disease. Secondary or reinfection TB Occurs when client's cell-mediated immunity is impaired due to: Stress Malnutrition HIV infection Age Mycobacteria begin to reproduce and infect lung. Active TB, which can be spread to others! Miliary or extrapulmonary tuberculosis Rapidly progressive form more common in children <5 years Early dissemination to other tissues If lesions are not found in lung, this is not contagious. Common symptoms include weight loss, failure to thrive, and other infections such as measles. Active TB (either primary or secondary) Organisms multiply, forming large areas of necrosis. Causing large open areas in lung - cavitation Cavitation promotes spreading into other parts of lung. Infection may spread into pleural cavity. Cough, positive sputum, radiograph showing cavitation Disease in this form is highly infectious when there is close personal contact over a period of time.

Hydrocele

Excessive fluid collects in the potential space between the layers of the tunica vaginalis One or both testes Fluid escapes form the peritoneal cavity if the proximal portion of the processus vaginalis, a section of the peritoneal membrane dose not close off as expected following descent of the testes Larger and firmer during daytime hours, fluid subsides during the night Risk of inguinal hernia, intestinal obstruction

H1-Receptor antagonists: Antihistamines

First Generation- "sedating" (Benadryl, Dramamine) Second Generation- "non-sedating" (Zyrtec,Allegra) Mechanism of Action: Blocks histamine receptor site on mucous membrane cells, thereby reducing the effect of histamine Decreases swelling of tissue, mucous production Anticholinergic effects: dry mouth, urinary retention Antipruritic effects Sedating effects Classified by the amount of sedation they cause. H1 Receptor antagonists: Antihistamines 1st generation (Diphenhydramine (Benadryl) Does not stop the actual allergic response - IGE mediated allergies, will still produce histamine from mast cells, and have antibody-antigen complexes Have anticholinergic effects, because they are not specific to the H1 receptor, they serve as antagonists for muscarinic receptors as well (anticholinergics), and this causes the side effect profile that you see. The second generation are a little more selective, (Fexofenadine: Allegra) but not 100%, so still see some of the problems Best results if taken before the exposure to allergen, limited effects afterwards Anticholinergic effects: dry mouth, dry mucus membranes, urinary retention Sometimes get CNS depression (sleepy) and worse with Alcohol- why? Some people get excitation with or CNS stimulation- nervous and tremors Second generation less anticholinergic side effects Motion sickness: suppress vomiting center in medulla, and depress neurons of vestibular apparatus of inner ear. Take before exposure. PD- want antichonergics to treat PD- tremor and psych drugs Insomnia, few days become tolerant only use 2 weeks or less Urticaria and rash- usually due to histamine, so do well.

TB Diagnostic Tests

First exposure or primary infection Indicated by positive tuberculin (skin) test results Active infections Acid-fast sputum test Chest radiograph Sputum culture and sensitivity Treatment Long-term treatment with a combination of drugs Length of treatment varies from 6 months to 1 year

Herpes Simplex Virus

HSV-1 or HSV-2 Transmitted skin to skin contact of vessicles/fluid Symptoms: Initial episode often worse than recurrent episodes Lymph node involvement, flu like symptoms Tingling burning prior to outbreaks Vesicular lesions Treatment: Antiviral medications Acyclovir Valcyclovir Education to prevent transmission Initial episode can be mild and not noticed Increased chance of cervical CA in women with HSV-2

Erectile Dysfunction (ED)

Inability to obtain or sustain an erection long enough to achieve successful intercourse Common disorder, Increases with age Medical conditions: Atherosclerosis, Diabetes, Kidney Disease, Stroke, HTN Smoking- increases incidence by 30%-60% Psychogenic Causes: depression, fatigue, guilt, insecurity Medications: thiazides, phenothiazines, SSRI, TCA, beta blockers and ACE inhibitors Autonomic nerves dilate arterioles leading to corpora cavernosa (the erectile tissue of the penis) Vascular spaces in corpora cavernosa fill with blood to cause rigidity Veins draining blood from corpora constrict to prevent blood from leaving Since an erection requires a precise sequence of events, ED can occur when any of the events is disrupted. 70% of ED cases are related to nerves arteries, muscles from medical conditions. Between 35 and 50 percent of men with diabetes experience ED.

Oral Contraceptives (OCP)

Prevent pregnancy Nearly 100% effective Prevent fertilization by inhibiting ovulation Either combination of estrogen and progestin or stand alone progestin Vary in dosages and type of estrogen and progestin Provide negative feedback to pituitary and prevent LH and FSH

Glucocorticoids

Inhaled glucocorticoids are used for long term prevention of asthmatic attacks Oral glucocorticoids may be used for short term management of acute, severe asthma Examples Beclomethasone (Beconase) Fluticasone (Flovent) Triamcinolone (Azmacort) Action: most potent natural anti-inflammatory substance. Dampen the activation of the inflammatory cells and increase the production of anti-inflammatory mediators. As with any product containing a steroid this medication should not be abruptly discontinued Decrease mucous and edema Sensitize the bronchial smooth muscle to be more response to beta-agonist stimulation Reduce bronchial hyper-responsiveness to allergens Decrease mucous and edema Sensitize the bronchial smooth muscle to be more response to beta-agonist stimulation Reduce bronchial hyper-responsiveness to allergens May be given systemically or inhaled Inhaled glucocorticoids are preferred therapy for the prevention of asthma attacks Symptoms improve in the first 1-2 weeks, 4-8 weeks for maximum benefit Clients w/ chronic asthma, combination therapy-long acting beta agonist and inhaled glucocorticoid Systemic glucocorticoids are used for unstable asthma, treatment 5-7days then changed to inhaled glucocorticoid Inhaled glucocorticoids are absorbed into the circulation slowly- minimal systemic effects Oral doses if taken >10 days can produce significant adverse effects including adrenal gland atrophy, peptic ulcers, and hyperglycemia Growth retardation is a concern when used w/children- oral and inhaled formulations Nursing Considerations- Monitor condition VS Monitor blood glucose Side effects w/systemic: vertebral compression fractures, anaphylactic reactions, mask or aggravation of infections, impaired wound healing, hyperglycemia and Cushingoid features Rinse mouth after each use DO NOT USE DURING AN ACUTE ATTACK

Cystic Fibrosis

Inherited (genetic) disorder Gene located on chromosome seven Tenacious mucus from exocrine glands Primary effects seen in lungs and pancreas Lungs Mucus obstructs airflow in bronchioles and small bronchi. Permanent damage to bronchial walls Infections are common. Commonly caused by P. aeruginosa and S. aureus Digestive tract Meconium ileus in newborns Blockage of pancreatic ducts Obstruction of bile ducts Salivary glands often mildly affected Reproductive tract Obstruction of vas deferens (male) Obstruction of cervix (female) Sweat glands Sweat with high sodium chloride content-1st sign of disease Signs and symptoms Meconium ileus may occur at birth. Salty skin May lead to sweat test and diagnosis of cystic fibrosis Signs of malabsorption Steatorrhea, abdominal distention Chronic cough and frequent respiratory infections Tend to increase over time Failure to meet normal growth milestones Diagnosis Genetic testing Sweat test Testing of stool Radiographs, pulmonary function tests Blood gas analysis Treatment Interdisciplinary approach Replacement therapy and well-balanced diet Chest physiotherapy

Mirena Intrauterine Device (IUD)

Inserted into uterus during office visit Mirena adds hormone component Progesterone only Risk of expulsion, uterine puncture (rare) Change every 5 years

3 Functions of the Respiratory System

Inspiration and expiration "Ventilation" Gas Exchange-movement of O2 and CO2 "Diffusion" O2 Utilization "Respiration"

Acute Respiratory Failure

May result from acute or chronic disorders Emphysema Combination of chronic and acute disorders Acute respiratory disorders Many neuromuscular diseases Signs may be masked or altered by primary problem Treatment Primary problem must be resolved Supportive treatment to maintain respiratory function

3 Phases to Monthly Cycle

Menses- Day 1-7 Proliferative Phase: Day 7-14 Secretory Phase: Day 14-28

Causes of Alkalosis

Metabolic Constipation for prolonged time Ingestion of excess sodium bicarbonate Diuretics that cause K+ depletion Severe vomiting Respiratory Hyperventilation Anxiety, asthma, high altitudes

Causes of Acidosis

Metabolic Severe diarrhea Kidney failure DM Excess ETOH ingestion Starvation Respiratory Hypoventilation Airway constriction Damage to respiratory center

Combination OCP's 28 different types available

Monophasic Constant dose of estrogen/progestin through 21 day cycle Biphasic Estrogen constant, progestin increased toward end of cycle to nourish uterine lining Triphasic Estrogen/progestin vary in 3 phases through cycle

Extended regimen OCP

Monophasic, combination oral contraceptive pill Menses once every 3 months Seasonique: 84 days on, 7 low dose estradiol Seasonalle: estradiol/levonorgestril,84 days on, 7 days inert pills

Ovarian & uterine cycles

Monthly cycles are governed by levels of pituitary hormones FSH and LH Ovarian follicles mature each month d/t FSH and produce estrogen **Day 14 of ovarian cycle estrogen high= LH surge= ovulation **Follicle left over becomes corpus luteum, secretes high levels of progesterone during the last half of the menstrual cycle The egg cell travels thru fallopian tube and into the uterus If no conception (no HCG), outer lining of uterus degenerates and sheds during menstruation

Carbon Dioxide (CO2) in Blood

Most CO2 in the blood is carried in the plasma Some is carried in RBCs In blood CO2 reacts with water to form carbonic acid: H2CO3 CO2 + H2O → H2CO3 In the lungs, this reaction reverses so that CO2 can be released Thus, increases in CO2 lead to more acidic blood - lower pH PaCO2 - partial pressure of carbon dioxide in the blood - indicates the amount of CO2 dissolved in blood Normal: 35-45 mmHg

Primary Atypical Pneumonia

Mycoplasma pneumoniae - bacterial Common in older children and young adults Transmitted by aerosol Frequent cough, antibiotic therapy Viral form caused by influenza A or B, adenoviruses, and RSV Unproductive cough, hoarseness, sore throat, headache, mild fever, malaise Infection varies greatly in severity. Infection is usually self-limiting.

Leukotriene Modifiers

Newer medications Actions-decrease inflammation and ease bronchoconstriction. Modify the action of leukotrienes which are mediators of the inflammatory response in asthmatic patients Synthesized by mast cells, neutrophils, basophils and eosinophils. When released the leukotrienes, promote edema, inflammation and bronchoconstriction Zileuton (Ziflo)- blocks lipoxygenase, the enzyme which synthesizes leukotrienes rapid onset of action 2 hours, dose q 4hours May cause liver toxicity Zafirlukast (Accolate) & Montelukast (Singulair) block leukotriene receptors. Decrease inflammation and indirectly reduce bronchospasm. Taken q 12 hours Caution in hepatic impairment, extensively metabolized in the liver, increased AST Increase PT with warfarin, ASA increases Zafirlukast levels Take on empty stomach

Hormone & Sperm Production

Normal endocrine function in males Follicle stimulating hormone regulates sperm production in men Luteinizing hormone aka interstitial cell-stimulating hormone regulates the production of testerone (created in testes)

Hormone Replacement Therapies (HRT)

Offers relief from menopausal symptoms Prevents osteoporosis related fractures May offer protection from colorectal cancer For use in women without history of CAD or cancers WHI study (2002): combination HRT significant increased risk of MI, stroke, breast ca, dementia and venous thromboembolism in women >60 Women taking estrogen-only HRT had increased stroke and thromboembolic disease

Chlamydia

One of the most common STI The leading cause of PID Pathogen: Chlamydia trachomatis- gm negative intracellular parasite Invades epithelial tissue of urogenital tract= inflammation Men: Urethritis, epididymitis, dysuria, itching, white discharge, swollen lymph nodes (inguinal), proctitis Women: often asymptomatic until PID develops Urethritis, cervicitis, salpingitis, bartholinitis Dysuria, urinary frequency Treatment: Antibiotics- Tetracycline or Azithromycin Treat all sexual partners Often treat for Gonorrhea at the same time Screen all sexually active women <24 years old annually Reportable disease

Aspiration Pneumonia

Passage of food, fluid, emesis, other foreign material into trachea and lungs Common problem in young children or individuals laying down when eating or drinking 1st response, sit them up or roll them on their side Result may be: Obstruction: aspirate is a solid object Inflammation and swelling: aspirate is an irritating liquid Predisposition to pneumonia Potential complications Aspiration pneumonia: inflammation, gas diffusion is impaired Respiratory distress syndrome: may develop if inflammation is widespread Pulmonary abscess: may develop if microbes are in aspirate Systemic effects: when aspirated materials (solvents) are absorbed into the bloodstream Signs and symptoms Coughing and choking with dyspnea Loss of voice if total obstruction Stridor and hoarseness Upper airway obstruction Wheezing Tachycardia and tachypnea In individuals with severe respiratory distress Nasal flaring, chest retractions, hypoxia Cardiac or respiratory arrest

Gonorrhea

Pathogen: N. gonorrhoeae - gm. Negative aerobic diplococcus Many resistant strains Attach to epithelial cells and damage mucosa Cause inflammatory response Gonococcal pharyngitis and conjunctivitis too Men: Dysuria d/t urethritis, purulent urethral discharge, epididymitis Can be asymptomatic Women: Frequently asymptomatic, Skenes and Bartholin gland infection, PID, anal and rectal infection, bacteremia, gonococcal arthritis Treatment: Antibiotics: ceftriaxone and doxycycline Culture drainage for C&S Treat partners Reportable disease

Pharmacologic Abortion

Removal of embryo by the use of drugs after implantation has occurred Mifeprex- RU486, followed by misoprostol (Cytotec) Given up to 9 weeks after conception Safer than surgical abortion Risks: bleeding Alternative: Methotrexate and Misoprostol

Treatment of Hypogonadism

Replacement therapy with testosterone or other androgens See improvement in days/weeks Improved libido Correct erectile dysfunction Reappearance of male sex characteristics (Virilization) Depression resolves Muscle strength improves

Oxygen Values in ABGs

SaO2: Oxygen saturation - % of hgb molecules which are attached to 4 oxygen molecules (fully saturated) Normal: >95% This is a good indicator of oxygen available to the tissues PaO2: partial pressure of oxygen in the blood - indicates the amount of oxygen dissolved in blood Normal: 80-100 mm Hg This is a good indicator of how much oxygen is diffusing across the alveolar-capillary membrane

Testicular Torsion

The twisting of testis or spermatic cord Compressing blood vessels EMERGENCY- Manual or Surgical repair needed to avoid ischemia of testicle Treat in ER- need ultrasound Can happen anytime Occurs frequently during puberty and after trauma Symptoms: Pain, swelling, retracted testicle

Treatment of UTI

Treat according to most likely microbe Antibiotic choice changes geographically based on resistance patterns Length of treatment varies Antibiotic Choices- Trimethoprim, Amoxicillin, Nitrofurantoin AZO/Pyridium Cranberry Juice

Treatment of Vaginosis/Vaginitis

Treat according to offending organism ** correct diagnosis important** Vaginal or Topical Bacterial Vaginosis & Trichomonas- Metronidazole, Clindamycin antibiotics, others Candidiasis- antifungal medication- Fluconazole PO/topical Lactobacillus- supplements, natural yogurt

COPD/Emphysema/Chronic Bronchitis

Treat infections Control cough and relieve bronchospasm Treatment of choice include Bronchodilators, inhaled glucocorticoid therapy, mucolytic and oxygen Encourage the patient to stop smoking. You can not cure COPD but you can slow the progression Avoid Beta-adrenergic antagonists (Beta-blockers) can cause bronchoconstriction Medications which cause respiratory depression such as opioids and barbiturates

URI/Common cold

Treat symptomatically: Watery nasal discharge Nasal congestion Sneezing Sore throat Malaise Headache Observe for signs of secondary bacterial infection

PE Treatment

Treatment Assessment of risk factors Prolonged bed rest and compression stockings Surgically inserted filter into vena cava (some cases) Heparin or streptokinase Mechanical ventilation Embolectomy

Trichomoniasis Ph> 4.5

Trichomonas vaginalis-anaerobic flagellated protozoa Frothy green/yellow vaginal discharge Fish-like odor STD

Adverse Effects of hormone contraceptives

With higher doses, greater risk of adverse effects Numerous drug to drug interactions Anticonvulsants & Antibiotics reduce effectiveness Warfarin, insulin and hypoglycemic agents are less effective when on OCP Possible Breast Cancer and Cervical Cancer risk Cardiovascular risks: thromboembolic disorders, and HTN Estrogen component can lead to venous and arterial thrombosis with resultant pulmonary embolism, MI or thrombotic stroke Abn. Uterine bleeding, elevated glucose, retinal disorder, melanoderma