Module 2

The emergency room provider diagnoses a client with a hemothorax. Which could be possible causes of this condition?

fractured ribs following a car accident

The client has symptoms of focal inflammatory condition of medium-sized and large arteries which includes diplopia. Which condition does the client have?

giant cell temporal arteritis

A 20 year old college student has a pelvic fracture and a severed leg from a motorcycle accident. She lost several units of blood. When the student arrived in the emergency department, her BP was very low, her pulse was high, and her skin was pale. The nurse knows that this client has developed which type of shock?

hypovolemic

The professor knows that the pathophysiology student understands the structure and function of blood vessels when the student states:

"Capillaries permit the exchange of material between the blood and interstitial fluid."

Atelectasis

- A complete or partial collapse of the entire lung or area (lobe) of the lung. - It occurs when the tiny air sacs (alveoli) within the lung become deflated or possibly filled with alveolar fluid. - Atelectasis is one of the most common breathing (respiratory) complications after surgery.

A young woman has been diagnosed by her family physician Raynaud disease. The woman is distraught stating, "I've always been healthy and I can't believe I have a disease now." What would be her physician's most appropriate response?

"If you make sure to keep yourself warm, it will have a fairly minimal effect; It'll also give you pills to enhance your circulation."

A nurse educator is explaining normal cardiac conduction and action potentials to a nursing cohort. How can the nurse best describe the term "slow response" (calcium current) to the students?

"It facilitates the entrance of calcium for the excitation-contraction mechanism that couples the electrical activity with muscle contraction. "

A client with heart failure has an echocardiogram performed, revealing an injection fraction of 40%. The nurse knows this EF is below normal ad explains to the client:

"This means your heart is not pumping as much blood out of the heart with each beat."

Acute arterial occlusion

*is considered a vascular emergency* - A sudden loss of limb perfusion for up to 2 weeks after the initiating event. - Acute arterial occlusion can occur in any peripheral artery of the upper and lower extremities. - May be caused by a diverse array of conditions but most often is the result of an arterial embolism or thrombosis of a previously diseased vessel.

Croup (acute laryngotracheobronchitits)

*seal-like cough* - An upper airway infection that blocks breathing and has a distinctive barking cough. - Croup generally occurs in children. - In addition to a barking cough, symptoms include fever, hoarseness, and labored or noisy breathing. -Most cases clear up with home care in three to five days. A doctor may prescribe a steroid for a persistent case. Rarely, a severe case may need hospital care.

Common cold

- A common viral infection of the nose and throat. In contrast to the flu, a common cold can be caused by many different types of viruses. - The condition is usually harmless and symptoms usually resolve within two weeks. - Symptoms include a runny nose, sneezing, and congestion. - High fever or severe symptoms are reasons to see a doctor, especially in children. - Most people recover on their own within two weeks. -Over-the-counter products and home remedies can help control symptoms.

Acute myocardial infarction

- A heart attack is a medical emergency. - A heart attack usually occurs when a blood clot blocks blood flow to the heart. - Without blood, tissue loses oxygen and dies. - Symptoms include tightness or pain in the chest, neck, back, or arms, as well as fatigue, lightheadedness, abnormal heartbeat, and anxiety. - Women are more likely to have atypical symptoms than men. - Treatment ranges from lifestyle changes and cardiac rehabilitation to medications, stents, and bypass surgery.

Tuberculosis

- A potentially serious infectious bacterial disease that mainly affects the lungs. - The bacteria that cause TB are spread when an infected person coughs or sneezes. - Most people infected with the bacteria that cause tuberculosis don't have symptoms. - When symptoms do occur, they usually include cough (sometimes blood-tinged), weight loss, night sweats, and fever. - Treatment isn't always required for those without symptoms. - Patients with active symptoms will require a long course of treatment involving multiple antibiotics. -The bacteria that cause tuberculosis are spread from person to person through tiny droplets released into the air via coughs and sneezes.

Tetralogy of fallot

- A rare condition caused by a combination of four heart defects that are present at birth. - Tetralogy of Fallot defects cause oxygen-poor blood to flow out of the heart and into the rest of the body. - Risk factors include a viral illness such as rubella during pregnancy, maternal alcoholism, or a family history of the condition. - Symptoms include blue-tinged skin and shortness of breath. - Surgery is typically performed the first year of life, followed by ongoing care.

Abdominal and thoracic aortic aneurysm rupture

- An abdominal aortic aneurysm (AAA) can be life-threatening if it bursts. Abdominal aortic aneurysms are most common in older men and smokers. An abdominal aortic aneurysm often grows slowly, without symptoms. As it grows, some people may notice a pulsating feeling near the navel. Pain in the back, belly, or side may be signs of impending rupture. Stopping smoking may slow their growth. Small ones may only need monitoring. Aneurysms that are too large or growing too quickly should be repaired with surgery. - A thoracic aortic aneurysm is a serious health risk because, depending on its location and size, it may rupture or dissect (tear), causing life-threatening internal bleeding. When detected in time, a thoracic aortic aneurysm can often be repaired with surgery or other less invasive techniques.

collateral circulation

- Collateral circulation is a network of tiny blood vessels, and, under normal conditions, not open. -When the coronary arteries narrow to the point that blood flow to the heart muscle is limited (coronary artery disease), collateral vessels may enlarge and become active. - This allows blood to flow around the blocked artery to another artery nearby or to the same artery past the blockage, protecting the heart tissue from injury.

Acute respiratory distress/ airway obstruction

- Condition in which fluid collects in the lungs' air sacs, depriving organs of oxygen. - Acute respiratory distress syndrome (ARDS) can occur in those who are critically ill or who have significant injuries. - It is often fatal, the risk increasing with age and severity of illness. -People with ARDS have severe shortness of breath and often are unable to breathe on their own without support from a ventilator. - Treatment includes oxygen, fluid management, and medication.

ejection fraction

- Ejection fraction (EF) refers to how well your left ventricle (or right ventricle) pumps blood with each heart beat. - Most times, EF refers to the amount of blood being pumped out of the left ventricle each time it contracts. - The left ventricle is the heart's main pumping chamber.

What medication is preferred for acute anaphylaxis?

- Epinephrine (epi-pen); - Epinephrine is the first and most important treatment for anaphylaxis, and it should be administered as soon as anaphylaxis is recognized to prevent the progression to life-threatening symptoms

Transmission of Legionnaire's disease

- People can get Legionnaires' disease or Pontiac fever when they breathe in small droplets of water in the air that contains the bacteria. - Less commonly, people can get sick by aspiration of drinking water containing Legionella. - This happens when water accidentally goes into the lungs while drinking. - People catch Legionnaires' disease by inhaling small droplets of tainted water, but not from drinking it. An infected person cannot generally pass the infection to another person, although it is possible in rare cases.

Pericardial effusion and cardiac tamponade

- Pericardial effusion is the buildup of too much fluid in the double-layered, saclike structure around the heart (pericardium). Lung cancer is the most common cause of malignant pericardial effusion. - Cardiac tamponade puts pressure on the heart and keeps it from filling properly. The result is a dramatic drop in blood pressure that can be fatal. - Symptoms include low blood pressure, shortness of breath, and lightheadedness. - Emergency treatment is required. Usually, a needle or small tube is used to drain excess fluid. (pericardiocentesis)

Pneumothorax

- Pneumothorax is air around or outside the lung. It may result from chest trauma, excess pressure on the lungs or a lung disease, such as chronic obstructive pulmonary disease (COPD), asthma, cystic fibrosis, tuberculosis or whooping cough. In some cases, the cause is unclear.

What medication classes are used with atrial fibrillation?

- Potassium Channel Blockers - Blood thinners to prevent clots and stroke - Beta-blockers to slow heart rate - Calcium channel blockers to slow heart rate - Digoxin to control heart rate - Channel blockers control heart rhythm

What are the objective indicators that a person has experienced a myocardial infarction? What lab values will you see? What ECG changes will you see?

- Pressure, tightness, pain, or a squeezing or aching sensation in your chest or arms that may spread to your neck, jaw, or back. Nausea, indigestion, heartburn, or abdominal pain. Shortness of breath. - Troponin T is a protein found in heart muscle. Measuring troponin T using a high-sensitivity troponin T test helps doctors diagnose a heart attack and determine your risk of heart disease. - ST segment elevation myocardial infarction (STEMI) - non-ST segment elevation myocardial infarction (NSTEMI)

Berry Aneurysm

- The most common type of brain aneurysm. - They make up 90 percent of all brain aneurysms, according to Stanford Health Care. - Berry aneurysms tend to appear at the base of the brain where the major blood vessels meet, also known as the Circle of Willis.

Discuss the pathophysiology of heart murmurs in general. What makes the sound? What sound is heard?

- The sound of a heart murmur is caused by blood flow within the heart. - Instead of 'lub-dub', the heartbeat may have an added sound like a hum, a whoosh, or a rasp. - The cause of the whooshing sound is the vibration of blood as it moves through the heart, which is normally undetectable by a stethoscope.

What lab values should be ordered on a pregnant woman with hypertension? Why? What do these indicate?

- blood pressure - hepatic enzyme level - platelet count - serum creatinine level - check for protein in the urine *these indicate preeclampsia*

blood pressure

- normal blood pressure is 120/80 - blood pressure is the pressure of blood pushing against the walls of your arteries - The first number, called systolic blood pressure, measures the pressure in your arteries when your heart beats. - The second number, called diastolic blood pressure, measures the pressure in your arteries when your heart rests between beats.

*BLOOD FLOW*

- superior/inferior vena cava - right atrium - mitral valve - right ventricle - pulmonary - - - - - - -

COPD

-A group of lung diseases that block airflow and make it difficult to breathe. *Emphysema and chronic bronchitis are the most common conditions that make up COPD* - Damage to the lungs from COPD can't be reversed. -Symptoms include shortness of breath, wheezing, or a chronic cough. -Rescue inhalers and inhaled or oral steroids can help control symptoms and minimize further damage.

Discuss orthostatic hypotension and the pathophysiology of this phenomenon.

-Orthostatic hypotension — also called postural hypotension — is a form of low blood pressure that happens when you stand up from sitting or lying down. -Orthostatic hypotension can make you feel dizzy or lightheaded, and maybe even cause you to faint.

What is the proper way to assess a childs tonsils with acute airway obstruction? What should the nurse avoid?

1. Allow children with acute upper airway obstruction to adopt a position of their choice and avoid causing distress 2. Decompensation of acute upper airway obstruction can be rapid and requires emergency airway management 3. In any child with severe acute upper airway obstruction, nebulized adrenaline may provide temporary relief while awaiting other definitive measures

The heart is a four-chambered muscular pump. In one day, how many gallons of blood are pumped throughout the body?

1800

Blood pH level

7.35-7.45

Which client is most likely to be experiencing vasodilation?

A 51-year-old man with a history of hypertension who is taking a medication that blocks the effect of the renin-angiotensin-aldosterone system.

What are the ABC's of healthcare? What does this mean? How do we prioritize airway first? Give some examples of when airway obstruction could occur.

A- airway: Airway is the main priority above all types of concerns. With an obstructed airway, air cannot get into the lungs and can hasten a fatal situation because there will be no oxygen that can be transported by the blood. How to know if there is a problem with the airway? Checking for obstruction is the first thing that you need to do. You will first need to check for any signs of obstructions by the mouth or throat that could prevent air from coming in. This is the reason why medical professionals turn the patient into their right side to avoid the tongue blocking the airway. *ex. choking on foreign object* B- breathing C- circulation

The heart controls the direction of blood flow. What is the role of the aortic valve?

controls the direction of blood flow from the left side of the heart to the systemic circulation

A client has been diagnosed with atrial flutter. Which assessment finding correlates with this diagnosis?

An atrial heart rate above 240 bpm.

Which client should most likely be assessed for orthostatic hypotension?

An older adult client who has experienced two falls since admission while attempting to ambulate to the bathroom.

AV node

As well as transmitting the impulse from the atria to the ventricles the atrioventricular node has two other important functions: synchronisation of atrial and ventricular contractions by a varying delay; and protection of the ventricles from rapid atrial arrhythmias.

Aspiration pneumonia

Aspiration pneumonia occurs when food, saliva, liquids, or vomit is breathed into the lungs or airways leading to the lungs, instead of being swallowed into the esophagus and stomach.

What is the role of beta-adrenergic drugs in the treatment of asthma?

Beta2 (ß2)-agonist medications are a type of inhaled bronchodilator used to treat asthma. In the pathophysiology of asthma, tightened airways cause wheezing, chest tightness, shortness of breath, and chronic cough. 1 ß2-agonists relax the smooth muscles of the airways to relieve these symptoms.

The efficiency of the heart as a pump often is measured in the amount of blood the heart pumps per minute. Which is the correct formula to figure out the cardiac output?

CO= SV x HR

The pediatrician is examining a young client and notes necrotizing damage to the coronary arteries in the child's echocardiogram. The pediatrician suspects the child has which of the following?

Kawasaki disease: A condition that causes inflammation in the walls of some blood vessels in the body. It's most common in infants and young children. Early stages include a rash and fever. Symptoms include high fever and peeling skin. In the late stages, there may be inflammation of medium-size blood vessels (vasculitis). It also affects lymph nodes, skin, and mucous membranes, such as inside the mouth. Kawasaki disease is usually treatable. Initial treatments include aspirin and intravenous immunoglobulin therapy given in a medical facility.

What are the modifiable and non-modifiable risk factors for atherosclerosis? What is the pathophysiology of this condition?

MODIFIABLE: - Smoking or tobacco use - Hypercholesterolemia and hypertriglyceridemia, including inherited lipoprotein disorders - Diabetes mellitus. - Hypertension. - Obesity (abdominal obesity) - Psychosocial stress. - Sedentary lifestyle and/or lack of exercise NONMODIFIABLE: - Age - Sex - Family history (genetics) *A build-up of cholesterol plaque in the walls of arteries causing obstruction of blood flow. Plaques may rupture causing acute occlusion of the artery by a clot. Atherosclerosis often has no symptoms until a plaque ruptures or the buildup is severe enough to block blood flow. A healthy diet and exercise can help. Treatments include medications, procedures to open blocked arteries, and surgery.*

What intervention is appropriate for a client with sarcoidosis?

corticosteroids

Which mechanism mediates long-term autoregulation of local blood flow in circulation?

collateral circulation

A parent of a toddler is concerned about the possible side effects of influenza immunizations. What will the nurse teach the parent regarding the flu vaccine?

The CDC recommends that all people 6 months and older should receive the annual influenza vaccine.

Bundle of His

a collection of specialized heart muscle cells that transmit electrical impulses from the AV node in the heart to the muscle cells of the heart wall

Which manifestation of left-sided heart failure can be diagnosed by examination of the lips and mucous membranes?

cyanosis

Which intervention is the priority for the medical management of a client with a dissecting aortic aneurysm?

administration of sodium nitroprusside and beta-adrenergic blocking medications

The nurse is caring for inmates in a correction facility. Which is the mode of transmission for the recent outbreak of tuberculosis?

airborne droplets

Acute-onset bronchial asthma causes wheezing and breathlessness as a result of which of the following?

airway inflammation

When reviewing diagnostic test results and physical assessment data for a client with a history of stage II hypertension, which of the following would be of most concern to the nurse?

an ejection fraction of 40%

A medical student is working with a 61 y.o male client in the hospital who has presented with a new onset of atrial fibrillation. Which course of treatment will the student most likely expect the attending physician to initiate?

anticoagulants and beta-blockers to control rate

A client is suffering from severe gastroesophageal reflux disease (GERD) and has been admitted to the hospital with a diagnosis of pneumonia. Which of the following would be the most likely cause for the development of pneumonia?

aspiration

An older adult client recently had a cerebrovascular accident that resulted in dysphagia. What is the nurse's greatest concern while feeding his client?

aspiration

A nurse is caring for a client with persistent atrial fibrillation. Which intervention is the priority?

assessing for shortness of breath or changes in level of consciousness

A nurse who works in a neonatal ICU is providing care for an infant who was born at 26 weeks' gestation. Which assessment should be the nurse's priority?

assessment of the infant's respiratory status and oxygen saturation levels

Surfactant

chemical produced in the lungs to maintain the surface tension of the alveoli and keep them from collapsing

A client is diagnosed with pulmonary embolism. Which symptom would most likely be present?

chest pain and dyspnea

Angina

chest pain caused by decreased blood flow to heart muscle

A client has just experienced stimulation of the vagus nerve. Which sign would the nurse anticipate the client to manifest?

decreased heart rate

A client's electrocardiogram monitor begins to sound an alarm and shows sustained ventricular fibrillation. The client is unconscious and without a pulse. Which priority intervention should the nurse take?

defibrillate the client

A diagnosis of tension pneumothorax would be suspected in which physical assessment finding?

deviated trachea

A client is reporting difficulty breathing when walking to the bathroom. The nurse documents this as:

dyspnea

Which diagnosis places a child at the greatest risk for airway obstruction?

epiglottis

The school nurse is doing a health class on the functional organization of the circulatory system. What is the function of the capillaries in the circulatory system?

exchange gases, nutrients, and wastes

Tachycardia

fast heart rate

An older adult client is newly diagnosed with hypertension. Which vascular changes in the aging adult can lead to hypertension?

increased elasticity of the arterial connective tissue

Which of the following is true regarding pulmonary circulation?

it is a low-pressure system that allows for improved gas exchange

At 4 am, the hemodynamic monitor for a critically ill in the ICU indicates that the client's mean arterial pressure is at the low end of the normal range; at 6 am, the clients MAP has fallen definitively below normal. The client is at risk for:

organ damage and hypovolemic shock.

SA node

pacemaker of the heart

A 3-year-old boy has developed croup following a winter cold. His care provider would recognize that which microorganisms and treatment are most likely to be related and effective, respectively?

parainfluenza virus, treated with a mist tent and oxygen therapy

Which factor represents the amount of blood that the heart must pump with each beat and is determined by the stretch of the cardiac muscle fibers and the actions of the heart prior to cardiac contraction?

preload

A client inhaled, drawing air into the oropharynx. From this location air will:

proceed through the trachea, bronchi, and then bronchioles.

The nurse knows that vasopressin (ADH) plays which role in blood pressure control?

promotes retention of water

A preventive measure to decrease the risk of developing rheumatic heart disease includes:

prompt diagnosis of streptococcal infections with a throat culture

Tachypnea

rapid breathing

A client in the ICU died shortly after developing multiple organ dysfunction syndrome. Which health problem most likely preceded the client's MOD'S?

sepsis

A client who presented with shortness of breath and difficulty climbing stairs has been diagnosed with pulmonary fibrosis, a disease characterized by scarring of the alveoli. Upon assessment of the lungs, what clinical manifestations should the nurse expect?

short, shallow breaths

Dyspnea

shortness of breath

Bradycardia

slow heart rate (less than 60 bpm)

The nurse is assessing a client's respiratory status for lung expansion and airway resistance. Which type of lung receptors respond to changes in pressure occurring in the walls of the airways?

stretch receptors

The nurse develops a plan to prevent atelectasis in a postsurgical client. Which intervention will be effective?

supervision of hourly deep-breathing exercises

A client arrives at the emergency department with dizziness and a near syncopal episode. Vital signs include a heart rate of 46 bpm and BP of 86/50 mm Hg. The cardiac monitors show regular rhythm as above. The client states the health care provider has been running blood work to rule out hypothyroidism. Based on the rhythm, what does the nurse report the client has?

symptomatic bradyarrhythmia

A nurse is evaluating a client to determine the effectiveness of medications given to reduce left ventricular afterload. Which hemodynamic parameter is most appropriate for the nurse to monitor?

systemic vascular resistance (SVR)

systole

the phase of the heartbeat when the heart muscle contracts and pumps blood from the chambers into the arteries

diastole

the phase of the heartbeat when the heart muscle relaxes and allows the chambers to fill with blood

Perkinje fibers

thin filaments that distribute electrical impulses to the ventricle myocardium and activate right and left ventricles.

Alveoli

tiny sacs of lung tissue specialized for the movement of gases between air and blood

Which serum biomarker is highly specific for myocardial tissue?

troponin

A person with a BP of 68/38 fainted after donating a unit of blood. The blood bank technician stated that the person was experiencing a low preload from loss of blood volume. The nurse knows that preload refers to which of the following?

venous return to the heart

What heart rhythms are fatal?

ventricular fibrillation and ventricular tachycardia *defib vfib*