Final

major complications of MI

- DYSRHYTHMIAS - Cardiogenic shock - Cardiac tamponade - Ventricular aneurysm - LV HF - Pulmonary edema - Papillary muscle dysfunction - Cardiac arrest

SE and nursing consideration of antidyshythmic medications

-ALL antidysrhythmics can cause dysrhythmias, SE: N/V, diarrhea, dizziness, blurred vision, headahce -obtain thorough drug and medical history -BP,HR, I&O (arrhythmia can cause HF), cardiac rhythm baseline and throughout. -before starting therapy measure K levels before. med/K level can effect each other and effect heart. asses for drug interactions, instruct pt regarding doses and SE to report, when to take med and pt education= HUGE. -monitor throughout drug therapy, assess drug levels in plasma as indicated, monitor for toxic effects and teach importance of adherance -IV meds= MUST USE PUMP, for pts on lols or digoxin, take pulse radial 60 secs before next med, and do not take med and notify provider if pulse less than 60 bpm. -monitor for therapeutic response: decreased BP in hypertensive pts, decreased edema, regular pulse rate, no irregularities.

MI and ACS, diagnosis

-MI can cause damage to conduction system, which can lead to abnormal rhythms. -hisotry of symptoms and physical exam -serum biomarkers (troponin, CKMB) -ECG (elevated ST, STEMI vs NSTEMI)

Describe the use, administration, common side effects, and nursing priorities for the following drugs: Odeansetron: Prochlorperazine: Dexamethasone: Metoclopramide: Lorazepam: Diphenhydramine:

-Odeansetron: Serotonin antagonist: works directly on the chemo trigger zone in the brain, best used for chemo induced N/V, especially good to give before chemo, post op- N/V. SE: low SE profile, headache, constipation, diarrhea -Prochlorperazine: Dopamine antagonist: works alters dopamine in the CNS, depresses chemo trigger zone in brain. best used for many type software N/V, also used in psych. -Dexamethasone: Glucocorticoid: suppresses inflammation and has Manu metabolic effects, best used: often used as part of a premedication to prevent N/V w chemo. rarely given alone for N/V. SE: watch for infection, blood sugars, weight gain. -Metoclopramide: Dopaminergic antagonist: increases gastric motility, best used for Nausea r/t decreased gastric motility, feeling full from. a few bites, used with GERD, good to add for chemo induced N/V treatment. SE: diarrhea, drowsiness, EPS, restlessness. -Lorazepam: Sedative/Benzo: depresses the CNS system. best used: good for all types of chemo induced N/V especially for anticipatory N/V (they have had it before bc of chemo and j the sight of chemo bag can make them vomit) SE: use w caution in elderly, increased risk of falls, sedation, low O2, confusion decreased LOC, very common!!!! -Diphenhydramine:Antihistamine: CNS depressant and anticholerginc actions, best used for motion sickness ( good w combo of other meds for pt who feel Nausea every time they move their head), use for allergies, not used alone for Nausea. SE: dry mouth, sedation.

Clinical Manifestations of Acute LV HF (severe) , Dx, and goals Treatment of Acute LV Failure, aka pulmonary edema:

-Respiratory distress, increased HR, S3, restlessness (lost perfusion to brain.) Dx: fluid volume overload, decreased cardiac output, acitivyt intolerance, hopelessness, risk for falls, ineffective health matainence, caregiver role strain, impaired mobility. goals: stablize pt, maintain balance (fluid, O2, electrolytes) -once stabilized, focus on more long term goals and prevention IV diuretics, MS04 (morphine), NTG, nitroprusside, high fowlers position, O2, foley Cather (really strict I&Os) LVAD: battery operated mechinal decide surgically implants to maintain function of the heart that has significant pump failure. (used a bridge to transplant)

medications used to treat arrhythmias: Class 1, sodium channel blockers and class 2 beta blockers. medications used to treat arrhythmias: Class 3 potassium channel blockers. medications used to treat arrhythmias: Class 4 Calcium channel blockers.

-class one is not used anymore or rarely sued. class 2: beta blockers: metoprolol!!!!, used to slow the heart rate down. blockade of myocardial B-adrenergic recpetors, direct membrane stabilizing effects -used for ventricular arrthymias , hypertensions, angina, MI SE: bradycardia, hypotension, dizziness, lightheaded confusion. Class 3: amiodarone: prolongs action potential, developed bc some people died from using Na channel blockers. -used for dysrhythmias that are difficult to treat. -life threatening ventricular tachycardia or fibrillation, a FIB or flutter resistant to other drugs. -only used in life threatening dysrhythmias. class 4 verapamil and dilitazem (CARDIZEM), can increase or decrease BP. -slow rate of AV condition in patients with AFIB, used for rate control and increases BP!/perfusions. used for paroxysmal SVT, rate control for AFIB and flutter, HTN, and angina -can cause bradycardia and HN.

enteral feedings:

-goes through the GI system, can be administered through short term (NGT) or long term (J/G tube) feeding tubes -advantages: keeps the gut working, short or long term nutritional support for those who cannot swallow well or safely. -reduced cost (less than TPN) risks: aspiration pneumonia, if lay flat w continuous feeding. comfort: NGT is uncomfortable -diarrhea or GI intolerance: only liquids all the time,

MI activity interventions and potential problems/ nursing action:

-immediately decrease workload on heart- prioritize the functioning of the heart. -bedrest 12-24 hours, limit activity/demands as need. -cardic rehab once stable, focus on building physical conditioning over time problems and how to fix: alt in comfort/pain: opioids, NTG, calm and quiet -impaired gas exchange/dypnea: positioning/ O2 -anixety/fear of death: pt education, reaasurance -activity intolerance: space activities, cardiac rehab -alt in elimination: stool softeners, I&Os -decreased CO/arrthmias: mointer ECG, VS, asses for major complications

general goals for acute MI

-restore perfusions (as quick as possible), decrease myocardial necrosis. (prevent HF and preserve LV function) -reduce pain and dyspnea -prevent and treat complication including life-threatening arrhythmias and other cardiac complications. -relief of sx, especially CP and dyspnea -prevent MACA, major adverse cardiac events

Diverticulitis

-stuff gets in the sacs and it gets infected infections and inflammation of the diverticula: can be acute or chronic -increased with age and associated with low fiber diets and chronic constipation. s/sx: cramps, narrow stools, constipations- can lead to obstruction, pain n/v, fever, leukocytosis- b/c inflammation dx: colonoscopy (if have diverticulosis: go right to CT, b/c more than likely have it), CT, abdominal X-ray, CBC (high WBC) tx: pharamcoligcal: IV fluids, PO or IV antibiotics, opioids, antispasmodics, once resolved add fiber supplements, probiotics, can had to cut out sections of intestines if bad. diet: NPO perhaps with NGT suction, once feeling better then clears then low fiber (don't want to add stress to bowels), once resolved high fiber and low fat. complications of diverticulitis: perforated bowel: v dangerous, possible sepsis medical emergency., abscesses, GI bleed, must manage these emergency situations.

colorectal cancer

-the most common cause of cancer deaths in the U.S. early screening is the key: 45-75 y/o, every 5 years colonoscopy, unless risk factors may lower age. -Manifestations may include: Change in bowel habits (second most popular/second fast symptoms), pencil sized stool, blood in stool-occult, tarry, bleeding. pain (abdominal or rectal), feeling of incomplete evacuation. risk factors: Age= #1 risk factor, family history of cancer or polyps, personal history of polyps., male, high alcohol intake (increases polyps), cigs smoking (damages DNA) , obesity (3x more chance, decreased fiber and increased fat= lots of inflammation that can lead to cancer)history of inflammatory bowel disease. -high fat/high protein/high beef diet/low fiber: high sat fat, send hormone to brain to let cancer cells keep growing.

MI: medications.

-troponin peak: 10-24 hours post damage: why serial troponin=important, if too early could miss it. initial/priority meds; MONA (not in priority order) M= MSO4 via IV push, morphine reduces pre/afterload O= Oxygen 2L NC, often 1st done, need more O2 to tissues N=NTG (nitro) sublingual x 3 Q5min, vasodilator vessels to help perfusion ASA 324 mg, chewed-faster release if chewed -metoprolol IVP if dysrhythmias develop -PCI (Cath lab), wonton 60-90 mins, or fibrinolytic agent within 30 (TPA break down fibrin in clot, allows repercussion but huge bleeding risk) minutes or arrival. -MEDS following MONA/immediate intervention -IV heparin drip-thin blood reperfusion past occlusion. IV nitro drip: vasodilate!, reperfuse daily management pilot MI -ASA to decrease clotting -statins to lower LDL, ASA/statin used long term -ACE inhibit -BB, ad ACE work to decrease BP/HR, help heart recover.

4. Facilitate team communication by initiating briefs, huddles, and debrief

1. Briefs: effective stragety for sharing the plan 1. Forms the team 2. Designs team role and responsibilities 3. Establishes climate ang goals 4. Engages team in short-term and long-term planning 2. Huddles: during the event 1. Hold ad hoc, to touch base to regain situation awareness 2. Discuss critical issues and emerging events 3. Anticipate outcomes and likely contingencies 4. Assign resources 5. Express concerns 3. Debriefs: after event occurred 1. Brief, informal exchange and feedback sessions 2. Occur after an event or shift 3. Designed to improve teamwork skills 4. Designed to improve outcomes (an accurate recounting of key events, analysis of why the event occurred, discussion of lessons learned and reinforcement of success, revised plan to incorporate lessons learned)

Classifying heart failure

1.) L or R HF, LV failure: HTN, CAD, Vascular disease-backs up in lungs, often starts here, most common post MI RV flair: LV failure, RV infarct, pulmonary HTN -backs up in perihphy, edema, JVD, weight giain -bi-vent failure: usually RV secondary to LV failure- both symptoms 2.)Acute or chronic, chronic is often after MI. 3.) systolic (reduced EF) or diastolic (decreased filling) 4.) low output: reduced pumping or high output failure: Fever, hyperthyroidism, pregnancy

CAD/Stable Angina pharmacologic management:

1.) lipid lowering agents/statins: (simvastatin/atorvastatin): lower LDL to less than 100, pts with metabolic syndrome, should lose weight and increase activity. lifestyle change not j meds -statins may have beneficial effects on vascular endothelium. -increase in creat and kinase=muscle weakness, liver probes= make sure to watch for 1. A. cholesterol absorption inhibitors, may lower LDL, may be used alone or with statins 1. B) Niacin (B3), may decrease endothelial buildup and reduce coronary events 2.)Calcium channels blockers: (diltiazem): slow HR and decrease strength of myocardial contraction, decrease O2 demand SE: hypotension, bradycardia, constipation. -monitor BP and HR> 3.) antiplatlet: decreases platelet aggregation, start with aspirin may add/or switch ASA=first line, then clopidogrel for pts who cant tolerate ASA or added with ASA. -heparin or other for hospitalized pts. nursing implications: IV forms in acute MI< monitor plt counts- blow 50 plt count, don't give -at increased risk for bleeding, safety precautions!!! 4.) beta blockers: metoprolol!!: block sympathetic stimulation to heart, decrease BR, reduce heart workload. can cause hypotension, bradycardia, libido/ED nursing implications: I&Os/ daily weights, assess for s/sx of HF( BB can cause HF), if hr less than 50 bpm, hold med. 5.) nitrates NITROGLYCERIN: prevent angina in stable angina: topical or extended release options. -dilates vessels increase BF to heart and perfusion in MI and non-stable. SE: causes dilation everywhere: can cause tachycardia, decreased BP, headache, dizziness given IV during ACS given sublingual: for chest pain, often given through tabs, if take 3 every 5 mins and doesn't improve go to hospital.

core measure and focus of nursing care AMI. -MI pt ed. and discharge teaching.

ASA (not NSAID) on arrival discharge meds: ASA, BB, statin, ACE, or ARB (L vent dysfunction) -smoking cessation ed. -thrombolytic therapy within 30 mins of arrival -PCI wishing 90 mins major focus: asses heart rhythm, lungs, and for edema/urine output -mointer cardiac rhythm continuously, asses and monitor pain and lab values, monitor troponin closely, maintain BR and O2, asses for anxiety, implement crisis intervention and pt education. pt ed/discharge: smoking cessation: 5 A's: asl, advise, assess, assist, arrange follow up -ensure they go home with BB, Ace 1, ASA, and plavix, statins, NTG -NSAIDS= contraindicated, ASA not NSAID -low NA diet and weight reduction -cardiac rehab -S/Sx of stable angina vc ACS, when to go to ER -s/sx of dperession SE of all meds and how to manage regimen.

Priorities for CAD and/or Stable angina:

ASA and antiplatlets: reduce clots, Blood pressure control: increased BP can lead to hardening of walls and artherscleorsis. cholesterol and ciggs increases plaque buildup, smoking causes vasoconstriction. diet and diabetes education and exercise

Identify safety concerns in the clinical setting..

Aspiration falls injuries seizures Suicide/Self Harm Pressure Injury- Infection risks

HD fistula care

Assess AV fistula daily by -lightly palpating for thrill - auscultating for bruit protect arm with fistula -No bps -no blood draws -no tourniquets -limb alert band

BUN and creatinine normal levels/function

BUN: blood urea nitrogen, index of renal function -affected by protein intake, tissue breakdown, and fluid volume changes. 8-21 -creatine: measures effectiveness of renal function, normal .51-1.21 -waste product of skeletal muscle,. in chronic 1.5-3.0 is a normal level for them.

Sinus bradycardia and tachycardia

Brady: same characteristics of NSR, except the rate is less than 60 bpm. etiology: response to MI or CAD (myocardial ischemia) lots of damage can slow conduction, vagal stimulation (causes PNS activation), electrolyte imbalances, drugs (beta blockers, opioids), increased ICP, highly trained athlete (normal)managing: only treat is symptomatic (fatigue), treatment of choice is atropine, look for underlying cause and correct/remove. pacemaker: internal or external can be used to keep HR above a certain number. want to increase HR bc if too low= not perfusing enough!!! tachycardia: same as NSR, but rate is over 100bpm. etiology: anxiety/emotional distress, exercise, fever/infection, drugs (caffeine, cocaine, etc), hyperthyroidism, fluid loss/bleeding, anemia or hypervolemia. treatment: may resolve with treatment of underlying causes fluid/blood admin, rest, drugs that reduce HR: calcium channel blockers ex: verapamil or dilimiazem, or beta blockers such as metoprolol.

ACS process

CAD is caused by atherosclerosis caused by many risk factors (HTN, diabetes, obese, etc.) then can progress to stable angina-which is relived by nitro or rest. warning sign ACS=MI and unstable angina: unstable: no abnormal troponin, no ST elevation MI= nonSTEMI= not ST elevation, elevated troponin bc infarct in heart STEMI= increased troponin and ST are elevated on ECG, severe and urgent, complete block to a large part of the heart, can causes lots of cardiac damage which can cause: Heart failure: not ACS, but can be caused by a STEMI, which bc of the infarct and damage the heart can't pump efficiently.

8. Compare and contrast chronic (from previous courses) and acute (discussed in thismodule) respiratory conditions

Chronic diseases discussed in previous courses do not have as. high of acuity and most of the chronic conditions your are more just trying to improve their oxygenation or breathing a little bit to improve QOL, where in more acute they are life threatening and there are more interventions/ treatments to actually fix the problem overall.

Angina diagnoses, and nursing goals:

Dx: activity intolerance or fatigue, decreased cardiac output, risk for deceased perfusion, impaired comfort, nausea, fear/anxiety, health matienancce (HTN/smoking), sedentary lifestyle, sexual dysfunction (lols) -goals: treatment when s/sx start, preventions (meds/lifestyle management), reduction of anxiety or stress, understanding disease and tx, absence of complication, adherence to self-care plan.

Nursing/coolaborative Dx, focus of therapy, and self-monitoring:

Dx: activity intolerance, hopelessness, risk for falls (r/t meds), ineffective health maintaence, fluid volume overload, decreased cardiac output., caregiver role strain, impaired mobility -Focus: improve survival and SYMPTOM CONTROL -self monitoring: success depends on self monitoring: low Na diet, less than 2g a day. daily weights and when to report -DASH diet, pt ed is critical to foster importance of dietary and med regimen -diabetics need glycemic control -dyslipidemia= need lipid control (statins) -fluid restrictions, I&Os !!!!!!

Analyze the assessment of risk for injurious falls and ways to minimize risk of injuryrelated to falls

Falls: ABCs: A= over 85, B= bone health (fx risk or history, osteoporosis, bone mets, steroid use), C= coagulation (coagulatory or on anticoagulant medications), S = surgery (within 14 days) Failure to communicate changes in assessments/interventions Failure to implement and document prevention interventions Unclear/incomplete handoffs Insufficient/unclear safety instructions Pt or family confusion related to nurse's teaching Assuming its only important to teach patient Education that fails to be individualized -to minimize falls, make sure that understand risk factors and communicate about changing fall risk status and ensure family and patient understands their individualized teaching.

Atrial fibrillation and flutter

Flutter: atrial rate: 250-400 bpm, may or may not be associated with a disease -etiology/triggers/diseases: thyroid, ETOH, caffeine, PE, pneumonia, s/p CV surgery, HTN, CAD, valvular diseases, HF, COPD, pericarditis, cardiomyopathy. A flutter: multiple P waves for each QRS management: treat underlying cause/lifestyle changes. meds: if rate is unstable, digoxin or dilitazem, - these are given to control rate -aminodarone can control the rhythm -if rate is superfast: more dangerous then slowed down, the ratio is quivering is blood can pool and clot if too fast and then can embolus and cause PE/brain/heart. -possible cardioversion -ANTICOAGS: these are given to prevent emboyltic event. ALWAYS GIVEN. AFIB: no discernable P wave, and the R:R is irreegular. -chaotic electrical activity in the atria, it quivers and doe not contract as a unit. paroxysmal: less than 7 days and comes and goes, the more you have it increases stroke risk. persistent: greater than 7 days, lasts more than 7 days at a time, increased stroke risk even more. permanent: unsuccessful treatment, give meds to decreased rate and control rhythm to decrease stroke risk. monitor for atrial embolism, CHADS score for anti-coat therapy. etiology: advanced age, MI, CAD, valvular disease, congenital heart defects, hyperthyroidism, stimulant medication abuse. s/sx: Fibrillatory waves: little waves of quivering then QRS -no discernible P waves, can be asymptomatic, PULSE deficit: apical pulse is different from the radial. rapid and irregular heartbeat, fluttering of thumping in chest, dizziness SOB, anxiety, weakness, fatigue, or confusion (these occurs because lack of perfusion due to the quiver), chest PAIN OR PRESSURE) treatment: ANTICOAGS, CCB, BB, digoxin, amiodarone, -cardioversion is greater than 48 hours, anticoag for three weeks after, because is can release a blood clot if there was one in the atrium. Cox-maze procedure, rewire conduction system, or pulomary vein ablation: create scar tissues to block impulse causing AFIB>

Apply knowledge of cardiovascular physiology in relation to cardiac anatomy and the conduction system of the heart, pathophysiology, pharmacology, chronic heart conditions (from NUR 323) and physical assessment.

Heart disease: leading cause of death in the US. modifiable risk factors: HTN, smoking, hyperlipidemia, diabetes, metabolic syndrome, obesity. non-mod: age, gender, race, fam history. heart sounds: S1= closing of tricuspid and mitral valves, beginning of systole S2= closing of pulmonic and aortic valves, end of systole, S3- gallop, usually decreased ef or L CHF= soft S4=gallop pt with L ventricular hytrophy, atrial kick coronary arteries: deliver blood to the heart, any disorder can lead to death of heart muscle bc lack of O2/nutrients. fill with blood during diastole, during contraction= pressure is too great to fill Left main: supplies blood to L heart muscle (ventricular and atria), L circumflex: supplies blood to outer and back of heart L anterior descending: supplies blood to front of heart R artery: supplies blood to R ventricle and Artria and to AV and SA nodes. divides into smaller branches that supple R atrium -SA node=pacemaker of heart, then to AV to bundle branches to purkinje fibers. fibers cause ventricular to contract and pump blood to aorta/ systemic. women: higher mortality after MI( more mild GI symptoms), higher false positive stress test, higher mortality after CABG, women diabetes=greater risk for CAD.

CKD diet

Low protein: (until ESRD), then you can increase protien bc getting filtered out every other day) Low sodium Low Potassium: limits fruits and veggies, use potassium free salt substitutes (LOW Na too, especially if heart disease) Low phosphate- limit cheese, nuts, colas fluid restriction: limit sodium intake to reduce thirst, about 500 mols more than most recent 24 hour output, or general 1500-2000 mLs a day. -high carb, high calorie. so body has energy it needs -often vitamins bc pt is missing a lot of vitamins through foods.

Differentiate between basic cardiac dysrhythmiasNormal sinus rhythm (normal findings)

NSR: starrt in the SA nodes, and has all aspects expected to see and within expected time frame: NORMAL-is regular and between 60-100 bpm, P waves upright with 1:1 with QRS

genetics nursing practice and family history

Nursing: 6 main tasks: Collect/interpret relevant family/medical history, perform physical and psychosocial assessment, identify those who need further genetics evaluation and counseling, refer them to appropriate genetic services, offer genetics info and services collaborate with specialists, participate in management and coordination or care of patient with genetic conditions. Family history: assess risk of certain disease, decide eon testing strategies, establish pattern of inheritance, indefity family members at increased risk, identify shared environmental risk factors, calculate risks, assess risk of passing on conditions to kids, determine recommend tx that may modify risk, make designs about management or surveillance.

Interpret values and implications for: absolute neutrophil count, red blood cells,platelets, hemoglobin, pancytopenia

RBC: normal: 3.0-5.8 HGB: normal 11.3-17.3 HCT: 31-55 normal -wbc: 4.5-11.1 -low hgb and low rbc= anemia! ANC: normal is greater than 2,000, ANC less =nuetropenia, this means immunocormprlsed, can fight infection as well -less than 500= severe neutropenia, and less than 100= agranulocytosis, these two can lead to death from just a simple cold. platelet- 150-450, less than 50= bleeding precaution are implemented, less than 20, bleeding frequently occurs, less than 5 spontaneous bleeding is likely and v dangerous. pancytopenia: a reduction in RBC, WBC, and platelets.

General relationship of therapeutic effects of chemo and side effects of chemo Development of Pancytopenia Nausea and vomiting, Alopecia, Mucositis

Side effects (all are drug and dose dependent): alopecia and skin change, mucositis, N/V/D, anorexia and cachexia bc of poor nutrition, bone marrow suppression: pancytopenia!!, Fatigue, infertility, cognitive changes (late effect), pain. -alopecia/skin changes: complete or partial alopecia and rashes or more fragile skin. -changes are usually temporary, but may be permanent. hair may be different when it grows back. nursing interventions: educate and help with expectations, cold therapy (put on head during chemo, can help to not lose hair), support pt choices, protect skin and head from sun. -mucositis: erythema, erosions along the mucosa-from mouth, esophagus, through anus. graded in severity: minor erythema to life threatening. nursing interventions: oral care (prevention and treatment), cold therapy: chew on ice during tx, pain control, infection prevention, education: most pt will get this, help with food choices. chemo induced N/V: PREVENT treat: aggressive and completely, consider pt and chemo characteristics, cold or room temp foods, protect form strong odors, do not allow to suffer without treatment: can be treated and prevent -managing CINV: antiemetics!!!!! zofran, reglan, compagine, Ativan, decadron, benadyrl. -non-pahrm in conjunction with meds: distraction, music, pressure points. general approach to symptoms management: education is key, prevention is the goal (N/V/D, pain, fatigue, malnutrition, mucositis). minimize those symptoms that can not be prevented. -integrative and healing arts: music therapy, reiki, pet therapy, art therapy, healing touch, aromatherapy, massage, meditation, yoga, etc.

instrinsic rates/pacemaker rule:

Sinus node: 60-100 bpm, rate normally, things can quicken or slow intrinsic rates. SA node= P wave.ventricles: 20-40 bpm. this would take over if SA and AV did not work, if SA not working- fastest pace=takes over.pacemaker: the pacemaker site with the fastest rate will vernally control the heart, well functioning system= SA nodeirritability: a site along conduction system becomes irritable and speeds up faster than the SA node, and there for takes over.escape mechanism: the normal pacemaker slows down or fails, and a lower pacing site takes over.

peritoneal dialysis (PD)

The removal of wastes, electrolytes and fluids from the body using peritoneum as dialysis membrane -introduction of a sterile dialyzing fluid through an implanted catheter into abdominal cavity -throgh process of osmosis, diffusions and active transport excess fluid and oslkutes are removed -when pt is done can unclamp and drain out fluid, into bag of fluids. want to look at bag and weight bag, must take out at least what you put in. look clear and yellow like urine, no sediments or cloudy.

Recognize the general acuity/urgency level of patients presenting with any of theaddressed oxygenation alterations

There is a high level of acuity with any of these pts presenting with oxygenation alternations because it can lead to not only improper oxygenation in the body and hypoxemia, but it can also lead to collapse of the airway/breathing in some situations, ABCS!!

cardiac enzymes

Troponin: <0.2 ug.L, if elevated indicates MI BNP: <300 pg/mL, if elevated indicates CHF, MI CK-MB: <10.5 pg/mL; determines the occurrence of recent MI -SERIAL LEVELS!!!!: could miss the elevated levels takes a while to peak

cardiac catheterization care and teaching post Cath

a diagnostic procedure in which a catheter is passed into a vein or artery and then guided into the heart -used for narrowing, stable and unstable angina, GOLD STANDARD, -once the Cath is passed into heart, dye is injected= angiogram -gets to see the narrowing t=of the vessel changes occur very fast, BLEEDING first priority. frequent assessments VS, ECG, pulse ox, UO, peripheral vascular assessment, LOC -bedrest with HOB 30 degreess monitor for s/sx of hemorrhage -affceted extremity straight -mointor for infecting during recovery period.

ACS (acute coronary syndrome)

a spectrum of clinical disorders caused by ischemic heart disease including: -STEMI, most vunerable -nonSTEMI: -UA, unstable angina -syndromes that may present when MI occurs, ranging from unstable angina to acute MI: common ER admission -any ACS=admit to hospital to run labs.

acute cholecystitis

acute inflammation of the gallbladder, 90% is caused by gall stones. Acalculous cholecystics: 10%, follows surgery, trauma, burns, torsion cystic duct obstruction: anything that hurts glall bladder in GI. s/sx: pain, tenderness, rigidity, of URQ. may radiate to sternum, right shoulder. sharp shooting pain, feels like a heart attack., N/V, fever, chills, elevated WBCS dx: ultrasound-identifies stones or thickening, hollow/fluid filled vs. solid. or ERCP: identify stones, tumors, narrowing in the bile ducts. medical management: decreased inflammation 80% heal with rest, IV fluids, NGT, antibiotics, analgesia, IV antibiotics, gut rest (NPO): low fat diet after recovery. ERCP after healed, do until gallbladder is decreased and back to normal, then slowly introduce food and a low fat diet.

PD advantages, contradictions, nursing care, complications

advantages: flexibility, independence, control. in charge of owns dialysis, less restricted diet exchanges must times a day, filtered out right away so no really restrictions, less stress on body, no giant fluid shifts like HD, more gradual contraindications: peritoneal adhesions- impairs exchange, recent abdominal surgery- inflmamation can cause scarring, inability of pt to perform own dialysis (broken wrist, cognitive disease) nursing care: pre-tx: baseline V.S., weight, labs,-electrolyetes and glucose. -make sure to warm solution: cold solution could lower core temp. during: VS q 30 mins, asses for respiratory distress and pain: can feel full but no pain monitor dressing and around site for weakness, make sure not leaking, monitor dwell time and initiate outflow post tx: record total amount of outflow, maintain accurate inflow and outflow record, weigh daily, monitor fluid status complications: peritonitis: inflammation of the perineum. -dialysate should be clear amber like urine when it drains -cloudy return is a sign of peritonitis (s/s of infection, must take care of immediately, quickly can become septic). -pain, exit sited and tunnel infections, dialystae leakage, and bleeding are other complications.

HD overview, complications, and nursing care:

advantages: no equipment at home, social contact, tx 3x week disadvantages: fixed schedule, no flexibility, need insertions (2x each time), diet and fluid restrictions contraindications: severe cardiac dysfunction: bc lots of toxins/fluid buildup, when finally gotten rid of, can cause low BP/hypotension, loss of extra fluid -lack of vascular access- must have -intolerance to systemic heparininization: heparin is given through IV lots to prevent clotting, pt can become sensitive to this and can cause thrombocytopenia. complications: dialysis disequilibrium syndrome- related to the rapid fluid shits, a dramatic one that leads to cerebral fluid shifts. this is dangerous are rare SE: N/V, drowsiness, Headaches, seizures, death, coma. common side effects: fatigue ( v common), SOB, hypotension, muscle cramping and arrhythmias, risk for infection nursing care: pre and post weight, know clients dry weight with all toxins and extra fluid taking out. -hold meds that must be held til after dialysis: (antibiotics, antihypertensives and water soluble vitamins, mointer VS, asses for hypotension, vascular access site, observe for bleeding, assess LOC -manage headaches, N/V -reinforce /teach diet limitations and all other care priorities.

GFR (glomerular filtration rate)

amount of plasma filtered through the glomeruli per unit ofttimes. over 60 is normal, tru GFR takes gender, race, age into account -since these have effect on muscle mass, if decreased=affect GFR -African America: more creatine then those who are white and effects GFR. -creatine clearance= the most reliable and bets measure of GFR. (125/200 ml.min) -pee in container for 24 hours, the measure the creatine in container and in blood, if higher in blood, then the kidneys are not excreting properly.

patho, clinical manifestations and nursing dx, interventions and goals for anemia

anemia: patho: can be because of bleeding, nutritional deficiencies., diseases such as sickle cell or renal, and chemo s/s: CNS: fatigue, dizziness, depression, impaired cognition function, mood changes insomnia. oral: changes in tongue, angular cheilitis (cracked red corners of lips). GI: anorexia and nausea. Vascular: low skin temp, pallor of skin, mucous membranes and conjunctiva. Immune: impaired T cell and macrophage function. GU: menstrual problems, loss of libido, impotence. CV: tachycardia, palpitation on exertion, murmers, S3 sound, dyspnea, SOB. body is trying to pump blood faster, and breathe faster to try and spread the decreased O2 around the body medical management: therapy depends on: underlying cause, severity, and symptoms. blood will be transfused if the pt hgb is under 7 and they are symptomatic. nursing diagnosis: FATIGUE number one diagnosis, activity intolerance, risk for falls and nausea. interventions: adequate diet, folate and iron!!, nutritional education, exercise should be encouraged (exercise can help to decrease fatigue and activity intolerance), lifestyle modifications (clustering ADLS/taking breaks), restoration activities: restoring quality of life.

Supraventricular arrhythmia and supra ventricular tachycardia

any rapid rhythm that originates form above the ventricles, includes a variety of rhythms SVT: an irritable foci above the ventricles, overrides the SA node, rate 150-200/minute, rhythm regular, P wave is often not identifiable, QRs usually normal. causes: common in kids and young adults, fever sepsis infections, caffeine, tobacco, ETOH, sympathomimetic drugs (increase SNS), CAD, chf, post CABG, COPD anesthesia, hypoxia, for pulmonate (R sided HF). -LEAST invasive first!!!! management: vagal maneuvers (start with this): stimulate vagal nerve and cause a PNS response: goal is to slow it down, so you can see the underlying rhtymn. unless unstable: have pt hold breath, blow into syringe, bear down, head in bucket of ice are all examples. -if that doesn't work then adenosine: want to give this very fast. -beta blockers, calcium channel blockers, cardio version- delivery of shock, less than resuscitation.

patho, clinical manifestations and nursing dx, interventions and goals for thrombocytopenia

causes: decreased platelet production: hematologic malignancies, aplastic anemia, toxins/meds, alcohol abuse. increased destruction: lupus leukemia, lymphoma, meds, infections. increased consumption: major bleeding, PE/thrombosis TRAUMA!. S/s: bleeding from skin, mucous membranes, and or body orifice: gums/stool/urine/monrrhagia, easy bruising, petechia: red spots all over skin or purple is dark skinned. medical management: therapy depends on underlying cause, severity and symptoms, platelet transfusion nursing diagnosis: RISk for injury and risk for bleeding intervention: avoid invasive procedures: no IM injections, no enemas, suppositories, catheters, etc., manual BP only- too much pressure can cause bleeding. instruct pt to call for help when getting out of bed if minimal fall risk, aggressively prevent constirpation, prevent HTN-can cause blood vessel damage that leads to Bain bleeds, humidified O2 when nessesscayr-dont want to dry out and lead to bleeding.

patho, clinical manifestations and nursing dx, interventions and goals for neutropenia

causes: decreased production of neutrophils: aplastic anemia, chemo, cancer, radiation or increased destruction of neutrophils: bacterial infection, immune disorders (lupus), medication induced, or viral diseases. manifestations: fever or chills!!!!, hypotension, dyspnea, cough, N/V/D. assessment: VS Q4- watching for fever and infections, skin and mucous membranes, making sure folds in skin are clean and dry, the mouth and pharynx and perineal area are watched because more suspecitble to infection. lung sounds: listening for pneumonia+BIG RISK medical: depends on underlying cause severity and symptoms. aggressive management at first signs of infection, prophylactic medicines. nursing diagnosis: RISK FOR INFECTION interventions: no contact with soil/plant/flower or pet litter boxes, avoid crowds and ill people, good personal hygiene, wash dishes in very hot water, run toothbrush through dishwasher, mointer VS, act immdeatly in rise or fall of temp, drop in BP, or increase in RR/HR, low microbial diet, safe handling of foods, wash fruits and veg

Angina s/sx, dx,

clinical manifestations: retrosternal pain, poorly localized may radiate to L arm bc referred pain., may feel a fullness or choking sensation, DM patients, elderly pts, and female pts may have different s/sx: usually more general, might not have characteristics of chest pain:SOB pallor, diaphoresis, dizziness, n/v, weakness diagnoses: r/o ACS, assessment, ECG, CXR, troponin levels, D d-dimer, electrolyte levels, BMP, CBC, drug screen, UA to rule out UTI. -important to rule out ACS, when someone has chest pain -prob of CAD is suggested by the presence of risk facts. ECG, biomakers, other. cardiac testing.

plural effusion: Patho, s/sx, nursing process, prioritize care, risk factors, medical/pahrm tx, medical dx:

collection of fluid in the plural space, always s/t other diseases such as CHF, TB, cancer =, etc. two types: transudate: plasma moving across capillary walls,s imbalance of hydrostatic or oncotic pressures (hf or renal) exudate: bacterial products or tumors chest pain, SOB (lung can't contract), tachycardia, minimal or absent breath sounds, egophony (E turns to A sound over consolidation, tracheal deviation, flat/dullness upon percussion goal is to drain the fluid!! need to get the fluid out to prevent tracheal deviation and improve oxygenation. breathing!!! is the patient able to breath/get proper oxygenation. treat the underlying cause!! plural effusion: Smoking and alcohol, History of contact with asbestos diagnosis: CXR, thorancentesis: not only to collect fluid to diagnose but also therapeutic intervention treatment: direct at the underlying cause!!, thoracentesis, pleurX portable collection device, pain and dyspnea management, manage drainage system, education: how to drain, s/s of infection, etc. plural effusions: teach about how to manage the underlying condition, teach about the at home drainage system and how to use it, and s/s of infections or problems with it. plural effusion: can be given drugs to treat the underlying cause such as diruretics for those with CHF.

following thoracic surgery: risks, care, etc.

complications they are at risk for: infection, pneumothorax/hemo, empyema (pus in lungs), ARDS (acute respiratory distress), atelectasis, pneumonia, fatigue, psychosocial distress. following surgery: explain what type of a procedure they had, how much lung was taken, explain importance of keeping breathing/coughing. encourage them to move as much as possible.

Breast cancer s/s and treatment (nonsurgical) and metastasis sites. Apply the nursing process for patients following breast surgery, including preventing lymphedema in women who have undergone axillary node dissection related to breast cancer.

diagnoses through biopsy, there's invasive and non invasive types of cancer s/s: mass, palpable or non-palpable, nipple retraction/inversion, thickening of skin or any change in texture, dimpling, increased venous prominence, nipple leakage, change in size or shape of breast, pain (Rare) -metastatic sites: bone, liver, brain, lung. treatment: chemo, radiation, hormonal therapy: estrogen modulatory or aromatase inhibitors, monoclonal antibodies after surgery care: care of drainage tubes: milk tubing, measure drainage, teach patients about drain, removal of drains. comfort: HOB elevated, arm elevated and pain management mobility: ROM exercise, posture and arm support: want to keep pressure off arm lymphedema prevention: no needle sticks, BPs, etc., protect arm from injury, burns, stings, sun exposure, etc. no hot tubs or hot baths. pressure sleeve may be worn, carry bags or purses on the other arm

Lukemia: diganostics, nursing diagnosis, treatment and pt care. -also MDS (myelodysplactic syndrome)

diagnoses: CBC: low hgb, low platlets, low or extremely high WBC, bone marrow aspiration and biopsy. over 20% of blast cells=AML. bone marrow biopsy: AML shows > 20% blast cells treatment: chemo, induction chemo: hit hard with lots and lots of chemo to get cells down to almost nothing in prep for stem cell transplant. kills healthy and non-healthy cells, 4-6 weeks hospitalized, neutropenia=HUGE!!!!, consolidation. SE: pancytopenia. stem cell transfer: done in leukemiaas, lymphomas, myeloma, myelodysplastic syndromes. has eligibility requirements and QOL requirements, two types: autologous from the pts own cells, and allergenic from someone eleses. nursing diagnoses: risk for infection, risk for bleeding, impaired oral mucous membranes, impaired nutrition, less than body requirements, acute pain, fatigue, anxiety risk for spiritual distress knowledge deficit. -MDS: disorder in the myeloid stem cell, tends to develop into acute leukemia, usually have one ia, platelets, hgb and WBC do not function like normal, age 65-70, more common in males, Dx: CBC shows macroytic anemia, low WBC, low plt tx: depends on severity.

Parenteral feedings (TPN/PPN)

does not go through GI system, goes through vascular system. must (almost always) be admin through a central line (very hard on veins, not very great for IV) advantages: Avoids the gut, short or long term nutritional support for those who cannot digest food (GI bleeds, chemo complications, or problems that require gut rest) risks: infections, costs, trouble with glucose control for those with DM

Describe the purpose, expected outcomes, and patient education for epoietin,filgrastim, and pegfilgrastim in the treatment of anemia and neutropenia.

epoietin: Anti-anemic: stimulates the production of red blood cells through erythropoiesis, may decrease bleeding time so heparin may be required. SE: seizures, CHF, MI, stroke, HTN, thrombotic events. -used to treat anemia. filgrastm and pegfilgrastim: colony stimulating factors, used to increase neutrophils, given SUB-Q, SE: pain, redness at site, bone pain.

Identify patient specific risks (ex. Falls, Pressure Injuries, Aspiration) and determine interventions and precautions

falls/injuries: at risk= ABCS, a=age over 85 y/o -B=bone health, fracture risk or history of osteoporosis, steroid use, etc. ) -C= coagulation (anticoagulants) -S= surgery: wishing the last 14 days Failure to communicate changes in assessments/interventions Failure to implement and document prevention interventions Unclear/incomplete handoffs Insufficient/unclear safety instructions Pt or family confusion related to nurse's teaching Assuming its only important to teach patient Education that fails to be individualized Pressure injuries: Immobility, lack of sensory perception, poor nutrition and hydration, medical conditions affecting blood flow, diabetesPreventions: turn pt. every 2 hours, do not use lotion in high-risk areas, do skin assessments frequently, promote adequate hydration and nutrition, keep pressure points off of mattress Aspiration: Older adult, stroke, ineffective airway clearance, dementia, impaired mental status, seizures, dental problemsPrevention: avoid distractions, make sure foods are small and easy to chew, eat and drink slowly, sit up straight when eating or drinking if possible

colelithiasis

gall stones: risk factors: Female, fat and forty - birth control pills, estrogen: Female, BCP/estrogen= can increase cholesterol which stones are made up of sometimes -diabetes, espically type two, increase in weight means more cholesterol, which is what stones are made of. -frequent weight changes -multiparous- must kids=changes in hormone and weight= increase cholesterol. 75%= made up of cholesterol, 25% pigment stones. clinical manifestations: Silent can have zero symptoms, pain or biliary colic (radiates to right back). painful then goes away, RUQ after eating, fever, N/V b/c stones get lodged, jaundice b/c a buildup of bile can occur, changes in urine or still, vitamin deficiency: can interfere w water solutions tx: no treatment is pain is not severe, lithotripsy: Laser that breaks up stones, ERCP, cholecystectomy- can occur if filled with stones. can be done surgical or laproscopic.

Analyze the role of pathophysiologic processes and health promotion of general malignant processes, including agents and factors found to be carcinogenic.

genetic mutation in the DNA is how cancer begins, this causes problems in the pathophysiologic process of new cells being made which leads to tumors to be created and to be spread. chemical agents, psychical agents, viruses, genetics all can cause cancer to happen and can be considered carcinogens. carcinogens: three part process of a malignant transformation of cells. initation: apoptosis changes: the cells that can be cancer avoid programmed cell death and not signfif til step two: -promotion: related exposure to carcinogens, causes proliferation and expansion of the initation cells, -progession: the altered cells increase the malignant behaviors angiogenesis: growth of new blood vessels that allow cancer to grow occurs), invade tissues and can now metastasize. -carcinogens examples: tobacco, sunlight exposure, radiation exposure, bacterial infections, industrial chemicals, asbestos.

Testing and screening genetics:

genetic testing: testing of individuals, analyze chromosomes, genes, and biomarkers. testing if individual has diseases. genetic screening: testing of population or groups, everyone gets tested independent of family history or risk factors. ex: screening ultrasounds for brith defects.

Genetics and Genomics def, and inheritance patterns.

genetics:- study of hereditary and applies to single genes and how they impact single gene disorder genomics: the study of interaction of all genes within an individual and how they interact with the environment. gene mutation: change in one or more genes, can be structural or functional, and inherited or required. autosomal dominant: affects female/male fam members equally, follows vertical pattern of inheritance. carried on one chromosome of a pair. 50/50 chance or normal or mutation. only need one gene to have condition -breast cancer, HLD, Huntington. autosmal recessive: pattern is more horizontal then vertical, relatives of a single generation tend to have the condition. Frequent in ethnic groups. -carrier: has one of the genes, no symptoms. need two genes to have the condition. if carrier has kid- 50%-carrier, 25% have condition, 25% no condition or carrier. X-linked: May be inherited in recessive or dominant patterns. gene is located only on X chromosome. dirsoder in all males who have gene. females can have carrier or be affected, if affected symptoms are usually less. mitochondrial: conditions associated with muscle of nerve tissues, only mom can pass it on, and all kids will inherit multifactorial/nontraditional: result from multiple gene mutations and enriovmetnal factors, may cluster in families. do not follow patten of inheritance. ex: HTN, cancer, DM

CKD presentation and management CKD progression

high serum creat, anemia (kidney not producing erythriopeotien), hyperhosphatemis, fluid rendition, HTN. magnet: manage and treat underlying causes (very tight glucose control, DM, damages vessels and nephrons) -teaching about the importantce of glucose management, smoking cessation, weight loss/excercise ( bring BP down, too much pressure damages vessels), salt intake (don't want to cause any more fluid retention). When kidney function is too poor to sustain life the term end stage kidneyor renal disease is used. (ESKD), must be treated with dialysis or a transplantation. palliative care is also an option GFR is below 15, nothing you do can help pt or the kidneys, have to have dialysis to live.

heart failure (HF), s./sx

inability of the heart to pump sufficient blood to meet the demand of the body -hallmark is exercise intolerance (/dyspnea on exertion) - most nausea re related to MI or chronic hypertension -others could include arrhythmias such as Afib, heart valve issues, or congenital defects. -fatigue -orthopnea (SOB laying back) -tachycardia- heart working harder -nocturia -chest pain -PND (nocturnal dyspnea) -Dyspnea -edema -behavioral changes- decreased O2 to brain -weight changes= fluid overload=increased weight,

gallbladder disease-surgical management

laparoscopic cholescystectomy: usually d/c home day of surgery, less painful/less complications than open. can often resume full employment and activities in 1-3 weeks. 5 pound lift limit for a few weeks. -teach pt/so about s/sx of complications: N/V, pain, anorexia, pain, dissensions of the abdomen, fever, dissensions: PERITONITIS: come back/call immediately. -shoulder pain: combat with walking. -CO2 in body, can get trapped in certain places, get trapping of air. teaching: manage pain, sitting up, walking, PRNS as perscribed -resume activity: light walking immediately, 5lb lifting restriction for 1 week. wound care: clean with mild soap, don't remove sterile-strips until they fall off diet: resume as tolerated, slowly introduce fats -s/sx to report, infection signs, n/v, abdominal pain.

Discuss risk factors and nursing priorities for patients with leukemias (acute and chronic) in terms of their clinical manifestations and management.Explain pathophysiology underlying immunocompromised state of patients with leukemia who have extremely high WBC counts.

leukemia is a neoplastic proliferation of a particular cell type- granulocytes and lymphocytes. increased level of WBC in circulation. classified to stem cell: lymphoid or myeloid (non lymph) and classified as acute or chronic. -general risk factors: genetic damage (ionizing radiation in past such as cancer before). drug and chemical exposure, genetics, viruses, chemotherapy. s/s: fatigue, weakness, dyspnea, bleeding, brushing, petechia, infection that doesn't resolve, fever, enlarged lymph nodes. -CHRONIC: slower onset and progression, survival is weak or years, two types, myeloid or lympothcytic CLL: Magliant clone of B lymphocytes (fully mature cells) average age is 71, higher chance with family hx, leukemia cells often in lymph node and spleen, can turn into agrresssive forms of leukemia, always have lymphocytosis. B cell symptoms!!!: fever, night sweats, weight loss. watch and wait from of treatment. CML: mutation on the myeloid stem cell. chromosome 22 and 9 switch, average age is 67, males have high incidence, uncontrolled proliferation of cells can causee bone marrow to expand and can cause bone pain. also enlarged liver/slpeen is common, increased blast cells. -ACUTE:rapid onset and progression, 100% mortality over weeks/months if left untreated, s/s: usually onset within a few weeks, younger and less comorbities= better survival chance. ALL: from uncontrolled increase in lymphoblasts from the lymphoid stem cell. 75% are from B, 25% from T, median age is 15, boys=more affected. better prognosis after stem cell transplant. AML: from genetic mutations in the myeloid hematopoietic stem cells: blast cells increased, most common leukemia, highest # of deaths, 68 years=average age, males=higher incidence.

intestinal obstructions types

mechanical obstruction: obstruction within the lumen of the bowel or pressure from outside the lumen. ex: intussception (bowel folds onto itself), volvus(twisting and cuts blood flow) , tumors/neoplasma, hernias, adhesions. ileus: intestinal musculature stops working properly, may be short term or due to chronic disease: muscles of bowel shut down, no peristalsis short term: bowel manipulation during surgery, meds: narcotics chronic: narcotic abuse, scleroderma: tightness in connective tissue, hard to move. SMALL VS LARGE BOWEL obstruction -narcotic and not walking= very easy to get ileus

HF compensatory mechanisms and tests and labs to diagnose

mechanisms: (HF doesn't compensate well, usually needs medical help) -increased HR and SV-trying to pump more since not as efficient -arterial vasoconstriction, sodium and h2o rendition, trying to increase perfusion -myocardial hypertrophy: try to strengthen heart to pump more diagnoses: (lower the EF= the more symptoms) -CXR-size of heart, ECHO (EF less than 55%), angiography, PA catheter (pressures), ECG, ejection fraction key info (result of echo) LAB: BNP: plasma levels may correspond to the severity of underlying cardiac dysfunction, provides prognostic info. present when edema is present -elevated BNP indicate a high risk of morality and mortality in patients with CHF or ACS, should be less than 100

digoxin

medication used to treat arrhythmias, cardiac glycoside, inhibits sodium potassium ATPase pump, positive inotrope, improves this strength of cardiac contraction and allow more calcium to be available for contraction. used for HF and atrial dysrhythmias . -MONITOR: potassium levels, drugs levels and for toxicity. hypokalemia potentiates dig toixicity.

Evaluate patients for development of complications from the conditions addressed(metastasis, respiratory compromise, problems with chest drainage systems, etc.)

metastasis: lung cancer can metastasize, often to the brain. liver, bone, and adrenal glands=usual places it spreads. to confirm, take biopsy of cells in the area= if lung cells in brain= it has metastasized. This can cause the patient to experience more symptoms and makes the cancer more fatal. -problems such as SOB/ trouble breathing can be caused by problems with chest drainage, trachea shift could also occur, which would cause abnormalities in the heart and on EKG.

Continuous Renal Replacement Therapy (CRRT)

method used to replace normal kidney function by circulating the patient's blood through a hemofilter and returning it to the patient -dialysis that is physiologic over 24 hours. -continuous filtering of the blood, very good for helping to rapidly reverse metabolic acidosis -used in critical care, often at the bedside -avoids fluids swings, and hypotension associated with HD.

Treatment of chronic failure

monitor I&OS and implement fluid restrictions -daily weights -cardiac rehab -increase quality of life -symptom management pharmacologic: ACE inhibitors (lisinopril) -direutics (furosemide) -K wasting!! -beta blockers: Coreg/ carvidolol -digoxin- help pumping ability of heart -nitrates: help perfuse and lower BP -oxegyn= more O2 to tissues -meds must be combined with lifestyle and self care management -rational polypahrmacy: balancing beneficial and adverse effects and monitoring how such drug regimens affect each patient with HF.

diverticulosis

multiple diverticula without inflammation (these are sac like herniations in the lining of the bowel that extend through a defect in the muscle layer). -HIGH FIBER: good, keeps it all clean and prevent infections. -may occur anywhere in the intestines, most common in the sigmoid colon. s/sx: often asymptomatic, sometimes pain. dx: found on routine colonoscopies tx: pharmacological: anagelsics, antispasmodics (only if having pain), bulk forming laxative :must keep stuff moving os not stuck in sacs diet: high fiber, low fat.

Apply concepts of neutropenic and thrombocytopenic precautions to the care ofpatients

neutropenia: wash your hands, masks, if you have a cold STAY AWAY from patient. immune system is really at risk, must do as much as possible to reduce any chance of any infections to spread to the patient. thrombocytopenia self care to tell pt: use an electric razor: no cuts, use as soft bristled toothbrush and do not floss: no gum bleeding, no ASA or NSAIDS-cause more bleeding. no contact sports. avoid anal intercourse (tissues in anus are very thin), take stool softener, no enemas or suppositories, do not blow nose or insert anything into nose=pressure can cause bleeding-notify provider if: persistent bleeding, excessive menstrual bleeding, blood in urine or stool

renal transplant

not a cure, (cause of failure could still be there post transplant, could damage new kidney) -usually will need more than one transplant in lifetime. -many people are waiting for donors -donors can be living or non-heart beating (brain dead) -living donors, espically family= best success rates. -paired kindly exchange: ill give my kidney to your mom if you give your kidney to my dad. -recipients have a responsibility to optimize their health: if obese, have lung disease, vascular disease, substance abuse, etc= put you lower on transplant list complications: rejection, acute tubular necrosis (from deceased donor, infections, surgical related complications, psychosocial stressors, SE from anti-rejections meds.

artifact

not a real rhythm, deviates from line, can have lethal rhythm underneath so important to go to bedside and look at pt. -often can occur due to pt moving around or bad connection-can be caused by tremors.

genetics ethical concerns:

nurses should: respect patients right to self-determination, autonomy provide privacy and uphold confidentiality clarify values and goals asses understanding of information provide genetic information/education to patients.

Lung surgery nursing goals, process,

nursing goals: improve gas exchange, improve airway clearance, improve knowledge, relives anxiety and pain, prevent impairment of upper exterminates (keep them moving) care: monitor pulmonary status-SP02, lung sounds respirations, VS Q2-4hrs, evaluate and treat pain, mointer EKG, HOB 30-40 degrees-to improve oxygenation, Turning, deep breathing., incentive spirometer, cough 1-2Qhrs splint when coughing, asses and monitor chest tubes -AIRWAY!! clearance and protection. make sure to stress deep breathing and coughing, and keep pain low.

Apply the nursing process, including prioritization of problems and interventions, to the care of patients receiving radiation therapy related to:Care and precautions for patients with low dose brachytherapy (implanted radioactive source) versus teletherapy

nursing roles communicating cancer diagnosis to the pt: be there, be aware, listen, ask questions for the pt, try to structure meeting time with physician with fam present and privacy/no interruptions. nursing care of radiation therapy: goals: cure, control, palliation, noeadjuvant, prophylactic. types: external (most common): tele therapy, internal (inserted into the body): brachytherapy -tele therapy: external beam radiation. emitted from a source external to the body, used to treat solid tumors -brachy: emitted from source placed in body, sealed source placed within or near tumor ex: seeds, tubes., needles. can be temporary= high dose, or permanent=low dose. nursing care for brachytherapy: proactively control s/sx, protect fam members (can be exposed to radiation if too close to the pt). manage pain/discomfort during treatment. STARTing RT: need to know: position of tumor r/t other organs (don't want to kill organ cells), and if tumor is radiosensitive. most beneficial when tumor is smaller, cells are rapidly dividing and poorly differentiated. starting RT nursing asses: pt perception of illness, tx recommendation, general health/are they able to tolerate laying down for hours for treatment.

phases in AKI and electrolytes to watch

onset/initation: marked by precipitating events, what happened to damage kiney oliguric: characterized by decrease in urine output 100-400ml/24 hours, does not respond to fluid challenges or diuretics. increase in fluid=no increase in urine output dieurectic: prompt onset marked by increase in urine output overall several days. tons of urine output, hypervolemia and electrolyte loss!, recovery: slow return to normal levels of renal activity, can take 3-12 months. however, can permanently reduce GFR 1-3%. hyperkalemia, hyperphospahtemia: increase bc kidney cannot excrete properly, leads to buildup. hypocalemia: phos and ca inversely related, it is pulled form bones to blood to try and decrease phos levels

Premature Atrial Contraction (PAC)

p wave comes early and often the p wave looks weird. , QRS is normal, PR interval may be normal or prolonged. management: treatment varies upon frequency and presence of symptoms. -not treated unless occurs more than 100 times over 24 hours. -reuduce caffeine, ETOH, smoking -beta blockers if treated.

Radiation therapy: Skin care with radiation therapyExpected side effects of radiation related to anatomic area being treated with radiation

patient teaching when starting radiation therapy: frequency or treatments, number of treatments, effects and SE, symptom management, self care:skin care, nutrition, fatigue symtom management: SE of radiation therapy are generally confined to area of treatment and fatigue. -weekly or every other week CBCs, hgb, plts, WBC. -skin care: wash only with warm water and unscented soap, wearing breathable clothing, soft and loose, don't apply any lotion, creams, products to skin in treated area unless prescribed by RT, don't remove any marking, don't expose irradiated skin ro sunlight or heat. -nutriton: nutrition consult for pt with head/neck, lung, GI tumors or who have unintended weight loss. consider pre-treatment PEG tube (feeding tube that goes right to stomach). weekly weigh ins, maintain weight during treatment, focus on nutrient rich foods that taste good. low residue to avoid diarrhea (avoid veggies whole grains in excess), nutritional supplements. -FAtigue: prepare pt that Fatigue is most common symptom. ask pt energy level at each visit, stay active: helps to prevent fatigue : walk cycle, aerobics, mult times a week. screen for and treat distressing conditions: pain, anemia, N/V, depression, hypothyroidism, etc.

Pneumothroax & hemothorax: patho,s/sx, risk factors, tx, nursing process.

pneumothorax: anti-infective specific to causative agent, pneumococcal vaccine, Flu and Covid vaxx.) -sharp, stabbing chest pains, SOB, cyanosis, fatigue, tachypnea, tachycardia, dry, hacking cough hemothorax: collapsed lung from blood in the plural space, caused by surgery or trauma SOB, rapid, shallow breathing, chest pain, hypotension, pale, cool, clammy skin, tachycardia, restlessness, anxiety Nursing process: chest tube!! drain pressure, watch for mediastinal shift. follow chest tube interventions. o Frequent assessments o Verify connection tubes are patent and connected o Assess that seal is intact o Note fluctuations in water seal chamber (wet suction), air leak indicator (dry suction) o NEVER clamp CT without order o Keep below level of chest o Check dressing for bleeding o Check for SQ emphysema o Monitor and measure drainage o Have emergency supplies ready o Prepare for removal risk factors: Smoking, Genetics, Previous pneumothorax, surgery main concerned is reliving the pressure in the lung. want to prevent any complications form not being treated. blood= low in lung, air= high in lung!!

Causes of AKI

pre-renal: physiological state of demised perfusion: occurs before the kidney: severe dehydration, excessive volume losses, hypotension heart failure/MI, sepsis, vascular occlusion (anything that decrease BF to the kidney) intra-renal: damage to the kidney or glomeruli: acute tubular necrosis. (most common, diabetes), infectious process, nephrotoxic agents (NSAIDS, ACE inhibit, radiographic, amiglycosides, antibiotics) post renal: associated with obstruction of the urianry system.: anything that obstructs urine from flowing out. -urethral obstruction, bladder, neurogenic problems, renal calcium, tumors, pregnancy.

treatment AKI and interventions/management:

pre-renal: rapidly reversible, correct primary hemodynamic abnormality. -stop whatever is blocking proper perfusion intra: management and focus on elimination of causative toxin, infections or other causes. prevention is KEY! post: resolves upon relief on obstruction if corrected quickly if tumor=surgery, UTI treatment. Drug therapy: modified dosages, to decreased stress on kidneys and compensate for decreased renal metabolism (less or more spread out antibiotics) -fluid balance, transfusions may be given in pre-renal causes diet therapy: decreased Na, K or food with phosphorus high carb and high calorie for energy and healing -initally low protien, following diuretic switch to high protien, high cal. managnemet: avoid using of nephrotoxic meds, maintain adequate hydration and nutrition (I&Os), minimize risk of infection, correct fluid and electyolye imbalances, skin care: prevention of skin breakdown r/t uremia (itching bc toxins aren't being excreted properly in blood and makes itch), malnutrition and immobility.

hemodialysis (HD)

process of removing excess fluids and toxins from the blood by continually shunting (diverting) the patient's blood from the body into a dialysis machine for filtering, and then returning the clean blood to the patient's body via tubes connected to the circulatory system ultrafiltration: movement of particles by pressure, also draws out extra fluid. access: Vascular access device: this is for short term use, can be sued in /aki for people who need to be dializyed two types of central venous catheters: internal jugular.subclavian: often preferred bc in chest, less chance for infection. femoral: other site, not preferred. advantages: quick, easy access, disadvantages: air embolus, infection rates are high. arteriovenous fistula: vein and artery are combined in a surgery, for long term use. -pressure of the artery strengthens vein and thickening walls so can handle to pressure of dialysis. -takes 1-4 months for vein to strengthen and become usuable -if you feel vein and fell a thrill and if u listen and hear a brewie- means vein is working and can be used!! arteriovenous graft: can be synthetic, used to create fistula using synthetic material -used in pts with bad vascular access, elderly, smokers, -fucntion the same way as a fistula, used for long term

Chemotherapy general facts

purposes of chemo and immune therapy: cure: single or multiple treatment modes (one chem drug or more), control, palliation. chem basic mechanisms of action: try to target chemo during cells proliferation, if given at right time= kills the most bad cells. chemo types: combination vs single agent, high dose with supportive therapy (dietician, PT, etc) induction chemo followed by stem cell transplant, in combo w immunetherapy. -chemo/immuno routes: oral (pills), IV, intrathecal: administed top of head or lumbar for CNS cancers, sub-Q or IM. chemo safe handling: chemo is toxic to healthy and non-healthy cells. protect: patient: safe venous access (vesicants and the danger of extravasation:tissue is damaged through chemo bc of IV: need good blood return. safe admin: chemo certification and ongoing education, yourself (PPE), enviorment: prevent spills! chemo is frequently excreted unchanged from body: treat pt body secretions like chemo, educate family: flush twice font share bathrooms, etc.

esophageal cancer:

risk factors: GERD, Barretts esophagus (change in cells of lining of esophagus, causes lots of inflammation that can cause cancer). smoking, ETOH, chronic exposure to hot liquids. two types: squamous cells aka flat cells, and adenocarcinoma: cancer from epithieal tissues -the bigger the tumor the more likely to invade other tissues manifestations: dysphagia- all food feels like trying to get down a dry piece of bread., fullness in throat or substernal area, regurgitation b/c squeezing of esophagus, hiccups, halitosis, weight loss and constitutional symptoms dx: EGD (scope), with BX ( if there is a tumor), CT, US. often diagnosed later, not great prognosis. management: surgery,, XRT, chemo -nursing goals and interventions: MAINTAIN airway, post-op: watching airway, trach management, NGT, care maintain nutrition: high calories, high protein, and liquid/soft diets, enteral feedings or TPN -prevent aspiration: manage oral secretions -promot comfort: physical and emotional support.

Discuss risk factors, and factors influencing the prognosis for patients with breast masses.

risk factors: female gender, age older=higher risk, family history (only 20% of breast cancer is family or genetically related), personal history- breast cancer before, genetic mutations (5-10% are from genetic mutation in tumor suppressor genes BRCA 1&2), hormonal factor: menarche before 12, menopause after 55, bearing no children, having first child after 30, RT- radiation therapy in the past- especially in chest. -modifiable risk factors: sedentary lifestyle and obesity, be psychically active and avoid excess weight for better prognosis. more fat=more estrogen=more risk. increase death rate! high fat diet may increase risk, alcohol and smoking, oral contraceptive use and post menopause hormone replacement= increases risk. breast feeding decreases risk. screening: 20-44: prompt reporting of breast changes, CBE by provider once a year 45+= prompt reporting of breast changes, CBE by provider, screening mamagrom every year 55+= yearly mammogram or every 2 years. -prevention for high risk patients: chemo prevention, can reduce risk of developing breast cancer was 50% or prophyalitc mastectomy reduces chance by 95%

Large bowel obstruction

s/sx: often develop slowly, constipation: or diarrhea (stool goes around block), altered shape of stool ( pencil thin), abdominal distensions, weakness, weight loss and anorexia, crampy lower abdomen pain. tx: NGT aspiration and decompression: GI rest if volvulus need urgent colonoscopy- must take care of before tissue dies, twisting of intestine. -rectal tube for decompressions -if cancer or diverticulitis 1-2 days then surgery- need to wait to reduce inflammation.

small bowel intestinal obstruction

s/sx: progress rapidly, crampy, colicky abdominal pain, absence of stool or flatus, vomitting, dehydration: thirst, drowsiness, malaise/aching, parched tongue, and mucos membranes (water is not being absorbed) -abdominal distention: the lower the obstruction, the more distention. -uncorrected obstruction leads to hypovolemic shock or septic shock, peritonitis or death tx: decompression through NGT, if secondary to adhesions (fibrous band from tissues or organs): obstruction will resolve 80% of the time. -other causes usually require surgery. -can do gastrografin challenge to determine need for surgery: have pt swallow contrast, 6/8 hours later take X-ray, if all through= good, if blocked=surgery -how they present is how you treat.

Sinus Arrhythmia

similar to NSR, except for the regularity, "regular irregular", increased rate with insirpation.-draw a line across R's will be uneven.-this is not treated, and this can be a baseline ECG

Angina types:

stable: is substernal pain or discomfort that is provoked by exertion or emotional stress and is relived by rest of nitroglycerin. "warning sign pain" unstable: iscehmic chest pain that occurs at rest (prolonged pt is doing nothing), in a crescendo pattern or is severe and of recent onset, falls into category of ACS (stemi and non-stem included) (not relived by rest or nitro)

Describe the roles of surgery, radiation therapy, chemotherapy, and immunotherapy/target therapy in treating cancer.

surgery: the first cancer treatment, look at first: want to see if can take out whole tumor to cure. types: prophylactic, diagnostic, curative, palliative, reconstructive. Radiation therapy: very localized, kills mostly only tumor cells. goals: cure, control, palliation, neoadjuvant (relives advanced disease, oncologic emergency SVA syndrome, prophylactic. chemo:purposes: cure, control, palliation, is toxic to not only the cancer cells but also good cells, kills both. immuno: purposes: cure, control, palliation. boosting immune function to help use the one body to kill the tumor. traget: target certain part of cell and has less effect on the cells around the tumor.

pneumonia: Patho, s/sx, nursing process, prioritize care, risk factors, medical/pahrm tx, medical dx.:

the cause is acute infection of the pulmonary parenchyma (lining of lung), is associated with some symptoms of acute infection and infiltrate on CXR. and adeventious lung sounds.most common cause of death from infectious disease. hypoxemia (confusion if severe), infectious (typical) vs non infectious, and then community vs hospital acquired s/s: pain, discomfort, myalgia, H/A, anxiety, chills fever, cough, sputum production, tachycardia/pnea, dyspnea, adeventious breath sounds, use of accessory muscles. diminished chest expansion, tactile fremitius increases over consolidation, percussion dull of consolidation (where disease is), as conditions worsen: hypotension, rapid/weak pulse, profound hypoxemia, dehydration, impeading shoc treat the underlying cause!, make sure to protect the clients airway!! may struggle with gas exchange and clearing the airway due the secretions!! look for s/sx of hypoxemia. diagnosis: impaired gas exchange, ineffective airway clearance, pain, imbalanced nutrition: less than, acitivyt intolerance, hyperthermia, fluid volume deficit. knowledge deficit/self care deficit, confusion-fall injury etc. expected outcomes: responds to treatment within 24-48hrs, VSS, pulse ox normal, able to rest while symptomatic, increased activity with recovery, adequate hydration and nutrition, adheres to medication regimes and interventions, does not develop complications risks: conditions that produce mucus or cause obstruction, chronic illness, nursing home residents!!!!!, winter, immunocompromised, smoking, shallow breathing, depressed cough or gag (can't clear secretions), NPO/NG (can't cough out secretions), antibiotic, ETOH intoxication, general anesthesia, older adult, reparatory therapy with equipment not properly cleaned CXR=DIAGNOSE!!!! sputum culture and stain to find type of bacteria to decide how to treat, CBC, blood culture, work up to decide underlying cause if opportunistic, ABG, electrolytes, bronchoscopy used to see what's going on and help. treatment (nonpharm): monitor for changes in status, support therapy (high fowler, O2, fluids, rest and activity balance), prevent aspiration if cause, health teaching: avoid crowds/stop smoking. incentive spirometer use pneumonia: teach the patient about the important of good hygiene -enourage them to avoid crowds, and to stop smoking. -if they have risk factors explain how to prevent them from causing pneumonia again (prevent aspiration example) anti-infective specific to causative agent, pneumococcal vaccine, Flu and Covid vaxx.

Covid-19: Patho, s/sx, nursing process, prioritize care.

the cause is viral infection of alveolar epithelial cells, those over 65 y/o and with comorbitites are at an increased risk. s/s: loss of taste or smell, fever or chills, cough, SOB, fatigue, muscle of body aches, headache, sore throat, congestion, N/V, diarrhea rest and fluids, making sure to educate the patient about avoiding crowds and getting proper nutrition to help recovery. fatigue, weakness, activity intolerance: nursing diagnosis nasal swab is used to diagnose, PCR or rapid. Antibody test is also available. rest and hydration, O2 or ventilator for very severe cases. prone position. monoclonal antibodies given early in disease for those at risk of severe s/s. social distancing, avoid large gathering, weathering cloth mask, N95 use, droplet precaution -Teach about importance of getting vexed, antivirals-can help

Influenza: Patho, s/sx, nursing process, prioritize care.

the cause is viral infection of respiratory epithelial cells in trachea and bronchi, Death is often underreported/falsely for the Flu, Clinical Manifestations: Headache, fever, chills, fatigue, weakness, Muscle aches, Anorexia (NV/Diarrhea), respiratory symptoms (mostly caused by GI symptoms.) nursing process: rest and fluids, making sure to educate the patient about avoiding crowds and getting proper nutrition to help recovery. -fatigue, weakness, activity intolerance: nursing diagnosis. -nasal swap to dx. : teach about the importance of getting the flu shot to prevent disease and minimize symptoms, teach about good hand hygiene, avoiding crowds and good health habiit antivirals to help diminish disease symptoms.

ESKD manifestations and management:

the greater the build up of waste products the more manifestations you will see, effects nearly every system -nuero: decreased LOC, confusion due to toxins, skin is dry due to decreased water in skin, also itchy. increased fluid retention, causes HTN and can cause HF. SOB/crackles, dyspnea if HF. N/V, stomach aches to due toxins. decreased libido, effect menstrual periods. fractures/ bine pain, because due to high phos, calcium leaves bones to try and lower it due to be inversely related. Also increased K+ levels. -cardiovasuclar disease is the number one cause of death in ESKD. management: pharm: calcium and phosphorus binders -sevelmer- give to prevent reabsorption of phosphorus in GI, leads to it be excreted -Calcium Acetate: does the same thing and decreases phos levels -calcium carbonate: increase the amount of CA, which pulls down phosphate levels. -sodium polystyrene: (kayexlate): this is used when K levels are high but no life threatening: binds to K so it cannot be absorbed and it excreted through diarrhea if K is high and life threatening: D50 into the IV, then 10 units of insulin after. (Can cause lethal arrhythmias) -erythropoietin supplement ], usually during HD. -cardiac agents to control BP. Renal replacement therapies: Hemodyalsis (HD) -continuous renal replacement therapy (CRRT) -peritoneal dialysis (PD) -kindey transplant.

Chronic Kidney Disease (CKD) Stages of CKD and main causes

the presence of kidney damage or decreased glomerular filtration rate for at least 3 months or more. many people do not know they have chronic kidney disease. MAIN causes: HTN, and diabetes- dehydration, cancer, or infections are other causes aswell. stage 1: normal kidney function, but urine findings or structural abnormalities of genetic trait point to kidney disease stage 2: mildly reduced kidney function stage 3: moderately reduced kidney fucnction stage 4: severely reduced kidney function stage 5: very severe, or end stage kidney disease. (no kidney function) -once at a stage v rare to over go back. however, do not have to progress, can stay at a stage.

Discuss the procedure for administering blood products r/t:a. Types of adverse reactions, preventive measures, potential causes, and nursingactions.

transfusion process: you want to asses labs (hgb), confirm the transfusion order, make sure consent is signed, explain procedure to the pt, including s/s if a transfusion reaction, baseline VS, wash hands standard precautions, prime blood tubing with .9NS, start IV with at least 20 gauge needle, obtain product from blood bank. check blood labels and confirm with another RN or physician (check ABO/Rh, ID number, Patient ID, expiration date), check blood for any unusual color/bubbles, start transfusion within 15-30min of arrival on unit, run transfusion very slowly for first 15 min: 1-2 mL per min, observe for s/s of reaction, may increase if asymptomatic after first 15 mins. continue to observe closely, BS q 12-30 min. D/C if not transfused within four hours, because risk for bacteria growing in blood put pt at risk. - only have four hours to get all blood in pt. why you want to start so quickly -must only us 0.9% NS- anything else could make the blood lyse. and then would be unusable. -20g needle bc blood is thick and any smaller could cause the blood to lyse as it gets squished through tube.

Lung cancer: Patho, s/sx, nursing dx/process, diagnoses/interventions (medical/pharm), and teaching plan for families, risk factors:

two types of lung cancers: small oat cell (most malignant, poor prognosis, poor response to surgery, fast growing (usually caused by smoking). goal here is to improve quality of life but not to cure. 2.) non-small cell: slower growing, amenable to surgery if localized or regional often asymptomatic til late in the course. cough is a major symptoms (any changes in cough characteristics= a sign ex: COPD always has a dry cough, cough is now wet!!!!). may have wheezing or pain, blood tinged sputum, dyspnea is often present early, occasionally there is reoccurring fever, hoarseness or facial edema, can be weakness fatigue, etc diagnosis: activity intolerance of fatigue, death anxiety or fear (bad prognosis), disturbed body image, hopelessness or powerlessness, risk for infection/bleeding due to chemo, nausea, pain, impaired sleep. expected outcomes: bad prognosis mostly focusing on improving quality and quantity of life, not curing, treating the psychosocial aspect of the pt. encourage to stop smoking. number one cause of cancer related death, main causes: smoking!!, the second hand smoke, e-cigs, air pollution, chemical and radiation exposures, Radom, genetics. overall 5 year survival rate is less than 20%, most cases could be prevented with smoking cessation, female smokers are at higher risk. most lung cancers are bronchogenic carcinomas the cancer is often discovered during a CXR, but BIOPSY confirms/diagnoses the cancer other exams= make us suspicious CT scans, sputum exam, bronchoscopy, PET/MRI is used to identify metastasis. interventions: informed and empowered clients (support system),improved comfort and QOL (palliative care), emotional well-being, maintain modified independence, interventions aimed at underlying problem teach the pt/fam about the poor prognosis, explain the importance stopping smoking, talk about palliative care and increasing quality of life/ instead of treating disease. explain about CT scans for those 50-80 with 20 pack year chemo, radiation often common to do a chemo/radiation combo, surgery (if non-small), immunotherapy, gene therapy, palliative care.

Types of adverse reactions, preventive measures, potential causes, and nursing actions The rationale for administering irradiated blood products

types of adverse reactions: febrile non-hemolytic (most common, your body reacts to blood). cause: recipient antibodies to donor luekocytes, inflammatory response, highest risk in people with multiple transfusion and pregnant women who are Rh neg and have a Rh pos child. s/s: fever, usually begins within two hours after transfusions that are not from other causes and chills prevention: Leuko-reduced blood products, pre medicate with antipyretics. onset: 2 hours Acute hemolytic (mot dangerous): administer incompatible blood, improper admin: use non .9% NS. s/s: fever, chills, low back pain, nausea, chest tightness, dyspnea, anxiety, hypotension, CV collapse, renal failure, HGB in urine. prevention: strict adherence to policies/procedures (double check!!), run blood slowly for 15 mins, administer only with NS onset: immediately. allergic reactions: cause: mild to sever allergic response to foriegn substance, s/s: mild-flushing, hives, itching. severs: bronchospasm, laryngeal edema, shock. treatment: mild- administer antihistamines, severe: epi, corticosteroids, vasopressors. prevention: transfuse plasma free products (washed), premed with antihistamines or corticosteroids. onset: within first 15 mins. Bacterial contamination: cause: contamination of blood product at any phase: s/s fever, chills, hypotension. prevention: aseptic technique, properly store product, change tubing, ensure transfusion is done after four hours. onset: within first 2 hours, but could take several hours. TACO- cause: too rapid infusion (CHF, EDEMA!) s/s: cough, dyspnea, sudden anxiety, crackles in lungs, HTN, tachycardia, JVD. prevention: adequate transfusion volume and flow rate, furosemide btw units. onset: variable, up 6 hours post TRALI: unknown cause think it has to due with antigens in donor blood reacting with recipients. , s/s edema everywhere, dyspnea, hypoxia, hypotension, fever, pulmonary edema. onset: ABRUPT, treatment: O2, fluids, possible initiation to prevent: limit amount of blood products transfused, screne donors. -irradiated blood- blood is ran through radiation to help get rid of leukocytes and T lymphocytes that could cause the recipient blood to react with the donor blood-prevents GVHD. really can help with people with multiple transfusion!!

Analyze nursing outcomes, interventions, and rationale for patients who have thoracicsurgery and/or chest drainage systems

§ Goals: o Improve gas exchange o Improve airway clearance o Improve knowledge o Relieve anxiety and pain o Prevent impairment of upper extremities § Interventions: o Monitor pulmonary status o VS Q2-4 hours, evaluate pain o Monitor EKG o HOB 30-45 degrees when stable o Turning (avoid turning to operated side) o Deep breathing, incentive spirometry o Cough Q 1-2 hours (spline when coughing) o Assess and monitor chest tubes