nur 180 exam 2

Normal Heart Values R/T perfusion

- Cardiac Output 4-8 Liters/min - Cardiac Index 2.8-4.2 L/min/m2- Takes Body size into account - Central Venous Pressure= Right Atrial Pressure- CVP/RAP 2-8 mmHg - Pulmonary Artery Pressure (PAP)= 25/10 mmHg MAP- 15 - Ejection Fraction- 50-70% - Cardiac Output = Heart Rate x Stroke Volume Preload Afterload Contractility

what is nonself for immune system

( foreign) is external agents. Such as microorganism, cells and tissue from other humans or animals. These have antigenic properties that the body recognizes as Nonself ( foreign).

pharma. therapy for gerd ( h2- receptor blockers)

(cimetidine, ranitidine, famotidine, nizatidine) - -Block histamine (H2) at the receptors of acid producing parietal cells - -Thus the production of hydrogen ions is reduced, resulting in decreased production of HCL. - -Nursing Implications ▪ Take at least 1 hour before or after antacid. ▪ Usually requires more than one dose a day.

pharm. therapy for gerd ( promobility agent )

(metoclopramide) - -gastroparesis (acid isn't moving) - -Not recommended for long-term use

whats happening with type 4 reactions

T Cell mediated rather than antibody mediated Local collection of lymphocytes and macrophages causes edema, induration, ischemia, and tissue damage at the site Tuberculin testing have induration and redness in 8-12 hours.(PPD) Contact dermatitis such as poison ivy. Latex allergy Insect stings. Organ transplantation rejection. Sarcoidosis-Fibrosis in lung tissue -lymphocyte reaction resulting in a delayed hypersensitivity response, causing local tissue destruction. -Type 1 diabetes falls under type V hypersensitivity because it activates a delayed reaction. -Stimulatory hypersensitivity, B-cell mediated, Autoantibodies bind to target cell and stimulate cells. Excess stimulation of a normal cell surface by an autoantibody, results in a continuous "turned-on" state for the cell. -May cause uncontrolled secretion of hormone. The feedback mechanism is lost. Ex: Grave's disease (Hyperthyroidism)--immune system disorder of the thyroid gland resulting from overactive thyroid gland -swelling of neck and profusion of the eyes.

What activates the Immune System?

The Immune System is activated by external agents. Examples: microorganism, minor cuts, surgeries & Systemic diseases

Positioning for Anaphylaxis:

The patient should be placed in a recumbent/supine position with elevation of the lower extremities and Epinephrine IM

Question: A patient who has experienced a hypersensitivity response determined to be autoimmune asks the nurse for information about this response. The nurse should include which of the following to describe the processes that differentiate the immune hypersensitivity response resulting from an autoimmune mechanism from those resulting from an allergic or alloimmune mechanism?

The trigger for an autoimmune response is a self antigen. Rationale: The primary trigger for a hypersensitive reaction is an environmental antigen. An autoimmune reaction is triggered by antigens from another individual The trigger for an autoimmune reaction is a self-antigen

Anaphylaxis:

This a life threatening allergic reaction that develops rapidly within seconds- minutes. This requires immediate Emergent action

explain what type of antigen is type 2 hypersensitive reaction

Tissue damage: may cause dyspnea or fever. Ex: Transfusion reaction, ABO incompatibility

What does type 3 for hypersensitivity look like:

Urticaria, fever, joint pain. Ex: serum sickness- Often seen when horse or rabbit serum injected. ( reaction to an injection of serum, typically mild-with skin rash, fever, joint stiffness)

diagnostic tests for hypersensitivity

WBC-:can detect circulating eosinophils RAST: measures the amount of IgE directed toward specific allergens Blood type : ordered before transfusion Skin testing: to determine causes of hypersensitivity reactions. They identify specific allergens to which an individual may be sensitive.

Nurses Role when we speak about the Immune System. What can we do with this information?

We can question client about Immunization HX and allergies

physical assessment for gallbladder disease

Weight Color of skin, sclera Abdominal tenderness Color of urine, stool

what is atherosclerosis R/T perfusion

a form of arteriosclerosis in which deposits of fat and fibrin obstruct and harden the arteries.

how are types 1, 2, & 3 mediated

antibody mediated

how are types 4 &5 mediated

cell mediated = not going to use antibodies

Systemic lupus Erythematosus-SLE

chronic inflammatory multisystem autoimmune disease that can effect the skin, joints, kidneys, nervous system, or other organs of the body.

sarcoidosis

clumps of abnormal tissue (granulomas) form in certain organs of the body The disease can affect almost any organ of the body, but it most commonly affects the lungs. Possible causes of sarcoidosis include: Excess sensitivity to environmental factors Genetics

What are the risks of plasmapheresis?

faintness. blurry vision. dizziness. feeling cold. stomach cramps.

Immune System is constantly threatened by

foreign substances, infectious agents and abnormal cells. Function is to protect the body from foreign antigens

whats a Specific response to the immune system

when the body cannot or is unable to destroy the invasion of these foreign agents, its takes it a step further by activating a more Specific response -tailored to particular types of invaders -acquired immunity

Immune System distinguishes Self

which is body cells, tissues, and fluids ( because they have unique antigenic properties that the IS recognizes)

5 classes of antibodies called what and what are they

immunoglobulins, which are proteins that make up Humoral immune response( found in body fluids, stimulates division)

List and explain the actions and side effects of beta lactams which are used for a patient with infection.

work by = inhibiting cell wall biosynthesis in the bacterial organism and are the most widely used group of antibiotics. • Penicillin = -Stevens-Johnson Syndrome -Warfarin effects are increased because of decreased Vit K in the gut • Cephalosporins = -With each generation, there is increased gram negative coverage and decreased gram + coverage ( if gram negative they would use a first generation antibiotic and if it were gram positive they would use latest generation ) • Carbapenems = -Imipenem/Cilastatin (Primaxin) -Side effect = seizures -Meropenem, Doripenem

what is cholecystitis

inflammation of the gallbladder

what is nephritis

inflammation of the kidneys Classifications based on area of involvement Glomerulonephritis Acute postinfectious glomerulonephritis (APIGN)

Type IV reaction

intense redness, itching, edema and thickening affect the skin in the area exposed to the antigen. Fragile vesicles are present. Poison Ivy is main perpetrator Risk increases with previous exposure because antigens must be formed with the first exposure before hypersensitivity is likely to occur ex: contact dermitis

what is bicarbonate what does it do what happens if something is affecting it

is a base, a buffer makes body into alkalotic state, something affects bicarb it's causing more acid

Glomerulonephritis

is a group of diseases that injure the part of the kidney that filters blood (called glomeruli). Other terms you may hear used are nephritis and nephrotic syndrome. When the kidney is injured, it cannot get rid of wastes and extra fluid in the body. If the illness continues, the kidneys may stop working completely, resulting in kidney failure.

Serum Sickness

is a hypersensitivity vasculitis due to foreign objects. Which often is the cause of horse serum proteins.

Dialysis

is a lot more complicated, since it is a form of kidney replacement therapy, beside from filtering thus removing fluid and small molecular metabolic waste products it also regulates fluid balance and metabolic processes essential to life

Allergic conjunctivitis

is an eye inflammation caused by an allergic reaction to substances like pollen or mold spores. The inside of your eyelids and the covering of your eyeball have a membrane called the conjunctiva.

Angioedema

is the rapid edema, or swelling, of the area beneath the skin or mucosa. It is normally an allergic reaction, but it can also be hereditary -due to mast cell activation in the dermis and/or subcutaneous tissue

Explain the pathophysiology of cellulitis

• Acute bacterial infection of the dermis and underlying connective tissue - Infection of the skin - Normal flora but overgrown - Skin helps us not get it, once you get a break in the skin, bacteria can get in and cause infection - Dry skin, not only cuts (feet usually) - Athlete's foot can cause this (thin skin, decrease elasticity) - Can lead to Sepsis - infection in blood or osteomyelitis - infection in bone - IV drug abuse

Explain the pathophysiology of urinary tract infection

• An infection that can include urethra, bladder, ureters and/or kidneys. - Elevated WBC in urine - Infection in urinary tract - Upper- kidneys - Lower- cystitis - Can contribute to PID (pelvic inflammatory disease) - Wiping the wrong way - Hygiene isn't the best Infecting agent • Escherichia coli • Staphylococcus saprophyticus • Proteus - foley/ catheters • Klebsiella - foley/ catheters • Serratia - foley/ catheters • Pseudomonas -foley/ catheters - Insurance isn't going to pay for the uti if it's any of those last 4 bc they know it's hospitals fault

Treatment of DVT r/t perfusion

• Anticoagulants • Thombin inhibitors • Thrombolytics- used to dissolve large clots with severe symptoms. • Direct and Catheter assisted thrombus removal •Vena Caval filters • Vein ligation

Complications of DVT: r/t perfusion

• Can cause Chronic Venous Insufficiency • Clot can break free and become embolism and travel to Lungs: -Pulmonary Embolism

Identify and explain diagnostic and laboratory tests associated with pneumonia

• Chest x-ray = draws areas that show infiltrate • Computed tomography = shows masses, more detailed then x-ray • Sputum gram stain = tells you what kind of infection ( gram +, gram - , rods, spirals ) • Sputum C&S • CBC = elevated WBC • Serology testing = to test for specific bacteria ( meningitis ) • Pulse oximetry • ABG = pneumonia increase co2, resp acidosis • Fiberoptic bronchoscopy = scope down trachia and into to see if there is occlusion - creatinine - most important to check for kidney failure - CT - pt will be placed on fluids. keep pt hydrated

what are the symptoms of pneumonia

• Cough • Excess mucus production • Dyspnea • Hemoptysis • Chest pain • Fever • Decreased appetite • Malaise • cyanosis

right sided heart failure R/T perfusion

• Edema in feet, legs, sacrum • Anorexia (lots of fluid in stomach, full) , nausea • RUQ pain (Liver engorgement) • JVD

left sided heart failure R/T perfusion

• Fatigue, activity intolerance •Dizziness, syncope, dyspnea • Short of Breath •No pulmonary edema • Possible S3 on auscultation: -Gallop

problems with perfusion

• Heart does not work well. Heart not filling or pumping well. • Fluid volume too high or too low. • Blood pressure too high or too low • Blood too thick or thin. • Hypercoagulable- Heredity, Cancer, dehydrated (when dehydrated, blood gets thicker) , surgery, immobility, blood stasis. • Pathways not clear. Narrowed, blocked

what is heart failure R/T perfusion

• Heart is unable to pump enough blood into circulation to meet the body's needs. • Occurs when heart is damaged or stressed • Problem may be with pumping or filling or both. • Heart is not able to contract and pump blood into the periphery or relax enough to fill properly as blood returns to heart. Often a combination.

Identify the signs and symptoms of gastroenteritis.

• Increased frequency of stooling • Increased water content in stool - Poop and pee, stool is water

Explain the pathophysiology of pneumonia

• Inflammation of the lung parenchyma • Infection is constantly a possibility • Lobar- entire lobe • Broncho- bronchi and bronchioles • Interstitial- interstitium (alveolar walls and connective tissue supporting the bronchial tree) • Miliary- throughout (numerous discrete inflammatory lesions)

Explain the pathophysiology of gastroenteritis

• Inflammation of the mucus membranes of the stomach and intestine (usually small bowel) • Bacterial- "Traveler's diarrhea" from e coli or Campylobacter "Dysentery" from Shigellosis • Viral- Rotaviruses -Norwalk virus Gastroenteritis

Pharmacologic Therapies: r/t perfusion

• Inhibit platelet aggregation • Aspirin • Clopidogrel (Plavix) • Cilostazol (Pletal) Vasodilator properties • Pentoxifylline (Trental) decreases viscosity.

Prevention of DVT/VTE r/t perfusion

• Low-molecular-weight heparins • Oral anticoagulation • Elevating foot of bed, knees slightly flexed • Early mobilization • Leg exercises • Intermittent pneumatic compression devices • Elastic stockings

Treatment of DV T cont. r/t perfusion

• Measures to reduce symptoms, inflammation • Warm moist compresses • Extremity rest • Anti-inflammatory agents • Bed rest- For large clots • Elevate legs • Antiembolism stockings, PCD • Return to activity • Encourage walking- when ordered. • Avoid prolonged sitting, standing • Avoid crossing legs • Avoid tight-fitting garments

Heparin Exercise r/t perfusion

• PTT- Partial Thromboplastin Time- 21(25)-35 seconds -Sometimes listed as aPTT -Therapeutic IV Heparin therapy : (1.5)2-2.5 times the normal limit of the PTT -Reversal is Protamine Sulfate IV. • Warfarin (Coumadin) Therapy monitored by the lab test associated with the Prothrombin time (PT) Best way of standardizing measurement of Prothrombin time to monitor oral anticoagulant therapy is by the INR -INR- International Normalized Ratio- Therapeutic level goal for most conditions is 2.0-3.0

Surgery for Arterial insufficiency: r/t perfusion

• Revascularization • Percutaneous transluminal angioplasty • Stent placement • Atherectomy • Endarterectomy • Bypass grafts

Explain individualized education to the patient with infection.

• Risk for social isolation • reassure that it's the pathogen, not the patient, requires precaution • Explain disease/transmission/treatment plan • Precautions in the home. • Wear gloves when changing dressing • Wash soiled clothing with disinfectant/bleach • Complete entire course of antimicrobial drug therapy- don't just stop when feeling better • When to call the healthcare practitioner- if they're not feeling better in 48-72 hr, those antibiotics should be kicking in. common side effect of antibiotics - N/V, diarrhea, can be hard on the stomach so eat with food unless said otherwise • ATB's- Use alt form of Birth control if on oral contraceptive 9/14/2018 11

Diagnostic tests for Peripheral Vascular Disease: r/t perfusion

• Segmental pressure measurements • Stress testing • Doppler ultrasound • Transcutaneous oximetry evaluates oxygenation of tissues • Angiography or Magnetic resonance angiography. • Ankle Brachial Index (ABI). How do you obtain this? • Ankle SBP/brachial SBP- Use a doppler • - normal >1.0. <0.9 = PAD • Brachial SBP = 150, Ankle SBP = 110, What can you tell me about this patients Peripheral Circulation? ABI= ?

whats our first line of defense for the immunity system

our skin and mucous membrane

Normal function of optimal perfusion

• Strong Heart to pump to entire body • All pathways clear without obstruction • Good arterial flow, no blockages. • Good vein function/valves to return blood back to heart • Blood viscosity optimal for flowing through vascular system. • Red blood cells to carry oxygen and nutrients • Optimal blood pressure- A MAP of 60 is necessary to perfuse coronary arteries, Brain, and kidneys. • Optimal hydration • if the blood is too thick than it will be harder to pump

classifications R/T perfusion

• Systolic ( ventricles don't contract, decreased output) versus diastolic ( heart doesn't relax and can't adequately fill, reload affected) failure (may have both) • Left-sided ( normal demand) versus right-sided (increase demand) failure (may have both) • Low-output versus high-output failure • Acute versus chronic failure • Pulmonary edema ( Cardiogenic) <-- results from left ventricle, decrease contractility and decreased ejection fraction

Pharmacologic therapy r/t perfusion

•Angiotensin-converting enzyme (ACE) inhibitors (prils) [prevention/decrease vasconstriction] •Angiotensin II receptor blockers (ARBs) Sartan [prevention/decrease vasconstriction] •Beta-blockers (olol) [inhibit SNS, decrease heart rate •Diuretics •Aldosterone Antagonist ( decrease BP) •Vasodilators •Digitalis •Antidysrhythmics ( for dysrhythmics) •Phosphodiesterase Inhibitors •B-Type Natriuretic Peptide

Monitoring Fluid Volume r/t perfusion

•Assess respiratory status •Monitor intake and output •Record abdominal girth •Measure hemodynamic parameters •Restrict fluids/ sodium •Weight gain is the number one best indicator of fluid volume excess

PAD pharmacology r/t perfusion

•Coagulation Modifier Drugs: -Anticoagulants, Antiplatelet, thrombolytic, Meds to reduce blood viscosity

peripheral Arterial Disease r/t perfusion: Risk factors for Arterial insufficiency

•Diabetes mellitus •Hypercholesterolemia• Hypertension •Cigarette smoking •High homocystine levels •Family history -obesity -sedentary lifestyle

Clinical Manifestations and Complications R/T perfusion

•Nocturia •Paroxysmal Nocturnal Dyspnea •Cardiogenic Pulmonary Edema •Hepatomegaly, splenomegaly (right side) •Impaired liver function •Dysrhythmias •Acute pulmonary edema •Renal Insufficiency (kidney not perfused) •Pleural Effusion (left side heart failure)

Peripheral Vascular Disease r/t perfusion

•PVD's are conditions affecting peripheral arteries and veins: -Peripheral Arterial Disease/Peripheral Atherosclerotic Disease (PAD) -chronic venous insufficiency (CVI)

Three Treatment Stages of Stroke r/t perfusion: 3. Rehabilitation

•Physical therapy •Occupation -speech therapy

Three Treatment Stages of Stroke r/t perfusion: 2.Acute care

•Rapid recognition and reaction to warning •Rapid emergency medical services dispatch •Rapid EMS transport and prenotification •Rapid diagnosis and treatment •Mechanical thrombectomy for pt with large vessel occlusion(LVO) •Within 6 hrs of stroke onset

Three Treatment Stages of Stroke r/t perfusion: 1. Prevention

•Screen for Modifiable Risk Factors •Lifestyle Modification

PAD management r/t perfusion

•Slow Athero/arteriosclerosis-Risk factor modification: -DM, HTN, Hyperlipidemia, smoking cessation, weight management. •Maintain Tissue Perfusion-Pharmacology, surgically, stents •Exercise program to improve collateral circulation •Position extremities to improve circulation: -Using Gravity, how should you position the legs/feet to improve arterial blood flow? -dependent= means down, below heart

Arteriosclerosis/ Atherosclerosis R/T perfusion

•These pathologic changes impair perfusion to the peripheral tissues. • Often referred to as "Hardening of the arteries" • Unable to expand/dilate to provide more oxygenated blood to muscles/tissues when needed. • Causes ischemia and often pain

chronic Venous Insufficiency CVI r/t perfusion: Risk factors for Venous insufficiency

•Thrombophlebitis •Obesity•prolonged standing or sitting. •Right sided Heart failure •Deep Vein Thrombosis

chronic Venous Insufficiency CVI r/t perfusion: Pathophysiology

•Valves in Veins which help blood move back up toward heart become incompetent. •Venous blood stagnates. •Pressures increase and may impede arterial flow. •Cells die. Red cell breakdown causes brown pigmentation •Venous stasis ulcers develop

Deep Vein Thrombosis (DVT) AKA: Venous thromboembolism (VTE) r/t perfusion

•Virchow's Triad- Etiology of DVT's •Stasis of blood •Vessel Damage •Increased blood coagulability

IgM antibodies

produced 48-72 hrs. after an antigen enters the body-responsible for primary immunity ( ex: produces antibodies activity against ABO blood group)

IgG antibodies

responsible for antiviral and antibacterial activity. This response is longer and stronger than other immunoglobulins.

risk factors of gerd

- Obesity - Excessive alcohol consumption - Smoking - -Hiatal hernia - -Pregnancy

pharam. therapy for gerd ( proton pump inhibitors: PPIs)

- Omeprazole (Prilosec) - Lansoprazole (Prevacid) - -Reduce gastric secretions, promote healing, relieve symptoms - -Relapse common after discontinuing - -Increase risk of hip fractures

Identify the signs and symptoms of pneumonia

- cough - excess mucous production (not every pneumonia has mucous production - dyspnea- (SOB on exertion ) - hemoptysis ( blood sputum which often means chronic ) - chest pain ( from coughing ) - fever - decrease appetite - matalise ( general weakness ) - cyanosis

signs of right sided heart failure R/T perfusion

- fatigue -ascites -enlarged liver and spleen -may be secondary to chronic pulmonary problems -DJV -anorexia and complaints of GI distress - weight gain -dependent edema (a term that doctors use to describe gravity-related swelling in the lower body)

what do you typically see in a patient with infection

- fever - increase WBC - increase metabolism - increase HR - increase RR - swelling - inflammation

Causes of Heart Failure R/T perfusion-- increased cardiac workload

- hypertension -valve disorders -anemias -congenital heart disease

** clinical manifestations of acute postinfectious glomerulonephritis

- presents in the pharnex: strep throat if antibiotic process isn't completed becomes superbug then becomes resistant and goes back into the cells after floating around in body OR goes to skin -Abrupt onset Hematuria, proteinuria, salt and water retention, azotemia 10-14 days after initial infection -Urine often brown or cola colored - Salt, water retention → hypertension, edema sitting in third spacing ( facial, hands, feet, periorbital ) -Fatigue, anorexia, nausea and vomiting, headache

PUD may be chronic with

- remissions and exacerbations -Exacerbations associated with Trauma Infection Other stressors -H. pylori often occurs in several members of a family Especially when water supply contaminated -Diet not a major factor -Caffeine, alcohol consumption may exacerbate disease

what is arteriosclerosis R/T perfusion

- thickening, loss of elasticity and buildup of calcification on arterial walls.

what are the symptoms of infection

- warm - swelling - redness - increase wbc - fever - inflammation - painful

List and explain the actions and side effects of sulfonamides which are used for a patient with infection.

- work by binding and inhibiting a specific enzyme called dihydropteroate synthase (DHPS). This enzyme is critical for the synthesis of folate, an essential nutrient. Mammals get folate from their diet, but bacteria must synthesize this vitamin • Sulfamethoxazole-trimethoprim (Bactrim) side effects : • Photosensitivity resulting in a rash • Hypoglycemia

explain what type of antigen is type 4 hypersensitive reaction

-( Delayed) T cells are stimulated and release lymphokines ( A SUBSTANCE produced by lymphocytes by activating macrophages) causing inflammation and tissue damage. - Ex: may see fever, erythema (redness). Contact dermatitis, tuberculin skin test

Describe evidence based care related to nutrition.

-- Determine healthy body weight for age and height. Refer to dietitian for complete nutrition assessment if 10% under healthy body weight or if rapidly losing weight. Legal intervention may be necessary. - Early diagnosis and a holistic team treatment of eating disorders are desirable -- Compare usual food intake to USDA Food Pyramid, noting slighted or omitted food groups. -Milk consumption has decreased among children while intake of fruit juices and carbonated beverages has increased. -A higher incidence of bone fractures in teenage girls has been associated with a greater consumption of carbonated beverages -- If client is a vegetarian, evaluate if obtaining sufficient amounts of vitamin B12 and iron. -Strict vegetarians may be at particular risk for vitamin B12 and iron deficiencies. --Observe client's ability to eat (time involved, motor skills, visual acuity, ability to swallow various textures). -Poor vision was associated with lower protein and energy (calorie) intakes --Observe for situations that indicate a nutritional intake of more than body requirements. - Such observations help gain a clear picture of the client's dietary habits.

Describe evidence based care related to insomnia.

-- Educate the patient on the proper food and fluid intake such as avoiding heavy meals, alcohol, caffeine, or smoking before bedtime. - Coffee, tea, chocolate, and colas which contain caffeine stimulate the nervous system. This may interfere with the patient's ability to relax and fall asleep. --Encourage daytime physical activities but instruct the patient to avoid strenuous activities before bedtime. - In insomnia, stress may be reduced by therapeutic activities and may promote sleep. -- Encourage patient to take milk. -L-tryptophan is a component of milk which promotes sleep. -- Remind the patient to avoid taking a large amount of fluids before bedtime. - This will refrain the patient from going to the bathroom in between sleep.

Describe evidence based care related to activity intolerance

-- Establish guidelines and goals of activity with the patient and/or SO. - Motivation and cooperation are enhanced if the patient participates in goal setting. -- Evaluate the need for additional help at home. -Coordinated efforts are more meaningful and effective in assisting the patient in conserving energy. -- Dangle the legs from the bed side for 10 to 15 minutes. -Prevents orthostatic hypotension. -- Assist with ADLs while avoiding patient dependency. -Assisting the patient with ADLs allows conservation of energy. Carefully balance provision of assistance

Describe evidence based care related to impaired comfort.

-- Foresee the need for pain relief. -Preventing the pain is one thing that a patient experiencing it can consider. Early intervention may decrease the total amount of analgesic required. -- Acknowledge reports of pain immediately. - One's perception of time may become distorted during painful experiences. Pain can be aggravated with anxiety and fear especially when pain is delayed. --provide rest periods to promote relief, sleep, and relaxation. - One's experiences of pain may become exaggerated as a result of exhaustion. -- Nonopioids (acetaminophen), a nonselective NSAID, or a selective NSAID (e.g., cyclooxygenase [COX]-2 inhibitor) -NSAIDs work in peripheral tissues. Some block the synthesis of prostaglandins, which stimulate nociceptors.

Describe evidence based care related to deficient fluid volume

-- Urge the patient to drink prescribed amount of fluid. -Oral fluid replacement is indicated for mild fluid deficit and is a cost-effective method for replacement treatment. --If patient can tolerate oral fluids, give what oral fluids patient prefers. Provide fluid and straw at bedside within easy reach. Provide fresh water and a straw. -Most elderly patients may have reduced sense of thirst and may require continuing reminders to drink. -- Emphasize importance of oral hygiene. - Fluid deficit can cause a dry, sticky mouth. Attention to mouth care promotes interest in drinking and reduces discomfort of dry mucous membranes. --Plan daily activities. - Planning conserves patient's energy.

Describe evidence based care related to Hyperthermia.

-- monitor closely, close to body temp (what is their fever and make it a little bit less) • Shivering increases temp • Setting of Blanket- close to body temp (what is their fever and make it a little bit less) --Adjust and monitor environmental factors like room temperature and bed linens as indicated. -Room temperature may be accustomed to near normal body temperature and blankets and linens may be adjusted as indicated to regulate temperature of the patient. --Eliminate excess clothing and covers. -Exposing skin to room air decreases warmth and increases evaporative cooling. --Encourage ample fluid intake by mouth. -If the patient is dehydrated or diaphoretic, fluid loss contributes to fever. --Noninvasive: cooling mattress, cold packs applied to major blood vessels -These measures help promote cooling and lower core temperature.

lifespan considerations for older adults with gerd

-6-17% experience GERD - -Age-related physiologic changes, conditions, medications can predispose - - May be asymptomatic - -May have atypical symptoms - -Antacids may not be useful - -Lifestyle, dietary changes difficult to make - -PPIs, H2 -receptor blockers

Pathophysiology and Etiology of stroke: r/t perfusion

-A stroke causes decreased Blood flow and oxygen -To cerebral neurons -Cellular metabolism ceases -Cells swell -Dead/dying cells surrounded by penumbra -Neurologic deficits used to identify location -Contralateral deficit

Clinical manifestations of PUD

-Abdominal pain: classic symptoms Gnawing, burning, aching, hunger-like Epigastric region Relieved by eating May be accompanied by heartburn or regurgitation, vomiting Presentation in older adult often less clear - Complication of PUD may be presenting symptom Complications - -Hemorrhage -Gastric outlet obstruction - Perforation

pharmacologic therapy for gerd (antacids)

-Antacids for mild, moderate symptoms (reduces heartburn symptoms quickly) -Commonly used Antacids include: Aluminum salts and/or Magnesium salts Calcium salts ▪ Sodium bicarbonate Alginates - Gaviscon

what is Type V of the 5 antibodies of hypersensitivity reactions

-Antibodies are produced with the property of stimulating specific cell targets. Ex: Graves Disease caused by antibodies that stimulate the thyroid-stimulating hormone, leading to over activity of the thyroid gland. -This is B cell mediated-Is your military intelligence. They seek out target and tag them. They then spray the bad guys tagging them with antibodies. B cells are produced in the bone marrow. They migrate to the spleen and other secondary lymphoid tissues where they mature. -T cells kills antigens that was sprayed by B cells (identified) -T cells -located in the bone marrow, like red and white blood cells, however T cells comes from the organ where they mature-which is the Thymus gland. T cells are your soldiers- they destroys the invaders

how to manage pain for pt with pud

-Assess pain ▪ Location, type, severity, frequency, duration - -Administer PPIs, other medications -Teach relaxation, stress reduction, lifestyle management techniques - -Avoid making assumptions about pain ▪ -Acute pain may indicate a complication or be unrelated to PUD

nursing process for hypersensitivity

-Assessment: Health Hx (Risk factors, hypersensitivities ( medication, bee sting), Physical Assessment (Mucous membrane of nose, mouth, skin for lesions, rashes, eyes ( tearing and redness), respiratory rate, adventitious breath sounds) -Diagnosis: Ineffective Airway Clearance, Decreased Cardiac Output (Airway, Breathing and circulation (ABC) are most important. With pt. in anaphylactic reaction) -Planning: Prevention of hypersensitivity reaction. (prevention through : data collection to help the client avoid exposure to known allergens) -Implementation-based on individual needs & nsg dx -Maintain a patent airway, Adm oxygen, insert an airway ( nasopharyngeal, oropharyngeal), provide reassurance to pt. -Monitor Cardiac status-( peripheral vasodilation and increase capillary permeability, resulting from the release of histamine can i impair cardia output) may indicate Shock-fall in BP, tachycardia, tachypnea, decreasing pulse pressure, insert large bore IV, Assess skin color, -Monitor LOC, ADM warmed IV fluids- warmed to prevent hypothermia from rapid administration of large amounts of fluids at room temp, insert Foley, -Once breathing is established, place client flat with legs elevated-enhance perfusion of central organs, such as the brain, heart and kidneys/ -Education on Using an EPIPEN, if client has had a severe reaction in the past -Encourage client to wear a medical alert bracelet) -Evaluation- Evaluated based on client progress in meeting goals. -Client will exhibit decrease symptoms and decreased frequency of hypersensitivity responses -Client will demonstrate proper techniques when using EPIPEN -Impaired Spontaneous Ventilation -Risk for Shock -Planning -Goals of Planning: Client will describe self care to reduce symptoms of seasonal allergies -Client will describe proper self administration of medications prescribed by the physician.

lifespan considerations for older adults with PUD

-Associated with NSAID use • -Co-therapy with NSAIDs lower risk of PUD - High-dose H2 -receptor antagonist (H2RA)

clinical manifestations of acute glomerulonephritis

-Asymptomatic or abrupt onset Flank or mid abdominal pain Irritability, malaise, fever -Microscopic hematuria in nearly all cases -Gross hematuria in up to 50% -Mild periorbital edema, dependent edema -Edema may progress to pleural effusion -Acute hypertension → encephalopathy -Oliguria may or may not be present

diagnostic tests for gerd

-Barium swallow - evaluates the esophagus, stomach and upper small intestine -Upper endoscopy - direct visualization of the esophagus, ability to biopsy tissue to rule out malignancy -Bernstein test - saline & dilute acid solutions instilled into the esophagus; in patients with GERD, the acid solutions produce S&S of heartburn and the saline does not; in patients who do not have GERD, neither solution produces any S&S -24-hour ambulatory pH monitoring - tube with pH electrode passed through the nose into the esophagus, collects data -Esophageal manometry - measures the pressure of the esophageal sphincter and esophageal peristalsis

nonpharmacologic therapy for nephritis

-Bedrest during acute phase -Fluid requirements determined by monitoring urinary output, weight, BP, serum electrolytes -Sodium may be restricted -Dietary protein may be restricted: tissue repair, healing, complete proteins ( meats, fish, eggs, chic peas) incomplete proteins (rice, cereal, bread, grains) -Plasmapheresis in conjunction with immunosuppressive therapy -Turn them every 2 hrs

Assessment: r/t perfusion

-Biggest Tool in any Health Professional Tool shed • Neurovascular Assessment!!! Compare Sides- R/L • Swelling • Pulses and quality • Sensation: numbness tingling pins and needles, pain, tenderness • Capillary refill • Temperature • Pallor, cyanosis

Chronic Venous Insufficiency CVI -Manifestation

-Bilateral lower extremity Edema-May be significant -Itching, dull leg pain increases with standing -Thin shiny atrophic skin -Cyanosis and brown skin pigmentation of lower leg and foot -Possible weeping dermatitis -Thick, fibrous (hard) SC tissue -Recurrent ulcerations of medial or anterior ankle -Ulcers are pink, superficial and often moist and wheeping. - normal temp -pulses normal - no gangrene

risk factors of PUD

-Chronic H. pylori infection -Chronic use of NSAIDs Aspirin is most ulcerogenic NSAID -Cigarette smoking -Advanced age -Low socioeconomic status -Crowded, unsanitary living conditions -Family history -Concurrent use of other drugs

Peptic Ulcer Disease (PUD)

-Chronic irritation, burning pain, and erosion of the mucosa to form an ulcer - can be caused by bacteria (Helicobacter pylori: Found in 70% of individuals with PUD, Oral-oral, fecal-oral spread, Contributes to ulcer formation) -often from NSAIDS

POSTOPERATIVE PATIENT TEACHING for gerd

-Clear liquid diet for 24 hours after the procedure (advanced gradually) • -After the first day, soft diet such as custard, pureed vegetables, mashed potatoes and applesauce • -Avoid NSAIDS and aspirin for 10 days • -Continue drug therapy as prescribed, usually a proton pump inhibitor and use liquid meds if possible • -No NG tube for at least 1 month • -Contact physician if the following occurs: chest or abdominal pain, bleeding, dysphagia, SOB, nausea or vomiting • -Prevent respiratory complications - IS (Incentive Spirometer), CDB (coughing & deep breathing)

Pharmacologic therapy for PUD

-Combination therapies to eradicate H. pylori - Two antibiotics + proton pump inhibitor (PPI) PPI with bismuth and two antibiotics -NSAID-induced ulcers - Discontinue NSAID if possible - If not possible, twice daily dosing with PPIs, histamine receptor antagonists, or sucralfate -Medications that decrease gastric acid - PPIs - H2 -receptor antagonists -Mucosal protectors - Sucralfate - Bismuth compounds - Antacids - Prostaglandin analogs

other complications r/t perfusion

-Communication disorders -Result of stroke affecting dominant hemisphere -Aphasia -Expressive -Receptive -Mixed or global -DysarthriaElimination Disorders -Partial loss of sensations that trigger elimination -Motor deficits -Mild weakness to severe limitation -Weakness, paralysis, spasticity -Specific deficits -Hemiplegia -Hemipares

observation and patient interview for pt with PUD

-Complaints of epigastric or left upper quadrant (LUQ) pain - -Heartburn - -Measures used for relief - -Nausea, vomiting - -Bright blood or "coffee grounds" in vomitus - -Medications, including NSAIDs - -Cigarette smoking, alcohol or drug use

Evaluation-Teach Back r/t perfusion

-Describes medications, purpose, side effects -Describes symptoms to report -explains importance of daily weights. -states what weight to call the doctor for. -Chooses appropriate low-sodium foods -States how they will modify routine for adequate rest period

nonpharmacologic therapy for gallbladder disease

-During acute attack Food intake may be eliminated Nasogastric (NG) tube relieves nausea and vomiting -Dietary fat intake may be limited -If bile flow is obstructed, administer fat soluble vitamins and bile salts

prevention for gerd

-Eat smaller, more frequent meals • -Avoid foods that stimulate acid production - Avoid eating close to bedtime -Elevate the head of bed to help prevent pressure on the lower esophageal sphincter -Avoid tight-fitting clothing around abdomen -Avoid smoking, alcohol -Maintain near or ideal body weight

complications of cholecystitis

-Empyema -Gangrene, perforation → peritonitis or abscess formation -Formation of fistula into adjacent organ -Gallstone ileus -Dead gut/ bowl- medical emergency, wont hear bowl sounds, belly hard, distended, pain

what are the complications with gerd

-Esophageal strictures: narrowing of the esophageal opening May lead to difficulty swallowing May lead to dysphagia - Barrett esophagus: replacement of the squamous cell epithelium of the lower esophagus with new tissue that more resistant to acid but is considered premalignant. -Hemorrhage and aspiration pneumonia

Patient Teaching-Health Promotion r/t perfusion: Activity

-Exercise intolerance -Moderate, progressive activity program

evaluation for gerd

-Expected outcomes may include - Patient expresses freedom from heartburn - Patient is free from pain - Patient verbalizes knowledge of GERD, appropriate diet, lifestyle changes - Patient demonstrates ability to manage symptoms -If outcomes not met - -Change medication, consider surgery

observation and pt interview for nephritis

-Facial or peripheral edema or weight gain -Fatigue, nausea and vomiting -Headache, malaise -Diabetes, SLE, kidney disease -Medications

diagnostic tests of PUD

-Focus is on treating the cause - Eradicating H. pylori infection - Treating or preventing ulcers related to NSAID use • -Upper GI series • -Gastroscopy • -Biopsy specimens tested for H. pylori • -Noninvasive testing for H. pylori

surgery for gerd

-For patients unresponsive to pharmacologic, lifestyle interventions • -Laparoscopic fundoplication - The gastric fundus is wrapped around the distal esophagus, narrowing the diameter of the lower esophageal sphincter - Treatment of choice for GERD • -Nissen fundoplication (open procedure-NGT in place for a few days) • -Endoscopic suturing system • -Burning spots on muscle around sphincter • -Surgery/ablation therapy for patients at risk of esophageal cancer

Pharmacologic therapy for gallbladder disease

-For patients who refuse or are inappropriate for surgery -Ursodiol:Drug to dissolve gallstones Best for stones with high cholesterol content Costly, may take up to 2 years High incidence of recurrent stone formation -Antibiotics for infections -Narcotic analgesic for pain relief

physical exam of pts with pud

-General appearance - -Vital signs - -Abdominal examination ▪ Shape and contour ▪ Bowel sounds ▪ Tenderness to palpation - -Presence of obvious or occult blood in vomitus, stool

**what is Acute postinfectious glomerulonephritis (APIGN)

-Glomerular damage results from immune complex reaction -Glomerular membranes thicken -Obstruction of capillaries → decreased glomerular filtration rate (GFR) -Vascular permeability increases → excretion of protein, red blood cells, red cell casts -Retention of sodium and water → edema

planning for pt with nephritis

-Goals may include that patient will Maintain urine output of 30 ml/hr Demonstrate dietary intake that adequately meets nutritional, caloric needs Demonstrate no signs or symptoms of infection Demonstrate no alterations in skin integrity

planning for gerd

-Goals may include that patient will - Exhibit decreased discomfort - Work with nurse to develop a plan for managing symptoms of GERD - Modify lifestyle and eating habits to prevent symptoms, esophageal damage - Verbalize understanding of long-term consequences of GERD - Achieve, maintain healthy weight

Risk Factors r/t perfusion

-Heart disease -Diabetes mellitus -Sleep apnea -Blood cholesterol levels -Smoking -Sickle cell disease -Substance abuse -Living in stroke belt -southeastern U.S. -Family history -Obesity -Sedentary lifestyle -Recent infections -History of TIAs -Oral contraceptives -Pregnancy -Childbirth -Menopause -Migraines with aura -Autoimmune disorders -Clotting disorder

complaints associated with gerd

-Heartburn after meals, when bending over, when reclining - -Pain in swallowing, regurgitation of sour material into mouth, atypical chest pain, tooth enamel erosion

Anaphylaxis: Clinical manifestations

-Hypotension, Increase pulse, dysrhythmias, dyspnea, Stridor, wheezes, laryngospasm ( may feel like choking) , bronchospasm ( airway closing) , AMS ( altered mental status) - Urine output: oliguria to anuria, abdominal cramping Vomiting diarrhea -Ex: husband reaction to ACE inhibitors.

what is Type I of the 5 antibodies of hypersensitivity reactions

-IgE mediated. Anaphylaxis is most severe. Allergen (can be ingested in food, injected as drugs, inhaled through the air, or absorbed through skin) -Triggered when allergen interacts with free IgE, it interacts with IgE ( antibodies) causing IgE to bind to mast cells and basophils. This antigen-antibody complex prompts release of histamine and other chemical mediators. -Ex: ragweed, pollen, food allergies-gets into nose from air ( antigen)-is presented to cells and goes to blood stream and binds to IgE. Which will then cause histamine to be released causing vasodilation-shock and anaphylaxis. Type 1 examples: Asthma, Allergic rhinitis and Eczema

explain what type of antigen is type 3 hypersensitive reaction

-Immune Complexes are deposited in tissue, resulting in generalized inflammatory reaction. -Ex: May see Urticaria ( skin rash triggered by reaction to food, etc.), fever, joint pain

PAD-Manifestations r/t perfusion

-Intermittent claudication-Pain with activity that subsides with rest •Worsening PAD indicated by Rest pain•Paresthesias(numbness) •Weak progressing to possibly absent pulses •Pallor with extremity elevation, dependent rubor •Thin, shiny, hairless skin: thickened toenails •Areas of discoloration/skin breakdown •Skin cool •Edema absent or mild -gangrene may occur

Hemorrhagic stroke r/t perfusion

-Intracranial hemorrhage -Ruptured cerebral blood vessel -Form that is most fatal -Types= Intracerebral, Subarachnoid -Manifestations= "Worst headache of my life", Nausea & Vomiting

Stroke r/t perfusion

-Ischemic (Cerebral ischemia is a condition in which a blockage in an artery restricts the delivery of oxygen-rich blood to the brain, resulting in damage to brain tissue) or hemorrhagic --> bleeding -Neurologic deficits vary depending on part of brain not getting perfused -5th leading cause of death in North America -Survivors have some degree of impairment -Highest incidence in people > 65

penumbra r/t perfusion

-Ischemic but still viable cerebral tissue -This region will die if reperfusion is not established during the early hours -the penumbra is where pharmacologic interventions are most likely to be effective

surgery for gallbladder disease

-Laparoscopic cholecystectomy Treatment of choice Minimally invasive Low risk of complications Hospital stay of <24 hours Not all patients are candidates -Cholecystectomy with CBD exploration When stones lodged in ducts insert T- tube into common bile duct to help drain that bile and to maintain patency of duct, promote bile passage -Patients who are poor surgical risks Cholecystostomy to drain gallbladder Choledochostomy Remove stones Position T- tube in CBD -Shock wave lithotripsy To dissolve large gallstones Used with drug therapy -Percutaneous cholecystostomy Ultrasound- guided drainage of gallbladder Used for high risk patients

prevention of PUD

-Meticulous hand hygiene -Implementing all recommendations related to food preparation -Medication to reduce the occurrence of peptic ulcers added for patients using NSAIDs -All patients started on long-term therapy with nonselective NSAIDs should be tested for H. pylori

how would you Restore and maintain fluid balance for pt with pud

-Monitor stools, gastric drainage for blood - -Maintain IV therapy with fluid volume and electrolyte replacement solutions - -Insert nasogastric (NG) tube, maintain its position and patency - -Monitor hemoglobin and hematocrit, serum electrolytes, blood urea nitrogen (BUN), creatinine values - Assess abdomen every 4 hours - -Maintain bedrest, head of the bed elevated

right CVA symptoms r/t perfusion

-Motor deficits on left side -Left visual field deficit -Spatial perceptual deficits -Unilateral Spatial Neglect USN -Impulsiveness -Easily distracted -Denial or unawareness of deficits -Poor judgment, overestimation

left CVA symptoms r/t perfusion

-Motor deficits on right side -Right visual field deficits -Language deficits -aphasia, agraphia or alexia -Slow & cautious behavior style -Anxiety before new skills attempt -Frustration , anger, depression, worrisome -Sense of guilt or worthlessness

Discharge Teaching for gerd

-No Straws • -Normal diet after 6 weeks of multiple, small meals • -Gradually explore tolerance to different foods • -Upright position when eating • -Avoid carbonated beverages and gas producing foods • -Excess air can be relieved by frequent position changes • -Avoid straining and prevent constipation • -Contact physician for fever above 101 degrees F, nausea, vomiting, or uncontrollable bloating or pain.

Non-pharmacologic therapy for PUD

-Nutrition - Balanced meals at regular intervals - Bland or restrictive diets no longer necessary Mild alcohol intake not harmful • -Smoking discouraged

assessment for gallbladder disease

-Observation and patient interview Current manifestations Duration of symptoms Risk factors or previous history Chronic diseases Diet Use of oral contraceptives or possibility of pregnancy

assessment or gerd

-Observation and patient interview - Health history - Manifestations such as heartburn, atypical chest pain, ability to tolerate various foods - Assess regurgitation, when symptoms increase, difficulty in swallowing • -Physical assessment - Abdominal distention, epigastric tenderness, bowel sounds - Mouth, throat, teeth, gums

what is active immunity

-Occurring Naturally when exposed to a pathogen. - an antigen is given in the form of a vaccine. -Example: pt. who recovers from a first case of the measles is immune to further infection. The immune system is stimulated to produce antibodies against a particular infectious agent. Develops as people is exposed to diseases or Immunized through vaccination.

Clinical Manifestations r/t perfusion

-One Sided -Depends on cerebral artery and brain affected -Weakness of face, arm, leg -Numbness of one side -Loss of vision -Speech difficulties -Sudden severe headache

lifespan consideration for older adults with nephritis

-Prevalence of acute interstitial nephritis increasing -Increased risk of chronic kidney disease, end-stage renal disease (ESRD) -Highest mortality risk if disease develops during hospitalization -May have fewer symptoms at outset -Pulmonary infiltrates may occur earlier Due to worsening of pre-existing condition

Patient Teaching-Health Promotion r/t perfusion: Medications

-Pulse -BP

what is chronic cholecystitis caused by

-Repeated bouts of acute cholecystitis -Persistent irritation of gallbladder wall by stones

what is passive immunity

-Results from the injection of antibodies or sensitized lymphocytes from another organism or infants from the transfer of antibodies through the placenta . -Can occur naturally from maternal antibodies transferred to fetus through the placenta. - is borrowed from another source, last for a short time. -when a person needs antibodies faster than the body can develop them, passive immunity is induced.. When this happens antibodies are produced in another human or animal host . Example: stepping on rusty nail-need immediate protection ( passive immunity) from tetanus, so Tetanus immunoglobulin is given. - Ex: Antibodies from mothers breast milk provide baby with protection from diseases a mother has been exposed to. This can protect the baby against infections during early years.

Complications r/t perfusion

-Sensory perceptual deficits -Hemianopsia -Agnosia -Apraxia -Ataxia -Neglect syndrome -Pain Cognitive and behavioral changes -Changes in consciousness -Emotional lability -Loss of self-control -Decreased tolerance for stress -intellectual change

Diagnostic tests for gallbladder disease

-Serum bilirubin -Complete blood count -Serum amylase and lipase -Abdominal x-ray, ultrasound of gallbladder -Oral cholecystogram= drink solution and a sonogram is done as pt is swallowing drinking to look at the the insides -Gallbladder scan

what is Type IV of the 5 antibodies of hypersensitivity reactions

-These are T-cell-mediated immune responses-not antibody-immediated and involve the T cells of the immune system. - Delayed not Immediate. It develops 24-48 hrs. after exposure to the antigen. Results from an exaggerated interaction between an antigen and normal cell mediated mechanisms , causing tissue damage at site of antigen contact, example Contact dermatitis ( intense redness, itching, edema, and thickening of skin. Ex; Antigens that can cause this reaction is poison ivy, latex allergy, also Hashimotos Disease- which is also called chronic lymphocytic thyroiditis causes hypothyroidism- under-active thyroid) -when the immune system attacks the butterfly-shaped gland in the neck ( thyroid), also Type I diabetes

diagnostic tests for nephritis

-Throat or skin cultures -Antistreptolysin O titer -Erythrocyte sedimentation rate -Kidney, ureter, bladder (KUB) abdominal x-ray -Kidney scan -Biopsy -Studies to evaluate kidney function Blood urea nitrogen (BUN) Serum creatinine Urine creatinine Creatinine clearance Serum electrolytes Urinalysis

Ischemic stroke: r/t perfusion

-Thrombotic stroke (blood clot and occlusion of large vessel by thrombus) -Embolic stroke (DVT, plaque from corotid, etc.) Blood clot or matter through cerebral vessels -CrytogenicStroke-1 in 3 ischemic strokes(unknown cause) -transient ischemic attach (TIA) Mini-stroke

for Gerd (Gastroesophageal Reflux Disease), what may the reflux result from

-Transient relaxation of lower esophageal sphincter (LES) -Incompetent lower esophageal sphincter - -Increased pressure within stomach • Contributing factors: Increased gastric volume - Certain body positions Pressure from obesity or tight clothing

pharmacologic therapy for nephritis

-Treat underlying disorders, reduce inflammation, manage symptoms -Use of diretics + fluids to hydrate, flush out kidneys, LOW dose -Risk with kidney disease is high BP: so for IV in hypertensive crisis, use diazide or hydralzine -Sodium restriction and diuretic to treat edema and mild hypertension -Antibiotics for acute postinfectious glomerulonephritis Avoid nephrotoxic antibiotics -Aggressive immunosuppressive therapy for acute inflammatory processes -Angiotensin-converting enzyme (ACE) inhibitors or angiotensin receptor blockers (ARBs) to reduce protein loss associated with nephrotic syndrome Reduce the protein and progression of renal failure -Antihypertensives to maintain blood pressure within normal levels Systemic, renal hypertension associated with poorer prognosis

collaboration for gallbladder disease

-Treatment depends on: Acuity of condition Patient's overall health status -Conservative treatment if Gallstones present but asymptomatic Low risk of complications -Surgery indicated: Frequent symptoms Acute cholecystitis or very large stones

whats happening with type 2 reactions for hypersensitivity

-Type II (Cytotoxic) hypersensitivity -IgG or IgM-type antibodies attach to a cell-bound antigen -Leading to tissue damage -looks like fever or dyspnea

Hypersensitivity

-abnormal or pathologic immune reaction that is caused by an immune response to repeated exposure to an antigen. - these reactions are a group of conditions in which the immune system, which normally serves a protective role, has a harmful effect. -Both allergies and many autoimmune disorders fall under the umbrella of hypersensitivity reactions, the difference being that allergies involve an immune reaction to common substances in the environment, whereas autoimmune diseases involve a direct immune reaction to tissues within the body.

what is afterload R/T perfusion

-after heart has filled -resistance as blood gets pumped out -increased with vasocontraction -decreased with dilation

Obstruction of ducts may cause what and and where

-biliary colic: also known as a gallbladder attack or gallstone attack, is when a colic (sudden pain) occurs due to a gallstone temporarily blocking the cystic duct;severe, steady pain -In epigastric region or right upper quadrant (RUQ) -May radiate to back, right scapula, or shoulder

Causes of Heart Failure R/T perfusion-- impaired myocardial function:

-coronary heart disease - cardiomyopathies - rheumatic fever - infective endocarditis

anaphylaxis Medications may include

-corticosteroids beta agonist to treat histamine induced bronchospasms. Remove the antigen if possible -Stop!!! -Sodium Bicarbonate to treat acidotic state. -Treat Bronchospasm with Bronchodilators, ( atrovent) steroids. -Calcium to replace calcium lost as a result of blood transfusions. Ex: Metabolic alkalosis can occur with massive blood transfusions due to breakdown of citrate stored in blood into bicarbonate or occurring due to the complex of citrate with serum calcium. This results in large amounts of Calcium been lost. -Antidysrythmatic agents to stabilize heart rhythm -Broad spectrum ABX to suppress organisms responsible for sepsis -A cardiotonic glycoside (e.g. digitalis) to treat cardiac failure -Antihistamine for angioedema-coticosteriod such as Prednisone. -Antihistamines work by blocking the effects of histamine.

contractility R/T perfusion

-how capable is the heart of contracting

CVI -Management: r/t perfusion

-how do you assist venous flow back to the heart? •Elevation of the legs frequently during day and above heart level at night: -Avoid sitting or standing for long periods. -Avoid tight fitting garments. (Death by Skinny jeans) •Relieving symptoms, promoting adequate circulation and prevent tissue damage. DON'T CROSS YOUR LEGS. •Reduce edema. Diuretics sometimes utilized. •Treat ulcers. -wet soaks, 4x a day. Or vein ligation, ulcer excision and then skin graft. •Hosiery/teds/ leg wraps-tighter at foot than calf

what is the preload R/T perfusion

-how much stretch the heart has -the more stretch, the more fill -before the heart contracts

what triggers the immune system

-impaired skin integrity -ex, burns and traumatic injury, skin and allergic disorders

What is acute cholecystitis? symptoms?

-inflammation of the gallbladder that develops over hours, usually because a gallstone obstructs the cystic duct. -Symptoms include right upper quadrant pain and tenderness, sometimes accompanied by fever, chills, nausea, vomiting, anorexia

List and explain the actions and side effects of monobactams which are used for a patient with infection.

-inhibits synthesis of the bacterial cell wall, by blocking peptidoglycan crosslinking -effective only against aerobic Gram-negative bacteria • Macrolides -Erythromycin, Azithromycin -increases the potential toxicity of Theophylline and Warfarin • Ketolides -Telithromycin -Associated with Liver damage • Tetracyclines -Doxycycline, Tetracycline, Tigecycline -Decreased absorption with milk, antacids and iron salts -Side effect = photosensitivity • Quinolones -Ciprofloxacin, Levofloxacin -Side effects include Q-T interval prolongation, seizures, and peripheral neuropathy -Decreased absorption with antacids, Ca, Mg, Fe, Zn and Sucralfate, dairy products

what is Type III of the 5 antibodies of hypersensitivity reactions

-involves Immune Complex mediated.: example serum sickness ( foreign serum such as horse antitetanus toxin - no longer used, but can get this in response to some drugs such as penicillin and sulfonamides) may produce fever , urticarial ( skin rash ) -These immune complexes can accumulate in the glomerular basement membrane of the kidneys following a bout with streptococcal infection or systemic lupus- developing glomerulonephritis/nephritis ( injured part of the kidneys that filters blood). ). -Type III can damage kidneys after bout with strep.

Post streptococcal glomerulonephritis (GN):

-is a disorder of the kidneys that occurs after infection with certain strains of streptococcus bacteria. -The infection does not occur in the kidneys, but in a different part of the body, such as the skin or throat. -The strep bacterial infection causes the tiny blood vessels in the filtering units of the kidneys (glomeruli) to become inflamed. This makes the kidneys less able to filter the urine -The disorder may develop 1 to 2 weeks after an untreated throat infection, or 3 to 4 weeks after a skin infection.

what is Type II of the 5 antibodies of hypersensitivity reactions

-is tissue specific reactions, Blood Transfusion reaction. -When the antibodies IgG or IgM form to a cell-bound Antigen such as ABO or RH antigen-this activation results in destruction of the target cell. Ex: RH - mother gets Rhogram to prevent Immune System from reacting to your baby blood. Prevents mother from making antibodies during her pregnancy.. It protects the fetus from its mothers antibodies. Given at 2 8 weeks in RH- mothers. -Used to prevent an immune response if baby is RH+- also given after delivery. -Ex: Hashimoto thyroiditis ( immune system attacks the thyroid) , Goodpasture syndrome( an autoimmune disorder when the immune system mistakenly attacks and destroys healthy body tissue)

Plasmapheresis

-is used to treat a variety of disorders, including those of the immune system, such as Good pasture's syndrome, Gillian-Barré syndrome, lupus -similar to dialysis; however, it removes the plasma portion of the blood where the antibodies are located. Plasma is the almost clear part of the blood which carries red cells, white cells, platelets and other substances through your bloodstream. ... -blood is filtered, the red blood cells given back, and plasma is removed in sick patients to remove the auto-antibodies causing illness and sometimes death, and being replaced by fresh frozen plasma infusions.

signs of left sided heart failure R/T perfusion

-paroxysmal nocturnal dyspnea (refers to attacks of severe shortness of breath and coughing that generally occur at night. It usually awakens the person from sleep, and may be quite frightening) - elevated pulmonary capillary wedge pressure (provides an indirect estimate of left atrial pressure (LAP). Although left ventricular pressure can be directly measured by placing a catheter within the left ventricle, it is not feasible to advance this catheter back into the left atrium.) -pulmonary congestion ( cough, crackles, wheezes, blood-tinged sputum, tachypnea) -restlessness -confusion -orthopnea -exertional dyspnea - fatigue -cyanosis

what types of symptoms you'll see with type 1 reactions for hypersensitivity

-pruritus, edema, rash, rhinitis, bronchospasm, and abdominal cramping, -Clinical symptoms: Redness Itching Mucus production Bronchial constriction

Patient Teaching-Health Promotion r/t perfusion: Nutrition

-sodium-restricted diet -Small frequent meals for energy conservation -Fluid restriction

explain what type of antigen is type 1 hypersensitive reaction

-the antigen is environmental, the response is called an allergy response , - Antibodies bind to cells- causing release of chemical that produces Inflammation : Tissue respond (ex: runny nose ,itchy eyes, allergic asthma, hay fever, anaphylactic shock or more severe and life threatening such as blood cell hemolysis = person's immune system destroys their RBC or laryngospasm= spasm of vocal cords) -Anaphylaxis & transfusion reactions are immediate hypersensitivity reactions -Contact Dermatitis is a Delayed response

PUD ulcers may affect

-the esophagus, stomach, or duodenum Superficial or deep Duodenal ulcers most common: -Usually in proximal portion of duodenum, near pylorus -Sharply demarcated -Usually <1 cm in diameter Gastric ulcers: -Found on lesser curvature and area immediately proximal to pylorus -Increased incidence of stomach cancer

Clinical manifestations choleLITHIASIS

-type of gallstone -Pain -Abrupt onset -Severe, steady -Localized to epigastrium and RUQ -May radiate to back, right scapula, shoulder -Lasts 30 minutes to 5 hours -Associated symptoms Nausea Vomiting

clinical manifestations of choleCYSTITIS

-type of gallstone -Pain -Abrupt onset, severe, steady, lasts 12-18 hours -Generalized in RUQ; may radiate to back, right scapula, shoulder -Aggravated by movement, breathing -Associated symptoms: Anorexia, nausea, vomiting RUQ tenderness and guarding Chills and fever

Causes of Heart Failure R/T perfusion-- acute noncardiac conditions

-volume overload -hyperthyroidism -fever, infection -massive pulmonary embolus

Identify the signs and symptoms of influenza

1. Coryza - red watery eyes 2. Cough 3. Substernal burning 4. Sore throat 5. Fever and chills 6. Muscle aches 7. Malaise 8. Fatigue

Glomerulonephritis S+S may include:

Acute: puffiness of your face in the morning, blood in your urine (or brown urine), urinating less than usual. Chronic: Blood or protein in the urine (hematuria, proteinuria), High blood pressure, Very bubbly or foamy urine, Swelling of your ankles or face (edema), Frequent nighttime urination

non-modifiable risk factors for gallbladder disease

Age= 30-40 Gender Ethnicity

What type of hypersensitivity reaction is allergic rhinitis? A. Type I B. Type II C. Type III D. Type IV

Allergic rhinitis- hay fever; type 1

Autoimmune disorders

the IS loses ability to recognize its own tissue and begins to attack them!

The response to the immune system may be Nonspecific:

this response prevents or limit the entry of invaders into the body. Not related to a particular cause. This response limits the extent of tissue damage and reduce the workload of the IS. Example : Inflammation

What type of hypersensitivity reaction are hemolytic transfusion reactions (Rh & ABO incompatibility)? A. Type I B. Type II C. Type III D Type IV

type 3

treatment for Post streptococcal GN :

Antibiotics, such as penicillin, will likely be used to destroy any streptococcal bacteria that remain in the body.

physical exam of pt with nephritis

Appearance, edema, lesions Vital signs, weight Urine specimen

promote balanced nutrition for pt with gallbladder disease

Assess nutritional status Diet history Height, weight, skinfold measurements Evaluate laboratory results Refer to dietitian, nutritionist for diet counseling Help patient learn to manage dietary restrictions Administer vitamin supplements as ordered

Diagnostic Testing R/T perfusion

B-type natriuretic peptide •Serum electrolytes (Na + K+) •Urinalysis, BUN, serum creatinine •Liver function tests (AST + ALT •Thyroid function tests• ABGs •CXR •ECG •Echocardiogram

implementation for pt with nephritis

Bedrest during acute phase Monitor fluid status Prevent infection Prevent skin breakdown Meet nutritional needs Provide emotional support to patient, family Prevent infection Protect skin integrity Promote nutritional balance Document urine specific gravity Maintain fluid restriction as ordered Frequent mouth care Carefully monitor and regulate IV infusions Prevent unnecessary fatigue Promote health self-esteem

What kind of education can you implement:

Can educate about modifiable risk factors ( such as Nutrition as it relates to food allergies, lactose intolerance, peanut, eggs) and encouraging routine vaccination

Immune responses serve what function?

Defense, Hemostasis-balance, and Surveillance

goals for gallbladder disease

Demonstrate no signs or symptoms of infection Report adequate pain control Demonstrate understanding of low fat diet with adequate intake of fat- soluble vitamins Verbalize awareness of symptoms to report immediately to healthcare provider

risk factors of nephritis

Diabetes mellitus and/or hypertension Prematurity, trauma, familial history Other diseases that damage kidney

what effective pain management provided for pt with gallbladder disease

Discuss relationship between fat intake and pain Teach ways to reduce fat intake Withhold oral food, fluids during acute pain Insert NG tube if ordered Administer narcotic analgesia for severe pain Place patient in Fowler position

care of t-tube for pt with gallbladder disease

Ensure it is properly connected to sterile container Monitor drainage, record as output Place patient in Fowler position Assess skin for bile leakage Teach patient how to manage tube when turning, ambulating, performing activities of daily living (ADLs) Teach patient care of T- tube as needed

evaluation for pt with nephritis

Expected outcomes may include Patient maintains or regains normal urine output Patient develops no areas of redness, abrasions, skin breakdown over pressure points Patient's temperature remains within normal limits Patient is free of secondary infection Patient maintains pre-illness weight, tolerates daily intake to meet nutritional requirements Patient takes medications as prescribed Patient's sodium and potassium levels reflect adherence to dietary restrictions If progress is unsatisfactory Thorough nursing assessment Further diagnostics may be needed

What does this look like ( Type IV):

Fever, erythema, and itching: such as Contact Dermatitis, TB skin test.

ANAPHYLAXIS INTERVENTION

First assess respiratory function; Oxygen CPR may be needed. Epinephrine (1:1000) 0.3 to 0.5 mL IV or SC. Antihistamines treat angioedema and urticaria. Treat bronchospasm. IV fluids. Monitor VS (BP/Resp)

for gallstones: what's the formation, the diet, where do most form. what do you avoid, migration where and what's it called when they get to where they're migrating to

Formation: maintain appropriate weight Diet high in fiber and low in fat Avoid rapid weight loss Most form in gallbladder (aids in digestion) Migration into ducts → cholangitis (A serious infection of the liver's bile ducts.)

Patient Teaching-Health Promotion r/t perfusion: Weight Monitoring

Functioning scale•2-3 lbs in a day, 5 lbs in a week

Patient Teaching-Health Promotion r/t perfusion: Reduction of Risk factor

HTN, High Cholesterol, diabetes management, sedentary, smoking

whats happening with type 1 reactions for hypersensitivity

Histamine receptors are causing contraction of smooth muscles of the airway and GI tract. In which you will have increase in capillary permeability ( the capacity of a blood vessel wall to allow for the flow of small molecules ( drugs, nutrients, water, ions ) in and out of the vessel causing dilation of vessels. -You may see this reaction in Asthma, allergic rhinitis ( hay fever) and food allergies

immune responses serve what function? ( Select all that apply) Defense Homeostasis Modification Surveillance

Homeostasis- stable equilibrium

This is an Overreaction of the IS to an antigen

Hypersensitivity. This is an excessive reaction to an antigen.

type 4 interventions

Immunotherapy/Desensitization (does not reduce the response. Corticosteroids and Anti-inflammatory agents can reduce discomfort.) Epinephrine Corticosteroids and Anti-inflammatory agents can reduce discomfort. Histamine blockers: Benadryl of minimal benefit because Histamine is not the main mediator however, can help with sleep and itching.

peripheral Arterial Disease r/t perfusion: -PAD) lesions obstruct vessel lumen

Inadequate to meet tissue needs Manifestations occur when vessel ≥ 60% occluded Arterial Ulcers may develop-Distally Collateral circulation develops

Explain the pathophysiology of influenza

Is a highly contagious, viral respiratory disease attacks your respiratory system — your nose, throat and lungs. -referred to as "the flu" -It is droplet -it's not the same as stomach "flu" viruses that cause diarrhea and vomiting.

Identify the signs and symptoms of urinary tract infection

LOWER: - Strong smelling urine - Frequence - Urgency - Hematuria - Pubic pain UPPER: - High fever - Abd flank pain - Chills - Dehydration - N/V

care for postoperative patient with gallbladder disease

Monitor vital signs every 4 hours Assist with coughing, deep breathing, incentive spirometry neuro assessment Look at dressing Place in Fowler position, encourage ambulation Administer antibiotics as ordered Look at I&O

pathophysiology of PUD

Mucosal barrier: thin coat of mucous gel and bicarbonate Protects gastric mucosa When cannot protect mucosa from damage by gastric digestive juices → ulcer

modifiable risk factors for gallbladder disease

Obesity= still prevelant health problem Medications Diet Rapid weight loss Dyslipidemia

Five signs of inflammation:

Pain Swelling Redness Heat loss of function

expected outcomes for pt with gallbladder disease

Patient reports adequate pain control Patient demonstrates food choices Low in fat, high in fat soluble vitamins Patient's temperature within normal limits Patient displays no symptoms of infection If progress unsatisfactory Nurse completes thorough assessment IV fluid, pain meds may be needed Surgical consult may be necessary

IgA antibody

Purpose is to protect mucous membrane from invading organisms ( viruses, certain bacteria-Escherichia coli)

Identify the signs and symptoms of cellulitis

Related to specific system: 1. Inflammation 2. Pain 3. Warmth 4. Redness 5. Swelling General symptoms: 1. Fever, chills, swollen lymph nodes

TREATMENT OF TYPE II CYTOTOXIC REACTIONS

Remove offending drug or blood product. Plasmapheresis= method of removing blood plasma from the body by withdrawing blood, separating it into plasma and cells and transfusing the cells back into the bloodstream. Filtration of plasma to remove specific substances/autoantibodies. Treatment is symptomatic Complications can be life threatening Respiratory failure Renal failure Hemolytic crisis= causes severe anemia. It's a autoimmune reaction. If the recipient's immune system attacks the red blood cells of the donor, it is called a hemolytic reaction. You can have an allergic reaction to a blood transfusion as well. These symptoms can include hives and itching. . S+S dark urine, jaundice, increase HR, Tx with O2, blood transfusion

whats happening with type 3 reactions for hypersensitivity

Results from formation of IgG or IgM antibody-antigen immune complexes in circulatory system These circulating complexes usually lodge in small blood vessels. Local, generalized Immune complex accumulates in the glomerular basement membrane of the kidneys Ex: Streptococcal infection or with Systemic Lupus Erythematous or glomerular nephritis Systemic: Fever urticarial, rash, arthralgia, lymph adenopathy , myalgia,