Exam 2

- Provide a gas exchange surface
- Move air to and from exchange surface
- Protect respiratory surfaces from environ.
- Defend against invasion by pathogens
- Production of sound
- Involved in the regulation of blood volume and control of body pH

What are the primary functions of the respiratory system?

- Chemoreceptors in the medulla oblongata, aortic arch, and carotid bodies sense changes in [H+] and arterial oxygen levels
- Signals sent to respiratory center in the medulla
- Nerve impulses transmitted to the pons which regulates respiratory muscles
-

How does chemical and neural control the respiratory system?

Stridor

Harsh, High-pitched sound heard on inspiration is common during upper airway obstructions ex: croup

Crackles (rales)

Bubbling/ppopping sound heard in the smaller airways typically when they fill with fluid commonly encountered with CHF and pulmonary edema

Wheezing (adventitious lung sound)

Whistling sound due to the narrowing of the pt's airways from edema, bronchoconstriction, or foreign body aspiration

Rhonchi

Rattling sound hear in the larger airways caused by excessive mucus

- Lung compliance (elasticity)--> how easy can the lungs inflate
- Resistance to airflow
- Air pressure variances

What are the mechanics of ventilation affected by?

Decrease lung compliance:
- Atelectasis: alveoli collapse
- Pneumonia: inflammatory process
- Pulmonary edema: Fluid in alveoli
Decrease Chest wall compliance:
- Obesity: excess fatty tissue over chest wall
- Kyphosis and scoliosis: changes in chest wall

What are conditions that decrease lung compliance? decrease chest wall compliance?

Conditions:
- Bronchial constriction: asthma
- Thickening of bronchial mucous: chronic bronchitis
- Secretions...mucous: chronic bronchitis
- Loss of lung elasticity: emphysema
Increased resistance leads to increased work of breathing (will result in shal

What are conditions that increase airway resistance and what is there to not about it

Obstructive: Difficult to exhale air
- COPD (emphysema and chronic bronchitis)
- Asthma
- Bronchiectasis
- CF
Restrictive: Difficult to fully expand and inhale air
- Interstitial lung disease
- Sarcoidosis
- Neuromuscular disease (ALS)
- Pulmonary fibrosi

What is the difference btw obstructive and restrictive lung disease and some examples?

Acute rhinosinusitis

A new infection that may last up to four weeks and can be subdivided symptomatically into severe and non-severe

Recurrent acute rhinosinusitis

Four or more separate episodes of acute sinusitis that occur w/in one year

Subacute rhinosinusitis

An infectionthat lasts btw 4-12 weeks and represents a transition btw acute and chronic infection

Chronic rhinosinusitis

When the signs and symptoms last for more than 12 weeks

- Nasal running, blocking sneezing, and itching more than 2 hours per day for linger than 2 wks
- Can be seasonal or all year around...also could be occupational
- 3/4 asthmatics have rhinitis
- Allergic rhinitis aka hay fever is caused by allergens ex: d

What are some s/s about rhinitis?

- Chronic nasal obstruction
- Sleep apnea
- Anosmia
- Chronic sore throats
- Orbital cellulitis: infection at the bone level
- Cavernous sinus thrombosis
- Brain abscess: could have infection from sinuses travel to the brain and result in meningitis
- Ost

What are some complications of sinusitis?

Flu:
- Onset: sudden
- Sneezing: occasional
- Sore throat/cough: early
- Muscle aches: often severe*
- Malaise/Fatigue: Severe*
- Chest sx: substernal burning common
- Duration: 6-7 days
- Fever: High, 102-104*
Common cold:
- Onset: gradual
- Sneezing: co

How to tell the difference btw a cold and the flu?

- H/A
- Fever (usually high)
- Malaise/muscle aches
- Runny/stuffy nose
- Sore throat
- Coughing
- Vomiting

What are some s/s of influenza?

- Administer analgesics, antipyretics, and decongestants as ordered
- Follow droplet and standard precautions
- Provide cool, humidified air but change the water daily to prevent pseudomonas superinfection
- Encourage pt to rest in bed and drink plenty of

What is apart of nursing care for a pt with influenza?

Obstruction of broncioles and alveoli which decrease gas exchange and increase exudate (increase fluids and cells that seeped out of organ/blood vessels)
- Body sent WBCs to handle infection but end up causing a blockage and making it harder to breath...c

What is pneumonia?

- cough
- chills, shaking, fever*
- tachycardia (body is trying to pump more blood around the lungs)
- Tachypnea/dyspnea*
- pleuritic chest pain*
- malaise
- Respiratory distress
- Decrease breath sounds
- Productive cough: yellow, blood-streaked, rusty s

What are s/s of pneumonia?

- Inflammation of the lung parenchyma by various microorganisms, bacteria, fungi, and viruses--> infection deep in the lungs
- Infective agent causes inflammation--> WBC fill alveoli--> decreased ability of alveoli to participate in gas exchange--> causes

What is the pathology of pneumonia?

Community-Acquired pneumonia (CAP)
- Occurs in community setting or within 48 hrs of admission
- Causative factors: strep pneumoniae and H. Influenza (elderly)
- Insidious onset: incidence of associated upper resp infections such as otitis media; adults c

What are the two different type of way to acquire pneumonia and how are they characterized?

- Elderly
- Very young
- Those with underlying health problem (ex: COPD, diabetes)
- Pts with HIV or who are immunosuppressed (ex: chemotherapy)
- Also, travel, recent upper respiratory infection or influenze

Who is at risk for pneumonia?

- Chest X-Ray: determine dx (tells us that we have pneumonia and not the flu)
- Sputum specimen- determines organism (what specific bacteria we have, what abx should be given)
- Blood culture: determine organism
Blood and sputum culture taken before abx t

How is pneumonia dxed?

Oxygenation assessment
Timing of the abx first dose- should start ASAP after culture , should improve by 24-48hrs after starting abx
Appropriate abx ordered- initially a broad spectrum abx, then change when Culture and sensitivity results back ofent start

What is the initial treatment for someone with pneumonia?

Continued vigilant assessment of VS and O2 stat
Comfort, pxing, administer meds - splint for pleuritic chest pain (b/c alveola fill up and now pushing on the very sensitive pleura)
Supplemental O2
Fluids, working w/ respiratory therapist for treatments -

What is apart of ongoing treatment for pneumonia?

Emphysema
- Accumulation of pus or fluid with demonstrable bacterial in pleural space
Pleural effusions
Septic shock
Respiratory failure

What are some complications of pneumonia?

It's when food particles manage to get into the trachea instead of the esophagus leading to an infection in the lungs
People at risk:
- GERD pts
- Hx of stroke
- Impaired LOC
- Depressed cough reflex
- Vommitting
- Supine Px

What is aspiration pnemonia? and Who is at risk for it?

- Head of bed elevated with sedated/intubated/NGT
- NGT- tube feeds off when flat
- Check placement of NGT
- During emesis- turn on side if sedated or flat if unable to sit up

How to prevent aspiration pneumonia?

- Highly contagious respiratory infection caused by an infection with mycobacterium tuberculosis bacilli
- Transmitted by airborne droplets from respiratory tract--> cough or sneeze
- Can be transmitted to meninges, kidneys, bones, or lymph nodes

What is tuberculosis?

Latent:
- after exposure pt develops localized infection in lings that is walled off by immune system.
- No symptoms and not contagious but can reactivate (may reactivate during times of high stress/immune system is low)
Active Disease
- Exposure person d

What are the two types of tuberculosis?

Latent:
- TB lives but doesn't grow in the body
- Doesn't make the person feel sick or have sx
- Can't spread from person to person
- Can advance to TB disease
- These individuals will test positive for a TB skin test--> will need a chest X-ray for cleara

How to describe the differences between latent and active tuberculosis

- Bacteria is inhaled into the lungs and multiples in the alveoli (can be transported to other parts of the body via bloodstream and lymph system)
- Inflammatory response occurs and bronchopneumonia develops
- Eventually a fibrous mass of dead/live bacter

What is the pathophysiology of TB?

Varies to none; insidious (typical, but don't match with what is going on)
- Early on: may be asymptomatic
- Most common is cough. Starts as nonproductive--> mucoid/mucopurulent sputum, may have hemoptysis
- Night sweats, loss of appetite, unintended weig

How does TB present/what are the sx?

AFB Smear (sputum smear--> faster)
- Acid-fast bacilli (AFB) are rod-shaped bacteria
- If acid-fast bacilli are present on any of the smears, a mycobacterial infection is likely
- A presumptive dx of TB can be made, but other follow up testing must be don

What are diagnostic tests for TB?

- For diagnostic purposes, all persons suspected of having TB at any site should have sputum collected for TB culture
- At least three consecutive sputum specimens are needed, each collected in 8-24hr intervals, with at least one being an early morning sp

What are things to note when doing diagnostic tests for TB?

Chest X-ray:
- May show small, patchy infiltrations of early lesions in the upper-lung field, calcium deposits of healed primary lesions (fibrosis tissue) or fluid of an effusion. Changes indicating more advanced TB may include cavitation, scar tissue/fib

How does a chest x-ray work as a diagnostic tool for TB? How about a TB skin test?

Greater than 15mm
- For the general public w/o risk factors
Greater than 10mm
- For residents of long-term care facilities
- Residents/employee of high-risk congregate settings
- Mycobacteriology lab personnel
- Comorbid conditions
- Children less than 4

What are positive finding of TB for skin tests in different populations?

- Isolation for confirmed new cases
- INH or rifampin
- Monitor liver toxicity
- Multiple drugs for active disease in addition to INH and rifampin
- DOT (directly observed therapy)- recommended for high risk/unreliable pts
- Pt is put in a neg pressure ro

What is apart of the management for TB?

Considerations:
- Adherence to rx regime - long course and multidrug; meds on empty stomach--> about 6 months of treatment
- INH need to avoid food with histamine such as red wine, aged cheese (flushing, H/A, hypotension, light-headedness)
- Rifampin-inte

What are nursing considerations and priorities for TB pts?

- TB
- Varicella
- Measles

what are some examples of airborne disease?

Category of respiratory disorders that obstruct airflow and over time result in ling tissue destruction and airway constriction... consists of:
- Emphysema: Inflammation lead to destruction of alveolar spaces, reducing surface area for gas exchange--> mem

What is COPD defined as? and what it's two parts?

Irreversible airflow obstruction
- Chronic inflammation that narrows airways; enlarges mucous glands; hypertrophies smooth muscle in airways
- Scar tissue forms and airway narrows
- Eventually pulmonary vessels thicken--> resulting in pulmonary HTN (this

What is the pathophysiology of COPD?

- Exposure to smoke: cigarette is the #1 cause as it damages cleaning mechanism, increases mucous, and produces carbon monoxide, but can also be from fires and fuel
- Occupational dust
- Fumes
- Family hx
- A antitrypsin deficiency: genetic deficiency cau

What are risk factors for COPD?

Sx:
- Dyspnea, chronic cough, sputum production
Exacerbations:
- Acute event characterized by a worsening of respiratory sx that is beyond day-to-day variations ex: flu
- Most common cause is infection
- Increase in Sx severity, congestion, severe tachypn

What are symptoms and exacerbations of COPD?

- Encourage Pursed lip breathing: helps slow expiration, prevent collapse of small airways, and pushes out CO2
- Encourage diaphragmatic breathing

What should be encouraged in the event of a COPD exacerbation?

Spirometry: not really used for dx, but useful to see day to day lung functioning
Pulmonary Function Tests: Gold standard for COPD dx
Remember that COPD is on a continuum and will progressively get worse

What are lung tests that are used to diagnose the stages of COPD?

Inflammation of the bronchi and bronchioles
- Inflammation results in hypersecretion of mucous; reduced ciliary function; gradual thickening of bronchiole wall; alter alveolar macrophages- so increased susceptibility to infection
Manifestations:
- SOB
- C

What is chronic bronchitis? and does it clinically manifest?

The presence of cough and sputum production for at least 3 months in each of 2 consecutive yrs (takes a long time to dx)

How is chronic bronchitis dxed?

Bronchodilators, expectorants, and steroids
- Opens up bronchioles to increase ability to take in air b/c bronchitis narrows this airway due to increased sputum production
If complicated by infections-abx
Low dose O2
At risk for: malnutrition (more diffic

How is chronic bronchitis treated?

- Abnormal distention of air spaces (air trapping) with destruction of alveolar walls (blebs)
- Impaired O2 and CO2 exchange from destruction of the walls of the overdistended alveoli
- As alveolar walls are destroyed, an increase in "dead space" results

What is the pathophysiology of emphysema?

- Dyspnea
- Dry mouth
- Lack of energy
- Feeling nervous/sad due to inability to obtain O2 leading to anxiety
- Difficulty sleeping
- Difficulty Eating--> increased risk for anorexia
- No Cyanosis--> increased Hgb production by ten-fold so they appear pin

What does a pt experience with emphysema?

- LFT: FEV1(forced expiratory volume)/FVC(forced vital capacity)<70 and reduced FEV1
- Arterial blood gas - Measure O2, CO2, and pH of blood with arterial stick
- High resolution CT scan (helps with differentiating lung disorders)

How is emphysema dxed?

Pharmacological therapy: improve ventilation (getting air in)/gas exchange (switching CO2 for O2)
Bronchodilators: relieve bronchospasm and improve ventilation
- Types: Beta 2 agonists (albuterol) and anticholinergic (Atrovent) and combination therapy
- M

What are pharmacological management for COPD?

Risk reduction
- Smoking cessation-program; quit date; medications--> chantix or nicotine replacement
- Preventative vaccines - influenza and pneumonia
Address precipitating factors
Reduce air "trapping"--> pursed lip breathing
Decreased pulmonary inflamm

Management of exacerbation of COPD?

Hyperinflation of the lungs
Hypoxemia (decrease O2)and Hypercapnia (increase CO2)
Pulmonary HTN--> causes pulmonary vein to narrow and lead to backflow
Damage beyond the lungs
Clinical Depression

What are functional effects of COPD?

Oxygen Therapy --> oxygenation
- LT, during activity/exercise, during an exacerbation
- Goal increase baseline pO2 and an O2 stat of90%
Aggressive pulmonary hygiene--> chest physiotherapy postural drainage
Hydration/Nutrition
- Hydration allows for the lo

What are nursing managements for COPD?

Prevention further disease
- Decrease smoking
Avoid Exacerbations
- Flu shots, decrease interactions w/ sick individuals, etc.
Prevention of functional disability

What are goals and treatment of COPD?

- Restlessness (anxiety cause increase in RR and HR)/ slight confusion
- H/A
- Tachypnea, dyspnea, tachycardia, mild HTN
- Decreased O2 saturation
- Hypoxia (decrease O2 in the body or part of body) vs Hypoxemia (decrease partial pressure of O2 in the blo

What are early sx of hypoxia?

- HTN
- Bradycardia
- Metabolic acidosis (body trapping CO2 and it goes to blood stream instead of exhalation or the kidneys are not removing enough acid from the body)
- Cyanosis (2/3 hgb in blood in unO2)
- Chronic lack of oxygen --> clubbing of fingers

What are early sx of hypoxia?

- Normal respiration is driven mostly by the levels of CO2 in the arteries, which are detected by peripheral chemoreceptors, and very little O2 levels
- An increase in CO2 will cause chemoreceptor reflexes to trigger an increase in ventilation
- The hypox

Why is giving COPD pt's too much O2 dangerous?

Hypercapnia

Acondition of abnormally elevatedCO2 levels in the blood--> shallow breathing
- PO2>45 mmHg

Hypocapnia

A state of reduced CO2 in the blood. Results from deep or rapid breathing
- PO2 < 35 mmHg

Postural Drainage

Placing pt in different pxs to allow gravity to assist in removal of bronchial secretions 2-3Xs a day for 10-15min

Chest PT

Helps dislodge mucous adhering to the bronchioles and bronchi--> percussion with cupped hands and vibration

Remove bronchial secretions, improve ventilation, and increase effectiveness of respiratory muscles

What is the goal of Chest PT and postural drainage?

Inflammation of both layers of pleurae
- Inflamed surfaces rub together with respirations, cause sharp pain intensified with inspiration; space is there for lubricant for lungs to expand and retract w/o friction
- Seen with PNA, URI, TB, and CA among othe

What is pleurisy and what is it characterized by?

Collection of fluid in pleural space usually secondary to another disease process:
- Large effusions impair lung expansion, cause dyspnea
- Caused by heart failure, TB, pneumonia, pulmonary infections, and cancers
- Decrease Bowel sounds over area on exam

What is a pleural effusion and what is it characterized by?

A chronic inflammatory disease of the airways
- Diffuse airway inflammation, mucosal edema
- Activated mast cells (these mast cells lead to more mucous)- make situation worse
Inflammation leads to airway spasm (reactive airway)
- Airflow obstruction
Can b

What is the pathophysiology of asthma?

- Cause not really known, though clear linksto both genetics (family hx) and environment
- Hx of atopic disease
- GERD (80% of pts with asthma)
- GERD is an irritant for asthma b/c gastric contents keep coming up
- Maternal tabacco
- Poor air quality

What causes asthma?

- Obesity (restriction on lungs)
- Genetic factors
- Smoking mothers (contribute to in utero resp dev)
- Air pollution
- Modern Diets (high in acid and can cause GERD)
- Exposure to allergens
- Exposure to Tabaco smoke
- Children: more common among boys
-

What are contributing risk factors to asthma?

- Allergy is the strongest predisposing factor
- Temperature (cold air can cause bronchospasms for some people)
- Pollutants
- Scents (lavendar)
- Exercise, stress
- GERD
- Respiratory infections

What are some common triggers for asthma?

- Consider pets in the home
- Replace carpets with hard floors
- Anti-allergenic with hard floors
- Regular vacuuming/steam cleaning of mattresses and household furniture
- Consider diet changes (those that would decrease GERD, decrease ETOH, caffeine, et

What are some ways the ways to eliminate triggers for asthma?

- The three most common sx are cough, dyspnea, an wheezing
- Increasing sx past few days; may be abrupt
- Cough with/without mucus
- Generalized wheezing first on expiration
- Chest tightness and dyspnea
- Patient is often very frightened/feels like suffo

What are clinical manifestations of asthma?

Quick relief of sx (rescue inhalers)
- Short acting beta-2-adrenergic agonist (albuterol)--> relaxes smooth muscle in bronchi; may increase HR slightly
- Short-acting anticholinergics (atrovent)--> Inhibits cholinergic receptors to relax airways (atrovent

What is apart of medical management for asthma?

Support anxiety fears - avoid sedatives which would decrease respiratory drive
Administers medication and assess response
Self care and monitoring:
- Identify/avoids triggers
- Manage episodic asthma; exercise asthma, etc.
- Uses peak flow meter: measures

What is apart of nursing care for pts with asthma?

Venous thromboembolism (VTE)

Disease that includes DVT and pulmonary embolism
- The third most common cardiovascular disease after Heart Attack and stroke

- Unilateral edema (one sided)
- Pain/tenderness
- Palpable cord
- Erythema, warmth along venous system
- Proximal veins often asymptomatic
- Common sites: Iliac, common femoral, deep femoral, and popliteal

What are clinical manifestations of DVT?

Pulmonary embolism

Obstruction of pulmonary artery or branch of blood clot, air, fat, amniotic fluid or septic thrombus-"blood clot to lungs

- Dyspnea/pleuritic chest pain
- Low grade fever
- Apprehension/restlessness
- Feeling of impending doom
- Cough hemoptysis

What are clinical manifestations of pulmonary embolism?

- Venous stasis
- Hypercoagulability
- Venous endothelial disease
- Certain disease states: heart disease, trauma, postop/postpartum, DM, COPD
- Other conditions: pregnancy, obesity, oral contraceptive use, constrictive clothing
- Previous hx of thromboph

What are risk factors of pulmonary embolism?

Prevention:
- Exercises to avoid venous stasis
- Early ambulation
- Anticoagulant therapy
- Sequential compression devices (SCDs)
Treatment:
- Measures to improve respiratory, CV status
- Anticoagulation, thrombolytic therapy
- Nonsurgical: O2, telemetry

What is apart of PE prevention and treatment?

Interfere w/ coagulation process by interfering with clotting cascade and thrombin formation
ex: Coumadin (warfarin sodium) and Heparin

What is the action of anticoagulants and examples?

- Prevention of thrombus formation
- Always administered on an infusion pump
- Thera effect 45 min
- Monitor PTT (goal 60-80s)
- Reverse with protamine sulfate--> antidote

What is there to note about heparin?

- Individual dose adjustment
- Based on INR (test that measures how long it takes for blood to clot)
- Oral administration
- Can take up to 3-5 days to see thera effect
- Vit K antidote

What is there to note about coumadin?

Alter formation of platelets by decreasing responsiveness of platelets to stimuli that would cause them to stick and aggregate on a vessel wall
- Aspirin and Plavix

How do antiplatelet drugs work and an example??

Activate the natural anticlotting system, conversion of plasminogen to plasmin
Activation of this system breaks down fibrin threads and dissolves any formed clot
ex: TPA and streptokinase

How do thrombolytic agents work and what are examples?

Permanent localized dilation of aorta within the ab
- 90% from atherosclerosis and worsened by HTN
- Most common location is below the bifurcation of the renal arteries

What is an aortic aneurysm?

Nonsurgical
- If not leaking will monitor size
- Manage BP
- Smoking cessation
Surgical Management:
- Indicated for aneurysm (incompetent vascular) >4.5 cm wide

What is treatment for an aortic aneurysm?

- Monitor V.S.
- s/s of infection
- Urine output --> b/c of bifurcation of renal artery
- Lower extremity circulation
- Ab distension

What is apart of nursing care for an aortic aneurysm?

Atherosclerosis
- Most common cause of CAD
- Plaque build up--> macrophages transform into foam cells leading to build up in the middle of the artery
- Clots
- MI or stroke
Secondary to:
- Unhealthy diet
- Lack of exercise
- Being overwt
- Smoking

What causes CAD?

BP is product of CO by peripheral resistance
Atherosclerosis
- Narrowed blood vessel lumen
- Less elasticity; stiff blood vessels
Consequences of atherosclerosis is:
- Increase in systemic vascular resistance
- Ventricles must pump against higher systemic

What is the pathophysiology of HTN?

Primary (essential)
- HTN from an unidentified cause
- 90-95% of U.S population who has HTN
Secondary:
- HTN r/t existing disease
- Narrowing of renal arteries, renal parenchyma disease, pregnancy, and medications

What are the categories of HTN?

Family Hx
Race/Gender
- Black M/F increase
- White M increase/white W decrease
- Hispanic F/M increase
Hyperlipidemia
Smoking
Age > 45; post-menopause

What are factors associated with Primary HTN?

Higher than 140/90

What is HTN defined as?

CAD w/ angina and MI
L ventricular hypertrophy d/t increased workload
HF (end stage)
Pathological changes to kidneys/renal insufficiency
TIA/CVA --> strokes
Retinal Hemorrhage
- Increase in HTN will lead to ruptured eye vessels--> see an eye doctor

What are complications of HTN?

Early:
- Typically no sx--> silent killer
Progression:
- H/A (from increased blood flow to brain)
- Facial flush (body is trying to pump more blood to brain)
- Dizziness (lack of O2)
- "organ specific" sx if HTN uncontrolled

What are early clinical manifestations of HTN? As it progresses?

BP
- Orthostatic
- Compare both arms --> will help with inspection to where plaques may originate
Eye Exam
- Due to vascular changes in the retina

What are apart of clinical assessment in HTN?

Lab tests: checking for renal issues/damage
- Urinalysis; proteinuria--> proteins get pushed through and there will be protein in urine
- Blood Chemistry: blood urea nitrogen (BUN), creatinine
ECG; check for signs of LV hypertrophy...is the P wave normal?

What are diagnostic tests for HTN?

Lifestyle:
- Wt reduction
- Decrease Na+
- DASH diet
- Limit ETOH
- Exercise
If lifestyle changes don't work then we use medications

What are some treatments for HTN?

1. Decrease Fluid Volume
- Na+ restricted diet
- Diuretics First Line of therapy, start with HCTZ as it is the most gentle. Use Lasix (furosemide) if HCTZ unsuccessful
2. Decrease Systemic Vascular resistance and decrease contractility(decrease's hearts d

What are the goals of HTN treatment and some examples of medications?

Inhibits Na+ and Water absorption in distal tubules of Kidneys
Nursing Considerations:
- Side effect of hypokalemia
- Potential for Orthostatic HypoTN, elderly at risk

How does HCTZ work? and what are some nursing considerations for it?

Hypertensive Urgency

Elevated BP, but no target organ damage
- BP >280/>120

Hypertensive Emergency

a situation in which blood pressure is severely elevated (>180/>120) and there is evidence of actual or probable target organ damage (ex: kidenys, heart, and brain)

- Severe H/A*
- Blurred Vision
- Dyspnea*, pulmonary edema
- Epistaxis*
- V
- Chest Pain (CP)
- Aortic dissection (aorta just comes off)
- Mental Status changes
*= same as in HTN urgency

What are some sx of a hypertensive emergency?

To reduce BP to 160/100 w/in 6 hrs
- Begin IV antihypertensive meds
- 12 lead EKG
- Monitor VS
- Observe for signs of cardiac ischemia or neurovascular complications (new numbness, tingling, weakness in extremities, facial droop, and slurred speech)

What is the goal of treatment for a HTN emergency? and what do we want to monitor?

- Angina
- MI
- CVD (Stroke)
- HF
- Hypertensive Heart Disease
- Heart arrhythmia
- Aortic aneurysms
- Peripheral artery disease
- Thromboembolic disease
- Venous thrombosis

What is apart of CAD?

- Coronary arteries supplied by blood off of aorta
- Heart has high O2 requirement
- Auto-regulation of coronary arteries: the ability of the tissues to control their own blood flow; to dilate or constrict to increase or decrease blood flow to meet demand

What is CAD?

Non:
- Family Hx
- Advancing Age
- Gender
- Ethnicity
Mod:
- Dyslipidemia (High LDL and low HDL)
- Smoking
- HTN
- DM
- Obesity
- Physical Inactivity

What are modifiable and nonmodifiable risk factors for CAD?

- Smoking cessation of Tabaco as it decrease O2, constricts coronary arteries, and irritates vessel walls
- Diet: Thera lifestyle changes, low saturated fat diet/ Mediterranean diet (veggies, fish, and little red meat)
- Exercise: 30 min/day most days...

What is apart of prevention for CAD?

Total: <200 mg/dl
HDL: >40 mg/dl
LDL: <70 mg/dl--> elevated increase CAD risk
Statin Drugs (lipitor): lower LDL and increase HDL...work by blocking cholesterol synthesis and reducing vessel lining inflammation
- need to monitor LFTs

What is the goal ranges for total cholesterol, LDL, and HDL? How can these levels be improved through medication?

- Pt's self-report most reliable indicator
- CP/chest pressure may radiate
- SOB
- N/V/indigestion
- Cool, clammy skin
- Anxiety, feeling of impending doom

What are clinical manifestations of ischemia?

Start of P wave: SA node depolarizes
Peak of P wave: Impulse arrives in the AV node
End of P wave: Impulse passes bundle of His
Beginning of QRS complex: Impulse passes through purkinje fibers
P wave: depolarization of atrial myocardium
QRS: Complex: depo

What do different points on an EKG mean?

irregular Heartbeats, are a problem with speed or pattern of the heartbeat
- Tachy and Bradycardia
Etiologies:
- Delayed after depolarization
- Heart block
- abnormal pacemaker (ectopic foci)
- Reentry circus movement
Risk Factors:
- Excessive caffeine, s

What are the types of arrythmias? and what are some etiologies? Risk factors?

Umbrella term when clinical sx are compatible with acute myocardial ischemia
- Ranges from stable angina pectoris to MI

What is ACS (acute coronary syndrome)?

Symptoms:
- CP, may radiate
- SOB
- N/V
-Indigestion
- Anxiety
- Cool, clammy skin
- Sense of impending doom
- Pts self-report is most reliable indicator
Signs:
- Increase RR and HR
- Cool, clammy skin
- S3 and S4 or new murmur
- Jugular vein distention
-

What are clinical manifestations of ischemia (MI)?

Stable Angina
- Provoked by exercise/activity, emotion, heavy meal
- Acute treatment: rest; Nitroglycerine--> can pretreat with Nitro before exercise
Unstable Angina
- New onset or increase in frequency and/or severity --> this means the blockage is bigge

What are the kinds of Angina Pectoris and why are they different?

- When the ST segment goes down, it means there is a blockage b/c blood is attempting to move around that muscle
- About depolarization and occurs in hypoxic conditions--> PARTIAL OCCLUSION/Partial thickness ischemia/Non Transmural
- Will be (+) for bioma

Why is there ST depression in NSTEMI Mi?

Emergent situation caused by acute onset of myocardial ischemia that could result in myocardial death/infarction
- Total Occlusion/Full thickness ischemia/Transmural
- Will be (+) for biomarkers and have an elevated ST segment
- Will need immediate re-per

Why is there ST depression in STEMI Mi?

Goal: to decrease O2 demand of myocardium and increase O2 supply
Acue:
- Rest
- O2
- NTG
- ASA (will prevent further thrombus formation)
- Get an EKG and biomarkers
Chronic:
- ASA and anti-platelet agents (Plavix)
- B-Blocker: decrease myocardial O2 consu

What is the medical management for an acute and chronic MI?

Dilates veins and arteries which reduces myocardial O2 consumption
For PO use:
- Put one tab SL--> 5 minutes apart for 3 times, if no relief call 911
- Use anticipatorily
- Keep a fresh supply in a dark container
- Side effects include: hypoTN and dizzine

What does Nitroglycerine do? and What are the instructions on how to give PO?

- Clinical Hx
- EKG Changes- changes in the leads that are involved with the injured section of the myocardium
- Lab Tests: (+) biomarkers

What is taken into account with the diagnosis of an MI?

CK (creatnine Kinase), CK-MB (creatnine Kinase myoglobin)
- Increased due to damaged cardiac cells
- Rises about 6 hrs after injury
- Peaks in 24 hours
Troponin I - most reliable
- Very sensitive and specific to cardiac injury
- Rises 3-4 hours after inju

What are some Cardiac Biomarkers that are used for the MI?

Reduce Myocardial O2 demand
- Bedrest
Relieve Pain
- NTG (decrease BP), morphine (decreases workload)
Enhance myocardial O2 supply
- Supplemental O2
Reduce Workload
- B-Blockers given w/in hrs of the start of MI may lower risk of early death after an MI
M

What are goals to the treatment of NSTEMI and how are they achieved?

Same as treatment for NSTEMI plus:
- Coronary Reperfusion --> dissolve clot and reperfuse threatened myocardium

WHat is apart of treatment for STEMI?

Thrombolysis
- W/in24 hrs
- TPA (alteplase)--> thins out blood and dissolves clots
Percutaneous Coronary Intervention (PCI)
- Coronary artery stenting, takes blockage and opens it up to allow for blood flow
- PTCA (Percutaneous transluminal coronary angio

What are Coronary Reperfusion Options?

Indications:
- Chest Pain > 20 min
- ST elevation
- Less than 12 hours since onset of sx
Contraindications:
- Bleeding or bleeding disorder
- Hx hemorrhagic stroke
- Recent Surgery
- Uncontrolled HTN
- Pregnancy
- Thrombocytopenia (hemorrhage risk)

What are some indications and contraindications for thrombolysis?

Potential for re-occlusion of coronary artery --> artery wall could go cause artery to spasm and reocclude
- Assess for CP, monitor VS
Assess for/minimize potential for bleeding
- Minimize skin punctures
- Avoid IM injections
- Avoid continual non-invasiv

What is apart of nursing care for thrombolysis?

- Access via femoral artery to radial artery
- Catheter passed to origin of coronary arteries
- Each artery injected with contrast material (Stent- metal mesh-deployed or angioplasty- balloon)
- Continuous Fluoroscopy
- At risk for dissection (ripped off)

What are some procedure highlights during cardiac catherizations (PCI)?

Pre:
- Informed consent
- Allergies to dye or shellfish
- Teaching (Will be awake during procedure, What to expect post op)
Post:
- Potential for bleeding risk r/t heparin and antiplatelet therapy
--- Bedrest
--- HOB <30 degress (want femoral to be able t

What is apart of the pre-procedure process for a PCI? Post?

Acute Period:
Reestablish myocardial O2 supply-demand balance
- Bedrest 12-24 hrs
- Supplemental O2
- B-Blockers, ASA, Plavis, Heparin (Lovenox)
- Reduce Anxiety
- Treat Pain
Prevent and Manage Potential Complications
- Continuous assessment: EKG, VS, and

What is apart of post-MI care for patients? How about Long Term?

- Non-invasive ways to eveluate the response of the cardiovascular system to stress
- Evaluated CAD, cause of CP, and functional capacity of heart after MI
- Monitor for EKG changes during stress - either exercise (treadmill) or pharmacological (drugs to

What is apart of a cardial stress test?

HTN
CAD
Valve Issues
Cardiomyopathy - disease of heart muscle
Among other Causes:
- Smoking
- Pulmonary HTN. etc

What are causes of HF?

Indicated Cardiac disease, in which there is a problem with the contraction of the ventricles (systolic failure) or filling of the ventricles (diastolic failure)
- Will cause low CO and activation of the RAAS system as a compensatory mechanism to maintain

What does HF mean?

Hx and physical exam
Chest X-Ray
- Cardiac enlargement (cardiomegaly), pulmonary congestion/edema
Blood Tests
- BUN/Creatinine will be elevated
- If you aren't perfusing the kidneys correctly then they are unable to excrete these things. May lead to kidne

What is apart of the assessment for HF?

LV cannot pump blood effectively out of the aorta to the systemic circulation
- Pressure backs up from L Side of the hear to the pulmonary veins and capillaries and eventually into the interstitial tissue
- Results in pulmonary edema and impaired gas exch

What is L-sided HF? what are some clinical manifestations and assessments made for L-Sided HF?

Right Ventricle cannot eject sufficient amounts of blood out of the pulmonary artery and blood backs into the systemic venous system
Manifestations:
- Fatigue
- Increase peripheral venous pressure
- Ascites
- Enlarged Spleen and Liver
- May be secondary t

What is R-Sided HF? what are some clinical manifestations?

Diet Modifications:
- Low Na+ < 2g/day--> helps decrease blood volume
- Fluid restriction
- Wt reduction, regular exercise, avoid ETOH/tobacco
- Teaching at discharge and home management (daily wts, coughing more frequently, when to call the doctor, etc.)

What are some interventions to HF?

Diuretics: remove excess extracellular fluid and increase rate of urine production
- Lasix (loop)--> inhibits Na+ and Cl- reabsorption in kidneys... is very potent/fast acting and can be given IV
- Side effects are hypokalemia (risk of arrythmias/normal c

What are some medications to be taken for HF?

Increases force of contractions, slows conduction from SA Node --> makes L ventricle more efficient and effective pump
- HR must be assessed before administration
- Used for sx control, no decrease in morbidity or mortality
Monitor for s/s of toxicity
- N

What is there to know about Digoxin (Lanoxin)?

Respiratory insufficiency due to pulmonary edema:
- Supplemental O2
- Px to maximize breathing/comfort--> High fowlers
- Anxiety reduction measures
Excess Fluid Volume
- Diuretics, Low Na+ diet, I+Os, Daily wts
- Potential for arrythmias r/t low K+
- Rena

What is apart of the care for a pt with HF?

Implantable cardiac defibrillator (ICD)--> shock the heart out of VF
Cardiac resynchronization (CRT) - biventricular pace marker/defibrillator that coordinated ventricular beats to increase CO
LVAD (Left Ventricular assist device)- a mechanical pump that

What are end stage options for HF?

Sudden pulmonary edema or chronic HF with added trigger such as afib caused by infection, anemia, MI, or noncompliance with meds
- S/s as with HF (R or L)
Treatment:
- ABCs!!!
- Reduce fluid excess (Lasix)
- Improve O2
- Perfuse vital organs
- Decrease af

What is acute decompensated HF? How is it treated?

Arterial Occlusive Disease
Venous Insufficiency Disease

What are the two types of peripheral vascular disease?

Common circulation problem; arteries carry blood to the legs or arms become narrow and get clogged
Main Cause:
- Atherosclerosis
Risk Factors
- Smoking
- DM
- BMI over 30
- HTN
- Increasing Age
- Family Hx

What is arterial occlusive disease? what is the main cause and Risk factors?

- Intermittent claudication
- Painful cramping in hip, thigh, or calf muscles after activity
- Leg numbness or weakness
- Coldness in LL or foot especially with symmetrical comparison
- Hair loss or slower hair growth on feel and legs
- Slower growth of t

What are the symptoms of arterial occlusive disease?

Nonsurgical:
- Lifestyle Changes
Meds:
- Cholesterol lowering agents
- BP meds
Surgical:
- Angioplasty
- Endarterectomy
- Stenting
- Surgical bypass

What are treatments for Arterial Occlusive Disease?

Ankle-Branchial Index
- In supine px measure in both arms using doppler
- Select higher reading as brachial pressure
- Measure BP at PT/DP in both legs and select higher reading in each leg
- Divide ankle pressure by arm results (1= normal, <.5 is severe

What are diagnostic tests for arterial occlusive Disease?

A clot will block blood flow through vein and cause pressure to build up
- Can be from leg injury or surgery, excessive wt gain/wt (can increase pressure or damage veins and valves)
- standing or siting too long(increased pressure in veins due to pooling

What is venous insufficiency?

Caused by incompetent or obstructed veins--> common cause of LE swelling
Risk Factors:
- Age
- Obesity
- Trauma
- Hx of DVT or phlebitis
- Surgical complication (orthopedic)
- Tight fitting garments
- Prolonged sitting or standing
- Family Hx

What is venous insufficiency caused by and risk factors?

- Less pain than arterial disease --> still able to getO2 to area, more about pressure build up
- Brawny skin discoloration -> blockage with buildup of fluid from cell metabolism stasis and getting worse
- Edema
- Warm skin
- Itching/stasis dermitis
- Sta

What are s/s of venous insufficiency?

- Venous doppler to rule out DVT
- No other tests: diagnostic of DVT exclusion

What are some diagnostics for venous insufficiency?

- No oral medication has yet been proven useful for the treatment of venous disease
- Gradual compression
- Surgery reserved for those with discomfort or ulcers refractory to medical management

What are treatments for venous insufficiency?

Arterial Disease:
- Dependent px
- Progressive exercise
- Decrease risk factors
- Foot Care
- Pulse checks
Venous Disease:
- Avoid prolonged sitting/standing
- Elevated Px
- Diuretics of limited value
- Graded compression stockings
- Meticulous skin care

What are nursing measures for arterial disease and venous disease?

Glands produce and secrete hormones directly to bloodstream and they travel to their target organ
Hormones act on target cells/organs to regulate and integrate many body functions:
- Cellular metabolism
- Use and storage of nutrients
- Growth and dev
- El

How does the endocrine system work? and how doe the hormones work?

Anterior Lobe:
- Thyroid stimulating Hormone (TSH)
- Adrenocorticotropic Hormone (ACTH)
Posterior Lobe:
- Vasopressin (ADH)

What are the parts of the pituitary gland and what are the man hormones they secrete?

Caused by pituitary tumor (usually benign) --> causes visual abnormalities due to proximity to optic nerve
Causes the hypersecretion of ACTH

What causes hyperfunction of the Anterior pituitary?

transphenoidal hypophysectomy
- Incision made in upper gingival mucoa in space btw gums and lip
- Performed using endoscope
- Duramater is closed with fat patch from thigh for protect and make sure the site stays intact

When the hyperfunction of the anterior pit is caused by a tumor, what is the procedure to be performed?

- Nose bleeds--> went through nose
- Internal cranial hemorrhage --> due to perforation
- Leaking of CSF --> why the fat patch is included but sill a risk
- Diabetes Insipidus
- Hypopituitarism

What are complications of transphenoidal hypophysectomy?

Promote healing of surgical incision
- Nasal Packing 1-3 days --> can soak up discharge from area and also b/c the nares take in things from the environment that could increase risk for infection
Prevent disruption of oral suture line
- Saline rinses to s

What are aspects that are unique to the postoperative care of transphenoidal hypophysectomy?

Nurses understand that CSF glucose level is proportional to the blood glucose
- Increase CSF glucose= High Blood Sugar (Decreased Integrity of tissue, glucose passing through the blood-brain barrier that shouldn't be)
- Decrease CSF Glucose = May be due t

Why are we testing nasal drainage for glucose in pts who had a transphenoidal hypophysectomy?

All happening due to a lower production of ADH
- Polyuria: increased Urination
- Polyphagia: Increased Huger
- Monitor for increased Urine output
- Dilute urine with specific gravity (<1.010, dilute urine)
- Increased and intense thirst: Polydipsia
- Pote

What are clinical manifestations of Diabetes Insipidus?

Dx by 24 hr urine sample for osmolarity
Medical Management:
- to replace ADH
- Prevent fluid volume deficit
- Fluid Replacement
Pharm Therapy:
- Desmopressin (DDAVP)
- Works by increasing kidney tubular reabsorption of water (pulls water back in)
Nursing

What is used to dx diabetes insipidus? Medical Management Goals/treatment/interventions?

Disorder of the Posterior Pit
- Characterized by excessive secretion of Vasopressin/ADH--> Kidneys retain H20
Causes:
- Cranial Surgery
- Lung Cancer
- Lung Infections
- head Injuries/infections

What are sx of inappropriate ADH (SIADH)? and what are some causes?

- Hypovolemic-concentrated urine (b/c holding onto water)
- Specific Gravity >1.030 (concentrated)
- Dilutional serum hyponatriema (due to retaining of water diluting Na+ )--> (< 135ml)
- Confusion
- Muscle Twitching
- N/V

What are clinical manifestations of SIADH?

Treatment:
- Eliminate Cause
- Diuretic and fluid restriction
- Sodium Replacement
Nursing Care:
- Monitoring Fluid Balance and serum electrolyte
- Monitor Urine Specific Gravity

What are treatments and nursing cares for SIADH?

Releases hormones that control metabolism for every cell in the body
- T3 and T4
- Calcitonin --> reduces calcium levels in the blood by two main mechanisms: It inhibits the activity of osteoclasts, which are the cells responsible for breaking down bone.

What is the thyroid's main function within the endocrine system?

Goiter

Visible Enlargement/hypertrophy of the thyroid gland
- Iodine deficiency can also be a cause
- Can occur in hypo/hyperthyroidism and normal states

Painless, but may "mechanically" affect respiratory and GI systems - size compresses esophagus/trachea

Why is goiter a concern?

Serum TSH: Tyroid stimulating hormone
- best screening test of thyroid function - from pit- stimulates the thyroid to produce thyroid hormones
Serum Free T4
- Confirms abnormal TSH
Serum T3 and T4
- Thyroid hormones frim thyroid to target organs
Radioacti

What are thyroid tests that can be run and what they mean?

Hyper:
- Decreased TSH
- Increased T3 and T4
Hypo:
- Increased TSH
- Decreased T3 and T4

What Thyroid Lab values are associated with hyperthyroidism? Hypothyroidism?

- Iodine-Deficiency
- Radiation for Cancer --> can eradicate part of thyroid's functioning and kill cells; response from radioactive iodine for overreactive thyroid
- Hashimoto's Disease: immune system attacks thyroid

What are some causes of hypothyroidism?

- Hair Thinning/Loss*
- Apathy, decreased LOC*
- Dry and Coarse Skin*
- Constipation
- Slow speech-Thick tongue
- Goiter*
- Slow HR
- Poor Appetite
- Infertility, Heavy menstruation
- Wt gain*
- Intolerance to Cold*
- Fatigue*
- Bradycardia*

What are some clinical manifestations of hypothyroidism?

Pharm:
- Synthetic tyroxin (Synthroid)--> based on serum TSH
Nursing Care:
- Pt education: Life-long medication, periodic blood tests with dose adjustments, s/s of hyperthyroidism
- Potential for myocardial ischemia: too fast of a metabolic change... hear

How is hypothyroidism clinically managed?

Decompensated Metabolic State and Mental status Changes
- HypoTN
- Resp depression
- Stupor
- Coma
- Death

What are clinical manifestations of myxedema coma?

Excessive output of thyroid hormone incidence
Types:
- Graves Disease (autoimmune)
- Toxic multinodular goiter
- Thyroiditis

What is hyperthyroidism and what are some of the types?

- Sweating
- Tremor
-Exophthalmos: Increased sympathetic stimulation of muscle that elevates the upper eyelid and muscle hypertrophies, not reversible
- Goiter
- Tachycardia/arrhythmias
- N/D
- H/A
- Wt loss
- Emotional Instability

What are some clinical manifestations of hyperthyroidism?

- Special eye care (issues with maintaining moisture)
- Eye protrusion with decreased blinking and movement--> will keep a patch on at night

What is special care to consider for hyperthyroid pt's with exophthalmos?

Goal is the reduction of hyperactivity:
- Pharmacologic
- Radioactive iodine therapy --> attempts to kill off some of these hyperactive cells. This usually will put people in a state of hypothyroidism
- Surgery

What are treatment options for hyperthyroidism?

Symptom management:
- Avoid stimulants, such as drugs, and foods that contain caffeine
- Assess cardiovascular status/EKG- risk for thyroid storm and cardiac issues
Nutritional consult/calorie count may be necessary
- Good appetite but wt loss
- 6 small b

What are general nursing considerations for pt's with hyperthyroidism?

Goal: to destroy the overactive thyroid cells so that thyroid hormones are no longer produced
- Almost all iodine becomes concentrated in the thyroid gland
- Thyroid cells are destroyed over several weeks (client will either become euthyroid or hypothyroi

What is the goal of radioactive iodine therapy for hyperthyroidism?

- Hyperpyrexia, temp in excess of 106f, dehydration (will start to kill brain cells)
- HR faster than 140 bpm, hypotension, atrial dysrhythmias, CHF
- N/V/D, ab pain, hepatocellular dysfunction - jaundice (cells are starting to loss function)
- Confusion,

What are clinical manifestations of a thyroid storm?

Indications:
- Med allergies
- Very large goiters
- Cancer
Preoperative: wait until normal thyroid fx
- SSKI administered to decrease vascularity of gland (to try and prevent bleeding)

What are indications for a subtotal thyroidectomy? What is apart of preoperative care?

Subtotal Thyroidectomy

excision of part of the thyroid gland

Potential for airway edema (glottis edema/compression of airway by growing hematoma --> collection of blood where we did surgery) First 48 hrs the risk is highest
Keep pt in semi-fowlers px; neck aligned & supported; cautious movement --> don't want to di

What is there to note about postoperative nursing care for a subtotal thyroidectomy?

If the blood calcium is low, PTH secretion is increased. The hormone acts on the bones to release calcium into the blood, on the intestines' to increase the absorption of Ca2+ from food, and on the kidneys to prevent ca2+ loss in urine

How does parathyroid hormone work?

Hypocalcemia
Manifestations
- weakness/tetany
- (+) trousseau's sign
- Laryngeal stridor
- Dysphagia
- tingling around the extremities

What can hypoparathyroidism lead to?

Potential for hypocalcemia r/t hypoparathyroidism
Risk of inadvertent surgical removal of parathyroid gland
- Monitor serum calcium levels
- Monitor for signs of tetany (tingling around the mouth, fingers, toes - early; Chvostek's Sign when cheek is strok

What is apart of postoperative nursing care r/t parathyroid damage from a subtotal thyroidectomy?

Caused by an overproduction of parahormone typically from parathyroid adenoma (tumor)

What is hyperparathyroidism?

- Vague or asymptomatic
- Increased Ca2+ absorption from bones, kidneys, and GI
- Bone decalcification and renal calculi dev (stay hydrated, avoid excess Ca2+)
- Dx: elevated serum Ca2+ (> 10.1)
Treatment:
- Removal ab tissue- minimally invasive

What are symptoms of hyperparathyroidism? and how is it treated?

Surgical removal of one or more parathyroid glands during thyroidectomy or radical neck dissection
Results:
- Deficiency of PTH
- Increase blood phosphate and decreased blood Ca2+ levels
- Absence of PTH results in decreased intestinal absorption of Ca2+

What is a parathyroidectomy? and what results because of this?

Monitor for Signs of Hypocalcemia:
- Provide specific parathyroidectomy care (Provide a high Ca2+ diet with Vit D and low in phosphorus, b/c phosphorus and Ca2+ compete)--> administer Ca2+ and Vit D

What are things to monitor with a parathyroid surgery?

Mineralocorticoid:
- Aldosterone
- Maintains the body's salt and water levels which regulate BP
Glucocorticoids:
- Cortisol
- Regulates body metabolism
- Stimulates glucose production
- Anti-inflammatory effects

What does the adrenal glands control hormone-wise?

- Increase blood glucose through gluconeogenesis by the liver
- Increases carb metabolism and protein catabolism
- Activates anti-inflammatory pathways: prevent release of substances that cause inflammation (risk for infections due to loss of inflammatory

What does cortisol control?

Primary adrenal insufficiency Insufficiency doesn't secrete enough cortical steroid
- Autoimmune disease
- TB
- Idiopathic atrophy
Secondary adrenal insufficiency--> pit doesn't secrete enough ACTH
- LT use of exogenous corticosteroids (hydrocortisone) -

What is Addison's Disease?

Hypoglycemia: hypocortisol causes inability to produce sugar
Hyponatremia: Na+ goes where water goes--> loss of fluid
Decrease BP
Muscle Weakness/Fatigue--> From sugar insufficiencies
Bronze-like pigmentation of skin (knuckles, knees, elbows)
Urinary freq

What are clinical manifestations of Addison's disease?

Diagnostic Test:
- Low early morning cortisol levels plasma ACTH
- Low blood glucose; hyponatremia
Medical Treatment:
- Hydrocortisone (ex: prednisone)
- Restore fluid balance/treat hypoglycemia and hyponatremia
- May need lifelong hormone replacement wit

What are diagnostic tests for Addison's Disease and medical treatments?

Life threatening condition that occurs when there is a severe deficiency of corticosteroids
Profound hypoTN, pain (H/A, ab), and circulatory shock due to uncontrolled loss of urine and sodium
- Rapid, weak pulse; tachypnea; thirst, confusion, unconsciousn

What is an Addison's crisis

Chronic Adrenocortical hyperactivity resulting in excessive secretion of corticosteroids
- Cortisol
- Aldosterone

What is Cushing's disease?

Cushing's Syndrome (primary)
- Tumors or hyperplasia of adrenal cortex that result in increased secretion of cortisol
Cushing's Disease
- Pit hypothalamus that result in increased ACTH

What is the difference between Cushing's syndrome and Cushing's disease?

Cushing syndrome is caused by prolonged exposure to elevated levels of either endogenous glucocorticoids or exogenous glucocorticoids:
- Pendulous abdomen (central obesity)
- Buffalo Hump
- Moon Face
- Facial Hair
- Ruddy complexion
- Increased BP (fluid

What are clinical manifestations of Cushing's disease?

Blood chemistry
Ultrasonography: pit or adrenal tumors
Dexamethasone suppression test
Identifies:
Abnormal release of cortisol (Cushing syndrome)
- Adrenal tumor that produces cortisol
- Pit tumor that produces ACTH
- Tumor in the body that produces ACTH

What are dx tests for cushing's disease?

Adrenalectomy:
- Primary adrenal hypertrophy
- Post-Op sx of adrenal insufficiency may begin to appear 12-48hrs due to reduction in high levels of circulating hormones. Temporary replacement therapy with hydrocortisone may be required for several months
-

What are surgical interventions for Cushing's Disease?

- Very effective in suppressing inflammation and auto-immune, control allergic rxns, rejecting of transplant but dangerous
- Used with many varied illnesses (ex: arthritis, asthma, and MS)
- Side effects: HTN, CAD, increase infection, muscle wasting, poor

How do exogenous glucocorticoids "steroids" work?