Pyelonephritis
When infection reaches the kidneys; potentially organ/life threatening. Usually caused by urinary tract obstruction; females 5 times more likely to develop.
ARDS (acute respiratory distress syndrome)
Occurs when fluid builds up in alveoli and prevents lungs from filling with oxygen.
Asthma (Reactive airway disease)
Chronic inflammatory disorder of the airway; can occur from any airborne irritants; leads to inflammation, wheezing, and constricted airways
Atelectasis
Incomplete expansion of part of the lungs
Chronic bronchitis
Respiratory disease (lasting at least 3 mo/year) in which mucus membranes in the bronchial passages become inflamed.
COPD (chronic obstructive pulmonary disease)
Group of lung diseases that block airflow and make breathing difficult. (Emphysema, chronic bronchitis, asthma, and CF all fall under COPD)
Cystic fibrosis
Autosomal recessive gene trait causes thickening of CT leads to fibrosis. Exocrine glands secrete abnormally thick mucus d/t defective epithelial ion transport. Thick mucus causes obstruction of bronchioles and predispose lungs to infection.
Emphysema
Permanent damage to lung(s); ^CO2
Min. cyanosis
Purse lip breathing
Dyspnea
Hyperresonacnce on chest percusion
Orthopnea
Barrel chest
Exertional dyspnea
Prolonged expiratory time
Speaks in short jerky sentences
Anxious
Uses accessory muscles to breathe
Th
Hemoptysis
bloody sputum (usually w/ cough)
Lung cancer
Uncontrolled growth of abnormal cells in one or both lungs. Cells do not function normally in the exhange of O2 and CO2. It is the top cause of cancer deaths in men and women
Orthopnea
Difficulty breathing while lying down
Pleural edema
Buildup of fluid in interstitial tissue (in the lungs)
Pleural effusion
Fluid buildup in pleural space (between ribs and lungs)
Early R.A.T. is late to B.E.D (respiratory distress s/s)
Early sx: Restlessness
Anxiety
Tachycardia
Late sx: Bradycardia
Extreme restlessness
Dyspnea (severe)
Small-cell lung cancer
(AKA oat cell cancer)
Makes up 10-15% of lung cancers
highly malignant (brain metastasis is common)
Tripod position
Indication of respiratory distress
Tuberculosis (TB)
Infects macrophages that attack and consume TB. Will see Ghon Complexes on CXR
Ventilation
If air flow is disrupted it is a ventilation problem
Perfusion
If blood flow is disrupted, it is a perfusion problem
What (s/s) would you see if cancer metastasized to the brain or spinal cord?
Impaired neuro/motor function; LOC
What is the difference between atelectasis and pneumothorax? What are the
similarities?
Atelectasis: incomplete expansion of alveoli (part of lung)
Pneumothorax: air in pleural space causing pressure on lung preventing expansion
What is the difference between an OPEN pneumothorax and a TENSION Pneumothorax? Which is most dangerous?
Open pneumothorax: occurs when air accumulates between chest wall and lung
Tension pneumothorax: when air is trapped in the pleural cavity resulting in increased pressure and mediastinal shift (most dangerous).
What is the significance of tracheal deviation (mediastinal shift)?
The trachea is displaced to the side w/ less pressure, meaning there is an increase in pressure caused by a tension pneumothorax
What is the definition of Hypercapnia and what can cause it?
Too much CO2 in the blood
Caused by problem w/ ventilation
What does the abbreviation "TCDB" stand for and why is this done?
Turn, cough, deep breath: helps to keep alveoli open and prevent further collapse
What does PaO2 measure and what is the normal range?
Measures oxygen in the blood (hypoxemia), nl range 80-100mmHg
What is a pneumothorax?
Air in the pleural space, as a result of the air in the pleural space, there is a partial or complete collapse of the lung.
What is hypoxia; how is hypoxia measured; and what is the normal range?
Hypoxia is low oxygen in the tissue, measured by SaO2, >95%
What is the precipitating even of ARDS and, what is one long-term effect?
Sepsis (other causes; lung/mult trauma, shock)
Long term effect: permanent lung damage, and psychological and cognitive impairment d/t lack of O2
What three factors cause atelectasis?
Blockage of air passages (bronchus/bronchioles)
Pressure on the outside of the lung
Surfactant failure
What is the 1st indicator of hypoxia?
Restlessness
A patient has been receiving 100% oxygen therapy by way of a nonrebreather mask for several days. He reports tingling in his fingers and shortness of breath. He is extremely restless and states that he has pain beneath his breastbone. Based on this histor
A. Hypercapnia resulting from decreased carbon dioxide elimination
B. Oxygen-induced atelectasis
C. Pleural effusion
D. Increased pH
What test is used to determine PaO2?
Arterial blood gas (ABG)
What does SaO2 measure?
Measures tissue perfusion (hypoxia). >95%
What causes a pneumothorax?
Trauma to chest: GSW/knife wound, rib fracture, some medical procedures. (Can also occur spontaneously)
6 P's of Dyspnea
Pulmonary/bronchial constriction
Possible foreign body
PE
Pneumonia
Pump failure
Pneumothorax
Causes of hemoptysis
TB (most common)
Mycobacterial infections (destroy pulm tissue)
Acute/Chronic bronchitis
Bronchiectasis
Indicators of severe hypoxia
Tripod position
Use of accessory muscles
Cyanosis
TB s/s; tx; dx
S/S: Progressive fatigue/Malaise
Pleuritic chest pain
Low grade temp (late afternoon)
Anorexia/Wt loss
Night sweats
Hemoptysis
Tx: 9 mo abx course (usually INH w/ B6)
Decreased activity
Isolation until neg sputum
Dx: CXR
TB skin test/quantiferon gold
Sput
Acute Tubular Necrosis (ATN)
Damage to kidney tubules: kidneys will suffer permanent damage (death) if enough tubules die.
most common in hospitalized pts
ADH (antidiuertic hormone)
Secreted by posterior pituitary gland; excretion caused by low blood volume, low sodium and high osmolarity of body fluids (ADH causes fluid retention to relieve dehydration)
Anemia and kidney disease
Decreased kidney function can lead to decreased erythropoietin production resulting in anemia
ANP (atrial) and BNP (ventricle)
Work together to lower BP
Anti-hypertensive meds
Ace inhibitors: -pril
ARBs: -sartan
Alpha blockers: -sin
Beta blockers: -olol (metoprolol)
Ca++ channel blockers: diltiazem, nifedipine, verapamil
Diuretics: furosemide, hctz, spironolactone
Azotemia
Increased BUN and creatinine in the blood w/o systemic s/s
Uremia
Increased BUN and creatinine with multiple system organ failure
S/S of renal failure
Poor appetite
Bone pain
Headache
Stunted growth
High urine output (diuresis phase)
No urine output (oliguric phase)
recurrent UTIs
Urinary incontinence
Pallor (anemia)
Full body edema
Bleeding tendencies (d/t coagulopathy)
Poor muscle tone
Change in menta
Diabete
Leading cause of kidney failure; caused by high BG levels which triggers inflammatory response.
Prominent s/s diabetes is damaging kidneys is proteinuria.
Electrolyte imbalance
Na+ loss and K+ retention in oliguric phase of renal failure
Glomerular filtration rate (GFR)
Nl range: 85-135; measure of how much blood is filtered by gomeruli every minute. Helps to detect early kidney disease (before creatinine)
(Acute) Glomerulonephritis
Inflammation of the glomerular membrane. Primary caused by untreated group A strep
2ry caused by other diseases/conditions.
Hematuria
Blood in urine
Kidney stones (renal calculi)
Flank pain, radiates from flank to groin, suprapubic pain
High urine concentration=stone forming. Dehydration is modifiable risk factor
Nephritic Syndrome
Inflammatory process that results in hematuria AND proteinuria
Blood urea nitrogen (BUN)
Nl range <20
Indicator of kidney damage
Nephrotic Syndrome
Permeability of glomerular pores allows large loss of protein molecules via the kidneys. Only proteinuria, no hematuria present
Oliguria
Decreased urine output (dehydration/kidney damage)
Anuria
NO urine production (kidney failure)
Periorbital edema
When edema is severe enough the area around the eyes fill with fluid and become swollen.
Proteinuria
Protein in urine
RAAS Response
1. Initiated by decreased perfusion to the kidneys.
2. The kidneys release renin.
3. Renin combines with angiotensinogen (from liver) to form Angiotensin I. (Occurs in blood stream)
4. Angiotensin I is converted in the lungs to angiotensin II by ACE.
5. A
Four phases of AKI
Onset: Sig blood loss, burns, fluid loss. Lasts hours to days
Oliguric: Urine output below 400mL/day. Lasts 8-14 days depending on nature of AKI
Diuretic: Occurs when AKI is corrected. Lasts 7-14 days
Recovery: Decreased edema, nl fluid/electrolyte balanc
Specific gravity
1.010-1.030; measure how dilute/concentrated urine is
Fixed specific gravity
Number never changes through multiple UAs; indicates kidneys can no long dilute/concentrate urine. Late sign of end stage kidney failure.
Renal failture (chronic)
progresses over at least 3 mo; results in permanent renal failure
UTI/Cystitis
Infection of lower urinary tract (bladder and urethra)
Vit D
Activated vit d allows GI tract to absorb calcium preventing hypocalcemia
6 major kidney functions
1. Filters blood
2. Maintains BP
3. Acid-base balance
4. Erythropoietin synthesis
5. Synthesis and release of renin
6. Activate vit D
What s/s would you expect to see if a person has lost protein through their urine (nephrotic syndrome)?
Edema; body will retain water when kidneys malfunction
Differences between cystitis and pyelonephritis
Cystitis: Frequency, urgency, dysuria, suprapubic tenderness
Pyelo: Fever, leukocytosis, N/V, flank pain/tenderness
What is the first s/s of kidney failure?
Edema
What are the two leading causes of CKD?
Diabetes (#1) and HTN (#2)
Ammonia
Brain toxic; high levels will cause change in LOC
Ascites
Free fluid accumulation in the abdomen; BP can drop w/ paracentesis.
What causes ascites?
1. Portal htn
2. Damaged liver not synthesizing serum protein
Asterixis
Flapping tremor of the hands
Colorectal cancer risk factors
Age: 50 yrs or older
Gender: Greater in men than women
Race: Black/Caucasia
Family Hx: 25% of colon cancer
Medical Hx: Crohn's or U.C.
Diet: Unhealthy fats; refined sugars/flour, low fiber/vitamins
Other: Obesity/sedentary lifestyle/lack of exercise, smok
Cholecystitis
(Usually) caused by gallstones or biliary sludge being trapped in opening of gallbladder.
Cirrhosis
Scarring of liver tissue causing it to function abnormally.
Crohn's disease
Autoimmune disorder that can occur anywhere in the GI tract. It involves ALL layers .
Esophageal varices
Large veins in esophagus caused by obstructed blood flow from portal vein.
Gastroesophageal reflux disease (GERD)
Intense heartburn (will r/o MI when seeking tx);
Esophageal sphincter is weak and allows backflow from stomach to esophagus. (Acid damages the lining.)
S/S of GERD
Pain occurs 30-60 min after a meal
Pain worse when lying down (pts will sleep w/ head elevated)
Pain worse when bending over.
GERD risk factors
Obesity
Pregnancy
Smoking
Hiatal hernia
Fatty foods
Alcohol
Chocolate
GI bleed s/s
Occult
Hematemesis
-Bright red emesis (very dangerous, usually from esophageal varices)
-Coffee ground emesis (usually d/t partial digestion in stomach.)
Melena (black, tarry stools: equivalent of coffee ground emesis; alkaline digestive enzymes breakdown
What are some causes of a GI bleed?
Hemorrhoids
Ulcers
Esophageal inflammation
Ulcerative colitis
Chron's disease
Hepatic encephalopathy
Damaged liver cannot break down protein; ^^ ammonia levels. Ammonia is highly brain toxic
Hepatitis A
Oral-fecal (food borne)
Hepatitis B
Blood/bodily fluid borne: Most commonly spread by unprotected sex, dirty needles, mom to baby. Major cause of liver cancer; vaccination available.
Hepatitis C
Blood/bodily fluid borne: Most commonly spread by unprotected sex, dirty needles, mom to baby.
Major cause of liver cancer. No vaccination; tx available
Hepatorenal syndrome
1. Decreased blood circulation will trigger RAAS system; causes vasoconstriction and ^BP.
2. Hepatic failure prevents removal of angiotensin; HTN will get worse if not corrected.
3. Azotemia will occur following kidney damage.
End stage renal failure.
Hiatal hernia
Protrusion of upper part of stomach through diaphragm. May be caused by a weakening of supporting tissue/structures. Usually only symptomatic if GERD is present.
Risk factors for HH
Age
Pregnancy
Obesity
Habitual vomiting
Weight training
Smoking/alcohol use
Irritable bowl syndrome (IBS)
functional GI disorder" caused by changes in the GI tract w/ damage.
Jaundice/icterus
Damaged liver cannot break down bilirubin (in RBCs) depositing in the skin turning it yellow.
Stools will be white.
Liver enzymes (LFTs)
ALT/AST increase w/ damage to liver tissue
Peptic ulcer disease
Erosion of GI mucosa usually caused by H. Pylori bacteria. Occurs in 90% of duodenal ulcers.
Risk factors of PUD
Smoking (1st and 2nd)
Alcohol use
NSAID use
Pruritis
Intense itching d/t jaundice/icterus
Ulcerative colitis (UC)
Autoimmune disease that occurs in the large intestine; only involves mucosal layer
What are some complications of ulcerative colitis?
Obstruction
Dehydration (fluid/electrolyte imbalance)
Anemia
Chronic bloody diarrhea
Unintended wt lostt
abd pain/cramping
HIGH risk for colorectal cancer
Asterixis is an early warning sign of what?
Hepatic encephalopathy
What is portal hypertension?
Increased blood pressure in the portal vein.
What is a common cause for portal htn?
Cirrohsis
What are some sx of portal htn?
Black, tarry stools
Hematemesis (emergency)
Ascites
Esophageal/stomach varices
Hemorrhoids
6 F's of Cholecystitis
Fair skin
Fat
Fertile
Female
Forties
Family hx
What is a warning sign of cholecystitis?
Pain immediately after eating (fatty foods).
What is the most common cause of cirrhosis?
Chronic alcohol use/abuse
*Can also be caused by hepatitis or hepatotoxic drugs (tylenol)
What are some complications of Chron's disease?
Perforation/obstruction
Malabsorption
Fluid/electrolyte imbalance
Diarrhea (dehydration)
Compensated
pH is NORMAL, other two values abnormal
Partially compensated
ALL values abnormal
Uncompensated
pH and ONE other value abnormal
Hypervolemia s/s
Edema
Abd swelling
HTN/heart problems
HA
Wt gain
hypovalemia s/s
Anxiety, pallor, confusion, oliguria/anuria, tachypnea
HypErtonics (fluid Enters blood stream)
Fluid is pulled from the tissue into the blood stream by high concentration of solutes. Large molecules (protein/glucose) attract water. Used for RAPID fluid replacement.
Ususally used in emergent situations to allow vessels to be filled to keep from losi
HypOtonics (fluid goes out of vessel)
Fluid moves from low to high concentrations . Used when tissue is dehydrated.
Isotonics (stay where I put it)
Most commonly used; fluid moves EQUALLY back and forth across a membrane w/o changing cell size.
*Preferred for fluid replacement d/t similar tonicity to blood.
Airborne precautions (You're on the air with MTV)
Precautions: private room, negative pressure when possible. 6-12 air exchanges/hour
Providers wear N95/HEPA
Pts/visitors to wear standard masks at all times
Measles (rubeola)
TB
varicella (also use contact*)
Contact precautions (Mrs. WEE says "can't touch this.")
Precautions: Gown/gloves, shoe/hair covers as needed.
MDRO
Respiratory infections
Skin infections
Wounds
Enteric infections (c. diff)
Eye infections (conjunctivitis)
Droplet precautions (Mr. Pimp drops in for an unwelcome visit.)
Precautions: standard room, mask for staff and visitors. Gloves/gown/eye protection as needed.
Meningitis
Rubella (German measles)
Pertussis
Influenza
Mumps
Pneumonia
Hypotonic solutions
0.45% NS
0.225% NS
D5W
Hypertonic solutions
3% saline
6%
Albumin
D50
Hetastarch
Isotonic solutions
0.9% NS
Lactated ringers
Calcium Ca++ (8.5-10.5)
Extracellular; CALMS muscles and nerves (Chvostek's signs)
Low Ca=laryngeal spasms
Hi Ca=muscle weakness
Sodium Na+ (135-145)
Extracellular; EXCITES nervous system
Low Na= same s/s fluid overload
Hi Na= same s/s dehydration
Potassium K+ (3.5-5.0)
Intracellular; affects cardiac tissue and GI tract
Low K=dysrhythmias, N/V, paresthesia, seizures, and constipation (calms GI)
High K=diarrhea (excites GI)
Magnesium Mg+ (1.5-3.0)
Intracellular; CALMS smooth muscle and DTRs
Low Mg= hyperreflexia
High Mg= resp failure
milk of magnesia=laxative