Nursing: Respiratory, CV, Hematology

S&S of Pneumothorax

-Ipsilateral (same side) chest pain
-Increased respiratory rate
-Dyspnea
-Increased heart rate
-Asymmetrical heart movement
-Hyperresonant upon percussion
-Decreased breath sounds

Immediate treatment of Pneumothorax

Chest Tube

S&S of Acute Onset Asthma

-Wheezing
-SOB
-Dyspnea
-Chest tightness
-Mucus production
-Coughing
-Use of accessory muscles

Immediate treatment of Asthma (quick relief)

Emergency Treatment: EPInephrine causes: bronchodilation, increased RR, increased HR, increased BP
Bronchodilators
-short-acting beta-adrenergic agonists
-Anticholinergics
-Corticosteroids

Ipratropium (Atrovent)
Class, Uses, Actions, Contraindications

Ipratropium (Atrovent)
Class: inhaled anticholinergic
Action: block muscarinic receptors on bronchi resulting in bronchodilation
Uses: to relieve bronchospasm associated with COPD & allergen-induced & exercise-induced asthma
Contraindications:
-peanut allergy
-narrow-angle glaucoma
-benign prostatic hypertrophy (due to anticholinergic effects)

Albuterol (Proventil)
Class, Uses, Actions, Contraindications

Albuterol (Ipratropium)

Class: Beta-2 Adrenergic Agonist

Action: selectively activate the beta-2 receptors in the bronchial smooth muscle resulting in bronchodilation
~Bronchospasm is relieved
~Histamine release is inhibited
~Ciliary motility is increased

Uses: to prevent asthma attack, tx for ongoing asthma attacks, long-term control of asthma

Contraindications:
-Tachydysrhythmias
-Caution in clients with diabetes, hyperthyroidism, heart disease, hypertension, & angina

Theophylline (Theolair)
Class, Uses, Actions, Contraindications

Theophylline (Theolair)
Class: methylxanthines
Action: relaxes bronchial smooth muscle resulting in bronchodilation
Uses: long-term control of chronic asthma
Contraindications:
-Caution in clients with heart disease, hypertension, liver & renal dysfunction, & diabetes
-Caution in children & older adults
Do not stop or start smoking while taking theophylline. Decreases clearance

Acetylcysteine (Mucomyst)
Class, Uses, Actions, Contraindications

Acetylcysteine (Mucomyst)
Class: Mucolytic
Action: enhance the flow of secretion in the respiratory passages
Uses: acute & chronic COPD, cystic fibrosis, antidote for acetaminophen poisoning
Contraindications:
-Not to be used in clients at risk for GI hemorrhage
-Caution in clients with PUD, esophageal varicies, & severe liver disease

Phenylephrine
Class, Uses, Actions, Contraindications

Phenylephrine
Class: Decongestant
Action: stimulate alpha-1 adrenergic receptors causing reduction in the inflammation of the nasal membranes
Uses: allergic rhinitis by relieving nasal stuffiness, decongestant for clients with sinusitis & the common cold
Contraindications:
-clients with chronic rhinitis
-Caution in clients with coronary artery disease & HTN

Reactive Airway Disease
Patho, S&S, Tx

Reactive Airway Disease (RAD)
-an asthma-like syndrome that developed after a single exposure to high levels of an irritating vapor, fume, or smoke.
S&S:
-SOB
-Chest tightness
-Wheezing
Tx: Bronchodilators

Chronic Obstructive Pulmonary Disease (COPD)
Patho, & Tx

COPD
-a group of respiratory disorders including: Chronic Bronchitis & Emphysema characterized by chronic and recurrent obstruction of airflow in pulmonary airways
-Bronchial-wall hypersecretion of mucus causes obstruction of airflow and mismatch of ventilation & perfusion
Tx: Albuterol (Proventil)

Bodies response to Respiratory Hypoxemia

-Hypoxemia
-Hypercapnea (increased PaCO2)
-Cyanosis
-Tachypnea (fast breathing)
...causes reflex vasoconstriction of the pulmonary vessels which further impairs gas exchange.
If left untreated, Hypoxemia can cause HTN & right-sided heart failure

A patient born with Alpha1 Antitrypsin Deficiency is likely to develop....

Emphysema & COPD
Alpha1 antitrypsin deficiency (AATD) can cause lung disease in adults and liver disease in adults & children.
-Alpha1 antitrypsin: an enzyme that protects the lungs from injury
Clients with AATD increase their risk of developing Emphysema & COPD if they are smokers!

Consistent use of nasal decongestant sprays can cause...

Rebound Congestion
Often confused with "nasal spray addiction".
Persistent use of nasal decongestants cause the nasal membranes to become "tolerant"--or less responsive to the effects of the medication. As a result, you must use more of the medication to have an effect or your congestion may worsen if you stop the medication (rebound congestion). Reversible
-Stop using for several weeks to reduce tolerance.

Treatment for non-productive cough include:

Expectorants: Guaifenesin
-Action: Liquify & loosen secretions
Antitussives: Dextromethorphan
-Action: Control non-productive cough

What medication class should not be used in an Asthmatic Patient?

Beta Blockers
They cause bronchoconstriction!

What is the role of Nitric Oxide in the vascular endothelium?

Nitric oxide is important to the regulation of blood flow.

Effects of NO:
-Direct vasodilation
-Indirect vasodilation by inhibiting Angiotensin II
-Anti-thrombotic
-Anti-inflammatory
-Antiproliferative

If production of Nitric Oxide is impaired or its bioavailablity is reduced, what can result?

-Vasoconstriction (coronary vasospasm, elevated systemic vascular resistance, HTN)
-Thrombosis due to platelet aggregation & adhesion to vascular endothelium
-Inflammation due to upregulation of leukocyte & endothelial adhesion molecules
-Vascular hypertrophy & stenosis

Disease conditions associated with abnormal Nitric Oxide production and availability:

-HTN
-Obestiy
-Dyslipidemias (hypercholesterolemia & hypertriglyceridemia)
-Diabetes (type I & II)
-Heart Failure
-Atherosclerosis
-Cigarette smoking

Which side of the heart if failing with (JVD) jugular venous distention?

JVD = Right-Sided Heart Failure

ACE inhibitors act on which body system?

ACE inhibitors act on the renin-angiotensin-aldosterone system
eg. Captopril

S&S of Pulmonary Edema

-Peripheral edema
-Sacral edema
-Pink-frothy sputum

What is the leading cause of death in young athletes?

Hypertrophic Cardiomyopathy

Inotropic medications effect the hearts...

Contraction

Chronotropic medications effects the hearts...

Heart Rate

Dromotropic medications effects the hearts...

Conduction velocity--impulse to contract
(dromo- "speed")

Preload of the Right Ventricle is measured by...

Central Venous Pressure (CVP)

Adverse effects of Phosphodiesterase Inhibitors...

-Hypotension
-Hyperthermia

What class of medications should NOT be used in clients with Left-Heart Failure?

Beta-Blockers
-Can causes further respiratory depression & exacerbate breathing difficulties

Dysrhythmia associated with sudden cardiac death...

Ventricular Fibrillation
Ineffective contraction of the ventricles (fibrillation) occurs when blood flow to the heart muscle is decreased by partial or complete blockage of the coronary artery.
A sudden, severe blockage may lead to MI

S&S of Cardiac Ischemia

-Angina pectoris
-Neck or jaw pain
-Arm pain
-Clammy skin
-SOB
-Nausea & vomiting

S&S of Angina

-Chest pain
-GERD
-No belly pain!

A common symptom of Cardiomyopathy...

Difficulty breathing

Beta-Adrenergic Agonists

DoBUTamine
-Increase HR (+ chronotrope)
-Increase contractility (+ inotrope)
-Increase rate of conduction through the AV node (+ dromotrope)
Tx of Acute CHF

Beta-Adrenergic Blockers

Metoprolol (Lopressor)
-Decrease HR (- chronotrope)
-Decrease contractility (-inotrope)
-Decrease rate of conduction though the AV node (- dromotrope)

Tx of Chronic CHF

Cardiac Glycosides

Digoxin
- Increase contractility (+ inotrope)
-Decrease HR (- chronotrope)
Tx of HF & A-Fib

Medications used for CHF & their effects...

Vasodilators: ACE inhibitors & nitrates
-Decrease workload of overworked cardiac muscle by reducing afterload
Diuretics
-Decrease blood volume, which decreases venous return & BP reducing preload
Beta-Adrenergic Agonists
-Stimulate the beta-receptors in the sympathetic nervous system, increasing calcium flow into the myocardial cells and causing increased contraction
Beta-Adrenergic Blockers
-Reduces myocardial stress of prolonged SNS activation

Phosphodiesterase Inhibitors
Class, Action, Uses, Contraindications

Phosphodiesterase inhibitors
-Class: Cardiotonic (inotropic) agent
Milrinone (Primacor): short-term management of CHF in patients who are receiving digoxin & diuretics.
-Action: blocks the enzyme phosphodiesterase, leading to an increase in myocardial cell adenosine monophosphate (cAMP), which increases calcium levels in the cell, causing stronger contraction & prolonged response to sympathetic stimulation
-Uses: short-term Tx of CHF in patients unresponsive to digitalis, diuretics, & vasodilators

S&S of Kawasaki Disease

-Fever
-Viral rash on stomach, chest, & genitals
-Severely red eyes
-Dry, cracked lips
-Swollen tongue
-White coating on tongue
-Swollen palms of hands and soles of feet
Most often effects children <5yrs>

Pericarditis

Inflammation of pericardium that can result from cardiomyopathy

Angiotensin II Receptor Blockers (ARBs)

ARBs (-sartan)
Action: selectively bind with angiotensin II receptor sites in vascular smooth muscle & the adrenal gland to block vasoconstriction & the release of aldosterone
Uses: HTN, CHF, slows progression of renal disease in pts with HTN & type 2 diabetes
Contraindications:
-renal artery stenosis/dysfunction
-pregnancy 2nd & 3rd trimester fetal injury

Angiotensin-Converting Enzyme (ACE) Inhibitors

ACE (-pril)
Action: block the production of angiotensin II to cause: vasodilation and excretion of sodium & water
Uses: Heart failure, HTN, MI, diabetic & nondiabetic nephropathy

What is the correlation between COX-2 enzyme & asthma?

Some people suffer from asthma & rhinitis attacks in response to aspirin & NSAIDs

NSAIDs effect on COX-2 Enzymes

NSAIDs inhibit prostaglandin synthesis of COX-1 & COX-2.
-COX2 is active at sites of trauma or injury
-NSAIDs block inflammation before all of the S&S can develop
-NSAIDs is a COX-2 inhibitor
-COX-2 inhibitors block the inflammatory action

What conditions cause Disseminated Intravascular Coagulation (DIC)?

Widespread coagulation and bleeding in the vascular compartment
Clinical conditions that may cause DIC include:
-Obstetric disorders (account for 50% of cases)
-Massive trauma
-Shock
-Infections
-Malignant disease (including Leukemia)

What conditions cause Idiopathic Thrombocytopenic Prupura (ITP)?

Widespread platelet thrombi in arterioles & capillaries of the heart, brain, & kidneys; thrombocytopenia; erythrocyte fragmentation causing hemolytic anemia and jaundice
ITP syndrome is occasionally precipitated by:
-Estrogen use
-Pregnancy
-Drugs
-Infections associated with HIV

What organ clears old RBCs in the body?

Spleen

Dark, cola-colored urine is due in part by what part of RBCs?

Iron

Tx of Pernicious Anemia

Pernicious anemia is a form of megaloblastic anemia due to vitamin B-12 deficiency due to impaired absorption.
Tx: life-long parenteral administration of Vit. B-12 B-12 cannot be absorbed orally

Ferrous Sulfate (Feosol)
Class, Action, Uses, Side Effects/Adverse Effects

Ferrous Sulfate (Feosol)
Class: Iron Preparation
Action: provide the iron needed for RBC production
Uses: Tx & prevention of Iron deficiency anemia
Side Effects/Adverse Effects:
-GI distress: nausea, constipation, heartburn
-Teeth staining
-Anaphylaxis risk with parenteral administration

What puts you at risk for Anemia?

-Women in their childbearing years
-Pregnancy
-Heavy menstrual periods
-Low-iron diet
-Chronic blood loss

WBCs that are mobilized for allergic response....

Lymphocytes: 20-30% of WBCs.
-Move from blood to tissue
-Function in lymph nodes or spleen to defend against foreign microbes
Monocytes: 3-8% of WBCs.
-Last for months of years
-Engulf foreign material
-Activate lymphocytes by presenting antigen to T-cells (immune response)

What are the types of WBC disorders & what precautions should be in place for these patients?

WBC Disorders:
-Chronic lymphocytic leukemia (CLL)
-Chronic myelogenous leukemia (CML)
-Acute lymphocytic leukemia (ALL)
-Acute myelogenous leukemia (AML)
Precautions:
-Infection protection
-Bleeding precautions
-Energy management

What is Agranulocytosis?

Inadequate amounts of white blood cells called neutrophils or granulocytes.
Causes:
-Bone marrow producing insufficient amounts of neutrophils
-When WBCs are destroyed faster than produced
Patients with Agranulocytosis are more prone to infection

Epoetin alfa (Epogen)
Class, Action, Uses, Contraindications

Epoetin alfa (Epogen)
Class: Hematopoietic Growth Factor
Action: act on the bone marrow to increase production of RBCs
Uses:
-Anemia in chronic renal failure
-Chemotherapy-induced anemia
Contraindications:
-Clients with uncontrolled HTN
-Caution in clients with cancers of the bone marrow

Dextromethorphan
Class, Action, Uses, Contraindications

Dextromethorphan
Class: Antitussive
Action: acts directly on medullary cough center of the brain to depress the cough reflex
Uses: control of non-productive cough
Contraindications:
-Do NOT use on post-op patients or those with head injury

What are the risk factors related to lab work with lipids?

Lipid transport in the body:
-dietary lipids absorbed by chylomicrons
-adipose & muscle cells take up lipids from chylomicrons
-chylomicrons remnants are intermediate density lipoproteins
-IDLs become LDL's (bad cholesterol)
-LDL's deliver fat to liver
-Some LDL's are taken by scavenger cells, macrophages

S&S of Venous Insufficiency

Venous Insufficiency
-Stasis dermatitis (brown discoloration of ankles & calfs)
-Edema
-Ulcers
-Shiny skin
-No hair