NR 583 Week 5 Worksheet
Student Name
Chamberlain University
NR-583: Informatics for Advanced Nursing Practice
Prof. Name
Date
NR 583 Week 5 Worksheet
Pulmonary Disorders
Discuss pulmonary edema. Include the pathophysiology, risk factors, and clinical manifestations.
Pulmonary edema occurs when an abnormal amount of fluid accumulates in the alveoli and lung interstitial spaces, interfering with oxygen diffusion. The pathophysiology may involve:
- Increased hydrostatic pressure (e.g., left-sided heart failure or fluid overload).
- Reduced oncotic pressure (e.g., low serum albumin levels in liver failure or nephrotic syndrome).
- Increased capillary permeability (e.g., acute respiratory distress syndrome or inhalation injury).
Risk factors include cardiovascular disease, renal dysfunction, severe infections, high altitude, and prolonged hypertension.
Clinical manifestations may present as shortness of breath, orthopnea, tachypnea, cyanosis, productive cough with frothy sputum, pulmonary crackles on auscultation, and hypoxemia that worsens with exertion.
Discuss pulmonary embolus. Include the pathophysiology, risk factors, and clinical manifestations.
A pulmonary embolus (PE) occurs when a thrombus, fat, air bubble, or amniotic fluid blocks the pulmonary artery or its branches. The pathophysiology includes obstruction of blood flow, resulting in increased pulmonary vascular resistance, impaired gas exchange, and strain on the right ventricle. Severe obstruction may lead to acute right-sided heart failure.
Risk factors include immobilization, trauma, surgery, obesity, pregnancy, smoking, oral contraceptives, and inherited clotting disorders such as Factor V Leiden.
Clinical manifestations often develop suddenly and include dyspnea, pleuritic chest pain, tachycardia, anxiety, cough, hemoptysis, diaphoresis, and in severe cases, syncope, hypotension, or sudden death.
Discuss pneumothorax. Include the pathophysiology and clinical manifestations.
A pneumothorax occurs when air enters the pleural cavity, disrupting the negative intrapleural pressure required for lung expansion. This may lead to partial or complete lung collapse. It may occur spontaneously, from chest trauma, or as a complication of invasive procedures and mechanical ventilation.
Clinical manifestations include sharp chest pain, dyspnea, decreased or absent breath sounds on the affected side, hyperresonance on percussion, tachypnea, and in the case of tension pneumothorax, tracheal deviation, hypotension, and cardiovascular collapse.
Discuss tuberculosis. Include the pathophysiology, incidence, risk factors, and clinical manifestations.
Tuberculosis (TB) is caused by Mycobacterium tuberculosis, a bacterium transmitted via airborne droplets. After inhalation, bacilli are engulfed by macrophages, leading to granuloma formation (Ghon complex). The disease may remain latent or progress to active infection if immune defenses fail.
Incidence: TB remains among the top causes of infectious disease–related mortality worldwide, with higher prevalence in low-income nations and regions with limited healthcare resources.
Risk factors: HIV/AIDS, immunosuppressive medications, malnutrition, diabetes, poverty, overcrowding, and close contact with infected individuals.
Clinical manifestations: Persistent cough with or without hemoptysis, weight loss, fever, night sweats, fatigue, chest pain, and reduced appetite. Disseminated TB may affect kidneys, spine, and central nervous system.
Hematologic Disorders
| Disorder | Pathophysiology | Risk Factors | Clinical Manifestations | Treatment |
|---|---|---|---|---|
| Leukemia | Uncontrolled proliferation of abnormal white blood cells, crowding out normal cells | Genetic mutations, radiation, prior chemotherapy | Recurrent infections, fatigue, bleeding, anemia, enlarged lymph nodes | Chemotherapy, radiation, targeted therapy, stem cell transplant |
| Anemia | Decrease in red blood cells or hemoglobin, reducing oxygen transport | Nutrient deficiencies, chronic disease, heredity | Fatigue, pallor, shortness of breath, tachycardia | Iron therapy, vitamin supplements, transfusions |
| Pernicious Anemia | Autoimmune destruction of parietal cells → vitamin B12 deficiency | Autoimmune diseases, gastric surgery, heredity | Glossitis, tingling, cognitive changes | Vitamin B12 injections or high-dose oral supplements |
| Sickle Cell Anemia | Mutation in hemoglobin gene → RBC sickling and hemolysis | African ancestry, family history | Pain crises, jaundice, organ damage, susceptibility to infections | Hydroxyurea, transfusions, hydration, pain control |
| Polycythemia Vera | Overproduction of RBCs due to bone marrow abnormality | Age >60, JAK2 gene mutation | Headaches, dizziness, itching, blood clots | Phlebotomy, aspirin, hydroxyurea |
Which lab value is commonly used to measure anemia?
Hemoglobin levels and hematocrit are the most common laboratory values for diagnosing anemia. Additional tests such as ferritin, vitamin B12, and folate may be ordered to determine the underlying cause.
Discuss the significance of petechiae and purpura.
Petechiae are pinpoint, red or purple spots under the skin caused by minor capillary bleeding, while purpura are larger areas of skin discoloration due to bleeding into tissues. Both may signal platelet abnormalities, clotting disorders, or bone marrow diseases. Their presence is often associated with conditions like thrombocytopenia, leukemia, or vasculitis.
Cardiovascular Disorders
Compare and contrast sympathetic and parasympathetic nervous system.
| Feature | Sympathetic Nervous System | Parasympathetic Nervous System |
|---|---|---|
| Primary function | “Fight or flight” response | “Rest and digest” response |
| Heart rate | Increases | Decreases |
| Respiratory rate | Increases | Decreases |
| Pupils | Dilated | Constricted |
| GI function | Decreases motility | Increases motility |
List one non-modifiable risk factor for hypertension.
Age is a non-modifiable risk factor, as arterial stiffness and vascular resistance typically increase with aging.
List three modifiable risk factors for hypertension.
- Obesity
- Excess dietary sodium
- Sedentary lifestyle
Define cardiac output and discuss its significance.
Cardiac output is the amount of blood pumped by the heart in one minute, calculated as stroke volume × heart rate. It is vital for ensuring adequate oxygen delivery and nutrient supply to tissues. A low cardiac output can result in hypotension, shock, and organ failure.
Atherosclerosis puts the individual at high risk for developing which cardiac disorder?
Atherosclerosis significantly increases the risk of coronary artery disease (CAD), myocardial infarction, and cerebrovascular events like stroke.
What does the lab test CPK-MB assess for?
Creatine phosphokinase-MB (CPK-MB) is an enzyme released from damaged myocardial cells. It is a key diagnostic marker for myocardial infarction and helps distinguish cardiac injury from other causes of chest pain.
Discuss the general treatment for cardiac conditions.
Management of cardiac conditions typically includes:
- Lifestyle modifications: Diet, exercise, weight control, smoking cessation.
- Medications: Antihypertensives, statins, anticoagulants, beta-blockers.
- Procedures: Angioplasty, coronary artery bypass surgery, pacemaker insertion.
- Patient education: Self-care practices and adherence to therapy.
Cardiac Disorders
What is cor pulmonale? What happens with cor pulmonale?
Cor pulmonale is right-sided heart failure secondary to chronic pulmonary hypertension. This condition results in right ventricular hypertrophy and venous congestion, often linked to chronic lung diseases such as COPD, interstitial lung disease, or pulmonary embolism.
Define congestive heart failure. List the signs, symptoms, and treatment.
Congestive heart failure (CHF) occurs when the heart cannot pump enough blood to meet the body’s demands.
- Signs and symptoms: Dyspnea, orthopnea, fatigue, edema, weight gain, nocturnal cough, and decreased exercise tolerance.
- Treatment: Diuretics, ACE inhibitors, beta-blockers, sodium restriction, lifestyle adjustments, and advanced therapies like implantable devices or transplant in refractory cases.
Why would you recommend avoidance of prolonged stress for a patient with congenital heart disease?
Prolonged stress triggers sympathetic nervous system activation, elevating heart rate and blood pressure. This increases cardiac workload, which may exacerbate congenital heart defects and predispose patients to arrhythmias or heart failure.
Explain why untreated essential hypertension is dangerous.
If left untreated, hypertension can damage vital organs by promoting arteriosclerosis. Complications include heart failure, chronic kidney disease, stroke, aneurysm, and retinopathy, which can result in blindness.
Define and explain the term intermittent claudication.
Intermittent claudication refers to cramping leg pain during physical activity caused by insufficient blood flow due to peripheral arterial disease. The pain is typically relieved with rest. It signals compromised circulation and risk for arterial obstruction.
Describe three early signs of shock and the rationale for each.
| Early Sign | Rationale |
|---|---|
| Tachycardia | Compensatory mechanism to maintain cardiac output |
| Cool, clammy skin | Peripheral vasoconstriction to preserve blood flow to vital organs |
| Altered mental status | Decreased cerebral perfusion due to reduced cardiac output and oxygen delivery |
List two types of congenital heart defects. Briefly describe each including any change in directional blood flow.
- Tetralogy of Fallot (TOF): Characterized by four defects—ventricular septal defect, pulmonary stenosis, right ventricular hypertrophy, and overriding aorta. It causes right-to-left shunting of blood, leading to cyanosis.
- Atrial Septal Defect (ASD): A hole in the atrial septum allows blood to flow from the left atrium to the right atrium (left-to-right shunt), increasing pulmonary circulation and workload on the right heart.
References
World Health Organization. (2024). Global tuberculosis report. WHO.
American Heart Association. (2023). Heart disease and stroke statistics. Circulation.
Centers for Disease Control and Prevention. (2024). Tuberculosis data and statistics. https://www.cdc.gov/tb
NR 583 Week 5 Worksheet
Huether, S. E., McCance, K. L., & Brashers, V. L. (2020). Understanding pathophysiology (7th ed.). Elsevier.
National Heart, Lung, and Blood Institute. (2023). Blood diseases and conditions. https://www.nhlbi.nih.gov