NR 583 Week 5 Worksheet

Pulmonary Disorders

Discuss pulmonary edema. Include the pathophysiology, risk factors, and clinical manifestations.

Pulmonary edema is a condition characterized by the accumulation of excess fluid in the alveoli and lung interstitial spaces, which interferes with the diffusion of oxygen. The pathophysiology can involve several mechanisms: increased hydrostatic pressure due to left-sided heart failure or fluid overload, decreased oncotic pressure from low serum albumin levels seen in liver failure or nephrotic syndrome, and increased capillary permeability as a result of acute respiratory distress syndrome or inhalation injury.

Risk factors include cardiovascular disease, renal dysfunction, severe infections, high altitude exposure, and prolonged hypertension. Clinical manifestations may present as shortness of breath, orthopnea, tachypnea, cyanosis, productive cough with frothy sputum, pulmonary crackles upon auscultation, and hypoxemia that worsens with physical 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 obstructs the pulmonary artery or its branches. The pathophysiology involves blockage of pulmonary blood flow, which increases pulmonary vascular resistance, disrupts gas exchange, and strains the right ventricle. In cases of severe obstruction, acute right-sided heart failure may develop.

Risk factors include immobilization, recent trauma, surgery, obesity, pregnancy, smoking, oral contraceptive use, and inherited clotting disorders such as Factor V Leiden. Clinical manifestations often appear 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 that is necessary for lung expansion, which can result in partial or complete lung collapse. This may occur spontaneously, due to chest trauma, or as a complication of invasive procedures or mechanical ventilation.

Clinical manifestations include sharp chest pain, dyspnea, decreased or absent breath sounds on the affected side, hyperresonance on percussion, and tachypnea. In cases of tension pneumothorax, tracheal deviation, hypotension, and cardiovascular collapse may occur.

Discuss tuberculosis. Include the pathophysiology, incidence, risk factors, and clinical manifestations.

Tuberculosis (TB) is caused by Mycobacterium tuberculosis, a bacterium transmitted through airborne droplets. Once inhaled, bacilli are engulfed by macrophages, leading to granuloma formation known as the Ghon complex. The disease may remain latent or progress to an active infection if immune defenses are weakened.

In terms of incidence, TB remains one of the leading causes of infectious disease–related mortality worldwide, particularly in low-income nations with limited access to healthcare. Risk factors include HIV/AIDS, immunosuppressive medications, malnutrition, diabetes, poverty, overcrowding, and close contact with infected individuals. Clinical manifestations typically include a persistent cough (with or without hemoptysis), weight loss, fever, night sweats, fatigue, chest pain, and reduced appetite. Disseminated TB may spread to the kidneys, spine, and central nervous system.

Hematologic Disorders

Which lab value is commonly used to measure anemia?

Hemoglobin and hematocrit levels are the most commonly used laboratory values for diagnosing anemia. Additional tests such as ferritin, vitamin B12, and folate may be performed to determine the underlying cause.

Discuss the significance of petechiae and purpura.

Petechiae are small red or purple spots under the skin caused by minor capillary bleeding, whereas purpura are larger patches of skin discoloration due to bleeding into the tissues. Both conditions indicate potential platelet abnormalities, clotting disorders, or bone marrow diseases and are often associated with conditions such as thrombocytopenia, leukemia, or vasculitis.

Cardiovascular Disorders

Compare and contrast sympathetic and parasympathetic nervous system.

List one non-modifiable risk factor for hypertension.

Age is a non-modifiable risk factor, as vascular stiffness and resistance increase naturally with aging.

List three modifiable risk factors for hypertension.

Obesity, excess dietary sodium, and a sedentary lifestyle are modifiable risk factors for hypertension.

Define cardiac output and discuss its significance.

Cardiac output refers to the amount of blood the heart pumps in one minute and is calculated as stroke volume multiplied by heart rate. It is essential for maintaining adequate tissue oxygenation and nutrient delivery. A decreased cardiac output can lead to hypotension, shock, and multi-organ dysfunction.

Atherosclerosis puts the individual at high risk for developing which cardiac disorder?

Atherosclerosis substantially increases the risk for coronary artery disease (CAD), myocardial infarction, and cerebrovascular accidents such as stroke.

What does the lab test CPK-MB assess for?

The CPK-MB test measures creatine phosphokinase-MB, an enzyme released when myocardial cells are damaged. It is a key diagnostic marker used to confirm myocardial infarction and differentiate cardiac from non-cardiac causes of chest pain.

Discuss the general treatment for cardiac conditions.

The general management of cardiac conditions involves lifestyle modifications, medications, and procedures. Lifestyle changes include a heart-healthy diet, regular exercise, weight control, and smoking cessation. Pharmacologic interventions include antihypertensives, statins, anticoagulants, and beta-blockers. In more severe cases, procedures such as angioplasty, coronary artery bypass surgery, or pacemaker insertion may be indicated. Patient education focusing on self-care and adherence to therapy is also essential.

Cardiac Disorders

What is cor pulmonale? What happens with cor pulmonale?

Cor pulmonale refers to right-sided heart failure secondary to chronic pulmonary hypertension. The increased pulmonary pressure causes right ventricular hypertrophy and venous congestion. It is commonly associated with 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 sufficient blood to meet the body’s metabolic needs. Common signs and symptoms include dyspnea, orthopnea, fatigue, edema, weight gain, nocturnal cough, and decreased exercise tolerance. Treatment options include diuretics, ACE inhibitors, beta-blockers, sodium restriction, and lifestyle modifications. In advanced cases, device implantation or heart transplantation may be necessary.

Why would you recommend avoidance of prolonged stress for a patient with congenital heart disease?

Prolonged stress activates the sympathetic nervous system, increasing heart rate and blood pressure. This heightened cardiac workload can exacerbate congenital heart defects and elevate the risk of arrhythmias or heart failure.

Explain why untreated essential hypertension is dangerous.

Untreated essential hypertension causes progressive damage to vital organs by promoting arteriosclerosis. This can lead to severe complications such as heart failure, chronic kidney disease, stroke, aneurysm formation, and hypertensive retinopathy resulting in vision loss.

Define and explain the term intermittent claudication.

Intermittent claudication is characterized by cramping leg pain during physical activity due to inadequate blood flow from peripheral arterial disease. The pain typically subsides with rest and serves as a clinical indicator of compromised circulation and potential arterial blockage.

Describe three early signs of shock and the rationale for each.

List two types of congenital heart defects. Briefly describe each including any change in directional blood flow.

Tetralogy of Fallot (TOF): This defect includes four abnormalities—ventricular septal defect, pulmonary stenosis, right ventricular hypertrophy, and overriding aorta. These collectively cause right-to-left shunting, leading to cyanosis.
Atrial Septal Defect (ASD): A hole in the atrial septum permits left-to-right blood flow between the atria, increasing pulmonary circulation and workload on the right heart.

References

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

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

World Health Organization. (2024). Global tuberculosis report. WHO.