ATI PN COMPREHENSIVE STUDY GUIDE-2023

ATI PN COMPREHENSIVE STUDY GUIDE-2023

PN2 Exam #2 Study Guide
ASTHMA
• Characterized by exacerbations of acute airway inflammation
• Airway obstruction occurs d/t bronchoconstriction, mucous, or inflammation whenexposed to a trigger
Clinical Manifestations:
• High-pitched, wheezing lung sounds
• Cough
• SOB
• Chest tightness
• Worsens at night or when triggers are present
Medications:
• Short Acting= Albuterol, Proventil, Ventolin
• Long Acting= Serevent
• Corticosteroids= Serevent, Advair
Education:
• Avoid triggers
• Stop/avoid smoking
• Teach which inhaler is rescue
Exacerbation Interventions:
• Give short-acting beta agonist
• IV corticosteroids depending on severity
• O2 via nasal cannula
• High-fowler’s position
• Calm atmosphere
Questions:
If a pt. is having an asthma attack how would you expect it to affect their VS?
• At first RR increased then decreased as attack progresses
• Tachycardia >120
• Decreased BP

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If you give a pt. Albuterol, what type of side effects would you expect to see?
• Increased HR
• Tremors
What are rescue medications for Asthma?
• Short-acting beta agonists (Albuterol)

EPITAXIS
• Nose bleed – d/t trauma, allergies, drug use
• Most frequent ED complaint
Interventions & Treatment:
• Anterior portion of nose = apply direct pressure for 5-10 while leaning forward
• Apply silver nitrate
• Apply lidocaine/ep with cotton pledge for 5-10 minutes
• Nasal packing for 2-5 days
• Educate on prevention – Vaseline, humidifiers

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COPD

• Chronic obstructive pulmonary disease – emphysema & chronic bronchitis
• Causes= air pollution, occupation, smoking
Primary Symptoms:
• Cough
• Sputum production
• DOE – Dyspnea On Exertion
Clinical Manifestations:
• Wheezes or crackles heard in lungs
• Prolonged expiratory phase
• Distant heart sounds
• Orthopneic position
• Barrel chest
• Use of accessory muscles
• Weight loss (dyspnea with eating)
• Late phase= clubbing to nails, right-sided HF, chronic cyanosis
Medications:
• Avoid frequent use of cough suppressants (antitussives) because coughing is a protective mechanism
• Limit narcotic use d/t respiratory depression can worsen hypercapnia
• Beta-Adrenergic Agonists: Albuterol, formoterol
• Anticholinergics: Atrovent, Spiriva
• Corticosteroids: short course only
• Methylxanthines: Theophylline (limited)
Interventions & Education:
• Pursed-lipped breathing
• Controlled coughing
• Controlled O2 therapy (1-2 L)
• Low sodium diet
• Diaphragmic breathing
• Conserve energy
• Small frequent meals
• Increase fluids

• BiPAP

RAYNAUD’S DISEASE
• Bilateral vasospasms; peripheral artery occlusive disease triggered by cold &stress
Clinical Manifestations:
• Pain & cyanosis followed by redness and pain (when warmed up)
• Pain is intermittent, extremities are numb & cold & may have swelling/ulcerations
Education:
• Stop smoking
• Exercise
• Control stress
• Avoid extreme temperatures

ALLERGIC RHINITIS
Prevention:
• Remove carpet
• Keep pets out of the house or out of bedrooms
• Wash linens in hot water
• Avoid heat & humidity
• Avoid feather pillows
• Avoid cigarette smoke
Medications:
• Fexofenadine (Allegra) = non-drowsy
• Pseudoephedrine (Sudafed) = non-drowsy
• Diphenhydramine (Benadryl) = drowsy

CYSTIC FIBROSIS
• An inherited, recessive, chronic, progressive, and frequently fatal disease of thebody’s exocrine mucus-producing glands
• Primarily affects the respiratory, digestive, and intestinal systems and pancreas
• Each parent passes the recessive gene to a child
Possible Complications:
• Lung abscesses
• Chronic bronchitis
• Honeycomb lung
• Bronchiectasis
• Chronic pancreatitis
• Malabsorption
• Cor pulmonale
Clinical Manifestations:

• Apical crackles
• Frequent infections
• Purulent secretions
• Productive cough
• Wheezing
• Dyspnea

• Recurrent infections
• Bronchiectasis
• Treatment:

• Infiltrates
• Scarring (CXR)
• Increased chest circumference
• Hyper-resonance with percussion
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• Clubbing
• Gassiness
• Diabetes

• Pancreatic insufficiency
• Pancreatitis
• Meconium ileus
• Diarrhea
• Abnormal sweat Cl concentrations
• Infertility
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• Referral to regional CF center
• Focus clearance and reduction of lower airway secretions, prevention & treatment of respiratory infections, pancreatic enzyme replacement, and adequate PO intake, and spsychosocialsupport.
• Surgery-lung transplant, long wait-list
• Interventions:
• Pancreatic Enzymes (may need replacement)
• Bulky, foul-smelling stools (malabsorption)

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• Give adequate salt
• TF/parenteral nutrition
• Daily weight

• Iron supplements
• PNEUMONIA
• Acute or chronic infection of one or both lungs caused by bacteria or virus
• Risk Factors:
• Increased age
• Immunocompromised
• Diabetes
• CHF
• Active malignancies
• Chronic diseases (i.e. sickle cell anemia)
• Clinical Manifestations:

• Fever/chills
• Productive or dry cough
• Tachycardia
• Cyanosis
• Joint pain/aches
• Hypotension
• Diagnostics:
• CBC
• Chest x-ray
• Treatment:
• Antibiotics
• Possible O2
• Pneumonia vaccine
• Rest & fluids
• Incentive spirometer, cough & deep breathing

• BUERGER’S DISEASE
• Occlusive disease mostly in small/medium arteries

• Headache
• Mood swings
• Anorexia
• Pleuritic chest pain
• Dyspnea
• Crackles in lungs

• Associated with clot formation and fibrosis of vessel wall
• Cause/Education:
• Smoking – especially young male smokers

• Stopping smoking will stop disease progression
• Clinical Manifestations:
• Thickened nail beds
• Intermittent claudication
• Cramps in legs after exercise
• Blackish ulcerations on the skin
• Extreme sensitivity to hot & cold
• Pain in digits
• Weak/thread peripheral pulses
• Diagnostics:
• Plethysmograph studies of the digits (early stages)
• Doppler U/S
• Arteriograms – the extent disease process

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• ANEMIA
• Low hemoglobin (RBC) level
• 1st cause = blood loss/hemorrhage
• 2nd cause = decreased RBC production d/t malnutrition, renal disease, or bonemarrow suppression
• 3rd cause = destruction of RBC/abnormal RBC structure (sickle cell anemia=crescent shaped)
• Clinical Manifestations:
• Fatigue
• Weakness
• Tachycardia
• Hypotension
• Hypoxia, SOB
• Pallor
• Chest pain
• Diagnostics:
• Full CBC
• Iron studies & Serum B12
• Haptoglobin & Erythropoietin
• Bone Marrow Aspiration
• Treatment:
• Iron replacement PO/IV
• Vitamin B12 IM/PO
• Folic Acid PO (green leafy veggies, liver, fruits, cereal)
• Erythropoietin
• RBC infusion
• O2 administration (especially in the sickle cell)
• Hemodynamic & cardiac monitoring

• TONSILLITIS
• History of otitis media, hearing difficulties, sore throat w/ swallowing

• Clinical Manifestations:
• Sore throat, change/loss of voice
• Reddened tonsils
• Swollen/tender neck lymph nodes
• Fever
• White/yellow coating on tonsils
• Snoring
• Diagnostics:
• Throat culture for group A strep. & bacterial infection
• CT if the infection is present to see if it spread to the neck region
• Pre-op CBC to assess for anemia/infections
• Tonsillectomy Education:
• Report= signs of hemorrhage, fever, excessive vomiting, unrelieved pain,

excessive coughing or swallowing
• Drink minimum of 8 glasses of water a day
• Soft foods for the first few days

• Avoid smoking & heavy lifting
• No gargling – can irritate the surgical site
• AORTIC ANEURYSM
• Permanent bulging and stretching of an artery – dilated 2x or greater in size
• Most common = Abdominal Aortic Aneurysm (AAA)
• Risk Factors:
• Hypertension = #1 risk
• Smoking
• Hyperlipidemia
• AAA Clinical Manifestations:
• Nausea/vomiting
• Back pain d/t pressure on spinal nerves
• Pulsation in the upper abdominal midline
• Auscultation of a bruit at aneurysm site – DO NOT palpate
• Thoracic Aorta Clinical Manifestations:
• Severe back pain-compression of surrounding tissues
• Bronchial obstruction & hoarseness
• Dyspnea & dysphasia
• Aphonia-r/t pressure on the laryngeal nerve
• Pulsating mass about the suprasternal notch
• Diagnostics:
• X-ray to identify the location of the mass
• CT scan
• Duplex Ultrasonography
• Transesophageal Echocardiography – thoracic aneurysms
• Treatment:
• Anti-hypertensives
• Anti-anxiety medications
• Surgery for aneurysms >6cm or are rapidly growing
• Aneurysms <6cm monitor with ultrasound every 6 months

• HEMOPHILIA

• Hereditary bleeding disorder resulting in deficient clotting factors (VII, IX, & X)
• Hemophilia A= VII deficient, from mothers to sons
• Hemophilia B= Christmas disease, from mothers to sons
• Hemophilia C= IX deficient, autosomal recessive
• Von Willebrand’s disease
• Clinical Manifestations:
• Joint & muscle pain
• Hemorrhages
• Bruises easily
• Complications:
• Untreated joint bleeding can cause permanent damage
• Diagnostics:
• Platelet levels

• Factor assay tests
• Coagulation tests
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• HEART FAILURE
• Heart cannot efficiently pump blood throughout the body – the heart doesn’t fill with enough blood or pump with enough force
• Compensates by increasing HR which dilates ventricles (increased HR = decreasedcardiac output)
• Diastolic HF:
• Inability to relax, causes a decrease in ventricular filling
• Systolic HF:
• Inability of the ventricles to contract and pump blood adequately
• More common – r/t aging d/t stiffness of vasculature
• Left-Sided HF:
• Reduced capacity to pump blood into the systemic circulation
• Decreased CO and stasis or “backup” of fluid into the pulmonary circulation

• Left-Sided Causes:
• Hypertension
• Alcoholism
• MI
• Coronary artery blockage
• Hypothyroidism
• Heart infection
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• Right-Sided HF:

• Left-Sided Symptoms:
• Dyspnea on exertion
• Orthopnea
• Cough w/ pink sputum
• Crackles, wheezes
• Cyanosis
• New S3 (ventricle gallop), heart murmur
• Pulmonary edema

• Reduced capacity to pump blood into the pulmonary circulation
• Causes stasis or “backup” of fluid in venous circulation

• Right-Sided Causes:
• Pulmonary hypertension
• Congenital heart diseases
• Heart valve diseases
• Chronic lung diseases (COPD,

Cystic Fibrosis)
• Left HF
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• Right-Sided Symptoms:
• JVD
• Dependent edema in LE
• Abdominal discomfort
• Nausea from fluid congestion
• Irregular heart rate
• Enlarged liver
• Weight gain

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• HF Diagnostics:
• ECG= thickening of the heart muscle and dysrhythmias
• ECHO= MAIN test – shows heart enlargement
• Decreased cardiac function tests
• CXR= heart enlargement
• Stress tests
• Cardiac Catheterization= identifies the degree of HR
• MRI= examines heart muscles
• BNP= determines the degree of HF
• HF Interventions:
• Goal= decrease heart workload, improve cardiac function & Symptoms
• Decrease fluid & sodium intake
• Elevate HOB, dangle legs
• O2 via non-rebreather or mechanical vent
• Pulmonary edema= sitting position, high O2, diuretics, intubate
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• CARDIAC/HF MEDICATIONS
• Diuretics:
• HF, HTN, DCM
• *Monitor for dehydration, hyponatremia, & hypokalemia
• Nitrates (have ‘nitr’ in the name):
• HF
• Do not give if pt. has hypotension, tachycardia, or bradycardia
• Commonly used for angina
• Increase venous capacity
• Beta Blockers (end in ‘lol’):
• HF, HTN, DCM
• Decreases HR & BP
• Decreases contraction force/workload
• Calcium-Channel Blockers (most end in ‘divine’):
• HF, HTN
• Decreases HR & BP

• Vasodilators
• Reduces angina
• Dilates coronary arteries
• ACE Inhibitors:
• HF, HTN, DCM
• Decrease pressure the heart must overcome to eject blood from the heart byinterfering with the renin-angiotensin-aldosterone system (RAAS)
• Promotes vasodilation
• Digoxin (Lanoxin):
• HF
• Cardiac glycoside
• Increase heart’s contractility

• Increases myocardial cell contraction
• Vasodilators:
• HF, HTN, DCM, Buerger’s Disease, Raynaud’s

• Isosorbide
• Decrease BP
• Anticoagulants & Antiplatelet:
• HF, DCM, Arteriosclerosis & Atherosclerosis, Thrombophlebitis
• Heparin, Lovenox, Coumadin, Aspirin, Plavix
• Prevent cardiac events
• Not primary tx of HF
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• DILATED CARDIOMYOPATHY (DCM)
• Disease of heart muscle resulting in dilated heart chamber (balloon expanding)
• Decreases force in heart contraction
• Leads to weak & thin heart wall – similar to right & left HF
• Associated with CHD, heart valve disease, & HTN
• Clinical Manifestations:
• SOB
• Lung congestion
• Dependent edema
• Fatigue
• Palpations
• Syncope
• Chest pain
• Diagnostics:
• EKG

• Cardiac catheter= heart tissue biopsy
• Medications:
• ACE inhibitors
• Beta-blockers
• Diuretics
• Anticoagulants
• Antiarrhythmics

• INFECTIVE ENDOCARDITIS
• Destructive infection of the heart’s inner lining (endocardium) or the heart valves
• Etiology/Causes:
• Surgery, dental procedures
• Artificial heart valve

• Rheumatic fever
• Congenital heart defects
• Heart Valve defects

• Streptococcal pharyngitis
• Clinical Manifestations:
• Vague infection findings
• Malaise
• Anorexia, weight loss
• Cough
• Back pain
• Heart murmurs
• Retinal hemorrhages (Roth spots)
• Petechiae
• Headaches
• Diagnostics:
• *Serial Blood cultures= to identify microorganism
• ECHO
• Treatment:
• Long-term IV antibiotics
• Possible surgery
• HYPERTENSION
• The harder the heart muscle works the greater the pressure on the heart wall
• Defined as BP >140/90 on two separate readings, at two different times
• Normal BP= 120/80
• Pre-Hypertension= 120/80 – 139/89
• Stage I Hypertension= 140/90 – 159/99
• Stage II Hypertension= >160/100
• Cuff bladder width= 40% of arm circumference
• Cuff bladder length= 80%-100% of arm circumference
• Modifiable Risk Factors:
• Sedentary lifestyle
• Smoking
• Obesity, physical inactivity
• Stress
• Drug abuse

• Caffeine
• High-fat diet
• Excessive alcohol intake (3+ drinks/day)
• Non-Modifiable Risk Factors:
• Family history
• African-American decent
• More common in Males until age 55
• Age 65+
• Clinical Manifestations:
• “Silent Killer”
• Fatigue
• Dizziness

• Angina
• Palpitations
• Dyspnea

• *Headache= most reported s/s – possibly r/t sleep apnea if upon waking
• Nocturia
• Diagnostics:
• Used to detect the underlying cause
• Electrolyte levels
• Fasting lipid profile
• Creatinine/BUN
• Sleep study
• Interventions:
• DASH diet= low fat & cholesterol – high grains, fruits & vegetables
• Avoid high sodium= canned foods, animal products

• PULSE PRESSURE
• Systolic – Diastolic = Pulse Pressure
• Example: BP= 120/80, PP= 40
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• PERIPHERAL ARTERY DISEASE (PAD)
• Plaque forms on the arterial walls, trapping emboli and causing blood flow to ceasedistally
• Risk Factors:
• Men 50+
• Postmenopausal women
• HTN, hyperlipidemia
• Obesity, decreased activity
• Smoking
• Diabetes
• Family history
• Stress
• Clinical Manifestations:
• Occurs unilaterally
• Skin mottling, ulcerations, black or gangrenous

• Muscle atrophy
• Shiny skin, sparse hair
• Thickened nails
• Six P’s (seen in affected extremity)
o Pulseless
o Pain – often worse at night, accompanied by cramping/fatigue
o Pallor
o Paresthesia
o Paralysis
o Poikilothermia (coldness)
• Interventions/Treatment:
• Place extremity in a dependent position to decrease pain

• Anticoagulants
• Percutaneous transluminal angioplasty (PTA)-balloon catheter
• Laser-assisted angioplasty and atherectomy

• Bypass grafts
• Amputation
• Diagnostics:
• Doppler pulses to assess for blood flow
• Ankle-brachial index (ABI)= measures the ratio of lower to upper extremity BP
• Ultrasound
• Treat-mill testing
• Arterio-angiograms= identify advancement/location of claudication

• TUBERCULOSIS
• Cough lasting 2+ weeks
• Weight loss – 3lbs/week considered significant
• Fever, night sweats
• Weakness
• Hemoptysis – progressed stage
• Medication:
• Given in different combinations that are tailored to pt. individual infection
• Isoniazid, Rifampin, Pyrazinamide, Ethambutol
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• ARTERIO & ATHERO-SCLEROSIS
• Arteriosclerosis: hardening of the small arteries
• Atherosclerosis: accumulation of plaque in large arteries
• Pathophysiology:
• An accrual of lipids, calcium, blood, carbohydrates, and fibrous tissue located on the intimal layer of the vessel
• Risk Factors:
• Increased age
• Men typically develop earlier than women
• African & Mexican-American
• Hypertension
• High cholesterol
• Physical inactivity

• Stress
• Obesity
• Tobacco
• Diabetes Mellitus
• Clinical Manifestations:
• Hypertension
• Heart disease
• Prolonged capillary refill
• Temp differences in extremities
• Cold extremities
• Bruits
• Nursing Assessment:
• Bilateral B/P readings

• Apical & radial pulse checks
• Need gravity to get increased circulation to lower extremities
• Diagnostics:

• Assess cholesterol levels (LDL levels)
• Homocysteine level > 15 indicates risk for CAD/PAD
• Coagulation studies
• Arteriography
• MRI: evaluate the extent
• Interventions:
• Diet: 30% or less in saturated fat, cholesterol intake <300 mg/day
• Increase exercise
• Smoking cessation
• Medications:
• Heparin, Lovenox – clot prevention
• Aspirin, Plavix – anti-platelet formation
• Cholestyramine – lowers blood cholesterol levels
• Simvastatin, Pravastatin, and Atorvastatin – lowers LDL levels
• Tricor (Fenofibrate) – lowers cholesterol and risk for pancreatitis
• Niacin (Vitamin B3) – lowers blood lipids

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