SU NSG 430 Cardiac Tamponade Complex Care Nursing

SU NSG 430 Cardiac Tamponade Complex Care Nursing ORDER NOW FOR CUSTOMIZED AND ORIGINAL ESSAY PAPERS ON SU NSG 430 Cardiac Tamponade Complex Care Nursing Create Your Own Case Study Discussion ForumInitial Post: For this discussion board post, you are to pick one topic that we have covered so far (ex: GI disturbances, arrhythmia etc.). You will create a case study or scenario revolving around this topic. You will need to come up with a patient, their history/situation and their clinical presentation. You can include any information that will help your reader understand what is going on with the patient. You should use references about the topic to help you create the situation. Then ask three questions, that you would like one of your colleagues to answer regarding your case study/scenario. These questions should be open ended and allow for critical thinking. SU NSG 430 Cardiac Tamponade Complex Care Nursing attachment_1 attachment_2 Chapter 17 Hematological and Immune Disorders Copyright © 2017 Elsevier Inc. All rights reserved. Anatomy and Physiology ? Hematopoiesis ? ? Blood cell formation Stem cells differentiate • Erythrocytes • Leukocytes • Thrombocytes Copyright © 2017 Elsevier Inc. All rights reserved. 2 Anatomy and Physiology (Cont.) Figure 17-1 ?Formation of the multiple different blood cells from the original pluripotent hematopoietic stem cell (PHSC) in the bone marrow. (From Hall J. Guyton and Hall Textbook of Medical Physiology. 13th ed. Philadelphia: Saunders. 2015.) Copyright © 2017 Elsevier Inc. All rights reserved. 3 Anatomy and Physiology (Cont.) ? Blood ? Plasma ? Solutes (e.g., ions) ? Serum proteins • Coagulation • Healing • Transport • Osmotic pressure ? Blood cells Copyright © 2017 Elsevier Inc. All rights reserved. 4 Anatomy and Physiology (Cont.) ? Erythrocytes: red blood cells (RBCs) ? ? ? Thrombocytes: platelets ? ? ? Erythropoietin stimulates production O2 transport Thrombopoietin stimulates production Clotting Leukocytes: white blood cells (WBCs) ? Fight infection and antigens ? Structure—granular and agranular ? Function—phagocyte or immunocyte Copyright © 2017 Elsevier Inc. All rights reserved. 5 Quick Quiz! What is another name for platelets? Erythrocytes B. Leukocytes C. Phagocytes D. Thrombocytes A. Copyright © 2017 Elsevier Inc. All rights reserved. 6 Granular Leukocytes ? Neutrophils ? ? Bacterial infections Eosinophils ? Allergens ? Parasites ? Basophils ? Allergic response ? Inflammatory response Copyright © 2017 Elsevier Inc. All rights reserved. 7 Agranular Leukocytes ? Monocytes ? ? Mature into macrophages Lymphocytes ? Defense against microorganisms ? Tumor immunity • Humoral—B lymphocytes • Cell-mediated—T lymphocytes ? Delayed hypersensitivity ? Autoimmune diseases ? Foreign tissue rejection Copyright © 2017 Elsevier Inc. All rights reserved. 8 Immune Anatomy and Physiology ? ? ? Immunity is the ability to resist and fight infection Antigen-antibody responses Autoimmune: body sees self as “nonself” and activates immune response Copyright © 2017 Elsevier Inc. All rights reserved. 9 Nonspecific Defenses ? Epithelial surfaces ? ? Intact skin and mucous membranes Inflammation and phagocytosis ? Initiated by cellular injury ? Tissue repair ? Cytokine and chemokine release ? Proinflammatory ? Antiinflammatory Copyright © 2017 Elsevier Inc. All rights reserved. 10 Specific Defenses ? ? Humoral immunity Cell-mediated immunity Copyright © 2017 Elsevier Inc. All rights reserved. 11 Humoral Immunity ? ? ? B lymphocytes Formation of antibodies Immunoglobulins ? IgG ? IgM ? IgA ? IgE ? IgD Copyright © 2017 Elsevier Inc. All rights reserved. 12 Cell-Mediated Immunity ? ? ? T lymphocytes Initiated by macrophages Cells ? ? ? Helper/inducer Suppressor Killer Copyright © 2017 Elsevier Inc. All rights reserved. 13 Hemostasis ? ? ? ? Platelets Blood proteins Vasculature Balance between clotting system and fibrinolytic system Copyright © 2017 Elsevier Inc. All rights reserved. 14 Coagulation Physiology Figure 17-3. Coagulation physiology. SU NSG 430 Cardiac Tamponade Complex Care Nursing Copyright © 2017 Elsevier Inc. All rights reserved. 15 Coagulation Pathway ? ? Cascade theory Initiating event ? ? ? Intrinsic pathway: injury to blood (factor XII) Extrinsic pathway: tissue injury (factor VII) Final common pathway ? Prothrombin to thrombin ? Fibrinogen to fibrin ? Clot Copyright © 2017 Elsevier Inc. All rights reserved. 16 Coagulation Pathway (Cont.) Figure 17-4 ?Coagulation cascade. (From McCance KL. Structure and function of the hematological system. In McCance KL, Huether SE, eds. Pathophysiology: The biologic basis for disease in adults and children. 7th ed. St. Louis: Mosby. 2014.) Copyright © 2017 Elsevier Inc. All rights reserved. 17 Fibrinolysis ? Stimulated by clot formation ? ? ? Thrombin released Stimulates conversion of plasminogen to plasmin Breakdown yields fibrin degradation products (FDPs), or fibrinogen split products (FSPs) Copyright © 2017 Elsevier Inc. All rights reserved. 18 Fibrinolysis (Cont.) Figure 17-5. Fibrinolysis. Copyright © 2017 Elsevier Inc. All rights reserved. 19 Hemostasis: Summary ? ? ? Activation of the coagulation cascade Formation of a stable fibrin clot Activation of the fibrinolytic system Copyright © 2017 Elsevier Inc. All rights reserved. 20 Assessment ? ? ? ? Past medical history Evaluation of patient concerns Physical examination Cues to hematological or immunological problems ? Altered oxygenation ? Bleeding ? Infection Copyright © 2017 Elsevier Inc. All rights reserved. 21 Assessment (Cont.) ? Diagnostic tests ? ? ? Complete blood count (CBC) with differential Coagulation profile Based on these findings, further testing may be required Copyright © 2017 Elsevier Inc. All rights reserved. 22 Erythrocyte Disorders Copyright © 2017 Elsevier Inc. All rights reserved. 23 Anemia ? Reduction of circulating RBCs or hemoglobin ? ? Poor tissue oxygenation Blood flow shunted to vital organs Copyright © 2017 Elsevier Inc. All rights reserved. 24 Causes of Anemia ? ? ? ? Blood loss (chronic or acute) Impaired production Increased RBC destruction Combination of these Copyright © 2017 Elsevier Inc. All rights reserved. 25 Quick Quiz! Anemia secondary to blood loss is: Aplastic B. Hemorrhagic C. Iron deficiency D. Hemolytic A. Copyright © 2017 Elsevier Inc. All rights reserved. 26 Types of Anemia ? ? ? ? ? ? ? ? Hemorrhagic Marrow failure Aplastic Hemolytic Sickle cell B12 deficiency Folic acid deficiency Iron deficiency—most common Copyright © 2017 Elsevier Inc. All rights reserved. 27 Assessment of Anemia ? Decreased circulating volume ? ? Signs of hypovolemia Decreased oxygenation ? Signs of hypoxemia ? Shortness of breath ? Compensatory mechanisms ? Increased heart rate ? Congestive heart failure may result Copyright © 2017 Elsevier Inc. All rights reserved. 28 Diagnosis of Anemia ? ? ? ? ? ? ? ? ? CBC Bone marrow biopsy Reticulocyte count (hemolytic) Transferrin (hemolytic) Haptoglobin (hemolytic) Electrophoresis (sickle cell) Schilling (B12) Folate (folic acid deficiency) Iron and ferritin (iron deficiency) Copyright © 2017 Elsevier Inc. All rights reserved. 29 Treatment of Anemia ? ? ? ? Depends on the cause and type Erythropoietin used to stimulate RBC production Splenectomy = hemolytic anemia Bone marrow transplantation = aplastic anemia Copyright © 2017 Elsevier Inc. All rights reserved. 30 Critical Thinking Challenge ? Many patients in the ICU have blood drawn frequently. SU NSG 430 Cardiac Tamponade Complex Care Nursing What strategies can be implemented to prevent anemia from occurring in these patients? Copyright © 2017 Elsevier Inc. All rights reserved. 31 Nursing Management of Anemia Diagnoses ? Decreased cardiac output ? Altered tissue perfusion ? Impaired gas exchange ? Risk for fluid volume excess or deficit ? Risk for infection Selected Interventions • Assess tachycardia, hypotension • Provide periods of rest • Administer O2 and monitor saturation • Monitor fluid volume status • Prevent infection Copyright © 2017 Elsevier Inc. All rights reserved. 32 WBC and Immune Disorders ? Immunocompromised patient ? Defect in WBC or immune physiology Copyright © 2017 Elsevier Inc. All rights reserved. 33 Immunocompromise ? ? ? ? Defects in WBCs or immune physiology Lack of normal defenses May be asymptomatic Infection is leading cause of death Copyright © 2017 Elsevier Inc. All rights reserved. 34 Immunocompromise (Cont.) ? ? ? Symptoms of infection are often absent Fever may be the only sign of infection Pain without signs of inflammation is also a cue Copyright © 2017 Elsevier Inc. All rights reserved. 35 Critical Thinking Challenge ? Discuss the following factors that contribute to immunocompromise as they relate to the critically ill patient: ? Invasive procedures ? Malnutrition ? Opportunistic pathogens ? Medications Copyright © 2017 Elsevier Inc. All rights reserved. 36 Quick Quiz! Immunocompromised patients may not demonstrate typical signs of infection. The only assessment that may indicate infection is: Fever B. Redness C. Swelling D. Purulent drainage A. Copyright © 2017 Elsevier Inc. All rights reserved. 37 Laboratory Analysis ? ? ? ? Leukopenia Low CD4 counts Decreased immunoglobulins No response to antigen skin test—anergy Copyright © 2017 Elsevier Inc. All rights reserved. 38 Medical Management ? Reverse the cause ? ? ? ? ? Cell replacement Bone marrow transplant Immunoglobulins Treat infections Nutrition Copyright © 2017 Elsevier Inc. All rights reserved. 39 Nursing Management ? ? ? ? ? ? Isolation Hygiene; wash hands Aseptic technique for procedures Good assessment for cues of infection Maintain skin integrity Optimum nutritional support Copyright © 2017 Elsevier Inc. All rights reserved. 40 Neutropenia ? Absolute neutrophil count less than 1500 cells/microliter ? ? ? ? Mild Moderate Severe Causes ? Overwhelming infection ? Radiation ? Inadequate production ? Exposure to chemicals and drugs ? High risk of infection Copyright © 2017 Elsevier Inc. All rights reserved. 41 Neutropenia Risks ? ? ? Overwhelming infection Radiation therapy Chemicals and drugs ? ? ? Antibiotics Chemotherapy Disease states Copyright © 2017 Elsevier Inc. All rights reserved. 42 Assessment of Neutropenia ? ? Classic symptoms of infection often absent Areas of heavy bacteria at risk for infection (mouth, perineum, IV sites, and catheter) Copyright © 2017 Elsevier Inc. All rights reserved. 43 Neutropenia Medical Management ? ? ? ? Prevent and treat infection Reverse cause Colony-stimulating factors Prophylactic antibiotics Copyright © 2017 Elsevier Inc. All rights reserved. 44 Neutropenia Nursing Management ? Similar to that used for immunocompromised patient Copyright © 2017 Elsevier Inc. All rights reserved. 45 Malignant WBC Disorders ? Leukemia ? ? Lymphoma ? ? Large number of immature cells Cancer affects lymphocytes Multiple myeloma ? Abnormal immunoglobulins Copyright © 2017 Elsevier Inc. All rights reserved. 46 Malignant WBC Disorders (Cont.) ? ? ? ? SU NSG 430 Cardiac Tamponade Complex Care Nursing Decreased number of functional WBCs Risk for infection Alteration in immune response Fever difficult to interpret Copyright © 2017 Elsevier Inc. All rights reserved. 47 Malignant WBC Disorders (Cont.) ? Symptoms often nonspecific ? Fatigue, malaise ? Myalgias ? Activity intolerance ? Night sweats ? Fever ? Other symptoms ? Bruising and bleeding ? Enlarged lymph nodes ? Thrombosis Copyright © 2017 Elsevier Inc. All rights reserved. 48 Malignant WBC Disorders (Cont.) ? Staging of disorders determines treatment ? ? ? ? Chemotherapy Biotherapy Bone marrow transplant Nursing care is based on treating and preventing infections Copyright © 2017 Elsevier Inc. All rights reserved. 49 Critical Thinking Challenge ? How are patients with malignant WBC disorders cared for differently than patients with other types of compromised immune systems? Copyright © 2017 Elsevier Inc. All rights reserved. 50 Immunodeficiency ? Primary ? ? Congenital abnormality Secondary ? Acquired Copyright © 2017 Elsevier Inc. All rights reserved. 51 Immunodeficiency: Acquired Immune Deficiency Syndrome (AIDS) ? ? ? ? Infection with human immunodeficiency virus (HIV) (retrovirus) Depletes helper T cells, CD4 cells, and macrophages Increased risk for opportunistic infections Transmitted via body fluids, blood, or blood products Copyright © 2017 Elsevier Inc. All rights reserved. 52 HIV Pathophysiology Figure 17-6. Human immunodeficiency virus (HIV) pathophysiology. CMV, Cytomegalovirus; CNS, central nervous system; ELISA, enzyme-linked immunosorbent assay; TB, tuberculosis. Copyright © 2017 Elsevier Inc. All rights reserved. 53 Diagnosis of AIDS ? ? CD4 count less than 200/microliter Indicator condition manifested Copyright © 2017 Elsevier Inc. All rights reserved. 54 Medical Interventions: HIV ? ? ? Antiretroviral medications Multidrug therapy has been more effective than monotherapy Supportive therapy: prevention of infection, nutritional support, analgesics, etc. Copyright © 2017 Elsevier Inc. All rights reserved. 55 Nursing Interventions: HIV ? ? ? ? Prevent infection Observe for adverse reactions to medications Provide psychosocial support Prevent transmission Copyright © 2017 Elsevier Inc. All rights reserved. 56 Critical Thinking Challenge ? ? Should visitors be restricted for the HIV-positive patient? Why or why not? Sometimes AIDS is diagnosed when the patient is admitted to the ICU with an opportunistic infection. Discuss the challenges of patient/family support in this situation. Copyright © 2017 Elsevier Inc. All rights reserved. 57 Bleeding Disorders ? Abnormality in stages of clotting ? Vasoconstriction ? Creation of platelet plug ? Development of clot ? Fibrinolysis ? ? Inherited or acquired Common in renal, hepatic, and gastrointestinal disorders; malnutrition Copyright © 2017 Elsevier Inc. All rights reserved. 58 Critical Thinking Challenge ? Describe the assessments for detecting bleeding disorders: ? Skin and mucous membranes ? Bodily fluids (How is this detected?) ? Internal bleeding (How is this detected?) Copyright © 2017 Elsevier Inc. All rights reserved. 59 Diagnosis of Bleeding ? CBC ? ? ? ? Hemoglobin Hematocrit Fibrinogen PT, aPTT Copyright © 2017 Elsevier Inc. All rights reserved. 60 Nursing Diagnoses ? ? ? ? ? Risk for Bleeding Ineffective Protection Ineffective Peripheral Tissue Perfusion Deficient Fluid Volume and Acute Pain Copyright © 2017 Elsevier Inc. All rights reserved. 61 Quick Quiz! The nurse is caring for a postoperative patient and notes “excessive” drainage on the abdominal dressing. A nursing intervention to assess the amount of blood loss is: Estimate the blood loss from the OR B. Monitor the WBC C. Weigh the abdominal dressings D. Weigh the patient daily A. Copyright © 2017 Elsevier Inc. All rights reserved. SU NSG 430 Cardiac Tamponade Complex Care Nursing 62 Nursing Management: Bleeding ? ? ? ? ? Assess blood loss Assess vital signs, hemodynamics, and perfusion Assess for signs and symptoms of hypovolemia Administer blood products and fluids Administer topical agents as needed Copyright © 2017 Elsevier Inc. All rights reserved. 63 ? Medical Management: Bleeding (Cont.) Whole blood • Albumin Packed RBCs • Granulocytes Leukocyte-poor RBCs • Plasma protein Platelets • Fresh frozen plasma ? Cryoprecipitate ? ? ? Review Table 17-11 to compare and contrast the products. Copyright © 2017 Elsevier Inc. All rights reserved. 64 Thrombocytopenia ? Decreased platelets ? ? ? Less than 100,000/microliter Risk for bleeding Treated with platelet transfusions Copyright © 2017 Elsevier Inc. All rights reserved. 65 Disseminated Intravascular Coagulation (DIC) ? ? ? ? Accelerated activation of clotting cascade Depletion of clotting factors Bleeding Secondary problem Copyright © 2017 Elsevier Inc. All rights reserved. 66 Pathophysiology of DIC ? ? ? ? ? ? Initiating event: procoagulants Stimulation of intrinsic or extrinsic pathway Clots in microvasculature Consumption of clotting factors Fibrinolysis FDPs: potent anticoagulants Copyright © 2017 Elsevier Inc. All rights reserved. 67 Pathophysiology of DIC (Cont.) Figure 17-7. Pathophysiology of disseminated intravascular coagulopathy. Copyright © 2017 Elsevier Inc. All rights reserved. 68 Etiology of DIC ? ? ? ? ? ? Infection Trauma (e.g., burns, crush) Obstetric conditions (e.g., abruptio placentae, amniotic fluid embolus, retained dead fetus) Hematological disorders Oncological disorders Other: shock or sepsis, acute respiratory distress syndrome Copyright © 2017 Elsevier Inc. All rights reserved. 69 Assessment of DIC ? ? ? Overt bleeding or oozing Occult bleeding Signs of platelet deficiency ? ? ? Petechiae Ecchymosis Decreased perfusion to organs ? Changes in mental status ? Infarction of tissue in digits and nose Copyright © 2017 Elsevier Inc. All rights reserved. 70 Laboratory Diagnosis: DIC ? ? ? ? ? ? ? Decreased platelets Decreased fibrinogen Prolonged PT, aPTT, thrombin time Elevated FDP or FSP Increased D-dimer Decrease in coagulating factors Decrease in hemoglobin and hematocrit Copyright © 2017 Elsevier Inc. All rights reserved. 71 Treatment of DIC ? ? Correct underlying cause Administer blood and components ? Platelets ? Fresh frozen plasma ? Cryoprecipitate ? Packed RBCs ? Stop abnormal coagulation ? Heparin: controversial when experiencing more hemorrhage than thrombosis Copyright © 2017 Elsevier Inc. All rights reserved. 72 Other Treatments of DIC ? ? SU NSG 430 Cardiac Tamponade Complex Care Nursing Antithrombin III (inhibits thrombin) Epsilon-aminocaproic acid (prevents fibrinolysis) Copyright © 2017 Elsevier Inc. All rights reserved. 73 Nursing Management of DIC ? ? ? ? ? ? Assess and prevent Conduct frequent laboratory analysis Administer blood products Assess circulation Relieve pain Assess for complications: shock, multisystem organ failure, impaired circulation Copyright © 2017 Elsevier Inc. All rights reserved. 74 Chapter 12 Shock, Sepsis, and Multiple Organ Dysfunction Syndrome Copyright © 2017 Elsevier Inc. All rights reserved. Introduction ? Shock is a clinical syndrome ? ? ? ? Life-threatening response to alterations in circulation Inadequate tissue perfusion Imbalance between cellular oxygen supply and demand Impacts all body systems ? Can lead to organ failure and death • Influenced by compensatory mechanisms • Influenced by successful interventions Copyright © 2017 Elsevier Inc. All rights reserved. 2 Review of Anatomy and Physiology ? Cardiovascular system ? Closed system: heart, blood, vascular bed • Vascular bed: arteries, arterioles, capillaries, venules, and veins ? Microcirculatory system ? Portion of the vascular bed between the arterioles and venules. Copyright © 2017 Elsevier Inc. All rights reserved. 3 Normal Anatomy and Physiology (Cont.) Copyright © 2017 Elsevier Inc. All rights reserved. 4 Pathophysiology ? ? Shock begins with cardiovascular system failure Alterations in at least one of four components: ? Blood volume ? Myocardial contractility ? Blood flow ? Vascular resistance Copyright © 2017 Elsevier Inc. All rights reserved. 5 Classification of Shock ? ? ? ? Hypovolemic Cardiogenic Obstructive Distributive (anaphylactic, neurogenic, septic) Copyright © 2013, 2009, 2005, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 6 Stages of Shock Stage I: Initiation ? ? ? Hypoperfusion: inadequate delivery or extraction of oxygen No obvious clinical signs Early, reversible Copyright © 2017 Elsevier Inc. All rights reserved. 7 Stages of Shock Stage II: Compensatory ? ? Sustained reduction in tissue perfusion Initiation of compensatory mechanisms ? Neural: baroreceptors and chemoreceptors ? Endocrine: ACTH and ADH ? Chemical • Low oxygen tension • Hyperventilation and respiratory alkalosis Copyright © 2017 Elsevier Inc. All rights reserved. 8 Stag … Get a 10 % discount on an order above $ 100 Use the following coupon code : NURSING10