Summary NUR 239 Unit 4 Exam Study Guide (complete A+ guide solution)2021
NUR 239 Unit 4 Exam Study Guide Genetics • Down syndrome – trisomy of chromosome 21 causes distinctive physical changes • Hemophilia – recessive X-linked, bleeding disorder • Marfan syndrome – autosomal dominant disorder, long, thin arms, eye, cardiac, and skeletal changes • Neurofibromatosis – autosomal dominant, genetic defect in tumor-suppression gene, nodules, spots • Huntington’s – autosomal dominant neurodegenerative disorder • Cystic fibrosis – autosomal recessive chloride ion transport disorder causing lung and pancreatic disease • Sickle cell – autosomal recessive, red blood cell defect Gene mutations • Error in DNA duplication • Occurs during replication process as result of substitution, loss or addition, or rearrangement of one or more base pairs • Most DNA defects are corrected by DNA repair mechanisms and are never detected. If there is loss of DNA repair mechanism enzymes, there is link to cancer. Period of vulnerability • 15-60 days after conception Teratogenic agents, including Fetal Alcohol Syndrome • Radiation; Molecular wt. of drug; Environmental chemical and drugs • Stage of pregnancy when drug was taken; Duration of drug exposure • Medications and illicit drugs - rate in which drug crosses placenta, duration of exposure, fetal stage of development during exposure, lipid-soluble drug cross placenta more readily, molecular wt. 500 cross more readily • Alcohol – passes freely across placenta, exerts harmful effects throughout gestation o Fetal alcohol syndrome: effects extend throughout pregnancy • Facial abnormalities, growth defects, CNS abnormalities • Should eliminate alcohol while pregnant- crosses placental barrier • Infectious Agents – TORCH (toxoplasmosis, other, rubella, cytomegalovirus, and herpes) • Nutritional Deficiencies – Folic Acid Nervous System Parkinson’s Disease: causes, clinical manifestations, diagnosis, medications • Causes: imbalance of dopamine and acetylcholine in the brain (less dopamine), could have genetic link, could be from head injuries earlier in life, could be from environment (pesticides, chemicals) • Clinical manifestations: resting tremor, bradykinesia, rigidity, postural hypotension; slow to start walking and difficult stopping • Medications: give at same time every day – even 5 min difference can cause adverse effects o Levodopa: dopamine receptor agonist, increases dopamine in the brain, main drug for Parkinson’s ▪ Nursing implications: counteracts with antidepressants (can lead to increased BP = stroke); administer after/ with food to prevent nausea but may delay absorption (high-protein interferes); contraindicative with narrow angle glaucoma; iron supplements shouldn’t be given at same time; 6-8 weeks to see results; CNS effects – hallucinations, vision changes (report to HCP) o Carbidopa: helps with nausea caused by levodopa, helps with breakdown of levodopa to dopamine o Benztropine: helps with sedation if having trouble sleeping; add-on med for Parkinson’s; anticholinergic med – calm down acetylcholine and increase dopamine ▪ Nursing implications: adverse effects – hallucinations, tachycardia, constipation (take in fiber); contraindicative with glaucoma; can take with food but causes dryness of the mouth – good oral care; causes water to be retained – void before administration; interferes with OTC meds – notify HCP on all meds; extreme heat/hot weather should be avoided A/Ischemic Stroke: causes, clinical manifestations, diagnosis, treatment • decreased or stopped blood flow usually due to clot (87% of all strokes) • weakness on one side of body, slurred speech, confusion, homobymous hemianopsia blindness, sensory loss • CT, ECG, carotid ultrasound Thrombolytic- alteplase (t-PA) • Can only use for ischemic strokes, Limited window of opportunity, Must start within 3 – 4.5 hours of symptom onset, Major risk for bleeding, Alteplase (tPA) – tissue plasminogen activator, Fibrinolytic – plasminogen activators (thrombolytic), Dissolves thrombi to re-establish blood flow or limit tissue damage, stimulates conversion of plasminogen to plasmin – an enzyme that breaks down fibrin • Antidote: aminocaproic acid (Amicar) Anticoagulants- heparin/enoxaparin • Use – Prophylaxis for patients at risk of developing a clot; therapeutically – management of acute thromboembolic disorders (DVT, thrombophlebitis, Pulmonary Embolus) • Must be given IV or subcutaneously, not absorbed in GI tract • Antidote: protamine sulfate • aPTT level is 1.5 x control (over 70 should stop infusion) • Low molecular weight Heparin (LMWH) – Lovenox (enoxaparin) is used frequently if the patient leaves hospital Antiplatelets- ASA, Clopidogrel (Plavix) Vitamin K Antagonists- warfarin • Use -Long-term prevention and management of venous thromboembolic disorders (DVT, PE, Afib, & prosthetic heart valves); most commonly used anticoagulant • Antidote: vitamin k • Lab: check PT and INR (should be between 2-3) – if over, hold the next dose and contact HCP; greater than 5 needs vitamin K Newer anticoagulants- Eliquis and others • Don’t have to check PT and INR levels so remember to review any antidotes, dietary instructions, and lab tests for these meds. espiratory System neumonia and TB- causes, clinical manifestations, diagnosis, treatment, medications • TB diagnosis: chest x-ray (see granulomas in lung tissue); tuberculin test (measure raised area, certain length in mm = exposure); sputum culture (confirms TB) • Clinical manifestations: low-grade fever, night sweats, productive cough, fatigue, weight loss (decreased appetite) • Medications: multidrug therapy is the best for active TB – reduces risk of drug resistance, drugs are synergistic; TB is slow growing so needs long term medications o Isoniazid, rifampin, pyrazinamide (contraindication with gout), ethambutol, vitamin B6 ▪ Nursing implications: don’t drink alcohol, rifampin causes orange body secretions, don’t wear contacts; bruise easily; oral contraceptives and Xanax become less effective; best on an empty stomach – 1 hr before or 2 hr after a meal (food decreases absorption – should only take with food if it causes GI upset); vision problems (ethambutol) – visual acuity decreases, red/green discrimination; vitamin B6 – prevents neuropathy - isoniazid (INH) causes peripheral neuropathy (numbness and tingling in fingers)
Geschreven voor
- Instelling
- Illinois State University
- Vak
- NUR 239 Pathophysiology and Pharmacotherapeutics I (NUR239)
Documentinformatie
- Geüpload op
- 3 oktober 2021
- Aantal pagina's
- 5
- Geschreven in
- 2021/2022
- Type
- SAMENVATTING
Onderwerpen
-
nur 239
-
nur 239 unit 4 exam study guide
-
genetics • down syndrome – trisomy of chromosome 21 causes distinctive physical changes • hemophilia – recessive x linked
-
bleeding disorder • marfan syndrome –
