Hi everyone! It has been a while since I posted to the Blog but you can see new review dates on docushare under Fernisa Sison Nursing 4 Review Calendar. I will be doing reviews the Fridays before each of your tests. Good luck everyone and congratulations to all those who have passed their boards. I'm looking forward to seeing the rest of you at work.

Have a great day everyone!

Fern

For all the N4 Nursing students. If you need help for the Respiratory tests or any other of the Units for N4 please e-mail me at fsison@deltacollege.edu. I have not heard from anyone and I will not schedule study groups until after the 14th of November unless I hear from you before the 6th. Thanks everyone and good luck.

Fernisa Sison
L214
954-5492

Here is the link to Respiratory information which is also located in Docushare.
http://docushare.deltacollege.edu/dsweb/HomePage

Click on docushare and the information is under Fernisa Sison or Nursing 101 then N4

Congratulations to everyone for making it to N4. Here is the Respiratory Case studies for the N4 Review on March 28th, L118. Please bring them.

Chapter 26: NURSING MANAGEMENT: Upper Respiratory Problems
Cancer of the Larynx

Patient Profile
Mr. Carlson, a 60-year-old white man, was admitted for evaluation of mild pain on swallowing and a persistent sore throat over the past year.

Subjective Data
· States that his symptoms worsened in the last 2 months
· Has used various cold remedies to relieve symptoms without relief
· Has lost weight because of decrease in appetite and difficulty swallowing
· Has smoked 3 packs of cigarettes a day for 40 years
· Consumes 6 cans of beer a day

Objective Data
Laryngoscopy
· Subglottic mass

Physical Examination
· Enlarged cervical nodes

Computed Tomography Scan
· Subglottic lesion with lymph node involvement

Collaborative Care
· Total laryngectomy with tracheostomy with inflated cuff
· Nasogastric tube

Critical Thinking Questions
1. What information in the assessment suggests that Mr. Carlson might be at risk for cancer of the larynx?
2. What diagnostic tests are typically performed to evaluate the extent of this problem?
3. What teaching should the nurse plan for Mr. Carlson before and after laryngectomy?
4. Discuss methods used to restore speech after laryngectomy.
5. What teaching is required to assist this patient to assume self-care after his surgery? What precautions should the patient take because of his stoma?
6. Based on the assessment data presented, write one or more nursing diagnoses. Are there any collaborative problems?

Chapter 27: NURSING MANAGEMENT: Lower Respiratory Problems
Aspiration Pneumonia

Patient Profile
Sam, a 27‑year‑old African-American male, was admitted to the hospital because of an uncontrollable fever. He was transferred from a long-term care facility. He has a history of a gunshot wound to his left chest. Following a cardiac arrest after the accident he developed hypoxic encephalopathy. He has a tracheostomy and gastrostomy tube. He has a history of methicillin-resistant Staphylococcus aureus (MRSA) in his sputum.

Subjective Data
· Family says that they visit him regularly and are very devoted to him.

Objective Data
Physical Examination
· Thin, cachectic African American man in moderate respiratory distress
· Unresponsive to voice, touch, or painful stimuli
· Vital signs: temperature 104° F (40° C), heart rate 120, respiratory rate 30, O2 saturation 90%
· Chest auscultation revealed crackles and scattered rhonchi in the left upper lobe

Diagnostic Studies
· Serum albumin 2.8 g/dl (28 g/L)
· White blood cell (WBC) count 18,000/ml (18 x 109/L)
· Sputum specimen: thick, green colored, foul smelling; cultures pending
· Arterial blood gases: pH 7.29, PaO2 80 mm Hg, PaCO2 40 mm Hg, bicarbonate 16 mEq/L
· Stool culture positive for Clostridium difficile
· Chest x‑ray: infiltrate in left upper lobe; no pleural effusions noted

Critical Thinking Questions
1. What types of infectious disease precautions should be taken related to Sam’s hospitalization?
2. What clinical manifestations of aspiration pneumonia did Sam exhibit? Explain their pathophysiologic bases.
3. What antibiotic medication is likely to be prescribed?
4. What is his oxygenation status and metabolic state?
5. What other clinical issues need to be addressed in his plan of care?
6. What family interventions would you initiate?
7. Based on the assessment data presented, write one or more appropriate nursing diagnoses. Are there any collaborative problems?

Chapter 28: NURSING MANAGEMENT: Obstructive Pulmonary Diseases
Asthma

Patient Profile
Mrs. S., a 30-year-old African American mother of two preschoolers, comes to the emergency department (ED) with severe wheezing, dyspnea, and anxiety. She was in the ED only 6 hours ago with an acute asthma attack.

Subjective Data
· Treated in the ED previously with nebulized albuterol and responded quickly
· Can speak only one- to three-word sentences
· Is allergic to cigarette smoke
· Began to experience increased shortness of breath and tightness in her chest when she returned home
· Used albuterol MDI (without a spacer) repeatedly at home with no relief

Objective Data
Physical Examination
· Uses accessory muscles to breathe
· Has audible wheezing
· Respiratory rate 34/min
· Auscultation reveals no air movement in lower lobes
· Heart rate 126 beats/min

Diagnostic Studies
· ABGs: PaO2 80 mm Hg, Paco2 35 mm Hg, pH 7.46
· PEFR: 150 L/min (personal best: 400 L/min)

Critical Thinking Questions
1. Why did Mrs. S. return to the ED? Explain the pathophysiology of this exacerbation of asthma.
2. What are the nursing care priorities for Mrs. S.?
3. What are the complications the nurse must be ready for based on her assessment of Mrs. S.?
4. What should be included in her discharge plan of care?
5. Based on the assessment data presented, write one or more nursing diagnoses. Are there any collaborative problems?

Good afternoon everyone! For those of you who are a little lost with the Genitourinary system, I am attaching a short pathophysiology review which might help you understand the system better. If you go to docushare under Nursing 101 you will also see Case studies for the Genitourinary system. If you have any questions, please call me at 954-5492 Locke 214 is my office.

Summary Review of Renal and Urologic Systems

Structures of the Renal System
1. The kidneys are paired structures lying bilaterally between the twelfth thoracic and third lumbar vertebrae.
2. The kidney is composed of an outer cortex and an inner medulla.
3. The calcyces join to form the renal pelvis, which is continuous with the upper end of the ureter.
4. The nephron is the urine-forming unit of the kidney and is composed of the glomerulus, proximal tubule, loops of Henle, distal tubule, and collecting duct.
5. The glomerulus contains loops of capillaries. The capillary walls serve as a filtration membrane for the formation of the primary urine.
6. The proximal tubule is lined with microvilli to increase surface area and enhance reabsorption.
7. The loops of Henle transport solutes and water, contributing to the hypertonic state of the medulla.
8. The distal tubule adjusts acid-base balance by excreting acid into the urine and forming new bicarbonate ions.
9. The ureters extend from the renal pelvis to the posterior wall of the bladder. Urine flows through the ureters by means of peristaltic contraction of the ureteral muscles.
10.The bladder is a bag composed of the detrusor and trigone muscles and innervated by parasympathetic fibers. When accumulation of urine reaches 250 to 300ml, mechanoreceptors, which respond to stretching of tissue, stimulate the micturition reflex.

Renal Blood Flow
1. Renal blood flows at about 1000to 1200 ml/min, or 20% to 25% of the cardiac output.
Blood flow through the glomerular capillaries is maintained at a constant rate in spite of a wide range of arterial pressures (autoregulation).
2. The glomerular filtration rate (GFR) is the filtration of plasma per unit of time and is directly related to the perfusion pressure of renal blood flow.
3. Autoregulation of renal blood flow and sympathetic neural regulation of vasoconstriction maintain a constant GFR.
4. Renin is an enzyme secreted from the juxtaglomerular apparatus; it causes the generation of angiotensin, a potent vasoconstrictor. The rennin-angiotensin system is thus a regulator of renal blood flow.
5. Natriuretic hormone from the right atrium of the heart promotes sodium and water loss by inhibiting aldosterone.

Kidney Function
1. The major function of the nephron is urine formation, which involves the processes of glomerular filtration, tubular reabsorption, and tubular secretion and excretion.
2. Glomerular filtration is favored by capillary hydrostatic pressure and opposed by oncotic pressure in the capillary and hydrostatic pressure in the Bowman capsule. The balance of favoring and opposing filtration forces is known as net filtration pressure (NFP).
3. The GFR is approximately 120 ml/min, and 99% of the filtrate is reabsorbed.
4. The proximal tubule reabsorbs about 60% to 70% of the filtered sodium and water and 90% of other electrolytes.
5. Because most molecules are reabsorbed by active transport, the carrier mechanism can become saturated at a point known as the transport maximum. Molecules not reabsorbed are excreted with the urine.
5. The distal tubules actively reabsorb sodium and secrete potassium and hydrogen for the regulation of electrolyte and acid-base balance.
6. The concentration of the final urine is a function of the level of antidiuretic hormone (ADH) that stimulates the distal tubules and collecting ducts to reabsorb water. The countercurrent exchange system of the long loops of Henle and their accompanying capillaries establishes a concentration gradient within the renal medulla that facilitates the reabsorption of water from the collecting duct.
7. The distal nephron regulates acid-base balance by excreting hydrogen ions and forming new bicarbonate.
8. The kidney secretes or activates a number of hormones that have systemic effects, including 1, 25-OH2D3 and erythropoietin.

Tests of Renal Function
1. Tests that measure renal clearance indicate how much of a substance can be cleared from the blood by the kidneys per given amount of time.
2. Creatinine, a substance produced by muscle, is measured in both plasma and urine to calculate a commonly used clinical measurement of GFR.
3. Both the plasma creatinine concentration and the blood urea nitrogen (BUN) levels indicate glomerular function. Plasma creatinine is measured to monitor progressive renal dysfunction; BUN is an indicator of hydration status.
4. Urinalysis involves evaluation of color, turbidity, protein, pH, specific gravity, sediment and supernatant.
5. Presence of bacteria, red blood cells, white blood cells, casts, or crystals in the urine sediment may indicate a renal disorder.

Aging and Renal Function
1. As a person grows older, a decrease occurs in the number of nephrons. Both renal blood flow and glomerular filtration rate decline.
2. Tubular transport and reabsorption decrease with age. Response to acid-base changes and reabsorption of glucose are delayed. Drugs eliminated by the kidney can accumulate in the plasma, causing toxic reactions.

Information retrieved from McCance, K., Huether, S. (2002). Pathophysiology: The Biologic Basis for Disease in Adults & Children. (4th ed.) St. Louise, Missouri: Mosby

Hope this helps.
Have a great day.

Fernisa Sison

For everyone that might be having trouble with Neurology, I have posted some information on Docushare, under Nursing 101. The following is a list of the information:

1. Epilepsy
2. Stroke
3. Parkinson's

Here is the new System Reviews dates and times. If anyone needs help just give me a call at 954-5492. I am in L214. Thanks everybody.

Fernisa Sison

System Reviews

“A review of Critical Care case studies”

Come for cases studies and discussion facilitated by
Fernisa Sison, RN, MSN-FNP, BC

October 25, 2005 10:30-11:30
Respiratory

November 1, 2005 10:30-11:30
Hematology/Immunology

November 8, 2005 10:30-11:30
Neurology

November 22, 2005inary 10:30-11:30
Genitour

November 29, 2005 10:30-11:30
Endocrine

December 6, 2005 10:30-11:30
Musculoskeletal

“Location-Locke 228”