Nursing care plans can be a pain to write… especially as a new nurse. Grab this two page (editable) template and guide for creating perfect nursing care plans.Grab Free CheatsheetFree PDF - Instant Delivery
Abdominal pain can be a very minor issue that is easily resolved, or a medical emergency. There are many different things that can cause abdominal pain, whose pathophysiology can differ widely. Abdominal pain can be classified as either acute or chronic. When a patient presents to the emergency department or outpatient environment with abdominal pain, it generally constitutes a lengthy workup to determine the cause, and therefore the pathophysiology. Additionally, abdominal pain can be referred pain, which can complicate the clinical picture even further.
Abdominal pain can be the result of pregnancy, ectopic pregnancy, trauma, a long list of gastric issues (gastroenteritis, constipation, diarrhea, irritable bowel syndrome, GERD, Chron’s disease, appendicitis, to name a few), hernias, allergic response, endometriosis, gallstones, severe menstrual cramps, hepatitis, miscarriage, and many more. Many disease processes result in abdominal pain, and some may present with abdominal pain even though it is not the typical clinical picture.
Cease painful stimuli, resolve underlying cause, minimize any subsequent damage.
Abruptio placentae, or placental abruption, is when the placenta partially or completely detaches prematurely from the uterus, causing a risk for hemorrhage. This is most often seen at 24-26 weeks gestation and is considered a serious complication. In mild cases, the patient may remain on restricted activity or bed rest for the duration of the pregnancy, but in more severe cases where there is maternal or fetal compromise, delivery is required. While placental abruption generally happens suddenly, chronic abruption may occur in which there is a small separation that causes slow bleeding behind the placenta.
Etiology is generally unknown, but risk factors include abdominal trauma, vascular disorders, hypertension (chronic or gestational), PROM or other rapid loss of amniotic fluid, infection, prior history of placental abruption, advanced maternal age (>35 yrs old) and maternal use of tobacco or cocaine. Complications of abruptio placentae include fetal growth restriction, distress or death, maternal blood loss and shock, blood clotting issues (DIC) and maternal kidney and organ failure.
Patient will have no or minimal bleeding; pain will be controlled, fetus will show no signs of distress
Advanced abruption and severe blood loss may lead to shock
Acute kidney injury, also known as acute renal failure, is when the kidneys stop working over the period of a few hours or a few days. People at risk for AKI are those who have high blood pressure, a chronic illness such as heart or liver disease or diabetes, or those who have peripheral artery disease. AKI requires immediate treatment but is usually reversible if treated quickly.
Acute kidney injury is a result of direct kidney damage, decreased blood flow or blockage of the urinary tract. Direct damage may be a result of sudden trauma to the kidneys, sepsis, scleroderma or allergic reaction. Other, more common, causes include a blockage in the ureters such as kidney stones, blood clots, enlarged prostate or multiple myeloma. Hypotension, severe diarrhea, infection, overuse of NSAIDs, dehydration or severe burns may cause decreased blood flow.
Restore kidney function to optimal state, patient will maintain hydration and be free from infection or chronic kidney damage.
Also known as acute kidney injury (AKI), is measured by the buildup of waste in your body and altered fluid levels because the kidneys are failing to do their job. The cause of the renal failure can also change the pathophysiology. There are three main causes: 1) decreased blood flow to the kidneys, 2) direct injury to the kidney/tissues, and 3) blockage of urine excretion. Inflammation to the kidneys or their structures (nephrons) can cause the kidneys to fail. Blockage of urine can cause a backup in the kidney, not allowing them to continue to filter out waste from the body or manage fluid levels.
There are many causes of kidney failure. For example, low blood perfusion to the kidneys can cause acute kidney failure from causes such as an infection/antibiotic use, hypotension potentially from blood loss (hemorrhage) or fluid loss (vomiting/ diarrhea), or even other organ failure (heart attack, liver failure). Another reason for kidney failure could be direct damage to the structures of the kidney itself. The biggest offender of kidney damage is sepsis, but also anything that can cause inflammation in the vessels of the kidneys (Vasculitis) as well as the attempt to treat it with too many NSAIDs can cause direct damage to the kidneys. Lastly, if the urine cannot be excreted, this can cause kidney failure. Kidney stones, enlarged prostates and some cancers can present problems for the urinary tract’s ability to excrete urine.
Return normal functioning of the kidney’s, including the nephrons, blood vessels, urethra, and ureters. Have the kidney labs be within normal limits and hopefully not have the patient on dialysis.
The adrenal glands, located above the kidneys, fail to produce an adequate amount cortisol, aldosterone or androgens. Cortisol is a glucocorticoid that influences the body’s ability to respond to stress and produce energy. Aldosterone is a mineralocorticoid that maintains the sodium-potassium balance that regulates blood pressure. Androgens are responsible for sexual development of men and the influence of muscle mass and sense of well-being in men and women.
A decrease in adrenal gland function may be caused by an autoimmune disease that damages the adrenal glands in which the body attacks the adrenal glands as if they were a foreign body. Damage to these glands may also be a result of severe infection of the adrenal glands, tuberculosis, or the spread of cancer.
maintain adequate hormone levels for optimized ability to create energy and respond to stress and electrolyte balance to regulate blood pressure
Alzheimer’s disease, sometimes called Alzheimer’s Dementia, is a progressive and irreversible neurological disorder that causes loss of memory and cognitive function. Symptoms begin gradually, with signs that are easily attributed to other factors such as misplacing items, forgetting appointments or getting lost in a familiar area. The disease may actually begin occurring in the fifties and sixties, but symptoms may not present until the client is in their eighties or nineties. Studies have shown that clients who reside in smaller living spaces, avoid social interaction or rarely leave their homes are twice as likely to have Alzheimer’s disease. Since Alzheimer’s is an irreversible disease, treatment is geared toward management of symptoms and promoting support and the best quality of life possible.
Diagnostic Criteria: Diagnosis of Alzheimer’s disease should not be applied when symptoms began following a stroke, traumatic brain injury (TBI), there is another known neurological disorder or when client is being treated with medications for other neurological disorders that would produce similar symptoms. The following characteristics must be met for diagnosis:
Client will maintain optimal level of independent or assisted functioning. Client will remain free from injury. Client will have minimal wandering behaviors. Client’s family will have adequate resources and support for coping with client’s disease.
Anaphylaxis is an acute, multiorgan, life threatening allergic reaction. Initial symptoms may look like a normal allergy with runny nose or rash and usually occur within minutes of exposure to an allergen. Within a few minutes, symptoms get more severe and can be deadly if not treated. Anaphylaxis requires immediate medical attention.
Anaphylaxis is caused by an overreaction of the immune system to a particular allergen. Triggers may be different for each person, but the most common triggers are peanuts, insect stings, latex, shellfish and eggs, and medications such as penicillin.
Restore effective breathing pattern and improved ventilation and maintain hemodynamic stability
Anemia is the lack of enough healthy red blood cells (RBC) or hemoglobin (HGB), which is the part of the red blood cell that binds oxygen to the blood. This lack of HGB restricts the amount of oxygen available to create energy within the cells (ATP). This decrease in oxygenation (hypoxia) results in altered pH and can lead to damage of organ systems including cardiac, respiratory and renal disease.
There are many causes for anemia to develop including bone marrow disorders and chronic diseases.
Treat the underlying cause of anemia and return to normal counts of RBCs and HGB.
Appendicitis is the obstruction and inflammation of the inner lining of the appendix. If left untreated, increasing inflammation and infection can lead to necrosis, gangrene or perforation of the appendix in which the infectious materials spill out into the abdominal cavity causing peritonitis. Appendicitis is considered a medical emergency and requires surgery to remove the appendix (appendectomy).
Obstruction of the appendix may result from fecal material, infection, a foreign body or cancer blocking the opening of the appendix. The bacteria from the collection of fecal matter or infection multiply rapidly which causes the appendix to become inflamed, distended and filled with pus, creating an obstruction.
Optimal pain relief and patient will be free from infection.
Aspiration occurs when something enters into the lungs that is not air. This sometimes causes aspiration pneumonia, but not always. For example, the patient has a gag reflex, causing coughing, or the cilia lining the lungs are able to sweep out the aspirated item. If the patient aspirates a secretion that has a high bacterial count they will likely get aspiration pneumonia. The difference physiologically speaking is that pneumonia will be treated with antibiotics.
This is likely caused by someone losing their gag reflex, but can also be caused by inability to clear secretions/emesis, as well as from a position or medication (such as a sedative medication). Someone with dysphagia, no matter the cause is at high risk for aspiration.
Patent airway, oxygenation maintenance, prevention of further complications such as pneumonia.
Shortness of breath
Low oxygen saturation
Lung sounds: Crackles and/or diminished
Putrid or frothy sputum
Bronchoconstriction and increased mucus production decreases the ability to bring air into the alveoli, decreasing the amount of oxygenation red blood cells are able to exchange. This can also lead to increased amounts of carbon dioxide (CO2) retention due to lack of ability to exhale the CO2.
Swelling and mucus aggregated from an irritant or “trigger” cause difficulty in breathing, wheezing lung sounds and hypoxia. Triggers include dust, pollen, smoke, infection, etc. Asthma can also be genetic, environmental, triggered by exercise or from allergies.
Decreased work of breathing and proper oxygenation to tissues.
An electrical activity disturbance in the heart that causes an irregular and often rapid heartbeat. The atria quiver sending confusing electrical signals to the ventricles, leaving them unsure of when to contract thus beating irregularly. During atrial fibrillation, the heart is a less effective pump because of the quivering as well as not emptying completely. This causes the blood to pool and a clot can form. The clot can venture out of the heart into the lungs (PE), brain (stroke) or extremities (DVT).
The specific cause of atrial fibrillation is unknown but there are risk factors that put someone at higher risk of developing afib. Risk factors such as smoking, hypertension, and obesity as well as conditions such as diabetes or heart disease increase the likelihood that a patient may get atrial fibrillation. Post surgical interventions present a major risk for atrial fibrillation as well. Approximately 30%-40% of cardiac surgery patients develop atrial fibrillation.
Decreasing risks of clot formation, a heart rate within normal limits and rhythm control. The ultimate outcome is converting back to normal sinus rhythm, however, many people live with atrial fibrillation, especially if rhythm control doesn’t work or isn’t necessary.
Cardiogenic shock is a state in which the organs are not receiving adequate oxygenated blood because of severe pump (heart) failure. It is an acute, sudden, extreme version of heart failure and is a medical emergency.
A myocardial infarction can cause cardiogenic shock because the heart muscle cannot pump effectively. Things that obstruct the flow of blood to the body can also cause cardiogenic shock – that includes cardiac tamponade (fluid build up around the heart that compresses it and prevents pumping) and pulmonary embolism (blood clot in the pulmonary arteries that prevent forward flow and prevent oxygenation of the blood).
The goal is to reverse the cause and restore sufficient cardiac output to the tissues. The hope would be to prevent any permanent damage from tissue ischemia and to prevent recurrence of cardiogenic shock.
Patient may have any combination of these signs depending on the cause of their cardiogenic shock
Cardiomyopathy is an abnormality of the cardiac muscle that leads to functional changes or impairment. There are three types: Dilated, Hypertrophic, and Restrictive.
Cardiomyopathy is typically caused by prolonged, uncontrolled hypertension, congestive heart failure, or congenital diseases. In each case the heart is having to work extra hard – the ventricles begin to change shape (or remodel) in response to the extra work.
To control HTN and manage symptoms and prevent long-term complications of low cardiac output. The only “cure” is heart transplant.
Fluid back up in the heart causing the heart to fail its’ functionality and pump ineffectively. Heart failure can be in the left side, right side or both. When both sides are failing, it is called congestive heart failure. Heart failure is measured by ejection fraction. Normally functioning hearts have 50% or higher ejection fractions. Anything less is concerning for heart failure.
Any issue with the cardiovascular system could potentially cause CHF (or put the patient at a much higher risk for CHF), such as myocardial infarction, coronary artery disease, hypertension, cardiomyopathy, heart arrhythmias, etc. Also any other comorbidities such as diabetes, thyroid issues, HIV, etc. contribute to heart failure occurring. If the CHF is acute in nature, it may have been caused by a virus, infection, or blood clot.
maximized cardiac functionality as well as decreased stress on the cardiovascular system.
Difficulty in Breathing
Coughing (produces a white or pink tinged mucus)
Heart palpitations or feeling like the heart is racing.
Crackles in the lung bases
Shortness of breath upon exertion
Cholecystitis is the inflammation of the gallbladder, which holds bile, a digestive juice, that is released into the small intestine. When the path (bile duct) between the gallbladder and small intestine is blocked, bile becomes trapped, builds up and causes inflammation. Surgical removal of the gallbladder is commonly required.
The cause of obstruction of the bile duct may vary. The majority of cases are caused by gallstones (calculi) that get trapped in the bile duct. Biliary sludge is the mixture of bile, cholesterol and salt that can build up and form a blockage. Other obstructions may develop from infection, tumors, or edema from compression of the blood vessels.
Patient will be free of pain and resume and maintain optimal diet and nutrition.
Chronic kidney disease includes conditions that damage the kidneys and decrease their ability to effectively filter waste products from the blood. Chronic kidney disease (CKD) develops slowly over time and often presents with no symptoms. Progressed kidney disease may lead to kidney failure which may require dialysis and lead to death.
The two most common causes of CKD are uncontrolled hypertension and diabetes mellitus. Long term elevated pressure of hypertension within the artery walls and damage to the blood vessels from excess glucose can reduce the blood flow to the kidneys causing improper filtration of waste. Prolonged obstruction, as with kidney stones, or recurrent urinary tract infections may also damage the kidneys and inhibit their ability to filter and remove waste products into the urine.
Maintain optimal control of blood pressure and blood glucose, avoid further progression of disease to cardiac involvement, maintain optimal fluid balance, and prevent complications.
Liver cirrhosis is a chronic, irreversible liver disease. Inflammation and fibrosis of liver cells (hepatocytes) lead to formation of scar tissue within the liver, which causes obstruction of hepatic blood flow and impedes proper liver function. This impaired blood flow leads to edema, ascites, esophageal varices, hemorrhoids, and varicose veins, among many other things. Since the liver is responsible for making many of the chemicals required by the body to function, breaking down and detoxifying substances and storing vitamins and minerals, many of the body’s systems fail to function when the liver is damaged.
Liver cirrhosis is primarily caused by diseases that damage the liver and leave scar tissue in place of healthy tissue. Alcoholic liver disease (26%) and Hepatitis C (21%) are the cause behind 47% of liver cirrhosis cases in the United States. Other factors such as nonalcoholic fatty liver disease, Hepatitis B and D, autoimmune disease and chronic heart failure with liver congestion may also result in cirrhosis.
Minimize progressive liver damage, optimize nutrition, maximize hepatic circulation, minimize and prevent respiratory complications
Orofacial clefts, individually known as cleft lip and cleft palate, are the most common birth defects. These defects happen early in pregnancy when the lips and palate do not form properly. Cleft lip is characterized by a slit or opening that goes through the lip and into the nose on one or both sides of the lip. Cleft palate is an opening in the roof of the mouth, called the palate. Cleft lip and cleft palate may occur together or individually.
During the early part of pregnancy, around week 7 or week 8, the tissues of the mouth and lips begin to form and join. Genetic and environmental factors are believed to be the cause of these tissues not joining correctly which leaves an opening in the lip or palate. Studies have shown that pregnant women who use certain medications to treat epilepsy and those who have diabetes or smoke are at increased risk of having a baby with orofacial clefts.
Patient will have normal breathing pattern; patient will have adequate nutrition; patient will have optimal hearing and speech
The heart fails to pump effectively, causing decreased perfusion forward of the failure and fluid back behind the failure. Heart failure can be left sided, right sided or both. When both sides are failing, it is called congestive heart failure (CHF). Heart failure is measured by ejection fraction. Normally functioning hearts have an ejection fraction of 55-75%. Anything less than 50% is concerning for heart failure.
Any issue with the cardiovascular system could potentially cause CHF (or put the patient at a much higher risk for CHF), such as myocardial infarction, coronary artery disease, hypertension, cardiomyopathy, valve disorders, arrhythmias, etc. Also any other comorbidities such as diabetes, thyroid issues, HIV, etc. contribute to heart failure occurring. If the CHF is acute in nature, it may have been caused by a virus, infection, or blood clot.
maximized cardiac functionality as well as decreased stress on the cardiovascular system.
Less air flow is able to flow into and out of the alveoli both trapping CO2 as well as restricting O2 entering.
There are two types of COPD: Chronic Bronchitis and Emphysema. The most common cause of COPD is smoking of any form: cigarette, pipe, cigar, second hand. Any lung irritant can cause COPD and also exacerbate it.
Clear, even, non-labored breathing while maintaining optimal oxygenation for patient.
Difficulty in Breathing
“I can’t breath”
Shortness of Breath
Inability to speak full sentences (have to stop to breath)
Similar to Cushing’s syndrome which is much more common, Cushing’s disease is a condition where the pituitary gland secretes too much hormone (ACTH) causing an overproduction of cortisol (stress hormone). It causes weight gain around the trunk and waist with fat loss in the less and arms. Patients may also develop a hump on the upper back that is caused by abnormal fat deposits. This disease weakens the immune system and can cause mood disorders such as anxiety and depression.
Cushing’s disease is caused by a tumor or excess growth (hyperplasia) on the pituitary gland. Cushing’s syndrome is similar in its production of excess cortisol, but is usually a result of other disease processes. As the pituitary secretes more hormone (ACTH), it stimulates the adrenal glands to produce more cortisol (stress hormone). Cortisol controls blood sugar levels, how the body uses carbohydrates, fats and proteins and reduces the immune system’s response to inflammation, therefore making the patient more susceptible to infection.
Manage symptoms, maintain normal blood pressure and a blood glucose level within appropriate range
Cystic fibrosis (CF) is an autosomal recessive genetic disorder which causes abnormalities in the secretory glands that produce mucus and sweat and mostly affects the lungs, pancreas, liver, intestines and sex organs. The mucus that is produced in the body becomes thick and sticky. Instead of lubricating the lungs and other organs, it clogs the airways in the lungs and the ducts, most frequently in the pancreas and liver. Almost all males with CF are sterile and most females have a hard time getting pregnant. Symptoms can range from mild to severe. CF can lead to other diseases such as diabetes and osteoporosis. Screening for CF is routinely done on newborns and diagnosis is generally made before symptoms are evident, often within the first month of life.
Cystic Fibrosis is caused by a recessive defect in the CFTR gene. The CFTR gene makes a protein that regulates the movement of salt and water through the cells. The mutation causes the protein to either not work very well, or not be produced at all. When this happens, there is no regulation of salt and water across the cell membranes and mucus that the body produces becomes dehydrated and salty. The hallmark sign for this disease is a salty taste to the skin.
Patient will maintain adequate ventilation and respiratory status; patient will have optimal nutritional status; patient will be free from infection.
Blood clots formed from any source, lodging in the patient leg or arm, impeding blood flow. This backup of blood pools in the extremity causing swelling, redness, warmth and pain.
Narrowing or occlusion of the vessels in an extremity. If caused by plaque (cholesterol and other substances) this could be from poor diet, lack of exercise, or genetics. However, blood stasis can cause aggregation of platelets and other blood products forming a clot that travels to the extremity (or heart, lungs or brain!). The most common cause of blood pooling (stasis) is Atrial Fibrillation (AFib). Other major causes are prolonged sitting, pregnancy, smoking, and birth control.
Stabilization of the blood clot or disintegration of the blood clot as well as prophylaxis treatment for future blood clots.
Diabetes Mellitus is when blood glucose (sugar in the blood) is unable to move into the cells and help in the making of ATP…AKA energy. The body makes insulin to assist with this process. Insulin is a hormone that allows the sugar in the blood to move across the cell wall so the body can use to to produce ATP. There are two types of diabetes. Type I and Type II.
Type I is an autoimmune disorder where the cells attack the insulin producing cells in the pancreas. Thus the body is producing very little or no insulin leaving the sugar in the blood and the cells starve.
Type II is when the cells don’t respond to the insulin trying to get sugar into them, called insulin resistance. Thus the sugar stays in the blood and the cells starve.
The cause for Type I diabetes is unknown, but hypothesized to be potentially genetic or triggered by a virus. The cause for Type II diabetes is caused by a storm of events culminating such as weight gain, lack of activity, genetics, and stress levels.
Blood sugar control with minimal side effects.
Hyperglycemia: BG >180 mg/dL
Hypoglycemia: <70 mg/dL
Numbness around the mouth
-Hot and Dry, Sugar High.
-Cold and clammy give them some candy!
Diabetes insipidus refers to the condition where the kidneys are unable to retain water. Even though the patient may be dehydrated, the kidneys cannot balance the fluid and produce large amounts of insipid urine (dilute and odorless). The kidneys normally produce 1-2 quarts of urine per day, but with diabetes insipidus, they may produce 3 – 20 quarts per day. This results in the patient feeling very thirsty and have the urge to drink large amounts of liquid.
The hypothalamus produces a hormone called vasopressin, an antidiuretic hormone (ADH) that tells the kidneys how much fluid to absorb from the bloodstream. This normally results in a lower amount of urine produced. When there is damage to the hypothalamus (Central diabetes insipidus, or CDI) or the kidneys are not able to respond to the vasopressin (Nephrogenic diabetes insipidus or NDI), the kidneys do not know when to stop removing fluid from the body, even if the body is already dehydrated. This results in the patient feeling extremely thirsty, which prompts them to drink more fluids, and therefore, secrete more dilute urine.
Prevent dehydration, manage symptoms and prevent complications
Diabetes Mellitus (DM) occurs when the body is unable to move glucose (sugar in the blood) into the cells to produce ATP (energy). Insulin is a hormone made by the pancreas that allows glucose to move across the cell wall. There are two types of diabetes mellitus, Type I and Type II.
Type I is an autoimmune disorder in which the immune system attacks the insulin-producing cells in the pancreas resulting in very little or no insulin being produced. This prevents the cells from receiving glucose and they begin to starve.
Type II is called insulin resistance diabetes because the cells no longer respond to insulin. Again, the glucose cannot enter the cells so it stays in the bloodstream and the cells starve.
The cause of diabetes is not known, but it is believed to be genetic or triggered by a virus. Sugar intake does not cause diabetes, but many factors may increase the risk of developing the disease. Factors include autoimmune disease, high blood pressure, overweight and obesity, physical stress (such as injury or surgery), heavy alcohol use, smoking and a history of gestational diabetes.
Maintain blood glucose levels within normal limits and prevent complications and progression of disease
Diabetic ketoacidosis is a serious complication of diabetes mellitus that occurs when uncontrolled blood sugar rises and the body can’t produce enough insulin to use the glucose. When this happens, the body begins to break down fat as energy which produces a build-up of acid in the bloodstream called ketones. This is a serious life-threatening condition that occurs most often in Type I diabetics
Ketoacidosis can occur when diabetic patients experience emotional or physical stress such as with bacterial infections (UTI, etc), prolonged vomiting, surgery or when they miss doses of insulin. Alcohol and drug abuse in a diabetic patient can also cause the body to produce ketones that poison the blood.
Maintain blood glucose level within the target range, maintain normal fluid balance
Diverticulosis: A benign condition where pouches form along the intestine wall. These pouches may form anywhere along the intestine, but are most commonly found at the end of the descending and sigmoid colons on the left side of the abdomen. They are also commonly found in the first section of the small intestine, but diverticula in this area rarely cause problems.
Diverticulitis: involves small abscesses or infection in one or more of the diverticula, or perforation of the bowel.
Diverticulosis- The thickening of the outer wall of the intestine causes narrowing of the inner space. This narrowing causes stool to move more slowly. Hard stools, produced from a low fiber diet, and slower transit time through the intestine create pressure on the intestinal wall, thus forming pockets called diverticula. These pockets are most often asymptomatic.
Diverticulitis- Stool passing slowly through the intestine deposits fecal material in the diverticula. Over time, bacterial overgrowth causes an inflammatory response and may form an abscess or infection in the diverticula. Advanced diverticular disease can result in perforations of the intestine and peritonitis if infection is leaked through the perforations into the abdominal cavity.
Patient will be free from pain and infection and will be compliant with appropriate diet and medication regimen.
Eczema is a chronic condition that causes inflammation of the skin. There are several types of eczema. The most common form is atopic dermatitis which can be triggered by foods, skin irritants, or environmental exposures. Eczema normally appears during infancy and often resolves by the teenage years. It most often affects the face, hands, feet, inner elbows and the back of the knees and causes an itchy rash to develop.
While it is believed to be genetic, eczema is also more common among infants who are formula-fed or received solid foods prior to 6 months of age and those with a family history of asthma or allergies. Atopic dermatitis, is thought to be due to a deficiency of a skin protein. Without this protein, the skin becomes more sensitive to environmental factors and irritants.
Patient will be free of rash and pain; patient’s skin will be free from excoriation and infection
Destruction of the alveoli shapes and functionality. Normally alveoli are little pouches of springy grapes, but patients with emphysema have misshapen pouches that are not springy. This causes CO2 to stay in the alveoli and not exhale out of the body as well as making it harder for O2 to enter into the alveoli. High levels of CO2 (which is acidic) can cause complications such as respiratory alkalosis.
Exposure to lung irritants in the air: smoke, air pollutants, chemicals, dust, etc. for prolonged periods of time and with repeated exposure.
Clear, even, non-labored breathing while maintaining optimal oxygenation for patient.
Difficulty in breathing
May notice they are avoiding certain activities that they used to participate in and now cannot due to breathing difficulties… “I used to play with the grandkids, now I can’t”
Shortness of Breath- especially upon exertion
Blue/Gray lips/fingernails- especially upon exertion
Inability to speak full sentences (have to stop to breath)
Endocarditis is inflammation of the lining and valves of the heart. It is often from an infectious source and can cause disorders of the valves and life threatening arrhythmias. Vegetations can form because of bacteria adhering to valves, which can then become embolic – causing heart attacks or strokes.
The two most common causes are IV drug use (because of the introduction of bacteria into the vascular system) and artificial valve replacement (because the bacteria tend to adhere to the artificial device).
To treat the cause and remove the source of infection while preserving cardiac output and preventing any major (or minor) complications.
A fever is the rise in body temperature above what is considered a normal range. Most physicians consider a fever to be a temperature over 100° when taken orally, 99° when taken under the arm and over 100.4° when taken rectally. The purpose of a fever is to help the body fight off infection. Fevers can be mild and benign, but they can also alert to more serious disease. Not all fevers need treatment. It is recommended that, unless the child is visibly uncomfortable or in pain, fevers under 102° should not be treated.
Dehydration is an excessive loss of fluid from the body and is another common issue among children. Most children get enough water from eating and drinking, but fluid loss in a child can be dangerous, leading to brain damage or even death.
The body’s temperature is controlled by the hypothalamus in the brain. When the body temperature rises, it is because the hypothalamus is resetting the temperature in response to some illness or infection. A higher temperature makes it more difficult for germs that cause infection to live. This is a normal defense system of the body and is not a disease in itself, but usually a symptom of some illness or infection. Alternatively, infants who are over bundled or in a very warm environment may develop a fever because the hypothalamus is not yet able to fully regulate temperature.
Dehydration occurs more often in infants and toddlers as they lose fluid much faster than older children and adults, and may occur from having an illness that causes vomiting or diarrhea or from fever. As the body temperature rises, the tissues use more water. If the child does not take in enough fluid when running a fever or with vomiting and diarrhea, they can dehydrate more quickly. Children who have other diseases such as diabetes may experience excessive urination that results in dehydration. In older children, sweating after play may contribute to fluid loss, but is not usually the only factor.
Patient will maintain optimal fluid balance; patient will exhibit vital signs within normal range; patient will be free from infection
GERD is the return (reflux) of stomach acid and contents into the esophagus, past the Lower Esophageal Sphincter (LES) causing irritation and thinning of the lower esophagus. Regurgitation often occurs without effort, such as when lying down or bending over. Frequent recurrences without treatment may lead to erosion of the mucus membranes of the lower esophagus.
Weakness or incompetence of the LES may be related to excessive pressure being placed on the abdomen such as in the case of obesity or pregnancy. Certain medications such as calcium channel blockers, sedatives, antidepressants and antihistamines relax the smooth muscle of the LES, which weakens the ability of the sphincter to fully close, thus allowing food and digestive acids to enter the esophagus. Patients who smoke or have a hiatal hernia are at increased risk of developing GERD.
Eliminate pain of the esophagus and regurgitation while maintaining normal function of lower esophageal sphincter and preservation of the esophageal tissue.
Gestational hypertension is having high blood pressure during the second half of pregnancy in women who have never had high blood pressure before. This is diagnosed when blood pressure exceeds 140/90. Gestational hypertension normally resolves within about 6 weeks after delivery.
Preeclampsia is high blood pressure during pregnancy that damages other organs, usually the kidneys and liver. Preeclampsia can be a serious complication and is often characterized by swelling of the face and hands and protein in the urine.
Eclampsia results when preeclampsia is left undiagnosed or treated and can be fatal. Eclampsia is diagnosed when patients with preeclampsia begin having seizures. These seizures can occur, even if the patient does not have a history of them.
Gestational hypertension– The cause is generally unknown, but is more common in patients who have kidney disease or diabetes prior to pregnancy, or those who have had gestational hypertension in previous pregnancies. Other risk factors include being pregnant with twins (or triplets), maternal age younger than 20 years old or older than 40 years old and being African American.
Preeclampsia– The blood vessels within the placenta do not develop properly and are narrower than normal. This extra pressure within the blood vessels puts stress on the maternal liver and kidneys. Certain genetic factors, immune system response and damage to the blood vessels may contribute to this abnormal development. This complication can result in growth restriction of the fetus, placental abruption or even preterm birth.
Eclampsia– Eclampsia is basically severe preeclampsia that results in seizures. When preeclampsia becomes severe and is not treated, it can result in seizures and could be fatal to mother and fetus. This usually results in having to terminate the pregnancy and deliver the fetus, regardless of gestational age.
Patient will have controlled blood pressure at or below 140/90; patient will have optimal functioning of organ systems without chronic damage; patient will carry pregnancy to term
Bleeding along the lining of the Gastrointestinal Tract is hard to recognize because it is not something you can see immediately, or necessarily get imaging or laboratory test work to discover the cause of bleeding right away. Upper GI bleeds will come out as dark tarry stools and lower GI bleeds will come out as bright red bleeding. Also, monitor for blood in the vomit, and be aware of coffee ground emesis because blood can curdle in the acidic stomach environment.
The bleeding along the GI tract is from a perforation somewhere in the intestines or stomach. Can be caused by too much acid (ulcer), an abnormal formation in the colon (tumor, polyp, hemorrhoids), inflammation of the lining (diverticulitis, colitis) or any sort of trauma to the GI tract.
Controlling and stopping of the bleeding, vital signs back to baseline, normal blood counts such as hemoglobin.
Glaucoma is group of diseases in which the pathophysiology is not fully understood. It is also a condition which remains largely asymptomatic until it is in its advanced stages. At its most basic level of understanding, the pressure in the eye on the optic nerve increases, which leads to cellular death and ultimately vision loss. The mechanisms in which the pressure increases differs between the different kinds of glaucoma. We will discuss the two most common.
Open-angle and angle-closure are the most common kinds. Open-angle accounts for approximately 90% of cases. It occurs over a long period of time. Slowly, drainage canals become clogged, which results in higher pressure. This can happen so slowly that the patient doesn’t even realize the visual deterioration is occurring until it’s quite advanced.
The second most common kind of glaucoma, angle-closure, is a sudden condition that comes on quickly and requires immediate treatment. It is usually related to some sort of eye trauma. This must be treated immediately and is considered a medical emergency, as permanent blindness can occur without appropriate treatment.
Because the most common kind of glaucoma occurs slowly over years without symptoms, screenings are essential. This is why a glaucoma test is routine in eye exams, even for young adults.
The exact cause of glaucoma is unknown. As far as the most common type of glaucoma, open-angle, the theory is that the drainage system of the eye becomes insufficient over time and subsequent pressure builds up.
Age (over 60), race, genetics/family history, eye injury, other eye pathology, as well as corticosteroid use are all risk factors for glaucoma.
Decrease intraocular pressure as quickly as possible, prevent further visual damage.
**May be asymptomatic
Seeing bright lights
Sudden sight loss
Severe eye pain
Slow visual changes
**May be asymptomatic
Gout is a common and painful form of arthritis that causes swollen, hot and stiff joints. When uric acid crystallizes, it settles into the joints and body tissues, most frequently affecting the big toe and, if not treated, progresses to the ankles, heels, wrists and hands. This results in severe pain, stiffness and redness at the joint. Gout attacks often occur in the middle of the night when the joint is immobile. Once the initial pain has subsided, general discomfort of the area can last for several weeks.
Excessive amounts of uric acid in the blood is the primary cause of gout. Other factors include genetics, dietary factors, use of diuretics and the inability of the kidneys to excrete uric acid. As the uric acid accumulates, crystals of monosodium urate form in the joints and tissues. 90% of cases are caused by the underexcretion of uric acid. Dietary factors as a cause for gout only comprise about 12% of cases, but changes to the diet help reduce the risk.
Relieve acute attack, prevent future attacks, promote optimal excretion of urates
Mitral Regurgitation – mitral valve cannot close completely, therefore blood back-flows into the LA
Mitral Stenosis – mitral valve cannot open fully or is narrowed, therefore blood can’t go into the LV
Aortic Regurgitation – aortic valve cannot close completely, therefore blood back-flows into the LV
Aortic Stenosis – aortic valve cannot open fully or is narrowed, therefore blood can’t get out of LV
When the blood can’t flow the direction it’s supposed to flow, cardiac output is compromised.
The most common cause of valve disorders is rheumatic fever or endocarditis which cause damage, vegetation, or thickening and scarring of the heart valves. An acute, emergent situation could be caused by mitral valve prolapse or papillary muscle rupture.
Preserve cardiac output where possible, and proceed to valve repair or replacement if cardiac output is compromised. Prevent post-op complications from valve repair or replacement.
May be asymptomatic except heart murmur. If cardiac output is compromised, may see these symptoms:
May be asymptomatic except heart murmur. If cardiac output is compromised, may see these signs:
Hemophilia is a genetic bleeding disorder that is characterized by a deficiency of clotting protein. Patients with hemophilia experience longer bleeding time than others because their blood clots much slower. The amount of clotting protein available in the blood determines the severity of hemophilia and categorizes it into three levels: mild, moderate and severe. Complications of the disease include bleeding into the joints, hemorrhage into the central nervous system or vital organs, and aspiration from bleeding into the airways.
Hemophilia is genetically (X) linked with females being the carriers, and males being affected by the disease. There are two types of hemophilia. Type A (classic) is caused by a deficiency of Factor VIII (8) clotting protein and is the most common, affecting 1 in every 10,000 males. Type B (Christmas disease) is caused by a deficiency of Factor IX (9) and affects 1 in every 30,000 males.
Patient will be free from bleeding complications; patient will be educated on how to prevent injury and bleeding; patient will have optimal physical mobility
The inflammation of the liver is called hepatitis and may be the result of lifestyle factors, chronic or autoimmune disorders or viral agents. Some forms of hepatitis are curable while other forms last a lifetime. Management and treatment of the disease depends on the causative factor. The widespread inflammation results in degeneration and necrosis of the liver. 70% of hepatitis cases (B and C) progress to a chronic state, cirrhosis or become fatal.
About half of all hepatitis cases are attributed to hepatitis viruses A, B and C. Chronic alcohol use, drugs and excessive use of some medications (acetaminophen, statins) as well as infection such as Epstein-Barr (mononucleosis), can impair the liver’s ability to filter toxins, produce and store metabolic chemicals and store vitamins and minerals.
Minimize progressive degeneration and necrosis of the liver, improve healthy lifestyle habits, maintain optimal nutrition and functionality of liver
Bilirubin is the yellow pigment that is left over when red blood cells break down. The liver normally absorbs and processes bilirubin, but in the newborn there are not enough enzymes present yet for the liver to absorb and metabolize the bilirubin. Therefore, about the second to fourth day after birth, the skin and eyes become yellow-tinted. If the jaundice is not treated, high levels of bilirubin can lead to brain damage.
In the newborn, the liver is not mature enough to have adequate levels of enzymes present to metabolize the bilirubin fast enough. Premature infants are at higher risk of jaundice as well as those who have had bruising during birth (as with forcep or vacuum assisted delivery), when there is a blood type difference between mother and baby, and in cases of neonatal sepsis. Breastfeeding infants will often develop jaundice as a result of dehydration or not enough calorie intake if they are having difficulty nursing.
Patient will have decreased yellowing of the skin and eyes; patient will have adequate nutritional intake; patient will have bilirubin level within normal range
Patient’s mother/caregiver reports:
Hyperemesis gravidarum is extreme morning sickness that causes long-lasting intense nausea, vomiting and weight loss. While many pregnant women experience morning sickness, hyperemesis gravidarum develops between the 4th – 6th weeks of pregnancy and may last longer than week 20. Symptoms may be so severe that they interrupt the patient’s daily activities.
While the exact cause is still unknown, many believe hyperemesis gravidarum is caused by a rapid rise in hormone (hCg) levels. This condition may last several weeks or throughout the majority of the pregnancy. Complications that may arise from excessive vomiting include dehydration, renal impairment, malnutrition and electrolyte imbalance.
Reduce and manage symptoms of nausea and vomiting; maintain appropriate nutrition and hydration; avoid complications and injury to patient and fetus
HHNS occurs in Type 2 diabetics when the body is unable to excrete excess sugar in the blood. The blood becomes very concentrated (hyperosmolar), but does not produce ketones. Initially, it causes polyuria, frequent urination, but as it progresses, the urine becomes more concentrated and takes on a dark appearance and frequency is decreased. Dehydration often occurs and can lead to seizures, coma and death. HHNS is a serious condition that generally affects the elderly population.
Most commonly, HHNS is triggered by periods of illness such as a common cold or bacterial infection. The inflammation process raises blood glucose levels. When the glucose level stays elevated, often over 600 mg/dL, for extended periods of time, polyuria occurs as the body pulls water from inside the cells to try to rid itself of the extra glucose through the urine. As the urine is expelled and the cells dehydrate, electrolytes become imbalanced as sodium, potassium and chloride are lost. Since some insulin is present in Type 2 diabetes, ketones are not produced. Severe dehydration leads to extreme thirst, confusion, seizures, coma and death.
Maintain blood glucose levels within target range for patient, attain optimal hydration and fluid balance.
The pathophysiology of HTN is quite complex. Blood pressure is essentially the amount of blood the heart pumps, as well as the resistance to blood flow in the actual arteries. If there is more blood and/or smaller arteries, naturally the pressure will be higher. When someone has higher pressure for an extended period of time, it begins to cause problems. HTN is called the silent killer because it can begin to cause problems without any symptoms. Some don’t realize this is happening until end-organ damage occurs, like kidney failure. Many times it has been happening for years undetected. The way it is detected is with a simple blood pressure screening, hopefully done at an annual physical. However, if someone does not regularly visit a physician and get checkups, then this may go undetected for a long period of time.
There is primary and secondary HTN. Primary HTN is caused by a combination of genetic and environmental factors. Secondary HTN comes from an identifiable cause (for example, sleep apnea or hyperthyroidism).
Keep in mind, higher blood pressure for a short period of time is normal. Your blood pressure will naturally increase during times of stress or pain, but the HTN we are discussing is chronically elevated even during times of relaxation.
Primary HTN can be caused by many different factors. Certain ethnicities have a higher incidence of HTN (African Americans). The older a person is, the higher the likelihood of HTN. Family history, body weight, sedentary lifestyle, not enough of certain vitamins (like Vitamin D), not enough potassium, too much sodium, or excessive stress can all be a causative factor of primary HTN.
Secondary HTN arises from various conditions like kidney/adrenal/thyroid issues, congenital blood vessel defects, sleep apnea, various meds (decongestants are a big one!), street drugs (cocaine, methamphetamines), tobacco and excessive alcohol use, and more, can all cause secondary HTN.
Control blood pressure down to a safe level appropriately. Please note, if a patient has had chronically elevated blood pressure for years or is in a hypertensive crisis , they may need their blood pressure lowered slowly, as they can have symptoms of hypotension at even normal blood pressure levels. Make sure you’re following orders very specifically and not decreasing the blood pressure too quickly in these instances.
**HTN frequently presents without symptoms, therefore the listed symptoms are not the typical presentation. If symptoms present, that means the disease process has most likely progressed significantly.**
**HTN frequently presents without symptoms, therefore the listed symptoms are not the typical presentation. If symptoms present, that means the disease process has most likely progressed significantly.**
Impetigo is the most common bacterial skin infection in children. Impetigo is highly contagious and normally appears around the nose, mouth and extremities. It is characterized by blisters with yellow fluid that rupture and leave a honey-colored crust. Impetigo is spread through direct contact with sores and scratching may cause the lesions to spread. The normal course of infection typically lasts 2-3 weeks without treatment. Systemic complications, including rheumatic fever and glomerulonephritis are rare, but can occur.
Impetigo is caused by common bacteria, usually Group A beta-hemolytic streptococcus or Staphylococcus aureus that enters through breaks in the skin. It often accompanies poor hygiene and is more prevalent in warm temperatures. The condition is considered contagious as long as lesions are present.
Patient will be free from infection and exhibit an absence of skin lesions; patient will not have systemic complications
Increased pressure within the cranial cavity (or skull) is caused by an increase in the volume of either the brain tissue, blood, or cerebrospinal fluid, or by the presence of another space-occupying lesion. This increased pressure will compress the brain tissue, causing damage to the neurons and leading to neuro changes and eventually herniation and brain death.
Anything that causes increased volume of brain tissue, blood, or cerebrospinal fluid within the skull – cerebral edema, hemorrhage, hydrocephalus, hypertension, cerebral vasodilation. Could also be caused by a space-occupying lesion such as a tumor or mass.
Minimize intracranial pressure to prevent any damage to nerve tissue and prevent long-term neurological deficits.
Leukemia is cancer of the blood forming tissues and usually involves the white blood cells. The bone marrow produces abnormal white blood cells that do not function properly. The life cycle of the white blood cells is changed and the cells do not die when they should, thus accumulating and taking up space. They eventually crowd out the good cells which impairs the growth and function of healthy cells. There are many types of leukemia. Some types can be cured while others cannot. Treatment is highly dependent upon the type of leukemia
Scientists don’t fully know the exact etiology of leukemia , but believe that it may come from a combination of genetic and environmental factors. Genetics, radiation or chemical exposure, viruses (HIV), previous chemotherapy, and those with Down Syndrome appear to have a higher incidence of leukemia.
Minimize complications and resolve if possible. Maximize the normal blood cells and minimize the abnormal cells.
Lymphoma refers to cancer of the lymphatic system. This system includes the lymph nodes (glands located throughout the body), spleen, thymus gland and bone marrow. There are two main types of lymphoma: Hodgkin’s and Non-Hodgkin’s lymphoma, and they are classified as such depending on the type of cell involved. Treatment depends on the type and severity. Lymphoma is characterized by painless, swollen lymph nodes.
Lymphoma begins when a disease-fighting white blood cell (lymphocyte) develops a genetic mutation. Doctors are still unclear as to what causes this change, but have found that the mutation causes the cells to multiply rapidly and go on living when normal cells would die. The accumulation of these diseased lymphocytes causes swelling of the lymph nodes. Certain risk factors increase the chance of developing lymphoma, including being male, over 55, having an impaired immune system or taking immunosuppressants, and certain infections such as Epstein-Barr virus and Helicobacter pylori.
Maintain adequate ventilation, prevent infection, manage pain and symptoms of side effects related to treatments
*Symptoms are not always present*
The meninges surround both the brain and the spinal cord to provide cushion and protection as well as create cerebrospinal fluid. In meningitis, these meninges get infected and inflamed, causing symptoms that range from altered level of consciousness (due to inflammation in the brain) to nuchal rigidity or numbness & tingling (because of the effect on the spinal cord).
Meningitis can be caused by bacteria or viruses, which can be introduced via the bloodstream as well as through invasive procedures or fractures of the skull. Transmission is via droplets and usually occurs in areas of population density or crowded living spaces such as college dorms, prisons, and homeless shelters.
Treat the underlying infection, decrease inflammation and swelling in the brain, and prevent long-term neurological deficits.
Mood disorders are a category of mental illnesses that affect a person’s emotional state over a long period of time. Emotions, or moods, may fluctuate frequently and seemingly without any reason. The most common of these are Major Depressive Disorder and Bipolar Disorder. Depression may be a common feature of other mental illnesses, but can occur independently as well. Clients with mood disorders are at higher risk for substance abuse and suicidal tendencies. Research has shown that there is a high incidence of depression among clients that also have chronic medical conditions such as heart disease, cancer, Alzheimer’s disease and hypertension. Treatment is geared toward managing symptoms through the use of medications and psychotherapy.
Diagnoses do not include symptoms related to other medical conditions or substance use, does not meet the criteria for another mental illness or psychotic disorder.
Major Depressive Disorder (MDD):
Bipolar Disorder (BPD):
Client will remain safe. Client will not cause harm to self or others. Client will demonstrate coping techniques. Client will identify appropriate actions for managing emotions.
Chronic, progressive disorder characterized by decreased acetylcholine activity in the synapses. This is due to insufficient acetylcholine secretion and excessive secretion of cholinesterase, the enzyme that inactivates acetylcholine. This causes a decrease in effective transmission of nerve impulses in the muscles, causing weakness and fatigue, especially in respiratory muscles.
MG is an autoimmune disorder which is often exacerbated by precipitating factors known as triggers. This includes stress, infection, hormone disturbances, trauma, and extreme temperatures.
Preserve functional ability, protect airway, and prevent complications such as myasthenic crisis or cholinergic crisis.
Cardiac muscle tissue death from lack of blood flow. The blood carries oxygen and nutrients to the cells. When this is decreased, cells die also called necrosis. Cardiac muscle cells dying is problematic as they do not regenerate (although there is some debate of this topic: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3042154/ )
Narrowing or occlusion of the cardiac vessels that perfuse the heart. The plaque that causes this could be from poor diet, lack of exercise, or genetics. It can also be from a deep vein thrombosis (DVT) that has broken free (embolus) and landed in the heart.
Re-perfusion to cardiac muscle and return of cardiac muscle functionality, or as much as possible.
Neutropenia is an abnormally low count of neutrophils, which is a type of white blood cell. Neutrophils are made in the bone marrow, so anything that inhibits or disrupts that process can result in neutropenia. It also can result if neutrophils are destroyed (by medications, for example) Neutropenia can be congenital or acquired.
Congenital neutropenia can result from conditions like Kostmann’s syndrome or myelokathexis.
Acquired neutropenia result from nutritional deficiencies, infections (Hep A, B, C, HIV, and more), medications, chemotherapy, leukemia, alcohol use disorder, rheumatoid arthritis, and more.
Restore neutrophil count, prevent additional destruction, prevent infection
**Neutropenia itself will typically not elicit symptoms, but its cause or subsequent infections may, which differ. Many patients are unaware until the lab is drawn and the diagnosis is made.
absolute neutrophil count < 1500 cells/mm3
Osteoarthritis (OA), a common degenerative joint disease, is the wearing down of the protective cartilage between the joints. The tendons, ligaments and ends of the bones also wear down, often developing spurs, that produce pain, inflammation and swelling. OA is the top cause of disability in the older population, but can affect people of any age, even in their 20s and 30s. Joint pain and stiffness are the hallmarks of osteoarthritis. It cannot be cured or reversed, but treatment is available to help relieve pain and improve mobility.
Several factors contribute to the development of OA, not just aging. People who have inherited defects in the genes responsible for making cartilage or who are born with joint deformities (i.e. scoliosis) are more likely to develop OA. Fractures or injuries to the joints or near the joints, especially back and knee injuries, increase the risk of degenerative disease. Overuse of the joints, like repeated bending, and obesity cause stress on the joints and cartilage and can lead to early development of OA.
Reduce and manage pain, improve functionality of joints and prevent further joint damage
Bone is a living tissue that is constantly breaking down and being replaced. Osteoporosis happens when growth of new bone does not keep up with the breaking down of old bone. This makes the bones very brittle and fragile. Primary osteoporosis is a result of the normal aging process, while secondary osteoporosis is a result of another disease process.
Bone regeneration normally takes place much faster than the deterioration process and the bones grow in mass reaching a peak in a person’s 20s. As people age, the breaking down process becomes faster than the regeneration process. The amount of bone mass at the peak can partly determine the likelihood of developing osteoporosis. There are many risk factors. It is most common in older women, due to a decrease in estrogen, as well as people taking corticosteroids or with a decreased dietary intake of calcium.
The goal of treatment is to address the underlying causes and prevent fractures.
There are typically no symptoms in the early stages of bone loss
Otitis media (OM) is an infection of the middle ear behind the tympanic membrane and is one of the most common illnesses in children, accounting for approximately 20% of primary care visits. OM may be viral or bacterial and, depending on cause, is generally treated with antibiotics.
In young children, the eustachian tube that connects the middle ear to the back of the throat is shorter and more horizontal than in older children and adults, making it easier for fluid to get trapped and become infected. Congestion from allergies, a cold, or sinus infection are common reasons for fluid to become trapped. Other causes include exposure to cigarette smoke and drinking while lying down. Untreated infections can lead to complications such as ruptured eardrum, cholesteatoma and delays in speech.
Patient will be free from pain and infection; patient will have optimal hearing; patient will be afebrile
Self-digestion of the pancreas by its own proteolytic enzymes (trypsin) causes acute inflammation of the pancreas. Enzymes within the pancreas may be prematurely activated by obstruction of gallstones in the bile duct. The enzymes then reflux back into the pancreatic duct causing inflammation, erosion and necrosis. There is an elevated risk of mortality due to hypovolemic shock, hypotension or multiple organ dysfunction. Acute pancreatitis is a sudden inflammation that only lasts a short time. Chronic pancreatitis is long-lasting and usually occurs after an acute episode.
Acute: In the US, 80%-90% of acute pancreatitis cases are the result of gallstones followed by alcohol intake. Other etiology includes infections, hypercalcemia, hypertriglyceridemia, trauma, pancreatic cancer, autoimmune disease and certain medications.
Chronic: Long-term alcohol use is the major contributor to chronic pancreatitis, in addition to gallstones, hereditary disorders, cystic fibrosis and hypertriglyceridemia
The desired outcome of pancreatitis is the absence of obstruction, inflammation or infection of the pancreas and bile duct. Patient will be free from pain and vomiting.
Some paranoid disorders such as paranoid personality disorder and paranoid schizophrenia may have more bizarre behavior and have intense feelings of distrust or fear. These clients will not confide in others and may be difficult to talk to as they often misinterpret harmless conversation or behavior.
Diagnostic Criteria: Criteria and symptoms must persist for one month or more, and cannot be attributed to substance use or another medical or mental condition.
Client will be able to identify appropriate coping techniques. Client remains safe and free from harm.
A degenerative neurological disorder characterized by a lack of controlled movement, caused by a depletion in circulating dopamine levels in the brain. Dopamine is a neurotransmitter responsible for controlled muscle movements.
A genetic component is suspected, but the true cause is not entirely understood. The depletion of dopamine results from atrophy of the substantia nigra – the structure within the midbrain that is responsible for secretion of dopamine.
Optimize independence and ability for self-care as long as possible. Improve dopamine levels within the brain to minimize symptoms. There is no cure.
Pediculosis capitis is more commonly known as “head lice” and is a common, very contagious, infestation of the human head louse in the patient’s hair. It generally infests the hair on the head and causes extreme itching. The itching is often a result of an allergic reaction to the louse saliva after it bites the skin. The louse feeds on human blood in order to survive. Head lice is most prevalent in schools, day care centers and nurseries.
Head lice are spread from person to person through direct contact with someone who already has an infestation. The easiest contact is during play such as sports activities, playgrounds and slumber parties, but can also be transmitted by sharing combs, brushes, hats and scarves, sports uniforms or using blankets or towels that were used by an infested person. Lice can only crawl and create a tickling sensation on the skin; they are not able to fly or jump from person to person.
Patient will be free from active lice infestation; patient will verbalize ways to prevent future reinfestation
Defects (open sores) in the protective lining of the stomach and upper small intestine. Gastric ulcers occur on the inside of the stomach and duodenal ulcers occur on the inside of the upper portion of the small intestine (duodenum). Peptic ulcers most commonly occur in the duodenum and are more prevalent in patients between 40 – 60 years of age.
Chronic use of NSAIDS (aspirin, ibuprofen, naproxen) weakens and thins the mucosal lining of the stomach and duodenum and greatly contributes to the formation of breaks in the protective lining. The primary cause of peptic ulcer disease (approx. 90%) is Helicobacter pylori bacterial infection. Heavy alcohol use and smoking increase the risk of PUD in patients with H. pylori infection. Other contributing factors include various illnesses such as Crohn’s disease, gastritis, hepatic disease and pancreatitis. Complications of peptic ulcers may include anemia, profuse bleeding, perforation, obstruction and certain cancers.
Relief of pain, absence of complications, maintain adequate nutrition
Pericarditis is inflammation of the pericardium – the outer layer of the heart and pericardial sac. Fluid and inflammation build up around the heart inside the pericardial sac, putting pressure on the heart and making it harder for the heart to fully relax and contract. It can cause heart failure or cardiac tamponade.
Pericarditis is caused by an infectious source, either viral, bacterial, or fungal. Fungal is the least common, while the Coxsackie virus is a common source.
To treat the cause and remove the source of infection while preserving cardiac output and preventing any major (or minor) complications.
Pneumonia is essentially when fluid or pus gets trapped in the alveoli of the lungs (pictured below) and impaired gas exchange results. This can impact one or both lungs.
Below are the important differentiations of pneumonia (these definitions, except the first one, are from Cleveland Clinic). Establishing the kind of pneumonia is essential, in that the treatment course can differ.
The first picture below is normal, unobstructed gas exchange. If you look to the second picture, you see the alveoli have an accumulation of fluid in them, which impairs the gas exchange that should occur to provide appropriate oxygenation into circulation. What results is coughing (many times producing phlegm), fever, chills, chest pain or pain when coughing, or cold/flu like symptoms. Inflammation can also occur. Antibiotics are administered, and the choice of which is dependent upon the offending pathogen, any other medical conditions going on with the patient, and if there are any antibiotic resistances present . Oral antibiotics are given typically for community-acquired pneumonia, however if the patient is hospitalized, they will most likely receive IV antibiotics. Steroids are typically administered to address inflammation.
Pneumonia can be caused by a virus, bacteria, fungus, or from inhaling something (a chemical, inhalant, or aspirating on food or fluid). This can be of particular risk to those with a weakened immune system or unable to keep your own airway clear (for example, unable to cough or maintain consciousness due to neurological or other injury).
Resolve the infection, optimize gas exchange, minimize impact from impaired gas exchange.
Postpartum hemorrhage is the excessive bleeding following delivery of a baby. For vaginal delivery, excessive bleeding would be more than 500ml and for cesarean delivery, more than 1000ml. This may happen with vaginal or cesarean delivery and occurs in 1-5 out of 100 women. The hemorrhage may occur immediately after birth, or over several hours following delivery.
Normally, the uterus continues to contract after the delivery of the baby and placenta. These contractions actually help close the vessels that supplied blood from the mother to the baby. When these contractions do not continue, or are not strong enough, hemorrhage occurs. Sometimes, a tear in the cervix, placenta or the blood vessels within the uterus may cause the hemorrhage. Risk factors include obesity, multiple births (twins or more), many previous pregnancies, blood clotting disorders, infection, prolonged labor or use of assistive devices such as forceps or vacuum to delivery the baby.
Patient will maintain optimal fluid balance and vital signs within normal limits
The rupture of fetal membranes (water breaks) before the beginning of labor is considered a complication of pregnancy known as premature rupture of membranes. This can happen at any gestational age, even full term. Despite what movies may depict, this sudden gush or steady trickle of fluid only occurs in about 10% of term pregnancies and 4% of preterm pregnancies. When the membranes rupture prior to 37 weeks gestation, it is considered preterm premature rupture of membranes (PPROM). Regardless of gestational age, when the membranes rupture, the protective barrier between the vagina and the fetus is lost and increases the risk of maternal and fetal infection.
There is no specific cause, but there are many factors that may increase the risk of PROM. Maternal or intra-amniotic infection and chronic disease, such as systemic lupus erythematosus, direct abdominal trauma, nutritional deficiencies, smoking and placenta abruption all increase the risk of PROM. Multiple pregnancy (twins or more) and a history of previous PROM also indicate an increased risk.
Patient will be free from infection (maternal and fetal); viable birth
Pressure ulcers are also called decubitus ulcers or bedsores. These are injuries to the skin and underlying tissues that develop after prolonged pressure in a particular area. Bedsores are common on the heels, sacrum and over bony prominences such as the elbows and shoulder blades. Pressure ulcers can develop and progress very quickly, but are preventable and treatable.
Pressure ulcers are caused by three main factors.
Pressure: Constant or prolonged pressure that restricts blood flow to any part of the body. If blood is restricted to an area, nutrition, oxygenation and tissue perfusion cannot take place. Without these essentials, the skin and nearby tissue is damaged and may eventually become necrotic.
Friction: As skin rubs against clothing or bedding, it can make weakened areas in the skin that are vulnerable to injury. This occurs often if the skin is consistently moist.
Shear: When skin slides against a surface, such as sliding down in the bed when the head only is elevated or transferring or positioning a patient by allowing the skin to move across the bedding. Fragile skin is easily ripped or torn this way.
Patient will experience healing of current pressure wounds, prevention of further skin injury and maintain optimal skin integrity
Essentially, at its most basic level, respiratory failure is inadequate gas exchange. Not enough oxygen is being exchanged in your lungs, and therefore it’s not getting into circulation.
There are three main types:
Your body desperately needs oxygenated blood to function. Therefore, if you’re not getting good gas exchange in the lungs and oxygenating your blood, your organs will suffer.
Many situations and/or conditions can result in respiratory failure. Trauma, medication (oversedation, for example), various disease processes (COPD, asthma, PE, pneumonia), damage to the actual lungs/surrounding tissue/spinal cord or nerves supporting the lungs/brain, and inhalation injuries are the major ones.
Restore oxygen levels of blood as appropriate and remove excess carbon dioxide
Essentially, skeletal muscle is destroyed (for various reasons) and their intracellular contents (in particular myoglobin) leak into the bloodstream. The kidneys can’t handle this large amount of myoglobin and it can damage them, and in some cases (roughly 30-40% of patients with this develop acute renal failure) can cause kidney failure.
Quite a few things can cause this. One that has been discussed more frequently recently is due to the increase in people engaging in high-intensity workouts (like CrossFit). This causes intense muscle breakdown, which can result in this condition. Trauma can also be a cause, as well as conditions of genetic origin, seizures, metabolic issues, temp-regulating issues, and many medications. A few medications that can cause this to occur include statins, diuretics, aspirin overdose (salicylate toxicity), recreational drugs like cocaine and amphetamines, and narcotics.
RA is an autoimmune disease where the immune system mistakenly targets and attacks the joint linings causing uncontrolled inflammation of the synovium. Joints on both sides of the body (bilateral) are affected, primarily the hands, wrists and knees. RA is characterized by bone erosion and joint deformity. As the disease progresses other joints may be affected symmetrically. Chronic inflammation and degenerative changes are the hallmark aspects of RA.
Doctors are still unsure as to what triggers RA, but it appears to be at least partially genetic in nature. This genetic predisposition makes the patient more susceptible to environmental factors like viruses and bacteria that may trigger the initial inflammation. Once the inflammation begins, the synovial fluid thickens and the tendons and ligaments weaken and stretch, resulting in the joint losing its shape and alignment.
While there is no cure, the goal of treatment is to manage the symptoms and slow disease progression. Medication, physical or occupational therapy and possibly surgery may be necessary.
Schizophrenia is a serious mental disorder that affects how a person thinks, feels and behaves. Patients often have difficulty distinguishing between reality and imagination and have difficulty communicating with others. Schizophrenia tends to run in families, but most frequently appears to be related to an imbalance of neurotransmitters (dopamine, glutamate and serotonin) that change the way the brain reacts to stimuli. Patients are not normally violent, but may react defensively to even the most well-intended gestures or stimuli.
Diagnostic Criteria: The patient must have experienced at least two of the following symptoms, one of which must be a positive symptom.
Symptoms must be present for at least 6 months with at least one month of active symptoms. Symptoms are not related to substance use/abuse or any other medical condition.
Patient will communicate effectively. Patient will demonstrate reality-based thought processes. Patient will demonstrate ability to distinguish between reality and hallucinations.
Seizures are a very complex neurological issue. Here is the definition from Medscape of a seizure: “a seizure results when a sudden imbalance occurs between the excitatory and inhibitory forces within the network of cortical neurons in favor of a sudden-onset net excitation” (source). Basically, abnormal electrical discharges are occurring in the brain. There are different kinds of seizures (epileptic, focal-onset, general-onset).
The exact cause of a seizure can be extremely difficult to pinpoint. John Hopkins Epilepsy Center divides seizures into two categories: provoked and unprovoked.
The etiology of provoked seizures can include: trauma, drugs or alcohol, tumors, medications, drug withdrawal, progressive brain disease, and more.
The etiology of unprovoked (or “natural”) seizures can include: fever, infection, metabolic issues, genetics, Alzheimer’s disease, and more. (Source link listed below)
Stop any current seizure activity as soon as possible, minimize damage, and prevent it from occurring in the future.
Sepsis is essentially an overactive/uncontrolled immune response to an infection. The immune system kicks into overdrive, for whatever reason, and cannot be calmed down. It’s like someone turned the dial all the way up on the immune system and ripped the dial off the dashboard. As the healthcare team, we are trying to turn the immune response down as best we can… but it is VERY challenging. This is a very complex issue which affects many body systems, with an overall mortality rate anywhere from 27-36% (and higher in patients in intensive care settings). The challenge is that it can present with very subtle symptoms and progress quickly. Time is of the essence in sepsis recognition and treatment.
Essentially, the cause of sepsis is the original infection. Examples include pneumonia, urinary tract infection, infection in the bloodstream (bacteremia), etc. It doesn’t have to be a bacterial infection, it can be a virus or a fungus as well.
Lessening the immune response, prevention cellular death, resolution of infection, minimizing damage from cellular oxygen deprivation and lactic acid build up, maximizing cardiac output and resolution of the condition.
Sepsis is essentially an overactive/uncontrolled immune response to an infection. The immune system kicks into overdrive, for whatever reason, and cannot be calmed down. It’s like someone turned the dial all the way up on the immune system and ripped the dial off the dashboard. As the healthcare team, we are trying to turn the immune response down as best we can… but it is VERY challenging. This is a very complex issue which affects many body systems, with an overall mortality rate anywhere from 27-36% (and higher in patients in intensive care settings). The challenge is that it can present with very subtle symptoms and progress quickly to septic shock. Time is of the essence in sepsis recognition and treatment.
Essentially, the cause of septic shock is the original infection. Examples include pneumonia, urinary tract infection, infection in the bloodstream (bacteremia), etc. It doesn’t have to be a bacterial infection, it can be a virus or a fungus as well.
Lessening the immune response, prevention of cellular death, resolution of infection, minimizing damage from cellular oxygen deprivation and lactic acid build up, maximizing cardiac output and resolution of condition.
Hypovolemic shock is a loss of blood volume leading to decreased oxygenation of vital organs. The body’s compensatory mechanisms fail and organs begin to shut down.
Any condition causing loss of circulating blood or plasma volume. Hemorrhage from any large source. Traumatic injuries. Burns (plasma loss due to capillary permeability). Prolonged vomiting or diarrhea.
The goal is to restore circulating blood volume, preserve hemodynamics, and prevent any damage to vital organs.
A hereditary disease that destroys red blood cells by causing them to become rigid and “sickle” shaped. Occurs mainly in persons of African descent. When red blood cells release oxygen to the tissues and O2 concentration is reduced, the red cells and become rigid, assuming a sickle shape. As the cells are re-oxygenated the sickle-shaped cells become clogged in the small blood vessels causing obstruction of the circulation. This results in damage to the various tissues.
A single genetic mutation of the hemoglobin molecule. Inheritance of the mutated gene from both parents results in sickle cell disease. A person who inherits the mutated gene from only one parent is a carrier of the trait. There is no cure for this condition.
Manage pain of SC crisis, promote optimal perfusion and prevention of complications
A stroke is essentially a neurological deficit caused by decreased blood flow to a portion of the brain. They will be classified as either hemorrhagic or ischemic. An ischemic stroke is the result of an obstruction of blood flow within a blood vessel. A hemorrhagic stroke is when a weaken blood vessel ruptures and blood spills into the brain where it shouldn’t be. Both of these can cause edema and cellular death. Lack of blood flow for greater than 10 minutes can cause irreversible damage.
Various things can cause an ischemic stroke, which comprises approximately 85% of all strokes. Some of those who are at highest risk are those on anticoagulation therapy. People are on anticoagulants therapy for various reasons (mechanical heart valves, atrial fibrillation, etc.) and if they become subtherapeutic and therefore their blood is too thick, a clot can easily form and end up in the brain, causing an ischemic stroke. Diabetes is also one of the major risk factors, in addition to atherosclerosis, hypertension, cardiac dysrhythmias, obesity, substances abuse, and oral contraceptives. Hemorrhagic strokes (the remaining 15% of strokes) can be caused by an aneurysm rupture (which are very difficult to predict… frequently noted increased incidence in smokers, drug abuse, and people with family history of a first-degree relative with one), high blood pressure, or the rupture of an arteriovenous malformation (which is genetic).
Restoring as much blood flow as possible as quickly as possible, and minimizing cellular death/damage is key. Clot-busting meds can be given to restore blood flow for ischemic strokes. Hemorrhagic strokes are managed by keeping the blood pressure controlled, controlling intracranial pressure, reversing any anticoagulants on board, and even very invasive procedures or surgery to relieve increased intracranial pressure. You want the patient to gain back as much function as possible. This is done slowly over time by the brain creating collateral circulation around the infarcted area. Physical, occupational, and speech therapy are essential aspects of stroke recovery. Some patients may make a complete recovery, while others may have profound deficits.
Syncope is essentially a loss of consciousness, which is typically caused by hypotension. The brain lacks adequate blood flow and a temporary loss of consciousness results.
Syncope typically has a cardiac etiology, but can also be due to many other things (like a side effect from a med, neuro issue, psych issue, or lung problem). When a cardiac etiology is suspected, a cardiac workup is completed. This typically includes cardiac monitoring, labs, and routine vital signs (specifically blood pressure and heart rate).
No additional syncopal events, no injury, identification of cause and treatment to prevent further episodes
SIADH is diagnosed as a collection of symptoms that take place with otherwise normal function. This syndrome is characterized by hyponatremia, concentration of urine and dilution of blood. The patient has an adequate amount of blood, but it is more dilute than normal. SIADH causes the body to retain fluid resulting in decreased electrolyte balance.
SIADH is caused as an effect of other disorders, often nervous system disorders such as epilepsy, Guillain-Barre syndrome or head trauma, or cancers of the pulmonary, brain, GI and genitourinary systems. It is caused when the hypothalamus is stimulated to produce excess amounts of AVP (arginine vasopressin) which is an antidiuretic hormone (ADH) that triggers the kidneys to retain fluid in the tubules and excrete sodium. As the amount of fluid builds up in the cells and tissues, it creates an imbalance of electrolytes, specifically sodium, causing hyponatremia. The excess fluid dilutes the blood instead of being excreted causing the urine to become concentrated.
Patient will maintain normal electrolyte and fluid balance
Lupus is a chronic autoimmune disease in which the immune system attacks different parts of the body causing inflammation and damage to various body tissues. Lupus can affect the skin, joints, heart, lungs, kidneys, blood vessels and brain. Patients with lupus may have phases of worsening symptoms called “flares” and other periods of milder symptoms. Lupus symptoms may mimic other disorders and may go undetected for several years. Management by a rheumatologist is recommended.
The exact cause of SLE is not known, but scientists believe it may be in part related to genetics. Environmental factors that seem to trigger lupus include sunlight, stress, viruses, trauma and some medications.
Reduce inflammation, regain optimal mobility, reduce organ dysfunction, reduce number and frequency of “flares”
Thrombocytopenia is when there is a low platelet count and an increased risk of bleeding. This is usually a side effect of another disease process such as leukemia and some immune system disorders, or the use of certain medications. Platelets, also called thrombocytes, are essential to the body as they clump together and form clots that seal blood vessels when injury or damage occurs. If bleeding does occur, it may be internal or external.
Many factors influence the development of thrombocytopenia such as cancers, autoimmune diseases, infections, surgery, alcohol use and certain medications. The condition can be inherited or acquired. Generally, a low platelet count develops when the bone marrow fails to produce enough thrombocytes, the bone marrow makes enough, but the body destroys them or uses them too quickly, or when the spleen holds on to too many platelets.
Increase platelet production and availability, minimize risk of excessive bleeding, treat underlying cause
** Patients may be completely asymptomatic **
Blood clots formed from any source, lodging in the patient leg or arm, impeding blood flow and causing inflammation. This backup of blood pools in the extremity causing swelling, redness, warmth and pain. These clots can dislodge and become embolic, lodging in the heart, lungs, or brain.
Narrowing or occlusion of the vessels in an extremity. If caused by plaque (cholesterol and other substances) this could be from poor diet, lack of exercise, or genetics. However, blood stasis can cause aggregation of platelets and other blood products forming a clot that travels to the extremity (or heart, lungs or brain!). The most common cause of blood pooling (stasis) is Atrial Fibrillation (AFib). Other major causes are prolonged sitting, pregnancy, smoking, and birth control. Virchow’s triad explains the 3 major contributors to the development of thrombophlebitis: venous stasis, damage to the inner lining of the vessel, and hypercoagulability.
Stabilization of the blood clot or disintegration of the blood clot as well as prophylaxis treatment for future blood clots. Prevention of complications such as embolic strokes, myocardial infarction, or pulmonary embolism.
*Note – the evidence shows that Homan’s Sign is an unreliable and nonspecific finding. It is only present in 33% of those with a DVT and should not be used as standard practice in isolation.
The tonsils are oval-shaped masses of tissue found on both sides of the back of the throat and help the immune system fight off bacteria and viruses that enter through the mouth. Tonsillitis occurs when the tonsils become inflamed or infected. Many cases resolve on their own, but some bacterial infections require treatment. Repeated bacterial infections, or those that do not respond to treatment, may result in surgery to remove the tonsils.
Viruses account for the majority of cases of tonsillitis and are usually seen in young children, under the age of five. The most common bacterial infection is Streptococcus pyogenes (strep throat). This is easily spread by being in close contact with other affected individuals and is especially common in school aged children. As the tonsils become swollen, the airway may become blocked which is an emergency. Complications of untreated tonsillitis include rheumatic fever and inflammation of the kidneys (poststreptococcal glomerulonephritis). Practicing good hand hygiene can help prevent the spread of viruses and bacteria that cause tonsillitis.
Patient will be free from pain and infection; patient will have adequate nutritional intake and hydration; patient will maintain adequate respiratory status
The urine is normally sterile, but exposure to bacteria at the distal urethra (meatus) may lead to colonization of bacteria within the urinary tract. Infection may take place anywhere within the urinary tract, including the lower urinary tract (cystitis), or the upper urinary tract (pyelonephritis). Cystitis refers to inflammation and infection of the bladder, Pyelonephritis refers to inflammation and infection of the kidneys.
The bacteria associated with 80% – 90% of urinary tract infections is Escherichia coli. Other bacteria that commonly cause infections include klebsiella, Enterococcus and Staphylococcus. Bacteria may be introduced to the urinary tract through the use of indwelling catheters. Antibiotic use disrupts the normal flora of the vagina and allows bacteria to grow and spread to the urethra, as does frequent or recent sexual intercourse. Difficulty voiding and inability to empty the bladder are also causes for the development of bacterial infections in the urinary tract.
Patient will be free from pain and symptoms of UTI and will be free of infection.
The forceful emptying of the stomach contents is known as throwing up (vomiting). Two or more loose, watery stools constitutes diarrhea. Vomiting and diarrhea without fever is common in children. Vomiting and diarrhea often occur together, but may happen independently of each other and at any time. The symptoms, while frustrating and worrisome, may serve as the body’s natural method to rid itself of the offending cause. Extended periods of vomiting or diarrhea may lead to dehydration.
A child’s gastrointestinal system is sensitive and may react to certain medications or foods that are hard to digest, such as sweets or undercooked meats. Other causes of vomiting and diarrhea may be virus, bacteria or parasites. Viral gastroenteritis is the most common cause of vomiting and diarrhea, specifically Rotavirus and Norovirus.
Patient will have soft, formed stools; patient will vomit less than 2 times in 24 hours; patient will maintain adequate hydration