Question

STUDY GUIDE FOR FINAL EXAM b51996199 2017 Review Angina Pectoris pinou Stable Angina Unstable Angina Variant Angina Review Anaphylactic Shock and medications to give ► Review s/s of Systemic Lupus Erythematosus Review releasing and removing restraints > Review s/s of pain Review s/s of Hypovolemic Shock AT 291 Review Pulse sites and what part of the body is used to evaluate circulation ► Review Teaching for Sprained/Strained Ankle Review Claudication Review the RICE Acronym Review Burns and characteristics ► Review Priorities for patient w/Closed Head Injury Review Interventions for a choking unconscious and conscious patient ► Review NSAIDs, Nitroglycerin, Spironolactone, Cephalosporin, Captopril, Digoxin, Enteric-coated naproxen, Enteric-Coated Aspirin Review Fat Emboli Review Abdominal Aortic Aneurysm ► Review s/s of blood transfusion reactions Review Neuropathic, Visceral, and somatic pain Review Metabolic/Respiratory Acidosis and Alkalosis

Answer 1

Angina is a form of chest pain or discomfort, as a result of reduced blood supply to heart muscles. This reduced blood supply results in reduced oxygen supply to heart muscles and as a result deficient waste removal from heart muscles leading to chest pain or discomfort. The most usual reason for this is some form of obstruction of coronary arteries due to medical conditions like atherosclerosis, which hampers blood supply to heart muscles resulting in ischemia.

• Stable Angina Pectoris: This is also known as effort angina and is one of the more common forms of angina. This type of angina is present when the patient is exerting himself e.g. running, brisk walking, climbing stairs, exercising etc. hence the name “effort angina.” Symptoms abate following the cessation of activity or after taking medications such as Nitro. Stable angina is usually predictable.
• Unstable Angina Pectoris: This type of angina is not that common, but is quite a serious condition when compared to stable angina. Symptoms are unpredictable, more intense, and are unrelieved with rest or medications. Unstable angina is a pain that starts even at rest, is of severe intensity, and not relieved by Nitro. It is an indication of heart attack and immediate medical attention is required. Unstable angina is also known as “crescendo angina.”
• Microvascular Angina Pectoris: It has angina like chest pain, but the cause is unknown. Scientists believe the cause to be poor functioning of the small vessels (microvessels) of arms, legs and heart. These vessels don’t have blockages in them, thus leading to difficulty in diagnosis. The prognosis of microvascular angina is excellent.

Anaphylaxis shock is a dangerous and potentially life-threatening condition caused by an allergic reaction. Many people use the terms anaphylaxis and anaphylactic shock to refer to the same thing. Anaphylactic shock, however, is a complication of anaphylaxis that occurs when the blood pressure drops very low, and the blood has trouble circulating.

Allergies occur when a person's immune system overreacts to a harmless substance called an allergen. This reaction causes the body to release chemicals that lead to irritation and other symptoms. Usually, allergic reactions are minor, causing symptoms such as a rash or a runny nose.

When a person's immune system dramatically overreacts to an allergen, it may release chemicals that affect multiple systems in the body. This can throw the person into anaphylaxis. In some people, anaphylaxis can include anaphylactic shock.

The most common symptoms of an anaphylactic reaction include:

• nose, mouth, skin, or stomach irritation, such as a rash, diarrhea, or congestion
• breathing difficulties or wheezing
• low blood pressure that can cause fainting, dizziness, or confusion
• swelling of the mouth, tongue, or throat
• swollen lips
• a choking sensation or trouble swallowing

In some people, anaphylactic shock occurs as well as anaphylaxis.

A person will experience symptoms related to low blood pressure and poor oxygen flow to their organs if they are in anaphylactic shock.

Someone in anaphylactic shock may also lose consciousness, lose bowel or bladder function, or experience chest pain.

Anaphylactic shock reactions are similar to other forms of medical shock. In someone experiencing a severe allergic reaction while in a life-threatening situation, it might not be possible to distinguish anaphylaxis from other causes of shock. In most people, however, the condition is easily detected because of recent exposure to an allergen.

Early signs

The early symptoms of anaphylactic shock vary and may initially seem relatively mild. They may include hives, itching, or a sense of dread.

People with a history of severe allergic reactions often have the same pattern of symptoms each time they react.

Early warning signs that a person may be going into anaphylactic shock include:

• turning blue or white
• swelling of lips or face
• grating, grainy cough
• wheezing
• breathing problems
• hives, particularly if over several areas

An epinephrine injector is a primary treatment for people experiencing anaphylaxis.

Also called an EpiPen, these injectors carry a single dose of the hormone epinephrine.

Epinephrine reverses the action of substances produced during the allergic reaction. It can also prevent the body from going into shock or reverse the process of shock if it has already started.

The EpiPen is usually injected directly into the thigh and is only available with a prescription from a doctor.

People should call 911 if they are experiencing or suspect they may be experiencing an anaphylactic reaction.

It is not safe to treat anaphylaxis at home or be driven to the hospital. If a person delays treatment, it can be fatal. Treatment always begins with the administration of epinephrine.

In cases of severe anaphylactic shock, a person may need additional treatment. This may include the following therapies and medications:

• administration of oxygen therapy
• intubation with a tube hooked to a machine to help with breathing
• beta-agonist injection to reduce swelling in the respiratory tract
• antihistamines to reduce the severity of the allergic reaction
• vasopressors to narrow blood vessels and raise blood pressure if it becomes dangerously low
• corticosteroids to help block allergic reactions and reduce swelling
• IV fluids for low blood pressure

It is important for people with a history of anaphylactic reactions to know which substances or allergens trigger symptoms.

Skin and mouth

It's common for a rash to develop over parts of the body that are exposed to the sun, including the face, wrists and hands. A butterfly-shaped rash over the cheeks and the bridge of the nose is especially common.

Some people with lupus notice that their fingers change colour in cold weather, going first very pale, then blue and finally red. This is called Raynaud's phenomenon and is caused by narrowing (constriction) of the blood vessels, which reduces the blood supply to the fingers or toes.

You may develop groups of mouth ulcers, which may come back repeatedly.

Hair

Some hair loss is common and can be severe in some people with lupus, but once a flare-up is brought under control the hair will usually grow back.

Joints

Joint pain is common in lupus, especially in the small joints of the hands and feet. The pain tends to move from joint to joint and is often described as 'flitting'.

Joint pain and swelling can be the main symptoms for some people, though lupus doesn't usually cause joints to become permanently damaged or deformed.

About 1 in 20 people with lupus develop more severe joint problems. Fewer than 1 in 20 have joint hypermobility or a form of arthritis called Jaccoud’s arthropathy, which can change the shape of the joints.

Kidneys

Around one in three people with lupus have significant inflammation of the kidneys, and kidney damage can sometimes occur. Kidney inflammation can be treated successfully in most patients if it's identified early with regular urine, blood pressure and blood testing by your doctor.

You must take any medication as prescribed by your doctor to make sure that your kidneys aren't permanently damaged.

Blood and blood vessels

Lupus can cause high blood pressure, particularly if the kidneys are involved. Steroid tablets, which are often used to treat lupus, can raise blood pressure particularly when used in high doses. Lupus can contribute to the development of high cholesterol, which should be checked yearly with a blood test and treated if necessary.

Lupus may also affect the bone marrow, causing amaemia and a reduction in the number of platelets (cells that help the blood to clot) and/or white blood cells. Blood-related problems like anaemia tend to be more common in children with lupus.

Some people with lupus are more at risk of developing blood clots in veins or arteries. This problem is usually caused by antiphospholipid antibodies. Some of these autoantibodies can also affect pregnancy, causing an increased risk of miscarriage (antiphospholipid syndrome).

Brain and nervous system

As many as one in three people with lupus may have migraines and may experience anxiety or depression. Some people have diziness, memory loss or confusion. Rarely, lupus can cause fits (similar to epilepsy) or feelings of paranoia (similar to schizophrenia) - though these complications only affect a small number of people with lupus.

Heart and lungs

Occasionally, lupus directly affects the heart and lungs. More often, it causes inflammation in the lining tissues around the heart (pericarditis) and lungs (pleurisy), both of which cause breathlessness and sharp pains in the chest. Rarely, large amounts of fluid develop in these lining layers, causing severe breathlessness.

More recently, we've found that lupus may also cause narrowing of the blood vessels. This can lead to increased risk of angina, heart attacks and strokes, so close monitoring and early treatment of factors such as high cholesterol and high blood pressure are vital.

Other organs

People with lupus can suffer swelling of the lymph glands, which may cause discomfort.

Less frequently, lupus can affect the lining tissue of the gut (serositis), the gut, pancreas, liver or spleen, causing pain in the abdomen. Very rarely, lupus can affect the eyes, causing a painful red eye or changes in the eyesight.