Tiêu đề NCM 112 SEMI FI ✅

SEMI FINALS COVERAGE LEC ● Cardiovascular disorders CM ○ RLE 1 ■ Rheumatic Endocarditis ■ Infective Endocarditis ■ Thromboangiitis Obliterans ■ Aortitis ■ Dissecting Aorta ■ Myocarditis ■ Pericarditis ■ Aortic Aneurysms ■ Other Aneurysms ○ RLE 2 ■ Arterial Embolism ■ Arterial Thrombosis ■ Chronic Venous Insufficiency ■ Raynaud's Disease ■ Venous Thrombosis ■ Deep Vein Thrombosis ■ Thrombophlebitis ■ Phlebothrombosis ○ RLE 3 ■ Leg Ulcers ■ Varicose Veins ■ Cellulitis ■ Lymphadenopathy ■ Lymphadenitis ■ Lymphangitis ■ Lymphedema ■ Elephantiasis ● Hematologic disorder ● Urinary disorders ● Renal disorders/ failure ● Metabolic & Endocrine RLE: ● Total Parenteral Nutrition ● Hemodialysis & PD ● Paracentesis ● Diagnostic Examinations ● Drugs & IV Computation SEMI FINALS COVERAGE 0 CARDIOVASCULAR CM TOPICS 1 I. INFECTIOUS DISEASES OF THE HEART1 A. Rheumatic Endocarditis 1 B. Infective Endocarditis 1 C. Myocarditis 3 D. Pericarditis 4 II. Thromboangiitis Obliterans (Buerger’s Disease) 4 III. ANEURYSMS 5 A. THORACIC AORTIC ANEURYSM 5 B. ABDOMINAL AORTIC ANEURYSM 6 C. Other Aneurysms 7 IV. Dissecting Aorta 7 V. Arterial Embolism and Arterial Thrombosis 7 VI. Raynaud’s Phenomenon 8 VII. VENOUS DISORDERS 9 A. Venous Thromboembolism (VTE) 9 B. Chronic Venous Insufficiency / Postthrombotic Syndrome 11 C. Leg Ulcers 11 D. Varicose Veins (varicosities) 13 VIII. LYMPHATIC DISORDERS 13 A. Lymphangitis and Lymphadenitis 14 B. Lymphedema and Elephantiasis 14 IX. CELLULITIS 15 X. OTHER 15 A. Aortitis 15 B. Venous Thrombosis 15 C. Thrombophlebitis 15 D. Phlebothrombosis 15 E. Lymphadenopathy 15 WEEK 12 - HEMATOLOGIC DISORDERS 15 Chap 32 - Assessment and Treatment 15 Hematologic System 15 Assessment and Diagnostic Evaluation 19 I. Hematologic Studies 19 II. Bone Marrow Aspiration and Biopsy 19 Hematologic Disorders 20 I. ANEMIA 20 D. Hypoproliferative Anemias 21 1. IRON DEFICIENCY ANEMIA 21 2. ANEMIAS IN RENAL DISEASE 21 3. ANEMIA OF CHRONIC DISEASE 21 4. APLASTIC ANEMIA 21 5. MEGALOBLASTIC ANEMIAS 21 6. MYELODYSPLASTIC SYNDROME 21 E. Hemolytic Anemias 21 1. SICKLE CELL ANEMIA 21 2. THALASSEMIA 21 3. GLUCOSE-6-PHOSPHATE DEHYDROGENASE DEFICIENCY 21 4. IMMUNE HEMOLYTIC ANEMIA 21 5. HEREDITARY HEMOCHROMATOSIS 21 II. POLYCYTHEMIA 21 A. Polycythemia Vera 21 B. Secondary Polycythemia 21 III. LEUKOPENIA 21 A. Neutropenia 21 B. Lymphopenia 21 IV. LEUKEMIA 21 A. Acute Myeloid Leukemia 21 B. Chronic Myeloid Leukemia 21 C. Acute Lymphocytic Leukemia 21 D. Chronic Lymphocytic Leukemia 21 V. MYELOFIBROSIS 21 VI. MULTIPLE MYELOMA 21 VII. LYMPHOMA 22 A. Hodgkin Lymphoma 22 B. Non-Hodgkin Lymphomas 22 VIII. BLEEDING DISORDERS 23 A. Primary Thrombocythemia 23 B. Secondary Thrombocytosis 23 C. Thrombocytopenia 23 D. Idiopathic Thrombocytopenic Purpura 23 E. Platelet Defects 23 F. Hemophilia 23 G. Von Willebrand’s Disease 23 IX. ACQUIRED COAGULATION DISORDERS 23 A. Liver Disease 23 B. Vitamin K Deficiency 23 C. Complications of Anticoagulant Therapy 23 D. Disseminated Intravascular Coagulation 23 E. Thrombotic Disorders 23 F. Hyperhomocysteinemia 23 G. Antithrombin Deficiency 23 H. Protein C Deficiency 23 I. Protein S Deficiency 23 J. Activated Protein C Resistance and Factor V Leiden Mutation 23 K. Acquired Thrombophilia E 23 Chapter 34 Management of Patients With Hematologic Neoplasms 28 WEEK 13 - URINARY DISORDERS 30 ANATOMY & PHYSIOLOGY: The Urinary System 30 Disorders of the Renal 38 I. FLUID AND ELECTROLYTE IMBALANCES IN RENAL DISORDERS 38 II. RENAL DISORDERS 38 III. Nephrosclerosis 38 IV. Primary Glomerular Diseases 39 V. Polycystic Kidney Disease (PKD) - genetic disorder characterized by growth of numerous cysts in kidneys 41 VI. RENAL CANCER (Renal cell carcinoma) 42 VII. RENAL FAILURE - 42 RENAL REPLACEMENT THERAPIES 46 VIII. RENAL TRAUMA 46 URINARY DISORDERS 47 I. INFECTIONS OF THE URINARY TRACT 47 A. Lower Urinary Tract Infections 47 B. Upper Urinary Tract Infections 50 1. ACUTE PYELONEPHRITIS 50 2. CHRONIC PYELONEPHRITIS 50 II. ADULT VOIDING DYSFUNCTION 50 A. Urinary Incontinence 50 B. Urinary Retention 52 C. Neurogenic Bladder 52 Catheterization 53 ➔ Indwelling Catheters 53 ➔ Suprapubic Catheters 53 III. UROLITHIASIS / NEPHROLITHIASIS 53 IV. GENITOURINARY TRAUMA 56 A. Bladder Trauma 56 B. Ureteral Trauma 56 C. Urethral Trauma 56 V. URINARY TRACT CANCERS 56 C. Cancer of the Bladder 56 VI. URINARY DIVERSIONS in Book P1383 57 Treatment Modalities - Hemo & PD - in RLE 57 Metabolic & Endocrine IVY 60


NCM 112 SEMI FI LEC by TONS and MADS b) Parenteral administered in doses that produce high serum concentration for significant period to ensure eradication of dormant bacteria within dense vegetations. c) Serum levels of antibiotic monitored. If ↓bactericidal → ↑dosages or different antibiotic d) Penicillin - medication of choice. e) Blood cultures monitor effect of therapy. f) Fungal endocarditis: antifungal amphotericin B (Abelcet, Amphocin, Fungizone) g) Temp monitored; course of fever is one indication of effectiveness of treatment. However, febrile reactions may occur as result of medication. 15. Surgical Management a) if infection does not respond to medications, patient has prosthetic heart valve endocarditis, has vegetation >1cm, or develops complications (septal perforation) b) Valve débridement or excision, débridement of vegetations, débridement/closure of abscess, and closure of a fistula. c) Aortic/mitral valve débridement, excision, or replacement in patients who: (1) Develop congestive HF despite treatment (2) Have >1 serious systemic embolic episode (3) Develop valve obstruction (4) Develop periannular (heart valve), myocardial, or aortic abscess (5) Have uncontrolled infection, persistent or recurrent infection, or fungal endocarditis d) Surgical valve replacement greatly improves prognosis. The aortic valve best treated with autograft. Most patients who have prosthetic valve endocarditis (infected valve replacements) require valve replacement. 16. Nursing Management a) Monitor temperature, Heart sounds (new or worsening murmur indicate dehiscence ofprosthetic valve, rupture of abscess, or injury to valve leaflets or chordae tendineae) b) Monitor S/S of systemic embolization, pulmonary infarction and infiltrates, organ damage (stroke, CVA, brain attack), meningitis, HF, MI, glomerulonephritis, splenomegaly. c) All invasive lines and wounds assessed for redness, tenderness, warmth, swelling, drainage, or other signs of infection. C. Myocarditis 1. Inflammatory process involving myocardium 2. Can cause heart dilation, thrombi on heart wall (mural thrombi), infiltration of circulating blood cells around coronary vessels and between muscle fibers, and degeneration of muscle fibers 3. Mortality varies with severity of symptoms. a) Mild symptoms recover completely; else cardiomyopathy and HF. 4. Pathophysiology a) Usually results from viral (coxsackievirus A/B, HIV, influenza A), bacterial, rickettsial, fungal, parasitic, metazoal, protozoal (Chagas disease), or spirochetal infection. b) It also may be immune related, occurring after acute systemic infections (rheumatic fever_ c) May develop in: immunosuppressive, endocarditis, Crohn disease, or SLE, inflammatory reaction to toxins (pharmacologic agents like anthracyclines for cancer therapy), ethanol, or radiation (especially to left chest or upper back). d) May begin in one small area of myocardium and then spread throughout the myocardium. e) Degree of myocardial inflammation and necrosis determines degree of interstitial collagen and elastin destruction. (1) Greater destruction → greater hemodynamic effect f) DCM & HCM are latent manifestations 5. Clinical Manifestations - Depend on type of infection, degree of damage, & capacity of myocardium to recover. a) May be asymptomatic, with infection that resolves on its own. b) May develop mild to moderate symptoms: fatigue, dyspnea, palpitations, and occasional discomfort in chest and upper abdomen. c) Most common: flulike. d) Sudden cardiac death or quickly develop severe CHF 6. Assessment and Diagnostic Findings a) Assessment may reveal no abnormalities; can go undiagnosed. b) Tachycardic, chest pain (with a subsequent cardiac catheterization demonstrating normal coronary arteries). c) Cardiac MRI with contrast - diagnostic guide to sites for endocardial biopsies for organism/ genome, immune process or radiation reaction d) W/o abnormal heart structure may suddenly develop dysrhythmias or ST–T-wave changes. e) If patient has structural heart abnormalities” cardiac enlargement, faint heart sounds (esp S1), a gallop rhythm, or a systolic murmur. f) ↑WBC and ↑ESR 7. Prevention: Prevention of infectious diseases by appropriate immunizations (eg, influenza, hepatitis) and early treatment appears 8. Medical Management a) Specific treatment for underlying cause: penicillin for hemolytic streptococci b) Bed rest to decrease cardiac workloa .& decrease myocardial damage & complications c) In young patients with myocarditis, activities should be limited for 6-month period or at until heart size and function returned to normal. d) Physical activity is increased slowly and instructed to report any symptoms that occur with increasing activity e) If HF or dysrhythmia develops: all management but beta-blockers avoided because they decrease strength of ventricular contraction (negative inotropic effect). 9. Nursing Management a) CV assessment focus: HF and dysrhythmias. b) Dysrhythmias: continuous cardiac monitoring c) 3