Zika in 2017

The majority of healthcare providers in the United States (US) first became familiar with Zika virus in early 2016 when it gained national attention following a large Zika virus outbreak in Brazil in 2015. With this outbreak, a concurrent increase in rates of microcephaly and ocular abnormalities in newborns was observed, suggesting an association between the two (Martines, 2016). Subsequent, retrospective analysis of a Zika outbreak in French Polynesia in 2013-2014 further supported the association between Zika virus infection and neurologic birth defects in newborns (Martines, 2016). The Centers for Disease Control and Prevention (CDC) and World Health Organization (WHO) first issued public health alerts in January 2016 and February 2016 to increase public awareness, mobilize resources, and expand knowledge of Zika virus. A priority of these efforts was preventing infection in pregnant women and women of reproductive age to avoid birth defects resulting from transmission of Zika virus to the fetus.

Since the initial public health alert, the CDC has provided extensive guidance and resources for healthcare providers based on current knowledge of Zika virus. Although the virus can be asymptomatic in adults, we know that it can cause significant morbidity and mortality to a fetus when contracted in utero, most significantly microcephaly and fetal demise.

Since the initial advisories of 2016, scientists and healthcare professionals have gained a better understanding of both transmission and the pathophysiologic effects of the virus. The CDC has an extensive system of surveillance, and a registry to monitor cases in the US as well as a registry of all pregnant women with Zika virus infection (the US Pregnancy Zika Virus Registry [USPZR]). All serologic testing for Zika virus is monitored through the CDC allowing for accurate and detailed surveillance.

zika-counseling.pngFrom the perspective of the healthcare provider, some of the more significant benefits of the CDC efforts have been the provision of straightforward guidelines for prevention and screening, and anticipatory guidance specific to pregnant women and women of reproductive age. Nurses play a critical role in educating patients and families and can be instrumental in reducing fears by providing patients with the accurate and up-to-date information necessary to remain healthy and reduce the risk of Zika virus infection and spread.




What We Know about Zika virus in 2017 (CDC, 2017):

  • Zika virus is spread primarily through the bite of the Aedes species of mosquito which are known to bite during both day and night.
  • Zika virus can be passed from a pregnant woman to her fetus and is linked to neurologic birth defects, specifically microcephaly.
    • Pregnant women should not travel to geographic regions with risk of Zika.
  • Zika virus can be passed sexually from a person who has Zika virus to his or her sex partners.
    • Pregnant women living with partners who have Zika virus or have traveled to regions with Zika virus should not have sex with their partner, or should use barrier protection/condoms during pregnancy.
    • Women of reproductive age (those reproductive planning and those at risk for unplanned pregnancy) should receive counseling similar to that of pregnant women in respect to risk reduction of Zika infection.
  • During the first week of infection, a person can spread Zika virus by being bitten by a mosquito that subsequently bites another person exposing them to blood containing Zika virus.
  • Most cases of Zika virus are asymptomatic; if symptoms are present, they may include fever, malaise, maculopapular rash, conjunctivitis, headache, and arthralgia.
  • There is no specific treatment or vaccine for Zika virus.
  • There has been mosquito-borne transmission of Zika virus in the continental US; the first confirmed case was August 1, 2016 in Miami, Florida.
 

Summary of CDC recommendations for the care of the pregnant woman (CDC, 2017): 

Major Recommendations
  • Pregnant women should not travel to areas with risk of Zika infection.
  • Pregnant women should use condoms/barrier protection with any sexual partner that lives in or has traveled to areas with risk of Zika.
Prenatal Care
 
  • Screen for potential Zika virus exposure at all prenatal visits. Examples of screening tools and testing algorithms can be found on the CDC website.
  • If exposure screening is positive, screen for symptoms (fever, rash, arthralgia or conjunctivitis) and/or fetal abnormalities on ultrasound.
  • Symptomatic women with possible Zika exposure should undergo serologic and/or urine testing for Zika virus.
  • Zika virus testing of asymptomatic women with potential Zika exposure varies based on region of travel.
 
 Zika virus testing includes:
  • Zika virus nucleic acid testing (NAT) (i.e. RNA) in urine and serum
  • Serum Zika virus and dengue virus immunoglobulin M (IgM)
    • If IgM is positive, equivocal, presumptive or possible, must confirm with serum plaque reduction neutralization test (PRNT) which tests viral specific neutralizing antibodies to Zika.
 
Management of pregnant women with Zika virus infection
 
  • Consider serial ultrasound every 3-4 weeks to evaluate for fetal abnormalities
  • Amniocentesis on a case by case basis
Management of pregnant women with potential exposure and no serologic evidence of Zika infection
  • Ultrasound to evaluate for fetal abnormalities.
    • If fetal abnormalities present, consider repeating Zika virus NAT and IgM testing.
    • If no fetal abnormalities, continue routine prenatal care and risk management for Zika virus exposure.
Postnatal recommendations in women with positive or presumptive Zika virus infection during pregnancy
  • Live birth: infant serum and urine testing for Zika virus NAT and Zika/Dengue IgM as well as Zika virus NAT and immune-histochemical (IHC) staining of umbilical cord and placenta; test CSF if available.
  • Fetal losses: Zika virus NAT and IHC staining of fetal tissues.
  • Breastfeeding is recommended. Zika virus has been found in breastmilk but there have not been reports of infection associated with breastfeeding; the benefits are thought to outweigh the theoretical risks of transmission via breast milk.
 
When a pregnant woman passes the Zika virus to her fetus during pregnancy, it can lead to congenital Zika syndrome (CDC, 2017b). While the full extent of potential health effects from Zika virus is unknown, we know that congenital transmission can lead to brain abnormalities including severe microcephaly, eye abnormalities, congenital contractures (clubfoot or arthrogryposis), hypertonia restricting movement soon after birth and hearing loss (CDC, 2017a, CDC, 2017b). There is guidance from the CDC for healthcare providers on neuroimaging of infants  with congenital Zika syndrome as well as specific guidance for the management of infants with Zika virus infection for the first 12 months, regardless of the presence of birth defects. The CDC is also responsible for the development of Zika Care Connect, which provides a network of referral sources and specialty healthcare services helping to facilitate access to resources for families affected by Zika virus.

Zika virus is a classic example of an emerging infectious disease in the US. The response from the CDC and WHO has been critical in making the public aware of this threat and successfully mobilizing resources to provide healthcare providers with the most current, scientifically-based evidence available. Nurses are often the first clinical contact a patient will have with the healthcare system.  We are in a position to educate and decrease fears associated with Zika virus, which was an unknown threat to most in the US less than 2 years ago. A major focus of education should be prevention, including educating patients on taking measures to prevent being bitten by mosquitos and efforts to reduce risk by informing patients of travel precautions to areas with risk of Zika infection for pregnant women, women of reproductive age and women and their partners trying to conceive. With this, we can contribute in public health efforts to prevent the spread of an emerging virus which poses serious health risks and the potential for catastrophic effects on newborn morbidity and mortality.

References:
Centers for Disease Control and Prevention (CDC), National Center for Emerging and Zoonotic Infectious Diseases, Division of Vector-Borne Diseases, (2017a). Zika Virus. Retrieved from: https://www.cdc.gov/zika/index.html June 2017.
Centers for Disease Control and Prevention (CDC), National Center for Emerging and Zoonotic Infectious Diseases, Division of Vector-Borne Diseases, (2017b). Zika, CDC Interim Response Plan, May 2017. Retrieved from: https://www.cdc.gov/zika/public-health-partners/cdc-zika-interim-response-plan.html
Martines, Roosecelis Brasil et al. (2016). Pathology of congenital Zika syndrome in Brazil: a case series. The Lancet, 388(10047), 898-904.
 
Megan Doble, MSN, RN, CRNP, FNP-BC, AGACNP-BC
 
 
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Posted: 6/23/2017 11:18:52 AM by Lisa Bonsall, MSN, RN, CRNP | with 0 comments

Categories: Diseases & Conditions


Systemic Vascular Resistance and Pulmonary Vascular Resistance: What’s the Difference?

In a previous blog post, we discussed preload and afterload. You may recall, preload is the amount of ventricular stretch at the end of diastole. Afterload is the pressure the myocardial muscle must overcome to push blood out of the heart during systole. The left ventricle ejects blood through the aortic valve against the high pressure of the systemic circulation, also known as systemic vascular resistance (SVR).1 The right ventricle ejects blood through the pulmonic valve against the low pressure of the pulmonary circulation, or pulmonary vascular resistance (PVR).1

Let’s dig a little deeper into these concepts.


Systemic vascular resistance (SVR)*

Systemic vascular resistance (SVR) reflects changes in the arterioles2, which can affect emptying of the left ventricle. For example, if the blood vessels tighten or constrict, SVR increases, resulting in diminished ventricular compliance, reduced stroke volume and ultimately a drop in cardiac output.1 The heart must work harder against an elevated SVR to push the blood forward, increasing myocardial oxygen demand. If blood vessels dilate or relax, SVR decreases, reducing the amount of left ventricular force needed to open the aortic valve. This may result in more efficient pumping action of the left ventricle and an increased cardiac output.2 Understanding SVR will help the bedside clinician treat a patient’s hemodynamic instability. If the SVR is elevated, a vasodilator such as nitroglycerine or nitroprusside may be used to treat hypertension. Diuretics may be added if preload is high. If the SVR is diminished, a vasoconstrictor such as norepinephrine, dopamine, vasopressin or neosynephrine may be used to treat hypotension. Fluids may be administered if preload is low.

SVR is calculated by subtracting the right atrial pressure (RAP) or central venous pressure (CVP) from the mean arterial pressure (MAP), divided by the cardiac output and multiplied by 80. Normal SVR is 700 to 1,500 dynes/seconds/cm-5.

Here’s an example:
If a patient's MAP is 68 mmHg, his CVP is 12 mmHg, and his cardiac output is 4.3 L/minute, his SVR would be 1,042 dynes/sec/cm-5.
 
SVR.jpg
 
Conditions that can increase SVR include1,2:
  • Hypothermia
  • Hypovolemia
  • Cardiogenic shock
  • Stress response
  • Syndromes of low cardiac output
Conditions that can decrease SVR include1,2:
  • Anaphylactic and neurogenic shock
  • Anemia
  • Cirrhosis
  • Vasodilation


Pulmonary vascular resistance (PVR)*

Pulmonary vascular resistance (PVR) is similar to SVR except it refers to the arteries that supply blood to the lungs. If the pressure in the pulmonary vasculature is high, the right ventricle must work harder to move the blood forward past the pulmonic valve. Over time, this may cause dilation of the right ventricle, and require additional volume to meet the preload needs of the left ventricle.1
 
PVR can be calculated by subtracting the left atrial pressure from the mean pulmonary artery pressure (PAP), divided by the cardiac output (CO) and multiplied by 80. To obtain the left atrial pressure, a pulmonary artery catheter (PAC) is needed to perform a pulmonary artery occlusion pressure (PAOP), also known as pulmonary artery wedge pressure (PAWP). Normal PVR is 100 – 200 dynes/sec/cm-5.

Here’s an example:
If a patient's mean PAP is 16 mmHg, his PAOP is 6 mmHg, and his cardiac output is 4.1 L/minute, his PVR would be 195 dynes/sec/cm-5.
 
PVR.jpg
 
Factors that increase PVR include1:
  • Vasoconstricting drugs
  • Hypoxemia
  • Acidemia
  • Hypercapnia (high partial pressure of arterial carbon dioxide [PaCO2])
  • Atelectasis
 Factors that decrease PVR include1:
  • Vasodilating drugs
  • Alkalemia
  • Hypocapnia (low PaCO2)
  • Strenuous exercise
The accuracy of SVR and PVR depends on the direct pressure measurements and indirect cardiac outputs from a pulmonary artery catheter which are subject to error. However, SVR can provide critical information when differentiating various types of shock and PVR is useful when diagnosing the severity of pulmonary hypertension.3 Understanding these parameters will help the bedside clinician better manage medications and hemodynamic instability.
 
*You may also see systemic vascular resistance index (SVRI) or peripheral vascular resistance index (PVRI) reported; these measurements are calculated by substituting cardiac index (CI) for CO in the equations.

References:
1. Breitenbach, J. (2010). Putting an end to perfusion confusion. Nursing Made Incredibly Easy!. 5(3): 50 60
2. Gowda, C. (2008). Don’t be puzzled by cardiovascular concepts. Nursing Made Incredibly Easy!. 6(4): 27-30.
3. Silvestry, F. (2015). Pulmonary artery catheterization: interpretation of hemodynamic values and waveforms in adults. Uptodate. Retrieved on April, 17, 2017 from https://www.uptodate.com/contents/pulmonary-artery-catheterization-interpretation-of-hemodynamic-values-and-waveforms-in-adults
 
Myrna B. Schnur, RN, MSN 

 
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Posted: 5/25/2017 10:11:09 AM by Lisa Bonsall, MSN, RN, CRNP | with 0 comments

Categories: Diseases & Conditions


Transmission-based isolation precautions for common pathogens

As a follow-up to our previous post on isolation guidelines, here is a list of transmission-based precautions recommended for common pathogens. 
 
Disease-specific-isolation-recommendations-500x750.png

Megan Doble, MSN, RN, CRNP
 
References:
Centers for Disease Control (CDC), 2016. Prevention Strategies for Seasonal Influenza in Healthcare Settings: Guidelines and Recommendations. Available at: https://www.cdc.gov/flu/professionals/infectioncontrol/healthcaresettings.htm#

Siegel, J.D., Rhinehart, E., Jackson, M., Chiarello, L., & the Healthcare Infection Control Practices Advisory Committee, (2007). Guideline for Isolation Precautions: Preventing Transmission of Infectious Agents in Healthcare Settings 2007. Available at: http://www.cdc.gov/ncidod/dhqp/pdf/isolation2007.pdf
 

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Posted: 4/9/2017 5:43:04 AM by Lisa Bonsall, MSN, RN, CRNP | with 0 comments

Categories: Diseases & Conditions Patient Safety


GI Nurses & Associates Week 2017

GI Nurses & Associates Week is March 20-24, 2017!

We wish those of you in this specialty a wonderful week, and we thank you for compassion and dedication. Please enjoy the content below, specially selected to help you in your practice.

For those of us in other specialties, GI disorders can be challenging. Please explore, and share, the content in this collection with your colleagues!
 
Colorectal Cancer  
Inflammatory Bowel Disease  
Irritable Bowel Syndrome  
Clostridium difficile  
Pancreatitis   
Have a great week!

 
Posted: 3/20/2017 7:42:52 AM by Lisa Bonsall, MSN, RN, CRNP | with 0 comments

Categories: Diseases & Conditions


Laboratory signs of sepsis [Infographic]

Patients with sepsis can present in a variety of ways making sepsis very difficult to diagnose. Clinicians are now encouraged to use tools, such as the Sequential (Sepsis-Related) Organ Failure Assessment Score (SOFA), to assist in screening for septic patients. In addition to the parameters outlined in the SOFA score (hypoxemia, blood pressure, platelets, bilirubin, creatinine, urine output, and Glascow Coma Scale), several other laboratory values may help identify patients at high risk for organ failure and sepsis.

Use this infographic as reference guide for lab results that you may see in septic patients.

Myrna B. Schnur, RN, MSN  
Reference:
Neviere, R. (2017, February 28). Sepsis syndromes in adults: Epidemiology, definitions, clinical presentation, diagnosis, and prognosis. Retrieved from UpToDate: https://www.uptodate.com/contents/sepsis-syndromes-in-adults-epidemiology-definitions-clinical-presentation-diagnosis-and-prognosis
Laboratory-signs-of-sepsis_300x750.png

 

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Posted: 3/11/2017 5:09:52 AM by Lisa Bonsall, MSN, RN, CRNP | with 1 comments

Categories: Diseases & Conditions


March is a great month to introduce you to LiveWiseMS.org!

MS-awareness-Month.pngMarch is Multiple Sclerosis (MS) Awareness Month and a great opportunity to spread the word about multiple sclerosis, a chronic, unpredictable autoimmune disease of the central nervous system (CNS), as well as to introduce you to a new patient resource site, LiveWiseMS.org.

According to the National MS Society, there are over 400,000 people in the U.S. and 2.3 million people worldwide living with multiple sclerosis. Chances are that you see patients with MS in your practice and probably know people personally who are affected by this disease.

MS causes a varying array of symptoms, including balance issues, muscle spasms, cognitive problems, pelvic floor disorders, depression, disability, and much, much more. No two cases of MS are exactly the same, and there is currently no cure.

Advances in research and treatment have been on the rise in the past few decades for MS. There is hope on the horizon for potential new therapies and treatment options that seek to repair, as well as prevent, damage to the CNS. Current disease-modifying therapies (DMTs) only work to hold off any worsening of the disease; they do not treat or repair any damage already done. More DMT options are being approved all the time, and current therapies have had some success for keeping MS at bay for as long as possible, and hopefully, in turn improving quality of life for patients. Fortunately, MS is not the disease it used to be, but there is still a lot of work that needs to be done.

13years.pngI am one of those 400,00 people in the U.S. living with multiple sclerosis, and I live my life daily trying to raise awareness, educate, and most importantly, support others living with this disease. Recently, my personal and professional lives met in what, I believe, to be a serendipitous moment, and I am fortunate to be part of an exciting new MS patient and caregiver resource site, LiveWiseMS.org.

LiveWiseMS.org emerged out of a partnership between Wolters Kluwer and the International Organization of MS Nurses (IOMSN), supported by an unrestricted educational grant from EMD Serono, Inc., a subsidiary of Merck KGaA. Working with nurses for over 15 years, I couldn’t be more excited to work with the nurses at the IOMSN and to be a part of this new site about a topic near and dear to my heart.

LiveWiseMS.org seeks to educate patients and care partners on an even higher level than typical patient education materials and to further empower them to live the best possible life with multiple sclerosis.  This unique site features condensed patient summaries of articles and information from trusted medical journals and textbooks. Patients can read these summaries, and if so desired to further educate themselves, they can continue on to read the original article. While focused on the MS patient, this site also serves as a great resource for those nurses and health care practitioners who may see patients with MS, but may not necessarily specialize in that particular area.

As I said, I couldn’t be more excited to be a part of LiveWiseMS.org. I share my story in the LiveWiseMS.org Blog section and interact with others through the Community section and social media pages such as Facebook and Twitter. My hope is to continue to support and empower the special population of #MSWarriors out there who seek to take back control over this disease that can make one feel so powerless.

I encourage you to visit LiveWiseMS.org today and to recommend it to your patients, as well as colleagues and friends. Knowledge is power so spread awareness about MS and gain valuable information through LiveWiseMS.org.
 

 

Posted: 3/3/2017 6:30:43 AM by Kim Fryling-Resare | with 1 comments

Categories: Diseases & Conditions


World Cancer Day and How Nurses Can Help

world cancer dayFebruary 4th is World Cancer Day, and the theme for the day between 2016 and 2018 is “We can. I can.” Here, at Lippincott Nursingcenter, we know there are a number of ways nurses can help bring awareness to this day, along with ways nurses can better care for patients affected by cancer. 

1. Spread the word: Follow these hashtags on your social media accounts to join the discussion around World Cancer Day. 

  • #WorldCancerDay
  • #WeCanICan

2. Stay informed: Stay up-to-date on the latest research and evidence around cancer.  
Subscribe to the peer-reviewed journals, Cancer Nursing and Oncology Times.
.Cancer NursingOncology Times
  • Earn continuing education credits with over 160 CE activities related to oncology.
  • Access evidence-based cancer content instantly at the point of care with Lippincott Advisor. The individual version of the app used by leading hospitals includes over 1,000 evidence-based content entries on cancer symptoms, drugs, treatments, and more. Download it now for only $29.95.
3. Take action: Get certified in oncology by visiting our Guide to Certification page and scrolling down to the Oncology Nursing Certification Corporation.  
Posted: 1/31/2017 8:34:22 AM by Cara Deming | with 0 comments

Categories: Diseases & Conditions


Cardiac Output and Cardiac Index – What's the Difference?

Mastering hemodynamics can be tricky, but the first step is understanding the terminology. Let’s take a look at cardiac output and cardiac index – how to calculate them and why they’re important.

Cardiac Output (CO)

Cardiac output is the volume of blood the heart pumps per minute. Cardiac output is calculated by multiplying the stroke volume by the heart rate. Stroke volume is determined by preload, contractility, and afterload. The normal range for cardiac output is about 4 to 8 L/min, but it can vary depending on the body’s metabolic needs. Cardiac output is important because it predicts oxygen delivery to cells.
 
Here’s an example:
If a patient's stroke volume is 75 mL with each contraction and his heart rate is 60 beats/minute, his cardiac output is 4,500 mL/minute (or 4.5 L/minute).
 
Cardiac-Output.png

Cardiac Index (CI)

The cardiac index is an assessment of the cardiac output value based on the patient’s size. To find the cardiac index, divide the cardiac output by the person’s body surface area (BSA). The normal range for CI is 2.5 to 4 L/min/m2.

Here’s an example of how to calculate the cardiac index:
If a patient’s cardiac output is 4.5 L/minute and his BSA is 1.25 m2, his CI would be 3.6 L/min/m2. If another patient has a cardiac output of 4.5 L/minute, but he has a BSA of 2.5 m2, his CI would be 1.8 L/min/m2.  
 
 Cardiac-Index.png
 
Both cardiac output and cardiac index are important to let us know if a patient’s heart is pumping enough blood and delivering enough oxygen to cells. We also use CO and CI values to manage certain drug therapy, such as inotropics and vasopressors.
   
References
Gowda, C. (2008). Don't be puzzled by cardiovascular concepts. Nursing Made Incredibly Easy!, 27-30.
Smeltzer, S. B. (2010). Brunner & Suddarth's Textbook of Medical-Surgical Nursing, Twelfth Edition. Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins.
Warise, L. (2015). Understanding Cardiogenic Shock: A Nursing Approach to Improve Outcomes. Dimensions of Critical Care Nursing, 67-77.
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Posted: 12/13/2016 9:40:25 AM by Lisa Bonsall, MSN, RN, CRNP | with 4 comments

Categories: Diseases & Conditions


Breath sounds: Test your knowledge

Below are the results of a recent nursing quiz about lung auscultation posted on our Twitter page. This revealed a need for clarification of common adventitious lung sounds and the commonly associated clinical conditions. 
breath sounds quiz
Answer: B. Crackles are heard when collapsed or stiff alveoli snap open, as in pulmonary fibrosis. Wheezes are commonly associated with asthma and diminished breath sounds with neuromuscular disease. Breath sounds will be decreased or absent over the area of a pneumothorax.
 
First, let’s review the most common adventitious lung sounds.
A wheeze is high-pitched continuous musical sound, which may occur during inspiration and/or expiration, due to an obstructive process. The classic wheeze may be referred to as “sibilant wheeze.” This refers to the high-pitched whistle-like sound heard during expiration, typically in the setting of asthma, as air moves through a narrow or obstructed airway.
wheeze breath sound.png
 
Alternately, what we often refer to as rhonchi is the “sonorous wheeze,” which refers to a deep, low-pitched rumbling or coarse sound as air moves through tracheal-bronchial passages in the presence of mucous or respiratory secretions.
rhonchi breath sound

In stridor, you’ll hear high-pitched, monophonic inspiratory wheezing. It’s typically loudest over the anterior neck, as air moves turbulently over a partially-obstructed upper airway.
 
stridor breath sound

Crackles, or rales, are short, high pitched, discontinuous, intermittent, popping sounds created by air being forced through an airway or alveoli narrowed by fluid, pus, or mucous. These sounds may also be heard when there is delayed opening of collapsed alveoli.
 
Crackles are typically heard during inspiration and can be further defined as coarse or fine. Coarse crackles are heard during early inspiration and sound harsh or moist. They are caused by mucous in larger bronchioles, as heard in COPD. Fine crackles are heard during late inspiration and may sound like hair rubbing together. These sounds originate in the small airways/alveoli and may be heard in interstitial pneumonia or pulmonary fibrosis.
 
coarse crackles breath sound

fine crackles breath sound

Now, let’s think about test-taking strategies. In this instance, it would be helpful to go through each clinical condition separately and predict what you may hear on auscultation.
 
The first choice was asthma. Asthma is a condition mediated by inflammation. The resulting physiologic response in the airways is bronchoconstriction and airway edema. This response is triggered by an irritant, allergen, or infection. As air moves through these narrowed airways, the primary lung sound is high-pitched wheeze. Initially the wheezes are expiratory but depending on confounding factors or worsening clinical symptoms, there may be inspiratory wheezes, rhonchi or crackles. For testing purposes, however, expiratory wheezes are associated with asthma.

The second choice was pulmonary fibrosis. This is a form of interstitial lung disease in which scarring (or fibrosis) is the hallmark clinical feature. This scarring leads to thickness and stiffness in the lungs. The most common adventitious sound associated with pulmonary fibrosis is fine bibasilar crackles. This may be hard to distinguish from congestive heart failure. The crackles are the result of the snapping open of collapsed, stiff alveoli.

Neuromuscular disease was the third choice. Neuromuscular disorders can cause respiratory problems through several pathways as the muscles responsible for breathing are affected. Diaphragmatic weakness can lead to hypoventilation; chest wall muscle weakness can lead to ineffective cough; and upper airway muscle weakness can lead to difficult swallowing and ineffective clearing of upper airway secretions. In general, there are not specific adventitious sounds associated with neuromuscular disorders.

Lastly, a pneumothorax is a collapsed lung. There would be loss of breath sounds over the area of a pneumothorax as there is no air movement in the area of auscultation.

So, this leads us to the correct answer. During lung auscultation, crackles are heard in pulmonary fibrosis, which is choice B.  

Reviewing what you know and thinking about each response choice can help you focus in on the correct answer. Do you have an easy acronym or pearl for remembering breath sounds, or some test-taking strategies to share?
 
Reference:
Hinkle, J. & Cheever, K.  (2013). Brunner & Suddarth's Textbook of Medical-Surgical Nursing. Philadelphia: Lippincott Williams & Wilkins.
 
Megan Doble, MSN, RN, CRNP
 
 
 
Posted: 10/11/2016 7:54:17 AM by Lisa Bonsall, MSN, RN, CRNP | with 4 comments

Categories: Diseases & Conditions


Preventing mosquito-borne illnesses [Infographic]

With Zika virus in the news and on our minds this season, we know some of the best advice for preventing this illness is to prevent infection via mosquito bites. See the infographic below for recommendations to prevent transmission of Zika virus and other mosquito-borne illnesses.
 
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Posted: 7/29/2016 8:35:34 PM by Lisa Bonsall, MSN, RN, CRNP | with 3 comments

Categories: Diseases & Conditions


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