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Detailed Summary of CNUR 203 Testable OSCE Pathophysiologies (Fall 2023)

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Course
CNUR 203 (CNUR203)

Institution
University Of Regina ( )

This document provides detailed, clearly laid out pathophysiologies for the CNUR 203 OSCE. Each disease process covered in the lab, which is testable for the OSCE, is included. Each pathophysiology map fits onto one standard sized page, so that all of the information is easy together and readable f...

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Uploaded on April 1, 2024
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Written in 2023/2024
Type Summary

nursing
saskatchewan polytechnic
saskpolytech
university of regina
osce
pathophysiology
final exam
scbscn
year 2 scbscn
second year scbscn
203
nursing school
disease processes

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Patho: Heart Failure
heart unable to pump blood effectively.
Right-Sided (Rest of body) Left-Sided (LUNGS)
Pathophysiology: usually consequence of left-sided HF or other Pathophysiology: inability of LV to effectively pump oxygenated blood
conditions that increase workload of right-side of heart into systemic circulation → reduced CO & increased pressure in LV →
RV pumps O2 depleted blood returning from body to lungs blood backing up into pulmonary circulation → pulmonary congestion
When right side of heart weakens → can’t effectively pump & fluid accumulation in lungs
blood into lungs → backlog of blood in venous system
Etiology (Causes): left-sided HF (specifically congestive HF) & Etiology (Causes): CAD, HTN, heart valve disease, cardiomyopathies,
chronic lung diseases (COPD, pulmonary HTN, congenital heart arrythmias, congenital heart defects, viral heart infections
defects, RV MI)
Anatomy (structural) & Physiology (function) Changes: RV → Anatomy (structural) & Physiology (function) Changes: LV
weakened RV struggles to pump blood into pulmonary dysfunction – LV becomes weakened or stuff reducing ability to
circulation → increased venous pressure → fluid retention contract & eject blood effectively; Increased LV pressure; backflow of
blood into left atrium into lungs → congestion
Risk Factors: Risk Factors:
Non-Modifiable: age, gender, family history Non-Modifiable: age, gender, family hx, ethnicity
Modifiable: uncontrolled HTN, CAD, tobacco, obesity, lifestyle Modifiable: uncontrolled HTN, CAD, diabetes, obesity, tobacco
Signs & Symptoms: peripheral edema, weight gain, fatigue, ABD Signs & Symptoms: SOB/SOBOE, fatigue, fluid retention, cough,
discomfort, JVD, SOB, tachycardia, nausea & loss of appetite tachycardia, wheezing, decreased exercise tolerance
Diagnosis: physical exam
Diagnostic Tests: CXR, ECHO, cardiac MRI, ECG, right heart cath
Laboratory Tests: BNP

Disease Complications: pulmonary HTN, Cor Pulmonale Disease Complications: pulmonary edema, kidney dysfunction,
(enlarged RV due to lung disease), arrythmias, multi-organ arrythmias, cardiogenic shock
failure
Treatments: Underlying cause; medications; lifestyle mods; O2 Treatments: medication (diuretics, ACE, beta blockers, ARBs,
therapy; cardiac resynchronization therapy (CRT), heart inotropic); lifestyle mods, cardiac rehabilitation, implantable devices
transplant (cardiac resynchronization therapy CRT or implantable cardioverter
Treatment goals - address cause, relieve symptoms, improve defibrillators ICDs), surgery, heart transplant
heart’s ability to pump effectively Treatment goals – reduce symptoms, improve heart function, prevent
complications
Nursing Management: Nursing Management:
Assess: Patient hx & symptoms; vitals; fluid balance; respiratory Assess: patient hx & symptoms; vitals & O2 sat; fluid balance;
status; cardiac assessment; PV assessment respiratory assessment; cardiac assessment
Do: med management; fluid & sodium restriction; O2 therapy, Do: med management; oxygen therapy; fluid & sodium retention;
positioning, monitor & document positioning (high or semi fowlers)
Teach: med adherence; dietary modification; fluid monitoring; Teach: medication; dietary modification; fluid monitoring; oxygen use,
oxygen use; symptom recognition; follow up care, DASH diet smoking cessation
Evaluation: symptoms management; fluid balance; patient Evaluation: symptom management; fluid balance; patient education;
education; ongoing monitoring ongoing monitoring

LABS: BNP (B-type Natriuretic Peptide): assists in diagnosis of HF; positive correlation to degree of left ventricular dysfunction.
Radiology/Imaging: CXR, ECG, ECHO, MIBI, Coronary Catheterization
Emergent (acute) Treatment: symptom relief, IV meds, monitoring, mechanical support (VAD, etc.)
Chronic treatment: medication, lifestyle mods, fluid/sodium management, regular follow-up, device therapy (pacemakers, etc), surgical
interventions (LVAD, etc.)
Referrals: cardiologist, electrophysiologist, heart failure specialist, cardiac surgeon, nephrology, endocrinology, pulmonology,
dietician/nutritionist, pharmacist, rehab specialist, social work, home health services

, Patho: COPD
Progressive, partially reversible airway obstruction & lung hyperinflation
Pathophysiology: Inflammatory response → bronchoconstriction, mucus production, damage to alveoli → structural changes like airway
remodeling, narrowing of bronchial tubes & emphysema → reduced airflow, increased resistance to breathing & difficulty exhaling
Etiology (Causes): long-term exposure to irritants with smoking being leading factor, can also include occupational exposures, pollution,
and genetic predisposition
Anatomy (structural) & Physiology (function) Changes:
• chronic inflammation & narrowing of airways → reduced oxygen exchange in lungs
• destruction of alveoli → decreased lung elasticity & impaired gas exchange
• chronic cough & mucus production are common due to increased production of mucus & decreased clearance
Risk Factors:
Non-Modifiable: genetics (hereditary); age (more common in older adults), infection, gender (males)
Modifiable: smoking; occupational exposures; air pollution; infections
Environmental: tobacco, occupational exposures, air pollution
Alpha 1 – antitrypsin deficiency; lungs lack this coating they are more exposed to damage by neutrophil elastase; it gets trapped in liver
causing damage
Signs & Symptoms: symptoms are often progressive & worsen over time
• chronic cough with or without mucus production
• SOB/SOBOE
• Wheezing
• Chest tightness
Diagnosis:
• Patient hx & symptom evaluation
• Spirometry (FEV1/FVC < 70%)
• Imaging – CXR or CT
• ABG analysis to evaluate oxygen & carbon dioxide levels
Disease Complications:
• Exacerbations – sustained worsening of dyspnea, cough, or sputum production → increased med use
• Acute respiratory failure
• Respiratory infections
• Cor Pulmonale – right sided HF (enlargement of right ventricle) due to pulmonary hypertension (high BP in lungs)
• Depression/anxiety/panic
• Malnutrition – difficulty eating & breathlessness → weight loss (small frequent meals high in protein & calories & low in carbs)
• Lung cancer
Treatments:
• Medication – bronchodilators, inhaled corticosteroids, combination inhalers, phosphodiesterase-4 inhibitors
• Oxygen therapy
• Pulmonary rehabilitation
• Lung volume reduction surgery
• Lung transplant
• Smoking cessation
• Vaccination
• Nutritional support
Nursing Management:
Assess: respiratory assess; oxygenation (SpO2); cough & sputum; activity tolerance, ABGs, CXR, ECG
Do: medication management; oxygen therapy (target 88-92%); breathing exercises (in nose 2 secs, out mouth 4 secs; diaphragmatic
breathing); cough & secretion management; positioning (high fowlers or tripod), smoking cessation, exercise (build up to 20 mins/day),
vaccinations (pneumococcal, influenza, covid), pulmonary rehab, manage anxiety/depression, drug therapy (bronchodilators &
corticosteroids)
Teach: medication education; symptom recognition; smoking cessation; lifestyle management
SOS for SOB – stop & rest in comfy position, get head down, get shoulders down, breathe in/out through mouth, breathe in & blow out
fast, blow out longer (use pursed lips if necessar7), slow breathing, begin to breathe in through nose, diaphragmatic breathing, stay in
position for 5 mins or longer
Evaluation: symptom management; medication adherence; self-care knowledge; oxygen therapy effectiveness; exacerbation prevention

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Detailed Summary of CNUR 203 Testable OSCE Pathophysiologies (Fall 2023)

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