MODULE AIM

▪ Describe the structure and function of the cardiovascular, respiratory,

digestive and urinary system.
▪ Identify the disorder of the selected system
▪ Explain the causes, pathophysiology, and clinical features of the disease
conditions.
▪ Explain the diagnostic measure used for the selected disorders.
▪ Utilize nursing process and model in the managements of the conditions
of the selected system.

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 THE CARDIOVASCULAR SYSTEM
The cardiovascular system consists of the heart, blood vessels, and blood. Its primary
function is to transport nutrients and oxygen-rich blood to all parts of the body and to carry
deoxygenated blood back to the lungs.

Components of the cardiovascular system

The cardiovascular system Trusted Source is the system responsible for delivering blood to
different parts of the body. It consists of the following organs and tissues:

The heart: A muscular pump that forces blood around the body.
A closed system of blood vessels: These vessels include:
Arteries: Vessels that carry blood away from the heart.
Veins: Vessels that bring blood back to the heart.
Capillaries: Tiny vessels that branch off from arteries to deliver blood to all body
tissuesTrusted Source.

There are two blood circulatory systems in the body. The first is the systemic circulatory
system. This is the main blood circulatory system that transports blood to the organs,
tissues, and cells throughout the body.

The second is the pulmonary circulatory system. This circulatory system moves blood
between the heart and lungs. It is where oxygen enters the blood and carbon dioxide leaves
the blood.

Structure of the heart

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The heart consists of four distinct chambers: two upper chambers called “atria” and two
lower chambers called “ventricles.” A wall or “septum” separates the atria and ventricles.
Valves control the flow of blood within the different chambers.
Blood follows the following path Trusted Source through the heart:

• Blood lacking oxygen returns from the body and enters the right atrium (upper right
chamber) via the inferior vena cava and superior vena cava veins.
• Blood flows through the tricuspid valve and enters the right ventricle (lower right
chamber).
• The right ventricle pumps blood through the pulmonary valve and out of the heart
via the main pulmonary artery.
• The blood then flows through the left and right pulmonary arteries into the lungs.
Here, the process of breathing draws oxygen into the blood and removes carbon
dioxide. As a result, the blood is now rich in oxygen.
• The blood returns to the heart and flows into the left atrium (upper left chamber) via
four pulmonary veins.
• Blood flows through the mitral valve and enters the left ventricle (lower left
chamber).
• The left ventricle pumps the blood through the aortic valve into a large artery called
the “aorta.” This artery delivers blood to the rest of the body.
The importance of the heart
The heart pumps bloodTrusted Source through closed vessels to every tissue within the
body. The blood itself then deliversTrusted Source nutrients and oxygen to all cells in the
body. Without blood, the cells and tissues would not function at their total capacity and
would begin to malfunction and die.

Structure
The heart is composed of three layers of tissue pericardium, myocardium and
endocardium.

Pericardium
The pericardium is made up of two sacs. The outer sac consists of fibrous tissue and the
inner of a continuous double layer of serous membrane. The outer fibrous sac is continuous
with the tunica adventitia of the great blood vessels above and is adher-
ent to the diaphragm below. Its inelastic, fibrous nature prevents overdistension of the
heart.

Myocardium

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The myocardium is composed of specialised cardiac mus-cle found only in the heart
untary control but, like skeletal muscle, cross-stripes are seen on microscopic examination.
Each fibre (cell) has a nucleus and one or more branches. The ends of the cells

Endocardium
This forms the lining of the myocardium and the heart valves. It is a thin, smooth, glistening
membrane which permits smooth flow of blood inside the heart. It consists of flattened
epithelial cells, continuous with the endothelium that lines the blood vessels.

What is cardiovascular disease? Cardiovascular disease is a group of diseases affecting

your heart and blood vessels. These diseases can affect one or many parts of your heart
and/or blood vessels. A person may be symptomatic (physically experiencing the disease) or
asymptomatic (not feeling anything at all).

Cardiovascular disease includes heart or blood vessel issues, including:

• Narrowing of the blood vessels in your heart, other organs or throughout your body.
• Heart and blood vessel problems present at birth.
• Heart valves that aren’t working right.
• Irregular heart rhythms.

Cardiovascular Diseases: Causes, Pathophysiology, and Clinical Features

CORONARY ARTERY DISEASE AND HEART FAILURE

Definition for Coronary artery disease:

CAD is a condition where the coronary arteries, which supply blood to the heart muscle,
become narrowed or blocked due to the buildup of cholesterol and other substances, known
as plaque, on the artery walls

PATHOPHYSIOLOGY FOR CORONARY ARTERY DISEASE

Plaque buildup in the arteries reduces blood flow to the heart muscle. This can lead to chest
pain (angina), heart attack (myocardial infarction), or other complications such as heart
rhythm disturbances or heart failure.

RISKS FACTORS FOR CORONARY ARTERY DISEASE

• High blood pressure (hypertension)
• High cholesterol levels (hypercholesterolemia)
• Smoking
• Diabetes
• Obesity
• Sedentary lifestyle
• Family history of CAD
• Age (risk increases with age)
• Gender (men are at higher risk, though risk increases in women after menopause)

SIGNS AND SYMPTOMS FOR CORONARY ARTERY DISEASE

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 • Chest pain or discomfort (angina)
• Shortness of breath
• Fatigue
• Nausea
• Sweating
• Weakness
• Palpitations
• Dizziness or lightheadedness

DIAGNOSIS FOR CORONARY ARTERY DISEASE

• Electrocardiogram (ECG/EKG)
• Stress test
• Coronary angiography
• Cardiac CT or MRI

TREATMENT FOR CORONARY ARTERY DISEASE

Lifestyle changes (healthy diet, regular exercise, smoking cessation)
Medications (aspirin, statins, beta-blockers, ACE inhibitors, calcium channel blockers, etc.)
Procedures (angioplasty with stenting, coronary artery bypass grafting - CABG)Cardiac
rehabilitation programs

HEART FAILURE
Definition: Heart failure is a chronic condition where the heart is unable to pump enough
blood to meet the body's needs. It can result from various underlying conditions that
weaken or damage the heart muscle.

TYPES OF HEART FAILURE

Systolic heart failure: The heart's pumping function is impaired, leading to decreased
ejection fraction (the percentage of blood pumped out of the heart with each contraction).
Diastolic heart failure: The heart's ability to relax and fill with blood is impaired, leading to
increased pressure in the heart chambers.

CAUSES FOR HEART FAILURE OR RISK FACTORS

• Coronary artery disease
• High blood pressure
• Heart valve disorders
• Cardiomyopathy (disease of the heart muscle)
• Heart infections (e.g., myocarditis)
• Congenital heart defects
• Diabetes
• Obesity
• Sleep apnea
• Thyroid disorders

SIGNS AND SYMPTOMS FOR HEART FAILURE

• Shortness of breath (dyspnea), especially during exertion or when lying flat

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 • Fatigue and weakness
• Swelling in the legs, ankles, or abdomen (edema)
• Rapid or irregular heartbeat
• Persistent cough or wheezing
• Decreased exercise tolerance
• Loss of appetite or nausea
• Difficulty concentrating or confusion

DIAGNOSIS FOR HEART FAILURE

• Physical examination
• Blood tests (BNP, NT-proBNP)
• Chest X-rayElectrocardiogram (ECG/EKG)
• Echocardiogram
• Cardiac MRI or CT scan
• Cardiac catheterization

TREATMENT FOR HEART FAILURE

Medications (diuretics, ACE inhibitors, beta-blockers, aldosterone antagonists, etc.)
Lifestyle modifications (low-sodium diet, fluid restriction, regular exercise)
Device therapy (pacemakers, implantable cardioverter-defibrillators - ICDs)
Surgical interventions (heart valve repair or replacement, ventricular assist devices - VADs,
heart transplant)
Cardiac rehabilitation programs

NURSING DIAGNOSIS FOR CORONARY ARTERY DISEASE & HEART FAILURE

(1) Activity intolerance related to decreased cardiac output as evidence by chest pain
(2) Ineffective tissue perfusion related to reduced blood flow as evidenced by narrowing of
the coronary arteries
(3) Risk for decreased cardiac output related to myocardial ischemia
(4) Imbalanced nutrition less than body requirements related to dietary restrictions as
evidence by weight loss

MANAGEMENT FOR CORONARY ARTERY DISEASE AND HEART FAILURE

Assessment and Monitoring: Regular assessment of cardiac function, vital signs, fluid status,
and symptoms is crucial.
Monitoring for signs of worsening HF or ischemia is essential for early intervention.
Medication Management: Administering medications as prescribed, including beta-blockers,
ACE inhibitors, ARBs, diuretics, and antiplatelet agents, to manage symptoms and prevent
complications.
Lifestyle Modification: Providing education and support for lifestyle changes such as smoking
cessation, dietary modifications (low-sodium, heart-healthy diet), weight management,
regular exercise, and stress reduction to improve overall cardiac health.Patient Education:
Educating patients about their condition, medications, potential side effects, and the
importance of adherence to treatment plans.

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Arrhythmias: A heart arrhythmia (uh-RITH-me-uh) is an irregular heartbeat. A heart
arrhythmia occurs when the electrical signals that tell the heart to beat don't work properly.
The heart may beat too fast or too slow. Or the pattern of the heartbeat may be
inconsistent.

A heart arrhythmia may feel like a fluttering, pounding or racing heartbeat. Some heart
arrhythmias are harmless. Others may cause life-threatening symptoms.

Types
In general, heart arrhythmias are grouped by the speed of the heart rate. For example:
Tachycardia (tak-ih-KAHR-dee-uh) is a fast heartbeat. The heart rate is greater than 100
beats a minute.
Bradycardia (brad-e-KAHR-dee-uh) is a slow heartbeat. The heart rate is less than 60 beats a
minute.

Causes
• A heart attack or scarring from a previous heart attack.
• Blocked arteries in the heart, called coronary artery disease.
• Changes to the heart's structure, such as from cardiomyopathy.
• Diabetes.
• High blood pressure.
• Infection with COVID-19.
• Overactive or underactive thyroid gland.
• Sleep apnea.
• Some medicines, including those used to treat colds and allergies.
• Drinking too much alcohol or caffeine.
• Illegal drug use or drug misuse.
• Genetics.
• Smoking.
• Stress or anxiety.
Symptoms
A heart arrhythmia may not cause any symptoms. The irregular heartbeat may be noticed
during a health checkup for another reason.

Symptoms of an arrhythmia may include:

• A fluttering, pounding or racing feeling in the chest.
• A fast heartbeat.
• A slow heartbeat.
• Chest pain.
• Shortness of breath.
• Other symptoms may include:
• Anxiety.
• Feeling very tired.
• Lightheadedness or dizziness.
• Sweating.
• Fainting or almost fainting.

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Pathophysiology:
Arrhythmias result from abnormalities in impulse formation, impulse conduction, or both.
Bradyarrhythmias: These occur due to decreased intrinsic pacemaker function or blocks in
conduction, primarily within the atrioventricular (AV) node or the His-Purkinje system2.
Tachyarrhythmias: Failure to maintain normal sinus rhythm leads to adverse heart
rhythms. These can cause the heart rate to be too fast (tachycardia) or too slow
(bradycardia), affecting blood flow and potentially leading to patient morbidity and
mortality.

Clinical Features:
Symptoms of arrhythmias can vary widely:
Palpitations: Feeling of fluttering, pounding, or racing heartbeat.
Dizziness or Lightheadedness: Especially during episodes of arrhythmia.
Chest Pain or Discomfort: May occur in some cases.
Shortness of Breath: Especially during exertion.
Fatigue: Due to inefficient pumping of blood.
Fainting (Syncope): In severe cases.

The Diagnostic Measure

Electrocardiogram (ECG or EKG): This common test records your heart’s electrical activity.
During an ECG, electrodes are placed on your skin to measure the heart’s rhythm .
Blood Tests: These measure specific substances in your blood, such as potassium,
electrolytes, and thyroid hormones.
Holter Monitors and Implantable Loop Recorders: These devices record your heart rhythm
over an extended period while you go about your daily activities. Holter monitors are worn
externally, while implantable loop recorders are placed under your skin.
Electrophysiology Study (EPS): An EPS measures the heart’s electrical activity. A cardiologist
threads a wire through a blood vessel to stimulate the heart electrically, triggering any
underlying arrhythmia.
Tilt Table Testing: This test helps identify the cause of fainting spells. You lie on a table that
moves from a lying-down position to an upright position, potentially inducing fainting.

STROKE
A stroke is a brain attack. It is a sudden interruption of continuous blood flow to the brain and a
medical emergency. A stroke occurs when a blood vessel in the brain becomes blocked or narrowed,
or when a blood vessel bursts and spills blood into the brain. Just like a heart attack, a stroke requires
immediate medical attention.

Types
A stroke can happen in two main ways: Something blocks the flow of blood, or something
causes bleeding in the brain.
Ischemic stroke. In 8 out of 10 strokes, a blood vessel that takes blood to your brain gets
plugged. It happens when fatty deposits in arteries break off and travel to the brain or when
poor blood flow from an irregular heartbeat forms a blood clot.
Hemorrhagic stroke. It's less common than an ischemic stroke but can be more serious. A
blood vessel in your brain balloons up and bursts, or a weakened one leaks.

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Uncontrolled high blood pressure and taking too much blood thinner medicine can lead to
this kind of stroke.

Causes
High blood pressure. Your doctor may call it hypertension. It's the biggest cause of strokes. If
your blood pressure is typically 130/80 or higher, your doctor will discuss treatments with
you.
Tobacco. Smoking or chewing it raises your odds of a stroke. Nicotine makes your blood
pressure go up. Cigarette smoke causes a fatty buildup in your main neck artery. It also
thickens your blood and makes it more likely to clot. Even second-hand smoke can affect
you.
Heart disease. This condition includes defective heart valves as well as atrial fibrillation, or
irregular heartbeat, which causes a quarter of all strokes among the very elderly. You can
also have clogged arteries from fatty deposits.
Diabetes. People who have it often have high blood pressure and are more likely to
be overweight. Both raise the chance of a stroke. Diabetes damages your blood vessels,
which makes a stroke more likely.
Medications. Some medicines can raise your chances of stroke. For instance, blood-
thinning drugs, which doctors suggest to prevent blood clots, can sometimes make a stroke
more likely through bleeding. Studies have linked hormone therapy, used for menopause
symptoms like hot flashes, with a higher risk of strokes. And low-dose estrogen in birth
control pills may also make your odds go up.
Age. Anyone could have a stroke, even babies in the womb. Generally, your chances go up as
you get older. They double every decade after age 55.
Family. Strokes can run in families. You and your relatives may share a tendency to get high
blood pressure or diabetes. Some strokes can be brought on by a genetic disorder that
blocks blood flow to the brain.
Gender. Women are slightly less likely to have a stroke than men of the same age. But
women have strokes at a later age, which make them less likely to recover and more likely to
die as a result.
Race. Strokes affect African-Americans and nonwhite Hispanic Americans much more often
than any other group in the U.S. Sickle cell disease, a genetic condition that can narrow
arteries and interrupt blood flow, is also more common in these groups and in people whose
families came from the Mediterranean, the Middle East, or Asia.
SourcesUpdate History

Pathophysiology
1. Ischemic Stroke:
o Cause: An ischemic stroke occurs due to a blockage or reduction in blood flow to
part of the brain.
o Effects: Brain tissue in the affected area does not receive sufficient oxygen and
nutrients, leading to cell death within minutes.
o Subtypes:
▪ Thrombotic Stroke: Caused by a blood clot forming within a blood vessel
supplying the brain.

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 ▪ Embolic Stroke: Occurs when an embolus (usually from the heart or large
arteries) travels to the brain and blocks a blood vessel.
o Treatment: Immediate medical attention is crucial to minimize brain damage. Clot-
dissolving medications (thrombolytics) or mechanical clot removal may be used.
2. Hemorrhagic Stroke:
o Cause: A hemorrhagic stroke results from sudden bleeding within the brain. It occurs
when a blood vessel ruptures or leaks.
o Effects: The bleeding increases pressure on brain cells, damaging them.
o Subtypes:
▪ Intracerebral Hemorrhage: Bleeding directly into brain tissue due to a
ruptured blood vessel.
▪ Subarachnoid Hemorrhage: Bleeding into the space between the brain and its
protective covering (meninges).
o Treatment: Controlling bleeding, managing blood pressure, and addressing the
underlying cause are essential.

Remember the acronym FAST when identifying stroke symptoms:

• Face: Check for facial drooping

• Arms: Assess arm weakness or drift.
• Speech: Observe slurred speech or changes in language.
• Time: Act promptly; call 911 or seek emergency medical help immediately.

Clinical presentation
1. MOTOR LOSS- cerebro vascular accident usually affect the upper motor neurons and
result in loss of voluntary control of movement
2. Communication loss . stroke affects speech and language in the following ways
• Dysarthia
• Dysphagia
• Apraxia
3. Dysfunction in visual perception
4. Bladder dysfunction

Diagnosis
1. Computerized tomography
2. Electro encephalogram
3. Lumber puncture

Nursing process
• Recognize and assess signs and symptoms of stroke.
• Activate emergency response and facilitate immediate medical intervention.
• Monitor and stabilize vital signs and neurological status.
• Coordinate diagnostic imaging, such as CT or MRI scans, to confirm the
diagnosis and determine the type of stroke.
• Implement time-sensitive treatments, such as thrombolytic therapy or
mechanical thrombectomy, if appropriate.

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 • Provide supportive care to manage complications and promote recovery,
including blood pressure control and prevention of secondary brain injury.
• Collaborate with healthcare professionals to develop an individualized stroke
care plan.
• Facilitate rehabilitation services, including physical, occupational, and speech
therapies, to optimize functional recovery.
• Educate patients and caregivers on stroke risk factors, prevention strategies,
and warning signs of a recurrent stroke.
• Offer emotional support and counseling to patients and families during the
recovery process.
Management of patient with stroke.
➢ Admit the patient in the coronary unit and nurse as an unconscious patient
➢ Use the Glasgow coma scale to asses the patient’s lever of unconsciousness.
➢ Monitor the level of unconsciousness and clear the airway
➢ Attend to the personal hygiene of the patient
➢ Give nutritious food low in fat and sodium
Diabetes
Diabetes is a chronic disease that occurs either when the pancreas does not produce enough insulin
or when the body cannot effectively use the insulin it produces. Insulin is a hormone that regulates
blood glucose. Hyperglycaemia, also called raised blood glucose or raised blood sugar, is a common
effect of uncontrolled diabetes and over time leads to serious damage to many of the body's
systems, especially the nerves and blood vessels.

Causes
• Unknown causes
1. Family pre-disposition
2. Obesity
3. Age- above 40 years
4. Previously diagnosed or impaired glaucous tolerance

Pathophysiology
In insulin dependent diabetes mellitus or type 1 diabetes the pancreas cannot produce
insulin because the insulin producing beta cells have been destroyed by an auto immune
process. The fasting hyperglycaemia as a result of excessive glucose production by the liver
as such, glucose got from food cannot be stored in the liver, hence elevated glucose in the
blood. Such patient experiences post pramdial (after meal) hyperglycaemia.

Sign and symptoms

➢ Polyuria – frequent urination nocturia
➢ Polyphagia – excessive thirst
➢ Polyphagia -excessive appetite
➢ Weight loss
➢ Glycosuria- sugar in the urine
➢ Irritability
➢ Abdominal discomfort
➢ Nausea and vomiting
➢ Eye disorders
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Nursing management
a) Diet
b) Education
c) Monitoring
d) Medication
e) Exercise
Management of diabetes

THE RESPIRATORY SYSTEM

The respiratory system consists of the set of organs and tissues involved in the uptake of
oxygen from the atmosphere and the release of carbon dioxide generated during aerobic
respiration. This gas exchange is also called breathing or external respiration.

Organs of the respiratory system

1. Nose: The nose serves as the entry point for air. It filters, warms, and moistens the
incoming air, making it suitable for the respiratory tract.
2. Pharynx (Throat): This tubular passage connects the nasal cavity to the larynx. It
plays a role in both respiration and digestion.
3. Epiglottis: A flap-like structure located at the base of the tongue, the epiglottis
prevents food and liquids from entering the windpipe during swallowing.
4. Larynx (Voice Box): The sound box of our respiratory system, the larynx houses the
vocal cords. It enables speech and produces sound when air passes through it.
5. Trachea (Windpipe): The windpipe is a sturdy tube that carries air from the larynx to
the bronchi. It contains cartilage rings to maintain its shape.
6. Bronchi: These are the first branches of the trachea, leading to the left and right
lungs. They further divide into smaller bronchioles.
7. Lungs: Our conical organs for respiration, the lungs contain millions of tiny air sacs
called alveoli. Here, oxygen diffuses into the bloodstream, and carbon dioxide is
expelled.
8. Alveoli: These sac-shaped bodies are the sites of gas exchange. Oxygen enters the
bloodstream, while carbon dioxide exits.

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The main function of your respiratory system is to pull in oxygen for your body’s cells
and get rid of carbon dioxide, a waste product. You achieve this by breathing in and
out and through gas exchange between the small air sacs of your lungs (alveoli) and the
blood vessels nearby. Here are some additional functions of the respiratory system:

1. Warming and Moisturizing: Your respiratory system warms and adds moisture to
the air you breathe in. It adjusts the air temperature to match your body’s needs and
ensures proper humidity levels.
2. Protection: Parts of your respiratory system can block harmful germs and
irritants from entering or expel them if they do get in.
3. Speech: The vibration of air against your vocal cords allows you to talk.
4. Smell: Breathing in air moves its molecules past your olfactory nerve, which sends
messages to your brain about how something smells1.
5. Acid-Base Balance: By removing carbon dioxide, your respiratory system
helps maintain the acid-base balance in your body.

1. Upper Respiratory Tract:

o Nose and Nasal Cavity: Located inside your nose, the nasal cavity filters,
warms, and humidifies incoming air.
o Mouth and Oral Cavity: The mouth also serves as an entry point for air.
o Sinuses: These air-filled spaces in the skull help regulate air pressure and
contribute to voice resonance.
o Pharynx (Throat): A common passage for both air and food.
o Larynx (Voice Box): Contains your vocal cords and enables speech.
2. Lower Respiratory Tract:
o Trachea (Windpipe): A tube that carries air from the throat to the lungs.
o Bronchi and Bronchioles: These branching tubes further distribute air within
the lungs.
o Lungs: Cone-shaped organs housing tiny air sacs called alveoli. Gas exchange
occurs in these alveoli.
o Diaphragm: A dome-shaped muscle that aids in breathing by contracting and
relaxing.
3. Gas Exchange:
o The biochemical process where:
▪ Oxygen diffuses from the air into the blood.
▪ Carbon dioxide and other waste gases diffuse from the blood into the air.
o Only the lungs are involved in this crucial gas exchange.
4. Additional Functions:
o Warming and Moisturizing: The respiratory system warms and adds moisture
to inhaled air.
o Protection: It blocks harmful germs and irritants.
o Speech: Vibration of air against vocal cords allows you to talk.
o Smell: Air movement past the olfactory nerve informs your brain about
smells.
o Acid-Base Balance: By removing carbon dioxide, it helps maintain body pH.

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Disorder of the respiratory system

1. Asthma:

Asthma is a lung disorder characterized by the narrowing and inflammation of the airways,
which carry air into the lungs. This condition results in symptoms such as shortness of
breath, wheezing, chest tightness, and persistent coughing. During an asthma attack,
patients may experience very low blood pressure, rapid breathing, and wheezing sounds
during both inspiration and expiration1.

The causes of asthma are not fully understood, but they likely involve a combination
of genetic and environmental factors. Here are some known triggers and factors associated
with asthma:

Allergens: Exposure to allergens like dust mites, animal dander, pollen, molds, cigarette
smoke, chemical pollutants, and cold air can trigger asthmatic symptoms.

Sinusitis: Inflammation of the sinuses can exacerbate asthma.

Extreme Emotional Responses and Physical Exercise: Emotional stress and vigorous exercise
may lead to symptoms.

Medications: Certain medications, such as aspirin, beta-blockers, or NSAIDs, can provoke

asthma.

Gastroesophageal Reflux Disease (GERD): Acid reflux can worsen asthma symptoms.

Dietary Factors: Insufficiencies in vitamins C and E, omega-3 fatty acids, and consumption of
foods with sulfites and preservatives may play a role.

Factors Associated with Development:

• Motherhood at a young age
• Poor maternal nutrition
• Lack of breastfeeding
• Premature birth
• Low birth weight
• Smoking
• Overweight

The pathophysiology of asthma involves the following key factors:

• Inflammation: Bronchiolar inflammation with airway constriction and resistance.
• Airway remodeling: Includes goblet cell hyperplasia, subepithelial fibrosis,
collagen deposition, mucosal gland hyperplasia, and smooth muscle hypertrophy.
• Genetic and environmental factors: Complex interactions contribute to asthma
development and severity.
• Variable airflow limitation: Due to inflammation, airway hyper-responsiveness,
and mucous hypersecretion.

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Asthma diagnosis measures
Medical History: Your doctor will begin by taking a detailed medical history. They’ll ask
about your symptoms, any triggers that worsen your symptoms (such as exposure to
allergens or exercise), and your overall health.
Physical Exam: A physical exam is performed to rule out other possible conditions. Your
doctor will listen to your lungs, check for wheezing, and assess your overall respiratory
health.
Spirometry: This is the primary diagnostic test for asthma. During spirometry, you’ll blow
into a machine that measures how fast you can breathe out and how much air you can hold
in your lungs. It helps assess lung function and airflow obstruction.
FeNO Test: In this test, you breathe into a machine that measures the level of nitric oxide in
your breath. Elevated levels of nitric oxide indicate inflammation in your lungs, which is
associated with asthma1.
Severity Classification: To determine the severity of your asthma, your doctor will consider
how often you experience symptoms and how severe they are. This helps guide treatment
decisions2.

Nursing management of asthma involves:

• Providing reassurance to relieve anxiety

• Alerting the physician immediately
• Observing the patient closely for respiratory arrest
• Monitoring the patient's respiratory rate continuously and other vital signs every
5 minutes

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 • Never leaving the patient alone
• Making sure the patient receives oxygen and bronchodilator and nebulizer
therapies as ordered
• Explaining the need for various inhalers and providing the patient with
information on treatment administered

Chronic Obstructive Pulmonary Disease (COPD)

2. Chronic Obstructive Pulmonary Disease (COPD): Chronic obstructive pulmonary
disease (COPD) is a chronic inflammatory lung disease that causes obstructed airflow
from the lungs. Symptoms include breathing difficulty, cough, mucus (sputum)
production and wheezing. It's typically caused by long-term exposure to irritating
gases or particulate matter, most often from cigarette smoke.

Causes
The major causes are:
• Smoking
• Air pollutants
Risk factors include:
• Occupational exposure- Intense and prolonged exposure to workplace dusts,
chemicals and fumes
• Asthma
• Early childhood infections
• Genetics ( Alpha 1 antitrysin deficiency )

Pathophysiology

Chronic obstructive pulmonary disease (COPD) is characterised by poorly reversible airflow

obstruction and an abnormal inflammatory response in the lungs. The latter represents the
innate and adaptive immune responses to long term exposure to noxious particles and
gases, particularly cigarette smoke. All cigarette smokers have some inflammation in their
lungs, but those who develop COPD have an enhanced or abnormal response to inhaling
toxic agents. This amplified response may result in mucous hypersecretion (chronic
bronchitis), tissue destruction (emphysema), and disruption of normal repair and defence
mechanisms causing small airway inflammation and fibrosis (bronchiolitis).

COPD may develop for years without any noticeable symptoms. It is generally diagnosed in
the moderate stage. Few common symptoms include:
• Shortness of breath, which gradually gets worse
• Shortness of breath during physical activity
• Frequent coughing, with or without sputum
• Wheezing
• Noisy breathing
• Tightness in the chest
• Tiredness
• Frequent infections of the lungs

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 • Change in appetite
• Weight loss

Chronic obstructive pulmonary disease diagnosis.

Spirometry: This is a simple breathing test that measures lung function. It helps determine
how well your lungs are working and whether there is airflow obstruction12.
Imaging Tests: Chest X-rays and CT scans are used to visualize the lungs and identify any
abnormalities or damage.
Blood Work: Blood tests can provide information about oxygen levels, inflammation, and
other factors related to lung health.
Pulse Oximetry: This non-invasive test measures the oxygen saturation in your blood. It’s
often done using a small device placed on your fingertip.
Physical Examination: Your doctor will evaluate your symptoms, ask about your complete
health history, and conduct a physical exam.

3. Lung Cancer:
Lung cancer is a serious condition that affects the lungs, and understanding its causes is
crucial.

1. Smoking: Cigarette smoking is the primary risk factor for lung cancer. It significantly
increases the chances of developing this disease. Even if you’ve smoked for many
years, quitting can still lower your risk.
2. Secondhand Smoke: Exposure to secondhand smoke is another risk factor. People
who are around smokers are also at risk of developing lung cancer.
3. Occupational Hazards: Certain occupational exposures can contribute to lung
cancer. These include exposure to asbestos, radon, and specific chemicals.
4. Air Pollution: Prolonged exposure to air pollution may play a role in lung cancer
development.
5. Hereditary Factors: Some individuals have a genetic predisposition that increases
their risk of lung cancer.
6. Chronic Lung Diseases: Previous chronic lung diseases can also be associated with
an elevated risk.

Clinical features

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 ➢ A new cough that doesn't go away
➢ Coughing up blood, even a small amount
➢ Shortness of breath
➢ Chest pain
➢ Hoarseness
➢ Losing weight without trying
➢ Bone pain
➢ Headache
Diagnosis process
➢ X-ray: X-ray of chest is taken to identify the presence of tumor.
➢ CT scan: CT scan of the lungs is performed to identify the location and size of the
tumor mass.
➢ Magnetic resonance imaging (MRI): MRI of the lungs can detect the severity and
spread of cancer cells.
➢ Positron emission tomography (PET): To observe the function of lungs and its
tissues.
➢ Sputum cytology: Sputum tests may be performed in certain cases to look for
cancerous cells.
➢ Biopsy: A small sample of the lung tumor cells is obtained to determine if they are
cancerous.
Nursing management of lung cancer involves

• Maintaining a patent airway

• Improving gas exchange
• Controlling the pain
• Maintaining fluid volume and nutrition
• Providing information about disease process, prognosis, and planned therapies
• Relieving breathing problems
• Managing symptoms of lung cancer
• Reducing fatigue
• Providing emotional support
• Patient education and health teachings

4. Tuberculosis (TB):

Tuberculosis (TB) is caused by Mycobacterium tuberculosis, a slow-growing bacteria that

thrive in areas of the body that are rich in blood and oxygen, such as the lungs.

• It spreads through infected droplets, released in the air by coughing, sneezing etc, by
the affected individual. It usually spreads after a prolonged exposure with the
infected individual.
Immunosuppressed (with weak immunity) individuals are at higher risk of contracting the
infection, and they include persons with:
• Diabetes
• Chronic Kidney diseases
• Cancer

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 • HIV/AIDS

Clinical features

Primary TB Infection:
Symptoms: Most people don’t experience symptoms during the primary infection. However,
some may have flu-like symptoms, including low fever, tiredness, and cough.
Description: During this stage, immune system cells capture TB germs. While most germs
are destroyed, some may survive and multiply.
Latent TB Infection:
Symptoms: There are no symptoms during latent TB infection.
Description: Immune system cells wall off the TB germs in lung tissue. The germs remain
dormant and don’t cause active disease.
Active TB Disease (Pulmonary):
Symptoms (usually gradual and worsening over weeks):
• Persistent cough
• Coughing up blood or mucus
• Chest pain
• Pain with breathing or coughing
• Fever
• Chills
• Night sweats
• Weight loss
• Loss of appetite
• Fatigue
Description: Active TB occurs when the immune system can’t control the infection. Germs
spread throughout the lungs, causing symptoms.
Active TB Disease (Extrapulmonary):
Symptoms: Vary based on the infected body part.
Common symptoms:
• Fever
• Chills
• Night sweats
• Weight loss
• Fatigue
• Pain near the site of infection

Pathophysiology
Human tuberculosis (TB) is primarily caused by Mycobacterium tuberculosis (Mtb) that
inhabits inside and amidst immune cells of the host with adapted physiology to regulate
interdependent cellular functions with intact pathogenic potential.

19
Diagnosis process
Physical Examination and History:
A healthcare provider will perform a physical examination, including listening to your
breathing with a stethoscope and checking for swollen lymph nodes.
They will also ask you questions about your symptoms and potential exposure to TB.

TB Tests:
If TB is suspected, your healthcare provider will order specific tests:
Skin Test (Tuberculin Test): A small amount of tuberculin is injected just below the skin on
your forearm.
Blood Tests: A blood sample is sent to a lab to check whether certain immune system cells
recognize tuberculosis.
Chest X-ray: An X-ray can reveal irregular patches in the lungs typical of active TB disease.
Sputum Tests:

Management
• Using a standardized course of treatment usually including 4 antibacterial
medicines.
• Using different antibiotics or second-line treatment for drug-resistant TB.
• Using case management interventions and directly observed therapy for all forms
of TB disease.
• Treating latent TB infections for three or four months and active TB disease for
four, six or nine months.
• Monitoring the patient's progress and side effects regularly.

THE DIGESTIVE SYSTEM

Human digestive system, system used in the human body for the process of digestion. The
human digestive system consists primarily of the digestive tract, or the series of structures
and organs through which food and liquids pass during their processing into forms that can
be absorbed into the bloodstream. The system also consists of the structures through which
wastes pass in the process of elimination and of organs that contribute juices necessary for
the digestive process.

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Functions
1. Ingestion:
o The process of taking in food through the mouth.
o Chewing (mastication) breaks down food into smaller particles, making it
easier to swallow.
2. Secretion:
o Various glands in the digestive system secrete substances that aid in
digestion.
o Salivary glands produce saliva, which contains enzymes (like amylase) to start
breaking down carbohydrates in the mouth.
o The stomach secretes gastric juices (including hydrochloric acid and pepsin)
to further break down food.
3. Digestion:
o Mechanical digestion: Physical breakdown of food by chewing and stomach
contractions.
o Chemical digestion: Enzymes break down complex molecules into simpler
forms.
o Stomach: Acid and enzymes break down proteins.
o Small intestine: Enzymes from the pancreas and small intestine digest
carbohydrates, proteins, and fats.
4. Absorption:
o Nutrient absorption occurs primarily in the small intestine.
o Nutrients (glucose, amino acids, fatty acids, vitamins, and minerals) are
absorbed into the bloodstream.
5. Motility:
o Coordinated muscle contractions move food along the digestive tract.
o Peristalsis: Waves of contractions push food forward.
o Segmentation: Mixing movements in the small intestine aid in nutrient
absorption.

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 6. Storage and Elimination:
o The stomach stores food temporarily.
o The large intestine absorbs water and electrolytes from undigested food,
forming feces (stool).
o Feces are eliminated through the anus during defecation.

Organs
1. Mouth:
2. Esophagus:
3. Stomach:
4. Small Intestine:
5. Large Intestine (Colon):
6. Rectum:
7. Anus:

Disorder of the system

Constipation
Constipation is a problem with passing stool. Constipation generally means passing fewer
than three stools a week or having a difficult time passing stool.

Symptoms
Symptoms of constipation include:
• Fewer than three stools a week.
• Hard, dry or lumpy stools.
• Straining or pain when passing stools.
• A feeling that not all stool has passed.
• A feeling that the rectum is blocked.
• The need to use a finger to pass stool.

Causes
Lifestyle causes
• Slow stool movement may happen when a person does not:
• Drink enough fluids.
• Eat enough dietary fiber.
• Exercise regularly.
• Use the toilet when there's an urge to pass stool.
Medicines
• Pain.
• High blood pressure.
• Seizures.
• Depression.
• Disorders of the nervous system.
• Allergies.

pathophysiology of constipation
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Constipation occurs when stool moves too slowly through the large intestine, also called the colon.
This delay may be due to drugs, organic conditions, or a disorder of defecatory function (i.e., pelvic
floor dysfunction), or a disorder that results from diet. If the stool moves slowly, the body absorbs
too much water from the stool, making it hard in consistency and difficult to push out of your body.

Nursing management of constipation includes:

• Relieving the symptoms through nonpharmacological approaches such as dietary

changes, lifestyle changes, and physical activity.
• Restoring normal bowel habits.
• Improving the patient’s quality of life.
• Encouraging fluid intake.
• Increasing fiber intake.
• Determining causative and contributing factors.
• Assessing the usual defecation pattern.

The pharmacological treatment for constipation depends on the severity and underlying
cause. Here are some common options:

1. Fiber Supplements: These include products like Citrucel, FiberCon, and

Metamucil. They work by adding bulk to the stool, making it easier to pass.
2. Osmotic Agents: Examples include Milk of Magnesia and Miralax. These agents
help retain water in the stool, softening it and promoting bowel movements.
3. Stool Softeners: Colace and Docusate are examples of stool softeners. They
make the stool softer and more comfortable to pass.
4. Lubricants: Mineral oil (often sold as Fleet) acts as a lubricant, making it easier
for stool to move through the colon.
5. Stimulants: Correctol and Dulcolax are stimulant laxatives. They stimulate the
muscles in the intestines, promoting bowel movements. However, it’s essential
to use stimulants cautiously and under medical supervision.

Acid Reflux and GERD (Gastroesophageal Reflux Disease)

Acid Reflux:

o Acid reflux, also known as gastroesophageal reflux (GER), occurs when

stomach acid flows back into the tube connecting your throat to your
stomach, called the esophagus.
o Symptoms of acid reflux include:
▪ Heartburn: A burning sensation in your chest, usually after eating,
which might be worse at night or while lying down.
▪ Regurgitation: Backwash of food or sour liquid.
▪ Upper abdominal or chest pain.
▪ Trouble swallowing (dysphagia).
▪ Sensation of a lump in your throat.

23
 o People often experience acid reflux occasionally, but when it happens
repeatedly over time, it can lead to GERD.

GERD (Gastroesophageal Reflux Disease):

o GERD is a more severe form of acid reflux.

o In GERD, the stomach contents flowing back up into the esophagus become
problematic.
o Additional symptoms may include:
▪ Chronic cough.
▪ Inflammation of the vocal cords (laryngitis).
▪ New or worsening asthma.
o Chronic inflammation in the esophagus due to GERD can lead to
complications such as esophagitis, where stomach acid causes injury,
erosions, or ulcers in the esophageal lining.

Causes and Risk Factors:

o GERD is caused by frequent acid reflux or reflux of nonacidic content from the
stomach.
o When you swallow, a circular band of muscle called the lower esophageal
sphincter (LES) relaxes to allow food and liquid into your stomach. If the LES
doesn’t relax properly or weakens, stomach acid can flow back into the
esophagus.
o Risk factors for GERD include:
▪ Obesity.
▪ Hiatal hernia: Bulging of the top of the stomach above the diaphragm.
▪ Pregnancy.
▪ Connective tissue disorders, such as scleroderma.
▪ Delayed stomach emptying.
▪ Aggravating factors like smoking, large meals, late-night eating,
certain foods (fatty or fried), certain beverages (alcohol or coffee), and
specific medications (such as aspirin).

Treatment Options:

o Lifestyle changes and medications can help manage GERD.

o Medications:
▪ Antacids (e.g., Omeprazole, Aluminium hydroxide/Magnesium
hydroxide/Simethicone) neutralize stomach acids for quick relief.
▪ H-2 receptor blockers (e.g., Cimetidine, Famotidine) provide longer
relief by decreasing acid production.
o Procedures:
▪ Linx surgery: A ring of tiny beads is wrapped around the LES to
prevent reflux while allowing food to pass.
▪ Nissen fundoplication: The upper part of the stomach wraps around
the LES to prevent reflux.

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 Dietary Considerations:

o Foods to eat:
▪ Vegetables, ginger, oatmeal, noncitrus fruits, lean meats, and egg
whites.
o Foods to avoid:
▪ High-fat foods, tomatoes, citrus fruits, chocolates, garlic, onions, spicy
foods, caffeine, and mint.

Pathophysiology of Gastroesophageal Reflux Disease

Gastroesophageal reflux disease pathophysiology is multifactorial and linked to a misbalance
between the aggressiveness of the refluxate into the esophagus or adjacent organs and the
failure of protective mechanisms associate or not to a defective valvular mechanism at the
level of the esophagogastric junction incapable of dealing with a transdiaphragmatic
pressure gradient. Antireflux mechanisms include the lower esophageal sphincter and
abdominal esophagus, the diaphragm, the angle of His, the Gubaroff valve, and the
phrenoesophageal membrane.

Diagnosis

Upper endoscopy
Your health care provider might be able to diagnose GERD based on a history of your signs
and symptoms and a physical examination.To confirm a diagnosis of GERD, or to check for
complications, your doctor might recommend:

• Upper endoscopy. Your doctor inserts a thin, flexible tube equipped with a
light and camera (endoscope) down your throat. The endoscope helps your
provider see inside your esophagus and stomach. Test results may not show
problems when reflux is present, but an endoscopy may detect inflammation of
the esophagus (esophagitis) or other complications.
• Ambulatory acid (pH) probe test. A monitor is placed in your esophagus to
identify when, and for how long, stomach acid regurgitates there. The monitor
connects to a small computer that you wear around your waist or with a strap
over your shoulder.

25
 The monitor might be a thin, flexible tube (catheter) that's threaded through
your nose into your esophagus. Or it might be a clip that's placed in your
esophagus during an endoscopy. The clip passes into your stool after about two
days.
• X-ray of the upper digestive system. X-rays are taken after you drink a chalky
liquid that coats and fills the inside lining of your digestive tract. The coating
allows your doctor to see a silhouette of your esophagus and stomach. This is
particularly useful for people who are having trouble swallowing.
You may also be asked to swallow a barium pill that can help diagnose a
narrowing of the esophagus that may interfere with swallowing.

• Esophageal manometry. This test measures the rhythmic muscle contractions

in your esophagus when you swallow. Esophageal manometry also measures
the coordination and force exerted by the muscles of your esophagus. This is
typically done in people who have trouble swallowing.
• Transnasal esophagoscopy. This test is done to look for any damage in your
esophagus. A thin, flexible tube with a video camera is put through your nose
and moved down your throat into the esophagus. The camera sends pictures to
a video screen.

nursing management strategies for gastroesophageal reflux disease (GERD).

As a nurse, your role is crucial in supporting patients with GERD and promoting their well-
being. Here are some essential nursing interventions:
1. Assessment:
o Regularly assess the patient’s pain level, noting its location and characteristics. Pain
associated with GERD can vary, and understanding its specifics helps tailor care.
o Evaluate other symptoms such as heartburn, regurgitation, and difficulty
swallowing.
2. Medication Administration:
o Administer prescribed medications to manage GERD symptoms:
▪ Antacids: These help neutralize stomach acid and provide quick relief.
▪ Proton pump inhibitors (PPIs): Reduce gastric acidity by inhibiting acid
production.
▪ H2 receptor antagonists: Also decrease acid production and alleviate pain1.
3. Positioning:
o Encourage the patient to adopt an upright position or elevate the head of the
bed during sleep.
o This positioning helps reduce reflux and minimizes discomfort1.
4. Patient Education:
o Educate the patient about lifestyle modifications:
▪ Dietary changes: Avoid trigger foods (e.g., fatty or spicy foods, citrus,
chocolate, caffeine).
▪ Weight management: Excess weight can worsen GERD.
▪ Smoking cessation: Smoking weakens the lower esophageal sphincter (LES).
▪ Meal timing: Avoid large meals close to bedtime.
o Stress the importance of adhering to prescribed medications and follow-up
appointments.

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 5. Monitoring and Follow-Up:
o Monitor the patient’s response to treatment.
o Assess for any adverse effects related to medications.
o Schedule regular follow-up visits to evaluate progress and adjust the care plan as
needed.

pharmacological management of gastroesophageal reflux disease (GERD).

1. Nonprescription Medications:

o Antacids: These medications neutralize stomach acid and provide quick relief.
Common antacids include:
▪ Calcium carbonate (found in products like Mylanta, Rolaids, and Tums).
▪ Antacids work by counteracting the acidity in the stomach, alleviating symptoms such
as heartburn and acid reflux.
o Lifestyle changes are also essential in managing GERD:
▪ Maintain a healthy weight: Excess weight can put pressure on your abdomen, leading
to acid reflux.
▪ Stop smoking: Smoking weakens the lower esophageal sphincter (LES), allowing acid to
flow back into the esophagus.
▪ Elevate the head of your bed: This position helps prevent reflux during sleep1.
2. Prescription Medications:
▪ Proton Pump Inhibitors (PPIs): These drugs suppress gastric acid production by
inhibiting the proton pump in the stomach lining. Examples include omeprazole
(Prilosec), esomeprazole (Nexium), and lansoprazole (Prevacid).
▪ H2 Receptor Blockers: These medications decrease acid production and provide longer
relief.
3. Surgical Options:
o Surgery may be considered if symptoms persist or complications arise:
▪ Linx Surgery: Surgeons wrap a ring of tiny beads around the lower esophageal
sphincter (LES). This strengthens the LES, preventing reflux while allowing food to pass
through.
▪ Nissen Fundoplication: In this procedure, the upper part of the stomach is wrapped
around the LES to prevent reflux

Gastroenteritis (Stomach Flu)

Viral gastroenteritis is an infection of your intestines that typically causes watery diarrhea,
pain or cramping in your abdomen, nausea or vomiting, and sometimes fever. People
commonly call viral gastroenteritis “stomach flu,” but the term is not medically correct. Flu
viruses do not cause viral gastroenteritis.

1. Symptoms:
o Watery, nonbloody diarrhea: This is a common symptom.
o Nausea and vomiting.
o Stomach cramps and pain.
o Occasional muscle aches or headache.
o Low-grade fever.
o Symptoms can range from mild to severe and usually last for a day or two, but
occasionally they may persist for up to 14 days1.
2. Causes:

27
 o Viral gastroenteritis is caused by various viruses, not by influenza (flu) viruses.
o The most common ways to contract it are through contact with an infected
person or by consuming contaminated food or water.
o While healthy individuals typically recover without complications, infants, older
adults, and those with compromised immune systems are at higher risk1.

Nursing management for Gastroenteritis

• Assessment Signs and symptoms Gastroenteritis, also commonly known as the
stomach flu, is an inflammation of the gastrointestinal tract. ...
• Diagnosis Medical history ...
• Treatment Fluid and electrolyte replacement ...
• Prevention Hand hygiene ...
• Patient Education Disease transmission ...
• Infection Control Isolation precautions ...
• Complications Dehydration ...
• Nutrition Dietary considerations ...

Diagnosis
Your doctor will likely diagnose viral gastroenteritis (stomach flu) based on symptoms, a
physical exam and sometimes on the presence of similar cases in your community. A rapid
stool test can detect rotavirus or norovirus, but there are no quick tests for other viruses
that cause gastroenteritis. In some cases, your doctor may have you submit a stool sample
to rule out a possible bacterial or parasitic infection.

Medical Treatment:
No Specific Medication: Viral gastroenteritis doesn’t respond to antibiotics because it’s
caused by viruses.
Stool Tests: In some cases, your doctor may request a stool sample to rule out bacterial or
parasitic infections.
Rotavirus Vaccine: Vaccination is recommended for infants to prevent rotavirus infections.

Urinary system
The urinary system is a body system that produces, stores and eliminates urine, the fluid
waste excreted by the kidneys. The urinary system consists of the kidneys, ureters, bladder,
and urethra. The kidneys filter the blood, removing waste and excess water, and regulate
blood volume, pressure, pH, and electrolytes. The urine travels from the kidneys through the
ureters to the bladder, and then exits the body through the urethra. The urinary system can
be affected by infections, stones, and other disorders

28
The main organs of the urinary system
1. Kidneys: These remarkable organs serve as blood filters. They extract waste
products, excess water, and electrolytes from the bloodstream, producing
urine. We have two kidneys, located on either side of the back, just below the
rib cage.
2. Ureters: These are ducts connecting the kidneys to the bladder. They
transport urine from the kidneys to the bladder.
3. Bladder: The bladder acts as a storage sac for urine. It expands as it fills up
and contracts during urination.
4. Urethra: This tube connects the bladder to the external body. It allows urine to
exit the body when we use the toilet.

DISORDERS OF THE SYSTEM

Diabetic Nephropathy: Diabetic nephropathy is damage to your kidneys caused by
diabetes. In severe cases it can lead to kidney failure. But not everyone with diabetes has
kidney damage.

Symptoms
You may have symptoms if your nephropathy gets worse. These symptoms include:
• Swelling (edema), first in the feet and legs and later throughout your body.
• Poor appetite.
• Weight loss.
• Weakness.
• Feeling tired or worn out.
• Nausea or vomiting.
• Trouble sleeping.

Causes
In people with diabetes, the nephrons slowly thicken and become scarred over time.
The nephrons begin to leak and protein (albumin) passes into the urine. This damage
can happen years before any symptoms begin.
Kidney damage is more likely if you:
• Have uncontrolled blood sugar
• Have high blood pressure
• Have type 1 diabetes that began before you were 20 years old
• Have family members who also have diabetes and kidney problems
• Smoke

Nursing Management
• Monitor blood pressure
• Educate patients on the disease
• Check urine for protein
• Check labs for BUN and creatinine
• Ensure patient eats a low protein diet
• Urge the patient not to smoke or use drugs that affect the kidney (NSAIDs)

29
 • Teach patient how to monitor blood glucose at home
• Encourage ambulation and exercise
• Teach patient about medication compliance
• Teach patient about options for dialysis
• Measure intake and output
• Check for edema
• Listen to the lung for rales and crackles

Kidney stones
Kidney stones, or renal calculi, are solid masses made of crystals. They can develop
anywhere along your urinary tract, which consists of the kidneys, ureters, bladder, and
urethra.

Causes of kidney stones

Kidney stones are most likely to occur in people between the ages of 20 and 50.
• dehydration
• obesity
• a diet with high levels of protein, salt, or glucose
• hyperparathyroid condition
• gastric bypass surgery
• inflammatory bowel diseases that increase calcium absorption
• taking medications such as triamterene diuretics, antiseizure drugs, and
calcium-based antacids
Symptoms and signs of a kidney stone
Kidney stones can cause severe pain. Symptoms of kidney stones may not occur
until the stone begins to move down the ureters.
• vomiting
• nausea
• discolored or foul-smelling urine
• chills

30
 • fever
• frequent need to urinate
• urinating small amounts of urine

kidney stones pathophysiology

Kidney stones are formed from substances in your urine that become too concentrated and
crystalize. These crystals can attach to each other and grow into larger stones23. The
crystals may adhere to the urothelium, the lining of the urinary tract, but the exact
mechanism is unclear.

Nursing management for kidney stones includes:

• Pain relief
• Preventing complications
• Maintaining adequate renal function
• Providing information about disease process/prognosis and treatment needs
• Implementing comfort measures (back rub, restful environment)
• Encouraging use of focused breathing, guided imagery, and diversional activities
• Assisting with frequent ambulation as indicated and increased fluid intake of at
least 3–4 L a day within cardiac tolerance
Diagnosis
Blood testing. Blood tests may reveal too much calcium or uric acid in your blood. Blood test
results help monitor the health of your kidneys and may lead your doctor to check for other
medical conditions.
Urine testing. The 24-hour urine collection test may show that you're excreting too many
stone-forming minerals or too few stone-preventing substances. For this test, your doctor
may request that you perform two urine collections over two consecutive days.
Imaging. Imaging tests may show kidney stones in your urinary tract. High-speed or dual
energy computerized tomography (CT) may reveal even tiny stones. Simple abdominal X-rays
are used less frequently because this kind of imaging test can miss small kidney stones.
Ultrasound, a noninvasive test that is quick and easy to perform, is another imaging option
to diagnose kidney stones.
Analysis of passed stones. You may be asked to urinate through a strainer to catch stones
that you pass. Lab analysis will reveal the makeup of your kidney stones. Your doctor uses
this information to determine what's causing your kidney stones and to form a plan to
prevent more kidney stones.

31
KIDNEY FAILURE
Acute kidney failure occurs when your kidneys suddenly become unable to filter waste
products from your blood. When your kidneys lose their filtering ability, dangerous levels of
wastes may accumulate, and your blood's chemical makeup may get out of balance.

Symptoms
Signs and symptoms of acute kidney failure may include:
• Decreased urine output, although occasionally urine output remains normal
• Fluid retention, causing swelling in your legs, ankles or feet
• Shortness of breath
• Fatigue
• Confusion
• Nausea
• Weakness
• Irregular heartbeat
• Chest pain or pressure
• Seizures or coma in severe cases

Causes
Acute kidney failure can occur when:
• You have a condition that slows blood flow to your kidneys
• You experience direct damage to your kidneys
• Your kidneys' urine drainage tubes (ureters) become blocked and wastes can't
leave your body through your urine

kidney failure pathophysiology

Kidney failure, also known as end-stage renal disease, occurs when the kidneys lose their
filtering abilities and dangerous levels of fluid, electrolytes, and wastes build up in the
body. Acute kidney failure, which develops rapidly, occurs when the kidneys suddenly
become unable to filter waste products from the blood

Nursing management of kidney failure includes:

• Promoting renal function

• Correcting or eliminating any reversible causes of kidney failure
• Providing supportive care
• Monitoring and managing fluid and electrolyte imbalances
• Optimizing nutrition
• Ensuring medication safety
• Maintaining ideal body weight without excess fluid
• Maintaining adequate nutritional intake

32
Diagnosis
• Urine output measurements. Measuring how much you urinate in 24 hours
may help your doctor determine the cause of your kidney failure.
• Urine tests. Analyzing a sample of your urine (urinalysis) may reveal
abnormalities that suggest kidney failure.
• Blood tests. A sample of your blood may reveal rapidly rising levels of urea and
creatinine — two substances used to measure kidney function.
• Imaging tests. Imaging tests such as ultrasound and computerized tomography
may be used to help your doctor see your kidneys.
• Removing a sample of kidney tissue for testing. In some situations, your
doctor may recommend a kidney biopsy to remove a small sample of kidney
tissue for lab testing. Your doctor inserts a needle through your skin and into
your kidney to remove the sample.

Urinary tract infections

A urinary tract infection (UTI) is an infection in any part of the urinary system. The urinary
system includes the kidneys, ureters, bladder and urethra. Most infections involve the lower
urinary tract — the bladder and the urethra.

Symptoms
UTIs don't always cause symptoms. When they do, they may include:
• A strong urge to urinate that doesn't go away
• A burning feeling when urinating
• Urinating often, and passing small amounts of urine
• Urine that looks cloudy
• Urine that appears red, bright pink or cola-colored — signs of blood in the
urine
• Strong-smelling urine
• Pelvic pain, in women — especially in the center of the pelvis and around the
area of the pubic bone
Types of urinary tract infections

Each type of UTI may result in more-specific symptoms. The symptoms depend on
which part of the urinary tract is affected.

33
 Part of urinary tract affected Signs and symptoms

Kidneys • Back or side pain

• High fever
• Shaking and chills
• Nausea
• Vomiting

Bladder • Pelvic pressure

• Lower belly discomfort
• Frequent, painful urination
• Blood in urine

Urethra • Burning with urination

• Discharge

Causes
• A previous uti
• Sexual activity
• Pregnancy
• Menopause
• Chronic health conditions
• Personal hygiene
Diagnostic Findings
Results of various tests help confirm the diagnosis of UTI.
Urine cultures. Urine cultures are useful in identifying the organism present and are
the definitive diagnostic test for UTI.
STD tests. Tests for STDs may be performed because there are UTIs transmitted
sexually.
CT scan. A CT scan may detect pyelonephritis or abscesses.
Ultrasonography. Ultrasound is extremely sensitive for detecting obstruction,
abscesses, tumors, and cysts.

Nursing Management
Nursing care of the patient with UTI focuses on treating the underlying
infection and preventing its recurrence.

• A history of signs and symptoms related to UTI is obtained from the

34
 patient with a suspected UTI.
• Assess changes in urinary pattern such as frequency, urgency, or
hesitancy.
• Assess the patient’s knowledge about antimicrobials and preventive
health care measures.
• Assess the characteristics of the patient’s urine such as the color,
concentration, odor, volume, and cloudiness.

Enlarged Prostate (BPH):

Benign prostatic hyperplasia (BPH)
Definition: BPH refers to the non-cancerous enlargement of the prostate gland. As the prostate
grows, it can press against the urethra and the bladder, leading to urinary symptoms.

Symptoms: The symptoms of BPH include:

• Frequent urination
• Nocturia (increased frequency of urination at night)
• Difficulty starting urination or straining while urinating
• Weak or continuous urine stream
• Dribbling at the end of urination
• Inability to empty the bladder completely
• Blood in urine
• Urinary incontinence
• Urinary retention
Causes: The exact cause of BPH is unknown, but hormonal changes in older men may play a role in
prostate enlargement. Other risk factors include age (men over 60), family history, diabetes,
obesity, and heart problems.

Diagnosis: Diagnosis involves a medical history, physical examination, and various tests, including
rectal examination, urine tests, antigen tests, and imaging (ultrasound, intravenous pyelogram,
etc.).

Pathophysiology:
This condition exists primarily in aging men. Because of this, it is thought that BPH is a result
of altered hormone levels associated with the normal aging process. The altered levels and
balance of androgens such as testosterone, estrogens, and gonadotropins are most likely
the primary causative factor in BPH. Changes in autocrine and paracrine growth factors,
such as insulin-like growth factor, epidermal growth factor, nerve growth factor, fibroblast
factor, IGF binding proteins, and transforming growth factor-beta also seem to contribute to
the disorder. Additionally, testosterone is converted to estrogen, which targets the prostate.
35
Nursing care management for patients with benign prostatic hyperplasia includes:

• Promoting pain relief

• Relieving urinary retention
• Preventing and managing complications such as urinary tract infections
• Monitoring for urinary retention and renal dysfunction
• Preparing and supporting the patient through surgical interventions if
required
• Maintaining urinary drainage
• Maintaining urethral catheter patency
• Avoiding over-distention of bladder (may lead to haemorrhage)

Diagnosis of BPH:
Medical History: Your healthcare provider will start by asking about your
symptoms and overall health.

Physical Examination:
Digital Rectal Exam (DRE): The provider inserts a gloved finger into your rectum to
check the size and consistency of your prostate. Enlargement or irregularities may
indicate BPH.
Urine Test: A lab analyzes a urine sample to rule out infections or other conditions
that can cause similar symptoms to BPH.

Additional Tests:
Prostate-Specific Antigen (PSA) Test: Measures PSA levels in the blood. Elevated
PSA levels may suggest BPH or other prostate conditions.
Urinary Flow Test: Measures the strength and amount of urine flow. Reduced flow
may indicate BPH.
Postvoid Residual Volume Test: Assesses how much urine remains in the bladder
after urination. High residual volume may indicate BPH.
Ultrasound: Determines the size and condition of the prostate.
Cystoscopy: A thin tube with a camera is inserted through the urethra to examine
the bladder and prostate.
Intravenous Pyelogram (IVP): An X-ray to check for abnormalities in the urinary
system.
Neurological Tests: Assess nerve function related to urinary symptoms.
Biopsy (if needed): Removes a tissue sample from the prostate to rule out cancer.

END

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