CCRN

CCRN Ischemic Stroke Overview

A stroke occurs when the blood supply to part of your brain is interrupted or reduced, preventing brain tissue from getting oxygen and nutrients. Brain cells begin to die in minutes. A stroke is a medical emergency, and prompt treatment is crucial. Early action can reduce brain damage and other complications.

Signs and Symptoms

• Trouble speaking and understanding what others are saying
• Paralysis or numbness of the face, arm or leg
• Problems seeing in one or both eyes
• Headache
• Trouble walking

Causes

There are two main causes of stroke: a blocked artery (ischemic stroke) or leaking or bursting of a blood vessel (hemorrhagic stroke). Some people may have only a temporary disruption of blood flow to the brain, known as a transient ischemic attack (TIA), that doesn't cause lasting symptoms.

Risk Factors

• Being overweight or obese
• Physical inactivity
• Heavy or binge drinking
• Use of illegal drugs such as cocaine and methamphetamine
• High blood pressure
• Cigarette smoking or secondhand smoke exposure
• High cholesterol
• Diabetes
• Obstructive sleep apnea
• Cardiovascular disease, including heart failure, heart defects, heart infection or abnormal heart rhythm, such as atrial fibrillation
• Personal or family history of stroke, heart attack or transient ischemic attack

Treatment

• Emergency IV medication - Activase
• Emergency endovascular procedures

 

CCRN GI Bleed Overview

Gastrointestinal (GI) bleeding is a symptom of a disorder in your digestive tract. The blood often appears in stool or vomit but isn't always visible, though it may cause the stool to look black or tarry. The level of bleeding can range from mild to severe and can be life-threatening.

Signs and Symptoms

• Vomiting blood, which might be red or might be dark brown and resemble coffee grounds in texture
• Black, tarry stool
• Rectal bleeding, usually in or with stool
• Lightheadedness
• Difficulty breathing
• Fainting
• Chest pain
• Abdominal pain

Causes

• Upper GI Bleed
  • Peptic Ulcers
  • Esophagitis
  • Varices
• Lower GI Bleed
  • Diverticular Disease
  • Tumors, Polyps
  • Inflammatory Bowel Disease
  • Hemorrhoids, Anal Fissures

Complications 

• Shock, Anemia, Death

Prevention

• Limit your intake of NSAIDS, Alcohol, Smoking

Treatment

• Endoscopy, Colonoscopy
• Proton Pump Inhibitors
• IV Fluids

 

CCRN Esophagogastrectomy Overview

Esophagectomy is a surgical procedure to remove some or all of the swallowing tube between your mouth and stomach (esophagus) and then reconstruct it using part of another organ, usually the stomach. Esophagectomy is a common treatment for advanced esophageal cancer and is used occasionally for Barrett's esophagus if aggressive precancerous cells are present. An esophagectomy may also be recommended for noncancerous conditions when prior attempts to save the esophagus have failed, such as with end-stage achalasia or strictures, or after ingestion of material that damages the lining of the esophagus.

Why It's Performed

Esophagectomy is the main surgical treatment for esophageal cancer. It is done either to remove the cancer or to relieve symptoms. During an open esophagectomy, the surgeon removes all or part of the esophagus through an incision in the neck, chest or abdomen. The esophagus is replaced using another organ, most commonly the stomach but occasionally the small or large intestine. In most circumstances, esophagectomy can be done with minimally invasive surgery, either by laparoscopy, robot assisted or a combination of these approaches. When the individual situation is appropriate, these procedures are done through several small incisions and can result in reduced pain and faster recovery than conventional surgery.

Risks

• Bleeding
• Infection
• Cough
• Leakage from the surgical connection of the esophagus and stomach
• Changes in your voice
• Acid or bile reflux
• Nausea, vomiting or diarrhea
• Respiratory complications, such as pneumonia
• Swallowing difficulties (dysphagia)
• Atrial fibrillation
• Death

Follow Up Care

• Lung therapy (pulmonary rehabilitation) to prevent breathing problems
• Pain management to treat heartburn and problems with swallowing
• Nutritional assessments to help with weight loss
• Psychosocial care if needed

 

CCRN Hemothorax Overview

Hemothorax is a collection of blood in the space between the chest wall and the lung (the pleural cavity).

Signs and Symptoms

• Anxiety
• Chest pain
• Low blood pressure (shock)
• Pale, cool and clammy skin
• Rapid heart rate
• Rapid, shallow breathing
• Restlessness
• Shortness of breath

Causes

The most common cause of hemothorax is chest trauma. Hemothorax can also occur in people who have:

• Blood clotting defect
• Chest (thoracic) or heart surgery
• Death of lung tissue (pulmonary infarction)
• Lung or pleural cancer -- primary or secondary (metastatic, or from another site)
• Tear in a blood vessel when placing a central venous catheter or when associated with severe high blood pressure
• Tuberculosis

Treatments

The goal of treatment is to get the person stable, stop the bleeding, and remove the blood and air in the pleural space.

• A chest tube is inserted through the chest wall between the ribs to drain the blood and air.
• It is left in place and attached to suction for several days to re-expand the lung.

If a chest tube alone does not control the bleeding, surgery (thoracotomy) may be needed to stop the bleeding. The cause of the hemothorax will be also treated. The underlying lung may have collapsed. This can lead to breathing difficulty. In people who have had an injury, chest tube drainage may be all that is needed. Surgery may not be necessary.  

CCRN COPD Overview

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. People with COPD are at increased risk of developing heart disease, lung cancer and a variety of other conditions. Emphysema and chronic bronchitis are the two most common conditions that contribute to COPD. These two conditions usually occur together and can vary in severity among individuals with COPD. Chronic bronchitis is inflammation of the lining of the bronchial tubes, which carry air to and from the air sacs (alveoli) of the lungs. It's characterized by daily cough and mucus (sputum) production. Emphysema is a condition in which the alveoli at the end of the smallest air passages (bronchioles) of the lungs are destroyed as a result of damaging exposure to cigarette smoke and other irritating gases and particulate matter. Although COPD is a progressive disease that gets worse over time, COPD is treatable. With proper management, most people with COPD can achieve good symptom control and quality of life, as well as reduced risk of other associated conditions.

Signs and Symptoms

• Shortness of breath, especially during physical activities
• Wheezing
• Chest tightness
• A chronic cough that may produce mucus (sputum) that may be clear, white, yellow or greenish
• Frequent respiratory infections
• Lack of energy
• Unintended weight loss (in later stages)
• Swelling in ankles, feet or legs

Causes

The main cause of COPD in developed countries is tobacco smoking. In the developing world, COPD often occurs in people exposed to fumes from burning fuel for cooking and heating in poorly ventilated homes. Only some chronic smokers develop clinically apparent COPD, although many smokers with long smoking histories may develop reduced lung function. Some smokers develop less common lung conditions. They may be misdiagnosed as having COPD until a more thorough evaluation is performed.

Risk Factors

• Exposure to tobacco smoke
• People with asthma
• Occupational exposure to dusts and chemicals
• Exposure to fumes from burning fuel
• Genetics

Complications

• Respiratory infections
• Heart problems
• Lung cancer
• High blood pressure in lung arteries
• Depression 

Treatments

• Quit smoking
• Medications
• Lung therapies
• in-home noninvasive home therapy

 

CCRN Lobectomy Overview

A lobectomy is a surgical procedure where an entire lobe of your lung is removed for a variety of reasons that may include a lung cancer diagnosis, infection, COPD or benign tumors. There are three lobes of your right lung and two lobes of your left lung. The procedure includes either a few small incisions (minimally invasive) or one longer incision (thoracotomy) on the side of your chest based on your particular diagnosis. With either approach, along with a lobe, nearby lymph nodes are also removed because of the possible spread of disease or cancer.

Patient Population

A lobectomy may be done when a problem is found in 1 lobe. A lobe may be removed so that disease isn't spread to the other lobes. This may be the case with tuberculosis or certain types of lung cancer. Chest and lung health conditions that may be treated with lobectomy include:

• Tuberculosis (TB)
• Lung abscess
• Emphysema
• Benign tumor
• Lung cancer
• Fungal infection

Risks

As with any procedure, there is a risk of bleeding or infection. You will be given antibiotics around the time of surgery to help prevent infection, and the risk of bleeding is minimal with this procedure. There is a small risk that you will need a drainage tube in for a prolonged period of time due to a leak in your lung. This usually heals on its own and will not require further procedures. As with any major surgery, there are also risks related to general anesthesia, such as a heart attack, stroke, blood clots or pneumonia.

Treatment

The procedure almost always needs an inpatient stay. This means that it may be done as part of a longer stay in the hospital. The way the procedure is done may vary. It depends on your condition and your healthcare provider's methods. In most cases, the procedure will follow this process:

• You will be asked to remove your clothes. You will be given a hospital gown to wear. You may be asked to remove jewelry or other objects.
• You will lie down on an operating table.
• An IV (intravenous) line will be put into your arm or hand.
• You may be given antibiotics before and after the procedure.
• You will be given general anesthesia. This is medicine that prevents pain and lets you sleep through the procedure.
• A breathing tube will be put into your throat and hooked up to a breathing machine (ventilator). Your heart rate, blood pressure, and breathing will be watched during the procedure.
• A soft, flexible tube (catheter) may be put into your bladder. This is to drain urine during the procedure.
• Hair in the area of surgery may be trimmed. The skin in the area will be cleaned with an antiseptic solution.
• A cut (incision) will be made on the front of your chest at the level of the lobe to be removed. The cut will go under your arm around to your back.
• When the ribs can be seen, a special tool will be used to spread them apart. The lung lobe will be removed.
• One or more tubes may be put into your chest. These are to help remove air and fluid after surgery.
• The cut will be closed with stitches (sutures) or staples. A bandage or dressing will be put on the area.
• A thin tube (epidural catheter) may be put in the area of the lower spine. This is done to send pain medicine into your back. It may be done in the operating room or in the recovery room.

 

CCRN Pneumonia Overview

Pneumonia is an infection that inflames the air sacs in one or both lungs. The air sacs may fill with fluid or pus (purulent material), causing cough with phlegm or pus, fever, chills, and difficulty breathing. A variety of organisms, including bacteria, viruses and fungi, can cause pneumonia. Pneumonia can range in seriousness from mild to life-threatening. It is most serious for infants and young children, people older than age 65, and people with health problems or weakened immune systems.

Signs and Symptoms

• Chest pain when you breathe or cough
• Confusion or changes in mental awareness (in adults age 65 and older)
• Cough, which may produce phlegm
• Fatigue
• Fever, sweating and shaking chills
• Lower than normal body temperature (in adults older than age 65 and people with weak immune systems)
• Nausea, vomiting or diarrhea
• Shortness of breath

Causes

Many germs can cause pneumonia. The most common are bacteria and viruses in the air we breathe. Your body usually prevents these germs from infecting your lungs. But sometimes these germs can overpower your immune system, even if your health is generally good. Pneumonia is classified according to the types of germs that cause it and where you got the infection.

Complications

• Bacteria in the bloodstream (bacteremia)
• Difficulty breathing
• Fluid accumulation around the lungs (pleural effusion)
• Lung abscess 

Treatment

Treatment for pneumonia involves curing the infection and preventing complications. People who have community-acquired pneumonia usually can be treated at home with medication. Although most symptoms ease in a few days or weeks, the feeling of tiredness can persist for a month or more.

• Antibiotics
• Cough Medicines
• Antipyretics 

 

CCRN Intracerebral Hemorrhage Overview

Intracerebral hemorrhage (ICH) is caused by bleeding within the brain tissue itself — a life-threatening type of stroke. A stroke occurs when the brain is deprived of oxygen and blood supply. ICH is most commonly caused by hypertension, arteriovenous malformations, or head trauma. Treatment focuses on stopping the bleeding, removing the blood clot (hematoma), and relieving the pressure on the brain. An ICH can occur close to the surface or in deep areas of the brain. Sometimes deep hemorrhages can expand into the ventricles – the fluid filled spaces in the center of the brain. Blockage of the normal cerebrospinal (CSF) circulation can enlarge the ventricles (hydrocephalus) causing confusion, lethargy, and loss of consciousness.

Signs and Symptoms

• headache, nausea, and vomiting
• lethargy or confusion
• sudden weakness or numbness of the face, arm or leg, usually on one side
• loss of consciousness
• temporary loss of vision
• seizures

Causes

• Hypertension: elevated blood pressure may cause tiny arteries to burst inside the brain. Normal pressure is 120/80 mm Hg.
• Blood thinners: drugs such as coumadin, heparin, and warfarin used to prevent clots in heart and stroke conditions may cause ICH.
• AVM: a tangle of abnormal arteries and veins with no capillaries in between.
• Aneurysm: a bulge or weakening of an artery wall.
• Head trauma: fractures to the skull and penetrating wounds (gunshot) can damage an artery and cause bleeding.
• Bleeding disorders: hemophilia, sickle cell anemia, DIC, thrombocytopenia.
• Tumors: highly vascular tumors such as angiomas and metastatic tumors can bleed into the brain tissue.
• Amyloid angiopathy: a buildup of protein within the walls of arteries.
• Drug usage: alcohol, cocaine and other illicit drugs can cause ICH.
• Spontaneous: ICH by unknown causes.

Treatment

Treatment may include lifesaving measures, symptom relief, and complication prevention. Once the cause and location of the bleeding is identified, medical or surgical treatment is performed to stop the bleeding, remove the clot, and relieve the pressure on the brain. If left alone the brain will eventually absorb the clot within a couple of weeks – however the damage to the brain caused by ICP and blood toxins may be irreversible. Generally, patients with small hemorrhages (<10 cm3) and minimal deficits are treated medically. Patients with cerebellar hemorrhages (>3 cm3) who are deteriorating or who have brainstem compression and hydrocephalus are treated surgically to remove the hematoma as soon as possible. Patients with large lobar hemorrhages (50 cm3) who are deteriorating usually undergo surgical removal of the hematoma.  

CCRN Chronic Respiratory Failure Overview 

Respiratory failure can happen when your respiratory system is unable to remove enough carbon dioxide from the blood, causing it to build up in your body. The condition can also develop when your respiratory system can’t take in enough oxygen, leading to dangerously low levels of oxygen in your blood. Respiratory failure may be acute or chronic. Acute respiratory failure is a short-term condition. It occurs suddenly and is typically treated as a medical emergency. Chronic respiratory failure, however, is an ongoing condition. It gradually develops over time and requires long-term treatment. Chronic respiratory failure usually happens when the airways that carry air to your lungs become narrow and damaged. This limits air movement through the body, which means that less oxygen gets in and less carbon dioxide gets out. Chronic respiratory failure can also be classified as hypoxemic or hypercapnic respiratory failure. Low blood oxygen levels cause hypoxemic respiratory failure. High carbon dioxide levels cause hypercapnic respiratory failure.

Signs and Symptoms

Symptoms of chronic respiratory failure may not be noticeable at first. They usually occur slowly over an extended period of time. When symptoms do develop, they may include:

• difficulty breathing or shortness of breath, especially when active
• coughing up mucous
• wheezing
• bluish tint to the skin, lips, or fingernails
• rapid breathing
• fatigue
• anxiety
• confusion
• daily headache

Causes

Diseases and conditions that commonly lead to chronic respiratory failure include:

• chronic obstructive pulmonary disease (COPD)
• complicated pneumonia
• cystic fibrosis
• spinal cord injuries
• stroke
• muscular dystrophy
• ALS (Lou Gehrig’s disease)
• injury to the chest
• drug or alcohol misuse
• smoking

Treatment

Although acute respiratory failure is a medical emergency that must be treated in a hospital, chronic respiratory failure may be managed at home, depending on its cause. In severe cases, medical professionals can help you manage the condition in a long-term healthcare center. Treatment options typically include:

• treating the underlying cause of respiratory failure
• removing excess carbon dioxide from the blood
• increasing oxygen levels in the blood

 

CCRN Empyema Overview

Empyema is also called pyothorax or purulent pleuritis. It’s a condition in which pus gathers in the area between the lungs and the inner surface of the chest wall. This area is known as the pleural space. Pus is a fluid that’s filled with immune cells, dead cells, and bacteria. Pus in the pleural space can’t be coughed out. Instead, it needs to be drained by a needle or surgery. Empyema usually develops after pneumonia, which is an infection of the lung tissue.

Signs and Symptoms

• having a case of pneumonia that does not improve
• a fever
• chest pain
• a cough
• pus in mucus
• difficulty breathing
• a crackling sound from the chest
• decreased breathing sounds
• dullness when tapping chest
• fluid in the lungs (visible with a chest X-ray)

Causes

Pneumonia is the most common cause of empyema. People who have undergone thoracotomies, or chest surgeries, might also be at risk of developing empyema if bacteria get into the wound.

Risk Factors

• being older than 70
• having been in the hospital recently
• having had chest surgery or trauma
• diabetes
• heart disease
• previous cancer
• chronic obstructive pulmonary disorder (COPD)
• intravenous drug use (in simple empyema cases)

Treatment

Treatment is aimed at removing the pus and fluid from the pleura and treating the infection. Antibiotics are used to treat the underlying infection. The specific type of antibiotic depends on what type of bacteria is causing the infection. The method used to drain the pus depends on the stage of the empyema. In simple cases, a needle can be inserted into the pleural space to drain the fluid. This is called percutaneous thoracentesis. In the later stages, or complex empyema, a drainage tube must be used to drain the pus. This procedure is usually performed under anesthesia in an operating room. There are different types of surgery for this: