NUR 2063 EXAM 3/NUR2063 ESSENTIALS OF PATHOPHYSIOLOGY EXAM 3 LATEST 2023 REAL EXAM 100+ QUESTIONS AND CORRECT ANSWERS RASMUSSEN |AGRADE

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Physiology reactions during “Fight or Flight”

– increased heart rate (tachycardia)
– anxiety
– sweating
– tremor
– increased blood glucose concentrations (due to glycogenolysis, or breakdown of liver glycogen).

Define Ventilation

movement of air into and out of the lungs artificially

Causes of Edema

– increased capillary hydrostatic pressure
– loss of plasma proteins (decreased capillary oncotic pressure)
– obstruction of lymphatic circulation
– increased capillary permeability

Define sign and how it’s used in diagnosis

What can be seen or measured

Define symptom and how it’s used in diagnosis

What the patient describes that is not visible to the healthcare practitioner

Define subjective data and how it’s used in diagnosis

Information from the client’s point of view (“symptoms”), including feelings, perceptions, and concerns obtained through interviews.

Define contraindication and how it’s used in diagnosis

A specific situation in which a drug, procedure, or surgery should not be used because it may be harmful to the person (Allergy to penicillin)

Know electrolytes that are higher in intracellular fluid

Potassium (K+)
Phosphorus (PO4-)
Sulfate (SO4-)

Know clinical manifestation of appendicitis and how to identify it

– Manifestations vary significantly in severity, from asymptomatic to sudden and severe.
– Pain near the umbilicus and McBurney point.
– The pain will temporarily subside if the appendix ruptures but then will return and escalate as peritonitis develops.
– Anorexia, nausea, vomiting, abdominal distention, and bowel pattern changes can also be associated with appendicitis. Fever, chills, and leukocytosis
– Monitored for signs and symptoms of peritonitis (e.g., abdominal rigidity, tachycardia, and hypotension).
Diagnostic procedures: history, physical examination, CBC, abdominal ultrasound, abdominal X-ray, abdominal CT, and laparoscopy.

Know clinical manifestation of peptic ulcer disease and how to identify it

– Some are asymptomatic
– Dull, gnawing pain, burning sensation in back or low mid epigastric are, heartburn, constipation or diarrhea, sour taste in the mouth, burping, n/v, bloating, urea present in breath, tarry stools

Know steps of laceration correction and what end goal is

– Closing a wound or laceration by placing sutures or stitches or staples in the skin to hold the edges of the wound together for proper healing.
– To stop bleeding, prevent infection, speed healing, and preserve the appearance and function of the injured area.

Know clinical manifestations of ARF; high and low levels of what is in the lungs

– A sudden inability of the respiratory system to provide O2 and/or remove CO2 from the blood

Know cause of pulmonary embolism

– occlusion in the pulmonary circulation, most often caused by a blood clot
– Pt. dehydrated, venous stasis from immobility, surgery or on birth control, clotting disorder, or heart arrhythmias like A-fib.

Know tool used to determine level of consciousness

– A measurement of a person’s arousability and responsiveness to a stimulus.
– Glascow Coma Scale (GCS)
– Neurologic assessment of a patient’s best verbal response, eye opening, and motor function.

Define cystitis

– Inflammation of the urinary bladder.
– It is often caused by infection and is usually accompanied by frequent, painful urination.

Define pyelonephritis

– Inflammation of the kidney and renal pelvis due to bacteria.

Know outcome of imbalance in PTH when high? low?

– This hormone helps regulate calcium levels in the blood. When calcium levels are low, the parathyroid glands increase PTH production. When calcium levels are high, the glands slow down the secretion of PTH.

Know outcome of imbalance in ADH when high? low?

– Antidiuretic hormone. Low levels of anti-diuretic hormone will cause the kidneys to excrete too much water. A high ADH level causes the body to produce less urine. A low level results in greater urine production.

Know outcome of imbalance in Calcitonin when high? low?

– A lack of calcitonin in the blood may increase a person’s risk of bone degradation and osteopenia,The overall effect of calcitonin is to lower the concentration of calcium in the blood when it rises above the normal value.

Know phases of acute kidney injury

– Oliguric
– Diuretic
– Chronic

Know common findings of ARDS

PCWP <18, CXR with bilateral pulmonary infiltrates, PaCO2:FiO2 ratio <200

Know clinical manifestations of left-sided heart failure

1. Pnea, SOB
2. Crackles
3. Oliguria
4. Frothy Sputum
5. Displaced Apical Pulse (Hypertrophy)

Know pathophysiology of multiple sclerosis

– Disease of the central nervous system characterized by the demyelination (deterioration of the myelin sheath) of nerve fibers, with episodes of neurologic dysfunction (exacerbation) followed by recovery (remission)

Define homeostasis

– The maintenance of a constant internal environment within the body; it’s a dynamic equilibrium.

Define diffusion

– Movement of molecules from an area of high concentration to an area of low concentration

Define osmosis

– Diffusion of water through a selectively permeable membrane

Know Gigantism and causes

– Growth Hormone hypersecretion in children

Know Acromegaly and causes

– Excessive secretion of growth hormones in adults.

Know Dwarfism and causes

– A condition caused by insufficient growth hormone in childhood

Know clinical manifestation of anaphylaxis

– A severe response to an allergen in which the symptoms develop quickly, and without help, the patient can die within a few minutes.

Know presentation of liver disease

1.) Changes in mentation are the first clinical signs. Cerebral edema, encephalopathy
2.) Jaundice
3.) Coagulation abnormalities
4.) Metabolic Acidosis
5.) Renal failure
6.) Multi-organ Failure

Know signs and symptoms of asthma

coughing, wheezing, SOB, tachycardia, hypoxia, and Respiratory alkalosis or acidosis (hyperventilation or hypoventilation respectively)

Know what causes atherosclerosis plaques in the body

– uncertain, believed to be related to injury to the endothelial lining
– condition in which fatty deposits called plaque build up on the inner walls of the arteries

Know what backwards effect of right-sided heart failure is

1. Jugular Vein Distention
2. Ascending Dependent Edema
3. Weight Gain
4. Hepatomegaly (Liver Enlargement)

Know what causes barrel chest in emphysema

– It occurs because the lungs are chronically overinflated with air, so the rib cage stays partially expanded all the time.

Know signs and symptoms of myocardial infraction

– Heart attack; death of myocardial tissue (infarction) caused by ischemia (loss of blood flow) as a result of an occlusion (plugging) of a coronary artery; usually caused by atherosclerosis; symptoms include pain in the chest or upper body (shoulders, neck, and jaw), shortness of breath, diaphoresis, and nausea

Know symptoms of COPD

– Chronic cough, excessive sputum production, wheezing, dyspnea, poor exercise tolerance

Know clinical manifestations of hyperthyroidism

– Heat intolerance, weight loss, sweating, anxiety, irritability, hyperactive reflexes, palpitations, EXOPTHALMOS (lid lag when gaze moves from downward to upward)

Know complications of compartment syndrome

– Rhabdomyolysis with AKI (due to myoglobinuria)- volksmanns ischemic contracture (necrosis followed by secondary fibrosis with calcification)

Define rheumatoid arthritis

– Chronic inflammatory disease, the most serious and crippling form of arthritis.
– Systemic, autoimmune disease
– Arises from immune system malfunction, immune system mistakenly attacks bone coverings as if they were foreign tissue

Know causes of contact dermatitis

– Contact with a skin allergen

Know the characteristics of coronary artery disease

– Atherosclerosis of the coronary arteries that reduces the blood supply to the heart muscle
– Chest pain or discomfort (angina)Weakness, light-headedness, nausea (feeling sick to your stomach), or a cold sweat. Pain or discomfort in the arms or shoulder. Shortness of breath

Define Cushing’s syndrome and know presentation

– A condition caused by prolonged exposure to high levels of cortisol

– Fatty hump between shoulders a rounded face, and pink purple stretch marks on skin, thinning fragile skin, slow healing of cuts, insect bites and infections, acne, decreased libido, decreased fertility, irregular or absent menstrual periods, fatigue, muscle weakness, cognitive difficulties, and headaches.

Know goal of treating anemia

– To restore the hemodynamics of the vascular systems and to replace lost red blood cells.

Know presentation of cystic fibrosis

1. Chronic lung disease (cough, sputum, hemoptysis, bronchiectasis, wheezing, dyspnea)
2. Recurrent episodes of infection
3. Sinus pain and polyps common

Know what happens in cerebral palsy patients and why it occurs

– Paralysis caused by damage to the area of the brain responsible for movement

Know pathophysiology for type 1 diabetes

– Diabetes caused by a total lack of insulin production; usually develops in childhood, and patients require insulin replacement therapy to control the disorder

Know characteristics of DIC

– Bleeding, from many sites in the body. Blood clots. Bruising. Drop in blood pressure. Shortness of breath. Confusion, memory loss or change of behavior. Fever.

– The condition affects the blood’s ability to clot and stop bleeding. Life-threatening disorder.

What is used to identify a Myocardial Infarction in a patient?

– Cardiac Troponin

Know presentation for Parkinson’s disease

-Begins insidiously with a resting “pill-rolling” tremor of one hand
-Cardinal signs include tremor, rigidity, resistance to passive motion that is not velocity dependent (cogwheel or lead pipe), akinesia, postural instability, festinating gait, falling backwards (retropulsion) or forwards (propulsion), mask face, micrographia

Know which organs are involved in developing esophageal varices

– Swollen, twisted veins in the esophagus that are especially susceptible to ulceration and hemorrhage. throat and stomach (esophagus).

Know which hormones raises blood sugar

– glucagon

Know pathophysiology of exercise-induced asthma

– A medical condition characterized by shortness of breath induced by sustained aerobic exercise

Know outcomes of gout

– Permanent joint damage. Some people with gout can also develop other health problems, such as severe arthritis, kidney stones and heart disease.

Know what causes peptic ulcers

family history of PUD
blood group type O
cigarette smoking
intake of foods and beverages containing caffeine
chronic aspirin and NSAID use**
stress
H. pylori infection**

Know what causes hepatic encephalopathy

1. GI bleeding
2. Hypokalemia (think loop diuretics)
3. Hypovolemia
4. Hypoxia
5. Sedatives or tranquilizers
6. Hypoglycemia
7. Metabolic alkalosis
8. Infection (including SBP)

HPV causes which type of cancer?

– Cervical cancer

Know cause of diabetic ketoacidosis and disease it is associated with

– Profound deficiency of insulin
– Type 1 diabetes

Define modifiable risk factors

Can be reduced; smoking, diabetes, obesity, elevated serum lipids, hypertension, sedentary lifestyle

Define nonmodifiable risk factors

– Age, gender, race, family history

Know outcomes of hyponatremia

– Cells swell because electrolyte concentration is higher inside than outside. Can produce CNS dysfunction and cerebral edema which is life threatening.
sodium levels drop rapidly — resulting in potentially dangerous effects, such as rapid brain swelling, which can result in a coma and death

Define hypovolemia

– Decreased blood volume

Know ranges of a normal ABG

pH: 7.35 – 7.45
PaCO2: 35 -45
HCO3 (bicarb): 22 – 26

Define passive immunity

– The short-term immunity that results from the introduction of antibodies from another person or animal. A newborn baby acquires passive immunity from its mother through breast milk

Know what causes increased intracranial pressure

– bleeding in the brain
– a tumor
– stroke
– aneurysm
– high blood pressure
– brain infection

What hormone decreases blood glucose and helps cells take up glucose?

– Insulin

Know clinical manifestations of leukemia

– Pallor, fatigue, purpura, fever

Know how to identify kidney disease

– Common symptoms include nausea and loss of appetite, itching and dry skin, and numbness in the hands, blood in urine(hematuria) Patients may experience excessive thirst and breath malodor.

Know risk factors for hypertension

– Non-Modifiable: Family history, age, gender, ethnicity [african american; male]Modifiable: Obesity, substance abuse, stress, diet, and sedentary lifestyle-Tobacco damages the lining of the artery walls, prone to plaque accumulation.-Nicotine constricts the blood vessels, elevate HR and BP.

Define intussusception

– Telescoping of a segment of the intestine

Know causes of spinal cord injury

– Trauma
– Slipped disk
– Infection
– Tumour growth
– Ischaemia/infarction
– Sport injuries

Define meningitis

– An inflammation of the meninges (membrane covering the brain) due to bacteria, viruses, yeast, fungus, toxins, or meningeal irritation resulting from other causations; bacterial from used to be the most common; however, with the advent of HIB and pneumococcal vaccines, the viral form may now be the most prevalent form.

Know properties of metastatic cancer

– Cancer that has spread from the place where it first started to another place in the body

Know causes of cardiogenic shock

– inadequate heart function
– the disease of muscle tissue
– impaired electrical system
– disease or injury

Know etiology of a Cerebral vascular accident

– Stroke refers to an interruption of the cerebral arterial blood supply. A CVA is an infarction of the brain, so it is often referred to as a brain attack.

Know organs affected by hypertension

– Brain
– Kidneys
– Eyes
– does not affect liver

Know causes of osteoporosis

– Corticosteroids, heparin pharmacology reactions
a condition characterized by a progressive loss of bone calcium that leaves the bones brittle

Know risk factors for pneumonia

– Advanced age
– Lung disease
– Smoking
– Immunosuppressed
– Bed ridden
– Post- Op

Define polycythemia

– Increased RBCs ; red blood cells (high hematocrit)

Know clinical findings of shock

-Tachycardia, tachypnea
-Cool, clammy extremities; peripheral pulses
-Decreased arterial BP (decompensation)
-Cyanosis and/or pallor
-Restlessness, apprehension, decreased mental function
-Poor urinary output

Define tension pneumothorax and know interventions

– A type of pneumothorax in which air that enters the chest cavity is prevented from escaping

– Immediate needle aspiration (14-16-gauge needle) 2nd ICS, MCL; Do not wait for CXR

Know cause of secondary brain injury after trauma

– The “after effects” of the primary injury; includes abnormal processes such as cerebral edema, increased intracranial pressure, cerebral ischemia and hypoxia, and infection; onset is often delayed following the primary brain injury.

– Impairment or local declines in cerebral blood flow (CBF)
– Causes of secondary brain injury include hematoma, contusion, diffuse brain swelling, systemic shock and intracranial infection.

Define generalized seizures, know hemisphere

– Seizures that involve the entire brain
Hemispheres of the brain
– The human brain is divided into two halves called the left and right hemispheres

Define sepsis

– A toxic (life-threatening) inflammatory condition arising from the spread of microbes, especially bacteria or their toxins, from a response of infection.

Bone stores electrolytes and acts as an electrolyte pool

Know this.

Know what lateral scoliosis looks like on x-ray

– Sideways curvature of vertebrae

Define stress incontinence

The leak of urine with an increase in abd pressure (cough, sneeze)
Unique to women
No nocturnal urine leak
Loss of urine < 50 mL. Occurs with increased intra-abdominal pressure (coughing, sneezing, laughing, lifting).

Best was to prevent transmission of infectious agents

– Washing hands with plain soap and water

Know what patient with hypoventilation looks like

– Decreased rate or depth of air movement into the lungs

Decreased cardiac output is the common finding of all forms of heart failure

know this.

Know key marker of Hodgkin disease

– CD30 antigen, a marker for Hodgkin’s lymphoma, is a receptor whose ligand defines an emerging family of cytokines with homology to TNF.

Know clinical manifestations of septic shock

-Fever
-Warm, flushed skin
-Abrupt personality changes
-Hypotension
-Oliguria
-Lactic acidosis

CT is the goal standard to diagnose ischemic/hemorrhagic shock

know this.

Kidneys secrete this to increase RBC production

– Erythropoietin (EPO)

The main functional process of the endocrine system is_______

– To secrete hormones that coordinate and direct target cells and organs

Know presentation for thrombocytopenia

– A condition in which there is an abnormally small number of platelets circulating in the blood

– Easy or excessive bruising (purpura) Superficial bleeding into the skin that appears as a rash of pinpoint-sized reddish-purple spots (petechiae), usually on the lower legs. Prolonged bleeding from cuts.

Know how mycobacterium tuberculosis is transmitted

– spread by droplet nucle
i- immune system usually prevents spread
– bacteria can remain alive in the lungs for many years (latent TB infection)

Know function of ribosomes

– Protein synthesis

What is the best way to prevent spinal cord injuries?

Driving defensively and using seat belts.
Follow sports safety guidelines for children, adolescents and adults.
Jumping rather than diving, into water.
Limiting use of medicines that lower blood-clotting ability, such as aspirin.
Don’t drive after drinking alcohol.

Know treatment for hemophilia A

– Clotting factor transfusions, recombinant clotting factors, desmopressin (DDAVP), and bleed precautions

– Hemophilia A is a hereditary bleeding disorder caused by a lack of blood clotting factor VIII.

Know clinical manifestations for sickle cell crisis

– Unexplained episodes of severe pain, such as pain in the abdomen, chest, bones or joints. Swelling in the hands or feet. Abdominal swelling, especially if the area is tender to the touch.

Define unstable angina pectoris

– Prolonged, worsening chest pain occurs without exertion, not relieved by rest or nitroglycerin.

Define stable angina pectoris

– Type of cardiac chest pain that is a result of ischemia that is initiated by increased demand (activity) and relieved with the reduction of that demand (rest).

Virchow’s triad includes

– The three factors of Virchow’s triad include intravascular vessel wall damage, stasis of flow, and the presence of a hypercoagulable state

Why is dialysis necessary for end-stage renal disease?

– With end-stage renal disease, you need dialysis or a kidney transplant to stay alive

Define reperfusion injury

– Injury to tissue that occurs after blood flow is restored

Altered LOCs is the most sensitive indicator of altered brain function

know this.

Define renin and what it used for, what it does

– Hormone secreted by the kidney that raises blood pressure

DIC is a severe complication of what?

– Sepsis

What results in prerenal kidney injury?

– Characterized by low GFR, oliguria, high urine specific gravity and osmolality, and low urine sodium

Flickr Creative Commons Images

Some images used in this set are licensed under the Creative Commons through Flickr.com.

Explain primary prevention
Preventing”; altering susceptibility or reducing exposure of disease for people

Explain secondary prevention
“Screening”; early detection, screening, and management of disease to catch disease early before it spreads

Explain tertiary prevention
“Treating” and preventing further complications from a disorder or disease after the person has the condition

What are examples of primary prevention?
Vaccinations and Handwashing

What are examples of secondary prevention?
PAP smears for STDs, lab work for HBA1C check, mammogram

What are examples of tertiary prevention?
Rehab for hip surgery, relearning ADL’s after amputation, Wound care after stroke to prevent pressure ulcer

What happens to the body during the sympathetic phase of the flight or fight response?
Pupils dilate, salivation inhibited, increase in HR, bronchodilation of airway, increased respirations, glucose release, inhibit GI/GU.

What happens to the body during the parasympathetic phase of the flight or light response?
Rest and Digest. Pupils constrict, salivation occurs, decreased HR, bronchoconstriction,decreased respiration, GI/GU systems resume action

Explain the role of the nucleus
control center of the cell, where DNA and genes are stored, produces mRNA to help build body proteins

Explain the role of the mitochondria
Powerhouse of the cell. Provides energy in ATP, and has its own set of DNA

Explain the role of the ribosome
produces RNA to produce proteins through transcriptions of DNA and translation of RNA into a protein

Explain the role of the lysosomes
helps breakdown and digest dead cells, organelles, or tissues

Explain the role of the rough ER
folded membranes that move proteins around the cell. Has ribosomes attached to it and helps produce proteins for the cell membrane

Explain the role of the smooth ER
helps the Liver and kidney cells to detoxify, lipid metabolism, synthesis of hormones, and calcium storage

Explain the role of the peroxisome
membrane cells that contain oxidase and catalase to detoxify harmful chemicals, breakdown hydrogen peroxide and filter metabolic wastes

Explain the role of the Golgi body
stacked membranes that act as the sorter and packager for proteins from the ER. Helps move things in and out of cell

Explain passive immunity
the transfer of preformed antibodies against specific antigens from a protected or immunized individual to an unprotected or non immunized person. Provides immediate and short term protection. No memory cells are produced. IgA and IgE. Passes protection

What are examples of passive immunity?
mom to fetus through placenta or mom to infant through breast milk. Serotherapy

Explain active immunity
a protective state owing to the immune system response as a result of active infection or immunization. It has to be activated in the body and the body has to fight it to have long term immunity

What are examples of active immunity?
Vaccinations

Explain what edema is
accumulation of fluid in the interstitial space. Leads to tissue swelling

What are some causes of edema?
increase in the forces that move fluid from capillaries to interstitial compartments or decrease in the opposite.

What are factors that contribute to edema?
Increase in hydrostatic forces in the capillaries that increases the blood volume, increased capillary permeability, CHF, HYPTN, decrease in plasma proteins like albumin (causes liver to hold onto more water- ascites, cirrhosis), blockage of lymph drainage

What is a hypersensitivity?
an overreaction to antigens or allergens that is beyond the normal range, leading to damage

What is a type 1 hypersensitivity?
anaphylactic. Occurs within 2-30mins of exposure. Can be systemic or localized. Binds to IgE and mast cells that release histamine, leukotrienes, and prostaglandins to create inflammation

Mediating Factor for type 1 hypersensitivity
IgE

Examples of type 1 hypersensitivity
allergic reaction to dust. someone eats peanuts and breaks out in hives and runny nose

How do we treat type 1 hypersensitivity reactions?
antihistamines to block histamine, beta adrenergics to bronchodilator , corticosteroids, to decrease inflammation. IgE therapy, epinephrine given during anaphylaxis through IV or through IM in epipens

What are signs and symptoms of a type 1 hypersensitivity reaction?
hives, runny nose, eczema, throat constriction, ,localized edema, wheezing, tachycardia, anaphylaxis.

Explain Type 2 Hypersensitivity
The cells attack healthy organs and blood, causing symptoms

Mediating factor for type 2 hypersensitivity
cytotoxic- IgM/ IgG

Examples of type 2 hypersensitivity
Blood transfusions when wrong blood given, hemolytic disease of newborn, grans disease, myasthenia gravis

What is type 3 hypersensitivity?
The igG antibodies are stuck beneath the membranes of cells. Can activate immune responses that can damage tissues. Immune complex

Mediating factor type 3 hypersensitivity
immune complexes

Examples type 3 hypersensitivity
RA, lupus

What is type 4 hypersensitivity?
there is a delayed cell reaction caused by the T cells. Antigens are phagocytized and are sensitized to receptors on the t cell. Reexposure causes the memory cells to release destructive cytokines.

Mediating factor type 4 hypersensitivity
delayed cell mediated

Examples type 4 hypersensitivity
TB test, contact dermatitis

Characteristics of benign tumors
Localized growth that is curable. They more closely resemble the original tissue type, they grow slowly, have little vascularity, rarely necrotic, and usually have similar function to the original cells. Can be fatal depending on the location (brain, heart,etc), usually grows at the original areas of the body. Encapsulated

Characteristics of malignant tumors
usually cancerous. They ignore growth controlling signals and replicate despite signals from the environment. They can escape signals and can die. they can also display different functions poorly or not at all related to the tissue. Greater degree of differentiation means that it is more aggressive. Can move around with a poor prognosis. Anaplasia, metastasis

S/S of peptic ulcer disease
epigastric burning pain that is usually relieved by food or antacids (gastric ulcers present on empty stomach but can be after food, duodenal ulcers present 2-3 hours after food and is relieved by food). Can also be life threatening as GI bleeding can occur without warning and cause a drop in H/H and dark tarry stools and hematemesis

What is H.pylori?
has a key role in promoting both gastric and duodenal ulcer formation and thrives in acidic areas. It slows down ulcer healing and can reoccur frequently, and taking it away can help ulcers heal

What is a functional bowel obstruction?
problem with the act of the bowel actually moving, such as things that inhibit movement from surgery, medications, opioids, low fiber diets that can slow motility or shut off the GI system from the SNS stimulation

What is a mechanical bowel obstruction?
blockage of the bowel inhibiting movement. adhesions, hernia, tumors, impacted feces, volvus or twisting of the intestines, intussusception

adhesions
bands of scar tissue joining two surfaces that are normally separated in the bowel

hernia
Protrusion of bowel through the wall of the cavity that normally contains it

volvus
twisting of the bowel

Intusseption
telescoping of the intestines

S/S of appendicitis
Periumbilical pain, RLQ pain, presence of a positive McBurneys point and rebound tenderness when one presses on the belly button and hip region and when the pressure is removed, the client has pain, nausea, vomiting, fever, diarrhea, RLQ tenderness, systemic signs of infection.

how to assess appendicitis
McBurney’s point technique when pressing on the belly button and RLQ hip region and removing the pressure causes intense pain, indicates positive appendicitis. Rebound tenderness= positive

rebound tenderness
pain that increases when pressure (as from a hand) is removed-in appendicitis

S/S of liver disease
hepatocellular failure (jaundice, decreased clotting, hypoalbuminemia, decreased vitamin D and K) and portal hypertension (GI congestion due to blockage of blood, more esophageal or gastric varies, hemorrhoids, enlarged spleen,)

what is jaundice?
green yellow staining of tissues from increased level of bilirubin as the liver cannot metabolize extra bilirubin. Found on eyes, skin, and mouth. present with liver disease

What is ascites?
pathological accumulation of fluid in the peritoneal cavity due to the loss of albumin in the liver, causing fluid to be free amongst the cells. It can cause a lot of pain in the abdomen, and it must be drained with a parenthesis

What is hepatic encephalopathy?
neuropsychiatric syndrome from too much ammonia in the blood as the liver cannot break it down. Dementia=ammonia and psychotic symptoms common along with jerking

What is portal hypertension?
Increased pressure in the portal venous system from a build-up of portal vein pressure due to progressive hepatic fibrosis which increases hepatic resistance

What is esophageal varices?
a complication of portal hypertension resulting from alcoholism or hepatitis. Causes the vessels in the esophagus to become dilated and bleed, and the rupturing can be forceful enough for one to bleed out

How do we treat esophageal varices?
reduce the hypertension, banding the varices to prevent rupturing and bleeding by cutting of the flow with a band

What role does albumin play in the blood?
Albumin helps keep fluid in the blood stream and in cells so it does not leak into other tissues. It can also carry other substances in the body

What happens to albumin during liver failure?
leads to low albumin levels, causing edema in the extremities and buildup of fluid in abdomen called ascites from fluid leaking through the cells and vessels into the tissues

Three functions of the kidneys
elimination, excretion, regulation

Explain elimination
discharge of waste (urine) from the body

Explain Excretion
removal of organic wastes from the blood

Explain regulation
regulating blood volume, ion concentration, blood pH and nutrients

Manifestations of renal disorders
Pain: usually in the back-flank area, felt at the CVA angle when one palpates with a closed fist and it causes the client tenderness. Pain upon micturition

What are abnormal urinalysis findings?
dark, strong smelling urine could denote decreased renal function, infection or dehydration, cloudy urine could denote infection or high WBC count. Ketones or glucose suggest diabetes, and proteinuria

Normal GFR
125 mL/min

Normal urine output per hour
30 mL/hr

What is polycystic kidney disease?
a congenital abnormality of the kidney that is genetically transmitted, and it results in fluid filled cysts on one or both kidneys that can lead to renal failure, needing dialysis, or kidney transplantation

What causes polycystic kidney disease?
genetics

Explain nephron
in the kidney and helps to filter blood and remove waste products. The kidney has 1-2 million of them

Explain hematuria
blood found in the urine not due to menstruation

Explain proteinuria
protein found in the urine

What is nephrolithiasis?
kidney stones that obstruct the ureters and kidneys. Usually made of calcium and can cause urinary stasis and pain

What is pyleonephritis?
infected and inflamed kidney, usually caused by e.coli from the lower urinary tract that ascends

Explain how to assess for pyelonephritis
Percussion at the CVA noting tenderness, pain when urinating, low GFR, concentrated urine with things in urine

s/s of pyelonephritis
CVA tenderness most common, fever, chills, N/V, anorexia or not willing to eat, flank pain

What is cystitis?
inflammation of the bladder (UTI)

How to prevent pyelonephritis
remove catheters as early as possible to prevent infection as it can spread

s/s of acute kidney injury (AKI)
low urine output, concentrated urine, low GFR, high BUN/CRE, sudden reduction in kidney function

3 Causes of AKI
Prerenal, intrarenal, postrenal

explain pre renal causes of AKI
disruption in renal perfusion and blood flow. It can cause low blood pressure, low blood volume, heart failure, renal artery obstruction, fever, vomiting, diarrhea, burns that lead to dehydration, Drugs such as ACE inhibitors or angiotensin 2 blockers, NSAIDs that can drop the blood pressure or cause bleeding

Explain intrarenal causes of AKI
damage or disruptions within the kidney blood vessels, tubules, or glomeruli. It can cause reduced blood supply within the kidneys, toxic injury with medications, chemo, and contrast medias, renal inflammation, or prolonged prostate/ stones/ in the post renal stage

Explain postrenal causes of AKI
caused by an obstruction in the urinary collecting system, urethra, bladder, or ureters due to stone, tumor, or enlarged prostate that results in elevated pressure in the Bowman’s capsule that impedes glomerular filtration. Prolonged injury can lead to intrinsic injury and irreversible damage

Examples of prerenal causes of AKI
low BP, hypovolemia, heart failure, renal artery occlusion, fever, vomiting, diarrhea, burns leading to dehydration, NSAIDs, and antihypertensives that drop the BP

Examples of intrarenal causes of AKI
chemo, contrast dye, prolonged kidney stones in the post renal stage

Examples of postrenal causes of AKI
renal stones, enlarged prostate, tumor in the urethra

What is compartment syndrome?
Damage to nerves and vasculature of an extremity due to compression. if untreated it can cause edema, increased pressure, reduced capillary flow, ischemia and necrosis

What must be done in compartment syndrome?
fasciotomy to reduce pressure in the area

What are the 5 P’s for compartment syndrome?
Pain paralysis paresthesia pallor pulselessness

What are pressure ulcers?
localized area of cellular necrosis resulting from pressure between any boney prominence and with an external object

Which populations are most likely to have a pressure ulcer?
elderly, bedridden patients, incontinent patients, those who are malnourished, bad hygiene, those with paralysis

Risk factors for pressure ulcers
poor nutrition, aging, immobility, sensory loss, bowel and bladder incontinence

Most common places to find pressure ulcers
buttocks, coccyx, heels, elbows, back of head, shoulders

stage 1 pressure ulcer
Intact skin with non blanching redness

stage 2 pressure ulcer
partial thickness skin loss involving the epidermis or dermis or both

stage 3 pressure ulcer
full thickness tissue loss with visible fat

stage 4 pressure ulcer
full thickness tissue loss with exposed bone, muscle or tendon

How can we prevent pressure ulcers
turning patients every 2 hours who are bedridden. Appropriate nutrition and hydration. float heels off bed, clean linens, doing incontinence care, movement of patients

What are electrolyte reservoirs?
where electrolytes are found at an abundance, usually in the bones

Which electrolytes are stored in the bones?
calcium, phosphate, magnesium

What is osteomyelitis?
severe pyogenic infection of bone and local tissues. the organism reaches the blood adjacent to soft tissue or directly into it. if not managed, necrotic bone can separate the bone into dead segments

Causes of osteomyelitis
burns, sinus disease, trauma, tumors, periodontal infection and pressure ulcers, open fractures, penetration of wounds, surgical contamination or use of metal screws

What is osteoporosis?
occurs when the rate of bone resorption is greater than bone formation. The bones end up becoming fragile and light

Who is most likely to get osteoporosis?
women age 60-80 that are caucasian

What are the causes of osteoporosis?
estrogen deficiency, poor calcium intake and disuse of supplements

S/S of osteoporosis
short stature, muscle wasting, back spasms and difficulty bending. bones will be porous and have holes in them, more fragile

How do we diagnoses osteoporosis?
bone mineral density scan with levels being -1.0 to -2.5

How do we treat osteoporosis?
calcium and vitamin D supplements, exercise, human parathyroid hormone, supplemental estrogen

What is rickets?
defective mineralization of both bone and growth plate cartilage in children

What causes rickets?
Vitamin D deficiency

Which population is affected by rickets?
children

S/S of Rickets
bowleg, knock kneed, beading of ribs, improper formation of teeth, long ends of the bones, pelvis deformities

What is osteomalacia?
a rare condition of the adult bone associated with vitamin D deficiency, resulting in decalcification and softening of bone.

Which population is affected with osteomalacia?
adults

What causes osteomalacia?
Low vitamin D in adults

What is osteoarthritis?
local degenerative disorder associated with aging and wear and tear from repetitive stress. Characterized by loss of articular cartilage, calcification, wear of bone and bone spurs. Non inflammatory, and the weight bearing joints are affected

What causes osteoarthritis?
long-term or excessive wear and tear on joints, aging, genetics

s/s of osteoarthritis
pain, stiffness, enlargement, tenderness, limited range of motion and deformity, crepitus

What are Heberden’s and Bouchard’s nodes?
boney bumps on fingers and joints caused by joint inflammation in osteoarthritis and RA

What is rheumatoid arthritis?
a chronic progressive inflammatory disease causing inflammation in the joints and resulting in painful deformity and immobility, especially in the fingers, wrists, feet, and ankles.

What causes rheumatoid arthritis?
autoimmune disorder

s/s of rheumatoid arthritis
s/s similar to osteoarthritis, malaise and fatigue.

What is psoriatic arthritis?
inflammation of the joint cavities associated with psoriasis

What is psoriatic arthritis associated with?
psoriasis

What causes psoriatic arthritis?
automimmune disorder where cells attack the joints if not corrected earlier

s/s of psoriatic arthritis
similar to RA, but secondary to psoriasis. oligoarthritis, combined soft tissue and peripheral joint disease

What is gout?
disorder in which the disturbance of uric acid metabolism leads to deposition of uric acid crystals in the joints

What is associated with gout?
uric acid and uric acid crystals

What causes gout?
hyperuricemia

s/s of gout
Severe pain in a peripheral joint, often great toe
Swelling of joint, redness
Trophi in lower extremities (small, white nodules visible through the skin)
Renal stones

What is gigantism?
occurs in childhood as a result of too much growth hormone. Occurs before skeletal plates fuse at the ends of bones. Leaves client with increased risk for cardiac problems

Which population is affected by gigantism?
children

What is dwarfism?
occurs when there is too little growth hormone. It causes short stature, hypoglycemia, delayed dental eruption, thin hair, poor nail growth, greater fat mass, decreased muscle mass, and delayed bone formation and puberty. Often is congenital or idiopathic.

What is acromegaly?
occurs in adults as a result of too much growth hormone. Occurs when the cells grow width wise amongst the bones.

Which population is affected by acromegaly?
adults

How do the bones grow in gigantism?
vertically or horizontally from the ends of bone.

How do the bones grow in acromegaly?
width wise

What is diabetes insipidus caused by?
lack of ADH

What does diabetes insipidous result in?
Results in the kidneys being unable to retain water in the body and a lot of urine output that is dilute. Extreme thirst. Lack of water leads to dehydration.

s/s of diabetes insipidus
dizziness, disorientation, nausea, tachycardia, headaches, low blood pressure, hypovolemia, high electrolytes in the blood- sodium, large volumes of dilute urine/ fluid are excreted, weight loss

What are patient with diabetes insipidus at high risk for developing?
hypovolemic shock

What is SIADH?
too much ADH in the body. Causes the body to retain too much water

S/S of SIADH
low urine output, high osmolarity, electrolytes are at a lower concentration, edema, weight gain, hyponatremia, cereal edema, seizures, confusion, coma

What are patients with SIADH at risk of developing?
cerebral edema

What organism causes pelvic inflammatory disease
Neisseria gonorrhoeae, chlamydia trachomatis

What organism causes cervical cancer
human papillomavirus or HPV

What organism causes UTI
e.coli

What organism causes herpes
herpes simplex 1/ 2 virus (depending on area of body)

What organism causes syphillis
Treponema pallidum

What is parathyroid hormone?
increases the calcium levels in the blood to be released from bone reservoirs by activating osteoclasts. It increases Ca absorption in the intestine and decreases Ca excretion in the urine

What is calcitonin?
decreases calcium levels in the blood and increases calcium levels in the bone. puts calcium back into the bones.

What electrolyte is affected by parathyroid hormone and calcitonin?
calcium

What is Cushing’s disease?
caused by excessive glucocorticoids from either a pituitary tumor or tumor or adrenal cortex or secondary to prescribed glucocorticoids

S/S of Cushing’s Disease
hyperglycemia, loss of muscle and bone, excess water and salt retention, weight gain, edema, hypernatremia, characteristic signs: moon face and the buffalo hump due to swelling and redistribution of fat, high BP and blood volume

What is Addison’s disease?
caused by adrenocortical insuffiency from not having enough steroids or glucocorticoids. Primarily from autoimmune conditions or removal of the adrenals, secondary to removal of corticosteroid therapy

S/S of Addison’s disease
weight loss, salt wasting of fluids, weakness, malaise, hyperpigmentation or bronzing of skin, hypoglycemia, and hyperkalemia. Reduced cardiac output, inadequate blood volume, low blood pressure

Hypothyroidism causes
caused by cells attacking the thyroid gland or surgical removal of tissues, iodine deficiency. Leads to a lack of T3/T4 and too much of TSH. The TSH recognizes the lack of the T3/T4 so more is pushed into it yet the thyroid cannot produce it.

Lab values for hypothyroidism
elevated TSH, low T3/T4

S/S hypothyroidism
low metabolism, weakness, lethargy, cold intolerance, low appetite, bradycardia, weight gain, dry skin, constipation, depression, difficulty concentrating, menstrual problems

Hyperthyroidism causes
excessive iodine, Graves’ disease, nonmalignant thyroid tumors, thyroid inflammation, and taking large amounts of thyroid hormone replacement

Lab values for hyperthyroidism
High T3/T4 levels, low TSH

S/S of hyperthyroidism
exophthalmos or eye budging, lid lag, vision changes, light sensitivity, high metabolism, rapid weight loss, insomnia, restlessness, cannot concentrate, tremors and irritability, palpitations, heat intolerance, diaphoresis, diarrhea, amenorrhea

type 1 diabetes mellitus patho
the inability for one to produce insulin needed to transport glucose into cells. They are insulin dependent. The beta cells in the pancreas are destroyed or not present. No insulin to stimulate production of glucagon, causing glucose levels to rise.

What must type 1 diabetes do with their condition?
take lifelong insulin

type 2 diabetes mellitus
caused by the cells of the pancreas becoming resistant ot insulin, and decrease of receptors on the target cells. They lose the ability to respond to cells. Results in decreased insulin production.

What must type 2 diabetics do with their condition?
take insulin or oral diabetic agents. can have a low sodium diet and exercise regularly to keep stress levels low, keep their blood pressure low and weight gain at a minimum

Normal blood sugar range
60-120

Hypoglycemia blood sugar levels
lower than 60

Hyperglycemia blood sugar levels
above 120

How do we diagnose diabetes?
random sampling of blood glucose over 200 mg, fasting blood glucose level of 126, or and Hgba1C over 6.5

Normal A1C level
4-6

Diabetic A1c level
above 6.5

Where should any diabetic aim their A1C level to be at?
less than 7

S/S of hyperglycemia
Dry mouth, increased thirst, blurry vision, weakness, headache, frequent urination “sugar high”

S/S of hypoglycemia
cold, pale, sweating, sleepy, lack of coordination, irritability, hunger

Which takes priority: hyperglycemia or hypoglycemia?
hypoglycemia

What do we need to do to treat hypoglycemia?
by giving 15g of carbs or D50 over time and rechecking the sugar every 15 minutes

What are the 3 P’s of diabetes?
polyuria, polydipsia, polyphagia

Explain polyuria
increased urination

Explain polydipsia
increased thirst

Explain polyphagia
increased hunger

Primary Brain Injury
occurs as a direct result of the initial insult to the brain

Examples primary brain injury
stroke, concussion, trauma

Secondary Brain injury
occurs as the response to the initial impact or trauma. Can be progressive damage resulting from the body’s response to the initial insult

Examples of secondary brain injury
brain swelling secondary to stroke or trauma

What is intracranial pressure?
the volume of the craniums brain tissue, CSF, and blood, overall pressure in the skull and spinal cord

What is increased ICP?
occurs when there is a rise in pressure from trauma, stroke, swelling, tumor, obstruction, etc. There is often compression occurring from the skull that does not allow the brain to expand, adding to the pressure becoming high

Result of increased ICP
cutting off of the blood supply, tissue damage, ischemia, hypoxia and eventually necrosis. brain cannot expand

Normal ICP range
0-15 mmHg

Increased ICP range
above 15 mmHg

S/S of increased ICP
LOC changes, headache, vomiting, drowsiness, impaired speech, low arousal, blurry vision, impaired pupil responsiveness to light reflex, unequal pupil size, fixed and dilated pupils, altered respiratory pattern, lack of movement

Explain the Glasgow Coma Scale
A scale that measures the degree or level of consciousness (LOC is always number #1 with neurological assessment)

What 3 categories is the Glasgow coma scale based on?
eye opening, verbal utterances, and motor reactions

Mild Range Glascow coma scores
Above 12

Moderate Range Glascow coma scores
9-12

Severe Range Glascow coma scores
less than 8

What score does it mean a patient is dead on the Glasgow coma scale?
3 or less

What is the most powerful predictor of outcome according to the Glasgow coma scale?
motor response

Explain decorticate posturing
abnormal flexion towards the core of the body

Explain decerebrate posturing
abnormal extension away from the body

What is an ischemic stroke?
From a sudden blockage of the cerebral artery secondary to a clot or emboli formation. Associated with atherosclerosis and clotting disorders and cardiac conditions that can push the clot to the brain.

Most common type of stroke is?
ischemic stroke

S/S of ischemic stroke
contralateral paralysis (Right brain controls left side, left brain controls right side) on one side of the body, facial drooping, ptosis, hemi-sensory loss, contralateral visual blindness, aphasia or speech difficulty

What is a hemorrhagic stroke?
results from a bleed within the brain. From secondary to severe and chronic hypertension, severe head trauma, aneurysm, weakness or rupture of a vessel, anticoagulant use, or arteriovenous malformation.

S/S of hemorrhagic stroke
one sided weakness, someone with right sided weakness – has a problem on the left side of the brain, drop on face, headache caused by bleeding, difficult to communicate, high blood pressure, impaired vision, nausea, seizures, unequal pupils, difficult respiration

How do we diagnose a stroke (type and location)?
Brain CT scan

Explain meningitis
inflammation of the meninges of the brain

Causes of meningitis
strep pneumonia, meningococcus, hemophilic influenza or can be viral. it reaches the person through the ears

S/S of meningitis
headache, fever, stiff neck (patient cannot touch chin to chest without pain), photophobia, purple rash, confusion delirium

Explain encephalitis
inflammation of the brain with swelling

Causes of encephalitis
west nile virus, HSV, equine cephalitis

S/S of encephalitis
fever, headache, malaise, muscle pain, rash, seizure, confusion, stupor, coma

How do we diagnose meningitis/ encephalitis?
CT, MRI lumbar puncture with pathogens in it- either clear or cloudy straw color

Generalized Seizure
whole brain surface is affected by the seizure

Absence Seizure
staring spells that last seconds

Myoclonic Seizure
single/ several jerks of the body

Atonic Seizure
loss of muscle tone, can cause falls as people drop during it

Tonic Clonic Seizure
jerking of many muscles

Focal Seizure
abnormal brain activity related to one hemisphere

Status Epilepticus
continuing series of seizures without recovery. Life threatening due to low perfusion and o2 to brain.

1st degree burn
Only the epidermis (red, painful, and edema)

2nd degree burn
epidermis and part of dermis (blistered)

3rd degree burn
Full thickness damage through skin into nerves and muscles. Absence of pain and neuropathy

How do we diagnose Seizures?
EEG is gold standard. lab work to rule out toxins or malnutrition, MRI, lumbar puncture

What should you do during a seizure?
maintain an airway, remove clothes that could constrict, lay person on left side, have suction and o2 at bedside, prevent aspiration, protect injury, document start and stop time of seizures, do not put anything in the mouth, dim room and quiet, give time to rest after the seizure as it deprives the brain of oxygen and energy

What is cerebral palsy?
A permanent impairment affecting automatic postural control and movement as a result of a non-progressive brain disorder

What is cerebral palsy caused by?
by prenatal infections or mechanical trauma to the head before, during or after birth or exposure to nerve damaging poisons or reduced oxygen supply to the brain

Is cerebral palsy reversible?
No but ti can be managed with surgery, casts, braces, rehab

What causes Parkinson’s disease?
the loss of dopamine producing neurons over time that are in the brain, dopamine deficiencies associated with motor impairment

S/S of Parkinson’s disease
difficulty initiating and controlling movements, slow movements, tremors that occur at rest, loss of facial expression, shuffling gait, absent arm swing

What are spinal injuries caused by?
trauma, MVA, fall, GSW, injury resulting in the spinal cord being compressed, transected or bruised. Secondary to bleeding, swelling, ischemia or inflammation

Types of spinal cord injuries
hyperflexion, hyperextension or compression

What is spinal shock?
occurs right away and is a loss of reflexes below the injury. The muscles are flaccid and at the end the flaccidity is replaced with spasms

What is neurogenic shock?
there is peripheral vasodilation resulting in hypotension, bradycardia, and circulatory collapse due to no pressure to move the blood in the body. Can potentially affect the respiratory system.

What is autonomic dysreflexia?
reflexive response due to sympathetic activation below the injury level such as visceral stimulation, hypertension, headache. Leads to flushing above the level of injury and clammy skin below it.

How do we treat spinal cord injuries?
do not move head or spine. stabilize with a brace to maximize recovery

What happens to co2 and o2 levels during hypoventilation?
causes o2 to not be able to get into the lungs and for co2 to be retained and not expelled from the lungs

What happens to co2 and o2 levels during hyperventilation?
causes too much co2 to be eliminated and too much o2 to be let into the lungs too fast

Normal pH
7.35-7.45

Normal CO2 range
35-45

Normal HCO3
22-26

Acidosis pH
less than 7.35

Alkalosis pH
greater than 7.45

Acidosis CO2
greater than 45

Alkalosis CO2
less than 35

Acidosis HCO3
less than 22

Alkalosis HCO3
greater than 26

What happens during respiratory acidosis?
pH is low and CO2 is high; leads to more CO2 retained and not enough O2

Examples of respiratory acidosis?
hypoventilation, opioid overdose, impaired airway, respiratory depression, COPD

What happens during respiratory alkalosis?
pH is high and CO2 is low; leads to not enough CO2 retained and too much oxygen held on

Examples of respiratory alkalosis?
hyperventilation, fever, anxiety, sepsis, brain trauma, ventilation

What happens during metabolic acidosis?
pH is low and HCO3 is low

Examples of metabolic acidosis?
aspirin toxicity, excessive alcohol use, lactic acid buildup. DKA, starvation, persistent diarrhea, kidney failure

What happens during metabolic alkalosis?
pH is high and HCO3 is high

Examples of metabolic alkalosis?
excessive vomiting or NG suctioning

What is asthma?
chronic inflammatory disorder of the airways from stimuli

What is extrinsic asthma?
caused by external factor such as pet dander, pollen dust from an IgE response

What is intrinsic asthma?
from internal factors such as inflammation, upper respiratory infections, air pollution, emotional stress, smoke

What is exercised induced asthma?
occurs 10-15 minutes after the end of exercise as a compensatory mechanism to warm airways

What are s/s of ALL asthma types?
wheezing, tight chest, dyspnea, cough, increased sputum production, hyper inflated chest, decreased breath sounds

Which organism causes TB?
mycobacterium tuberculosis

How does TB enter the body?
inhalation of small droplets containing the bacteria that are expelled with cough, sneeze or talking. It enters into the lungs and the macrophages ingest the microorganism. Seen on the chest x ray as chon complexes for the small clusters

How is TB classified?
primary is asymptomatic but when reactivated can impair the immune system

S/S TB
low grade fever, chronic cough with bloody sputum, night sweats, fatigue, weight loss

How do we diagnose TB?
sputum culture, PPD test but does not work when one is exposed, CXR

How do we prevent the spread of TB?
wear N95 mask, place patient in negative pressure room

What is COPD?
result of both chronic bronchitis and emphysema that causes irreversible decrease for the lungs to force air out, lower lung elasticity and move air out

What can COPD result in?
hypoventilation, co2 retention, decrease in pH, hypoxemia.

Causes of COPD
smoking or air pollution

S/S of COPD
SOB, will be thin due to increased respiratory effect, increased calorie use, working hard to breathe, use of accessory muscles in a tripod position, pursed lip breathing, cough, clubbing of fingers, barrel chest. Will need o2

What is cystic fibrosis?
Excess mucus in the lungs, digestive track and liver

What causes cystic fibrosis?
genetics

s/s of cystic fibrosis
cough, thick sputum that is overproduced, recurrent infections and bronchitis, dyspnea, tachycardia, sternal retractions, unequal breath sounds, crackles and rhonchi, barrel chest, clubbing, fatty stools

What is pneumonia?
inflammation of the lungs from an infection

Etiology of Pneumonia
The organism enters the lung, multiplies and triggers pulmonary inflammation that invade alveolar sacs that fill with fluid that is hard to cough up.

Causes of pneumonia
aspiration, inhaled contaminants from the mouth, virus, hospital or community acquired infections.

Who is most at risk for getting pneumonia?
elderly, intubated patients, ill patients, hypoxic patients, immunocompromised patients.

s/s of pneumonia
crackles and bronchi breath sounds over affected tissue, chills, fever, cough with white or cloudy sputum.

What is ARDS?
damage to the alveolar capillary membrane that causes wide spread pulmonary edema and severe shortness of breath. Associated with decline in o2 that does not respond to supplementary o2. the client becomes hypercapnia and acidotic.

Etiology of ARDS
atelectasis and decrease in lung compliance and surfactant, fibrosis, pulmonary edema, disruptions in o2 transport, hypoxemia. Lungs fill with fluid- dyspnea, o2 will drop, frothy sputum, hypoximea, co2 is trapped low Ph

Causes of ARDS
severe trauma, sepsis, aspiration, fat emboli, shock.

S/S of ARDs
Dyspnea, labored and shallow respirations productive cough with frothy sputum, crackles or rales, hypoxia, cyanosis, fever, hypotension, tachycardia, restlessness, confusion, lethargy and anxiety.

What is a tension pneumothorax?
Accumulation of air in the pleural space usually from trauma that creates an open sucking chest wall where air enters during inspiration but does not escape during expiration. Creates low venous return and cardiac output.

S/S of pneumothorax
tachycardia, hypotension, tracheal shift with deviated trachea, neck vein distension, subcutaneous emphysema

How do we treat tension pneumothorax?
depends on severity of the problem and cause of leak. Must remove air to restore pressure. Chest tube with h2o seal that draws air out of the lung without leaks.

What is Virchow’s triad?
conditions that promote thrombus formation.

3 parts of Virchow’s triad
Endothelial injury, sluggish blood flow, and increased coagulopathy

How does virchows triad increase a patients risk for a PE?
additional platelets and inflammatory mediators come to the site, stagnant blood low allow platelets and clotting factors to form and adhere to the vessel and increased coagulopathy states promotion of the clot that can be dislodged and sent to the lungs from a peripheral site.

What is a thrombus?
blood clot that is stasis and has platelets, fibrin and dead cells

What is a pulmonary embolism?
blood clot in the lungs

What is an emboli?
Intravascular mass that travels and occludes downstream vessels

What is a DVT?
Blood clot in an extremity (usually in calf) in the vein

What is an arterial thrombus?
blockage of an artery

What is a venous thrombus?
blockage of vein

causes of anemia
reduced number of red blood cells from the result of blood loss, bone marrow failure, renal failure, nutritional deficiencies, and abnormal hemoglobin

hemorrhagic anemia
caused by blood loss

aplastic anemia
failure of blood cell production in the bone marrow

iron deficiency anemia
from lack of iron in the diet, resulting in insufficient hemoglobin

What is PICA?
craving for nonfood substances such a dirt, clay, ice, Landry starch, cardboard or hair

Problem with PICA
often indigestible, toxic and can cause infection

perncious anemia
from lack of vitamin b12

sickle cell anemia
from a mutated hemoglobin molecule that causes RBCs to be in a spiky or crescent shape. Cells are stiff, rupture easily, do not carry enough o2 and can clog small vessels. crises are painful

Thalessemia
blood disorder causing reduced hemoglobin on the rbcs. Target shaped cells. S/S: fatigue, weakness, paleness, slow growth.

What types of disorders are sickle cell and thalassemia?
genetic

What are the complications of anemia?
renal failure, fatigue, dyspnea, hypoxima, pale, cold, low metabolic activity

How do we treat anemia?
from the causes! can give o2, blood transfusion if needed

What is polycythemia?
abnormal excess of RBCs leading to thicken blood that clots easily

What is polycythemia vera?
bone marrow cancer that causes high RBC count

What is a secondary cause of polycythemia?
due to low o2 available, affects those at high altitudes

How do we treat polycythemia?
blood dilution where blood is removed and replaced with saline

What is thrombocytopenia?
low platelet count due to bone marrow suppression from chemo, decreased production, decreased platelet survival, intravascular dilation of circulating platelets

What results from thrombocytopenia?
longer bleeding time, petechial, purpura, bleeding gums, hematuria

What do we educate clients with thrombocytopenia?
no contact sports, physical trauma, use electric razors, soft tooth brush, put pressure on wounds.

What is DIC?
life threatening condition in which there is widespread coagulation followed by massive bleeding due to depletion of clotting factors, causing one to bleed out

DIC causes
trauma, malignancy, burns, sepsis, shock and abuptio placente. There is widespread clot formation in small vessels.

S/S DIC
bleeding from multiple sites of the body, clots, bruising and petechiae, hypotension due to low blood volume, shortness of breath, confusion, LOC changes, fevers. Bleed at some time as clotting

How do we treat DIC?
removal or correction of the cause, support major organs, give fresh plasma or packed rbcs, platelets, etc, use heparin to minimize further consumption of clotting factors. Monitor aPTT with heparin use!

What hormone plays a role in RBC production?
erythropoietin

Where is erythropoietin produced?
kidneys

What is a key feature of Hodgkins lymphoma?
Has Reed-Sternberg cells that look like owl eyes

S/S of Hodgkin’s Lymphoma

• Enlarged, painless mass, most often in the neck, but may be mediastinal
  [Growth of the mass is from cytokines and growth factors secreted by malignant cells)
• Lymphadenopathy from local symptoms associated with pressure/obstruction

What is a key feature of non Hodgkins lymphoma?
no reed sternberg cells

How are lymphomas diagnosed?
often asymptomatic, bone marrow biopsy, blood smear

Modifiable risk factors for hypertension
diet, sedentary lifestyle, obesity and weight gain, metabolic syndrome, elevated blood sugar levels, type 2 diabetes, elevated cholesterol, alcohol, smoking

Non-modifiable risk factors for hypertension
family history, genetics, age, ethnicity

primary hypertension
causes are idiopathic but risk factors increase change of having it. Client will often have no symptoms until damage is done to organs

secondary hypertension
based from another condition, common in children, from renal disease or coaction of aorta or obstructive sleep apnea or form medications

Medications used with Hypertension
diuretics to lower blood volume, antihypertensive like beta blockers, ACE inhibitors, A2RB, calcium channel blocker

What are the complications of uncontrolled hypertension?
heart disease, kidney disease, PVD, stroke, heart failure, blindness, hemorrhage

RAAS system steps
Renin from kidney is released and it triggers Angiotensin 1 that constricts the blood vessels. It is then converted to angiotensin 2 with ACE enzyme. Angiotensin 2 vasoconstricts and increases the BP by increasing peripheral resistance

Which organ secretes renin
kidney

What happens with aldosterone and ADH during RAAS system
aldosterone is retained so salt is retained and water will follow as well so ADH will be retained

Purpose of RAAS system
increased the blood pressure and blood volume by hormones and constriction of the vessels

What is coronary artery disease?
Narrowing of the small blood vessels that supply blood and oxygen to the heart. from plaque build up

What causes coronary artery disease?
Caused by plaque buildup in the arteries that impedes blood flow. Can also be damage from bacteria or viruses or an inflammatory response.

S/S of coronary artery disease
chest pain, SOB, dysrhythmias, heart attack, heart failure or death

What does coronary artery disease put someone at risk for?
hypertension, stroke, and increased BP due to narrowing and blockage

What is atherosclerosis?
plaque buildup from fatty material and causes the blood vessels to narrow. Usually from cholesterol, lipids, macrophage deposits that will also cause inflammation

Initiating factor of atherosclerosis
damage to the endothelium inner layer

What is stable angina?
chest pain that occurs with activity or emotional stress. The pain is predictable and is elicited by the same stimuli.

What is unstable angina?
chest pain that is unpredictable, increases over time, duration and severity

Is stable angina relieved with rest and nitroglycerin?
yes

Is unstable angina relieved with rest and nitroglycerin?
no

How do we diagnose acute heart conditions?
12 lead EKG

after load
the pressure or force needed to eject blood from the heart

pre load
the amount of blood returning to each ventricle or that enters and fills at rest

cardiac output
the amount of blood pumped out by each ventricle in 1 minute

what happens during heart failure?
the heart cannot pump effectively, blood cannot move and can back up. CO is decreased as fluid cannot move

Left sided heart failure
affects the lungs and can often lead to right sided heart failure. low CO from the left ventricle causing back up into the lungs

S/S of left sided heart failure
respiratory related! Pulmonary congestion, pulmonary edema, dyspnea, tripoding, gasping, cough with frothy sputum, crackles, hypoxemia, and cyanosis

right sided heart failure
when the right ventricles do not pump the blood, leading to blood backing up into the body

S/S of right sided heart failure
peripheral edema, ascites, JVD, confusion, hepatomegaly nd splenomegaly

What is shock?
imbalance between blood flow and cardiac output. Causes low perfusion

S/S of all Shock
HYPOTENSION, rapid breathing, cold and clammy skin, rapid but weak pulse, dizziness, fainting or weakness, AMS

What is cardiogenic shock?
from severe ventricular dysfunction associated with MI. Decreased cardiac output, elevated left ventricular preload, pulmonary edema.

What is obstructive shock?
from an obstruction that prevents the cardiac filling and stroke volume. From PE, cardiac tamponade or the blood spilling out into the pericardium causing compression, tension pneumothorax or increase of air in the lung cavity that puts pressure on heart

What is hypovolemic shock?
low blood volume, inadequate circulation of the blood usually from a bleed, burn or 3rdspacing. S/S: high HR, cool pale skin, hypotension, cyanosis, low urine output

types of distributive shock
neurogenic, anaphylactic, septic

What is distributive shock?
too many of the blood vessels are dilated, causing peripheral pool of blood.

What is anaphylactic shock?
from a systemic inflammatory response from mast cells releasing vasodilatory mediators causing hypotension from an allergy

S/S of anaphylactic shock
hives, itching, bronchoconstriction, angioedema, stridor, wheezing, and hypotension

What is neurogenic shock? (heart)
widespread vasodilation due to the loss of sympathetic nerve function to activate arterial smooth muscles. From a brain injury, drug overdose or SCI

What is septic shock?
from a response to bacteria or infection. The inflammation leads to profound vasodilation, activation of the clotting cascade, DIC, hypotension, hypoxia, increased capillary permeability

what are complications of shock?
DIC, acute renal failure, multiple organ dysfunction syndrome

DIC and shock
in septic shock, where there is one bleeding but uses up all the clotting factor causing bleeding and ischemia to the tissues.

ARF and shock
from hypotension causing lower blood flow, low GFR

What is multiple organ dysfunction syndrome?
when 2 or more organ systems are affected usually in septic shock that respond to antigens and activate inflammatory response leading to destruction of tissues and organ failure

what is hemostasis?
stoppage of bleeding/ blood clotting

stages of hemostasis

1. Vascular spasm 2. Platelet Phase 3. Coagulation Phase 4. clot retraction 5. clot dissolution

Explain Vascular spasm
immediate response to blood vessel injury resulting in constriction of damaged blood vessel. Happens in about 20-30 mins

Explain Platelet plug formation
platelets form a plug that temporary seal the break in the wall, they stick to collagen fibers exposed and becomes sticky and swell and release chemicals to attract other platelets to site of injury to form the plug.

Explain coagulation phase
blood clotting and the rbcs are trapped and turned into a gel with prothrombin to create a fibrin mesh around the hole and blood cells until the blood vessel can have permanent repair.

explain clot retraction
regression in the size of the blood clot over several days

Explain clot dissolution
dissolving or breakdown of the clot

What medications can affect the hemostasis?
heparin and lovenox can increase chance of bleeding

What is hemophilia?
different hereditary bleeding disorders caused by a deficiency of clotting factors

S/S of hemophilia
prolonged bleeding with minor injury that can be life threatening, joint damage, bleeding in joint cavities.

Hemophillia A
factor 8 deficiency

Hemophillia B
factor 9 deficient

Treatment hemophilia A
factor 8 concentrate

Treatment hemophilia B
plasma

What type of disorder is hemophilia?
genetic

normal BP range
120/80

Normal HR range
60-100 bpm

Normal respiratory rate
12-20 breaths per minute

High BP
140/90

Low BP
90/60

bradypnea
less than 12 breaths per minute

Tachypnea
more than 20 breaths per minute

Tachycardia
heart rate above 100 bpm

Bradycardia
heart rate less than 60 bpm

Normal temperature
98.6

fever temperature
100.4

What is a sign?
something you can observe

examples of signs
Bleeding, fever, swelling, rash

What is a symptom?
subjective sensation that the person feels from the disorder

examples of symptoms
pain, dizziness, itching, nausea

What is anaplasia?
Loss of cell differentiation and tissue organization. in malignant tumors

What is metastasis?
cancer cells leaving a tumor and invading other parts of the body

Physiology reactions in the body during “fight or flight” response?
Increased heart rate

Ventilation
The transport of air from the atmosphere to the lungs and out again.

Edema
Caused by decreased plasma protein

Clinical Manifestation of Hyperthyroidism
Tachycardia

What electrolytes are higher in ICF (Intracellular Fluid)
Potassium , Magnesium, Phosphates and Proteins

Steps of Laceration Correction
Homeostasis, Vasospasm (blood vessels narrow to decrease blood flow & increase BP), Platelet Plug Formation (activation, aggression, and adherence of platelets into a plug that serves as a barrier against blow flowing out of the vessels). Coagulation (clotting, changes blood to gel.

Homeostasis
A tendency to maintain a balanced or constant internal state; the regulation of any aspect of body chemistry, such as blood glucose, around a particular level

Appendicitis
inflammation of the vermiform appendix, obstruction arises inside of the appendix

clinical manifestations of Appendicitis
Pain near umbilcus that moves to LRQ= McBurney that increases 12-24 hours. Aggravated by movement

Peptic ulcer disease (PUD)
Erosive lesions affecting the lining of the stomach or duodenum.

Clinical Manifestations of Peptic ulcer disease
Adymptomatic, epigastric or abdominal pain, abdominal cramping, heartburn, indigestion, chest pain, N/V, fatigue, unexplained weight loss.

Acute Respiratory Failure (ARF)
Life threatening condition resulting from COPD, Asthma, ARDS, ALS, Alcohol/drug overdose, spinal cord injury.

Clinical Manifestations of Acute Respiratory Failure (ARF)
Shallow respirations, headaches, tachycardia, dysrhythmias, lethargy, confusion, oxygen levels drop below 50 and carbon dioxide become high above 50.

pulmonary embolism (PE)
Emboli=originate in venous circulation, travels to the right side of heart the to pulmonary circulation creating a pulmonary embolism.

Cystitis
inflammation of the bladder

Pylonephritis
infection of the kidneys

PTH (parathyroid hormone)
Is secreted when calcium levels DROP

Calcitonin
Is secreted when calcium levels are HIGH

Acute Kidney Injury (AKI) Stages
Prerenal, Intrarenal, Postrenal = sudden loss of renal function over a period of days to weeks)

Prerenal
Disrupt blood flow on it’s way to the kidneys

Intrarenal
direct damage to the kidneys by inflammation, toxins, drugs, infection, or reduced blood supply

Postrenal
Interferes with the urine excretion

acute respiratory distress syndrome (ARDS) Clinical Main.
Dyspnea, labored breathing, abnormal lung sounds, cough/frothy, hypoxia, cyanosis, fever hypotension, tachycardia, restlessness, confusion, lethargy, anxiety

Left side heart failure clinical Manifestations
Pulmonary fluid accumulation, dyspnea, activity intolerance

Pathophysiology of multiple sclerosis
Neuro inflammatory disease that involves an abnormal/ immune mediated process directed gains the CNS = progressive & irreversible demyelination of brain, spinal cord & cranial nerve neurons. Inflammatory damage occurs in diffuse patches through the nervous system and slows or stops nerve impulses.

Diffusion
Movement of molecules from an area of higher concentration to an area of lower concentration.

Osmosis
Movement of water or another solvent across the cellular membrane from an area of low solute concentration to an area of high solute concentration.

acromegaly
Increased bone size caused by excessive GH levels in adulthood (caused by hyperpituarism)

Giantism
Tall stature caused by excessive GH levels prior to puberty (childhood) (caused by hyperpituarism)

Dwarfism
Dificent levels of GH somatotropin or soma tropic releasing hormones, resulting in short stature. (Hypopituitarsm)

clinical manifestations of asthma
wheezing, cough, dyspnea, chest tightness, shortness of breathe, prolonged expirations phase, tachypnea, hypoxia, anxiety

causes of atherosclerosis
Endothelial injury to vessel walls due to smoking, dyslipidemia, hypertension, diabetes mellitus, elevated c-reactive proteins levels, elevated homocysteine levels, autoimmune processes and some infections.

Backwards effects of right-sided heart failure
Blood backs up in the right atrium, then in the peripheral circulation, causes increased peripheral pressures in capillary bed.

Emphysema
Causes barrel chest b/c the anterior -posterior thoracic diameter from 1:2 to 1:1.

Clinical Manifestations: myocardial infarction
Asymptomatic, unstable angina, fatigue, nausea & vomiting, SOB, coughing diaphoresis, indigestion, elevation in cardiac bio markers, EKG changes, Dysrhythmias, anxiety, syncope, dizziness, sleep disturbance.

Clinical Manifestations of hyperthyroidism
Exophhthalmos (blugging eyes), sudden weight loss, tachycardia, dysrhythmias, hypertension, increased appetite, nervousness, anxiety, difficult concentrating, tumor, diaphoresis, abnormal uterine bleeding, sensitivity to heat, diarrhea, goiter, difficulty sleeping

Complications of compartment syndrome
Permanent tissue damage

rheumatoid arthritis
A chronic systemic disease characterized by inflammation of the joints, stiffness, pain, and swelling that results in crippling deformities. Causes chronic synoritis

causes of contact dermatitis
Direct exposure to an irritant/ allergen – producing substance (soaps, body fluids, chemicals) Allergen (metal, chemicals, adhesives, cosmetics & plants)

Characteristics of coronary artery disease (CAD)
Angina (jaw, neck, arm, back) indigestion- like sensation nausea and vomiting, cool clammy extremities, diaphoresis, dyspnea, fatigue weakness, sleep disturbances

Cushing’s syndrome
a condition caused by prolonged exposure to high levels of cortisol Glucocorticoids (round full red face=moon face), buffalo hump, muscle weakness/wasting.

Goal for treating anemia
Increased erythropoiesis to increased production, vasodilation, tachycardia to increase blood floe, increased respiratory rate to increase oxygen saturation.

Cystic fibrosis
Salty skin, meconium ileus due to excess mucus production, steatorrhea, fat-soluble vitamin deficiency.

cerebral palsy
Affects motor movement and muscle coordination, cognition and communication caused by damage to the cerebellum during child birth. Brain abnormalities.

Imbalances for SIADH
Increased renal water retention due to excessive ADH levels.

Pathophysiology for type 1 diabetes
Immune system destroys pancreatic beta cells. Unknown cause

Glucagon
The hormone that raises blood sugar. (Epinephrine, cortisol, ACTH, growth hormone, thyroxine and Asprosin)

Diagnosis a patient with MI(myocardial infraction)
EKG, cardiac bio maker, stress testing, nuclear imaging and angiography.

Presentation of Parkinson’s Disease
Tremors, stooped posture, mask like fancies, arms flexed at elbows and elbows and waist, hips and knees slightly flexed, short shuffling step.

characteristics of DIC
Endothelial damage, release of tissue factor, activation of factor X. Disease triggers coagulation cascade and fibrinolytic pathway.

Outcomes of GOUT
Joint deformities and limited joint movement, joint pain, tophi ( 4 phase) 1. Asymptomatic 2. Acute flares and attacks 3. Clinically inactive 4. Chronic gout

peptic ulcer
Are caused by an imbalance between destructive forces (excess acid production) and protective mechanisms (decreased mucus production) induced by a secondary process rather than an image defect.

Hepatic encephalopathy
Is caused by serve liver damage. It affects the brain functions and doesn’t remove toxins from the blood. Increased blood ammonia levels. Hepatitis or cirrhosis.

HPV causes
cervical cancer and cirrhosis

Diabetic Katoacidosis (DKA)
Is caused by a PH imbalance marked by increased ketones in the urine due to insufficient insulin. Starved cells result in a fat breakdown that produces toxic fatty acid production of the ketones 3. (Diabetes Mellitus)

Modifiable risk factors
contributors of a noncommunicable disease that can be altered by changing one’s behavior or environment

Non-modifiable risk factors
age, gender, genetics

Hypotremia
abnormally low blood sodium levels. Causes cerebral edema, nerve conduction becomes impaired

passive immunity
the short-term immunity that results from the introduction of antibodies from another person or animal or recombinant DNA.

Causes of increased intracranial pressure
TBI and other conditions that increase the volume in the skull (tumor, hydrocephalus, cerebral edema + hemorrhage) (monro-kellie hypothesis)

Clinical Manifestations of leukemia
Leukopenia, anemia, thrombocytopenia, joint swelling intake, bone pain, weight loss, anorexia, hepatomegaly, splenomegaly, CNS dysfunction

risk factors of hypertension
Cardiovascular disease, CAD, MI, HF, Stroke

intussusception
telescoping of the intestines (slides into another portion) (mechanical bowel obstruction)

spinal cord injuries
Are caused by direct injury to spinal cord or indirect damage to surrounding bones, tissues or blood vessels as a result of blunt or penetrating physical forces. (Motor vehicle accidents, falls, sports, gunshot wounds)

Minor spinal cord injury
Weakening vertebral structures (Ra or osteoporosis)= pulled, pressed, sideways or compressed = head, neck, back twists

Meningitis
inflammation of the meninges and subarachnoid space resulting from infection.

Cerebrovascular accident
CVA= stroke = causes permanent damage, interrupts brain blood flow results total vessel occlusion or cerebel vessel rupture (thrombus, embolus, plaque) cerebral aneurysm arteriovenous malformation or hypertension.

Organs effected by hypertension
Heart, eyes, brain and kidneys

osteoprosis
A condition in which the body’s bones become weak and break easily. Caused by mutlipe pathogenetic mechanisms that interact to cause a decrease in osteoclast activity or an increase in osteoblasts activity. Wrist or vetebrae and the compact bones becomes thin. Cytokines production that increase bone resorption.

polycythemia vera
Bone marrow produces too many erythrocytes, sometimes too many leukocytes and platelets. (Neoplasticism disease due to uncontrolled cell proliferation’s (increased blood cell #’s = increased blood volume.)

risk factors of pneumonia
Aspiration of gastric content endotracheal intubation, respiratory suctioning, inhalation of smoke or chemicals.

Clinical findings of shock
Thirst, dry mucus membrane, tachycardia, thready pulse, restlessness, anxiety and irritability, tachycardia, cool pale skin, hypotension, cyanosis, dizziness, confusion, syncope, decreased urinary output, hyperlactoemia, metabolic acidosis.

tension pneumothorax (Most serious)
When pressure in the pleural space i greater than the atmospheric pressure.

Treatment for tension pneumothorax
Removal of air and reestablishment of negative pressure allowing for full lung expansion. (Tho race ties and placement of a chest drainage tube w/ suction to remove fluid + reestablishes negative pressure.

Metastatic Cancer
Cells invade local tissue, over run neighboring cells.

clinical manifestations of septic shock
Decreased CO when arterial blood pressure decreases, kidneys release renin to increase BP and peripheral resistance.

Cause of Intrarental Kidney Injury
Contrast Dye

Thrombocytopenia
Is caused by decreased platelet production, platelet dilution from transfusion decreased platelet survival.

Generalized seizures
Are a result of abnormal neuronal activity on both sides of the brain.

Sepsis
A condition resulting from the presence of harmful microorganisms In the blood or other tissues and the body’s response to their presence, potentially leading to the malfunctioning of various organs, shock, and death.

Lateral scoliosis
Looks like a “S” on a X- Ray

stress incontinence
the inability to control the voiding of urine under physical stress such as running, sneezing, laughing, or coughing – sphincter muscle of the bladder weakness.

Prevent transmission of infectious agents
Wash hands, limit contact, eye hygiene and discarding contaminated ophthalmic products.

Hodgkin Disease Key Marker
Reed-Sternberg cells

The standard goal to diagnose ischemic/hemorrhagic stroke.
CT Scan

What do kidneys secrete to increase RBC production
Erythropoietin

What is the main function of the endocrine system
To release hormones into the bloodstream

Thrombocytopenia
Decreased platelet levels a condition that increases the risk of bleeding and infection.

Mycobaterium tuberculosis
Is transmitted person-to-person through the inhalation of tiny infected aerosol droplets.

Ribosomes
Makes proteins on the RER and poly sores (Found in the cytoplasm)

Preventing spinal cord injury
Wear safety equipment, avoid illicit drug use, alcohol use consumption, get vaccinated, maintain adequate nutrition.

Treatment for Hemophilia A
Transfusions, replacing factor VIII in the blood, DDAVP nasal spray replaces factor VIII, Amicar (an antifibrinolytic agent) may be prescribed to control dental bleeding, and safety precautions to prevent injury

Clinical Manifestations for sickle cell crisis
Stomach and bone pain, dyspnea, fatigue, fever, jaundice, pollor, skin, ulcers, angina, painful + prolonged erection, visit impairment, frequent infections, leg ulcers, stroke.

Stable Angina
Ischemia that is initiated by increased demand (activity) and relieved with the reduction of that demand (rest)

Unable Angina
Change in pain, considered a preinfarction state. (Chest pain becomes unpredictable occurs @ rest. Or increases infrequency or intensity.

Virchow’s triad
Pulmonary embolism (triad = blood stasis, endothelial damage, hyper coagulation) Promote thrombusformation.

Dialysis is necessary for end stage renal disease
Purifying the blood of a person who kidneys are not working, (Filter blood + rid of waste).

reperfusion injury
is the tissue damage caused when blood supply returns to the tissue after a period of ischemia or lack of oxygen. The absence of oxygen and nutrients from blood during the ischemic period creates a condition in which the restoration of circulation results in inflammation and oxidative damage through the induction of oxidative stress rather than restoration of normal function. (Anoxia or Hypoxia) Secondary Injury that occurs after reestablished blow flow.

Renin
hormone secreted by the kidney; it raises blood pressure by influencing vasoconstriction (narrowing of blood vessels)
-also promotes production of the protein (angiotensin I to angiotensin II and stimulates aldosterone secretion)

DIC
Is a severe complication of pancreatitis

What are the results of prerenal kidney injury?
Extremely low blood pressure or blood volume (hemorrhage, sepsis, dehydration, shock, traumatic injury)
Heat dysfunction (myocardial infarction + heart failure)

Normal ABG values
pH: 7.35-7.45

PCO2: 35-45

PO2: 95-100

Bicarb: 22-26

BE: -2.4+ 0 +2.5

O2 Sat 96%-98%

Sign
What can be seen or measured

Symptom
what the patient tells you, but not visible

Subjective
what the patient says

Contraindication
Is specific situation in which a drug, procedure or surgery should not be used because it may be farmful to the person.

Decreased cardiac output is the common findings of all forms of heart failure
True

Altered LOCs is the most sensitive indicator of altered brain function
True

Name the condition of excess GH released by the pituitary gland in childhood
Gigantism

What is the clinical mai infestation of hypertension
Tachycardia

Cushing syndrome is often associated with
Increased glucocorticoid production

This is a characteristic of Disseminated Intravascular Coagulopathy
Clotting, bleeding

The first step in dermal injury correction is
Re-establish homeostasis

The pathophysiology of exercise-induced asthma includes
Post exercise bronchospams

This causes hepatic encephalopathy
Increased blood ammonia levels

Patients with hypovolemia can exhibit
Fatal swelling in the brain

What causes a mechanical bowel obstruction?
Intussusception

The identifies metastatic cancer
Cell invade local tissue, overrun neighboring cells

A pneumothorax is defined by a
Large amount of air in the pleural space

A generalized seizure causes neuronal abnormalities in
Both hemispheres

Hypoventilation results in __ in the blood
Increased CO2

A clinical manifestation of septic shock includes
Decreased CO

When arterial blood pressure decreases, kidneys release __ to increase
Renin

What increases the risk of women’s predisposition to UTI’s
Short perineum

What causes a ridged abdomen in peritonitis patients
Peritoneal inflammation

What is the cause of leiomyoma?
Genetic mutations

Treatment for oral cancer includes:
Surgery

What is the cause of NAFLD?
Insulin Resistance

What is the cause of pyelonephritis
UTI due to E. Coli

What’s are the clinical manifestation of acute pancreatitis
Nauseas and vomiting

What is the cause of a hiatal hernia?
Weak diaphragm muscle

What causes HSVI and HSVII
Herpes Simplex Virus

Antibiotics use results in
Diarrhea

Virchow’s Triad includes all of the following EXCEPT:
Damage to arterial wall

Symptoms of ARDs include all the following EXCEPT
Retention of oxygen due to damage of the alveoli

Which of the following conditions occur as a result of increased ammonia levels in the bloodstream?
Hepatic encephalopathy

Contrast dye causes which of the following kidney injury?
Intrarenal

True or False: Primary brain injury results from the body’s response to tissue damage
False

Irreversible brain injury that can occur before, during, or after birth is known as
Cerebral palsy

Virchow’s Triad includes all of the following EXCEPT
Damage to arterial wall

Thrombocytopenia is caused by all of the following EXCEPT
Overproduction of platelets

Which of the following ABG values is outside of the normal range?
HCO3 18

True or False: Non-Hodgkin’s Lymphoma is diagnosed by the presence of Reed-Sternberg cells in a blood smear/sample
False

All of the following are examples of modifiable risk factions for HTN except
Age

All of the following are presenting symptoms of left-sided HF except
Peripheral edema

All of the following are presenting signs of shock EXCEPT
Tachypnea

Renin, a hormone that increases BP when arterial BP decreases, is produced by the __
Kidneys

All of the following are causes of obstructive shock EXCEPT
Severe ventricular dysfunction

Causes of obstructive shock
Pulmonary embolism, cardiac tamponade, tension pneumothorax

Bronchoconstriction, urticaria, peripheral dilation, and increased capillary permeability are symptoms of which shock?
Anaphylactic shock

Virchow’s triad includes
Venous blood stasis, damage to venous wall, increased coagulability

Symptoms of ARDs include
Severe hypothermia, decrease in lung compliance, pulmonary edema

Thrombocytopenia is called by
Decreased platelet production, platelet dilution from transfusion, decreased platelet survival

Symptoms of Left-sided HF
Dyspnea, crackles auscultation in lung, cough with frothy sputum

Signs of shock
Altered mental status, cool, clammy skin, tachypnea

clinical manifestations of anaphylaxis
feeling lightheaded or faint, breathing difficulties such as fast, shallow
breathing, wheezing, tachycardia, clammy skin, confusion and anxiety, collapsing or
losing consciousness

Presentation of liver disease
Jaundice, abdominal pain and swelling, swelling in the legs and ankles, inflammation of liver.

Cirrhosis
Chronic, progressive, irreversible diffuse damage to the liver resulting in decreased liver function.

Symptoms of COPD
SOB, wheezing, chest tightness, chronic cough that may produce sputum that is green, clear, white or yellow, frequent respiratory infections, lack of energy, unintended weight loss, swelling in ankles, feet or legs

Pathophysiology of type 1 diabetes
Immune system destroys pancreatic beta cells, can be viral/environmental trigger in genetically susceptible people due to an autoimmune reaction.

Exercise Induced Asthma
Occurs 10-15 mins after physical activity ends; symptoms can linger 1 hour, cool/dry results in asthmatic symptoms that is compensatory mechanism to warm, moisten airway

Identify kidney disease
Tired, less energy, trouble concentrating, trouble sleeping, dry and itchy skin, need to urinate more often, hematuria, foamy urine, persistent puffiness around eyes.

Secondary brain injury after trauma
Refers to the change that evolves over a period of hours to days after the primary brain injury.

Bone stores electrolytes and acts as an electrolytes and acts as an electrolyte pool
Site of fat, mineral storage(calcium) and hematopoiesis.

A patient with hypoventilation looks like
Cyanosis, drowsiness, fatigue, morning headache, swelling of ankles, anxiety, disturbed sleep, labored breathing, SOB, depression, slow and shallow breathing

Physiological concepts of flight or fight response?
The release of catecholamines and cortisol during the alarm stage of the generalized adaptation syndrome. SNS triggers an acute stress response. Pupils dilate, HR and BP increases, bladder relaxes.

Define Homeostasis.
Equilibrium of the body.

Function of a ribosome?
Aid in protein production.

Hormone that raises blood sugar?
Glucagon

Main function of the endocrine system?
The glands of the endocrine system secrete a wide range of hormones and chemical messengers that help regulate growth, development, mood metabolism, and reproduction.

Function of plasma protein?
Albumin, globulins, and fibrinogen. Maintains osmotic pressure, coagulation factors, transports antibodies, hormones, lipids, vitamins, and minerals.

Intracellular contain a high __– note which electrolytes
Potassium, magnesium and phosphate

Physiologic effect of hyponatremia?
Results from low serum sodium levels (<135 mEq/L). As sodium levels decrease, water shifts into cells. This can cause unstable gait, osteoporosis, attention deficit, cells swell.

Define hypovolemia
fluid deficit in the intravascular compartment

This stores electrolytes and acts like an electrolyte pool in the body
the kidneys

Define “sign”, “contraindication”
Sign: something found during an exam, or diagnosis testing that indicates something
Contraindication: Anything (including a symptom or medical condition) that is a reason for a person to not receive a particular treatment or procedure because it may be harmful

Normal range of sodium
135-145 mEq/L

Clinical manifestations of fluid volume overload
Hypovolemia. C/M: swelling (edema) of the feet, ankles, wrists, face, high BP, headache, and bloating.

Know components of insensible water loss
The amount of body fluid lost daily that is not easily measured, from the respiratory system, skin, and water in the excreted stool.

Define hypotonic, hypertonic, and isotonic solutions
Hypotonic: Lower concentration of sodium/solutes in solution than the blood cells swell
Hypertonic: Higher concentration of sodium/solutes in solution than the blood cells shrink
Isotonic: equal concentrations

define osmosis
movement of water from low concentration to high across a cell membrane

Normal pH of blood
7.35-7.45

define diffusion
movement of solutes: from high to low concentration

An increase in sodium and osmolality is associated with a deficiency in water
true

How does the body maintain acid-base balance?
Normal acid-base balance is maintained by the lungs and kidneys.
Carbon dioxide, a by-product of normal metabolism, is a weak acid.
The lungs can prevent an increase in the partial pressure of carbon dioxide (Pco2) in the blood by excreteting the carbon dioxide (CO2) produced by the body. The kidney tubules maintain pH.

Clinical manifestations of metabolic acidosis
anorexia, nausea, vomiting, abdominal pain, weakness, lethargy, confusion, coma, decreased cardiac output

Define sepsis
an extreme systemic inflammatory response to infection

always wash your hands to prevent transmission of infectious agents
true

know the steps of the inflammatory process

1. Blood vessels dilate to bring blood flow to injured area
2. Blood vessel walls become permeable
3. Fluid and phagocytes pass out of the capillaries
4. Lymphatic drainage removes poisonous substances
5. Phagocytes accumulate to ingest bacteria and other foriegn bodies. This cleans up cellular debris caused by iinjury/damage

warmth and redness during cellulitis infection is due to what?
infection and inflammation

fever is an indicator of homeostatic control in the body

Know the role of histamine during an allergic reaction and outcomes
Histamine increases the permeability of the capillaries to WBCs and other proteins, allowing them to engage in foreign invaders in the infected tissues.

Systemic effect during an inflammatory response
systemic inflammatory response syndrome (SIRS) is an exaggerated defense response of the body to noxious stressor (infection, trauma, surgery, acute inflammation, ischemia, or reperfusion, or malignancy) to localize and then eliminate the endogenous or exogenous source of the insult.

Clinical manifestations of anaphylaxis
a severe, potentially life threatening allergic reaction. CM include swelling, difficulty breathing/ swallowing, shortness of breath, chest tightness, wheezing, cramps, hives, etc.

disorders associated with an excessive immune response
asthma, systemic anaphylaxis, due to inflammation

passive immunity
the immunity is given to you already, body does not have to work for it

define autoimmune disease
the bodys immune system attacks healthy cells. its an overactive and inappropriate immune response.

define and know the role of a monocyte, neutrophils macrophages, lymphocytes
Monocytes: WBC that replinish macrophages and dendritic cells in normal states and respond to inflammation by migrating to infected tissue
Neutrophils: infection fighting agents, which are usually the first to arrive on the scene of an infection
Macrophages: WBC within tissues, produced by differentiation of monocytes; they phagocytize and stimulate lymphocytes and other immune cells to respond to pathogens.
Lymphocytes: T cells, natural killer cells, B cells. they provide immunity against viral infections and make antibodies.

Define leukocytosis
increased WBC count

Define active acquired immunity
body must build antibodies and work for the immunity

define metastic cancer
cancer that spreads from the origin

know the goal of systemic cancer treatment
to destroy cancerous cells in multiple locations of the body

differentiate from benign and malignant tumors
Benign: consists of differential cells which are rapidly reproducing usually encapsulated. remains localized.
Malignant: usually consist of undifferentiated, non-functioning cells which reproduce rapidly, penetrating surrounding tissues and spreading to secondary areas

fatigues is an early symptom of cancer
true

know the steps of carcinogenesis
initiation, promotion, progression

define anaplasia
uncontrolled proliferation and loss of differentiation

define “tumor grading” of cancer cells
stage 1: cancer is localized to small area, hasn’t spread to lymph nodes
stage 2: cancer grown, hasn’t spread
stage 3: cancer has grown larger and possibly spread to lymph nodes or other tissues
stage 4: cancer has spread to other organs and areas of the body

know the tumor, node, metastasis grading scale and definitions
method of expressing the extent of cancer by evaluating the tumor size, nodal involvement, and metastatic progress.

know different burn types (all)
first degree: superficial, reddening of the epidermis
second degree: partial thickness, affects epidermis and dermis, redness, swelling, and blistering
third degree: full thickness, affects deeper tissue, charred skin that may be blacked and numb

know what to look for/ assess in a patient with atopic dermatitis
dry, itchy skin, blistering, most reddened skin, white patches

know clinical picture/outcome of pediculosis patient
lice. 1-3mm long

prevention methods of squamous cell carcinoma
using sunscreen
wearing protective clothing
avoid self tanning

know clinical picture/outcome of atopic dermatitis
exudative lesions, erythema, and scaling around the eyes. creases of the skin are mostly affected.

know changes in elderly skin
it becomes thinner, loses fat and elasticity

Know clinical picture/outcome of gout
sudden, severe attacks of pain, swelling, redness, and tenderness in the joint. Most often the big toe.

cause of osteoporosis
osteoporosis is a condition characterized by a progressive loss of bone calcium that leaves the bone brittle.
causes: decreased intake of protein, vitamin C and D, smoking, excessive alcohol intake, excessive phosphorus intake

know clinical picture/ outcome of shoulder dislocation
when upper arm bone pops out of the shoulder blade socket

differentiate between osteomalacia and rickets
osteomalacia is a softening and weakening of bones in children, usually because of an extreme and prolonged vitamin D, Calcium, or phosphate deficiency. Rickets is for children.

differentiate between sprain and strain
strain: an injury to a muscle or tendon that often involves stretching or tearing of the muscle or tendon.

Sprain: is an injury to a ligament that often involves stretching or tearing of the ligament.

be able to identify scoliosis
lateral deviation of the spine, shoulders may be uneven, looks like patient is leaning

know complications of compartment syndrome
compartment syndrome is a serious condition that results from pressure increases in the body compartment, usually the muscle fascia in the case of fractures. Muscle scarring, infection, decreased blood flow, nerve damage.

know clinical/outcome of osteoporosis
osteoporosis is a condition characterized by a progressive loss of bone calcium that leaves the bone brittle. CM include muscle scarring, infection, decreased blood flow, nerve damage

Know/identify all bone fractures and images- be able to identify and distinguish

Define dislocation
injury where bone is forced out of its normal position

know clinical/outcomes of fibromyalgia
fibromyalgia is a syndrome predominately characterized by widespread muscular pain and fatigue. this disorder affects the joints, muscles, tendons, and surrounding tissues. Unknown cause.

distinguish between rheumatoid arthritis and osteoarthritis.
Osteoarthritis: is caused by mechanical wear and tear on joints

Rheumatoid: is an autoimmune disease where the body’s own immune system attacks the joints.

Define ankylosing spondylitis
a chronic progressive inflammatory disease of unknown origin, first affecting the spine and adjacent structures (including the sacroiliac joints, intervertebral spaces, and costovertrebral joints)and commonly progressing to eventual fusion of the involved joints

know clinical picture/outcome of Paget disease
Abnormal bone destruction and remodeling. Bones appear enlarged or deformed.

know cause of mechanical bowel destruction
physical barriers, due to foreign bodies, tumors, adhesions, hernias, intussusception, volvulus, strictures, crohn’s disease, diverticulitis, fecal impaction

Excessive H. pylori causes what
peptic ulcers

risks for developing liver cancer
hep B or C, cirrhosis, inherited liver disease such as hemochromatosis and Wilson’s disease. Nonalcoholic fatty liver. disease, diabetes, toxin exposure.

Patient most at risk for intestinal obstruction
people who’ve had abdominal surgery

patient most likely to develop pancreatic cancer
patients with intestinal adhesions from surgery, those with hernias, or colon cancer

which patient is most likely to develop hepatitis B, presentation of disease
Babies during childbirth, drug users, health care providers, people with multiple sex partners, gay men, dialysis patients, inmates, pregnant women

Hepatitis A is mainly transmitted by the oral-fecal route
true

know clinical picture/outcome esophageal varices
esophageal varies are enlarged veins in the esophagus. they’re often due to obstructed blood flow through the portal vein, which carries blood from the intestine, pancreas, and spleen to the liver.

symptoms of liver disease
jaundice, abdominal pain and swelling, swelling in the legs, nausea

know the clinical picture/outcome esophageal cancer
difficulty swallowing, abnormal weight loss, chest pain/pressure, indigestion

know complications of end-stage liver cirrhosis
ascites, encephalopathy, portal hypertension, vatical bleeding, hepatorenal syndrome

Main CM of gastric ulcers
upper abdominal pain, chest pain, fatty food intolerance, nausea, vomiting burning stomach pain

physical assessment technique that assesses kidney disease
palpate behind the rib cage and iliac crest , and right coastal margin. Press and ask patient to take deep breaths. Feel for lower pole of the kidney.

importance of dialysis
performs as the kidneys, it removes waste and excess water from the body

Hemorrhage would result in pre-renal kidney injury
true

what triggers the RAAS system?
sudden drop in BP reduced blood volume

CM of increased renin secretion
Hypotension (low BP). Blood loss. Lack of blood flow to your kidneys

Know the function of the kidney
Main job is to cleanse the blood of toxins and transform the waste into urine

Organism that causes pyelonephritis
pyelonephritis is an infection that has reached one or both kidneys. Escherichia coli.

Why are casts present with acute poststreptococcal glomerulonephritis
because the inflamed tubules mold RBCs and proteins into a mass

Polycystic kidney disease results in gradual degeneration of the kidneys
true

know the phases of kidney injury
initial (prodromal) phase: Asymptomatic. although renal damage is occurring, the nephrons that are still functioning to compensate for those that are not.

Second (oliguric) phase: impaired glomerular filtrations leads to solute and water reabsorption. this reabsorption decreases daily urine output to approximately 400 mL or less, such that waste products begin to accumulate (uremia).

Third (diuretic) phase: renal function gradually returns as healing and cellular regeneration occur. Diuresis occurs due to tubular damage that impairs the kidneys ability to concentrate urine. Daily urine output in this phase can be as much as 5L. The excessive urine output can lead to dehydration and electrolyte imbalances.

Recovery stage: glomerular function gradually returns to normal. this final stage can persist for 3-12 months. depending on the individuals age and overall health, full renal function may be regained.

know clinical picture/outcome end-stage renal disease
a medical condition in which a persons kidneys cease functioning on a permanent basis leading to the need for regular course of long-term dialysis or a kidney transplant to maintain life.

Hypokalemia and hyperkalemia causes what in the heart?
cardiac arrhythmias

Low GFR and increased urea indicate early stages of renal failure
true

define azotemia
elevated levels of urea and other nitrogen compounds in the blood. Buildup of waste products

Fluid and sodium retention is measured by what and what in the body
heart and kidneys?

complications of renal calculi
AKA kidney stones. complications can include severe infections including septicemia (blood poisoning) which can be life-threatening. renal scarring and damage to the kidneys, resulting In permanent renal failure.

Define cystitis
inflammation of the bladder

define and distinguish all forms of incontinence in the body
Nocturnal incontinence: involuntary urination while sleeping.

Stress incontinence: describes loss of urine from intra-abdominal pressure (stress) exerted on the bladder by coughing, sneezing, laughing, exercising, or lifting something heavy.

Urge incontinence: sudden urge to urinate with little or no warning

Reflex incontinence: refers to urinary incontinence caused by trauma or damage to the nervous system (caused by spinal cord injury above the second to fourth vertebrae, multiple sclerosis, and diabetes Mellitus)

Overflow incontinence: is the result of an inability to empty the bladder

Mixed incontinence: occurs when the patient experiences symptoms of more than one type of urinary incontinence

Functional incontinence: occurs in many older adults, especially residents of nursing homes. in such a case, a physical or mental impairment prevents toileting in time. for example, a person with severe arthritis may not be able to undress quickly enough to prevent incontinence.

Gross total incontinence: a continuous leaking of urine, day or night, or the periodic uncontrollable leaking of large volumes of urine. in these cases, the bladder has no storage capacity.

Transient incontinence: urinary incontinence resulting from a temporary condition. such conditions may include delirium, infection, atrophic vaginitis, use of certain meds.

Define enuresis
involuntary urination by a child after the age of 4-5 years, when bladder control is expected.

blood and protein leaking through the filtrate causes dark urine in glomerulonephritis patients
true

know normal flow of urine
kidneys to ureters to. bladder to urethra

why is cystitis more common in females
Because a women’s urethra is shorter and is in close proximity to areas that contain bacteria.

most common symptoms of malignant bladder tumor