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Patho
Test 4
| Question | Answer |
|---|---|
| if a patient has athersclerosis what are they at greater risk for | stroke |
| athersclerosis | narrowing of vessels due to lipid and fat lessens blood supplay and creates turbulent flow which can lead to a thrombosus |
| emboli | clot mets |
| variscosities | vein permanently dilated |
| hypertension | pressure system is always working hard- silent killer |
| ischemic atrophy | turn down blood flow to an area causes it atrophy but not die |
| transient ischemic attack | athersclerosis in carotid arteries- vascular spasm cuts the whole area off then releases- lasts 24 hours |
| angenapectoris | heart pain due to lack of blood supply- work related |
| intermittient clottication | calf pain based on how much work you have done |
| angiography | inject die into circulatroy system that shows up in x-ray |
| location of ulcers tells you what | what kind of problem- venous is around calf or ankle and arterial is around toes |
| fundoscopic exam | looks at back of eye at the vessels |
| what are the 3 different processes of developing athersclerotic plaques | thickening of intimal and media layer in arterioles, calcification of the media in large arteries, and development of lipid rich plaque with fibrous cap |
| coronary artery disease | athersclerosis in coronary arteries |
| 6 major risk factors for athersclerosis | hyperlipidemia, hypertension, cigarette smoking, diabetes, obesity, and hyperhomocysteinemia |
| hyperhomocysteinemia | risk to develop clots in venous system- tx is good diet of B6 and 12 |
| 4 minor risk factors for athersclerosis | old age, family history, low activity level, and negative psych factors |
| 50% of myocardial infarctions and 75% of strokes attributed to what | diabetes |
| what percentile BP is considered hypertension | 95th in children |
| what percentile BP is considered prehypertension in children | 90-95th or greater thatn 120/80 |
| 5 cardiovascular manifestations of elevated BP | heart failure, accelerated athersclerosis, myocardial infarction, anneurysm, aortic dissection |
| aortic dissection | blood erodes in between the 2 walls of the vessel until massive eruption of blood occurs |
| 5 neurologic manifestations of elevated BP | stroke, intraparenchymal bleeding, blindness, memory impairment, chronic renal failure |
| intraparenchymal bleeding | bleeding in an outside place |
| 3 types of vasculitis | systemic lupus erythematosus, polyarterities nodosa, temporal arteritis |
| polyarteritis nodosa | nodular inflammatory thickening of medium sized arteries- kidneys and other places- causes obstruction of blood flow |
| 3 functional vascular diseases | Raynaud's, thrombophlebitis, pulmonary emboli |
| thrombophlebitis- | thickening and sluggish blood flow- could thicken into thrombis and embolize |
| cardiogenic shock | body is in shock bc hear is not pumping |
| hemmorhagic shock | hypovolumic- not enough volume to keep body working |
| Septic shock | total body infection- small vessels shut down |
| neurogenic shock | spinal cord is damaged- turns off below injury |
| what happens if more than 40% of left ventricle is infarcted | cardiogenic shock followed by death |
| most common congenital heart defect | bicuspid aortic valve defect |
| bicuspid aortic valve defect | fatigued, painful, child, left heart hypertrophies, backflow during diastole |
| what are the symptoms of patent ductus arteriosus | fast breathing, poor feeding, rapid pulse, shorness of breath, sweating while feeding, tires very easily, poor growth |
| Tx patent ductus arteriosus | indomethacin or ligation |
| patent ductus arteriosus | PDA connects pulmonary artery to the descending aorta in fetal circulation, closes after birth, but can dilate due to hypoxia or prostoglandis E1 and E2 |
| acyanotic congenital heart defects | left to right shunts |
| 2 acyanotic congenital heart defects | ventricular septal defects (more common 20-30%) and atrial septal defects |
| Tx for acyanotic congenital heart defects | surgerically corrected with dacron patch |
| acyanotic | normal amount of oxygen in bloodstream |
| coarctation of the aorta | narrowing of a small stretch of the aorta- means high BP to areas before coarctation and low BP to areas beyond it |
| 4 parts of tetralogy of Fallot | VSD, Pulmonary artery senosis, overriding aorta, r ventricular hypertrophy- all means right to left shunt- cyanotic |
| TET spells | Tetralogy of fallot spells- shunting of blood due to increase in cyanosis of blood- they will squat to increase systemic resistance and reverse R-L shunting |
| hypoplastic left heart syndrome | rare cyanotic heart defect in which they only have 1 ventricle- high mortatlity rate (24%) |
| Tx for hypoplastic left heart syndrome | no surgery- death is certain, heart transplant, or palliative procedures (staged surgeries to keep infant alive) |
| PT issues for hypoplastic left heart syndrome | poor feeding, growth, and development; and parent education |
| angina pectoris | chest pain due to iscemia of the myocardium |
| 3 types of angina pectoris | stable- work related- can say at what point local chest wall hurts and only lasts 5-15 min; unstable- more frequent and severe; variant- occurs at rest- can have dys- or arryhthmia |
| Tx for stable and variant angina pectoris | nytroglycerines and Ca channel blockers respecitvely (Ca blockers because variant has atrial spasms as well) |
| 3 txs for Coronary artery disease | Balloon angioplasty, coronary artery bypass graft (transverse thoracis or great saphenous), or stent placement |
| what are 2 inflammatory diseases | rheumatic heart disease and endocarditis |
| rheumatic heart disease | uncommon hypersensitivity disorder, group A hemolytic strep, weakens heart valves, murmurs, rheumatic valvulitis, heart failure and infective endocarditis |
| Endocarditis | subacute bacterial- alpha hemolytic strep (gradual) and acute baterial endocarditis- staph aureus (rapid) |
| Myocarditis | inflammation of the myocardium (middle layer of the heart), usually a viurs, abrupt onset, no specific Tx |
| Support Txs for myocarditis | digitalis (pumps heart stronger), vasodilators, diuretics, steroids |
| coxsackievirus | most important myodcarditis virus |
| enterovirus | responsible for most cases of myocarditis and 50% of cases of dilated cardiomyopathy |
| 3 types of cardiomyopathy | restrictive, dilated, and hypertrophic |
| restrictive cardiomyopathy | radiation fibrosis, amyloidosis, inborn errors of metabolism, deposition of iron in hemosiderosis, mm get stiff and volume is decreased- thus cannot eject enough blood int systemic circulation |
| dilater cardiomyopathy | alcohol toxicity, pregnancy-associated, genetic, diffuse ischemic injury |
| Hypertrophic cardiomyopathy | sudden death, undiagnosed young athletes, heart wall thickens, genetic origin |
| atrial fibrillation | uncoordinated contraction of the heart m- irregular electrical transmission- blood sits and may clot and produce embolus, irregular pulse faintness dizzines weakness palpitation and/or chest pain- can lead to congestive heart failure |
| Who gets atrial fibrillation | old men |
| Tx atrial fibrillation | controlling the rate at whcihc the ventricles respond |
| Myocardial infarction | necrosis of a portion of the myocardium, sx similar to angina, |
| Categorization of MIs | size, location, and degree of involvement of the myocardial wall |
| Compliactions of MIs | dysrrhytmia, heart failure (damaged heart wall or major vessel occlusion), thrombosis (DVT or PE), damage to bundle branch, pap mm, aneurysm |
| 3 types of dysrrhytmia | AV heart block, V tachycardia, A fribillation |
| V-tac | up over 100bpm |
| V-fib | even faster, need paddles to reset SA node rhythm |
| Doppler echo cardiogram looks at | diastole and systole |
| Complicated MI lead to ejection fraction like... | 35% |
| prognosis after MI | depends on the amount of ventricular damage, remaining cardiac capacity, cardiac status and other risk factors |
| Congestive heart failure | inability of heart to meet/maintain cardiac output- caused by ischemia, MI, injurious lifestyle, and aging- contributes to progressive renal dysfunction and anemia |
| cardiac output equals | heart rate X stroke volume |
| primary Sx of congestive heart failure | dyspnea |
| Risk factors for congestive heart failure | women, smoking, diabetes, hypertension |
| Left-sided heart failure | most common, fluid may back up in lungs causing dyspnea |
| right sided heart failure | often occurs with elft-sided- fluid may back up into abdomen, lungs and feet- induces swelling |
| systolic heart failure | L ventricle cant contract vigorously indicating a pumping problem |
| diastolic heart failure (heart failure with normal ejection fraction) | left ventricle cant relax or fill fully, indicating a filling problem |
| muscles of inspiration | diaphragm, external intercostals, accessory muscles- scalene, traps, SCM |
| total lung capacity | inspiratory capacity plus the functional residual capacity or vital capacity plus residual volume |
| Tidal volume | Tidal volume is the lung volume representing the normal volume of air displaced between normal inspiration and expiration when extra effort is not applied approx. 500mL |
| Inspiratory reserve volume | the maximal amount of additional air that can be drawn into the lungs by determined effort after normal inspiration |
| Expiratory reserve volume | the additional amount of air that can be expired from the lungs by determined effort after normal expiration |
| Residual volume | the volume of air still remaining in the lungs after the most forcible expiration possible and amounting usually to 60 to 100 cubic inches |
| Inspiratory capacity | the total amount of air that can be drawn into the lungs after normal expiration |
| Functional residual capacity | Functional Residual Capacity is the volume of air present in the lungs, specifically the parenchyma tissues, at the end of passive expiration |
| Vital capacity | the greatest volume of air that can be expelled from the lungs after taking the deepest possible breath |
| 2 main types of pulmonary disease | Obstructive and restrictive |
| 5 types of obstructive pulmonary disease | COPD- chronic bronchitis and emphysema, asthma, cystic fibrosis, pneumonia, tuberculosis |
| 7 types of restrictive pulmonary disease | tumor, pulmonary fibrosis, pneumoconioses, sarcoidosis, atelectasis, pulmonary emboli/edema, aging |
| obstructive pulmonary disease | affects mvmt of air in and out of the lungs |
| most ppl with COPD have what 2 diseases | chronic bronchitis and emphysema |
| pneumonia | infectious and inflammatory lung diseases affecting lobes of the lunch- can be bacterial, viral, or fungal- in some ways obstructive and restrictive |
| bronchopneumonia | pneumonia in the bronchioles and alveoli |
| walking pneumonia | viral pneumonia- less severe |
| risk factors for pneumonia | smoking, chronic lung diseases, immunodeficient, malnutrition, younger and older, anesthesia depresses nervous system |
| Sx pneumonia | sharp, pleuritic pain (deep breath), hacking productive cough, rust or green sputum, dsypnea, tachypnea, cyanosis, fever, fatigue, headache, decreased chest excursion, aches and pains, confusion |
| pathology of pneumonia | starts with inflammatory response of mast cells not eliminating the pathogen, then organisms multiply, then toxins released by microorgansims damage to mucousal membranes |
| How prevelant is pneumonia in the US | one million cases a year and one of the leading causes of death |
| Tx for pneumonia | antibiotics if bacterial, if viral- treat symptoms, all patients need hydration, nutrition, chest therapy, breathing exercises, and supplemental O2 as needed- possibly postural drainage |
| pulmonary tuberculosis | infection bt mycobacterium tuberculosis, airborne isolation, transmitted via infected milk |
| exposure numbers on tuberculosis | 10% of those exposed go on to get active disease- 5% are primary TB (get it immediately)- 5% have reactivation of TB (get it later) |
| pathology of TB | infection to clinical disease- granulomas progress- multiplication of the bacillus- cavity formation- progressive inflammation- extensive destruction of lung tissue and bronchi |
| Ghon's complex | granulomas in the middle lobe of lung and lymph nodes- shows evidence that primary TB has healed |
| pathology primary TB | inhale myobacterium TB- local reaction- cell-mediated hypersensitivty- granuloma formation secondary to inflammation- ghon's complex in latent stage |
| Sx TB | coughing, night sweats, fatigue, anorexia, dyspnea, pleuristic chest pain |
| TX TB | 6-9 months meds, surgery to remove part of lung, PT if needed |
| Chronic obstructive lung disease characteristics | alteration in airflow in smaller airways because of one or more of the following: smooth mm constriction, mucosal edema, retention of secretions, occlusion of bronchioles by secretions |
| chronic bronchitis | productive cough at 3 months a year for 2 consecutive years, cilia don't propel mucous to mouth, starts in larger bronchi, causes a reduction in number of open airways long term |
| what causes excessive, irreversible mucous production | hypertrophy of the mucous glands in the walls of the bronchi, increase of goblet cells in epithelial lining of the bronchial tree |
| causes of bronchitis | smoking and enviornmental irritants |
| impairments in chronic bronchitis | cough, excessive sputum, wheeze, dyspnea, cyanosis, finger clubbing (advansced), prone to flu and strep pneumonia |
| acute bronchitis | infection/inflammation of the bronchial tree often as the result of a cold, sore throat, mucous production |
| medical Tx of chronic bronchitis | stop smoking, bronchiodilator inhaler, steroids (inhaled or oral), antimicrobial therapy for infections, O2 therapy if R sided heart failure |
| PT intervention for chronic bronchitis | breathing exercises, airway clearance, home exercises, pulmonary rehab (progressive walking with or without O2) |
| Peripheral airway disease (PAD) | precursor to emphysema, inflammation of the small airways due to irritants, destruction and distention of alveolar tissue with over expansion of the lungs, difficulty exhaling traps air in the lung tissue |
| Emphysema vs COPD | problem getting air out vs in |
| emphysema | usually secondary to PAD of chronic bronchitis (troubles in the large airways) |
| Primary emphysema | result of alpha antitrypsin deficiency- seen first in adolescents- can have variations with a moderate loss of these proteins which may develop emphysema more easily |
| pathology of emphysema | chronic inflamation with narrowing, thickening of bronchioles initially; loss of elasticity in alveoi- loss of recoil; air trapped; obstruction; dead space increased; blebs and bullae |
| blebs and bullae | blisters where the lunch has weakened |
| Sx emphysema | dyspnea- progressive DOE, pink puffers, flat diaphragm, use accessory muscles in inspiration, finger clubbing in advanced stages |
| what makes people breathe automatically | hypercapnic drive- build of CO2 |
| Tx emphysema | stop smoking, O2 therapy- sats should be at least 87-90%- medicare will pay for O2 at home, volume reduction surgery |
| what are emphsema pts problems with expiration | dont exhale fully before inhaling |
| PT tx for emphysema | pursed lip breathing, very poor posture (extension of trunk turns of accessory breathing mm), control ration of inspiration to expiration at 2:3 |
| PT interventions for emphysema | inc endurance and strength, deep breathing exercises, transfer and ambulation training, monitor: O2 sats, O2 delivery, peak flow, vital signs |
| what do you see in COPD pts | occlusion (by secretion) and collapse of bronchioles, whole lung loses elasticity, X-ray shows hyper inflated lungs, flat diaphragm, enlarged R venticle due to inc pulmonary artery pressure, and Co Pulmonale (R sided heart failure) |
| asthma | reverisble inflammatory condition, affects the small airways, bronchioles become obstructed by mm spasm, swelling of mucosa, and thick secretions; severe prolonged atacks over many years is emphysema |
| etiology of asthma | allergic, non-allergic, exercise-induced, inflammation (inhaled steroids), bronchoconstriciton |
| asthma attack | rapid onset, diffiuclty expiring (wheeze), lasts more than 24 hours is is status asthmaticus and medical emergency |
| Tx for asthma attack | relax breathing, inhaler, O2 |
| Cystic fibrosis | genetic disease caused by defective gene that codes for Na and Cl transport in the epithelial cells that line the lungs and other organs such as the pancreas |
| sx of cystic fibrosis related to what | particular mutation that has been inherited |
| Old test for CF | sweat Cl test- take baby's sweat and measure how much Cl was in it |
| what happens to males with CF | sterile due to trouble with exocrine fx |
| life expectancy for CF | 28- most fatal disease of caucasions |
| inheritence of Cf | autosomal- recessive gene, inherited from both parents, affects 1 in 1500 births in whites- no one else |
| Pathology CF | sald does not move properly bc of the defective gene, thick viscid mucous production in pancreas blocks the ducts- causes degeneration and fibrosis- lack of pancreatic enzymes to aid digestion, decreased islets of langerhans |
| Sx CF | cough, thick mucous production, dyspnea, barrel chest, frequent infections- ofen with pseudomonas, hypoxia, finger clubbing, pulmonary hypertension, Cor pulmonale, malnourished, bulky foul smelling poop |
| psuedomonas | green lung growth due to infection- smells awful |
| Tx CF | medications- pancreatic enzymes, diet, PT- postural drainage, exercise, for athletes: maintain calorie intake, maintain weight, electrolyte balance |
| Bronchiectasis | dilation of the bronchi due to obstruction and infection (usually lower lobe), caused by other respiratory disease that was treated inadequately or by an infection distal to an obstruction |
| Bronchiectasis caused by | TB, bronchitus, pneumonia, CF |
| Pathology of Bronchiectasis | air does not reach airways distal to blockage, collapse of smaller airways and alveoli, destruction of alveoli walls, obliteration of smaller bronchi and bronchioles, larger bronchi lose their rigidity and elasticity |
| Sx Bronchiectasis | cough, lots of sputum, hemoptysis, repeated infections, weight loss, fatigue, may get clubbing of fingers |
| Tx Bronchioectasis | meds, PT, sugery, hydration, O2 if needed |
| Restrictive lung diseases | intrapulmonary restrictions: tumors, pulmonary fibrosis, atelectasis, pulmonary edema, normal aging |
| restricted | kept from inflating- happens with pulmonary fibrosis |
| atelectasis | part of lung crumples up and doesn't inflate |
| Extrapulmonary restrictive pulmonary dieseases | pleural problems, thoracic or abdominal surgery, postural abnormalities, neuromuscular diseases stroke, lack of excursion of the diaphragm |
| Intersitial lung diseases | pulmonary edema, acute respiratory distress syndrome, pneumoconoiosis, sarcoidosis, diffuse idiopathic pulmonary fibrosis |
| diffuse idiopathic pulmonary fibrosis | excessive fibrous/connective tissue in lungs with fibroblastic activity, fibrous thickening of the alveolar septa (rigid), O2?CO2 exchange is difficult, dyspnea, chronic cough, dec in lung volume/total lung capacity |
| Atelectesis | secondary condition in which part of lung collapses- two types- obstructive and compressive- though it is a restrictive disrorder |
| Sx atelectesis | dyspnea, diminished breath sounds and mvmt, inc respiration, cyanosis, febrile- may not run fever, elevated diaphragm on affected side- may have something pressing from below |
| Tx atelectesis | obstructive- remoce obstruction via surgery or vigorous chest PT, compressive- remove or treat cause |
| Pneumothorax | collection of air in pleural cavity secondary to trauma, lung disease or spontaneous- treat with a chest tube |
| pulmonary edema | build up of fluid in the lungs, prevents gas exchange, usually result of L ventricular failure with pulmonary hypertension, can be complication of thoracic surgery |
| Sx pulmonary edema | dyspnea, cough, excessive sweating, confusion |
| Adult respiratory distress syndrome | rapid acute respiratory failure following a systemic or pulmonary insult that can lead to cardiopulmonary failure |
| what is ARDS associated with | multiple fractures, septic shock, diffuse pulmonary infections, burns, embolisms, near drowning, drugs- fatality rate is 40-70% |
| Pathology ARDS | damage to capillary endothelial cells and alveolar epithelial cells which inactivate th surfactant and allows contents of capillary bed to lead into alveoli- pulmonary edema, alvelolar collapse |
| Tx ARDS | mechanical ventilation, chest PT, exercise programs, mobility training, functional activity training, monitor vital signs and O2 uptake |
| pneumoconioses | group of lung disorders characterized by inhaling small particles in the air: silicosis, asbestos, black lung, fungi, other substances |
| pulmonary fibrosis | restrictive disease in which fibroblasts make excessive tissue which changes the shape of alveolar walls, lung volume decreases |
| Tx pulmonary fibrosis | meds: steroids, immunomudulator agents, antibiotics to treat infections; prevention: avoid expsure to particulates, tight fitting masks; education |
| Flail chest | bad adjacent rib and sternal fractures where ribs could pierce pleura and ribs now do opposite during breathing |
| splinting | teaching patients how to deep breate and cough without splitting sutures |
| precaution after sternum cracked in surgery | raising arms to high |
| 5 functions of the GI tract | Ingestion- amylases, motility- move the food, secretion- digestive enzymes, digestion and absorption, elimination |
| where do babies get their gut bacteria | from mom on the way out |
| Congenital conditions of GI tract | tracheoesophageal fistula, pyloric stenosis, Meckel's diverticulum, necrotizing enterocolitis, hirschsprung disease |
| Tracheoesophageal fistula | most common esophageal anomally, 1 in 4000 births |
| Pyloric stenosis | projectile vomiting |
| necrotizing enterocolitis | preterm babies with immature gut- some of intestine has died and needs to be removed surgically |
| Hirschsprung disease | lack of ganglion cells in the rectum- leads to distension- megacolon- can't squeeze poop out- chronic constipation |
| out pouching of illium | failure of embryonic connection to disappear |
| Irritable Bowel Syndrome | idiopathic, dietary modifications, not the same as inflammatory bowel disease |
| inguinal hernia | out pocketing of the abdominal wall into the groin "rupture"- loop of bowel can become trapped- medical emergency (sepsis and necrosis)- common surgery- men>women |
| hiatil hernia | stomach comes up past the diaphragm |
| Gastroesophageal reflux disease | continual irritation of mucosa and submucosa, problem with lower sphincter |
| Crest syndrome | esophogeal dysfunction, raunaud's phenom, calcinosis, sleroadtylyl (bowing of fingers), telangiectasia- blood vessels around the mouth |
| Celiac disease | malabsorbtion syndrome- 1-2% pop, gluten causes injury to the mucosal lining of the small intestine |
| Sx celiac disease | diarrhea, gas, vitamin K deficiency, Ca deficiency |
| Celiac disease at risk for | T-cell lymphoma in the intestines and T-cell mediated hypersensitivity |
| 3 places for neoplasms in the GI tract | esophogeal- adenocarcinoma and squamous cell, stomach- primary and extranodal involvement associated with lymphoma and colorectal- common |
| Esophogeal cancer | 1-2% of all cancers- men>60 |
| risk factors for esophogeal cancer | genetic predisposition, dietary habits, chronic irritation, chronic severe reflux, barrett's esophagus (premalignant condition |
| Sx esophogeal cancer | dysphagia, pain, lymph node changes, fatigue |
| Tx esophogeal cancer | endoscopy, surgery, chemo |
| Gastric cancer risk factors | Jap, male, >30, H. pylori infection |
| pathology of gastric cancer | spreads by lymph, blood, and local invasion |
| Tx for gastric cancer | surgery, chemo |
| Gastritis | acute and chronic- caused by heliocacter pylori (25%), autoimmune, NSAIDs, alcohol; predisposition for gastric cancer and lymphoma |
| peptic ulcer disease | sharply punched out area of duodenum, 75% of those with peptic ulcer have H pylori infection |
| Crohn's disease | Inflammatory bowel disease- appears in adolescence and in 50-70s, patchy involvement in intestines, common in distal illium, problem with fat and vitamin absorbtion |
| Ulcerative colitis | continuous invovement, small bowel not involved, inflammation causes friability, develop pseudopolyps and scleosing cholangitis- scarring |
| Cirrhosis of liver | liver disease caused by hepatitis, characterized by interference with local blood flow and hepatocyte damage |
| ascytes | stomach full of fluid and watermelon like due to combo of hydrostatic pressure, oncotic pressure, and capillary permeability |
| Esophogeal varices | veins are congested and get backed up- severe sodium retention and over night weight gain due to fluid retention |
| Sx of ascites | moderate to severe abdominal discomfort, increased abdominal girth, increased weight, severe Na retention, dilutional hyponatremia, renal failure |
| Tx ascites | paracentesis- draw off excess fluid |
| contraindications for trnsplant | malignancy, HIV, active infection, psych issues, multiple organ failure |
| Immunosurrpessive med | azathiorprine, cyclosproine, corticosteroids, OKT3 |
| Sx rejection | fever, fatigue, Heart- arrhytmia, syncope peripheredema; lungs: cough, tachypnea, incr secretions; kidney: tenderness over graft, wt gain, nausea; liver: jaundice, dark urine, pale stool, abd pain |
| PT role in transplants | get pt into shape prior to, early after: pulmonary hygiene, positioning/ROM, early mobilization, monitor VS, education |
| Pt role farther after transplant | streghtening, CV enducrance, functional training, prevent weight gain, education |
| immunosuppressive side effects of transplant | decrease bone density, avascular necrosis, steroid induced myopathies, fine tremors, prolonged wound healing |
| ex prescription | ex to fatigue- add 1-2 min/day- goal 30 min nonstop daily before decreasing frequency |
| lung transplant | 20% come from cadavers, 3 yr survival rate is 63%, donor should be of comparable lung and chest size |
| surgical technique for lung trnasplant | single lung: posterolateral thracotomy; bilateral: clamshell incision, anterior trnsveres thoracosternotomy |
| Heart transplant facts | 30% die waiting for donor, 3 yr survial rate 75%, donors are men<40 women <50 normal cardiac function, no chest rauma, CA, infection |
| Surgical technique for heart transplant | orthotopic: native heart replaced with donor, heterotopic: native heart assists donor |
| Liver transplant facts | 3 yr survival rate 75%, donor- cadever: whole or split liver with no trauma and norm fx, living: small portion or right lobe- healthy, no active infection or substance abuse |
| surgical technique for liver transplant | midline incision and L axillary incision |
| Kidney transplant facts | most common, 3 yr sr 82%, donor: ABO compatible, 6 antigen match |
| Surgical technique for kidney transplant | oblique lower abdominal incision and extraperitoneal placement iliac fossa |
| Bone marrow transplant facts | 3 yr sr 70%, autologous: only for malignancies, must be in remission; allogenic: both non-malignancies and malignancies |
| Surgical technique for bone marrow transplant | immunosuppression, aspirate marrow from iliac crest or sternum, marrow filtered and infused through central venous line |
| upper urinary system | kidney, renal pelvis, ureter |
| lower urinary system | bladder urethra |
| UTI risk factors | old, woman, urinary instrumentation, abnormal urinary anatomy, abnormal urologic system fx, immunologic deficiencies |
| Sx UTI | urinary frequency, hesitancy, urgency, dyuria, low back/abdominal pain, heaturia, pyruria, fecer, chills, malaise, confusion, lethargy, psychotic behavior, incoherent speech |
| UTI causitive organisms | E-coli 80%, staph 10%, other bacteria 10% |
| Dx URI | urinalysis and symptoms, urine culture |
| UTI prevention | hydrate, avoid catheters, good hygiene, avoid urine retention, activity, avoid bladder irritants- caffiene, bubble baths, alcohol, dietary modifciations |
| Tx UTI | upper UTI requires hospitilization and IV, lower just antibiotics, hydrate, probiotic supplement |
| Renal stone disease | 80-90% Ca |
| Sx renal stone disease | flank pain radiating to groin, diaphoresis, nausea, vomiting |
| Risk factors renal stone disease | male, old, geography, Ca supplements, fluid intake, side sleeping, developed countries |
| Dx and Tx renal stone disease | abdominal radiograph; 5-6 mm stones will pass, pain meds, antibiotics, lithotripsy- sound waves used to break up big stones |
| renal stone disease prevention | increased fluid intake, dietary modification |
| renal cancer facts | 2% of all cancers, risk factors: smoking, obesity, genetics, occuplation exposure to chemicals, poor nutrition |
| Sx renal cancer | silent in early stages, mets to lungs or skeletal system, hematuria, abdominal or flank pain, palpable abdominal mass, unexplained weight loss, fatigue |
| Dx Tx renal cancer | CT scan and TNM staging; surgical removal |
| end stage renal disease | renal fx drops below 5%, uremia- inc blood or nitrogen, all systems affected, musculoskeletal- affects electrolytes and dvelopment of long bone, neurologic- synapses don't fire well- no coordination, CV- change in vessel constriction, skin- inc waste |
| Tx end stage renal disease | hemodialysis- blood cleansing 3 times a week for 3-4 hours, peritoneal dialysis, transplant |
| fistula- | connect a to v to increase blood flow- gets 18 gage needle- can cleanse blood without collapsing a |
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maffuhamilton