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NURS 241
| Question | Answer |
|---|---|
| pathology | lab study of cell and tissue changes associated with disease |
| physiology | study of normal functioning and mechanisms of living systems |
| disease | specific symptoms, deviation from normal structure or function of any part |
| health | absence of disease, now more defined as physical, mental, and social wellbeing. concept may differ among individuals |
| disease develops when | changes occur leading to a state where homeostasis cannot be maintained |
| body always compensates to | maintain homeostasis |
| homeostasis is maintained by | blood pressure, temperature, and fluid balance |
| diagnosis | identification of disease thru evaluation of signs and symptoms |
| etiology | cause of disease |
| etiology agents (cause of disease) | inherited, congenital, viruses, metabolic derangements, nutrition |
| idiopathic | unknown cause |
| iatrogenic | disease caused by medical treatment. ex:UTI |
| predisposing factor | promote development or increase risk of disease aka risk factors. ex-age gender, diet (male parkinson's) |
| prophylaxis | measure designed to preserve health and prevent spread of disease |
| primary prevention | prevent before it begins ex-flu shot |
| secondary prevention | interventions to slow a disease or minimize factors already present ex-cancer screening |
| tertiary prevention | manages long term complicated health problems ex-stroke=physical therapy |
| pathogenesis | development of disease or sequence of events involved in tissue change ex - salmonella, rabies, HIV |
| onset | start of disease process |
| acute | short term illness that develops quickly with marked signs |
| chronic | develops gradually but lasts a while ex-diabetes |
| latent | disease is present or in early stages but no signs are evident |
| prodromal period | non specific to specific changes in symptoms |
| manifestations | clinical evidence or effects, signs and symptoms of a disease ex-redness, swelling |
| signs | obvious to all but patient ex-rash, fever |
| syndrome | collection of signs and symptoms, affects more than one organ ex-downs syndrome |
| exacerbation | worsening |
| precipitating factor | triggers acute episode ex-physical activity causes chest pain |
| sequelae | unwanted outcomes of primary condition of disease ex-stroke causing paralysis |
| convalescence | period of recovery and return to normal health after disease |
| prognosis | likelihood for recovery based on average outcomes |
| morbidity | disease rates within a group |
| epidemiology | tracking pattern of disease includes data on transmission and distribution of disease. ex-tracking covid cases |
| incidence | number of new cases in a given population noted within a stated period time |
| prevalence | number of new and old or existing cases within a population |
| epidemic | occurs regionally |
| pandemic | globally |
| communicable disease | infections can be spread one person to another |
| tissues are | modified as a response to hormonal stimulation changes are reversible |
| atrophy | decrease in size of cells, reduced tissue mass |
| hypertrophy | increase in size of individual cells resulting in enlarged tissue mass |
| hyperplasia | increase in number of cells resulting in large tissue mass |
| metaplasia | one matire cell type is replaced by a different mature cell type |
| dysplasia | cells vary in size and shape, mitosis increases |
| anaplasia | cells are undifferentiated (cancer), malignant tumor basis |
| neoplasia | new growth commonly called a tumor |
| apoptosis | programmed cell death.intentonal and normal |
| necross | death of one or more cells as a result of irreversible damage |
| ischemia | decreased supply of oxygenated blood to a tissue |
| infarcation | cell death resulting from lack of oxygen |
| lysis | rupture, breakdown of cell |
| gangrene | area of nectrotic tissue with lack of blood supply |
| water is the | major component of the body. the medium where metabolic reactions take place and helps with transportation |
| water carries | nutrients and removes waste, transports enzymes, moves blood cells |
| how much percent is water | 60% |
| females have | lower percent of water |
| elderly and obese have | lower percent of water |
| 2 main fluid compartments | intracellular (fluid inside cells), extra cellular |
| extracellular fluid | intravascular fluid (in blood veslles), interstitial fluid (between cells), transcellular (within synovial cavities) |
| movement of water | constantly circulates, equal amount going in as coming out. loss through urine as well as insensible |
| balance of water and electrolytes is maintained through | hypothalamus, ADH hormone, aldosterone (retain sodium and excrete potassium), atrial natriuretic peptide-stimulate elimination of water |
| water moves between | vascular compartment and interstitial compartment through semipermeable capillary membranes |
| osmotic pressure | pulls fluid into a space |
| hydrostatic pressure | pushes fluid out of space |
| what contributes to osmotic pressure | proteins and electrolytes. more solutes=higher osmotic pressure |
| osmosis | movement of water from an area of low solute concentration (ISF) to high concentration (blood) |
| diffusion | movement of solutes from area of high to low |
| fluid excess-edema | excessive amount of fluid in interstitial compartment which causes swelling of tissues. more severe in dependent areas of the body ex-butt, ankles, feet |
| edema affects | venous return, arterial circulation, and cell function |
| causes of edema | increased capillary hydrostatic pressure (pushes excess fluid out of capillaries into tissue), loss of pplasma proteins (decreases osmotic pressure), obstruction of lymphatic circulation, increased capillary permeability |
| effects of edema | increased body weight, functional impairment, impaired aertrial curculation, tissue breakdown |
| pitting edema | occurs in presense of excess interstitial fluid which moves aside when firm pressure is applied by fingers . depression remanins |
| dehydration | insufficient body fluid resulting from inaququate intake or loss of fluid. most common in extracellular compartment |
| hypovolemia | depletion of circulaitng fluid in the body |
| fluid loss is measured by | body weight. mild deficit-decrease 2%. moderate-decrease 5%, secere decrease 8% |
| isotonic dehydration | proportionate loss of fluid and electrolytes |
| hypotonic dehydration | refers to loss of more electrolytes of water |
| hypertonic dehydration | loss of more fluid than electrolytes |
| causes of dehydration | vomitting, diahrehea, insufficient water intake |
| effects of dehydration | dry mucous membranes, decreased skin turgor, lower blood pressure, weak pulse, increased hematocrit, decreased mental function. pale skin |
| third spacing | condition where fluid moves from the blood (intravascular space) into the interstitial space, which is the area between cells and tissues, or other non-functional areas ex-fluid in abdonmial cavity and burns. result is fluid deficit in vascular componen |
| sodium | primary cation in extracellular fluid. levels are high in extracellular fluids (blood) and low inside cell. controlled by kidneys . essential in conduction of nerve impulses |
| sodium blood range | 135-145 mEq/mL. maintenance of extracellular fluid volume. essential for nerve impluses |
| hyponatremia | serum sodium levels below 135 mEq/mL |
| causes of hyponatremia can result from | direct loss of sodium from body or excess of water |
| common causes of low serum sodium levels | sweating, diuretic drugs, insufficient aldosterone, chroic renal failure, excessive water intake |
| effects of hyponatremia | impair nerve conduction and results in fluid imbalances, decreased osmotic pressure may cause fluid shifts |
| hypernatremia | excessive sodium level in blood and extracellular fluid. Na>145 mEq/L. results from ingestion of large amounts of sodium without proportionate water intake |
| causes of hypernatremia | insufficient adh, loss of thirst mechaniasm, diarrhea, rapid respiration |
| effects of hypernatremia | fluid shift out of cell owing to increased osmotic pressure |
| hypernatremia manifestations | weakness, agitation, increased thirst, decreased urine output |
| potassium | major intracellular cation. normal blood range-3.5-5 mEq/L. ingested in foods |
| insulin promotes | movement of potassium out of blood into cells loweing potassium levels |
| acidosis | low blood pH, shift potassium ions out of cells into extracellular fluid |
| alkalosis | high blood ph. move more potassium into cells |
| potassium has a role in | metabolic processes and nerve conduction, muscle contraction |
| abnormal potassium levels have a significant effect on | contractions of cardiac muscle causing changes in the electrocardiogram |
| hypokalemia | low serum potassium levels <3.5 mEq/L. results from diahrea, diuretic drugs, excessive aldostoerone , decreased dietary intake |
| effects of hypokalemia | paresthesias-abnormal touch sensations, decreased appetite |
| hyperkalemia | high serum potassium levels > 5 mEq/L |
| causes of hyperkalemia | renal failure, aldosterone deficit, potassium sparing diuretic drug, leakage of intracellular potassium into extracellular fluid in patient with tissue damage.ekg changes which can cause cardiac arrest, fatigue, muscle weakness |
| calcium | extracellualr cation, normal range-8.6-10.2 mg/Dl. ingested in foods, stored in bone |
| calcium balance is controlled by | parathyroid hormone and calcitonin but influenced by vitamin d |
| vitamin d promotes | calcium movement from bone and intestines into blood. ingesthed thru skin but activated in kidneys |
| calcium and phosphate ions in extracellular fluid have an | inverse relationship |
| calcium functions | provides structural strength for bones and teeth. stability of nerve membranes controlling pearmeability needed for nerve conduction, muscle contractions, metabolic processes |
| hypocalcemia | low serum calcium level <8.6 mg/dL |
| causes of hypocalcemia | hypoparathyrodism-decreased parathroid hormone. malabsorption syndrome-decreases intestinal absorption of calcium and votamin d. renal failure |
| effects of hypocalcemia | too much calming effect on muscles so everythong is slowed and irritated. muscle twitching, exaggerated reflexes, spasms of larnyx, weakened heart contractions. chvostek-spasm of face wehn tapped infront ear. trousseau-finger spasm blood pressure cuff on |
| hypercalcemia | high serum calcium level. >10.2 mg/dL |
| hypercalcemia causes | excess releasenof calcium from bones, hyperparathyroidism-high pth, immobility, increased take of calcoum |
| effects of hypercalcemia | depressed neuromuscular activity leading to muscle weakness/tone, cardiac contractions increase in strength leading to dysrhythmias, kidney stones |
| magnesium | normal level- 1.7-2.3 mg/dL, enzyme reactions, found in green veggies |
| hypomagnesemia | results from malnutirion |
| effects of hypomagnesima | neuromuscular hyperirritability, tremors. insomnia. personalty cahnges, increased heart rate |
| hypermagnesemia | occurs with renal failure. effects-depressed neuromuscular function, decreased reflexes, lethargy, cardiac arrhythmias |
| phosphate | normal range-2.5-4.5 mg/dl. located in bone. inverse relationship with calcium, important in bone mineralization and matabolic process |
| hypophosphatemia causes | malabsorbtion syndrome, diarrhea, excessive use of antacids, alkalosis, high Ca=low Phos |
| hypophosphatemia effects | tremors, weak reflexes, paresthesias, confusion, stupor, anorexia, difficult swallowing |
| hyperphosphatemia causes | result of renal failure |
| hyperphosphatemia effects | manifestations of hyperphosphatemia are the same as hypocalcemia |
| acid base balance | essential to homeostasis because all enzymes can function only with narrow ph range. normal range-7.35-7.45, acidosis=ph less than 7.4. alkalosis=greater than 7.4 ph (fewer Hydrogen ions) |
| 3 mechanisms that control ph to keep it in normal range | buffer pairs-circulate in the blood respond to ph changes immediatly. alter carbon dioxide levels by changing respiratory rate. kidneys modify excretion rate of acids |
| the lungs can change only amount of | carbon dioxide in the body, but compesates for pH changes quickly |
| kidneys are | slow to compensate for a change in ph, but are the most effective ,mechanism bc they excrete all types of acids and adjust biocarbonate levels |
| to control serum ph... | buffer systems are in blood. buffer is a combo of weak acid and its alkaline salt. this neutralizes components maintaining ph levels |
| biocarbonate system | major extracellular fluid buffer and used to assess acid base status |
| respiratory system control of serum ph | when carbon dioxide/hydrogen levels increase, chemoreceptors stimulate respiratory control center to increase respiratory rate, removing more carbon or acid from body |
| when alkalosis develops, respiratory rate | decreases, retainng more carbon and increases acid levels in body |
| renal system control of ph | kidneys can reduce acid content of the body by exchanging hydrogn for sodium ions. kidneys produce bicarbonate ion for the buffer pair as needed |
| types of basic types of acid base imbalance | respiratory acidosis, respiratory alkalosis, matabolic acidosis, metbolic alkalosis |
| cause of acid base imbalance determines | first change in ratio of acid to base or CO2 to HCo3 |
| respiratory disorders are always represnted by an | initial change in carbon dioxide. all other prblems are metabolic and result from an initial change in bicarbonate ions |
| acid base compensation occurs when | the body system not involved in the cause of the imbalance adjusts its functioning to make up for the imbalanceex--if patient has respiratory disorder causing acidosis, the lungs cannot compensate effectivley, but the kidneys can |
| compensation is | limited and patient must be monitored carefully if there is an ongoing threat to homeostasis. if kidneys and lungs cannot compensate adequatley, ratio changes and serum ph moves out of normal ramge. the imbalance is determiend decompensatioon |
| respiratory acidosis | results from increase in carbon levels bc of respiratory problems that cause slow breathing. |
| metabolic acidosis | results from decrease in serum bcarbonate due to loss of bicarbonate such as diarrhea, renal disease, increase utilization of bicarbonate |
| acid base imbalances effects of acidosis | nervous system impairment, manifested by headache, lethargy, weakness, confusion. compensation- lungs which causes rapid breathing to get rid of excess co2 |
| respiratory alkalosis | results from lack of co2 due to hyperventilatioon which blow off too much co2. caused by anxiety, fever, head injuries |
| metabolic alkalosis | results from too much bicarbonate or loss of hydrogen ions thru kidneys or gi tract |
| effects of acid base alkolosis imablance | increases irritability of nervous systemm causing restlesness, twitching, numbness of fingers, coma, seizures |
| treating acid base imbalances | identify and treat underling cause, fluid replacement, administer bicarbonate, diet modification |
| respiratory system transports | oxygen and removes carbon |
| The upper respiratory tract is made up of the | passageways that conduct air between the atmosphere and the lungs |
| lower respiratory tract consists of the | the trachea, bronchial tree, and the lungs, where gas exchange takes place. |
| whats integral to function of respiratory system | the pulmonary circulation, the muscles required for ventilation, and the nervous system |
| en air is inhaled into the respiratory system, it first enters the | nasal passages , where it is warmed and moistened by the highly vascular mucosa. |
| Foreign material is filtered out by the | mucous secretions and hairs before the air enters the delicate lung tissue. |
| Opening off the nasal cavity through small canals are four pairs of | paranasal sinuses, which are small cavities in the skull bones They are named according to the bones in which they are located—the frontal, ethmoid, sphenoid, and maxillary sinuses. |
| Excessive amounts of mucus or particles stimulate a | a sneeze or a cough, which assists in expelling unwanted material away from the lungs. |
| The airflow continues through the | the nasopharynx and larynx into the trachea. On the posterior wall of the nasopharynx are located the pharyngeal tonsils or adenoids, which consist of lymphoid tissue, another defense against the inhalation of foreign material. |
| The palatine tonsils, popularly called the tonsils, are | lymphoid tissue located in the posterior portion of the oral cavity. |
| Also opening off the nasopharynx are the two | auditory (eustachian) tubes, which connect to the middle ear cavities. |
| The pharynx, where the nasopharynx joins the oropharynx, serves as a | a common passage for air and food and descends to the point of separation of the esophagus and trachea. |
| In the airway, the cartilaginous epiglottis protects the | opening into the larynx, or voice box, by flipping up or down during swallowing or ventilation. |
| The larynx consists of | various cartilages and their associated muscles. |
| There are two pairs of | vocal cords, which are infoldings of the mucous membrane. |
| As inspired air is tracked downward through the larynx | , it flows into the trachea, or windpipe |
| At the lower end of the trachea, inhaled air proceeds into the | right or left primary bronchus. The right bronchus is larger and straighter and therefore is the more likely destination for any aspirated matieral |
| Each major or primary bronchus then branches into | into many smaller (secondary) bronchi and then into bronchioles, forming an inverted bronchial “tree.” |
| Air in the bronchioles then flows into the | alveolar ducts and alveoli, or air sacs, which resemble a cluster of grapes. |
| gas exhange takes place in | alveoli |
| The inside surfaces of the alveoli are coated with a | a small amount of fluid containing surfactant, which prevents total collapse of the alveoli during expiration. |
| The lungs are | cone-shaped structures positioned on either side of the heart |
| The mediastinum is the region in the | the center of the chest that contains the heart, the major blood vessels, the esophagus, and the trachea. |
| The dome-shaped muscular diaphragm forms the | inferior boundary. |
| The right lung is divided into | three lobes and the left lung into two lobes because of the position of the heart. |
| Each lung is covered by its own | double-walled sac, the pleural membrane |
| The visceral pleura is | attached to the outer surface of the lung and then doubles back to form the parietal pleura |
| parietal pleura | , which lines the inside of the thoracic cavity, adhering to the chest wall and the diaphragm. |
| The pleural fluid between the visceral and parietal layers provides | lubrication during respiratory movements and a force that provides cohesion, or “sticking together” (high surface tension), between the two pleural layers during inspiration. |
| The thorax | consisting of ribs, vertebrae, and sternum (breastbone), provides a rigid protective wall for the lungs. |
| The upper seven pairs of ribs | ribs (true ribs) articulate with the vertebrae and are attached to the sternum by costal (hyaline) cartilage |
| next three pairs of ribs | are “false” ribs, and are connected to the costal cartilage of the seventh rib, not directly to the sternum |
| . The last two ribs (also false) | the eleventh and twelfth pairs, are attached only to vertebrae and are therefore called floating ribs. |
| Between the ribs are | located the external and internal intercostal muscles, which move the thoracic structures during ventilation. |
| ventilation | process of moving air in and out of lungs |
| Airflow during inspiration and expiration depends on a | pressure gradient, with air always moving from a high-pressure area to a low-pressure area (flow is one way only!). |
| If atmospheric pressure is higher than air pressure inside the lungs | air will move from the atmosphere into the lungs (inspiration). |
| For expiration to occur, | , the pressure must be higher in the lungs than in the atmosphere. These pressure changes in the lungs result from alterations in the size of the thoracic cavity. |
| Compliance is the term used to refer to | the ability of the lungs to expand. Compliance depends largely on the elasticity of the tissues, but can also be affected by other factors. |
| Gas exchange is the | the flow of gases between the alveolar air and the blood in the pulmonary circulation. |
| Diffusion of oxygen and carbon dioxide in the lungs depends on the | the relative concentrations or partial pressures of the gases, and movement of each gas always occurs from a high-pressure area to a low-pressure area. |
| Oxygen diffuses from | alveolar air, an area with a high concentration of oxygen, to the blood in the pulmonary capillary, which has a low concentration of oxygen, until the concentrations become equal. |
| , carbon dioxide diffuses out of the | the pulmonary capillary into the alveolar air, depending on its relative concentrations. |
| The pulmonary circulation is composed of the | the pulmonary arteries, which bring venous blood (dark blue-red in color) from the right ventricle of the heart to be oxygenated |
| pulmonary capillaries | in which diffusion or gas exchange occurs; and the pulmonary veins, which return the oxygenated blood (bright red) to the left atrium of the heart. |
| The oxygenated blood moves from the | left ventricle of the heart, which pumps the blood into the aorta, and the systemic circulation starts. |
| Spirometry | pulmonary function testing is used to test pulmonary volumes, measuring volume and airflow times. |
| ABG | determinations are used to check oxygen, carbon dioxide, and bicarbonate levels, as well as serum pH. |
| Exercise tolerance testing is useful in | patients with chronic pulmonary disease for diagnosis and monitoring of the patient’s progress. |
| radiography | may be helpful in evaluating tumors or infections such as pneumonia or tuberculosis (TB). |
| Bronchoscopy may be used in | performing a biopsy or in checking for the site of a lesion or bleeding. |
| Culture and sensitivity tests on | exudates from the upper respiratory tract or sputum specimens can identify pathogens and assist in determining the appropriate therapy. |
| sneezing | reflex response to irritation in the upper respiratory tract and assists in removing the irritant. Associated with inflammation or foreign material in the nasal passages. |
| coughing | irritation caused by nasaldripping into the oropharynx, from inflammation or foreign material in the lower respiratory tract, or from inhaled irritants. occasional cough is normal in a healthy person, persistent cough evidence of a respiratory disease. |
| sputum | mucoid discharge from the respiratory tract may have significant characteristics depending on the abnormality causing it: Normal secretions are relatively thin, clear, and colorless or cream color. |
| sputum colors | Yellowish-green, cloudy, thick mucus is often an indication of a bacterial infection.Rusty or dark-colored sputum is usually a sign of pneumococcal pneumonia |
| hemoptsis | is blood-tinged (bright red) frothy sputum that is usually associated with pulmonary edema |
| Thick, tenacious (sticky) mucus may occur in patients with | asthma or cystic fibrosis (CF). |
| The normal rate (eupnea) is | 10 to 18 respirations per minute, and the normal pattern is regular and effortless. |
| Kussmaul respirations | deep rapid respirations or “air hunger,” are typical of a state of acidosis or may follow strenuous exercise. |
| Labored respirations | or prolonged inspiration or expiration times are often associated with obstruction of the airways. |
| wheezing | or whistling sounds indicate obstruction in the small airways. |
| stridor | a high-pitched crowing noise, usually indicates upper airway obstruction |
| breath sounds | may be abnormal or absent in respiratory disorders. Rales are light bubbly or crackling sounds associated with serous secretions in lower areas of lungs. rhonci are deeper sounds from thick mucus in middle lungs. absense of sounds=collapse of lung/no air |
| dyspnea | shortness of breath. manifested with exertion |
| Severe dyspnea may be accompanied by | flaring of the nostrils (nares), use of the accessory respiratory muscles, or retraction (pulling in) of the muscles between or above the ribs. |
| Orthopnea is | is dyspnea that occurs when a person is lying down. Pulmonary congestion develops as more blood pools in the lungs when the person lies down, and also as the abdominal contents push upward against the lungs. |
| Paroxysmal nocturnal dyspnea is a | sudden acute type of dyspnea common in patients with left-sided congestive heart failure. During sleep the body fluid is redistributed, leading to pulmonary edema, and the individual wakes up gasping for air and coughing |
| cyanosis | bluish coloration of skin from deoxygenated hemoglobin in blood |
| clubbed fingers | result from chronic hypoxia |
| pleaural pain | results from inflammation or infection of the parietal pleura. It is a cyclic pain that increases as the inflamed membrane is stretched with inspiration or coughing. |
| friction rub | a soft sound produced as the rough membranes move against each other, may be heard. |
| Changes in Arterial Blood Gasses (ABGs) | A small amount of arterial blood is taken from the radial artery (wrist) to assess oxygenation of the blood. Main components include serum pH, arterial O2, arterial CO2, and bicarbonate (HCO3) |
| Hypoxemia | refers to inadequate oxygen in the blood (low PaO2) |
| hypoxia | : inadequate oxygen supply to the cells |
| compensation for hypoxia | impairment include increased cardiovascular activity, such as tachycardia and increased blood pressure |
| common cold (infectious rhinitis) | more than 200 causes. Caused by a viral infection of the upper respiratory tract Most common pathogen is a rhinovirus. Spread through respiratory droplets, which are directly inhaled or are spread by secretions. swelling of mucous membranes of pharnx |
| manifestations of cold | nasal congestion (swelling of mucous membranes). rhinorrhea (runny nose), sneezing, mouth breathing, sore throat, headache, malasise, cough, slight fever |
| treating cold | symptomatic. medications, humidifiers to keep secretions moist, handwashing, antibiotics do not cure infections bc its a virus |
| sinusitis (sinus infections) | inflamation of sinuses. bacterial infectoons secondary to cold. causative organisms-streptococci, pnemococci, exudate (drainage)baccumulates causing pressure to build in sinus cavity |
| sinusitis manifestations | pain in facial bones, congested, fever, sore throat. |
| sinus treatments | antibiotics to clear bacterial infections. decongestants and analgesics (pain management) |
| Laryngotracheobronchitis (Croup) | common viral infection in children, begins as upper respiratory infection. larnyx becomes inflamed which leads to obstruction in airway and barking cough. more severe at night. cool and moisturized air relives obstruction. self limited |
| epiglottitis | inflammation of epiglotis. caused by bacterial organism. swelling of larnyx which looks like red ball in throat. fever and sore throat. refuses to swallow. drooling and stridor is apparent. antibiotics treat it |
| scarlet fever | common in children. upper respiratory infection caused by group a b hemolytic streptococcus. Symptoms usually begin with a fever and sore throat; chills, vomiting. typical “strawberry” tongue is caused by the exotoxin produced by the bacteria. antibiotics |
| flu | type a, b,c. sudden acute onset. fever, fatigue, aching. cause pnemonia if not treated. treatment is sympotomatic and supportive unless secondary bacteria occurs. antiviral drugs like tamiflu. prevent by vaccine |
| bronchiolitis (RSV) | young children. caused by rsv. trasmitted by oral droplets. most frequent in winter. risk factor- smoking, fsmily history of astma. symptooms-wheezing, short breath, rapid respiration, cough, rales, malaise, fever. |
| pneumonia | lower tract infection. infection of alveoli in lungs. may develop as acute or secondary. risk following aspiration. |
| nosocomial pneumonia | aquired in hospital. usually bacterial. 48-72 hours after being admitted. affcets those with less resistance |
| community acquired pnemounia | May be viral or bacterial. Can affect healthy persons, for example, following influenza, as well as persons with underlying cardiovascular or respiratory disease. |
| Aspiration pneumonia: | involves aspiration of vomitus or other secretions or liquids, which is irritating to tissues, or nasopharyngeal secretions |
| lobar pneumonia | localized in one or mor elung lobes. inflmmation or congestionin alvelor wall. drainage is in alveoli. interfers with oxygen diffusion. rbcs accumulate in alveolar exudate forming a solid mass in lobe called consolidation. rusty colored sputum. |
| empyema | pockets of pus that have collected inside a body cavity |
| lobar pnemounia diagnosed and manifestations | chest x rays, sputum sample. high fever, chills, fatigure, leukocytosis, dyspnea, tachycardia, pleuritic pain, rales, coughs, confusion. treat wt abtibiotics and give fluids |
| bronchopneumonia | diffuse pattern of infection in both lungs, often in lower lobes. beggins in bronchial mucosa and spreads to alveoli |
| legionnaire disease | Pneumonia caused by a gram-negative bacterium, Legionella pneumophila If untreated, the infection causes severe congestion and consolidation, with necrosis in the lung and possibly fatal consequences. |
| covid 19 | lower tract infection. caused by SARS-CoV-2virus. rapid and firm attachment to lung cells and triggering of a cytokine storm (lifethreatning systemic immune reaction. body releases too much cytokines) severe body inflammation. |
| covid manifestations | fever, cough, sneeze, difficult breathing, loss of taste, body aches, sore throat, nausea, confusion |
| ocvid diagnostic and treatment | lab test. supportive care, pain relievers, cough syrup, rest, fluid. may include mechanical ventilation |
| tuberculoisis | lower tract. 1-2% of new cases have drug resistant forms of disease. disease of poverty and crowding. high mortality of hiv ppl |
| patho of TB | microbes resistat to drying. maby disinfectants dont kill bacteria. can be destroyed by uv light. usually caused by Mycobacterium tuberculosis and primarily affects the lungs. |
| Primary infection occurs (TB) | microorganisms first enter the lungs, are engulfed by macrophages, and cause a local inflammatory reaction. Lymphocytes and macrophages cluster together to form a granuloma at the site of inflamation |
| dormant | not causing issues at time, but can in the future. |
| primary tb continued | The bacilli may remain viable in a dormant state inside the tubercle for years, and are therefore a potential danger. By about 6 to 8 weeks the immune response is complete. This is considered primary or latent infection. |
| tb As long as the individual’s resistance and immune responses remain high, the bacilli remain | walled off within the tubercle; the individual has been exposed to and infected by the bacillus but does not have active disease and is asymptomatic. |
| extrapulmonary TB | rapid progressive form in which multiple granulomas affect large areas of lungs and disseminate into circulation to other tissuees |
| Secondary or Reinfection TB | Stage of active infection Often arises years after primary infection, when the bacilli, hidden in the tubercles, are reactivated, usually because of decreased host resistance. As the organisms multiply, tissue destruction occurs, forming necrosis |
| cavitation secondary tb | with formation of a large open area in the lung and erosion into the bronchi and blood vessels. Hemoptysis is common as blood vessels are eroded. |
| tb etiology | M. tuberculosis is transmitted by oral droplets released from a person with active infection that are inhaled into another individual’s lungs. In some countries in which milk is not pasteurized, TB may be caused by ingestion |
| primary or latent tb | cannot be spread bc its dormant |
| manifestations of tb | primary tb is asymptomatic. onset of secondary tb is gradual-anorexia, malaise, fatigue, weight loss, night sweats, cough, sputum containing blood |
| tb diagnosis | first exposure=positive skin test. active infection can be confirmed by chest x ray, ct scan, culture of sputum, routine testing |
| tb treatment | usually treated at home or in general hospital. drugs |
| histoplasmosis | lower respiraoty tract infections. common in midwestern. caused by fungus histoplasma capsulatium thats inhaled on dust particles. common in opportunistic ppl. involves granulomas and necrosis. cough fever and fatigue. skin tests used. treatment-antifung |
| anthrax | bacterial infection of kindney, respiratory tract, or gi tract of humans and cattle. causes flu like symptoms following incubation period of 1-7 days. 3-5 days= severe acute distress with fever. patient goes into shock bc toxins are relased. |
| cystic fibrosis | usually found in newborns. obstructive lung disease. genetic caused by mutations in CFTR gene. defects in exocrine glands causes abnormally thick secretions. primary effects seen in lungs and pancreas where mucus obstructs passages. |
| cystic fibrosis pathophysiology | digestive tract first sign-meconium ileus in newborns, small intestine is blocked by mucus preventing the excretion of meconium shortly after birth.pancreas- ducts of exocrine glands become blocked, leading to deficit of pancreatic digestive enzyme |
| cystic fibrosis etiology | most parents must be carriers to pass on. common in whites from northern european descent. transmitted a an autosomal recessive disorder. high population is asymptomatic |
| CF manifestations | meconium ileus appears at birth. excessive salty skin, steatorrhea (fat stool), distended abdomen, failure to gain weight, chronic cough, failure to meet milestones |
| how is CF diagnosed | genetic testing, sweat is analyzed, x rays to lungs, blood gas analysis, pulmonary function tests |
| CF treatment | cant be cured. requires physicians, nurses, pharmacists, dieticians. intensive chest physiotherapy. humidifiers promote drainage. aerobic exercises. replacement therapy for pancreatic enzymes. well balanced diet. oxygen therapy, heart transplant |
| aldosterone | causes the reabsorption of both sodium ions and water from the kidney tubules ■ Aldosterone makes you hold on to (retain) sodium (Na) and water and excrete (get rid of) potassium |
| anp and bnp | These hormones, which are released by the cardiac muscle fibers in response to increased pressure within the cardiac chambers, stimulate the elimination of water and sodium in the urine |
| lung cancer | primary or secondary tumors. primary-cancer originates in lungs. secondary-cancer metastasizes to lungs. benign lung gtumors are rare. 3rd most common cancer |
| Lung cancers are divided into two main group | : small cell lung cancer (SCLC) and non-small cell lung cancer (NSCLC) The main subtypes of NSCLC are adenocarcinoma, squamous cell carcinoma, and large cell carcinoma. |
| Bronchogenic carcinoma, arising from the | bronchial epithelium, is the most common type of malignant lung tumor |
| The first change in the lungs is usually | usually metaplasia, a change in the epithelial tissue, associated with smoking or chronic irritation, which is reversible if the irritation ceases. if not, dysplasia occurs |
| Tumors in the lungs have many effects: | Obstruction of airflow by tumor growth into a bronchus causes abnormal breath sounds and dyspnea. Inflammation surrounding the tumor stimulates a cough and predisposes to secondary infection. Pleural effusion, hemothorax, pneumothorax. systemic effects |
| factors in lung cancer | Cigarette smoking, “Secondhand smoke, Occupational or industrial exposure to carcinogens |
| Lung Cancer Manifestations | Persistent cough, dyspnea, and wheezing, Detection on chest x-ray taken when develops pneumonia or other complications Hemoptysis, when tumors erode tissue Pleural involvement, , Chest pain |
| lung cancer diagnosis | imaging test, biopsy, sputum |
| lung cancer treatment | surgery, chemo, radiation, immunotherapy, radiosurgery (lazer) |
| aspiration | food, fluid, vomitus, drugs, or other foreign material into the trachea and lungs. right lower lung is often destination of aspirated material Normally cough removes material from upper tract, vocal cords and epiglottis prevent entry into lower tract. |
| aspiration results | obstruction, whether the aspirate is a solid object causing obstruction directly or an irritating liquid causing inflammation and swelling. Inflammation may interfere with gas exchange and predispose to pneumonia. |
| aspiration pnemonia | the alveoli are involved in the inflammation, and gas diffusion is impaired |
| complications from aspiration | Respiratory distress syndrome develop if inflammation is widespread. Pulmonary abscess develop if microbes are in the aspirate. Certain materials such as solvents, if aspirated in large amounts, may be absorbed into the blood and cause systemic effects. |
| aspiration happens when | any age when the swallowing or gag reflex is depressed for any reason, for example, following anesthesia or stroke, or in patients with coma or neurologic damage. Individuals who eat or drink or perhaps take medications when lying down also risk |
| manifestations of aspiration | cough, shortness of breath, stridor, wheezing, tachycardia, nasal flaring. |
| prevention and treatment of aspiration | Adults should avoid talking or moving about when chewing and swallowing , Ensure patients are sitting up, awake, alert, and have an intact gag reflex before attempting to offer food or fluids. Oxygen and supportive therapy |
| sleep apnea | Sleep apnea results when than pharyngeal tissues collapse during sleep leading to repeated, momentary cessation of breathing. Men are more often affected than women, and the incidence increases with age and obesity. |
| manifestations of sleep apnea | Loud snoring with intermittent gasps for air directly related to chronic hypoxia and fatigue and include type 2 diabetes, pulmonary hypertension, right-sided congestive heart failure, cerebrovascular accident, depression, and daytime sleepiness. |
| sleep apnea treatment | cpap machine. delivers room air at higher pressure. wore when sleeping |
| asthma | periodic episodes of severe but reversible bronchial obstruction in persons with hypersensitive or hyperresponsive airways. Frequent repeated attacks of acute asthma may lead to irreversible damage in the lungs and the development of chronic asthma. |
| asthma attacks occur in | response to stimuli such as respiratory infections, exposure to cold, exercise, drugs such as aspirin, stress, and inhalation of irritants such as cigarette smoke. |
| asthma. The bronchi and bronchioles respond to the stimuli with three changes: | Inflammation of the mucosa with edema Contraction of smooth muscle (bronchoconstriction) Increased secretion of thick mucus in the passages These changes create partially or totally obstructed airways and interfere with airflow and oxygen supply. |
| (asthma) Partial obstruction of the small bronchi and bronchioles results in | in air trapping and hyperinflation of the lungs. Total obstruction of the airway results when mucus plugs completely block the flow of air in the already narrowed passage. |
| Status asthmaticus | persistent severe attack of asthma that does not respond to therapy. It may be fatal owing to severe hypoxia and acidosis leading to cardiac arrhythmias or central nervous system depression. |
| etiology of astma | A family history of hay fever, asthma, and eczema is common. Viral upper respiratory infections frequently precipitate attacks. Increased air pollution |
| manifestations of asthma | cough, tight feeling in chest, unable to talk, wheezing, rapid breathing, thick mucus, hypoxia, tachycardia, respiratory acidosis |
| asthma treatment | Avoidance of common triggering factors, including airborne irritants or drugs is recommended. Good ventilation in the home, school, and workplace is helpful. |
| treating acute asthma | Controlled breathing techniques and a reduction in anxiety, inhalers, Status asthmaticus must treated in the hospital setting. |
| copd | common chronic respiratory disorders that are characterized by progressive tissue degeneration and obstruction in the airways of the lungs Debilitating conditions that affect the individual’s ability to work and function independently. |
| copd includes | emphysema, chronic bronchitis, and chronic asthma COPD causes irreversible and progressive damage to the lungs. Eventually, respiratory failure may result because of severe hypoxia or hypercapnia. |
| emphysema | Destruction of the alveolar walls and septae, which leads to large, permanently inflated alveolar air spaces |
| The breakdown of the alveolar wall results in the following: | Loss of surface area for gas exchange Loss of pulmonary capillaries, affecting perfusion and the diffusion of gases Loss of elastic fibers, affecting the ability of the lung to recoil on expiration |
| emphysema leads to | Air trapping and increased residual volume Overinflation of the lungs Fixation of the ribs in an inspiratory position and an increased anterior-posterior diameter of the thorax |
| as emphysema advances | Adjacent damaged alveoli join, forming very large air spaces. These air-filled spaces are called blebs or bullae. Large blebs near the surface of the lung may rupture, resulting in pneumothorax. Hypercapnia. infections, pulmonary hypertensions |
| emphysema etiology/manifestations | smoking/air pollutants. dyspnea, barrel chest,fatigue, clubbed fingers, anorexia |
| emphysema treatment/diagnosis | chest x ray and pulmonary function tests. Avoidance of respiratory irritants , smoking cessation, immunizations, pulmonary rehabilitation programs, pursed lip breathing, antibiotics, bronchodilators, oxygen therapy |
| chronic bronchitis | differentiated by significant changes in the bronchi resulting from constant irritation from smoking or exposure to industrial pollution. The effects are irreversible and progressive. |
| chronic bronchitis pathophysiology | inflamed mucosa, increased secretions, chronic irritation, thickening of bronchial wall, low O2 levels, cyanosis, severe dyspnea, fatigue |
| chronic bronchitis etiology | history of cigarette smoking or living in an urban or industrial area, particularly in geographic locations where smog is common. Heavy exposure to inhaled irritants leads to inflammation and frequent infections, initiating the cycle |
| chronic bronchitis manifestations | constant cough, shortness of breath, thick secretions, rhonci, cyanosis, hypoxia, severe weight loss |
| chronic bronchitis treatment | reduce exposure to irritants, vaccines, low flow oxygen, expectorants, bronchodilators, and appropriate chest therapy |
| pulmonary edema | fluid collection in alveoli reducing oxygen and lung expansion. When hydrostatic pressure in the pulmonary capillaries becomes high, for example with congestive heart failure, fluid shifts out of the capillaries into the alveoli. |
| pulmonary edema pathophysiology | Excessive amounts of fluid in the alveoli interfere with gas exchange, causing severe hypoxemia, as well as with the action of surfactant, leading to difficulty in expanding the lungs, which ultimately collapse . capillaries can rupture |
| pulmonary edema etiology | Congestive heart failure Low serum protein (albumin) Inhalation of toxic gases Pulmonary Hypertension |
| pulmonary edema manifestations | cough, orthopnea, rales |
| as pulmonary edema increases | Hemoptysis often occurs. Blood-tinged frothy sputum Labored breathing. The individual feels as if he or she is drowning. Hypoxemia increases. Cyanosis develops in the advanced stage. |
| pulmonary edema treatment | treat cause, supplemental oxygen, positive pressure ventilation, increase risk of pneumonia, upper body elevated |
| pulmonary embolism | blood clot or mass that obstructs pulmonary artery, blocking flow of blood thru lung tissue. originate from deep leg veins |
| pulmonary embolism patho | An embolus to the lungs travels from its source through veins until reaches the heart and pulmonary artery. lodges as soon as it reaches a smaller artery in lungs through which it cannot pass. Small pulmonary emboli are frequently “silent” or asymptomatic |
| Large emboli (usually those involving >60% of the lung tissue) affect the | cardiovascular system, causing right-sided heart failure and decreased cardiac output (shock). |
| pulmonary embolism etiology | immobility, sitting in plane or car for a long time, trauma, childbirth, dehydration, cancer, Thrombi tend to break off with sudden muscle action or massage, trauma, or changes in blood flow. |
| manifestations of pulmonary embolism | transient chest pain, cough, dyspnea (small emboli) Chest pain occurs, which increases with coughing or deep breathing Tachypnea Dyspnea, hemoptysis (larger emboli) |
| massive pulmonary emboli manifestations | Severe chest pain Low blood pressure Rapid weak pulse Loss of consciousness Fat emboli are distinguished by the development of acute respiratory distress, a petechial rash on the trunk, and neurologic signs such as confusion and disorientation. |
| pulmonary embolism/treatment | Ventilation/Perfusion (VQ) scan Chest CTA. oxygen is administered, and usually heparin or streptokinase (fibrinolytic agents) as well, to prevent additional clots. Mechanical ventilation may be necessary |
| atelectasis | collapse of alveoli, When the alveoli become airless, they shrivel up as the natural elasticity of the tissues dominates. This process also interferes with blood flow through the lung. affects oxygen diffusion |
| what can cause atelectasis | occurs with pulmonary edema or respiratory distress syndrome, preventing expansion of lung. Postop atelectasis common occurs 24 to 72 hours after, particularly abdominal surgery, due to pain with breathing and slow shallow respirations from anesthesia. |
| atelectasis manifestations | May be asymptomatic if mild Dyspnea, increased heart and respiratory rates, abnormal breath sounds, and chest pain |
| atelectasis treatment | Deep breathing, forced coughing, changing body positions |
| pleural effusion | excess fluid in pleural cavity. Large amounts of fluid first increase the pressure in the pleural cavity and then cause separation of the pleural membranes, preventing their cohesion during inspiration. These effects prevent expansion of the lung |
| pleural effusion etiology | hemothorax-when fluid is blood resulting from trauma, cancer, or surgery. empyema- fluid is purulent as a result of infection, often related to pneumonia. |
| pleural effusion manifestations | dyspnea, chest pain, increased respiratory rate, absense of breath sounds, tracheal deviations, hypotension |
| pleurisy | is manifested by cyclic pleuritic pain and a friction rub heard on auscultation as the rough, swollen membranes move against each other during respiratory movements |
| pleural effusion treatment | Thoracentesis (needle aspiration of fluid) Chest tube may be needed for drainage Fluid may be sent for analysis |
| pneumothorax | air in pleural cavity. causes separation of the pleural membranes by air, preventing expansion of the lung and leading to lung collapse. |
| types of pneumothorax | closed-when air can enter the pleural cavity through an opening directly from the internal airways. There is no opening in the chest wall. open-atmospheric air entering the pleural cavity through an opening in the chest wall |
| tension pneumothorax | most serious form of pneumothorax. one-way valve effect, the opening enlarges on inspiration, promoting airflow into the pleural cavity.expiration,opening is sealed off, preventing removal of air. tension unaffected side pulls trachea to unaffected side. |
| pneumothorax manifestations | cough,dyspnea,chest pain, breath sounds reduced, unequal chest expansion, hypoxia |
| pneumothorax treatment | hospital asap. open-covered with inclusive dressing. chest tube. penetrating objects should not be removed |
| flail chest | results from fractures of thorax. 3-6 ribs in two different places, or fracture of sternum and number of consecutive ribs. Chest wall rigidity is lost, resulting in paradoxical (opposite) movement during inspiration and expiration |
| During inspiration: The flail or broken section of ribs moves | inward rather than outward. This inward movement of the ribs prevents expansion of the affected lung |
| On expiration: The unstable flail section is | pushed outward by the increasing intrathoracic pressure. Hypoxia results from the limited expansion and decreased inspiratory volume of the flail lung |
| flail chest treatment | stabilize flail sections with flat heavy object to limit outward paradoxical movement of the thorax until surgical repair can be performed. |
| acute respiratory distress syndrome | Injury to the alveolar wall and capillary membrane leads to release of chemical mediators, increased permeability of alveolar capillary membranes, increased fluid and protein in the interstitial area and alveoli, and damage to the surfactant cells. |
| Acute Respiratory Distress Syndrome (ARDS) results in | decreased diffusion of oxygen, reduced blood flow to the lungs, difficulty in expanding the lungs, and diffuse atelectasis. Microthrombi develop in the pulmonary circulation, causing stiffness and decreased compliance. |
| ARDS etiology | Severe or prolonged shock may cause ARDS Initial lung injury may be caused by inhalation of toxic chemicals or smoke, excessive oxygen concentration in inspired air, severe viral infections in the lungs, toxins from systemic infection |
| ARDS manifestations | Dyspnea Restlessness Rapid, shallow respirations Increased heart rate ABG measurements indicate a significant decrease in PO2 rales, cough, cyanosis, lethargy |
| ards treatment | Treat underlying cause Oxygen therapy and mechanical ventilation Poor prognosis with high fatality rate |
| Functions of the Urinary System | Removal of metabolic wastes ● Removal of hormones, drugs, and other foreign material, Regulation of water, electrolytes, and acid–base balance in the body ● Secretion of erythropoietin ● Activate vitamin D ● Regulation of blood pressure |
| The Kidneys | located behind the peritoneum, covered by a fibrous capsule and embedded in fat, superior portion protected by ribs, inside kidney is cortex/ outer layer, majority of the glomeruli, medulla/inner section of tissue, consists of tubules and ducts |
| Each kidney consists of | over a million nephrons, the functional units of the kidney. ● The renal corpuscle is the blood-filtering component of each nephron. ○ The renal corpuscle consists of Bowman’s capsule and the glomerulus |
| The tubule consists of three parts (kidneys) | proximal convoluted tubule, the loop of Henle, and the distal convoluted tubule. ● During filtration, a large volume of fluid, including wastes, nutrients, electrolytes, and other dissolved substances, passes from the blood into the tubule. |
| In the kidney tubule | reabsorption of essential nutrients, water, and electrolytes takes place, and secretion of certain wastes and electrolytes occurs. ● The collecting ducts transport the urine to the renal pelvis. |
| kidney tubule reabsorption | Water is reabsorbed by osmosis. As the filtrate progresses through the loop of Henle and the distal convoluted tubule, electrolytes and water are adjusted to the body’s current needs. adh hormone, antidieuretic, anp reduces sodium |
| renal arteries and veins | control the pressure in the glomerular capillaries and glomerular filtration pressure. This determines the glomerular filtration rate. By constricting the arterioles, amount of blood in the glomerular capillaries is adjusted, and filtration is maintained |
| The degree of constriction in the arterioles is controlled primarily by | local autoregulation, the sympathetic nervous system (SNS), and the renin–angiotensin mechanism |
| autoregulation | refers to the small, local reflex adjustments in the diameter of the arterioles that are made in response to minor changes in blood flow in the kidneys. ○ The SNS increases vasoconstriction in both arterioles when stimulated. |
| renin | secreted by cells in the kidney when blood flow in the afferent arteriole is reduced for any reason. Through a series of enzyme reactions, renin acts on the plasma protein angiotensinogen to produce angiotensin I,powerful vasocontrictor |
| If blood flow in the kidney is seriously impaired | both the SNS and the renin–angiotensin mechanism are activated to restore blood pressure and blood flow to vital areas. |
| Blood Pressure and the Kidneys | Blood pressure is related to kidney function, and it is elevated with renal disease. |
| ● When the blood flow or blood pressure in the afferent arteriole decreases for any reason | the renin–angiotensin–aldosterone triad is stimulated. ● Angiotensin not only causes systemic vasoconstriction; it also stimulates the secretion of aldosterone, increasing bp |
| When the filtrate has been processed in the tubules and collecting ducts, it is considered to be | urine and it flows from the kidneys, into the ureters, and then into the urinary bladder |
| the bladder | composed of smooth muscle that falls in rugae, or folds, to form an expandable sac. located in pelvic cavity. The bladder has openings for the two ureters to bring urine in, as well as an outlet for the urethra through which urine flows out |
| voiding | Micturition occurs when reflex is stimulated by increased pressure as bladder distends. The reflex is transmitted by parasympathetic nerves extending to sacral spinal cord. |
| urinalysis | normally is clear and straw-colored and has a mild odor. ● The constituents and characteristics of urine may vary with dietary intake, drugs, and the care with which a specimen is handled |
| urinalysis abnormals | Cloudy presence of large amounts of protein, blood cells, or bacteria and pus Dark color— hematuria, excessive bilirubin content, or highly concentrated urine ○ Unusual l odor—may indicate infection or result from dietary components or medication |
| Specific gravity indicates the ability of the | tubules to concentrate the urine; a very low specific gravity (dilute urine) usually is related to renal failure (assuming normal hydration) |
| blood tests bun and creatinine | elevated levels indicate failure to excrete nitrogen wastes (resulting from protein metabolism) attributed to decreased GFR |
| blood tests serum ph and bicarbonate | acid-base imbalances may indicate decreased GFR and failure of the tubules to control the acid–base balance |
| blood tests hemoglobin | low hemoglobin = anemia; indicates decreased erythropoietin secretion |
| Urine culture and sensitivity | used to identify causative organism in urinary infection and select drug treatment |
| cystoscopy | visualizes the lower urinary tract and may be used in performing a biopsy or removing kidney stones |
| biopsy | may be used to acquire tissue specimens to allow microscopic examination of suspicious lesions in the bladder or kidney. |
| dialysis | artificial kidney,” which can be used to sustain life after the kidneys fail. ● Dialysis is used to treat someone who has acute renal failure until the primary problem has been reversed, or it can be used for patients in end-stage renal failure |
| hemodialysis | The patient’s blood moves from an implanted shunt or catheter in an artery, often in the arm, through a tube to a machine where wastes, fluid, and |
| Peritoneal Dialysis | Dialyzing fluid is administered into the patient’s peritoneal cavity (abdomen) via an implanted catheter. Fluid, wastes, and electrolytes are filtered out of the blood and the fluid then drains out of the peritoneal cavity into a container. |
| Diuretic Drugs | used to remove excess sodium ions and water from the body, therefore increasing the excretion of water through the kidneys and urinary output. ● In turn, this reduces fluid volume in the tissues (edema) and blood. side effect- loss of electrolytes |
| Incontinence | Loss of voluntary control of the bladder ■ Stress Incontinence: Increased intraabdominal pressure forces urine through the sphincter; usually occurs with coughing, lifting, or laughing ■ Overflow Incontinence: results from incompetent bladder sphincter |
| retention | Inability to empty the bladder ○ Urinary retention requires manual drainage of the bladder with a catheter |
| Neurogenic Bladder | caused by damage to the spinal cord; may cause either retention or incontinence |
| UTIS | Cystitis and urethritis are considered infections of lower urinary tract,pyelonephritis is upper tract infection. Most are ascending, arising from organisms in the perineal area and traveling along the continuous mucosa in the urinary tract to the bladder |
| utis pathophysiology | The common causative organism is Escherichia coli, which is one of the resident flora of the intestine. |
| uti etiology | Older men with prostatic hypertrophy and retention of urine frequently develop infections ● Common predisposing factors for UTIs include incontinence with incomplete emptying of the bladder, retention of urine in the bladder, and any flow obstruction |
| Cystitis and Urethritis | The bladder wall (cystitis) and urethra (urethritis), are inflamed, red, swollen, and in some cases ulcerated ● In most cases the cause of cystitis is a bacterial infection, |
| Urethritis is usually caused by a | sexually transmitted infection, but it can sometimes also result from an injury from an instrument such as a urinary catheter or exposure to an irritating chemical such as an antiseptic. |
| Cystitis and Urethritis ● Manifestations | lower abdomen pain, dysuria, urgency, frequency, nocturia, cloudy urine with odor, malaise, fever. treat wt antibiotics |
| Pyelonephritis patho | Infection of one or both kidneys ○ Infection extends from the ureter into the kidney, involving the renal pelvis and medullary tissue (tubules and interstitial tissue). ○ Purulent exudate fills the kidney pelvis and calyces |
| Pyelonephritis manifestations | Dysuria (painful urination) ○ Dull aching pain in the lower back or flank area ○ Fever, malaise, nausea, leukocytosis ○ Abnormal urinalysis: hematuria and bacteriuria |
| Pyelonephritis treatment | antibiotics, fluid intake |
| Glomerulonephritis (Acute Poststreptococcal Glomerulonephritis) | follows streptococcal infection with certain strains of group A beta-hemolytic Streptococcus. ● These infections usually originate as upper respiratory infections, middle ear infections, or “strep throat.” Certain strains initiate an immune disorder |
| APSGN develops | 10 days to 2 weeks after the antecedent infection; primarily affects children between the ages of 3 and 7 years |
| Glomerulonephritis (Acute Poststreptococcal Glomerulonephritis) ● Pathophysiology | antibodies, formed as usual from earlier streptococcal infection, create an antigen–antibody complex that lodges in the glomerular capillaries and causes inflammatory response in glomeruli of kidney. increased capillary permeability/cell proliferation |
| Glomerulonephritis (Acute Poststreptococcal Glomerulonephritis) ● Pathophysiology pt 2 | inflammatory response is severe, the congestion and cell proliferation nterfere with filtration in the kidney ○ Acute renal failure if blood flow impaired decreased blood flow in the kidney. increased renin. elevated bp/edema |
| Glomerulonephritis (Acute Poststreptococcal Glomerulonephritis) ● Manifestations | dark/cloudy urine, Facial and periorbital edema occur initially, followed by generalized edema, flank pain,oliguria |
| Glomerulonephritis (Acute Poststreptococcal Glomerulonephritis) ● Diagnostic Tests | urinalysis, blood tests, Blood levels of anti-DNase B, streptococcal antibodies, ASO, and ASK are elevated. ○ Metabolic acidosis, with decreased serum bicarbonate and low serum pH, is present. |
| Glomerulonephritis (Acute Poststreptococcal Glomerulonephritis) ● Treatment | Steroids to decrease inflammation and antihypertensives to reduce BP ○ Sodium, protein, and fluid restrictions may be necessary ○ In most cases, recovery takes place with minimum residual damage |
| Nephrotic Syndrome | Nephrotic syndrome is secondary to a number of renal diseases, as well as to a variety of systemic disorders (e.g., systemic lupus erythematosus, exposure to toxins or drugs) |
| Nephrotic Syndrome ● Pathophysiology | There is an abnormality in the glomerular capillaries that allows large amounts of plasma protein, primarily albumin, to escape into the filtrate (urine) ○ This causes hypoalbuminemia with decreased plasma osmotic pressure and edema. |
| Nephrotic Syndrome ● Pathophysiolog pt 2 | The decreased blood volume also increases aldosterone secretion, leading to more severe edema ○ The other significant components of nephrotic syndrome are the high levels of cholesterol in the blood and lipoprotein in the urine. |
| Nephrotic Syndrome ● Manifestations | roteinuria and lipiduria via urinalysis ○ Frothy urine ○ The significant sign of nephrosis is the massive edema (anasarca) associated with weight gain and pallor, skin breakdown |
| Nephrotic Syndrome ● Treatment | Steroids to reduce inflammation in the kidney ○ Sodium restriction ○ High protein diet (due to protein loss in urine) ○ Nephrotic syndrome tends to recur and requires frequent monitoring and continued treatment. |
| Urinary Tract Obstructions | n older men, the urinary tract is frequently obstructed by benign prostatic hypertrophy or prostatic cancer. ● Common causes of obstruction in men and women include tumors, inflammation, scarring, stenosis, congenital defect |
| Urolithiasis (Urinary Calculi/Kidney Stones) ● Pathophysiology | Calculi can develop, stones, Calculi tend to form when there are excessive amounts of relatively insoluble salts in the filtrate (such as calcium), Calculi may lead to infection because they cause stasis of urine in the area and irritate the tissues |
| When located in the kidney or ureter, calculi may cause | the development of hydronephrosis |
| Urolithiasis (Urinary Calculi/Kidney Stones) ● Etiology | Approximately 75% of calculi are composed of calcium salts, with the remainder consisting primarily of uric acid ○ Calcium stones (phosphate, oxalate, or carbonate) form when calcium levels in the urine are high because of hypercalcemia ○ Immobility |
| Urolithiasis (Urinary Calculi/Kidney Stones) ● Manifestations | flank pain, Obstruction of the ureter causes an attack of “renal colic,” consisting of intense spasms of pain in the flank area radiating into the groinNausea, vomiting, tachycardia, cool and moist skin |
| Urolithiasis (Urinary Calculi/Kidney Stones) ● Treatment | Small stones can be passed eventually, and the urine strained to catch stones for analysis, extracorporeal shockwave lithotripsy, which uses sound waves to break up the stone, and laser lithotripsy, increase fluids |
| Hydronephrosis | Dilation of renal pelvis and calyces by back pressure from obstruction of flow, Occurs as a secondary problem, a complication of calculi, but also of tumors, scar tissue in kidney/ureter, and untreated prostatic enlargement, Urine continually forming |
| Renal Cell Carcinoma | primary tumor arising from tubule epithelium, asymptomatic in early stage and often metastasized to liver, lungs, bone, initial sign painless hematuria. dull, aching flank pain; a palpable mass; unexplained weight loss Removal of kidney is treatment |
| Bladder Cancer | diagnosed by urine cytology and biposy, hematuria, dysuria, and infections, Predisposing factors include the male gender, age > 50, cigarette smoking, and occupational exposure to chemicals ● Treatment-surgical resection, chemotherapy, and radiation |
| Surgical creation of a urinary diversion (alternate means of collecting urine) may be required if the | bladder must be removed bc of cancer |
| Nephrosclerosis ● Pathophysiology | vascular changes ■ thickening and hardening of the walls of the arterioles and small arteries and narrowing or occlusion of the lumina of the blood vessels reduce the blood supply to the kidney, causing ischemia and atrophy |
| Nephrosclerosis may be | primary or secondary to hypertension or diabetes ○ In any case, a vicious cycle can develop with the kidneys and hypertensive changes, and this must be broken to prevent renal failure or other complications of hypertension |
| Nephrosclerosis treatment | Reduce sodium intake ○ Antihypertensive medications to decrease BP and maintain renal blood flow |
| Vesicoureteral reflux is | caused by a defective valve in the bladder, causes urine to backflow into the kidneys |
| agenesis | refers to a developmental failure of one kidney to develop. This is asymptomatic and usually is an incidental finding if diagnosed at all |
| hypoplasia | or failure to develop to normal size, is often a unilateral defect. Sometimes it results from fibrosis in the kidney rather than being a true developmental flaw |
| ectopic kidney | is a kidney and its ureter out of normal position. A common location is lower in the abdominal or pelvic cavity. Kidney function is normal. In this position the ureter may become kinked, causing obstruction or infection |
| fusion of two kidneys | during development is a common malformation, resulting in a single “horseshoe” kidney. Usually kidney function is normal. |
| Polycystic Kidney | Multiple cysts develop in both kidneys and gradually expand over the years, first enlarging the kidneys and then compressing and destroying kidney tissue until chronic renal failure occurs ● Transmitted as an autosomal dominant gene on chromosome 16 |
| Acute Renal Failure ● Pathophysiology | acute failure of both kidneys ○ The failure is usually reversible if the primary problem is treated successfully. ○ Dialysis may be used to temporarily |
| Acute Renal Failure ● Etiology | Acute bilateral kidney disease, such as glomerulonephritis, which reduces GFR. ■ Severe and prolonged circulatory shock or heart failure, Nephrotoxins such as drugs, chemicals, or toxins, which cause tubule necrosis Occasionally mechanical obstructions |
| Acute Renal Failure ● Manifestations | Acute renal failure usually develops rapidly. ○ Blood tests show elevated serum urea nitrogen (BUN) and creatinine, as well as metabolic acidosis and hyperkalemia, confirming the failure of the kidneys to remove wastes |
| acute renal failure treatment | Treat the underlying cause ○ Dialysis may be needed during the oliguric phase. ○ Recovery from acute renal failure is evidenced by increased urine output |
| Chronic Renal Failure ● Pathophysiology | several stages, progressing from decreased renal reserve to insufficiency to end-stage renal failure or uremia. ○ As nephrons are damaged and lost, GFR decreases. elevation in creatinine and BUN levels as nitrogenous waste products accumulate in blood |
| chronic renal failure | Gradual irreversible destruction of the kidneys over a long period ● The gradual loss of nephrons is asymptomatic until it is well advanced because the kidneys normally have considerable reserve function. |
| chronic renal failure pt 2 | Fluid and electrolytes can no longer be filtered and excreted, so they are retained. ○ Oliguria, then anuria develops. ○ Kidneys can no longer maintain acid-base balance. |
| Chronic Renal Failure ● Manifestations | Oliguria ■ Dry, pruritic, and hyperpigmented skin, easy bruising ■ Peripheral neuropathy—abnormal sensations in the lower limbs ■ Impotence and decreased libido in men, chs, lethargy |
| Chronic Renal Failure ● Manifestations | Failure of the kidney to activate vitamin D for calcium absorption and metabolism, combined with urinary retention of phosphate ion, leading to hypocalcemia and hyperphosphatemia with osteodystrophy |
| Chronic Renal Failure ● Diagnostic Tests | Anemia, acidosis, and azotemia are the key indicators of chronic renal failure ■ Laboratory studies will show anemia (decreased H&H and RBC), azotemia (increased BUN and creatinine, and acidosis (decreased serum pH) ■ Electrolyte abnormalities |
| Chronic Renal Failure ● Treatment | Medications to stimulate erythropoiesis and decrease phosphate levels ○ Dialysis, kidney transplant, Intake of fluid, electrolytes, and protein must be restricted, because the kidneys are limited in their ability to excrete excess wastes |
| The heart functions as the | pump for the circulating blood in both the pulmonary and systemic circulations. |
| blood flow order | vena cava > right atrium > tricuspid valve > right ventricle > pulmonic valve > pulmonary artery > lungs > pulmonary veins > left atrium > mitral valve > left ventricle > aortic valve > aorta > systemic circulation |
| The heart is located in the | mediastinum between the lungs and is enclosed in the double- walled pericardial sac |
| The heart is composed of three layers of tissue: | Epicardium: serous membrane covering the outer surface of the heart ○ Myocardium: composed of specialized cardiac muscle cells that contract rhythmically and forcefully to pump blood endocardum- Innermost layer;four heart valves that separate chambers |
| Atrioventricular (AV) Valves | eparate the atria from the ventricles ○ Tricuspid valve: separates right atria from right ventricle ○ Mitral valve: separates left atria from left ventricle |
| Semilunar valves: | located at the exits from to the large arteries from the ventricles ○ Aortic Valve ○ Pulmonic Valve |
| separates the left and right sides of the heart. | septum |
| Sinoatrial (SA) Node: | pacemaker of the heart; site at which electrical impulses in the heart originate ○ Located in the wall of the right atrium |
| AV node | located in the floor of the right atrium near the septum. ○ Only anatomic connection between the atrial and ventricular portions of the conduction system |
| coronary arteries | n the outer surface of the heart perfuse the cardiac muscle. |
| Collateral circulation | is important if an artery becomes obstructed. ○ When obstruction develops gradually, more capillaries from nearby arteries tend to enlarge or extend into adjacent tissues to meet the metabolic needs of the cells |
| The cardiac cycle refers to the alternating sequence of | diastole, the relaxation phase of cardiac activity, and systole, or cardiac contraction, which is coordinated by the conduction system for maximum efficiency. |
| Cardiac output | volume of blood ejected by a ventricle in 1 minute. ○ Cardiac output = Heart Rate x Stroke Volume |
| Stroke Volume | volume of blood pumped by the heart with each contraction |
| cardiac reserve | refers to the ability of the heart to increase output in response to increased demand |
| preload | volume of blood within the ventricle at the end of diastole (right before the ventricle contracts) |
| afterload | resistance left ventricle must overcome to eject blood out to the rest of the body |
| BP | refers to the pressure that blood exerts against the walls of arteries in systemic circulation. ● In adults, a normal pressure is commonly around 120/70 mm Hg at rest. |
| systolic pressure | he higher number, is the pressure exerted by the blood when ejected from the left ventricle. |
| diastolic pressure | the lower value, is the pressure that is sustained when the ventricles are relaxed |
| Peripheral vascular resistance is the | force opposing blood flow, or the amount of friction with the vessel walls encountered by the blood |
| Vasoconstriction | decreased diameter or lumen size of a blood vessel ○ Vasoconstriction increases peripheral vascular resistance and therefore increased BP |
| vasodialation | increased diameter or lumen size of a blood vessel ○ Vasodilation decreases peripheral vascular resistance and therefore decreases BP |
| ADH | increases water reabsorption through the kidney, thus increasing blood volume. ADH, also known as vasopressin, also causes vasoconstriction. ADH ↑ BP |
| aldosterone increases | blood volume by increasing reabsorption of sodium ions and water. Aldosterone ↑ BP |
| renin-angiotensin-aldosterone system | kidneys is an important control and compensation mechanism that is initiated when there is any decrease in renal blood flow. This stimulates the release of renin, |
| Echocardiogram | ultrasound of the heart; provides useful information regarding valvular abnormalities, congenital defects, and changes in heart structure or function |
| Chest X-ray: | show the shape and size of the heart, as well as any evidence of pulmonary congestion associated with heart failure |
| Coronary angiography | visualize blood flow through coronary arteries |
| troponin | blood test: used to measure the levels of blood proteins called troponins. These proteins are released when cardiac muscle has been damaged. ○ The more damage to the heart, the higher the levels of the troponins |
| Very high levels of the proteins are an indication that a | heart attack occured |
| Coronary Artery Disease (CAD) | ncludes angina pectoris or temporary cardiac ischemia and myocardial infarction (MI) or heart attack ● May ultimately lead to heart failure, serious dysrhythmias, or sudden death. ● Men tend to develop heart disease at an earlier age than women |
| Angina, or chest pain, occurs when there is | deficit of oxygen to the heart muscle. ■ This can occur when the blood or oxygen supply to the myocardium is impaired, when the heart is working harder than usual and needs more oxygen |
| Insufficient myocardial blood supply is associated with | atherosclerosis (build up of fatty plaque in the artery walls), arteriosclerosis (hardening and thickening of the arteries), vasospasm (a localized contraction of arteriolar smooth muscle), and myocardial hypertrophy |
| Precipitating factors of angina attacks | are related to activities that increase the demands on the heart, such as running up stairs, getting angry, having a respiratory infection with fever, being exposed to weather extremes or pollution, or eating a large meal. |
| Angina Pectoris ● Manifestations | , intermittent brief episodes of substernal chest pain, usually triggered by stress. tightness in the chest and may radiate ■ Pallor ■ Diaphoresis (excessive sweating) ■ Nausea |
| Angina Pectoris ● Treatment | Anginal pain is usually quickly relieved by rest and the administration of coronary vasodilators, such as nitroglycerin. ■ The drug may relieve vasospasm in the coronary arteries, but primarily acts to reduce systemic resistance |
| Myocardial Infarction (MI) | involves the death of myocardial tissue because of ischemia (deficiency of blood). ● For those who survive an MI, there is notably greater risk of a second MI, CHF, or stroke occurring within a short time. |
| Myocardial Infarction (MI) ● Pathophysiology | coronary artery (or arteries) is totally obstructed, leading to prolonged ischemia and cell death, or infarction, of the heart wall. ■ The most common cause is atherosclerosis, usually with thrombus attached. heart tissue becomes necrotic |
| Myocardial Infarction (MI) ● Manifestations | chest pain that radiates to the left arm, shoulder, jaw, or neck. or vasodilators. Women often report a milder pain, more like indigestion ○ Pallor, Diaphoresis ○ Nausea ○ Dizziness and weakness ○ Dyspnea hypotension |
| Myocardial Infarction (MI) ● Diagnosis | EKG changes ○ Elevated cardiac troponin levels |
| MI treatment | Supplemental oxygen, morphine ○ Anticoagulants or thrombolytic agents , CABG surgery, cath lab |
| Myocardial Infarction (MI) ● Potential Complications | death shortly after MI occurs frequently (in about 25% of patients), usually owing to ventricular arrhythmias. ○ Cardiogenic shock CHF |
| Congestive Heart Failure (CHF) Pathophysiology | heart is unable to pump sufficient blood to meet the metabolic needs. usually is a chronic condition. ● Depending on the cause, one side of the heart usually fails first. Cardiac output or stroke volume decreases, resulting in less blood |
| Left-sided CHF: | left ventricle cannot pump all of its blood into the systemic circulation ○ The normal volume of blood returning from the lungs cannot enter the left side of the heart. ○ This eventually causes congestion in the pulmonary circulation,fluid backup |
| Right-sided CHF | right ventricle cannot maintain its output, so less blood proceeds to the left side of the heart and the systemic circulation (forward effect). or congestion, is apparent in the systemic circulation by increased blood volume and congestion in the legs |
| Congestive Heart Failure (CHF) Etiology | nfarction that impairs the pumping ability or efficiency of the conducting system, valvular changes, or congenital heart defects may cause failure of the affected side. ● Presently coronary artery disease is the leading cause of CHF,pulmonary disease, |
| Congestive Heart Failure (CHF) Manifestations | Forward effects are results of decreased cardiac output or ventricle’s inability to pump enough blood. Decreased blood supply to the tissues and general hypoxia Fatigue, and shortness of breath, especially with exertion, Exercise intolerance, Dizziness |
| Congestive Heart Failure (CHF) Manifestations | backup effects of CHF are caused by the congestion or backup of blood behind the affected ventricle. ● Backup effects differ depending on the affected ventricle. ● Right-sided heart failure causes fluid backup in systemic circulation |
| Left-sided heart failure causes | fluid backup in the lungs: ○ Dyspnea and orthopnea (difficulty in breathing when lying down) ○ Cough ○ Paroxysmal nocturnal dyspnea ○ Pulmonary edema ○ Rales or crackles ○ Decreased oxygen saturation |
| Congestive Heart Failure (CHF) Diagnosis | Chest X-Ray to visualize cardiomegaly and fluid in lungs ● Arterial blood gas (ABG) to measure oxygenation |
| CHF treatment | Treat underlying problem ● Fluid and sodium restriction ● Medication therapy: antihypertensives, diuretics, and vasodilators |
| Congenital Heart Defects | Structural defects in the heart that develop during the first 8 weeks of embryonic life ● Structures such as valves, septal walls, heart chambers, or blood vessels may be altered or missing. ● Both genetic and environmental factors contribute |
| Congenital Heart Defects Pathophysiology | valvular defects that interfere with the normal flow of blood, septal defects that allow mixing of oxygenated blood from the pulmonary circulation with unoxygenated blood from the systemic circulation, shunts or abnormalities of the large vessels |
| Congenital Heart Defects Etiology | multifactorial and reflect a combination of genetic and environmental influences. ● These defects are often associated with chromosomal abnormalities, such as Down syndrome. ● Environmental factors include viral infections |
| Congenital Heart Defects Manifestations | Pallor and cyanosis ○ Tachycardia ○ Dyspnea on exertion and tachypnea ○ A squatting position, clubbed fingers |
| Congenital Heart Defects Diagnosis | Diagnostic imaging ● Cardiac catheterization ● Echocardiograms ● ECG |
| Congenital Heart Defects Treatment | Surgical repair ● Supportive measures like oxygen and medications ● Some septal defects close spontaneously with time |
| Congenital Heart Defects include: | Ventricular septal defect: opening in the septum that separates the R and L atria or R and L ventricle; AKA “hole in the heart” ● Valvular Defects, tetragoy of fallot |
| tetragoy of fallot | Includes four anomalies or defects: ○ Pulmonary valve stenosis, ventricular septal defect, right ventricular hypertrophy, and transposition of the aorta (aorta in an abnormal position) |
| Rheumatic Fever and Rheumatic Heart Disease ● Pathophysiology | cute systemic inflammatory condition that appears to result from an abnormal immune reaction occurring a few weeks after an untreated infection, usually caused by certain strains of group A beta-hemolytic Streptococcus. ○ The inflammation the heart |
| Rheumatic Fever and Rheumatic Heart Disease ● Pathophysiology | Antibodies to the streptococcus organisms form as usual and then react with connective tissue (collagen) in the skin, joints, brain, and heart, causing inflammation. ○ The heart is the only site where scar tissue occurs |
| Pericarditis: | inflammation of the outer layer, may include effusion (excessive fluid accumulation), which impairs filling |
| myocarditis | inflammation develops as localized lesions in the heart muscle, may interfere with conduction. |
| Endocarditis: | he most common problem ■ Affects the valves, which become edematous. Small, wartlike vegetations form along the outer edge of the valve cusps. |
| Rheumatic Fever and Rheumatic Heart Disease treatment | Antibiotics such as penicillin |
| Rheumatic Fever and Rheumatic Heart Disease ● Manifestations | Low-grade fever ○ Leukocytosis ○ Malaise ○ Anorexia and fatigue ○ Tachycardia, even at rest, is common ○ Heart murmurs that indicate the site of inflammation ○ Epistaxis and abdominal pain |
| Infective Endocarditis ● Pathophysiology | Heart valves are attacked by Staphylococcus aureus or other strains of strep ○ Microorganisms in the general circulation attach to the endocardium and invade the heart valves. Vegetations are large, fragile masses made up of fibrin strands, platelets |
| Infective Endocarditis ● Pathophysiology | acute stage, these vegetations may interfere with the opening and closing of the valves. ○ Pieces may break away, forming infective or septic emboli that then cause infarction and infection in other tissues. |
| Infective Endocarditis ● Etiology | congenital defects, rheumatic fever, mitral prolapse, and artificial or replacement valves. Persons with septal defects, catheters, or other artificial implants are also susceptible to infection. ○ Intravenous drug users |
| Infective Endocarditis ● Diagnosis | Transesophageal echocardiogram (TEE) may also be used to reveal the presence of vegetations |
| Infective Endocarditis manifestations | Fever, chills ○ Impaired heart function ○ Osler nodes (painful red nodules on the fingers) ● Treatment: antibiotics |
| Pericarditis ● Pathophysiology | Inflammation of the pericardium, in which the rough, swollen surfaces cause chest pain and a friction rub (a grating sound heard on the chest with a stethoscope). ○ In some cases, an effusion may develop |
| cardiac tamponade | Small volumes of fluid in the pericardium have little effect on heart function, but a large amount of fluid that accumulates rapidly may compress the heart and impair its expansion and filling, thus decreasing cardiac output |
| Pericarditis manifestations | Tachycardia, chest pain, dyspnea, cough, friction rub, EKG changes |
| Pericarditis treatment | Pericardiocentesis: a needle is used to aspirate or drain fluid from the pericardial sac |
| Hypertension ● Pathophysiology | ]idiopathic.hypertension develops when the blood pressure is consistently above 140/90 mm Hg. ○ In essential hypertension there is an increase in arteriolar. decrease in the diameter of the arterioles causes a major increase in peripheral resistance |
| Hypertension ● Pathophysiology | vasoconstriction leads to decreased blood flow through the kidneys, increased renin, angiotensin, and aldosterone. hard and thick narrowing the lumen |
| Etiology hypertension | Idiopathic ○ Predisposing factors: male gender, African American race, high sodium intake, alcohol consumption, obesity, stress |
| Hypertension ● Manifestations | Often asymptomatic ○ Fatigue, malaise ○ Morning headache ○ Consistently elevated BP |
| Shock | results from a decreased circulating blood volume, leading to decreased tissue perfusion and general hypoxia. ● In most cases, cardiac output is low |
| Shock ● Pathophysiology | can lead to acidosis. blood pressure drops. In patients with shock there is usually less cardiac output, and blood flow through the microcirculation is decreased |
| Shock ● Pathophysiology | Organs and tissues can no longer function or undergo mitosis. Eventually the cells degenerate and die. ○ When organ damage occurs, shock may be irreversible. ○ Multiple organ failure may occur even after the patient appears to be stabilized. |
| Shock ● Etiology | Hypovolemic shock results from loss of blood or loss of plasma from the circulating blood. ○ Cardiogenic shock is associated with cardiac impairment, such as acute infarction of the left ventricle, or arrhythmias. |
| shock ex | Vasogenic: vasodilation causes decreased BP ○ Anaphylactic-rapid vasodilation by the release of large amounts of histamine in a severe allergic reaction. ○ Septic shock may develop in persons with severe infection as the bacteria produce endotoxins |
| Shock ● Manifestations | Cool, moist, pale skin, tachcycardia, Lethargy and weakness ○ Hypoxemia ○ Metabolic acidosis ○ Hypotension |
| Shock ● Treatment | Treat underlying problem ○ Fluid replacement and blood transfusions for hypovolemic shock ○ Medications like antihistamines for anaphylactic shock ○ Antibiotics for septic shock ○ Supplemental oxygen ○ Vasoconstricting medication |
| The digestive tract is divided into two sections | the upper tract, consisting of the mouth, esophagus, and stomach, and the lower tract, consisting of the intestines |
| peritoneum | large serous membrane in the abdominal cavity. ○ The parietal peritoneum covers the abdominal wall and the superior surface of the urinary bladder and uterus, and then it continues, reflecting back to form the visceral peritoneum |
| The peritoneal cavity refers to the | potential space between the parietal and visceral peritoneum. A small amount of serous fluid is present in the cavity to facilitate the necessary movement of structures such as the stomach. |
| The mesentery is a | double layer of peritoneum that supports the intestines and conveys blood vessels and nerves to supply the wall of the intestine. |
| The greater omentum is a | layer of fatty peritoneum that hangs from the stomach like an apron over the anterior surface of the transverse colon and the small intestine. |
| Food and fluid are taken into the body through the mouth, where the | initial phase of mechanical breakdown and digestion takes place, and are then stored in the stomach, where processing continues. |
| mastication | akes place as the teeth break down solid food and mix it with saliva |
| amylase | which begins the digestion of carbohydrate in the mouth. |
| During the process of swallowing, | the bolus of food enters the esophagus and peristalsis pushes the food down the esophagus into the stomach |
| he lower esophageal (gastroesophageal, or cardiac) sphincter separates the | end of the esophagus from the opening of the stomach and prevents the reflux of gastric contents back up the esophagus. |
| The stomach is | expansible muscular sac that acts as a reservoir for food and fluid. ● When empty, the stomach wall falls into folds, or rugae. ● Numerous glands are located in the mucosa, and there is a layer of thick protective mucus covering the inner surface |
| The gastric glands located in the fundus of the stomach contain | parietal cells that secrete hydrochloric acid. |
| The liver is | located in the upper right quadrant (URQ) of the abdomen under the diaphragm and serves as the “metabolic factory” of the body. ● The hepatocytes, or liver cells, are arranged in lobules. |
| Venous blood from the portal vein transports | nutrients absorbed from the stomach and intestines (hepatic portal circulation), as well as from the pancreas and spleen. |
| Absorbed nutrients are taken up by the | hepatocytes to be stored |
| the liver synthesizes | plasma proteins (albumin), clotting factors, and cholesterol. |
| in conjunction with the hormone insulin, the liver responds to high levels of | blood glucose by glycogenesis, converting glucose to glycogen, which is stored in the liver. |
| Alternatively, the hepatocytes break down | liver glycogen to glucose (glycogenolysis) when blood glucose levels drop |
| The hepatocytes of the liver constantly produce | bile. excess stored in gallbladder |
| the cells of the exocrine pancreas are | arranged in lobules throughout the organ; they secrete digestive enzymes, electrolytes, and water. ● Pancreatic amylase aids in the digestion of carbohydrates and lipase |
| The ileum is the | major site of absorption of nutrients |
| The mucosa of the small intestine is covered with | villi and microvilli. These numerous tiny projections greatly increase the absorptive surface area of the small intestine |
| Many goblet cells in the mucosa secrete | large quantities of mucus into the intestine to protect the intestinal wall and buffer the acidic contents. |
| The ileocecal valve marks the | entry point from the ileum into the large intestine or colon |
| cecum | first section of the colon, from which the appendix extends |
| moving superiorly from the cecum is the | ascending colon, which becomes the transverse colon and then passes down the left side as the descending colon |
| Absorption of large amounts of water and electrolytes takes place in the | colon |
| Colonic movements are | slow to allow absorption of fluid and formation of the solid feces |
| The transverse and descending colon are marked by, strong | peristaltic contractions that occur several times daily |
| The rectum stores the | solid feces until sufficient distention of the rectal wall stimulates the defecation reflex. |
| Recurrent vomiting of undigested food from previous meals indicates a problem with | gastric emptying |
| Steatorrhea | “fatty diarrhea,” marked by frequent bulky, greasy, loose stools, often with a foul odor. These stools are characteristic of malabsorption syndromes, such as celiac disease or cystic fibrosis |
| Frank blood | refers to red blood, often on the surface of the stool |
| Gas develops | normally in the digestive tract from swallowed air and digestive and bacterial action on food. Certain foods or alterations in motility also promote gas production |
| In an adult, a BMI greater than | 30=obesity |
| Esophageal Cancer | primarily squamous cell carcinoma and is most commonly found in the distal esophagus. ● Esophageal cancer is associated with chronic irritation |
| Hiatal Hernia | when part of the stomach protrudes through the opening in the diaphragm into the thoracic (chest) cavity. ● The signs of hiatal hernia include heartburn, which occurs after meals and results from reflux of the gastric contents up the esophagus. |
| Gastroesophageal Reflux Disease (GERD) | periodic flow of gastric contents into the esophagus. ● Episodes of reflux causing heartburn frequently occur 30 to 60 minutes after eating or at night. Frequent reflux gastric acid leads to inflammation and ulceration of the mucosa. treat with antacids |
| Gastritis | Inflammation of the stomach |
| acute gastritis | gastric mucosa is inflamed. bleeding if the mucosal barrier is severely damaged. caused by microorganisms, food allergies, excess alcohol intake, irritating or spicy foods anorexia, epigastric pain or cramping, hematemesis indicates ulceration |
| Chronic Gastritis | atrophy of the mucosa of the stomach, with loss of the secretory glands. seen in individuals with chronic peptic ulcers, alcohol, and the elderly. ● mild epigastric discomfort, anorexia, or intolerance for foods |
| Persons with chronic gastritis have an increased risk of | peptic ulcers and gastric carcinoma. |
| Gastroenteritis | stomach and the intestines in an inflammatory process. caused by infection. inflammation of the gastric mucosa stimulates vomiting diarrhea results when the inflammation of the intestines causes increased motility |
| Peptic Ulcers patho | in the proximal duodenum but are also found in the antrum of the stomach or lower esophagus. single, small, round cavities with smooth margins that penetrate the submucosa. ○ Ulcers may erode more deeply and eventually perforate the gastric wall |
| Peptic ulcers occur more easily when the | mucosal barrier that protects the lining of the stomach is damaged or when there is excessive hydrochloric acid. |
| Peptic Ulcers ● Etiology | H. pylori is considered an underlying cause of the majority of cases of peptic ulcers. ○ Severe or prolonged stress ○ Caffeine and alcohol intake, cigarette smoking, and ingestion of irritating foods ○ Medications such as aspirin and NSAIDs |
| Peptic Ulcers ● Manifestations | pigastric burning or aching pain, occurring 2 to 3 hours after meals ○ Pain is often relieved by ingestion of food or antacids ○ Heartburn, nausea, vomiting, and weight loss may occur. treat wt antibiotics |
| Gastric Cancer | primarily in the mucous glands. ● The lesion is ulcerative type with an irregular crater and a raised margin. ● H. pylori infection is associated with a higher risk |
| Dumping Syndrome | Control of gastric emptying is lost; large quantities of ingested food are rapidly “dumped” into the intestine. ● after gastric resection (e.g., partial gastrectomy), because the pyloric sphincter is removed. ● Abdominal cramps, nausea, and diarrhea |
| Cholelithiasis refers to formation of | gallstones, which are masses of solid material or calculi that form in the bile |
| Cholecystitis refers to | inflammation of the gallbladder and cystic duct. |
| Cholelithiasis (Gallstones) ● Pathophysiology | initially in the bile ducts, gallbladder, or cystic duct. ○ cholesterol or bile pigment (bilirubin) or may be of mixed content, including calcium salts. ○ Small stones may be “silent” excreted in the bile, larger stones obstruct the flow of bile |
| Cholelithiasis (Gallstones) ● Pathophysiology | stone obstructs bile flow in the cystic or common bile duct, biliary colic develops, consisting of severe of pain resulting from strong muscle contractions attempting to move the stone along. -pancreatitis |
| Cholelithiasis (Gallstones) ● Etiology | Cholesterol gallstones occur twice as often in women as men. ○ They tend to develop in individuals with high cholesterol levels in the bile. ○ Factors that indicate a high risk for gallstones include obesity |
| Cholelithiasis (Gallstones) ● Manifestations | Gallstones are frequently asymptomatic. ○ However, larger calculi may obstruct a duct at any time, causing sudden severe waves of pain (biliary colic) in the RUQ of the abdomen or epigastric area, often radiating to the back and right shoulder |
| Jaundice | yellowish color of the skin and other tissues that results from high levels of bilirubin in the blood. ● The color is usually apparent first in the sclera, or white area of the eye. Bilirubin is a product of the hemolysis of red blood cells |
| Hepatitis | nflammation of the liver. It may be idiopathic (such as a fatty liver) or result from a local infection (such as viral hepatitis), from an infection elsewhere in the body (e.g., infectious mononucleosis), or from chemical or drug toxicity. |
| Viral Hepatitis ● Pathophysiology | result from infection by a group of viruses that specifically target the hepatocytes. ■ These include Hepatitis A, B, C, D, and E ○ Cell injury results in inflammation and necrosis in the liver. Both the hepatocytes and the liver are swolen |
| Viral Hepatitis ● Pathophysiology | Chronic inflammation with hepatitis B, C, and D. defined as persistent inflammation and necrosis of the liver for more than 6 months. permanent liver damage ○ Hepatitis B, C, and D may exist in a carrier state, in which is asymptomatic |
| Viral Hepatitis ● Manifestations-Preicteric Stage | fatigue and malaise, anorexia and nausea, and general muscle aching, mild RUQ discomfort; Elevated liver function tests (LFTs): AST and ALT |
| hepatitis Icteric Stage | onset of jaundice as serum bilirubin levels rise; stools become light in color, the urine becomes darker, and the skin becomes pruritic; The liver is tender and enlarged |
| hepatitis Posticteric Stage | recovery stage marked by reduction in signs and symptoms |
| Viral Hepatitis ● Treatment | No cure for the virus ○ Supportive measures such as rest and a diet high in protein, carbohydrate, and vitamins are most useful. ○ Antivirals and other medications may be used for some strains of hepatitis |
| Cirrhosis ● Pathophysiology | progressive destruction of liver tissue leading eventually to liver failure, when 80% to 90% of the liver has been destroyed. ○ Liver demonstrates extensive diffuse fibrosis and loss of lobular organization |
| Cirrhosis ● Pathophysiology | Decreased removal and conjugation of bilirubin ■ Decreased production of bile ■ Impaired digestion and absorption of nutrients, particularly fats and fat-soluble vitamins ■ Decreased production of blood clotting factors |
| Cirrhosis ● Etiology | excessive alcohol consumption, obstruction of bile flow, or chronic hepatitis |
| Cirrhosis ● Treatment | Supportive or symptomatic treatment, such as avoiding fatigue and exposure to infection, is necessary. ○ Liver transplant may be an option |
| Acute Pancreatitis ● Pathophysiology | nflammation of the pancreas resulting from autodigestion of the tissues ○ Pancreatic digestive enzymes are prematurely activated within the pancreas itself |
| Acute Pancreatitis ● Pathophysiology | Severe pain, caused by the autodigestion of nerves and the inflammation, contributes to shock. ○ Septicemia or general sepsis may result from the escape of bacteria and toxins |
| Acute Pancreatitis ● Etiology | auses are gallstones and alcohol abuse. ■ Gallstones may obstruct the flow of bile and pancreatic secretions into the duodenum or cause reflux of bile into the pancreatic duct. |
| Acute Pancreatitis ● Manifestations | Severe epigastric or abdominal pain radiating to the back ○ Signs of shock—low blood pressure, pallor and sweating, and a rapid but weak pulse—develop as inflammation and hemorrhage cause hypovolemia |
| Acute Pancreatitis ● Diagnosis | Elevated serum amylase and lipase levels ○ Leukocytosis |
| Acute Pancreatitis treatment | oral intake is stopped, and bowel distention is relieved to reduce pancreatic stimulation. ○ Shock and electrolyte imbalances are treated. ○ Analgesics may be given for pain relief |
| Celiac Disease | autoimmune reaction to gluten genetically. ● The autoimmune reaction to gluten leads to inflammation in the small intestine, causing damage to the villi ○ The villi atrophy, resulting in less surface area available for absorption of nutrients |
| Inflammatory Bowel Disease (IBD) | ncludes Crohn’s Disease and Ulcerative Colitis (UC) ● Autoimmune conditions with a genetic link ● These diseases are characterized by remissions and exacerbations, as well as considerable diversity in the severity of clinical effects. |
| Crohn’s Disease ● Pathophysiology | affect any area of the digestive tract, but it occurs most frequently in the small intestine ○ Inflammation occurs in a characteristic distribution called skip lesions, with affected segments clearly separated by areas of normal tissue. |
| Crohn’s Disease ● Manifestations | melena, diarhea, Pain and tenderness are often centered in the right lower quadrant. ○ Anorexia, |
| Ulcerative Colitis (UC) ● Pathophysiology | inflammation commences in the rectum and progresses in a continuous fashion proximally through the colon. The small intestine is rarely involved. ○ The mucosa and submucosa are inflamed |
| Ulcerative Colitis (UC) ● Manifestations | Diarrhea is present, consisting of frequent watery stools marked by the presence of blood and mucus and accompanied by cramping pai, fever, weight loss |
| Inflammatory Bowel Disease (IBD) ● Treatment | avoid stressors that may precipitate exacerbations ○ Anti-Inflammatory medications and steroids ○ Immunotherapeutic agents to suppress autoimmune response ○ Surgical resection |
| Irritable Bowel Syndrome (IBS) | most common is caused by dysfunctional gi motility: either rapid or delayed transit time of feces through the bowel ● Causes abdominal pain, gas, bloating, and nausea with diarrhea (rapid transit) or constipation ● Rome Criteria is used for diagnosis |
| Appendicitis | Inflammation and infection of the appendix, caused by obstruction of the appendiceal lumen by a fecalith (a hard, stony mass of feces in the intestine) ○ The increasing congestion and pressure within the appendix lead to ischemia and necrosis of wall |
| Appendicitis ● Manifestations | Periumbilical pain related to the inflammation and stretching of the appendiceal wall ○ Pain becomes more severe and localized in the lower right quadrant (LRQ) of the abdomen (McBurney Point) ○ Nausea, vomiting, fever |
| Diverticular Disease | A diverticulum is a herniation or outpouching of the mucosa through the muscle layer of the colon wall, frequently in the sigmoid colon. ● Diverticulosis is asymptomatic diverticular disease |
| Colorectal Cancer ● Pathophysiology | Most malignant neoplasms of the colon develop from polyps ■ A polyp is a mass, often on a stem, that protrudes into the lumen, and many polyps represent genetic abnormalities. ■ As polyps increase in size, they carry risk of dysplasia |
| Colorectal Cancer ● Etiology | primarily in persons older than age 55 years ○ Long-term ulcerative colitis in a patient increases the risk of cancer developing, often at a younger age ○ Genetic factors are responsible for the increased occurrence, low fiber diet increases risk |
| Colorectal Cancer ● Manifestations | Vague cramping pain, small flat pellets or “ribbon” stool, and a feeling of incomplete emptying ○ Fatigue, weight loss, or iron-deficiency anemia ○ Unexplained change in bowel habits, melena |
| Colorectal Cancer ● Treatment | Surgical removal of involved area; may require a colostomy ○ Radiation ○ Chemotherapy |
| Intestinal Obstruction | Lack of movement of the intestinal contents through the intestine. ● Because of its smaller lumen, obstructions are more common and occur more rapidly in the small intestine, but they can occur in the large intestine as well |
| Intestinal obstruction occurs in two forms. | Mechanical obstructions- tumor, adhesions, hernias, or other tangible obstructions. ○ Functional- neurologic impairment, such as spinal cord injury or a lack of propulsion in the intestine, and are often referred to as paralytic ileus. |
| Intestinal Obstruction ● Pathophysiology | mechanical obstruction of the flow of intestinal contents occurs, a sequence of events develops as follows: ■ Gases and fluids accumulate in the area proximal to the blockage, distending the intestine |
| Intestinal Obstruction ● Pathophysiology | ntestinal distention leads to persistent vomiting with additional loss of fluid and electrolytes. ○ If the obstruction is not removed, the intestinal wall becomes ischemic and necrotic |
| Intestinal Obstruction ● Manifestations | Colicky abdominal pain ○ Borborygmi, vomitting, no stool passed |
| Intestinal Obstruction ● Treatment | Decompression of the stomach by suction ○ Nothing by mouth (NPO) ○ Replace fluids and electrolytes ○ Surgery and antibiotics |
| The nervous system is made up of 2 types of cells | neurons and supportive glial cells. |
| Neurons | The main functional unit of the nervous system |
| cell body | contains the nucleus and cytoplasm |
| dendrites | are short processes extending from the cell body, they receive impulses from other neurons and conduct them to the cell body |
| axon | tail-like projection from the cell body that carries impulses to other neurons or end organs ■ Many axons are covered with a white, lipid protein substance called the myelin sheath |
| Glial Cells (glia): | Provide support, nourishment, and protection to neurons ● Make up about half of brain and spinal cord mass |
| Nerve Regeneration: | Certain portions of neurons and some subsets of glial cells can regenerate in optimal conditions. Neurogenesis may also occur from stem cells. |
| The purpose of a neuron is to | initiate, receive, and process nerve impulses or messages |
| Synapse | junction between two neurons, where nerve impulses are transmitted from one neuron to the next or to glands or muscles |
| Neurotransmitters: | chemicals that affect the transmission of impulses across the synaptic cleft ● Examples: serotonin, epinephrine, norepinephrine, acetylcholine, GABA |
| The initiation of a nerve impulse begins with the | generation of an action potential. ○ A series of action potentials travel along the axon ○ When the impulse reaches the end of the axon, a chemical reaction involving neurotransmitters transmit the impulse across the synapse |
| Nodes of Ranvier: | gaps in the myelin sheath that allow the action potential to travel faster by jumping from node to node |
| The CNS consists of the | brain, spinal cord, and cranial nerves I and II |
| The cerebrum is composed of the right and left hemispheres and divided into 4 lobes | Frontal: memory, higher cognitive functioning, speech production ○ Temporal: integrates visual and auditory data, speech reception ○ Parietal: interprets spatial information ○ Occipital: processes sight |
| Basal ganglia: | voluntary movements, automatic skeletal muscle activity |
| Limbic system: | concerned with emotion, aggression, feeding behavior, and sexual response |
| Diencephalon | Thalamus: major relay center for sensory input ■ Hypothalamus: directly influences release of hormones from the anterior pituitary gland |
| The brainstem includes the | midbrain, pons, and medulla. ○ Contains centers for sneezing, coughing, swallowing, hiccuping, and vomiting. ○ The medulla is concerned with respiratory, vasomotor, and heart function |
| Reticular Activating System (RAS) | regulates arousal, alertness, and sleep- wake transitions |
| The cerebellum coordinates | voluntary movement and maintains stability and equilibrium |
| Ascending Tracts | Carry sensory information to higher levels of the CNS ○ This sensory information comes from receptors in the skin, muscles, joints, viscera, and blood vessels |
| Descending Tracts: | Carry impulses responsible for muscle movement (motor) from brain to cranial and peripheral nerves |
| The peripheral nervous system consists of the | cranial nerves, spinal nerves, and parts of the autonomic nervous system (ANS) |
| Spinal Nerves | Nerves originating from the spinal cord that contain a pair of dorsal sensory (afferent) nerve fibers and ventral motor (efferent) fibers |
| Autonomic Nervous System (ANS) | involuntary functions of heart muscle, smooth muscle, and glands through both efferent and afferent pathways ● Divided into the sympathetic and parasympathetic systems ○ Sympathetic = fight or flight ○ Parasympathetic = rest and digest |
| The brain’s blood supply arises from the | internal carotid arteries (anterior circulation) and the vertebral arteries (posterior circulation) ● The Circle of Willis is formed by communicating arteries that join the basilar and internal carotid arteries |
| Blood Brain Barrier | Physiologic barrier between blood capillaries and brain tissue ● Protects the brain from harmful agents, while allowing nutrients and gases to enter |
| 3 protective membranes that surround the brain and spinal cord | Dura mater: outermost layer ■ Falx cerebri ○ Arachnoid: fragile, web-like membrane that lies between the dura mater and pia mate. pia mater-vascular innermost layer of the meninges |
| Skull | Protects the brain from external trauma ● Composed of 8 cranial bones and 14 facial bones ● Foramen magnum ○ Hole through which the brain stem extends to the spinal cord. |
| Vertebral Column | Protects the spinal cord, supports the head, and provides flexibility. ● Made up of 33 individual vertebrae: 7 cervical, 12 thoracic, 5 lumbar, 1 sacral, and 1 coccygeal |
| Intracranial Pressure (ICP | the pressure exerted by the brain, cerebrospinal fluid (CSF), and blood vessels within the skull. |
| Brain Tumors ● Pathophysiology | Benign tumors as well as malignant tumors can be life-threatening because they increase ICP. ○ Brain tumors are named according to the tissue from which they arise |
| Transient Ischemic Attack (TIA) | emporary localized reduction of blood flow in the brain.TIAs may occur. sign of stroke. ● Pathophysiology ○ May be caused by partial occlusion of an artery by atherosclerosis, a small embolus, a vascular spasm, or local loss of autoregulation |
| Transient Ischemic Attack (TIA) ● Manifestations | emains conscious. ○ Intermittent short episodes of impaired function, such as muscle weakness in an arm or leg, visual disturbances, or numbness and paresthesia in the face, may occur. ○ Transient aphasia or confusio |
| Cerebral Vascular Accident (CVA or stroke) ● Pathophysiology | infarction of brain tissue that results from lack of blood. ○ Tissue necrosis may be an outcome of total occlusion of a cerebral blood vessel by atheroma or embolus, which causes ischemia, or may be the consequence of a ruptured cerebral vessel |
| Cerebral Vascular Accident (CVA or stroke) ● Pathophysiology | Ischemic strokes occur when an artery in the brain becomes occluded by a thrombus or embolus ● Thrombotic ischemic stroke: a thrombus (blood clot) develops in an artery that is already narrowed and damaged by atherosclerosis, |
| embolism ischemic stroke | an embolus (thrombus, air, fat, vegetative growth, etc...) lodges in a cerebral artery, leading to ischemia and infarction |
| Hemorrhagic strokes occur when there is | bleeding into the brain tissue ● Usually caused by rupture of a cerebral artery in a patient with severe hypertension ● Hemorrhagic strokes are frequently more severe |
| Cerebral Vascular Accident (CVA or stroke) ● Pathophysiology | Cerebral edema and an increasing area of infarction in the first 48 to 72 hours tend to increase the neurologic deficits. ○ As the inflammation subsides, neurologic function increase |
| Cerebral Vascular Accident (CVA or stroke) ● Etiology | diabetes, hypertension, systemic lupus erythematosus, elevated cholesterol levels, hyperlipidemia, atherosclerosis, a history of TIAs, increasing age, obstructive sleep apnea, and heart disease. ○ The combo of oral contraceptives and cigarette smoking |
| Cerebral Vascular Accident (CVA or stroke) ● Manifestations | Contralateral paralysis (opposite side of stroke) or muscle weakness is present, usually on one side of the body. ○ Aphasia, facial drooping, slurred speech, sensory loss in the legs, confusion, loss of problem- solving skills, and personality changes. |
| Cerebral Aneurysm ● Pathophysiology | An aneurysm is a localized dilation in an artery. ○ These “berry” aneurysms develop where there is a weakness in the arterial wall where branching occurs. ■ The force of blood at this point leads to bulging in the wall |
| Cerebral Aneurysm ● Pathophysiology | Rupture often results from a sudden increase in blood pressure during exertion, and bleeding occurs into the subarachnoid space. ○ Blood is irritating to the meninges and causes an inflammatory response and irritation |
| Cerebral Aneurysm ● Manifestations | A massive rupture or subarachnoid hemorrhage is manifested by an immediate, severe, “blinding” headache, vomiting, photophobia, and, perhaps, seizures or loss of consciousness. ○ Death may occur shortly after rupture |
| Meningitis ● Pathophysiology | Infection of the meninges ○ Typically caused by a virus, bacteria, or sometimes a parasite or fungus ○ Microorganisms reach the brain via the blood, by extension from nearby tissue, or by direct access through head wounds. ○ Infection spreads rapidly |
| Meningitis ● Etiology | In children and young adults, Neisseria meningitidis, or meningococcus is the usual causative organism ○ It is spread by respiratory droplets. ○ Epidemics are common in schools or institutions where close contact. prophylatic treatment |
| Meningitis ● Manifestations | headache, back pain, photophobia, and nuchal rigidity, fever, vomitt |
| Encephalitis | Infection and inflammation of the parenchymal or connective tissue in the brain ● Necrosis and inflammation develop in the brain tissue. West Nile fever is a form of encephalitis |
| Guillain-Barre Syndrome ● Pathophysiology | inflammatory condition of the peripheral nervous system. ○ An abnormal immune response, perhaps an autoimmune response, precipitated by a preceding viral infection or immunization. These changes cause impaired nerve conduction |
| Guillain-Barre Syndrome ● Pathophysiology | critical period develops when the ascending paralysis involves the diaphragm and respiratory muscles. ○ Recovery is usually spontaneous, with the manifestations diminishing in reverse order |
| Concussion: | temporary, reversible interference with brain function, usually resulting from a mild blow to the head that causes sudden excessive movement of the brain, disrupting neurologic function and leading to brief change in level of consciousness |
| contusion | : is a bruising of brain tissue |
| Closed head injury | occurs when the skull is not fractured in the injury, but the brain tissue is injured |
| open head injury | are those involving fractures or penetration of the brain by sharp objects or flying debris |
| Basilar skull fractures | occur at the base of the skull and are often accompanied by leaking of CSF through the ears or nose |
| Coup-Contrecoup injuries occurs when | two areas of the brain are injured. The initial impact of the brain hitting the front and inside of the skull causes an area of damage at the site of impact |
| Brain Hemorrhage/Hematoma ● Pathophysiology | Hematomas and hemorrhages are classified by their location in relation to the meninges, as follows: ■ Epidural hematoma (on top of the dura) results from bleeding between the dura |
| Subdural hematoma | (below the dura) develops between the dura and the arachnoid layer. Usually caused by a venous bleed that occurs slowly |
| Acute hematoma | signs present in about 24 hours |
| Subarachnoid (below the arachnoid layer)hemorrhage occurs in the | space between the arachnoid layer and pia mater |
| Intracerebral hematoma | bleeding within the brain tissue itself |
| In all types of hematomas, the bleeding leads to | ocal pressure on adjacent tissue and a general increase in ICP. ○ Herniation may result |
| Brain Hemorrhage/Hematoma ● Manifestations | Dependent on size and location of hematoma ○ May cause focal motor and sensory deficits, aphasia, headache, altered level of consciousness ○ Seizures ○ Rhinorrhea or otorrhea from CSF |
| Brain Hemorrhage/Hematoma ● Treatment | Diagnosed with head CT or brain MRI ○ Surgery may be needed to evacuate the hematoma and decrease ICP ○ Small bleeds may be treated conservatively and monitored |
| Spinal Cord Injury ● Pathophysiology | sually results from fracture or dislocation of the vertebrae which compresses, stretches, or tears the spinal cord. ○ The supporting ligaments and the intervertebral disc may be damaged also. ○may result from hyperextension or hyperflexion of neck |
| Complete transection (severing) or crushing of the cord causes | irreversible loss of all sensory and motor functions at and below the level of injury. ○ Partial transection or crushing injuries may allow recovery of some function. ○ Prolonged ischemia and necrosis lead to permanent damage |
| spinal cord etiology | May be caused by falls, motor vehicle accidents, sporting injuries, or gun violence |
| Spinal Cord Injury ● Manifestations | During the early stage of spinal shock, all neurologic activity ceases at and below the level of injury. This effects, motor, sensory, reflex, and bowel and bladder function. ○ Recovery from spinal shock is indicated by the gradual return of reflexs |
| Spinal Cord Injury ● Manifestations | Paralysis of all four extremities is termed tetraplegia (quadriplegia) ○ Paraplegia refers to paralysis of the lower part of the trunk and legs. ○ Autonomic dysreflexia: complication of spinal cord injuries. ■Noxious stimuli such as a distended bladder |
| Hydrocephalus | condition in which excess CSF accumulates within the skull, compressing the brain tissue and blood vessels |
| Spina Bifida | ○ neural tube defects The basic problem in spina bifida is failure of the posterior spinous processes on the vertebrae to fuse, which may permit the meninges and spinal cord to herniate, resulting in neurologic impairment. |
| Cerebral Palsy | group of disorders marked by some degree of motor impairment, caused by genetic mutations, abnormal fetal formation of functional brain areas, infection, or brain damage in the perinatal period. nonprogressive |
| Seizure Disorders ● Pathophysiology | results from a sudden, spontaneous, uncontrolled discharge of neurons, which causes abnormal motor or sensory activity and possibly loss of consciousness. ○ The affected neurons are hyperexcitable |
| Generalized seizure | multiple foci or origins in the deep structures of both cerebral hemispheres and the brain stem, and cause loss of consciousness. They involve all of or large portions of the brain |
| Partial seizures | single or focal origin, often in the cerebral cortex, and may or may not involve altered consciousness. They involve small, specific portions of the brain. Partial seizures may progress to generalized seizures. |
| Seizure Disorders ● Etiology | May be idiopathic, inherited, or occur after a brain injury or infection |
| Absence seizures | brief loss of awareness; individual will not respond to external environment; may resemble day-dreaming or a staring spell; lasts for 5 to 10 seconds |
| Tonic-clonic seizures: | sudden loss of consciousness, followed by muscle rigidity (tonic phase) and then rhythmic muscle contractions causing jerking movements (clonic phase); may lose bowel and bladder function ■ Seizures may be preceded by an aura: |
| Jacksonian seizure | focal motor seizure in which the clonic contractions begin in a specific area and spread progressively; for example, the contractions “march” up the arm and then to the face. |
| Multiple Sclerosis (MS) ● Pathophysiology | demyelination of the neurons of the brain, spinal cord, and cranial nerves. ○ Loss of myelin slows down the conduction of impulses in the affected fibers. ○ Later, larger areas of inflammation and demyelination, termed plaques, become visible |
| Multiple Sclerosis (MS) ● Manifestations | Blurred vision is a common early sign. ○ Often, weakness initially occurs in the legs. ○ Diplopia (double vision), scotoma (a spot in the visual field), or dysarthria (poor articulation) may occur if CNs are affected ○ Paresthesias |
| Parkinson Disease ● Pathophysiology | decreased number of neurons in the substantia nigra secrete dopamine, an inhibitory neurotransmitter, leading to an imbalance between excitation and inhibition ○ The excess stimulation affects movement and posture by increasing muscle tone and activity |
| Parkinson Disease etiology | May be idiopathic, inherited, or related to environmental factors ○ Can be secondary to trauma or vascular disease |
| Parkinson Disease ● Manifestations | Tremors in the hands at rest ○ A repetitive “pill-rolling” motion of the hands. Tremors cease with voluntary movement. ○ Muscle rigidity ○ Slow movements (bradykinesia) ○ Lack of associated involuntary movement occurs |
| Amyotrophic Lateral Sclerosis (ALS) ● Pathophysiology | degenerative disease affecting motor neurons in brain and spinal cord. bad neuorns leads to a mix of spastic and flaccid paralysis and hyperreflexia. muscle weakness eventually affects respiratory function. Sensory and cognitive function are not affected |
| Manifestations als | muscle weakness and atrophy, leading to paralysis ○ Muscle cramps and twitching ○ Eventually swallowing and respiration are impaired, and a ventilator is required |
| Myasthenia Gravis ● Pathophysiology | Autoimmune disorder that destroys acetylcholine receptors in the muscles; leading to decreased acetylcholine and preventing muscle stimulation |
| Myasthenia Gravis manifestations | Muscle weakness in the face and eyes, sometimes progressing to the arms and trunk ○ Diplopia and ptosis ○ Difficulty chewing and speaking ○ Respiratory function may be affected |
| Huntington Disease ● Pathophysiology | Progressive brain atrophy and neuron degeneration caused by depletion of the neurotransmitter GABA. |
| Huntington Disease etiology | Usually an inherited autosomal dominant condition ○ Disease doesn't manifest until mid-life in affected individuals |
| Huntington Disease manifestations | Mood swings, personality and behavioral changes ○ Restlessness and choreiform (rapid, jerky) movements in the arms and face |
| Alzheimer Disease ● Pathophysiology | Brain tissue atrophies ○ Neurofibrillary tangles in the neurons and plaques made of the protein beta-amyloid are found in large numbers in the affected parts of the brain |
| alzheimer etiology | Decline in memory, language, and cognitive function ○ Inability to perform ADLs, incontinence ○ Cannot recognize family members |
| Bone | form the skeletal system and provide rigid support and protection for the body. ○ Bone also has important metabolic functions related to calcium metabolism and storage |
| hemoptysis | in bone marrow, which is where new blood cells are produced |
| long bones | the humerus and femur, consist of a long, hollow shaft with two bulbous ends |
| short bones | are generally square-like in shape and are found in the wrist and ankle. |
| flat bones | occur in the skull and are relatively thin and often curved |
| Irregular bones | have many projections and vary in shape, are represented by the vertebrae and the mandible. |
| Osteocytes: | mature bone cells |
| Osteoblasts secrete the | matrix of bone; meaning osteoblasts build bone |
| Osteoclasts are responsible for | bone resorption; meaning osteoclasts break down bone |
| osteoblast and osteoclast activity depends on | two hormones: calcitonin and parathyroid hormone |
| Compact bone forms a | tightly-packed, strong and rigid structure that forms the outer covering of bones |
| Cancellous or spongy bone is | less dense and forms the interior structure of bones. ○ Spongy bone is made up of plates of bone bordering cavities that contain marrow. |
| A typical long bone consists of the | diaphysis, a thin shaft, between two larger ends or epiphyses. The diaphysis is formed of compact bone surrounding a medullary cavity containing marrow. The metaphysis is the area where the shaft broadens into the epiphysis. |
| The epiphysis is made up of | spongy bone |
| The end of each epiphysis is covered by | hyaline cartilage (articular cartilage), which facilitates movement at points of articulation between bones |
| Bone is covered by | periosteum, a fibrous connective tissue. The periosteum contains osteoblasts, blood vessels, nerves, and lymphatics. |
| Synovial joints are | freely movable joints and are the most common type of joint in the body, the ends of the bone are covered with articular (hyaline) cartilage, providing a smooth surface and a slight cushion during movement |
| The joint cavity or space between the articulating ends of the bones is filled with a small amount of | synovial fluid, which facilitates movement |
| The synovial fluid is produced by the | synovial membrane (synovium), which lines the joint capsule to the edge of the articular cartilages. |
| Ligaments are | straps across the joint made of connective tissue that link two bones, which support the joint and prevent excessive movement of the bones. |
| tendons attach | muscle to bone |
| Fractures | break in the rigid structure and continuity of a bone. ● Fractures can be classified in several ways: ○ A complete fracture occurs when the bone is broken to form two or more separate pieces, an incomplete fracture the bone is only partially broken |
| An open or compound fracture results when | the skin is broken. The bone fragments may be angled and protrude through the skin. In open fractures there is more damage to soft tissue, including the blood vessels and nerves |
| In a closed fracture the | skin is not broken at the fracture site |
| Simple fracture | a single break in the bone in which the bone ends maintain their alignment and position |
| Segmental fracture | a bone break in which several large bone fragments separate from the main body of a fractured bone |
| Pathologic fracture results from | weakness in the bone structure because of conditions such as a tumor or osteoporosis. The break occurs spontaneously or with very little stress on the bone |
| Transverse fracture is | a fracture across the bone. |
| Oblique fracture is a | break at an angle to the diaphysis of the bone |
| Spiral fracture is a | break that angles around the bone, usually caused by a twisting injury. |
| Fractures ● Pathophysiology | When a bone breaks, bleeding occurs from the blood vessels in the bone and periosteum, leading to formation of a hematoma or clot.Necrosis occurs at the ends of the broken bone |
| In children, fractures usually heal in approximately | 1 month; in adults, the process requires 2 or more months. A fracture in an elderly person may require many months to heal. ■ Any secondary problem such as foreign material or infection at the site delays healing |
| Complications of bone fracture: | Muscle spasms at the fracture site ■ Infections ■ Compartment syndrome: increased pressure within the fascia, fat emboli |
| Fractures ● Manifestations | Swelling, tenderness at the site ○ Inability to move the broken limb ○ Pain usually occurs immediately after the injury ○ Severe pain may cause shock, with pallor, diaphoresis, hypotension, and tachycardia. ○ Crepitus |
| Dislocations | the separation of two bones at a joint with loss of contact between the articulating bone surfaces. ● Usually one bone is out of position, whereas the other remains in its normal location. |
| Dislocations cause considerable | soft tissue damage, including damage to the ligaments, nerves, and blood vessels as the bone is pulled away from the joint. Severe pain, swelling, and tenderness develop. Deformity and limited movement are usually evident. |
| Sprains and Strains | A sprain is a tear in a ligament. ● A strain is a tear in a tendon. ● Ligaments and tendons support the bones in a joint and can easily be torn when excessive force is exerted on a joint. 6 weeks to recover |
| Osteoporosis | common metabolic bone disorder characterized by a decrease in bone mass and density, combined with loss of bone matrix and mineralization. ● More common in women as they age |
| Osteoporosis patho | During the continuous bone remodeling process, bone resorption exceeds bone formation, leading to thin, fragile bones that are subject to spontaneous fracture, particularly in the vertebrae |
| Osteoporosis ● Etiology | Bone mass normally peaks in young adults, and then gradually declines, depending on genetic factors, nutrition, weight bearing activity, and hormonal levels. ■ Age: More common in older adults, especially postmenopausal women ■ Sedentary life, steroid |
| Osteoporosis ● Manifestations | Compression fractures of the vertebrae ○ Back pain ○ Abnormal curvatures of the spine , loss height |
| Osteoporosis ● Treatment | Dietary supplements of calcium, vitamin D, and protein ○ Regular weight bearing exercise program such as walking or weightlifting ○ Medications to inhibit osteoclast activity |
| Osteomyelitis | bone infection usually caused by bacteria, and sometimes fungi. ● The microorganisms can enter the blood from an infection anywhere in the body and spread to the bones. |
| Lordosis | characterized by the spine curving significantly inward at the lower back |
| Kyphosis | referred to as hunchback or humpback; characterized by an abnormally rounded upper back |
| scoliosis | characterized by either an S- or C-shaped sideways curve to the spine ● Treatments include surgery, weight loss, wearing a back brace, exercises, and physical therapy |
| Bone Tumors | majority of primary bone tumors are malignant. ● Bone is also a common site of secondary tumors, particularly in the spine and pelvis. Metastatic bone tumors usually are secondary to malignant tumors in the breast, lung, or prostate |
| Osteosarcoma is a | primary malignant neoplasm that usually develops in the metaphysis of the femur, tibia, or fibula in children or young adults, particularly males |
| Ewing sarcoma is another | malignant neoplasm common in adolescents that occurs in the diaphysis of long bones |
| Chondrosarcomas arise from | cartilage cells and are more common in adults older than 30 years. |
| muscular dystrophy | group of inherited disorders characterized by degeneration of skeletal muscle. ● Duchenne MD is the most common type, affecting young boys, with a prevalence of about 3/100,000 males. |
| muscular dystrophy patho | metabolic defect, a deficit of dystrophin (a muscle cell membrane protein), leads to degeneration and necrosis of the muscle cell. ○ Skeletal muscle fibers are replaced by fat and fibrous connective tissue |
| Muscular Dystrophy ● Manifestations | 3 years of age. weakness in the pelvic girdle causes a waddling gait and difficulty with climbing stairs or attaining an upright position. ○ The “Gower maneuver,” in which the child pushes to an erect position by using the hands to climb up the legs, |
| Fibromyalgia | group of disorders characterized by pain and stiffness affecting muscles, tendons, and surrounding soft tissues (not joints) |
| Fibromyalgia patho | no obvious signs of inflammation or degeneration in the tissues. ○ The cause is not known, but it appears to be related to altered central neurotransmission, resulting in increased soft tissue sensitivity to substance P high in women |
| Fibromyalgia ● Manifestations | Generalized aching pain ○ Fatigue ○ Sleep disturbances ○ Depression ○ Irritable bowel syndrome |
| Osteoarthritis ● Pathophysiology | ○ The articular cartilage, of weight bearing joints in particular (e.g., hips, knees), is damaged and lost through erosion from excessive mechanical stress. The surface of the cartilage becomes rough and worn |
| Osteoarthritis ● Etiology | associated with obesity, aging, and injury to the joint. ○ OA often develops in specific joints because of injury or excessive wear and tear on a joint. |
| Osteoarthritis ● Manifestations | Aching pain that occurs with weight bearing and movement ○ Pain becomes more severe as the degenerative process advances. ○ Joint movement is limited. ○ Frequently the joint appears enlarged ○ Crepitus |
| Rheumatoid Arthritis ● Pathophysiology | autoimmune disorder causing chronic systemic inflammatory disease. ○ The disease often commences insidiously with symmetric involvement of the small joints such as the fingers, followed by inflammation and destruction of additional joints |
| he first step in the development of RA is an | abnormal immune response, causing inflammation of the synovial membrane, leading to a red, swollen, and painful joint. |
| Rheumatoid Arthritis ● Pathophysiology | During subsequent exacerbations, the process continues with synovitis (inflammation of synovial membrane), cartilage erosion, fibrosis (scaring), and ankylosis (joint fixation and deformity). ○ Joints become contracted and deformed |
| Rheumatoid Arthritis ● Manifestations | Bilateral aching, inflamed joints; first in the fingers and wrists ○ Red and swollen joints tender to touch ○ Joint stiffness after rest that improves with activity ○ Fatigue, anorexia, mild fever |
| Infectious (Septic) Arthritis | usually develops in a single joint. ● The joint is red, swollen, and painful, with decreased range of movement. The synovium is swollen, and a purulent exudate forms. ● Blood-borne bacteria such as gonococcus or staphylococcus are the source |
| Gout (Gouty Arthritis) | from deposits of uric acid and urate crystals in the joint that then cause an acute inflammatory response. ● Uric acid is a waste product of purine metabolism that is normally excreted through the kidneys. ● A sudden increase in serum uric acid levels |
| A tophus is a | large, hard nodule consisting of urate crystals that have been precipitated in soft tissue or bone, causing a local inflammatory reaction. |
| Ankylosing Spondylitis | chronic progressive inflammatory condition that affects the sacroiliac joints, intervertebral spaces, and costovertebral joints of the axial skeleton. ● It is deemed an autoimmune disorder with a genetic basis |
| Ankylosing Spondylitis patho | vertebral joints become inflamed and eventually fuse together. ○ The result is ankylosis or fixation of the joints, leading to a loss of mobility. ○ Inflammation begins in the lower back at the sacroiliac joints and progresses up the spine. ○ Kyphosis |
| Ankylosing Spondylitis ● Manifestations | Initially low back pain and morning stiffness ○ Pain is often more marked when lying down and may radiate to the legs ○ As calcification develops, the spine becomes more rigid, |
| Bursitis is an | inflammation of the bursae associated with bones, muscles, tendons, and ligaments of various joints. The bursae are small fluid-filled sacs that act as cushions at or near the structures of the joint |
| Synovitis is an | inflammation of the synovial membrane lining the joint |
| Tendinitis is the | irritation or inflammation of the tendon. It is usually characterized by a dull ache at the site of tendon attachment, tenderness, and mild swelling. |
| gower manuever | the characteristic way children with proximal muscle weakness, most notably from Duchenne muscular dystrophy (DMD), get up from a squatting position |
| Functions of blood: | Transport oxygen and nutrients to all tissues ○ Remove waste products of cellular metabolism ○ Play a critical role in the body’s defenses/immune |
| pulmonary circulation which transports | oxygen from the lungs to the heart, |
| systemic circulation which delivers | oxygenated blood to the rest of the body |
| he walls of arteries and veins are made up of three layers: | tunica intima, tunica media, and tunica externa |
| Autoregulation | process in which arterioles vasodilate or vasoconstrict to accomodate to the needs of the local cells |
| Vasodilation increases | blood flow to an area while vasoconstriction decreases blood flow to an area |
| Composition of blood: | Blood cells: red blood cells (RBCs) or erythrocytes, white bloods cells (WBC) or leukocytes, and platelets (Plt) or thrombocytes |
| hemoglobin, | carries oxygen to tissues; most prominent blood cell |
| All blood cells originate in | red bone marrow |
| Hemostasis | process of stopping bleeding, consists of three steps: 1. Vasoconstriction - to decrease blood flow 2. Thrombocytes stick together 3. Blood clot formation |
| Fibrinolysis is the process of | breaking down blood clots |
| Persons with type O blood lack | A and B antigens and therefore are considered universal donors |
| Anemias | blood disorders in which there is a deficiency or lack of hemoglobin, the oxygen carrying protein in red blood cells |
| Pernicious Anemia | Caused by the malabsorption of vitamin B12 from lack of intrinsic factor (IF) produced in the glands of the gastric mucosa ○ Intrinsic factor is required for vitamin B12 to be absorbed in the small intestine |
| Aplastic Anemia | Impairment of failure of the bone marrow, causing decreased production of all blood cells (RBCs, WBC, and platelets) - called pancytopenia ○ Bone marrow failure may be caused by toxins |
| Hemolytic Anemias | result from excessive destruction of RBCs, or hemolysis, leading to a low erythrocyte count and low total hemoglobin. ● Includes sickle cell anemia |
| Sickle Cell Anemia ● Pathophysiology | inherited characteristic leads to the formation of abnormal hemoglobin, hemoglobin S (HbS). ○ When this altered hemoglobin is deoxygenated, it changes the shape of the RBC from a disc shape to a crescent or “sickle” shape |
| Hemophilia A | Bleeding disorder caused by a deficit of clotting factor VIII (8) ○ Transmitted as an X-linked recessive trait: manifested in men but women are asymptomatic carriers |
| Disseminated Intravascular Coagulation (DIC) ● Pathophysiology | Life threatening condition that involves both excessive bleeding and excessive clotting ○ The process causes multiple thromboses (clots) and infarctions |
| Polycythemia ● Pathophysiology | occurs when there is overproduction of RBCs and other cells in the bone marrow. ○ Secondary polycythemia is increased production of RBCs in response to prolonged hypoxia. |
| Polycythemia ● Manifestations | Hepatomegaly (enlarged liver) and splenomegaly (enlarged spleen) ○ High blood pressure and bounding pulse from increased blood volume ○ Blood clots and infarctions ○ Congestive HF |
| Leukemias Pathophysiology | Group of blood cancers affecting WBCs ● Occurs when one or more types of WBCs present as undifferentiated, immature, nonfunctional cells that multiply uncontrollably in the bone marrow |
| Leukemias Manifestations | Multiple recurrent infections from nonfunctional WBCs ● Bleeding from low platelets ● Anemia from low RBCs ● Bone pain, fever |
| Peripheral Vascular Disease ● Pathophysiology | Narrowing or blockage of peripheral blood vessels, usually in the lower extremities, as a result of atherosclerosis. ○ Atherosclerosis is the accumulation of lipid plaques inside the walls of large arteries. ○ Thrombi develop easily in arteries |
| Peripheral Vascular Disease ● Manifestations | Fatigue and weakness in the legs from decreased blood flow ○ Intermittent claudication: leg pain occurring with movement as a result of ischemia (lack of blood and O2) ○ Numbness, tingling, burning, weak pulse |
| Aortic Aneurysms ● Pathophysiology | aneurysm is a localized dilatation and weakening of an arterial wall. The most common location is the abdominal or thoracic aorta. ● Etiology ○ Common causes are HTN, trauma, congenital defects, and atherosclerosis, Treatment-BP control/ surgery |
| Varicose Veins ● Pathophysiology | Varicosities are irregular dilated and tortuous areas of the superficial or deep veins. The most common location is the legs, but varicosities are also found in the esophagus (esophageal varices) and the rectum |
| Varicose Veins ● Etiology | Many factors can increase pressure in the leg veins, such as standing for long periods of time, crossing the legs, wearing tight clothing, or being pregnant. |
| The release of hormones from glands is most frequently controlled by a | negative feedback mechanism |
| There are essentially two categories of endocrine problems | an excessive amount of hormone and a deficit of hormone. ● The manifestations of hormonal disorders reflect the actions of the hormone. |
| Diabetes Mellitus | Insulin is a hormone produced by the beta cells of the pancreas. Insulin pushes glucose out of the blood and into the sells, thus lowering serum/blood glucose levels. ● Diabetes mellitus is caused by a relative deficit of insulin secretion |
| Type 1 diabetes mellitus | more severe form. ○ It occurs more frequently in children and adolescents, but can develop at any age. ○ An autoimmune reaction causes destruction of the pancreatic beta cells. Because the beta cells are destroyed, no insulin is produced at all, |
| Type 2 diabetes mellitus is based on | decreased effectiveness of insulin. This abnormality may involve decreased pancreatic beta cell production of insulin or increased resistance by body cells to insulin or a combination of these factors. ● Type 2 is a milder form of diabetes |
| Diabetes Mellitus Pathophysiology | A deficit (not enough) of insulin causes glucose to accumulate in the blood instead of moving into the cells. This leads to: ○ Hyperglycemia: high blood glucose levels ○ Glucosuria: excess glucose in the urine ○ Excess urination, called polyuria |
| Diabetes Mellitus Manifestations | Hunger (polyphagia) ○ Fatigue ○ Thirst (polydipsia) ○ Excess urination (polyuria) ○ Dry mouth |
| Diabetes Mellitus Diagnosis | A normal fasting blood glucose level is 70 - 120 mg/dL ● A fasting blood sugar level of 126 mg/dL or more, taken on more than one occasion, confirms a diagnosis of diabetes. |
| Diabetes Mellitus Acute Complications | Hypoglycemia ○ Low blood glucose levels caused by excessive insulin ○ Manifests as weakness, tremors, pale moist skin, poor concentration, slurred speech, tachycardia ○ Treatment consists of immediate administration of a concentrated carbohydrate |
| Diabetic Ketoacidosis (DKA) | Occurs when there is a deficiency of insulin, allowing blood glucose levels to get dangerously high ○ Mostly occurs with type 1 DM ○ Because there is no insulin, glucose does not move into the cell, so cells must find an alternative energy source |
| Diabetes Mellitus Chronic Complications | Prolonged hyperglycemia damages small and large blood vessels in all parts of the body, leading to complications such as; ○ Heart attacks, strokes, peripheral vascular disease, kidney failure, blindness, infection, diabetic wounds |
| Growth Hormone | Also known as somatotropin ● Released from the pituitary gland ● Deficiency of GH can cause dwarfism or short stature |
| Acromegaly: | excess GH in adults; bones become broader and heavier, and the soft tissues grow, resulting in enlarged hands and feet, a thicker skull, and changes in the facial features |
| Antidiuretic Hormone (ADH) | Also known as vasopressin ● Causes body to retain fluid ● Released from the pituitary gland ● Diabetes insipidus |
| syndrome of Inappropriate Antidiuretic Hormone | excess ADH → too much fluid is retained → blood becomes diluted with excess water, causing hyponatremia (low sodium) |
| Thyroid Disorders | pituitary gland secretes thyroid stimulating hormone (TSH) ● TSH tells the thyroid gland to release the two thyroid hormones: triiodothyronine (T3) and thyroxine (T4). ● The thyroid gland is located in the anterior neck |
| The thyroid hormones T3 and T4 regulate | metabolism |
| Goiter | enlargement of the thyroid gland, which is often visible on the anterior neck. ● Goiters are caused by various hypothyroid and hyperthyroid conditions, low iodine |
| Hyperthyroidism (Grave’s Disease) | Excess secretion of T3 and T4 because of an overactive thyroid ● Causes increased metabolic activity in the body ● Manifestations: heat intolerance, tachycardia, hypertension, weight loss with thin appearance, restlessness |
| Hypothyroidism | Deficiency of T3 and T4 from the thyroid gland ● Causes decreased or slowed metabolic activity in the body ● Manifestations: pale, cool, and dry skin; cold intolerance; bradycardia; lethargy and brain fog; weight gain |
| Adrenal Hormone Disorders | drenal glands are two triangular-shaped glands located on top of each kidney ● The adrenal glands secrete steroid hormones: ○ Mineralocorticoids = aldosterone ○ Glucocorticoids = cortisol |
| Cushing Syndrome | Caused by excess secretion of the glucocorticoid cortisol from the adrenal glands ● Cortisol = stress hormone ● Manifestations: round and puffy face (moon face), fat accumulation at the back of the neck (buffalo hump), increased fat in the abdomen |
| Addison Disease | Caused by a deficiency of all adrenal steroid hormones: glucocorticoids (cortisol), mineralocorticoids (aldosterone), and androgens ● Caused by an autoimmune reaction ● Manifestations: fatigue; hypotension; weight loss; hyperpigmented bronze |
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cwehner125