Maryville NUR 611 Patho Exam 3 QUESTIONS AND ANSWERS COMPLETED(2022/2023

Maryville NUR 611 Patho Exam 3 QUESTIONS AND ANSWERS COMPLETED(2022/2023Explain the pathophysiology associate with Type 1 and Type 2 DM. DM 1 Is the result of an autoimmune mediated specific loss of beta cells in the pancreatic islet. One of the basic patho of type 2 DM is the development of insulin resistant tissue cells. Explain what occurs in panhypopituitarism Panhypopituitarism is the term correctly associated with the lack of all anterior pituitary hormones. List the clinical manifestations of hypothyroidism The individual develops a low basal metabolic rate, cold intolerance, lethargy, tiredness, and slightly lower basal body temperature. Differentiate diabetes insipidus, diabetes mellitus and SIADH DM: is not a single disease but a group of clinical heterogeneous disorders that have glucose intolerance in common. DI: is an insufficiency of ADH, leading to polyuria and polydipsia. SIADH: is characterized by high levels of ADH in the absence of normal physiologic stimuli for its release. The symptom common to all these conditions is thirst. What causes the microvascular complications of DM Microvascular complications are a result of capillary basement membranes thickening and endothelial cell hyperplasia. What is the cause of diabetes insipidus Inability of the kidney to increase permeability of water. This causes excretions of large volumes of dilute urine, leading to increase in plasma osmolality. Describe the pathophysiological changes associated with Addison's disease Addison disease is a result of hyposecretion of adrenal cortex hormones. Describe the pathophysiological changes associated with hypoparathyroidism The most common cause of hyperparathyroidism is damage caused during thyroid surgery. In hypothyroidism a lack of circulating PTH causes a depressed serum calcium level resulting in the symptomatology mentioned in the stem. What are the causes and pathophysiological changes associate with ketoacidosis? In a state of relative insulin deficiency there is an increase in insulin counter regulating hormones including catecholamine's, cortisol, glucagon, and GH. Catecholamine's, cortisol, glucagon and GH antagonize insulin by increasing glucose production. In addition, these hormones decrease use of glucose. Profound insulin deficiency results in decrease glucose uptake, increase fat mobilization with release if fatty acids, and accelerated gluconeogenesis and ketogenesis. Ordinarily, ketones are used by tissues as an energy source to regenerate bicarbonate. Hyperkalemia is a result of a compensatory mechanism directed at eliminating metabolic acidosis. What is acromegaly? Acromegaly is a term for adults who have been exposed to continuously high levels of GH, whereas the term gigantism is reserved for children and adolescents. Differentiate hypothyroidism and Graves' disease One of the cause's hypothyroidism is a deficiency of endemic iodine. Hypothyroidism are the lower levels of thyroid hormone, without the negative feedback of TH in the pituitary, there is an increase secretion of TSH that may lead to goiter. As a result in decreased energy metabolism resulting in constipation, regulatory mechanisms are overridden by abnormal immunologic mechanisms that result in the stimulation of excessive TH. The systemic symptoms of thyrotoxic crisis include hyperthermia and tachycardia; the remaining options are not associated with this disorder. Describe the pathophysiology related to chronic DM A number of serious complications are associated with any type of DM and include microvascular (retinopathy, nephropathy, and neuropathy) and macrovascular (CAD, CVA, PVD) disease and infection. What happens during hypoglycemia? A person with type 1 DM experiences hunger, lightheadedness, tachycardia, pallor, HA and confusion. The most likely cause of these symptoms is hypoglycemia, which is often caused by a lack of systemic glucose resulting from muscular activity. What is the metabolic syndrome? It also has been called the insulin resistance syndrome or syndrome X. It is a clustering of clinical traits occurring together that increase the risk for accelerated cardiovascular disease and type 2 DM. Combination of medical disorders that increase the risk of developing cardiovascular disease and DM. Describe how DM causes peripheral neuropathy It is a form of "dying back" neuropathy, in which the distal portions of the neurons are initially and eventually more severely affected. The earliest morphologist change in both the peripheral nerves and CNS is axonal degeneration that preferentially involves sensory nerve fibers, particularly the smaller polymodal unmyelinated peripheral C fibers and the larger myelinated A delta fibers. Trace the electrical activity of the heart. Normally electrical impulses arise in the SA nose, which is often called the pacemaker of the heart. The SA node is located at the junction of the right atrium and superior vena cava, just above the tricuspid valve. Numerous automatic nerve endings are within the node. The SA node is heavily innervated by both sympathetic and parasympathetic nerve fibers. The SA node P cells, so-called because they are pale and primitive appearance, are assumed to be the site of impulse formation. The action potential is transmitted from the atrial to the ventricular myocardium through fibers of the conduction system, traveling first to the AV node then the bundle of his and finally through the bundle branches of the interventricular septum to Purkinje fibers of the heart wall. Identify the location of the neurotransmitters in the heart. Sympathetic neural stimulation of the myocardium and coronary vessels depends on the presence of adrenergic receptors, which bind specifically with neurotransmitters of the sympathetic nervous system. Define adrenergic receptors. Sympathetic neural stimulation of the myocardium and coronary vessels depends on the presence of adrenergic receptors, which bind specifically with neurotransmitters of the sympathetic nervous system. Discuss left-ventricular end diastolic pressure. This is a concept expressed in Frank Starling law, cardiac muscle, like other muscle, increases its strength of contraction when it's stretched. Define Frank-Starling law As stated in Frank-Starling law, the volume of blood in the heart at the end of diastole (the length of its muscle fibers) is directly related to the force (strength) of contraction during the next systole. Discuss the effect of angiotensin II on the heart. Angiotensin II is a powerful vasoconstrictor and stimulates the secretion of aldosterone from the adrenal gland. Angiotensin II is also growth promoter in cardiovascular tissues, resulting in monocyte and vascular hypertrophy and progression of hypertension. Neural effects of angiotensin II include stimulation of thirst, release of ADH, and increases in sympathetic nervous system output. Angiotensin II also causes structural changes in blood vessels (remodeling) that contribute to permanent increases in peripheral resistance and make vessels more vulnerable to endothelial dysfunction and platelet aggregation. Define pulsus paradoxus. Pulsus paradoxus means that the arterial blood pressure during expiration exceeds arterial pressure during inspiration by more than 10 mmHg. This clinical finding reflects impairment of diastolic filling of the left ventricle plus reduction of blood volume within all 4 cardiac chambers. List the indicators for an acute myocardial infarction (AMI). When coronary blood flow is interrupted for an extended period, myocyte necrosis occurs, these results in an MI. In the majority of cases of MI, the decrease in coronary flow is the result of atherosclerotic CAD, other causes include coronary spasm and coronary artery embolism. The first s/s of acute MI is usually sudden, severe CP. It's not possible to distinguish between angina and MI by s/s alone, although pain associated with MI tends to be more severe and prolonged. It may be described as heavy and crushing, such as a "truck sitting on my chest," radiation to the neck, jaw, back, shoulder or left arm is common. Some individuals (especially older adults or those with DM) experience no pain, thereby having a "silent" infarction. Infarction often stimulates a sensation of unrelenting indigestion. Nausea and vomiting may occur because of reflex stimulation of vomiting centers by pain fibers. Vasovagal reflexes from the area of the infracted myocardium also may affect the GI tract. Catecholamine release results in sympathetic stimulation, producing diaphoresis and peripheral vasoconstriction that cause the skin to become cool and clammy. List the clinic indicator for a coronary thrombus. These individuals usually have marked elevations in the ST segments on ECH and are categorized as having a STEMI. Define pericarditis It's an acute inflammation of pericardium. Most individuals with acute pericarditis describe several days of fever, myalgias, and malaise followed by the sudden onset of severe CP that worsens with respiratory movements and with lying down. Although the pain may radiate to the back, it's generally felt in the anterior chest and may be confused initially with the pain of acute MI. Individuals with acute pericarditis also may report dysphagia, restlessness, irritability, anxiety, and weakness. It is also the most common cardiovascular complication of HIV infection. List the causes and types of cardiomyopathy Cardiomyopathies are a diverse group of disease that primarily affects the myocardium. Most are the result of underlying cardiovascular disorders, such as ischemic heart disease and HTN. Cardiomyopathies also can be secondary to infectious disease, exposure to toxins, systemic connective tissue disease, infiltrative and proliferative disorders, or nutritional deficiencies. Dilated cardiomyopathy causes decreased ejection fraction, increased end diastolic and residual volumes, decreased ventricular stroke volume, and biventricular failure. Dilated cardiomyopathy (congestive cardiomyopathy) is characterized by ventricular dilation and grossly impaired systolic function, leading to dilated heart failure. Hypertrophic caridomyopathy is characterized by thickening of the septal wall, which may cause outflow obstruction to the left ventricular outflow tract. Restrictive cardiomyopathy may occur idopathically or as a cardiac manifestation of systemic diseases, such as scleroderma, amylodosis, sarcoidosis, lymphoma, and hemochromatosis, or a number of inherited storage diseases. Discuss the effect of HTN on the kidney In the kidney vasoconstriction and resultant decreased renal perfusion cause tubular ischemia and preglomerular arteriopathy. Describe the blood flow through the heart The pumping action of the heart consists of contractions and relaxation of the myocardial layer of the heart wall. Each ventricular contraction and the relaxation that follows it constitute one cardiac cycle. During relaxation, termed diastole, blood fills the ventricles. The contraction that follows, termed systole, propels the blood out of the ventricles and into the circulation. Differentiate β1 and β2 receptors in the heart. The beta 1 receptors are found mostly in the heart, specifically the conduction system (AV and SA nodes, purkinje fibers) and the atrial and ventricular myocardium. The Beta 2 receptors are found mostly on coronary arterioles and cause coronary vasodilatation when stimulated by epinephrine. Diagram the action potential of the myocardial cell. Phase 0 consists of depolarization. This phase lasts 1-2 milliseconds and represents rapid sodium entry into the cell. Phase 1 is early repolarization, in which calcium slowly enters the cell. Potassium is moved out of the cell during phase 3, with a return to resting membrane potential in phase 4. The time between action potentials correspond to diastole. Discuss surfactant in the lung. Type II alveolar cells secrete surfactant, a lipoprotein that coats the inner surface of the alveolus and facilitates its expansion during inspiration, lowers alveolar surface tension at end expiration, and thereby prevents lung collapse. Discuss the pulmonary anatomy as it relates to pressure The lungs are divided into 3 zones on the basis of the relationships among all the factors affecting pulmonary blood flow. Alveolar pressure plus the forces of gravity, arterial blood pressure and venous pressure affect the distribution of perfusion. Zone 1 is where alveolar pressure exceeds pulmonary arterial and venous pressures. The capillary bed collapses, and normal blood flow ceases. Normally zone 1 is a very small part of the lung at the apex. Zone 2 is the portion where alveolar pressure is greater than venous pressure but not greater than arterial pressure. Blood flows through zone 2, but it's impeded to a certain extent by alveolar pressure. Zone 2 is normally above the level of the left atrium. In zone 3 arterial and venous pressures are greater than alveolar pressure and blood flow is not affected by alveolar pressure. Zone 3 is in the base of the lungs. Blood flow through the pulmonary capillary bed increases in regular increments from the apex to the base. What part of the brainstem is responsible for automatic rhythm of respiration? The respiratory center is composed of several groups of neurons located bilaterally in the brainstem, the dorsal respiratory group, the ventral respiratory group, the pneumotaxic center, and the apneustic center. Describe how to effectively monitor a person's alveolar ventilation. The adequacy of alveolar ventilation cannot be accurately determined by observation of ventilator rate, patterns or effort. To determine the adequacy of ventilation, an arterial blood gas must be performed to measure PaCO2 Describe the cause of dyspnea. It's the subjective sensation of being unable to get enough air. It's often described as breathless, air hunger, SOB, labored breathing, and preoccupation with breathing. Dyspnea is common symptom of respiratory disease. Dyspnea is a result of decreased pH, increased PaCO2, and decreased PaO2, stimulation of stretcher or J-receptor, and and fatigue of the intercostals muscle and diaphragm. What cause proximal nocturnal dyspnea (PND)? Another type of positional dyspnea in PND, in