NURS 548 Advanced Pathophysiology Final Exam Review

NURS 548 Advanced Pathophysiology Final Exam Review Name the characteristics of acute Rhinosinusitis Answer: 1. facial pain 2. headache 3. purulent nasal discharge 4. decreased sense of smell 5. fever Name the characteristics of Mycobacterium tuberculosis homins Answer: 1. Aerobic 2. Have a protective waxy capsule 3. Can stay alive in "suspended animation" for years Miliary TB Answer: Minute lesions, resembling millet seeds, resulting from tuberculosis eroding into the blood vessel, disseminating the area and affecting almost any organ, particularly the brain, meninges, liver, kidney, and bone marrow. Meat inspection and milk Pasteurization were introduced to protect the food supply. Neonatal Respiratory Distress Syndrome Answer: 1. Lack of surfactant; infants are not strong enough to inflate their alveoli 2. Protein-rich fluid leaks into the alveoli and further blocks oxygen uptake 3. Treatment with mechanical ventilation may lead to bronchopulmonary dysplasia and chronic respiratory insufficiency Atelectasis Answer: Incomplete expansion of the lung or portion of the lung Pneumothorax Answer: 1. air enters the pleural cavity 2. Air takes up space, restricting lung expansion 3. Partial or complete collapse of the affected lung Spontaneous Pneumothorax Answer: An air-filled blister on the lung that ruptures Traumatic Pneumothorax- Open Answer: Air enters the pleural cavity through the wound on inhalation and leaves on exhalation Traumatic Tension Pneumothorax Answer: Air enters the pleural cavity through the wound on inhalation but cannot leave on exhalation Name the causes of Intrinsic (Nonatopic) Asthma Answer: 1. Respiratory Infections- epithelial damage, IgE production 2. Exercise, hyperventilation, cold air- loss of heat and water may cause bronchospasm 3. Inhaled Irritants- inflammation, vagal reflex 4. Aspirin and other NSAIDS- abnormal arachidonic acid metabolism Characteristics of Bronchiectasis Answer: Infection and inflammation destroy smooth muscle in airways, causing permanent damage A manifestation of chronic bronchitis not typically seen in this type of patient Answer: Cor Pulmonale Manifestations seen in Hypercapnia Answer: 1. Increased Respiration 2. Decreased Nerve Firing- carbon dioxide narcosis, disorientation, somnolence, coma 3. Decreased muscle contraction UTI in special populations- Women Answer: More common in women than men, peak ages 15-24 yr olds Pregnant women at increased risk for UTIs UTI in special populations- Children Answer: Common in young children Often involve pyelonephritits UTI in special populations- Elderly Answer: Relatively common 2nd most common form of infection, after respiratory infections, among healthy community-dwelling elderly Nephrotic syndrome Answer: Increased permeability of glomerulus Cardiovascular Consequences of CRF Answer: 1. Decreased blood viscosity 2. Increased blood pressure 3. Decreased oxygen supply Cardiovascular Consequences of Chronic Renal Failure Answer: Less erythropoietin causes anemia-lower blood viscosity- blood flows through vessels more swiftly- heart rate increases- increased workload on left heart- left ventricle dilation and hypertrophy-not enough oxygen to support LV contraction- causing angina, ischemia, & LHF Neurogenic Bladder Disorders- Flaccid Bladder Answer: Failure to empty urine - May occur because of injury to the micturition center of sacral cord, cauda equina, or sacral spinal nerves - Peripheral neuropathies (a complication of diabetes mellitus) may lead to flaccid bladder What is happens in overflow incontinence? Answer: Occurs when intravesicular pressure exceeds the maximal urethral pressure What is the most common cause of overflow incontinence in men? Answer: Prostate Enlargement What are the consequences of inflammation and damage to the bowel? Answer: Hemorrhage- anemia Perforation- peritonitis Decreased mucosal function - malabsorption Decreased bacterial containment- sepsis What are the characteristics of Crohn's disease? Answer: 1. Sharply demarcated, granulomatous lesions that are surrounded by normal-appearing mucosal tissue. 2. Multiple lesions are referred to as "skip lesions" 3. Characteristic "cobblestone" appearance 4. Marked inflammatory and fibrotic changes of the submucosal layer 5. areas of involvement- primary ileum, secondarily colon 6. diarrhea is common 7. Rectal bleeding is rare 8. Fistulas, strictures and perianal abscesses are all common 9. Development of cancer is rare What are the characteristics of infectious enterocolitis? Answer: 1. Exudate to dilute toxins 2. Hypermotility that may cause vomiting 3. Decreased intestinal function- food not absorbed; water absorbed into bowel by osmosis resulting in osmotic (explosive) diarrhea Mechanical Obstruction Answer: 1. Severe, colicky pain 2. Borborygmus 3. Audible, high-pitched peristalsis; peristaltic rushes 4. Awareness of intestinal movements What is celiac disease? Answer: An immune mediated disorder triggered by ingestion of gluten-containing grains Adenomatous Polyps Answer: 1. Most common neoplasm of the intestine 2. Benign neoplasms coming from the intestinal epithelium 3. Most cases of colorectal cancer begin as adenomatous colonic polyps Name the 4 functions of the liver Answer: 1. Carbohydrate, protein, and lipid metabolism - Sugars- stored as glycogen, converted to glucose, used to make fats -Proteins- synthesized from amino acids; ammonia made into urea - Fats- oxidized for energy, synthesized, packaged into lipoproteins 2. Drug and hormone metabolism - biotransformation into water-soluble forms - detoxification or inactivation 3. Bile production 4. Bilirubin elimination Prehepatic (Excessive Red Blood Cell Destruction) causes of Jaundice Answer: 1. Hemolytic blood transfusion reaction 2. Hereditary disorders of the red blood cell: sickle cell anemia, thalassemia, Spherocytosis 3. Acquired hemolytic disorders 4. Hemolytic disease of the newborn 5. Autoimmune hemolytic anemias Which viral hepatitis subtypes can lead to chronic Hepatitis Answer: HBV, HCV, and HDV Fatty liver (steatosis) Answer: 1. First stage in liver disease 2. Liver cells containing fat deposits; liver is enlarged Consequences of portal hypertension Answer: 1. Increased pressure in peritoneal capillaries causes ASCITES 2. Portosystemic shunting of blood causes - Development of collateral channels such as Caput medusae, Hemorrhoids, Esophageal varices - Shunting of ammonia and toxins from the intestine into the general cirulation causing HEPATIC ENCEPHALOPATHY 3. Splenomegaly leads to ANEMIA, THROMBOCYTOPENIA, AND LEUKOPENIA Prerenal renal failure Answer: There is a DECREASED blood supply. Caused by shock, dehydration and vasoconstriction Postrenal renal failure Answer: Urine flow is blocked. Caused by stones, tumors, enlarged prostate Intrinsic renal failure Answer: Kidney tubule function is decreased. Caused by ischemia, toxins, intratubular obstruction Clinical Manifestations of Chronic Renal Failure Answer: Hypertension Heart failure Edema Hyperkalemia Pericarditis Impaired immune function Skin disordes GI mainfestations Neurologic manifestations- neuropathies Sexual dysfunction Coagulopathies- bleeding Impaired erythropoietin production causing anemia Acid-base imbalance leading to acidosis osteodystrophies List the consequences of liver failure Answer: 1. hematologic disorders such as - anemia, thrombocytopenia, coagulation defects and leukopenia 2. Endocrine disorders - Fluid retention, hypokalemia, disordered sexual dysfunctions 3. Skin disorders - jaundice, red palms, spider nevi 4. hepatorenal syndrome - azotemia, increased plasma creatinine, oliguria 5. hepatic encephalopathy - asterixis, confusion, coma, convulsions Choledocholithiasis Answer: Stones in the common bile duct of the gallbladder Pancreatic Cancer Answer: 1. 4th leading cause of cancer death in US 2. Smoking is a major risk factor for pancreatic cancer 3. Most cancer of the pancreas has metastasized at the time of diagnosis 4. Pain management is one of the most important aspects of management Where do tertiary hormone disorders originate? Answer: Abnormality in stimulation from the hypothalamus- releasing hormone Where do secondary hormone disorders originate? Answer: Abnormality in stimulation from the pituitary- Tropic hormone Where do primary hormone disorders originate? Answer: Abnormality in the gland- hormone Functions of growth hormone Answer: Growth-promoting actions: Bone and cartilage- increased linear growth, body organs- increased size and function, muscle- incresed lean muscle mass Anti-insulin effects: adipose tissue- increased lipolysis and FFA use; decreas in adiposity, carbohydrate metabolism- decreased glucose use; increased blood glucose Hashimoto's Thyroiditis Answer: An autoimmune(acquired) disease whereby the body attacks the thyroid causing hypothyroidism Name the various actions of cortisol Answer: 1. Plasma protein increased 2. Immune/inflammatory systems suppressed 3. Catabolism increased - Muscle breakdown - Blood Glucose increased - SNS response increased Endocrine Pancreas: Islets of Langerhans Answer: Alpha Cells- Glucagon Beta Cells- Insulin and amylin Delta Cells- Somatostatin PP Cells- Pancreatic Polypeptide Describe the pathogenesis of Type II Diabetes Answer: A combination of beta cell dysfunction and insulin resistance Pathogenesis of Type II Diabetes Answer: 1. Impaired insulin secretion 2. Increased basal hepatic glucose production 3. Carbohydrate absorption 4. Decreased insulin-stimulated glucose uptake Chronic complications of Diabetes Mellitus Answer: Increased glucose levels allow glucose to bind to proteins in - Hemoglobin - HbA1C has higher O2 affinity - Nephropathy, retinopathy - Increased risk of therosclerosis Increased vulnerability to infections Autonomic Neuropathy Answer: 1. Defects in vasomotor and cardiac responses 2. Impaired motility of the GI tract 3. Inability to empty bladder 4. Sexual dysfunction Consequences of upper motor neuron damage Answer: 1. Weakness and loss of voluntary motion 2. Spinal reflexes remain intact but cannot be controlled by the brain causing - increased muscle tone - hyperreflexia - spasticity True statements about Myasthenia Gravis Answer: 1. Autoimmune disease - gradual destruction of acetylcholine receptors - associated with thymus tumor or hyperplasia 2. Gradual development of weakness - from proximal to distal prtions of the body 3. Myasthenia crisis: respiration compromised Basal Ganglia Dysfunction can increase patterned movement Answer: 1. hyperkinesia - choreiform: jerky movements - athetoid: continuous twisting movements - ballismus: violent flinging movements - dystonia: rigidity Signs and symptoms of Parkinson's disease Answer: 1. Tremor 2. Rigidity 3. Bradykinesia (slow movement) 4. Loss of postural reflexes 5. Autonomic system dysfunction 6. Dementia Amyotrophic Lateral Sclerosis (ALS) Answer: 1. Damages both upper and lower motor neurons 2. UMN damage - weakness, loss of motor control - loss of control over spinal reflexes causing stiffness and spasticity 3. LMN damage - irritation- fasciculations - Decreased neuron firing - weakness, denervation atrophy, hyporeflexia Central Cord syndrome Answer: damage to axons near the gray matter - Arms affected more than legs Anterior Cord Syndrome Answer: Damage to anterior section of cord - Motor functions affected; touch sensation not affected Brown-Sequard syndrome Answer: Damage to one side of cord - Motor function lost on that side; pain/temperature sensation lost from other side Causes of Intracranial Pressure (ICP) Answer: 1. Compartment syndrome in the skull 2. Brain Swelling 3. Hydrocephalus 4. Tumors Traumatic Brain Injury Answer: Primary Injuries- due to impact - Microscopic damage: concussion, diffuse axonal injury Secondary Injury- due to: - Hemorrhage - Ischemia - Infection - Increased intracranial pressure Epidural Hematoma Answer: a type of traumatic brain injury (TBI) in which a buildup of blood occurs between the dura mater (the tough outer membrane of the central nervous system) and the skull. Subdural Hematoma Answer: A subdural hematoma (SDH) is a collection of blood below the inner layer of the dura but external to the brain and arachnoid membrane (see the images below). Subdural hematoma is the most common type of traumatic intracranial mass lesion Intracerebral Hematoma Answer: It can be caused by brain trauma, or it can occur spontaneously in hemorrhagic stroke. Non-traumatic intracerebral hemorrhage is a spontaneous bleeding into the brain tissue. Non-traumatic can refer to increased exertion, tension or stress, occurring within the brain. Bacterial Meningitis Answer: S/S- fever and chills, headache stiff neck and back, abdominal and extremity pains, nausea and vomiting. Caused by Strep pnsumoniae, H. influenza or Neisseria meninitidis Viral Meningitis Answer: Less severe course than bacterial Usually caused by coxsackle B and echovirus Absence seizure (petit mal) Answer: disturbances in consciousness Atonic seizure Answer: loss of muscle tone Myoclonic seizure Answer: muscles contract Tonic-Clonic (grand mal) Seizure Answer: muscle contraction and loss of consciousness Generalized convulsive status epilepticus Answer: Seizures continue without recovery between them Dementias Answer: Alzheimer's: amyloid plaques Pick Disease: Pick bodies Prion diseases: prion proteins - Creutzfeld-Jakob Disease