NR 283 Exam Review 3 PATHOPHYSIOLOGY Rated A+

NR 283 Exam Review 3 PATHOPHYSIOLOGY Rated A+ NR 283 Exam Review 3 PATHOPHYSIOLOGY Gastrointestinal • GI bleeding a. Upper GI bleeding: esophagus, stomach, duodenum b. Lower GI bleeding: jejenum, ileum, colon, rectum Hematemesis: bloody vomit (from esophagus) Hematochezia: bright-red blood (colon, rectum “hemmoroid”) Melena: burgundy color (old blood; jejunum) Occult bleeding: hidden bleeding (blood cells present in feces) Hiatal Hernia: • part of the stomach protrudes through the opening (hiatus) in the diaphragm into the thoracic cavity • Cause: too much pressure (repetitively) on stomach muscles; coughing, vomiting, straining during BM a. Sliding: ususally when pt is in supine position; common b. Paraesophogeal/Rolling: due to weak or enlarged hiatus in diaphragm; leads to ulceration • s/s: heartburn “pyrosis”, frequent belching, discomfort when laying down, substernal pain radiating to shoulder & jaw Gastritis: Acute vs. Chronic, Signs and Symptoms • Inflammation of stomach • Acute -characteristics: red & edematous, ulcerated & bleeding -s/s: anorexia, nausea, vomiting, hematemesis (bleeding in stomach), epigastric pain, cramps, fever/headache, diarrhea • Chronic -characteristics: atrophy of mucosa of stomach, loss of intrinsic factor for absorbing B12 -s/s: vague; mild epigastric discomfort, intolerance for spicy/fatty foods Pts w chronic g. at risk for peptic ulcers & gastric carcinoma Peptic Ulcer Disease: • Cause: common- H. pylori infection or vasoconstrictions by stress smoking, shock, circulatory impairment in elderly, scar tissue, severe anemia • s/s: epigastric burning, localizing pain, stomach emptying, heartburn, nausea, vomiting, weight loss • location: proximal duodenal, antrum of stomach, Cholelithiasis: “gallstone” • cause: formation of gallstones • s/s: radiating pain, nausea/vomiting, jaundice Hepatitis: Types, transmission, Signs and Symptoms Hep A infectious Oral/fecal; contaminated water/shellfish/anal intercourse Hep B chronic Blood/body fluids; exposed to infected blood/body secretions (mother to baby) Hep C chronic Blood/body fluids; post transf, IV drug use • s/s: liver- inflammation, necrosis, edematous & tender Hepatic Encephalopathy: Cause and diagnosis • decline in brain function that occurs as a result of severe liver disease • cause: buildup of toxins in blood when liver fails • s/s: difficulty thinking, personality changes, poor concentration, confusion, musty or sweet breath, seizures, shaky hands, slow movements Cirrhosis: Signs and Symptoms, Complications • destruction of liver cells leading to liver failure • cause: alcoholic liver disease, biliary (immune disorder), postnecrotic (chronic hep, long term exposure to toxic materials), metabolic storage disorders • s/s: initial- fatigue, anorexia, weight loss, anemia, diarrhea, dull aching pain in RUQ; advanced- ascites, peripheral edema, increased bruising, jaundice, encephalopathy, esophageal may rupture, hemorrhage, circulatory shock, • Stages (alcoholic liver disease): -Initial—fatty liver (asymptomatic; reversible) -Second—alcoholic hepatitis (inflammation, cell necrosis, fibrous tissue formation; irreversible) Third—end stage cirrhosis (fibrotic tissue replaces norm tissue; little remaining function) Esophageal varices: Causes, Signs and Symptoms, complications • Abnormal, enlarged veins in the esophagus • Cause: when normal blood flow is blocked by a clot/scar tissue in the liver; cirrhosis • s/s: hematemesis, melena, lightheaded, jaundice, ecchymosis, ascites • complications: hemorrhaging, hypovolemic shock, death Crohn’s disease: “skip lesions” • commonly in ileum (sm. Intest.); inflammatory bowel disease • cause: unknown • s/s: diarrhea w/ cramping, stool soft/semiformed, melena present if ulcers erode, pain/tenderness in RLQ, anorexia, weight loss, anemia, fatigue Ulcerative Colitis: • Inflammation starting in the colon/rectum; inflammatory bowel disease • cause: genetic- abnormal immune response in GI tract; “unknown” • s/s: diarrhea, frequent watery stools w/ hematochezia & mucus, cramping, anemia, fever, weight loss Appendicitis: Cause, Signs and Symptoms • common in young adults; inflammation & infection of the vermiform appendix • cause: obstruction of appendiceal lumen & fluid buildup inside appendix • s/s: periumbilical pain, nausea, vomiting, pain in RLQ Intestinal Obstruction: Signs and Symptoms, complications • lack of movement of intestinal contents thru the intestine • cause: obstruction of tumors, adhesion, hernias, or impairment of peristalsis • s/s: colicky pain, borborygmi (rumbling/gurgling sound made by movement of fluid/gas in intestine), vomiting, abdominal distension, restlessness, diaphoresis w/tachycardia, hypovolemia (dehydration, weakness, confusion, & shock), constipation Gastric Cancer: Predisposing factors • predisposing factors: H. pylori, diet (preservatives w/ nitrates & nitrites), smoked foods, genetics (Blood type A), moving to a diff geographic location • asymptomatic in early stages leading to poor prognosis • s/s: anorexia, indigestion, epigastric discomfort, weight loss, fatigue, feeling of fullness of eating, occult bleeding Pancreatitis: Causes, Signs and Symptoms • autodigestion of the pancreatic tissue; may be acute or chronic • cause: gallstones, alcohol abuse • s/s: severe abdominal pain radiating to back, hypovolemic shock, fever, abdominal distension, decreased bowel sounds (decreased peristalsis) Gastroesophageal reflux “GERD” • flow of gastric contents into esophagus; can cause heartburn after 30-60min of eating • avoid: caffeine fatty & spicy foods, alcohol, smoking • cause: hiatal hernia, delayed gastric emptying, competence of lower esophageal sphincter • s/s: heartburn, chest pain, dysphagia, regurgitation of food, sensation of lump in throat Renal Functions of the Kidney “AWETBED” • Acid-base balance • Water removal • Erythropoiesis • Toxin removal • Bp control • Electrolyte balance • D vitamin D activation Pyelonephritis: Causes, signs and symptoms • Ureter-kidney; purulent exudate fills pelvis & calcyces • Cause: kidney stones, reflux, trauma • s/s: cystitis, dull aching pain in lower flank, high fever Cystitis: Causes, causative organisms, signs and symptoms • Lower UTI; inflammation of bladder; capacity reduced • Cause: bacteria travels up the urethra (E. coli) • s/s: pain in lower abdomen, dysuria, urgent/frequent voiding, nocturia, fever, malaise, nausea, leukocytosis, cloudy unusual odor Renal Calculi “Kidney Stones” or Urolithiasis • cause: urine becomes concentrated allowing minerals to crystalize & to stick together; insufficient water intake • s/s: renal colic: spams of pain in flank radiating to groin, nausea, vomiting, cool moist skin, rapid pulse Glomerulonephritis • Cause: streptococcal infection; antistreptococcal antibodies lodging in glomerular capillaries • s/s: urine is dark & cloudy, facial/periorbital edema, Bp elevation, flank/back pain, malaise, fatigue, headache, anorexia, nausea Bladder Cancer: Risk factors, signs and symptoms • Risk: 50% are smokers, recurrent infections, chemical workers • Cause: dysplasia of bladder cells • s/s: hematuria, dysuria or frequency Polycystic Kidney Disease • cause: genetics: autosomal dom. Chromosome 16 • clin. manifestation: -no indications in child-young adulthood -first signs around age 40; chronic ren. fail. becomes symptomatic & dialysis is needed Kidney Failure “end stage renal failure: ESRD” Causes, Clinical manifestations, treatment • cause: other health problems that have permanently damaged kidneys overtime; both kidney must be involved • common causes: diab. Type I & high Bp Acute: • Sudden, acute • Cause: burns, severe shock, heart failure, nephrotoxins (massive exposure), acute bilateral kidney infection/inflammation • s/s: oliguria, uremia, elevated- serum urea nitrogen, creatinine, metabolic acidosis, hyperkalemia • treatment: dialysis Chronic: • Irreversible, slow, insidious • Cause: nephrosclerosis, diabetes mellitus, nephrotoxins (long term exposure), chronic bilateral kidney inflammation/infection, polycystic disease • s/s: polyuria w dilute urine, anemia, fatigue, hypertension, uremia, oliguria, acidosis, azotemia • Manifestations: decreased reserve: 60% nephron loss, insufficiency: 75% nephron loss, end stage renal failure “uremia”: 90% nephron loss Labs associated with kidney failure • Urinalysis: a. Normal: clear/straw colored & mild odor b. Abnormal: cloudy/dark color & unpleasant/unusual smell • Blood tests a. BUN: blood, urea, nitrogen b. Creatinine c. ABG—high metabolic acidosis d. Anemia—deficient erythropoiesis; anemic e. Electrolyte- high K, Mg, Ca, & low Na & Fe f. Urine culture & sentivity, radiologic tests (US, CT, MRI, IVP) g. Biopsy h. Cystoscopy ***Be sure to cover pathophysiology, etiology, signs and symptoms, diagnostic tests for the following endocrine topics: Endocrine SIADH “syndrome of inappropriate ADH” • Excess ADH • Produced by hypothalamus; ADH: regulates amount of water in blood • Cause: fluid retention triggered by stress • s/s: hyponatremia, mental confusion, irritability DI “Diabetes Inspidus” • deficit of ADH • Produced by hypothalamus; ADH: regulates amount of water in blood • Cause: injury or surgery, genetic, electrolyte imbalance, or drugs • s/s: polyuria w/ large amounts of dilute urine, thirst leading to dehydration, glucose not present in urine Hypo/hyperthyroidism Hyperthyroidism • “Graves Disease” exophthalmos( protruding eyes, decreased blinking/eye movement) • Etiology: produced by pituitary gland • Patho: occurs in women older than 30 • Cause: too much TSH (thyroid stimulating hormone) • s/s: soft kin, silky hair, increased energy, always hungry but can’t gain weight, insomnia, anxiety, heat intolerant, severe diarrhea Hypothyroidism • Hashimoto’s thyroiditis • Etiology: produced by pituitary gland • Cause: too little TSH • s/s: dry scaly skin, brittle hair, alopecia, fatigue, anorexia but gains weight, cold intolerant, constipation Hypo/hyperparathyroidism Hypoparathyroidism • cause: lack of parathyroid glands • leads to hypocalcemia • s/s: increase neuroexcitability, tingling fingers & around mouth, muscle spasm, tetany, weak cardiac muscle, hypotension, increased peristalsis, diarrhea, nausea, cramps Hyperparathyroidism • cause: adenoma, hyperplasia, renal failure • leads to hypercalcemia • s/s: decreased neuroexcitability, personality change, muscle weakness/decreased tone, forceful cardiac contraction, hypertension, polyuria, thirst, renal calculi, decreased peristalsis, constipation, nausea Cushing’s Syndrome/Disease • Produced by adrenal gland • excess cortisol (cortisol control blood sugar levels, regulate metabolism, reduce inflammation) • s/s: increased blood sugar, weight gain- truncal obesity, mood swings, tissue paper skin, moon face- round, dorsocervical fat pad, deep purple striae (stretchmarks) Addison’s Disease • too little cortisol • produced by adrenal gland • s/s: decreased blood sugar levels, poor stress response, fatigue, weight loss, frequent infections, hyperpigmentation Pheochromocytoma • benign tumor of the adrenal medulla • can cause hypertension • s/s: headache, heart ache, heart palpitations, sweating, anxiety Diabetes Mellitus Type I and II: Type 1 Type 2 Age of onset Children & adults Older but younger adults Onset Acute Insidious Etiology Autoimmune destruction Lifestyle, obesity, environmental factors Body weight Thin Obese Plasma Insulin level Low to no insulin Insulin resistant Treatment Insulin injections Oral hypoglycemic (lower blood sugar) or insulin injections if oral treatment doesn’t work Diagnostic tests s/s Cool & clammy, confusion, fight/flight response, vasocontriction, pale, diaphoretic, staggering, agitated, tremors Hot & dry, sugar’s dry ** polyuria, polydipsia, polyphagia FOR BOTH Musculoskeletal RICE: treatment of joint injuries • rest, immobilization, compression, elevation Sprain: tear in a ligament Strain: tear in a tendon; Fractures: a break in the rigid structure of a bone • complete: broken in two or more place • incomplete: bone partially broken “greenstick” frequent in children • open: skin broken • closed: broken bone not protruding from skin • impacted: one end of bone is forced into another bone • pathologic: weakness in bone structure • stress: repeated, excessive stress Named by number of lines: • simple— single break • comminuted—“jigsaw” multiple pieces broken • compression—occurs in vertebrae Dislocations: separation of two bones at a joint Compartment Syndrome • edema within one area of limb ; ischemia/infarction of tissue if arterial blood supply is compressed; leads to gangrene • cause: overly tight cast, crushing injury • s/s: aching, burning, cramping, weakness, numbness, tingling Rheumatoid Arthritis • autoimmune disorder; chronic systemic inflammatory disease, greater in women • cause: unknown; genetic factor, viral infection • manifestations: muscular atrophy, bone alignments shift, muscle spasms caused by inflammation/pain, deformity • s./s: fatigue, depression, malaise, anorexia, low-grade fever, iron defiency, painful joints, stiffness, redness & swelling of joints, joints become fixed & deformed Gout • common in men older than 40 yrs; uric acid buildup in the joints (hyperuricemia); usualy found in big toe (hallux), uric acid will form crystals • cause: hyperuricemia • s/s: without warning in middle of night, pain can be excruciating,inflamed/redness Osteoarthritis • wear & tear joint disease • cause: increased weight bearing or lifting, obesity, aging, genetic • patho: surface of cartilage becomes rough and worn, loss of normal range of motion • s/s: aching pain w/weight bearing & movement, joint movement limited, difficulty walking, difficulty mastication/dysphasia, bony enlargement of distal phalangeal joints Osteomalacia/Rickets: Cause: signs and symptoms • soft bones; leads to compression fractures • cause: lack of vitamin D due to dietary deficit, malabsorption, lack of sun exposure Osteoporosis: Causative factors, signs and symptoms, complications • decrease in bone mass & density • s/s: back pain, abnormal curvature of spin (kyphosis/scoliosis), loss of height Disuse Atrophy • muscle atrophy; muscle is no longer as active as usual; common in elderly • cause: prolonged bed rest, wearing of cast, bedridden, malnutrition • s/s: one limb may be smaller than the other, weakness in limb Neurological Levels of consciousness/arousal • confusion/disorientation • unresponsive • difficult in arousal (coma) ***use Glasgow Coma Scale Cerebral vascular accident “Stroke” • blood flow to a part of brain is stopped by blockage or rupture of a blood vessel • s/s: depends on location of the obstruction… difficulty walking, dizziness, loss of balance/coordination, aphasia, numbness, paralysis in face, leg, or arm (usually one side of body), blurred/darkened vison • types: 1. ischemic stroke: blood clot blocks blood vessel & prevents blood & O2 perfusion to brain a) embolic: clot forms somewhere else in body & travels to brain; sudden b) thombotic: clot forms in blood vessel within brain; gradual 2. hemorrhage stroke: blood vessel ruptures (hemorrhages) & prevents blood perfusion to brain; sudden, occurs w/activity Transient ischemic attack: Signs and symptoms • temporary of blood flow to brain • manifestation are same as stroke; lasts less than 24 hrs; considered as a pre-warning for a stroke • s/s: weakness, numbness/paralysis to facial nerves, arms/legs (one side of body), blindness, dizziness, loss of balance, sudden severe headache Traumatic Brain Injury • may include skull fractures, hemorrhage & edema, direct injury to brain tissue 1. Contrecoup: “acceleration-deceleration injury” injury on front & back of brain; ex: shaken baby syndrome 2. Closed head injury: skull isn’t fractured, but brain tissue is injured & blood vessels may rupture Hematomas a. Epidural hematoma: bleeding between dura & skull; artery b. Subdural hematoma: small tear in veins between dura & arachnoid; venous c. Subarachnoid hematoma: CSF & bleeding between arachnoid & pia d. Intracerebral hematoma: contusion • s/s: seizures, cranial nerve impairment, otorrhea, rhinorrhea Concussion: signs and symptoms • injury to brain that results in temporary loss of normal brain function • s/s: headache, confusion, nausea, vomiting Skull Fractures: Types and locations 1. closed: “simple fracture”; skin isn’t broken 2. open: “compound fracture”; skin is broken, bone emerges 3. depressed: skull is indented or extended into brain cavity 4. linear: straight line 5. comminuted: broken into 3 or more sections Increased Intracranial Pressure: Signs and symptoms, complications • decreasing level of consciousness, headache, vomiting, increasing pulse pressure, papilledema (pressure around brain causing eye swelling), ptosis (drooping of upper eyelid), Cushing’s reflex: 1. Bp--- systolic high, diastolic low 2. Bradycardia 3. Bradypnea Parkinson’s Disease • Disorder of movement; degeneration of basal ganglia; loss of dopamine & excess activity of neural cells • Cause: unknown; genes & environmental factors • Manifestations: tremors, rigidity, bradycardia Amyotrophic Lateral Sclerosis ALS • Lou Gehrig Disease; affects upper & lower motor neurons of brain & spinal cord; pt has normal intellectual & sensory function • Cause: unknown • s/s: difficulty walking/normal activities, tripping/falling, weakness in leg, feet, ankles, hand weakness/clumsiness, slurred speech & dysphasia, muscle cramps & twitching in arms Multiple Sclerosis: Etiology, signs and symptoms, prognosis • disease of brain & spinal cord in CNS; develops after viral infection, demyelination of neurons • s/s: vision/sensory impairment, dysphagia, muscle weakness, slurred speech, fatigue Huntington’s Disease • cause: heredity; progressive breakdown of nerve cells in brain; causes movement, cognitive, psychiatric disorders • s/s: involuntary jerking, writhing movements (chorea), muscle rigidity, slow/abnormal eye movement, impaired gait, posture & balance, dysphasia, dysphagia Spinal Cord Injury • damage to any part of the spinal cord or nerves • cause: fracture, dislocation of vertebrae, compression • s/s: pain & numbness, burning sensation, inability to move or walk, inability to feel pressure, heat, or cold, muscle spasms, loss of bladder/bowel control, dyspnea Seizures: Types, signs and symptoms • cause: high/low blood sugar, alcohol, cerebral lesions, trauma, bleeding in brain, hypoxia • aura: pre warning of a peculiar or auditory sensation before seizure occurs • types: 1. absence 2. tonic-clonic: tonic- concraction, clonic- relaxation Encephalitis • inflammation of the braincause: viral infection • s/s: headache, fever, aches in muscles or joints, fatigue/weakness, confusion, seizures, loss of sensation or paralysis Meningitis • inflammation of meninges surrounding the brain & spinal cord • cause: bacterial infection • s/s: high fever, stiff neck, severe headache, confusion, seizures, lethargy, skin rash Environmental Factors Results of Heavy Metal Damage Chemical Types and damage Biological Agents Contaminated Food and Water Substance Abuse and Associated Problems Physiological dependence Predisposing factors Potential Complications Immobility Contracture • stiffness or tightening of tissues in muscles, joints, tendons, ligaments, skin • s/s: loss of movement in affected area, pain Dermal Ulcers • long time to heal • s/s: skin discoloration, itching, scabbing, swelling of skin near ulcer, dry flaky skin around ulcer, pain tenderness in affected area, hair loss near area Paralysis: loss of muscle function • Paraplegia: both legs • Quadriplegia: both arms & legs • Hemiplegia: paralysis in one side of body • Diplegia: both legs or both arms Orthostatic Hypotension • Low Bp • Risk of falling Deep Vein Thrombosis • Blood clots, poor blood circulation, inactivity • Can break off and risk pulm embolism Pneumonia • Infection that inflames air sacs in one/both lungs • s/s: chest pain w/coughing or breathing, coughing w/phlegm, fatigue, fever, sweating, chills, nausea, vomiting, diarrhea Atelectasis • Collapse of lung; aveoli deflates • s/s: dyspnea, hyperpnea, wheezing, coughing Constipation • infrequent bowel movement; difficult passing of stool; fewer than 3 BM/wk • s/s: lumpy hard stools, straining Kidney Stones • renal colic- moderate to severe; starts in flank and radiates to groin • urgency, frequent, hematuria Bladder Infection “cystitis” • inflammation of the bladder • cause: UTI • s/s: dysuria, frequent/urgent voiding, lower abdomen pain