NR-507 Midterm Exam Study Guide – Advanced Pathophysiology | Chamberlain

Midterm Exam - NR507 / NR 507 (Latest 2023 / 2024) : Advanced Pathophysiology - Chamberlain NR-507 Advanced Pathophysiology Midterm Exam S1 First heart sound, closure of mitral and tricuspid valves in systole S2 Second heart sound, closure of aortic and pulmonic valves in diastole Preload Diastolic filling with venous blood Contractility Systolic ejection Afterload Resistance to systolic ejectionEquation for cardiac output Stroke volume x heart rate Sustained tachycardia causes Decreased stroke volume Ischemia, acidosis and cardiomyopathy cause Decreased contractility HTN, pulmonary disease and aortic valve damage cause Increased afterload What is the most immediate effect on afterload? HTN Hemorrhage and decreased volume decreases and Preload and afterload Increased preload increases Stroke volume Right sided HF is also called Cor pulmonale Cor pulmonale causes and is caused by Enlargement of RV, pulmonary HTN from chronic lung disease5 causes of lung disease leading to cor pulmonale? COPD PE Pulmonary fibrosis OSA Myasthenia gravis, polio 4 causes of heart failure CAD HTN Cardiomyopathy Faulty valves 4 events that lead to HF HTN Increased LV preload Increased LA preload Pulmonary edema Define ventilation The ability to inhale and exhale air Define perfusion The ability of lungs and tissues to perform gas exchange Intrinsic asthma Internal trigger (anxiety) Extrinsic asthma External trigger, allergic response mediated by IgE Asthma s/s Wheezing Chest tightness SOB Asthma treatment - 3 classes/medications Beta 2 agonists-albuterol, anticholinergics for bronchodilation-ipratropium, oral steroids to reduce inflammation-prednisone Chronic bronchitis s/s Productive cough Dyspnea Wheezing Rhonchi Cyanosis Where does damage occur in bronchitis? Airway What is the lamina propria? Thin connective tissue, forms moist linings/mucous membranes Where are inflammatory cells activated in chronic bronchitis? Lamina propria What plays a significant role in chronic bronchitis development? Lamina propria What is a long-term effect of COPD? (Blood) Secondary polycythemia S/S in polycythemia secondary to COPD Increased HCT by RBC compensation, can lead to blood clotWhat is a long-term effect of COPD? (lungs) Alveolar hyperinflation, decreased ability to exhale, air trapping Where is erythropoietin produced? Kidneys Where is angiotensin converting enzyme (ACE) produced? Lungs Where is angiotensinogen synthesized? Liver What is the role of ACE? Activate angiotensin I to form angiotensin II What is the most important component of filtration? Blood (hydrostatic) pressure Define reabsorption Movement of content from glomerular filtrate to blood Define excretion Elimination from the body Define secretion Movement of contents from blood to the nephron Define glomerulonephritis Decreased GFR causes increased BUN and creatinine Acute renal failure is Reversible Most common cause of ARF? Pre-renal Causes of pre-renal failure (5) Volume depletion Polyuria from DM V+D, fluid loss from burn or hemorrhage Hypoperfusion Causes of pre-renal hypoperfusion Decreased CO from HF or MI, atherosclerosis Pathophysiology of pre-renal failure Decreased blood to glomerulus, decreased GFR, decreased renal blood flow = activation of RAA Cause of intra-renal failure Damage to kidney (glomerulus, tubules, interstitium, or vasculature) Most common cause of intra-renal failure ATN-ischemia, toxins Pathophysiology of intra-renal failure Injury causes loss of function, decreased tubule reabsorption, increased sodium and h2o excretion Cause of post-renal failure Obstruction in collecting duct, ureter, bladder or urethra What can cause post-renal failure? (6) Stones Calculi Strictures BPH Tumor Neurogenic bladder Define contrast-induced nephropathy (CIN) Injury from contrast administration, 3rd most common hospital-acquired ARI Who is at risk for developing CIN? DM, CKD Define chronic kidney disease (CKD) Long-term permanent decline in renal function is used to determine stage of CKD GFR CKD can be caused by and factors Intrinsic (glomerulonephritis), extrinsic (DM) and are the primary causes of ESRD DM and HTN Normal GFR 125 mL/min Define RIFLE Risk (90-120) Injury (60-89) Failure (30-59) Loss (15-29) End (15) Define vesicoureteral reflux Retrograde flow of urine from bladder to ureters RBCs lack and Endoplasmic reticulum and nucleus Average RBC lifespan 120 days, 3-4 months RBCs are removed by located primarily in the Macrophages, spleen Define hematopoiesis Formation of blood cellular components Where is the primary site of hematopoiesis in adults? Red bone marrow Consequences of decreased o2 due to lack of Hgb (5) Fatigue Pallor Weakness Dyspnea DizzinessMicrocytic anemia (2) Iron deficiency Thalassemia Macrocyclic anemia (2) B12 deficiency (pernicious anemia), folate deficiency Iron deficiency anemia is / Microcytic/hypochromic reflects the body's total iron stores Ferritin Low ferritin = Anemia Early lab markers in developing microcytic or microcytic anemia is Increased RBC distribution width (RDW) Causes of iron deficiency anemia Decreased iron intake, hemorrhage (colitis, cirrhosis, ulcers, lesions, menorrhagia) It takes ml of blood loss per day to lose mg of iron 2-4, 1-2S/S of pernicious anemia (3) Fatigue Dyspnea Peripheral neuropathy in BLE Risk factors for pernicious anemia (3) Older adults H pylori Decreased b-12 absorption Define hemolytic anemia RBCs are destroyed Causes of hemolytic anemia Mismatched blood types, autoimmune disease, drug-induced allergic reaction Sickle-cell anemia and thalassemia are Autosomal recessive genetic disorders Define sickle-cell anemia Inherited one normal Hb gene and one abnormal Hb geneDefine thalassemia Two inherited abnormal Hb genes causing decreased circulating HGB prevents neural tube defects Folate What is the role of transferrin? Plasma protein that combines with iron for liver storage as ferritin, transfers iron to bone marrow 3 primary causes of CKD HTN DM SLE Pathway of airflow through the lungs Inhaled through ventilation into lungs, ow from alveoli to pulmonary capillaries, to pulmonary veins, to L side of heart, to systemic circulation Chronic bronchitis is diagnosed when chronic productive cough persists for for 3 months, 2 consecutive years Lymphadenopathy is both a of and the response to Symptom, disease, body's, illnessTx for chronic bronchitis Thin secretions, chest physiotherapy Chronic bronchitis causes lung damage! Irreversible 3 electrolytes needed for myocardial contractility Ca2+, Na, K+ makes up 25% of myocardial cells for high ATP production Mitochondria + = myocardial muscle contraction Actin and myosin 2 atrioventricular valves Tricuspid Mitral (bicuspid) 2 semilunar valves Pulmonary and aortic Where is the tricuspid valve located? RA to RVWhere is the mitral valve located? LA to LV Where is the pulmonary valve located RV to pulmonary artery (lungs) Where is the aortic valve located? LA to aorta (systemic circulation) Preload is increased by and CHF and hypervolemia Preload is decreased by or External pressure (tamponade) or hypovolemia Afterload is increased by , , which leads to HTN, valve disease, COPD, pulmonary HTN Afterload is decreased by and ( ) Hypotension, vasodilation, shock High-output failure is caused by what? (4) Severe anemia, hyperthyroidism, and sepsis (extreme febrile state), nutritional deficienciesSecondary hypertension is most often caused by or Disease, drugs is the most common primary DX in the US! Secondary HTN Activation of RAA preload and afterload, cardiac workload = HF symptoms Increases, increases, worsening What causes an increased risk of aneurism? HTN Hyaline sclerosis and atherosclerosis are examples of Vascular remodeling 4 target organs of HTN Eyes Kidneys Heart Brain Hypoxia causes contractility of heart muscle DecreasedEjection fraction = / SV, EDV What is beriberi? Thiamine deficiency Extrinsic asthma is more common in and Children, males Intrinsic asthma is typically seen in over Adults, age 40 In cystitis, and are the most common causes E. Coli, Staph How many nephrons in each kidney? 1 million How many capillary beds surround each nephron? 2 The kidneys filter per minute 1200 mL Blood-borne pathogens are trapped in GlomerulonephritisWhen kidneys don't work, and are retained, causing , , and which leads to HF Na, h2o, HTN, hypervolemia, edema Proteinuria causes Muscle wasting Proteinuria causes oncotic pressure and Decreased, tissue edema Define oliguria Decreased urine production What % of nephrons are needed for normal kidney function? 25 HGB molecule can carry o2 molecules 1, 4 Where are RBCs made in the fetus? Yolk sac then liver and spleen Where are RBCs made in 0–5-year-olds? Bone marrow of all cells Where are RBCs made after 20 years of age? Red marrow of large bones