NUR 2063 / NUR2063: Essentials of Pathophysiology Exam 2 Review

NUR 2063 / NUR2063: Essentials of Pathophysiology Exam 2 Review Cryptorchidism Complications - ANS Fibrotic tubules with deficiency in spermatogenesis, infertility. Amenorrhea - ANS Absence of menstruation Amenorrhea Causes - ANS Hormonal disturbances Stress Neoplasms (ovarian, adrenal, pituitary tumors) Complications of Dialysis - ANS Cardiovascular disease Hypervolemia Depression Prostatitis - ANS Inflammation of the prostate. Most common association is E. coli. Prostatitis S/S - ANS Fever Chills Tender prostate Low back pain Dysuria Leukocytosis Renal Calculus Cause - ANS Urine becomes supersaturated with specific solute that forms crystals. Crystallization is enhanced when a person is dehydrated or has higher than normal levels of solute in the urine from excessive secretion (calcium, uric acid). Renal Calculus S/S - ANS Dull, localized flank pain Acute discomfort accompanied by nausea and vomiting, diaphoresis (sweating), tachycardia, and tachypnea (abnormal, rapid breathing) Renal colic (intermittent, sharp pain) develops as the stone moves to the ureteropelvic junction Benign Prostatic Hypertrophy S/S - ANS Urinary retention Obstruction to flow Decreased stream Hesitancy; difficulty initiating a stream Interruption of the stream Infection caused by retention .Aldosterone - ANS "salt-retaining hormone". Steroid that promotes the retention of Na+ by the kidneys. Na+ retention promotes water retention, which promotes a higher blood volume and pressur Antidiuretic Hormone (ADH) - ANS Promotes retention of water by kidneys and increases blood pressure. Chronic Renal Failure Risk Factors - ANS Diabetes Hypertension Recurrent pyelonephritis Acute tubular necrosis Glomerulonephritis Polycystic kidney disease Family history of CKD Smoking Age over 65 Ethnicity Chronic Renal Failure Causes - ANS The outcome of the progressive and irrevocable loss of nephrons. More than 75% of the total number of nephrons must be lost before clinical manifestations appear. .Cystitis Causes - ANS Inflammation of the bladder lining, may result from bacterial, fungal, or parasitic infections; chemical irritants; foreign bodies (e.g., stones); or trauma. By far the most common is bacterial infection. Cystitis Pathogenesis - ANS E. coli adheres to bladder epithelium, colonizes, and invades host cells. Cystitis S/S - ANS Acute onset of frequency, urgency, and dysuria; pain may be present in the suprapubic area. The urine may appear pink because of hematuria or cloudy as a result of the infectious organism. Human Papillomavirus (HPV) - ANS Highly communicable STI that infects epithelial cells and proliferates into pruritic, painful lesions. Leading cause of cervical cancer. Oral Cancer - ANS Presents at the base of the mouth or border of the tongue. Hiatal Hernia - ANS Defect in diaphragm allowing a portion of the stomach to pass through the diaphragmatic opening into the thorax. Causes of Hiatal Hernia - ANS Aging Chronic straining Coughing Obesity Pregnancy Ascites (accumulation of protein-containing fluid within the abdomen) Gastritis - ANS Inflammation of the stomach lining S/S of Gastritis - ANS Postprandial discomfort Anorexia Nausea Vomiting Hematemesis (vomiting blood) Peptic Ulcer Disease - ANS A break or ulceration in the protective mucosa lining of the lower esophagus (LES), stomach, or duodenum. Causes of Peptic Ulcer Disease - ANS H. pylori NSAIDs S/S of Peptic Ulcer Disease - ANS Burning pain on empty stomach Eating relieves pain Life-threatening complications, such as GI bleeding, may occur with no warning. Metrorrhagia - ANS Bleeding between menstrual periods Metrorrhagia Causes - ANS Bleeding from endometrium during ovulation Uterine malignancy Cervical erosions Endometrial polyps Estrogen therapy Hypomenorrhea - ANS Deficient amount of menstrual flow; reduced flow .Hypomenorrhea Causes - ANS Endocrine or systemic disorders interfering with hormones Partial obstruction of menstrual flow Oligomenorrhea - ANS Infrequent menstruation Oligomenorrhea Cause - ANS Endocrine/systemic disorder causing failure to ovulate Polymenorrhea - ANS Increased frequency of menstruation Polymenorrhea Cause - ANS Endocrine/systemic disorder causing ovulation .Menorrhagia - ANS Increase in amount or duration of bleeding; prolonged and heavy bleeding Menorrhagia Cause - ANS Lesions of reproductive organs .Enuresis - ANS Intermittent incontinence while asleep. Most common in childhood. Stress urinary incontinence (SUI) - ANS Occurs when urine is involuntarily lost with increases in intraabdominal pressure Precipitated by effort or exertion Because of weakening of pelvic muscles or intrinsic urethral sphincter deficiency May be because of obesity, childbirth-related trauma, pelvic surgery, diabetes, or degenerative neurologic diseases that impair nerves that innervate the bladder .Urgency urinary incontinence (UUI) - ANS Involuntary sudden leakage of urine along with or immediately following the sensation of a need to urinate (urgency) Because of an overactive detrusor muscle May be idiopathic, because of bladder infection, radiation therapy, tumors or stones, or CNS damage Overactive Bladder Syndrome - ANS Urgency associated with increased daytime frequency and nocturia Mixed Incontinence - ANS Results from a combination of stress and urge incontinence Neurogenic Bladder - ANS Broad classification of voiding dysfunction in which the specific cause is a pathology that produces a disruption of nervous communication governing micturition. Overflow Incontinence - ANS Bladder becomes so full that it leaks urine, or "overflows" Causes: obstruction of the urethra; underactive/inactive detrusor muscle Functional Incontinence - ANS Related to physical or environmental limitations resulting in an inability to access a toilet in time Transient Incontinence - ANS Sudden onset and as a result of potentially reversible conditions such as infections, constipation, or fecal impaction. .HSV-1 Pathogenesis - ANS Associated with infection above the waist (oral, lips, eyes, epidermis). Often affects children 5 years. HSV-1 S/S - ANS "Cold sores," "chancres" HSV-2 Pathogenesis - ANS "Genital herpes" Mostly genital, anal, and perianal HSV-2 S/S - ANS Oral lesions Genital infection includes fluid-filled vesicles after 3-7-day incubation period Type 1 Diabetes Mellitus - ANS Absolute insulin deficiency Type 2 Diabetes Mellitus - ANS Insulin resistance leads to a relative lack of insulin .Acromegaly - ANS Caused by high IGF (insulin like growth factor) and elevated GH (growth hormone). Coarse facial features, defined jaw, deepened voice, increased shoe size. Occurs in adults. .Pituitary Gigantism - ANS Excess GH that occurs in childhood before the skeletal epiphyses closes. Left untreated, may grow 8' tall with increased risk of cardiomegaly and heart failure. Hyperthyroidism S/S - ANS Insomnia, restlessness, tremor, irritability, palpitations, heat intolerance, diaphoresis, diarrhea, inability to concentrate that interferes with work performance; enlarged thyroid gland Increased basal metabolic rate leads to weight loss, although appetite and dietary intake increase. Amenorrhea/scant menses Hyperthyroidism Lab Values - ANS Undetectable TSH levels are the best indicator. Elevated serum T4 and T3. Hypothyroidism Lab Values - ANS Increased TSH levels. Low serum T4 and T3. Thyroid Storm - ANS (Accelerated hyperthyroidism) Form of life-threatening thyrotoxicosis that occurs when excessive amounts of thyroid hormones are acutely released into circulation Increased temperature Tachycardia Hypertension Extreme restlessness Glycogenolysis - ANS Glucagon breaks down stored glucose during the fasting state. Diabetic Ketoacidosis Pathogenesis - ANS Continued insulin deficiency leads to lipolysis of body tissues--free fatty acids produced by the breakdown of fat from adipose tissue. Diabetic Ketoacidosis S/S - ANS Deep, labored respirations that are "fruity" in odor (Kussmaul respirations) Hypovolemia Hyperkalemia Cushing Syndrome - ANS Hypercortisolism; excess circulating glucocorticoids. Exogenous steroid use is the most common cause. Cushing Syndrome S/S - ANS Round face with prominent, flushed cheeks ("moon face") Weight gain with increasing total body fat, especially the abdomen Thin, fragile skin Dorsocervical & supraclavicular fat pad Mood swings Insomnia Loss of libido Diabetes S/S - ANS Polyuria Polydipsia Polyphagia (hunger) Nausea Fatigue Blurred vision More prone to infections Dawn phenomenon: rise in glucose in early morning hours from growth hormone, cortisol, glucagon, and epinephrine release Myxedema - ANS Occurs in severe or prolonged hypothyroidism Generalized, nonpitting edema Decreased level of consciousness, hypotension, hypothermia May progress to coma Diabetes Insipidus Pathogenesis - ANS Insufficient ADH activity characterized by excessive loss of water in the urine. With insufficient amounts of ADH, urine cannot be concentrated and free water is lost, causing hyperosmolality and hypernatremia. Diabetes Insipidus S/S - ANS Polyuria (excessive urination) Patient may void up to 15 L of urine daily Nocturia Polydipsia (excessive drinking) Hypernatremia Syndrome of Inappropriate Antidiuretic Hormone (SIADH) Pathogenesis - ANS Excessive ADH from ectopic production from tumors, notably primary lung malignancies Excess ADH stimulates renal tubules to reabsorb water despite decreased blood osmolality. Adrenal insufficiency and hypothyroidism can cause increased ADH secretion and hyponatremia. SIADH S/S - ANS Hyponatremia High urine osmolality Low serum osmolality Weakness, muscle cramps, N/V, postural BP changes, poor skin turgor, fatigue, anorexia, lethargy Confusion, hemiparesis, seizures, coma Primary Endocrine Disorder - ANS Intrinsic malfunction of the hormone-producing gland. Ex. thyroid gland fails to secrete thyroid hormones and serum level T4 becomes lower Secondary Endocrine Disorder - ANS Malfunction of the hypothalamus/pituitary cells that control the hormone-producing target gland. Ex. Pituitary gland fails to release TSH, secondarily reducing thyroid gland production, so both T4 and TSH levels are abnormally low in circulation. Hormones Released by Anterior Pituitary Gland - ANS Growth hormone Thyroid-stimulating hormone Adrenocorticotropic hormone (stimulates secretion of glucocorticoids (cortisol and aldosterone)) Parathyroid Gland - ANS Regulates parathyroid hormone (PTH) Detects serum calcium concentration and help maintains constant levels through the regulation of calcium absorption and resorption from bone Bladder Cancer - ANS Predisposing factors include smoking and exposure to carcinogenic chemicals (cigarettes, aniline, dyes, paint, cement) Chronic UTI is associated with increased risk Graves' Disease - ANS Form of hyperthyroidism with increased synthesis and secretion of T4 and T3 that presents with thyromegaly (diffusely enlarged thyroid), thyrotoxicosis, and, often, exophthalmos (enlargement of retroorbital muscles causing protrusion of the eyes). Cortisol - ANS Can exhibit mineralorticoid (function is to maintain normal salt and water balance by promoting sodium retention and potassium excretion) activity in high concentrations. Gastroesophageal Reflux Disease (GERD) - ANS The backflow of gastric contents into the esophagus through the LES GERD S/S - ANS Reflux esophagitis (esophageal inflammation caused by the highly acidic refluxed material) Heartburn Regurgitation Chest pain Complications include esophageal strictures & Barrett's esophagus Functional Obstruction - ANS the loss of propulsive ability by the bowel and may occur after abdominal surgery or in association with hypokalemia, peritonitis, severe trauma spinal fractures, ureteral distention, and the administration of medications such as narcotics. Antibiotic-Associated Colitis (Pseudomembranous Enterocolitis) - ANS Acute inflammation and necrosis of the large intestine, usually affecting the mucosa, but sometimes extending to other areas. .Antibiotic-Associated Colitis (Pseudomembranous Enterocolitis) Causes - ANS Clostridium difficile (exposure to antibiotics) Patients with cancer or who have undergone abdominal surgery are at particular risk. .S/S of Enterocolitis - ANS Diarrhea (often bloody) Abdominal pain Fever Leukocytosis Sepsis Colonic perforation (rare) Mechanical Obstruction S/S - ANS Increased bowel sounds initially, accompanied by abdominal pain, nausea, and vomiting Mechanical Obstruction Pathogenesis - ANS Adhesions, hernia, tumors, impacted feces, volvulus (twisting), or intussusception (telescoping). Hirschsprung Disease - ANS Congenital disorder of the large intestine in which the autonomic ganglia are reduced or absent. Most commonly found in infants and children. Stasis of the stool and megacolon may occur in the abnormally innervated section of the bowel. Pancreatitis - ANS Inflammation of the pancreas. Autodigestion of the pancreas from enzyme activation. Causes of Pancreatitis - ANS High fat diet Alcohol intake .Pancreatitis S/S - ANS Steady, boring pain in epigastrium or LUQ Increases in intensity Severe tenderness on palpation Radiates or penetrates to back Nausea and vomiting Abdominal distention Hypoactive bowel sounds Low-grade fever Pancreatitis Prevention - ANS Limit alcohol consumption Low-fat diet Regular exercise Smoking cessation Pyelonephritis Cause - ANS Kidney infection Ascends from lower urinary tract Most effective preventative measure is early removal of catheter .Pyelonephritis S/S - ANS Costovertebral angle (CVA) tenderness is the classic symptom. It is frequently accompanied by fever, chills, nausea, vomiting, and anorexia. Serum Prostate-Specific Antigen - ANS Most commonly the first test for prostate cancer .Dysmenorrhea S/S - ANS Sharp, suprapubic cramping severe enough to limit activity Nausea Vomiting, Diarrhea, Headache Uterine Prolapse - ANS Uterus sinks from its normal position in the pelvic cavity and sags into the vagina Treatment: hysterectomy Gallstones S/S - ANS May be asymptomatic Persistent epigastric/RUQ pain Intolerance to fatty foods Belching Flatus Bloating Epigastric burning .Appendicitis S/S - ANS Periumbilical pain RLQ pain ("McBurney's point") (classic, but may be anywhere) Nausea Vomiting Fever Diarrhea RLQ tenderness Systemic signs of inflammation C Difficile Treatment - ANS Metronidazole Oral vancomycin Oral fidaxomicin Fecal transplant Complications of Perforated Gallbladder, Bowel - ANS Necrosis leading to bowel gangrene, sepsis, peritonitis, and shock. Hepatitis s/s - ANS Jaundice RUQ pain Malaise Anorexia Nausea Low-grade fever Dysphagia Type 1 - ANS Problems in delivery of food/fluid into esophagus. Worse with liquids than solids. .Dysphagia Type 2 - ANS Problems in transport of bolus down esophagus. Sensation food is "stuck" behind sternum. Dysphagia Type 3 - ANS Problems in bolus entry into stomach. Tightness or pain in substernal area during swallowing process Cryptorchidism Pathogenesis - ANS "Hidden testes": testes incompletely descended, external to the canal or located in a position other than scrotum