NUR 2063 Pathophysiology Rasmussen College Final Exam questions and answers with solutions 2025

NUR 2063 Pathophysiology Rasmussen College Final Exam questions and answers with solutions 2025 Explain primary prevention - ANSWER Preventing"; altering susceptibility or reducing exposure of disease for people Explain secondary prevention - ANSWER "Screening"; early detection, screening, and management of disease to catch disease early before it spreads Explain tertiary prevention - ANSWER "Treating" and preventing further complications from a disorder or disease after the person has the condition What are examples of primary prevention? - ANSWER Vaccinations and Handwashing What are examples of secondary prevention? - ANSWER PAP smears for STDs, lab work for HBA1C check, mammogram What are examples of tertiary prevention? - ANSWER Rehab for hip surgery, relearning ADL's after amputation, Wound care after stroke to prevent pressure ulcer What happens to the body during the sympathetic phase of the flight or fight response? - ANSWER Pupils dilate, salivation inhibited, increase in HR, bronchodilation of airway, increased respirations, glucose release, inhibit GI/GU. What happens to the body during the parasympathetic phase of the flight or light response? - ANSWER Rest and Digest. Pupils constrict, salivation occurs, decreased HR, bronchoconstriction,decreased respiration, GI/GU systems resume action Explain the role of the nucleus - ANSWER control center of the cell, where DNA and genes are stored, produces mRNA to help build body proteins Explain the role of the mitochondria - ANSWER Powerhouse of the cell. Provides energy in ATP, and has its own set of DNA Explain the role of the ribosome - ANSWER produces RNA to produce proteins through transcriptions of DNA and translation of RNA into a protein Explain the role of the lysosomes - ANSWER helps breakdown and digest dead cells, organelles, or tissues Explain the role of the rough ER - ANSWER folded membranes that move proteins around the cell. Has ribosomes attached to it and helps produce proteins for the cell membrane Explain the role of the smooth ER - ANSWER helps the Liver and kidney cells to detoxify, lipid metabolism, synthesis of hormones, and calcium storage Explain the role of the peroxisome - ANSWER membrane cells that contain oxidase and catalase to detoxify harmful chemicals, breakdown hydrogen peroxide and filter metabolic wastes Explain the role of the Golgi body - ANSWER stacked membranes that act as the sorter and packager for proteins from the ER. Helps move things in and out of cell Explain passive immunity - ANSWER the transfer of preformed antibodies against specific antigens from a protected or immunized individual to an unprotected or non immunized person. Provides immediate and short term protection. No memory cells are produced. IgA and IgE. Passes protection What are examples of passive immunity? - ANSWER mom to fetus through placenta or mom to infant through breast milk. Serotherapy Explain active immunity - ANSWER a protective state owing to the immune system response as a result of active infection or immunization. It has to be activated in the body and the body has to fight it to have long term immunity What are examples of active immunity? - ANSWER Vaccinations Explain what edema is - ANSWER accumulation of fluid in the interstitial space. Leads to tissue swelling What are some causes of edema? - ANSWER increase in the forces that move fluid from capillaries to interstitial compartments or decrease in the opposite. What are factors that contribute to edema? - ANSWER Increase in hydrostatic forces in the capillaries that increases the blood volume, increased capillary permeability, CHF, HYPTN, decrease in plasma proteins like albumin (causes liver to hold onto more water- ascites, cirrhosis), blockage of lymph drainage What is a hypersensitivity? - ANSWER an overreaction to antigens or allergens that is beyond the normal range, leading to damage What is a type 1 hypersensitivity? - ANSWER anaphylactic. Occurs within 2-30mins of exposure. Can be systemic or localized. Binds to IgE and mast cells that release histamine, leukotrienes, and prostaglandins to create inflammation Mediating Factor for type 1 hypersensitivity - ANSWER IgE Examples of type 1 hypersensitivity - ANSWER allergic reaction to dust. someone eats peanuts and breaks out in hives and runny nose How do we treat type 1 hypersensitivity reactions? - ANSWER antihistamines to block histamine, beta adrenergics to bronchodilator , corticosteroids, to decrease inflammation. IgE therapy, epinephrine given during anaphylaxis through IV or through IM in epipens What are signs and symptoms of a type 1 hypersensitivity reaction? - ANSWER hives, runny nose, eczema, throat constriction, ,localized edema, wheezing, tachycardia, anaphylaxis. Explain Type 2 Hypersensitivity - ANSWER The cells attack healthy organs and blood, causing symptoms Mediating factor for type 2 hypersensitivity - ANSWER cytotoxic- IgM/ IgG Examples of type 2 hypersensitivity - ANSWER Blood transfusions when wrong blood given, hemolytic disease of newborn, grans disease, myasthenia gravis What is type 3 hypersensitivity? - ANSWER The igG antibodies are stuck beneath the membranes of cells. Can activate immune responses that can damage tissues. Immune complex Mediating factor type 3 hypersensitivity - ANSWER immune complexes Examples type 3 hypersensitivity - ANSWER RA, lupus What is type 4 hypersensitivity? - ANSWER there is a delayed cell reaction caused by the T cells. Antigens are phagocytized and are sensitized to receptors on the t cell. Reexposure causes the memory cells to release destructive cytokines. Mediating factor type 4 hypersensitivity - ANSWER delayed cell mediated Examples type 4 hypersensitivity - ANSWER TB test, contact dermatitis Characteristics of benign tumors - ANSWER Localized growth that is curable. They more closely resemble the original tissue type, they grow slowly, have little vascularity, rarely necrotic, and usually have similar function to the original cells. Can be fatal depending on the location (brain, heart,etc), usually grows at the original areas of the body. Encapsulated Characteristics of malignant tumors - ANSWER usually cancerous. They ignore growth controlling signals and replicate despite signals from the environment. They can escape signals and can die. they can also display different functions poorly or not at all related to the tissue. Greater degree of differentiation means that it is more aggressive. Can move around with a poor prognosis. Anaplasia, metastasis S/S of peptic ulcer disease - ANSWER epigastric burning pain that is usually relieved by food or antacids (gastric ulcers present on empty stomach but can be after food, duodenal ulcers present 2-3 hours after food and is relieved by food). Can also be life threatening as GI bleeding can occur without warning and cause a drop in H/H and dark tarry stools and hematemesis What is H.pylori? - ANSWER has a key role in promoting both gastric and duodenal ulcer formation and thrives in acidic areas. It slows down ulcer healing and can reoccur frequently, and taking it away can help ulcers heal What is a functional bowel obstruction? - ANSWER problem with the act of the bowel actually moving, such as things that inhibit movement from surgery, medications, opioids, low fiber diets that can slow motility or shut off the GI system from the SNS stimulation What is a mechanical bowel obstruction? - ANSWER blockage of the bowel inhibiting movement. adhesions, hernia, tumors, impacted feces, volvus or twisting of the intestines, intussusception adhesions - ANSWER bands of scar tissue joining two surfaces that are normally separated in the bowel hernia - ANSWER Protrusion of bowel through the wall of the cavity that normally contains it volvus - ANSWER twisting of the bowel Intusseption - ANSWER telescoping of the intestines S/S of appendicitis - ANSWER Periumbilical pain, RLQ pain, presence of a positive McBurneys point and rebound tenderness when one presses on the belly button and hip region and when the pressure is removed, the client has pain, nausea, vomiting, fever, diarrhea, RLQ tenderness, systemic signs of infection. how to assess appendicitis - ANSWER McBurney's point technique when pressing on the belly button and RLQ hip region and removing the pressure causes intense pain, indicates positive appendicitis. Rebound tenderness= positive rebound tenderness - ANSWER pain that increases when pressure (as from a hand) is removed-in appendicitis S/S of liver disease - ANSWER hepatocellular failure (jaundice, decreased clotting, hypoalbuminemia, decreased vitamin D and K) and portal hypertension (GI congestion due to blockage of blood, more esophageal or gastric varies, hemorrhoids, enlarged spleen,) what is jaundice? - ANSWER green yellow staining of tissues from increased level of bilirubin as the liver cannot metabolize extra bilirubin. Found on eyes, skin, and mouth. present with liver disease What is ascites? - ANSWER pathological accumulation of fluid in the peritoneal cavity due to the loss of albumin in the liver, causing fluid to be free amongst the cells. It can cause a lot of pain in the abdomen, and it must be drained with a parenthesis What is hepatic encephalopathy? - ANSWER neuropsychiatric syndrome from too much ammonia in the blood as the liver cannot break it down. Dementia=ammonia and psychotic symptoms common along with jerking What is portal hypertension? - ANSWER Increased pressure in the portal venous system from a build-up of portal vein pressure due to progressive hepatic fibrosis which increases hepatic resistance What is esophageal varices? - ANSWER a complication of portal hypertension resulting from alcoholism or hepatitis. Causes the vessels in the esophagus to become dilated and bleed, and the rupturing can be forceful enough for one to bleed out How do we treat esophageal varices? - ANSWER reduce the hypertension, banding the varices to prevent rupturing and bleeding by cutting of the flow with a band What role does albumin play in the blood? - ANSWER Albumin helps keep fluid in the blood stream and in cells so it does not leak into other tissues. It can also carry other substances in the body What happens to albumin during liver failure? - ANSWER leads to low albumin levels, causing edema in the extremities and buildup of fluid in abdomen called ascites from fluid leaking through the cells and vessels into the tissues Three functions of the kidneys - ANSWER elimination, excretion, regulation Explain elimination - ANSWER discharge of waste (urine) from the body Explain Excretion - ANSWER removal of organic wastes from the blood Explain regulation - ANSWER regulating blood volume, ion concentration, blood pH and nutrients Manifestations of renal disorders - ANSWER Pain: usually in the back-flank area, felt at the CVA angle when one palpates with a closed fist and it causes the client tenderness. Pain upon micturition What are abnormal urinalysis findings? - ANSWER dark, strong smelling urine could denote decreased renal function, infection or dehydration, cloudy urine could denote infection or high WBC count. Ketones or glucose suggest diabetes, and proteinuria Normal GFR - ANSWER 125 mL/min Normal urine output per hour - ANSWER 30 mL/hr What is polycystic kidney disease? - ANSWER a congenital abnormality of the kidney that is genetically transmitted, and it results in fluid filled cysts on one or both kidneys that can lead to renal failure, needing dialysis, or kidney transplantation What causes polycystic kidney disease? - ANSWER genetics Explain nephron - ANSWER in the kidney and helps to filter blood and remove waste products. The kidney has 1-2 million of them Explain hematuria - ANSWER blood found in the urine not due to menstruation Explain proteinuria - ANSWER protein found in the urine What is nephrolithiasis? - ANSWER kidney stones that obstruct the ureters and kidneys. Usually made of calcium and can cause urinary stasis and pain What is pyleonephritis? - ANSWER infected and inflamed kidney, usually caused by from the lower urinary tract that ascends Explain how to assess for pyelonephritis - ANSWER Percussion at the CVA noting tenderness, pain when urinating, low GFR, concentrated urine with things in urine s/s of pyelonephritis - ANSWER CVA tenderness most common, fever, chills, N/V, anorexia or not willing to eat, flank pain What is cystitis? - ANSWER inflammation of the bladder (UTI) How to prevent pyelonephritis - ANSWER remove catheters as early as possible to prevent infection as it can spread s/s of acute kidney injury (AKI) - ANSWER low urine output, concentrated urine, low GFR, high BUN/CRE, sudden reduction in kidney function 3 Causes of AKI - ANSWER Prerenal, intrarenal, postrenal explain pre renal causes of AKI - ANSWER disruption in renal perfusion and blood flow. It can cause low blood pressure, low blood volume, heart failure, renal artery obstruction, fever, vomiting, diarrhea, burns that lead to dehydration, Drugs such as ACE inhibitors or angiotensin 2 blockers, NSAIDs that can drop the blood pressure or cause bleeding Explain intrarenal causes of AKI - ANSWER damage or disruptions within the kidney blood vessels, tubules, or glomeruli. It can cause reduced blood supply within the kidneys, toxic injury with medications, chemo, and contrast medias, renal inflammation, or prolonged prostate/ stones/ in the post renal stage Explain postrenal causes of AKI - ANSWER caused by an obstruction in the urinary collecting system, urethra, bladder, or ureters due to stone, tumor, or enlarged prostate that results in elevated pressure in the Bowman's capsule that impedes glomerular filtration. Prolonged injury can lead to intrinsic injury and irreversible damage Examples of prerenal causes of AKI - ANSWER low BP, hypovolemia, heart failure, renal artery occlusion, fever, vomiting, diarrhea, burns leading to dehydration, NSAIDs, and antihypertensives that drop the BP Examples of intrarenal causes of AKI - ANSWER chemo, contrast dye, prolonged kidney stones in the post renal stage Examples of postrenal causes of AKI - ANSWER renal stones, enlarged prostate, tumor in the urethra What is compartment syndrome? - ANSWER Damage to nerves and vasculature of an extremity due to compression. if untreated it can cause edema, increased pressure, reduced capillary flow, ischemia and necrosis What must be done in compartment syndrome? - ANSWER fasciotomy to reduce pressure in the area What are the 5 P's for compartment syndrome? - ANSWER Pain paralysis paresthesia pallor pulselessness What are pressure ulcers? - ANSWER localized area of cellular necrosis resulting from pressure between any boney prominence and with an external object Which populations are most likely to have a pressure ulcer? - ANSWER elderly, bedridden patients, incontinent patients, those who are malnourished, bad hygiene, those with paralysis Risk factors for pressure ulcers - ANSWER poor nutrition, aging, immobility, sensory loss, bowel and bladder incontinence Most common places to find pressure ulcers - ANSWER buttocks, coccyx, heels, elbows, back of head, shoulders stage 1 pressure ulcer - ANSWER Intact skin with non blanching redness stage 2 pressure ulcer - ANSWER partial thickness skin loss involving the epidermis or dermis or both stage 3 pressure ulcer - ANSWER full thickness tissue loss with visible fat stage 4 pressure ulcer - ANSWER full thickness tissue loss with exposed bone, muscle or tendon How can we prevent pressure ulcers - ANSWER turning patients every 2 hours who are bedridden. Appropriate nutrition and hydration. float heels off bed, clean linens, doing incontinence care, movement of patients What are electrolyte reservoirs? - ANSWER where electrolytes are found at an abundance, usually in the bones Which electrolytes are stored in the bones? - ANSWER calcium, phosphate, magnesium What is osteomyelitis? - ANSWER severe pyogenic infection of bone and local tissues. the organism reaches the blood adjacent to soft tissue or directly into it. if not managed, necrotic bone can separate the bone into dead segments Causes of osteomyelitis - ANSWER burns, sinus disease, trauma, tumors, periodontal infection and pressure ulcers, open fractures, penetration of wounds, surgical contamination or use of metal screws What is osteoporosis? - ANSWER occurs when the rate of bone resorption is greater than bone formation. The bones end up becoming fragile and light Who is most likely to get osteoporosis? - ANSWER women age 60-80 that are caucasian What are the causes of osteoporosis? - ANSWER estrogen deficiency, poor calcium intake and disuse of supplements S/S of osteoporosis - ANSWER short stature, muscle wasting, back spasms and difficulty bending. bones will be porous and have holes in them, more fragile How do we diagnoses osteoporosis? - ANSWER bone mineral density scan with levels being -1.0 to -2.5 How do we treat osteoporosis? - ANSWER calcium and vitamin D supplements, exercise, human parathyroid hormone, supplemental estrogen What is rickets? - ANSWER defective mineralization of both bone and growth plate cartilage in children What causes rickets? - ANSWER Vitamin D deficiency Which population is affected by rickets? - ANSWER children S/S of Rickets - ANSWER bowleg, knock kneed, beading of ribs, improper formation of teeth, long ends of the bones, pelvis deformities What is osteomalacia? - ANSWER a rare condition of the adult bone associated with vitamin D deficiency, resulting in decalcification and softening of bone. Which population is affected with osteomalacia? - ANSWER adults What causes osteomalacia? - ANSWER Low vitamin D in adults What is osteoarthritis? - ANSWER local degenerative disorder associated with aging and wear and tear from repetitive stress. Characterized by loss of articular cartilage, calcification, wear of bone and bone spurs. Non inflammatory, and the weight bearing joints are affected What causes osteoarthritis? - ANSWER long-term or excessive wear and tear on joints, aging, genetics s/s of osteoarthritis - ANSWER pain, stiffness, enlargement, tenderness, limited range of motion and deformity, crepitus What are Heberden's and Bouchard's nodes? - ANSWER boney bumps on fingers and joints caused by joint inflammation in osteoarthritis and RA What is rheumatoid arthritis? - ANSWER a chronic progressive inflammatory disease causing inflammation in the joints and resulting in painful deformity and immobility, especially in the fingers, wrists, feet, and ankles. What causes rheumatoid arthritis? - ANSWER autoimmune disorder s/s of rheumatoid arthritis - ANSWER s/s similar to osteoarthritis, malaise and fatigue. What is psoriatic arthritis? - ANSWER inflammation of the joint cavities associated with psoriasis What is psoriatic arthritis associated with? - ANSWER psoriasis What causes psoriatic arthritis? - ANSWER automimmune disorder where cells attack the joints if not corrected earlier s/s of psoriatic arthritis - ANSWER similar to RA, but secondary to psoriasis. oligoarthritis, combined soft tissue and peripheral joint disease What is gout? - ANSWER disorder in which the disturbance of uric acid metabolism leads to deposition of uric acid crystals in the joints What is associated with gout? - ANSWER uric acid and uric acid crystals What causes gout? - ANSWER hyperuricemia s/s of gout - ANSWER Severe pain in a peripheral joint, often great toe Swelling of joint, redness Trophi in lower extremities (small, white nodules visible through the skin) Renal stones What is gigantism? - ANSWER occurs in childhood as a result of too much growth hormone. Occurs before skeletal plates fuse at the ends of bones. Leaves client with increased risk for cardiac problems Which population is affected by gigantism? - ANSWER children What is dwarfism? - ANSWER occurs when there is too little growth hormone. It causes short stature, hypoglycemia, delayed dental eruption, thin hair, poor nail growth, greater fat mass, decreased muscle mass, and delayed bone formation and puberty. Often is congenital or idiopathic. What is acromegaly? - ANSWER occurs in adults as a result of too much growth hormone. Occurs when the cells grow width wise amongst the bones. Which population is affected by acromegaly? - ANSWER adults How do the bones grow in gigantism? - ANSWER vertically or horizontally from the ends of bone. How do the bones grow in acromegaly? - ANSWER width wise What is diabetes insipidus caused by? - ANSWER lack of ADH What does diabetes insipidous result in? - ANSWER Results in the kidneys being unable to retain water in the body and a lot of urine output that is dilute. Extreme thirst. Lack of water leads to dehydration. s/s of diabetes insipidus - ANSWER dizziness, disorientation, nausea, tachycardia, headaches, low blood pressure, hypovolemia, high electrolytes in the blood- sodium, large volumes of dilute urine/ fluid are excreted, weight loss What are patient with diabetes insipidus at high risk for developing? - ANSWER hypovolemic shock What is SIADH? - ANSWER too much ADH in the body. Causes the body to retain too much water S/S of SIADH - ANSWER low urine output, high osmolarity, electrolytes are at a lower concentration, edema, weight gain, hyponatremia, cereal edema, seizures, confusion, coma What are patients with SIADH at risk of developing? - ANSWER cerebral edema What organism causes pelvic inflammatory disease - ANSWER Neisseria gonorrhoeae, chlamydia trachomatis What organism causes cervical cancer - ANSWER human papillomavirus or HPV What organism causes UTI - ANSWER What organism causes herpes - ANSWER herpes simplex 1/ 2 virus (depending on area of body) What organism causes syphillis - ANSWER Treponema pallidum What is parathyroid hormone? - ANSWER increases the calcium levels in the blood to be released from bone reservoirs by activating osteoclasts. It increases Ca absorption in the intestine and decreases Ca excretion in the urine What is calcitonin? - ANSWER decreases calcium levels in the blood and increases calcium levels in the bone. puts calcium back into the bones. What electrolyte is affected by parathyroid hormone and calcitonin? - ANSWER calcium What is Cushing's disease? - ANSWER caused by excessive glucocorticoids from either a pituitary tumor or tumor or adrenal cortex or secondary to prescribed glucocorticoids S/S of Cushing's Disease - ANSWER hyperglycemia, loss of muscle and bone, excess water and salt retention, weight gain, edema, hypernatremia, characteristic signs: moon face and the buffalo hump due to swelling and redistribution of fat, high BP and blood volume What is Addison's disease? - ANSWER caused by adrenocortical insuffiency from not having enough steroids or glucocorticoids. Primarily from autoimmune conditions or removal of the adrenals, secondary to removal of corticosteroid therapy S/S of Addison's disease - ANSWER weight loss, salt wasting of fluids, weakness, malaise, hyperpigmentation or bronzing of skin, hypoglycemia, and hyperkalemia. Reduced cardiac output, inadequate blood volume, low blood pressure Hypothyroidism causes - ANSWER caused by cells attacking the thyroid gland or surgical removal of tissues, iodine deficiency. Leads to a lack of T3/T4 and too much of TSH. The TSH recognizes the lack of the T3/T4 so more is pushed into it yet the thyroid cannot produce it. Lab values for hypothyroidism - ANSWER elevated TSH, low T3/T4 S/S hypothyroidism - ANSWER low metabolism, weakness, lethargy, cold intolerance, low appetite, bradycardia, weight gain, dry skin, constipation, depression, difficulty concentrating, menstrual problems Hyperthyroidism causes - ANSWER excessive iodine, Graves' disease, nonmalignant thyroid tumors, thyroid inflammation, and taking large amounts of thyroid hormone replacement Lab values for hyperthyroidism - ANSWER High T3/T4 levels, low TSH S/S of hyperthyroidism - ANSWER exophthalmos or eye budging, lid lag, vision changes, light sensitivity, high metabolism, rapid weight loss, insomnia, restlessness, cannot concentrate, tremors and irritability, palpitations, heat intolerance, diaphoresis, diarrhea, amenorrhea type 1 diabetes mellitus patho - ANSWER the inability for one to produce insulin needed to transport glucose into cells. They are insulin dependent. The beta cells in the pancreas are destroyed or not present. No insulin to stimulate production of glucagon, causing glucose levels to rise. What must type 1 diabetes do with their condition? - ANSWER take lifelong insulin type 2 diabetes mellitus - ANSWER caused by the cells of the pancreas becoming resistant ot insulin, and decrease of receptors on the target cells. They lose the ability to respond to cells. Results in decreased insulin production. What must type 2 diabetics do with their condition? - ANSWER take insulin or oral diabetic agents. can have a low sodium diet and exercise regularly to keep stress levels low, keep their blood pressure low and weight gain at a minimum Normal blood sugar range - ANSWER 60-120 Hypoglycemia blood sugar levels - ANSWER lower than 60 Hyperglycemia blood sugar levels - ANSWER above 120 How do we diagnose diabetes? - ANSWER random sampling of blood glucose over 200 mg, fasting blood glucose level of 126, or and Hgba1C over 6.5 Normal A1C level - ANSWER 4-6 Diabetic A1c level - ANSWER above 6.5 Where should any diabetic aim their A1C level to be at? - ANSWER less than 7 S/S of hyperglycemia - ANSWER Dry mouth, increased thirst, blurry vision, weakness, headache, frequent urination "sugar high" S/S of hypoglycemia - ANSWER cold, pale, sweating, sleepy, lack of coordination, irritability, hunger Which takes priority: hyperglycemia or hypoglycemia? - ANSWER hypoglycemia What do we need to do to treat hypoglycemia? - ANSWER by giving 15g of carbs or D50 over time and rechecking the sugar every 15 minutes What are the 3 P's of diabetes? - ANSWER polyuria, polydipsia, polyphagia Explain polyuria - ANSWER increased urination Explain polydipsia - ANSWER increased thirst Explain polyphagia - ANSWER increased hunger Primary Brain Injury - ANSWER occurs as a direct result of the initial insult to the brain Examples primary brain injury - ANSWER stroke, concussion, trauma Secondary Brain injury - ANSWER occurs as the response to the initial impact or trauma. Can be progressive damage resulting from the body's response to the initial insult Examples of secondary brain injury - ANSWER brain swelling secondary to stroke or trauma What is intracranial pressure? - ANSWER the volume of the craniums brain tissue, CSF, and blood, overall pressure in the skull and spinal cord What is increased ICP? - ANSWER occurs when there is a rise in pressure from trauma, stroke, swelling, tumor, obstruction, etc. There is often compression occurring from the skull that does not allow the brain to expand, adding to the pressure becoming high Result of increased ICP - ANSWER cutting off of the blood supply, tissue damage, ischemia, hypoxia and eventually necrosis. brain cannot expand Normal ICP range - ANSWER 0-15 mmHg Increased ICP range - ANSWER above 15 mmHg S/S of increased ICP - ANSWER LOC changes, headache, vomiting, drowsiness, impaired speech, low arousal, blurry vision, impaired pupil responsiveness to light reflex, unequal pupil size, fixed and dilated pupils, altered respiratory pattern, lack of movement Explain the Glasgow Coma Scale - ANSWER A scale that measures the degree or level of consciousness (LOC is always number #1 with neurological assessment) What 3 categories is the Glasgow coma scale based on? - ANSWER eye opening, verbal utterances, and motor reactions Mild Range Glascow coma scores - ANSWER Above 12 Moderate Range Glascow coma scores - ANSWER 9-12 Severe Range Glascow coma scores - ANSWER less than 8 What score does it mean a patient is dead on the Glasgow coma scale? - ANSWER 3 or less What is the most powerful predictor of outcome according to the Glasgow coma scale? - ANSWER motor response Explain decorticate posturing - ANSWER abnormal flexion towards the core of the body Explain decerebrate posturing - ANSWER abnormal extension away from the body What is an ischemic stroke? - ANSWER From a sudden blockage of the cerebral artery secondary to a clot or emboli formation. Associated with atherosclerosis and clotting disorders and cardiac conditions that can push the clot to the brain. Most common type of stroke is? - ANSWER ischemic stroke S/S of ischemic stroke - ANSWER contralateral paralysis (Right brain controls left side, left brain controls right side) on one side of the body, facial drooping, ptosis, hemi-sensory loss, contralateral visual blindness, aphasia or speech difficulty What is a hemorrhagic stroke? - ANSWER results from a bleed within the brain. From secondary to severe and chronic hypertension, severe head trauma, aneurysm, weakness or rupture of a vessel, anticoagulant use, or arteriovenous malformation. S/S of hemorrhagic stroke - ANSWER one sided weakness, someone with right sided weakness - has a problem on the left side of the brain, drop on face, headache caused by bleeding, difficult to communicate, high blood pressure, impaired vision, nausea, seizures, unequal pupils, difficult respiration How do we diagnose a stroke (type and location)? - ANSWER Brain CT scan Explain meningitis - ANSWER inflammation of the meninges of the brain Causes of meningitis - ANSWER strep pneumonia, meningococcus, hemophilic influenza or can be viral. it reaches the person through the ears S/S of meningitis - ANSWER headache, fever, stiff neck (patient cannot touch chin to chest without pain), photophobia, purple rash, confusion delirium Explain encephalitis - ANSWER inflammation of the brain with swelling Causes of encephalitis - ANSWER west nile virus, HSV, equine cephalitis S/S of encephalitis - ANSWER fever, headache, malaise, muscle pain, rash, seizure, confusion, stupor, coma How do we diagnose meningitis/ encephalitis? - ANSWER CT, MRI lumbar puncture with pathogens in it- either clear or cloudy straw color Generalized Seizure - ANSWER whole brain surface is affected by the seizure Absence Seizure - ANSWER staring spells that last seconds Myoclonic Seizure - ANSWER single/ several jerks of the body Atonic Seizure - ANSWER loss of muscle tone, can cause falls as people drop during it Tonic Clonic Seizure - ANSWER jerking of many muscles Focal Seizure - ANSWER abnormal brain activity related to one hemisphere Status Epilepticus - ANSWER continuing series of seizures without recovery. Life threatening due to low perfusion and o2 to brain. 1st degree burn - ANSWER Only the epidermis (red, painful, and edema) 2nd degree burn - ANSWER epidermis and part of dermis (blistered) 3rd degree burn - ANSWER Full thickness damage through skin into nerves and muscles. Absence of pain and neuropathy How do we diagnose Seizures? - ANSWER EEG is gold standard. lab work to rule out toxins or malnutrition, MRI, lumbar puncture What should you do during a seizure? - ANSWER maintain an airway, remove clothes that could constrict, lay person on left side, have suction and o2 at bedside, prevent aspiration, protect injury, document start and stop time of seizures, do not put anything in the mouth, dim room and quiet, give time to rest after the seizure as it deprives the brain of oxygen and energy What is cerebral palsy? - ANSWER A permanent impairment affecting automatic postural control and movement as a result of a non-progressive brain disorder What is cerebral palsy caused by? - ANSWER by prenatal infections or mechanical trauma to the head before, during or after birth or exposure to nerve damaging poisons or reduced oxygen supply to the brain Is cerebral palsy reversible? - ANSWER No but ti can be managed with surgery, casts, braces, rehab What causes Parkinson's disease? - ANSWER the loss of dopamine producing neurons over time that are in the brain, dopamine deficiencies associated with motor impairment S/S of Parkinson's disease - ANSWER difficulty initiating and controlling movements, slow movements, tremors that occur at rest, loss of facial expression, shuffling gait, absent arm swing What are spinal injuries caused by? - ANSWER trauma, MVA, fall, GSW, injury resulting in the spinal cord being compressed, transected or bruised. Secondary to bleeding, swelling, ischemia or inflammation Types of spinal cord injuries - ANSWER hyperflexion, hyperextension or compression What is spinal shock? - ANSWER occurs right away and is a loss of reflexes below the injury. The muscles are flaccid and at the end the flaccidity is replaced with spasms What is neurogenic shock? - ANSWER there is peripheral vasodilation resulting in hypotension, bradycardia, and circulatory collapse due to no pressure to move the blood in the body. Can potentially affect the respiratory system. What is autonomic dysreflexia? - ANSWER reflexive response due to sympathetic activation below the injury level such as visceral stimulation, hypertension, headache. Leads to flushing above the level of injury and clammy skin below it. How do we treat spinal cord injuries? - ANSWER do not move head or spine. stabilize with a brace to maximize recovery What happens to co2 and o2 levels during hypoventilation? - ANSWER causes o2 to not be able to get into the lungs and for co2 to be retained and not expelled from the lungs What happens to co2 and o2 levels during hyperventilation? - ANSWER causes too much co2 to be eliminated and too much o2 to be let into the lungs too fast Normal pH - ANSWER 7.35-7.45 Normal CO2 range - ANSWER 35-45 Normal HCO3 - ANSWER 22-26 Acidosis pH - ANSWER less than 7.35 Alkalosis pH - ANSWER greater than 7.45 Acidosis CO2 - ANSWER greater than 45 Alkalosis CO2 - ANSWER less than 35 Acidosis HCO3 - ANSWER less than 22 Alkalosis HCO3 - ANSWER greater than 26 What happens during respiratory acidosis? - ANSWER pH is low and CO2 is high; leads to more CO2 retained and not enough O2 Examples of respiratory acidosis? - ANSWER hypoventilation, opioid overdose, impaired airway, respiratory depression, COPD What happens during respiratory alkalosis? - ANSWER pH is high and CO2 is low; leads to not enough CO2 retained and too much oxygen held on Examples of respiratory alkalosis? - ANSWER hyperventilation, fever, anxiety, sepsis, brain trauma, ventilation What happens during metabolic acidosis? - ANSWER pH is low and HCO3 is low Examples of metabolic acidosis? - ANSWER aspirin toxicity, excessive alcohol use, lactic acid buildup. DKA, starvation, persistent diarrhea, kidney failure What happens during metabolic alkalosis? - ANSWER pH is high and HCO3 is high Examples of metabolic alkalosis? - ANSWER excessive vomiting or NG suctioning What is asthma? - ANSWER chronic inflammatory disorder of the airways from stimuli What is extrinsic asthma? - ANSWER caused by external factor such as pet dander, pollen dust from an IgE response What is intrinsic asthma? - ANSWER from internal factors such as inflammation, upper respiratory infections, air pollution, emotional stress, smoke What is exercised induced asthma? - ANSWER occurs 10-15 minutes after the end of exercise as a compensatory mechanism to warm airways What are s/s of ALL asthma types? - ANSWER wheezing, tight chest, dyspnea, cough, increased sputum production, hyper inflated chest, decreased breath sounds Which organism causes TB? - ANSWER mycobacterium tuberculosis How does TB enter the body? - ANSWER inhalation of small droplets containing the bacteria that are expelled with cough, sneeze or talking. It enters into the lungs and the macrophages ingest the microorganism. Seen on the chest x ray as chon complexes for the small clusters How is TB classified? - ANSWER primary is asymptomatic but when reactivated can impair the immune system S/S TB - ANSWER low grade fever, chronic cough with bloody sputum, night sweats, fatigue, weight loss How do we diagnose TB? - ANSWER sputum culture, PPD test but does not work when one is exposed, CXR How do we prevent the spread of TB? - ANSWER wear N95 mask, place patient in negative pressure room What is COPD? - ANSWER result of both chronic bronchitis and emphysema that causes irreversible decrease for the lungs to force air out, lower lung elasticity and move air out What can COPD result in? - ANSWER hypoventilation, co2 retention, decrease in pH, hypoxemia. Causes of COPD - ANSWER smoking or air pollution S/S of COPD - ANSWER SOB, will be thin due to increased respiratory effect, increased calorie use, working hard to breathe, use of accessory muscles in a tripod position, pursed lip breathing, cough, clubbing of fingers, barrel chest. Will need o2 What is cystic fibrosis? - ANSWER Excess mucus in the lungs, digestive track and liver What causes cystic fibrosis? - ANSWER genetics s/s of cystic fibrosis - ANSWER cough, thick sputum that is overproduced, recurrent infections and bronchitis, dyspnea, tachycardia, sternal retractions, unequal breath sounds, crackles and rhonchi, barrel chest, clubbing, fatty stools What is pneumonia? - ANSWER inflammation of the lungs from an infection Etiology of Pneumonia - ANSWER The organism enters the lung, multiplies and triggers pulmonary inflammation that invade alveolar sacs that fill with fluid that is hard to cough up. Causes of pneumonia - ANSWER aspiration, inhaled contaminants from the mouth, virus, hospital or community acquired infections. Who is most at risk for getting pneumonia? - ANSWER elderly, intubated patients, ill patients, hypoxic patients, immunocompromised patients. s/s of pneumonia - ANSWER crackles and bronchi breath sounds over affected tissue, chills, fever, cough with white or cloudy sputum. What is ARDS? - ANSWER damage to the alveolar capillary membrane that causes wide spread pulmonary edema and severe shortness of breath. Associated with decline in o2 that does not respond to supplementary o2. the client becomes hypercapnia and acidotic. Etiology of ARDS - ANSWER atelectasis and decrease in lung compliance and surfactant, fibrosis, pulmonary edema, disruptions in o2 transport, hypoxemia. Lungs fill with fluid- dyspnea, o2 will drop, frothy sputum, hypoximea, co2 is trapped low Ph Causes of ARDS - ANSWER severe trauma, sepsis, aspiration, fat emboli, shock. S/S of ARDs - ANSWER Dyspnea, labored and shallow respirations productive cough with frothy sputum, crackles or rales, hypoxia, cyanosis, fever, hypotension, tachycardia, restlessness, confusion, lethargy and anxiety. What is a tension pneumothorax? - ANSWER Accumulation of air in the pleural space usually from trauma that creates an open sucking chest wall where air enters during inspiration but does not escape during expiration. Creates low venous return and cardiac output. S/S of pneumothorax - ANSWER tachycardia, hypotension, tracheal shift with deviated trachea, neck vein distension, subcutaneous emphysema How do we treat tension pneumothorax? - ANSWER depends on severity of the problem and cause of leak. Must remove air to restore pressure. Chest tube with h2o seal that draws air out of the lung without leaks. What is Virchow's triad? - ANSWER conditions that promote thrombus formation. 3 parts of Virchow's triad - ANSWER Endothelial injury, sluggish blood flow, and increased coagulopathy How does virchows triad increase a patients risk for a PE? - ANSWER additional platelets and inflammatory mediators come to the site, stagnant blood low allow platelets and clotting factors to form and adhere to the vessel and increased coagulopathy states promotion of the clot that can be dislodged and sent to the lungs from a peripheral site. What is a thrombus? - ANSWER blood clot that is stasis and has platelets, fibrin and dead cells What is a pulmonary embolism? - ANSWER blood clot in the lungs What is an emboli? - ANSWER Intravascular mass that travels and occludes downstream vessels What is a DVT? - ANSWER Blood clot in an extremity (usually in calf) in the vein What is an arterial thrombus? - ANSWER blockage of an artery What is a venous thrombus? - ANSWER blockage of vein causes of anemia - ANSWER reduced number of red blood cells from the result of blood loss, bone marrow failure, renal failure, nutritional deficiencies, and abnormal hemoglobin hemorrhagic anemia - ANSWER caused by blood loss aplastic anemia - ANSWER failure of blood cell production in the bone marrow iron deficiency anemia - ANSWER from lack of iron in the diet, resulting in insufficient hemoglobin What is PICA? - ANSWER craving for nonfood substances such a dirt, clay, ice, Landry starch, cardboard or hair Problem with PICA - ANSWER often indigestible, toxic and can cause infection perncious anemia - ANSWER from lack of vitamin b12 sickle cell anemia - ANSWER from a mutated hemoglobin molecule that causes RBCs to be in a spiky or crescent shape. Cells are stiff, rupture easily, do not carry enough o2 and can clog small vessels. crises are painful Thalessemia - ANSWER blood disorder causing reduced hemoglobin on the rbcs. Target shaped cells. S/S: fatigue, weakness, paleness, slow growth. What types of disorders are sickle cell and thalassemia? - ANSWER genetic What are the complications of anemia? - ANSWER renal failure, fatigue, dyspnea, hypoxima, pale, cold, low metabolic activity How do we treat anemia? - ANSWER from the causes! can give o2, blood transfusion if needed What is polycythemia? - ANSWER abnormal excess of RBCs leading to thicken blood that clots easily What is polycythemia vera? - ANSWER bone marrow cancer that causes high RBC count What is a secondary cause of polycythemia? - ANSWER due to low o2 available, affects those at high altitudes How do we treat polycythemia? - ANSWER blood dilution where blood is removed and replaced with saline What is thrombocytopenia? - ANSWER low platelet count due to bone marrow suppression from chemo, decreased production, decreased platelet survival, intravascular dilation of circulating platelets What results from thrombocytopenia? - ANSWER longer bleeding time, petechial, purpura, bleeding gums, hematuria What do we educate clients with thrombocytopenia? - ANSWER no contact sports, physical trauma, use electric razors, soft tooth brush, put pressure on wounds. What is DIC? - ANSWER life threatening condition in which there is widespread coagulation followed by massive bleeding due to depletion of clotting factors, causing one to bleed out DIC causes - ANSWER trauma, malignancy, burns, sepsis, shock and abuptio placente. There is widespread clot formation in small vessels. S/S DIC - ANSWER bleeding from multiple sites of the body, clots, bruising and petechiae, hypotension due to low blood volume, shortness of breath, confusion, LOC changes, fevers. Bleed at some time as clotting How do we treat DIC? - ANSWER removal or correction of the cause, support major organs, give fresh plasma or packed rbcs, platelets, etc, use heparin to minimize further consumption of clotting factors. Monitor aPTT with heparin use! What hormone plays a role in RBC production? - ANSWER erythropoietin Where is erythropoietin produced? - ANSWER kidneys What is a key feature of Hodgkins lymphoma? - ANSWER Has Reed-Sternberg cells that look like owl eyes S/S of Hodgkin's Lymphoma - ANSWER - Enlarged, painless mass, most often in the neck, but may be mediastinal [Growth of the mass is from cytokines and growth factors secreted by malignant cells) - Lymphadenopathy from local symptoms associated with pressure/obstruction What is a key feature of non Hodgkins lymphoma? - ANSWER no reed sternberg cells How are lymphomas diagnosed? - ANSWER often asymptomatic, bone marrow biopsy, blood smear Modifiable risk factors for hypertension - ANSWER diet, sedentary lifestyle, obesity and weight gain, metabolic syndrome, elevated blood sugar levels, type 2 diabetes, elevated cholesterol, alcohol, smoking Non-modifiable risk factors for hypertension - ANSWER family history, genetics, age, ethnicity primary hypertension - ANSWER causes are idiopathic but risk factors increase change of having it. Client will often have no symptoms until damage is done to organs secondary hypertension - ANSWER based from another condition, common in children, from renal disease or coaction of aorta or obstructive sleep apnea or form medications Medications used with Hypertension - ANSWER diuretics to lower blood volume, antihypertensive like beta blockers, ACE inhibitors, A2RB, calcium channel blocker What are the complications of uncontrolled hypertension? - ANSWER heart disease, kidney disease, PVD, stroke, heart failure, blindness, hemorrhage RAAS system steps - ANSWER Renin from kidney is released and it triggers Angiotensin 1 that constricts the blood vessels. It is then converted to angiotensin 2 with ACE enzyme. Angiotensin 2 vasoconstricts and increases the BP by increasing peripheral resistance Which organ secretes renin - ANSWER kidney What happens with aldosterone and ADH during RAAS system - ANSWER aldosterone is retained so salt is retained and water will follow as well so ADH will be retained Purpose of RAAS system - ANSWER increased the blood pressure and blood volume by hormones and constriction of the vessels What is coronary artery disease? - ANSWER Narrowing of the small blood vessels that supply blood and oxygen to the heart. from plaque build up What causes coronary artery disease? - ANSWER Caused by plaque buildup in the arteries that impedes blood flow. Can also be damage from bacteria or viruses or an inflammatory response. S/S of coronary artery disease - ANSWER chest pain, SOB, dysrhythmias, heart attack, heart failure or death What does coronary artery disease put someone at risk for? - ANSWER hypertension, stroke, and increased BP due to narrowing and blockage What is atherosclerosis? - ANSWER plaque buildup from fatty material and causes the blood vessels to narrow. Usually from cholesterol, lipids, macrophage deposits that will also cause inflammation Initiating factor of atherosclerosis - ANSWER damage to the endothelium inner layer What is stable angina? - ANSWER chest pain that occurs with activity or emotional stress. The pain is predictable and is elicited by the same stimuli. What is unstable angina? - ANSWER chest pain that is unpredictable, increases over time, duration and severity Is stable angina relieved with rest and nitroglycerin? - ANSWER yes Is unstable angina relieved with rest and nitroglycerin? - ANSWER no How do we diagnose acute heart conditions? - ANSWER 12 lead EKG after load - ANSWER the pressure or force needed to eject blood from the heart pre load - ANSWER the amount of blood returning to each ventricle or that enters and fills at rest cardiac output - ANSWER the amount of blood pumped out by each ventricle in 1 minute what happens during heart failure? - ANSWER the heart cannot pump effectively, blood cannot move and can back up. CO is decreased as fluid cannot move Left sided heart failure - ANSWER affects the lungs and can often lead to right sided heart failure. low CO from the left ventricle causing back up into the lungs S/S of left sided heart failure - ANSWER respiratory related! Pulmonary congestion, pulmonary edema, dyspnea, tripoding, gasping, cough with frothy sputum, crackles, hypoxemia, and cyanosis right sided heart failure - ANSWER when the right ventricles do not pump the blood, leading to blood backing up into the body S/S of right sided heart failure - ANSWER peripheral edema, ascites, JVD, confusion, hepatomegaly nd splenomegaly What is shock? - ANSWER imbalance between blood flow and cardiac output. Causes low perfusion S/S of all Shock - ANSWER HYPOTENSION, rapid breathing, cold and clammy skin, rapid but weak pulse, dizziness, fainting or weakness, AMS What is cardiogenic shock? - ANSWER from severe ventricular dysfunction associated with MI. Decreased cardiac output, elevated left ventricular preload, pulmonary edema. What is obstructive shock? - ANSWER from an obstruction that prevents the cardiac filling and stroke volume. From PE, cardiac tamponade or the blood spilling out into the pericardium causing compression, tension pneumothorax or increase of air in the lung cavity that puts pressure on heart What is hypovolemic shock? - ANSWER low blood volume, inadequate circulation of the blood usually from a bleed, burn or 3rdspacing. S/S: high HR, cool pale skin, hypotension, cyanosis, low urine output types of distributive shock - ANSWER neurogenic, anaphylactic, septic What is distributive shock? - ANSWER too many of the blood vessels are dilated, causing peripheral pool of blood. What is anaphylactic shock? - ANSWER from a systemic inflammatory response from mast cells releasing vasodilatory mediators causing hypotension from an allergy S/S of anaphylactic shock - ANSWER hives, itching, bronchoconstriction, angioedema, stridor, wheezing, and hypotension What is neurogenic shock? (heart) - ANSWER widespread vasodilation due to the loss of sympathetic nerve function to activate arterial smooth muscles. From a brain injury, drug overdose or SCI What is septic shock? - ANSWER from a response to bacteria or infection. The inflammation leads to profound vasodilation, activation of the clotting cascade, DIC, hypotension, hypoxia, increased capillary permeability what are complications of shock? - ANSWER DIC, acute renal failure, multiple organ dysfunction syndrome DIC and shock - ANSWER in septic shock, where there is one bleeding but uses up all the clotting factor causing bleeding and ischemia to the tissues. ARF and shock - ANSWER from hypotension causing lower blood flow, low GFR What is multiple organ dysfunction syndrome? - ANSWER when 2 or more organ systems are affected usually in septic shock that respond to antigens and activate inflammatory response leading to destruction of tissues and organ failure what is hemostasis? - ANSWER stoppage of bleeding/ blood clotting stages of hemostasis - ANSWER 1. Vascular spasm 2. Platelet Phase 3. Coagulation Phase 4. clot retraction 5. clot dissolution Explain Vascular spasm - ANSWER immediate response to blood vessel injury resulting in constriction of damaged blood vessel. Happens in about 20-30 mins Explain Platelet plug formation - ANSWER platelets form a plug that temporary seal the break in the wall, they stick to collagen fibers exposed and becomes sticky and swell and release chemicals to attract other platelets to site of injury to form the plug. Explain coagulation phase - ANSWER blood clotting and the rbcs are trapped and turned into a gel with prothrombin to create a fibrin mesh around the hole and blood cells until the blood vessel can have permanent repair. explain clot retraction - ANSWER regression in the size of the blood clot over several days Explain clot dissolution - ANSWER dissolving or breakdown of the clot What medications can affect the hemostasis? - ANSWER heparin and lovenox can increase chance of bleeding What is hemophilia? - ANSWER different hereditary bleeding disorders caused by a deficiency of clotting factors S/S of hemophilia - ANSWER prolonged bleeding with minor injury that can be life threatening, joint damage, bleeding in joint cavities. Hemophillia A - ANSWER factor 8 deficiency Hemophillia B - ANSWER factor 9 deficient Treatment hemophilia A - ANSWER factor 8 concentrate Treatment hemophilia B - ANSWER plasma What type of disorder is hemophilia? - ANSWER genetic normal BP range - ANSWER 120/80 Normal HR range - ANSWER 60-100 bpm Normal respiratory rate - ANSWER 12-20 breaths per minute High BP - ANSWER 140/90 Low BP - ANSWER 90/60 bradypnea - ANSWER less than 12 breaths per minute Tachypnea - ANSWER more than 20 breaths per minute Tachycardia - ANSWER heart rate above 100 bpm Bradycardia - ANSWER heart rate less than 60 bpm Normal temperature - ANSWER 98.6 fever temperature - ANSWER 100.4 What is a sign? - ANSWER something you can observe examples of signs - ANSWER Bleeding, fever, swelling, rash What is a symptom? - ANSWER subjective sensation that the person feels from the disorder examples of symptoms - ANSWER pain, dizziness, itching, nausea What is anaplasia? - ANSWER Loss of cell differentiation and tissue organization. in malignant tumors What is metastasis? - ANSWER cancer cells leaving a tumor and invading other parts of the body