NUR 2063 / NUR2063: Essentials of Pathophysiology

What are the three stages of AKI presentation? - Prodromal - Oliguric - post-oliguric Causes of chronic kidney disease - Outcome of progressive and irrevocable loss of functional nephrons. - Due to kidney not recovering • Can lead up to end-stage renal disease (ESRD) which requires dialysis Risk Factors of chronic kidney disease - Diabetes - Hypertension - Recurrent pyelonephritis - Polycystic kidney disease - History of exposure to toxins - Age over 65 - Ethnicity (African American male higher risk) complications of chronic kidney disease - hypertension and cardiovascular disease - uremic syndrome - metabolic acidosis - electrolyte imbalances - bone and mineral disorders - malnutrition - anemia - pain - depression Hypertension and cardiovascular disease - (increased blood volume) Hypervolemia, escalated atherosclerotic process Uremic Syndrome - Can't get rid of normal metabolic waste Retention of metabolic wastes, impaired healing, pruritusm dermatitis, and uremic frost (itching & discomfort) Metabolic acidosis - Retention of acidic waste products, hyperkalemia Electrolyte Imbalances - Retained potassium (hyperkalemia), phosphorus, and magnesium Bone and mineral disorders Elevated phosphorus and PTH causes altered bone/mineral metabolism. Kidneys are unable to reabsorb calcium (body steals calcium from parts of the body) Malnutrition - Decreased intake, depression, and dietary limitations (Decreased salt, protein and potassium) Anemia - Lack of erythropoietin (produces new RBC), uremia shortens RBCs life Pain - Many reasons; disease itself, treatment, comorbidities Depression - Comorbid conditions; disease itself; disruption of social interactions and relationships Urge Incontinence - Sudden need to void with an involuntary leakage of urine If it happens at night (nocturia) it is called overactive bladder Stress Incontinence - Small amounts of urine are voided involuntarily when there is an increase in intraabdominal pressure. (More common in women following childbirth; Can occur with coughing, sneezing and lifting heavy objects) Neurogenic bladder From a disruption of nervous communication that controls micturition. Seen in individuals with stroke, Parkinson's, MS, and spinal cord injuries. Functional Incontinence - Secondary to physical or environmental limitations such as not getting to the toilet in time. Mixed Incontinence - A combination of both stress and urge incontinence More common in elderly women Overflow Incontinence - When the bladder becomes full and overflows (Due to something physically blocking; NOT from holding urine) Cystitis (UTI) - Inflammation of the bladder lining due to E. coli from infections, chemical irritants or stones. General S/S of Cystitis (UTI) - frequency, urgency, dysuria, suprapubic pain, and cloudy urine S/S of Cystitis (UTI) in Children - fever, irritability, poor feeding, vomiting, and diarrhea. S/S of Cystitis (UTI) in older adults - delirium and new onset incontince. . Patient teachings to prevent cystitis - Urinate before and after sexual intercourse - Wipe front to back - Take antibiotics as prescribed - Increase fluid intake - Do not resist urge to urinate What can happen if cystitis does not resolve? - It can lead up to kidney infections. . Benign Prostatic Hyperplasia (BPH) - Enlargement of prostate gland S/S of Benign Prostatic Hyperplasia (BPH) - Decreased stream, Hesitancy (difficulty initiating stream), and infection caused by retention. Hydrocele - Fluid collection progressively surrounding the testicle or spermatic cord causing swelling by evening. Testicular Torsion (Primarily in prepubertal males) - Twisting of the spermatic cord with compromised vascular supply and ischemia, followed by infarction. - Can cut off blood supply & lead up to necrosis and ischemia Endometriosis - Endometrial tissue outside the lining of the uterine cavity, abnormal tissue implant (endometrioma) S/S of Endometriosis - Dysmenorrhea (painful menses), pain w/ intercourse, pain w/ defecation, & pain begins 5 to 7 days before menses and lasts for 2 to 3 days. Uterine Prolapse - Prolapse (sinking) of the uterus from its normal position into the vagina S/S of Uterine Prolapse - Depends on the severity of prolapse, discomfort in walking/sitting, difficulty urinating, vaginal discomfort, and bleeding. S/S of Pelvic Inflammatory Disease (PID) - Abdominal tenderness, pelvic pain, purulent (thick and mucus) vaginal discharge and fever. which organisms/viruses contribute to pelvic inflammatory disease (PID)? - Neisseria gonorrhoeae and chlamydia trachomatis which organisms/viruses contribute to cervical cancer? - Human Papillomavirus (HPV) which organisms/viruses contribute to UTIs? - E. coli which organisms/viruses contribute to syphilis? - Treponema pallidum which organisms/viruses contribute to herpes? - HSV-2 Incubation phase (syphilis) - 10 to 90 days Primary phase (syphilis) begins with formation of chancre - Painless, ulcerative lesion at original portal of entry - Female- may go unnoticed - Men- chancre on genitalia - Resolves spontaneously within 3 to 6 weeks Secondary Stage(syphilis) - Low-grade fever, sore throat, & mucosal or cutaneous rash Latent phase(syphilis) - No symptoms present, contagious, can last 40 years, & two thirds remain asymptomatic . Late phase(syphilis) - Final, destructive phase of disease; cardiovascular and CNS at risk for damage, blindness and paresis. What organ systems is most affected by syphilis? - vascular system What are the five stages of syphilis? - Incubation, primary, secondary, latency and Late Pregnancy Induced Hypertension (PIH) - 0.5% To 8% pregnancies - Rapid rise in arterial blood pressure associated with the loss of large amounts of protein in the urine (proteinuria) - Pre-eclampsia- HBP during pregnancy . S/S of Pregnancy Induced Hypertension (PIH) - Edema, renal failure, liver malfunction, extreme hypertension, arterial spasm in kidneys, brain, and liver, and decreased renal flow and GFR. Hyperemesis Gravidarum - Excessive vomiting during pregnancy - 0.3% to 2% pregnancies . S/S of Hyperemesis Gravidarum - Severe vomiting, electrolyte imbalances (loss of potassium) and hepatic/renal damage which can lead up to death if not corrected. What is the concern with chlamydial infection during labor/delivery? - The mother can infect the infant during labor/delivery. Dwarfism - decreased GH secretion that results in a short stature and delayed puberty; cells are not effective - May be due to congenital, tumors, radiation or trauma to head. S/S of dwarfism - Growth below third percentile, irregular setting of permanent teeth, thin hair, poor nail growth, delayed puberty, and decreased muscle mass. Gigantism - Occurs in childhood before the skeletal epiphyses closes (before bones fuse: length growth). - May grow to 8ft if left untreated Acromegaly - Occurs in adults after skeletal epiphyses close (after bone fuses; width growth) - Only portions of the body are affected. Diabetes Insipidus Due to decrease or lack of ADH production - Low ADH, Low water in body - HIGH UO, Polyuria - High sodium (hyponatremia) - High H&H and serum osmolality (increased concentration of solutes in blood) from dehydration S/S of Diabetes Insipidus - Dizziness, disorientation, nausea, rapid heart rate (due to hypovolemia), and headaches Risk of Diabetes Insipidus - Hypovolemic shock Syndrome of Inappropriate Antidiuretic Hormone Secretion (SIADH) Body produces too much ADH - High ADH, water intoxication - LOW UO, oliguria - Low sodium (dilutional) S/S of Syndrome of Inappropriate Antidiuretic Hormone Secretion (SIADH) - edema, weight gain, and hyponatremia (can lead up to cerebral edema due to the cells swelling from hyponatremia) What is Antidiuretic Hormone (ADH)? - Also known as somatostatin; regulates water balance in body and keeps water in body (water retention). What is What is Antidiuretic Hormone (ADH) also known as? - Somatostatin What electrolyte is most affected by disorders of ADH production? - Sodium Review the differences between hypothyroidism and hyperthyroidism. - The difference between Hyperthyroidism and Hypothyroidism is that hypothyroidism is due to an autoimmune issue while hyperthyroidism is due to autoantibodies binding and stimulating TSH receptors. Hyperthyroidism Abnormally elevated calcium levels in blood due to excess PTH. - Most commonly caused by graves' disease (autoantibodies bind and stimulate TSH receptors). - Thyromegaly (enlargement of thyroid), exophthalmos (bulging of eyes), lid lag, vision changes, and photophobia. Thyromegaly - enlargement of thyroid exophthalmos - bulging of eyes S/S of Hyperthyroidism Insomnia, restlessness, tremor, palpitations, heat intolerance, diaphoresis, diarrhea, and amenorrhea (scant menses). . Hypothyroidism - most commonly caused by autoimmune thyroiditis - Iodine deficiency (needed for T3/T4 formation) S/S of Hypothyroidism - Lethargy, cold intolerance, bradycardia, weight gain, dry skin, constipation, difficulties with concentration/memory, loss of hair, and menstrual irregularities. What labs can be drawn to determine if an individual is suffering from a thyroid disorder? - T3, T4, and TSH hormone What is parathyroid hormone (PTH)? - Increases calcium levels in blood Which electrolyte is primarily affected by PTH disorders? - Calcium What's another name for Cushing's syndrome? - hypercortisolism Cushing's syndrome (hypercortisolism) - caused by excessive glucocorticoids and a pituitary tumor or tumor of the adrenal cortex S/S of Cushing's syndrome - Hyperglycemia, loss of muscle and bone, excess water and salt retention, weight gain, hypertension, edema, swollen moon face (rounding of face) and redistribution of fat to the abdomen and the posterior neck (buffalo hump) What is another name for Addison's disease? - adrenocortical insufficiency . Addison's disease (adrenocortical insufficiency) - due to not enough steroid being produced; adrenocortical insufficiency, decreased glucocorticoid levels (usually decreases cortisol); due to autoimmune condition or removal of adrenal glands; sudden withdrawal from corticosteroid therapy S/S of Addison's disease (adrenocortical insufficiency) - Weight loss, weakness, hyperpigmentation (bronzing) of skin, hypoglycemia, and hyperkalemia. Type I diabetes mellitus - Diagnosed in young children/adolescents - Autoimmune disorder- beta cells in pancreas destroyed - Unable to produce insulin Type II diabetes mellitus Most common form of DM - Cells become resistant to insulin, decrease insulin receptors on target cells (unable to bind to target cells.) - Overtime insulin production by pancreas decreases signs and symptoms of hypoglycemia - Dizziness, Sweating, Hunger, Irritability or moodiness, Anxiety or nervousness, and Headache Hyperglycemia - High levels of sugar/glucose in blood; hot & dry sugar high Hyperglycemia S/S - Dry mouth, increased thirst, blurred vision, frequent urination, weakness, and headache Hypoglycemia - Low levels of sugar/glucose in blood; cold & clammy=candy Hypoglycemia S/S - Sleepiness, sweating, pallor, irritability, and hunger signs and symptoms of hyperglycemia - hypertension, cardiovascular disease, stroke, retinopathy (loss of vision), diabetic neuropathy (losing sensation in nerves), and nephropathy (kidney damage) What are the three Ps? - Polyuria - increased urination - Polydipsia - increased thirst - Polyphagia - increased hunger Polyuria - increased urination . Polydipsia - increased thirst . Polyphagia