NR 283 PATHOPHYSIOLOGY EXAM 2 STUDY GUIDE (Newest 2023/2024) Verified Content

NR 283 PATHOPHYSIOLOGY EXAM 2 STUDY GUIDE (Newest 2023/2024) Verified Content NR 283 PATHOPHYSIOLOGY EXAM 2 STUDY GUIDE Chapter 8: Skin Disorders 1. Viral infections a. Take antiviral to reduce viral shedding (can’t proliferate) 2. Autoimmune skin disorders a. Shingles b. Pemphigus  blisters i. 2 forms = vulgaris & foliaceus ii. Antibodies disrupt the cohesion between the epidermal cells causing blisters to form iii. Treatment = systemic glucocorticoids such as prednisone & other immunosuppressants 3. Psoriasis a. A chronic inflammatory skin disorder caused by abnormal T cell activation b. Cells are shedding epithelium a lot faster than they should (increased mitosis) = flakiness c. lesions found on face, scalp, elbows & knees d. Treatment = glucocorticoids, tar preparations & antimetabolites 4. HSV I and HSV II (Herpes Simplex Virus I & II) a. Type I = cold sores & fever blister b. Type II = genital c. Spread by direct contact 5. HPV (Human Papilloma Virus) a. Types 1-4 = plantar warts b. Types 6 & 11 = genital warts c. Predisposing factor: Cancer  Cervical 6. Fungal infections (mycoses) a. Most are superficial b. Diagnosed by skin scrapings c. Treatment = topical antifungal d. Athletes foot = Tinea pedis & Tinea capitis = cradle cap 7. Scabies a. Invasion by mite bite (female burrows, male fertilizes the female & dies, female lays eggs & dies, repeat) b. highly communicable in any setting and does not respect social status i. put patient in a private room ii. nurse should wear gloves & gown c. Itchy; Burrows appear on the skin as tiny, brown lines d. Common sites = between the fingers, wrists, inner surface of elbow & waistline e. Treatment = lindane (gamma-hexachlorocyclohexane) 8. Contact dermatitis a. Exposure to an allergen = Pruritic rash (wool, itchy) b. No immune response c. Treatment = topical glucocorticoid 9. Atopic dermatitis (eczema) a. A common problem in infancy & may persist in adulthood b. A familial type I hypersensitivity often associated with hay fever & asthma c. Atopic = refers to an inherited tendency toward allergic conditions d. Etiology = chronic inflammation results from the response to allergens; eosinophilia (high level of WBCs in the blood) & increased serum IgE levels indicate the allergic basis e. S&S = pruritic lesions, skin appears dry & scaly f. Treatment = avoid aggravating agents & topical glucocorticoids 10. Hansen’s disease (Leprosy) a. Myobacterium leprae b. Infects the skin, mucous membrane & peripheral nerves c. Determined by a skin biopsy d. Treatment = antibiotics 11. Impetigo a. Very contagious b. Common in infants and children c. Cause by S. aureus (antibiotic resistant strains are increasing) d. Transmitted by close physical contact or fomites e. Pruritis is common which leads to scratching & further spread of infection f. Lesions usually on face g. Treatment = topical antibiotic for early stages & systematic administration for extensive lesions 12. Scleroderma a. Tight, thin, shiny, hard, immovable skin b. increased collagen deposit in arterioles & capillaries reduces blood flow c. Can be systemic d. Raynaud disease  cold finger tips e. Treatment = anti-inflammatory drugs such as NSAIDs or corticosteroids & immunosuppressant therapies 13. Kaposi Sarcoma a. Usually in patients with HIV/AIDS (immunocompromised) b. May affect the viscera as well as the skin c. Etiology = Herpesvirus 8 (KSHV); malignant cells arise from the endothelium in small blood vessels d. S&S = Multiple skin lesions (large, irregular shaped, may be darker in color aka purple/brownish) often on the face, scalp, oral mucosa, or lower extremities e. Treatment = combination of radiation, chemotherapy, surgery & biologic therapy f. Put patient in protective isolation (protect them from our germs) 14. Malignant Melanoma a. Melanocytes effected; usually detected late = a bad prognosis b. Itchy, grows rapidly, metastasizes, irregular borders c. Development depends on genetics, exposure to UV radiation (sunbathing), hormones, & immunosuppressed d. Treatment = surgery, radiation & chemotherapy 15. Basal Cell Carcinoma a. Pearly white borders 16. Cancer a. Radiation = shrinks’ tissue b. Chemotherapy = eradicates cells c. Complete Blood Count (CBC) d. Monitor white blood count 17. Pediculosis = lice Chapter 13: Respiratory Disorders 1. Primary control centers for breathing are located in the medulla and pons 2. Pulmonary Volumes a. Tidal Volume (TV) = amount of air entering lungs with each normal breath (500mL) b. Residual Volume (RV) = amount of air remaining in the lungs after forced expiration (1200mL) c. Inspiratory Reserve (IRV) = maximal amount of air that can be inhaled in excess of normal quiet inspiration (3000mL) d. Expiratory Reserve (ERV) = maximal volume of air expired following a passive expiration (1100mL) e. Vital Capacity (VC) = maximal amount of air expired following a maximal inspiration (4600mL) i. Incentive spirometer used to measure this f. Total Lung Capacity (TLC) = total volume of air in the lungs after maximal inspiration (5800mL) 3. Dyspnea = a subjective feeling of discomfort that occurs when a person feels unable to inhale enough air 4. Cyanosis = the bluish coloring of the skin and mucus membranes that results from large amounts of unoxygenated hemoglobin in the blood 5. Gas exchange a. Oxygen diffuses into the blood through the alveoli b. Flow of gases between the alveolar air & blood c. Depends on the3 relative concentrations (partial pressures) of the gases (PO2 & PCO2) d. Dalton’s law = each gas moves along its partial pressure gradient, independent of other gases 6. Oxyhemoglobin Dissociation Curve a. Relationship between percentage saturation of hemoglobin & PO2 7. Arterial blood gas levels a. Know the values: i. Oxygen = ii. Carbone dioxide = normal is 35-45 iii. Bicarbonate = normal is 24 iv. Serum pH = acidosis is less than 7.35, normal is 7.36-7.44, & alkalosis is greater than 7.45 b. Hypoxemia = inadequate oxygen in blood; decrease from ~105 to 60 mm Hg; chemoreceptors respond c. Hypoxia = inadequate supply of oxygen to the cells d. Hypercapnia = increased carbon dioxide in the blood; CO2 easily diffuses into Cerebrospinal fluid (CSF); causes respiratory acidosis e. Hypocapnia = low carbon dioxide concentration (low partial pressure of CO2) in blood; may be caused by hyperventilation; causes respiratory alkalosis 8. Boyle’s law: “As the size of the thoracic cavity decreases, the pressure inside the cavity decreases” 9. Respiratory mucosa (where is it located) a. Consists of pseudostratified ciliated columnar epithelial cells, which includes mucous-secreting goblet cells. Mucous blanket traps & cilia sweeps foreign particles out of the respiratory tract  Starts in nares and ends in the alveoli  Respiratory mucosa is CONTINUOUS 10. Chemoreceptors a. Central = medulla b. Peripheral = carotid bodies c. Purpose = detects changes in carbon dioxide, hydrogen ion, and oxygen levels in the blood or cerebrospinal fluid (CSF) 11. Characteristics of sputum and what variations represent a. General manifestation of respiratory disease b. Yellow/greenish, cloudy, thick mucus = usually bacterial infection c. Rusty/dark colored = usually pneumococcal pneumonia d. Large amounts of purulent with foul odor = may be associated with bronchiectasis e. Thick, tenacious, mucus = asthma or cystic fibrosis i. blood-tinged sputum—may result from chronic cough; may also be sign of tumor or tuberculosis f. Hemoptysis = Blood-tinged (bright red) frothy sputum, usually associated with pulmonary edema 12. Laryngotracheobronchitis a. Common in children (3 months - 3 years) b. Gradual onset; inflammation of larynx & trachea; can obstruct the airway c. CROUP  what causes it? = parainfluenza viruses & adenoviruses 13. Tuberculosis a. Protect ourselves from these patients (airborne = need to wear masks) b. Caused by mycobacterium tuberculosis c. Spread by oral droplets (can stay live for about 3 weeks when dried) d. Common in crowded living conditions (poor) & the immunocompromised e. It is not limited to the lungs f. S&S = weight loss, failure to thrive, infection (measles), cavitation in the lungs, cough, positive sputum, radiograph, skin test g. Treatment = a combination of drugs for 6-12 months h. Types i. Primary infection = when microorganism first infects lungs; engulfed by macrophages – local infection ii. Secondary = active infection; often years after primary infection; brought back because of cell-mediated immunity is impaired (stress, age, infection) iii. Miliary/Extrapulmonary = more common in kids; rapidly progressive form 14. Cystic Fibrosis a. Inherited genetic disorder located on chromosome 7 b. Tenacious mucus; affects lungs & pancreas c. Mucus blocks airflow in bronchioles & small bronchi d. Infections (Pseudo. Aureus & Staph. Aureus) 15. Atelectasis = the non-aeration or collapse of a lung or part of a lung leading to a decreased gas exchange & hypoxia a. A collapsed lung; marked by airway obstruction (also may be a cause) b. Sound of lung is decreased on that side & the chest doesn’t rise on that side c. S&S = small areas are asymptomatic; large areas cause dyspnea, increased heart & respiratory rates, & chest pain d. Treatment = treat the cause & re-expand the collapsed lung; deep breathing exercises, changing body positions, forced coughing; removal of fluid, tissue or tumor; chest clapping or percussion, postural drainage, & medications to open airways & loosen mucus 16. Pneumothorax a. Patients with cancer (branchiogenic carcinoma) b. Happens because of tumor, blood in lungs, pleural effusion i. Eats through lungs = air can get through ii. Air in lungs c. Hemothorax = blood in thoracic space 17. Pleural Effusion = the presence of excessive fluid in the pleural cavity Chapter 10: Blood Disorders 1. Vitamin K = purpose of it in the liver is because it is a clotting factor a. Platelets and prothrombin help with clotting in blood 2. ABO  Know blood types – based on antigens in the plasma & membrane of the erythrocytes o O = no rbc antigen, anti-A & anti-B antibodies in plasma, can only receive O o A = A rbc antigen, anti-B antibodies in plasma, can receive A or O o B = B rbc antigen, anti-A antibodies in plasma, can receive B or O o AB = A & B antigen, no antibodies in plasma, can receive A, B, O, or AB  What antibodies are present (A=A, B=B, O=NONE)  Rh (+ or -) o + = antigen D in plasma membrane o - = absence of antigen D  O- = universal donor  AB = universal recipient 3. Hyperchromic Erythrocytes = RBCs that lack color a. indicative of iron deficiency anemia 4. Anemias = reduce oxygen transport in blood due to a decrease in hemoglobin content a. Iron deficiency anemia i. Insufficient iron impairs hemoglobin synthesis = reducing the amount of oxygen transported in blood ii. Microcytic (small), hypochromic (pale) RBCs = not carrying the oxygen they need iii. Hemoglobin levels are low (hypochromic); decreased production iv. Frequently a sign of an underlying problem (cancer) v. Etiology = decreased dietary intake, malabsorption, chronic blood loss, severe liver disease vi. S&S = pallor of skin, fatigue, lethargy, irritability, tachycardia, delayed healing, menstrual irregularities vii. Treatment = give iron to take with orange juice because vitamin C absorbs iron (must use a straw to avoid discoloration of teeth) b. Sickle cell anemia i. Abnormal hemoglobin (HbS) = unstable & changes shape in hypoxemia; RBC elongates & hardens in a sickle shape when oxygen levels are low – have a short life span ii. Occurs whenever oxygen levels are lowered iii. Cells are too large to pass & obstruction leads to multiple infarctions & areas of necrosis iv. Etiology = recessive inheritance; appears at 12 months  Cause = autosomal recessive (genetic disorder)  Occurs in homozygous recessive  Common in African Americans & Middle East  S&S = pallor, weakness, tachycardia, dyspnea, hyperbilirubinemia, splenomegaly, growth & development are delayed  Additional effect = painful crisis with multiple infarctions; organ failure c. Pernicious Anemia = vitamin B12 deficiency i. Lack of absorption because of lack of intrinsic factor (owing to immune reaction) ii. RBCs = megaloblasts (immature nucleated cells); short life span iii. Very large, immature, nucleated erythrocytes iv. Vitamin B12 is needed for the function & maintenance of neurons v. Tongue is typically enlarged, red, sore, & shiny (big & beefy) vi. Etiology = deficit of intrinsic factor owing to immune reaction vii. Gastric bypass patients viii. Additional effects = neurologic damage & achlorhydria d. Aplastic Anemia = impairment or failure of bone marrow i. RBCs = often normal cells; pancytopenia ii. May be temporary or permanent iii. Often idiopathic iv. Blood counts indicate pancytopenia (all/whole; decrease) v. Identification of cause & prompt treatment needed for bone marrow recovery  Etiology = bone marrow damage or failure  Additional Effects = excessive bleeding & multiple infections  Cancer of the blood; HIV are prone 5. Leukemias = group of neoplastic disorders involving WBC (uncontrolled production in bone or lymph nodes) a. WBCs & RBCs are low; depresses the immune system = prone to infections so put patients in isolation rooms & limit visitors; wear gowns, gloves & masks to protect them from you; no fresh fruits or flowers b. Acute leukemias i. High proportion of immature nonfunctional cells in bone marrow & peripheral circulation ii. Onset is usually abrupt; complications; usually in children & young adults iii. Acute lymphocytic leukemia (ALL) = B-lymphocytes & young children 1. Multiple opportunistic infections occur because cells are immature & have weakened function 2. The most common childhood cancer 3. Cause = unknown; association with chromosomal abnormalities (translocation) iv. Acute myelogenous (or myelocytic) leukemia (AML) = granulocytic stem cells & adults 1. Cause = exposure to radiation, chemicals, & certain viruses v. Acute monocytic leukemia = monocytes & adults c. Chronic leukemias i. Higher proportion of mature cells ii. Insidious onset with mild signs & better prognosis; common in older adults iii. Chronic lymphocytic leukemia (CLL) = B-lymphocytes & adults greater than 50 years iv. Chronic myelogenous leukemia (CML) = granulocyte stem cells & adults 30-50  Predisposing factors 6. Polycythemia a. Primary = Vera i. Increased production of erythrocytes & other cells in the bone marrow = thick blood = hard to get through arteries & vessels ii. Cells have hypertrophy because of increased work iii. Blood volume is increased (hematocrit increased) iv. Causes increase in BP v. Phlebotomy done to remove 500 cc blood & 500 cc of IV to dilute blood vi. Neoplastic disorder b. Secondary = erythrocytosis i. Increase in RBCs in response to prolonged hypoxia ii. Increased erythropoietin secretion iii. Compensation mechanism to provide increased oxygen transport 7. Warning signs of excessive bleeding & possible blood-clotting disorders a. Persistent bleeding from gums & nosebleeds b. Petechiae = pinpoint flat red spots on skin or mucous membranes (like a rash) c. Frequent purpura & ecchymoses (large, purplish red or greenish bruises) d. Hematemesis = bleeding into a joint (swollen, red & painful) e. Hemoptysis = bright red flecks in sputum (coughing up blood) f. Hematemesis = vomiting blood (often brown like coffee grinds; may be red) g. Blood in feces h. Feeling faint & anxious, low BP, rapid pulse 8. Hemophilia A (classic hemophilia) = a deficit or abnormality of clotting factor VIII a. Most common inherited clotting disorder; X-linked recessive trait b. S&S = prolonged or severe hemorrhage after minor trauma, persistent oozing of blood after minor injuries, hematomas is common, hemarthrosis (spontaneous bleeding into joints), hematuria (blood in urine or feces) may occur c. Precautions = avoid ASA or ASA-containing drugs, be prepared with supplies in case of emergency, lab tests to check for current blood-clotting status; avoid contact sports & sharp objects, use electric razors & avoid enemas d. Treatment = desmopressin (DDAVP), replacement therapy 9. Disseminated Intravascular Coagulation (DIC) = excessive bleeding & clotting at the same time a. An often-life-threatening condition that involves both excessive bleeding & excessive clotting b. Consumption of clotting factors and fibrinolysis leads to hemorrhage & eventually hypertension & shock c. Etiology = a variety of disorders can initiate it such as obstetric complications (abruptio placenta = rips off uterine wall), carcinomas & trauma d. S&S = low plasma fibrinogen level, thrombocytopenia occurs, prolonged bleeding (hemorrhage) accompanied with low BP & shock, respiratory impairment, seizures & acute renal failure with oliguria e. Treatment = difficult & depends if hemorrhages or thromboses are dominant; must treat underlying cause successfully; prognosis depends on the severity of the problem Chapter 12: Cardiac Disorders 1. Stroke volume and compensative mechanisms 2. Systolic pressure = the pressure exerted by the blood when ejected from the left ventricle 3. Diastolic pressure = the pressure that is sustained when the ventricles are relaxed 4. Preload = volume of venous return back to the heart; refers to the mechanical state of the heart at the end of diastole with the ventricles at their maximum volume 5. Afterload = volume/pressure of blood that causes the ejection of the blood from the left ventricle; the force required to eject blood from the ventricles & is determined by the PR to the opening of the semilunar valves 6. Peripheral resistance (PR) = the force opposing blood flow, or the amount of friction with the vessel walls encountered by the blood 7. Cardiac output =volume of blood ejected by a ventricle in one minute; depends on SV & HR 8. Stroke Volume = the volume pumped from one ventricle in one contraction; varies with sympathetic stimulation & venous return 9. CO (cardiac output) = SV (stroke volume) ´ HR (heart rate) a. CO is a combination of HR & SV  blood volume pumped per minute (~mL) b. Decrease in output and stroke volume = increase of HR c. If HR increases, CO decreases because SV decreases (doesn’t have enough time to refill same amount of blood) d. BP (blood pressure) = CO (cardiac output) x PR (peripheral resistance) 10. Angina a. Chest pain; occurs when there is a deficit of oxygen to the heart muscle b. Precipitating factors = running upstairs, getting angry, respiratory infection with fever, exposure to weather extremes or pollution, or eating a large meal c. S&S = substernal chest pain described as a tightness or pressure, pallor, diaphoresis (excessive sweating), & nausea d. Treatment = coronary vasodilators such as nitroglycerin e. Stable i. when a certain activity causes chest pain it is stable; usually triggered by physical or emotional stress f. Unstable i. More serious form; refers to prolonged pain at rest & of recent onset; may be the result of a break in atheroma; may precede a MI ii. Random chest pains whether or not activities/exertion are performed 11. Deep Vein Thrombosis (DVT) a. Patients who are post op are at risk – put sequential compression devices on them or anti-embolic stockings (ted stockings) b. Do not massage their legs because it can move the clot c. Thrombophlebitis = refers to the development of a thrombus in a vein in which inflammation is present d. Phlebothrombosis = a thrombus forms spontaneously in a vein without prior inflammation (inflammation may develop secondarily in response to the thrombus) e. Critical problem is that venous thrombosis may lead to pulmonary embolism f. S&S = aching, burning, or tenderness in the affected leg, leg may be warm and red, may cause edema, a positive Homans sign (pain in the calf muscle when the foot is dorsiflexed), systemic signs such as fever, malaise & leukocytosis g. Treatment = compression or elastic stockings, exercise to reduce stasis, anticoagulant therapy, fibrinolytic therapy, & thrombectomy 12. Myocardium Infarction (MI) a. An MI (heart attack) involves the death of myocardial tissue due to ischemia (deficiency of blood); occurs when a coronary artery is totally obstructed, leading to prolonged ischemia & infarction (cell death) of the heart wall b. Pathophysiology  TOTAL OCCULTION c. Warning signs: Chest pain (feeling of pressure, heaviness, or burning especially with increased activity), sudden shortness of breath, sweating, fatigue, weakness, nausea, indigestion, anxiety & fear d. Most common cause: Atherosclerosis involving thrombosis e. S&S = pallor, diaphoresis, dizziness, dyspnea, hypotension & low-grade fever f. Cardiac patient who is suspected of having an MI must check for levels of troponin (protein released when cardiac muscle has been damaged)/CPK which is indicative of cardiac muscle death g. Total blockage occurs  part of myocardium isn’t getting blood  that part of the heart dies  shock occurs 13. Tetralogy of Fallout a. Disease of infant that is born cyanotic; caused by a hole in the heart b. Surgery is usually later on because it may heal on its own c. Most common cyanotic congenital heart condition d. Four defects are = i. Pulmonary valve stenosis = restricts outflow from the right ventricle, leading to right ventricle hypertrophy & high pressure in the right ventricle ii. VSD = iii. Dextroposition of the aorta (to the right over the VSD) = iv. Right ventricle hypertrophy = e. Blood from right atrium to left ventricle; mixing deoxygenated blood with oxygenated blood and sending out f. VSD  blood from left to right  not blue because blood is oxygenated twice 14. Cardiac Dysrhythmias a. Bradycardia = slower than 60/minute; Stroke Volume increased & possibly reduced Cardiac Output b. Tachycardia = fast 100-160/minute; possibly reduced Cardiac Output c. Atrial flutter = 160-350/minute; less filing time & often reduced Cardiac Output d. Fibrillation = over 300/minute; uncoordinated muscle contractions; no filling, no output, cardiac standstill 15. Congestive Heart Failure (CHF)= inability of the heart to pump blood to meet the demand of the body a. Left-sided CHF i. Causes = infarction of left ventricle, aortic valve stenosis, hypertension, hyperthyroidism ii. Basic effects = decreased cardiac output, pulmonary congestion iii. Forward effects = fatigue, weakness, dyspnea, exercise intolerance, cold intolerance iv. Compensations = tachycardia & pallor, secondary polycythemia, daytime oliguria v. Backup effects = orthopnea, cough producing white or pink-tinged phlegm, shortness of breath, paroxysmal nocturnal dyspnea, hemoptysis, rales b. Right-sided CHF i. Causes = infarction of right ventricle, pulmonary valve stenosis, pulmonary disease (cor pulmonale) ii. Basic effects = decreased cardiac output, systemic congestion, & edema of legs & abdomen iii. Forward effects = fatigue, weakness, dyspnea, exercise intolerance, cold intolerance iv. Compensation = tachycardia & pallor, secondary polycythemia, daytime oliguria v. Backup effects = dependent edema in feet, hepatomegaly & splenomegaly, ascites, distended neck veins, headache, flushed face 16. Coronary Artery Disease (CAD) a. Includes angina pectoris and myocardial infarction b. Arteriosclerosis = general term for all types of arterial changes; usually degenerative changes in people over 50 & diabetes; elasticity is lost, walls become thick & hard, lumen narrows & may become obstructed c. Risk factors = i. Nonmodifiable = age, gender, genetic factors, ii. Modifiable = obesity or diets high in cholesterol & animal fat, cigarette smoking, sedentary lifestyle, diabetes mellitus, poorly controlled hypertension, combination of oral contraceptives & smoking, combination of high blood cholesterol & high BP d. Treatment = lose weight, minimize sodium intake, control diabetes & hypertension, stop smoking, exercise, & potentially oral anticoagulant & surgical intervention 17. Lipids a. LDL = bad so you want them to be Low b. What it promotes if untreated: ATHROMA c. HDL = good so you want them to be High