NR507- Advanced Pathophysiology Final Exam/Final Exam - NR507 / NR 507 (Latest 2023 / 2024) : Advanced Pathophysiology - Chamberlain

NR507- Advanced Pathophysiology Final Exam/Final Exam - NR507 / NR 507 (Latest 2023 / 2024) : Advanced Pathophysiology - Chamberlain Acute renal failure Reversible Determining prognosis- kidneys respond to diuretic with good output; this indicates that kidneys are functioning well Acute Pyelonephritis Diagnosing by clinical symptoms alone can be difficult; can be similar to cystitis Diagnosis established by: -Urine culture -Urinalysis (WBC casts indicates pyelonephritis, but may not always be present) -Signs/Symptoms -Complicated pyelonephritis requires blood cultures and urinary tract imaging Renal Calculi (Renal Stones) Goals of Treatment: Manage acute pain Promote passage of stone Reduce size of stone Prevent new stone formation Chronic Renal Failure Chronic Kidney Disease (CKD) is a progressive loss of renal function associated with systemic disease such as hypertension, diabetes mellitus (most significant risk factor), systemic lupus erythematosus or intrinsic kidney disease CKD stage is determined by estimates of GFR and albuminuria Who is a candidate for dialysis? End-stage renal disease (ESRD) is the final stage of CKD with the number one cause being diabetes mellitus combined with hypertension. At this point, the patient is completely dependent on dialysis to survive. CKD is classified into five stages and is based on the patient's GFR rather than symptoms. Patients will need dialysis when the following symptoms are present: --Metabolic acidosis. --Hyperkalemia: Hyperkalemia in the presence of EKG changes (peaked T-waves) is an indication for dialysis. --Hyperkalemia by itself is not an indication for dialysis. --Drug toxicity: Drug toxicity due to the following drugs is an indication for dialysis and include salicylates, Lithium, Isopropanol, Methanol and Ethylene glycol). --Fluid volume overload that is not responsive to diuretics. --Uremic symptoms due to nitrogenous wastes in the blood stream. Stage I CKD There is kidney damage with normal or elevated GFR 90-120 Stage II CKD There is kidney damage with mild decrease in GFR 60-89 Stage III CKD There is a moderate decrease in GFR 30-59 Stage IV CKD There is a severe decrease in GFR 15-29 Stage V CKD Kidney failure- End-stage renal disease <15 (dialysis) Once Stage IV is reached, progression to Stage V is inevitable as well as dialysis or kidney transplant Complications of Decreased GFR Anemia Hypertension Decreased calcium absorption Hyperlipidemia Heart failure Left ventricular hypertrophy Fluid volume overload Hyperkalemia Hyperparathyroidism Hyperphosphatemia Metabolic acidosis Malnutrition (late complication) GERD Warning signs include: Symptoms over age of 50: -Dysphagia (difficulty swallowing) -Odynophagia (pain on swallowing) -Nausea and vomiting -Weight loss -Melena -Early satiety (feeling full after eating very little food Hiatal Hernia Often asymptomatic Generally, a wide variety of symptoms develop later in life and are associated with other GI disorders, primarily GERD --Sliding hiatal hernia: treatment usually conservative. Individuals can diminish reflux by eating small, frequent meals and avoiding the recumbent position after eating. Abdominal supports and tight clothing are avoided and weight control recommended for obese individuals. Duodenal Ulcer Characteristic manifestation = chronic intermittent pain in epigastric area Pain begins 30 minutes to 2 hours after eating when stomach is empty Not unusual for pain to occur in middle of the night and disappear by morning Peptic Ulcer Disease Peptic ulcer is a break or ulceration in the protective mucosal lining of the lower esophagus, stomach or duodenum Least likely to occur in the large intestine Major Depressive Disorder SSRIs are the standard first-line treatment for major depression Initial selection of an antidepressant includes: -Assessment of symptoms -Age -Side effects -Safety -Cost Social Anxiety Disorder Fear and avoidance of social situations Example: anxious person may feel very uncomfortable having a conversation or interacting with others and very conscious of being scrutinized and humiliated or rejected by others Schizophrenia Diagnosis: Advanced neuroimaging techniques have revealed structural brain abnormalities A consistent finding is the enlargement of the lateral and third ventricles and the widening of frontocortical fissures and sulci . Schizophrenia Positive symptoms ("More" symptoms): Hallucinations Delusions Formal thought disorder Bizarre behavior Schizophrenia Negative symptoms Flattened affect Alogia Anhedonia Attention deficits Apathy Schizophrenia Cognitive symptoms: Inability to perform daily tasks requiring attention and planning Hypothyroidism Most common thyroid function disorder Affects between 0.1% and 2% of the U.S. population More common in women and elderly Hormone replacement therapy with the hormone levothyroxine is the treatment of choice Thyroid-Stimulating Hormone (TSH) TSH released by anterior pituitary Review hypothalamic-pituitary axis (Picture) Thyroid-releasing hormone (hypothalamus) Hyperthyroidism/ Grave's Disease Two most distinguishing factors of Grave's disease = pretibial myxedema and exophthalmos Treatment directed at controlling excessive TH production, secretion or action and includes antithyroid