NR 283 / NR283: Pathophysiology Exam 2 Review (Latest 2021 / 2022) Chamberlain College, Study Guides, Projects, Research of Nursing

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NR I 283: I Pathophysiology IExam I 2 IReview

(Chapters I6,7, I13, I8, Iand I10)

Chapter I 6: IInfection I & I Chapter I 7: IImmunology ◈ I I B I cells I - I HUMORAL I IMMUNITY ➥ I Created Iin Ibone Imarrow, Imature I in Ibone Imarrow ○ Proceeds Ito Ithe Ispleen Ior Ilymphoid Itissue ➥ I Creates IImmunity ○ production Iof I antibodies I or I immunoglobulins ○ After Iexposure Ito Iantigens, Iand Iwith Ithe Iassistance Iof IT Ilymphocytes, Ithey IbecomeI antibody-producing I plasma Icells. I B I lymphocytes I act I primarily I against I bacteria Iand Iviruses Ithat Iare Ioutside Ibody Icells. IB-memory Icells Ithat Iprovide Ifor Irepeated Iproduction Iof Iantibodies Ialso Iform Iin Ihumoral Iimmune Iresponses. ➥ I Usually Iin Iblood Iand Ilymphs ➥ I I I I Antibodies I - I immunoglobulins ○ IgG I- Imost Icommon Iand Iplentiful ➢ Can Icreate Iantibodies Iagainst Ifungus, Ibacteria, Ietc. ○ IgA ➢ Found Iin Itears, Isaliva, Icolostrum ○ IgM ➢ Has Ito Ido Iwith Iyour Iblood I- IABO ○ IgD ➢ Activates IB Icells

T ICells

○ IgE ➢ Allergies, IEosinophils

➥ ICreated Iin IBone IMarrow, Imature Iin IThymus ➥ I I I Creates I CELL-MEDIATED I immunity ○ develops Iwhen IT Ilymphocytes Iwith Iprotein Ireceptors Ion Ithe Icell Isurface Irecognize antigens Ion Ithe Isurface Iof Itarget Icells Iand Idirectly Idestroy Ithe Iinvading Iantigens ○ These Ispecially Iprogrammed IT Icells Ithen Ireproduce, Icreating Ian I“army” Ito IbattleIthe Iinvader, Iand Ithey Ialso Iactivate Iother IT Iand IB Ilymphocytes. I T Icells Iare Iprimarily I effective I against I virus-infected Icells, Ifungal I and I protozoal Iinfections, Icancer Icells, Iand Iforeign Icells Isuch Ias Itransplants ➥ I ILymph I nodes ➥ I Usually Iin Icells ➥ I I Memory I cells ➥ I Different Itypes Iof Iimmunity ○ Natural Iactive I :Chicken Ipox ○ Artificial IActive I : IVaccine IChickenpox ○ Natural Ipassive : IPregnant Imom Ihad Ichicken Ipox ○ Artificial I Passive : I rattlesnake I bite I- I serum ○ Innate Iimmunity I : Iborn Ithat Iway

◈ I I I Humoral I Immunity ➥ Antibodies Iare Iproduced Ito I protect Ithe I body

◈ I I Memory I Cells ➥ I Normally Ithe Iimmune Isystem Iignores I“self” Icells, Idemonstrating I tolerance. IWhen Ithe immune Isystem I recognizes I a I specific I non–self-antigen Ias Iforeign, Iit Idevelops Ia Ispecific I response I to I that I particular I antigen I and I stores Ithat I particular Iresponse I in I its I memoryI cells I for Ifuture Ireference Iif Ithe Iantigen Ireappears Iin Ithe Ibody

➥ I For Iexample, I lymphoid Itissue Iin Ithe Ipharynx, Isuch Ias Itonsils Iand Iadenoids, Ican IcaptureIantigens Iin Imaterial Ithat Iis Iinhaled Ior Iingested Iand Iprocess Ithe Iimmune Iresponse. INote Ithat Ia Iperson Imust Ihave Ibeen Iexposed Ito Ithe Ispecific Iforeign Iantigen Iand Imust Ihave developed Ispecific Iimmunity Ito Iit I(such Ias Iantibodies) Ibefore Ithis Idefense Iis Ieffective. IThisIresponse Iis Iusually Irepeated Ieach Itime Ithe Iperson Iis Iexposed Ito Ia Iparticular Isubstance I(antigen) Ibecause Ithe Iimmune Isystem Ihas Imemory Icells. IImmune Iresponses Ithat Ioccur Iafter Ithe Ifirst Iintroduction Iof Ithe Iantigen Iare Iusually Imore Irapid Iand Iintense Ithan Ithe IinitialIresponse.

◈ I I I Antibodies ➥ I I IAntibodies Iare Ia I specific Iclass Iof I proteins Itermed I immunoglobulins ➥ I I IEach Ihas Ia Iunique I sequence Iof Iamino Iacids I ( variable I portion, I which I binds I to Iantigen) attached Ito Ia Icommon Ibase I( constant I region Ithat Iattaches Ito Imacrophages) ➥ I I I IgG I - I most I common I and I plentiful ○ Can Icreate Iantibodies Iagainst Ifungus, Ibacteria, Ietc. ➥ I IgM ○ first Ito Iincrease Iin Ithe Iimmune Iresponse; Iactivates Icomplement; Iforms Inatural antibodies ● is Iinvolved Iin Iblood IABO Itype Iincompatibility Ireaction ➥ I IgA

➥ I I IIgE

○ Found Iin Itears, Isaliva, Icolostrum I(liquid Ithat Iappears Ibefore Ibreast Imilk)

○ Allergies, IEosinophils ➥ I IgD ○ Activates IB Icells

◈ I I I Antigens ➥ I I I Foreign I substance, Imicrobes I or Icomponent I of Icell I that I stimulates I immune I response; I non- self Iantigen

◈ I I Culture Iand I Sensitivity ➥ I I Culture ○ test Ito Ifind Igerms I(such Ias Ibacteria Ior Ia Ifungus) Ithat Ican Icause Ian Iinfection. ➥ I I Sensitivity ○ test Ichecks Ito Isee Iwhat Ikind Iof Imedicine, Isuch Ias Ian Iantibiotic, Iwill Iwork Ibest Ito treat Ithe Iillness Ior Iinfection. ➥ I A Iculture Iand Isensitivity Itest Imay Ibe Idone Ion Imany Idifferent Ibody Ifluids, Isuch Ias Iurine, mucus, Iblood, Ipus, Isaliva, Ibreast Imilk, Ispinal Ifluid, Ior Idischarge Ifrom Ithe Ivagina Ior Ipenis.

◈ I I Titer ➥ Measures I levels I of I serum I immunoglobulins ➥ I I A Inursing Istudent Ihas Ito Iprovide I her I immunization I record? ○ TITER

◈ IHypersensitivities -Types Iand ICategories Iand Idefinition ➥ Type I 1 I - Iallergic I reactions ○ Common ➢ Caused Iby Iallergen ➢ skin Irashes ➢ hay Ifever ○ Causative I mechanism ➢ Exposure Ito Iallergen

➢ Development Iof IIgEs ➢ Mast Icells ○ Complications ➢ Anaphylaxis ○ Reactions ➢ Hay Ifever ◆ Nasal Imucosa ➢ Food Iallergies ◆ Digestive Itract Imucosa ➢ Atopic I dermatitis I / I eczema ◆ Skin ➢ Asthma ◆ Bronchial Imucosa ➥ I I I Type I 2 I - I Cytotoxic I Hypersensitivity, I Antibody ○ Antigen Iis Ipresent Ion Icell Imembrane ➢ May Ibe Inormal Ibody I component I or Iexogenous ○ Blood Itype Ireaction ○ Circulating IIgGs Ireact Iwith Iantigen ➢ Destruction Iby Iphagocytosis Ior Icytolytic Ienzymes ○ Example: Iresponse Ito Iincompatible Iblood Itransfusion ➥ I IType I 3 I- IImmune IComplex IHypersensitivity ○ Antigen Icombined I with I antibody ➢ Forms Iimmune Icomplexes, Ideposited Iin Itissue ➢ Activation Iof Icomplement Isystem ➢ Autoimmune Idiseases ○ Process Icauses Iinflammation Iand Itissue Idestruction ○ Examples: IGlomerulonephritis Iand IRheumatoid Iarthritis ➥ I I Type I 4 I- I Cell IMediated I or IDelayed IHypersensitivity ○ Delayed Iresponse Iby Isensitized IT Ilymphocytes ○ Released Iof Ilymphokines ○ Inflammatory Iresponse ○ Destruction Iof Iantigen ○ Examples: ITuberculin Itest, Icontact Idermatitis, IAllergic Iskin Irash, I poison Iivy

◈ I I S/S I of I Anaphylactic I Shock ➥ I I I I Severe, I life-threatening ➥ I I I Systemic I hypersensitivity I reaction ➥ I I I Decreased Iblood I pressure I caused Iby I release I of I histamine ➥ I I I Airway I obstruction ➥ I Severe Ihypoxia ➥ I Can Ibe Icaused Iby: ○ Latex Imaterial ○ Insect Istings ○ Nuts Ior Ishellfish: Ivarious Idrugs ➥ I Signs Iand Isymptoms ○ Generalized Iitching Ior Itingling, Iespecially Iin Ioral Icavity ○ Decreased IBP ○ Coughing, Idifficulty Ibreathing, Ifeeling Iweak, Idizzy, Ifainting, Isense IofIfear/panic, Ihives I(urticaria) ○ Edema Iaround Ieyes, Ilips, Itongue, Ihands, Ifeet ○ Collapse Iwith Iloss Iof Iconsciousness ➥ I I Treatment ○ Requires Ifirst Iaid Iresponse ➢ Epipen ➢ 911 ○ Treatment Iin Iemergency Idepartment ➢ Epinephrine, IGlucocorticoids, IAntihistamines, IOxygen ➢ Stabilize IBP

◈ I I I Blood I transfusion I reaction ➥ I Signs Iof Ia Itransfusion Ireaction Iinclude Ia Ifeeling Iof Iwarmth Iin Ithe Iinvolved Ivein, Iflushed face, Iheadache, Ifever Iand Ichills, Ipain Iin Ithe Ichest Iand Iabdomen, Idecreased IbloodIpressure, Iand Irapid Ipulse. ➥ I What Ihappens Iwhen I a Ipt Iget Ia Iwrong Iblood Itransfusion? ○ ANSWER ITHIS! ○ Hemolysis I or I hemolytic I reaction ➥ I Another Iinherited Ifactor Iin Iblood Iis Ithe IRh Ifactor, Iwhich Imay Icause Iblood Iincompatibility Iif the Imother Iis IRh-negative Iand Ithe Ifetus Iis IRh Ipositive. IRh Iblood Iincompatibility IbetweenImaternal Iand Ifetal Iblood.. ➥ I Plasma Ior Icolloidal Ivolume-expanding Isolutions Ican Ibe Iadministered Iwithout Irisk Iof Ia reaction Ibecause Ithey Iare Ifree Iof Iantigens Iand Iantibodies.

◈ I I I Cell-mediated I hypersensitivity I TYPE I IV-Contact I dermatitis-poison I ivy ➥ I Examples: IContact Idermatitis: Itransplant Irejection ➥ I Mechanism: IAntigen Ibinds Ito IT-lymphocyte; Isensitized Ilymphocyte Ireleases Ilymphokines ➥ I I IEffects: I Delayed I inflammation ➥ I Contact Idermatitis ○ Allergic Iskin Irash ○ Poison Iivy

◈ I I Innate Iimmunity I(born Ithis Iway) I- IAT IBIRTH ➥ I The Iimmunity Iyou Iwere Iborn I with ➥ I nonspecific Idefense Imechanisms Ithat Icome Iinto Iplay Iimmediately Ior Iwithin Ihours Iof Ian antigen's Iappearance Iin Ithe Ibody ➥ I include Iphysical Ibarriers Isuch Ias Iskin, Ichemicals Iin Ithe Iblood, Iand Iimmune Isystem Icells that Iattack Iforeign Icells Iin Ithe Ibody. ➥ I The Iinnate Iimmune Iresponse Iis Iactivated Iby Ichemical Iproperties Iof Ithe Iantigen.

◈ I I I Passive I immunity ➥ I Naturally IAcquired: Iantibodies Iare Itransferred Ifrom Imother Ito Ichild Ieither Iplacenta Ior breast Imilk ➥ I Artificially IAcquired: IHealth Icare Iworkers Iintroduce Iantigens Iin Ivaccines, Ithe Ibody responds Iwith Iantibody Ior Icell-mediated Iimmune Iresponses, Iincluding Ithe Iproduction IofImemory Icells.(given Ivirus Iand Iantibodies)

◈ I I I IAcquired/Active I immunity ➥ I Naturally IAcquired: Ithe Ibody Iresponds Ito Iantigens Ithat Ienter Inaturally, Isuch Ias Ia Iperson contracts I a Idisease ➥ I Artificially IAcquired: IAntigen Iintroduced Iby Ivaccine, Iyour Ibody Iactively Imaking IantibodiesIvaccination Itriggers Ian Iimmune Iresponse

◈ I I Viral I Replication ➥ I I Some I viruses Iremain I in I a I latent I stage; I they Ienter Ihost I cells Iand Ireplicate Itheir I DNA I in Ihost I cells I very Islowly Ior Inot Iat Iall Iuntil Isometime Ilater. IViruses Ican Ialso Iinsert Itheir Icapsid Iproteins Iinto Ithe Icell Imembrane Iof Ithe Ihost Icells; Ithese Icells Iare Ithen Irecognized Ias viral Iinvaders Iand Iare Iattacked Iby Ithe Ibody's Iimmune Isystem. ➥ I Frequently Ione Itype Iof Ivirus Iexists Iin Imany Isimilar Iforms Ior Istrains, Iand Iviruses Itend ItoImutate, Ior Ichange Islightly, Iduring Ireplication I(e.g., Ithe Icold Ior Iinfluenza Iviruses).

➥ IBecause Iof Itheir Iunique Icharacteristics, Iviruses Iare Idifficult Ito Icontrol. IThey Ican Ihide Iinside Ihuman Icells, Iand Ithey Ilack Itheir Iown Imetabolic Iprocesses Ior Istructures Ithat ImightIbe Iattacked Iby Idrugs.

◈ I I Carrier I Definition ➥ a I person I or I organism I infected I with I an I infectious I disease I agent, I but I displays I noIsymptoms.

◈ I I I Nosocomial I Infection ➥ An I infection I acquired I in I a I healthcare I facility.

◈ I I Sterile Iareas Iof Ithe Ibody ➥ body Icavity, Ilungs, Icentral Inervous Isystem, Icirculatory Isystem I& Iupper Iurogenital Iregions ➥ I URINE I( Iit Iis Inot IURETHRA)

◈ I I I Opportunistic I Infection ➥ infection Icaused Iby Ipathogens I(bacteria, Iviruses, Ifungi, Ior Iprotozoa) Ithat Itake Iadvantage of Ian Iopportunity Inot Inormally Iavailable, Isuch Ias Ia Ihost Iwith Ia Iweakened Iimmune Isystem,Ian Ialtered Imicrobiota I(such Ias Ia Idisrupted Igut Iflora), Ior Ibreached Iintegumentary Ibarriers ➥ I IHow? IWhen Iyour Igut Iflora Iis Iimbalanced

◈ I I I Bacteremia ➥ I I invasion I of Ithe Ibloodstream Iby I bacteria. ➥ I Bacteria Iin Iyour Iblood ➥ I This Imay Ioccur Ithrough Ia Iwound Ior Iinfection, Ior Ithrough Ia Isurgical Iprocedure Ior Iinjection ➥ I Bacteremia Imay Icause Ino Isymptoms Iand Iresolve Iwithout Itreatment, Ior Iit Imay Iproduce fever Iand Iother Isymptoms Iof Iinfection. IIn Isome Icases, Ibacteremia Ileads Ito Iseptic Ishock, Ia Ipotentially Ilife-threatening Icondition.

◈ I I Antiseptic Ivs. I Disinfectant ➥ I I IAntiseptics Iand Idisinfectants Iare Iboth Iused I to I kill I or I to I limit Ithe I growth Iof Imicroorganisms, however,they Idiffer Ion Ithe Iplace Ithey Iare Iused. ➥ I Antiseptic Iis Iused Ion Iliving Itissues Iand Icells Ito Idestroy Iany Itypes Iof Iinfections Iwhich Imay be Iliving Ion Ithe Itissue ➥ IDisinfectants Iare Imeant Ito Idestroy Imicroorganisms Iwhich Ican Iinfect Inon-living Iobjects

◈ I I I Prodromal ➥ Irelating Ito Ior Idenoting Ithe Iperiod Ibetween Ithe Iappearance Iof Iinitial Isymptoms Iand Ithe Ifull development Iof Ia Irash Ior Ifever ➥ IA Ipatient Iis Isweating, Ishe Ifeels I like Ishe I is Icoming Idown Iwith Isomething. IWhatIperiod Iis Ishe Iexperiencing Ithis…. IAnswer Iis Iprodromal

◈ I I I Anaerobes ➥ I any Iorganism Ithat Idoes Inot Irequire Ioxygen Ifor Igrowth. IIt Imay Ireact Inegatively Ior Ieven Idie if Ioxygen Iis Ipresent ➥ I I What I is I true Iabout Ianaerobes? IThey Ican Isurvive Iwithout Ioxygen

◈ I I I IAutoimmune I diseases ➥ IDevelopment Iof Iantibodies Iagainst Iown Icells Ior Itissues ➥ I TEST: IAutoimmune I disorders I occur I when Ithe Iimmune Isystem Icannot I distinguishIbetween Iself I and Inon–self-antigens. I The Iexact Icauses Iof Iautoimmune Idiseases/disorders Iare Istill Iunknown. ➥ I I IAutoantibodies Iare Iantibodies I formed Iagainst I self-antigens

○ Loss Iof Iself-tolerance ➥ I Disorder Ican Iaffect Isingle Iorgans Ior Itissues Ior Ican Ibe Igeneralized ➥ I I Examples: ○ Hashimoto Ithyroiditis, Isystemic Ilupus, Ierythematosus, Irheumatic Ifever, Imyasthenia gravis, Iscleroderma, Ipernicious Ianemia ➥ I I I Immunodeficiency ○ Partial Ior Itotal Iloss Iof Ione Ior Imore Iimmune Isystem Icomponent ○ Increased Irisk Iof Iinfection Iand Icancer ○ Predisposition Ito Ithe Idevelopment Iof Iopportunistic Iinfections I- Icaused Iby Inormal flora ○ Usually Idifficult Ito Itreat Ibecause Iof Iimmunodeficiency ○ Prophylactic Iantimicrobial Idrugs Imay Ibe Iused Iprior Ito Iinvasive Iprocedures

◈ I I AIDS I common I cause I of I death ➥ I Chronic Iinfectious Idisease Icaused Iby Ihuman Iimmunodeficiency Ivirus I(HIV) ➥ I I HIV Idestroys Ihelper I T I cells I - ICD4 Ilymphocytes ➥ I Loss Iof Iimmune Iresponse ➥ I Increase Isusceptibility Ito Isecondary Iinfections Iand Icancer ➥ I I I Prolonged I latent I period ➥ I I IDevelopment Imay I be I suppressed I by Iantivirals ➥ I I I HIV-Positive I individuals ○ Virus Iis Iknown Ito Ibe Iin Ithe Ibody ○ No Ievidence I of I immunosuppression ➥ I AIDS ○ Marked Iclinical Isymptoms, Imultiple Icomplications ➥ I Individual Ioften Iidentified Ias IHIV-Positive Ibefore I development Iof IAIDS ○ Current Itherapies Istart Iif IHIV Iinfection Iis Idiagnosed Iin Iearly Istage ➥ I History: ○ First Icase Irecognized Iin I1979, IHIV Iidentified Iin I 1984 ○ Considered Ipandemic, Ioccurs Iin Iboth Imen Iand Iwomen

➥ I COMMON ICAUSE IOF IDEATH I- I Pneum ocystis ICarinii

◈ I I I Bacterial I Endospores ➥ I I dormant, I touch, I and Inon-reproductive I structure I produced I by I certain I bacteria. I They I allow bacteria Ito I survive Ih armful Ien viron men tal Icon ditions. ➥ IEndospore Iformation Iis Iusually Itriggered Iby Ilack Iof Inutrients Iand Iusually Ioccurs Iin Igram- positive Ibacteria. ➥ I I Bacillus I Subtilis I and I Clostridium I are Iexamples Iof Ibacteria I known Ito Iproduce I endospores.

◈ I I I Infection I Control I Measures ➥ understanding Ithe Itransmission, Iand Ibreaking Ithe Ichain Iof Iinfection ➥ I I To I break Ithe I cycle Iand Iminimize Ithe I risk Iof I infection: ○ The Ireservoir Ior Isources Iof Iinfection Imust Ibe Ilocated Iand Iremoved. ISources Iand contacts Imust Ibe Iidentified Iin Isome Isituations, Iespecially Iwhen IasymptomaticIcarriers Imay Ibe Iinvolved, Ior Iwhen Itravelers Imay Ibe Iinfected: ➢ Contaminated Ifood Ior Iwater Ior Icarrier Ifood Ihandlers Ishould Ibe Iidentified Ito prevent Icontinued Itransmission Ior Iepidemics Iof Iinfectious Idisease. ➢ In Isome Icases, Iinfection Ican Ibe Itransmitted Ibefore Iclinical Isigns Iare Ievident in Ithe Iinfected Iperson, Iand Ithis Ipermits Iwidespread Icontamination Iif ItheIincubation Iperiod Iis Iprolonged. ➢ Infected Itravelers Ishould Irefrain Ifrom Itravel Ito Iprevent Ispreading Iinfectious diseases Iinto Inew Iareas, Iand Itravelers Iwho Ibecome Iill Ishould Iseek IpromptIhealth Icare Iand Ishare Itheir Ispecific Itravel Ihistory Iwith Ihealth Icare Iworkers.

○ The Iportal Iof Iexit I(secretions, Ie.g., Iblood, Isaliva, Iurine) Iof Imicrobes Ifrom ItheIreservoir Ishould Ibe Iblocked. ○ Knowledge Iof Ithe Imode I(droplet, Ifecal-oral) Ior Imodes Iof Itransmission Iof Ispecific infections Iis Iessential Ito Iblock Itransmission. ➥ I I Additional Itechniques I to Ireduce I transmission Iinclude:

1. Adequate Icleaning Iof Isurroundings Iand Iclothing.
2. Sterilization Iof Ifomites Iby Iexposure Ito Iheat Iusing Iseveral Imethods, Isuch Ias autoclaving.
3. Disinfectants Iare Ichemical Isolutions Ithat Iare Iknown Ito Idestroy Imicroorganisms Ior their Itoxins Ion Iinanimate Iobjects.
4. Antiseptics Iare Ichemicals Iapplied Ito Ithe Ibody Ithat Ido Inot Iusually Icause Itissue damage, Isuch Ias Iisopropyl Ialcohol-70%, Iwhich Iis Ithe Iactive Iingredient Iin IhandIsanitizers.

◈ I I I Universal I Precautions ➥ I Universal Iprecautions I provide Ithe Ibasic Iguidelines I by I which Iall Iblood, I body Ifluids, Iand Iwastes Iare Iconsidered I“infected” I in Iany Iclient I regardless I of Ithe Iclient's Iapparent Icondition. ➥ I I TEST IQ: Iyou Ishould Itreat Iall I fluids Ilike I it I is I infectious ➥ I There Iare Itwo Ilevels, Ione Igeneral Ifor Iall Iindividuals, Iand Ione Ispecific Ito Iknown Iinfections at Ispecific Isites Iin Ithe Ibody, Ifor Iexample, Ithe Iintestines. ➥ I Gloves Iand Iappropriate Iprotective Iapparel Iare Ithen Iused Ito Ireduce Ithe Itransmission Iof organisms Iin Ieither Idirection, Ithat Iis, Ifrom Ipatient Ito Icaregiver Iand Ifrom Icaregiver ItoIpatient. ➥ I Guidelines Ihave Ibeen Iestablished Ifor Ithe Idisposal Iof Isuch Ipotentially Idangerous Iitems Ias needles, Itissue, Iand Iwaste Imaterials. ➥ I The ICDC Ican Ibe Iconsulted Ifor Iappropriate Iand Iup-to-date Iinformation. ➥ I (Also Irefer Ito IInfection IControl IMeasures)

Chapter I13: IRespiratory

➔ Purpose Iand IGeneralIfunction ◆ Transport Iof Ioxygen Ifrom Iair Ito Iblood ● Oxygen Iis Inecessary Ifor Icellular Imetabolism ◆ Removal Iof Icarbon Idioxide Ifrom Ithe Iblood ● Carbon Idioxide Iis Ia Iwaste Iproduct Ifrom Imetabolism ◆ Two Ianatomical Iareas: ● UpperIrespiratory Itract I- Iresident Iflora ○ Nasal Icavity ◆ Warming Iand Imoistening Iof Iair ◆ Foreign Imaterial Itrapped Iby Imucous Isecretions ○ Nasopharynx ◆ Pharyngeal Itonsils Iin Iposterior Iwall ○ Palatine Itonsils ◆ Lymphoid Itissue Iin Iposterior Iportion Iof Ioral Icavity ○ Oropharynx ◆ Common Ipassage I for Iair Iand I food ◆ Epiglottis Iprotects Iopening Iinto Ilarynx ○ Larynx ◆ Two Ipairs Iof Ivocal Icords ○ Trachea ◆ Lined Iby Ipseudostratified Iciliated Iepithelium ◆ C-shaped Irings Iof Icartilage ● Lower Irespiratory Itract I- Isterile ○ Bronchial Itree I(continuous Ibranching) ◆ Trachea Ibranches Iinto:

➔ Status IAsthmaticus

● Right Iand Ileft Iprimary Ibronchi ● Secondary Ibronchi ● Bronchioles ● Terminal Iand IRespiratory IBronchioles ● Alveolar Iducts ● Alveoli

◆ a Isevere Icondition Iin Iwhich Iasthma Iattacks Ifollow Ione Ianother Iwithout Ipause. ◆ Status Iasthmaticus Iis Ia Ipersistent Isevere Iattack Iof Iasthma Ithat Idoes Inot Irespond Ito therapy. IIt Iis Ioften Irelated Ito Iinadequate Imedical Itreatment. ◆ It Imay Ibe Ifatal Iowing Ito Isevere Ihypoxia Iand Iacidosis Ileading Ito Icardiac Iarrhythmias Ior central Inervous Isystem Idepression. ◆ Doesn’t I respond I to I bronchodilators

➔ ABG IInterpretation

1. Know Ithe InormalIvalues.

Know Ithe Inormal Iand Iabnormal IABG Ivalues Iwhen Iyou Ireview Ithe Ilab Ireports. IThey’re IfairlyIeasy Ito Iremember: Ifor IpH, Ithe Inormal Ivalue Iis I7.35 Ito I7.45; I35-45 Ifor IpaCO2; Iand I22- 26 Ifor IHCO3. IRemember Ialso Ithis Idiagram Iand Inote Ithat IpaCO2 Iis Iintentionally Iinverted Ifor Ithe Ipurpose Iof Ithis Imethod.

2. Determine Iif IpH Iis Iunder Iacidosis Ior Ialkalosis Next Ithing Ito Ido Iis Ito Idetermine Ithe Iacidity Ior Ialkalinity Iof Ithe Iblood Ithrough Ithe Ivalue Iof pH. IThe IpH Ilevel Iof Ia Ihealthy Ihuman Ishould Ibe Ibetween I7.35 Ito I7.45. IThe Ihuman Ibody IisIconstantly Istriving Ito Ikeep IpH Iin Ibalance. pH Ilevel Ibelow I7.35 Iis Iacidosis IpH Ilevel Iabove I7.45 Iis Ialkalosis 3. Determine Iif Iacid-base Iis Irespiratory Ior Imetabolic Next Ithing Iyou Ineed Ito Idetermine Iis Iwhether Ithe Iacid Ibase Iis IRespiratory Ior IMetabolic. paCO2 I= IRespiratoryIHCO3 I= IMetabolic 4. Remember IROME Still, Iit Iall Iboils Idown Ito Imnemonics. IThe Imnemonic I RO-MEIRespiratory IOpposite When IpH Iis Iup, IPaCO2 Iis Idown = IAlkalosis When IpH Iis Idown, IPaCO2 Iis Iup = IAcidosis

Metabolic I Equal

When IpH Iis Iup, IHCO3 Iis Iup = IAlkalosis

When IpH Iis Idown, IHCO3 Iis Idown = IAcidosis

5. Tic-Tac-Toe And I yes, IABG Iproblems I can I be I solved I work Iusing Ithe Itic-tac-toe Imethod. IAll I you Ihave Ito do Iis Imake Ia Iblank Ichart Isimilar Ito Ithis: 6. Mark Ithe IChart Using Ithe Ilab Iresult Ivalues, Imark Ithem Ion Iyour Itic-tac-toe. ILet’s Ibegin Iwith Ithis Isample problem: pH: I7.26, IpaCO2: I32, IHCO3: I 18 Using Ithe Inormal Ivalues Ireference Ichart Iin Ithe Ifirst Istep, Idetermine Iwhere Ithe IvaluesIshould Ibe Iunder Iin Ithe Itic-tac-toe. IIn Ithe Igiven Iexample, Ithe Isolution Iis Ias Ifollows: pH Iof I7.26 Iis ILOW = IACID Iso Iplace IpH Iunder IAcid paCO2 Iof I 32 Iis ILOW = IBASE Iso Iplace IpaCO2 Iunder IBaseIHCO3 Iof I 18 Iis ILOW = IACID Iso Iplace IHCO3 Iunder IAcid

YourIchartIshould Ilook Ilike Ithis:

7. Match Iit Iup In Ithis Istep, Idetermine Iat Iwhich Icolumn Imatches Iup Iwith Ithe IpH. IIn Ithe Igiven Iexample, HCO3 Igoes Iwith IpH. IHCO3 Iis Iconsidered IMetabolic I(shown Iin Istep I3), Iand Iboth Iare Iunder

Acid, Iso Ithis Iexample Iimplies IMetabolic IAcidosis.

Therefore I this IABG I is I METABOLIC IACIDOSIS!

➔ Respiratory ILabs ◆ Common Itests Iinclude: ● Spirometry-pulmonary Ifunction Itesting I(PFT) Iis Iused Ito Itest Ipulmonary Ivolumes, measuring Ivolume Iand Iairflow Itimes. ● Arterial Iblood Igas Ideterminations Iare Iused Ito Icheck Ioxygen, Icarbon Idioxide, Iand bicarbonate Ilevels Ias Iwell Ias Iserum IpH. ● Oximeters Imeasure IO2 Isaturation. ● Exercise Itolerance Itesting Iis Iuseful Iin Ipatients Iwith Ichronic Ipulmonary Idisease Ifor diagnosis Iand Imonitoring Iof Ithe Ipatient's Iprogress. ● Radiography Imay Ibe Ihelpful Iin Ievaluating Itumors Ior Iinfections Isuch Ias Ipneumonia or Ituberculosis. ● Bronchoscopy Imay Ibe Iused Iin Iperforming Ia Ibiopsy Ior Iin Ichecking Ifor Ithe Isite Iof Ia lesion Ior Ibleeding. ● Culture Iand Isensitivity Itests Ion Iexudates Ifrom Ithe Iupper Irespiratory Itract Ior Isputum specimens Ican Iidentify Ipathogens Iand Iassist Iin Idetermining Ithe IappropriateItherapy.

➔ General Imanifestation Iof Irespiratory Idisease ◆ ˜Sneezing ● Reflex Iresponse Ito Iirritation Iin Iupper Irespiratory Itract ● Assists Iin Iremoving Iirritant ● Associated Iwith Iinflammation Ior Iforeign Imaterial ◆ ˜Coughing ● Irritation Icaused Iby Inasal Idischarge ● Inflammation Ior Iforeign Imaterial Iin Ilower Irespiratory Itract ● Caused Iby Iinhaled Iirritants ◆ ˜Sputum ● Yellowish-green, Icloudy, Ithick Imucus ○ Often Iindication Iof Ia Ibacterial Iinfection ● Rusty Ior Idark-colored Isputum ○ Usually Isign Iof Ipneumococcal Ipneumonia ● Very Ilarge Iamounts Iof Ipurulent Isputum Iwith Ifoul Iodor ○ May Ibe Iassociated Iwith Ibronchiectasis ● Thick, Itenacious Imucus ○ Asthma Ior Icystic Ifibrosis, Iblood-tinged Isputum—may Iresult Ifrom Ichronic cough; Imay Ialso Ibe Isign Iof Itumor Ior Ituberculosis ● Hemoptysis ○ Blood-tinged I(bright Ired) Ifrothy Isputum, Iusually Iassociated Iwith Ipulmonary edema

◆ ˜Breathing I patterns Iand I characteristics ● Eupnea ○ Normal Irate ● Kussmaul Irespirations ○ Deep Irapid Irespirations—typical Ifor Iacidosis; Imay Ifollow Istrenuous Iexercise ● Labored Irespiration Ior Iprolonged Iinspiration Ior Iexpiration ○ Often Iassociated Iwith Iobstruction Iof Iairways ● Wheezing Ior Iwhistling Isounds ○ Indicate Iobstruction Iin Ismall Iairways ● Stridor ○ High-pitched Icrowing Inoise ○ Usually Iindicates Iupper Iairway Iobstruction ◆ ˜Breath Isounds ● Rales ○ Light Ibubbly Ior Icrackling Isounds, Iwith Iserous Isecretions ● Rhonchi ○ Deeper Ior Iharsher Isounds Ifrom Ithicker Imucus ◆ Absence ● Nonaeration Ior Icollapse I of I lungs ◆ ˜Dyspnea ● Subjective Ifeeling Iof Idiscomfort ○ May Ibe Icaused Iby Iincreased Icarbon Idioxide Ior Ihypoxemia ○ Often Inoted Ion Iexertion, Isuch Ias Iclimbing Istairs ● Severe Idyspnea Iindicative Iof Irespiratory Idistress ○ Flaring Iof Inostrils ○ Use Iof Iaccessory Irespiratory Imuscles ○ Retraction Iof Imuscles Ibetween Ior Iabove Iribs ● Orthopnea ○ Occurs Iwhen Ilying Idown ○ Usually Icaused Iby Ipulmonary Icongestion ● Paroxysmal Inocturnal Idyspnea ○ Sudden Iacute Itype Iof Idyspnea ○ Common Iin Ipatients Iwith Ileft-sided Icongestive Iheart Ifailure ◆ Cyanosis ● Bluish Icoloring Iof Iskin Iand Imucous Imembrane ○ Caused Iby Ilarge Iamounts Iof Iunoxygenated Ihemoglobin Iin Iblood ◆ Pleural Ipain ● Results Ifrom Iinflammation Ior Iinfection Iof Iparietal Ipleura

➔ Hyperventilation ◆ Hyperventilation Iwith Ia Iprolonged Iexpiratory Iphase, Iuse Iof Ithe Iaccessory Imuscles, Iand hyperinflation Ileading Ito Idevelopment Iof Ia I“barrel Ichest” Imark Ithe Iventilation Idifficulty. ITypical Iposture Iis Ia Isitting Iposition, Ileaning Iforward I(tripod Iposition), Ito Ifacilitate Ibreathing. IThe Ichest Iis Ihyperresonant Ion Ipercussion. IHyperventilation Imaintains IadequateIoxygen Ilevels Iuntil Ilater Istages. ◆ Decreased ICO ◆ Hypercapnia Icauses Irespiratory Iacidosis, Iand Iacidosis Idepresses Ithe Inervous Isystem ◆ IIHypocapnia, Ior Ilow IPCO2, Imay Ibe Icaused Iby Ihyperventilation Iafter Iexcessive Iamounts Iof carbon Idioxide Ihave Ibeen Iexpired. IHypocapnia Icauses Irespiratory Ialkalosis. IRespiratoryIalkalosis Idevelops Iinitially Ibecause Iof Ihyperventilation.

➔ Hemoptysis ◆ coughing Iup Iof I blood I or I blood-stained Imucus I from I the Ibronchi, I larynx, Itrachea, I or I lungs ◆ Bloody Isputum

➔ Hypoxemia ◆ Marked Idecrease Iin Ioxygen ● Chemoreceptors I respond ● Important Icontrol Imechanism Iin Iindividuals Iwith Ichronic Ilung Idisease I- Imove Ito hypoxic Idrive ➔ Hypoxia

➔ Respiratory IPatterns I(Cheyne-Stokes, IKussmaul, IApnea)

◆ Cheyne-Stokes Irespirations, Iwith Ialternating Iapnea IandIperiods Iof IincreasingIand Idecreasing Irespirations, IdependingIon Ithe Isite Iof Ithe Ilesion. ◆ Kussmaul I - Iprone Ito Ikidney Ifailure Ipatients ◆ Apnea -cessation Iof Ibreathing.

➔ Signs I of I respiratory I distress: ◆ Collapsed Ilungs ◆ Long Iterm Ieffects Ion Ilungs ◆ Can Icause Iasthma Iand Ipredisposing Ifactors Ito Iallergies ◆ Premature Ilabor Icauses Ipreemies Ito Ihave Icollapsed Ilungs ● Have Ito Igive Ito Imother Iabout I 24 Ihrs Ibefore Iinfant Iis Iborn Iso Ithat Ithey Ican Iproduce septal Icells

➔ Pulmonary I edema-signs I and I symptoms ◆ Vascular Idisorder ◆ Fluid Icollecting Iin Ialveoli Iand Iinterstitial Iarea ● Can Iresult Ifrom Imany Iprimary Iconditions ● Reduces Iamount I of I oxygen Idiffusing I into Iblood ● Interferes Iwith Ilung Iexpansion ◆ May Idevelop Iwhen: ● Inflammation Iin Ilungs Iis Ipresent ○ Increases Ipermeability Iof Icapillaries ● Plasma Iprotein Ilevels Iare Ilow ○ Decreases Iosmotic Ipressure Iof Iplasma ● Pulmonary Ihypertension Idevelops ◆ Signs/Symptoms ● Cough, Iorthopnea, Irales I- Iin Imild Icases ● Hemoptysis I (coughing Iup Iblood)

● Frothy, I blood-tinged Isputum

➔ COPD

◆ Chronic Iobstructive Ipulmonary Idisease I(COPD), Isometimes Ialso Icalled Ichronic Iobstructive lung Idisease I(COLD), Iis Ia Igroup Iof Icommon Ichronic Irespiratory Idisorders Ithat Iare Icharacterized Iby Iprogressive Itissue Idegeneration Iand Iobstruction Iin Ithe Iairways Iof ItheIlungs. ◆ They Iare Idebilitating Iconditions Ithat Iaffect Ithe Iindividual's Iability Ito Iwork Iand Ifunction independently. ◆ Examples: Iemphysema, Ichronic Ibronchitis, Iand Ichronic Iasthma ◆ causes Iirreversible Iand Iprogressive Idamage Ito Ithe Ilungs ◆ Eventually, Irespiratory Ifailure Imay Iresult Ibecause Iof Isevere Ihypoxia Ior Ihypercapnia ◆ Emphysema ● Destruction Iof Ialveolar Iwalls Iand Iseptae ● Leads Ito Ilarge, Ipermanently Iinflated Ialveolar Iair Ispaces ● Emphysema Imay Ibe Ifurther Iclassified Iby Ithe Ispecific Ilocation Iof Ithe Ichanges; Ifor example, Iin Ithe Idistal Ialveoli I(panacinar) Ior Ibronchiolar I(centrilobular) Iarea. ● Several Ifactors Icontribute Ito Ithe Idestruction Iof Itissue Iin Ithe Ialveoli. ○ In Isome Iindividuals Ithere Iis Ia Igenetic Ideficiency Iof Ialpha1-antitrypsin, Ia protein Inormally Ipresent Iin Itissues Iand Ibody Ifluids Ithat Iinhibits Ithe Iactivity IofIproteases, Iwhich Iare Idestructive Ienzymes Ireleased Iby Ineutrophils Iduring Ian Iinflammatory Iresponse. IAn Iexample Iof Ia Iprotease Iis Ielastase, Iwhich Ibreaks Idown Ielastic Ifibers. IThis Idestructive Iprocess Iseems Ito Ibe Iaccelerated Iin Ipersons Iwith Ilow Ialpha I 1 I-antitrypsin Ilevels. IThis Igenetic Itendency Iis Ioften Ifound Iin Iindividuals Iwho Idevelop Iemphysema Irelatively Iearly Iin Ilife. ○ Cigarette Ismoking Iincreases Iboth Ithe Inumber Iof Ineutrophils Iin Ithe Ialveoli Iand the Irelease Iand Iactivity Iof Ielastase, Ibut Idecreases Ithe Ieffect Iof Ialpha1- Iantitrypsin, Ithus Igreatly Icontributing Ito Ithe Ibreakdown Iof Ialveolar Istructures. ○ Certain Ipathogenic Ibacteria Ipresent Iwith Iinfection Ialso Irelease Iproteases. ○ The Ichanges Iin Ithe Ilung Itissue Ihave Imany Ieffects Ion Ilung Ifunction:

1. The Ibreakdown Iof Ithe Ialveolar Iwall Iresults Iin: a. Loss Iof Isurface Iarea Ifor Igas Iexchange b. Loss Iof Ipulmonary Icapillaries, Iaffecting Iperfusion Iand Ithe diffusion Iof Igases c. Loss Iof Ielastic Ifibers, Iaffecting Ithe Iability Iof Ithe Ilung Ito Irecoil Ion expiration d. Altered Iventilation-perfusion Iratio Ias Ivarious Ichanges Ioccur Iin the Ialveoli e. Decreased Isupport Ifor Iother Istructures Isuch Ias Ithe Ismall bronchi, Iwhich Ioften Ileads Ito Icollapse Iof Ithe Iwalls Iand IadditionalIobstruction Iof Iairflow Iduring Iexpiration
2. Fibrosis Iand Ithickening Iof Ithe Ibronchial Iwalls Ihave Iresulted Ifrom Ichronic Iirritation Iand Ithe Ifrequent Iinfections Iassociated Iwith Ismoking IandIincreased Imucus Iproduction. IThese Iconditions Ilead Ito: a. Narrowed Iairways b. Weakened Iwalls c. Interference Iwith Ipassive Iexpiratory Iairflow
3. Progressive Idifficulty Iwith Iexpiration Ileads Ito: a. Air Itrapping, Iand Iincreased Iresidual Ivolume b. Overinflation Iof Ithe Ilungs c. Fixation Iof Ithe Iribs Iin Ian Iinspiratory Iposition, Iand Ian Iincreased anterior-posterior Idiameter Iof Ithe Ithorax I(barrel Ichest) d. Diaphragm Iappears Iflattened Ion Ix-rays

4. With Iadvanced Iemphysema, Iand Isignificant Iloss Iof Itissue: a. Adjacent Idamaged Ialveoli Icoalesce Iforming Ivery Ilarge Iair Ispaces. INormally Ithe Iuninflated Ilung Iappears Ito Ibe Ia Isolid Imass.IWith Iemphysema, Ithe Ilung Iappears Ito Ihave Imany Ilarge Iholes IinIit. ISometimes Ione Ican Isee Ithrough Ithe Iscraps Iof Iremaining Itissue Ifrom Ione Iside Ito Ithe Iother. IThese Iair-filled Ispaces Iare Icalled Iblebs Ior Ibullae. b. The Itissue Iand Ipleural Imembrane Isurrounding Ilarge Iblebs Inear the Isurface Iof Ithe Ilung Imay Irupture, Iresulting Iin Ipneumothorax. c. Hypercapnia Ibecomes Imarked. d. Hypoxic Idrive Ifor Iinspiration Idevelops Ias Ithe Ipatient's respiratory Icontrol Iadapts Ito Ia Ichronic Ielevation Iof IcarbonIdioxide Ilevels, Iand Ihypoxia Ibecomes Ithe Idriving Iforce Ifor Irespiration.

➔ Cystic IFibrosis ◆ common Iinherited Idisorder Iin Ichildren ◆ mean Isurvival Iage Iin I 2006 Iwas I 37 Iyears ◆ Pathophysiology ● Also Icalled Imucoviscidosis, Iis Ia Igenetic Idisorder. ● Several Imutations Ito Ithe ICFTR Igene Ihave Ibeen Iidentified Iand Irelate Ito Ia Iprotein involved Iin Ichloride Iion Itransport Iin Ithe Icell Imembrane. ● This Idefect Iin Ithe Iexocrine Iglands Icauses Iabnormally Ithick Isecretions, Isuch Ias tenacious Imucus. IThe Iprimary Ieffects Iof Icystic Ifibrosis Iare Iseen Iin Ithe Ilungs Iand Ithe Ipancreas, Iwhere Ithe Isticky Imucus Iobstructs Ithe Ipassages; Iother Itissues Iare Iaffected Iless Ifrequently. ● In Ithe Ilungs, Ithe Imucus Iobstructs Iairflow Iin Ithe Ibronchioles Iand Ismall Ibronchi, causing Iair Itrapping Ior Iatelectasis Iwith Ipermanent Idamage Ito Ithe Ibronchial Iwalls ● Organisms Icommonly Icausing Iinfection Iin Ipatients Iwith Icystic Ifibrosis Iinclude IP. aeruginosa Iand IS. Iaureus ◆ Etiology ● The Imutated ICFTR Igene Ifor Icystic Ifibrosis Iis Ilocated Ion Ithe Iseventh Ichromosome, and Ithe Idisease Iis Itransmitted Ias Ian Iautosomal Irecessive Idisorder ◆ Signs/Symptoms ● Meconium Iileus Imay Ioccur Iat Ibirth ● Salty Iskin I- Ican Iperform Isweat Itest ● Signs Iof Imalabsorption ● Chronic Icough Iand Ifrequent Irespiratory Iinfection

➔ Acute IRespiratory IDistress ISyndrome I(ARDS) ◆ considered Ito Ibe Ia Irestrictive Ilung Idisorder ◆ multitude Iof Ipredisposing Iconditions Isuch Ias Isystemic Isepsis, Iprolonged Ishock, Iburns, aspiration, Iand Ismoke Iinhalation Imay Icause IARDS ◆ onset Iof Irespiratory Idistress Iusually Ioccurs I 1 Ito I 2 Idays Iafter Ian Iinjury Ior Iother Iprecipitating event ◆ basic Ichanges Iin Ithe Ilungs Iresult Ifrom Iinjury Ito Ithe Ialveolar Iwall Iand Icapillary Imembrane, leading Ito Irelease Iof Ichemical Imediators, Iincreased Ipermeability Iof Ialveolar Icapillary Imembranes, Iincreased Ifluid Iand Iprotein Iin Ithe Iinterstitial Iarea Iand Ialveoli, Iand Idamage ItoIthe Isurfactant-producing Icells ● result Iin Idecreased Idiffusion Iof Ioxygen, Ireduced Iblood Iflow Ito Ithe Ilungs, Idifficulty Iin expanding Ithe Ilungs, Iand Idiffuse Iatelectasis ◆ Signs/Symptoms

● Early Isigns Imay Ibe Imasked Iby Ithe Ieffects Iof Ithe Iprimary Iproblem. ● Onset Iis Iusually Imarked Iby Idyspnea, Irestlessness, Irapid, Ishallow Irespirations, Iand increased Iheart Irate. IArterial Iblood Igas Imeasurements Iindicate Ia IsignificantIdecrease Iin IPO

➔ Pneumonia I (Aspiration, I Nosocomial) ◆ Lower Irespiratory Itract Iinfection ◆ Classification Iis Ibased Ion: ● Causative Iagent I:viral, Ibacterial, Ifungal ● Anatomical Ilocation Iof Iinfection: Ithroughout Iboth Ilungs Ior Iconsolidated Iin Ione Ilobe ● Pathophysiological Ichange: Ichanges Iin Iinterstitial Itissue, Ialveolar Iseptae, Ialveoli ● Epidemiological Idata: Inosocomial Ior Icommunity-acquired

➔ Tuberculosis: ISigns Iand Isymptoms, Itransmission ◆ Cause ● Mycobacterium Ituberculosis Itransmitted Iby Ioral Idroplets Ifrom Ipersons Iwith Iactive infection ● Occurs Imore Ifrequently Iwith: ○ People I living Iin Icrowded Iconditions ○ Immunodeficiency ○ Malnutrition ● Primarily Iaffects Ilungs, Iother Iorgans Imay Ialso Ibe Iinvaded ● TEST IQuestion: ○ s/s Inight Isweat ○ Airborne Iisolation I(respiratory)

➔ Pulmonary IEmbolus: ICause, Isigns Iand Isymptoms ◆ Blood Iclot Ior Imass Ithat Iobstructs Ipulmonary Iartery Ior Iany Iof Iits Ibranches ◆ Effect Iof Iembolism Idepends Ion Imaterial, Isize, Iand Ilocation ◆ Small Ipulmonary Iemboli Imight Ibe I“silent” Iunless Ithey Iinvolve Ia Ilarge Iarea Iof Ithe Ilung ◆ Large Iemboli Imay Icause Isudden Ideath ◆ 90% Iof Ipulmonary Iemboli Ioriginate Ifrom Ideep Ivein Ithromboses Iin Ilegs: Ithey Iare preventable ◆ Signs/Symptoms ● Small Iemboli I- ITransient I chest Ipain, Icough, I dyspnea ● Larger Iemboli I- Iincreased Ichest Ipain Iwith Icoughing Ior Ideep Ibreathing; Itachypnea and Idyspnea Idevelop Isuddenly ○ Later I- Ihemoptysis Iand Ifever Ioccur ○ Hypoxia ● Massive Iemboli I- ISevere Icrushing Ichest Ipain, Ilow IBP, Irapid Iweak Ipulse, Iloss Iof consciousness ➔

Chapter I8: IIntegumentary ➔ Review Iof Iskin ◆ largest Iorgan Iin Ithe Ibody ◆ Two Ilayers ● Epidermis ○ consists Iof Ifive Ilayers, Iwhich Ivary Iin Ithickness Iat Idifferent Iareas Iof Ithe Ibody. ○ no I blood I vessels I or I n erves I (avascular) ● Dermis ○ Nutrients Iand Ifluid Idiffuse Iinto Iit Ifrom Iblood Ivessels Ilocated Iin Ithe Idermis ◆ Appendages

● Hair Ifollicle ○ lined Iby Iepidermis Ithat Iis Icontinuous Iwith Ithe Isurface ○ Each Ihair Ifollicle Ihas Ismooth Imuscle Iattached Ito Iit, Ithe Iarrector Ipili, controlled Iby Isympathetic Inerves ● Sebaceous Iglands ○ produce Ian Ioily Isecretion, Isebum, Iwhich Ikeeps Ithe Ihair Iand Iskin Isoft Iand retards Ifluid Iloss Ifrom Ithe Iskin ● Sweat Iglands ○ Eccrine , Ior Imerocrine, Iglands Iare Ilocated Iall Iover Ithe Ibody Iand Isecrete Isweat through Ipores Ionto Ithe Iskin Iin Iresponse Ito Iincreased Iheat Ior Iemotional IstressI(SNS Icontrol). ○ Apocrine I sweat Iglands Iare Ilocated Iin Ithe Iaxillae, Iscalp, Iface, Iand Iexternal genitalia, Iand Ithe Iducts Iof Ithese Iglands Iopen Iinto Ithe Ihair Ifollicles. ◆ Functions Iof Iskin ● When Iunbroken, I it I provides Ithe I first Ilin e Iof I defen se I against I invasion I by microorganisms Iand Iother Iforeign Imaterial. IThe Isebaceous Iglands Iproduce IsebumIwhich Iis Iacidic Iand Iinhibits Ibacterial Igrowth. IThe Iresident Iflora Iof Ithe Iskin Iis Ia Ideterrent Ito Iinvading Iorganisms. ● Skin Iprevents Iexcessive I fluid Iloss. ● It Iis Iimportant Iin Icontrolling Ibody Itemperature, Iusing Itwo Imechanisms: Icutaneous vasodilation, Iwhich Iincreases Iperipheral Iblood Iflow, Iand Iincreased Isecretion IandIevaporation Iof Isweat—both Ihave Ia Icooling Ieffect Ion Ithe Ibody ● Sensory Iperception Iprovided Iby Ithe Iskin Iis Iimportant Ias Ia Idefense Iagainst environmental Ihazards, Ias Ia Ilearning Itool, Iand Ias Ia Imeans Iof IcommunicatingIemotions. ● Another Iimportant Ifunction Iof Ithe Iskin Iis Ithe Isynthesis Iand Iactivation Iof Ivitamin ID on Iexposure Ito Ismall Iamounts Iof Iultraviolet Ilight. ➔ Lesions ◆ characteristics Iof Iskin Ilesions Iare Ifrequently Ihelpful Iin Imaking Ia Idiagnosis ◆ may I be Icaused Iby Isystemic Idisorders Isuch Ias Iliver Idisease, Isystemic Iinfections Isuch Ias chickenpox I(typical Irash), Ior Iallergies Ito Iingested Ifood Ior Idrugs, Ias Iwell Ias Iby IlocalizedIfactors Isuch Ias Iexposure Ito Itoxins ➔ Carbuncles ◆ Collection Iof Ifuruncles Ithat Icoalesce Ito Iform Ia Ilarge Iinfected Imass ◆ Type Iof Iskin Ibacterial Iinfection ◆ Boils ◆ Where Iwould Iyou Ifind Icarbuncles? IHair Ifollicles

➔ Vesicles ◆ Fluid Ifilled Ior Iair Ifilled Isacs ◆ Blisters ◆ Type Iof Iskin Ilesion ◆ Clear Ifluid Iair Ifilled Isac

➔ Papules ◆ Wart Ilike ◆ Firm, Ielevated Iskin Ilesion

➔ Macules ◆ Freckles Ior Isun Ispots ◆ Small, Iflat Iarea Ion Iskin Iwith Ichange Iin Icolor ◆ Type Iof Iskin Ilesion

➔ Tinea ICapitus ◆ Ringworm Ion I scalp ◆ Think ICap I= Ihead

➔ Herpes IZoster ◆ varicella- Izoster Ivirus I( IVZV) ◆ intitial Iinfection Iw/ Ivaricella, Ifollowed Iyrs Ilater Iby Iherpes Izoster ● Shingles, I chicken I pox

➔ Pemphigus ◆ An Iautoimmune Idisorder Icausing Iblisters Ito Iform Ion Ithe Iskin ◆ is Ian Iautoimmune Idisorder Ithat Icomes Iin Iseveral Iforms: Ipemphigus Ivulgaris, Ipemphigus foliaceus, Iand Ipemphigus Ierythematosus. ◆ The Iseverity Iof Ithe Idisease Ivaries Iamong Iindividuals. ◆ The Iautoantibodies Idisrupt Ithe Icohesion Ibetween Ithe Iepidermal Icells, Icausing Iblisters Ito form. ◆ In Ithe Imost Icommon Iform, Ipemphigus Ivulgaris, Ithe Iepidermis Iseparates Iabove Ithe Ibasal layer. ◆ Blisters Iform Iinitially Iin Ithe Ioral Imucosa Ior Iscalp Iand Ithen Ispread Iover Ithe IfaceIand Itrunk Iduring Ithe Iensuing Imonths. ◆ The Ivesicles Ibecome Ilarge Iand Itend Ito Irupture, Ileaving Ilarge Idenuded Iareas Iof Iskin covered Iwith Icrusts. ◆ Systemic Iglucocorticoids Isuch Ias Iprednisone Iand Iother Iimmunosuppressants Iare Iused Ito treat Ipemphigus.

➔ Impetigo ◆ Bacterial Iinfection IcausedIby IStaphylococcus IAureus, IVERY Icontagious ◆ common Iinfection Iin Iinfants Iand Ichildren Ibut Ican Ialso Ioccur Iin Iadults I(day Icares Ior Igyms) ◆ Spread Iby IDIRECT Icontact ◆ Signs/Symptoms ● Lesions Icommonly Ioccur Ion Ithe Iface Iand Ibegin Ias Ismall Ivesicles, Iwhich Irapidly enlarge Iand Irupture Ito Iform Iyellowish-brown Icrusty Imasses ● Underneath Ithis Icharacteristic Icrust, Ithe Ilesion Iis Ired Iand Imoist Iand Iexudes Ia honey-colored Iliquid ◆ Treatment ● Topical Iantibiotics Imay Ibe Iused Iin Ithe Iearly Istages, Ibut Isystemic Iadministration Iof these Idrugs Iis Inecessary Iif Ithe Ilesions Iare Iextensive. IUnfortunately, Ithe Inumber Iof Iantibiotic-resistant Istrains Iof I S. Iaureus I is Iincreasing, Iresulting Iin Ilocal Ioutbreaks IofIinfection

➔ Urticarial Ilesions: IAppearance Iand Icause ◆ Urticaria I(hives) I results Ifrom Ia Itype II Ihypersensitivity I reaction, Icommonly Icaused Iby Iingested Isubstances Isuch Ias Ishellfish Ior Icertain Ifruits Ior Idrugs. IThe Isubsequent Irelease IofI histamine I causes Ithe Ieruption Iof Ihard, Iraised Ierythematous Ilesions Ion Ithe Iskin, Ioften Iscattered Iall Iover Ithe Ibody I(Fig. I 8 - 4). IThe Ilesions Iare Ihighly Ipruritic. IOccasionally Ihives also Idevelop Iin Ithe Ipharyngeal Imucosa Iand Imay Iobstruct Ithe Iairway, Icausing Idifficulty Iwith Ibreathing. IIn Ithis Icase, Imedical Iassistance Ishould Ibe Isought Ias Iquickly Ias Ipossible.

➔ Malignant IMelanoma ◆ This Imuch Imore Iserious Iform Iof Iskin Icancer Idevelops Ifrom Ithe Imelanocytes Iand Iis increasing Iin Iincidence. IThe Idevelopment Iof Imalignant Imelanoma Idepends Ion IgeneticIfactors, Iexposure Ito Iultraviolet Iradiation, Iand Ihormonal Iinfluences.

◆ Melanomas Iarise Ifrom Imelanocytes Iin Ithe Ibasal Ilayer Iof Ithe Iepidermis Ior Ifrom Ia Inevus I(mole), Ia Icollection Iof Imelanocytes. IThere Iare Imany Itypes Iof Inevi, Imost Iof Iwhich Ido Inot Ibecome Imalignant. INevi Ithat Igrow; Ichange Ishape, Icolor, Isize, Ior Itexture; Ior Ibleed Iare Ito Ibe Isuspected I(Box I8-1). IMalignant Imelanoma Ioften Iappears Ias Ia Imulticolored Ilesion Iwith Ian Iirregular Iborder I(Fig. I8-15). IMelanomas Igrow Iquickly, Iextending Idown Iinto Ithe Itissues,Ithen Imetastasize Iquickly Ito Ithe Iregional Ilymph Inodes Iand Ithen Ito Iother Iorgans, Ileading ItoIa Ipoor Iprognosis Iin Imany Icases. IWhen Ithey Iare Isurgically Iremoved, Ian Iextensive Iamount Iof Itissue Iaround Iand Ibelow Ithe Ilesion Iis Iexcised Ias Iwell Ito Iensure Ithat Iall Ithe Imalignant Icells Iare Iremoved. IAdditional Iradiation Iand Ichemotherapy Inow Iprovides Ia I5- year Isurvival Irate Iof Iapproximately I99% Iin Icases Iof Ilocalized Itumors Iand I7% Ito I70% Iin Icases Iin Iwhich Ithe Itumor Ihas Iinvaded Ior Imetastasized, Idepending Ion Iwhat Itissues Ihave Ibeen Iinvaded Iand Ithe Iextent Iof Ithe Imetastasis. IIn Ithe IUnited IStates I80% Iof Imelanomas Iare Iidentified IinIthe Ilocalized Istage.

➔ Herpes ISimplex IVirus I(I Iand III) ◆ Pain Iaround I your Imouth ◆ Something Ion I your I lip ◆ Type II I(cold Isores) ● most Icommon Icause Iof Icold Isores Ior Ifever Iblisters, Iwhich Ioccur Ion Ior Inear Ithe Ilips ● Infected Isaliva ● ◆ Type I 2 I(genital Iherpes) ● may Icause Ioral Ias Iwell Ias Igenital Ilesions. ● Caused Iby Imucous Imembrane Icontact ◆ virus Iis Ispread Iby Idirect Icontact Iwith Ifluid Ifrom Ithe Ilesion

➔ Candidiasis: ISigns Iand Isymptoms, Ilocations. I- Iselect Iall Ithat Iapply ◆ Yeast I infection I- I vaginal ◆ causes Iintense Iitching, Iswelling, Iand Iirritation ◆ Caused Iby I Candida Ialbicans ◆ Oral Iinfection I - I thrush ◆ Select Iall: IVagina IandImucous Imembrane

➔ Pressure IUlcer: I FirstIindication- Iredness ◆ Also Iknown Ias Idecubitus Iulcers I(pressure Isores Ior Ibedsores) ◆ Cavity Iwith Iloss Iof Itissue Ifrom Ithe Iepidermis Iand Idermis, Ioften Iweeping Ior Ibleeding ◆ Pressure Iat Ithese Ipoints Icauses Iischemia Iand Inecrosis Iof Itissue, Ileading Ito Idecubitus ulcers I(pressure Isores Ior Ibedsores) ◆ Other Ifactors Ithat Ipromote Iskin Ibreakdown Iand Idevelopment Iof Idecubiti I(pressure Iulcers) include: ● Poor Igeneral Icirculation Ior Ianemia ● Edema ● Inadequate Isubcutaneous Itissue Iin Ithe Ielderly Ior Idebilitated Iperson ● Loss Iof Isensation ● Prolonged Istatic Ipositioning ● Mechanical Iirritation Ior Ifriction Iby Iclothing, Ibraces, Ior Iother Iequipment ● Excessive Imoisture Ifrom Iperspiration Ior Iurine ● Poor Ipersonal Ihygiene ● Inadequate Inutrition Ior Ihydration ● Trauma Ito Ithe Iskin Idue Ito Ifriction Iagainst Iclothing Ior Isheets Iif Ia Ipatient Iis Imoved without Idue Icare Ior Islides Idown Iin Ibed, Ior Iif Iskeletal Imuscle Ispasms Ioccur; IadhesiveItape Imay Iirritate Ithe Iskin Idirectly Ior Iindirectly Iwhen Iit Iis Iremoved ◆ Pressure Iulcers Iare Idifficult Ito Iheal Iunless Ithe Ipredisposing Iconditions Ican Ibe Iremoved.

◆ The Iaffected Iarea Ifirst Iappears Ired, Iand Ithen Isuperficial Iskin Ibreakdown Iis Iapparent. IUlceration Ifollows, Iand Ithe Iarea Imay Ibecome Ia Ipurplish-red Icolor Iif Ithe Idamage Iis Ideep. IEventually Inecrosis Idestroys Ideeper Itissue, Iand Ia Ilarge Iopen Iarea Idevelops Iwith Ifull- Ithickness Idamage. ILocal Iinfection Iis Icommon. ◆ Bedsores I— Ialso Icalled Ipressure Iulcers Iand Idecubitus Iulcers I— Iare Iinjuries Ito Iskin Iand underlying Itissue Iresulting Ifrom Iprolonged Ipressure Ion Ithe Iskin. IBedsores Imost Ioften Idevelop Ion Iskin Ithat Icovers Ibony Iareas Iof Ithe Ibody, Isuch Ias Ithe Iheels, Iankles, Ihips IandItailbone. ◆ People Imost Iat Irisk Iof Ibedsores Iare Ithose Iwith Ia Imedical Icondition Ithat Ilimits Itheir Iability to Ichange Ipositions Ior Ithose Iwho Ispend Imost Iof Itheir Itime Iin Ia Ibed Ior Ichair. ◆ Bedsores Ican Idevelop Iquickly. IMost Isores Iheal Iwith Itreatment, Ibut Isome Inever Iheal completely. IYou Ican Itake Isteps Ito Ihelp Iprevent Ibedsores Iand Iaid Ihealing.

➔ Keloids ◆ A Iraised Iscar Iafter Ian Iinjury Ihas Ihealed. ◆ Excessive I collagen ◆ Who Iis Imore Isusceptible Ito Ikeloids? I African Iamericans ◆ , I asians, Iamerican Iindians. IOr Inorthern Ieuropeans I- Ifind Ithat Iout

➔ Psoriasis ◆ Chronic Iinflammatory Iskin Idisorder Ithat Iaffects I1% Ito I3% Iof Ithe Ipopulation Iand Iis considered Ito Ibe Igenetic Iin Iorigin Ifollowing Irecent Iresearch Istudies Iin Imice ◆ Onset Iusually Ioccurs Iin Ithe Iteen Iyears, Iand Ithe Icourse Iis Imarked Iby Iremissions Iand exacerbations I(comes Iand Igoes) ◆ Pathophysiology ● results Ifrom Ithe Iabnormal Iactivation Iof IT Icells Iand Ian Iassociated Iincrease Iin cytokines Iin Iaffected Itissues. IThese Iimmunologic Ichanges Ithen Ilead Ito Iexcessive Iproliferation Iof Ikeratinocytes Iand Ithe Isymptoms Iof Ithe Idisease ● The Irate Iof Icellular Iproliferation Iis Igreatly Iincreased, Ileading Ito Ithickening Iof Ithe dermis Iand Iepidermis. IEpidermal Ishedding Imay Ioccur Iin I 1 Iday Irather Ithan ItheInormal I2-week Iturnover Iperiod. ◆ Signs/Symptoms ● The Ilesion Ibegins Ias Ia Ismall Ired Ipapule Ithat Ienlarges ● Silvery Iplaque Ilesions ◆ Treatment ● includes Iglucocorticoids, Itar Ipreparations, Iand, Iin Isevere Icases, Ithe Iantimetabolite methotrexate. IExposure Ito Iultraviolet Ilight Iis Ifrequently Ipart Iof Ithe ItreatmentIregimen

➔ Pustule ◆ Elevated Ilesion Ifilled Iwith Ipus ◆ Pimple

➔ Nevi I(Nevus)/mole Ievaluation ◆ ABCD I sign ● Area Iof Imole Iis Iincreased, Iborder Iis Iirregular, Icolor Ichange, Idiameter Iincreased

➔ Contact IVs IAtopic Idermatitis ◆ Contact ● may Ibe Icaused Iby Iexposure Ito Ian Iallergen Ior Iby Idirect Ichemical Ior Imechanical irritation Iof Ithe Iskin ● Allergic I dermatitis Imay Iresult Ifrom Iexposure Ito Iany Iof Ia Imultitude Iof Isubstances, including Imetals, Icosmetics, Isoaps, Ichemicals, Iand Iplants

○ Typical Iallergic Idermatitis Iis Iindicated Iby Ia Ipruritic, Ierythematous, IandIedematous Iarea, Iwhich Iis Ioften Icovered Iwith Ismall Ivesicles. ● Example: IPoison IIvy ◆ Atopic ● Atopic Idermatitis I(eczema) Iis Ia Icommon Iproblem Iin Iinfancy Iand Imay Ipersist Iinto adulthood Iin Isome Ipersons. ● Atopic Irefers Ito Ian Iinherited Itendency Itoward Iallergic Iconditions ● Eosinophilia Iand Iincreased Iserum IIgE Ilevels Iindicate Ithe Iallergenic Ibasis Ifor Iatopic dermatitis I (type I I Ihypersensitivity).

Chapter I10: IHematology ➔ Anemia: IDifferent Itypes I(Iron Ideficiency, IPernicious, ISickle ICell, IHemolytic, IAplastic) IcellIappearance, Icauses, Isigns Iand Isymptoms, Itreatment. ◆ KNOW I SIGNS I OF IANEMIA: I Fatigue, I pallor, Idyspnea, Itachycardia ◆ Anemias Icause Ia Ireduction Iin Ioxygen Itransport Iin Ithe Iblood Idue Ito Ia Idecrease Iin hemoglobin I content. ◆ The Ilow Ihemoglobin Ilevel Imay Iresult Ifrom Ideclining Iproduction Iof Ithe Iprotein, Ia Idecrease in Ithe Inumber Iof Ierythrocytes, Ior Ia Icombination Iof Ithese Ifactors. ◆ Anemias Imay Ibe Iclassified Iby Itypical Icell Icharacteristics Isuch Ias Isize Iand Ishape (morphology) I or I by Ietiology

◆ Iron Ideficiency IAnemia ● Insufficient Iiron Iimpedes Ithe Isynthesis Iof Ihemoglobin, Ithereby Ireducing Ithe Iamount of Ioxygen Itransported Iin Ithe Iblood ● this Iresults Iin Imicrocytic I(small Icell), Ihypochromic I(less Icolor) Ierythrocytes Iowing Ito a Ilow Iconcentration Iof Ihemoglobin Iin Ieach Icell ● Iron Ideficiency Iis Icommon ● Take Iiron Isupplement Iwith Icalcium, Inot Imilk

◆ Pernicious IAnemia I– IPARESTHESIA I= ITINGLING IOF IHANDSIANDINUMBING ● A Idecrease Iin Ired Iblood Icells Iwhen Ithe Ibody Ican't Iabsorb Ienough Ivitamin IB-12. ● characterized I by I very I large, I immature, I nucleated Ierythrocytes. ● deficit Iof Ivitamin IB12 Ileads Ito Iimpaired Imaturation Iof Ierythrocytes Iowing Ito interference Iwith IDNA Isynthesis ● Significant Ideficit Iof IVit. IB12 Iwill Icause Isymptoms Iin Ithe Iperipheral Inerves ● Lack Iof Iintrinsic Ifactor ● WHY IDO IPEOPLE IWITH IPERNICIOUS IANEMIA IHAVE ITO IGET IB12 ISHOTS?? ○ Because IB12 Iis Ihard Ito Iget Iabsorbed Iinto Ithe Iblood ● KnowIall I 4 Itypes Iof IAnemia

◆ Aplastic I Anemia ● results Ifrom Iimpairment Ior Ifailure Iof Ibone Imarrow, Ileading Ito Iloss Iof Istem Icells Iand pancytopenia I(the Idecreased Inumbers Iof Iall Icells, Ierythrocytes, Ileukocytes, IandIplatelets Iin Ithe Iblood) I Pan Imeans Iall ● Prone Ito Ifrequent Iinfections Iand Iexcessive Ibleeding ● Aplastic Ianemia Imay Ibe Ia Itemporary Ior Ipermanent Icondition Idepending Ion Ithe cause ○ Viruses, I particularly I hepatitis IC, I may I cause Iaplastic Ianemia. ● Requires Iblood Icount Iand Ibiopsy Ifor Iidentification, Icauses I and Itreatment Ifor Ithe blood I deficiency

◆ Hemolytic IAnemia

● result Ifrom Iexcessive Idestruction Iof IRBCs, Ior Ihemolysis, Ileading Ito Ia IlowIerythrocyte Icount Iand Ilow Itotal Ihemoglobin ● have Imany Icauses, Iincluding Igenetic Idefects Iaffecting Istructure, Iimmune Ireactions, changes Iin Iblood Ichemistry, Ithe Ipresence Iof Itoxins Iin Ithe Iblood, Iinfections Isuch IasImalaria, Itransfusion Ireactions, Iand Iblood Iincompatibility Iin Ithe Ineonate ● Example: ○ Sickle ICell IAnemia ◆ A Igroup Iof Idisorders Ithat Icause Ired Iblood Icells Ito Ibecome Imisshapen and Ibreak Idown. IC-shaped ◆ gene Ifor IHbS Iis Iautosomal Irecessive Iand Iis Ivery Icommon Iin Iindividuals from IAfrica Iand Ithe IMiddle IEast. ◆ Sickle Icell Icrisis Ioccurs Iwhenever Ioxygen Ilevels Iare Ilowered ◆ Sickle-shaped Icells Iare Itoo Ilarge Ito Ipass Ithrough Imicrocirculation ◆ Obstruction Ileads Ito Imultiple Iinfarctions Iand Iareas Iof Inecrosis ◆ Signs/symptoms ● Do Inot Ishow Iuntil I 12 Imonths Iold ● Severe Ipain Idue Ito Iischemia ● Pallor, I weakness, I tachycardia, I dyspnea, I jaundice, I congestive heart Ifailure ◆ Treatment: ● Folic Iacid Isupp. IBone Imarrow Itransplant I(only Icure), immunization Iagainst Ipneumonia, Iinfluenza, Imeningitis ◆ They Ihave Iimmunity Ito Imalaria ◆ Sickle Icell Iare Itoo Ilarge Ito Ipass Ithrough Ithe Imicrocirculation ◆ It’s Iinherited ◆ WHY IDO IPATIENTS IWITH ISICKLE ICELLIUSUALLY IHAVE IVASCULARIOBSTRUCTIONS? ● Obstruction Ileads ItoImultiple Iinfarctions IandIareas Iof necrosis

◆ Thalassemia IAnemia I(genetic Idefect/ Imost Icommon) ● Lack Ieither IAlpha Ior IBeta IglocalIchains Iin Ihemoglobin ● results Ifrom Ia Igenetic Idefect Iin Iwhich Ione Ior Imore Igenes Ifor Ihemoglobin Iare missing Ior Ivariant. ● When Itwo Igenes Iare Iinvolved, Ithalassemia Iis Imoderate Ito Isevere. ● This Iabnormality Iinterferes Iwith Ithe Iproduction Iof Ithe Iglobin Ichains, Iand Itherefore, the I amount I of Ihemoglobin Isynthesized Iand Ithe Inumber Iof IRBCs Iis Ireduced. ● most Icommon Igenetic Idisorder Iin Ithe Iworld Iand Iit Ioccurs Iin Itwo Icommon Iforms. ○ Thalassemia Ibeta I(autosomal Idominant Iinheritance) Ioccurs Ifrequently Iin people Ifrom IMediterranean Icountries Isuch Ias IGreece Ior IItaly, IandIthalassemia Ibeta Iis Ithe Imore Icommon Iform. ○ The Ialpha Iform Iis Ifound Iin Ithose Iof IIndian, IChinese, Ior ISoutheast IAsian descent. IBecause Imore Ithan Ione Igene Iis Iinvolved, Ithere Iare Imany Ipossible Igene Imutations Iwith Ivaried Ieffects Ion Ihemoglobin Isynthesis Iand Ithe IseverityIof Ithe Iresultant Ianemia.

➔ Polycythemia IVera: Icauses, Isigns Iand Isymptoms, Itreatment ◆ When I your Ibody Imakes Itoo Imuch Iblood ◆ Primary Ipolycythemia ◆ Increased Iproduction Iof Ierythrocytes Iand IotherIcells Iin Ibone Imarrow I(keepsImaking Iand Imaking) ◆ Neoplastic I disorder ◆ Signs/Symptoms ● Distended Iblood Ivessels, Isluggish Iblood Iflow

● Increase IBP, Ihypertrophied Iheart I(heart Ienlarging Iin Isize) ● Hepatomegaly I (condition I of Ienlarged I liver) I Splenomegaly I(enlarged Ispleen) ● Dyspnea, Iheadaches, Ivisual Idisturbances, Ithrombosis Iand Iinfarction ◆ Treatment ● Identify Icause ● Drugs/radiation I - I suppress I bone I marrow I activity ● Periodic I phlebotomy

➔ Universal IDonor Iand Ipatho Ibehind Iit ◆ a Iperson Iof Iblood Igroup IO, Iwho Ican Iin Itheory Idonate Iblood Ito Irecipients Iof Iany IABO IbloodIgroup Idue Ito I lack Iof IA Iand IB IANTIGENS

➔ DIC: ISigns Iand Isymptoms, Icause ◆ WhatIdoes Ia Ipatient Iwith IDisseminated IIntravascular ICoagulation Ishow? ◆ Involves I both I excessive I bleeding I and I clotting; I widespread, I uncontrollable I hemorrhage ◆ Clotting Ifactors Iare Ireduced ItoIa Idangerous Ilevel ◆ Poor Iprognosis Iwith Ihigh Ifatality Irate ◆ Complications Iof Imany Iprimary Iproblems ● Infections, Icarcinomas, Imajor Itrauma

➔ Leukemia: ◆ Group I of Ineoplastic I disorders Iinvolving IWBC, Iuncontrolled IWBC Iproduction Ion Ibone Ior lymph Inode ◆ Large Inumbers Iare Ireleased Iinto Igeneral Icirculation ◆ Infiltrate Ilymph Inodes, Ispleen, Iliver, Ibrain, Iand Iother Iorgans ◆ Acute Ileukemias I(ALL Iand IAML) ● High Iproportion Iof Iimmature Inonfunctional Icells Iin Ibone Imarrow Iand Iperipheral circulation ● Onset Iusually Iabrupt, Imarked Isigns Iof Icomplications ● Signs/Symptoms ○ Severe Ibone Ipain, Iweight Iloss, Ifatigue, Ipossible Ifever ○ Enlarged Ilymph Inodes, Ispleen, Iliver ○ Headache, Ivisual Idisturbance, Idrowsiness, Ivomiting ● Treatment ○ Chemotherapy, IBiological Itherapy ◆ Chronic Ileukemias I(CLL Iand ICML) ● Higher Iproportion Iof Imature I cells ● Insidious Ionset, Imild Isigns Iand Ibetter Iprognosis ○ Common Iin Iolder Iadults

➔ Erythropoietin: IFunction ◆ Originating Ifrom Ithe Ikidney, Istimulates Ierythrocyte Iproduction Iin Ithe Ired Ibone Imarrow Iin response Ito Itissue Ihypoxia, Ior Iinsufficient Ioxygen Iavailable Ito Icells.

➔ Pancytopenia, IPetechiae, IPurpura ◆ Petechiae ● Pinpoint, Iflat, Ired Ispots Ion Iskin Iand Imucous Imembrane ◆ Purpura ● reddish-blue Idiscoloration Iof Ithe Iskin Idue Ito Ibleeding; Ibruise. ◆ Pancytopenia ● decrease Iin Iall Iblood Icells, Ierythrocytes, Ileukocytes, Iand Ithrombocytes ◆ PETECHIA IAND IPURPURA IMEANS IEXCESSIVE IBLEEDING

➔ Aplastic IAnemia Isigns Iand Isymptoms ◆ Impairment Ior Ifailure Iof Ibone Imarrow

◆ May Ibe Itemporary Ior Ipermanent ◆ Often Iidiopathic Ibut Ipossible Icauses Iinclude: ● Myelotoxins ○ Radiation, Iindustrial Ichemicals, Idrugs ● Viruses ○ Particularly Ihepatitis IC ● Autoimmune Idisease ○ Systemic I Lupus IErythomatosus I (SLE) ● Genetic Iabnormalities ○ Myelodysplastic Isyndrome ○ Faconi’s Ianemia ◆ Blood Icounts Iindicate Ipancytopenia I(deficiency Iof Iall Ithree Icellular Icomponents Iof Ithe blood) ● Bone Imarrow Ibiopsy Imay Ibe Irequired ● Erythrocytes Ioften Iappear Inormal ◆ Failure Ito Iidentify Icause Iand Itreat Ieffectively Iis ILIFE ITHREATENING

TEST IQUESTIONS IFROM I CAS:

(DiagramIof ICirculatory ISystem I(optional IforIfuture Ipurposes)

**1. Surfactant I- Iwhy Iis Iit Iimportant??

2. Obstructive IAirway IDisorders
3. Restrictive IAirway IDisorders**