Pathophysiology Final Exam Review Notes, Exams of Pathophysiology

Download Pathophysiology Final Exam Review Notes and more Exams Pathophysiology in PDF only on Docsity! NR283 - Pathophysiology - Final Exam (review exam 1 and 2) 2023. Type 1 Diabetes - ✓✓✓*ZERO* insulin production *Cause:* - autoimmune *Patho:* - beta cells are destroyed *S&S* - polyuria - polyphagia - polydipsia - glucose in urine - dehydration - hyperglycemia Type 1 Diabetes Crisis - ✓✓✓*DKA* *Cause:* - infection - stress - medication incompliance - diet incompliance *Patho:* - hyperglycemia -> zero insulin -> body goes elsewhere for energy -> break down of fats -> ketones -> acidosis (DKA) *S&S* - polyuria - polyphagia - polydipsia - F/E imbalance - fruity breath - ketonuria - kussmaul breathing (rapid deep breaths) Type 2 Diabetes - ✓✓✓insulin resistance decreased insulin production *Cause:* - genetics - obesity *Patho:* - resistance DT insulin not working - decrease production (body compensation - releases insulin) - stops releasing insulin DT nonuse (hyperinsulemia) *S&S* - polyuria - polyphagia - polydipsia - glucose in urine - hyperglycemia *acidosis death* *reversible with diet and exercise* Type 2 Diabetes Crisis - ✓✓✓*HHNKS* - rare *Cause:* - elderly - poor diet *Patho:* - insulin resistance *S&S* - SEVERE hyperglycemia - SEVERE dehydration - electrolyte imbalance *Complications:* - hyperglycemia -- confusion -- lethargy -- coma -- slurred speeche -- parathesia (pins and needles) -- shakiness -- diaphoresis - nephropathy (ESKD) - neuropathy (amputation) - retinopathy (blindness) *reversible with diet and exercise* hyperthyroidism - ✓✓✓*Grave's Disease* *Cause:* - autoimmune *Patho:* - formation of antibodies -> attach to receptors on thyroid gland -> over works thyroid -> over production of TH - neurogenic (brain tumor) - nephrogenic (kidney disease/ tumor) *S&S* - decreased reabsorption - dehydration - hypernatremia - increased urine output (diluted - LARGE amount) - decreased BP *get rid all water* *dehydration death* Cushing's Disease - ✓✓✓*increased cortisol and aldosterone* *Cause:* - adenoma on pituitary gland *S&S* - weight gain - moon face - buffalo hump - truncal obesity - hyperglycemia DT insulin resistance - hypertension - edema - decreased potassium - delayed wound healing - increase risk of infection - delay stress response Addison's Disease - ✓✓✓*decreased cortisol and aldosterone* *Cause:* - autoimmune - adrenal gland destroyed or tumor *S&S* - hyperglyccemic - dehydration - increased potassium - decreased sodium - risk of infection - decreased stress response - hyperpigmentation (bronze - increased ACTH) fracture - ✓✓✓*a break in the integrity of a bone.* *Complete* - bone broken, forming separate pieces *Incomplete* - bone only partially broken *Open (compound)* - skin broken *medical emergency* *Closed* skin not broken *Complications* - Infections - Ischemia - Compartment syndrome -- Increased pressure of fluid — compress nerve and blood vessel — severe pain, ischemia and necrosis - Fat emboli *Signs and symptoms * - Deformity -- crepitus -- inflammation (pain, edema, swelling) *Others: Shock, hypotension, and tachycardia due to severe pain* sprain - ✓✓✓a tear in a *ligament* *Signs and symptoms* - pain - swelling - discoloration due to hematoma - strength and ROM is limited strain - ✓✓✓a tear in a *tendon* *Signs and symptoms* - pain - swelling - discoloration due to hematoma - strength and ROM is limited osteoporosis - ✓✓✓*Decrease in bone mass and density* *Forms:* - Primary - Idiopathic - Secondary - complication of another disorder *Patho* - Bone resorption exceeds formation. - Results in loss of compact bone *Signs and symptoms* - Asymptomatic until fracture occur - Can cause compression fractures of vertebrae, wrist, or hip - Can lead to kyphosis and scoliosis *Predisposing factors* - Age 50+ years - Decreased mobility or sedentary lifestyle - Hormonal factors -- Excess corticosteroids or parathyroid hormone (PTH) -- Deficit of estrogen or testosterone - Deficits of calcium, vitamin D, or protein - Cigarette smoking - Lower BMI - Asian or European ancestry - Excessive caffeine intake osteoarthritis - ✓✓✓*Degenerative—wear and tear joint disease* *Patho* - Articular cartilage is damaged. - Surface of cartilage becomes rough and worn - Joint space becomes narrower. - Secondary inflammation of surrounding tissue *Etiology* - Primary form -- weight-bearing, obesity, aging - Secondary form -- follows trauma or repetitive use - Genetic factors thought to play a role - Weight-bearing joints most frequently affected but finger joints also involved *Signs and symptoms* - *Aching pain with weight-bearing and movement* - *Joint movement is limited* - *Predisposition to falls* - Bony enlargement of distal interphalangeal joints--Heberden's node - Crepitus - No systemic signs or changes in serum levels. - X ray evidence—joint changes *more pain with activity* rheumatoid arthritis - ✓✓✓*Autoimmune disorder--systemic inflammatory disease* *Higher incidence in women, affects all age groups* *Patho* - Remissions and exacerbation lead to regressive damage to the joint. - *Symmetric involvement of the small joints* - atelectasis -- respiration slow and shallow - Deep breathing and coughing more difficult - Stasis of secretions - Drugs -- sedatives and analgesics - Depress neuromuscular activity and respiratory control center systemic effects of immobility - Gastrointestinal Effects - ✓✓✓*Constipation* - Caused by muscle inactivity, weak muscle and body position - Reduced food, fiber, fluid intake *Decreased dietary intake* - Appetite reduced *Obesity* - When prolonged immobility occurs and caloric intake exceeds energy need systemic effects of immobility - Urinary Effects - ✓✓✓*Infection* - Stasis of urine and calculi are predisposing factors. *Renal calculi (stones)* - More likely in people with hypercalcemia *Bladder infection* - Common if catheters are used *Dehydration* systemic effects of immobility - Neural and Psychological Effects - ✓✓✓*Pain* -Immobility can cause the stimulation of sensory receptors in the skin and effected tissue leading to pain. *Negative psychological effects* - Depression, anxiety, confusion, etc. effects of stress response - ✓✓✓- Elevated blood pressure and increased heart rate - Bronchodilation and increased ventilation - Increased blood glucose levels - Arousal of the central nervous system - Decreased inflammatory and immune responses general effects of neurologic dysfunction - ✓✓✓*Local (Focal) Effects* - Signs related to the specific area of the brain or spinal cord in which lesion is located *Level of Consciousness* - Decreased level of consciousness or responsiveness -- *Early changes with acute brain disorders* - Levels of reduced consciousness -- Somnolent, lethargy, obtunded, stuporous -- *The most serious level: loss of consciousness or coma* *Vegetative state* - Loss of awareness and mental capabilities, has sleep-wake cycles, is not able to communicate and only displays reflexive and non-purposeful behavior resulting from diffuse brain damage *Locked-in syndrome* - Individual is aware and capable of thinking but is paralyzed, cannot communicate verbally due to complete paralysis of nearly all voluntary muscles in the body except for the eyes -- Eye or eyelid movements are the main method of communication. *Motor Dysfunction * - Weakness and paralysis - *Hyperreflexia* -- Muscle tone and reflexes maybe increased - *Spastic paralysis* -- leads to immobility resulting contracture in the affected limbs - *Flaccid* -- absence of tone - De*c*orti*c*ate and d*e*c*e*r*e*brat*e* posturing -- Severe brain damage *Sensory Deficits* - Sensory loss may involve touch, pain, temperature, and position and the special senses of vision, hearing, taste, and smell. *Language Disorders* - Aphasia -- Inability to comprehend or express language -- Receptive—damage to Wernicke's area --- Inability to read or understand the spoken word --- *Source*—inability to process information in the brain -- *Expressive*—damage to Broca's area --- Impaired ability to speak or write fluently or appropriately -- Mixed, global—damage to both areas or to the fibers and tracts between them --- Can't express self or comprehend others' language - Dysarthria -- Motor dysfunction affecting muscles used in speech brain death - ✓✓✓*Cessation of brain function * - Absence of brainstem reflexes or responses - Absence of spontaneous respirations when ventilator assistance is withdrawn - Establishment of the certainty of irreversible brain damage by confirmation of cause of the dysfunction possible S&S of increased cranial pressure (ICP) - ✓✓✓*Increase in fluid or additional mass causes increase in pressure in the brain* *Early signs* - *Decreasing level of consciousness or decreased responsiveness (lethargy)* - *Decreased pupillary responses* - (Severe headache: from stretching of dura and walls of large blood vessels* - *Vomiting (often projectile)* -- Result of pressure stimulating the emetic center in the medulla - Papilledema -- Caused by increased ICP and swelling of the optic disc *Late sign * - *Cushing triad* 1. *Increase of systemic blood pressure with increase pulse pressure* due to systemic vasoconstriction -- Send more blood to brain 2. *Bradycardia* -- slowing heart rate -- response by baroreceptors to hypertension 3. *Irregular respiration pattern* - Pupils become fixed and dilated - Ptosis (droopy eyelid) may occur. head trauma - concussion - ✓✓✓*mild traumatic brain injury (MTBI)* - sudden excessive movement of the brain, disrupting neurologic function and leading to loss of consciousness - Amnesia, headaches - *reversible* Spinal cord injury - spinal shock - ✓✓✓*Complete loss* of reflex function (skeletal, bladder, bowel, sexual function, thermal control, and autonomic control) at and below the level of the injury transient ischemic attacks (TIA) - ✓✓✓*Result from temporary localized reduction of blood flow in the brain* *Recovery occurs within 24 hours* *Caused by* - Partial occlusion of an artery, Atherosclerosis, Small embolus - Vascular spasm, Local loss of autoregulation *Signs and symptoms* - The manifestations are related to the location of the ischemia - Remain conscious -Intermittent short episode of impaired function *Repeated attacks may be a warning sign for obstruction related to atherosclerosis (CVA)* cerebrovascular accident (CVA) - ✓✓✓*An acute neurologic deficit lasting more than 24 hours and caused by cerebrovascular etiology* - Brain tissue necrosis that results from lack of blood. - 5 minutes of ischemia causes irreversible nerve cell damage. *Medical Emergency* - visual disturbance -- blurred vision, diplopia (double vision), scotoma (spot in visual field), - sensory deficits -- paresthesia, areas of numbness, burning, tingling -weakness in legs -- progressive weakness and paralysis extending to the upper limbs Others symptoms include: dysarthria, Loss of coordination, bladder, bowel and sexual dysfunction, chronic fatigue *Complications* - Immobility -- respiratory infection, decubitus ulcers, contractures, etc. Parkinson - ✓✓✓*Progressive degenerative disorder * *Dysfunction of the extrapyramidal motor system* - *Progressive degeneration in basal nuclei, mainly in the substantia nigra* - *Decreased secretion of dopamine, an inhibitory neurotransmitter* -- Due to decreased number of neurons in the substantia nigra -- Result of Imbalance between excitation and inhibition in basal nuclei *Primary or idiopathic Parkinson's disease* - Usually develops after age 60 *Secondary parkinsonism* - caused by Encephalitis - Trauma (e.g., sports injury) - Vascular disease - Drug-induced (e.g., phenothiazine tranquilizers) *S&S* - Resting tremors - Muscular rigidity - Difficulty initiating movement - Postural instability dementia - ✓✓✓*Progressive chronic disease* *Cortical function is decreased.* - Impaired cognitive skills: thinking, judgment, and learning - Memory loss - Confusion -Behavioral and personality changes *Causes* - Vascular disease - Infections - Genetic disorders - AD is the most common form of dementia Alzheimer Disease (AD) - ✓✓✓*Progressive cortical atrophy* *Neurofibrillary tangles, senile plagues which disrupt neural conduction* *ACh deficit also occurs in the affected brain* *Signs and symptoms* - Extend over 10 to 20 years - *Early stage* -- gradual loss of memory and lack of concentration -- Impaired learning, poor judgment -- *Behavioral changes* --- Irritability, hostility, mood swings - Cognitive function, memory, and language skills continue to decline (wandering) - *Late stage* -- Inability to recognize family -- lack of environmental awareness -- incontinence -- change in food intake -- immobility *5 A's* - anomia -- can't remember names of things - apraxia -- misuse of objects - can't identify - agnosia -- inability to recognize familiar things - aphagia -- inability to speak - amnesia -- memory loss amyotrophic lateral sclerosis (ALS) - ✓✓✓*Lou Gehrig's disease* *Progressive degenerative disease affecting upper motor neurons in the cerebral cortex and lower motor neurons in brainstem and spinal cord* *Cognition unimpaired* *Sign and symptoms* - Upper extremity weakness and atrophy - Progressive muscle weakness and loss of fine motor coordination--fall - The weakness and paralysis progress throughout the body - Dysarthria, swallowing and respiration are impaired - Death usually from respiratory failure - Hypoxia and hypercarbia, and having difficulty expelling mucous secretions myasthenia gravis - ✓✓✓*Autoimmune disorder* *Autoantibodies to acetylcholine (ACh) receptors form.* - Destruction of Ach receptor sites→ skeletal muscle weakness - *Facial and ocular muscles usually affected first* *Signs and symptoms* - *Muscle weakness in face and eyes* -- Impaired vision, monotone speech, difficult chewing and swallowing, head droops, arms become weaker - Edrophonium chloride (Tensilon) test *Complication* - Dysphagia and aspiration are significant problems! - Upper respiratory infections - *Myasthenic crisis - respiratory impairment* sources of pain - ✓✓✓- Inflammation - Infection - Ischemia and tissue necrosis - Stretching of tissue - Stretching of tendons, ligaments, joint capsule - Chemicals - Burns - Muscle spasm referred pain - ✓✓✓*Pain is perceived at a site distant from the source.* phantom pain - ✓✓✓*Pain or another sensation such as itching or tingling occurs in some individuals, usually adults, after an amputation.* acute pain - ✓✓✓*Type* - a warning - fast - localized *Stimuli* - injury - mechanical - thermal *Response* - sudden - short term - stress response - increased pulse and blood pressure - cool, moist skin - N/V *treatment* - effective if identified chronic pain - ✓✓✓*Type* - slow - diffuse