NR507 Advanced Pathophysiology MidTerm Study Guide, Exams of Nursing

Download NR507 Advanced Pathophysiology MidTerm Study Guide and more Exams Nursing in PDF only on Docsity! NR507 Advanced Pathophysiology MidTerm Study Guide 2023 Hypersensitivity: Type 1 - Type 1: Allergic reaction, Mediated by IgE, Inflammation due to mast cell degranulation Local symptoms: -itching -rash Systemic symptoms: -wheezing Most dangerous = anaphylactic reaction systemic response of hypotension, severe bronchoconstriction Main treatment: epinephrine reverses the effects Hypersensitivity: Type 2 - Type 2: Cytotoxic reaction; tissue specific (ex: thyroid tissue) Macrophages are the primary effectors cells involved Can cause tissue damage or alter function Grave's disease (hyperthyroidism) - example of altering thyroid function, but does not destroy thyroid tissue Incompatible blood type- example of cell/tissue damage that occurs; severe transfusion reaction occurs and the transfused erythrocytes are destroyed by agglutination or complement-mediated lysis. Type 1 Hypersensitivity VS. Type 2 Hypersensitivity - Type 1 Hypersensitivity Organ Specific Antibody binds to the antigen on the cell surface Type 2 Hypersensitivity Not Organ Specific Antibody binds to the soluble antigen outside the cell surface that was released into the blood or body fluids, and the complex is then deposited in the tissues Hypersensitivity: Type 3 - Examples - Rheumatoid arthritis: Antigen/antibodies are deposited in the joints Systemic Lupus Erythematosus (SLE)- very closely related to autoimmunity- antigen/antibodies deposit in organs that cause tissue damage Hypersensitivity: Type 4 - Delayed response Does not involve antigen/antibody complexes like Types 1, 2 and 3 Is T-cell mediated Differentiating Between the Rash of a Type 1 vs. Type 4 Reaction: - Type 1: Immediate hypersensitivity reactions, termed atopic dermatitis, are usually characterized by widely distributed lesions Type 4: Contact dermatitis (delayed hypersensitivity) consists of lesions only at the site of contact with the allergen The key determinant is the timing of the rash: -Type 1 = Immediate -Type 4 = Delayed: Several days following contact, ex would be poison ivy Treatment of Type 4 Rash - A non-severe case of contact dermatitis would be treated with topical corticosteroid. Why not epinephrine or antihistamines? -Epinephrine is for emergent Type 1 anaphylactic reactions. Antihistamines act on the H1 receptors. Type 4 does not involve mast cells and H1 receptors. Antibiotics not appropriate since not an infection Autoimmunity - Autoimmune disease can be familial, Affected family members may not all develop the same disease, but several members may have different disorders characterized by a variety of hypersensitivity reactions, These include autoimmune and allergic reactions Associations with particular autoimmune diseases have been identified for a variety of major histocompatibility complex (MHC) alleles or non-MHC genes Alloimmunity - General term used to describe when an individual's immune system reacts against antigens on the tissues of other members of the same species. Examples: Neonatal disease where the maternal immune system becomes sensitized against antigens expressed by the fetus, Transplant rejection, Transfusion reaction Primary Immunodeficiency - Most primary immune deficiencies are result of single gene defects Something is lacking with the immune system itself. Example: B-lymphocyte deficiency - one of the most severe forms of a primary immunodeficiency Aortic Stenosis - Blood backed up into left ventricle causing perfusion problems for the rest of the body Causes: Bicuspid aortic valve- congenital condition (only two cusps to the aortic valve which usually has three cusps)- the two cusps get damaged quicker because they are doing the work of three Age related calcification- obstruction/ stenosis Smoking, High BP, Hypertension, Hyperlipid, Diabetes Rheumatic Fever Signs & Symptoms = SAD S: Syncope A: Angina D: Dyspnea **Fainting Chest pressure upon exercising Sustained, laterally displaced apical pulse Mid-systolic crescendo-decrescendo murmur heard loudest at base and radiating to the neck S4 gallop present** Aortic Regurgitation - Blood is coming back from the Aorta into the L. Ventricle through the Aortic Valve Causes Widening or aneurysmal change of the aortic annulus (ring of fibrous tissue surrounding the aorta) Endocarditis Rheumatic Fever Signs & Symptoms Fatigue Syncope SOB Palpitations Widened Pulse Pressure L. Ventricular Dilation Early diastolic murmur along left sternal border **Shortness of breath that progressively worsens High pitched early diastolic murmur heard loudest at left lower sternal border Diastolic rumbling sound at the heart's apex Systolic crescendo-decrescendo murmur heard at the left upper sternal border A chest x-ray may show signs of pulmonary edema and cardiomegaly** Mitral Stenosis - Blood is going to back up into the L. Atrium and Lungs Causes Rheumatic Fever / Rheumatic Heart Disease Endocarditis Signs & Symptoms Fatigue SOB Exercise intolerance Cough L. Atrial enlargement Pulmonary congestion/edema Diastolic rumble Opening snap before Diastolic rumble **As mitral stenosis progresses, symptoms of decreased CO occur, especially during exertion Shortness of breath on activity Pounding/racing heart Associated w/ history of Rheumatic HD A low-pitched murmur auscultated at the heart's apex JVD and bilateral crackles in lung bases noted ECG demonstrates A-FIB and Left Ventricular Hypertrophy** Mitral Regurgitation - Blood goes from L. Ventricle to L. Atrium and then to the Lungs Causes - Anything that causes LV dilation Remodeling process (post MI) Dilated cardiomyopthathy Rheumatic Fever/ Rheumatic Heart Disease Endocarditis Papillary muscle dysfunction/rupture/ chordae tendinae Calcification of the valve/around the valve Signs & Symptoms Acute Chronic **Shortness of breath JVD, Crackles in bilateral lung bases Blowing pansystolic murmur heard best at heart's apex and radiates to back and axilla** Obstructive vs. Restrictive Pulmonary Disease - Obstructive: decreased FEV1 indicates airway obstruction along with low FEV1/FEV ratio 56% Restrictive: FEV1/FVC ratio above 70%, Review EDapt examples Asthma - Airways constricted Intrinsic: triggered by something internal such as anxiety Extrinsic: triggered by something in outside environment- something in the air (dust mites/pet dander) In mildest form of asthma (intermittent), short acting beta2-agonist inhalers are prescribed Mild-persistent asthma will have night symptoms 3-4 days a month COPD - Diagnosis based on Hx of symptoms, physical exam, chest imaging, pulmonary function tests and blood gas analysis Pulmonary function testing reveals airway obstruction (decreased FEV1) that is progressive and unresponsive to bronchodilators, Emphysema, Chronic bronchitis COPD Staging According to GOLD Guidelines- Based on degree of airway limitation - Gold 1: Mild: FEV1≥80% predicted Gold 2: Moderate: 50% ≤FEV1 <80% predicted Gold 3: Severe: 30% ≤FEV1 <50% predicted Gold 4: Very Severe: FEV < 30% predicted Emphysema - Damage occurs in the alveoli, Impairs gas exchange, Issue is in expiration- they can get air in but cannot get air out Air trapping, Pursed lip-breathing Increased A&P diameter, Barrel chest Chronic Bronchitis - Productive cough with copious amounts of sputum dyspnea wheezing rhonchi and cyanosis of the skin and mucous membranes Damage occurs in the airway- not the alveoli, Mucous Plugs Forced Vital Capacity (FVC) - Normal 80-120% The FVC measures the volume of air in the lungs that can be exhaled. Patient inhales as deep as possible and then exhales as long and as forcefully as possible. Obstructive: Will be decreased or normal Restrictive: Will be decreased