NUR 2063 / NUR2063: ESSENTIALS OF PATHOPHYSIOLOGY EXAM 2 REVIEW STUDY GUIDE, Exams of Nursing

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NUR 2063 / NUR2063: ESSENTIALS OF

PATHOPHYSIOLOGY EXAM 2 REVIEW STUDY

GUIDE

1. What are the three stages of AKI presentation?: - Prodromal

• Oliguric
• post-oliguric

2. Causes of chronic kidney disease: - Outcome of progressive and irrevocable loss of functional nephrons.

• Due to kidney not recovering
• Can lead up to end-stage renal disease (ESRD) which requires dialysis

3. Risk Factors of chronic kidney disease: - Diabetes

• Hypertension
• Recurrent pyelonephritis
• Polycystic kidney disease
• History of exposure to toxins
• Age over 65
• Ethnicity (African American male higher risk)

4. complications of chronic kidney disease: - hypertension and cardiovascular disease

• uremic syndrome
• metabolic acidosis
• electrolyte imbalances
• bone and mineral disorders
• malnutrition
• anemia
• pain
• depression

5. Hypertension and cardiovascular disease: - (increased blood volume) Hyper- volemia, escalated atherosclerotic process

6. Uremic Syndrome: - Can't get rid of normal metabolic waste Retention of metabolic wastes, impaired healing, pruritusm dermatitis, and uremic frost (itching & discomfort) 7.. Metabolic acidosis: - Retention of acidic waste products, hyperkalemia
7. Electrolyte Imbalances: - Retained potassium (hyperkalemia), phosphorus, and magnesium
8. Bone and mineral disorders: Elevated phosphorus and PTH causes altered bone/mineral metabolism. Kidneys are unable to reabsorb calcium (body steals calcium from parts of the body)
9. Malnutrition: - Decreased intake, depression, and dietary limitations (De- creased salt, protein and potassium)
10. Anemia: - Lack of erythropoietin (produces new RBC), uremia shortens RBCs life
11. Pain: - Many reasons; disease itself, treatment, comorbidities
12. Depression: - Comorbid conditions; disease itself; disruption of social interac- tions and relationships
13. Urge Incontinence: - Sudden need to void with an involuntary leakage of urine If it happens at night (nocturia) it is called overactive bladder
14. Stress Incontinence: - Small amounts of urine are voided involuntarily when there is an increase in intraabdominal pressure. (More common in women following childbirth; Can occur with coughing, sneezing and lifting heavy objects)
15. Neurogenic bladder: From a disruption of nervous communication that controls micturition. Seen in individuals with stroke, Parkinson's, MS, and spinal cord injuries.
16. Functional Incontinence: - Secondary to physical or environmental limitations such as not getting to the toilet in time.
17. Mixed Incontinence: - A combination of both stress and urge incontinence More common in elderly women
18. Overflow Incontinence: - When the bladder becomes full and overflows (Due to something physically blocking; NOT from holding urine)

20. Cystitis (UTI): - Inflammation of the bladder lining due to E. coli from infections, chemical irritants or stones.
21. General S/S of Cystitis (UTI): - frequency, urgency, dysuria, suprapubic pain, and cloudy urine
22. S/S of Cystitis (UTI) in Children: - fever, irritability, poor feeding, vomiting, and diarrhea.
23. S/S of Cystitis (UTI) in older adults: - delirium and new onset incontince. 24.. Patient teachings to prevent cystitis: - Urinate before and after sexual intercourse

• Wipe front to back
• Take antibiotics as prescribed
• Increase fluid intake
• Do not resist urge to urinate

25. What can happen if cystitis does not resolve?: - It can lead up to kidney infections. 26.. Benign Prostatic Hyperplasia (BPH): - Enlargement of prostate gland
26. S/S of Benign Prostatic Hyperplasia (BPH): - Decreased stream, Hesitancy (difficulty initiating stream), and infection caused by retention.
27. Hydrocele: - Fluid collection progressively surrounding the testicle or spermatic cord causing swelling by evening.
28. Testicular Torsion (Primarily in prepubertal males): - Twisting of the spermat- ic cord with compromised vascular supply and ischemia, followed by infarction.

• Can cut off blood supply & lead up to necrosis and ischemia

30. Endometriosis: - Endometrial tissue outside the lining of the uterine cavity, abnormal tissue implant (endometrioma)
31. S/S of Endometriosis: - Dysmenorrhea (painful menses), pain w/ intercourse, pain w/ defecation, & pain begins 5 to 7 days before menses and lasts for 2 to 3 days.
32. Uterine Prolapse: - Prolapse (sinking) of the uterus from its normal position into the vagina
33. S/S of Uterine Prolapse: - Depends on the severity of prolapse, discomfort in walking/sitting, difficulty urinating, vaginal discomfort, and bleeding.
34. S/S of Pelvic Inflammatory Disease (PID): - Abdominal tenderness, pelvic pain, purulent (thick and mucus) vaginal discharge and fever.

35.which organisms/viruses contribute to pelvic inflammatory

disease (PID)?-

: - Neisseria gonorrhoeae and chlamydia trachomatis

36. which organisms/viruses contribute to cervical cancer?: - Human Papillo- mavirus (HPV)

37. which organisms/viruses contribute to UTIs?: - E. coli

38. which organisms/viruses contribute to syphilis?: - Treponema pallidum

39. which organisms/viruses contribute to herpes?: - HSV-

40. Incubation phase (syphilis): - 10 to 90 days
41. Primary phase (syphilis): begins with formation of chancre

• Painless, ulcerative lesion at original portal of entry
• Female- may go unnoticed
• Men- chancre on genitalia
• Resolves spontaneously within 3 to 6 weeks

42. Secondary Stage(syphilis): - Low-grade fever, sore throat, & mucosal or cuta- neous rash
43. Latent phase(syphilis): - No symptoms present, contagious, can last 40 years, & two thirds remain asymptomatic 44.. Late phase(syphilis): - Final, destructive phase of disease; cardiovascular and CNS at risk for damage, blindness and paresis.
44. What organ systems is most affected by syphilis?: - vascular system
45. What are the five stages of syphilis?: - Incubation, primary, secondary, latency and Late
46. Pregnancy Induced Hypertension (PIH): - 0.5% To 8% pregnancies

• Rapid rise in arterial blood pressure associated with the loss of large amounts of protein in the urine (proteinuria)
• Pre-eclampsia- HBP during pregnancy 48.. S/S of Pregnancy Induced Hypertension (PIH): - Edema, renal failure, liver malfunction, extreme hypertension, arterial spasm in kidneys, brain, and liver, and decreased renal flow and GFR.

49. Hyperemesis Gravidarum: - Excessive vomiting during pregnancy - 0.3% to 2% pregnancies 50.. S/S of Hyperemesis Gravidarum: - Severe vomiting, electrolyte imbalances (loss of potassium) and hepatic/renal damage which can lead up to death if not corrected.
50. What is the concern with chlamydial infection during labor/delivery?: - The mother can infect the infant during labor/delivery.

52. Dwarfism: - decreased GH secretion that results in a short stature and delayed puberty; cells are not effective

• May be due to congenital, tumors, radiation or trauma to head.

53. S/S of dwarfism: - Growth below third percentile, irregular setting of permanent teeth, thin hair, poor nail growth, delayed puberty, and decreased muscle mass.
54. Gigantism: - Occurs in childhood before the skeletal epiphyses closes (before bones fuse: length growth).

• May grow to 8ft if left untreated

55. Acromegaly: - Occurs in adults after skeletal epiphyses close (after bone fuses; width growth)

• Only portions of the body are affected.

56. Diabetes Insipidus: Due to decrease or lack of ADH production

• Low ADH, Low water in body
• HIGH UO, Polyuria
• High sodium (hyponatremia)
• High H&H and serum osmolality (increased concentration of solutes in blood) from dehydration

57. S/S of Diabetes Insipidus: - Dizziness, disorientation, nausea, rapid heart rate (due to hypovolemia), and headaches
58. Risk of Diabetes Insipidus: - Hypovolemic shock
59. Syndrome of Inappropriate Antidiuretic Hormone Secretion (SIADH) Body produces too much ADH: - High ADH, water intoxication

• LOW UO, oliguria
• Low sodium (dilutional)

60.S/S of Syndrome of Inappropriate Antidiuretic Hormone Secretion

(SIADH)-

: - edema, weight gain, and hyponatremia (can lead up to cerebral edema due to the cells swelling from hyponatremia)

61. What is Antidiuretic Hormone (ADH)?: - Also known as somatostatin; regu- lates water balance in body and keeps water in body (water retention).

62. What is What is Antidiuretic Hormone (ADH) also known as?: -

Somatostatin

63. What electrolyte is most affected by disorders of ADH production?: - Sodi- um

64. Review the differences between hypothyroidism and hyperthyroidism.: - The difference between Hyperthyroidism and Hypothyroidism is that hypothyroidism is due to an autoimmune issue while hyperthyroidism is due to autoantibodies binding and stimulating TSH receptors.
65. Hyperthyroidism: Abnormally elevated calcium levels in blood due to excess PTH.

• Most commonly caused by graves' disease (autoantibodies bind and stimulate TSH receptors).
• Thyromegaly (enlargement of thyroid), exophthalmos (bulging of eyes), lid lag, vision changes, and photophobia.

66. Thyromegaly: - enlargement of thyroid
67. exophthalmos: - bulging of eyes
68. S/S of Hyperthyroidism: Insomnia, restlessness, tremor, palpitations, heat in- tolerance, diaphoresis, diarrhea, and amenorrhea (scant menses). 69.. Hypothyroidism: - most commonly caused by autoimmune thyroiditis

• Iodine deficiency (needed for T3/T4 formation)

70. S/S of Hypothyroidism: - Lethargy, cold intolerance, bradycardia, weight gain, dry skin, constipation, difficulties with concentration/memory, loss of hair, and men- strual irregularities.
71. What labs can be drawn to determine if an individual is suffering from a thyroid disorder?: - T3, T4, and TSH hormone
72. What is parathyroid hormone (PTH)?: - Increases calcium levels in blood

73. Which electrolyte is primarily affected by PTH disorders?: -

Calcium

74. What's another name for Cushing's syndrome?: - hypercortisolism
75. Cushing's syndrome (hypercortisolism): - caused by excessive glucocorti- coids and a pituitary tumor or tumor of the adrenal cortex
76. S/S of Cushing's syndrome: - Hyperglycemia, loss of muscle and bone, excess water and salt retention, weight gain, hypertension, edema, swollen moon face (rounding of face) and redistribution of fat to the abdomen and the posterior neck (buffalo hump)
77. What is another name for Addison's disease?: - adrenocortical insufficiency 78.. Addison's disease (adrenocortical insufficiency): - due to not enough steroid being produced; adrenocortical insufficiency, decreased glucocorticoid levels (usually decreases cortisol); due to autoimmune condition or removal of adrenal glands; sudden withdrawal from corticosteroid therapy

79. S/S of Addison's disease (adrenocortical insufficiency): - Weight loss, weak- ness, hyperpigmentation (bronzing) of skin, hypoglycemia, and hyperkalemia.
80. Type I diabetes mellitus: - Diagnosed in young children/adolescents

• Autoimmune disorder- beta cells in pancreas destroyed
• Unable to produce insulin

81. Type II diabetes mellitus: Most common form of DM

• Cells become resistant to insulin, decrease insulin receptors on target cells (unable to bind to target cells.) - Overtime insulin production by pancreas decreases

82. signs and symptoms of hypoglycemia: - Dizziness, Sweating, Hunger, Irri- tability or moodiness, Anxiety or nervousness, and Headache
83. Hyperglycemia: - High levels of sugar/glucose in blood; hot & dry sugar high
84. Hyperglycemia S/S: - Dry mouth, increased thirst, blurred vision, frequent urination, weakness, and headache
85. Hypoglycemia: - Low levels of sugar/glucose in blood; cold & clammy=candy
86. Hypoglycemia S/S: - Sleepiness, sweating, pallor, irritability, and hunger
87. signs and symptoms of hyperglycemia: - hypertension, cardiovascular dis- ease, stroke, retinopathy (loss of vision), diabetic neuropathy (losing sensation in nerves), and nephropathy (kidney damage)
88. What are the three Ps?: - Polyuria - increased urination

• Polydipsia - increased thirst
• Polyphagia - increased hunger

89. Polyuria: - increased urination 90.. Polydipsia: - increased thirst 91.. Polyphagia: - increased hunger
90. Diabetic ketoacidosis: Occurs in Type I DM; continued insulin deficiency leads to lipolysis of body.

• Metabolism of fats leads to free fatty acids (FFA)
• FFAs are transformed into ketones, leading to ketoacidosis.

93. S/S of Diabetic ketoacidosis: - Deep, labored respirations (Kussmaul respira- tions) due to the body trying to get rid of extra CO2, acetone (fruity) breath odor, polyuria, polydipsia, polyphagia, dehydration, and hypovolemia.
94. Why does Diabetic ketoacidosis occur?: - due to the FFAs transforming into ketones

95. Which person is most prone to develop nephrolithiasis? One

with: A. dehydration

B. an exercise routine C. hypotension D.a nephroblastoma

96. A patient develops kidney dysfunction from hemorrhage.

Which type of kidney injury will be documented on the chart?: A.

Prerenal kidney injury

B. Postrenal kidney injury C. Intrinsic kidney injury D.Intrarenal kidney injury

97. A patient has acute tubular necrosis and is in the oliguric

phase. Which laboratory finding is of greatest concern to the

nurse?: A. Hyponatremia

B. Hyperkalemia C. Hypernatremia D.Hypokalemia

98. An 83-year-old patient is confused, anxious, lethargic, and has no

appetite. Which of the following conditions may be responsible?: A.

Bladder cancer

B. Cystitis C. Nocturnal enuresis D.Ureterolithiasis-Cystitis

99. Which of the following laboratory results are consistent with diabetes insipidus?: A. Decreased serum osmolality, increased urine osmolality B. Hypernatremia and low serum levels of ADH C. Elevated serum calcium, decreased serum phosphorus D.High serum GH levels

100. A patient has a low cortisol level from autoimmune

destruction of the adrenal gland. Which diagnosis will the nurse

observe documented on the chart?: A. SIADH

B. Diabetes insipidus C. Cushing syndrome D.Addison disease

101. A patient with type 1 diabetes mellitus is pale, has

tremors, and is diaphoretic. What does the nurse suspect the

patient is experiencing?: A. Hypoglycemia

B. Hyperglycemia C. Nonketotic Hyperglycemic Hyperosmolar Syndrome (NHHS) D.Diabetic ketoacidosis

102. Esophageal cancer is a complication of which of the following GI condi- tions?: A. peptic ulcer disease B. GERD C. ulcerative colitis D.Crohn's disease

103. Colectomy and fecal transplant are treatments for which of

the following conditions?: A. ulcerative colitis

B. Intussusception C. gallstones D.pseudomembranous colitis (C DIFF)

104. two thirds of all pancreatitis cases are due to gallstones TRUE

OR FALSE-

: - FALSE; It's due to alcohol

105. Proteinuria is a classic symptom of which group of

disorders?: A. gastritis

B. pituitary disorders C. glomerulopathies D.diabetes

106. Which of the following is NOT a symptom in individuals w/

acute glomeru- lonephritis following ²hemolytic strep infection?: A.

coffee-colored urine

B. decreased urine output C. increased GFR D.edema

107. Causes of postrenal kidney injury include all of the following EXCEPT: A. stone obstructing a ureter B. enlarged prostate C. bladder tumor D.hypotension

108.. All of the following are causes of intrinsic/intrarenal

failure EXCEPT: A. hypovolemia

B. methamphetamine C. contrast dye D.prolonged postrenal failure

109. Pain that begins 5 to 7 days before the peak of menses may be due to which of the following?: A. pelvic inflammatory disease B. endometriosis C. Hyperemesis gravidarum D.syphilis

110. Symptoms of this disorder include copious amounts of

dilute urine, hypovolemia and hypernatremia (serum): A.

SIADH

B. Diabetes mellitus C. diabetes insipidus D.Cushings syndrome

111. Type I diabetes is typically the result of insulin resistance and decreased presence of insulin receptors on cells TRUE OR FALSE: - FALSE; It's due to an autoimmune disorder; commonly hashimotos

112. Common signs and symptoms of gastrointestinal disorders

as a whole: - Pain

• Nausea
• Vomiting
• Diarrhea
• Constipation 113.. Gastritis: - Inflammation of the stomach lining

114. Causes of Gastritis: - Precipitated by ingestion of irritating substances (Ex. alcohol and aspirin, NSAIDs, viral, bacteria, & autoimmune)
115. GERD: - Backflow of gastric contents into esophagus through lower esophageal sphincter (LES) (Due to a problem with sphincter)
116. Causes To GERD: increases abdominal pressure, fatty foods, caffeine, large amounts of alcohol, cigarette smoking, & pregnancy
117. What are complications of GERD if left untreated?: - it can cause cellular changes leading up to esophageal cancer (Barrett esophagus) and the individual can develop pulmonary symptoms (cough, asthma, and laryngitis: from reflux in breathing passages)
118. peptic ulcer disease S/S: - Epigastric burning pains, gastric ulcers, duodenal ulcer and GI bleeding.
119. What is the role of H. pylori in peptic ulcer disease?: - The role of Pylori is that it promotes both gastric and duodenal ulcer formation. It thrives in acidic conditions causing slow rates of ulcer healing and a high rate of recurrence.
120. pseudomembranous colitis: - A highly contagious acute inflammation and necrosis of large intestine
121. What contributes to pseudomembranous colitis?: - Caused by Clostridium difficile (c.diff is kept in check by other bacteria in our system but due to exposure to antibiotics the other bacteria cannot keep it in check.)
122. pseudomembranous colitis Treatment: - Stop current antibiotic (if possible)

• Oral antibiotics - metronidazole or vancomycin
• Recurrence common
• Fecal transplant - transfer of fecal material from another healthy person to the source patient via enema or gastric tube
• Colectomy - removal of portion of colon (remove disease portion)

123. Ulcerative Colitis: Chronic inflammatory disease of the mucosa of the rectum and colon.

• Associated with increased cancer risk after 7 to 10 years of disease

• Have exacerbations and remissions
• Bloody diarrhea (only difference between ulcerative colitis and crohn's disease)
• Treatment: Corticosteroids (mainstay for acute), Broad spectrum antibiotic, Im- munomodulating agents (Azathioprine or Mercaptopurine); used in severe cases

124. Crohn's Disease (regional enteritis or granulomatous colitis): - Chronic inflammation of the colon or terminal ileum.
125. Chron's disease S/S: - Intermittent bouts of fever, diarrhea (with or without blood)

• Treatment: Alleviating and reducing inflammation (NO CURE)

126. Appendicitis: - Inflammation of the vermiform appendix
127. Appendicitis S/S: - Periumbilical pain, RLQ pain "McBurney's point", nausea, vomiting, fever, diarrhea, RLQ tenderness, systemic signs of inflammation.
128. How do we assess for Appendicitis?: - Rebound tenderness between the belly button and hip bone. 129.. Causes of bowel obstructions: - previous abdominal surgery w/ adhesions, congenital abnormalities of bowel (born with), and metastatic carcinoma.
129. Mechanical obstruction: - Something is physically blocking movement of material. Ex. Adhesions (tissue cells fused and stuck), hernia, tumors, impacted feces, volvu- lus (twisting of intestine), and intussusception (intestines collapse into themselves).
130. Functional Obstruction: - Due to change in movement Ex. Conditions inhibiting peristalsis such as certain medications (anticholinergics; stimulate flight or fight response), opioids and low fiber diets.
131. Signs and symptoms of liver disease: - Hepatocellular failure (Jaundice)- green/yellow staining of tissues by bilirubin

• Decreased clotting factors
• Hypalbuminemia
• Portal hypertension
• Ascites - pathologic accumulation of fluid in peritoneal cavity
• Hepatic Encephalopathy - swelling of brain

Complex neuropsychiatric syndrome from too much ammonia (can cause dementia and psychotic symptoms, mild confusion, and lethargy.)

133. What is another term for end stage liver disease?: -

Cirrhosis

134. Cirrhosis (end stage liver disease): - irreversible end stage of many different hepatic injuries Alcoholism, acute hepatitis, toxic hepatitis (taking too much tylenol), and liver is fibrotic and scarred

135.. S/S of gallstones: - Severe right upper abdominal pain, radiates to back, fever, and elevation of bilirubin.

136. what are the three phases that contribute to gallstone formation?:

• Su- persaturation of bile with cholesterol causing precipitation of cholesterol (Crystal formation).
• Nucleation of bile crystals (crystals grow and stick together).
• Hypomotility (stasis of bile) allowing stone growth. Bile is not moving as freely and is sluggish.

137. Pancreatitis: - Inflammation of the pancreas
138. S/S of Pancreatitis: - Radiates or penetrates to back, hypoactive bowel sounds, low-grade fever, and nausea and vomiting.
139. What are some causes to pancreatitis?: - Biliary tract disease, hypertriglyc- eridemia (high glucose), & ethanolassociated (alcoholism).
140. What are the function of the kidneys?: - Kidney functions to get rid of excess fluid, manage blood volumes (BP), nutrients and ion concentrations (Acids & Base).
141. How do we assess for renal disorders?: - Assess for renal disorders by checking for flank pain (CVA Tenderness) at the costovertebral angle.
142. Cystic kidney disease: - genetically transmitted renal disorder resulting in fluid filled cysts; localized to one area or can affect both kidneys.
143. Cause of cystic kidney disease: - Genetics
144. Nephrons: - each of the functional units in the kidney, consisting of a glomeru- lus and its associated tubule, through which the glomerular filtrate passes before emerging as urine
145. Hematuria: - Blood within urine
146. Proteinuria: - Protein in urine
147. Nephrolithiasis (Renal calculi): - Kidney stones (crystal aggregates com- posed of organic and inorganic materials located within the urinary tract)
148. Pyelonephritis: - Infection of kidney
149. Cystitis: - inflammation of the bladder lining
150. Postinfectious acute glomerulonephritis S/S: - Impetigo, Strep, smoky/cof- fee colored urine, proteinuria, edema, and decreased urine output.
151. What typically triggers Postinfectious acute glomerulonephritis?: - impeti- go triggered by ²-hemolytic streptococcus.

152. What age group is predominantly affected by

Postinfectious acute glomerulonephritis?: - children

153. Berger's disease (IgA nephropathy) S/S: - Hematuria (blood in urine), and upper respiratory or gastrointestinal viral infections.
154. What typically triggers Berger's disease (IgA nephropathy)?: - Upper res- piratory or gastrointestinal viral infections

155. What age group is predominantly affected by Berger's

disease (IgA nephropathy)?: - Adults

156. Acute Kidney Injury (AKI): - Disruptions in fluid (fluid overload), electrolyte, and acid-base balances.
157. S/S of Acute Kidney Injury (AKI): - Electrolytes are unable to get rid of potassium which leads up to hypertension which can escalate to further cardiac issues.

• Retention of nitrogenous waste products (due to waste not being able to come out)
• Increased serum creatinine
• Decreased glomerular filtration rate (GFR)

158. What are the sites of disruption for AKI?: - prerenal, intrinsic, and postrenal
159. Prerenal: - Disruption/diminishing to renal perfusion (something is affecting the flow of blood to the kidney) Ex. Blood clot, heart failure, hypotension, and severe sepsis. S/S: Hypotension, renal artery obstruction (blood clot), fever, vomiting, diarrhea, burns, overuse of diuretics, hemorrhage, severe sepsis, and hear failure.
160. Postrenal: - Disruption to urine flow distal to the kidney (Ex. Stone, ureter damage, enlarged prostate, and urethra damage). Leads to acute tubular necrosis (intrinsic) and irreversible kidney damage. (backflow of urine causes the damage)
161. Intrinsic: - Damage/disruptions within the kidney blood vessels, tubules, or glomeruli (Ex. Tumors and medications).

Causes: Nephrotoxic insult (certain medications), chemotherapy, contrast me- dia(dye), and prolonged postrenal failure.

162. Prodromal Phase: - Normal or declining output; Serum BUN and creatinine begin to rise.
163. Oliguric Phase: Sudden drop in amount of urine produced per hr./per day.

• S/S: Fluid excess, hyperkalemia, edema, hypertension, and uremic syndrome.
• Dialysis may be required.

164. Post oliguric phase: start to see recovery; Not all patients get to this recovery stage

• Urine volume increases (diuresis- increase in very dilute urine)
• GFR increases - May last 1 week; full recovery 1 year