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Exam 2 (Latest 2021 / 2022) Rasmussen
STRESS – WHAT IS IT?, PURPOSE OF, WHAT DETERMINES RESPONSE?
WHAT IS IT? – physical, chemical or emotional factor that results in tension of body or mind, real or perceived threat to homeostasis, can be positive or negative
PURPOSE –
WHAT DETERMINES RESPONSE –
SELYE GAP SYNDROME STAGES, BODY’S RESPONSES TO
STAGES – ALARM, RESISTANCE, EXHAUSTION:
ALARM – the stressor upsets homeostasis or cellular balance; releases epi and norepi, and cortisol; Body has decreased resistance to stressors
RESISTANCE – Body fights back by adjusting to the stress; body trying to return to homeostasis; Glucose, free fatty acids and amino acids elevated for energy, growth and repair
EXHAUSTION – Rest permits enhanced adaptation; No rest = overtraining, injury, lack of adaptation; point where body can no longer reach homeostasis; Allostatic overload – “cost” of body’s organs and tissues for an excessive or ineffectively regulated allostatic response
STRESS IN CHILDREN:
PHYSIOLOGICAL – Immune system, stunt in growth, high blood pressure
MEDIATORS OF STRESS, E.G. NOREPINEPHRINE,
EPINEPHRINE, CORTISOL – WHAT DO THEY DO?
Norepinephrine (Catecholamines) – released during alarm stage; constricts blood vessels and raises blood pressure; reduces gastric secretions and increases night and far vision
Epinephrine (Catecholamines) – released during the alarm stage; enhances myocardial contractibility, increases heart rate, and increases cardiac output; causes bronchodilation; increases the release of glucose from the liver(glycogenolysis) and elevates blood glucose levels
Cortisol (Glucocorticoid) – released during alarm stage; primary glucocorticoid; may be synergistic or antagonistic to catecholamines; suppresses the immune system, decreases serotonin, increases blood sugar, increases blood pressure, decreases sensitivity to pain, and heightens memory and attention
Exam 2 (Latest 2021 / 2022) Rasmussen
ALDOSTERONE (mineralocorticoid)– essential for sodium conservation in the kidneys, salivary glands, sweat glands, and colon
LONG TERM GLUCOCORTICOID EFFECTS ON BODY :
osteoporosis, inability to fight infection (comp host), can weaken muscle/atrophy of skeletal muscle
ENDORPHINS AND ENKEPHALINS:
ENDORPHINS - are an endogenous opioid peptide derived from cells in the
hypothalamus, have analgesic properties
ENKEPHALINS – One of two types of pain-suppressing pentapeptides; they are produced in the body and are located in the pituitary gland, brain, and GI tract
Module 2
PHAGOCYTOSIS:
WHAT IS IT? – When leukocytes attack the bad cells and “eat” them
STEPS IN CARCINOGENESIS, INITIATION, PROMOTION,
PROGRESSION:
INITIATION – Initiating events in chromosomes (such as aberrations) or in DNA; initiators are radiation, chemical carcinogens, UV etc.
PROMOTION – low doses of tumor initiators are necessary to convert the initiated cells to cancer cells; EX: TPA, phorbol esters, estrogen and excessive fat
PROGRESSION – Increased genetic instability resulting in aggressive growth phenotype
GENERAL CHARACTERISTICS OF BENIGN VS MALIGNANT
TUMORS:
Exam 2 (Latest 2021 / 2022) Rasmussen
IMMUNOGLOBULIN:
WHAT IS IT? -
Module 3
MYASTHENIA CRISIS: weakening muscle functioning results in respiratory failure
KELOID – Overgrowth of scar tissue
HERPES ZOSTER (SHINGLES) – Acute inflammatory disease of a dermatomal segment of the skin; believed to be reactivated by latent varicella zoster virus from previous chicken pox; Unilateral, painful, can result in postherpetic neuralgia Vesicles on erythematous base of single or associated group of dorsal root ganglia;
ATOPIC DERMATITIS – complex genetic disease resulting from gene-gene and gene- environment interaction; highest incidence in children most of which are less than 5yrs old; pruritis always present; usually on face, scalp or exterior surfaces of extremities; SIGNS – erythema, papules, lichenification (skin condition that is caused by excessive itching or rubbing which results in thick leathery patches of skin)
COMPARTMENT SYNDROME – complication of soft tissue injury; results from swelling and bleeding within a restricted area; can be either acute, chronic or crush; pale and shiny due to lack of blood flow; swelling crushes nerves which causes excruciating pain; Treatment is emergent decompression which is where they cut through tissue to relieve pressure
5 P’s – pain out of proportion, paralysis, paresthesia, pallor, and pulselessness
RHEUMATOID ARTHRITIS – systemic, autoimmune, inflammatory; women are 2-3x more likely than men with the peak age being 40-50; it affects the hands, wrists, knees and feet more; if it is in the spine it usually affects the upper cervical area; symptoms are malaise, fatigue, diffuse musculoskeletal pain; bilaterally symmetric
HEALING PROCESS – 3 phases – THE FASTEST HEALING OCCURS WHEN EDGES ARE WELL APPROXIMATED
INFLAMMATORY PHASE – begins at time of injury and can last up to 4 days; clotting of platelets, constriction of blood vessels, WBCs kills bacteria
Exam 2 (Latest 2021 / 2022) Rasmussen
PROLIFERATION OR GRANULATION PHASE – begins about day 3 and overlaps inflammatory phase; fibroblasts help reduce new collagen, create new blood vessels, and repair epithelial tissue
Granulation tissue – highly vascular, very fragile and very susceptible to infection
REMODELING PHASE - can continue for 6 months to a year; collagen continues to increase; tissue begins to contract with the help of fibroblasts; adds to the strength of new tissue; scar made up of collagen fibers
Module 4: GI
PEPTIC ULCER DISEASE:
WHAT IS IT? – Disorder of the upper GI tract by action of hydrochloric acid and pesin
CAUSES? – H. Pylori (75% of cases with duodenal ulcers and 60% of those with stomach/gastric ulcers), NSAIDS, excess secretion of acid, stress
WHERE IS IT FOUND? – stomach, and duodenum (usually proximal duodenum)
MECHANISM – Uncertain
HEPATOCELLULAR CARCINOMA:
WHAT IS IT? – Most common form of liver cancer; usually occurs in patients with underlying chronic liver disease and cirrhosis
SIGNS/SYMPTOMS – Weight loss, upper abdominal pain, jaundice, anorexia
TREATMENT- surgery, transplant, freezing or heating the cancer cells, and chemotherapy
GASTRITIS:
WHAT IS IT? – Inflammation of the stomach lining
CAUSES? – Acute is caused by ingestion of toxins like alcohol, aspirin, or other irritating substances
- Can also be caused by viral, bacterial, or autoimmune disease
SIGNS/SYMPTOMS – Anorexia, nausea, vomiting, and postprandial discomfort
- Occasional hematemesis due to mucosal damage
Exam 2 (Latest 2021 / 2022) Rasmussen
- Most commonly caused by infection; E-COLI is the most common pathogenic cause and it usually originates in the urethra
RISK FACTORS? – being a female, old age, catheterization, diabetes, bladder dysfunction, poor hygiene, and urinary stasis
- Children who have a congenital defect called vesicoureteral reflux often have a high risk of cystitis
BPH (BENIGN PROSTATIC HYPERTROPHY):
WHAT IS IT? – Enlargement of the prostate
SIGNS/SYMPTOMS – Hesitancy (difficulty initiating a stream), decreased stream or dribbling, urinary retention, obstruction to flow, interruption of the stream, infection caused by retention
HORMONES INVOLVED WITH URINATION:
HSV:
WHAT IS IT?: Herpes Simplex Virus; causes contagious sores that are often found around the mouth and or genitalia. There is no cure, but it can be treated and prevented by medications.
TYPE 1: Oral herpes (cold sores)
TYPE 2: Genital warts (sexually transmitted)
PYELONEPHRITIS:
WHAT IS IT? - inflammation of the kidneys caused by infection; usually caused by E. Coli
CAUSES- due to ascending urinary tract infection
RISK FACTORS- pregnancy, diabetes mellitus, anatomical abnormalities, and obstructions
SIGNS/SYMPTOMS – CVA tenderness, fever, chills, n/v, anorexia, fever induced dehydration
TREATMENT- usually 7-10 days of antibiotics
Module 6 Diabetes/Endocrine
PRIMARY ENDOCRINE DISEASE:
WHAT IS IT?: A disease that originates within the gland in question
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EXAMPLE: Primary hyperthyroidism is a defect in the thyroid.
SECONDARY ENDOCRINE DESEASE:
WHAT IS IT?: Represents change in one organ as a result of disease in another organ
EXAMPLE: Secondary hyperthyroidism may be due to a TSH secreting pituitary adenoma.
DIABETES TYPE 1:
WHAT IS IT?: A chronic adolescence condition in which the pancreas produces too little or no insulin.
SYMPTOMS: Increased thirst, frequent urination, hunger, fatigue, and blurred vision.
TREATMENT: Uncurable, but can be treated by monitoring blood sugar levels, insulin therapy, diet, and exercise.
DIABETES TYPE 2:
WHAT IS IT?: Adult-onset chronic condition that affects the way the body processes sugar; the body does not produce enough insulin or it resists it.
SYMPTOMS: Sometimes none occur, increased thirst and urination, hunger, fatigue, and blurred vision.
TREATMENT: Diet, exercise, medication, and insulin therapy.
MYXEDEMA:
WHAT IS IT?: Severe form of hypothyroidism that can occur when left untreated or is not treated sufficiently.
SYMPTOMS: Dry and pale skin, swelling of the face, tongue, and legs.
TREATMENT: Synthetic hormones, antibiotics, steroids, and oxygen support.
GRAVE’S DISEASE (HYPERTHYROIDISM):
WHAT IS TI?: AKA: Basedow’s disease; the immune system attacks the thyroid and causes it to produce more thyroid hormone than the body needs.
SYMPTOMS: Anxiety, hand tremor, heat sensitivity, weight loss, puffy eyes, and enlarged thyroid.
TREATMENT: Medications and sometimes removal of the thyroid
Exam 2 (Latest 2021 / 2022) Rasmussen
DIAGNOSIS- Lumbar Puncture (LP)
TREATMENT – IV antibiotics
PREVENTION – Vaccinations for HIB and Meningitis
HEAD INJURY TYPES:
HYPOXIA IMPACT ON BRAIN CELLS: O2 too low so not enough ATP produced
HEMORRHAGIC STROKE:
WHAT IS IT? – Hemorrhage within or around the brain; usually occurs secondary to severe, chronic hypertension; degree of secondary injury and associated morbidity and mortality much higher than in ischemic stroke
WHERE DOES IT MOST OFTEN OCCUR? – in the basal ganglia or thalamus
TREATMENT? – Cardiovascular stabilization, brain CT to determine type and location, ICP monitoring and management, Blood pressure management (keep mildly hypertensive at first
ISCHEMIC STROKE:
WHAT IS IT? – Stroke that results from sudden occlusion of cerebral artery secondary to thrombus formation or emboli
THROMBOTIC STROKE – associated with atherosclerosis and coagulopathies
EMBOLIC STROKE – associated with cardiac dysfunction or dysrhythmias
(A-FIB)
CLINICAL MANIFESTATIONS – Contralateral hemiplegia, hemisensory loss, and contralateral visual field blindness
TREATMENT- Salvaging the penumbra is the aim of early thrombotic therapy; however, treatment must be started within 3 hours of symptom onset to be maximally effective, thrombolytics, anticoagulant, antiplatelet, stents
Exam 2 (Latest 2021 / 2022) Rasmussen
ALZHEIMER DISEASE:
WHAT IS IT? – Characterized by amyloid plaques and neurofibrillary tangles, degeneration of neurons in temporal and frontal lobes, brain atrophy; deficient synthesis of acetylcholine
CAUSE - remains unknown, although genetic factors and environmental triggers suspected
RISK FACTOR – family history, and age
REPERFUSION INJURY:
SEIZURE DISORDER : refers to recurrent seizures (epilepsy), classified by clinical symptoms and EEG
WHAT IS IT? – Transient neurologic event of paroxysmal abnormal or excessive cortical electrical discharges
CLINICAL MANIFESTATIONS – Disturbances of skeletal motor function, sensation, autonomic visceral function, behavior, or consciousness
CAUSES – Cerebral injury, lesions, metabolic/nutritional disorders, idiopathic (no known cause)
DIAGNOSIS – EEG, Laboratory studies (to identify metabolic/nutritional deficits, infections, and exposure to toxins), LP (for CNS infections), CT and MRI (for structural causes)
TREATMENT – DURING (maintain airway, protect from injury, document course of seizure), anticonvulsant medications (continue until no seizures for at least 2 years and then gradually withdraw), avoid triggers, surgery (removal or seizure foci or neurostimulation)
GENERALIZED/ GRAND MAL:
WHAT IS IT? – seizure involving whole brain surface; involvement of the thalamus and tonic- clonic (grand mal) jerking of many muscles
Exam 2 (Latest 2021 / 2022) Rasmussen
CEREBRAL PLASY:
WHAT IS IT? – Diverse group of crippling syndromes that appear during childhood and involve permanent, nonprogressive damage to motor control areas of the brain
CAUSES – Prenatal infections or disease of the mother; mechanical trauma to the head before birth or after birth; exposure to nerve damaging poisons or reduced oxygen supply to the brain
TREATMENT – varies depending on the nature and extent of brain damage; muscle relaxants, anticonvulsants, orthopedic therapy, casts, braces, and traction; botox for pain and range of motion
ALS: AMYOTROPHIC LATERAL SCLEROSIS (Lou Gehrig’s Disease)
WHAT IS IT? – Progressive neurodegenerative disease; it affects the nerve cells in the brain and spinal cord; 100% fatal
EARLY SIGNS/SYMPTOMS – Muscle twitching, dropping things, slurred speech, muscle cramps, tripping, uncontrollable crying or laughing
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LATER SIGNS/SYMPTOMS – Progressive muscle weakness beginning typically in hands, feet or limbs spreading throughout; trouble chewing, swallowing, speaking and breathing, generally no pain
TREATMENT – Riluzole can extend life 3 to 6 months or Edaravone reduces decline in daily functioning, unknown life extension
CAUSE/MECHANISM – No direct cause identified
MULTIPLE SCLEROSIS:
WHAT IS IT? – Chronic demyelinating disease of the CNS that primarily affects young adults; autoimmune disorder that results in inflammation and scarring of myelin sheaths covering nerves and slowly progresses
CAUSE- Unknown
MOSTLY AFFECTS – the optic and oculomotor nerves and spinal nerve tracts
CLINICAL MANIFESTATIONS – Double/blurred vision, weakness, poor coordination, and sensory deficits; bowel and bladder control may be lost; memory impairment common
DIAGNOSIS – MRI
Module 8: Respiratory
ASTHMA:
WHAT IS IT? – Airway inflammation; increased airway responsiveness to a variety of stimuli, two types – extrinsic and intrinsic
EXTRINSIC – Allergic, pediatric onset; 1/3 to ½ of asthma cases; IgE is elevated
Pharmacologic therapy, allergen specific immunotherapy, and environmental control
INTRINSIC – Non-allergic, adult onset; develops in middle age with less favorable prognosis, no history of allergies, respiratory infections or psychological factors appear to be contributory
CLINICAL MANIFESTATIONS – Wheezing, feeling of tightness of chest, dyspnea, cough (dry or productive), increased sputum production (thick, tenacious, scant, and viscid), hyperinflated chest, decreased breath sounds
Exam 2 (Latest 2021 / 2022) Rasmussen
CLINICAL MANIFESTATIONS – Patient is typically overweight, commonly associated with emphysema, SOB on exertion, excessive sputum, chronic cough (more severe in mornings), evidence of excess body fluids (edema, hypervolemia), cyanosis (late sign)
DIAGNOSIS – Chest X-ray, Pulmonary function test, ABG (Arterial blood gases), ECG, secondary polycythemia (R/t continuous or nocturnal hypoxemia)
TREATMENT – Goals (block progression of the disease, return to optimal respiratory function, return to ADLs), Medication (inhaled short acting B2 agonists, inhaled anticholinergic bronchodilators, cough suppressants, antimicrobial agents, inhaled/ oral corticosteroids, theophylline products)
EMPHYSEMA:
WHAT IS IT? – Abnormal enlargement of the distal air sacs, destructive changes of the alveolar walls without fibrosis; damage is irreversible and is associated with chronic bronchitis
CAUSES – Smoking >70 packs/year, air pollution, certain occupations (mining, welding, working with asbestos), a1-antitrypsin deficiency
PATHOGENESIS – Reduction in pulmonary capillary bed (exchange of O2 and CO2 between alveolar and capillary blood impaired), Loss of elastic tissue in lung, air becomes trapped in distal alveoli, loss of alveolar wall and air trapping leads to bullae formation
CLINICAL MANIFESTATIONS – Progressive, exertional dyspnea, thin, use of accessory muscles, pursed-lip breathing, cough, digital clubbing, barrel chest
DIAGNOSIS – Pulmonary function test, Chest x-ray, ECG, ABG, Patient history, common physical findings (Thin, wasted individual hunched forward, using accessory muscles, decreased breath sounds, prolonged expiration, decreased heart rate, hyperresonance, decreased diaphragmatic excursion, chronic morning cough
TREATMENT – O2 therapy, smoking cessation, medications (inhaled short acting B2 agonists, inhaled anticholinergic bronchodilators, cough suppressants, antimicrobial agents, inhaled/ oral corticosteroids, theophylline products)
PLEURAL EFFUSION:
WHAT IS IT? - Fluid or pus in the pleural cavity
CAUSES – Pneumonia, heart failure, cirrhosis of the liver, rheumatoid arthritis, lupus, mesothelioma, low protein level in the blood
TREATMENT – Thoracentesis (drains fluid)
Exam 2 (Latest 2021 / 2022) Rasmussen
PNEUMOTHORAX:
WHAT IS IT? – Accumulation of air in the pleural space
PRIMARY – Spontaneous, occurs in tall thin men 20 to 40 years; no underlying disease factors, cigarette smoking increases risk
SECONDARY – Results or complications from preexisting pulmonary disease
CLINICAL MANIFESTATIONS – Small pneumothoraxes’ (<20%) are usually not detectable on physical examination, tachycardia, decreased or absent breath sounds on affected side, hyperresonance, sudden chest pain on affected side, dyspnea
DIAGNOSIS – ABG, ECG, Chest X-ray
TREATMENT – Depends on severity; less than 15-25% lung collapse = treat symptomatically and monitor closely; greater than 15-25% = chest tube placement with H2O seal and suction to remove pleural air; Chemical pleurodesis (Promotes adhesion of visceral pleura to parietal pleura to prevent further ruptures); Thoracotomy (permits stapling or laser pleurodesis of ruptured blebs)
COPDs – types: Asthma, Chronic bronchitis, Emphysema, Bronchiectasis, Cystic Fibrosis
SARCOIDOSIS:
WHAT IS IT? – Multisystem granulomatous disease
CAUSE – Unknown
CLINICAL MANIFESTATIONS – 30-50% without symptoms; malaise, dyspnea of insidious onset, dry cough
PULMONARY FIBROSIS:
WHAT IS IT? – Scarring of the lungs, no cure; average life expectancy 3-5 years
Pons & medulla – respiratory center
Exam 2 (Latest 2021 / 2022) Rasmussen
NOT RELIEVED BY REST
WHAT IS IT? – chest pain associated with intermittent myocardial ischemia
CORONARY HEART DISEASE:
WHAT IS IT? – Characterized by insufficient delivery of oxygenated blood to the myocardium
ETIOLOGY – Atherosclerosis, possible microcirculation abnormalities
HOW IS MI DIFFERENT FROM UNSTABLE ANGINA:
WHY IS SHOCK LIFE THREATENING?
SEPTIC SHOCK:
WHAT IS IT? – Results from severe systemic inflammatory response (SIRS) to infection
CAUSES – Gram-negative and gram-positive bacteria, fungal infections
INITIAL FINDINGS – Fast deep respirations, AMS, and cool clammy skin
TREATMENT – Antibiotics, IV fluids, and drugs to improve cardiac and vascular performance
OBSTRUCTIVE SHOCK:
WHAT IS IT? – Results from mechanical obstructions impending blood flow
CAUSES – Pulmonary embolism, cardiac tamponade, and tension pneumothorax
CLINICAL MANIFESTATION – Right sided heart failure
Module 10 - Blood
ERYTHROPOIETIN:
Hormone produced primarily by the kidneys that stimulates bone marrow to produce erythrocytes
Exam 2 (Latest 2021 / 2022) Rasmussen
HEMATEMESIS:
Blood in vomit
CLOT FORMATION:
RESULT OF ANEMIA:
Tissue hypoxia due to the low oxygen carrying capacity of the blood, orthostatic and nonorthostatic hypotension, vasoconstriction, pallor, tachypnea, dyspnea, tachycardia, transient murmurs, angina pectoris, heart failure, intermittent claudication, night cramps in muscles, lightheadedness, tinnitus, roaring in the ears, and faintness
HEMOSTASIS:
conceptualized as a state of being in which all systems are in balance around a particular ideal “set-point.”
SICKLE CELL CRISIS HOW DOES IT CAUSE PAIN:
DISSEMINATED INTRAVASCULAR COAGULATION (DIC):
WHAT IS IT? – Immune activation of the clotting cascade results in widespread clot formation which consumes platelets and clotting factors resulting in bleeding in other areas
CAUSES- Usually due to septic shock
WHY WOULD YOU TEST BLOOD COAGULATION?
WHY DOES HEPATIC FAILURE CAUSE BRUISING?
