Download NURS 231 PATHOPHYSIOLOGY FINAL EXAM 2024 and more Exams Nursing in PDF only on Docsity! NURS 231 PATHOPHYSIOLOGY FINAL EXAM 2024 WITH ACTUAL CORRECT QUESTIONS AND VERIFIED DETAILED ANSWERS BY EXPERTS |FREQUENTLY TESTED QUESTIONS AND SOLUTIONS |ALREADY GRADED A+|NEWEST |GUARANTEED PASS |LATEST UPDATE When the hypothalamus is triggered by endogenous pyrogens, what substance does it create to cause a fever? Prostaglandin E2 If a person has a temperature of 43 degrees celcius, what is expected? Death occurs at 43 degrees " x results from prolonged sweating and electrolyte loss that is not replenished." a. malignant hyperthermia b. heat cramps c. heat stroke d. heat exhaustion b. heat cramps "x results from profuse sweating and vasodilation from prolonged hot environmental temperatures" a. heat cramps b. heat exhaustion c. heat stroke d. malignant hyperthermia b. heat exhaustion Someone with heat exhaustion can expect which physiological consequences? dehydration, hypotension, decreased plasma volume, decreased cardiac output, and tachycardia "x is a rare inherited disorder that causes calcium dysfunction in muscle cells that causes uncontrolled muscle contraction and metabolism." a. malignant hyperthermia b. heat stroke c. heat cramps d. heat exhaustion a. malignant hyperthermia is a rare inherited disorder that is triggered by inhaled anaethetics or muscle relaxants; the person's muscle's continuously contract, increasing their oxygen consumption, metabolism, and lactic acid production. What are physiological consequences of untreated malignant hyperthermia? Acidosis, cardiac dysrhythmias, cardiac arrest, decreased cardiac output, hypotension, oliguria and/or anuria. "x is a potentially lethal condition caused by an overstressed or impaired thermoregulatory centre." a. heat cramps b. malignant hyperthermia c. heat exhaustion d. heat stroke d. heat stroke is caused by an overworked thermoregulatory centre from excessive environmental heat exposure, excessive exertion, or from impaired thermoregulatory function. What are the physiological consequences of untreated heat stroke? The thermoregulatory centre fails, causing the body to be unable to regulate internal temperature; rapid pulse rate, confusion, agitation, coma, CNS degeneration, cerebral edema, swollen dendrites, renal tubule necrosis, hepatic failure, delirium, and death. At what temperature does someone become hypothermic? a. 35 degrees celcius b. 36.2 degrees celcius c. 37 degrees celcius d. 41 degrees celcius a. a core body temperature of 35 degrees celcius or less is classified as hypothermia What is a central fever? What induces it? A sustained, noninfectious fever caused by trauma such as damage to the CNS, inflammation, increased intracranial pressure or bleeding, injuries, hemorrhagic shock, major surgery or thermal burns. What is the normal body temperature range? 36.2-37.7 What numerical difference would you expect between oral temperature and rectal temperature? 0.5 degrees celcius What temperature assessment method is the most expressive of the body's core temperature? rectal temperature Man gets out of bed and acts out his dream while he is dreaming. What is occurring?: a. parasomnia, somnambulism b. dyssomnia, sleep apnea c. parasomnia, REM sleep behaviour disorder d. dyssomnia, insomnia c. this man is experiencing REM sleep behaviour disorder, which is a parasomnia Child walks around the house while he still is asleep. What is occurring?: a. parasomnia, somnambulism b. dyssomnia, sleep apnea c. parasomnia, REM sleep behaviour disorder d. dyssomnia, insomnia a. the boy is experiencing somnambulism, a parasomnia Which fibre in the pain pathway is unmyelinated and responsible for sending signals of dull, non- localised pain sensation? C-fibres Which fibre in the pain pathway is lightly myelinated and responsible for sending signals of sharp, localised pain sensation? A-delta fibres Why do pain pathways cross over to the other side of the spinal cord before being sent to the brain? Pain sensations from one side of the body go to the contralateral side of the brain. A brain injury in the sensory area on one side of the brain will cause a sensory defect on the opposite side of the body What is the location of the cell bodies of pain neurons that serve as the "gate" for the gate control theory of pain? the posterior (dorsal) horn of the grey matter of the spinal cord The --- is responsible for thermoregulation and modifies heat production, heat --- , or heat loss mechanisms, based on input from thermoreceptors. hypothalamus; conservation Which sleep stage does dreaming occur? REM sleep Papilledema is edema of the --- nerve where it enters the eyeball and is associated with --- intracranial pressure optic; increased Pain that is felt in an area remote from its point of origin is called ---- pain. referred Your patient states: "When I started exercising at the gym, the trainer told me not to wipe off my sweat but let it stay on my skin so I would not get heat illness. Why should I do that? Being sweaty is not ladylike!". What is an appropriate response? When you exercise, your body generates more heat. Leaving the sweat on your skin while you are exercising is beneficial because it evaporates, removing excessive heat from your body. That is a protection against heat illness. Think of being sweaty during exercise as a sign that you are taking steps to be stronger and healthier. A nurse colleague says: "I understand why my patients get fevers from exogenous pyrogens when they have bacterial infections, but how can a patient who does not have an infection get a mild fever after surgery?". What is an appropriate response? When our immune cells respond to the tissue injury of surgery, they secrete chemicals that we call endogenous pyrogens. These chemicals circulate to the hypothalamus and trigger fever, just like the exogenous pyrogens that you mentioned. Mr. Smith is receiving therapeutic hypothermia after a brain injury. His wife says, "I understand why his hand feels so cold, but should I worry because his skin is so pale?" What is an appropriate response? Do not worry because he is pale; that is a normal response to a cold body temperature. The body directs blood away from the skin to keep heat from leaving the body. That makes the skin look pale. Mr. Redd does physical labor in a factory near large furnaces. After several hours of work, during which his clothes became soaked with sweat, Mr. Redd began to feel weak. He kept working without drinking water. Near the end of his shift, Mr. Redd became lightheaded and nauseated, and then fainted. He was taken to the employee health office with the following results: low BP, tachycardia, no dysrhythmias, increased body temperature and respiratory rate, warm and damp skin, and functioning reflexes. 1. What is the most likely condition Mr. Redd is experiencing? 2. Explain the physiological reasons why he is experiencing these symptoms. Heat exhaustion. He developed heat exhaustion from the interplay of several factors. He was producing heat with physical labor in a hot environment; thermoregulatory mechanisms caused him to sweat profusely, but he was not able to replace the water and salt loss from the sweat, so he became dehydrated. As Mr. Redd's body temperature began to rise, his hypothalamus triggered widespread cutaneous vasodilation. The combination of decreased circulating blood volume and widespread cutaneous vasodilation caused his blood pressure to decrease so that he was not able to perfuse his brain. Tachycardia arose because Mr. Redd's arterial baroreceptors sensed his decreased blood pressure and stimulated his sympathetic cardioaccelerator nerves. Mr. Boult, age 61, reports "awful burning pain" in his feet and calves for the past 4 months. He was diagnosed with type 2 diabetes 24 years ago. He manages his diabetes with oral antidiabetic medications. All of his vital signs and lab tests are within normal ranges. However, upon physical assessment he has a lack of touch sensation in feet and to the midpoint of calves bilaterally, and dry skin. What type of condition does Mr. Boult most likely have? diabetic neuropathy Why would someone with diabetic neuropathy not have physiologic manifestations of pain such as tachycardia and elevated blood pressure? The body will physiologically adapt to persistent/chronic pain, so the sympathetic nervous system is not activated as it would be in acute pain. What is the difference between neuropathic pain and nociceptive pain? Neuropathic pain occurs when nerves are damaged. The injured nerves become hyperexcitable and fire in the absence of pain signals from the tissues. On the other hand, nociceptive pain occurs when the free nerve endings of primary pain afferents respond to stimuli from the tissues. Nociceptive pain occurs when the nerves are intact. What is unique about the neurotransmitters serotonin and norepinephrine as they relate to pain? Serotonin and norepinephrine are inhibitory in the medulla and pons of the brain, but excitatory in peripheral nerves. ______ pain is caused by lesions in the nerves, excitability/sensitivity of primary sensory neurons, or a dysfunction in pain processing centres in the brain or spinal cord. Neuropathic pain Acute/nociceptive pain can be classified in which 3 categories? 1. visceral (pain in internal organs, transmitted by C fibres) 2. somatic (pain in muscles, joints and skin, trasmitted by a-delta fibres) 3. referred (pain is felt in an area distant from the point of origin) What are the body's heat production methods? Heat loss methods? Heat production: shivering/muscle contraction, vasoconstriction, slowed breathing rate, metabolism. Heat loss: vasodilation, radiation, conduction, convection, evaporation of sweat, decreased muscle tone, increased respiration. How does the hypothalamus raise it's set point? Pyrogens IL-1, IL-6, TNF and interferon induce the hypothalamus to release prostaglandin-E2, which raises thermal set point. Explain how alpha-beta fibres can reduce pain in the gate control theory. Alpha-beta fibres are located in the dorsal horn and are non-nociceptive receptors (transmit touch and vibration sensations, not pain). The stimulation of alpha-beta/non-nociceptive fibres closes the the gate, which reduces the sensation of pain. a & c. Opioids can be mild or strong agonists, or agonist-antagonists. Which of the following are STRONG opioid agonists? (select all that apply): a. morphine b. codeine c. hydromorphone hydrochloride d. oxycodone e. hydrocodone bitartrate f. fentanyl g. methadone a, c, d, f, g Pentazocine (Talwin) is a... opioid agonist-antagonist What are the 3 classes of opioids? morphine-like, meperidine-like, methadone-like What is the major difference between opioid antagonist-agonists, and opioid agonists? agonist-antagonists bind to receptors and cause DIMINISHED pain sensations; agonists bind to receptors and block ALL pain sensation Opioid agonist-antagonists bind to which receptors? (select all that apply): a. mu receptors b. kappa receptors c. delta receptors a & b Fentanyl patches are contraindicated in which patients? Fentanyl patches should not be given to non-opioid tolerant patients due to the risk of causing severe respiratory depression! immediate release opioids have a duration of approximately __ hours 4 extended-release opioids have a duration of approximately ___ hours. 12 hours A patient states they are allergic to morphine. What should the nurse consider? Many patients say they have an allergy to morphine when in reality they experience adverse effects of morphine, like nausea, vomiting and itching. These are not TRUE allergies (they would not cause anaphylaxis). It's important for the nurse to ask for more details of the patient's reported allergic reactions to assess if a true allergy exists. Opioids should not be given to patients with... asthma or respiratory insufficiency Opioids have an affinity for which opioid receptor? mu Binding to the mu receptors causes which unpleasant symptoms? itching, rash and vasodilation A nurse should expect a greater histamine release in a patient taking naturally derived opiates than synthetic opioids. True or false? True What are the most common adverse effects of opioids? nausea, constipation, vomiting and urinary retention Opioid withdrawal in an opioid-naive patient can occur as early as: a. 3 weeks of opioid treatment b. 3 days of opioid treatment c. 4 weeks of opioid treatment d. 2 weeks of opioid treatment d. 2 weeks of opioid treatment What drug interactions occur with opioid drugs? any CNS depressants, including benzodiazepines, barbiturates, antihistamines, alcohol, and promethazine (increase risk of respiratory depression). Also, MAOI's (seizures, hypotension, and respiratory depression) Which of the following is NOT an opioid agonist?: a. morphine b. codeine c. fentanyl d. naltrexone d. naltrexone is an opioid antagonist Which of the following is NOT an opioid agonist-antagonist?: a. methadone hydrochloride b. pentazocine (Talwin) c. nalbuphine (Nubain) d. buprenorphine a. methadone hydrochloride is a opioid agonist List some opioid agonists: →Fentanyl (strong) →Codeine (mild) →Codeine + Acetaminophen (Tylenol #3/#4) →Hydrocodone (mild) →Hydrocodone+Acetaminophen (Vicodin) →Hydrocodone+Ibuprofen →Oxycodone (Roxicodone) (strong) →Oxycodone+Acetaminophen (Percocet) →Oxycodone+Aspirin (Percodan) →Hydromorphone (Dilaudid) (strong) →Levorphanol →Meperidine (Demerol, CII) (strong) →Methadone (Dolophine) (strong) →Morphine (MS Contin, CII) (strong) →Oxymorphone →Tramadol (Ultram) List some non-opioid analgesics NSAIDS (acetaminophen, aspirin, ibuprofen, naproxen, cox2 inhibitors) Acetaminophen is different from other NSAIDs in that it... is NOT anti-inflammatory and does NOT have GI or acid-base side effects. What is some drug interactions with acetaminophen? Alcohol, warfarin, beta blockers, anti-cholinergics, barbiturates, phenytoin and rifampin NSAIDS and corticosteroids are both used to treat _____, but NSAIDs have ____ side effects than corticosteroids. inflammation; less NSAIDs are considered opioid-_____ drugs. opioid-sparing drugs, in that they do not bind to opioid receptors but block pain through a different mechanism (inhibiting prostaglandin) NSAIDs are contraindicated in patients with Allergies to other NSAIDs or aspirin, people w/ bleeding disorders, vitamin K deficiency, or peptic ulcers If a woman is taking NSAIDs throughout pregnancy, at what gestation would it be best for her to stop NSAID therapy due to the bleeding risk? After 32 weeks the risk of bleeding with NSAIDs increases in pregnancy a. calcitonin Calcitonin is an excitatory neurotransmitter that induces pain sensations. Which of the following is NOT an endogenous opioid?: a. nociceptin b. serotonin c. endocannabinoids d. endorphins b. serotonin Serotonin is an inhibitory neurotransmitter, but not considered an endogenous opioid. What is diffuse noxious inhibitory control? a pain-modulating pathway that presents 2 noxious stimuli at different sites to reduce pain perception (ex. acupuncture, massage therapy, cold/heat therapy) Acute pain has physical manifestations, such as... increased HR, increased BP, diaphoresis and dilated pupils. Visceral pain can have physical manifestations, such as... nausea, vomiting, hypotension or shock Chronic pain does not have physical manifestations, but often has psychological ones, such as... depression, dietary changes, sleeping changes, preoccupation with pain, avoidance, irritability, and fatigue. Diabetic neuropathy is considered peripheral neuropathic pain. True or false? True Explain migraines last 4-72 hours -uni-lateral head pain that is throbbing in nature - accompanied by photophobia (light sensitivity), phonophobia (sound sensitivity), and nausea or vomiting - pain can worsen with activity - more common in women - can include auras A patient comes in complaining of severe headaches that feel like a "band" of pressure wrapping all around the head. What is the most likely kind of headache they are experiencing?: a. migraine b. cluster headache c. tension headache c. a tension headache If someone is to be diagnosed with chronic migraines, they must experience migraines for how long? 15 days per month for at least 3 months What neurotransmitter imabalances occur during migraines? increase in the excitatory neurotransmitter glutamate, and decrease in the inhibitory neurotransmitter serotonin Describe cluster headaches - uni-lateral pain that feels stabbing or throbbing - symptoms may include tear production, ptosis, and nasal congestion on the ipsilateral (same) side - pan can last for minutes to hours, and occur at least 8 times a day - more common in men Describe tension headaches The most common type of headaches - lasts for several hours or days - mild to moderate pain that is felt bilaterally and feels like pressure - often accompanied with tender and tight face and neck muscles (SCM, traps, mastoid, masseter, frontal and temporal muscles) A female patient comes in complaining of an intense, throbbing headache and nausea that has been lasting for 24 hours. What kind of headache is this most likely? migraine A patient comes in complaining of "non-stop, throbbing" headaches on their left temple. They also mention that they keep crying out of their left eye, their left eye is drooping, and they can't breathe out of their left nostril. They are very worried they may be having a stroke. What do you think might be happening? Cluster headaches are experienced on one side of the head and can be accompanied by tears, congestion, and eye ptosis on the affected side. These often feel like throbbing pain, and occur at least 8 times a day, which would explain why the patient is complaining of "non-stop, throbbing" headaches. A patient is laying with their arms flexed and their legs and feet extended. This is the decerebrate posture. True or false? False. Flexion of the upper extremities and extension of the lower extremeties is the DECORTICATE position. Think: arms are flexed towards the "CORE" for deCORticate position. A patient with increased ICP is laying with their arms extended at their sides and their legs and feet extended. This is the decerebrate posture. True or false? True. List the letters in the correct order of decreasing consciousness: A. Light coma B. Disorientation C. Lethargy D. Confusion E. Obtundation F. Deep coma G. Stupor D (confusion), B (disorientation), C (lethargy), E (obtundation), G (stupor), A (light coma), F (deep coma) What is the difference between hyperkinesia and hypertonia? Hyperkinesia is excessive movement, but hypertonia is abnormally increased muscle tone. What is the difference between arousal and awareness? Arousal is a state of being awake, but awareness involves content of thought. What is the difference between delirium and dementia? Delirium is an acute confusional state caused by dysfunction of neurons and potentially is reversible; dementia is a confusional state caused by death of neurons and is not reversible What is the difference between paralysis and paresis? Paralysis is loss of voluntary motor function, but paresis is weakness (partial paralysis) of voluntary motor function. What is the difference between paraplegia and hemiplegia? Paraplegia is paralysis of both lower extremities, but hemiplegia is paralysis of the upper and lower extremities on one side of the body. When continuous seizures last more than 5 minutes, the person is said to have what? status epilecticus Obstruction of the flow of cerebrospinal fluid causes which of the following?: a. hydrocephalus b. focal seizures c. microcephalus d. splenomegaly a. hydrocephalus When intracranial pressure equals mean systolic blood pressure, cerebral blood flow... a. increases b. decreases c. stops d. coagulates What is agnosia? Agnosia is a category of defecits where the patient lacks recognition of familiar object as perceived by the senses. This could involve all the senses (visual, tactile or auditory) What is aphasia/dysphasia? In the dictionary, aphasia and dysphasia have different meanings: aphasia means 'total inability to communicate" dysphasia means 'impaired ability to communicate' But aphasia and dysphasia are generally used to mean the same thing: 'difficulty with spoken and written communication following injury to the brain'. If someone has expressive aphasia, what area of the brain is most likely affected? Broca's area If someone has receptive aphasia, what area of the brain is most likely affected? Wernicke's area A patient was cliff diving and hit their head on a rock, suffering an extensive brain injury. Is this an example of a primary of secondary brain injury? Primary brain injury (brain injury caused by the original trauma) A patient has meningitis and suffers brain damage. Is this an example of a primary or secondary brain injury? Secondary brain injury, because the damage is a result of an original trauma (in this example, infection) What are some things that could alter cerebral blood flow? excessive cerebral blood volume, reduced cerebral perfusion, elevated intracranial pressure Describe vasogenic edema a decrease in selective permeability and in increase in general permeability of the cerebral capillary endothelium causes protein to leak into the extracellular space of the brain, causing fluid to follow (osmosis). Describe cytotoxic/metablolic edema cells lose active transport ability, potassium flows out of the cells and sodium flows into the cells, causing water to follow it (osmosis) and swell the cell. Describe interstitial cerebral edema movement of cerebrospinal fluid from the ventricles of the brain into the extracellular fluid spaces, causing an increase in fluid volume around the ventricles and increased hydrostatic pressure within the white matter of the brain. What is hydrocephalus? excess fluid in cerebral ventricles, subarachnoid space, or both which of the following would you expect to see with hypotonia (select all that apply)?: a. fatigue easily b. continuous muscle contraction c. difficulty sitting or standing without arm support d. inability to stand on toes a, c, d Which of the following would you expect to see with hypertonia (select all that apply): a. fatigue easily b. continuous muscle contraction c. muscle spasticity d. muscle hypertrophy a, b, c, d Spasticity, paratonia, dystonia and rigidity are examples of: a. hypotrophy b. hydrocephalus c. hypertrophy d. paraplegia c. hypertrophy (increased muscle tone and increased resistance to stretch) Tourettes, Parkinsons and Huntingtons are conditions that are related to disease of muscles. True or false? False. These are neurological disorders that have effects on muscle movement, but do not originate in the muscles. What is hyperkinesia? excessive, purposeless movement What is hypokinesia? reduced movement What are upper motor neuron syndromes? Motor dysfunction resulting from interruption of the pyramidal system at the level of the cerebrum, brainstem, or spinal cord, that causes destruction of the desending motor pathways. What are lower motor neuron syndromes? imapired voluntary and involuntary movements, related to the number of lower motor neurons affected, that affect deep tendon reflexes and cause muscle atrophy. Muscular dystrophy, Myasthenia Gravis, Poliomyelitis, and Bulbar Palsy are examples of what syndrome? Lowe Motor Neuron Syndromes Cerebral Palsy and Multiple Sclerosis are examples of what syndromes? Upper Motor Neuron Syndromes Motor neuron diseases are those in which cells are ______ destroyed ALS is an example of what kind of disease? A motor neuron disease that affects both upper and lower motor neurons leading to progressive muscle wasting and scarring of the corticospinal tract What is epilepsy? chronic neurological syndrome related to excessive electrical activity of neurons in the cerebral cortex grey matter leading to recurrent seizures What is a seizure? Excessive stimulation of neurons in the brain leading to abnormal neuronal activity and changes in brain function What is a convulsion? Involuntary spasmodic contractions of any or all voluntary muscles throughout the body, including skeletal, facial, and ocular muscles What is primary epilepsy? Epilepsy without a known cause What is secondary epilepsy? Epilepsy with a known cause, including trauma, infection, or cerebrovascular disorders What are febrile seizures? Seizures occur during high fevers in children Which of the following is NOT a generalized onset seizure?: a. tonic-clonic seizure b. abscence seizure c. complex focal onset seizure d. drop attack How do anti-epileptic drugs work? Stabilize neurons by altering flow of sodium, calcium, potassium and magnesium ions, which reduces overall cell excitabiltiy and nerve impulse conduction. SOME anti-epileptic drugs work by increasing GABA levels or altering blood flow to focalized areas, but these are not as common. Someone preparing for brain surgery may be given an anti-epileptic drug prophylactically. True or false? True. anti-epileptic drugs are general drugs that are not specific to certain types of seizures. True or false? False. Anti-epileptic drugs are not "one size fits all" but often target specific kinds of seizures. Anti-epileptic drugs have minimal contraindications, but many side effects. True or false? True. What are the first line anti-epileptic drugs? (choose all that apply): a. barbiturates b. gabapentin c. pregabalin d. hydantoins a & d Barbiturates, Hydantoins, Iminostilbenes, and valproic acid are examples of what class of drug? anti-epileptic drugs Which of the following is NOT an anti-epileptic drug?: a. primidone b. phenobarbital c. phenytoin d. merepidine e. carbamazapine f. pregabalin g. gabapentin d. merepidine is an opioid Increased intrcranial pressure is a medical emergency. True or false? True. Which of the following is a normal ICP?: a. 135-145mmHg b. 5-15mmHg c. 28mmHg d. 45mmHg b. 5-15mmHg is a healthy ICP. Anything over 20mmHg requires immediate medical attention! What are things that can increase ICP naturally (not to a pathological level). body temperature, carbon dioxide and oxygen levels, body position, arterial and venous pressure, and increased intraabdominal pressure (coughing, sneezing) What is cerebral perfusion pressure? Pressure gradient across the brain tissue, the required pressure to perfuse the brain tissues. CPP = MAP - ICP Normal is 60 to 100 mm Hg Which of the following IS a normal CPP?: a. 5-15mmHg b. 40-60mmHg c. 130mmHg d. 60-100mmHg d. 60-100mmHg If the CPP is below 50mmHg, what occurs? The brain is not being perfused, which will lead to death if left untreated. How do you calculate the CPP? mean arterial pressure (MAP) - intracranial pressure (ICP) = CPP How do you calculate the mean arterial pressure? (diastolic blood pressure x 2) + (systolic blood pressure) / 3 Calculate the CPP with an ICP of 19 and a BP of 90/42. Is your finding a medical emergency? diastolic BP (42) x 2 = 84 + systolic BP (90) = 174 174/3 = 58 (MAP) 58 (MAP) - 19 (ICP) = 39 CPP the CPP is 39: this is a medical emergency! What can cause increased intracranial pressure (to pathological levels)? Injury, increased cerebrospinal fluid, hemmorhage, hematoma, tumour, infection, hydrocephalus Fill in the missing blanks in the chain of events: increased ICP --> decreased CPP --> decreased _____ --> decreased nutrients and oxygen delivered to the brain --> increased ___ blood pressure to compensate --> swelling --> ICP increased further --> ____ of brain tissue into brain stem ---> death. blood flow to brain; systolic; herniation What are the symptoms of increased ICP? (think of the acronym "MIND CRUSHED") Mental status changes Irregular breathing (cheynes stokes) Nerve changes to oculomotor and optic nerves Decerebrate/Decorticate posturing Cushings triad (widened pulse pressure, decreased HR, irregular breathing) Reflex + for babinski Unconscious Seizures Headache Emesis Deterioration of motor function If a baby has cyclopia, what is the outcome? miscarriage Describe anencephaly part of the skull bone and brain fails to develop in utero = miscarriage Describe encephalocele Herniation of the brain through the soft spot in the skull of an infant (80% end in miscarriage, remaining 20% have high chance of dying after birth) Describe meningocele (spina bifida) Sac protruding from spine containing cerebrospinal fluid and meninges, but NO nerves or spinal cord. Child will survive/mild form of spina bifida. Describe myelomeningocele (spina bifida) Sac protruding from the spine containing cerebrospinal fluid, meninges, spinal cord and nerves. Below the lesion/sac is considered malformed: minimal motor, sensory, reflex and autonomic functions. More severe form of spina bifida. 80% of children born with myelomeningocele also experience what condition? Hydrocephalus What is a Chiari malformation? herniation of the cerebellum more than 5 mm beyond the margin of the foramen magnum; commin in spina bifida What is craniostenosis? the premature closing of 1 or more fontanelles Vertebral injuries tend to occur at the most _____ (rigid or mobile) portions of the vertebral column. mobile Migraine causes ______ (unilateral or bilateral) head pain. unilateral Blood in the subarachnoid space after hemorrhage causes ____ (infection OR inflammation) and can ____ (impair or potentiate) circulation of cerebrospinal fluid. inflammation, impair Most cases of encephalitis are caused by ____ (bacteria or viruses). viruses Brain tumors cause both local and ____ (focal or generalized) effects. generalized Activation of the trigeminal vascular system is an important part of the pathophysiology of _____ (tension or migraine) headaches. migraine What is the difference between a brain contusion and a concussion? A brain contusion is a focal bruise that occurs when blood leaks from an injured blood vessel, but a con- cussion is a diffuse traumatic brain injury. Bleeding between the dura mater and the skull causes an ______ hematoma. epidural A classic cerebral concussion is characterized by loss of ______ for less than 6 hours, accompanied by retrograde and anterograde ______ and a confusional state. consciousness; amnesia Release of excitatory neurotransmitters after brain injury causes secondary neural injury known as _______ excitotoxicity Neurogenic shock, also called _______ shock, is characterized by bradycardia and _____ blood pressure. vasogenic; low Any brain abnormality caused by blood vessel pathophysiology is called a ________ disease: a. vasogenic b. vascular c. cerebrovascular d. encephalitic c. cerebrovascular The nucleus _______ is the gelatinous inner portion of an intervertebral disk that protrudes if the disk herniates. pulposus Clinical manifestations of an ischemic stroke vary, depending on which ______ is obstructed. artery A person who has a ______ type headache experiences bilateral headache with a sensation of a tight band or pressure around the head tension A localized collection of pus in the brain is called a brain ______ abscess Which of the following is NOT a characteristic of Multiple Sclerosis?: a. nerve demyelination in the central nervous system b. etiology is partly genetic c. symptoms vary depending on location of lesions d. a return of function with some residual weakness d. MS is a progressive disease that gradually declines, with some periods of intermittent recovery that doesn't last. Mr. Kanodi is upset. His son Calvin developed an acute subdural hematoma after being hit in the head by a golf ball during a tournament. "Why do they want to make a hole in his skull?" he says. "They could damage his brain!" What is an appropriate response? I know you are worried about Calvin's safety. See how Calvin is responding less and less to you when you try to talk with him? The bleeding above the surface of his brain is squeezing his brain and causing it to function poorly. It can damage his brain unless surgery is done to relieve the pressure. Mr. Samuels had a thoracic spinal cord injury, and he has completed rehabilitation. His brother says, "I do not understand why he has so many muscle spasms in his legs. My friend had nerve damage in an auto accident and his leg is paralyzed too, but it just lies there flabby-like. Why are my brother's legs so spastic?" What is an appropriate response? Your brother and your friend have different types of injuries. Your friend has damage to the nerves that go from his spine to his leg muscles. Nerves are like electrical wires that send signals. Your friend's mus- cles do not get any signals, so they just lie there "flabby-like," as you said, and he cannot move them. Your brother has damage to different nerves: the ones that go down his spine from his brain. That is why he cannot tell his legs to move. However, the nerves that go from his spine to his leg muscles are still working. His legs are spastic because his muscles are getting messages to contract, but those messages are no lon- ger initiated or coordinated by his brain. Mrs. Kelso, who has multiple sclerosis, says, "Why did it take my doctors 7 years to figure out that my symptoms were caused by multiple sclerosis?". What is an appropriate response? Multiple sclerosis damages the insulating myelin on nerve cells, and they do not work well. The signs and symptoms of multiple sclerosis are different in different people because the damage can occur many different places in the brain and spinal cord. A college campus has an outbreak of meningococcal meningitis. The student health personnel are preparing fliers to post in the dormitories to inform students about signs and symptoms of this infection. What two major signs and symptoms should they list on the fliers, telling students to seek immediate medical assistance if they occur? Severe headaches and neck stiffness. Mr. Tom Costa, age 71, had a stroke last year that made his right upper and lower extremities quite weak. He has smoked for 55 years and is obese. He was diagnosed with atrial fibrillation, high blood pressure, and type 2 diabetes mellitus while he was hospitalized with his stroke. His father died of a heart attack at age 50; his paternal grandfather had a stroke and died a year later after a second stroke. His mother and both of her parents had type 2 diabetes. Based on his story, is it more likely that he had an ischemic or hemorrhagic stroke? Ischemic A patient recovering from a stroke asks the RN why he needs to call his physician if he has a TIA if TIA's go away on their own. How should the RN respond? Although the signs and symptoms of a TIA do go away, TIAs are a big risk factor for having another stroke. The same changes in your blood vessels that cause TIAs also cause strokes. That is why it is important to protect your blood vessels by taking your blood pressure and other medications, manag- ing your diabetes and your weight, and working to stop smoking. I know these changes are challeng- ing, but they help protect you from another stroke. Your doctor wants to know if you have a TIA so she can help you. The glomerulus of the nephron GFR is calculated by _____ clearance.: a. chloride b. sodium c. bicarbonate d. creatinine d. creatinine clearance A glomerular filtration rate of 45 for three consecutive months indicates... kidney disease or failure 60-70% of sodium and water is returned to the bloodstream in the ______ of the kidneys. proximal convoluted tubule The proximal convoluted tubule utilises ATP to transport sodium and water. True or false? True. 20-25% of sodium is reabsorbed in the _____ of the kidneys. the loop of Henle Which of the following is NOT a symptom of hyperkalemia?: a. hypotension and bradycardia b. diarrhea c. decreased deep tendon reflexes d. muscle weakness c. decreased DTR. In hyperkalemia, DTR and increased, not decreased! Which of the following is NOT a symptom of hypokalemia?: a. muscle paralysis and cramping b. constipation c. abdominal distention d. hypotension d. hypotension Hypotension is a symptom of hyperkalemia. What are the 3 functions of Na+? 1. maintain blood pressure 2. maintain blood volume 3. maintain pH balance Which of the following is NOT a sign/symptom of hypernatremia?: a. increased thirst b. seizure and coma c. nausea and vomiting d. increased muscle tone b. seizure and coma Seizures and comas occur in a hyponatremic state, but not hypernatremia. Which of the following is NOT a sign/symptom of hyponatremia?: a. nausea and vomiting b. tachycardia c. weak/thready pulse d. respiratory arrest a. nausea and vomiting Nausea and vomiting is a severe sign of hyPERnatremia, not hyponatremia. Chloride mainly follows around the ion _____ and does mostly the same things. Sodium (Na+) Which of the following is NOT a symptom of hyperchloremia?: a. swollen dry tongue b. confusion c. nausea and vomiting d. exhessive diarrhea d. excessive diarrhea This is a symptom in HYPOcholemia Which of the following is NOT a symptom of hypochloremia?: a. diarrhea b. vomiting c. confusion d. fever c. confusion Confusion is a common symptom for hyperchloremia. Magnesium's main purpose is to maintain muscles, especially in the uterus, heart and deep tendon reflexes. True or false? True. Magnesium is required for ___ and ____ absorption. calcium and vitamin D Which of the following is NOT a symptom of hypermagnesemia?: a. tachycardia b. hypotension c. depressed deep tendon reflexes d. bradycardia a. tachycardia Which of the following is NOT a symptom of hypomagnesemia?: a. increased deep tendon reflexes b. abnormal eye movements including nystagmus c. diarrhea d. bradycardia d. bradycardia What are the 3 main functions of calcium in the body? 1. blood clotting factors 2. strong bones 3. maintain heart beat Which of the following IS a sign of hypercalcemia?: a. diarrhea b. constipation c. rapid deep tendon reflexes d. bone fractures b. constipation is a symptom of hypercalcemia. Which of the following is NOT a sign of hypocalcemia?: a. circumoral tingling b. diarrhea c. trousseau's sign d. kidney stones d. kidney stones Kidney stones are experienced in hypercalcemic states. Calcium has an inverse relationship with ____ Phosphate If a patient has hyperphosphatemia, would they be hypocalcemic or hypercalcemic? Phosphate and calcium are opposites, therefore, in a state of high phosphate, calcium would be LOW: hypocalcemia. Which of the following would NOT be expected in hyperphosphatemia?: a. risk for bleeding The most dangerous effect of hyperkalemia is its action on the ____ (kidneys or heart). heart Hypercapnia means an excess of _____ (metabolic acid or carbon dioxide) in the blood. carbon dioxide Edema caused by right sided heart failure is caused by: a. lymphatic obstruction b. increased capillary hydrostatic pressure c. decreased plasma oncotic pressure d. increased capillary permeability b. increased capillary hydrostatic pressure Edema caused by an infected wound is caused by: a. lymphatic obstruction b. increased capillary hydrostatic pressure c. decreased plasma oncotic pressure d. increased capillary permeability d. increased capillary permeability Edema caused by a clot in a vein is casued by: a. lymphatic obstruction b. increased capillary hydrostatic pressure c. decreased plasma oncotic pressure d. increased capillary permeability b. increased capillary hydrostatic pressure Protein malnutrition resulting in edema is caused by: a. lymphatic obstruction b. increased capillary hydrostatic pressure c. decreased plasma oncotic pressure d. increased capillary permeability c. decreased plasma oncotic pressure Edema resulting from a bee sting is caused by: a. lymphatic obstruction b. increased capillary hydrostatic pressure c. decreased plasma oncotic pressure d. increased capillary permeability d. increased capillary permeability End-stage renal disease causes edema due to: a. lymphatic obstruction b. increased capillary hydrostatic pressure c. decreased plasma oncotic pressure d. increased capillary permeability b. increased capillary hydrostatic pressure Who has a greater percentage of body weight as water: a lean woman or an obese woman? A lean woman Who has a greater percentage of body weight as water: an infant or an adult? An infant Who has a greater percentage of body weight as water, if both people weigh the same: a woman or a man? A man Who has a greater percentage of body weight as water, if both people weigh the same: a 56-year-old man or a 78-year-old man? A 56 year old man Where is the potassium ion concentration greater: extracellular fluid or intracellular fluid? Intracellular Where is the sodium ion concentration greater: extracellular fluid or intracellular fluid? Extracellular fluid Which is greater: the pH of an acid solution or the pH of an alkaline solution? alkaline Which is greater: the respiratory rate during metabolic acidosis or the respiratory rate during metabolic alkalosis? Respiratory rate would be higher in metabolic acidosis. What cerebral clinical manifestations occur when neurons swell or shrink? Confusion, coma, lethargy and seizures Aldosterone is stimulated by angiotensin II and increased plasma potassium levels. True or false? True Aldosterone increases renal sodium and water reabsorption, and increase renal excretion of potassium and hydrogen ions. True or false? True. Antidiuretic hormone is stimulated by decreased arteriol blood pressure and increased plasma osmolality. True or false? True Antidiuretic hormone decreases renal reabsorption of sodium and water, and decreases renal excretion of potassium and hydrogen. True or false? False. ADH increases renal reabsorption of sodium and water, and increases renal excretion of potassium and hydrogen. What is the difference between volatile and non-volatile acids? A volatile acid (carbonic acid) is excreted by the lungs, but a nonvolatile acid (metabolic acid) is excreted by the kidneys With regard to an acid-base imbalance, what is the difference between correction and compensation? Correction of an acid-base imbalance returns the bicarbonate and carbonic acid concentrations to normal, but compensation for an acid-base imbalance returns the bicarbonate-to-carbonic acid ratio to normal (20:1) while the actual bicarbonate and carbonic acid concentrations are abnormal. An ____ fluid has the same concentration of solute as the plasma. isotonic The two most important PLASMA buffers are ____ and ____. carbonic acid-bicarbonate; hemoglobin Calculating the anion gap may help to distinguish between different causes of metabolic _______ acidosis Overuse of phosphate-containing over-the-counter enemas can cause ______, which in turn will _____ the plasma calcium concentration. hyperphosphatemia; decrease Mr. Wiggins has been sobbing and breathing deeply and rapidly for an hour since his wife died. He is most likely at risk for which of the following?: a. isotonic fluid deficit, hypokalemia and metabolic alkalosis b. respiratory acidosis c. respiratory alkalosis d. isotonic fluid excess and hypokalemia c. respiratory alkalosis Mr. Jenkins is comatose from a heroin overdose. Which is he at highest risk for developing?: a. isotonic fluid deficit, hypokalemia and metabolic alkalosis You can figure out the fluid and electrolyte imbalances in oliguric end-stage renal disease patients if you remember that the kidneys normally excrete water and sodium, potassium, magnesium, phosphate, and metabolic acids. With oliguria, these will not be excreted and will accumulate in the body. Therefore you can expect isotonic fluid excess, hyperkalemia, metabolic acidosis, possibly hypermagnesemia, and hyperphosphatemia Spironolactone is a loop diuretic. True or false? False. Spironolactone is a potassium-sparing diuretic, and acts in the collecting duct and distal convoluted tubule of the kidneys. What is the mechanism of spironolactone? aldosterone antagonist Spironolactone and other potassium-sparing diuretics cause Na+ _____ (excretion or reabsorption), H2O ______ (excretion or reabsorption), and K+ _____ (excretion or reabsorption). excretion, excretion, reabsorption. Why would a potassium sparing diruetic be using in conjuction with a thiazide? Thiazide diuretics cause potassium, magnesium and chloride loss, but when used alongside a potassium- sparing diuretic, it counteracts the potassium and chloride loss. Spironolactone can be used to treat hyperaldosteronism. True or false? True. Spironolactone blocks aldosterone receptors. What are the contraindications of spironolactone? renal failure, hyperkalemia, adrenal insufficiency What are some drug interactions with spironolactone? other potassium-sparing diuretics, K+ supplements, ACE inhibitors and lithium. Furosemide is a loop diuretic. True or false? True. Furosemide is also known as... a. Bumex b. Lasix c. Aldactone d. Esidrix b. Lasix What is the mechanism of action for furosemide (Lasix)? acts in the ascending Loop of henle by blocking chloride and sodium reabsorption and activates kidney prostaglandins, which increases vasodilation and reduces blood pressure. What are the indications for furosemide (Lasix)? hypertension, liver cirrhosis, renal disease, and edema related to heart failure. What are some adverse effects of furosemide (Lasix)? Electrolyte imbalance (especially related to sodium, potassium and calcium), hypokalemia, changes in plasma levels of insulin, glucoagon and growth hormone, dehydration, nausea/vomiting, and ototoxicity. Which of the following is NOT a class of diuretics?: a. Loop b. Osmotic c. Potassium-Sparing d. DAI's d. DAI's is not a class of diuretics; CAI's are. Which of the following is NOT a diuretic?: a. acetazolamide b. thiazide c. buprenorphine d. mannitol c. buprenorphine buprenorphine is an analgesic, not a diuretic. Explain the mechanism of action for thiazides. work in the distal tubule by blocking sodium potassium, and chloride reabsorption, and causing relaxation of the arterioles Explain the mechanism of action for osmotic diuretics. work all along the nephron, but especially in the proximal and distal convoluted tubules. Increases osmotic pressure in the glomerulus, causing fluid to enter into the glomerulus from the surrounding tissue, leading to diuresis. Explain the mechanism of action of carbonic anhydrase inhibitors (CAI's). work in the proximal tubule by reducing the availability of hydrogen needed for active transport of sodium and water back into the blood, thereby reducing the absorption of sodium and water back into the body. Because of their rapid onset of action, _____ diuretics are particularly useful when rapid diuresis is needed. Loop Even when kidney function is diminished, _____ diuretics can still work even with creatinine clearance below 25mL/min. loop _______ drugs may diminish the reduction of vascular resistance induced by loop diuretics, because these two drug classes have opposite effects on prostaglandin activity. non-steroidal anti-inflammatories (NSAIDs) _______ is by far the most commonly used loop diuretic in clinical practice furosemide (Lasix) The trade name Lasix was derived from the fact that the duration of action is ____ hours. 6 Furosemide (Lasix) is contraindicated in.... anuria, hypovolemia, electrolyte depletion, and a known drug allergy. potassium-sparing diuretics are also known as _________ diuretics, because they block ____ receptors. aldosterone-inhibiting diuretics, aldosterone. ______ is the most commonly used of the potassium-sparing diuretics. spironolactone (Aldactone) Adverse effects of spironolactone (Aldactone) Gynecomastia Amenorrhea Irregular menses Postmenopausal bleeding Severe _____ depletion causes depressed ventilation, depressed insluin secretion and glycogen synthesis, increased thirst, polyuria, delayed ventricular repolarization, decreased smooth muscle tone, and a lowered charge of the ECF affecting membrane potentials. a. Sodium b. Chloride c. Potassium d. Calcium c. Potassium Carbonic acid requires ______ to split into CO2 and H2O. carbonic anhydrase Normal ratio of bicarbonate to carbonic acid 20:1 What are the symptoms of metabolic acidosis? Kussamaul Respirations (deep, rapid hyperventilation), headache, dizziness, lethargy, respiratory depression, confusion, coma, nause/vomiting, diarrhea, or death. Explain the hemoglobin buffering system red blood cells drop off O2 to the tissues, and pick up H+, bicarbonate, or CO2. Red blood cells have carbonic anhydrase to cleave carbonic acid into H+ and bicarbonate. Red blood cells bring those to the lungs where carbonic anhydrase is used again in order for the lungs to exhale H2O and CO2. What conditions could cause respiratory acidosis? asthma, pneumothorax, emphysema, COPD, pneumonia, aspiration, bronchitis, opioid drug use, or head injury. If respiratory acidosis occurs from a long-term pulmonary condition, such as emphysema, the kidneys will compensate by increasing ___ levels. bicarbonate What are some clinical manifestations of alterations in acid-base balance? Seizures, coma, muscle tetany/contractions, altered consciousness, anxiety, cardiac arrhythmias, tingling in the extremities, vomiting or diarrhea, or respiratory depression. Compensation is proportionate to the amount of H+ and bicarbonate imabalance. True or false? True. Decompensation is when the body is able to fix the root problem of the acid-base imbalance, and no longer requires compensation mechanisms. True or false? False. Decompensation is when the body cannot adequately compensate/buffer any longer. If the core/root issue of the acid-base imbalance is not fixed, death will ensue. What is desmopressin? synthetic antidiuretic hormone. What are indications for desmospressin? polyuria, polydipsia (excessive thirst), and nocturia associated with diabetes insipidus and head injury/surgery involving the pituitary gland. It can also be helpful in treating some blood disorders because it increases clot formation and platelet aggregation. What is the mechanism of action of desmopressin? Desmopressin mimics the effects of naturally occurring ADH, which increases renal water resorption in the distable convoluted tubule and collecting duct, and concentrates urine. However, this effect also increases the risk for water intoxication from decreased urine output. What are some adverse effects of desmopressin? increased blood pressure, headache, fever, vertigo, uterine cramping, nausea, heartburn, cramps, tremors, sweating, nasal congestion. Can also increase risk of thrombolytic event. What is a severe adverse effect of ibuprofen if 800+mg/day is taken over a long period of time? Increased risk of stroke and myocardial infarction Most fatalities associated with NSAID use are related to _______ (side effect). In addition, acute kidney injury is quite common with NSAID use, especially if the patient is _______. GI bleeding; dehydrated What are the indications for ibuprofen? Fever, pain, inflammation, arthritis, and dysmennorhea. If you have a fever, all of these drugs could help EXCEPT... a. ibuprofen b. acetaminophen c. aspirin d. tramadol d. tramadol is an analgesic, not an antipyretic. What is the mechanism of action for antihistamines? Antihistamine drugs work by blocking the histamine receptors on the surfaces of basophils and mast cells, thereby preventing the release and actions of histamine stored within these cells. They do not push off histamine that is already bound to a receptor but compete with histamine for unoccupied recep- tors. What are the indications for antihistamines? Relief of symptoms associated with allergies, including rhinitis, urticaria, and angioedema, and adjunctive therapy in anaphylactic reactions some antihistamines are used to treat motion sickness (dimenhydrinate and meclizine), insomnia (diphenhydramine), parkinson-like reactions (diphenhydramine), and other nonallergic conditions What is the mechanism of action for bronchodilators? Beta-agonists (like salbutamol, and salmeterol) stimulate beta-adrenergic receptors by simulating the effects of norepinephrine of the sympathetic nervous system. This causes bronchial smooth muscle to relax, bronchioles to dilate, and airflow to increase. Non-selective adrenergic agonist drugs (like epinephrine) stimulate alpha-adrenergic receptors in the lung parenchema, causing vasoconstriction and subsequent reduction in the amount of edema and secretions of the mucous membranes. Body levels of adrenal corticosteroids are regulated by the... hypothalamic-pituitary-adrenal (HPA) axis What is the mechanism of the HPA axis? Levels of adrenal corticosteroids fall below the threshold, which stimulates the hypothalamus to secrete corticotropin-releasing hormone (CRH). CRH stimulates the anterior pituitary gland to release adrenocorticotropic hormone (ACTH). ACTH eventually gets transported to the adrenal cortex, where it triggers the adrenal cortex to make corticosteroids. Once corticosteroids are manufactured and released into the bloodstream, they eventually reach a desireable level and signal the HPA axis to turn off. What are the effects of corticosteroids in the body? Regulating fluid and electrolytes (water, sodium, potassium, and hydrogen ions), influences pH, suppress inflammatory process, affect metabolism, suppress the immune response, stress response, and blood pressure control. What is the role of glucocorticoids/corticosteroids in the inflammatory response? Stabilize mast cells and lysosomes, decrease migration of WBCs to an area of inflammation, decrease capillary permeability to inflammatory cells, and reduce the release of IL-1 from white blood cells. Pulmonary diseases are classified as either infectious or ______, acute or ______, and obstructive or ______. noninfectious; chronic; restrictive The most common symptoms of any pulmonary disease are: a. cough and shortness of breath (dyspnea) b. apnea and dyspnea c. repiratory acidosis and dyspnea d. wheezing and coughing a. cough and shortness of breath (dyspnea) What is hemoptysis? Causes? Coughing up blood-tinged sputum Causes: indicates infection or inflammation causing damage to the bronchi or lung parenchyma. Examples: chronic bronchitis, pneumonia, bronchogenic carcinoma, TB, bronchiectasis, aspergilloma A patient has increased tidal volume, decreased ventilatory rate, increased effort breathing, prolonged inspiration and prolonged expiration, accompanied by wheezing or stridor. Is this a large airway obstruction or a small airway obstruction? Large airway obstruction A patient has increased ventilatory rate, decreased tidal volume, increased effort breathing, prolonged expiration, accompanied by wheezing. Is this a small or large airway obstruction? Small airway obstruction If hypoventilation is left untreated, what can occur? drowsiness, hypoxia, disorientation, and altered tissue function related to acidosis. If hyperventilation is left untreated, what can occur? c. cystic fibrosis d. emphysema d. emphysema What is the difference between pneumonia and bronchitis? Bronchitis is an infection of the airway or bronchi. Pneumonia is infection of the lower respiratory tract. ______ is a lung infection in which granulomas form in the lungs, lay latent, and may migrate to the lymphatic system: a. novel coronavirus b. bronchitis c. pneumonia d. tuberculosis d. tuberculosis Which of the following is NOT a part of the upper respiratory tract?: a. nose b. bronchi c. nasopharynx d. oropharynx e. laryngopharynx f. larynx b. bronchi Which of the following is NOT a part of the lower respiratory tract?: a. bronchial tree b. larynx c. trachea d. lungs b. larynx What are the accessory structures of the pulmonary system? diaphragm, intercostal muscles, rib cage and mouth. long-acting beta adrenergic bronchodilators are used in the acute phase of an asthma attack. True or false? False. What are adverse effects of beta-adrenergic bronchodilators? Nervousness, anxiety, restlessness, insomnia, anorexia, tremor, hyperglycemia, heart stimulation, headache, tachycardia, angina, and nausea How do anti-cholinergic bronchodilators work? By blocking cholinergic, bronchoconstricting receptors - reduce mucus secretions Are anti-cholinergic bronchodilators useful in treating acute asthma attacks? No. They are useful in preventing bronchospasms, but not in acute onset. What are the asverse effects of anti-cholinergic bronchodilators? Nausea, dry mouth, nasal congestion, heart palpitations, GI distress, urinary retention, increased intraocular pressure, headache, cough and anxiety. How do xanthine derivatives work? cause bronchodilation by relaxing smooth muscle in the airways Xanthine Derivatives are not suitable for treatment of acute asthmatic attacks. true or false? True. They are used as a preventative treatment, not acute treatment. What are anti-tussives? Depress cough reflex - opioid and non opioid What are expectorants? Drugs that aid in the expectoration (removal) of mucus Reduce the viscosity of secretions Disintegrate and thin secretions What are decongestants used for? Treat nasal congestion that is as a result of the common cold, hay fever, acute or chronic rhinitis, and sinusitis. The majority of oxygen enters tissues via hemoglobin offloading. True or false? True ______ are chemicals hat produce ions when they dissolve in water. electrolytes What are the typical concentrations of the following ions in the intracellular fluid?: a. calcium (high or low) b. sodium (high or low) c. bicarbonate (high or low) d. Chloride (high or low) e. potassium (high or low) a. low b. low c. low d. low e. high What are the typical concentrations of the following ions in the interstitial/vascular fluid?: a. calcium (high or low) b. sodium (high or low) c. bicarbonate (high or low) d. Chloride (high or low) e. potassium (high or low) a. high b. high c. moderate d. high e. low If sodium is transported out of the cell, it requires ATP because.... sodium is the most copious cation outside of the cell, therefore, if it is leaving the cell it is going against the gradient. Hyponatremia causes ____ (swelling or shrinking) of the cells, _______-tension, and _____-cardia. swelling; hypotension; tachycardia Hypernatremia causes ____ (swelling or shrinking) of the cells, ______-tension, and _____-cardia. shrinking; hypertension; tachycardia Osmotic pressure is generated as water moves across a membrane, determined by the pull of non- permeable particles on the other side of the membrane. True or false? True. capillary filtration pressure moves water in which direction? pushes water out of the capillary into the interstitial spaces If osmotic pressure causes fluid to move back into the intravascular space, this is called ______. reabsorption in capillaries, fluid leaves the arteriole by following the _______ gradient, but returns to the venous return by following the _______ gradient. hydrostatic pressure gradient; osmotic/colloid gradient. osmoreceptors, located in the ______, are activated by decreased blood volume or cellular dehydration. hypothalamus 1. increased antidiuretic hormone Which of the following would result from a deficit of plasma proteins? Select one: 1. Increased osmotic pressure 2. Increased hydrostatic pressure 3. Decreased osmotic pressure 4. Decreased hydrostatic pressure 3. decreased osmotic pressure Which substance directly controls the reabsorption of water from the collecting ducts? Select one: 1. Renin 2. Aldosterone 3. Angiotensin 4. Antidiuretic hormone 4. antidiuretic hormone When a patient is receiving diuretic therapy, what best reflects the patient's fluid volume status? Select one: 1. Blood pressure and pulse 2. Intake, output, and daily weight 3. Abdominal girth and calf circumference 4. Serum potassium and sodium levels 2. Intake, Output and Daily Weight When is the best time for a patient to receive antidiuretics to reduce the amount of disruption of their daily routine? In the morning Fatigue is characterized by what 3 things? 1. perception of generalized weakness 2. mental fatigue 3. decreased ability to complete activities Fatigue is classified as a health problem if it persists for... a. 1+ week b. 2+ weeks c. 3+ weeks d. one month+ b. 2 weeks There are 3 kinds of fatigue classifications. What are they? 1. Unknown etiology 2. Physiological (due to an imbalance in sleep, nutrition and activity) 3. Secondary (due to an underlying health condition) Fatigue is classified as chronic if it persists for... 6+ months What are some physiological causes of fatigue (not related to health conditions, but physiological processes themselves) 1. buildup of metabolic waste/waste products in the body 2. inflammatory process 3. an insufficient supply of nutrients needed for functioning Which fatigue is resistant to treatment: temporary or chronic? Chronic What populations are at the highest risk for fatigue? Women, older adults, and middle-aged adults 2/3 of all chronic fatigue is related to which of the following (choose all that apply): a. seasonal affective disorder b. an underlying medical/psychiatric disorder c. medication side effects d. isolation/loneliness b. 2/3 of all chronic fatigue is related to either the side effects of medications or an underlying diagnosis (secondary fatigue) What are interventions for a nursing assessment related to a patient complaining of fatigue? - PQRSTU - assess the impact on their daily life - ask them to explain how it feels/subjective data - observe their general appearance (facial expressions, hygiene) - palpate lymph nodes and thyroid - auscultate the lungs and heart - assess muscle strength against resistance - perform a cranial nerve assessment - assess deep tendon reflexes - perform any diagnostic tests (CBC, ESR, renal and liver function, HIV antibodies, thyroid function and urinalysis) What are primary prevention techniques for fatigue? Balancing sleep and wakefulness, getting adequate exercise, having a healthy diet, providing patient education for patients at particular risk for fatigue disorder What are some interventions a patient can perform to manage fatigue? exercise 30 minutes a day, eat a balanced diet, get adequate sleep, manage any underlying conditions that can cause fatigue, manage stress with relaxation techniques, have planned rest/nap breaks, use CNS stimulants if needed, consider CBT psychotherapy, stretch/yoga regularly, and go for walks. What is the difference between hypnotics and sedatives? Sedatives reduce excitability but don't cause sleep unless given in high doses. Hypnotics cause sleep. What is a long-term side effect of prolonged sedative/hypnotic drug therapy? Interference with REM sleep, daytime drowsiness and fatigue, interruptions of sleep cycles What is the mechanism of action for benzodiazepines? Bind to cell receptors enhancing the effect of GABA (inhibitory neurotransmitter), which slows the activity of nerves in the brain What are the indications for benzodiazepines? Commonly used for sedation, relief of agitation or anxiety, treatment of anxiety-related depression or bipolar disorder, sleep induction for sleep disorders, skeletal muscle relaxation for muscle spasms, treatment of acute seizure disorders, treatment and prevention of the symptoms of alcohol withdrawal, and used as an adjuncts in anaesthesia. What are the contraindications of benzodiazepines? pregnancy, known drug allergy, open-angle glaucoma, elderly (increases risk of falls and dementia), impaired kidney or liver function What can happen if a pregnant woman takes benzodiazepines? Increases the risk of low birth weight babies and preterm delivery What are the adverse effects of taking benzodiazepines? - ataxia (balance, coordination and speech disturbances) - confusion, amnesia - fatigue/lethargy/drowsiness - lightheadedness, dizziness, vertigo - headaches - feeling "hungover", dry mouth, and GI upset - visual disturbances - restlessness and/or irritability. What are some nursing considerations to help with the adverse drug reactions of benzodiazepines? Dizziness/vertigo: have patient rise slowly, avoid driving heavy machinery, and take drug in the evening GI upset: take meds with food, regular water and fibre intake, and exercise respiratory depression, coma, and/or death How would you treat an overdose of barbiturates? activated charcoal, O2 ventilation, maintain airways and give diuretics to increase excretion of the drug What are drug interactions of barbiturates? -antihistamines - CNS depressants (benzodiazepines, alcohol, opioids, etc.) - monoamine oxidase inhibitors (MAOI's) - tricyclic antidepressants - anti-coagulants, oral contraceptives, glucocorticoids (because barbiturates increase liver metabolism, it can reduce the effectiveness of other drugs causing health problems in some conditions) What is the most commonly prescribed barbiturate, and what is it indicated for? Phenobarbital; used for seizure disorders Which of the following is NOT a barbiturate?: a. fluoxetine b. phenobarbital c. amobarbital d. secobarbital a. fluoxetine. fluoxetine is a SSRI (anti-depressant) What is the site of action for muscle relaxants? Either the CNS (centrally acting) or the skeletal muscle (direct acting) How do direct acting muscle relaxants work in the body (physiological mechanism)? By reducing the excitability and response to stimuli in the muscle fibres by reducing calcium released What are the indications for muscle relaxants? Cerebral palsy, multiple sclerosis, cerebral lesions, Parkinsons, Huntingtons, or muscle injury What are the side effects of muscle relaxants? - lightheadedness, dizziness - euphoria, confusion - fatigue, drowsiness - muscle weakness, muscle stiffness -GI upset, diarrhea, constipation - headache - slurred speech - erectile dysfunction - weight gain What are nursing interventions for an overdose on muscle relaxants? No pharmaceutical antidote; maintain airway, ECG monitoring, IV fluids to reduce risk of crystalluria What is the indication for baclofen (Lioresal)? muscle relaxant indicated for chronic spasticity what is the indication for cyclobenzaprine hydrochloride? muscle relaxant indicated for muscle spasms related to muscle injury Which of the following is a muscle relaxant?: a. baclofen (Lioresal) b. fluconazole c. lidocaine d. amobarbital a. baclofen (Lioresal) fluconazole is an antifungal, lidocaine is an anaesthetic, and amobarbital is a barbiturate (CNS depressant) During sleep, the body releases hormones that regulate what functions? Growth and recovery, energy, metabolism, and endocrine function What are the health outcomes of adequate, healthy sleep? reduced BP, HR, RR, O2 consumption, anxiety, and arousal What are the health outcomes of irregular, inadequate sleep? - increased risk of developing a chronic disease - reduced cognitive function, memory and thought processing - increased irritability, impaired emotional regulation - decreased job performance - impaired endocrine and immune function What is sleep hygiene? habits that affect sleep quality and quantity What habits can impair sleep quality? - naps in the late afternoon - screen time before bed - eating high sugar, fat, or spicy foods before bed - engaging in stressful activities before bed - alcohol use 4 hours before bed - certain medications/stimulants before bed (ie. nictoine, caffeine, asthma medications, amphetamines, thyroid medications, anti-arthythmics, anti-depressants, steroids, alpha or beta blockers and diuretics) What habits can improve sleep quality? - 30 minutes of exercise per day - having a comfortable sleep environment (cool temperature, dark room) - relaxation techniques or reading before bed - scheduling medications effectively - sticking to a sleep schedule/routine - healthy eating patterns and healthy diet - treating any sleep disorders - managing stress levels What are the 4 stages of sleep? Stage 1: feeling tired or drowsy, some muscle twitching or feeling of falling, brain and muscle activity slows, easily awakened Stage 2: body temperature drops, brain activity slows, eye movement stops, body processes slow, muscles alternate between tone and relaxation Stage 3/4: slow delta brain waves, drop in BP, RR, body temp, and muscle activity, and difficult to wake Describe non-REM sleep collectively, sleep stages 1-3, previously known as stages 1-4. Rapid eye movement sleep (REM) is not included. There are distinct electroencephalographic and other characteristics seen in each stage. Unlike REM sleep, there is usually little or no eye movement during these stages. Dreaming is rare during NREM sleep, and muscles are not paralyzed as in REM sleep. 75% of all time asleep is non-REM Which of the following is expected in non-REM sleep (select all that apply)?: a. muscle paralysis b. penile erection/clitoral engorgement c. reduced body temperature d. decreased steroid levels e. increased steroid levels f. decreased cerebral blood flow g. increased cerebral blood flow c, d, f What physiological changes occur in REM sleep? muscle paralysis, increased parasympathetic activity, loss of temperature regulation, altered RR, BP and HR, penile erection/clitoral engorgement, steroid release, dreams, increased cerebral blood flow, increased brain activity What physiological changes occur in non-REM sleep? minimal tissue damage Quick resolution of injury Ex: abrasion on the knee Regeneration cellular healing is what? tissue is regenerated by new cells. This only occurs if cells are able to regenerate. Ex: liver Replacement cellular healing is what? original cells cannot regenerate. The result normal cells are replaced by another type of cell. What type of cells usually replace normal cells in replacement healing? connective/scar What can result from replacement healing? decreased function What are the two healing processes 1. First intention (sutured) 2. Second intention (open healing) What is first intention healing process? 1. injury and inflammation (suture holds edges together 2. granulation tissue and epithelial growth 3. small scar remains uses fibroblast What is the second intention healing process? 1. injury and inflammation (no suture- open edges) 2. granulation tissue and epithelial growth 3. large scar remains-due to increased fibrinous and scar tissue Factors that promote healing youth good nutrition: protein, Vit A&C adequate Hemoglobin Effective Circulation Clean, undisturbed wound Factors that delay healing advanced age (reduced mitosis) Poor nutrition Dehydration Anemia Circ. problems irritation Infection Prolonged use of glucocorticoids Complications of healing loss of function contracture/obstruction adhesions Keloids Ulcerations Metaplasia What is a Keloid an abnormal response to scar formation (big puffy scar) Steps of the inflammatory response 1. damaged tissues release histamines increasing blood flow to the area 2. histamines cause capillaries to leak, releasing phagocytes and clotting factors into wound 3. phagocytes engulf bacteria, dead cells, and cellular debris 4. platelets move out of the capillary to seal the wounded area; What are the non-specific defenses 1. fluids (tears, saliva, mucus, gastric) 2. barriers (skin and membranes) 3. Phagocytosis What are the specific defenses 1. Humoral 2. Cell mediated What are the granulocytes neutrophils basophils eosinophils What are neutrophils most abundant phagocyte (70-75%) - usualy increased to show bacterial infection (left shift) What are basophils histamine releasing phagocyte What are Eosinophils phagocytes released in -Type I allergic Histamine release What are the agranulocytes B-Cells T-Cells Monocyte-Macrophage What cells are involved in specific immunity B & T cells Humoral immunity is which cell B cell Cell mediated immunity is which cell T cell what are monocytes they sound alarm -present in the lymph node to specific immunity system and become AG presenting cells then the B cells pump out AB When do monocytes become macrophages diapedesis into the tissue Local effects of Inflammation redness (Rubor) Warmth (calor) Swelling/Edema Pain Loss of function What is exudate fluid collection at site of increased vascular permeability What are the types of exudate serous fibrinous purulent abscess hemorrhagic 1. tissue damage 2. vasoconstriction 3. vasospasm inhibits blood flow to allow platelet plug what are the 2 coagulation pathways intrinsic pathway extrinsic pathway Intrinsic pathway prothrombin to thrombin conversion blocked =increased aPPT aPPT partially activated thrombo plastin time checked in the use of heparins Extrinsic pathway Vit K blocked= PT-> thrombin blocked which = incr. PT/INR PT/INR prothrombin time-> the amt of time it takes prothrombin to turn into thrombin checked in the use of Warfain (coumadin) Antidote to Warfarin (coumadin) Vit K Fibrinogen converts to fibrin and creates netting Platelets acts as large shingles and adhere together RBCs acts as large cushions to make heavy clot What proteins in the coagulation cascade are made in the liver prothrombin fibrinogen What elements is an essential cofactor in the coagulation cascade calcium What are the types of hypersensitive reactions Type 1: Allergic Type 2: Cytotoxic Type 3: immune Complex Type 4: Cell-Mediated Type 1: allergic what is it and examples/causes it is the released of histamines, IgE mediated, Mast cell reaction ex: allergies, anaphylaxis: such as insect stings, nuts, shellfish, antibiotics What is anaphylaxis life threatening due to systemic vasodilation (low BP) and tissue edema such as bronchial edema Type 1: allergic early signs and sx: pruritis, tingling, coughing, SOB Type 1: allergic late signs and sx: dizziness, fainting, low BP, Hives, Edema does a type 1 reaction occur in 1st exposure no, body needs to develop response Type 2: Cytotoxic what is it and cause ABO incompatibility -if incompatible blood is given in transfusion, host blood will attackk donor blood Type 2: Cytotoxic signs and sx SOB, CP, Diaphoresis, Jaundice, can result in death Type 3: Immune Complex what is it when the Ag-Ab complex is not removed and deposited in the tissues. This will activate the complement in the tissues cause damage to host tissue from inflammation Type 3 : Immune Complex causes/examples serum sickness, post-streptococcal glomerulonephritis, rheumatic fever. and autoimmune disorders Type 4: Cell Mediated is the reaction instant? no reaction is delayed may take a couple of days Type 4: Cell Mediated what is it T- cells become sensitized to antigens, causing cell destruction mediated through cytokines Type 4: Cell Mediated examples Mantoux TB skin test, Contact dermatitis, Graft-Host rejection: Transplant rejection Cancer etiology malignant tumors usually caused by mutations loss of: -organization -growth inhibition -contact controls -Cell-Cell communication Cancer Staging determines the extent of the dz. and is monitored throughout the course of the dz. provides tx. and prognosis Cancer staging TNM T: Tumor: size of PRIMARY tumor N: extent of regional NODE involvement (# of nodes) M: signs of distant invasion: METASTATIC Spread Cancer spreading methods 1. invasion 2. Metastasis 3. Seeding Cancer Spread: Invasion local spread, where the tumor grows into the adjacent tissues and destroys normal cells Cancer Spread: Metastasis spreading to distant sites via blood or lymph Cancer Spread: Seeding movement of neoplastic cells in body fluids or along membranes usually in a cavity. Can also occur from procedures (iatrogenic) What is anemia reduced RBC which causes decreased O2 capacity Types of anemias (6) Iron deficiency Pernicious Aplastic Sickle Cell Homozygous recessive gene that leads to abnormal hemoglobin Benefit to Sickle cell sickle cell trait is protective against malaria w/o sickling Signs and SX of Sickle Cell severe anemia hyperbillirubinemia splenomegaly vascular occlusions- lead to SC crisis CHF Infections Thalassemia beta etiology common in ppl of mediterranean descent Thalassemia Alpha etiology common in ppl of indian, Chinese, or southern Asia descent Thalassemia patho genetic defect in which one or more of the genes for protein portion of the Hgb are variant or missing Thalassemia minor only 1 globin affected Thalassemia Major if 1 or more globin unit affected -known as Cooley's Dz How is Thalassemia names after the globin affected -either alpha or beta Signs and SX of Thalassemia usual signs and sx of anemia hyperbilirubin Jaundice-Fe overload Hyperactive bone marrow growth retardation Polycythemia patho increased bone marrow stimulation -causes incr. RBC, granulocytes, platelets -incr. viscosity -incr. thrombocytes -hepatospenomegaly Polycythemia Signs and Sx cyanosis hepatomegaly splenomegaly pruritis HTN HA Full and Bounding Pulse Dyspnea Visual Disturbances thromboses/Infarctions CHF Where are peptic ulcers most commonly found proximal duodenum Characteristics of Peptic Ulcers single, small, round cavities with smooth margins that penetrate the mucosa What can peptic ulcers cause gastric perforation Peptic ulcers etiology H. Pylori inadequate blood supply ulcerative agents (ASA,NSAID, ETOH, Steroids) More common in Western country men and type O blood Peptic Ulcers Signs and SX Epigastric Pain/burning Pain often relived with ingestion of Food or antacids Heartburn/Nausea/vomit/weight loss FE anemia-blood in stool Stress ulcer etiology severe trauma massive burns serious systemic problems Stress Ulcer Patho multiple ulcers within hours of precipitating event -stress causes decr. blood flow causes decreased. mucous and epithelial regeneration, so no protective barrier Peptic Ulcer Healing granulation tissue forms deep within cavity difficult due to constant exposure to irritants Peptic Ulcer Complications hemorrhage bacterial peritonitis Obstruction CHF Patho heart is unable to pump sufficient blood to meet the metabolic demands of the body CHF etiology usually precipitated by a primary condition -HTN -CAD (leading) -MI -Valve defects CHF Compensatory Mechanisms 1. R.A.A.S: Incr. fluid retention and PVR 2. SNS stim.: Incr. PVR and HR 3. Cardiac Hypertrophy/Dilation: less agile myocardium (does not snap back) CHF diagnosis: CXR: shows cardiomegaly and/or pulm edema Pulm Artery Cath: High PA pressures lead to Rt Ventricule HF ABGs: Measure arterial hypoxia BNP: Brain natriuretic peptide or B-type natriuretic peptide BNP Hormone with CHF released with overstretch of ventricle, fluid overload stimulates kidneys to increase water excretion very useful in differentiating between CHF vs. Lung dz in SOB, cough CHF general signs and sx: decreased blood flow/blood supply to organs general tissue hypoxia fatigue -NTG -Aspirin Renal Failure Types Acute Chronic Actue Renal Failure Patho kidneys fail to fx bc: 1. reduced renal artery flow 2. inflammation or obstruction of the tubules causing ischemia Acute Renal Failure etilogy systemic both kidneys- bilateral -from glomerulonepheritis, neurotoxins, vancomycin, mechanical obstructions Acute Renal Failure s/sx increased BUN, Creatinine, metabolic acidosis, hyperkalemia, Acute Renal Failure complications Death, Chronic renal failure Etiology Chronic Renal Failure chronice damage from pyelonephritis, polycystic kidney dz, HTN, Diabtes, nephrotoxins Complications of Chronic Renal Failure metabolic acidosis, fluid overload, hyperkalemia, death, TX of chronic Renal failure dialysis or transplant how many stages in Chronic Renal failure 3 ` Stage 1 S/SX of CRF 60% loss of nephrons, dec GFR, normal BUN and creatine, nephrons are able to incr. filtration capacity Stage 2 S/Sx of CRF 75% loss "renal insufficiency" GFR 20% normal w/ incr. BUN and creatine, Failure to concentrate urine High output HTN Stage 3 S/SX of CRF Uremia or End Stage Renal failure 90% nephron loss GFR negligible incr. BUN and Creatine, Azotemia- uremia frost and urine smelling breath TB etiology caused by mycobacterium tuberculosis that invades the lungs and spread by droplets Types of TB primary secondary PRimary TB (latent) not contagious local infection Secondary TB active, contagious, Where does TB mostly occur in ppl in close quarters, low resistance immigrants recent travelers TB s/sx Wt. loss purulent hemoptysis malaise/fatigue PM TB s/SX low grade fever prolonged night sweats prolonged productive severe cough TB diagnostics test for Primary TB Mantoux TB skin test TB secondary diagnostic test CXR, sputum culture, CT scan, NAA Resp. Failure ABG values pH: <7.3 (acidotic) "50-50" club PaO2 < 50 Pa CO2> 50 -values are unable to maintain body metabolism Resp. failure etiology COPD (end stage) chest trauma PE Acute Asthma MG ALS MD Pancreatitis patho inflammation of the pancreas from auto-digestion of the tissues -Acute or Chronic Pancreatitis etiology gallstones, ETOH abuse Pancreatitis S/Sx severe epigastric/abdominal pain radiating to the back signs of shock low grade fever ab distention decreased bowel sounds Pancreatititis complications massive inflammation, bleeding, necrosis Liver failure etiology hepatitis -idopathic, fatty liver, infection, toxicity, cirrhosis Liver failure how many stages 3 Stage 1 Liver Failure is called? sudden often with CVA Hemorrhage effects widespread and severe -often fatal Seizure definition sudden, spontaneous uncontrolled discharge or neurons in the brain Seizure disorder recurrent seizure Seizure Patho neurons in the epileptogenic focus are hyperexcitable and have a lower threshold for stimulation seizure etilogy may be primary (idiopathic) or secondary (acquired) seizure onset occurs before age 20 in 75% of cases Seizure Diagnostic tests EEG: electroencephalogram Direct Observation MRI -Secondary: may be caused by a tumor/mass Types of seizures Partial Generalized Partial patho simple or focal -arise from the epileptogenic focus related to the area of damage in the cortex -occur in children and adults -single focus -may or may not cause LOC -may progress to generalized Partial S/SX rpt. jerking movements tingling auditory/visual experience no LOC bizzare behavior Hallucinations/Deja vu Spaced out Amnesia/drowsiness Generalized seizure def. involves multipe foci in both cerebral and hemisphere and brainstem -cause LOC Generalized Seizures types Petit Mal Grand Mal Petit Mal S/Sx absence seizures -last 5-10 sec -occur several times a day -brief loss of consciousness -sometimes transient facial movement -"starring" Grand Mal S/SX tonic-clonic -spontaneous occurrence -prodromal signs (N/irritablility/muscle twitching) -Aura: (peculiar visual/auditory sensation) -LOC -strong tonic muscle contractions, including cry, noise, -clonic stage of muscle contraction, followed by subsiding contractions -postictal stage Generalized seizures Precipitating Factors loud noises bright lights -biochemical stiumli -stress -hypoglycemia -Medication -Hyperventilation (alkalosis) DM 1 patho usually complete cessation of insulin productiion from the beta cells of islets of langerhans -"Sweet Pee" DM 1 etiology autoimmune destruction/family history -DKA often at diagnosis What is insulin -anabolic hormone- builds complex -transports glucose into cell -synthesizes glycogen (storage) -inhibits glucagon Notes about usage of insulin brain and GI tract do not need insulin to use glucose DM 2 patho develops as a result of insulin resistance from tissues -usually high BMI, middle aged, high- glucose diet DM 2 etiology familial, lifestyle, environmental factors, DKA process and insulin specific hyperglycemia glucosuria dehydration anerobic metabolism lactic acidosis & (insulin specific) cellular hypoglycemia lipid catabolism free fatty acid release LABs for DKA - lowered pH (acidic) -due to incr. fatty acids, ketones, - Decr. HCO3- due to dehydration leading to decr. GFR leading to inability to clear acid -HyperKalemia: due to metabolic acidosis bc H+ pushes K out of cell S/SX and DKA N/V/Ab pain/Lethargy/Weakness -dehydration: thirst, dry membrane, warm dry skin, rapid weak pulse, low BP, oliguria -Metabolic Acidosis: 0 Kussmal resp: deep, rapid Coma definition does not respond to painful or verbal stimuli, body flaccid, some reflexes may still be present Deep Coma: No reflexes. dilated pupils, slow pulse, slow, irregular pulse and respirations Vegetative state loss of awareness and mental capabilities resulting from diffuse brain damage -Brainstem fx con't (resp, circ, cardio, autonomic intact) Locked in syndrome the ind is aware and capable but paralyzed and cant communicate Brain Death total loss of brain fx; only thing keeping them alive are machines Posturing: prognosis Upper Motor Neurons Location -Located in Frontal Lobe Cerebral Cortex and Spinothalamic Tract Posturing: prognosis Upper Motor Neurons S/Sx -weakness and paralysis on opposite side of the body (contralateral) -Muscle tone and reflexes increased -spastic paralysis and contracture Posturing: prognosis Low Motor Neurons location located in the anterior horns of the spinal cord Posturing: prognosis Lower Motor Neurons S/Sx -weakness and paralysis on the same side of the body (ipsilateral) -loss of muscle tone and loss of reflexes (Areflexia) DeCORticate: Rigid flexion in the upper limbs, adducted arms -cerebral cortex damage -flexion to "Core of body" DeCEREbrate: all 4 extremities in rigid extension -hyperpronation of forearms and plantar flexion of the feet -brain stem (Cerebellum) damage Aphasia def. inability to COMPREHEND or express language Expressive: Broca's area -cannot speak or write language appropria Receptive: Wernicke's Area -cant understand written or spoken language Global: Both areas -cannot express self or comprehend others Dysarthria: words cannot be articulated clearly, as a result of motor dysfunction -usually results from cranial nerve damage or muscle impairment Agraphia impaired writing ability Alexia Impaired reading ability Agnosia loss of recognition of association: Ex: inability to recognize objects ICP def Intercranial pressure ICP patho brain tissue, CSF , and blood are encased in non-exandable space (skull) therefore, ICP results in less arterial cerebral blood supply and compression of brain tissue -decr. in neuron fx and brain tissue dies -ICP begins at site of problem -eventually, incr. ICP spreads throughout by CNS via CSF and blood -leads to widespread loss of FX ICP etiology brain hemmorhage, trauma, cerebral edema, infection, tumors ICP S/SX Decr. LOC, HA, Vomiting, ICP vital signs incr. BP and widening pulse pressure bradycardia First sign of Incr. ICP change in LOC (lethargy, decreased responsiveness) -as ICP increases further, invokes cushing's reflex and cushings triad Cushings reflex : cerebral ischemia stimulates reflex from the vasomotors center -systemic vasoconstriction -Baroreceptors -Chemorecp Cushings Reflex S/SX -incra. vasocontriction- incr cerebral blood suppy -incr. BP -PSN to SA Node : Bradycardia -Bradypnea - Cushings Triad HTN, Bradycardia, Bradypnea -if pressure not relieved will lead to herniation Meningitis def inflammation of the meninges Patho of Meningitis micro-organisms reach the brain via the blood by -nearby tissue -direct trauma/surgery After entering CSF, infection spreads rapidly in CNS -inflammatory response leads to increased ICP -exudate covers the brain -exudate is present in CSF, and blood vessels of brain dilate and rupture Etiology of Meningitis