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Patho_ Unit 5 & 6 Study Guide
1. What is status asthmaticus? How can patients present? - life-threatening, prolonged asthma attack - does not respond to usual treatment - Maintaining a patent airway is critical
o endotracheal intubation with ventilation support may be necessary
o respiratory alkalosis from expelling too much carbon dioxide
▪ r/t tachypnea and hypoxemia
o expiratory wheezing, dyspnea, chest tightness, cough, anxiety,
tachypnea, and tachycardia
o respiratory muscles fatigue as obstruction of airflow and hyperinflation
continue
▪ CO2 retention and then respiratory acidosis
2. What is the presentation of a spontaneous pneumothorax? - Pneumothorax = air in pleural cavity
o Can lead to partial or complete collapse of lung
- Spontaneous (absence of trauma)
o Small air blister on top of lung (bleb) ruptures
▪ Weakness in lung tissue
▪ Bleb may rupture
o sudden chest pain over the affected lung, chest tightness, anxiety,
and dyspnea.
o Physical findings can include tachypnea, tachycardia, and decreased
breath sounds as well as hyperresonance over the affected area.
Chest expansion may be asymmetrical.
44. Characteristics of tension pneumothorax - Most serious consequence of pneumothorax - Occurs when pressure in pleural space is greater than the atmospheric pressure
o Increased pressure r/t air getting trapped in pleural space during inspiration
o Air does not escape during exhalation
▪ Causes lung collapse ▪ Shifts heart to inflated lung
- Manifestations
o All manifestations of pneumo’s, plus…
o Can lead to deviated trachea and mediastinal shift
o Hypotension
o Rapid deterioration
o CV collapse
45. What medical term is used to identify the accumulation of air in the pleural space? - pneumothorax 6. What is pleural effusion and how can you diagnose it? - the accumulation of excess fluid in the pleural cavity. - Diagnostic procedures :
o history, physical examination,
o chest X-ray, CT,
o ABGs, and CBC.
o Thoracentesis (needle aspiration of fluid) with subsequent examination
▪ to distinguish between transudative versus exudative effusions is
indicated when there is a new pleural effusion
o look at size, appearance (blood, fluid, etc.), cells, pH, protein levels, etc
47. Type of pleural effusion in which fluid becomes watery and diffuses out of the capillaries because of increased blood pressure or decreased capillary oncotic pressure? o Transudative vs exudative o Transudative o Caused by systemic process (ex. HF, kidney disease) o r/t changes in hydrostatic/osmotic pressures ▪ shift fluid into plueral space o hypoproteinemia (low amount of protein) ▪ with cirrhosis or kidney disease ▪ reduction in oncotic pressure (“holding pressure”) drawing water out of capillaries an into plueral space o exudative o localized lung or pleural alteration such as inflammation 5. What is the importance of surfactant? - found in the surface of the alveoli.
14. What is the purpose of positive end-expiratory pressure setting on a ventilator? - provides an external pressure to avoid alveoli collapse at the end of expiration so that
more alveoli (recruitment) remain available for gas exchange.
20. What is the end tidal carbon dioxide detector used for? - To measure CO2 produced and exhaled during breathing o Aka: hypercapnia - low ETCO2 = poor ventilation and perfusion 9. What is the main difference between tuberculosis tests? - tuberculin skin test (TST) (also known as the Mantoux test) or a blood test called interferon gamma release assays (IGRAs). - TST o Injection of purified protein-derivative below dermis; local reaction o The TST can provide false positives on patients that received the Calmette-Guérin (BCG) vaccine or that were previously treated by TB. - IGRA
o measure CD4+ T cells.
o The IGRAs are not affected by the BCG vaccine, and, therefore, are
more accurate in those previously vaccinated.
- The TST or the IGRAs do not help to differentiate between latent and active TB.
Because of the uncertainty that the TB skin test creates,
o ch est X-rays and sputum for stained smears and cultures (most definitive)
are used after a positive TST is noted (either to confirm an original case or
to assess reinfection).
49. How is the Mantoux test read? o Small amount of purified protein-derivative tuberculin is injected just below dermis o If infection, local reaction (redness/induration) occurs o 5+ mm o HIV infected o Recent contact w/ TB o Organ transplants o Immunosuppressed o 10+mm o Recent immigrants
o Injection drug users o High risk setting (clinical places, labs, etc) o Children under 4 o 15+mm o Anyone with known risk factors
19. What are the symptoms of tuberculosis? - Latent o No symptoms and not infectious - chronic o Productive cough, hemoptysis o night sweats o fever, chills o fatigue o unexplained weight loss, anorexia 10. What is Pulmonary emboli? What happens to the alveoli? - PE o One or more of arteries of lungs becomes blocked by blood clot o Decrease in blood flow to lung tissue downstream - Consequence o Impaired gas exchange o Decreased or absent perfusion in areas of lungs o This is called V/Q mismatch 3. Airway narrowing and obstruction is a complication of?
Croup. (laryngotracheobronchitis) It is the result of edema of the subglottic area and may extend
to the bronchi.
8. What is the cause of croup? - Laryngotracheobronchitis, or croup - viral infection in children 3 months to 3 years of age, but it can occur in older children and adults. - The most common causes are parainfluenza viruse s. Other viruses include adenoviruses and respiratory syncytial virus, and bacterial causes include Mycoplasma pneumoniae. 11. When to use antibiotics for acute rhinosinusitis? - Most causes are from viruses, but bacterial is suspected if:
o Inflammation of bronchioles ▪ Small airways become inflamed and swollen ▪ Mobilization of eosinophils, neutrophils, monocytes, and lumphokines
- Initiate inflammatory process - Mucous collects in small airways o Obstruction leads to air trapping and hyperinflation o Manifestations ▪ Rhinorrhea, Cough, malaise, fever ▪ Decreased appetitie ▪ Vary degrees of respiratory distress - Tachycardia, tachypnea - Expiratory wheezing - Rales or ronchi - Rapid shallow breathing, labored breathing o Think: bronchioles are more dowstream of in lungs 50. What is RSV and what is it associated with? o Respiratory syncytial virus o A type of bronchiolitis o Acute inflammation of bronchioles o Often in children under 1 (or elderly) o Transmission o Through contact with or inhalation of infected respiratory droplets o Fall and winter months o RF o Neonatal prematurity o Asthma family hx o Cigarette smoking 51. Treatment of acute bronchitis o Treatment is supportive o Antypyretics o Analgesics o Antihistamines o Decongestants o Cough suppresants o Can prevent pneumonia o Bronchodialtors o Abx if bacterial infection o Also… o Increasing fluid intake
o No smoking o Humidified air o Think: bronchi are more upstream in lungs
52. Hand, foot, and mouth disease (HFMD) presentation? o Enterovirus/coxsackievirus o Transmission o Respiratory secretions o Fecal matter o Presentation o Small blisters/vesicles ulcerate mainly on buccal mucosa and tongue ▪ Can also be tongue and palate, back of mouth, uvula ▪ Grayish-white lesions o Fever, malaise, odynopagia (painful swallowing) o Treatment: symptom relief 16. What is Histamine, prostaglandins, and leukotrienes and when are they released? - they are inflammatory mediators released as a result of mast cell degranulation - during an early, acute episode of asthma 23. How is streptococcal pharyngitis presented?
o caused by a bacterial streptococcus
o Sore throat, scratchy throat
o Painful swallowing
o Fever
o Cervical lymphadenopathy
o Tonsillar erythema, hypertrophy, and exudative
o Rash can form on neck and chest (red papules)
18. What are the chronic implications of Gastroesophageal reflux disease and asthma? - Chronic cough = 8 weeks or more - Three most common causes: o Postnasal drip, asthma, and GERD - Reflux can: o Worsen asthmas symptoms o Cause coughing, pneumonia, choking
▪ cardiomegaly
▪ DM
▪ Pancreatitis
▪ rectal prolapse
▪ liver disease
▪ cholelithiasis
▪ osteoporosis
▪ hyponatremia
▪ metabolic alkalosis
▪ infertility.
47. What condition is often associated with meconium ileus? o When mucus blocks the intestines in the newborn o From CF 24. Pulmonary disorder characterized as restrictive (prevention of full lung expansion)?
o 2 types of pulmonary disorders: restrictive and obstructive
o Restrictive pulmonary disorders prevent adequate inhalation due to the inability of the
lungs to expand.
o Ex: acute respiratory distress syndrome
26. What is COPD and what is the patient presentation?
o COPD
o Irreversible airway and/or alveolar abnormalities
o Caused by smoking
o Persistent respiratory symptoms
▪ Can result in functional disabilities
▪ Can result in hypoxia and hypercapnia
▪ Can result in respiratory failure
o Heightened inflammatory response infiltrates airway
▪ Fibrosis ensues
- Leads to small airway damage and airflow limitation
o Presentation
o Cough (productive on not)
o Chest tightness and wheezing
o Dyspnea
▪ As it progresses, it will happen at rest too
o Hypoxemia
▪ Increased RBC production
▪ Clubbing of fingers
▪ Cyanosis
▪ Pulmonary hypertension
o Malaise, fatigue, lack of appetite
o Anxiety and depression
43. Significant etiology for chronic obstructive pulmonary disease (COPD) o Smoking with subsequent inflammatory response and damage 55. How is empyema characterized for? o r/t exudative pleural effusions o empyema = grossly purulent effusions in the pleural space from lymphatic drainage
27. What is aldosterone responsible for regulating?
o Regulates sodium
o When released, it increases reabsorption of sodium (holding on to soidum and therfore
water)
o Can lead to hypertension
28. Know urine-specific gravity.
o It is a reflection of urine concentration, hydration status and kidney function.
o This test is used in conjunction with serum values to identify causes of alterations
in urine output or serum electrolyte imbalances.
o measures the number and size of solutes in the urine
o as opposed to the number of solutes in urine.
o Normal range: 1.005 -1.
o High means:
▪ Dehydration
- Body excretes less water in order to hold on to fluid/volume
▪ extra stuff in urine
- Glucose, protein, RBC, WBC, bacteria, etc.
▪ Heart/kidney perfusion issues
- Kidney does not excrete as much fluid bc it senses
volume/fluid/perfusion issues
o Low means
▪ Lots of fluid
● Albumin creates oncotic pressure ○ “Pulling” or “holding” pressure ○ Water is pulled in with higher oncotic pressures ● Albumin might be used to increase blood volume in patients with trauma, shock, poor capillary permeability
39. What are the signs of fluid deficit? ● Hypernatremia or hyponatremia depending on losses ● Thirst ● Altered level of consciousness ● Hypotension (and ortho-hypo) ● Compensatory tachycardia ● Weak and thready pulses ● Flat jugular veins ● Decreased skin turgor ● Dry mucous membranes ● Oliguria ● Possible weight loss ● Sunken fontanelles (in infants) 60. How do osmotic forces occur? - Movement of water depends on hydrostatic (pushing pressure) and osmotic (pulling pressure) o Solute concentration is what determines osmotic pressure o Sodium is responsible for most of the osmotic force in the ECF and serum sodium concentration is determined by water balance. 61. What is hydrostatic pressure? - created by the water pushing against the cell membrane. 62. Venous obstruction is a cause of edema because of an increase in pressure? - Any increase in volume or obstruction in the venous system can increase capillary hydrostatic pressure and lead to edema. o Volume: In conditions that cause sodium and water conditions ▪ Ex. Heart failure, renal failure o Obstruction: Also could be in conditions where veins are unable to return blood to heart (venous insufficiency) ▪ Ex. Deep vein thrombosis 63. Differences between Isotonic, Hypertonic, Hypotonic and Normotonic solutions - Isotonic solutions: o (e.g., 0.9% saline, lactated Ringer’s solution, 5% dextrose in water solution)
o have concentrations of solutes equal to those in the intravascular compartment. As a result of these equivalent solute concentrations (i.e., equal in the IV solution and plasma), isotonic solutions allow fluid to move equally between compartments and do not cause notable shifts in fluid volume
- Hypotonic solutions: o (e.g., 0.45% saline) o have a lower concentration of solutes (i.e., lower osmotic pressure) than those in the intravascular compartment. o Hypotonic solutions cause fluid to shift from the intravascular compartment to the intracellular space. ▪ Aka: into the cell; enlarged cell
- Hypertonic solutions : o (e.g., 5% dextrose in 0.9% saline, 3% saline, 10% dextrose in water) o have a higher concentration of solutes (i.e., higher osmotic pressure) than those in the intravascular compartment. o Hypertonic solutions cause fluid to shift from the intracellular compartment to the intravascular space. ▪ Aka: water leaves the cell; shrunken cell 69. The primary organ regulating electrolyte and fluid balance is?
- kidneys 70. Healthy kidneys can excrete up to per hour.
- 1 L of fluid per hour
- Men need 3 L per day and women need 2 L per day 48. Clinical manifestation of obstructive sleep apnea o Snoring (habitual, loud, frequent) o Periods of silence in breathing/apnea o Nighttime choking, gasping or breath holding o Nonrestorative sleep o Day time sleepiness o Fatigue o Poor concentration o Irritability o Possible nocturia and morning h/a 4. What is a likely physical exam finding to support the most common cause of obstructive sleep apnea syndrome in children?
- Enlarged tonsils and adenoids are a particular risk factor
▪ n/v ▪ anorexia
- treatment o treat causeantidiarrheal, dialsysis, etc. o IV sodium bicarb o Correct possible hyperkalemia (DKA) ▪ IV insulin, kayexalate, etc. o Improve oxygenation ▪ Vent, oxygen, etc 57. Respiratory alkalosis
- causes o hyperventilationblowing off CO ▪ anxiety, pain, fever
- compensation o kidneys excrete less H+ and reabsorb less HCO
- manifestations o usually short term o neuro ▪ irritability ▪ paresthesia ▪ tetany ▪ seizures
- treatment o increase CO o treat cause ▪ breath into paper bag ▪ sedatives (for vent or off vent) ▪ therapeutic comminication 58. Respiratory acidosis
- causes o hypoventilationholding on to CO ▪ brain truama, drug overdose o respiratory congestion ▪ COPD, pneumonia, pulmonary edema
- compensation o kidneys excrete more CO2 and absorb more HCO
- manifestations o neuro
o CV ▪ h/a ▪ blurred vision ▪ lethargy, confusion ▪ muscle twitching, paralysis ▪ Arrhythmias ▪ Hypotension o Skin ▪ Flushed with diaphoreis
- Treatment o Improve respiratory status o Treat problem ▪ Abx for pneumonia ▪ Narcan for drugs o Oxygen/vent 59. Metabolic alkalosis
- causes o vomiting o excessive antacid use ▪ think: alkalosis is brought on by an “anti-acid” medication o excessive suctioning/vent ▪ removing acidic content
- compensation o kidneys increase HCO
- manifestations o s/s of hypocalcemia ▪ tetany ▪ increased DTR o possible dysrhythmias o possible decrease in respirations
- treatment o treat cause ▪ antiemetics and fluid replacement ▪ potassium chloride ▪ calcium if hypoCa 30. Know compensated respiratory acidosis o Kidneys compensate o Think: healthy system has to kick in to help affected one
Think: hypertonic solutions causes cells to shrivel and shrink
71. Hyponatremia causes? - Causes o Excessive water retention from impaired excretion ▪ Renal failure ▪ SIADH ▪ Gastric losses - Vomiting - diarrhea ▪ Diuretics - Excrete sodium and not as much water o Prolonged exercise - s/s o neuro ▪ like dehydration - lethargy, confusion, irritability, seizures, coma - dry mucous membranes - thirst, decreased urine output - hypotension? 68. Sodium and water retention are caused by? - Excessive sodium o Excess IV fluids (especially hypertonic) o Excess dietary intake o Corticosteroid disorders ▪ Think: facial edema from prednisone o Near drowining in salt water - Excessive water o Psychogenic polydipsia o Intake o SIADH o Hypotonic IV o Cardiac and renal disorders - Decreased elimination of sodium and water o See above 40. Treatment for severe hyperkalemia? ● Methods to increase excretion ○ Dialysis
○ Sodium polystyrene sulfonate (Kayexalate) ○ Insulin with IV dextrose ○ Calcium gluconate (for dysrhythmias)
65. Parathyroid hormone and calcitonin responsible for? - Calcium regulation o Inverse with phosphorus - Parathyroid hormone o pulls bone calcium into bloodstream and increases renal absorption o Activates vitamin D o Calcium levels increase - Calcitonin o Pushes excess Ca into bone, decreases intestinal absorption, and increases renal excretion o Calcium levels decrease 35. Know hypercalcemia presentation? o hypoCa = excitability o tetany, trousseau, chvostek o hyperCa = depression o neuro ▪ LOC changes ▪ Lethargy, stupor, coma ▪ Muscle weakness, atrophy ▪ Decreased DTR ▪ Osteoporosis - Ca is in bloodstream, not bone o Cardiac ▪ EKG changes and dysrthymias ▪ Hypertension ▪ Cardiac arrest o Renal ▪ Renal calculi ▪ Dehydration ▪ Renal insufficiency o GI ▪ Anorexia ▪ n/v ▪ constipation ▪ abdominal pain
