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Pathophysiology and Pharmacology - Sem 2
Yr
Pharmacology - The study of drugs and their interactions with living systems Pharmacokinetics - What the body does to the drug Pharmacodynamics - What the drug does to the body Pharmacotherapeutics - The treatment of pathologic conditions through the use of drugs Medication - A substance that is used to treat or prevent disease or relieve pain Drug -
- A chemical agent capable of producing biological responses in the body
- Therapeutic = positive effect
- Adverse = negative effect Abbreviations -
- PRN = when required
- Stat = give immediately
- Bd = 2x daily
- Tds = 3x daily
- Qid = 4x daily
- Mane = morning
- Nocte = night
- PV = per vagina
- PR = per rectum
- NG = Nasogastric
- MDI = metered dose inhaler
- IM = Intramuscular
- SUBCUT = subcutaneous
- PO = Oral
- Sublingual = under the tongue
- IV = intravenous
- Neb = nebulised
- PICC = peripherally inserted central catheter
- PEG = percutaneous endoscopic/enteral gastrostomy
- CVC = central venous catheter
- PCA = patient controlled analgesia Digestion -
- Breakdown of ingested food
- Absorption of nutrients into the blood Metabolism -
- Production of cellular energy (ATP)
- Anabolic and Catabolic pathways Process of The Digestive System -
- Mechanical Digestion
- Propulsion
- Chemical Digestion
- Absorption
- Defecation Gastrointestinal Reflux - Weakness of the sphincter, acid back flows into the oesophagus with a less protective lining which causes a burning sensation (heartburn) Oesophagitis - Inflammation of the oesophagus Oesophageal Reflux (Pathophysiology & Cause) - Exposes the oesophageal mucosa to the irritant effects of gastric fluids Oesophageal Reflux (Symptoms) -
- Painful to swallow
- Burping Oesophageal Reflux (Nursing Priorities & A-E) -
- Positioning = sit up, avoid bending
- Small meals = avoid foods that reduce sphincter tone; caffeine, fats, chocolate
- Avoid alcohol and smoking Oesophageal Reflux (Treatment - Medication & Interventions) -
- Proton pump inhibitors
Barium Swallow (Esophagogram/X-ray) - Swallow barium and a series of x-rays are taken to watch the barium moving through your mouth and throat Gastritis -
- Acute Gastritis = inflammation of the gastric mucosa
- Chronic Gastritis = chronic changes to the gastric mucosa Peptic Ulcer Disease (Pathophysiology & Cause) - An abrasion of the stomach or small intestine (ulcers) Peptic Ulcer Disease (Symptoms) -
- Heartburn
- Painful to swallow
- Burping Peptic Ulcer Disease (Nursing Priorities & A-E) -
- Positioning = sit up, avoid bending
- Small meals = avoid foods that reduce sphincter tone; caffeine, fats, chocolate
- Avoid alcohol and smoking Peptic Ulcer Disease (Treatment - Medication & Interventions) -
- Antibiotics (where H. pylori is present)
- Antacids (relieve ulcer symptoms) Inflammatory Bowel Disease -
- Crohn's Disease
- Ulcerative Colitis
Crohn's Disease (Pathophysiology & Cause) -
- Chronic inflammation of the intestinal tract
- Anywhere in digestive tract, mainly small intestine (illium and beginning of colon)
- Entire depth
- Surgery is not curative Crohn's Disease (Symptoms) -
- Diarrhoea
- Nutritional deficiencies
- Pain in abdomen Crohn's Disease (Nursing Priorities & A-E) -
- Symptom management
- Nutritional support - total parenteral nutrition (TPN)
- Pain management Crohn's Disease (Treatment - Medication & Interventions) -
- Corticosteroids = decreasing the inflammatory response
- Antibiotics = bacterial infection Ulcerative Colitis (Pathophysiology & Cause) -
- Inflammatory condition of the large intestine (rectum and colon)
- Inner lining
- Bowel wall is affected symetrically
- Surgery is curative Ulcerative Colitis (Symptoms) -
- Diarrhoea
- Stools contain mucous and blood
- Fatigue, anorexia and weakness Ulcerative Colitis (Nursing Priorities & A-E) -
- Surgery (complete removal of bowel, formation of ileoanal anastomosis or permanent ileostomy)
- Nutritional support - total parenteral nutrition (TPN) Ulcerative Colitis (Treatment - Medication & Interventions) -
- Anti-inflammatory drugs โ corticosteriods
- Immunosuppressant drugs (eg cyclosporin) Irritable Bowel Syndrome (IBS) -
- Functional gastrointestinal disorder
- More likely to have anxiety and depression
- Abdominal pain associated with altered bowel habits Colorectal Cancer (Pathophysiology & Cause) - Starts as a polyp, spreads and metastasis around the body Colorectal Cancer (Symptoms) -
- Change in bowel habits
- Alternating diarrhoea/constipation Colorectal Cancer (Nursing Priorities & A-E) -
- Nutritional support - total parenteral nutrition (TPN)
- Pain management
Colorectal Cancer (Treatment - Medication & Interventions) -
- Polyp removal via colonoscopy
- Postoperative chemotherapy or radiotherapy Colonoscopy - Allows the doctor to look inside the entire rectum and colon while a patient is sedated Biopsy - The removal of a small amount of tissue for examination under a microscope Diverticulitis -
- Formation of pouches (diverticula) within the bowel wall
- Large intestine, or colon Appendicitis -
- Inflammation and infection of the appendix
- Treatment = antibiotics or removal Ileostomy - Opening into the ileum Colostomy - Opening into the colon Stoma Management -
- Routine postoperative observations
- Pain relief
- IV fluids, fluid balance chart
- Observe wound and any drains
- Positioning - pillow under knees for open surgery for comfort Bowel Obstruction (Pathophysiology & Cause) -
- Mechanical Causes o Hernias o Tumours
- Paralytic Causes o Impaired peristalsis o Intestinal ischaemia Bowel Obstruction (Symptoms) -
- Absolute constipation
- Abdominal distension Bowel Obstruction (Nursing Priorities & A-E) -
- Postoperative observations and care
- Bowel observations and documentation
- NGT and IV hydration (correct electrolyte imbalance) Bowel Obstruction (Treatment - Medication & Interventions) -
- Surgery = if tumour or blood supply of bowel is in danger
- Treatment depends on type and cause Haemorrhage -
- Above the stomach = vomiting blood
- Stomach = coffee- grounds
- Intestine = faecal occult blood (melaena)
- Rectum = red blood coating stools
- Nursing management o ABCDE o IV access o Hypovolaemia o Prepare patient for scope and/or theatre Liver Cirrhosis - Liver tissue is replaced by fibrous tissue, as a result of tissue damage by toxins or other processes (eg: alcohol) Hepatitis -
- Inflammation of the liver
- Acute = up to 8 weeks
- Chronic = 6+ months Pancreatitis - Inflammation of the pancreas Gallbladder Disease -
- Inflammation of the gall bladder Causes of Constipation -
- Metabolic and endocrine disorders = diabetes,
- Neurogenic = parkinson's disease
- Adverse drug effects = analgesics
- Lifestyle = poor bowel movement habits Diarrhoea -
Increase in volume, fluidity or frequency of bowel movements Vomiting (Emesis) - The forceful expulsion of the contents of one's stomach through the mouth and sometimes the nose Endocrine System - Secretes various hormones that regulate the activities of the body Hypothalamus - Portion of the brain that link the nervous system to the endocrine system via the pituitary gland The Pituitary Gland -
- Posterior Pituitary Gland
- Anterior Pituitary Gland
- Posterior Pituitary Gland -
- Oxytocin = let down of milk
- ADH = kidneys retain water
- Anterior Pituitary Gland -
- TSH = thyroid gland to release its hormones
- GH = consumption of fats as an energy source
- ACTH = adrenal cortex to release its hormones
- FSH = maturation & release of eggs
- LH = maturation & release of eggs Thyroid Gland -
- Thyroxine (T4)
- Triiodothyronine (T3) Parathyroid Glands - Parathyroid hormone = increase level of calcium in blood Adrenal Glands -
- Located on the tops of the kidneys
- Medulla = Adrenaline and Norepinephrine
- Cortex = aldosterone & cortisol Pancreas -
- Beta cells = insulin
- Delta cells = somatostatin Cellular Respiration โ ATP - Metabolic reactions that take place in the cells to convert energy from nutrients into ATP Glycogenesis - Glucose โ> glycogen Glycogenolysis - Fat/protein โ> glycogen Gluconeogenesis - Fats/protein โ> glucose Insulin Glucose Metabolism -
- Cell membranes impermeable to glucose
- Insulin binds to insulin receptor on cell surface
- Moves from inactive site to cell wall
- Glucose transported across cell wall Hormonal Regulation - Low BGL = Glucose uptake High BGL = Glycogenolysis Diabetes Mellitus -
- Inability of the body to produce or to use insulin, resulting in a lack of ability to use or metabolise glucose
- Type 1
- Type 2 Diabetes Insipidus -
- Treatment = surgical removal of the pituitary Diabetes Mellitus โ Type 1 (Pathophysiology & Cause) -
- Autoimmune โ T-cells & antibodies attack the beta cells to prevent the making and secretion of insulin
- Causes destruction of Beta cells
- Decrease production of insulin = no glucose uptake into cells
- High BGL, causes liver to release glucose into blood stream Diabetes Mellitus โ Type 1 (Symptoms) -
- Marked elevation of Blood Glucose
- Rapid onset of symptoms
Diabetes Mellitus โ Type 1 (Nursing Priorities & A-E) -
- Symptom relief
- Control of BSL
- Prevention and treatment of long-term and acute complications Diabetes Mellitus โ Type 1 (Treatment - Medication & Interventions) -
- Insulin
- Pancreas/kidney and islet cell transplant Diabetes Mellitus โ Type 2 (Pathophysiology & Cause) -
- Resistance to insulin (hyperglycaemia despite presence of insulin)
- Pancreases makes insulin, but target cells needing to convert glucose into energy using insulin become resistant.
- Increased glucose production causing high BGL Diabetes Mellitus โ Type 2 (Symptoms) -
- Feeling very thirsty
- Needing to urinate more often than usual
- Blurred vision Diabetes Mellitus โ Type 2 (Nursing Priorities & A-E) -
- Educate the patient (disease, diet, treatment)
- Consider lifestyle change before starting medication Diabetes Mellitus โ Type 2 (Treatment - Medication & Interventions) -
- Oral Hypoglycaemic
- Insulin Gestational Diabetes -
Glucose intolerance detected during pregnancy (2-5%) Diabetic Ketoacidosis (Pathophysiology & Cause) -
- Insulin doesn't work โ> hyperglycaemia/high BGL (can't breakdown glucose) โ> osmotic shift causing excessive urination โ> dehydrated & loose electrolytes โ>
- Breaks down fatty acids to use as alternate energy source (glucose isn't available) โ> by-product of breaking down fats is ketones
- Ketones โ> highly acidic which result in metabolic acidosis
- Usually affects type 1 DKA pH -
- Normal pH = 7.35-7.45 (DKA = 7.3 or less)
- Normal BGL = 4-8 (DKA = 11+)
- Normal DKA = under 0.6 (DKA = 1.5+) Diabetic Ketoacidosis (Symptoms) -
- Lethargy
- Nausea
- Vomiting Diabetic Ketoacidosis (Nursing Priorities & A-E) -
- Fluid replacement: lots around 6 - 8 litres lost
- Insulin = IV insulin (faster, can increase/decrease rate)
- Glucose = at fixed rate to stabilise glucose level while removing ketones (increase in ketones aren't lowering)
- Potassium & electrolyte replacement Diabetic Ketoacidosis (Treatment - Medication & Interventions) -
- Prevent hypoglycemias = glucose & insulin on the same cannula (can get both โ won't have one pump running while one might be broken etc)
- Check BGL + Ketones levels hourly
- Rebound DKA = taken off treatment too soon Hyperosmolar Hyperglycaemia State (HHS) -
- BGL are too high for a long period (high concentration of salts & glucose)
- Leading to severe dehydration and confusion, no Keatons just hyperglycaemia
- Treatment = Lower blood glucose levels and hydrate patient Hypoglycaemia -
- Low level of blood glucose
- Treatment o Mild = glucose or fasting acting sugar (15gm) o Severe = SC or IM glucagon Hyperglycaemia -
- High level of blood glucose
- Treatment o Hydration and dietary status o Ketones o Missed doses of insulin Hyperthyroidism -
- Overproduction of thyroxine, causing metabolism to speed up
- Causes = graves disease, inflammation, noncancerous growths
- S & S = Goiter & weight loss
- Treatment = Removal of thyroid or destruction of thyroid Hypothyroidism -
- Under-secretion of thyroxine, causing lowering of the body's metabolism
- Causes = medications, surgical removal, hashimoto's disease
- S & S = lethargy & weight gain
- Treatment = Thyroxine replacement (medications) Cretinism -
- A congenital form of hypothyroidism (deficiency of thyroid hormones in mother)
- Treatment = thyroid hormones Cushing's Syndrome -
- Overproduction of steroids by adrenal cortex, or by overuse/abuse of steroidal drugs
- Treatment = removal of the adrenal cortex Addison's Disease -
- Underproduction of steroids by adrenal cortex
- Treatment = Replacement and regulation of steroids Graves Disease - Autoimmune disorder that is caused by hyperthyroidism and is characterised by goiter Hashimoto's Disease - Autoimmune disease in which the body's own antibodies attack and destroy the cells of the thyroid gland Insulin - Regulates blood sugar levels by facilitating the uptake of glucose into tissues Continuous Glucose Monitoring (CGM) - A device used to continuously monitor blood glucose levels
Sliding Scale Insulin - Adjusted doses dependent upon individual blood glucose Anaphylaxis -
- Severe, life-threatening, generalised or systemic hypersensitivity reaction
- Characterised by rapidly developing life threatening airway and/or breathing and/or circulation
- Treatment = Epinephrine & Intravenous fluids Human Musculoskeletal System - It is made up of the bones of the skeleton, muscles, cartilage, tendons, ligaments, joints, and other connective tissue that supports and binds tissues and organs together Spongy (Cancellous) v Compact (Cortical) Bone -
- Spongey = network of bone with spaces (strong but light), reduces energy to move around
- Compact = weight bearing, strong
- Marrow = red โ> produce blood cells Strain - A condition resulting from damaging a muscle or tendon Sprain - Stretching or tearing of ligaments Joint Dislocation (Pathophysiology & Cause) -
- When a joint becomes disconnected from its socket
- Joint will require immobilisation for several weeks to allow injured joint tissues to heal Joint Dislocation (Symptoms) -
- Pain
- Deformity
- Limited movement Joint Dislocation (Nursing Priorities & A-E) -
- Immobilisation to allow injured joint tissues to heal
- Postoperative; elevation of limb
- Pain relief, comfort
- Check for complications - DVT, compartment syndrome Joint Dislocation (Treatment - Medication & Interventions) -
- Realignment of bones/back into socket
- Physical therapy to strengthen surrounding muscles
- Surgery for repeated incidences Herniated Disk -
- Discs are pads that serve as "cushions" between the vertebral bodies
- Outer layers split or rupture, inner layer centre squeezed outwards Fractures (Pathophysiology & Cause) - A greater stress is placed on a bone than it can withstand Fractures (Symptoms) -
- Tenderness at fracture site
- Swelling Fractures (Nursing Priorities & A-E) -
- Immobilisation to allow injured joint tissues to heal
- Postoperative; elevation of limb
- Pain relief, comfort
- Check for complications = DVT, compartment syndrome Fractures (Treatment - Medication & Interventions) -
- Physical therapy to strengthen surrounding muscles
- Surgery for repeated incidences Fracture - Types -
- Greenstick = a 'bend' or partial break
- Impacted = fracture fragments are wedged together
- Compression = two bones crushed together
- Comminuted = More than two pieces of fractured bone Bone Healing -
- Haematoma formation (1-2 days)
- Fibrocartilaginous callus formation
- Ossification (3rd - 4th week)
- Remodelling (10 - 18 weeks) Complications of Fractures -
- Deep Vein Thrombosis
- Compartment Syndrome
- Fracture blisters
- Fat Embolism Syndrome
- Osteomyelitis Hypovolaemic Shock -
- Caused by insufficient circulating blood volume
- Treatment = replace fluids Compartment Syndrome -
- Increased pressure within a confined space
- Puts pressure on blood vessels and nerves = compromises limb (limb ischemia)
- Treatment = reduce the pressure (Fasciotomy) Fasciotomy - Excessive swelling and pressure, create incision in limb to elevate pressure until swelling is decreased 5 P's -
- Pain = pain response in
- Pulse = palpate peripheral pulses
- Parlour = poor circulation/obstruction, no venous return
- Parenthesis = sensation (tingling)
- Paralysis = movement Surgical Reaction & Fixation of Fractures -
- ORIF = open reduction internal fixation โ go in for surgery, open up wound and re-aline bone and use devices to pin fracture
- Gets patient back on feet earlier
- Infection risk = foreign object into body External Fixation -
- Puts pins through the bone and immobilises the fracture (prevents movement), temporarily while waiting for swelling to decrease
- Pin care = cleaned regularly and prevent infection
Joint Replacement Risks -
- DVT
- Anaesthetic risk
- Compartment syndrome
- Nerve damage
- Infection Rhabdomyolysis -
- Damaged muscle tissue releases its proteins and electrolytes into the blood
- Causes renal failure
- Makes patient acidotic
- Treatment = fluid replacement & temporary dialysis Osteoarthritis (Pathophysiology & Cause) -
- Inflammation of the bone and joint
- Degenerative (joint overuse - wear and tear) Osteoarthritis (Symptoms) -
- Joint pain
- Swelling, stiffness
- Limited ROM Osteoarthritis (Nursing Priorities & A-E) -
- ADL assistance
- Medication = analgesia, anti-inflammatories
- Physical rehabilitation Osteoarthritis (Treatment - Medication & Interventions) -
- Replacement of complete joint (arthroplasty)
- Surgery = arthroscopic treatment Rheumatoid Arthritis (Pathophysiology & Cause) -
- A chronic autoimmune disorder in which the joints and some organs of other body systems are attacked
- Inflammation of entire joint (synovial membrane, cartilage, ligament, tendons)
- Affects women more than men Rheumatoid Arthritis (Symptoms) -
- Synovial tissues become inflamed
- Joint pain and stiffness, swelling
- Fatigue & weakness Rheumatoid Arthritis (Nursing Priorities & A-E) -
- Reduce pain, stiffness, swelling, and maintain mobility
- Education
- Assistance with daily living Rheumatoid Arthritis (Treatment - Medication & Interventions) -
- Medications = analgesia, anti- inflammatories, DMARDS
- Physiotherapy Osteomyelitis - Inflammation & infection of bone and bone marrow
- Acute Osteomyelitis
- Chronic Osteomyelitis
- Acute Osteomyelitis - Acute infection of the bone (up to 6 weeks)
- Chronic Osteomyelitis - Chronic infection of the bone (6+ weeks) Osteoporosis (Pathophysiology & Cause) - Loss of bone mass, and deterioration in the structure of cancellous bone Osteoporosis (Symptoms) - No symptoms until bone fracture occurs Osteoporosis (Nursing Priorities & A-E) -
- Increase in weight bearing exercise
- Vitamin D supplementation
- Prevention = diet, lifestyle changes Osteoporosis (Treatment - Medication & Interventions) - Drugs to stimulate bone formation Paget Disease -
- Chronic inflammation of bones, resulting in thickening and softening of bones
- Bones may bow or fracture
- Treatment = NSAIDs or anti-inflammatories for pain Systemic Lupus Erythematosus "SLE" -
- Chronic inflammatory disease that can affect any organ system, including musculoskeletal
- Treatment = symptomatic Gout -
- Hereditary metabolic disease that is a form of acute arthritis
- Excessive uric acid in the blood and around the joints
- Treatment = Pain relief, reduce dietary sources of purines Osteomalacia - Rickets (Pathophysiology & Cause) - Softening of the bones due to defective bone mineralization (lack of vitamin D) Osteomalacia - Rickets (Symptoms) -
- Soft weak bones
- Poor nutrition Osteomalacia - Rickets (Nursing Priorities & A-E) -
- Improved sunlight exposure
- Improved diet: calcium and vitamin D Osteomalacia - Rickets (Treatment - Medication & Interventions) -
- Treatment for any underlying disorder
- Surgery to correct bone deformities Tendonitis - Inflammation of a tendon Bursitis - Inflammation of a bursa (fluid-filled sacs that reduce friction between joints) Blood -
- Connective tissue made of plasma, erythrocytes, leukocytes, and platelets
- Plasma = 55%
- Formed elements = 45%
Plasma -
- Straw colour fluid
- 92% is water
- 8% = proteins, antibodies, hormones, gases, waste products Red Blood Cells (Erythrocytes) -
- Transport oxygen and carbon dioxide
- Live for 120 days White Blood Cells (Leukocytes) -
- Respond to injury or infection
- Involved in phagocytosis, cell-mediated and antibody-mediated immune responses Platelets (Thrombocytes) -
- Needed to form blood clots to stop bleeding
- Clump together to form a platelet plug & stimulate clotting cascade Cell Mediated Immunity - Linked to the role of T-cell, stimulated by lots of different chemicals release in response to infection Anti-body Mediated Immunity - Brought about by exposure of B-lymphocytes to an antigen Innate Immunity -
- No memory
- Non-specific
- First line of defence