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WGU D236 Patho Study Guide
Pressure that is due to albumin in the bloodstream? Oncotic Oncotic a form of osmotic pressure exerted by proteins In the blood, _____ is the most common plasma protein and is, therefore, a primary determinant of oncotic pressure albumin _____ controls osmotic pressure in vascular system, builds volume Albumin One question was about the difference in children and adult immunity Possible answer: naive T cells Learning check question: Which differences in immunity make children and older adult patients more susceptible to infections? Choose 2 answers Younger patients have fewer memory cells to combat infection Older adult patients have a dwindling population of naive T cells Older adult patients have more memory cells to combat infection Younger patients have a large population of naive T cells Older adult patients have a large population of naive T cells Younger patients have fewer memory cells to combat infection Older adult patients have a dwindling population of naive T cells Rationale: younger patients have not been exposed to many pathogens, which means that they have fewer memory cells than adults. The primary immune response is relatively weak compared to a secondary response mediated by memory cells. Older adult patients do not have as many T cells compared to younger patients. When these patients encounter novel pathogens, the reduced number of naive T cells gives clonal selection fewer opportunities to "find" T cells that will be effective. Fluid and electrolyte levels are regulated by _______, which regulates actions such as thirst, ADH, the kidneys, and RAAS. osmoreceptors Fluid deficit causes
-Excessive loss -Inadequate intake -Or combination of both Fluid deficit risk factors -Vomiting/diarrhea -Excessive sweating -Insufficient water intake Fluid deficit manifestations -dry mucous membranes -decreased skin turgor -decreased urine output -low blood pressure -tachycardia -confusion ROME for ABGs Respiratory Opposite Metabolic Equal If pH and pCO2 are moving in opposite directions, then it is pCO2 levels that are causing the imbalance and it is respiratory in nature If they are moving the same direction then it is metabolic in nature Buffers, renal compensation, and respiratory compensation help to maintain a blood pH of
7.35-7. A patient with a viral illness and severe vomiting has an elevated CO2 level and a blood pH of 7.53. She is breathing slowly. What condition does the patient have? Metabolic alkalosis Metabolic acidosis Respiratory alkalosis Respiratory acidosis Metabolic alkalosis The patient's pH and CO2 level are both elevating (moving in the same direction). This indicates metabolic alkalosis. The CO2 level is high because her respiratory system is attempting to compensate for the high pH by exhaling less and retaining more CO To prevent changes in pH, the body employs buffer systems. The body utilizes 3 buffer systems: proteins, phosphates, and the carbonic acid-bicarbonate system Carbonic acid-bicarbonate system first line of defense is _____, second line of defense is _____ respirations; kidneys Carbonic acid-bicarbonate system equation The equation moves in both directions CABS Equation: When CO2 levels are elevated, the equation moves ________, forming more H+ and HCO3- ions toward the right
BNP - it's released when fluid volume excess is present Compare and contrast hemodialysis and peritoneal dialysis Hemodialysis: -machine pumps blood from the body and filters waste -3x a week for hours in a clinic -acute kidney failure Peritoneal: -no machine, injection into abdominal cavity and waste products diffuse into cavity then drained -continuous filtration and less disruption but requires some training -not for overweight or severe kidney failure patients Hemodialysis takes blood out of the body via a _____, and puts blood back into body through a
PIV; central line NOTE there are several questions about signs and symptoms of different electrolyte imbalances Sodium levels 135- Hyponatremia causes Vomiting Diuretics Excessive administration of dextrose and water IVs Burns, wound drainage Excessive water intake SIADH Hyponatremia manifestations poor skin turgor, dry mucosa, headache, decreased salivation, decreased blood pressure, nausea, abdominal cramping, neurologic changes, lethargy, confusion, seizures Hypernatremia causes excess water loss, excess sodium administration, diabetes insipidus, heat stroke, hypertonic IV solutions Hypernatremia manifestations thirst; elevated temperature; dry, swollen tongue; sticky mucosa; neurologic symptoms; restlessness; weakness Potassium levels 3.5- Potassium is essential for what? transmission and conduction of nerve impulses, normal cardiac rhythms, and skeletal and smooth muscle contraction (heart) Hypokalemia causes B.A.D. L.O.A.D. B-arters/Conns syndrome(hyperaldosteronism) A-lkalosis D-iuretics
L-axative abuse O-ther causes: insulin overdose A-cute glucose load D-iarrhea Hypokalemia manifestations fatigue, anorexia, nausea, vomiting, dysrhythmias, muscle weakness, cramps, paresthesias, glucose, intolerance, decreased muscle strength, deep tendon reflexes (DTRs), decreased cardiac output Hyperkalemia causes MACHINE Medications- ace inhibitors and NSAIDS Acidosis- metabolic and respiratory Cellular destruction- burns, traumatic injury Hypoaldosteronism/hemolysis Intake- excessive Nephrons, renal failure Excretion Hyperkalemia manifestations Muscle weakness, paresthesia, paralysis, cardiac rhythm irregularities (leading to possible ventricular fibrillation and cardiac arrest) How can hyperkalemia lead to cardiac arrest? A major function of potassium is to conduct nerve impulses in muscles. Too low and muscle weakness occurs and too much can cause muscle spasms. This is especially dangerous in the heart muscle and an irregular heartbeat can cause a heart attack Calcium levels 8.5-10. Calcium is essential for what? muscle contraction, blood clotting, nerve impulse transmission, strength of teeth and bones Calcium is excreted by the kidneys (urine) Hypocalcemia causes hypoparathyroidism, malabsorption, pancreatitis, alkalosis, massive transfusion of citrated blood, renal failure, medications, vitamin D defeciency Hypocalcemia manifestations Positive Trousseau's or Chvostek's sign Laryngeal stridor Dysphagia Tingling around the mouth or in the extremities Cardiac dysrhythmias Muscle twitching Tetany Hypercalcemia causes malignancy and hyperparathyroidism, bone loss related to immobility, bone cancer
True or false: in Marfan syndrome, the aorta and heart valve structures are commonly affected (heart murmur and pectus exavatum) True Marfan syndrome manifestations Leads to excessive growth in height; excessively long, thin fingers and toes with excessive joint flexibility; subluxation of the lens of the eye; and various chest wall abnormalities, usually pectus excavatum Sudden dyspnea with pneumothorax Defective elastic fibers in the aorta - leads to dissecting aneurism of the aorta and heart valve disorders Turner syndrome A chromosomal disorder in females in which either an X chromosome is missing, making the person XO instead of XX, or part of one X chromosome is deleted. Testing requires for turner syndrome Genetic testing, hormone level evaluation, echo, bone density scan, bone age testing Turner syndrome treatment growth hormone and estrogen therapy Turner syndrome manifestations
- underdeveloped ovaries (sterile)
- short stature (4'7")
- amenorrhea
- infertility
- webbing of the neck
- edema
- underdeveloped breasts and wide nipples
- high number of aborted fetuses Respiratory rate increases during exercise. How does this increased respiratory rate allow the body to maintain a homeostatic pH level? The increased exhalation of CO2 helps to increase pH The increased respiratory rate allows more CO2 to be exhaled. Since CO2 reacts with water to form carbonic acid, getting rid of more CO2 through increased respiration will raise pH An ICU patient's arterial blood gas results show low pH and low CO2 levels. The patient's respiratory rate is increased. What is the name of this condition? Metabolic acidosis Since the pH is low, and the pH and CO2 are trending in the same direction, the condition is metabolic acidosis. The low CO2 indicates that CO2 is not causing the acidosis. The increased respiratory rate lowers blood CO2 in an attempt to compensate for the metabolic acidosis Your patient has pulmonary edema, which raises levels of CO2 in the blood. What helps the patient's body to compensate for this increase? The kidneys excrete more H+ and conserve HCO3- The increased CO2 level will generate more carbonic acid. The body must compensate for the decreased pH. Excreting more H+ and conserving HCO3- will both help to increase pH.
Arthritis inflammation of a joint Osteoarthritis inflammation of the bone and joint Most common type of degenerative joint disease, most commonly affected are the cervical, lumbosacral spine, hip, knee, and first metatarsal phalangeal joint osteoarthritis Heberden and Bouchard's nodes Small bumps that grow on the joints, especially the fingers - telltale sign of osteoarthritis Osteoporosis a condition in which the bones become fragile and break easily Osteoporosis is usually more prevalent in the ____ wrist, vertebrae, and upper femur True or false: Bone formation occurs throughout life in the remodeling process, and requires adequate calcium in the diet True Insufficient calcium in diet causes inadequate calcium blood levels that stimulate ____ parathyroid gland activity ____ regulates blood calcium by stimulated bone remodeling, triggering vitamin D synthesis in the kidney, enhancing GI absorption of calcium and reabsorbing calcium in the kidney PTH AVN (avascular necrosis) deterioration of bone caused by insufficient blood supply AVN is commonly associated with fractures of ____ femoral head and neck, scaphoid, neck and body, and proximal humerus AVN symptoms pain and weakness, motor weakness, abnormal gait, lack of rehab progress ____ is used to detect AVN MRI AVN treatment surgical removal of necrotic bone Describe the process of articular degeneration. Which cells are involved in this process and what is their function? The thinning and breakdown of the articular cartilage that covers joints and acts as a lubricant and cushion. This articular cartilage is comprised of chondrocytes in a matrix of collagen and aggrecan. The chondrocytes produce enzymes and other proteins that slowly break down and reform the matrix, allowing for regeneration. Stress caused by being overweight or physical trauma can cause chondrocytes to speed up the matrix breakdown process relative to the reformation process, leading to a thinning of the articular cartilage. You receive a patient who has experienced a burn on the right leg. You note the burn contains small blisters and is extremely pinkish red and shiny/moist. The patient reports severe pain. You document this burn as: A. 1st Degree (superficial)
- major factor is HTN
- neurologic deficit is apparent
- high mortality Subarachnoid hemorrhage arterial branch in the subarachnoid space ruptures, d/t head trauma or an aneurysm rupture, "worst headache of my life" 4 types of intracranial bleeds includes: epidural, subdural and subarachnoid hemorrhages and hematomas NOTE One question was about someone coming into the ER with a head injury, know the s/s of concussion and contusion Cerebral Concussion (Mild Traumatic Brain Injury) Individuals with mild TBI can develop postconcussive syndrome (PCS), which includes headaches, lethargy, mental dullness, and other symptoms that can persist for several months after a TBI. Cerebral contusion
- the bruising of brain tissue as the result of a head injury that causes the brain to bounce against the rigid bone of the skull
- s/s: severe headache, dizziness, vomiting, increased size of one pupil, sudden weakness in arm or leg
- the person may seem restless, agitated, or irritable, often has memory loss
- symptoms can last several hours to weeks
- as brain tissue swells, increase in drowsiness or confusion
- VS may show decreased heart rate and respirations, HTN See 169 more
