2920 Pathophysiology Exam One Flashcards
define genetics
study of heredity and inherited characteristics
define mutation
change or damage to a gene that alters genetic code
autosomal dominant genetic disease
abnormal allele is dominant and normal allele is recessive
what is the recurrence risk of autosomal dominant diseases if one parent is affected? Both parents?
50% chance for one parent, 75% chance if both affected
are males or females more affected in autosomal dominant disorders?
both are affected equally
examples of autosomal dominant disorders
BRCA gene cancers (breast and ovarian)
Huntington’s disease
familial hypercholesterolemia
marfan syndrome
autosomal recessive genetic diseases
abnormal allele is recessive, and the person must be homozygous for the disease to be expressed
what is the recurrence rate of autosomal dominant diseases if parents are heterozygous? what is the chance of children being a carrier?
25% risk of disease recurrence, 50% chance of child being a carrier
what are some examples of autosomal recessive disorders?
cystic fibrosis
sickle cell disease
tay-sachs disease
PKU
who is usually affected by x linked recessive disorders? who is usually a carrier?
men are usually affected because they have only one x chromosome, women can be carriers
can affected men transmit x linked disorders to their sons?
no, because they give only their Y chromosome
what are some examples of x linked recessive disorders?
duchenne muscular dystrophy
hemophilia
color blindness
wiskott-aldrich syndrome
Is familial hypercholesterolemia autosomal dominant or recessive?
dominant
pathophysiology: familial hypercholesterolemia
liver lacks production LDL receptors, so patient has increasingly high levels of LDL
clinical manifestations: familial hypercholesterolemia
cholesterol exceeding 600 mg/dL
early atherosclerosis
early adult coronary artery disease or MI
pathophysiology: marfan syndrome
gene mutation that causes connective tissue weakening, which leads to weakening and aneurysms of vascular structures that will eventually rupture
clinical manifestations: marfan syndrome
tall stature heart murmurs ligament hypermobility syncope dyspnea joint issues
what is the most common lethal inherited disease in caucasians?
cystic fibrosis
pathohysiology: cystic fibrosis
dysfunction of gene that regulates chloride channels, leading to salt and chloride exchange issues in epithelial cells
clinical manifestations: cystic fibrosis
pancreatic enzyme deficiency
thick respiratory mucus and difficulty breathing
everything clogged with thick mucus and severe dehydration in all systems
pathophysiology: tay sachs disease
genetic mutation causing deficiency of lysozomal enzyme, leading to progressive destruction of neurons
clinical manifestations: tay-sachs disease
cherry red spots on retina
incoordination and flaccid muscles
cognitive impairment
symptoms often present in early infancy
pathophysiology: wilson’s disease
genetic disorder of copper metabolism, leading to copper deposits in the body that damage hepatocytes
clinical manifestations: wilson disease
cirrhosis tremor speaking issues ataxia clumsiness/dystonia seizures
pathophysiology: kleinfelter syndrome
extra x or y chromosome, only affects males
clinical manifestations: kleinfelter syndrome
less puberty changes (decreased testicle development, gynecomastia)
diabetes and obesity
cognitive impairment
skeletal/heart abnormalities
pathophysiology: turner syndrome
complete or partially missing x chromosome in females
clinical manifestations: turner syndrome
webbed feet and neck short stature infertility amenorrhea cardiovascular problems hypothyroidism
pathophysiology: down syndrome
trisomy of chromosome 21
clinical manifestations: down syndrome
cognitive impairment dysmorphic facial features heart disease weak immune system only one hand crease
pathophysiology: prader-willi syndrome
mutation of chromosome 15 causing hypothalamic dysfunction
clinical manifestations: prader willi syndrome
obesity and overeating hypotonia low IQ short stature seizures hypogonadism
pathophysiology: huntington disease
adult onset autosomal dominant neurodegenerative disorder causing degeneration of specific neurons at basal ganglia and cortex
clinical manifestations: huntington disease
movement issues (tremors progressing rapidly to parkinsonian symptoms) cognitive issues dementia depression rapid progression to death
pathophysiology: COPD
chronic bronchitis + emphysema causing airflow limitations that lead to narrowing, excessive mucus, and loss of alveolar elasticity
airway permanently remodeled
what are manifestations of a COPD exacerbation?
worsening shortness of breath at rest
increased secretions
increased purulence of secretions
general manifestations of COPD?
dyspnea barrel chest cough/wheeze cyanosis hypoxia
risk factors: COPD
age smoking history being male asthma AAT deficiency bacterial or viral infections inhalation of chemicals/dust/pollution
ARDS stands for
acute respiratory distress syndrome
pathophysiology: ARDS
alveolar injury triggers inflammation, which makes the capillary membrane more permeable. this increases pulmonary edema and impairs gas exchange. vasculature also narrows causing pulmonary hypertension
what is atelectasis?
alveolar collapse
what are the first signs of ARDS?
sudden onset dyspnea and being unable to catch breath
what are later signs and manifestations of ARDS?
sudden progressive pulmonary edema restlessness confusion rapidly dropping O2 sats hypoxemia and hypercapnia crackles in lungs
what is the number one cause of ARDS?
sepsis
what are some examples of things that can cause indirect lung injury leading to ARDS?
sepsis drug overdose massive transfusion prolonged cardiopulmonary bypass surgery severe head injury acute pancreatitis traumatic injury
what are some direct lung injury examples that can lead to ARDS?
aspiration of gastric contents pneumonia air/fat/amniotic fluid emboli inhalation of toxic substances near drowning oxygen toxicity radiation pneumonitis
what is the pathophysiology of pre-eclampsia?
unknown, but it is a progressive problem that stems from the placenta
what is the first problem that leads to the complications of pre-eclampsia?
inadequate vascular remodeling of the spiral arteries (they fail to widen)
what problems occur because the spiral arteries fail to widen in pre-eclampsia?
decreased placental perfusion
hypoxia
what happens to the endothelial cells because of decreased placental perfusion and hypoxia in pre-eclampsia?
they malfunction and release toxic substances
what three things occur because of endothelial cell dysfunction in pre-eclampsia?
vasospasm
increased peripheral resistance
increased endothelial cell permeability
increased peripheral resistance gives rise to…
hypertension
increased endothelial cell permeability leads to..
edema and protein loss
vasospasm causes what problems in pre-eclampsia?
headache and visual disturbances
what is the end result of the pre-eclampsia disease cascade?
decreased tissue perfusion to all organs
what are some primary clinical manifestations of pre-eclampsia?
hypertension headache blurred vision edema increased CNS irritability
what are the blood pressure criteria for pre-eclampsia diagnosis?
BP greater than or equal to 140/90 on at least two occasions at least four hours apart
what will happen to hemoglobin and hematocrit levels in pre-eclampsia?
decreased hemoglobin
increased hematocrit
what happens when pre-eclampsia progresses to eclampsia?
seizures, coma, and death
what is the name of the syndrome that occurs in severe pre-eclampsia?
HELLP syndrome
what is HELLP syndrome?
hemolysis, elevated liver enzymes, low platelets
is HELLP syndrome easily detected?
no, many women are asymptomatic and don’t know they have it
what are risk factors for developing preeclampsia?
first pregnancy age over 40 or under 19 family history or personal history of preeclampsia multifetal pregnancy chronic hypertension renal disease diabetes or other vessel disorders African American
what are the risks to the unborn infant in preeclampsia cases?
preterm birth
low birth weight infants
poor fetal oxygenation
decreased amniotic fluid
what does RSV stand for?
respiratory syncytial virus
what is RSV?
a lower respiratory RNA virus that primarily occurs in very young children or elderly people with lung diseases
what is the pathophysiology of RSV?
the virus invades the bronchioles and lower respiratory tract, causing airway obstruction, edema, and mucus production
the narrow airways allow air to be inhaled but exhalation is hindered, causing air trapping
what do the endothelial cells of the respiratory tract do in RSV?
they fuse together, making swollen giant cells that clog the airway and create a lot of mucus and exudate
what are initial manifestations of RSV?
cold-like symptoms
what are progressive symptoms of RSV?
retractions
high RR
cyanosis
wheezing and stridor
what are severe symptoms of RSV?
fever
listlessness
minimal breath sounds
what are some of the main risk factors for RSV?
premature infants infants less than one year old crowded living conditions congenital heart disease immunodeficiency winter or early springtime being male non-breastfed having a mother who smokes
pathophysiology of malignant hyperthermia
autosomal dominant trait that causes a reaction to anasthesia.
it is a hypermetabolism of skeletal muscle due to altered control of intracellular calcium
what is usually the first sign of malignant hyperthermia?
muscle rigidity
what is the treatment for malignant hyperthermia?
dantrolene (a muscle relaxant)
what is the pathophysiology and manifestations of anaphylaxis?
extreme allergic immune response causing hypotension, tachycardia, bronchospasm, and pulmonary edema
what is the treatment for anaphylaxis?
subcutaneous epinephrine and fluids
if that isnt working, vasopressors can also be given
what are some of the duties of of a preoperative nurse?
full patient assessment/interview/history asking about allergies and meds vitals and labs surgery teaching and informed consent pre-op medications family history and medical history pulses in all extremities color/movement/sensation
What are some of the roles/duties of the intraoperative nurse?
take report from the pre-op nurse
advocate for the patient in the surgery room
call for pause to make sure everything is correct before beginning
ensure safety and sterility
monitor vitals, blood loss, and intake and output
report off to post-op nurse
what are some of the duties of the postoperative nurse?
monitor patients and ensure they are stable before moving them out of PACU monitor ABCs/vitals/LOC administer meds and manage pain assess psychological status discharge planning and education
before what point is a birth considered premature?
anytime before 37 weeks
the majority of preterm birth mortalities occurs in babies born before when?
32 weeks
what is considered the age of viability (when a premature infant has a chance at survival)?
24 weeks
what are some causes of preterm birth?
gestational diabetes hypertension or preeclampsia placental disorders seizures advanced maternal age smoking obesity
what are some complications of preterm birth?
death immature lungs oxygen toxicity apneic spells aspiration risk immature GI system inability to regulate temperature startle easily prone to strokes due to weak vessels
what complications can occur due to immature GI system in premature babies?
bowel obstruction
holes in bowels
how can a nurse stimulate breathing in preterm babies prone to apneic spells?
flick their toes
how does the suck/swallow reflex work in preterm babies?
they have a suck reflex but no swallow reflex
pathophysiology of respiratory acidosis
decreased ventilation causes accumulation of acidic CO2 in the bloodstream
what are some common pulmonary causes of respiratory acidosis?
pulmonary obstruction respiratory depression pneumonia asthma/lung disease underventilation or hypoventilation CF COPD
what are some common non-pulmonary causes of Respiratory acidosis?
overdose of sedatives or narcotics
neuromuscular disorders (GB, MS)
nervous system damage
cardiopulmonary arrest
pathophysiology of respiratory alkalosis
usually hyperventilation causes excess CO2 elimination, so less acid than normal is in the bloodstream
what are some common pulmonary causes of respiratory alkalosis?
pneumonia overventilation/hyperventilation pulmonary edema or embolus lung disease with shortness of breath asthma
what are some common non-pulmonary causes of respiratory alkalosis?
anxiety pain liver disease fever/infection/sepsis CNS disorders alcohol or salicylate intoxication
what is the pathophysiology/etiology of metabolic acidosis?
increased acid production, decreased acid excretion, or loss of base in the body
what are some common causes of increased non-carbonic acid in the body (leading to metabolic acidosis)?
DKA lactic acidosis alcoholic or uremic acidosis toxic substance ingestion shock renal disease hypokalemia hypocalcemia hypomagnesia
what are some common causes of bicarbonate loss (leading to metabolic acidosis)?
prolonged diarrhea
renal tubular acidosis
interstitial renal disease
what electrolyte imbalance can occur as a result of compensatory mechanisms to correct metabolic acidosis?
hyperkalemia
pathophysiology/etiology of metabolic alkalosis
depletion of hydrogen ions, which are usually lost through the kidneys or GI system
what electrolyte imbalance can cause metabolic alkalosis, and why?
hypokalemia, due to hydrogen ions shifting into the intracellular space to make up for missing potassium
what are some common causes of metabolic alkalosis?
bicarbonate ingestion potassium wasting diuretics loss of gastric fluid from suctioning or vomiting cushing syndrome primary or secondary hyperaldosteronism
how will you know if an ABG is partially compensated?
all three values will be abnormal
how will you know if an ABG is fully compensated?
pH will be normal and the other two values will be abnormal
normal PaCO2 levels
35-45
normal bicarb levels
22-26
normal PaO2
80-100
what is acute renal injury
a rapid decrease in renal filtration function
what are the four phases of AKI?
initial
oliguric
diuretic
recovery
initial phase of AKI
initial insult/injury to kidneys, usually occurs over hours to days
oliguric phase of AKI
decreased urine output
decreased GFR
retention of urea, creatinine, and potassium
diuretic phase of AKI
beginning of recovery, high urine output put urine is undiluted, so patient still retains waste products
fluid replacement is vital
fibrosis may begin to occur in the kidneys
recovery phase of AKI
may or may not happen if it does happen... urine is appropriately concentrated inflammation goes down renal function returns may take months to a year to fully recover and kidneys may have scar tissue
what does the RIFLE scale look at as pertains to AKI?
creatinine
urine output
GFR
what is a red flag/emergency manifestation of AKI?
encephalopathy (confusion)
what are other clinical manifestations of AKI?
oliguria
fluid overload
uremia, causing encephalopathy, anemia, hyperkalemia, metabolic acidosis, thrombocytopenia, and neuromuscular irritability
pulmonary edema
what are the three categories of kidney injuries that can cause AKI?
prerenal
intrarenal
postrenal
what are some examples of prerenal injuries that can cause AKI?
low BP
shock
hypovolemia
anything decreasing renal perfusion
what are some examples of intrarenal injuries that can cause AKI?
kidney damage from nephrotoxic drugs (NSAIDs, antibiotics, radioopaque dyes)
sepsis
infection (glomerulonephritis, pyelonephritis)
what are some examples of postrenal injuries/problems that can cause AKI?
obstruction of urine outflow from things like BPH, blader disorders
spinal cord injuries causing issues with bladder emptying
tubule obstruction
what is the number one killer in AKI?
infection (sepsis)
when might a cancer patient need to be put on neutropenic precautions?
when/if WBC levels get too low
what is superior vena cava syndrome?
cancer emergency in which the SVC is obstructed by tumor or thrombosis
clinical manifestations of superior vena cava syndrome
facial/periorbital edema
headache
seizures
distended neck veins
what is spinal cord compression?
cancer emergency in which cancer is present in the epidural space of the spinal cord, compressing it
clinical manifestations: spinal cord compression
intense localized back pain vertebral tenderness motor weakness autonomic loss sudden immobility
what is third space syndrome?
cancer emergency in which fluid shifts from the vascular space to the interstitial space. usually happens after surgery, septic shock, or immunotherapy
why does third space syndrome not go away in cancer patients?
because their cells are weak/unhealthy, and unable to mobilize the fluid back into the vascular space and out of the body
clinical manifestations: third space syndrome
signs of hypovolemia: hypotension, tachycardia, decreased urine output
edema
what is SIADH?
syndrome of inappropriate antidiuretic hormone, a cancer emergency in which chemo or cancer cells cause the production of excess ADH, leading to fluid retention
clinical manifestations: SIADH
water retention hypotonic hypernatremia weight gain weakness anorexia/N/V seizures personality changes decreased reflexes coma
what is tumor lysis syndrome?
cancer emergency that usually occurs shortly after first chemo treatment if its going to occur. its a rapid release of intracellular contents (potassium, phosphorus, urea) into the body
clinical manifestations: tumor lysis syndrome
hyperuricemia hyperphosphatemia hyperkalemia hypocalcemia weakness cramps diarrhea nausea/vomiting
what is cardiac tamponade?
cancer accumulation in which fluid accumulates in the pericardium. pericardium is typically constricted by tumor or pericarditis secondary to radation
clinical manifestations: cardiac tamponade
distant/muted heart sounds (may sound like listening through a well) heavy feeling chest SOB cough tachycardia dysphagia hoarseness N/V sweating decreased LOC anxiety
what is carotid artery rupture?
cancer emergency usually caused by radiation to the head or neck in which the arterial wall is invaded by a tumor or eroded by surgery/radiation
manifestations of carotid artery rupture
bleeding, ranging from mild oozing to spurting blood explosion from carotid artery
in heart failure, what four problems in the body can lead to decreased cardiac output?
volume overload
pressure overload
myocardial disease
rapid heart rate
what two specific problems will result from poor cardiac output?
decreased renal perfusion
increased autonomic nervous system stimulation
decreased renal perfusion will trigger the activation of what?
RAAS (renin-angiotensin-aldosterone system)
what does the RAAS do?
causes everything to constrict and increases sodium and water retention
what is the end result of the RAAS?
increased blood volume
what will result in the body because of increased autonomic nervous system stimulation?
vasoconstriction increased systemic vascular resistance pallor sweating tachypnea tachycardia
what is the end result in the heart when the RAAS and the autonomic nervous system are activated?
increased diastolic pressures in the left and right ventricles, which in turn increases pressure in the atriums
what symptoms arise from increased right atrium pressure?
elevated jugular venous pressure
hepatomegaly
interstitial edema
poor GI absorption
what symptoms arise from increased left atrium pressure?
pulmonary edema and associated pulmonary symptoms
what formula/calculation determines the degree of heart failure?
ejection fraction
what is ejection fraction?
a measurement of the percent of blood leaving the left ventricle every time it contracts
what are some signs and symptoms of left sided heart failure?
paroxysmal nocturnal dyspnea restlessness confusion orthopnea tachycardia pulmonary congestion fatigue cyanosis
what specific signs and symptoms indicate pulmonary congestion?
cough crackles wheezes blood tinged sputum tachypnea
what is the most common cause of right sided heart failure?
left sided heart failure
what are some signs and symptoms of right sided heart failure?
fatigue increased peripheral venous pressure ascites enlarged liver and spleen distended jugular veins anorexia and GI distress weight gain dependent edema
what are some things that can cause cardiac arrhythmias?
drugs, alcohol, caffeine, infection, shock, stress
what are some labs and diagnostics that need to be monitored related to cardiac conduction and function?
ECG BNP CKP-MB cardiac troponin magnesium/calcium/potassium
what is a PVC?
premature ventricular contraction: the ventricle beats independently without waiting to sequential conduction of other nodes
how does one calculate heart rate on an ECG?
take 300 and divide it by the number of large boxes between QRS complexes
describe v-tach and necessary interventions
wide and bizarre QRS complexes because just the ventricle action is seen.
shock, CPR, and epinephrine are needed
describe v-fib and necessary interventions
just random waves with no pattern, very serious problem. needs shock, CPR, and epi
describe supraventricular tachycardia and necessary interventions
very fast HR (up to 200 BPM). may be transient and require no intervention, or may need adenosine and a shock
describe sinus bradycardia and necessary interventions
normal heart pattern at a very slow rate. give atropine and use artificial pacing if no response can be obtained
what should be done for a patient in asystole?
CPR, oxygen, IV fluids, intubation, anything to get them back
what should be done immediately for clients with chest pain? (think MONA)
morphine
oxygen
nitroglycerin
asprin
what is the most common cause of acute MI?
atherosclerosis
pathophysiology of MI
blockage of coronary artery/arteries causes prolonged ischemia of cardiac tissue, which causes necrosis and irreversible cell damage if not treated immediately
STEMI
ST elevation (on EKG) MI. this is a more serious MI as the ischemia goes all the way to the endocardial wall
NSTEMI
non-ST elevation MI. ischemia hasn’t progressed as far and there is more time for interventions
what are manifestations of MI?
chest pain and pressure initial HTN, then hypotension elevated LDL diaphoresis dyspnea extreme anxiety pallor radiating pain and pressure (to shoulder, arm, jaw, or back) fatigue weak pulses
what is the gold standard lab test when looking for MI?
troponin
what does troponin measure?
how many cardiac cells have died. drawn repeatedly to look for bell curve of cell death
what lab test will help determine if someone is headed for heart failure?
BNP
what are risk factors for MI?
atherosclerosis angina pectoris diabetes elevated LDL smoking and tobacco use family history being male or being a post-menopausal woman
