2920 Pathophysiology Exam Three Flashcards
explain the pathophysiology of DKA
glucose enters the body, but there is no insulin to let it into the cells
glucose remains in bloodstream, elevating BG levels
liver
cell starvation leads to the liver breaking down glycogen and and the body to start breaking down fat for energy
liver creates glucose from fatty acids, which also leads to ketone formation
buildup of ketones and glucose in the bloodstream
how do ketones change blood chemistry?
they are very acidic, decreasing blood pH
why is electrolyte loss an issue in DKA?
because plasma osmolality goes up, causing osmotic diuresis and loss of electrolytes in urine
how does DKA differ from HHS?
DKA involves ketone formation from lipolysis because there is no insulin in the body at all. therefore it usually happens in type one diabetes, because they have no endogenous insulin.
HHS does not normally involve ketone formation, because type two diabetics usually have enough insulin present to prevent this
what symptoms do DKA and HHS share?
severe hyperglycemia
hyperosmolarity
dehydration
how quickly can/does DKA manifest?
often within 4-10 hours
what are manifestations of DKA?
glucose greater than 250 mg/dL pH lower than 7.3 (metabolic acidosis) bicarb less than 15 mEq/L ketonuria nausea and vomiting dehydration hyperventilation coma polyuria/polyphagia/polydipsia hypotension tachycardia irritability weight loss hyperkalemia fruity smelling breath
what is the specific type of respirations seen in DKA?
Kussmaul respirations
what is the treatment plan for DKA?
Hydration
Insulin
Electrolytes
what are risk factors for DKA?
type one diabetes not taking insulin exercise stress infection/fever (majorly increases insulin needs) undiagnosed T1DM alcohol abuse
why don’t you want to lower blood glucose too quickly in DKA?
it can cause cerebral edema from the rapidly changing osmolarity of brain fluids
what will be manifestations of liver necrosis in acute liver failure?
decreased bilirubin metabolism decreased bile in GI tract decreased vitamin K absorption increased urobilinogen decreased metabolism of nutrients decreased plasma protein
what are manifestations of decreased bilirubin metabolism?
hyperbilirubinemia
jaundice
what is a common manifestation of decreased bile production?
light colored stools
what is the risk with decreased vitamin K absorption?
bleeding tendency
what is a key manifestation of increased urobilinogen?
dark urine
what is an outcome of decreased metabolism of proteins, carbs, and fats in acute liver failure?
hypoglycemia
what are manifestations that accompany decreased plasma proteins?
ascites and edema
what lab values will be abnormal in acute liver failure?
increased AST, ALT, and alkaline phosphatase
increased bilirubin
increased prothrombin time
decreased albumin
what are two common (general) causes of acute liver failure?
liver inflammation (often viral infection) chemical damage
what is one of the first signs of acute liver failure and why?
changes in mentation due to hepatic encephalopathy
what are common manifestations of acute liver failure?
jaundice hyperbilirubinemia anorexia ascites dark urine RUQ pain spider angiomas hepatomegaly and splenomegaly steatorrhea decreased protein levels decreased adrenal and sex hormones high ammonia levels
what are risk factors for acute liver failure?
all risk factors for hepatitis alcohol abuse (especially mixed with tylenol) medications gastric bypass surgery iron overload malnutrition or rapid weight loss obesity chemical/toxin exposure wilson disease wild mushrooms epstein barr virus
what is the pathophysiology of bowel obstruction?
something blocks the bowel, and increased peristalsis and mucus production at obstruction site worsen the issue. swelling at area will cause increased permeability of intestines, leading to fluid and electrolyte shifts and possible hypovolemic shock
what are the two classes of bowel obstructions?
mechanical and non-mechanical
what is the number one cause of mechanical obstruction?
adhesions: formations of tissue that bind organs and tissues together (often as a result of surgery) and can obstruct bowel
what is the biggest risk with a complete bowel obstruction?
perforation of bowel
what is a key indicators of a high bowel obstruction?
vomiting (often projectile)
what are some indicators of a lower bowel obstruction?
waves of pain and tenderness that occur with peristalsis
less or absent vomiting, and if present, will have a more fecal smell
what are some general manifestations of any bowel obstruction?
abdominal distension nausea pain diarrhea (if partial obstruction) hyperactive bowel sounds (borborygmi) high pitched bowel sounds above area of obstruction
what does continuous pain indicate in a bowel obstruction?
ischemia or necrosis
what are risk factors for bowel obstruction?
surgery abdominal hernias inflammatory diseases of the bowel infections like diverticulitis colon cancer
what treatment can help relieve pressure buildup with a bowel obstruction?
NG tube with suction
what are some key manifestations with tramatic brain injury?
changes in level of consciousness
increased intracranial pressure and associated symptoms
diabetes insipidus due to pressure on the pituitary gland
what is involved in primary insult in a spinal cord injury?
trauma damages neurons and glial cells due to stretching or laceration
describe what happens during the secondary insult of a spinal cord injury
ongoing, progressive damage continues due to ischemia and vascular changes, inflammatory cell release, neuronal death, and scar tissue formation
what is the number one risk factor for spinal cord injury?
being a male between the ages of 16 and 30
what are other risk factors for spinal cord injury?
motor vehicle use
age over 65
risk taking behaviors
bone or joint disorders
what kind of spinal cord injuries will cause respiratory issues?
injury at c4 or above
what kind of spinal cord injuries will cause neurogenic shock and cardiac issues?
injury at T6 or above
what are other clinical manifestations of spinal cord injury?
inability to regulate temperature temporary or permanent loss of sensory, motor, or autonomic function (depends a lot on where the injury is) urinary retention GI immobility pain venous pooling/DVT
describe spinal shock
flaccid paralysis that occurs because of initial injury to the spinal cord. it will manifest as flaccid muscles, paralysis, loss of sensation below the level of injury, and bladder/bowel dysfunction. This is an initial response to spinal cord injury and may resolve hours to weeks after injury
what is autonomic hyperreflexia?
massive uncompensated cardiovascular reaction mediated by the SNS that occurs because of injury at T6 or higher
how will autonomic hyperreflexia manifest?
increased BP decreased HR no vasodilation flushing above the level of injury blurred vision anxiety nausea can lead to status epilepticus, stroke, MI, and death
what can cause autonomic hyperreflexia?
return of reflexes following spinal shock
skin stimulation
overdistended bladder or constipation
what are some types of skeletal trauma?
sprains
strains
fractures
what are some signs and symptoms of skeletal trauma?
bleeding tissue disruption swelling pain at joints/injury site limited movement changes in sensation and mobility deformity muscle spasms
what should the nurse do if she suspects abuse?
separate the injured party and parents/potential abusers, then ask both what happened and compare stories
what should the nurse chart in suspected abuse cases?
exactly what the family/parties said happened, with direct quotes in quotation marks
what accounts for about 75% of traumatic deaths?
chest trauma
what are the two general types of chest trauma?
blunt trauma
penetrating trauma
what are risk factors for chest trauma?
motor vehicle accident fall assault crush injury explosion knives gunshots arrows
what are general signs and symptoms of chest trauma?
dyspnea respiratory distress air escaping from chest wound decreased BP rapid thready pulse dysrhythmias bruising on torso asymmetrical chest movements
what is a pneumothorax?
air enters the pleural cavity due to injury/penetration, changing the negative pressure to positive pressure and causing the lung to collapse
what are manifestations of pneumothorax?
tachypnea dyspnea respiratory distress air hunger decreased O2 sats decreased or absent breath sounds decreased chest wall movement
what is a hemothorax?
accumulation of blood in pleural space due to injury
what are manifestations of hemothorax?
dyspnea
diminished or absent breath sounds
decreased hemoglobin
shock
what is a tension pneumothorax?
air enters the pleural space but cannot escape, causing increasing pressure on the lung and heart, eventually pushing them into the space of the unaffected lung
what are manifestations of tension pneumothorax?
cyanosis air hunger agitation tracheal deviation neck vein distention hyperressonance
what is a flail chest?
fracture of two or more adjacent ribs in two or more places, causing an unstable chest wall
what are manifestations of flail chest?
paradoxical chest movements
respiratory distress
tachycardia
what is cardiac tamponade?
blood collecting in the pericardial sac, compressing the myocardium and preventing ventricular filling
what are manifestations of cardiac tamponade?
muffled/distant heart sounds
hypotension
neck vein distention
increased central venous pressure
what are risk factors for abdominal injury?
MVA
blows
falls
stab wounds
what are manifestations of abdominal trauma?
guarding/splinting hard and distended abdomen decreased bowel sounds abrasions bruising pain hematemesis hematuria hypovolemic shock ecchymosis around umbilicus and flanks
what indicates a need for CPR?
absent pulse
absent breathing
unresponsiveness
what are the two types of wound disruption?
dehiscence and evisceration
what is dehiscence?
wound pulling apart at suture lines
how will the client describe wound dehiscence?
might say they heard a pop or felt something give away
how does a nurse prevent wound dehiscence?
have the patient splint surgical incision with a pillow and exhale while moving to not strain the incision
what should the nurse do if dehiscence occurs?
call the physician, cover the site with sterile gauze soaked in saline, and position the patient flat with knees bent
what is evisceration?
organs or intestines protruding out from a wound/incision
what should the nurse do if the patient is experiencing evisceration?
call the surgeon, cover the wound with gauze soaked in sterile saline, and position them on their back with knees bent
what are four major neurotransmitters that can play a role in mental health?
dopamine
norepinephrine
serotonin
gaba
what is too much dopamine linked to? too little?
too much: schizophrenia and addiction
too little: parkinsonianism and depression
what is too little norepinephrine linked to?
depression
what is too much serotonin linked to? too little?
too much: schizophrenia
too little: depression and bipolar
what is too little GABA associated with?
panic attacks
what is delirium?
a sudden cognitive impairment that is typically reversible
what are causes of delirium?
hospitalization, especially in the ICU sleep deprivation drug toxicity or withdrawal CVA or head injury sensory deprivation acid base imbalance hypoglycemia infection dementia (increases risk)
what are manifestations and onset of delirium?
onset: develops over a couple of days
manifestations: hyperactive, hypoactive, impulsivity, aggression, decreased attention span, confusion, withdrawal, hallucination, insomnia, cognitive impairment
what is schizophrenia?
a psychotic disorder in which the patient loses touch with reality
what are risk factors/epidemiological factors for development of schizophrenia?
living in an urban area
being a male
first degree relatives with schizophrenia
father older than 60
how much more likely is someone to develop schizophrenia if a first degree relative has it?
ten times more likely
what does the neurotransmitter theory speculate about schizophrenia?
that changes/excess of dopamine, serotonin, norepi, and GABA can cause schizophrenia
what is typically seen in neuroimaging studies of schizophrenic patients?
loss of overall brain volume
increased size of lateral and third ventricles
reduced brain symmetry
reduced cortical tissue
what are some immune abnormalities that are often present in those with schizophrenia?
decreased production of T cell interleukin 2
decreased lymphocytes
presence of antibrain cell antibodies
what are common positive manifestations of schizophrenia?
disheveled appearance aggression hallucinations hearing voices suicidal ideation/attempts violence
what are common positive manifestations of schizophrenia related specifically to speech?
echolalia (repeating what others say)
clang associations
word salad
neologisms (words that only have a meaning to the patient)
what are common negative manifestations of schizophrenia?
flat affect poverty of speech apathy lack of motivation decreased movement decreased interest in hygiene
what are some possible pathophysiological explanations for depression?
deficiency of serotonin, dopamine, and norepinephrine.
decreased activity in the neocortex and increased activity in the limbic system
endocrine and hormonal changes/imbalances
what are some risk factors/epidemiological factors for depression?
17% of people report it women twice as frequently affected as men genetic component postpartum women especially at risk rural living chronic illness trauma or abuse in childhood menopausal or postmenopausal use of certain medications
what are three reasons for why patients starting a new antidepressant are at increased risk for suicide in the first few weeks?
- the meds dont reach therapeutic effect for 3-4 weeks
- antidepressants interfere with brain chemistry and there is no perfect science to it
- patient may get more sleep and rest in those weeks, and then have more energy to carry out suicide plans
how long must patients experience manifestations of PTSD to get a diagnosis?
at least one month
are men or women more likely to suffer PTSD?
women
what are some pathophysiological factors for PTSD?
patho is not fully understood, but in PTSD, patients have chronic autonomic hyperactivity due to stress.
Genetics are a factor
smaller hippocampus (which regulates fear and rage) is seen in PTSD patients
amygdala (fight or flight) plays a role
patients often have a smaller prefrontal cortex, which normally suppresses the stress response
what are risk factors for PTSD?
experiencing a threat of death or serious injury (especially war situations)
being female
intense or long lasting trauma
childhood trauma/abuse/neglect
anxiety and depression
lack of support system
first degree relatives with mental health issues
what are clinical manifestations of PTSD?
flashbacks insomnia hyperarousal hypervigilance responding to triggering events like the initial trauma reduced mastery of life skills bad dreams intrusive thoughts and reliving initial trauma feelings of guilt and blame
how long does it take for antidepressants to become therapeutic in the body?
3-6 weeks
what drug class is the first choice for depression treatment today?
SSRIs
what do SSRIs do?
increase serotonin levels in the brain
what are side effects of SSRIs?
decreased libido
serotonin syndrome
suicide
why are SSRIs more desirable than other depression meds?
they are less toxic and have less unpleasant side effects
what are manifestations of serotonin syndrome?
confusion GI issues agitation fever anxiety hallucinations diaphoresis tremors
what is an example of a tricyclic antidepressant?
amitriptyline
what are some side effects of amitiptyline?
anticholinergic symptoms
sedation
cardiotoxicity/MI/serious cardiac issues
why are MAOIs usually the last choice for depression treatment?
because they can have serious/fatal dietary interactions with foods containing tyramine (hypertensive crisis possible)
what is an example of a MAOI?
phenylzine (nardil)
what do SNRIs do in the body?
increase serotonin and norepinephrine
why are SNRIs a good second choice for depression treatment?
because they have less serious side effects than TCAs and MAOIs
what are some examples of SNRIs?
venlafaxine
duloxetine
what do benzodiazapines do in the body?
decrease anxiety and promote muscle relaxation
what are adverse effects of benzos?
sedation dependence fatigue respiratory depression weakness
what are some examples of benzodiazapines?
diazepam
lorazepam
who should use extra caution when taking benzodiazapines?
elderly people and those who have never taken them before
what is lithium most commonly used for?
bipolar disorder
why should lithium levels be watched closely?
because it has a narrow therapeutic window and lithium toxicity is a risk
what is an example of an anticonvulsant that can also be used as a mental health adjunct?
tegretol
what do antipsychotics do in the body?
block dopamine in the brain
why are doctors trying to reduce the use of first generation antipsychotics?
because they have many adverse side effects
what are some of the major side effects of first generation antipsychotics?
weight gain
increased WBCs
sexual dysfunction
tardive dyskinesias
what are some examples of first gen antipsychotics?
chlorpromazine
haloperidol
why are second generation antipsychotics more desirable?
less side effects, and no extrapyramidal symptoms
what are some examples of second generation antipsychotics?
risperidone
lurasidone
explain the pathophysiology of alcohol abuse and withdrawal
alcohol stimulates the reward pathway in the brain (much like dopamine) while also depressing the CNS. When someone goes into withdrawal, there is an imbalance of GABA and glutamate, and the CNS becomes increasingly irritable
what neurotransmitter deficiency increases risk for substance abuse?
dopamine
what are early manifestations of alcohol withdrawal (12-24 hours after last drink)?
irritability, diaphoresis, headache, tachycardia, anxiety
what are common manifestations of alcohol withdrawal 24-72 hours after the last drink?
seizures, tremors, hallucinations, insomnia
what is a life threating side effect of alcohol withdrawal that can set in 3-5 days after the last drink?
delirium tremens
what are manifestations of delirium tremens?
tremulousness, disorientation, hallucinations, fever
what are risk factors for alcoholism?
genetics (dopamine receptor insufficency)
chronic use
what specific gene is linked to alcoholism?
DRD2 gene
what are risk factors for alcohol withdrawal syndrome?
previous withdrawal/DTs/chemical dependency treatment
age over 40
genetics
comorbid conditions or comorbid substance use
history of mood disorders
over 10 years of alcholism
hypertension (SBP over 140)
why does alcohol use increase risk for hypertension?
because alcohol damages blood vessels and nerves
what scale is used to measure alcohol withdrawal?
CIWA scale
what does a nurse do with a CIWA score above 8?
typically give benzodiazapines on a sliding scale per prescription
what does a nurse do with a CIWA score below 8?
keep reassessing the patient using the CIWA scale
why are benzodiazapines used in the acute setting for alcoholics?
because they fill the same/similar role in the CNS that alcohol does in order to prevent delirium tremens
what kind of infection is chlamydia?
bacterial
what are manifestations of chlamydia? (in both men and women)
often none (silent infection)
if symptoms present..
men will have painful urination
women will have painful urination and vaginal discharge
chlamydia is a leading cause of what?
infertility in women
gonorrhea is what kind of infection?
bacterial (gram negative)
what are manifestations of gonorrhea?
painful urination
vaginal discharge
itching
genital pruritus
trichomoniasis is what kind of infection?
parasitic (caused by a protozoan)
what are manifestations of trichomoniasis?
often no symptoms, but if present:
men: burning with urination and ejaculation
women: painful urination, vaginal itching, painful intercourse, yellow green discharge
what kind of infection is herpes?
viral infection
what are the two types of HSV and how are they different?
HSV-1 usually manifests as cold sores around the mouth, while HSV-2 usually manifests as genital warts
what are manifestations of HSV?
burning, itching, tingling at site of infection. Then vesicles/ulcerations that form and rupture, which can be painful and associated with flu-like symptoms
what kind of infection is syphilis?
bacterial
what is the initial manifestation of syphilis?
chancre (skin lesion that looks like a scab)
what are secondary manifestations of syphilis?
rash malaise sore throat fever anorexia GI issues genital warts
what are tertiary manifestations/complications of syphilis?
granulomatous lesions that form in the neurological system, what can cause mental status changes, hearing and vision loss, meningitis, stroke, dementia, ataxia, and other sensory changes. overall physical and mental deterioration will occur if untreated
what are general risk factors for the development of an STD?
women more than men (except for syphilis)
age between 15 and 25
incarceration
incorrect or lack of condom use
sharing needles when doing drugs
high risk sexual behavior/having multiple partners
what should a patient always be instructed to do when it is discovered they have an STD?
tell their partner(s) about STD
