344 Test 2 Study Guide Topics Flashcards
Increase in ADH ___ urine output
decreases
Decrease in ADH increases __ output
urine
Normal Sodium levels
135 to 145 mEq/L
Sodium attracts
water
Special cells in the kidneys monitor for __ levels
sodium
If the kidneys detect a decrease in sodium levels, __ is released which (indirectly) causes blood pressure to rise
renin
When you have too much sodium (hypernatremia) your kidneys cannot excrete the excess sodium and also retain water at the same time. This increased fluid volume raises
blood pressure
Sodium is also used to determine the concentration of
urine
Potassium is mostly ___ the cell membrane during rest
inside
when the cell is stimulated, potassium
flows out
An increase in K+ (hyperkalemia) causes the resting membrane potential to become more
positive
An increase in K+ (hyperkalemia) causes the resting membrane potential to become more positive moving it closer to the
threshold
plays key roles in cell signaling
calcium
plays key roles in muscle contraction
calcium
plays key roles in blood clotting
calcium
Normal calcium level is
8.5 to 10.5 mg/dL
Calcium affects __ ___ and automaticity via calcium channels
cardiac contractility
a special process in cardiac muscle where calcium ions diffuse in, making the cell more positive (depolarizing toward threshold)
Calcium leak
As part of the normal contraction cycle, heart cells have a special phase called
plateau
Cardiac cell remains above __ potential during plateau (remains active).
threshold
The plateau phase happens because ___ ___ continue allowing calcium ions to leak in, keeping the membrane positive.
calcium channels
The heart cell contraction ends when the calcium channels ___; this ends the plateau and the cell repolarizes
close
Calcium channel blockers are used as ___ drugs
antihypertensive
drugs that relax and widen blood vessels by affecting the muscle cells in the arterial walls.
Calcium channel blockers
are particularly effective against large vessel stiffness, one of the common causes of elevated systolic blood pressure in elderly patients
Calcium channel blockers
also frequently used to alter heart rate, to prevent cerebral vasospasm, and to reduce chest pain caused by angina
Calcium channel blockers
CCBs can directly influence the synthesis of ___ in adrenocortical cells, with consequent impact on the clinical treatment of hypertension
aldosterone
Calcium and ___ have an inverse relationship
Phosphate
An important cause of hypocalcemia is __ failure
renal
Only ___ calcium is able to participate in body functions
ionized
Hypercalcemia or Hypocalcemia, hypertension
Hypercalcemia
Hypercalcemia or Hypocalcemia, inhibits nerve activity
Hypercalcemia
Hypercalcemia or Hypocalcemia, Muscle weakness
Hypercalcemia
Hypercalcemia or Hypocalcemia, Increased thirst, urinating, kidney problems
Hypercalcemia
Hypercalcemia or Hypocalcemia, causes hypotension, cardiac insufficiency, arrhythmia.
Hypocalcemia
Hypercalcemia or Hypocalcemia, cause tetany, hyperactive reflexes, spasm
Hypocalcemia
Normal sys
Normal dias
Prehypertension sys
120-139
Prehypertension dias
80-89
Stage 1 hypertension sys
140-159
Stage 1 hypertension dias
90 to 99
Stage 2 hypertension sys
> 160
Stage 2 hypertension dias
> 100
Among young men and women, hypertension is more common in
men
With age, hypertension
increases
Kind of hypertension where the cause is unknown
primary hypertension
Kind of hypertension where the cause is related to a specific illness
secondary hypertension
Between primary and secondary, the most common hypertension is
primary
A single BP reading is not enough to diagnose
hypertension
Elevated pressure during systole can lead to heart failure on the ___ side
left
Family history, race, and age are ___ risk factors in hypertension
Constitutional risk factors (part of primary hypertension)
primary hypertension is aka
essential hypertension
An infant’s BP is much ____ than an adult’s
lower
diastolic pressure begins to decline when someone turns 50; systolic pressure
continues to rise
another factor contributing to development of hypertension is ___ resistance
insulin
Raises BP acutely, but not chronically
stress (therefore it’s not really a risk factor)
Reduction of salt, sodium, alcohol can reduce risk for
hypertension
Abdominal fat verse buttock/leg fat: which is more of a risk for hypertension
Abdominal
Oral ___ agents can cause hypertension
contraceptive
street drugs, sympathomimetics, erythropoietin, licorice, sleep apnea can be risk factors for
secondary hypertension
the goal of treating hypertension is to reduce BP below
140/90
The goal of treating hypertension for diabetic patients is to reduce BP to
less than 130/80
Hypertension causes __ ventricular hypertrophy
left
Can also cause peripheral vascular disease, retinopathy, and chronic kidney disease
Hypertension
happens when the veins can’t function properly for example, the valves wear out or skeletal muscle pumps are impaired
Venous HTN
The build-up of fats, cholesterol, and other substances in and on the artery walls
Atherosclerosis heart disease
Atherosclerosis involves __ cell injury
Endothelial
Atherosclerosis involves Migration of ___ cells
inflammatory
Atherosclerosis involves __ muscle proliferation and lipid deposition
Smooth
Atherosclerosis involves Gradual development of the atheromatous ___
plaque
a procedure where fluid is aspirated from the pericardium (the sac enveloping the heart)
Pericardiocentesis
chest pain caused by reduced blood flow to the heart muscle
Angina
angina symptom of ___ artery disease, it can be acute or chronic
coronary
angina can be relieved by rest or
nitroglycerine
__ angina occurs with activity, cold weather, or stress
stable
___ angina occurs at rest
unstable
___ angina is caused by coronary artery spasm
variant (aka vasospastic)
unstable angina, or angina that is new ___/___ intensity means you could be at serious risk for heart attack
new onset/increasing
stable angina and variant angina are caused by
chronic ischemic heart disease
unstable angina is caused by
acute coronary syndrome
Signs and Symptoms, Hypotension (LOW BP) and Shock
Acute MI
Signs and Symptoms, Weakness in arms and legs
Acute MI
Signs and symptoms of __ __
Nausea, Vomiting
Tachycardia (high HR) Vasoconstriction
Anxiety, feeling of impeding doom
Acute MI
ventricular wall is weak and swells into a blood bubble
Ventricular Aneurysms
complication of acute MI can include __ failure
heart failure
complication of acute MI can include ___ (inflammation of the Heart)
Pericarditis
complication of acute MI can include ___ ___ (not enough blood for heart to pump)
Cardiogenic Shock
complication of acute MI can include ___ (blood clot obstruction)
Thromboembolism
complication of acute MI can include ___ aneurysm
ventricular aneurysm
cardiac muscle disease is aka
Cardiomyopathy
In hypertrophic cardiomyopathy, there’s a thickening of the __ septum and the left ___
ventricular septum and left ventricle
hypertrophic cardiomyopathy can be used by mutation in
genes
hypertrophic cardiomyopathy is treated with
beta blockers
hypertrophic cardiomyopathy is the most common cause of death in
young athletes
Rare disease in which the ventricle walls are __ but not necessarily thicker
rigid
symptoms- dyspnea, peripheral edema, fatigue, weakness
restrictive cardiomyopathy
a condition in which the heart’s ability to pump blood is decreased because the heart’s main pumping chamber, the left ventricle, is enlarged and weakened
Dilated Cardiomyopathy
In some cases, it prevents the heart from relaxing and filling with blood as it should
Dilated Cardiomyopathy
Heart is 2 to 3X heavier
Dilated Cardiomyopathy
Walls of the Heart become thinned and stretched and Weak
Dilated Cardiomyopathy
In dilated cardiomyopathy, ejection of blood is very low (__% vs Normal heart 65%)
25%
a weakness of the heart muscle that by definition begins sometime during the final month of pregnancy through about five months after delivery
Peripartum Cardiomyopathy
In Peripartum Cardiomyopathy what % of women recover fully
50%
In Peripartum Cardiomyopathy what % of women have ventricular dysfunction or heart failure
50%
Valve will not open all he way
Stenosis
Valve will not close all the way
Regurgitation
What is a regurgitant heart murmur
Blood leaking backwards when valves should be closed
What is a stenotic heart murmur
blood shooting through narrow opening when valve is open
4 types of shock
cardiogenic
hypovolemic
obstructive
disruptive
type of shock, heart not pumping
cardiogenic
type of shock, decreased C02
cardiogenic
type of shock, hypotension and hypoperfusion
cardiogenic
Most common cause of cardiogenic shock
Acute MI
type of shock, blue skin, nails, and lips.
cardiogenic
type of shock, decrease in systolic (normal diastolic), decrease in urine output, neurologic changes
cardiogenic
cardiogenic shock is treated with meds and
mechanical support with a balloon pump
type of shock, loss of 15% of blood
hypovolemic
type of shock,
Excessive dehydration
Hemorrhage
Loss of plasma
Loss of whole blood
hypovolemic
type of shock,
Thirst Increased HR Cool Clammy Skin Decreased arterial BP Decreased Urine Output Altered mental status
hypovolemic
type of shock, mechanical blockage
obstructive
type of shock, characterized by the heart no filling properly
obstructive
type of shock, elevated right heart pressure due to right heart dysfunction
obstructive
obstructive shock is treated with
surgery
type of shock, Caused by:
Pneumothorax
Dissecting aortic aneurism
Cardiac tamponade (compression of heart due to fluid filling pericardial sac)
obstructive
compression of heart due to fluid filling pericardial sac
Cardiac tamponade
Most common type of distributive shock
Sepsis
the 3 types of distributive shock (SAN)
Sepsis, anaphylactic, neurogenic
distributive shock associated with elevated WBCs, thrombocytopenia, oliguria, organ failure
Sepsis
distributive shock associated with warm, flushed skin
sepsis
Sepsis involves a complex process of releasing pro-inflammatory mediators and ___
cytokines
Very rare type of distributive shock
neurogenic
type of shock that involves decreased sympathetic control of blood vessel tone
neurogenic
type of distributive shock associated with spinal cord injuries
neurogenic
type of distributive shock where skin is dry and warm
neurogenic
type of distributive shock where death can occur within minutes
anaphylactic
type of distributive shock causes severe systemic allergic reaction in our bodies
anaphylactic
During anaphylactic shock, the immune reaction releases ___ into blood
histamines
type of shock that can manifest circulatory collapse, bronchospasm, angioedema
anaphylactic
allergies to food, penicillin, insect bites, latex can cause what kind of shock
anaphylactic
Symptoms of what kind of distributive shock Cramps Apprehension Warm or burning sensation of the skin Itching Urticaria (hives) Respiratory Distress Coughing, wheezing, choking, difficulty breathing
anaphylactic
People who suffer from __ shock should carry an epinephrine pen
anaphylactic
for people with bronchial asthma, the cough is worst
at night and early morning
asthma that involves an allergy
atopic asthma
atopic asthma is a type __ hypersensitivty
type 1
For atopic asthma, the acute response involves __ cells and the late response involves __
mast cells
WBC
non-atopic asthma is called __ asthma
instrinsic asthma
Triggered by Respiratory infections Exercise Hyperventilation Cold air Drugs & Chemicals Hormonal changes Gastroesophageal reflux
intrinsic asthma
Common cause of COPD is
smoking
Obstruction of small airways causing Chronic Cough
Chronic Bronchitis
Chronic Bronchitis and emphysema are both types of
COPD
kind of COPD thats associated with irritation from smoking and recurrent infections
chronic bronchitis
type of COPD- Diagnosis comes from a history at least 2 years where at least 3 months a years there is a consecutive productive cough
chronic bronchitis
type of COPD where there’s an enlargement of air space & destruction of Alveolar Walls
Emphysema
type of COPD that is thought to result from the breakdown of ELASTIN and other wall components
Emphysema
type of COPD,
Caused most commonly by
SMOKING
GENETICs –deficiency of alpha1 antitrypsin synthesis
Emphysema
In COPD (chronic bronchitis and emphysema) the Po2 level falls below
55
Involves low O2 (hypoxia) and high CO2 (hypercapnea)
COPD (chronic bronchitis and emphysema)
A Recessive disorder in Chloride transport proteins
cystic fibrosis
characterized by a high amount of NaCl in Sweat
cystic fibrosis
In cyctic fibrosis there is less Na+ and __ in respiratory mucas and pancreatic secretions
water
Thick mucus obstructs airways and pancreatic and bile ducts
cystic fibrosis
cystic fibrosis mostly is in what age group
child/adolescent
excessive fat in feces
Steatorrhea
Steatorrhea and weight loss are symptoms of
cystic fibrosis
Bronchiectasis Infection causes permanent ___ of bronchi
dilation
Bronchiectasis Infection causes permanent dilation of bronchi by destroying __ and __ tissue
muscle and elastic
Signs and Symptoms Chronic cough Hundreds of ml’s of foul smelling sputum a day Wheezing Dyspnea Weight loss Anemia
Bronchiectasis Infection
Recruitment of compensatory mechanisms to try and increase O2 to tissues
o Tachycardia
o Palpations
Anemia
overt symptom of sickle cell anemia
jaundice
a condition that occurs when your body stops producing enough new blood cells
Aplastic Anemia
Symptoms:
Petechiae (small skin hemorrhages)
Ecchymosis (bruises)
Aplastic Anemia
caused by High doses of RADIATION
o Chemicals
o Toxins
Aplastic Anemia
Caused by B12 Deficiency and Folic Acid Deficiency, which causes impaired DNA synthesis
megaloblastic anemia
symptoms, o Brittle Hair and Nails o Spoon shaped fingers o Smooth tongue o Sores in corner of mouth
Iron deficiency Anemia
potentially dangerous pregnancy complication characterized by high blood pressure.
Preeclampsia
Preeclampsia: Causes unknown however many think has something to do with __ blood flow leading to the release of toxic mediators that alter blood vessels throughout body
placental
symptoms,
o Persistent headache
o Cerebral or visual disturbances
o Hydatidiform mole
Preeclampsia
the occurrence of seizures in pregnant women who have preeclampsia
Eclampsia
edema is caused by ___ed capillary pressure
increased capillary pressure (pressure builds as fluid collects)
edema is caused by ___ed colloid osmotic pressure
decreased
Signs and Symptoms Gasping for air Rapid pulse Skin moist and cool Lips and nails blue
Pulmonary Edema
Signs and Symptoms
Neurological issues once O2 to brain gets lowered
CRACKLES
Frothy Pink Sputum
Pulmonary Edema
Disorders of the heart muscle. Usually associated with disorders of myocardial performance
Cardiomyopathies
Primary Cardiomyopathies are classified as __, mixed or acquired based on their etiology
genetic
Many cases are of unknown cause and are referred to as ___ cardiomyopathy
idiopathic
• Unexplained ventricular hypertrophy with disproportionate thickening of the ventricular sputum
Hypertrophic Cardiomyopathy
• Massive hypertrophied left ventricle reduces the chamber size and decreases stroke volume that results from impaired diastolic filling
Hypertrophic Cardiomyopathy
muscles need more oxygen and perform less efficiently, person is prone to heart failure and may suffer sudden death during exertion.
Hypertrophic Cardiomyopathy
CHF means your heart cannot pump efficiently causing blood to back up into the __ and arteries. The heart becomes overworked attempting to maintain blood flow and it may weaken and enlarge
lungs
Risk factors for sudden death among patients with HCM include:
Family h/o __ or sudden cardiac death
syncope
The incomplete opening of the mitral valve during diastole, left atrial distention, and impaired filling of the left ventricle
Stenosis
Most commonly the result of rheumatic fever
Stenosis
Incomplete closure of the mitral valve. May result in a rigid and thickened valve that does not open or close completely. This allows the left atrium to undergo compensatory responses. Blood leaks when the mitral valve should be closed
Regurgitation
During regurgitation, there is incomplete closure of the mitral valve, this causes the __ ventricle to be impaired
left
Acute failure of the circulatory system to supply the peripheral tissues and organs of the body with adequate blood supply, resulting in hypoxia (oxygen deficiency in body tissue)
Shock (Circulatory Failure)
Types of Shock:
- Loss of WBC
- Loss of plasma
- Loss of extracellular fluid
Hypovolemic
Types of Shock:
- Related to low peripheral blood flow and excessive sympathetic stimulation
Hypovolemic
Types of Shock:
- Thirst, increased heart rate, cool and clammy skin, decreased arterial pressure, decreased urinary output
Hypovolemic
Types of Shock:
- Myocardial damage (myocardial infraction, contusion)
- Sustained arrhythmias
- Acute valve damage, ventricular septal defect
- Cardiac surgery
Cardiogenic
Types of Shock:
Signs and Symptoms:
- Consistent with those of end stage heart failure
- Lips, nail bed, and skin may become cyanotic
- Decreased blood pressures and urine output
- Alterations in cognition and consciousness due to poor cerebral profusion
Cardiogenic
Types of Shock:
- GOAL: Increase cardiac contractibility without increasing heart rate
Cardiogenic
Types of Shock: - Inability of the heart to fill properly (cardiac tamponade)
Obstructive
Types of Shock: - problem with outflow from the heart (pulmonary embolus, cardiac myxoma, pneumothorax, or dissecting aneurysm)
Obstructive
Types of Shock:
- Loss of sympathetic vasomotor tone (neurogenic shock)
- Presence of vasodilating substances in the blood (anaphylactic shock)
- Presence of inflammatory mediators (septic shock)
- Normal volume of blood does not fill the circulatory system
Distributive
Types of Shock: Caused by decreased sympathetic control of blood vessel tone due to a defect in the vasomotor entre in the brain stem or the sympathetic outflow to the blood vessels.
Neurogenic
Types of Shock: - Outflow can be interrupted by brain injury, depressant action of drugs, general or spinal anesthesia, hypoxia, or lack of glucose (insulin reaction).
- General anesthesia (induction)
Neurogenic
Types of Shock: Most severe systemic allergic reaction resulting from an immunologically mediated reaction in which vasodilator mediators are released into the blood
Anaphylactic Shock
Types of Shock: Treatment-
- Administration of oxygen, antihistamine drugs, corticosteroids, and bronchodilators.
Anaphylactic Shock
Types of Shock: Treatment
- The person should be placed in the supine position to prevent decrease in venous return.
Anaphylactic Shock
Eclampsia is characterized by the presence of ___ in urine
protein
premature destruction of RC, the retention of iron, and the other products of hemoglobin destruction, and a compensatory increase in erythropoiesis
Hemolytic Anemia
edema that occurs when plasma proteins have accumulated in the tissue spaces and coagulated
Non-pitting edema
life span of sickle cells
20 days
disease where ventricle walls are RIGID not necessarily thicker
Restrictive Cardiomyopathy
Can result from decreased production of erythrocytes by the bone marrow
anemia
Deficient amount of iron leads to decreased ___ synthesis
hemoglobin
Iron in the body is used
repeatedly (not always excreted)
The most common cause of iron deficiency is
blood loss
what happens to the heart rate during anemia
tachycardia
what causes spoon shaped deformity of the finger nails
iron deficiency
smooth tongue, brittle hair and nails, eating abnormal substances
iron deficiency
To prevent iron deficiency in infants, give supplements and avoid
cow’s milk
B12 is needed to prevent ____ breakdown which would lead to neurologic complications
myelin
An important cause of B12 deficiency is ___ anemia
pernicious
___ anemia results from autoimmune destruction of gastric mucosa
pernicious anemia
____ anemia is caused by by inhibition of DNA synthesis
megaloblastic anemia (the DNA problem can be caused by lack of B12)
When B12 is deficient, red cells are abnormally ___ in size
large
condition where the RBCs have immature nuclei and the membrane is oval shaped instead of biconcave
pernicious anemia
pernicious anemia can be reversed by
oral dose or injection of B12
Anemia is defined as an abnormally low number of ___, or low level of ___, or both
RBCs or hemoglobin
Anemias caused by premature destruction of RBC
hemolytic anemia
Anemias that result from ineffective hematopoises (premature death of RBCs in the bone marrow) are associated with inappropriately high levels of
iron absorption from the gut
OTC drug that can be used as an immediate treatment if MI is suspected
aspirin
MI often involves the rupture of ___ which leads to blockage of an artery
plaque
kind of edema that occurs when the accumulation of interstitial fluid exceeds the absorptive capacity of the tissue
pitting edema
In this form of edema, the tissue water becomes mobile and can be moved when you press with your finger
pitting edema
Edema that occurs when the swollen area is firm and discolored
nonpitting edema
Pitting verse nonpitting: seen in areas of local infection or trauma
nonpitting
Edema can be treated by administering d____ or a____
diuretics or albumin
Edema can also be treated with light massage, tight garments, and ___ ___ ___ exercise
range of motion
____ edema occurs with conditions that impair the blood brain barrier
vasogenic edema
___ edema involves an increase in intracellular fluid
cytotoxic edema
describes an accumulation of fluid in the lower parts of the body (for example, happens because of gravity while standing for long periods)
dependent edema
Edema caused by decreased colloid osmotic pressure (decreased albumin) is ___ edema
generalized edema
jaundice is aka
icterus
Jaundice can be caused by impaired uptake of bilirubin by ___ cells
liver
