Exam 2 Flashcards
Kussmaul Breathing
Deep rapid breathing caused by increased acidity seen in DKA
Cheyne Stokes Breathing
Hypernea with apnea, common with AV HF, sleep apnea, CVA
Obstructive Lung dz
- obstruction worse on expiration
- Conditions that make it harder to empty lungs
- dyspnea
- chronic cough
- sputum
- Asthma
- Cystic fibrosis
- COPD (emphysema and chronic broncitis)
- laminar airflow
- progressive
- most common in world
- Risk; tobacco, dust and chemicals, air pollution, birth defects
Restrictive lung dz
- Diseases that make it harder for the lungs to fill with air
- Aspiration
- Atelectasis
- Bronchiectasis
- Lung ca
- PNA/TB
- Bronchiolitis (common in kids; happens with chronic bronchitis or toxic chemical/viral inhalation in adults)
- Pulmonary fibrosis
- Inhalation disorders (various substances)
Gas transport
- Ventilation in lungs
- Diffusion of O2 from aveoli to capillaries
- Perfusion to systemic capillaries
- Diffusion of O2 to cells from capillaries
- Diffusion of CO2 in reverse order
Ventilation and Perfusion ratio
- Normal = 0.8
Starling forces of fluid movement
- Hydrostatic pressure - hydrostatic pressure in blood vessels is the pressure of the blood against the wall. It is the opposing force to oncotic pressure.
- Osmotic pressure is defined as the pressure that must be applied to the solution side to stop fluid movement when a semipermeable membrane separates a solution from pure water
- Oncotic pressure: colloid osmotic-pressure, is a form of osmotic pressure induced by the proteins, notably albumin, in a blood vessel’s plasma (blood/liquid) that displaces water molecules, thus creating a relative water molecule deficit with water molecules moving back into the circulatory system within the lower
- According to Starling’s law, for homeostasis to occur oncotic pressure needs to equal hydrostatic pressure
- Hydrostatic pressure is the “push” force and osmotic pressure is the “pull” in fluid movements.
- Increased hydrostatic pressure = positive net filtration
- Increased oncotic pressure = negative net filtration
Net Filtration Pressure
- Difference between osmotic and hydrostatic pressure at the vascular bed.
- The balance of the four Starling forces that determines the net flow of fluid across the capillary membrane.
Hypernatremia
- Hypernatremia
- Hypernatremia
- Serum sodium >145 mEq/L
- Related to sodium gain or water loss•Water movement from the ICF to the ECF
- Intracellular dehydration
- Manifestations•Clinical•
- Thirst, weight gain, bounding pulse, and increased blood pressure
- Central nervous system
- Muscle twitching and hyperreflexia (hyperactive reflexes), confusion, coma, convulsions, and cerebral hemorrhage
Hyponatremia
Serum sodium level <135 mEq/L•Sodium deficits cause plasma hypoosmolality and cellular swelling
Causes: Pure sodium loss•Low intake•Dilutional hyponatremia
Manifestations:•Most life-threatening: cerebral edema and increased intracranial pressure•Lethargy, confusion, decreased reflexes, seizures, and coma•If leads to loss of ECF and hypovolemia, see hypotension, tachycardia, decreased urine output
If dilutional from excess water (hypervolemic hyponatremia), see weight gain, edema, ascites, jugular vein distention
HyperKalemia
- Tall Peaked T waves
- Abdominal (belly) pain and diarrhea.
- Chest pain.
- Heart palpitations or arrhythmia (irregular, fast or fluttering heartbeat).
- Muscle weakness or numbness in limbs.
- Nausea and vomiting.
Normal Potassium
3.6 - 5.2
Normal Sodium
135-145
Hypokalemia
Weakness and fatigue (most common)
Muscle cramps and pain (severe cases)
Worsening diabetes control or polyuria.
Palpitations.
Psychological symptoms (eg, psychosis, delirium, hallucinations, depression)
ST depression
myocardial paralysis
Hypernatremia
- thirst
- fatigue
- muscle spasms/twitching
- irritability
- altered level of consciousness, dry mouth, fast heart rate, or insufficient urine production
- seizure/coma
Hypocalcemia
- severe cases, symptoms include muscle cramps, confusion, and tingling in the lips and fingers.
- Intestinal cramping and hyperactive bowel sounds
- convulsions and tetany
- Prolonged QT
- Cardiac arrest
- Chvostek sign: increased irritability of the facial nerve, manifested by twitching of the ipsilateral facial muscles on percussion over the branches of the facial nerve
- Trousseau’s sign : Hypocalcemia; The sign is observable as a carpopedal spasm induced by ischemia secondary to the inflation of a sphygmomanometer cuff, commonly on an individual’s arm
Hypercalcemia
Causes:
- Hyperparathyroidism•Bone metastases with calcium resorption from breast, prostate, renal, and cervical cancer•Sarcoidosis •Excess vitamin D•Many tumors that produce PTH
SE:
- Many nonspecific: fatigue, weakness, lethargy, anorexia, nausea, constipation•Impaired renal function, kidney stones•Dysrhythmias, bradycardia, cardiac arrest•Bone pain, osteoporosis
Magnesium
- Intracellular cation
- 1.8-3.0
- cofactor in enzyme reactions
- increases neuromuscular excitability
Hypomagnesium
Causes
- Malnutrition •Malabsorption syndromes•Alcoholism•Urinary losses (renal tubular dysfunction, loop diuretics)
SE
- numbness · tingling · muscle cramps · seizures · muscle spasticity · personality changes · abnormal heart rhythms
- tetany
- chvostek and tressou signs
Hypermagnesemia
- nausea.
vomiting.
neurological impairment.
abnormally low blood pressure (hypotension)
flushing.
headache.
- trouble breathing
- cardiac arrest
Normal calcium levels
8.6 - 10.3
Bicarb normal
22-26 (23-30)
High Bicarb
the body is having trouble maintaining its acid-base balance, either by failing to remove carbon dioxide through the lungs or the kidneys or perhaps because of an electrolyte imbalance, particularly a deficiency of potassium
metabolic alkalosis
Vomiting
dehydration
Low bicarb
metabolic acidosis
Normal chloride
95-105
hyperchloridemia
- kidney dysfunction
- dehydration
- cushing’s
hypochloridemia
- decreased intake or decreased loss
*
Aveoli I cells
structure
Alveoli II cells
Surfactant
V/Q mismatch
Normal RBC
- 7 - 6.1 (men)
- 2 - 5.4 (women)
Normal Hgb
- 5 -17.5 (men)
- 0 -15.5 (women)
Normal Hct
41 - 50% (men)
36 - 48% (women)
Normal plts
150 - 450
Normal WBC
4 - 11
Arteriosclerosis vs atherosclerosis
Arteriosclerosis is a general term for the hardening of arteries and a loss of elasticity in arterial walls. Atherosclerosis is specifically a condition where arteries harden as a result of plaque buildup on artery walls.
PAD
narrowing of the peripheral arteries serving the legs, stomach, arms and head. (“Peripheral” in this case means away from the heart, in the outer regions of the body.) PAD most commonly affects arteries in the legs. Both PAD and coronary artery disease (CAD) are caused by atherosclerosis
Smoking.
Diabetes.
Obesity (a body mass index over 30)
High blood pressure.
High cholesterol.
Increasing age, especially after age 65 or after 50 if you have risk factors for atherosclerosis.
Primary HTN
Essential or idiopathic hypertension➢Affects 92% to 95% of individuals with hypertension➢Risk factors: •High sodium intake•Natriuretic peptide abnormalities•Inflammation•Larger body habitus•Insulin resistance
Secondary HTN
Secondary hypertension➢Caused by a systemic disease process that raises peripheral vascular resistance or cardiac output
Malignant HTN
Malignant hypertension is extremely high blood pressure that develops rapidly and causes some type of organ damage.
Collagen vascular disease, such as scleroderma
Kidney disease
Spinal cord injuries
Tumor of the adrenal gland
Use of certain medications, including birth control pills and MAOIs
Use of illegal drugs, such as cocaine
missing BP meds
Fusiform anuresym
Fusiform aneurysm: An outpouching or widening of an artery or a vein that is shaped like a spindle.
Saccular anuerysm
Dissecting aneurysm
False aneurysm
Extravascular hematoma that communicates with the intravascular space
Pernicious anemia
Pernicious anemia (per-NISH-us uh-NEE-me-uh) is a condition in which the body can’t make enough healthy red blood cells because it doesn’t have enough vitamin B12
- LOW RBC
- Low vitamin B12
- High homocysteine and MMA
- intrinsic factor antibodies/ parietal cell antibodies
Folate deficiency anemia
- Absorption of folate occurs in the upper small intestine•Not dependent on any other factor•Similar symptoms to pernicious anemia except neurologic manifestations generally not seen•Treatment requires daily oral administration of folate
Iron deficiency anemia
Most common type of anemia worldwide•
Iron stores in body are low•
Nutritional iron deficiency or blood loss•
Metabolic or functional deficiency•
Manifestations when serum Hgb decreased to 7 or 8 gm/dl•Early: fatigue; weakness; shortness of breath; pale earlobes and palms, conjunctiva•
Iron deficiency anemia (Cont.)•
Progression of iron deficiency causes:•Brittle, thin, coarsely ridged, and spoon-shaped nails (koilonychia)•A red, sore, and painful tongue•Dry, sore corners of mouth (angular stomatitis)
Aplastic anemia
A rare condition in which the body stops producing enough new blood cells.
Aplastic anemia develops as a result of bone marrow damage. The damage may be present at birth or occur after exposure to radiation, chemotherapy, toxic chemicals, some drugs, or infection
- low RBC
- Low WBC
- Low plts
- Abnormal bone marrow biopsy
Anemia of chronic inflammation
Occurs with long term illness and or infections•Low circulating blood levels of iron•Iron stores are high•Inflammation interferes with body ability to use stored iron.•2nd most common type.
Thalessima
blood disorder passed down through families (inherited) in which the body makes an abnormal form or inadequate amount of hemoglobin. Hemoglobin is the protein in red blood cells that carries oxygen. The disorder results in large numbers of red blood cells being destroyed, which leads to anemia
Sickle cell anemia
Sickle cell anemia is an inherited red blood cell disorder in which there aren’t enough healthy red blood cells to carry oxygen throughout your body. Normally, the flexible, round red blood cells move easily through blood vessels.
Right sided HF
the right chamber has lost its ability to pump. That means your heart can’t fill with enough blood, and the blood backs up into the veins. If this happens, your legs, ankles, and belly often swell.
Ususally caused by L sided HF, congenital, arrhythmias, valve defects, CAD, lung Dz,
Left sided HF
When the left side of the heart is failing, it can’t handle the blood it is getting from the lungs. Pressure then builds up in the veins of the lungs, causing fluid to leak into the lung tissues. This may be referred to as congestive heart failure. This causes you to feel short of breath, weak, or dizzy
Systolic HF
the left ventricle of your heart can’t contract completely. That means your heart won’t pump forcefully enough to move your blood throughout your body in an efficient way. It’s also called heart failure with reduced ejection fraction
Diastolic HF
stiff left ventricle with decreased compliance and impaired relaxation, which leads to increased end diastolic pressure
Pulmonary congestion despite normal stroke volume and cardiac output•Causes include myocardial hypertrophy and ischemia, diabetes, valvular and pericardial disease
Inability of the heart to generate adequate cardiac output to perfuse tissues•Ventricular remodeling•Causes include myocardial infarction, myocarditis, cardiomyopathy
Ejection fraction
Ejection fraction (EF) is a measurement, expressed as a percentage, of how much blood the left ventricle pumps out with each contraction. An ejection fraction of 60 percent means that 60 percent of the total amount of blood in the left ventricle is pushed out with each heartbeat.
LVEDP
Left ventricular end-diastolic pressure (LVEDP) is an important measure of ventricular performance and may identify patients at increased risk for developing late clinical symptoms of heart failure (HF)
Stages of shock
FVE/FVC ratio
cut off is 70
The FEV1/FVC ratio is a measurement of the amount of air you can forcefully exhale from your lungs
ARDS
Condition in which fluid collects in the lungs’ air sacs, depriving organs of oxygen.
Acute respiratory distress syndrome (ARDS) can occur in those who are critically ill or who have significant injuries. It is often fatal, the risk increasing with age and severity of illness.
People with ARDS have severe shortness of breath and often are unable to breathe on their own without support from a ventilator.
Treatment includes oxygen, fluid management, and medication.
The pathophysiology of ARDS is driven by an aggressive inflammatory reaction. Indirect injury occurs as part of a systemic inflammatory response syndrome (SIRS), which can be due to infective or non-infective causes such as pancreatitis or trauma; when SIRS is caused by infection it is called sepsis.
Pulmonary edema
Pulmonary edema is often caused by congestive heart failure. When the heart is not able to pump efficiently, blood can back up into the veins that take blood through the lungs. As the pressure in these blood vessels increases, fluid is pushed into the air spaces (alveoli) in the lungs
