Exam 6 Flashcards
Glomerulonephritis (Nepritic syndrome)
Inflammation of the glomerulus
Patho of nephritic syndrome
antibodies attack glomerulus
antigen/antibody complex circulating isn bloodstream clogs glomerulus
kidneys don’t filter correctly
Risk factors for Nephritic syndrome
immunocompromised, hepatitis, viral infections, bacterial infections (strep), SLE, IgA nephropathy, goodpasture’s syndrome
S/S of Nephritic syndrome
hypertension
oliguria (< 400 mL/24hrs)
Proteinuria
edema
Cola-colored urine (blood)- hematuria
Nephrotic syndrome
Losing large amounts of protein
Cause: damage to glomerulus.
S/S of Nephrotic syndrome
Proteinuria
Edema
hypoalbuminemia
Release of aldosterone
hypertension
hyperlipedemia
pleural effusion
foamy urine
S/S of hypoalbuminemia
Peripheral edema
hyperlipidemia
S/S of Aldosterone release
increased edema
hypertension
Classification: Pre-renal AKI
Decreased renal blood flow
(before the kidney)
Classification: Renal AKI
Damage to renal architecture
caused by ischemia or toxins
Classification: Post-renal AKI
Obstruction of urinary outflow
Causes of Pre-renal AKI
Hypovolemia, dehydration, hemorrhage, trauma
Cardiovascular disorders, atherosclerosis, vasodilation
Compensation of pre-renal AKI
RAAS system activation
ADH release
Causes of renal AKI
Acute tubular necrosis
Glomerulonephritis, kidney transplant rejection, nepholithiasis
Medications: aspirin, furosemide, NSAIDS, recreational drugs, iv contrast
Acute tubular necrosis
Destruction of tubular epithelial cells » necrosis » cast forms and edema » tubular obstructions » oliguria
Nepholithiasis
Kidney stones
Causes of post-renal AKI
BPH (most common, Men)
Nephrolithiasis
Blockage of ureters, bladder, or urethra
AKI phases
Oliguric phase
diuretic phase
recovery phase
Classification: Oliguric phase
oliguria < 400mL/day
1-7 days of injury
Labs: casts, RBCs, WBCs, sp gr fixated at 1.010
metabolic acidosis
hyperkalemia and hyponatremia
elevated BUN and Creatinine
Fatigue and malasie
Classification: diuretic phase
Increase urine output: 3-5 L/day
hypovolemia, dehydration
hypotension
BUN and Creatinine begin to normalize
Recovery phase
Starts with GFR increases
BUN and Creatinine plateau then lower
Hydroureter
Accumulation of urine in ureter
Steps of hyrdoureter
- Occlusion in ureter
- Increase hydrostatic pressure
- Dilation of ureter
- Dilation of renal pelvis (hydronephrosis)
- increased glomerular pressure
- Decreased GFR and blood flow, increased pressure
- Tubular atrophy
- Loss of nephrons
- Inability to concentrate urine
Chronic kidney disease
Progressive and irreversible damage to kidneys
build up of waste
Causes of chronic kidney disease
diabetes mellitus (uncontrolled)
Hypertension
Results of Increase in BUN and Creatinine
Decrease in GFR
S/S of Chronic kidney disease
hyperkalemia
hyocalcemia
anemia
high hydrogen ions
decrease GFR
Increased BUN/Creatinine
increased intravascular volume
confusion (uremia)
treatments for Chronic kidney disease
Vitamin D and Calcium supplements
Decrease potassium, sodium, phosphorus and magnesium intake
Polycystic kidney disease
Autosomal dominant disorder that causes sacs on kidney.
Enlarge and impede function
S/S of polycystic kidney disease
HTN, Renal failure, fluid filled cysts
Bladder cancer
Urothelial Carcinoma (most common)
Cause: chronic irritation
S/S of bladder cancer
Painless, intermittent gross hematuria
sensation of incomplete emptying, UTI symptoms
S/S of Nephrolithiasis
Abrupt flank pain, radiating to groin
N/V
Hematuria
Oxalate stone
Most common
too much calcium/oxalate, not enough fluid
Urate stones
Uric acid
fluid loss
Underlying conditions for urate stones
diabetes, metabolic syndrome, high protein diets
phosphate stones
renal tubular acidosis
cystine stones
too much cystine
xanthine stones
tiny crystals come together, may see some abdominal pain and hematuria
Struvite stones
caused by bacteria, seen in UTIs
Stress incontinence
Involuntary leakage during coughing and sneezing.
poor pelvic support or weak sphincter
Urge incontinence (overactive bladder OAB)
overactive detrusor muscle causes leakage
causes urgency and frequency
overflow incontinence
too much fluid accumulates
Seen in BPH, urinary obstructions,
Neurogenic bladder
nerve fiber malfunction between bladder and spinal cord
Functional incontinence
inability to hold from CNS problems
stroke, psychiatric disorders, prolonged immobility, dementia/delerium
Mixed incontinence
stress and overactive bladder
Ottis media
inner ear infection
blockage of eustachian tube from inflammation
Glaucoma
Accumulation of pressure causes iris to block drainage canal
Open angle glaucoma
slow, iris in correct posistion
Closed angle glaucoma
sudden, iris pushed against cornea
ventilation
inhalation and exhalation
perfusion
blood flow to pulmonary vessels
diffusion
oxygenation, gas exchange at the alveolar level
Common ventilation issues
asthma, COPD, apnea, phrenic nerve damage, cystic fibrosis, bronchitis
Common diffusion issues
Alveolar edema: pulmonary edema, pneumonia, ARDS, emphysema
Common perfusion issues
Pulmonary embolism, Primary pulmonary hypertension
Upper respiratory tract structures
Nasal cavity, pharynx, larynx
lower respiratory tract structures
trachea, primary bronchi, lungs
Upper respiratory tract infections
Viral, will resolve with symptom management
Lower respiratory tract infections
Viral or bacterial,
more aspiration in right lung
infections impairs gas exchange
Hypoxia
decreased O2 to tissue
Response to hypoxia
increased RR
Detected and signaled by the carotid body
S/S of hypoxia
Headache/confusion
dyspnea/coughing
tachycardia
cyanosis
Atelectasis
Collapse of a section of alveoli
cause: blockage of a bronchiole by disease or edema (Post -op)
Influenza
viral infection of epithelial cells causes pulmonary inflammation
S/S of influenza
High fever
runny nose/sore throat/cough
myalgia
N/V
Covid
Viral infection of pulmonary alveolar epithelial cells leading to damage of alveolar wall
S/S of Covid
fever
cough/dyspnea
fatigue
sore throat
taste/smell loss
GI: N/V/D
Pneumonia
Lower respiratory tract infection usually bacterial
isolated to one area of lungs
high risk of hypoxemia
O2 treatment
need antibiotics
S/S of Pneumonia
SOB, fever, productive cough, weakness, confusion, crackles, crepitations
Asthma
Bronchoconstriction
Inflammation » mucous production and recurrent obstruction
S/S of asthma
dyspnea, expiratory wheezing cough, tachypnea
Asthma triggers
Exercise and allergens
ventilation issue
COPD
Chronic Emphysema and Bronchitis
Risks of COPD
Pulmonary hypertension » right-sided heart failure
Emphysema
Damage and scarring of alveoli
loss of surfactant (incomplete exhalation)
Reduced surface area
lack of O2 and CO2w exchange
Chronic bronchitis
Inflammation of bronchi
excess mucus
caused by toxins or irritants
S/S of COPD
SOB, chronic cough, barrel chest, hypoxia, hypercapnia/hypercarbia, polycythemia, respiratory acidosis, cyanosis
CO2 Narcosis
tolerance for high CO2 leads to a drive to breathe is signaled by hypoxemia and high O2 treatment can turn off drive to breathe
Pneumoconiosis (black lung)
Dust inhalation leads to scarring, pulmonary fibrosis, airway obstruction and poor expansion
inflammation
Obstructive sleep apnea
relaxation fo pharyngeal/laryngeal muscles leads to respiratory distress.
Causes night wakings
Risk factors for Apnea
Obesity, male, alcohol, smoking, congestion/infection
Effects of apnea
Pulmonary hypertension » right sided heart failure
daytime fatigue
memory defects
pulmonary hypertension
resistant blood flow from heart to lungs
Damage to lungs increases artery pressure
Increases right ventricular strain
Causes of pulmonary hypertension
primary - unknown
secondary - COPD, PE, OSA, pulmonary fibrosis
Acute respiratory distress syndrome (ARDS)
Massive inflammation after a life threatening injury.
Diffusion issue
S/S of Acute respiratory distress syndrome (ARDS)
Dyspnea, rapid breathing, fever, productive cough
Cystic fibrosis
Autosomal recessive disorder
Causes increased mucus secretions that impair lungs, pancreas and reproduction
Effects of cystic fibrosis
Lungs: recurrent infection, hypoxia
Pancreas: blocks enzymes, malabsorption, weightloss, pancreatic failure,
reproduction: infertility
Pulmonary embolism
dislodged thrombus obstructs pulmonary artery
VQ mismatch: ventilation but no perfusion
Risk factors for Pulmonary embolism
DVT
femur fracture, immobility, cancer, birth control pills, pregnancy, smoking, obesity
S/S of Pulmonary embolism
SOB, hemoptysis (bloody cough), pleuritic chest pain, syncope, hypoxemia
Pneumothorax
Collapse of lung from separation of visceral and parietal pleura
hemothorax
blood accumulation in pleural space
pleural effusion
fluid accumulation in pleural space
tension pneumothorax
collapse of lung causing hemodynamic instability due to pressure on right side of the heart.
S/S of tension pneumothorax
Hypotension, tachycardia, tracheal deviation toward unaffected side
JVD, absent breath sounds on one side
flail chest
broken ribs that cause inward movement on inspiration
decreased ventilation
