Other Systems Flashcards
What symptoms will a patient with end stage kidney disease most likely demonstrate
Decreased urine output and anemia
Primary vs secondary vs tertiary healing by intention
Primary: wound edges clean, approximated by sutures, or if superficial partial thickness such as abrasion or blisters.
Secondary: Can’t be approximated. Require ongoing wound care, heal by migrating granulation tissue. Usually associated with pathology such as diabetes.
Tertiary: Delayed primary intention healing-wounds at risk for sepsis or dehiscence.
Wound contamination vs colonization vs infection
Contam: The presence of non-replicationg bacteria on a wound surface that causes no additional tissue injury and does not stimulate an inflammatory response.
Colonization: Replication of bacteria on wound surface that does not invade or further injury, but can delay healing, or may actually help by preventing worse organisms from invading
Infection: Inflammatory, invading, significant delay of healing.
The different general recommendations for arterial/venous ulcers.
Arterial: Avoid elevating limbs
Venous: Elevate limbs when sleeping
Neuropathic vs pressure ulcers
Neuro: usually a result of ischemia and peripheral neuropathy
Pressure: ischemia and pressure
1) Arterial vs 2) Venous vs 3) Neuropathic Ulcers: Location
1) Lower 1/3 of leg-even to distal toes
2) Proximal to medial malleolus
3) Areas of foot susceptible to pressure or shear
1) Arterial vs 2) Venous vs 3) Neuropathic Ulcers: Appearance
1) smooth, well defined, deep, no granulation
2) irregular, shallow
3) Well-defined oval/circle, callused rim, no necrosis, goo granulation
1) Arterial vs 2) Venous vs 3) Neuropathic Ulcers: Exudate
1) minimal
2) moderate/heavy
3) low/moderate
1) Arterial vs 2) Venous vs 3) Neuropathic Ulcers: Pain
1) severe
2) mild to mod
3) low to mod
1) Arterial vs 2) Venous vs 3) Neuropathic Ulcers: Pedal pulses
1) diminished/absent
2) normal
3) diminished/absent
1) Arterial vs 2) Venous vs 3) Neuropathic Ulcers: edema
1) normal
2) increased
3) decreased
1) Arterial vs 2) Venous vs 3) Neuropathic Ulcers: skin appearance
1) thin, shiny, hair loss, yellow nails
2) flaky, dry, brownish
3) dry, inelastic, shiny, decreased sweat/oil
Wound classification by depth
1) superficial
2) partial thickness
3) full
4) subcutaneous
1) epidermis intact
2) through epidermis, may be partially into dermis
3) through dermis into subcutaneous fat
4) through to fat, tendon, muscle, bone
Wagner ulcer grade classification scale: 0-5
0) skin intact, pre-ulcerative lesions, healed ulcers, bony deformity
1) Superficial ulcer, not involving subcutaneous
2) Penetrates through subcutaneous, potentially exposing bone, lig, or joint capsule
3) Osteitis, abscess or osteomyelitis
4) Gangrene of digit
5) Gengrene of foot requiring disarticulation
Pressure Ulcer stages I-V
I: intact, redness
II: Loss of dermis
III: full thickness tissue loss, tendon/muscle not exposed
IV: full thickness with exposed bone/tendon/muscle
V: Suspected deep tissue injury
Which type of selective debridement shouldn’t be used with an infected wound?
Autolytic.
Sharp and enzymatic can be used with an infection
Selective vs non-selective debridement
selective: only nonviable tissue
The 3 types of non-selective debridement
Wet-to-dry, wound irrigation, hydrotherapy
What type of U/S used for wound healing?
low intensity, pulsed duty cycle
Which 2 types of dressings can’t be used on infected wounds, which one usually used for infected wounds?
Hydrocolloids, transparent film
Alginates
Desquamation
Peeling or shedding of the outer layers of the epdidermis.
Friable
tissue that readily tears, fragments or bleeds
Maceration
skin softening from prolonged exposure to moisture
Normotrophic scar
collagen fibers aligned in parallel fashion
Turgor
speed at which skin resumes its shape after being pinched
The 3 zones of burn injury
Zone of 1) coagulation (Most severe center, cell damage)
2) stasis
3) hyperemia (outermost, inflamed but will heal easily)
Approximate healing times for superficial partial thickness and deep partial thickness burns
partial: 5-21
deep: 21-35
Child values for the rule of 9s for burns
A child under 1 year has 9% taken from the LE and added to the head and neck. Each year of life 1% added back to LE until 9 years old
What is the rule of 9s for? what is it not for?
it estimates the percent of body burned, isn’t prognostic, and doesn’t account for severity.
The use of compression garments that provide ____ to ___ mm Hg is believe d to create an environment that facilitate the balance of collagen synthesis and lysis, improving scar structure, in burns requiring >____ days to heal, and should be worn for ____ to ____ hours
15-35, 14, 22-23
Dry vs wet gangrene
Dry: due to blood vessel disease
Wet: due to bacteria infection-selling causes sudden stoppage of blood flow
Onychomycosis
nail fungus
Tinea pedis
athlete’s foot
What is Tay-Sachs disease?
absent/deficient enzyme so accumulate GM2 within the brain. autosomal recessive, mental retardation/paralysis, no cure
What is Wilson’s disease?
hepatolenticular degeneration. Can’t metabolize copper, kayserl-fleischer rings in the eyes. Athetoid, ataxia etc.
Trousseau’s sign
during BP, first sign of hypokalemia, occlusion of artery induces involuntary muscle contractions in hand
Osteoporosis typically affects which type of bone
cortical and trabecular
Osteomalacia:
bones soft secondary to to a calcium or phosphorus deficiency
Paget’s disease
heightened osteoclast activity, the bone appears enlarged but it is weak, most common in patients over 50
Different hormones that the adrenal cortex and medulla produce:
cortex: corticosteroids that regulate water and sodium balance, the body’s response to stress, the immune system, sexual dvlpmt, and metabolism.
medulla: epinephrine (HR and BP)
The _____ are the hormone-producing cells in the pancrease. The apha cells produce ____ and beta produce ____
Islets of Langerhans.
Alpha: glucagon
Beta: Insulin
Steroid hormones:
Also called:
Unique because:w
prostaglandins
don’t circulate in the blood
Amine hormones:
Also called:
Main one is:
catecholamines
Epinephrine
Peptide hormones:
Main one:
Insulin
Which 3 orthopedic conditions common with hyperpituitarism?
Bilateral carpal tunnel, arthritis, osteophyte formation
Ambulation/exercises should be done ______hours/days following pituitary tumor/gland removal
24 hrs
Which visual and cardiovascular effects can be present with hypopituitarism?
ortho hypot. and bilateral hemianopsia
Addison’s vs Cushings
Addisons: hypofunction of the adrenal cortex-dereased cortisol and aldosterone. Hypotension, weakness, anorexia, weight loss, altered pigmentation.
Cushing’s: hyperfunction. Excessive cortisol due to excessive ACTH from pituitary. Hyperglycemia, growth failure, moon face, buffalo hump, hypertension, male gynecomastia.
Hashimoto’s thyroiditis: hyper or hypo?
hypo
Postpartum thyroiditis:
hyper for first 1-4 months, 4-8 months
Grave’s disease: hypo or hyper?
hyper-most specific cause, autoimmune disease
What is pseudohypoparathyroidism?
hypoparathyroidism, shortened 4th and 5th metacarpals.
Elevated serum phophate levels, which type of parathyroidism?
hypo
decreased for hyper
Gout occurs with what?
hyperparathyroidism
increased neuromuscular activity occurs with which parathyroidism?
hyper
American diabetes assoc. recommends blood glucose to be ___ to ___ before a meal and <_____ after a meal
180-200 mg/dl
<180
Ketoacidosis more common with DM1 or DM2?
DM1
Signs of ketoacidosis?
dyspnea, a fruity breath odor, dry mouth, nausea, vomiting , confusionOutcomes
Patient’s Progress at 16 weeks:
Completing10 single-leg squats without internal rotation of the hip or knee valgus/instability
Walking on the treadmill, at his maximal speed, for 15 minutes without gait deviations or reports of knee pain
Running on the treadmill, four, two-minute intervals, with normal gait pattern, no pain
Goals at 20 weeks:
Obtaining a limb symmetry index ≥ 90% vertical jump, hop for distance, side hop
Running on the treadmill, four or more, five-minute intervals, with normal gait pattern, no pain
Primary syndromes for hypogonadism in males and females;
males; Klinefelter’s
females: Turner
People with GERD usually prefer to lie on which side/
L: because R may promote acid flowing into the esophagus
Pain from ulcers can radiate to which quadrant and shoulder?
R upper quadrant and shoulder
Diverticulitis
From diverticulosis-pouch-like protrusions in the colon. 10% of people over 40 80% asymptomatic.
Which type(s) of hepatitis does/do not progress to chronic disease or cirrhosis?
A
Which type(s) of hepatitis is/are transmitted through blood? Which fecal/oral?
B and C
A
Cholecystitis vs cholelithiasis
cystitis: inflammation
lithiasis: stones
Which type of drugs decrease symptoms of nausea and vomiting?
aniemetic agents
What happens to urine output, sodium and potassium with acute renal failure?
Oligouria (decreased urine), hyperkalemia, sodium retention
The 5 stages of kidney disease according to the National Kidney Foundation
1) damage but normal GFR (90 or greater)
2) GFR 60-89
3) GFR 30-59
4) GFR 15-29
5) failure (<15)
Most common type of incontinence?
Urge: intense urge to void due to detrusor muscle contraction
_______ _______ is when the linea alba is separated >2 fingers
diastasis recti
Pregnant women should remain at ____ to ____% of their max HR
50-60
Ditropan and Detrol are what kind of agents?
Overactive bladder agents
Cinobac (cinoxacin) and Furadantin (nitrofurantoin) do what?
Urinary anti-infective agents that are not traditional antibiotics
what is cystocele?
bulging of the bladder into the vagina
what is retocele?
the bulging of the anterior wall of the rectum into the vagina secondary to weakening of the pelvic supporting structures
C A U T I O N for cancer
change in bowel/bladder a sore that won't heal unusual bleeding/discharge thickening/lump indigestion/difficulty swallowing obvious change in wart/mole nagging cough/hoarsness
National institute stage for cancer, 0-IV
0: only in layer of cells in which it began, not all cancers have a stage 0
I: only in tissue of origin
II: adjacent tissues, may have micrometastases in lymph nodes
III: signs of fixation in adjacent tissue, likelihood of lymph involvement is high
IV: beyond primary site to bone or another organ
A risk factor for Hodgkin’s lymphoma is exposure to the ______ ______ virus
Epsein-Barre virus
Cancer in glandular cells is called __________
adenocarcinoma
exercise for pts undergoing cancer treatment: HR in a range of ____ to _____% max
40-65%
Most common type of pediatric brain tumor?
astrocytoma
