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Cardiology LPN-BSN > Patho exam 2 > Flashcards

Patho exam 2 Flashcards

1
Q

___ ___ is a vein in which blood has pooled.

Distended, tortuous, and palpable veins.

Causes by trauma or gradual venous distention.

Risk factors: 
Age
Female
Family history
Obesity
Pregnancy 
DVT
Prior leg injury
A

Varicose veins

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2
Q

___ ___ ___ inadequate venous return over a long period

Due to varicose veins or valvular incompetence

Venous stasis ulcers

A

Chronic venous insufficiency

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3
Q

___ ___ ___ syndrome

Progressive occlusion of the superior vena cava

Leads to venous distention of upper extremities and head.

Oncologic emergency

A

Superior vena cava syndrome

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4
Q

Veins return blood to the heart, via the vena cava, or the pulmonary vein.

Veins are wide and thinner and less muscular, have valves and hold a lot of the circulating blood.

A

Know

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5
Q

___ ___ thrombus formation in the veins

Obstruction of venous flow leading to increased venous pressure

Factors promoting thrombosis (triad of virchow)
Venous stasis, venous endothelial damage, hypercoagulable state, cancer, orthopedic surgery trauma, heart failure.

A

Venous thrombosis

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6
Q

___ is blood clot attached to a vessel wall

A

Thrombus

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7
Q

___-___ is a detached blood clot (moves around)

A

Thrombo-embolus

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8
Q

___ is a consistent elevation of systemic arterial blood pressure

Sustained systolic blood pressure of 130 mmHG or greater or a diastolic pressure of 80mmHG or greater

A

Hypertension

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9
Q

___ hypertension is essential or idiopathic

Genetic and environmental factors

Affects 92% to 95% of individuals with hypertension

Risk factors: family history, diet(high sodium, low K+, calcium, magnesium)

Tobacco and alcohol consumption

Obesity and glucose intolerance

A

Primary hypertension

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10
Q

___ hypertension is caused by a systemic disease process that raises peripheral vascular resistance or cardiac output.

Renal vascular or parenchymal disease, adrenocortical tumors, adrenomedullary tumors, and drugs

A

Secondary

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11
Q

___ hypertension- chronic hypertensive damage to blood vessels and tissues leading to target organ damage in the heart, kidney, brain, and eyes

-myocardial hypertrophy

A

Complicated hypertension

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12
Q

___ __ rapidly progressive hypertension

Systolic pressure >180mmHg and or diastolic pressure usually >120mmHg

Life threatening

A

Hypertensive crisis

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13
Q

___ hypotension- decrease in both systolic and diastolic blood pressure upon standing.

Lack of normal blood pressure compensation in response to gravitational changes on the circulation.

Acute orthostatic hypotension- more common in elderly, if electrolyte is off, bed bound, dehydration

Chronic orthostatic hypotension- secondary to a disease

A

Orthostatic hypotension

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14
Q

___ is a local dilation or outpouching of a vessel wall or cardiac chamber

True aneurysms- weakening of all three layers of the wall.

Aorta is most susceptible, especially abdominal

Causes atherosclerosis, hypertension

Can lead to aortic dissection or rupture

A

Aneurysm

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15
Q

__ __ is a blood clot that remains attached to the vessel wall.

Risk factors: intimal injury/ inflammation, obstruction of flow, pooling (stasis)

Thromboembolus- mobile blood clot

A

Thrombus formation

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16
Q

____ is a bolus of matter that is circulating in the blood steam.

Dislodged thrombus 
Air bubble
Amniotic fluid 
Aggregate of fat
Bacteria
Cancer cells
Foreign substance
A

Embolism

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17
Q

Peripheral vascular disease

___ ___ autoimmune disease of the peripheral arteries

*strongly associated with smoking.

Characterized by the formation of thrombi filled with inflammatory and immune cells

Thrombi become organized and fibrotic, result in permanent occlusion of portions of small and medium sized arteries in feet and hands.

*causes pain tenderness in hands and affected area

Can often lead to gangrenous lesions and amputations

A

Thromboangitis obliterans (buerger disease)

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18
Q

Peripheral vascular disease

___ ___ is episodic vasospasm in arteries and arterioles of the fingers, less commonly the toes.

Primary- vasospastic disorder of unknown origin

A

Raynaud phenomenon

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19
Q

Peripheral vascular disease

____ ___ ___ is secondary to other systemic diseases or condition:

Collagen vascular disease, pulmonary hypertension, hypothyroidism, long term exposure to cold environments, changes in skin color and sensation

A

Secondary raynaud phenomenon

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20
Q

_____ is a form of arteriosclerosis

Thickening and hardening caused by accumulation of lipid laden macrophages In arterial wall.

Plaque development

Risk factors: diabetes, smoking, hyperlipidemia, dyslipidemia, hypertension, autoimmunity

A

Atherosclerosis

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21
Q

___ is progression- inflammation of endothelium

Cellular proliferation
Macrophage migration and adherence
LDL oxidation (foam cell formation) *
Fatty streak
Fibrous plaque 
Complicated plaque

Results inadequate perfusion, ischemia, necrosis

A

Atherosclerosis

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22
Q

___ __ ___ in the lower extremities Is also linked to coronary artery disease

Atherosclerotic disease of arteries that perfuse limbs

Intermittent claudication

Toe nails, hair, skin color/numbness seen also

A

Peripheral arterial disease

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23
Q

___ ___ ___ is any vascular disorder that narrows or occludes the coronary arteries leading to myocardial ischemia

Atherosclerosis is the most common cause

Primary cause of heart disease in US

A

Coronary artery disease

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24
Q

___ __ ___ is conventional (major) risk factors

Nonmodifiable *
Increase age *
Family history*
Male gender or female gender post menopausal

Modifiable* 
Dyslipidemia 
Hypertension 
Cigarette smoking 
Diabetes mellitus and insulin resistance 
Obesity/sedentary lifestyle 
Atherogenic diet
A

Coronary artery disease

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25
Q

Blood flow through heart

Superior vena cava> right atrium> tricuspid valve> right ventricle > pulmonary valve> pulmonary artery> lungs > left atrium> left ventricle> aorta> rest of body

A

Know

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26
Q

___ ___ ___ is transient * myocardial ischemia

Local, temporary deprivation of the coronary blood supply

A

Coronary artery disease

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27
Q

___ angina most common, recurrent, predicable chest pain.

Can be relieved w rest or NTG

No damage to heart

A

Stable

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28
Q

___ ___ asymptomatic and seen in diabetics. No damage to heart tissue

A

Silent ischemia

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29
Q

___ angina results from reversible myocardial ischemia.

A

Unstable

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30
Q

___ ___ extended obstruction of the myocardial blood supply causing myocyte necrosis

A

Myocardial infarction

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31
Q

MI- complete occlusion of artery is ___

A

STEMI

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32
Q

MI is partial occlusion of artery ____

A

Non stemi

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33
Q

The first 24 hours after MI is important bc they can have sudden death. Arrhythmias is major.

A

Know

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34
Q

Myocardial infarction

Manifestations: sudden severe chest pain, may radiate

Nausea vomiting

Diaphoresis

Dyspnea

Complications: sudden cardiac arrest due to ischemia, left ventricular dysfunction, and electrical instability

A

Know

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35
Q

___ ___ inflammation of pericardium, viral or bacterial

A

Acute pericarditis

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36
Q

___ __ accumulation of fluid in pericardium cavity

A

Pericardial effusion

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37
Q

___ is medical emergency, rapid accumulation of fluid compresses heart contraction.

A

Tamponade

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38
Q

___ ___ caused by a virus that causes the two pericardium layers to stick together, gradual, fibrous scar

A

Constrictive pericarditis

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39
Q

Disorders of endocardium

___ ___ mitral valve prolapse syndrome, acute rheumatic fever and rheumatic heart disease, infective endocarditis

A

Valvular dysfunctions

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40
Q

___ __ ___ ___ one of both cusps of mitral valve billow upward into left atrium during systole

Mitral regurgitation if blood leaks into atrium

Patients can be asymptomatic or have vague symptoms

*most common valve disorder in US

A

Mitral valve prolapse syndrome

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41
Q

__ __ is a systemic, inflammatory disease caused by a delayed immune response to pharyngeal infection by the group A B hemolytic streptococcus

Febrile illness

Inflammation of the joints, skin, nervous system, and heart.

If left untreated may cause rheumatic heart disease

A

Rheumatic fever

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42
Q

___ ___

Common manifestations: 
Fever
Lymphadenopathy 
Arthralgia 
Nausea/vomiting and abdominal pain
Tachycardia 
Epistaxis (nose bleed) 
Major clinical manifestations: 
Carditis 
Poly arthritis 
Chorea 
Erythema marginatum (rash) 
Subcutaneous nodules

Treatment: treat strep infection

A

Rheumatic fever

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43
Q

___ ___ is inflammation of the endocardium

Agents:
Bacteria 
Viruses 
Fungi 
Rickettsiae 
Parasites

Patho genesis-
Damaged (prepared) endocardium
Blood borne microorganisms adherence (IV drug user or dental procedure)
Proliferation of the microorganism (vegetation)

A

Infective endocarditis

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44
Q

___ ___ classic findings:

Fever
Murmur*
Petechial lesions of the skin, conjunctiva, and oral mucosa

Characteristic finding:

Osler nodes
Janeway lesions

Other: weight loss, back pain, night sweats, and heart failure.

Picline and 6-10 week of IV abx at home and sometime oral abx after and then possibly valve replacement

A

Infective endocarditis

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45
Q

___ ___ heart is unable to generate adequate cardiac output

Inadequate perfusion of tissues
Increased diastolic filling pressure of left ventricle
Pulmonary capillary pressures increase

A

Heart failure

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46
Q

___ a period of relaxation when the heart is filling with blood

A

Diastole

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47
Q

___ is a period of contraction when the heart is pulling blood from ventricles

A

Systole

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48
Q

Left heart failure

__ heart failure

Ejection fraction less than 40%

Inability of the heart to generate adequate cardiac output to perfume tissues

Stroke volume: contractility- ability of heart to eject blood, preload- amount of stretch the ventricles fill, after load the Amount of pressure the ventricles exert.

Disruptions decrease cardiac output
Failing cardiac output progressively worsens heart

Manifestations: dyspnea, orthopnea, cough of frothy sputum, fatigue, decrease urine output, and edema
Pulmonary edema, hypotension/hypertension, S3 gallop

A

Systolic heart failure

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49
Q

___ heart failure

Inability of right ventricle to provide adequate blood flow at a normal venous pressure

Most commonly caused by a diffuse hypoxic pulmonary disease

Manifestations: peripheral edema, hepatosplenomegly

A

Right heart failure

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50
Q

___ is where cardio vascular system fails to perfuse the tissues adequately

Leads to impaired cellular metabolism
Impaired oxygen use
Impaired glucose use

Manifestations: based on type, often include
Feeling weak, cold, hot, nauseated, dizzy, confused, afraid, thirsty, sob,

Hypotension, tachycardia, increased respiratory rate

A

Shock

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51
Q

Type of shock

___ =heart failure

A

Cardiogenic

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52
Q

Type of shock

__ = insufficient intravascular fluid volume

A

Hypovolemic

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53
Q

Type of shock

__= neural alterations of vascular smooth muscle tone

A

Neurogenic

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54
Q

Type of shock

___= immunologic processes

Sudden onset, can die within mins if not addressed. Anxious, dizzy, SOB, hives

A

Anaphylactic

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55
Q

Type of shock

__ =infection can lead to bacteremia the sepsis and septic shock

A

Septic

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56
Q

___ ___ ___ syndrome

Progressive dysfunction of two or more organ systems resulting from an uncontrolled inflammatory response to illness or injury

Causes: most common: sepsis, septic shock

Other: severe trauma, burns, major surgery, blood transfusion, renal or liver failure, pancreatitis

A

Multiple organ dysfunction syndrome

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57
Q

Multiple organ dysfunction syndrome

Manifestations:

Fever
Tachycardia
Dyspnea 
Altered mental status
Hyper dynamic/hyper metabolic of individual organ systems seen
Renal
GI
Cardiac
Nervous
A

Know

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58
Q

Three lethal arrhythmias

Asystole
Ventricular tachycardia
Ventricular fibrillation

A

Know

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59
Q

___ is a subjective sensation of uncomfortable breathing

A

Dyspnea

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60
Q

___ dyspnea when a person is lying down

A

Orthopnea

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61
Q

___ ___ ___ awaken at night gasping for air

A

Paroxysmal nocturnal dyspnea

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62
Q

S/S of ___ ___

Cough-
Acute-develops due to URI
Chronic-smoker or contact with resp irritants at work

Abnormal sputum- identify debris or organisms to determine therapy needed

Hemoptysis-blood sputum pink or red

Abnormal breathing patterns- kussmaul respiration’s (tachypnea) (metabolic acidosis-DKA patients) and cheyne stokes respiration’s-breathing is no longer regulated and bad sign. Right before death. Deep slow breathing to rapid shallow breathing then a pause

A

Pulmonary disease

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63
Q

S/S of pulmonary disease

Cyanosis-bluish discoloration as a result of low o2 saturation

Clubbing-result of chronic hypoxemia/chronic lung conditions

Pain-pleural lining infection/inflammation, coughing, chest wall non-compliance

A

Know

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64
Q

Conditions caused by pulmonary disease or injury

___ is increased carbon dioxide concentration in arterial blood

A

Hypercapnia

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65
Q

Conditions caused by pulmonary disease or injury

___ is reduced oxygenation of arterial blood** Ventilation perfusion abnormalities

A

Hypoxemia

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66
Q

Conditions caused by pulmonary disease or injury

___ __ __ is result if inadequate alveolar ventilation ** requires support

A

Acute respiratory failure

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67
Q

___ refers to the air flow to the alveoli

A

Ventilation

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68
Q

____ refers to the blood flow to the tissues, in the lungs refers to the blood amount in the capillaries around the alveoli (area of gas exchange)

A

Perfusion

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69
Q

VQ ratio = ventilation perfusion ratio

Mismatching is termed shunting.

Results in alveoli dysfunction and poor perfusion

0.8 1:1

A

Know

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70
Q

V/Q mismatches

Normal ventilation, poor perfusion would be an example of pulmonary embolus

Normal perfusion, poor ventilation would be an example of aspiration.

A

Know

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71
Q

Space between the mouth and alveoli is all considered dead space. As air moves in and out it doesn’t contribute to oxygenation.

A person may have a tracheostomy is to reduce the amount of dead space to increase ventilation

A

Know

72
Q

Pleural abnormalities

•pneumothorax- (spontaneous or secondary) change in negative pressure within the pleural space. It disrupts the ability for recoil and compliance of lung and chest wall.
Presence of air or gas in the pleural space.

Manifestations: sudden pleural chest pain
Tachypnea (high RR)
Dyspnea (SOB)
Absent or decreased breath sounds on affected side

A

Know

73
Q

Pleural abnormalities

•tension pneumothorax- occurs rapidly/life threatening; air can enter but not escape.
Tracheal deviation away from affected lung
Hypotension
Severe hypoxemia
Chest tube Insertion to treat

A

Know

74
Q

Pleural abnormalities

___ ___ is fluid in pleural space

A

Pleural effusion

75
Q

Transudative means

A

Watery

76
Q

Exudative means

A

WBC and plasma proteins

77
Q

Hemothorax means

A

Blood

78
Q

Empyema means

A

Pus

79
Q

Manifestations of pleural effusion:

Mediastinal shift
Cardiovascular changes
Decreased breath sounds on affected side
Pleural friction rub over inflamed area

Diagnose by thoracentesis (needle aspiration) to remove and identify fluid type

A

Know

80
Q

Pleural abnormalities

___ is infected pleural effusion (pus accumulation

A

Empyema

81
Q

Manifestations of empyema

Cyanosis 
Fever 
Tachycardia
Cough 
Pleural pain 
Decreased breath sounds over affected area

Diagnosis is thoracentesis and sputum culture

Treatment is antimicrobials and chest tube drainage

A

Know

82
Q

Restrictive lung diseases

___ is a passage of fluid and solid particles into the lungs, result if swallow cough dysfunction

Manifestations: sudden onset of choking, intractable cough, fever, wheezing

A

Aspiration

83
Q

Restrictive lung diseases

___ is collapse of lung tissue- common after surgery or immobilization

Production of viscous secretions and pooling in dependent areas; mismatching and shunting occurs.

Manifestations: dyspnea, cough, fever, leukocytosis

Treatment: deep breathing (incentive spirometer) position changes, early ambulation- promotes expansion of collapsed alveoli

A

Atelectasis

84
Q

Restrictive lung diseases

___ is persistent abnormal dilation of the bronchi

Manifestation: chronic productive cough, hemoptysis, and clubbing (chronic hypoxemia)

A

Bronchiectasis

85
Q

Inhalation disorders

___ ___ causing respiratory dysfunction, damage to airway lining; inflammation, edema, ciliary damage, surfactant changes.

A

Gaseous irritants

86
Q

Inhalation disorders

___ ___ is disruption in surfactant production and reduced lung compliance due to oxygen free radicals

A

Oxygen toxicity

87
Q

Inhalation disorders

___ -dust particles of toxic substances inhaled, cause fibrosis of lung disease

A

Pneumoconiosis

88
Q

Inhalation disorders

___-allergic, inflammatory disease from inhaling particles that imitate an auto immune hypersensitivity reaction

A

Pneumonitis

89
Q

___ ___ is excess water* in the lung due to changes in hydrostatic and oncotic pressures and capillary permeability.

Left sided heart failure =changes in fluid shifting and fluid developing in lungs

Injury to capillary lining=permeability and fluid development

Blocked lymphatic channels= inability to remove excess fluid

A

Pulmonary edema

90
Q

Manifestations of pulmonary edema

Dyspnea 
Hypoxemia 
Increased work of breathing 
Inspiratory crackles 
Pink frothy sputum 
C02 retention (hypercapnia)
A

Know

91
Q

______

Acute inflammation and diffuse alveolar capillary injury that results from injury or severe systemic inflammation

Progressive manifestations:
Dyspnea and hypoxemia despite supplemental o2
Hyperventilation (respiratory alkalosis)*
Decreased tissue perfusion (metabolic acidosis) and organ dysfunction
Increased work of breathing, decreased tidal volume, and hypoventilation
Hypercapnia(respiratory acidosis)
Respiratory failure, decreased cardiac output, hypotension=death
Treatment: early detection, vent support, oxygenation, preventing inf, prevention of further complications

A

Acute respiratory distress syndrome (ARDS)

92
Q

ARDS can cause severe pulmonary edema

A

Know

93
Q

___ ___ ___ is narrowing of airways resulting in airway obstruction that is worse with EXPIRATION

Accessory muscles of expiration required
Increased work of breathing

Dyspnea and wheezing

A

Obstructive lung disease

94
Q

___ is chronic obstruction of airways.

Causes bronchial hyper responsiveness, constriction of airways, and reversible airflow obstruction.

Pulsus paradoxus- variation in pulse as breathing
Status asthmaticus- stuck in asthma attack

S/S: expiratory wheezing, dyspnea, and tachypnea

Peak flow meters (to measure expiratory flow rate-EFR), corticosteroids, beta agonist inhalers, and anti inflammatory user to treat

FEV- forced expiratory volume

A

Asthma

95
Q

Asthma S/S

SOB
difficulty breathing 
Dry cough 
Night cough 
Wheezing 
Chest pain
A

Know

96
Q

____ is characterized by persistent air flow limitation

It’s progressive

Associated with chronic inflammatory responses

Emphysema& chronic bronchitis equals This

A

COPD

97
Q

____ ____ is hypersecretion of mucus

Chronic productive cough

Lasts for at least 3 months of the year and for at least 2 consecutive years

Manifestations: productive thick mucous with cough, hypoventilation/difficulty breathing

Bronchodilators, expectorants, chest PT used to treat

A

Chronic bronchitis

98
Q

___ is abnormal permanent enlargement of the gas exchange airways accompanied by destruction of alveolar walls without obvious fibrosis

Inherited deficit of A1- antitrypsin

Loss of elastic recoil*
Air trapping*

A

Emphysema

99
Q

___ ___

Acute infection or inflammation of the airways or bronchi

Commonly follows viral illness

Production of sputum

Acute bronchitis causes symptoms similar to those of pneumonia but* does not demonstrate pulmonary consolidation and chest infiltrates*

A

Acute bronchitis

100
Q

___ is a lower respiratory tract infection (alveoli)

Community acquired
Streptococcus pneumoniae
Influenza

Healthcare acquired
Ventilator associated

Manifestations: preceded by upper respiratory infection (most cases)

Consolidation: fever chills, dry cough, pain, dyspnea, crackles

A

Pneumonia

101
Q

TB

Progressive fatigue,
Malaise
Anorexia
Weight loss

Chronic productive cough
Night sweats 
Hemoptysis(advanced state)
Pleuritic pain- chest pain 
Low grade temp in late afternoon
A

Know

102
Q

Treatment of TB:

TB med 6-12 months
Decreased activity
Resp isolation until negative sputum
Requently out PT basis

Dx: TB skin test
Chest x ray
Sputum studies- 3 specimens collected on different days

A

Know

103
Q

___ __ is occlusion caused by an embolus

Blood clot, tissue fragment, lipids, foreign body, air bubble, amniotic fluid

A

Pulmonary embolism

104
Q

Pulmonary emboli is commonly from the deep veins DVT in lower leg

A

Know

105
Q

___ ___ is result of pulmonary hypertension

Pulmonary hypertension creates chronic pressure overload in the right ventricle- right ventricular enlargement*

A

Cor pulmonale

106
Q

Laryngeal cancer:

Manifestations:
Progressive hoarseness w no voice loss
Dyspnea
Cough

A

Know

107
Q

Lung cancer

Nearly 80% caused by smoking

Manifestations: cough with sputum production
Hemoptysis
Chest pain

A

Know

108
Q

___ is a red blood cell that carry Hgb for oxygenation of tissues.

Low- anemia
High- polycythemia

A

Erythrocytes

109
Q

___ is several type of white blood cells- immune system inflammation

Low- immune dysfunction
Cancer- leukemias

A

Leukocytes

110
Q

___ cells main function is immune

A

T cells (thymus)

111
Q

__ cells main function is immune

A

B cells (bone)

112
Q

___ form blood clots (thrombi) stop bleeding

Low-bleeding
High-clotting DVT

A

Thrombocytes

113
Q

___ means there is not enough red blood cells (erythrocytes) to carry enough oxygen to cells. RBC don’t have enough hgb to carry enough oxygen. RBC don’t work right (shape/morphology)

A

Anemia

114
Q

Anemia manifestations:

Cause: reduced oxygen carrying capacity

Classic anemia S/S
Fatigue
Weakness
Dyspnea
Dizziness w position change 
Classic anemia signs
Rapid HR
Pallor
Heart murmur 
Enlarged heart, even failure
A

Know

115
Q

What triggers rbc production

Low oxygen levels in the kidneys stimulate the release of ERYTHROPOIETIN, a hormone

Erythropoietin stimulates the blood marrow to release RBC

Sometimes immature RBC (reticulocytes) are released indicating higher production

Need enough iron to make the hgb for new RBC

A

Know

116
Q

2 basic causes of anemia

  1. Loss of RBC
  2. Diminished erythropoesis (not making RBC)
A

Know

117
Q

Anemia classification by morphology

By size and hgb shape and size. Identify terms that end in cytic.

Hgb content- identified by terms that end in chromic

Anisocytosis-red cells in various sizes

Poikilocytosis- red cells in various shapes

A

Know

118
Q

Anemia’s of blood loss:

Acute blood loss

Post hemorrhagic anemia-
Normocytic-normochromic anemia (too fast to compensate, cells look normal)
Effects depend on rate of hemorrhage
Often due to trauma or surgery

Chronic blood loss- when blood loss is greater than replacement compacity of blood marrow.
Iron deficiency anemia can occur, not taking in enough iron to replace RBC
Associated with slow blood loss like menstruation, colon cancer

Loss due to RBC destruction too (hemolytic anemia)

A

Know

119
Q

Macrocytic, normochromic anemias (big RBC)

Also termed megablastic anemia’s

Characterized by unusually large stem cells

Result if defective DNA synthesis

Nutrient deficits of folate, vitamin B 12

A

Know

120
Q

___ ___ (macrocytic anemia)

Cause: lack of intrinsic factor from gastric parietal cells
Required for vitamin b12 absorption
Results in vitamin b12 deficiency

Manifestations : early symptoms nonspecific and vague
When hgb at 7-8 g/dl
Weakness, fatigue, difficulty walking, paresthesias, loss of appetite, abdominal pain, weight loss, sore tongue

Neurologic manifestations irreversible

Treatment: life long B12 replacement

A

Pernicious anemia

121
Q

___ ___ (macrocytic anemia)

Humans dependent on daily dietary intake of folate

Absorption of folate occurs in the upper small intestine

No neurological symptoms

Common in alcohol abuse

A

Folate deficiency

122
Q

Microcytic hypo chronic anemia- small pale RBC

Red cells are abnormally small containing low hgb

Related to iron deficiency
Disorders of iron metabolism (rare)

Chronic loss of RBC (mensuration, cancer)

Poor intake or absorption of dietary iron (common)

A

Know

123
Q

Microcytic hypochromic anemia’s:

___ ___ anemia is most common nutritional disorder worldwide

Causes: dietary deficiency, impaired absorption, increased requirement, chronic blood loss

A

Iron deficiency

124
Q

Iron deficiency anemia:

Manifestations when hgb decreased to 7 or 8 per/dL

Early symptoms are nonspecific: fatigued weakness, sob, pale earlobes, palms, conjunctiva.

Progression of iron deficiency causes:

Brittle, thin, coarsely rigid and spoon shaped nails (kolionychia)

Cheilosis, stomatitis, painful ulceration in mouth

Dysphasia(difficulty swallowing)

A

Know

125
Q

Normocytic normochromic anemia

Cells are normal but not enough of them

Low RBC count

Causes: acute blood loss or hemorrhage
Hemolysis- red blood cells broken down, die too soon
Chronic illness or inflammation
Aplastic anemia- bone marrow can’t make any blood cell types

A

Know

126
Q

___ ___
Normocytic normochromic anemia
Cause: bone marrow depression, results in reduction all 3 hematopoietic cell lines (RBC, WBC, platelet)

Manifestations- all types of blood cells missing.
Low RBC- fatigue, pallor
Low platelets- petechiae, bruising, bleeding gums, nose, GI.
Low WBC- increased infections

Why? Damaged bone marrow due to cancer, leukemia, radiation, medication/ chemo

A

Aplastic anemia

127
Q

___ ___
Normocytic normochromic anemia’s

RBC fragile, die too fast

Causes: drugs, infection, genetic abnormalities of RBC (sickle cell) auto immune conditions where body attacks own RBC

Added problem: getting rid of hgb breakdown product, bilirubin, leads to jaundice

A

Hemolytic anemia

128
Q

___ ___
Normocytic normochromic anemia

Cause: bone marrow depression, results in reduction of all 3 hematopoietic cell lines (RBC wbc platelets)

Manifestations: all types of blood cells missing
Low RBC-fatigue, pallor
Low platelet- petechiae, bruising, bleeding gums, nose, GI)
Low wbc- increased infections

Why? Damaged bone marrow due to cancer, leukemia, radiation, medications/chemo

A

Aplastic anemia

129
Q

Anemia of chronic disease
Normocytic normochromic anemias

Decreased erythropoiesis and impaired iron utilization in chronic disease or inflammation

Common hospitalized patients
AIDS- increased destruction of RBC by macrophages in spleen*
Rheumatoid arthritis
Lupus erythematosus
Hepatitis
Renal failure- decrease erythropoietin and decrease RBC
Malignancies

A

Know

130
Q

Anemia of chronic disease

Result from erythrocytes life span
Suppressed production of erythropoietin
Ineffective bone marrow response
Altered iron metabolism in macrophages

A

Know

131
Q

___ is over production of RBC (erythrocytes)

A

Polycythemia

132
Q

___ ___ is result of dehydration (less plasma) and hemoconcentration of the blood

A

Relative polycythemia

133
Q

__ __

Primary absolute (polycythemia vera)- a cancer

Secondary absolute polycythemia is defined as an absolute increase in red blood cell mass

Hereditary hemochromatosis is a genetic disorder that can cause severe liver disease and other health problems.

A

Absolute polycythemia

134
Q

___ ___

Also known as primary polycythemia

Blood cancer in which bone marrow makes too many RBC, wbc, and platelets are also often increased

Manifestations: due to increased red cell mass and hematocrit

Increased blood volume and viscosity (thickness)
Hyper coagulability (blood clots too easily)

Cerebral thrombosis (stroke) one of the main causes of death

A

Polycythemia vera

135
Q

___ high leukocyte count

A

Leukocytosis

136
Q

Low leukocyte count

A

Leukopenia

137
Q

___ (also called neutrophillia)

Increase in granulocytes, mostly neutrophils

Neutrophillia is normal in the first stages of infection or inflammation

If the need for neutrophils increases behind the supply, immature neutrophils are released

Phenomenon is termed “shift to the left”

When the population returns to normal “shift to the right”

A

Granulocytosis

138
Q

___ is reduction in circulating neutrophils

Causes: prolonged severe infection
Decreased production
Reduced survival
Abnormal neutrophil distribution

Granulocytopenia (severe neutropenia) and agranulocytosis (absence of granulocytes)
Chemo

RESULTS IN VULNERABILITY to INFECTION

A

Neutropenia

139
Q

___ is increase in circulating eosinophils
Triggered by hypersensitivity reactions (allergic)
Allergic disorders and parasitic invasions

A

Eosinophilia

140
Q

___ is decrease in circulating eosinophils. Caused by migration of cells to inflammatory sites.

Other causes: Cushing syndrome and stress

A

Eosinopenia

141
Q

___ is increase in circulating basophils. Response to inflammation and hypersensitivity (allergic reactions)

Seen in myeloproliferative disorders (overactive bone marrow)

A

Basophilia

142
Q

___ is a decrease in circulating basophils

Occurs in acute infections, hyperthyroidism, ovulation and pregnancy, long term steroid therapy

A

Basophilia

143
Q

____ is decrease in circulating basophils

Occurs in acute infections, hyperthyroidism, ovulation, and pregnancy: long term steroid therapy

A

Basopenia

144
Q

___ is increase in circulating monocytes

Often transient and not due to low monocyte production

Usually occurs w neutropenia in later stages of infections when monocytes are needed to phagocytize* organisms and debris

A

Monocytosis

145
Q

___ is decrease in circulating monocytes

Very rare

A

Monocytopenia

146
Q

____ is increase in number or proportion of lymphocytes

Caused by acute viral infections * particularly caused by Epstein Barr virus

A

Lymphocytosis

147
Q

____ is decrease in circulating lymphocytes

Causes: low production due to immune deficiencies

Destruction by drugs, viruses, or radiation.

A

Lymphocytopenia

148
Q

___ ___ is a benign acute, self limiting infection of B lymphocytes transmitted by saliva through personal contact.

Most common cause: EBV

Other viruses that cause similar symptoms: 
Cytomegalovirus 
Hepatitis 
Influenza 
HIV
Rubella
A

Know

149
Q 
Infectious mononucleosis symptoms at time of diagnosis: 
Fever 
Fatigue*
Sore throat 
Swollen cervical lymph nodes 
Increased lymphocyte count 
Atypical activated lymphocytes

Serious complications are rare: splenic rupture is common cause of death

A

Know

150
Q

___ is a malignant disorder of the bone marrow and blood

Excessive accumulation of leukemic cells

Cells crowd bone marrow

Decreased function of hematopoietic cells

Pancytopenia lower-than-normal number of red and white blood cells and platelets in the blood.

A

Leukemia

151
Q

Leukemia arise from stem like cells. A blood stem cell undergoes multiple steps to finally become a red blood cell, platelet, or wbc.

A

know

152
Q

___ ___ leukemia has too many lymphoblasts

most common leukemia in chikdhood (80%)

most are b cell origin

manifestations: bone marrow depression causes: fatigue, bleeding, fever, anorexia, and neurologic symptoms

A

acute lymphocytic ALL

153
Q

__ ___ leukemia

too many myleoblasts

most common adult leukemia

manifestations: bone marrow depression causes: fatigue, bleeding, fever, anorexia, and neurologic symptoms

A

Acute myelogenous leukemia

154
Q

___ ___ leukemia

3 stages

Philadelphia chromosome (95%)

Too many blood cells made in bone marrow

A

Chronic myelogenous leukemia (CML)

155
Q

___ __ leukemia

Predominately seen in older adults (over 60)

Too many immature lymphocytes and immunologically incompetent (can’t fight infections)

Follows a slow chronic course

A

Chronic lymphocytic leukemia CLL

156
Q

Manifestations of leukemia

Anemia
Bleeding
Thrombosis
Hemorrhage 
DIC
Fever/infection 
Weight loss
Neurologic manifestations 
Bone pain
Elevated uric acid 
Liver, spleen, and lymph node enlargement
A

Know

157
Q

Alterations in lymphoid function:

Alterations include:

Lymphadenopathy (swollen lymph nodes)

Malignant lymphomas (lymph node cancer)

Plasma cell malignancy

A

Know

158
Q

___ lymphoma

Reed sternberg cells

Not specific

Derived from B cell

Has not undergone successful immunoglobulin gene rearrangement

Would normally undergo apoptosis

A

Hodgkin

159
Q

Hodgkin lymphoma manifestations

Fever, weight loss, night sweats, adenopathy (swollen glands) pruritis (itching, medistinal mass, splenomegaly (enlarged spleen) and abdominal mass

Find a painless “rubbery” enlarged node on neck usually found on men when shaving

A

Know

160
Q

___ ___ lymphoma-

Generic term for a diverse group of lymphoid neoplasms

Real classification
B cell neoplasms
T cell and NK cell neoplasms

Risk factors include being older, male, white, plus having:
Certain immune disorders, auto immune or HIV/AIDS
Exposure to mutagenic chemicals
Infection with certain cancer related virus
Immune responses related to organ transplantation

A

Non Hodgkin lymphoma

161
Q

____ lymphoma

Most common type of non Hodgkin lymphoma in children

Particularly African children

Is a very fast growing tumor of the jaw and facial bones

Epstein Barr virus is found in nasopharyngeal secretions or patients

A

Burkitts

162
Q

___ ___ is a bone marrow disease with plasma cell tumors in bone

Frequently the myeloma produces the bence Jones protein

Bence Jones found in urine, toxic renal cells and may cause renal failure

Bone pain may be first symptom

Serum calcium level is high **

A

Multiple myeloma

163
Q

___ is decrease in circulating platelet

A

Thrombocytopenia

164
Q

____ is increase in circulating platelets

A

Thrombocythemia

165
Q

Thrombocytopenia -defined as a platelet count less than 150k

Less than 100k becomes clinically significant

Less than 50k hemorrhage from minor trauma

Less than 15k spontaneous bleeding*

Less than 10k severe bleeding

Pseudo thrombocytopenia
Error in lab giving a false reading for thrombocytopenia

A

Know

166
Q

___ ___ ___ igG antibodies target heparin platelet factor 4 complex

Typically causes 50% drop in platelet count

A

Heparin induced thrombocytopenia

167
Q

___ ___ ___ igG antibody that targets platelets

Antibody coated platelets are sequestered (gathered up) and removed from circulation

Acute- develops after a viral infection is one of the most common childhood bleeding disorders

A

Immune (idiopathic) thrombocytopenic purapura

168
Q

___ ____ ___ is a thrombotic (clotting) micro angiography (small or micro vessel disease)

Platelets aggregate, form microthrombi (tiny clots) and cause occlusion (blockage) of arterioles and capillaries

Familial or acquired

Results in low platelets so bleeding

A

Thrombotic thrombocytopenia purapura

169
Q

___ ____

Myeloproliferative neoplasm (bone marrow cancer) involving defect in bone marrow megakaryocyte progenitor cells

Megakaryocyte in the bone marrow are produced in excess

Microvasculature thrombosis or hemorrhage occurs

A

Essential (primary) thrombocythemia

170
Q

___ ___ is following a splenectomy bc platelets cannot be stored in spleen

A

Secondary thrombocythemia

171
Q

Alterations of coagulation:

Caused by problems with clotting factors

2 main problems:

  1. Impaired hemostasis(unable to stop bleeding)
  2. Thromboembolic disorders (forms clots when they should not)
A

Know

172
Q

Impaired hemostasis

Inability to coagulate blood and form stable fibrin clot

Causes: vitamin K deficiency
Vitamin K is needed for prothrombin * the procoagulant factors (VII, Xl,X) and proteins C and S (anticoagulants)
Vitamin K is absorbed from the intestine made by gut bacteria.

Consumptive coagulopathy- imbalance in clot formation and dissolving leads to tiny clots throughout the body. Platelets and clotting factor used up “consumed” so no clots formed, bleeding uncontrolled (DIC)

A

Liver disease
Hepatic liver cells produce most factors in hemostasis
Liver damage causes production of fewer clotting factors

173
Q

___ ___ ___ caused by many disease processes, especially sepsis (severe inf)

Manifestations: show wide variability but not involve abnormal bleeding

Bleeding from venipuncture sites
Bleeding from arterial lines
Purapura, petechiae, and hematoma (bleeding)
Symmetric cyanosis of fingers and toes

Treatment is infusion of coagulation factors removing the cause

A

Disseminated intravascular coagulation DIC

174
Q

___ is a fixed clot narrowing it blocking a blood vessel

A

Thrombus

175
Q

___ is a floating clot that moves upstream in the blood

A

Embolus

176
Q

Thromboembolic disorders are a complication of many illnesses, related to decreased mobility

Major cause of deaths

Clots lead to ischemia due to blockage of blood vessels so
DVT usually in legs
Stroke
Myocardial infarction
Pulmonary embolism (PE) blocking lung arteries

Causes: virchows triad is a 3 factor that causes clots.

  1. Damage to blood vessel walls due to injury
  2. Slowed blood flow, due to less activity
  3. Hypercoagulability from hereditary thrombophilias (leyden factor V) and acquired hypercoagulability
A

Know

Cardiology LPN-BSN (1 decks)

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