patho exam 3 Flashcards
sodium lab value
136-145
potassium lab value
3.5-5
magnesium lab value
1.7-2.2
calcium lab value
9-11
phosphate
3.2-4.3
leukocytes
subcat: gran & agran
-neutrophils (gran)
-lymphocytes (agran)
-monocytes (agran)
-eosinophils (gran)
-basophils (gran)
immunity & inflammation
granulocytes
have cells w/ a nucleus in several lobes & granules -> they release mediators w/ immunity & inflammatory properties
agranulocytes
have a nucleus but have few to no granules -> still aid in immunity & inflammation
neutrophils
-1st to arrive
-bands (immature/left) & segs (mature/right)
-shift to left = acute phase
increase w/ acute bacteria infections & trauma
lymphocytes
-primary cells of immune response (T&B cells) that live in the lymphoid tissues
increase w/ chronic bacterial infection & actute viral infection
monocytes
phagocytosis
increase w/ bacterial infections & cancers (or could be lower for cancer)
eosinophils
increase w/ allergic rx or parasitic infections
worms, wheezes & weird disease
basophils
increase w/ allergic rx
low hgb indicates
bleeding, folate/b12 defic, cancers, kidney & liver disease
high hgb indicates
polycythemia, COPD, high alt, heavy smoking
low hct indicates
anemia, bleeding, bleeding disorders, fluid imbalances
high hct indicates
polycythemia, COPD, dehydration, shock, congenital heart disease
neutropenia precautions
-good hygiene
-avoid contact w/ sick people
-avoid raw fruits, veg, & grains
-keep doors closed
neutropenia
absolute count < 1000
infectious mononucleosis
infection of B lymphs caused by epstein barr virus
myelodysplastic syndrome
a group of related hematologic disorders characterized by a change in the quantity and quality of bone marrow elements (bone marrow failure)
myelodysplastic syndrome CM
(cytopenias) anemia, infection & spontaneous bleeding or bruising
leukemias
malignant neoplasms of cells originally derived from a single hematopoietic cell line (WBC that are unregulated and/or undifferentiated)
leukemic cells
-immature & unregualated
-proliferation in bone marrow
-circulate in blood
-infiltrate spleen, lymph nodes
leukemia classifications
according to their predominant cell (lymphocytic or myelocytic) & whether the condition is acute or chronic
what is the most common childhood leukemia
acute lymphocytic (lymphoblastic) leukemia
what is the most common leukemia in older adults
chronic lymphocytic leukemia
malignant lymphomas
neoplasms of cells derived from lymphoid tissues (hodgkin disease & nonhodgkin disease)
what cell is specific to hodgkin disease
reed-stenberg cell: a distinctive tumor cell found w/ lymph biopsy
hodgkin disease
characterized by painless, progressive, rubbery enlargement of single node or group of nodes, usually around the neck (good prognosis)
nonhodgkin disease
neoplastic disorder of lymphoid tissue that spreads early (to liver, spleen & bone marrow), characterized by painless, superficial lymphadenopathy
multiple myeloma
plasma cell cancer (B cells), atypical proliferation of one of immunoglobulins “M protein” which increases osteoclast activity unable to maintain humoral immunity
multiple myeloma characteristics
bone pain/fractures, impaired production of RBC & WBC
hypercalcemia
hyponatremia causes
-GI loses
-renal losses (diuretics)
-skin loses (burns, wounds)
-fasting diets, polydipsia (water intox)
-excess hypotonic fluid
hyponatremia S/s
-confusion/altered LOC
-anorexia, muscle weakness
-can lead to seeizures/coma
with Na, think
brain
hyponatremia treatment
-Na replacement (slowly)
-PO/IV
-IV fluids
-treat underlying problem
for dilutional, fluid restriction
hypernatremia causes
-IV fluid
-near drowning
-not enough fluid intake or too much water loss
-profound diuresis
will not get from eating too much salty food
hypernatremia S/s
-altered LOC/confusion, seizure, coma
-extreme thirst (hypereosmolality)
-dry, sticky mucous membranes
-muscle cramps
hypernatremia
-if H20 loss, add water
-if Na excess, remove sodium
what is the main source of K+
diet
hypokalemia causes
-renal or GI losses
-acid base disorders
hypokalemia S/s
-cardiac rhythm disturbances (can be lethal)
-muscle weakness, leg cramps
-decreased bowel motility
magnesium
helps stabilize cardiac muscle cells by blocking K+
hypomagnesium causes
-GI or renal losses
-limited intake
-alc abuse
-pancreatitis
-hypergly
hypomagnesium S/s
-hyperactive reflexes
-confusion
-cramps
-tremors
-seizures
nystagmus
hypermagnesium causes
-increased intake accompanied by renal failure (chronic renal failure pt who take milk of mag, OB pt)
hypermagnesium S/s
-lethargy
-floppiness
-muscle weakness
-decreased reflexes
-flushed warm skin
-decreased pulse/BP
calcium think
bone & thyroid
K+ think
heart
hypocalcemia: positive chovstek’s
-ipsilateral twitching of the circumoral muscles in response to gentle tapping of the facial nerve just anterior to the ear eye will close if present
hypocalcemia: positive trousseau’s
-carpal spasm upon inflation of a BP cuff to 20 mmHg above the pt’s systolic blood pressure for 3 mins will see twitch
hypercalcemia causes
-hyperparathyroidism
-cancers (breast, lung, hematologic)
-tums overdose
hypercalcemia S/s
calcium acts like a sedative
-fatigue
-lethargy
-confusion
-weakness
-leading to seizures
-coma
what form of phosphorous is measured
inorganic (circulating and measured)
phosphate
-essential for ATP formation
-needed for glucose, protein, & fat metabolism
-part of DNA & RNA
hypophosphatemia causes
-decreased absorption
-antacid
-severe diarrhea
-increased kidney elimination
-malnutrition
hyperphosphatemia causes
-kidney failure
-laxatives
hyperphos S/s
-usually asymptomatic
-muscle spasms
-paresthesia
-tetany
(sim to hypoCa)
fungal transmission: implementation
tineas -> skin to skin touching
fungal transmission: inhalation
cryptococcal -> through air
fungal transmission: taking antibiotics
candidiasis
superficial fungal skin lesions
-tinea pedis/captitis/versicolor
-candidiasis
tinea corporois
ringworm of the body
tinea pedis
athlete’s foot - dry, scaling pruritic lesions
treatment: topical anti fungals
tinea versicolor
skin on the upper chest, back or arms - rash - risks are hot climates, sweating, oily skin, weakened immune system not contagious
treatment: topical anti fungal including shampoos
tinea capitis
hair (cradle cap) - scaly erythematous lesions and hair loss
treatment: PO systemic anti fungals
tinea cruris
ringworm of the groin
herpes zoster is
shingles , activated by immunosuppression, stress or illness
treatment: anti virals
prodrome
burning/tingling along dermatome & then rash develops w/ vesicles that dry and crust over
bacteria skin infections
-impetigo
-abscess
-furuncle
-cellulitis
-MRSA
impetigo
-causative agents: staph & strep
-acute & contagious
-appearance: vesicles, pustules, crust
-treatment: tropical antibacterial (bactroban)
abscess
-inflamed skin w/ pus
-tender
-treatment: incision & drainage -> antibiotics
furuncle
bacterial infection of hair follicle
treat w/ I&D -> PO antibiotics
carbuncle
painful, deep swelling of the skin caused by bacteria
treat w/ I&D -> antibiotics
cellulitis
-causes: bacteria infection of skin & surrounding tissues (initial wound becomes infected)
-not contagious (possible bite)
-appearance: red, swollen, warm
-treatment: PO systemic antibiotics, IV based on severity
MRSA high risk
high school wrestlers, child care workers, & people who live in crowded conditions
MRSA treatment
-hospital: IV vancomycin or zyvox
-community acquire: bactrim or dicloxacillin
prophylaxis
bactroban nasal ointment prior to surgery
actinic keratosis
-benign lesions
-d/t damage by sun’s UV rays
-common in fair skin persons
-rough, scaly, red plaques
solar lentigos
-benign lesions
-also known as liver/age spots
can indicate cancer risk
skin cancer: basal cell
most common, least often malignant (usually won’t be problematic)
-sun
-translucent, shiny, pearly nodule -> ulcer
skin cancer: squamous cell
2nd most common, can metastasize to remote areas
-sun
-curable if early treatment
-red & scaling, slightly elevated lesion, irregular border, shallow
skin cancer: melanoma
rarer, but high rates of metastasis
-can spread to epidermis & dermis
-risks: blonde/red hair, freckles upper back, blistering sunburn before 20, outdoor job as a teenager
pulmonary embolism
most serious DVT complication
the thrombus becomes lodged in our permanent pulmonary circulation preventing gas exchange
chronic thromboembolic pulmonary HTN
rare, most common symptom is SOB
caused by repeated clots in the lung which causes increased pressure in the lung circulation
post thrombotic syndrome
8-70% of pt who have DVT/VTEs can develop
related to chronic inflammation & chronic venous htn
causes damage to the vein walls leading to pain, achy, fatigue, sensation of swelling, cramps, itching, parenthesis, bursting pain w/ exercise, color change
phlegmesia cerula dolens (pain blue inflammation)
when clots are in your major leg veins and they become totally occluded sudden massive swelling w/ deep pain
-can lead to amputation or gangrene
what is the first sign of a GI tract disorder
diarrhea
episodic diarrhea
intermittent food allergies or irritant (like caffeine)
osmotic diarrhea
increased amounts of osmotically active solutes (**epsom salt & mag sulfate), water rushes into the colon area resulting in diarrhea
tube feeding
secretory diarrhea
causes by some kind of bacteria or toxin which increases secretion & inhibits reabsorption of water in the gut bacteria: vibrio cholerae & staph aureus
exudative diarrhea
active sites of inflammation in the bowel lumen that results in excitation of mucus, blood & protein from those sites open internal wounds, water gets pulled into the intestines leading to diarrhea Crohns & UC
diarrhea related to motility disturbances
result of decreased absorption in the small intestine so large amounts of fluid will be delivered to the colon gastrectomy, dumping syndrome & IBS
hypersen: type 1
-allergens
-IgE on Mast Cells
-Mediator release
allergic rhinitis, asthma, urticaria
hypersen: type 2
-IgG and IgM antibodies
-attach cells (on surface, leads to cell death)
-cell lysis
wrong blood given, newborn/mother Rh incompatibilliaty, autoimmune disorders
hypersen: type 3
-IgG or IgM antibodies
-accumulate in tissues (deposits)
-inflammation
arthritis, glomerulonephritis, lupus
hypersen: type 4
-delayed Tcell activation
-cytokines
-48 to 72 hr peak
contact dermatitis, tuberculin
opioid onset, peak & duration
onset: 12-24 hr
peak: 72 hr
duration: less @1wk
benzo onset & peak
onset: 6-12hr
peak: 2 wks
alc onset & peak
onset: 8 hr
peak: 1-3 day
treatment for benzo & alc withdrawal
-thiamine
-lorazepam
-diazepam
