Patho Exam 4 Flashcards
effect of post renal obstruction in kidney
Hydronephrosis
main cause of stroke
thrombosis (ischemic stroke) is more common than hemorrhagic stroke
rhythmic jerking of major muscle groups
clonic seizure (vs tonic clonic seizures aka change from jerking to either full on fixed in position to the jerking aka GRAND MAL)
sign of basilar skull fracture
-CSF (clear fluid) leaking from nares or ears
-Raccoon eyes (black eyes bilaterally)
first indication of increased ICP
decreased LOC
hypotonic IVs cause water to move…
Into the cells
sign of AKI (acute kidney injury)
oliguria aka low urine output- less than 30mL per hr
pH 7.50, PCO2 50, PO2 85, HCO3 35, SaO2 95
metabolic alkalosis
burns, crush injury, CKD, CHF, ACE, ARB, NSAID use
hyperkalemia
(bc kidney injuries impact potassium bc muscles need potassium to function)
signs of cerebellar dysfunction
poor coordination & abnormal gait aka ataxia
common cause of metabolic acidosis
DKA (Diabetic ketoacidosis)
definition of hyrdonephrosis, kidneys are
swollen/edematous & distended
CKD, DKA, burns, diarrhea, vomiting, fever dehydration, DI (diabetes insipidus), increased dietary intake
hypernatremia
(bc increased dietary intake & diarrhea are key words)
absent bowel sounds, hypotension, bradycardia, absent or weak DTRs
signs of spinal shock
this can cause bone pain, arrhythmia, kidney stones, GI upset
hypercalcemia
periorybital edema, proteinuria, oliguria are signs of this
glomerulonephritis
this metabolic factor can increase cerebral blood flow causing an increase ICP
PCO2 increase
(decrease blood flow to brain will increase ICP)
buildup of nitrogenesis waste in the blood
azotemia
neurotransmitter decreased inmysento gravis
acetylcholine (ACH)
Most common pre-renal injury to the kidney
hemorrhage, hypovolemic shock
how does body respond to acid base balance
buffer
difficulty speaking
dysphasia (partial loss vs aphasia is full loss)
electrolyte abnormality causes muscle spasms, cramps, paresthesia
hypocalcemia
cause of anemia in CKD
low level of erythropoietin
problem w/ Guillain Barre Syndrome
respiratory is priority due to paralysis
signs of waste build up in the blood stream
uremia
pH 7.50 pCO2 55 PO2 55 HCO3 31 SaO2 92
metabolic alkalosis
physical signs of compensation for metabolic acidosis
hyperventilation - rapid & deep respirations
priority system to assess w/ potassium abnormality
cardiovascular system
NSAIDs, CKD, diuretics, CHF, increased water intake can cause abnormalities w/ this electrolyte
Hyponatremia
sports & head injury w/ brief LOC but normal near assessment
concussion
feet & wrists flexed, elbows extended
decerebrate posturing
(deCORticate posturing = pulled into the CORe)
excessive sweating, vomiting, diarrhea, diuretics, poor dietary intake, CKD, alcoholism are risk factors for this electrolyte abnormality
hypokalemia
labs used to monitor kidney function
BUN, creatinine, GFR
risk factors for respiratory acidosis
spinal cord, brain injury, opioids/narcotics bc reduced RR
example of isotonic IV
Normal Saline 0.9%
condition of intermittent exacerbation of musculoskeletal weakness and remission
MS (Multiple sclerosis)
causes of urinary tract obstruction
-BPH
-Renal calculi
hypertonic solution move water…
Out of the cell
what provides collateral circulation to the brain
Circle of Willis
(good & bad things; bad thing is most common site of aneurism)
if pH is elevated, will there be increased or decreased hydrogen ions present?
decreased
what would you call it when a pt is looking at you but nothing else (spells of staring)
absence seizure
What important renal enzyme is released in response to decreased blood flow to the kidneys resulting in increased blood pressure and sodium retention?
Renin
What hormone is produced by the kidneys that stimulates Red Blood Cell production?
Erythropoietin
normal pH level
7.35 - 7.45
this is inactive if you have poor renal function which can cause what
Vit D
which can cause hypocalcemia
Decreased blood flow and perfusion to the kidney
pre renal dysfunction
(occurs bc of reduced CO or severe hypovolemia or shock….not enough fluid pumping to kidneys AKA DECREASED PERFUSION)
Actual injuries to the kidney
intra renal dysfunction
(occurs d/t damage to renal tissue. Trauma or toxic injury d/t nephrotoxic medications, kidney infections, systemic illnesses that affect the kidneys such as NSAIDS, post streptococcal glomerulonephritis, HTN, DM (direct damage to kidney due to trauma, infection, disease)
Obstruction of urine outflow from the kidneys
post renal dysfunction
(obstructive uropathy, kidney stones, prostate gland enlargement, bladder cancer…obstruction, not allowing the flow out of the kidneys, causes backflow…this can lead to hydronephrosis)
Normal BUN (Blood Urea Nitrogen level)
& what can affect BUN level?
5-20 mg/dL
BUN can be high or low based on hydration status (look at gravity – it tells you dehydration)
Can be seen in those with extremely muscular individuals (athletes) and high protein diets bc of high muscle breakdown. Muscle cell proteins break down into amino acids which are nitrogen compounds.
low albumin means low this
low protein
pre vs intra vs post renal
Prerenal (most common): decreased perfusion
Intrinsic: medications, infections
Postrenal: obstruction
edema w/ fluid leakage after you move your finger print
Anasarca
this it the destruction of RBCs
in CRF- it is not regulating RBC production
hemolysis
this is a complication in CRF that is confusion, coma, death
Encephalopathy
this is the renal blood filtered per unit of time
GFR (glomerular filtration rate)
this is combination of clinical findings that occurs when the glomeruli are damaged. When glomeruli are injured, they become hyperpermeable to protein and the substances in the blood stream … the is significant protein loss (proteinunira), hypoalbuminia, hyperlipidemia)
nephrotic syndrome
this involves the spinal cord and cortex of the brain to control voiding.
Micturition reflex
Hydronephrosis vs hydroureter
Hydroureter - dilation of the ureter caused by obstruction.
Hydronephrosis - distention of the renal calyces and pelvis as a result of obstruction of the outflow of urine distal to the renal pelvis. Can cause kidney tissue damage
(We can reverse hydronephrosis, but usually cant if hydroureter)
Force of fluid pressure in bloodstream
hydrostatic pressure
Pressure by solutes in solution
osmotic pressure
“colloid pressure”
pressure due to albumin in blood
oncotic pressure
Concentration of solutes/kg solution
osmolality
Number of osmoles of solute per liter of solution
osmolarity
this is an example of isotonic solution
Lactated ringers – temporary replacement for blood
NS 0.9% saline
this is an example of hypertonic solution
3% NaCl
ICF to ECF so cells shrink. This is more rare bc it’s dangerous to use. Used in ICU or surgery sometimes. Used for cerebral edema (swelling in brain)
this is an example of hypotonic solution
0.45% NaCl
(ECF to ICF to treat dehydration. Causing cells to enlarge)
dehydration causes this
Decreased circulating blood volume leads to tachycardia and hypotension
causes of dehydration
-Reduced fluid intake
-Reduced ADH or kidneys not responsive to ADH
-Burns, fever, perspiration
-Osmotic diuresis, as occurs with elevated blood glucose levels
Hypernatremia
Na / K pump
Sodium = extracellular electrolyte
Potassium = intracellular electrolyte
The Na/K pump is constantly at work trying to retain K in the cell and move Na outside of the cell.
**3 Na out, 2 K in
low sodium levels
Hyponatremia
(Low sodium is less than 135)
s/s of hypovolemic hyponatremia
& treatment?
& cause?
thirst, dry mouth, orthostatic hypotension, tachycardia, azotemia (high BUN), oliguria,
h/a, lethargy, apathy, confusion, h/v/d, muscle cramps/spasms
**burns, fistulas, wounds, diarrhea, vomiting cause this
treatment : Slow replacement of sodium with adequate fluid (an isotonic fluid 0.9% normal saline)
high levels of sodium
hypernatremia
High sodium = greater than 145
s/s of hypernatremia
& treatment?
Fluid overload: hypertension, edema, weight gain
no fluid overload: Dehydrated, thirst, tachycardia, oliguria
treatment: fix the underlying cause
s/s of hypokalemia
& treatment?
cause?
s/s = Anorexia, cardiac arrhythmias, leg cramps
cause of it: NPO status, etoh abuse. Bariatric surgery (malabsorption due to decreased stomach size). Eating disorders.
treatment: Replace potassium at acceptable rate, Rapid K+ infusion can cause cardiac arrest
s/s of hyperkalemia
& treatment?
& cause?
s/s = Numbness/tingling, cramping, diarrhea, apathy, mental confusion.
**cause = decrease in renal perfusion, such as decreased cardiac output, will diminish the kidney’s ability to excrete K. Can also occur d/t major muscle trauma b/c K is released rapidly from muscle cells.
treatment: depends on cause, but possibly diuretic
s/s Hypercalcemia
(Greater than 10 mg/dL)
-Decreased Neuromuscular excitability
-Constipation
-Renal calculi
-Ventricular arrhythmia
-Hyperreflexia
s/s hypocalcemia
(less than 8.7 mg/dL)
-neuromuscular excitability
-Paresthesia
-Weakness
-Bone pain/fragility/dry skin/hair
-hypotension
-cardiac arrhythmias
-Chvostek’s Sign (facial twist when touching face)
-Trousseau’s sign (weird hand spasms from bp cuff)
how does the buffer system work ?
Donating H+ when solution is too basic
Absorbing H+ when solution is too acidic
normal pCO2 levels
35 - 45 mmHg
normal HCO3 levels
22 to 26
respiratory compensation means what?
increased ventilation
metabolic (renal) compensation means what?
adjust HCO3 and H+
metabolic vs respiratory (which is same/different)
metabolic - same
respiratory - different
elevated CO2
aka hypoventilation
respiratory acidosis
reduced CO2
aka hyperventilation
respiratory alkalosis
Elevated acid other than CO2 (i.e., ketones)
metabolic acidosis
Excess base or loss of H+ ions
metabolic alkalosis
compression of lower spinal nerves causing bowel/bladder dysfunction and leg weakness
cauda equina syndrome
Hypoventilation vs hyperventilation
Hypoventilation can be caused by CNS depression (sedation, given pain meds etc) can’t get rid of enough CO2 - respiratory acidosis
hyperventilation can be caused by CNS stimulation or excitation…. gets rid of too much CO2 bc you’re blowing it off way too fast - respiratory alkalosis
s/s of respiratory alkalosis
anxiety
restlessness
pain
CNS excitation
increased VS
normal or decreased BP
cardiac problems
electrolyte imbalances
s/s of respiratory acidosis
CNS depression
respiratory distress
decreased BP but increased VS
Increased respirations, tachycardia, hypotension, confusion
metabolic acidosis
Confusion, dizziness, weakness, diarrhea
metabolic alkalosis
pt has severe asthma, what is going on ?
respiratory acidosis is occurring … so pt will hyperventilate (respiratory alkalosis will happen!) to compensate
signs of increasing ICP?
-Decreased level of
-consciousness
-Pupillary dilation
-Headache
-Vomiting
-Papilledema
-Increased BP
-Cushing’s triad: (Hypertension, Widened pulse pressure,
Bradycardia,
Abnormal respiratory pattern)
The Glasgow Coma Scale (GCS) is based off what 3 things
- Eye opening
- Verbal response
- Motor response
Lowest GCS: 3 (coma!)
Highest GCS: 15 (normal)
2 types of posturing
- Decorticate
(Flexed arms, clenched fists, rigid legs)
**Corticospinal tract damage
2.Decerebrate
(Arms held straight outward with toes pointed downward)
**Upper brainstem damage SO WORSE!
Bleeding in space below the dura mater,
Usually due to tearing of bridging veins in subdural space,
Most common type of traumatic intracranial hematoma…
Slow bleeding, but blood can accumulate over time
Acute: within 72 hours after head injury
Subacute: take up to 7 days
SDH (subdural hematoma)
2 types of these:
traumatic one of these: 1 of most common head injuries, Tearing of cerebral & meningeal vessels within subarachnoid space,
Post-traumatic cerebral vasospasm in response to blood
Aneurysmal one of these:
-Weakened area of vessel, may rupture
“Berry aneurysm”
In 50% of cases, symptoms precede rupture
“Thunderclap headache” and has
Rapid decline.
-Rupture of artery causes blood to fill subarachnoid space,
Blood irritates tissues and puts pressure on brain, can cause obstructive hydrocephalus,
Pressure may cause brain herniation
Subarachnoid Hemorrhage (SAH)
Spinal nerves at end of spinal cord
Cauda equina
the temporary loss of reflexes
areflexia - sign of spinal shock!
Results from primary injury,
Flaccid muscles, paralysis, lack of sensation below injury, bowel & bladder dysfunction,
Loss of the anal reflex or bulbocavernosus reflex, (Contraction of the anal sphincter with squeezing of the glans penis or tugging on a Foley catheter),
Autonomic function also disrupted
Areflexia which is due to
Spinal shock
this type of shock occurs in patients with injuries at T6 and above
neurogenic shock
affects Speak language,
Expressive aphasia if there is dysfunction of this area
Broca’s area
Comprehend (understand) language,
Receptive aphasia if there is dysfunction of this area
Wernicke’s area
this is the base of brain,
Formed by posterior cerebral artery & internal carotid,
Common site for aneurysms (weakness in arterial wall)
Circle of Willis
2 types of stroke, which is most common?
ischemic (most common which is thrombus or embolus) and hemmoraghic stroke (rupture of cerebral artery)
mini stroke , no permanent injury but can warn future stroke is coming
Transient ischemic attack (TIA)
risk factors for ischemic stroke vs risk factors for hemorraghic stroke
ischemic:
-Afib
-carotid stenosis
-cerebral arteriosclerosis
hemorrhagic:
-hypertension
-oral anticoagulation
-cerebral aneurism
which stroke is more deadly?
Hemorrhagic stroke - occurs when a cerebral artery ruptures & can no longer bring blood to the brain tissue (less common than ischemic)
hypertension, bradypnea, and bradycardia are signs of what
Cushing’s triad aka pressure on brain stem
risk factors for stroke
Hypertension (HTN)
Hyperlipidemia
Diabetes
Smoking
Obesity
Lack of exercise
Atrial fibrillation
Oral contraceptives
Excess alcohol
Family history
Age 55+
Gender
Male risk is greater than female
Ethnicity
African American risk is greater than Caucasian
Sickle cell disease
Transient ischemic attack (TIA)
Amyloid accumulation
This causes a thunderclap headache (comes out of nowhere, most severe headache that causes n/v even seizure, stiff neck, etc)
SAH (Subarachnoid hemorrhage) = brain bleed
how to know if someone had stroke
(FAST)
Facial droop
Arm weakness
Speech difficulty
Time to call 911
spinal injuries
Higher injuries (e.g., C4) may need ventilatory support, while lower injuries might require mobility aids.
this disorder is the degeneration of myelin
MS
if this is positive, toes flare up and show a upper motor neuron disorder
Babinski reflex
Orthostatic hypotension, sleep disturbances, GI disturbances and impaired thermoregulation are symptoms of what?
Bradykinesia (slowing muscle movements), resting tremors, muscle rigidity is the classic triad
Parkinson’s neurodegeneration disorder
Progressive neurodegenerative disorder characterized by loss of upper and lower motor neurons
Symptoms include painless muscle weakness and atrophy
ALS (Amyotrophic Lateral Sclerosis)
Weakness, numbness, balance problems, blurred vision
Dysphagia, hemiparesis, paraparesis may develop with this disorder
MS
Postinfectious disease
Acute inflammatory demyelination
Weakness varies from mild weakness to complete paralysis, including respiratory muscles
Guillain-Barré Syndrome (GBS)
Autoimmune neuromuscular disorder that can occur at any age.
ptosis is the first sign!
Caused by loss of ACH receptors in neuromuscular junction
Muscle weakness and fatigue
Myasthenia Gravis (MG)
fluid accumulates in cavities without fluid such as pericardial sac, peritoneal cavity, pleural space
third spacing
what causes anemia in CKD?
Low EPO levels cause your red blood cell count to drop and anemia to develop
hypovolemeia vs hypervolemia
& causes!
hypovolemia = condition that occurs when your body loses fluid, like blood or water. (dehydration is a cause)
hypervolemia = too much fluid in your body
(heart failure, kidney failure, cirrhosis causes this)
s/s of brain herniation
-Irregular or slow pulse.
-Severe headache.
-Weakness.
-Cardiac arrest (no pulse)
-Loss of consciousness, coma.
-Loss of all brainstem reflexes (blinking, gagging, and pupils reacting to light)
-Respiratory arrest (no breathing)
