Patho Final Study Guide Flashcards
Right sided heart failure
leads to dependent edema, enlarged organs (liver or spleen), decreased appetite, or ascites.
Dependent edema: whatever part of the body is lowest. If lying flat could be peripheral edema. Is standing up could be peripheral lower extremity edema
Left sided heart failure
leads to pulmonary edema, dyspnea, orthopnea, paroxysmal nocturnal dyspnea, fatigue, weakness, restlessness, anxiety, bronchospasms, or wheezing.
Advanced heart failure
may lead to Cheyne-Stokes respiration, sleep apnea, blood clot formation due to sluggish blood flow, depression, and/or declining mental function
Physical Exam of HF
crackles, wheezes, presence of S3 and S4, cyanosis, jugular venous distention, weight gain, edema
Serum analysis for people with HF?
CBC to look for anemia or infection as possible causes
Urinalysis for proteinuria which is associated with CV disease
Electrolytes for fluid retention or renal dysfunction
BUN/Creatinine for possible reduction in renal blood flow, look at them together, not just one or the other
Fasting blood sugar: elevated levels increase risk of heart failure
Liver function tests to evaluate liver function
Natriuretic peptide (B-type) increases in heart failure and are closely associated with NYHA classifications IMPORTANT TO KNOW: (normal values are less than 100 pg/mL)
Pharmacologic Meds for heart failure
may include any single or combination therapy of the following classification of drugs:
ACE inhibitors: interrupt conversion of angiotensin 1 to angiotensin 2, decreasing cardiac work and increasing cardiac output improving blood flow
Angiotensin 2-receptor blockers: block the action of angiotensin 2 with similar effects
Beta-blockers: block the beta receptors inhibiting the sympathetic nervous system slowing heart rate and lowering blood pressure. These may also reduce the force of contraction causing more problems, but when used with ACE inhibitors may improve outcomes.
Diuretics: relieve symptoms of fluid overload
Vasodilators: relax the smooth muscle of the vessels, reduce afterload, and reduce the work of the heart
Digitalis preparations: positive inotropic effect improving contractility, slows conduction and increases fill time of the ventricles.
Oxygen therapy: to promote adequate oxygenation.
It is important to note that treating and managing co-morbidities is also important in managing heart failure.
Oliguria
Oliguria is when urine output is lower than expected.
anuria
absent urine
syncope
fainting
phlebitis
pain, redness along the vein, discontinue IV, apply a warm compress
Atrial fibrillation, or AFib
occurs when many unstable electrical impulses misfire and may result in the atria quivering out of control.
Ventricular fibrillation:
can stop the heart from beating and cause cardiac arrest. It occurs in the ventricles, which are unable to pump blood out of your heart to the body and brain due to the irregular heartbeat.
beta 2 agaonis is for acute asthma attack and they all end In
-erol
what would we give with someone with hyperkalemia
kayexalate
- insulin
- sodium bicarbonate
- calcium gluconate
hypernatremia
too much sodium
What does the RAAS system do?
rennin and angiotensoin response to BP and causes vasoconstriction
-aldosterone hold onto sodium or water
treatment for hyponatremia
LR
or normal saline if they are NPR
Hypocalcemia
this the chvostek’s and trusseas
- tingling of the mouth is common
- risk of bleeding and fractures
- cardiac dysrhythmias
Hypercalcemia
"moans grons and stones" Administer biphosphonates - bone pain -severe muscle weakness -Decreased DTR -kidneys stones
calcium role
adds strenth to bones and teeth
cofactor in blood clotting
and essential ni muscle contraction
Ataxia
isa degenerative disease of the nervous system. Many symptoms of Ataxia mimic those of being drunk, such as slurred speech, stumbling, falling, and incoordination. These symptoms are caused by damage to the cerebellum, the part of the brain that is responsible for coordinating movement.
Aphasia
loss of ability to understand or express speech, caused by brain damage.
Dysphagia
swallowing difficulties. Some people with dysphagia have problems swallowing certain foods or liquids, while others can’t swallow at all. Other signs of dysphagia include: coughing or choking when eating or drinking. bringing food back up, sometimes through the nose.
Dysarthria
a motor speech disorder inwhich the muscles that are used to produce speech are damaged, paralyzed, or weakened. The person with dysarthria cannot control their tongue or voice box and may slur words.
What can we do to prevent stroke?
Antiplatelet agent- prevents the formation of new clots usually warfin
Management of hypertension - taking thiazide diuretic, calcium channel blocker and ACE or ARBS
- controlling cholesterol
-statins
Diabetes: risk factors?
Diabetes: risk factor, complications
risk factors
Family History of diabetes (parents, siblings)
Obesity
African Americans, Hispanics Americans, Native Americans, Asian American, Pacific Islanders (Type 2, Type 1 whites are more likely)
45 years or older
Previously identified impaired fasting glucose or impaired glucose tolerance
Hypertension
High cholesterol and/or triglycines
History of gestational diabetes of baby over 9 pounds
Diabetes complications
DKA (Diabetic Ketoacidosis)
Will have:
Hyperglycemia: will lead to dehydration and loss of electrolytes
Ketosis: rapid breakdown of your energy stores from your muscles and your fat deposits d/t lack of insulin. (Liver converts amino acids to glucose and converts fatty acids to ketones)
Metabolic acidosis: excess of keto acids that have bicarb ion. Bicarb is going to these ketones and there’s a decrease in serum bicarbs. If you have decrease in serum bicarb, you’re putting your body into metabolic acidosis.
Definitive Diagnosis BG levels >250 mg/dL Low serum bicarbonate Low atrial pH Positive urine and serum ketones
Symptoms Polyuria, polydipsia, polyphagia Nausea, vomiting, fatigue Stupor that can progress to a coma Fruity smelling breath (rotting fruit) Hypotension and tachycardia
DKA vs. HHS (Hyperglycemic Hyperosmolar state)
DKA: Lower blood glucose levels and Ketoacidosis
HHS: No ketoacidosis (because there’s still insulin being made)
hyperglycemia in the AM
Dawn phenomenon
Rise in blood glucose between 5am-9am
Not sure the exact reason. Maybe because at night there’s an increase in growth hormone and metabolism. That naturally causes increase in blood glucose.
When they wake up, they have hyperglycemia
Somogyi effect
Happens d/t rebound hypoglycemia
If they have nighttime insulin or diabetes med and don’t have a snack. *Very important for someone with diabetes to have a snack before bed
Will have hypoglycemia in middle of the night. Body tries to compensate and increases blood glucose and causes hyperglycemia.
To figure out if patient has Dawn phenomenon or Somogyi effect, check blood sugar in middle of night.
Dawn = normal blood glucose
Somogyi = hypoglycemia
To figure out if the patient has Dawn phenomenon or Somogyi effect
check blood sugar in middle of night.
Dawn = normal blood glucose
Somogyi = hypoglycemia
Both will have hyperglycemia in the AM
HTN- # stages
, American College of Cardiology Normal BP <120/80 Elevated BP 120-129/<80 Stage 1 hypertension 130-139/80-89 Stage 2 hypertension ≥140/≥90 Hypertensive Crisis >180/>120
HTN- prevention
Controlling weight
Structured physical activity
Low sodium diet with** potassium supplementation within the diet, more vegetables, fruits and grains*****
Alcohol consumption should be no more than 2 drinks per day men and 1 drink per day for women
hypotension
isotonic fluids
COPD is a
combination of disorders and may be used as a catch all diagnosis for those with either chronic bronchitis or emphysema
incentive spirometer
what I used after surgery
- used to exercise lungs get ball to certain point
spritgtromy
inhale and exhale
Emphysema
air trapping (decreased airflow with expiration) large alveolar sacs and the bronchial inflammation and mucus and bronchial tubes, they’re not able to get air through
chronic bronchitis
inflammation of the mucous membranes of the Bronchial tubes that’s longer than 3 months
risk factors of COPD
risk factors
Smoking (most common)
Occupational irritants: people working in dry cleaning with toxic chemicals, work in mines, construction workers, oil field/rig workers, agriculture, chemicals with lawn care, people that live next to farms
history of asthma
non-cardiac conditions that cause heart failure
CAD Chemo valve disorders hyper hypothyroidism Fever infection massive PE lung disease
COPD stages
COPD Manifestations:
Mild COPD or stage 1
FEV1 about 80% or more of normal
slight limitations to activity
COPD Manifestations:
Moderate COPD or Stage 2
FEV1 between 50 and 80% of normal
Increased coughing and breathing difficulty
COPD Manifestations:
Severe COPD or Stage 3
Severe emphysema with a FEV1 between 30 and 50% of normal
COPD Manifestations:
Very severe COPD or Stage 4
or end stage COPD with a lower FEV1 than stage 3 or people with blood oxygen levels and a stage FEV1
Profound changes to quality of life
Emphysema symptoms
Dyspnea: first symptom Minimal cough Air trapping and hyperinflation cause barrel chest Thin Tachypneic Pursed lip breathing "barrel chest"
Treatment of COPD
medications used and their purpose
Vaccinations to prevent infection (flu and pneumonia)
COVID may be added to this
Supplemental oxygen
supplement what’s not going in or to compensate for some of that mismatch that may be going on
Target is 80 to 92% depending on age of the person and severity of disease
most people will be at 90-92% unless it’s a severe disease or they are getting older. Might go as low as 88%
Healthy people are usually around 98-100%
Targeting is 2 liters per minute of oxygen if they require supplemental oxygen, could go as high as 4, but generally its 2
Percussion. Vibration and postural drainage
Will help mobilize those secretions to help them expel and expiate those so they don’t develop pneumonia and further worsening of their condition
Complications of CKD
SOB gastric ulcers dialysis metallic taste -air embolism
Asthma- s/s early SIGNS ,
Chronic lung disease that causes narrowing of the airways (Bronchi and Bronchioles)
They are chronically inflamed
shortness of breath (easily fatigued with physical activity)
frequent cough (night) and issues sleeping
s/s similar to cold, sneezing, scratchy throat, tired
irritable
wheezing with activity
if using a peak flow meter, reading is reduced
what part of the brain regulates emotions
lymbic
axomtomia means increased BUN
true
Arterial ulcersdevelop as the result of damage to thearteriesdue to a lack of blood flow to the tissue.
S/S red, yellow, or black sores. deep wound. tight, hairless skin. leg pain at night. no bleeding. the affected area is cool or cold to touch from minimal blood circulation. leg reddens when dangled and turns pale when elevated.
Venous ulcersdevelop from damage to the veins caused by an insufficient return of blood back to the heart. Unlike otherulcers, theselegwounds can take months to heal, if they heal at all
S/S
Shallow sore with a red base, sometimes covered by yellow tissue.
Unevenly shaped borders.
Surrounding skin may be shiny, tight, warm or hot, and discolored.
Leg pain.
If the sore becomes infected, it may have a bad odor and pus may drain from the wound.
Comfort
