patho test #1 Flashcards
1
Q
pain pathway
A
afferent - brain interprets - efferent
2
Q
A-delta
A
fat and purposeful - acute pain that helps us from gettin g hurt
3
Q
c-fiber
A
slower- chronic pain - ongoing or intermittent
4
Q
pain facilitators
A
glutamate, substance P, histamine, prostaglandin, bradykinin
5
Q
pain inhibitors
A
opioids, GABA, cannabinoids, serotonin, norepinephrine
6
Q
GABA is ______ when drinking
A
depressed
7
Q
acute pain is a response from
A
the sympathetic nervous system
8
Q
chronic pain
A
pain without a sympathetic response
9
Q
impulses synapse at
A
dorsal horn
10
Q
facilitators are also known as
A
excitatory
11
Q
what do excitatory neurotransmitters do
A
increase sensitivity and responsiveness and respond to injury and inflammation
12
Q
endogenous opioids
A
morphine like neuropeptides - mu, kappa, and delta
13
Q
what do endogenous opioids do?
A
prevent opening of ion channels - slows pain response and digestion
14
Q
patients on pain meds are usually constipated. what neurotransmitter causes that?
A
mu
15
Q
endocannabinoids
A
phospholipids - modulate pain, sleep, immune function, appetite, and stress response
16
Q
pain is
A
highly subjective
17
Q
pain threshold
A
minimum stimuli needed to recognize pain. is similar amongst individuals
18
Q
perceptual dominance
A
what’s bothering them the worst is what a patient will tell you about, but still do a full assessment incase there is something else wrong
19
Q
what can increase pain threshold
A
sexual activity and acupuncture which increases neuromodulators
20
Q
pain tolerance
A
the most amount of pain one can endure. varies among people and can vary depending on what the person is going through
21
Q
what can lower pain tolerance
A
anger, anxiety, depression, isolation, chronic pain, tiredness
22
Q
what can raise pain tolerance
A
diversion, rest, alcohol, medications, and culture
23
Q
acute pain
A
sudden and responsive to treatment
24
Q
acute on chronic
A
exacerbation of pain will take 20-40% more opioids
25
chronic pain
persistent and reoccurring. greater than 3 months, and resistant to pharmacological treatment
26
somatic pain
msk pain give NSAIDs
27
visceral
organ pain give opioids
28
opioid naive
either haven't had them or haven't had them in a really long time. exacerbated drug response and side effect due to lack of exposure to drug
29
opioid tolerant
adapted state of repeated drug exposure resulting in decreased efficacy of drug - it will be difficult to achieve desired response to pain
30
PCA
patient controlled analgesia
31
PCA by proxy
when someone else that is not the patient pushes the button - not good
32
ER vs IR
extended release and immediate release
33
breakthrough pain
severe pain that erupts while the patient is already medicated with a long acting painkiller - should use IV or IR for it
34
adjuvant
a agent that modifies the effect of other agents - used to decrease the amount of opioids used
35
examples of adjuvants
NSAIDs, antidepressants, anti epileptics, corticosteroids
36
sign of opioid withdrawal
N/V, HTN, tachycardia, pain, sometimes seizures
37
number one cause of acute kidney injury
sepsis because of decrease percussion to the kidney
38
oliguria vs anuria
oliguria - under 400 mL urine per day
| anuria - without urine
39
causes of acute kidney injury
sepsis, ischemic injury, and toxic injury
40
kidney labs during acute kidney injury
increased creatinine, increased BUN, decrease GFR
41
can acute kidney injury be reversed
yes
42
what does acute kidney injury cause
inflammatory response, vascular response, and cell death
43
signs of acute kidney injury
hyperkalemia, hypermagnesemia, hyperphosphatemia, metabolic acidosis
44
uremia vs azotemia
uremia - a syndrome of renal failure and includes elevated blood urea and creatinine levels accompanied by fatigue, anorexia, nausea, vomiting, pruritus, and neurologic changes
azotemia - characterized by increased blood urea nitrogen levels and frequently increased serum creatinine levels. Renal insufficiency or renal failure causes azotemia.
45
normal BUN level
8-20
46
normal creatinine
0.7-1.4
47
what happens when bodys compensates with H+
causes potassium to leave the cell and causes even more potential to have hyperkalemia
48
prerenal acute renal injury
involves the heart and decreased cardiac output not HTN this causes inadequate renal perfusion
49
causes of prerenal acute renal injury
hypovolemia/hypoperfusion, sepsis, cardiac insufficiency (decreased cardiac output), and arterial renal stenosis
50
how do you treat prerenal acute renal injury
identify cause and treat the cause and increase BP
51
what happens to GFR, renin, ADH, and NA/h2o during prerenal acute renal injury
decrease GFR and increased renin and ADH. Na and H2O retention
52
opioid overdose death usually from
respiratory depression
53
what would you be likely to see during an assessment of an opioid overdose
low RR
54
harmful AE from morphine
hypotension
55
what electrolyte can cause cardiac arrest if you give it too fast
potassium
56
wrong concentration of what electrolyte can put pt into acute exacerbation of heart failure
sodium
57
intrarenal acute kidney injury
problem inside the kidney
58
causes of intrarenal acute kidney injury
tubular necrosis caused by HTN, bilateral pyelonephritis, DIC, myoglobin, ischemia, toxicity
59
DIC
disseminated intravascular coagulation - is a condition in which blood clots form throughout the body, blocking small blood vessels
60
postrenal acute kidney injury
problems effecting the kidney after the kidney
61
what can cause postrenal acute kidney injury
bilateral obstruction - stones obstructing
BPH
neurogenic bladder - bladder not voiding on own
62
intrarenal acute kidney injury treatment
antibiotic to get rid of infection
63
goals for acute kidney injury
identify cause and prevent injury, fluid and electrolyte balance, BP regulation, prevent infection, make sure medications aren't nephrotoxic
64
what can the progression of renal failure lead to
progressive cell death
65
what happens when the kidney is recovering
function is restored but cannot concentrate, polyuria with Na, H2O, and potassium loss, fluid and electrolyte imbalance
66
how long can kidney recovery take
3-12 months
67
examples of dietary sources of potassium
spinach, tuna, strawberry, cucumber, banana, avocado, mango
68
hypotonic
not enough salt in blood
69
hypertonic
too much salt in blood
70
#1 body system effected by altered sodium level
brain
71
hypokalemia symptoms
irregular pulse and dysrythmias with flattened t and u waves, GI upset, and myalgias to paralysis with respiratory failure
72
myalgias
muscle aches
73
hyperkalemia
peaked Ts with widening QRS, myalgias, paralysis, GI upset
74
hyperkalemia treatment
sodium polystyrene sulfonate, calcium gluconate, IV insulin/dextrose, hemodialysis
75
calcium replacements
carbonate, gluconate, chloride
76
GFR
best lab for renal function - mL of blood per min though glomerulus
77
lab value for hydration
BUN - test for urea
78
urinalysis with increased protein =
decreased renal function
79
blood in urine =
renal stones
80
top causes of chronic kidney disease
DM- uncontrolled hyperglycemia - causes glucose to stick to artery wall which cause damage to artery supplying blood to kidney
HTN (systemic), glomerulonephritis, lupus, chronic UTI
81
who has higher risk of chronic kidney disease
geriatrics, African American, hispanics, Pacific Islanders, native Americans
82
chronic kidney disease is defined by
GFR below 60 for over 3 months
83
treatment of chronic kidney disease
identification, protection of remaining glomerular function, correct F&E imbalance supplementation, protein restriction, dialysis, and possible renal transplant
84
what medications would you give to chronic kidney disease pt
Ace inhibitors/ARBs, glycemic control, antilipemics, make if patient is on nephrotoxic drugs that the benefit of giving the drug outweighs the risk, and supplementation with Ca, vitamin D, and iron
85
why do you want to restrict protein in chronic kidney disease
so they have less protein destroying the endothelial layers
86
epoetin alfa
Epoetin alfa is a man-made form of a protein that helps your body produce red blood cells
87
platelet aggregation
the clumping together of platelets
88
antipyretic
used to prevent or reduce fever
89
osteoarthritis
degenerative, low grade inflammatory joint disease
90
what can cause osteoarthritis
obesity, repetitive trauma on load bearing joints, or too much work on joints such as running
91
what happens to joints during osteoarthritis
erosion of cartilage, thickening and inflammation of synovial capsule, osteophytosis, and pain with limited range of motion
92
treatment for osteoarthritis
plain films which are a 2 dimensional picture and NSAIDs to cut out inflammatory response, exercise, weight loss, and assistive devices because joint stiffness decrease with movement
93
osteophytosis
new bone formation of joint margins also called bone spurs
94
when cartilage gets broken up the fragments are taken up by the cartilage cells and digested by
the cell's own lysosomal enzymes
95
what 2 things are thought to play a major role in cartilage degradation in osteoarthritis pt
proinflammatory cytokines - interleukin 1 and tumor necrosis factor
96
gout
syndrome caused by either overproduction or under-excretion of uric acid and is characterized by inflammation and pain in the joints
97
hyperuricemia
An excess of uric acid in the blood.
98
what does uric acid do to tissues
crystallizes, forming insoluble precipitates that are deposited in connective tissues throughout the body.
99
where are 50% of initial attacks of gout
on the big toe. will be swollen and red
100
if you have gout what are you more likely to get
1000x more likely to get kidney stones
101
treatment for gout
fluids - up to 3L/day, diet considerations, NSAIDs, allopurinol (zyloprim)
102
diet considerations for gout pt
no beef, pork, organ meats, shellfish, or beer
103
agranulocytosis
also known as granulopenia, is an acute condition involving a severe and dangerous leukopenia (lowered white blood cell count)
104
aplastic anemia
condition that occurs when your body stops producing enough new blood cells
105
osteoporosis
silent progressive bone loss in which pt has more bone resorption and new bone formation
106
woman with osteoarthritis who are 50 or older have a ______ more risk for fracture compared to men who are at a
woman - 50%.
| men - 20% factor risk in later years
107
most common areas of fracture in osteoporosis pt
femur, wrist, and thoracic/lumbar spine
108
advanced disease state in osteoporosis pt shows as
pain and bone deformity and can have kyphosis
109
kyphosis
vertebral collapse
110
postmenopausal induced osteoporosis
from estrogen deficiency which causes and abundance of RANKL and decrease influence of OPG, and more bone destroyers than bone formers
111
what does OPG do
stops bone resorption
112
glucocorticoid-induced osteoporosis
caused from taking corticosteroids which causes an increase of osteoclast survival, inhibits osteoblast formation, and decrease OPG production
113
increase of osteoclast survival causes
longer periods of bone resorption
114
fatal complications of hip fracture
fat embolus from lipids in the bone marrow, PNA, and hemorrhage. 24% of those with hip fracture die within the first year of injury
115
identify the primary function of the renal system
maintain homeostasis by reabsorbing nutrients and conserving water
116
where exactly in the kidney does blood filtration take place
at the glomerulus
117
what is normal GFR
60 - 120 mL/min
118
what do juxtaglomerular cells do
they regulate renal blood flow and systemic blood pressure by secreting renin
119
what stimulate juxtaglomerular cells
macula dense cells stimulates them in response to low sodium
120
2 natural (hormonal) antagonists to the RAA system
urodilatin and BNP
121
urodilatin
hormone that causes natriuresis through increasing renal blood flow
122
anti-diuretic hormone is released in response to
low blood volume and causes reabsorption of water
123
the majority of the body's water is typically located where?
in the intracellular space
124
which fluid compartment is potassium found in larger amounts
potassium is found in larger amounts inside the cell
125
unilateral leg swelling is seen in a patient with a DVT due to which net filtration abnormality
an increase in capillary hydrostatic pressure
126
identify two abnormalities most likely seen on a ECG after a pt has a severe crush injury
prolonged PR interval and widened QRS
127
aldosterone =
sodium retention
128
when is BNP released and what 3 effects does it have on the body
BNP is released when there is too much sodium. It causes vasodilation, sodium and water excretion, and decrease in blood pressure.
129
When are colloids indicated and WHY would they be a good choice for these indications?
Colloids are indicated in treatment of burns, hepatic failure, and CHF. Colloids are a good choice for these treatments because they bring the oncotic pressure within the vascular space back up and increase fluid volume by moving the fluid from the interstitial space back into the vascular space, which overall will help with the high fluid volume and edema that occur in these patients
130
Describe what happens in the vascular space when hypertonic fluids are given.
Hypertonic solutions cause the concentration of the vascular space to increase by pulling the fluids from inside the cells into the plasma fluids. Patients are at an increased risk for volume overload with these solutions
131
what would want to ask before giving IV fluids
questions about fluid volume overload
132
function of red bone marrow
blood cell formation
133
yellow bone marrow is primarily
fat
134
what 2 things can an intraosseous catheter deliver to the bloodstream
medications and IV fluids
135
name 2 reasons why RANKL is secreted by osteoblasts
To maintain quality when microfractures occur, or when minerals such as calcium or phosphate need to be released into the bloodstream
136
RANKL
The interaction of RANK with its ligand (RANKL) has been identified as the final common pathway through which bone resorption is regulated
137
identify 4 synovial joints
Hinge joint- knee, ball and socket joint- hip, pivotal joint- C1 (to move head around), and the joints in the hand and wrist
138
why do synovial joints lose mobility and stability
When the fluid within the joint decreases or increases it causes the person pain and will decrease the mobility and stability of the joint. This can be caused by rheumatoid arthritis and other autoimmune disorders.
139
when is creatinine released into the blood
Creatinine is a normal byproduct and is released into the blood stream due to skeletal muscle metabolism.
140
elevated serum myoglobin indicates
injury to the muscle
141
lactic acid is used as a marker for the
severity of sepsis
142
what decreases the ability of RANKL to initiate bone resorption
estrogen
143
why do people gain weight as they age when they don't increase their caloric intake
muscle mass decreases at the rate of about a half of a pound per year, which decreases metabolism. This is the cause of the shift of people gaining weight without increasing their caloric intake after the age of 30
144
chronic kidney disease is not apparent until
less than 25% function remains
145
uremia
abnormally high waste amounts in blood
146
GFR of kidney failure
below 15
147
GFR of kidney disease
15-60
148
rheumatoid arthritis
auto-immune condition that causes inflammation of the joints through the activation of synovial fibroblasts and immune response
149
fibroblasts
any cell from which connective tissue is developed
150
angiogenesis
physiological process through which new blood vessels form from pre-existing vessels
151
how is rheumatoid arthritis diagnosed
rheumatoid factor (autoantibodies) which is detectable in the blood
152
stages of rheumatoid arthritis
1. Inflammation of synovium - T and B cell and neutrophil infiltration into synovium which causes inflammation and some loss of mobility
2. Formation of pannus and angiogenesis - layer of vascular fibrous tissue - will damage bone and cartilage due to RANKL activation
3. Space within the joint will disappear and erosion of joint and supporting ligaments and tendons
4. Bony ankylosis - bones will fuse together - cause stiffness and immobility of joint
153
extrasynovial nodules
inflammatory cells surrounding cellular debris. happens in rheumatoid arthritis and can occur in the subcutaneous tissue, lungs, heart, or eyes
154
what is urea
waste product produced from liver breaking down protein
155
if you have decreased GFR what happened in the body
decreased urine output, increased fluid, increased waste in blood, and electrolyte imbalance - body will becomes acidic and go into metabolic acidosis
156
How can myoglobin cause infrarenal injury?
excess myoglobin may thus cause renal tubular obstruction, direct nephrotoxicity (ischemia and tubular injury), intrarenal vasoconstriction
157
how can sepsis lead to kidney injury
blood pressure drops dangerously low, affecting how the blood flows through your body. Because the blood can’t flow as quickly as it should, it can’t deliver the nutrients needed by the body’s tissues and organs. At the same time, the blood begins to clot within the blood vessels (called disseminated intravascular coagulation, or DIC), slowing down blood flow even more.
158
Intact nephron hypothesis
loss of nephron mass with progressive kidney damage causes surviving nephrons to sustain normal kidney function – compensation for loss - beginning of CKD
159
tubulointerstitial fibrosis
injury to the tubule and capillary leads to generation of chemotactic and adhesive factors that result in macrophage and T-cell accumulation
160
why does chronic kidney disease cause bone pain
- Kidneys activate vitamin D – helps absorb Ca in CKD kidney not activating vitamin D so low calcium and High phosphate levels cause even lower calcium levels because calcium binds to phosphate
o Bone reabsorption associated with the low vitamin D and calcium = osteodystrophy
- Hyperparathyroidism
o Parathyroid gland secrete parathyroid hormone when calcium levels are low
o Parathyroid hormone indirectly influences osteoclast by stimulating the bones to release calcium into the blood = decreased bone health and possible bone pain
161
what does chronic kidney disease do to CV and pulmonary system
causes pulmonary edema, HTN, HF, edema
162
why does chronic kidney disease cause pulmonary edema, HTN, HF, edema
Symptoms due to fluid overload and metabolic acidosis
163
why does chronic kidney disease cause pericarditis
toxin buildup
164
neurologic effect from chronic kidney disease
lethargy, Encephalopathy, seizures, coma, Peripheral neuropathy
165
why does chronic kidney disease cause lethargy, Encephalopathy, seizures, coma, Peripheral neuropathy
- Lethargy/dizziness – decrease in red blood cell
- Encephalopathy, seizures, coma – accumulation of uremic toxins
- Peripheral neuropathy – uremic toxins also
166
why does chronic kidney disease cause Anemia, epistaxis (nose bleed), bruising
because of the reduced erythropoietin secretion and toxins alter platelet function. patient can look pale
167
why does chronic kidney disease cause N/V and anorexia
retention of metabolic acids and waste products
168
what type of skin problems can you see on a CKD patient
pruritic excoriations, frost, sallow pigmentation, discolored nails
169
pruritic excoriations
due to deposits of urea crystals on skin “frost”- this is because of the build up of urea
170
frost
uremic frost – urea coming out of skin and causes a little yellow shine
171
sallow pigmentation
retention in urochromes which contributes to sallow yellow color
172
CKD and muscles
myopathy (muscle weakness) – due to decrease amount of protein
173
what can CKD do to reproductive health
- overall reduced level of sex hormones
- amenorrhea (absence of menstruation) – reduced level of estrogen
- impotence- men may have a reduction in testosterone
- infertility – low sperm count and germinal cell dysplasia
174
why can CKD pt have hypothyroidism
Uremia delays the response of thyroid stimulating hormone receptors and Ts levels are often low
175
insulin resistance in chronic kidney pt
Related to proinflammatory cytokines and alterations in adipokines (causes high leptin and low adiponectin)
176
dyslipidemia in chronic kidney pt
Uremia causes deficiency in lipase
177
what happens to your immune system with CKD
Immune system is suppressed due to uremia (high level of urea in blood)
178
how much should an adult pee each day
1-2 liters
179
what structure actually produces the urine
nephrons
180
what shows up in urine during CKD
protein and blood
181
what hormones are produced by the kidney
EPO (erythropoietin) and renin
182
what happens with the hormones the kidney produces in CKD
EPO is low so pt could be anemic. Glomerulus filtering less water - so body thinks we have low BP so it releases renin to increase BP - even more fluid volume
183
more protein in urine =
more endothelial destruction
184
Two factors that Have consistently been recognized to Advanced renal disease
proteinuria and Angiotensin II activity
185
why do CKD pt get metabolic acidosis
because there is a diminished ability to excrete H+ and generate bicarb which leads to acidosis
186
EKG during hypokalemia
long QU interval and prominent U waves
187
EKG during hyperkalemia
peaked T waves
188
EKG during hypocalcemia
QT prolongation
189
EKG during hypercalcemia
shortening of the ST segment
190
steps to late stage of CKD
1. HTN in arteries going to the kidney which causes release of renin which causes more HTN and over time will cause vessel thickening and narrowing which will lead to glomerulosclerosis.
2. sclerosis causes ischemic injury and nephron loss
3. nephrons are compensating for other lost nephrons so there is glomerular hyperfiltration that is tolerated during early stages, but not in late
4. hyperfiltration causes more sclerosis from the pressure
5. more loss if nephrons
6. nephrons can not compensate any more and you have a decrease in GFR
191
what causes proteinuria
increased capillary permeability which allows protein to pass through and causes loss of negative charge and protein spills into interstitial space
192
what leads to nephron injury and ischemia
inflammation, hyperfiltration, and permeability to protein which causes increases pressure in the kidneys and decreased blood flow which leads to ischemia
