Pathophysiology Flashcards
CVA
Etiology: Blockage of arteries that limit blood circulation to the brain and result in brain damage
CC: Unilateral/focal sx; weakness/numbness/visual& speech deficits
RF: HTN, HDL, DM, Smoking, FHx of CVA, PMHx of CVA or TIA, AFIB
PE: 1. Hemiparesis
2. Unilateral Paresthesia
3. Neurological deficits (Visual field & Aphasia)
Dx: Clinically; CT is clear
MED: tPA (Blood-thinner that reverses CVA Sx)
Document time of onset & Sx improve rapidly
Hemorrhagic CVA/Brainbleed
E: spontaneous or traumatic rupture of blood vessels in the brain
CC: sudden, throbbing HA
Assox sx: HA, seizure, AMS, numbness, weakness, changes in vision & speech
PE: Unilateral Neurological Deficits
Dx: CT & LP
TIA
E: temporary changes in vessels depriving brain of O2
CC: transient focal neurological deficits (strength, sensation, vision, speech)
Dx: clinically
**Sx last <1hr
Meningitis
E: inflammation and infection of meninges
CC: Neck pain & HA
ASx: Neck stiffness, neck pain, fever, AMS
PE: Meningismus & Nuchal Rigidity
Dx: LP
Bacterial or Viral
Spinal Cord Injury
E: Trauma causing bilateral numbness & weakness in extremities
CC: neck p, back p, extremity weakness & numbness
PE: mid-line bony tenderness, deformities (or step-offs), rectal tone, bilateral extremity numbness & weakness
Dx: C-spine CT, T-spine CT, L-spine CT
Seizures (SZ)
E: abnormal electrical activity in the brain causing abnormal physical manifestations
CC: seizure activity, syncope
ASx: confusion, HA, injuries (tongue-bite), incontinence
PE: Somnolent, postictal (confused)
M: Keppra, Depakote, Neurontin, Dilantin, Tegretol
Bell’s Palsy
E: inflammation or infection of facial nerve causing weakness in muscles of one side
CC: sudden onset droopy face
Pertinent negative: no extremity weakness; no changes in vision or speech
PE: Unilateral weakness of upper and lower facial muscles
Dx: Clinically
HA/Cephalgia
E: HTN, Sinusitis, migraines
CC: pressure, throbbing HA w/ gradual onset
Pert.Neg: No fever, numbness, weakness, neck-pain or stiffness
AMS
E: multiple causes: infection, neurological, hypoglycemia
CC: confusion, decreased responsiveness
RF: dementia, old age, MD, EtOH * drug use
*maybe caused by UTI, demntia, hypoglycemia
Syncope
E: Temporary loss of blood circulation to the brain due to dehydration or hypovolemia
CC: passing out vs. about to pass-out
Vertigo
E: room-spinning due to inner ear infection or neurological probs
CC: room spinning, disequilibrium, worsens w/ head motion
ASx: N/V & Tinnitus
PE: Nystagmus, Roberg, Dix-Hallpike test
Dx: Clinically
Appendicitis
E: infection of the appendix causing inflammation and possible rupture
CC: RLQ pain that is constant, gradual, and that worsens upon movement
PE: RLQ tenderness, McBurney’s point tenderness
Dx: CT A/P w/ PO contrast
ASx: Fever, N/V, decreased appetite
SBO
Small Bowel Obstruction
CC: abd pain, constipation, vomiting
RF: elderly, infants, narcotic drug usage, abd surgery
PE: abd tenderness, abd distension
Asx: abd distention, bloating, no BMs
Dx: CT A/P w/ PO contrast & Acute abd series (AAS)
Cholelithiasis/Cholecystitis
E: condensation of bile from liver to form stones that can irritate, inflame, and obstruct gallbladder
CC: sharp pain that worsens upon eating, taking a deep breath, and palpitation
Dx: US
PE: RUQ tenderness
worsened by eating fatty food
GI Bleeding
E: Bleeding in upper or lower GI tract
CC: Hematemesis, Hematochezia, Melena, Coffee ground emesis
ASx: SOB, lightheadedness, weakness, abd pain, rectal pain
PE: melena, conjunctiva, pallor, tachycardia, grossly bloody stool
Dx: positive heme in stool
Diverticulitis
E: inflammation and infection of diverticuli RF: old age, diverticuli CC: LLQ pain ASX: N, diarrhea, fever Dx: CT A/P w/ PO contrast
Pancreatitis
E: inflammation of the pancreas CC: LUQ & epigastric pain RF: EtOH abuse & cholecystitis ASx: N/V PE: LUQ and epigastric tenderness Dx: heightened lipase & amylase levels (lipase primarily)
GERD
E: Regurgitation of stomach acid into esophagus
CC: epigastric pain and burning
PE: epigastric tenderness
Med: GI cocktail
***May cause anxiety about cardiac illnesses due to proximity of heart & stomach; cardiac workup is done
C-diff colitis
Bacteria that causes persistent diarrhea
Gastroenteritis
GI Bug; causes vomiting and diarrhea; bacterial or viral
Crohn’s disease
Immune disease causing diarrhea & abd pain
IBS
Sensitive bowel prone to diarrhea
Gastritis
aka stomach ache
irritated stomach causing vomiting
UTI
E: infection of urinary tract (bladder or urethra)
RF: F
CC: dysuria
ASx: urgency, frequency, malodorous urine, AMS
PE: suprapubic tenderness
Dx: Urine Dip/Urinalysis (WBC, bacteria & nitrile in urine measured)
Pyelonephritis
E: infection of kidney tissue (usually spread from UTI)
CC: Flank pain & dysuria
RF: F & frequent UTI
ASx: N/V & fever
Dx: CT abd/pel w/no contrast or confirmed UTI by CVA tenderness
PE: CVA tenderness (Costovertebral angle tenderness)
Renal Calculi
Nephrolithiasis
Urolithiasis
ET: dislodged from kidney, causes irritation and bleeding of the urethra
CC: Sharp flank pain radiating to groin
ASx: N/V, hematuria, unable to void
PE: CVA tenderness
Dx: Pel/abd CT without contrast & RBC from UA
Ectopic Pregnancy
E: potential for rupture; fatal / urgent
CC: lower abd pain, vaginal bleeding
Dx: US of fetus
Ovarian Torsion
E: twisting of ovarian artery and reduction of blood supply to ovary, resulting in potential ovarian infarct
CC: LLQ & RLQ abd pain
PE: adnexal tenderness LLQ & RLQ
Dx: US pelv—(assesses blood flow to the ovaries)
document times for pt arrival, US results, surgical consultations*
Testicular Torsion
E: twisting of spermatic artery and reduced blood flow, causing loss of one of the testicles
CC: testicular pain
PE: testicular tenderness & swelling
Dx: US scrotum
Musculoskeletal Back Pain
E: pain in the lower back, paraspinal & in extremities
Pert.Neg: no LE weakness, no incontinence
PE: paraspinal tenderness & Straight leg raise (SLR) with sciatica
May be due to trauma
Extremity Injuries
E: Pain/swelling caused by trauma
CC: pain
ASx: swelling, bruising, deformity, limited ROM
PE: intact distal CSMT (circulation, sensation, motor function, tendon); no tendon or ligament laxity; limited ROM secondary to pain
Pert. Neg: no motor weakness or numbness
AAA
E: widened and weakened arterial wall at risk of rupture
CC: mid-line abd pain
PE: unequal femoral pulses, mid-line pulsatile abdominal mass, hypotension, abd bruit
Dx: CT A/P w/ contrast
Aortic Dissection
E: separation of chest muscle wall from the aorta’s membrane, putting it at risk of rupture
CC: chest pain radiating to the back (ripping and tearing)
PE: hypotension
Dx: CT A/P w/ contrast
DVT
E: formation and growth of blood clot in LE due to slow moving blood circulating in the veins of the LE
CC: pain and swelling of LE
PE: calf tenderness
RF: PMHx or FHx of DVT or PE, Pregnancy, Immobility, BCP, Smoking, trauma, casts, recent surgeries
Dx: US LE
Cellulitis
E: infection of the skin CC: Pain, swollen, red, calor (warm), tense (induration) PE: erethema, edema, calor, induration, Tx: Abx Dx: clinically
Abscess
E: infection of skin with purulent pockets underneath skin
CC: painful, swollen, red
Procedure: I&D
PE: Fluctuance (pocket-like), induration (tense), purulent discharge/drainage
Dx: clinically
Rash
E: skin appearance changes due to localized or generalized reactions to meds, bacteria, virus, fungus, insect bite, etc.
CC: Rash that is erethematous, pruritic, painful
Dx: clinically
Allergic Rxn
E: Body’s immunological response to an unknown substance with inflammation causing a rash, swelling, SOB or itching
CC: rash, swell, SOB, pruritous
PE: facial angioedema, edema, urticaria (hives, wheals)
ED concern is respiratory failure & anaphylaxis
Adverse Reaction
N/V
Diarrhea
Abd pain
dizziness
DKA
E: Hyperglycemia & production of ketones due to lack of shortage of insulin
CC: Persistent vomiting
RF: DM
ASx: polyuria, polydipsia, SOB
PE: tachypnea, ketotic odor (fruity), dry mucous membrane
Dx: by acidosis (low pH) through ABG or VBG or by positive serum ketones
Psychological Disorder
E: produce abnormal thought, behavior, action
PMHx: depression, bipolar, schizophrenia, Anxiety, PTSD, Alcoholism, Drug abuse, Suicide Attempt
CC: suicide ideation (SI), Homicide Ideation (HI), overdose, self-injury, Hallucinations (visual or auditory), Substance Abuse
PE: flat affect, HI, SI, Tangential or pressured speech
Medically cleared for psychological evaluation
Physical Trauma
E: Trauma causing bone fractures, nerve severance, blood vessel rupturing, and internal organ damage depending on MOI
CC: MVA or GSW
AMeds: Blood thinners (ASA, Coumadin, Plavix)
Dx: by CT or XRay depending on MOI and trauma protocol
Neurological injury * HA, Cervical/lumbar pain, confusion, LOC, weakness, numbness
Internal Organ injury *SOB, CP, Abd pain
MOI
E: the way damage to the skin, muscle, bone, & organ happened.
MVA: Head-on Collision T-bone collision Rear-impact Collision rollover collision victim ejected from vehicle Motorcylce, ATV crash Pedestrian vs. Vehicle
Stabbed?
Location, length of blade, angle of penetration
GSW?
Type of gun, caliber, distance from the victim, bullet deformity
How it occurred, when it occurred and what surface did it land on?
