Patho Exam 2

Droplet Transmission Precautions

"Mr. PIMP drops off his pro's" Larger droplet particles do not travel as far as airborne particles, only about three feet from the source. Many droplet pathogens require CONTACT as well as DROPLET precautions. Precautions: Standard Mask is always required! additionally, Private Room or cohort Mask, as well as Gown, gloves, and eye protection as needed. ~M - Meningitis don't forget "most MEN are pimps" remember that this "m" is MENingitis. ~R - Rubella (GERMAN measles) ~P - Pertussis (whooping cough) ~I - Influenza ~M - Mumps ~P - Pneumonia

Contact Transmission Precautions

"Mrs. Wee" Precautions: Always use gloves, and gown, but may use shoe and hair covers as needed. ~M - multidrug resistant organism (MDRO) ~R - respiratory infection ~S - skin infections ~W - wound infection ~E - enteric infection - clostridium difficile (may want full contact gear) ~E - eye infection - conjunctivitis or pink eye

Anemia

"Not enough Red Blood Cells" The only way to deliver O2 to tissues is for hemoglobin (found in RBCs) to bind to red blood cells and go through gas exchange in the lungs. When there are not enough red blood cells, tissues develop HYPOXIA. When hemoglobin formation is defective, the hemoglobin molecule may not be able to bind O2 or even survive. This results in various forms of anemia. There are more than 400 types of anemia, which are divided into 3 groups: 1) Anemia caused by blood loss. 2) Anemia caused by decreased or faulty red blood cell production. 3) Anemia caused by destruction of red blood cells.

Airborne Transmission Precautions

"You're on-the-AIR with MTV" Small airborne particles can travel several feet, especially if propelled by a cough or a sneeze. Precautions: Hepa-N95 Mask is required! additionally, Private Room - negative pressure with 6-12 air exchanges/hour. ~M- measles regular (Rubeola) and don't forget, "It's all about ME on MTV" to remember that this "m" is MEasles. ~TB - tuberculosis (Care provider must wear N95 mask in Patient room. Patient wears standard mask in public areas). ~Varicella - Chicken Pox (But also use contact precautions)

Autoimmune Diseases: Risk Factors and Mechanisms

- The body makes antibodies against itself, the body does not recognize some tissues as belonging to the body. - Genetic predisposition is common, runs in families. - Triggered by: Chemical / biologic substances, such as: viruses, bacterial infection, or Abnormal immune cells. - More common in women 3 to 1 ratio, especially of childbearing age, which is 16 to 35 years of age. - All ages affected.

Aplastic Anemia

-Etiology Caused by the destruction of bone marrow stem cells, or the failure of bone marrow to replace dying cells. This affects all blood components! -High Risk Groups Anyone Can be caused by environmental toxins, chemo or radiation, toxic drugs! -Symptoms Anemia signs and symptoms (RBC's destroyed)! Infection (WBC's destroyed)! Bleeding tendencies (platelets destroyed)!

Stages of Infection microbiology

-Incubation: NO signs or symptoms. The number of pathogens in the body have NOT reached a large enough number to cause symptoms. -Prodrome or Prodromal: First onset of signs and symptoms of an infection, such as malaise or lethargy, fever. -Acute: Phase of maximum effect or damage to the body. Can be further delineated by the "Invasive" and "Decline" phases of Acute Infection. -Resolution or Convalescence: The body's defenses begin to overcome the pathogen and signs and symptoms decrease.

3 types of Sickle Cell Crisis

1. Vaso-occlusive - occurs when the sickled red blood cells trigger the formation of blood clots with in the circulation. Tissue damage is minor and can resolve within a week. Dehydration and infection is an initiating cause. More serious results can include- Stroke, Pulmonary infarction, Myocardial infarction, Gangrene. 2. Sequestration - When the sickled red blood cells are removed from the general circulation by the spleen. The severity depends on the amount of blood removed and held in the spleen and liver thereby reducing the amount of circulating red blood cells. Can produce hypovolemic shock. 3. Aplastic - Caused by exhaustion of the bone marrow. Erythropoiesis cannot keep up with the constant need to replace red blood cells. Sickled red blood cells have a lifespan of 10-20 days. This constant stress on bone marrow stems cells can eventually lead to bone marrow failure. -Nursing Consideration for treating all types of sickle cell CRISIS: Treat with oxygen, IV fluids to reverse dehydration, and Pain medication. If pain is not treated, patient will go into shock. This is one of the few times when pain is considered PHYSIOLOGICAL and not PSYCHSOCIAL on NCLEX.

Blood Pressure Medications: ABCD

A: Ace inhibitors end in "pril" ARBS end in "sartan" Alpha-blockers end in "sin" B: Beta Blockers end in "lol" C: Calcium Channel Blockers include: Diltiazem, Nifedipine, Verapamil D: Diuretics include: Furosemide, HCTZ, Spironolactone cause body to excrete fluid resulting in a lower blood pressure.

Nutritional Anemia: Folate (vitamin B-9)

Also called Folic Acid, this key element is an integral part of cell growth, especially Red Blood Cells. Deficiencies during pregnancy can cause birth defects of a baby's brain and spine. Low Folate levels are caused by dietary deficiency or other factors: 1 - Overcooking or eating too few veggies may cause a folate deficiency. 2 - Other: Pregnancy, alcohol abuse, malnutrition, medications, intestinal diseases. -Symptoms abdominal pain sore tongue anorexia, or weight loss

Angina Pectoris vs Myocardial Infarction

Angina pectoris is the term for chest pain or discomfort due to coronary heart disease. It occurs when the heart muscle doesn't get as much blood as it needs. This usually happens because one or more of the heart's arteries is narrowed or blocked, also called ischemia. Cause Temporary cardiac ischemia caused by increased myocardial workload. EKG changes none or transient Plasma Enzyme Levels Normal Pain relief rest, nitroglycerin Beta blockers, Calcium channel blockers. Myocardial Infarction A heart attack. Abbreviated MI. The term "myocardial infarction" focuses on the myocardium (the heart muscle) and the changes that occur in it due to the sudden deprivation of circulating blood. The main change is necrosis (death) of myocardial tissue. Cause Irreversible ischemia produces infarction, necrosis and scarring. EKG changes Permanent abnormal changes. Plasma Enzym Levels Elevated troponin, and CK-MB Pain relief O2, nitroglycerin, narcotics anticoagulants, thrombolytics, angioplasty.

Vector

Arthropods which are insects or arachnids, that transmit pathogens to humans. The arthropods that most commonly serve as vectors include: - blood sucking insects such as mosquitoes, fleas, lice, biting flies and bugs, - blood sucking arachnids such as mites and ticks. The term "vector" refers to any arthropod that transmits a disease through feeding activity. Vectors typically become infected by a disease agent while feeding on infected vertebrates, such as, birds, rodents, other larger animals, or humans, and then pass on the microbe to a susceptible person or other animal.

Lab tests: BNP, CK-MB, Troponin, and CRP

BNP is excreted from cardiac tissue when the ventricles are "stretched". BNP is specific for heart failure, whereas CK-MB and Troponin are specific for Myocardial inaction and tissue death. elevated CRP indicates high risk for heart problems.

PTT, PT, INR, D-Dimer pertinent blood clotting lab tests.

Bleeding time tests: -PT and INR (International Normalized Ratio) are used to test patients on Coumadin blood thinning medication. -PTT test patients on Heparin blood thinning medication. Blood clot test: -D-Dimer This test is done to determine the extent of clotting in the body and is done for DVT (deep vein thrombosis), P.E. (pulmonary embolism) and DIC (disseminated intravascular coagulopathy).

Hypertension Risk Factors

Blood pressure is consistently higher than 140/90! The vicious cycle: A major cause of Hypertension is due to ARTERIAL INJURY (blood clots) which leads to arterial constriction. Narrowed arteries increase the resistance the heart has to pump against. Pressure goes up in the heart because it is pushing so hard to get the blood out. Ironically the forceful blood flow then causes more ARTERIAL INJURY. Normal blood pressure range for adults is 100/60 to 140/90. High Risk: -Family history or genetics. -Race or African heritage. -Age, over 50. -Gender, males are higher risk. -insulin resistance, as in type 2 diabetes. -diet -obesity -alcohol -smoking

Buerger's Disease vs Raynaud's Disease

Buerger's Disease or Thrombangitis obliterans Etiology: Disease of the Arteries and veins in the arms and legs. Causes is unknown, possibly autoimmune, triggered by tobacco use. Incidence: Men younger than 35 years, who are heavy smokers. Pathophysiology: Peripheral arterial inflammation causes thrombus formation and vasospasm leading to occlusion. Signs and Symptoms: Pain, tenderness, dependent rubor, and SHARP. Treatment: Smoking cessation, vasodilators, amputation. Raynaud's Disease Etiology: Unknown, possibly genetic. Incidence: young women. Pathophysiology: cold, stress, drugs triggers digital arterial vasospasm resulting in distal to proximal that causes reduced blood flow to the extremities. Signs and Symptoms: Fingers turning white after exposure to temperature changes or emotional events, pallor or cyanosis, numbness, cold progressing from distal to proximal part of limb, followed by redness and throbbing pain. Treatment: avoiding triggers, vasodilation Note: poor circulation in hands, so don't put oximeter on finger.

Types of Pathogens: Chlamydia and Rickettsia

Can reproduce independently like bacteria, but need a host cell for energy, like viruses. ~ Chlamydia is a sexually transmitted disease. ~ Rickettsia is carried by ticks and lice, and causes Rocky Mountain Spotted Fever and Typhus.

Anemia: Signs, Symptoms, and Treatment.

Clinical manifestations common to ALL anemias: - Plasma expansion or "watery" blood, which is less viscous blood. when spun in a centrifuge there is a greater amount of "Clear" portion of blood as compared to red blood cells. This causes more turbulent blood flow, and "pale" look of blood. - Decreased hemoglobin and hematocrit levels in the blood indicate anemia. Physical signs and symptoms of anemia are a result of HYPOXIA, which is a low oxygen level in blood. 1. Fatigue, which is decreased energy production, and the most common sign of anemia. 2. Tachypnea, which is an increased respiratory rate. 3. Tachycardia, which is an increased heart rate to circulate red blood cells more freely. 4. Pallor, which is pale skin and mucous membranes, caused by decreased red blood cells in blood vessels. Anemias . (NOT ENOUGH RBC's) Note: Assess for anemia by checking inside of person's mouth for pale colored mucosa and gums. Treatment may vary: Treatment depends on the underlying diagnosis. -Iron supplements may be used for iron deficiency. -Vitamin B supplements maybe used for low vitamin levels. -Blood transfusions may be used for blood loss. -Medications to induce blood formation may be used if the body's blood production is reduced.

Disseminated Intervascular Coagulopathy

DIC is a coagulation disorder that results in both Blood Clotting and Hemorrhaging! DIC is not itself a specific illness; rather, it is a complication or an effect of the progression of other illnesses. !It is always secondary to an underlying disorder and is associated with a number of clinical conditions, generally involving activation of systemic inflammation! Definition - DIC is a serious disruption in the body's clotting mechanism. Normally, the body forms a blood clot in reaction to an injury. With DIC, the body overproduces many small blood clots throughout the body, depleting the body of clotting factors and platelets. These small clots are dangerous and can interfere with the blood supply to organs, causing dysfunction and failure. Then, massive bleeding can occur due to the body's lack of clotting factor and platelets. DIC is life-threatening and needs to be treated promptly. Coagulation and Inflammatory pathways interact in substantial ways. It is clear that there is cross- communication between the two systems, whereby inflammation gives rise to activation of the clotting cascade and the resultant coagulation stimulates more vigorous inflammatory activity. There are a number of different triggers that can cause a hemostatic imbalance, giving rise to a hypercoagulable state. The chemical mediator, cytokine, is released when the inflammatory response is trigger. Cytokine is implicated as a causative agent in DIC. Damage to the vascular endothelium triggers the release of clotting factors (factor X) which produce micro thrombi throughout the body. When the patient's clotting factors are exhausted, the patient then hemorrhages because there are no clotting factors left to stop the bleeding. This leads to poor organ perfusion and ultimately to organ failure. Stage 1 is a triggering event! such as: • !Sepsis and septic shock! • !Obstetrics complications! • !Trauma, especially burns & Head Injury! • Blood Transfusions • Hematologic disease • Some Cancers Stage 2 is the Clotting Phase! • DVT (deep vein thrombosis) • Renal failure (clots in kidneys) • Difficulty breathing (clots in lungs) • Neurologic changes (clots in brain) • Numbness (clots in spinal cord) • Liver dysfunction (clots in liver) Stage 3 is the Hemorrhage Phase! • !Blood oozing from an existing IV site! • Bleeding gums • GI bleeds • Petechiae • Purpura • Ecchymosis Treatment includes! 1 - Life support (oxygen, give fluids/IV meds to maintain blood pressure; probable drug-induced coma) 2 - Treat the underlying cause (i.e., give antibiotics if caused by an infection) 3 - Give heparin (to stop the clotting process) 4 - Platelet transfusion (restores lost platelets)

PAOD vs DVT

DVT is Venous Cause: Sedentary, such as sitting long periods, or bed bound. Vessel injury leads to DVT. Signs and Symptoms: SHARP Pulse present Edema present Color is pink to red Temp is warm to hot Pain is aching, throbbing Treatment: Anticoagulant Embolectomy PAOD is Arterial Cause: Vasospasm Atherosclerosis Vessel injury Signs and Symptoms: the 5 P's Pulse low or absent no Edema Color pale to mottled Temp cool to cold Pain is sharp, or numb Treatment: Thrombolytic Embolectomy

Human Immunodeficiency Virus (HIV)

HIV is Pathological: exposure to virus leads to antibody formation called the "window period" in which infection is present and transmittable but not detectable. - In the case of HIV, the body's antibodies are not strong enough to fight off the infection, leaving the HIV free to multiply and damage the immune system. Seroconversion: this refers to the ability to detect HIV antibody in the serum and typically occurs in 1 to 3 months, but can be delayed for up to 6 months. Seroconversion leads to acute disease; however the disease may be latent for years. The typical path of disease follows three phases: 1 - Primary infection phase 2 - Latency phase and 3 - Overt AIDS phase.

Epidemiological Triangle

Host: "Who"The person or population with the disease. Agent: "What" The disease causing organism. Environment: "Where" Place in which the host and agent interact. Example: Chicken Pox Host: Humans Agent: Varicella virus, aka Varicella Zoster, or herpes zoster. Environment: Airborne pathogen, meaning it is transmitted via cough and sneezing of infected person. Also by contact, meaning touching the infected open lesions before they crust over.

Orthostatic Vital Signs.

How to do Orthostatic B/P reading: 1st: Take blood pressure lying down 2nd: take blood pressure reading immediately after patient SITS. 3rd take blood pressure reading after the patient stands for 3 minutes, if they are able to stand up that long. Orthostatic (postural) Hypotension: is A decrease in both Systolic & Diastolic blood pressure on standing from a reclining position. There must be at least a 20 point drop in the systolic pressure to be considered an orthostatic change. Heart rate is often more sensitive than blood pressure changes and will increase to compensate for low blood volume. Normal or compensatory vasoconstrictor response on standing is replaced by marked vasodilation, which leads to blood pooling in the muscle vasculature & renal beds.

Idiopathic Thrombocytopenia

Idiopathic Thrombocytopenia Purpura or ITP, is an Autoimmune disorder that causes an IgG antibody to bind with platelets, destroying their function. Results in low platelet count and signs and symptoms of bleeding. Definition of IDIOPATHIC: arising spontaneously or from an obscure or unknown cause.

Fomites

Inanimate objects that pathogens live on things like door knobs, bedding, drinking glass, stair railing, etc.

Heart Failure: Left

LEFT HEART FAILURE: Congestive heart failure CHF Etiology: Myocardial Infarction, hypertension (HTN), Aortic valve disease Pathophysiology: Decreased left ventricular emptying causes Decreased perfusion to body tissues Increased volume and pressure in left ventricle Increased volume and pressure in left atrium Increased volume in pulmonary veins Increased volume in pulmonary capillary bed Fluid transudate moves from capillaries to alveoli Alveolar space fills with fluid Pulmonary Edema Signs and Symptoms: • Exertional and nocturnal dyspnea • Hemoptysis (blood tinged sputum) • Orthopnea • Cough • Cyanosis • Elevated pulmonary capillary pressure Signs and symptoms of Respiratory Distress.

Hypotension

Low blood pressure, below 90 systolic. Caused by: - Low Fluid volume or Hypovolemia, can be a result of dehydration or blood loss. - Prolonged immobilization, blood pressure will decrease who the body adjusts to very little movement, seen in wheelchair or bed bound patients. - Medications, such as diabetics, or anti-hypertension medications. - Neurological disease/damage. • Signs and symptoms include: lightheadedness, dizziness, fainting also called syncope, pallor, diaphoresis, visual disturbances • If Severe: Will cause heart attack and Death. • Treatments include: -Fluid bolus "FLUID CHALLENGE" Rule of Thumb: Replace one liter of fluid for each 10 point drop in systolic pressure or 10 point rise in heart rate -blood transfusion or fluid volume expanders as needed. and treating underlying cause.

MCV, MCH, and RDW significance.

MCV, MCH, and RDW are tests used to determine what type of anemia a patient has.

Anaphylactic/Allergic: Type 1 Hypersensitivity

Mast Cells in the tissue release numerous chemical mediators such as histamines, cytokines, prostaglandins and kinins (bradykinin) that cause the symptoms of Anaphylactic shock such as: -Laryngeal edema causing airway obstruction [an AIRWAY problem]. -Smooth muscle contraction results in constricted airways so lungs are unable to take in air, a *Breathing problem. -Vasodilation results in hypovolemia or low blood volume that in turn causes hypotension, which is low blood pressure. Low blood pressure prevents major organs from getting blood which leads to shock, a *Circulation problem. -Vomiting, a *Circulation problem, and abdominal cramping. A severe allergic reactions can cause Anaphylactic Shock, and can result in death in 6 minutes, because the blood flow to the brain and vital organs is decreased to the point that the organs begin to die from lack of oxygen. Eosinophils, in the blood, are leukocytes that are responsible for the late response. Examples of Type 1 hypersensitivity are Asthma, bee stings in sensitized individuals, pollen exposure, or food allergies. Reactions can range from mild itching, runny nose to anaphylactic shock and death.

Mortality

Measures the incidence of death in a population. It is measured in various ways, often by the probability that a randomly selected individual in a population at some date and location would die in some period of time.

Morbidity

Measures the incidence of ill health. It is measured in various ways, often by the probability that a randomly selected individual in a population at some date and location would become seriously ill in some period of time.

Types of Pathogens: Prions

Mutated, or poorly folded, protein molecule. Causes brain disease in humans and animals (mad cow disease). Can incubate for decades before s/s appear. S/s of brain damage. No cure currently.

Natural and Artificially Acquired Immunity.

Naturally Acquired: -Active Infection; or contact with pathogen. -Passive Antibodies pass from mother to fetus via placenta; or to infant through mother's milk. Artificially Acquired: -Active Vaccine of dead or attenuated pathogens, which isis a vaccine created by reducing the virulence of a pathogen, but still keeping it viable or "live". -Passive Injection of immune serum (gamma globulin).

Nutritional Anemia: Vitamin B-12

Pernicious Anemia is caused by: 1. Vitamin B-12 deficiency 2. Absent gastric Intrinsic Factor Low Vitamin B-12 levels are caused by: 1. Dietary: Eating little or no meat may cause a lack of B-12. 2. Lack of Intrinsic Factor (IF): Intrinsic factor, which is a protein excreted by the stomach, and is needed for Vitamin B12 absorption because B-12 is destroyed in gastric juices if not bound to Intrinsic Factor. If stomach and upper intestine are damaged or removed, Intrinsic factor is not secreted, so there is no absorption of Vit B-12. This can be caused by: -Conditions causing lack of intrinsic factor such as, Crohn's Disease, Gastric by-pass, or Cancer. - Requires lifelong B12 replacement injections. -Symptoms abdominal pain sore tongue anorexia, or weight loss peripheral neuropathy tingling, or numbness

Platelets what abnormal values mean.

Platelets Normal range is 150,000 to 400,000. Platelets, also called thrombocytes, are special cell fragments that play an important role in normal blood clotting. A person who does not have enough platelets may be at an increased risk of excessive bleeding and bruising. The CBC measures the number and size of platelets present. In general, a low platelet count occurs because: -The body's bone marrow doesn't make enough platelets. -The bone marrow makes enough platelets, but the body destroys them or uses them up. -The spleen holds on to too many platelets. Thrombocytosis is a high platelet count, >400,000. Platelet count is Increased in the following conditions: • Some cancers • Inflammatory conditions • Birth control pills • Recovery phase of trauma/surgery Thrombocytopenia is a low platelet count,<150,000 Platelet count is decreased in the following conditions: • Autoimmune disorder • Medications such as aspirin, ibuprofen, acetaminophen (damages liver bleeding problem) • "G" herbs (garlic, ginger, ginkoba, ginseng) • Chemotherapy/radiation • Cancers that damage the bone marrow (leukemia/lymphoma) • DIC (disseminated intravascular coagulation)

Red Blood Cell Count: what abnormal values mean.

Red Blood Cell Count (RBC) 3.6 to 5.4 Polycythemia! Red blood cell count is elevated (> 5.4) in the following conditions: • Cardiovascular disease • Stress • Polycythemia vera • Smokers • High altitude • Hemoconcentration and dehydration • Renal cell carcinoma and other erythropoietin-producing neoplasms Anemia: too few red blood cells, or hemoglobin in blood; results in diminished oxygen carrying capacity that can result in tissue hypoxia. Red blood cell count is decreased (<3.6) in the following conditions: • Anemias • Hemorrhage • Hemolysis • Failure of marrow production • Chronic renal failure -Hematocrit 37 to 50% -A low hematocrit means patient is loosing blood, either internally or externally. -Can be affected by a person's fluid status: >50% caused by dehydration, and <37% caused by fluid overload. -Critical low <15% causes heart failure. -Critical high >60% causes blood clotting problems. -Hemoglobin 12 to 16.5 (measured in grams) >16.5 indicates polycythemia <12 indicates anemia -Reticulocyte count: (tic) immature red blood cells, If elevated this indicates that mature red blood cells are depleted for some reason, either they are not being produced fast enough, or the adult red blood cells may be dying faster than 120 days.

Complete Blood Count Lab Values

Red Blood Cell Count (RBC) 3.6 to 5.4 -Hematocrit 37 to 50% -Hemoglobin 12 to 16.5 White Blood Cell Count (Total WBC) 5,000 to 10,000 -Must order a CBC "with differential" to get the percent of neutrophils and lymphocytes. -Neutrophils 47 to 63% -Lymphocytes 24 to 40% Platelets 150,000 to 400,000

Blood components and associated organs.

Red blood cells -Kidney which produces Erythropoietin. -damage to the kidney can cause anemia White blood cells -Thymus -damage to thymus can cause infection problems Platelets also called thrombocytes. -Liver -damage to the liver can cause bleeding tendencies -The Bone Marrow and Spleen are associated with all blood components. The spleen is the blood component grave yard.

Hypersensitivity Reactions (four types)

Remember ACID 1-4 Type 1: Anaphylactic/Allergic: Type 2: Cytotoxic: Type 3: Immune complex disease: Type 4: Delayed hypersensitivity (cell mediated):

Types of Pathogens: Virus

Requires a host cell to inject its "viron" particle into the host cell which then triggers the host cell's DNA or RNA to replicate a virus. -Needs a HOST to replicate and survive. Often a bacteria cell.

Heart Failure: Right

Right-sided heart failure occurs in about 1 in 20 people. Coronary artery disease is the most common cause of heart failure in the United States, but it can be a complication of other conditions. In right-sided heart failure, the right ventricle loses its pumping function, and blood may back up into other areas of the body, producing congestion. Congestion affects the liver, the gastrointestinal tract, and the limbs. In addition, the right ventricle may be unable to pump blood efficiently to the lungs and to the left ventricle. Causes of right-sided heart failure include left-sided heart failure and lung diseases such as chronic bronchitis and emphysema (the R. ventricle must pump harder to overcome the lung resistance caused by constricted air passages). Other causes include congenital heart disease, clots in pulmonary arteries, pulmonary hypertension, and heart valve disease. Symptoms Swelling of feet and ankles Shortness of breath Distended Jugular (neck) veins Irregular fast heartbeat Fatigue Weakness Fainting Urinating more frequently at night [nocturia] Palpitations (sensation of feeling the heart beat) A variety of different situations may trigger an episode of heart failure, including: Increased intake of fluids or salt o Fever Infections Anemia Blockage in the coronary arteries Irregular heartbeats (arrhythmias) Overactive thyroid gland (hyperthyroidism) Kidney disease Prescription or medication: treat underlying cause; give diuretics to reduce edema and fluid overload; give cardio tonic drugs to improve heart performance. DX or Diagnosis testing: Chest x-ray, BNP lab test* (Brain Natriuretic Peptide) NOTE: do not let the name fool you - BNP is actually excreted from cardiac tissue in humans (specifically the ventricles), not the brain. Also called "B-type Natriuretic Peptide."

Stages of Shock

Shock always causes HYPOtension. Hypotension is most often due to Hypovolemia, which is low volume causes Poor Perfusion, which means blood is not getting into body tissues so OXYGEN is not being delivered and Organs stop functioning and body DIES. -Inflammatory process is triggered. 3 Stages of Shock: -Compensatory— Mechanisms are activated to maintain perfusion to heart and brain, and epinephrine and norepinephrine are excreted to activate the "Fight or Flight" part of the Adrenergic Nervous System. -Progressive stage- Begins as compensating mechanisms fail to maintain homeostasis. Tissues become hypoxic because of poor perfusion. Cells switch to anaerobic metabolic and lactic acid builds up and produces metabolic acidosis. Also, cells die, break open, and release potassium which compounds acidosis. Depressed myocardial function causes hypoxia which then promotes the release of endothelial mediators. These chemical mediators cause VASODILATATION and endothelial abnormality leading to venous pooling and increase CAPILLARY PERMEABILITY, which increase risk of DIC. -Irreversible/refractory- Permanent organ damage occurs which leads to cell death. Hypotension results from increased capillary permeability. Lactate is converted to lactic acid and builds up due to anaerobic metabolism. So a HIGH Lactate level (blood test) is an indicator of POOR prognosis for the patient. Also Lactate can be tested in veinous blood, rather than arterial blood which is needed for an ABG. Circulatory and respiratory failure occurs and death is inevitable.

Sickle Cell Anemia

Sickle Cell Anemia is the genetic malformation of hemoglobin in Red Blood Cells that diminishes the cell's ability to function. High risk groups include people of African heritage. Symptoms include: -hepatomegaly, or enlarged liver. -splenomegaly, or enlarged spleen. -localized thrombosis, or a blood clot occurring inside a blood vessel. -Sickle Cell Crisis Sickle Cell Anemia is caused by an autosomal recessive defect of hemoglobin. Individuals with the single defective gene have sickle cell "trait" while those with 2 defective genes have sickle cell disease. And can be diagnosed at birth with Newborn screens or through amniocentesis. There are several drug therapies and bone marrow transplants available, but there is risk of complications of rejection i.e. septicemia or Host vs Graft disease. Notice there is a difference between Sickle cell Anemia and Sickle cell CRISIS !

Shock: Signs, Symptoms, Treatment and Causes.

Signs and Symptoms of Shock: Change in Level of Consciousness (LOC) Restlessness and irritability due to cerebral hypoxia this is the 1st sign of hypoxia. Tachycardia and Tachypnea. Cool pale caused by vasoconstriction in limbs in order to squeeze blood to the core. Diaphoretic which is when skin feels cool and clammy. Hypotension Decreased Urine Output or oliguria due to poor kidney perfusion. Acidosis causes CNS depression. Heart Dysrhythmias due to poor cardiac perfusion. Respiratory Failure due to poor lung perfusion. Treatment for Shock: Intubate as needed (AIRWAY) Give oxygen (BREATHING) Cardiac monitoring (CIRCULATION) Maintain perfusion w/drugs and fluids (CIRCULATION) Treat underlying cause Teat PRIORITY = - Airway (intubation, suctioning) - Breathing (Oxygen) - Cardiac and Circulation (monitor heart, pump fluids to keep adequate blood pressure) Causes of Shock: Hypovolemic: Deficient circulating vascular volume (hemorrhage) Cardiogenic (Obstructive) Secondary to heart failure resulting from: • Inability of the heart to fill properly (pericarditis) • Obstruction to outflow from the heart (PE, Pneumothorax, Hemothorax, dissecting aneurysm • Pump failure Distributive: septic, anaphylactic, neurogenic - Altered regulation of vascular tone ~ SEPTIC SHOCK: Infection commonly caused by Gram negative bacteria toxin causing massive vasodilation ~ ANAPHYLACTIC SHOCK: Overwhelming immune response (vasodilation) to an allergen ~ NEUROGENIC SHOCK: Loss of blood vessel tone, causing displacement of the vascular vol. away from the heart & central circulation. Example: Spinal Shock - Spinal Cord Injury

Signs vs Symptoms

Signs are Determined by medical professional. Objective information regarding an illness. Can be seen/ felt/ heard/ smelled by another person and/or "measured". Examples: Temperature, weight, the condition of a wound, the character of the pulse, breath sounds heard through a stethoscope, etc. Symptoms are felt by a patient. Symptoms are Subjective information regarding an illness. Cannot be seen/ felt/ heard/ smelled by another person, or measured with objectives instruments. Pain is always a subjective finding because the patient is the only one to experience it.

Nutritional Anemia: Iron

The Bone marrow needs iron to make hemoglobin. Iron deficiencies are caused by lack of iron in the diet or by blood loss: -Metabolic demands such as pregnancy, and breastfeeding. -Blood loss through excessive menstruation, childbirth, or blood donation. -Digestive conditions, such as Crohn's OR the removal of stomach or small intestine. -Medications, or excess caffeine. Iron Replacement: - Mineral supplements or Iron injections; or consumption of foods that are high in iron such as, soybeans, lentils and beans, red meat, chicken, fish, fortified foods. -Symptoms stomatitis, difficulty swallowing, headache, confusion, memory loss, !"lightheaded", dizzy!

Hemoglobin (Hgb)

The oxygen-carrying pigment and predominant protein in the red blood cells. ~ Takes up to 1/3 the surface space of an erythrocyte ~ Is measured in grams

Hematocrit (Hct)

The proportion, or percent of the blood that consists of packed red blood cells in a given sample. The hematocrit is expressed as a percentage by volume. The red cells are packed by centrifugation. For example, an hematocrit of 25% means that there are 25 milliliters of red blood cells in 100 milliliters of blood.

Comorbidity

The simultaneous presence of two or more morbid conditions or diseases in the same patient, which may complicate a patient's hospital stay. Example: A person with heart failure could have a "comorbidity" of diabetes that will have to be treated also. The presence of comorbidity could make the primary condition harder to treat / heal.

Acquired Immune Deficiency Syndrome (AIDS)

There are three things needed to diagnose AIDS: 1. HIV test is positive. 2. Opportunistic infection. 3. CD4, T Helper cell count is less than 200. (all statements must be true to confirm AIDS) HIV Positive: The ELISA Test is a lab test that identifies various antibodies in blood (seroconversion) and is used to help identify HIV. If test detects antibody it is repeated. If second test is positive a Western Blot (WB) test is performed. If the WB detects virus then HIV infection is confirmed. Opportunistic Infections: account for the majority of deaths from AIDS. Because the immune system is malfunctioning, patients are susceptible to respiratory, gastrointestinal, and nervous system infections. AIDs patients are also more susceptible to malignancies, i.e.,Kaposi Sarcoma - a cancer that causes patches of abnormal tissue to grow under the skin, in the lining of the mouth, nose, and throat or in other organs. Lymphocytes affected by AIDS: CD8 Killer T-cells and CD4 Helper T-cells

Types of Pathogens: Protozoal

These are parasitic animals that infect or colonize other animals, which then transmit them to humans. In some cases, they directly infect the human host. Parasites can be transmitted by food, water, feces, or insects (worms or ticks/fleas/lice).

Reservoir

These are the carriers of the disease such as., animals infected with rabies can pass on the pathogen. The reservoir of an infectious agent is the habitat in which the agent normally lives, grows, and multiplies. Reservoirs include humans, animals, and the environment. The reservoir may or may not be the source from which an agent is transferred to a host. For example, the reservoir of Clostridium botulinum is soil, but the source of most botulism infections is improperly canned food containing C. botulinum spores. Human Reservoir: Diseases that are transmitted from person to person without intermediaries include the sexually transmitted diseases, measles, mumps, streptococcal infection, and many respiratory pathogens. Because humans were the only reservoir for the smallpox virus, naturally occurring smallpox was eradicated after the last human case was identified and isolated. Carriers commonly transmit disease because they do not realize they are infected, and consequently take no special precautions to prevent transmission. Animal Reservoir: Humans are also subject to diseases that have animal reservoirs. Many of these diseases are transmitted from animal to animal, with humans as incidental hosts. Examples: Rabies from bats, dogs, cats, etc., plague, from rodents. Many newly recognized infectious diseases in humans, including HIV/AIDS, Ebola infection and SARS, are thought to have emerged from animal hosts, although those hosts have not yet been identified. Environmental Reservoir: This can be plants, soil, water in the environment. For example, outbreaks of legionnaires disease are often traced to water supplies in cooling towers and evaporative condensers.

Types of Pathogens: Gram negative bacteria

These types of bacteria are endotoxin producing. Endotoxins are not released until the bacteria dies, as it does when a person is on antibiotic medication. High levels of endotoxin can trigger a systemic inflammatory response leading to septic shock, DIC, and ARDS. - Can reproduce independently.

Types of Pathogens: Gram positive bacteria

These types of bacteria are exotoxin producing. Exotoxins are released while the bacteria is alive and reproducing. Some Exotoxins are potent enough to kill the host, such as: botulism, cholera, diphtheria, tetanus. -Toxoid immunizations - DPT shot, protects agains diphtheria, pertussis, tetanus. - Can reproduce independently.

Myeloma (Cancer of the Blood)

This cancer affects the type of B-cell that makes antibodies. Staging system can be used because this type of cancer has skeletal or soft tissue tumors. This type of cancer starts in a type of B-Cell Lymphocyte called plasma cells, located in the bone marrow. These are protein-making cells which normally make all of the different kinds of proteins that comprise the antibodies, or immunoglobulins, of the immune system. In multiple myeloma, the bone marrow cells stop making different forms of protein in response to the immune system's needs and instead starts to produce a single abnormal type of protein referred to as a !"monoclonal" or M protein! Multiple myeloma plasma cell populations accumulate and these collections of cells called plasmacytomas can erode the hard outer shell or cortex of the bone that normally surrounds the marrow. These weakened bones show thinning of the bone such as is seen in nonmalignant osteoporosis or what appear to be punched out or lytic bone lesions. These lesions may cause pain and even breaks, pathological or spontaneous fractures of the bones affected by the cancer. [NOTE: Myeloma is NOT leukemia]. MM could result in the following: -Skeletal tumors - OR - Soft tissue tumors • Malignant plasma cells form solid tumors in the soft tissue. • More common in men than women. • Develops after 40 years of age -Signs and symptoms!: • Bone pain and pathological fractures, which occur spontaneously without an injury. • Hypercalcemia, an increase in serum calcium levels, from calcium moving from the bone into the blood. • Tumor markers - "M-proteins" found in serum and "Bence-Jones protein" found in urine. • Myeloma nephrosis caused by damage to kidneys by paraproteins, that cause hyperviscosity of body fluids, which is a distinctive feature of Myeloma. • Usual signs and symptoms of bone marrow damage, blood dyscrasias. Prognosis is not good: -Early diagnosis and treatment equals 3 to 5 years survival. -Late diagnosis and treatment equals 50% of patients die within 3 months and 90% within 2 years.

Deep Vein Thrombosis or DVT

This is a Venous Disorder. Etiology: diminished blood flow, especially in the legs, and pressure. RISK FACTORS: -Prior history of a DVT this is the #1 highest risk factor -Pregnancy -sitting for long periods like when driving, flying, or desk job; -Birth control pills; -obesity; -smoking Pathophysiology: hemostasis and the activation of intrinsic clotting cascade causes thrombus formation that is the source of blood clots that break off and travel to different parts of the body. Emboli, usually to lungs and causing pulmonary emboli or PE. Signs and Symptoms: tenderness, swelling, redness and warmth in affected leg, when compared to other leg. Treatment: anticoagulants such as Heparin, Coumadin, Plavix or Lovenox and prevention.

Leukemias (Cancer of the Blood)

This is a cancer of the White blood cells!, and is a malignant development of leukocytes. Over proliferation of nonfunctioning white blood cells in the bone marrow that grows faster than the functioning cells. Eventually the leukemia cells crowd out all the functioning blood cells in the bone marrow which leads to the various signs and symptoms of leukemia (anemia, infections and bleeding problems). Leukemia is classified by its speed of progression and the type of cells involved. There are 4 main types of leukemia, based on whether they are acute or chronic, and myeloid or lymphocytic: -Acute myeloid leukemia or myelogenous leukemia (AML) -Chronic myeloid leukemia or myelogenous leukemia (CML) -Acute lymphocytic leukemia or lymphoblastic leukemia (ALL) -Chronic lymphocytic leukemia (CLL) Leukemia is classified by first or second. The primary differences between the four main types of leukemia have to do with their rates of progression and where the cancer develops. "Chronic" leukemia cells do not mature all the way, so they are not as capable of defending against infections as normal lymphocytes. "Acute" leukemia cells begin to replicate before any immune functions have developed. The first type of classification is by how fast the leukemia progresses: 1. Acute leukemia. In acute leukemia, the abnormal blood cells are immature blood cells (blasts). They can't carry out their normal functions, and they multiply rapidly, so the disease worsens quickly. Acute leukemia requires aggressive, timely treatment. 2. Chronic leukemia. There are many types of chronic leukemias. Some produce too many cells and some cause too few cells to be produced. Chronic leukemia involves more mature blood cells. These blood cells replicate or accumulate more slowly and can function normally for a period of time. Some forms of chronic leukemia initially produce no early symptoms and can go unnoticed or undiagnosed for years. The second type of classification is by type of white blood cell affected: 1. Lymphocytic leukemia. This type of leukemia affects the lymphoid cells (lymphocytes), which form lymphoid or lymphatic tissue. Lymphatic tissue makes up your immune system. 2. Myelogenous leukemia. This type of leukemia affects the myeloid cells. Myeloid cells give rise to red blood cells, white blood cells and platelet-producing cells. Leukemia Signs and Symptoms!: - Lymphadenopathy! - Swelling lymph nodes. May swell without any other signs and symptoms or swell in random patterns. - Anemia, Infection, Bleeding problems! (due to bone marrow damage that affects all blood cells) - Malignant leukocytes crowding the bone marrow and leading to decreased erythrocyte and thrombocyte production, resulting in a Pallor or pale skin color!

Peripheral Arterial Occlusive Disease or PAOD

This is an Arterial Disorder Caused by atherosclerotic blockages in the LARGE arteries like carotid and femoral, and not smaller arteries coronary, aortic arch, brain. Signs and symptoms begin to show when artery is 50% occluded. Most common symptom is "Claudication" also referred to as "Intermittent Claudication." Whether a patient progresses to limb amputation largely depends on the number and severity of cardiovascular risk factors such as smoking, hypertension, or diabetes. Continued smoking has been identified as the adverse risk factor most consistently associated with the progression of PAOD.

Delayed hypersensitivity (cell mediated): Type 4 Hypersensitivity

This is an example of Cell mediated rather than antibody mediated. These T cell lymphocytes attack some types of viruses and microbes. They are also triggered in contact dermatitis, like poison ivy antigens. It is called "delayed hypersensitivity" because it takes 24 to 72 hours for symptoms to show.

Cytotoxic: Type 2 Hypersensitivity

This is antibody mediated response to an antigen on a cell surface. When the antibody attacks the antigen, it also kills the cell to which it is attached, thus the name "CYTOtoxic". A primary example of TYPE II hypersensitivity is blood incompatibilities, and when a RH-negative mother develops antibodies against her RH-positive baby's blood. The mom's antibodies then attack the baby's blood cells because they have RH factor coating.

Thrombosis:

This is the Formation of blood clots. Clotting can occur in the arteries or veins, but is More common in veins due to lower blood pressure and slower flow of blood in veins as compared to arteries. Increase risk of blood clot formation: -Abnormal blood flow - increased turbulence as caused by high blood pressure. More common in arterial system. Damage to vessel walls or blood cells trigger intrinsic clotting cascade. -Injured vessel walls - Interior of blood vessels can be damaged by the development of atherosclerotic plaque (can lead to the development of strokes or heart attack.); Deep Vein Thrombi in legs break off to create Pulmonary Emboli. -Altered blood constituents - Increased viscosity of blood [Dehydration can increase risk of clot formation]. Thrombocytosis, which is an increased or abnormal production of platelets, and may be a marker for cancer since 40% of people with unexplained high platelet count have cancer). Treatment of Thrombosis: -Anti-coagulant drugs- Thin the blood to prevent future clots but no effect on existing clots, such as Heparin, Coumadin, or Aspirin. -Thrombolytic drugs- Breaks up or dissolves existing blood clots, which are the main cause of both heart attacks and stroke but do not prevent future clots.

Polycythemia Vera

This is the opposite of anemia, and there are too many red blood cells. -Primary (Absolute) - autosomal inheritance. Caucasian with European Jewish ancestry are more at risk . -Secondary (Relative) - physiologic response to chronic hypoxia that triggers the body to make more RBCs for oxygen transport in an effort to get more oxygen to the cells of the body. 1. Sleep Apnea - Due to either Obstructive Sleep Apnea (airway "collapses" during sleepblockage of air and snoring) or Central Sleep Apnea (the brain does not signal the lungs to breathe). Both types result in oxygen deprivation. 2. COPD - (Chronic Obstructive Pulmonary Diseases such as asthma and emphysema that hamper gas exchange in the lungs. 3. Heart failure - reduces tissue profusion, which create hypoxic tissue even if the blood volume and concentrations are normal. The low oxygenation will trigger an increase in production of RBCs. 4. Pulmonary disease - gas exchange between lungs and vasculature may be impaired. The decrease in O2 exchange will produce hypoxia and trigger an increase in production of RBCs. 5. High Altitude - body compensates for lower O2 levels at higher altitudes by making more RBCs to carry oxygen. Takes 6-8 weeks to build up enough erythrocytes. -Signs & symptoms: caused by reduced blood flow - Plethora: ruddy complexion; -Fatigue; Dizziness; -Headache Treatment includes the regular blood removal of erythrocytes to decrease the concentration. Radioactive phosphate also used.

Autoimmune Diseases

This is when the body is unable to distinguish self from foreign. Cells of the immune system attack various parts of the body depending on the type of AI disease involved. AI diseases are currently Incurable. There are more than 80 different types of autoimmune diseases, the most common of which are: -Rheumatoid arthritis (RA) most common affecting 1% of world population. -Type 1 Diabetes. -Inflammatory Bowel Disease and Crohns Disease. -Lupus, systemic lupus erythematosus (SLE). -Psoriasis.

Lymphoma (Cancer of the Blood) & Hodgkin's vs. Non-Hodgkin's lymphoma.

This type of cancer originates in the Lymphocytes of the lymphatic system. This blood cancer that affects the lymphatic system causing an overproduction of malfunctioning lymphocytes. This overload compromises the immune system. Lymphoma can develop in many parts of the body, including lymph nodes, bone marrow, blood, spleen and other organs. There are 2 types: !Hodgkin's Lymphoma!: Cells Affected • B-Cell lymphocytes, and Reed-Sternberg Cells are present. Age of Onset • 20 to 30 years, more common in younger population, especially college age males. Node Involvement • Cervical, inguinal, axially, and retroperitoneal. • Extra nodal involvement is uncommon. Symptoms • !Painless swollen lymph nodes! • !Weight loss! • !Bone Marrow Damage, and blood dycrasias! • Fever, night sweats, and generalized weakness. Curability • !About 99%! !Treatment! • Localized radiation therapy • Generalized Chemotherapy • Immunotherapy / MAB drugs • Bone marrow stem cell transplant !Non-Hodgkin's Lymphoma!: Cells Affected • !B and T Cells! Age of Onset • people over 50 years old (95% of cases are adults) Node Involvement • Cervical, inguinal, and femoral. • Extra nodal involvement is common. Symptoms • !Painless swollen lymph nodes! • !Weight loss! • !Bone Marrow Damage, and blood dycrasias! • Fever, night sweats, and generalized weakness. • Pleural effusion • Abdominal pain • Splenomegaly Curability • !Less than 25%! !Treatment! • Localized radiation therapy • Generalized Chemotherapy • Immunotherapy / MAB drugs • Bone marrow stem cell transplant

Causes of Thrombocytopenia

Thrombocytopenia is a deficiency of platelets in the blood. This causes bleeding into the tissues, bruising, and slow blood clotting after injury. ~Altered Coagulation - Thrombocytopenia is a platelet count < 140,000, and is a reduced number of thrombocytes leading to impaired clotting ability. ~Idiopathic Thrombocytopenia Purpura or ITP~ is an Autoimmune disorder that causes an IgG antibody to bind with platelets, destroying their function. Results in low platelet count and signs and symptoms of bleeding. ~Thrombotic Thrombocytopenia Purpura or TTP: is Thought to be caused by widespread endothelia damage that triggers thrombosis and platelet destruction. signs and symptoms include: Fever, hemolytic anemia, renal failure, neurologic decline. ~Drug Induced: A hypersensitivity reaction causes platelet destruction. Heparin can induce a Type III Hypersensitivity reaction that can quickly be resolved after eliminating drug. Signs & symptoms of Thrombocytopenia: Epistaxis Menorrhagia Bleeding gums Purpura Petechiae GI Bleeds Treatment: -Immunosuppression Treatments (Treatment for TTP) -Plasmapheresis (Treatment for TTP) -Eliminate the causative drug -Platelet infusion

Types of Pathogens: Fungal

Transmitted by spores, such as molds and yeast. The cause of many "opportunistic" infections in an immunocompromised host. Example: People with AIDS or on chemotherapy are prone to get oral "thrush" and other yeast or fungal infections. Women taking antibiotics can develop a vaginal overgrowth of candida albicans.

MAB drugs :Monoclonal Antibodies

Treatment for Autoimmune Disorders: Depends on area of the body affected, but often includes immunosuppression drugs (also used to treat cancer) such as steroids and Methotrexate; and Monoclonal Antibodies (drug names end in "-mab" which is a handy way to remember that anyone taking these drugs "must-avoid-bugs" or germs, because they are immunocompromised). MABs are the designer drugs of the future because they can target specific cell types (such as cancer cells) without damaging surrounding tissue as traditional chemotherapy does. A Monoclonal antibody that inhibits TNF, which is Tumor necrosis factor, and suppresses the system can be used to treat Autoimmune disorders and caner.

Immune complex disease: Type 3 Hypersensitivity

When an antibody binds to an antigen it can make a complex that the body cannot absorb. These complexes then trigger the inflammatory response. These complexes cause damage to organs and blood vessels causing kidney damage or vasculitis. Immune complexes also play a damaging role in Lupus as well as glomerulonephritis.

White Blood Cell Count : what abnormal values mean.

White Blood Cell Count (Total WBC) Normal range is 5,000 to 10,000 -Must order a CBC "with differential" to get the percent of neutrophils and lymphocytes. Leukocytosis: White blood cell count is elevated > 10,000, in the following conditions: -Neutrophils 47 to 63% >63% indicates an acute bacterial infection, because neutrophils only live 5 to 10 days. -Lymphocytes 24 to 40% >40% indicates a viral infection, OR Chronic bacterial infection, because lymphocytes are the body's second line of defense. -Eosinophils are elevated in allergies or parasitic infection. Leukopenia: White blood cell count is decreased <5,000, in the following conditions: -Steroid, or medications containing them such as prednisone. -Chemotherapy -Bone Marrow Failure, seen win aplastic anemia or cancer such as leukemia. -Use of anti seizure medications such as Tegretol.

Rapid "3 Second Assessment"

[ABCD assessment model] a complete head-to-toe rapid assessment of all major body systems in 3 seconds!!! Using this model to assess a patient will help you keep your priorities straight. Airway/Breathing: look for chest rise. If present, the person has an open airway and is ventilating adequately. Cardiac/circulation: feel radial pulse. If present then person has at least an 80 systolic B/P which is adequate to perfuse the brain. Note dysrhythmias; character of pulse (weak or bounding). Feel temperature & moisture on skin. Deficit of NEURO functions: Ask person to move feet. This assesses the acoustic nerve; the ability of the brain to process information; brain's ability to send a signal down the spinal cord; & ability of the spinal cord to send nerve impulses to the most distal nerves in the body (feet). If everything works, the person is neurologically intact.

Heart Attack: Myocardial Infarction: coronary occlusion

pain: sudden onset, substernal, crushing, tightness, severe, unrelieved by nitroglycerin, may radiate to back, neck, jaw, shoulders, and arms. signs and symptoms: dyspnea, syncope caused by decreased blood pressure, nausea, vomiting, extreme weakness, diaphoresis, increased heart rate, and denial is common. Treatment: O2 Medications, Monitory, Dietary Restrictions that decrease NA / cholesterol / caffeine, sometimes PIC, Surgery, Pacemaker.