patho midterm review
acute bronchitis pathogenesis
Airway -> inflammation -> obstruction -> respiratory distress -> wheezing
hypertensive urgency
BP will be lowered over 24-48 period using oral **no end organ damage - give oral antihypertensives
infection leads to progressive immunodeficiency and AIDs
CD4 and T cells fall below 200 cells lymphocytes = 14% can lead to kaposi's sarcoma, lymphoma, and squamous cell carcinoma
Which factor explains why a client who experiences an acute episode of rheumatoid arthritis has swollen finger joints?
Inflammation in the joint's synovial lining
pneumothorax
Presence of air or gas in the pleural space caused by rupture of pleura and chest wall
oxygen and carbon dioxide transported in circulation
RBCs transport oxygen veins carry carbon dioxide back to the heart
acute arterial occlusion
absense of arterial circulation = emergency! - swelling happens after surgery, blood flow accumulates in the muscles = compartment syndrome
Which clinical condition will result in changes in the integrity of the arterial walls and small blood vessels?
atherosclerosis
scleroderma
autoimmune disorder by forming scar tissue -> natural immune response to help heal *body overproduces collagen
pericardial effusion significance
causes decreased oxygenation and and decreased perfusion
Which assessment findings would indicate a possible asthma exacerbation? Select all that apply
- tachycardia - wheezing
SLE
chronic multisystem inflammatory autoimmune disease - multiple organs are affected = can lead to organ failure *butterfly rash is common
rheumatoid arthritis
chronic, systematic, progressive deterioration of connective tissue cause: - autoimmune, but unknown = classified as an immune complex disorder clinical findings - immobility, pain, muscle spasms
risk factors of breast cancer
hormonal influences reproductive factors dietary factors family history age hx of cancer lack of access to healthcare
chronic lymphoid leukemia
affects bone marrow - large painless lymph nodes, and enlarged lymph nodes *not treatable bc of slowness of manifestations
acute bronchitis manifestations
airway becomes inflamed and narrowed low grade cough sore throat + or nonproductive cough
role of inflammation in asthma
alveoli gets inflamed = release of inflammatory mediators *causing excessive mucous production and airway plugging
pericarditis cause
infectious agents, usually viral or bacterial; or insult to mediastinal structures
The arterial blood gases for a client with acute respiratory distress are pH 7.30, PaCO2 55 mm Hg, and HCO3 23 mEq/L. How would the nurse interpret these findings?
uncompensated respiratory acidosis
chronic myeloid leukemia
unique chromosome abnormality = philadelphia - not responsive to chemo - survival rate is poor - splenomegaly is common sx
modes of transmission of HIV
unprotected sex injecting drugs pregnancy, childbirth, breastfeeding blood transfusions and organ transplants
Which food would the nurse recommend for a child who is at risk for developing rickets?
yogurt
type 2 hypersensitivity reaction
reaction with blood transfusions, and blood associated things *destruction of RBCs = hemolytic reaction - occurs 15-30 mins after exposure
A client newly diagnosed with scleroderma states, "Where did I get this from?" How would the nurse reply?
"The exact cause is unknown, but it is thought to be a result of autoimmunity."
Which statement indicates a client understands transmission of the human immunodeficiency virus (HIV)? Select all that apply
- "I can contract HIV by participating in oral sex." - "HIV is contracted by using contaminated needles." - "Babies can contract HIV because of contact with maternal blood during birth"
pain of endometriosis differentiated from dysmenorrhea
- Endometriosis Pain: extremely severe pain, pain with defecation - Dysmenorrhea Pain: pain in lower part of abdomen and in vagina
Which potential clinical manifestations would the nurse associate with a client diagnosed with systemic lupus erythematosus (SLE)? Select all that apply
- joint pain - facial rash - pericarditis
A client is hospitalized with emphysema. The nurse recognizes the importance of assessing for clinical indicators of hypoxia based on which condition associated with the disease?
Loss of aerating surface
Endometriosis is a condition in which:
ectopic endometrial tissue is present
tumor grading
evaluated amount of differentiation - GX = cannot be determined - G1 = cells are well differentiated - G2 = cells are moderately differentiated - G3 = cells are poorly differentiated, but tissue origin is established
pericarditis significance
can cause: - cardiac tamponade: results from restriction or excessive pericardial fluid in the pericardial sac - pulsus paradoxus: ↓BP during inspiration - friction rub - tachycardia = not enough blood so heart has to speed up to get blood to rest of the body
clinical manifestations of heart failure
difficulty breathing or shortness of breath = accumulation of fluid in the lungs edema/fluid retention dizziness, fatigue, weakness rapid or irregular heartbeat
pathogenesis of gouty arthritis
disturbance of uric acid metabolism - buildup of uric acid crystals
A 32-year-old female complaining of severe pain with menstruation and inability to participate in her routine household activities is likely experiencing
dysmenorrhea
clinical consequences of superficial obstructions
raised and tortuous veins = varicose
type 3 hypersensitivity reaction
rare reaction, not tissue specific reaction *reaction to certain exposures (being bitten by snake, bee, etc) - "serum sickness"
How would the nurse document a drop in blood pressure when a client moves rapidly from a lying to a standing position?
orthostatic hypotension
6 P's acute arterial occlusion manifestations
pallor paresthesia paralysis pain polar pulseless
how can HIV be prevented
post exposure prophylaxis - taking it very soon after exposure helps to prevent infection
clinical findings of plasma deficits of electrolytes
- Sodium: vomiting, diarrhea, sweating = fatigue, muscle cramps, N/V, hypotension - Calcium: increases excitability of nerves = abdominal cramping, hyperactive reflexes, seizures, Chvostek's and Trousseau's sign -> tetany - Magnesium: caused by chronic alcoholism - Phosphorus: anorexia, paresthesia, diminished reflexes, respiratory compromise, impaired cardiac function
clinical findings of plasma excesses in electrolytes
- Sodium: weakness, thirst, edema of foot and ankle, accumulation of fluid in the lungs causing crackles - Calcium: decreases neuromuscular function = decreased reflexes, decreased bone density, lethargy, depressed cardiac conduction - Potassium: risk for cardiac arrest!, muscle dysfunction, cramping and diarrhea - Magnesium: depression of neuromuscular function = lethargy, hypotension, drowsiness, bradycardia, flushing - Phosphorus: conjunctivitis, pruritis, cardiac valve calcifications, may be the result of renal failure
factors altering balance between myocardial oxygen supply and demand
- angina increases workload of the heart and increases oxygen demand - heart failure makes the heart unable to meet energetic demands of body tissues
A client with a recent history of head trauma is at risk for orthostatic hypotension. Which assessment finding(s) observed by the nurse would relate to this diagnosis? Select all that apply
- fainting - weakness - lightheadedness
Which clinical manifestations would lead the nurse to contact the health care provider regarding the potential development of acute osteomyelitis? Select all that apply.
- fever - erythema - tenderness to area chronic = ulcers and drainage
Which finding in a client with pulmonary edema requires the most rapid action by the nurse?
Oxygen saturation 82%
COPD manifestations
SOB chronic cough edema hx of smoking chills, muscle aches
fat emboli syndrome
fat emboli releases from bone marrow and enters the bloodstream and becomes trapped in pulmonary and dermal capillaries - sx: SOB, tachypnea, altered mental status - tx: early ambulation and supplemental oxygen
mechanism of tissue injury with hypersensitivity reaction
initiation from inflammatory process - body reacts with foreign agent
asthma manifestations
breathing is labored and rapid, use of accessory muscles status asthmaticus = persistent, severe attack that does not respond to initial therapy
role of bicarb buffer in regulating pH
buffer in the ECF = first line defense against pH imbalances - bicarb ion is the base portion - carbonic acid is weak acid portion = excreted via respiratory system
A client with known peripheral arterial disease calls the clinic and tells the nurse about experiencing several symptoms. Which symptom requires the most rapid action by the nurse?
chest pain
acute myeloid leukemia
chromosomal translocation (genetic alterations) - bone pain = most common sx
tumor staging
classifies solid tumors and tumor sizes - TX = Unable to evaluate primary tumor - T0 = no evidence of primary tumor - Tis = tumor in situ (localized and treatable) - T1, T2, T3, T4 = size and extent of tumor
Which client with complications of fracture would the nurse expect may be treated with a fasciotomy?
compartment syndrome
complications that can occur from a fracture
compartment syndrome fat emboli syndrome DVT
assessment of arterial obstructions
cool to touch thickened nails pallor when elevated rubor when dependent
Which finding in a client with asthma exacerbation requires the most rapid action by the nurse?
decreased breath sounds
chronic venous insufficiency
deep - valvular incompetence involves deep veins
compartment syndrome
occurs when swelling causes increased pressure in muscle compartment - manifestations = leads to decreased blood flow and potential nerve and muscle damage, causes continued ischemia - dangers: amputation - management: need to call surgeon immediately if something doesn't look right, look for 6 P's
5 cardinal signs of inflammation
pain heat swelling redness loss of function
osteoarthritis
progressive non-inflammatory arthritis cause: - destruction of bone under cartilage, weight bearing joints are affected - overuse disorder clinical findings - nodules on joints crepitus with joint movement
manifestations of bone infection
puss formation in the bone blood flow occluded ischemia bone necrosis
pH 7.16; CO2 69 and HC03 23
respiratory acidosis
Which explanation will the nurse give when a client asks about what causes varicose veins?
"Incompetent valves of superficial veins."
factors affecting distribution of ventilation and perfusion
COPD - mucosal hypertrophy and edema - airway narrowing from bronchial smooth muscle contraction Oxygen Saturation - hypoxemia: deficient level of blood O2 - hypoxia = decreased tissue oxygenation
common systemic manifestations of AIDs and opportunistic infections
HIV associated dementia retinopathy and malignancies impact on CV, renal, hepatic, endocrine systems
predisposing factors for heart failure
HTN CAD previous MI smoking, overweight, diet high fat not enough exercise
Which finding would the nurse expect to identify in a client who has osteoarthritis that would not be present in clients with rheumatoid arthritis?
Heberden nodes
Which assessment finding by the clinic nurse who is caring for a client with chronic bronchitis is most important to communicate to the health care provider?
Temperature of 101.8 F
dvt
formation of clot at distal extremity led to clot fragments to break loose and enters circulation - tx: prophylactic anticoagulants, SCD's , and early mobilization
type 1 hypersensitivity reaction
highly sensitized response to an allergen *does not occur with first exposure , but does happen with second exposure *releases antihistamines
After a spontaneous pneumothorax, a client's assessment findings include extreme drowsiness, tachycardia, and tachypnea. The nurse suspects which condition?
hypercapnia
osteoporosis
imbalance of osteoblasts that form new bone and osteoclasts that reabsorb bone *bone loss increases after menopause (loss of estrogen)
lungs and kidneys compensating for acid-base imbalance
increased renal excretion of metabolic acid - as kidneys excrete more metabolic acid, bicarb concentration increases
body's response when coming in contact with organism
inflammation is caused by various insult to the body such as burns, injury, or surgical procedures
COPD pathogenesis
inflammation is the result of neutrophil activity mucous production leads to mucous plugs and causes increased airway obstruction and decreased oxygenation
primary hypertension
known as essential hypertension *idiopathic cause - most common type of HTN - end organ damage = "silent killer"
how is BP regulated
lose weight = obesity big cause diet = reduce fat and sodium decrease lipids smoking and alcohol cessation
Which clinical manifestations would the nurse expect to find in a client who has acute human immunodeficiency virus (HIV) infection? Select all that apply
malaise swollen lymph nodes
acute lymphoblastic leukemia
malignancy of the lymphatic system - most common in children - SX: loss of appetite, fatigue, and abdominal pain
arterial obstructions
manifests as distal ischemia - intermittent claudication = pain with activity and gets better with rest late sx: painful arterial ulcer around one toe
venous obstructions
manifests as edema - inflammation of vein and accompanied by a thrombus = thrombophlebitis DVT = can manifests into a PE = happens extremely fast
An arterial blood gas report indicated the client's pH is 7.25, PaCO2 33 mm Hg, and HCO3- is 20 mEq/L. Which disturbance would the nurse identify based on these results?
metabolic acidosis
role of respiratory system in regulating carbonic acid
second defense against acid-base balance disorders - during expiration, lungs effective carbonic acid - balance of carbonic acid remaining in the body is based on depth and rate of respiration - dependent on normal functioning respiratory system
Which clinical finding would the nurse expect for a client with hypertensive emergency?
severe pounding headache
type 4 hypersensitivity reaction
slow to react! - mediated by t cells (have memory function) - memory cells form in 7-14 days to response from antigen
hypertensive emergency
sudden increase in either/both systolic and diastolic pressures - evidenced by organ damage = this determines treatment **use IV antihypertensive agents
pericardial effusion cause
too much fluid impairs heart function
osteomalacia
vitamin D deficiency - inadequate concentration of vitamin D, calcium, or phosphorus; poor vitamin D metabolism **leads to softening of the bones
manifestations of type 1 reactions
wheezing eyes swell shut tongue swells can lead to anaphylaxis - angioedema, hypotension, vasodilator, dyspnea
pleural effusion
· A buildup of fluid between the tissues that line the lungs and chest · Chest tube is used to drain fluid
tension pneumothorax
· Air enters pleural space on inspiration = pt can still breathe · Absent lung sounds on affected side · Chest tube will be put in to expand the lung = MED EMERGENCY