Pathophysiology exam 2

You're providing diet teaching to a patient with ulcerative colitis about what types of foods to avoid during a "flare-up". Which foods below should the patient avoid? SELECT-ALL-THAT-APPLY:* A. Ice cream B. White Rice C. Fresh apples and pears D. Popcorn E. Cooked carrots

A,C,D

A pt who uses a fentanyl (Duragesic) patch for chronic cancer pain complains to the cnurse of the rapid onset of pain at a level 9 (0 to 10 scale) and request (something for pain that will work quickly" The nurse will document this as a. Somatic pain b. Referred pain c. Neuropathic pain d. Breakthrough pain

Ans: D

A client fell from a ladder and broke his ankle and is being seen in the emergency department for severe ankle pain with swelling and limited range of motion. What type of pain does the nurse recognize the client experiencing? a) Subacute pain b) Acute pain c) Visceral pain d) Chronic pain

Acute pain Acute pain is pain that is elicited by injury to body tissues and activation of nociceptive stimuli at the site of local tissue damage. It is generally of short duration and tends to resolve when the underlying pathologic process has resolved. Acute pain's purpose is to serve as a warning system. It alerts a person to the existence of actual or impending tissue damage and prompts a search for medical help.

During morning rounds, the nurse asks a patient, How are you today? The pt responds, You today, you today, you today! And mumbles the words. This speech pattern is an example of: a. Echolalia b. Clanging c. Word salad d. Preservation

Ans: A

Unlike disorders of the motor cortex and corticospinal (pyramidal) tract, lesions of the basal ganglia disrupt movement: A) Without causing paralysis B) Posture and muscle tone C) And cortical responses D) Of upper motor neurons

Ans: A Feedback: Disorders of the basal ganglia comprise a complex group of motor disturbances characterized by tremor and other involuntary movements, changes in posture and muscle tone, and poverty and slowness of movement. They include tremors and tics, spasticity, hypokinetic disorders, and hyperkinetic disorders. Unlike disorders of the motor cortex and corticospinal (pyramidal) tract, lesions of the basal ganglia disrupt movement but do not cause paralysis. Disorders of the upper motor neuron pyramidal tracts are characterized by spasticity and paralysis.

A client asks, "What do these basophils and mast cells do in the body?" The health care provider responds that they: A) Are involved when you have an allergic reaction B) Stiffen your cell membranes so bacteria cannot enter C) Help your body to eliminate parasitic infections D) Help your body produce immune responses

Ans: A Feedback: The basophil, which is a blood cell, is related to the connective tissue mast cell that contains similar granules. Both the basophils and mast cells are thought to be involved in allergic and hypersensitivity reactions. These cells do not stiffen the cell membranes. In parasitic infections, the eosinophils use surface markers to attach themselves to the parasite and then release hydrolytic enzymes that kill it. Lymphocytes migrate through the peripheral lymphoid organs, where they recognize antigens and participate in immune responses.

A family brings their father to his primary care physician for a checkup. Since their last visit, they note their dad has developed a tremor in his hands and feet. He also rolls his fingers like he has a marble in his hand. The primary physician suspects the onset of Parkinson disease when he notes which of the following abnormalities in the client's gait? A) Slow to start walking and has difficulty when asked to "stop" suddenly B) Difficulty putting weight on soles of feet and tends to walk on tiptoes C) Hyperactive leg motions like he just can't stand still D) Takes large, exaggerated strides and swings arms/hands wildly

Ans: A Feedback: The cardinal symptoms of Parkinson disease (PD) are tremor, rigidity (hypertonicity), and bradykinesia or slowness of movement. Bradykinesia is characterized by slowness in initiating and performing movements and difficulty in sudden, unexpected stopping of voluntary movements. Persons with the disease have difficulty initiating walking and difficulty turning. While walking, they may freeze in place and feel as if their feet are glued to the floor, especially when moving through a doorway or preparing to turn. When they walk, they lean forward to maintain their center of gravity and take small, shuffling steps without swinging their arms.

Disorders of the pyramidal tracts, such as a stroke, are characterized by: A) Paralysis B) Hypotonia C) Muscle rigidity D) Involuntary movements

Ans: A Feedback: Disorders of the pyramidal tracts (e.g., stroke) are characterized by spasticity and paralysis, whereas those affecting the extrapyramidal tracts (e.g., Parkinson disease) by involuntary movements, muscle rigidity, and immobility without paralysis. Hypotonia is a condition of less than normal muscle tone, hypertonia or spasticity is a condition of excessive tone, and paralysis refers to a loss of muscle movement. Upper motor neuron (UMN) lesions produce spastic paralysis and lower motor neuron (LMN) lesions flaccid paralysis.

A client has had severe heart burn associated with persistent gastroesophageal reflux for many years. Which of the following statements made by the client leads the nurse to suspect the client is having a complication related to his reflux? The client is having: A) Difficulty in swallowing with feelings that food is "stuck" in the throat B) Burning sensation a half-hour after a meal C) Substernal chest pain that radiates to the shoulder and arm D) "Hoarseness" unrelieved by coughing or taking a drink of water

Ans: A Feedback:Complications can result from persistent reflux, which produces a cycle of mucosal damage that causes hyperemia, edema, and erosion of the luminal surface. Strictures are caused by a combination of scar tissue, spasm, and edema, which narrow the esophagus. The most frequent symptom of gastroesophageal reflux is heartburn. Other symptoms include belching, wheezing, chronic cough, hoarseness, and epigastric or retrosternal area chest pain, radiating to the throat, shoulder, or back. Because of its location, the pain may be confused with angina.

An 86-year-old female client has been admitted to the hospital for the treatment of dehydration and hyponatremia after she curtailed her fluid intake to minimize urinary incontinence. The client's admitting laboratory results are suggestive of prerenal failure. The nurse should be assessing this client for which of the following early signs of prerenal injury? A) Sharp decrease in urine output B) Excessive voiding of clear urine C) Acute hypertensive crisis D) Intermittent periods of confusion

Ans: A Feedback:Dehydration and its consequent hypovolemia can result in acute renal failure that is prerenal in etiology. The kidney normally responds to a decrease in GFR with a decrease in urine output. Thus, an early sign of prerenal injury is a sharp decrease in urine output. Postrenal failure is obstructive in etiology, and intrinsic (or intrarenal) renal failure is reflective of deficits in the function of the kidneys themselves.

Disorders of the pyramidal tracts, such as a stroke, are characterized by: A) Paralysis B) Hypotonia C) Muscle rigidity D) Involuntary movements

Ans: A Feedback:Disorders of the pyramidal tracts (e.g., stroke) are characterized by spasticity and paralysis, whereas those affecting the extrapyramidal tracts (e.g., Parkinson disease) by involuntary movements, muscle rigidity, and immobility without paralysis. Hypotonia is a condition of less than normal muscle tone, hypertonia or spasticity is a condition of excessive tone, and paralysis refers to a loss of muscle movement. Upper motor neuron (UMN) lesions produce spastic paralysis and lower motor neuron (LMN) lesions flaccid paralysis.

The client is undergoing diagnostic workup for possible Hodgkin type of lymphoma. Which of the following laboratory results would confirm the diagnosis of Hodgkin lymphoma? A) Reed-Sternberg cells B) Bence Jones proteins C) M-type protein antibodies D) Philadelphia chromosome

Ans: A Feedback:Hodgkin lymphoma is diagnosed by the presence of Reed-Sternberg cells. Philadelphia chromosomes are found in chronic myelogenous leukemia cells. M-type protein antibodies are diagnostic for multiple myeloma. Bence Jones proteins are found in the urine of people with multiple myeloma.

Which of the following physiologic principles would be considered a function of the somatic nervous system? A) The act of typing a report using a computer keyboard B) Withdrawing the hand after touching a hot surface C) The patellar reflex "knee jerk" activated by tapping the patellar tendon abdominal viscera D) The beginning of depolarization in the cardiac conduction of impulses

Ans: A Feedback:The somatic nervous system provides sensory and motor innervation for all parts of the central nervous system (CNS) and peripheral nervous system (PNS) except viscera, smooth muscle, and glands. The autonomic nervous system (ANS) provides efferent motor innervation to smooth muscle, the conducting system of the heart, and glands.

Of the following clients, which would be at highest risk for developing hyperkalemia? A) A male admitted for acute renal failure following a drug overdose B) A client diagnosed with an ischemic stroke with multiple sensory and motor deficits C) An elderly client experiencing severe vomiting and diarrhea as a result of influenza D) A postsurgical client whose thyroidectomy resulted in the loss of some of the parathyroid glands

Ans: A Feedback: There are three main causes of hyperkalemia: (1) decreased renal elimination; (2) a shift in potassium from the ICF to ECF compartment; and (3) excessively rapid rate of administration. The most common cause of serum potassium excess is decreased renal function. Stroke does not typically have a direct influence on potassium levels, whereas vomiting and diarrhea can precipitate hypokalemia. Loss of the parathyroid influences calcium, not potassium, levels.

A client with a diagnosis of liver cirrhosis secondary to alcohol abuse has a distended abdomen as a result of fluid accumulation in his peritoneal cavity (ascites). Which of the following pathophysiologic processes contributes to this third spacing? A) Abnormal increase in transcellular fluid volume B) Increased capillary colloidal osmotic pressure C) Polydipsia D) Impaired hormonal control of fluid volume

Ans: A Feedback: Third spacing represents the loss or trapping of extracellular fluid (ECF) in the transcellular space and a consequent increase in transcellular fluid volume. The serous cavities are part of the transcellular compartment located in strategic body areas where there is continual movement of body structures—the pericardial sac, the peritoneal cavity, and the pleural cavity. Polydipsia and increased fluid intake alone are insufficient to cause third spacing, and increased capillary colloidal osmotic pressure would result in increased intracellular fluid (ICF). The etiology of third spacing does not normally include alterations in hormonal control of fluid balance.

A college student goes to the campus health office complaining of diarrhea, lower right abdominal pain, and weight loss. Suspecting Crohn disease, the nurse will assess for which complication associated with this diagnosis? A) Urine that has the look and smell of feces B) Inability to control diarrhea C) Tender right upper quadrant pain upon deep palpation D) Necrotic abscesses from twisting of the bowel

Ans: A Feedback:Crohn disease is a recurrent, granulomatous type of inflammatory response with formation of multiple sharply demarcated, granulomatous lesions that are surrounded by normal-appearing mucosal tissue. There usually is a relative sparing of the smooth muscle layers of the bowel, with marked submucosal layer inflammatory and fibrotic changes. Complications of Crohn disease include fistula formation, abdominal abscess formation, and intestinal obstruction. Fistulas are tube-like passages that form connections between different sites in the gastrointestinal tract. They also may develop between other sites, including the bladder, vagina, urethra, and skin (hence, the urine will smell like feces). Characteristics of ulcerative colitis (rather than Crohn disease) are crypts of Lieberkühn lesions in the base of the mucosal layer, formation of pinpoint mucosal hemorrhages, and development of crypt abscesses that become necrotic.

While assessing a peritoneal dialysis client in his or her home, the nurse notes that the fluid draining from the abdomen is cloudy, is white in color, and contains a strong odor. The nurse suspects this client has developed a serious complication known as: A) Peritonitis B) Bowel perforation C) Too much sugar in the dialysis solution D) Bladder erosion

Ans: A Feedback:Potential problems with peritoneal dialysis include infection, catheter malfunction, dehydration, hyperglycemia, and hernia. Bowel perforation can occur, but the fluid would be stool colored. The client may develop hyperglycemia; however, this will not cause the fluid to be cloudy. If bladder erosion had occurred, the fluid would look like urine and not be cloudy and white.

Of the following clients, which would be at highest risk for developing hyperkalemia? A) A male admitted for acute renal failure following a drug overdose B) A client diagnosed with an ischemic stroke with multiple sensory and motor deficits C) An elderly client experiencing severe vomiting and diarrhea as a result of influenza D) A postsurgical client whose thyroidectomy resulted in the loss of some of the parathyroid glands

Ans: A Feedback: There are three main causes of hyperkalemia: (1) decreased renal elimination; (2) a shift in potassium from the ICF to ECF compartment; and (3) excessively rapid rate of administration. The most common cause of serum potassium excess is decreased renal function. Stroke does not typically have a direct influence on potassium levels, whereas vomiting and diarrhea can precipitate hypokalemia. Loss of the parathyroid influences calcium, not potassium, levels.

One of the most common distinctions of pain is whether is is acute or chornic. Which examples describe chronic pain? Select all that apply: a. A pt is receiving chemotherapy for bladder cancer. b. An adolescent is admitted to the hospital for appendectomy c. A pt is experiencing a ruptured aneurysm d. A pt who has fibromyalgia requests pain meds e. A pt has back pain related to an accident that occurred last year f. A pt is experiencing pain from second-degree burns

Ans: A, D, E

A heart failure client has gotten confused and took too many of his "water pills" (diuretics). On admission, his serum potassium level was 2.6 mEq/L. Of the following assessments, which correlate to this hypokalemia finding? Select all that apply. A) Polyuria B) Constipation C) Bradycardia D) Paresthesia with numbness of the lips/mouth E) ECG showing short runs of ventricular fibrillation

Ans: A,B,D Feedback:The manifestations of hypokalemia include alterations in neuromuscular, gastrointestinal, renal, and cardiovascular function. There are numerous signs and symptoms associated with gastrointestinal function, including anorexia, nausea, and vomiting. Atony of the gastrointestinal smooth muscle can cause constipation, abdominal distention, and, in severe hypokalemia, paralytic ileus. Urine output and plasma osmolality are increased; urine specific gravity is decreased; and complaints of polyuria, nocturia, and thirst are common. The most serious effects of hypokalemia are on the heart. The first symptom associated with hyperkalemia typically is paresthesia (a feeling of numbness and tingling). Hyperkalemia results in prolongation of the PR interval; widening of the QRS complex with no change in its configuration; and decreased amplitude, widening, and eventual disappearance of the P wave. The heart rate may be slow. Ventricular fibrillation and cardiac arrest are terminal events.

A client with a history of heart and kidney failure is brought to the emergency department. Upon assessment/diagnosis, it is determined the client is in decompensated heart failure. Of the following assessment findings, which are associated with excess intracellular water? Select all that apply. A) Lethargy B) Confusion C) Hyperactive deep tendon reflexes D) Seizures E) Firm, rubbery tissue when palpating lower extremities

Ans: A,B,D Feedback:Hyponatremia is usually defined as a serum sodium concentration of less than 135 mEq/L. Muscle cramps, weakness, and fatigue reflect the effects of hyponatremia on skeletal muscle function and are often early signs of hyponatremia. The cells of the brain and nervous system are the most seriously affected by increases in intracellular water. Symptoms include apathy, lethargy, and headache, which can progress to disorientation, confusion, gross motor weakness, and depression of deep tendon reflexes. Seizures and coma occur when serum sodium levels reach extremely low levels. Hypovolemia, third spacing (maldistribution of body fluid), and dehydration are associated with hypernatremia and/or hypertonicity

The ulcerative colitis client should be assessed by the health care provider for which of the following clinical manifestations? Select all that apply. A) Persistent diarrhea B) Steatorrhea C) Stool containing blood (hematochezia) D) External hemorrhoids E) Prolapsed colon

Ans: A,C Feedback: Unlike Crohn disease, which can affect various sites in the gastrointestinal tract, ulcerative colitis is confined to the rectum and colon. Ulcerative colitis typically presents as a relapsing disorder marked by attacks of diarrhea. The diarrhea may persist for days, weeks, or months and then subside, only to recur after an asymptomatic interval of several months to years or even decades. Because ulcerative colitis affects the mucosal layer of the bowel, the stools typically contain blood and mucus. Nutritional deficiencies are common in Crohn disease because of diarrhea, steatorrhea (fatty stools), and other malabsorption problems. Crohn disease causes granulomatous changes, often referred to as skip lesions because they are interspersed between what appear to be normal segments of the bowel. External hemorrhoids and prolapsed colon are not associated with ulcerative colitis.

A client has visited the health care provider following several days of nausea/vomiting and abdominal pain. The provider thinks the client may have Helicobacter pylori (H. pylori) infection. As part of the education provided, the client should be informed that which of the following complications can occur if this infection is not eradicated? Select all that apply. A) GI bleeding due to peptic ulcer formation B) Failure to thrive due to malabsorption C) Pyloric stenosis due to inability to empty the stomach D) Gastric cancer due to metaplasia changes in the cells

Ans: A,D

The physician thinks a teenager is having clinical manifestations of irritable bowel syndrome. Which of the following complaints would support this diagnosis? Select all that apply. A) Pain is relieved by defecation. B) Pain is most severe at night. C) Pain is worse after and between meals. D) Pain is described as "cramping" in the lower abdomen. E) Belching makes the pains go away.

Ans: A,D Feedback:A hallmark of irritable bowel syndrome is abdominal pain that is relieved by defecation and associated with a change in consistency or frequency of stools. Irritable bowel disease is characterized by persistent or recurrent symptoms of abdominal pain, altered bowel function, and varying complaints of flatulence, bloating, nausea and anorexia, constipation or diarrhea, and anxiety or depression. Abdominal pain usually is intermittent, is described as cramping in the lower abdomen, and does not usually occur at night or interfere with sleep. Inflammatory bowel disease is characterized by blood in stool. Peptic ulceration pain occurs when the stomach is empty

On morning assessment of your patient in room 2502 who has severe burns. You notice that fluid is starting to accumulate in his abdominal tissue. You note that his weight has not changed and his intake and output is equal. What do you suspect? a. Third spacing b. This is normal and expected after a burn and it is benign c. Document this finding as non-pitting abdominal edema d. Intravascular compartment syndrome

Ans: A.

While playing outside in the snow, a young child complained of painful fingertips since he would not keep his gloves on. In the emergency department, the nurse knows this painful sensation is a result of which transmission of proprioceptive somatosensory information? A) Reflexive networks B) Type C dorsal root ganglion neurons C) Anterolateral pathway D) Myelinated type B trigeminal sensory neurons

Ans: B Feedback:All somatosensory information from the limbs and trunk shares a common class of sensory neurons called dorsal root ganglion neurons. The unmyelinated type C fibers have the smallest diameter and the slowest rate of conduction. They convey warm-hot sensation and mechanical and chemical as well as heat- and cold-induced pain sensation. Somatosensory information from the face and cranial structures, however, is transmitted by trigeminal sensory neurons, which function in the same manner as the dorsal root ganglion neurons. The second-order neurons communicate with various reflex networks and sensory pathways in the spinal cord and contain the ascending pathways that travel to the thalamus. In contrast to the dorsal column-medial lemniscal pathway, the anterolateral pathway transmits sensory signals such as pain, thermal sensations, crude touch, and pressure that do not require highly discrete localization of the signal source or fine discrimination of intensity.

Leukocytes consist of three categories of cells that have different roles in the inflammatory and immune responses. Which of the following leukocytes is correctly matched with its function? A) Lymphocyte—phagocytosis B) Eosinophils—allergic reactions C) Basophils—engulf antigens D) Monocytes—release heparin

Ans: B Feedback: Eosinophils, a type of granulocyte, increase in number during allergic reactions. Lymphocytes (agranulocytes) consist of three cell types that are not phagocytes but do have an important role in the immune response. Basophils and mast cells release heparin and histamine in response to allergens. Monocytes and macrophages are phagocytes that engulf antigens.

A client diagnosed with schizophrenia has been admitted to the emergency department (ED) after ingesting more than 2 gallons of water in one sitting. Which of the following pathophysiologic processes may result from the sudden water gain? A) Hypernatremia B) Water movement from the extracellular to the intracellular compartment C) Syndrome of inappropriate secretion of ADH (SIADH) D) Isotonic fluid excess in the extracellular fluid compartment

Ans: B Feedback: Excess water ingestion coupled with impaired water excretion (or rapid ingestion at a rate that exceeds renal excretion) in persons with psychogenic polydipsia can lead to water intoxication (hyponatremia). A disproportionate gain of water with no accompanying gain in sodium results in the movement of water from the extracellular to the intracellular compartment. Hyponatremia accompanies this process. Because of the lack of sodium increase, accumulated fluid is hypotonic, not isotonic. SIADH is not a consequence of excess water intake.

Which of the following clients may be experiencing the effects of neuropathic pain? A) A girl whose playground accident resulted in an arm fracture B) A man with pain secondary to his poorly controlled diabetes C) An elderly woman with a stage III pressure ulcer D) A man whose pain is caused by gastric cancer

Ans: B Feedback:Conditions that can lead to pain by causing damage to peripheral nerves in a wide area include diabetes mellitus, alcohol use, hypothyroidism, rash, and trauma. Fractures, wounds, and cancer pain do not typically have an etiology that is rooted in the neurologic system.

A patient with cirrhosis has a massive hemorrhage from esophageal varices. In planning care for the patient, the nurse gives the highest priority to the goal of a. Controlling bleeding b. Maintenance of the airway c. Maintenance of fluid volume d. Relieving the patient's anxiety

Ans: B Rational: Maintaining gas exchange has the highest priority because oxygenation is essential for life. The airway is compromised by the bleeding in the esophagus and aspiration easily occurs. The other goals would also be important for this patient, but they are not as high a priority as airway maintenance.

A client has been admitted for deterioration of her renal function due to chronic renal failure. Her admission K+ level is 7.8 mEq/L. The nurse would expect to see which of the following abnormalities on her telemetry (ECG) strip? Select all that apply. A) Tachycardia (fast rate) with frequent early ventricular beats (PVCs) B) Prolonged PR interval with widening of the QRS complex C) Ventricular fibrillation D) Atrial flutter with a 2:1 conduction ratio

Ans: B,C Feedback: Hyperkalemia decreases membrane excitability, producing a delay in atrial and ventricular depolarization, and it increases the rate of ventricular repolarization. If serum K+ levels continue to rise (above 6 mEq/L), there is a prolongation of the PR interval; widening of the QRS complex with no change in its configuration; and decreased amplitude and widening and eventual disappearance of the P wave. The heart rate may be slow. Ventricular fibrillation and cardiac arrest are terminal events

During treatment of a patient with a Minnesota balloon tamponade for bleeding esophageal varices, which nursing action will be included in the plan of care? a. Encourage the patient to cough and deep breathe. b. Insert the tube and verify its position q4hr c. Monitor the patient for SOB d. Deflate the gastric balloon q8-12hr

Ans: C

Which is client is least likely to be at risk for the development of third spacing? a. The client with cirrhosis b. The client with liver failure c. The client with DM d. The client with CKD

Ans: C

A major factor in the development of hepatic encephalopathy is: A) Hypersplenism B) High sodium level C) Neurotoxin accumulation D) Steroid hormone deficiency

Ans: C Feedback:Although the cause of hepatic encephalopathy is unknown, the accumulation of neurotoxins, which appear in the blood because the liver has lost its detoxifying capacity, is believed to be a factor. The liver metabolizes the steroid hormones; therefore, these hormones are often elevated in persons with liver failure and cause feminization (rather than encephalopathy) of male clients. Hypersplenism associated with liver failure is a factor in the development of anemia, thrombocytopenia, and leukopenia. Although the mechanisms responsible for the development of ascites are not completely understood, several factors seem to contribute to fluid accumulation, including salt and water retention by the kidney and increase in capillary pressure due to portal hypertension and obstruction of venous flow through the liver.

Which of the following assessments should be prioritized in the care of a client who is being treated for a serum potassium level of 2.7 mEq/L? A) Detailed fluid balance monitoring checking for pitting edema B) Arterial blood gases looking for respiratory alkalosis C) Cardiac monitoring looking for prolonged PR interval and flattening of the T wave D) Monitoring of hemoglobin levels and oxygen saturation

Ans: C Feedback:The most serious effects of hypokalemia are on the heart, a fact that necessitates frequent electrocardiography or cardiac telemetry. Hypokalemia produces a decrease in the resting membrane potential, causing prolongation of the PR interval. It also prolongs the rate of ventricular repolarization, causing depression of the ST segment, flattening of the T wave, and appearance of a prominent U wave. This supersedes the importance of fluid balance monitoring, arterial blood gases, oxygen saturation, or hemoglobin levels.

A patient with severe cirrhosis has an episode of bleeding esophageal varices. To detect possible complications of the bleeding episode, it is most important for the nurse to monitor a. Prothrombin time b. Bilirubin levels c. Ammonia levels d. Potassium levels.

Ans: C Rationale: The blood in the GI tract will be absorbed as protein and may result in an increase in ammonia level since the liver cannot metabolize protein well. The prothrombin time, bilirubin and potassium levels should also be monitored, but these will not be affected by the bleeding episode.

Acute gastritis refers to a transient inflammation of the gastric mucosa that is most commonly associated with: A) Diarrhea B) Food allergies C) Gastric reflux D) Alcohol intake

Ans: D Feedback: Acute gastritis refers to a transient inflammation of the gastric mucosa that is most commonly associated with local irritants such as bacterial endotoxins, alcohol, or aspirin. Gastritis associated with excessive alcohol consumption often causes transient gastric distress, which may lead to vomiting, bleeding, and hematemesis. Allergic response to ingested substances may cause acute itching, rash, vomiting, or diarrhea. Gastric reflux causes esophageal inflammation rather than gastritis.

A client develops interstitial edema as a result of decreased: A) Vascular volume B) Hydrostatic pressure C) Capillary permeability D) Colloidal osmotic pressure

Ans: D Feedback:Edema can be defined as palpable swelling produced by an increased interstitial fluid volume. The physiologic mechanisms that contribute to edema formation include factors that (1) increase capillary filtration (hydrostatic) pressure, (2) decrease the capillary colloid osmotic pressure, (3) increase capillary permeability, or (4) produce obstruction to lymph flow.

Which of the following characteristics differentiates inflammatory diarrhea from the noninflammatory type? A) Larger volume of diarrhea B) Electrolyte imbalances C) Absence of blood in the stool D) Infection of intestinal cells

Ans: D Feedback: Inflammatory diarrhea may be caused by invasion of intestinal cells, whereas noninflammatory diarrhea normally results from the disruption of the normal absorption or secretory process. The volume of diarrhea is typically smaller and bloody. Electrolyte imbalances may accompany either type.

A teenager has been diagnosed with failure to thrive. The health care providers suspect a malabsorption syndrome. In addition to having diarrhea and bloating, the client more than likely has what hallmark manifestation of malabsorption? A) Feeling there is incomplete emptying of the bowel B) Abdominal distention C) Esophageal reflux with heartburn D) Fatty, yellow-gray, foul-smelling stools

Ans: D Feedback:General symptoms of malabsorption syndrome include diarrhea, flatulence, bloating, cramping, and weight loss. A hallmark of malabsorption is steatorrhea, characterized by fatty, yellow-gray, and foul-smelling stools. Feeling there is incomplete emptying of the bowel is one of the signs/symptoms of colon cancer. Abdominal distention occurs with many GI diseases and is not specific to malabsorption syndrome. Esophageal reflux with heartburn is usually associated with GERD

A female client with a history of chronic renal failure has a total serum calcium level of 7.9 mg/dL. While performing an assessment, the nurse should focus on which of the following clinical manifestations associated with this calcium level? A) Complaints of shortness of breath on exertion with decreased oxygen saturation levels B) Difficulty arousing the client and noticing she is disoriented to time and place C) Heart rate of 120 beats/minute associated with diaphoresis (sweaty) D) Intermittent muscle spasms and complaints of numbness around her mouth

Ans: D Feedback:Spasms and numbness are characteristic of hypocalcemia. Respiratory effects, tachycardia, and diaphoresis are not associated with low calcium levels, whereas decreased level of consciousness can be indicative of hypercalcemia

During an assessment of a 32-year-old patient with a recent head injury, the nurse notices that the patient responds to pain by extending, adducting, and internally rotating his arms. His palms pronate, and his lower extremities extend with palmar flexion. Which statement concerning these findings is most accurate? This patients response: a. Indicates a lesion of the cerebral cortex b. Indicates a completely nonfunctional brainstem c. Is normal and will go away in 24-48 hours d. Is a very ominous sign and may indicate brainstem injury

Ans: d These findings are all indicative of decerebrate rigidity, which is a very ominous condition and may indicate a brainstem injury.

Water movement between the ICF and ECF compartments is determined by: a. Osmotic forces b. Plasma oncotic pressure c. Antidiuretic hormone d. Buffer systems

Answer: A. Osmotic forces

Which of the following is the best example of object recognition? A. Seeing a particular visual stimulus and mentally rotating it B. Seeing a particular visual stimulus and identifying it as the letter M C. Solving a complex reasoning problem D. Switching your attention from one convo to another

Answer: B. Seeing a particular visual stimulus and identifying it as the letter M

NSAIDs and aspirin contribute to the formation of gastritis by inhibiting the _____. A. immune system B. production of acid C. synthesis of prostaglandins D. production of mucus

Answer: C. Synthesis of prostaglandins The synthesis of prostaglandins is decreased due to the anti-inflammatory action of the drugs; therefore, acid production is unregulated.

NSAIDs and aspirin contribute to the formation of gastritis by inhibiting the _____. A. immune system B. production of acid C. synthesis of prostaglandins D. production of mucus

Answer: C. Synthesis of prostaglandins The synthesis of prostaglandins is decreased due to the anti-inflammatory action of the drugs; therefore, acid production is unregulated.

A child who is experiencing the signs and symptoms of influenza has vomited frequently over the last 24 hours. Vomiting results from stimulation of what site in the neurologic system? A) Myenteric plexus B) Intramural plexus C) Vagus nerve D) Chemoreceptor trigger zone

Answer: D

Which organ system should the nurse monitor when the patient has long-term potassium deficits? a. Central nervous system (CNS) b. Lungs c. Kidneys d. Gastrointestinal tract

Answer: c. Kidneys Rationale: Long-term potassium deficits lasting more than 1 month may damage renal tissue, with interstitial fibrosis and tubular atrophy.

Water movement from the side of the membrane having a lesser number of particles and greater concentration of water to the side having a greater number of particles and lesser concentration of water is termed: A) Active Transport B) Osmosis C) Diffusion D) Filtration

B) Osmosis Osmosis is the force that moves water from the side of the membrane having a lesser number of particles and greater concentration of water to the side having a greater number of particles and lesser concentration of water. Active transport is the movement of ions against an electrical or chemical gradient. Diffusion is the process by which particles in solution move from an area of higher concentration to lower, resulting in equal distribution. Filtration is the process of passing a liquid through a filter that is accomplished by gravity, vacuum, or pressure.

Crohn's disease is recognized by sharply demarcated, granulomatous lesions that are surrounded by normal-appearing mucosal tissue. The nurse recognizes these lesions to be defined by which of the following descriptions? a) Pyradimal b) Triangular c) Mosaic d) Cobblestone

Cobblestone A characteristic feature of Crohn's disease is the sharply demarcated, granulomatous lesions that are surrounded by normal-appearing mucosal tissue. When there are multiple lesions, they are often referred to as skip lesions because they are interspersed between what appear to be normal segments of the bowel. The surface of the inflamed bowel usually has a characteristic "cobblestone" appearance resulting from the fissures and crevices that develop, surrounded by areas of submucosal edema.

A 28-year-old man presents with complaints of diarrhea, fecal urgency, and weight loss. His stool is light-colored and malodorous, and it tends to float and be difficult to flush. He has also noted tender, red bumps on his shins and complains of pain and stiffness in his elbows and knees. Sigmoidoscopy reveals discontinuous, granulomatous lesions; no blood is detected in his stool. Which of the following diagnoses would his care team first suspect? a) Diverticulitis b) Crohn disease c) Colon cancer d) Ulcerative colitis

Crohn disease Crohn disease, like ulcerative colitis, causes diarrhea, fecal urgency, weight loss, and systemic symptoms such as erythema nodosum and arthritis. Unlike ulcerative colitis, it also causes steatorrhea but is not as likely to cause blood in the stool. The granulomatous "skip" lesions confirm the diagnosis of Crohn disease. Neither diverticulitis nor colon cancer would cause this combination of symptoms and signs

What causes the deep slow pain and fast pain receptor sites - know the receptor and neurotransmitter

Deep slow pain: elicited by mechanical, thermal, and chemical stimuli Fast pain: elicited by mechanical and thermal stimuli Neurotransmitter: Glutamate and Substance P Deep slow pain: nociceptive stimuli (mechanical, thermal, and chemical) activate C-fibers to elicit slow-wave pain o Continuously conducted pain is transmitted by unmyelinated C-fibers and from the spinal cord to the thalamus using the more circuitous and slower-conducting paleospinothalamic tract (Noris, 5th ed, Ch. 14) o The transmission of impulses between nociceptive neurons and dorsal horn neurons is mediated by the chemical neurotransmitters glutamate and substance P (neuropeptide) Fast pain: nociceptive stimuli (typically mechanical or thermal) activate A delta fibers to elicit fast pain o Fast, sharply discriminated pain moves from the receptors to the spinal cord using myelinated A delta fibers and from the spinal cord to the thalamus using the neospinothalamic tract (Noris, 5th ed, Ch. 14)

What does the somatic nervous system control?

Functionally the peripheral nervous system is divided into two branches: the autonomic and somatic nervous systems. The somatic (soma means "body") nervous system provides sensory and motor innervation for all parts of the CNS and PNS except the visceral structures, conduction of heart, sweat glands, and exocrine glands of GI tract. The somatic nervous system provides sensory input for the nervous system to feel the world around you and after interpretation by the brain is sent with motor output to the voluntary skeletal muscles → controls voluntary movement of skeletal muscle Two major neuron types: • Sensory neurons, also known as afferent neurons, are responsible for carrying information from the nerves to the CNS. • Motor neurons, also known as efferent neurons, are responsible for carrying information from the brain and spinal cord (CNS) to muscle fibers throughout the body.

Signs and symptoms of hypo/ hyper CA

Hypocalcemia (<8.5 mg/dL) think CAFFEINE Paresthesia (numbness) Muscle cramps/spasms, hyperactive reflexes Tetany Hypotension Stridor Laryngeal spasms Arrhythmias Deep tendon flexes increased Positive Chvostek test- touch the face and you will get a twitch Positive Trousseau tests - carpal spasms after cuff inflation Causes: Hypoparathyroidism Neck surgery- possible knock thyroid or parathyroid Thyroidectomy GI diseases (malabsorption) - Crohn's disease- malabsorption due to inflammation, ulcerative colitis, Short Gut - removing some of the gutt Hypercalcemia (>10.5 mg/dL) Polyuria Muscle weakness Ataxia, loss of muscle tone Lethargy Stupor and coma Hypertension Anorexia, nausea, vomiting, constipation Kidney stones Loss of muscle tone Brittle bones Arrythmias Altered level of consciousness (ALOC) Low pulse/low respirations Decreased deep tenden reflex (DTR) Causes: Hyperparathyroidism hormone Renal failure/kidney problems Thiazide/lithium Overuse of calcium carbonate antacids Malignant neoplasms/cancer Thyroid overgrowth Prolonged immobilization

Signs and symptoms of hypo/ hyper K

Hypokalemia (<3.6 mEq/L) THINK RELAX Muscle weakness, fatigue, cramps, tenderness Paresthesia Anorexia, nausea, vomiting, constipation, abdominal distention Confusion, depression Cardiac arrhythmias, ECG changes (longer PR interval) Hyperkalemia (>5.5 mEq/L) Muscle weakness Paresthesia Nausea, vomiting, intestinal cramps, diarrhea ECG changes (peaked narrow T waves, shortened QT waves) Risk of cardiac arrest with severe

Signs and symptoms of hypo/ hyper Magnesium

Hypomagnesemia (think caffeine) Paresthesia Ataxia, dizziness Hyperactive reflex Muscle fasciculation, tetany Confusion, disorientation Tachycardia, hypertension, cardiac arrhythmias Hypermagnesemia (think relax) Lethargy Hyporeflexia, muscle weakness Confusion, coma Hypotension, cardiac arrhythmias

Signs and symptoms of hypo/ hyper Na

Hyponatremia (<135 mEq/L) Early signs: Muscle cramps, weakness, fatigue Nausea, vomiting, abdominal cramps, diarrhea Apathy, lethargy, headache Disorientation, confusion, gross motor weakness, depression of DTR Seizure and coma (severe hyponatremia) Hypernatremia (>145 mEg/L) Dry skin and mucous membranes Decreased tissue turgor Decreased salivation and lacrimation Elevated body temperature Headache, disorientation, agitation Decreased DTR Seizures and coma (severe hypernatremia)

Signs and symptoms of hypo/ hyper Phosphate

Hypophosphatemia (<2.5 mg/dL) Paresthesia Confusion, stupor, coma Seizures Joint stiffness, bone pain Hyperphosphatemia (>4.5 mg/dL) Paresthesia Tetany Hypotension Cardiac arrhythmias Causes: Kidney failure Excessive intake of phosphate

Causes of hypernatremia?

Increase ECF tonicity, causing movement of water out of ICF (resulting in cellular dehydration) d/t: • Net water loss can occur through the urine, gastrointestinal tract, lungs, or skin • increased losses from resp tract during fever or exercise, • watery diarrhea, • highly osmotic tube feedings • therapeutic administration of excess amounts of sodium-containing solutions HIGH SALT Hypercortisolism- cushing's syndrome (too much ADH so retain Na) Increased Na intake or IV route GI feeding without adequate H2O supplement Hypertonic solution (ex. 3% saline) Sodium excretion decreased ex. Corticosteroids Loss of fluids (dehydrated, fever, sweating) Thirst impairment When caring for clients with disorders of sodium balance, the nurse know that which finding is consistent with hypernatremia? Sodium 158 mEq/L (158 mmol/L) and serum osmolality of 320 mOsm/kg (320 mmol/kg) Normal serum sodium is between 135 and 145 mEq/L. Hypernatremia-elevated sodium level-implies a plasma sodium level above 145. Because of extra particles in the bloodstream, serum osmolality is greater than 295 mOsm/kg.

Crohn's disease not only affects adults but also can occur in children. The nurse assesses for which of the following major manifestations in children with Crohn's disease? a) Weight gain b) Malnutrition c) Halitosis d) Dental caries

Malnutrition When Crohn's disease occurs in children, one of the major manifestations may be retardation of growth and significant malnutrition.

Where is the primary visual cortex in the brain?

Occipital lobe

A patient is admitted with an abrupt onset of referred pain to the epigastric area, with an episode of nausea. On the nurse's initial assessment, the patient is lying still and taking shallow breaths, with a rigid abdomen. Which of the following problems is the patient experiencing? a) Peritonitis b) intussusception c) Peptic ulcer d) Ulcerative colitis

Peritonitis The onset of peritonitis may be acute, as with a ruptured appendix, or it may have a more gradual onset, as occurs in pelvic inflammatory disease. The pain usually is more intense over the inflamed area. The person with peritonitis usually lies still because any movement aggravates the pain. Breathing often is shallow to prevent movement of the abdominal muscles. The abdomen usually is rigid and sometimes described as board-like because of reflex muscle guarding.

Sensory pathways in the spinal cord to the thalamus are which ones?

Paleospinothalamic tract- to the reticular activating system= affects arousal, mood, and attention? Neospinothalamic tract- to the thalamus= allows localization, identification of pain?

A client is experiencing chest pain that radiates to the left arm and neck. The nurse would interpret this pain as: a) Visceral b) Somatic c) Referred d) Cutaneous

Referred Referred pain is pain that is perceived at a site different from its point of origin but innervated by the same spinal segment. Visceral pain originates in the visceral organs and is one of the most common pains produced by disease, cutaneous pain arises from superficial structures, and somatic pain originates in deep body structures

The nurse is studying sensory systems. She understands that signal transduction of an impulse to the thalamus for processing is accomplished by which of the following? a) Fourth-order neurons b) First-order neurons c) Second-order neurons d) Third-order neurons

Second-order neurons Second-order neurons communicate with various reflex networks and sensory pathways in the spinal cord and travel directly to the thalamus. First-order neurons transmit sensory information from the periphery to the CNS. Third-order neurons relay information from the thalamus to the cerebral cortex.

What part of the brain control sleep and wake cycles? (The textbook- pg. 842 only mentioned the thalamus as an essential part of sleep- weak cycle.)

Slide 8 of Chap.35 : The paleospinothalamic tract activates the reticular activating system - controls sleep/wake cycles and allows you to maintain a state of consciousness There are several structures within the brain are involved with sleep • The hypothalamus, a peanut-sized structure deep inside the brain, contains groups of nerve cells that act as control centers affecting sleep and arousal. Within the hypothalamus is the suprachiasmatic nucleus (SCN) - clusters of thousands of cells that receive information about light exposure directly from the eyes and control your behavioral rhythm. • Some people with damage to the SCN sleep erratically throughout the day because they are not able to match their circadian rhythms with the light-dark cycle. Most blind people maintain some ability to sense light and are able to modify their sleep/wake cycle. • The brain stem, at the base of the brain, communicates with the hypothalamus to control the transitions between wake and sleep. (The brain stem includes structures called the pons, medulla, and midbrain.) • Sleep-promoting cells within the hypothalamus and the brain stem produce a brain chemical called GABA, which acts to reduce the activity of arousal centers in the hypothalamus and the brain stem. • The brain stem (especially the pons and medulla) also plays a special role in REM sleep; it sends signals to relax muscles essential for body posture and limb movements, so that we don't act out our dreams. • The thalamus acts as a relay for information from the senses to the cerebral cortex (the covering of the brain that interprets and processes information from short- to long-term memory). • During most stages of sleep, the thalamus becomes quiet, letting you tune out the external world. But during REM sleep, the thalamus is active, sending the cortex images, sounds, and other sensations that fill our dreams. • The pineal gland, located within the brain's two hemispheres, receives signals from the SCN and increases production of the hormone melatonin, which helps put you to sleep once the lights go down. • People who have lost their sight and cannot coordinate their natural wake-sleep cycle using natural light can stabilize their sleep patterns by taking small amounts of melatonin at the same time each day. • Scientists believe that peaks and valleys of melatonin over time are important for matching the body's circadian rhythm to the external cycle of light and darkness. • The basal forebrain, near the front and bottom of the brain, also promotes sleep and wakefulness, while part of the midbrain acts as an arousal system. Release of adenosine (a chemical by-product of cellular energy consumption) from cells in the basal forebrain and probably other regions supports your sleep drive. Caffeine counteracts sleepiness by blocking the actions of adenosine. • an almond-shaped structure involved in processing emotions, becomes increasingly active during REM sleep. • Reference: https://www.ninds.nih.gov/Disorders/Patient-Caregiver-Education/Understanding-Sleep

When caring for clients with disorders of sodium balance, the nurse know that which finding is consistent with hypernatremia?

Sodium 158 mEq/L (158 mmol/L) and serum osmolality of 320 mOsm/kg (320 mmol/kg) Normal serum sodium is between 135 and 145 mEq/L. Hypernatremia-elevated sodium level-implies a plasma sodium level above 145. Because of extra particles in the bloodstream, serum osmolality is greater than 295 mOsm/kg.

Slide with the definitions of confusion, stupor, obtunded, coma, you will be given a description and you have to choose which one. Ch 35 page 928 What Edition book???

These terms describe Level of Consciousness (LOC) LOC reflect awareness and response to the env't. LOC goes in a flow from consciousness → confusion → delirium → obtunded → stupor → coma. For example, the earliest sign is inattention, mild confusion, disorientation, and blunted. Then the delirious person becomes more inattentive, and can be lethargic or agitated. From the book and from HA neuro handout Confusion: disturbance of consciousness characterized by impaired ability to think clearly and to perceive, respond to, and remember current stimuli; also, disorientation Delirium : (acute confusional state): clouding of consciousness (dulled cognition, impaired alertness)/State of disturbed consciousness with motor restlessness, transient hallucinations, disorientation, and sometimes delusions Obtundation: Sleeps most of the time, difficult to arouse/ Disorder of decreased alertness with associated psychomotor retardation Stupor : spontaneously unconscious; responds only to persistent and vigorous shake or pain/ A state in which the person is not unconscious but exhibits little or no spontaneous activity Coma : completely unconscious; no response to pain or any external or internal stimuli/ a state of being unarousable an unresponsive to external stimuli or internal needs; often determined by the glasgow scale

A client is admitted to the acute care facility with severe pain in the abdomen related to inflammatory bowel disease. What type of pain will the nurse be administering medication to relieve? a) Cutaneous pain b) Visceral pain c) Referred pain d) Somatic pain

Visceral pain Visceral pain has its origin in the visceral organs (in the chest or abdomen) and is one of the most common pains produced by disease. While similar to somatic pain in many ways, both the neurologic mechanisms and the perception of visceral pain differ from somatic pain. One of the most important differences between surface pain and visceral pain is the type of damage that causes pain. Strong contractions, distention, or ischemia affecting the walls of the viscera can induce severe pain.

A client has developed a ruptured appendix. The nurse is aware the client is at high risk for: a) Peritonitis b) Gastritis c) Diarrhea d) Vomiting

a) Peritonitis Complications of a ruptured appendix include peritonitis, localized peril abscess formation, and septicemia. Vomiting may occur with peritonitis; however, the physiologic effect of peritonitis places the client at highest risk. Diarrhea and gastritis may occur from viral or bacterial infections, food intolerance, or gastric irritation

Ulcerative colitis is an inflammatory bowel disease. The nurse identifies which of the following as a common sign of ulcerative colitis? a) Lesions surrounded by normal-appearing mucosal tissue b) Formation of fistula c) Mucus and blood stools d) Periods of exacerbations and remissions

c) Mucus and blood stools Ulcerative colitis is a nonspecific inflammatory condition of the colon. Unlike Crohn disease, which can affect various sites in the GI tract, ulcerative colitis is confined to the rectum and the colon. Ulcerative colitis presents as a relapsing disorder that affects the mucosal layer of the bowel; the stools typically contain blood and mucus. Fistula formation is common in Crohn disease, which is characterized by periods of exacerbations and remission. Ulcerative colitis has continuous involvement of the colon, beginning with the rectum

A client has begun to display manifestations of hepatic encephalopathy. The family is concerned and asks the nurse what caused this condition to develop. Which is the best response by the nurse? a. Increase of clotting factors in blood b. Lack of hemoglobin in the blood c. Accumulation of ammonia in the blood d. Intake of a high-protein, high-fat diet

c. Accumulation of ammonia in the blood

A nurse is reviewing the admission assessment data of a client diagnosed with acute gastritis. The nurse determines that the condition most likely occurred as a result of: a. Drinking a glass of red wine once a week. b. A sinus infection that causes severe headaches c. Arthritis treated wit high levels of NSAIDs agents d. Consuming a diet that is high and fiber and prepared with multiple spices.

c. Arthritis treated wit high levels of NSAIDs agents

Pericarditis signs and symptoms

i) Angina (chest pain) (1) Why? (a) Squeezing the heart (b) Everywhere ii) Jvd iii) Dyspnea

Signs and symptoms of peripheral artery disease (PAD)

i) Lack of blood flow going to extremities ii) Coldness iii) Intermittent claudication iv) Probably also have artery disease in coronary/everywhere v) PAD and CAD patients are at risk for (1) MI (2) Stroke !

DASH Diet and what diet a cardiac patient needs to be

i) What it looks like (1) Low salt (2) Low fat (3) No alcohol (4) No smoking (5) High fiber (a) Stools move more easily (b) Less chance of stress/straining, "less change of vasovagaling on the toilet" (6) Most are on diuretics ii) How to education the patient

Color and or consistency of stools with bleeding, gall bladder disorders, Crohns, Ulcerative colitis, celiac disease, irritable bowel syndrome

o Black stool - upper GI bleed o Bright Red stool - lower GI bleed (colon, rectum, hemorrhoids, local bleeding) o Gall bladder issues- chalky, white, clayish due to no bile o Crohn's disease- stool can be bloody, pt can go between being constipated or having diarrhea o Irritable bowel syndrome- stool with mucus, slimy consistency o Crohn's: diarrhea (less bloody than Ulcerative colitis, some blood because of inflammation), constipation o Ulcerative colitis • Stools contain blood and mucus • Mild form: less than four stools daily, with or without blood • Moderate form: more than four stools daily • Severe: more than six bloody stools daily o Celiac disease - diarrhea with or w/o abdominal cramping o Irritable bowel syndrome • Occult blood in stool (acute onset of symptom)

Complications of GERD

o Complications: strictures and Barrett esophagus can result from persistent reflux • Produces a cycle of mucosal damage that causes hyperemia, edema, and erosion of the luminal surface • Barrett esophagus: abnormal change (metaplasia) in the cells of the lower portion of the esophagus characterized by a reparative process in which the squamous mucosa that normally lines the esophagus gradually is replaced by abnormal columnar epithelium resembling that in the stomach or intestines

Characteristics of Crohn's disease (pg. 959 5th edition textbook)

o Crohn's disease is a recurrent, granulomatous type of inflammatory response that can affect any area of the gastrointestinal tract from the mouth to the anus • Can be found anywhere along the gastrointestinal tract from the mouth to the anus • Not confined to one location like ulcerative colitis • Activation of inflammatory mediators that cause nonspecific tissue damage • Common factor to cause the disease is environmental such as smoking o Characteristic feature of Crohn disease is the sharply demarcated, granulomatous lesions surrounded by normal-appearing mucosal tissue • When the lesions multiply, they are called skip lesions because they're interspersed between what looks like normal segments of the bowel • Not continuous like ulcerative colitis • Affects submucosal layer more than mucosal layer, so there's less bloody diarrhea compared to ulcerative colitis • Surface of the inflamed bowel has a cobblestone appearance • Over time, bowel walls become thickened and inflexible o Characterized by: • Remissions and exacerbations of diarrhea • Fecal urgency • Weight loss • Nutritional deficiencies due to diarrhea, steatorrhea, and malabsorption problems o Acute complications: • Intestinal obstruction that can develop during periods of severe and sudden onset (fulminant) of disease • Complications: • Fistula formation, abdominal abscess formation, and intestinal obstruction

When increased ICP occurs what happens?

o Excessive ICP can obstruct cerebral blood flow, destroy brain cells, displace brain tissue, otherwise damage delicate brain structure. o cells, displace brain tissue, otherwise damage delicate brain structure. o Posturing is an indicator of severe brain injury • Looks like • ➢ Decorticate posturing o Clenched fist o Feet pointing inward o Center part of brain ➢ Decerebrate posturing o Mid brain - pons o Arms at side of body -Compensation: decreased brain tissue, CSF, or blood in the skull. -Herniation: the brain pushes from higher-pressure regions to lower-pressure regions. -Hydrocephalus: progressive enlargement of the ventricular system from increased CSF.

Characteristics of Gastritis and causes

o Gastritis is the inflammation of the stomach lining. o Causes: spicy foods, excessive alcohol and anti-inflammatory drugs. Acute gastritis: - A transient inflammation of the gastric mucosa - most associated with local irritants such as bacterial endotoxins, alcohol, and aspirin Chronic Gastritis - characterized by the absence of grossly visible erosions and the presence of chronic inflammatory changes - leads eventually to atrophy of glandular epithelium of the stomach Types of gastritis: 1. H. pylori gastritis 2. Autoimmune gastritis 3. Multifocal atrophic gastritis 4. Chemical gastropathy

What happens when the vagus nerve is stimulated?

o Increase GI activity o decreases HR o pupil dilation o vasodilation o CN (X) - sensory and motor components innervate pharynx, gastrointestinal tract, heart, spleen, and lungs o Parasympathetic innervation of heart (pg. 628) • Originates from vagal nucleus in medulla • Effect of vagal stimulation on heart is limited to heart rate (HR) • Increased vagal activity slows pulse through release of acetylcholine ANS both para and sympathetic Layers within enteric NS Sympathetic NS inhibitory, decreased motility and secretions o Vagus nerve provides parasympathetic innervation for the heart, trachea, lungs, esophagus, stomach, small intestine, proximal half of the colon, liver, gallbladder, pancreas, kidneys, and upper portions of the ureters o Has several afferent & efferent components o Unilateral loss of vagal function: results in slowed gastrointestinal motility, a permanently husky voice, & uvula deviation away from damaged side Where is the primary visual cortex in the brain? can seriously damage reflex maintenance of cardiovascular & respiratory reflexes; swallowing may become difficult; occasionally paralysis of laryngeal structures causes life-threatening airway obstruction o Achalasia occurs when the lower esophageal sphincter fails to relax due to a disruption in the input from the enteric neural plexus and the vagus nerve.

Causes of Vomiting (PPT and Ch 36)

o Nausea is considered to function as a protective mechanism, warning the organism to avoid potential toxic ingestion. • Vomiting removes noxious agents from the GI Tract • Contents vomited are called vomitus o Four areas of stimulus for Vomiting • GI tract • CNS • Vestibular Apparatus (Motion Sickness) • Chemoreceptor (Drugs/Toxins) o Vomiting involves: • Two functionally distinct medullary centers ➢ Vomiting center and chemoreceptor trigger zone • Act of vomiting is a reflex that is integrated in the vomiting center which is located in the dorsal portion of the reticular formation of the medulla near the sensory nuclei of the Vagus • The chemoreceptor trigger zone is located in a small area on the floor of the fourth ventricle, where it is exposed to both blood and cerebrospinal fluid. It is thought to mediate the emetic effects of blood-borne drugs and toxins o Vomiting is accompanied by autonomic responses such as salivation, vasoconstriction, pallor with sweating, and tachycardia

Types of abnormal movement slide- you will be given a description and you choose what type of movement

o Paralysis = loss of movementto this...it's just what I have so far 😊) • Cerebellar ataxia = decomposition of movement, w/each component of movement occurring separately, jerky/slow movements, over/under reaching • Basal Ganglia Dysfunction ➢ Tremors o This movement disorder causes involuntary rhythmic shaking of parts of the body, such as the hands, head or other parts of the body. The most common type is essential tremor. ➢ Tics o A habitual spasmodic contraction of the muscles, most often in the face o Tourettes Syndrome • This is a neurological condition that starts between childhood and teenage years and is associated with repetitive movements (motor tics) and vocal sounds (vocal tics). ➢ Hypokinetic disorders - Bradykinesia (ex: PD) ➢ Hyperkinetic disorders Syndrome o Chorea: jerky movements o Athetosis: continuous twisting movements o Ballismus: violent flinging movements o Dystonia: rigidity • Parkinsonism ➢ Tremor ➢ Rigidity ➢ Bradykinesia (slow movement) ➢ Loss of postural reflexes ➢ Autonomic system dysfunction ➢ Dementia

What can cause Hyperkalemia (what metabolic/ pathological conditions)

o Still adding more • Hyperkalemia aka high potassium • 3 major causes of potassium excess are (1) decreased renal elimination (2) administration (IV admin) too fast (3) movement of potassium from ICF to ECF • Burns and crushing injuries cause cell death and release of potassium into the ECF • Multiple transfusion of RBCs can cause hyperkalemia and if the transfusions are given rapidly, this is potentially life threatening.

What are the causes of hepatic encephalopathy? Pg 1003 (5th ed)

o The cause is unknown, but the accumulation of neurotoxins, which appear in the blood because the liver has lost its detoxifying capacity, is believed to be a factor. One of the suspected neurotoxins is ammonia. o Side effects: An early sign of HE is flapping tremor called asterixis. Confusion, coma, and convulsions, px can be combative, fatigue, bad breath due to ammonia, slurred speech, pruritis, increase bleeding because the liver creates anticoagulation factors. o People with alcohol abuse = more prone to getting hepatic encephalopathy o Treatment: No protein diet due to the increase of ammonia. Lactulose will absorb all the excess ammonia in the body and excrete it out through stool. Neomycin (antibiotic) can also be given to kill the bacteria in the gut in order to prevent them from breaking down protein which will increase ammonia levels in the blood stream.

What is water movement between ICF and ECF compartments called?

o Third Spacing- any obstruction of lymph flow causes fluid to accumulate in the serous cavities. Although the accumulation of third-space fluids produces a gain in body weight, it does not contribute to the body's fluid reserve or function. o This amount can increase considerably in conditions such as ascites, in which large amounts of fluid are sequestered in the peritoneal cavity. When the transcellular fluid compartment becomes considerably enlarged, it is referred to as a third space, because this fluid is not readily available for exchange with the rest of the ECF Osmosis-the movement of water across a semipermeable membrane from the side of the membrane with the lesser number of particles and greater concentration of water to the side with the greater number of particles and lesser concentration of water

Characteristics of Ulcerative Colitis. (pg. 961 5th edition textbook)

o Ulcerative colitis is a nonspecific inflammatory condition of the colon, localized in the colon • Incidence and prevalence of ulcerative colitis depends on geographic location • Compared to Crohn's disease (affects various sites in the GI tract), the inflammatory response in ulcerative colitis is confined to the rectum and colon so that colectomy is curative o Disease can happen at any age with peak incidence between 15-25 y/o o Inflammation is confluent and continuous and doesn't skip areas like in Crohn's disease o Cause of ulcerative colitis is unknown but common factor to cause the disease is environmental such as smoking o Characteristic feature are the lesions that form in the crypts of Lieberkuhn in the base of the mucosal layer • Forms pinpoint mucosal hemorrhages which become crypt abscesses • These inflammatory lesions may become necrotic and ulcerate • Mucosal layer ends up with tongue-looking projections that look like polyps, called pseudopolyps • Over time, bowel wall thickens due to repeated episodes of colitis o Characterized by: • How much of the colon is affected? What's the extent of inflammation? • Severity is rated mild, moderate, severe, or fulminant • Common form is mild where the person has <4 stools daily with or without blood, no systemic signs of toxicity, normal erythrocyte sedimentation rate (ESR) • Moderate disease with >4 stools daily, low signs of toxicity • Severe disease with >6 bloody stools daily with signs of toxicity (fever, tachycardia, anemia, elevated ESR • Fulminant disease with >10 stools with continuous bleeding, fever, and other signs of toxicity, abdominal tenderness, distension, need for blood transfusions • Remissions and exacerbations of diarrhea • Fecal urgency • Weight loss o Acute complications: • Intestinal obstruction that can develop during periods of severe and sudden onset (fulminant) of disease

Know the slide with the hemi, para, plegia, esia.

· Paralysis = loss of movement · Paresis = weakness · Plegia = stroke or paralysis · Mono = one limb · Hemi = both limbs on one side · Di- or para = both upper limbs or both lower limbs · Quadri- or tetra- = all four limbs · Esia = condition

Recognition of an Object Called?

• Agnosia: failure to recognize form and nature of object with normal sensory function ➢ Results from localized lesions in parietal lobe • Echolalia: meaningless repetition of another person's spoken words as a symptom of a psychiatric disorder

Ascites in liver patients, what are the causes? What is ascites?

• Ascites is a pathological accumulation of fluid in the peritoneal cavity. o Pathophysiology • Pts with cirrhosis • Portal hypertension → increase in hydrostatic pressure, decreased colloidal osmotic pressure, salt and water retention 1. Increased pressures in the portal vein 2. Leads to a production of nitric oxide causing dilation of the abdominal vessels 3. This increases blood flow in the abdominal vessels 4. Which reduces blood flow to the major organs 5. As a result, renin-angiotensin-aldosterone system is activated 6. Which leads to an increase of sodium and water retention. 7. Lymphatic flow is increased proximal to the point of vascular obstruction and when the normal capacity of the lymphatic system is overwhelmed the transudate fluid moves across the surfaces of the liver, mesentery and intestines into the peritoneal cavity. o Treatment: • Primary treatment paracentesis- drain the peritoneal cavity by sticking a large needle into the abdomen • Ammonium may be high, you want them to poop it out • Pt may be on diuretics

What organ is damaged with prolonged hyperkalemia?

• Chronic hyperkalemia is almost always associated with chronic kidney disease. • Some kidney disorders, such as sickle cell nephropathy, lead nephropathy, and systemic lupus nephritis, can selectively impair tubular secretion of potassium without causing kidney failure. • The most serious effect of hyperkalemia is on the heart. o Hyperkalemia decreases membrane excitability, producing a delay in atrial and ventricular depolarization, and it increases the rate of ventricular repolarization. o As the serum potassium concentration rises, there is a characteristic sequence of changes in the ECG that are due to the effects of hyperkalemia on atrial and ventricular depolarization (represented by the P wave and QRS complex) and repolarization (represented by the T wave and QRS complex).3 • The earliest ECG changes are peaked and narrowed T waves and a shortened QT interval, which reflect abnormally rapid repolarization o Ventricular fibrillation and cardiac arrest are terminal events. • Detrimental effects of hyperkalemia on the heart are most pronounced when the serum potassium level rises rapidly. • Persons with kidney failure may require hemodialysis or peritoneal dialysis to reduce serum potassium levels.

Esophageal varices complications & how to avoid complications

• Esophageal varices: abnormal, enlarged veins in the esophagus and develops when blood flow to the liver is blocked, during portal hypertension, cirrhosis, and/or liver failure. • Complication: BLEEDING, elevated liver enzymes, if the varices start to bleed then we will have s&s of hemorrhage which will lead to tachycardia, hypotension and decrease hemoglobin and hematocrit. • Treatment: non-selective beta blockers and vasoconstrictors. • Occurs in people with Cirrhosis, Portal Hypertension, Liver Failure • Cirrhosis: end-stage chronic liver disease where functional liver tissue has been replaced by fibrous tissue • Associated with alcoholism • Loss of liver function • Accompanies metabolic disorders that cause the deposition of minerals in the liver: o Hemochromatosis: iron deposition o Wilson disease: copper deposition • Manifestations of Cirrhosis: o Weight loss (sometimes masked by ascites) o Weakness o Anorexia o Diarrhea or constipation o Hepatomegaly o Jaundice o Abdominal pain o Portal hypertension (late manifestation of cirrhosis) o Ascites (late manifestation of cirrhosis) o Esophageal varices (late manifestation of cirrhosis) o Splenomegaly (late manifestation of cirrhosis) • Treatment plan for Cirrhosis o Reducing salt intake, alcohol reduction. Use of ammonia reducer such as Lactulose. Beta blockers and diuretics. Antiviral or antibiotics to either avoid infection or if cause of cirrhosis is due to viral/bacterial infection. • Portal Hypertension: increased resistance to flow in the portal venous system and sustained portal vein pressure • Caused by different obstructions that increase hepatic blood flow: o Prehepatic obstructions causes of portal hypertension include portal vein thrombosis and external compression bc of cancer or enlarged lymph nodes that produce obstruction of the portal vein before it enters the liver o Posthepatic obstruction: any obstruction to blood flow through hepatic veins beyond liver lobules, within or distal to the liver, caused by thrombosis of the hepatic veins, RSHF, Veno-occlusive disease o Intrahepatic obstruction: include obstruction of blood flow within the liver o Treatment: beta blockers or nitrates may be prescribed alone or in combination with endoscopic therapy to reduce the pressure in varices and further reduce the risk of recurrent bleeding Transjugular intrahepatic portosystemic shunt can also be utilized. • Liver Failure: sudden and massive liver destruction, as in fulminant hepatitis, progressive damage to the liver (alcohol cirrhosis) • Treatment: eliminating alcohol intake when conditions caused by alcoholic cirrhosis, preventing infections, providing sufficient carbohydrates and calories to prevent protein breakdown, correcting fluid and electrolyte imbalances (hypokalemia), decreasing ammonia production in GI tract by controlling protein intake

Types of pain slide you will be given a "patient scenario" and you have to ID the type of pain is located in the most posterior portion of the brain's occipital lobe.

• It is responsible to color, motion, and depth perception. • Slide 17 1.1. Acute - generally short duration and remits when the underlying pathological process has resolved. • Elicited by surgery or trauma to body tissues and activation of nociceptive stimuli at the site of tissue damage. • Pains location, radiation, intensity, and duration as well as those factors that aggravate or relieve it, provide essential diagnostic clues. 1.2. Chronic - pain persists longer than reasonably expected after an inciting event and is sustained by factors that are both pathologically and physically remote from the originating cause. • Highly variable. From minor to unrelenting. • Often associated with loss of appetite, sleep disturbances, and depression. 1.3. Cutaneous - arises from superficial structures, such as the skin and subcutaneous tissues. • It is a sharp pain with a burning quality and may be abrupt or slow in onset. • It can be localized accurately and may be distributed along the dermatomes. • Due to overlap of nerve fiber distribution between the dermatomes, the boundaries are often not as clear as dermatome diagrams indicate. 1.4. Deep Somatic - originate in deep body structures, such as the periosteum, muscles, tendons, joints, and blood vessels. • More diffused than cutaneous pain. • Various stimuli - such as strong pressure exerted on bone, ischemia to muscle and tissue damage can produce deep somatic pain. • Radiation of pain from original site can occur • Ex.) damage to spinal nerve root can cause pain along fiber distribution. 1.5. Visceral - pain originate from visceral organs. • Most common pain produces by disease. • Not all viscera evoke pain (e.g., liver, lung) • Pain diffuses and poorly localized in nature. • Due to low density of nociceptors in the viscera. 1.6. Referred - pain perceived at a site different from its point of origin but innervated by the same spinal segment. • Ex. Pain associated w/ MI is commonly perceived as pain to the left arm, neck and chest. • Sites of referred pain are determined embryologically with the development of visceral and somatic structures that share the same site for entry of sensory information into the CNS and move to more distal location. • Could also be somatic pain • Ex. Pain referred to the chest wall could be caused by nociceptive stimulation of the peripheral portion of the diaphragm.

What the different types of WBC (eosinophil, neutrophil, monocytes) i) what they do ii) where they come from iii) Which one is most abundant in body? neutrophils iv) What the mature into

• Neutrophils: Primary pathogen-fighting cells • Eosinophils: Help control allergic responses; fight parasites • Basophils: Blood cells; release heparin, histamine, and other inflammatory mediators • Mast cells: Tissue cells; release heparin, histamine, and other inflammatory mediators; involved in allergic reactions Monocytes → Macrophages: Antigen-presenting cells; produce inflammatory mediators- Largest WBC- b) Signs and Symptoms lymphomas i) Hodgkins (1) presence of an abnormal cell called a Reed-Sternberg cell (2) painless enlargement of a single node or group of nodes (3) The initial lymph node involvement typically is above the level of the diaphragm (i.e., in the neck, supraclavicular area, or axilla). (4) Frequent mediastinal masses (5) Chest discomfort with cough or dyspnea (6) fevers, chills, night sweats, and weight loss. (7) Pruritus and intermittent fevers associated with night sweats (8) Advanced/signs when it spreads: (a) Fatigue, anemia when it spreads (b) liver, spleen, lungs, digestive tract and sometimes CNS involvement (c) Immune defect in cell-mediated response (susceptible to fungal, viral, protozoal infection) ii) Non-hodgkins (1) painless lymphadenopathy (isolated or widespread) (2) involved lymph nodes- retroperitoneum, mesentery, pelvis (3) frequently involves bone marrow iii) intermediate/aggressive forms- fever, drenching night sweats, weight loss (1) susceptible to bacterial, viral, fungal infections associated with hypogammaglobulinemia and a poor humoral antibody response

Common causes of Peritonitis

• Peritonitis: an inflammatory response of the serous membrane that line the abdominal cavity and covers the visceral organs • → can be caused by bacterial invasion or chemical irritation ♦ Most commonly: enteric bacteria enter the peritoneum because of break in the wall of one of the abdominal organs ♦ *fun facts about the peritoneum that increase its vulnerability to protect itself from peritonitis: o It is large, unbroken space that favors the dissemination of contaminants o Large surface that permits rapid absorption of bacterial toxins into the blood Signs and symptoms •Muscles of the abdominal wall tighten to protect the inflamed bowel. -Board-like abdomen •Pain and sympathetic nervous stimulation cause the bowel to freeze in position. -Reflex paralysis or paralytic ileus •Diaphragm and accessory breathing muscle movements decrease. -Shallow breathing • The most common causes of Peritonitis: • Peptic ulcer • Ruptured appendix • Perforated diverticulum • Gangrenous bowel • Pelvic inflammatory disease • Gangrenous gallbladder • Other causes: • Abdominal trauma and wounds Can lead to sepsis

Characteristics of upper motor neurons

• Upper motor neurons (UMNs) project from the motor cortex to the brain stem or spinal cord, where they directly or indirectly innervate the lower motor neurons (LMNs) of the contracting muscles; sensory feedback from the involved muscles that is continuously relayed to the cerebellum, basal ganglia, and sensory cortex; and a functioning neuromuscular junction (NMJ) that links nervous system activity with muscle contraction • Upper motor neurons, which exert control over lower motor neurons, project from the motor strip in the cerebral cortex to the ventral horn and are fully contained in the central nervous system • UMN disorders involve neurons that are fully contained within the CNS and include the motor neurons arising in the motor areas of the cortex and their fibers as they project to the spinal cord

Why are elderly patients at risk for dehydration?

• With age, people experience hypodipsia - a decrease in the ability to sense thirst. • Commonly associated with lesions in the hypothalamus (where thirst center is located) • This inability to perceive and respond to thirst in the older adult can be the result of a stroke, and may be further influenced by confusion, sensory deficits, and motor disturbances. • As a result of hypodipsia, it is common that older adults will forget to or will not think to drink enough because they don't feel thirsty, ultimately putting them at risk for dehydration.