Final Part 2 Patho

HYPOGLYCEMIA:

! ! !MOST DANGEROUS! ! ! ▪Occurs in starvation or if treatment of hyperglycemia with insulin lowers blood glucose too far. ▪CNS changes→ due to brain using glucose as its only source of energy. ▪S/S usually manifest when blood sugar level at or below 70 mg/dL.-Irritable, mental confusion, shaky/trembling, diaphoretic →ultimately leads to a coma when blood sugar reaches 40 -50 mg/dL.

Squamous Cell Carcinoma:

"2nd Most Common -2ndMost Lethal. " SCCs typically appear as persistent, thick, rough, scaly patches that can bleed if bumped, scratched or scraped. They often look like warts and sometimes appear as open sores with a raised border and a crusted surface. They can become disfiguring and sometimes deadly if allowed to grow. SCCs may occur on all areas of the body including the mucous membranes and genitals but are most common in areas frequently exposed to the sun, such as the rim of the ear, lower lip, face, balding scalp, neck, hands, arms and legs.

Alert and oriented

"A & O x 3"means Alert and Oriented to "person," "place" and "time."

Atelectasis

"Air sac CANNOT EXPAND" Incomplete expansion of a part of the lungs(the alveoli cannot fill with air); caused by-(1)Blockage of the air passages (bronchus/bronchioles) -or-(2) Pressure on the outside of the lung, -or -(3)Surfactant failure.

Hashimoto's Disease

"Autoimmune thyroiditis" most common cause of hypothyroidism anti-thyroid antibodies destroy thyroid; can be an inherited dysfunction(diagnosed in babies); result of taking hyperthyroidism meds or thyroid surgery. Myxedema -an extreme complication of hypothyroidism; patients exhibit multiple organ abnormalities; progressive mental deterioration. Also called myxedema coma or crisis. Myxedema also refers to the swelling of the skin and soft tissue that occurs in patients who have hypothyroidism. Myxedema occurs when the body's compensatory responses to hypothyroidism are overwhelmed by a precipitating factor such as infection. S/S: Weight gain, cold intolerance, constipation, joint pain/muscle weakness, irregular menstrual periods, brittle hair and nails, decreased C02,bradycardia Basal Metabolic Rate-Decreased, Mental and physical sluggishness, somnolence.

Over time GERD causes the tissue of the throat to develop precancerous dysplasia (Barrett's Esophagitis) and could develop into esophageal cancer -so advise your patients,

"DO NOT IGNORE HEARTBURN -it can lead to throat cancer".

Diabetic ketoacidosis(DKA)

"Diabetic coma" characterized by ketoacidosis and hyperglycemia High risk: Type I or Type II diabetics Undiagnosed DM Predisposing factors: Illness, sepsis Stress, trauma medications Presenting symptoms: Polyuria, polydipsia, TISSUE dehydration, N/V,SZs, coma Acidosis: Kussmaul breathing, "fruity" acetone breath Laboratory Findings: -Extreme Hyperglycemia-KETONES(blood/urine/breath) Treatment: 1. Rehydration -IV fluids (isotonic and hypOtonic fluids)2. IV Insulin3. Replace electrolytes as needed

Pancreatic Stools:

"Foamy floaters" -bulky unformed stools, unusually foul-smelling, greasy stools (steatorrhea). The stool is light-colored and may even contain oil droplets. This is caused because pancreas enzymes are not breaking down fat in the intestines.

Melanoma Carcinoma:

"Least Common -Most Lethal. " The most dangerous form of skin cancer. Tumors originate in the pigment-producing melanocytes of skin. Can arise from an existing mole or develop a new lesion. Melanoma is caused mainly by intense, occasional UV exposure (frequently leading to sunburn), especially in those who are genetically predisposed to the disease. If melanoma is recognized and treated early, it is almost always curable, but if it is not, the cancer can advance and spread to other parts of the body, where it becomes hard to treat and can be fatal.

Osteoporosis

"Porous bone." Refers to bone density that is far lower than normal peak density. This disease is characterized by too little bone formation, excessive bone loss, or a combination of both, leading to bone fragility and an increased risk of fractures especially of the hip, spine and wrist. There are usually no s/s until bones start breaking for no reason. Bone is living tissue that is constantly being broken down and replaced by the body. Osteoporosis occurs when the creation of new bone does not keep up with the body's removal of old bone. It mostly affects elderly women, who can be devastated by a fall that breaks their hip (1 in 5 elderly women who break a hip will die within a year).What causes osteopenia and osteoporosis? Bones naturally become thinner beginning in middle age because existing bone cells are reabsorbed by the body faster than new bone is made. As this occurs, the bones lose minerals, heaviness (mass), and structure, making them weaker and increasing their risk of breaking. All people begin losing bone mass at about 30 years of age(Yikes!!!). The thicker a person's bones are at age 30, the longer it takes to develop osteopenia or osteoporosis. Osteopenia/Osteoporosis may also be the result of a one or more other conditions, disease processes, or treatments. Women are far more likely to develop osteopenia and osteoporosis than men. This is because women have a lower peak bone density and because the loss of bone mass speeds up as hormonal changes take place at the time of menopause.

STROKE Treatment

"Time" is vital in saving brain tissue. Thrombolytic medication ("clot-buster" drugs) must generally be given within 3 hours of onset of symptoms. Thrombolytic medicine can be given for ISCHEMIC STROKE(Thrombolytic or Embolic strokes) but can NOT be given in a HEMORRHAGIC stroke because it will cause more bleeding in the brain.

*In the most severe cases UC can cause damage to the nerve plexus, resulting in colonic dysmotility, dilation, and eventual infarction and gangrene—a condition termed ______ _______ This condition is characterized by a thin-walled, large, dilated colon that may eventually become perforated.

"Toxic Megacolon."

Osteogenesis Imperfecta

"brittle bone disease" -The most common hereditary bone disease. Etiology: Autosomal dominant type I & IV and autosomal recessive type II & III Pathophysiology: Biochemical defect in ability to synthesize collagen. Abnormal collagen results in incomplete development of bones, ligaments, and sclera(so some children will have light blue colored sclera). Due to decreased bone density, "Brittle bones" will result in variable degrees of fragility (different types of OI are worse than others-there are 8 different types of OI). S/S: Bone fractures as babies(even during birth); short, bowed, deformed limbs; short stature; spinal curves; blue sclera. Rx: Treat fractures, protect bones, IV osteoporosis medication (alendronate -"Fosamax"-same med used for osteoporosis tx).

Adrenal cortex

"covering"(outer 90% of adrenal gland) excretes glucocorticoids (Cortisol), mineralocorticoids/SALT (Aldosterone), and Androgens (sex hormones).These steroids help regulate the body's response to chronic stress.

Specific gravity-fixed

"fixed" is a late sign of END STAGE renal failure kidney can no longer concentrate or dilute urine. SG measure dilution/concentration of urine.

Occult blood

"hidden blood" can only be detected by a stool smear test

Asterixis

"liver flap" flapping tremor of hand-early sign of hepatic encephalopathy. Counting flaps correlates with severity.

Adrenal medulla

"middle" inner 10% of adrenal gland) excretes catecholamines (epinephrine and norepinephrine) that are responsible for "fight or flight" response.

Emphysema

"pink puffer" permanent lung damage. Lungs lose their ability to recoil after each respiration-breath only in response to low 02 levels. Removes their respiratory drive and causes respiratory arrest. High 02 retention.

IBS

'functional GI disorder" s/s caused by changes in how GI tract works with GI tract damage-PAIN RELIEVED WITH DEFECATION

There are many underlying disorders that can cause hemoptysis

("bloody sputum or coughing up blood"), ranging from heart problems to trauma to infections to lung disease. Worldwide, TUBERCULOSIS is the most common cause of hemoptysis. In industrialized countries, the most common causes are bronchitis, bronchiectasis, and bronchogenic carcinoma. In patients with AIDS, the most common cause of hemoptysis is pneumonia. In about 15 to 30 percent of cases, the underlying problem is never found—undiagnosed hemoptysis is commonly referred to as idiopathic hemoptysis.

Specific Gravity

(1.010 -1.030) measures how dilute or concentrated the urine is. Useful to diagnose fluid status (especially dehydration which causes very concentrated urine) and Diabetes Insipidus (polyuria that is very dilute, caused by brain damage due to trauma; infection; tumors, etc.). AFIXED SPECIFIC GRAVITY in which the number never changes through multiple urine tests indicates the kidney can no longer concentrate or dilute urine. This is an indicator of severe kidney failure.

Hepatic Encephalopathy

(1003)Damaged liver will not break down or synthesize protein which results in elevated ammonia levels. Ammonia is brain-toxic and high levels will cause changes in LOC. Increased ammonia and toxins unable to be processed by the liver are shunted from the GI tract into the circulation. Many toxins freely cross the blood-brain barrier causing neurologic S/S. Confusion, asterixis*(see below), apraxia, stupor, seizures, coma

Autonomic Dysreflexia Steps

(A)A strong sensory input (sometimes called a "noxious" stimulus)below the level of spine injury is carried into the spinal cord via intact peripheral nerves. The most common origins are bladder and bowel needing to empty, but could be a bed sore, ingrown toenail, etc.(B)This strong sensory input travels up the spinal cord and evokes a massive reflex sympathetic surge from the thoracolumbar sympathetic nerves, causing widespread vasoconstriction, most significantly in the sub diaphragmatic or splanchnic vasculature[BELOW the level of the injury]. So, peripheral arterial hypertension occurs. (C)The brain detects this hypertensive crisis through intact baroreceptors in the neck delivered to the brain through cranial nerves IX and X. (D)The brain attempts two maneuvers to halt the progression of this hypertensive crisis. •First, the brain attempts to shut down the sympathetic surge by sending descending inhibitory impulses. These impulses are unable to travel to most sympathetic outflow levels because of the spinal cord injury at T6or above. Inhibitory impulses are blocked in the injured spinal cord. •In the second maneuver, the brain attempts to bring down peripheral blood pressure by slowing the heart rate through an intact Vagus (parasympathetic) nerve; however, this compensatory bradycardia is inadequate, and hypertension continues. Once the inciting stimulus is removed, reflex hypertension resolves.http://emedicine.medscape.com/article/322809-overviewIn summary, the sympathetic nerves prevail below the level of neurologic injury, and the parasympathetic nerves prevail above the level of injury. The sympathetic response causes VASOCONSTRICTION BELOW the injury; parasympathetic nerves VASODILATION ABOVE the injury. The vasoconstriction below the injury causes HYPERTENSION, pounding headache, visual changes, anxiety; pallor; and goose bumps below the level of injury.

Uterine Cancer

(Endometrial) 40%of Gyn CA; Most common in postmenopausal women. Increased risk due to age, late menopause, never giving birth, infertility, obesity/diabetes,/high blood pressure(do you recognize "Metabolic Syndrome?"), and hormone replacement (estrogen)treatment.[pg.1136] S/S: related to type. "Red Flag" sign is painless abnormal vaginal bleeding in 90% of cases.

Clinical manifestations of glomerulonephritis:

(Evident in 10-15 days) ▪Acute hematuria (NephRITIC Syndrome) ▪Proteinuria (NephROTIC Syndrome) ▪Low serum albumin(see nephrotic syndrome) ▪E D E M A ▪Eventually oliguria

LFTs

(Liver Function Tests) [specifically the liver enzymes ALT and AST] increase when liver tissue has been damaged allowing the enzymes to escape into the blood.

Blood urea nitrogen (BUN)

(Normal range = Less than 20)Urea is the by-product of protein metabolism in the liver. The ammonia formed in this process is synthesized to urea in the liver. Creation of BUN is the most important catabolic pathway for eliminating excess nitrogen in the human body. Measuring how much BUN is in the blood is an indicator of kidney damage. However, BUN is also affected by dehydration, so it only indicates kidney damage if Creatinine levels are also elevated.

Occult Blood smear

(aka, Hemoccult or Guaiac) tests stool samples for occult blood

Stress Fx

(aka, fissure fractureor "Hairline Fractures") -a fatigue-induced fracture of the bone caused by repeated stress over time. Insteadof resulting from a single severe impact, stress fractures are the result of accumulated trauma from repeated submaximal loading, such as running or jumping.

Pulmonary Edema

(also called pleural edema), is a buildup of fluid in the interstitial tissue of the lung. Pulmonary edema occurs when the alveoli fill up with excess fluid seeped out of the blood vessels in the lung instead of air. This can cause problems with the exchange of gas (oxygen and carbon dioxide), resulting in breathing difficulty and poor oxygenation of blood. Sometimes, this can be referred to as "water in the lungs" when describing the condition to patients. Commonly caused by left sided heart failure(back up of fluid into the lungs) but also can be caused by kidney failure(kidney does not remove excess body fluid); Sepsis(See below under ARDS) or any lung damage that involves inflammation.

Hematoma

(clot)formation→ within hours after injury or surgery (48-72 hours).

Displaced vs. Aligned Fx

(displaced Fx do not heal well and interfere with limb function)

HYPERGLYCEMIA

(increased blood sugar) > 130 before a meal ▪Glycosuria: sugar in the urine (remember that Glucose does not belong in urine!) ▪Fatigue: cells cannot take glucose in, →Lethargy ▪Polyuria(increased urination from osmotic diuresis caused by glucose molecules attracting water)▪Polyphagia: increased hunger →cells sense they are starving ▪Polydipsia: increased thirst →d/t increased tonicity of blood ▪Ketoacidosis(ketosis): break down of fats for energy →process stops at the ketone level due to no glucose →results in increased ketones in blood.

Chronic bronchitis

(is a COPD)[pg. 822]-chronic hyper-secretion of thick mucus(thicker than normal) and productive cough that lasts for at least 3 months of the year and for at least 2 consecutive years. Chronic Bronchitis is a serious long-term disorder that often requires regular medical treatment. It is caused by inspired irritants that increase mucus production and the size & number of mucous glands along with damage to cilia that prevents movement of mucous out of the bronchus. Chronic Bronchitis is considered a COPD due to its obstructive nature, and in fact is usually present in emphysema patients. Smoking (inhaled personally or second hand) is a common cause of bronchitis. Cigarette smoking damages the cilia(tiny hair-like structures in the lungs) that are responsible for brushing out debris, irritants, and excess mucus. Smoking damage to the cilia prevent them from functioning properly, thus increasing chances of developing chronic bronchitis. Once clogged with mucus, the lungs are then vulnerable to viral and bacterial infections, which over time distort and permanently damage the lungs' airways. This permanent condition is called COPD.

Urticaria

(raised rash -hives) seen in Contact Dermatitis: Type IV (Delayed)Hypersensitivity

Closed(skin intact) vs. Open or Compound Fx

(skin is broken open-exposing the bone to infection)

Diabetes Insipidus vs mellitus

*Diabetes Insipidus is in NO WAY related to Diabetes Mellitus! Diabetes simply means "polyuria, "which is a symptom of both Diabetes Insipidus and Diabetes Mellitus (high blood sugar).

GERD RISK FACTORS

*Obesity *Pregnancy *SMOKING * Hiatal hernia *Fatty foods *ALCOHOL * Chocolate

LATE signs of ICP

-(Brain herniation is imminent) Impaired reflexes(corneal, gag, and swallowing) Papilledema(optic disc swelling) Abnormal posturing-Decorticate/decerebrate

Pressure ulcer risk factors

-Age ▪Incontinence ▪Mobility limitations ▪Smoking ▪Nutritional status ▪Diabetes ▪Steroids (prednisone)

Vasogenic Edema

-Blood-brain barrier damage causes increased capillary permeability. This occurs with conditions that impair the function of the blood-brain barrier and allow transfer of water and proteins from the vascular space into the interstitial space →swollen brain tissue.

The hypothalamus hormones go to the pituitary to stimulate the secretion of other hormones. Because the hypothalamus regulates other glands it indirectly controls:

-Body temperature -Blood nutrients -Blood osmolarity -Emotions -Blood hormone levels -Pain -Inflammatory mediators -Sleep cycles

Secondary brain injury:

-Causes damage to parts of the brain that were not initially injured -Damage caused by the inflammation process -Swelling →ICP →brain herniation →tissue necrosis

Cushing disease dx procedures

-FBS is increased -Plasma cortisol is INCREASED -serum sodium is INCREASED -serum potassium is INCREASED

Primary brain injury:

-Focal Injuries: Contusions, Hematoma's -Diffuse Injuries: Concussions; Diffuse Axonal Injury; Traumatic Subarachnoid Hemorrhage

Lung Cancer Categories:

-Non-Small Cell Lung Cancers-the most common type of lung cancer(about 85%).Squamous cell carcinoma, adenocarcinoma, and large cell carcinoma are all subtypes of non-small cell lung cancer. •Small-Cell Lung Cancer-also called oat cell cancer. About 10%-15% of lung cancers. Highly malignant and BRAIN METASTASIS is common-poor prognosis; Chemotherapy is usually the main treatment for small-cell lung cancer. (Study question: What s/s would you see if cancer metastasized to the spinal cord or brain?)

Cytotoxic Edema

-The blood-brain barrier remains intact but a disruption in cellular metabolism impairs functioning of the sodium/potassium pump. Active transport failure leads to K+ loss and Na+ retention increasing cellular H2O. This leads to ischemia of brain tissue and necrosis of brain cells.

Pleural Effusion

-a buildup of fluid between the ribs and the lungs in the pleural space. Fluid can be serous fluid, pus (empyema), lymph fluid, or blood (hemothorax).This type of fluid collection can be removed (aspirated) with a needle because it is in a cavity of the body. If large enough a pleural effusion can cause a "compression atelectasis" (see pg. 3of outline).

Cushing's disease s/s

-increased susceptibility to infections -HYPERNATREMIA hypertension, edema, weight gain, moon face appearance and buffalo bump, obese trunk, pendulous abdomen, thin extremities -HYPOKALEMIA weakness and fatigue, constipation, U wave upon ECG (T wave hyperkalemia) -Hirsutism -Acne and striae -easy bruising -INCREASED MACULINITY AMONG FEMALES

Pathophysiology of Alzheimer's

-neuronal proteins develop into neurofibrillary tangles causing areas of degenerated tissue called senile plaques. These plaques impair transmission of neural impulses.

Beta blockers

-olol

Ace inhibitors

-pril

Colorectal Cancer

1 in 20 diagnosis 1/3 die from it. 50+ age. Men more common. Black and Caucasian. Family History: 25% Medical Hx: Crohns or ulcerative colitis. Diet: Unhealthy fats refined sugars & flour, low fiber, and low vitamins, obesity, lack of exercise, smoking, alcohol consumption.

COLORECTAL CANCER Risk Factors:

1 in 20 people will be diagnosed with colon cancer and 1/3 die from this cancer.1.Age: 50 years old or older2.Gender: Greater in men than in women3.Race:Black and Caucasian4.Family History: 25% of colon cancer5.Medical Hx of Crohn disease or ulcerative colitis6.Diet:Unhealthy fats, refined sugars and flour, low fiber, and low vitamins7.Other: Obesity/lack of exercise; smoking; alcohol consumption

Testicular Cancer

1% of male CA; 15-35 yrs. old—self-exam to check for painless mass. Highest risk among men who have a history of undescended testicle as an infant or who have a family history. HIGH CURE RATE. RX: Removal [orchiectomy]of affected testicle & chemo.

Perfusion [blood flow in the lungs] can be affected by:

1) Blood clots impeding or stopping blood flow to the lung tissue; 2) Blood moving by the alveoli too fast for the exchange of gases to take place between the alveoli sac and the capillary (e.g., tachycardia); or 3) blood moving too slow to oxygenate the lungs (bradycardia, heart blocks, heart failure, etc.).

Hepatorenal syndrome

1-Decreased circulating blood volume leads to decreased renal perfusion triggering the renin-angiotensin system→ vasoconstriction and increased B/P 2-Hepatic failure prevents removal of excess Angiotensin so the process is not reversed and HTN gets worse. 3-Following the kidney damage, less urine is removed from the body, so waste products that contain nitrogen build up in the bloodstream(azotemia). Manifests by: Na+ and H2O retention, Oliguria Increased BUN, and Creatinine levels

Alzheimer's-how it works

1-clumps of protein grow in brain 2-protein strands twist, damaging brain cells 3-brain cells die, certain areas of brain shrink Age 65 and up at risk could affect younger people

Alzheimer's disease-how it happens

1-clumps of protein grow in brain 2-protein strands twist, damaging brain cells 3-brain cells die, certain areas of brain shrink Age 65 and up at risk-could happen to younger people

Tuberculosis ~ WHO WEARS THE MASK?

1. In Patient's hospital room or home: VISITORS and MEDICAL STAFF coming into the patient room or home must wear a respirator mask(N-95 mask) to protect themselves from TB exposure. If a mask is not available, give the individual a tissue and instruct them to cover their mouth and nose when coughing or sneezing(Utah Department of Health*).However, A respirator mask should NOT be worn by a patient since it may result in increased difficulty in breathing for the patient.2. Transporting a TB patient outside of their hospital room: "People with suspected or confirmed infectious TB disease[who are in public areas]should wear a standard surgical or procedure mask, if possible. Patients should be instructed to keep the mask on and to change the mask if it becomes wet. If patients cannot tolerate a mask, they should observe strict respiratory hygiene and cough etiquette procedures.

Renin-angiotensin-aldosterone system (RAAS)

1. Initiated by decreased perfusion to the kidneys. 2.The kidneys release renin. 3.Renin combines with angiotensinogen (from the liver) to form Angiotensin I. This takes place in blood stream. 4.Angiotensin I is converted in the lungs to angiotensin II by Angiotensin Converting Enzyme(ACE). 5.Angiotensin II stimulates the adrenal cortex to release aldosterone. 6.Aldosterone directs the kidney to reabsorb more sodium. 7. Water follows the sodium back into the blood stream and blood pressure is increased.

The chronic inflammation of Crohn's can lead to significant problems such as-

1. Malabsorption: folic acid(→anemia), calcium/vitamin D(→bone weakness) 2. Fluid and electrolyte imbalance 3. Diarrhea and dehydration4. Anal fissures

Important Nursing Considerations:

1. Obtain a history of medication allergies before giving the first dose of antibiotics, since this class of drug is very prone to causing allergic reactions. 2. Do multiple "Neuro Checks" each day (remember the 5 "P's" of neurovascular assessment) to monitor for compartment syndrome that may be developing due to swelling in a limb. Circumferential burns (burns that encircle a limb, appendage, or body part) are especially high risk for compartment syndrome. 3. Mark around the area of redness with a permanent marker (include date) so progress of treatment of the cellulitis can be measured. If redness on the skin extends past the marker line, this is an indication that the chosen treatment/antibiotic is not effective for the type of pathogen infecting the skin.

RENAL DYSFUNCTIONS are caused by one of three things:

1. PRERENAL causes -Severe decrease in blood flow to the kidneys 2. INTRINSIC causes -Damage to the structures within the kidney 3. POSTRENAL causes -Obstruction of urine leaving the kidney

Many processes ensure B/P remains normal:

1. RAAS and ADH raise pressure when it's too low 2. Natriuretic Peptides (ANP/BNP) lower B/P when it is too high.

The 2 main types of Rectal CA polyps are:

1.Adenomatous polyps (adenomas):These polyps sometimes change into cancer. Because of this, adenomas are called a pre-cancerous condition.2.Hyperplastic polyps and inflammatory polyps: These polyps are more common, but in general they are not pre-cancerous.

Meningitis

1.Bacterial-usually from direct exposure or systemic bacteremia-most serious form of meningitis-can cause long term and or permanent brain damage/death. High mortality rate. 2.Viral(aseptic) -usually from upper respiratory infection-most common cause of meningitis and usually the least severe. Often resolves in2 weeks without treatment. 3.Fungal-usually found in immunosuppressed individuals.

Manifestations of Lung Cancer:

1.CHANGES IN ORGAN FUNCTION -Lung damage, inflammation, and organ failure. 2.LOCAL EFFECTS OF TUMORS -Compression of nerves or veins, gastrointestinal obstruction. 3.HORMONES SECRETED BY TUMOR CELLS -a lung tumor can release hormones that cause problems such as low blood sodium levels or high blood calcium levels. 4.NONSPECIFIC SIGNS OF TISSUE BREAKDOWN (e.g., protein/muscle wasting, bone breakdown, pathological fractures)

Clinical Manifestations of Pyelonephritis

1.Flank pain[Costovertebral (CVA) tenderness] 2.Fever/chills 3.Nausea/vomiting 4.Leukocytosis 5.Purulent urine (WBCs, bacteria and/or blood in urine) These s/s in BOLD (#1, 2, & 3) are what distinguish the difference between Pyelonephritis and the less severe UTI's.

FES Classic Triad:

1.Respiratory-dyspnea, hypoxia, and/or chest pain are caused by fat emboli traveling to the lungs. Usually the FIRST indicator. May progress to ARDS. 2.Neurologic-confusion/drowsiness, altered mental status, seizures and stroke like s/s caused by fat emboli traveling to the brain 3.Petechial rash caused by fat emboli traveling to the capillaries of the skin. LAST to appear and usually resolves in 7 days. Rash appears in conjunctiva (eye), oral mucosa, neck and axilla. DX: Diagnosed based on clinical presentation of s/s. Imaging and lab tests are not conclusive. TX: No specific treatment for FES. Stabilizing the fx (fracture) quickly (splints/surgery, etc.) reduces the risk for FES. Otherwise, must treat symptoms to reduce morbidity and prevent complications.

GFR-glomerular filtration rate

125 mL/min (normal 85-125) Affected by anything that would decrease blood flow in kidney (HF, atherosclerosis, hypotension)

Cervical Cancer

20%of Gyn CA; 40-45 peak incidence-one cause is HPV virus. Highest risks are females who have had more than 10 sexual partners and early age start of sexual activity.[pg. 1133 ] Dx: Pap Smear: The primary purpose of a Pap smear is to obtain cytology(cell)samples from the cervix to examine the cervical cells for atypical changes. Cell changes can represent a continuum of morphologic changes with indistinct boundaries that may gradually progress to cancer in situ and then to invasive cancer. Rx: Chemotherapy, radiation (and brachytherapy), Hormone and other medication, surgery

Duodenal Ulcers

25-50 years old: Any age, usually early adulthood Men > women 3 or 4:1 Hyperacidity Increased Ulcerogenic drugs : Increased use of ETOH / tobacco Bacterial infection : Often H. pylori Pain : Pain relieved by eating, common nocturnal, remissions and exacerbations Hemorrhage : Common

Prostate Cancer

3rd highest cause of cancer deaths in America. Most common male cancer. Risk factors: AGE: over 50 (60% > 65 yrs.).FAMILY HISTORY:1stdegree relative (father, brother) and 2nddegree relative (grandfather or uncle) are at highest risk. RACE: Black men. DIET: Possibly increased dietary fats may alter hormone production and increase risk. S/S: Early stage-NO INITIAL S/S so prostate cancer has usually metastasized before discovered. Late stage-s/s can be similar to s/s of BPH(urgency, frequency, nocturia, hematuria or blood in ejaculate).Sites of metastasis: Lungs (via lymph system) and Spinal column/pelvis (bone pain is often the 1stpresenting s/s). How Diagnosed: Combination of TWO tests -PSA blood test and DRE physical exam1.Prostate specific antigen(PSA)blood test and prostate biopsy if PSA is high[NOTE-PSA can also be high in BPH and Prostatitis so a DRE is also done].2.Digital Rectal Exam(DRE)-a gloved finger is inserted into rectum to check the size of the prostate and to palpate for abnormal bumps if present. Less effective in detecting prostate CA than PSA tests but may find CA in men with normal PSA level.3.Transrectal ultrasound may detect cancers that are too small to be detected by DRE. Screening Recommendations: Age 50for men who are at average risk of prostate cancer and are expected to live at least 10 more years.[Additional recommendations: Age 45 for men at high risk of developing prostate cancer. This includes African Americans and men who have a first-degree relative (father, brother, or son) diagnosed with prostate cancer at an early age (younger than age 65).Age 40for men at even higher risk (those with more than one first-degree relative who had prostate cancer at an early age). Rx: surgery(on prostate and sometimes complete orchiectomy to remove testicles and stop testosterone production), radiation, chemotherapy.

IBS dx

3x/month for 3+ mos altered bowel function with GI damage and complaints (flatulence, bloating, constipation, diarrhea)

Gastric

55-70 years old Men > women 3 or 4:1 Hyperacidity Normal to low Ulcerogenic drugs Moderate use of ETOH / tobacco Associated gastritis Common Bacterial infection : May be Present Pain relieved by eating, uncommon nocturnal, no remission and exacerbation Hemorrhage less common

Cholecystitis risk factors:

6 "F's" Fair, Fat, Fertile, Female, Forties, Family. Other risks include Crohn's, diabetes, hyperlipidemia, pregnancy *Hallmark symptom-PX IMMEDIATELY after eating

Normal range for blood sugar

70 -130 mg/dL

Indoor Tanning Increases Melanoma Risk by

74%

Pa02 levels

80-100

Risks for Acute Tubular Necrosis(ATN) include

: ❖Low blood pressure(hypotension) lasting longer than 30 min. ❖Septic shock due to severe infection ❖Dye(contrast) used for x-ray studies ❖Medications that are toxic to the kidneys (such as aminoglycoside antibiotics or amphotericin) ❖Injury or trauma that damages the muscles(release of myoglobin from muscles →kidneys cannot filter this large molecule so it causes kidney damage) ❖Blood transfusion reaction ❖Recent major surgery

Glomerulonephritis can result in EITHER

:1-NEPHRITICSYNDROME(an inflammatory process that results in hematuria and proteinuria), OR; 2-NEPHROTICSYNDROME(permeability of the glomerular pores allows large losses of protein molecules through the kidney -just proteinuria, not hematuria).

Post hepatic:

< AFTER>any obstruction to flow through the hepatic veins beyond the liver lobules, either within or distal to the liver such as right sided heart failure or thrombosis of hepatic veins.

Prehepatic:

< BEFORE>portal vein →thrombosis, cancer, enlarged lymph nodes, compression.

Intrahepatic:

<WITHIN>conditions that cause obstruction of blood flow within the liver such as alcoholic cirrhosis.

Osteomyelitis

A MONTH OF TREATMENT Bone INFECTION. A serious medical problem that could require a month or more of IV antibiotics, two to three times A DAY! Bone infections are difficult to treat because of the low blood supply associated with bone as compared to soft tissue. Ultimately may require surgery to remove damaged bone. Infection can be introduced directly through a bone break; or spread from infected skin/muscles/tendons next to the bone. Also, bacteria can travel to the bone through the blood from another part of the body (called hematogenous osteomyelitis). Osteomyelitis can also be a complication of bone surgery especially if metal rods or plates are used to stabilize the bones. May result in amputation if infection cannot be stopped -or death. S/S: Bone pain; fever/chills, elevated WBCs, general discomfort and just not feeling well. If there is an open wound or an incision after surgery, there may be purulent drainage and other s/s of inflammation.

Intracerebral Hematoma

A blood clot deep in the middle of the brain that is hard to remove. Pressure from this clot may cause damage to the brain. Surgery may be needed to relieve the pressure. Can be either arterial or venous.

Autonomic Dysreflexia

A condition common in patients with spinal cord injury at T6 and above (T6 -C1).Causes Dangerously high blood pressure-(can be high enough to cause a stroke or seizures), skin pallor, and goose flesh associated with piloerector response. Autonomic dysreflexia is often triggered by a "noxious" stimulus below the spinal cord injury such as a full bladder. Other triggers can be: UTIs; overfull bowel; GI problems; pressure sores; sexual activity; tight clothing; temperature extremes or quick temperature changes; skin problems or even ingrown nails.

Stage III pressure ulcer

A full-thickness loss of skin with extension into subcutaneous tissue but not through the underlying fascia

Unstageable

A full-thickness tissue loss in which the base of the ulcer is covered by slough or eschar to such an extent that the full depth of the wound cannot be appreciated

Stage IV pressure ulcer

A full-thickness tissue loss with extension into muscle, bone, tendon, or joint capsule

What to Look for with moles:

A mole that is evolving -shrinking, growing larger, changing color, begins to itch or bleed. A portion of the mole appears newly elevated or raised from the skin. Melanoma lesions often grow in size or change in height rapidly. Anyone who has more than 100 moles is at greater risk for melanoma.

Tuberculosis and Other Mycobacterial Infections

A mycobacterium is a type of bacteria that causes a variety of infections, including tuberculosis. A mycobacterial infection can destroy pulmonary tissue, usually by forming cavities in the airway walls. The hemoptysis that results is usually mild to moderate and may be associated with other symptoms, including unexplained weight loss, cough, purulent sputum (thick, opaque, yellowish white discharge),and a history of mycobacterial exposure. A chest x-ray usually shows signs of infection, including a visible cavity, and the mycobacterium should be microscopically visible in the patient's sputum.

Stage II pressure ulcer

A partial-thickness loss of skin involving epidermis and dermis

Alzheimer's Etiology:

A progressive decline in first MENTAL then PHYSICAL abilities. Most common form of dementia (accounts for 60% -80% of dementia cases).Dementia symptoms gradually worsen over several years. In its early stages, memory loss is mild, but with late-stage Alzheimer's, individuals lose the ability to carry on a conversation and respond to their environment. Alzheimer's is the sixth leading cause of death in the United States. Those with Alzheimer's live an average of 8-10 years after their symptoms become noticeable to others, but survival can range from four to 20 years, depending on age and other health conditions.

(Suspected) deep tissue injury

A purple or maroon localized area of discolored intact skin or blood-filled blister due to damage of underlying soft tissue from pressure or shear

Maceration

A softening, whitish look to the intact skin around wounds caused by excessive moisture. Often occurs when exudate is not well managed by dressings. Also occurs when incontinence pads/briefs are not changed often enough. occurs when it is consistently wet. The skin softens, turns white, and can easily get infected with bacteria or fungi. *Seen in Pressure Ulcers

Muscular Dystrophy

A term used to describe several disorders that produce progressive deterioration of skeletal muscle. The most common variety begins in childhood, primarily in boys, but other types do not show until adulthood. Etiology-Genetic: Autosomal dominant or X-linked recessive. Pathophysiology-Muscle fibers have altered metabolism and are unable to metabolized necessary substances causing necrosis and phagocytosis of muscle cells, but muscle is replaced by fat or connective tissue. In toddlers, parents may notice enlarged calf muscles (see image at right). This enlargement is known as pseudohypertrophy, or "false enlargement," because the muscle tissue is abnormal and may contain scar tissue. S/S: Progressive, symmetric weakness of the skeletal muscles. Also, may lose ability to walk and have trouble breathing or swallowing. Exacerbation and remission are common, and the weakness is unilateral. Pre-natal care is important for growth and maturation of cells.1.Rapidly progressive: onset by 5 yr / terminal in late adolescence or early adulthood (20 yr)2. Slowly progressive: onset from 10-30 yrs / may survive well into adulthood Effects of MD on the Heart Lack of dystrophin can weaken the muscle layer in the heart (myocardium), resulting in a condition called cardiomyopathy. Over time, sometimes as early as the teen years, the damage done by MD to the heart can become life-threatening. The heart should be monitored closely, usually by a pediatric cardiologist. Effects of MD on the Lungs Beginning at about 10 years of age, the diaphragm and other muscles that operate the lungs may weaken, making the lungs less effective at moving air in and out. Although the child may not complain of shortness of breath, problems that indicate poor respiratory function include headaches, mental dullness, difficulty concentrating or staying awake, and nightmares. Weakened respiratory muscles make it difficult to cough, leading to serious respiratory infections. A simple cold can quickly progress to pneumonia. It's important to get flu shots, and when infections occur, to get prompt treatment. Dx: Diagnosed through muscle biopsy, genetic testing, and enzyme tests. Rx: No cure. Medication is used to treat s/s.

Urinalysis

A urine sample can provide a great deal of information about how the kidney is functioning. Urinalysis is useful for detecting infection or other kidney issues.

During physical exam of a newborn, the nurse palpates the scrotal sac and only locates one testicle. Which statement about undescended testicles is most accurate? A)"The child can become infertile later in life as a result of decreased sperm count." B)"This is more common in full-term infants when compared to premature births." C)"This may be a precursor to the development of prostate cancer later in life." D)"The child will need surgery to move the testes back into the scrotal sac since they rarely descend spontaneously."

A) "The child can become infertile later in life as a result of decreased sperm count."

An elderly female has slowly developed dementia and loss of vision. She is being evaluated for nursing home placement. Routine admission blood work reveals that the client tested positive for which STI associated with her current symptoms? A) Tertiary syphilis B) Chlamydial C) Gonorrhea D) Human papillomavirus infection

A) Tertiary syphilis

A woman who has developed vulvovaginal candidiasis will likely go to her health care provider complaining of: Select all that apply. A)Pruritus (itching) B)Dyspareunia C)Frothy, foul-smelling discharge D)Painful urination E)Pustules on labia

A, B, & D

When comparing the differences between Peyronie's Disease and Priapism, which of the following are characteristic for clients with Priapism? Select all that apply. A) Prolonged painful involuntary erection lasting longer than 6 hours B) Thick, yellow discharge from the penis C) Most common in Sickle Cell disease D) Presence of a hard mass on the tunica albuginea of the penis E) Can be caused by a spinal cord injury or a stroke

A, C, & E

A young boy is admitted to the ER with 50% burns to the chest and legs. The skin is white, dry, and there is no pain. Which type of burn does the boy have? A. 3rd Degree Burn B. Superficial partial thickness C. Deep partial thickness D. 1st Degree Burn

A.

Compare the different types of rheumatic disorders (arthritis), Chapter 50

A. Osteoarthritis(OA): B. Gouty arthritis: C. Rheumatoid arthritis(RA): D. Systemic Lupus Erythematosus (SLE): E. Ankylosing Spondylitis: F. Reactive arthritis: MISC

Which of the following changes are normal in the elderly population? (Select all that Apply) A. The dermis and epidermis thin as one ages. B. An increase in the amount of subcutaneous tissue. C. A thickening of blood vessels. D. Increased amount of padding on the buttocks. E. Skin may become dry, rough, and scaly

A., C., & E.

What does "A, B, C, D, E" mean regarding skin cancer assessment?

A= Asymmetry(one side of mole is NOT the same as the other side) B= Border of mole is irregular. C = Color is variable(e.g., brown/ black/tan colors in the same mole)or dark color. D= Diameter>6mm(about the same diameter as an eraser on a #2 pencil) E= Elevation -raised from the surrounding skin, and/or...E = Evolution (changes) in the appearance of nevi over time

Ventilation

AIR FLOW alveoli gas exchange (tumors, obstructions, asthma, pneumonia)

NOTE:NEVER GIVE A PATIENT WITH EPIGASTRIC/ABDOMINAL PAIN

ANYTHING TO EAT OR DRINK!!! They may need surgery and if you give them water to drink you may be delaying an emergency surgery!

Metabolic syndrome fact

According to the American Heart Association, 47 million Americans have it. That's almost a staggering one out of every six people[1 out of 3 adults according to the American College of Preventive Medicine].

Ovarian Cancer

According to the CDC*, Ovarian cancer causes more deaths than any other cancer of the female reproductive system. Incidence: 5% of Gynecologic CA; 40-70 peak incidence; 70% is bilateral. Higher risk if a family history of ovarian and/or breast cancer. S/S: G.I upset possibly. Because s/s are so vague, 75% of cases have metastasized before being detected! There are NO SCREENING TESTS for ovarian cancer. NOTE: The CA-125 test is NOT specific to ovarian CA.

Hiatal Hernia Rx:

Acid suppressing medication, and surgery if severe enough. The presence of a hiatal hernia can be observed during an endoscopic exam (looking at the esophagus and stomach with a scope).

Activate Vitamin D

Activated Vitamin D allows the GI tract to absorb more Calcium. Without Vitamin D, the GI tract would not be able to absorb as much calcium, so would have a risk for hypocalcemia.

NEPHRITICSYNDROME

Acute NEPHRITICSYNDROME is an acute inflammatory process that occludes the glomerular capillary lumen and damages the capillary wall. It may occur as a renal-limited primary disorder, such as acute post infectious glomerulonephritis, or as a secondary complicating disorder in systemic diseases, such as Diabetes or Lupus. In its most dramatic form, acute nephritic syndrome is characterized by sudden onset of hematuria(either microscopic or grossly visible, with red cell casts), variable degrees of proteinuria, diminished glomerular filtration rate (GFR), oliguria, and signs of impaired renal function. Extracellular fluid accumulation, edema, and hypertension develop because of the decreased GFR and enhanced tubular reabsorption of salt and water.

Delirium

Acute reversible state of agitated confusion. Disoriented to time and place with hallucinations. Usually symptomatic of a disease and is reversible with treatment of the disease. Can be caused by a high fever.

Crohn's risk factors, s/s

Age 15-40 N/V RLQ pain, distention, familial, diarrhea, bloody stool, wt loss.

Alzheimer's RISK FACTORS include

Age, Heredity (genetic predisposition), and Family HX. Hispanics and African-Americans are at greater risk because there is a connection between HEART health and BRAIN health. According to a growing body of evidence, risk factors for vascular disease —including diabetes, high blood pressure and high cholesterol—may also be risk factors for Alzheimer's and stroke-related dementia.

Levels of Consciousness in descending function:

Alert and oriented("A & O x 3"means Alert and Oriented to "person," "place" and "time.") •Confused and disorganized •Lethargy(oriented but slowed motor and speech) •Obtundation(needs continuous stimuli to maintain arousal) •Stupor(vocalization to pain, has decreased motor movement) •Coma(does not respond appropriately to stimuli. No verbal response)

Complete Spinal Injury

All FUNCTION(motor, sensory, reflex, and autonomic function)is lost below the damaged spinal cord. Causes: Spinal cord severed (transected); disruption of nerve fibers although they may remain intact; or interruption of blood supply to a segment or spinal cord resulting in complete destruction of neural tissue. Because there is no motor nerve communication with the brain →flaccid paralysis. Loss of vasomotor tone can result in severe low B/P or bradycardia depending on the level of injury.

Ulcerative Colitis

Also an autoimmune disease Lesions only occur in the colon →chronic dehydration(⬇water reabsorption)and malnutrition-Ulcerative lesions only involve the mucosal layer-May lead to cavity formation with small hemorrhages and abscesses-Wall of bowel thickens and ulcerations are fibrotic in later stages

ABSORPTION Atelectasis:

Alveoli CANNOT EXPAND because the airways are blocked, and air cannot get into the air sac, or there is no nitrogen in the air sac to keep it open. Example: Post-Op Atelectasis= 1.Oxygen (given in general anesthesia) pushesCO2 and Nitrogen gases out of the alveoli. 2.Oxygen then leaves the alveoli too as it gets absorbed into the capillaries. 3.No gas is left in the alveoli to keep it open.

Alzheimer's disease

Alzheimer's is the sixth leading cause of death in the United States. Those with Alzheimer's live an average of 8-10 years after their symptoms become noticeable to others, but survival can range from four to 20 years, depending on age and other health conditions.

STUDY QUESTION: What S/S would you expect to see if a person has lost protein through their urine as occurs in Nephrotic Syndrome?

Answer: EDEMA. When kidneys are malfunctioning, the body retains water and causes full body edema (the Pillsbury Doughboy!). If severe, even the area around the eyes fills with fluid and gets puffy. This is called PERIORBITAL EDEMA

Pulmonary Embolism (P.E.)

Arteries in the lungs become blocked by a blood clot. This restricts blood flow to a portion of the lung resulting in a "Perfusion Mismatch", and ultimately that portion of the lung can die. Most times, a pulmonary embolism is caused by blood clots that travel from the legs (deep vein thrombosis -DVT)or, rarely, other parts of the body). Commonly, a DVT breaks off and travels to the lungs after first passing through the right side of the heart and ultimately lodging in pulmonary artery of the lung.

Intermediate stage: ACIDOSIS [Respiratory and Metabolic]

As hypoxia worsens, the lungs will not be able to maintain the fast rate of breathing and then RESPIRATORY ACIDOSIS will develop as CO2builds up. METABOLIC ACIDOSIS will also develop as the acid from CO2and breakdown of cells increases (recall that K+ is released from cells when they are injured/die which contributes to the acid load). Also, without adequate oxygen for metabolism, the body moves from aerobic to anaerobic metabolism and produces lactate, which is also an acid.

Cholecystitis(Gallbladder)

Associated with cholelithiasis

Asterixis Factoid

Asterixis["flapping tremor" of the hand] is an early sign of hepatic encephalopathy. The hand will flap involuntarily when the wrist is extended; caused by metabolic encephalopathy of any cause, but especially decompensated liver failure; aka, "Liver Flap": Counting the number of "flaps" per minute correlates with the degree of severity of HEPATIC ENCEPHALOPATHY.

Cystic Fibrosis

Autosomal recessive gene abnormality causing multisystem disease. Thickening of the connective tissue leads to fibrosis (nonfunctioning tissue). Exocrine or mucus-producing glands secrete abnormally thick mucus because of defective epithelial ion transport. In the lungs, thick secretions obstruct the bronchioles and predispose the lungs to chronic infections. Secretions are like "rubber cement"!

During infertility workup, the client is diagnosed with chlamydial infection. The health care provider will especially be looking for which complication of chlamydial infections that can interfere with egg transportation? A)Uterine cancer B)Fallopian tube damage C)Amenorrhea D)Vaginal adhesions

B) Fallopian tube damage

When educating a teenager diagnosed with genital herpes (herpes simplex virus type 2, HSV-2), the health care provider needs to inform her of the importance of careful follow-up since she may be at greater risk for future development of: A) Cervical cancer B) HIV transmission C) Localized necrosis D) Urinary tract infection

B) HIV transmission

2. The first step in self-management of contact/irritant dermatitis is A. Take antihistamines to control the itch B. Identify and remove the causative agent C. Use over-the-counter hydrocortisone cream D. Refer for allergy testing

B.

A 44-year-old man has been brought to the emergency department with severe electrical burns resulting from a workplace accident. The most immediate threat to this client's survival at this time is: A. Infection B. Hemodynamic instability C. Acute pain D. Decreased protein synthesis & impaired healing.

B.

A fire in a campground went out of control and a man sustained burns to his hands, arms, and chest. Another camper immediately removed his ring from his burned hand. Why did he do this? A. to be able to assess the fingers more accurately B. to prevent a tourniquet affect C. to prevent infection D. to avoid interference with first aid treatment of the burn

B.

A woman who has been on two antibiotics states her tongue burns and she does not want to eat. Her tongue is white with milky plaque that does not rub off. Which condition does she have? A. Impetigo B. Candidiasis C. Iron deficiency D. Herpes

B.

A child has been admitted to the burn unit after pulling a pan of hot water off the stove. Given the fact that there is primarily second-and third-degree burns, the health care worker should prioritize care to focus on which of the following? Select all that apply. A. Minimize pain medication administration to not compromise the child's respiratory effort. B. Focus on replacing fluids that have been lost from the vascular, interstitial, and cellular compartments. C. Assess for indications that the child's airway has been compromised by assessing breath sounds and voice quality. D. Withhold foods/nutrition since the GI tract may have slowed down in response to stress. E. Maintain sterile field when doing dressing changes and debridement.

B., C., & E.

Perfusion

BLOOD FLOW blood clots

Lab tests

BLOOD tests [BUN, Creatinine, GFR] URINE tests [Urinalysis &Creatinine Clearance]

Meningitis

Bacterial-usually from direct exposure or systemic bacteremia-most serious form of meningitis-can cause long term and or permanent brain damage/death. High mortality rate. 2.Viral(aseptic) -usually from upper respiratory infection-most common cause of meningitis and usually the least severe. Often resolves in 2 weeks without treatment. 3.Fungal-usually found in immunosuppressed individuals.

Gower's Sign:

Because of weakened leg muscles, children with DMD have a distinctive way of rising from the floor, called a Gowers' maneuver. They first get on hands and knees, then elevate the posterior, then "walk" their hands up the legs to raise the upper body

Angioma

Benign skin tumor (NOT CANCEROUS) resulting from the excessive proliferation of blood vessel cells (endothelial cells). Typically, these tumors are present at or near the surface of the skin and can appear anywhere on the body. An angioma is entirely harmless to the body unless it is damaging adjacent tissues. Angiomas are not removed except for cosmetic reasons, not to improve the physical health of the patient.

EC: Hypovolemic shock

Bleeding occurs from both the soft tissue that is injured by the broken bone and from the bone itself. Bones w/red marrow bleed profusely and internally (so no obvious outward s/s of bleeding).Yellow bone marrow contains fatty tissue and contributes to Fat Emboli (pg 4of outline).Significant amount of blood can be lost from circulation just by the blood pooling in the tissue of a closed fracture. Notice in the figure of how much blood loss can occur from Pelvis, Femur and Thorax(sternum)fractures(all locations of RED bone marrow).If Fx bleeds too much →will cause Acute Tubular Necrosis.(Read about ATN in Renal chapter of textbook).TREAT FOR SHOCK(O2, fluids, blood transfusion) and infection if an open Fx.

Estimated Blood loss with fractures and hypovolemic shock

Bleeding occurs from both the soft tissue that is injured by the broken bone and from the bone itself. Bones w/red marrow bleed profusely and internally (so no obvious outward s/s of bleeding).Yellow bone marrow contains fatty tissue and contributes to Fat Emboli. Significant amount of blood can be lost from circulation just by the blood pooling in the tissue of a closed fracture. Notice in the figure of how much blood loss can occur from Pelvis, Femur and Thorax(sternum)fractures(all locations of RED bone marrow).If Fx bleeds too much →will cause Acute Tubular Necrosis. TREAT FOR SHOCK(O2, fluids, blood transfusion) and infection if an open Fx.

Hepatitis C

Blood/body fluid borne. -No Vaccine available. Treated with antiviral med -Interferon (Intron A). With acute hepatitis C, the virus is eliminated in 25% of people. The other 75% become chronically infected and later may develop serious complications such as liver failure and liver cancer. Progress is being made on cures for Hepatitis C Virus through the use of antiviral medications, but the drugs area very costly option for treating this chronic and debilitating disease.

Hepatitis B

Blood/body fluid borne. Most common cause in US is through unprotected sex, but can also be spread by needle sticks, Mom-to-baby, etc.-Heptavax vaccine* (must complete series of 3); IgG immunoglobulin and Interferon (Intron-A)can be given to unvaccinated patient. If a chronically infected mother gives birth, 90% of the time her infant will be infected and develop chronic hepatitis B, usually for life. This may give rise to serious complications of liver disease later in life such as liver damage, liver failure, and liver cancer.

Hepatitis B

Blood/body fluid borne. Most common cause in US is through unprotected sex, but can also be spread by needle sticks, Mom-to-baby, etc.-Heptavax vaccine* (must complete series of 3); IgG immunoglobulin and Interferon (Intron-A)can be given to unvaccinated patient. If a chronically infected mother gives birth, 90% of the time her infant will be infected and develop chronic hepatitis B, usually for life. This may give rise to serious complications of liver disease later in life such as liver damage, liver failure, andliver cancer.

Breathing

Bronchioles and alveoli (gas exchange)

Acute Bronchitis and Chronic Bronchitis

Bronchitis (acute and chronic) are a very common cause of hemoptysis that results from recurrent coughing that irritates and eventually breaks down the mucosal lining of the airways. The hemoptysis is usually mild and often associated with a purulent sputum (thick, opaque, yellowish-white discharge), low-grade fever and occasionally, wheezing. Usually the sputum is examined under the microscope to look for the pathogenic culprit. A chest x-ray is usually normal. The patient is usually prescribed cough suppressants and antibiotics.

Lung Cancer

Bronchogenic carcinoma (cancer originating in the lining of the bronchi) is a less common cause of hemoptysis than bronchitis or bronchiectasis but is an important one. About 7 percent of patients with bronchogenic cancer are initially diagnosed because of hemoptysis. About 20 percent of patients with bronchogenic cancer experience hemoptysis at some point. The bleeding results from: 1.Necrosis of the tumor (death of the cells that make up the tumor)2.The rupture of small blood vessels in the area3.A tumor invading one of the pulmonary blood vessels →major hemorrhage can result Massive bleeding can occur if the tumor erodes into one of the large pulmonary vessels. Hemoptysis can also result from metastatic cancer to the lungs (especially breast, kidney, colon, and esophageal metastases). The cancer causes bleeding in much the same way that bronchogenic carcinoma causes bleeding.

Contusion:

Bruising of the brain surface underneath a fracture or at the under-surface of the frontal and temporal lobes, due to shearing forces. Diagnosed on CT scan.

Which of the following statements about screening for prostate cancer is most accurate? A) Digital rectal examination detects the majority of new cases of prostate cancer. B) A positive prostate-specific antigen (PSA) test is definitive for prostate cancer. C) BPH and prostatitis can confound prostate screening results. D) Digital rectal examination and PSA testing have been proven ineffective.

C) BPH and prostatitis can confound prostate screening results

When explaining polycystic ovary syndrome (PCOS) to a newly diagnosed client, the health care worker states, "This ovarian dysfunction is caused by: A) Absent FSH." B) Insulin deficit." C) Elevated LH." D) Low androgen."

C) Elevated LH."

When educating a group of teenagers about sexually transmitted infections, the school nurse also mentions that cervical CA has been associated with which of the following Viral infections? A)Chlamydia trachomatis B)Herpes simplex C)Human papilloma virus D)Varicella zoster

C) Human papilloma virus

Which of the following disorders of the male genitourinary system creates the most urgent need for prompt and aggressive surgical treatment? A) Epididymitis B) Benign prostatic hyperplasia (BPH) C) Testicular torsion D) Erectile dysfunction

C) Testicular torsion

Men older than age 50 are at high risk for benign prostatic hypertrophy (BPH), with complications that include: A) Hypospadias and other congenital anomalies B) Scrotal edema and palpable painless mass C) Urinary frequency and retention with weak urine stream D) Testicular cancer

C) Urinary frequency and retention with weak urine stream

Which one of the following skin disorders seen in elderly persons is considered a premalignant lesion? A. Angioma B. Melanoma C. Actinic Keratosis D. Presence of squamous cells

C.

TESTS for PUD and UGIB:

CBC Hematocrit & Hemoglobin H. pylori blood test Occult blood smear EGD (Esophagogastroduodenoscopy) to visualize and perhaps stop a GI bleed Biopsy of stomach tissue (to test for H. Pylori) -done during the EGD procedure

*NOTE: Diabetes and Hypertension are the leading causes of

CHRONIC kidney failure

Patients with COPD live with persistently elevated

CO2 levels and therefore do not respond to high PCO2to stimulate respirations. Instead, they breathe only in response to low oxygen levels. Therefore, if too much oxygen is given to someone with COPD, it removes their respiratory drive and causes respiratory arrest. (Also see "Causes of Hemoptysis" on the last page for more info about Emphysema).

There are many other potential causes of urinary tract obstructions such as

Cancer, BPH, blood clots, malformations, and inflammatory response to infections. They are significant because they all cause backflow of urine into the kidney. This increases pressure in the kidney →kidney damage; or introduces pathogens into the kidney →kidney infections.

Cardiovascular changes from burns

Capillary permeability is increased, leading to loss of intravascular proteins and fluids into the interstitial compartment. Vascular depletion despite fluid replacement → hypovolemic shock. Peripheral and splanchnic (visceral organ) vasoconstriction occurs and myocardial contractility is decreased. These changes, coupled with fluid loss from the burn wound, result in systemic hypotension and end organ hypoperfusion. Hypovolemia can also cause ACUTE TUBULAR NECROSIS (ATN) →decreased urine output is an indicator of progressing renal failure.HYPOVOLEMIA: FLUID RESUSCITATION is the highest priority (after Airway/Breathing). Capillary permeability→3rdspacing of fluid throughout the body →massive edemaPlasma Proteins lost-Protein is able to escape from blood vessels (due to increased permeability) →loss of oncotic pressure in veins so fluid is not pulled out of tissue. Tachycardia -develops due to hypovolemia Hemoconcentration-caused by fluid loss →high Hct (concentrated RBCs). Viscous blood →blood clots. DIC (disseminated intravascular coagulopathy) triggered by body trauma. End Stage Organ Failure -caused by hypoperfusion of vital organs. Severe edema(caused by 3rdspacing of fluid in the tissues) may necessitate an escharotomy(surgery to cut through dead leathery skin caused by the burn) to allow swelling tissue to expand. For instance, if the burn involves the chest, the skin of the chest will be cut to allow the lungs to expand, otherwise the person would suffocate.

#2 RANDOM FACTOID: The primary regulator of respiration is highCO2-not low oxygen!

Central Chemoreceptors in the brain are more sensitive to carbon dioxide levels than to O2 levels. The brain makes changes in breathing rate and depth based on CO2 levels in the blood and cerebral spinal fluid.

Complications of Crohn's Disease:

Chronic inflammatory condition of the bowel. The bowel wall becomes congested, thickened, leading development of abscesses and fistulas. Scar tissue interferes with movement of chyme through the intestine and perforation or obstruction can occur.

Cirrhosis

Cirrhosis is scarred liver tissue that does not function normally. The most common cause of cirrhosis is chronic alcohol use[Alcoholic Hepatitis]. Ethyl alcohol (ETOH)is oxidized by the liver to acetaldehyde which damages hepatocytes. Cirrhosis can also be caused by viral hepatitis or hepatotoxic drugs, i.e., acetaminophen (Tylenol).

Peptic Ulcer Disease (PUD) Tx:

Combination Drug Therapy= antibiotics to kill the H. pylori along with acid-suppressing medication(i.e., ulcers are curable!).

Peptic Ulcer Disease Rx:

Combination Drug Therapy= antibiotics to kill the H. pylori along with acid-suppressing medication(i.e., ulcers are curable!). Active UGIBs can often be cauterized during endoscopy.

Compressed vs. Transected cord:

Compressed→ Spinal cord remains intact but could be contused ("bruised") and swollen, thereby preventing conduction of nerve signals below the point of injury. Transected→ Spinal cord is completely severed.

INFLAMMATORYBOWELDISEASES(IBD)

Crohn's Disease and Ulcerative Colitis IBD is an "umbrella term" that includes Crohn's Disease (CD)and Ulcerative Colitis (UC)since both diseases produce bowel inflammation

A patient has been receiving 100% oxygen therapy by way of a nonrebreather mask for several days. He reports tingling in his fingers and shortness of breath. He is extremely restless and states that he has pain beneath his breastbone. Based on this history and assessment findings, the nurse should suspect: A. Hypercapnia resulting from decreased carbon dioxide elimination B. Oxygen-induced atelectasis C. Pleural effusion D. Increased pH

D -CORRECT ANSWER. The patient has increased pH due to over oxygenation and has s/s of respiratory alkalosis. (A. is incorrect -hypercapnia means retaining C02, not eliminating C02. B. Atelectasis is caused by alveolar collapse -not by retention of O2. C. Pleural effusion is a collection of fluid in the lungs usually due to infection or inflammation).

Which of the following signs and symptoms is most clearly suggestive of primary genital herpes in a male client? A) Presence of purulent, whitish discharge from the penis B) Emergence of hard, painless nodules on the shaft of the penis C) Production of cloudy, foul-smelling urine D)Itching, pain, and the emergence of pustules on the penis

D)Itching, pain, and the emergence of pustules on the penis

Which of the following actions could result in pressure ulcer formation by skin shearing? A. Rolling the client from a supine to side-lying position B. Applying powder to buttocks area when diaphoresis has become a problem C. Inserting a peripheral intravenous catheter D. Pulling a stroke client up in bed

D.

Diabetes Insipidus

DEFICIENCY of ADH = kidneys excrete large volumes of urine (polyuria) o Dehydration due to polyuria(low B/P, weak pulse, high Hct/Hgb) o Concentrated blood = HIGH SERUM osmolarity and HYPERNATREMIA o Polyuria = LOW URINE osmolarity& low specific gravity o At risk for HYPOVOLEMIC SHOCK

Acute Tubular Necrosis (ATN)

Damage to the tubule cells of the kidneys, which can then lead to acute kidney failure. Acute tubular necrosis (ATN) is usually caused by a lack of oxygen to the kidney tissues(ischemia of the kidneys). It may also occur if the kidney cells are damaged by a poison or harmful substance. ATN is one of the most common causes of ACUTE Kidney Injury (failure)in hospitalized patients. ATN is reversible in most people. The goal of treatment is to prevent life-threatening complications of acute kidney failure. Treatment focuses on preventing the excess buildup of fluids and wastes, while allowing the kidneys to heal. Patients should be watched closely for deterioration of kidney function.

Jaundice

Damaged liver cannot break down the bilirubin found in RBCs. The bilirubin deposits in the skin and sclera of the eyes -turning the skin and sclera "yellowish orange." Causes intense pruritis (itching).-Hemolysis of RBC's increases Bilirubin levels. -Obstruction of bile flow from liver increases reabsorption -Intrahepatic disease inhibits Bilirubin conjugation and excretion Jaundice -aka, "Icterus," S/S = Yellow orange sclera/skin, dark urine "coke syrup", light color stools "clay colored", anorexia, fatigue, pruritus

Acute Kidney Injury

Decreased blood flow(i.e. ATN) to the kidneys for 20 -30 minutes. This may occur from blood loss, surgery, cardiac arrestor shock. Obstruction or blockage along the urinary tract (triggers the inflammatory response of the body) or E. Coli infection of the kidney. Glomerulonephritis the glomeruli become inflamed due to development of large antigen-antibody immune complex molecules which impairs the kidney's ability to filter urine. Nephrotoxic medications cause damage to the kidneys that leads to Acute Renal Failure.

Hepatorenal syndrome

Decreased circulating blood volume leads to decreased renal perfusion triggering the renin-angiotensin system→ vasoconstriction and increased B/P 2-Hepatic failure prevents removal of excess Angiotensin so the process is not reversed and HTN gets worse.3-Following the kidney damage, less urine is removed from the body, so waste products that contain nitrogen build up in the bloodstream(azotemia). Prognosis is poor because renal failure is irreversible unless liver transplantation is performed. Overall, the mortality of patients with liver failure is substantially worse if they develop hepatorenal syndrome. Without therapy, most patients die within weeks of the onset of the renal impairment Na+ and H2O retention Oliguria Increased BUN and Creatinine levels

NEPHROTIC SYNDROME

Definition: Excretion of 3.5 gm or more of urinary protein per day NEPHROTIC SYNDROME is not a specific glomerular disease, but a constellation of clinical findings that result from an increase in glomerular permeability and loss of plasma proteins in the urine. Nephrotic syndrome allows molecules the size of a large protein to slip through -such as albumin -but will not allow anything larger (such as a red blood cell)to escape. Therefore, there is no hematuria present in this condition. The loss of protein in the urine cause slow serum albumin levels.

TREATMENT of chronic renal failure:

Depends on the degree of kidney function that remains. •Medications (to help with growth, prevent bone density loss, and/or to treat anemia) •Diuretic therapy or medications (to increase urine output) •Specific diet restrictions(protein is limited due to buildup of urea) •Dialysis •Kidney transplantation

S/S of spinal cord injury

Depends on type of spinal injury and location on the spinal column Cervical Spine Injury= quadriplegia(paralysis that results in the partial or total loss of use of all limbs and torso). Thoracic Spine Injury(T1 -T7)= paraplegia(impairment in motor or sensory function of the lower extremities). C1 -C3 injury: Requires mechanical ventilation of the patient

Ischemia

Deprivation of oxygen with reduced or interrupted blood flow

Kidney Failure and DIABETES:

Diabetes is the most common cause of kidney failure, accounting for nearly 44 percent of new cases. Even when diabetes is controlled, the disease can lead to chronic kidney disease and kidney failure. Kidney damage is caused by high blood glucose levels which triggers the INFLAMMATORY RESPONSE leading to blood vessel injury in the kidneys. The kidney's then do not receive adequate oxygen leading to chronic renal failure and the inability of the kidneys to filter blood. A prominent S/S that diabetes is damaging the kidney is the finding of protein in the urine(called "proteinuria" or "albuminuria.")

Chronic Renal Failure

Diabetes: High blood sugar damages blood vessels throughout the body, especially in the kidneys, which prevents filtration of waste products from the body. Hypertension-high blood pressure damages the kidney filters which then increases blood pressure even more. Nephrotic syndrome-a condition that has several different causes. Nephrotic syndrome is characterized by protein in the urine, low protein in the blood, high cholesterol levels, and tissue swelling. Chronic obstructions can cause urine backflow (hydronephrosis) and increased pressure in the kidney that lead to Chronic RF.

Chronic Renal Failure/chronic Kidney Disease(CKD) Causes:

Diabetes; chronic High B/P; birth abnormalities; Lupus; Polycystic Kidney Disease.

IBS Rx:

Dietary management is being focused on "FODMAP" foods that seem to cause hyperstimulation of the intestines (see video below). General diet recommendations are to eat smaller, more frequent meals, reduce fat content, avoid dairy/alcohol/caffeine, avoid gas producing foods); stress management; medications (laxatives or antidiarrheal medications as needed; Antidepressants).

Cholecystitis Rx

Dietary modification (a no-fat diet) Surgery-a laparoscopy procedure called a cholecystectomy or "Lap Chole"

Cholecystitis Rx:

Dietary modification (a no-fat diet), or Surgery-a laparoscopy procedure called a cholecystectomy or "Lap Chole" for short, if the gallbladder is not swollen/infected, otherwise will need to have a traditional gallbladder surgery.

3 calcium channel blockers

Diltiazem, verapamil, nifedipine

Herniation:

Displacement of brain tissue towards the other side of the brain which increases pressure on the non-injured side. The further the brain tissue has herniated "passed midline" the worse the prognosis.

TYPES of Ulcers

Duodenal Gastric Stress

Atelectasis S/S

Dyspnea, chest pain or cough.

Broken kidneys cannot filter or excrete fluid, so the primary s/s of kidney damage is

EDEMA

Emphysema info

Emphysema PERMANENT damage to the lung as a result of the inflammatory process. Abnormal [and permanent] enlargement of the airways accompanied by destruction of alveolar walls without obvious fibrosis. The lungs lose their ability to recoil after each respiration. The characteristic sign of emphysema is the anatomical change in the patient's chest from oval to round("barrel chest") as a result of the body trying to adjust for the extra work of breathing (WOB).

Hematomas (blood clots)

Epidural Subdural Intracerebral

Peptic Ulcer Disease (PUD) S/S

Epigastric(substernal) or chest pain (dull, achy, or sharp) that starts about 2 hours after eating or in the middle of the night after the stomach has emptied. Dangers of peptic ulcers are anemia, profuse bleeding, and stomach cancer.

Peptic Ulcer Disease S/S:

Epigastric(substernal) or chest pain (dull, achy, or sharp) that starts about 2 hours after eating or in the middle of the night after the stomach has emptied. PUD pain is often relieved by eating. Ulcers may self-resolve or worsen to the point of causing internal bleeding (UGIB -upper gastrointestinal bleeding) or stomach/duodenal perforation. Ulcers are a common finding in patients who have unexplained low hematocrit/hemoglobin. Dangers of peptic ulcers are anemia, profuse bleeding, and stomach cancer.

Peptic Ulcer Disease (PUD)

Erosion of the stomach lining. The bacteria Helicobacter pylori(H. pylori)are present

Make Erythropoietin

Erythropoietin signals the bone marrow to create Red Blood Cells (RBCs). Without Erythropoietin, the body would not be able to make new RBCs which would lead to ANEMIA, and anemia leads to fatigue and s/s of hypoxia.

causes about 85% of acute bladder and kidney infections

Escherichia coli

Detoxes:

Especially ETOH (med-speak for "ethyl alcohol") and drugs

Cholecystitis(Gallbladder)

Etiology: Associated with cholelithiasis(gallbladder stones composed of cholesterol and bile)and may be "superimposed" on chronic Cholecystitis(inflammation of the gallbladder).In the majority of cases, acute cholecystitis is caused by gallstones or biliary sludge getting trapped at the gallbladder's opening. Can also be caused by infection, injury, or tumor.

Polycystic Ovary Syndrome

Etiology: Endocrine disorder (excess LH compared to FSH) -possibly genetic. No cure at present time. Affects 1 in 10 women Pathophysiology: Unbalanced hormones lead to ovulation and menstrual irregularities that cause polycystic ovaries to develop. Lack of progesterone may predispose women to increased CA risk. Leading cause of female infertility! S/S:As a result of endocrine disorder, the client with polycystic ovary syndrome will likely exhibit •Male pattern baldness(due to higher level of male hormones)•Metabolic syndrome with insulin resistance(and subsequent obesity)•Irregular menstrual cycles Rx: Relief of symptoms; hormone replacement(birth control pills); Anti-androgen drugs; antidiabetic drug(such as Metformin to treat insulin resistance);Laparoscopic Ovarian Drilling procedure (see PCOS video above).

Epididymitis

Etiology: Inflammation of the epididymis secondary to UTI or STD Incidence: < 35 years old = STD; > 35 years old= UTI Pathophysiology: pathogen ascension from urethra or bladder →inflammation. Risk factors include sexual activity, heavy physical exertion, and bicycle/motorcycle riding. S/S: acute scrotal/inguinal pain, urethral discharge, dysuria Rx: antibiotics, scrotal support[NOTE: elevation of scrotum RELIEVES PAIN-see Prehn sign below*]*Prehn sign: When checking for the Prehn sign during an examination, the affected scrotum is elevated. This action relieves the pain of epididymitis but exacerbates the pain of torsion (positive Prehn sign). The elevation takes the weight of the testis off the epididymal suspension.

Diabetes Insipidus [D.I.] **(MEMORY AID: "Dry Inside")

Etiology: Inflammatory, Autoimmune, or vascular diseases; Head injury/brain surgery, etc. Patho: Increased volumes of dilute urine →increased SERUM osmolarity→ dehydration S/S:-Dilute Urine(specific gravity<1.005) (decreased URINE osmolarity)-Polyuria (>200 mL/hr),-Hypernatremia-Excess Thirst Tx: Medication and ISOTONIC fluid replacement to reverse dehydration(possibly hypotonic if tissue dehydration is severe

Tuberculosis etiology

Etiology: M. tuberculosis infects macrophages that attack and consume the TB. The TB bacteria are not destroyed by the macrophage enzymes, so TB remains in the macrophage. However, the macrophage still triggers a cell-mediated response(inflammatory response...sound familiar?)Ghon Complexes form around the macrophage which eventually heals, shrinks, scars over, and calcifies. These "cavitations" can be seen on an x-ray. They take up space in the lung and impair breathing. Small numbers of organisms may remain viable for years. Later if immune mechanisms decline or fail, latent TB can develop into secondary TB.

Benign Prostatic Hypertrophy or hyperplasia

Etiology: Nonmalignant enlargement of prostate. Age-related but otherwise unknown etiology. Incidence: 70% in 60-70 year old range and 80% of 70+ year old males. United States has highest incidents. Pathophysiology: diminished hormone →glandular cells hypertrophy→ urethral obstruction S/S:(Similar to a UTI)-Incomplete emptying of the bladder, straining to void, frequency, urgency, weak/decreased urine stream, incontinence, nocturia (waking up at night to void).Urine retention and backflow up the ureters can lead to kidney failure. Can give a false-positive PSA test [Prostate Specific Antigen test for prostate CA]. Rx: Temporary tx is urinary catheterization(to remove retained urine from bladder). Surgical intervention can cause impotence [during transurethral resection of the prostate (TURP), an instrument is inserted up the urethra to remove the section of the prostate that is blocking urine flow].

Tricomoniasis

Etiology: Protozoa(Trichomonas vaginalis) Incidence: Anyone, but greater with multiple sexual partners. Pathophysiology: Parasitic infection. 3rdmost commonly reported STD. Can also be transmitted via fomites (like swimming pools and hot tubs). Infection with "Trich" makes it easier to get infected with other STD pathogens. S/S: Frequently asymptomatic in men. In women there is a thick, foamy, or frothy, foul-smelling green discharge, burning pain with urination and/ or itching. "Strawberry cervix" are pinpoint areas of hemorrhaging on the cervix and vaginal wall that can be diagnostic for Trichomonas which can be seen via colposcopy. Rx: Antiprotozoal medication

Endometriosis

Etiology: Unknown cause. Growth of endometrial (uterine) tissue outside of the uterus such as on the ovaries, bowels, or bladder. Pathophysiology: Endometrial tissue goes through the same cycles that the uterus does, including bleeding. Bleeding from the endometriosis goes into the surrounding tissue and causes pain as well as significant pelvic adhesions. Adhesions can cause obstruction, constrictions, or distortions of pelvic/abdominal organs that can cause bowel blockages (pain on defecation), bladder constrictions (dysuria), and infertility (blockage or malformation of fallopian tubes. S/S: May be asymptomatic or cause severe, debilitating pain. Rx: pain meds; ESTROGEN suppressing drugs; surgery to remove endometriosis lesions; total hysterectomy and removal of fallopian tubes and ovaries.

Human papillomavirus

Etiology: Virus (over 150 different types of HPV). In most cases, HPV goes away on its own and does not cause any health problems in 1-2 years. However, virtually all cases of cervical cancer are caused by HPV, and just two HPV types, 16 and 18, are responsible for about 70% of all cases. The Centers for Disease Control and Prevention (CDC) estimates that more than 90% and 80%, respectively, of sexually active men and women will be infected with at least one type of HPV at some point in their lives. Around one-half of these infections are with a high-risk HPV type. •HPV Pathophysiology: Virus is spread by having vaginal, anal, or oral sex with someone who has the virus. There is no direct test for HPV. •HPV S/S: Possibly genital warts, or evidence of cervical cancer (positive Pap smear), or cancer of the throat, penis or anus. •HPV Rx: HPV vaccination for males and females(series of 2 -3injections over 6 months)

Skin Cancer

Etiology: all skin cancers are related to excessive sunlight exposure. Incidence is higher among fair-skinned individuals with high UV exposure(including tanning beds).Skin CA generally originates from nevi (moles), so it is important to teach patients how to do self-inspection. S/S: See "ABCDE's" of Mole Assessment (next page). Dx/Rx: Biopsy of lesion (to determine type of cancer)and surgical removal.

Grave's disease/hyperthyroidism

Etiology: autoimmune abnormalities (IgG) called Grave's Disease(most common cause);benign tumors; thyroiditis (thyroid inflammation). ➢Incidence: less common than hypothyroidism; 20-40 year olds, women (5:1). ➢Patho: Excess excretion of T4 and T3 ➢S/S: Weight loss, heart irregularity/tachycardia, heat intolerance, diarrhea, hypermetabolism, Restless, irritability, anxiety wakefulness, Sore muscles, exophthalmos(PERMANENT eye bulging), insomnia. Basal metabolic-Increased

Candidiasis (yeast infx)

Etiology: fungal (yeast) infection with Candida albicans. Vaginal yeast infections are one of the most frequent reasons that women visit a doctor. Incidence: anyone; greater with the following risk factors: antibiotic use (antibiotics destroy the normal bacteria that keep yeast under control), pregnancy (2ry to high hormone levels), uncontrolled diabetes (yeast loves the glucose!), or compromised immune system (HIV patients, chronically ill patients); can be but is not usually transmitted sexually unless through oral sex. Pathophysiology: candida normally lives in the mouth and intestines, as well as in the vaginas of healthy women. When the body's normal acidity doesn't control the growth of this fungus, an overgrowth can occur. Unfortunately, some couples transmit it back and forth in what can seem to be a never-ending cycle. S/S: thick white (creamy) or "clumpy" or "cottage-cheese looking" vaginal discharge, itching, redness, burning pain with urination, dyspareunia. Rx: antifungal medications and prevention

Scoliosis

Etiology: idiopathic, other bone disorders Incidence: female > male. Worsens dramatically with the puberty growth spurt! Pathophysiology: lateral deviation of spine →unilateral compression of vertebrae: Organs and soft tissues shorten and tighten on the compressed side of the body but stretch out and pull on structures in the opposite of the body. This is very damaging to heart/lungs in particular and will shorten the person's life span to about 40 years if not surgically corrected. S/S: unilateral hip or shoulder prominence, backaches, altered gait, and thoracic/abdominal contents uncomfortable because of compression. TX: Surgery with rods ("Harrington rods") to straighten the spine as much as possible and decompress internal organs. Major spinal surgery because so much of the spine (and corresponding spinal nerves) is exposed.

Cryptorchidism (undescended testicle)

Etiology: in utero developmental delay Incidence: 20%premature boys have undescended testicle(s); 75%-90% descend by age1.Pathophysiology: failure of testes to descend into scrotal sac. Risk of TESTICULAR cancer in the undescended testicle is 4 to 10 times higher than in the general population! Reduced fertility possibly due to length of time the testes were in the abdomen (rather than outside of the body in the scrotal sac where it is cooler) S/S: no testes palpable in scrotum. May do laparoscopy to confirm diagnosis since other imaging is not reliable. Rx: none(wait to see if the testicle descends spontaneously by age 1 to maximize fertility), or orchiopexy**Orchiopexy(or orchidopexy) is a surgery to move an undescended testicle into the scrotum and permanently fix it there. Orchiopexy also describes the surgery used to resolve testicular torsion.

Herpes

Etiology: viral infection with Herpes simplex 1(cold sores found around the mouth) or Herpes simplex 2 (genital herpes). NOTE: Both types (1 & 2) can be found together in either the mouth or genital area as a result of oral sex practices. The virus resides on nerve ganglia and migrates to the skin/mucosa surface when in active phase. Incidence: anyone, but having multiple sex partners increases the risk for contracting the virus. Pathophysiology: viral infection Transmission -by direct contact with active lesions or by virus-containing fluid such as saliva or cervical secretions so virus can be transmitted when there are no visible lesions or evidence of active disease; recurrence is common. Herpes can be passed on to babies during childbirth causing a potentially fatal disease in the baby. Occurs in three stages ◦Primary -initial outbreak of virus occurs as blisters ◦Latency -virus remains dormant in ganglia ◦Recurrent stage -virus is reactivated, travels along peripheral nerves to site of initial infection, causing characteristic symptoms

Urinary Tract Obstruction

Example: Kidney Stones (aka, Renal Calculi)

FILTERS BLOOD

Excretion of metabolic waste products, especially Protein by-products(creatinine, urea, ammonia) and many drugs.

The MULTI-TASKING kidneys have these six important functions.

FILTERS BLOOD BLOOD PRESSURE ACID-BASE BALANCE Make Erythropoietin Make and Release RENIN Activate Vitamin D

6 "F's" of Cholecystitis

Fair Fat Fertile Female Forties Family

RISK FACTORS for Cholecystitis are classically called the "SIX F's of Cholecystitis

Fair Fat Fertile Female Forties Family Hx

FES

Fat Embolism Syndrome occurs 1-3 days after fx-usually long bones or pelvis FES is a serious consequence of fat emboli producing a distinct pattern of clinical symptoms and signs (see Classic Triad below).A fat embolism occurs most commonly following a fracture of the pelvis, femur, or tibia and is more frequent in closed rather than open Fx. Multiple fractures (such as occur in major trauma events) are more likely to lead to fat embolism than single fractures. Since the incidence increases with the number of fractures involved, patients with a single long bone fracture have a 1-3% chance of developing the syndrome, but it has been reported in up to 33% of patients with bilateral femoral fractures. Fat embolism syndrome can also occur in relation to other trauma, for example, soft tissue injury, liposuction, and bone marrow harvest. Non-trauma-related causes (e.g. acute pancreatitis, sickling crisis) are less likely to lead to fat embolism syndrome compared with those associated with trauma. An overall mortality of 5-15% has been described.

DX testing:

Fecal occult blood test(stool smear) because cancerous polyps bleed a small amount that does not show in the stool but can be detected with this method); and colonoscopy(to locate, biopsy, and remove polyps).Colon screening should begin at age 50, or sooner with a family history and for patients in high risk groups. NOTE: New Treatment Standard: The United States Preventive Services Task Force recommends taking low-dose aspirin to prevent COLORECTAL CANCER.

6 kidney functions

Filters blood regulates blood pressure acid-base balance makes erythropoietin makes and releases renin activates vitamin D

Burn Classifications:

First degree-erythema, pain, epidermal destruction only (partial thickness). Heals quickly without scarring. The skin maintains its ability to function as a water vapor and bacterial barrier. Heals in 3-10 days. Example: Sunburn or an injury caused by briefly touching a hot pan, curling iron, etc. Second degree-involve both the epidermis and dermis and are red to pale ivory moist-looking skin, blisters within minutes, extreme pain because nerves are still intact. 3-4 weeks healing. Third degree-full thickness burns that extend through the subcutaneous tissue. This includes the nerve layer so there is no pain from the portion of the wound that is 3rddegree. Muscle/tendon/bone tissue may be involved.(Remember: All three degrees of burns are usually present with any burn injury).Results in major scarring. Skin grafting is usually required to replace dead tissue. May require ESCHAROTOMY(to relieve pressure from swollen tissue). At risk for compartment syndrome and/or joint contractures.

ARDS Development and Progression

First stage: Respiratory ALKALOSIS Intermediate stage: ACIDOSIS [Respiratory and Metabolic] Intermediate stage: PULMONARY EDEMA Intermediate state: BLOOD CLOTTING Late stage: RESPIRATORY FAILURE

** IMPORTANT concept to understand** Balancing Fluid Resuscitation

Fluid resuscitation is aimed at supporting the patient throughout the initial 24-hour to 48-hour period of hypovolemia. The critical concept in burn shock is that massive fluid shifts can occur even though total body water remains unchanged. Fluid replacement must be carefully monitored, however, because the HYPOVOLEMIC Phase can suddenly end and the HYPERVOLEMIC Phase begin -then the patient is at risk for consequences of over-resuscitation!** * Hypovolemic Phase: Even though the patient is edematous (and often unrecognizable after 24 hours of a serious burn due to massive edema), they are still DEHYDRADED due to fluid not being in the vasculature (blood vessels are low in fluid because fluid is trapped in the tissue. Fluid is trapped in the tissue because the plasma proteins are burned off and there is no "pulling power" to pull fluid out of the tissue back into the veins.) Hypervolemic Phase: Once the body starts to stabilize various body systems, the capillaries will no longer be "leaky" and the fluid shift out of the vessels will stop. At this point, the patient is at risk for developing FLUID OVERLOAD due to all the fluids given during the initial fluid resuscitation phase. NOTE: Electrolytes must also be given during fluid resuscitation to replace electrolytes lost out of the burned tissue and/or to prevent dilutional electrolyte imbalances.

Cerebrovascular infarction:

Focal brain necrosis due to complete and prolonged ischemia that affects all tissue elements (neurons, glia, and vessels). In every infarct, there is a central core of total ischemia and necrosis, which is irreversible.

Ascites

Free Fluid in the abdomen caused by two problems: #1-Portal hypertension increases capillary hydrostatic pressure("PUSHES" fluid out of vessels into the gut)and,#2 -damaged liver does not synthesize serum protein →decreased oncotic pressure (no protein in vessels to "PULL" the fluid out of the gut back into the veins).Abdominal distension, displaced diaphragm leading to dyspnea, peritonitis. Treatment: Paracentesis

Nursing Care for Head Injury and TBI:

Frequent assessment of LOC (using GCS). Keep patient's head elevated 30° to prevent increased intracranial pressure. (NOTE: an order that reads: "HOB ⬆ 30°" means "Keep the head of bed up 30 degrees"). Protect airway (suction equipment at the patient's bedside) due to vomiting.

Pancreatic Disease Rx:

GI rest(nothing by mouth or NG tube until condition is controlled because food causes the pancreas to try excreting digestive enzymes which increases the patient's pain. Primary goal is pain control and treat underlying cause(possibly with antibiotics).If patient is without food for a week, may consider giving nutrients via an IV.

Upper Gastrointestinal(UGI) tract

Gastroesophageal Reflux Disease(GERD) Hiatal Hernia Peptic Ulcer Disease (PUD)

Storage:

Glycogen[a "glucose package" -stored in the liver for release as needed by the body].

3 diuretics

HCTZ spironolactone-potassium sparing furosemide-potassium loss

Cholecystitis S/S

Hallmark Symptom: Pain IMMEDIATELY after eating S/S: PAIN-especially when eating food containing any fat. The duodenum signals the gallbladder when there is fat present so the GB will release bile into the intestine and begin breaking down the fat.

Cholecystitis s/s

Hallmark Symptom: Pain IMMEDIATELY after eating fatty food. Pain can mimic heart attack Light color or Clay-colored stools

Cushing's Disease

Have an extra 'cushion' of hormone Adrenal cortical HYPERsecretion S/S are the same as the side effects of Prednisone

Types of Muscle Weakness caused by Strokes

Hemiplegia Monoplegia Paralysis Diplegia/Paraplegia Tetraplegia/Quadriplegia

Viral Hepatitis: Signs &symptoms

Hepatitis is difficult to recognize and diagnose because S/S are so vague/nonspecific. Liver damage is often far advanced by the time the problem is diagnosed. ❑Can be either Acute or Chronic ❑Fatigue, weakness, loss of stamina ❑Nausea, vomiting, diarrhea, anorexia ❑Fever and flu-like symptoms ❑Dark colored urine ❑Jaundice of skin and sclera (aka, icterus) *❑Intense Pruritis due to icterus**These are the only s/s that are specific to liver disease

Hiatal Hernia S/S:

Hiatal hernias rarely causes/sunless GERD is present also(See GERD above -reflux, dysphagia, heartburn, epigastric pain). Just as with GERD, Hiatal Hernia pain can mimic a heart attack, so chest pain has to be carefully evaluated to rule out cardiac causes for any chest pain first before treating it as a GI problem.

Primary regulator or respiration

High C02, NOT oxygen

Fluid backup causes

High fluid volume "pushes" fluid into other organs and blood vessels -Esophageal varices -Hemorrhoids -Splenomegaly

*Compartment Syndrome

High pressure →vessel constriction and tissue necrosis

Pathophysiology of stone formation

High urine concentrations of stone forming substances precipitates into a crystal Alkaline urine increases aggregates of calcium phosphate Acid urine promotes crystallization of uric acid Stone growth in pelvis or calyces Risk of obstruction if stone > 5 mm

S/S of Cellulitis:

Hyperemia (increased flow of blood due to vasodilation causes engorgement or congestion of the tissue) →Erythema(redness), warmth, edema, pain (There's "SHARP" again!). May also have systemic s/s of fever, chills, malaise, and lymphadenopathy.

HHS [hyperglycemic hyperosmolar syndrome]

Hyperosmotic Hyperglycemic Nonketotic state [HHNK]) one of the two of the most serious acute complications of diabetes-the other being DKA. Both present with extremely HIGH blood sugar (hyperglycemia) more severe hyperglycemia but no ketoacidosis. High Risk: Type II diabetics Very old/very young Renal compromise Predisposing factors: Sepsis/MI/Pancreatitis Low perfusion →glycogen from liver→ hi blood sugar→ thick blood→ dehydration Presenting symptoms: Polyuria, polydipsia, TISSUE dehydration, N/V, SZs, coma NO Acidosis Laboratory Findings: -Extreme Hyperglycemia-NO ketones Treatment: 1. Rehydration -IV fluids (isotonic and hypOtonic fluids)2. IV Insulin3. Replace electrolytes as needed

Cushing's disease risk factors

Hyperplasia of adrenal gland

Kidney Failure and HYPERTENSION

Hypertension is the 2ndmost common cause of CRF and can be seen not only as a cause of kidney disease but also as a result of damage created by the disease. As kidney disease progresses, physical changes in the kidneys lead to increased blood pressure. Therefore, a dangerous spiral, involving rising blood pressure and factors that raise blood pressure occurs. Remember that ATHEROSCLEROSIS of blood vessels causes INFLAMMATION and HYPERTENSION.

UGB(upper GI bleed) and LGIB(lower GI Bleeds)

I can be either slow/chronic with minimal S/S or sudden and life-threatening. If, for instance, an ulcer perforates through the stomach lining, stomach acid will enter the peritoneal cavity causing sudden agonizing pain and a RIGID ABDOMEN. A perforated ulcer will cause sepsis and can progress to shock either due to loss of blood or systemic infection. On the other hand, it the ulcer bleeds slowly, the patient may experience fatigue and anemia without realizing there is an ulcer.

Ventilation:

If AIR FLOWis disrupted it is a Ventilation Problem.

Perfusion:

If BLOOD FLOW is disrupted, it is a Perfusion Problem.

Long-Term Effects of ARDS:

If patients survive, they will have PERMANENT lung damage, as well as psychological and cognitive impairment due to the brain being deprived of adequate oxygen.

Colorectal Cancer S/S

In its early stage, it usually doesn't have symptoms, so having a screening test is important to find early stage (and curable) colon CA. Later stages of colon CA may have these s/s:➢Changes in bowel movements, including constipation or diarrhea that don't seem to go away➢ Feeling like can't empty bowels completely or urgently need to have a bowel movement➢ Rectal bleeding or cramping ➢Dark patches of blood in or on stool ;or long, thin, "pencil stools"➢ Abdominal discomfort or bloating ➢Unexplained fatigue, loss of appetite, and weight loss➢ Pelvic pain, which can happen in the later stages of the disease

PATHOPHYSIOLOGY & MANIFESTATIONS of Nephrotic Syndrome

Increased glomerular membrane permeability to protein →proteinuria ▪Loss of plasma proteins: Hypoalbuminemia →decreased oncotic pressure →full body Edema and fluid overload in the lungs/heart/brain ▪Loss of immunoglobins →increased susceptibility to infection ▪Loss of specific transporter proteins (E.g. Decreased transport of vitamin D3 →decreased calcium absorption)▪Hyperlipidemia: increased hepatic synthesis of lipids combined with decreased albumin levels ▪Increased LDL & VLDL →increased risk of atherosclerosis ▪Lipiduria (fats in the urine)

Polyuria

Increased urine output -could be due to a pathologic condition (such as diabetes)or just increased fluid intake. In either case, the kidneys are not damaged!

Decorticate Posturing

Indicates a lesion in the cerebral hemispheres/midbrain Indicates that there may be damage to the cerebral hemispheres, and possibly midbrain. An ominous sign of severe brain damage but not as bad as decerebrate posturing. (Limbs "Point to the Core" of the body).

*Osteomyelitis

Infection of the bone

Meningitis Pathophysiology:

Infection of the meninges/spinal fluid/ventricles(droplet precautions-one of the "M's" in "MR PIMP").Cerebral Spinal Fluid (CSF)and ventricles become inflamed leading to obstruction of CSF flow, edema of infected tissues, and potential ischemia due to increased ICP.

Pyelonephritis

Infection reaches the kidney! Affects the tubules, interstitium, and pelvis of the kidney. A potentially organ-and/or life-threatening infection that often leads to renal scarring. Bacteria usually reach the kidney by ascending from the lower urinary tract but may also reach the kidney via the bloodstream. Causes-cystitis(UTI's), urinary tract obstruction with reflux infection with E. coli, proteus, or pseudomonas Epidemiology-FEMALES are5timesmore likely to develop acute pyelonephritis

Pleuritis/Pleurisy

Inflammation of the lining of the lungs and chest (the pleura) that causes chest pain when taking a breath or coughing. The normally smooth surfaces lining the lung (the pleura) become rough. They rub together with each breath resulting in a rough, grating sound called a friction rub.

Stage I pressure ulcer

Intact skin with signs of impending ulceration, initially presenting non-blanchable erythema(redness)indicating reactive hyperemia

Complications of Ulcerative Colitis:

Intestinal obstruction Dehydration, Fluid, and electrolyte imbalances Malabsorption, Iron deficiency anemia Chronic bloody diarrhea mixed with mucus Weight loss Abdominal cramping and pain Nausea vomiting and the urge to defecate Acute complications = hemorrhage, toxic megacolon*and possible colon perforation. HIGH RISK FOR COLORECTAL CANCER due to development of dysplasia. Requires frequent colonoscopy screening.

Complications of Ulcerative Colitis:

Intestinal obstruction Dehydration, Fluid, and electrolyte imbalances Malabsorption, Iron deficiency anemiaChronic bloody diarrhea mixed with mucus Weight loss Abdominal cramping and pain Nausea vomiting and the urge to defecate Acute complications = hemorrhage, toxic megacolon*and possible colon perforation. HIGH RISK FOR COLORECTAL CANCER due to development of dysplasia. Requires frequent colonoscopy screening.

Lower Gastrointestinal tract

Irritable Bowel Syndrome (IBS) Crohn's Disease Ulcerative Colitis Cirrhosis

Cerebrovascular Accidents(CVA, Brain Attack, or Stroke)

Ischemic (Thrombotic} Embolic Hemorrhagic

Aphasia can be caused by a CVA.

It is the loss of comprehension or production of language that impairs the patient's ability to communicate. 1-Expressive Aphasia: Patient understands what is being said to them but cannot speak (or "express" themselves) coherently. 2-Receptive Aphasia: Patient can speak coherently but does not understand (is not "receiving") what is being said to them.

*Rheumatoid Arthritis

Joint pain at rest

*Osteoarthritis

Joint pain with movement

Why Splint a Fracture?

Keep a CLOSED Fx from becoming an OPEN Fx o Can reduce pain (relieves muscle spasm) o Prevents further injury to soft tissue o Protects injured limb during transport/transfer

S/S of renal problems

Kidney = flank pain Ureters = radiating pain from flank to groin Bladder & Urethra = suprapubic and groin pain

1st indicator of hypoxemia/hypoxia

LOC

Airway

Larynx, trachea, and large bronchus

Left and right heart failure

Left: •Exertional and nocturnal dyspnea •Hemoptysis(blood tinged sputum)•Orthopnea Cough •Cyanosis •Elevated pulmonary capillary pressure/edema S/S of Respiratory Distress Right: Fatigue(2ry to ↓ blood/O2perfusion) Distended jugular veins(neck)Enlarged Liver and spleen Ascites, GI disturbances Elevated BNP Dependent edemas/s of EDEMA

CROHN'S DISEASE

Lesions in large and small bowel, "skip" lesions are common, affects entire bowel wall thickness Anal / Perianal fistulas : Common (may require a colostomy) Tx : Steroids/"Mab" drugs. Surgery to remove portions of nonfunctioning colon is common

Ulcerative Colitis

Lesions only occur in the colon →chronic dehydration(⬇water reabsorption)and malnutrition-Ulcerative lesions only involve the mucosal layer

*Fat Embolism

Lipids enter blood stream →lungs →dyspnea

ULCERATIVE COLITIS

Location of lesions : Large Intestine only, no "skip" lesions, affects mucosal layer only Bloody stools : Common Treatment Steroids & "-mab" drugs; possibly surgery

S/S of Head Injury and TBI:

Loss of consciousness, headache, vomiting, drowsy, confusion, seizure, drowsiness, restlessness, agitation, LOC changes, contralateral hemiplegia, ICP, signs of herniation. Check fluid draining from ears and/or nose with a glucometer for the presence of glucose (cerebral spinal fluid)which indicates skull fracture. Ecchymosis around the eyes ("raccoon eyes") or behind the ears ("battle sign") are also signs of a basilar skull fracture. Points to Remember 1.H.I. can result from a ground level fall, especially in the elderly2.Assume "C-SPINE INJURY" will occur with any H.I. (do not move injured person!)

Hypovolemic Shock

Low blood volume

Symptoms of lung cancer

Lung cancer does not produce S/S until well advanced[has metastasized to distant parts of the body]which makes it more difficult to treat. As lung cancer stages advance, lung cancer symptoms include coughing that is unrelieved with cough medicine, wheezing, shortness of breath, dyspnea, and bloody sputum (hemoptysis). If the disease is far advanced, patients may experience unaccountable weight loss(cachexia) and various other common symptoms of lung cancer. The diagnosis is confirmed through a tissue biopsy.

First stage: Respiratory ALKALOSIS

Lungs initially try to compensate for hypoxia by breathing faster(tachypnea which will cause HYPERVENTILATION). This will result in RESPIRATORY ALKALOSIS to begin with because CO2(an acid) is being removed from the body.

ACUTE Renal Failure/Acute Kidney Injury CAUSES:

May include, but are not limited to blood loss, burns, trauma, sepsis, nephrotoxic drugs, ATN, glomerulonephritis and pyelonephritis.

Rx for osteoporosis

Medication that slows the rate of bone loss(Alendronate -"Fosamax").

lower G.I. bleed

Melena, occult blood, hematochezia

S/S of Alzheimer's

Mental changes begin with "Recent Memory" loss then progress to "Remote Memory" loss. Signs of mental damage precede the physical signs of illness progression. Most common s/s include: ▪Cognitive: mental decline, difficulty thinking and understanding, mental confusion, disorientation, delusion, inability to create new memories, inability to recognize common things, inability to do simple math, difficulty concentrating, making things up, confusion in the evening hours, or forgetfulness. ▪Behavioral: agitation, lack of restraint, meaningless repetition of own words, irritability, personality changes, aggression, difficulty with self-care, or wandering and getting lost. ▪Mood: loneliness, anger, apathy, mood swings, or general discontent. ▪Psychological: paranoia, hallucination, or depression ▪Also common: restlessness, behavioral s/s, loss of appetite, inability to combine muscle movements, or jumbled speech.

IBS and Mental Health Problems:

Mental health or psychological problems such as panic disorder, anxiety, depression, and post-traumatic stress disorder are common in people with IBS. The link between these disorders and development of IBS is unclear. GI disorders, including IBS, are often found in people who have reported past physical or sexual abuse. Researchers believe people who have been abused tend to express psychological stress through physical symptoms.

Diagnostic Criteria for Rheumatoid Arthritis (RA)

Morning stiffness lasting for at least 1 hour and persisting for over 6 weeks Arthritis with swelling of 3 or more jointsRheumatoid nodules (firm, non-tender subcutaneous masses found over pressure areas) Positive serum rheumatoid factor(RF level) Characteristic radiologic changes (erosions or decalcifications) noted in hands and wrists

Basal cell Carcinoma:

Most Common-Least Lethal. BCCs often look like open sores, red patches, pink growths, shiny bumps, or scars and are usually caused by a combination of cumulative and intense, occasional sun exposure. Rarely metastasizes. A persistent, non--healing sore is a very common sign of an early BCC. Can be an open sore that bleeds, oozes, or crusts and remains open for a few weeks, only to heal up and then bleed again.

Cause of lung cancer

Most cases of bronchogenic carcinoma occur in smokers. Heavy smokers have a 20 times' greater chance of developing lung cancer than nonsmokers, however, nonsmokers can get lung cancer. Passive smoking is also an established risk factor for the development of lung cancer. Research has shown that non-smokers who reside with a smoker have a 24% increase in risk for developing lung cancer when compared with other non-smokers. Cancer can also be caused by exposure to air pollution or radon gas.

Rectal CA Pathophysiology:

Most colorectal cancers begin as a growth called a polyp on the inner lining of the colon or rectum. Some types of polyps can change into cancer over the course of several years, but not all polyps become cancer. The chance of changing into a cancer depends on the kind of polyp.

Diabetes and kidney disease

Most common cause of kidney failure, polyuria, proteinuria

Pancreatitis s/s

N/V, severe pain, must keep NPO

Anuria

NO urine production (kidney failure)

Risk factors for Stroke -Brain Attack:

NON-Modifiable Risk Factors: Genetics. Having a family history of strokeAge. Being 55 or over Gender. Slightly more than half of all strokes occur in men, but more than 60% of stroke deaths occur in women, possibly because women tend to be older when they have strokes Race. Black and Hispanic Medical history. Having had a prior stroke, TIA(see Transient Ischemic Attack on next page), or heart attack** * * * * * * * * * * * Modifiable Risk Factors: ❖High blood pressure-most important controllable risk factor ❖Smoking ❖Atherosclerosis narrowing /stiffening of the arteries from plaque ❖Diabetes ❖Atrial fibrillation(causes clots to form in the heart)❖High cholesterol levels ❖Overweight-especially abdominal fat** ❖Lack of exercise ❖Overconsumption of alcohol ❖Use of cocaine or amphetamines ❖Vasculitis (inflamed blood vessels) ❖Birth control pills

Acute Bronchitis

NOT a COPD) causes the hacking cough and phlegm production that sometimes accompanies an upper respiratory infection. In most cases, the infection is viral in origin, but sometimes it's caused by bacteria. The mucus membrane should return to normal after resolution of the initial lung infection, which usually lasts for several days.

Irritable Bowel Syndrome (IBS) S/S

No G.I. damage, psych, some s/s of inflam. bowel disease at least three times a month for the last 3 months altered bowel function w/o GI damage, and varying complaints of flatulence, bloating, nausea, anorexia, constipation or diarrhea

Concussion

No gross pathology. Possible transient loss of consciousness. CT scan is normal. Post-concussion syndromes/s are headaches and memory lapses.

Concussion:

No gross pathology. Possible transient loss of consciousness. CT scan is normal. Post-concussion syndromes/s are headaches and memory lapses.

Anuria

No urine production (kidney failure)

Immunological changes due to burns

Non-specific down regulation of the immune response occurs, affecting both cell mediated and humoral pathways→ patients become immunocompromised. Patients are therefore more prone to infections(skin and systemic infections) due to open wounds and poorly functioning immune system.

Ventilation can be too fast (hyperventilation) for the exchange of gases to take place between the alveoli sac and the surrounding capillary.

OR, oxygen gets into the alveoli, but carbon dioxide cannot get out due to constricted airways as in asthma. OR, Air gets into the alveoli, but cannot get into the blood due to the buildup of fluid, mucous, inflammation in the alveoli as in asthma, pneumonia, tumors, obstructions, etc.

Portal hypertension

Obstructed flow in liver causes backup of fluid in Portal Veins →vein & organ engorgement. Most often due to cirrhosis. Increased vein pressure causes fluid to back up into vital organs causing those organs to stop functioning (i.e., splenomegaly). Portal HTN also causes the veins in the esophagus to engorge with blood, causing the veins to distend (esophageal varices) and possibly to burst -Bright red blood vomit (hematemesis)is a sign this has happened -Emergency action necessary. Pressure in the portal vein forces fluid out of the vein into the abdomen which contributes to ascites. Esophageal / stomach varices, splenomegaly, ascites, hemorrhoids

Herniation

One side of brain moves toward the other side due to swelling Displacement of brain tissue towards the other side of the brain which increases pressure on the non-injured side. The further the brain tissue has herniated "passed midline" the worse the prognosis.

Hepatitis A

Oral-fecal(food borne)-most common type of Hepatitis in the US. Havrix vaccine* (must be given 3 weeks prior to exposure);IgG immunoglobulin is given after an exposure to unvaccinated patient. Hepatitis A is spread from person to person via fecal contamination because the virus is present in the stool. It is spread via contaminated food or water by an infected person who gets small amounts of stool on his or her hands, does not wash his or her hands, and passes the stool onto food that is eaten by others. An example of this is outbreaks of hepatitis A in daycare centers for young children when employees don't wash their hands after changing diapers, and they then pass the viruses to the next child they feed.

6 P's of dyspnea

P- Pulmonary Bronchial Constriction P- Possible Foreign Body P- Pulmonary Embolus P- Pneumothorax P- Pump Failure P- Pneumonia

Cholecystitis s/s:

PAIN especially after eating food with fat (this is different than ulcer pain that is relieved with eating food. Pain can mimic a heart attack. Light/clay colored stools

S/S of Compartment Syndrome to check for:

PAIN is 1stand MOST IMPORTANT symptom. No amount of pain medication relieves the pain. A very concerning sign is pain that occurs with active or passive stretch (positive Homan's Sign).Recall that this condition is one of the 5 exceptions when Pain is considered PHYSICAL (takes higher priority) and not PSYCHSOCIAL(any kind of pain that is not sudden and/or severe must wait until all the patient's physical needs are met first).Eventually, the severe burning and stinging type pain gives way to numbness and loss of function from the muscle infarct. Increased pain and numbness or tingling(paresthesia) are the EARLY SIGNS. Decreased pulses or capillary refill, decrease in temp (cold) and color changes (pale or cyanotic)are LATE signs. Paralysis of the limb is the LAST sign.

Chronic Renal Failure/chronic Kidney Disease(CKD)

PERMANENT KIDNEY FAILURE

Pelvic Inflammatory Disease

PID is an infection and inflammation of the uterus, ovaries, and other female reproductive organs which causes scarring in these organs. This can lead to infertility, ectopic pregnancy, pelvic pain, abscesses, and other serious problems. PID is the most common preventable cause of infertility in the United States. Etiology: Gonorrhea and chlamydia, are the most common causes of PID. Women are at greater risk if they are sexually active and younger than 25; or have more than one sex partner. S/s-pain in the lower abdomen, fever, smelly vaginal discharge, irregular bleeding, and pain during intercourse or urination. Doctors diagnose PID with a physical exam, lab tests, and imaging tests. Antibiotics can cure PID. Early treatment is important. Waiting too long increases the risk of infertility.

Pancreatic Disease S/S:

PPPPAAAAIIIINNNN!!!!Especially epigastric pain, fever, leukocytosis, nausea and vomiting, abdominal distention, increased bowel sounds, hypotension,and shock(look up "WHY" in textbook).Can mimic a heart attack, so it is necessary to rule out cardiac causes for pain (just like for GERD and Ulcers, etc.) because the pancreas is so near to the heart.

Nephrotic Syndrome→

PROTEIN LOSS (what does low protein do to the body?)

Nephrotic syndrome

PROTEIN LOSS through kidney-high cholesterol, permeability of the glomerular pores

GERD S/S:

Pain is worse when lying down or bending over. Patients will complain of having to sleep in a recliner or with the head of the bed elevated to relieve the pain. NOTE: This pain can mimic a heart attack because the stomach is so close to the heart -or -patients with heart problems tell themselves they are just "having heartburn" and delay going to the ER for a cardiac workup.(Teach patients not to assume their chest pain is heartburn!). Also could develop respiratory S/S due to gastric reflux entering larynx.

A defining characteristic of IBS is

Pain that is relieved by defecation (having a bowel movement)

Embolic

Patho: Emboli break off from thrombi in the aorta or carotids S/S: Acute onset, often moderate HA, occasional brief LOC, no Hx TIA's Rx: -anticoagulants-eliminate cause

Embolic stroke

Patho: Emboli break off from thrombi in the aorta or carotids S/S: Acute onset, often moderate HA, occasional brief LOC, no Hx TIA's Rx: -anticoagulants-eliminate cause

Hemorrhagic

Patho: Hypertension, aneurysm, or ruptured vessels S/S: Acute onset, severe HA, + stiff neck, + LOC, + blood in Cerebral Spinal Fluid Rx: Stop bleed, decrease ICP & vasospasm(NO ANTICOAGS)

Hemorrhagic stroke

Patho: Hypertension, aneurysm, or ruptured vessels S/S: Acute onset, severe HA, + stiff neck, + LOC, + blood in Cerebral Spinal Fluid Rx: Stop bleed, decrease ICP & vasospasm(NO ANTICOAGS)

Ischemic (Thrombotic} CVA/stroke

Patho: Thrombi cause arterial occlusion(narrows blood vessel)= MOST COMMON S/S: Acute onset (hrs to days), occasional HA, no LOC, + Hx*TIA's Rx: Decrease edema and ICP

Ischemic (Thrombotic} stroke

Patho: Thrombi cause arterial occlusion(narrows blood vessel)= MOST COMMON S/S: Acute onset (hrs to days), occasional HA, no LOC, + Hx*TIA's Rx: Decrease edema and ICP

Peptic Ulcer Disease (PUD)

Pathophysiology: Erosion of the stomach lining. The bacteria Helicobacter pylori(H. pylori)are present in more than 90% of duodenal ulcers and about 80% of stomach ulcers. Stress Ulcers are common in hospitalized patients:-Develop due to burn trauma; head injuries; critically ill patients.-Multifactorial cause but shock is a known cause (low blood perfusion to stomach).-Treated with PPI (proton-pump inhibitor drugs), i.e., I.V. pantoprazole [Protonix].

Irritable Bowel Syndrome (IBS)

Pathophysiology: IBS is considered a "functional gastrointestinal (GI) disorder", meaning symptoms are caused by changes in how the GI tract works; but without damage to the GI tract(as does occur with Ulcerative Colitis and Crohn's Disease). IBS is a group of symptoms that occur together, not a disease. In the past, IBS was called colitis, mucous colitis, spastic colon, nervous colon, and spastic bowel. The disorder has both physical and mental causes.

Pancreatic disease (Pancreatitis)

Pathophysiology: Injury or obstruction of pancreas causing digestive enzymes to leak into pancreatic tissue --> auto-digestion of tissue OR formation of cysts. PRIMARY CAUSE IS ALCOHOL ABUSE, followed by blockages caused by gallstones. •Alcohol abuse-ETOH stimulates pancreatic enzymes and causes obstruction of pancreatic duct/sphincter. •Gallstones-get into common bile duct and block pancreas excretion.

Hiatal Hernia

Pathophysiology: Protrusion of the upper part of the stomach through the diaphragm into the thorax causing congestion of blood flow and ischemia. This pressure weakens the opening that the esophagus enters through the diaphragm at the "hiatus" of the stomach -which gives the name "Hiatal" hernia(HH).The exact cause of hiatal hernias is unknown. The condition may be due to a weakening of the supporting tissue which allows the diaphragm ring to widen and allow stomach tissue to rise up through it.

Mnemonic to Remember Liver Functions:

People Drink So Much Produces ABC: Albumin, Bile, & Coagulation Factors Detoxes Storage Metabolism

HI RISK POPULATIONS for TB

People from underdeveloped countries; High density living conditions (correctional facilities, long-term care, homeless shelters); Immunocompromised (HIV, diabetes, kidney disease, cancers, steroid use, etc.); Children <4 years old.

Stress

Persons with severe stress or trauma(hospitalized patients)* Both genders Increased stress factors Increased hyperacidity Increased use of ETOH, ASA, NSAID's Acute and common associated gastritis Bacterial infection : not a factor Pain : Asymptomatic until hemorrhage or perforation Hemorrhage : Very Common

Meningism s/s

Photophobia is the intolerance of bright light Nuchal rigidity is the inability to flex the neck forward due to rigidity of the neck muscles; if flexion of the neck is painful but full range of motion is present, nuchal rigidity is absent. Opisthotonus is a type of spasm of the whole body that leads to legs and head being bent back and body bowed backwards. Can occur in some types of meningitis, tetanus, strychnine poisoning. Kernig's sign is positive when the thigh is bent at the hip and knee at 90-degreeangles, and subsequent extension in the knee is painful (leading to resistance).This may indicate subarachnoid hemorrhage or meningitis. Brudzinski's neck sign is the appearance of involuntary lifting of the legs when lifting a patient's head while the patient is lying supine.

Intermediate state: BLOOD CLOTTING

Platelets respond to the inflammation and tissue damage by making micro clots throughout the lung tissue. This adds to the problem by blocking perfusion, which in turn leads to worsening hypoxia.

Difference between EFFUSION and EDEMA

Pleural Effusion-Fluid in the Pleural cavity which can be drained out via thoracentesis. -Pulmonary edema-swelling of the interstitial lung tissue -Cannot be drained out.

NOTE: In your future nursing education you may be asked to add additional "P's":

Polar-Cool compared to other limb (indicating an arterial blockage or lack of perfusion), aka, Poikilothermia. Pressure-Compartment pressure measurements in Compartment Syndrome Position-If the patient is in a traction device, are they positioned correctly to maintain bone alignment?

Chronic Renal Failure/chronic Kidney Disease(CKD) S/S:

Poor appetite, Vomiting o Bone pain o Headache(cerebral edema due to Na+ imbalance) o Stunted growth in kids o High urine output (Diuresis phase) or no urine output (Oliguric phase) o Recurrent urinary tract infections o Urinary incontinence o Pale skin (anemia) Full body edema(due to fluid retention) •Bleeding tendencies (due to coagulopathies) •Poor muscle tone •Change in mental alertness(Na+ imbalance) •Labs = High BUN and creatine •Electrolyte imbalances(sodium loss and potassium retention) in oliguric phase •Detectable abdominal mass

Clinical Manifestations of Liver Disease/Failure

Portal hypertension Ascites Hepatic Encephalopathy Jaundice Hepatorenal syndrome

Testicular Torsion

Potential Urologic EMERGENCY Etiology: Twisting of the spermatic cord that suspends the testis [testis=singular, testes=plural].Incidence: Increased in neonates and adolescents. Spontaneous onset, especially for boys entering puberty during periods of testicular growth. Pathophysiology: inadequate attachment of testes to tunica vaginalis →spermatic cord twists →ischemia and loss of the testis. S/S: extreme testicular pain (sudden onset), scrotal edema, nausea/vomiting. Cremasteric reflex is absent[natural reflex causes the testicles to retract when the skin of the inner thigh is stroked]. Rx: manual or surgical reduction within 6 hours to save the testis. [NOTE: elevation of the scrotum INCREASES PAIN-see Prehn sign below*]

Actinic Keratosis (Solar Keratosis):

Precancerous Skin Lesions Small, scaly patches that are caused by too much sun. Commonly occur on the head, neck, or hands, but can be found elsewhere. Can be an early warning sign of skin cancer. Most keratosis lesions do not become cancerous, but it is recommended they be removed to prevent the development of squamous cell skin cancer. Fair-skinned, blond, or red-haired people with blue or green eyes are most at risk.

Hepatic Pathologies

Prehepatic Intrahepatic Post hepatic

Pressure ulcer common sites

Pressure ulcers are most common in the elderly or people with spinal cord injuries or other conditions that restrict mobility. Decubiti tend to develop over bony prominences such as heels, tailbone, elbow, hip, etc. Pressure ulcers can develop in as little as 12 -24 hours but the clinical presentation of pressure ulceration can be deceiving to the inexperienced observer. Soft tissue, muscle, and skin resist pressure to differing degrees. Generally, muscle is the least resistant and will become necrotic before skin breaks down. Also, pressure is not equally distributed from the bony surface to the overlying skin; it is greatest at the bony prominence, decreasing gradually toward the periphery. A small area of skin breakdown may represent only the tip of the iceberg, with a large cavity and extensive undermining of skin edges beneath.

Bilateral orchiectomy (to eliminate testosterone)

Prostate CA

Dietary fat intake can increase risk

Prostate CA

Most common cancer in American men

Prostate CA

No initial s/s so metastasis is common

Prostate CA

Occurs to usually older men

Prostate CA

Atelectasis treatment

Pulmonary Hygiene: Incentive spirometry and TCDB (Have patient "Turn, Cough, and Deep Breath" frequently). These actions are intended to keep the alveoli open and prevent further lung collapse.

BLOOD PRESSURE REGULATION:

RAAS = Raises B/P vs. ANP/BNP = Lowers B/P

Respiratory distress

RAT BED restlessness, anxiety, tachypnea, tachycardia, bradycardia, extreme restlessness, dyspnea

Kidney stones

RBC in urine only. Renal calculi risk factors: Males, 20-40+, desert/tropical residents, inadequate fluid intake during sports, heavy work, alcoholic consumption

Kidney stones/calculi

RBCs in urine risk factors: male gender (20-40), desert/tropical region (dehydration), inadequate fluid intake (sports, heavy work, alcohol) hematuria, N/V, flank pain

Abnormal Substances: If ANY of these are found in the urine, it indicates a problem:

RBCs(could be kidney stones, infection, bladder inflammation, kidney damage, etc.) WBCs(more than a few WBCs indicate the presence of infection) PROTEIN(kidney is damage allows large protein molecules to escape)-proteinuria GLUCOSE(if blood sugar is too high, glucose will "spill" into the urine)-glucosuria CASTS or crystals (pieces of mineral deposits that are breaking loose and being shed into the urine)

Kussmaul respirations:

Rapid, deep breathing to blow off CO2 (an acid) to compensate for acidosis

Osteomalacia

Refers to a softening of bones, often caused by a vitamin D deficiency(called "rickets" in children). Soft bones are more likely to bow and fracture than are harder, healthy bones. Osteomalacia is not the same as osteoporosis, which can also lead to bone fractures. Osteomalacia results from a defect in the bone-building process, while osteoporosis develops due to a weakening of previously constructed bone. Muscle weakness and achy bone pain are the major symptoms of osteomalacia. Rickets is most common in children who are between 6 and 36 months old. Children are at the highest risk of rickets because they're still growing. Children might not get enough vitamin D if they live in a region with little sunlight, follow a vegetarian diet, or don't drink milk products. Treatment for osteomalacia involves replenishing low levels of vitamin D and calcium and treating any underlying disorders that may be causing the deficiencies.

Osteopenia

Refers to bone density that is lower than normal peak density but not low enough to be classified as osteoporosis(bone mineral density T-score between -1.0 and -2.5).However, individuals with osteopenia are at higher risk for developing osteoporosis so osteopenia can be thought of as "pre-osteoporosis. "In fact, osteopenia contributes to the pathology of ALL metabolic bone diseases.

BLOOD PRESSURE

Regulated by adjusting blood volume and serum osmolarity (by concentrating or diluting the urine) and secreting the hormone RENIN.

Make and Release RENIN

Renin plays an important role in the renin-angiotensin-aldosterone system(RAAS) in the body. When released, this system works to INCREASE BLOOD PRESSURE. With no renin, the RAAS system won't work. This will lead to hypotension.

Symptoms of hypoxia

Restlessness Anxiety Tachycardia and tachypnea Bradycardia Extreme restlessness Dyspnea

#1RANDOMFACTOID:The first indicator of HYPOXEMIA/HYPOXIA is a Change in LOC[level of consciousness] such as

Restlessness, confusion, anxiety, personality changes, etc., because low oxygen is registered in the brain FIRST. The brain responds to hypoxemia long before the tissues become hypoxic (in other words, before a major change can be detected by an oximeter, since it measures the level of oxygen in the tissue).

Rheumatoid arthritis

Rheumatoid Arthritis(RA)-Systemic/chronic inflammation(p. 1245) Etiology: autoimmune disease-genetic predisposition inflammation is immunologically triggered. Incidence: 1-2% of adults; female: male = 3:1(no surprises here...women are far more prone to all the autoimmune diseases!) Pathophysiology: antibodies form immune complexes that are deposited in synovium→ inflammation →fluid/leukocyte infiltration →synovial thickening →compromised circulation →metabolic acidosis →erosion of articular cartilage, ligament/tendon inflammation →granulation tissue develops →scar formation→ joint immobility. The inflammation often affects other organs and systems of the body including the lungs, heart, and kidneys. Usual onset is 30-50 years, but can occur in children (Juvenile RA), teens, and elderly.

S/s of tuberculosis

S/S: Symptoms of TB disease in the lungs include coughing, with or without blood, and chest pain. General symptoms of TB disease also include fever, night sweats, weight loss and tiredness. Symptoms of TB disease in other parts of the body depend on what area is affected. Some people with TB disease have no symptoms.

RISK FACTORS for PUD

SMOKING (and 2ndhand smoke) ALCOHOL (ETOH) use NSAID use (aspirin, ibuprofen, naproxen, etc.)

Peptic Ulcer Disease Risk Factors

SMOKING (and 2ndhand smoke) ALCOHOL (ETOH) use NSAID use (aspirin, ibuprofen, naproxen, etc.).

pulmonary embolism s/s:

SOB, chest pain, s/s of hypoxia and cough

Risk Factors for Integumentary Problems

Skin pigmentation(fair skin and light-colored hair) Ethnicity (Caucasian) Exposure to chemicals, radiation, or excessive sun Trauma(burns, open wounds, compression wounds, etc.) Pathogens (bacterial/viral/fungal/parasitic) Anything causing decreased circulation (either local or systemic), obesity, smoking, CHF, bedridden patients, PAD, DVT, etc. Body states causing compromised immunity (CA, AIDS, CKF, type 1 and type 2 Diabetes, steroid meds, etc.)

Incomplete Spinal Injury:

Some FUNCTION(either motor, sensory or both) is preserved. Only a portion of the spinal cord maybe injured (i.e., Central Cord Syndrome and Anterior Cord Syndrome). Prognosis for return of function is better in an incomplete injury because of preservation of axonal function. Involuntary Anal Reflex: Contraction of the anus when lightly touched (called the "anal wink"). If this reflex is present in a person paralyzed after a spinal cord injury, the injury may be incomplete, and the chance of recovery is better than if the reflex were absent.

Spinal transection

Spinal cord is completely severed.

Risks for Bacterial conditions

Staphylococcus and Streptococcus bacteria most common bacterial cause; compromised immune system, HIV, radiation and/or chemotherapy; open wounds; poor sterile technique by medical staff; BEING IN A HOSPITAL! Exposure to MRSA and multiple other drug resistant organisms are still a major problem. Examples: Impetigo[superficial skin infection] and Cellulitis[deeper skin infection].

Thyroid Crisis

Storm, also called thyrotoxicosis or thyroid storm, is a life-threatening condition that develops rapidly and causes a severe increase in metabolic rate. A major sign of thyroid storm is a marked elevation of body temperature, which may be as high as 105-106 F, along with tachycardia/heart palpitations and dangerously high blood pressure. This leads to chest pain, dyspnea and potential heart failure/cardiac arrest. Tx: Drugs to lower the temperature, heart rate and blood pressure. Thyroid crisis usually occurs in the first 12 hours after thyroidectomy.

Who Gets Skin Cancer, and Why?

Sun exposure is the biggest cause of skin cancer. But it doesn't explain skin cancers that develop on skin not ordinarily exposed to sunlight. Exposure to environmental hazards, radiation treatment, and heredity may play a role. Have you had a "blistering sunburn" before? How long have you lived in HIGH-ALTITUDE UTAH?

Rx for Alzheimer's

Supportive care to maintain function. Medication is sometimes helpful to slow the rate of mental loss but will not cure or prevent ongoing decline in either mental or physical symptoms.

causes of COPD

Symptoms of COPD often do not appear until significant lung damage has occurred, and they usually worsen over time. Cigarette smoking is the leading cause of COPD. Most people who have COPD smoke (or used to smoke). Long-term exposure to other lung irritants—such as air pollution, chemical fumes, or dust—also may contribute to COPD.

Hypoglycemia

Synonyms: Insulin shock, Insulin reaction High Risk: Taking insulin or oral antidiabetic meds; Brittle diabetic Predisposing factors: medication ⬇food intake ⬆exercise Presenting symptoms: pale, sweating, tachycardia, hunger, anxiety, restlessness, tremors-Seizure/Coma Laboratory Findings: glucose < 70mg/dL Treatment IV: glucose (D50)

Burn injuries can result in both LOCAL and SYSTEMIC responses

Systemic Response-Release of cytokines, histamines & other inflammatory mediators at the site of injury has a systemic effect once the burn reaches 20 -30%of total body surface area. Respiratory changes—Inflammatory mediators cause bronchoconstriction, and in severe burns adult respiratory distress syndrome(ARDS)can occur. Cardiovascular changes—Capillary permeability is increased, leading to loss of intravascular proteins and fluids into the interstitial compartment. Vascular depletion despite fluid replacement → hypovolemic shock. Peripheral and splanchnic (visceral organ) vasoconstriction occurs and myocardial contractility is decreased. These changes, coupled with fluid loss from the burn wound, result in systemic hypotension and end organ hypoperfusion. Hypovolemia can also cause ACUTE TUBULAR NECROSIS (ATN) →decreased urine output is an indicator of progressing renal failure Metabolic changes—the basal metabolic rate increases up to three times its original rate. This, in addition to visceral organ hypoperfusion, necessitates early and aggressive enteral feeding (tube feeding) to decrease catabolism and maintain gut integrity. The body's stress response is triggered →increased catecholamine(causing heart dysrhythmias) and cortisol excretion (high blood glucose could result). Immunological changes—Non-specific down regulation of the immune response occurs, affecting both cell mediated and humoral pathways→ patients become immunocompromised. Patients are therefore more prone to infections(skin and systemic infections) due to open wounds and poorly functioning immune system

Systemic vs local s/s of Rheumatoid Arthritis

Systemic S/S: Initially may present with vague systemic symptoms such as anorexia, weight loss, fever, and loss of energy. Early in the disease there are signs of inflammation("SHARP!")and decreased movement of smaller joints (hands, feet, wrists, elbows) and progresses to larger joint immobility (knees, hips, spine). Local S/S: (occur weeks or months later) painful, tender, stiff (worse in morning), swollen, warm joints; joint deformity over time. NOTE: pain is worse with rest(opposite s/s from osteoarthritis).Joint pain improves with movement.

Difference in S/S between UTI(local inflammation of bladder/urethra/ureters)and PYELONEPHRITIS(kidney infection →

Systemic infection with s/s of fever/chills/N/V, etc.)

Use of Respiratory Protection with TB patients:(TEST QUESTION)

TB is an AIRBORNE contagion (remember the mnemonic -"You're On-the-Air with MTV"). The Center for Disease Control (CDC) and Utah Dept. of Health has made the following recommendations when working with suspected or actual TB patients: ▪Place patient in an isolation room (with negative pressure) as soon as TB is suspected ▪Implement Respiratory/Airborne Precautions (Care Providers wear N-95 masks)▪Have individual wear a standard/surgical mask if tolerated while in public areas.

Four types of hypersensitivity

TYPE I-Anaphylactic/Allergic TYPE II-Cytotoxic TYPE III-Immune complex disease TYPE IV-Delayed hypersensitivity (cell mediated)

GERD Rx:

Take Acid-suppressing medications(a proton-pump inhibitor like omeprazole).Stop Smoking and avoid 2ndhand smoke(increases gastric irritation and causes vasoconstriction which decreases healing);stop caffeine; check for gluten intolerance; Maintain a high-protein, low-fat diet. Sleep with the head of the bed elevated. Stay upright for 2 to 3 hours after eating.

Laceration:

Tearing of the brain substance. Diagnosed by CT scan.

High cure rate

Testicular CA

Occurs usually to younger men

Testicular CA

Painless testicular mass

Testicular CA

Requires orchiectomy of affected testicle

Testicular CA

History of undescended testicle

Testicular or Prostate CA

Chlamydial infection

The CDC estimates that 1 in 20 sexually active women aged 14 -24 has chlamydia. Chlamydial infection is one of the leading causes of infertility in women. It is also a leading cause of PID. PID is a serious disease that often requires hospitalization for inpatient care, including intravenous (IV) antibiotics, testing to rule out tubo-ovarian abscess, and intensive counseling on the complications of recurrent infections. The risk of ectopic pregnancy in women who have had PID is 7-10 times greater than that for women without a history of PID. In 15% of women who have contracted PID, chronic abdominal pain is a long-term manifestation that most likely is related to pelvic adhesions in the ovaries and fallopian tubes. Chlamydial infections also increase the risk of acquiring HIV infection by increasing genital mucosal inflammation. Pregnant women with a chlamydial infection can pass the infection on to their infants during delivery, and this may develop into chlamydial pneumonia or chlamydial conjunctivitis. Untreated neonatal conjunctivitis can result in blindness. Other potential complications of chlamydial infection are miscarriage, preterm delivery, and urethral scarring in men. Etiology: bacteria (Chlamydia trachomatis) Incidence: anyone, but greater with multiple partners. One of the most common STDs(reported twice as often as gonorrhea). Can be transmitted to baby during vaginal birth. Can cause PID and infertility. Pathophysiology: bacterial infection S/S: frequently asymptomatic. If S/S are present: dysuria (painful urination), genital pain, dyspareunia, vaginal/penal discharge that is mucopurulent (creamy off-white or yellowish color), abdominal pain. Chlamydia can infect the rectum, throat, urethra, cervix. Rx: antibiotic therapy

Glomerular filtration rate (GFR).

The GFR is 125 mL/min (normal range is 85-135 mL/min).It is a measure of how much blood (in mL) gets filtered by the glomeruli every minute. The GFR helps to detect kidney disease in its early stages more reliably than the creatinine test alone. GFR is affected by anything that would decrease the amount of blood flowing through the kidneys. This could include heart failure, atherosclerosis or hypotension, among other things.

In COPD, air flow is impaired because of one or more of the following:

The airways and air sacs lose their elastic quality. The walls between many of the air sacs are destroyed. The walls of the airways become thick and inflamed. The airways make more mucus than usual, which can clog them.

Opisthotonus picture

The back is rigid and arching, and the head is thrown backward.

The Blood-Brain Barrier

The brain is the only organ known to have its own security system, a network of blood vessels that allows the entry of essential nutrients while blocking other substances. The brain's blood vessels are lined with endothelial cells that are wedged tightly together, creating a nearly impermeable boundary between the brain and bloodstream. Unfortunately, this barrier is so effective at protecting against the passage of foreign substances that it often prevents life-saving drugs from being able to repair the injured or diseased brain. New studies are guiding researchers toward creative ways to open this barrier and "trick" it into allowing medicines to enter.

Intermediate stage: PULMONARY EDEMA

The combination of hypoxia and acidosis causes damage to the epithelial wall between the alveoli and the adjacent capillaries that forms the blood/air barrier. When this membrane is damaged, fluid from the blood is able to seep into the air sacs and drown the patient slowly (or rapidly in some cases of sepsis which also adds the component of "leaky capillary" syndrome to the picture).Also, since the damaged lining is inflamed, it starts oozing very thick exudate or "pus" [white blood cells, dead cell debris, etc.) which cannot be cleared out of the alveoli.

Late stage: RESPIRATORY FAILURE

The continued acidosis and tissue death ultimately cause further hypoxia, decreased cardiac output, hypotension, and death. (About 40% of the people who develop ARDS will die from the complications).

Somogyi phenomenon

The effect is caused by nighttime hypoglycemia, which leads to a rebound hyperglycemia in the early morning hours. Blood sugar drops (hypoglycemia)during triggers the stress response [release of epinephrine and cortisol from the adrenal glands]. Cortisol stimulates gluconeogenesis to bring the blood sugar back up to normal. However, it results in rebound hyperglycemia →elevated glucose level in the morning.[BOOMERANG curve].

Signs and symptoms of UTI in the elderly

The elderly with a UTI are often misdiagnosed with senior dementia or Alzheimer's disease, because a UTI can mimic symptoms of such conditions. Also, between 30% and 40% of elderly patients with serious infection don't exhibit the hallmark sign of fever due the inability of the immune system to mount a response to infection because of aging. As the bacteria in the urine spread to the blood stream and cross the blood-brain barrier, confusion and other cognitive difficulties can be the result. UTI is the most common cause of LOC changes in the elderly!

Ventilation / Perfusion Abnormalities

The lung has the capability to compensate for mismatches in ventilation and perfusion. If ventilation is greater than perfusion, the ARTERIOLES dilate and the BRONCHIOLES constrict, increasing perfusion while reducing ventilation. If ventilation is less than perfusion, the ARTERIOLES constrict while the BRONCHIOLES dilate to correct the imbalance.

Viral Hepatitis and Liver Cancer-

The major cause of liver cancer is HEPATITIS B AND C and can develop silently as the liver becomes cirrhotic. Blood tests, ultrasound examinations, CT and MRI scans can help identify the cancers, but liver biopsy is needed for a definitive diagnosis of cancer. Liver CA is LETHAL. Even if found early, only a small proportion of patients can be cured.

On February 14, 2018, the Food and Drug Administration (FDA) cleared the first blood test that can help healthcare practitioners assess the severity of concussions in adults.

The newly approved blood test, called the Brain Trauma Indicator(BTI), helps determine whether a CT scan is needed in people with suspected concussion. The test measures two brain-specific proteins, ubiquitin C-terminal hydrolase (UCH-L1) and glial fibrillary acidic protein (GFAP), that are rapidly released by the brain into the blood within 12 hours of serious brain injury. Test results can be available within three to four hours. Low blood levels of these proteins indicate that, if the person has damage, it is likely too small to be seen on a CT scan. If these protein levels are high, healthcare practitioners could rule out mild concussion and order a CT scan to look for bleeding and damage that would require intervention.

Albumin

The primary plasma protein in charge of oncotic/osmotic pressure in blood veins is synthesized in the liver Not enough protein in the plasma means body fluid is stuck in 3rd space because there is no protein in blood veins available to PULL it out Which will cause ASCITES and PORTAL HTN

Metabolic Syndrome

The release of cortisol from the adrenal glands contributes to ⬆BS and insulin resistance

Fat Embolism

The term fat embolism indicates the often-asymptomatic presence of fat globules that travel to and get lodged in the lung tissue. The majority (95%) of cases occur after major trauma. Fat emboli occur in almost 90% of all patients with severe injuries to bones, although only 10% of these are symptomatic.(Fat globules originate from yellow bone marrow or surrounding adipose tissue)Etiologic Theories for causes of fat embolism: ➢Mechanical-subcutaneous fat at fracture site or bone marrow gain venous access. ➢ Biochemical-stress hormones lead to lipid instability and emboli develop in the veins.

Pneumonia

The term pneumonia describes inflammation of the parenchymal structures of the lung, such as the alveoli and bronchioles. Although antibiotics have significantly reduced the mortality rate from pneumonias, these diseases remain a leading cause of morbidity and mortality worldwide, particularly among the elderly and those with debilitating diseases. Etiologic agents include both infectious(pathogen-caused by bacteria, viruses, fungus, etc.) and noninfectious agents(i.e., inhalation of toxic gases, aspiration of a foreign body or vomit, drug-induced, etc.).NOTE: Lung inflammation is called PNEUMONIA if caused by a pathogen and PNEUMONITIS if caused by noninfectious agents.

LUNG Cancer

The top cause of cancer deaths in both men and women. Lung cancer is the uncontrolled growth of abnormal cells in one or both lungs. These abnormal cells do not function as normal lung cells do in the exchange of oxygen and carbon dioxide. As they grow, the abnormal cells can form tumors that interfere with the functioning of the lung by crowding out normal lung tissue or by making HORMONES that interfere with lung function.

TB TESTS:

The tuberculin skin test and TB blood tests. A positive TB skin test or TB blood test only tells that a person has been exposed to the TB bacteria. It does not tell whether the person has latent TB infection(LTBI) or has progressed to ACTIVE TB disease. NOTE: The increasingly common QuantiFERON-TB (QFT) blood test is highly specific and sensitive for the M. tuberculosis that causes TB. A positive result is strongly predictive of true infection with M. tuberculosis. However, QFT cannot distinguish between ACTIVE tuberculosis disease and LATENT tuberculosis infection. Other tests, such as a chest x-ray and/or a sample of sputum, are needed to see whether the person has contagious TB disease.

Signs of a GI bleed

The type of blood we see coming out of the body will give us a clue about where the bleeding source is located, so it can be found and fixed.

Brain/cerebral edema:

This is localized in the glial cells, myelin sheaths, and intercellular spaces. It causes increased intracranial pressure, which may impair brain circulation, or result in brain herniation. It may be missed in early CT scans. Later CT scans or MRI show edema more reliably.

Crohn's Disease

This painful autoimmune disorder(no medical cure) results in inflammatory lesions that may occur anywhere in the G.I. tract(from mouth to anus) but more often in the ascending colon and terminal ileum.

GCS

This scale helps to gauge the impact of a wide variety of conditions affecting the patient's level of consciousness such as acute brain damage due to -Trauma -Vascular injuries -Infections -Hypoxia -Metabolic disorders(renal failure, liver failure, hypoglycemia, or diabetic ketoacidosis)

Glasgow Coma Score

This scale helps to gauge the impact of a wide variety of conditions affecting the patient's level of consciousness such as acute brain damage due to -Trauma -Vascular injuries -Infections-Hypoxia-Metabolic disorders(renal failure, liver failure, hypoglycemia, or diabetic ketoacidosis)

ACID-BASE BALANCE:

Through reabsorption or excretion of Hydrogen ions [H+] and bicarbonate [HCO3].

Hypercapnia

Too much carbon dioxide in the BLOOD (caused by a problem with ventilation)

Spinal Cord Injury(SCI) Pathophysiology

Trauma, tumors, concussion, contusion, compression, tearing, or ischemic injury to the spinal cord with or without vertebral(bone)damage. Commonly associated w/injury at C1-C2, C4-C7, and T12-L2. Assessing SCI can be difficult because impairment may manifest in a variety of ways depending on the degree of cord damage.

TREATMENT for acute and chronic renal failure:

Treatment of acute renal failure depends on the underlying cause. Reminder -ACUTE renal failure can be reversible; CHRONIC renal failure is permanent damage. •Hospitalization •Administration of intravenous (iv) fluids in large volumes (to replace depleted blood volume) •Diuretic therapy or medications (to increase urine output) •Close monitoring of important electrolytes such as potassium, sodium, and calcium •Medications (to control blood pressure) •Specific diet requirements (low protein because kidney cannot flush protein byproduct -urea) •Dialysis

Causes of Hemoptysis

Tuberculosis and Other Mycobacterial Infections Acute Bronchitis and Chronic Bronchitis Bronchiectasis Lung Cancer Pneumonia

red blood emesis

UGIB, life-threatening emergency

What causes cellulitis?

USUALLY caused by a break in the skin allowing a pathogen access to underlying tissue:•Skin injury: A cut, abrasion, burn, or bite (human bites are the most infectious, followed by cat bites). •Medical procedures: Surgery, IV's, any invasive activity. •A new tattoo or piercing. •Problems that cause skin breakdown, such as eczema, psoriasis, or a fungal infection like athlete's foot. •Sometimes cellulitis can occur even if there wasn't an obvious break in the skin.

HIGH RISK for a P. E.

Use of birth control pills(causes hypercoagulation), large bone fractures(releases fatty emboli-causing Fat Embolism Syndrome-FES), smoking(vasoconstriction slows blood flow →clot formation),atrial fibrillation(clots form in atria of the heart), Post-operatively [3 -10 days after]especially orthopedic surgeries.

DX of pulmonary embolism:

V/Q Scan (Nuclear Medicine test) and blood tests (remember "D-Dimer")and Platelet count.

The abbreviation for ventilation/perfusion is "V/Q."

V/Q Scans are done on the lungs to evaluate lung function after a pulmonary embolus (PE). Nuclear particles are used in the scan to visualize the lungs. The ventilation part of the test looks at the ability of air to reach all parts of the lungs, while the perfusion part evaluates how well blood circulates within the lungs.

pulmonary embolism dx

V/Q scan, D-Dimer

Vaccines & IgG shots

Vaccines are given before exposure to prevent hepatitis(A or B)*IgG(Gammaglobulin)immunoglobulin shot is a short-term general antibody that can be given after exposure to hepatitis to strengthen the immune system and help the body fight the hepatitis virus -it is not a cure for hepatitis

Types of Cerebral Edema

Vasogenic Edema Cytotoxic Edema The most dangerous outcome of cerebral edema is increased ICP due to brain injury. Cerebral edema or bleeding can result in increased intracranial pressure which is the most serious complication of a head injury. There are two types of brain edema.

Meningitis Incidence:

Viralis most common; bacterialis most severe. Spread by social contact such as handshakes or sneezes. Occurs to all ages, genders, races, etc. High density living conditions (colleges, prisons, camps, military, etc.) allows for contagion to spread easier so these populations are higher risk.

Hepatitis s/s

Virus, late s/s, of liver disease, can lead to liver CA

Cushing's Triad:

Vital sign changes seen in ICP indicating pressure on the brain stem. Hypertension(Widening Pulse Pressure-the difference between the Systolic and Diastolic B/P increases) Bradycardia(reflexive slowing of the heart to compensate for increased B/P) Hypoventilation(Respiration slows down)→Hypercapnia(↑CO2)which causes vasodilation leading to worse cerebral edema and increased ICP.

Pyelonephritis

WBC & RBC in urine, high fever, females 5x more likely. Backward flow/reflux of infected urine. Flank pain, fever/chills, N/V.

Pyelonephritis

WBC and RBC in urine, temperature present female 5x more likely to get it.

Dx of osteoporosis:

Women should be screen starting at age 65and men at age 70. Testing is done via a bone density test (DEXA scan)of the hip and spine to diagnose osteoporosis (DEXA stands for dual energy x-ray absorptiometry).DEXA scans are also recommended for anyone past menopause, or people who have unexplained fractures (spontaneous or "pathological" fractures).Bone mineral density (DEXA Scan) results: T-score of -2.5 or lower= osteoporosis.

Bartholinitis

[Infection of Bartholin glands]pg.1129Etiology:bacterial infections, STD's Pathophysiology: contamination of opening of Bartholin's gland →infection/trauma obstructs flow of secretions→ swelling, pain, erythema S/S: erythema, edema, pain, purulent drainage, fever, malaise. Can form into a pustule (cyst). Rx: warm compresses, antibiotics, incision and drainage

Subdural Hematoma:

a blood clot that forms between the dura and the brain tissue. If this bleeding occurs quickly it is called an acute subdural hematoma. If it occurs slowly over several weeks, it is called a chronic subdural hematoma. The clot may cause ICP and may need to be removed surgically. May be either arterial or venous bleed but is usually venous so the rate of blood flow is slower and the hematoma (hemorrhage) develops slower.

Epidural Hematoma

a blood clot that forms between the skull and the top lining of the brain (dura). This blood clot can cause fast changes in the pressure inside the brain. Usually an ARTERIAL bleed so can expand very quickly. Early sign is ipsilateral pupil dilation(dilation of pupil on the same side as the brain hematoma).

Bronchiectasis

a chronic dilation and consequent infection of the bronchioles and bronchi that results from obstruction in the bronchi. The dilation results from damage to the surrounding supportive tissue and is usually a result of infection or fibrosis (the abnormal formation of scar tissue). Cystic fibrosis is an example of a disease that leads to bronchiectasis. In addition to hemoptysis, patients with bronchiectasis often have a severe cough and chronic purulent sputum (thick, opaque, yellowish white discharge).

Avulsion Fx

a chunk of bone attached to a tendon or ligament gets pulled away from the main part of the bone.

Cellulitis

a common skin infection caused by bacteria, most often strep or staph, that invade through the skin to deeper tissues. Most cases are mild -lasting several days to a couple of weeks-and are treated with oral antibiotics (abx). But cellulitis can sometimes progress to sepsis requiring treatment with IV abx.

Eschar

a dry, dark scab or falling away of dead skin, typically caused by a burn, or by the bite of a mite, or as a result of anthrax infection. -Unstageable pressure ulcer-A full-thickness tissue loss in which the base of the ulcer is covered by slough or eschar to such an extent that the full depth of the wound cannot be appreciated -Third degree burn-full thickness burns that extend through the subcutaneous tissue. This includes the nerve layer so there is no pain from the portion of the wound that is 3rd degree. Muscle/tendon/bone tissue may be involved.(Remember: All three degrees of burns are usually present with any burn injury).Results in major scarring. Skin grafting is usually required to replace dead tissue. May require ESCHAROTOMY(to relieve pressure from swollen tissue). At risk for compartment syndrome and/or joint contractures. -Severe edema (caused by 3rd spacing of fluid in the tissues) may necessitate an escharotomy(surgery to cut through dead leathery skin caused by the burn) to allow swelling tissue to expand. For instance, if the burn involves the chest, the skin of the chest will be cut to allow the lungs to expand, otherwise the person would suffocate.

In Cholecystitis, pain can mimic

a heart attack(severe, radiating to between shoulder blades and up neck, unrelenting and non-reproducible just like cardiac pain). Other S/S of Cholecystitis are nausea, vomiting, fever, leukocytosis, jaundice (with obstruction) and Light color or Clay-colored stools because bile is being blocked from entering the intestine. Bile (bilirubin in the bile) gives stool a brown color, so without bile the stools will lack color.

OCCULT GI bleeding

a positive fecal occult blood test result when there is no evidence of visible blood in feces.

Paracentesis

a procedure to aspirate fluid[ascites]that has collected in the abdomen(peritoneal fluid). Ascites may be caused by infection, inflammation, an injury, or other conditions, such as cirrhosis or cancer. Paracentesis also may be done to take the fluid out to relieve intraabdominal pressure that is causing pain in people with cancer or cirrhosis, or to allow the person to breath better. As much as a gallon of fluid (4 liters) can be taken out. This results in severe LOW BLOOD PRESSURE! This can lead to shock or KIDNEY damage (remember ATN?!?).This procedure is not currative -the ascites will return if caused by cirrhosis of the liver.

Pheochromocytoma

a tumor of the adrenal medulla that secretes excessive catecholamines (epinephrine/norepinephrine/dopamine) resulting in HYPERtension, TACHYcardia, HYPERglycemia, HYPERmetabolism, and weight loss.

Opisthotonus

a type of spasm of the whole body that leads to legs and head being bent back and body bowed backwards. Can occur in some types of meningitis, tetanus, strychnine poisoning.

Creatinine

a waste product from the normal breakdown of muscle tissue. As creatinine is produced, it is filtered through the kidneys and excreted in urine as a normal product of metabolism. If Creatinine is elevated in the blood that means it is not being excreted through the kidneys. An elevated creatinine along with an elevated BUN value, indicate kidney damage.

Incidence of Alzheimers:

a. Familial Alzheimer Disease-"FAD" or Early-onset Alzheimer's -30% of cases, occurs before 50 yrs. b. Nonhereditary (late-onset) Alzheimer-70% of cases; occurrence after age of 50.

Cystic Fibrosis

abnormal thick rubber cement mucous, salty skin, inability to gain weight, failure to thrive, greasy/fatty stools

Acute renal failure

acute tubular necrosis most common cause in hospitalized patients. Abrupt-reversible. Decreased blood flow (20-30 mins) obstruction, glomerulonephritis nephrotoxic medications

In some cases, a collapsed lung is caused by

air blisters (blebs/bulla) that break open, sending air into the space around the lung. This can result from mechanical ventilator is set too high, or without warning to people with weakened alveoli (such as COPD patients). Tall, thin people and smokers are more likely to have a collapsed lung. In some cases, a collapsed lung occurs without any cause. This is called a spontaneous pneumothorax or collapsed lung.

Pneumothorax

air escapes from lung-can be a result of a bursting bleb

Pneumothorax

air in the pleural cavity. A collapsed lung occurs when air escapes from the lung.

Transient Ischemic Attack(TIA's)

aka, "Mini-stroke" -Considered "angina of the brain." Definition: Brief episodes of neurologic dysfunction. Can have all the S/S of a stroke but reverses before infarction occurs. TIA's are temporary and resolve without treatment.NO PERMANENT DAMAGE. Often called a "mini stroke," TIA's are a warning sign for a brain attack (stroke) since they frequently precede Thrombotic brain attack. About 1 in 3 people who have a transient ischemic attack will eventually have a stroke, with about half occurring within a year after the transient ischemic attack. The causes of TIAs are the same as those of ischemic stroke and include atherosclerotic disease of cerebral vessels and emboli.

Crohn's Inflammatory Lesions involve

all layers of the bowel wall and can cause fistulas(tunnels) to other organs or other parts of the body. Because of these fistulas and the colon not absorbing properly, the patient is prone to fluid and electrolyte imbalances as well as malabsorption of vitamins/minerals. Characteristic "skip lesions"= involve some areas of the bowel but not all-"Cobblestone" appearance of intestinal lining.

Spinal Shock

all reflexes including somatic(voluntary)and autonomic involuntary)are TEMPORARILY lost below level of injury. Average 1-3 weeks but may be up to 3 months. Resolves as edema/injury resolves. Could have HYPERreflexia (spacisity)for another year after sensation returns.

Antidiuretic hormone(ADH)

also called Vasopressin •Secreted by the posterior pituitary gland. •Released in response to increased osmolality(⬆blood concentration).•Regulates water in the body by signaling the kidney to retain water and sodium. •Excretion of ADH is caused by: Low blood volume; low sodium; high osmolarity of body fluids(i.e., dehydration -ADH will cause fluid retention to relieve the dehydration).

Small-Cell Lung Cancer

also called oat cell cancer. About 10%-15% of lung cancers. Highly malignant and BRAIN METASTASIS is common-poor prognosis; Chemotherapy is usually the main treatment for small-cell lung cancer. (Study question: What s/s would you see if cancer metastasized to the spinal cord or brain?)

Pressure Ulcers

also known as Decubitus Ulcers, Pressure Sores and bed sores-this condition results from unrelieved pressure in one area and/or shearing forces on the skin and is exacerbated by moisture which leads to maceration* of tissue. Continuous pressure on tissue prevents underlying capillaries from filling with blood which impairs oxygen exchange. Tissue becomes ischemic and results in cell necrosis. *Maceration of the skin occurs when it is consistently wet. The skin softens, turns white, and can easily get infected with bacteria or fungi.

Creatinine CLEARANCE

also provides an estimate of kidney function and of the actual GFR. However, in addition to the serum (blood sample) creatinine, this test requires a timed urine collection(24 hours)for urine creatinine measurement in order to compare blood and urine creatinine concentrations and to calculate the clearance. (NOTE: If a female patient begins menstruating during the 24 hours of the urine collection, you must notify the doctor because the resultswill not be valid because of excess protein in urine from menstrual blood).

Common problems associated with chronic kidney disease include

alterations in fluid and electrolyte balance; disorders of skeletal (related to Vitamin D not available to process Calcium), hematologic (decrease in erythropoietin →anemia), cardiovascular, immune, neurologic, and integumentary systems.

Atelectasis

alveoli cannot expand due to blockage, pressure, or surfactant failure absorption-cannot expand (postop, anesthesia, foreign object, mucus, etc) compression-outside pressure push alveoli and compress (tumor, pleural effusion)

Myxedema

an extreme complication of hypothyroidism; patients exhibit multiple organ abnormalities; progressive mental deterioration. Also called myxedema coma or crisis. Myxedema also refers to the swelling of the skin and soft tissue that occurs in patients who have hypothyroidism. Myxedema occurs when the body's compensatory responses to hypothyroidism are overwhelmed by a precipitating factor such as infection.

antihypertensive meds

angiotensin II/vasopressin in ADH

Oblique Fx

angled Fx

Rx for Rheumatoid Arthritis:

anti-inflammatory meds, i.e., NSAIDS and steroids such as prednisone (immune suppressant -avoid exposure to sick people/do not get vaccinated/monitor for "Cushing's syndrome" s/s);Monoclonal Antibody meds(the "MABs"—Do you remember the mnemonic, "Must-Avoid-Bugs" because MABs suppress the immune system). Additional Tx: physical therapy, surgery on affect joints.

ADH

antidiuretic hormone (vasopressin) secreted by posterior pituitary gland. Released in response to increased osmolarity/high blood concentration. Regulates water by retaining it and sodium. (low blood volume, low sodium, high osmolarity of body fluids)

RISK FACTORS for Cholecystitis

are classically called the"SIX F's of Cholecystitis": fair, fat, female, fertile, forty, family history Other risk factors include Crohn's Disease, diabetes, hyperlipidemia, pregnancy, long labor(causes damage to gallbladder) or RAPID weight loss.

Ammonia levels

are monitored due to the liver's decreased ability to break down protein.High ammonia levels cause encephalopathy (brain damage)

Strains and Sprains

are soft tissue injuries of tendons and ligaments. Repair time can be longer than a bone fracture due to poor blood supply to these types of tissues. •Sprain is an injured or torn ligament •Strain is an injured tendon(Memory Tip: There is a "T" in sTrain and Tendon) •RICE is recommended treatment: Rest, Ice, Compression (Ace wrap, splints), and Elevation of the injury on a chair or pillow when laying down. Also, can treat with nonsteroidal anti-inflammatory meds (NSAIDs).

Cirrhosis s/s

ascites, portal HTN, jaundice, encephalopathy

Crohn's Disease

autoimmune disorder (no medical cure) results in inflammatory lesions involving all layers that may occur anywhere in the G.I.

Crohn's

autoimmune disorder with no medical cure-inflammatory lesions that can occur anywhere in the G.I. tract most often in the colon & terminal ileum involving all layers of the bowel wall causing fistulas to other organs (colostomy needed). Patient is more prone to fluid and electrolyte imbalances and malabsorption "skip lesions" cobblestone intestinal lining. Causes perforation or obstruction.t c

The most common cause of pyelonephritis is the

backward flow (reflux) of infected urine from the bladder to the upper urinary tract. Bacterial infections also may be carried to one or both kidneys through the bloodstream or lymph glands from infection that began in the bladder.

Aneurysm

ballooning of a weakened portion of an arterial wall

MELENA

black "sticky" stools that look like tar (and smell awful!) is caused by the partial digestion of blood in the small/large intestines (where alkaline digestive enzymes breakdown the blood). Melena can originate from a bleeding site in the stomach or intestines.

Melena

black and tar-looking stools

Bilirubin

blood bread-down product

Pulmonary embolism

blood clot from perfusion mismatch-DVT High risk: BC pills, large bone fractures, smoking, a-fib, post op 3-10 days after

Hep B

blood/body-sex, needles, mom to baby, Heptavax (3)

Hemoptysis

bloody sputum-TB most common cause

"Greenstick" Fx

bone bends and cracks, instead of breaking completely into separate pieces. This type of broken bone most commonly occurs in children because their bones are softer and more flexible than are the bones of adults.

Comminuted Fx

bone is broken into fragments as in a crushing injury

Impaction Fx

bone is jammed into another bone

Ammonia

brain toxic-high levels cause change in LOC and hepatic encephalopathy-brain damage. Monitored due to the liver's decreased ability to bread down protein.

Hematochezia

bright red blood caused by hemorrhoids, not usually serious

Lung CA

bronchogenic carcinoma-smoking 20x greater chance. No symptoms until metastasized. Dx: tissue biopsy.

pleural effusion

buildup of fluid between the ribs and lungs in the pleural space-can be drained

Urinary tract infections/cystitis

can have no symptoms frequency, urgency, dysuria, low back pain, nitrites *Elderly often misdiagnosed with senior dementia of Alzheimer disease. UTI is the most common cause of LOC changes in elderly. E. Coli & prosteus most common. Sexually active females, toddlers, diabetics catheter prostatic hypertrophy

Just as with GERD, Hiatal Hernia pain

can mimic a heart attack, so chest pain has to be carefully evaluated to rule out cardiac causes for any chest pain first before treating it as a GI problem.

Bronchogenic carcinoma

cancer that originates in the lining of the bronchi. About 90 percent of lung cancers are bronchogenic. The other 10 percent begin in the bronchioles, alveoli, or trachea.

A patient coming to the ER with CHEST PAIN maybe given a ___________ to RULE OUT a M.I. This combination of medications contains an acid suppressing liquid (Mylanta)and usually a numbing medication like viscous lidocaine. If the pain goes away after drinking this "cocktail" then the problem can be diagnosed as GI and not cardiac. Also, if the pain is worse when the patient lies down, it is caused by GERD and not a cardiac problem.

cardiac cocktail

Acute Tubular Necrosis→

caused by ISCHEMIA (what are the different ways this can be caused?)

Pathological (spontaneous)Fx

caused by disease that leads to bone weakness. Most commonly due to osteoporosis but may also be due to other pathologies such as: cancer, infection, inherited bone disorders, or a bone cyst.

Hypertension and kidney disease

caused by nephritic syndrome, damages kidney filters-2nd most common cause of permanent renal failure

COMPRESSION Atelectasisis

caused by outside pressure pushing on the alveoli and collapsing it -such as a space-occupying tumor, or a pocket of pleural effusion.

S/S of ATN

change in LOC, oliguria, full body edema, cardiac potassium imbalance, fixed specific gravity (late)

S/S of lung CA

changes in organ function-lung damage, inflammation, organ failure local effects of tumors-nerve and vein compression, GI obstruction tumor cells secreting hormones-low blood sodium, high blood calcium muscle wasting, bone breakdown

Flaccid Paralysis

characterized by limp(floppy)unresponsive muscles that cannot contract. Can be caused by infections(i.e., polio, botulism, Guillan Barre Syndrome)and toxins or damage to the spinal cord or brain.

CBC

check RBCs and platelet status

COPD

chronic air flow limitation (chronic bronchitis, asthma, cystic fibrosis, and emphysema) S/S appear after significant lung damage. Pursed lip, hypoxia signs, barrel chest, smoking, digital clubbing)

Systemic Lupus Erythematosus (Lupus, SLE)

chronic, autoimmune disease that can damage any part of the body (skin, joints, and/or organs inside the body). Lupus can range from mild to life-threatening. There is currently no cure for lupus. SLE is a complex autoimmune disorder that results from widespread (systemic) immune complex deposition and secondary tissue injury. It is characterized by the presence of antinuclear antibodies(ANAs) and multiple organ system involvement. ▪Women are diagnosed 9 times more often than men and usually between the ages of 15 and 45. ▪Risk factors include exposure to sunlight, certain prescription medications, infection with Epstein-Barr virus, and exposure to certain chemicals. ▪It is believed that lupus results from both genetic and environmental (epigenetic) stimuli. ▪Environmental factors include extreme stress, exposure to ultraviolet light, smoking, some medications and antibiotics, infections and the Epstein-Barr virus (in children). S/S: achy joints, swelling of hands and feet, fever, fatigue, skin lesions, rash(called a "butterfly" rash on the face), anemia, chest pain, light sensitivity, hair loss and more. Tx: corticosteroids, immunosuppressive drugs(Examples: Methotrexate, Infliximab)and lifestyle changes.

Spiral Fx

circles the bone

If the GB or bile duct is blocked by a stone, "sludge", or an infection, the GB

contracts harder trying to overcome the obstruction to squeeze out some bile which results in severe pain. Pain can starts within a few minutes after eating anything with fat in it. (NOTE: this is different than ulcer pain that is relieved with eating food).

Parathyroid

controls calcium levels HYPER parathyroidism HIGH Calcium means Muscles are TOO calm" causes an elevated level This, in turn, reduces calcium stores in the bone, causing bone demineralization which sets the stage for pathologic fractures and a risk for injury.

Acute tubular necrosis

damage to the renal tubules of the kidneys due to presence of toxins in the urine or to ischemia/lack of oxygen-leads to acute renal failure uremia, change in LOC, oliguria, fixed specific gravity

Jaundice/Icterus

damaged liver can't break down the bilirubin found in RBCs. Yellowish orange skin and sclera.

Risks for Fungal infections

debilitating disease; poor nutrition; poor hygiene(or poor hygiene care of patients by care providers); tropical climates; contact with infection source-showers and pools, footwear, excessive sweating, moist clothing, diapers and incontinence underwear.

Acceleration

deceleration head injury -"Coup-contrecoup" hitting both front and back of head. Results in brain contusions and hematomas(more than one injury from the same blow).

Hepatorenal syndrome

decreased circulating blood volume triggers RAAS, vasoconstriction and high blood pressure-waste products that contain nitrogen buildup in the bloodstream(azotemia) -sodium and water retention, oliguria, increased BUN and creatinine levels.

Protein loss

decreased protein in the capillaries -> no pulling action to draw fluid out of tissues: -Ascites -Lung congestion

Oliguria

decreased urine output (could be caused by dehydration or kidney failure)

Oliguria

decreased urine output caused by dehydration or kidney failure

Compression Fx

defined as a vertebral bone in the spine that has decreased at least 15 to 20% in height due to fracture. Caused by osteoporosis or trauma (substantial force is required to break a bone in the spine).

Osteoarthritis(OA)

degenerative joint disease (aka, "DJD") is the breakdown/erosion of cartilage in joints caused by wear and tear over time. Etiology: Often related to obesity (weight-bearing trauma to the joints); aftermath of joint injury; or heredity factors. Most commonly in the major weight bearing joints of hips, knees and spine. Incidence: 60 million people in US (including your poor old teacher Tana!)Pathophysiology: articular cartilage damage →develop fissures →cartilage erodes →subchondral bone exposed →loss of joint padding resulting in pain w/movement. Also, bone callouses (called "bone spurs" or osteophytes) form which can interfere with joint movement and cause pain to soft tissue rubbing against the rough edges of the spur. S/S: joint pain (worse with use / better with rest),stiffness, joint and limb instability. o Px (pain) in affected joint after repetitive use o Joint Px worse later in the day o Px/stiffness after long periods of inactivity(i.e. sitting in patho class for 4 hours!) or getting out of bed in a.m. o Swelling, warmth, crepitus around the affected joint o Bony enlargement of the joints from spur formations Rx: rest, anti-inflammatories(especially NSAID meds like Ibuprofen and Aspirin), joint support, surgery(joint replacements).

Chronic renal failure

diabetes hypertension nephrotic syndrome chronic obstructions 3+ mos

High risk for developing cellulitis:

diabetes; weakened immune system(Chemo, on prednisone or other steroid; areas of edema. This high-riskgroup tends to get sicker from cellulitis and is more likely to get cellulitis again.

IBS S/S

diagnosed when a person has had abdominal pain or discomfort at least three times a month for the last 3 months without other disease or injury that could explain the pain. The pain or discomfort of IBS may occur with a change in stool frequency or consistency or be relieved by a bowel movement. Persistent or recurrent symptoms of abdominal pain, altered bowel function w/o GI damage, and varying complaints of flatulence, bloating, nausea, anorexia, constipation or diarrhea. IBS accompanies anxiety or depression.

Cholecystitis rx

dietary modifications or surgery

Coma

does not respond appropriately to stimuli. No verbal response

"Coffee-ground emesis"

due to partial digestion of blood in the stomach by stomach acids.

First degree

erythema, pain, epidermal destruction only (partial thickness). Heals quickly without scarring. The skin maintains its ability to function as a water vapor and bacterial barrier. Heals in 3-10 days. Example: Sunburn or an injury caused by briefly touching a hot pan, curling iron, etc.

Gastroesophageal Reflux Disease(GERD)

esophageal sphincter is weak and does not close completely after food enters the stomach, which allows the backflow of gastric juices from the stomach to enter the esophagus. Heartburn is caused as chyme and gastric acid regurgitates into the esophagus about 30 -60 minutes after meals causing inflammation of esophageal mucosa and tissue erosion(causing ESOPHAGTIS).When this tissue heals it causes fibrosis(scar tissue) that does not stretch as well as the original esophageal tissue. taking too many of these antacids (like "Tums" or "Rolaids") can cause an electrolyte imbalance because they are high in sodium and calcium or magnesium.

Kidney Stones (Renal Calculi) are considered a POSTRENAL condition

even though stones are formed in the kidneys, they do not damage the kidney. They cause obstructions which by definition are "Postrenal".

Delusion

false belief brought about without appropriate external stimuli (unrelated to reality)

Crohn's Disease S/S:

fluid and electrolyte imbalances Characteristic "skip lesions" perforation or obstruction fistulas

pulmonary edema

fluid buildup in interstitial tissue caused by left sided heart failure-cannot be drained

Procallus

formation (cellular proliferation) →by osteoblasts within days. Formation of a fibrocartilage "collar" within a few days on either side of the fracture which then forms a bridge.

Callus

formation→ osteoblasts continue to move in and out of the bridge to help keep it firm. Usually occurs 3-4 weeks after injury.

Acute Kidney Injury(AKI)

formerly known as Acute Renal Failure -has an abrupt onset and is potentially reversible.

Ascites

free fluid in the abdomen caused by two problems 1. Portal hypertension increases hydrostatic pressure 2. Damaged liver does not synthesize serum protein and decreases oncotic pressure. Abdomen distention, displaced diaphragm leading to dyspnea, peritonitis. Tx: Paracentesis. Cause: Inflammation, injury, cirrhosis, CA. Causes severe low BP-an lead to shock and kidney damage.

Third degree

full thickness burns that extend through the subcutaneous tissue. This includes the nerve layer so there is no pain from the portion of the wound that is 3rddegree. Muscle/tendon/bone tissue may be involved.(Remember: All three degrees of burns are usually present with any burn injury).Results in major scarring. Skin grafting is usually required to replace dead tissue. May require ESCHAROTOMY(to relieve pressure from swollen tissue). At risk for compartment syndrome and/or joint contractures.

Irritable Bowel Syndrome (IBS)

functional gastrointestinal (GI) disorder without damage to the GI tract Pain that is relieved by defecation

Cholecystitis

gallbladder stones composed of cholesterol and bile or biliary sludge getting trapped at the gallbladder's opening.

Hiatal Hernia risk factors

goes up with age, pregnancy, obesity, habitual vomiting (as in eating disorders), weight training, and smoking/alcohol.

Hiatal Hernial Risk Factors:

goes up with age, pregnancy, obesity, habitual vomiting (as in eating disorders), weight training, and smoking/alcohol. Hiatal hernias are very common and occur often in people over 50 years old.

Metabolic syndrome is not a disease in itself. Instead, it's a

group of risk factors To be diagnosed with metabolic syndrome, you would have at least three of these risk factors. ✓Large Waist Size(abdominal fat deposits*):For men: 40 inches or larger. For women: 35 inches or larger ✓Cholesterol: High Triglycerides: 150 mg/dL or higher ✓Cholesterol-Low" Good" Cholesterol (HDL):For men: Less than 40 mg/dL; For women: Less than 50 mg/dL ✓High Blood Pressure: Either having blood pressure of 135/85 mm Hg or greater or using a high blood pressure medicine ✓Blood Sugar: High Fasting Glucose Level 100 mg/dL or higher risk factors double the risk of BLOOD VESSEL ANDHEART DISEASE,& they increase the risk of DIABETES by five times.

Upper G.I. bleed

hematemesis (bright red blood or coffee ground emesis)

UTI

hematuria, WBCs & bacteria in urine, nitrites. Misdiagnosed with senior dementia or alzheimer disease. Confusion UTI the most common cause of LOC changes in elderly. (e.coli, proteus)

Nephritic syndrome

hematuria, proteinuria, azotemia, oliguria, HYPERTENSION, edema

hepatic encephalopathy

high blood ammonia, asterix factoid, changes in LOC, progressive confusion, stuporous impaired thinking and judgement, neuromuscular disturbances, hyperreflexia

Asthma

hyperresponsiveness to any number of irritants, wheezing, react strongly to inhaled substances

Chronic Bronchitis

hypersecretion of thick mucous and productive cough for 3 months of the year for at least 2 consecutive years.

Risks for ATN

hypotension for 30+ mins, septic shock, dye, meds, injury, blood transfusion reaction, recent major surgery

Bilirubin

if liver does not make bile, bilirubin [blood breakdown byproduct]is not cleared from the blood

C.F Pathophysiology

impaired chloride and sodium reabsorption. Chloride movement alters vascular osmolarity and triggers sodium to shift from the secreting cells on glands and mucous membranes to the vascular space.

Uremia

increased BUN & creatinine with multiple system organ failures

Uremia

increased BUN and Creatinine WITH multiple system organ failures

Azotemia

increased BUN and Creatinine(in the blood)WITHOUT systemic s/s

azotemia

increased BUN and creatinine (in the blood) without systemic s/s

Uremia

increased BUN and creatinine with multiple system organ failures

Hyperemia

increased flow of blood due to vasodilation causes engorgement or congestion of the tissue (s/s of cellulitis and stage 1 of pressure ulcers)

Liver enzymes (AST/ALT)

increases when liver tissue has been damaged allowing enzymes to escape in blood

Decerebrate Posturing

indicates a lesion in the brainstem lower in the brainstem. Very poor prognosis.(Hands point away from body = "Brain has gone away").

HEMATEMESIS

indicates that the bleeding is from the upper gastrointestinal tract, usually from the esophagus, stomach, or proximal duodenum.

Decorticate posturing

indicates that there may be damage to the cerebral hemispheres, and possibly midbrain. An ominous sign of severe brain damage but not as bad as decerebrate posturing. (Limbs "Point to the Core" of the body).

ARDS

infection causing SIRS. Body releases chemical mediators. Clotting factors, vasodilation agents, etc. Lungs stop producing surfactant which leads to atelectasis. 1st stage-respiratory alkalosis-hyperventilation 2nd stage-acidosis, pulmonary edema, and blood clotting through lung tissue last stage-respiratory failure, 40% die from complications long term effects-permanent lung damage, psychological and cognitive development

pneumonia

inflammation of alveoli and bronchioles caused by a pathogen. Pneumonitis-noninfectious agents.

ACUTE GLOMERULONEPHRITIS(GN):

inflammation of the glomerular membrane. Primary GN-Untreated Group A streptococcal infection. Secondary GN-Caused by other diseases/conditions .•Antibodies produced against strep organism cross-react with glomerular endothelial cells •Immune complex(Ig G) formation of immune complexes(antigen/antibody complexes)in glomerulus(Type 3 Hypersensitivity).Activation of complement (involved in the clotting cascade) •Recruitment of neutrophils and macrophages •Endothelial injury from free radicals and proteases •Inflammatory mediators cause increased glomerular membrane permeability •Loss of negative charge of basement membrane •Release of growth factors →diffuse endothelial and mesangial cell proliferation •Thickened glomerular membrane •Decreased GFR due to Injury to the glomerulus, basement membrane, and glomerular capsule

Coagulation Factors

insufficient clotting factors will cause bleeding problems. (Recall from the Hematological System Unit that the "Associated Organ" for Platelets is the Liver)

Second degree

involve both the epidermis and dermis and are red to pale ivory moist-looking skin, blisters within minutes, extreme pain because nerves are still intact. 3-4 weeks healing.

Asthma (aka, Reactive Airway Disease)

is a chronic inflammatory disorder of the airway. Inflammation results from HYPER-RESPONSIVENESS of the airway to any number of airborne irritants from pollen to perfume; exercise, infections, air pollution and anxiety can all trigger an asthma attack. All the products of inflammation (chemical mediators such as histamines, bradykinins, and cytokines) go into mass production and over whelm the lungs. This results in inflammation leading to constricted airways and the characteristic "wheezing" sounds. The inflammation makes the airways swollen and very sensitive. The airways tend to react strongly to certain inhaled substances. When the airways react, the muscles around them tighten. Narrowed airways reduces airflow into the lungs. Swelling also can worsen, making the airways even narrower. Cells in the airways might make more mucus than usual. The mucus produced is sticky and thick which can further narrow the airways. This chain reaction can result in asthma symptoms. Symptoms can happen each time the airways are inflamed.

Bronchitis

is a respiratory disease in which the mucus membrane in the lungs' bronchial passages becomes inflamed. As the irritated membrane swells and grows thicker, it narrows or shuts off the tiny airways in the lungs, resulting in coughing spells that may be accompanied by phlegm and breathlessness. The disease comes in two forms: ACUTE(lasting from one to three weeks) and CHRONIC(lasting at least 3 months of the year for two years in a row). People with asthma or emphysema may also have asthmatic bronchitis, inflammation of the lining of the bronchial tubes.

Opisthotonus

is a type of spasm of the whole body that leads to legs and head being bent back and body bowed backwards. Can occur in some types of meningitis, tetanus, strychnine poisoning.

CBC

is also done to check RBCs and platelet status.

HEMATOCHEZIA

is bright red blood from the rectum (due to hemorrhoids & anal fissures, diverticulosis, or infection). Bright red blood from rectum is usually nota serious problem (although your patient will THINK it is!!!)

Rectal CA age

is increasing rapidly in the 40 to 50-yearage range. An NIH study found most patients diagnosed with colon or rectal cancer under age 50whoexperience signs & symptoms have left colon or rectal cancers and are diagnosed with more advanced diseases.

CHRONIC Renal Failure→

is permanent

Kernig's sign

is positive when the thigh is bent at the hip and knee at 90-degree angles, and subsequent extension in the knee is painful (leading to resistance).This may indicate subarachnoid hemorrhage or meningitis.

ACUTE Renal Failure→

is reversible

Brudzinski's neck sign

is the appearance of involuntary lifting of the legs when lifting a patient's head while the patient is lying supine.

Nuchal rigidity

is the inability to flex the neck forward due to rigidity of the neck muscles; if flexion of the neck is painful but full range of motion is present, nuchal rigidity is absent.

Photophobia

is the intolerance of bright light

"Meningism"

is the term used for a group of s/s that are commonly present (but not always) when the meninges are irritated, as in infection [meningitis], subarachnoid hemorrhages, or other diseases. Some or none of the signs may be present for any given patient with meningitis, but if present, is suggestive of meningeal irritation: Photophobia is the intolerance of bright light Nuchal rigidity is the inability to flex the neck forward due to rigidity of the neck muscles; if flexion of the neck is painful but full range of motion is present, nuchal rigidity is absent. Opisthotonus is a type of spasm of the whole body that leads to legs and head being bent back and body bowed backwards. Can occur in some types of meningitis, tetanus, strychnine poisoning. Kernig's sign is positive when the thigh is bent at the hip and knee at 90-degreeangles, and subsequent extension in the knee is painful (leading to resistance).This may indicate subarachnoid hemorrhage or meningitis. Brudzinski's neck sign is the appearance of involuntary lifting of the legs when lifting a patient's head while the patient is lying supine.

Decerebrate posturing

is usually indicative of more severe damage indicating a lesion in the cerebellum or lower in the brainstem. Very poor prognosis.(Hands point away from body = "Brain has gone away").

Pruritus

itching which can be severe and debilitating s/s of Contact Dermatitis: Type IV (Delayed)Hypersensitivity

Vitamin D

kidneys activate it and allow GI tract to absorb more calcium-can cause osteoporosis without it

Anemia and kidney disease

kidneys make erythropoietin which signals bone marrow to make RBCs. Without this, anemia, fatigue, and hypoxia happen.

BUN

less than 22 creation of BUN is the most important catabolic pathways for eliminating excess nitrogen in the human body. BUN only indicates kidney damage if creatinine is also elevated

BUN

less than 22-urea is the byproduct of protein metabolism in the liver. Ammonia formed in this process is synthesized to urea in the liver. Ammonia formed in this process is important catabolic pathway for eliminating excess nitrogen in the human body. BUN is an indicator for kidney damage but also dehydration-only indicates kidney damage if creatinine is also elevated.

Risks for Bites and Infestations:

living in overcrowded conditions, unsanitary conditions, insect breeding areas (i.e., standing water can provide a breeding area for mosquito larvae infected with West Nile Virus, which is found in UTAH. WNV can lead to encephalitis with permanent neurologic/physical disabilities).

ANP/BNP

low BP-natriuretic hormones

Hypoxemia

low oxygen in the BLOOD (which can then lead to hypoxia)

Hypoxia

low oxygen in the TISSUE(caused by a problem with perfusion)

Pneumonia info

lung infection caused by a number of different microorganisms. When a healthy person inhales one of these microbes, the immune system responds and prevents the microbe from reproducing and causing infection. But, in people with weakened immune systems (e.g., patients with AIDS), the microbes settle in the lungs, where they grow and multiply. As the lung tissue tries to protect itself, the lungs fill with liquid, blood,and pus. In addition to hemoptysis, other symptoms include a high fever, cough, and chest pain.

RAAS system

makes and release renin-increases BP

RAAS

makes and releases renin-increased BP.

Urinary Tract Obstruction Risk Factors

male gender, age 20-40 yrs., living in a desert or tropical region(prone to dehydration), inadequate fluid intake (sports, heavy physical work, alcohol consumption, etc.) NOTE: the modifiable risk factors all cause dehydration.

OVERTGI bleeding

may manifest as hematemesis, melena, or hematochezia

Cognition

means thinking skills that include awareness, language calculation and memory.

Azotemia

mental confusion-increased BUN & creatinine (in the blood) WITHOUT systemic s/s

Non-small lung cancer

most common

TB

most common cause of hemoptysis, fever, night sweats, wt loss, fatigue Isolation rm, N95 caregivers/visitors, standard surgical mask in public for pt.

ANP

natriuretic peptide that lowers BP when too high released by heart atria, blocks aldosterone secretion and action and inhibits renin secretion.

BNP

natriuretic peptide that lowers BP when too high ventricular. Important in diagnosing heart failure. Produced when heart muscle stretches too far.

ANP/BNP

natriuretic peptides that lower BP. Causes the kidney to excrete sodium. Since water goes out of the body, this will decrease overall fluid volume and BP will go down.

Obtundation

needs continuous stimuli to maintain arousal

Hep C

no vaccine-blood/body-antiviral interferon

Fixed specific gravity

number never changes means kidney no longer concentrates or dilutes urine. Indicator/late sign of kidney failure. (acute tubular necrosis)

Signs and Symptoms of ATN

o Central Nervous System: Change in LOC, confusion, delirium (due to Hypernatremia and cerebral edema) o Oliguria or anuria: due to severe kidney damage. o Full body EDEMA: due to fluid and sodium retention. Also due protein loss through tubules. o Cardiac Problems: due to potassium imbalance (kidneys control excretion of potassium). o Fixed Specific gravity: LATE sign of END STAGE kidney failure.

EARLY signs of ICP

o Decreased LOC o Pupil changes: PERRLA("Pupils Equal, Round, Reactive to light, and Accommodation") o Vision abnormalities (brain swelling is putting pressure on the optic and oculomotor nerves) o Headache o Vomiting (pressure on the vagal nerve center of the brain that controls vomiting) o Nuchal rigidity-stiff neck(see "Meningitis" s/s later in the outline

Metabolic Bone Disease: Osteomalacia, Osteopenia, Osteoporosis

o Disorders of bone strength/mass/structure o Caused by abnormalities in absorption of vitamin D or minerals (calcium or phosphorus)

Osteoporosis RISK FACTORS

o Family history of osteoporosis o Genetics: Thin build, Caucasian, or Asian race o Gender: Women o Menopause(reduction in estrogen levels) o Lifestyle: Smoking, cola drinks, excessive alcohol consumption o Eating disorders or metabolism problems (reduced intake or absorption of vitamins and minerals, i.e., Calcium, Vitamin D). o Limited physical activity(weight-bearing exercise strengthens bones) o Chemotherapy, or medicines such as steroids

Serious Complications Associated with Orthopedic Injuries

o Venous Thromboembolism/Fat Embolism (pg 4of outline) o Hypovolemic Shock (severe blood loss)pg 3below o Infection -Osteomyelitis o Compartment syndrome(limb-threatening complication)see pg. 3of outline o Acute Tubular Necrosis/Acute Kidney Injury**Remember ATN from the Renal Unit? Kidney damage begins soon after loss of blood perfusion as would happen in blood loss from a trauma or break in a femur or pelvis.

Pressure ulcer stages

o(Suspected) deep tissue injury-A purple or maroon localized area of discolored intact skin or blood-filled blister due to damage of underlying soft tissue from pressure or shear o Stage I -Intact skin with signs of impending ulceration, initially presenting non-blanchable erythema(redness)indicating reactive hyperemia o Stage II -A partial-thickness loss of skin involving epidermis and dermis o Stage III -A full-thickness loss of skin with extension into subcutaneous tissue but not through the underlying fascia o Stage IV -A full-thickness tissue loss with extension into muscle, bone, tendon, or joint capsule o Unstageable-A full-thickness tissue loss in which the base of the ulcer is covered by slough or eschar to such an extent that the full depth of the wound cannot be appreciated

small lung

oat cell CA. Chemotherapy tx.

GI bleed s/s

occult blood-nonvisible and overt-hematemesis, melena, or hematochezia

Compartment Syndrome

occurs when injured tissue swells within the fascia and connective tissues inside of a limb causing an increase in the pressure within that "compartment" which causes ischemia, nerve damage and potentially the loss of a limb if not immediately treated. Muscle necrosis can occur in as little as 4 to 8 hours and irreversible damage can occur within24 hours after injury. Both fractures and crush injuries can create a compartment syndrome situation but should also be considered as a possibility if the patient experiences unusual pain and immobility after vigorous exercise. **Vigilant nursing assessment of potential compartment syndrome is essential to save the tissue and function of the affected appendage, so remember to assess the 5 P's!

Metabolism

of protein. Protein digested in Small Intestine →Ammonia byproduct →liver and metabolized into urea →sent to kidney for removal in urine.

Hepatitis A

oral/fecal-foodborne-IgG given after, Harrix 3wks before

Dementia

organic brain degeneration, progressive, untreatable, irreversible decline in mental function

Lethargy

oriented but slowed motor and speech

Pa02

partial pressure of oxygen in arterial blood

Signs of bleeding tendencies

permanent kidney failure due to coagulopathies

Kernig's sign

positive when the thigh is bent at the hip and knee at 90-degreeangles, and subsequent extension in the knee is painful (leading to resistance).This may indicate subarachnoid hemorrhage or meningitis.

Glomerulonephritis

presence of antigen-antibody complexes inflammation of glomerular membrane. Group A strep infx untreated (HA, high BP, face/eye edema, lethargic, low grade fever, wt gain-proteinuria, hematuria, oliguria, dysuria) can result in nephritic syndrome.

Glomerulonephritis

presence of antigen/antibody complexes. Primary-untreated group A strep infx. Low GFR. (Headache, hypertension, periorbital edema)

Did you know that Christopher Reeve (who was quadriplegic and wheelchair bound for 9 years) actually died from complications of an infected _____!

pressure ulcer

Healthcare costs increase dramatically due to ____. The inpatient length of stay is 3-5 times longer for those with these.

pressure ulcers

Chronic renal failure(CRF)

progresses over at least 3 months → permanent renal failure.

Hiatal hernia

protrusion of upper stomach causing congestion of blood flow and ischemia-causes s/s with GERD-can mimic heart attack-needs to be ruled out

A blockage or abnormality of the urinary system, such as those caused by stones, tumors, congenital deformities, or loss of bladder function from nerve disease, increases a person's risk of .

pyelonephritis

Erythema

redness of the skin. Caused by vasodilatation related to inflammation, infection, or injury. Stage I of pressure ulcers-Intact skin with signs of impending ulceration, initially presenting non-blanchable erythema(redness)indicating reactive hyperemia First degree burns -erythema, pain, epidermal destruction only (partial thickness). Heals quickly without scarring. The skin maintains its ability to function as a water vapor and bacterial barrier. Heals in 3-10 days. Example: Sunburn or an injury caused by briefly touching a hot pan, curling iron, etc.

RENAL FAILURE

refers to temporary or permanent damage to the kidneys that result in loss of normal kidney function. There are two different types of renal failure -acute and chronic

Meningitis Rx

related to pathogen (antibiotic or antifungal meds); vaccination is available against some pathogens.

ANP

released by atria-blocks aldosterone secretion and action and inhibits renin secretion.

CLINICAL MANIFESTATIONSOF KIDNEY STONES

renal colic, hematuria, nausea and vomiting, flank pain or pain that spreads to the lower abdomen/groin. Pain caused by a kidney stone may change —for instance, shifting to a different location or increasing in intensity —as the stone moves through the urinary tract. Pain associated with kidney stones can be severe(give narcotic pain meds) and IV fluids to help flush the kidney. Patient may need lithotripsy to break up stones.

coffee ground vomitus

results from the partial gastric digestion of blood

Cirrhosis

scarred liver tissue The most common cause of cirrhosis is chronic alcohol use[Alcoholic Hepatitis]. Ethyl alcohol (ETOH)is oxidized by the liver to acetaldehyde which damages hepatocytes.

Cirrhosis

scarred liver tissue caused by chronic alcohol use-alcohol hepatitis. ETOH is oxidized by the liver to acetaldehyde which damages hepatocytes. Also can be caused by vital hepatitis or hepatoxic drugs (tylenol). Causes porta hypertension/fluid backup-esophageal varices, hemorrhoids, splenomegaly AND protein loss causing ascites and lung congestion, spider angiomas-face, neck, shoulders, jaundice, edema.

Hypothalamus

secretes tropic hormones that target the anterior pituitary. knows the state of the body and maintains homeostasis. The hypothalamus produces releasing and inhibiting hormones, which stop and start the production of other hormones throughout the body. The hypothalamus is involved in many functions of the autonomic nervous system, as it receives information from nearly all parts of the nervous system. "Thyrotropin-releasing" hormone, "Gonadotropin-releasing" hormone, "Corticotrophin-releasing" hormone, etc. are examples of some of the releasing hormones generated by the hypothalamus. Somatostatin and Dopamine are examples of inhibiting hormones.

Shearing

seen in pressure ulcers

Symptoms of pulmonary embolism:

shortness of breath(S.O.B.), chest pain, s/s of hypoxia, and cough.

s/s of pulmonary embolism

shortness of breath(S.O.B.), chest pain, s/s of hypoxia, and cough.

Chronic viral hepatitis

slowly attacks the liver over many years without causing symptoms. When s/s do appear, they are vague and nonspecific, so Hepatitis can go undetected until significant liver damage is present. An estimated 4.4 million Americans are living with chronic (lifelong) hepatitis. Most do not know they are infected.

TUBERCULOSIS

so named because the bacteria form "tubercles" -an airborne transmitted infection that can spread through the lymph nodes and bloodstream to any organ in the body but primarily strikes the lungs. The Mycobacterium can stay in "suspended animation" for years before manifesting if at all. A single cough can generate 3000 infective droplets, with as few as 10 bacilli needed to initiate infection. TB is still considered the top infectious "Killer" in the world(followed by AIDS/Hepatitis/Malaria). New and dangerous forms of the disease --resistant to some of the commonly used drug treatments --have created a public health crisis in many large cities worldwide. TB can be either ACTIVE TB(infected, symptomatic AND contagious) or LATENT TB(infected but not symptomatic and not contagious). Latent TB can develop into active TB.

Electrolyte imbalance & kidney disease

sodium loss & potassium retention cause permanent kidney failure in oliguric phase

LFTs

specifically the liver enzymes ALT and AST

GERD

sphincter does not close completely allowing backflow heartburn 30-60 mins after meals, taking antacids can lead to high NA, Ca, and magnesium. s/s: pain is worse when lying down or bending over

ARDS

starts with an Acute lung injury/insult(ALI) of some type (infection/sepsis, trauma, hypoxic event, aspiration of gastric juices/vomit, pulmonary embolism, blood transfusion reaction, etc.)that causes SEVERE LUNG INFLAMMATION-also referred to as SIRS[Systemic Inflammatory Response Syndrome].In response to lung injury, the body releases chemical mediators, clotting factors, vasodilating agents, etc. which damage the lung further. In particular the alveoli and surrounding capillary bed is severely damaged and rendered useless. The lung stops producing surfactant(the oily substance that holds the lung in place in the chest cavity and keeps the alveoli from collapsing inside the lung) which leads to atelectasis.

Nuchal rigidity

stiff neck is the inability to flex the neck forward due to rigidity of the neck muscles; if flexion of the neck is painful but full range of motion is present, nuchal rigidity is absent. s/s of meningitis

Transverse Fx

straight across the bone

Signs of a GI bleed

sudden agonizing pain RIGID ABDOMEN OCCULT GI bleeding OVERT GI bleeding HEMATEMESIS MELENA HEMATOCHEZIA

If the reflux is severe enough, a _____ can be done (a Nissen Wrap/ fundoplication-say that fast 5 times!) this surgery wraps the top part of the stomach around the esophagus to make a tighter sphincter. Once this is done, the patient will not be able to vomit or belch air from the stomach.

surgery

Atelectasis is common soon after

surgery or in patients who have limited mobility in the hospital(secretions build up in the lungs due to immobility). Pneumonia may develop quickly after atelectasis starts in the affected part of the lung. In an adult, atelectasis in a small area of the lung is usually not life threatening. The rest of the lung can make up for the collapsed area, bringing in enough oxygen for the body to function. But large areas of atelectasis may be life threatening, especially in a baby or small child, or in someone who has another lung disease or illness.

Treatment of lung cancer

surgery, chemotherapy, and/or radiation. When lung cancer spreads too far to be cured, treatments can still help patients live longer and have a better quality of life. Radiation and chemotherapy can shrink tumors and help control symptoms, such as bone pain or blocked airways.

S/S of cystic fibrosis

tasting skin, repeated lung infections, inability to gain weight ("failure to thrive" in kids), greasy/fatty stools (due to lack of digestive enzymes).

PT, PTT, INR

test for bleeding problems

Ammonia

test to measure liver's ability to break down protein

occult blood smear

tests stool samples for hidden blood

Metabolic changes due to burns

the basal metabolic rate increases up to three times its original rate. This, in addition to visceral organ hypoperfusion, necessitates early and aggressive enteral feeding (tube feeding) to decrease catabolism and maintain gut integrity. The body's stress response is triggered →increased catecholamine(causing heart dysrhythmias) and cortisol excretion (high blood glucose could result).❖Catabolism(muscle wasting) must be controlled with enteral feedings or the body will steal protein from the heart muscle after skeletal muscle is depleted as an energy source. ❖Stress hormones excreted→ hyperglycemia and GI bleed/ulcers. ❖Hyperkalemia(potassium released into the blood stream from damaged cells) causes ACIDOSIS. ❖Skin Breakdown due to edematous tissue (degrades quickly) and tissue wasting (impedes tissue repair).

Most infections involve the lower urinary tract

the bladder and the urethra. Also called "Cystitis" which is more specifically an infection of the bladder. Treatable with antibiotics (ABX).

Dawn phenomenon

the blood glucose level gradually rises through the night in response to cortisol release. This stimulates the liver to excrete glycogen throughout the night so there is no hypoglycemic episode as there is with Somogyi's. Instead the glucose rises steadily throughout the night.["Rises gradually likethe sunat DAWN"].

Pneumonia s/s

the lungs fill with liquid, blood, and pus. In addition to hemoptysis, other symptoms include a high fever, cough, and chest pain.

Non-Small Cell Lung Cancers

the most common type of lung cancer(about 85%).Squamous cell carcinoma, adenocarcinoma, and large cell carcinoma are all subtypes of non-small cell lung cancer.

Cirrhosis(scar tissue) prevents

the normal flow of blood through the liver causing fluid back-up that leads to PORTALHYPERTENSION. Also, damaged liver tissue cannot synthesize protein, so there is not enough protein in the blood to pull fluids out of the tissue leading to ACITES.

Meningism

the term used for a group of s/s that are commonly present (but not always) when the meninges are irritated, as in infection [meningitis], subarachnoid hemorrhages, or other diseases.

Stress ulcers are so common in hospitalized patients that

they are given an acid-suppressing medication by IV prophylactically to prevent ulcers from occurring to begin with(usually pantoprazole/Protonix).

Pathologic Posturing

to painful stimuli indicates serious brain damage. "Abnormal Flexion" = Decorticate and "Abnormal Extension" = Decerebrate posturing.

Measuring HYPOXEMIA

too little oxygen in the blood PaO2 = measures oxygen in the blood -80-100mm Hg Obtained from an arterial blood sample (ABG*) but requires a painful needle into an artery to get blood. More accurate than an oxygen saturation measurement

Measuring HYPOXIA

too little oxygen in the tissue SaO2 = measures tissue perfusion -pulse oximeter reading>95% Obtained from an oxygen saturation measurement [probe applied to finger, toe, earlobe, etc.] Less accurate than an ABG blood draw, but painless and noninvasive.

Bile

transports Bilirubin [blood breakdown byproduct], and cholesterol o Buildup of bilirubin in the tissues →jaundice(yellow) in skin and sclera, and o Buildup of Cholesterol(hyperlipidemia)

Indicators of hypoxia

tripod position Use of accessory muscles cyanosis

Severe hypoxia

tripod position, accessory muscle use, cyanosis

orthopnea

trouble breathing when laying down flat

BNP

ventricular-helps dx HF, produced when the heart muscle is stretched out too far

"Bright red emesis"

very dangerous sign-requires emergency treatment

Stupor

vocalization to pain, has decreased motor movement

Azotemia

waste products that contain nitrogen buildup in the bloodstream.

In cystic fibrosis, because sodium is leaving the tissue,

water follows which leads to dehydration of the tissue. As a result, the mucous in the lungs, pancreas and biliary ducts gets very thick (and obstructs normal processes).Interesting note: CF is often discovered by moms who taste salt on the skin of their babies when they kiss them.

Esophageal varices

when hypertension causes veins to distend and burst bright red blood indicates this happened

PT, PTT, INR

will be drawn to test for bleeding problems.

Risk factors for developing ATELECTASIS include:

~Anesthesia*~Foreign object in airway (common in children)*~Lung diseases(inflammation blocks airways)*~Mucus that plugs the airway*~Prolonged bed rest w/few changes in position*~Shallow breathing (i.e., hurts to breathe)*~Pressure on lungs caused by pleural effusion**~Tumors that block an airway**

Lung diseases can also increase the chance of getting a collapsed lung. These include

~Asthma ~COPD ~Cystic fibrosis ~Tuberculosis ~Whooping cough

STAGES of Alzheimer's disease:

~First: Short-term memory loss ~Second: Confusional stage (Disorientation, lack of insight, impaired hygiene and language use, "sundowner" syndrome) ~Third: Incontinence; long-term memory loss(inability to recognize family and friends)

Respiratory changes from burns

—Inflammatory mediators cause bronchoconstriction, and in severe burns adult respiratory distress syndrome(ARDS)can occur. o Inhalation of super-heated air instantly "boils" the throat/airway tissue o Airway closes rapidly -Immediate intubation is required o Burns above the nipple line, singed facial hair, soot around face == need for rapid intubation o Enclosed spaces (closets, furnace rooms, sheds, etc.)== high risk for inhalation injury Pleural edema (fluid trapped in the interstitial tissue of the lungs due to loss of protein molecules through burned tissue)→left-sided heart failureInhalation of caustic fumes (natural products of combustion; chemicals; petroleum)→inhalation pneumoniaBronchoconstriction (caused by chemical mediators) and Pneumonia (due to fluid overload & sepsis).

S/S of Osteoporosis:

•A fracture that occurs more easily than expected •Back pain, 2ry to fractured or collapsed vertebra •Loss of height over time •A stooped posture

Unconsciousness related to death

•Cerebral death-An irreversible coma or a persistent vegetative state •Brain death-absent cerebral function and unable to maintain physiologic homeostasis

Pathophysiology-infection with bacterial organisms (E. Coli most common). Individuals at high risk:

•Females > than males due to anatomy •Toddlers (especially little girls) •Sexually active female •Individuals with diabetes mellitus •Indwelling urinary catheter •Prostatic hypertrophy/obstructions to urine flow

Hyperglycemic signs of impending danger:

•Fruity breath: due to increased ketones in blood •Dehydration: due to increased loss of water and electrolytes (skin "Hot & Dry") •Kussmaul respirations: Rapid, deep breathing to blow off CO2 (an acid) to compensate for acidosis

Clinical Manifestations of UTI's.

•May have no symptoms •Frequent urination •Urgent need to urinate •Dysuria(painful urination •Suprapubic or low back pain •Hematuria, WBCs and bacteria in urine •Nitrites in urine •Cloudy urine

Signs/Symptoms of acute renal failure depend on the underlying cause.

•Oliguria or Anuria •Anemia s/s (fatigue/short of breath) •Nausea and vomiting •Abdominal pain •Edema (due to fluid retention) •Periorbital edema •Pale skin(due to anemia, ⬇erythropoietin) •History of taking certain medications •History of trauma •History of recent infection •SEE Acute Tubular Necrosis (ATN)

Treatment for Cerebral Edema:

•Positioning of patient -Head of bed elevated 30 degrees (gravity allows for better brain drainage). •Hypertonic IV fluids-to pull fluid out of the brain. Examples: hypertonic saline and mannitol(a sugar alcohol that attracts fluid out of the brain). •Diuretics-medication to increase the production of urine, to help reduce fluid overload. •Corticosteroids-to suppress the inflammatory response and reduce swelling in the brain. •Surgical decompression-removing part of the skull allows the brain to swell without being compressed.

S/S of Meningitis:

•Throbbing headache •Nuchal rigidity(stiff neck) •Fever •Photophobia •Projectile vomiting •Altered LOC •Increased ICP •Red purpuric or blotchy rashes that do not blanch when applying pressure •Kernig's sign and/or Brudzinski's sign may be present (see diagram below under Meningism).

S/S of Meningitis:

•Throbbing headache •Nuchal rigidity(stiff neck) •Fever •Photophobia •Projectile vomiting •Altered LOC •IncreasedICP •Red purpuric or blotchy rashes that do not blanch when applying pressure •Kernig's sign and/or Brudzinski's sign may be present

STRESS

→Hypothalamus →Anterior Pituitary →ACTH →Adrenal Cortex →Cortisol Release

Ossification

→final laying down of bone. Fragments are firmly united. Mature bone replaces callus. Safe to remove cast.

Remodeling

→involves resorption of the excess bony callus that develops in the marrow space and encircles the external aspect of the fracture site.

Hematemesis can be either

▪"Bright red emesis" (very dangerous sign-requires emergency treatment) ▪"Coffee-ground emesis "due to partial digestion of blood in the stomach by stomach acids.

Other possible causes of glomerular injury

▪Drugs or toxins ▪Vascular disorders ▪Systemic diseases (diabetes, Lupus) ▪Viral infection

Causes of nephrotic syndrome

▪Glomerulonephritis ▪Genetic defects in the glomerular membrane ▪Systemic diseases (Diabetes, Lupus, etc.) ▪Drugs ▪Infections Only protein is found in the urine sample (No RBCs, no WBCs, no bacteria)

Symptoms of Autonomic Dysreflexia:

▪HTN(due to vasoconstriction); ▪A slow heartrate (bradycardia)-to compensate for HTN. ABOVE the injury-PARASYMPATHETIC Nervous System dominates -causing vasodilation! ▪A flushed face and/or red blotches on the skin above the level of spinal injury(due to vasodilation).Nasal congestion(sinus vasodilation).Pounding headache(vasodilation in brain and HTN). ▪Sweating above the level of spinal injury(activation of glands by parasympathetic NS). BELOW the injury-S y m p a t h e t i c Nervous System dominates -causing vasoconstriction!▪Pale, cold, clammy skin below the level of injury(due to vasoconstriction).▪Goose bumps below the level of spinal injury.

Symptoms of Autonomic Dysreflexia:

▪HTN(due to vasoconstriction); ▪A slow heartrate (bradycardia)-to compensate for HTN.ABOVE the injury-Parasympathetic Nervous System dominates -causing vasodilation! ▪A flushed face and/or red blotches on the skin above the level of spinal injury(due to vasodilation).Nasal congestion(sinus vasodilation).Pounding headache(vasodilation in brain and HTN). ▪Sweating above the level of spinal injury(activation of glands by parasympathetic NS). BELOW the injury-S y m p a t h e t i c Nervous System dominates -causing vasoconstriction! ▪Pale, cold, clammy skin below the level of injury(due to vasoconstriction). ▪Goose bumps below the level of spinal injury.

Acute Complications

▪Intestinal obstruction or perforation ▪Perianal abscesses, fistulas ▪May require removal of the inflamed intestine requiring an "ostomy"

6 GLANDS you need to know...

✓In the BRAIN: Hypothalamus and Pituitary glands ✓In the THROAT: Thyroid and Parathyroid glands ✓In the ABDOMEN: Pancreas and Adrenal glands

Natriuretic*Hormones:ANP/BNP work together to lower Blood Pressure

➢Atrial(ANP) is released by the heart atria, blocks aldosterone secretion and action; and inhibits renin secretion. ➢Ventricular(BNP) -produced by the heart ventricles. This is important in diagnosing heart failure. It is produced when the heart muscle is S T R E T C H E D out too far.*Natriuretic hormones cause the kidney to excrete sodium (natrium). Since water follows sodium out of the body, this will decrease overall fluid volume and blood pressure will go down.