Study For Patho # 2 Several, Chapter 28 Alterations of Pulmonary functions in children mid, Pathophysiology Ch. 27 Alterations of Pulmonary Function mid, Chapter 26 Structure and function of pulmonary system, Chapter 26: Structure/function of the Pul...

Clinical manifestations skin hyper pigmentation

***increased ACTH levels activates melanocytes causing skin hyper pigmentation; could be due to other hormones as well

Central or Secondary Hypothyroidism causes

***less common*** -d/t pituitary or hypothalamic failure -TSH, T3, T4 will all be LOW

Clinical manifestations immune suppression

- (body things we can spare our energy)

Plasma

- 50% to 55% of the blood volume - Liquid portion that contains organic and inorganic elements

Composition of blood

- 92% water and 8% solutes -6 quarts (5.5 L)

Ventricular septal defect (VSD)

- Abnormal communication between the ventricles - Most common type of congenital heart lesion - Two types

Atrial septal defect

- Abnormal opening between the atria; blood flows from left atria to right atria - Ostium primum defect, Ostium secundum defect, Sinus venosus defect

Emphysema

- Abnormal permanent enlargement of the gas-exchange airways accompanied by destruction of alveolar walls without obvious fibrosis - Inherited deficit of α1-antitrypsin - Loss of elastic recoil

Manifestations of Tetralogy of Fallot

- Acute cyanosis at birth or gradual cyanosis - Gradual clubbing, poor growth; Tet spells - If untreated, emboli, stroke, brain abscess, seizures

Obstructive lung diseases

- Airway obstruction that is worse with expiration - Common S/S dyspnea and wheezing

Common obstructive disorders

- Asthma - COPD - Emphysema - Chronic bronchitis

Manifestations of atrial septal defect

- Asymptomatic at early age - Pulmonary symptoms on exertion at later age

Extramedullary hematopoiesis

- Blood cell production in tissues other than bone marrow i.e. spleen and liver - Usually a sign of disease

COPD

- Characterized by persistent airflow limitation - Usually progressive - Most common chronic lung disease in world

Asthma

- Chronic inflammatory disorder of the airways - Inflammation results from hyperresponsiveness of the airways - Can lead to obstruction and status asthmaticus - Symptoms include expiratory wheezing, dyspnea, and tachypnea - Peak flow meters, corticosteroids, beta agonists, and anti-inflammatories used to treat

Atelectasis

- Compression atelectasis - Absorption atelectasis - Surfactant impairment - partial or complete collapse of the lung

S/S of Pulmonary Disease

- Cough - Abnormal sputum - Hemoptysis - Abnormal breathing patterns (Kussmaul and Cheyne-Stokes respirations) - Hypoventilation - Hyperventilation - Cyanosis - Clubbing - Pain

Chief functions of the hematologic system

- Delivery of substances needed for cellular metabolism - Removal of wastes - Defense against microorganisms and injury - Maintenance of acid-base balance

Hematopoietic stem cells (HSCs)

- Develop into blood cells - Colony-stimulating factors (CSFs)

Platelets

- Disk-shaped cytoplasmic fragments - Essential for blood coagulation and control of bleeding

Lymph nodes

- Facilitate maturation of lymphocytes - Transport lymphatic fluid back to the circulation - Cleanse the lymphatic fluid of microorganisms and foreign particles

Kussmaul respirations

- Hyperpnea - Deep and labored breathing

Chronic bronchitis

- Hypersecretion of mucus and chronic productive cough that lasts for at least 3 months of the year and for at least 2 consecutive years - Inspired irritants increase mucus production and the size and number of mucous glands - The mucus is thicker than normal - Bronchodilators, expectorants, and chest physical therapy used to treat

Pulmonary fibrosis

- Idiopathic - A respiratory disease in which scars are formed in the lung tissues, leading to serious breathing problems

Manifestations of coarctation of the aorta

- If severe decreased CO, acidosis, hypotension at birth - If undiagnosed, no manifestations until find hypertension in upper extremities at older age

Manifestations of aortic stenosis

- Infant: if significant faint pulses, hypotension, tachycardia, and poor feeding - Older children: may have complaints of exercise intolerance - Risk for bacterial endocarditis

Bronchiolitis

- Inflammatory obstruction of the small airways - Most common in children - Occurs in adults with chronic bronchitis, in association with a viral infection, or with inhalation of toxic gases

Eosinophils

- Ingest antigen-antibody complexes - Induced by IgE hypersensitivity - Increase in parasitic infections

Pneumonia

- Lower respiratory tract infection - Caused by bacteria, viruses, fungi, protozoa, or parasites - Healthcare acquired (HCAP) or community acquired (CAP)

Manifestations of VSD

- May be asymptomatic - If severe: increased pulmonary blood flow from left-to-right shunt; pulmonary hypertension (Eisenmenger syndrome)

Granulocytes

- Membrane-bound granules in their cytoplasm - The granules contain enzymes capable of destroying microorganisms - Inflammatory and immune functions - Capable of ameboid movement (diapedesis)

Agranulocytes

- Monocytes and macrophages make up the mononuclear phagocyte system (MPS) - Monocytes: immature macrophages - Macrophages: in tissues - Lymphocytes: mature to T cells, B cells, plasma cells - Natural killer (NK) cells

Erythrocytes

- Most abundant cell in the body - Responsible for tissue oxygenation - Biconcavity and reversible deformity - 120-day life cycle

Pneumococcal

- Most common and lethal form of pneumonia

Tuberculosis

- Mycobacterium tuberculosis - Acid-fast bacillus - Airborne transmission - Tubercle formation - Caseous necrosis - Positive tuberculin skin test (PPD)

Aortic stenosis

- Narrowing of the left ventricular outlet - Causes increased workload on left ventricle and left ventricular hypertrophy - Various types

Pulmonic stenosis

- Narrowing of the pulmonary valve causing resistance to flow from right ventricle to pulmonary artery - Right ventricular hypertrophy - Pulmonary atresia

Pulmonary embolus

- Occlusion of a portion of the pulmonary vascular bed by a thrombus, embolus, tissue fragment, lipids, or an air bubble - Pulmonary emboli commonly arise from the deep veins in the lower leg - Virchow triad (Venous stasis, hyper-coagulability, and injuries to the endothelial cells that line the vessels)

Venous sinuses

- Phagocytosis of old, damaged, and dead blood cells - Blood storage: 300ml

Neutrophils

- Polymorphonuclear neutrophil (PMN) - Phagocytes in early inflammation

Cor pulmonale

- Pulmonary heart disease - Right ventricular enlargement - Secondary to pulmonary hypertension - Pulmonary hypertension creates chronic pressure overload in the right ventricle

Types of non-small cell lung cancer

- Squamous cell carcinoma - Adenocarcinoma - Large cell carcinoma

Dyspnea

- Subjective sensation of uncomfortable breathing

Risk factors for COPD

- Tobacco smoke - Occupational dusts and chemicals - Air pollution - Any factor affecting lung growth during gestation and childhood

Inhalation disorders

- Toxic gases - Pneumoconiosis - Silica - Asbestos - Coal

Mixing Defects

- Transposition of the great arteries - Aorta arises from the right ventricle and the pulmonary artery arises from the left ventricle - Results in two separate, parallel circuits

Pleural Abnormalities

- Transudative effusion - Exudative effusion - Empyema - Chrlothorax

Clinical manifestations protein wasting

- which means they'll have skinny limbs

Clinical Manifestations cortisol-induced insulin resistance

-(receptors on target cell affected), therefore, there is an increase in gluconeogenesis and usage of glycogen storage

With SIADH, the patient will have low serum osmolarity, which means

-<225 -low amount of electrolytes in comparison to water -HYPONATREMIA (<135)**

Patients with SIADH have abnormally high

-ADH/vasopressin secretion -leading to an increased number of aquaporin channels in the renal collecting ducts, retaining water

Hypoplastic left heart syndrome

-Abnormal development of the left-sided cardiac structures (Obstruction to blood flow from the left ventricular outflow tract) -Underdevelopment of the left ventricle, aorta and aortic arch; mitral atresia or stenosis; coarctation of the aorta -Manifestations occur early in newborn (cyanosis, tachypnea, decreased CO) -Fatal in early life if untreated

Stages of the Kawasaki Disease

-Acute: capillaries, venules, arterioles, and the heart become inflamed -Subacute: inflammation of larger vessels; coronary aneurysms appear -Convalescent: medium-sized arteries begin granulation process; small vessel inflammation decreases -Post-convalescent: scarring of vessels, thickening of tunica intima, calcification, coronary artery stenosis

Anterior Pituitary secretes

-Adrenocorticotropic hormone (ACTH) releases cortisol -Melanocyte-stimulating hormone (MSH) promotes pituotary secretion of melatin -Somatotropic hormones Growth hormone: Prolactin(breast milk) -Glycoprotein hormones:egg/sperm Follicle-stimulating hormone Luteinizing hormone: female and male, progesterone and testosterone -Thyroid-stimulating hormone -Luteinizing hormone-reproduction process -Follicle-stimulating hormone -Beta-lipotropin -Beta-endorphins: help rel

Secreted by the posterior pituitary

-Antidiuretic hormone (ADH): diuretics release fluid so antidiuretic retain fluid and increase plasma --Controls plasma osmolality -Oxytocin Uterine contractions and milk ejection in lactating women

Adrenal Cortex disorders: Primary Hyperaldosteronism

-Conn's Syndrome; too much salt -abnormality of the adrenal cortex

Who is at risk for developing hypoparathyroidism?

-DiGeorge syndrome -family history of parathyroid disorder -autoimmune endocrine diseases, e.g., Addison's disease (attacking parathyroidism) -r/t alcoholism, malnutrition, malabsorption, TPN, chemo, ATB therapy

The Endocrine System Functions:

-Differentiation of reproductive system and CNS in fetus -Stimulation of growth and development -Coordination of the male and female reproductive systems -Maintenance of internal environment:homeostasis -Adaptation to emergency demands of body

Mechanism of Hormone Action: Lipid-soluble hormones

-Easily diffuse across the plasma membrane and bind to cytosolic or nuclear receptors -Steroid hormones

Patent ductus arteriosus

-Failure of the ductus arteriosus to close -allows blood to shunt from the aorta to pulmonary artery causing left-to-right shunt

Primary hyperthyroid conditions include

-Graves disease (autoimmune) -toxic multi-nodular goiters -thyroid cancer -thyrotoxic crisis or thyroid storm

Heart Failure

-Heart is not able to maintain cardiac output at level that meets demands of body -Result from poor ventricular function -Complication of many congenital heart defects

Mechanism of Hormone Action: Water-soluble hormones

-High molecular weight -Cannot diffuse across the plasma membrane -First messenger:(insulin, binds to plasma membrane) Hormone Signal transduction -Second-messenger molecules: Calcium Cyclic adenosine monophosphate (cAMP) Cyclic guanosine monophosphate (cGMP) Tyrosine kinase system Inositol triphosphate (IP3)

Grave's disease is a Type...

-II hypersensitivity/autoimmune disorder

Coarctation of the aorta manifestations

-If severe decreased CO, acidosis, hypotension at birth -If mild, no manifestations until find hypertension in upper extremities at older age

Hormones are released:

-In response to an alteration in the cellular environment -To maintain a regulated level of certain substances or other hormones-homestasis

Inappropriate amounts of hormone deleviered to targer cell

-Inadequate hormone synthesis -Failure of feedback systems -inactive hormones -dysfunctional delivery. system

Adrenal medulla

-Innervated by the sympathetic nervous systems; epinephrine is majority thats released; stimulate fight or flight -Chromaffin cells (pheochromocytes) --Chromaffin cells secrete the catecholamines epinephrine (majority) and norepinephrine -Release of catecholamines has been characterized as a fight or flight response -Catecholamines promote hyperglycemia bc need to increase blood sugar levels

Adrenal Glands

-Located close to upper pole of each kidney -adrenal cortex -adrenal medulla

Hypertension in children differs from adults because:

-Often has an underlying disease -Renal disease or coarctation of aorta -A cause of the hypertension in children is almost always found

Aging and the Endocrine System

-Organ atrophy and weight loss with vascular changes -Decreased secretion and clearance of hormones -Variable change in receptor binding and intracellular responses: they may not be able to uptake hormones as well bc may not be able to bind them old people go to bed early bc melatonin builds in body earlier glucose intolerance bc not eating as much decreased sexual activity decreased calcitonin so decreased bone density and increased risk of fractures

Intracellular disorders have acquired defects in

-POST-receptor signaling cascades -INSIDE the target cell

Amylin

-Peptide hormone co-secreted with insulin -Delays nutrient uptake: delaying gastric emptying after meals -Suppresses glucagon secretion

Cerebrovascular Disease

-Perinatal stroke -Childhood stroke --Ischemic - sickle cell, cerebral arteropathies, cardiac anomalies --Hemorrhagic - congenital AV malformations

Pancreatic somatostatin

-Possible involvement in regulating alpha- and beta-cell secretions: inhibit secretion of insulin polypeptides Gastrin,ghrelin,andpancreaticpolypeptidesstimulate appetite

Lipid-soluble hormones are primarily circulating bound to a carrier

-Rapid and long-lasting response -Diffuse freely across the plasma and nuclear membranes and bind with cytosolic or nuclear receptors -have to be attached to something to move through the plasma -estrogen , progestrogen -rapid with long lasting effects last from hours to days

melatonin regulates

-Regulates circadian rhythms and reproductive systems: more melatonin, more sleepy, bring down resp. rate; as it wears off we start to wake up during the day -Role in onset of puberty: assists in release of gonadotropin

Secondary Hyperparathyroidism

-SOMEWHERE ELSE AFFECTING THE THYROID -compensatory response of parathyroid glands to chronic hypocalcemia -associated with DECREASED renal activation of vitamin D (renal failure) or malabsorption within the gut; both organs are causing low Ca+

Glucagon

-Secretion is promoted by decreased blood glucose levels -Stimulates glycogenolysis:breakdown of glycogen, gluconeogenesis, and lipolysis

islets of Langerhans

-Secretion of glucagon and insulin Cells: Alpha—glucagon-stimulate breakdown of glycogen Beta—insulin-opposite effect of glucagon and amylin Delta—somatostatin and gastrin- F cells—pancreatic polypeptide:digestive enzymes

Water-soluble hormones circulate in free, unbound forms

-Short-acting response -Bind to surface receptors -lasting seconds to minutes

Parathyroid glands

-Small glands located behind the upper and lower poles of the thyroid gland -Produce parathyroid hormone (PTH) --Increases serum calcium and decreases serum phosphate --Antagonist of calcitonin (thus increases bone resorption and serum calcium) --Vitamin D (cofactor-needed so path can properly work) needed for PTH function

Hormones General characteristics:

-Specific rates and rhythms of secretion: maintaining homeostasis --Diurnal, pulsatile, and cyclic and patterns that depend on circulating substances -Operate within feedback systems (positive and negative) -Affect only target cells with appropriate receptors(key looking for lock on target cells) -Are excreted by kidneys or deactivated by liver or cellular mechanisms

Neural Tube Defects

-Spina bifida occulta -Vertebral defect that is not visible -No neurologic dysfunction -Spinal cord and spinal nerves normal

Insulin

-Synthesized from proinsulin -Secretion is promoted by increased blood levels of glucose, amino acids, GI hormones (regulated by serum blood glucose, so when blood levels rise, it is going to be secreted) -Facilitates the rate of glucose uptake into the cells of the body -Anabolic hormone --Synthesis of proteins, lipids, and nucleic acids

Posterior Pituitary Hormones

-Synthesized with their binding proteins in the supraoptic and paraventricular nuclei of the hypothalamus -can be effected by alcohol and different drugs and stuff like that

Endocrine Pancreas

-The pancreas is both an endocrine and an exocrine gland: produces hormones and also produces digestive enzymes -islets of langerhans: glucagon, insulin -Gastrin, ghrelin, and pancreatic polypeptides -Pancreatic somatostatin -Glucagon -Insulin -Amylin

Thyroid gland

-Two lobes lie on either side of the trachea -Isthmus: separate lobes -Follicles (follicle cells surrounding colloid) -Parafollicular cells (C cells) -Secrete calcitonin which treats any bone disorders -Regulation of thyroid hormone secretion -Thyrotropin-releasing hormone and thyroid-stimulating hormone control rate of metabolism in body follicles are cavities ike behave and les tsp be absopred in there an released into body

Mechanism of Hormone Action

-Water-soluble hormones circulate in free, unbound forms (short-acting response ex. insulin) -Lipid-soluble hormones are primarily circulating bound to a carrier

Myxedema and Hypothyroidism

-a complex of connective tissue fibers separated by large amounts of protein and mucopolysaccaride binds water, resulting in a meshwork of fluid and fibers...more substantive, therefore, will not pit -results in non-pitting, body edema in the eyes, hands and feet

Pathophysiology of hypocortisolism

-a decrease in cortisol leads to -a decrease in aldosterone which leads to -a decrease in androgens which leads to -an increase in ACTH (loss of negative feedback loop, always on causing a darkness in skin tone)

Who is usually affected by acromegaly?

-adults -40 to 50 year olds **yet is usually a slow progression, so s/sx may not truly appear until that age

Panhypopituitarism

-all pituitary hormones are ABSENT -Cortisol -Thyroid -GH (significant in children) -gonadal failure; loss of secondary sex characteristics -no prolactin (no lactating in women postpartum; the pituitary gland is the problem, not the hypothalamus)

What is the most common cause of HYPERpituitarism?

-benign adenoma -a slow growing tumor that presses on the cells or the anterior pituitary **70-90% of the anterior pituitary gland needs to be damaged BEFORE clinical symptoms will appear

Clinical manifestations of BOTH primary and secondary hyperparathyroidism

-bone resorption which will lead to pathological fractures, kyphosis of dorsal spine and vertebral compression (getting shorter, hunchbacked) -PRIMARY ONLY: hypercalciuria (excess amount of Ca+ spilling over into the urine, ALKALINE URINE, hyperphosphaturia just due to the natural role of PTH -these components lead to kidney stones which may lead to kidney infection -muscular, nervous, and GI systems affected: fatigue, HA, depression, anorexia, N/V (VAGUE) **S/SX depend if Ca+ is low (secondary) or high (primary)

What can cause SIADH?

-brain injury (closed head injury) or infection (can be anything from a trauma to a stroke to meningitis) -ectopically produced ADH associated with a cancer

Small cell lung CA

-cancer cells can perform unlike they should -these cells can secrete high amounts of ADH

Inappropriate response by target cell

-cell surface receptor-associated disorders -intracellular disorders

With diabetes insipidus, patients are not able to

-concentrate urine -may be partial or total

Primary hypothyroidism is due to

-congenital defects -autoimmune thyroiditis (Hashimoto disease) -latrogenic loss of thyroid tissue after treatment of hyperthyroidism

Adrenal Cortex Disorders: hypercortisolism

-cushing disease -excessive anterior pituitary secretion of ACTH (secondary disease); not in the adrenal cortex -more common in adults and in women

When there is a loss of thyroid tissue, there is

-decreased production of T3 and T4 which INCREASES the production of TSH, which causes hyperplasia of the thyroid (GOITER); constant stimulation of receptors keeps the thyroid large

Again, since the urine is quickly exiting the renal system, the urine specific gravity is

-decreased, below 1.002 -very dilute urine **polydipsia d/t thirst mechanism; need COMPENSATION

Clinical Manifestations glucose intolerance

-development of DM

Origin of the name Diabetes Insipidus

-diabetic patients tended to urinate a lot -nothing to do with sugar though

Extension to hypothalamus leads to

-disturbances of wakefulness, thirst, appetite and temperature **extension means the tumor is now pressing on the hypothalamus

Clinical manifestations "thin skin"

-due to loss of collagen -purple striae due to loss of collagen (capillaries visible) -skin stretches over adipose tissue **white striae are d/t rapid weight loss and gain

How is someone diagnosed with hyperthyroidism?

-elevated thyroid hormone levels -T3 and T4

Appearance of patient with Acromegaly

-enlarged extremities, like forehead and tongue -maxilla lengthens and the mandible protrudes -the voice deepens -if it is before the growth plate closes, giantism can occur

What may be a casual factor of thyroid carcinoma?

-exposure to ionizing radiation during childhood -e.g. Hodgkin reaction

Adrenal Cortex disorders: Secondary Hyperaldosteronism

-extra adrenal stimulus -like angiotensin in the RAA system

Two types of failure when it comes to hormonal disorders...

-feedback mechanisms fail to function -dysfunction of an endocrine gland d/t cancer, an autoimmune disease, etc

Signs and symptoms of Graves disease: ophthalmopathy

-functional abnormalities: gaze lag; eyelids are slow too -infiltrative changes like fatty buildups under the eyes and inflammation/edema -GLOBE PROTRUSION -bulging eyes=exophthalmos

Since the urine is constantly exiting the body, the blood serum osmolarity is

-high -above 295 -hypernatremia

The hormonal disorders will either be described as

-hypo -hyper

Patients with hypoparathyroidism will be

-hypocalcemic -hyperphosphatemic

Clinical manifestations virilization

-in females; means "like a man" -e.g. facial hair, acne, oligomenorrhea **change made by a hormone other than cortisol

With SIADH, there is water intoxication

-in the blood -d/t enhanced renal water retention

Intracellular disorders: example of inadequate synthesis of a second messenger

-inadequate synthesis of the second messenger cAMP so that the target cell fails to express the usual hormonal effect

Adrenal Cortex Disorders: cushing syndrome

-increased cortisol regardless of etiology -s/sx refers to the manifestations -2nd kinds, 3rd is d/t drugs

Most of the s/sx of hypoparathyroidism deals with hypocalcemia

-increased nerve and muscle excitation -tetany...check with the 2 tests -seizures, laryngeal spasms (think of the location of the organ), loss of body/scalp hair, bone deformities

Pathophysiology of hyperaldosteronism

-increased sodium reabsorption leads to an increase in extracellular volume and hypokalemia

With SIADH, there is concentrated urine

-increased specific gravity, above 1.030 -urine will be very dark, not a lot (oliguria)

HypOparathyroidism is commonly caused by

-injury during head and neck surgery (injury to the glands) **all people would experience low Ca+ and high PO4- in this scenario

Hypothyroidism has an

-insidious onset, hard to see coming

HypOpituitarism

-involves the organ itself, so its a primary disorder **most common is Sheehan syndrome

Clinical manifestations altered mental status

-irritability and depression (psychotic episodes)...think roid rage

S/sx of hypothyroidism

-low BMR, therefore, cold intolerance, lethargic **complete opposite of Grave's disease -myxedema is characteristic sign of SEVERE/long-standing disease....alters composition of dermis and other tissues

With low levels of PTH, there is

-low serum calcium and high serum phosphate

Cushing-like syndrome

-may develop in relation to EXOGENOUS administration of glucocorticoids -high dose of steroids

Clinical manifestations hypertension

-minteralcorticoids promote increase in Na+ and a decrease in K+ -aldosterone; therefore, a change made by a hormone other than cortisol

Hypothyroidism is the

-most common thyroid disorder -again, most common in women

Clinical manifestations catabolic effects:

-muscle weakness, osteoporosis/pathological fractures

Thyroid hormone

-must have iodine in the body for the thyroid gland to work -Secreted in response to TSH -90% T4(iodine ions)-tetraiodinan ions and 10% T3 --Most T4 then converted to T3 -Bound to thyroxine-binding globulin, thyroxine-binding prealbumin, albumin, or lipoproteins(how it travels throughout the body) -Affects growth and maturation of tissues, cell metabolism, heat production, and oxygen consumption-has the impact on your metabolism

Central type of Diabetes Insipidus is called and involves

-neurogenic -caused by an absence of ADH -d/t a lesion of the hypothalamus, pituitary stalk, posterior pituitary **more specifically a stroke and/or ischemia could have been the cause

With SIADH, hyponatremia can lead to severe consequences like

-neurological damage -swollen brain cells

Pathophysiology behind hypercortisolism

-no diurnal/circadian secretion patterns of ACTH and cortisol and -no increase in ACTH and cortisol secretion in response to a stressor -there is no reserve for fight or flight without a rhythm

What is characteristic of secondary hyperthyroidism?

-normal to increased TSH levels -d/t TSH secreting pituitary tumors

Primary Hyperparathyroidism

-occurs more in older adults -grow and secrete, grow and secrete, grow and secrete -most (80%) results from chief cell adenoma= increased secretion of PTH -PTH is not responding to usual feedback control of hypocalcemia; secreting PTH despite NOT having LOW levels of Ca+ -patient is now HYPERCALCEMIC; no negative feedback loop

Without PTH, resorption

-of calcium from bone is impaired; therefore, there is no s/sx in the bone

Why do patients with acromegaly have a decreased life expectancy?

-only if their condition is left untreated -acromegaly leads to HTN and DM (Higher blood glucose levels may result from excessive growth hormone production) -eventually the HTN will lead to an after load problem, causing LVH and HF -The incidence of heart disease is increased, likely due to enlargement of the heart muscle, which impairs its functioning (called cardiomyopathy). High blood pressure is more common in acromegaly. Some people have problems with their heart valves. Heart failure may occur if acromegaly is uncontrolled.

Myxedema Coma

-opposite of thyroid storm, yet still a medical emergency -diminished LOC -everything shuts down...hypothermia, hypoventilation, hypotension, hypoglycemia, lactic acidosis

Endocrine System organs

-pineal gland pituitary gland thyroid gland parathyroid gland thymus pancreas adrenal gland testis ovary

Central/secondary hyperthyroid includes

-pituitary adenoma *back in the brain, outside the thyroid)

Latrogenic

-post surgical

Sheehan syndrome

-postpartum pituitary infarction d/t hemorrhage -the pituitary gland is extremely VASCULAR, therefore, is vulnerable to infarct -the pituitary gland DOUBLES IN WEIGHT during pregnancy -PAN PITUITARY

Signs and symptoms of Graves disease: dermopathy

-pretibial myxedema -subcutaneous swelling on anterior portion of LEs -maybe some induration and erythema (hardness and redness)

ACTH independent cushing syndrome

-primary -usually d/t adrenal tumors in the gland -does NOT matter what is up with ACTH

Adrenal Cortex disorders: hypocortisolism (other corticosteroids may be low too)

-primary=addison's disease -most often caused by autoimmune reaction/disease that destroys cortical cells

Clinical manifestations

-progressive weakness throughout day, especially with stress (decrease in fluid) -GI disturbances (anorexia, N/V, diarrhea) -hypoglycemia w/ mental confusion r/t an absence of cortisol (decrease in gluconeogenesis and usage of glycogen storage by liver) -hyperpigmentation r/t increased secretion of ACTH -vitiligo (white patchy areas of depigmentations d/t destruction of melanocytes) -hypotension (there is a decrease in blood volume since there is a renal loss of Na+) -addisonian crisis

Thyrotoxic storm

-rare but very serious -metabolic processes are too revved up...fatal

Regulation of calcium reabsorption from

-renal tubules is impaired YET -phosphate reabsorption by renal tubules increases

Intracellular disorders: the cell can also (and thirdly),

-respond abnormally to the second messenger

Adrenergic effects

-rev up -increased heart rate -palpitations -nervousness -HTN -increased cardiac contractility -heat intolerance, skin hot and moist

Intracellular disorders: inadequate synthesis of a second messenger

-second messengers are needed to transduce the hormonal signal into an intracellular event

ACTH dependent cushing syndrome

-secondary -may occur at any age, but mainly 30-50 -most common complication of cushing disease

Addisonian Crisis

-severe hypotension and vascular collapse

Other reasons for pituitary infarction?

-shock -sickle cell disease -head trauma -meningitis -vascular malformations -surgical ablation

The mucous membranes in the larynx and pharynx thicken causing

-slurred speech and hoarseness -thickness causing this

Ectotopically means

-somewhere else in the body

What is diagnostic for primary hyperthyroidism?

-suppressed serum TSH -depressed negative feedback control, turn off stimulating hormone, do not need it

SIADH stands for

-syndrome of inappropriate antidiuretic hormone **affects posterior pituitary gland

With Nephrogenic Diabetes Insipidus,

-target organ response; intracellular disorder -caused by faulty response of renal cells to ADH -r/t diseases and drugs like anesthetics -can be acquired (like statement above) or genetic **there is an inhibition of generation of cAMP in the renal cells (decrease in formation of aquaporin channels)

Parathyroid hormone regulates

-the amount of Ca2+ and PO4- in the blood and in the bone -Causes efflux of Ca+ from the bone to the blood (resorption); PO4- at times, too -also leads to Ca+ reabsorption within the kidney; the kidney releases Vitamin D allowing enhanced absorption of Ca+ in the gut; PO4- is always excreted

Adenomatous tissue secretes

-the hormone of the cell type from which it arose; can just happen with one cell type like only GH -may hyper secrete GH, TSH, FSH, LH

The clinical manifestations of hypopituitarism are variable d/t

-the hormones affected

With the anterior pituitary gland, neurosecretory cells from

-the hypothalamus secrete RELEASING (tropic) and INHIBITING hormones into the pituitary portal system -the anterior pituitary secretes its hormones in response

Cell surface receptor associated disorders lead to a DECREASE in

-the number of receptors -therefore there is defective hormone-receptor binding

In the posterior pituitary, neuro-secretory cells in

-the thalamus produce oxytocin and ADH -the axon endings secrete or transmit the hormones into the bloodstream

Cell surface receptor associated disorders, instead of a problem with the number of receptors,

-there can be impaired receptor function -receptors become "insensitive" to the hormone even though the hormone can physically be at the receptor **think of insulin resistant diabetes

In order for a patient to be diagnosed with SIADH,

-there has to be the absence of conditions that alter volume status -there cannot be CHF or renal disease -in order to make a nursing diagnosis, there needs to be a matching clinical story

Cell surface receptor associated disorders can deal with ANTIBODIES

-these antibodies either block receptors completely or mimic the action of the needed hormone **autoimmune -can be a positive or negative effect (neither are good)

Adrenal Medulla disorder: Pheochromcytoma

-these tumors secrete catecholamines continuously **very rare, few are malignant -causes HTN, tachycardia, palpitations -headache -weight loss -diaphoresis **s/sx related to SNS

Signs and symptoms of Graves disease: goiter

-thyroid enlargement (goiter) -caused by stimulation of TSH receptors by the IgG autoantibodies -these antibodies not only cause the release of T3/T4 but cause growth

Findings of thyroid carcinoma

-thyroid nodules -mets to the lungs, brain and bone **not smooth with palpation -changes in voice, swallowing -most are euthyroid (normal T3, T4): normal size, normal hormone -most tumors are well differentiated **more likely to look like thyroid cells more than they don't

Grave's disease is the result of

-thyroid stimulation with auto-antibodies against the TSH receptor, which stimulates the production of T3 and T4 **will not see increased TSH

Hyperthyroidism can also be called

-thyrotoxicosis

Why does dermopathical changes occur?

-thyrotropin receptor antigens on fibroblasts and recruited T lymphocytes; reacting to the T lymphocytes since this is an autoimmune disease

Thyroid Carcinoma

-treatable one; most do not succumb -most common endocrine malignancy, but still relatively rare -occurs more in women

Clinical manifestations weight gain:

-truncal obesity, moon face and buffalo hump r/t accumulation of adipose tissue in trunk, facial, and cervical areas -there is also Na+ and H2O retention

Patients with DI can urinate

-up to 12 liters per day **polyuria**

Acromegaly (from a pituitary tumor, hyperpituitarism)

-usually a GH secreting adenoma

Hypothyroidism affects

-virtually all body systems

A pituitary adenoma can also lead to

-visual disturbances -r/t pressure on optic chiasm and other cranial nerves (oculomotor, trigeminal)

Cell surface receptor associated disorders occur mainly with

-water soluble hormones like INSULIN because there has to be a connection with a receptor and fat-soluble hormones can be diffused through the membrane

Intracellular disorders: may be faulty response to hormone-receptor binding

-water-soluble hormones -there is no generation of a second messenger period **this can deal with the receptors that are present within the cell, even within the nucleus**

A nurse is teaching a client about the respiratory system. Which area (see diagram) should the nurse use to identify a structure that is a part of the upper airway? 3681172309 1 Area 1 2 Area 2 3 Area 3 4 Area 4

1 Area 1

How is the majority of oxygen transported to a client's cells and tissues? 1 Bound to hemoglobin 2 Dissolved in the plasma 3 Bound to white blood cells 4 Dissolved in the pulmonary capillary

1 Bound to hemoglobin

A nurse is talking about the structure of the pulmonary system that provides a defense mechanism by moving entrapped particles toward the oropharynx to be swallowed or expectorated. Which structure is the nurse describing? 1 Cilia 2 Nostrils 3 Turbinates 4 Macrophages

1 Cilia

What type of specialized respiratory epithelial cells line a client's conducting airways? 1 Ciliated epithelial cells 2 Keratinized epithelial cells 3 Squamous epithelial cells for gas diffusion 4 Cells that secrete enzymes to digest foreign particulates

1 Ciliated epithelial cells

Which piece of equipment should the nurse obtain to monitor a client's oxygen saturation level? 1 Oximeter 2 Stethoscope 3 Nasal cannula 4 Arterial blood gas kit

1 Oximeter

A nurse is teaching about the circulation that feeds the lung tissues and participates in gas exchange. Which term should the nurse use to describe this type of circulation? 1 Pulmonary circulation 2 Bronchial circulation 3 Coronary circulation 4 Systemic circulation

1 Pulmonary circulation

A nurse is teaching a client about the process of gas transport. Which steps should the nurse include in the teaching session? 1 Sighing, diffusion, reserve 2 Diffusion, perfusion, ventilation 3 Perfusion, rebreathing, sighing 4 Ventilation, reserve, rebreathing

2 Diffusion, perfusion, ventilation

A nurse is asked where gas exchange occurs in the respiratory system. How should the nurse respond? 1 In the cilia 2 In the alveoli 3 In the bronchi 4 In the trachea

2 In the alveoli

A nurse is teaching about the type of lung receptor that is activated when a client inhales dust and starts to cough. Which term should the nurse use to describe this type of lung receptor? 1 J receptors 2 Irritant receptors 3 Chemoreceptors 4 Stretch receptors

2 Irritant receptors

A client asks the nurse what causes "sneezing attacks." The nurse should answer this question based upon the knowledge that which structure triggers the sneeze reflex? 1 Nasal hairs and turbinates 2 Irritant receptors in the nares 3 Upper respiratory tract mucosa 4 Irritant receptors in the trachea and large airways

2 Irritant receptors in the nares

Which information indicates the nurse has a correct understanding of the location of a client's respiratory center? 1 It is located in the alveoli. 2 It is located in the brain stem. 3 It is contained in the cerebral cortex. 4 It is contained in one major type of neuron.

2 It is located in the brain stem.

Which term should the nurse use to describe the serous membrane covering the client's lungs? 1 Parietal pleura 2 Visceral pleura 3 Parietal peritoneum 4 Visceral peritoneum

2 Visceral pleura

C

26. A nurse recalls posthemorrhagic anemia can result in death when a patient's blood loss is in excess of: a. 20% to 29% b. 30% to 39% c. 40% to 49% d. 50% to 59% REF: p. 506

Which term should the nurse use to describe receptors that monitor the pH and arterial pressure of carbon dioxide (Paco2) of arterial blood? 1 J receptors 2 Irritant receptors 3 Chemoreceptors 4 Stretch receptors

3 Chemoreceptors

A nurse is teaching a client about the type of cell lining the bronchi. Which information from the client indicates teaching was successful? 1 Hila cells line the bronchi. 2 Carina cells line the bronchi. 3 Ciliated cells line the bronchi. 4 U-shaped cartilage cells line the bronchi.

3 Ciliated cells line the bronchi.

A nurse is teaching a client about the major muscles of inspiration. Which information should the nurse include as an example of a major muscle of inspiration? 1 Scalene 2 Trapezius 3 Diaphragm 4 Sternocleidomastoid

3 Diaphragm

A client is a mouth breather. Which processes are not as efficient as those in a nose breather? 1 Diffusing and perfusing 2 Coughing and exhaling 3 Filtering and humidifying 4 Ventilating and vocalizing

3 Filtering and humidifying

An infant has a condition that causes a deficiency of surfactant. When the parents ask the nurse where surfactant is made, how should the nurse respond? 1 In the trachea 2 In the large airways 3 In the air sacs of the lungs 4 In the tiny, small respiratory tubes

3 In the air sacs of the lungs

A nurse is asked what the most important cause of pulmonary artery constriction is. What is the nurse's best reply? 1 It is hematocrit. 2 It is carbonic acid. 3 It is low alveolar Po2. 4 It is plasma proteins.

3 It is low alveolar Po2.

Which is the most important cause of pulmonary artery constriction in a client? 1 Acidemia 2 Alkalosis 3 Low alveolar Po2 4 High alveolar Po2

3 Low alveolar Po2

Which term should the nurse use to describe the region between the lungs that contains the client's heart, great vessels, and esophagus? 1 Hilum 2 Alveolus 3 Mediastinum 4 Pleural cavity

3 Mediastinum

What type of pressure is located in the client's pleural space? 1 Partial 2 Positive 3 Negative 4 Complete

3 Negative

n which zone of a client's lung are the arterial and venous pressures greater than alveolar pressure? 1 Zone I 2 Zone II 3 Zone III 4 Zone IV

3 Zone III

A nurse is teaching the staff about the acinus. Which information should the nurse include about a structure of the acinus? 1 Nares 2 Larynx 3 Trachea 4 Alveolar ducts

4 Alveolar ducts

The nurse plans to teach a client about oxygen and carbon dioxide. Which information would be appropriate for the nurse to include in the teaching plan? 1 Carbon dioxide is less soluble than oxygen. 2 Oxygen diffuses more quickly than carbon dioxide. 3 The capillary beds do not allow for the exchange of carbon dioxide. 4 Carbon dioxide is eliminated to maintain normal acid-base balance.

4 Carbon dioxide is eliminated to maintain normal acid-base balance.

A nurse assesses an adult client as part of an annual health examination. Which assessment finding does the nurse recognize as abnormal while the client is at rest? 1 Respirations: even and regular 2 Occasional bowel sounds in all quadrants 3 Diameter of chest increases during inspiration 4 Sternocleidomastoids contract during inspiration

4 Sternocleidomastoids contract during inspiration

Which information from the client indicates teaching by the nurse was successful about upper airway structures? 1 The carina is in the upper airway. 2 The trachea is in the upper airway. 3 The bronchi are in the upper airway. 4 The oropharynx is in the upper airway.

4 The oropharynx is in the upper airway.

Adrenal cortex

80% of an adrenal gland's total weight Zona glomerulosa: aldosterone secreted, targets kidneys, increases their absorption of sodium, water; accelerates loss of potassium Zona fasciculata: middle layer, secretes glucocorticoids so cortisol, targets liver, accelerates rate of glucose synthesis and glycogen formation Zona reticularis: most inner layer of cortex, has androgens (aldosterone, estrogen), more effect on women and children, promotes bone and muscle and blood formation -Stimulated by adrenocorticotropic hormone (ACTH): regulate release of cortisol, stress can increase this secretion -Glucocorticoid hormones --Direct effects on carbohydrate metabolism --Anti-inflammatory and growth-suppressing effects --Most potent naturally occurring glucocorticoid is cortisol; more stress more cortisol secretion Mineralocorticoid hormones --Affect ion transport by epithelial cells ---Increase the activity of the sodium pump of the epithelial cells: increase absorption of sodium and water ---Cause sodium retention and potassium and hydrogen loss Most potent naturally occurring mineralocorticoid is aldosterone ---Regulated by the renin-angiotensin system Adrenal estrogens and androgens --Estrogen secretion by the adrenal cortex is minimal --The adrenal cortex secretes weak androgens ---Androgens are converted by peripheral tissues to stronger androgens such as testosterone

A

A 10-year-old male is diagnosed with leukemia. The nurse assesses for which other condition that could be associated with his disease? a. Down syndrome b. Hemophilia c. Hyperthyroidism d. Pheochromocytoma REF: p. 513

D

A 10-year-old male presents with abdominal swelling, night sweats, fever, and weight loss. He is diagnosed with Burkitt lymphoma. Upon obtaining the history, which of the following is the most likely cause? a. Cytomegalovirus (CMV) b. Adenovirus c. Human papillomavirus (HPV) d. Epstein-Barr virus (EBV) REF: p. 519

C

A 15-year-old female presents with splenomegaly, hepatomegaly, and lymph node enlargement. She is diagnosed with infectious mononucleosis. What should the nurse tell the patient about the recovery time? a. 72 hours b. 3 to 5 days c. A few weeks d. Six months REF: p. 511

B

A 15-year-old male is diagnosed with infectious mononucleosis. When the patient asks how he got this disease, how should the nurse respond? The most likely cause is: a. Adenovirus b. Epstein-Barr virus (EBV) c. Cytomegalovirus (CMV) d. Toxoplasma gondii REF: p. 511

B

A 15-year-old male with infectious mononucleosis is being given instructions on how to prevent the spread of this infection to others. Which statement represents a correct instruction? a. Wear a surgical mask when others are in the room. b. Do not share drinking glasses or eating utensils. c. Avoid all contact with other people. d. No precautions are necessary. REF: p. 511

A

A 2-year-old malnourished child has vitamin B12 and folate deficiencies. A blood smear suggests the deficiency is macrocytic and normochromic. The nurse would expect the hemoglobin to be: a. Normal b. Sporadic c. Low d. High REF: p. 501

A

A 20-year-old female has an increase in eosinophils. When the patient wants to know the most likely cause of the eosinophilia. What is the nurse's best response? a. Parasitic invasion and allergic reactions b. Viral and bacterial infections c. Stress and anxiety reactions d. Fungal infections and delayed hypersensitivity REF: p. 509

D

A 20-year-old female undergoes lab testing for anemia. Results show high iron, bilirubin, and transferrin and low hemoglobin and hematocrit. Which of the following is the most likely diagnosis to be documented on the chart? a. Pernicious anemia b. Folate deficiency anemia c. Iron deficiency anemia d. Sideroblastic anemia REF: p. 505

B

A 21-year-old female was recently diagnosed with iron deficiency anemia. In addition to fatigue and weakness, which of the following clinical signs and symptoms would she most likely exhibit? a. Hyperactivity b. Spoon-shaped nails c. Gait problems d. Petechiae REF: p. 504

A

A 21-year-old woman was recently diagnosed with iron deficiency anemia. Her hematocrit is 32%. Which of the following treatments would the nurse expect to be prescribed for her? a. Iron replacement b. Splenectomy c. A bone marrow transplant d. No treatment is necessary REF: p. 504

C

A 22-year-old female just delivered a healthy baby girl. She suffered from eclampsia during her pregnancy, and on the second postpartum day she complained of bleeding gums and bruising on her arms and legs. Hematology lab tests indicate that she had disseminated intravascular coagulation (DIC). Further review of lab tests by the nurse revealed an increase in: a. Platelets b. Hematocrit c. Fibrin degradation products (FDPs) d. Protein C REF: p. 528

D

A 25-year-old female has a heavy menses during which she loses a profuse amount of blood. Which of the following adaptations should the nurse expect? a. Movement of fluid into the cell b. Decreased cardiac output c. Decreased oxygen release from hemoglobin d. Peripheral vasoconstriction REF: p. 501

C

A 30-year-old female presents with hematuria, menorrhagia, and bleeding gums. She is diagnosed with immune thrombocytic purpura (ITP). A nurse realizes the most likely cause is: a. Allergy-induced platelet lysis b. An immune response to hypersplenism c. Antibody destruction of platelets d. T cell injury to megakaryocytes REF: p. 524

D

A 34-year-old male presents in the emergency room with extreme fatigue and shortness of breath. His skin and sclera appear to have a yellowish discoloration. These assessment findings are consistent with which type of anemia? a. Posthemorrhagic anemia b. Iron deficiency anemia c. Aplastic anemia d. Hemolytic anemia REF: p. 501

D

A 35-year-old female is diagnosed with lymphadenopathy. Which assessment finding will help confirm this diagnosis? a. Small, hard lymph nodes b. Disordered lymph nodes c. Nonpalpable, nontender lymph nodes d. Enlarged lymph nodes REF: p. 515

C

A 35-year-old female is diagnosed with vitamin B12 deficiency anemia (pernicious anemia). How should the nurse respond when the patient asks what causes pernicious anemia? A decrease in ______ is the most likely cause. a. Ferritin b. Gastric enzymes c. Intrinsic factor d. Erythropoietin REF: p. 501

C

A 35-year-old male has enlarged lymph nodes in the neck and a mediastinal mass. He was diagnosed with Hodgkin lymphoma. Which of the following abnormal cells would the nurse expect to find with this disease? a. Merkel cell b. Schwann cell c. Reed-Sternberg cell d. Kupffer cell REF: p. 516

B

A 35-year-old male with hyperthyroidism begins treatment to decrease thyroid activity. A nurse monitors for which of the following conditions that could result secondary to the treatment? a. Eosinophilia b. Basophilia c. Monocytosis d. Lymphocytosis REF: p. 509

C

A 40-year-old female develops disseminated intravascular coagulation (DIC). Upon obtaining the history, which finding is the most likely cause of this condition? a. Snake bite b. Blood transfusion c. Sepsis d. Immune thrombocytopenic purpura (ITP) REF: p. 527

B

A 40-year-old male vegetarian is diagnosed with folate deficiency anemia. He reports that he is an alcoholic. Which of the following factors put him at greatest risk for developing his disease? a. Being vegetarian b. Being alcoholic c. Age d. Gender REF: p. 503

A

A 45-year-old male is diagnosed with macrocytic, normochromic anemia. The nurse suspects the most likely cause of this condition is: a. Defective DNA synthesis b. Abnormal synthesis of hemoglobin c. Defective use of vitamin C d. Blocked protein synthesis REF: p. 501

A

A 45-year-old male is diagnosed with sideroblastic anemia. When he asks what the most likely cause of this disease is, what is the nurse's best response? a. Ineffective iron uptake and abnormal hemoglobin production b. Misshapen erythrocytes with low hemoglobin c. Decreased levels of tissue iron with megaloblastic erythrocytes d. Premature erythrocyte destruction and erythropoietin deficiency REF: p. 505

C

A 5-year-old female is diagnosed with acute leukemia. The nurse will most likely treat this patient with: a. Bone marrow transplant b. Immunotherapy c. Chemotherapy d. Localized radiation therapy REF: p. 513

B

A 5-year-old male was diagnosed with normocytic-normochromic anemia. Which of the following anemias does the nurse suspect the patient has? a. Sideroblastic anemia b. Hemolytic anemia c. Pernicious anemia d. Iron deficiency anemia REF: p. 501

D

A 50-year-old female is diagnosed with primary thrombocythemia. A nurse would expect the blood smear to reveal _____ platelets. a. Defective b. Fragmented c. Consumed d. Overproduced REF: p. 525

A

A 50-year-old female was diagnosed with sideroblastic anemia. Which of the following assessment findings would most likely occur? a. Bronze colored skin b. Decreased iron c. Normochromic erythrocytes d. Aplastic bone marrow REF: p. 505

A

A 52-year-old male IV drug user was diagnosed with hepatitis C 5 years ago. He is now experiencing impaired blood clotting. The nurse suspects a decrease in which of the following vitamins? a. K b. D c. E d. B12 REF: p. 526

A

A 57-year-old male presents to his primary care provider for red face, hands, feet, ears, and headache and drowsiness. A blood smear reveals an increased number of erythrocytes, indicating: a. Polycythemia vera (PV) b. Leukemia c. Sideroblastic anemia d. Hemosiderosis REF: p. 506

B

A 58-year-old female presents in the clinic presenting with fatigue, weight loss, and tingling in her fingers. Laboratory findings show low hemoglobin and hematocrit, a high mean corpuscular volume, and normal plasma iron. These assessment findings are consistent with which type of anemia? a. Hemolytic anemia b. Pernicious anemia c. Iron deficiency anemia d. Aplastic anemia REF: p. 501

B

A 60-year-old female emphysema patient experiences a rapid and pounding heart, dizziness, and fatigue with exertion. Which of the following respiratory assessment findings indicate the respiratory system is compensating for the increased oxygen demand? a. Bronchoconstriction b. Increased rate and depth of breathing c. Dyspnea d. Activation of the renin-angiotensin response REF: p. 501

B

A 62-year-old female tells her health care provider she has been experiencing regular night sweats that cause her to wake up drenched. She also remarks that she has been unintentionally losing weight. Physical exam reveals enlarged lymph nodes on her neck that do not appear to be painful. She should be screened for which of the following cancers? a. Epstein-Barr virus b. Hodgkin lymphoma c. Acute leukemia d. Burkitt lymphoma REF: p. 517

C

A 65-year-old male experienced loss of appetite, weight loss, lemon-yellow skin, liver enlargement, and a beefy red tongue shortly before his death. Autopsy suggested pernicious anemia, and the cause of death would most likely reveal: a. Brain hypoxia b. Liver hypoxia c. Heart failure d. Kidney failure REF: p. 503

B

A 65-year-old male is diagnosed with multiple myeloma. He reports severe pain. This pain can be attributed to: a. Neuropathic infiltrations b. Destruction of bone tissue c. Tissue hypoxia d. Accumulation of toxic proteins REF: p. 520

B

A 67-year-old female has chronic gastrointestinal bleeding. A nurse recalls the primary cause of her anemia is: a. Vitamin B12 deficiency b. Iron deficiency c. Folate deficiency d. Bone marrow failure REF: p. 504

A

A 67-year-old female is admitted to the emergency department with a diagnosis of polycythemia vera (PV). Which treatment should the nurse discuss with the patient? a. Therapeutic phlebotomy b. Restoration of blood volume by plasma expanders c. Administration of packed red blood cells d. Iron replacement therapy REF: p. 507

C

A 67-year-old female is admitted to the emergency department with a diagnosis of polycythemia vera. Upon taking the history, the patient will most likely report: a. Hyperactivity b. Decreased blood pressure c. Chest pain d. A pale skin color REF: p. 507

D

A 67-year-old male was diagnosed with polycythemia vera (PV) but refused treatment. His condition is at risk for converting to: a. Chronic lymphocytic leukemia b. Burkitt lymphoma c. Multiple myeloma d. Acute myeloid leukemia REF: p. 508

C

A 68-year-old female is admitted to the emergency department with a diagnosis of polycythemia vera (PV). A nurse realizes the patient's symptoms are mainly the result of: a. A decreased erythrocyte count b. Rapid blood flow to the major organs c. Increased blood viscosity d. Vessel injury REF: p. 507

B

A 70-year-old male is brought to the emergency department, where he dies shortly thereafter. Autopsy reveals polycythemia vera (PV). His death was most likely the result of: a. Acute renal failure b. Cerebral thrombosis c. Sepsis d. Acute leukemia REF: p. 508

A client's heart valve that is located between the right atrium and right ventricle is stenosed. The nurse will be caring for which client?

A client with a stenosed tricuspid valve The tricuspid valve is located between the right atrium and right ventricle, and it prevents blood in the right ventricle from returning to the right atrium during systole. The mitral valve, also known as the bicuspid valve, is not located between the right atrium and right ventricle but rather between the left atrium and left ventricle. The semilunar valves are the pulmonary and aortic valves, so they are not located between the right atrium and right ventricle.

A nurse hears in report that the team will be caring for a client with a low ejection fraction. The nurse will be caring for which client?

A client with ventricular failure A decrease in ejection fraction is a hallmark of ventricular failure. Deep vein thrombosis does not affect ejection fraction; it is a venous problem. A client with increased heart contractility and a client with an overactive sympathetic nervous system will tend to have increased, not decreased, ejection fraction.

Clubbing

A condition affecting the fingers and toes in which proliferation of distal soft tissues, especially the nail beds, results in thickening and widening of the extremities of the digits; the nails are abnormally curved, the nail beds excessively compressible, and skin over them red and shiny

B

A newborn is diagnosed with congenital intrinsic factor deficiency. Which of the following types of anemia will the nurse see documented on the chart? a. Iron deficiency anemia b. Pernicious anemia c. Sideroblastic anemia d. Hemolytic anemia REF: p. 502

B

A nurse checks individuals with liver disease for clotting problems because: a. The liver is often the site of platelet pooling. b. Clotting factors are produced in the liver. c. High levels of bilirubin interfere with the clotting system. d. Treatment medications for liver failure cause fibrinolysis. REF: p. 526

D

A nurse is preparing to teach the staff about aplastic anemia. Which information should the nurse include? Aplastic anemia is caused by: a. Iron deficiency b. Excess levels of erythropoietin c. Hemolysis d. Stem cell deficiency REF: p. 506

C

A nurse is teaching the staff about disseminated intravascular coagulation (DIC). Which information should the nurse include? The sequence of events in DIC is initiated by the release of: a. Histamine b. Fibrin c. Tissue factor d. Plasmin REF: p. 527

Acute Epiglottitis

A patient presents with a high fever, irritability, sore throat, inspiratory stridor, muffled voice and severe respiratory distress what would the nurse suspect

Croup

A patient presents with a seal-like barking cough, they recently had an episode of rhinorrhea, sore throat, low-grade fever, inspiratory stridor and a hoarse voice, what would the nurse suspect

C

A patient's anemia is described as having erythrocytes that demonstrate anisocytosis. The nurse would recognize the erythrocytes would be: a. Pale in color b. Present in various sizes c. Able to assume various shapes d. Live only a few days REF: p. 501

Hyperpituitarism

A release of too much anterior pituitary hormones and is commonly caused by a benign, slow-growing pituitary adenoma

B

A staff member asks what leukocytosis means. How should the nurse respond? Leukocytosis can be defined as: a. A normal leukocyte count b. A high leukocyte count c. A low leukocyte count d. Another term for leukopenia REF: p. 508

Traumatic brain injury

A traumatic insult to the brain possibly producing physical, intellectual, emotional, social, and vocational changes

Ventricular septal defect

Abnormal communication between the ventricles Most common type of congenital heart lesion Two types

Atrial septal defect

Abnormal opening between the atria; blood flows from left atria to right atria

Cheyne-Stokes respirations

Abnormal pattern of breathing characterized by progressively deeper and sometimes faster breathing, followed by a gradual decrease that results in a temporary stop in breathing called an apnea

Hypoparathyroidism

Abnormally low levels of PTH commonly due to damage of the parathyroid during thyroid surgery

Diabetic ketoacidosis (DKA)

Accumulation of ketone bodies cause a drop in pH resulting in metabolic acidosis. Switch to lipid metabolism. Type 1

What is Guillan-Barre syndrome?

Acquired inflammatory disease causing demyelination of the peripheral nerves with relative sparing of axons Acute onset, ascending motor paralysis Humoral and cellular immunologic reaction

Manifestations of Tetralogy of Fallot

Acute cyanosis at birth or gradual cyanosis Gradual clubbing, poor growth; Tet spells If untreated, emboli, stroke, brain abscess, seizures

What is Encephalitis?

Acute febrile illness, usually of viral origin with nervous system involvement Most common forms of encephalitis are caused by arthropod-borne viruses and herpes simplex virus

Low levels of growth hormone (GH)

Affect growth in children and can result in hypopituitary dwarfism

D

After initial compensation, what hemodynamic change should the nurse monitor for in a patient who has a reduction in the number of circulating erythrocytes? a. Increased viscosity of blood b. Decreased cardiac output c. Altered coagulation d. Hyperdynamic circulatory state REF: p. 501

Spleen

Aged red cells are sequestered and destroyed by macrophages of the MPS, primarily in the _______

Panhypopituitarism

All hormones are deficient

Kawasaki disease

Also known as mucocutaneous lymph node syndrome Acute, self-limiting systemic vasculitis that may result in cardiac sequelae Usually occurs in children under 5 years of age and in winter or spring

What is meningitis?

An infection of the meninges

B

An oncologist is discussing multiple myeloma. Which information should the oncologist include? Multiple myeloma can be defined as a neoplasm of: a. T cells b. B cells c. Immature plasma cells d. Mature red blood cells REF: p. 518 | p. 520

What are Mycotic aneurysms?

Aneurysms caused by infection.

Which term should the nurse use to describe new collateral vessel formation in a client?

Angiogenesis New collateral vessels are formed through the process of angiogenesis. Cells of the larger vessels are nourished by the vasa vasorum, small vessels located in the tunica externa. A single tropomyosin molecule (a relaxing protein) lies alongside seven actin molecules. Automaticity, or the property of generating spontaneous depolarization to threshold, enables the sinoatrial and atrioventricular nodes to generate cardiac action potentials without any stimulus.

Transposition of the great arteries: mixed defects

Aorta arises from the right ventricle and the pulmonary artery arises from the left ventricle

Obstructive Defects

Aortic stenosis Coarctation of the aorta Valvular aortic stenosis Subvalvular aortic stenosis Pulmonic stenosis

What should the nurse monitor to determine a client's afterload?

Aortic systolic pressure Aortic systolic pressure is a good index of afterload. Temperature can help determine infectious processes, not afterload. Electrolyte tests can help determine fluid and electrolyte levels, not afterload. Arterial blood gases help determine pH of the blood.

A client has injured the endothelium of a blood vessel. Which area (see diagram) should the nurse choose to illustrate the damaged area?

Area 1 The tunica intima contains the endothelium, the innermost lining of the blood vessels. Elastic arteries have a thick tunica media with more elastic fibers than smooth muscle fibers. The smooth muscle is part of the tunica media. The adventitia is the outermost lining of the blood vessel.

A nurse is teaching a client about the anatomy of the heart. Which area (see diagram) should the nurse choose to illustrate the cardiac chamber with the thickest wall?

Area 4 The left ventricle's myocardium is several times thicker than that of the right ventricle because the left ventricle myocardium must be strong enough to pump against the high pressure of the systemic arterial pressure (92 mm Hg). The right ventricle must only pump against the lower pressure pulmonary arterial pressure (15 mm Hg). The two atria have the thinnest walls because they are low-pressure chambers.

Hemostasis

Arrest of bleeding

What is the most common aneurysm?

Arterial Venous Malformation. It looks like a bowl of spaghetti.

What is a Thrombotic Stroke?

Arterial occlusions caused by thrombi formed in arteries supplying the brain or in intracranial vessels Transient ischemic attacks

oxygen

As pressure decreases at the tissue level this dissociates from hemoglobin

Restrictive lung diseases

Aspiration, atelectasis, bronchiectasis, bronchiolitis, pulmonary fibrosis, inhalation disorders, pulmonary edema

What is an Intracerebral Hemorrhage?

Associated with MVA and falls Intracerebral hemorrhage and resultant hematoma acts as an expanding mass There is Increased ICP and compression of brain tissues with resultant edema

Atrial septal defects manifestatios

Asymptomatic at early age Pulmonary symptoms on exertion at later age

Patent ductus arteriosus manifestations

Asymptomatic or pulmonary overcirculation (dyspnea fatigue, poor feeding)

Manifestations of PDA

Asymptomatic or pulmonary overcirculation (dyspnea, fatigue, poor feeding)

Tricuspid atresia additional defects

Atrial septal defect Hypoplastic or absent right ventricle Enlarged mitral valve and left ventricle Pulmonic stenosis

Primary adrenal insufficiency hypocortisolism (Addison disease)

Autoimmune that causes destruction of cells in adrenal cortex leading to inadequate synthesis of cortisol. Hyperpigmentation due to ACTH, elevated potassium

Idiopathic Addison disease

Autoimmune. Associated with other autoimmune conditions and is usually inherited as autosomal recessive trait

What are some types of Meningitis?

Bacterial meningitis Aseptic (viral, nonpurulent, lymphocytic) meningitis Fungal meningitis Tubercular (TB) meningitis

A nurse is discussing pressure receptors located in the aortic arch and carotid arteries that affect a client's heart rate and blood pressure. Which reflex is the nurse describing?

Baroreceptor reflex The baroreceptor reflex facilitates both blood pressure changes and heart rate changes. It is mediated by tissue pressure receptors (called pressoreceptors or baroreceptors) in the aortic arch and carotid arteries. Distention of the atria causes stimulation of atrial receptors (for example, when intravascular volume is increased by intravenous infusions). This causes activation of the Bainbridge reflex, which increases heart rate. The Frank-Starling and Poiseuille eponyms refer to various concepts, including laws, curves, and spaces, but not to reflexes. The Frank-Starling law of the heart describes the length-tension relationship of preload to myocardial contractility (as measured by stroke volume). The Poiseuille law shows the relationship among blood flow, pressure, and resistance. Resistance in a vessel is inversely related to blood flow—that is, increased resistance leads to decreased blood flow.

What the risk factors for Subarachnoid Hemorrhages?

Being female, smoking, drug use(cocaine)

A client says that the mitral valve is diseased and wants to know where this valve is located. Which information by the nurse is the best response?

Between the left atrium and the left ventricle The mitral valve is located between the left atrium and the left ventricle. The valve between the right atrium and the right ventricle is the tricuspid valve, not the mitral valve. The aortic valve is between the left ventricle and the aorta. The pulmonic valve is between the right ventricle and the pulmonary artery. Test-Taking Tip: Relax during the last hour before an exam. Your brain needs some recovery time to function effectively.

What is a Subarachnoid hemorrhage?

Blood escapes from defective or injured vasculature into the subarachnoid space

A client has a regular heart rate of 54 beats/min. How should the nurse document this finding?

Bradycardia Bradycardia is defined as a heart rate of less than 60 beats/min. Normal sinus rhythm is defined as an impulse rate between 60 and 100 per minute. Dysrhythmia is abnormal rhythms. Tachycardia is an abnormally fast heart rate of more than 100 beats/min.

2000

COMPLETION A 35-year-old male was diagnosed with hepatitis B. Further tests revealed neutropenia characterized by a neutrophil count less than _____ per milliliter. REF: p. 509

100,000

COMPLETION A nurse realizes a patient has thrombocytopenia when the platelet count is below _____ platelets per cubic millimeter. REF: p. 532

Globulins

Carrier proteins and immunoglobulins (antibodies)

Secondary hyperthyroidism

Caused by TSH-secreting adenomas

Pernicious anemia

Caused by vitamin b12 deficiency

Liver disease

Causes a broad range of hemostasis disorders: defects in coagulation, fibrinolysis, & platelet number/function

Erythropoietin

Causes an increase in red cell production and release from bone marrow

Phenochromacytomas

Chromaffin cells (from adrenal gland) tumor that secretes catecholamines

What is Myasthenia Gravis?

Chronic autoimmune disease IgG antibody produced against acetylcholine receptors (antiacetylcholine receptor antibodies) Weakness and fatigue of muscles of the eyes and the throat, causing diplopia, difficulty chewing, talking, swallowing.

hyperplasia of globlet cells, bronchiectasis, pneumonia, hyoixia, and fibrosis

Chronic inflammation leads to what

A grade 4 concussion is what?

Classical Cerebral Concussion. Characteristics include Disconnection of cerebral systems from the brainstem and reticular activating system Physiologic and neurologic dysfunction without substantial anatomic disruption Loss of consciousness (<6 hours) Anterograde and retrograde amnesia Uncomplicated (no focal injury) Complicated (focal injury)

Total anomalous pulmonary venous connection

Classified by point of attachment Supracardiac Cardiac Infracardiac

Metabolic syndrome

Combination of central obesity, dyslipidemia, and preHTN that can put you at high risk for type 2 DM and cardiovascular disease

Test Card to

Combine

Graves disease

Common cause of hyperthyroidism. Autoimmune condition. STI antibodies form against TSH receptors in they thyroid overstimulating them to secrete TH.

Disseminated Intravascular Coagulation

Complex, acquired disorder in which clotting & hemorrhage simultaneously occur Result of increased protease activity in the blood caused by unregulated release of thrombin with subsequent fibrin formation & accelerated fibrinolysis

Surfactant

Compliance is ensured by an adequate production of what

Adrenocortocotropic hormone (ACTH) deficiency

Cortisol and aldosterone deficiency

Hemoptysis

Coughing up blood

Status of tissue oxygenation

Cyanotic defects Acyanotic defects

What are petichial hemorrhages common with?

DAI

Which head injuries cause the most deaths?

DAI diffuse anoxol injuries.

A client has a drop in cardiac output. Which assessment finding does the nurse expect to observe?

Decreased mean arterial blood pressure A decrease in the cardiac output causes an immediate drop in the mean arterial blood pressure and arteriolar flow. An increase in cardiac output without a decrease in peripheral resistance will cause both arterial volume and arterial pressure to increase. Overall, the renin-angiotensin system is activated after volume depletion or hypotension (decreased cardiac output) and is suppressed after volume repletion.

Which condition will cause the client's body to activate the renin-angiotensin-aldosterone system (RAAS)?

Decreased perfusion to the kidney The primary factor that stimulates renin release is a drop in renal perfusion as detected by the juxtaglomerular cells. The RAAS is not activated by decreased perfusion to the brain, liver, or lungs.

Inherited metabolic disorders

Defects in amino acid metabolism - screening at birth -Phenylketonuria (PKU) --Hyperphenylalaninemia - inability to convert PKU to tyrosine Storage diseases -Lysosomal storage diseases - disorder of lipid metabolism (not included in newborn screening) -Tay-Sachs disease - example

Leukocytes (white blood cells)

Defend the body against infection and remove debris

Mesenchymal stem cells (MSCs)

Develop into osteoclasts, fibroblasts, and adipocytes

Development of Nervous System in Children

Develops from embryonic ectoderm in stages: -Formation of neural tube - (3 - 4 weeks gestation) -Development of forebrain (occurs 2-3 month gestation) -Neuron proliferation and migration (3 - 5 months gestation) -Formation of synapses (5 months to postnatally) -Myelinazation (birth to 4 years postnatally) Rapid development of brain during third, fourth, fifth gestational months Fontanelles "soft spot" = anterior closes 18 mos. Posterior closes 2-3 mos. Head growth -Hydrocephalus - CSF compartment enlarged (↑ICP, bulging font.) -Microcephaly - head circumfrance below 2% for age (genetics, toxins) Reflex responses -Neonatal reflexes disappear in predictable order - see box 17.1

What are characteristics of chronic Subdural Hematoma?

Develops over weeks to months Older adults Alcohol abuse 80% complain of chronic headaches and have tenderness at site of injury

What are characteristics of acute Subdural Hematoma?

Develops within 48 hours Often located at the top of the skull

A nurse is describing the part of the cardiac cycle in which the ventricles are filled during relaxation. What is the nurse discussing?

Diastole The heart muscle relaxes and allows blood to flow through it as it fills passively during diastole. The heart muscle contracts to move blood through the chambers during systole. Ventricular ejection refers to the blood being moved out of the ventricles. Mechanically, the isovolumic phase of ventricular systole is defined as the interval between the closing of the atrioventricular valves and the opening of the semilunar valves.

A nurse is teaching the client about the respiratory pump. Which information should the nurse include in the teaching session?

Downward movement of the diaphragm occurs The respiratory pump acts during inspiration (not expiration), when the veins of the abdomen are partially compressed by the downward movement of the diaphragm. The skeletal muscle pump occurs during skeletal muscle contractions. The heart valves are not affected by the respiratory pump; it is venous return and venous pressure that are affected.

Secondary hypocortisolism

Due to prolonged exogenous glucocorticoids like prednisone. Cant immediately stop taking because will result in adrenal crisis

Primary polydispia

Due to too much water intake, water intoxication.

Orthopnea

Dyspnea when a person is lying down

Pulmonary Veins

Each one drains several pulmonary capillaries, dispersed randomly throughout the lung, leave the lung at the hila and enter the left atrium

A nurse is discussing the tendency of the lungs to return to the resting state after inspiration. Which term should the nurse use to describe this process? 1 Collectins 2 Compliance 3 Elastic recoil 4 Surface tension

Elastic recoil

Other Childhood Tumors

Embryonal tumors: -Neuroblastoma - most common cancer in infants less than 1 year of age -Retinoblastoma - eye tumor --Inherited - dx during first year of life --Acquired - dx during 2 - 3 years of age

Which information from the client indicates teaching by the nurse was successful for the layers of the heart, beginning on the inside?

Endocardium, myocardium, and epicardium (serous pericardium) The three layers of the heart wall in order, beginning on the inside, are endocardium, myocardium, and epicardium (serous pericardium). The supracardium is not a layer of the heart wall. The mesocardium is not a layer of the heart. The ventricles of the heart are separated by the interventricular septum.

Epilepsy and Seizure Disorders

Epilepsy diagnosed when child has more than one unprovoked seizure Seizures -Neurologic -Systemic (DM) Febrile seizures -Benign

Anemia classification

Etiology (cause) & morphology

Pulmonary edema

Excess water in the lungs

Cushing disease

Excessive anterior pituitary secretion of ACTH

Primary hyperparathyroidism

Excessive secretion of PTH from one or more parathyroid glands and mainly caused by parathyroid adenomas and results in hypercalcemia

If a client has problems with the exchange of nutrients between the blood and the tissues, which vessels are affected?

Exchange of nutrients between the blood and the tissues takes place in the capillaries. Venules deliver blood into the veins. Arterioles branch into the capillaries. Lymphatic vessels remove excess fluid and protein that accumulate in the tissues. Capillaries

Allergic alveolitis

Extrinsic allergic alveolitis (hypersensitivity pneumonitis)

Patent ductus arteriosus (PDA)

Failure of the ductus arteriosus to close Allows blood to shunt from the aorta to pulmonary artery, causing left-to-right shunt

Truncus arteriosus

Failure of the embryonic artery and the truncus arteriosus to divide into the pulmonary artery and the aorta The trunk straddles an always present VSD Types I, II, and III

What are causes of brain injury?

Falls 28% Motor vehicle crashes 20% Moving objects or moving against stationary objects 19% Assault 11% Sports-relBasilar skull fractureated events Blasts (military active duty

Classic anemia symptoms

Fatigue, weakness, dyspnea (difficulty breathing), & pallor

The peripheral vascular system supplies blood to which area in a client's body?

Feet The peripheral vascular system is an imprecise term used to describe the part of the systemic circulation that supplies the skin and the extremities, particularly the legs and feet. Pulmonary circulation provides blood to the lungs. Coronary circulation carries blood to the heart. The carotid artery supplies blood to the brain. Test-Taking Tip: Start with answering all the questions that you feel confident in answering. If you cannot immediately think of the answer to a question, give it a few seconds of thought. If the answer comes to you, mark it and move on. If not, skip it, circle the number so you know to come back to it, and go to the next question.

Kawasaki Disease: Diagnosis (five of six major findings)

Fever for 5 or more days (unresponsive to antibiotics) Bilateral conjunctivitis without exudation Erythema of oral mucosa (strawberry tongue) Changes in the extremities, such as peripheral edema and erythema with desquamation of palms and soles Polymorphous rash Cervical lymphadenopathy

C

For a patient experiencing hypersplenism, the nurse expects the erythrocytes to be: a. Proliferated b. Activated c. Sequestered d. Infected REF: p. 521

What is a embolic stroke?

Fragments that break from a thrombus formed outside the brain.

Types of small cell lung cancer

From neuroendocrine tissue

Albumins

Function as carriers and control the plasma oncotic pressure

What is Blunt (closed, non-missile) trauma?

Head strikes hard surface or a rapidly moving object strikes the head The dura remains intact; brain tissues not exposed to the environment Causes focal (local) or diffuse (general) brain injuries

Regulation of Hormone Release

Hormones are regulated by chemical(blood glucose), hormonal (one gland working better than another), or neural factors -Negative feedback (glucose; spike in blood sugar, insulin released until blood sugar comes back down) -positive feedback(oxytocin when pregnant, builds up in body until contractions or normal and until baby is delivered)

Hormone Transport and Action

Hormones are released into the circulatory system by endocrine glands --Target cell(little cells that have the approbate lock on them and are specific to one hormone) --Up-regulation(if there are low concentrations on the hormones, we make more) --Down-regulation(we decrease the amount of hormone) --Hormone effects: --Direct effects --Permissive effects-less obvious, can make an maximum response itself

A

How should the nurse prepare a patient who is to receive a Schilling test for pernicious anemia? a. Administer radioactive cobalamin and measure its excretion in the urine. b. Measure antigen-antibody immune complexes. c. Measure serum ferritin and total iron-binding capacity. d. Administer folate and evaluate folate content in a blood serum sample. REF: p. 503

Hypoventilation

Hypercapnia (excessive carbon dioxide in the bloodstream,)

Syndrome of inappropriate antidiuretic hormone secretion

Hypersecretion of ADH in the absence of normal stimuli for its release (retain water-prevent diuresis)

Hyperventilation

Hypocapnia ( a state of reduced carbon dioxide in the blood)

Diabetes Insipidus (DI)

Hyposecretion of ADH resulting in partial of total inability to concentrate the urine leading to polyuria (frequent urination) and polydyipsia (frequent drinking)

Manifestations of pulmonic stenosis

If severe: cyanosis from right-to-left shunt through atrial septal defect; decreased CO

Pulmonic stenosis manifestation

If severe: cyanosis from right-to-left shunt through atrial septal defect; decreased CO

Tricuspid atresia

Imperforate tricuspid valve Lack of communication between the right atrium and right ventricle

Systemic hypertension

In children defined as systolic and diastolic pressure that is over the 95th percentile for age and gender on at least three occasions

B

In disseminated intravascular coagulation (DIC), the nurse assesses for active bleeding after intravascular clotting because: a. Prothrombin is activated. b. Clotting factors are depleted. c. Inflammatory mediators are released. d. Tissue factor (TF) is inactivated. REF: p. 532

Tricuspid atresia manifestations

In newborn, cyanosis, tachycardia, dyspnea, poor feeding In older child, signs of chronic hypoxemia

lower, increases, 2-4 months

Incidence of SIDS is _______________in the first month, ___________ in the second month, and peaks at _____________

Secondary hyperparathyroidism

Increased PTH secretion due to chronic hypocalcemia, vitamin D deficiency, and kidney disease. Pulls calcium from the bones resulting in kyphosis, hypercalciurina, hypercalemia

Thyrotoxicosis/hyperthyroidism

Increased TH levels due to any cause

Hypercortisolism

Increased secretion of cortisol that leads to cushing disease and cushing syndrome.

Manifestations of aortic stenosis

Infant: if significant faint pulses, hypotension, tachycardia, and poor feeding Older children: may have complaints of exercise intolerance Risk for bacterial endocarditis

Who are at-risk individuals for traumatic brain injury?

Infants 6 months to 2 years School-age children Adolescents and young adults 15 to 35 years of age People more than 70 years of age Men 1.5 times as likely to sustain a TBI Persons living in high-crime areas

Empyema

Infected pleural effusion; pus

What is radiculitis?

Inflammation of the spinal nerve roots.

What is Open (penetrating, missile) trauma?

Injury breaks the dura and exposes the cranial contents to the environment Causes primarily focal injuries

Coup injury?

Injury directly below the point of impact

What is Contrecoup?

Injury on the pole opposite the site of impact

Flail chest

Instability of a portion of the chest wall

Childhood obesity Risk

Insulin resistance, diabetes, cardiovascular disease Childhood nutrition, level of physical activity, and engagement of sedentary activities (TV, computer use, etc.)

What are Plexus Injuries?

Involves the nerve plexus distal to the spinal roots but proximal to the formation of the peripheral nerves.

if you have a stroke, you have signs of _____________?

Ischemia

While teaching about arteries the nurse mentions the endothelium. A staff member asks what this is. What is the nurse's best response?

It forms the inner lining of the blood vessels. The blood vessels and heart are lined with highly specialized cells called endothelial cells, which compose a layer of tissue called the endothelium. The internal lining of blood vessels is not connective tissue, which is the outer lining. The muscular lining of blood vessels is the tunica media, which is the middle layer.

A coworker asks a nurse how cardiac output is determined. How should the nurse respond?

It is the product of stroke volume and heart rate The product of the stroke volume and the heart rate provides the amount of cardiac output. None of the other options (MAP, SVR, or pulse pressure) are factors in cardiac output.

What are the 3 grades of concussions?

I—confusion, disorientation, and momentary amnesia II—momentary confusion and retrograde amnesia III—confusion with retrograde and anterograde amnesia

Macrocyclic-normochromic anemia

Large RBCs & normal hemoglobin concentration

Spleen

Largest secondary lymphoid organ

Atrioventricular canal defect manifestations

Left-to-right shunt and pulmonary overcirculation

A client's muscular arteries constrict. How should the nurse interpret this finding?

Less blood flow through the vessels Contraction narrows the vessel lumen (the internal cavity of the vessel), which diminishes flow through the vessel (vasoconstriction). When the smooth muscle layer relaxes, more blood flows through the vessel lumen (vasodilation). The same amount and no change in blood flow do not occur with vasoconstriction.

Lymphocytopenka

Less than normal

Pineal Gland

Located near center of brain Secretes melatonin

Follicle-stimulating hormone (FSH) and luteinizing hormone (LH) deficiency

Loss of secondary sex characteristics

What happens with Neurogenic shock?

Loss of sympathetic outflow Vasodilation Hypotension Bradycardia Hypothermia

What is an example of a demyelinating disorder?

MS Multiple Scerosis.

A, B, D, E

MULTIPLE RESPONSE A 15-year-old male is diagnosed with infectious mononucleosis. Which of the following assessment findings would he most likely demonstrate? (Select all that apply.) a. Lymph node enlargement. b. Fever and sore throat c. Rash on the trunk and extremities d. Fatigue e. Enlargement of liver and spleen REF: p. 511

A, B, C

MULTIPLE RESPONSE A patient has microcytic hypochromic anemia. Which of the following pathogenic mechanisms may cause anemia in this patient? (Select all that apply.) a. Decreased erythrocyte life span b. Failure of mechanisms of compensatory erythropoiesis c. Disturbances of the iron cycle d. Increased basal metabolic rate e. Swelling in the tissues REF: p. 501

C, D, E

MULTIPLE RESPONSE A patient wants to know about risk factors for acute leukemia. Which of the following should the nurse include? (Select all that apply.) a. Cytomegalovirus (CMV) infection b. Eating genetically modified food c. Chemotherapy treatment for other cancers d. Excessive ultraviolet radiation exposure e. Ovarian cancer REF: p. 513

Clotting factors

Mainly fibrinogen

Congenital Heart Defects

Major cause of death in the first year of life other than prematurity

Valvular aortic stenosis

Malformed or fused cusps Progressive obstruction with episodes of ischemia Strenuous activity limited

Leukemia

Malignant disorder of the blood and blood forming organs

Cushing syndrome

Manifestations resulting from chronic exposure to excess cortisol

Splenic pulp

Masses of lymphoid tissue containing macrophages and lymphocytes and lymphoid follicles

Prenatal, environmental, and genetic risk factors of congenital heart defects

Maternal rubella or increased age Diabetes Alcoholism PKU Drugs Hypercalcemia Antepartal bleeding Prematurity Chromosome aberrations

Prenatal, environmental, and genetic risk factors for congenital heart defects

Maternal rubella or increased age, type 1 diabetes, alcoholism, PKU, drugs, and hypercalcemia Antepartal bleeding Prematurity Chromosome aberrations

Ventricular septal defect manifestations

May be asymptomatic If severe: increased pulmonary blood flow from left-to-right shunt; pulmonary hypertension (Eisenmenger syndrome)

Posterior pituitary

Median eminence Pituitary stalk Pars nervosa

Infections

Meningitis - is an inflammation (swelling) of the protective membranes covering the brain and spinal cord known as the meninges -Aseptic - could be viral but not bacterial -Bacterial -Viral Viral encephalitis - inflammation of the brain -direct invasion of virus or post infection as a result of an autoimmune disease

Malformation of Brain Development

Microcephaly -True (primary) microcephaly - autosomal recessive genetic or chromosomal -Secondary (acquired) microcephaly - infection, trauma, metabolic, maternal anorexia

Diabetic nephropathy

Microvascular disease of chronic DM. Damage to glomerularous in kidneys and tubular atrophy, andglomerulosclerosis

Diabetic retinopathy

Microvascular disease of chronic DM. Leading cause of blindness.

Diabetic neuropathies

Microvascular disease of chronic DM. Peripheral nerve damage, decreased nerve GF, ischemia

A nurse is describing blood flow through the heart and describes the valve that directs blood flow from the left atrium to the left ventricle. Which term, if used by the client, will indicate to the nurse that the teaching about the valve was successful?

Mitral The mitral valve directs blood from the left atrium to the left ventricle. The aortic valve lies between the left ventricle and the aorta. The pulmonic valve lies between the right ventricle and the pulmonary arteries. The tricuspid valve directs blood from the right atrium to the right ventricle.

Lymphocytosis

More than normal

Hypothyroidism

Most common and results in the deficient production of TH by the thyroid gland

Type 1 Diabetes Mellitus

Most common pediatric chronic disease. Slowly progressive autoimmune T-cell mediated disease that destroys beta cells of the pancreas. Environmental and genetic. Hypoinsulinemia which increases glucagon

Primary hypothyroidism

Most common, results from autoimmune thyroiditis

Type 2 Diabetes Mellitus

Mostly affects Indian and Alaskan adults with risk factors including obesity, age, HTN, physical inactivity, and gentians. Starts with pancreas beta cell resistance to insulin then eventually hypoinsulinemia and hyperglycemia

A nurse teaches the staff about the metabolic hypothesis of autoregulation. Which information from the staff indicates teaching was effective about the location of where autoregulation originates?

Myocardium The metabolic hypothesis of autoregulation proposes that the autoregulation of coronary vessels originates in the myocardium, not the endocardium or the visceral or parietal pericardium.

Aortic stenosis

Narrowing of the aortic outflow tract Caused by malformation or fusion of the cusps Causes increased workload on left ventricle and left ventricular hypertrophy Various types

Coarctation of the aorta

Narrowing of the lumen of the aorta that impedes blood flow

Coarctation of the aorta

Narrowing of the lumen of the aorta that impedes blood flow Almost always in a juxtaductal position

Pulmonic stenosis

Narrowing of the pulmonary outflow tract Abnormal thickening of the valve leaflets Narrowing of the valve with resistance to flow from right ventricle to pulmonary artery Right ventricular hypertrophy Pulmonary semilunar valve atresia

Structural Malformations

Neural tube defects Anterior midline defects Spina bifida - most common -Anencephaly - bone and part of brain missing (stillbirth) -Encephalocele - Herniation of portion of brain and meniges -Meningocele - saclike cysts of meninges filled with spinal fluid -Myelomeningocele - hernia protrusion (meninges, spinal fluid, spinal cord with nerves)

What occurs with spinal shock?

Normal activity of the spinal cord ceases at and below the level of injury; sites lack continuous nervous discharges from the brain Complete loss of reflex function (skeletal, bladder, bowel, sexual; thermal control; autonomic control)

Normal-normochromic anemia

Normal size RBCs & normal hemoglobin

Iron deficiency anemia

Nutritional iron deficiency

Major types of atrial septal defects

Ostium primum Ostium secundum Sinus venosus

Polycythemia

Overproduction of RBCs

Hemoglobin

Oxygen-carrying protein of the erythrocyte

Defects with increased pulmonary blood flow

PDA, atrial septal defect, VSD

Anterior pituitary

Pars distalis Pars tuberalis Pars intermedia Secretes tropic hormones

Aspiration

Passage of fluid and solid particles into the lungs

Defects Increasing Pulmonary Blood Flow

Patent ductus arteriosus (PDA Atrial septal defect Ventricular septal defect Atrioventricular canal defect Tetralogy of Fallot Tricuspid atresia

What is Kernig's sign?

Patient lays down, bring leg up and straighten it, when you straighten it they have pain.

Bronchiectasis

Persistent abnormal dilation of the bronchi

Thrombocytopenia

Platelet count less than 150,000 platelets/uL of blood

thrombopoietin, 10

Platelet levels are regulated by ________. Platelets circulate for__ days before losing their functional capacity.

Viral URI

Pneumonia is usually proceeded by _______ ___

Acute leukemia

Presence of undifferentiated or immature cells

ANS

Pulmonary circulation is innervated by what

Total anomalous pulmonary venous connection (TAPVC

Pulmonary veins connect to the right side of the heart, directly or indirectly through one or more systemic veins that drain into the right atrium

Anemia

Reduction in the total nimber of RBCs in the circulating blood or decrease in the quality or quantity of hemoglobin

PND (Paroxysmal nocturnal dyspnea)

Refers to attacks of severe shortness of breath and coughing that generally occur at night

Chylothorax

Results from lymph formed in the digestive system called chyle accumulating in the pleural cavity due to either disruption or obstruction of the thoracic duct

Atrioventricular canal defect

Results from nonfusion of the endocardial cushions Demonstrates abnormalities in the atrial and ventricular septa and atrioventricular valves Complete, partial, and transitional AVCs

Transposition of the great arteries: mixed defects

Results in two separate, parallel circuits Unoxygenated blood circulates continuously through the systemic circulation Oxygenated blood circulates continuously through the pulmonary circulation

Hemodynamic alterations

Right-to-left shunt, left-to-right shunt

Complications of PDA

Risk for bacterial endocarditis

Patent ductus arteriosus complications

Risk for bacterial endocarditis

Creating a set

SET

Respiratory infections

SIDS could have a possible relationship to what

Males

SIDS is more common in what gender

Viral pneumonia

Seasonal and usually self-limiting

Poikolocytosis

Shapes

Anisocytosis

Sizes

Microcytic-hypochromic anemia

Small RBCs that contain low amounts of hemoglobin

Subvalvular aortic stenosis

Stricture caused by a fibrous ring below a valve Konno procedure used to correct

What are Cerebrovascular accidents (CVAs) and what are two kinds?

Strokes. Thrombotic Stroke and Embolic Stroke.

Basophils

Structurally and functionally similar to mast cells

Tetralogy of Fallot

Syndrome represented by four defects: - Ventricular septal defect (VSD) - Overriding aorta - Pulmonary valve stenosis - Right ventricle hypertrophy

Tetralogy of Fallot

Syndrome represented by four defects: Ventricular septal defect (VSD) Overriding aorta Pulmonary valve stenosis Right ventricle hypertrophy

What is a classical concussion?

Temporary axonal disturbances causing attention and memory deficits but no loss of consciousness

What is a mild concussion?

Temporary axonal disturbances causing attention and memory deficits but no loss of consciousness

Defects decreasing pulmonary blood flow

Tetralogy of Fallot

The nurse teaches a client about the lymphatic system. Which information from the client indicates teaching was successful?

The lymphatic system allows for leakage from the vascular system to be reabsorbed into the body's circulatory system. Capillary outflow exceeds venous reabsorption by about 3 L/day, so some fluid lags behind in the interstitium. To maintain sufficient blood volume in the cardiovascular system, this fluid must eventually rejoin the bloodstream; this is the function of the lymphatic system. Lymphatic vessels are thin walled with valves and thus most resemble veins. Lymph consists primarily of water and small amounts of dissolved proteins, mostly albumin, that are too large to be reabsorbed. It is a pumpless system.

Endomitosis

The megakaryocyte breaks up into fragments

C

The nurse will check which of the following tests to directly measure iron stores? a. Serum ferritin b. Transferrin saturation c. Bone marrow biopsy d. Total iron-binding capacity REF: p. 504

B

The people from which country have the lowest risk for Hodgkin lymphoma? a. United States b. Japan c. Denmark d. Great Britain REF: p. 517

Hematopoiesis

The process of blood cell production

A man reports that he had to have a pacemaker put in because his normal pacemaker would not work. This client asks the nurse what the normal pacemaker is. Which information by the client indicates teaching was successful?

The sinoatrial node The sinoatrial node is considered the pacemaker of the heart. The bundle of His helps conduct electrical impulses down the inner ventricles. The coronary sinus is a vein that drains blood from the cardiac veins into the right atrium, and it does not contain autorhythmic myocardial cells. The atrioventricular node initiates a signal that is conducted through the ventricular myocardium by way of the bundle of His and Purkinje fibers.

Chemoreceptors

These sense the effectiveness of ventilation by monitoring the PH status of cerebrospinal fluid and oxygen content of arterial blood

Larynx

This connects the upper and lower airways

Diffusion ceases

This happens when alveolar and capillary oxygen pressures equiliberate

Pulmonary circulation

This has a lower pressure than systemic circulation

Acute epiglottitis

This is a severe, rapidly progressive, life-threatening infection of the epiglottis and surrounding area, historically caused by Haemophilus influenzae type B

Croup

This is an acute laryngotracheaobronchitis, common in children from 6 months to 5 years of age, commonly caused by a virus (parainfluenza), and causes subglottic edema

Cystic Fibrosis

This is an autosomal recessive inherited disease

SIDS

This is defined as sudden death of an infant under 1 year of age that remains unexplained

Alveolocapillary membrane

This is formed by the shared alveolar and capillary walls and gas exchange occurs across this membrane

Carbon dioxide

This is more soluble in plasma compared to oxygen

Spasmodic Croup

This is seen in older children, has a sudden night onset without prior illness

Which information from the client indicates teaching by the nurse was successful for systolic blood pressure?

This is the blood pressure when the ventricles contract The systolic blood pressure is the arterial blood pressure during ventricular contraction or systole. The diastolic blood pressure is the arterial blood pressure during ventricular filling or diastole. If the ventricles stopped there would be no blood pressure. Test-Taking Tip: After you have eliminated one or more choices, you may discover that two of the options are very similar. This can be very helpful, because it may mean that one of these look-alike answers is the best choice and the other is a very good distractor. Test both of these options against the stem. Ask yourself which one completes the incomplete statement grammatically and which one answers the question more fully and completely. The option that best completes or answers the stem is the one you should choose. Here, too, pause for a few seconds, give your brain time to reflect, and recall may occur.

compliance

This is the ease with which the lungs and chest wall expand during inspiration

Ventilation

This is the process by which air flows into and out of the gas-exchange airways and is controlled by sympathetic and parasympathetic division of the ANS

Elastic Recoil

This is the tendency of the lungs and chest wall to return to their resting state after inspiration. The forces of the chest wall and lungs are in opposition and pull on each other creating the normal negative pressure of the pleural space

Trachea, Bronchi, and Terminal bronchioles

This is what consists of the lower airways

Neuroreceptors

This monitors the mechanical aspects of ventilation

C

Thrombocytopenia may be: a. Transient or consistent b. Normal or abnormal c. Congenital or acquired d. Active or inactive REF: p. 523

Autoimmune thyroiditis

Thyroid autoantibodies and autoreactive T lymphocytes infiltrate and destroy thyroid gland

Thyroid-stimulating hormone (TSH) deficiency

Thyroid deficiency

Hyperosmolar hyperglycemic nonketotic syndrome (HHNKS)

Type 2. Higher glucose resulting in severe dehydration, polyuria, and loss of electrolights. Normal pH

Hypersecretion of prolactin

Typically caused by prolactinomas

Hypersecretion of growth hormone (GH)

Usually associate with hyperpituitarism and is usually caused by GH-secreting pituitary adenomas

This is normally passive, however abdominal and internal intercostal muscles do help

What are the accessory muscles of expiration

Sternocleidomastoid and Scalene muscles

What are the accessory muscles of inspiration

Ventilate the alveoli, diffuse gases into and out of the blood, perfuse the lungs so the body recieves oxygen

What are the functions of the pulmonary system

Diaphragm and External intercostals

What are the major muscles of inspiration

Mucous plugging, chronic inflammation, and chronic infection of the small airways

What are the typical features of CF lung disease

humoral factors

What are vasoconstriction and vasodilation controlled by

even distribution of ventilation and perfusion within the lungs

What does efficient gas exchange depend on?

Nasopharynx and Oropharynx

What is contained in the upper airways

Diaphragm and External intercostals

What is the major muscles of inspiration

Visceral Pleura

What is the name of the membrane that encases the lung

Parietal Pleura

What is the name of the serous membrane that lines the chest wall

Emergency airway and antibiotics

What is the treatments for Acute epiglottitis

Type II alveolar cells

What produces the surfactant

Lungs, digestive tract, and reproductive organs

What systems does Cystic Fibrosis affect

B

When a nurse is reviewing lab results and notices that the erythrocytes contain an abnormally low concentration of hemoglobin, the nurse calls these erythrocytes: a. Hyperchromic b. Hypochromic c. Macrocytic d. Microcytic REF: p. 501

D

When a patient wants to know why vitamin B12 and folate deficiencies cause anemia, how should the nurse respond? a. Red blood cells are unable to differentiate into erythrocytes. b. Red blood cells have malformed hemoglobin molecules. c. Red blood cells have decreased O2-carrying capacity. d. Red blood cells have a shorter life span. REF: p. 506

night

When does SIDS normally occur

B

When the nurse sees a diagnosis of hereditary hemochromatosis on the chart, the nurse knows this is a disorder of: a. Intravascular coagulation b. Iron overload c. Leukocytosis d. Granulocytosis REF: p. 508

What is a Brudzinski sign?

When you flex the head and there is pain. Example - Meningitis.

Alveoli

Where does gas exchange occur

C

Which of the following individuals should the nurse assess first for a vitamin B12 deficiency anemia? a. 3-year-old female who is a fussy eater b. 26-year-old female in the second trimester of her first pregnancy c. 47-year-old male who had a gastrectomy procedure (removal of the stomach) d. 64-year-old male with a history of duodenal ulcers and gastrointestinal bleeding REF: p. 503

Smoking

__________ is related to cancers of the larynx, oral cavity, esophagus, and urinary bladder

What is a Cerebral hemorrhage?

a hemorrhagic stroke

What is the most common cause of Subarachnoid hemorrhages?

aneurysms.

Children with systemic hypertension are commonly

asymptomatic

What is a Hemorrhagic stroke (ICH)?

bleeding into the brain tissue

What is a Cerebral infarction?

brain tissue death at the sit of the stroke

What is a fusiform aneurysm?

explosion along the whole artery.

Static encephalopathies

fixed lesion without ongoing disease Cerebral palsy - disorder of muscle tone or posture caused by injury or abnormal development before, during, or after birth up to 1 year

gluconeogenesis

formation of glucose from noncarbohydrate sources

What is a Compound fracture?

fractures exposed through the skin

issue with pineal gland

look at sleep cycle melatonin levels

Can you do a Lumbar puncture with someone who has a brain tumor?

no. because it will herniate.

increased incidence of primary hypertension in older children is related to

obesity

What is coup-contra coup head injury?

one that occurs either front to back or side to side.

hypothalamus

president of endocrine system then pituitary gland is vice president, carrying out orders from hypothalamus

memorize what table

slide 11

What is a Lacunar stroke?

stroke in the deeper structures

What is a Basilar skull fracture?

underneath the base of the skull. Battle's Signs and Raccoon Eyes are an example.