Exam 4

gas exchange in lungs

-primary function of lungs -each alveolus is surrounded by a network of capillaries which bring deoxygenated blood from pulmonary arteries (originate from right ventricle of heart) - the walls of alveoli are one cell thick which facilitates diffusion of CO2 from blood into lungs and O into the blood -oxygenated blood returns to left atrium of heart via pulmonary veins -driving force of gas exchange is pressure differential of gases -when blood initially arrives at alveoli, it has a low partial pressure of O and a high partial pressure of CO2 which facilitates transfer of each down its respective concentration gradient -no energy is required for gas transfer -respiratory system adjusts if moved to higher altitudes where less oxygen is available

Normal intracranial pressure

5-15 mmHg

Asthma

A chronic allergic disorder characterized by episodes of severe breathing difficulty, coughing, and wheezing.

COPD (chronic obstructive pulmonary disease)

A group of lung diseases that block airflow and make it difficult to breathe.

PNEUMONIA

An inflammation of lung tissue, wherer the alveoli in the affected areas fill w/fluid Pathophysiologic changes • Changes in interstitial tissue, alveolar septae, or alveoli - Epidemiologic data • Nosocomial (hospital-acquired) • Community-acquired

Transient Ischemic Attack - TIA Cause

Atherosclerosis - Vascular spasm - Small embolus

Multiple Sclerosis

Autoimmune disorder causing t-cell destruction of myelin in CNS, onset 20-50 years of age • Triggered by viral insult, T cells auto-reactive - damages myelin • Affects brain, spinal cord, optic nerves - MOTOR and SENSORY • Acute stage = inflammation, partial demyelination • Chronic stage = scarring with plaque formation • Females more than males—2:1

Meningitis

Bacterial or viral inflammation of meninges causing edema brain and spinal cord Bacterial meningitis - most severe form • H. influenza • Strep pneumoniae(pneumococcus) • Neisseria Meningitidis(meningococcus)

What is not a complication of bone healing

increased circulation

bronchitis

inflammation of the bronchial tubes

TB treatment

isoNiazid 6month-neuro Rifampin 6 month-red pyrizinamide 2month stop- hyperuricemia, don't treat Ethambutal 2 month stop-Eye

Rheumatoid arthritis signs and symptoms. Select 2.

joints symmetrically affected red, swollen painful joints

What degree of neurological impairment is seen with a complete transection of the spinal cord?

loss of sensation and motor activity below the level of injury indicates that there is no motor or sensory function below the site of injury."

Why can excessive supplemental oxygen administration to COPD patients be detrimental?

low oxygen levels are their primary stimulus to breathe The healthy person is stimulated to breathe when CO2 accumulates in the bloodstream and activates the respiratory center in the brain." "In persons who develop long-term chronic hypercapnia, the respiratory center becomes insensitive to accumulation of CO2 as a stimulus for breathing. The body changes its respiratory stimulus to low oxygen levels (hypoxia), instead of high CO2 levels. This often occurs in person with long-term COPD.

What is a complication of bone healing

malunion fat embolus nerve damage

Parkinson's Disease

Dysfunction of the extrapyramidal motor system - Progressive degeneration in basal nuclei - Imbalance between excitation and inhibition in basal nuclei (DEFICIENT DOPAMINE - excess Acetylcholine

Myasthenia gravis S&S

Facial weakness, monotone voice - Progressive muscle weakness, fatigue, difficulty chewing, swallowing, speaking, facial movement True muscle fatigue- not a sense of tiredness • Decreased contractile force of muscles occurring with repetitive motions • blinking, walking, talking, chewing • Swallowing and respiratory function may be affected • Rest improves muscle function

Fibromyalgia has an extremely thought out and well known pathophysiology.

False

Meningitis S&S

Fever, nuchal rigidity, headache, and photophobia • Kernig's and Brudzinski's signs • Lumbar puncture needed for diagnosis - + bacteria, mirky color

TB test

First exposure or primary infection • Indicated by positive tuberculin (skin) test results - Active infections • Acid-fast sputum test • Chest radiograph • Sputum culture and sensitivity • Quantiferon GOLD blood test (latent and active)

Phantom Pain

Following an amputation - Pain, itching, tingling • Usually does not respond to common pain therapies • May resolve within weeks to months • Phenomenon not fully understood

Somatic pain

From skin (cutaneous) - Bone /muscle - Conducted by sensory fibers

When a person does not realize they are having pain because other sensations, such as touch and temperature, close or inhibit the pain impulse's ability to travel to the brain, this is referred to as

Gate control theory The Gate Control Theory of pain refers to the theory that "when large nerve fibers from the periphery are stimulated" (such as by rubbing, applying cold, or other stimulus to the area), "small-diameter pain fibers cannot get through the interneuron gate", since "the gate is closed".

What increases inctracranial pressure

Hemorrhagic Stroke • High mortality rate • Bleeding causes cerebral edema by compressing the brain = increased intracranial pressure (ICP)

seizure etiologies

Hypoxia-ischemia Stroke/Intracranial hemorrhage Hypoglycemia Metabolic disease Intracranial infection Developmental defects Drug intoxication or withdrawal

Coup injury

Injury directly below the point of impact

Contrecoup

Injury on the side opposite the site of impact

Core Ischemia and Ischemic Penumbra

Ischemic penumbra area - cerebral EDEMA occurs which increases ischemia and further damages neurons neuron death is irreversible Can lead to anoxic encephalopathy or pressure on brain stem Ischemia impairs cellular metabolism and causes release of excessive glutamate

Anoxic encephalopathy

Lack of oxygen delivery causes decreased level of consciousness

Lumbar Sacral

Loss of bowel and bladder control Pain Sensory changes Spasticity and weakness

Tonic-clonic or Grand Mal seizures

Loss of consciousness - Rhythmic tonic and clonic movement up to 5"

Multiple Sclerosis S&S

Manifestations determined by areas of demyelination - Blurred vision; weakness in legs - EARLY - Diplopia (double vision); scotoma (spot in visual field) - Dysarthria - poor articulation - Paresthesia, areas of numbness, burning, tingling - Progressive weakness and paralysis extending to the upper limbs - Loss of coordination; bladder, bowel and sexual dysfunction; - DYSPHAGIA - swallowing difficulty (late disease state) - Chronic fatigue - Cognitive - memory loss (recent)

Generalized seizures

Multiple foci or origins - both hemispheres involved • Deep structures of cerebral hemispheres and brainstem involved bilaterally - Cause loss of awareness or consciousness

Tuberculosis - TB etiology

Mycobacterium tuberculosis - Aerobic bacillus resistant to drying - can live in dried sputum for weeks - Gram negative acid -fast bacilli "protected" from macrophages by outer cell wall - Resistant to many antibiotics Destroyed by ultraviolet light, heat, alcohol, glutaraldehyde, formaldehyde Normal neutrophil response does not occur - Cell-mediated immunity normally protection

Atypical pneumonia

Mycoplasma pneumoniae - bacterial • Common in older children and young adults • Transmitted by aerosol - not highly contagious • Frequent cough, antibiotic therapy

Nociception

NS response to painful stimuli - Afferent neurons carry signal after stimulation by • Thermal means: extreme temperatures • Chemical: i.e., acids or chemicals produced by body (bradykinin, histamine, prostaglandin) • Physical: pressure, vibration • Nocioreceptors are located in skin, muscle, connective tissue, bone, circulatory system, abdominal and thoracic viscera

Chronic Pain

Occurs over extended time; may be recurrent • Usually more difficult to treat than acute pain • Often perceived to be generalized Individual may be fatigued, irritable, depressed • Sleep disturbances common • Specific causes may be less apparent. • Appetite may be affected. - Leading to weight gain or loss • Frequently affects daily activities

Visceral pain

Originates in organs - Conducted by sympathetic fibers - May be acute or chronic

Which of the following conditions or actions can cause primary osteoarthritis?

Over-use of joints, aging, obesity "Risk factors for OA (Osteoarthritis) include aging, obesity, history of participation in team sports, history of trauma or overuse of a joint, and heavy occupational work. Obesity has become a particularly common risk factor, as excess body weight places excess pressure on the knees and hips."

Thoracic Spine

Paralysis in legs but arms can still function Loss of bowel and bladder control Pain

A patient has hypoxia, dyspnea and lack of breath sounds on one side. Chest x-ray shows a mediastinal shift. You suspect which of the following has occurred?

Pneumothorax Clinical signs and symptoms of a pneumothorax include chest pain, dyspnea, and increased respiratory rate... auscultation may reveal a lack of breath sounds on the affected side.... A mediastinal shift toward the contralateral, undamaged lung may be apparent.... Pulse oximetry and ABG analysis demonstrate hypoxemia

Parkinson's Disease S&S

Postural instability- "Pill rolling" hand movement Bradykinesia - slow movement

Absence or Petit Mal seizures

Present with little or no movement usually found in pediatrics Last seconds , normal activity to blank stare with possible tremors then back to regular activity. "Blank stare"

Seziure signs

Prodromal signs Aura Loss of consciousness Strong tonic muscle contractions

When a patient has a history of left ventricular heart failure, this increases their risk of developing which of the following?

Pulmonary Edema "The most common cause of pulmonary edema is left ventricular heart failure (LVF)... as a result, hydrostatic pressure builds backward... the high hydrostatic pressure within the pulmonary capillaries causes fluid from the blood to diffuse into the interstitial tissues.

Increased ICP: Eye Changes

Pupil reaction to light is indicative of an intact pathway between cranial nerve II in the midbrain then back to the oculomotor cranial nerve III - any defect in symmetrical pupil response is due to brainstem damage

Concussion (mild brain trauma)

Reversible interference with brain function

Deficit of vitamin D & phosphates, sunlight exposure can cause what problem? (select 2)

Rickets Osteomalacia

Seizure Disorders

Seizure: sudden, abnormal disorderly discharge of neurons within the brain characterized by transient alteration in brain function

C4 and C7

Severe weakness in arms with no motor function or sensation in legs Loss of bowel and bladder control Pain

Causes of Pain

Signal between periphery, spinal cord, and brain • Simple reflex arc - Response at spinal cord level, does not involve brain • Nociceptors - Pain nerves • Spinal cord - Pain signals up to brain through ascending tract (spinothalamic tract) Brain Connection The brain interprets pain signals •

A football player injures their ACL. What kind of injury occurred?

Sprain

Tuberculosis - TB Stages

Stage 1: Primary or Latent infection - TB Infection • Organism first enters the lungs • Engulfed by macrophages - local inflammation, granuloma formation (tubercle) • TB skin test will be +, X-rays positive • Not contagious if normal immune response If cell-mediated immunity is inadequate: - Mycobacteria reproduce and begin to destroy lung tissue - Contagious if cell mediated response is inadequate Stage 2: Secondary or reinfection TB - Active TB - Occurs when client's cell-mediated immunity is impaired due to: • Stress • Malnutrition • HIV infection • Age - Mycobacteria begin to reproduce and infect lung. - Active TB, which can be spread to others!

increased intracranial pressure

Stage 1—brain vasoconstriction and venous compression- AUTOREGULATION— compensatory alteration of blood vessel diameters • Stage 2—systemic arterial decreased LOC, bradycardia, pupils small and fixed vasoconstriction and elevated blood pressure • Clinical changes—confused, drowsy, pupils, breathing • Stage 3—brain tissue hypoxia, hypercapnia

Parkinson's Disease Diagnosis

TRAP - Tremor at rest - Rigidity - Akinesia (or bradykinesia)- slow movement - Postural/gait instability- shuffling, stumbling • No laboratory tests

Carpal Tunnel Syndrome:A numbness and tingling in the hand and arm caused by a pinched nerve in the wrist

TRUE

Transient Ischemic Attack - TIA

Temporary reduction in cerebral blood flow causing ischemia 25% progress to stroke

Pneumothorax S/S

Tension pneumothorax - serious • Result of an opening through chest wall and parietal pleura or from a tear in the lung tissue and visceral pleura • Air entry into pleural cavity on inspiration but hole closes on expiration, trapping air > increased pleural pressure and atelectasis causing lung to collapse. • Mediastinal shift possible • ABSENT breath sounds on affected side, severe dyspnea

Why do strain and sprains take so long to heal?

There is little vascularization of tendons/ligaments, therefore healing is slow

Between C1 and C3

Unable to breathe without respirator Unable to move arms and legs Between

Acute Pain

Usually sudden and severe, short term • Indicates tissue damage • May be localized or generalized • Initiates physiologic stress response - ↑ blood pressure and heart rate; cool, pale, moist skin; ↑ respiratory rate; ↑ skeletal muscle tension • Vomiting may occur. • Strong emotional response may occur

Why does a pulmonary embolus cause hypoxia to develop?

blocked blood supply causes an area of the lungs to not be perfused A Pulmonary Embolus (PE) is when a clot has "traveled to the pulmonary arterial circulation and caused obstruction of arterial blood flow through the lungs". This, as a result, leads to inadequate arterial blood flow and gas exchange in the area of the PE.

Decr volume of one or more compartments will decrease ICP

brain tissue, CSF or circulation. Methods: • Ventriculostomy - drains CSF • Lower B/P - decreased blood volume in brain- drugs: mannitol (hypertonic) • Lower CO2 level - vasoconstrict cerebral arteries reducing blood volume • Remove brain tissue surgically - lobectomy • Decompressive craniectomy - remove section of skull

What is not a step in the fracture healing process?

cartilaginous

Viral pneumonia

caused by several different types of viruses and accounts for approximately half of all pneumonias

causes the expanded anterior-posterior chest diameter in emphysema that results in a barrel-chest appearance.

chronic air trapping with hyperinflation A barrel-shaped chest is commonly present in emphysema; this is a shape that has an equal diameter of the width and depth of the chest. In healthy persons the width of the chest should be double the depth of the chest. In emphysema, there is an accumulation of air in the alveoli, which over time increases the width and depth of the thoracic cage.

atelectasis

collapsed lung; incomplete expansion of alveoli

What sign is often the earliest indicator of increased intracranial pressure?

decreased level of consciousness "Signs of increasing ICP include decreased LOC (level of consciousness), pupillary dilatation, headache, vomiting, increased blood pressure, and papilledema."

Osteoarthritis affects joints bilaterally

false

What are steps in the fracture heling process

hematoma remodeling bony callus

A generalized seizure is characterized by

impaired awareness and bilateral cerebral involvement "Seizures are described as focal or generalized depending on the involvement of one or both hemispheres of the brain...Generalized seizures arise within one hemisphere and rapidly involve neurons distributed across both cerebral hemispheres." In seizures classified as "Generalized onset", the person will have "impaired awareness" and motor or non-motor activity (as in an absence seizure).

Hemorrhagic Stroke

occurs when a blood vessel in the brain leaks or ruptures; also known as a bleed

A malignant tumor of the bone is called a. synoviosarcoma b. osteofibroma c. osteosarcoma d. myeloma

osteosarcoma

What sign is commonly observed in a person with a basilar skull fracture?

periorbital bruising (raccoon eyes) "ecchymoses around both eyes ('raccoon eyes') and a bruise behind the ear ('Battle's sign').

A patient presents with high fever, fatigue and dyspnea. Upon assessment you find tachycardia and tachypnea, labs show leukocytosis and X-ray shows consolidation in the lung. What disease process do you suspect the patient has?

pneumonia The person with pneumonia can have many signs/symptoms, including: cough, fever, chills, pleuritic chest pains with deep breaths, dyspnea, decreased exercise tolerance, fatigue, myalgias (achiness), tachypnea, use of accessory muscles for breathing, tachycardia, and crackles in lungs. (See "Clinical Presentation", Capriotti, 2nd Ed., Pg. 485) "A chest x-ray is the most important diagnostic study in the diagnosis of pneumonia (see Figure 20-6). (Consolidation is seen as white areas on the chest x-ray, showing that air has been replaced by fluid or other.) CBC with differential will suggest either a bacterial or viral infection

What groups are at risk of developing osteoporosis? Select 2

post menopausal women men with decreased testosterone

At risk groups for osteoporosis includes... select all that apply

postmenopausal women women with decreased estrogen men with decreased testosterone

An ER patient complaining of nausea and severe left jaw pain is diagnosed with a myocardial infarction. What type of pain is she experiencing?

referred pain "Referred pain occurs when the pain response occurs at a distance from the actual pathology....The best-known example of referred pain is pain experienced during myocardial infarction. Nerves from damaged heart tissue convey pain signals to spinal cord levels C4-T4 on the left side, which happen to be the same levels that receive sensation from the left side of the chest and part of the left arm. The brain doesn't have a strong neurosignature of the heart, but it does have a strong impression from the adjoining thoracic skin and muscles, so it interprets the signals from the heart as pain in the chest and left arm."

Clonic seizures

repetitive jerking movements

What is the best description of the disease known as cor pulmonale?

right-sided heart failure due to pulmonary hypertension Chronic pulmonary disease is the leading cause of RVF (right ventricular failure). When pulmonary disease is the etiology of RVF, the condition is referred to as cor pulmonale. In cor pulmonale, the initiating event of heart failure is a lung disease that causes chronic hypoxia. The heart starts out in good health until a lung disease exerts detrimental effects on the right ventricle.

Decerebrate posturing in a head injury victim indicates which type of brain damage?

severe brain stem damage "Decerebrate posture is an abnormal position where the arms are held straight out and toes pointed downward. The shoulders and neck are slightly arched as the patient lies supine. Decerebrate posturing results from upper brainstem damage and indicates more extensive brain damage than does decorticate posturing."

In patients with pneumonia, why does excess mucus in the alveoli reduce gas exchange?

the alveolar-capillary interface is widened mucous and exudative edema accumulate between the alveoli and capillaries. The alveoli attempt to open and close against the purulent exudate; however, some cannot open.... A layer of edema and infectious exudate at the capillary-alveoli interface hinders optimal gas exchange. The patient can become hypoxic and hypercapnic, with obstructed exchange of O2 and CO2 at the pulmonary capillaries.

What pulmonary disorder is spread by droplets and presents with weight loss, night sweats, cough with purulent sputum and low grade fever?

tuberculosis TB (Tuberculosis) is spread by the inhalation of airborne droplets containing M. tuberculosis bacteria." Clinical presentation of a person with active TB include "chronic cough, which produces purulent sputum; hemoptysis; weight loss; anorexia; chest pain; and a low-grade fever with night sweats

A form of arthritis that first affects the spine and adjacent structures and, as it progresses, causes a forward bend of the spine is...

ankylosing spondylitis

Guillain-Barre syndrome

autoimmune condition that causes acute inflammation of the peripheral nerves in which myelin sheaths on the axons are destroyed, resulting in decreased nerve impulses, loss of reflex response, and sudden muscle weakness

What pathophysiology results in Parkinson's Disease?

basal ganglia degeneration with reduced dopamine levels "Pathologically, Parkinson's disease is mainly associated with progressive loss of dopamine-producing cells in the substantia nigra, which is within the basal ganglia of the midbrain. The basal ganglia modulates movements, such as posture, standing, walking, or writing. In the basal ganglia, Ach (acetylcholine) and dopamine are the neurotransmitters that modulate the body's movements. Ach stimulates muscle movement, whereas dopamine has an inhibitory effect on movement. The depletion of dopamine in Parkinson's disease creates an imbalance of these two neurotransmitters. The effects of unopposed Ach are apparent in the tremor and abnormal spasmodic, muscle movements." "...There is also an accumulation of an abnormal protein called alpha-synuclein found in structures called Lewy bodies in the brainstem, spinal cord, and regions of the cortex....the accumulation of this protein is associated with neurodegeneration and cell death."

Embolic CVA

blockage from foreign matter, migration into smaller vessels, abrupt onset. No signs but possibly headaches or seizures

Epidural Hematoma (EDH) results in

Cause: skull fracture lacerating meningeal artery Result: rupture meningeal artery - increased intracranial pressure with rapid bleeding - may cause midline shift

Rheumatoid Arthritis: A _____ inflammatory disorder affecting many joints, including those in the hands and feet.

Chronic

Myasthenia gravis

Chronic T and B cell autoimmune disease affecting neuromuscular junction Acetylcholine receptors destroyed by IgG antibodies ** Destruction of muscle receptor sites preventing muscle stimulation: - TRUE skeletal muscle weakness

What typically results from chronic hypoxia? (Select 3 that apply)

Clubbing of the fingers Polycythemia Pulmonary hypertension

Transient Ischemic Attack - TIA S&S

Confusion - Muscle weakness - Numbness Lacunar infarct - Small infarcts in brain due to occlusion of tiny blood vessels

Pneumothorax

air in the pleural cavity caused by a puncture of the lung or chest wall

Emphysema

a condition in which the air sacs of the lungs are damaged and enlarged, causing breathlessness.

FOCAL seizures

a short motor, sensory, or autonomic disturbance that commonly begins in one part focused on one part of the body it may spread to other parts of the body and may result in generalized convulsions

Ischemic Stroke

a type of stroke that occurs when the flow of blood to the brain is blocked

Bronchopneumonia

acute inflammation of the walls of smaller bronchioles with spread to lung parenchyma Several species of microorganisms may be the cause Staph, Strep, H. Infuenza, Pseudomonas

lobar pneumonia

affects larger areas of the lungs, often including one or more sections, or lobes, of a lung AKA: Streptococcal Pneumonia ( 90% Pneumococcal) - Usually caused by Streptococcus pneumoniae, some Klebsiella pneumonaie - Infection localized in one or more lobes