patho midterm review

acute bronchitis pathogenesis

Airway -> inflammation -> obstruction -> respiratory distress -> wheezing

hypertensive urgency

BP will be lowered over 24-48 period using oral **no end organ damage - give oral antihypertensives

infection leads to progressive immunodeficiency and AIDs

CD4 and T cells fall below 200 cells lymphocytes = 14% can lead to kaposi's sarcoma, lymphoma, and squamous cell carcinoma

Which factor explains why a client who experiences an acute episode of rheumatoid arthritis has swollen finger joints?

Inflammation in the joint's synovial lining

pneumothorax

Presence of air or gas in the pleural space caused by rupture of pleura and chest wall

oxygen and carbon dioxide transported in circulation

RBCs transport oxygen veins carry carbon dioxide back to the heart

acute arterial occlusion

absense of arterial circulation = emergency! - swelling happens after surgery, blood flow accumulates in the muscles = compartment syndrome

Which clinical condition will result in changes in the integrity of the arterial walls and small blood vessels?

atherosclerosis

scleroderma

autoimmune disorder by forming scar tissue -> natural immune response to help heal *body overproduces collagen

pericardial effusion significance

causes decreased oxygenation and and decreased perfusion

Which assessment findings would indicate a possible asthma exacerbation? Select all that apply

- tachycardia - wheezing

SLE

chronic multisystem inflammatory autoimmune disease - multiple organs are affected = can lead to organ failure *butterfly rash is common

rheumatoid arthritis

chronic, systematic, progressive deterioration of connective tissue cause: - autoimmune, but unknown = classified as an immune complex disorder clinical findings - immobility, pain, muscle spasms

risk factors of breast cancer

hormonal influences reproductive factors dietary factors family history age hx of cancer lack of access to healthcare

chronic lymphoid leukemia

affects bone marrow - large painless lymph nodes, and enlarged lymph nodes *not treatable bc of slowness of manifestations

acute bronchitis manifestations

airway becomes inflamed and narrowed low grade cough sore throat + or nonproductive cough

role of inflammation in asthma

alveoli gets inflamed = release of inflammatory mediators *causing excessive mucous production and airway plugging

pericarditis cause

infectious agents, usually viral or bacterial; or insult to mediastinal structures

The arterial blood gases for a client with acute respiratory distress are pH 7.30, PaCO2 55 mm Hg, and HCO3 23 mEq/L. How would the nurse interpret these findings?

uncompensated respiratory acidosis

chronic myeloid leukemia

unique chromosome abnormality = philadelphia - not responsive to chemo - survival rate is poor - splenomegaly is common sx

modes of transmission of HIV

unprotected sex injecting drugs pregnancy, childbirth, breastfeeding blood transfusions and organ transplants

Which food would the nurse recommend for a child who is at risk for developing rickets?

yogurt

type 2 hypersensitivity reaction

reaction with blood transfusions, and blood associated things *destruction of RBCs = hemolytic reaction - occurs 15-30 mins after exposure

A client newly diagnosed with scleroderma states, "Where did I get this from?" How would the nurse reply?

"The exact cause is unknown, but it is thought to be a result of autoimmunity."

Which statement indicates a client understands transmission of the human immunodeficiency virus (HIV)? Select all that apply

- "I can contract HIV by participating in oral sex." - "HIV is contracted by using contaminated needles." - "Babies can contract HIV because of contact with maternal blood during birth"

pain of endometriosis differentiated from dysmenorrhea

- Endometriosis Pain: extremely severe pain, pain with defecation - Dysmenorrhea Pain: pain in lower part of abdomen and in vagina

Which potential clinical manifestations would the nurse associate with a client diagnosed with systemic lupus erythematosus (SLE)? Select all that apply

- joint pain - facial rash - pericarditis

A client is hospitalized with emphysema. The nurse recognizes the importance of assessing for clinical indicators of hypoxia based on which condition associated with the disease?

Loss of aerating surface

Endometriosis is a condition in which:

ectopic endometrial tissue is present

tumor grading

evaluated amount of differentiation - GX = cannot be determined - G1 = cells are well differentiated - G2 = cells are moderately differentiated - G3 = cells are poorly differentiated, but tissue origin is established

pericarditis significance

can cause: - cardiac tamponade: results from restriction or excessive pericardial fluid in the pericardial sac - pulsus paradoxus: ↓BP during inspiration - friction rub - tachycardia = not enough blood so heart has to speed up to get blood to rest of the body

clinical manifestations of heart failure

difficulty breathing or shortness of breath = accumulation of fluid in the lungs edema/fluid retention dizziness, fatigue, weakness rapid or irregular heartbeat

pathogenesis of gouty arthritis

disturbance of uric acid metabolism - buildup of uric acid crystals

A 32-year-old female complaining of severe pain with menstruation and inability to participate in her routine household activities is likely experiencing

dysmenorrhea

clinical consequences of superficial obstructions

raised and tortuous veins = varicose

type 3 hypersensitivity reaction

rare reaction, not tissue specific reaction *reaction to certain exposures (being bitten by snake, bee, etc) - "serum sickness"

How would the nurse document a drop in blood pressure when a client moves rapidly from a lying to a standing position?

orthostatic hypotension

6 P's acute arterial occlusion manifestations

pallor paresthesia paralysis pain polar pulseless

how can HIV be prevented

post exposure prophylaxis - taking it very soon after exposure helps to prevent infection

clinical findings of plasma deficits of electrolytes

- Sodium: vomiting, diarrhea, sweating = fatigue, muscle cramps, N/V, hypotension - Calcium: increases excitability of nerves = abdominal cramping, hyperactive reflexes, seizures, Chvostek's and Trousseau's sign -> tetany - Magnesium: caused by chronic alcoholism - Phosphorus: anorexia, paresthesia, diminished reflexes, respiratory compromise, impaired cardiac function

clinical findings of plasma excesses in electrolytes

- Sodium: weakness, thirst, edema of foot and ankle, accumulation of fluid in the lungs causing crackles - Calcium: decreases neuromuscular function = decreased reflexes, decreased bone density, lethargy, depressed cardiac conduction - Potassium: risk for cardiac arrest!, muscle dysfunction, cramping and diarrhea - Magnesium: depression of neuromuscular function = lethargy, hypotension, drowsiness, bradycardia, flushing - Phosphorus: conjunctivitis, pruritis, cardiac valve calcifications, may be the result of renal failure

factors altering balance between myocardial oxygen supply and demand

- angina increases workload of the heart and increases oxygen demand - heart failure makes the heart unable to meet energetic demands of body tissues

A client with a recent history of head trauma is at risk for orthostatic hypotension. Which assessment finding(s) observed by the nurse would relate to this diagnosis? Select all that apply

- fainting - weakness - lightheadedness

Which clinical manifestations would lead the nurse to contact the health care provider regarding the potential development of acute osteomyelitis? Select all that apply.

- fever - erythema - tenderness to area chronic = ulcers and drainage

Which finding in a client with pulmonary edema requires the most rapid action by the nurse?

Oxygen saturation 82%

COPD manifestations

SOB chronic cough edema hx of smoking chills, muscle aches

fat emboli syndrome

fat emboli releases from bone marrow and enters the bloodstream and becomes trapped in pulmonary and dermal capillaries - sx: SOB, tachypnea, altered mental status - tx: early ambulation and supplemental oxygen

mechanism of tissue injury with hypersensitivity reaction

initiation from inflammatory process - body reacts with foreign agent

asthma manifestations

breathing is labored and rapid, use of accessory muscles status asthmaticus = persistent, severe attack that does not respond to initial therapy

role of bicarb buffer in regulating pH

buffer in the ECF = first line defense against pH imbalances - bicarb ion is the base portion - carbonic acid is weak acid portion = excreted via respiratory system

A client with known peripheral arterial disease calls the clinic and tells the nurse about experiencing several symptoms. Which symptom requires the most rapid action by the nurse?

chest pain

acute myeloid leukemia

chromosomal translocation (genetic alterations) - bone pain = most common sx

tumor staging

classifies solid tumors and tumor sizes - TX = Unable to evaluate primary tumor - T0 = no evidence of primary tumor - Tis = tumor in situ (localized and treatable) - T1, T2, T3, T4 = size and extent of tumor

Which client with complications of fracture would the nurse expect may be treated with a fasciotomy?

compartment syndrome

complications that can occur from a fracture

compartment syndrome fat emboli syndrome DVT

assessment of arterial obstructions

cool to touch thickened nails pallor when elevated rubor when dependent

Which finding in a client with asthma exacerbation requires the most rapid action by the nurse?

decreased breath sounds

chronic venous insufficiency

deep - valvular incompetence involves deep veins

compartment syndrome

occurs when swelling causes increased pressure in muscle compartment - manifestations = leads to decreased blood flow and potential nerve and muscle damage, causes continued ischemia - dangers: amputation - management: need to call surgeon immediately if something doesn't look right, look for 6 P's

5 cardinal signs of inflammation

pain heat swelling redness loss of function

osteoarthritis

progressive non-inflammatory arthritis cause: - destruction of bone under cartilage, weight bearing joints are affected - overuse disorder clinical findings - nodules on joints crepitus with joint movement

manifestations of bone infection

puss formation in the bone blood flow occluded ischemia bone necrosis

pH 7.16; CO2 69 and HC03 23

respiratory acidosis

Which explanation will the nurse give when a client asks about what causes varicose veins?

"Incompetent valves of superficial veins."

factors affecting distribution of ventilation and perfusion

COPD - mucosal hypertrophy and edema - airway narrowing from bronchial smooth muscle contraction Oxygen Saturation - hypoxemia: deficient level of blood O2 - hypoxia = decreased tissue oxygenation

common systemic manifestations of AIDs and opportunistic infections

HIV associated dementia retinopathy and malignancies impact on CV, renal, hepatic, endocrine systems

predisposing factors for heart failure

HTN CAD previous MI smoking, overweight, diet high fat not enough exercise

Which finding would the nurse expect to identify in a client who has osteoarthritis that would not be present in clients with rheumatoid arthritis?

Heberden nodes

Which assessment finding by the clinic nurse who is caring for a client with chronic bronchitis is most important to communicate to the health care provider?

Temperature of 101.8 F

dvt

formation of clot at distal extremity led to clot fragments to break loose and enters circulation - tx: prophylactic anticoagulants, SCD's , and early mobilization

type 1 hypersensitivity reaction

highly sensitized response to an allergen *does not occur with first exposure , but does happen with second exposure *releases antihistamines

After a spontaneous pneumothorax, a client's assessment findings include extreme drowsiness, tachycardia, and tachypnea. The nurse suspects which condition?

hypercapnia

osteoporosis

imbalance of osteoblasts that form new bone and osteoclasts that reabsorb bone *bone loss increases after menopause (loss of estrogen)

lungs and kidneys compensating for acid-base imbalance

increased renal excretion of metabolic acid - as kidneys excrete more metabolic acid, bicarb concentration increases

body's response when coming in contact with organism

inflammation is caused by various insult to the body such as burns, injury, or surgical procedures

COPD pathogenesis

inflammation is the result of neutrophil activity mucous production leads to mucous plugs and causes increased airway obstruction and decreased oxygenation

primary hypertension

known as essential hypertension *idiopathic cause - most common type of HTN - end organ damage = "silent killer"

how is BP regulated

lose weight = obesity big cause diet = reduce fat and sodium decrease lipids smoking and alcohol cessation

Which clinical manifestations would the nurse expect to find in a client who has acute human immunodeficiency virus (HIV) infection? Select all that apply

malaise swollen lymph nodes

acute lymphoblastic leukemia

malignancy of the lymphatic system - most common in children - SX: loss of appetite, fatigue, and abdominal pain

arterial obstructions

manifests as distal ischemia - intermittent claudication = pain with activity and gets better with rest late sx: painful arterial ulcer around one toe

venous obstructions

manifests as edema - inflammation of vein and accompanied by a thrombus = thrombophlebitis DVT = can manifests into a PE = happens extremely fast

An arterial blood gas report indicated the client's pH is 7.25, PaCO2 33 mm Hg, and HCO3- is 20 mEq/L. Which disturbance would the nurse identify based on these results?

metabolic acidosis

role of respiratory system in regulating carbonic acid

second defense against acid-base balance disorders - during expiration, lungs effective carbonic acid - balance of carbonic acid remaining in the body is based on depth and rate of respiration - dependent on normal functioning respiratory system

Which clinical finding would the nurse expect for a client with hypertensive emergency?

severe pounding headache

type 4 hypersensitivity reaction

slow to react! - mediated by t cells (have memory function) - memory cells form in 7-14 days to response from antigen

hypertensive emergency

sudden increase in either/both systolic and diastolic pressures - evidenced by organ damage = this determines treatment **use IV antihypertensive agents

pericardial effusion cause

too much fluid impairs heart function

osteomalacia

vitamin D deficiency - inadequate concentration of vitamin D, calcium, or phosphorus; poor vitamin D metabolism **leads to softening of the bones

manifestations of type 1 reactions

wheezing eyes swell shut tongue swells can lead to anaphylaxis - angioedema, hypotension, vasodilator, dyspnea

pleural effusion

· A buildup of fluid between the tissues that line the lungs and chest · Chest tube is used to drain fluid

tension pneumothorax

· Air enters pleural space on inspiration = pt can still breathe · Absent lung sounds on affected side · Chest tube will be put in to expand the lung = MED EMERGENCY