Patho FINAL - Old content!

Leukocytes

WBC - part of body’s inflammatory response

Leukopenia

Decreased leukocytes - immunosuppression or deficiency

Leukocytosis

Increased leukocytes - ongoing infectious process

Neutropenia

Decreased neutrophils - immunosuppression or deficiency

Neutrophilia

Increased neutrophils - active infection !!

Erythrocytes (RBC) do what..

Carry O2 to tissues

High erythrocytes/hemoglobin

Chronic low O2 levels in blood (hypoxia)

Low erythrocytes/hemoglobin

Blood loss!!

High hematocrit

Body making too many RBC

Low hematocrit

Body not making enough RBC

Thrombocytes function

Allows blood to clot

High Thrombocytes

Inflammatory process/disease

Low Thrombocytes

Conditions causing blood clots

Thrombocytosis

High platelets - risk for thrombus formation

Thrombocytopenia

Decreased platelets - increased risk of bleeding & infection

What is anemia?

Decreased number of RBC/reduced hemoglobin/abnormal hemoglobin results in decreased O2 carrying capacity & creates tissue hypoxia

Anemia symptoms (ALL of them)

Weakness, fatigue, pallor, syncope, dyspnea, tachycardia

Key finding in iron-deficiency anemia

Low Fe!!!

How is iron-deficiency anemia diagnosed?

With serum iron levels (ferritin & iron)

How is iron-deficiency anemia treated?

Identify & address cause, supplemental iron intake

Key findings of pernicious anemia

Low cobalamin (B12) level & neuro s/s

Symptoms of pernicious anemia

• Personality or memory changes

• Positive Babinski’s sign

B12 key is needed for…

DNA synthesis or myelin-producing neural cells - when LOW causes neuro symptoms

Onset of pernicious anemia

Insidious, sudden & severe

What does autoimmune lack of intrinsic factor have to do w/ pernicious anemia?

Intrinsic factor is the substance responsible for intestinal absorption of B12

Key findings of aplastic anemia

• Bone marrow depression of all blood cells

• Low RBC, WBC, Platelets

Medical term for low RBC, WBC & platelets

Pancytopenia!

Define hemolytic anemias

Excessive erythrocyte destruction, or hemolysis

Bottom-line issue & cause of sickle cell anemia

RBC have a crescent or sickled shape caused the abnormal hemoglobin, Hemoglobin S

What is sickle cell anemia characterized by?

Sickle cell crisis: painful episodes of tissue ischemia & necrosis that can last for hrs to days

What is polycythemia vera?

Rare neoplastic disease of abnormally high erythrocytes

How can polycythemia vera lead to gout?

Due to the high turnover of RBC, which results in higher-than-normal uric acid prod.

If the left ventricle fails, what is the order of blood back up?

Through the bicuspid valve, to the left atria, into the pulmonary veins, finally to the lungs

Primary symptom of LS heart failure

Fluid in lungs - dyspnea, crackles/rhales

If blood backs up into lungs, what order will it lead to edema of periphery?

Through the pulmonic valve, into R ventricle, through tricuspid valve, into R atria, to the body

Primary symptom of RS heart failure

Edema in periphery (JVD, increased CVP)

Pathway of RAAS

• Angiotensinogen is secreted by liver & renin is secreted by kidneys resulting in Angiotensin 1

• Angiotensin 1 plus Angiotensinogen Converting Enzyme (ACE) from the lungs combine to make Angiotensin II

• Angiotensin II causes the Adrenal cortex in kidneys to release Aldosterone

What is afterload?

Pressure LV needs to eject blood out of heart into aorta

What does the SNS do to afterload when activated?

Increases it through vasoconstriction

What does the RAAS system do to afterload when activated?

Increases it by causing further vasoconstriction

What is preload?

Amount of blood returning to heart

What does the RAAS system do to preload when activated?

Increases it by increasing Na+ reabsorption which leads to increase blood volume returning to heart

What electrolyte is decreased when RAAS is activated?

K+

What is the final product of RAAS & what does it cause?

Aldosterone! Leads to Na+ reabsorption, K+ excretion & vasoconstriction

What is CVP?

Central venous pressure - internally monitored number that represents fluid volume

Norm CVP

2-6 mm Hg

What disease does high CVP indicate?

Heart failure!!

Normal path of electrical signal in heart

SA node - AV node - Bundle of His - R/L Bundle Branches - Purkinje fibers

P-wave on ECG

Depolarization of atria in response to SA node signal

Notch between p-wave & QRS on ECG

Time for ventricles to fill

QRS on ECG

Depolarization of ventricles which is the main pumping action of the ventricles (hides repolarization of atria)

T-wave on ECG

Ventricular repolarization

What is pericarditis?

Inflammation of pericardium (sac that surrounds, protects & supports heart)

Primary symptoms of pericarditis

• Pericardial friction rub (grating sound)

• Sharp, sudden, severe chest pain that increases w/ deep inspiration & decreases when sitting up/leaning forward

What do high erythrocyte sedimentation rate (ESR) and C-reactive proteins indicate?

Inflammation!!

What 3 other cardiac diseases can pericarditis lead to?

Pericardial effusion, cardiac tamponade & constrictive pericarditis

What is Cardiac tamponade?

Life-threatening cardiac compression from fluid accumulation (heart has no room to beat)

Symptoms of acute development known as Beck’s triad

• HYPOtension

• JVD

• Muffled heart sounds

What is infective endocarditis?

Infection of endocardium & heart valves

2 factors needed for infective endocarditis to occur?

Abnormal endocardium & bacteria in bloodstream

Key symptoms of infective endocarditis

• Flulike symptoms

• Roth spots (round hemorrhagic retinal lesions w/ small white centers)

• Splinter hemorrhages under nails

• Osler’s nodes (tender raised subcutaneous lesions of fingers/toes)

• Janeway lesions (small non-tender erythematous or hemorrhagic macular or nodular lesions on palms or soles of feet)

• Embolisms

What is the risk w/ thrombi?

Thrombi that travel (embolism), causing microemboli & microhemorrhage

At risk groups for infective endocarditis

IV drug users, those having dental procedures

Define stenosis

Narrowing; less blood can flow through valve

Two other names for regurgitation

Insufficiency or incompetence

Define regurgitation

Insufficient closure; bidirectional blood flow

What does stenosis & regurgitation result in?

Decreased CO, increased workload, & hypertrophy

What is a cardiomyopathy?

Conditions of the myocardium (muscle portion of heart) that weaken, enlarge, or make it rigid

Bottom-line issue of dilated cardiomyopathy

Ventricles become enlarged & weakened

What can dilated cardiomyopathy lead to?

Blood stagnation causing thrombi to develop

When do manifestations of dilated cardiomyopathy appear?

As compensatory mechanisms fail - blood backs up into the pulmonary system

What is orthopnea?

SOB when lying down that worsens when you stand or sit up

KEY nursing implication of dilated cardiomyopathy

Only affects SYSTOLIC function (as worsens, will affect diastolic too)

Bottom-line issue w/ Hypertrophic cardiomyopathy

Septum wall between ventricles is affected becoming stiff & unable to relax

Hypertrophic cardiomyopathy is a common cause of sudden cardiac death in what group so you need to avoid…

Young ppl (especially young athletes)!! Avoid strenuous activity due to risk of sudden death

KEY nursing implication of Hypertrophic cardiomyopathy

Affects SYSTOLIC & DIASTOLIC function

Bottom-line issue w/ Restrictive cardiomyopathy

Rigidity of ventricles but myocardium does not thicken

Does Restrictive cardiomyopathy always have symptoms?

No!!

Prognosis of Restrictive cardiomyopathy

Poor!! Will need heart transplant - no transplant = die of heart failure

Key nursing implicatiom of Restrictive cardiomyopathy

Affects DIASTOLIC function

Bottom-line issue of heart failure

Heart is unable to pump an adequate amount of blood to meet the body’s metabolic needs

What is LS heart failure & symptoms

Due to ineffective L ventricle contractility, blood backs up to pulmonary circulation causing pulmonary congestion, dyspnea & activity intolerance

What is RS heart failure & symptoms

Due to ineffective R ventricle contractively, blood backs up to peripheral circulation causing: Edema & weight gain

What two compensatory mechanism kick in to increase CO but makes the situation worse?

SNS & RAAS

How does SNS & RAAS worsen heart failure?

When CO is decreased, these systems kick in causing increased PVR (vasoconstriction) & increased blood volume (Na+ reabsorbed, water passively following) & decreased K+. This results in increase preload & afterload. But the heart was unable to maintain CO prior to this increase, results in downward cycle of continuing to increase preload & afterload until they start meds or the heart collapses.

Aneurysm bottom-line issue

Wall of arteries weaken because of high pressures, plaque & infections; the weakened areas balloon outward

Are symptoms always present w/ Aneurysms?

NO! Most are asymptomatic until they rupture

Most serious & potential consequence of an Aneurysm

Exsanguination is a possible consequence

When is surgery performed for an Aneurysm?

If symptomatic or Diameter is >5 cm

Bottom-line issue of shock

Inadequate tissue & organ perfusion

Compensatory mechanisms w/ Aneurysm & what happens when they fail

SNS & RAAS!! Leads to tissues hypoxia & acid/base imbalances

What is distributive shock?

Massive vasodilation causes same effect as hypovolemia (but volume is not the issue)

3 subtypes of distributive shock

• Neurogenic shock

• Septic shock

• Anaphylactic shock

What happens in anaphylactic shock that doesn’t happen in any other shocks?

Bronchospasms & laryngeal edema which can impair respiratory status - ONLY shock to directly cause BREATHING ISSUES!!!

Bottom-line issue in cardiogenic shock

Left ventricle cannot maintain adequate CO - enough blood but pump isn’t working

Bottom-line issue in hypovolemic shock

• Venous return declines b/c of external blood volume losses; heart function not impaired but not enough blood in body

• GUN SHOT WOUND!!!!

Shock is an emergent condition, so what does it require?

Immediate intervention!!! Or client death is imminent

Shock symptoms

• MAP <65

• Tachycardia

• Hypotension

• Cool, clammy, & pale skin

• Cyanosis

• Tachypnea progressing to Cheyne-Stokes respiration (period of fast, shallow breathing, followed by slow, heavier breathing & moments of apneas)

Define thrombi

A blood clot that consists of platelets, fibrib, RBCs & WBCs

Define emboli

A portion or all of the thrombus breaks loose and travels through circulatory system