Patho Exam 2

What is the most significant risk factor for COPD

• Smoking cessation

  • biggest impact in reducing risk of developing COPD

  • accelerated decline in pulmonary function slows to almost nonsmoking levels

• Carbon monoxide

  • decrease O2 carrying capacity

    • increase heart rate

    • impaired psuchomotor performance and judgment

What is a cardiac complication of COPD

• respiratory insufficiency and failure

• pneumonia

• chronic atellectasis

• pneumothorax

• cor pulmonale (right sided heart failure)

Why do patients with COPD lose weight

• thre primary symptoms

  • chronic cough

  • sputum production

  • dyspnea

• Weight loss due to dyspnea- encourage easy to eat foods

• “barrel chest” and club fingers

what classification of drugs are used first for fast relief of airway obstruction in COPD and asthma

• Bronchodilators: Short-Acting and Long-Term Inhaled Beta2- Adrenergic Agonists

• administering bronchodilators by inhalation is most effective and the treatment of first choice to relieve acute asthma

• two general types of inhaled beta 2-adrenergic agonists are used for asthma management:

  • rescue inhalant medications (quick relief, short-acting drugs) used during periods of acute symptoms and exacerbations

    • Albuterol (Proventil HFA, Ventolin HFA, Pro AirResp Click)

  • maintenance inhalant medications (long term control drug used to achieve and maintain prophylactic control of persistent asthma

  • MOA: stimulates the beta 2 adrenergic receptors in the smooth muscle of the bronchi and bronchioles. The enzyme adenyl cyclase causes increased production of cyclic AMP, resulting in bronchodilation

What deficiency is seen in younger people diagnosed with COPD

• Alpha-1 Antitrypsin

• Protein that protects the lung

• produced in the liver

• deficiency increased risk of lung and liver disease

• the destruction is all over

  • panlobular (panacinar) emphysema

  • the destruction is all over- its a genetic problem

What clinical manifestation occurs with chronic hyperinflation of the lungs and “dead space”

barrel chest

AP diameter: 1:1

PAIN

what is pain

• complex experience

• dynamic interactions between physical, cognitive, spiritual, emotion and environmental factors

  • not just a response to injury

• Acute pain is protective → promotes withdrawal from painful stimuli, allows injured parts to heal, and teach avoidance

• Pain can be defined as whatever the patient says it is, and it exist whenever the patient say it does

what happens during the transduction phase of the pain process

• physiology of pain (nociception)

• transduction → transmission → perception → modulation

• during transduction, painful stimuli is converted to action potentials at the sensory receptor

  • occurs at the end of A-delta fibers and C-fibers

what is the difference between A-delta fibers and C-fibers in pain transmission

• A-delta

  • small diameter

  • myelinated- rapid tranmsission of pain

  • pain is sharp, stinging, cutting, and pinching, it localized (know where to pull hand away from)

• C-fibers

  • small diameter

  • unmyelinated, slow transmission of pain

  • pain is dull, burning, aching, poorly localized (can’t pin point where it hurts)

what are some examples of therapies related to the Gate Control Theory of pain

• during modulation

• synaptic transmission of pain signals is altered

  • can be amplified or dampened

  • neurotransmitters

  • opioids such as ENDORPHINS mediate pre synaptic (inhibit)

  • morphine MIMICS the effect of endorphins

• Gate Control Theory

  • theory that if we block the pain before it gets to the brain we can stop or lower pain perception

  • touch, rubbing skin, massage, distraction acupuncture, getting active, TENS units

What is the difference between referred and phantom pain

• refee

what are the indications for the drug gabapentin

• atypical pain medications

• gabapentin (Neurontin) and pregablin (Lyrica)

• Anti convulsants

• MOA: though to spontaneously suppress neuronal firing

• Indications: to complement effects of opioids

  • used specifically for neuropathic pain

• AE: drowsy, dizzy, visual problems

  • con only be partially reverses with Naloxone

What are the indications of naloxone or when would it be used

• naloxone (Narcan)

• opioid antagonist

• MOA: binds to opioid receptors but DOES NOT ACTIVATE (just clogs them up)

  • onset is < 2 mins

  • route: IV, IM or intranasal

• Indications: antidote to reverse effects of morphine and morphine-like drugs (opioids) - respiratory depression

• AE:

  • abrupt reversal of opioid effects with Recurrent pain

  • increased blood pressure

What are the bodys “natural” painkillers

• endorphines

Urological and Male Reproductive

What are the signs of testicular cancer

• early clinical manifestations

  • enlargement of testicle

  • painless mass noted

  • if discomfort present (30-40%)

    • dull ache in groin

    • sensation of heaviness

• Late clinical manifestations

  • possible acute pain

  • mainfestations based on metastatic spread

    • cough

    • hemoptysis

    • swelling of lower extremities

    • back pain

    • dizziness

What are risk factors for prostate cancer

• non-modifiable

  • age

  • family history

  • race/ethnicity

• modifiable

  • obesity and metabolic syndrom

  • caffeine

  • physical activity

what are the clincal manifestations of BPH

• frequencey and urgency

• delay in initation

• reduction in force

• increased urination time

• dribbling

Who is at risk for urosepsis

• definition: severe systemic response to UTI that can be life threatening

• who at risk

  • elderly patients

  • diabetics

  • immunosuppressed patients

• prognosis

  • high mortality

• treatment : source control is key, administration of ABX, follow cultures and supportive care

who would not be able to take bactrim for a complicated UTI

• bactrim: AKA Septra, Sulfatrim (sulfa drug)

• works on synthesis of folate inside bacteria, halting DNA and protein synthesis

• metabolized by liver, and CYP450. excreted in urine, metabolized in liver

• used for treatment of uncomplicated UTI and MRSA coverage

• SE: nausea/vomitting, can cause sunburn

• safe in pregnancy after trimester 1

What is the MOA of phenazopyridine (Pyridium)

• urinary tract analgesic

• prototype: phenazopyridine (Pyridium)

• Therapeutic use; reliefe

• MOA: dye used in paints- local analgesic action

• Side/Adverse effects

  • well tolerated

  • reddish-orange urine

what are some atypical UTI symptoms in the elderly

• anxiety

• confusion

• lethargy

• anorexia

• history of falling may be exacerbated due to UTI symptoms

URI and atelectasis

the nurse is administering diphenhydramine to a client. the nurse would monitor the client for which of the below side effects of this medication?

• ataxia, drowsiness, vertigo, slurred speech

• drowsiness

• diphenhydramine is a first gen antihistamine

  • suppresses activity in key regions of the subcortical area of the central nervous system

• Ataxia, vertigo and slurred speech are not associated with 1st gen antihistamines.

the nurse instructs a client to breathe deeply to open collapsed alveoli. which explanation could the nurse offer to explain the relationship between alveoli and improved oxygenation?

• the alveoli need oxygen to live

• the alveoli have no direct effect on oxygenation

• collapsed alveoli increase oxygen demand

• oxygen is exchanged for CO2 in the alveolar membrane

• oxygen is exchanges for CO2 in the alveolar membrane

• the exchange of oxygen and carbon dioxide occurs in the alveolar membrane

• if the alveoli collapse this exchange cannot occur because pulmonary ventilation is reduced

which of the conditions below causes a steeple sign on X-ray

• epiglottis

What are the classic signs and symptoms of allergic rhinitis

• inflammatory disorder

• upper airway, lower airway, and eyes

• clinical manifestations: sneezing, rhinorrhea, prutitus, nasal congestion, watery, ithcy eyes

• triggered by allergens- binds to IgE antibodies on mast cells- release inflammatory mediators

• environmental triggers: dust mites, mold, etc- avoid contact as part of treatment

Upper GI

peptic ulcer (PUD) etiology

• H. pylori

• Injury causing substances

  • NSAIDS, ASA, alcohol

• excess secretion of acid

• stress- physiologic stress

• smoking

• family history

what is the connection between proton pump inhibitor omeprazole, instrinstic factor, and vitamin B12 level?

1. acid degrades meat, releasing vitamin B-12 (colabalamin)

2. parietal cells secrete intrinsic factor

3. in the duodenum, B12 binds to intrinsic factor

4. instrinsic factor shuttles B12 into the cells of the illeum

• (B12 binds to transcobalamin once in the plasma)

What is the MOA of pantoprazole (Protonix)

• Proton Pump Inhibitors (PPI)

• Prototype

  • omeprazole (Prilosec)

  • Pantoprazole (Protonix)

• MOA

  • binds to proton pump

  • irreversibly inhibits the secretion of HCL

• Indication

  • short term treatment of PUD and GERD

explain difference between COX-1 and COX-2

How do NSAIDS cause PUD

• NSAIDS work by inhibiting (blocking) 2 enzymes

  • COX-1:

    • found in all tissues

    • one of its jobs is to protect gastric mucosa by secreting prostaglandin E (PGE)

  • COX-2:

    • found at site of injury

    • mediates inflammation and pain

  • So what happens if you inhibit COX-1

    • when NSAIDS block or inhibit the COX-1 pathway, they reduce levels of protective prostaglandins which protect the gastric mucosa which can lead to peptic ulcer disease

      • NSAID EX: ibuporfen, naproxen, aspirin, and celecoxib

What is GERD and what are the risk factors

• Gastroesophageal reflux disease

• backflow from the stomach into esophagus

• highly acidic material

• what can it result in

  • Inflammation

  • pain

  • complications: ulceration, scarring, strictures, Barrett esophagus

• Anything that alters closure strength of LES or increases abdominal pressure

  • EX

    • fatty foods

    • caffeine

    • large amounts of alcohol

    • ciagaretter smoking

    • sleep position

    • obesity

    • pregnancy

    • pharmacologic agents

Lower GI

A post op patient is receiving morphine for pain. which of the below medications might you expect to see on the MAR

• docusate sodium

• senna

• psyllium

• magnesium hydroxide

• docusate sodium

• docusate sodium lubricate fecal material and walls, promotes fat absorption into fecal mass

• used often in conjunction with opioids in the hospital to prevent opioid-induced constipation

a client with a clostridium difficile is a risk for which of the complications listed below? what is the treatment for c. diff?

• bowel perforation

• abdominal cramping

• low grade fever

• dumping syndrome

• bowel perforation

• bowel perforation is a complication of having c diff. infection

• abdominal cramping and fever are expected manifesations of c diff infection

• dumping syndrome is associated with impaired stomach function (after bariatric surgery, for example)

• the best treatment for C diff is the antibiotic vancomycin

What are the classic signs and symptoms of IBS

• Manifestations

  • diarrhea, constipation, combination of both

  • cramping abdominal pain

  • nausea

  • mucus in stool

• pharmacotherapy

  • antidiarrheals

  • anticholinergic/antispasmotics

  • laxatives

What is dumping syndrome and what are the S/S

• dumping of stomach contents into small intestine

• Manifestations

  • nausea

  • weakness

  • sweating

  • diarrhea

• pharmacotherapy

  • Octrotide (Sandostatin)

  • antidiarrheal

  • Route: SQ

  • SE: nausea, vomitting, and upset stomach

what dietary changes can a patient make to decrease risk of constipation

• defined: small, infrequent, or difficult BM

• fewer than 3 BMs/week

• causes

  • diet (low in fiber) - increase fiber

  • lack of exercise

  • slowed peristalsis

  • pathologic conditions

    • obstruction or diverticulitis

which of the mechanisms listed below would a nurse recall when caring for a client prescribed bisacodyl (Ducolax) for constipation?

• producing bulk

• softening feces

• lubricating feces

• stimulating peristalsis

• stimulating peristalsis

• bisacodyl stimulates the intestinal mucosa, precipitating a bowel movement

• stimulant laxative

which of the actions below is responsible for the therapeutic effect of docusate sodium

• lubricates the feces

• creates an osmotic effect

• stimulates intestinal wall muscle activity

• absorbs water and increases bulk

• lubricates the feces

• docusate sodium promotes the drawing of fluid into the stool, which softens and lubricates the feces

• creating an osmotic effect in the GI tract is the action of saline laxatives, such as magnesium hydroxide or other hyperosmotic, such as lactulose

• stimulating motor activity of the GI tract is the action of peristaltic stimulants such as bisacodyl

Diabetes

Type 1 diabetes

• most common pediatric chronic disease

  • diagnosis about 12 years old

  • aout 5-10% of DM

• Two types

  • idiopathic

    •