Pathophysiology Exam II: Hematogical, neurological, and respiratory System

Hematopoiesis

Production of all blood cells, self-renewing

Erythropoiesis

production of red blood cells

Leukopoiesis

production of white blood cells

Thrombopoiesis

production of platelets

Hemostasis

stoppage of bleeding and formations of clots

Cell type: RBC

Primary function: Oxygen Delivery.

If low: Fatigue, pallor

Cell type: WBC

Primary Function: Fights infections

if low: Infection risk

Platelets

Primary Function: Stops bleeding

If low: Bleeding risk

Leukemia

cancer of white blood cells

Acute Lymphoblastic Leukemia

ACUTE

Most common childhood leukemia

Increased lymphoblasts

Symptoms:

Fatigue

Bruising

Recurrent infections

Major types of WBC

Neutrophil, Eosinophil, Basophil, Monocyte, Lymphocyte

Hemostasis Steps

vascular spasm, platelet plug, coagulation

Acute Myelogenous Leukemia (AML)

ACUTE

Hallmark: Auer rods

Priority concerns:

Infection

Bleeding

Petechiae

Bleeding gums

Chronic Lymphocytic Leukemia (CLL)

CHRONIC

Hallmark: Smudge cells

Older adults, progression is slow

Chronic Myelogenous Leukemia (CML)

Hallmark: Philadelphia chromosome

Common findings:

Splenomegaly

Left upper quadrant discomfort

Fatigue

Lymphoma

malignant tumor of lymph nodes and lymph tissue

Hodgkin's lymphoma

distinguished from other lymphomas by the presence of large, cancerous lymphocytes known as Reed-Sternberg cells

Anemia

A condition in which the blood is deficient in red blood cells, in hemoglobin, or in total volume.

iron deficency anemia

anemia caused by inadequate iron intake

Risk factors: Heavy menstrual periods, Chronic blood loss

Findings: fatique, pallor, microcytic RBCS, Pica

Vitamin B12 Deficiency Anemia

produced by inadequate intake of B12 in diet

Health impact: Neurological symptoms, numbness, tinging, balance changes

Non-Hodgin's Lymphoma

a group of more than 20 different types of lymphomas that occur in older adults and do not show Reed-Sternberg cells

Thrombocytopenia

low platelet count

Causes

Easy bruising

Petechiae

Bleeding Gums

Prolonged Bleeding

Sickle Cell Disease

Genetic disorder in which red blood cells have abnormal hemoglobin molecules and take on an abnormal shape.

Results: RBC sickiling, Vascular Occlusion, tissue ischemia

CNS

central nervous system; brain and spinal cord

PNS

Peripheral nervous system; nerves outside CNS.

Parkinson disease

degeneration of dopamine-producing neurons in the basal ganglia, occurring in later life and leading to tremors, weakness of muscles, and slowness of movement.

Clasic findings: resting tremor, rigidity, bradykinesia, shuffling gait

carbidopa-levodopa

A medication used to treat Parkinson's disease. Improves movement, reduces tremors, improves walkings

Multiple Sclerosis (MS)

disease of the central nervous system characterized by the demyelination (deterioration of the myelin sheath) of nerve fibers, with episodes of neurologic dysfunction (exacerbation) followed by recovery (remission)

Findings: weakness, unillateral deficits, blurred vision, fatigue

Multiple Sclerosis clinical point

Fevers can worsen symptoms because heat impairs conduction through damaged myelin

Auer rods

AML

Smudge cells

CLL

Reed-Sternberg cells

Hodgkin lymphoma

Philadelphia chromosome

CML

B12 deficiency

Neurologic symptoms

Thrombocytopenia

Bleeding

Parkinson

↓ dopamine

MS

Demyelination

TIA

Future stroke risk

Meningitis

Fever + headache + neck stiffness

Seizure care

Airway & safety

Early ICP sign

Decreased LOC

Fixed dilated pupil

Emergency

Surfactant

Reduces surface tension

Epiglottitis

Drooling

Pneumothorax

Unilateral decreased breath sounds

COPD

Airflow obstruction

Emphysema

Loss of recoil

TB

Cough + weight loss + night sweats

PE

Sudden chest pain + dyspnea

CN III

Pupil response

CN III/IV/VI

Eye movements

CN IX/X

Swallowing/gag reflex

CN XI

Shoulder shrug

Carbidopa-levodopa

Improves Parkinson symptoms

Antiseizure medications

Never abruptly stop

Normal pH range

7.35-7.45

Normal PaCO₂ range

35-45 mmHg

Normal HCO₃ range

22-26 mEq/L

Respiratory Acidosis lab values

pH ↓, CO₂ ↑

Respiratory Acidosis common causes

COPD, Hypoventilation

Respiratory Alkalosis lab values

pH ↑, CO₂ ↓

Respiratory Alkalosis common cause

Hyperventilation

Transient Ischemic Attack (TIA)

coined Mini-stoke (but not a stroke)

brief episode of loss of blood flow to the brain, usually caused by a partial occlusion that results in temporary neurologic deficit (impairment); often precedes a CVA

Strong warming sign of future stroke

Temporary neurologic symptoms

Symptoms resolve completely

stroke

a medical emergency that occurs when blood flow to the brain is cut off or severely reduced, depriving brain cells of oxygen and causing them to die within minutes

Ischemic Stroke: Accounts for about 85% to 87% of all cases and happens when a blood clot or plaque blocks an artery supplying the brain.

Hemorrhagic Stroke: Caused by a weakened blood vessel that leaks or ruptures, putting dangerous pressure on brain tissue.

Stroke Symptoms

Sudden weakness or numbness of the face, arm or leg, especially on one side of the body

•Sudden dizziness, loss of balance or coordination, or trouble walking

•Sudden confusion, trouble speaking or understanding

•Sudden trouble seeing •Sudden severe headache

Clinical priorities of a stroke

Time of symptom onset, neurologic assessment, rapid diagnostic testing

Meningitis

CNS infection

inflammation of the meninges

Menigitis symptoms

fever, stiff neck, neuro symptoms, headache, backache; bulging fontanels in infant.

Nochal Rigidity=Cant touch chin to chest (sign of meningitis)

Big risk factor for college age students living close together (Dorms)

encephaliitis

CNS infection, inflammation of the brain

Encephalitis symptoms

headache, fever, cerebral dysfunction, disordered thought patterns, and, often, seizures

Seizures

Sudden, uncontrolled electrical disturbances in the brain.

Priority during seizure

Protect patient from injury

Priority after seizure

Airway, side-laying positions, assess oxygenation

(NEVER stop anti-epileptic medication abruptly)

Increased intracranial pressure (ICP)

Elevated pressure within the skull affecting brain function.

First indicator: decrease level of consciousness, Fixed dialated pupil, pupillary changes

Priority: Notify Provider Immediately

ICP interventions

Elevate HOB ~30 degrees

Maintain neck alignment

Avoid excessive coughing

Prevent Valsalva maneuver

Allow rest periods

Traumatic Brain Injury (TBI)

A traumatic insult to the brain capable of producing physical, intellectual, emotional, social, and vocational changes.

Treatment for TBI

Hypertonic Saline

Pulls fluid out of swollen brain tissue

reduces cerebral edema

Lowers ICP

Spinal Cord Injury

the type of paralysis is determined by the level of the vertebra closest to the injury

CN III (3)

Name: Oculomotor

Function: Pupil constriction, eye movement

Assessment: PERRLA, Light Response

FIndings: Nonreactive pupil = possible CN III Dysfunction

CN III, IV, VI (3,4,6)

Names (in order): oculomotor, trochlear, abducens

Control: Extra-ocular eye movements

Assessment: Six cardinal fields of gaze

Remembers: eyes move together with CN III, IV, VI

CN IX, X (9,10)

Names: glossopharyngeal and vagus

Function: swallowing, gag reflex

Assessments: degree of difficulty when swallowing, or coughing while drinking

Risk: Aspiration

CN XI (11)

Name: Accessory

Function: Shoulder Shrug, Head turn against resistance

Assessment: shrug shoulders

Epileptic vs. non-epileptic seizures

Epileptic seizures are caused by sudden, abnormal electrical discharges in the brain, while non-epileptic seizures (often called functional or psychogenic seizures) look similar but show normal brain wave activity on an EEG (caused by psychological factors like stress, trauma, or emotional processing, or physical mimics like low blood sugar, heart arrhythmias, or fainting (syncope))

Alzheimer's Disease

a progressive and irreversible brain disorder characterized by gradual deterioration of memory, reasoning, language, and, finally, physical functioning

Vascular Dementia

form of dementia caused by a stroke or other restriction of the flow of blood to the brain

Delirium

an acutely disturbed state of mind that occurs in fever, intoxication, and other disorders and is characterized by restlessness, illusions, and incoherence of thought and speech.

Major parts of the brain

Cerebrum, Cerebellum, Brainstem, Limbic system

glial cells

cells in the nervous system that support, nourish, and protect neurons

Major regions of the spinal cords and (spinal nerves)

Cervical, thoracic, lumbar, Sacral

Upper Respiratory system

Immune system, filtration, Humidity

Lower respiratory tract

Air and gas exchange

Pneumonia

An inflammation of lung tissue, where the alveoli in the affected areas fill w/fluid

Signs: fever, cough, crackles (air moving through alveolar fluid)

Surfactant

chemical produced in the lungs to maintain the surface tension of the alveoli and keep them from collapsing

Epiglottitis

A disease in which the epiglottis becomes inflamed and enlarged and may cause an upper airway obstruction.

Concerning findings (Medical emergency!!! usually in children): Drooling, Difficulty swallowing

Priority: Airway Management

Pneumothorax

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

Common findings: Sudden dyspnea, chest pain, unilateral decrease breathing sounds

COPD (chronic obstructive pulmonary disease)

is a progressive, long-term lung condition that makes it hard to breathe by blocking airflow and damaging lung tissue

Findings: Prolonged expiration, air trapping, diminished breath sounds

Emphysema

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

WHY: loss of alveolar elastic recoil

Results: air trapping, hyperinflation

Tuberculosis (TB)

infectious disease caused by Mycobacterium tuberculosis; lungs usually are involved, but any organ in the body may be affected

SYMPTOMS: persistent cough, weight loss, night sweats, hemoptysis (coughing up blood or mucus from the lungs)

AIRBORNE PRECAUTIONS

Hypoxemia

Low oxygen level in the arterial blood

hypoxemia vs hypoxia

hypoxemia is low oxygen in the arterial blood and hypoxia is low oxygen in the tissues; hypoxia may be cause by hypoxemia or may be due to cardiac or other problems, including toxins