clinical pathophysiology final

sodium

135-145mEq/L

potassium

3.5-5.0mEq/L

chloride

97-107mEq/L

bicarbonate

22-26mEq/L

calcium

9.0-10.2 mEq/L

phosphorus (phosphate)

3.0-4.5mg/dL

magnesium

1.3-2.1mg/dL

pH range

7.35 - 7.45

acidic —> basic

PaCO2 range

35 - 45

basic —> acidic

HCO3 range

22 - 26

acidic - basic

what is the normal WBC?

4,500 - 11,000

what is the normal hemoglobin level?

11 - 18 g/dL

what is the normal platelets count?

150,000 - 450,000

what are the signs and symptoms of a cervical injury?

paralysis below the neck

• quadriplegia: 4 limbs paralyzed

  • quad = 4

  • diplegia: sounds like paralyzed

• breathing impaired - life threatening

  • happens to a lot of sports figures

what are the signs and symptoms of a thoracic injury?

paralysis of the trunk of the body

• paraplegic (2 legs)

• legs, pelvic organs

what are the signs and symptoms of a lumbar injury?

legs and leaky bladder

what are premature atrial contractions (PACs)?

early, extra heartbeats originating in the atria

• ekg characteristics: early P wave may look different from the normal P wave

what is an atrial flutter?

atrial electrical activity becomes rapid and regular (250-350 bpm), leading to a sawtooth pattern

• ekg characteristics: F waves (sawtooth pattern) instead of normal P waves

what is an atrial fibrillation (AFib)?

chaotic electrical activity in the atria, leading to an irregular and often rapid heart rate

• ekg characteristics: irregularly irregular rhythm, absent P waves, fibrillatory waves

what is an ejection fraction

a key measurement used to assess how well the heart is pumping blood.

• percentage of blood that is pumped out of the left ventricle w/ each contraction, compared to the total amount of blood in the ventricle before the heart pumps

EF = (stroke volume / end-diastolic volume) x 100

what is the normal EF percentage?

55%-70% of the blood in the left ventricle w/ each heart beat

what is Graves disease?

an autoimmune disorder characterized by thyroid-stimulating immunoglobulins (TSI) or TSH receptor antibodies that abnormally activate the thyroid gland

Hyperthyroidism w/ goiter and ophthalmopathy

• affects 0.5%-1% under 40yo

what is the etiology of graves disease?

associated w/ other autoimmune disorders like myasthenia gravis

linked to MICA genotypes: MICA A5 (risk), MICA A6/A9 (protective)

what can opthlamopathy in graves disease lead to?

diplopia, vision loss, and corneal ulceration due to exopthalmos (protruding eyeball)

what are some treatment and considerations for graves disease?

• opthalmopathy usually stabilizes after treating hyperthyroidism

• can worsen after radioiodine treatment; glucocorticoids may be prescribed

what is cushing syndrome?

hyper-cortisolism

what are clinical manifestations of Cushing syndrome?

fat redistribution: buffalo hump, moon face, protruding abdomen

muscle weakness and thinning extremities due to muscle wasting

skin changes: thin, parchment-like skin, purple striae (stretch marks)

osteoporosis, back pain, compression fractures

metabolic changes: hypokalemia, hypertension, renal stones

increased susceptibility to infections due to suppressed immune response

emotional lability, mood swings, euphoria, or psychosis

gastric issues: increased acid secretion, ulcers, and bleeding

androgen excess: hirsutism, acne, menstrual irregularities in women

what are the diagnosis of cushing syndrome?

step 1: hypercortisolism diagnosis (urinary cortisol, plasma cortisol)

step 2: determine cause (CRH test, dexamethasone, suppression, imaging)

what are the treatments of cushing syndrome?

surgery: pituitary adenoma removal (transsphenoidal surgery)

radiation or pharmacologic treatments based on the cause

goal: correct the cause of hypercortisolism without damaging pituitary or adrenal glands

what is endometriosis?

The presence of endometrial tissue outside the uterine cavity

• the endometrium is the inner lining of the uterus, a muscular organ in the pelvis

can cause pelvic pain, heavy or painful periods, and infertility

what is ectopic pregnancy?

implantation of the fertilized ovum outside of the uterine cavity, most commonly in a fallopian tube

• the fetus is not viable, and salpingectomy is performed to remove both the embryo and the fallopian tube

what is cryptorchidism?

PARTIAL or ABNORMAL descent of ONE or BOTH TESTICLES into the SCROTAL SAC

• commonly seen in neonates

• most cases —> spontaneously resolves

where is the normal opening of the urethral for a penis?

on the head

what is hypospadias?

a congenital condition where the opening of the urethra is located on the underside of the penis instead of at the tip.

what is epispadias?

a congenital condition where the urethra ends on the upper side of the penis.

what is plaque?

Fast growth of skin cells that appear in a few small spots looking similar to dandruff.
(Psoriasis & eczema)

what is urticaria?

hives wheal, weal
Superficial skin coloring or pale skin swelling, usually surrounded by erythema that lasts anywhere from a few minutes to 24 hours (Heat hives)

what are the types of fractures?

Closed Fracture

• Does not break skin

Open Fracture “Compound”

• skin surface broken

• tetanus

• bone protrudes through —> osteomyelitis

Complete Fracture

• bone is broken into pieces

Incomplete Fracture “Greenstick”

• partially through bone

Spiral Fracture

• common in child abuse

Oblique Fracture

• bone breaks at an angle

• common in ankle

Compression Fracture “Impact”

• collapsed bone in front area of vertebrae

• after high fall or jump

Crush “Compression” Fracture

• entire collapse of vertebrae

• under heavy objects

• DEADLY FAT EMBOLISM

what is a hip fracture?

• shortening of leg on the affected area

• muscle spasms around the affected area

• ecchymosis on thigh and hip

• groin & hip pain w/ weight bearing

what is compartment syndrome?

extremely painful condition that happens when pressure within the muscles builds to dangerous levels - cutting off blood flow & O2, resulting in a dead limb

decreased perfusion

• PAIN

  • Unrelieved with morphine

  • Not resolving with medication 

  • Extreme pain with passive movement

  PARESTHESIA

  • “Tingling” “burning” “numbness”

  • Problems moving or extending fingers or toes.

  • “Great difficulty” 

what are PMSC used in intervention for cast & care?

Pulses: pulses - NOT pulseless

Movement: grips

Sensation: NO tingling, numbness

Capillary refill & Color:

• NOT over 3 secs

• NOT pale “pallor”

• temperature — NOT cold or cool

what are the 6 Care P’s

Pallor, Pulse, Pain, Paresthesia, Paralysis, Pressure

what do you do for itching under cast?

Use cool air from a hair dryer to alleviate itching, but avoid inserting objects into the cast

how do you assess for circulation?

Check capillary refill, pulse, and skin temperature.

what are cast care complications?

*Hot Spots: Infection

*Compartment syndrome: decreased tissue perfusion 

Pain: 

• unrelieved with morphine 

• Unresolved with medication

• Extreme pain with passive movements 

Paresthesia:

• Tingling, burning numbness

• Problems moving/extending fingers 

how do you use crutches?

• 1. Weight on hands & arms NCLEX TIP

  • NOT armpits! = injury to the brachial plexus nerves 

  • DO NOT use someone else’s crutches 

  2. Technique Gait 

  • Step 1: both crutches forward WITH injured leg 

  • Step 2: move unaffected leg forward 

  3 types of gaits

  • 2 point 

  • 3 point 

  • 4 point gait: most advanced gait

  “Most closely resembles normal walking”

how do we document for pressure injuries?

Document full head to toe skin assessment upon injury within 24 hours

Why do we turn patients q1-2h for pressure injuries?

To prevent tissue breakdown and promote circulation, turning patients regularly redistributes pressure on the skin and underlying tissues.

what is a stage 1 pressure injury?

1 layer damage (epidermis)

red skin is NONblanchable & NOT broken

what is a stage 2 pressure injury?

2 layers of skin damage

open wound: affecting both the epidermis & dermis

wound bed is red/pink & shiny

what is a stage 3 pressure injury?

3 layers of skin damage (epidermis, dermis & subcutaneous)

full thickness skin loss into the subcutaneous fat; wound may tunnel under the edges of the wound bed

what is a stage 4 pressure injury?

4 layers of skin damage

extends all the way down into muscle, bone, or tendon

what is an unstageable pressure injury?

eschar (black/brown)

• dead necrotic tissue

• esCHARCOAL

slough (yellow stringy)

• slough = skin of a chicken

*these wounds needs to be debrided before a stage is made

what is a deep tissue pressure injury?

the fatty tissue is injured below the skin (dark purple, & sometimes open wound)

what are characteristics for burns?

first-degree (superficial)

• dry w/ blanchable redness

second-degree (partial thickness)

• painful blisters

• *red, moist, shiny fluid vesicles”

third-degree (full-thickness)

• dry waxy white, leathery, or charred black color, non-blanchable

fourth-degree (full-thickness)

Second, you feel the MOST pain.

Third and fourth are the most deadly

what is a pre-hospital care for burns?

cool injury w/ water is the primary intervention

• briefly soak area

• NO ice, creams, antibiotic ointment to open skin

cover area “clean dry cloth”

clothing & jewelry removal

• not adhered

for burns, do no remove…

clothing/jewerly adhering to burn prior to provider care

what is the top intervention for major burns?

IV fluids Lactated Ringers/Normal Saline only

which lab (electrolyte) is elevated after burns?

K+ potassium

What are the rule of 9’s used for?

Total Body Surface Area: used to calculate exact amount of fluid resuscitation needed

Head and neck: 9% total (4.5% front and back)

Arms: 9% total each arm (4.5% front and back)

Legs: 18% total each leg (9% front and back)

Upper and lower back: 9% each → together 18%

Perineum: 1%

when do you worry about the urine output and when is the volume concerning?

It indicates potential kidney injury or dehydration when it falls below 30 mL/hour.

what is best indicator of effective fluid resuscitation?

Urine output reflects renal perfusion and hydration status

how do you use crutches up and down the stairs?

• UPstairs

  1. UP with Strong leg

  2. Cane moves next 

  3. Weak leg last 

  DOWNstairs

  1. Descend with cane

  2. Weaker leg down

  3. Strong leg 

how do you use a cane?

1. Stronger side HOLDS the cane

2. Move cane 1st, weak leg 2nd 

2 points of support on the floor

how do you care for minor burns?

CCC

• Cool water, cover the area, clothing removal 
  

C - Cool water

• Briefly soak area

• NO ice, creams, antibiotic ointment to open skin 

C - Cover the area - “Clean dry cloth” → to prevent infection and more damage 

C - Clothing & jewelry removal 

• Not adhered 

HCP remove anything sticking to the skin

what are major burns treatment?

Assessment of Fluid Resuscitation

1. Urine output 

30 mL/hr or MORE    

2. Blood pressure

(90/systolic or MORE)

3. Heart rate less than 120/min

what is the average hematocrit in women?

36%-44%

what is the average hematocrit in men?

41%-50%