Important Topics on Final

Shock

-decreased blood volume/circulatory stagnation causes poor tissue/organ perfusion.

-This is a condition of circulatory failure and impairment of VITAL organs.

Compensatory mechanisms (Stages of Shock)

-sympathetic nervous system (rapid and weak pulse),

-renin-angiotensin-aldosterone system activated

-Pale, cold, and clammy skin, tachypnea and altered level of consciousness

Progressive stage (Stages of Shock)

-compensatory mechanisms fail,

-tissues become hypoxic,

-cells switch to anaerobic metabolism,

-lactic acid accumulates (due to tissue hypoxia)

-metabolic acidosis develops

Irreversible (Stages of Shock)

organ damage occurs

Neurogenic shock (Distributive Shock)

loss of vascular sympathetic tone/autonomic function (massive vasodilation)

Septic Shock (Distributive Shock)

-bacterial endotoxins activate an immune reaction

- clinical manifestation: decrease CO

Cardiogenic shock (Distributive Shock)

left ventricle cannot maintain adequate cardiac output due to massive and severe Myocardial Infarction

Hypovolemic shock (Distributive Shock)

-venous return reduced due to massive external blood volume loss or dehydration

Heart Failure

-Also known as congestive heart failure, caused by inadequate pumping.

- leads to decreased Cardiac Output (clinical manifestation common with ALL types of HF) and increased preload/afterload.

Heart failure Causes

-congenital defect

-myocardial infarction

-valvular disease

-dysrhythmia

-thyroid disease

Compensatory mechanisms involved in Heart Failure

-sympathetic nervous system

-renin-angiotensin-aldosterone system
-hypertrophy

They help at first but perpetuate heart failure

Left-sided failure

-cardiac output falls; blood backs up to pulmonary circulation,

causing pulmonary congestion, dyspnea, and activity intolerance

(****Left = Lung)

Causes Of Left Sided Heart Failure

-left ventricular infarction

-hypertension

-aortic or mitral valve stenosis

Right-sided failure

-blood backs up to peripheral circulation, causing edema/weight gain

*****(Right=rest of body)

Causes of Right Side Failure

-Pulmonary disease

-left-sided failure

-pulmonic or tricuspid valve stenosis

Right sided Heart Failure Manifestations

-Congestion of Peripheral tissues

-Dependent edema and ascites

-Liver Congestion

-GI Tract congestion

-signs related to impaired liver function

-Anorexia

-GI distress, weightloss

Left Sided Heart Failure

-Decreased Cardia Output

-Pulmonary congestion

-Pulmonary edema

-Activity intolerance

-Decreased tissue perfusion

-impaired gas exchanged

-cyanosis and signs of hypoxia

-cough with frothy sputum

-Orthopnea

-Paroxysmal nocturnal dyspnea

Endometriosis

-Endometrium grows in areas outside the uterus

-The abnormal endometrial tissue continues to act as it normally would duringmenstruation

– Blood becomes trapped and irritates the surrounding tissue

Where Endometriosis grows

-the fallopian tubes, ovaries, and peritoneum, but the
tissue can grow anywhere in the body

Endometriosis Complications

-pain, cysts, scarring, adhesions, and infertility

Endometriosis Manifestations

-dysmenorrhea (Menstrual Cramps)

-menorrhagia

-pelvic pain

-infertility,
-pain during or after intercourse

Polycystic Ovarian Syndrome (PCOS)

-excess androgen production from the ovaries

-the pituitary gland secretes high levels of LH (luteinizing hormone) and
the ovaries make excess androgens.

-The continued presence of FSH (follicle stimulating hormone) allows for follicle development, but maturation of the follicles does not occur…

-so NO OVULATION OCCURS = infertility

Chronic anovulation leads to…

bilaterally distended and cystic ovaries

Polycystic Ovarian Syndrome (PCOS) Manifestations

-Menstrual Irregularities
-Excess Androgen Production
-Polycystic Ovaries
-Acanthosis Nigricans- darkened velvety
discoloration of the skin
(from insulin resistance)

Excess androgen exposure results in…

• Multiple immature ovarian follicles
• Decreased progesterone production
• Increased acyclic (constant) estrogen
production
• Anovulation→Infertility
• Amenorrhea
• Hirsutism (abnormal growth of hair on face
and body)
• Acne
• Obesity from conversion of androgens to
estrogen in adipose tissues
• Hypertension
• Diabetes
• Obstructive sleep apnea

Cryptorchidism

when one of both testes do not descend from the abdomen to the scrotum prior to birth

Multiple Sclerosis

-Debilitating autoimmune condition that involves a progressive and
irreversible demyelination of brain, spinal cord, and cranial nerves

-Damage occurs in diffuse patches throughout the nervous system
and slows or stops nerve impulses

-Most common in women, Caucasians, and those living in temperate
climates

Multiple Sclerosis Complications

-epilepsy

-paralysis (most often the legs)
-depression

-Characterized by remissions and exacerbations

Multiple Sclerosis Manifestations

-Fatigue
• Ataxia
• Muscle spasms
• Paresthesia or abnormal sensation in any
area
• Problems moving arms or legs
• Urinary frequency, urgency, hesitancy, or
incontinence
• Vision issues (e.g., diplopia and vision loss in
one eye)
• Decreased attention span, poor judgment,
and memory loss
• Weakness in one or more arms or legs
• Unsteady gait
• Lack of coordination, spasticity
• Tremor in one or more arms or legs
• Constipation and stool leakage
• Difficulty reasoning and solving problems
• Dizziness
• Hearing loss
• Sexual dysfunction
• Slurred speech
• Dysphagia
• Possible transverse myelitis

Transient Ischemic Attack (TIA)

-A temporary episode of cerebral ischemia that
results in symptoms of neurologic deficits

• Also called ministrokes because these
neurologic deficits mimic a cerebrovascular
accident (CVA) due to lack of blood flow to part
of the brain or stroke except that these deficits
resolve within 24 hours (1–2 hours in most
cases)

• May occur as a single episode or in a series
• Warning sign that a CVA may be impending;
however, not all CVAs are preceded by a TI

Transient Ischemic Attack Manifestations (TIA)

-Begin suddenly and last for a short period
• Manifestations are the same as for a stroke
• Reflect the location of the ischemia
• Muscle weakness or paralysis of the face,
arm, or leg (usually unilateral)
• Unilateral paresthesia
• Aphasia or receptive aphasia
• Dysphagia
• Changes in sensation (e.g., touch, pain,
temperature, pressure, hearing, and taste)
• Change in levels of consciousness
• Personality, mood, or emotional changes
• Confusion
• Dysgraphia
• Difficulty reading
• Vision issues (e.g., diplopia, nystagmus,
and partial or complete loss of vision)
• Agnosia (inability to recognize or
identify sensory stimuli)
• Ataxia
• Vertigo or dizziness
• Incontinence of bowel or bladder

Cerebrovascular Accident (CVA)

-Also known as a stroke or brain attack
-An interruption of cerebral blood supply
-Ischemic damage is permanent

Causes of Cerebrovascular Accident (CVA)

-total vessel occlusion (e.g.,thrombus, embolus, or plaque)

-cerebral vessel rupture (e.g., cerebral aneurysm, arteriovenous malformation = arteries that feed directly into veins through vascular tangles or abnormal vessels)

-hypertension)

Major types of CVA

-ischemic strokes are the most common
-Hemorrhagic strokes are the most fatal

Cerebrovascular Accident (CVA) continued

-Complications: neurologic deficits and death

-Most common in African Americans and those living in the Southeast region

-Manifestations are similar those of a TIA except that CVA symptoms do not resolve

-Additional manifestations: headaches may be present with hemorrhagic strokes because of increasing ICP

Additional Risk Factors of CVA

-physical inactivity

-psychosocial stress

-obesity

-hypertension
-smoking

-dyslipidemia

-diabetes mellitus

-atherosclerosis

-oral contraceptive usage,
-excessive alcohol consumption

-illicit drug use

-advancing age

Hypothyroidism

-a condition in which the thyroid does not produce sufficient amounts of the thyroid hormones (TH) = T3 and T4 (TSH Elevated)

-Relatively common (1 out of 500 Americans has the condition)

-May be a result of hypothalamus, pituitary, or thyroid dysfunction

Causes of Hypothyroidism

-autoimmune thyroiditis (also called Hashimoto’s thyroiditis) and

-iatrogenic

Manifestations of Hypothyroidism

low heart rate fatigue

sluggishness

increased sensitivity to cold
constipation

pale and dry skin

facial edema

hoarseness

hypercholesterolemia
unexplained weight gain

myalgia

arthralgia

muscle weakness

heavier than normal
menstrual periods

brittle fingernails

hair loss or thinning

bradycardia

hypotension
depression

goiter

Myxedema

rare and life-threatening advanced hypothyroidism

Manifestations of Myxedema

-marked hypotension

-non-pitting periorbital edema

-respiratory depression

-hypothermia

-lethargy

-non-pitting peripheral edema

-coma

Hyperthyroidism

-A condition of excessive levels of thyroid hormones, resulting in a
hypermetabolic state

-Additional complications: dysrhythmias, heart failure, and
osteoporosis

Hyperthyroidism causes

-excessive iodine

-Graves’ disease- an autoimmune condition
-(exophthalmos & tachycardia)

-nonmalignant thyroid tumors,

-thyroid inflammation, and

- taking large amounts of thyroid hormone replacement

Hyperthyroidism Manifestations

-sudden weight loss

-tachycardia/palpitation

-hypertension,
-increased appetite

-nervousness

-anxiety or anxiety attacks

-irritability
-tremor (usually a fine trembling in the hands)

-diaphoresis (excessive sweating)

-changes in menstrual patterns

-increased sensitivity to heat

-diarrhea

-goiter

-difficulty sleeping

-exophthalmos

Thyrotoxicosis

-(thyroid storm) is a medical emergency!!!

Cushing Syndrome

-Condition of excessive amounts of glucocorticoids (Adrenocorticotropic hormone = ACTH)

-Excess Cortisol

Causes of Cushing Syndrome

- iatrogenic from ingestion of glucocorticoid medications

-adrenal tumors that secrete glucocorticoids

-pituitary tumors that secrete ACTH and cortisol

-paraneoplastic syndrome

Manifestations of Cushing Syndrome

-obesity (especially around the trunk)

-“moon” face,

-“buffalo hump” = fatty pad between the shoulders

-muscle weakness

-fragile skin

-delayed growth

-development, purple striae,

-thin skin that bruises easily

- delayed wound healing

-osteoporosis

-hirsutism and thinning hair,

-insulin resistance

-hypertension

-edema

-hypokalemia

-mood changes
-Immunosuppression

Addison’s Disease

Deficiency of adrenal cortex hormones (glucocorticoids, mineralocorticoids, and androgens) = low cortisol

Causes of Addisons disease

-autoimmune conditions

-infections

-hemorrhage

-tumors

-pituitary dysfunction that results in insufficient ACTH levels

Addisons disease Manifestations

-hypotension

-changes in heart rate

-hypoglycemia

-chronic diarrhea
-hyperpigmentation

-pallor

-extreme weakness

-fatigue

-anorexia

-mouth lesions on the inside of a cheek

-nausea

-vomiting

-salt craving

-slow and sluggish movement

-unintentional weight loss
-mood changes

-depression

-hyperkalemia

Diabetes Mellitus

-A group of conditions characterized by hyperglycemia resulting from defects in insulin production, insulin action, or both

-Impaired insulin production or action results in abnormal carbohydrate, protein, and
fat metabolism because of the glucose transportation issue

Complications of Diabetes Mellitus

-hyperglycemia

-diabetic ketoacidosis (metabolic) (due to the breakdown of
fats)

-ketones in urine

-acetone breath

-flushing

-rapid deep breathing,

-tachycardia
-hypoglycemia

-diaphoresis

-pallor

-tremors

-heart disease

-stroke

-hypertension
-retinopathy→ leading to blindness, —nephropathy→Kidney disease, amputation,

-delayed healing(prone to infection)

Peripheral neuropathy

Manifestations of Diabetes Mellitus

-hyperglycemia

-glucosuria

-polyuria

-polydipsia (thirst)

-polyphagia(seen more with Type I DM) (hunger)

-weight loss

-blurred vision

-and fatigue

Diabetes Keto Acidosis

The lack of insulin causes mobilization of fatty acids for energy, leading to an increased production of ketones

Diabetes Keto Acidosis Manifestations

-hyperglycemia

-metabolic acidosis

-dehydration

Kussmaul's respirations

are deep, rapid respirations that release excess acids
through the lungs. This causes a release of acetone (a form of ketones)

breath subsequently has a sweet, fruity odor

Type 1 Diabetes

-Previously called insulin-dependent and juvenile-onset, it develops when the body’s
immune system destroys pancreatic beta cells (Autoimmune)

-Must have insulin since their beta cells are destroyed.

-MOST LIKELY to experience Hypoglycemia! Crucial education about consuming
fast-acting carbohydrates before exercise is important!

-Stress: Increases glucocorticoids→counteracts Insulin function→increase blood
glucose levels.

What increases blood glucose

-Glucagon (increases blood glucose by facilitating the conversion of glycogen
to glucose in the liver) vs Insulin (decreases blood glucose)

Type 2 Diabetes

-Usually begins as insulin resistance
-The pancreas gradually loses its ability to produce insulin

-Usually managed initially with oral antidiabetic medications that increase
insulin production and action
-As the condition progresses, supplemental insulin is often necessary as
pancreatic production declines

Type 2 Diabetes Risk Factors

-advancing age

-obesity

-family history of DM

-history of gestational
diabetes,

-impaired glucose metabolism

-physical inactivity

-African Americans,
Hispanics, Native Americans, Asians, Native Hawaiians, and other Pacific Islanders

Syndrome of Anti-Diuretic Hormone (SIADH)

excess production and release of ADH

SIADH Signs and symptoms

-Decreased urine output
(concentrated)
-Severity of symptoms depends on serumsodium levels
-Anorexia

-nausea,
-vomiting

-headache
-irritability
-disorientation,
-cramps,

-weakness
-Psychosis

-gait
-disturbances
-seizures

-coma

Diabetes Insipidus

-Insufficient ADH

-inability to concentrate or retain water

causes:

-Inadequate kidney response to ADH

- Water intoxication

Graves Disease

an autoimmune disorder that causes the thyroid to produce too much hormone, resulting in hyperthyroidism

Hydrocephalus

-Common condition of excess cerebrospinal fluid (CSF) accumulation within the skull

-Ventricles dilate and the brain and blood vessels become compressed
• Pressure thins the cortex, causing severe brain damage

Hydrocephalus causes

– CSF flow disruption: noncommunicating or an obstructive hydrocephalus
– CSF is not properly absorbed by the bloodstream: communicating hydrocephalus

Risk factors Hydrocephalus

-prematurity

-pregnancy complications other congenital defects (especially nervous system
defects),

-nervous system tumors

-CNS infections

-cerebral hemorrhage

-severe head injuries

Hydrocephalus Manifestations in infants

-large head

-a rapid increase in the head size

-bulging fontanelle
-vomiting (often projectile), lethargy,
-irritability

-high-pitched cry

-feeding difficulties

-seizures

- eyes that gaze downward
-development delay

Hydrocephalus Manifestations in older adults

-headache

-vomiting

- nausea

-blurred vision or diplopia

-sluggish pupil response to light,
-eyes that gaze downward

-uncoordinated movements

-extreme fatigue, slowing or
regression of development

-memory loss,
-confusion

-urinary incontinence

-irritability,
-personality changes

-impaired performance in school or work

Meningitis

-Inflammation of the meninges and subarachnoid space, usually resulting from an infection

Causes of Meningitis

-Infection or irritant triggers the inflammatory process, leading to swelling of the meninges and increased ICP

Risk factors of Meningitis

-younger than 25 years of age

-living in a community setting (College Dorms)
-pregnancy

-working with animals

-immunodeficiency

-Nurse caring for this patient must be wearing a mask!

Meningitis Manifestations

-Can be self-limiting (viral) or life-threatening (acute bacterial)

-fever, chills

-mental status changes

-nausea
-vomiting

-photophobia

-severe headache

-stiff neck (nuchal rigidity)

-agitation

-bulging fontanelle

-decreased consciousness
-opisthotonos

-poor feeding or irritability in children

-tachypnea,
-tachycardia

-rash

Menorrhagia

medical term for heavy or prolonged menstrual bleeding

Increased Intracranial Pressure

-Increased volume in the cranial cavity

- traumatic brain injury

-cranial tumor
-hydrocephalus

-cerebral edema

-hemorrhage

Manifestations of Increased Intracranial Pressure

-Generally include decreasing level of consciousness

-vomiting (often projectile)

-increasing blood pressure with increasing pulse pressure

-bradycardia

-papilledema (optic nerve swelling),

-fixed and dilated pupils

-posturing

-headache (early manifestation), and blurred vision.

Manifestations of Increased Intracranial Pressure Infants

include separated sutures and bulging fontanel

Manifestations of Increased Intracranial Pressure children and adults

-behavioral changes

-visual changes

-severe headache
-lethargy

-neurologic deficits

-seizures

Parkinson’s Disease

• Progressive condition involving the destruction of the substantia nigra
in the brain
• Results in a lack of dopamine

-No cure

Parkinson’s Disease Manifestations

Slowing or stopping of automatic movements
(e.g., blinking)
• Constipation
• Urinary hesitancy and/or urgency
• Dysphagia
• Drooling
• Anosmia
• Masklike appearance to face
• Myalgia
• Muscle cramps and dystonia, rigidity.
• Rigid or stiff muscles (often beginning in the
legs)
• Slowed, quieter speech with monotone voice
• Stooped position
• Anxiety, stress, and tension
• Confusion
• Orthostatic hypotension

• Problems with movement:
• Difficulty initiating or continuing
movement (e.g., walking or getting out
of a chair)
• Loss of fine hand movements (writing
may become small and difficult to read;
eating can become more difficult)
• Shuffling, unsteady gait
• Slowed movements
• Dementia
• Depression
• Syncope

Parkinson’s Disease Manifestations (Tremors)

-Usually occur in the limbs at rest or when the limb is held out
– Go away during purposeful movement
– Eventually can be seen in the head, lips,
tongue, and feet
– May be worse when tired, excited, or
stressed
– Finger–thumb rubbing (“pill-rolling”
tremor)

Dementia

-A group of conditions in which cortical function is decreased, impairing
cognitive skills and motor coordination

• Issues with memory are common and include short-term memory
losses as well as confusion about historical events

• Behavioral and personality changes interfere with relationships, work,
and activities of daily living. Advanced dementia→ inability to problem
solve

Alzheimer’s Disease

-Most common form of dementia
• Brain tissue degenerates and atrophies, causing a steady decline in memory and mental abilities
• The hallmark changes in the brain: presence of neurofibrillary tangles and amyloid plaques

-Not a part of normal aging, but risk increases with age

Alzheimer’s Disease etiology

-Amyloid plaques mix with a collection of additional proteins, neuron remnants, and other nerve cell pieces

– Neurofibrillary tangles: abnormal collections of a protein called tau that clumps together

– Connections between neurons responsible for memory and learning are lost; neurons cannot survive when their connections to other neurons are lost

-Diagnosis is often difficult and often involves ruling out other conditions

Alzheimers Continued

-memory loss

-problems with abstract thinking

-difficulty finding the right word to express thoughts even follow conversations

-difficulty reading and writing

-disorientation(even in familiar surroundings)

-loss of judgment

-difficulty performing familiar tasks

-personality changes

-hallucinations

-incontinence of bowel or bladder

Skin Cancer (ABCDE)

▪ Asymmetry
▪ Border irregularity
▪ Color variations
▪ Diameter larger than 6 mm
▪ Elevation

-Any skin growth that bleeds or will not heal
-Any skin growth that changes in appearance over
time

Pleural Effusion

Excess fluid in the pleural cavity, which may include exudates,
transudates, blood, and pus and can impair breathing

Pleural Effusion Manifestations

-dyspnea

-chest pain

-tachypnea

-racheal deviation
(absent lung sounds and dullness over the affected area)

-tachycardia
-pleural friction rub

Pneumothorax

-Air in the pleural cavity, which can cause lung to collapse

Tension pneumothorax

-the most serious type, can cause affected lung to collapse

-Occurs when the pressure in the pleural space is greater than the atmospheric pressure

-Due to trapped air in the pleural space or air from a positive-pressure mechanical ventilator

Pneumonia

an infection that inflames the air sacs in one or both lungs, which can fill with fluid or pus

Pneumonia Causes

infectious agents, injurious agents or events, and pulmonary secretion stasis (patients who are hospitalized and immunocompromised are at highest risk)

Viral Pneumonia

usually mild, can lead to secondary bacterial pneumonia

Bacterial Pneumonia

more common than viral, most often due to Streptococcus pneumoniae

Aspiration pneumonia

- from aspirated fluid(emesis, saliva) or food entering the lungs
– Causes: impaired gag reflex, improper lower esophageal sphincter closure, inappropriate gastric tube placement

Leukemias

-Leukemia is cancer of the leukocytes (not lymphocytes), the second most common blood cancer after lymphomas

-Leukemia cells abnormally proliferate and crowd normal blood cells. This will produce dysfunctional
immature leukocytes

-Leukemias are classed as acute (less differentiated) or chronic (more differentiated), lymphoid or myeloid (depending on cell line)

Leukemia Manifestations

Leukopenia, anemia, thrombocytopenia→ Pancytopenia
– Lymphadenopathy
– Joint swelling, bone pain, weight loss,
anorexia
– Hepatomegaly, splenomegaly
– Central nervous system dysfunction
– Increased risk for opportunistic infection due to many non-functional
immature leukocytes

Anemia

-decreased number of erythrocytes, reduction of hemoglobin, or abnormal hemoglobin; decreases oxygen-carrying capacity and creates tissue hypoxia

Anemia Manifestations

- weakness

-fatigue

-pallor

-syncope (fainting)

-dyspnea,
-tachycardia (compensatory mechanism) (NOT chest pain)