Pathophysiology Quiz 4

What is Dantrolene? What does it do?

-it acts on skeletal muscle to inhibit muscle contraction by inhibitiing the release of calcium

-causes decreased strength of muscle contraction

What is anemia?

low RBC count

What are the general effects of anemia?

-Reduction in oxygen-carrying capacity

-Tissue hypoxia

-Compensatory mechanisms to restore tissue oxygenation

What is aplastic anemia?

a reduction of hematopoietic tissue in the bone marrow, fatty marrow replacement, pancytopenia

ChatGPT explanation:

aplastic anemia, the bone marrow becomes empty or contains very few stem cells, leading to:

Anemia (low RBCs): fatigue, pallor, shortness of breath

Leukopenia (low WBCs): frequent infections

Thrombocytopenia (low platelets): easy bruising, bleeding gums, noseblee

What medication helps with gout?

What foods should a person with Gout avoid? (select all that apply)

a. anything with protein

b. meat products

c. stay hydrated

d. alcohol intake

b. meat products

d. alcohol intake

What are the common symptom of a fat embolism?

petechiae rash, SOB, decreased LOC

A little girl has sickle cell anemia. Which symptom would you most likely expect to see?

What are the four stages of anesthesia?

1. analgesia,

2. excitement

3. surgical anesthesia

4. medullary depression

Which stage of anesthesia relaxation of muscle, loss of consciousness, regular respirations, pupil dilation?

surgical anesthesia

What are interventions to prevent respiratory complication?

-monitoring vital signs

-implementing deep breathing

-incentive spirometry

-turning in bed every 2 hours

-ambulating when safe

-maintaining hydration

-coughing

-avoiding positions that decrease ventilation

- monitoring response to narcotic analgesics

What should be included in informed consent?

-provider who is doing it and their qualifications

-description of procedure

-alternatives therapies

-risks and benefits

-expected outcome

-must be in the language of the person consenting

What are the risk factors for osteoporosis?

-female sex

-increasing age

-family history of osteoporosis

-insufficient dietary calcium

What is the disease that effects the bones of the hands and the wrist?

rheumatoid arthritis?

What should you do for the treatment fracture or soft tissue injuries?

RICE:

-Rest

-Ice

-Compression

-Elevation

Phases of bone and joint healing?

-inflammation

-repair

-remodeling

What is the inflammation phase of bone/joint healing?

formation of a hematoma (blood clot)

What is the repair phase of bone/joint healing?

involves fibrocartilage formation, soft bone formation, and then hardening of that bone

What is the remodeling phase of bone/joint healing?

soft bone is turned to hard/compact bone and gets back into its original form

What are the four types of muscle injuries?

-Idiopathic inflammatory myopathy

-Muscular dystrophy

-Myasthenia Gravis

-Chronic muscle pain

What is Idiopathic inflammatory myopathy?

extensive degeneration of muscle fibers causing inflammation

What is Muscular dystrophy?

progressive muscle weakness; genetic

What is a kind of muscular dystrophy? What is it?

Duchenne muscular dystrophy (rapid decline) and becker muscular dystrophy (slower progression)

What is Myasthenia Gravis?

autoimmune disease cause profound muscle weakness and fatigabilty caused by antibodies that destroy acetylcholine receptors (need to stimulate calcium for muscle contraction)

What is a type of Chronic muscle pain?

Fibromyalgia syndrome

What is fibromyalgia syndrome?

cause is unknown

s/s: pain, stiffness, sleep dysfunction

What is Osteoarthritis?

progressive inflammation of diarthroidal joints

immune mediated disorders

1. rheumatoid arthritis

2. systemic lupus erythematosus

3. Sjogren syndrome

4. Scleroderma

5. Ankylosing spondylitis

What is rheumatoid arthritis?

a chronic autoimmune disease that causes inflammation and damage to the joints.

What is systemic lupus erythematosus?

a chronic autoimmune disease where the body's immune system mistakenly attacks its own healthy tissues and organs.

What is Scleroderma?

a chronic autoimmune disease that causes thickening and hardening of the skin and connective tissues

What is reactive arthritis?

aka Reiters syndrome; a type of inflammatory arthritis that develops as a reaction to an infection elsewhere in the body, often in the digestive or urinary tract, or genitals

Enteropathic arthritis

is a type of inflammatory arthritis that develops in people with inflammatory bowel disease (IBD), such as Crohn's disease and ulcerative colitis

Crohn's disease

The exact cause of Crohn's disease is unknown, but it is believed to be an autoimmune disorder in which the body's immune system mistakenly attacks healthy cells in the GI tract.

What is ulcerative colitis?

The exact cause of UC is unknown, but it is believed to be an autoimmune disorder where the body's immune system mistakenly attacks the healthy cells in the colon

What is hemophilia?

excessive bleeding due to lack of clotting factors

What is Hemophilic arthropathy?

aka hemarthroses; occurs in people with hemophilia where people bleed into joints

What is gout/gouty arthritis?

uric acid deposit in tissue

Before surgery you are doing an assessment on a patient and then mention an allergy to Lidocaine. Who should you notify?

a. the surgeon

b. the perioperative nurse

c. the anesthiologist

c. the anesthesiologist

Two different kinds of muscle relaxants?

1. direct acting

2. central acting

What are central acting muscle relaxants?

work in the upper CNS

What are examples of central acting muscle relaxants?

Baclofen, cyclobenzapine, and carisoprodol

What are the contraindication and AE of cyclobenzapine?

use caution in the elderly

What are the contraindication and AE of Baclofen?

-Seizure disorders (can lower seizure threshold)

-Renal impairment (drug is renally excreted)

-Stroke patients (may worsen muscle tone)

-Pregnancy and breastfeeding (risk vs. benefit must be evaluated)

-Mental health disorders

What is the patient teaching for receiving general anesthesia?

-Information about the anesthetic

-Medications that may be used pre-operatively

-Effects of the medication pre-operatively

-Measures to maintain patient safety

-How the patient will feel during recovery

-Signs and symptoms to report during recovery and afterward

What are direct acting muscle relaxants?

work directly in the muscle to prevent calcium from initiating muscle contraction

What are examples of direct acting muscle relaxants

botox

Three bone and joine injuries caused by metabolic issue?

-osteoporosis

-rickets

-osetomalacia

-paget's disease

What osteoporosis?

osteoclasts break down faster than osteoblasts can repair, reduced bone mass, reduced bone density

What is Rickets?

weak bones in childrens due to vit. D deficiency (commonly causes bowed legs)

What is Osteomalacia?

weak bones usually adults due to vit. D deficiency

What is Paget's disease?

excessive bone destruction followed by bone repair (as opposed to it happening at the same time)

What happens to muscle contraction if acetylcholine is blocked?

acetylcholine is the primary neurotransmitter for muscle contractions and stimulates calcium release

What is the process of muscle contraction?

1. Acetylcholine (ACh) released into synaptic cleft at the Neuromuscular junction

2. ACh binds to motor end plate and makes action potential that triggers...

3. SR releases calcium

4. Calcium moves the resting proteins (troponin and tropomyosin) away from cross bridge sites of actin and myosin

5. Myosin binds to actin forming cross bridge

6. ATP used to pull actin filaments (myosin pulls actin)

7. ATP used to detach myosin head and reattach for next power stroke

8. Muscle relaxes and calcium return to SR, resting proteins return to block bridge sites between myosin and actin

What is calcium's role on muscle contraction?

calcium displaces two proteins that block muscle contraction

WITHOUT CALCIUM MUSCLE CONTRACTION CANNOT TAKE PLACE

Compartment syndrome

injury caused when tissues such as blood vessels and nerves are constricted within a space as from swelling or from a tight dressing or cast

What level pressure injury has serosanginous drainage, and fatty tissue exposure?

stage 3

Local vs. General anesthetia

local anesthesia: is applied to specific area on the body

general anesthesia: is used to affect LOC; makes the patient unconscious during a procedure

Phases of anesthesia

1. induction

2. maintenance

3. recovery

What is the maintenance phase of anesthesia?

consistent stage of surgical anesthesia

What is deep vein thrombosis?

-thrombosis forming in the deep veins, generally of the lower extremities

- classical symptoms include swelling of the leg, tenderness of the calf, increased warmth and pain on passive dorsiflexion

What is a pulmonary embolism?

a condition in which one or more arteries in the lungs become blocked by a blood clot

What are the stages of hemostasis?

primary hemolysis and secondary hemolysis

What is secondary hemolysis?

formation of the fibrin clot or coagulation

What happens with vitamin K deficiency?

-reduction in coagulation factors, -particularly prothrombin

-increased clotting time

-minor injury can lead to internal hemorrhage/death

-hemorrhages also appear externally

A client is admitted to the emergency department several hours after a motor vehicle crash. The car's driver-side airbag was activated during the accident. Which assessment requires the nurse's immediate intervention?

a. Disorientation

b. Hemoptysis

c. Pulse oximetry reading of 94%

d. Chest pain with movement

b. Hemoptysis

Rationale: The nurse should be concerned about possible pulmonary contusion. Interstitial hemorrhage accompanies pulmonary contusion. Bleeding may not be evident at the initial injury, but the client develops hemoptysis and decreased breath sounds up to several hours after injury as bleeding into the alveoli or airways occurs. The pulse oximetry reading is within normal limits and chest pain is expected with movement after chest trauma. Disorientation needs to be investigated, but does not take priority over a breathing problem.

A burrowed line across the write indicates?

a. tick

b. scabies

c.

d.

b. scabies

What is Lyme disease?

tick-borne disease

s/s: rash, fever, headaches, muscle and joint pain