WGU D236 Patho - Megan/Shay’s Study Guides

What is the primary determinant of oncotic pressure?

Albumin

Form of osmotic pressure exerted by proteins

Oncotic Pressure

What is the difference between adult and child immunity?

Naive T Cells

Fluid and electrolyte levels are regulated by _________________, which regulates actions such as thirst, ADH, the kidneys, and RAAS.

Osmoreceptors

What are the causes of dehydration?

#Excessive loss

#Inadequate intake

#Both

What s/sx are associated with dehydration?

#Dry mucous membranes

#Decreased skin turgor

#Decreased urine output

#Low blood pressure

#Tachycardia

#Weak heart rate

#Confusion

A patient with a viral illness and severe vomiting has an elevated CO2 level and pH of 7.53. She is breathing slowly. What condition does she have?

Metabolic alkalosis

The patient's pH and CO2 levels are both elevated (moving in the same direction). This indicates metabolic alkalosis. The CO2 level is high because her respiratory system is attempting to compensate for the high pH by exhaling less and retaining more CO2.

Normal CO2 level

35-45

Normal pH level

7.35-7.45

Normal HCO3 level

22-26

Michael's pulmonary edema leads to respiratory acidosis. How does pH impact Michael's basal metabolic panel? Choose 3 answers.

His CO2 level is increased because his lungs have difficulty removing it from the bloodstream.

His calcium level is reduced because the elevated concentration of H+ makes it easier for Ca+ to bind to albumin.

His CO2 level is decreased because his lungs have difficulty adding it into the bloodstream.

His sodium level is decreased due to hypervolemia.

His K+ is elevated because, as H+ moves inside of cells in an attempt to get it out of the bloodstream, K+ moves from cells into the bloodstream.

His CO2 level is increased because his lungs have difficulty removing it from the bloodstream.

His sodium level is decreased due to hypervolemia.

His K+ is elevated because, as H+ moves inside of cells in an attempt to get it out of the bloodstream, K+ moves from cells into the bloodstream.

A hormone panel was done on a patient with congestive heart failure and fluid volume overload. Which elevated hormone on the patient's chart is indicative of the body's attempt to reduce the fluid overload?

Antidiuretic hormone (ADH)

Brain natriuretic peptide (BNP)

Aldosterone

Renin

BNP

BNP is released when fluid volume excess is present.

Normal sodium level

135-145

Hyponatremia is indicated by what lab result? S/Sx?

Na < 135

Loss of energy or fatigue

Nausea and vomiting

Headache

Confusion

Muscle spasms

Low blood pressure

Dark scanty urine

Irritability, disorientation and neurological manifestations

Seizures

Hypernatremia is indicated by what lab result? S/Sx

Na > 145

Excessive thirst

Extreme fatigue

Confusion

Muscle twitching or spasms

Restlessness

Seizures

Normal potassium level

3.5-5.0

Hypokalemia is indicated by what lab result? S/Sx

K < 3.5

#Muscle fatigue/cramping

#Nausea, vomiting, constipation

#Cardiac dysrhythmias

#Paresthesia (numbness/tingling)

Hyperkalemia is indicated by what lab result? S/Sx?

K > 5.0

Muscle weakness/paralysis

Paresthesia (numbness/tingling)

Cardiac dysrhythmias

Cardiac arrest/MI

Normal calcium level

8.5-10.5

Hypocalcemia is indicated by what lab result? S/Sx?

Calcium < 8.5

Overexcitability of the muscles

Muscle twitching

Paresthesia (numbness/tingling)

Chvostek and Trousseau sign (twitching on the cheek when touched)

Cardiac dysrhythmias

Hypercalcemia is indicated by what lab result? S/Sx?

Calcium > 10.5

Muscle weakness

Loss of muscle tone

Spontaneous fractures

Kidney stones

Cardiac dysrhythmias

Normal magnesium level

1.6-2.6

Hypomagnesemia is indicated by what lab result? S/Sx?

Magnesium level < 1.6

Tremors

Hyperreflexia

Insomnia

Muscle cramps

Irregular heart beat

Hypermagnesemia is indicated by what lab result? S/Sx?

Magnesium level > 2.6

Hyporeflexia

Lethargy

Respiratory depression

N/V

Slow/Irregular heart beat

Tay-Sachs Disease

An autosomal recessive inherited genetic disorder caused by a recessive allele (chromosome 15) that leads to the accumulation of certain lipids in the brain. Seizures, blindness, and degeneration of motor and mental performance usually become manifest a few months after birth, followed by death within a few years.

Marfan Syndrome

Inherited autosomal dominant trait (only one abnormal copy of the Marfan gene inherited from one parent) FBN1 gene. Genetic connective tissue disorder that can affect aorta and heart valve structures.

**If one parent has Marfan syndrome, each child has a 50% chance of inheriting the abnormal gene and developing the condition. If both parents have the condition, the risk of their child inheriting the abnormal gene and developing Marfan syndrome increases to 75%.

Turner Syndrome

A chromosomal disorder in females in which either an X chromosome is missing, making the person XO instead of XX, or part of one X chromosome is deleted.

Underdeveloped ovaries (sterile)

Short stature (under 4' 7")

Amenorrhea

Webbing of the neck

Edema

Underdeveloped breasts/wide nipples

Respiratory rate increases during exercise. How does this increased respiratory rate allow the body to maintain a homeostatic pH level?

The increased exhalation of CO2 helps to increase pH.

(The increased respiratory rate allows more CO2 to be exhaled. Since CO2 reacts with water to form carbonic acid, getting rid of more CO2 through increased respiration will raise pH)

An ICU patient's arterial blood gas results show low pH and low CO2 levels. The patient's respiratory rate is increased. What is the name of this condition?

Metabolic acidosis

(Since the pH is low, and the pH and CO2 are trending in the same direction, the condition is metabolic acidosis. The low CO2 indicates that CO2 is not causing the acidosis. The increased respiratory rate lowers blood CO2 in an attempt to compensate for the metabolic acidosis.)

Your patient has pulmonary edema, which raises levels of CO2 in the blood. What helps the patient's body to compensate for this increase?

The kidneys conserve H+ and conserve HCO3-

The kidneys excrete more H+ and conserve HCO3-

The kidneys conserve H+ and excrete more HCO3-

The kidneys excrete more H+ and excrete more HCO3-

The kidneys excrete more H+ and conserve HCO3-

(The increased CO2 level will generate more carbonic acid. The body must compensate for the decreased pH. Excreting more H+ and conserving HCO3- will both help to increase pH.)

Heberden and Bouchard's nodes are indicative of what disease process?

Osteoarthritis

You receive a patient who has experienced a burn on the right leg. The burn has small blisters, is markedly pinkish red, and has a shiny and moist appearance. When the patient is asked about pain level, the patient describes it as severe.

What level of burn does this patient present?

Superficial thickness / Partial or intermediate thickness / Full Thickness / Fourth Degree

Second Degree (partial thickness)

Second degree: Partial thickness burns can be either superficial partial thickness or deep partial thickness, depending on the degree of tissue necrosis of the dermal layer. These burns can char the epidermis and papillary dermal layer, with resultant edema and formation of epidermal blisters. Burned skin is wet, raw, and pink or cherry red in color that blanches with pressure.

Identify degrees of burn, and other s/s to that degree burn

First-degree (Superficial) burns affect only the outer layer of the skin. They cause pain, redness, and swelling (no blistering/scarring).

Second-degree (Partial or intermediate thickness) burns affect both the outer and underlying layer of skin. They cause pain, redness, swelling, and blistering. Pink/Cherry in color that blanches.

Third-degree (Full thickness) burns affect the deep layers of skin. High risk of infection.

Fourth-degree burns involve muscle or bone.

A 56-year-old female presents with superficial partial-thickness burns to the anterior head and neck, front and back of the left arm, front of the right arm, posterior trunk, front and back of the right leg, and back of the left leg.

Calculate the total body surface area percentage that is burned using the Rule of Nines.

63%

The Rule of Nines is a rapid method used during the prehospital and emergent phase of care. The body is divided into regions that present 9%, or multiples of 9, with the exception of the perineum, which is 1% of BSA (body surface area). The face and back of the head are 4.5% each, so the entire head is 9%, the anterior and posterior portion of the arm is 9%, and the total for each leg is 18%. Anterior head and neck (4.5%), front and back of the left arm (9%), front of the right arm (4.5%), posterior trunk (18%), front and back of the right leg (18%), back of the left leg (9%) which equals 63%.

An adolescent male patient is brought to the emergency department after spending a long day at the beach. The patient's head, neck, and trunk from the waist upwards and legs from the knees downward are bright red and edematous. The patient is crying and reports 8 out of 10 on the pain scale and an inability to find a comfortable position.

What is the most likely classification of this burn?

Superficial Thickness / Partial or Intermediate Thickness / Full Thickness / Fourth Degree

Superficial / First Degree Burn

Superficial burns are reddened and painful.

Burn that requires surgery, forms more scars and are less painful?

Superficial thickness / Partial or Intermediate Thickness / Full Thickness / 4th Degree

Deep partial thickness / Second Degree Burn

-Blisters/weeps

-Risk of infection/scarring increase with depth of burn

Describe an intracranial bleed in the epidural space

Typically caused by a head injury and usually with a skull fracture.

Occurs between the skull bone and the outmost membrane layer, the dura mater.

High pressure bleeding is a prominent feature.

You may briefly lose consciousness.

Describe an intracranial bleed in the subdural space

Collection of blood on the surface of your brain.

Typically caused by your head moving rapidly forward and stopping, such as a car accident or shaken baby syndrome.

More common in older people and people with a history of heavy alcohol use.

Describe an intracranial bleed in the subarachnoid space

Occurs between the brain and the thin tissues that cover the brain.

The most common cause is trauma but it can also be d/t the rupture of a major blood vessel in the brain (intracerebral aneurysm).

A sudden, sharp headache usually comes before a subarachnoid hemorrhage. Typical symptoms also include loss of consciousness and vomiting.

Describe an intracranial bleed in the intracerebral space

Occurs inside the brain.

Not usually the result of an injury.

Prominent warning sign is the sudden onset of neurological deficits. Symptoms progress over minutes to hours and include headache, difficulty speaking, n/v, decreased consciousness, weakness in one part of the body, and elevated blood pressure.

Cerebral Concussion (Mild Traumatic Brain Injury)

Individuals with mild TBI can develop postconcussive syndrome (PCS), which includes headaches, lethargy, mental dullness, and other symptoms that can persist for several months after a TBI.

Signs and symptoms of cerebral contusion

Severe headache, dizziness, vomiting, increased size of one pupil, and sudden weakness in an arm or leg. The person may seem restless, agitated, or irritable. Often, the person has memory loss.

These symptoms can last for several hours to several weeks, depending on the severity of the injury. As the brain tissue swells, the person may feel increasingly drowsy or confused.

Vitals may show decreased heart rate and respirations and hypertension, which are signs of pressure on the brainstem.

What is the cause of Bell's Palsy?

Unknown, but thought to be due to virus, or autoimmunity.

Doctors believe that the most likely cause of Bell's palsy in pregnant women is the Herpes virus.

#Cold sores and genital herpes (herpes simplex)

#Chickenpox and shingles (herpes zoster)

#Infectious mononucleosis (Epstein-Barr)

#Cytomegalovirus infections

#Respiratory illnesses (adenovirus)

#German measles (rubella)

#Mumps (mumps virus)

#Flu (influenza B)

#Hand-foot-and-mouth disease (coxsackievirus)

What are signs/symptoms of cerebral edema?

# Headache

# Neck pain or stiffness

# Nausea or vomiting

# Dizziness

# Irregular breathing

# Vision loss or changes

# Memory loss

# Inability to walk

# Difficulty speaking

# Stupor

# Seizures

# Loss of consciousness

What neuro conditions cause flat emotions and sleep disturbances?

#Alzheimer's

#Schizophrenia

#Parkinson's disease

What are the s/sx of Parkinson's?

#Gait changes

#Resting tremor

#Increased muscle tone (rigidity)

#Slow gait/movements (bradykinesia)

What are the s/sx of Amyotrophic Lateral Sclerosis (Lou Gehrig's disease)?

Upper motor neurons become sclerotic and die

Weakness in upper and lower extremities, head drop, speech changes, dysphagia.

Treatment: Riluzole (Rilutek) - works by changing the activity of certain natural substances in the body that affect nerves and muscles.

What are the s/sx of Multiple Sclerosis?

#Episodes of muscle weakness

#Numbness

#Blurred vision

#Fatigue

What is Huntington's and what are s/sx?

Autosomal dominant inherited disorder.

S/Sx do not develop until adulthood and include movement (spasticity); chorea (lack of control), cognitive function, depression, psychosis, dementia, degeneration of neurons.

A provider is providing care for a patient following a hemorrhagic cerebrovascular accident (CVA). The patient asks the provider to explain what happened during the CVA.

Which response by the provider is best?

"A blood vessel in your brain broke open, causing bleeding in your brain and a lack of blood flow to an area."

An older adult patient presents to the emergency department after dropping a pot of boiling water onto their feet. The skin on the patient's left foot is white with profound swelling of the ankle. The patient denies any significant pain.

What is the most likely classification of this burn?

Superficial thickness / Partial or Intermediate Thickness / Full Thickness / Fourth Degree

Full thickness/Third Degree Burn

Full thickness burns may be white and the surrounding area is edematous. Due to the damage the nerve endings, pain is minimal or absent.

Riluzole (Rilutek) used for what?

Medication used to treat amyotrophic lateral sclerosis (ALS; Lou Gehrig's disease). Class of medications called benzothiazoles.

It works by changing the activity of certain natural substances in the body that affect nerves and muscles.

A provider is working with a patient who is recovering from a subarachnoid hemorrhage caused by a cerebral aneurysm. The patient asks the provider to explain what happened.

What is the best response by the provider?

"You experienced a spasm of the arteries in your brain, which prevented blood flow to an area."

"When you fell and hit your head, a blood vessel broke and you experienced bleeding into your brain."

"A clot developed in an artery of your brain, which increased the blood pressure and caused the artery to rupture."

"An artery in your brain had a weakened area, which ruptured, causing bleeding into your brain."

"An artery in your brain had a weakened area, which ruptured, causing bleeding into your brain."

A cerebral aneurysm results when the muscle layer of an artery is weakened and an outpouching occurs. When the weakened area ruptures, bleeding into the brain occurs.

The provider is caring for a client who reports experiencing episodes of muscle weakness, accompanied by profound fatigue and blurry vision. Which diagnosis is the most consistent with these signs?

Multiple Sclerosis

Hypertension causes traumatic damage to the endothelium of the arteries. Which organs have arteries that are at a particular risk for damage?

Brain, heart, eyes, and kidneys

Which problem causes a myocardial infarction or heart attack?

An occlusion of a coronary artery most commonly from a thrombus (blood clot).

What are the characteristics of primary/essential hypertension?

Idiopathic; common "silent killer"

BP consistently > 130/80

What are the characteristics of secondary hypertension?

Results from other disease or disorder

Renal disease; endocrine disorder; pheochromocytoma (adrenal tumor)

What are the characteristics of malignant/resistant hypertension?

Severe, rapidly progressing; uncontrolled

Diastolic pressure extremely high

Many complications

What are the risk factors, manifestations, and complications of hypertension?

Risk Factors: Age, sex, heredity, lifestyle

Manifestations: Asymptomatic, vague symptoms (fatigue, malaise, morning headache)

Complications: Sclerosis, narrowing of vessels, atheroma formation (fatty build up in arteries)

What are the causes of heart failure?

MI (left ventricle)

CAD

HTN

Chronic lung disease (R ventricle needs to work harder to push blood through pulmonary circulation if there is an obstructive lung disease)

Valve problems

What are the compensatory mechanisms of heart failure?

#Renin and aldosterone secretion (vasoconstriction and blood volume is increased)

#SNS response (increases heart rate/vasoconstriction - epinephrine and norepinephrine)

#Cardiac hypertrophy (increased size of the heart)

What are complications of heart failure?

#Cardiogenic shock

#Acute pulmonary edema

#Organ failure

What lab test is an indication of heart failure?

B-Type Natriuretic Peptide (BNP) - a hormone produced by the heart. BNP > 500 are considered indicative of heart failure.

What are causes of left sided heart failure?

#MI

#Valve stenosis

#HTN (has to push after the afterload)

What is the RAAS system?

Renin-angiotensin-aldosterone system - a major mechanism in the regulation of arterial blood pressure. It is a compensatory mechanism that raises blood pressure and increases blood volume in response to decreased renal perfusion.

What is the patho of left sided heart failure?

Decreased cardiac output and pulmonary congestion

What are the manifestations of left sided heart failure?

Forward Effects (in the body - not getting oxygenated blood)

#Fatigue and weakness

#Exercise intolerance

Backward Effects (in the lungs - blood backing up to the lungs)

#Dyspnea

#Orthopnea

#Pink-frothy sputum

#SOB

#Rales/Crackles

What does the body do to compensate for left sided heart failure?

#Tachycardia

#Pallor

#Daytime oliguria (low urine output)

What are the causes of right sided heart failure?

#MI (R Ventricle)

#Valve stenosis

#Pulmonary disease/hypertension (has to push through the lungs)

What is the patho of right sided heart failure?

Decreased cardiac output and systemic congestion

What are the manifestations of right sided heart failure?

Forward Effects (to the lungs)

#Dyspnea

#Fatigue and weakness

#Exercise intolerance

Backward Effects (systemic congestion/fluid back up - cannot maintain venous return)

#Edema (feet, legs, buttocks, ascites, hepato and splenomegaly)

#JVD (jugular vein distention)

Right sided heart failure compensation?

#Tachycardia

#Pallor

#Daytime oliguria (low urine output)

What is endothelial dysfunction and what can it be caused by?

A type of non-obstructive CAD in which there are no artery blockages, but the large vessels on the heart's surface constrict (narrow) instead of dilating (opening).

Can be caused by several conditions, including diabetes, metabolic syndromes, HTN, smoking and physical inactivity.

What is cardiac valve disease?

One or more of the valves in your heart don't work properly

What is cardiac valve regurgitation?

Regurgitation (or leakage of the valve).

When the valve(s) do not close completely, it causes blood to flow backward through the valve. This reduces forward blood flow and can lead to volume overload in the heart.

What is cardiac valve stenosis?

Stenosis (or narrowing of the valve).

When the valve(s) opening becomes narrowed, it limits the flow of blood out of the ventricles or atria. The heart is forced to pump blood with increased force to move blood through the narrowed or stiff (stenotic) valve(s).

What is the main cause of mitral valve stenosis?

Rheumatic fever, which is related to strep infections.

What is mitral valve stenosis?

Narrowing of the mitral valve, restricting blood flow into the main pumping chamber (left ventricle).

**Can cause fatigue and SOB.

What is mitral valve regurgitation?

A condition in which the heart's mitral valve does not close tightly, which allows blood to flow backward in the heart causing backup of blood and hydrostatic pressure into the left atrium, pulmonary veins, and pulmonary capillaries - resulting in pulmonary edema.

What is heart vegetation?

Abnormal growths (vegetations) that contain collections of bacteria may form in the heart at the site of the infection and damage the heart valves, which can cause them to leak.

**Can lead to endocarditis.

What is endocarditis?

A life-threatening inflammation of the inner lining of the heart's chambers and valves (endocardium).

A patient asks the provider about a new diagnosis of aortic stenosis. What does the provider explain about stenosis?

It is caused by calcium deposits forming around the rim of the valve, which reduces the flexibility of the valve.

It describes the valve leaflets shifting into the atrium with contraction, due to thickening of the valve leaflets.

It is a thickening and narrowing of the valve that decreases the ability of blood to move through the valve.

It is a failure of the valve to close properly, due to damage to the chordae tendineae that anchor the valve leaflets.

It is a thickening and narrowing of the valve that decreases the ability of blood to move through the valve.

**A narrowing or stricture to the blood flow from the left ventricle to the aorta and may also affect the pressure in the left atrium.

Which type of valve defect leads to a diastolic murmur?

#Narrowing (stenosis) of the mitral or tricuspid valves

#Regurgitation of the aortic or pulmonary valves

Which type of valve defect leads to a systolic murmur?

Many variations of mitral and tricuspid valve regurgitation and ventricular septal defect.

What is a thrombus?

An aggregation of platelets and red blood cells (clot) found in the location where it formed.

What is an embolus?

Can be a thrombus (blood clot), gas bubble, fat globule, mass of bacteria, or other foreign body that has traveled through the bloodstream until becoming lodged in a blood vessel that is too small for it to pass though, blocking the blood flow.

**When an embolus occludes a blood vessel, it is called an embolism or embolic event.

What are 2 contributing factors to developing an aneurysm?

#A weakening of an artery wall that results in bulging or dilation of the artery

#Can be caused by arteriosclerosis, degenerative vascular disease, or other causes.

What are distinguishing characteristics of endocarditis?

#Prosthetic valves and pacemakers are risk factors

#Often caused by infection of the endocardium of the heart

What are distinguishing characteristics of pericarditis?

#Caused by inflammation of the pericardium (thin membrane around the heart), often due to MI

#Can result in cardiac tamponade if high levels of fluid accumulate and compress the heart

**Sharp/stabbing pain worsens with deep breathing or cough.

How does malignant hypertension differ from benign hypertension?

Malignant hypertension is high blood pressure that has resulted in multiple complications.

Benign hypertension is high blood pressure without evidence of end target organ damage.

HTN is never truly benign in that it causes damage to the endothelium that may not be evident for years.

A patient presents with a blood pressure of 204/102. The patient complains of chest palpitations, a headache and blurred vision. What is the patient experiencing?

Hypertensive crisis

The patient's systolic BP > 180 combined with symptoms of organ damage indicates hypertensive crisis.

A patient who recently underwent a knee replacement suddenly complains of severe SOB and anxiety. What disorder is the most likely cause of the patient's symptoms?

Pulmonary embolism

Patients are at risk for thrombosis and embolism following a major orthopedic surgery like knee replacement. The patient's sudden onset of symptoms suggests pulmonary embolism.

A patient asks the provider about a new diagnosis of aortic stenosis.

What does the provider explain about stenosis?

It describes the valve leaflets shifting into the atrium with contraction, due to thickening of the valve leaflets.

It is caused by calcium deposits forming around the rim of the valve, which reduces the flexibility of the valve.

It is a failure of the valve to close properly, due to damage to the chordae tendineae that anchor the valve leaflets.

It is a thickening and narrowing of the valve that decreases the ability of blood to move through the valve.

It is a thickening and narrowing of the valve that decreases the ability of blood to move through the valve.

What is the difference between Hodgkin's Lymphoma and Non Hodgkin's Lymphoma?

The main difference between the two is the specific lymphocyte each involves.

**Hodgkin's is marked by the presence of Reed-Sternberg cells, which are not present in non-Hodgkin's lymphoma.

Signs and Symptoms of Hodgkins Lymphoma

#Painless swelling of lymph nodes in the neck, armpits, or groin.

#Persistent fatigue

#Fever

#Night sweats

#Losing weight without trying

#Severe itching

#Pain in lymph nodes after drinking alcohol

#Electrolyte imbalance causing palpitations, diarrhea, muscle weakness

What is Non-Hodgkin's Lymphoma?

A cancer that starts in white blood cells called lymphocytes, which are part of the body's immune system. Non-Hodgkin lymphomas happen when white blood cells known as lymphocytes mutate or change.

Includes any type of lymphoma except Hodgkin's.

Lymphomas start in either B or T cells, but B-cell lymphomas are most common.

What is lymphedema?

Swelling or accumulation of fluid due to blockage

Enlargement in one or more lymph nodes, usually due to infection

Enlarged lymph nodes that become palpable and tender

Cancers of lyphocytes residing in the lymphatic vessels.

The swelling or accumulation of the fluid due to a blockage in the lymphatic system caused by scar tissues from damaged lymph vessels or lymph nodes.

It is often seen in patients who had their lymph nodes removed and had surgery or radiation to remove cancer.

What is lymphadenitis?

Swelling or accumulation of fluid due to blockage

Enlargement in one or more lymph nodes, usually due to infection

Enlarged lymph nodes that become palpable and tender

Cancers of lyphocytes residing in the lymphatic vessels.

Enlargement in one or more lymph nodes, usually due to infection.

Lymph nodes are filled with white blood cells that help the body fight infections.

What is lymphadenopathy?

Swelling or accumulation of fluid due to blockage

Enlargement in one or more lymph nodes, usually due to infection

Enlarged lymph nodes that become palpable and tender

Cancers of lyphocytes residing in the lymphatic vessels.

Enlarged lymph nodes that become palpable and tender.