Patho Exam II

Altered physiological function with chronic stress

Cardiovascular, gastrointestinal, immune, neurologic systems

Altered psychological factors with chronic stress

Depression, accidents, suicide, chronic alcoholism, drug abuse, eating disorders

What lab level increases with chronic stress

cortisol

Third Space

Place in the body that's not supposed to hold fluid - pericardial sac pleural cavity

Anasarca

wide-spread

Diabetes Insipidus

Deficiency of ADH/decreased renal response to ADH causing a pt to excrete a large volume of urine

Syndrome of Inappropriate ADH

A failure of the negative feedback system that regulates release and inhibition of ADH. ADH secretion continues even when serum osmolality is decreased, causing marked water retention and dilution hyponatremia.

Lab Levels of Potassium

3.5 -5 MEQ/L

Etiology of Hypokalemia

Can arise from Cushing syndrome, inappropriate use of medications (not taking them), diuretics,steroids

Signs/Symptoms of Hypokalemia

cardiac irritability paralytic ileus (paralyzed gut), hyporeflexia, mental changes

Etiology of Hyperkalemia

Potassium rich diet and medications, Whole blood or packed cells

Signs/Symptoms of Hyperkalemia

(Heart )depressed cardiac conduction (cardiac monitoring), prolonged PR interval, renal problem

Lab Levels Magnesium

1.5 - 2.5 MEQ/L

Etiology of Hypomagnesemia

malnutrition, diarrhea

Signs/Symptoms of Hypomagnesemia

hyperactive deep tendon reflexes, personality changes

Etiology of Hypermagnesemia

increased intake with decreased renal excretion

Signs/Symptoms of Hypermagnesemia

bradycardia, hypotension, lethargy

Lab Levels of Phosphorus

2.5 - 5 MG/DL

Lab levels of Calcium

8.5 - 10.0 MG/DL

Etiology of Hypocalcemia

Thyroidectomy (parathyroid glands are responsible for calcium monitoring, usually gets injured in operation)neuro+muscular

Signs/Symptoms of Hypocalcemia

skeletal muscle cramps(muscle spasms), seizures, laryngospasm, asphyxiation, death,tetany

Etiology of Hypercalcemia

renal failure, hyperparathyroidism, immobility (buildup of Ca in blood)paraneoplastic syndrome

Signs/Symptoms of Hypercalcemia

decreased neuromuscular excitability, bone fracture risk, renal stones

Lab levels of Sodium

135 - 145 MEQ/L

Etiology of Hyponatremia

Diaphoresis (profuse sweating), diuretics(makes you pee) , drainage

Signs/Symptoms of Hyponatremia

tachycardia, hypotension, coma, polyuria, decreased skin turgor

Etiology of Hypernatremia

renal failure (can't dispose of waste via pee)

Signs/Symptoms of Hypernatremia

CNS irritability (tingling, irritable), dry flushed skin

What eliminates stuff from our body?

Renal System

What happens if the renal system isn't working?

Retaining electrolytes

Arterial Blood Gas Levels pH

7.35 - 7.45

Arterial Blood Gas Levels PaCO2 (Carbon Dioxide)

45 - 35

Arterial Blood Gas Levels HCO3 (Bicarbonate)

22 - 26

Arterial Blood Gas Levels PAO2 (Oxygen)

80 - 100

Causes of Respiratory Acidosis

damage to respiratory center in medulla from trauma or narcotics, airway obstruction chronic (Trauma -> impaired ventilation -> acidosis)

Manifestations Respiratory Acidosis

headache, irritability, blurred vision, psychological change

Treatment for Respiratory Acidosis

improve ventilation

Causes of Metabolic Acidosis

excess production of fixed acid from diabetic ketoacidosis or lactic acidosis, decreased renal function, increased bicarbonate losses from diarrhea,causes decreased cardiac output

Compensatory Mechanisms for Metabolic Acidosis

increase ventilation with the elimination of CO2 to increase pH (you blow off acid when you breathe)

Manifestations of Metabolic Acidosis

stupor and coma

Treatment for Metabolic Acidosis

controversial bicarbonate supplements

Causes of Respiratory Alkalosis

hyperventilation

Manifestations of Respiratory Alkalosis

hyperexcitability of nervous system, light-headed, tingling of fingers and toes

Treatment for Respiratory Alkalosis

treat underlying cause such as hypoxia by administering oxygen conserve carbon dioxide by rebreathing in paper bag

Causes of Metabolic Alkalosis

excess base loading, loss of stomach acids, bulimia nervosa

Manifestations of Metabolic Alkalosis

mental confusion, tetany, carpopedal spasm (hand spasm)

Treatment for Metabolic Alkalosis

correct the cause

Know what you see with localized inflammation

swelling, pain, heat, redness - varies with vascular supply

People with impaired healing

ischemia, excessive bleeding, excessive fibrin formation, chronic conditions such as diabetes, obesity, smoking

Guillain-Barre

autoimmune disorder with ascending/descending motor weakness/paralysis

Etiology of Guillain-Barre

history of immunizations

Signs/Symptoms w/ Guillain-Barre

ascending weakness, paresthesia (tingling), paralysis

Ascending Muscle Weakness

starts in the legs and spreads to the arms.

Descending Muscle Weakness

moving down the body instead of going up. More dangerous due to troubles in respiratory muscles causing difficulty breathing

Parkinson's

Chronic, debilitating, progressive disorder of the basal ganglia and substantia nigra. Low dopamine

CM Parkinson's

tremors, rigidity, cogwheel, stooped posture with slow, shuffling, propulsive , drooling, dysphagia (difficulty swallowing),

Amniotropic lateral sclerosis (ALS)

upper/lower motor neuron disease characteristed by weakness and paralysis in all parts of life. (ascending/descending)

Multiple Sclerosis (MS)

demyelinating disorder of CNS myelin

CM of MS

optic neuritis, diplopia (people usually have vision problems first)

CM of Spinal Cord Injuries

Upper (Breathing issues) v Lower (bowel, bladder, immobility) neuron interruption; Primary (initial assault) v. Secondary (fallout from assault) injury

Autonomic Dysreflexia

abnormal, overreaction of the involuntary (autonomic) nervous system to stimulation. The nervous system of people with AD over-responds to the types of stimulation that do not bother healthy people.

Blood pressure of a pt. w/ a spinal cord injury

suddenly goes very high.

Intracranial pressure

7 - 15 mmHg

Increased intracranial pressure, what happens?

Presses on Vital structures leading to brain herniation

Cushing's triad

With signs of brain herniation (poking through a spot its not supposed to) -> hypertension, bradycardia, and irregular respiration BP increases

Decorticate Position

lesion of cerebral hemisphere - arms bent and hands turned inward, feet and legs extended out

Decerebrate Position

lesion of diencephalon (thalamus/hypothalamus), midbrain & upper brain stem, arms straightened, feet turned inward hands outward

Coup

injury occurred at impact

Contrecoup

injury occurs at opposite end of impact

Primary brain injury

caused by impact

Secondary brain injury

damage from swelling, infection, cerebral hypoxia

Hematoma

A pool of mostly clotted blood that forms in an organ, tissue, or body space. Usually caused by a broken blood vessel that was damaged by surgery or an injury.

Epidural

bleeding b/w skull and dura resulting from tear of artery (middle meningeal)

Epidural Usually occurs

in younger indiv. - brief period of unconsciousness, consciousness regained, them rapid progression to unconsciousness

Subdural

bleeding between dura and arachnoid from venous tear

Subdural Usually

develops slowly with signs/symptoms in 24 hours to weeks or can also develop rapidly. May progress to increased ICP, posturing, and seizures

TIA (Transient Ischemic Attack)

'warning stroke' w/ signs/symptoms resolved w/in 24hrs

Hemorrhagic Stroke

An emergency condition in which a blood vessel BURSTS causing bleeding inside the brain.

Causes of Hemorrhagic Stroke

risk w/ age, AV (arteriovenous) malformation

Meningitis

bacterial infection causing strep to release an endotoxin which causes swelling of the protective membranes covering the brain and spinal cord.

Signs/Symptoms of Meningitis

nuchal rigidity (stiff neck) w/ nausea, photophobia, altered mental status, brudzinski (flexion of neck results in flexion of hip & knees involuntarily)decorticate

Hemiparesis

Muscle weakness or partial paralysis on one side of the body can affect the arms, legs, and facial muscles.

Cerebrovascular accident (Stroke)

Damage to the brain from interruption of its blood supply.

CM of stroke

Sudden numbness or weakness in the face, arm, or leg, especially on one side of the body. Sudden confusion, trouble speaking, or difficulty understanding speech. Sudden trouble seeing in one or both eyes. Sudden trouble walking, dizziness, loss of balance, or lack of coordination.

Lower motor neuron, biggest problem

When the lower motor neurons cannot receive signals from the upper motor neurons, it can cause muscle stiffness (spasticity) and overactive reflexes. This can make voluntary movements slow and difficult.

What bod system isn't working to get rid of potassium?

Renal System

What body system isn't working if potassium is low(hypokalemia)

Cardiac system

What body system isn't working if there are low levels of calcium?

affects neuromuscular system

manifestations of hypocalcemia

tetany, circumoral numbness, paresthesias, hyperactive DTRs, Trousseau's sign, Chovstek's sign, seizures, respiratory symptoms of dyspnea and laryngospasm, abnormal clotting, anxiety

What causes respiratory acidosis?

hypoventilation

Hyponatremia clinical manifestations

Low blood pressure and high heart rate

Calcium issues affect which systems?

Neuro, muscular, bones

If someone had a seizure or bone fracture what mineral deficiency problem are they having

calcium deficiency problem

Manifestation of metabolic acidosis

decreased cardiac input due to whole body in overload

What is the cause of respiratory alkalosis?

hyperventilation

What are the normal magnesium levels?

1.5-2.5 mEq/L

If the magnesium level is 1.0 what are the clinical manifestations?

Hyperactive deep tendon reflexes, personality changes

myasthenia gravis

Neuromuscular junction disorder results in skeletal and muscle weakness

CM of myasthenia gravis

Ptosis , dysphasia, speech, muscle weakness

Spinal cord injury

Autonomic disreflexia high BP low HR