EXAM 4 for Nurse 225

Normal Blood Gas Values

PaCO2: 35 to 45

pH: 7.35 to 7.45

HCO3: 22 to 26

Acidosis

accumulation of excess acids hydrogen ions and deficiency of base

Respiratory Acidosis

hypoventilation. Blood gas values pH less than 7.35 and PaCO2 greater than 50

Metabolic Acidosis

decreased pH in blood and body tissues as a result of an upset in metabolism

Alkalosis

reduction of acids and an increase of bicarbonate ions

Respiratory Alkalosis

hyperventilation. pH greater than 7.45 and PaCO2 less than 35.

Metabolic Alkalosis

the level of base bicarbonate is abnormally high or there is a decrease in hydrogen ion concentration. Blood gas value resulting in pH greater than 7.45 and HCO3 greater than 26.

Cystic Fibrosis

autosomal recessive disorder that results in the excessive production of mucus, leading to chronic obstructive pulmonary disease in early childhood.

Pathophysiology of Cystic Fibrosis

lack the necessary protein to transport chloride, leading to thick, viscous mucus in organs, primarily the lungs, and high levels of sodium and chloride in sweat.

Bronchiectasis

a permanent enlargement of the large bronchi, often associated with respiratory infections, leading to atelectasis, abscesses, destruction, and necrosis of the bronchial wall.

Emphysema

breakdown of the elastin and fiber network of the alveoli, causing the alveoli to enlarge and their walls to be destroyed, leading to a barrel chest appearance.

Chronic bronchitis

inflammation of the bronchi persisting over a long time

Chronic Bronchitis pathophysiology

bronchial mucosal glands hypertrophy, increasing the number and size of goblet cells, which results in inflammatory cell infiltration and edema of the bronchial mucosa. The bronchial walls thicken, impeding airflow.

blue bloaters

unable to increase ventilator effort to maintain adequate gas exchange. These patients eventually develop cyanosis and edema.

Polycythemia

In severe cases of chronic bronchitis, the kidneys may produce increased red blood cells, increasing blood viscosity and the risk of blood clots.

Atelectasis

collapse of a lung or an alveolus. A collapsed lung cannot participate in air exchange.

Causes of Atelectasis

Without oxygen, little surfactant is produced. Blood flow is not interrupted, but it travels through airless alveoli, which can lead to hypoxemia.

Compression Atelectasis (secondary)

This occurs when something compresses the lung, such as a tumor, fluid, or a puncture wound.

Resorption Atelectasis (secondary)

This results from a blockage of the alveolus, which can be caused by mucus buildup (as seen in pneumonia, cystic fibrosis, or after surgery).

Contraction Atelectasis (secondary)

This is a result of fibrosis of the lungs or pleura.

Primary Atelectasis

This happens in infants born with collapsed alveoli at birth, especially in premature infants who lack sufficient surfactant

Flail Chest

an acute injury of the chest wall resulting in instability of the chest wall, typically caused by blunt trauma or penetrating objects.

Identification of Flail Chest

the injured section of the chest wall exhibits paradoxical movement during respiration.

Inspiration in Flail Chest

The negative pressure created within the lung cavity causes the unstable chest wall section to collapse inward.

Expiration in Flail Chest

The positive pressure causes the chest wall section to expand outward.

Common Bacteria Causing Pneumonia

Streptococcus pneumoniae (most common), Staphylococcus, Haemophilus influenzae, and Pseudomonas (Gram negative).

Fungi Causing Pneumonia

Aspergillus fumigatus, Candida albicans, and Pneumocystis carinii.

Pathophysiology of Pneumonia

inflammation in the lung, leading to airspaces becoming engorged with fluid/RBCS/exudate and infiltration of lymphocytes, neutrophils, erythrocytes, and fibrin.

Atypical Pneumonias

caused by viral and mycoplasma infections of the alveolar septum & lung interstitium. does not present with the usual pattern.

Pleuritis (Pleurisy)

inflammation of the pleura, often accompanied by an abrupt onset of pain. It can be classified as primary or secondary.

Pleuritis Pathophysiology

Inflammation of visceral and parietal pleurae > Friction between pleurae on inspiration

Pneumothorax

entrance of air into the pleural cavity, resulting in complete or partial collapse of the lung.

Pneumothorax Pathophysiology

Air enters the pleural space, disrupting the normal negative pressure that keeps the lung inflated, thus leading to lung collapse.

spontaneous pneumothorax

occurs when a weak area on the lung ruptures in the absence of major injury, allowing air to leak into the pleural space.

traumatic pneumothorax

caused by penetrating or non-penetrating injuries

tension pneumothorax

An accumulation of air or gas in the pleural cavity that progressively increases pressure in the chest that interferes with cardiac function with potentially fatal results.

Iatrogenic pneumothorax

caused by medical procedures

Pulmonary Tuberculosis

type of pneumonia caused by the acid-fast bacillus, Mycobacterium tuberculosis. It can be a primary infection (new) or secondary TB (reactivation of dormant bacilli).

pyelonephritis

inflammation of the renal pelvis and the kidney

Bladder Cancer

cancerous tumor that arises from the cells lining the bladder; major sign is hematuria

Risk Factors for Bladder Cancer

cigarette smoking (most significant risk factor), exposure to chemicals and dyes, and chronic use of phenacetin-containing analgesics.

Acute Renal Failure (ARF)

a rapid decrease in renal function, generally recognized by a fall in urinary output and an increase in BUN and/or creatinine.

Symptoms of Acute Renal Failure

Symptoms associated with uremia, metallic taste in mouth, muscle cramps, edema and skin rash due to the buildup of uremic toxins.

Risk Factors for Acute Renal Failure

Ischemia due to conditions causing reduced blood flow to the kidneys, exposure to nephrotoxins, sepsis (infection), and certain medications.

Chronic Renal Failure (CRF)

a progressive inability of the kidneys to respond to changes in body fluids and electrolyte composition. This leads to an inability of the kidneys to produce sufficient urine.

Renal Failure

the kidneys are unable to adequately filter waste products from the blood and regulate fluid and electrolyte balance.

Edema

Swelling caused by fluid retention, which can be a sign of renal failure.

Impaired Waste Excretion

The kidneys are unable to effectively filter and remove metabolic waste products such as urea and creatinine from the blood.

Fluid and Electrolyte Imbalance

Impaired regulation of fluid volume, sodium, potassium, and other electrolytes in renal failure.

Reduced Urine Production

Commonly seen as oliguria in ARF, with significant diminishment in later stages of CRF.

Impaired Hormone Production

Disruption of essential hormone production by the kidneys, leading to anemia and hypertension.

Acid-base Imbalance

Inability of the kidneys to maintain the body's pH balance, often leading to metabolic acidosis.

Pyuria

Presence of white blood cells or pus in the urine, indicating infection.

Nitrites

Substances produced by some bacteria, indicative of a UTI.

Leukocyte Esterase

An enzyme produced by white blood cells, indicative of a UTI.

Kidney Failure Urinalysis Findings

Can include proteinuria, hematuria, or abnormal casts.

Proteinuria

indicate kidney damage.

Abnormal Casts

Microscopic structures formed in the kidney tubules, indicative of kidney issues.

Peptic ulcer disease

ulcer that may be located in the lower end of the esophagus, the stomach, or the duodenum.

pathophysiology of Peptic ulcer disease

erosion of the mucosal layer of stomach or duodenal tissue caused by loss of mucosal lining and gastric acid/pepsin. This erosion can lead to complications such as bleeding and perforation.

Hiatal hernia

Protrusion of the stomach into the mediastinal cavity by way of the diaphragm, often due to weakening of the lower esophageal sphincter.

Crohn's Disease

A chronic inflammatory condition of the bowel characterized by patchy areas of inflammation that can occur anywhere in the GI tract, most commonly in the ileum or colon.

Ulcerative Colitis

An inflammatory disease affecting the mucous membranes of the colon, which can affect part or all of the colon and rectum.

Mechanical bowel obstruction

Caused by adhesions, hernias, tumors, and impacted stool; the most common type in children.

Paralytic bowel obstruction

Results from a lack of peristalsis, caused by abdominal surgery, infection, and certain medications.

Gallstones (cholelithiasis)

hardened cholesterol stones formed as a result of bile crystallization, with causes like cirrhosis and Crohn's disease.

Chronic Pancreatitis

A more progressive and long-term inflammatory process, potentially leading to scarring and loss of pancreatic function.

Glomerulonephritis

inflammation of the glomeruli in the kidneys that leads to impaired kidneys' ability to filter waste

Diverticulitis

Inflammation/infection that occurs when food particles get trapped in the small bulging pouches on the lining of the colon.

Peritonitis

Local or generalized inflammation of the peritoneum, dangerous due to potential causes like infections and ruptured organs leading to severe systemic illness.

Hepatic Encephalopathy

A decline in brain function that occurs as a result of severe liver disease.

Jaundice

A condition characterized by yellowing of the skin and eyes due to high levels of bilirubin in the blood.

Cholecystitis

The inflammation of the cystic duct caused by the lodging of a gallstone in the duct, which can be acute or chronic.

Pathophysiology of pancreatitis

Involves inflammation of the pancreas caused by factors such as gallstones, excessive alcohol consumption, certain medications, and trauma.

Renin-angiotensin-aldosterone system (RAAS)

Influences blood pressure in the body and is related to fluid status, becoming more involved in hypertension.

Malignant hypertension

A severe form of hypertension that can lead to significant health complications.

Primary hypertension

increased vascular resistance due to vasoconstriction or narrowed peripheral blood vessels that leads to v. hypertrophy,

Secondary hypertension

secondary to other diseases and involves multiple systems with direct or indirect impact on the renal system.

Aneurysm

permanent dilation of an artery or an outpouching of the wall of an artery.

Dissecting aortic aneurysm

An aneurysm where there is a tear in the aorta wall, allowing blood to flow between the layers of the wall.

Fusiform aneurysms

Occur when a vessel weakens and bulges on all sides, resulting in a cylindrical shape.

Saccular aneurysms

Sac-like or berry-shaped outpouchings and are the most common type of cerebral aneurysm.

Pseudoaneurysms (fake)

result from an injured blood vessel wall that leaks, often as a complication of medical procedures like cardiac catheterization.

Varicose veins

superficial veins that are twisted and enlarged, most often affecting the lower extremities.

Pathophysiology of varicose veins

Involves chronic venous insufficiency resulting from incompetent valves, leading to a reduction in venous return and an increase in venous pressure.

Raynaud's Disease

a condition of small arteries and arterioles of the fingers and skin that constrict in response to cold or emotional upset.

Symptoms of Raynaud's Disease

Includes changes in skin color of the hands, ischemia, tissue hypoxia, and potential gangrene.

Buerger's Disease (Thromboangiitis Obliterane)

an inflammatory occlusive disease involving the medium-sized arteries.

Symptoms of Buerger's Disease

Includes pain, intolerance to cold and emotional stress, decreased pulses in the feet, rubor and cyanosis of the extremities, and decreased circulation.