NURS3107-Pathophysiology Final Exam Study Guide Fall 2022

Cerebrovascular Accidents

• Ischemic, Embolic, Hemorrhagic, Thrombotic
• Clinical Manifestations: hemiplegia, hemiparesis, flaccidity, ataxia
• Symptoms: Sudden unilateral weakness, speech issues, confusion, facial droop.
• FAST: Face drooping, Arm weakness, Speech difficulty, Time to call 911.

Multiple Sclerosis

• Progressive immune-related demyelination disease of the CNS
• Clinical manifestations vary.
• T and B lymphocytes cross the blood–brain barrier, T cells remain in the CNS and promote the infiltration of other agents that damage the immune system.
• Immune system attack leads to inflammation that destroys myelin.
• Manifestations: fatigue, weakness, numbness, difficulty in coordination, loss of balance, pain, and visual disturbances

Myocardial Infarction

• Unstable angina: reduced blood flow in coronary artery (rupture of a plaque)
• Cloth formation can develop (not completely occlude artery) – Can result in chest pain
• MI – plaque rupture and thrombus formation results in complete occlusion of artery
• Leads to ischemia and necrosis of the myocardium

Peptic Ulcers

• Erosion caused by increased concentration of acid (pepsin) or decreased resistant normal protective barrier
• Mucosa can’t secrete enough mucous to act as a barrier
• Mucosa is then exposed to HCl (and other irritating agents) -> inflammation -> injury -> erosion
• NSAIDs can be a major contributing factor (inhibits prostaglandin synthesis) which is associated with disruption of the normal protective barrier
• Associated with H. pylori
• Clinical manifestations: Pain (A dull gnawing feeling or burning in the midepigastrium), Heart burn, Vomiting

Gout

• Hyperuricemia – Serum greater than 7
• Urate crystal deposition
• Gout attacks related to uric levels
• Inflammatory response
• Risk factors: age, body mass index, alcohol consumption, hypertension, and diuretic use

Arterial Blood Gases

• Measures acidity (pH), oxygen (PaO2), carbon dioxide (PaCO2), bicarbonate (HCO3^-), and oxygen saturation (SaO2) of arterial blood.
• pH: 7.35–7.45
• PaCO_2: 35–45 mmHg
• HCO_3^-$: 22–26 mEq/L
• PaO_2: 80–100 mmHg
• SaO_2: 95–100%
• Respiratory Acidosis: ↑ PaCO_2, ↓ pH → caused by hypoventilation
• Respiratory Alkalosis: ↓ PaCO_2, ↑ pH → caused by hyperventilation
• Metabolic Acidosis: ↓ HCO_3^- , ↓ pH → causes include DKA, diarrhea, renal failure
• Metabolic Alkalosis: ↑ HCO_3^- , ↑ pH → caused by vomiting, diuretics, antacid overuse

Pneumonia

• Inflammation of the lung parenchyma
• Classifications: CAP, HAP, HCAP, VAP, Aspiration Pneumonia
• Alveoli develop an inflammatory reaction and exudates which interfere with diffusion of oxygen and CO_2$$.
• WBC (mainly neutrophils) migrate into the alveoli
• Risk Factors: Conditions with mucus, Immunosuppression, Smoking, Immobility, ETOH use, Age

COPD

• Inflammatory Process
• Airways narrow- excess mucus
• Scar tissue formation
• Lungs develop abnormal inflammatory response to particles, gasses, and other elements
• Signs & Symptoms: Chronic cough, Sputum production, Dyspnea on exertion, Barrel chest, Clubbing
• Major Risk Factor: Environmental exposure – cigarettes

Cirrhosis

• Types: Alcoholic, Postnecrotic, Biliary
• Clinical manifestations: Liver enlargements, Portal obstruction, Ascites, Infection and peritonitis, Varices, GI varices, Edema, Vitamin deficiency, Anemia, Mental deterioration
• Alteration of blood flow to the liver -> increase in pressure in the veins that carry blood through the liver -> Esophageal varices, Ascites
• Hepatic encephalopathy: Changes in motor function, Changes in level of consciousness (restlessness & confusion -> seizure & coma)

Crohn’s Disease

• Location: Anywhere in GI tract, especially terminal ileum; skip lesions.
• Symptoms: Abdominal pain, weight loss, diarrhea, fistulas.
• Diet: Low-fiber during flares, avoid high-fat foods, lactose.

Diverticulitis

• Infection and inflammation of diverticula
• Diverticulum – Sac-like herniation of the lining of the bowel that extends through a defect in the muscle layer
• Diagnosis is usually by colonoscopy

Diverticulosis

• Multiple diverticula without inflammation
• Cause: Outpouchings in colon wall.
• Symptoms: Often asymptomatic; can have mild cramping.
• Diet: High-fiber to prevent diverticulitis.

Myasthenia Gravis

• Autoimmune disorder affecting the myoneural junction
• Antibodies directed at acetylcholine at the myoneural junction impair transmission of impulses
• Manifestations: Diplopia and ptosis, Weakness of facial muscles, swallowing and voice impairment (dysphonia), generalized weakness

Deep Vein Thrombosis

• Cause: Clot in deep veins (usually legs); Virchow’s triad (stasis, injury, hypercoagulability).
• Symptoms: Swelling, warmth, redness, tenderness.
• Complication: Pulmonary embolism

Heart Failure

• Left-Sided: Pulmonary symptoms—dyspnea, orthopnea, crackles.
• Right-Sided: Systemic symptoms—edema, JVD, hepatomegaly.

Ulcerative Colitis

• Location: Colon and rectum, continuous lesions.
• Symptoms: Bloody diarrhea, urgency, cramping.
• Diet: Low-fiber during flares, avoid dairy, caffeine, spicy food.

Cholecystitis

• Inflammation of gallbladder (can be acute or chronic)
• Pain tenderness, rigidity of RUQ that can radiate to midsternal or right shoulder
• Gallstone is obstructing bile outflow.

Rheumatoid Arthritis

• Autoimmune, chronic & progressive
• Occurs in synovial tissue
• Hallmarks: Inflammation, Autoimmunity, Degeneration
• Symptoms: Pain, Joint swelling, Limited movement, Stiffness, Weakness, Fatigue

Osteomyelitis

• Infection of the bone
• Occurs because of: Extension of soft tissue infection, Direct bone contamination, Bloodborne spread from another site of infection
• Causative organisms: Methicillin-resistant Staphylococcus aureus (MRSA)
• If left untreated, bone abscess can form, resulting in chronic osteomyelitis
• Systemic symptoms: Sepsis—chills, high fever, rapid pulse
• Local symptoms: painful, swollen, extremely tender

Osteoporosis

• Characterized by reduced bone mass, deterioration of bone matrix, and diminished bone architectural strength.
• Bones become progressively porous, brittle, and fragile.
• Risk factors: Alcohol, tobacco, family history, bone fracture during adulthood, inactive lifestyle, inadequate calcium and vitamin D intake
• Labs/diagnostics: Diagnosed by dual energy x-ray absorptiometry (DXA) for bone mineral density (BMD)
• Prevention: Balanced diet high in calcium and vitamin D throughout life, Regular weight-bearing exercises

Neurotransmitters

• Communicate messages from one neuron to another or to a specific target tissue
• Acetylcholine- excitatory
• Glutamate- excitatory
• Norepinephrine- primarily excitatory
• Serotonin-inhibitory
• Gamma-aminobutyric acid (GABA)- inhibitory
• Dopamine- inhibitory

Normal and Abnormal Lab Values

• Sodium: 135–145 mEq/L
• Potassium: 3.5–5.0 mEq/L

Stages of CKD

• Stage 1: GFR ≥ 90 (with damage)
• Stage 2: GFR 60–89
• Stage 3: GFR 30–59
• Stage 4: GFR 15–29
• Stage 5: GFR < 15 (End-Stage Renal Disease)

Hypothyroidism

• Results from suboptimal levels of thyroid hormone
• Symptoms of hyperthyroidism may later be followed by those of hypothyroidism and myxedema
• Lab value trends: ↓TSH (suppressed) ↑Free T4 and ↑T3
• Clinical manifestations: Extreme fatigue, Hair loss, brittle nails, dry skin, Voice changes, Menstrual disturbances

Hyperthyroidism

• Graves’ disease (most common cause)
• Thyrotoxicosis: excessive output of thyroid hormone (thyroid storm)
• Autoimmune disorder
• Clinical manifestations: Nervousness, rapid pulse, heat intolerance, tremors, skin flushed, warm, soft, and moist, exophthalmos, increased appetite, weight loss, elevated systolic BP, cardiac dysrhythmias

Chvostek

• Facial twitching when the cheek is tapped.
• Indicates: Hypocalcemia (low calcium).

Trousseau

• Carpal spasm when a BP cuff is inflated.
• Indicates: Hypocalcemia.

Grave’s Disease

• Type: Autoimmune hyperthyroidism.
• Symptoms: Weight loss, heat intolerance, tachycardia, anxiety, exophthalmos (bulging eyes)
• Labs: ↓TSH, ↑T3 and ↑T4.

Renal Calculi

• Calculi (stones) in the urinary tract or kidney
• Pain and hematuria
• Causes: may be unknown
• Diagnosis: radiography, blood chemistries, and stone analysis; strain all urine and save stones

Fluid Volume Deficits/Excess

Functions of the Kidney

• Urine formation
• Excretion of waste products
• Regulation of electrolytes and acid-base balance
• Control of water balance and blood pressure
• Regulation of red blood cell production
• Synthesis of vitamin D to active form

Functions of Insulin

• Insulin is a hormone secreted by beta cells of the pancreas that helps regulate blood glucose levels by promoting glucose uptake into cells.
• Lack of insulin or insulin resistance leads to hyperglycemia

ADH

• Regulates water balance by increasing water reabsorption in the kidneys.
• SIADH: Excess ADH -> water retention, hyponatremia, confusion, seizures.
• Diabetes Insipidus: ADH deficiency -> excessive urination, dehydration, low urine specific gravity.

Erythropoietin

• Produced by: Kidneys in response to low oxygen levels.
• Function: Stimulates red blood cell production in the bone marrow.
• Relevance: Decreased in chronic kidney disease → anemia, fatigue.

Cushing’s Disease

• Excessive adrenocortical activity or corticosteroid medications
• Clinical manifestations: Hyperglycemia, central-type obesity with “buffalo hump”, heavy trunk and thin extremities, fragile, thin skin, ecchymosis, striae, weakness, HTN, “moon-face”, acne, Virilization in women