N212 Pathophysiology Study Guide Exam 3

Hypertension

• Effects on Heart:

  • Damaged heart muscle leading to hypertrophy.
  • Left ventricle enlargement due to increased resistance.

• Stage 2 Hypertension:

  • Systolic blood pressure over 140/90.
  • Normal blood pressure: 120/80.

• Complications of Hypertension:

  • Brain stroke
  • Blood vessel damage
  • Kidney failure
  • Vision loss
  • Heart attack
  • Bone loss

• Effects on Kidneys:

  • Decreased urine output.
  • Ineffective blood filtering.
  • Increased workload for kidneys.

• Beta Blocker Contraindications:

  • Hold if heart rate (HR) < 60 bpm.
  • Hold if systolic blood pressure (BP) < 90 or 110.
  • Hold if patient has asthma.

Hypovolemic Shock

• First Priority:

  • Establish IV access.
  • Administer fluids.

• Organ Response:

  • Organs start shutting down.

• Third-Spacing:

  • Fluid accumulation in the interstitial space, unavailable for body use.

Myocardial Infarction (MI)

• Physiological Causes:
  • Plaque buildup in coronary artery walls leading to blood clot formation.
  • Metabolic syndrome: concurrent hypertension, high lipids, and diabetes.
  • Smoking.
  • Family history and genetics.
  • Obesity.
  • Inactivity.

Hypertension & Heart

• Direct Cause:
  • Increases afterload - the heart has to pump harder against higher pressure.
  • Leads to left ventricular hypertrophy (LVH) (the heart muscle thickens).
  • Over time, can cause heart failure, arrhythmias, and MI.

Blocked Vessels

• Affected Vessels:

  • Coronary arteries (heart muscle): angina, MI, heart failure.
  • Carotid and cerebral arteries (brain): TIAs and ischemic stroke.
  • Renal arteries (kidneys): uncontrolled HTN and CKD.
  • Peripheral arteries (legs): PAD, claudication, poor wound healing.

• Cause of Blockage:

  • Atherosclerosis: chronic inflammatory process with plaque buildup in arteries.
  • Plaque composition: LDL (bad cholesterol), triglycerides, WBCs (foam cells), calcium, and fibrous tissue.

Cardiac Damage Labs

• Labs to Identify Cardiac Damage:
  • Cardiac troponin
  • Lipids
  • CBC
  • CMP
  • CRP/ESR
  • EKG
  • Echo, CT, MRI
  • O_2 therapy
  • CK-MB
  • BNP

Heart Failure

• Common Symptoms:
  • SOB
  • Chest pain
  • Pulmonary edema
  • Sudden weight gain
  • Tired
  • Coughing
  • Dizziness
  • Edema in lower extremities
  • Loss of appetite
  • Abdominal bloating
  • Sleep disturbance

Right-Sided Heart Failure

• Right side of the heart receives deoxygenated blood.
• Fluid backs up into the abdomen and liver.
• Assessment Findings:
  • Cough.
  • Elevated BNP.
  • Abnormal heart assessment.
  • Neck vein distention.
  • Abnormal breathing sounds.
• Symptoms:
  • Edema
  • Distended jugular vein

Left-Sided Heart Failure

• Symptoms:

  • Pulmonary edema
  • SOB
  • Hacking cough
  • S3

• Effect on Kidneys:
  Renin-angiotensin-aldosterone system activation

Beta Blockers in Heart Failure

• Lowers heart rate and blood pressure.

Stroke

• Hemorrhagic Stroke:

  • Brain bleed due to ruptured blood vessel.
  • Loss of consciousness.
  • Contraindications: TPA, Aspirin, anticoagulants.

• Ischemic Stroke:

  • Blood clot in the brain.
  • Treatment: Anticoagulant, TPA.

DIC (Disseminated Intravascular Coagulation)

• Basic Physiology:

  • Clotting followed by bleeding.

• Early Signs & Symptoms:

  • Petechiae.

Diabetes

Hyperglycemia

Signs and Symptoms

Hypoglycemia

Signs and Symptoms

Insulin Resistance

Contributing Factors and Risk Factors
Most at Risk Population

Gestational Diabetes

Impact on Fetus
Mom with Hyperglycemia = Large Baby
Population at Risk - Asian Indian women
Comorbidities - Mortality Risks

DKA (Diabetic Ketoacidosis)

• Signs and Symptoms
• Priority - intervention in caring for that patient

HHS (Hyperosmolar Hyperglycemic Syndrome)

• Basic Physiology
• Labs
• Signs and Symptoms
• Management
• Interventions
  • Insulin therapy
  • Electrolyte correction

Somogyi and Dawn Phenomenon

• High blood glucose levels in the morning due to different causes.
• Hypoglycemia at night followed by rebound hyperglycemia in the morning.

Intervention

SIADH (Syndrome of Inappropriate Antidiuretic Hormone Secretion)

• Lab Findings
• Impact on Kidneys
• Urine Lab Findings
• Medications to Give / NOT to Give

Diabetes Insipidus

• Signs and Symptoms
• Neurological Side Effect
• Causes
• Pathophysiology
  • Increased cortisol levels.
  • Lacking ADH.
  • Excessive urination.
  • High sodium due to excessive urine.
    Electrolyte Ranges

Thyroid

• Thyroid Function
• Feedback for Thyroid and Pituitary Gland
• Expected Findings (Labs): Low & High
• TSH, T3, T4 Labs
• Disease Association: Hypothyroid vs Hyperthyroid

Grave’s Disease

• Signs and Symptoms
  • Bulging eyes
  • Skinny
  • Hyperthyroid
  • TSH low
  • T4 high

Hashimoto's

• Laboratory Findings
• Hypothyroid vs. Hashimoto’s

Thyroid Storm

• Pathophysiology

  • Going too fast.

• Signs

• Hypothyroid vs. Hyperthyroid

• Medications

Secondary Hypothyroidism

Myxedema

• Associated Condition

Iodine

• Role of Iodine in Thyroid Disease
• Foods to Avoid: Hyperthyroid vs. HYPOthyroid

Cushing’s and Addison’s Disease

• Cortisol Levels Relation
• Role of ACTH
• Signs and Symptoms

Addison’s Disease

• Role of Aldosterone
• Medical Treatment
  Signs and Symptoms

Fibromyalgia

Signs and Symptoms

Migraine

Signs and Symptoms
Photophobia

Tension Headaches

Signs and Symptoms
Migraine vs Tension Headaches

Otitis Media

• Signs and Symptoms

Meniere’s Disease

What is Going on in the Ear, Fluid, What are You Going to see?

*Common Symptoms

Glaucoma

• Vision Loss
  • “Look through a straw”

Macular Degeneration

• Education to Patient
• How does Age-Related Macular Degeneration Affect the Eye?
• Consequences of Untreated Macular Degeneration
• Type of Vision Loss

Retinopathy

• Most Common Retinopathy in Clinical Practice
• Common Cause of Retinal Detachment
• Complications of Retinopathy of Prematurity