Final Exam Study Guide Cells Atrophy- Decrease in cell size- reduced tissue mass-result of insufficient blood flow-reversible. Hypertrophy- increase in cell size- enlarged tissue mass- because of increased workload- weight lifter. Hyperplasia- increased number of cells- enlarged tissue mass- breast tissue at puberty. Metaplasia-mature cell is replaced by a different mature cell type that can better endure the stress or change. Dysplasia-cells vary in size, shape, and appearance- dysplasia on a pap smear. Anaplasia- undifferentiated cells with variable nuclear and cell structures. -used to measure aggressiveness or a tumor- seen in most malignant tumors Neoplasia-new growth- known as a tumor. Benign vs malignant (aggressive growing masses of cancer) Aptosis- Programmed Cell death- Red Blood cells live for 120 days. Necrosis- Death of one or more cells, tissue, or organs due to oxygen deprivation Ischemia- Decreased oxygen in the cells Hypoxia- reduced oxygen in tissues Fluid Electrolytes Potassium – 3.5-5 – Main electrolyte in electrical function of the heart Hypokalemia- Decreased K+ concentration in the blood Caused by- Vomiting, prolonged diarrhea (significant loss of potassium), NGT suction, diuretics, Signs-anorexia, muscle weakness, decreased DTR’s, ventricular dysrhythmia, shallow respirations, postural hypotension, Serum PH Elevates causing Alkalosis. Hyperkalemia-Increased K+ concentration in the blood Caused by- Renal Failure, Severe infection, burns, crush injury/trauma. Signs- Peak t waves, wide QRS complex, v fib, cardiac arrest, nausea, diarrhea, muscle twitching, parathesis, Serum PH decreases causing acidosis Calcium- 8.5-10.5 total calcium 4.5-5.6 Ionized calcium Calcium controls the muscles. Hypocalcemia-decreased Ca2+ in the blood Caused by- Hypoparathyroidism, renal failure, thyroidectomy, Vit D deficiency, pancreatitis. Signs- hyperactive reflexes, Trousseau’s sign, Chvostek’s sign, seizures paresthesia, confusion/irritability, tetany Hypercalcemia-Increased Ca2+ in the blood Caused by- Hypoparathyroidism, malignant cancers, overuse of calcium antacids (tums) prolonged immobilization. Signs- lack of coordination, anorexia, nausea, confusion, decreased neuro excitability, cardiac issues, heart block. Sodium-135-145 Sodium Controls Neuro Hyponatremia- Decreased Na+ in the blood Caused by- vomiting, excessive water intake, burns, diuretics, SIADH Signs- confusion, muscle cramps, headaches, seizures Hypernatremia- To much Na+ in the blood Caused by- Diabetes insipidus, Alka-Seltzer over use, inadequate water intake Signs- dehydration, tachy, weak thready pulse, agitation, decreased reflexes, disoriented. Causes of Edema Increased capillary hydrostatic pressure- Caused increased volume- force causes increase in fluid out of capillaries into tissues-( pulmonary edema, heart failure, renal failure) Loss of plasma proteins- mostly decreased albumin which then causes decreased plasma osmotic pressure. Obstruction of lymphatic system- Excessive fluid is not returned and in normal circulationCaused by a blockage or enlarged lymph nodes. Increased capillary permeability- localized edema- caused by infection, burns. Is an inflammatory response. Net hydrostatic pressure- based on the difference between the hydrostatic pressure within the capillary compared to the pressure of the interstitial fluid as well as the relative osmotic pressure within the blood and interstitial fluid. Fluid Volume Deficit- Dehydration- hypovolemia Decrease in body fluids. Caused by- Vomiting diarrhea, sweating, fever, heat stroke, thyroid crisis, severe burns. Serious dehydration seen in infants and elderly- lack reserve and lack ability to conserve quickly. Signs- dry mucus membranes, dry skin, low blood pressure, weak pulse, tachy, lethargy and weakness Hypovolemic Shock- hemorrhaging out- loss of whole blood cells. Asthma Asthma is a chronic inflammatory disorder in the pathways of the lungs. Bronchi and Bronchiole. It comes and goes with flares known as asthma attacks that are reversible. Previous exposure memory and IGE Inflammation causes the airway to swell and produce mucus and so that inflammation makes the airways more sensitive to certain asthma attacks. Extrinsic Asthma- Occurs with type I hypersensitivity- Acute episodesIntrinsic Asthma- adult onset-hyperresponsive airway initiates attacks- attack stimuliRespiratory infections-stress-cold exposure-inhalation of irritants-exercise-drugs. Inflammation Type 1- (Immediate hypersensitive reaction) Allergies, atopic dermatitis, anaphylaxis. IGE, Asthma Type 2- (Antibody-mediated immune reaction) Cytotoxic- blood transfusion Anti -A or Anti-B antibodies will destroy A, B, IgG Type 3- (Immune complex reactions) Immune complex- Inflammation and tissue destructionautoimmune disorders- Lupus, RA, Hashimoto’s. Type 4- (Cell mediated/ Delayed hypersensitivity) TB skin test, transplant rejection. Skin Changes Atopic Dermatitis- Excezma- allergies Contact Dermatitis- pruritic rash based on contact with irritants. Psoriasis-Inflammatory skin disorder Dry silvery scales. Impetigo- highly contagious staph in children Sometimes adults Herpes simplex- cold sores- genital herpes Fungal Infection Tinea pedis- athletes foot Tinea Capitis- Scalp Tinea Corpus- Rest of body- Ringworm Tinea Unguium- Infection of the nail Basal Cell Carcinoma- Most common type Of skin cancer. Grows Slow Squamous Cell Carcinoma- Painless malignant Epidermis Good prognosis when lesion is removed Malignant Melanoma- Highly metastatic skin cancer mole that changes A- Changes in appearance and is asymmetrical B- Change in border C- Change in Color D- Increase in Diameter E- Evolution Respiratory Disease Respiratory alkalosis- panic attack- loss of carbon dioxide- Hyperventilating Respiratory acidosis is the retention of carbon dioxide- Hypersleep apnea, CNS depressants, head truma, COPD, Asthma, Pneumonia causes mental status changes. Hypercapnia- Increased carbon dioxide levels in the blood. Causes respiratory acidosis- nervous system depression Older adults have impaired ciliary action- sense of smell will be decreased. Circulatory and Blood Disorders Shock- Decreased perfusion, vasoconstriction. Can cause skin to appear pale, ashen Iron Deficiency Anemia- Decreased hemoglobin production- Spoon shaped nail- tired-Blood loss- Check hemoglobin level. Pernicious Anemia- Deficient of intrinsic factor B12 Aplastic Anemia- Red bone marrow failure Sickle Cell Anemia- Cells are sickle shaped causing infarctions and pain. Genetic Hematocrit- measuring the blood that reflects the percent of erythrocytes present in the plasma. Inadequate absorption of phosphorus is associated with Vit D deficiency. CML-Stem Cell - Adults age 30-50- Chronic AML- Stem Cell- Acute CLL- Chronic -B lymphocyte ALL- Acute- Children-B lymphocyte Ecchymosis-Large purplish areas on the skin from bleeding. Hematuria- Blood in the urine Hemoptysis- Coughing up blood Petechia- pinpoint or flat red spots on skin a mucus membraned bleeding of a capillary or small arterial. Congestive Heart Failure Left sided CHF- caused by infarction of left ventricle, aortic valve stenosis, hypertension, hyperthyroidism- Causes- Decreased cardiac output and pulmonary congestion- signs weight gain, peripheral edema, JVD, acitis, fatigue, weakness, exercise intolerance, cold intolerance. Right Sided CHF- caused by a weak heart from Infarction of right ventricle, pulmonary valve stenosis, pulmonary disease- causes decreased cardiac output, systemic congestion, edema of legs and abdomen, fatigue, weakness and cold and exercise intolerance, orthopnea. Coronary Artery Disease Collect data like elevated serum cholesterol, elevated blood pressure, blood glucose levels above 100. Cigarette smoking. Daily activity level, obesity, length of any hormone replacement therapy. Cardiac Arrest is cessation of all cardiac activity and function. NO ventricular contractions. No cardiac output and no circulating blood volume. Cardiac output- the amount of blood pumped by each ventricle in 1 minute. Stable Angina Pectoris- often relieved with rest or administration of vasodilator like nitroglycerin. Valvular defects- failure of valve to close completely allowing blood to regurgitate or leak backwards. Hypertension- tired or fatigued. Over long-time increased blood pressure causes damage to the arterial walls and they become hard and thick. Causing a narrowing of the lumen. Blood supply is reduced and then leads to ischemia and necrosis and then loss of function. Most frequent damaged areas are brain, kidneys, and retina. Peripheral Vascular disease- abnormalities in the arteries and veins outside of the heart that prolong vasoconstriction- poor pedal pulses, paresthesia, intermittent claudication, fatigue or weakness of the leg, feeling of heavy in the leg or foot, poorly perfused areas, cyanotic when elevated. Vasoconstriction-a stimulation of the sympathetic nervous system that is a stress response. Results in elevated heart rate, blood pressure and increased respiratory rate and reduces the flow of oxygen and blood flow to GUT. Digestive Disorders Peptic ulcers- gastric and duodenal- epigastric burning or aching 2-3 hours after meals at night. Relieved by ingestion of food or antacids. Occult blood in stool or IDA are diagnostic indicators. – Can cause hemorrhage rupture or obstruction. Stress ulcers- cause by trauma, head injury, hemorrhage or sepsis. Colorectal cancer screening- 55+ with family history of colorectal cancer. Inflammatory Bowel Diseases Crohn’s Disease- located in the terminal ileum and sometimes the colon- lesions on all layers. Called skip lesions, loose semi formed stools, fistulas and abscesses are common complications. Causes pain, malabsorption, and malnutrition. Ulcerative Colitis- located in the colon and rectum- lesions on mucosa and are diffuse- frequent watery stools with blood and mucus Visceral pain Burning sensation-inflammation and ulceration of upper digestive tract Dull Aching pain- stretching of liver capsule. Cramping or diffuse pain- inflammation, distention, stretching of intestines Colicky severe pain- recurrent smooth muscle contractions or spasms. Severe inflammation or an obstruction. Urinary Disorders Incontinence Stress- pressure or stress causes urine to spill out- coughing, laughing, sneezing, running, jumping. Urge- sudden urge to urinate- neurogenic bladder. Overflow- leads to dribbling urine- incomplete emptying. Functional- Cognitive dysfunction- forgets to go Urinalysys- can show large amounts of protein, blood, bacteria, pus Dark color can be blood, too much bilirubin or a sign of dehydration Odor can signal infection. Acute Renal Failure- caused by- sever shock, burns, nephrotoxins, acute bilateral kidney infection. Onset is sudden and acute. Signs are oliguria and increased serum urea. Chronic Renal Failure- Caused by Diabeties, longterm nephrotoxin exposure, chronic bilateral kidney infection or polycystic kidney disease. Onset is slow- signs are plyurea with diluted urineanemia, fatigue, hypertension. Liver and Pancreas Disorders Liver- breaks down and builds up many biological molecules, stores vitamins and iron. Destroys old blood cells and produces bile to aid in digestion. Pancreatitis- Lipase and amylase for diagnosis Ascites and esophageal varices for Cirrhosis complications Bone and Joint Disorders Bone Disorders Osteoporosis- Decrease in mass and density of the matrix. Mostly in Vertebrae and femoral neck. Bone reabsorption exceeds bone formation. Causing thin fragile fractures. Both men and women though woman are more at risk Causes kyphosis and scoliosis. Calcium and Vit D deficiency take both and fluoride to help Rheumatoid Arthritis- Auto immune-Caused by antibodies against IGG- causes inflammation, joint swelling, and stiffness. Gout- uric acid deposits- genetic- causes inflammation and pain. Types of Fractures Pain Referred pain- Paint that is far from the source of the problem. Cardiac- Shoulder and arm. Gallbladder shoulder. Phantom pain- pain in an area that is no longer there- lost R leg and still have pain like it’s there. Acute pain- Sudden onset sever and has a physical and emotional response. Chronic pain- insidious- becomes part of everyday life. ADLs are affected. Neurological Disorders Ischemic stroke- Clot- caused by- Athrosclerosis in cerebral artery Hemorrhagic stroke- bleeding in the brain- cased by arteriosclerosis and hypertension Meningitis- Caused by infection, head trauma, and Lupus- Bacterial meningitis is most contagious- viral is most common and most tested. Lumbar puncture is the test Signs are headache, stiff ridged neck, high temp, photophobia, altered LOC, bulging fontanelle of a baby, Kernig sign and Brudzinski sign. Spinal cord injuries Paraplegia- waist down Quadriplegia shoulders down. (depends on where the injury is) Substance Abuse Overdose- to much of a substance that can cause significant damage Narcan For narcotic overdose Flumazenil for Benzodiazepines Withdrawal- Physical dependence Irritability, tremors, nausea, vomiting, stomach cramps, High BP, psychotic episodes ( they are very sick) Treatments Heroine-methadone Alcohol deterrent- disulfiram Vitamin Replacement Endocrine Disorders Adrenal- Cortisol Hypo Addison’s Disease Signs- Low Blood sugar, poor stress response, fatigue, weight loss, infection, low Na+, hypotension, hyperpigmentation, Hyperkalemia Treat- replacement therapy Hyper Cushing’s Disease Signs- High blood sugar, fragile skin, round puffy face, obesity in the abdomen and trunk, hypertension, unusual hair growth Pancreas- Insulin Hypo Diabetes type 1- Autoimmune in childhood. Some adults can develop. Low beta cells so body does not produce insulin Signs- Polyuria, Polydipsia, polyphagia, High blood sugar, glucosuria. Treatment- Diet and exercise and Sub Q insulin Complications- DKA- Diabetic Keto Acidosis- Caused by infection-Very high blood sugar, ketones in urine, metabolic acidosis, dehydration, low urine output, kussmals respirations, lethargy. Hyper Diabetes type 2- Happens to order adults- obesity, sedentary lifestyle, and diet- Insulin resistance due to few insulin receptors working. Signs- Polyuria, Polydipsia, polyphagia, High blood sugar, glucosuria Treatment- oral meds, exercise, diet (In the hospital insulin) Complications- HHS- hyperosmolar hyperglycemic state- caused by infection and taking into many carbs-blood sugars over 600, no ketones, speech issues, lethargy, dehydrated, Pituitary- ADH Hypo Diabetes insipidus- Caused by head injury or damage to the brain Signs- high urine output, diluted urine, polyuria, no glucose in urine, polydipsia, decreased blood pressure, Treatment- Vasopressin -ADH Hyper SIADH- Syndrome of inappropriate Anti Diuretic Hormone- Caused by- small cell lung cancer, severe brain trauma, sepsis infection of the brain like meningitis. Signs- Low Na+, decreased LOC, confusion, weight gain, low urine output, edema, seizures, hypoosmolality Treatment- decrease fluid level with diuretics and Na+ Thyroid- T3 T4 Hypo- Low and Slow 1st – Low T4 Low T3 High TSH 2nd – Low T3 Low T4 Low TSH Low Iodine Hashimoto’s- Autoimmune disease Signs- Low metabolism, weight gain, cold intolerance, lethargy, slow brain, hair loss, dry skin Treatment- replacement therapy- levothyroxine Complications- Myxedema Coma- low RR causing respiratory failure, non-pitting facial edema, hypothermic, hypoglycemia, hypotensive Hyper- Graves’ Disease 1st - High T3 High T4 Low TSH 2nd – High T3 High T4 High TSH Hyperplasia- To many thyroid cells- Women over 30 and causes exophthalmos- Bulging eyes Signs- Goiter, High BP, Weight loss, High HR, increased appetite, jittery, heat intolerance, (Sympathetic nervous system overdrive) Treatment- Radioactive iodine, removal of thyroid, anti- thyroid meds. (these will kill thyroid so thyroid replacement will then be needed.) Complications- Thyroid Storm- Thyrotoxicosis- hyperthermia, CHF, Tachy, delirium, hypertension crisis.
