2920 Pathophysiology Exam One Flashcards
(170 cards)
1
Q
define genetics
A
study of heredity and inherited characteristics
2
Q
define mutation
A
change or damage to a gene that alters genetic code
3
Q
autosomal dominant genetic disease
A
abnormal allele is dominant and normal allele is recessive
4
Q
what is the recurrence risk of autosomal dominant diseases if one parent is affected? Both parents?
A
50% chance for one parent, 75% chance if both affected
5
Q
are males or females more affected in autosomal dominant disorders?
A
both are affected equally
6
Q
examples of autosomal dominant disorders
A
BRCA gene cancers (breast and ovarian)
Huntington’s disease
familial hypercholesterolemia
marfan syndrome
7
Q
autosomal recessive genetic diseases
A
abnormal allele is recessive, and the person must be homozygous for the disease to be expressed
8
Q
what is the recurrence rate of autosomal dominant diseases if parents are heterozygous? what is the chance of children being a carrier?
A
25% risk of disease recurrence, 50% chance of child being a carrier
9
Q
what are some examples of autosomal recessive disorders?
A
cystic fibrosis
sickle cell disease
tay-sachs disease
PKU
10
Q
who is usually affected by x linked recessive disorders? who is usually a carrier?
A
men are usually affected because they have only one x chromosome, women can be carriers
11
Q
can affected men transmit x linked disorders to their sons?
A
no, because they give only their Y chromosome
12
Q
what are some examples of x linked recessive disorders?
A
duchenne muscular dystrophy
hemophilia
color blindness
wiskott-aldrich syndrome
13
Q
Is familial hypercholesterolemia autosomal dominant or recessive?
A
dominant
14
Q
pathophysiology: familial hypercholesterolemia
A
liver lacks production LDL receptors, so patient has increasingly high levels of LDL
15
Q
clinical manifestations: familial hypercholesterolemia
A
cholesterol exceeding 600 mg/dL
early atherosclerosis
early adult coronary artery disease or MI
16
Q
pathophysiology: marfan syndrome
A
gene mutation that causes connective tissue weakening, which leads to weakening and aneurysms of vascular structures that will eventually rupture
17
Q
clinical manifestations: marfan syndrome
A
tall stature heart murmurs ligament hypermobility syncope dyspnea joint issues
18
Q
what is the most common lethal inherited disease in caucasians?
A
cystic fibrosis
19
Q
pathohysiology: cystic fibrosis
A
dysfunction of gene that regulates chloride channels, leading to salt and chloride exchange issues in epithelial cells
20
Q
clinical manifestations: cystic fibrosis
A
pancreatic enzyme deficiency
thick respiratory mucus and difficulty breathing
everything clogged with thick mucus and severe dehydration in all systems
21
Q
pathophysiology: tay sachs disease
A
genetic mutation causing deficiency of lysozomal enzyme, leading to progressive destruction of neurons
22
Q
clinical manifestations: tay-sachs disease
A
cherry red spots on retina
incoordination and flaccid muscles
cognitive impairment
symptoms often present in early infancy
23
Q
pathophysiology: wilson’s disease
A
genetic disorder of copper metabolism, leading to copper deposits in the body that damage hepatocytes
24
Q
clinical manifestations: wilson disease
A
cirrhosis tremor speaking issues ataxia clumsiness/dystonia seizures
25
pathophysiology: kleinfelter syndrome
extra x or y chromosome, only affects males
26
clinical manifestations: kleinfelter syndrome
less puberty changes (decreased testicle development, gynecomastia)
diabetes and obesity
cognitive impairment
skeletal/heart abnormalities
27
pathophysiology: turner syndrome
complete or partially missing x chromosome in females
28
clinical manifestations: turner syndrome
```
webbed feet and neck
short stature
infertility
amenorrhea
cardiovascular problems
hypothyroidism
```
29
pathophysiology: down syndrome
trisomy of chromosome 21
30
clinical manifestations: down syndrome
```
cognitive impairment
dysmorphic facial features
heart disease
weak immune system
only one hand crease
```
31
pathophysiology: prader-willi syndrome
mutation of chromosome 15 causing hypothalamic dysfunction
32
clinical manifestations: prader willi syndrome
```
obesity and overeating
hypotonia
low IQ
short stature
seizures
hypogonadism
```
33
pathophysiology: huntington disease
adult onset autosomal dominant neurodegenerative disorder causing degeneration of specific neurons at basal ganglia and cortex
34
clinical manifestations: huntington disease
```
movement issues (tremors progressing rapidly to parkinsonian symptoms)
cognitive issues
dementia
depression
rapid progression to death
```
35
pathophysiology: COPD
chronic bronchitis + emphysema causing airflow limitations that lead to narrowing, excessive mucus, and loss of alveolar elasticity
airway permanently remodeled
36
what are manifestations of a COPD exacerbation?
worsening shortness of breath at rest
increased secretions
increased purulence of secretions
37
general manifestations of COPD?
```
dyspnea
barrel chest
cough/wheeze
cyanosis
hypoxia
```
38
risk factors: COPD
```
age
smoking history
being male
asthma
AAT deficiency
bacterial or viral infections
inhalation of chemicals/dust/pollution
```
39
ARDS stands for
acute respiratory distress syndrome
40
pathophysiology: ARDS
alveolar injury triggers inflammation, which makes the capillary membrane more permeable. this increases pulmonary edema and impairs gas exchange. vasculature also narrows causing pulmonary hypertension
41
what is atelectasis?
alveolar collapse
42
what are the first signs of ARDS?
sudden onset dyspnea and being unable to catch breath
43
what are later signs and manifestations of ARDS?
```
sudden progressive pulmonary edema
restlessness
confusion
rapidly dropping O2 sats
hypoxemia and hypercapnia
crackles in lungs
```
44
what is the number one cause of ARDS?
sepsis
45
what are some examples of things that can cause indirect lung injury leading to ARDS?
```
sepsis
drug overdose
massive transfusion
prolonged cardiopulmonary bypass surgery
severe head injury
acute pancreatitis
traumatic injury
```
46
what are some direct lung injury examples that can lead to ARDS?
```
aspiration of gastric contents
pneumonia
air/fat/amniotic fluid emboli
inhalation of toxic substances
near drowning
oxygen toxicity
radiation pneumonitis
```
47
what is the pathophysiology of pre-eclampsia?
unknown, but it is a progressive problem that stems from the placenta
48
what is the first problem that leads to the complications of pre-eclampsia?
inadequate vascular remodeling of the spiral arteries (they fail to widen)
49
what problems occur because the spiral arteries fail to widen in pre-eclampsia?
decreased placental perfusion
| hypoxia
50
what happens to the endothelial cells because of decreased placental perfusion and hypoxia in pre-eclampsia?
they malfunction and release toxic substances
51
what three things occur because of endothelial cell dysfunction in pre-eclampsia?
vasospasm
increased peripheral resistance
increased endothelial cell permeability
52
increased peripheral resistance gives rise to...
hypertension
53
increased endothelial cell permeability leads to..
edema and protein loss
54
vasospasm causes what problems in pre-eclampsia?
headache and visual disturbances
55
what is the end result of the pre-eclampsia disease cascade?
decreased tissue perfusion to all organs
56
what are some primary clinical manifestations of pre-eclampsia?
```
hypertension
headache
blurred vision
edema
increased CNS irritability
```
57
what are the blood pressure criteria for pre-eclampsia diagnosis?
BP greater than or equal to 140/90 on at least two occasions at least four hours apart
58
what will happen to hemoglobin and hematocrit levels in pre-eclampsia?
decreased hemoglobin
| increased hematocrit
59
what happens when pre-eclampsia progresses to eclampsia?
seizures, coma, and death
60
what is the name of the syndrome that occurs in severe pre-eclampsia?
HELLP syndrome
61
what is HELLP syndrome?
hemolysis, elevated liver enzymes, low platelets
62
is HELLP syndrome easily detected?
no, many women are asymptomatic and don't know they have it
63
what are risk factors for developing preeclampsia?
```
first pregnancy
age over 40 or under 19
family history or personal history of preeclampsia
multifetal pregnancy
chronic hypertension
renal disease
diabetes or other vessel disorders
African American
```
64
what are the risks to the unborn infant in preeclampsia cases?
preterm birth
low birth weight infants
poor fetal oxygenation
decreased amniotic fluid
65
what does RSV stand for?
respiratory syncytial virus
66
what is RSV?
a lower respiratory RNA virus that primarily occurs in very young children or elderly people with lung diseases
67
what is the pathophysiology of RSV?
the virus invades the bronchioles and lower respiratory tract, causing airway obstruction, edema, and mucus production
the narrow airways allow air to be inhaled but exhalation is hindered, causing air trapping
68
what do the endothelial cells of the respiratory tract do in RSV?
they fuse together, making swollen giant cells that clog the airway and create a lot of mucus and exudate
69
what are initial manifestations of RSV?
cold-like symptoms
70
what are progressive symptoms of RSV?
retractions
high RR
cyanosis
wheezing and stridor
71
what are severe symptoms of RSV?
fever
listlessness
minimal breath sounds
72
what are some of the main risk factors for RSV?
```
premature infants
infants less than one year old
crowded living conditions
congenital heart disease
immunodeficiency
winter or early springtime
being male
non-breastfed
having a mother who smokes
```
73
pathophysiology of malignant hyperthermia
autosomal dominant trait that causes a reaction to anasthesia.
it is a hypermetabolism of skeletal muscle due to altered control of intracellular calcium
74
what is usually the first sign of malignant hyperthermia?
muscle rigidity
75
what is the treatment for malignant hyperthermia?
dantrolene (a muscle relaxant)
76
what is the pathophysiology and manifestations of anaphylaxis?
extreme allergic immune response causing hypotension, tachycardia, bronchospasm, and pulmonary edema
77
what is the treatment for anaphylaxis?
subcutaneous epinephrine and fluids
| if that isnt working, vasopressors can also be given
78
what are some of the duties of of a preoperative nurse?
```
full patient assessment/interview/history
asking about allergies and meds
vitals and labs
surgery teaching and informed consent
pre-op medications
family history and medical history
pulses in all extremities
color/movement/sensation
```
79
What are some of the roles/duties of the intraoperative nurse?
take report from the pre-op nurse
advocate for the patient in the surgery room
call for pause to make sure everything is correct before beginning
ensure safety and sterility
monitor vitals, blood loss, and intake and output
report off to post-op nurse
80
what are some of the duties of the postoperative nurse?
```
monitor patients and ensure they are stable before moving them out of PACU
monitor ABCs/vitals/LOC
administer meds and manage pain
assess psychological status
discharge planning and education
```
81
before what point is a birth considered premature?
anytime before 37 weeks
82
the majority of preterm birth mortalities occurs in babies born before when?
32 weeks
83
what is considered the age of viability (when a premature infant has a chance at survival)?
24 weeks
84
what are some causes of preterm birth?
```
gestational diabetes
hypertension or preeclampsia
placental disorders
seizures
advanced maternal age
smoking
obesity
```
85
what are some complications of preterm birth?
```
death
immature lungs
oxygen toxicity
apneic spells
aspiration risk
immature GI system
inability to regulate temperature
startle easily
prone to strokes due to weak vessels
```
86
what complications can occur due to immature GI system in premature babies?
bowel obstruction
| holes in bowels
87
how can a nurse stimulate breathing in preterm babies prone to apneic spells?
flick their toes
88
how does the suck/swallow reflex work in preterm babies?
they have a suck reflex but no swallow reflex
89
pathophysiology of respiratory acidosis
decreased ventilation causes accumulation of acidic CO2 in the bloodstream
90
what are some common pulmonary causes of respiratory acidosis?
```
pulmonary obstruction
respiratory depression
pneumonia
asthma/lung disease
underventilation or hypoventilation
CF
COPD
```
91
what are some common non-pulmonary causes of Respiratory acidosis?
overdose of sedatives or narcotics
neuromuscular disorders (GB, MS)
nervous system damage
cardiopulmonary arrest
92
pathophysiology of respiratory alkalosis
usually hyperventilation causes excess CO2 elimination, so less acid than normal is in the bloodstream
93
what are some common pulmonary causes of respiratory alkalosis?
```
pneumonia
overventilation/hyperventilation
pulmonary edema or embolus
lung disease with shortness of breath
asthma
```
94
what are some common non-pulmonary causes of respiratory alkalosis?
```
anxiety
pain
liver disease
fever/infection/sepsis
CNS disorders
alcohol or salicylate intoxication
```
95
what is the pathophysiology/etiology of metabolic acidosis?
increased acid production, decreased acid excretion, or loss of base in the body
96
what are some common causes of increased non-carbonic acid in the body (leading to metabolic acidosis)?
```
DKA
lactic acidosis
alcoholic or uremic acidosis
toxic substance ingestion
shock
renal disease
hypokalemia
hypocalcemia
hypomagnesia
```
97
what are some common causes of bicarbonate loss (leading to metabolic acidosis)?
prolonged diarrhea
renal tubular acidosis
interstitial renal disease
98
what electrolyte imbalance can occur as a result of compensatory mechanisms to correct metabolic acidosis?
hyperkalemia
99
pathophysiology/etiology of metabolic alkalosis
depletion of hydrogen ions, which are usually lost through the kidneys or GI system
100
what electrolyte imbalance can cause metabolic alkalosis, and why?
hypokalemia, due to hydrogen ions shifting into the intracellular space to make up for missing potassium
101
what are some common causes of metabolic alkalosis?
```
bicarbonate ingestion
potassium wasting diuretics
loss of gastric fluid from suctioning or vomiting
cushing syndrome
primary or secondary hyperaldosteronism
```
102
how will you know if an ABG is partially compensated?
all three values will be abnormal
103
how will you know if an ABG is fully compensated?
pH will be normal and the other two values will be abnormal
104
normal PaCO2 levels
35-45
105
normal bicarb levels
22-26
106
normal PaO2
80-100
107
what is acute renal injury
a rapid decrease in renal filtration function
108
what are the four phases of AKI?
initial
oliguric
diuretic
recovery
109
initial phase of AKI
initial insult/injury to kidneys, usually occurs over hours to days
110
oliguric phase of AKI
decreased urine output
decreased GFR
retention of urea, creatinine, and potassium
111
diuretic phase of AKI
beginning of recovery, high urine output put urine is undiluted, so patient still retains waste products
fluid replacement is vital
fibrosis may begin to occur in the kidneys
112
recovery phase of AKI
```
may or may not happen
if it does happen...
urine is appropriately concentrated
inflammation goes down
renal function returns
may take months to a year to fully recover and kidneys may have scar tissue
```
113
what does the RIFLE scale look at as pertains to AKI?
creatinine
urine output
GFR
114
what is a red flag/emergency manifestation of AKI?
encephalopathy (confusion)
115
what are other clinical manifestations of AKI?
oliguria
fluid overload
uremia, causing encephalopathy, anemia, hyperkalemia, metabolic acidosis, thrombocytopenia, and neuromuscular irritability
pulmonary edema
116
what are the three categories of kidney injuries that can cause AKI?
prerenal
intrarenal
postrenal
117
what are some examples of prerenal injuries that can cause AKI?
low BP
shock
hypovolemia
anything decreasing renal perfusion
118
what are some examples of intrarenal injuries that can cause AKI?
kidney damage from nephrotoxic drugs (NSAIDs, antibiotics, radioopaque dyes)
sepsis
infection (glomerulonephritis, pyelonephritis)
119
what are some examples of postrenal injuries/problems that can cause AKI?
obstruction of urine outflow from things like BPH, blader disorders
spinal cord injuries causing issues with bladder emptying
tubule obstruction
120
what is the number one killer in AKI?
infection (sepsis)
121
when might a cancer patient need to be put on neutropenic precautions?
when/if WBC levels get too low
122
what is superior vena cava syndrome?
cancer emergency in which the SVC is obstructed by tumor or thrombosis
123
clinical manifestations of superior vena cava syndrome
facial/periorbital edema
headache
seizures
distended neck veins
124
what is spinal cord compression?
cancer emergency in which cancer is present in the epidural space of the spinal cord, compressing it
125
clinical manifestations: spinal cord compression
```
intense localized back pain
vertebral tenderness
motor weakness
autonomic loss
sudden immobility
```
126
what is third space syndrome?
cancer emergency in which fluid shifts from the vascular space to the interstitial space. usually happens after surgery, septic shock, or immunotherapy
127
why does third space syndrome not go away in cancer patients?
because their cells are weak/unhealthy, and unable to mobilize the fluid back into the vascular space and out of the body
128
clinical manifestations: third space syndrome
signs of hypovolemia: hypotension, tachycardia, decreased urine output
edema
129
what is SIADH?
syndrome of inappropriate antidiuretic hormone, a cancer emergency in which chemo or cancer cells cause the production of excess ADH, leading to fluid retention
130
clinical manifestations: SIADH
```
water retention
hypotonic hypernatremia
weight gain
weakness
anorexia/N/V
seizures
personality changes
decreased reflexes
coma
```
131
what is tumor lysis syndrome?
cancer emergency that usually occurs shortly after first chemo treatment if its going to occur. its a rapid release of intracellular contents (potassium, phosphorus, urea) into the body
132
clinical manifestations: tumor lysis syndrome
```
hyperuricemia
hyperphosphatemia
hyperkalemia
hypocalcemia
weakness
cramps
diarrhea
nausea/vomiting
```
133
what is cardiac tamponade?
cancer accumulation in which fluid accumulates in the pericardium. pericardium is typically constricted by tumor or pericarditis secondary to radation
134
clinical manifestations: cardiac tamponade
```
distant/muted heart sounds (may sound like listening through a well)
heavy feeling chest
SOB
cough
tachycardia
dysphagia
hoarseness
N/V
sweating
decreased LOC
anxiety
```
135
what is carotid artery rupture?
cancer emergency usually caused by radiation to the head or neck in which the arterial wall is invaded by a tumor or eroded by surgery/radiation
136
manifestations of carotid artery rupture
bleeding, ranging from mild oozing to spurting blood explosion from carotid artery
137
in heart failure, what four problems in the body can lead to decreased cardiac output?
volume overload
pressure overload
myocardial disease
rapid heart rate
138
what two specific problems will result from poor cardiac output?
decreased renal perfusion
| increased autonomic nervous system stimulation
139
decreased renal perfusion will trigger the activation of what?
RAAS (renin-angiotensin-aldosterone system)
140
what does the RAAS do?
causes everything to constrict and increases sodium and water retention
141
what is the end result of the RAAS?
increased blood volume
142
what will result in the body because of increased autonomic nervous system stimulation?
```
vasoconstriction
increased systemic vascular resistance
pallor
sweating
tachypnea
tachycardia
```
143
what is the end result in the heart when the RAAS and the autonomic nervous system are activated?
increased diastolic pressures in the left and right ventricles, which in turn increases pressure in the atriums
144
what symptoms arise from increased right atrium pressure?
elevated jugular venous pressure
hepatomegaly
interstitial edema
poor GI absorption
145
what symptoms arise from increased left atrium pressure?
pulmonary edema and associated pulmonary symptoms
146
what formula/calculation determines the degree of heart failure?
ejection fraction
147
what is ejection fraction?
a measurement of the percent of blood leaving the left ventricle every time it contracts
148
what are some signs and symptoms of left sided heart failure?
```
paroxysmal nocturnal dyspnea
restlessness
confusion
orthopnea
tachycardia
pulmonary congestion
fatigue
cyanosis
```
149
what specific signs and symptoms indicate pulmonary congestion?
```
cough
crackles
wheezes
blood tinged sputum
tachypnea
```
150
what is the most common cause of right sided heart failure?
left sided heart failure
151
what are some signs and symptoms of right sided heart failure?
```
fatigue
increased peripheral venous pressure
ascites
enlarged liver and spleen
distended jugular veins
anorexia and GI distress
weight gain
dependent edema
```
152
what are some things that can cause cardiac arrhythmias?
drugs, alcohol, caffeine, infection, shock, stress
153
what are some labs and diagnostics that need to be monitored related to cardiac conduction and function?
```
ECG
BNP
CKP-MB
cardiac troponin
magnesium/calcium/potassium
```
154
what is a PVC?
premature ventricular contraction: the ventricle beats independently without waiting to sequential conduction of other nodes
155
how does one calculate heart rate on an ECG?
take 300 and divide it by the number of large boxes between QRS complexes
156
describe v-tach and necessary interventions
wide and bizarre QRS complexes because just the ventricle action is seen.
shock, CPR, and epinephrine are needed
157
describe v-fib and necessary interventions
just random waves with no pattern, very serious problem. needs shock, CPR, and epi
158
describe supraventricular tachycardia and necessary interventions
very fast HR (up to 200 BPM). may be transient and require no intervention, or may need adenosine and a shock
159
describe sinus bradycardia and necessary interventions
normal heart pattern at a very slow rate. give atropine and use artificial pacing if no response can be obtained
160
what should be done for a patient in asystole?
CPR, oxygen, IV fluids, intubation, anything to get them back
161
what should be done immediately for clients with chest pain? (think MONA)
morphine
oxygen
nitroglycerin
asprin
162
what is the most common cause of acute MI?
atherosclerosis
163
pathophysiology of MI
blockage of coronary artery/arteries causes prolonged ischemia of cardiac tissue, which causes necrosis and irreversible cell damage if not treated immediately
164
STEMI
ST elevation (on EKG) MI. this is a more serious MI as the ischemia goes all the way to the endocardial wall
165
NSTEMI
non-ST elevation MI. ischemia hasn't progressed as far and there is more time for interventions
166
what are manifestations of MI?
```
chest pain and pressure
initial HTN, then hypotension
elevated LDL
diaphoresis
dyspnea
extreme anxiety
pallor
radiating pain and pressure (to shoulder, arm, jaw, or back)
fatigue
weak pulses
```
167
what is the gold standard lab test when looking for MI?
troponin
168
what does troponin measure?
how many cardiac cells have died. drawn repeatedly to look for bell curve of cell death
169
what lab test will help determine if someone is headed for heart failure?
BNP
170
what are risk factors for MI?
```
atherosclerosis
angina pectoris
diabetes
elevated LDL
smoking and tobacco use
family history
being male or being a post-menopausal woman
```
