Patho Final Study Guide

Question 1

Right sided heart failure

Answer 1

leads to dependent edema, enlarged organs (liver or spleen), decreased appetite, or ascites.
Dependent edema: whatever part of the body is lowest. If lying flat could be peripheral edema. Is standing up could be peripheral lower extremity edema

Question 2

Left sided heart failure

Answer 2

leads to pulmonary edema, dyspnea, orthopnea, paroxysmal nocturnal dyspnea, fatigue, weakness, restlessness, anxiety, bronchospasms, or wheezing.

Question 3

Advanced heart failure

Answer 3

may lead to Cheyne-Stokes respiration, sleep apnea, blood clot formation due to sluggish blood flow, depression, and/or declining mental function

Question 4

Physical Exam of HF

Answer 4

crackles, wheezes, presence of S3 and S4, cyanosis, jugular venous distention, weight gain, edema

Question 5

Serum analysis for people with HF?

Answer 5

CBC to look for anemia or infection as possible causes
Urinalysis for proteinuria which is associated with CV disease
Electrolytes for fluid retention or renal dysfunction
BUN/Creatinine for possible reduction in renal blood flow, look at them together, not just one or the other
Fasting blood sugar: elevated levels increase risk of heart failure
Liver function tests to evaluate liver function
Natriuretic peptide (B-type) increases in heart failure and are closely associated with NYHA classifications IMPORTANT TO KNOW: (normal values are less than 100 pg/mL)

Question 6

Pharmacologic Meds for heart failure

Answer 6

may include any single or combination therapy of the following classification of drugs:
ACE inhibitors: interrupt conversion of angiotensin 1 to angiotensin 2, decreasing cardiac work and increasing cardiac output improving blood flow
Angiotensin 2-receptor blockers: block the action of angiotensin 2 with similar effects
Beta-blockers: block the beta receptors inhibiting the sympathetic nervous system slowing heart rate and lowering blood pressure. These may also reduce the force of contraction causing more problems, but when used with ACE inhibitors may improve outcomes.
Diuretics: relieve symptoms of fluid overload
Vasodilators: relax the smooth muscle of the vessels, reduce afterload, and reduce the work of the heart
Digitalis preparations: positive inotropic effect improving contractility, slows conduction and increases fill time of the ventricles.
Oxygen therapy: to promote adequate oxygenation.
It is important to note that treating and managing co-morbidities is also important in managing heart failure.

Question 7

Oliguria

Answer 7

Oliguria is when urine output is lower than expected.

Question 8

anuria

Answer 8

absent urine

Question 9

syncope

Answer 9

fainting

Question 10

phlebitis

Answer 10

pain, redness along the vein, discontinue IV, apply a warm compress

Question 11

Atrial fibrillation, or AFib

Answer 11

occurs when many unstable electrical impulses misfire and may result in the atria quivering out of control.

Question 12

Ventricular fibrillation:

Answer 12

can stop the heart from beating and cause cardiac arrest. It occurs in the ventricles, which are unable to pump blood out of your heart to the body and brain due to the irregular heartbeat.

Question 13

beta 2 agaonis is for acute asthma attack and they all end In

Answer 13

-erol

Question 14

what would we give with someone with hyperkalemia

Answer 14

kayexalate

• insulin
• sodium bicarbonate
• calcium gluconate

Question 15

hypernatremia

Answer 15

too much sodium

Question 16

What does the RAAS system do?

Answer 16

rennin and angiotensoin response to BP and causes vasoconstriction
-aldosterone hold onto sodium or water

Question 17

treatment for hyponatremia

Answer 17

LR

or normal saline if they are NPR

Question 18

Hypocalcemia

Answer 18

this the chvostek’s and trusseas

• tingling of the mouth is common
• risk of bleeding and fractures
• cardiac dysrhythmias

Question 19

Hypercalcemia

Answer 19

"moans grons and stones"
Administer biphosphonates 
- bone pain
-severe muscle weakness
-Decreased DTR 
-kidneys stones

Question 20

calcium role

Answer 20

adds strenth to bones and teeth
cofactor in blood clotting
and essential ni muscle contraction

Question 21

Ataxia

Answer 21

isa degenerative disease of the nervous system. Many symptoms of Ataxia mimic those of being drunk, such as slurred speech, stumbling, falling, and incoordination. These symptoms are caused by damage to the cerebellum, the part of the brain that is responsible for coordinating movement.

Question 22

Aphasia

Answer 22

loss of ability to understand or express speech, caused by brain damage.

Question 23

Dysphagia

Answer 23

swallowing difficulties. Some people with dysphagia have problems swallowing certain foods or liquids, while others can’t swallow at all. Other signs of dysphagia include: coughing or choking when eating or drinking. bringing food back up, sometimes through the nose.

Question 24

Dysarthria

Answer 24

a motor speech disorder inwhich the muscles that are used to produce speech are damaged, paralyzed, or weakened. The person with dysarthria cannot control their tongue or voice box and may slur words.

Question 25

What can we do to prevent stroke?

Answer 25

Antiplatelet agent- prevents the formation of new clots usually warfin Management of hypertension - taking thiazide diuretic, calcium channel blocker and ACE or ARBS - controlling cholesterol -statins

Question 26

Diabetes: risk factors?

Answer 26

Diabetes: risk factor, complications risk factors Family History of diabetes (parents, siblings) Obesity African Americans, Hispanics Americans, Native Americans, Asian American, Pacific Islanders (Type 2, Type 1 whites are more likely) 45 years or older Previously identified impaired fasting glucose or impaired glucose tolerance Hypertension High cholesterol and/or triglycines History of gestational diabetes of baby over 9 pounds

Question 27

Diabetes complications

Answer 27

DKA (Diabetic Ketoacidosis) Will have: Hyperglycemia: will lead to dehydration and loss of electrolytes Ketosis: rapid breakdown of your energy stores from your muscles and your fat deposits d/t lack of insulin. (Liver converts amino acids to glucose and converts fatty acids to ketones) Metabolic acidosis: excess of keto acids that have bicarb ion. Bicarb is going to these ketones and there’s a decrease in serum bicarbs. If you have decrease in serum bicarb, you’re putting your body into metabolic acidosis. ``` Definitive Diagnosis BG levels >250 mg/dL Low serum bicarbonate Low atrial pH Positive urine and serum ketones ``` ``` Symptoms Polyuria, polydipsia, polyphagia Nausea, vomiting, fatigue Stupor that can progress to a coma Fruity smelling breath (rotting fruit) Hypotension and tachycardia ```

Question 28

DKA vs. HHS (Hyperglycemic Hyperosmolar state)

Answer 28

DKA: Lower blood glucose levels and Ketoacidosis HHS: No ketoacidosis (because there’s still insulin being made)

Question 29

hyperglycemia in the AM

Answer 29

Dawn phenomenon Rise in blood glucose between 5am-9am Not sure the exact reason. Maybe because at night there’s an increase in growth hormone and metabolism. That naturally causes increase in blood glucose. When they wake up, they have hyperglycemia Somogyi effect Happens d/t rebound hypoglycemia If they have nighttime insulin or diabetes med and don’t have a snack. *Very important for someone with diabetes to have a snack before bed Will have hypoglycemia in middle of the night. Body tries to compensate and increases blood glucose and causes hyperglycemia. To figure out if patient has Dawn phenomenon or Somogyi effect, check blood sugar in middle of night. Dawn = normal blood glucose Somogyi = hypoglycemia

Question 30

To figure out if the patient has Dawn phenomenon or Somogyi effect

Answer 30

check blood sugar in middle of night. Dawn = normal blood glucose Somogyi = hypoglycemia Both will have hyperglycemia in the AM

Question 31

HTN- # stages

Answer 31

``` , American College of Cardiology Normal BP <120/80 Elevated BP 120-129/<80 Stage 1 hypertension 130-139/80-89 Stage 2 hypertension ≥140/≥90 Hypertensive Crisis >180/>120 ```

Question 32

HTN- prevention

Answer 32

Controlling weight Structured physical activity Low sodium diet with** potassium supplementation within the diet, more vegetables, fruits and grains***** Alcohol consumption should be no more than 2 drinks per day men and 1 drink per day for women

Question 33

hypotension

Answer 33

isotonic fluids

Question 34

COPD is a

Answer 34

combination of disorders and may be used as a catch all diagnosis for those with either chronic bronchitis or emphysema

Question 35

incentive spirometer

Answer 35

what I used after surgery | - used to exercise lungs get ball to certain point

Question 36

spritgtromy

Answer 36

inhale and exhale

Question 37

Emphysema

Answer 37

air trapping 
(decreased airflow with expiration)
large alveolar sacs and the bronchial inflammation and mucus and bronchial tubes, they're not able to get air through

Question 38

chronic bronchitis

Answer 38

inflammation of the mucous membranes of the Bronchial tubes that's longer than 3 months

Question 39

risk factors of COPD

Answer 39

risk factors Smoking (most common) Occupational irritants: people working in dry cleaning with toxic chemicals, work in mines, construction workers, oil field/rig workers, agriculture, chemicals with lawn care, people that live next to farms  history of asthma

Question 40

non-cardiac conditions that cause heart failure

Answer 40

``` CAD Chemo valve disorders hyper hypothyroidism Fever infection massive PE lung disease ```

Question 41

COPD stages

Answer 41

COPD Manifestations: Mild COPD or stage 1 FEV1 about 80% or more of normal slight limitations to activity COPD Manifestations: Moderate COPD or Stage 2 FEV1 between 50 and 80% of normal Increased coughing and breathing difficulty COPD Manifestations: Severe COPD or Stage 3 Severe emphysema with a FEV1 between 30 and 50% of normal COPD Manifestations: Very severe COPD or Stage 4 or end stage COPD with a lower FEV1 than stage 3 or people with blood oxygen levels and a stage FEV1 Profound changes to quality of life

Question 42

Emphysema symptoms

Answer 42

``` Dyspnea: first symptom Minimal cough Air trapping and hyperinflation cause barrel chest Thin Tachypneic Pursed lip breathing "barrel chest" ```

Question 43

Treatment of COPD

Answer 43

medications used and their purpose Vaccinations to prevent infection (flu and pneumonia) COVID may be added to this Supplemental oxygen supplement what's not going in or to compensate for some of that mismatch that may be going on Target is 80 to 92% depending on age of the person and severity of disease most people will be at 90-92% unless it’s a severe disease or they are getting older. Might go as low as 88% Healthy people are usually around 98-100% Targeting is 2 liters per minute of oxygen if they require supplemental oxygen, could go as high as 4, but generally its 2 Percussion. Vibration and postural drainage Will help mobilize those secretions to help them expel and expiate those so they don’t develop pneumonia and further worsening of their condition

Question 44

Complications of CKD

Answer 44

``` SOB gastric ulcers dialysis metallic taste -air embolism ```

Question 45

Asthma- s/s early SIGNS ,

Answer 45

Chronic lung disease that causes narrowing of the airways (Bronchi and Bronchioles) They are chronically inflamed shortness of breath (easily fatigued with physical activity) frequent cough (night) and issues sleeping s/s similar to cold, sneezing, scratchy throat, tired irritable wheezing with activity if using a peak flow meter, reading is reduced

Question 46

what part of the brain regulates emotions

Answer 46

lymbic

Question 47

axomtomia means increased BUN

Answer 47

true

Question 48

Arterial ulcers develop as the result of damage to the arteries due to a lack of blood flow to the tissue.

Answer 48

``` S/S red, yellow, or black sores. deep wound. tight, hairless skin. leg pain at night. no bleeding. the affected area is cool or cold to touch from minimal blood circulation. leg reddens when dangled and turns pale when elevated. ```

Question 49

 Venous ulcers develop from damage to the veins caused by an insufficient return of blood back to the heart. Unlike other ulcers, these leg wounds can take months to heal, if they heal at all

Answer 49

S/S Shallow sore with a red base, sometimes covered by yellow tissue. Unevenly shaped borders. Surrounding skin may be shiny, tight, warm or hot, and discolored. Leg pain. If the sore becomes infected, it may have a bad odor and pus may drain from the wound. Comfort