patho 1,2

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enyldoow
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132546
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patho 1,2
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2012-02-04 20:56:47
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Patho
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Exam 1
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  1. Example of an acute wound
    a paper cut that closes in a few days
  2. example of a chronic wound
    restoration process in interrupted , venous stasis ulcers, diabetic foot ulcers, pressure ulcers.
  3. What are the three phases of wound healing
    • inflammatory
    • proliferative
    • remodeling
  4. when is the inflammatory phase initiated
    after injury and last 2-6days. it is needed for wound healing to occur.
  5. examples of cellular atrophy
    Cell shrinkage, cast, menopause, denervation
  6. what is hypertrophy
    the cell enlarges.
  7. what is metaplasia
    Cell changes type. I.e Ger. response is compensatory
  8. Dysplasia
    Abnormal cells. Cervical dysplasia leading to cervical cancer. potentially reversible
  9. What initiates the wound healing process
    Cytokines
  10. What are the cardinal signs of inflammation
    Redness, heat, swelling, loss of function, pain, purulent exudate
  11. What is the cellular phase of inflammation
    when neutrophils and monocytes move from circulation to the site of injury.
  12. In what phase is collagen being layed down in the wound healing process
    proliferative phase
  13. who is at risk for wound dehiscense
    Obese patients.
  14. What is contamination
    Organisms are present
  15. what is colonization
    organisms are multiplying and competing for nutrients and oxygen but have not yet invaded into tissues.
  16. what is infection
    invasion into tissue to the extent the wound will not heal, a severe infection may make the host sick
  17. Second phase of wound healing
    proliferative phase last 3 to 21 days after inuury. Collagen is laid down to strengthen wound. Caps grow accross the wound increaing blood supply. This is where granulation tissue is seen. it is translucent
  18. final phase of wound healing
    Remodeling phase- begins about day 21 and lasts up to 2 years. collagen fibers are now the dominant features. scar is seen.
  19. explain primary intention
    characterized by prompt wound closure. surgical scar or clean laceration are examples. results in very little granulation tissue, minimal scarring and contracture
  20. Keloid
    a hypertrophic scar that is due to an excessive amount of collage
  21. Remodeling
    change that occurs in scar
  22. What is contact inhibition
    When basal cells migrate across a wound and stopping when they come in contact with each other
  23. what is the goal in wound management
    • Protect wound from
    • heat cold,
    • moisure,
    • contamination
    • mechanical forces
  24. what are the nurse managing option in wound care
    • maintain initial post op dressing for a minimum 24 hours
    • keep wound dry
    • splint when moving or coughing
    • pain management
    • watch for healing ridge.
  25. Secondary intention
    • wounds left open and have greater tissue damage. has more scar and granulation tissue and contraction seen.
    • Has a higher risk of infection
    • greater need for nutritional support
  26. contraction
    the puckering the body does to close a wound
  27. tertiary intention
    Closure delayed to treat local infection or contamination. i.e appendectomy.
  28. my goal in wound management
    • establish a healing environment
    • -provide moisture
    • absorb exudates
    • remove dead tissue
    • reduce microorganisms
    • fill dead space
    • nutritional support
    • thermal regulation
  29. Nursing interventions for wounds
    • look at the whole patient and other disease conditiond impsvyinh healing (diabetes and vascular insufficiency)
    • evaluate nutrition
    • asses for pain
    • identify s/Sx of infection
    • treat from the patient out to the wound
    • Identify the diference between contamination and infection
  30. Wet wounds-what is the goal
    • Absorb exudate, maintain moist environment. ie calcium alginate, wound V.A.C slightly moistened gauze
    • cover- gauze, ABD, exudry, tranparent film, polyurethane foam, thin hydrocolloid
  31. Dry wound what is the goal
    • hydrate the wound
    • allow for absorption of exudate
    • Protect from microorganims

    • cover
    • amorphous hydro gel
    • wet to moist gauze
    • alginate/hydrogel
    • silver/moitened silver pad
    • Enzymatic ointment
  32. shallow wound what is the goal
    • Absorb exudate
    • maintain moist surface,
    • Protect surrounding tissue
    • address underlying cause of wound

    • example
    • Roll absorbent dressings
    • calcium alginate
    • polyurethane foam
    • compression wraps
  33. Deep wounds goale
    • Fill dead space,
    • absorb exudate
    • maintain moist environment

    • example
    • calcium alginate
    • wound V.A.C slighly moistened gauze
    • cover
    • gauze, ABD, Exudry
    • Trnasparent film
    • Polyurethane foam
    • thin hydrocolloid
  34. Eschar and necrotic tissue goal
    • Remove necrotic tissue while minimizing damage to the viable tissue.
    • how to accomplish that
    • surgical debridement
    • conservative sharp wound debridement
    • enzymatic ointment
    • autolytic
  35. what is the exception to eschar and necrotic tissue
    except on heels. if exhar is intact and there is no sign of infection leave the exhar alone.
  36. how do you treat wounds
    treat from the patient out support nutrition, manage pain, hydrate, treat infection, tight blood sugar control, oxygenation, protect from contamination and infection.
  37. Homeostasis
    the purposeful maintenance of a stable internal environment which has physiologic processes that oppose change.
  38. component of the negative feedback mechanism
    • sensor- detects change
    • Integrator/comparator- compares incoming data to set point
    • effector system - returns the sensed function to within the range of the set point.
  39. steady state requires what
    that any tendency toward change automatically meets with facctors resisting change
  40. functions of the body's control systems
    • regullate cellular function
    • control life processes
    • integrate functions of the different organ systems.
  41. what are the effects of stress
    • physical - threathens homeostasis
    • emotional - cause negative feelings
    • socia l - cause relationship problems
    • intellectural - impairs problem solving
    • spiritual - challenges belief/values
  42. Ca
    • needed for bone formation, muscle excitability, blood coagulation, conduction of neuromuscular impulses, adult level 8.6 to 10mg/dl
    • regulating of acid base
    • blood clotting
    • bones/teeth
    • sedating/calming effect of nerves
    • thansmission of nerve impulse t
  43. what is fluid volume deficit
    dehydration in which fluid intake of the body is not sufficient to meet the fluid needs of the body.
  44. what is fluid volume excess?
    fluid intake or fluid retentionnt that exceed the fluid needs of the body. aka fluid overload or overhydration
  45. what causes hypocalcemia
    • low calcium level <8.5 results in hypoparathyroidism
    • alkalosis
    • hypomagnesia
    • hypoalbuminemia
    • hyperphospatemia
    • inadequate vitamin D
    • renal dz
    • malapsorption
  46. What are the sign and symptoms of hypocalcemia
    • is due to increased neuromuscular irritability
    • trousseau's sign/chvosteks sign
    • tetany
    • parethesias and tingling in hands and feet
    • mental status changes
    • hyperactivity of bs
    • diarrhea
    • decreased bp
    • decreased myocardial contractility
  47. causes of hypercalcemia
    • increased intake or absorption
    • hyperparathyroidism
    • cancer
    • immobility
    • hypophosphatemia
    • vitamin D intoxication
    • steroid tx
    • milk -alkali syndrome
  48. symptoms of hypercalcemia
    • due to decreased neuromuscular irritability
    • hypertension
    • impaired memory
    • lethargy
    • confusion
    • hypoactive bs
    • constipation
    • pain
  49. role of mg
    • major role in enzyme rxns
    • nerve impulse
    • heart rhythm
    • decreases or blocks release of ach
    • role in converting atp to adp
    • role in pth and preeclampsia
    • role in secretion and action of insulin
  50. causes of hypomagnesia
    • decreased intake or absorption
    • etoh
    • medication
    • Gi losses
  51. sign and symptoms of hypomagnesia
    • muscle twitching
    • tremors
    • hyperactive reflexes
    • cns changes--moog change
    • depression
    • confusion
    • anorexia
    • severe deficiency can lead to tetany
    • convulsion
    • ****S/Sx similar to hypocalcemia and hypokalemia because they are all cation
  52. causes of hypermagnesemia
    • increased intake or decreased excretion
    • meds containing mg
    • addissons disease
    • volume depletion
    • intreated DKA
  53. signs and symptoms of hypermagnesemia
    • decreased DTR's
    • hypotension
    • bradycardia
    • flushing
    • sensation of warmth
    • cns depression
  54. role of phosphorus
    • regulate ca
    • formation of teeth and bone
    • muscle fxn, nervous system function
    • atp
    • cell membrane
    • acid base reg
    • role in met and fats and proteins
    • inerse relationship with calcium
  55. causes of hypophosphatemia
    • respiratory or metabolic acidosis
    • increased release of pth
    • refeeding syndrom
    • etoh
    • decreased intake
    • increased excretion
    • ju[erca;ce,oa
    • meds
  56. sign and symptoms of hypophosphatemia
    • anemia
    • bruising
    • CNS ---slurred speech
    • confusion
    • seizures
    • circumoral and fingertip/extremety numbness and tinglin
    • paresthesias,
    • tetany,
    • spasms
    • dysrhythmias
    • respiratory muscle fatigue
    • hypo bs
  57. causes of hyperphosphatemia
    • respiratory or lactic acidosis, Diabetic Ketoacidosis
    • rhabdomyolyis
    • renal insufficiency
    • hypocalcemia
    • chemo tx
    • excess intake
    • massive blood transfussion
    • meds
  58. symptoms of hyperphosphotemia
    • mos s/sx r/t development of hypocalcemia,
    • tetany
    • numbness
    • tinglin
    • muscle spams
    • anorexia
  59. where is most of the water in the body found
    • 30L in cell
    • 11L ecf
    • 3L plasma
  60. ECF
    • made up of intersticial and intervascular space
    • 30% of body water is outside the cell
    • - 5% intravascular
    • -25% intersticail
  61. ICF
    60% of body fluid lives inside the cells includes Cerebrospinal, synovial, pleural GI tract
  62. in enfants what percentage of fluid is in ECF
    50%
  63. Osmosis
    Movement of fluids from low solute to high solute due to hydrostatic pressure.
  64. what are crystalloids
    small molecules that can move across body membranes
  65. what are collids
    large molecules that cannot move easily across body membranes (proteins)
  66. how is concentration of solutes expressed
    osmolality = tonicity
  67. diffusion
    movement of molecules from high concentration to low. depnds on molecule size of molecule. large move slower, increase tem increase molecule movement
  68. active transport
    movement from low concentration to high. requires energy and pump
  69. coloidal osmotic pressure
    protein keep fluid from leaking into tissue. proteins attract water. decrease albumin results in decreased plasma oncotic pressure
  70. who has more body water
    newborns who are 77% water
  71. who has less water
    • the elderly who her have 47% wat
    • they have diminished organ dificiency
    • altered thirst- which influences fluid intake and elimation
    • meds
  72. major ions of ECF
    Na, CL, water protein, organic acid
  73. ICF ions
    • Potassium
    • PO4
  74. sodium lab values
    135-145meg/l
  75. K lab values
    3.5-5meq/l
  76. what occurs if glucose/inlusin and tpn given
    • causes a shift in phosphate into cells from ECF
    • hypophosphatemia can occur in acute alcohol withdrawal, overuse of antacid, tissue trauma, infants drinking cows milk can get hyperphosphatemia
  77. what is hct
    hematocrit measures volume of cells in relation to plasma. hematocrit level increases in severe dehydration and decreases with fluid overload
  78. s/sx of hyponatremia
    • irritability, confusion, cns symptoms related to brain cell swelling, posutral hypotension, rapid/thready pulse, dry mucous membranes
    • caused by renal diuretics, hypotonic iv fluids, CHF,
  79. s/sx of hypernatremia
    • caused by insensible water loss, osmotic diuresis,,, sodium increaed hypertonic iv
    • S/SX intense thirst, dry sticky mucous membranes, red tongue, weakness, decreased LOC
  80. K how do we get it
    ingested, not produced: raw carrots and tomatoes, avocado, spinach, beef, pork cod, dried fruit, banana, orange, oj, milk
  81. what is k inportant for
    • maintaining icf water balance
    • skeletal and cardiac muscle activity
    • acid base balance
    • inverse relation ship with Na
  82. Hypokalemia causes
    • starvation
    • low k diet
    • no k in iv fluids and NPO
    • GI loss
    • ileostomy
    • increased aldosterone level cause na retention and loss of K
    • dialysis
    • diaphoresis
  83. signs and symptoms of hypokalemia
    • low k alters resting membrane potential
    • exitability problems
    • fatigue,
    • progressive muscle weakness,
    • cramps,
    • weak irregular pulse
    • cardiac dysrhythmias _ ST depression, flattened T wave,
    • dig toxicity
  84. hypercalemia causes
    • excess intake of KCL, tranfusion of aged blood
    • inpaired renal excretion aldosterone deficiency, K sparing diuretic impair kidney excretion, ace inhibitors (adenocorticoenzyme)
    • crush injury,
    • tumor lysis
    • acisosis
  85. what causes release of engiotensin
    low blood flow to kidney
  86. how much is 1kg water in L
    • 1kg is 1L
    • 1000ml of water is 1kg
  87. if you drink 240ml of water how much weight will you gain
    .24kg
  88. what is BUN
    measures liver and kidney function
  89. Hypovolemia
    • fluid and lytes together leaves intravacular space first
    • iteology - sweat, polyurea, fever, ng suction, fistula, blood loss, 3rd spacing (ascites), loop diuretic (lasix),
  90. s and sx of hypovolemia
    decreased weight, I<O dry mucous membrane, weak rapid pulse, decreased cap refill, decreased turgor /tentin, increased hematocrit, increased urince specific gravity and BUN
  91. ECF deficit nursing management
    • assess clinical signs
    • monitor wt, I/O, VS, Turgor
    • Oral, skin care
    • Administer fluids as ordered
    • safety for OHTN
  92. Hypervolemia
    • iteology- increased intake ; excessive NACL diet or meds, rapid NaCL IV
    • increased retention CHF, CRF, cirrhosis, Venous obstruction, steoirds.
  93. signs and symptoms of hypervolemia
    • in>out, bounding pulse,
    • moist MM edema, cracles,
    • dyspnea, confusion, edema can be caused by increased capillary hydrostatic pressure, decreased plasma oncotic pressure, increased cap permeability, sodium to low as body tries to rid water
  94. where does the extra fluid go
    • ECF ICT - first spacing
    • Accumulatioon in IS (dependant edema- second spacng
    • fluid where not normally found - ascites- peritoneal vacity- 3rd spacing
  95. what can cause edema
    • increased: cap hydrostaitic pressure, cap permeability
    • decreased plasma oncotic pressure
  96. what physiologic process is responsible for fluid removal
    • venous hydrostatic pressure,
    • oncotic pressure of intravascualar and intersitial spaces
    • intact semipermeable capillary wall,
    • tissue tension a
    • lymphatic flow.
  97. who is at risk for dehydration-hyperosmolar
    elderly, hyperventilation, fever, acidosis, enteral feedings
  98. what to do for dehydration
    monitor diet, restrict sodium, d5w/hypotonic fluid to reduce sodium
  99. overhydration/hypo-osmolar who is at risk
    • water goes into cell, causes cellular and tissue edema
    • infants if formula diluted to save cost, exercisers athlete who sweat and only replace with water, head inujury (siadh causes water retention
  100. nursing management for overhydration/hyponatremia
    • diet includes sodium limit water
    • assess clinical signs
    • vs i and o
    • monitor diet

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