Other Systems- Metabolic, Endocrine, Gastrointestinal

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Other Systems- Metabolic, Endocrine, Gastrointestinal
2012-12-18 14:34:09
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Other Systems- Metabolic, Endocrine, Gastrointestinal
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  1. Phenylketonuria
    • syndrome with mental retardation (behavioral and cognitive) dur to elevation of serum phenylalanine
    • brain is primary organ affect
    • autosomal recessive
  2. Tay-Sachs Disease
    • accumation of gangliosides in the brain
    • autosomal recessive
    • at 6 months will start to miss developmental milestones
    • usually die by 5
  3. Mitochondrial disorders
    • genetically inherited or spontaneous DNA mutations
    • symptoms vary: muscle coordination, muscle weakness, visual and hearing problems
    • want to alleviate current symptoms and slow progression
  4. Wilsons Disease
    • autosomal recessive
    • defect in body's ability to metabolize copper, which causes copper to accumulate in the brain, liver, cornea, and kidney
    • pt has kayser-fleischer rings
  5. Metabolic alkalosis
    • pH rises ABOVE 7.45
    • occurs from: continuous vomitting, ingestion of antacids, diuretic therapy
    • S/S: nausea, diarrhea, prolonged vomitting, muscle fasciculations, cramping
    • could cause coma, seizures, and respiratory paralysis
  6. metabloic acidosis
    • pH drops BELOW 7.35
    • occurs from: renal failure, lactic acidosis, starvation, ketoacidosis, severe diarrhea
    • S/S: hyperventilation, vomitting, diarrhea, cardiac arrhythmias
  7. Osteomalacia
    • bones become soft secondary to calcium or phosphorus deficiency
    • S/S: aching, fatigue, weight loss, LE bowing, thoracic kyphosis
  8. Osteoporosis
    • decrease in bone mass, increasing risk for fracture
    • declining osteoblast function coupled with loss of calcium
    • S/S: kyphosis, height decrease, dowagers hump, postural changes
    • T-score -1 to -2.5 indicative of osteopenia
    • T-score less than -2.5 indicative of osteoporosis
    • Risk factors: female, asian or caucasian, insufficient calcium intake, smoking alcohol
  9. Paget's Disease
    • heightened osteoclast activity, however excessive bones lacks true structural integrity
    • S/S: bony deformities
  10. hypothalamus
    • regulation of autonomic nervous system (body temp, appetite, sweating, sexual behavior, fear, BP)
    • impacts other endocrine galnds based on impact of pituitary gland
  11. pituitary gland
    • located just below hypothalamus
    • releases hormones that regulate several other endocrine glands
    • secretes endorphins that act on nervous system and reduce person's sensitivity to pain
    • creates sex hormones
  12. thyroid gland
    • produces thyroxine and triiodothryonine
    • controls rate at which cells burn fuel from food
  13. parathyroid gland
    • produce parathyroid hormone which is an antagonist to calcitonin and maintains normal blood levels of calcium and phosphate
    • increases reabsorption of calcium and phosphate from bones to blood
  14. adrenal glands
    • located at top of each kidney (outter part adrenal cortex, inner part adrenal medulla)
    • adrenal cortex: produces corticosteroids to regulate water and sodium balance, response to stress, immune system, sexual development
    • adrenal medulla: produces epinephrine to increase HR and BP when stress increases
  15. pancreas
    • includes endocrine and exocrine tissues
    • upper left quadrant
    • islets of langaerhans are hormone producing in pancreas
    • ensure consistent level of glucose within bloodstream and properly maintain stores of energy
  16. ovaries
    provide estrogen and progesterone
  17. testes
    secrete androgens (testosterone)
  18. Hyper/hypo pituitarism
    • hypopituitarism: decreased or absent hormonal secretion from anterior pituitary gland causes short stature (dwarfism), delayed growth and puberty, diabetes insipidus
    • hyperpituitarism: excessive secretion, gigantism, acromegaly, hirsutism, galactorrhea, amenorrhea, infertility, impotence
    • bilateral carpal tunnel, arthritis, osteophyte formation are common with HYPER
    • orthostatic hypotension common with HYPO
  19. Adrenal dysfunction- addison and cushings
    • Addison's disease: hypofunction of adrenal cortex causing fluid and electrolyte imbalances, hypotension, weakness, anorexia, weight loss, altered pigmentation
    • Cushings syndrome: hyperfunction of adrenal gland causing truncal obesity, purple abdominal striae, moon shaped face, buffalo hump, male gynecomastia
  20. Thyroid dysfunction- HYPO and HYPER
    • hypothryoidism: fatigue, weakness, decreased HR, weight gain, constipation, commonly caused by hashimoto's thyroiditis or underdeveloped thyroid gland
    • graves disease (hyperthyroidism): goiter, heat intolerance, nervousness, weight loss, tremor
    • after pregnancy HYPERthyroidism first then HYPO
  21. Parathyroid dysfunction- HYPO and HYPER
    • hypoparathryoidism: hypocalcemia, seizures, cognitive defects, short stature, tetany, muscle spasms & pain
    • hyperparathyroidism: hypercalcemia, renal stones and kidney damage, bone deformity, muscle wasting
  22. diabetes type I and II
    • Type 1 diabetes: pancrease fails to produce insulin, so insulin dependent, S/S are polyphagia, weight loss, ketoacidosis, polyuria, dehydration,
    • Type II diabetes: resistance to insulin action and inadequate insulin secretion, S/S the same but no ketoacidosis- control glucose through diet, exercise, oral meds, and insulin injections
  23. Glucose levels
    • 70-130 prior to meal or <180 after a meal
    • hyperglycemia: >180-200, increased thirst & frequent urination, be careful of ketoacidosis in type I (fruity breath)
    • hypoglycemia: <70, hunger, sweating, shaking, dizzy, clumsy, headache
  24. GI system overivew
    • Upper GI: mouth, esophagus (transports), stomach (secretes hormones to release digestive enzymes)
    • Lower GI small intesting: duodenum (neutralizes acid), jejunum (absorbs water & electrolytes), ileum (absorbs bile)
    • Lower GI large intestine: ascending, transverse, descending colon, sigmoid, rectum, anus
    • gland organs: gallbladder (store and release bile), liver (produce bile), pancreas (secretes insulin)
  25. GERD
    • incompetent lower esophageal sphincter allowing reflux of gasatric contents
    • LEFT sidelying preferred so acid flowing into the esophagus is NOT promoted
  26. Gastritis
    • inflammation of gastric mucosa or inner layer of stomach
    • erosive gastritis (acute)
    • non-erosive gastritis (chronic)
    • peptic ulcer disease: comnonly caused by H pylori infection & chronic NSAID use, bloody stools, burning or heartburn
  27. Irritable bowel syndrome
    • recurrent symptoms of upper and lower GI system interferring with normal function of colon
    • abdominal pain, bloating/distention, nausea, vomitting, anorexia
  28. diverticulitis
    • inflamed or infected diverticula, pouch like protrusions in the colon
    • tenderness over left side of lower abdomen
  29. hepatitis
    • inflammatory process within the liver
    • S/S: fatigue, anorexia, headache, flu symptoms, lighter stool
    • if exposed to blood or body fluids of an infected person must receive immunoglobulin therapy immediately
  30. Cirrhosis of the liver
    • healthy tissue of the liver is replaced with scar tissue that blocks the flow of blood through the organ
    • usually caused by alcoholism or hep C
    • ascites and fluid accumulation int he ankles/feet may occur as well
  31. Cholecystiti or cholelithiasis
    • inflammation of gallbladder, gall stones are cholelithiasis
    • severe upper right quadrant pain with muscle guarding, tenderness and rebound pain
  32. Gastrointestine Management
    • antacid agents: neutralize gastri acid and increase intragastric pH
    • H2 receptor blocks: bind to histamine receptors to prevent histamine activated release of gastric acid
    • proton pump inhibitors: blook secretion of gastric cells into the stomach
    • anticholinergics: block effects of acetycholine on parietal cells in the stomach, decrease gastric acid
    • emetic agents: induce vomitting
  33. Quadrant pains
    • Left upper: spleen injury, aortic aneurysm, gastric ulcer
    • right upper: cholecystitis, hepatitis
    • left lower: kidney stone, uretal stone
    • right lower: kidney stone, appendicitis, cholecystitis
  34. Neurogenic bladder
    • damage to cerebral control
    • frequent UTIs, urine leakage, inability to empty, loss of urge to urinate when full
  35. different types of urinary incontinence
    • stress: activities that increase intrabdominal pressue (sneeze, cough, jump)
    • urge: intense urge to void, there have been changes in the smooth  muscle of the bladder
    • overflow: once the stream is initiated it is weak and has post void dribble
    • functional: decrease in mental awareness or mobility preventing person from going to the bathroom in toilet
  36. Lifestyle modifications for bladder
    • fluid intake should be 2,500 mL a day
    • void every 3-4 hours
    • stop smoking and weight loss program
  37. Renal failure
    • generally occurs secondary to DM or HTN
    • decrease in filtration rate and fail to adeautely filten toxins and waste from blood
    • stage 1-5 kidney disease (5= kidney failure)
    • hemodialysis generally takes 5 hours, potential for dehydration and hypotension post dialysis
  38. pregnancy
    • weight gain between 25-35 pounds
    • respiratory diaphragm elevates
    • increased oxygen consumption, blood volume and cardiac output
    • hypotension in supin beacuse of pressure on inferior vena cava, left side lying will reduce that pressure
    • absolute contraindications: restrictive lung disease, incompetent cervix, multiple gestation at risk for prematurity, 2nd or 3rd trimester bleeding, premature labor, ruptured membranes
    • exercise at 50-60% max HR for 30 minutes
    • after childbirth coccyx and sacrum often become hypermobile
  39. General S/S of Cancer
    • C: change in bowel/bladder
    • A: sore that won't heal
    • U: unusual bleeding/discharge
    • T: thickening/lump develops
    • I: indigestion or swallow difficulty
    • O: change in wart/mole
    • N: nagging cough
  40. Skin Cancer
    • Basal cell carcinoma: slow growing form of skin cancer tha rarely metastasizes
    • malignant melanoma: spreads and metastizes quickly to brain, lung, liver, bone, & skin
    • asymmetri, borders, color, diameter
  41. breast cancer
    • most common female malignancy
    • metastases to: lymph nodes, lungs, bone, skin, brain
  42. lung cancer
    • rapid metastasis: pulmonary vascular system, adrenal gland, brain, bone, liver
    • poor prognosis
  43. pancreatic cancer
    metastasize to: liver, lungs, pleura, colon, stomach, spleen
  44. brain cancer
    may occur as primary tumor, but often develops as a metastasis
  45. lymphoma
    • cancer of lymphatic system
    • Hodgkins disease: most curable
    • non-hodgkins: progression varies
  46. prostate cancer
    adenocarcinoma is most common of prostate cancer
  47. Leukemia
    • cancer of the blood
    • will spread to lymph nodes, liver, spleen and other areas
  48. astrocytoma
    50% of pediatric brain tumors
  49. neuroblastoma
    • tumor from primitive ectodermal cells of neural plate that is found in the sympathetic nervous systme
    • most common malignant tumor in kids
  50. treating people undergoing cancer treatment
    • verify weight bearing and clearnace for mobility if have bone metastases
    • monitor platelet (low counts thrombocytopenia means will bruise easy) and hematocrit/hemoglobin (risk of dizziness) counts, neutrophil (neutropenia is low count and at risk for infection)
    • 40-65% peak HR
    • don't exceed 12 RPE
  51. osteogenic sarcoma
    • bone cancer in children
    • will metastasize quickly
  52. Fat soluble vitamins
    • vitamin A: eyes, epithelial tissue, normal growth and development, reproduction
    • vitamin D: increase blood levels of minerals (Ca and phosphorus)
    • Vitamin E: antioxidant in cell membrane
    • Vitamin K: used for blood clotting
  53. Water Soluble Vitamins
    • Vitamin B12: involved in carbs, protein, and fat metabolism
    • B3: regulate energy metabolism
    • B6: metabolizes proteins, amino acids, carbs, and fat
    • B12: aids in hemoglobin synthesis
    • Vitamin C: combats infection and facilitates wound healing
  54. MInerals
    • Calcium: facilitates muscle contraction & relaxation, builds strong bones and teeth, aids in coagulation
    • chloride: facilitates the maintenance of fluid and acid-base balance
    • magnesium: builds strong bones and teeth, activates enzymes, regulates heartbeat
    • phosphorus: strengthens bones, oxidation of fats and carbs
    • potassium: fluid and acid-base balance
    • sodium: maintenance of acid-base balance
    • iron: assists in oxygen transport and cell oxidation
  55. Acute vs. Chronic Renal Failure
    • Acute: sudden decline, increase in BUN & creatinine, secondary to damage....
    • chronic: progressive deterioration in renal function, DM< severe HTN, glomerulopathis, obstructive uropathy, interstitial nephritis, polycystic kidney disease