Pathopysiology

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Savsta
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224238
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Pathopysiology
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2013-06-23 01:30:38
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Disease pathophysiology signs symptoms nursing considerations treatment
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praxis exam semester one
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  1. Guillian-barre syndrome
    • auto immune disorder
    • causing damaged to myelin sheath  of peripheral nerves
    • damaged myelin sheath results in faulty sending of signals between nerves and muscles
    • prognosis 4 weeks to one year
  2. Guilian-barre syndrome
    Signs + symptoms
    • tingling/numbness in limbs
    • muscle weakness in limbs
    • unsteadiness
    • stinging 
    • paralysis (loss of motor function)
    • sensory loss
    • pain
    • hypotension
    • bradycardia
  3. Guillian-barre syndrome
    nursing considerations
    • close monitoring of pt respiration
    • if severe may requires ICU and ventilation 
    • ensure pt treament is effective in reduciong pain
    • assess pt mobility and limbs
    • does pt need a wheelchair?
  4. Guillian-barre syndrome treatment
    • IV immunoglobulin (antibodies)
    • rehabilitation after treatment to regain functions that was lost, assists with ADL
  5. Multiple sclerosis
    • auto immune disease of CNS
    • affecting the brain, spine, optic nerves
    • degeneration of CNS myelin sheath and loss of axon
  6. MS signs and symptoms
    • muscle weakness in the extremities
    • difficulty with coordination and balance
    • numbness
    • speech impediments
    • tremors
    • dizziness
    • fatigue
    • pain
  7. MS nursing considerations
    • assess the girth, muscle strength, weakness and coordination
    • encourage ambulation with observance of proper gait and assistance
    • physiotherapy and counselling referal
    • ensure all personal belonging are within reach
  8. MS treatment
    • Corticosteroids are mainly used to reduce the inflammation that spikes during a relapse
    • beta interferon slows down the progression of physical disability
    • copaxone- myelin basic protein
    • antibody
  9. Parkinson's disease
    a progressive disorder that characterized by muscle rigidity, absence of movement and involuntary tremors.
  10. Pathophysiology of PD
    Cell in the substantia nigra becomes impaired or died resulting in low levels of dopamine neurotransmitter in the brain causing symptoms of PD
  11. PD signs and symptoms
    • rigidity
    • shuffling gait
    • difficulty initiating voluntary movement
    • postural changes
    • brandykinesia
    • akinesia
    • hand tremors
  12. PD nursing considerations
    • review pt diet regime, should consist of low protein, high fibers and vitamins
    • assess pt gait
    • ensure pt has suitable footwear
  13. Treatment of PD
    • Levodopa crosses BBB, converted to dopamine, high levels of dopamine assist movement
    • Carbidopa doesn't cross BBB, it prevent the breakdown of levodopa prior to reaching the BBB. Lower dose of levodopa in the BBB reduces the risk side effects
  14. what is the purpose of the substantia nigra?
    Produce dopamine and controls movements
  15. How does the loss of dopamine affect the presentation of symptoms you see associated with parkinson's disease?
    Reduction of dopamine in the  corpus striatum interrupts the balance between inhibitory dopamine and excitatory acetylcholine, preventing affected brain cells from performing normal function with CNS therefore causing parkinson's symptoms
  16. alkinesia
    absence of movement
  17. bradykinesia
    slowness in performing movement
  18. Medical term for involuntary acceleration
    Festinating gait/ parkinsonian gait
  19. MODE OF ACTION OF SINEMENT
    Levodopa passes into the blood brain barrier and is converted to dopamine, therefore increases concentration of dopamine in the brain. Increased levels of dopaimine improves nerve conduction an assist with movement

    Carbidopa does not cross the blood brain barrier, instead it prevents the breakdown of Levadopa before reaching the BBB, this allows lower doses of levadopa to be used and decreases the risk of side effects
  20. Side effects of Sinemet
    • nausea
    • vomiting
    • confusion
    • glaucoma
    • dyskinesia 
    • alkinesia
    • hallucinations
  21. Amantadine
    Antiviral, antiparkinsonian agent

    Stimulates natural dopamine rather than replacing it.  It mimics the signal from dopamine lost in Parkinson't disease
  22. Amitriptyline
    • Tricyclic antidepressant
    • blocks reuptake of norepinephrine and serotonin into nerve endings
    • best taken before bedtime
    • side effect- sleepiness, dry mouth, increased appetite, confusion, constipation
  23. Role of dopamine
    Chemical messager in the brain works with acetylcholine to transmit messages from the brain to body especially important in coordinate movement (motor function), regulates sleep, behavior, reward, pleasure, memory, attention
  24. On/off phenomenon in parkinson's disease
    abrupt and unpredictable changes in mobility when taking levodopa

    • 0n- able to move
    • off- immobile

    can switch in a brief period of time
  25. Anaphylaxis
    • Type 1 hypersensitivity allergic reaction to a normal stimulus
    • IgE bind to mast cells and basophil
    • Mast cell release histamine and heparin
    • Vasodilation of smooth muscle occur due to release of histamine and heparin
    • contraction last up to one hour
  26. Anaphylaxis signs and symptoms
    • hives
    • respiratory distress
    • systemic shock
    • vasodilation
    • vascular collapse
    • wheezing
  27. Anaphylaxis nursing consideratons
    • ensure pt is not taking beta blockers as it reduces the efficiency of adrenaline
    • ensure right dosage of adrenaline is given according to age
    • if attack is less severe lie flat and raise legs
    • if difficulty breathing have pt sit upright
    • remove stimulus if appropriate
    • do not induce vomiting
    • d
  28. ANAPHYLAXIS treatment
    • give adrenaline immediately to prevent and relieves laryngeal oedema and circulatory collapse 
    • provide bronchodilator and reduces the release of histamine and other mediators
    • O2, IV access, fluid replacement, antihistamines, hydrocortisone
  29. Alzheimer
    a neurological progressive disorder of cognitive and behaviour impairment

    Plaques develop and commonly occur in the hippocampus and other areas of cerebra cortex causing neuro destruction and loss of brain tissue. Lack of acetylcholine in the brain results in symptoms of alzheimer
  30. Alzheimer signs and symptoms
    • memory loss
    • confusion
    • increased anxiety 
    • wondering 
    • mood and personality changes
  31. Alzheimer nursing ocnsiderations
    • a daily report of pt behaviour should be documented
    • ensure pt have anxiety med for PRN
    • assess pt mental status 
    • encourage sufficient food and
    • adequate nutrition
    • inspect pt’s skin for evidence of trauma, injury
    • ensure the environment is safe and suitable for pt
  32. Alzheimer Treatment
    • Cholinesterase inhibitors help with the cognitive symptoms of Alzheimer's. They work by preventing the breakdown of a chemical messenger in the brain called acetylcholine, which is important for learning, memory, and attention
    • Donepezil(Aricept) is approved to treat mild, moderate, and severe Alzheimer's
    • Rivastigmine (Exelon) and Galantamine (Razadyne) are approved to treat mild to moderate Alzheimer's
  33. KORSAKOFF’S SYNDROME
    A neurological disorder due to lack of thiamine (vitamin b1) due to excessive alcohol consumption over prolonged period
  34. Korsakoff's syndrome pathophysiology
    Thiamine  plays a role in metabolizing glucose to produce energy for the brain. An absence of thiamine therefore results in an inadequate supply of energy to the brain, particularly the hypothalamus (which regulates body temperature, growth and appetite and has a role in emotional response
  35. Myocardia Infartion
    Result from reduced blood flow through one of the coronary arteries. This causes myocardial ischemic and necrosis of cells. Reduced blood flow is caused by occlusion from atherosclerosis, thrombosis, platelet aggregation, or coronary spasm.
  36. Signs and symptoms of MI
    • fatigue
    • pallor
    • perspiration
    • hyperthermia
    • angina
    • SOB
    • severe pain
    • hypotension
    • tachycardia
  37. Why is hypotension and tachycardia a common deviation during MI
    Due to the plaque blockage and necrosis of cell, the heart ability to pump blood is reduced therefore causing the heart to beat faster as it tries to pump blood to the rest of the body resulting in increased heart rate and increased cardiac output.
  38. atrial fibrillation
    Major risk for stroke

  39. Ventricular tachycardia
    Ventricular tachycardia is a fast heart rhythm that starts in the ventricles

  40. Asystole (abnormal)
    absence contractions of the heart

  41. Ventricular fibrillation
    Ventricular fibrillation is an abnormally irregular heart rhythm caused by rapid, uncoordinated fluttering contractions of the ventricles

  42. Assessment to undertake for acute MI
    • Pain assessment
    • Baseline vital signs
    • ECG scan
  43. Medication to treat hypotension and tachycardia in acute MI
    beta blockers because it reduces heart rate and cardiac output. It works by preventing stimulation of the sympathetic nervous system by inhibiting the action of catecholamines (norepinephrine and epinephrine) at beta-adrenergic receptors.
  44. Metaprolol
    • beta adrenergic blocker or betablocker
    • used to treat heart problem including angina and hypertension
    • Prevent stimulation of the sympathetic nervous system by inhibiting the action of catecholamines at beta-adrenergic receptors
  45. Nursing consideration for Metoprolol
    • Check apical/ radial pulse before administration
    • warn pt against abrupt discontinuation of treatment
    • inform pt about early signs of heart failure and instruct them to seek medical help asap
  46. Thrombolytic therapy
    Thrombolytic therapy is the use of drugs to break up or dissolve blood clots, which are the main cause of both heart attacks and stroke.

    Thrombolytics work by dissolving a major clot quickly. This helps restart blood flow to the heart and helps prevent damage to the heart muscle.
  47. Contradications for thrombolytic therapy
    • A recent head injury
    • Bleeding problems
    • Bleeding ulcers
    • Pregnancy
    • Surgery
    • Taken blood thinning medications such as CoumadinTrauma
    • Uncontrolled high blood pressure
  48. Nursing consideration for thrombolytic therapy pt
    • Monitor patient respiratory rates
    • Look out for signs of side effects
    • ensure medication is taken as prescribed
  49. drug commonly used for thrombylisis
    Plasminogen activator (tPA)

    thrombolytic drugs include

    • Needs to be given within 12 hoursof symptom onset
    • Alteplase
    • reteplase
    • streptokinase

    Tenecteplase should be given asap within sixe hours of symptom onset
  50. mode of action for thrombolytic drugs
    Covert pasminogen to plasmin, which dissovles  plasma protein
  51. Thrombolytic drug interactions
    NSAID, oral anticoagulants, heparin, and antiplatelets increased risk of bleeding

    Aminocaproic acid inhibits streptokinase and can be used to revreser it fibrinolytic effects
  52. Vascular dementia
    A subtle, progressive decline in memory and cognitive function caused by a series of strokes.

    Strokes occurs when blood supply to the brain is blocked by blood clot in the artery or when the artery burst. When this happens, brain cells are deprived of oxygen and die, causing damage to the cortex of the brain that is associated with learning, memory and language functioning
  53. Signs and symptoms of vascular dementia
    • memory loss
    • depression
    • confusion
    • loss of social skills
    • agitation
    • tremors
    • weakness or altered sensation in the limbs and face
    • loss of bladder and bowel control
    • hallucination
    • delusions
    • slur speech
    • inappropriate laughing or crying
    • balance problem
  54. pt provide you with the same answer. What is the possible relevance of this related to the provisional diagnosis of Vascular dementia
    Vascular dementia affects the cortex of the brain which is responsible for learning memory and language. When the cortex of the brain is damaged, due to lack of blood supply, it can affect a person's thinking process, memory and other cognitive functioning
  55. lymphoedema
    A condition resulting in accumulation of fluid in the interstitial space due to the blockage of the lymphatic channels, may be due to infection, tumor or surgically removed. It mostly affects the arms and legs.
  56. Signs and symptoms of lymphoedema
    • swelling of the limbs
    • weight gain
    • feeling of tightness or fullness in the limbs
    • aching, pain
    • weakness in affected limb
  57. Essential advice to avoid lymphoedema
    • avoid tight clothing
    • maintain health weight, BMI below 26
    • avoid food high in salt
    • Maintain skin integrity
    • elevate limb when possible
    • regular exercise
  58. Function of the lymphatic system
    • Collect and transport tissue fluids from the intercellular spaces in all the tissues of the body, back to the veins in the blood system
    • Returns plasma proteins to the bloodstream
    • New lymphocytes are manufactured in the lymph nodes
    • assist the body to build up an effective immunity to infectious diseases
    • lymph nodes play an important role in the defence mechanism of the body. They filter out micro-organisms and foreign substances
    • it transports large molecular compounds (enzymes & hormones) from their manufactured sites to the bloodstream
  59. Asthma
    A chronic disorder of the airways that involves a complex interaction of airway obstruction, bronchial hyper-responsiveness and inflammation
  60. Asthma pathophysiology
    exposure to allergens and irritants can trigger an asthma attack. During an asthma attack, muscles surrounding the bronchial tubes tighten (bronchospasm), narrowing the air passage and interrupting the normal flow of air into and out of the lungs. Airflow is further interrupted by an increased in mucus secretion, forming mucus plugs, and swelling of the bronchial tubes.
  61. Asthma symptoms
    • wheezing
    • tightness in chest
    • difficulty breathing
    • cough
    • SOB
  62. what is the role of beta 2 adrenergic receptors in the respiratory system and where are they primarily found
    Beta 2 receptors mediate bronchodiation

    Primarily located in smooth muscles of bronchioles, blood vessels and uterus
  63. Beta 2 adrenergic agonists
    work by relaxing bronchial smooth muscles, stabilizing mast cell membranes and inhibiting mast cell mediators
  64. Spacer techniques
    1. Shake the puffer well, remove cap and place the inhaler outlet into the end of the spacer.

    2. Place the spacer mouthpiece between the lips and breathe out through the mouthpiece. Depress the inhaler canister once.

    3. Take a slow, deep breath in. Remove the spacer and hold your breath for approximately 10 seconds. If you are unable to hold your breath, breathe in and out slowly through the spacer for 4 breaths. Both techniques are effective.
  65. Purpose of a spacer
    The purpose of the spacer chamber is to hold the medication released from the Meter Dose Inhaler so that a child has the time to more effectively inhale the medication.
  66. caring for spacer device
    • Spacer should be cleaned once a month in hot soapy water to prevent build up of medicine residue
    • spacer should be replaced every 6-12 months check with your prescriber
    • ensure no one else uses your spacer
    • Keep out of reach of children
    • Use spacer as described on label or as directed by prescriber
  67. Peak flow meter techniques
    • hold peak flow upright
    • make sure line is at "0"
    • Big breath in
    • place into meter into mouth- seal lips around it completely
    • Big breath out- quick and hard as possible
    • record best of 3
  68. Nebuliser
    Small device that convert a drug from a solution into an aerosol form by means of a compressor/compressed gas source
  69. How a nebuliser works
    • Works by a flow of gas passing through a very small hole (Venturi)
    • rapid expansion of air causes a negative pressure that sucks the nebulised fluid up the feeding tube system to be inhaled
    • approx 12% of solution reaches the lungs
    • therefore doses are higher than aerosol inhaler
  70. Nebuliser techniques
    • Check expiry date of drug
    • Sit upright position
    • place compressor near pt and plug into mains
    • assemble the nebuliser
    • connect tubing and compressor
    • pour prescribe solution into chamber
    • close lid and turn on compressor, mist should appears
    • assist pt to apply mask/ mouth piece
    • tell pt to breath through mouth an avoid talking
    • tap on nebuliser every few minutes to avoid condensation
    • once misting has stop, which of device and remove mask/mouthpiece
    • wash and dry nebuliser chamber and store away
    • offer pt a drink
    • document that nebuliser has been administered as per protocols
    • hands hygiene
  71. Bronchiolitis
    Respiratory condition that involves inflammation of the bronchial tubes, resulting in excessive secretions of mucus and tissue swelling causing narrowing bronchial tubes, making it progressively more difficult to breath. Commonly affects children under 2 years of age
  72. Why is antibiotic not used to treat bronchiolitis
    In most cases, the cause is a virus and antibiotics will not help.
  73. Side effects of bronchiolitis
    • *inflammation of bronchi
    • *coughing
    • *production of sputum
    • *SOB
    • *Wheezing
    • *fever/chills
    • *chest pain
    • *Blocked/runny nose
    • *fatigue

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