cumulative portion

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jam110007
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252286
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cumulative portion
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2013-12-10 09:47:10
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3220 final exam fall
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  1. acute inflammation
    • short term response associated will all types of tissue injury
    • lasts minutes to days
    • types of WBC involved is mostly neutrophils
    • exudates are present
  2. 2 phases of acute inflammation
    • vascular phase 
    • cellular phase
  3. vascular phase of acute inflammation
    hemodynamic changes

    • 1. vascoconstriction response - stops bleeding 
    • -----occurs 5-10 minutes
    • -----dec. blood blow
    • 2. hyperemic response - brings rescue materials [prostaglnadins and luekotrienes]
    • -----inc. blood flow
    • -----inc. capillary permeability, leaking
    • -----causes exudates
  4. cellular phase/response of acute inflammation
    • delivery of WBC [mainly neutrophiles] to injury site
    • ativation of neutrophiles
    • phagocytosis - cleans up
  5. cellular response part 1
    1. granulocytes -3 types

    • Neutrophils 
    • - moves in within 90 min
    • polymorphonuclear neutrophils [PMNs or segs] <= immature neutrophils
    • ----shift to the left on CBC

    • Eosinophils
    • - inc. in allergic reactions
    • - inc. in parasite infections

    • Basophils
    • - contain histamine + other mediators
  6. total WBC
    4,500 to 10,800
  7. shift to the left
    • due to severe infection 
    • mature neutrophils have 7 hr life span
    • if immature PNM count > 8% total PMN, have left shift
  8. cellular response part 2
    • 2. Monocytes = Macrophages 
    • move in within 5 hours
    • within 48 hours are dominant WNC
    • produce active substances that change blood vessels [permeability] - prostaglandin, leukotrienes, cytokines PAF
    • eat more than neutrophils, last longer
    • trigger immune system 
    • wall shut off, they can't eat
  9. neuropathic pain
    • abnormal processing of sensory input by the peripheral or central nervous system
    • peripheral nerves affected by injury or disease 
    • coming from a problem with the nerve 
    • common types: diabetes
  10. centrally generated neuropathic pain
    phantom pain
  11. peripherally generated neuropathic pain
    • painful polyneuropathies [diabetic pain]
    • painful mononeuropathies [nerve pain]
  12. obstructive lung Dx
    • obstructive lung Dx
    • airway that is worse with Expiration, requires more force emptying
    • shared symptoms: dyspnea
    • shared sign: wheezing
    • VQ mismatch
  13. asthma
    • chronic inflammatory disorder of the bronchial mucosa that causes hyper-responsiveness and constriction of airways 
    • occurs in all ages, but common in children in urban area
    • cause is unclear, probably a combination of immune response, genetics, ans environment
  14. asthma patho: early response
    antigen response activates B cells to produce IgE. inflammatory mediators are released causing vasodilation, edema, and mucous secretion
  15. asthma patho: late response
    begins 4-8 hrs later with latent release of inflammatory mediators
  16. characteristics of asthma
    • airway obstructions 
    • airway inflammation
    • airway hyper-responsiveness
  17. asthma signs and symptoms
    • cough
    • wheezing
    • chest tightness
  18. COPD
    • include emphysema and bronchitis
    • obstructive 
    • clinical diagnosis: any pt. who has dyspnea, chronic cough or sputum production, and Hx of exposure to risk factors for the Dx
    • spirometry required for diagnosis: presense of a post-bronchodilatory FEV1/FVC < 0.70 confirms the presense of airflow limitations
  19. a patient with acute exacerbation of COPD may have an ABG reveling what?
    respiratory acidosis
  20. chronic bronchitis
    • hypersecretion of mucus and chronic productive cough that lasts at least 3 months of th year and occurs 2 years in a row
    • airflow obstructed by mucus
    • inc. airway resistance, bronchospasm, chronic inflammation
    • V/Q mismatch [perfusing but not ventilating]
    • right ventricular decompensation [cor pulmonale]
    • known as blue bloaters
  21. why are they called blue bloaters
    • cyanosis
    • peripheral edema
    • non-fighters resp drive is inc.
  22. chronic bronchitis TX
    • stop smoking
    • pursed lip breathing 
    • ipratropium [dries up secretions]
    • bronchodilators 
    • expectorants [cough up secretions]
    • resp therapy - chest PT
  23. emphysema patho
    • narrow bronchiole 
    • decreased elastic recoil 
    • destruction of alveolar wall 
    • less surface for gas
    • V.Q mismatch - loss ventilation perfursing area
  24. why are they called pink puffers
    • fights 
    • pink puffer - pink color to skin
    • barrel chest - using accessory muscles. air traping, muscle wasting, and weight loss 
    • pursed lip breathers
  25. respiratory acidosis
    sue to hypoventilation resulting in too much CO2 in the blood

    • signs and symptoms include
    • - headache
    • - blurred vision 
    • - lethargy
    • - coma
  26. respiratory alkaloids
    hyperventilation resulting in too little CO2

    causes include hypoxemia, fever, anemia 

    • signs and symptoms
    • - dizziness
    • - confusion
    • - paresthesias
    • - passing out
  27. glucocorticoids
    • - gargle after use [can get thrush (candadisis)]**
    •  
    • - take adequate calcium and vitamin D
    •  
    • - not to use for acute attack
  28. Diabetes 1
    • —- Used to be called insulin dependent diabetes (IDDM) or juvenile diabetes
    • - —Beta cell destruction leading to absolute insulin deficiency [beta cells do not make any insulin, occurs progressively over the years]
    • 1A: autoimmune , genetic susceptibility and environmental factors
    • —1B: nonimmune , or idiopathic [not sure why it occurs], resulting from other disease, such as pancreatitis
  29. diabetes type 1 signs and symptoms
    • —- Long, progressive preclinical period
    • —- Polydipsia [drinking a lot], polyuria [urinating a lot]
    • - —Protein and fat breakdown occurs because of lack of insulin, resulting in weight loss
    • - —May present in Diabetic Ketoacidosis (DKA)
    • How most pt present in types one

    —
  30. type 2 diabetes
    • - —Used to be called non insulin dependent diabetes (NIDDM) or adult - onset diabetes
    • - More common than type 1
    • - —Increased prevalence in children
    • - —By the time diagnosed, have usually had it for several years
  31. type 2 signs and symptoms
    • —- Nonspecific
    • - Usually overweight, dislipidemic, hyperinsulinemic [trying to compensate high sugars by releasing more insulin], and hypertensive

    • —May
    • have polydipisia, polyuria
    • - Fatigue, pruritis, recurrent infections, visual changes , paresthesia [tingling in fingers and toes – peripheral neuropathy]
    • - Macrovasular consequences [coronary arteries, etc.]
  32. long term complications of DM
    • CAD
    • peripheral vascular Dx
    • Retinopathy 
    • renal Dx
    • nephropathy 
    • neuropathy
  33. what leads to acidosis in DKA 
    Increase in ketones causes a drop in pH causing metabolic acidosis

    - When we break down fatty acids it forms ketones, which are acidic. They can take a while to build up in the body. Remember, insulin inhibits glycolysis [break down of fat/fat metabolism] so if your body has no insulin, the fat in your body will begin to break down causing you to become acidotic
  34. Diuretic meds include
    • high loops
    • thiazide
    • potassium sparing
    • osmotic
  35. ACE inhibitor meds end in
    -PRILS
  36. Calcium channel blocker meds end in
    -IPINE
  37. angiotensin 2 receptor blocker meds end in
    -SARTAN
  38. beta-adgrenergic blocker meds end in
    -olol
  39. signs and symptoms of hypotension
    • dizsiness or light-headedness
    • blurrly vision
    • confusion
    • weakness
    • fatigue 
    • nausea

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