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Coagulation disorder with paradoxical thrombosis and hemorrhage.
Disseminated Intravascular Coagulation (DIC)
An acute complication of hypotension and septicemia; a common cause of respiratory failure.
Disseminate Intravascular Coagulation
What are some s/s of DIC?
- shortness of breath
- weak, thready pulse
- cold & clammy skin
BGL > 600 mg/dL
plasma osmolarity > 320 mOsm/L
depression of sensorium
- Hyperosmolar Hyperglycemic State (HHS)
- *No ketoacidosis
What type of pts is HHS mostly seen in?
Most frequently in people with type 2 diabetes.
What happens to water in people with HHS?
It is pulled from the cells (including brain cells)
s/s of HHS?
- excessive thirst
- changes in CNS (sometimes mistaken for stroke)
What is osteoporosis?
- Loss of mineralized bone mass;
- the bone resorption exceeds bone formation
- Usually the bone loses density, which measures the amount of calcium and minerals in the bone
When does the loss of bone mineral density increase related to osteoporosis?
early menopause (decrease in estrogen)
What is the main cause of fractures in older adults?
If hCG levels do not decrease in a pt with a hytadiform mole, what may develop?
What can a high level of hCG hormone indicate in a person who is not pregnant?
Cancer. Some cancerous tumores produces hCG
What is TPA (Tissue Plasminogen Activator)?
- A protein that catalyzes the conversion of plasminogen to plasmin and causes the breakdown of clots.
- (plasmin digests fibrin, & clot dissolves)
When would TPA be used as a treatment?
Embolic or Thrombotic Stroke
When would administration of TPA be contraindicated?
hemmorhagic stroke or head injury
What is a molar pregnancy?
- instead of a fetus growing in the uterus, an abnormal growth is and shows similar s/s of pregnancy.
- This predisposes the pt to developing choriocarcinoma.
What are the normal levels of hCG when a woman is not pregnant?
What does an hCG level of between 5 and 25 mean?
You MIGHT be pregnant
At what level is hCG upon confirmation of pregnancy?
What causes a cardiac tamponade?
pericardial effusion (fluid im the pericardial CAVITY)
What is cardiac tamponade?
- The heart is compressed due to accumulation of fluid, pus, or blood in the pericardial SAC.
- decrease in SV, CO, & organ perfusion
- increased intracardiac pressure
Where is HDL made?
in the liver
What does HDL do?
carries cholesterol from peripheral tissues back to liver
What is HDL mostly made of?
What is 54% of the plasma proteins and helps maintain BV by contributing to osmotic pressure?
What kind of defects is CHF associated with?
acyanotic (abnormal circulation, but all blood entering systemic system is oxygenated)
CHF is a common complication of what?
What is CHF (congestive heart failure)?
- Heart is unable to pump effectively
- pressure in the heart increases.
- As a result, the heart cannot pump enough oxygen and nutrients to meet the body's needs.
What is barrel chest an indication of? What causes it?
- Use of accessory muscles to breath because lungs are chronically over-filled with air
What is emphysema?
damage to the air sacs cause air pockets which trap air and breathing is difficult
What is the significance of AAT (Alpha-1-antitrypsin) in emphysema?
- They normally protect the breakdown of elastin by proteases.
- If someone is deficient in AAT (produced in the liver), it can result in emphysema.
What is Addison Disease?
- hypofunction of the adrenal cortex
- lack of cortisol, aldosterone, androgens
Why is there an increase in ACTH in Addioson Disease pts?
lack of feedback inhibition
Clinical manifestations of Addision disease.
- hyponatremia (no aldosterone)
- hyperkalemia (decreased excretion)
- decreased ECF
- decreased CO
- hyperpigmentation (elevated ACTH)
Other than helping in the stress response, what else does cortisol help with (Addison disease pts lack this)?
- regulate blood pressure & immune system
- balance the effect of insulin in regulating the blood sugar level
Addison disease pts lack aldosterone. Why is aldosterone important?
- It helps regulate salts in the blood and
- helps to control blood pressure.
If a pt came in with stiffness, wt loss, and swelling of BOTH hands and wrists, what would you suspect?
Rheumatoid arthritis is a chronic, systemic, progressive deterioration of what?
Connective Tissue (synovium) of joints
What would you leave out when assessing a pt with suspected rheumatoid arthritis?
ROM - this causes pain and is limited
What is multiple sclerosis?
inflammation and destruciton of the CNS myelin
What is the focus for treatment in MS?
Where do symptoms usually begin in MS pts?
weakness in arms, eventually progressing to spastic paralysis
What is shock?
- Widespread, serious reduction of tissue perfusion
- leads to generalized impairment of cellular fxn
Most common cause of shock.
What causes septic shock?
- release of endotoxins by bacteria;
- act on nerves in vascular space and cause pooling;
- decreases venous rtn & CO = poor systemic perfusion
Early signs of shock.
agitation and restlessness due to cerebral hypoxia
Complete failure of bone ends to unite.
Fracture healing doesn't occur at normal rate of 6-8 weeks.
Deformity at the fracture site caused by malalignment of fracture at time of immobilization.
What is a fat embolism?
fat molecules in the bloodstream combine with platelets and form an embolus.
Normal Hct levels.
Normal Hgb values.
- Men: 13.5-18 g/dL
- Women: 12-15 g/dL
What prevents ECF from becoming too acidic or too alkaline?
Most common cause of death from a fracture.
Common cause of hemiplegia.
- damage to the corticospinal tracts in one hemisphere of the brain due to:
- obstruction/rupture of a cerebral artery
- or brain tumor.
Sharp, bright, burning pain. Can have fast or slow onset.
Pain that stems from tendons, muscles, joints, periosteum, & BV.
Deep Somatic Pain
Pain that orginates from internal organs; diffused at first may be localized.
A large pulmonary embolus can affect the heart how?
cause rt side heart failure
s/s of pulmonary embolus.
chest pain, shortness of breath