Patho Final

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Patho Final
2014-02-22 19:40:56

patho hesi
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  1. shock?
    widespread serious reduction of tissue perfusion (lack of O2 and nutrients

    prolonged=impaired cellular functioning
  2. who's at risk for shock?
    • very young, very old
    • post MI
    • severe dysrythmia
    • adrenocortical dysfunction
    • recent hemorrhage/blood loss
    • burn pts
    • massive infection
  3. early signs of shock?
    • agitation 
    • restlessness
    • from cerebral hypoxia
  4. Hypovolemic Shock
    most common

    related to internal or external blood or fluid loss
  5. cardiogenic shock
    • related to ischemia or impairment in tissue perfusion bc of:
    • MI
    • HFailure
    • serious arrythmia
  6. how does distributive shock occur?
    • excessive vasodilation
    • impaired distribution of blood flow
  7. Three types of distributive shock?
    • Septic
    • Anaphylactic
    • Neurogenic
  8. What happens with Anaphylactic shock?
    • (Allergen)
    • respiratory stress bc of bronchial constriction leading to airway obstruction
    • could lead to vascular collapse

    acute or life threatening
  9. Neurogenic Shock?
    • (injury)
    • loss of vasomotor tone and sympathetic innervation of the heart causes injury to descending sympathetic pathways in the spinal cord
  10. Septic Shock
    • Endotoxins released by bacteria cause:
    • vascular pooling
    • diminished venous return
    • reduced cardiac output
  11. What is obstructive shock?
    • tamponade
    • emboli
    • or compartment syndrome leads to physical obstruction=impedes filling or outflow=reduced cardiac output
  12. what can all types of shock lead to?
    • SIRS-Systemic Inflammatory Response Syndrome
    • MODS - Multiple Organ Dysfunction Syndrome
  13. what do you do when cardiogenic shock exists with pulmonary edema? (from pump failure)
    High Fowler w legs down (to reduce venous return)

    decreases further venous return to the left ventricle.
  14. List five assessment findings that occur in most shock victims
    • Tachycardia
    • tachypnea,
    • hypotension
    • cool clamy skin
    • decreased in urinary output
  15. If a client is in cardiogenic shock, what might result from administration of volume-expanding fluids,
     what intervention can the nurse expect to perform in the event of such an occurences?
    • Pulmonary edema;
    • admin cardiotonic drugs such as digitalis preps
  16. differentiate btwn hypovolemic and cardiogenic shock. How might the nurse determine the existence of cardiogenic shock?
    • History of MI with lt ventricular failure
    • or possible cardiomyopathy with symptoms of pulmonary edema
  17. minimum renal output per hour?
    30 ml/hr
  18. List four measurable criteria that are expected of shock crisis.
    • BP mean of 80 to 90;
    • PO2 >50;
    • CVP above 6 cm of H2O;
    • urine output less than 30ml/hr
  19. What is DIC?
    • Disseminated Intravascular Coagulation-
    • coagulation disorder w paradoxical thrombosis and hemorrhage

    Treat with Heparin
  20. DIC is an acute complication of what?
    • hypotension
    • septicemia
    • (suspected when blood is oozing from 2+ unexpected sites
  21. Mean arterial pressure
    level of pressure in the central arterial bed

    • measured indirectly by BP measurement
    • measured directly thru arterial catheter insertion
  22. Cardiac Output= CO
    Volume of blood ejected by the left ventricle per unit of time
  23. stroke volume
    Amount of blood ejected per beat x heart rate
  24. central venous pressure= CVP
    pressure in Right Atrium

    • 2-6mmHg
    • normal
  25. Diagnosis of DIC
    • Prothrombin time- prolonged;
    • partial thromboplastin time- prolonged;
    • fibrinogen-decreased
    • platelet coun- decreased;
    • fibrin degradation (spilt) products increased
  26. T-wave
    repolarization of ventricle
  27. intra aortic balloon pump
    balloon pump machine to assist heart to pump blood

    balloon goes into femoral artery and inflates when heart relaxes-deflates just before systole to send blood into circulation
  28. Intermittent claudification
    most prominent symptom of PAD (peripheral artery disease)(atherosclerosis that interferes with blood flow)

    pain due to insufficient blood flow
  29. cholelithiasis
    gallbladder stones

    Ca and Cholesterol cause crystals in mucosal lining of gallbladder
  30. Cholelithiasis causes
    • obesity
    • oral contraceptives
    • cirrhosis
    • family history
    • Crohn's hyperlipidemia
    • DM
  31. salivary amylase
    • Salivary glands
    • secreted into GI tract
    • digests starch and glycogen
  32. 1.  Cardiac
    Output= CO
  33. Volume of blood ejected by
    the left ventricle per unit of time
  34. stroke
  35. Amount of blood ejected per
    beat x heart rate
  36. central
    venous pressure= CVP
    pressure in Right Atrium

    • 2-6mmHg
    • normal
  37. Diagnosis
    of DIC
    • Prothrombin time-prolonged; 
    • partial thromboplastin time- prolonged;
    • fibrinogen-decreased
    • platelet coun- decreased; 
    • fibrin degradation (spilt) products increased
  38. T-wave
    repolarization of ventricle
  39. tissue plasminogen activator
    • 1.  tissue
    • plasminogen activator

    • converts plasminogen to
    • plasmin which digests the fibrin strands in order to dissolve clots

    sourced from liver, plasma, and vascular endothelium
  40. normal
    platelet levels

    <100,000 concern of severe bleeding
  41. AV node rate
    40-60 min

    in lower half of atrial septum gets impulses from SA node

    if SA nodes ceases-automaticity foci will start pacemaking
  42. cardiac
    • accumulation of fluid in
    • pericardial cavity=restricts ventricular filling and cardiac output drops
  43. acute tamponade
    small amount of fluid accumulation

  44. congestive
    heart failure CHF
    • heart is unable to pump
    • it's own volume

    • tachycardia            cyanosis
    • tachypnea
    • profuse sweating
    • edema - sudden weight gain
    • enlarged liver
  45. ST segment Post MI
    • after an MI, ST Elevation
    • is elevated telling us that there is a block of blood flow to the myocardium

    • st elevation = block or infarct
    • st segment = early ventricular repolarization
  46. which enzyme is measured for suspected pancreatitis?
    • Amylase - high in pancreatitis
    • serum and urine levels peak after 4-8 hrs of onset of acute pancreatitis
  47. Three types of stomach polyps
    masses of cells that form on the inside lining of your stomach

    • Hyperplastic
    • Fundic Gland
    • Adenomas
  48. Hyperplastic Polyps
    form as rx to chronic inflammation (gastritis)

    unlikely to become cancerous unless bigger than 3/4 inch (2cm)

    associated w H. Pylori
  49. Fundic Gland Polyps
    • form in glandular cells in lining of stomach 
    • in people with rare inherited syndrome -familial adenomatous polyposis
    • can become cancerous
  50. Ademonas
    • least common stomach polyp-but most likely to become stomach cancer
    • form on glandular cells inside stomach lining
  51. Pancreatitis
    inflammation of pancreas

    • cause by:
    • Alcoholism
    • high triglycerides
    • hypercalcemia
    • biliary
    • infection
  52. Hyperosmolar Hyperglycemic State
    (nonketotic syndrome)
    • Hyperglycemia BGL >600
    • Hyperosmolarity Plasma osmolarity (>310)
    • dehydration
    • abscence of ketoacidosis
    • depression of the sensorium
  53. exophthalmos
    bulging of the eye out of the orbit "proptosis"

    bilateral (graves disease)

    • unilateral (orbital tumor)
    •      eyelids fail to close
    •      dryness or damage
    •      redness or irritation
    •      blindness
  54. Which disorder causes bronzing of the skin in 90% of cases?
  55. General Adaptation Syndrome
    • Enlarged adrenal cortex
    • thymus gland atrophy
    • peptic/duodenal ulcers

    Hans Selye "stress is multifactorial and has a universal, non-specific stress response"