patho ch 18

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patho ch 18
2011-06-21 14:18:55

ch 18
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  1. adrenergic
    related to the sympathetic nervous system transmitters, norepinephrine (noardenaline) and epinephrine (adrenaline)
  2. anastomosis
    a connection between two blood vessels or tubes
  3. angioplasty
    repair of a blood vessel
  4. auscultation
    listening for sounds, perhaps with a stethoscope, within the body, eg. lungs, heart, intestines.
  5. autoregulation
    automatic regulation or reflex control of blood flow in an area depending on the local needs
  6. baroreceptors
    a sensory nerve receptor that is stimulated by a change in pressure, perhaps blood pressure
  7. bradycardia
    abnormally slow heart rate
  8. cardiomegaly
    a heart that is larger than normal size
  9. depolarization
    a reversal of charges at a cell membrane; an electrical change in an excitable cell in which the inside of the cell becomes positive (less negative) in relation to the outside. This is the opposite of polarization and is caused by a rapid overflow of sodium ions.
  10. ectopic
    away from the normal position, displaced
  11. electrodes
    an electrical terminal or lead, a conductive medium, in electrotherapy, an instrument with a point or surface from which to discharge current to the patient's body
  12. endarterectomy
    removal of the intima and any obstructive material in an artery
  13. hemoptysis
    frothy sputum containing streaks of blood, usually bright red; spitting up blood.
  14. mircocirculation
    blood flow in the very small vessels, arterioles, capillaries and venules
  15. murmur
    an abnormal sound heard in the heart, caused by a defective valve or opening in the heart
  16. orthopnea
    difficult or labored breathing when recumbent that is usually relieved by an upright position
  17. sulcus
    a furrow, groove, depression, or fissure, esp. of the brain
  18. syncope
    fainting, temporary loss of consciousness
  19. synergistic
    a combination of substances or agents that produce an effect greater than expected
  20. tachycardia
    excessively rapid heartbeat
  21. slide
    shock defined
    shock occurs when there is inadequate perfusion of body tissues, perfusion depends on : an effective heart pump, an intact vascular system, tissues are able to use O2 and nutrients
  22. slide
    pathophysiology of shock
    severe prolonged relaxation of arteries and veins, decreased arterial pressure and venous pooling at capillary level, hypoxia and accumulation of products of cellular damage, increased capillary permeability and formation of clots, shifting of intravascular volume to tissues
  23. slide
    shock, normal compensatory mechanisms
    sympathetc responses, vasoconstriction (baroreceptors and chemoreceptors), absorption of fluid form interstitial spaces, conservation of Na and H2O, renin angiotensin mechanism (ADH), all of these responses are short term. (citric acid cycle, cells use anaerobic pathway as alternative way to conserve energy)
  24. slide
    types of shock
    • hypovolemic, obstructive, distributive (neurogenic, anaphylactic, and septic)
    • identification is key to recovery
  25. slide
    hypovolemic shock
    characterized by decreased blood volume, states of hypovolemic shock: 1. initial-blood volume decreases. 2. compensatory- maintain perfusion and BP, no cell damage. 3. progressive- decompensation, blood flow impaired, capillary permeability increased, blood flow sluggish to organs, enzyme changes and damage. 4. irreversible- VS changes, death, even if blood flow is restored- it's too late.
  26. slide
    clinical manifestations of hypovolemic shock
    thirst (baroreceptors and chemoreceptors sense fluid changes, hypothalamus), Increased HR (working hard to get oxygenated blood to tissues), cool and clammy skin, decreased BP (lack of volume in area=less pressure), change in mentation (lack of), Oliguria (100-400 mL passed in 24 hours b/c of aldosterone RAS), restless/apprehension.
  27. slide
    treat hypovolemic shock
    O2, monitoring cardiac, restore vascular volume, fluids (LRs, artificial blood, plasma expanders, and blood), CVP and PCWP (pressures in the heart), Vasoactive drugs (increase perfusion) and dopamine (increase BP).
  28. slide
    obstructive shock
    is circulatory shock that results from mechanic obstruction of flow of blood through the central circulation (heart), results in increased right heart pressure, and decreased venous return to heart, may have increased CVP and JVD.
  29. slide
    distributive shock
    loss of blood vessel tone leading to enlargement of vascular compartment and displacement of vascular volume, three shock state fall into this pattern; neurogenic shock, anaphylactic shock, septic shock.
  30. slide
    neurogenic shock
    decreased sympathetic control of blood vessel tone due to defective vasomotor center in the brain. (hypoxic, low insulin or glucose (hypoglycemic), HR low, skin dry and warm.)
  31. slide
    anaphylactic shock
    characterized by massive vasodilation and pooling of blood in peripheral BVs, caused by an immune mediated reactions where vasodilator substances like histamine are released in the blood, common causes-antibiotics, bee stings.
  32. slide
    septic shock
    associated most often by b-bacteremia although can be caused by other organisms such as gram+ bacilli, and fungi with even greater mortality, associated with patho. complications such as pulm. insufficiency, DIC, and MODS. septicemia-fever vasodilation, warm flush skin, mild hyperventilation, behavioral changes. (antibacterials, vasopressors, dopamine, fluids). find causative agent with cultures.
  33. slide
    complications of shock
    acute resp. distress syndrome, acute renal failure, GI complications (bleeding), disseminated intravascular coagulation (DIC), multiple organ dysfunction syndrome (MODS).