Pathophysiology Final Rasmussen University Winter 2021/2022

Traumatic Brain Injury - ANSWER •Usually caused by a sudden and violent blow or jolt to the head (closed injury) or a penetrating (open injury) head wound that disrupts the normal brain function. •The injury can bruis ...

Traumatic Brain Injury - ANSWER •Usually caused by a sudden and violent blow or jolt to the head (closed injury) or a penetrating (open injury) head wound that disrupts the normal brain function. •The injury can bruise the brain, damage nerve fibers, and cause hemorrhaging. Traumatic Brain Injury Complications - ANSWER Complications -Can occur from one significant event or multiple mild events -Changes in thinking, sensation, language, or emotions -Seizures -Alzheimer's disease -Parkinson's disease -Memory decline -Depression -Death Concussion - ANSWER A condition associated with closed TBIs momentary interruption of brain function •Usually results from a mild blow to the head that causes sudden movement of the brain, disrupting neurologic functioning. •May or may not lead to a loss of consciousness. •Amnesia, confusion, sleep disturbances, and headaches may occur for weeks or months. Traumatic Brain Injury Manifestations - ANSWER Manifestations •May be vague and develop slowly, or may be sudden and severe. •Symptoms may improve and then suddenly worsen. •The outward appearance of the head is not an indication of the injury severity. •Not being able to recall event details •Indications of a concussion •Changes in or unequal pupil size •Seizures •Asymmetrical facial features •Fluid draining from the nose, mouth, or ears •Fracture of skull or face •Bruising of face •Swelling at site of injury •Scalp wound •Impaired hearing, smell, taste, speech, or vision •Inability to move one or more limbs •Irritability (especially in children) •Personality changes •Unusual behavior •Loss of consciousness •Bradypnea •Hypotension •Restlessness •Lack of coordination •Lethargy •Stiff neck •Vomiting Traumatic Brain Injury Diagnosis and Treatment - ANSWER •Diagnosis: history, physical examination (including using the Glasgow Coma scale), head computed tomography, head magnetic resonance imaging, and ICP monitoring •Treatment: rest, analgesics (specifically acetaminophen [Tylenol]), cold compresses, osmotic diuretics (e.g., mannitol), antiseizure agents, sedatives, surgery, rehabilitation (e.g., physical, speech, and occupational therapy) Increased Intracranial Pressure - ANSWER •Increased volume in the cranial cavity •Causes: traumatic brain injury, tumor, hydrocephalus, cerebral edema, and hemorrhage Meningitis - ANSWER •Inflammation of the meninges, usually resulting from an infection. •CSF may also become affected. •Causes: bacteria (e.g., Neisseria meningitidis, Streptococcus pneumoniae, and Haemophilus influenzae), viruses (e.g., enterovirus, measles, influenza, and herpes), tumors, and allergens. •Infection or irritant triggers the inflammatory process, leading to swelling of the meninges and increased ICP. Meningitis Manifestations and Complications - ANSWER •Manifestations: fever, chills, mental status changes, nausea, vomiting, photophobia, severe headache, stiff neck (meningismus), agitation, bulging fontanel, decreased consciousness, opisthotonos (abnormal positioning that involves rigidity and severe arching of the back with the head thrown backward), poor feeding or irritability in children, tachypnea, and rash •Complications: permanent neurologic damage, seizures, hearing loss, blindness, speech difficulties, learning disabilities, behavior problems, paralysis, renal failure, adrenal gland failure, shock, and death Encephalitis - ANSWER •Inflammation of the brain and spinal cord, usually resulting from an infection. •Causes: virus (e.g., coxsackievirus, echovirus, poliovirus, adenovirus, herpes virus, cytomegalovirus, Eastern equine encephalitis virus, West Nile virus, St. Louis virus, measles, and mumps) and bacterial infections (e.g., Lyme disease, tuberculosis, and syphilis). •Infection triggers the inflammatory response that causes vasodilatation, increased capillary permeability, and leukocyte infiltration. •The inflammatory process can cause nerve cell degeneration and diffuse brain destruction. •May be primary (direct viral infection of the brain and spinal cord) or secondary (travels from elsewhere in the body). •Most cases are mild and self-limiting, but can be severe and life threatening. •Vulnerable groups to more severe progression: immune-compromised persons, young children, older adults, those living in high-incidence areas, and those frequently outdoors. •Complications: cerebral edema, cerebral hemorrhage, and brain damage. Encephalitis Manifestations and Treatment - ANSWER •Result from meningeal irritation and neurologic damage. •Similar to meningitis but with a more gradual onset. •Most cases are mild and go undetected. •Include: flulike symptoms, headache, neck rigidity, confusion, hallucinations, personality changes, diplopia, seizures, muscle weakness, paresthesia or paralysis, loss of consciousness, tremors, abnormal deep tendon reflexes, rash, and bulging fontanel. Treatment •Usually self-limiting, requiring no treatment •Rest •Adequate nutrition, including plenty of liquids •Respiratory support •Reorientation and emotional support •Analgesics and antipyretics to relieve headaches and fever •Antiviral agents (if viral) •Antibiotic therapy (if bacterial) •Corticosteroids to reduce cerebral edema •Antiseizure agents •Sedatives to treat irritability and restlessness •Physical, speech, and occupational therapy •Prevention: vaccinations, wearing protective clothing, using mosquito repellant, and eliminating water sources Ischemic strokes - ANSWER strokes caused by blockage in a blood vessel in the brain Ischemic damage is permanent hemorrhagic stroke - ANSWER occurs when a blood vessel in the brain leaks or ruptures; also known as a bleed Alzheimer's Disease - ANSWER •Most common form of dementia. •Brain tissue degenerates and atrophies, causing a steady decline in memory and mental abilities. •The exact etiology is unknown, but associated with three pathologic characteristics -Amyloid plaques mix with a collection of additional proteins, neuron remnants, and other nerve cell pieces. -Neurofibrillary tangles: abnormal collections of a protein called tau that clumps together. -Connections between neurons responsible for memory and learning are lost; neurons cannot survive when their connections to other neurons are lost. Alzheimer's Disease Manifestations and Treatment - ANSWER Manifestations •Insidious onset •Course may extend 10-20 years •Include memory loss, problems with abstract thinking, difficulty finding the right word to express thoughts or even follow conversations, difficulty reading and writing, disorientation (even in familiar surroundings), loss of judgment, difficulty performing familiar tasks, personality changes, hallucinations, and incontinence of bowel or bladder •Treatment: -No cure, nor therapies that will slow the progression -Medications to manage symptoms and maximize functioning: cholinesterase inhibitors (e.g., donepezil [Aricept], rivastigmine [Exelon], galantamine [Razadyne]), memantine (Namenda), vitamin E, ginkgo, and Huperzine A -Other strategies: memory aids (e.g., calendars), nutritional support, physical exercise, cognitive activities, safety precautions (e.g., supervision and removing clutter), maintaining a calm environment, social interactions, coping strategies, and support Multiple Sclerosis Manifestations - ANSWER •Vary depending on the degree of damage and the specific nerves affected. •Characterized by remissions and exacerbations. •Exacerbations may last for days to months. •Fever, hot baths, sun exposure, and stress can trigger or worsen these episodes. May progress without remissions. •Fatigue •Loss of balance •Muscle spasms •Paresthesia or abnormal sensation in any area •Problems moving arms or legs •Weakness in one or more arms or legs •Unsteady gait •Lack of coordination •Tremor in one or more arms or legs •Constipation and stool leakage •Urinary frequency, urgency, hesitancy, or incontinence •Vision issues (e.g., diplopia and vision loss) •Decreased attention span, poor judgment, and memory loss •Difficulty reasoning and solving problems •Dizziness •Hearing loss •Sexual dysfunction •Slurred speech Dysphagia Seizure - ANSWER •Seizure: transient physical or behavior alteration that results from an abnormal electrical activity in the brain •Causes: altered membrane ion channels, altered extracellular electrolytes, and imbalanced excitatory and inhibitory neurotransmitters Epilepsy - ANSWER •Epilepsy: seizure disorder resulting from spontaneous firing of abnormal neurons; characterized by recurrent seizures for which there is no underlying or correctable cause •Complications: brain damage, traumatic brain injury, aspiration, mood disorders, and status epilepticus (seizures that last longer than 20 minutes or subsequent seizures occur before the individual has fully regained consciousness) Spinal Cord Injury - ANSWER •Result from direct injury to the spinal cord or indirectly from damage to surrounding bones, tissues, or blood vessels. •Causes: motor vehicle accidents, falls, violence, sports injuries, and weakening vertebral structures (e.g., rheumatoid arthritis or osteoporosis). •Direct damage can occur if the spinal cord is pulled, pressed sideways, or compressed. -This damage may occur if the head, neck, or back twists abnormally during an accident or injury. •Hemorrhage, fluid accumulation, and edema can occur inside or outside the spinal cord (but within the spinal canal). •The accumulation of blood or fluid can compress the spinal cord and damage it. •Spinal shock: temporary suppression of neurologic function because of spinal cord compression; neurologic function gradually returns. Complications •Loss of neurologic functioning •Varying degrees of paralysis •Cauda equina syndrome: injury to the nerve roots in the area of the cauda equina •Autonomic hyperreflexia: a massive sympathetic response that can cause headaches, hypertension, tachycardia, seizures, stroke, and death; most commonly associated with injuries above T6 •Neurogenic shock: an abnormal vasomotor response secondary to disruption of sympathetic impulses •Respiratory failure •Effects of immobility (e.g., constipation, pulmonary infections, urinary infections, thrombus, impaired skin integrity, contractures) •Changes in bowel and bladder function •Sexual dysfunction •Chronic pain •Death Spinal Cord Injury Manifestations and Treatment - ANSWER •Cervical injuries can affect both the upper and lower extremities and include breathing difficulties, loss of normal bowel and bladder control, paresthesia, sensory changes, spasticity, pain, weakness, paralysis, blood pressure instability, temperature fluctuations, and diaphoresis. •Thoracic injuries affect the lower extremities; the manifestations can be the same as those for cervical injuries. •Lumbar sacral injuries can affect the lower extremities in varying degrees; manifestations are similar to those of cervical injuries, with the exception of breathing difficulties. Treatment •Immediate: -Immobilization of the spine -Corticosteroid agents to reduce swelling -Spinal traction to reduce the fracture and immobilize the spine -Surgical repair of vertebral fractures or surgical removal of the fluid compressing the spinal cord (decompression laminectomy) -Respiratory management -Bed rest •Long-term: -Physical, occupational, and speech therapy -Mobility assistive devices -Electronic devices (brain-computer interface) -Long-term respiratory management -Meticulous skin care -Bowel and bladder training or management -Antispasmodic agents and Botox injections to treat muscle spasms -Pain management -Nutritional support -Prompt treatment of infections Acute Bronchitis - ANSWER •Inflammation of the tracheobronchial tree or large bronchi •Causes: viruses, bacterial, irritant inhalation, and allergic reactions •Treatment: antipyretics, analgesics, antihistamines, decongestants, cough suppressants, bronchodilators, increasing fluid intake, avoiding smoke, and humidifying air Chronic Bronchitis - ANSWER •Blue bloaters" •Characterized by inflammation of the bronchi, a productive cough, and excessive mucus production •Complications: frequent respiratory infections and respiratory failure Chronic Bronchitis Manifestations and Treatment - ANSWER •Manifestations: hypoventilation, hypoxemia, cyanosis, hypercapnia, polycythemia, clubbing of fingers, dyspnea at rest, wheezing, edema, weight gain, malaise, chest pain, and fever •Treatment: oxygen therapy (in limited amounts), bronchodilators, corticosteroids, antibiotics (if bacterial infection is present), postural drainage, chest physiotherapy, and increased hydration Acute Bronchitis Manifestations - ANSWER Manifestations: productive and nonproductive cough, dyspnea, wheezing, low-grade fever, pharyngitis, malaise, and chest discomfort Emphysema - ANSWER •"Pink puffers." •Destruction of the alveolar walls leads to large, permanently inflated alveoli. •Enzyme necessary for lung remodeling is deficient. •Loss of elastic recoil and hyperinflation of the alveoli, leading to air trapping. •Causes: genetic predisposition and smoking. Emphysema Manifestations and Treatment - ANSWER •Manifestations: dyspnea upon exertion, diminished breath sounds, wheezing, chest tightness, tachypnea, hypoxia, hypercapnia, increased anterior-posterior thoracic diameter (from 1:2 to 1:1), activity intolerance, anorexia, and malaise •Treatment: same as chronic bronchitis with addition of pursed-lip breathing Chronic Obstructive Pulmonary Disease COPD - ANSWER •Debilitating chronic disorders characterized by irreversible, progressive tissue degeneration and airway obstruction. •Severe hypoxia and hypercapnia can lead to respiratory failure. •Oxygen begins to drive breathing. Can also lead to cor pulmonale. •Causes: smoking, pollution, chemical irritants, and genetic mutation •Often asymptomatic early or masked by smoking •Two main conditions: chronic bronchitis and emphysema Asthma - ANSWER •Chronic disorder that results in intermittent, reversible airway obstruction •Characterized by acute airway inflammation, bronchoconstriction, bronchospasm, bronchiole edema, and mucus production •A variety of triggers from infections to smoke •Extremely common Extrinsic asthma - ANSWER •Increased IgE synthesis and airway inflammation, resulting in mast cell destruction and inflammatory mediator release. •Mediator release causes bronchoconstriction, increased capillary permeability, and mucus production. •Generally presents in childhood or adolescence.. •Triggers: allergens such as food, pollen, dust, and medications. Intrinsic asthma - ANSWER •Not an allergic reaction •Usually presents after age 35 years •Triggers: upper respiratory infections, air pollution, emotional stress, smoke, exercise, and cold exposure Nocturnal asthma - ANSWER •Usually occurs between 3:00 and 7:00 a.m. •May be related to circadian rhythms—at night, cortisol and epinephrine levels decrease, while histamine levels increase, leading to bronchoconstriction Exercise-induced asthma - ANSWER •Usually occurs 10-15 minutes after activity. •Symptoms can linger for an hour. •May be a compensatory mechanism to warm and moisten the airways. •Followed by a refractory period that begins within 30 minutes and can last 90 minutes. Occupational asthma - ANSWER •Caused by a reaction to substances at work. •Symptoms develop over time, worsening with each exposure and improving when away from work. Drug-induced asthma - ANSWER •Frequently caused by aspirin—prevents the conversion of prostaglandins, which stimulate leukotriene release, a powerful bronchoconstrictor. •Can be fatal. •Reactions can be delayed up to 12 hours after drug ingestion. Pneumonia - ANSWER •Causes: infectious agents, injurious agents or events, and pulmonary secretion stasis •Viral -Usually mild -Can lead to secondary bacterial pneumonia •Bacterial -More common than viral -Most often Streptococcus pneumoniae Aspiration pneumonia - ANSWER -Causes: impaired gag reflex, improper lower esophageal sphincter closure, inappropriate gastric tube placement Lobar pneumonia - ANSWER Confined to a single lobe Bronchopneumonia - ANSWER -Most frequent type -A patchy pneumonia throughout several lobes Interstitial pneumonia or atypical - ANSWER -Occurs in the areas between the alveoli -Routinely caused by viruses or by uncommon bacteria Nosocomial pneumonia - ANSWER -Develops more than 48 hours after a hospital admission Community-acquired pneumonia - ANSWER -Acquired outside the hospital or healthcare setting Tuberculosis TB - ANSWER •Caused by the bacillus, Mycobacterium tuberculosis •Fairly controlled until recently •Resistant strains have developed in those immune compromised •Most frequently occurs in the lungs, but can spread to other organs Carried by airborne droplets Tuberculosis Primary Infection - ANSWER Primary Infection -When bacillus first enters the body. -Macrophages engulf the microbe, causing a local inflammatory response. -Some bacilli travel to the lymph nodes, activating the type IV hypersensitivity reaction. -Granuloma and tubercle forms. -Caseous necrosis and Ghon complexes develops. -Bacilli can remain dormant for years. -Usually asymptomatic. Will test positive now. Tuberculosis Secondary Infection - ANSWER •Secondary infection -Reactivation of dormant bacilli -Can spread to other organs -Symptoms usually develop Tuberculosis Manifestations and Treatment - ANSWER •Manifestations: productive cough, hemoptysis, night sweats, fever, chills, fatigue, unexplained weight loss, anorexia, and symptoms depending on other organ involvement •Treatment: antimicrobial combination therapy for at least six months •Prevention: vaccination, respiratory precautions, adequate ventilation, and appropriate isolation Acute Respiratory Distress Syndrome (ARDS) - ANSWER •Rapidly developing respiratory failure •Results from fluid accumulation in the alveoli due to a systemic or pulmonary event that is not cardiac in origin •Causes: shock, burns, aspiration, and smoke inhalation acute hypoxemia •Complications: respiratory and metabolic acidosis; pulmonary fibrosis; pneumothorax; bacterial infections; decreased lung function, muscle wasting; memory, cognitive, and emotional issues; and death Acute Respiratory Distress Syndrome (ARDS) Manifestations and Treatment - ANSWER •Manifestations: dyspnea, labored and shallow respirations, rales, productive cough with frothy sputum, hypoxia, cyanosis, fever, hypotension, tachycardia, restlessness, confusion, lethargy, and anxiety •Treatment: endotracheal intubation with mechanical ventilator, oxygen therapy, corticosteroids, antibiotics (if bacterial infections are present), and emboli precautions Cystic Fibrosis - ANSWER •Life-threatening condition resulting in severe lung damage and nutrition deficits •Affects cells that produce mucus, sweat, saliva, and digestive secretions -Secretions become thick and tenacious. •Caused by mutation on seventh chromosome, leading to abnormality in protein involved in chloride cellular transport •Autosomal recessive •Complications: atelectasis, recurrent infections, cor pulmonale, respiratory failure, malabsorption, malnutrition, electrolyte imbalances, sterility, and infertility Cystic Fibrosis Manifestations and Treatment - ANSWER •Manifestations: meconium ileus, salty skin, steatorrhea, fat-soluble vitamin deficiency, chronic cough, hypoxia, fatigue, activity intolerance, audible rhonchi, and delayed growth and development •Treatment -Replace pancreatic enzyme, bile salt, and fat-soluble vitamins -High-protein and low-fat diet -Increased fluid intake -Intensive chest physiotherapy -Postural drainage -Coughing exercises -Humidified air -Bronchodilators -Regular, moderate exercise -Early, aggressive treatment of infections with antibiotics -Oxygen therapy Heart-lung transplant Pneumothorax - ANSWER Air in the pleural cavity •Manifestations: sudden chest pain, chest tightness, dyspnea, tachypnea, decreased breath sounds over the affected area, asymmetrical chest movement, trachea and mediastinum deviation, anxiety, tachycardia, pallor, and hypotension pulmonary embolism - ANSWER clot or other material lodges in vessels of the lung Arterial blood gas (ABG) - ANSWER acidosis alkalosis An ABG is a blood test that measures the acidity, or pH, and the levels of oxygen (O2) and carbon dioxide (CO2) from an artery. The test is used to check the function of the patient's lungs and how well they are able to move oxygen into the blood and remove carbon dioxide. Acidosis - ANSWER pH below 7.35 Alkalosis - ANSWER pH above 7.45 Anemia - ANSWER •Results from a decreased number of erythrocytes, reduction of hemoglobin, or presence of abnormal hemoglobin •Decreases O2-carrying capacity, leading to tissue hypoxia •Several types with varying etiology •General manifestations: weakness, fatigue, pallor, syncope, dyspnea, and tachycardia Polycythemia - ANSWER •Abnormally high erythrocytes •Rare •Considered a neoplastic disease •Increased blood volume and viscosity, leading to tissue ischemia and necrosis •Complications: thrombosis, hypertension, heart failure, hemorrhage, splenomegaly, hepatomegaly, and acute myeloblastic leukemia Polycythemia Manifestations and Treatment - ANSWER •Manifestations: cyanotic or plethoric skin, high blood pressure, tachycardia, dyspnea, headaches, visual abnormalities •Treatment: chemotherapy, radiation, phlebotomy, and managing clotting disorders Leukopenia - ANSWER Abnormally low white blood cell count •Normal range = 5,000 to 10,000 cells/mL3 blood Thrombocytopenia - ANSWER low platelet count •Normal platelet levels range from 150,000 to 350,000 cells/mL3 Leukemia - ANSWER •Second most common blood cancer •Cancer of the leukocytes •Leukemia cells abnormally proliferate, crowding normal blood cells Acute lymphoblastic leukemia - ANSWER •Affects primarily children •Responds well to therapy •Good prognosis Acute myeloid leukemia - ANSWER •Affects primarily adults •Responds fairly well to treatment •Prognosis somewhat worse than that of acute lymphoblastic leukemia Chronic lymphoid leukemia - ANSWER •Affects primarily adults •Responds poorly to therapy, yet most patients live many years after diagnosis Chronic myeloid leukemia - ANSWER •Affects primarily adults •Responds poorly to chemotherapy, but the prognosis is improved with allogeneic bone marrow transplant Leukemia Manifestations and Treatment - ANSWER •Manifestations: leukopenia, anemia, thrombocytopenia, lymphadenopathy, joint swelling, bone pain, weight loss, anorexia, hepatomegaly, splenomegaly, and central nervous system dysfunction •Treatment: chemotherapy and bone marrow transplant Lymphoma - ANSWER •Cancers affect lymphatic system •Most common hematologic cancer in the US •Two main types -Hodgkin's Non-Hodgkin's Hodgkin's Lymphoma Staging - ANSWER •Staging -Stage I: The lymphoma cells are in one lymph node group or one part of a tissue or an organ. -Stage II: The lymphoma cells are in at least two lymph node groups on the same side of the diaphragm, or the lymphoma cells are in one part of a tissue or an organ and the lymph nodes near that organ. -Stage III: The lymphoma cells are in lymph nodes above and below the diaphragm. Lymphoma cells may be found in one part of a tissue or an organ near these lymph node groups. Cells may also be found in the spleen. -Stage IV: Lymphoma cells are found in several parts of one or more organs or tissues, or the lymphoma cells are in an organ and in distant lymph nodes. -Recurrent: The disease returns after treatment. Non-Hodgkin's Lymphoma - ANSWER No Reed-Sternberg cells Sickle Cell Anemia - ANSWER •Neither recessive nor dominant—co-dominant. •Hemoglobin S causes erythrocytes to be abnormally shaped. •Abnormal erythrocytes carry less oxygen and clog vessels, causing hypoxia and tissue ischemia. Sickle cell trait - ANSWER -Heterozygous. -Less than half of erythrocytes are sickled. Sickle cell disease - ANSWER -Homozygous. -Most severe. -Almost all erythrocytes are sickled. Sickle Cell Anemia Manifestations and Treatment - ANSWER •Manifestations -Typically appear around 4 months of age -Sickle cell crisis •Painful episodes that can last for hours to days •Pain caused by tissue ischemia and necrosis •Triggered by dehydration, stress, high altitudes, and fever •Manifestations include abdominal pain, bone pain, dyspnea, delayed growth and development, fatigue, fever, jaundice, pallor, tachycardia, skin ulcers, angina, excessive thirst, frequent urination, priapism, and vision impairment •Treatment -No cure, palliative -Stem cell research showing promise -Medications (e.g., Hydrea [hydroxyurea]) -Avoid sickling triggers -Other strategies: oxygen therapy, hydration, pain management, infection control, vaccinations, blood transfusions, bone marrow transplants, genetic counseling Thalassemia major - ANSWER Thalassemia major is the most severe form of beta thalassemia. It develops when beta globin genes are missing. The symptoms of thalassemia major generally appear before a child's second birthday. The severe anemia related to this condition can be life-threatening. Hemophilia A - ANSWER •X-linked recessive bleeding disorder •Deficiency or abnormality of clotting factor VIII •Varies in severity •Manifestations: bleeding or indications of bleeding (e.g., bruising, petechia, etc.) •Treatment: clotting factor transfusions, recombinant clotting factors, desmopressin (DDAVP), and bleed precautions Disseminated Intravascular Coagulation DIC - ANSWER •Life-threatening complication of many conditions •Results from an inappropriate immune response •Widespread coagulation followed by massive bleeding because of the depletion of clotting factors •Complications: shock and multisystem organ failure Disseminated Intravascular Coagulation Manifestations and Treatment - ANSWER •Manifestations: tissue ischemia and abnormal bleeding •Treatment: identify and treat underlying cause, replace clotting components, and prevent activation of clotting mechanisms Thalassemia - ANSWER •Autosomal dominant inheritance •Abnormal hemoglobin from a lack of one of two proteins that make up hemoglobin (alpha and beta globin) •Manifestations: abortion, delayed growth and development, fatigue, dyspnea, heart failure, hepatomegaly, splenomegaly, bone deformities, jaundice Hypertension - ANSWER •Prolonged elevation in blood pressure. •Excessive cardiac workload due to vasoconstriction, which leads to increased afterload. •Vasoconstriction decreases renal blood flow, leading to inappropriate activation of the renin-angiotensin-aldosterone system. •Hypertension can be classified into systolic or diastolic based on which measure is elevated. Primary hypertension - ANSWER -Most common form -Develops gradually over time Secondary hypertension - ANSWER -Tends to be more sudden and severe -Causes: renal disease, adrenal gland tumors, certain congenital heart defects, certain medications, and illegal drugs Malignant hypertension - ANSWER -Especially intense form -Does not respond well to treatment Pregnancy-induced hypertension - ANSWER -Hypertension first seen in pregnancy -Indicators: high blood pressure, proteinuria, and edema -Risk factors: history of pregnancy-induced hypertension, renal disease, diabetes mellitus, multiple fetuses, and maternal age less than 20 years or greater than 40 years -Complications: seizures, miscarriages, poor fetal development, and placental abruption Treatment: bed rest and magnesium sulfate Hypertension Manifestations Complications and Treatment - ANSWER •Manifestations -"Silent killer" -Symptoms, when present, include fatigue, headache, malaise, and dizziness •Complications: atherosclerosis, aneurysms, heart failure, stroke, hypertensive crisis, renal damage, vision loss, metabolic syndrome, and memory problems •Treatment: -Based on JNC8 standards. -Early detection and management are essential to prevent complications. Heart Failure - ANSWER •Inadequate pumping •Leads to decreased cardiac output, increased preload, and increased afterload •Causes of heart failure: congenital heart defects, myocardial infarction, heart valve disease, dysrhythmias, thyroid disease •Compensatory mechanisms activated. -Activation of the sympathetic nervous system -Activation of the renin-angiotensin-aldosterone system -Ventricular hypertrophy •The compensatory mechanisms help at first, but create a vicious cycle (perpetuate heart failure). Coronary Artery Disease - ANSWER •Atherosclerotic changes of the coronary arteries •Impairs myocardial tissue perfusion •Angina: chest pain resulting from myocardium ischemia •Infarction: necrotic damage to the myocardium •Causes: atherosclerosis, vasospasms, thrombus, and cardiomyopathy Coronary Artery Disease Manifestations, Complications - ANSWER •Complications: myocardial infarction, heart failure, dysrhythmias, and sudden death •Manifestations: angina, indigestion-like sensation, nausea, vomiting, clammy extremities, diaphoresis, and fatigue Atherosclerosis - ANSWER •Chronic inflammatory disease characterized by thickening and hardening of the arterial wall. •Inflammatory process is triggered by a vessel wall injury. •Lesions develop on the vessel wall and calcify over time. •Leads to vessel obstruction, platelet aggregation, and vasoconstriction •Complications: peripheral vascular disease, coronary artery disease, thrombi, hypertension, and stroke •Manifestations: asymptomatic until complications develop •Treatment: similar to dyslipidemia with the addition of angioplasty, bypass, laser procedures, and artherectomy Peripheral Vascular Disease - ANSWER •Narrowing of the peripheral vessels •Causes: atherosclerosis, thrombus, inflammation, and vasospasms •Thromboangiitis obliterans: an inflammatory condition of the arteries •Raynaud's disease: vasospasms of arteries, usually in the hands, because of sympathetic stimulation -Raynaud's phenomenon: associated with an autoimmune condition •Manifestations: pain, intermittent claudication, numbness, burning, nonhealing wounds, skin color changes, hair loss, and impotency •Treatment: reducing contributing factors, angioplasty, bypass procedures, laser procedures, atherectomy, antiplatelet agents, anticoagulants, thrombolytics, and lipid-lowering agents peripheral artery disease - ANSWER A form of peripheral vascular disease in which there is partial or total blockage of an artery, usually one leading to a leg or arm. acute coronary syndrome - ANSWER sudden symptoms of insufficient blood supply to the heart indicating unstable angina or acute myocardial infarction Myocardial Infarction - ANSWER •Death of the myocardium. •Coronary artery blood flow is blocked due to atherosclerosis, thrombus, or vasospasms. •Manifestations -Some are asymptomatic—"silent" MI. -Symptoms, when present, include angina, fatigue, nausea, vomiting, shortness of breath, diaphoresis, indigestion, elevation in cardiac biomarkers, electrocardiogram changes, dysrhythmias, anxiety, syncope, and dizziness. •Treatment -Varies depending on timing of treatment. -Immediately: morphine, oxygen, nitrate, aspirin; thrombolytics can also be administered. -Post-MI: similar to those for atherosclerosis. Stable Angina - ANSWER goes away with demand reduction Unstable Angina - ANSWER increased intensity or frequency, does not go away with demand reduction, or occurs at rest Shock - ANSWER •Decreased blood volume or circulatory stagnation resulting in inadequate tissue and organ perfusion Cardiogenic shock - ANSWER Left ventricle cannot maintain adequate cardiac output. Anaphylactic shock - ANSWER Excessive allergic reaction Hypovolemic shock - ANSWER Venous return reduces because of external blood volume losses. Distributive shock - ANSWER A condition that occurs when there is widespread dilation of the small arterioles, small venules, or both. Sympathetic Nervous Systems - ANSWER Controls fight or flight response Heart rate increases Blood pressure increases Pupils open Ventilation - ANSWER The process of inspiration and expiration Alveoli - ANSWER air sacs in the lung where gas exchange occurs. Potassium and Magnesium - ANSWER electrolytes that are higher concentrated within the cell symptom - ANSWER subjective evidence of a disease, such as pain or a headache sign - ANSWER objective evidence of disease such as a fever cause of edema - ANSWER A decrease of plasma protein. The pressure change causes a fluid shift. appendicitis - ANSWER inflammation of the appendix right lower quadrant pain Balance - ANSWER Another word for homeostasis hemostasis - ANSWER First stage - clotting vascular spasm Platelets aggregate during acute respiratory failure - ANSWER oxygen levels are down CO2 levels are up A pulmonary embolism - ANSWER A DVT in the lower extremity can cause this A sensitive indicator of neurological change - ANSWER level of consciousness Use Glasgow Coma Scale to measure cystitis - ANSWER inflammation of the bladder Glands that regulate calcium - ANSWER thyroid gland - T3, T4, calcitonin parathyroid gland - parathyroid hormone Right sided heart failure symptoms - ANSWER Peripheral edema (legs and hands common) Left sided heart failure symptoms - ANSWER pulmonary edema, wet coughing, shortness of breath, and dyspnea multiple sclerosis - ANSWER demyelination - destruction to the myelin sheath disruptions in nerve impulse conduction Anaphalaxis - ANSWER lungs - narrow and constrict capillary - dilate / increase peripherally - swell because vessels open Liver failure - ANSWER yellow skin yellow sclera distended abdomen asthma - ANSWER wheezing SOB - shortness of breath cough coronary artery disease (CAD) - ANSWER atherosclerotic plaque builds up and damages the endothelium of the coronary arteries emphysema lecture - ANSWER damage to the alveoli air can get in, but not out myocardial infarction symptoms - ANSWER chest pain that persists shoulder pain jaw pain pain in left arm