Rasmussen Patho Final Exam Questions and Answers

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Causes include ingestion of alcohol, aspirin, NSAIDs; can also be caused by a virus, bacteria, an autoimmune disorder Treatment: Remove the offending agent! Chronic Gastritis - ANSWER *H.Pylori is ... almost always a factor Causes: Person-to-Person, Fecal/Oral, Reservoir in water sources Complications: PUD, Atrophic Gastritis, Gastric Adenocarcinoma, Mucosal Lymphoma, Decreased Acid, and Intrinsic Factor PUD - Peptic Ulcer Disease - ANSWER Disorders of the upper GI Tract caused by the action of Acid and Pepsin. Injury to the mucosa of the esophagus, stomach, and duodenum. Causes: *H.Pylori (HIGHLY CONTAGIOUS), NSAIDs, Stress, Smoking, and Genetics Clinical Manifestations: Epigastric burning pain (relieved by food intake or antacids) Complications: GI Bleeding and Perforation Tx: Sulcralfate, PPIs, Avoid caffeine and alcohol PUD - Ulcer Types: MOST COMMON - ANSWER Gastric Ulcer: Pain occurs on an empty stomach; may present soon after a meal Duodenal Ulcer: Pain 2-3 hours after meal; relieved by food intake Ulcerative Colitis (IBD - Inflammatory Bowel Disease) - ANSWER Chronic inflammation of the mucosa - rectal and colon - leading to large ulcers Complications: *Bloody Diarrhea, Lower abdominal pain; *Exacerbations and Remissions Treatment: Corticosteroids, Broad Spectrum Antibiotics Chron's Disease - ANSWER An immune-mediated disease that can affect any part of the digestive tract. There is NO CURE. Complications: Granulomas, Fistulas, Ulcerations, Strictures, and Fibrosis Bowel Obstruction Manifestations - Types - ANSWER Mechanical: Increased bowel sounds, abdominal pain, and N/V Functional: Absent bowel sounds Upper Jejunal: Vomiting, dehydration, and electrolyte depletion Distal Small Bowel/Ilium: Constipation What percentage of the pancreas is Endocrine function? - ANSWER 5% - Pancreas secretes hormones into the blood *Exocrine function: Pancreas secretes digestive juice into the duodenum Pancreatic Cancer - ANSWER About 2% of all CA; Ranks 4th among malignant deaths. Risks: Smoking, Obesity Manifestations: Jaundice, Malabsorption, weight loss, abdominal pain, nausea Tx: Surgery, Chemo Gastroesophageal Varices Management - ANSWER Varicies are a result of Portal Hypertension d/t Cirrhosis of the liver; Alcoholism and Viral Hepatitis Dx: Endoscopy, Abdominal CT Scan, Upper GI Barrium Tx: Fluids (NaCl), Administer Blood Products, Vasopressin IV, H2 Blockers, PPIs; Surgical Banding and Balloon Therapy Diverticulosis - ANSWER Syndrome of "Outpouchings"/Herniations through the muscular layer of the colon. *HIGH FIBER DIET Diverticulitis - ANSWER Inflammation of the "Outpouchings" *LOW FIBER DIET Assessment of Kidney Disease - ANSWER Palpation of the CVA for pain/tenderness *CVA = Costalvertebral Angle Kidney Cancer S/S - ANSWER Is typically asymptomatic until advanced. Most common is CVA tenderness, hematuria, palpable abdominal mass, dyspnea, cough, bone pain secondary to metastasis Dialysis Benefits and Risks - ANSWER Used for pts with ATN/CKD in stage 5 in order to remove metabolic waste and correct fluid and electrolyte imbalances. Pts are at risk for Hypotension after treatment because they Hypertensive prior to treatment. TYPES of Acute Kidney Injury (AKI) - ANSWER PRERENAL: Conditions that diminish perfusion of the kidney - Hypovolemia, Hypotension, Heart Failure, Renal Artery Obstruction, Fever, Burns, Edema, Ascites, ACE Inhibitors, NSAIDs POSTRENAL: Obstruction of the normal outflow of urine from kidneys - Renal Pelvis, Ureters, Bladder Outlet, Urethra Causes: BPH, Kinked Catheter, Intra-abdominal Tumors, Strictures, Calculi INTRINSIC/INTRARENAL: Primary dysfunction of the nephrons and the kidney itself! The most common problem within the renal tubules results in *ATN(Acute Tubular Necrosis). Causes of ATN: Nephrotoxic insults: Contrast Media, Sepsis, Vancomycin, Chemo; Lack of O2, Alcohol, Drugs PHASES of Acute Kidney Injury (AKI) - ANSWER PRODROMAL: *Insult to the kidney has already occurred. Serum BUN and Creatinine is ELEVATED. OLIGURIC: Normal urine output of 50-400mL daily. Oliguria, Uremia, decreased GFR, Hypervolemia. S/S: Fluid excess, Hyperkalemia, Uremic Syndrome, Metabolic Acidosis POSTOLIGURIC: Termination of the Oliguric phase represents recovery. Urine volume increases, tubular function improves fluid volume deficit until kidneys recover. Cystitis - ANSWER Acute onset of frequency, Urgency and Dysuria, Suprapubic Pain, Hematuria, Cloudy Urine. LOC in elderly could present as Dementia, as well as new-onset incontinence. Toxic Causes of Intrarenal Kidney Injury - ANSWER Prolonged postrenal failure, blood transfusion reaction, antibiotics/antifungal, antiviral, *CONTRAST MEDIA, chemo drugs, recreational drugs, snake venom, environmental factors Renin Angiotensin-Aldosterone System (RAAS) and the relationship between the autoregulation and the kidneys - ANSWER Kidneys attempt to: Regulate Perfusion and Maintain GFR Glomerulus - ANSWER Is located in the Nephron inside the kidney. It is also the site of fluid filtration Gomerulonephritis - ANSWER Inflammation of the glomeruli within the kidney. Immune-mediated conditions that produce IgA Nephropathy, Berger's Disease: These are the most commonly diagnosed What will be spilling into the urine? PROTEIN! Characterized by abrupt onset of hematuria, proteinuria, oliguria, edema, and hypertension Staph infection associated with glomerulonephritis Type I Diabetes - ANSWER *Makes NO insulin. It is characterized by the destruction of B cells of the pancreas. It affects children and adolescents. HYPERGLYCEMIA Type II Diabetes - ANSWER *Insulin Resistant and is the most common type of diabetes. What is resistant to the insulin? CELLS and PERIPHERAL TISSUE. Risks include: Obesity, Aging, Sedentary Lifestyle Polys of Diabetes - ANSWER *Hyperglycemia: Polydipsia, Polyphasia, Polyuria Cushing's Syndrome - ANSWER *Hypercortisolism: Characterized by mood swings, insomnia, Moon Face, Fine hair, Hirsutism, Truncal Obesity, Thin skin Traumatic Brain Injury (TBI) - ANSWER A traumatic insult to the brain capable of producing physical, intellectual, emotional, social, and vocational changes. *Leading cause of death and disability in the U.S. TBI - Primary Injury - ANSWER Result of the initial trauma or injury on brain cells. Focal:Localized Injury Polar: Caused by acceleration/deceleration movement of brain within the the skull: Double injury Diffuse: Caused by movement of brain within the skull: Axonal injury TBI - Secondary Injury - ANSWER Increases ICP and pt usually dies Reperfusion Injury - ANSWER Secondary injury that occurs after reestablishing blood flow. Tx/Therapy: Medication, Surgery to restore blood flow to blocked arteries Increased Cranial Pressure (ICP) - ANSWER The pressure exerted by the contents of the cranium. 0-15 mm Hg The volume of the cranium consists of CSF, Blood and Brain Tissue The patient might be sedated. May need to raise the HOB and ensure there is no stimulation in the environment What is the most sensitive indicator of altered brain function? - ANSWER Change in the patient's LOC! Cerebrovascular Disease (CVA): Types of Stroke - ANSWER ISCHEMIC: Sudden occlusion of a cerebral artery secondary to thrombus formation or embolization. Insufficient blood flow to the brain tissue results in oxygen deprivation and rapid cerebral deterioration. Thrombotic is r/t atherosclerosis and hypercoaguability Embolic is r/t cardiac source HEMORRHAGIC: Intracerebral brain bleed Diagnosed by CT Scan! Meningitis - ANSWER Inflammation of the meninges of the brain and spinal cord. Microbial invasion of the CNS. Streptococcus Pneumoniae is the most common bacterium. Bacteria reaches the CNS via the bloodstream, para-nasal sinuses or ears Encephalitis - ANSWER Inflammation of the brain usually caused by a virus. Herpes Virus is the most common viral cause. Glascow Coma Scale (GCS) - ANSWER A neurological scaled used to determine the level of consciousness of a patient. Mild 13-15 Moderate 9-12 Severe 8 or below Seizure Disorders: Classifications - ANSWER Generalized: Whole-brain surface is affected Absence (Petit-Mal): Kids, Staring spells Atypical Absence: Myoclonic Jerks Myoclonic: Single to Several Jerks Atonic: DROP attack/Fall down Tonic-Clonic (Grand-Mal): Jerking/Many Muscles Status Epilepticus - ANSWER Back-to-Back Seizures with no recovery in between episodes Dementia - ANSWER A slowly progressive decline in mental abilities, including memory, thinking, and judgment, that is often accompanied by personality changes What is NOT a clinical manifestation of HYPONATREMIA? - ANSWER THIRST T or F: Thirst is a clinical manifestation of HYPERnatremia - ANSWER True What electrolytes are affected by the kidney's inability to regulate? - ANSWER Potassium, Phosphorous, Magnesium Hypoventilation is a build up of what? - ANSWER PaCO2 What is the goal for a pt with ARDS (Acute Respiratory Distress Syndrome) - ANSWER Keep the pts PaO2 value >60! What is the tx for Tension Pneumothorax? - ANSWER Emergent needle aspiration/decompression *Chest tube placement with H2O seal Pneumonia - ANSWER Inflammatory reaction in the alveoli and interstitium of the lung. *Can result from 3 sources: 1. Aspiration of Oropharyngeal secretions composed of normal bacterial flora and/or gastric contents 2. Inhalation of contaminants (virus-Mycoplasma) 3. Contamination from the systemic circulation Classifications: Community or Hospital-Acquired, bacterial, atypical, and viral. Risks: Elderly, pts with a diminished gag reflex, critically ill, pts hospitalized, hypoxic pts, immunocompromised pts C.Manifestations: Chills, cough, fever, headache, malaise Dx: Chest x-ray, Sputum C&S, WBC>15,000 Tx: Antibiotic Therapy How is TB transmitted? - ANSWER Airborne, Droplet; Spreads via Cough, Sneeze, Shouting, Singing Sources of Electrolyte Stores - ANSWER BONES serve as a reservoir of calcium, magnesium, phosphate ions. CELLS serve as a reservoir of potassium, magnesium, phosphate and calcium ions **Also known as ELECTROLYTE POOLS!! Anemia - ANSWER Lack of RBCs to carry O2 to tissues. S/S: Tired, Weak, Fatigue What is the hormone that kidneys secrete? - ANSWER *ERYTHROPOIETIN: Stimulates production of RBCs Polycythemia - ANSWER RBCs are present in excess, increasing blood viscocity and causing hypertension. Thrombocytopenia - ANSWER A common cause of Generalized bleeding. Regardless of the cause, fewer platelets are available, and inadequate hemostasis is the potential result! Causes: Radiation, Chemo, Anemia, Bone cancer, viral and bacterial infections, DIC, Splenomegaly, Hypothermia, Massive blood transfusions C.Manifestations: Spontaneous mucosal, deep tissue, and intracranial bleeding Dx: Low platelet count Tx: dc suspected drug, avoid aspirin *Administer corticosteroids, immunosuppressants, IV immunoglobulin, rituximab *Splenectomy may be helpful: removes a major site of platelet destruction DIC (Disseminated Intravascular Coagulation) - ANSWER Acquired hemorrhagic syndrome in which both clotting and bleeding occur simultaneously. Widespread clotting in small vessels leads to the consumption of the clotting factors and platelets causing bleeding. Tx: Removal or correction of the underlying cause and support of major organ systems. Replacement of depleting clotting factors with fresh frozen plasma, packed RBCs, platelets, or cryoprecipitate may be needed. Chronic Myelogenous Leukemia (CML) - *Diagnosis is by identifying which chromosome abnormality? - ANSWER Ph+ (Philadelphia Chromosome) S/S: High granulocyte count on CBC and splenomegaly. Fatigue, Weight Loss, Diaphoresis, Bleeding, Abdominal pain d/t enlarged spleen *Prognosis is POOR GERD (Gastroesophageal Reflux Disease) - ANSWER Backflow of gastric contents into the esophagus through the LES. C.Manifestations: Heartburn, regurgitation, chest pain, dysphagia Complications: Esophageal strictures; Barret Esophagus, Pulmonary symptoms r/t esophagitis: cough, asthma, and laryngitis Tx: PPIs are the mainstays fo treatment for chronic GERD. However, long-term use can lead to malabsorption of vitamin B12, iron, magnesium, and calcium. Increasing LES pressure, enhancing esophageal clearance, improving gastric emptying and suppressing gastric acidity. Avoid smoking and aggravating food/drink, OTC antacids and histamine blockers. Initial symptoms of Malignancies - ANSWER Weight loss, decreased appetite, cough, lumps, change in bowel or bladder habits, bleeding, discharge, fever What would a nurse expect to find in a pt with ARF (Acute Respiratory Failure)? - ANSWER Respiratory Acidosis A toddler ingested morphine, a medication that causes respiratory depression. What condition(s) would you monitor this pt for? - ANSWER Hypoxemia and Hypercapnia Severe hypoxemia is a common finding in a serious condition known as: - ANSWER ARDS (Acute Respiratory Distress Syndrome) Patients with COPD experience air trapped in the alveoli. This leads to the appearance of: - ANSWER Barrel chest Hypoventilation has symptoms r/t: - ANSWER Decreased CO2 in the alveoli What equipment would you need in the emergency treatment for a pt with a Tension Pneumothorax? - ANSWER Chest tube with H2O seal What is the essential complication of Anemeia? What is the goal of the treatment for Anemia? - ANSWER Complication is tissue hypoxia, and the goal for treatment is to restore tissue oxygenation Which of the following are CM of Left Sided Heart Failure? Select all that apply. Jugular Venous Distension Cough with frothy sputum Crackles auscultated in lungs Dyspnea - ANSWER Cough with frothy sputum, Crackles aus [Show More]

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