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NR |! 545 |! PATHOPHYSIOLOGY |! EXAM|| |! || |! ACTUAL |!
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- This |! area |! is |! the |! most |! common |! site |! for |! epistaxis |! to |! occur |!
- |! Kiesselbach’s |! plexus
- This |! class |! of |! medication |! binds |! to |! specific |! receptors |! on |! beta |! cells |! in |! the |! pancreas |! to |! stimulate |! the |! release |! of |! insulin
- Sulfonylureas |! and |! Meglitinides
- This |! acute |! situation |! in |! a |! patient |! with |! uncontrolled |! hyperthyroidism |! is |! usually |! precipitated |! by |! infection |! or |! surgery. |! It |! is |! life |! threatening |! because |! of |! the |! resulting |! hyperthermia, |! tachycardia, |! and |! heart |! failure |! and |! delirium. |! Thyrotoxicosis
- These |! are |! chemical |! messengers |! that |! may |! be |! classified |! by |! action, |! source, |! or |! chemical |! structure. |! Hormones
- These |! two |! body |! systems |! work |! together |! to |! regulate |! metabolic |! activities. |! Endocrine |! and |! Neuro
- A |! harmless |! microbe |! that |! is |! normally |! resident |! in |! the |! intestine. |! E-coli
- This |! is |! the |! mechanism |! of |! action |! of |! tamsulosin |! when |! treating |! benign |! prostatic |! hypertrophy. |! Alpha |! 1 |! blocker
- This |! condition |! is |! concerning |! in |! a |! client |! who |! has |! had |! pyelonephritis |! and |! subsequent |! scarring
- chronic |! renal |! failure
- This |! is |! indicative |! of |! the |! leakage |! of |! albumin |! into |! the |! filtrate |! due |! to |! inflammation |! and |! increased |! capillary |! permeability APSGN |! – |! acute |! post-streptococcal |! GN
- This |! lab |! results |! indicates |! a |! failure |! to |! excrete |! nitrogen |! wastes |! due |! to |! decreased |! GFR
- BUN |! and |! Serum |! Creatinine
- Most |! common |! cause |! of |! hyperaldosteronism? Noncancerous |! (benign) |! tumor |! of |! the |! adrenal |! gland Pheochromocytoma
- This |! class |! of |! medication |! reduces |! the |! amount |! of |! stomach |! acid |! produced |! in |! the |! lining |! of |! the |! stomach
- This |! involves |! the |! transfer |! of |! gases |! between |! air-filled |! spaces |! in |! the |! lungs |! and |! blood |! – Diffusion |! / |! Gas |! Exchange
- Statins |! reduce |! inflammation, |! modify |! composition, |! and |! promote |! stabilization |! of within |! the |! vessel |! wall |! – |! plaque |! stabilization
- This |! medication |! class |! is |! contraindicated |! in |! heart |! failure |! due |! to |! risk |! of |! fluid |! retention
- This |! bacteria |! category |! is |! most |! commonly |! associated |! with |! Urinary |! tract |! infections |! - E-coli |! (gram |! negative) |! produces |! nitrites |! in |! urine Urine |! WBC |! 95% |! sensitivity Urine |! Leukocyte |! esterase |! 60-90% |! sensitivity
- This |! physical |! exam |! maneuver |! is |! completed |! by |! instructing |! the |! client |! to |! lift |! the |! right |! leg |! against |! gentle |! pressure |! applied |! by |! the |! examiner |! to |! help |! indicate |! acute |! appendicitis |! - |! Psoas
- This |! test |! is |! inexpensive |! and |! most |! reliable |! test |! for |! Helicobacter |! pylori |! – |! Breath |! test |! or |! Stool |! H. |! Pylori
- This |! organ |! structure |! produces |! and |! secretes |! bile |! to |! emulsify |! fats |! - |! liver
- This |! is |! the |! most |! common |! cause |! of |! hyperaldosteronism |! – |! tumor |! adrenal |! gland |! or |! pheo
- This |! condition |! causes |! an |! opacity |! on |! the |! lens |! and |! decreased |! visual |! acuity |!
- In |! male |! clients, |! this |! bacteria |! is |! the |! most |! causative |! agent |! - |! E-coli |! UTI?
- The |! MOA |! of |! beta |! blockers |! in |! clients |! with |! heart |! failure |! – |! reduce |! myocardial |! workload
- Use |! of |! carvedilol |! for |! heart |! failure |! has |! been |! associated |! with |! this |! compared |! to |! atenolol |! - Beta |! 2 |! blockade? |! – |! bronchoconstriction Carvedilol |! is |! a |! mixed |! nonselective |! beta |! blocker |! affecting |! beta |! 1, |! beta |! 2 |! and |! alpha |! 1 |! receptors. Beta |! 1 |! – |! when |! stimulated |! increases |! heart |! rate, |! AV |! conduction |! and |! contractility Beta |! 2 |! – |! when |! stimulated |! produces |! vasodilatory |! effects |! on |! vascular |! smooth |! muscle |! cells |! in |! the |! lungs |! and |! uterus
Anatomy, |! Physiology, |! Assessment, |! Diagnosis |! and |! Treatment |! of |! the |! following |! Endocrine: Type |! I |! Diabetes -autoimmune |! destruction |! of |! pancreatic |! beta |! cells |! > |! severe |! insulin |! deficiency -caused |! by |! T |! lymphocytes. |! Islet |! cell |! antibodies |! are |! markers |! of |! beta |! call |! destruction Objective: |! loss |! of |! SQ |! fat, |! muscle |! wasting, |! blurred |! vision, |! postural |! hypotension Type |! II |! Diabetes -insulin |! resistance |! “hallmark |! for |! DM |! II |! and |! inadequate |! insulin -Obesity |! is |! main |! factor |! for |! DM |! II -stronger |! genetic |! component |! than |! type |! I |! DM Objective: |! obesity, |! local |! fat |! deposits, |! high |! waist |! circumference |! 40/35, |! -Acanthosis |! nigricans |! is |! dark |! discoloration |! of |! body |! folds |! and |! creases, |! HTN Labs: |! urine |! glucose, |! urine |! ketones |! fasting |! BG |! > |! 126 |! mg/dl |! HbA1c |! >6.4% |! Oral |! glucose |! tolerance |! test
Insulin: Insulin Onset|! Peak |! Duration |! Rapid |! Acting: |! 1513 |! Novolog |! Humalog |! Apidra 15-30 |! minutes 30 |! minutes- |! 2.5 |! hours 3-6.5 |! hours Short |! Acting: |! 3026 |! Regular |! insulin |! Humulin |! R |! Novolin |! R 30-60 |! minutes 2-3 |! hours 4-6|! hours Intermediate: |! 2616 |! NPH Humulin |! N |! Novolin |! N 1-2 |! hours 6-14 |! hours 16-24|! hours |! Long |! Acting: |! 124 |! Glargine 1 |! hour >24 |! hours Long |! Acting: |! Levemir 1-2 |! hours 6-8 |! hours 12 |! hours |! 0.2 |! u/kg 20 |! hours|! 0.4|! u/kg |! Albumin |! bound
Diabetes |! insipidus |! Hyperaldosteronism Cushing's|! syndrome/disease |! Hyperthyroidism |! Addison’s |! disease Endocrine |! hormones |! (cortisol, |! thyroid |! stimulating) Exam |! III |! Study |! Guide All |! content |! topics |! from |! Exam |! I |! and |! Exam |! II |! Study |! Guide +Plus+ Anatomy, |! Physiology, |! Assessment, |! Diagnosis |! and |! Treatment |! of |! the |! following |! Renal: GFR Anatomy Total |! amount |! of |! filtrate |! formed |! by |! the |! renal |! corpuscles |! in |! both |! kidney |! per |! minute. |! (First |! step |! in |! making |! urine) Physiology |! The |! kidneys |! may |! fail |! to |! function |! for |! many |! different |! reasons. |! Either |! directly |! reduced |! blood |! flow |! into |! the |! kidney |! or |! inflammation |! and |! necrosis |! of |! the |! tubules |! cause |! obstruction |! and |! back |! pressure, |! leading |! to |! greatly |! reduced |! GFR |! and |! oliguria |! (reduced |! urine |! output) |! or |! anuria |! (no |! urine |! output). Assessment
Diagnosis Elevated |! serum |! urea |! (blood |! urea |! nitrogen |! [BUN]) |! and |! serum |! creatinine —indicate |! failure |! to |! excrete |! nitrogen |! wastes |! (resulting |! from |! protein |! metabolism) |! due |! to |! decreased |! GFR Metabolic |! acidosis |! (decreased |! serum |! pH |! and |! decreased |! serum |! bicarbonate)— |! indicates |! decreased |! GFR |! and |! failure |! of |! the |! tubules |! to |! control |! the |! acid–base |! balanc Clearance |! tests, |! such |! as |! creatinine |! or |! insulin |! clearance, |! or |! radioisotope |! studies |! are |! used |! to |! assess |! GFR. Treatment Dialysis, |! either |! peritoneal |! or |! hemodialysis, |! may |! replace |! kidney |! function |! temporarily |! or |! long |! term. Proteinuria Anatomy Protein |! in |! the |! urine. Physiology |! Causes: |! dehydration, |! inflammation, |! hypotension, |! kidney |! stones Assessment |! Frequent |! urination, |! SOB, |! Edema |! in |! your |! face, |! feet, |! ankles, |! N&V, |! muscle |! cramping |! at |! night, |! foamy |! or |! bubbly |! urine Diagnosis Urinalysis. |! Creatinine |! test, |! GRF|! test, |! Treatment • Na |! restriction
- Protein |! and |! fluid |! intake |! is |! decrease |! (severe |! cases |! ) |! Drug |! treatments
- glucocorticoids |! to |! reduce |! the |! inflammation
- antihypertensives |! to |! reduce |! high |! blood |! pressure Creatinine/BUN
Fosfomycin |! for |! pregnant |! women. UTI Anatomy Inflammation |! of |! the |! bladder Physiology |! Bacteria |! ascends |! the |! urinary |! tract |! system |! causing |! an |! infection. |! Shorter |! urethra |! and |! the |! proximity |! of |! the |! vagina |! and |! anus |! can |! contribute |! to |! cystitis Assessment |! Dysuria, |! urgency, |! frequent |! urination, |! gross |! hematuria. |! Different |! smelling |! urine, |! suprapubic |! pain, |! low |! grade |! fever, |! suprapubic |! tenderness, |! urethral |! discharge, |! febrile Diagnosis Clean |! catch |! midstream |! urine |! collection Treatment Nitrofurantoin |! and |! Trimethoprim-sulfamethoxazole |! are|! considered |! first |! line |! treatment. Renal |! Colic Anatomy Physiology |! Obstruction |! of |! the |! ureter |! causes |! an |! attack |! of |! “renal |! colic,” Assessment |! • renal |! colic,” |! consisting |! of |! intense |! spasms |! of |! pain |! in |! the |! flank |! area |! radiating |! into |! the |! groin |! that |! last |! until |! the |! stone |! passes |! or |! is |! removed.
- The |! severe |! pain |! may |! be |! accompanied |! by |! nausea |! and |! vomiting, |! cool |! moist |! skin, |! and |! rapid |! pulse. Diagnosis Radiologic |! examination |! confirms |! the |! location |! of |! the |! calculi. Treatment • Small |! stones |! can |! be |! passed |! eventually |! and |! the |! urine |! strained |! to |! catch |! stones |! for |! analysis.
- extracorporeal |! shockwave |! lithotripsy, |! which |! uses |! sound |! waves |! to |! break |! up |! the |! stone, |! and |! laser |! lithotripsy, |! which |! uses |! a |! ureteroscope |! to |! locate |! the |! stone |! and |! a |! scope-mounted |! laser |! to |! destroy |! it |! percutaneous |! nephrolithotomy.
- In |! some |! cases, |! drugs |! may |! be |! used |! to |! partially |! dissolve |! the |! stones. Glomerulonephritis Pathophysiology Acute |! occurs |! after |! infections |! such |! as |! strep |! throat |! and |! are |! referred |! to |! as |! acute |! poststreptococcal |! glomerulonephritis. Chronic |! glomerulonephritis |! can |! be |! caused |! by |! HTN, |! DM, |! and |! CA Symptoms Subjective- |! Acute: |! abdominal |! pain, |! decreased |! urinary |! output, |! edema |! to |! face |! and |! ankles. Subjective- |! Chronic: |! decreased |! urinary |! output, |! edema |! to |! face |! and |! ankles, |! fever |! chills, |! weight |! loss, |! night |! sweats, |! and |! fatigue, |! rash, |! muscle |! aches, |! frequent |! nighttime |! urination, |! bubbly |! or |! foamy |! urine Objective- |! Acute: |! hematuria, |! proteinuria, |! hypertension, |! edema |! Objective- |! Chronic: |! hematuria, |! proteinuria, |! hypertension, |! edema, |! hypercoagulability Laboratory|! & |! diagnostic |! testing|! Urinalysis- |! proteinuria, |! hematuria, |! and |! erythrocyte |! casts |! CMP- |! elevated |! serum |! urea, |! creatine, |! pH GFR- |! decreased Treatment First |! line |! is |! penicillin |! which |! is |! a |! bactericidal If |! pt |! has |! mod |! to |! server- |! ACE |! inhibitor |! or |! angiotensin |! II |! receptor |! antagonists |! If |! fluid |! retention- |! diuretic If |! nephrotic |! syndrome- |! prednisone |! with |! immunosuppressants |! like |! cyclophosphamide |! and |! azathioprine Anatomy, |! Physiology, |! Assessment, |! Diagnosis |! and |! Treatment |! of |! the |! following |! GI: |! Gastric |! ulcer
Assessment |! Subjective:
- N/V/Diarrhea
- Abdominal |! cramping |! and |! pain
- Low-grade |! fever
- malaise |! Objective:
- May |! exhibit |! signs |! of |! dehydration |! (tachycardia, |! threaded |! pulse, |! hypotension |! and |! weight |! loss) |! abdominal |! pain |! and |! tenderness, |! guarading |! and |! an |! elevated |! temperature. tenesmus |! (persistent |! spasms |! of |! the |! rectum |! associated |! with |! a |! need |! to |! defecate) |! Diagnosis • No |! labs |! recommended |! in |! the |! diagnosis |! of |! viral |! enteritis
- Bacterial |! gastroenteritis |! is |! due |! to |! C.dif, |! rotavirus, |! salmonella, |! shigella |! and |! campylobacter.
- Giardia |! and |! cryptosporidium |! are |! found |! with |! parasitic |! infection |! CBC |! may |! note |! low |! WBC |! for |! suspected |! parasitic |! gastroenteritis, |! culture |! or |! stools |! studies |! (ova |! and |! parasites) |! will |! identify |! the |! organisms. Treatment First |! line:
- Hydration, |! rest, |! replacements |! electrolytes, |! management |! of |! pain/fever |! and |! observation.
- Antibiotic |! therapy, |! Azithromycin, |! Vancomycin, |! Metronidazole |! or |! Fidaxomicin- |! severe |! bacterial |! or |! parasitic. *antidiarrheals |! and |! antiemetics |! are |! not |! recommended |! spec |! - |! C.dif |! or |! E.coli Appendicitis Pathophysiology Inflammation |! and |! infection |! in |! the |! appendix Symptoms Initially |! causes |! periumbilical |! pain, |! then |! nausea |! and |! vomiting, |! and |! finally |! severe |! and |! localized |! pain |! to |! the |! lower |! right |! quadrant
McBurney’s |! Point |! With |! the |! client |! in |! a |! supine |! position, |! slowly|! apply|! pressure |! over |! McBurney’s |! point |! and |! quickly |! release; |! if |! there |! is |! severe |! pain |! when |! the |! pressure |! is |! released, |! it |! may indicate |! acute |! appendicitis. Treatment Surgical |! removal |! of |! the |! appendix |! and |! antibiotic |! treatment Abdominal |! assessments |! such |! as |! McBurney’s |! sign, |! Psoas |! sign, |! etc |! Helicobacter |! pylori Anatomy The |! most |! common |! causes |! of |! Peptic |! ulcers |! disease |! PUD |! include |! H.Pylori |! infection |! and |! the |! use |! of |! NSAIDSm |! H.pylori |! can |! be |! communicated |! through |! person |! to |! person |! contact |! and |! contaminated |! food |! and |! water. |! NSAIDS |! can |! cause |! erosions |! and |! weakening |! of |! the |! gastrointestinal |! lining |! allowing |! H.pylori |! to |! penetrate. |! 2 |! mayor |! PU |! 1) |! Duodenal |! 2) |! gastric Physiology Assessment |! Same |! as |! gastric |! ulcers |! Diagnosis Same |! as |! gastric |! ulcers Treatment |! Goulds |! Combination |! therapy|! for |! Helicobacter |! pylori |! infection |! Clarithromycin |! (Biaxin)
- Metronidazole |! (Flagyl)
- Tetracycline
- Cefoperazone
- Amoxicillin Antibacterials, |! such |! as |! clarithromycin |! (Biaxin) |! or |! azithromycin |! (Zithromax), |! are |! effective |! against |! Helicobacter |! pylori |! infection |! and |! are |! usually |! combined |! with |! a |! proton |! pump |! inhibitor |! such |! as |! omeprazole |! (Prilosec). |! Metronidazole |! is |! used |! to |! treat |! protozoal, |! helminthic |! as |! well |! as |! bacterial |! infections.
Diagnosis Labs |! or |! diagnostic |! test |! to |! test: |! urine |! glucose, |! urine |! ketose, |! fasting |! plasma |! or |! serum |! glucose |! (126 |! mg/dl |! or |! more), |! oral |! glucose |! tolerance |! testing |! if |! fasting |! plasma |! glucose |! is |! less |! than |! 126 |! mg/dl, |! HbA1C, |! serum |! fructosamine, |! and |! self-monitoring |! blood |! glucose Treatment Insulin: |! short-acting, |! rapid |! onset |! of |! action, |! short-acting |! regular, |! intermediate-acting, |! and |! long-acting. Diabetes |! insipidus Anatomy Diabetes |! insipidus |! results |! from |! a |! deficit |! of |! ADH. |! This |! deficit |! may |! originate |! in |! the |! neurohypophysis. Physiology |! Head |! injury |! or |! surgery |! may |! cause |! a |! temporary |! condition. |! In |! some |! cases, |! the |! condition |! is |! considered |! to |! be |! nephrogenic, |! when |! the |! renal tubules |! do |! not |! respond |! to |! the |! hormone. |! The |! latter |! may |! be |! genetic |! or |! linked |! to |! electrolyte |! imbalance |! or |! drugs. Assessment |! Polyuria |! with |! large |! volumes |! of |! dilute |! urine, |! Thirst, |! eventually |! causing |! severe |! dehydration |! (note |! that |! glucose |! is |! not |! present |! in |! the |! urine |! with |! diabetes |! insipidus |! as |! it |! is |! in |! cases |! of |! diabetes |! mellitus) Diagnosis Water |! deprivation |! test, |! MRI, |! genetic |! screening |! Treatment Replacement |! therapy |! for |! ADH |! is |! available. Hyperaldosteronism Anatomy Happens |! when |! one |! or |! both |! of |! your |! adrenal |! glands |! produce |! too |! much |! aldosterone. |! Adrenal |! glands |! are |! located |! at |! the |! top |! of |! each |! kidney. Physiology |! Aldosterone |! is |! a |! hormone |! that |! helps |! regulate |! your |! blood |! pressure |! by |! controlling |! levels |! of |! potassium |! and |! sodium |! in |! your |! blood. |! Most |! commonly |! caused |! by |! adrenal |! adenomas |! (noncancerous |! tumors)
Assessment |! Medical |! resisant |! high |! bp, |! hypernatremia, |! hypomagnesemia, Diagnosis BMP, |! PRC |! (plama |! renin |! concentration), |! or |! PRA |! (plasma |! renin |! activity), |! aldosteron |! suppression |! test |! (intake |! of |! Na |! then |! 24hr |! urine |! to |! measure |! aldosterone |! in |! urine), |! CT |! to |! check |! for |! tumor Treatment Main |! goal |! manage |! BP, |! surgery |! to |! remove |! tumor, |! Spironolactone |! (Aldactone), |! Eplerenone |! (Inspra), |! Amiloride |! (Midamor) |! *Males |! may |! experience |! erectile |! dysfunction |! and |! gyneomastia |! with |! long |! term |! use |! of |! spironolactone. Cushing's |! syndrome/disease Anatomy Manifestation |! of |! excessive |! corticosteroids |! from |! corticosteroid |! drugs |! Physiology |! Pituitary |! corticotropin |! secreting |! tumor Assessment |! Subjective: |! fatigue |! and |! reduced |! endurance, |! muscle |! atrophy |! caused |! weakness |! with |! difficulty |! standing |! up |! from |! a |! seated |! position |! or |! climbing |! stairs, |! backache, |! headache, |! oligomenorrhea |! or |! amenorrhea |! in |! women, |! erectile |! dysfunction |! in |! men Objective: |! truncal |! obesity |! with |! reddish |! purple |! cutaneous |! striae |! over |! the |! abdomen |! and |! other |! parts, |! dryness |! and |! pigmentation |! of |! the |! skin |! and fragility |! of |! skin |! vessels, |! excessive |! facial |! hair |! and |! baldness, |! cyanosis |! and |! mottling |! of |! the |! skin |! of |! the |! extremities |! and |! osteoporosis Diagnosis MRI, |! salivary |! cortisol |! (two |! measures), |! 24 |! hour |! free |! cortisol |! excretion, |! 1 |! mg |! dexamethasone |! suppression |! test Treatment Ketoconazole |! (1at|! step), |! metyrapone, |! mitotane, |! cabergoline, |! mifepristone, |! pasireotide Hyperthyroidism
