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a

—"enlarged prostate" proliferation of prostate glandular tissue that is a common age-related change-- begins at age 40-45 and continues until death; by age 60, 60% of men have an enlarged prostate.
b. S&S
1) as the gland enlarges it can compress the urethra where it passes through the prostate, resulting in varying degrees of obstruction to urinary flow.
2) S/S include urgency, delay in starting urine flow, decrease in flow of urine, urine retention
A. benign prostastic hyperplasia (BPH)
B. prostate cancer
C. testicular cancer
D. dysmenorrhea

a

b. S&S
1) as the gland enlarges it can compress the urethra where it passes through the prostate, resulting in varying degrees of obstruction to urinary flow.
2) S/S include urgency, delay in starting urine flow, decrease in flow of urine, urine retention
A. benign prostastic hyperplasia (BPH)
B. prostate cancer
C. testicular cancer
D. dysmenorrhea

a

diagnosis
1) history of S&S
2) enlarged prostate is felt on digital rectal exam (should be done yearly beginning at age 50).
3) sometimes PSA elevated.
d. treatment
1) certain meds geared towards decreasing size of prostate
2) also surgery to decrease size—TURP (transurethral resection of the prostate); a certain amount of hyperplastic tissue is "resected," meaning "surgically removed."
A. benign prostastic hyperplasia (BPH)
B. prostate cancer
C. testicular cancer
D. dysmenorrhea

b

malignant neoplastic condition of the prostate gland
b. the most common cancer in American males.
c. risk factors include age over 50, family history, a diet high in saturated fat, high testosterone levels (promotes tumor growth).
A. benign prostastic hyperplasia (BPH)
B. prostate cancer
C. testicular cancer
D. dysmenorrhea

b

often dx'd by elevated PSA -prostate-specific antigen
1) tumor marker that is specific to the prostate gland and will be elevated when there is an inflammatory or malignant process of the prostateoccurring.
2) this is measured yearly in men over 50 to screen for prostate cancer.
f. yearly routine screening should be done, starting between age 40-50, with PSA and rectal examination of the prostate.
A. benign prostastic hyperplasia (BPH)
B. prostate cancer
C. testicular cancer
D. dysmenorrhea

c

malignant neoplastic condition of the testicle.
b. occurs most commonly in age range 15-35; higher incidence in males with
unresolved cryptorchidism (undescended testes) because a testis that remains in the abdomen cannot be checked regularly for signs of cancer (_________can be detected early when regular self-exam done)
A. benign prostastic hyperplasia (BPH)
B. prostate cancer
C. testicular cancer
D. dysmenorrhea

d

_______________(undescended testes) associated with testicular cancer
A. benign prostastic hyperplasia (BPH)
B. gyncosims
C. dysmenorrhea
D. cryptorchidism

c

S&S
1) painless testicular mass is the usual presenting sign.
2) may have testicular heaviness or dull ache in the lower abdomen.
d. detection / treatment
1) has a cure rate of 95% when caught early; testicular self-exam should be done monthly, for early detection
2) surgery, radiation, or chemotherapy
A. benign prostastic hyperplasia (BPH)
B. prostate cancer
C. testicular cancer
:D. dysmenorrhea
18:30

d

infection
inflammation, discomfort in penis, sometimes dysuria, occasionally a discharge
A. benign prostastic hyperplasia (BPH)
B. prostatitis
C. testicular cancer
D. urethritis

b

infection
inflammation / infection of prostate— same S&S as above.
c. both most often caused by sexually transmitted infections (STIs) such as Chlamydia & gonorrhea.
A. benign prostastic hyperplasia (BPH)
B. prostatitis
C. GU Infection
D. urethritis

a

d. treatment
1) certain meds geared towards decreasing size
2) also surgery to decrease size—TURP (transurethral resection of the prostate); a certain amount of hyperplastic tissue is "resected," meaning "surgically removed."
A. benign prostastic hyperplasia (BPH)
B. prostatitis
C. GU Infection
D. urethritis

c

general term for menstruation that is more painful, frequent, and/or larger in bleeding volume than is normal.
b) most often cause by hormonal disturbances but variety of other causes.
A. benign prostastic hyperplasia (BPH)
B. endometriosis
C. dysmenorrhea
D. amenorrhea

d

absence of menses due to variety of causes (ex—anorexia, over-exercising); in later life can mean onset of menopause
A. benign prostastic hyperplasia (BPH)
B. endometriosis
C. dysmenorrhea
D. amenorrhea

b

__________presence of functioning endometrium outside the uterus.
1) affects 15% of women of reproductive age and can cause infertility.
2) caused by retrograde menstruation: in addition to being sloughed off with the menstrual blood via cervix & vagina, which is normal, endometrial tissue can abnormally escape into pelvic cavity via fallopian tubes
3) this ecotopic (out of place) endometrium responds to the menstrual hormones by proliferating and bleeding wherever it implants itself, just as if it is still in the uterus.
4) S&S include dyspareunia (pain during intercourse), dysmenorrhea, pelvic pain.
5) treatment usually involves hormonal therapy and/or surgery.
A. ecotopic
B. endometriosis
C. dysmenorrhea
D. amenorrhea

a

this ___________(out of place) endometrium responds to the menstrual hormones by proliferating and bleeding wherever it implants itself, just as if it is still in the uterus.
A. ecotopic
B. endometriosis
C. dysmenorrhea
D. amenorrhea

b

4) S&S include dyspareunia (pain during intercourse), dysmenorrhea, pelvic pain.
5) treatment usually involves hormonal therapy and/or surgery.
A. ecotopic
B. endometriosis
C. ovarian cancer
D. amenorrhea

c

malignant neoplastic condition of the ovaries with unknown etiology.
a. causes the most cancer deaths related to the female reproductive system-- by the time someone is diagnosed the cancer is often advanced and treatment is difficult.
b. early S&S very vague—bloating, mild abdominal discomfort, constipation
1) for this reason, if not found early during yearly pelvic exams often metastasizes before can be diagnosed
2) metastasizes intra-abdominally, causing such symptoms as pain, ascites (especially from liver involvement), dyspepsia, vomiting, alterations in bowel movements.
A. ecotopic
B. endometriosis
C. ovarian cancer
D. amenorrhea
31

a

infections
a. reproductive tract—
1) an infection in a woman's reproductive tract is often called ______
2) most often starts with STI (sexually transmitted infection) such as Chlamydia infecting and inflaming the cervix-- cervicitis (other STIs such as gonorrhea can cause PID too, but Chlamydia is most common)
3) infection often then spreads into uterus (endometritis and/or myometritis), fallopian tubes (salpingitis), and ovaries (oophertis) - salpingo-oopheritis = infection of fallopian tubes AND ovaries
4) S&S—varies according to how severe the infection & spread: a)usually abnormal vaginal discharge present
b) pelvic / abdominal pain usually has pattern of being worse with movement, so patient tends to want to be still
5) sequela—can cause infertility; tx—antibx, pain killers
A. pelvicinflammatory disease (PID)
B. endometriosis
C. ovarian cancer
D. amenorrhea

a

3) infection often then spreads into uterus (endometritis and/or myometritis), fallopian tubes (salpingitis), and ovaries (oophertis) - salpingo-oopheritis = infection of fallopian tubes AND ovaries
4) S&S—varies according to how severe the infection & spread: a)usually abnormal vaginal discharge present
b) pelvic / abdominal pain usually has pattern of being worse with movement, so patient tends to want to be still
5) sequela —can cause infertility; tx—antibx, pain killers
A. pelvicinflammatory disease (PID)
B. urologic infection
C. ovarian cancer
D. amenorrhea

b

can involve just bladder (cystitis) and/or kidneys (pyelonephritis) or entire tract (UTI—urinary tract infection)
2) pathogen can be bacterial, fungal, viral, or parasitic (most common organism of infection is E. coli, usually part of normal intestinal flora)
3) highest risk group—women, due to:
a) proximity of anus and vaginal os ("os" = "opening") to the urethral meatus
b) much shorter urethra = shorter distance from outside to urinary tract
4) S&Ss
a) dysuria --pain on urination, frequency and urgency of urination due to irritation on pressure-sensors of bladder; usually small amount of urine voided at a time.
c) hematuria --from irritation / inflammation of bladder and other linings of urinary tract.
d) pyuria--pus in urine; makes urine cloudy, foul-smelling.
e) abdominal & sometimes back pain at costovertebral angle where kidneys are located (if pyelonephritis), sometimes fever
5) dx'd by S&S, UA (urinalysis), and sometimes urine C&S (culture & sensitivity)
A. pelvicinflammatory disease (PID)
B. urologic infection
C. ovarian cancer
D. amenorrhea

b

Mostly Women
S&Ss
a) dysuria --pain on urination, frequency and urgency of urination due to irritation on pressure-sensors of bladder; usually small amount of urine voided at a time.
c) hematuria --from irritation / inflammation of bladder and other linings of urinary tract.
d) pyuria--pus in urine; makes urine cloudy, foul-smelling.
e) abdominal & sometimes back pain at costovertebral angle where kidneys are located (if pyelonephritis), sometimes fever
5) dx'd by S&S, UA (urinalysis), and sometimes urine C&S (culture & sensitivity)
A. pelvicinflammatory disease (PID)
B. urologic infection
C. STI
D. amenorrhea

c

bacterial infection caused by trachomatis; S&S include:1) urethritis in men—inflammation, discomfort in penis, sometimes dysuria, occasionally a discharge
2) most common cause of PID in women (see S&S of PID)
A. gonorrhea
B. genital herpes
C. chlamydia
D. syphilis

a

1) bacterial infection of the genital tracts of men and women caused by Neisseria
2) women may be asymptomatic, or may have vaginal discharge or bleeding, and/or go on to have full PID
3) men tend to have purulent discharge from the penis and dysuria
A. gonorrhea
B. genital herpes
C. chlamydia
D. syphilis

d

STI caused by spirochete Treponema pallidum
2) if treated during first stage, easily treated with antibx, but can become systemic & evolve into other stages if not treated early.
3) course of the disease:
a) 1st stage-- primary: lesions (chancres) of the skin develop anywhere that the microbe touches mucous membranes or skin (lips, labia, penis)
A. gonorrhea
B. genital herpes
C. chlamydia
D. syphilis

b

caused by simplex virus (HSV), subtype 2 (HSV2)
a) HSV 1 invades lips & surrounding area-- sometimes known as having "cold sores"—can be passed on via kissing, but otherwise not considered an STI.
b) HSV 2 is an STI-- invades genital area & can spread to perineum & anus.
(1) infection appears on skin as painful, red, often crusty-looking crops of lesions
(2) break-out episodes occur sporadically and often depend on stress level.
(3) sometimes there are systemic S&S such as fever and malaise during break-out episodes.
2) patho of HSV2
a) after initial infection has resolved, HSV penetrates local nerve fibers & then travels up to spinal ganglion and lies dormant
b) travels "back down" to genital area or to circumoral area periodically, usually in times of stress, & breaks out on skin again.
3) tx--once a person contracts HSV, it is there for life; antivirals can help control S&S, but can't cure it.
A. gonorrhea
B. genital herpes
C. chlamydia
D. syphilis

b

2) patho of HSV2
a) after initial infection has resolved, HSV penetrates local nerve fibers & then travels up to spinal ganglion and lies dormant
b) travels "back down" to genital area or to circumoral area periodically, usually in times of stress, & breaks out on skin again.
A. gonorrhea
B. genital herpes
C. Obstructive disorder
D. syphilis

c

1) anything that interferes with flow of urine from kidneys to urethral meatus can be classified as obstructive disorder
2) most potentially harmful sequela (if obstruction not removed/treated quickly) is hydronephrosis
A. gonorrhea
B. genital herpes
C. Obstructive disorder
D. syphilis

a

connects kidneys to bladder
A. Ureter
B. Urethra

b

connects bladder to outside
A. Ureter
B. Urethra

d

("water on the kidney") is enlargement of & pressure in renal pelvis & calyces due to pathologic accumulation of fluid
b) it is caused by retrograde ("back-up") urinary flow that can't get past an obstruction in ureters, bladder, and/or urethra
c) within a short time this accumulation of urine can lead to infection & eventual fibrosis (scarring & stiffening of tissue), within the kidney & significant decline in function of nephrons
A. gonorrhea
B. genital herpes
C. Obstructive disorder
D. hydronephrosis

obstructions, tumors, scarring, pelvic, prolapse

specific __________(obstructions) (a couple of these are gender-specific; others can happen in either gender equally)
1) ________(tumors)
2) _________(scarring) (called adhesions) from previous problems (eg, STDs, endometriosis. various surgeries) can cause strictures (ie, pinching, narrowing) of ureter and/or urethra.
3) in females: ___(pelvic) organ pelvic organ ______(prolapse)
a) a prolapse is a "falling-down" or intrusion of an organ due to deterioration of muscle tone holding it in place or other factors
b) best example is uterine prolapse (uterus drops from its normal mooring and puts pressure on bladder, urethra, or other structures—acts as obstruction to urine)

a

Obstructive Disorder (uterus drops from its normal mooring and puts pressure on bladder, urethra, or other structures—acts as obstruction to urine)
A. uterine prolapse
B. genital herpes
C. Kidney stones
D. hydronephrosis

obstructive, males, bph, neurogenic, plegia

_______(Obstructive) Disorder in _____(males): ______(BPH)—urine can't get through a urethra narrowed by large prostate (prostate is the obstruction)
5) ______(neurogenic) problems—para_____(plegia), quadriplegia-- neurogenic bladder dysfunction (bladder loses tone—acts as obstruction to urine flowingforward)

stones, calculus, lith

kidney _____(stones)
a) other terms for stone: ______(calculus) (calculi is plural) or "_____(lith);" applications / examples according to area found:
(1) kidney stones = renal calculi = renal lithiasis= nephrolithiasis
(2) ureteral calculus= ureteral lithiasis = kidney stone in ureter
(3) urethral calculus= urethral lithiasis = kidney stone in urethra

c

Risk Factors
(1) male gender (4 times more likely)
(2) having gout: uric acid accumulation or overproduction
(3) dehydration—not drinking enough water, sweating, etc.
(4) various dietary factors
(5) diseases such as multiple myeloma that cause
hypercalcemia
A. uterine prolapse
B. genital herpes
C. Kidney stones
D. hydronephrosis

c

patho:
(1) as urine is formed in the renal tubules it becomes supersaturated with calcium, uric acid, or other ions which eventually bond together and form a type of crystal these can attract each other and form "stones" in kidney pelvis
(2) iare greater than about 2mm, as they flow into the ureter with urine, they can then get stuck in the ureter  obstruction urine backs up, AKA retrograde urine flow  can cause
hydronephrosis & possible renal failure if obstruction
remains.
d) S&S:
(1) excruciating flank and/or groin pain that comes & goes in spasms—AKA colicky pain
(2) presence of hematuria from stone "raking" the ureteral lining
e) dx is based on clinical presentation, hematuria, and diagnostic tools such as CAT scan.
f) tx
(1) pt usually sent home on pain meds & "push fluids instructions" to try to get stone to pass on its own
(2) if too large to pass, lithotripsy done (sound waves bombard & dissolve the stone) or surgery (if other measures not successful)
A. uterine prolapse
B. genital herpes
C. Kidney stones
D. hydronephrosis

c

d) S&S:
(1) excruciating flank and/or groin pain that comes & goes in spasms—AKA colicky pain
(2) presence of hematuria from stone "raking" the ureteral lining
e) dx is based on clinical presentation, hematuria, and diagnostic tools such as CAT scan.
f) tx
(1) pt usually sent home on pain meds & "push fluids instructions" to try to get stone to pass on its own
(2) if too large to pass, lithotripsy done (sound waves bombard & dissolve the stone) or surgery (if other measures not successful)
A. uterine prolapse
B. genital herpes
C. Kidney stones
D. hydronephrosis

a

~95% water and the other 5% contains urea (AKA urea nitrogen), creatinine, a certain amount of Na, K, PO4, & other solutes (also other substances like hormones, etc.) is the
A. Normal urine
B. Abnormal urine
C. Megatrophy Urine

b

glomerulus
a) as blood enters glomerulus from afferent arteriole, it circulates in the glomerular capillaries, which have basement membranes that serve as a screening, or filtration, tool—
A. Normal urine
B. glomerular membrane
C. Bowman's capsule
D. tubular secretion

d

movement of fluids and solutes from the peritubular capillaries (ie, vascular circulation) to the cells lining the tubular lumen, and from there into the tubular lumen
A. Normal urine
B. glomerular membrane
C. Bowman's capsule
D. tubular secretion

c

GFR is an important concept—when a problem or disorder decreases the GFR, we know that the appropriate amount of water and solutes are not being sent into the urine, thus increasing risk of accumulation of wastes & water in the body.
(3) clinically (in patients you are taking care of as a nurse), decreases in GFR often can be seen as
A. Normal urine
B. increased urine output
C. decreased urine output
D. tubular secretion

d

tubular reabsorption
A. movement of fluids and solutes from the tubular lumen into the cells lining the tubular lumen, and from there into the peritubular capillaries to disengage the vascular circulation
B. movement of fluids and solutes from the tubular lumen into the cells lining the tubular lumen, and from there into the glomerular capillaries to join the vascular circulation
C. movement of fluids and solutes to the tubular lumen into the cells lining the tubular lumen, and from there into the peritubular capillaries to join the vascular circulation
D. movement of fluids and solutes from the tubular lumen into the cells lining the tubular lumen, and from there into the peritubular capillaries to join the vascular circulation

high

If kidneys aren't working properly, person would have _____________(high/low) serum creatinine & urea nitrogen

low

If kidneys aren't working properly, person would have _____________ (high/low) urine creatinine & urea nitrogen.

fluid, deficit, angio, 2, aldosterone, retention, na

_____(fluid) _____(deficit) low fluid sensed by the kidneys renin secreted by the JGA (juxtaglomerular apparatus—area around the glomeruli of each nephrons unit)  ultimately stimulates creation of ______(angio)tensin __(2), which stimulates secretion of ___________(aldosterone) by adrenals aldosterone goes to DCT (distal convoluted tubule)causes __________(retention) of ___(Na)+ into the blood, followed by H2O (in exchange for holding onto Na+, the kidney tubules excrete K+)

fluid, oveload, bnp, anp, heart, excrete

_______(fluid) _______(overload) ____(BNP) & _____(ANP) secreted by ____(heart) & go to renal tubules, which are stimulated to _____(excrete) more water into the urine you will void large amounts of more dilute urine (kidneys have gotten rid of water to help your overloaded state)

kidneys, reg, hco3, h, activate, d, erythropoietin

maintenance of certain metabolic functions; the _______(kidneys):
a. greatly affect acid / base balance by:
1) making & ____(reg)ulating ______(HCO3).
2) deciding how much ___(H)+ (acid gang member) to excrete or hold onto
b. help to promote stable nutrition by minimizing non-appropriate substances such as proteins from entering urine.
c. regulate calcium absorption by _________(activate) vitamin __(d)(you get vitamin D from diet, and from effect of sun on skin cells, but still must be activated by kidneys)
d. regulate BP by increasing or decreasing renin as needed (renin begins RAAS response regulates fluid volume and arterial vasoconstriction & therefore has a part in regulating pressure in the arteries).
e. help promote stable hematological status by:
1) making hormones such as __________(erythropoietin), which helps with RBC birth & growth
2) making sure no RBCs "spill" from blood to urine.

gfr, low, aki, ckd

when a person's ___(GFR) and/or waste product secretion ____(low), even a small amount, we consider that person to be at some point on a spectrum from acute kidney injury _____(AKI) to chronic kidney disease ______(CKD)- ie, the spectrum of renal compromise (concept map below).

a

abrupt (occurs over <48hrs) decrease in urine output (ie, GFR) and/or in serum creatinine, so typical patient has acute oliguria and/or acute jump in serum creatinine.
b. the patient can fully recover or can go on to have some degree of kidney problems, often depending on how quickly the problem is caught & fixed.
A. acute kidney injury (AKI)
B. chronic kidney disease (CKD)
C. anemia
D. pruritis

b

S&S include oliguria and often decreased preload S&S such as dry mucus membranes, poor skin turgor.
2) causative factors of the decreased preload include acutely decreased
arterial flow to the kidneys due to:
a) acute vasoconstriction or trauma to aorta and/or renal arteries
b) hypotension / hypovolemia from hemorrhage, dehydration, etc; and /or an inadequate CO
3) prognosis/tx:
a) treatment includes giving fluids and/or fixing other basic problem such as vasoconstriction / heart problem, etc.
b) if NOT reversed fairly early, patient can go into intrarenal
A. acute kidney injury (AKI)
B. prerenal acute kidney injury (AKI)
C. intrarenal acute kidney injury (AKI)
D. postrenal acute kidney injury (AKI)

d

occurs when there is an acute obstruction that occurs somewhere between kidneys & urethral meatus.
1) examples of causative factors:
a) urethral obstruction such as BPH in a man or
uterine prolapse in a woman.
b) ureteral obstruction such as calculi
2) patho/S&S/prognosis of postrenal AKI (THINK OBSTRUCTION)
a) usually acute oliguria plus S&S of the causal problem, such as pain from a kidney stone
b) prognosis for return to normal renal function is good if the obstruction is "fixed" fairly quickly... but if not:
(1) as with any obstruction in the urinary apparatus,
there is a risk of retrograde flow of urine up into the kidneys.
(2) this urine back flow can result in hydronephrosis & intrarenal
A. acute kidney injury (AKI)
B. prerenal acute kidney injury (AKI)
C. intrarenal acute kidney injury (AKI)
D. postrenal acute kidney injury (AKI)

c

1) something goes wrong IN the kidney tissue, leading to ATN, acute tubular necrosis
2) S&S are oliguria, & high serum creatinine, plus casts in UA, and other renal-specific lab changes
3) if not fixed, can go into CKD
A. acute kidney injury (AKI)
B. prerenal acute kidney injury (AKI)
C. intrarenal acute kidney injury (AKI)
D. postrenal acute kidney injury (AKI)

b

1) something goes wrong with arterial flow BEFORE the kidneys
2) S&S include oliguria, plus fluid volume deficit issues
3) if not fixed, can go into intrarenal AKI
& possibly CKD
A. acute kidney injury (AKI)
B. prerenal acute kidney injury (AKI)
C. intrarenal acute kidney injury (AKI)
D. postrenal acute kidney injury (AKI)

d

1) something goes wrong with urine flow AFTER the kidneys
2) S&S include oliguria and S&S of obstruction
3) if not fixed, can lead to hydronephrosis, then intrarenal AKI & possibly CKD
A. acute kidney injury (AKI)
B. prerenal acute kidney injury (AKI)
C. intrarenal acute kidney injury (AKI)
D. postrenal acute kidney injury (AKI)

b

Fluid volume deficit is only involved in
A. acute tubular necrosis (ATN)
B. prerenal acute kidney injury (AKI)
C. intrarenal acute kidney injury (AKI)
D. postrenal acute kidney injury (AKI)

c

2) the kidneys have acutely diminished function from direct kidney tissue; injury; examples:
a) effect of nephrotoxic drugs; poisons & toxins; renal infections
b) autoimmune situations; example here will be post-streptococcal glomerulonephritis (GN)
(1) most often happens in conjunction with recovery from strep throat; antibody that attacked strep then attacks tissues such as glomeruli of kidneys (and/or valves of heart...remember rheumatic heart disease?)
(2) patho: autoantibody attaches to the glomerular membranes  irritates them, begins inflammatory process neutrophils, macrophages infiltrate area inflammatory mediators are released glomerular
capillaries pathologically vasodilate & leak protein & blood into urine.3) no matter what the initial trigger of intrarenal AKI is, the basic problem becomes ischemia to kidney and death to tubules tubular necrosis - this is called ATN--
A. acute tubular necrosis (ATN)
B. prerenal acute kidney injury (AKI)
C. intrarenal acute kidney injury (AKI)
D. postrenal acute kidney injury (AKI)

a

ischemia eventual necrosis of tubules this leads to dead cells of the tubular lining being sloughed off into the lumen of the tubulecasts formation tubular blockage / sluggish urine flow
(2) when there is tubular blockage, it creates pressure on the Bowman's capsule & glomerular capillaries  reduced GFR oliguria & decreased ability to excrete creatinine.
A. acute tubular necrosis (ATN)
B. prerenal acute kidney injury (AKI)
C. intrarenal acute kidney injury (AKI)
D. postrenal acute kidney injury (AKI)

b

S&S scenario: a patient in the hospital following a drug overdose drops urine output from 35ml/hr to 15 ml/hr within 24 hrs, the nurse suspects AKI, because of:
A. the chronic oliguria, lab work shows serum creatinine is high,
(2)the nurse suspects prerenal AKI, because of: the patient's initial dx (drug overdose), the urinalysis (UA) shows casts
B. the acute oliguria, lab work shows serum creatinine is high,
(2)the nurse suspects intrarenal AKI, because of: the patient's initial dx (drug overdose), the urinalysis (UA) shows casts
C. the acute oliguria, lab work shows serum creatinine is low,(2)the nurse suspects intrarenal AKI, because of: the patient's initial dx (drug overdose), the urinalysis (UA) shows casts
D. the acute oliguria, lab work shows serum creatinine is low,(2)the nurse suspects postrenal AKI, because of: the patient's initial dx (drug overdose), the urinalysis (UA) shows casts

c

cause is usually the narrowing or blockage of arteries supplying brain (carotid or vertebral arteries) or intracranial arteries themselves
1) usually related to atherosclerosis and other processes that damage arterial walls, resulting in same process as plaque formation in coronary arteries
2) patho: diminished perfusion to brain tissuecellular ischemia, injury, and/ or infarction (death)inflammatory processswelling, cerebral edemaincreased ICPfurther decrease in perfusion
3) can be thrombotic in nature and/or embolic
a) thrombotic stroke—occurs from a clot or plaque that blocks off the artery in which it has developed & causes ischemia distally.
b) embolic stroke—when fragments that break from an arterial thrombus (as above) & travel "downstream" until they "get stuck" in a smaller
A. diffuse injury stroke
B. TIA transient ischemic attack
C. ischemic brain attack
D. hemorrhagic brain attack

b

can happen in either thrombotic or embolic situation & causes the same S&S as a fully-evolved stroke, but does not damage brain tissue because it is transient, i.e., temporary— resolves itself quickly
2) by definition, S&S from this type only last <24 hours & have no lasting neurologic deficit (some TIAs last less than 5 minutes)
3) however, it are often a warning that more serious, fully-evolved stroke can occur at later date (without tx, 80% of pts with this have full strokes later!)
A. diffuse injury stroke
B. TIA transient ischemic attack
C. ischemic brain attack
D. hemorrhagic brain attack

c

examples of specific potential thrombotic & embolic events:
a) atrial fibrillation (5-fold increase in risk for stroke) disorganized motion of the left atrium allows some incoming blood to pool & promotes stasis  small clots develop in portion of atria break off travel to brain via carotids lodge in a cerebral arteryischemia / infarct to distal tissue
b) atherosclerosis of carotids common place for thrombi to develop; small clots can break off from these & travel downstream.
c) air emboli (usually iatrogenic—ex, during surgery)
d) clots around mitral or aortic valve prosthesis or vegetation from around infected valve
e) intracranial artery plaque can develop in the circle of Willis; if breaks free can lodges in smaller arteries.
A. diffuse injury stroke
B. TIA transient ischemic attack
C. ischemic brain attack
D. hemorrhagic brain attack

d

_______ is usually caused by the effects of blood that leaks out directly onto brain tissue (in most areas of brain there is normally NO blood directly on brain tissue—is carried in arteries & veins, and when arrives at capillary beds, O2 & nutrients diffuse into tissue cells & CO2 & other wastes diffuse out of cells)
2) ex: an intracerebral aneurysm begins to leak blood onto brain tissue  blood irritates the tissue inflammatory processswelling, cerebral edema increased ICPcellular ischemia, injury, and/ or infarction of the surrounding area.
A. diffuse injury stroke
B. TIA transient ischemic attack
C. ischemic brain attack
D. hemorrhagic brain attack

d

the pressure of hypertension
2) weakened arterial walls from atherosclerosis
3) aneurysms-- pts with intracranial aneurysms can remain asymptomatic for many years, but once leakage of blood and/or rupture begins, usually have intense headache and may suddenly lapse into unconsciousness
4) congenital vascular malformations—deformities in the arteries that predispose them to bleed
5) bleeding into a tumor
6) coagulation disorders (ex—hemophilia, excess coumadin, etc) cause:
A. diffuse injury stroke
B. TIA transient ischemic attack
C. ischemic brain attack
D. hemorrhagic brain attack

a

S&S do not depend on whether the stroke is ischemic or hemorrhagic—can't tell from clinical presentation whether a stroke is one or the other.
2) S&S depend on
A. site
B. cause
C. disease
D. containment

diffuse, injury, symmetric

diffuse, injury, symmetric

b

a) being alert or easily arousable to alertness if asleep ("wakeful" areas of brain are ok)
b) being oriented X 4 (self, time, place, events)
c) following commands appropriately
d) having normal speech (speech centers in brain ok)
e) conversing appropriately (cognition, "mental status" ok)
Are signs of
A. site
B. Normal Level of consciousness (LOC)
C. Abnormal Level of consciousness (LOC)
D. containment

c

not being alert: from being lethargic to inability to awaken the patient at all (coma)
b) not oriented to some or all of self, time, place, events
c) doesn't follow commands
d) speech might be garbled or no speech at all
e) verbal responses / conversational efforts show inappropriate or dysfunctional mental status; examples:
(1) confusion - spectrum of severity
(2) behavioral changes such as withdrawal or aggression
Are signs of
A. site
B. Normal Level of consciousness (LOC)
C. Abnormal Level of consciousness (LOC)
D. containment

d

so if there is a focal lesion related to a CN, expect to have asymmetric findings, with the defect manifesting unilaterally on the same side, ie, the ____________ side, of the lesion
A. pyramidal
B. Normal Level of consciousness (LOC)
C. Abnormal Level of consciousness (LOC)
D. ipsilateral

b

--if there is focal cerebral edema around a CN that enervates the right side of the face, you would expect to see a facial defect on the ________________side.
A. left
B. right

b

if there is focal cerebral edema around a right CN that is supposed to cause the normal reflex of the pupil constricting to light, you would expect to see no constriction in the ___________pupil
A. left
B. right

a

corticospinal tracts-- descending (motor) tracts ("cortico"—cortex of brain); also called _________________________ tracts
(a) bundles of long axons that originate in the cell bodies of certain areas of the motor cortex on either side of the brain.
A. pyramidal
B. Normal Level of consciousness (LOC)
C. Abnormal Level of consciousness (LOC)
D. ipsilateral

b

descending (motor) tracts ("cortico"—cortex of brain); also called pyramidal tracts
A. pyramidal
B. corticospinal tracts
C. spinothalamic tracts
D. ipsilateral

b

anatomically, these axons cross over, or decussate from their point of origin in the cerebral cortex to the opposite side of the body at the junction between the spinal cord and brain stem
A. pyramidal
B. corticospinal tracts
C. spinothalamic tracts
D. ipsilateral

c

ascending (sensory) tracts.
(a) carry sensations of pain, temperature, crude and light touch from body to brain (thalamus) for processing.
(b) the spinothalamic tracts cross over from one side of the body to the other side of the brain similar to corticospinal tracts, but in a different area.
A. pyramidal
B. corticospinal tracts
C. spinothalamic tracts
D. ipsilateral

d

if there is a focal lesion related to corticospinal or spinothalamic tracts in the brain, expect to see _______________ sensorimotor changes i.e stroke on the left side would see motor below the shoulder on the right side
A. symmetric
B. corticospinal tracts
C. spinothalamic tracts
D. asymmetric

a

the pathologic changes will usually be unilateral, on the _________________side of the body because of decussation —ie, abnormal findings on the opposite side of the lesion in the brain.
A. contralateral
B. corticospinal tracts
C. spinothalamic tracts
D. asymmetric

b

ex: a patient with a tumor on the right side of the brain would have decreased strength & sensation of arms and legs on the contralateral, or _______________side of the body.
A. right
B. left

a

Above the shoulder injury response we would see injuries on the
A. same
B. opposite (contralateral)

b

Below the shoulder injury response we would see injuries on the
A. same
B. opposite (contralateral)

c

a "positive babinski" reflex (AKA plantar reflex) means that stroking plantar surface of foot makes big toe flex ("upgoing toe").
b) this is normal until after 2 years old; after that, it is a sign of ____________ dysfunction of some sort.
A. cardiac
B. respiratory
C. neurologic
D. asymmetric

d

ex— a patient stops breathing arteries are carrying deoxygenated blood to the brainthe whole brain becomes hypoxic & edematous IIP
2) S&S are seen equally throughout the body, both above & below shoulders:
a) sensation, muscle tone, movement, & strength would be weaker bilaterally & often fairly symmetrically.
b) reflexes weaker, usually symmetrically, and sometimes there is bilateral positive Babinski's.
A. cardiac injury
B. respiratory injury
C. neurologic injury
D. diffuse injury

d

usually see brain stem abnormalities, all due to cerebral edema & IICP putting pressure on brain stem:
a) diminished LOC : most often with brain stem problems, patient is comatose or in near-coma state (see page 333)
b) if patient is comatose, sometimes can see bizarrely abnormal motor responses to stimuli, such as decerebrate & decorticate posturing (pg 338), reflecting effect of cerebral edema on brain stem nuclei.
c) breathing, heart rate and blood pressure changes due to pressure on the medulla, which controls those autonomic functions; example of breathing pattern changes—Cheyne-Stokes (seen in patients in comatose state who are not on ventilator)
d) protective reflexes such as sneezing, coughing, gagging, & swallowing are diminished or lost
e) a variety of other problems such as mixed degree of cranial nerve problems (remember, the CN's originate in the brain stem) such as HR problems when the vagus nerve (CN X) is affected.
A. cerebellar CVA
B. respiratory injury
C. neurologic injury
D. diffuse injury

a

there are usually problems with coordination and balance:
1) vertigo, nystagmus (rapid eye movement).
2) nausea and vomiting .
3) loss of coordination.
4) falling down.
A. cerebellar CVA
B. cerebral hemispheric
C. neurologic injury
D. diffuse injury

b

general patho: lack of blood flow OR bleeding in an area of the left or right of cerebrum results in swelling & edema  S&S are from three possible sets of deficits:
a) sensorimotor deficits caused by lesion / pressure on CNs in / near the affected area in that location
b) sensorimotor deficits caused by lesion / pressure on corticospinal tracts in / near the affected area in that place
AND/OR
b) deficits based on what "special functions" are controlled by that hemisphere.
2) to best assess how a hemispheric stroke has affected sensorimotor status, divide body into longitudinal halves & then consider each half above the shoulders & then separately below the shoulders
A. cerebellar CVA
B. cerebral hemispheric
C. neurologic injury
D. diffuse injury

c

cerebral hemispheric stroke, sensorimotor assessment above the shoulders (eyes, face, tongue, some shoulder function) :

A. (1) what you are assessing: resting nerves (RN) function— ie, is there a lesion in a RN and/or in the cerebral brain tissue around it?
(2) is the lung equal to the rate, tone, movement, strength? If not, consider that there might be a focal problem with a RN.
B. (1) what you are assessing: cardiac nerves (CN) function— ie, is there a lesion in a CN and/or in the cerebral brain tissue around it?
(2) is the pumping equal to the right side in sensation
C. (1) what you are assessing: cranial nerves (CN) function— ie, is there a lesion in a CN and/or in the cerebral brain tissue around it?
(2) is the left side equal to the right side in sensation, tone, movement, strength? If not, consider that there might be a focal problem with a CN.
D. (1) what you are assessing: cranial nodes (CN) function— ie, is there a lesion in a CN and/or in the cerebral brain tissue around it?
(2) is the right side equal to the right side in sensation, tone, movement, strength? If not, consider that there might be a focal problem with a CN.

a

(1) what you are assessing: certain parts of the sensorimotor apparatus — the corticospinal tracts & the spinothalamic tracts-- is there a lesion in one of these tracts and/or in the cerebral brain tissue around it?
(2) is the left side equal to the right side in sensation, tone, movement, strength? If not, consider that there might be a focal lesion and/or edema where a corticospinal tract passes through that cerebral hemisphere.
A. sensorimotor assessment below the shoulders
B. sensorimotor assessment above the shoulders
C. assessing deficits that special / specific to each hemisphere
D. diffuse injury

c

in most people, the left hemisphere controls
(a) many aspects of speech, so patient with left hemispheric CVA might have dysphasia or aphasia— general terms referring to varying degrees of inability to comprehend, integrate, and express language
(b) ability to do math, organize, reason, and analyze, so
these faculties might be impaired with left hemispheric stroke.
(2) in most people, the right hemisphere controls
(a) spatiality—where you are in space, & where things are around you; sometimes people with a right hemispheric lesion develop what is called left-sided neglect- a tendency to completely ignore the environment on the left side. (ex—pt won't perceive that there is anything on the left side of a plate of food or that there is a nurse standing on his left)
(b) also is the seat of insight (including insight to his/her disease), creativity, face recognition, musical ability, etc.
A. sensorimotor assessment below the shoulders
B. sensorimotor assessment above the shoulders
C. assessing deficits that special / specific to each hemisphere
D. diffuse injury

a

hemispheric CVA in most people, the right hemisphere controls
A. spatiality—where you are in space, & where things are around you; sometimes people with a right hemispheric lesion develop what is called left-sided neglect- a tendency to completely ignore the environment on the left side. (ex—pt won't perceive that there is anything on the left side of a plate of food or that there is a nurse standing on his left). Also is the seat of insight (including insight to his/her disease), creativity, face recognition, musical ability, etc.
B. many aspects of speech, so patient with CVA might have dysphasia or aphasia— general terms referring to varying degrees of inability to comprehend, integrate, and express language. Ability to do math, organize, reason, and analyze

b

hemispheric CVA in most people, the left hemisphere controls
A. spatiality—where you are in space, & where things are around you; sometimes people with a right hemispheric lesion develop what is called left-sided neglect- a tendency to completely ignore the environment on the left side. (ex—pt won't perceive that there is anything on the left side of a plate of food or that there is a nurse standing on his left). Also is the seat of insight (including insight to his/her disease), creativity, face recognition, musical ability, etc.
B. many aspects of speech, so patient with CVA might have dysphasia or aphasia— general terms referring to varying degrees of inability to comprehend, integrate, and express language. Ability to do math, organize, reason, and analyze

a

A patient is alert and oriented X 4. He is able to smile to command on the left side of his face, but not on the right, which droops a bit—ie, he definitely has facial asymmetry.
(1) where is the focal lesion—right or left hemisphere?
A. right
B. left

a(spatility)

A patient is alert and oriented X 4. He is looking down on a plate but can't see the left side of it, where is the focal lesion—right or left hemisphere?
A. right
B. left

b

If right hand is in a claw like shape the lesion is on the
A. right
B. left
33

c

diagnosis & treatment of brain attack:(1 hour diagnosis)
D.
a. dx made through history of incident, presenting S&S, CAT scan, MRI
1) public is encouraged to use the "act FAST" scale—
A. Face: Ask the person to smile. Does one side of the face droop? Arms: Ask the person to raise both arms. Does one arm drift downward? Speech: Ask the person to repeat a simple sentence. Are the words slurred? Can he or she correctly repeat the sentence? Transfer: If the answer to any of the above questions is yes, transport is important. Don't call 911 just drive.
B. Face: Ask the person to smile. Does one side of the face droop? Air: Ask the person to breath. Sound: Ask the person can they hear. Can he or she hear correctly? Time: If the answer to any of the above questions is yes, time is important. Immediately, call 911 or go to the nearest hospital emergency room. Brain cells are dying.
C. Face: Ask the person to smile. Does one side of the face droop? Arms: Ask the person to raise both arms. Does one arm drift downward? Speech: Ask the person to repeat a simple sentence. Are the words slurred? Can he or she correctly repeat the sentence? Time: If the answer to any of the above questions is yes, time is important. Immediately, call 911 or go to the nearest hospital emergency room. Brain cells are dying.

d

A hemorrhagic stroke may need
A. correct underlying problem such as atrial fibrillation with drugs, etc, thrombolytic drugs (clot-busters) but must be within 2 hours of start of incident ("with a brain attack, time is brain!"), institution of anticoagulant therapy: at first Heparin, then send home on Coumadin
B. t-pa
C. rest
D. may need surgical intervention for certain types of hemorrhagic strokes

a

ischemic stroke
A. correct underlying problem such as atrial fibrillation with drugs, etc, thrombolytic drugs (clot-busters) but must be within 2 hours of start of incident ("with a brain attack, time is brain!"), institution of anticoagulant therapy: at first Heparin, then send home on Coumadin
B. t-pa
C. rest
D. may need surgical intervention for certain types of hemorrhagic strokes

b

2 types
1) f(FAD)—inheritance-linked - can be early onset or late
2) non-hereditary (AKA sporadic)-- late onset—70% of cases
A. seizures
B. Alzheimer's disease
C. Parkinson's disease
D. multiple sclerosis

b

exact cause unknown, but thought to be due to genetic mutation that improperly encodes a normal protein called amyloid end result is accumulation of abnormal amyloid in brainthe abnormal amyloid forms plaque-like material called senile plaques.
2) also, microtubules of neurons in the brain become distorted and twisted and form a neurofibrillary tangle.
3) the amyloid plaques and the neurofibrillary tangle combine to disrupt normal nerve impulses in the brain.
c. clinical manifestations
1) dementia—a type of forgetfulness that is different from normal absentmindedness; emotional upset, behavioral changes
2) if posterior frontal lobe is involved, there are also motor changes such as rigidity, and postural & gait change
A. seizures
B. Alzheimer's disease
C. Parkinson's disease
D. multiple sclerosis

c

is a basal ganglia dysfunction disease caused by unknown source, but suspected to be genetic, viral, or environmental toxin-induced depletion in dopamine
a) a decrease in dopamine tips the scales of balance towards cholinergic, excitatory activity --not actually more acetylcholine, but more effect.)
b) the result of increased cholinergic
effect gives S&S related to hypertonia (rigidity) & dyskinesia (movement disorder)
A. seizures
B. Alzheimer's disease
C. Parkinson's disease
D. multiple sclerosis

c

S&S
1) any dysfunction of the extrapyramidal system (not just Parkinson's, but with any disease process or drug that disorders function of basal ganglia) results in "parkinsonianisms"—ie, characteristic S&S below
2) hypertonia manifestations include
a) overall rigidity, often noticed in the face—mask-like face
b) "cog-wheel rigidity" of forearm
c) dysarthria (difficulty forming words)
d) dysphagia (difficulty swallowing)
3) dyskinesia manifested as
a) involuntary facial & trunk movements such as "Parkinson's tremor"—a pattern of alternating movements between thumb & forefinger described as "pill-rolling"
b) inability to make appropriate posture adjustment when tipping or falling, so walking takes on typical pattern called "basal ganglion gait" AKA "Parkinsonian gait"—stooped, shuffling posture; decreased arm swing
A. seizures
B. Alzheimer's disease
C. Parkinson's disease
D. multiple sclerosis

c

treatment for _________'s— give medication containing dopamine (L-dopa) and anticholinergic medications (benadryl)
A. seizures
B. Alzheimer's disease
C. Parkinson's disease
D. multiple sclerosis

d

relatively common autoimmune disorder, onset between 20 & 50, with male/female ratio 1:2
b. patho overview: previous viral insult has occurred in genetically susceptible person stimulates abnormal immune response in the CNS person's own T-cells attack a myelin protein in brain neurons
A. seizures
B. Alzheimer's disease
C. Parkinson's disease
D. multiple sclerosis

d

inflammation & injury from T-cell attack degenerates the myelin in multifocal areas—this degeneration is known as demyelination & the areas are called demyelinating lesions, or demyelinating plaques
3) depending on degree of demyelination & inflammation, nerve conduction is sporadically blocked or altered over 20 year period or so, there is often scarring and hardening ("sclerosis") of neuroglia (supporting tissue in brain) & deterioration of axons
4) causes progressive loss of functioning, because when axons become demyelinated, they transmit the nerve impulses 10 times slower than normal myelinated ones
A. seizures
B. Alzheimer's disease
C. Parkinson's disease
D. multiple sclerosis

d

S&S
1) overview
a) generally S&S are variable, individualistic, and usually asymmetric, since plaques are unevenly distributed in brain (can be symmetric, but this would be more uncommon)
b) have periods of remission & exacerbation in an irregular fashion, often related to stressors such as heat, cold, and emotional pressures.
2) typical S&S:
a) parasthesia--unusual sensory sensation such as numbness, shooting pains, etc
b) weakness of certain muscles asymmetrically—one leg affected, or one arm, etc.
c) if cerebellum also affected, can have vertigo, incoordination, & ataxia--staggering gait
d) other possibilities (depending on areas of lesions): dysarthria (difficulty speaking due to actual jaw muscle weakness); double vision, bladder control problems
A. seizures
B. Alzheimer's disease
C. Parkinson's disease
D. multiple sclerosis

b

severe episodic headaches that occur in a typical pattern for each person but usually some elements are common:
1) prodrome (S&S before the headache, including an aura, sometimes),
2) headache itself, which is often unilateral and accompanied by N,V, photophobia (light hurts eyes), phonophobia (sound hurts ears)
3) postdrome—washed out, tired, weak.
A. seizures
B. migraines
C. meningitis
D. myasthenia gravis

b

b. patho:
1) exact cause unknown, but thought to be a disorder of blood flow to brain.
2) those who get migraines seem to have hyperreactivity to certain stressful events or to chemicals (wine, chocolate)
3) first phase of migraine: stress  spasm of arteries at base of brain flow to brain reduced platelets begin to clump, releasing serotonin a powerful vasoconstrictor further constrict ischemia to brain (S&S sometimes similar to ischemic stroke at this point)
4) second phase: body senses this decrease in CPP & dilates intracerebral arteries to compensate prostaglandins are part of that dilatory response & they will cause pain; also, the increased blood flow may cause a throbbing sensation.
c. tx—trigger-avoidance, NSAIDS, serotonin-inhibitors like Immitrex.
A. seizures
B. migraines
C. meningitis
D. myasthenia gravis

a

sudden, explosive, disorderly charge of neurons—sudden, transient alteration in brain function
b. can be due to congenital seizure disorder (epilepsy) or to an acute problem in the brain, such as a head injury or stroke
c. classified as general and partial
1) general (used to be called grand mal seizures)
a) can be precipitated by brain irritation due to cerebral edema
b) S&S: patient is ALWAYS unconscious; movement is tonic-clonic --alternating rigidity & contraction of muscles
2) partial—begin locally and can have varied level of unconsciousness
d. post condition
1) a synonym for convulsion is ictus, and the state of a patient following the end of a seizure is sometimes known as post-ictal
2) the patient is often dazed, confusion, and sometimes combative—the brain's "circuits" are still not back to normal.
A. seizures
B. migraines
C. meningitis
D. myasthenia gravis

a

can be precipitated by brain irritation due to cerebral edema
b) S&S: patient is ALWAYS unconscious; movement is tonic-clonic --alternating rigidity & contraction of muscles
A. general seizures
B. partial seizures
C. status epilepticus

b

begin locally and can have varied level of unconsciousness
A. general seizures
B. partial seizures
C. status epilepticus

c

unremitting, not-responsive to medications
A. general seizures
B. partial seizures
C. status epilepticus

c

overview / patho:
` 1) organisms are spread via sneezing, coughing, sharing utensils, etcmicrobe enters highly vascular nasopharyngeal area & crosses into blood blood system takes it to the meninges via the blood-vessel-rich choroid plexus inflammatory process begins that eventually results in increased vascular permeability and edema.
2) can be caused by many different organisms; most common two are viral & bacterial
A. seizures
B. migraines
C. meningitis
D. myasthenia gravis

b

also known as aseptic meningitis— ie, almost never causes sepsis.
2) same basic spread & entry as other meningitis but much milder S&Ss and clinical course than bacterial
A. bacterial meningitis
B. viral meningitis

a

can be caused by several strains of bacteria
a) the most common are meningococcus & pneumococcus
b) these are more virulent and dangerous than the other & cause a worse clinical picture for the patient
A. bacterial meningitis
B. viral meningitis

c

S&S :
a) S&S related to edema:
(1) S&S of edema of meninges surrounding brain are due to the increased ICP:
(a) photophobia (pain in eyes when exposed to light); also can have blurred vision
(b) headache, irritability, restlessness, decreased LOC
(c) nausea & vomiting
(2) S&S of edema of meninges surrounding spinal cord manifest as signs of meningeal irritation:
(a) neck stiffness, also know as nuchal rigidity
(b) positive Brudzinski's and /or Kernig's signs— maneuvers that demonstrate any kind of meningeal irritation
sometimes petechiae and purpura
A. seizures
B. viral meningitis
C. bacterial meningitis
D. myasthenia gravis

c

, but gold standard is lumbar puncture ("spinal tap") -- specimen of CSF obtained and sent to lab for analysis; CSF will show:
a) high WBC count
b) higher-than-normal protein count because of the presence of bacteria and protein exudates (from inflamed meningeal blood vessels & increased vascular permeability)
c) lower glucose than usual, because bacteria is "eating" the glucose
d) blood (there should be no blood in the CSF normally)
A. seizures
B. migraines
C. meningitis
D. myasthenia gravis

b

Overview
1. main category we will study under is neuromuscular junction disorders
2. normal A&P of neuromuscular junction
a. the synapse between neuron and effector muscle is called the neuromuscular junction (NMJ).
b. correct function of the NMJ involves balance of several events at the synapse that result in movement of muscle:
1) release of adequate amounts of acetylcholine from the neuron
2) its subsequent binding to receptors of the effector muscle cell
3) as part of body's "checks and balance" system, cholinesterase is also released at the synapse to break down any extra acetylcholine that isn't used at the receptor sites (cholinesterase is "the clean-up crew")
3. abnormalities
a. anything that decreases acetylcholine production and/ or reception, and/or anything that increases cholinesterase can cause muscle weakness
b. one of most common neuromuscular junction disorders is myasthenia gravis
A. Central nervous system (CNS) disorders
B. Peripheral nervous system (PNS) disorders
C. meningitis
D. myasthenia gravis

d

chronic autoimmune disease sometimes associated with thymic tumor or other changes in thymus (mechanism for this unclear)
b. antibodies produced by the body's own immune system block, alter, or destroy the receptors for acetylcholine
Symptoms are symptomatic
A. Central nervous system (CNS) disorders
B. Peripheral nervous system (PNS) disorders
C. meningitis
D. myasthenia gravis

d

S&S:
a.one of main signs is progressive muscle weakness with motor activity--
1) this is because with each repeating nerve impulse the amount of acetylcholine released usually declines
2) this is normal in everyone-- healthy people have lots of receptors to "pick up" every last drop of acetylcholine
3) in , autoantibodies destroy many of the receptors, so even a "normal" reduction in acetylcholine quickly results in inability to complete nerve transmission to muscle cells.
b. so, hallmark of is muscle weakness that increases during periods of activity and improves after periods of rest
1) this weakness can include muscles that control eye and eyelid movements, facial expression, chewing, talking, and swallowing, and neck and limb movements
2) if affects breathing, called myasthenia crisis
3. tx—anticholinesterase drugs, steroids; sometimes thymectomy helps
A. Central nervous system (CNS) disorders
B. Peripheral nervous system (PNS) disorders
C. meningitis
D. myasthenia gravis

a

pupillary dilation, usually occurs equally in both pupils upon exposure to less light—ie, the less the light, the more the dilation.
b. results from sympathetic nervous system releasing norepinephrine and stimulating alpha-1 adrenergic receptors on iris.
A. mydriasis
B. miosis
C. diplopia
D. nystagmus

b

pupillary constriction, usually occurs equally in both pupils upon exposure to light
b. results from parasympathetic fibers within cranial nerve III (the oculomotor nerve) releasing acetylcholine, which act on receptors on iris.
c. damage (ischemia, increased pressure, etc) to CNIII will cause the loss or diminishing of pupillary constriction abilities, so that pupil will dilate abnormally & will not respond to light (or respond sluggishly).
1) this is an important sign of a neurologic disorder such as increased cranial pressure.
2) it is usually an ipsilateral sign—"same side"--ie, if there is malfunction in the right eye, the source of the problem is on the right side of the brain and/or cranial nerve.
A. mydriasis
B. miosis
C. diplopia
D. nystagmus

c

double vision; caused by a week ocular muscle, neuromuscular disease, cerebral hemisphere diseases, or thyroid disease.
A. mydriasis
B. miosis
C. diplopia
D. nystagmus

d

rhythmic, involuntary, unilateral or bilateral movement of the eyes.
a. can be horizontal or vertical movement.
b. can be congenital or can be a sign of cerebellum or inner ear dysfunction—associated with vertigo and balance problems.
A. mydriasis
B. papilledema
C. diplopia
D. nystagmus

b

edema and inflammation of the optic nerve where it enters the retina.
b this is caused by the blockage of venous return from the retina mainly because of increased intracranial pressure
c. can't be seen by naked eye—have to assess via ophthalmoscope
A. mydriasis
B. papilledema
C. diplopia
D. nystagmus

a

A person diagnosed with meningitis will be at risk for
a. increased intracranial pressure.
b. decreased cerebral edema.
c. a negative Kernig's sign.
d. motor tract decussation.

b

Upon assessing his patient, a nurse notes right-sided hemiparesis and aphasia which began 2 days ago. He therefore thinks it is most likely that the patient has had
a. basal ganglion issues.
b. a CVA involving the left hemisphere of the brain.
c. a brain attack involving the right hemisphere of the brain.
d. a TIA involving the left hemisphere of the brain.

b

A nurse reviewing the drug list of a Parkinson's patient notes that he is on an anticholinergic drug. The nurse knows that the reason for the patient to be on this drug this is most likely:
a. due to risk for increased environmental allergies.
b. to suppress some of the function of acetylcholine in the brain.
c. stimulation of adrenergic receptors in the eyes.
d. to decrease dopamine levels of the brain.

d

A patient with myasthenia gravis is on a drug to block cholinesterase. This drug is most likely being taken to decrease the
a. amount of acetylcholine in neuromuscular junctions.
b. serotonin secreted by platelets.
c. effect of hypertonia.
d. breakdown of acetylcholine in neuromuscular junctions.

d

A patient complains of vertigo, N, V, and nystagmus. Which of the following would be the most likely diagnosis?
a. brain stem stroke.
b. macular degeneration.
c. brain attack of right hemisphere.
d. cerebellar CVA.

b

S&S of unconsciousness, bilateral decerebrate posturing, and Cheyne-Stokes breathing pattern would be typical of:
a. a focal lesion in the right cerebral hemisphere.
b. diffuse increase in ICP.
c. Alzheimer's.
d. multiple sclerosis.

c

A serotonin-blocking drug will most likely to be given in which situation?
a. "I've had a migraine for hours—the pain is killing me."
b. "Nurse Ratchet, this patient is post-ictal."
c. "I'm having a pre-migraine aura, but it's not bad."
d. "My dad's memory is getting worse and worse."

c

CSF testing on a patient with fever and neck stiffness shows a high protein level. This is most likely due to
a. leakage of protein into the CSF from spinal cord injury.
b. edema from an embolic stroke.
c. the presence of bacteria in the CSF.
d. the presence of amyloid in the CSF.

d

Following an illness, a patient becomes hypocalcemic. Which of the following compensatory mechanisms is likely to occur to increase the calcium in her blood?
a. the pituitary will decrease its secretion of T4.
b. the thyroid will increase secretion of calcitonin.
c. a negative feedback mechanism will decrease secretion of parathyroid hormone.
d. a negative feedback mechanism will increase the secretion of PTH.

b

A person with Graves disease likely has all the following EXCEPT:
a. an autoimmune disease
b. Hashimoto's thyroiditis
c. goiter.
d. a heart rate of 120.

a

Lab work is done on a person with Graves disease . The expected findings would be a ___TSH and a _____T4.
a. low; high
b. high; low
c. normal; high
d. high; normal.

c

Lab work is done on a person with Graves disease . The patientgoes into a crisis state, which is called
a. myxedema coma.
b. tetany.
c. thyroid storm.
d. cretinism.

c

Osteopenia is likely associated with all the following EXCEPT:
a. hypercalcemia.
b. hyperparathyroidism.
c. high levels of calcitonin.
d. increased osteoclastic activity.

b

A patient who just came out of general anesthesia has lab work done. The serum osmo is 165. The nurse taking care of this patient suspects that the _____ is due to _________.
a. hyperosmolality: diabetes insipidus (DI).
b. hypoosmolality: syndrome of inappropriate ADH (SIADH).
c. dry mucus membranes: SIADH.
d. shift of calcium into blood: a state of hypopolarization inside the cells.

b

A patient who just came out of general anesthesia has lab work done. The serum osmo is 165. The nurse iwould expect all the following S&S EXCEPT:
a. signs of cerebral edema such as decreased LOC.
b. signs of cerebral cell dehydration such as headache.
c. generalized edema
d. crackles in the lungs upon auscultation.

a

is also know as hypophysis, located in brain near base of skull
2. known as master gland because it secretes many important hormones that govern other glands (including these that we will talk about in our 2 endocrine lectures):
a. antidiuretic hormone (ADH)
b. thyroid-stimulating hormone (TSH)
A. pituitary gland
B. diabetes insipidus
C. syndrome of inappropriate antidiuretic hormone (SIADH)
D. Hyperthyroidism

b

[undersecretion]
a. nomenclature of : means "to pass too much urine;" means "flavorless" (refers to the fact that the urine has no color because it is very dilute)
b. etiology & mechanisms of DI:
1) renal-related etiology: —"sick" kidneys often have a decreased response of renal tubules to ADH
2) CNS-related etiologies:
a) a lesion such as a pituitary tumor causes the gland to diminish its secretion of ADH
b) acute abnormality in the brain such as head injury or other causes of cerebral edema & IICP in the brain can put pressure on the pituitary gland & cause it to diminish ADH secretion
3) whatever the etiology, without the influence of ADH, you won't "hold onto" water effectively --water will indiscriminately flow from the peritubular capillaries of the kidneys into the tubules and becomes very dilute urine
A. pituitary gland
B. diabetes insipidus
C. syndrome of inappropriate antidiuretic hormone (SIADH)
D. Hyperthyroidism

b

S&S (in this general order):
a) you void huge amounts (polyuria) of dilute urine
b) this makes you thirsty, so you drink water, but it just flows right out no matter how much you drink.
c) this translates eventually to your blood compartment having less water  concentration increaseshigher serum osmolality  since the blood now has a higher osmolality than the next door tissue compartment (all over the body), water will be PULLED INTO the blood compartment (and constantly "peed out") leaving the tissue cells dehydrated & shrunken
d) so you have S&S of dehydration eventually, which include: poor skin turgor& dry mucous membranes; t to b
A. pituitary gland
B. diabetes insipidus
C. syndrome of inappropriate antidiuretic hormone (SIADH)
D. Hyperthyroidism

b

1) ectopically-produced (ectopic = "outside usual") ADH such as from small-cell bronchogenic cancer
2) various drugs that effect the brain, especially general anesthetics(sometimes seen in post-op recovery period).
3) trauma to brain such as brain tumors, head injury, etc. (swelling of brain puts pressure on pituitary gland, but can be in opposite way than DI; in in this there is OVERsecretion of ADH.)
A. pituitary gland
B. diabetes insipidus
C. syndrome of inappropriate antidiuretic hormone (SIADH)
D. Hyperthyroidism

c

characterized by abnormally high levels of ADH: you "hold onto" water
too much by abnormally decreasing urination results in increased vascular fluid volume essentially means that water has been added to the blood = diluted plasma compartment & lower serum osmolality small amounts highly concentrated urine.
2) S&S include
a) decreased urine output (oliguria) because
your body is holding onto water inappropriately in the vascular space
b) since the plasma compartment is so dilute now, which way is water PULLED IN when the blood reaches all the tissues? B to T edema
c) S&S are related to the above fluid overload situation, including peripheral & pulmonary edema.
A. pituitary gland
B. diabetes insipidus
C. syndrome of inappropriate antidiuretic hormone (SIADH)
D. Hyperthyroidism

a

more about T3 & T4 hormones:
a. typically, these are the thyroid hormones that are most often mentioned in thyroid disorders; calcitonin is less talked about.
b. their adequate production is very dependent on iodide uptake from blood -- iodide is consumed in our diet (from seafood and iodized salt)
c. T3 & T4 act on receptor cells of many different organs and affect body's:
A. metabolic rate, caloric requirements, oxygen, growth & development, brain & nervous system functions
B. respiratory rate, caloric requirements, carbon dioxide, growth & development, brain & nervous system functions
C. metabolic rate, caloric requirements, oxygen, growth & development, PNS system functions
D. cardiac rate, caloric requirements, oxygen, shrinkage & development, brain & nervous system functions

d

is the state of having excess T3 & T4 production and release
b. the most common cause-- Graves disease:
1) an autoimmune disorder in which autoantibodies attack/stimulate TSH receptors on the thyroid
2) the autoantibodies do this by "mimicking" TSH results in thyroid secreting more T3 & T4
A. pituitary gland
B. diabetes insipidus
C. syndrome of inappropriate antidiuretic hormone (SIADH)
D. Hyperthyroidism

c

the state of having excess T3 & T4 production and release
b. the most common cause--
A. Hypothyroidism
B. exophthalmus
C. Graves disease
D. Hyperthyroidism

d

lab work (this is also part of diagnosis): serum T4 will be higher than normal range and serum TSH will be lower than normal
b. other features of include is one of "overactive" S&S, due to the processes caused by high levels of T3, T4:
1) pysch/CNS—nervous, irritable, tremors, insomnia, emotionally labile, sometimes psychosis (hallucinations, paranoia)
2) cardiovascular—tachycardia, increased afterload, sometimes HF due to increased heart workload
3) GI—increased appetite, diarrhea
4) hair changes
a) hair follicles are very sensitive to your metabolic state & get "stressed" by too much thyroid hormone—hair thins out or falls out (alopecia).
b) like goiters, alopecia can happen in the other one, too, but cause would be different
A. Hypothyroidism
B. exophthalmus
C. Graves disease
D. Hyperthyroidism

b

(bulging eyes from deposits of excess tissue behind eyes) one of the signs of hyperthyroidism
A. Hypothyroidism
B. exophthalmus
C. Graves disease
D. Hyperthyroidism

d

goiter- an enlargement of the thyroid gland that can sometimes be easily visualized; causes:
a) changes occur because the cells are being pathologically stimulated by autoantibodies to increase their thyroid hormone output ("overdrive" = increased size of cells)
(1) the enlargement is a result of overactive cells
7) other body changes:
a) fatigue & weight loss (due to "overdrive" state using up energy), increased body temp & overall heat-intolerance, skin is usually flushed, warm, and damp from excessive sweating.
3. as with most endocrine disorders, hyperthyroidism has an extreme state; it is called thyrotoxic crisis (AKA thyroid storm)
a. this is a hyperthyroid emergency triggered by some stressor such as infection, trauma, surgery, etc
A. Hypothyroidism
B. exophthalmus
C. Graves disease
D. Hyperthyroidism

d

S & S's:
1) neuro: extreme restlessness & agitation; delirium; seizures; coma.
2) circulatory: severe tachycardia, heart failure, shock
3) other: diaphoresis, hyperthermia (103-105 F)
4. treatment:
a. antithyroid meds that inhibit synthesis of thyroid hormones
b. surgery-- thyroidectomy (usually ~ 90 % removed)
A. Hypothyroidism
B. exophthalmus
C. Graves disease
D. Hyperthyroidism

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