Med Surg

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Pathophysiology

involves the study of functional or physiologic change in the body from disease processes. As a disease develops, the changes in the normal anatomy &/or physiology may be obvious or may be hidden, occurring at the cellular level. As such, pathophysiology includes some aspects of pathology.

Medical History

Essential to identify any impact health care activities might have on a patient's condition, or how a patient's illness might complicate care.

Common cellular adaptations

a) atrophy, b) hypertrophy, c) hyperplasia, d) metaplasia, e) dysplasia, f) anaplasia, g) neoplasm

Atrophy

decrease in size. **CAUSES: reduced use, insufficient nutrition, decreased neurological or hormonal stimulation, and aging.

Hypertrophy

Increase in size. **CAUSES: additional work by tissue (EX enlarged heart), consistent exercise on skeletal muscle, and excessive hormonal stimulation.

Hyperplasia

Increased number. **CAUSES: compensatory mechanism, hormonal imbalance, increased risk of cancer possibility

Metaplasia

One mature cell type replaced by different mature cell type. **CAUSES: Vitamin A deficiency, adaptive mechanism

Dysplasia

Cells vary in size and shape, large nuclei, and rate of mitosis increased. **CAUSES: chronic irritation or infection, possibly pre-cancerous.

Anaplasia

Cells are undifferentiated, have variable nuclei and cell structure, and numerous mitotic figures. **CAUSES: associated with malignancy, or cancer, tumor grades.

Neoplasm

"New growth" tumor (benign, malignant) malignant=cancer.

Causes of cell damage

a) ischemia, b) physical agents, c) mechanical damage, d) chemical toxins, e) microorganisms, f) abnormal metabolites, g) nutritional deficits, h) fluid/electrolyte imbalance

Necrosis

death of a group of cells

Gangrene

Area of necrotic tissue that has been invaded by bacteria.

Defense mechanisms

Used by the body to protect itself from anj injurous agent. may be specific or non-specific.

1st Line of defense

Skin or mucous membrane

2nd Line of defense

Phagocytosis and inflammation (non-specific)

3rd Line of defense

Immune system (specific)

Ischemia

Lack of oxygen

Physical Agents

Excessive temperature or radiation

Mechanical damage

Pressure/tearing tissue

Microorganisms

Bacteria, viruses, and parasites

Inflammation

Normal defense mechanism a) Localizes and removes injurous agent, b) removes cellular debris, c) initiates healing process, d) Allows restoration of structure and function, e) regeneration of damaged tissue must occur to have complete restoration of function.

Systemic affects of inflammation

a) mild fever, b) malaise, c) headache, d) anorexia

Chronic inflammation

May follow an acute inflammation who's cause has not been completely sured OR a chronic irritation (smoking)

Acute inflammation

Develops immediately and lasts a short time

Cardinal Signs and Symptoms of Inflammation

a) erythema, b) heat, c) sweling, d) pain

Inflammatory response

1) Damaged tissues release histamines, increasing blood flow to the area. 2) Histamines cause cappillaries to leak, releasing phagocytes and clotting factors into the wound. 3) Phagocytes engulf bacteria, dead cells, and cellular debris. 4) Platelets move out of the cappillary to seal the wounded area.

Inflammation as it relates to PT

Plays a vital role in the healing process. PTA should support the healing process and encourage pts to do the same.

Healing by 1st intention

suture (faster)

Healing by 2nd intention

large open wound (slower)

Regeneration

Healing process that occurs in damaged tissue in which cells are capable of mitosis. Damaged tissue is replaced.

Repair

1) Begins with blood clot, then inflammation. 2) After 3-4 days phagocytes, monocytes and macrophages have removed debris. 3) Granulation tissue grows in the gap. 4) Epithelial cells undergo mitosis extending across the wound. 5)Fibroblasts produce collagen (scar tissue).

Scar Tissue

Fills the defect or gap in tissue. Overgrowth of scar tissue can cause a) loss of ROM, b) contracture (fixation and deformity of joint), c) adhesions (band of scar tissue joining 2 surfaces that are normally separated), d) hypertrophy and ulceration.

Factors that affect tissue healing

1) growth factors, 2) health, 3) presence of comorbidalities, 4) tobacco and caffeine, 5) nutrition, 6) type of tissue, 7) local or systemic infection, 8) medical treatment

Effect of prolonged immobilization

Tissue dehydrates and becomes less elastic, less plastic, and more brittle. Capsular structures (ligaments) become stiff and weak.

Immune response

1) specific defense, 2) Responds to specific substances, cells, toxins, or proteins, 3) Detects and destroys unknown material, 4) Demonstrates tolerance by ignoring self cells, 5) Recognizes specific antigens as foreign (develops specific response and stores response in memory for future reference).

Immunology

Covers the study of all aspects of the immune system. a) physiological, b) immunological disorders, c) characteristics and components of immune system

Benefits of a properly working Immune system

decreases risk of infection, provides protection, reduces susceptibility to common everyday infectious agents

Active Immunity

Person's own body develops antibodies, or T cells, in response to specific antigen introduced into body.

active natural immunity

direct antigen exposure **memory

active artificial immunity

vaccine **memory

Passive Immunity

Antibodies transferred from one person to another.

Passive natural immunity

invitro and breast milk **no memory

Passive artificial immunity

Rabies or anti-venom, immunoglobulin ** no memory

Skin

1st line of defense. Acts as barrier.

Tissue transplant rejection causes

Occurs when the immune system is responding to the foreign tissue resulting in destruction of the organ.

Tissue transplant rejection treatment

Involves immunosuppression techniques that reduce the immune response and prevent rejection. -drug intervention

Type I- Hypersensitivity

Allergic reactions, hay fever, food allergies, atopic dermatitis (eczema), asthma

Type II- Cytotoxic Hypersensitivity

Reaction to different blood type (Rh factor)

Type III- Immune Complex Hypersensitivity

Glomerulnephritis, rheumatoid arthritis

Type IV- Cell-mediated or Delayed Hypersensitivity

TB test, contact dermatitis, allergic skin rash

anaphylaxis

Severe life-threatening. Hypersensitivity reaction resulting in: 1) decreased BP, 2) airway obstruction, 3) severe hypoxia.

Anaphylaxis EFFECTS

itching, tingling, coughing, difficulty in breathing, weakness, dizziness, fainting, fear/panic, edema in eyes, lips, tongue, hands, feet, hives, loss of conciousness

Autoimmune disorders

Occur when individuals develop antibodies to their own cells or cellular material and these antibodies then attack the individual's tissues (EX lupus)

HIV risk in healthcare professions

Great concern over, but little evidence of, transmission to healthcare workers from infected patients other than by accidental injury or the presence of open skin lesions. Should assume risk of some infection from contact with bodily fluids and follow universal precautions.

AIDS

chronic infectious disease caused by HIV which destroys helper T-cell lymphocytes, causeing loss of the immune response and increase susceptibility to secondary infection and cancer. Prolonged latent period followed by period of active infection.

Fluid distribution

Fluids entering should equal fluids exiting to maintain balance

Extracellular Compartment (ECF)

1) intravascular fluid (IVF) - blood, 2) interstitial fluid (ISF) - inside cell, 3) cerebrospinal fluid (CSF), 4) transcellular fluid - pericardium or synovial joint cavities

Intracellular Compartment (ICF)

fluid inside the cell

Edema Causes

1) increased capillary hydrostatic pressure (blood volume. 2) Loss pf plasma proteins, 3) Obstruction of lymphatic circulation, 4) Increased capillary permeability **Occurs in extracellular compartment

Dehydration Causes

1) vomiting/diarrhea, 2) excessive sweating, 3) diabetic ketoacidosis with loss of fluid, electrolytes, and glucose in urine

Dehydration Effects

1) decrease in interstitial and intravascular fluids causing dry mucous membrane, lower BP, increased hematocrit. 2) Increase in thirst, 3)increased HR, 4)pale cool skin due to constricted blood vessels, 5) decreased urine output.

Hyponatremia

Low Sodium Levels

Hyponatremia Causes

1) Direct sodium loss or excess fluid in the extracellular compartment dilluting sodium content 2) diarrhea 3) vomiting 4) diuretic

Hyponatremia Effects

1) Muscle twitching, weakness 2) Lethargy, seizures, coma, confusion 3) Bypotension, tachycardia, 4) nausea and vomiting 5) oliguria or anuria

Hypernatremia

High sodium levels

Hypernatremia Causes

1) High sodium intake 2) Loss of water faster than loss of sodium 3) Loss of thirst mechanism 4) watery diarrhea 5) Prolonged periods of rapid respiration

Hypernatremia Effects

1) Agitation 2) Pitting edema, hypertension, 3) Thirst 4) dyspnea, respiratory arrest , death

Hypokalemia

lowpotassium levels

Hypokalemia Causes

1) diarrhea, diuresis 2) excessive aldosterone or glucocorticoids 3) decreased dietary intake, 4) insulin to treat ketoacidosis

Hypokalemia Effects

1) arrhytmia, cardiac arrest 2) anorexia, nausea, constipation 3) fatigue, muscle twitch, weakness, leg cramps 4) shallow respiration, 5) postural hypotension, polyuria, mocturia

Hyperkalemia

high potassium levels

Hyperkalemia Causes

1) renal failure, 2) aldosterone deficit, 3) diuretics 4) displacement of potassium from cells by prolonged or severe acidosis.

Hyperkalemia Effects

1) arrhythmia, 2) nausea, diarrhea, leg cramps 3) muscle weakness, flacid paralysis

Hypocalcemia

low calcium levels

Hypocalcemia Causes

1) hypoparathyroidism 2) malabsorption 3) deficient serum albumin 4) increased serum pH

Hypocalcemia Effects

1) tetany, tingling fingers 2) confusion, irritability 3) arrhythmia

Hypercalcemia

High calcium levels

Hypercalcemia Causes

1) uncontrolled release of calcium ions from the bones due to neoplasms 2) hyperparathyroidism 3) immobility 4) increased calcium intake 5) milk-alkalai syndrome

Hypercalcemia Effects

1) apathy, lethargy 2) anorexia, nausea, constipation 3) polyuria, thirst 4) kidney stones 5) arrhythmia, increased BP

Importance of acid -base balance

Cell enzymes can only function in a very narrow pH range

Respiratory acidosis

CAUSE: shallow respiration and respiratory congestion

Metabloic acidosis

CAUSE: Shock, diabetic ketoacidosis, renal failure, diarrhea

Acidosis EFFECTS

headache, lethargy, weakness, confusion. Leads to coma and death

Respiratory Alkylosis

CAUSE: hyperventilation

Metaboli Alkylosis

CAUSE: vomiting and excessive antacid intake

Alkylosis EFFECTS

restlessness, muscle twitching, tingling and numbness of fingers, tetany, seizures and coma

Acid-base imbalance treatment

Underlying cause of imbalance should be diagnosed and removed. Add/remove fluid or electrolytes

Hematocrit

M 45-52% F 37-48%

Hemoglobin

M 13.5-18 g/100mL F 12-16 g/100mL

Sodium (Na+)

135-142 mEq/L

Potassium (Ka)

3.8-5 mEq/L

Blood glucose (fasting)

70-110

WBC

4500-10500 /mm3

O2 saturation (SaO2)

96-98%

Prothrombin (PT/INR)

1.5-2.5 sec.

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