Pathophysiology (Nursing 232 Rick Daniels, Donna Dial)-Exam Three (Final) Study Guide
Terms in this set (319)
Respiratory Syncytial Virus. Respiratory syncytial virus (RSV) causes infections of the lungs and respiratory tract. It's so common that most children have been infected with the virus by age 2. Respiratory syncytial (sin-SISH-ul) virus can also infect adults. Symptoms include:
Congested or runny nose
Infants are most severely affected by RSV.ected by RSV.
acute coronary syndrome
sudden symptoms of insufficient blood supply to the heart indicating unstable angina or acute myocardial infarction
Cardiac Output X Peripheral Vascular Resistance =
Heart Rate X Stroke Volume =
Cardiac Output (CO)
Arteries, veins, capillaries
Small arteries that control amount of flow to capillaries by constriction
Collect blood from capillaries and can hold 70% of the body's blood
Innermost layer of smooth tissue, reduces friction.
Type of muscle tissue which is used by various systems to apply pressure to vessels and organs. Smooth muscle is composed of sheets or strands of smooth muscle cells. These cells have fibers of actin and myosin which run through the cell and are supported by a framework of other proteins. Controls size of lumen
Elastic and collagen fibers
Auto-regulation of blood flow
Changed by the need of the cell in the area.
Examples of auto-regulation
Local tissue needs: decreased pH & O2--->Vasodilation
Release of histamine or increase temp--->vasodilation
Bradykinin---->increased capillary permeability
A powerful vasodilator that increases capillary permeability and constricts smooth muscle
neural and hormonal control
Examples of neural-hormonal control
Autonomic nervous System-Sympathetic Nervous System-blood vessels
Antidiuretic hormone (ADH)
Neural-hormonal control of Sympathetic Nervous System explained
-Baroreceptors sense change in BP
-Relayed to medulla: SNS and epinephrine act on Beta1-adrenergic receptors in the heart and the heart rate and force both go up. Additionally, SNS, epinephrine and norepinephrine act on Beta1 receptors in arterioles and constriction increases.
(SNS)-affects smooth muscle of blood vessels; causes constriction
(SNS)-Located in the brain; stimulation causes vasodilation
Beta 2 receptors
(SNS)-Primarily in the lungs; causes bronchodilation, mild blood vessels dilation in the muscles
Parasympathetic nervous system
-Discussed more with cardiac arrhythmias
-Vagus nerve affects the heart rate
-Does not affect BP as much as SNS
Renin-angiotensin-aldosterone system. When blood flow is low, juxtaglomerular cells in the kidneys secrete renin directly into circulation. Plasma renin then carries out the conversion of angiotensinogen released by the liver to angiotensin I. Angiotensin I is subsequently converted to angiotensin II by the enzyme angiotensin converting enzyme. Angiotensin II is a potent vaso-active peptide that causes blood vessels to constrict, resulting in increased blood pressure. Angiotensin II also stimulate the secretion of the hormone aldosterone from the adrenal cortex. Aldosterone causes the tubules of the kidneys to increase the reabsorption of sodium and water into the blood. This increases the volume of fluid in the body, which also increases blood pressure.
Formation of a clot in the blood vessel
Do clots form more often in the arterial or venous system?
-More commonly in venous system - legs or pelvis (DVT)
-Arterial clots can form in chambers of heart
Factors contributing to thrombosis
Long travel time
Drugs(BCP or erythropoietin)
Deep vein thrombosis, deep venous thrombosis
Signs and symptoms of a DVT
Increase warmth Pain
Positive Homan's sign (Note: not that predictive in dx of DVT)
Pain in the calf with dorsiflexion of the
foot (Note: not that predictive in dx of DVT)
Diagnosis of a DVT
*Examine for the underlying cause
A D-dimer test is a blood test that can be used to help rule out the presence of a serious blood clot.
When you get a cut, your body takes a bunch of steps to make your blood clump up. It's a normal part of healing -- without it, you'd keep bleeding and have a much more serious problem to deal with.
Once the bleeding stops, you don't need the clot anymore. So your body takes a series of steps in the other direction and breaks the clot down.
At the end of all that, you have some leftover substances floating around in your blood -- like how you'd have wood dust all over after a building project.
One of those leftovers is called D-dimer. It's part of a protein. Normally, with a little time, it goes away. But you can get high levels of D-dimer in your blood if you have a major clot like with deep vein thrombosis (DVT).
Test that uses high-frequency sound waves to measure the amount of blood flow through your arteries and veins, usually those that supply blood to your arms and legs. Vascular flow studies, also known as blood flow studies, can detect abnormal flow within an artery or blood vessel
Underlying causes of DVT
The blood clots of deep vein thrombosis can be caused by anything that prevents your blood from circulating or clotting normally, such as injury to a vein, surgery, certain medications and limited movement.
Risk factors for DVT
-Inheriting a blood-clotting disorder
-PRolonged bed rest
-Injury or surgery
-Birth control pills
-Being overweight or obese
-Inflammatory bowel disease
-Sitting for long periods of time
Treatment of DVT
Anticoagulation therapy if suspect formation of new clots
Vena Cava Filter
Graduated compression stocking or intermittent pneumatic compression (IPC) devices
Blockage in one of the pulmonary arteries in your lungs. In most cases, pulmonary embolism is caused by blood clots that travel to the lungs from the legs or, rarely, other parts of the body (deep vein thrombosis).
Signs of a pulmonary embolism
Small clot: can be asymptomatic
Moderate: ◦ Fluid and blood fill the alveoli in area, ◦ Reflective vasoconstriction ◦ Increase in blood vessel pressure
Large: ◦ 60% or more of lung tissue ◦ Leads to right-sided heart failure, acute cor pulmonale ◦ Decrease cardiac output on left side ◦ Shock, sudden death
Cor pulmonale is defined as an alteration in the structure and function of the right ventricle (RV) of the heart caused by a primary disorder of the respiratory system. Pulmonary hypertension is often the common link between lung dysfunction and the heart in cor pulmonale
Symptoms of a pulmonary embolism
Sudden onset of tachypnea and dyspnea
Later hemoptysis and fever
General sympathetic reaction: anxiety, restlessness, pallor Massive PE: low BP, rapid weak pulse, loss of consciousness
Fat emboli: petechial rash on trunk
Diagnosis of pulmonary embolism
Chest xray, V/Q lung scan, or helical CT scan
Quantitative D-dimer assay
Conventional pulmonary angiogram only if other diagnostic tests (above) are not conclusive because it is expensive and invasive)
Treatment of pulmonary embolism
Anticoagulation Therapy: Unfractionated Heparin, Lowmolecular weight heparin, and oral anticoag. (e.g., warfarin) at time of diagnosis
Thrombolysis: tx if hemodynamic compromise
Embolectomy: massive PE, can have fibrinolysis tx.
Vena Cava Filters: if unable to do anticoag. Tx., hx of massive PE and suspected recurrence
any of a group of diseases characterized by thickening and loss of elasticity of arterial walls
A common form of arteriosclerosis with yellowish plaques containing cholesterol, lipoid material narrowing the size of arteries.
Etiology of Atherosclerosis
Mainly affects large and medium arteries:
◦ coronary (CAD)
◦ cerebral, carotid, (CVA)
◦femoral arteries: (arterial PVD)
General Process of Atherosclerosis
Damage to the endothelial surface Inflammatory response with increased wall permeability
LDL breach layer, Leukocytes drawn Platelet aggregate: release platelet growth factor
Increase growth of smooth muscle, proliferate (thrombus CAD) PLAQUE: smooth muscle cells, lipoproteins, inflammatory debris Repeated
Risk factors for Atherosclerosis
Inc. total and LDL cholesterol
Arterial Peripheral Vascular Disease
Signs and symptoms of PVD
Cold, decrease hair growth, glossy appearance
Pallor when elevated; rubor when dependent
Sharp pain with activity, improved at rest
Ulcer development: heels, malleolus, distal phalanges
Relatively rare condition of the smaller arteries, evidenced by brief vasospasms and narrowing of blood vessels (vasoconstriction)
True or False: Raynaud's Syndrome is most common in males
Raynaud's Syndrome is most common in females (from puberty to menopause).
Raynaud's affects the __________
Distal Extremities, such as earlobes and the nose.
True or false:
Raynaud's can be triggered by emotional stress and the cold.
Management of Raynaud's Syndrome
Avoid cold, stressors, smoking S/S are not serious Insulated clothing (e.g., gloves)
Warm water soaks
Biofeedback & relaxation techniques
Calcium channel blockers (nifedipine)
Topical NTG ointment to fingers & dorsum of hand Prostaglandin therapy
Acute Arterial Occlusion
Acute arterial occlusion is considered a vascular emergency. Acute arterial occlusion is defined as a sudden loss of limb perfusion for up to 2 weeks after the initiating event. If blood flow to your toe, foot, or leg is completely blocked, the tissue begins to die. This is called gangrene.
Causes of acute arterial occlusion
Acute thrombus /embolism, trauma, external compression
Six P's of Assessment
Pain or tenderness
Pallor (pale skin)
Parasthesia (pins and needles)
Pulses diminished or absent
Rare disease of the arteries and veins in the arms and legs. In Buerger's disease — also called thromboangiitis obliterans — your blood vessels become inflamed, swell and can become blocked with blood clots (thrombi).
Etiology of Buerger's Disease
Men; 20-40; higher in Israel, Asia, India
Signs and symptoms of men Buerger's Disease
Distal extremity ischemia; pain at rest; ulcerations
Treatment of Buerger's Disease
Antibiotics; amputation; good wound care; stop smoking; prostaglandins, hyperbaric oxygen Therapy
Obstruction of venous flow can lead to
Occurs when the leaflets do not close completely, letting blood leak backward across the valve. This backward flow is referred to as "regurgitant flow."
If valves in the superficial veins of the lower legs are weak or damaged, blood can flow backward and pool in the vein, causing the veins to stretch or twist.
Causes of varicose veins
Pregnancy, obesity, standing a lot, poor venous return, hereditary
Signs and Symptoms of varicose veins
Mild to severe pain; legs cramps; swelling
Treatment of varicose veins
Keep legs elevated, cosmetics, antiembolic stockings
Chronic venous insufficiency
Also known as Venous Stasis Ulceration. The venous wall and/or valves in the deep veins of the legs are not working effectively, making it difficult for blood to return to the heart from the legs. CVI causes blood to "pool" or collect in these veins, and this pooling is called stasis.
Etiology of Chronic Venous Insufficiency
Aging; poor CV output; poor venous return
Clinical manifestations of Chronic venous insufficiency
◦ Reddish-brown color (distal to proximal)
◦ Pain in dependent position
◦ Edema & inflammation
Chronic venous insufficiency (AKA: Stasis Ulcerations) Management
* Elevate lower extremities
* Stop smoking
Made by hypothalamus and stored in the posterior pituitary gland; and secreted from the pituitary (Note: osmoreceptors influence the stimulation of ADH, as well as ADH secretion being stimulated by baroreceptors in the aorta and carotid arteries). The kidneys then reabsorb water which increases BP.
An abnormal or excessive accumulation of a body fluid.
Systolic Blood Pressure
(Korotkoff sound begins) pressure exerted by blood when ejected from the left ventricle
Reduced myocardial contractility
- EF <40%
- loss of pumping cell from damage
- chronic over-exercised beta cell receptors by SNS - prognosis worsens as EF drops
Left-sided HF can cause fluid buildup in __________
True or False:
Right-sided HF often leads to edema
JVD (jugular vein distention) is a sign of
Compensating Mechanisms Related to Heart Failure
Increased HR, Increased contractility
Ventricle wall tension goes up ----->
The amount of sarcomere stretch experienced by cardiac muscle cells at the end of ventricular filling during diastole. Preload is directly related to ventricular filling.
The force or load against which the heart has to contract to eject the blood. Contractility is the intrinsic strength of the cardiac muscle independent of preload, but a change in preload will affect the force of contraction. Afterload is the 'load' to which the heart must pump against..
End diastolic volume
The amount of blood present in the ventricles just before contraction.
Important determinant of stroke volume
Ejection fraction (EF) is a measurement, expressed as a percentage, of how much blood the left ventricle pumps out with each contraction. A healthy ejection fraction of 60 percent means that 60 percent of the total amount of blood in the left ventricle is pushed out with each heartbeat.
Pressure that occurs when the ventricles are relaxed (korotkoff sound disappears)
Disorder of myocardial relaxation
- both active and passive stage of diastolic relaxation are impaired
- EF is > 50%
- poor left ventricular compliance with lower diastolic volume and high pressure
Difference between the systolic and diastolic pressure
Heart Failure Clinical Manifestations
•Group of symptoms that make the syndrome:
F - fatigue
A - activity limitation
C - congestion
E - edema
S - SOB
Mean Arterial Pressure
(2 X DBP + SBP)/3 : useful for titrating IV vasoactive drugs
The condition of increased pressure or force in the arterial wall
Etiology of Primary Hypertension
◦ Essential hypertension: unknown etiology; most common type;
◦ CV Risk factors
◦ Outcomes: renal damage; Left Vent. Hypertrophy; MI
Etiology of Secondary Hypertension
◦ Known, identifiable cause
◦ Infants/peds most often have secondary hypertension
◦ Sleep apnea, drugs, CRD, Primary Aldosteronism, Cushings or steroid therapy, pheochromocytoma, thyroid or parathyroidism
Etiology of Emergency Hypertension
◦ That which is caused by crisis: can cause CVA, emboli, MI, HF, etc. - DBP >120 and acute end-organ damage
Risk Factors of HTN
DM - insulin, glucose Hyperlipidemia-total, HDL, LDL
Drugs that elevate the rate of bodily urine excretion and decrease preload
Angiotensin-converting enzyme (ACE) inhibitors
Angiotensin-converting enzyme (ACE) inhibitors help relax your veins and arteries to lower your blood pressure. ACE inhibitors prevent an enzyme in your body from producing angiotensin II, a substance that narrows your blood vessels.
Decrease HR and contractility
Beta blockers work by blocking the effects of the hormone epinephrine, also known as adrenaline.
Beta blockers cause your heart to beat more slowly and with less force, which lowers blood pressure. Beta blockers also help open up your veins and arteries to improve blood flow.
Angiotensin II receptor blocker
Medications that block the action of angiotensin II by preventing angiotensin II from binding to angiotensin II receptors on the muscles surrounding blood vessels. As a result, blood vessels enlarge (dilate) and blood pressure is reduced.
Aldosterone Receptor Blocker
Aldosterone receptor antagonists (also called an antimineralocorticoid, MCRA, and sometimes MRA) are a class of drugs which block the effects of aldosterone. Aldosterone is the main mineralocorticoid hormone in the body and is produced in the adrenal cortex of the adrenal gland. Aldosterone increases sodium reabsorption by the kidneys, salivary glands, sweat glands and colon. At the same time, it increases the excretion of hydrogen and potassium ions.
By blocking the effects of aldosterone, aldosterone receptor antagonists block the reabsorption of sodium, which encourages water loss. Consequently, this leads to a decrease in blood pressure and a reduction in fluid around the heart.
Calcium Channel Blockers
Heart and vessel contraction
Calcium channel blockers lower your blood pressure by preventing calcium from entering the cells of your heart and arteries. Calcium causes the heart and arteries to contract more strongly. By blocking calcium, calcium channel blockers allow blood vessels to relax and open.
Decrease HR and vessel contractility
Reduce the effect alpha-1-adrenergic receptors. Alpha-1 adrenergic receptors occur in vascular smooth muscle, the central nervous system, and other tissues. When alpha blockers bind to these receptors in vascular smooth muscle, they cause vasodilation.
Affect the muscles in the walls of your arteries and veins, preventing the muscles from tightening and the walls from narrowing.
As a result, blood flows more easily through your vessels. Your heart doesn't have to pump as hard, reducing your blood pressure.
Normal blood pressure
Your blood pressure is normal if it's below 120/80 mm Hg
Elevated blood pressure
Elevated blood pressure is a systolic pressure ranging from 120 to 129 mm Hg and a diastolic pressure below 80 mm Hg. Elevated blood pressure tends to get worse over time unless steps are taken to control blood pressure.
Three components of Breathing Mechanics
Opposing lung forces
Stage 1 Hypertension
Stage 1 hypertension is a systolic pressure ranging from 140 to 159 mm Hg or a diastolic pressure ranging from 90 to 99 mm Hg.
The relationship between pressure and flow. The resistance increases as the airway passages narrow.
◦ Smooth muscle constriction
◦ Foreign body
Stage 2 hypertension
More severe hypertension, stage 2 hypertension is a systolic pressure of 160 mm Hg or higher or a diastolic pressure of 100 mm Hg or higher.
Lungs ability to inflate and chest wall expandability.
◦ Neonates and children have increased lung compliance up to 3.5 years old due to chest wall flexiblity
◦ Elderly have decrease in lung compliance due to rib rigidity and loss in elastic fibers in the lungs
Nasopharynx, oropharynx, and laryngopharynx
Larynx, trachea, bronchi, bronchopulmonary segments, terminal bronchioles, and acinus.
Filter, warm, humidify
◦ Vascular turbinates heats air to body temperature and humidifies to 80%
◦ Large hair and cilia filter and sweep particles trapped in mucous to nasopharynx
◦ Connects to middle ear through Eustachian tubes to give middle ear atmosphere pressure. Note: eustachian tube is shorter and more horizontal in children ◦ Muscle controlled cartilage to stop food going in middle ear
Pharynx posterior to the oral cavity
Opposing Lung Forces
Elasticity VS chest wall expansion
Chest wall expandability (note: not usually measured)
and Lung expandability
Blocks the opening to the trachea to allow food to pass
Produces sound, transports air, continues to warm. Moistens, and filters
Blood supply to the lungs comes from
1.Bronchial artery system, and 2.Pulmonary artery system
Age related variations of respiratory system:
PaO2 varies across the ages. Adult norms are 90- 100 and elderly norms can be ____to_____
Process of moving air into the lungs and distributing air within the lungs to gas exchange of O₂ and CO₂
Neural control centers of Ventilation
Medulla oblongata (muscle stimulation) and pons (rate of respiration and blocks ramp signal)
Neural control centers of Ventilation: Central Chemoreceptors
Medulla responds to CO2 and decrease in Ph
Neural control centers of Ventilation:
Aortic arch and carotid bodies respond to arterial O2
Neural control centers of Ventilation:
Stretch receptors in alveolar, bronchi and bronchioles
Neural control centers of Ventilation:
Muscles and tendons to increase respirations with exercise
Neural control centers of Ventilation:
Aortic arch and carotid arteries increases BP and decreases respiration
Distribution of Blood Flow
Perfusion is affected by
◦ Body position
◦ Pressure of capillaries vs. alveoli
An abnormal route of blood flow through the heart or lungs that allows movement
of blood into the arterial system without passing through oxygenated areas of the lung.
A pathological condition that results when the alveoli of the lungs are perfused with blood as normal, but ventilation (the supply of air) fails to supply the perfused region. In other words, the ventilation/perfusion ratio (the ratio of air reaching the alveoli to blood perfusing them) is zero.
The higher amount of shunted blood, the greater the hypoxia
Barriers to Diffusion
Thickening of alveolar -capillary membrane (e.g., pneumonia, pulmonary edema); decreased available surface (e.g., emphysema); aging
When delivery of air to the alveoli is insufficient to meet the need to provide oxygen and remove CO2 . Examples are: medications, sleep apnea, chest wall damage.
An increase in the amount of air entering the alveoli, which leads to hypocapnia. Note: example causes are pain, fever, anxiety.
Deficient blood oxygen
A decrease in tissue oxygenation
True or False:
A decrease in blood flow leads to an increase in oxygen delivery
A decrease in blood flow leads to a decrease in oxygen delivery.
Acute Respiratory Failure
A state of disturbed gas exchange resulting in abnormal arterial blood gases.
Acute Respiratory Failure Etiology
Neuromuscular alterations (e.g., quadriplegia, hemiplegia); chest trauma; emphysema; ARDS (Acute respiratory distress syndrome)
Manifestations of Acute Respiratory Failure
Hypoxia, hypercapnia, confusion, decreased level of consciousness (LOC), restlessness, dizzy, hypotension, tachycardia
Acute Respiratory Failure Diagnosis
Clinical picture; ABGs; chest X-Ray
Management of Acute Respiratory Failure Diagnosis
Mechanical ventilator; treat the cause; medications; supportive care
A sustained increase in pulmonary arterial pressure above 30 mm/Hg systolic
Etiology of Pulmonary Hypertension
Portal hypertension of cirrhosis; HIV; chronic bronchitis; emphysema
Pathophysiology of Pulmonary Hypertension
Pulmonary vessels thicken as a result of tissue hypoxia and acidosis; then nodular lesions within the blood vessels form and impede pulmonary circulation
Manifestations of Pulmonary Hypertension
Exercise intolerance; syncope; fatigue; chest pain; hemoptysis; pulmonary edema
Diagnosis of Pulmonary Hypertension
Clinical picture; pulmonary artery catheter; chest X-ray; 12 lead ECG
Management of Pulmonary Hypertension
Vasodilators; surgical shunt
Pulmonary Venous Thromboembolism
Undissolved detached material that occludes blood vessels to the pulmonary vasculature
Pathophysiology of Pulmonary Venous Thromboembolism
Dislodged thrombus travels toward the heart and lungs and occlude vessels
Manifestations of Pulmonary Venous Thromboembolism
Restlessness, apprehension, anxiety, dyspnea, chest pain that is sudden. Note: this condition may mimic a myocardial infarction
Diagnosis of Pulmonary Venous Thromboembolism
Lung scan; helical angiography; ABGs; chest X-ray; ECG; cardiac enzymes. Note: the diagnostics are done to "rule out" an MI.
Management of Pulmonary Venous Thromboembolism
Prevention (range of motion if immobile; anticoagulants); oxygen; heparin; thrombolytics.
Lung cancer causes about 1/3 of all cancer deaths in men and ¼ in women.
Etiology: smoking causes 85%
Patho: various types of cancer cell types
Manifestations: weight loss, anemia, dyspnea, cough, chest pain, hemoptysis, increased sputum
Management: chemo, radiation, laser therapy, surgery
Disorders: Diseases of the Lung Parenchyma
-Granulomatous disease (Sarcoidosis, tuberculosis,
-Pneumoconioses (Occupational lung disease)
-Acute interstitial pneumonitis
Collagen disease (Rheumatoid arthritis, scleroderma,
systemic lupus erythematosus)
-Vascular Diseases (Pulmonary edema, pulmonary embolism)
Disorders: Extrapulmonary Restriction
Chest wall disease (Kyphoscoliosis, ankylosing spondylitis,
Neuromuscular disease (Quadriplegia, hemiplegia, Guillain-Barré
syndrome, myasthenia gravis,
amyotrophic lateral sclerosis, muscular
Pleural diseases (Pleural effusion, hemothorax,
(Abdominal distention, surgery, pregnancy)
Tiny sacs that are covered in capillaries where oxygen exchange for CO₂ takes place.
Obstructive Lung Disease
Obstructive lung disease and its characteristic narrowing of pulmonary airways hinder a person's ability to completely expel air from the lungs. The practical result is that by the end of every breath, quite a bit of air remains in the lungs. Some common conditions related to obstructive lung disease include:
-Chronic obstructive pulmonary disease (COPD), which encompasses emphysema and chronic bronchitis
Restrictive Lung Disease
People suffering from restrictive lung disease have a hard time fully expanding their lungs when they inhale. That is, it's more difficult to fill lungs with air. This is a result of the lungs being restricted from fully expanding. This can occur when tissue in the chest wall becomes stiffened, or due to weakened muscles or damaged nerves. Any of these factors can restrict the expansion of the lungs. Some of the conditions classified as restrictive lung disease include:
-Interstitial lung disease
-Neuromuscular disease, such as amyotrophic lateral sclerosis (ALS)
Severe but reversible hyper responsiveness of the bronchi and bronchioles
Two basic types :
Extrinsic asthma (allergic) (1/3 to 1/2 of all cases)
Intrinsic asthma (non-allergic): develops in middle age with less favorable prognosis
Many have both
Smooth muscle contraction
Inflammation of the mucosa with edema
Increased secretion of thick mucus
True or False:
Asthma can lead to either respiratory acidosis or respiratory alkalosis
Respiratory alkalosis at first due to hyperventilation
Respiratory acidosis with air trapping and fatigue
ABG of respiratory failure due to asthma
ABG with PO2 below 50, PCO2 above 50
Acute inflammation of trachea and bronchi
Etiology: variety of viruses (e.g., influenza A or B) Patho: inflamed and narrowed airways, increased mucus production, loss of ciliary function
Sx: usually mild onset and self-limited; cough, lowgrade fever, sore throat, fatigue
Dx: presentation, chest x-ray TX: supportive; antibiotics when bacterial
Airway becomes swollen and tight, making it difficult to move air in and out. More mucus develops further obstructing the airway.
Most patients have chronic bronchitis and emphysema, which is labeled Chronic Obstructive Pulmonary Disorder (COPD). Note: chronic bronchitis labeled Type B ("blue bloater") Airway becomes swollen and tight, making it difficult to move air in and out. More mucus develops further obstructing the airway
Most patients have chronic bronchitis and ________________.
Most patients have chronic bronchitis and emphysema, which is labeled Chronic Obstructive Pulmonary Disorder (COPD). Note: chronic bronchitis labeled Type B ("blue bloater")
In people with emphysema, the air sacs in the lungs (alveoli) are damaged. Over time, the inner walls of the air sacs weaken and rupture — creating larger air spaces instead of many small ones. This reduces the surface area of the lungs and, in turn, the amount of oxygen that reaches your bloodstream.
Also labeled Type A COPD ("Pink Puffer"); frequently combined with chronic bronchitis
What percentage of cases of chronic bronchitis are due to smoking?
Pink puffer is a generalized term for a person who is thin, breathing fast and is pink. They usually present with shortness of breath and pursed lip breathing. It's an old term for what we would now recognize as severe emphysema.
Pathophysiology of chronic bronchitis
Changes in the airway with chronic inflammation, swelling of bronchial mucosa, hyperplasia of mucous glands, increased bronchial walls. Note: results in obstruction to airflow.
Blue bloater is a generalized term referring to a person who is blue and overweight. They usually present with shortness of breath and they have a chronic cough. It's an old term for what we would now recognize as severe chronic bronchitis.
Clinical Manifestations of chronic bronchitis
Excessive sputum, chronic cough, increased body fluids, history of smoking, malaise, fatigue, loss of libido, insomnia. Note: cough with sputum more severe in morning. Note: labeled "Blue Bloater" from edema associated with right-sided heart failure.
Diagnosis of chronic bronchitis
Chest x-ray, pulmonary function tests, ABG, ECG
Treatment of chronic bronchitis
Inhaled beta₂ agonists, inhaled anticholinergics, cough suppressants. Note: may also use corticosteroids. Note: essential to discontinue smoking.
An extreme vasoconstriction producing cessation of flow to the fingers and toes produces the characteristic signs and symptoms of Raynaud
syndrome. Sometimes earlobes or the tip of the nose are also affected.
The arterial wall deteriorates until it is weakened sufficiently to bulge outward. The underlying cause may be atherosclerotic changes in the vessel; a
congenital weakness; or a weakening induced by infection, inflammation, or traumatic injury.
True Aneurysms vs False Aneurysms
In true aneurysms, all three tunicae are involved (intima, media, and adventitia), whereas in false aneurysms, at least one tunica is left unaffected.
Dissecting Aortic Aneurysm
The tear in the arterial wall creates
a channel for blood flow.
the weakening is confined
to one side of the vessel, producing a lateral ballooning.
weakening on both sides of the vessel wall—a
the most common cerebral
aneurysm; it is shaped like a berry, with a neck or stem.
Common causes of arterial obstruction are
vasospasm, and aneurysms. Emboli are the usual cause of acute arterial
____________ is the most common cause of chronic progressive arterial
risk factors for the development of atherosclerosis
smoking, hyperlipidemia, male gender,
advancing age, sedentary lifestyle, obesity, glucose intolerance, and a family
history of cardiovascular disease (CVD).
Acute arterial obstruction is accompanied by the classic manifestations
known as the six Ps. They are:
pallor, paresthesia, paralysis, pain, pulselessness, and
polar (cold to touch).
Programmed cell death
Refers to an inadequate supply of O₂ to the cells
Lack of blood supply to the body parts
Epiglottitis is a rapidly progressive cellulitis of the epiglottis and adjacent soft tissues. The causative organism is primarily H. influenzae type B (Hib). It is most often seen in children 2 to 4 years old. This condition is a true medical emergency and may necessitate intubation.
Croup syndrome describes a number of acute viral and inflammatory
diseases of the larynx.
The child presents with a history of upper respiratory tract infection
or cold that has developed into a barking cough with stridor.
High pitched wheeze most likely from airway obstruction in the larynx or trachea
Bronchiolitis is characterized by widespread inflammation of bronchioles
attributable to infectious agents such as respiratory syncytial virus (RSV) (50% of cases), influenza virus (type A, B, or C), or bacteria (H.
influenzae, pneumococci, or hemolytic streptococci)
RSV occurs in yearly epidemics in winter to spring, usually
in children younger than ____years.
In adults, bronchiolitis is commonly associated with
smoking, toxic fumes, and immunosuppression.
Clinical manifestations of bronchiolitis
Common clinical features include wheezing attributable to
bronchospasm, crackles, decreased breath sounds, retractions, increased
sputum, dyspnea, tachypnea (rapid, shallow respirations), and low-grade
Diagnoses of bronchiolitis
Patients commonly have an elevated WBC count. The chest radiograph
may show enlarged air sacs, interstitial infiltrates, atelectasis, or severe
Treatment of bronchiolitis
Adequate oxygenation is maintained by providing humidified oxygen;
monitoring blood gases or oxygen saturation; and administering oral, inhaled, or intravenous bronchodilator agents and, in selected cases,
Cystic fibrosis (mucoviscidosis) is an autosomal-recessive disorder of the exocrine glands. It is the most common genetic lung disease in the United States, with an incidence of 1 in 2000 to 3000 Caucasian births.
Sx: history of cough as child or young adult; thick, tenacious sputum; digital clubbing, dyspnea, tachypnea, rhonchi, barrel chest, history of multiple respiratory infections, associated with variety of other diseases (e.g., cirrhosis, DM, gallstones)
¨ DX: clinical and laboratory findings: ABGs, pulmonary function tests, sputum culture, chest x-ray, stool exam reveals fat, sweat test (note: to find pilocarpine iontophroesis)
Kidneys filter _____ gallons of fluid each day
Kidney's Role in Collecting and Eliminating Waste
Filters blood flowing through the glomeruli
Releases the filtered substance from the tubules
Reabsorbs filtered fluids through the tubules
K+ excretion in distal tubules
Glomerular Filtration Rate
GFR is rate kidneys filter blood in 1 minute
GFR is related to renal blood flow
Normal GFR is 90 -120 ml/min measured by 24 hour creatinine clearance
When GFR begins to fall the body responds by excreting Na and thirst response.
When GFR falls below 10 mL/min/1.73 m 2 creatinine and urea rise (uremia).
True or False:
The heart is the most important organ for the long term control of blood pressure
The kidneys are the most important organs for the long term control of blood pressure
Maintain acid-base and fluid balance
Eliminate wastes and detoxify the blood
Regulate blood pressure
Erythropoiesis (RBC production)
Regulate Calcium and Vitamin D formation
The renin-angiotensin-aldosterone system (RAAS) is a signaling pathway responsible for regulating the body's blood pressure.
"salt-retaining hormone" which promotes the retention of Na+ by the kidneys. na+ retention promotes water retention, which promotes a higher blood volume and pressure
Erythropoietin; produced primarily by the kidneys, promotes growth of red blood cells
Nephrotic syndrome is a glomerulopathy in which there is a urinary
elimination of >3 to 3.5 grams of protein per day due to glomerular
generalized edema, and a propensity for thrombus formation.
Production of red blood cells
The kidneys assist with the conversion of Vitamin ___ to an active form
By age 70, there is a _____% loss in nephrons
Kindney's role in acid base balance
Secretes excessive hydrogen ions (H+)
Regulates the concentration of bicarbonate ions (HCO3-)
Lungs and kidneys work together for acidbase balance
Compensate for respiratory acidosis and alkalosis
A ball of capillaries surrounded by Bowman's capsule in the nephron and serving as the site of filtration in the kidney.
Glomerular disorders result from alterations in the structure and function of the glomerular capillary circulation and are broadly delineated as glomerulopathies.
Disease states in which the kidney is the only or the predominant organ involved
Result from a variety of systemic disorders
Result from drug exposure, infection, or glomerular injury in setting of multisystem/vascular abnormalities
Glomerulopathies commonly result in
Proteinuria, hematuria, red blood cell (RBC) urinary casts, decreased GFR, and hypertension
Inflammation of the glomeruli of the kidney
The abrupt onset of varying degrees of hematuria, proteinuria, oliguria, azotemia, edema, and hypertension.
Blood in the urine
The presence of an abnormal amount of protein in the urine
Kidney's role in fluid balance
Antidiuretic hormone (ADH): from the posterior pituitary, regulates the concentration of body fluids (water) by altering the permeability of the kidneys
Aldosterone: regulates water reabsorption by increasing sodium reabsorption in the distal tubules
Decreased urine output
(Excessive) urea and nitrogenous substances in the blood
Puffy swelling of tissue from the accumulation of fluid
Nephrotic syndrome is a glomerulopathy in which there is a urinary elimination of >3 to 3.5 grams of protein per day due to glomerular leakiness.
Although bladder infections are quite common, especially in women, pyelonephritis is unlikely to occur unless there is obstruction or ureteral reflux that allows contaminated urine to enter the kidney. Infection of the kidney from the bloodstream is rare in comparison to infections that ascend from the lower urinary tract.
E. coli is the causative organism in the large majority of acute pyelonephritis cases.
Small atrophied kidneys with diffuse scarring and blunting of the calices secondary to persistent or
recurrent infection of the kidney. Chronic reflux of infected urine into the renal pelvis is the typical cause of chronic pyelonephritis.
Renal calculi, or lithiasis, are crystal aggregates composed of organic and inorganic materials located within the urinary tract. These calculi can form within the kidney, in the tubules, or in the collecting system and may then migrate to more distal structures.
Active Vitamin D is necessary for _______ absorption in the intestines
Pain in the kidney
Renal agenesis means a failure of one or both kidneys to embryonically develop.
Renal Blood Pressure Regulation
Renin and angiotensin production is increased in the kidney when stimulated by hypotension
A condition in which some fetal development of the kidneys has occurred but they are smaller than normal.
Acute kidney injury (AKI), also known as acute renal failure, represents a broad spectrum of kidney diseases ranging from minor changes in renal function to complete renal failure requiring renal replacement
Prerenal Kidney Injury
When AKI develops because of diminished perfusion of the kidney, it is termed prerenal kidney injury because the etiology occurs before the kidney itself.
• Absolute decrease in circulating volume
• Cardiogenic shock
• Cardiac tamponade
• Heart failure
• Myocardial infarction
Postrenal Kidney Injury
Obstruction in the urinary tract below the kidneys causes waste to build up in the kidneys . It is not as common as intrinsic acute kidney injury (AKI) or acute tubular necrosis (ATN).
• Kinked or obstructed catheters
• Intraabdominal tumors
Intrinsic/Intrarenal Kidney Injury
Damage to the kidneys causes a sudden loss in kidney function. The most common causes of intrinsic acute kidney injury are acute tubular necrosis (ATN), acute glomerulonephritis (AGN), and acute interstitial nephritis (AIN) .
• Acute tubular necrosis
• Prolonged prerenal failure
• Radiographic contrast media
• Acute glomerulonephritis
The supply of oxygen to and removal of wastes from the cells and tissues of the body as a result of the flow of blood through the capillaries.
Abnormal accumulation of fluid in the abdomen
RIFLE Classification for Staging Acute Kidney Injury
End-stage Kidney Disease
Diffuse Interstitial Lung Disease
Thickening of the alveolar interstitium. Synonyms frequently presented in the literature include interstitial pneumonia, diffuse parenchymal lung disease, Hamman-Rich syndrome, intrinsic fibrosing alveolitis, cryptogenic fibrosing alveolitis, and idiopathic pulmonary fibrosis.
Inflammation or swelling of the tissue lining the sinuses. Healthy sinuses are filled with air. But when they become blocked and filled with fluid, germs can grow and cause an infection. Conditions that can cause sinus blockage include: The common cold
Inflammation of the pharynx (sore throat). Causes of pharyngitis include viral infections, such as common colds, and bacterial infections, such as group A Streptococcus. Pharyngitis is a common condition and rarely a cause for concern. Viral pharyngitis often clears up on its own within a week or so.
Laryngitis is an inflammation of your voice box (larynx) from overuse, irritation or infection. Inside the larynx are your vocal cords — two folds of mucous membrane covering muscle and cartilage.
Angina pectoris literally means chest pain and is associated with intermittent myocardial ischemia. Bouts of chest pain and associated symptoms are generally recurrent and may be precipitated by conditions that increase myocardial oxygen demand, such as exercise; stress; sympathetic nervous system activation; and increased preload, afterload, heart rate, or muscle mass.
- windpipe -a large membranous tube reinforced by rings of cartilage, extending from the larynx to the bronchial tubes and conveying air to and from the lungs; the windpipe.
Stable angina is the most common form and is therefore called classic or typical angina. Stable angina is characterized by stenotic atherosclerotic coronary vessels that reduce coronary blood flow to a critical level. Stable angina is generally relieved by rest
Prinzmetal variant angina
Characterized by unpredictable attacks of anginal pain. Vasospasm has been identified as the probable mechanism leading to variant angina, although the cause of the vasospasm is unknown.
Chest pain that occurs while a person is at rest and not exerting himself. May be indicative of MI
Unstable Angina and MI
In both cases, plaque rupture with subsequent acute thrombus development is thought to occur. In unstable angina, the occlusion is partial or the clot is dissolved before the death of myocardial tissue. In MI, the occlusion is complete and the thrombus persists long enough for development of irreversible damage to myocardial cells, resulting in necrosis.
Right-sided heart failure
Right ventricular hypertrophy and heart failure due to pulmonary hypertension
Sudden cardiac death syndrome
Also called Sudden Cardiac Arrest, this is usually defined as unexpected death from cardiac causes within 1 hour of the onset of symptoms.
Sudden Cardiac Death is most often associated with _______.
Myocardial infarction (heart attack)
A heart attack occurs when the flow of blood to the heart is blocked. The blockage is most often a buildup of fat, cholesterol and other substances, which form a plaque in the arteries that feed the heart (coronary arteries). The plaque eventually breaks away and forms a clot. The interrupted blood flow can damage or destroy part of the heart muscle.
Ventricular Septal Defect
A ventricular septal defect is the most common congenital cardiac anomaly. The ventricular septum develops between the fifth and sixth weeks of fetal life as the membrane derived from the endocardial cushion
fuses with the muscular septum. Blood flow through the defect is usually left to right and produces an acyanotic shunt
An acyanotic heart defect, is a class of congenital heart defects. In these, blood is shunted (flows) from the left side of the heart to the right side of the heart due to a structural defect (hole) in the interventricular septum.
The heart is unable to pump adequate blood volume to meet tissue demands.
• HF can be systolic, diastolic or both
• Right vs left heart failure
• High mortality with 50% dying in 5 yrs
• Highest mortality = low EF, congestive symptoms
Left-Sided Heart Failure
Left-sided HF is most often associated with left ventricular infarction and systemic HTN.
The backward effects of left-sided HF may produce
dramatic clinical symptoms attributable to pulmonary dysfunction
Deeper explanation of Left-Sided Heart Failure
Ineffective pumping of the left ventricle results in an accumulation of blood within the pulmonary circulation. As hydrostatic pressure builds within the pulmonary veins and capillaries, fluid is forced from
the capillaries into interstitial and alveolar spaces, causing edema. Pulmonary congestion and edema are associated with a number of clinical findings. Dyspnea, or breathlessness, occurs early in the progression of left-sided HF and may be considered the cardinal
present at birth
Right-Sided Heart Failure
Because the right and left ventricles function in series, left ventricular failure eventually increases the workload on the right ventricle. Consequently, the right ventricle may fail.
The etiology of right ventricular failure must include all the causes of left ventricular failure. Isolated right ventricular failure is rare and is usually a consequence of right ventricular infarction or pulmonary disease.
Obstruction of the blood supply to an organ or region of tissue, typically by a thrombus or embolus, causing local death of the tissue.
The cardiac valve that lies between the left atrium and the left ventricle. The valve is normally closed during ventricular systole (heart sound S1) and open during ventricular diastole.
Disorders of the Mitral Valve
Three important disorders of the mitral valve are:
Stenosis, regurgitation, and prolapse.
Renal Disease and HTN
Hypertension causes: ◦ Fluid and electrolyte imbalance ◦ Renin-angiotensin hyperactivity
High B/P can damage blood vessels and cause hardening of the kidneys (nephrosclerosis) which can cause chronic renal failure
Note: kidney disease can cause HTN and HTN can cause kidney disease
Mitral Valve Stenosis
In mitral stenosis the flow of blood from the left atrium into the left ventricle is impaired. Mitral stenosis is therefore characterized by an abnormal left atrial-left ventricular pressure gradient during ventricular
Normally the pressures in the atrium and ventricle are nearly equal during ventricular diastole when the mitral valve is open. With mitral valve stenosis, atrial pressure remains higher than ventricular pressure throughout diastole.
The ventricles begin to contract
Ventricular diastole is the period during which the two ventricles are relaxing from the contortions/wringing of contraction, then dilating and filling
Systolic Blood Pressure
The peak pressure, produced by the contracting ventricles
Diastolic Blood Pressure
The pressure in your arteries when the ventricles are relaxed
Mitral regurgitation is characterized by backflow of blood from the left ventricle to the left atrium during ventricular systole.
Mitral Valve Prolapse
Mitral valves that balloon into the left atrium during ventricular systole.
The semilunar valve separating the aorta from the left ventricle that prevents blood from flowing back into the left ventricle.
Disorders of the Aortic Valve
The primary disorders of the aortic valve are stenosis and regurgitation.
Formation of calcium deposits on the aortic cusps.
Aortic calcifications accumulate over several decades and generally become clinically apparent in individuals
70 to 90 years old.
Coronary artery disease is the narrowing or blockage of the coronary arteries, usually caused by atherosclerosis.
Aortic regurgitation results from an incompetent aortic valve that allows blood to leak back from the aorta into the left ventricle during diastole.
Tetralogy of Fallot
The four defining features of tetralogy of Fallot are:
(1) a ventricular septal defect,
(2) an aorta positioned above the ventricular septal opening (overriding aorta),
(3) pulmonary stenosis that obstructs right ventricular
(4) right ventricular hypertrophy
Inflammation of a vein associated with a clot formation
In the venous system, thrombosis alters venous return,
impairing removal of metabolic wastes and producing swelling (edema). When inflammation occurs in a vein (phlebitis) and is accompanied by the formation of a thrombus, it is called thrombophlebitis.
A stasis ulcer is an ulcer (a crater) that develops in an area in which the circulation is sluggish and the venous return (the return of venous blood toward the heart) is poor. A common location for stasis ulcers is on the ankle.
(Buerger disease) is a rare inflammatory condition
affecting both small- and medium-size arteries and veins of the upper and lower extremities, producing varying degrees of obstruction.
vasculitis is strongly associated
Nephroblastoma (Wilms Tumor) is the fifth most frequently occurring pediatric malignancy and the most common childhood kidney cancer. Seventy-five percent of the cases occur in children less than 5 years old.
Nephroblastomas are typically large, well-encapsulated tumors that grow rapidly.
Polycystic Kidney Diseases
Polycystic kidney disease (PKD) is an inherited disorder in which clusters of cysts develop primarily within your kidneys, causing your kidneys to enlarge and lose function over time. Cysts are noncancerous round sacs containing fluid. The cysts vary in size, and they can grow very large.
Autosomal-Recessive Polycystic kidney disease
Autosomal recessive polycystic kidney disease (ARPKD) is a genetic condition that is characterized by the growth of cysts in the kidneys (which lead to kidney failure) and liver and problems in other organs , such as the blood vessels in the brain and heart.
Autosomal-Dominant Polycystic Kidney Disease
Autosomal dominant polycystic kidney disease (ADPKD) is a genetic disorder characterized by the growth of numerous cysts in the kidneys. It is the most common inherited disorder of the kidneys. Symptoms usually develop between the ages of 30 and 40, but they can begin earlier, even in childhood.
Involves stretch receptors located in the alveolar septa, bronchi, and bronchioles , the Hering-Breuer reflex is a protective mechanism that terminates inhalation, thus preventing overexpansion of the lungs.
Sensory inputs to the respiratory control center include:
-Central chemoreceptors --Peripheral chemoreceptors
-Hering-Breuer stretch receptors
normal total red cell mass with changes in plasma volume (pregnant women have 43% more plasma volume).
Central chemoreceptors within the ______________________respond to changes in CO2 level and pH
Actual decrease in the numbers of red blood cells (decreased production or increased destruction of RBC's).
A stimulus to breathe occurs when a small increase in ______________________leads to stimulation of chemoreceptors.
arterial carbon dioxide tension (PaCO2)
failure of blood cell production in the bone marrow
Peripheral chemoreceptors located in the ______________ and carotid bodies respond primarily to decreases in arterial ______ concentration.
aortic arch, O2
iron deficiency anemia
anemia caused by inadequate iron intake
stretch receptors located in the alveolar septa, bronchi, and bronchioles are involved in __________
The Hering- Breuer reflex
sickle cell anemia
a genetic disorder that causes abnormal hemoglobin, resulting in some red blood cells assuming an abnormal sickle shape
___________________ located in the muscles and tendons of movable joints respond to body movement (exercise)
hemolytic disease of the newborn (HDN)
condition developing in fetus when mother's blood type is Rh-negative and baby's blood is Rh-positive; antibodies in mother's blood enter fetus' bloodstream through placenta and destroy fetus' red blood cells; causes anemia, jaundice, and enlargement of spleen; treated with intrauterine blood transfusion; also called erythroblastosis fetalis. Prevent with RhoGAM
Baroceptors located in the aortic arch and carotid arteries respond to changes in ________________.
the blood pressure
ulcer (a crater) that develops in an area in which the circulation is sluggish and the venous return (the return of venous blood toward the heart) is poor. A common location for stasis ulcers is on the ankle.
Acute asthma attack Tx
¡ Beta2-adrenergic agent: relax bronchial smooth muscles
¡ Controlled breathing
¡ Glucocorticoids: e.g., Beclovent best at reducing secondary inflammation
¡ Accolate: leukotriene receptor antagonist
¡ Singulair: block inflammatory response
¡ Cromolyn Sodium: decrease in chemical mediator response
¡ Theophylline: bronchodilator oral agent used less than in the past
acute arterial occlusion
an emergency because it may result in profound ischemia that the involved limb becomes gangrenous and sepsis may begin. Usually thrombus or embolus is the cause.
6 P's- pallor, paresthesia, paralysis, pain, polar, pulseless
- In Western Populations-There is a ______ lifetime risk for the development of hypertension
Thromboangiitis obliterans (Buerger's disease)
an occlusive vascular condition usually associated with smoking and affecting a leg or foot in which a small /medium sized artery become inflamed and thrombotic
Types of aneurysms
saccular, fusiform, false, dissecting
inflammation of a vein accompanied by the formation of a blood clot.
Deep vein thrombosis (DVT)
A disorder involving a thrombus in one of the deep veins of the body, most commonly in the lower extremities. May be asymptomatic but usually edema, local inflammation, dilated superficial vein due to increased venous pressure.
describe tetralogy of Fallot
four defining features are
1) a ventricular septal defect,
2) an aorta positioned above the ventricular septal opening (overriding pulmonary aorta),
3) pulmonary stenosis that obstructs right ventricular outflow,
4) right ventricular hypertrophy.
Ventricular septal defect
most common congenital cardiac anomaly. Usually occurs with other defects. It should develop between week 5-6 and if the defect is large enough, right sided heart failure and a loud systolic murmur.
Polycystic kidney disease
genetically transmitted kidney disorders. Autosomal recessive forms are evident at birth. Autosomal dominant types appear later in life. Expanding cysts disrupt urine formation and flow. The inevitable renal failure will necessitate dialysis or transplantation.
Nephroblastoma is the fifth most frequent pediatric malignancy and the most common childhood kidney cancer. 75 % of cases occur in children less than 5 years old. A palpable abdominal mass is evident in 80% of the cases (abdominal pain, hypertension and hematuria are usually present).
some fetal development of the kidneys has occurred but they are smaller than normal
failure of either one or both kidneys to develop
review the "previous units of study" covered in the first two exams-
electrolytes- calcium, potassium ranges
Immune response- cell mediated
Function of adrenal medulla
Review IV fluid concentrations
Review IV fluid concentrations
difficult or labored breathing
Portion of the lung involved in gas transfer—the alveoli, alveolar ducts and respiratory bronchioles
high levels of fatty acids in blood
Rheumatic heart disease
Rheumatic heart disease is a condition in which the heart valves have been permanently damaged by rheumatic fever. The heart valve damage may start shortly after untreated or under-treated streptococcal infection such as strep throat or scarlet fever.
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