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PATHO FINAL (old material)
Terms in this set (82)
How do physical and mechanical barriers contribute to defense mechanisms?
Physical and mechanical barriers contribute to defense mechanisms by being part of the innate immunity. They are the first line of defense and consist of normal flora and intact barriers. They also help defend against opportunistic pathogens.
What are antimicrobial peptides?
Antimicrobial peptides (AMPs) are part of innate immunity. AMPs work to kill microbes such as bacteria, fungi, and yeast
What two types of defensins contribute to the biochemical barrier?
Defensin molecules can be subdivided into α and β types. The α-defensins often require activation by proteolytic enzymes, whereas the β-defensins are synthesized in active forms.
What is the normal bacterial flora? What is its role in defense?
Normal bacterial flora is the flora we get from our mothers, and it can be found in our gut, respiratory tract, and skin. Normal gut flora plays a huge role in our first defense (innate immunity) as it facilitates digestion and prevents pathogen colonization, defending our body from opportunistic infection and keeping the majority of our immune system healthy.
What are opportunistic microorganisms?
Opportunistic microorganisms are non pathogenic microorganisms that generally lay dormant in our microbiome. These microorganisms take advantage of the host's body when the immune is suppressed causing pathogen-like infections.
What are the three most important products of the complement system?
Opsonin is important for opsonization of pathogens in order to increase their likelihood of phagocytosis. Anaphylatoxin causes the mast cell to release histamine which will cause vasodilation. C5b forms a membrane attack complex that damages bacteria.
How is the coagulation cascade activated? How is it related to the plasma kinin cascade?
The coagulation cascade can be activated in two ways. The intrinsic pathway is initiated by Hageman factor (factor XII), which circulates in inactive form in the blood. When Hageman factor contacts injured endothelium, the intrinsic clotting pathway is activated. The extrinsic pathway is activated when endothelial cells and macrophages are damaged, releasing tissue thromboplastin. Products of the plasma kinin cascade are able to activate Hageman factor.
What factors control the plasma protein systems of inflammation?
1. complement factor
2. clotting system (Factor XII)
3. kinin system (Hageman Factor)
What are cytokines? How do cytokines promote inflammation?
Cytokines are proteins produced by macrophages. As part of the immune system, cytokines regulate the body's response to disease and infection, as well as mediate normal cellular processes in your body.
What products do the mast cells release during inflammation, and what are their effects?
Mast Cells degranulate to release inflammatory mediators: histamine and cytokines. Mast cells also stimulate production of prostaglandins, leukotrienes, platelet-activating factor, and heparin.
Vasodilates blood vessels to increase permeability, allowing white blood cells (neutrophils & macrophages) to reach the target site. Plasma/RBC can leak out, causing edema (swelling) at the site.
Chemotactic factors released to attract pro-inflammatory mediators (like interleukins & TNF) to target site.
Trigger more inflammation, fever, and a pain response.
Overproduction causes inflammation in the smooth muscle of the lungs--common in asthma and allergic rhinitis.
5). Platelet-activating factor
Encourages platelets to aggregate (gather and stick together). This traps the pathogen to the area so it cannot spread throughout the body.
Stimulates production of bradykinin, which causes inflammation and pain.
What phagocytic cell types are involved in the acute inflammatory response? What is the role of each?
Neutrophils and macrophages
During acute inflammatory response, neutrophils migrate to the inflamed area and line the vessel wall through a process called margination. Here, they phagocytize foreign material present within the inflamed site until macrophages appear.
What are the four steps in the process of phagocytosis?
Step 1: Activation of the phagocyte.
Step 2: Chemotaxis of phagocytes (for wandering macrophages, neutrophils, and eosinophils)
Step 3: Attachment of the phagocyte to the microbe or cell.
Step 4: Ingestion of the microbe or cell by the phagocyte.
Describe how acute inflammation differs from chronic inflammation. What characteristics do they share?
Acute inflammation lasts for about 8-14 days while chronic inflammation lasts 2 weeks or longer. Sometimes, an unsuccessful acute inflammatory response occurs before chronic inflammation occurs. Both of these types of inflammation are part of the second line of defense.
Describe various ways wound healing may be dysfunctional.
Dysfunctional would healing can cause:
- excessive bleeding
- excessive fibrin deposits
- chronic disease
What are some causes of delirium?
Some causes of delirium are due to stress like for older adults, heat stress can lead to delirium for them. For all ages, infection and dehydration are common as a cause of delirium. Drugs can also contribute to delirium from their toxicity, adverse effects, or misuse.
Why can so many conditions precipitate seizures?
Seizures are a result of abnormal electrical discharges within the brain that result in involuntary movement and/or behavior and sensory alterations. A seizure can be caused by many conditions because the brain is a complex organ that requires a specific range of nutrients to function properly. Many disorders that precipitate seizures can highly affect the brain and how certain processes function. Small changes in nutrients and hormones can cause a seizure and with the many conditions that can alter these comes many conditions that precipitate seizures. Examples of such conditions include electrolyte imbalance, hypoglycemia, endocrine dysfunction, as well as tumors, trauma, or infections.
Why is continued seizing dangerous?
Seizures occur when neurons lack O2 and become inflammed. Prolonged seizures mean that cerebral neurons continuously undergo disorderly discharges, which could ultimately lead to the apoptosis and cell death of cerebral neurons due to lack of O2.
What is the nurses role in care of an Alzheimer's patient?
One of a nurse's roles in caring for an Alzheimer's patient is successful conversation. When speaking to an Alzheimer's patient, diminish distractions and background noise, converse one-on-one to avoid confusion, keep things simple, avoid arguments, and continue to speak with them even if they stop responding.
Explain the pathophysiology of Parkinson's Disease
Parkinson's disease is a motor disease that is accompanied by systemic motor and neurologic symptoms. This disease results from the death of dopaminergic neurons. Signs of this disease include tremors, bradykinesia, impaired posture and balance, and rigid muscles.
Explain in detail, the difference between Alzheimer's and Dementia.
1) It is a type of dementia (most common type); 2) unknown cause, "amyloid cascade hypothesis" is a plausible explanation; 3) The duration is 8-20 years; 4) Onset age is typically 65, but it can occur as early as 30; 5) symptoms are: difficulty remembering new information; In advanced stages, someone would experience disorientation, mood/behavior changes.
1) A brain related disorder caused by other conditions; 2) caused by, Alzheimer's disease, stroke, thyroid issues, vitamin deficiencies, reactions to meds, and brain tumors; 3) Considered as permanent damage; 4) Onset age is typically 65 and older; 5) symptoms include issues with memory, focus, attention, visual perception, reasoning, judgment, and comprehension.
What are the neurotransmitters involved in Alzheimer's Disease and explain their role in detail and the patient symptoms from their abnormalities.
The neurotransmitter involved in Alzheimer's Disease is acetylcholine. In Alzheimer's disease, the amount of acetylcholine declines - this contributes to the decline in a patient's memory, attention, as well as other cognitive functions. Patients with Alzheimer's disease can experience difficulty remembering newly learned information, issues with advancement, disorientation, and mood and behavior changes. This disease specifically targets the cholinergic system, making significant changes in a patient's cognitive and behavioral functions. Patients can experience onset of this disease as early as the age of 30, but typically this disease's onset is closer to 65 years of age. Alzheimer's can last anywhere from 8 to 20 years.
What are the neurotransmitters involved in Parkinson's Disease and explain their role in detail and the patient symptoms from their abnormalities.
Parkinson's Disease is an "idiopathic, chronic, progressive degenerative disorder of the CNS" caused by low concentrations of the neurotransmitter, dopamine. There is progressive depletion of dopamine, causing the symptoms of slow movement (bradykinesia), tremors, and rigidity.
How do healthcare providers detect Alzheimer's and Parkinson's diseases. Explain.
In order to diagnose these diseases healthcare providers often take a medical history as well as a family history as it can be genetic. They will then proceed to conduct a series of tests such as memory, problem solving, and counting. They will look for a change in personality or behavior. Conduct other tests such as blood and urine to rule out other possible causes of the problem. Lastly, healthcare providers will look at brain scans such as CT, PET, and MRI to rule out any other causes.
Explain the pathophysiology of migraines and current treatments.
Migraines are a chronic neurovascular disorder that leads to episodic, often unilateral, throbbing head pain. The pain that comes from migraines is associated with cortical spreading depression, in which neurons are depolarized in waves and trigeminal nociceptors are activated. Migraines also involve altered brain excitability, causing hyper-excitability in the cerebral and occipital cortices. This is caused by the activation of the trigeminovascular system which also leads to cerebral vasodilation.
The most common treatment for migraines are triptans, which are selective serotonin agonists. NSAIDS and opioids may also be used to control the pain associated with migraines. Prophylactic drugs may also be prescribed to reduce the frequency, severity, and duration of migraines. These drugs include tricyclic antidepressants and antihypertensives. Other methods of prophylaxis are Botox injections and use of a TENS unit.
What is the function of hepatocytes and Kupffer cells?
Kupffer Cells - The functions of these cells include phagocytosis of large particles, secretion of immune-regulatory mediators, and orchestration of a cooperative system within the liver in terms of microcirculation and protection of the hepatocytes.
Hepatocytes - perform most of the liver's functions: metabolism, storage, digestion, and bile production.
What is the function of the gallbladder?
The gallbladder holds and stores bile that is released during digestion and helps aid digestion. When the gallbladder is inflamed it is called cholecystitis and when gallstones form in the gallbladder it is called cholelithiasis. There is bile backup when the bile duct is blocked by stones.
How do pancreatic beta cells differ from acinar cells?
Pancreatic beta cells control insulin production. Acinar cells are responsible for the transportation of enzymes.
What are the best clinical indicators of acute GI bleeding blood loss?
Upper GI bleeding usually presents with hematemesis (vomiting of fresh blood), "coffee-ground" emesis (vomiting of dark altered blood), and/or melena (black tarry stools).
You may need a complete blood count, a test to see how fast your blood clots, a platelet count and liver function tests. Also stool tests.
How does peritonitis develop with bowel obstruction?
The GI tract is not sterile and contains plenty of bacteria which are needed to keep us healthy. If the lining breaks when there is a bowel obstruction, the bacteria can leak out to spaces where it is not supposed to be (like into the sterile abdominal space) and can cause an infection in the abdomen known as peritonitis.
What is the most common cause of chronic gastritis?
Gastritis is an inflammation of the protective lining of the stomach. The most common cause of chronic gastritis is associated with infectious agents. Specifically the bacteria H. pylori. Gastritis is associated with the infiltration of chronic inflammatory cells into the gastric mucosa.
Compare the three types of peptic ulcers.
There are three types of peptic ulcers: gastric, esophageal, and duodenal ulcers.
The main differences are the locations at which the ulcers are found. These ulcers can be found in the stomach, esophagus, and the small intestine (duodenum to be specific) respectively. Peptic ulcers are often caused by a malignant bacteria H. pylori and continued usage of NSAIDs.
What causes a stress ulcer?
An ulcer can happen in the stomach when the mucosal barrier is worn away and overwhelmed by HCl.
Why are Crohn disease and ulcerative colitis called inflammatory bowel diseases?
Crohn's disease and ulcerative colitis are inflammatory bowel diseases because they are chronic inflammation of the GI tract. Ulcerative colitis affects the mucosa and sub-mucosa of the colon. And Crohn's disease affects the entire digestive tract.
What is cancer?
It is defined as a disease that causes abnormal cells to divide without control and are able to invade other tissues. It is also called neoplasia.
Identify the major differences between benign and malignant tumors.
- benign means kind... but it is not always kind when the tumor is sitting in an organ
- encapsulated, well-differentiated, or have well-defined cells and walls
- benign can still GROW → death and bleeding but do not invade beyond their capsule
- tumors initially benign can progress to cancer and become malignant
- more rapid growth and break through any type of organ, invades blood vessels, lymphatics, and surrounding structures
- non encapsulated
- loss of cell differentiation and absence of normal tissue organization (breast cancer travels to the liver for example - you can't tell where it started from)
- lymphatic system will throw cancer anywhere in the body
- metastasis (ability to spread): most deadly characteristic
- anaplasia: the loss of specialized features in mature malignant tumor cells/tissue
- produces lots of proteinases that destroy other cells
- tumor necrosis factor (TNF): if it increases, we will have a lot of inflammation. When TNF is too high, the inflammation will cause heat, swelling, redness, pain, and loss of function → cardinal sign of cancer
How do cancers protect themselves from cell death?
Cancers protect themselves from cell death by mutating the genomes to change programmed cell death, to evade growth suppressors, and they have the ability to suppress signals that send for help from the immune system. They also steal from normal cells to sustain life and grow a supply of blood vessels to receive nutrients.
Identify cancers that are the result of chronic inflammation.
The inflammatory diseases colitis, pancreatitis and hepatitis, for example, are linked to a greater risk of colon, pancreatic and liver cancers, respectively. In these diseases, immune cells create highly reactive molecules containing oxygen and nitrogen that can damage DNA.
Describe the major clinical manifestations of cancer. Why may some patients need epogen?
Clinical manifestations: CAUTION acronym
C - change in bowel or bladder movement
A - a sore throat that doesn't heal
U - unusual bleeding or discharge
T - thickening or lump in breast or any part of body
I - indigestion or difficulty swallowing
O - obvious change in mole
N - nagging cough or hoarsness
Patients may need epogen when they are receiving chemotherapy because it can destroy red blood cells and epogen will help patient produce more RBCs
How is cancer diagnosed?
- tumor markers are molecules in the blood, urine, or other body fluids that indicate a change in the status of tumor growth
- a biopsy is the extraction of a tissue sample to more closely evaluate the presence or status of a disease (several types of biopsy including fine needle aspiration, core needle biopsy, incisional biopsy, excisional biopsy- examination of the tissue by a pathologist provides the histology grade of the tumor)
- radiographic tests including positron emission tomography (PET) which is used to identify increased metabolism and x-ray computerized tomography (CT) which displays a series of cross-sectional scans obtained by examining body organs with x-ray (contrast can be added to distinguish between benign and malignant tumors)
What are the most common treatments of cancer?
1) surgery - works by directly removing the tumor
2) radiation - provides X rays that kill the individual cell
3) chemotherapy - provides chemicals that can kill those individual cells but have side effects.
Discuss how epigenetic processes can be modified by environmental factors.
Epigenetic is how the environment can change how genes work; the DNA sequence is unaffected but how they are expressed can change from external factors. Things like age, outside environment, and lifestyle can greatly influence epigenetic changes. Air pollution, smoking, and consuming lots of sugar are some examples.
Explain how nurses play a role in helping patients and families deal with cancer.
To help patients and families deal with cancer, it is important to practice "holding space." Holding space means nurses need to pause and give patients a moment to verbalize their emotional needs or concerns. As advocates for our patients, we must address their wants and needs even if they differ from those of the family members. We need to be good listeners and carefully observe their body language to get a sense of how they are feeling. We should not expect or force patients to proceed with their treatment. Additionally, we should encourage family members to rest and suggest some support groups. Overall, providing emotional support is important.
What are the stages of bone wound healing and what cells contribute?
There are four stages in the repair of a broken bone:
1) the formation of a hematoma at the break
2) the formation of a fibrocartilaginous callus
3) the formation of a bony callus
4) remodeling and addition of compact bone
Inflammatory cells (T-cells, B-cells, mast cells, macrophages, eosinophils, and neutrophils) are the initial cellular component of the fracture environment, followed by mesenchymal progenitor cells, endothelial cells, chondrocytes, osteoblasts, and finally osteoclasts.
Define the differences between tendons and ligaments.
Ligaments connect bone to bone in joints and are elastic and more flexible. They also have less blood supply and collagen compared to tendons.
Tendons connect muscle to bone and are tougher, inflexible structures
Describe significant changes in the musculoskeletal system with aging.
- loss of bone density: associated with osteoporosis, which is more common as we age (associated with loss of sex hormones, inadequate amounts of calcium in diet, inadequate/absence of exercise)
- inflammation or wearing down of the cartilage at joints: associated with osteoarthritis (cartilage is worn down or damaged - usually caused by stress)
- loss of muscle tone: sarcopenia (weakness of muscle due to aging)
How does noninflammatory joint disease differ from inflammatory joint disease? Describe two principal features of each.
Osteoarthritis is characterized by the wear and tear on the joints; this breaks down cartilage on the joints, thus making bones rub on each other. It is not accompanied by the severe degree of inflammation associated with other types of arthritis.
Rheumatoid Arthritis is a chronic autoimmune disorder characterized by inflammation and disfigurement of multiple joints. Autoantibodies (rheumatoid factors) activate the inflammatory response in joints.
How does rheumatoid arthritis affect the skin, heart, lungs, and kidneys?
Skin: Rheumatoid patients can develop skin disorders. RA rashes can appear on the skin as red, painful, and itchy patches. They may also be seen as deep red pinpricks. The most common site for a rash associated with RA is on the fingertips. In some cases, a rash may form painful ulcers.
Heart: Inflammation causes plaque build-up in the arteries, which slowly narrows blood vessels raising blood pressure and blocking blood flow to the heart. This can cause heart attack, heart failure, peripheral vascular disease, and stroke.
Lungs: RA can also lead to inflammation within the small airways of your lungs. Over time, chronic inflammation in this area can cause thickening in these airways and lead to mucus blockages in your lungs. This may cause shortness of breath, a chronic dry cough, fatigue, weakness, and loss of appetite.
Kidneys: RA patients have a higher risk of developing glomerulonephritis — an inflammation of the kidney's glomeruli, which can impair kidney function and lead to chronic kidney disease.
What is the main objective clinical finding in fibromyalgia?
The main objective clinical finding in fibromyalgia is diffused pain, fatigue, increased sensitivity to touch (which consists of 18 tender points throughout the trunk and limbs of the body), a lack of systemic or local inflammation, as well as a lack of sleep. Patients may also show signs of anxiety and depression.
What is the main objective clinical finding in osteoarthritis and osteomyelitis?
The main objective clinical findings in osteoarthritis include damage of articular cartilage, Heberden nodes, Bouchard nodes, ossification and deformity of joint, erosion of cartilage, inflammation, and thickening of the joint capsule.
The main objective findings in osteomyelitis include a positive culture result, pus at the site of infection, new bone formation, inflammation, and edema.
In rhabdomyolysis, the rapid breakdown of muscle and cell contents occurs due to overexercise, trauma, drugs, DKA, and electrolyte imbalance. Myoglobin will be found in blood, which is toxic when it stays in the body too long and ultimately causes kidney dysfunction. In the lab, we will see elevated serum CK (creatinine kinase) level, which we all make when we work out, but 5 - 10 times higher in rhabdomyolysis. The BUN (blood urea nitrogen), which is muscle waste will also be elevated.
Explain/describe fractures discussed in lecture.
Oblique fracture: a fracture that has an oblique angle to the bone shaft
Occult fracture: a fracture that is hidden and hard to see on an X-ray
Open fracture: a fracture where the bone protrudes outside the skin
Pathologic fracture: a fracture that occurs because the bone was weakened by an underlying disease
Segmented fracture: a fracture with two different fracture lines that isolate a bone segment
Spiral fracture: a fracture that spirals around the bone typically due to movements with a lot of torque, common in athletes
Transverse fracture: a fracture that has a horizontal break; straight across the bone
Greenstick fracture: a perforation or splintering of the bone, it is incomplete and common in children
Impacted fracture: a fracture where ends of bones are jammed together
What are some symptoms a nurse will find (subjective and objective) when a patient has dehydration and rhabdo.
With rhabdomyolysis, a nurse should expect to find acute renal failure as myoglobins from the breakdown of muscle will obstruct flow through the nephron. Coagulopathy can also be expected when a patient has rhabdo. The rise in calcium levels will cause skeletal muscle contraction, mitochondrial dysfunction, and lead to skeletal muscle cell death.
Patients with dehydration can be expected to experience confusion, lightheadedness, lethargy, headache, and difficulty paying attention.
What is the difference between A-delta and C fibers?
A-delta fibers are larger and myelinated. They're responsible for transmitting sharp and fast pain, and they are well localized.
C fibers are small and unmyelinated. The pain they transmit is poorly localized and feels aching/dull and constant.
Give two examples of pain excitatory and inhibitory neurotransmitters.
Excitatory NTs: Increase the responsiveness of nociceptors
- Peripherally triggered: Prostaglandins, histamine, bradykinin
- Triggered in the brain and spinal cord: Glutamate, aspartate, substance P, calcitonin
Inhibitory NTs: inhibit pain
- Spinal cord: GABA and glycine // NE and serotonin helps with pain inhibition in the medulla and pons but can excite peripheral nerves
How do A-delta fibers inhibit pain and cause pain?
A-delta fibers are myelinated nociceptors that transmit fast and usually sharp pain to the dorsal horn of the spinal cord.
What are two differences between nociceptive pain and neuropathic pain?
Neuropathic pain is caused by inflammation, irritation, or neural tissue compression.
Nociceptive pain is the body's reaction to painful stimuli such as a pulled back muscle or bone, and it does not cause nerve damage itself.
Why is temperature regulation important?
It is important to keep our body's temperature regulated to ensure our body is kept in homeostasis. Temperature regulation allows our body to withstand different environments and is a response to a cool or warm-core. Without temperature regulation, our bodies can develop disorders, such as heat cramps, heat exhaustion, heatstroke, and malignant hyperthermia, which can lead to patients going into shock and can be fatal when unrecognized.
What are the principal heat production methods? Heat loss methods?
Heat cramps are severe spasms in the abdomen and extremities. Heat exhaustion is a prolonged high core temperature. Heatstroke is the result of stress in the regulation center that impairs the ability to release heat. Malignant hyperthermia is triggered by anesthesia where the body senses it and raises it.
How does the hypothalamus alter its set point to change body temperature?
Heat exhaustion or stroke will cause the hypothalamus to react by activating the sweat glands which then cool of the body. It is how the body internally reacts to heat. In response to extreme cold, the hypothalamus will react by causing the body to shiver which warms the body up.
Explain how nociception changes as we age.
Pain threshold is the lowest intensity of pain that a person can sense or recognize. As we age, our pain threshold increases, which means that we lose our ability to feel pain that other people (with normal pain thresholds) feel. As we age, heat and pain threshold both increase, so the elderly are not able to sense changes in temperature or changes in pain as well.
Explain The affective-motivational, sensory-discriminative, and cognitive-evaluative systems. Please give examples.
Affective-motivational system: the internal perceptions of your body. This is a conditioned avoidance behavior, it is learned. A positive example of this is when you hear a car honk behind you at a stoplight, you drive forward.
Sensory-discriminative system: is used to identify the presence, character, location, and intensity of pain. If patients are not having the expected sympathomimetic responses of pain, this could mean the patient is perceiving things differently and something may be wrong psychologically.
Cognitive-evaluative system: when the individual's learned behavior is overridden by the task at hand. This system can modulate the perception of pain. An example of this is when an athlete has to lie in an ice bath after exercise. The person can put themself in that uncomfortable feeling because they need to.
What mechanisms produce hypercapnia?
Hypercapnia is excessive carbon dioxide in the bloodstream.
When air is trapped it causes hyperexpansion of the chest and puts our respiratory muscles at a disadvantage. This creates an increase in workload of breathing which leads many diseased individuals to develop hypoventilation and hypercapnia.
What mechanisms produce hypoxemia?
Hypoxemia is decreased arterial oxygen levels due to acute lung diseases. Mechanisms involved with hypoxemia are decreased inspired oxygen partial pressure, alveolar hypoventilation, diffusion impairment, ventilation-perfusion (V-Q) mismatch, and right-to-left shunt.
How does pneumothorax differ from pleural effusion?
Pneumothorax is the presence of air between the visceral and parietal pleura that produces lung tissue compression, causing compromised lung dysfunction. It is caused by trauma or complications related to medical procedures and chronic diseases
Pleural effusion is a collection of excess fluid in the pleural space, which develop due to excess production of pleural fluid or decreased drainage of the fluid. Excess pleural fluid is usually due to increased hydrostatic pressure pushing fluid into pleural space (heart failure & cirrhosis), increased capillary permeability (tuberculosis, RA), or negative pleural pressure (atelectasis). Pleural effusions are common after thoracic or high abdominal surgeries, and they may develop with the inflammatory process in the lungs or inflammatory diseases.
Contrast aspiration and atelectasis.
Aspiration is when a foreign substance or secretion gets into the trachea or lungs. Symptoms vary depending on what substance gets inside.
Atelectasis is a partial collapse of the lung or alveoli and/or the inadequate inflation of the lung. Regions of the lung experiencing atelectasis will have lower levels of ventilation. Leading to a V/Q mismatch.
What mechanisms cause airway obstruction in asthma?
When an antigen enters the airway and triggers the adaptive immune response, a cascade of mediator effects take place that comprises the: a) early response to asthma and b) the delayed or lingering symptoms.
a) Early response - Characterized by mast cell degranulation and release of inflammatory mediators including: leukotrienes, histamines, bradykinins, prostaglandins, platelet-activating factor and interleukins --- This pro-inflammatory response caused by these mediators results in: vasodilation, capillary permeability, mucosal edema, bronchospasm, narrowing of airways and goblet cell secretions
b) Delayed response - WBC's (eosinophils, lymphocytes, neutrophils) cause a late response (4-8 hours after early response) releasing more mediators. ---The latent response of mediators causes bronchospasm, mucosal secretion, edema, and obstructed airflow. Air can become trapped in alveoli since the bronchioles are so obstructed by constriction and mucus.
How does emphysema affect oxygenation and ventilation?
Emphysema is the enlargement of gas exchange airways due to alveolar wall destruction. Because there's an enlargement of space that gas has to travel to in order to defuse and get to the blood stream, emphysema decreases oxygenation. Emphysema also decreases ventilation because due to the destruction of alveoli, the sacs are unable to expand to get enough O2 and they're unable to recoil to get out enough CO2.
Define chronic bronchitis and pneumonia.
Chronic bronchitis is a chronic obstructive pulmonary disease (COPD) and occurs when irritants in airways cause inflammation with infiltration of neutrophils, macrophages, and lymphocytes in bronchial walls. This causes the basement membrane to increase in thickness and resulting in a loss of structural support for smaller airways. Chronic irritation of the airways causes goblet cell proliferation and submucosal gland hypertrophy, which increases the production of mucus. The accumulation of mucus makes airway breathing unsterile, which leads to infection. For chronic bronchitis, there are copious amounts of green mucus within inflamed bronchioles.
Pneumonia is an infection of the respiratory tract that can begin in the upper respiratory tract and progress into the lower respiratory tract. It is caused by infection from bacteria, viruses, fungi, protozoa, and parasites. Pneumonia is acquired by inhalation or aspiration of a pathogen and it is categorized by the microorganism. It can occur in several different settings: community-acquired pneumonia (CAP), hospital-acquired pneumonia (HAP), and ventilator-associated pneumonia (VAP).
Explain a V/Q mismatch.
Ventilation (V) refers to the flow of air into and out of the alveoli, while perfusion (Q) refers to the flow of blood to alveolar capillaries.
A V/Q mismatch stands for ventilation-perfusion mismatch. Ventilation is the oxygen and carbon dioxide in the lungs and perfusion is the demand by the lungs. Thus, V/Q mismatch means that the oxygen and carbon dioxide in the lung does not meet the demand of the lung tissue. This is a shunt because the area that should be perfused is not getting the oxygen required. A V/Q mismatch and shunt will cause respiratory disease and ineffective breathing patterns.
What is a shunt (lungs)?
A shunt is areas of the lungs that are perfused but not ventilated. It usually happens when you are sick and can be found in those with asthma, pulmonary edema, or pneumonia. Unoxygenated blood returns to the left side of the heart without participating in gas exchange.
Explain what a nurse will see (signs and symptoms) of a pulmonary embolism. What would the patient feel?
A pulmonary embolism is a clot that has somehow lodged itself in the pulmonary vascular system. It often presents as sudden, unexplained shortness of breath, chest pain, anxiety, a feeling of dizziness/lightheadedness, palpitations, and sweting.
sense of impending doom
Explain the difference between emphysema and an upper respiratory tract infection.
Emphysema and an upper respiratory infection both adversely affect the lungs but differ in their mechanisms of action.
Emphysema is often a chronic disease that causes structural damage to the lungs, most notably the loss of elasticity and recoil. The loss of elasticity and recoil creates shortness of breath that is the characteristic of the disease. Additionally, emphysema patients are in a chronic state of mild hypoxia. As a result, the body accommodates and alters its signaling mechanisms that trigger automatic breathing. Because of these alterations, it is important to not place these patients on oxygen.
An upper respiratory infection is caused by an infectious microbe, and tissue destruction comes from both the immune response to fight the pathogen as well as the destructive properties of the pathogen itself. These infections are contagious.
Why is the Frank-Starling law of the heart important to the understanding of heart failure?
The frank-starling law of the heart states that increased preload and myocardial stretch causes an increase in the heart's contraction. This is important when dealing with heart failure because the heart's contractibility will be hindered, decreasing cardiac output, stroke volume, and venous return.
Discuss the baroreceptor reflex and explain its influence on blood pressure and heart rate.
The baroreceptor reflex is controlled by the autonomic nervous system and keeps the blood pressure at a constant level to ensure blood supply to all the organs of the body. Baroreceptors are found in the carotid sinus of the heart and detect changes in blood pressure. If it detects low blood pressure, it will signal to cause vasoconstriction to increase the pressure of the blood vessels.
Why is capillary flow increased with increased mean arterial pressure?
Mean arterial pressure is the average pressure in your arteries during the cardiac cycle. It can be increased with vasoconstriction. As the artery constricts the blood meets more resistance thus flow is impaired in the artery, however, it creates a pressure gradient for blood to move into the arterioles and capillaries, thus increasing capillary flow.
the higher the pressure, the greater the amount that gets pushed out and through the capillaries -- there will be perfusion to end organs
Why is angiotensin significant in blood flow?
it constricts blood vessels and helps maintain blood pressure
Identify the factors regulating blood pressure.
- Baroreceptors in aorta/ventricles detect low BP and hormones influence BP regulation through vascular smooth muscle and blood volume by vasoconstricting/vasodilating
- Baroreceptors in juxtaglomerular apparatus detects low BP --> RAAS system activation
- cardiac output, vascular resistance, blood volume, blood viscosity, vessel wall compliance
What are the causes of orthostatic hypotension? If someone goes into any type of shock, what is the main treatment?
caused by dehydration, malnourishment, blood vessels failing to constrict when changing positions. If someone goes into shock, lay them down and elevate the legs and feet slightly then call for help
Define atherosclerosis and briefly describe how it develops.
Atherosclerosis is the hardening of arteries and the lessening of vessel compliance. This is caused by a buildup of plaque (from smoking, an unhealthy diet, not managing cholesterol, and being inactive).
Why do hypertension and dyslipidemia increase the likelihood of developing coronary artery disease and a stroke?
hypertension increases blood flow and the pressure on the vessel walls
dyslipidemia is the increase of lipids circulating in the blood
the combination allows for more fatty buildup faster in the vessels and not giving the body time to break it down leads to atherosclerosis
Explain 3 components of blood that cause coronary artery disease, be thorough.
high blood cholesterol levels, high blood pressure, high blood glucose
Explain what happens in the systolic and diastolic cycles.
The diastolic and systolic values are a measurement of the pressure exerted by the heart to circulate blood throughout the body.
The diastolic value measures the pressure of the heart as the ventricles relax and are being filled with blood. This occurs when blood travels from the atrial chambers of the heart into the ventricular chambers.
Systolic pressure measures the pressure exerted by the ventricles of the heart. During this phase of contraction, the heart contracts to move blood through the pulmonary trunk and aorta.
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