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Patho foucus 7

Terms in this set (71)

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Restrictive pulmonary disease
a problem with inspiration, getting the air in.
Fibrosis (restrictive) the movement of air due to scarring of the lung
obstructive pulmonary disease
a problem with expiration, getting the air out.
Emphysema, chronic bronchitis, and asthma have prolonged expiration trying to get the air out.
Ventilation
When O2 and CO2 are not being exchanged properly in the alveoli. -Pneumonia causes mucous in the alveoli and pulmonary edema causes fluid in the alveoli. Gas exchange through fluid or mucous instead of air is much more difficult
Perfusion
The blood vessels around the alveoli are not available for gas exchange.
Pulmonary embolus (blood clot that has traveled to the lungs) blocks the blood vessel around the alveoli and there is no blood available for gas exchange.
Respiratory distress syndrome (RDS
SOB, RR increases, pt unable to breathe, Retractions of the chest wall occur as the patient has difficulty getting air in.
Cyanosis of the lips and mucous membranes occur as the oxygen level decreases in the blood.
Audible respiratory sounds can be heard-stridor (noise on inhalation) and grunting (noise on exhalation).
Upper respiratory infection (URI)
Inflammation of the nose and throat caused by bacteria or viruses.
A runny nose occurs as the immune system reacts and fluid enters the area.
Congestion of the nose is due to swelling
Sore throat, Fever/ temp increases (immune response to kill bacteria
Pneumonia
mucous in the alveoli usually caused by bacteria or viruses.
SOB, chest pain, cough, fever
Viral URI tx
is treated symptomatically, throat lozenge for sore throat and nasal decongestant for congested nose.
Bacterial URI tx
Hydration, throat lozenge, nasal decongestant, rest, antibiotics
Viral pneumonia tx
Hydration, rest, chest physiotherapy
Bacterial pneumonia tx
Hydration, rest, chest physiotherapy, antibiotics
What is asthma?
-Constriction of airway smooth muscle, swelling of airway mucosal layer, mucous production.
-Histamine release triggers symptoms
-Triggers include smoke, paint, food, aspirin, stress
Wheezing on expiration
Emphysema
is caused by destruction of elastin, which is necessary for the normal recoil of the lung. Inflammation causes more neutrophils that make too much elastase
-Genetic defect can cause alpha-1 antitrypsin deficiency
-Pt can get O2 in but can't get CO2 out. Trapped air in the lungs causes a barrel chest
-"Pink puffer" refers to pink lips due to having enough oxygen and pursed lips
Chronic bronchitis
due to an overgrowth of mucous glands caused by chronic irritation fromsmoking.
-Nagging cough for at least 3 months of the yr for 2 yrs in a row
-Blue bloater" refers to blue lips from decreased O2 & increased chest diameter due to trying to take bigger and deeper breaths
Pleural effusion
Causes dyspnea, chest pain with inhalation (pleurisy), and a dry cough. The problem is outside of the lung in the pleural cavity so nothing is in the lung to cough up. Thoracentesis is insertion of a needle or catheter into the pleural space to drain the fluid.
Transudative pleural effusion
fluid leaks out of the blood vessel into the pleural space.
Symptom: liver failure reports dyspnea, chest pain with inhalation (pleurisy), and a dry cough. Thoracentesis done to drain pleural fluid. Fluid tested negative for protein. Lab results show low plasma proteins (albumin) in the blood.
Exudative effusion
when there is an inflammatory process as pneumonia which causes blood vessels dilate and leak fluid. Protein and other large molecules (cholesterol) are in the leaked fluid.
-Symptoms: dyspnea, chest pain with inhalation (pleurisy), and a dry cough. Thoracentesis done to drain fluid from pleura space. Fluid tested positive for protein and cholesterol.
Pneumothorax
is air accumulation in the pleural space. It can be an open pneumothorax where there is an injury to the chest wall that lets air in. Causes may be a fractured rib, bullet wound, or stab wound.
Tension pneumothorax
is an opening to the outside that lets air in on inspiration but no air leaves on expiration.
- A pt with a stab wound in the right chest has left tracheal deviation and no breath sounds on the right side. Chest tube placed right chest.
Hypoxic vasoconstriction
is constriction of the pulmonary blood vessels (around the alveoli) due to hypoxia. Emphysema, chronic bronchitis, and asthma can cause this. If it is throughout the lungs (global) and chronic, this can lead to pulmonary HTN.
-Pt with chronic bronchitis has chronic low oxygen levels.
Pulmonary HTN
is high pressure in the blood vessels of the lungs.
Symptoms include SOB, exercise intolerance, and cough. Scarring of the lungs occur after time. As the pressure rises, blood backs up into the right ventricle, the right atrium, and then to the body.
-Symptoms of emphysema: dizziness, lightheadedness, and occasional fainting. Edema is noted in the feet and ankles. Right ventricular hypertrophy noted on echocardiogram.
Tuberculosis (TB)
The macrophages can eat the bacteria and destroy it, but it is still alive and dormant inside the macrophages andare multiplying in the lungs.
-Symptoms: fever, chills, and wt. loss, waking up at night sweating, coughing a lot, and coughing up blood. Chest pain occurs with coughing, about 4 weeks. Chest X-ray shows a nodule in the lung, sputum culture positive for TB.
Latent TB
The TB test will be positive because their immune system has seen the bacteria, but there will be No signs of disease. The chest X-ray will be normal and the sputum culture will be negative.
Symptoms: Pt has a positive TB test. Chest X-ray is normal. Sputum culture is negative for TB. Denies cough, nights sweats, or difficulty breathing
Progressive TB/ active TB
Signs of active disease will occur such as fever, chills, cough, bloody sputum, difficulty breathing, chest pain with coughing, night sweats, and weight loss. The TB positive, Chest X-ray shows a large cavity in the chest. Sputum culture is positive.
What are effective ways to to prevent spread of TB?
N95 mask, surgical mask, social distancing, UV light, HEPA filters trap the bacteria and prevent it from returning in the air, Sleep in own room at night, Negative pressure room.
ARDS (acute respiratory distress syndrome)
is massive lung inflammation. Fluid leaks out of the capillary into the space between the alveoli and the capillary and eventually enters the alveoli (pulmonary edema). Fluid leaks due to the inflammation and due to damage to the membrane b/w the alveolus and capillary (alveolar-capillary membrane).
ARDS: Phase 1
No symptoms although fluid is starting to leak between the alveoli and the capillary membrane. Lung sounds are clear and chest CXR is normal.
ARDS: Phase 2
SOB and increased RR. The fluid is now surrounding the alveoli but has not entered the alveoli. This decreases lung compliance and causes the first symptoms.
ARDS: Phase 3
fluid enters the alveoli/pulmonary edema. Inspiratory crackles are heard on inspiration and the CXR shows white out because fluid is in the alveoli instead of just air.
Hematologic system
Anemia, Leukemia, Myeloma
Anemia
a Decrease in rbc which causes a Decrease in O2 delivery to the cells and organs.
If the brain receives little O2
Occurs dizziness, fatigue, and inability to concentrate
If the heart receives little O2
Chest pain can occur with exercise or emotional distress
O2 to the cells for body compensation
Increasing HR, RR, Rbc production
RBC production
-Kidney senses low O2 levels in the blood
-Kidney releases erythorpoientin
-Erythorpoietin stimulates the hematopoietic stem cell
-Erythroblasts are made
-Erythrocytes are produced
Underproduction of RBC due to RF
(erythropoietin is not secreted)
-Bone marrow failure from infection (virus, tumor)
-Decreased HgB components
-Decrease /reticulocyte count is low
-RF
Destruction of normal RBC
-Hemorrhage
-Immune syst disorders
-Infection (bacteria/virus)
-Increased reticulocyte count
Underproduction
-Decreased bone marrow activity
-RBCs can be macrocytic (lack of DNA precursor) normocytic (due to RF or bone marrow failure), or microcytic (decreased hgb)
Destruction of RBCs
-RBCs are normocytic
-Increased bone marrow activity to replace lost rbc
ALL microcytic anemias are caused by:
are caused by problems making hgb
Cyteroblastic anemia
Problem with making protoporpherin for hemoglobin
Iron deficiency anemia
Inadequate amounts of iron in the body to make hemoglobin
Thalassemias
Defect in alpha or beta globin
Anemia of chronic disease
Problem with iron access to make hemoglobin
Decreased dietary intake of Iron
Diet low in green leaf vegetables
Infants less than 6 mos on breast milk
Increased the Iron for body needs/rapid growth
rapid increase in blood volume:
-Iron is needed for hemoglobin in children and adolescents.
- In pregnancy
Decreased absorption of Iron
-Celiac disease
-Gastrectomy to lose wt., remove cancer, repair peptic ulcer
-Taking proton pump inhibitors to decrease stomach acid
Increased blood loss
-Heavy menstrual periods
-Peptic ulcer disease
-Colon cancer/polyps
Anemia of chronic disease
Microcytic anemia with an inflammation condition
Inflammation condition
-Increase in hepcidin releases which causes - a decrease in absorption of Fe from the gut and- a decrease in the cycling of Fe in the liver.---Causes a decrease in Hb production and results in anemia.
Leukemia S/S
-decreased rbc count, hb, and hct,
- decreased platelet count, -Increased respirations,
-Bone pain, Weakness and fatigue,
-WT loss, Multiple bruises, -Increased WBC count,
-SOB
Leukemia S/S
Weakness, Fatigue, SOB, Increased RR, Pallor (low rbc), prolong bleeding and easy bruising (low platelets) and Frequent infections (low WBC).
Acute Leukemia
-S?S within weeks
-Very immature cells
-Grows very rapidly
Chronic Leukemia
-Grows more slowly
-More mature cells but still underdeveloped
-S/S may not appear for years.
Myeloid Leukemia
-Blast cells that have developed into monocytes, neutrophils, basophils, eosinophils, and megakaryocytes.
lymphoid leukemia
Blast cells that have developed into T-lymphocytes/ B-lymp
acute lymphoid leukemia (ALL)
-Most common cancer in children
-Increased risk with Down's Syndrome
TdT found in leukemic cells.
B-cell (ALL)
-Chromosome translocations b/w 9 and 22 (adults)
-Chromosome translocations b/w chromosome 12 and 21 (children)
T-cell (ALL)
-Most common in teenagers
-Mass in thymus
B-cell Chronic lymphoid leukemia (CLL)
-Smudge cells
-Generalized lyphadenopathy
-Hypogammaglobinemi
-Autoimmune hymolytic anemia.
Leukemia Tx
chemo, radiation, bone marrow transplant
Chemotherapy induction
-Kill rapidly dividing cells.; 3 phases
Phase 1 Induction
High doses of chemotherapy agents are given to kill as many cells as possible and achieve remission (no leukemic cells in the bone marrow aspirate).
Phase 2: consolidation
-Kill a remaining leukemic cells
-To prevent spread to the brain, agents are injected into the cerebrospinal fluid.
Phase 3: Maintaince
The same agents are used as in phase 1 but at lower dosages. The goal is to prevent return of the cancer.
multiple myeloma
are cause by four main abnormalities that occur with the disease:
1. Overproduction of one type of antibody or immunoglobulin (Ig)/ monoclonal production
-antibody deposits in the kidney and causes RF.
-Signs of RF: increased BUN and creatinine -Voiding more often, and thirst (from losing water from the kidney).
2. Plasma cells secreting factors that increase bone turnover.
-Causes lytic bone lesions (holes in the bone) and hypercalcemia
-bone lesions can cause fractures and low back pain
-Hypercalcemia causes constipation, nausea, and poor appetite
3. Crowding of the bone marrow.
-A decrease in red blood cells causes anemia as evidenced by tiredness, fatigue, and pale skin.
-A decrease in platelets causes thrombocytopenia as evidenced by bleeding and bruising.
4. Decreased production of normal antibodies or immunoglublins.
Immunoglobulins are produced in decreased amounts that leads to increase risk of infection.
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