Cushing's disease: too much cortisol; hyperfunction of adrenal glands
1. s/sx: increased catecholamines (epi, norepi, and dopamine), increase BP,
sweating/diaphoresis, tremor, nervousness, moon face
2. tx: reduce steroid, meds to inhibit cortisol, treat s/sx
Addison's disease: AKA adrenal insufficiency; not enough cortisol, hypofunction of adrenal cortex
1. s/sx: deficiency in hormones, bronze hyperpigmentation, anorexia, N/V, abd. Pain, diarrhea,
trembling, fluid/electrolytes imbalances, uncommon
2. tx: hormone replacement therapy Varicose veins
◦damaged valves allow back flow and veins become enlarged, dilated, and twisted
◦appears swollen, raised, blue/purple, red
◦painful (sometimes)
◦typically benign
◦affects superficial veins and more often women
tx: exercise, compression stockings, procedure to remove vein
Stasis Ulcer
◦breakdown of skin caused by fluid buildup from poor vein function (venous insufficiency)
◦caused by poor venous return/venous stasis, vein valve back flow, injury, clots, age,
immobility, obesity
◦s/sx: fluid leaking from skin, edema & inflammation, distal reddish-brown coloring, pain
◦weeks to months to years
◦mostly occurs in lower extremities
◦tx: elevate, hygiene, wound care, bedrest, smoking cessation, safety (decreased sensation) •occurs in the lower legs
•dangerous because embolus can break off and move and block pulmonary artery (PE)
•damage to vein by surgery, inflammation, infection, and injury
•s/sx: pain, swelling, tenderness, warm skin, or NONE
•risk factors: prolonged inactivity, hypercoagulable states, increased supplemental estrogen
•tx: oral anticoagulants (blood thinners), thrombolytics (clot busters), compression stockings,
procedure to place filter •when DVT breaks off (forming an embolus) and travels through the heart into the pulmonary artery
•EMERGENCY
•risk factors: cardiac disease, surgery, cancer, clotting disorder, smoking, obesity, pregnancy,
supplemental estrogen
•s/sx: acute SOB, chest pain, cough, anxiety
•tx: thrombolytics, thrombectomy •breakdown of skin •caused by fluid buildup from poor vein function (venous insufficiency)
caused by poor venous return/venous stasis, vein valve back flow, injury, clots, age, immobility,
obesity
•s/sx: fluid leaking from skin, edema & inflammation, distal reddish-brown coloring, pain
•healing weeks to months to years
•mostly occurs in lower extremities
•tx: elevate, hygiene, wound care, bedrest, smoking cessation, safety (decreased sensation) increased pressure in the arterial wall
•Risk factors: CAD, HF, stroke, renal failure, PVD
•S/sx: HA, arrhythmias, vision changes, nosebleeds
•Causes: sedentary lifestyle, diabetes, obesity
•Lifestyle changes: low sodium diet type, exercise, stress management, med compliance
•Patient education r/t BP (diastolic/systolic) and HTN Airways narrow and swell, can produce extra mucus causing difficulty breathing. lung disease characterized by 1) airway obstruction that is reversible (but not completely in some patients) 2) airway inflammation 3) increased airway reactivity to a variety of stimuli
Pathology
· Periodic episodes
· Severe but reversible hyper responsiveness of the bronchi and bronchioles
· 2 basic types
Extrinsic asthma (allergic): 1/3 to ½ of all cases
Intrinsic asthma (non-allergic): develops in middle age with favorable prognosis
•Many have both
· 3 changes:
•Smooth muscle contraction
•Inflammation of the mucosa with edema
•Increased secretion of thick mucus
· Partial obstruction: leading to air trapping, air is pulled in; since expiration is a passive process, less force leads to trapped air. (causes residual volume to increase).
· Total obstruction: edema and mucus plugs lead to atelectasis or nonaeration of distal tissue, resulting in collapse of this secretion
· Status asthmaticus: persistent severe attack that may not respond to treatment. Note: can be fatal with hypoxia, acidosis, cardiac arrhythmias, CNS depression, and death.
· Etiology
· Exercise induced asthma
•Common in children
•Bronchospasm occurs within 3 minutes after exercise and usually resolves in 60 minutes
· Occupational asthma
•Results with occupational exposures to allergies (metals, textiles, dust)
· Drug-induced asthma
•Can be mild to severe. (Note: can be fatal due to anaphylactoid reactions)
· Manifestations:
· Cough
· Dyspnea
· Tight chest
· Tachycardia
· Hypoxia
· Respiratory alkalosis at first d/t hyperventilation
· Respiratory acidosis with air trapping and fatigue
· Respiratory failure: ABG with PO2 below 50, PCO2 above 50
· Diagnosis
· ABG
· Blood test: eosinophil count and IgE increased
· CXR
· Lung function tests
· Peak flow meter
· Treatment
· Prevention
· Acute attacks
•Beta2-adrenergic agent: relax bronchial smooth muscles - (rescue inhaler)
•Controlled breathing, supportive O2
•Glucocorticoids: e.g., Beclovent best at reducing secondary inflammation, IV steroids
· Prophylaxis
•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
•Environmental controls (ie - no smoking) Airway becomes swollen and tight, making it difficult to move air in and out. More mucus develops further obstructing the airway. Note: chronic bronchitis labeled Type B ("blue bloater"). Most patients have chronic bronchitis and emphysema.
· Pathology: changes in the airway with chronic inflammation, swelling of bronchial mucosa, hyperplasia of mucous glands, increased bronchial walls. Note: results in obstruction to airflow.
· Etiology: smoking (90%), airway infections, physical and chemical irritants. Note: patient is often overweight, in 30-40 age range with dyspnea on exertion
· Manifestations: 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: chest x-ray, pulmonary function tests, ABG, ECG
· Management: Inhaled beta2 agonists, inhaled anticholinergics, cough suppressants. Note: may also use corticosteroids. Note: essential to discontinue smoking.