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Marian University
Pathophysiology Exam 2
220
Nursing
Not Applicable
02/16/2016

Additional Nursing Flashcards

 


 

Cards

Term
Function of Water
Definition
  • criticical in maintainig homeostasis
  • solvent of metabolic reactions
  • transport nutrients and wasts from cells
  • transport enzymes in the digestive system
  • transport blood 
  • facilitates joint movement
Term
Infants
Definition
  • High water content
  • More susceptible to effects of dehydration
  • vomiting and diarrhea
  • 70% Body Water Composition
Term
Elderly and Obese
Definition
Have lessbody water percentage
Term
Adult Male
Definition
60 % water
Term
Adult Female
Definition
50% Water
Term
Fluid Compartments: Inracellular compartment (ICF)
Definition
Everything Inside - majority of water is in the cell
Term
Fluid Compartments: Exracellular compartment (ECF)
Definition

Everything outside of the cell!

This includes IVF, ISF, CSF, and Transcellular Fluid

Term
Intravascular Fluid (IVF)
Definition
Blood (the vascular compartment) Labs are drawn from here.
Term
Interstital Fluid (ISF)
Definition
bathes cells, supplies cell "transportation" of needs
Term
Cerebrospinal fluid (CSF)
Definition
In the exracellular compartment (ECF) of the spine - think epidural
Term
Transcellular fluids
Definition
pericardial or joint
Term
Flow of Water/Nutrients:
Definition

1. Major cellular membrane: between ISF and ICF (Active Transport). ATP Used

2. IVF (blood) and ISF/Cells: free flow of nutrients/wastes (Gradient) Example: Osmosis

Term
Fluid Balance: Movement of water
Definition
"Free"
Term
Osmosis:
Definition
the flow of water from high concentration of water to low concentration of water ( moves toward high concentration of salt, higher osmolarity)
Term
osmolarity
Definition
measures the conenctration of molecules per volume of solution
Term
3 Major Force involved in Flow Shifts:
Definition

1) Hydrostatic Pressure

2) Osmotic Pressure

3) Permeability

Term

 

Hydrostatic Pressure

Definition

"Push" pressure to take fluid out from...

ex: Arterial blood pressure (pushes blood out of vascular and into interstitial fluid)

Term
Osmotic Pressure (Sponge)
Definition

Pulling or Sucking pressure to bring fluid toward 

Ex: Chemicla mediators of inflammation, Blood Proteins (Albuming) keep fluid in Vascular compartment.

Term
Permeability
Definition
Ability for fluid to get through the membrane
Term
Control of fluid balance
Definition

Thirst mechanism in the hypothalamus: osmoreceptors in high salt concentration: Ex: ADH - Antidiuretic hormone stimulate reabsorption of "Pure Water"

- Low BP: kidneys secrete renin to stimulare adrenal gland secretion. * Aldosterone signals kidney increase in reabsorption  of Na+ and H2O

Term
Edema: Intravacular shifts to Interstital Fluid
Definition

Excessive amount of fluid in interstitial compartment

  • swelling or enlargement of tissue
  • localized and generalized as anasarca
  • highly visible and relatively invisible
  • pitting or non-pitting
Term

Cause of Edema:

 

Definition

Increased capillary hydrostatic pressure (HTN) - Increased hydrostatic pressure

Loss of Albumin (low osmotic pressure)

Obstruction of the lymph system (Increased hydrostatic pressure) "backup"

Increased capillary permeability (Inflammation)

Term

Effects of Edema:

 

Definition
  • swelling
  • pitting
  • increased body weight from retention (Rationlae for daily weight check in CHF and Renal Dz)
  • Functional impairment, joints
  • Pain
  • Impaired arterial circulation (delayed healing)
Term
Dehydration:Insufficient Body Fluid
Definition

Insufficiency from either excessive loss, inadequate intake, or both

*More serious in infants and elderly

decrease in fluid reserves

decrease in ability to conserve fluid quickly under stress

Electrolytes significantly effect fluid balance, especially Sodium Na+

Term
Causes of Dehydration
Definition
  1. Vomiting and Diarrhea
  2. Excessive Sweating
  3. Diabetic Ketoacidosis (insensible loss, polyuria)
  4. Insufficient water intake
  5. Insensible loss: respiration, metabolism (fever)
  6. Third Spacing: "nonfunctional" collection of fluid
Term
Signs and Symptoms of Dehydration
Definition
  • Dry Mucous Membranes
  • Decreased skin turgor
  • Low BP
  • weak, thready pulse
  • fatigue
  • Increase Hct (blook becomes concentrated)
  • Metabolic acidosis (lack of glucose circulation)
  • Polydipsia-excessive thirst, Oliguria - small amounts of urine (ADH, renin/Aldosterone secretion)
  • Tachycardia constricting cutaneous blood vessels (pale, cool skin)
  • Water pulled to blood, so cells lose water, decreasing function (mental confusion, LOC)
Term
Electrolytes: What are the big 3?
Definition
  1. Sodium
  2. Potassium
  3. Calcium
Term
Sodium (Na+)
Definition
  • (135-145 mEq/L)
  • Major Cation on in the ECF (high in intravascular/low in intracellular)
  • Allows for diffusion of fluid between vascular and interstitial compartments (osmosis) 
  • Controlled by the Na-K pump (active transport)
  • 90% of solutes in ECF
  • Maintains nerve conduction
Term

Causes of

Hyponatremia (<135 mEq/L)

 

Definition
  • Sweating/Vomiting/Diarrhea
  • Many diuretics
  • Hormonal Imbalances
  • Low Aldosterone
  • Addison's Dz
  • SIADH: True disease and paraneoplastic syndrome
Term
Effects of Hyponatremia <153 mEq/L
Definition
  • Impaired nerve function
  • fluid imbalance
  • Decreased osmotic pressure in ECF
  • Hypovelemia-decrease in blood volume, Hypotension
  • Brain cells may swell (more Na in cells)
  • Cerebral Edema - confusion, coma, sz, or death
  • Treatment: give Na+ Usually hypertonic fluid
Term
Causes of Hypernatremia (>145 mEq/L)
Definition
  • Insufficient ADH (excessive loss of "pure" water)
  • Loss of thirst mechanism (hypth & pituitary
  • Watery diarrhea (more water loss than salt)
  • Insensible loss: prolonged period of rapid respiration (thyroid storm)
Term
Effects of Hypernatremia (>145 mEq/L)
Definition
  • Increased Osmotic pressure of IVC
  • Fluid pulle/sucked out of cells
  • Cell crenation - cells "dry up" - water follows blood
  • Decreased cell function, including decreased LOC
  • Weakness/agitation
  • Increased thirst, dry, rough mucous membranes
  • Decreased urine output (ADH secreted)
  • Increased urine output * ONLY if diabetes insipidus - No ADH
  • TREATMENT:Dilute blood NA+ Hypotonic or Isotonic IV fluids
Term
Potassium: K+ (3.5-5 mEq/L)
Definition
  • Major Intracellular Cation: Serum levels are LOW
  • Major control is over the RENAL system
  • Controlled by the Na-K pump (active transport)
  • Affected by acid-base balance
Term
Potassium and Acidosis, what happens?
Definition

Acidosis shifts K+ out of cells = increased blood K+ 

Regulated by Insulin

*No Insulin function = Altered K+ Transport (Elevated blood K+)

Term
Potassium and Alkalosis, what happens?
Definition
Alkalosis shifts K+ into cells, decreasing blood K+
Term
K+ Sources
Definition

Food- bananas, legumes, nuts

kidney reabsorption

Term
K+ Loss
Definition

Vomiting/Diarrhea

Kidney excretion through diuretics

Term
K+ Functions
Definition
  • Important in nerve conduction/action potential (Na-K pump)
  • Critical in cardiac cycle
  • Abnormal levels: High or Low, adversely affect the cardiac cycle
Term
Causes of Hypokalemia (<3.5 mEq/L)
Definition
  • Severe diarrhea
  • K+ wasting diuretics (loops)
  • Excessive Aldosterone (spares Na+ and wasts K+
  • Excessive glucocorticoids
  • Decreased dietary intake
  • Rapid treatment of DKA (insulin infusion, acid correction)
Term
Effects of Hypokalemia (<3.5 mEq/L)
Definition
  • LETHAL: Cardiac dysrythmias
  • EKG changes: Flattened T-wave
  • Skeletal muscle weakness 
  • Shallow resp
  • Fatigue
  • Parathesis - "pins and needles"
  • Decreased digestive tract motility = nausea
  • Decreased kidney function
  • Decreased Urine concentration - polyuria
  • Treatment: give K+ (po or IV) IV=SLOWLY!! (max 10 mEq/hr)
Term
Causes of Hyperkalemia (>5 mEq/L)
Definition
  • Renal failure (Acute or Chronic)
  • Severe Acidosis - displaced froms cells by H+
  • K+ - sparing diuretics (Aldosterone blockers, Decreased Na+
  • Aldosterone deficit (Addison's Disease) Low Na+= High K
  • Massive Trauma: leakage of intracellular K+ into IVC
  • DKA: Acidosis shifts K+ into blood and Decrease insulin function
Term
Effects of Hyperkalemia (>5mEq/L)
Definition
  • LETHAL: Cardiac Dysrythmias
  • EKG changes: Peaked T-waves
  • Muscle weakness (leads to paralysis/Asystole)
  • Fatigue
  • Nauasea
  • Parasthesias - "pins and needles"
  • Treatment: Lower K+
  • Insulin, Glucose, Sodium Bicarb * Insulin and Base = push K+ back into the cell and out of blood
Term

Calcium: Ca++ (9-10.5 mg/dL)

 

Definition
Important Extracellular Cation
Term
Calcium Source:
Definition
  • Food
  • Bone (stored in bone and blood)
  • Excreted in Urine and Feces
Term
Calcium Control:
Definition
  • Parathyroid Hormone (PTH): stimulates GI absorption & Bone Breakdown (High Ca++)
  • Calcitonin (CAL):stimulates Bone building (Ca++ storage) and lowers blood Ca++
Term
Calcium Influenced By:
Definition
  • Vitamin D (cofactor in Ca++ absorption and usage)
  • Phosphate: Inversely related to Ca++ (Values go in opposite directions)
  • Alkalosis: limits Ca++ ioization (active form); includes hypocalcemia
Term
Ca++ Functions:
Definition
  • Bone Strength
  • Metabolic Processes (coenzyme)
  • Nerve Tissue stability: Calcium - Ca-lms skeletal muscle fibers
  • Cardiac tissue strength: Ca-lcium strengthens Ca-rdiac contractions
  • *Ca calms contractions of skeletal muscles, but strengthens contractions of cardiac tissue
Term
Causes of Hypocalcemia (<9.0 mg/dL)
Definition
  • Hypoparathyroidism
  • Malabsorption or diet deficiency
  • Serum Albumin Deficiency (bound to protein)
  • Alkalosis (increased pH): cannot ionize/activate
  • Hyperphosphatemia - abnormally high levels of phosphate, lowers Ca++ levels in blood
Term
Effects of Hypocalcemia (<9.0 mg/dL)
Definition
  • Increased skeletal nerve excitation
  • Muscle twitching, hyperactive reflexes
  • Capopedal spasms, Chvostek's, Trousseau's
  • Tetany; sustained muscle contraction
  • Decreased Cardiac strength - conduction delays, arrythmias, Low BP
  • TREATMENT: give calcium salts
Term
Causes of Hypercalcemia (>10.5 mg/dL)
Definition

Realse of Ca++ from bones (neoplasms)

Hyperparathyroidism (excess bone demineralization)

Immobility: leads to bone demineralization

Increased intake of Ca++

Milk-Alkali Syndrome (Ca++/Base)

Term
Effects of Hypercalcemia(>10.5 mg/dL)
Definition
  • Depression of skeletal contraction
  • Muscle weakness, Decreased muscle tone
  • Letargy, Stupor, personality changes
  • Anorexia, nausea
  • Increased cardiac functions - Arrythmias possibe
  • If Excess PTH cause: bone destructions and Fx's
  • TREATMENT: phosphate salts
Term
IV Fluids
Definition
Intravenous fluids - enter into vascular system, so, they are in the extracellular fluid (ECF)
Term
Osmotic Pressure
Definition
"Salt Power", "water sucking" - High pulls fluid toward it. Represents salt tension that pulls water toward it.
Term
Isotonic
Definition
Same osmotic pressure, so, no fluid shifts.
Term
Isotonic Fluid
Definition

0.9% NS -- 308 mOsm/L

Ringer's Lactate -- 275 mOsm/L

About 300 = Isotonic

** Dextrose 5% water D5W starts Isotonic; then becomes hypotonic

Term
Hypotonic
Definition
Lower osmotic pressure, fluid shifts away from hypotonic. Pulls fluid into the cell (ICF) *think hippo-tonic*
Term
Hypotonic Fluid
Definition
0.45% NS (1/2 NS) -- 154 mOsm/L
Term
Hypertonic
Definition
higher osmotic pressure, so fluid shifts toward hypertonicity. Pulls fluid into IVC (blood)
Term
Hypertonic fluid
Definition

3% Sodium Chloride (3% NS) -- 1026 mOsm/L

5% Sodium Chloride (5% NS) --1710 mOsm/L

10% Dextrose in Water (D10W) -- 505 mOsm/L

D5NS (406) D5 1/2 NS (406), D5NS (560) D5LR (525)

**All Dextrose solutions (except D5W) are hypertonic. D5W is isotonic, then hypotonic

Term
Colloids
Definition

Contain large molecules which are hypertonic - shifts fluid out of ICF into ECF/IVF 

Ex: Mannitol (large sugar) Albumin (large protein) *Good for cellular edema

Term
Acid-Base Balance: Arterial Blood Gas Analysis
Definition

Cellular enzymes/metabolism can only function in a narrow pH 

* Optimal pH for cellular meatbolism is 7.35-7.45

Cellular death at <6.8 (acidosis) or >7.8 (alkalosis)

Term
What is pH
Definition

Logarithmic calculation of amt of acid (H+ = Acid)

Logarithmic= inversely related 

So, High H+ = LOW pH (Acidosis) Acidic

Low H+ = High pH (Alkalosis) Basic

Term
What's the need for pH
Definition

All cellular metabolism creates Acidotic by-products

One major by-product of cellular respiration is Carbon Dioxide (CO2), which is Acidic

Term
Buffer systems
Definition
Used to protect function, store, transport, and dispose of acid in body (weak acid-base pair)
Term
Buffer Compensation Mechanisms: Respiratory: Lungs
Definition

Acidosis: Increased Respiratory Rate (Blows off CO2, decreasing blood pH)

*FASTEST compensation process w/ significant changes in Minutes!!

HC203 to H2O + CO2

Unable to function in: COPD, Resp Failure, Lung Dz

Term
Buffer Compensation Mechanisms: Metabolic: Kidneys
Definition
  • Acidosis: Kidneys cleave and excrete H+ 
  • Return Bicarb base (HCO3-) to blood
  • Alkalosis: Decrease H+ cleaving; retain more H+
  • ** SLOW compensation process hours to days for response but most potent/effective (still slow)
  • H2CO3 to HCO3- + H+
  • Unable to function in: Renal Dz (acute or chronic)
Term
Compensation
Definition

Recall Homeostasis, body makes changes...

Body then compensates or reacts to keep pH within normal range (7.35 -7.45).

So, if Respiratory flawed (COPD, pneumonia) Increasing CO2, kidneys MUST compensate

Term
Decompensation
Definition
Body is unable to return to pH to normal physiological range (7.35 to 7.45)
Term

Acidosis (pH less than 7.35)

Respiratory

Definition
  • Pneumonia
  • Airway obstruction (aspiration or asthma)
  • Medications depressing respiratory center
  • Chronic Respiratory acidosis (COPD - CO2)
Term

Acidosis (pH less than 7.35)

Metabolic

Definition
  • Loss of Bicarb ions
  • Diarrhea (HCO3 stored in gut)
  • Dehydration (anaerobic respiration)
  • Internal Bleeding
  • Diabetic Ketoacidosis
  • Renal Dz
Term
Effects of Acidosis (pH less than 7.35)
Definition
  • Headache
  • Lethargy
  • Drowsiness
  • Confusion
  • CNS depression
  • Coma/Death
  • Compensation: Increased RR, acidic urine
Term

Alkalosis (pH greater than 7.35)

Respiratory

Definition
  • Hyperventilation
  • Anxiety
  • Fever
  • ASA OD
  • Brainstem Dz
  • Brain Injury
Term
Alkalosis (pH greater than 7.35) Metabolic
Definition
  • Early vomiting (removes H + Cl before dehydration)
  • NG suction
  • Iatrogenic (overcorrection of Acidosis)
Term
Effects of Metabolic Acidosis
Definition
  • CNS Irritability
  • Restlessness
  • Muscle Twitching
  • Tingling
  • Numbness of fingers
  • Tetany
  • Sz
  • Coma
  • Compensation: Decreased RR, Bicarb excretion through kidneys
Term
pH
Definition

Normal range: 7.35 to 7.45

Low = Acidosis

High = Alkalosis

Term
pCO2
Definition

Normal Range: 35-45

Low = Alkalosis

High = Acidosis

Term
HCO3
Definition

normal range: 22-26

low: acidosis

high: alkalosis

Term
Endocrine Glands
Definition
Orgin (and target) of hormones for function * Hormones secreted directly into bloodstream
Term
Negative feedback loop
Definition

Healthy Endocrine system: hormones 

*Opposition system: Opposite Hormones

Term
Central Control: Hypothalamic-Pituitary Axis
Definition
The interactions among these organs constitute the HPA axis, a major part of the neuroendocrine system that controls reactions to stress and regulates many body processes, including digestion, the immune system, mood and emotions, sexuality, and energy storage and expenditure.
Term
Central Control: Hypothalamic-Pituitary Axis
Definition
The interactions among these organs constitute the HPA axis, a major part of the neuroendocrine system that controls reactions to stress and regulates many body processes, including digestion, the immune system, mood and emotions, sexuality, and energy storage and expenditure.
Term
Endocrine Hormones:
Definition

Hypothalamus stimulates Pituitary Hormone Release.

Specific hormones stimulate specific organs into certain processes

Response from organs offers negative feedback to satisfy hypothalamus

Term
Endocrine Disorders: 2 types: Excess and Deficit
Definition

Manifestations are dependent on which specific hormone is in excess or deficit

Most common cause of endocrine pathophysiology is BENIGN TUMORS adenomas

Resistance/Insensitivity of target cell receptors can create "relative deficit"

Term
Diagnostic Tests: Blood Test:
Definition
  • Glucose Tolerance Test: Glucose tests to assess organ response
  • 24-hr Urine: assess catecholamine amount (epinephrine and norephinephrine)
  • CT/MRI
  • Biopsy of Endocrine Organ
Term
Diagnotic Test: Negative Feedback for Homeostasis
Definition

If organ doing it's job- hormone is normal in blood

If NOT hormone release is high

perform blood test!!!

Term
Diagnotic Treatment
Definition

Deficits: treat with missing hormone

excess: treat by removing tumor and can be treated with radiation or "shock" meds

ex:SSKI - shrinks thyroid gland and reduces hormones being produced

Term
Diabetes Mellitus "sweet polyuria" "sweet pee"
Definition

 A deficit of insulin secretion from beta-cells if islets of Langerhans in the Pancreas

*The lack of response by the cells to the insulin = insulin resistance

Term
What is insulin?
Definition
  • Anabolic Hormone - builds complex substances from simple molecules)
  • Transports glucose - out of blood and into cells for metabolism
  • Synthesizes glycogen - for energy storage when glucose abundant
  • Inhibits glucagon: catabolic hormone breaks down glycogen and increases blood glucose
Term
What requires insulin for proper glucose metabolism?
Definition

Skeletal Muscles


*Without cells metabolize fats and proteins and creates fatty acids

Term
What two body systems do not need insulin to use glucose?
Definition
Brain and GI tract are not affected by low glucose in insulin deficit
Term
Diabetes Mellitus: Type 1:
Definition
  • Usually, complete cessation of insulin production
  • Acute onset: Ketoacidosis frequent complication of diagnosis (or infection)
  • Usualy thin frame, younger onset (often auto-immune reaction)
Term
Diabetes Mellitus: Type 2:
Definition
  • Develops as a result of insulin resistance from tissues
  • Insidious onset: takes years to develop. Ketoacidosis NOT likely
  • Usually high BMI, middle-aged, high-glucose diet
Term

 

Diabetes Type 1: 

Definition

Age of Onset: Children/young adults

Onset: Acute

Etiology: Autoimmune destruction/Family History

Body Weight: Thin

Plasma Insulin level: Low

Treatment: Insulin replacement

Occurrence of hypoglycemia or ketoacidosis: Frequent

Term
Diabetes Type II:
Definition
  • Older Adults
  • Onset: Gradual
  • Etiology: Familial, lifestyle, environmental factors (diet)
  • Body Weight: Obese
  • Plasma Insulin level: decreased or normal
  • Tx: diet, exercise, oral hypoglycemia agents or insulin replacements
  • Ketoacidosis: less common
Term
Prevelance of Type 2
Definition

9% of the population of adults 20 + 

* Higher incidence in Afro Am., Latinos, and Native Am.

Term
Prevelane of Type 1
Definition
More often diagnosed in childhood. At risk for DKA -- often diagnosed while in DKA
Term
Gestational Diabets
Definition

Form of Type 2

Pregnancy hormone protect against hypoglycemia

Often precursor for Type 2 DM later in life.

Term
Gestational Diabets
Definition

Form of Type 2

Pregnancy hormone protect against hypoglycemia

Often precursor for Type 2 DM later in life.

Term
What are examples of the initial stage of Diabetes Mellitus?
Definition
  • Decreased transportation and cell usage of glucose
  • Blood glucose levels begin to rise (hyperglycemia)
  • Kidneys are unable to filter all glucose out of filtrate = glucosuria
  • glucosuria leads to polyuria
  • Dehydration leads to anearobic metabolism
  • Dehydration leads to thirst (polydipsia)
  • Lack of nutrients in the cells stimulates appetite (polyphagia)
Term
Symptoms of DM:
Definition
  • Weight gain
  • Abdominal Girth
  • Nocturia
  • Weight Loss
  • Lethargy
  • Polydipsia
  • Fatigue
  • Elevated A1C
  • Dry Mouth
Term
3 P's of DM
Definition
  1. Polyuria
  2. Polydipsia
  3. Polyphagia
Term
Long-term complications of DM:
Definition

Microangiopathy: thickened capillary basement membrane; tissue necrosis - diabetic nephropathy(CKD), retinopathy, peripheral neruopathy

Macroangiopathy: Large Arteries affected

- CAD, CVA, MI, Ulcers (infection and gangrene of wounds)

Neuropathy: Ischemia/ altered metabolism, degeneration of nerve fibers - numbness, tingling, impaired sensation, muscle weakness/wasting and Autonomic damage (bladder, impotence)

Cataracts: clouding of eye lens - abnormal metabolism of glucose; accumulation of sorbitol and water in lens 

Term
What is DKA?
Definition

Lack of glucose in the cells results in catabolism of fats/proteins for energy

Byproduct of catabolism: fatty acids (FFA) and ketones

Term
Signs and Symptoms of DKA:
Definition
  • Nausea, vomiting, abdominal pain, lethargy, weakness
  • Dehydration (from polyuria) Results in anaerobic metabolism (more acids)
  • Thirst, dry mucous membranes, warm dry skin, rapid weak pulse, low BP, oliguria
Term
DKA and Metabolic Acidosis:
Definition
From renal insufficiency (dehydration) and catabolism (FFA)
Term
Kussmaul Respirations:
Definition
deep, rapid breathing, Fruity breath (ketones) decreased responsiveness: decreased LOC, Respiratiory depression!!
Term
Hyperkalemia: from Na/K+ pump needing insulin and acidosis
Definition
Treatment: Hydration, insulin drip, bicarb (maybe, possibly) Potassium (DEFINITELY) monitoring and replacement
Term
DKA: Polyuria and Dehydration:
Definition

results in decreased renal GFR (decreased bicarb)

Also, decreased ability to clear acid (H+) from blood and worsens 

metabolic acidosis = kussmaul respirations

Term
DKA: Electrolyte (K+) Imbalance: hyperkalemia:
Definition
  • Na/K pump insulin-dependent (K+ unable to be moved into cell)
  • Metabolic Acidosis: H+ in cell "pushes K+ out" into bloodstream and results in hyperkalemia
  • *As acidosis/insulin def. is corrected, K+ will move back in and lower K+
Term
HNK
Definition
HyperOsmolar Hyperglycemic NONKetotic Coma
Term
TPN
Definition
Total Parenteral Nutrition
Term
HNK is most common in?
Definition
Type 2 DM - often associated with prolonged TPN
Term
Etiology of HNK
Definition
overindulgence of CHO's, infections *common in elderly
Term
SIGNS & SYMPTOMS of HNK:
Definition

Related to Dehydration:

Neurologic deficits

abnormal reflexes

muscle weakness

diffiulty speaking

*If not corrected, coma and death may result (Hypernatremia = neuro)

Term
SIGNS & SYMPTOMS of HNK:
Definition

Related to Dehydration:

Neurologic deficits

abnormal reflexes

muscle weakness

diffiulty speaking

*If not corrected, coma and death may result (Hypernatremia = neuro)

Term
How is HNK similar to DKA:
Definition
Hyperglycemia and Dehydration Occur
Term
What is the difference between HNK and DKA?
Definition
Since insulin is sufficient for metabolism in the HNK patient, NO catabolism, NO FFA or Ketones and therefore, NO major metabolic acidosis
Term
In HNK, what does Glucosuria lead to?
Definition
High Osmotic Pressure
Term
What is osmotic pressure followed by in HNK?
Definition
Polyuria
Term
What happens after polyuria?
Definition
Dehydration
Term
Prevention & Treatment of Diabetes Mellitus: Diet
Definition
  • Low Simple CHO's (low glycemic index) Minimize insulin surge
  • low cholesterol/Lipids
  • manage weight (Higher BMI/abd girth increases DM risk
Term
Prevention & Treatment of Diabetes Mellitus:Exercise
Definition
  • Increase insulin uptake of muscles/cells
  • Increase insulin receptor sensitivity (opposite of resistance)
  • Assists with weight management
  • Reduce stress (glucocorticoids increase glucose levels)
Term
Prevention & Treatment of Diabetes Mellitus: Treatment: Oral Meds for Type 2:
Definition

1) Stimulate Beta Cells of pancreas to secrete more insulin

  • Glyburide, repaglinide

2) Reduce insulin resistance at cellular insulin recptor site

Metformin (Glucophage)

3) Increase receptor sensitivity to insulin at cellular level

  • Avandia
Term
Prevention and Treatment of Diabetes Mellitus: SQ Meds: Type 1 (2):
Definition
Different insulin types have different peak times/durations
Term
Hypoglycemia
Definition
"Insulin Shock" - the body's alarm to hypoglycemia
Term
Signs and Symptoms of Hypoglycemia
Definition

Neurologic: confusion, slurred speech, unsteady gait, SZ

Sympathetic: Tachycardia, Diaphoresis, Anxiety, Tremors

*Beta-blockers may block this alarm*

Term
What are the functions of the parathyroid hormone (PTH)?
Definition

Bone demineralization

Elevate blood Ca++

Calcium regulation

Tells GI tract to make Vit E to move Ca++ back into blood stream

Term
Causes of HYPOparathyroidism:
Definition
  • Congenital deficiency
  • Surgery/Radiation to neck
  • Autoimmune Dz
Term
Signs and Symptoms of of HYPOparathyroidism:
Definition
  • HYPOCALCEMIA, leading to...
  • Skeletal Muscle: Increased excitatin of nerves
  • Twitching/spasms (tetany)
  • Chvostek (cheek twitch)
  • Trousseau (forearm flap)
  • Cardiac Muscle
  • Weakened cardiac contractions
  • Hypotension
  • Arrythmias
Term
Causes of HYPERparathyroidism:
Definition

Adenoma

Hyperplasia of Organ

Secondary renal failure

 

Term
Signs and Symptoms of HYPERparathyroidism:
Definition

HYPERcalcemia which leads to...

Skeletal Muscle:

Flaccid muscle tone, weakness

Cardiac Muscle:

Forceful cardiac contractions

Bones:

Osteoporosis/Pathological Fx's

Renal:

Urolithasis (Ca++stones), polyuria

Treatment: Calcitonin (Moves Ca++ into bone)

Term
AntiDiuretic Hormone: ADH
Definition

Secreted by Posterior Pituitary during hypovolemia or hypotension

*Also known as Vasopressin

 

Term
What are the actions of ADH?
Definition

*Kidneys: stimulates water reabsorption (concentrates urine)

*Cardiovascular: Increases peripheral vascular resistance (increase BP)

 

Term
What are the causes of Low ADH? (Low ADH is Diabetes Insipidus)
Definition

Head Injury or Surgery

Nephrogenic: kidneys don't respond to ADH

Term
What are the signs and symptoms of low ADH? (ADH IS diabetes insipidus
Definition

Polyuria: low SG in urine (dilute)

Polydipsia: thirst

Dehydration

Hypostension from hypovolemia

Hypernatremia: Confusion, change in LOC

Treatment: Desmopressin (Form of ADH)

Term
What are the causes of High ADH? (High ADH IS SIADH or syndrome of inappropriate ADH)
Definition

Stress/overconsumption of water

Paraneoplastic: Bronchogenic Carcinoma

Term
What are the signs and symptoms of High ADH? (High ADH IS SIADH or syndrome of inappropriate ADH)
Definition

Oliguria: high SG in urine (Concentrated)

Hyponatremia: Fluid shifts INTO cells

Cerebral Edema: Mental confusion, irritability, sz, coma, death

Treatment: Diuretics & Sodium tablets

Term
Thyroid Hormone
Definition

Secreted by thyroid gland

stimulated by pituitary release of TSH

Term
What are the 2 functions of TSH (Thyroid Stimulating Hormone)?
Definition

1) Stimulates thyroid hormone to release thryroid hormones *Monitored to evaluate Thyroid function

2) Stimulates thyroid to grow (hypertrophy) and produce more T3/T4 *Goiter

Term
What are the 2 types of Thyroid Hormone?
Definition

1) T-3 - Triiodothyronine

2) T4 - Thyroixine - bound to protein and inactive

Term
What are the actions of T-3 and T4?
Definition

Increased Metabolic Rate

Increased Heat production

Increased HR

Term
What are the actions of T-3 and T4?
Definition

Increased Metabolic Rate

Increased Heat production

Increased HR

Term
How to check thyroid disease?
Definition
High TSH = thyroid is not working
Term
Thyroid: Goiters
Definition
Main cause of pituitary TSH
Term
What causes TSH secretion to increase?
Definition
If unable to produce active thyroid hormone
Term
Thyroid: Goiters
Definition

Goitrogens: cabbage, turnips, Lithium, Floride

(Block T3/T4 production and increase TSH release)

Thyroid gland growth: Goiter

Term
Toxic Goiter:
Definition

Results from hyperactivity of thyroid gland

Hyperthyroid Crisis/Thyroid Storm can result

Term
Thyroid Disease: Causes of Hypothryroidism:
Definition

Myxedema

Hashimoto's Thyroiditis: Autoimmune

Cretinism:congenital hypothyroid

Term
Diagnostic Tests for Thyroid Disease
Definition
TSH, T3, T4 T3-uptake, Autoantibody assyas, Radiology
Term
Signs & Symptoms of HYPOthyroidism:
Definition
  • Cold intolerance
  • Weight gain
  • Tingling/numbness of extremeties
  • Lethargy/Fatigue
  • Depression
  • PeriOrbital Edema (eye swelling)
  • Myxedema: puffy face and thick tongue
  • Myxedema Coma: hypotension, coma
  • Treatment: Thyroid Hormone, usually Thyroxine
Term

HYPERthyroidism: Grave's Disease 

Labs: low TSH & High T3 & T4

Causes of hyperthyroidism?

Definition

Autoimmune factor

thyroid tumor

more common in women under 30 

 

Term

HYPERthyroidism: Grave's Disease 

Labs: low TSH & High T3 & T4

Causes of hyperthyroidism?

Definition

Autoimmune factor

thyroid tumor

more common in women under 30 

 

Term
Signs and Symptoms of Hyperthyroidism
Definition

heat intolerance

increased SNS stimulation: 

ex. palpitations, nervousness

Exopthalmos:

eye protrusion

Thyroid storm/Crisis:

Hyperthermia, Tachycardia, CHF, Delierium

Treatment: Radioactive Iodine, surgery, SSKI

Term
Adrenal Gland
Definition

Ad - Above, -renal - kidey: glands on top of kidneys

 2 parts: Adrenal Medulla 

Adrenal Cortex 

Term
What does the Adrenal Medulla produce?
Definition
Catecholamines
Term
what are catecholamines?
Definition
Epinephrine and Norepinephrine
Term
What does epinephrine do?
Definition
Vasoconstriction/Tachycardia (HR, BP) known as "Epi"
Term
What does Norepinehprine do?
Definition
Vasconstricion (BP), but little HR effect
Term
What is a Pheochromocytoma?
Definition
Benign tumor of adrenal medulla - increased catecholamine secretion
Term
What are teh signs and symptoms of Adrenergic, SNS, Effects?
Definition

HA

Tachy

Heart Palp

Diaphoresis

Anxiety Attack

Treatment: usually surgery to remove tumor

Term
Adrenal Gland: What hormones does the Cortex produce?
Definition
Corticoids and Androgens (sex hormones)
Term
Where are adrenal cortex hormones derived?
Definition

Cholesterol

Activated by ACTH (adrenocorticotropin Hormone)

Term
What is Mineralicorticoid?
Definition

Aldosterone (Regulated by Angiotensin II and K+)

Primary function: Sodium retention, Water retention

Term
What is glucocorticoid:
Definition

Cortisol: activated by stress response, catecholamines

Primary Function: Elevation of blood glucose, blood pressure

Term
What is Hypercortisolism: Cushing's Syndrome
Definition
Excessive amount of glucocorticoids
Term
Causes of Cushing's Syndrome?
Definition

Adrenal adenoma

Pituitary adenoma

Ectopic Adenoma

Iatrogenic (steroid admin)

Term
What are the signs and symptoms of Cushing's Syndrome (hypercortisolism)?
Definition

Catabolic Effect: Muscle wasting

Metabolic Changes: Hirsutism (body hair)

Retention of Sodium and Water

(mineralicorticoid activity)

Immune suppression (increased infection and decrease healing)

Erythrocyte production (stress response)

Emotional Iability

Moon Faces: Round, swollen faces

Term
What is Addison's Disease?
Definition
Adrenocorticol insufficiency - complete deficiency of Adrenocortical hormones
Term
What are the causes of Addison's Disease?
Definition

Autoimmune Reactions (Type III Hypersensitivity)

Tumors

Term
What are the signs and symptoms of Addison's Disease?
Definition

Decreased/labile glucose levels (low cortisol)

Poor stress response (frequent infections)

Fatigue & Weight loss

Low Serum Na+ (BP lability)

Hyperkalemia (No Aldosterone)

Decreased body hair: decreased androgen activity

Hyperpigmentation: (ACTH hypersecretion -- MSH)

Cardiac arrhythmias and failure

Anemia (decreased erhythrocyte production)

Treatment: hormone replacement (Hydrocortisone)

Addisonian Crisis: lethargy, dilirium, fever

Term
When a person has Addison's Disease what is high?
Definition
  • K+ 
  • Ca++
  • Fever
  • Muscle Pain
Term
When a person has Addison's Disease what is low?
Definition
  • Blood Sugar
  • Na+
  • Blood Pressure
  • Immunity
Term
What is the stress response?
Definition

Systemic response to a stressor (change in homeostasis) 

** Plays enormous role in disease development and exacerbation

Term
What is a stressor?
Definition
Any factor that creates a significant change in the body or the environment
Term
What are examples of stressors?
Definition

Physical, Psychological, or both

Real or anticipated

Short-term or long-term

Term
Who created the GAS - General Adaptation Syndrome?
Definition
Hans Selye in 1946
Term
What is distress?
Definition

If the body is unable to restore homeostasis

1) the stressor becomes harmful

2) Age, illness, and attitude affect stress response

Term
What are the 3 stages of GAS
Definition

1) alarm: activation of hypothalamus, SNS, Adrenal glands (Epi, Norepi, Cortisol)

2) Resistant: Hormone levels elevated (Adrenals), Organs at peak performance

3) Exhaustion: Body is unable to return to homeostasis OR continue peak response

Term
Signs of Stress Response
Definition

Increase BP

Increase HR

CNS Arousal

Increase glucose levels

Bronchodilation

Increased Ventiliation

Decreased Inflammatory/Immune

Increased O2 level

Increased Circulation

Increased Metabolism

Term
Short-Term Stressors
Definition

Enhances Cognition

Enhances memory

Endorphins (pain)

Term
Long Term Sterssors
Definition

Disruption of intellectual function

Disruption of memory

Acute Renal Failure

Stress Ulcers

Infection

Slow healing

PTSD (nightmares, depression)

Term

Sympathetic Nervous System

 

Definition
"Fight or Flight" "Adrenergics"
Term
What are Adrenergics
Definition
Hormones of action for the sympathetic nervous system
Term
What are the adrenal catecholamines?
Definition
Epinephrine and norepinehrine
Term
What is the action of adrenergics?
Definition
Wide spread action. Stimulates peripheral and central receptors
Term
What is the parasympathetic nervous system?
Definition
Cholinergic or Muscarinic
Term
What are the effects of the Parasympathetic Nervous system?
Definition
Flex and Digest
Term
Whater are the 3 major functions of cholinergic activity?
Definition
  1. Increase availability of acetylcholine at NMJ (increased muscle contraction)
  2. Increase secretions (GI, lacrimation, salivation
  3. Decreased heart rate (Vagus nerve) - Bradycardia (decreased cardiac output)
Term
Stress Reduction
Definition

Adequate Rest

Healthy diet 

etc

Term
Stress Reduction
Definition

Adequate Rest

Healthy diet 

etc

Term
Whater are the 3 major functions of cholinergic activity?
Definition
  1. Increase availability of acetylcholine at NMJ (increased muscle contraction)
  2. Increase secretions (GI, lacrimation, salivation
  3. Decreased heart rate (Vagus nerve) - Bradycardia (decreased cardiac output)
Term
What is pain?
Definition
Subjective unpleasant condition or feeling of dicomfort. Results from stimulation of Nociceptors.
Term

What are nociceptors?

 

Definition
pain receptors
Term
Stress Reduction
Definition

Adequate Rest

Healthy diet 

etc

Term
When does pain occur?
Definition

Occurs with tissue ischemia or damage from:

Inflammation, infection, stretch, ischemia, tissue necrosis, burns

Term

What are nociceptors?

 

Definition
pain receptors
Term
When does pain occur?
Definition

Occurs with tissue ischemia or damage from:

Inflammation, infection, stretch, ischemia, tissue necrosis, burns

Term
What is Somatic Pain?
Definition
Conducted through nerve fibers (Somatotopic arrangement)
Term
What is Visceral Pain?
Definition
originates in organs and travels through sympathetic fibers
Term
what is the pain threshold?
Definition
Level of stimulation required to activate perception of pain
Term
Dermatome
Definition
specific area of the skin from which spinal nerves conduct signals
Term
Reflex response
Definition

occurs as a result of sudden pain - is protective

*causes involuntary muscle contraction/movement without brain involvement

*Action is initiated at dorsal root ganglion in spine before the brain is aware

Term
Pain tolerance
Definition
degree of pain that is endured before a person must take action.
Term
Reflex Arc
Definition

Pain - Dorsal Root - Immediate efferent (motor) response

*Occurs without CNS involvement "No upper management"

Term
What is the RAS?
Definition

Reticular Activating System

Pain-Spinothalamic Tracts - RAS- Thalamus-Somatosensory Cortex - Hypothalamus (stress response) - Limbic System (emotional)

Term
What are the spinothalamic tracts?
Definition
Conduct pain to the brain; decuss (cross) at level of pain and ascend to brain
Term
What are the 2 spinothalamic tracts?
Definition

1) paleospinothalamic tract - slow, dull, chronic pain impulses

2) Neospinothalamic tract: fast, sharp, acute pain impulses

Term
RAS
Definition

Arousal state of RAS in pons and medulla influence brain awareness

* MAny drugs are the target of Reticular activating system, dulling pain

Term
What is the somatosensory cortex?
Definition
Somatotopic arrangement helps identify location of pain
Term
Thalamus
Definition
Limbic System (emotional)
Term
Hypothalamus
Definition
stress response/adrenals
Term
What are the characteristics of pain?
Definition
Location, Desrciption, Timing, Modifying Factors
Term
Signs and Symptoms of Pain:
Definition
Increased HR, Increased RR, Increased BP, N/V, Anxiety and Fear, Body Language (posture, guarding)
Term
What is referred pain?
Definition
Sensation of pain are felt in a distant site from origination * Usually pain is visceral (heart or gut)
Term
What is phantom pain?
Definition
sensation of tingling/burning/itching in an amputate limb
Term
Examples of Pain Tolerance:
Definition
Conditioning, Age, Culture/Family Traditions, Individual attitude, Anxiety/Fear, Fatigue, Hunger, Prior Experiences
Term
What are the methods of pain control?
Definition

Analgesics

Sedatives and antianxiety meds (anxiolytics)

Anesthesia (local, regional, and general)

Term
What are 2 types of pain blocking?
Definition

Gate-control theory

Pathway Blockage

Term
What is gate-control theory?
Definition
Stimulus overload, creating spinothalamic "traffic jam"
Term
What is pathway blockage?
Definition
Many meds block either a pathway or its transmitter
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