Reading...
Play button
Play button
Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
471 Cards in this Set
- Front
- Back
|
What are the two types of white blood cells
|
Granulocytes and a granulocytes
|
|
|
What are the three types of granulocytes?
|
Neutrophils, eosinophils, basophils
|
|
|
What are the two types of agranulocytes?
|
Lymphocytes and monocytes
|
|
|
What are the three components of blood?
|
Red blood cells, white blood cells, platelets
|
|
|
What is the normal value of a white blood cell count?
|
5k to 10k
|
|
|
What is leukopenisa?
|
Too few WBC’s
|
|
|
What is leukocytosis?
|
Too many WBC’s
|
|
|
Why do we care about differential white cell counts?
|
So that we know how long an infection has been there
|
|
|
If lymphocytes are high what kind of infection is taking place?
|
Viral
|
|
|
In neutrophilic leukocytosis, what does a shift to the left mean?
|
It means an increase in bands which shows the onset or progression of an infection
|
|
|
Inf neutrophilic leukocytosis what does a shift to the right mean?
|
It means a decrease in bands and that the infection is resolving
|
|
|
If eosinophils are high what kind of infection is going on?
|
Parasitic or an allergic reaction
|
|
|
If basophils are high what kind of infection is going on?
|
Allergic reaction
|
|
|
Describe leukemic cells
|
There is an overproduction of immature blood cells and they do not function like mature leukocytes
|
|
|
Immature WBC cannot do what?
|
Cannot phagocytize and they do not provide immunity
|
|
|
Leukemic cells interfere with what?
|
The maturation of all other blood cells
|
|
|
What are the seven warning signs of acute leukemia?
|
Fatigue, pallor, weight loss, repeated infections, easy bruising, nosebleeds, hemorrhage
|
|
|
What are the clinical manifestations of acute leukemia?
|
-fatigue:anemia
-bleeding: thrombocytopenia -bone pain: bone marrow expansion -infection: neutropenia -CNS involvement: leukostasis -Hyperuricemia: rapid turnover of leukemic cells |
|
|
More children have what type of cancer than any other cancer?
|
Leukemia
|
|
|
What does pallor mean?
|
Pale
|
|
|
What are the symptoms like in leukemia?
|
Sudden and stormy because of depressed bone marrow
|
|
|
What are the three causes of leukemia?
|
1. Exposure to radiation
2. Secondary to chemo which is a poison 3. Genetic connection |
|
|
What is the treatment for acute leukemia?
|
Chemotherapy, irradiation, bone marrow transplantation
|
|
|
Where can the bone marrow comes from for the transportation for acute leukemia?
|
Identical twin, sibling, other donor, autologous
|
|
|
Who has ALL leukemia?
|
2-4 year olds
|
|
|
Who has AML Leukemia?
|
Adults 60-65
|
|
|
What can massive necrosis of malignant cells during therapy of acute leukemia lead to?
|
Hyperkalemia, heyperphoshatemia, hyperuricemia, hypomagnesemia, hypocalcemia, acidosis
|
|
|
Lymphomas result when….
|
A lymphocyte undergoes a malignant change ang begins to multiply, eventually crowind out healthy cells and reating tumors that enlarge the lymph nodes or other parts of the immune system
|
|
|
What are the causes of lymphomas?
|
Hodgkins and non hodgkins
|
|
|
In hodgkins lymphoma, there is a _____ _______ of the lymphatic structures
|
Malignant neoplasm
|
|
|
What is the etiology of hodgkins lymphoma?
|
Infectious agent that is suspected
|
|
|
Who typically gets hodgkins lymphoma?
|
Adults 18-35 or over 50
|
|
|
What is the distinguishing factor in hodgkins lymphoma?
|
Reed-sternberg cell
|
|
|
What are the clinical manifestations of hodgkins lymphoma?
|
Painless profressive increase in size of a single node or group of nodes, dry nonproductive cough related to hilar lympadenopathy, persistent fever, night sweats, weight loss, pain in node after drinking alcohol, impaired immunity, impaired cell mediated immunity, elevated neutrophils, mild normocytic normochromic anemia, eosinophilia, hypergammaglulinemia, hypogammaglobulinemia
|
|
|
In staging of hodgkins lymphoma what does the number mean?
|
How many lymph nodes are involved
|
|
|
In the staging of hodgkins lymphoma what does the location tell us
|
Are the involved lymph nodes on one side of the diaphragm or both?
|
|
|
In staging of hodgkisn what does dissemination tell us?
|
Has the disease disseminated to the bone marrow or liver or both
|
|
|
What is the treatment of hodgkins disease?
|
Chemotherapy, radiation therapy
|
|
|
What is a neoplastic disorder of the lymphoid tissue?
|
Non-hodgkins lymphoma
|
|
|
What is the etiology of non-hodgkins lymphoma?
|
Virus suspected
|
|
|
What is the pathophysiology of non-hodgkins lymphoma?
|
Monocytes affected, painless lymphadenopathy, may progress to extranodal involvemen, hummoral immunity is impaired
|
|
|
Define multiple myeloma
|
Lymphoproliferative disorder of plasma cells in which IgG and IgA are produced. A single malignant plasma cell proliferates and there are too many produced.
|
|
|
In multiple myeloma where do the malignant plasma cells gather?
|
In bone marrow to produce tumor
|
|
|
What is the pathophysiology of multiple myeloma in the skeletal system?
|
Lysis of bone (osteoporosis, severe boen pain, pathological fractures, hypercalcemia)
|
|
|
What is the pathophysiology of multiple myeloma in the hematological system?
|
Bone marrow infiltration, bone marrow replacement, anemia, thrombocytopenia, bleeding, hypogammaglobulinemia
|
|
|
What is the pathophysiology of multiple myeloma in the renal system?
|
Hyperuricemia due to rapid run over of cells, hypercalcemic nethropathy, renal infiltration by plasma cells
|
|
|
What is the pathophysiology of multiple myeloma in the nervous system?
|
Cord compression, intracranial plasma cell masses, neuropathy
|
|
|
What is the pathophysiology of multiple myeloma in the hyperviscosity syndrome?
|
Sludging in capillaries, purpura, retial hemorrhage, papilledema, coronary ischeimia, CNS symptoms
|
|
|
What does the hematologic system include?
|
All the blood cells, the bone marrow, and the lymphoid tissue
|
|
|
What is blood made up of?
|
45 percent formed elements, 55 percent plasma
|
|
|
What are the formed elements?
|
RBC WBC and platelets
|
|
|
What are the purposes of the hematologic system?
|
1. To carry oxygen and nutrients
2. Transports hormones 3. Remove waste products 4. Deliver cells to prevent infection, stop bleeding, and promote healing |
|
|
Define plasma
|
The watery, straw colored fluid that is part of the lymph and blood in which the leukocytes and erythrocytes are suspended
|
|
|
What is plasma made up for?
|
Ninety percent water, ten percent plasma proteins
|
|
|
What are the plasma proteins?
|
Electrolytes, glucose, fats, bilibrubin, and gases
|
|
|
what are plasma cells essential for?
|
For carrying the cellular elements of the blood through the circulation, transporting nutrients, maintaining acid base and transporting waste
|
|
|
Define albumin
|
It is made in the liver and maintains the osmotic pressure and blood volume
|
|
|
Define globulins
|
They bind to insoluble hormones to make them soluble. This allows the substances to be taken from place of manufacture to the site of action ex. Thyroid hormone
|
|
|
Define other globulins
|
The antibodies that travel through the blood to fight infection
|
|
|
What does hematopoiesis refer to?
|
Blood formation
|
|
|
In the fetus where are blood cells formed?
|
Bone marrow, liver, spleen
|
|
|
Where are blood cells formed in adults?
|
Bone marrow
|
|
|
Where are some of the places that bone marrow is found?
|
Cranial bones, ribs, vlavicles, pelvis, humerus, sternum, vertebrae, scapulae, femurs
|
|
|
What does erythropoiesis refer to?
|
The formation of erythrocytes
|
|
|
what are the two stages of erythropoiesis?
|
- Proliferation
- Differentiation |
|
|
Define the stem cell theory
|
All blood cells are produced from a single progenitor cell called the stem
|
|
|
What are erythrocytes?
|
Red blood cells
|
|
|
How many erythrocytes do we have per mm cubed?
|
4-5 million
|
|
|
Why are erythrocytes higher in men?
|
Increased muscle mass, increased oxygen consumption and also testosterone stimulates the production of RBC
|
|
|
What slows RBC production?
|
Estrogen
|
|
|
What do erythrocytes transport?
|
Oxygen and carbon dioxide
|
|
|
What do erythrocytes serve as to help maintain acid base balance?
|
Buffer system
|
|
|
Do erythrocytes have a nucleus?
|
No
|
|
|
Erythrocytes have a flexible what?
|
Cell membrane
|
|
|
What do erythrocytes contain?
|
Hemoglobin
|
|
|
What are the five stages of erythrocyte development?
|
Proerythroblast, basophilic erythroblast, polychromatophilic erythroblast, orthochromatic erythroblast, reticulocyte
|
|
|
Describe a proerythroblas
|
Large nucleus
|
|
|
Describe a basophilic erythroblast
|
Hemoglobin synthesis begins and it stains blue
|
|
|
Describe a plychromatophilic erythroblast
|
Hemoglobin synthesis continues and it stains red and blue
|
|
|
Describe a orthrochromatic erythroblast
|
Nucleus shrinks and more hemoglobin is synthesized
|
|
|
In a reticulocyte what is the cell filled with
|
Hemoglobin
|
|
|
What is the nucleus like in a reticulocyte?
|
Nucleus shrinks and is more extruded
|
|
|
What is observed in a reticulocyte?
|
Basophilic stippling
|
|
|
What is the life span of a reticulocyte?
|
One day
|
|
|
How large is the cell of a erythrocyte?
|
8 microns
|
|
|
What kind of disc is a erythrocyte?
|
Biconcave
|
|
|
What is the life span of a erythrocyte?
|
120 days
|
|
|
Describe what happens during hypoxemia
|
Pulmonary disorders, shock, low oxygen concentration in inspired air, and anemia
|
|
|
What does erythropoietin allow the kidneys to do?
|
Sense oxygen levels in the blood that pass through them
|
|
|
if oxygen is low what do the kidneys do?
|
Produce more erythropoietin
|
|
|
What does erythropoietin act on the bone marrow to stimulate?
|
Rbc production
|
|
|
How many days does it take for mature rbc’s to appear in circulation?
|
Up to five days
|
|
|
In renal failure, ___ erythropoietin is secreted. This results in what?
|
Less, results in anemia
|
|
|
In renal failure, what can be given?
|
Epogen
|
|
|
What happens during a renal tumor? What does this result in?
|
More erythropoietin is secreted, results in polycythemia
|
|
|
What are the seven substances needed for erythropoiesis?
|
Amino acids,iron, copper, pyrixoxine, cobalt, vitamin b12, folic acid
|
|
|
After how many days does the cell membrane of a red blood cell die?
|
120
|
|
|
When describing a RBC, how do you describe the size?
|
Cytic
|
|
|
When describing a RBC, how do you describe the color?
|
Chromic
|
|
|
What is normocytic?
|
Cells of normal size
|
|
|
What is normochromic?
|
Cells with normal amounts of hemoglobin
|
|
|
Define anisocytosis
|
Variation in size
|
|
|
Define poikilocytosis
|
Variation in shape
|
|
|
Give two examples in which a rbc can be poikilocytotic?
|
Spherocytosis, sickle cell anemia
|
|
|
Describe the RBC count in men
|
4.7-6.1
|
|
|
Describe the RBC count in women
|
4.2-5.2
|
|
|
Define hemoglobin
|
Complex protein molecule which contains iron
|
|
|
Where is hemoglobin carried?
|
In the RBC
|
|
|
How many hemoglobin/RBC?
|
300
|
|
|
Describe what is going on in hematocrit
|
Increase in dehydration due to an increase in ECF volume
|
|
|
What is MCV?
|
Mean corpuscular volume
|
|
|
What is MCHC?
|
Mean corpuscular hemoglobin concentration
|
|
|
What is less helpful in determining the type of anemia?
|
Mean corpuscular hemoglobin
|
|
|
Define anemia
|
Refers to a decrease in the number of red blood cells or quantity of hemoglobin
|
|
|
What is the result of anemia?
|
Decreased oxygen carrying capacity of the blood
|
|
|
What is anemia classified by?
|
Size of RBC, color of RBC
|
|
|
What is the reticulocyte count useful for?
|
Evaluating anemia, erythropoeisis effectiveness, bone marrow response to anemia
|
|
|
What is reticulocytopenia?
|
Ineffective erythropoeisis
|
|
|
What is reticulocytosis?
|
Blood loss, high altitude
|
|
|
What are the etiologies of anemia?
|
Blood loss, hemolysis, nutritional deficiencies, intrinsic factor deficiency, genetic alterations, cone marrow suppression or destruction
|
|
|
What are the manifestations of hemorrhagic anemia?
|
Acute and chronic blood loss, hypovolemia, hypoxemia, restlessness, diaphoresis, tachycardia, dyspnea
|
|
|
What are the two characteristics of hemorrhagic anemia?
|
Normocytic, normochromic. Increased reticulocyte count
|
|
|
What is the etiology of hemolytic anemia?
|
Mechanical injury to RBC, ag-ab reaction, hereditary membrane defects
|
|
|
What is hemolytic anemia characterized by?
|
Normocytic, normochromic, increased reticulocyte count
|
|
|
In type O there are no ______ on the RBC. They have what types of antibodies and what is a special characteristic?
|
There are no antigens. They have A and B antibodies and they are universal donors
|
|
|
What type of antigen does type a have?
|
A
|
|
|
What type of antibody does type a have?
|
B
|
|
|
What type of antigen does type b have?
|
B
|
|
|
What type of antibody does type b have?
|
A
|
|
|
What type of antigens does type ab have?
|
Ab
|
|
|
What type of antibodies does type ab have?
|
None
|
|
|
Type ab is a universal what?
|
Recipient
|
|
|
What is the rhusus factor?
|
Type of blood antigen and positive is most common
|
|
|
What is the pathophysiology of transfusion reactions?
|
Lysis of RBC’s, release of hemoglobin, jaundice, DIC and bleeding, renal failure
|
|
|
Describe the hemolytic transfusion reaction
|
Usually ABO incompatability and it’s a severe reaction
|
|
|
Describe the febrile transfusion reaction
|
Antibodies agains donor WBC.. temp elevates
|
|
|
Describe the allergic transfusion reaction
|
Antibodies against donor proteins, urticaria and pruritis
|
|
|
Describe the delayed hemolytic reactions in a transfusion reaction
|
Undetected antibodies in the recipient’s serum it causes a fall in the hematocrit
|
|
|
What are the clinical manifestations of transfusion reactions
|
Heat along the vein, flushing, urticaria, headache, lumbar pain, chill, fever, chest pain, abdominal cramping, tachycardia, nausea and vomiting, hypotension, red urine
|
|
|
Define autoimmune hemolytic anemia
|
RBC’s are hemolyzed by an immune response
|
|
|
Describe hemolytic anemia
|
It is acquired, and it carried on a mosquito. It feeds on the hemoglobin of RBC’s and can spread into other cells. Hemolysis occurs in the spleen
|
|
|
Define glucose 6 phosphate dehydrogenase deficiency
|
It is a deficiency of and X linked enzyme necessary for converting glycerol to glucose primarily in males
|
|
|
In G6pd deficiency, what are the factors that contribute to hemolysis?
|
Drugs, viral infections, bacterial infection, diabetic ketoacidosis
|
|
|
Once the triggering factor is removed from g6pd deficiency what happens?
|
Recover
|
|
|
Hereditary spherocytosis is a ___________- condition
|
Autosomal dominant
|
|
|
What happens to the RBC in hereditary spherocytosis?
|
The cell membrane changes from biconcave disc to sphere
|
|
|
What is a spherocyte?
|
It is a fragile thing and hemolysis occurs which is often trapped in the spleen
|
|
|
In hereditary spherocytosis what happens to the RBC lifespan?
|
It is reduced
|
|
|
Who does physiological jaundice occur in?
|
Newborns
|
|
|
In physiological jaundice you switch from HbF to what?
|
HbA
|
|
|
In physiological jaundice there is a rapid hemolysis of what?
|
HbF
|
|
|
In physiological jaundice what is released into circulation?
|
Bilirubin
|
|
|
Immature what unables the us to handle the rapid overturn?
|
Liver
|
|
|
What percentage of newborns have physiological jaundice?
|
70 percent
|
|
|
When is physiological jaundice usually evident and how long does it last?
|
48 hours after birth and lasts 5-7 days
|
|
|
What is the treatment for physiological jaundice?
|
Bilirubin light/photo therapy
|
|
|
How does the bilirubin light/ phototherapy work?
|
The skin absorbs the light which helps convert bilirubin to a more water soluble form that can be excreted
|
|
|
In pernicious anemia what is vitamin b12 necessary for?
|
Maturation of RBC’s
|
|
|
What is the etiology of pernicious anemia?
|
Poor absorption of vitamin b12, atrophy of the gastric mucosa, decreased gastric acid secretion, decreased secretion of intrinsic factor
|
|
|
What are the consequences of pernicious anemia?
|
Impairs the development of RBC’s, impairs the development of somatic cells, impairs myelin formation
|
|
|
What are some of the classic symptoms of pernicious anemia?
|
Weakness, sore tongue, numbness and tingling in the extremities, and jaundice
|
|
|
What are the characteristics of pernicious anemia?
|
Decrease hemoglobin, macrocytic, megaloblastic, anisocytosis, poikilocytosis, leucopenia, thromobocytopenia
|
|
|
What is folic acid necessary for?
|
Maturation of erythrocytes, necessary for DNA synthesis
|
|
|
What are the risk groups for folic acid deficiency anemia?
|
Infants, adolescents, pregnant females, lactating females, alcoholics, and the elderly
|
|
|
What are the characteristics of folic acid anemia
|
Macrocytic, megaloblastic, ansiocytosis, poikilocytosis
|
|
|
What are the signs and symptoms of folic acid anemia
|
Fatigue, shortness of breath, palpitations, glossitis, nausea, anorexia, forgetfulness
|
|
|
What are some foods high in folic acid?
|
Asparagus, beef liver, broccoli, collards, mushrooms, oatmeal, peanut butter
|
|
|
What is the treatment for folic acid anemia?
|
Eat food rich in folic acid, avoid overcooking, take folic acid supplement orally or parenterally
|
|
|
What is iron needed for?
|
Hemoglobin synthesis
|
|
|
Each molecule of hemoglobin carries how many molecules of oxygen?
|
One
|
|
|
Define oxyhemoglobin
|
The combination of hemoglobin and oxygen
|
|
|
Define carboxyhemoglibin
|
Combination of hemoglobin and co
|
|
|
How does iron circulate in the body?
|
As transferring
|
|
|
When iron combines with apoprotein what does it form?
|
Ferritin
|
|
|
What does ferritin indicated?
|
The level of the bodies stored iron
|
|
|
Where is ferritin stored?
|
Liver, spleen, and bone marrow
|
|
|
What are the etiologies of iron deficiency?
|
Inadequate diet, chronic blood loss, increased need
|
|
|
What are the characteristics of iron deficiency anemia?
|
Hypochromic, microcytic anemia
|
|
|
What is the etiology of aplastic anemia?
|
Drug toxicity, radiation, chemicals, infections
|
|
|
What is often the cause of aplastic anemia?
|
Not known idiopathic
|
|
|
What is aplastic anemia a disorder of
|
The stem cells in the boen marrow
|
|
|
In aplastic anemia insufficient numbers of what are produced
|
Blood cells
|
|
|
What are the characteristics of aplastic anemia?
|
Normocytic, normochromic, depletion of leukocytes, depletion of platelets
|
|
|
What are the three causes of aplastic anemia
|
Suppression of bone marrow, replacement of bone marrow, congenital
|
|
|
Sickle cell trait is what?
|
Heterozygous
|
|
|
What are the hemoglobin levels like in sickle cell trait?
|
Normal
|
|
|
What are the reticulocyte levels like in sickle cell trait?
|
Normal
|
|
|
In sickle cell trait most show no symptoms unless what?
|
They have a severe hypoxic episode
|
|
|
Sickle cell disease is what
|
Homozygous
|
|
|
What are the three major pathophysio9logical processes associated with sickle cell disease?
|
Severe hemolysis, widespread vaso-occlusion, infarction of many tissues and organs
|
|
|
What are some factors which induce sickling?
|
Hypoxia, fever, acidosis, dehydration, infection
|
|
|
What are the sequelae of hemolysis?
|
Anemia, jaundice, gallstones, cardiomegaly, leg ulcers, poor physical development, delayed maturation
|
|
|
What are the sequelae of vaso-occlusion aka sickle cell crisis
|
Severe pain of bone muscles and abdomen, acute chest pain, strokes, eye damage, functional hypospenism, autospnectomy, liver kidney and lunch gailure, priapism
|
|
|
How do you manage sickle cell crisis?
|
Hydration to correct hypertonicity, correct acidosis, correct hypoxia, antibiotic therapy, transfusion therapy, sedation and analgesia, bone marrow transplant, hydroxyurea
|
|
|
How long do sickle cells last?
|
10-20 days
|
|
|
With sickle cell disease patient usually maintains what in hemoglobin levels?
|
Fairly normal levels
|
|
|
What are the manifestations of sickle cell disease?
|
Weakness, listlenssness, tachypnea, tachycardia
|
|
|
Define hyposplenism
|
Reduced splenic function
|
|
|
Define thalassemias
|
Defective or absent synthesis of alpha or beta chains of the hemoglobin molecule
|
|
|
Describe beta thalassemia
|
Defective beta chain, Mediterranean descent
|
|
|
Describe alpha thalassemia
|
Defective alpha chain, Africans and black Americans
|
|
|
What are the characteristics of thalassemias
|
Deficient hemoglobin synthesis, microcytic, hypochromic anemia
|
|
|
In thalasseias an unaffected chain continues to be produced what does this lead to?
|
Red blood cell destruction and anemia
|
|
|
Thalassemia major is a what type of disorder?
|
Homozygous autosomal recessive
|
|
|
What are the characteristics of thalassemia?
|
Microcytic, hypochromic anemia
|
|
|
What are the pathophysiological consequences of thalassemia?
|
Defect in hemoglobin synthesis, ineffective erythropoiesis, hemolysis
|
|
|
What are the clinical manifestations of thalassemia major?
|
Fatigue, splenomegaly, jaundice, severe anemia, cardiomegaly, hepatomegaly, jaundice mental retardation enlargement of face fracture of long bones
|
|
|
What type of disorder is thalassemia minor?
|
Heterozygous autosomal recessive
|
|
|
What are the characteristics of thalassemia minor?
|
Mild anemia and micocytic, hypocrhomic anemia
|
|
|
Polycythemia is not a what?
|
Anemia
|
|
|
What is polycythemia?
|
An excess of blood cells
|
|
|
What are the two types of polycythemia?
|
Relative and absolute
|
|
|
Describe relative polycythemia
|
Hemoconcentration
|
|
|
Describe absolute polycythemia
|
Red cell mass is increased
|
|
|
What are the effects of polycythemia?
|
Increased whole blood viscosity, and increased blood volume
|
|
|
Define hemostasis
|
The cessation of blood flow which is a multi step process. It is a semisolid clot with RBC’s trapped inside a fibrin meshwork
|
|
|
What are the three steps involved in hemostasis
|
Vessel spasm, formation of platelet plug, blood coagulation
|
|
|
What does vessel spasm help with in hemostasis?
|
Helps reduce blood flow
|
|
|
Describe formation of platelet plug as pertaining to hemostasis
|
It adheres to the vessel walls and then the platelets stick together
|
|
|
What happens in the vessel spasm first line of defense?
|
The vessel constricts, blood flow is diverted, and thromboxane a2 contributes to vasoconstriction
|
|
|
When is thromboxane a2 released?
|
When platelets aggregate and when cells are injured
|
|
|
What does platelet adherence depend on?
|
Von willebrand’s factor
|
|
|
What is von willebrand’s factor produced by?
|
Endothelial cells of blood vessels
|
|
|
Where does von willebrand’s factor circulate and what does it carry?
|
Circulates in the blood and carries factor VIII
|
|
|
What happens in platelet aggregation?
|
Platelets clump together
|
|
|
What are the three things platelet aggregation is induced by?
|
ADP, thrombin, thromboxane A2
|
|
|
Thromboxane A2 is a very potent what
|
Vasoconstrictor
|
|
|
What does cytoclooxygenase convert arachidonic acid to?
|
Thromboxane A2
|
|
|
What are some drugs that prevent platelet aggregation?
|
Asprin
|
|
|
Where are most coagulation factors produced?
|
In the liver
|
|
|
What are three natural anticoagulants?
|
Antithrombin III, protein c, protein s
|
|
|
What is the average platelet count?
|
150k to 400k
|
|
|
What is rarely the cause of hemorrhage unless the platelet count is less than 20k?
|
Thrombocytopenia
|
|
|
What is the best test of platelet function?
|
Bleeding time
|
|
|
What is the normal bleeding time?
|
2-8 mins
|
|
|
If the bleeding time is prolonged what are some problems?
|
Thrombocytopenia, von willebrand’s disease, qualitative platelet defects
|
|
|
Define prothrombin time
|
PT, it evaluates extrinsic coagulation factors and it monitors the response to anticoagulants
|
|
|
Define aPTT
|
Activated partioal thromboplastin time. It evaluates intrinsic pathways of coagulation factors and monitors heparin therapy
|
|
|
Describe hemophilia a
|
Factor VIII deciciency and it’s x
linked recessive |
|
|
Describe hemophilia b
|
Factor IX deficiency, x linked recessive, clinically indisnguishable from hemophilia a
|
|
|
Describe hemophilia c
|
Factor XI deficiency, autosomal recessive disease, bleeding is less severe than a or b
|
|
|
What are the pathophysiological effects of hemophilia?
|
Hemathrosis, epistaxis, hematuria, hematoma, bleeding into tissue of airway, bleeding into brain and spinal cord
|
|
|
What is the treatment of hemophilia?
|
Replace deficient factor, prevent injury
|
|
|
Who is affected by von willebrand’s disease?
|
Both sexes its autosomal dominant
|
|
|
In von willebrand’s disease what is deficient?
|
Factor VIII
|
|
|
What are the symptoms of von willebrand’s disease?
|
Bruising, excessive menstrual flow, nose bleeding, gi bleeding, prolongued bleeding with minor procedures
|
|
|
What is the treatment for von willebrand’s disease?
|
DDAVP, plasma, oral contraceptives, urokinase, streptokinase, tissue plasminogen activator
|
|
|
what is ITP characterized by?
|
A sudden onset of petechia and purpura
|
|
|
What is the treatment for ITP?
|
Corticosteroids, immunosuppressive agents, IV gamma globulin, plasmaphoresis, spleenectomy
|
|
|
What are some of the possible causes of consumptive thrombocytopenia?
|
Hemolytic uremic syndrome, bacterial infection, viral infection
|
|
|
What are some of the causes of DIC?
|
Trauma, shock, hypoxia, acidosis, sepsis, massive hemolysis, obstetric disorders, venomous snakebite, transfusion of incompativle blood, glomerulonephriris, liver disease, malignancies, transplant rejection
|
|
|
What are the signs of DIC?
|
Bleeding from one or more locations, bleeding from venipunctures, large eccymoses/skin petechia, thrombosis, peripheral cyanosis, gi bleeding, hematura
|
|
|
What is the treatment of DIC?
|
Treat underlying cause, fresh frozen plasma, platelet transfusions, heparin therapy which is controversial
|
|
|
If there is impaired liver function there is a decrease in the synthesis of what?
|
Clotting factors
|
|
|
Vitamin k is a ___ soluble vitamin which is obtained from what and produced where?
|
Fat soluble which is obtained from cow’s milk and green leavy vegetables and it’s produced in the colon
|
|
|
What is the function of vitamin k?
|
To activate II, VII, IX, and X
|
|
|
What are some drugs that inhibit vitamin k coagulation?
|
Coumadin, aspirin, dilantin
|
|
|
Henoch-schonlein purpura is what?
|
Nonthrombocytopenic
|
|
|
What does henoch-schonlein purpura follow?
|
URI, allergy, drug sensitivity, viral illness
|
|
|
What are the signs of henoch-schonlein purpura?
|
Symmetric purpura of buttocks and lower extremeties, endema
|
|
|
what are the complications of henoch-schoenlin purpura?
|
Gi symptoms, nephritis
|
|
|
What is the treatment for henoch-schonlein purpura?
|
Supportice, corticosteroids, acetaminophen
|
|
|
What test do you use to test for heparin?
|
aPTT
|
|
|
What is the antidote for heparin?
|
Protamine sulfate
|
|
|
What lab test do you use to test for Coumadin?
|
PT
|
|
|
What is the antidote for Coumadin?
|
Vitamin k
|
|
|
What do fluids serve to do?
|
Transport gases, nutrients, and waste
|
|
|
Define electrolyte
|
Dissolved in a solution to form charged ions
|
|
|
Define osmosis
|
The movement of water from an area of low concentration of electrolytes to an area of higher concentration
|
|
|
What is osmosis attempting to do?
|
To water down the highly concentrated environment
|
|
|
Osmosis occurs without what?
|
Use of energy
|
|
|
Define diffusion
|
Movement of electrolytes from area of high concentration to an area of lower concentration
|
|
|
What is diffusion trying to do
|
To even out the concentration gradient
|
|
|
Diffusion occurs without what?
|
Use of energy
|
|
|
What does osmotic pressure represent?
|
The concentration of electrolytes in fluid
|
|
|
The increase in electrolytes = increase in what?
|
Osmotic pressure
|
|
|
Define isotonic
|
The same osmotic pressure between the cell and the extracellular fluid
|
|
|
In isotonic conditions the cell stays the ___
|
Same
|
|
|
Define hypotonic
|
Solution has a lower osmotic pressure
|
|
|
In hypotonic conditions the cell will ____
|
Swell
|
|
|
Define hypertonic
|
Solution has a higher osmotic pressure than the cell
|
|
|
In hypertonic conditions the cell will ___
|
Shrink
|
|
|
In a normal adult what percentage of the body is fluids?
|
60 percent
|
|
|
Where does fluid exchange occur
|
In the capillaries
|
|
|
Define interstitial fluid
|
Fluid that exists in tissues between cells
|
|
|
Interstitial fluid does not include what
|
Plasma
|
|
|
Interstitial fluid usually exists in what form
|
Gel form so that it is distributed evenly and to keep vascular fluid from moving out of the cell
|
|
|
What does interstitial fluid act as if there is a fall in vascular volume?
|
Reserve
|
|
|
Plasma is the ____ fluid
|
Vascular
|
|
|
What does plasma carry?
|
Carries blood cells throughout the body
|
|
|
What does plasma help to do?
|
Keep vascular volume up and therefore vascular pressure
|
|
|
Define transcellular fluid
|
Fluids found in the sacs surrounding some vital organs
|
|
|
Where does the body have fluid filled sacs and what are they for?
|
In areas of continuous movement to prevent damage to vital organs
|
|
|
What are some examples of transcellular fluid?
|
Peritoneal cavity, csf, synovial fluid
|
|
|
Define edema
|
It is palpable swelling that occurs due to an increase in interstitial fluid volume
|
|
|
What are the systematic causes of edema?
|
Heart disease, kidney disease, pregnancy, burns
|
|
|
How do you assess an edema?
|
Weight, visual, measurements, pitting
|
|
|
What are the treatments for edema?
|
Diuretics, support hose, elevation
|
|
|
Define third spacing
|
Increase in fluid of a body cavity or sac
|
|
|
What is third spacing closely linked with?
|
Poor lymphatic drainage
|
|
|
What are some examples of third spacing?
|
Peridcardial effusion, ascites, pleural effusion
|
|
|
What are the labs that test electrolyte balance?
|
BMP and CMP
|
|
|
What does the BMP test for?
|
NA, cl, k, co2, glucose, BUN, cr, Ca
|
|
|
What doe s the CMP test for?
|
Liver enzymes, total protein, albumin
|
|
|
Describe the isotonic fluid volume deficit
|
It is when sodium choloride loss is proportionate to the water loss
|
|
|
In isotonic fluid volume deficit describe the electrolyte concentration
|
It is usually the same unless others are out of balance for some reason
|
|
|
What doe isotonic fluid volume deficit result in?
|
Low blood volume
|
|
|
What are the causes of isotonic fluid volume deficit?
|
Acute gastroenteritis, some kidney disease
|
|
|
What are the signs and symptoms of isotonic fluid volume deficit?
|
Weight loss, hypotension, tachycardia, week pulse, poor capillary refill, dry mouth
|
|
|
Describe isotonic fluid volume excess
|
Increase volume of water and sodium chloride proportionately
|
|
|
In isotonic fluid volume deficit describe the electrolyte concentration
|
It is usually the same unless others are out of balance for some reason
|
|
|
What doe isotonic fluid volume deficit result in?
|
Low blood volume
|
|
|
What are the causes of isotonic fluid volume deficit?
|
Acute gastroenteritis, some kidney disease
|
|
|
What are the signs and symptoms of isotonic fluid volume deficit?
|
Weight loss, hypotension, tachycardia, week pulse, poor capillary refill, dry mouth
|
|
|
Describe isotonic fluid volume excess
|
Increase volume of water and sodium chloride proportionately
|
|
|
Describe the electrolyte concentration in isotonic fluid volume excess
|
Usually the same unless others are out of balance for some reason
|
|
|
What does isotonic fluid volume excess result in?
|
Excess in blood volume
|
|
|
What are the causes of isotonic fluid volume excess?
|
Heart failure, kidney problems, corticosteroids
|
|
|
What are the signs and symptoms of isotonic fluid volume excess?
|
Weight gain, full bounding pulse
|
|
|
What is the treatment for isotonic fluid volume excess?
|
Low sodium diet, diuretics
|
|
|
Describe hyponatremia
|
Low sodium concentration
|
|
|
What is hyponatremia common in?
|
Elderly due to decreased renal function and poor homeostatic controls with disease
|
|
|
Hyponatremia may be_____, _____, or _____
|
Hypo, normo, hyper volemic
|
|
|
What are the signs and symptoms of hyponatremia?
|
Muscle cramps, weakness, fatigue, and later neurological changes including seizures
|
|
|
What are the causes of hyponatremia?
|
Water intoxication, decreased renal function
|
|
|
What is the treatment of hyponatremia?
|
Dependent on wheter it is hypo normo or hypervolemic
|
|
|
Describe hypernatremia
|
Increase in sodium which gives an increase tonicity of plasma which results in cellular dehydration
|
|
|
Hypernatremia does not occur ____ since even small amounts of sodium result in thirst
|
Often
|
|
|
Who does hypernatremia typically occur in?
|
Infants and severely demented
|
|
|
What are the signs and symptoms of hypernatremia?
|
Thirst, decrease UOP, neuro changes if severe
|
|
|
What is the treatment for hypernatremia?
|
Water or hypotonic IVF if severe
|
|
|
What is potassium in the body regulated by?
|
The kidneys via aldosterone
|
|
|
Why are the cells of the body very sensitive to changes in potassium?
|
Because it is responsible for conducting impulses
|
|
|
What are the causes of hypokalemia?
|
Poor dietary intake, loss of stuff, redistributed between ECF and ICF
|
|
|
What are the signs and symptoms of hypokalemia?
|
EKG changes, arrhythmias, fatigue, muscle cramps
|
|
|
What is the treatment for hypokalemia?
|
Oral potassium, IV potassium if chronic
|
|
|
Describe what hyperkalemia is
|
An elevated serum potassium level
|
|
|
What are the causes of hyperkalemia?
|
Almost always due to renal failure
|
|
|
s/s of hyperkalemia
|
Muscle weakness, dyspnea, arrhythmias
|
|
|
What is the treatment of hyperkalemia
|
Low potassium diet and dialysis
|
|
|
Describe hypocalcimeia
|
Decreased serum calcium level
|
|
|
What causes of hypocalcimeia
|
Mostly renal failure
|
|
|
s/s of hypocalcimieia
|
Increased excitation of nerve and muscle cells, parathesia, tetany seizures and death
|
|
|
Treatment of hypocalcimeia
|
Dialysis, high calcium diet
|
|
|
Describe hypercalcemia
|
Increased serum calcium level
|
|
|
What are the causes of hypercalcemia
|
Cancers, bone wasting, hyperparathyroidism
|
|
|
s/s of hypercalcemia
|
Decreased excitation of nerve and muscle cells, changes in personality, arrhythmia
|
|
|
Treatment of hypercalcemia
|
Hydration to increase excretion, loop diuretics
|
|
|
What is the normal blood ph?
|
7.35-7.45
|
|
|
An acid molecule is….
|
One that can release a positive hydrogen ion
|
|
|
A base is…..
|
A molecule that can accept a positive hydrogen ion
|
|
|
What is ph a measure of?
|
The positive hydrogen concentrations
|
|
|
What are acidic byproducts?
|
By products of metabolism
|
|
|
What is less important when you are measuring blood ph?
|
Nonvolatile acids
|
|
|
What is co2
|
Byproduct of cellular respiration
|
|
|
Where does co2 circulate?
|
Attached to hemoglobin, dissolved in plasma, a part of bicarbonate
|
|
|
Small amount of co2 will bind with water t o make what?
|
Carbonic anahydrase (h2co3)
|
|
|
Where are bases controlled?
|
In the kidneys even though it is derived from co2
|
|
|
What is the primary cause of problems with ph?
|
The initiating event that occurs in respiratory system or metabolic system
|
|
|
What are changes in ph characterized by?
|
Initiating system, ph level
|
|
|
What is included in the initiating system
|
Respiratory, metabolic
|
|
|
What is included in ph level?
|
Acidosis, alkalosis
|
|
|
Define controls
|
When a change occurs the body will attempt to compensate with help from the system that has not failed
|
|
|
What are the two control centers?
|
Lungs will compensate for metabolic problems, kidneys will compensate for lung problems
|
|
|
In respiratory acidosis if blood becomes too acidic due to a decrease in co2 what happens?
|
expiration in the lungs then the kidneys will produce for HCO3 to balance out the acid
|
|
|
In respiratory alkalosis if the blood becomes to alkaline due to an increase in co2 what happens?
|
Expiration in the lungs and the kidneys will excrete more HCO3 to the urine to balance out the alkaline CO2
|
|
|
In metabolic acidosis if the kidneys excrete too much HCO3 in the urine or if metabolic produce acid builds up due to a dysfunctional metabolic process what happens?
|
The lungs will blow off more CO2 to balance out the acid
|
|
|
In metabolic alkalosis if the kidneys secrete too much HCO3 into the blood or if other alkaline metabolic byproduct build up due to a dysfunctional metabolic process then what happens
|
The lungs will blow off less CO2 to balance out the alkalinity
|
|
|
Compensation is a mechanism that attempts to do what?
|
Balance out the state created by the primary cause
|
|
|
Where is arteriol blood gases drawn from?
|
Artery
|
|
|
What does arterial blood gases measure?
|
Ph, paO2, PaCo2, HCO3
|
|
|
What is the purpose in measure PaO2?
|
To make sure patient is oxygenating well
|
|
|
If ph is less than 7.35 if is what?
|
Acidosis
|
|
|
If ph is greater than 7.45 then it is what?
|
Alkalosis
|
|
|
Pulmonary circulation is ___
|
Central
|
|
|
Systemic circulation is ___
|
Peripheral
|
|
|
Where do arteries carry blood?
|
Away from the heart
|
|
|
Where do veins carry blood?
|
To the heart
|
|
|
Arteries usually carry _____ blood, except for what artery?
|
Oxygenated, pulmonary
|
|
|
What are the four structures of the heart
|
Pericardium, epicardium, myocardium, endocardium
|
|
|
In the heart, the atri are
|
Thin walled
|
|
|
In the heart ventricles are
|
Thick walled
|
|
|
What do valves in the heart ensure?
|
That there is flow in only one direction
|
|
|
Atreoventricular include what valves?
|
Tricuspid and mitral valves
|
|
|
What valves does semilunar include?
|
Aortic and pulmonic valves
|
|
|
Where are there no valves?
|
Where blood enters the heart
|
|
|
The heart creates it’s own what?
|
Electrical conduction
|
|
|
What cells are responsible for conduction?
|
Pacemaker
|
|
|
What does AV node slow?
|
The impulse giving the atrium time to contract before the ventricle contracts
|
|
|
What does depolarization represent?
|
Contraction
|
|
|
What does repolarization mean?
|
Back to rest
|
|
|
Describe heart block
|
Atria and ventricles contract independently
|
|
|
Describe PVC
|
Ectopic pacemaker initiates ventricular contraction
|
|
|
Describe fibrillation-quivering
|
Atrial or ventricular can be either, must be treated immediately
|
|
|
What do EKG’s measure
|
The waves of the heart
|
|
|
Define atheroschlerosis
|
Abnormal thickening and hardening of the arterial walls
|
|
|
What are the three layers of the arteries?
|
Tunica intima, tunica media, tunica externa
|
|
|
What are the complications of atherosclerosis?
|
Hypertension, inadequate tissue perfusion, weakening or outpouching of vessel walls
|
|
|
What are the modifiable risk factors of atherosclerosis?
|
Cig smoking, hypertension, hypercholesterolemia, activity level, diabetes, stress
|
|
|
What are the unmodifiable risk factors of atherosclerosis?
|
Heredity, gender, age
|
|
|
What is the treatment for atheroschlerosis?
|
Diet, lipid lowering drugs
|
|
|
Familial hypercholesterolemia is a what type of disorder?
|
Autosomal dominant
|
|
|
In familial hypercholesterolemia cholesterol is elevated from what?
|
Birth
|
|
|
What are xanthomas?
|
Cholesterol deposits
|
|
|
What is thromboangititis obliterans/buerger’s disease?
|
It is an inflammatory disease of the peripheral arteries that affect young men who smoke cigs
|
|
|
What is the patho physiology of buerger’s disease?
|
Emboli, vasospasm, usually involves hands and feet, ischemia which causes pain and eventually necrosis
|
|
|
s/s of buerger’s disease
|
Pain, diminished or absent pulse, cyanosis, reddish blue, skin shiny, diminished hair growth
|
|
|
Treatment of buerger’s disease
|
Stop smoking, vasodilators, sympathectomy
|
|
|
What is raynauds disease
|
Attacks of vasospasms in small arteries and arterioles usually in fingers sometimes toes
|
|
|
Manifestations of raynauds
|
Pallor, numbness, sensation of cold in the digits, bilateral, cyanosis, rubor, throbbing
|
|
|
Some diseases that are secondary to raynauds include…
|
Scleroderma, serum sickness
|
|
|
Treatment of raynauds
|
Remove stimulus, treat the disease process
|
|
|
What is PVD
|
Disease of blood vessels outside of the heart and brain, typically a narrowing of vessels
|
|
|
Define aneurysm
|
Localized outpouching of a vessel wall or cardiac chamber
|
|
|
Define true aneurysm
|
Involves all three layers
|
|
|
Define false aneurysm
|
Clot within the adventitial layer
|
|
|
Define dissecting
|
Blood within the adventitial layer
|
|
|
What does acture arterial occlusion usually result from?
|
A thrombus or emboli that originates in the heart
|
|
|
s/s of acute arterial occlusion
|
Acute pain, tingling, weakness, pallor, coldness, loss of sensation, loss of reflexes, loss of function
|
|
|
What is a Doppler?
|
A study used to look at vessels
|
|
|
Treatment for acute arterial occlusion
|
Thrombolysis, heparin, embolectomy
|
|
|
What are the predisposing factors to varicose veins?
|
Standing, high intraabdominal pressure (pregnancy)
|
|
|
Risk factors for venous thrombosis
|
Prolonged bed rest, immobilization, long periods of immobility, deficiencies of naturally occurring anticoagulants,postpartum period, oral contraceptives, dehydration
|
|
|
What are three naturally occurring anticoagulants
|
Antithrombin iii, protein c, protein s
|
|
|
Location of venous thrombosis
|
Venous sinuses of the soleus musle, posterior tibial vein, peroneal vein
|
|
|
Clinical manifestations of venous thrombosis
|
Pain, swelling, deep muscle tenderness, fever, malaise, homan’s sign
|
|
|
What is homan’s sign
|
Deep pain in calves
|
|
|
What is compartment syndrome
|
Vessels and nerves lie between muscles causing a compartment
|
|
|
Etiology of compartment syndrome
|
Casts, infiltration of IV fluids, tissue swelling, trauma, bleeding
|
|
|
Complications of compartment syndrome
|
Permanent loss of function, limb contracture, necrosis
|
|
|
s/s of compartment syndrome
|
Pain,loss of sensory function/motor function, skin tut shiny warm and red, pallor, coldness, capillary refill greater than 3seconds
|
|
|
Treatment of compartment syndrome
|
Remove restrictive dressing, remove cast, fasciotomy
|
|
|
What are pressure ulcers
|
Ischeimic or necrotic lesions related to decreased blood flow
|
|
|
Causes of pressure ulcers?
|
External pressure that exceeds capillary pressure, friction, shearing process
|
|
|
Describe stage one of a pressure ulcer
|
Nonblanchable erythema of intact skin
|
|
|
Describe stage two of a pressure ulcer
|
Partial thickness skin loss
|
|
|
Describe stage three of a pressure ulcer
|
Full thickness skin loss
|
|
|
Describe stage four of a pressure ulcer
|
Damage to the muscle, bone, or supporting structure
|
|
|
Define coronary artery disease
|
Refers to any process which narrows the coronary arteries
|
|
|
Risk factors of coronary artery disease?
|
Hyperlipidemia, hypertension, cig smoking, diabetes, genetic predisposition, upper body obesity, sedentary lifestyle
|
|
|
When does myocardial ischemia develop
|
When coronary blood flow or oxygen content of coronary blood is not sufficient to meet tissue demands
|
|
|
What is angina in the chest caused by?
|
Myocardial ischemia
|
|
|
What are the three types of angina?
|
Stable, unstable, pinzmetals
|
|
|
Describe stable angina
|
With exertion, usually relieved by rest
|
|
|
Describe unstable angina
|
New or increasing often at rest
|
|
|
Describe pinsmetals angina
|
Variant, vasospastic, often at rest or during sleep
|
|
|
Pathophysiology of myocardial ischemia
|
Insufficient oxygen, cells switch to anaerobic respiration, lactic acid is formed, cellular function impaired
|
|
|
Treatment of myocardial ischemia?
|
Nitrates cause peripheral veins and to a lesser extent peripheral arteries dilate, beta blockers increase oxygen supply and reduce myocardial demand, calcium channel blockers, antiplatelet drugs
|
|
|
Define myocardial injury
|
Myocardial injury is a progressive form of myocardial ischemia
|
|
|
Define myocardial infarction
|
Refers to the death of a portion of the myocardium
|
|
|
Pathophysiology of an infarction..
|
O2 supply inadequate, cells switch to anaerobic respiration, lactic acid accumulates, electrolyte problems, lysosomes release enzymes, cell membrane is disrupted, cell contents released
|
|
|
How long does it take for the heart to repair after an infarction
|
Starts 24 hours later
|
|
|
Treatment of a myocardial infarction..
|
Thrombolytic agents, bed rest, pain relief, vasodilation, oxygen, dietary measures, early administration of beta blockers, stool softners
|
|
|
Define dysrhythmia
|
Disturbance of the cardiac rhythm
|
|
|
Causes of dysrhythmias?
|
Ischemia, hypoxia, lactic acidosis, electrolyte imbalances
|
|
|
Risk factors of a myocardial infarction…
|
Over 65, previous angina pectoralis or MI, hypotension or cardiogenic shock, acute systolic hypertension
|
|
|
Describe cardiomyopathy
|
Ventricles are enlarged and stretched so there is poor cardiac output. Common to have arrhythmias and sudden cardiac death
|
|
|
What are the causes of left ventricular failure?
|
Myocardial infarction, cardiomyopathy, systemic hypertension, aortic stenosis, aortic regurgitation, mitral stenosis, mitral regurgitation
|
|
|
Pathophysiology of left ventricular failure?
|
Decreaed cardiac output, blood left in ventricle at the end of contraction, elevated pressure and volume transmitted to pulmonary vessels ,increase hydrostatic force drives fluid into aleoli
|
|
|
Treatment of left ventricular failure?
|
Vasodilators, ACE inhibitors, diuretics, restrict sodium intake, restrict fluid intake,intraaorrtic balloon pump, surgery for valvular dysfunction
|
|
|
Causes of right ventricular failure?
|
RHF is the LHF, pulmonary disease either acute or chronic
|
|
|
Pathophysiology of right ventricular failure?
|
Pulmonary vessenls become engourged, pulmonary vascular resistance increases, right ventricle has to work harder, RV volume and pressure increase, RA volume and pressure increase, superior and inferior vena cavae pressures increase, enck veins distend, liver becomes engorged, ascites and peripheral edema develop
|
|
|
Treatment for right ventricular failure?
|
Treat underlying LHF or pulmonary disease, diuretics, restrict fluid intake, digitalis, bed rest
|
|
|
Define stenosis
|
Narrowing and failure to open fully
|
|
|
Define insufficiency
|
Incompetent valves
|
|
|
Define endocarditis
|
Infection of endocardium
|
|
|
Whats normal BP?
|
120/70
|
|
|
What is blood pressure the product of?
|
Cardiac output
|
|
|
What is blood pressure maintained by?
|
Adjusting co for PVR
|
|
|
Blood pressure is _______ most of the time
|
Asymptomatic
|
|
|
What can hypertension lead to?
|
Vascular damage in essential organs (kidney lead, stroke, retinopathy, L ventricular hypertrophy, MI, arrythmias
|
