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61 Cards in this Set

  • Front
  • Back
common cause of renal cysts are.

Who usually gets these
1) obstructions that increase intratubular pressure
2) changes in the basemnet membrane of the renal tubules.

These fluid accumulations can result in compressed blood vessels.

Older people usually get simple or acquired cysts.
effects of renal obstruction
blood stasis,
back up of traffic on obstuction
symptoms of simple or acquired cysts.
flank pain
HTN (hypertension)
urinary calculi more frequently found in ...

Of the 4 types of stones, [calcium, magnesium ammonium phosphate, uric acid, and cysteine], which is the most common?


calcium-assoiciated with increased amounts of calium in the blood.

other factors in stones
Excessive bone resorption caused by immobilty
Bone disease
Renal tubular acidodis
uric acid stones
occur in gout
2 types of kidney stone pain
renal colic, excrutiating pain on the flank radiates to abdomen

nausea vomiting

Non-colicyk pain, dull deep pain im back that varkies in intensity

fluid (urine) dilates the renal pelvis and calices, causing progressive atrophy of renal tissue due to urinary outflow obstruction.

Causes are obstruction, such as congenital disorder or kidney stones, causing pressure or urine to build up.

Permenat damage may occur
How common is UTI?

UTI can occur where...

Which location is more serious?

What is the most common cause?

Who is at increased risk?

Contributing factors are...
2nd most common bacterial infection seen. (1st is respiratory tract infection)

anywhere along the tract, upper or lower

Upper UTIs are more serious

EColi is most common cause.

Increased risk populations include: sexually active women, people w/ neurogenic disorders, men with prostate disease.

Contributing factors:
local immune responses
pathogen virulence
obstruction and reflux
urinary catheter, source of irritation and portal for bacteria
urinary catheter
lower UTI symptoms
urinary frequency,
lower back pain, dysuria [difficulty urinating or pain on urination], foul odor on urine which may be cloudy
upper UTI
abrupt onset of chills, fever
maliase, lower UTI symptoms, nausea and vomiting
pain on palpatation or percussion
The most damaging effects of obstructive disorders are
urine stasis-redisposes to kiney stones
backpressure. (backup pressure)

interferes with renal blood flow, destroys kidney tissue, prdisposes to hydronephrosis
polycystic kidney disease
Autosomal dominant, common heriditary disease in the US.

Renal cysts are fluid filled sacs /segments of a dilated nephron. Fluid collects in cysts, enlarging the kidneys. HTN
pain from enlarged cysts
people with polycyctic kidney disease have a higher risk of developing ....
renal carcinoma
clnical manifestations of obstruction are...
renal dysfunction
glomerular dysfunction:
Explain glomerulonephritis.

What cell changes occur?
permeability problems
inflammatory condition,
leading cause of renal failure in the US

cell chnages are proliferative, sclerotic, and membranous changes. These changes may be diffuse, focal, or segmental.
What are three types of glomerulonephritis?
nephritic syndrome
nephrotic syndrome
chronic glomerulonephritis
GN (glomerular nephritis)

diminshed GFR

Damaged capillary allows RBC to escape.

cells proliferate, swell, and become permeable.

brown colored urine
oliguria (decreased or absent urine production)
hematuria, with red cells cast
edema of hands and face
acute proliferative GN...

follows what?
is the most common GN

Capillary membrane swells and becomes permeable to plasma protein and blood.

Pee looks like coke.

follows Group A hemolytic streptococci infection
rapidly progressive glomerulonephritis
no known cause
lupus, goodpasture syndrome associated w the condition
recruitment of monocytes
S/S consistent with acute prolific GN
nephrotic syndrome
Group of findings that result from increased glomerular permeability to plasma proteins, cuasing massive of protein in the urine. Pee looks like frothy beer.

diabetes ?
lupus ?
derangement that causes increased permeability?
chronic GN end result is
small kidneys
slow progression to end stage renal disease
diabetes has kidney problems as major symptom, why?
Blood sugar elevation increases GFR and pressure.
hypertension is both a cause and a symtpom of renal disease, T/F?
acute pyleonephrites
caused by urinary catheterization, reflux, and pregnancy, characterized by

abrupt onset of chills backpain and malaise, dyuera
Wilms tumor
kidney cancer affecting young children, median age 3.

grows to a large size, encapsulated

hypertension and large abdminal mass

associated with anomalies
renal cell carcinoma
old men usu affected.

other risk factor is obesity and occu[patinal hazards.
most reliable indicater of renal cell carcinoma is
T/F, viruses are the most frequnt cause of respiratory infections?
what viruses cause the cold?
parainfluenza virus
respiratory synctial virus
corona viruses
greatest source of spread of cold
the fingers
most common portal of entry for the cold?
nasal mucosa and conjunctival surface of eyes
Resp. Tract Inf. can involve the upper, lower or _______
both tracts
S/S of cold
excessive production of nasal secretions and lacrimation, or tearing of the eyes

mucous membranes become reddened, swollen, and bathed in secretions


sore throat and horseness


self-limited,l;asting about 7 days
manifestations of acute rhinositis
lasts from 5-7 days in the case of acute viral and up to four weeks in the case of acute bacterial rhinosinuitis, and up to four weeks in acute bacterial rhinosinusitis

difficult to ditinguish from a cold

history of preceding cold and the presence of purulent rhinitis (stuffy nose, pain on bending, unilateral maxilliary pain, and pain in teeth common w/ involvement of maxiliary sinuses.

the epithelial changes that occur during acute and subacute forms of rhinosinusitis are usually reversable
manifestations of chronic rhinositis
lasts beyond 12 weeks
only symtpms may be nasal obstruction, sense of fullness in the ears, postnasal drip, hoarseness, chronic cough, loss of taste or smell, bad breath

Sinus pain is often absent

Persons with chronic may have little bouts of acute.

The epithelial changes during acute and chronic sinusitis are usually reversible, BUT the mucosal changes with chronic often are IRREVERSIBLE
chronic rhinositis vs acute big difference?
The epithelial changes during acute and chronic sinusitis are usually reversible, BUT the mucosal changes with chronic often are IRREVERSIBLE

Chronic lasts much longer
pneumonia is...
inflammation of the parenchymal structures of the lung, such as alveoli and bronchioles

so, it is a lower respiratory problem.

can be infectious or non-infectious 9gastric secretions inhaled into the lungs)
most common cause of community acquired pneumonia is...
who is more at risk for nosocomial pneumonia?
persons requireing ventilation

immune compromised (AIDS, people w/ bone marrow transplants, etc)

chronic lung disease

people w/ endotracheal intubation or tracheotomy
2 microbes that cause nosocomial pneumonia?
S. Aureus
acute bacterial pneumonia is considered

3 conditions that predispose someone to it?

1) loss of the cough reflex
2) damage to ciliaed endothelium that lines the respiratory tract
3) impaired immune defenses
is pneumonia an upper or lower airway problem?
Another name for s. pneumoniae?

S/S pf s. pneumonia

onset is sudden and includes:
severe shaking chill
watery sputum
pleuritc pain
dry or productive cough
abnormal chest x-ray
WBC elevated > 10000
bronchial breath sounds with crackles
Legion aires disease S/S
begins 2-10 days after infection

antigens of L. Pneumoniphila in the urine

pneumonia is present, along with diarrhea, hyponatremia, and confusion
what is big differnece between legionaires and pneumonia
Legionares includes diarrhea, and it has anigens of L. Pneumophila in urine

Legionaries is spread through infected warm water
Primary atypical pneumonia is...

What are 2 types?

Mycoplasma caused by mycoplasma pneumoniae

Viral caused by influenza virus
characteristics of Primary atypical pneumonia ?
patchy inflammatroy chnages in the lungs, largely confined to the alveloar septa and pulmonary interstitium.
What is most common cause of primary atypical pneumonia?
mycoplasma pneumoniae
clinical course of primary atypical pneumonia?
varies widely from:
mild infection that masquerades as a chest cold, to a fore serious or even fatal outcome

symptoms may be confined to chills /fever, headache, and muscle aches and pains, cough when present and is characteristically dry, hacking, and non-productive
TB transmission route...

What has made it spread so much?
airborne, spred by talking, sneezing, or coughingthrough minute droplet nuclei

pathogenesis of TB
inhaled droplet passes down the brachial tree and implants on a alveoli.

bacilli are surrounded and engulfed by macrophages which initiate a cell mediated immune response that eventually contains the infection

Tubercle bacilli grows slowly, infected macrophages degrade mycobacteria and present antigen to T lymphocytes to increase concentration of lytic enzymes which also damage the lung tissue.

this porocess take 3-6 weeks to become efective. Note: it is during this time that the skin test becomes positive indicating the cell-mediated hypersensitivity response.

A Ghon focus, which contains the tubercle bacilli, modified macrophages, and other immunbe cells develops in persons with intact cell-mediated response

tubercle bacilli drain along with lymph channels to tracheobronchial lymph nodes of affected lung.

The primary lung lesion with lymph node granulomas are called ghon-complex.
You are in your acute care clinical rotation (this will happen in the
fall) and when looking at your assignment, you note you are taking care of Ms. Jones
who has ESRD. You are unable to assess her because she in in dialysis. But your
instructor will expect you to know the pathophysiology behind all of her clinical
kidney regulates phospahate excretion, so if not working, phosphate goes up and calcium goes down.

renal osteodystrophy - bone tenderness, muscle weakness, can't move around well,
fractures are common

also would have pale dry skin, and dry mucous membranes due to reduced sweat glands and oil glands
A 16
year old girl came into the ER following a MVC (motor vehicle collision). She was
practicing driving with her father when she became dizzy (I think ... I missed the first 5
Anyway, on admission her electrolytes showed hyperkalemia and her ECG showed a
very slow heart rhythm. I think she had a cardiac arrest and Dr. Carter et al.
successfully resuscitated her.
Dr. Carter et al. was very confused as to why a 16 y.o. would have hyperkalemia. Her
father relates that she had a kidney transplant (donated by the dad) because of
polycystic kidney disease. "So she should not have hyperkalemia ... her kidneys are
fine", he said.
The father also said his daughter was taking a medication for seizures. Dr. Carter had
never heard of the medication before and sent a med student off to research it.
What is going on here?
The seizure med was nephrotoxic and fried her transplanted kidney - so
she was in acute renal failure.

Her HR was slow due to hyperkalemia, so her electrical conduction
system was messed up. I don't know if she went into asystole (no heart beat at all) or ventricular fibrillation (which does not produce any CO).

Pts with transplanted kidneys have to be extremely careful with drugs because of excretion.
You say nephritic, I say nephrotic ...
What's the difference between these 2 syndromes?
Nephritic - Blood in urine, inflammatory response

Nephrotic - Protein in urine, edema, hyperlipidemia
You are a volunteer nurse at a homeless shelter. A middle-aged man tells you that he's
been 'sweaty' at night and has a 'bad cough with blood in it'. You recognize him from 3
months ago and it seems he's lost a lot of weight. You ask him 'are your clothese looser
than normal?' He says 'yeah ... I don't feel like eating'.
What's going on here?
Blood in sputum in alert sign for TB- which is more common in homeless shelters, correctional
facilities, and drug treatment facilities.

It's pretty advanced too. The granulomatous lesions have evaded the blood
clinical manifestations of influenza?
The major difference I have found between a cold and the flu is the total fatigue, higher fever, and
muscle pain.
A cold feels more localized but a flu feels more systemic.

Both a pleural effusion and pneumothorax affect the pleural space ... but what's the
difference between these 2 disorders?
BOTH can cause collapse of the lung, but pneuo is air and pleural
effusion is fluid.
Why are patients with emphysema called 'pink puffers' and patients with chronic
bronchitis called 'blue bloaters'?
A person with pulmonary emphysema has both a loss of ventilation (air coming into &
spreading out in the lungs) and perfusion (blood getting through the lung tissue & O2
getting into the blood) in the lungs because of alveolar breakdown & decreased surface
area. These people are "pink puffers". They struggle to breath and huff & puff to keep
enough air coming into the lungs and by doing so are able to overventilate and thus
maintain relatively normal blood gas levels until late in the disease. So they are puffers
who stay pink (O2 in the blood).
A person with chronic obstructive bronchitis has a lot of bronchial secretions and airway
obstruction that causes mismatching of ventilation and perfusion. These people can't
overcome this by huffing and puffing, so instead they become hypoxic and cyanosis
develops. These are the blue bloaters because they can't get eough O2 into the blood
and have a bluish color.
People with emphysema tend to be barrel chested due to the increased lung volume due
to the breakdown of the alveolar walls.
Can anyone explain why pulmonary HTN and cor pulmonale may be connected to a cardiac disorder?
Normally, the left side of the heart produces a higher blood pressure in order to pump
blood to the body. The right side pumps blood through the lungs under much lower
Any condition that leads to prolonged high blood pressure in the arteries or veins of the
lungs (pulmonary hypertension) puts a strain on the right side of the heart and makes it
pump harder. When this right ventricle fails or is unable to properly pump against these
abnormally high pressures, this is called cor pulmonale.
You are working in the ICU when your charge nurse tells you that you'll be taking care of Mr. Smith who is transferring to the ICU from the orthopedic unit. He was in a MVC 2 days ago and has a chest wall injury. He's now in respiratory failure and they are bringing him to the ICU to be intubated and placed on a ventilator.

Explain to me what respiratory failure means ... and tell me what clinical manifestations
you think he will exhibit.
Respiratory failure is when a patient's lungs fail to oxygenate blood adequately and there is too much carbon dioxide.

ABG's of Po2 less than or equal to 60 mmHg and PCO2 greater than or equal to 50 mmHg may indicate respiratory failure.

too little oxygen (hypoxemia) to cells causes : impaired mental performance and visual acuity, hyperventilation, cyanosis, tachycardia, increased BP

Too much carbon dioxide (hypercapnia) causes air hynger, flushed skin, sedaive effect, dilates vessels