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134 Cards in this Set

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Anterior pituitary located...
in the optic chasm
-it's a tight fit so if it enlarges it causes problems. if it gets knocked around it can malfunction at ANY time.
-tumors on the anterior pituitary can cause problems too simply because they take up space.
anterior pituitary secretes...
-ACTH
-melanocyte stimulating hormone
-somatotropic (growth and prolactin)
-glycoprotein (FSH and LH-testosterone stimulation)
-TSH (thyroid stimulating)
oxytocin
stimulates uterus contractions and ejection of milk
thyroid gland
-engine for the body
-Metabolism
-not much room to grow
-swallowing displaces thyroid up for palpation
regulation of secretion from thyroid
TSH made by the pituitary gland
a benign tumor in the parathyroid gland could cause...
increased calcium drawn out which could lead to renal calcium
Endocrine pancreatic cells
-Alpha: make glucagon
-Beta: make amylin (suppresses glucogon secretion after meals: use enzyme to produce an injection diabetic patient can give themselves after meals to decrease glucose and feel full
-delta: makes somatastatin: breaks down carbs, proteins, fat and gastrin.
middle of adrenal gland known as
adrenal cortex
adrenal cortex stimulated by
ACTH (from anterior pituitary)
cortex secretes...
-glucocorticoids: cortisol-protects body during stress: ESSENTIAL to life
-mineralocrticoids: aldosterone: helps conserve sodium an dplays in renin-angiotensin mechanism for BP: not enough causes BP to decrease, too much causes increase BP
-Adrenal estrogen and androgen: females get androgen and males get estrogen in small doses.
2 parts of adrenal gland
cortex and medulla
medulla
catecholamines: fight or flight response: epinephrine and norepinephrine
Description of Diabetes...
If glucose doesn’t reach your cells, they begin to weaken. Also, the unused sugar builds up in your blood stream damaging everything from your blood vessels to your organs. There are 2 common types of diabetes, referred to as ‘type 1′ and ‘type 2′. Broadly speaking, ‘type 1′ diabetes occurs earlier in life, usually in childhood, and basically means that your pancreas is not producing any insulin at all, or producing far less than your body needs. ‘Type 2′ diabetes occurs later in life, usually in your 40s, and occurs when your body is making insulin, but is not able to make proper use of it.
two hormones secreted by posterior pituitary
ADH and Oxytocin
what hormone determines the concentration of urine?
ADH
s/s of low sodium (hyponatremia)
thirsty, neurologic changes, convulsions
SIADH...
syndrome of inappropriate ADH production
pathophysiology of SIADH
holding too much fluid (by holding too much ADH), leads to hypertension, edema, water intoxication
commong problem associated with SIADH
hyponatremia!
treatment of SIADH
give hypertonic fluid
s/s of hyperthyroid
-hot, tired out even though feeling hyper, tachycardia, more acne, anxious and irritable, pt can eat lots but never gain any weight. See this in elderly--can lead to osteopenia and osteoporosis
treatment of hyperthyroid
slow HR using a beta blocker
identify where the problem is with a blood test and do a scan with use of dye
give radioactive iodine for pt to drink and it kills the thyroid tissue: can lead to hypothyroidism
graves...
body produces antibodies to thyroid and causes hormones to spill out
s/s of graves
pt has exopthlamus (bulging eyes)
rash: comes and goes even after treatment.
goiter!
tachycardic and weight loss
hypothyroidism commonly mistaken for
depression
s/s of hypothyroidism
weight gain, lethargic, cold, dry and brittle hair
if the problem is pituitary making too much TSH, both levels will be high, but if the pituitary isn't making enough, both will be low. But if the problem is the thyroid, the levels will be opposite.
general explanation
patho of DM type 1
severe, absolute lack of insulin caused by loss of beta cell function. Can be GENETIC, AUTOIMMUNE OR ENVIRONMENTAL, most types are from beta cell autoantibodies and antibodies to insulin
s/s of DM type 1
weight loss and 3 P's (polydipsia, polyuria and polyphagia)
somogyi effect
hypoglycemia at night followed by rebound hyperglycemia in the morning
dawn phenomena
early morning rise in blood sugar with no hypoglycemia in the night.
what causes the microvascular and macrovascular problems associated with diabetes?
they are both directly related to the increased level of glucose.
examples of microvascular affects of diabetes type 2?
-retinopathy (eyes): retinal ischemia resulting from blood vessel changes and RBC's aggregation, factors are age and length of diagnosis
-nephropathy: most common cause of end stage renal failure. Microalbuminuria is the first manifestation of renal dysfunction, leading to proteinuria that is continuous; as kidney cont. to dysfunction we may see more hypoglycemia because they are unable to clear the insulin as quickly
examples of macrovascular affects of diabetes type 2
PAD (peripheral artery disease) and CAD (coronary artery disease)
cushings...
hyperfunction of adrenal cortex
patho of cushings
excessive anterior pituitary production of ACTH leading to elevated cortisol; excessive cortisol despite the ACTH levels
s/s of cushings
weight gain (moon face and buffalo hump), sodium and water retention, glucose intolerance, muscle wasting, weakness, bone loss, hyperpigmentations, HTN, suppressed immune system, hypokalemia.
Addison's disease...
-primary adrenal insufficiency
-low level of cortisol secretion, rare, caused by autoimmune problems (more common in women).
increased level of CO2 in the blood causes...
increase in respiration rate
ventilation...
mechanical movement of air in and out: not a good measure of how adequate breathing is.
perfusion...
actual getting oxygen to the tissues
there's usually a negative pressure in the lungs that sucks the tissue against the chest wall. with out this pressure, the alveoli shrivel and can't expand.
-if something punctures the pleural cavity, air rushes in and positive pressure builds and shifts the stuff in the mediastinum. this is a tension pneumothorax and this is why we put in chest tubes.
general information
mediastinum...
space between the lungs
-esophagus, trachea, heart and great vessels located there.
dyspnea
-subjective
-sensation of shortness of breath
abnormal breathing patterns
kussmaul
cheyne-stokes
kussmaul...
increased respiratory rate, breathe in a lot but only exhale a little: runners: increase oxygen, not blowing off enough carbon dioxide
cheyne-stokes
periods of shallow breathing that lead to deep breathing leading to apnea
-see it at end of life due to decreased blood flow to the brainstem: hypotensive
hypoventilation
less than 12 breaths/minute
hyperventilation
greater than 24
hyperventilation leads to
hypocapnia which leads to resp. alkalosis
hypoventilation leads to
hypercapnia which leads to respiratory acidosis
cyanosis: central vs peripheral
central: lips and face
peripheral: nail beds-tissue!
clubbing
enlargement of end of digit related to chronic decreased oxygen. leads to hypoxia in the tissue
cough
s/s of pulmonary disease: acute vs chronic: dry vs productive
heoptysis
blood in sputum
abnormal sputum
change in sputum; normal is thin and clear, anything else is abnormal
hypercapnia
too much carbon dioxide
hypoxemia
not enough oxygen in the blood
acute respiratory failure
-occurs with pt with resp history
-PaOxygen drops to 50--will need ventilation or respiratory support
-PaCarbon dioxide rises to 50--acute respiratory failure
pulmonary edema
excess fluid, water in lung: crackles in lower lobes: pink, frothy sputum
bronchiolitis
inflammation of small bronchioles that lead to alveoli: seen in children less than 5 years old
bronchiectasis
persistent, abnormal enlargment of bronchi: leads to CF
pneumothorax
air or gas in pleural space: lungs shrivel up to the mediastinum
effusion
presence of fluid in pleural space: NOT in lung
chest wall restriction
r/t obesity: multiple trauma: deformed chest wall, muscle wasting, immobility
flail chest
instability of a portion of chest wall: 4-5 ribs fractured in a row: lung will bubble up and cause instability with the ribs: needs stability: wrap the chest to treat and promote healing
Acute respiratory distress syndrome (ARDS)
diffuse capillary injury
seen in pts in the ICU
caused by sepsis and multiple trauma
Asthma
-reversible
-hyperresponsiveness to an allergen: leads to diffuse mucous production and inflammation of airway
-expiratory wheezing, dyspnea, tachypnea, nonproductive cough during flare up: chest feels tight
-tx with fast acting inhaler to open airway: ;makes cough become more productive and avoid triggers!
COPD
chronic bronchitis and/or emphysema
chronic bronchitis
-blue bloaters
-productive cough for three months in 2 consecutive years (most often in the fall or spring): not reversible
-pt will have bronchial edema, increased risk for infection
-treat after assessing the sputum
emphysema
-pink puffers
-permanent enlargment of alveoli and lose recoil ability: this traps air and increases chest diameter: no fibrosis
-prevention is key
-
PE: pulmonary embolism
-symptoms are correlated with how much blood is being obstructed
-chest pain and short of breath initially
-caused by venous stasis, vessel injury, hypercoagulability, thrombus formation, dislodgement, occlusion of pulmonary circulation, clinical problems, tissue death
-tx: clot busters: anticoagulants: heparin drips: 6-8 hours to therapeutic (3 days) then coumadin.
croup
-acute laryngotracheobronchitis
-common in children 6mo.-5years
-caused by virus (parainfluenza, influenza A or RSV)
-obstruction below epiglottis
-barking cough, stridor
-tx: clod air, will spontaneously resolve, may need nebulizing steroids
respiratory distress of the newborn
occurs in premis with an immediate onset
-due to no surfactant production or very little
-s/s: tachypnea, nasal flaring, grunting, retractions
-steroids increase production of surfactant.
asthmatic breath sounds =
WHEEZING
SIDS: sudden infant death syndrome
unknown cause
most common between 3-4mo.
-most common in premies, boys, multiple births
nephron
1.2 million in the kidney
-functioning aspect of the kidney
GFR
best indication of kidney function
-tells us how well the blood is moving through the functioning units and how well they're filtering
-if not filtering well, creatinine and BUN will be elevated in the blood stream.
distal tubule
-sodium reabsorbed and potassium secreted
-principles cells: reabsorb sodium and secrete potassium
-intercalulated cells: reabsorb bicarb and potassium: secrete H: leading to acid base imbalance
lasix
affects kidneys at the distal tubule by preventing the reabsorption of sodium which leads to increased water loss and increased potassium loss.
proximal tubule joins the
loop of henle to the medulla of the kidney where urine is concentrated.
bruit is
turbulent blood flow in renal artery: indicative of increased blood pressure
erythropoeitin
responsible for RBC production and supplies renal oxygen.
kidney stones are most often made of
calcium oxylate
most common sign of kidney infection
flank pain and hematuria
risk factor for kidney infection
urine stasis
Post renal kidney infection...
caused by obstruction in the ureter or bladder
-causes urine to back up into kidney and cause renal failure
UTI: cause and s/s
-e. coli
-low back pain, confusion, dysuria, polyuria
pyelonephritis vs uti
pyelonephritis causes more systemic problems and s/s
peylonephritis s/s
acute fever, flank pain, dysuria
chronic phylonephritis is most damaging because it causes
scarring to the kidney which causes damage to the nephrons which leads to chronic renal failure
chronic renal failure
-normochromic normocytic anemia
-10-13% of nephrons are functioning: increased toxins in the body
-fluid and electrolyte imbalance due to decreased function of distal tubules
-decreased calcium causes parathyroid hormone to pull calcium out of bones.
-uremia=protein breakdown accumulation in the blood: this is why we limit protein intake
-increased incidence of GI bleed d/t uremia causing inflammation in the colon
-pruritis d/t calcium and uremia build up.
chronic renal failure can be caused by what specific systemic disease
diabetes
stages of chronic renal failure
-insufficiency: slow decrease in function
-failure: slow decrease in function followed by systemic effects
-end stage: decreased function to 10%
acute renal failure caused by
impaired blood flow to the kidneys (post trauma)
chronic renal failure will have the following clinical s/s
-sodium and water loss: leads to hold on to water and potassium which leads to edema
-pruritis due to urea and calcium levels
-immunosuppresion
-anemia: decreased production of erythropoietin which leads to RBCs
-cardiac hypertension
hypospadias
urethral meatus is on the under (ventral) surface of the penis: caused by adv. maternal age, environment
epispadias
presence of urethral opening on the dorsal surfface (upper) of the penis
renal agensis
only have one kidney
vesicoureteral reflux
-retrograde flow of urine back to the ureters: may need surgical repair
-s/s: UTIs, fever, poor growth and development
five grades of vesicoureteral reflux
-Grade I: reflux into non-dilated distal ureter
-Grade II: reflux into pelvis with out dilation
-Grade III: reflux with dilated ureter
-Grade IV: reflux with grossly dilated ureter and calyces
-Grade V: massive reflux and tortuous dilation and effacement of calyces.
2 sphincters of the stomach
-upper: stops air from getting in to the stomach
-lower: stops gastric acid from getting up in the esophagus
ptylin
enzyme that initiates digestion of carbs
peristalsis
movement that coordinates contraction and relaxation of the muscles in the esophagus (just the last 2/3, upper 1/3 is done manually)
small intestine breakdown...
duodenum to jejunum to ileum to ileocecal vavlve to large intestine
villi
functional unit of digestion system
large intestine breakdown
secum to appendix to colon (ascending-right side, transverse, descending-left side) to sigmoid to rectum to anus
common place to have pain due to colon
lower left quadrant due to descending and sigmoid colon placement
renal agensis
only have one kidney
vesicoureteral reflux
-retrograde flow of urine back to the ureters: may need surgical repair
-s/s: UTIs, fever, poor growth and development
five grades of vesicoureteral reflux
-Grade I: reflux into non-dilated distal ureter
-Grade II: reflux into pelvis with out dilation
-Grade III: reflux with dilated ureter
-Grade IV: reflux with grossly dilated ureter and calyces
-Grade V: massive reflux and tortuous dilation and effacement of calyces.
2 sphincters of the stomach
-upper: stops air from getting in to the stomach
-lower: stops gastric acid from getting up in the esophagus
ptylin
enzyme that initiates digestion of carbs
peristalsis
movement coordinated with contraction and relaxation of muscles in esophagus: just last 2/3; upper 1/3 is voluntary
intestines in order
juodenum to jejunum to ileum to ileocecal valve to secum to appendix to (right side) ascending colon, transverse colon to (left side) descending colon to sigmoid to rectum to anus
most common place to have abdominal pain due to colon?
left lower quadrant due to placement of the descending colon and sigmoid colon
gall bladders importance with clotting factors
bile salts (made in the gall bladder) + vit. k (synthesized in the liver) = clotting factors
constipation
decline in normal stool pattern
diarrhea
passing of water with stool not just loose stool
-babies will have water rings around their stool
why aren't hematocrit and hemoglobin levels not the best way to judge blood loss?>
they don't change quickly with acute blood loss
PUD: peptic ulcer disease: risk factors and 2 types
RF: smoking, increased age, meds (nsaids and asa), alcohol, chronic disease, h. pylori, stress
-duodenal and gastric
duodenal vs. gastric
-duodenal: most common in young people: cause-H. pylori and NSAIDS: penetration of mucosal barriers: epigastric pain immediately after eating: WEIGHT LOSS
-Gastric: seen in older pts. increase in mucosal barrier permeability to hydrogen ions (acid), they have 214/7 stomach aches that are relieved with eating but pain occurs 10-15 minutes after eating.
portal hypertension
-obstruction in portal venous system or superior vena cava
-caused most commonly by cirrhosis
-increased pressure in the liver (pt won't necessarily have systemic HTN)
-can lead to varices (similiar to aneurysm) in esophagus and can bleed out.) this also causes ascitis!
bile salts absorb
fats (but the bile salts aren't even produced until about 30 minutes after the meal by the liver so this is why it takes so long for fats to be digested)
pancreas secretes
amylase and lipase
acute pancreatitis is cause by...
damage, blocked pancreatic duct (autodigestion occurs) and it becomes enlarged and mushy: usually d/t chronic alcohol use
-s/s are n/v, ascites and abdominal pain
pyloric stenosis
hypertrophy of pyloric sphincter muscle
-more common in full term white boys
-leads to projectile vomiting and nothing else at wk 2 or 3
meconium ileus...
meconium caused intestinal obstruction in a newborn. made up of intestinal secretion and amniotic secretions: kids have problems within the 1st 24 hours of life: they will vomit
-first indication of possible cystic fibrosis
child nutrition deficiencies
-kwashiorkor: protein
-marasmus: overall nutrients
Acid Base Imbalance Ranges:
1) carbon dioxide
2) bicarb
3) pH
1) 35-45
2) 21-28
3) 7.35-7.45
s/s of metabolic acidosis
HA, lethargy, kussmaul respirations
s/s of metabolic alkalosis
weakness, muscle cramps, hyperactive reflexes, tetany, shallow slow respirations, confjusion, convulstions, atrial tachycardia
s/s of respiratory acidosis
blurred vision, breathlessness, restlessness, apprehnsion
-skin is warm and flushed: increased carbon dioxide causes the vasodilation
s/s of respiratory alkalosis
dizziness, confusion, tingling of extremities: coma: vasoconstriction decreases cerebral blood flow