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85 Cards in this Set
- Front
- Back
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ASTHMA Card 1
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- characterized by airway narrowing r/t branchospasm, mucous membrane edema, & increased production of thick sputum
- inpredictable and variable. attack lasts mins to hrs, & then may be assymptomatic 1) extrensic:allergic rxn to specific allergan (pollen, spores, milk) 2) Intrinsic: no identifiable factor (maybe virus, exercise, emotion) 3) Mixed: MOST COMMON |
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ASTHMA Card 2
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Following exposure to causative agent, 3 things hapen causing airway obstruction:
1. Bronchospasm due to constriction of bronchial smooth muscle 2. Histamine release due to allergic rxn (increased mucous production) 3. Histamine can also cause dialation of capillaries in bronchial tree (causing mucosal edema) |
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ASTHMA Card 3
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Major difficulty is on expiration b/c it's difficult to force air out through constricted swollen bronchioles. aka Hyperinflation
Pt. will exhibit wheezing, prolonged expirations |
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ASTHMA Card 4
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May sit upright, use accessory muscles, chest tightness, cough may be productive or nonproductive.
tx: open airway Status asthmatics: sustained asthma attack, resistent to treatment, stat situation |
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CHRONIC BRONCHITIS Card 1
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Primary cause: SMOKING, hypertrophy of mucus secreting glands, increase in goblet size & #, decreased ciliary activity, & bronch edema w/ narrowing airways
S/X: chronic cough w/ sputum production, frequent infections |
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EMPHYSEMA Card 1
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Lung disorder: characterized by abnormal enlargement of air spaces (alveoli) distal to terminal bronchioles, alveolar walls & capillary network are destroyed, airways are narrowed, & decreased lung elasticity.
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EMPHYSEMA Card 2
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Patho: destruction of elastin & collagen structure in the lungs, bronchioles collapse on expiration, air trapped in lungs, & overinflation.
As alveoli destroyed, merge into blebs in pleaural space. Decreased surface area available for diffusion of O2 & CO2. Bulla: if belbs b/c really big |
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EMPHYSEMA Card 3
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Manifestations: early dyspnea, chest b/c barrel shaped due to lung over inflation, minimal cough, & no cyanosis.
Tx: Can't undo damage, but relieve airway obstruction |
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CHRONIC OBSTRUCTIVE PULMONARY DISEASE
(COPD) |
COPD pts often have combination of bronchitic & emphysema.
Often develop heart problems b/c heart has to pump hard to deliever enough oxygenated blood. (R sided heart failure family) |
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Atelectasis
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mucus plugs/obtructs small airway
precurser to pnemonia |
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PNEUMONIAS Card 1
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"infection in the lungs", bacterial, fungal, or viral
Predisposing factors: decreased cough reflex, tube in respiratory track, smoking, immobility, U.R. infections, chronic disease, & immunosuppresed |
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PNEUMONIAS Card 2
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Organisms enter lungs by:
1. inhalation 2. aspiration 3. hematoygenous (via blood, uncommon) Classified by CAUSITIVE AGENT: 1. lobar (entire lobe consolidated) 2. bronchopnemonia 3. interstitial (in alveolar walls) |
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BACTERIAL PNEUMONIA
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90% Community Aquired
Sx: chills, fever, chest pain, rusty sputum, & ~ 12 hrs later cough X-ray: diagnostic, consolidation of lung/lungs Lab: elevated WBC count, neutrofils dominate, increased O2 levels, sputum sample Tx: antibiotics |
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Bateremia
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bacteria moves into blood stream
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VIRAL PNEUMONIA
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COMMON CAUSE IN CHILDREN.
Sx: vague: headache, fever, dry cough Tx: none. no antibiotics (antibiotics preventative for secondary infection) |
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HYPOSTATIC PNEUMONIA
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RARE, result of no movement.
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Fungal Infections
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Diagnose: w/ skin tests & sputum cultures
Tx: 6-8 wks |
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ASPIRATION PNEUMONIA
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Pt aspirates orophayngeal drainage, food/water from mouth or GI contents
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TUBERCULOSIS Card 1
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High Risk in: immuno suppressed, lower income, close living situations, elderly, & alcoholics
AFB: myobacterium is gram + acid fast bacilli Mode of transmission: droplets Sx: fatigue, weight loss, late afternoon fever, night sweats |
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TUBERCULOSIS Card 2
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Skin Testing: does not tell us active vs. exposure
redness: 10 or more mm = + 5-9 mm = "doubtful" repeat test 0-4 mm = negative |
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TUBERCULOSIS Card 3
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Sputum Culture: takes 2-4 wks, definitive mechanisms for diagnosis
Sputum Smear: heavy growth needed, not as accurate X-ray: lesion in the lungs would appear Tx: combination therapy, 2 or more drugs, meds taken for active dz until 6 months after sputum culture converts to - |
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CANCER IN THE LARYNX
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- common in smokers, men, & air polution exposure
Sx: cough, clears throat freq., enlarged lymph nodes Dx: laryngoscopy, biopsy of growths Tx: depends on extent of cancer (remove, radiate, chemo) |
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CANCER IN THE LUNGS Card 1
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Causitive Factors
1. SMOKING- 85% 2. increased risk in some occupations 3. diet 4. familial 5. passive smoke |
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CANCER IN THE LUNGS Card 2
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Patho: classified by cell type
Sx: cough, increased sputum, hemoptysis, dyspnea, aching in chest, anorexia, fatigue, & wt loss Dx: x-ray, CAT scan |
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CANCER IN THE LUNGS Card 3
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Tx: SURGERY tx of choice combined with radiation & chemo
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BLUNT TRAUMA
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MOST COMMON FX OF RIBS
little damage externally, but internal damage commonly caused by car accidents, fall, crushing injures |
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PENETRATING TRAUMA
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sharp foreign object penetrates chest wall
(knife, bullet, "running with scissors" |
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CHEST TRAUMA
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2 kinds: blunt & penetrating
Sx: pain on inspiration, splinting, pneumonia Tx: prevent pain so will breathe normally |
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FLAIL CHEST
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fx of multiple & adjacent ribs
injured area moves inward on inspiration & bulges out on expiration Tx: O2 & stabilization |
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PNEUMOTHORAX
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Define: accumulation of air in the pleural space which may collapse lung
Sx: DOE, increased resp., increased pulse, deminished breathe sounds Tx: goal is to remove air from pleural space & reestablish - pressure so that lung can expand |
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CLOSED PNEUMOTHORAX
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1. BLUNT TRUMA PUNCTURES LUNG, RUPTURE IN VISCERAL PLEURA
2. ALVEOLAR OR BRONCHIAL DAMAGE CAUSES LEAKAGE OF AIR INTO PLEURAL SPACE COMMON CAUSE: EMPHYSEMA, OVER GROWN ALVEOLI BURST |
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OPEN PNEUMOTHORAX
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EXTERNAL OPENING THRU THE CHEST WALL (KNIFE, SURGERY, GUN)
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TENSION PNEUMOTHORAX
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PROGRESSION OF TRAPPED AIR
Sx: quick, deviated thorax |
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CHEST TUBES
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THORACTOMY TUBES, may be inserted in surg., ER, bedside between parietal & visceral space
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PULMONARY DISEASE
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USUALLY FROM DVT IN LEG,
Classic Sx: sudden dyspnea, tachynea, tachycardia, restlessness Dx: lung scan, pulmonary angiogram Tx: O2, heparin, cardiac monitoring Preventative: low does heparin or coumadin |
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PULMONARY EDEMA
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ACCUMULATION OF FLUID IN THE ALVEOLI CAUSED BY AN INCREASE IN THE HYDROSTATIC PRESSURE IN THE PULMONARY CIRCULATION OR A DECREASE IN THE ONCOTIC PRESSURE OF THE PULMONARY CIRCULATION
Tx: reduce hydrostatic pressure |
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PLEURAL EFFUSION
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FLUID ACCUMULATED IN PLEURAL CAVITY/LUNGS
Tx: w/ draw fluid w/ needle |
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Lower GI Tract Anatomy
SMALL INTESTINE |
Function: responsible for COMPLETING DIGESTION & ABSORBTION of sugars, fatty acids, amino acids, H2O, electrolytes, & vitamins
20-25 ft long 3 segments: DUODENUM, JEJUNUM, ILEUM |
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Lower GI Tract Anatomy
LARGE INTESTINE = COLON |
Funtion: ABSORBTION OF H2O & ELECTRLYTES, final digestion of protiens, & production of Vitamin K
5-6 ft long BEGINS AT THE CECUM W/ APPENDIX, ASCENDING COLON, TRANSVERSE COLON, DESCENDING COLON, SIGMOID, RECTUM, ANUS |
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DIAGNOSTIC STUDIES FOR INTESTINAL DISEASES
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1. proctoscopy, sigmoidoscopy, colonoscopy: direct visualization of bowel & means to obtain biopsy material
2. stool samples 3. barium swallow (upper GI series) & ba enema (lower GI series) x-rays taken after barium ingested |
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DIARRHEA
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SYMPTOM, NOT A DISEASE
frequent watery stools Cause: contaminated food & H2O, viral infection, meds, malabsorbtion syndromes, & stress Leads to loss of fluids, electrolytes, & nutrients Tx: commonly support pt. w/ IV fluid |
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CONSTIPATION
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Occasional constipation caused by decreased fiber or fluid intake & lack of activity.
Other causes: disease of the colon & rectum, meds, spinal cord injury, & habitual laxative use Sx: fullness, distention, nausea, & flatus Impaction: dried stool in bowel Tx: treat cause if possible (diet, stool softners, exercise) |
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"ACUTE ABDOMEN"
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TEMPORARY DIAGNOSIS UPON ADMITTING
used for pts. w/ Sx suggesting an abdominal condition Causes: appendicitis, bowel obstruction, gall bladder inflammation, cancerous condtion, ulcers |
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APPENDICITIS Card 1
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1. obsruction of lumne of the appendix w/ feces
2. leads to inflammation & necrosis 3. perforation of the appendix 4. results in leakage of the infection into the peritoneal area |
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APPENDICITIS Card 2
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Sx: EARLY- vague, nausea, slightly elevated temp., abd pain, NVD LATER- pain localizes at Mc Burney's pt, rebound tenderness
Tx: appendectomy |
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PERITONITIS
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Inflammation of peritoneum from BACTERIA or CHEMICAL
Sx: abd pain, board-like rigidity of the abd, elevated temp, WBC, pulse, & rate, decreased B/P Dx: (abd paracentesis)w/draw fluid from peritonial cavity w/ needle/syringe Tx: identify & treat cause |
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GASTROENTERITIS
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NVD, fever, elevated WBC
usually VIRAL in origin- can be caused by bacteria or protozoa Tx: NPO till NV cease, food and electrolyte replacement |
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IRRITABLE BOWEL SYNDROME (IBS)
"SPASTIC COLON" |
Chronic, non-infectious disorder, associated w/ stress
alternate b/t diarrhea & constipation common in women Tx: stress management, high fiber diet, meds |
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INFLAMMATORY BOWEL DISEASE
(CHROHN'S DISEASE, ULCERATIVE COLITIS) |
Define: recurrent inflammatory diseases of the intestines: chronis & unpredictable
ETIOLOGY UNKNOWN, but possibly related to infection, autoimmunity, & famialial tendency |
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ULCERATIVE COLITIS Card 1
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Define: inflammation & ulceration of colon & rectum
MOVES IN A CONTINUAL PATTERN (rectum, up the sigmoid, up the colon) NO INFLAMMATION IN SMALL INTESTINE INCREASED RISK OF COLON CANCER |
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ULCERATIVE COLITIS Card 2
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Manifestations: bloody diarrhea, cramps, pain, fever, wt loss, perforation of the bowel
Dx: colonoscopy reveals areas of scarring, barium enema Tx: REMOVE ENTIRE COLON |
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CHROHN'S DISEASE Card 1
"REGIONAL ENTERITIS" |
CAN AFFECT ANY PART OF THE BOWEL
Patho: NOT CONTINUOUS "SKIP LESIONS", AFFECTED AREAS ARE SEPERATED BY AREAS OF NORMAL TISSUE "COBBLESTONE" APPEARANCE FISTULAS ARE COMMON |
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CHROHN'S DISEASE Card 2
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Sx: similar to ulcerative colitis w/ mild to severe diarrhea
Complications: scarring, obstructions, fistula formation Dx: barium enema "string sign" Tx: remove colon, doesn't cure |
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BOWEL OBSTRUCTIONS
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GI contents cannot pass thru the bowel
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INTESTINAL POLYPS
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Define: little growths, most are found in the sigmoid colon & rectum
Tx: polyps are removed ("polypectomy") & biopsy performed to determine if malignat or benign |
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CANCER OF THE COLON & RECTUM Card 1
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20% of all CA deaths in US
Patho: usually it is an adenocarcinoma, the cancer spread thru the wall of the bowel into the lymph & blood vessels & metabolizes via the blood & lymph, usually to the liver |
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CANCER OF THE COLON & RECTUM Card 2
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Sx: R side of colon- pt may present w/ ANEMIA, weakness, fatigue, & occult bleeding.
Left side of colon (MORE COMMON)- changes in bowel habits, narrow stools, & rectal bleeding Dx: digital rectal exam, sigmoidoscopy & colonoscopy |
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DIVERTICULOSIS & DIVERTICULITIS
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Define: outpouching in the intestinal wall, may be related to chronic constipation
Sx: NO SYMPTOMS USUALLY Tx: high fiber diets & metamucil In acute situation, pt needs to be NPO or on clear liquids |
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HERNIA Card 1
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Define: protusion of part of intestine thru an abnormal opening or weakened area in abd wall
Sx: bulging occurs in the area when the pt stands or strains Tx: surgery called" herniorrhaphy, loop of the bowel is placed back where it belongs |
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HERNIA CLASSIFICATIONS
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REDUCIBLE: protrusion of part of intestine goes back into place when pt lies down or manually presses on it
IRREDUCIBLE: the protrusion can't be replaced or reduced STRANGULATED: loop of intestine b/c trapped in the herniated area which reduces both intestinal flow & blood supply to the bowel |
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INGUINAL, FEMORAL, & UMBILICAL HERNIAS
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INGUINAL- MEN
FEMORAL- WOMEN UMBILICAL- BABIES |
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HEMMORHOIDS
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Define: varicosities in veins of anus & rectum
Prediposing factors: pregnancy, chronic constipation, straining to defecate. heavy lifting Tx: hemorrhoidal oint, stool softners, sitz baths for comfort & clensing Hemorrhoidectomy- surgery where hemorrhoids are ligated & removed |
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LIVER ANATOMY
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ESSENTIAL FOR LIFE
LARGEST BODY ORGAN receives blood from HEPATIC ARTERY & PORTAL VEIN 1st organ exposed to substances (meds, food) |
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Kupffer Cells
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Found in the Liver
macrophages present to engulf bacteria & foreign substances |
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LIVER FUNCTIONS
8 GENERAL |
1.FORMATION & EXCRETION OF BILE
2.METABOLISM OF FOODSTUFFS DELIEVERED BY THE PORTAL VEIN 3. PROTEIN METABOLISM 4. FAT METABOLISM 5. STORAGE 6. STEROIDS 7.DETOXIFICATION 8. "FLOOD & FILTER" |
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Liver Function: Metabolism of foodstuffs delievered by the portal vien after absorbtion from intestines.
A. GLYCOGENESIS B. GLYCOGENOLYSIS C. GLUCONEOGENESIS |
A. glucose converted to glycogen & stored
B. glycogen broken back down to glucose as needed C. synthesis of glucose from amino acids & fats in absence of glucose |
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Liver Function:
Protein Metabolism |
1. manufacture of plasma proteins such as albumin
2. clotting factors, prothrombin, fibrinogen 3. urea formation- NH3 is formed from breakdown of amino acids. ammonia is synthesized into urea & excreted by kidneys & intestines |
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Liver Function: Fat Metabolism
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Fat metabolism of cholesteral & tri-glycerides into fatty acids w/ ketones as end-product
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Liver Function: Storage
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Storage of fat soluable vitamins and minerals
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Live Function: Steroids
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liver inactivates & excretes aldosterone, estrogen, progesterone, testosterone, & glucocorticoids
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Liver Function: Detoxification
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drugs & other potentially harmful substances are reduced to inactive substances which can then be excreted by the kidneys
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Liver Function: "Flood & Filter"
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flood- blood backed up from the vena cava & liver becomes congested
filter- kupffer macrophage cells remove bacteria & debris |
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GALL BLADDER
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STORES & CONCENTRATES BILE TILL NEEDED
HORMONE: CCK, released when food enters the duodenum, bile assists w/ digestion of fats, bile salts reabsorbed & returned to liver for re-use |
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PANCREAS
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Endocrine & Exocrine
Exocrine- production of digestive enzymes: amylase, lipase, & peptidase Enzymes empty into sm intestine thru CBD |
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Diagnostic Liver Tests
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1. serum bilirubin
2. urine bilirubin 3. SGPT - elevated in liver dz. 4. Serum proteins - decreased in liver dz. 5. serum amylase & lypase - increased in obstruction or inflammation of pancreas |
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JAUNDICE aka icteris
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elevated bilirubin
EXCESS PRODUCTION OF BILIRUBIN- due to increased destruction of RBCs OBSTRUCTING JAUNDICE- bilirubin gets conjugated but the bile can't flow from liver HEPATOCELLULAR JAUNDICE- problem w/ liver cells, causes a decreased uptake of bilirubin |
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Disease of the Liver:
HEPATITIS |
inflammation of the liver
may be viral or toxic Hep A thru Hep E |
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HEPATITIS A Card 1
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SPREAD THRU FECAL - ORAL ROUTE
2 WKS B4 symp. occur High incidence in: poor hygiene, food-bourne outbreaks, restaurant workers, food handlers, & day care centers MAINLY SEEN IN CHILDREN |
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HEPATITIS A Card 2
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Onset: abrupt onset of symp., course of 1-2 months
INCUBATION PERIOD: 28 - 30 days Dx: based on symp. & blood test Prevention: HANDWASHING! |
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HEPATITIS B
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Spread thru: blood, body fluids (sex, IV drug use)
Incubation Period: 60-90 days Onset: insidious (don't feel well) Detection: blood work Prevention: vaccine Hep B |
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HEPATITIS - ALL
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Patho: inflammation of liver w/ areas of necrosis
Systemic effects: enlarged lymph nodes, jaundice, pancreatitis During acute phase, increase in liver enzymes Bilirubin- urine may turn dark B4 jaundice obvious on skin Sx: asymptomatic to fatal Dx: based on symtoms, exposure history, elevated bilirubin may persist for 6 months Tx: preventative care |
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Gall Bladder Dz. Card 1
cholecystitis |
acute or chronic inflammation of the GB due to bile statis secondary to a stone (cholelithiasis)
Incidence: 4x more common in women, fam. hx, obese, diabetes, sedentary, elevated cholesterol levels |
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Gall Bladder Dz Card 2
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sx: onset of RUQ pain, radiates to R shoulder due to colicky spasms, fever, clay colored stool, brown urine
Dx: ultrasouns Tx: NG tube, meds, antibiotics Surgical: cholectstectomy Traditional- upper abd incision, T-tube Laproscopic- 24 hrs, no acute inflammation |
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PANCREATITIS Card 1
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Define: inflammation of the pancreas, ass. w/ GB or liver dz., trauma
ESP. COMMON IN ALCOHOLICS Sx: sudden pain in epigastric area, radiates to back, NV, abd rigidity, decr. BS, fever, elev. WBC elev. serum amylase |
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PANCREATITIS Card 2
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tx: eliminate causative factor, rest pancreas to decrease enzyme production by keeping NPO, NG tube to suction
Pain relief w/ demerol, NOT morphine |
