Download Exam Review: Heart Failure, Immunodeficiency, Hematology, and Valve Disorders and more Quizzes Pathophysiology in PDF only on Docsity!
MIDTERM TEST |EXAM REVIEW| NR507 ADVANCED
PATHOPHYSIOLOGY ALREADY GRADED A+
"Heart Failure - CORRECT ANSWER=> Pathophysiology (Wk 2 Discussion)
Underlying patho is that there is less cardiac output to meet the body's oxygen demands. Over time there is decreased contractility, decreased stroke volume, increased left ventricular end- diastolic volume (LVEDV) When contractility is decreased, stroke volume falls, and LVEDV increases. This causes dilation of the heart and an increase in preload. Major risk factor is long standing hypertension. Preload = stretch Afterload = resistance"
"Differentiate between Right and Left Heart Failure - CORRECT ANSWER=> Sometimes right-sided
heart failure can occur due to left-sided heart failure due to the back up of fluid from the left side to the right. Sometimes right-sided heart failure can occur without there being left-sided heart failure; this usually occurs because the person has long standing pulmonary issues (COPD). Patients will have classic R. sided heart failure symptoms without L. sided heart failure symptoms: Right JVD distention, Peripheral edema, Hepatosplenomegaly"
"Stages of Heart Failure (ACC/AHA) - CORRECT ANSWER=> -Stage A: patient has risk factors (CAD) but
no symptoms; no structural heart damage -Stage B: patient has structural heart damage (MI), but still has no symptoms -Stage C: patient is symptomatic with alteration in their daily functions due to dyspnea, swelling, etc. This is where the NYHA functional classifications come into play -Stage D: end-stage heart-failure - have maximized medications to treat it. May need heart transplant or pacemaker" "NYHA Functional Classifications- It's all about the impact on the patient's activity caused by the HF
symptoms: - CORRECT ANSWER=> -Stage I: Mild- no limitation of physical activity; Ordinary physical
activity does not cause symptoms -Stage II: Mild- slight limitation of physical activity; comfortable at rest; Ordinary physical activity results in fatigue, palpitation, dyspnea or anginal pain. -Stage III: Moderate- marked decrease in physical activity; marked limitation of physical activity; comfortable at rest. Less than ordinary activity causes fatigue, palpitation, dyspnea or anginal pain. - Stage IV: Severe- inability to carry on any physical activity without discomfort. Symptoms of HF or the anginal syndrome may be present even at rest. If any physical activity undertaken, discomfort is increased."
"Heart Valve Disorders - CORRECT ANSWER=> Signs and Symptoms (Edapt Scenarios), Murmur
Characteristics, Important to know Anatomy"
"Autoimmunity - CORRECT ANSWER=> Autoimmune disease can be familial, Affected family members
may not all develop the same disease, but several members may have different disorders characterized by a variety of hypersensitivity reactions, These include autoimmune and allergic reactions Associations with particular autoimmune diseases have been identified for a variety of major histocompatibility complex (MHC) alleles or non-MHC genes"
"All immunity - CORRECT ANSWER=> General term used to describe when an individual's immune
system reacts against antigens on the tissues of other members of the same species. Examples: Neonatal disease where the maternal immune system becomes sensitized against antigens expressed by the fetus, Transplant rejection, Transfusion reaction"
"Primary Immunodeficiency - CORRECT ANSWER=> Most primary immune deficiencies are result of
single gene defects Something is lacking with the immune system itself. Example: B-lymphocyte deficiency - one of the most severe forms of a primary immunodeficiency"
"Secondary Immunodeficiency - CORRECT ANSWER=> Complication of some other physiological
condition/disease, Malnutrition one of most common causes worldwide. Example: Pt. with HIV gets pneumocystis carinii"
"Hematology - CORRECT ANSWER=> Anemias, Involve RBCs, Most of body's iron stores come from the
recycling of iron from old RBCs"
"Iron Deficiency Anemia - CORRECT ANSWER=> Microcytic/Hypochromic Anemia, Caused by disorders
of hemoglobin synthesis, particularly iron deficiency, Ferritin is an important measurement that reflects the body's total iron stores, The NP will order a ferritin level to get an idea of the body's total iron stores, Low ferritin reflects anemia"
"Major Lab Marker for Anemia - CORRECT ANSWER=> Increased RBC distribution width (RDW) is one
of the earliest lab markers in developing microcytic or macrocytic anemia"
"Folate Deficiency - CORRECT ANSWER=> Can cause megaloblastic anemia, Alcoholics can easily get
folate deficiency Ferritin level normal Hgb low Hct low"
"Vitamin B-12 Deficiency - CORRECT ANSWER=> Fatigue, Dyspnea, Peripheral Neuropathy in BLE
(numbness and tingling) Risk Factors: Older adults, H-pylori infection
Mid-systolic crescendo-decrescendo murmur heard loudest at base and radiating to the neck S4 gallop present**"
"Aortic Regurgitation - CORRECT ANSWER=> Blood is coming back from the Aorta into the L. Ventricle
through the Aortic Valve Causes Widening or aneurysmal change of the aortic annulus (ring of fibrous tissue surrounding the aorta) Endocarditis Rheumatic Fever Signs & Symptoms Fatigue Syncope SOB Palpitations Widened Pulse Pressure L. Ventricular Dilation Early diastolic murmur along left sternal border Shortness of breath that progressively worsens High pitched early diastolic murmur heard loudest at left lower sternal border Diastolic rumbling sound at the heart's apex Systolic crescendo-decrescendo murmur heard at the left upper sternal border A chest x-ray may show signs of pulmonary edema and cardiomegaly"
"Mitral Stenosis - CORRECT ANSWER=> Blood is going to back up into the L. Atrium and Lungs
Causes Rheumatic Fever / Rheumatic Heart Disease Endocarditis Signs & Symptoms Fatigue SOB Exercise intolerance Cough L. Atrial enlargement Pulmonary congestion/edema Diastolic rumble Opening snap before Diastolic rumble **As mitral stenosis progresses, symptoms of decreased CO occur, especially during exertion Shortness of breath on activity
Pounding/racing heart Associated w/ history of Rheumatic HD A low-pitched murmur auscultated at the heart's apex JVD and bilateral crackles in lung bases noted ECG demonstrates A-FIB and Left Ventricular Hypertrophy**"
"Mitral Regurgitation - CORRECT ANSWER=> Blood goes from L. Ventricle to L. Atrium and then to the
Lungs Causes - Anything that causes LV dilation Remodeling process (post MI) Dilated cardiomyopthathy Rheumatic Fever/ Rheumatic Heart Disease Endocarditis Papillary muscle dysfunction/rupture/ chordae tendinae Calcification of the valve/around the valve Signs & Symptoms Acute Chronic Shortness of breath JVD, Crackles in bilateral lung bases Blowing pansystolic murmur heard best at heart's apex and radiates to back and axilla"
"Obstructive vs. Restrictive Pulmonary Disease - CORRECT ANSWER=> Obstructive: decreased FEV
indicates airway obstruction along with low FEV1/FEV ratio 56% Restrictive: FEV1/FVC ratio above 70%, Review EDapt examples"
"Asthma - CORRECT ANSWER=> Airways constricted
Intrinsic: triggered by something internal such as anxiety Extrinsic: triggered by something in outside environment- something in the air (dust mites/pet dander) In mildest form of asthma (intermittent), short acting beta2-agonist inhalers are prescribed Mild-persistent asthma will have night symptoms 3-4 days a month"
"COPD - CORRECT ANSWER=> Diagnosis based on Hx of symptoms, physical exam, chest imaging,
pulmonary function tests and blood gas analysis Pulmonary function testing reveals airway obstruction (decreased FEV1) that is progressive and unresponsive to bronchodilators, Emphysema, Chronic bronchitis"
Restrictive: Normal or > 70%"
"Diffusing capacity - CORRECT ANSWER=> The diffusing capacity is simply how well the lungs are able
to exchange gas"
"Residual volume (RV) - CORRECT ANSWER=> RV is the amount of air that remains in the lungs after a
forceful exhalation"
"Total Lung Capacity (TLC) - CORRECT ANSWER=> RV + FVC = TLC
Normal range is 80-120% of predicted Obstructive: >120% (represents hyperinflation) Restrictive: <80%"
"Microcytic anemia - CORRECT ANSWER=> (MCV<80 fL) describes RBCs that are small.
Iron deficiency Sideroblastic Thalassemia Anemia of chronic disease"
"Macrocytic anemia - CORRECT ANSWER=> (MCV>100 fL) describes RBCs that are large.
B12 deficiency (pernicious anemia) Folate deficiency"
"Normocytic anemia - CORRECT ANSWER=> (MCV 80-99 fL) describes RBCs that are normal in size.
Anemia of inflammation and chronic disease Hereditary spherocytosis G6PD deficiency Paroxysmal nocturnal hemoglobinuria"
"Hypochromic anemia - CORRECT ANSWER=> RBCs with less hemoglobin than normal. As a result, the
RBCs appear pale in color (MCHC is low)."
"Hyperchromic anemia - CORRECT ANSWER=> RBCs with more hemoglobin than normal. As a result,
the RBCs appear a dark hue or red than normal cells (MCHC is high)."
"Normochromic anemia - CORRECT ANSWER=> RBCs that have a normal amount of hemoglobin. As a
result, the RBCs appear neither pale nor dark (MCHC is normal)."
"Decreased tissue oxygenation from anemia can manifest as signs and symptoms of the following: -
CORRECT ANSWER=> Severe fatigue
Pallor Weakness Dyspnea Dizziness"
"Cardiac Output (CO) - CORRECT ANSWER=> The amount of blood that the heart pumps in 1 minute.
CO is also known as cardiac contractility. CO=heart rate (HR) x stroke volume (SV)."
"Stroke Volume (SV) - CORRECT ANSWER=> The volume of blood pumped out of the left ventricle
during each systolic cardiac contraction."
"Afterload - CORRECT ANSWER=> The force, or load, which the heart must contract against in order to
pump blood. Afterload is also known as systemic vascular resistance (SVR)."
"Preload - CORRECT ANSWER=> The amount of stretch that the cardiac muscle exhibits at the end of
ventricular filling."
"Right-sided Heart Failure - CORRECT ANSWER=> S/Sx:
Jugular vein distention Hepatosplenomegaly Peripheral edema CorPulmonale Tricuspid valve damage Right ventricle superior vena cava (preload) pulmonary artery (afterload) Causes of right heart failure include: 1) pulmonary disease that causes pulmonary hypertension. This is the most common cause; 2) right ventricular myocardial infarction (MI), which weakens the cardiac muscle; 3) right ventricular hypertrophy (secondary to cardiac damage); 4) tricuspid valve damage (causing backflow of the blood into the right atrium or right ventricle after ejection); 5) secondary failure as a result of left heart failure due to the build-up of pressure in the damage left ventricle"
"Left-Sided Heart Failure - CORRECT ANSWER=> S/Sx:
Increased left ventricular afterload Decreased ejection fraction Increased left ventricular preload
Antibody binds to the soluble antigen outside the cell surface that was released into the blood or body fluids, and the complex is then deposited in the tissues"
"Hypersensitivity: Type 3 - Examples - CORRECT ANSWER=> Rheumatoid arthritis: Antigen/antibodies
are deposited in the joints Systemic Lupus Erythematosus (SLE)- very closely related to autoimmunity- antigen/antibodies deposit in organs that cause tissue damage"
"Hypersensitivity: Type 4 - CORRECT ANSWER=> Delayed response
Does not involve antigen/antibody complexes like Types 1, 2 and 3 Is T-cell mediated"
"Differentiating Between the Rash of a Type 1 vs. Type 4 Reaction: - CORRECT ANSWER=> Type 1:
Immediate hypersensitivity reactions, termed atopic dermatitis, are usually characterized by widely distributed lesions Type 4: Contact dermatitis (delayed hypersensitivity) consists of lesions only at the site of contact with the allergen The key determinant is the timing of the rash: -Type 1 = Immediate -Type 4 = Delayed: Several days following contact, ex would be poison ivy"
"Treatment of Type 4 Rash - CORRECT ANSWER=> A non-severe case of contact dermatitis would be
treated with topical corticosteroid. Why not epinephrine or antihistamines? -Epinephrine is for emergent Type 1 anaphylactic reactions. Antihistamines act on the H1 receptors. Type 4 does not involve mast cells and H1 receptors. Antibiotics not appropriate since not an infection"
