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3129 Exam 4
n/a
254
Nursing
Undergraduate 3
07/21/2014

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Term
Alpha cells of pancreas are responsible for what?
Definition
glucagon
Term
Beta cells of the pancreas are responsible for what?
Definition
insulin
Term
What is the primary function of insulin?
Definition
move glucose to tissues for growth; decreases blood glucose levels
Term
Insulin secretion is simulated by what type of stimulation?
Definition
cholinergic/vagal
Term
What organ does not require insulin for glucose transport?
Definition
Brain
Term
What is the primary function of glucagon?
Definition
in liver to increase blood glucose; stimulates glycogenolysis; stimulated by hypoglycemia and SNS response
Term
What is the possible purpose of somatostatin?
Definition
regulating alpha and beta cell secretions
Term
Describe the diagnostic factors of diabetes mellitus
Definition
>1 fasting blood glucose >126
Term
What are the 3 classic symptoms of hyperglycemia?
Definition
polyuria, polydipsia, polyphagia
Term
Hyperglycemia is a potent stimulant for ______
Definition
atherosclerosis
Term
Describe Type 1 Diabetes Mellitus
Definition
insulin dependent diabetes mellitus, juvenile onset
Term
What are the two types of type 1 diabetes mellitus?
Definition
immune (immune destruction of beta cells from drugs chemicals or viruses); non-immune (idiopathic); type 2 sensitivities
Term
What are 3 results of beta cells destruction?
Definition
decreased progressing to absent insulin secretion, excess of glucagon, hyperglycemia
Term
Describe polyuria
Definition
glucose exceeds renal threshold and appears in urine; glucose pulls water to urine to be excreted
Term
Describe polydipsia
Definition
water is attracted from body cells leading to intracellular dehydration
Term
Describe polyphagia
Definition
depletion of cellular stores of nutrients leads to cellular starvation triggering hunger
Term
What are the 3 classic sign of diabetes in lamense terms?
Definition
pee a lot, thirsty and hungry
Term
How does stress reduction treat diabetes?
Definition
reduces cortisol secretion which causes hyperglycemia
Term
Describe type 2 diabetes mellitus
Definition
non insulin dependent; obesity is common characteristic; traditionally 40+; cellular resistance to insulin following yrs of hyperinsulinemia; can be controlled with diet and exercise
Term
Describe the clinical manifestations of type 2 diabetes
Definition
slow onset of recurrent infections, visual changes from abnormal water balance in eyes, parasthesias from neuropathies, genital pruritis, 3 Ps
Term
What are two meds for glucose control in type 2 diabetes?
Definition
oral hypoglycemic or insulin
Term
Describe the acute complications of diabetes mellitus
Definition
neurologic symptoms r/t decrease glucose to brain (headache, visual changes, confusion, lost concentration, tremors, seizures, death from insulin shock)
Term
What are the SNS symptoms of acute complications of diabetes?
Definition
tachycardia, pallor, diaphoresis, palpitations
Term
If a diabetic has a SNS response during sleep, what do you do?
Definition
wake them up and take blood glucose
Term
Describe the patho of DKA
Definition
develops with deficiency of insulin and increase in insulin counterregulatory hormones (cortisol, glucagon)
Term
What are the clinical manifestations of DKA?
Definition
3 PS, fruity breath, metabolic acidosis, kussmaul respirations
Term
Describe HHNK
Definition
hyperosmolar hyperglycemic non ketonic diabetes; similar patho to dka but glucose >600; NOT in type I; 3 Ps and weight loss
Term
Describe diabetic neuropathies
Definition
hyperglycemia leads to atherosclerosis then ischemia to nerves r/t uncontrolled glucose; can effect internal organs and extremities
Term
Describe and give examples or visceral neuropathies
Definition
gastroparesis (delayed gastric emptying), neurogenic bladder (bladder paralysis with retention), Impotence (sexual dysfunction in males)
Term
What is a consequence of neuropathy?
Definition
amputation
Term
Gives examples of microvascular diseases from chronic complications of diabetes
Definition
diabetic retinopathy (leading cause of blindness/visual impairment), diabetic neuropathy (most common cause of end stage renal disease [ESRD])
Term
Give examples of macrovascular disease from chronic diabetes
Definition
CAD (leading cause of MI and heart ischemia), CerebroVD (leading cause of CVA/stroke), PVD (leading cause of infection/gangrene/lower extremity amputation)
Term
Why are diabetics at increased risk for infection?
Definition
hypoxia, ischemia and decreased WBC from vascular disease; decreased sensory ability; pathogens multiply due to increased glucose
Term
Describe glycosylated hgb/Hgb A1C
Definition
increase in glycated hgb; Hgb A1c reflects blood sugar levels for past 2-3 months (high= high, low= more normal)
Term
What are the value ranges for Hgb A1c?
Definition
Normal: <6.5
Excellent: 6.5-7.5
Good: 7.5-8.5
Fair: 8.5-9.5
Poor: >9.5
Term
Define heart failure
Definition
dysfunction that leads to inability of heart to properly perfuse tissues
Term
What are 4 mechanisms of heart failure?
Definition
altered contractility, altered ratio of O2 supply and demand, blood clot formation, atrial dysrhythmias
Term
What is left heart failure called?
Definition
congestive heart failure
Term
What is the name of right heart failure?
Definition
cor pulmonale
Term
What are the causes of L heart failure?
Definition
increased afterload/resistance, increased fluid volume, decreased function from ischemia/infarction
Term
Describe Frank Starling's law of the heart
Definition
low preload=low contractility, as preload increases contractility increases, increased preload past optimum results in decreasing contractility
Term
Systolic heart failure is ___ failure
Definition
forward
Term
Diastolic heart failure is ____ failure
Definition
backward
Term
ID:
inability of heart to generate adequate CO to perfuse tissues
Definition
systolic heart failure
Term
ID:
pulmonary congestion despite normal stroke volume and CO
Definition
diastolic heart failure
Term
Describe backward failure of the heart
Definition
pulmonary edema and impaired gas exchange from increased hydrostatic back pressure; continued backpressure causes RVF
Term
What is cardiogenic shock?
Definition
extreme LVF
Term
Describe forward heart failure
Definition
systolic failure-> less forward blood flow-> baroreceptors sense decreased pressure-> decrease renal perfusion->SNS->RAA stimulated
Term
What are the clinical manifestations of LVF?
Definition
pulmonary edema, crackles/rales, dyspnea, dry cough, hypotension, stress response
Term
What information can be provided by an echocardiogram?
Definition
ultrasound of the heart; valve status, ejection fraction: the lower it is the worse the heart failure (60-75 is normal)
Term
Describe natriuretic peptides
Definition
produced in response to heart chamber stretching; ANP= atrial, BNP=ventricular
Term
What hypoxic pulmonary disease can cause RHF?
Definition
COPD
Term
___ HF follows ___ HF
Definition
right;left
Term
Describe biventricular failure
Definition
typical LVF leading to RVF
Term
Describe high output failure
Definition
inability of heart to supply body with nutrients r/t anemia/hyperthyroidism with cardiac exhaustion+
Term
Describe cardiogenic shock
Definition
impaired tissue perfusion caused by anaerobic metabolism leads to lactic acidosis
Term
What is a consequence of the trabeculated trait of the endocardium?
Definition
gives bacteria a place to hide
Term
What are the 4 cardiomyopathies?
Definition
ischemic cardiomyopathy, dilated, hypertophic (asymmetrical septal hypertrophy), restrictive
Term
What are the types and causes of valvular dysfunction?
Definition
stenosis (opening problem) and regurgitation (closing problem); rheumatic fever, infective endocarditis CAD and MI
Term
What are two risks of valvular dysfunction?
Definition
blood clot formation; atrial dysrhythmias
Term
Define syncope
Definition
fainting
Term
Describe MVPS
Definition
Mitral valve prolapse syndrome; cusps of mitral valve prolapse into LA; causes mitral regurgitation; genetic (marfan's), hyperthyroidism?
Term
Describe rheumatic fever/heart disease
Definition
inflammatory disease caused by delayed immune reaction to GABHS; autoimmune; can cause scarring of endocardium/valves
Term
What is the classic clinical manifestation of acute rheumatic fever/heart disease?
Definition
polyarthritis (all synovial joints esp. large extremities)
Term
What are the major manifestations of jones criteria (acute rheumatic fever)?
Definition
carditis, polyarthritis and chorea
Term
What are the 3 critical elements of infective endocarditis
Definition
turbulent blood flow damage preps endocardium for colonization; endocardium is colonized; microorgs proliferate and promote endocardial vegetation
Term
What are the classic signs of infective endocarditis?
Definition
fever, new murmur, petechiae of skin, nails, mouth and conjunctiva
Term
What are the classic manifestations of embolic sequelae?
Definition
splinter hemorrhages, conjunctival petechiae, osler's nodes, janeways lesions
Term
Describe pericardial tamponade
Definition
large pericardial effusion; life threatening
Term
What is an important clinical manifestation of acute pericarditis?
Definition
pericardial friction rub; ischemia on ECG
Term
Transudate is evidence of what?
Definition
LHF. fluid volume excess
Term
Exudate is evidence of what?
Definition
pericardial injury
Term
Describe Beck's Triad
Definition
manifestation of pericardial effusion; hypotension, muffled heart sounds, JVD
Term
Describe pulse paradoxis
Definition
decreased BP on inspiration, increased BP on expiration
Term
Describe constrictive pericarditis
Definition
consequence of chronic pericarditis and SLE; adhesion of pericardial layers;gradual
Term
What are the RHF manifestations of constrictive pericarditis?
Definition
JVD, peripheral edema, hepatomegaly
Term
Describe chorea
Definition
St Vitus Dance with CNS involvement from rheumatic fever
Term
What are the two possible causes of a urinary tract obstruction?
Definition
anatomic/mechanical and functional defect (peristalsis failure)
Term
What are the 4 effects of UT obstruction?
Definition
urine may accumulate behind obstruction; obstructed ureter= hydroureter; obstructed renal pelvis/calyces=hydronephrosis; obstructed urethra= cystitis (possible)
Term
What 4 possible substances can a kidney stone be made of?
Definition
calcium, struvite, uric acid and cystiene
Term
How can prolonged bed rest lead to kidney stones?
Definition
bed rest leads to demineralization of bone, hypercalciuria and stone formation
Term
Define KUB
Definition
kidneys, ureter, bladder
Term
Describe the pain associated with kidney stones
Definition
colic pain (rhythmic) with nausea and vomitting
Term
What are some ways of treating kidney stones?
Definition
increase urine flow, decrease dietary cause, adjust pH (make acidic for Ca and alkaline for Uric acid), hydrate
Term
People who tend to be "stone formers" should drink what?
Definition
orange juice
Term
Describe a functional urinary tract obstruction
Definition
neurogenic bladder: loss of control, motor paralysis, sensory paralysis
Term
What are the evaluations for a neurogenic bladder?
Definition
assessment for distension, loss of sensation of bladder fullness, decreased output compared to intake
Term
What is the most common UTI bacteria?
Definition
gram negative from bowel
Term
What is the most common UTI?
Definition
cystitis: inflammation of the bladder
Term
What is the sign for UTI in elderly?
Definition
change in mental status
Term
Describe pyelonephritis
Definition
infection of the renal pelvis and interstitium; tubules are primarily effected, renal inflammation and edema, leukocytosis with left shift
Term
Describe glomerulonephritis
Definition
inflammation of the glomerulus; associated with SLE, post strep, may scar and damage glomeruli
Term
What are the clinical manifestations of glomerulonephritis?
Definition
casts, proteinuria, salt and water retention, elevated creat
Term
Describe nephrotic syndrome
Definition
excretion of 3.5> gram of protein/day in urine; low albumin and edema
Term
What are 3 categories of cause of acute renal failure?
Definition
pre-renal, intrarenal (damage directly to nephrons), post-renal
Term
What are the most common causes of chronic renal failure?
Definition
diabetes and hypertension
Term
What is the functional unit of the kidney?
Definition
nephron
Term
What structure of the kidney helps in fluid, electrolyte and acid base balance?
Definition
tubules
Term
What is the purpose of the juxtaglomerular apparatus?
Definition
sensing status of blood to determine renin secretion
Term
What are the important functions of the nephron?
Definition
forms filtrate of protein free plasma, regulates fluid volume, pH range, ADH and water/sodium
Term
Why may protein end up in the urine?
Definition
inflammatory damage and increased capillary permeability
Term
What is the best indirect measure of renal function?
Definition
Creatinine
Term
What is the best measurement of patient hydration? (kidneys)
Definition
BUN
Term
Describe turbidity from a urinalysis
Definition
clarity; urine should be clear even if there is color to it
Term
Describe specific gravity from a urinalysis
Definition
concentration in comparison to water (1). The higher the number the more concentrated the urine is
Term
Why would ketones be present in the urine?
Definition
Fat; if patient has DKA (sugar and fat); not enough carbs for E, on starvation status
Term
What are some reasons blood may be in the urine?
Definition
inflammation, kidney stones, low platelets
Term
What could cause bilirubin to be in the blood?
Definition
issue with the liver, hemolytic anemia, gallstones
Term
Crystals in the blood indicate what?
Definition
kidney stones
Term
How much bacteria is permissible to be in the urine?
Definition
100k
Term
When is there an increase in WBC in the urine?
Definition
UTI which causes nitrates to change to nitrites
Term
What developmental changes are there for the elderly regarding renal function?
Definition
decreased kidney size, renal blood flow, nephrons and GFR; Glomerular capillaries atrophy
Term
What does schizophrenia mean? Describe it
Definition
split mind; disorganization of personality in social function/distorted reality
Term
What are 3 symptoms of schizo? How long must the be present for diagnosis?
Definition
delusions, hallucinations, disorganized speech; 6 months
Term
What is the average age of onset of schizo?
Definition
16-30
Term
What is the estimated cost of schizo annually?
Definition
62.7 billion
Term
What is the chance that one seperate twin will develop schizo if the other has it?
Definition
35-58
Term
What is the most common side effect of many psych meds?
Definition
extrapyramidal symptoms
Term
What are the 4 phases of schizo?
Definition
premorbid, prodromal, schizo, residual
Term
What are the 5 divisions of schizo?
Definition
paranoid, disorganized, catatonic, residual, undifferentiated
Term
What type of schizo has the best prognosis?
Definition
paranoid
Term
What type of schizo has blunt affect as a symptom?
Definition
residual
Term
What are the positive symptoms of schizo?
Definition
delusions, hallucinations, magical thinking, paranoia
Term
What are the negative symptoms of schizo?
Definition
flat or blunted affect, apathy, anhedonia, autism
Term
During auditory hallucination there is an increase in activity in what part of the brain?
Definition
broca's area
Term
Define Echolalia
Definition
repeating what is said to the person or by the person
Term
What are two common assessment tools for schizo and psychotic disorders?
Definition
Abnormal involuntary movement scale (AIMS) and global assessment of functioning scale (GAF)- 1-100
Term
What was a monumental treatment for schizo and psych disorders?
Definition
thorazine
Term
What is an important EPS?
Definition
dystonia
Term
Define renal failure
Definition
kidnets cannot remove waste from blood leading to altered fluid, electrolyte and acid base balance
Term
Define azotemia; What term is it interchangeable with?
Definition
high levels of urea, creat., and other waste products in blood; uremia
Term
Describe ARF
Definition
Acute Renal Failure; sudden onset but reversible, increase in plasma BUN and creat
Term
What are the 5 high risk groups for ARF?
Definition
elderly,dehydrated, hypotensive, critically ill, surgical patients
Term
Define oliguria
Definition
scanty urine; <30mL output/hour
Term
ID type of ARF:
imparied renal blood flow (reduced perfusion), GFR declines from decrease in filtration pressure; most common cause
Definition
Prerenal ARF
Term
If prerenal ARF is not corrected what does it lead to?
Definition
acute tubular necrosis
Term
ID type of ARF:
ATN, acute glomerulonephritis, vascular disease (malignant hypertension), toxic injury
Definition
intrarenal ARF
Term
Give 2 examples of toxic injury
Definition
nephrotoxic (from meds/drugs) and free hgb with hemmolysis
Term
ID type of ARF:
Occurs with UT obstructions that affect kidneys and increase upstream pressure
Definition
postrenal ARF
Term
What are 3 things that cause postrenal arf?
Definition
prostatic hypertrophy, bladder outlet obstruction, bilateral ureteral obstruction
Term
What are the 4 phases of ARF and then end result if untreated?
Definition
initiation, oliguria, diuresis, recovery; CRF and ESRD
Term
What are the effects of oliguria?
Definition
high bun, creat., potassium; metabolic acidosis, volume overload, uremic symptoms
Term
What are the uremic symptoms?
Definition
anorexia, nausea, vomiting, fatigue, muscle jerks, uremic pericarditis,
Term
What are the 3 signs of uremic pericarditis?
Definition
chest pain, pericardial friction rub, pericardial tamponade
Term
Describe diuresis
Definition
gradual urine output increase and GFR recovers; watch for dehydration
Term
What are the causes of CRF?
Definition
diabetic neuropathy, hypertension, glomerulonephritis, polycystic kidneys, SLE, BPH
Term
What are the classifications of decreased renal function?
Definition
reduced renal reserve= GFR 50%
Renal insufficiency= GFR 25%
Renal failure= GFR <20%
Term
What are the signs of renal insufficiency?
Definition
increased BUN and creat, mild anemia, mild uremia
Term
What stage of CRF is marked by oliguria, metabolic acidosis and severe anemia?
Definition
renal failure
Term
What is uremic frost?
Definition
waste products crystalize on skin
Term
Describe what happens in liver dysfunction (chart)
Definition
increase in liver enzymes, bilirubin and coag measures; decrease in proteins/albumin
Term
What helps fix coag meas. issues?
Definition
FFP and Vitamin K
Term
Define unconjugated
Definition
indirect=unprocessed=pre-liver
Term
Define conjugated
Definition
direct=processed
Term
What is the most common cause of extrinsic mechanical obstruction in dysphagia?
Definition
tumors
Term
Describe achalasia
Definition
functional dysphasia; decreased muscle function in esophagus; food accumulates in boggy tissue
Term
Describe the clinical manifestations of dysphagia
Definition
stabbing pain, difficulty swallowing, regurgitation, vomiting, weight loss, aspiration->pneumonia
Term
Describe GERD
Definition
gastroesophageal reflux disease; inflammatory response to reflux
Term
How does delayed gastric emptying contribute to GERD?
Definition
lengthens time of reflux and increases acid content of chyme
Term
How does the presence of a hiatal hernia contribute to GERD?
Definition
weakens lower esophageal Sphincter (LES)
Term
What are 2 important clinical manifestations of GERD?
Definition
heartburn and regurgitation of chyme; upper abdomen pain within 1 hr of eating "chest pain"
Term
Describe a hiatal hernia
Definition
protrusion of upper stomach through diaphragm and into thorax leading to GERD, dysphagia, heartburn and epigastric pain
Term
Define pyloric obstruction
Definition
narrowing of opening between stomach and duodenum; n/v with food but no bile
Term
What is the term ileus used for?
Definition
functional obstruction of the intestines
Term
What accounts for 60% of small bowel obstructions?
Definition
adhesions of scar tissue
Term
Define volvulus
Definition
twisting of the bowel
Term
Describe the pathology of mechanical intestinal obstruction
Definition
inflammation causes bowel edema, large amounts of fluid gather in bowel-> hypovolemia/shock, electrolyte deficiencies
Term
What are the clinical manifestations of mechanical intestinal obstruction vs. functional?
Definition
early borborygmi, high tinkling bowel sounds then hypoactive, visual peristalsis; hypoactive bowel sounds
Term
What is the treatment for intestinal obstruction?
Definition
NG tube to suction
Term
What are the clinical manifestations of mechanical bowel obstruction?
Definition
hypovolemia leading to shock, strangulation->gangrene and sepsis, multiple organ system failure
Term
What is the major cause of type B chronic gastritis?
Definition
helicobactor pylori (eats protective mucus)
Term
What is the result of chronic gastritis and who does it effect?
Definition
thinning of stomach wall; elderly
Term
What are factors that increase gastric acid production?
Definition
increase parietal cells, increase sensitivity to food , vagal stimulation, decreased inhibition of HCl
Term
What are factors that impair mucosal barrier protection?
Definition
ischemia, prostaglandin inhibition by NSAIDS, H. pylori
Term
What is an important clinical manifestation of gastritis?
Definition
eating followed by pain pattern
Term
What is the most common type of PUD?
Definition
dudenal ulcers
Term
What are the clinical manifestations of PUD?
Definition
gnawing chest pain while stomach is empty or at night; relieved by antacids
Term
What are the two types of ischemic stress ulcers?
Definition
curling's ulcer r/t burn injury; cushing's ulcer r/t head injury or brain surgery
Term
What are two conditions that cause impaired absorption by intestinal mucosa?
Definition
UC and Crohn's disease
Term
What are 5 diseases that cause impaired digestive processes?
Definition
chronic pancreatitis, pancreatic cancer, CF, biliary obstruction, liver disease
Term
What are 4 local clinical manifestations of maldigestion and malabsorption?
Definition
diarrhea, abdominal distension, cramping, steatorrhea
Term
Define IBS and give two examples
Definition
diseases with malabsorption as a feature; ulcerative colitis and crohn's disease
Term
Describe ulcerative colitis
Definition
chronic inflammatory disease that causes ulceration of colon mucosa (rectum and sigmoid)
Term
Describe a primary lesion in ulcerative colitis
Definition
inflammation at base of crypt of lieberkuhn in large intestine
Term
Describe the clinical manifestations and prognosis for ulcerative colitis
Definition
frequent diarrhea (10-20x/day) with blood and mucus; increased colon cancer risk
Term
Describe the pathology and clinical manifestations of crohn disease
Definition
inflammatory disease of small and large (ascending and transverse) intestine; rectum rarely involved; nonbloody diarrhea
Term
What is the most common cause of peritonitis?
Definition
bacteria, normal bowel flora
Term
Describe ACTH
Definition
produced by anterior pituitary; stimulated by CRH from hypothalmus
Term
Describe glucocoticoid hormaones
Definition
cortisol is most potent type; effects carb metabolism, awareness and sleep habits
Term
Describe minerlocorticoid hormones
Definition
aldosterone is most potent type; affect ion transport
Term
What part of the body is responsible for adrenal estrogens and androgens?
Definition
adrenal cortex
Term
What is the purpose of the chromaffin cells and where are they located?
Definition
secrete majority of epi and nor epi; adrenal medulla
Term
Describe primary hypersecretion
Definition
gland cause; adrenal initiated hypersecretion
Term
Describe secondary hypersecretion
Definition
pituitary caused; anterior pituitary initiated hypersecretion
Term
Describe exogenous administration of hypersecretion
Definition
taking corticosteroid meds
Term
Describe ectopic hypersecretion
Definition
initiated by tumors, etc
Term
Chronically taking corticosteroids with lead to what?
Definition
cushing's syndrome
Term
What is the difference between cushing disease and cushig syndrome?
Definition
disease is from excessive pituitary secretion of ACTH; syndrome is excessive level of cortisol regardless of cause
Term
What are some effects of hypersecretion of adrenal cortex?
Definition
friable skin, increased fat deposition, hypertension, hypocalcemia
Term
What are some effects of hypersecretion of adrenal glands?
Definition
virilization and feminization
Term
Regardless of cause of cushing's, you need to worry about the ____ for fear of ____
Definition
bones; hypocalcemia
Term
Those with cushing's need ___ therapy
Definition
antihypertension
Term
Describe hyperaldosteronism
Definition
primary (conn disease), hypertension, hypokalemia, metabolic alkalosis, accelerated atherosclerosis
Term
Describe adrenocortical hypofunction
Definition
primary=addison disease; secondary =pituitary hypofunction
Term
ACTH exces leads to _____
Definition
hyperpigmentation
Term
What are the clinical manifestations of Adrenocortical hypofunction?
Definition
weakness, easily tired, GI disturbances hypoglycemia, vitiligo
Term
Describe adrenal medulla hyper function
Definition
caused by tumors from chromaffin cells; pheochromocytomas; secrete catecholamines continuously or by episode
Term
Describe colorectal cancer
Definition
2nd most common COD in US; Tends to occur in 50+, high SES, diet and lifestyle
Term
What are the 3 risk factors for colorectal cancer?
Definition
genetics, diet (high fat, low fiber, low Ca), and Chronic constipation
Term
Most colorectal cancers develop from ____ ____
Definition
adenomatous polyps
Term
Describe the progression of colorectal cancer
Definition
slow multistep process with long in-situ phase; liver metastasis is common
Term
What are 5 conditions often confused with colorectal cancer?
Definition
diverticulitis, chronic UC, crohn's disease, appendicitis, thrombosed hemmorhoids
Term
What is an early sign of colorectal cancer?
Definition
hemmocult in stool
Term
What are 3 late signs of colorectal cancer?
Definition
anemia, bowel obstruction, liver metastasis
Term
Describe Dukes classification for colorectal cancer
Definition
A: Cancer limited to bowel wall
B: Cancer extending through the bowel wall
C: Nodal Mets regardless of extension into bowel wall
D: Distant Mets regardless of primary site
Term
What is a common treatment for colorectal cancer?
Definition
colon resection (anastomoses and colostomy)
Term
What are the 3 incompressable components of the cranium?
Definition
CSF, blood and brain tissue
Term
Describe the monro kellie doctrine
Definition
increase in any of the 3 incompressable elements of the brain must be balanced by either or both remaining elements; if not ICP increases
Term
What is the most readily displaceable element of cerebral fluid?
Definition
CSF; cerebral blood volume is next
Term
What is the purpose of the jugular veins?
Definition
drain the head
Term
What is increased ICP usually caused by?
Definition
increase in intracranial blood volume
Term
Describe stage 1 increased ICP
Definition
displacement of CSF from cranium to spinal column attempt to decrease ICP; compensatory: asymptomatic
Term
Describe stage 2 increased ICP
Definition
expansion of cranial contents exceeds compensatory abilities; altered LOC, normal vitals
Term
Describe stage 3 increased ICP
Definition
ICP approaches MAP and brain tissue becomes hypoxic; CPP drops; decreased LOC, sluggish pupils, cushing's triad (late)
Term
Describe CPP
Definition
MAP-ICP; determines cerebral blood flow; injured brain needs CPP>70; increase ICP decreases CPP; normal range 60-100
Term
What is the widening of pulse pressure?
Definition
systolic hypertension
Term
Describe stage 4 increased ICP
Definition
brain tissue herniates from high pressure area to low pressure area, hemorrhage, obstructive hydrocephalus; coma, aniscoria
Term
What is the most potent cerebral vasodilator?
Definition
PaCO2
Term
What are 3 ways of treating someone with increased ICP?
Definition
decrease blood volume (diuretic), minimize CSF (diuretic), decrease brain tissue (surgery, diuretic)
Term
CSF flows in ___ space
Definition
subarachnoid
Term
Describe communicating hydrocephalus
Definition
CSF not effectively reabsorbed; caused by subarachnnoid hemorrhage; caused by platelets and clotting factors clogging system
Term
Describe noncommunicating hydrocephalus
Definition
CSF drainage from ventricular system impaired; caused by obstructions (tumor, inflammation)
Term
What is a classic sign of hydrocephalus?
Definition
sundown eyes
Term
What type of shunt for hydrocephalus is at risk for peritonitis?
Definition
Ventricular peritoneal (VP)
Term
What are some clinical manifestations of meningitis?
Definition
positive brudzinski and kernig's signs, opisthotonus, nucchal rigidity
Term
Describe normal CSF
Definition
clear, odorless, protein:15-45, glucose, few or no WBC and RBC
Term
What is the relationship between CSF glucose and blood glucose?
Definition
CSF is 2/3 blood
Term
What is the purpose of a lumbar puncture and what info does it give?
Definition
rule out meningitis; fever, meningeal signs, mental status changes
Term
Describe the 2 types of CVA
Definition
thromboembolic (TIA less than 24 hrs); Hemorrhagic (hypertension and ruptured aneurysms)
Term
TIA is an early sign of what?
Definition
thromboembolic strokes
Term
What is the FAST acronym for?
Definition
Face Arms Speech Time; brain attacks
Term
TIA is to ___ as ____ is to an MI
Definition
Stroke; Angina
Term
What are the warning signs of an intracranial aneurysm?
Definition
sudden severe headache (thunderclap headache); meningeal signs, bloody CSF with subarachnoid bleed
Term
What is the main symptom of subarachnoid hemorrhage?
Definition
severe sudden headache after a pop or snap feeling in the head, bloody CFS, meningeal signs
Term
What is the name for intracerebral brain tumors?
Definition
gliomas
Term
Describe encapsulated gliomas
Definition
noninvasive, displace and compress CNS tissue cause ischemia and impaired neuro function
Term
Describe nonencapsulated gliomas
Definition
invasive, destroys normal CNS tissue;
Term
What is the most common primary CNS tumor? Describe it
Definition
astrocytoma; astrocytes that have lost normal growth restraint and proliferate
Term
Describe I and II grade astrocytomas
Definition
well differentiated, slow growing, infiltrative, cause headaches early on
Term
Describe grade 3 and 4 astrocytomas
Definition
poorly differentiated; mostly in frontal and temporal lobes, 4 has areas of necrosis; focal signs (hemoparesis, dysphagia)
Term
What are 3 important clinical manifestations of brain tumors?
Definition
headache, seizure and increased ICP
Term
Describe oligodendrocytoma
Definition
slow gorwing well diffrentiated, focal/generalized seizure comes first; increased ICP
Term
Describe ependymoma
Definition
gliomas from ependymal cells from walls of ventricles; obstructive hydrocephalus is common, non-encapsulated
Term
What are the clinical manifestations of ependymoma?
Definition
difficulty with balance and fine motor skills
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