Patho physiology notes ch 1,2, 21 PDF

Preview

Summary

Download Patho physiology notes ch 1,2, 21 PDF

Description

Chapter 1: Introduction to Pathophysiology Pathophysiology- A and P basis.           

“Patho” means the disease process Pathophysiology; involves the study of functional or structural changes resulting from disease processes. Disease; is a deviation from the normal state of health and function. Signs and symptoms-how you know patient has a problem, looking at the past and the present Syndrome; A collection of signs and symptoms, often affecting more than one organ or system, that usually occur together in response to a certain condition. Pathogenesis; the development of a disease or sequence of events related to tissue changes involved in the disease process. Path-chronic diseases-diabetes in the past can cause different issues in the present and future, have to know the past. Present illness, medication, herbal medications, over the counter Allergies, previous hospitalizations, therapies, surgeries, genetic predisposition, family history Predisposing factor- if the patient has a genetic history, healthy lifestyle and what they are doing, something we identify; the patient does not have a disease yet. *Usually used to develop preventive measures. Nutrition, exercise, mental health, occupational, environment, heredity, socioeconomic status, age, gender

*Double blind studies used in health research: neither the members of the control group or the experimental group nor the person administering the treatment knows who is receiving the experimental therapy. The 3rd stage of evaluation process for a new therapy’s effectiveness and safety. * Evidence-based research: when the data collected from the research process confirm that the new treatment has increased effectiveness and is safe. Primary Prevention- the goal is to protect healthy people from developing a disease or experiencing an injury in the first place. o Education about good nutrition, the importance of regular exercise, and the dangers of tobacco, alcohol, and other drugs. o Education on legislation about proper seatbelt and helmet use o Regular exams and screening test to monitor risk factors for illness o Immunization against infectious disease o Controlling potential hazards at home and in the workplace.

Secondary Prevention- the interventions happen after illness or serious risk factors have already been diagnosed. The goal is to halt or slow the progress of disease (if possible) in its earliest stages; in the case of injury, goals include limiting long-term disability and preventing re-injury. o Telling people to take daily, low-dose aspirin to prevent a 1st/2nd heart attack or stroke. o Recommending regular exams and screening test in people with known risk factors for illness. o Providing suitably modified work for injured workers. Tertiary Prevention- focuses on helping people manage complicated, longterm health problems such as diabetes, heart disease, cancer, and chronic musculoskeletal pain. The goals include preventing further physical deterioration and maximizing quality of life. o Cardiac or stroke rehabilitation programs o Chronic pain management programs o Patient support groups Main goal is to educate the patient about what is going on with them.     

Etiology (causes of disease) -the factor that caused the patient to have the disease, bacteria or viruses (pathogens) Idiopathic-unknown reasons why a patient gets an illness or a disease. (Need this for RUA) Iatrogenic- an error in treatment or procedure that may cause a disease. Ex: an unwanted effect of a Rx drug. Fever-is considered a systemic sign of disease. Epidemic- A situation when there is a higher than expected number of cases of an infectious disease within a given area.

When you talk about a disease, what are the causes? What are the predisposing factors-The manifestations of a disease are best defined as the: 1.) Signs-what you can see (objective) of said disease 2.) Symptoms-what the patient tells you (subjective)of said disease 

Diagnosis-head to toe assessment, lab tests, XRAYS etc., signs and symptoms, treatment, complications, 1. Adverse reaction to medication and complications are different. 2. How do we treat the patient? - (Not talked about in detail) …BUT



Disease process …can be,

1. Acute- A short-term illness that develops very quickly with perhaps a high fever or severe pain (sudden/short term-less than 6 months) OR 2. Chronic- (EX: diabetes) …Acute can become chronic-if illness is reoccurring*    



   

Subclinical state-patient has a disease but there are no obvious signs or symptoms (HIV/AIDS, pancreatic cancer) Incubation period-communicable disease, such as chicken pox Syndrome-combination of signs and symptoms with multiple organs involved Comorbidity-one disease affects another one. (Patient has high blood pressure and diabetes- creates a cardiovascular problem) this is not past history these are current issues that are going on with the patient. (NO 100 percent treatment) Prognosis- Predicted outcome of likelihood of recovery from a specific disease or expected outcome of the disease. Epidemiology-the study of the disease processes ( The science of tracking the occurrence and distribution of diseases) Morbidity- disease rate within a group (incidence) Mortality- Death rate Communicable disease…spread by, 1. Airborne (TB)-in a negative pressure room so it doesn't spread through ducts, have to be isolated, 2. Skin to skin- (Chicken pox, CDIF, MERSA,), 3. Body fluid- (AIDS, hepititus, cytomegalovirus,) 4. Droplet- (flu, cold, meningococcal, rubella). (Shorter distance cannot be transmitted through ducts, so no isolation is needed when treating patients with these types of infections or diseases.

http://www.sahealth.sa.gov.au/wps/wcm/connect/public+content/sa+health+interne t/health+topics/health+conditions+prevention+and+treatment/infectious+diseases/w ays+infectious+diseases+spread (website for diseases) 

Cellular adaptations…



Atrophy- refers to a decrease in the size of cells, resulting in a reduced tissue mass. Common causes include…  Reduced use of the tissue,  Insufficient nutrition,  Decreased neurologic or hormonal stimulation,  And aging.

Example: The shrinkage of skeletal muscle that occurs when a limb is immobilized in a cast for several weeks. 

Hypertrophy- refers to an increase in the size of individual cells, resulting in an enlarged tissue mass. 1. This increase may be caused by additional work by the tissue, as demonstrated by an enlarged heart muscle resulting from increased demands. 2. A common example of hypertrophy is the effect of consistent exercise on skeletal muscle, leading to an enlarged muscle mass. 3. Excessive hormonal stimulation may also stimulate cell growth. (Steroids) *Ex: Rigorous weight lifting/body building regimens may result in the skeletal muscle cells undergoing: hypertrophy



Hyperplasia- is defined as an increased number of cells resulting in an enlarged tissue mass. 1. In some cases, hypertrophy and hyperplasia occur simultaneously, as in the uterine enlargement that occurs during pregnancy. 2. Hyperplasia may be a compensatory mechanism to meet increased demands, or it may be pathologic when there is a hormonal imbalance. 3. In certain instances there may be an increased risk of cancer when hyperplasia occurs.



Metaplasia- occurs when one mature cell type is replaced by a different Mature cell type. 1. This change may result from a deficit of vitamin A. 2. Sometimes, metaplasia may be an adaptive mechanism that provides a more resistant tissue; for instance, when stratified squamous epithelium replaces ciliated columnar epithelium in the respiratory tracts of cigarette smokers. 3. Although the new cells present a stronger barrier, they result in decreased defenses for the lungs because cilia are no longer present as a defense mechanism for the simpler squamous cells in the mucosa.

Dysplasia- is the term applied to tissue in which the cells vary in size and shape, large nuclei are frequently present, and the rate of mitosis is increased. A change in a tissue marked by cells that vary in size and shape and show increased mitotic figures…



1. This situation may result from chronic irritation infection, or it may be a precancerous change. 2. Detection of dysplasia is the basis of routine screening tests for atypical cells such as the Pap smear (Papanicolaou test on cervical cells). • Anaplasia- refers to cells that are undifferentiated with variable nuclear and cell structures and numerous mitotic figures. 1. Anaplasia is characteristic of cancer and is the basis for grading the aggressiveness of a tumor. *Know diff between: undifferentiated (Stem cells/ are not specialized for any particular function) & differentiated cells (cells are those that have been subject to specific epigenetic modifications to the cell) • Neoplasia- means “new growth,” and a neoplasm is commonly called a tumor. 1.) Tumors are of two types, benign and malignant. 2.) Malignant neoplasms are referred to as cancer. Benign tumors do not necessarily become malignant. 3.) Benign tumors are usually considered less serious because they do not spread and are not life threatening unless they are found in certain locations, such as the brain, where they can cause pressure problems. 4.) The characteristics of each tumor depend on the specific type of cell from which the tumor arises, resulting in a unique appearance and growth pattern. (Biopsy confirmation of malignant tumor) Apoptosis-preprogrammed cell death/destruction-this is a normal occurrence in the body, (after 120 days RBC die) *Damaged cells may be able to repair themselves.  Ischemia-deficit of oxygen in the cells usually due to respiratory or circulatory problems. EX: Stroke, MI: there is an issue with blood circulation and blood oxygenation, so the cells die, this results in ex. Above. Reasons of death would be cardiovascular and respiratory.  Hypoxia-reduced oxygen in the cells-for a short period of time the cells did not receive enough oxygenation, (EX: frost bite.) reason of death would be respiratory issue. *Caseation necrosis refers to an area where: dead cells form a thick cheesy substance. *A circumstance that causes a sudden acute episode of a chronic disease to occur is termed: Precipitating factor.



*When prolonged ischemia occurs to an area of the heart, the resulting damage is referred to as: INFARCTION.

* Cell damage may be caused by exogenous sources such as certain food additives. *Hypoxia leads to ischemia* (BUT both can be reversed) 

Necrosis: when a group of cells in the body dies. 2.) Liquefaction necrosis-dead cells liquefy because of release of enzymes (brain) 3.) Coagulation necrosis- cell proteins are altered and denatured (blood)heart and blood, kidneys) 4.) Fat necrosis- fatty tissue broken down into fatty acids. (Mesentery) 5.) Caseous necrosis- coagulation necrosis with a think yellow “cheesy” substance forms. (Lungs-Classic sign of TB)

 

Infarction-are of dead cells as a result of oxygen deprivation Gangrene- area of necrotic tissue that has been invaded by bacteria.

*Homeostasis refers to; maintenance of a stable internal environment. *Complication: used to describe a new and secondary or additional problem that arises after the original disease has been established. ***Causes of cell injury or death: 1. Hypoxia 2. Exposure to excessive cold 3. Excessive pressure on a tissue 4. Chemical toxins

Seven Steps to Health: 1. Be a non-smoker and avoid second-hand smoke. 2. Eat 5 to 10 servings of vegetables and fruits a day. Choose high-fiber, lower-fat foods. If you drink alcohol, limit your intake to one to two drinks a day. 3. Be physically active on a regular basis. This will also help you maintain a healthy body weight. 4. Protect yourself and your family from the sun. 5. Follow cancer screening guidelines. 6. Visit your doctor or dentist if you notice any change in your normal state of health. 7. Follow health and safety instructions at home and at work when using, storing and disposing of hazardous materials. Usually included in a medical history:

1. 2. 3. 4. 5.

Past illness or surgeries Current illnesses, acute and chronic Rx’d medication or other treatments Non Rx’d drugs and herbal remedies Current allergies

CHAPTER 2: Fluid, Electrolyte, and Acid Base Imbalances 

 

  

Fluid and electrolytes-the body needs 1500-3000 ml of water per day Water helps to maintain homeostasis- the balance of intake and output Urine output=1500 ml. OR 30 ml/hour (min) less than this indicates dehydration *Also…output can be through sweating, breathing, and feces* Normal serum pH is 7.4, to maintain the ratio of carbonic acid to bicarbonate ion must be 1:20. When many excess hydrogen ions accumulate in the blood, what happens to serum pH? The pH: Decreases Insensible fluid loss- through skin, breathing (expiration), sweating (perspiration) Kidney is the slowest but most effective control for acid-base balance. Increase carbonic acid-effect on the body of abnormally slow respirations.

*60% is the correct proportion of H2O to body weight to be expected in a healthy male adults’ body. *with that being said 4% is the correct proportion of blood (to body weight) in an adult male’s body. 1.) Dehydration-Initially, dehydration involves a decrease in interstitial and intravascular fluids. These losses may produce direct effects such as:    

  

Dry mucous membranes in the mouth/rough oral mucosa (signs) Decreased skin turgor-(elasticity) Lower blood pressure, weak pulse, and a feeling of fatigue Increased hematocrit, (volume) indicating a higher proportion of red blood cells compared with water in the blood-also hemoglobin * elevated hematocrit reading: Fluid deficit Decreasing mental function, confusion, and loss of consciousness, which develop as brain cells lose water and reduce function Sunken eyes Low BP/high heart rate-sign of hypervolemia The body attempts to compensate for the fluid loss by:

   



Increasing thirst Increasing the heart rate Constricting the cutaneous blood vessels, leading to pale and cool skin Producing less urine and concentrating the urine, increasing the specific gravity, as a result of renal vasoconstriction and increased secretion of ADH and aldosterone Increased Antidiuretic hormone (ADH)

Common causes of dehydration include:



 

  

Vomiting and diarrhea, both of which result in loss of numerous electrolytes and nutrients such as glucose, as well as water; drainage or suction of any portion of the digestive system can also result in deficits Excessive sweating with loss of sodium and water Diabetic ketoacidosis with loss of fluid, electrolytes, and glucose in the urinewhen sugar is too high and you lose key-tones and urine. Kidneys are filtering a lot of key-tones and losing a lot of fluid. (Type 1 diabetes) Insufficient water intake in an elderly or unconscious person-dysphasiadifficulty swallowing Use of a concentrated formula in an attempt to provide more nutrition to an infant. Trauma-loss of blood volume

How do we diagnose this?  Physical assessment Treatments  Isotonic solution (ECF)-0.9% sodium chloride, D5 (dextrose)-we don't give this because its too much sugar.  Hypotonic- less solute than the isotonic solution 0.45% normal saline  Hypertonic- more solutes D5 and normal saline (combine these-two isotonic)  Albumin-increases the protein. (This is a hypertonic solution) OR 2.) Excess- Fluid excess occurs in the extracellular compartment and may be referred to as isotonic/iso-osmolar, hypotonic/hypo-osmolar, or hypertonic/hyper-osmolar, depending on the cause. The osmolarity or the concentration of solute in the fluid, affects fluid shifts between compartments, including the cells. *Third-spacing: combination of decreased circulating blood volume combined with excess fluid in a body cavity. *Na+ (sodium) is the primary cation (positively charged ion) in the extracellular fluid Edema- (fluid overloaded)… refers to an excessive amount of fluid in the interstitial compartment, which causes a swelling or enlargement of the tissues. Edema may be localized in one area or generalized throughout the body. -Depending on the type of tissue and the area of the body, edema may be highly visible or relatively invisible…or not accurately reflect the amount of fluid hidden in the area.  Edema is usually more severe in dependent areas of the body, where the force of gravity is greatest, such as the buttocks, ankles, or feet of a person in a wheelchair.  Prolonged edema interferes with venous return, arterial circulation, and cell

function in the affected area. Causes of Edema- (Four causes) 1. Increased capillary hydrostatic pressure=to higher BP or blood pressure), which prevents return of fluid from the interstitial compartment to the venous end of the capillary, or forces excessive amounts of fluid out of the capillaries into the tissues.  Excessive pressure (on arteries), often due to increased blood volume, (hypervolemia) can force fluid into the alveoli, interfering with respiratory function. Associated with… - Kidney failure, - Pregnancy, - Congestive heart failure, or - Administration of excessive fluids. Examples:  In pregnancy- the enlarged uterus compresses the pelvic veins in the seated position and when a pregnant woman must stand still for long periods of time, the pressure in the leg veins can become quite elevated, causing edema in the feet and legs.  Congestive heart failure- the blood cannot return easily through the veins to the heart, raising the hydrostatic pressure in the legs and abdominal organs and causing ascites, or fluid in the abdominal cavity 2. The loss of plasma proteins, (particularly albumin, which results in a decrease in plasma osmotic pressure.)  Plasma proteins usually remain inside the capillary, don't really move through the semipermeable capillary membrane.  Deficit of plasma protein is decrease osmotic pressure.  The presence of fewer plasma proteins in the capillary allows more fluid to leave the capillary and less fluid to return to the venous end of the capillary.  Protein may be lost in the urine (look for albumin) through kidney disease, or  Synthesis of protein may be impaired in patients with malnutrition and mal-absorption diseases or with liver disease. (very common in elderly people)  Protein levels may drop acutely in burn patients who have large areas of burned skin; the subsequent inflammation and loss of the skin barrier allow protein to easily leak out of the body. Frequently excessive sodium levels in the extracellular fluid accompany the two causes just mentioned.



When sodium ions are retained, they promote accumulation of fluid in the interstitial compartment by… increasing the ISF osmotic pressure and decreasing the return of fluid to the blood. *Ex: when the osmotic pressure of the blood is elevated above normal, H2O would shift form the interstitial compartment into the blood.



Blood volume and blood pressure-usually elevated.

High sodium levels are common in patients with… (Aldosterone is the primary control of serum Na+ levels) 1. 2. 3. 4.

Heart failure, High blood pressure, Kidney disease, Increased aldosterone secretion.

3.) Edema may result from…   

Obstruction of the lymphatic circulation.-lymph drains fluid and filters foreign bodies Obstruction usually causes a localized edema…excessive fluid and protein are not returned to the general circulation. This situation may develop if… 1. A tumor/infection damages a lymph node (breast cancer, mastectomy) OR 2. Lymph nodes are removed, as they may be in cancer surgery.

*4.) Increased capillary permeability- This usually causes localized edema and may result from ...