Patho responses PDF

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Patho responses APINCH APINCH is the acronym used to classify high risk medication that if administered incorrectly, either too much or too little can have significant harm to the patient. A-Antimicrobials (antibiotics such as penicillin) & antipsychotic such as benzodiazepine, benzos cause hypnotic, sedative and anxiolytic effects on the patient, therefore administering too little can cause the patient to still be anxious whereas too much can cause the patient to relax too much and may increase their risk of falls. Antimicrobials may produce anaphylactic reactions particularly penicillin P- potassium and other concentrated electrolytes potassium levels need to remain between 3.5-5mmol/L because in the extracellular space potassium must be within the narrow range slightly higher it can cause the heart to stop in systole and can cause death. Sodium concentration must remain between 135-145mmol/L if this is above or below it will result in serious consequences. I-insulin too little insulin can cause the patient to go into hyperglycaemia (high blood sugar levels) if not treated immediately adverse effects can occur and if administered too much hypoglycaemia (low blood sugar) may cause delirium, tremors and comas. N-narcotics & sedatives narcotics such as codeine and morphine because they can depress the respiratory system as well as the sedative medication. C- chemotherapeutic agents are highly toxic and cause damage to both cancerous cells and healthy cells and stops them from dividing (antimetabolic), they need to be given carefully as they may disturb the metabolic rate of normal cells. H- heparin & other anticoagulants administering too little of anti-coagulants may cause an increase in blood clots whereas too much can cause the blood to thin too much and likely to cause bleeding in the brain and cause stroke.

Hypovolemic shock Hypovolemic shock can be caused by trauma, surgical interventions or ruptured ulcers. Shock can be described as a sudden large decrease in blood volume. There are four stages of shock. The initial onset of shock is often within the first 30 seconds, this involves a sudden decrease in blood volume, decreased cardiac out, decreased blood pressure all of which Leads to a lack of oxygen to the brain which leads to a loss of consciousness. Due to the lack of oxygen, cells increase lactic acid formation resulting in an increase in acidosis.

The second stage of shock I compensation. The body employs physiological, hormonal and bio-chemical mechanisms to reverse the condition. Firstly, the baroreceptors detect a change in blood pressure (very low), the baroreceptors send a signal to the brain which stimulates the sympathetic response sends a signal to increase adrenaline and noradrenaline. Resulting in an increase in blood pressure and Heart rate. Chemoreceptors detect an increase of carbon dioxide in the blood & hydrogen ions in the blood, chemoreceptors send a message to the peripheral arterioles to vasoconstrict. Thus, increase BP. There is a sudden increase in anti-diuretic hormone which helps to retain water in the kidneys, this leads to an increase in water reabsorption and a decrease in urine output to help increase blood volume. Renin angiotensin system is activated. Renin gets released into the blood stream due to hypoxia. angiotensin one is converted to angiotensin two through the angiotensin converting enzyme in the lungs. Angiotensin two constricts blood vessels to vasoconstrict therefore increasing peripheral resistance, increasing Blood pressure and blood volume. If the causes of shock is not treated successfully shock proceeds to the progression stage this includes a build-up of lactic acid= often leading to acidosis, pressure within the capillaries increase, sodium ions build up allowing potassium ions to leak out of cells and intravascular clotting, platelets form clot formation causing obscuration. The last stage if shock is not treated is the refectory period which may lead to MOD multiple organ failure shock cannot be reversed. The patient now has severe brain damage and death of a result.

Oedema Oedema refers to an excessive accumulation of fluid within the interstitial spaces. The four main causes of oedema are due to uncreased capillary hydrostatic pressure, lowered plasma oncotic pressure, lymphatic channel obstruction, increased capillary membrane permeability. Increased capillary hydrostatic pressure, is when there is an increase of pressure inside the capillaries which can often be caused by, peripheral vascular disease, heart failure and renal failure. Lowered plasma oncotic pressure this is often due to a decrease in the plasma protein albumin, this often leads to oedema. Conditions where plasma proteins are significant reduced include loss in urine (proteinuria), malnutrition (kwashiorkor), decreased production. Lymphatic channel obstruction is caused by a blockage of lymph nodes therefore there is unsuccessful drainage of fluid. An example of lymphatic channel obstruction is after a mastectomy of the breast, this involves the removal of axillary lymph nodes, this leads to insufficient drainage of fluid down the arm, this results in lymphoedema. Leading to an increase of water in the capillaries, increase in hydrostatic pressure and an increase of water within Intestinal spaces. The last cause of oedema is due to an increase capillary membrane permeability which is caused by an inflammation of the capillaries for example anaphylaxis.

Anaphylactic shock – long answer patho

Anaphylaxis is the most serve and immediate hypersensitivity type one reaction and can occur within seconds after exposure to allergen. Anaphylactic shock is deadly if not treated immediately with epinephrine, death may occur. The sensation phase (first exposure to antigen) When exposed to a certain antigen such as peanuts, milk, wheat, bee stings, pollen and medications are a few things that may cause an allergic reaction/ abnormal immune response. When exposed to an allergen such as peanuts, macrophages phagocytize the antigen, antigen presenting cells present the antigen on their cells maker, B cells then convert and produce interleukin 4, B cells (antibody creating cells of the immune system) then proliferate into plasma cells, which release large amounts of immunoglobin E (igE) systemically throughout the body, igE binds to mast cells in the skin, gastrointestinal tract, respiratory system and peripheral blood basophils (sensitisation occurs) and stimulate the release of chemicals such as histamine, serotonin, bradykinin, interleukins, interferons and prostaglandins as well as other chemical mediators of immunity which travel all over the body. Effector phase: Histamine and other inflammatory mediators causes increased vasodilation (decrease blood pressure), smooth muscle spasms, mucosal oedema, increase capillary permeability, cause bronchoconstriction in the lungs, oedema in the alveoli, laryngeal oedema which causes a constriction of the vocal cords and airways which is considered as the main cause of death, serve hypotension and loss of consciousness occurs. This results in clinical symptoms such as flushing, itching, swelling, dizziness, difficulty breathing (due to bronchospasm) and loss of consciousness. There is no compensatory mechanism for anaphylactic shock by the body as it has already affected the airways causing laryngeal oedema, the respiratory system needs to be functioning for these compensatory mechanisms to work. Each time exposed to the allergen the body produces larger and larger amount of IgE and histamine, therefore, is considered very dangerous which exposed the second time!...