Exam 2 Patho 1 PDF

**[ABCs]** a. Airway, Breathing, Circulation. 2. **[ABG's: ARTERIAL BLOOD GAS]** **An arterial blood gas (ABG) test** is a blood test that measures the levels of oxygen and carbon dioxide in your blood. It also checks the balance of acids and bases, known as the pH balance, in your blood. ###...

**[ABCs]** a. Airway, Breathing, Circulation. 2. **[ABG's: ARTERIAL BLOOD GAS]** **An arterial blood gas (ABG) test** is a blood test that measures the levels of oxygen and carbon dioxide in your blood. It also checks the balance of acids and bases, known as the pH balance, in your blood. ### **Why is an ABG test done?** ABG tests are often used to: 1. Assess how well your lungs are functioning 2. Diagnose and monitor [respiratory disorders] like pneumonia or asthma 3. Assess acid-base balance in the blood, which can be affected by conditions like kidney disease or diabetes 4. Important for assessing respiratory and metabolic function. **What do the results mean?** The results of an ABG test will show: - **Partial pressure of oxygen (PaO2):** Measures the amount of oxygen in your blood. - **Partial pressure of carbon dioxide (PaCO2):** Measures the amount of carbon dioxide in your blood. - **pH:** Measures the acidity or alkalinity of your blood. - **Oxygen saturation (SaO2):** Measures the percentage of hemoglobin in your blood that is carrying oxygen. - **Bicarbonate (HCO3-):** Measures the amount of bicarbonate in your blood, which helps regulate pH. 3. ACS **[Acute coronary syndrome:]** - Acute coronary syndrome (ACS) is a term used to describe a group of heart conditions that occur when blood flow to the heart muscle is suddenly reduced or blocked. - An Acute expression of ischemic heart disease, implying a lack of Oxygen to the Myocardium and associated with some general symptoms. - [Persons with an Acute Coronary Syndrome (ACS) are routinely classified as low risk or high risk for infarction based on the following: ] - Presenting characteristics - ECG variables - Serum cardiac markers - The timing of presentation. - Includes: Unstable angina and myocardial infarction (MI). - Signs/Symptoms: Chest pain, shortness of breath, sweating 4. **ARD's Acute Respiratory Distress Syndrome** - Several conditions may lead to ARDS - They all produce similar pathologic lung changes that include diffuse epithelial **cell injury with increased permeability of the alveolar-capillary membrane** 1. [Aspiration] of gastric contents 2. Major trauma (with or without fat emboli) 3. [Sepsis] secondary to pulmonary or non-pulmonary infections 4. [Acute pancreatitis ] 5. [Hematologic disorders ] 6. [Metabolic events ] 7. *Reactions to drugs and toxins* - **Memory jogger to remember the progression of ARDS, use this mnemonic.** 1. **A**ssault to the pulmonary system 2. **R**espiratory distress 3. **D**ecreased lung compliance 4. **S**evere respiratory failure 5. **[Anatomy and Assessment of Respiratory system]** 1. The respiratory system comprises two lungs, conducting airways, and associated blood vessels. 2. The primary function of the respiratory system is gas exchange. 3. The alveoli are the chief units of gas exchange. 4. During ventilation, air is taken into the body on inhalation (inspiration) and travels through respiratory passages to the lungs. 5. Oxygen (O2) in the lungs replaces carbon dioxide (CO2) in the blood (at the alveoli) during perfusion, and then CO2 is expelled from the body on exhalation (expiration). 6. Disease or trauma may interfere with the respiratory system's vital 7. work affecting any of the following structures and functions: - conducting airways - lungs - breathing mechanics - neurochemical control of ventilation - **[UPPER AIRWAYS include:]** 1. Nasal cavity 2. Nasopharynx 3. Oral cavity 4. Oropharynx 5. Laryngopharynx 6. Larynx - **[Lower airways include]** 1. Trachea 2. Apex of lungs 3. Carina 4. Right superior lobar bronchus 5. Right main bronchus 6. Left main bronchus Assessment Techniques: Inspection, palpation, percussion, auscultation. Signs of Dysfunction: Cyanosis, decreased breath sounds, wheezing. 6. **ANGINA (Ischemic chest pain)** A. Angina is a warning sign that the blood supply has issues and if they are not treated, portions of the heart can die. B. Chest pain limits blood flow to the heart. C. Specifically, myocardium (it is heart muscle) D. There are two coronary arteries, the left and the right. - **[Stable Angina]** a. The initial manifestation of ischemic heart disease in approximately half of persons with coronary artery disease. b. [Stable angina is typically triggered by physical exertion or emotional stress and is relieved by rest or nitroglycerin.] c. OVERTIME can lead to unstable angina. 1\. See it Coming (predictable) 2\. Short Lived (less than 15min) 3\. Stop with rest (nitroglycerin) 4\. Stiff Arteries - **[Causes of Unstable angina]** a. Atherosclerotic plaque disruption b. Platelet aggregation c. Secondary hemostasis d. **[Unstable angina: is angina that is substernal (below the breastbone) chest discomfort, not relieved by rest or nitroglycerin; often describes as an elephant sitting on my chest. It is accomplished by symptoms such as pallor, diaphoresis (Sweating), dyspnea, nausea, and vomiting.]** e. **Remember Unstable angina the 4 "UN" s** 1. Unexpected chest pain. 2. Unaltered chest pain (rest or Nitro don't help) 3. Unrelenting (less than 15 minutes with multiple episodes. 4. Un survivable without treatment. - **[Characteristics of Pain Associated with Unstable Angina]** a. The pain has a more persistent and severe course and is characterized by at least one of three features: b. It occurs at rest (or with minimal exertion), usually lasting more than 20 minutes (if not interrupted by nitroglycerin). c. A potent Vasodilator d. **[It is severe and described as frank pain and of new onset.]** [ **(something that occurs suddenly). Female patient can walk in the ER stating pain in the jaw radiating to shoulder.** ] e. It occurs with a pattern that is more severe, prolonged, or frequent than previously experienced. - **[Chronic Stable Angina]** - Associated with a fixed coronary obstruction that produces a disparity between coronary blood flow and metabolic demands of the myocardium. **[Nonpharmacologic Treatment of Angina]** 1. Smoking cessation in persons who smoke 2. Stress reduction 3. Regular exercise program 4. Limiting dietary intake of cholesterol and saturated fats 5. Weight reduction if obesity is present 6. Avoidance of cold or other stresses that produce vasoconstriction. 7. ***[Embolus]*** a. An embolus is a freely moving particle, such as a blood clot, that breaks loose and travels in the larger vessels of the circulation until lodging in a smaller vessel and occluding blood flow. b. Emboli are usually a complication of heart disease: ischemic heart disease, atrial fibrillation, or rheumatic heart disease. c. The Seven "P" s of Acute Arterial Embolism (clot in the arteries) 1. Pistol shot (acute onset) 2. Pallor: pale appearance 3. Polar (cold) 4. Pulselessness 5. Pain 6. Paresthesia: numbness 7. Paralysis 8. **[Endocarditis: A Serious Heart Infection]** Caused by bacteria and fungi a. A damaged endocardial surface b. A portal of entry by which the organism gains access to the circulatory system c. The presence of valvular disease, prosthetic heart valves, or congenital heart defects provides an environment conducive to bacterial growth. d. In persons with preexisting valvular or endocardial defects, simple gum massage or an innocuous oral lesion may afford the pathogenic bacteria access to the bloodstream. e. **[Infective endocarditis:]** is a type of endocarditis caused by an infection. It occurs when bacteria or fungi enter the bloodstream and attach to damaged or artificial heart tissue. f. Invasion of the heart valves and endocardium by a microbial agent, g. Formation of bulky, friable vegetations and destruction of underlying cardiac tissues and Systemic manifestations a. Definition: Respiratory disorders involving inflammation of the lung structures (alveoli and bronchioles). b. What causes pneumonia: Infectious agents, such as bacteria and viruses and Noninfectious agents, such as gastric secretions aspirated into the lungs. **[Factors Facilitating the Development of Pneumonia]** a. An exceedingly virulent organism b. A large inoculum: The inoculum is any part of the pathogen that can initiate infection. c. Impaired host defenses: A deficient immunologic defense may allow infection to become established. d. Immunocompromised Person such as patient with AIDS, CANCER Classifications of Pneumonias - According to the source of infection - Community-acquired - Hospital-acquired \- According to the immune status of the host - Pneumonia in the immunocompromised person - **[Infection that is detected within the first 48hrs of hospitalization is defined as community acquired infection, whereas infection that occurs later during the course of hospitalization is defined as nosocomial or hospital acquired infection.]** **[Tuberculosis:]** - Caused by the mycobacterium M. Tuberculosis - Outer waxy capsule that makes them more resistant to destruction - Infect practically any organ of the body; the lungs are most frequently involved - Macrophage-directed attack, resulting in parenchymal destruction - **[Cell-mediated immune response ]** - **[Confers resistance to the organism ]** - **[Development of tissue hypersensitivity ]** - **[TB is spread through air from person to person. Tiny particles containing M. TB may be expelled into the air when a person with infectious TB of the lungs, airway or larynx.]** - **[Cough, speak, sings, people nearby breather in these TB bacteria.]** **[Here are some key points of TB]** 1. **[TB is a potentially severe infectious disease caused by Mycobacterium tuberculosis. ]** 2. While it mainly affects the lungs, it can also impact other organs such as the kidneys, spine, and brain **Transmission and Spread:** 3. TB spreads through the air when infected individuals cough, sneeze, or spit. Tiny droplets containing TB germs can be inhaled by others, leading to infection. 4. Crowded places and close living conditions facilitate the spread of TB. 5. People with weakened immune systems, such as those with HIV/AIDS, are at higher risk of contracting TB. 6. Tb is spread, negative room or hepa filter. ***[Diagnosis and Treatment: ]*** - Diagnosis involves physical examination, skin tests (such as the tuberculin skin test), blood tests, and imaging (like chest CT scans). - Antibiotics are used to treat TB, but drug-resistant forms pose challenges. - Proper medications and care can cure TB, but treatment duration may span several months. **[Prevention: ]** - The BCG vaccine helps prevent TB, especially in children. BCG will always be positive. - Measures include wearing masks around infected individuals, maintaining separate utensils and rooms, avoiding large gatherings, practicing good hygiene, and keeping living spaces well-ventilated. **[PAD : peripheral arteray disease. ]** 1. [The classic symptom of PAD is intermittent claudication, which refers to pain, cramping, or weakness in the leg muscles during activities such as walking or climbing stairs.] **[Etiology OF PAD]** - [The primary risk factor for developing PAD is smoking, which significantly increases the deposition of atherosclerotic plaques in the arteries. ] - [Other risk factors include diabetes mellitus, hypertension, hyperlipidemia, obesity, and a family history of cardiovascular disease.] [Classifications of Rhinosinusitis on exam IMPORTANT !!!] 1. [Acute rhinosinusitis ] - May be of viral, bacterial, or mixed viral--bacterial origin. - May last from 5 to 7 days up to 4 weeks - Symptoms: facial pain, headache, and copious amounts of thick purulent nasal discharge 2. Subacute rhinosinusitis - Lasts from 4 weeks to less than 12 weeks 3. Chronic rhinosinusitis - Lasts beyond 12 weeks 4. Rhinitis: inflammation of the nasal mucosa. 5. Sinusitis: inflammation of the paranasal sinuses. Definition and Functions of the Pericardium 1. Definition: A double-layered serous membrane. 2. Functions: - Isolates the heart from other thoracic structures - Maintains its position in the thorax - Prevents it from overfilling - Contributes to coupling the distensibility between the two ventricles during diastole; they both fill equal. 3. [Pericarditis (pericardial disorder 1)] - [An acute inflammatory process of the pericardium, which is thin, sac like membrane surrounding the heart. When someone has pericarditis, this protective swollen and irritated. ] - [Example is infection and trauma ] - [Can be acute, chronic, or constrictive. ] 4. **[Pericardial Effusion ]** - The accumulation of fluid in the pericardial cavity 5. **[Cardiac Tamponade ]** - Slow or rapid compression of the heart due to accumulation of fluid, pus, or blood in the pericardial sac. 6. **[Constrictive Pericarditis]** (pericardial disorder 2) - Calcified scar tissue develops between the visceral and parietal layers of the serous pericardium. - Cardiac output and cardiac reserve become fixed. - Ascites (fluid build-up in the abdomen), pedal edema, dyspnea on exertion, and fatigue, Kussmaul sign. Disorders of the Pleura 1. [Pleural effusion]: abnormal collection of fluid in the pleural cavity - Transudate or exudate, purulent (containing pus), chyle, or sanguineous (bloody) 2. [Hemothorax] is a severe condition where blood collects in the pleural space, which is the hollow area between your lungs and your rib cage 3. [Pleuritis] is a condition where the pleura, which are the thin layers of tissue that line the lungs and chest wall, become inflamed 4. [Chylothorax] occurs when chyle, a milky fluid from your digestive tract, escapes into the pleural space surrounding your lungs. 5. **[Chylothorax]** occurs when chyle, a milky fluid from your digestive tract, escapes into the pleural space surrounding your lungs. 6. [Atelectasis] refers to the collapse or closure of a lung, resulting in reduced or absent gas exchange. It may affect part or all of the lungs. It is a condition where the alveoli are deflated, unlike pulmonary consolidation. 7. [Empyema] is a medical condition characterized by the accumulation of pus within the pleural space, which is the cavity between the lung and the membrane surrounding. **[Pleural Effusion: An abnormal collection of fluid in the pleural cavity]** - Types of fluid are - Transudate - Exudate - Purulent drainage (empyema) - Chyle - Blood **Pulmonary Embolism** Development: A blood-borne substance lodges in a branch of the pulmonary artery and obstructs the flow **Types:** - Thrombus: arising from DVT - Fat: mobilized from the bone marrow after a fracture or from a traumatized fat depot - Amniotic fluid: enters the maternal circulation after rupture of the membranes at the time of delivery **Pulmonary Hypertension** Signs and Symptoms of Secondary Pulmonary Hypertension - Dyspnea and fatigue - Peripheral edema - Ascites - Signs of right heart failure (cor pulmonale) - A disorder characterized by an elevation of pressure within the pulmonary circulation - Pulmonary arterial hypertension. **Causes of respiratory failure** 1. **Impaired ventilation** - **Upper airway obstruction** - Weakness of paralysis of respiratory muscles - Chest wall injury 2. Impaired matching of ventilation. 3. Impaired diffusion - Pulmonary edema - Respiratory distress syndrome. **Treatment of respiratory failure** - [Oropharyngeal (OPA) or nasopharyngeal : These are devices inserted orally or nasally to secure an open airway.] - [Intubation: This is the process of inserting a tube into the trachea in order to establish an airway and facilitate breathing support via mechanical ventilation. ] - [Airway suctioning: This is the process of clearing secretions from a patient's airway.] **[ROME: ACID BASE Mnemonic]** -COPD AND asthma are two conditions that can cause respiratory acidosis. Hyperventilation or anxiety can cause respiratory alkalosis. Signs and symptoms of hypertension **[Nonpharmacologic Treatment of Angina]** - Smoking cessation in persons who smoke - Stress reduction - Regular exercise program - Limiting dietary intake of cholesterol and saturated fats - Weight reduction if obesity is present - Avoidance of cold or other stresses that produce vasoconstriction. Sarcoidosis -Sarcoidosis is an inflammatory disease characterized by the formation of tiny collections of inflammatory cells called "granulomas." - These granulomas can deposit in any part of the body and affect almost any organ, but the most affected areas are the lungs, lymph nodes, eyes, and skin. - The occupational lung diseases - Hypersensitivity pneumonitis - Lung diseases caused by exposure to toxic drugs