test.txt

• concentration of the blood
• Normal 270-295

135-145

40-45%

10-20

• insufficiency of ADH, leading to polyuria and polydipsia
• hx of head injury, pituitary tmor, craniotomy

• Neurogenic (central)
• Nephrogenic

• insufficient ADH
• may follow head injury or surgery near the lesion area

• End organ failure
• insensitivity of the renal tubule to ADH
• drugs and disorders damage the renal tubule

• Partial or total inabilty to concentrate urine. Insufficient ADH secretion causes secretion of large volumes of dilute urine, leading to an increase in plasma osmolatity
• urine out put 3 to >12 L/day
• Specific Gravity 1.00-1.005
• Dehydration can develop rapidly

• measure of concentration of urine
• Normal 1.010 - 1.020

• Monitor fluids
• Replace Fluids
• Check neuro states
• Check vital signs
• check muccous membranes

• Polyuria, nocturia, thirst, polydipsia
• increase plasma osmolality
• decrease urine spenific gravity
• decreased urine osmolality
• hypovolemia, tachycardia, decreased b/p

condition that results from increased levels of thyroid hormone. could be due to graves disease, adenomas, carcinomas, pituitary issue

Graves disease

• result of increased circulating thyroid hormones
• increased T3, T4, decreased TSH
• clubing fingers, Tremors, increaed diarrhea, Menstrual changes (amenorrhea), intolerance to heat, fine straight hair, bulging eyes, facial flushing, enlarged thyroid, tachycardia, increase systolic BP, breast enlargement, weight loss, muscle wasting, nervousness, increased appetite

• more common in women, Familial tendency, autoimmune disease
• Thyroid autoantibodies are found in more than 95% of clients

suppression of TSH and TRH, increased iodine uptake, increaed thyroid gland metabolism, lead to enlargment of the gland

• enlarged thyroid gland
• can be seen ini both hypo and hyperthyroidism

subcutaneous swelling legs and hands

Exophthalmos (Bulging eyes), Edema of the orbital contents, protrusion of the globe can occur which can lead to visual disturbances, irritation, pain

• excerbation of hyperthyroidism
• worsened thyrotoxic state that can be fatal if not treated
• death can occur w/i 48hrs
• most frequently occurs in undiagnosed, partially treated and stressed individuals

infections, cardiopulmonary disorders, emotional distress, poor preparation for thyroid surgery

Hyperthermia, tachycardia, high-output heart failure, agitation, NVD

most common throid disorder due to deficient productoin of thyroid hormone by the throid gland

• loss of functional throid tissue
• leads to decreased production of TH
• that leads to increased production od TSH
• that may lead to goiter

• due to problem w/ pituitary gland and insufficient TSH
• pituitary tumors
• Decreased TSH, decreased TH

nonbacterial inflammation preceded by a virus

• destruction of thyroid tissue
• ex-Hashimoto disease

hair loss, apathy, lethargy, dry skin (coarse & Scaly), muscle aches and weakness, constipation, intolerance to cold, receding hairline, facial & eyelid edema, Dull-blank expression, extreme fatigue, thick tongue, slow speech, anorexia, brittle nails and hair, menstrual disturbances

• alteration in the composition of the dermis and other tissues
• protein-mucopolysaccharide complex binds w/ water

• excerbation of Hypothroidism
• decreased LOC, hypothermia, hypoventilation, hypoglycemia,
• LIFE THREATENING

occurs in infants as a result of absent thyroid tissue and hereditary defects in thyroid hormone synthesis

due to untreated congenital hypothyroidism

• most common cause is exposure to ionizing radiation during childhood. Small thyroid nodule or metastatic tumor in lungs, brain, bone
• s/s due to pressure on surrounding tissue

• manifestation of hypercortisolism from any cause
• Cushing disease
• Benign or Malignant adrenal tumor
• Ectopic Cushing
• Iatrogenic Cushing

• 1. more than one fasting plasma glucose level >or = 126 mg/dl
• 2. plasma glucose value in the 2 hr sample of OGTT > 200 mg/dl
• 3. Casual plasma glucose level > or = 200mg/dl with symptoms
• 4. HgbA1C= normal <7%

shows overal status of a person BS for the past few months

• Type 1
• Type 1.5
• type 2
• Gestational

• autoantibbodies detected of pancreas and B cells
• 95%
• peakage 11-13 years

• cause unknown
• no evidence of autoimmunity

Polyuria, polydipsia, polyphagia, weight loss, fatigue, increase frequency of infection, rapid onset, insulin dependent, familial tendency, peak incidence from 10-15 years

lack of insulin

to elevated glucose levels pull water from cells which results in intracellular dehydration

the effects of hyperglycemia as an osmotic diuretic renal threshold for glucose excreded

depletion of cellular stores of CHO, fats, proteins, resulting in cellular starvation

fluid loss w/ osmotic diuresis, loss of body tissue

metabolic changes

• 1. Peripheral insulin resistance
• 2. Deranged secrections of insulin by pancreatic cells
• 3. increased glucose production by the liver

obesity, diabesity, visceral fat

• 1. hyperglycemia
• 2. hypertension
• 3. hyperlipidemia-High triglycerides (>150
• 4. Abdominal obsesity

70-110

genital pruritus, visual changes, parethesias, fatigue

Fasting glucose >100 and <126 mg/dl

2 hour postload glucose level greater than or equal to 140 but less that 200 mg/dl

glucose intolerance first recognized during pregnacy, most likely in the third trimester. Following pregnancy glucose may normalize remaini impaired or progress to Diabetes Mellitus.

• lowered plasma glucose 45-60 mg/dl
• occcurs more frequently in individuals treated w/ insulin

• tachycardia, diaphoresis, pallor, tremors, dizziness, headahcem visual changes
• Adrengic-pallor, sweating, tachycardia, sweating, palpitations, hunger, restlesness, anxiety, tremors, clammy skin
• Neurogenic- Fatigue, irritabilty, headache, visual changes, dizziness, convulsions

• most commonly occurs in Type 1 diabetics
• develops when ther is an absolute or relative deficiency of insulini and an increase in insulin counterregulatory hormones. Hepatic glucose production increases. peripheral glucose usage decreases, fat mobiliaztion increase and ketogenesis is simulated

• catecholamines, cortisol, glucagon, growth hormon
• are realses during a stress responce

type 1, illness, infection, trama, surgery, mi, stress evernt

• Hyperglycemia (BG 300-750)
• Ketosis (Ketones come from fat metabolism)
• Metabolc Acidosis (ketones acid) ,low bicarb <15, low pH <7.3

polyuria, polydipsia, N/V, Fatigue, hypotension, tachycardia, stupor leads to coma, abdominal pain, fruity breath, kussmauls respirations

• Hyperventilation
• rapid , deep

fluid loss from osmotic diuresis due to hyperglycemia

K+ normal or elevated (Met Acid= high K+), shift of H20 and K+ from EC due to hyperosmolarity of ECF due to hyperglycemia, NA normal or decreased

• diverticula
• asymptomatic diverticular disease
• diverticulosis
• inflammation of pouchings
• diverticulitis
• most frequent site for diverticulitis
• sigmoid colon

form at weak points in colon wall, usually where arteries penetrate tunica mucularis to nourish mucosal layer. colonic mucosa herniates through smooth muscle layers. muscle hypertrophy and contraction occurs

• age
• diet of refined foods

• may be vague or absent
• cramping
• diarrhea, constipation, distention, flatulence
• inflammation and abcesses may occur
• fever, leukocytosis tenderness, LLQ
• Mass that protrudes into lumen of gut. benign neosplasm
• adenomatous polyp
• raised mucosal nodules of adenomatous polyp
• sessile
• attached by stalk of adenomatous polyp
• pedunculated
• most common site of adenomatous polyp
• rectosigmoid colon
• 3rd most common cause of cancer and cancer death in us for men and women most begin with adenomatous polyp > 50 years of age
• colorectal cancer
• risk factors of colorectal cancer
• family hx
• ulcerative colitis
• high fat, lowfiber diet
• alcohol
• sedentary lifestyle
• smoking

• depends on site
• bleeding
• change in bowel habits
• pain is late sign

• jaundice (icterus)
• may see 1st in sclera

• portal hypertension
• normal is 3 mm Hg
• d/t obstruction, thrombosis, inflammation, cirrhosis
• Altered immunologic response to antigen that results in disease or damage to host
• hypersensitivity

• Type I: IgE mediated
• Type II: Tissue-specific reactions
• Type III: Immmune complex mediated
• Type IV: Cell Mediated
• Seasonal allergic rhinitis and asthma are examples of:
• IgE mediated reaction
• Rate of development-Immediate
• Antibody involved-IgE
• Effector cells involved-Mast cells
• Participation of complement-NO
• Autoimmune thrombocytopenic purpura, Graves disease, autoimmune hemolytic anemia are examples of:
• Tissue specific reaction
• Rate of development-Immediate
• Antibody involved- IgG and IgM
• Effector cells involved-Macrophages in tissues
• Participation of complement-Frequently
• Systemic lupu erythematosus is an example of:
• Immune complex mediated reaction
• Rate of development-Immediate
• Antibody involved-IgG and IgM
• Effector cells involved- Neutrophils
• Participation of complement-Yes
• Contact sensitivity to poison ivy and metals (jewelry) are examples of:
• Cell-mediated reaction
• Rate of development-Delayed
• Antibody involved-None
• Effector cells involved-lymphocytes and macrophages
• Participation of complement-No

• IgE mediated-result of excessive or inappropriate production of IgE antibodies after exposure to some type of environmental antigen.
• With initial exposure to antigen, IgE (immunoglobulin)binds to Fc receptor on surface of mast cell. Individual now sensitized to antigen. Antigens cause allergic responses called allergens. With subsequent exposure to antigen, tiny sacs in mast cells called granules break open and release histamine, which then triggers inflammatory response
• Most potent mediator of Type I reaction
• Histamine
• Contracts Bronchial smooth muscles
• Increases Vascular permeability
• Increases blood flow to affected area
• Increased gastric acid secreation (N/V)
• Examples of Type I
• Hay fever
• Food and drug allergies
• Bee stings
• Asthma
• Anaphylaxis

• Sudden onset
• GI symptoms
• Urticaria-hives
• ENT and respiratory symptoms
• Anaphylaxis-rapid onset, urticaria, cramps, difficulty breathing. Caused by bronchospasm, angioedema, hypotension, shock. Can be Lethal

• Predisposition to develop allergies
• Genetic tendency
• Higher quantities of IgE
• More Fc receptors on mast cells which connect IgE

• Blood transfusions-red blood cell reaction
• Specific cell or tissue (tissue specific antigens) is target of immune response. Direct interaction b/t IgG and IgM class antibodies and tissue or cell surface antigens.

• Cell is destroyed by antibodies and complement
• Antibody may cause cell destruction through phagocytosis
• Toxic products produced by neutrophils
• Antibody dependent cell mediated cytotoxicity (ADCC)
• Cell malfunctions

• Erythroblastosis Fetalis-Rh or Abo incompatibility b/t blood of mother and fetus
• Hemolytic anemia-antibodies produced against red blood cells could be drug induced
• Transfusion reaction-Antibodies produced against donor cells

• Abnormal creation that forms. ex-autoimmune disorder
• caused by antigen antibody immune complexes formed in circulation and deposited later in vessel walls and other tissue.
• Size influences whether remain in plasma or lodge in tissues where they result in tissue damage.
• Complement activated and neutrophils degranulate enzymes damage tissue. can damage and destroy healthy tissue

• Serum sickness
• Systemic lupus erythematosus
• arthus reaction-local reaction
• Acute glomerulonephritis that follows strept infection

• Mediated by Sensitized T lymphocytes
• Don't involve antibody
• Reaction delayed-24-72 hours after exposure

• Graft rejection
• Skin test for TB
• Allergic contact dermatitis- poison ivy and metals

• Breakdown of tolerance to own antigens
• SLE
• Chronic multisystem inflammatory disease-abnormal antibodies attack RBC's
• Autoantibodies against nucleic acids, erythrocytes, Coagulation porteins, platelets
• Deposition of circulating immune complexes containing antibody against host DNA
• More common in females
• Clinical manifestation-Butterfly rash, Lupus

• Not just localized-can become systemic
• facial rash
• discoid rash
• photosensitivity
• Oral or nasophyaryngeal ulcers
• arthritis
• serositis
• renal disorders
• neurologic dis
• hematologic disorder
• immunologic disorder
• Presence of antinuclear antibody-blood test of ANA-titer. some reaction going on in body if ANA is elevated

• Acquired Immunodeficiency Syndrome (AIDS)
• Blood borne pathogen. Increasing faster in women than men.
• Depletes CD4 Th cells
• Incidence:Worldwide 5 mill/yr
• US 31K/yr

• Retrovirus
• Genetic information stored in RNA rather than DNA
• Contains reverse transcriptase to convert RNA into double stranded DNA
• Integrase inserts new DNA into infected cells genetic material
• Structure:GP 120 proteins bind to CD$ molecule found on surface of CD4 Th cells

800-1000 cells/mm3

• Antibody 4-7 wks after blood products
• Antibody 6-14 mo after sexual transmission
• Window period
• Can still be infectious
• Early signs-flu symptoms, swollen lymph glands, diarrhea, fatigue

Organisms produce infection in persons w/impaired immune function

• Encephalopathy
• Myelopathy
• Neuropathy
• Viral meningitis
• Opportunistic infections
• Neoplasms
• Bleeding

• Tumors of the skin are normally associated with aging
• Seborrheic Keratosis
• Actinic Keratosis

• Benign proliferation of the basal cells that produce smooth or waxy elevated lesions
• more common in older adults
• on chest, back, face
• Shades of tan, yellow, flesh colored, brown-black lesions

• precancerous tumors associated with exposure to UV radiation of the sun
• risk=individuals w/ unprotected light skin
• pigments patchese of rough skin

• Mole
• pigments and nonpigmented
• Flat and elevated
• watch for malignant transformation

fair complexion, excessive exposure to the sun, tanning salons, or ultraviolet radiation predisposes a person

• caused by sunlight exposure
• on face, neck
• slow growth
• metastatic spread rate
• more common in men then women

• start as nodule
• Pearly/Ivory
• Depressed Center and rolled borders
• progressess to ulceration with waxy borders

• A tumor of the epidermis
• Malignant potential
• sun exposure and fair complexion
• Red, scaly, elevated, irregular borders
• shallow chronic ulcer

• A tumor originating from the melanocytes
• Rapidly progressive, metastatic
• intermittent intense sun exposure
• Raised, black, brown most from Nevi or moles shades of red, blue or white

cells that synthesize the pigment melanin

• A=Asymmetry
• B=Border Irregularity
• C=Color variation
• D= diameter >6mm
• E=Evolving Change

• Vascular Malignancy
• Endothelial Cell
• Purplish brown macules-develop into plaques and nodules
• Immunosuppression, transplant recipient, AIDS, African middle aged blacks, Jewish descent