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Coagulation disorder with paradoxical thrombosis and hemorrhage.
Disseminated Intravascular Coagulation (DIC)
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An acute complication of hypotension and septicemia; a common cause of respiratory failure.
Disseminate Intravascular Coagulation
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What are some s/s of DIC?
- shortness of breath
- weak, thready pulse
- cold & clammy skin
- hematuria
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BGL > 600 mg/dL
plasma osmolarity > 320 mOsm/L
dehydration
depression of sensorium
- Hyperosmolar Hyperglycemic State (HHS)
- *No ketoacidosis
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What type of pts is HHS mostly seen in?
Most frequently in people with type 2 diabetes.
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What happens to water in people with HHS?
It is pulled from the cells (including brain cells)
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s/s of HHS?
- weakness
- dehydration
- polyuria
- excessive thirst
- changes in CNS (sometimes mistaken for stroke)
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What is osteoporosis?
- Loss of mineralized bone mass;
- the bone resorption exceeds bone formation
- Usually the bone loses density, which measures the amount of calcium and minerals in the bone
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When does the loss of bone mineral density increase related to osteoporosis?
early menopause (decrease in estrogen)
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What is the main cause of fractures in older adults?
Osteoporosis
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If hCG levels do not decrease in a pt with a hytadiform mole, what may develop?
choriocarcinoma
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What can a high level of hCG hormone indicate in a person who is not pregnant?
Cancer. Some cancerous tumores produces hCG
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What is TPA (Tissue Plasminogen Activator)?
- A protein that catalyzes the conversion of plasminogen to plasmin and causes the breakdown of clots.
- (plasmin digests fibrin, & clot dissolves)
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When would TPA be used as a treatment?
Embolic or Thrombotic Stroke
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When would administration of TPA be contraindicated?
hemmorhagic stroke or head injury
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What is a molar pregnancy?
- instead of a fetus growing in the uterus, an abnormal growth is and shows similar s/s of pregnancy.
- This predisposes the pt to developing choriocarcinoma.
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What are the normal levels of hCG when a woman is not pregnant?
< 5
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What does an hCG level of between 5 and 25 mean?
You MIGHT be pregnant
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At what level is hCG upon confirmation of pregnancy?
> 25
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What causes a cardiac tamponade?
pericardial effusion (fluid im the pericardial CAVITY)
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What is cardiac tamponade?
- The heart is compressed due to accumulation of fluid, pus, or blood in the pericardial SAC.
- decrease in SV, CO, & organ perfusion
- increased intracardiac pressure
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Where is HDL made?
in the liver
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What does HDL do?
carries cholesterol from peripheral tissues back to liver
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What is HDL mostly made of?
50% protein
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What is 54% of the plasma proteins and helps maintain BV by contributing to osmotic pressure?
albumin
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What kind of defects is CHF associated with?
acyanotic (abnormal circulation, but all blood entering systemic system is oxygenated)
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CHF is a common complication of what?
congenital disease
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What is CHF (congestive heart failure)?
- Heart is unable to pump effectively
- pressure in the heart increases.
- As a result, the heart cannot pump enough oxygen and nutrients to meet the body's needs.
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What is barrel chest an indication of? What causes it?
- Emphysema
- Use of accessory muscles to breath because lungs are chronically over-filled with air
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What is emphysema?
damage to the air sacs cause air pockets which trap air and breathing is difficult
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What is the significance of AAT (Alpha-1-antitrypsin) in emphysema?
- They normally protect the breakdown of elastin by proteases.
- If someone is deficient in AAT (produced in the liver), it can result in emphysema.
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What is Addison Disease?
- hypofunction of the adrenal cortex
- lack of cortisol, aldosterone, androgens
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Why is there an increase in ACTH in Addioson Disease pts?
lack of feedback inhibition
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Clinical manifestations of Addision disease.
- hyponatremia (no aldosterone)
- hyperkalemia (decreased excretion)
- decreased ECF
- decreased CO
- hyperpigmentation (elevated ACTH)
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Other than helping in the stress response, what else does cortisol help with (Addison disease pts lack this)?
- regulate blood pressure & immune system
- balance the effect of insulin in regulating the blood sugar level
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Addison disease pts lack aldosterone. Why is aldosterone important?
- It helps regulate salts in the blood and
- helps to control blood pressure.
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If a pt came in with stiffness, wt loss, and swelling of BOTH hands and wrists, what would you suspect?
Rheumatoid arthritis
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Rheumatoid arthritis is a chronic, systemic, progressive deterioration of what?
Connective Tissue (synovium) of joints
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What would you leave out when assessing a pt with suspected rheumatoid arthritis?
ROM - this causes pain and is limited
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What is multiple sclerosis?
inflammation and destruciton of the CNS myelin
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What is the focus for treatment in MS?
preventing infection
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Where do symptoms usually begin in MS pts?
weakness in arms, eventually progressing to spastic paralysis
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What is shock?
- Widespread, serious reduction of tissue perfusion
- leads to generalized impairment of cellular fxn
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Most common cause of shock.
Hypovolemia
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What causes septic shock?
- release of endotoxins by bacteria;
- act on nerves in vascular space and cause pooling;
- decreases venous rtn & CO = poor systemic perfusion
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Early signs of shock.
agitation and restlessness due to cerebral hypoxia
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Complete failure of bone ends to unite.
Nonunion
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Fracture healing doesn't occur at normal rate of 6-8 weeks.
Delayed union
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Deformity at the fracture site caused by malalignment of fracture at time of immobilization.
Malunion
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What is a fat embolism?
fat molecules in the bloodstream combine with platelets and form an embolus.
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Normal Hct levels.
Men: 40-54%
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Normal Hgb values.
- Men: 13.5-18 g/dL
- Women: 12-15 g/dL
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What prevents ECF from becoming too acidic or too alkaline?
HCO3 (buffer)
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Most common cause of death from a fracture.
Hypovolemic shock
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Common cause of hemiplegia.
- damage to the corticospinal tracts in one hemisphere of the brain due to:
- obstruction/rupture of a cerebral artery
- or brain tumor.
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Sharp, bright, burning pain. Can have fast or slow onset.
Cutaneous
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Pain that stems from tendons, muscles, joints, periosteum, & BV.
Deep Somatic Pain
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Pain that orginates from internal organs; diffused at first may be localized.
Visceral pain
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A large pulmonary embolus can affect the heart how?
cause rt side heart failure
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s/s of pulmonary embolus.
chest pain, shortness of breath
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