HESI Pathophysiology Review Q&A

HESI Pathophysiology Review 1. What is TPA? What are at least 2 conditions where you might see it given as a medication? Why would we not give it? tPA: clot busting agent used to reduce the effects of CVA (stroke) in some individuals. It is contraindicated for anticoagulant drugs. The release of tissue plasminogen (tPA) from injured blood vessels and tissues, converts plasminogen to plasmin. Plasmin is a potent enzyme that digests fibrin strands (this leads to clot dissolution). 2. Know the triad that would lead you to conclude your patient is experiencing cardiac tamponade Fluid compresses the heart, prevents stretching & filling, reduces CO Arterial pressure falls, venous pressures rise, pulse pressure narrows Beck’s Triad: Distant, muffled heart sounds (like under water, fluid), JVD, decreased BP =EMERGENCY pericardiocentesis with surgical repair as appropriate is needed (16-18 gauge needle inserted into pericardial space to relieve pressure and analyze fluid) Manifestations include heavy feelings over the chest, shortness of breath, tachycardia, cough, dysphagia, hiccups, hoarseness, nausea, vomiting, excessive perspiration, decreased level of consciousness, pulses paradoxes, distant or muted heart sounds, and extreme anxiety, neck vein distension 3. The 3 Ps of diabetes Polydipsia: osmolality, polyuria: osmotic diuresis, and polyphagia: cell starvation 4. What electrolyte is of most concern with kidney failure patients? Potassium: cardiac 5. Review the signs of hypokalemia and hyperkalemia Hypokalemia: muscle cramps, weakness, cardiac arrhythmias, flattening of the T wave, confusion and drowsiness, and irritability Hyperkalemia: peaked T wave, v-fib, cardiac arrest, muscle weakness, respiratory distress 6. Right sided heart failure versus left sided heart failure CHF: Occurs when the heart is unable to pump sufficient blood to meet the metabolic needs of the body; usually occurs secondary; may present as an acute episode but usually is a chronic condition; may result from an infarction or a valve defects may arise from increased demands on the heart, such as those imposed by hypertension or lung disease; Left-Sided Heart Failure: Characterized by impaired pumping ability of left side of heart; Eventually backs blood up into pulmonary circulation (crackles)- THIS IS BAD-FLUID IN THE LUNGS MEANS LESS AIR IN THE LUNGS; Results in elevated pressure and congestion in pulmonary veins/capillaries; Symptoms: Fatigue, activity intolerance, shortness of breath, cough, orthopnea, paroxysmal nocturnal dyspnea **tripod position (leaning over: usually seen); **Pulmonary congestion: pink frothy sputum, cough, crackles, wheezes, tachypnea Right-Sided Heart Failure: Characterized by impairment of pumping ability on right side of heart; Backup of blood followed by congestion and elevated pressure in systemic veins and capillaries; Most common cause is left-sided dysfunction; Symptoms result from volume overload leading to ascites and edema; Patients may complain of abnormal bloating and discomfort, with poor appetite and sometimes nausea and vomiting 7. Can you tell the difference between diabetes insipidus, diabetes mellitus type 1 & type 2? DI: lack of ADH action, dehydration DM1: complete lack of insulin, usually diagnosed young; Absolute absence of insulin – must have injections or insulin pump for life. NOT oral meds; Two types: immune mediated (most common, especially in children; Latent autoimmune diabetes (LADA) in adults Genetic disposition + trigger (eg infection) + T cell hypersensitivity to beta cell antigen) and idiopathic (less common, no autoimmune component) DM2: lifestyle changes, accounts for 90% of diabetes, strong correlation with diabetes, genetic component, cellular resistance to insulin, deranged insulin secretion: beta cells fail, increased glucose production by liver; diagnosed later d/t insidious onset; frequent infections, slow wound healing, blurred vision; Usually oral meds as initial pharmacotherapy but often require insulin therapy later; often require insulin when acutely ill on temporary basis 8. Can you summarize the difference between multiple sclerosis and ALS? How about how do they differ from Parkinson's? MS: (Multiple Sclerosis) involves a progressive demyelination of the neurons in the brain, spinal cord, and cranial nerves; characterized by remissions and periods of exacerbations; considered a disease of young to middle-aged adults with the onset usually being between 20 and 50 years of age; Onset is usually insidious and gradual; course is unpredictable; debilitating autoimmune disorder; Clinical manifestations: fatigue, ataxia, muscle spasms, paresthesia or abnormal sensations, difficulty moving arms or legs, unsteady gait, tremor, bowel and bladder issues, decreased attention span, difficulty reasoning, dizziness, hearing loss; Predisposing factors include being between 20- 40 years old, smoking, women, and caucasian ethnicity ALS: (Amyotrophic Lateral Sclerosis) progressive degenerative disease affecting both upper motor neurons in the cerebral cortex and lower motor