What makes the blood acidic in respiratory failure?
- Low O2 levels and is retaining
- high CO2 which makes the blood acidic
ARF:
acute respiratory failure
ARDS:
adult respiratory distress syndrome
IRDS:
infant respiratory distress syndrome
There are two types of ARF what are they? Hypoxemia
- low PaO2 (oxygenation)
- Poor ventilation
- poor perfusion (need oxygen to perfuse)
There are two types of ARF what are they? Hypercapnia
- High PaCO2 (carbon dioxide)
- Leads reduce alveolar ventilation
- Metabolic and respiratory acidosis (acidic pH < 7.3, and high CO2 content)
Mechanical ventilation assists with ___________ and ______________ via positive pressure.
- ventilation
- gas exchange
If a patient has: severe hypoxemia with low PaO2 even while on 10 L/min of oxygen via a non-rebreather mask has a low blood pressure is tachycardic and shallow respirations what could they have?
ARDS
What is another name for IRDS?
Hyaline membrane disease
What is the primary cause of the loss of lung compliance and alveolar surface tension in infants with IRS? The loss of:
lack of surfactant
The answer to #7: has three primary roles: what is a surfactant?
- Prevents movement of fluid into the alveoli and keeps the lungs “dry” and non-congested
- Lowers the surface tension in the alveoli on inspiration
- Helps keep the alveoli open on expiration
What is a pulmonary embolism?
- Clot in the lungs
- blocking off blood flow
- reducing amount of deoxygenated blood, reaching lungs for oxygenation
What is the different between an exudate and non-exudate cause of pneumonia? Exudate: (secretion and fluid):
No exudate:
- Exudate: (secretion and fluid): bacterial cause
- No exudate: viral cause
What is the purpose of sputum culture?
To check what bacteria/virus is in it
In a patient with pulmonary tuberculosis what are some unique findings
- Granulomatous inflammation
- Ghon tubercles (necrotic nodules from fibrosis and calcification of chronic inflammation on x-ray)
Does being ‘positive’ on a TB test mean that you actively have TB?
No, it checks to see if you have been exposed
What Is the worst type of lung neoplasm?
Small cell- (5% survival rate) most aggressive, metastases, widespread
What is the most common type of lung neoplasm?
Squamous cell- in main bronchi
What is adenocarcinoma often misdiagnosed as?
- Chronic bronchitis
- emphysema
Who is most likely to have pulmonary hypertension?
Young women 20’s-30’s, unknown cause and progress rapidly
How does pulmonary hypertension affect the pulmonary artery?
Thickened, atherosclerosis can develop from the tension and stress
Would you expect pulmonary artery pressures to be high or low? Why?
High- because when you have pulmonary hypertension it raises your pulmonary arteries high above 25 mmHg
Would you expect right ventricular pressures in a pulmonary hypertension patient to be low or high?
High- right ventricular hypertrophy (thickens and strengthens to match pushing against high pulmonary artery pressures)
What are some examples of ‘pneumoconiosis’ or occupational lung diseases?
- Anthracosis (coal)
- Silicosis (dust containing silica)
- Asbestosis (asbestos fibers)
Where do 95% of pulmonary embolism blood clots originate from?
Lower extremities/pelvis
A pulmonary embolism isn’t always clot sometimes it can be:
- fat
- air
- amniotic fluid
The most at RISK for developing a pulmonary embolism are the following:
- Venous stasis> underlying venous disease or they are truck driver/sitting for long periods of time
- Bed bound
- Hypercoagulability (over clot already)
How do you think a pulmonary embolism can lead to right sided heart failure?
- PA pressures will rise from occlusion/lack of blood flow
- Increase pulmonary arterial pressure and increase right ventricular workload which leads to the right side being overwhelmed by the increased workload and fail.
What types of fluid and electrolyte components are INTRAcellular?
- Potassium
- Magnesium
- proteins
The #1 best route to intake electrolytes normally is:
oral
What is hydrostatic pressure?
- Helps maintain the balance of fluid between the capillaries
- It is a pressure exerted by a fluid when it is at rest. The pressure responsible for pushing fluid out of the blood and into the interstitial spaces between the cells maintaining fluid balance
When hydrostatic pressure is off balance what does this result in? (know the term)
edema and pooling of fluid in tissues
Ways we excrete fluid and electrolytes include:
- sweat
- insensible> water loss (respiratory tract, skin)
- urine
- Lungs
- feces
- Urine excretion is important! (Gives us info on what a patient has too much or not enough of)
- ADH: excreted when there is excessive eater/fluid build up,
- Aldosterone: excreted when there is too much sodium and loss of potassium
- Atrial natriuretic factor: (comes from heart/atrium when under pressure)
Some abnormal ways of losing fluid and electrolytes include the following please explain what they are:
- Emesis: vomiting (diarrhea)
- chest tubes: drain fluid, blood
- endotracheal tubes: help establish airway but patients can aspirate fluid out of tube if not placed properly
- Hemorrhage: blood loss from rupture
A patient is having uncontrollable muscle contractions and some ventricular arrhythmias. What electrolyte should you check?
Calcium
A patient is thirsty and is getting agitated and combative with you. What electrolyte should you check?
sodium
A patient was just coded (CPR and defibrillation) performed for showing Torsades De Pointes on their EKG. You know they have a history of drinking heavily. What lab level would you like to check?
Magnesium
Metabolic acidosis
(too much Hydrogen ion? Give Bicarb)
- ↓ pH
- ↑H+
- primary disturbance (↓HCO3-)
- secondary response- (↓pCO2)
Metabolic alkalosis
(Give potassium if low and fluid)
- ↑pH
- ↓ H+
- primary disturbance ( ↑HCO3-)
- secondary response- (↑pCO2)
Respiratory acidosis
(too much CO2? Hyperventilate to ‘breathe’ it out)
- ↓ pH
- ↑H+
- primary disturbance (↑pCO2)
- secondary response- ( ↑HCO3-)
Respiratory alkalosis
(not enough CO2? Breathe into a paper bag, SLOW respirations)
- ↑pH
- ↓ H+
- primary disturbance (↓pCO2)
- secondary response- (↓HCO3-)
What is the treatment for respiratory alkalosis?
not enough CO2?
- Breathe into a paper bag
- SLOW respirations
What is the treatment for metabolic acidosis?
too much Hydrogen ion?
- Give Bicarb
What is the ‘filter’ components of the kidney?
Cortex (filter, outer part)
What component of the kidney regulates urine concentration?
Collecting ducts (medulla: inner part)
80% of a patients nephrons are:
cortical (short, within the cortex)
20% of a patients nephrons are:
juxtamedullary (long loops of henle, extend into the medulla)
What are the TWO main structures of a nephron?
Renal tubule
Renal Corpuscle
Renal tubule:
- PCT (proximal convoluted tubule)
- Loop of henle/nephric loop
- DCT (distal convoluted tubule)
Renal Corpuscle:
- Outer parietal layer
- Middle basement membrane
- Inner visceral layer
How much of your cardiac output supplies blood to the kidneys?
20-25%
Why do we check creatinine levels before a heart cath?
As a measure of kidney function, We give them contrast, sedation and fluid, so we need to know how well the kidneys will filter them out.
Why are creatinine levels a good indication for kidney function?
- It is the end product of muscle metabolism
- freely filtered but NOT absorbed which makes it a good measure of renal function because it strictly ‘passes through’ the kidneys- like contrast would
Is it common for our kidneys to slow down as we age?
- After 4th degrade we lose glomeruli
- GFR (glomerular filtration rate) slows over time
- Decrease in hormone production directly affects kidney function
What information can you get from a urine test?
- Odor
- color
- clarity
- pH osmolality> concentrated? Diluted? Specific gravity> concentration levels Protein
- glucose( diabetes)
- bile Blood cells> shouldn't be there but if present, it is a problem
- Crystals
- casts> abnormal degrative material
What types of patients have glucose in their urine?
Diabetics
In patients with renal agenesis born with one kidney what normally happens to it over time?
Bilateral
Unilateral
Bilateral:
- Incompatible with life
Unilateral:
- Usually born without left kidney
- the kidney they do have will hypertrophy from increased workload
What is the second leading cause of kidney failure?
Chronic pyelonephritis
- Repeated and persistent infections leading to fibrosis of interstitial lining
- Second leading cause of renal failure
What are some treatments for renal calculi?
Renal calculi: Different types usually calcium oxalate or calcium phosphate may have pain hematuria
- Passes spontaneously
- Basket retrieval
- Lithotripsy (to shatter stone with vibration)
What type of obstructive kidney disease is most common in children?
Nephroblastoma (Wilm’s tumor)
What happens during nephrotic syndrome and what do those patients lose a lot of?
- Over filtration of proteins
- Failure to reabsorb small proteins
- Loss of albumin at a rate Faster than the liver can produce Edema from loss of hydrostatic pressure
Explain briefly the different between the three types of renal failure:
Pre: (before kidneys)
Condition has negative affect on kidney leading to reduction in perfusion
Causes:
- hypovolemia (burns or hemorrhage/trauma)
- decreased cardiac output
- change in peripheral vascular resistance (usually from anaphylaxis)
Intrarenal: (within the kidney)
Condition causing damage to renal tubule or blood vessels
Causes:
- inflammatory
- ischemia
- nephrotoxic Kidney can not regenerate if cause is inflammatory or ischemic (reversible)
- Kidney can regenerate if cause is nephrotoxic
Post: (after kidney)
- Condition obstructing flow from kidney to urethral meatus
- building up pressure within kidney
Causes:
- clots
- stones
- strictures and tumors
Renal failure is directly related to the loss of function of _________ leading to renal insufficiency.
some or all nephrons
What lab levels are good to monitor renal failure patients?
- BUN
- Creatinine
- Electrolytes
- Urine test
- Cystoscopy (view bladder under dilation)
- Radiography
- CT
- MRI ultrasounds
What nerves innovate the bladder?
Pelvic nerves S2-S3
What do patients who lose voluntary control have to do to excrete urine?
Self-cath
What is the function of the bladder?
To store urine
Why are we concerned with bladder and prostate issues in the cath lab?
Concern of static urine leading to infection and calculi. This is why they are often treated with antibiotics – from an infection.
What are the two symptoms of bladder stones?
- blood in the urine
- suprapubic pain.
How do tumors in the bladder occur? (causes)
- 20-30% from occupational exposure to chemicals, smoking and rubber.
- Can grow by direct extension or into the lymph nodes - how it metastasizes.
Who’s ureters are longer males or females?
Male
What is considered the ‘lower’ GU tract in males?
- Bladder (stores urine)
- Urethra
Name two congenital disorders of the penis?
- Micropenis: defect in testosterone production
- Urethral valves: can cause obstructions
- Urethrorectal and fistulas: requires surgery, gas through urethra or urine through rectum (I had a patient with this).
- Hypospadias
- Epispadias
What types of systemic diseases can also cause acquired diseases of the penis?
- Diabetes
- PVD (peripheral vascular disease)
Hydrocoele:
collection of fluid around the testes than can lead to swelling in the scrotum
Spermatocele:
a cyst develops and collects sperm
What is the definition of prostatitis:
Inflammation of the prostate
What cancer is most common in males?
Prostate cancer
What cancer is most common in females?
Breast cancer (carcinoma)
What are the 3 layers of the uterus?
- endometrium
- myometrium
- serosa
The menstrual cycles has TWO functions or purposes what are they?
- to stimulate the production of an ovum
- prepare the endometrium for implantation of a fertilized ovum
Hormones are important in our body. Identify what hormones are used for each: Breast development:
Breast development:
- requires estrogen
- progesterone
- growth hormone
- prolactin
Milk production:
- prolactin to product the milk ,
Milk excretion:
- oxytocin to excrete the milk
Pregnancy is concerning to our cardiac system. Name what INCREASES in a woman during pregnancy that we would be concerned with?
- Metabolism increases by 15%
- Cardiac output increases by 30-40%
- Increase blood volume
- Increased oxygen utilization by 20%
- GRF (glomerular filtration rate) of the kidneys increases by 50%
What is responsible for dysmenorrhea?
- increase in prostaglandins causes overstimulation of the uterus causing contractions and ischemia to the endometrium
What is the cause of hypertension in pregnant women?
Increase and/or retention of:
- Lead to toxemia
- Lead to Pre-eclampsia
- High BP
- Protein in urine
- Salt
- Water retention
- edema
Who is most at risk for breast cancer?
- Family history
- age
- exposure to radiation
How many types of herpes are there?
- Herpes virus infections (1 and 2)