PATHO EXAM #4 STUDY GUIDE

1.​ Differentiating..
Fluid + Electrolyte disorders
-​ Hypovolemia (fluid volume deficit): from any sort of fluid loss, decreased blood
volume, → dehydration + hypovolemic shock: RAPID PULSE, hypotension, dy
membranes, + confusion
-​ Hypervolemia (fluid volume excess): excessive fluid intake, kidney failure, or fluid
shifts. Excess fluid in interstitial intravascular compartments. EDEMA, JUD, pulm
congestion, HTN
Electrolyte disorders
-​ hyponatremia: water excess / sodium loss. Cellular swelling, headache, confusion,
nausea, + muscle weakness
-​ hyperkalemia: from renal failure or potassium sparing diuretics. excitability of cells,
-s muscle cramps, arrhythmias, cardiac arrest
Acid-Base disorders
-​ Respiratory acidosis: from hypoventilation (COPD), T CO2 > confusion, headache +
resp distress
-​ Metabolic acidosis: que to excess acid or loss of bicarb. presents w/ KUSSMAUL
BREATHING, fatigue + confusion
-​ Metabolic alkalosis: from excess bicarbonate or acid loss (VOMITING), → muscle
weakness, lightheadedness, hypokalemia.
2.​ MEDICATIONS
Diuretics
-​ Loop diuretics (furosemide): for hypervolemia tol fluid by promoting diresis, and kt
excretion
-​ K+ sparing diuretics (Spironolactone): prevent K+ loss in conditions causing
hypokalemia
Electrolyte Replacements
-​ Potassium chloride: for hypokalemia, orally or lU,
-​ Calcium Gluconate: stabilize cardiac cell membrane in T K+
Acid-Base Management
-​ Sodium Bicarb: for metabolic ACIDOSIS to T pH
-​ Albuterol: L k+ levels by shifting k+ into cells in hyperkalemia
3.​ MOA Of MEDS
-​ Loop Diuretics: inhibit Nat + Chloride reabsorption in the loop of Henle, Increased
water excretion, Nat, Chloride + It, reducing blood volume + fluid overload
-​ K+ sparing Diuretics: block aldosterone receptors, Decrease Nat + water
reabsorption while retaining K+
-​ Sodium Bicarb: provides bicarbonate ions that buffer excess hydrogen ions,
Increased blood plt & counteracting acidosis
-​ Calcium Gluconate: stabiles myocardial cells by decreasing the threshold for
excitation, w the nsi of arrhythmias + hyperkalemia
4.​ Nursing Considerations for MEOS
Diuretics:
-​ pre: check BP, k+ levels, + renal function.
-​ post: monitor fluid output, electrolyte levels, + BP.
Electrolyte Replacements:
-​ Pre: confirm electrolyte levels in renal function. IV assessment
-​ Post: monitor electrolyte, especially kt, educate on s/s of imbalances (cramping +
palpitations)
Sodium Bicarb:
-​ Pre: assess blood pH + bicarb levels. monitor for contraindic. like alkalosis
-​ Post: monitor blood pH, resp status, + signs of overcorrection (metabolic alkalosis).
Educate the pt on client + s/s of imbalance
Acid- Base Imbalances
1.​ Respiratory Acidosis (PH <7.35 + C02 > 45)
-​ cause: Increased co2 in blood from impaired ventilation. COPD, pneumonia or resp
depression
-​ Patho: Increased c02 shifts chem equation → Increase hydrogen ions → Low pH
-​ compensation: kidneys retain bicarb to fix excess acid
-​ S/S: confusion, drowsiness, headache, tachycardia, + cyanosis
Respiratory Alkalosis (pH > 7.45 + (02 135)
-​ cause: excess decrease in co2 from hyperventilation (anxiety, fear, pain, fever)
-​ patho: excessive breathing cut of C02→ hydrogen → Increased pH
-​ compensation: traneys excrete bicarb to upH
-​ SIs: Lightheadedness, dizziness, numbness, tingling + arrhythmias
Metabolic Acidosis (pH <7.35 + HCO3 222)
-​ cause: Increased acids + loss of bicarb from DKA, lactic acidosis, kidney failure, or
prolonged diarrhea
-​ patho: Increased acid or Decrease bicarb Decrease blood ph
-​ compensation: lungs increase ventilation to decrease cO2
-​ S/S: KUSSMAUL BREATHING (deep, laboreal), fatigue, confusion, hypotension +
arrhythmias
Metabolic Alkalosis (pH >7.45 or HCO3 > 260)
-​ Cause: Decrease in hydrogen ions or Increase in bicarb from vomiting, diuretics, or
Increased bicarb ingestion
-​ patho: Decreased in hydrogen ions or increase in bicarb raises blood pH
-​ compensation: lungs decrease ventilation to retain coa
-​ S/S: muscle weakness, cramps, confusion, lightheaded, hypokalemia.
Fluid Volume Deficit (hypovolemia) Minimal= 10-15%, mod = 25%, severe = >40%
-​ - Dehydration /hypovolemia, occurs when there is decreased fluid in intravascular &
interstitial fluid
-​ - causes: vomiting, diarrhea, Increased sweating, diuretics, hemorrhage, DI, etc.
-​ - patho: Decreased fluids > Increased blood volume + Increased concentration of
Solutes → cell dehydration
-​ - S/S: dry mucous membranes, & skin turgor, sunkenness, Low BP, High HR, High
RR, oliguria, dizziness, weakness, confusion, + extreme thirst
-​ complications: hypovolemic shock, seizures, & coma if severe
-​ management: fluid replacement (PO/IV), VS, I/Os , electrolyte levels.
Fluid Volume Excess (hypervolemia)
-​ hypervolemia, excess of fluid in intravascular/ interstitial spaces
-​ causes: HF, kidney failure, Increased Na+ intake, IV fluid overload, hormonal
imbalances
-​ patho: increased fluid intake/retention → increased blood volume + fluid shifts →
edema + increased workload on heart
-​ S/S: peripheral and pulmonary edema, weight gain, + distended neck veins,
bounding pulse, High BP, + tachycardia, crackles in lungs, dyspnea, orthopnea,
confusion + lethargy (cerebral edema)
-​ complications: severe case may lead to pulmonary edema, resp distress or HF
-​ management: Decrease fluids + Na+ intake, diuretics, VS, resp status, daily weights,
+ electrolyte levels
OSMOSIS
-​ movement of solutes across membrane from lesser concentration to greater
concentration - stops when concentration is =
DIFFUSION
passive transport of solutes from higher concentration to lower concentration → equal
distribution of solutes
ACTIVE TRANSPORT
-​ moving from lower to higher concentration w/ physiologic pump.
-​ sodium-potassium pump= Increased extracellular Na+, Increased intracellular K+
(needs ATP)
FILTRATION (kidney/nephron)
-​ moving from High hydrostatic pressure to Low hydrostatic pressure
ISOTONIC (NS, LR, 5% DW)
-​ no exchange of water → cell remains constant
HYPOTONIC (0.5% NS)
-​ Decreased solute concentration, water › solution, water moves out of cell
HYPERTONIC (5% D/NS, 5% D1/2NS, 10% D/W, 05LR, 3% NaCI)
-​ Increased solute concentration > water
Electrolyte Imbalances
Sodium (Na+)
Hyponatremia (Na+ <135)
-​ causes: Increased water intake, kidney disease, SIADH, vomiting, diarrhea,
diuretics
-​ S/S : headache, confusion, seizures, muscle weakness, lethargy, coma
-​ management: Decreased water intake, saline solutions, monitor Na+
Hypernatremia (Na+ >145)
-​ causes: dehydration, DI, hypertonic IV fluids, Increased salt intake
-​ S/S: thirst, dry mucous, restless, agitated, weak, seizure, coma and hyperreflexia
-​ management: gradual fluid replacement (hypotonic), monitor sodium levels, seizure
precautions
Potassium (k+)
Hypokalemia (K+ <3.5)
-​ causes : diuretics, vomiting, diarrhea, increased sweating, decreased K+ intake
-​ - SIS: muscle weakness, cramps, arrhythmias, fatigue, decreased motility & reflexes
-​ - management: PO/IV K+, (NEVER IVP), dietary K+, EKG for arrhythmias
Hyperkalemia (K+>5)
-​ causes: renal failure, k+ sparing diuretics, acidosis, burns/ trauma
-​ - SIS: muscle weakness, paresthesias, Increased T waves, Low HR, cardiac arrest
-​ management: diuretics, calcium gluconate, insulin w/ glucose, monitor EKG
Calcium (Ca+)
Hypocalcemia (Ca+ <8.6)
-​ causes: decreased vitamin D, hypoparathyroidism, renal disease, pancreatitis, blood
transfusions
-​ S/S: muscle spasms, tetany, Chvostek’s + Trousseau's signs, numbness, tingling,
arrhythmias, hyperactive DTR
-​ management: calcium supplements, vitamin D, seizure precautions
Hypercalcemia (Ca >10,2)
-​ causes: hyperparathyroidism, malignancy, immobilization, increased vitamin D
-​ S/S: muscle weakness, confusion, kidney stones, arrhythmias, polyuria
 -​ management: Increase fluid intake, diuretics, calcitonin, bisphosphonates to
decrease calcium levels
Magnesium (Mg+)
Hypomagnesemia ( Mg+ < 1.8)
-​ causes: chronic alcoholism, malnutrition, diarrhea, diuretics
-​ S/S: neuromuscular irritability, tremors, seizures, confusion, Increased DTR,
cardiac arrhythmias, (+) Chvostek’s + Trousseau’s sign
-​ management: PO/IV mag sulfate, dietary mag, monitor arrhythmias
Hypermagnesemia (Mg+ > 2.5)
-​ causes: renal failure, excessive magnesium intake
-​ S/S: muscle weakness, Decreased DTR, resp depression, hypotension, arrhythmias
-​ Management: IV calcium gluconate, diuretics, dialysis
phosphorus (PO-)
Hypophosphatemia (PO- <2.5)
-​ causes: malnutrition, alcohol abuse, hyperparathyroidism, DKA treatment
-​ S/S: muscle weakness, resp. failure, rhabdomyolysis, paresthesia, bone pain
management: phosphorus supplements, Increased dietary intake, IV phosphate
Hyperphosphatemia (PO- >4.5)
-​ causes: renal failure, hypoparathyroidism, Increased phosphate intake
-​ S/S: similar to hypocalcemia, muscle cramps, tetany
-​ management: phosphate binders, dietary restriction, dialysis

1. Causes, classification....
Diabetes Mellitus
Tуре І :
-​ cause: autoimmune destruction of beta cells, Insulin deficiency
-​ Patho: Decreased insulin prevents glucose uptake by cells causing hyperglycemia +
reliance on fat metabolism, ketone production
-​ manifestations: polyuria, polydipsia, polyphagia, weight loss, fatigue, DKA
Type 2:
-​ cause: insulin resistance combined w/ eventual decrease in insulin production
 -​ Patho: insulin resistance in muscle, fat, + liver cells → Increased glucose →
overproduction of insulin → decline in insulin
-​ manifestations: fatigue, recurrent infections, slow wound healing, blurred vision,
hyperglycemic hyperosmolar state in severe cases
Metabolic syndrome
-​ cause: associated w/ obesity, inactivity,+ genetics
-​ Patho: insulin resistance, central obesity, decreased HDL, HTN, all increasing
cardiovascular disease ask
-​ manifestations: HTN, High glucose, High waist circumference, High triglycerides,
Low HDL cholesterol
Pituitary Gland Disorders
Hypopituitarism (hormone deficiency)
-​ is caused by trauma, infection, tumors
-​ S/S: growth hormone deficiency (short stature), TSH deficiency (hypothyroidism),
ACTH insufficiency (adrenal insufficiency)
Hypopituitarism (hormone excess)
-​ → from pituitary adenomas
-​ excess ACTH causes cushing's disease, excess GH causes acromegaly /giantism
Thyroid Gland Disorders
Hypothyroidism (Hashimoto's thyroiditis)
-​ cause: autoimmune destruction of thyroid tissue
-​ patho: Low thyroid hormone → slow metabolism (manifest: fatigue, weight gain,
cold intolerance, wite, constipation, myxedema)
Hyperthyroidism (Grave's disease)
-​ cause: autoimmune activation of TSH receptors
-​ patho: excess thyroid hormone increases metabolic rate
-​ manifest: decreased weight, heat intolerance, tachycardia, tremors, exophthalmos
Adrenal Gland Disorders
Cushing's Syndrome (Hormone Excess)
-​ cause: Increased exposure to I cortisol levels from endogenous (pituitary adenomas
or exogenous source (steroids)
 -​ manifest: moon face, central obesity, muscle weakness, hypertension, hyperglycemia
Addison's Disease (Hormone Deficiency)
-​ cause: autoimmune destruction of adrenal cortex
-​ manifestations: fatigue, weight loss, hypotension, hyperpigmentation, hyponatremia,
hyperkalemia
2.​ MEDICATIONS
Diabetes Mellitus
-​ Type l: insulin therapy (rapid acting, long, regular)
-​ Type 2: Oral hypoglycemics (metformin, sulfonylureas)
-​ GLP-I agonists, DPP-4 inhibitors, insulin
Pituitary Disorders
-​ Growth hormones for GH deficiency, dopamine agonists