misc
Aggregated platelets, clotting factors, and fibrin adhere to vessel wall
arterial decreases blood flow peripherally causing ischemia
venous alters venous return to the heart caused swelling
clinical manifestations: Arterial - intermittent claudication, cool, cyanotic, 6 P's
clinical manifestations: venous (DVT)- swelling, increased skin temp, pain in calf with dorsiflexion
What is a thrombus?
Etiology: congenital anomalies or trauma most common reasons
patho: abnormal communication between arteries and veins
clinical manifestations: alterations in oxygenation, systemic hemodynamic changes, HA, hemorrhagic stroke, dementia, seizures
What is arteriovenous fistula?
Etiology: cold or emotional stress
Patho: extreme Constriction, cessation of blood flow to fingers and toes affecting local nerve function
white fingertips, cyanosis, and red from reactive hyperemia, pain, and numbness
What is raynauds syndrome?
Etiology: genetic
abnormality in the sequence of intrinsic pathway coagulation
Patho: X linked recessive disorder= results in abnormal factor VIII or factor IX
What is hemophilia?
Acute or chronic systemic disease unknown cause
questionable autoimmune
first degree relative increases risk
patho: development of multiple, uniform, noncaseating granulomas, affects multiple organs (most common lung and lymph nodes), Abnormal T-cell function
malaise, fatigue, wt loss, fever, dyspnea of insidious onset, dry non-prod cough, erythema nodosum (lesions with painful nodes lower extremities), macules, papules, elevated liver enzymes, hypercalcemia
What is Sarcoidosis?
clot within the bloodstream travels to a new site of obstruction
dislodges from a vessel or valvular leaflet in the heart
clinical manifestations: stroke, PE
Stroke-thromboemboli from left side of heart exits aorta and most commonly lodge in cerebral artery resulting in stroke
travels venous circulation and returns to right side of heart in PE
What is an embolus?
DBP > 120
Can cause CVA, HF, MI, aortic dissection, retinopathy
warning symptoms: HA, persistent nosebleeds, chest pain, palpitations
What is a hypertensive crisis?
Eriology: associated with smoking
patho: inflammatory condition that affects small and medium size arteries & veins of upper & lower extremities
cool to touch, decreased hair growth mainly on legs. dry, thin, glossy, skin, diminished or absent pulses, sharp stabbing pains, ulcers
what is Buerger's disease?
Etiology: autosomal dominant disorder that affects factor VIII and platelet dysfunction
inhibits platelets from sticking to injured tissue
more prone to bleeding
epistaxis, mucosal bleeding, ecchymosis, gi bleeding
What is Von Willebrand disease?
Etiology: aka extrinsic allergic alveolitis, restrictive & occupational disease, 80-90% nonsmokers
genetic predisposition, type III hypersensitivity reaction, granulomatous inflammation in lungs, hallmark of disease=diffuse pulmonary fibrosis in upper lobes
Acute: symptoms start in 4-6 hrs after exposure and resolve in 18-24 hours, chills, sweating, shivering, mylgias, malaise, lethargy, dyspnea at rest, dry cough, tachypnea, chest discomfort, cyanosis (late), crackles in lung bases
What is Hypersensitivity Pneumonitis?
Intermediate clinical manifestations:
acute febrile episodes, progressive pulmonary fibrosis with cough, dyspnea, fatigue, cor pulmonale (right-sided HF related to lung disorders)
sudden constriction of arterial smooth muscle
may result in obstruction of flow
cause may be related to environmental factors such as cold temp or emotional stress, hormones, sensitivities to food additives
clinical manifestations: cerebral vasospasm (migraine), headache, hypoxia, cardiac vasospasm=angina
What is a vasospasm?
sudden increase in either or both SBP & DBP accompanied by evidence of end-organ damage
abnormalities of CNS are most common end organ-damage associated-stroke, encephalopathy, intercranial hemorrhage
increase HR and BP
rapid but controlled reduction of BP using primarily parenteral meds and should be in critical care
What is a hypertensive emergency?
Etiology: impaired venous return
Patho: impaired venous return leads to increased capillary pressure & the involved limb becomes edematous
chronic venous insufficiency
aching, heavy, discomfort, darkened raised tortuous veins
What are varicosities?
Patho: acute inflammation of the trachea and bronchi
etiology: Viral or non-viral, heat, inhale smoke or chemicals, allergic reactions
airways become inflamed & narrowed from capillary dilation, swelling from fluid exudation, infiltration with inflammatory cells, increased mucus, loss ciliary function, loss of portions of ciliated epithelium
Tests: recent onset of cough (hallmark(, CXR
Usually mild and self limiting, cough (production or non-productive, low grade fever, substernal chest discomfort, sore throat, postnasal drip, fatigue
What is acute bronchitis?
etiology: accumulation of air in the pleural space
Spontaneous-rupture of small subpleural blebs apices, air enters pleural space, lung collapses, rib cage springs out
related to preexisting disease-underlying lung problem
trauma in origin-buildup of air pressure in pleural space, air cannot escape during expiration, lung collapses on same side forcing mediastinum toward opposite side deviated trachea
What are primary, secondary, and tension pneumothorax?
infectious process / inflammation caused by infection of the intima of the artery
S/S: pain, warmth, tenderness, lump
What is phlebitis?
more common than hypertensive emergency
treatment is slower-rapidly decrease in BP is associated with substantial mortality
Brought under control in 24-48 hours with oral meds
rule out anxiety, pain, or withdrawal of alcohol or BP meds
What is a hypertensive urgency?
Etiology/patho: valvular incompetence in deep veins in the leg
pain decreases with ambulation and elevation, venous stasis ulcer, warm, tough, thickened skin, areas of dark pigmentation
Venous stasis ulcer: rupture of superficial veins
What is chronic venous insufficiency?
Etiology: cigarette smoking (90%), repeated airway infections, genetic predisposition, chronic or recurrent productive cough >3 months > 2 + successive years, Type B COPD blue bloater, hypersecretion mucus, persistent, irreversible when paired with emphysema, more in males, . 30-40 years old
patho/etiology: chronic swelling of bronchial mucosa results in scarring, hyperplasia of bronchial mucous gland/goblet cells, increased bronchial wall thickness, pulmonary HTN, destruction of bronchial walls
Typically overweight, commonly associated with emphysema, SOB on exertion, excessive sputum, chronic cough worse in the am, evidence of excess body fluids (edema, hypervolemia), cyanosis (late sign)
what is chronic bronchitis?
tests: CXR, pulmonary function test, ABG, ECG
Etiology: pathologic collection of fluid or pus in pleural cavity as result of another disease process
Types:
Transudates: associated with HF or other edematous such as ascites
exudates: malignancies, pneumonia, PE, Sarcoidosis
empyema due to infection in the pleural space
hemothorax-blood in pleural space from chest trauma
chylothorax or lymphatic: develops from trauma as a result of leakage of lymph fluid from the thoracic duct
What is a pleural effusion?
some clinical manifestations: dyspnea, decreased chest wall movement, pleuritic pain worse with inspiration, dry cough, absence of breath sounds, dullness to percussion (primary finding)
congenital anomalies or pathologic processes
patho:damage to valves affecting blood flow
Clinical manifestations: venous stasis ulcers, tissue hypoxia
What is valvular incompetence?
etiology/patho: response to position changes associated within the nervous system
orthostatic: drop in SBP of over 20mmHg or a decrease in DBP of over 10mmHg within 3 minutes of standing
dizziness, blurred vision, confusion
What is hypotension?
Etiology: abnormality of blood vessels that can occur with meds like warfarin
usually autoimmune
petechiae or pinpoint hemorrhages
women 30-60 years of age
classified by length of disease: Newly diagnosed: persistent (3-12 months): chronic (>12 months)
What is Purpura (ITP) Immune Thrombocytopenic Purpura?
Type A COPD, Pink Puffer, Destructive changes of the alveolar walls, abnormal enlargement of distal air sacs,
damage is irreversible, associated with chronic bronchitis
smoking > 70 packs/year, air pollution, miners, welding, asbestos, a1-Antitrypsin deficiency (genetic)
patho: group of genes, release of proteolytic enzymes from neutrophils & macrophages causing alveolar damage, loss of elastic in tissue in lung, bullae (large thin-walled cysts in lung), round chest, inactivation of a1-antitrypsin which normally protects lung parenchyma.
What is Emphysema?
S/S: progressive exertional dyspnea, cough (minimal or absent), use accessory muscles, mild decrease in Pao2 and spo2, decreased breath sounds (lack of crackles/rhonchi), chronic morning cough, prolonged expiration, clubbing fingers, barrel, chest, wheezing, pursed-lip breathing
Etiology: more common in males, cause unknown
90% have positive HLA-B27 antigen
progressive, inflammatory disease
low to mid back pain with stiffness increased with prolong rest, pain and stiffness decrease with exercise, restrictive lung dysfunction, breathing difficulty
What is ankylosing spondylitis?