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Differentiate between nosocomial and community acquired.
(my own words) Well in a general sense nosocomial is acquired in the hospital and community is elsewhere in the community,…hmmm who would of thought.
What causes pneumonia
(page 771) Pneumonia is acute infection of the lower respiratory tract caused by bacteria, viruses, fungi, protozoa, or parasites…Aspiration of oropharyngeal secretions is the most common route of lower respiratory tract infection;…Another route of infection is through inhalation of microorganisms that have been released into the air when an infected individual coughs, sneezes or talks, or from aerosolized water such as that from contaminated respiratory equipment.
List type of organism that causes TB
(page 773) Tuberculosis (TB) is an infection caused by Mycobacterium tuerculosis, an acid-fast bacillus that usually affects the lungs, but may invade other body systems.
Describe how TB is transmitted from person to person
(page 774) Like some types of pneumonia, tuberculosis is transmitted from person to person in airborne droplets.
Describe the signs and symptoms of Pulmonary embolism.
(page 775) Pulmonary embolism is occlusion of a portion of the pulmonary vascular bed by an embolus, which can be a thrombus (blood clot), tissue fragment, lipids (fats), or an air bubble. The most common emboli are thrombi dislodged from deep veins in the thigh. (and pelvis) They also can originate in the pelvis, particularly in pregnant women.
Describe the probable outcome of a massive PE
(my own words) DEATH plus what the book says
What are measures to prevent Pulmonary embolism
(page 776) The ideal treatment for pulmonary embolism is prevention through risk factor analysis and elimination of predisposing factors for individuals at risk. Venous stasis in hospital patients is minimized by leg elevation, bed exercises, position changes, early postoperative ambulation, and pneumatic calf compresion. Clot formation is also prevented by prophylactic low-dose anticoagulant therapy; less anticoagulant is required to prevent a clot than to treat one.
Differentiate between cerebral and brain death
(page 362-363) Brain death occurs when the brain is damaged so completely that it can never recover and cannot maintain the body's internal homeostasis. Irreversible coma, or cerebral death, is death of the cerebral hemispheres exclusive of the brain stem and cerebellum. Brain damage is permanent, and the individual is forever unable to respond behaviorally in any significant way to the environment. The brain may continue to maintain internal homeostasis.
Describe the criteria for brain death
(page 363) Completion of all appropriate and therapeutic procedures. Unresponsive coma (no motor or reflex movements). No spontaneous respiration. No ocular responses to head turning or caloric stimulation; dilated, fixed pupils. Isoelectric (flat) EEG (electrocerebral silence) Persistence of these signs for 30 minutes to 1 hour and for 6 hours after onset of coma and apnea. Confirming test indicating absence of cerebral circulation (optional)
Describe the Monroe kellie doctrine and it’s implications for ICP
(page 827)The skull is a rigid compartment containing three components: brain, blood, and CSF. If one component increases and is not accompanied by a decrease in one or both of the other components, the result is increased ICP.
List the term used to describe infected pleural effusion
(page 760) Empyema (infected pleural effusion), the presence of pus in the pleural space, is a complication of respiratory infection, usually pneumonia caused by Staphylococcus aureus, Escherichia coli, anaerobic bacteria, or Klebsiella pneumoniae. In children, community-acquired pneumonia caused by Streptococcus pneumoniae accounts for the increased incidence of pediatric empyema seen in the last decade.
What chronic lung condition is thought to be caused by interactions between genetic and environmental factors
(page 764) Asthma genetics play an important and complex role in the etiology of the disease. Apparently, environmental factors interact with inherited factors to increase the risk of asthma and to cause attacks of bronchospasm.
What life threatening condition is characterized by prolonged bronchospasm and hypoxemia
(page 766) If broncho spasm is not reversed by usual measures, the individual is considered to have severe bronchospasm or status asthmaticus.
What is the chronic lung condition that results in increased and thickened mucous that leads to airway closure
(page 768) Chronic bronchitisis defined as hypersecretion of mucus and chronic productive cough for at least 3 months of the year (usually the winter months) for at lest 2 consecutive years.
List common causes of chronic bronchitis
(page 770 [table 26-4]) Productive cough, dyspnea, wheezing, history of smoking, barrel chest, prolonged expiration, cyanosis, chronic hypoventilation, polycythemia, cor pulmonale.
What is the underlying pathophysiology of emphysema that results in airway obstruction
(page 770) Emphysema begins with destruction of alveolar septa, which eliminates portions of the pulmonary capillary bed and increases the volume of air in the acinus. It is postulated that inhaled oxidants in tobacco smoke and air pollution inhibit the activity of endogenous antiproteases and stimulate inflammation with increased activity of the proteases.
What part of the pathophysiology of emphysema causes the barrel chest (increase in AP chest diameter)
(page 770) The combination of increased residual volume and diminished caliber causes part of each inspiration to be trapped in the acinus. Air trapping causes hyperexpansion of the chest, which puts the muscles of respiration at a mechanical disadvantage.
Which is the major neurotransmitter lacking in Parkinsons disease. What are the common signs/symptoms
(page 414) Nigral and basal ganglial loss of neurons with depletion of dopamine, an inhibitory neurotransmitter, is the principal biochemical alteration in Parkinson disease. S/S The classic manifestations of Parkinson disease are tremor at rest (resting tremor), rigidity (muscle stiffness), bradykinesia/akinesia (poverty of movement), postural disturbance, dysarthria, and dysphagia. They may develop alone or in combination, but as the disease progresses, all are usually present.
What is orthopnea?
(page 752) Pulmonary congestion tends to cause dyspnea when the individual is lying down (orthopnea). The horizontal position redistributes body water, causes the abdominal contents to exert pressure on the diaphragm, or decreases the efficiency of the respiratory muscles. Orthopnea generally is relieved by sitting up in a forward-leaning posture or supporting the upper body on several pillows
What are Kussmal respirations?
(page 752) Strenuous exercise or metabolic acidosis induces Kussmaul respirations (hyperpnea), which is characterized by a slightly increased ventilatory rate, very large tidal volumes and no expiratory pause.
What are Cheyne stokes respirations?
(page 752) Cheyne-Stokes respirations are characterized by alternating periods of deep and shallow breathing. Apnea lasting from 15 to 60 seconds is followed by ventilations that increase in volume until a peak is reached; then ventilation (tidal volume) decreases again to apnea. Cheyne-Stokes respirations result from any condition that slows the blood flow to the brain stem, which in turn slows impulses sending information to the respiratory centers of the brain stem. Neurologic impairment above the brain stem is also a contributing factor.
What is hematemesis?
(page 984) Hematemesis-Bloody vomitus; either fresh, bright red blood or dark grainy digested blood with "coffee grounds" appearance.
Describe the heart condition that may manifest with paroxysmal nocturnal dyspnea
(page 752) Some individuals with left ventricular failure wake up at night gasping for air and have to sit up or stand to relieve the dyspnea (paroxysmal nocutrnal dyspnea [PND]). PND results from fluid in the lungs caused by the redistribution of body water while the individual is recumbent.
Describe the signs and symptoms of pulmonary edema
(page 756) Pulmonary edema is excess water in the lung. The normal lung is kept dry by lymphatic drainage and a balance among capillary hydrostatic pressure, capillary oncotic pressure and capillary permeability. In addition, surfactant lining the alveoli repels water, keeping fluid from entering the alveoli. Predisposing factors for pulmonary edema include heart disease, acute respiratory distress syndrome, and inhalation of toxic gases. (SEE FIGURE 26-3; page 756)
Explain the common etiology of aspiration pneumonia
(page 756-757) Aspiration is the passage of fluid and solid particles into the lung…Aspiration of acidic gastric fluid (pH<2.5) may cause severe pneumonitis (localized lung inflammation). Bronchial damage includes inflammation, loss of ciliary function, and bronchospasm. In the alveoli, acidic fluid damages the alveolocapillary membrane, allowing plasma and blood cells to move from capillaries into the alveoli, resulting in hemorrhagi pneumonitis. The lung becomes stiff and noncompliant as surfactant production is disrupted, leading ot further edema and collapse...The rate of deaths resulting from aspiration-caused pneumonitis is greater than 50%.
Explain why a spinal cord injury in the cervical region may be life threatening
(page 397) Cellular and subcellular alterations and tissue necrosis occur. Cord swelling increases the individual's degree of dysfunction, so that it is hard to distinguish functions permanently lost from those temporarily impaired. In the cervical region, cord swelling may be life threatening because it may cause impairment of the diaphragm function (phrenic nerve exit at C3 to C5) and vegetative functions (mediated by the medulla oblongata)
Explain the cause, signs/symptoms of autonomic hyperreflexia
(page 400) Autonomic hyperreflexia (dysreflexia) may occur after spinal shock resolves. The syndrome is associated with a massive, uncompensated cardiovascular response to simulation of the sympathetis nervous system. The condition is life threatening and requires immediate treatment...Characterisitics include paraoxysmal hypertension (up to 300 mm Hg, systolic), a pounding headache, blurred vision, sweating above the level of the lesion with flushing of the skin, nasal congestion, nausea, piloerection caused by pilomotor spasm, and bradycardia (30 to 40 beats/min). The most common cause is a distended bladder or rectum, but any sensory stimulation can elicit autonomic hyperreflexia.
List the risk factors for thrombotic strokes
(page 404) Cerebral thrombosis develops most often with atherosclerosis and inflammatory disease processes (arteritis) that damage arterial walls.
Describe the signs and symptoms of a TIA (differentiate with s/s of a CVA)
Describe the s/s of a subarachnoid hemorrhage
(page 407) With a subarachnoid hemorrhage, blood escapes from a defective or injured vessel into the subarachnoid space. Early manifestations associated with leaking vessels are episodic and include headache, changes in mental status or level of consciousness, nausea and/or vomitng, and focal neurologic defects.
Describe the early signs/symptoms of alzheimers disease
(page 413) Initial clinical minifestations are insidious and often attributed to forgetfulness, emotional upset, or other illness. The individual becomes progressively more forgetful over time, particularly in relation to recent events.
Differentiate between thrombotic and hemorrhagic stroke and associated risk factors
(page 405) Thrombotic: Arteries supplying brain occluded by thrombi, increased coagulation, inadequate cerebral profusion: dehydration, hypotension, prolonged vasoconstriction. Hemorrhagic: ruptured aneurysms or vascular malformations, risks associated with hypertension, bleeding tumor, head trauma, illicit drug use
Describe the difference between a coup and contrecoup injury
(page393) Coup injury: impact against an object. Contrecoup injury: impact within the skull.
Describe the difference between subdural and epidural hematoma
Subdural-venous: slower to develop S/S. Epidural-arterial: Usually you'll see S/S right away
Explain why basilar skull fractures are at risk for meningeal infections
(page 396) Exposure to the outside environment. Basilar skull fracture is determined based on clinical findings.
Describe the signs/symptoms of a mild concussion

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