9

Pathology Blueprint Final Exam

85 questions 2 hours
1) Assessing patient for pain
o COLDSPA
2) Discerning what things go where on patients health history
3) Assessing for common skin changes (3)
o Occurs in aging skin, hair, and nails
o Skin
Pale
Skin lesions
Dry
Lose turgor (check by pinching of skin)
o Hair: thinner
o Nails: thickened, yellow, brittle (not yellow nail syndrome just aging) (if all nails have
the changes then probably local. If on just one or few nails, then probably not local)
(systemic vs local causes of nail problems)
4) Understanding kidney stones (6)
o Renal calculi are a type of obstructive disorder
o Renal Calculi (Theories)
Saturation theory: Urine is supersaturated with stone components. (calcium,
salts, uric acid, magnesium, phosphorous, cysteine)
Matrix theory: Organic materials act as a nidus for stone formation. (crystals
organic components crystalize and all things like calcium and salts to attach to)
Inhibitor theory: A deficiency of substances that inhibit stone formation. (natural
stone inhibitors are magnesium and citrate)
Tamhorsphalt Mucoprotein (glucoprotein) that is produced by kidney to
decrease crystallization
No one really knows exactly how this is caused
o Four Types of Renal Calculi
Calcium stones (i.e., oxalate or phosphate)
Most stones are calcium oxalate or calcium phosphate
Increased calcium in the blood and urine so we get renal calculi, excessive
bone resorption (bone loss which is people on steroids, elderly, and the
immobile) therefore everyone at the hospital is at risk for renal calculi
Magnesium ammonium phosphate stones
Struvite
Caused by bacteria that has urace which increases the phosphate
Causes HUGE stones called stag horns
These stones you cant get out with a laser you need surgery
They cause a lot of damage
Uric acid stones
Gout or situations that increase uric acid like chemotherapy
Uric acid stones grow best in an acidic environment
High purine diet
Cysteine stones
Amino acid
Usually what kids get (genetic defect)
Causes them to get the struvite stones but there is no bacteria so no
infection process
Renal Colic
Ureters stretching from the stone

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Pain in the flanks and upper outer quadrant of the abdomen depending on
which kidney
Cool and clammy
Vomiting and nausea
Best intervention and prevention is to stop taking oxalate in (any food
with leaves, and chocolate, and Vitamin C)
Moderation is the key
Understanding pathology for rheumatoid arthritis and assessment for it (9)
o Autoimmune disorder Cells for some reason are triggered to attack what it considers
self which leads to multiple organ system failure
o Very painful and debilitating because of loss of mobility
o The antibodies attack the synovial fluid and joint architecture destruction
(inflammation)
o Attacks many organs in addition to these
o Possible genetic predisposition
o Rheumatoid factorantibody against IgG fragments in most patients
o Pannusdestructive vascular granulation tissue destructive to adjacent cartilage
and bone
Pannus destroys the cartilage and erodes the bones
o Collagen is destroyed and over time pannus formations occur, narrowing the joint
space
o Signs and symptoms
Joint pain, swelling, warmth, erythema, and lack of function are classic
symptoms.
Palpation of joints reveals spongy or boggy tissue.
Fluid can usually be aspirated from the inflamed joint.
Begins with small joints in hands, wrists, and feet
Compartment syndrome
Pathology for renal failure (6)
o When kidneys fail
o Less waste is removed; more waste remains in the blood
o Unable to regulate fluid, electrolyte, and pH balance
o Acute vs. chronic renal failure
Acute
Abrupt onset and is usually reversible
Can result in chronic
Chronic
Develops slowly over time
Ends in renal failure
o Nitrogenous compounds build up in the blood
o Looking for BUN (blood urea nitrogen) and creatinine
o Renal function approximated by: initial creatinine level/ current creatinine level
This will give you a measure of the kidney function
Pathology and assessment for gout (9)
o Caused by uremia and body deposits it in the joint spaces because it thinks it will hurt
it
o Most commonly seen in the big toe First MTP joint (podagral)
o Painful, swollen, red hot joint with sudden onset
o Type of arthritis that usually occurs in only one joint at a time
o More common in men than women and increases with age
o Risk factor includes drinking lots of beer, obesity, and kidney disease
o Diagnose by taking sample of fluid from inflamed joint to analyze for uric acid crystals

No blood test confirms this & just because you have high uric acid in blood doesnt
mean you have gout
o Increased serum uric acid crystals precipitate in the joint inflammation
o Acute gouty arthritis
o Tophiaccumulation of crystalline deposits
Seen in eyelids, hands, etc.
Uric acid deposits the body is trying to get rid of
o Gouty nephropathy
o Uric acid kidney stones
9) Oliguria and acute renal failure (6)
o Acute renal failure Sudden and almost complete loss of kidney function over hours to
days
Increase in serum creatinine and BUN
Oliguria Urine output less than 400 mL per day
Anuria Urine output less than 50 mL per day
Higher specific gravity = MORE concentrated urine
Lower specific gravity = DILUTE more watery urine
o Phases of Acute Renal Failure
Initiation phase Onset. Begins with the initial insult and ends when oliguria
develops
Increase in BUN and creatinine that can last hours to days
Urine output is less than 30 mL or less per hour (anuria)
Oliguric phase Decrease in urine output approximately 100 400 mL/24 hours.
It doesnt respond to fluid changes or diuretics
Increase in creatinine, BUN, potassium, and magnesium
Decrease in bicarbonate, calcium, and GFR
F & E abnormalities, and metabolic acidosis
Can last from 1-2 weeks
Uremic symptoms first appear and life-threatening conditions such as
hyperkalemia develop
Diuretic phase Occurs when the source of the obstruction has been removed
but there is residiual scarring and edema of the renal tubules exist
A gradual increase in urine output which signal that GFR has started to
recover. The patient will have a lot of urine in the phase about 4L in 24
hours. Patient just cant concentrate their urine (increased specific gravity)
Gradual onset = 2-6 weeks after oliguric phase
Electrolyte losses because they are putting out so much urine
Monitor them for dehydration Administer crystalloids (D5W or NS) to
prevent dehydration
Monitor the BUN and creatinine levels These will level off at a lower level
and plateau up and down
GFR will be increased (this increase contributes to the massive loss of
electrolytes which requires the administration of IV crystalloids), urine
output will be 2-4 L per day
Recovery phase Can last up to a year
Edema decreases
Renal tubules begin to function adequately
F & E balance are restored
GFR has returned to 70% normal
o Types of Acute Kidney Injury
Prerenal
o

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Marked decrease in renal blood flow

Something happens before the blood gets to the kidneys
o Decreased cardiac output, clot, atherosclerosis
Blood supply decreased
o Shock, dehydration, vasoconstriction (all cardiac output)
Postrenal
Obstruction of urine outflow from the kidney
Cant get urine out so sitting urine which causes crystals and stones
Urine flow blocked
o Stones, tumors, enlarged prostate
Intrinsic
Damage to the structures within the kidney
Acute kidney injury
o Something goes wrong with the glomerulus, basement membrane,
or Bowmens capsule inside the kidney
Kidney tubule function decreased
o Ischemia, toxins, intratubular obstruction

Anemia (4)
o Anemia = not enough healthy RBCs
o Iron deficiency anemia
Hypochromic = Pale
Microcytic = Smaller in size = Anisocytosis (irregular size) = Too small
Poikilocytosis (irregular shape) = Oblong cells
Microcytic hypochromic anemia which you can see on the CBC
Blood loss or deficient diet
Low hemoglobin, hematocrit, serum iron, and ferritin
o Megaloblastic anemia
Big, giant, ineffective cells
Those with vitamin B12 deficiency most commonly get it (Cobalamin)
Pernicious anemia Born with deficiency (get B 12 shots for the rest of their
life)
Can get it from vegetarian diet (beans)
Most common reason is alcoholism. Too much alcohol results in this
Look at mean corpuscular volume on CBC. As it elevates cells get bigger
Impaired DNA synthesis = enlarged RBCs
Folic acid deficiency
o Sickle cell anemia
Inherited disease that causes sickling of the cells

Cells of this shape get stuck everywhere (kidney and arteries which causes
ischemia) also causes great pain
The cells dont act correctly
Patients with this are really compromised
Dilute the effect by giving fluid so they dont get stuck places
Sickle cell consequences
Sickled cells more likely to be destroyed
o Jaundice, pigment gallstones
Sickled cells block capillaries
o Acute pain
o Infarctions cause chronic damage to the liver, spleen, heart,
kidneys, eyes, bones
o Pulmonary infarction = acute chest syndrome
o Cerebral infarction = stroke
Sickle cell anemia inheritance Handed down through the mother, so mother
has to have the trait or the disease to make it happen
o Aplastic anemia (bone marrow depression)
Like cancer. Stops the bone marrow from functioning at all
Depresses all cells not just RBCs
Patients need a bone marrow transplant
o Chronic disease anemias
Chronic inflammation
From stress, disease, patients with chronic disease also have anemia
because they are chronically inflamed. Also lowers the bone marrow
function
Chronic renal failure
Genital urinary symptoms and common conditions (match symptom to condition)
Glomerulonephritis
o Disorders of glomerular function
o Acute nephritic syndromes
Usually caused by viruses typically strep
Sick with strep 7 12 days later you start having oliguria
Damage occurs in the capillary wall in the glomerulus
o Rapidly progressive glomerulonephritis
Good pasture syndrome Antibodies to the basement membrane. Causes it to
be scarred and damaged
Basement membrane is how things get from blood into the kidney
Causes things to stay in the blood and we retain too much water and toxins etc.
o Chronic glomerulonephritis
Develops from an acute case
Most resolve from proper treatment but not always so they become chronic
Scarring and problems end in renal failure
Strep is very dangerous so always watch for kidney failure
Cola colored urine Visible blood in the urine (NCLEX)
Incontinence (6)
o Urinary incontinence Involuntary loss of urine
o Stress incontinence
Urine leakage due to weakness of detrusor muscles
Seen in women who have given birth vaginally
Also seen in obesity
People cough, laugh, or have a Valsalva maneuver they leak urine
Kegel exercises are good for this

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Urge incontinence
Strong desire to void frequently which causes an overactive bladder
Have to go really bad and cant get somewhere fast enough
o Mixed incontinence: stress + urge incontinence
Common in older women, menopausal women, many who have had vaginal
births, and obesity
o Overflow incontinence
Obstructions, big prostrate, tumor
Causes dribbling or weak stream
Little bit is getting around but not enough to get bladder to give the right signals
o Nocturnal enuresis
Urinate at night or urinate incontinently while sleeping
Happens with drugs, sedation at night, and with children (up till 6 years old)
After 6 neurological signals to bladder make them strong enough to hold urine
over night
o Post-micturition dribble
Urinate, think bladder is empty, little while later you get a little dribble
o Continuous urinary leakage
Happens with problems with storing urine or neurologic damage which doesnt
allow for sphincter to close, or tumors on sphincter which causes continuous
leakage
Parkinsons (7)
o Basal ganglia dysfunction Effects the way the brain coordinates the muscle
movements in the body (substantia nigra = dopamine is the neurotransmitter)
o Cells in the substantia nigra become damaged and die = less dopamine produced =
nerve messages to muscles become slow and abnormal
o S/S: Tremor (shaking), rigidity (stiffness of muscles), and bradykinesia (slow movement)
Slow at first and then too fast at the end
o Loss of postural reflexes and autonomic system dysfunction
o Dementia
o Parkinsonian gait
Shuffling, stooped, and cob wheel (NCLEX)
Cob-wheel is not constantly moving but intermittent fast movement, very rigid
Very typical of Parkinsons but could be other things
Pancreatitis (5)
o Autodigestion of the Pancreas (pancreatitis you are eating your own pancreas)
o Activated enzymes begin to digest the pancreas cells (activated too soon)
Severe pain results = left upper quadrant that always radiates to the back and
flanks
Radiate means the pain is where the disease is and is also spreading
elsewhere
Referred means you dont have pain at the site but you have it elsewhere
See a lot of Cullens sign (see it in any peritonitis) = Superficial edema, bruising
in the subQ
Inflammation produces large volumes of serous exudate = hypovolemia
o Enzymes that the pancreas produces (amylase & lipase) appear in the blood
If amylase and lipase are 3x the normal amount you probably have pancreatitis
o Areas of dead cells undergo fat necrosis (Trypsin destroyed & now amylase & lipase are
also eating)
Fat necrosis releases calcium
Calcium from the blood deposits in them = Hypocalcemia (in the blood)
Abdominal distention and lots of retroperitoneal fluids especially in the flanks
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Chronic pancreatitis (pancreatic cancer) has similar signs and symptoms to acute
pancreatitis
GERD (5)
o Gastroesophageal reflux disease Loss of tone of the ilea (esophageal sphincter).
Persistent reflux of gastric contents into the esophagus
o GERD is acid staying in the esophagus over time = causes a lot of damage
o Treated with antacids, H2 receptor antagonists, and proton pump inhibitors
o Reflux leads to GERD leads to Barrets esophagus leads to esophageal cancer (15%
survival rate)
Acid base balance (6)
o Metabolic acidosis
Uncompensated (uncorrected) HCO3 < 22 mEq/L; pH < 7.4
Severe diarrhea: Bicarbonate-rich intestinal (and pancreatic) secretions
rushed through digestive tract before their solutes can be reabsorbed;
bicarbonate ions are replaced by renal mechanisms that generate new
bicarbonate ions.
Renal disease: failure of the kidneys to rid body of acids formed by normal
metabolic processes.
Untreated diabetes mellitus: lack of insulin or inability of tissue cells to
respond to insulin, resulting in inability to use glucose; fats are used as
primary energy fuel, and ketoacidosis occurs.
Starvation: Lack of dietary nutrients for cellular fuels, body proteins and
fat reserves are used for energyboth yield acidic metabolites as they are
broken down for energy.
High ECF potassium concentrations: Potassium ions compete with H+ for
secretion in renal tubules; when ECF levels of K + are high, H+ secretion is
inhibited.
o Metabolic alkalosis
Uncompensated (HCO3 >26 mEq/L; pH > 7.4)
Vomiting or gastric suctioning: loss of stomach HCl requires that H+ be
withdrawn from blood to replace stomach acids; thus H + decreases and
HCO3 proportionally.
Selected diuretics: cause K+ depletion and H2O loss. Low K+ directly
stimulates the tubule cells to secrete H+. Reduced blood volume elicits the
renin-angiotensin mechanism, which stimulates Na+ reabsorption and
H+ secretion.
Ingestion of excessive sodium bicarbonate (antacid): bicarbonate moves
easily into ECF, where it enhances natural alkaline reserve.
Constipation: prolonged retention of feces, resulting in increased amounts
of HCO3 being reabsorbed.
Excessive aldosterone: (adrenal tumors) promotes excessive reabsorption
of Na+, which pulls increased amount of H + into urine. Hypovolemia
promotes the same relative effect because aldosterone secretion is
increased to enhance Na+ (and H2O) reabsorption.
o Respiratory acidosis
Uncompensated (PCO2 >45 mm Hg; pH <7.4)
Impaired gas exchange or lung ventilation (chronic bronchitis, cystic
fibrosis, emphysema): Increased airway resistance and decreased
expiratory air flow, leading to retention of carbon dioxide.
Rapid, shallow breathing: Tidal volume markedly reduced.
Narcotic or barbiturate overdose or injury to the brain stem: depression of
respiratory centers, resulting in hypoventilation and respiratory arrest.
o Respiratory alkalosis
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Uncompensated (PCO2 < 35 mm Hg; pH > 7.4)

Direct cause is always hyperventilation: hyperventilation is pain/anxiety,
asthma, pneumonia, and at high altitude represents effort to raise P O2 at
the expense of excessive carbon dioxide excretion.
Brain injury or tumor: abnormality of respiratory controls.
Appendicitis (5)
o Inflammation of the appendix
o Abrupt onset of epigastric pain burst that moves to the right lower quadrant. Patient
can immediately point out the pain with one finger
o Signs/symptoms Increased temperature, increased WBCs, and emergency due to
peritonitis
o Tests for appendicitis
Rebound tenderness
Psoas sign Pain in RLQ when right leg is hyperextended. Illiopsoas muscle is
irritated
Obturator sign Pain in RLQ when leg is rotated in and out
Hypersensitivity test Exaggerated pain due to skin hypersensitivity
Ulcerative colitis (5)
o Type of (chronic) inflammatory bowel disease (Crohns and ulcerative colitis)
o Symptoms include abdominal pain, fever, diarrhea, and weight loss (same as Crohns)
o No skip lesions
o Occurs only in the rectum and colon. Wont see it out of the large intestine
o Has a higher risk for cancer then Crohns
Cirrhosis (5)
o Scar tissue (inert or doesnt work) partially blocks sinusoids and bile canaliculi
Less blood flow in the liver which backs up into the organs that come before the
liver, which means portal hypertension
The veins from the stomach, intestines, spleen, and pancreas merge into the
portal vein which goes into the liver
o Long term effects of any type of damage
o Liver feels like it has lots of bumps = lumpy appearance
Carpal tunnel syndrome
Fractures (9)
o Transverse
Straight across
Immediate problem is lots of bleeding and damage to surrounding blood vessels,
nerves, and muscles (also pain and immobility)
This can be life threatening
Needs to have a lot of force to cause a transverse fracture (high impact)
Story must match the injury
o Oblique
Starts higher and goes down the leg and comes out the other side
o Spiral
Crack around the bone but bone doesnt come apart
Caused by twisting injuries
Concerning in children
Story must match the injury
Seen often in kids who put their arms in washing machines
o Commuted
More than one piece of bones or lots of pieces of bones
Patient will need external fixation pins need to hold the bones apart

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If they get an infection though they could die because pins go straight to bones
and its hard to treat the bone marrow because not good circulatory access to
bone marrow (very scary)
Segmental
Piece of the bone come out
Butterfly
Bite of the bone come out
Usually comes from disease (maybe from injury)
Means that part of the bone is not strong
Seen in Pagets, Ewing sarcoma in kids, lots of bone cancers can present like this
Also in osteopenia, and osteoporosis in elderly
Bones that just arent very soft
Impacted
Femoral bone impacts up into the pelvis
Jump out of window and land on feet

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Osteoporosis (9)
o Someone with osteopenia has a fracture
then you know it means osteoporosis
o Decreased bone mineral density (BMD)
o Decreased cancellous (spongy) bone strength
o Decreased bone matrix and mineralization
o Bone resorption > bone formation
Barlow and Ortolanis (9)
o Developmental dysplasia of the hip (congenital birth defect)
Common at birth and check for it at birth
Get them in a harness (Plavicks harness) to keep joint stable and keep hip in
socket so it can grow fully
Barlow and Ortolanis signs (tests)
Barlows Feel if it thunks out of the socket
o Put fingers behind the gluteus and the thigh
o Adduct the thigh and you can hear it popping out
Ortolanis Bring thighs back in you can hear it going back in
Find it early so there is no problem with growth and development

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Breast exam (6)

o Ask if they are finding any lumps and if the lump is changing?
If it changes with menstrual cycle it is probably not cancer
o Redness, warmth, dimpling
Dimpling Portion of the breast that is indented
Telling you something about what is underneath the skin
o Change in the size of the breast or consistency (soft becomes firm etc.)
o History of present heath concern: COLDSPA
Character, onset, location, duration, severity, pattern, associated factors
o Past health history
If they have had any breast disease, breast trauma, or implants
Cancer risk is increased with breast implants
Also disfigurement is increased with breast implants
Age of menstruation and menopause
Earlier menstruation and more delayed menopause increases risk
Ask about children
Age of mom with first pregnancy increases risk of BC if first child is after
age of 30 or if they never have a child (breast function meant to provide
milk)
o Family history
Number one thing is to know history of primary female relative
Has mom or sister had/have breast cancer
Means that women is at a major increased risk for breast cancer
Genetic test can prove this
o Lifestyle and health practices
Taking hormones?
Contraceptives?
Stop at age 30 because of risk for cardiovascular and cancer
Antipsychotic drug use (increases risk)
Live/work in area contaminated with benzene, asbestos, or radiation
Caffeine intake
Exercising without proper bra support
o Abnormalities on Inspection
Peau dorange Orange peel breast. Bunch of tiny dimples. Inflammatory breast
cancer. Most aggressive breast cancer. VERY BAD
Pagets disease Presents as a scaly rash usually around nipples or areola. Very
invasive as well. That invasive means its somewhere else as well.
Retracted nipple Suggests malignancy.

Dimpling Caused by malignant tumor that has fibrous strands attached to the
breast tissue and fascia of the muscles. As muscle contracts it draws the breast
tissue and skin with it, causing dimpling or retraction
Retracted breast tissue Restricted movement or retraction when having the
client lean forward at waist means fibrosis and fixation of the underlying tissues
due to malignant tumor.
o Abnormalities on Palpation
Cancerous tumors Irregular, firm, hard, not defined masses that may be fixed
or mobile. Usually not tender and occur after age of 50
Malignant tumors often found in upper outer quadrant of breast. They are
unilateral with irregular, poorly delineated borders. Hard, non-tender, and
fixed to underlying tissue.
Fibroadenomas Lesions that are lobular, ovoid, or found. Firm, well-defined,
seldom tender, and usually singular and mobile. Occur more commonly between
puberty and menopause.
Usually 1-5 cm, round or oval, mobile, firm, solid, elastic, non-tender,
single or multiple benign masses found in one or both breasts
Fibrocystic breast tissue that feels ropy, lumpy, or bumpy in texture is
referred to as nodular or glandular breast tissue
Benign breast disease Also called fibrocystic breast disease. Marked by round,
elastic, defined, tender, and mobile cysts. Most common from age 30 to
menopause, after which it decreases.
Consists of bilateral, multiple, firm, regular, rubbery, mobile nodules, with
well-demarcated borders. Pain and fullness occurs just before menses.
Milk cysts Sacs filled with milk
Mastitis Infection
These can turn into an abscess during breast feeding or after recently
giving birth
Lipomas Collection of fatty tissue that can appear as a lump
Vaginitis
Syphilis
Chlamydia and gonorrhea
Ovarian cancer
BPH
o Enlarged prostate that puts pressure on the ureter. Normal in men as they age
o The pressure is what is responsible for the signs and symptoms
o If it gets too big then there is dribbling of urine, or cant start the stream etc.
o Prostate should normally be the size of a walnut
o If bigger than walnut then you cant find the valley (sulcus)
Sexual assault assessment (8)
o Pregnant women among the most abused group
Diabetes
Diabetic ketoacidosis
Hypo and hyperthyroidism
Thyroid crisis
Hypocalcemia and hypercalcemia (6)
o Ca (Calcium)
8.5-10.8 mEq/L (standard values so it can be unique to the lab)
Closely regulated by kidneys and parathyroid hormone
Plays a role in blood clotting, hormone secretion, receptor functions, nerve
transmission, and muscular contraction
Has inverse relationship with phosphorus
If calcium is high then phosphorus is low and vice versa

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Has synergistic relationship with magnesium

Means that they are compatible and go the same way
Regulated by
Vitamin K - Comes from the GI tract bacteria
Parathyroid hormone
o Sitting on the thyroid
o Remove the thyroid in thyroid disease then you remove the
parathyroid and patient has trouble with calcium, magnesium, and
phosphorus
Calcitonin - Comes from the thyroid

Calcium Imbalance (look at whats unique, unusual, and what is ABC)

Hypercalcemia
Increased intake or release:
o Calcium antacids
o Calcium supplements
o Cancer
o Immobilization
o Corticosteroids
o Vitamin D deficiency
o Hypophosphatemia
Deficit excretion:
o Renal failure
o Thiazide diuretics
o Hyperparathyroidism
Hypocalcemia
Excessive losses:
o Hypoparathyroidism
o Renal failure
o Hyperphosphatemia
o Alkalosis
o Pancreatitis
o Laxatives
o Diarrhea
o Other medications
Deficient intake:
o Decreased dietary intake
o Alcoholism

o Absorption disorders
o Hypoalbuminemia
o Calcium Assessment
Hypercalcemia
dysrhythmias, ecg changes (same on both)
confusion (same on both)
decreased memory (same on both)
headache
lethargy, stupor, coma
muscle weakness, decreased deep tendon reflexes
anorexia, nausea, vomiting constipation, abdominal pain
Hypocalcemia
dysrhythmias, ecg changes (same on both)
increased bleeding tendencies
anxiety, confusion, depression, irritability
fatigue, lethargy
increased deep tendon reflexes, tremors, muscle spasms, tetany
Seizures
laryngeal spasms (airway therefore concerning) (could have
inflammation of airway then no breathing)
increased bowel sounds, abdominal cramping
positive Trousseaus and Chvosteks signs
o Chvosteks
Tap below ear on the facial nerve (affected by calcium)
If calcium is low there will be twitching on the ipsilateral side
(same side)
Means laryngeal spasms which is an emergency
o Trousseaus
Take blood pressure cuff and blow pretty high and leave it
there for several minutes
Flexion of the wrist and phalanges
Cramping of the thumb
o Hyperkalemia causes cells to fire more easily
o Hypercalcemia the cells are less likely to fire more easily
Electrolyte imbalance (discerning which one is present) (6)

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Hypo
Diminished deep tendon
reflexes, muscle weakness
Diminished deep tendon
reflexes, muscle weakness
Muscle weakness,
constipation
Laryngeal spasms, positive
Chvosteks and Trousseaus
signs
Decreased deep tendon
reflex
Seizure, P450, Torsades,
EKG

135 SODIUM 145

96 CHLORIDE 106
3.5 POTASSIUM 5
8.5 CALCIUM 10.8

2.5 PHOSPHOROUS 4.5

1.3 MAGNESIUM 2.1

Hyper
Fever, decreased urine
output
Fever, decreased urine
output
ECG, muscle cramping,
respiratory depression
Decreased deep tendon
reflex
Laryngeal spasms,
positive Chvosteks and
Trousseaus signs
Renal failure, antacids,
excessive laxatives
(RENAL)

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HH and NS hyper osmolarity (6)

Addisons
Mixedema
Crohns disease (5)
o Type of (chronic) inflammatory bowel disease (Crohns and ulcerative colitis)
o Effects the mucous membrane lining of the bowel (it gets thicker and does not function
as it should) causing chronic malabsorption
o Symptoms include abdominal pain, fever, diarrhea, and weight loss (same as ulcerative
colitis)
o Causes skip lesions Ulcer then strip of well tissue then ulcer etc. Seen on endoscopy
o Occur anywhere in GI system including the lips to the anus. Chronic inflammatory
genetic disease the effects the whole GI system
o Some believe it is autoimmune but not sure
o Problem is it permanently changes the lining of the gut
o Has a high risk for cancer but not as high as ulcerative colitis
Correct abdominal assessment (5)
o Order for abdominal assessment is inspection, auscultation, percussion, and palpitation
o Only system in which this is different
Immunity (acquired versus passive) (1)
Pressure ulcer grading (3)
o Pressure Ulcer Risk Factors (we use the Braden Scale) = 0-12 is bad (lower the worse
the score)
Perception
Decreased perception
If you cant feel pain, you are more at risk for a pressure ulcer
People that dont have good pain perception are diabetics, mental illness,
those that are on ventilators, drug induced coma etc.
Mobility
Always sitting means skin youre sitting on gets pressure on the bones and
squishing the bones
Pressure points Elbows, hip bones, coccyx bone, heels/calcaneous bone
These are the common places we see pressure points
Moisture
Macerates skin Breaks the skin down
Makes it soupy
They get this from sweat, incontinence, and not moving
Nutrition
Need protein, lots of calories
Sick people are at a risk factor because they arent eating
Friction or shear against surfaces
Slide over something can tear and shear the skin
Shear Cut off the blood supply
See this in patients that are constantly getting moved
Tissue tolerance decreased
Immune system and integrity of the tissue
o Pressure Ulcer Risk Reduction
Inspect the skin at least daily and more often if at greater risk using risk
assessment tool (such as Braden Scale or PUSH tool) and keep flow chart to
document. (also take pictures)
Bathe with mild soap or other agent; limit friction; use warm, not hot, water; set
bath schedule that is individualized.

For dry skin: use moisturizers; avoid low humidity and cold air.
Avoid vigorous massage.
o Pressure Ulcer Stages (stages can happen really rapidly if pressure is not released)
Stage I Skin is in contact and it is non blanchable. Can be a red blotch.
Stage II Shallow or open ulcer with red or pink wound bed, or an intact blister.
Stage III All the skin is gone (epidermis and dermis) and youre into the subQ.
Into the fat (yellowy whitish look). This is where tunneling starts. Ulcer may look
small but extends far beyond under the surface.
Stage IV Full sickness. Exposes tendons and muscles. Underlying structures
and even bone.
Unstageable Filled with eschar (black hard plaque body makes to heal the
wound). Cant stage because the eschar blocks the wound bed.
Wound must always heal from the bottom up. Cant allow skin to grow over the
bottom up till the wound bed heals. Pack ulcers.
Skin examination
Looking at ABG levels (6)

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pH
PCO2 (lungs)
HCO3
(kidneys)
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ABG Levels
A 7.34 7.45 B
B 35 45 A
A 22 26 B

Discerning difference between acidosis and alkalosis (6)

o pH H elps distinguish between acidosis and alkalosis but doesnt reveal the cause
o PCO2 Indicates whether condition is caused by respiratory system
PCO2 over 45mm Hg = Respiratory system is CAUSE of problem = Respiratory
acidosis
PCO2 below 35 mm Hg = Respiratory system not the cause but is COMPENSATING
PCO2 within normal limits = Respiratory system not the cause or compensating
PCO2 inverse with blood pH (PCO2 rises as blood pH falls)
o HCO3
Metabolic acidosis = HCO3 below 22 mEq/L
Metabolic alkalosis = HCO3 above 26 mEq/L
HCO3 in direct correlation with blood pH (HCO3 rises as blood pH rises)
DIC (4)
o Ultimate outcome is bleeding even though it is a coagulation problem
o Loss of platelet factors
o Body clots too much therefore it is then unable to clot
o Body bleeds out
Acquired immune deficiency
Discerning assessment of the eyes (8)
o Internal Eye Structures
Inspect the optic disc.
Inspect the retinal vessels.
Reddish orange in light skinned people
Brown in dark skinned people
Arteries and veins are unique because they are switched in the retina
Optic nerve inserts at fovea
The big vessel are the veins and the arteries are small
Blue vessels are arteries
Red vessels are veins

Inspect the retinal background.

See cotton wool spots means retinal damage from hyperglycemia
Inspect the fovea and macula.
Fovea is located nasally and is a yellow disc and round
If it is swollen the physiologic cup then there is intracranial pressure
Macula
Inspect the anterior chamber
Sensorineural versus conductive hearing issues (8)
o Conduction
Something is blocking the hole (conduction)
Swimmers ear Water staying the ear canal
You get breakdown (maceration) from wet skin that stays wet for too long
Surfers ear Bone becomes inflamed in the canal. It scars and heals from the
wind and cold water and you have to get it surgically repaired
o Sensorineural
Problem with sensation or neural damage
Caused by trauma, infection, brain damage, or nerve damage
o When testing for this the outcomes are different which determines what types of
hearing loss
o Sensorineural is the more damaging type
o Conduction can almost always be fixed
o Rinne test (tuning fork) Air conduction should be twice as long bone conduction
Common changes in the eyes (8)
o Presbyopia is a common condition in clients over 45 years of age.
o Yellowish nodules on the bulbar conjunctiva are called pinguecula. These harmless
nodules are common in older clients, appearing first on the medial side of the iris and
then on the lateral side.
o Arcus senilis, a normal condition in older clients, appears as a white arc around the
limbus.
o Though usually abnormal, entropion and ectropion are common in older clients.
o Optic nerve discs are larger in blacks, Asians, and Native Americans than in Hispanics
and non-Hispanic whites.
Accurate hearing testing (8)
o Whisper Test
Have client place a finger on the tragus of one ear.
Whisper a two-syllable word 1 to 2 feet behind the client.
Repeat on the other ear.
Need to know if it is a problem with conduction of sensorineural
o Weber Test
Use tuning fork placed on the center of the head or forehead.
Ask whether the client hears the sound better in one ear or the same in both
ears.
Need to know if it is a problem with conduction of sensorineural
o Rinne Test
Use tuning fork and place the base on the clients mastoid process.
When the client no longer hears the sound, note the time interval, and move the
tuning fork in front of the external ear. When the client no longer hears the
sound, note the time interval.
Need to know if it is a problem with conduction of sensorineural
o Romberg Test
Tests equilibrium.
Feet together and arms at side, close eyes for 20 seconds.
Check for swaying.

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Need to know if it is a problem with conduction of sensorineural

Negative Romberg is normal
Eye assessment (8)
o Distant Visual Acuity
Cranial nerve 2 - Optic
Snellen chart
Normal acuity is 20/20 with or without corrective lenses
o Near Visual Acuity
Cranial nerve 2 - Optic
Handheld vision chart
Normal acuity is 14/14 with or without corrective lenses
o Confrontation Test
Testing visual fields
Peripheral vision
People need peripheral vision for balance, and to drive
o Testing Extraocular Muscular Function
Corneal light reflex test: Use penlight to observe parallel alignment of light
reflection on corneas.
Should see light shining on cornea in the middle
Dont see this means the eye is not focused on the light and is veering off
Infants have this and its normal
Abnormal in adult or child
Cover test: Use opaque card to cover an eye to observe for eye movement.
Look for mystagmis
One eye is not pulling its weight and is weak
Positions test: Observe for eye movement.
o Pupillary Reaction to Light
Darkened room (this is most important)
Have client focus on a distant object
Shine light obliquely into the pupil and observe the pupils reaction to light
Normally, pupils constrict
Shifting gaze from far to near
Normally, pupils constrict
Spinal cord injury (7)
o Immediate damage causes:
Spinal shock
Temporary complete loss of function below injury
o Primary neurologic injury
Irreversible damage to neurons
Generally, from infection but can be from tumor or injury
o Secondary Injury to the Spinal Cord (damage to the blood vessels in spinal cord so
decreased blood supply)
Neurons and white matter in area of initial damage are affected.
Possible causes include:
Damage to blood vessels in the spinal cord supplying the area
Decreased vasomotor tone decreasing blood supply
Local release of substances that cause vasospasm
Release of digestive enzymes from damaged cells
The secondary can be responsible for a lot of the symptoms we see
o Partial Spinal Cord Injury
Central cord syndrome: central gray or white matter
Arms more affected than legs

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Damage to central cord that doesnt reach the outside

There will sacral sparing will have difficulty with bowel and bladder
Will mostly have upper extremity symptoms
Not lower extremity symptoms
Anterior cord syndrome: anterior section of cord
Motor functions affected; touch sense not affected
Problem with the anterior cord artery (front side/ventral)
Artery has a problem for some reason - Compression, tumor, or lytic
problem where it has been lysed by trauma
Loss of motor function, and pain, and temperature but proprioception is
maintained
Posterior cord syndrome
Damage to posterior cord (back or dorsal side)
Get loss of proprioception
Both upper and lower loss of function to spinal cord
Brown-Squard syndrome: one side of cord
Motor function lost on that side; pain/temperature sensation lost from
other side
Half of the right or left side of the brain has an injury (hemi-section) you
get ipsilateral weakness (same side) with loss of proprioception (test
sensation of position) and contralateral loss of pain and temperature
sensation
Conus medullaris syndrome: sacral and lumbar
Bowel, bladder, sexual function defects
Autonomic Dysreflexia
Spinal injury so blood pressure goes out of control because of lack of
neurological control of the blood pressure so you get hypertensive and the body
cannot respond to whatever signals they are sending the brain
In spinal cord injuries this means they have a full bladder so if you get a catheter
in the symptoms go away
Can be lethal with blood pressure going sky high
Complete Spinal Cord Injury No function or sensation below the level of injury
8 Cervical
C7 is the hallmark of whether you can breathe on your own (thoracic
notch)
Below you can breathe
Above you probably cant
C1 means youre going to die thats it
Damage here means they have little or no movement of upper and lower
extremity muscles but have movement of head and neck and maybe
shoulders
Damage from C1-C3 means they need long term mechanical ventilation
because of damage to diaphragm so they cant breathe
Damage to C4 means no damage to diaphragm so they can breathe on
their own
C5 has ability to flex elbow
C6 is able to extend their wrist
C7 is able to extend their elbow
o Highest level of injury and still be able to live independently
C8 has functional finger flexion
12 Thoracic

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Damage here means they have innervation and function of all upper
extremity muscles including the hand
5 Lumbar
5 Sacral
Depends on the level of injury gives you the signs and symptoms
To upper motor neurons (T12 and above)
Spinal reflexes still work
No longer modulated by the brain
Hypertonia, spastic paralysis
To lower motor neurons (T12 and below)
Cells in spinal reflex arcs damaged
Flaccid paralysis
Seizures (determining the type of seizure youre looking at) (7)
o Abnormal, excessive nerve firing
o Provoked seizures Fever, metabolic imbalances, brain injury (tumors, drug abuse,
vascular lesions)
o Unprovoked (epileptic) seizures Cause unknown
o Focal Seizures
Without Impairment of Consciousness or Awareness
Limited to one hemisphere
Could be no change in consciousness
With Impairment of Consciousness or Awareness
One hemisphere to other
o Generalized Seizures
Involve both hemispheres
Tonicclonic: muscle contraction, loss of consciousness
Absence: disturbances in consciousness
Myoclonic: muscles of the face, trunk, extremities contract
Tonic: voluntary muscles of the legs and arms contract
Clonic: bilateral, symmetric, rhythmic muscle contractions
Atonic: loss of muscle tone
Problems with hypothalamus
Vertigo (8)
o Menieres disease Chronic disorder of the inner ear
o Causes problems with vertigo and tinnitus (and hearing loss)
o Ideopathic
o Usually unilateral but can develop into bilateral
Health history related to neurological complaints (7)
o History of present health concern
Headache (COLDSPA)
Location Frontal, occipital (tension and migraine), temporal (ice pick pain
headache/brain freeze)
Onset When does it happen? Headaches that wake you up in the middle
of the night arent a good sign. Ones that dont have an onset (just started
3 weeks ago and havent gone away) are very concerning as well. If they
havent gotten better we are suspecting tumor or mass
Duration
Severity Warning sign (flag) is the worst headache youve ever had. This
is a terrible finding. Increases level of concern
Pattern Comes every 4 weeks during menstrual cycle means its
probably normal
Associated symptoms Scary ones are:

o
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Seizures
What happened before, during, or after
Before you can have an aura (they know its coming), involuntary
articulations (screams) (not normal screams)
During do they have tonic-clonic movements (rhythmic contracting), are
they awake and alert, do they pass out, do they hit their head and fall, do
they lose control of their bowel and bladder (important info to note)
Physiological problem with seizing? (What do seizures do?) Not just falling
and getting hurt. Besides the brain. Muscles contract over and over
because of the acid building up (myoglobin muscle dump which is toxic)
Dizziness, numbness, tingling (more signs to look at)
Changes in sensory (smell, hearing, vision, temperature, and ability to
feel)
o Changes in speaking and difficulty swallowing are important
Changes in temperature and ability to feel
Problems with muscle control (too weak to contract)
o Past health history
History of head injury
History of central and peripheral infections
Infections Meningitis, encephalitis, syphilis (these can damage nervous system)
History of memory loss Very concerning, both short term and long term
Long term is more concerning
In memory loss short term goes first, long term goes last
The last person remembers before they forget everything is their name
Forgetting this is bad
History of smoking, drinking, taking drugs (all of these effect the nervous
system)
History of lifting things for a living Can damage neurological system doing that
o Family history
o Lifestyle and health practices
Cranial nerve tests (7)
o Cranial nerves rhyme - On old Olympus towering top a Finn and German viewed some
hops
o Sensory/Motor rhyme - Some say marry money but my brother says big brains/boobs
matter more
Cranial nerve tests (7)
o I Olfactory
Sensory
Test with smell (keep their eyes closed)
o II Optic
Sensory
Test with Snellen for visual acuity
Should be 20/20
Legal definition of blindness is 20/200
Need to be 20 feet away
Rosenthal is 14 inches away and is the hand held ones
o III Oculomotor
Motor
Innervates the eyelid should be 2mm over the iris

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Changes in vision
Nausea and vomiting
These are very concerning

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If you can see the entire iris in whole eye that is hyperthyroidism
Called exophthalmos
Extra ocular movement test Look for eyes to flicker out of focus
Dilantin toxicity - If iris has lateral flipping then it is toxicity
PEARL
Pupils equal and reactive to light
Pupils contract in light then dilate in darkness
Look for these in 3, 4, and 6 nerves
IV Trochlear
Motor
Innervates the eyelid should be 2mm over the iris
If you can see the whole eye that is hyperthyroidism
V Trigeminal
Both
Test sensory and motor
Test temporal and masseter muscle contraction
Put hand over temporal muscle and have them clench their jaw and same
with masseter muscle
Should feel equal strength of contraction if trigeminal working
If the patient had a stroke then the masseter and temporal muscle on the
right side would be weak
Sharp and dull to the face (close eyes and say if sharp or dull)
Corneal reflex Cornea is covering over iris
Corneal tear is agonizing
Have them look away and you touch the cornea and if it hurts they blink
and do on both sides
VI Abducens
Motor
Innervates the eyelid should be 2mm over the iris
If you can see the whole eye that is hyperthyroidisms
VII Facial
Both (motor and sensory)
Test by smiling, frowning, puffing out cheeks, showing teeth, closing eyes against
resistance
Should be equal on both sides of the face
VIII Acoustic (Vestibular Cochlear)
Sensory
Test hearing
Do the whisper test, Renee and Weber
Whisper behind their ear and see if they can hear
Weber normal Hear the ringing in both ears
Renee normal Air conduction is twice the bone conduction
Test whether it is sensory neural loss or conductive loss
Most common conductive hearing loss is wax
Dont every put cold water in someones ear (test vestibular cochlear)
IX Glossopharyngeal (Test 9 and 10 together)
Both
Tongue blade in mouth and say ahh
Look for the uvula and soft palate to rise equally at the midline
If it doesnt rise in the midline this is scarring
X Vagus
Both

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Gag reflex is an indication of vagus and glossopharyngeal function

Swallowing Should be symmetric
Quality of voice (hoarseness is a bad sign)
XI Spinal Accessory
Motor
Test with shoulder shrug against resistance (testing the trapezius)
Turn head against resistance (testing sternocleidomastoid)
XII Hypoglossal
Motor
Tongue strength
Make them push tongue against cheek, and ROM of tongue

Nursing diagnosis for cerebral injury (7)

o Decreased cerebral tissue perfusion
Testing cerebellar function (7)
o Cerebellum = Muscle tone, movement, and balance
o Upper and lower motor neurons and the cerebellum
o Assess condition and movement of muscles.
Need to know all the major muscles to test motor
Step on the gas test test strength of gastrocnemius
o Evaluate balance.
Test balance Heel to shin test
Tandem Stand on one foot and hop (evaluating balance)
Gait Normal looks like the opposite hand swings with the opposite leg
Left foot right hand etc
o Perform Romberg test.
See if they fall when eyes are closed
Cerebellum function (if they fall could be indicative of a tumor)
Make sure to keep arms out to catch them if they fall
o Assess coordination.
Finger to nose alternating with eyes closed (like DUI)
Alternating movements

Test with anything that requires coordination

Cerebellum function

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DVT
Arterial insufficiency (review) (4)
Heart failure (4)
o Compensation in heart failure Based on Frank-Starling law of the heart
If the cardiac output goes down the body will try to compensate by stimulating
the sympathetic nervous system, and the renin-angiotensin-aldosterone system
which causes myocardial hypertrophy (make heart cells get bigger)
All these methods can temporarily increase the cardiac output but in the long
term they make it worse
o Manifestations of Heart Failure
Fluid retention, edema, respiratory distress, pulmonary congestion, fatigue,
exercise intolerance, cyanosis, sympathetic nervous system effects because of
the overcompensation, and if really bad Cheyne-Stokes breathing (breathing
pattern very specific to heart failure; shallow breathes, deep, then shallow, then
apnea, then starts all over)
Effects of impaired pumping, decreased renal blood flow (RAA pathway), and
SNS
o Left-Sided Heart Failure Failure to produce cardiac output
Diastolic: LV does not accept enough blood from lungs
Systolic: LV does not pump enough blood to body
Blood backs up: Left heart lungs right heart body
Body lacks blood
The lungs fill with blood
o Right-Sided Heart Failure Problems with cardiac output or more importantly problems
with congestion in the lungs (problems with breathing) (dont oxygenate the blood)
Diastolic: RV does not accept enough blood from body
Systolic: RV does not pump enough blood to lungs
Blood backs up: Right heart body (edema) left heart lungs
Body fills with blood
The lungs do not oxygenate enough blood

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MI/MONA (4)
o Caused by ischemia
o Classic presentation of MI is chest, left arm, jaw, and pain in the center of the back
o Feeling of doom, something bad is happening

Women would die before they could be diagnosed with coronary heart disease because
they dont present with the same symptoms
o Women present with anxiety (sudden onset), they dont have chest pain
o If someone is having an MI look at enzymes in body. The cells die and break apart
o Most accurate marker of MI from ischemic cell destruction is troponin (shows as
elevated)
o Acute coronary syndromes (MI indicators)
ECG changes
T-wave inversion Repolarization of the ventricles. Follows the S wave
(QRS is the contraction)
o Ischemic heart means your heart cant repolarize correctly. So there
is an inversion. Dips below the central line and becomes a U
ST-segment depression or elevation Distance between S and T wave
Abnormal Q wave Very strong indicator or MI
Serum cardiac markers
Proteins released from necrotic heart cells
Myoglobin, creatinine kinase, and troponin
o Creatinine kinase Break down muscle cells. Not specific to cardiac.
Could also mean they run three miles (also skeletal)
o Troponin Most specific to cardiac muscle
o Myoglobin Comes from cardiac and skeletal muscle breakdown
o Chest pain Severe, crushing, constrictive OR like heartburn (if heartburn isnt getting
better)
o Sympathetic nervous system response
GI distress, nausea, vomiting
Tachycardia and vasoconstriction
Anxiety, restlessness, feelings of impending doom
o Hypotension and shock Weakness in the arms and legs (another symptom of women)
o Cardiac artery is the worst artery to have an MI in
Lateral ascending artery Supplies blood to the septum of the heart
Commonly called the widow maker because it causes them to just drop over
dead
o Complications of acute MI Heart failure, cardiogenic shock, pericarditis,
thromboemboli, rupture of the heart, ventricular aneurysms, and chronic pain
Knowing normal blood values (4)
Cardiac assessment (4)
Respiratory tract infection and assessment
COPD
COPD
Interpreting respiratory assessment findings (disease based on assessment findings)
Interpreting respiratory assessment findings (disease based on assessment findings)
Pulmonary embolus
Respiratory assessment (normal and abnormal findings)
COPD
Adventitious lung sounds
o

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Compartment syndrome
Testicular pain
Menstrual cycle
Autoimmune
Congestive heart failure (4)
Common eye diseases (8)
o Conjunctivitis Inflammation of the conjunctiva
Pink eye
Caused from staph and strep (most common cause is viral)
o Cataracts (lens abnormality)
Lens opacity that interferes with transmission of light to the retina (cloudiness of
the iris)
Aging is most common cause
Surgery is the only treatment - implant a new lens
o Retinopathy
Involve the small blood vessels of the retina
Characterized by changes in vessel structure - microaneurysms,
neovascularization (formation of new blood vessels), hemorrhage, retinal
opacities
Changes in the retina are most commonly caused diabetes (sugar is no good for
the retina)
Leading cause of blindness in developed countries is diabetes and hypertension
o Retinal detachment
Separation of neurosensory retina from the pigment epithelium
Primary symptom is painless changes in vision
o Macular degeneration
Degenerative changes in the central portion of the retina that result primarily in
loss of central vision
Most common cause of reduced vision in the elderly
o Glaucoma
Too much pressure in the eye, will kill the optic nerve
Emergency if pressure comes on suddenly

Tx: diuretic carbonic anhydrase inhibitor (diamox) or mannitol, or may need

surgical intervention to relieve pressure
Closed-angle - worse bc pressure cant escape
Open-angle - pressure develops over time, not as bad as closed-angle
End stage renal disease (6)
o Chronic kidney disease
o Fewer nephrons are functioning
o Glomerular filtration rate significantly lower for more than 3 months
Normal GFR = 120 130
Decreased GFR of less than 60 means about half of the nephrons are lost
1 million nephrons in the kidney
GFR less than 60 means 500,000 nephrons
o Remaining nephrons must filter more
Hypertrophy The remaining nephrons have to filter more fluid because the
others arent able to do the job so they get really big and hypertrophy because
they have to do more work than they should
o Can be caused by diabetes, hypertension, glomerulonephritis, systemic lupus,
polycystic kidney disease
o Chronic Kidney Disease Manifestations
Uremia/azotemia: increased creatinine then BUN
CNS, GI, immune disturbances
Altered fluid, electrolyte, acid-base balance
Salt wasting, acidosis, hyperkalemia
Cardiovascular complications
Hypertension, heart disease
GI disorders
Anorexia, nausea, vomiting, ulceration (in the mouth)
Mineral metabolism disorders metastatic calcifications, and bone disease
Hyperphosphatemia hypocalcemia increased PTH calcium
resorption from bone bone loss
o Metastatic calcifications
Decreased vitamin D activation increased PTH, impaired osteoblasts
Decreased inflammation and immunity
CNS and PNS alternations
Peripheral neuropathy, restless leg syndrome, uremic encephalopathy
Sexual dysfunction
Impotence, hypofertility, dysmenorrhea (painful period and very common
in women with chronic kidney disease)
Skin disorders
Dryness, bruising, Terry nails (tells us about how the liver is going which is
not well when kidney isnt functioning)
Many of these are hard to manage by themselves but incredibly difficult when
paired with chronic kidney problems
Less waste is removed so more waste is in the blood
Decreased fluid, pH, and electrolytes
Increased creatinine and BUN
Creatinine = 0.6 1.2
BUN = 10 20 (7 18)

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