1. 5
Introduction to Pathophysiology

2. Objectives Define the following terms Aerobic metabolism
Anaerobic metabolism
Cardiac output
Cell membrane
Cell nucleus
Dead air space
Dehydration
DNA
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3. Objectives Define the following terms Edema Electrolytes Metabolism
Patent
Pathophysiology
Perfusion
Stroke volume
Tidal volume
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4. Objectives
Explain the importance of understanding basic pathophysiology.
Differentiate between the processes of aerobic and anaerobic cellular metabolism.
Explain the concept of perfusion, including the components necessary to maintain perfusion.
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5. Objectives Describe the composition of ambient air.
Explain how changes in respiratory system function can affect ventilation.
Describe the transport of oxygen and carbon dioxide in the blood.
Discuss factors that affect cardiac output.
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6. Objectives
Describe the two ways the heart can fail resulting in decreased cardiac output.
Model a desire for Continuous Quality Improvement (CQI) both personally and professionally.
Value the importance of quality research and its connection to good patient care.

7. Topics
Pathophysiology The Cardiopulmonary System Hypoperfusion and Shock

8. PATHOPHYSIOLOGY

9. Pathophysiology Pathophysiology
The study of how disease processes affect the body
Allows for better identification of certain signs and symptoms to a specific course of treatment

10. Pathophysiology The Cell Basic unit of the human body Cell membrane
All organs and systems
Cell membrane
Outer protective layer of cell
Controls movement in and out of cell
Disease processes can alter effectiveness.
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11. Pathophysiology The Cell Nucleus Glucose is a basic nutrient for cell.
DNA
Glucose is a basic nutrient for cell.
Converts to energy through metabolism
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12. Pathophysiology The Cell Water Membrane regulates movement in and out.
Cells dry and die without enough water.
Cellular function is interrupted with too much water.
Influences the concentrations of electrolytes
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13. Pathophysiology The Cell Oxygen Fuels metabolism Aerobic metabolism
Normal glucose metabolism using oxygen
Carbon dioxide is a byproduct.
Critical Thinking: What medical condition commonly deals with low levels of glucose? What can EMRs do to help increase the amount of glucose in the body?
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14. Pathophysiology The Cell Oxygen Fuels metabolism Anaerobic metabolism
Abnormal glucose metabolism without oxygen
Creates increased byproducts of carbon dioxide and lactic acid
Accumulated waste makes body acidic and toxic.
Critical Thinking: What medical condition commonly deals with low levels of glucose? What can EMRs do to help increase the amount of glucose in the body?

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Figure 5.1a Aerobic metabolism requires an adequate supply of glucose and oxygen.
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16. Figure 5.1b Anaerobic metabolism occurs when there is not enough oxygen.

17. Pathophysiology Fluid Balance The body is 60% water.
Balance is necessary for proper cellular function.
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18. Pathophysiology Fluid Balance
Body adjusts fluid levels through intake and elimination of fluids.
Drinking fluids
Sweating
Breathing
Urination
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19. Pathophysiology Disruption of Fluid Balance Dehydration
Not enough fluid intake
Excessive fluid elimination
Vomiting and diarrhea
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20. Pathophysiology Disruption of Fluid Balance Edema or swelling
Fluid trapped in the body's tissues from illness
Hands, legs and feet
Injury
Capillaries leak

21. Think About It
A patient's fluid balance can easily be assessed externally.
Dry mucous membranes, sunken eyes, tachycardia, and low blood pressure can indicate dehydration.
Edema in the ankles and feet can give an indication of poor fluid distribution.

22. THE CARDIOPULMONARY SYSTEM

23. The Cardiopulmonary System
Cardiovascular and respiratory systems work together.
Respiratory system
Transfers oxygen to the bloodstream
Cardiovascular system
Transports oxygen to the body's cells
Brings carbon dioxide back to the lungs for elimination

24. The Cardiopulmonary System
Respiratory System
Structures
Airway
Lungs
Muscles of respiration
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25. The Cardiopulmonary System
Respiratory System
Airway
Movement of air in and out of the chest requires a patent airway.
Upper airway obstructions
Obstructions above the trachea prevent air from reaching the lower airway.
Altered mental status
Foreign bodies
Trauma
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26. The Cardiopulmonary System
Respiratory System
Airway
Lower airway complications
Bronchoconstriction increases airway resistance and decreases amounts of air that reaches the alveoli.
Asthma

27. Figure (A) In the alveoli is where the exchange of oxygen and carbon dioxide take place. (B) The alveoli are surrounded by capillaries that bring in oxygen and venules that carry away carbon dioxide.

28. The Cardiopulmonary System
Respiratory System
Lungs
Diaphragm and chest wall responsible for pressure changes that stimulate breathing
Tidal volume
Air moved in and out in one breath
Class Activity: Evaluate the adequacy of tidal volume by assessing the rise and fall of the chest and auscultating the breath sounds of their classmates.
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29. The Cardiopulmonary System
Respiratory System
Lungs
Dead air space
Air remaining in the space between the mouth and alveoli
About 150mL
Class Activity: Evaluate the adequacy of tidal volume by assessing the rise and fall of the chest and auscultating the breath sounds of their classmates.
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30. The Cardiopulmonary System
Respiratory System Dysfunction
Disruption of respiratory control
Damage to the medulla oblongata
Stroke
Brain tumors
Infection
Toxins and drugs
Spinal cord injuries and diseases
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31. The Cardiopulmonary System
Respiratory System Dysfunction
Disruption of pressure
Chest cavity is a closed container.
Diaphragm, ribs and intercostal muscles change the size of the cavity.
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32. The Cardiopulmonary System
Respiratory System Dysfunction
Disruption of pressure
Lungs are attached to the chest with two membranes.
Parietal pleura on the chest wall
Visceral pleura on the lung
Pleural space
May accumulate blood and air
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33. The Cardiopulmonary System
Respiratory System Dysfunction
Disruption of pressure
Expanded chest cavity creates negative pressure and lets air in.
Relaxed chest cavity creates positive pressure and forces air out.
Hole in the chest wall affects the changes in pressure.
Blood or air in the pleural space creates a hemothorax or a pneumothorax.
Talking Point: Diaphragm drops and a chest cavity expands to create a negative pressure. The tendency is for the air on the outside of the chest is to move to the area of negative pressure. When the lungs fill up, the pressure is now greater in the chest so the air moves back out to equalize the pressure.
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34. The Cardiopulmonary System
Respiratory System Dysfunction
Disruption of lung tissue.
Damage to lung tissue reduces ability for gas exchange.
Trauma
Pneumonia
Infection
Reduced oxygen levels and increased carbon dioxide levels

35. The Cardiopulmonary System
Respiratory System Compensation
Brain monitors carbon dioxide levels in blood.
Increases or decreases respiration rate and tidal volume as needed

36. The Cardiopulmonary System
Cardiovascular System
Blood
Transport system of the body
Insufficient quantity leads to poor circulation.
Critical Thinking: What are some ways blood volume can be increased?
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37. The Cardiopulmonary System
Cardiovascular System
Blood vessels are pathways.
Arteries
Carries oxygenated blood away from the heart
Veins
Carries deoxygenated blood to the heart
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38. The Cardiopulmonary System
Cardiovascular System
Blood vessels are pathways.
Arterioles
Feeds oxygenated blood to the capillaries
Capillaries
Offloads oxygen and picks up carbon dioxide
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39. The Cardiopulmonary System
Cardiovascular System
Blood vessels are pathways.
Pulmonary arteries
Carries deoxygenated blood from the heart to the lungs
Pulmonary veins
Carries oxygenated blood from the lungs to the heart
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40. The Cardiopulmonary System
Cardiovascular System
Blood pressure
Created by the beating heart to move blood around the body
Talking Point: Dilation of vessels can come from sever allergic reactions/anaphylaxis, injuries to the brain and spinal cord and sepsis. Decreased volume results from major hemorrhage and. leaking of fluid through capillary walls from sepsis or other infections.
Talking Point: Constriction of vessels can come from chronic smoking, drugs, and genetics. Increased fluid is associated with CHF. Results of Hypertension include stroke, heart attack, and kidney failure.
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41. The Cardiopulmonary System
Cardiovascular System
Blood pressure
Diameter of blood vessels and volume of blood directly affects amount of pressure.
Dilated vessels and blood loss decreases pressure.
Hypotensive
Talking Point: Dilation of vessels can come from sever allergic reactions/anaphylaxis, injuries to the brain and spinal cord and sepsis. Decreased volume results from major hemorrhage and. leaking of fluid through capillary walls from sepsis or other infections.
Talking Point: Constriction of vessels can come from chronic smoking, drugs, and genetics. Increased fluid is associated with CHF. Results of Hypertension include stroke, heart attack, and kidney failure.
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42. The Cardiopulmonary System
Cardiovascular System
Blood pressure
Diameter of blood vessels and volume of blood directly affects amount of pressure.
Constricted vessels or increased fluid in the blood increases pressure.
Hypertensive
Talking Point: Dilation of vessels can come from sever allergic reactions/anaphylaxis, injuries to the brain and spinal cord and sepsis. Decreased volume results from major hemorrhage and. leaking of fluid through capillary walls from sepsis or other infections.
Talking Point: Constriction of vessels can come from chronic smoking, drugs, and genetics. Increased fluid is associated with CHF. Results of Hypertension include stroke, heart attack, and kidney failure.
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43. The Cardiopulmonary System
Cardiovascular System
Heart
4 chambered pump designed to move blood
Stroke volume
Volume of blood ejected from the heart in one contraction
Talking Point: Heart rate directly affects cardiac output. If the heart rate gets too fast, heart does not have enough time to fully contract and eject the right amount of blood which decreases the stroke volume and in turn decreases cardiac output.
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44. The Cardiopulmonary System
Cardiovascular System
Heart
Cardiac output
Amount of blood ejected from the heart in one minute
Increased heart rate leads to increased CO.
If rate is too fast, output actually decreases.
>180 bpm in adults
Talking Point: Heart rate directly affects cardiac output. If the heart rate gets too fast, heart does not have enough time to fully contract and eject the right amount of blood which decreases the stroke volume and in turn decreases cardiac output.
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45. The Cardiopulmonary System
Cardiovascular System
Heart
Cardiac output
Autonomic nervous system response adjusts cardiac output.
Sympathetic "fight or flight" response
Parasympathetic response
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46. The Cardiopulmonary System
Cardiovascular System
Heart failure
Electrical failure
Tachycardia
Bradycardia
Ventricular fibrillation
Mechanical failure
Trauma
Squeezing of the heart muscle
Loss of cardiac muscle due to cell death

47. Think About It
The best way to assess a patient's tidal volume is to watch the chest rise and fall while counting the ventilations per minute.
Hypoxia leads to cell death.
Getting your patient on oxygen can delay the change to anaerobic metabolism.
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48. Think About It
Low blood pressure can lead to hypoxia and cell death. What are some ways that EMRs can attempt to increase pressure?

49. HYPOPERFUSION AND SHOCK

50. Hypoperfusion and Shock
Delivery of oxygen and nutrients and removal of waste to every cell and organ
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51. Hypoperfusion and Shock
All components of the cardiopulmonary system must be functioning.
Oxygen delivered all the way to the alveoli and carbon dioxide transported all the way out
Enough available blood, a functioning pump, and enough pressure to make the exchange

52. Hypoperfusion and Shock
Shock occurs when perfusion fails.
Hypoperfusion
Cells become hypoxic without perfusion of adequate oxygen.
Switch to anaerobic metabolism
Lactic acid and waste products build up.
Cells eventually die.
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53. Hypoperfusion and Shock
Compensation
Sympathetic nervous system compensates for hypoperfusion.
Vessels constrict.
Heart rate increases.
Pupils dilate.
Skin sweats.
Brain responds to increased levels of carbon dioxide.
Increased and deeper respirations
Talking point: These signs of compensation should be visible during patient assessment. Describe how you expect your patient to present if they were compensating for Hypoperfusion.

54. Hypoperfusion and Shock
Pediatric Compensation
One of the leading causes of death in pediatric patients.
Children compensate differently than adults.
Increased heart rate is the main mechanism.
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55. Hypoperfusion and Shock
Pediatric Compensation
Vasoconstriction allows them to maintain blood pressure with significant volume loss.
Blood pressure is an unreliable factor during assessment.
Higher metabolism rates burn off oxygen faster.
Talking Point: Since children are better at compensating than adults, EMR may have a false sense of security in the impression of their patient. Continually reassess to recognize subtle changes in the condition of the pediatric patient.

56. Think About It
Recognizing compensation is an important element in the assessment of a patient because it can rapidly identify the patient in shock.
EMRs should always be on the lookout for telltale signs of shock such as increased heart rate, decreased blood pressure, and abnormal respiratory rates.

57. SUMMARY

58. Summary
Understanding pathophysiology helps you understand the basic and most important functions of the body and their critical dysfunctions.
Delicate balance of fluid in the body
Levels must be appropriate in the major spaces and balanced constantly to maintain life.
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59. Summary Aerobic metabolism Anaerobic metabolism
The normal way the body converts glucose into energy
Anaerobic metabolism
Not as efficient, and it creates significantly more waste product
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60. Summary
Perfusion
Combined function of the respiratory and cardiovascular systems.
All functions needed to order to deliver oxygenated blood to the cells
Oxygen is introduced into the body from the ambient air.
Respiratory system moves air in and out of the lungs.
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61. Summary Inspired air pairs with circulating blood for perfusion.
Appropriate quantities ensure adequate delivery of oxygen to the cells.
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62. Summary The cardiovascular system
Transport mechanism for oxygen, carbon dioxide, and nutrients for the cells
Requires the presence of appropriate elements of blood, pressure within the system, and a functioning pump
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63. Summary Cellular metabolism
Relies upon a constant supply of glucose and oxygen
Normal metabolism relies upon perfusion and the successful operation of the cardiopulmonary system.

64. REVIEW QUESTIONS

65. Review Questions
How is the process of aerobic metabolism different from the process of anaerobic metabolism?
What is perfusion and what are the components necessary to maintain it?
How do changes in respiratory function affect ventilation?
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66. Review Questions
How are oxygen and carbon dioxide transported in the blood?
What are the factors that affect cardiac output?
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67. Review Questions
What are the two ways the heart can fail and result in decreased cardiac output?
What are the responses by the body when the sympathetic nervous system is stimulated?

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