A male client with a massive pulmonary embolus is tachycardic, hypotensive, and has audible bilateral pulmonary crackles. His arterial blood gas (ABG) results are: pH 7.0: PaCO, 66 mm Fig; HCO3- 24 mEq/L (24 mmol/L); PaO, 60 mm Hg. Based on these findings, this client is at greatest risk for which pathophysiological condition?

Reference Ranges:

pH [7.35 to 7.45] PaCO, [35 to 45 mm Hg]

HCO3- [21 to 28 mEq/L (21 to 28 mmol/L)]

PaO, [80 to 100 mm Hg]

Chronic osteoarthritis (OA) is a degenerative joint disease characterized by the breakdown of joint cartilage and underlying bone changes. The pathophysiological process of OA involves various factors contributing to joint pain and inflammation. Here's why option C is the correct choice:

A) Inflammation results from deposition of crystals in the synovial space of joints producing irritation:

This statement is more characteristic of crystal-induced arthritis, such as gout or pseudogout, where crystals (e.g., urate or calcium pyrophosphate crystals) deposit in the joints and cause acute inflammation and irritation. While inflammation may occur in OA, it is primarily a result of mechanical stress and cartilage degradation rather than crystal deposition.

B) Inflammation is caused by immune complex and autoantibody deposition in connective tissue:

This statement is more characteristic of autoimmune diseases such as rheumatoid arthritis (RA), where immune complex deposition and autoantibody production lead to chronic inflammation and joint damage. In OA, inflammation is not primarily mediated by immune complex deposition or autoantibodies.

C) Joint inflammation occurs when chondrocyte injury destroys joint cartilage, producing osteophytes:

Correct. In osteoarthritis, joint inflammation occurs as a result of chondrocyte injury and cartilage breakdown. Over time, the degenerative changes in the joint lead to the formation of osteophytes (bone spurs) at the joint margins. These changes can irritate surrounding tissues, including the synovium, ligaments, and tendons, contributing to joint pain and inflammation.

D) Joint destruction happens due to an autoimmune inflammation involving IgG response to an antigen:

This statement is more characteristic of autoimmune arthritis, such as rheumatoid arthritis (RA), where autoantibodies (e.g., rheumatoid factor, anti-citrullinated protein antibodies) target joint tissues, leading to chronic inflammation and joint destruction. In OA, joint destruction primarily results from mechanical stress and wear-and-tear on the joint structures rather than autoimmune mechanisms.

Benign prostatic hyperplasia (BPH) is a condition characterized by non-cancerous growth of the prostate gland, leading to its enlargement. This enlargement can contribute to urinary retention by obstructing the flow of urine through the urethra. Here's the breakdown of the explanation:

A) Abnormal growth results in loss of bladder muscle tone:

While BPH can lead to urinary symptoms such as urinary frequency, urgency, and nocturia, it does not directly cause loss of bladder muscle tone. Instead, the enlarged prostate gland obstructs the bladder outlet, making it difficult for urine to pass through the urethra.

B) Inflammation causes spasms of the gland:

Inflammation of the prostate gland, known as prostatitis, can cause symptoms such as pelvic pain, dysuria, and urinary frequency, but it is not typically associated with BPH. BPH is characterized by benign growth of the prostate tissue rather than inflammation and spasms.

C) The enlarged gland compresses the urethra:

Correct. The primary mechanism by which BPH causes urinary retention is by compressing the urethra, which obstructs the flow of urine from the bladder. As the prostate gland enlarges, it can constrict the urethra, leading to symptoms such as hesitancy, weak urinary stream, incomplete emptying, and urinary retention.

D) Nerve compression decreases the sensation that the bladder is full:

While compression of nerves in the pelvic region can contribute to urinary symptoms, such as decreased sensation of bladder fullness, it is not the primary mechanism by which BPH causes urinary retention. The compression of the urethra by the enlarged prostate gland is the main factor leading to urinary obstruction and retention.