Pathophysiology Exam 1

stresser exceeds the abilty to adapt & a person develops type 2 diabetes

What is an an example of allostatic overload?

catecholamines

both a hormone and a neurotransmitter (epinephrine and norepinephrine)

hormone

released by endocrine glands and travel through blood and act on distant target cells. The effects are slower to build but longer lasting.

neurotransmitter

released by nerve cells, travel across synapse to act on nearby cells, fast to act byt short lasting,

alarm stage

The fight or flight stage of the general adaption syndrome, the sympathetic nervous system is the first to react, epinephrine and norepinephrine are released from the adrenal medulla with acts immedietly but not long term.

Symptoms of epinephrine and norepinephrine

increased BP, respiration rate, blood flow to muscles, heart rate, blood sugar

decreased fllow to GI, dialate pupils, dialate bronchiols, bronchodialation, dialate pupils, sweating, dry mouth, feeling of nervouses, tremors possible

Hypothalmic pituitary adrenal (HPA) Axis

SNS reacts the fastest but we need energy to keep going . Endocrine system kicks in to produce hormoes and prolongs the ability to deal with a stressor

communication network

CRF (corticotropin- releasing factor )

ACTH (adrenocorticotropin hormone)

HPA Axis

controls reactions to stress and regulates digestion, the immune system, mood, emotions, and sexuality

cortisol

primary stress hormone

cortisol affects

increase glucose, enhance brain functioning, increase BP, enhance the body’s ability to mobilize glucose, amino acids, and fat stores for cellular energy production, decrease inflammation, enhance immune suite for 1st 3-5 days

the role of the hormone aldosterone is

reabsorb Na and water, excrete k and in the bladder

Antidiuretic Hormone(ADH) and Aldosterone

Hormones that act in renal tubules of the kidney that are trying to increase blood volume and blood pressure

Antidiuretichormone (ADH)

Vasopressin from the pituitary gland that stops excretion of H2O

Aldosterone

from the adrenal cortex and reabsorbs Na and water

Resistance Phase

the second stage of general adaption syndrome continual release of catecholamines (epi/NE) & hormones to manage the stressful event. if stressful event ends- parasympathetic nervous system takes over for the sympathetic nervous system

Acetylcholine

a neurotransmitter of PNS (cholinergic) that lowers HR, vasodilation of peripheral arteries, lowers BP, bronchoconstriction, constricts pupils, increases blood flow to bowels, increased blood flow to the urine activity, and a feeling of relaxation.

exhaustion phase

teh third stage of general adaption theory - no longer to maintain homeostasis and high levels of hormones, the body overwhelmed and resources are depleted, decreased immune system. long term cortisol secretion, high blood sugar, high blood pressure, wt gain, run down and unable to cope, mood disorders

lifestyle factors to combat stress

healthy nutrition, exercise, good sleep habits, support network, reduce caffeine intake, good balance, humor, journaling, mediation, prayer, yoga

What hormones are released in the HPA axis the stress response

Which type of IV solution has less solutes than blood and causes fluid to move from the ECF to the ICF

Fluid homeostasis

there are 3 mechanisms that sense the volume/ concentration of fluid

What mechanisms sense low fluid volume

Osmireceptors/ ADH and and Renin- Angitensin- aldosterone- system (RAAS)

What mechanisms sense high fluid volume?

Natriuretic Peptides (ANP, BNP)

osmoreceptors & ADH

fluid shifts from ICF to ECF (cells shrink) ———- in hypothalamus sense high osmolality >295 and activates thirst center , hypothalamus makes ——- and releases from posterior pituitary and travels to nephrons, holds onto water/ vasoconstriction

Renin Angiotensin Aldosterone System (RAAS)

activated: hypotension, hypovolemia, dehydration, low cardiac output, kidneys sense a decrease in perfusion, renin in release from kidneys and converts angiotensinogen (from liver) to angiotensin 1 which is then converted to angitensin 2 in lungs by angiotensin converting enzyme (ACE). this ids a vasoconstrictor tat activates the adrenal cortex to release aldosterone which increases sodium and water reabsorption and excretes potassium this in turn raises BP and blood volume

Natriuretic peptides

natriuresis is excreting NA and H2O

BNP (B-type natriuretic peptide)

released by ventricals when stretched with too much volume causing diuresis (urination

ANP (atrial natriuretic peptide)

released from atria when stretched with too much volume

Hypervolemia

fluid volume overload/ low osmplarity/ low Na

increased hydrpostatic pressure (heart failure), low oncotic pressure (low albumin), cangesin capillary permeability- inflammatory response sodium retention- H2O follows Na Hypervolemic hypernatremia

Causes of hypovolemia

what is the term for fluid in the plural space

edema, sequestered fluids(third-spacing) fluid in abnormal places (pleural, pericardial), weight gain (2 lbs=0.907 kg 1L fluid) ascites (fluid in peritoneal space), crackles in lungs, dyspnea, hypertension, bounding pulse

symtoms for flid volume overload

Fluid volume deficient (hypovolemia)

fluid moves out of ICF causing cells to shrink,

poor fluid intake, excessive loss of (bleeding, vomiting bleeding), burns, fever, perspiration, osmotic diuresis (high blood glucose) hypernatremia, high osmolarity (>295)

causes of hypovolemia

oliguria (normal urine output 30mL/hr or 400 mL/fay, wt loss, dry mucous membranes, poor skin turgor, hypotension

symptoms of hypovolemia

Intake/Output

record 24 hour

sensible water loss

what we can measure

insensible water loss

what we cannot easily measure

daily weight

change of 2lbs/24 hrs would be concerning

which of the following is activated by a pt with hypervolemia

an 80 yrr old male in in the ER getting evaluated for vomiting 3x days. What symptoms do ypu expect him to have

hypovolemic hypernatremia (low volume, low Na)

most coomon electrolyte imbalance, loss of Na2 and H2O, caused by vomiting, diarrhea, excess sweating, burns, diuretics, osmotic diuresis (increased urination d/t uncontrolled DM), Symtoms are dry mouth, hypotension tachycardia, oliguria, lethargy. muscle cramps, headache.

hypervolemia hyponatremia (high volumr, low sodium)

Na is diluted in excess water cause bt heart, liver, kidney failure, SIADG, no dehydration symptoms, water shifts ECF→ICF as cels move more NA (cell swelling) seizures, coma, irreversible brain damage from brain swelling

hypernateemia (low or hugh volume)

cells become dehydrated and shrink cellls follow NA

Hypervolemic: excess Nabintake (IV, high aldosterone)

Hypocolemic: loss of water most common cause (GI loss, exercise), signs of dehydration, seven mental changes

parathyroid hormone (PTH)

helps with bone formation and breakdown

Vitamin D (calcitriol)

helps with teh gI tract absorbs Ca

calcitonin

produced by the thyroid

Low calcium

PTH (Parathyroid hormone) increases and bone releases Ca into bloodstreamm, kidneys hoold onto Ca GI tract absorbs Ca

high Ca

a 32-amino acid peptide hormone produced by the C-cells in the thyroid gland that lowers blood calcium levels, opposing parathyroid hormone (PTH). It acts by inhibiting bone-resorbing osteoclasts and reducing renal calcium reabsorption.

calcitonin released and keeps Ca in bones kidneys excrete Ca and Gi tract decreases absorption of Ca

a pt passed out after exercising in the middle of summer and reports a headache cramps and thirst

hypercalcemia

a 44 yr old women is admitted to the hospital for weakness, anorexia, nausea, vomitting x1 week. she was recently diagnosed with breat cancer with metastasis to bone. which electrolyte imbalalnce do you expect her to have

potassium

The nurse is ediucating a pt with renal failure to avoid foods such as avocados, orange juice, and potatoes beacsue they contain which electrolyte

hypermagnesemia

this elctrolyte imbalance can coexist with low calcium levels and cuase hyperreflexia, tremors, and. muscle cramps

hypervolemia

a pt with liver disease is found to have hypoalbuminemia which has a decreased oncotic efffect resulting in which fluid imbalanve

hyperkalemia

a 30 yr old mal epresents to ER following a sever motor vehicle accident and is found to have severe muscle trauma and renal failure. He has paresthesias in his extremities and an EKG reveals wide QRS complexes and tell peaked T waves. What do you expect

hypovolemia

after a fall from a ladder a pt is found to have internal bleeding the compensatory mechanism RAAS is activated in respose to?

hyperphosphatemia

a 77 yr old female has been recieveing dialysis for renal failure for the last 4 years. The nurse is concerned for which other elctrolytes imbalnce when the the pt arrives to th edialysis clinic wirh retany and hypocalcemia?

hypervolemia

a 90 yr old male with dyspnea is found to have an osmolarity 270 mmil/kg (275-295), Na 130 mEq/L (135-145) and a cheat xray reveals a pleural effusion. wjich typre of fliuid imbalance is this?

hypocalcemia

this electrolyte imbalance is regulated by teh parathyroid hormone and common symtoms include tetany, cardiac, dysrhythmias, and a positive, Trousseaus sign

hypernatremia

which electrolyte imbalance causes water to be pulled from the ICF to the ECF leadinf to cell dehydation

stressor

physical or psychological challenging demand on the body that arouses a response from multiple organ system

homeostasis

bodys ability to maintain stable internal environment

acute stress

response to intermediate stimuli intensity varies in response to stimuli and ends after threat is avoided.

chronic stress

prolonged activation of stress to a perceived threat that does not end quickly (linked to diminishing immunity, cancer, heart disease, depression, and other illnesses)

Seyle Stress response theory

decribes the bodies reaction to acute stress. threat to homestasis and provokes a coordinated response that involves neural, endocrine, and immune responses (short term=protective respose/ prolonged exposure= diminishing effect)

adaptive ability

the way an individual handles a stressor and maintains homestasis

McEwens Stress Response Theory

cumulative effect of frequent recurrent stress, frequent stressors change physiological balance and create a new set point

Allostasis

dynamic state of balance in response to a stressor, acheiving stability through physiological and behavioral changes in response to stress

allostatic load

wear and tear on the body systems caused by stress reactions

allostatic overload

stress exceeds the bodies ability to adapt leaidng to disease or dysfunction

intracellular fluid (ICF)

40% of total body weight (TBW)

extracellular fluids

outside of cell- 20% of TBW mainly intavascularly (blood vessel), contains electrolytes, proteins oxygen, glucose, nutrients, and waste products, includes plasma and interstitial fluid

interstital fluids

filtrate of blood located between cell or between cells and capillaries- between tissue cells

60%

what percent of human body is water

cell membrane

what separates Intracellular and extracellular compartments

capillary membrane

separates intravascular and interstitial compartments

semipermeable membrane

solutes and fluids move between the compartments through a

solute

the compound inside a solvent

solvent

liquid in which a solute dissolves in to form a solution

diffusion

water and electrolytes passively move from high to low concentration to reach equilibrium

osmosis

solvent moves from low to high concentration solution, large molecules unable to pass through membrane, primary means by which water is transported into and out of cells

facilitated transportation (facilitated diffusion)

molecules move through the membrane w/ help from a carrier protein (insulin facilitates diffusion of glucose)

activated transport

must have energy (ATP) to pass through the membrane against a concentration gradient (low to high concentration) like teh sodium potassium pump (ATP pump Na out of cell and K into cell)

osmolarity

number of osmoles of solute per liter of solution

osmolality

concentration of solutes per kg of solvent (concentration of particles dissolved in body fluid)

275-295 mmol/kg

normal range of osmolality

less concentrated too much fluid diluting solutes

<275

more concentrated low fluid making solutes more concentrated

>295

isotonic fluids

water stays in the vasculature

hypotonic fluid

water flow out of the vasculature to cells

hypertonic solution

water enters the vasculature from cells

Sterlings Law of Capillary Forces

2 opposing forces at every capillary bed to keep fluid in the correct compartment

hydrostatic pressure

pressure exerted by fluid against a vessel wall or membrane, pushes fluid out, heart pumps fluid out of ISF and ICF to deliver oxygen/nutrients

osmotic pressure

pulls fluid back in, solutes (mainly Na) put fluids and waste products back in from ICF & ISF to the ESF, pressure re

Oncotic pressure

type of osmotic pressure exerted by albumin (plasma proteins) that pulls what into bloodstream

high hydrostatic pressure, low oncotic pressure

Arteries pressure

low hydrostatic pressure high oncotic press

veins pressure

electrolytes

charged ions dissolved in body fluid

cations

positively charged (MG, Na, Ca, H)

anions

negatively charged (phosphate, sulfate, Cl, bicarb)