Patho test 2

Force of fluid pressure in the bloodstream—pushes stuff away from it. Depends on the volume of blood (plasma)

Hydrostatic Pressure

pressure by solutes in solution-pulls stuff in. depends on the number of osmotically active molecules. The pressure needed to stop osmosis

Osmotic pressure

"colloid pressure." Pressure due to albumin in the blood

Oncotic pressure

concentration of solutes per kg of solution

Osmolarity

number of osmoles (solutes) per liter of solution

Osmolality

The ability of the combined effect of all of the solutes to generate an osmotic driving forces that causes water movement

Tonicity

same tonicity as blood; 0.9% NaCl

Isotonic

Fewer particles (more water) than blood; IV infusion causes shift from ECF into ICF

hypotonic

More particles (less water) than blood
IV infusion pulls water from ICF into ECF; 3% NaCl

Hypertonic

RAAS System:
1- Low blood pressure or Low circulation detected by the \_________
2- Kidneys secrete \______, which stimulates the liver
3- (Liver) Converts angiotensinogen to \__________________ (lungs)
4-Angiotensin I converted to Angiotensin II which stimulates the adrenal gland to release \_________
5-This stimulates the peripheral arterial vasoconstriction which \____________ \_________ \________
6- Aldosterone increases sodium and water \__________ into bloodstream and causes \__________ secretion into urine

kidneys, renin, liver, angiotensin I, aldosterone,
raises blood pressure, reabsorption, potassium

RAAS System net effect:

increased BP, increased blood volume

Edema is caused by an \_______ of fluid in the ISF and ICF compartments

excess

Primary causes of edema:
-Elevated \___________ pressure
-This \____________ ECF volume as occurs in heart failure

hydrostatic, increases

Primary causes of edema:
-Decreased \_________ in blood
-\__________________ which can cause liver failure or malnutrition
-Alterations in capillary \__________ like in histamines or inflammation
-\___________ Retention due to illness or consumption of salty foods; This pulls fluid from the \_______ into the \_______

osmotic, hypoalbuminemia. permeability, sodium, ICF, ECF

If you push on it and it leaves a dent

pitting edema

low urine output

oliguria

Oliguria is less than _ml/day or less than __ to _____ ml/hour

400, 20, 30

The kidneys needs to yield a minimum of \______mL of fluid daily to sufficiently excrete waste products.

400

Symptoms associated with \_______________:
-dark urine with high urine specific gravity
-poor skin turgor
-tiredness
-dizziness
-orthostatic hypotension
-dry mouth

dehydration

Occurs in dehydration, is a systolic blood pressure decrease of at least 20 mmHg or a diastolic blood pressure decrease of at least 10 mmHg within 3 minutes when going from a lying to a standing position

orthostatic hypotension

Function of ____:__
\-fluid regulation and _________
\-Disturbance: cell shrinking/swelling, happens in the brain--> mental status ______ and _ problems

sodium, osmosis, abnormalities, CNS

Sodium less than 135mL

hyponatremia

sodium greater than 145mL

hypernatremia

Causes of hyponatremia:
-\_________ dysfunction
-diuretic usage
-\______ losses

adrenal, GI

Hyponatremia caused excessive loss of sodium

hypovolemic hyponatremia

Hyponatremia caused by excess fluids diluting sodium
Symptoms: headache, lethargy, cramps

hypervolemic hyponatremia

Function of \____________
-Resting \________ potential
-Disturbances: membrane \_________ problems, arrythmias
-K\=Kardiac

Potassium, membrane, potential

Low potassium less than 3.5:___________

* Visible on ECG: prolonged ______,__ flattened T wave, prominent _ wave

hypokalemia, QR, U

Most common cause of hypokalemia is

diuretic use

high potassium greater than 5.2:\_________
-caused by decreased \_________ perfusion
-ECG effects: \______ QRS, peak \_______, bradycardia

hyperkalemia, wide, T

Function of: \__________
-Bones, teeth, blood clotting
-Disturbances: \___________ in calcium leads to an \_________ in permeability to sodium which leads to an \_________ in \____________
Causes: contractions, confusion, spasms, \____________
AND VICE VERSA
-\____________ in calcium leads to a \__________ in the \_____________ of sodium which leads to a \___________ in excitability
Causes: constipation, lethargy, \________, decreased neuromuscular excitability

Calcium, decrease, increase, increase, excitability, seizures, increase, Increase, decrease, permeability, decrease, fatigue

low calcium less than 8.7:
-Causes paresthesia, seizures, arrhythmias, excitability
-Chvostek's in the face
-Trousseau's in the arm/hand

hypocalcemia

high calcium greater than 10:
-Causes increase PTH and in cancer
-Weakness, decreased excitability, kidney stones

hypercalcemia

Function of _________
\-bones, teeth, ATP, buffering agent
\-Dysfunction: decrease in phosphate leads to a decrease in ______ leads to a decrease in _______ activity
\-Causes a decrease in _____, oxygen transport, _ function, and blood clotting
OR
\-Increase in phosphate leads to an increase in binding calcium leads to a calcium deposition in soft tissue

phosphate, ATP, enzyme, phosphate, metabolism, WBC

low phosphate

hypophosphatemia

high phosphate

hyperphosphatemia

Function of \__________
-Stored in bones, affects active transport of Na and potassium
-Dysfunction: nerve and muscle excitability problems
-In the brain: delirium
-In the heart: arrythmia and long QT

magnesium

low magnesium

hypomagnesemia

high magnesium

Hypermagnesemia

calcium and phosphate are \_________ related

inversely

normal blood levels for sodium

135-145

normal blood levels for potassium

3.5-5.2

Which of the followin is a hypotonic solution?
-0.9% saline
-0.25% sodium chloride
-5% dextrose and lactated Ringer's
-5% dextrose in water

b

The Osmoreceptors stimulate which of the dolloinf to release ADH in response to dehydration:
-The hypothalamus
-The anterior pituitary
-The posterior pituitary
-The kidneys

c

The oncotic pressure is dependent on:
-Pressure due to volume of blood
-Pressure due to plasma proteins
-Pressure to stop osmosis
-Pressure by solutes in a solution

b

The patient is receiving Captopril - an ACE inhibitor - the nurse knows that this drug
-Inhibits the conversion of renin to angiontensin
-Inhibits the conversion of angiontensin to angiontensin I
-Inhibits the conversion of angiotensin I to angiotensin II
-Inhibits the conversion of angiontensin II to aldosterone

c

acid donate

hydrogen ions

bases accept

hydrogen ions

normal pH

7.35-7.45

low pH

acidosis

high pH

alkalosis

carbon dioxide combines with water to form

carbonic acid

carbonic acid dissociates to form

bicarbonate and hydrogen ions

bicarbonate is a

weak base

hydrogen is a

strong acid

When carbon dioxide is elevated, the equation moves right and \_______ are produced

bicarbonate and hydrogen ions

When hydrogen ions are elevated, the equation moves left and \________ is produced

carbon dioxide

Two organs that regulate pH

lungs and kidneys

To regulate pH
-Lungs respond in \_______ but \_________ be maintained
-Kidneys respond in \_________ but have \________ term results

minutes, cannot, hours/days,, long

Acid/Base imbalance:____________ _________

* ____ventilation, CO2 exhaled and equation moves toward the left, H+ ion concentration falls, _ pH

respiratory acidosis, increase, raises

Acid/Base imbalance:\____________ \_________
-\______________ ventilation, CO2 retained and equation moves toward the right, H+ ion level elevated, \________ pH

respiratory alkalosis, decrease, lowers

Acid/Base imbalance:\____________ \_________
-retain HCO3- and excretes H+

Metabolic Acidosis

Acid/Base imbalance:\____________ \_________
-retains H+ and excretes HCO3-

Metabolic Alkalosis

PCO2 levels

35-45

HCO3 levels

22-26

SaO2 levels

95-100%

Cause: elevated CO2
Example hypoventilation
-Deeper breathing

respiratory acidosis

Cause: decreased CO2
Example hyperventilation
-Breathe into a paper bag

Respiratory Alkalosis

Cause: elevated acid other than carbon dioxide (ketones)
Example: lactic acidosis

metabolic acidosis

Cause: excess base or loss of H+ ions
Examples: severe vomiting, use of diuretics

metabolic alkalosis

Measures severity of metabolic acidosis
-Measures the difference between measured cations and anions

anion gap

Normal ranges for anion gap

8-16

An \________ anion gap:
-Lactic acidosis
-Ketoacidosis
-Renal failure
-Aspirin overdose
-Ingestion of methanol or glycerol

elevated

A \______ anion gap:
-GI loss of bicarbonate
-Increased renal bicarbonate loss
-Hyperaldosteronism
-Ingestion of ammonium chloride

normal

As long as lung function is normal, hyperventilation will cause which of the following? SATA
-Increased pH
-Decreased CO2
-Decreased hydrogen ions
-Acidosis
-Increased hydrogen ions

a,b,c

Nursing students are studying for an examination. Which of the following statements show correct understanding of compensations for acid-base imbalances? Select all that apply.
-The lungs compensate more quickly than the kidneys
-The kidneys maintain acid-bae compensation longer than the lungs
-The kidneys can compensate for metabolic acid-base disorders but not pulmonary disorders
-The lungs compensate primarily for respiratory acid-base imbalances
-The lungs, kidneys, and spleen are the primary organs for compensation for acid-base imbalances

a, b

A nursing student examines a patient and notes the following: poor skin turgor, edema, oliguria, dry mucous membranes, and hypertension. Which signs and symptoms do not support the student's diagnosis of dehydration? Select all that apply.
-poor skin turgor
-edema
-oliguria
-dry mucous membranes
-hypertension

b, e

A laboratory report shows abnormal serum calcium levels. Which of the following tissues will the nurse need to evaluate, as these tissues are affected by abnormal calcium levels?
-Parathyroid gland
-Nervous system
-skeletal muscles
-lungs
-cartilage

a,b,c

Nursing students are learning about the renin-angiotensin-aldosterone system. They are amazed at its complexity, comment on the number of organs involved, and decide to make a list of these organs. Which of the following organs make their list?
-liver
-kidney
spleen
-lungs
-pituitary

a, b, d

A nurse is reviewing a patient's fluid status, as well as plasma values for electrolytes. The nurse knows which ion most significantly influences plasma volume levels?
-calcium
-potassium
-magnesium
-sodium

sodium

A patient presents with metabolic alkalosis with following values: pH of 7.5 and bicarbonate of 50 mEq/L. Which would the nurse expect to find as signs of compensation?
-decreased ventilation
-hypocapnia (low CO2)
-increased RBC synthesis
-decrease PO2

a

A patient presents with cyanosis, pH of 7.30, hypercapnia, and tachycardia. Which acid-base disorder is most likely?
-Respiratory acidosis
-Respiratory alkalosis
-Metabolic acidosis
-Metabolic alkalosis

a

A nurse is reviewing a set of laboratory values. Which result requires the immediate follow-up by the nurse?
Plasma K+ 3.0 mEq/L
Plasma K+ 4.0 mEq/L
Plasma K+ 4.5 mEq/L
Plasma K+ 5.0 mEq/L

a

Which of the following laboratory values supports the clinician's assessment of edema related to malnutrition?
Hypercalcemia
Hypoalbuminemia
Hypernatremia
Hyperkalemia

b

As the nurse checks the patient's medication chart, he notices medications listed, including diuretics. Which plasma ion would most likely need monitoring given this information?
Potassium
Magnesium
calcium
phosphorus

a

A nursing educator is determining whether a student nurse can assess the difference between hypovolemic and hypervolemic hypernatremia. Which answer indicates that the student has the correct understanding?
-Hypervolemic hypernatremia may be accompanied by edema.
-Hypervolemic hypernatremia results in hypotension.
-Hypervolemic and hypovolemic hypernatremia present in similar manner.
-Hypovolemic hypernatremia is often noted by apparent weight gain.

a

An athlete competed in a long duration endurance event lasting more than 8 hours. Results from laboratory values obtained in the Emergency Department show that he lost a significant amount of fluid and electrolytes. What phrase may be most applicable to his current status?
-Hypervolemic hyperkalemia
-Hypovolemic hyponatremia
-Hypervolemic hypernatremia
-Hypovolemic hypernatremia

b

A nursing student want to remember which vital signs may indicate fluid volume depletion. Which of the following would be best to remember?
-Increased heart rate and decreased respirations
-Increased heart rate and decreased blood pressure
-Increased blood pressure and increased respirations
-Increased respirations and decreased heart rate

b

A young child is rushed to the emergency department having ingested a large amount of bicarbonate. Which acid-base imbalance does the nurse expect to be present?
-Respiratory acidosis
-Respiratory alkalosis
-Metabolic acidosis
-Metabolic alkalosis

d

A nursing student is listing the factors measured in arterial blood gases. She states partial pressure of arterial oxygen, partial pressure of arterial carbon dioxide, and pH. Which factor is she missing?
-hydrogen ions
-partial pressure oxygen
-bicarbonate
-A1c

c

A nurse is working with a patient diagnosed with metabolic alkalosis. Which of the following values support this diagnosis?
pH of 7.2, bicarbonate of 22 mEq/L
pH of 7.6, bicarbonate of 46 mEq/L
pH of 7.2, bicarbonate of 46 mEq/L
pH of 7.6, bicarbonate of 22 mEq/L

b

A patient presents with metabolic alkalosis. Please place the following events in the proper sequence as to how the pulmonary system will attempt to compensate for the change in pH.
a: increased hydrogen ion concentration
b:increased serum pH
c:pH returning to normal
d:increased carbon dioxide levels
e:decreased ventilation

b, e, d, a, c

A nurse sees a patient with hyperkalemia due to acid-base disturbance. Which acid-base disturbance most likely caused the hyperkalemia?
-Respiratory acidosis
-Respiratory alkalosis
-Metabolic acidosis
-Metabolic alkalosis

c

Sodium levels are the highest in which level:
-ICF
-ECF
-ISF

ECF

Please place in the proper order the sequence of events related to how the RAAS activation causes an increase in blood pressure.
a: RAAS activated
b: aldosterone released
c: increased blood volume
d: low blood pressure detected by kidneys
e:increased sodium and water reabsorption by the kidneys
f:increased blood pressure

d, a, b, e, c, f

The enzyme that converts carbon dioxide in water into carbonic acid is called:
a: fumarase hydratase
b: pyruvate carboxylase
c: carbonic anhydrase
d: acetyl-CoA carboxylase

c

In metabolic alkalosis, the kidney compensates by:
a: retaining more HCO3
b: excreting more H+
c: retaining more H+
d: excreting more HCO3
e:retaining more CO2
f: excrete more HCl-

c, d

Which of the following can cause respiratory alkalosis:
a:hyperventilation
b:hypoventilation
c:GI loss of bicarbonate
d:excess loss of H+ due to diuretic use

a

Which of the following disturbances is associated with an elevated anion gap SATA:
a: lactic acidosis
b: ketoacidosis
c: renal failure
d: increased GI loss of bicarb
e: decreases renal absorption of bicarb

a,b,c

A patient has the following arterial blood gas results: blood pH 7.53, PaCO2 40, and HCO3 30
A: fully comp metabolic alk
B:uncomp metabolic alk
C:Part comp met acid
d: part comp met alk

b