Exam 2 Patho

What is osmosis?

The process of water moving from an area of low concentration of solute to a higher concentration of solutes across a semi-permeable membrane to equalize concentration

What is osmolality?

A measure of concentration of dissolved particles in a fluid. ex. blood or urine

What is osmolarity?

The number of osmoles of a solute per liter of solution

What does water follow?

SALT WATER ALWAYS FOLLOWS SALT

How does albumin relate to this stuff?

Albumin is associated with oncotic pressure.

What is oncotic pressure?

Albumin pulls water to it and keeps water inside blood vessels

What is Kwashiorkor?

This is a condition that results from inadequate protein intake

What is it when there is low albumin because of a lack of protein

Ascites. This affects Africans a lot bc they dont get enough protein

What is tonicity

The amount of solutes in the solution compared with the bloodstream

How does the body respond to dehydration?

• Osmoreceptors stimulate thirst

• Anti Diuretic Hormone (ADH) is released from pituitary gland & decreases urine output

• Increased HR (Tachycardia) &hypotension

  • RAAS is activated

What is RAAS?

This is the Renin-Angiotensin-Aldosterone System

How is RAAS activated?

From little blood flow to kidney (Severe dehydration)

What is the net result of RAAS?

Vasoconstriction and increased BP

How does RAAS work?

• Renin is released from kidneys

  • Converts angiotensinogen to angiotensin

• Angiotensin 1 is converted to angiotensin 2

  • This is done in the lungs by angiotensin-converting enzyme (ACE)

• Angiotensin 2 (vasoconstrictor)

  • This activates the adrenal cortex to release aldosterone

• Aldosterone

  • This increases sodium and water reabsorption and potassium secretion by kidneys

What causes dehydration?

Reduced fluid intake, burns, fever, perspiration, osmotic diuresis as seen in DKA

How do you assess dehydration?

The best way is daily weights then Is & Os and decreased urine output

What are signs of dehydration?

Dark urine with high SG, dry mucous membranes, low urine output, thirst

Natriuresis

This is the excretion of large amounts of sodium and water

What is Brain Natriuretic Peptide (BNP)?

Rgus us when heart ventricles dilate due to excess fluid. BNP is released to tell the kidneys to excrete more water and sodium

What are causes of hypervolemia?

CHF, CKD, excess IV fluids, sodium retention

What are ways to assess the fluid status of hypervolemia?

DAILY WEIGHTS!! Is & Os and urine output

What are signs of hypervolemia?

Weight gain, high urine output, HTN, ascites, crackles in lungs, dyspnea, edema

What is transudate?

Serous filtrate of plasma and RBC

What is exudate?

It means infection so there are WBCs, RBCs, and inflammatory signs

Electrolyte imbalance for sodium?

Think brain!

Potassium imbalance

Think heart

Calcium imbalance

think bones

Magnesium imbalance

Think calm and sedate

Phosphorus imbalance

Think teeth

Chloride imbalance

Think cellular

TIME FOR ABGS!!!

You got this be proud of yourself

What is the correct pH level for ABGs?

between 7.35 and 7.45. Too low is acidic and too high is basic

What gas is considered an acid in our body?

CO2

What ion is considered an acid in our body?

H+ and it is super strong

What ion is considered a base in our body?

HCO3 aka BiCarb

What are normal CO2 stats?

35 to 45. High CO2 is acidosis and low is Alkalosis

What are normal HCO3 (bicarb) levels?

Between 22 and 26. Too high is a base and too low is acidic

TIME FOR HEMATOLOGY RAHHHHH

YOU GOT THIS

What is blood composition?

• Plasma makes up 55%

  • Albumin, ions, gases, nutrients, and waste

• Erthrocytes make up 45%

  • Red Blood Cells

• Buffy Coat makes up <1%

  • Platelets and Leukocytes

Hemolysis

The destruction of RBCs

Lysis

Destruction of cells

Petechiaie

Small red dots due to bleeding under the skin

Leukocytosis

Higher than normal WBCs

Microcytosis

Smaller than normal RBCs

Thrombocytopenia

Lower than normal platelet count

Leukopenia

Lower than normal WBC count

What does -penia mean

POOR LIKE YOU HOE

Pancytopenia

Lower than normal WBC, RBC, and platelet count

Thrombocytosis

Higher than normal platelet count

What is hematopoiesis

The creation of RBCs

Where are RBCs made?

In the red bone marrow specifically in the stroma

What is in the yellow bone marrow?

This is where fat is stored

What happens to your marrow as you get older?

It turns from mostly red to yellow

What are stem cells?

These are the OG cells that have not been differentiated yet

What are baby RBCs?

Reticulocytes

What is the anagram to remember all the WBCs in order of most to least?

Never Let Monkeys Eat Bananas

Which two leukocytes are phagocytes?

Neutrophils and monocytes

What are special about lymphocytes?

These have memory and they help make up our immune system

What do Eosinophils do?

They release anti histamines and fight against allergy

What do Basophils do?

These release histamines. They play a role in hypersensitivity

What does it mean where there are a lot of new leukocytes

Lots of immature WBCs means there is a new infection this is called a band-emia or a left shift

Leukemias

Proliferation of cancerous WBCs. This makes lots of T Cells that are all useless, they just take up space

Lymphomas

These are cancers of the lymph nodes. Abnormal proliferation of B and T cells

What is ALL

Acute lymphatic leukemia. Mainly in children with 80% survival rate. Immature T or B cells

What is CLL

This is the old ppl version of ALL. Mainly in 70 or older. B cell malignancy

What is AML

Acute Myelogenous Leukemia. This is the proliferation of undif myeloid cells

What is CML

The old ppl version of AML and found in 65 or older

What are B symptoms?

• Unexplained weight loss

• Soaking wet night sweats

• Unexplained fever

What is Hodgkins Lymphoma?

Most common in ages 15-20 and over 50. It is a B cell abnormality

Non Hodgkins Lymphoma

More common in older folks. B or T cell abnormalities. Large painless lymph node is often the first sign. HIV makes things worse

What are neutropenic precautions

The patient has no immune system so they have to be super protected.

• No fruits

• No flowers

• No plants

• No raw or undercooked meat

• No pimple popping

What does high H H mean?

1. High altitude

2. Super dehydrated

   1. Anything that lowers O2 levels

What does low H H mean

1. Nutritional deficit

2. Blood loss

3. CKD

   1. Fluid volume overload

What anemia is microcytic and hypochromic

Iron deficiency anemia

What anemia is macrocytic and hyperchromic

B12 and folic acid deficiency

What anemia is normocytic and normochromic

Blood loss anemia

What does mean corpuscular volume mean

It relates to the size of the RBC

What does mean corpuscular hemoglobin concentration mean

It relates to the color of the RBC. If it is red enough or not

What is the universal blood recipient

AB+

What is the universal donor

O-

How should you take iron?

Take it on an empty stomach and with vitamin C such as OJ

What does liquid iron do?

Stains the hell outta your teeth

How do you treat pernicious anemia

You have to get vitamin B12 shots because your body does not absorb cyanocobalamin

Sickle cell anemia blood life span

Short life of 10-12 days

What happens to ppl with sickle cell

They get dactylitis which is EXTREMELY painful

What are the 4 priorities of educating those with sickle cell

• They MUST rest

• They need to prevent infections

  • getting vaccines and staying away from sick ppl

• Avoid stress

• Stay hydrated

What are the three steps of hemostasis?

1. Vasoconstriction

2. Platelet Plug

3. Coagulation

What are the coagulation pathways

• Intrinsic

  • Activated partial thromboplatin time (aPTT)

• Extrinsic

  • Prothtombin time (PT)

  • International normalized ratio (INR)

What does INR measure?

How long it takes for blood to clot normal is 1 minute

What breaks down a clot?

Plasmin eats the fibrin

What is D-Dimer?

This is the break down of a clot

What does it mean if there are high D-Dimers?

It means a clot is present in the blood stream

What are anti platelet drugs?

This is aspirin and it makes drugs slippery

What are anticoagulation drugs

• Heparin

• Low Molecular Weight Heparin

• Warfarin

What are thrombolytic agents

These are clot busters and an example is streptokinase. Used for strokes must be within 3 hours

What is hemophilia

This is an X-linked recessive gene so men are symptomatic. Abnormal bleeding

TIME FOR IMMUNITY!!! YAYAYAY

ALMOST DONE

What is an antigen

This is a “non self” marker that causes the body to start an immune response

What does it mean to be immunodeficient

It means your have a weakened immune system

What is autoimmunity

This attacks “self” cells