Pathophysiology Test 2

Major component of the body

Water

Intracellular compartment (ICF)

Watery liquid found entirely inside the cells

-2/3 of total body water

Extracellular compartment (ECF)

All body fluid located outside the cells

-1/3 of total body water

-Intravascular, Interstitial, Cerebrospinal fluid, Transcellular fluids

Intravascular Fluid (IVF)

Extracellular fluid inside blood vessels

Interstitial Fluid (ISF)

Extracellular fluid that fills in the spaces between most of the cells of the body

Cerebrospinal Fluid (CSF)

Plasma-like clear fluid circulating in and around the brain and spinal cord

Transcellular Fluid (TCF)

A specialized subset of extracellular fluid that is separated from blood plasma by an additional layer of epithelial cells

Amount of water entering the body =

Amount of water leaving the body

Hydrostatic

Pushes water out of capillaries

Osmotic/Oncotic pressure

Pulls water into capillaries (reabsorption)

Filtration

The movement of fluid out of the capillary and into the interstitial space

Capillary Hydrostatic Pressure

-Blood pressure

Facilitates the outward movement of water from the capillary to the interstitial space

Capillary (Plasma) Oncotic Pressure

Attracts water from the interstitial space back into the capillary

Interstitial Hydrostatic Pressure

Facilitates the inward movement of water from the interstitial space into the capillary

Interstitial Oncotic Pressure

Attracts water from the capillary into the interstitial space

Antidiuretic hormone (ADH)

Hormone produced by the neurosecretory cells in the hypothalamus that stimulates water reabsorption from kidney tubule cells into the blood and vasoconstriction of arterioles

Aldosterone

"Salt-retaining hormone" which promotes the retention of Na+ by the kidneys

-Na+ retention promotes water retention, which promotes a higher blood volume and pressure

Atrial Natriuretic Peptide (ANP)

Hormone secreted from atrial cells of the heart in response to atrial stretching and an increase in circulating blood volume. ANP has been identified as a diuretic that causes sodium loss and inhibits the thirst mechanism

T-Type Natriuretic Peptide

A hormone synthesized and released by myocardial (heart) cells

-Works to regulate fluid, sodium, and potassium levels in the body

-Signals the kidneys to excrete excess water and salt through urine, helping to reduce edema and lower BP

Edema

Excessive amount of fluid in the interstitial compartment

Edema Causes

-Increased capillary hydrostatic pressure

-Loss of plasma proteins (decreased oncotic pressure)

-Increased capillary membrane permeability

-Lymphatic channel obstruction

Clinical Manifestations of Edema

-Generalized or Localized =

-Sudden or gradual weight gain (fluid gain), swelling, puffiness, tight-fitting clothes or shoes, limited movement of joints

-Fluid accumulation = Increased distance of travel

-Increased tissue pressure = Impaired blood flow, ischemia, poor wound healing, increased risk of infection, pressure injuries

Treatment of Edema

-Lymphedema (more firm) Wraps

-Diuretic (Furosemide, Lasix)

Dehydration

Insufficient body fluid

-More serious in infants and older adults

Water loss =

Electrolyte and protein loss

Dehydration Causes

Sweating, sunburns, vomiting & diarrhea, insufficient water intake, appropriate formula mixing

Effects/Clinical Manifestations of Dehydration

Tenting (Tugor), pale, dry mucus membranes, low BP, high HR, weak pulse, confusion, lethargic, sleepy

Attempts to Compensate for Fluid Loss

-Increasing thirst

-Increasing HR

-Constriction of cutaneous blood vessels

-Producing less urine (Concentration of urine)

Signs and Symptoms of Edema

-Localized swelling

-Pale, gray, or red skin color

-Weight gain

-Slow, bounding pulse; high BP

-Lethargy, possible seizures

-Pulmonary congestion, cough, rales

-Decreased hematocrit

-Decreased serum sodium

-Urine: Low specific gravity, high volume

Signs and Symptoms of Dehydration

-Sunken, soft eyes

-Decreased skin tumor, dry mucous membranes

-Thirst, weight loss

-Rapid, weak, thready pulse, low BP, and orthostatic hypotension

-Fatigue, weakness, dizziness

-Increased body temperature

-Increased hematocrit

-Increased electrolytes

-Urine: High specific gravity, low volume

Normal Sodium (Na+) Value

135-145 mEq/L

Normal Potassium (K+) Value

3.5-5.0 mEq/L

Normal Calcium (Ca2+) Value

8.5-10.5 mg/dL

Normal Magnesium (Mg2+) Value

1.5-2.5 mEq/L

Hyperkalemia

Potassium >5.0

Hyperkalemia (Cardiac)

Peaked T waves, hypotension, bradycardia from decreased cardiac output

Hyperkalemia (Neuromuscular)

Paresthesia and paralysis, cramping muscles, increased deep tendon reflexes

Hyperkalemia (GI)

Nausea, vomiting, abdominal cramping, and diarrhea -> Hyperactive bowel sounds

Hyperkalemia (Kidney)

Oliguria, kidney damage

Common causes of Hyperkalemia

Excessive intake, a shift of potassium from cells to the ECF, cellular breakdown, decreased renal excretion, or drugs that decrease renal potassium excretion

MURDER acronym

-Muscle cramping

-Urinary issues (oliguria, anuria)

-Respiratory distress

-Decreased cardiac contractility

-EKG changes

-Reflexes, hyperreflexive

Hypokalemia

Potassium

Hypokalemia (Cardiac)

Flattened, ST depression, flattened T waves

Hypokalemia (Neuromuscular)

Flaccid paralysis, decreased deep tendon reflexes, lethargy

Hypokalemia (GI)

Nausea, vomiting, constipation, abdominal distention, decreased motility -> hypoactive to absent bowel sounds

Hypokalemia (Kidney)

Water loss, thirst, inability to concentrate urine

Common causes of Hypokalemia

Reduced intake of potassium, an increased movement of potassium into the cells, and increased losses of potassium

Hypernatremia

Sodium >145

Sighs & Symptoms of Hypernatremia

-Skin flushed, edematous

-Agitation, restlessness

-Low-grade fever

-Thirst

Late and serious sign of Hypernatremia

Thick, dry, sticky tongue (VERY SPECIFIC)

Causes of Hypernatremia

-Medications, meals (too much sodium intake)

-Osmotic diuretics

-Diabetes insipidus

-Excessive water loss

-Low water intake

Hyponatremia

Sodium

Hyponatremia (Neuro)

Seizures, confusion, headache, coma, cerebral, edema, increased intracranial pressure

Hyponatremia (G)

Nausea, vomiting

Hyponatremia (Hypovolemic)

Hypotension, Tachycardia

Hyponatremia (Hypervolemic)

Weight gain, swelling, jugular vein distention

Causes of Hyponatremia

Loss of sodium, inadequate intake of sodium, or sodium dilution secondary to excess water

Signs & Symptoms of Hyponatremia

-Stupor, Coma

-Anorexia

-Lethargy

-Tendon reflexes

-Limp muscles

-Orthostatic hypotension

-Seizures

-Stomach cramping

Range of Chloride

95-105

Chloride

Always following sodium, so the signs/symptoms of hyperchloermia/hypochloremia are the same as hypernatremia/hyponatremia

Hypermagnesemia

Magnesium >2.5

Hypermagnesemia (Cardiac)

Bradycardia, hypotension

Hypermagnesemia (Neuro)

Decreased DTR

Hypermagnesemia (Respiratory)

Depressed, shallow respirations

Causes of Hypermagnesemia

Renal failure, too many laxatives

Hypomagnesemia

Magnesium

Hypomagnesemia (Cardiac)

Tachycardia, hypertension, Torsades de Pointes

Hypomagnesemia (Neuro)

Muscle cramps, tetany, irritability

Hypomagnesemia (Eyes)

Nystagmus

Nystagmus

Involuntary rapid eye movements

Causes of Hypomagnesemia

Malnutrition, malabsorption syndromes, alcoholism, diuretic use

Hypercalcemia

Calcium >10.2

-Bones, beats, bladder, and GI issues

Hypercalcemia (Bones)

Bone pain, osteoporosis, fractures

Hypercalcemia (Beats)

Bradycardia, dysrhythmias, cardiac arrest

Hypercalcemia (Bladder)

Kidney stones, impaired renal function

Hypercalcemia (GI issues)

Constipation, nausea, anorexia

Causes of Hypercalcemia

Neoplasms, hyperparathyroidism, demineralization caused by immobility, increased intake of calcium or vitamin D

Hypocalcemia

Calcium

Hypocalcemia Signs & Symptoms

-Chovstek sign (cheek)

-Arrythmias

-Troussea sign (taking the BP)

-Stridor, laryngeal spasms

-Numbness and tingling, especially around the mouth

Causes of Hypocalcemia

Hypoparathyroidism, malabsorption syndrome, renal failure, not enough intake of calcium or vitamin D

Acid-Base Balance

-Essential to homeostasis

-Cell enzymes only function within a narrow pH range (7.35-7.45)

pH range

7.35-7.45

Acid-Base Balance Buffers

-Respiratory controls acid (Takes minutes)

-Kidneys modify excretion of acid and absorption of base to regulate pH (Slow but most significant)

Acidosis

Excess of hydrogen ions

-Decrease in serum pH (

Alkalosis

Deficit of hydrogen ions

-Increase in serum pH (>7.45)

Acid-Base Imbalances

Metabolic, Respiratory, or Mixed

Compensation Mechanisms for pH Imbalances

-Do NOT remove the cause

-Balances the proportion of acids (hydrogen ions) and bases (bicarbonate ions) in circulation

Decompensation

Life threatening

-Problems become more severe

-Additional problems occur

-Compensation mechanisms are exceeded or fail

Structures of the Pulmonary System

2 lungs, upper and lower airways, blood vessels, diaphragm, and chest wall

Right Lobe of Lung

Upper, Middle, Lower

Left Lobe of Lung

Upper, Lower

Diaphragm

A muscle that separates thoracic and abdominal areas

Mediastinum

Space between lungs

-Contains heart, great vessels, esophagus

Conducting Airways

Allow air into and out of the gas exchange structures of the lung

Upper airway

-Nasopharynx, oropharynx

-Larynx (vocal cords, glottis)

-Trachea

Nasopharynx, Oropharynx

Warms and humidifies air, removes foreign particles

Larynx

-Vocal cords, glottis

-Essential for normal swallowing, aspiration prevention

Trachea

-Upper and lower airway

-Connects larynx to bronchi

Gas-Exchange Airways

-Respiratory bronchioles

-Alveolar ducts

-Alveoli

Alveoli

-Primary gas-exchange units of the lung

-Surrounded by alveolar capillaries