Exam 2 Flashcards
A patient with an elevated potassium level is likely to exhibit:
Peaked T-Waves on an EKG
Most abundant Cation in the Intracellular fluid (ICF)
Potassium
The concentration gradient of this cation between the Extracellular Fluid (ECF) and Intracellular Fluid (ICF) is essential for generation of electrical impulses.
Potassium
Elevated Potassium levels can cause:
Abnormal electrical conduction in the heart and life-threatening dysrythmias
Decreased Potassium can cause:
No symptoms if mild
Dysrhythmias if moderate or severe; also Constipation, fatigue, muscle weakness or spasms, muscle damage and paralysis
Which electrolyte is most prevalent in the extracellular fluids, particularly in the intravascular space?
Sodium (Na)
Electrolyte needed for generation of electrical signals in the body
Sodium (Na)
The Na+/K+ pump located in the cellular membrane keeps Na+ _____ the cell and K+ _____ the cell
Outside; Inside
Symptoms of a Na+ imbalance:
Lethargy
Confusion
Weakness
Swelling
Seizures
Coma
Hydrostatic pressure is an important influence in the movement of water and nutrients across the fluid compartments of the body. In the situation where a patient had an elevated blood pressure, what effect would an increased hydrostatic pressure in the vascular space have on fluid and electrolyte movement?
The pressure would push fluid into the interstitial space causing edema.
Hydrostatic pressure _____ water between the interstitial and capillary spaces
Pushes
Osmotic (Oncotic) pressure _____ water between the interstitial and capillary spaces
Pulls
Increased blood volume and stretching of the heart tissue causes the cells lining the atria and ventricles to secrete:
Atrial Natriuretic Peptide (ANP)
Hormone secreted to increase blood volume and BP:
Atrial Natriuretic Peptide (ANP)
How does Atrial Natriuretic Peptide (ANP) have the opposite effect of aldosterone?
Inhibits the absorption of Na+ and increases glomerular filtration causing an increase in urine output
ANP decreases what
Circulating blood volume and blood osmolarity.
Atrial Natruiretic Peptide (ANP) and B-type natriuretic Peptide (BNP) are secreted from the cardiac atria and ventricles respectively. ANP signals in an endocrine and paracrine manner to _____ and _____. BNP acts locally to _____.
Decrease BP, cardiac Hypertrophy; reduce ventricular fibrosis
A measurement of PaCO2 indicate the effectiveness of:
Lung ventilation
Lab reports the following blood gas results for your patient:
PH: 7.67
PaCO2: 53MM HG
HCO3: 37 mEq/L
Uncompensated Respiratory Alkalosis
The kidneys respond to acid-based disturbances by:
Excreting and reabsorbing hydrogen or bicarbonate
The Lab reports the following blood gas results for your patient:
PH: 7.3
PaCO2: 50 mm HG
HCO3: 34 mEq/L
Fully compensated respiratory acidosis
Rapid Breathing causes the body to:
Get rid of carbon dioxide
Secretion of aldosterone results in:
Increased blood volume
Secreted by the adrenal cortex when the ECF Na+ level is decreased; it prevents Na+ and H2) loss
Aldosterone
Acts on kidney nephrons and triggers them to reabsorb Na+ and H2) from the urine back into the blood, increasing blood osmolarity and blood volume.
Aldosterone
Prevents excess exertion of Na+ by the kidneys and prevents K+ from getting too high
Aldosterone
______ activated when blood flow or pressure to the kidneys decreases.
Renin-Angiotensin-Aldosterone System. (RAAS)
The Lab reports the following ABG results for your patient:
pH: 7.33
PaCO2: 40mm HG
HCO3: 20 mEq/L
Metabolic acidosis
What patient would be most likely to have decreased intravascular oncotic pressure? A patient with:
Liver failure
A hallmark EKG characteristic of the patient with hyperkalemia is the presence of:
Tall, peaked T waves
A nursing home patient has been admitted with water intoxication. What will his admission orders most likely include?
Monitor neurological status
When planning care for a dehydrated patient, the nurse remembers the principle of water balance is closely related to _____ balance.
Sodium (Na+)
A 64 year old male with a long history of smoking complains of excessive tiredness, shortness of breath, and overall ill feeling. Lab results reveal decreased pH increased CO2, and normal bicarbonate ion. These findings help confirm the diagnosis of:
Respiratory acidosis
A patient who has had prolonged vomiting has a blood gas drawn with the following results:
PH: 7.42
PaCO2: 51
HCO3: 33
Fully compensated metabolic alkalosis
A nurse is caring for a client who is having a panic attack and begins to hyperventilate. The client reports dizziness and circumoral tingling and numbness. What is the immediate acid base imbalance the client is experiencing?
Respiratory alkalosis
A 33 year old male with type 1 diabetes mellitus presents with an elevated blood sugar and blood gas of:
Ph: 7.32
PaCO2: 33
HCO3: 19
Partially compensated metabolic acidosis
If your patient has hyerphosphatemia, he is likely to also have what secondary electrolyte disturbances:
Hypocalcemia
A nurse is preparing to teach about erythropoietin. Which information should the nurse include? Erythropoietin is produced by the body in the:
Kidneys
A patient has a lack of intrinsic factor because of a gastric resection surgery. They are at risk for which form of anemia?
Pernicious anemia
In polycythemia vera, painful pruritis occurs secondary to:
Release of histamine from excessive mast cells
Erythrocytes are vital to which primary function in the body?
Carrying oxygen to tissues
A client with iron-deficiency anemia is scheduled for a complete blood count. The nurse anticipates that the report will show which characteristics of the red blood cells (RBCs)?
Microcytic, hypochromic
Filgastim and oprelvekin should not be given to which of the following patients?
Cancer of the bone marrow
Which of the following is NOT TRUE regarding folate (folic acid) deficiency?
Folate deficiency results in normochromic, normocytic anemia
Blood loss of approximately ___________ mL leads to serious adverse effects such as hypovolemic shock.
1000 mL.
Iron deficiency anemia is most likely to occur in a patient with a history of:
Bleeding ulcers
A patient complains of intolerable nausea and heartburn from taking an oral iron preparation. What should the nurse instruct the patient to do?
Consult with the provider
Cyanocobalamin is usually given
By injection
A pregnant patient is told that she will need to take RhoGam to prevent hemolytic disease of the newborn. Hemolytic disease of the newborn occurs when:
An Rh negative mom has an Rh positive baby
Use of larger doses of ________ to achieve hemoglobin levels of >11g/dL is associated with increased risk of hypertension, MI, stroke, and heart failure.
Epoetin
In chronic leukemia, the predominant cell is:
Mature, but doesn’t function normally
A client presents to the emergency department with severe menstrual bleeding where she is soaking three to four pads/hour. Following assessment, which of the following findings indicates that her body is trying to increase its cardiac output?
Heart rate 120 beats/minute
Hemolytic anemia is characterized by excessive red blood cell destruction and compensatory:
Increased erythropoietin from the kidney
A patient presents to the office for an annual check-up and discloses that she has been craving eating chalk. Which condition should the patient be evaluated for?
Iron Deficiency Anemia
Ferritin levels are directly related to the amount of available ______ stored in the body.
Iron.
Macrocytic (megaloblastic) anemias caused by folic acid or vitamin B12 deficiencies can seriously affect RBC production. Which of the following lab results would correlate with this diagnosis?
Mean corpuscular volume (MCV) of 120 fL (high).
A patient is diagnosed with Disseminated Intravascular Coagulation (DIC) as a result of sepsis. The nurse knows this patient is at risk for: SELECT ALL THAT APPLY
Group of answer choices
Bleeding
Pernicious anemia
Clotting
Death
Bleeding, Clotting, and Death.
Composition of blood
Aprox.
45% blood cells
55% Plasma
92% water
7% Plasma proteins
1% Other
Life span of platelets
4-10 days
Erythrocytes
Red Blood cells
Carry O2 to tissues
Thrombocytes
Platelets
Contribute to clotting
Leukocytes
White blood cells
Participate in immune response/fighting infections.
Leukocytes: Granulocytes
Neuophils
Basophils
Eosiphils
Leukocytes: Agranulocytes
Monocytes
Lymphocytes
An increase in RBCs could mean:
Polycythemia
an increase in WBCs could mean:
infection, inflammation, malignancy
An increase in platelets/coagulation factors
Hypercoagulable state (risk of clots and strokes)
Decrease in RBCs could mean:
Anemia
Decrease in WBCs could mean:
Immunodeficiency
Decrease in platelets/coagulation factors
Hypocoagulable state (risk of bleeding)
Anemia
Reduction in the total number of red blood cells in the circulating blood or reduction in the quality or quantity of hemoglobin
Causes of Anemia
Not enough production of RBCs
Excess destruction of RBCs
Blood loss
Mild Anemia
Hemoglobin 10.0 g/dL-12.0g/dL (women) 13.5 g/dL (men)
Moderate Anemia
Hemoglobin 8.0-10.0 g/dL
Severe Anema
Hemoglobin 6.5-7.9 g/dL
Life-threatening Anema
Hemoglobin less than 6.5 g/dL
Pernicious Anemia
Vitamin B12 deficiency
Risk factors: older adults, Family trends, Gastric resection, Alcoholism, Long term use of PPI
Iron Deficent Anemia
Iron deficiency anemia will have microcytic (small) and hypochromic (pale, low color) cells.
Iron Deficent Anemia risk factors/causes:
Common causes of iron deficiency anemia include: loss of blood from GI bleeds, heavy menses, peptic ulcers, and those with a lack of iron in the diet, such as vegans. There is an increased risk for infants, adolescents, and pregnant patients.
In acute leukemia, the predominant cell is:
the cells are undifferentiated or immature (usually blast cells).
Aplastic Anemia
Disorder of stem cell in bone marrow
Insufficient production of RBC
Related to: cytotoxic agents/drugs, radiation, antibiotics
Hemolytic Anemia
RBCs are destroyed faster than they carn be replaced
three groups of drugs for thromboembolic deisorders
Anticoagulants: suppressing the production of fibrin
Antiplatelets: Inhibit platelet aggregation
Thrombolytics: Promote lysis of fibrin
Ferrous sulfate
Thera. Anti-anemic drug
Iron supplement
Administered via IV, Z-track IM
Oral tabs (do not crush)
Black Box Warning: Non-intential overdoses of rion containing products are a leading cause of fatal poisoning in children
Drug-Drug interaction and drug food interaction may affect absorption
Iron Dextran
Given in Pts who have experienced intolerable or ineffective oral dosing
Given via IV
May cause anaphylactic reaction, hypotension, persistent pain with IM injection
Sodium Ferric Gluconate Complex and Iron Sucrose
Alternatives to Iron dextran
May cause Hypotension and cramps
Cyanocobalamin
Thera. Drug for anemia
purified form of vit B12
Folic Acid
Used for Megaloblastic (macrocytic anemia due to folic acid deficiency
Prevents neural tube defect in pregnancy
supplement for poor nutrition related to alcohol use
Can mask manifestations of B12 deficiency
Anticoagulants
Heparins
Vitamin K antagonist
Direct Thrombin Inhibitors
Direct Factor XA Inhibitors
Antiplatelets
Heparin and Heparin deriviatives
Rapitd anticoagulation
Adverse events: hemorrhage, hypersensitivity. thrombocytopenia
Contraindications: low platelets, uncontrolled bleeding
Antidote: Protamine sulfate
Low Molecular Weight Heparin (LMWH)
prevention and treatment of DVT and ischemic complications
Administered subQ based on body weight
may cause bleeding, immune mediated thrombocytopenia, sever neurologic injury
Antidote Protamine sulfate
Warfarin
Anticoagulant with delayed onset
Long term prophylaxix and treatment of thrombosis
may cause hemorrhage
Drug and food interactions
Antidote Vit K
Direct Thrombin Inhibitors
DVT prophylaxis and treatement and prevention of stroke due to afib
Administration orally
may cause bleeding and GI disturbances
Antidote Idarucizumab
Direct factor XA inhibitors
DVT prophylaxis and treatement and prevention of stroke due to afib
Administration orally
may cause bleeding and GI disturbances
Antidote Andexanet
Antiplatelets
Asprin
Clopidogrel
Thrombolytics
Used to prevent MI strokes, massive Pulmonary Embolism
May cause bleeding and fever
Monitor aPTT PT Hgb and Hct
Desmopressin (DDAVP)
Used in mild forms of hemophilia A, bleeding caused by trauma and surgery
IV or intranasal administration
Antihemophilic Factor VII
Used mainly for hemophilia A
Slow IV push or infusion
may cause headache itching skin rash and sensititivity
Factor IX (Christmas Factor)
Unsed mainly for Hemophilia B
Erythropoietic Growth Factos
Epoetin alfa
used for anemia due to chemo and HIV med
administered subq or IV
Sodium Na+
Most abundant cation in the ECF
when out of balance pt may experience lethargy, confusion, weakness, swelling, seizures, and coma
Potassium K+
Most abundant cation in the ICF
EKG changes with potassuim changes
hypokalemia (ST depression) and hyperkalemia (Tall peaked T wave)
Calcium Ca++
Most abundant cation in the body
increased Ca++ can cause kidney stones, abdominal pain, depression, and cardiac dysrythmias
decreased Ca++ may cause weakness, muscle spasms, and cardiac dysrhythmias
Magnesium Mg++
required for relaxation of smooth muscles, contraction of skeletal muscles, stimulation of neurons in the brain
increased Mg++ can cause cardiac dysrhythmias, muscle weakness, N&V, Breathing difficulties (Ofen accompanied with increased Ca++ and K+)
Decreased Mg++ may cause cardia dysrhythmias, muscle weakness, muscle cramps, confusion, hallucinations (Often accompanied with decreased K+)
Cl-
Most abundant anion in the ECF
Phosphate PO4-
Found in every cell in the body but stored mainly in bones and teeth
Fluid Volume Deficit (FVD) Types
Isotonic Dehydration: loss of water and Na+
Hypotonic Dehydration: loss of more Na+ than H2O (Na+ deficiency in ECF)
Hypertonic Dehydration: Loss of more H2O than Na+
Normal pH of blood in human arterial body
(acidic) 7.35-7.45 (basic)
Normal PaCO2 (respiratory) in human arterial blood
(acidic) 45-35 (basic)
Normal HCO3 (Metabolic) in human arterial blood
(acidic) 22-26 (basic)
