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Pathophysiology > Exam 2 > Flashcards

Exam 2 Flashcards

Fluids/Electrolytes; Acid/Base; Neuro

1
Q

4 places water/solute can go (interstitially)

A

absorbed into cells
reabsorbed into bloodstream
stay in interstitial space
move to lymphatic system

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2
Q

What regulates water balance

A

endocrine (ADH/Aldosterone)
renal (reabsorption/excretion)
GI (reabsorption/elimination)

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3
Q

What is the other name for ADH

A

vasopressin

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4
Q

When water moves from high–> concentration

A

diffusion

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5
Q

When water crosses a semi-permeable membrane

A

osmosis

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6
Q

When water is sent through a membrane by force

A

filtration

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7
Q

Where are volume receptors for ADH located

A

L. and R. atria

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8
Q

Where are baroreceptors (pressure receptors) located

A

aorta, pulmonary arteries, carotid sinus

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9
Q

Hypertonic

A

too much solute in relation to water

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10
Q

Hypotonic

A

small amount of solute in relation to water

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11
Q

What causes decreased tonicity?

A

hypotonic IV, poor salt intake, increase in ECF

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12
Q

What causes increased tonicity?

A

hypertonic IV, excess salt intake, decrease in ECF

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13
Q

Part of neuron that carries nerve impulse to cell body

A

dendrite

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14
Q

Part of neuron that carries nerve impulse away from cell

A

axon

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15
Q

The nerve glue, supports neurons, greater in number

A

neuroglia cells

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16
Q

What influences cerebral spinal fluid

A

CO2, O2, Hydrogen concentration

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17
Q

What arteries supply blood to brain

A

internal carotid
vertebral arteries

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18
Q

Path of veins leaving brain

A

cerebral vein –> venous plexus/dural sinus –> internal jugular vein

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19
Q

What impacts nerve regeneration?

A

location of injury
type of injury
inflammatory response
scarring
if crushed or cut injury

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20
Q

Norepinephrine

A

mood, sleep, arousal

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21
Q

What has affect on norepinephrine

A

cocaine and meth block reuptake

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22
Q

Acetylcholine

A

heart contractions, BP, gland secretions

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23
Q

What affects acetylcholine

A

decreased amount seen in Alzheimer’s

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24
Q

Dopamine

A

pleasure pathway

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25
Q

What affects dopamine

A

destruction seen in Parkinson’s
excess –> delirium

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26
Q

Histamine

A

arousal, thermoregulation, cerebral circulation

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27
Q

GABA

A

post synaptic inhibition for neurons

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28
Q

What affects GABA

A

anti seizure medications increase GABA function

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29
Q

Serotonin

A

mood, anxiety, sleep induction

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30
Q

Monroe Kellie Doctrine

A

if one of three factors goes up without any of them decreasing, there is an increased ICP

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31
Q

What factors impact ICP

A

brain tissue
blood
CSF

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32
Q

Cerebral perfusion pressure equation

A

MAP - ICP

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33
Q

What makes up peripheral nervous system

A

cranial and spinal nerves (branches/ganglia)

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34
Q

Sympathetic NS

A

fight or flight
dilated pupils
increased HR/BP
stops peristalsis

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35
Q

Parasympathetic NS

A

rest and digest
constricted pupils
lower HR
salivary secretion

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36
Q

Intracranial Pressure

A

hydrostatic forced measured in CSF

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37
Q

What elevates ICP

A

cerebral edema, too much CSF, hypercapnia, hypoxemia

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38
Q

Elevated ICP Manifestations

A

pounding headache
projectile vomiting
bulging baby fontanel

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39
Q

Water accumulation in brain tissue

A

Cerebral edema

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40
Q

Why does cerebral edema occur

A

increased capillary permeability from a trauma, infection, or tumor

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41
Q

Cerebral edema can lead to _________ _______________

A

brain herniation

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42
Q

Excess fluid in cranial vault and subarachnoid space

A

hydrocephalus

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43
Q

Mechanisms of hydrocephalus

A

increased CSF production
ventricle obstruction
impaired CSF absorption
(all lead to increased ICP)

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44
Q

Hydrocephalus manifestations

A

enlarged head circumference
bulging baby fontanel
declined LOC

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45
Q

Proximal convoluted tubule reabsorbs ____________________

A

Na, H20, glucose, amino acids, HCO3, phosphate

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46
Q

Proximal convoluted tubule secretes ____________________

A

K, H2, medications

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47
Q

Descending Loop of Henle reabsorbs ________________

A

water

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48
Q

Descending Loop of Henle secretes ______________

A

solutes

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49
Q

What type of urine does the Descending Loop of Henle produce?

A

concentrated urine

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50
Q

Ascending Loop of Henle reabsorbs ______________

A

solutes

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51
Q

Ascending Loop of Henle secretes _______________

A

water

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52
Q

What type of urine does the Ascending Loop of Henle produce?

A

diluted urine

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53
Q

Distal Convoluted Tubule reabsorbs _________________

A

some Na and Ca

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54
Q

Collecting Duct reabsorbs __________________

A

H20, salt

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54
Q

Distal Convoluted Tubule secretes __________________

A

H2 or HCO3 (depends on pH)

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55
Q

Collecting Duct secretes _____________________

A

Na, K, H, HCO3 (depends on fluid balance and can possibly reabsorb)

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56
Q

What portion of the nephron depends on fluid balance to secrete or reabsorb solutes?

A

Collecting Duct

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57
Q

What hormones are the collecting duct sensitive to?

A

ADH (vasopressin)
Aldosterone

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58
Q

What portion of the nephron depends on pH balance to secrete or reabsorb solutes?

A

Distal convoluted tubule

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59
Q

What is the order of nephron flow

A

PCT –> Descending Loop of Henle –> Ascending Loop of Henle –> DCT –> Collecting Duct

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60
Q

Glomerular filtration rate

A

filtration of plasma through the glomeruli per minute

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61
Q

What can decrease GFR

A

decreased MAP
decreased renal blood flow

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62
Q

Glomerular filtration rate relates to _____________ ___________________

A

perfusion pressure

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63
Q

What is the goal of auto regulation?

A

stop systemic BP regulations from affecting the GFR (glomeruli)

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64
Q

Process of auto regulation if systemic blood pressure increases

A

Afferent arterioles constrict to stop increased filtration pressure and glomerular blood flow

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65
Q

Process of auto regulation if systemic blood pressure decreases

A

afferent arterioles dilate to allow increased filtration pressure and glomerular blood flow

66
Q

What part of the nervous system is part of neural regulation

A

sympathetic NS

67
Q

Process of neural regulation when systemic BP drops

A

increased sympathetic NS activity in kidneys –>
tells arterioles to constrict –>
decreases renal blood flow –>
Result: decreased GFR

68
Q

What is the purpose of neural regulation

A

keep salt & water in bloodstream to help systolic BP

69
Q

What activates neural regulation

A

exercise, change in body position, hypoxia

70
Q

When is the RAAS neural regulation used

A

when patient is hypotensive/hypovolemic
(acute or chronic changes)

71
Q

Purpose of RAAS neural regulation

A

regulate blood volume, electrolytes, systemic vascular resistance

72
Q

Process of RAAS when pressure drops

A

1) Renin is released from kidneys
2) Mixes with angiotensin (liver) to make angiotensin I
3) ACE (lungs) converts angiotensin I to angiotensin II
4) angiotensin II triggers vasoconstriction and release of aldosterone

73
Q

Order of hormones in RAAS

A

Renin
angiotensin
angiotensin I
angiotensin II
aldosterone

74
Q

What hormones act on the kidneys but are not secreted from them?

A

ADH
Aldosterone
Natriuretic Peptide

75
Q

Antidiuretic Hormone purpose

A

affects urine output by…
increasing BP & water reabsorption (distal tubule/collecting duct)

76
Q

Aldosterone purpose

A

increase BP
prevent hyperkalemia
regulate pH
stimulate Na reabsorption
increase excretion of K/H2

77
Q

Natriuretic Peptide function

A

relieve heart wall pressure by… excreting Na/H20, stop renin/aldosterone secretion, vasodilate to increase urine output

78
Q

What hormones are synthesized by the kidneys?

A

Vitamin D
Erythropoetin

79
Q

Vitamin D function

A

helps Ca/P absorption in small intestine

80
Q

What stimulates Vitamin D secretion

A

PTH in kidneys where it is activated

81
Q

Erythropoetin function

A

stimulates bone marrow to make RBCs

82
Q

How is erythropoietin activated?

A

detection of decreased O2 in kidneys –>
stimulates erythropoietin secretion–>
bone marrow stimulated to make RBCs

83
Q

What is the Renal Function test

A

indirect measurement of GFR, reabsorption, excretion, and renal blood flow

84
Q

Purposes for Renal Function test

A

diagnostic/prognostic data of kidneys
medication dosaging
if patient can have contrast test

85
Q

What is BUN?

A

waste product of protein breakdown

86
Q

What is Creatinine?

A

normal muscle breakdown waste

87
Q

What can creatinine elevation be a detection of?

A

kidney failure

88
Q

Creatinine Clearance Function

A

blood vs urine creatinine

89
Q

What test is the best to measure GFR?

A

creatinine clearance

90
Q

What do you look for in a urinalysis?

A

glucose, ketones, nitrous, bilirubin, casts

91
Q

What is the ideal pH of urine?

A

6

92
Q

What type of urine is seen with a high specific gravity?

A

concentrated

93
Q

What type of urine is seen with a low specific gravity?

A

dilutes

94
Q

What can the presence of nitrites in a urinalysis indicate?

A

a possible UTI

95
Q

What is important to know about upper urinary tract obstructions

A

organ will hypertrophy to get past the obstruction

96
Q

Manifestations of lower urinary tract obstruction

A

nocturne, frequent daytime voiding dysuria

97
Q

3 Anatomic obstructions to urine flow

A

urethral stricture, prostate enlargement, pelvic organ prolapse

98
Q

What is the complication to upper urinary tract obstructions

A

cellular destructions and neuron death

99
Q

What occurs if urinary obstruction is upper and lower

A

kidney stones

100
Q

Cause of kidney stones

A

salt turns from liquid to solid due to change in temperature or pH

101
Q

What are alkaline kidney stones made of

A

calcium phosphate stones

102
Q

What are acidotic kidney stones made of

A

uric acid stones

103
Q

Manifestations of kidney stones

A

flank pain
hematuria
dysuria

104
Q

Nephrotic Syndrome

A

protein is excreted due to damaged glomeruli

105
Q

Causes of nephrotic syndrome

A

diabetes
lupus

106
Q

Manifestations of nephrotic syndrome

A

foamy urine
hypoalbuminemia
hyperkalemia

107
Q

Acute Glomerulonephritis

A

glomerular inflammation from post strep infection

108
Q

Manifestations of Acute glomerulonephritis

A

hematuria
lower proteinuria
decreased GFR

109
Q

Severe manifestations of acute glomerulonephritis

A

oliguria
hypertension

110
Q

Chronic glomerular nephritis secondary causes

A

diabetic nephropathy
lupus

111
Q

Nephritic Syndrome and its manifestations

A

intraglomerular inflammation
hematuria/low proteinuria

112
Q

Azotemia

A

increased BUN and creatinine
no symptoms of kidney failure yet

113
Q

Uremia

A

elevated BUN and creatinine
end stage renal failure
Symptoms: fatigue, neuro changes, vomiting

114
Q

Pyelonephritis

A

upper urinary tract infection (kidneys)

115
Q

Prerenal Acute Kidney Failure Etiologies

A

hypovolemia, decreased O2, low perfusion, shock

116
Q

Intrarenal Acute Kidney Failure Etiologies

A

(worst kind)
acute tubular necrosis
renal artery/vein occlusion

117
Q

Postrenal Acute Kidney Failure Etiologies

A

ureteral obstruction or bladder neck obstruction

118
Q

Acute Kidney Failure Manifestations

A

increased BUN
increased creatinine

119
Q

Chronic renal failure diagnostic test

A

creatinine clearance test

120
Q

What percent of kidney function is renal insufficiency

A

25%

121
Q

What percent of kidney function is end stage renal failure

A

less than 15%

122
Q

Chronic renal failure complications

A

solute imbalance
hyperkalemia
hypertension
anemia

123
Q

Chronic renal failure manifestations

A

uremia
oliguria
neuro changes

124
Q

Where is fluid located in young children

A

extracellularly

125
Q

Fluid Electrolyte Balance in children

A

more diluted urine
low urea excretion

126
Q

What leads to fluid imbalances in children at a higher rate than adults

A

diarrhea
poor feeding
infection/illness

127
Q

What is the most common renal cancer

A

renal cell carcinoma in proximal tubule

128
Q

Renal Cell Carcinoma manifestations

A

1st asymptomatic–> fatigue/ weight loss
then classic triad: hematuria, flank pain, palpable mass

129
Q

What type of bladder tumor is more invasive and dangerous

A

non papillary

130
Q

Type of encapsulated benign tumor in renal cortex

A

renal adenoma

131
Q

Immature tubular transport capacity

A

ability to excrete K, reabsorb HCO3, or buffer H2 with ammonia

132
Q

Vesicoureteral Reflux Manifestations

A

unexplained fever
poor growth/development
urinary obstruction

133
Q

What is vesicoureteral reflux

A

back flow of urine from bladder to ureter or kidneys

134
Q

What facilitates potassium into the cell

A

insulin
aldosterone

135
Q

What facilitates potassium out of cells

A

acidosis
cell lysis

136
Q

Etiologies for hyperkalemia

A

decrease excretion of aldosterone
taking ACE inhibitors

137
Q

Hyperkalemia Manifestations

A

muscle weakness
urine changes
restlessness
decreased HR
EKG changes (peaked T wave)
reflexes decrease
*Remember MURDER!!

138
Q

Etiologies of hypokalemia

A

diabetic ketoacidosis
diarrhea
vomiting
laxatives

139
Q

Manifestations of hypokalemia

A

hyporeflexia
paralysis
skeletal muscle weakness
U wave
(REMEMBER Harry Potter slays unicorns!!)

140
Q

Manifestations of hypercalcemia

A

bone pain
kidney stones
abdominal pain
increased urination
mental status changes

141
Q

What can cause hypercalcemia

A

hyperparathyroidism
excess vitamin D

142
Q

Manifestations of hypocalcemia

A

Chvostek sign
tetany
convulsions
tingling
hyperactive reflexes
*REMEMBER- “cats take cuddly toys home”

143
Q

Etiology of hypermagnesemia

A

renal failure
excess antacids

144
Q

Manifestations of hypermagnesemia

A

hyporeflexia
hypotension
bradycardia

145
Q

Cause of hypomagnesemia

A

malnutrition
alcoholism
loop diuretics

146
Q

Manifestations of hypomagnesemia

A

hyperreflexia
nystagmus
muscle cramps

147
Q

What electrolytes is phosphate inversely related to?

A

Calcium

148
Q

What electrolyte has the same relationship with Sodium

A

Chloride (but Na dominates)

149
Q

What electrolyte is HCO3 inversely related to?

A

Chloride

150
Q

Magnesium antagonizes what electrolyte? (inverses of each other)

A

Ca

151
Q

Etiology for hyperphosphatemia

A

renal failure
chemotherapy

152
Q

Etiology for hypophosphatemia

A

Vitamin D deficiency
alcohol abuse
respiratory alkalosis

153
Q

Describe pH and paCO2 in respiratory acidosis

A

low pH, high paCO2

154
Q

Describe pH and paCO2 in respiratory alkalosis

A

high pH, low paCO2

155
Q

Describe pH and HCO3 in metabolic acidosis

A

low pH, low HCO3

156
Q

Describe pH and HCO3 in metabolic alkalosis

A

high pH, high HCO3

157
Q

Metabolic acidosis manifestations

A

Kussmaul’s respirations
lethargy –> confusion –> coma
oliguria

158
Q

Metabolic alkalosis manifestations

A

muscle cramps
seizures
tetany

159
Q

Respiratory alkalosis manifestations

A

rapid respirations
accessory muscle usage
paresthesias

160
Q

Respiratory acidosis manifestations

A

bradypnea
shallow breaths
lethargy

161
Q

Mechanism for respiratory acidosis

A

hypoventilation leads to excess CO2 in blood

162
Q

Mechanism for respiratory alkalosis

A

hyperventilation –> reduced serum CO2

Pathophysiology (6 decks)

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