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
2
Q
What regulates water balance
A
endocrine (ADH/Aldosterone)
renal (reabsorption/excretion)
GI (reabsorption/elimination)
3
Q
What is the other name for ADH
A
vasopressin
4
Q
When water moves from high–> concentration
A
diffusion
5
Q
When water crosses a semi-permeable membrane
A
osmosis
6
Q
When water is sent through a membrane by force
A
filtration
7
Q
Where are volume receptors for ADH located
A
L. and R. atria
8
Q
Where are baroreceptors (pressure receptors) located
A
aorta, pulmonary arteries, carotid sinus
9
Q
Hypertonic
A
too much solute in relation to water
10
Q
Hypotonic
A
small amount of solute in relation to water
11
Q
What causes decreased tonicity?
A
hypotonic IV, poor salt intake, increase in ECF
12
Q
What causes increased tonicity?
A
hypertonic IV, excess salt intake, decrease in ECF
13
Q
Part of neuron that carries nerve impulse to cell body
A
dendrite
14
Q
Part of neuron that carries nerve impulse away from cell
A
axon
15
Q
The nerve glue, supports neurons, greater in number
A
neuroglia cells
16
Q
What influences cerebral spinal fluid
A
CO2, O2, Hydrogen concentration
17
Q
What arteries supply blood to brain
A
internal carotid
vertebral arteries
18
Q
Path of veins leaving brain
A
cerebral vein –> venous plexus/dural sinus –> internal jugular vein
19
Q
What impacts nerve regeneration?
A
location of injury
type of injury
inflammatory response
scarring
if crushed or cut injury
20
Q
Norepinephrine
A
mood, sleep, arousal
21
Q
What has affect on norepinephrine
A
cocaine and meth block reuptake
22
Q
Acetylcholine
A
heart contractions, BP, gland secretions
23
Q
What affects acetylcholine
A
decreased amount seen in Alzheimer’s
24
Q
Dopamine
A
pleasure pathway
25
What affects dopamine
destruction seen in Parkinson's
excess --> delirium
26
Histamine
arousal, thermoregulation, cerebral circulation
27
GABA
post synaptic inhibition for neurons
28
What affects GABA
anti seizure medications increase GABA function
29
Serotonin
mood, anxiety, sleep induction
30
Monroe Kellie Doctrine
if one of three factors goes up without any of them decreasing, there is an increased ICP
31
What factors impact ICP
brain tissue
blood
CSF
32
Cerebral perfusion pressure equation
MAP - ICP
33
What makes up peripheral nervous system
cranial and spinal nerves (branches/ganglia)
34
Sympathetic NS
fight or flight
dilated pupils
increased HR/BP
stops peristalsis
35
Parasympathetic NS
rest and digest
constricted pupils
lower HR
salivary secretion
36
Intracranial Pressure
hydrostatic forced measured in CSF
37
What elevates ICP
cerebral edema, too much CSF, hypercapnia, hypoxemia
38
Elevated ICP Manifestations
pounding headache
projectile vomiting
bulging baby fontanel
39
Water accumulation in brain tissue
Cerebral edema
40
Why does cerebral edema occur
increased capillary permeability from a trauma, infection, or tumor
41
Cerebral edema can lead to _________ _______________
brain herniation
42
Excess fluid in cranial vault and subarachnoid space
hydrocephalus
43
Mechanisms of hydrocephalus
increased CSF production
ventricle obstruction
impaired CSF absorption
(all lead to increased ICP)
44
Hydrocephalus manifestations
enlarged head circumference
bulging baby fontanel
declined LOC
45
Proximal convoluted tubule reabsorbs ____________________
Na, H20, glucose, amino acids, HCO3, phosphate
46
Proximal convoluted tubule secretes ____________________
K, H2, medications
47
Descending Loop of Henle reabsorbs ________________
water
48
Descending Loop of Henle secretes ______________
solutes
49
What type of urine does the Descending Loop of Henle produce?
concentrated urine
50
Ascending Loop of Henle reabsorbs ______________
solutes
51
Ascending Loop of Henle secretes _______________
water
52
What type of urine does the Ascending Loop of Henle produce?
diluted urine
53
Distal Convoluted Tubule reabsorbs _________________
some Na and Ca
54
Collecting Duct reabsorbs __________________
H20, salt
54
Distal Convoluted Tubule secretes __________________
H2 or HCO3 (depends on pH)
55
Collecting Duct secretes _____________________
Na, K, H, HCO3 (depends on fluid balance and can possibly reabsorb)
56
What portion of the nephron depends on fluid balance to secrete or reabsorb solutes?
Collecting Duct
57
What hormones are the collecting duct sensitive to?
ADH (vasopressin)
Aldosterone
58
What portion of the nephron depends on pH balance to secrete or reabsorb solutes?
Distal convoluted tubule
59
What is the order of nephron flow
PCT --> Descending Loop of Henle --> Ascending Loop of Henle --> DCT --> Collecting Duct
60
Glomerular filtration rate
filtration of plasma through the glomeruli per minute
61
What can decrease GFR
decreased MAP
decreased renal blood flow
62
Glomerular filtration rate relates to _____________ ___________________
perfusion pressure
63
What is the goal of auto regulation?
stop systemic BP regulations from affecting the GFR (glomeruli)
64
Process of auto regulation if systemic blood pressure increases
Afferent arterioles constrict to stop increased filtration pressure and glomerular blood flow
65
Process of auto regulation if systemic blood pressure decreases
afferent arterioles dilate to allow increased filtration pressure and glomerular blood flow
66
What part of the nervous system is part of neural regulation
sympathetic NS
67
Process of neural regulation when systemic BP drops
increased sympathetic NS activity in kidneys -->
tells arterioles to constrict -->
decreases renal blood flow -->
Result: decreased GFR
68
What is the purpose of neural regulation
keep salt & water in bloodstream to help systolic BP
69
What activates neural regulation
exercise, change in body position, hypoxia
70
When is the RAAS neural regulation used
when patient is hypotensive/hypovolemic
(acute or chronic changes)
71
Purpose of RAAS neural regulation
regulate blood volume, electrolytes, systemic vascular resistance
72
Process of RAAS when pressure drops
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
Order of hormones in RAAS
Renin
angiotensin
angiotensin I
angiotensin II
aldosterone
74
What hormones act on the kidneys but are not secreted from them?
ADH
Aldosterone
Natriuretic Peptide
75
Antidiuretic Hormone purpose
affects urine output by...
increasing BP & water reabsorption (distal tubule/collecting duct)
76
Aldosterone purpose
increase BP
prevent hyperkalemia
regulate pH
stimulate Na reabsorption
increase excretion of K/H2
77
Natriuretic Peptide function
relieve heart wall pressure by... excreting Na/H20, stop renin/aldosterone secretion, vasodilate to increase urine output
78
What hormones are synthesized by the kidneys?
Vitamin D
Erythropoetin
79
Vitamin D function
helps Ca/P absorption in small intestine
80
What stimulates Vitamin D secretion
PTH in kidneys where it is activated
81
Erythropoetin function
stimulates bone marrow to make RBCs
82
How is erythropoietin activated?
detection of decreased O2 in kidneys -->
stimulates erythropoietin secretion-->
bone marrow stimulated to make RBCs
83
What is the Renal Function test
indirect measurement of GFR, reabsorption, excretion, and renal blood flow
84
Purposes for Renal Function test
diagnostic/prognostic data of kidneys
medication dosaging
if patient can have contrast test
85
What is BUN?
waste product of protein breakdown
86
What is Creatinine?
normal muscle breakdown waste
87
What can creatinine elevation be a detection of?
kidney failure
88
Creatinine Clearance Function
blood vs urine creatinine
89
What test is the best to measure GFR?
creatinine clearance
90
What do you look for in a urinalysis?
glucose, ketones, nitrous, bilirubin, casts
91
What is the ideal pH of urine?
6
92
What type of urine is seen with a high specific gravity?
concentrated
93
What type of urine is seen with a low specific gravity?
dilutes
94
What can the presence of nitrites in a urinalysis indicate?
a possible UTI
95
What is important to know about upper urinary tract obstructions
organ will hypertrophy to get past the obstruction
96
Manifestations of lower urinary tract obstruction
nocturne, frequent daytime voiding dysuria
97
3 Anatomic obstructions to urine flow
urethral stricture, prostate enlargement, pelvic organ prolapse
98
What is the complication to upper urinary tract obstructions
cellular destructions and neuron death
99
What occurs if urinary obstruction is upper and lower
kidney stones
100
Cause of kidney stones
salt turns from liquid to solid due to change in temperature or pH
101
What are alkaline kidney stones made of
calcium phosphate stones
102
What are acidotic kidney stones made of
uric acid stones
103
Manifestations of kidney stones
flank pain
hematuria
dysuria
104
Nephrotic Syndrome
protein is excreted due to damaged glomeruli
105
Causes of nephrotic syndrome
diabetes
lupus
106
Manifestations of nephrotic syndrome
foamy urine
hypoalbuminemia
hyperkalemia
107
Acute Glomerulonephritis
glomerular inflammation from post strep infection
108
Manifestations of Acute glomerulonephritis
hematuria
lower proteinuria
decreased GFR
109
Severe manifestations of acute glomerulonephritis
oliguria
hypertension
110
Chronic glomerular nephritis secondary causes
diabetic nephropathy
lupus
111
Nephritic Syndrome and its manifestations
intraglomerular inflammation
hematuria/low proteinuria
112
Azotemia
increased BUN and creatinine
no symptoms of kidney failure yet
113
Uremia
elevated BUN and creatinine
end stage renal failure
Symptoms: fatigue, neuro changes, vomiting
114
Pyelonephritis
upper urinary tract infection (kidneys)
115
Prerenal Acute Kidney Failure Etiologies
hypovolemia, decreased O2, low perfusion, shock
116
Intrarenal Acute Kidney Failure Etiologies
(worst kind)
acute tubular necrosis
renal artery/vein occlusion
117
Postrenal Acute Kidney Failure Etiologies
ureteral obstruction or bladder neck obstruction
118
Acute Kidney Failure Manifestations
increased BUN
increased creatinine
119
Chronic renal failure diagnostic test
creatinine clearance test
120
What percent of kidney function is renal insufficiency
25%
121
What percent of kidney function is end stage renal failure
less than 15%
122
Chronic renal failure complications
solute imbalance
hyperkalemia
hypertension
anemia
123
Chronic renal failure manifestations
uremia
oliguria
neuro changes
124
Where is fluid located in young children
extracellularly
125
Fluid Electrolyte Balance in children
more diluted urine
low urea excretion
126
What leads to fluid imbalances in children at a higher rate than adults
diarrhea
poor feeding
infection/illness
127
What is the most common renal cancer
renal cell carcinoma in proximal tubule
128
Renal Cell Carcinoma manifestations
1st asymptomatic--> fatigue/ weight loss
then classic triad: hematuria, flank pain, palpable mass
129
What type of bladder tumor is more invasive and dangerous
non papillary
130
Type of encapsulated benign tumor in renal cortex
renal adenoma
131
Immature tubular transport capacity
ability to excrete K, reabsorb HCO3, or buffer H2 with ammonia
132
Vesicoureteral Reflux Manifestations
unexplained fever
poor growth/development
urinary obstruction
133
What is vesicoureteral reflux
back flow of urine from bladder to ureter or kidneys
134
What facilitates potassium into the cell
insulin
aldosterone
135
What facilitates potassium out of cells
acidosis
cell lysis
136
Etiologies for hyperkalemia
decrease excretion of aldosterone
taking ACE inhibitors
137
Hyperkalemia Manifestations
muscle weakness
urine changes
restlessness
decreased HR
EKG changes (peaked T wave)
reflexes decrease
*Remember MURDER!!
138
Etiologies of hypokalemia
diabetic ketoacidosis
diarrhea
vomiting
laxatives
139
Manifestations of hypokalemia
hyporeflexia
paralysis
skeletal muscle weakness
U wave
(REMEMBER Harry Potter slays unicorns!!)
140
Manifestations of hypercalcemia
bone pain
kidney stones
abdominal pain
increased urination
mental status changes
141
What can cause hypercalcemia
hyperparathyroidism
excess vitamin D
142
Manifestations of hypocalcemia
Chvostek sign
tetany
convulsions
tingling
hyperactive reflexes
*REMEMBER- "cats take cuddly toys home"
143
Etiology of hypermagnesemia
renal failure
excess antacids
144
Manifestations of hypermagnesemia
hyporeflexia
hypotension
bradycardia
145
Cause of hypomagnesemia
malnutrition
alcoholism
loop diuretics
146
Manifestations of hypomagnesemia
hyperreflexia
nystagmus
muscle cramps
147
What electrolytes is phosphate inversely related to?
Calcium
148
What electrolyte has the same relationship with Sodium
Chloride (but Na dominates)
149
What electrolyte is HCO3 inversely related to?
Chloride
150
Magnesium antagonizes what electrolyte? (inverses of each other)
Ca
151
Etiology for hyperphosphatemia
renal failure
chemotherapy
152
Etiology for hypophosphatemia
Vitamin D deficiency
alcohol abuse
respiratory alkalosis
153
Describe pH and paCO2 in respiratory acidosis
low pH, high paCO2
154
Describe pH and paCO2 in respiratory alkalosis
high pH, low paCO2
155
Describe pH and HCO3 in metabolic acidosis
low pH, low HCO3
156
Describe pH and HCO3 in metabolic alkalosis
high pH, high HCO3
157
Metabolic acidosis manifestations
Kussmaul's respirations
lethargy --> confusion --> coma
oliguria
158
Metabolic alkalosis manifestations
muscle cramps
seizures
tetany
159
Respiratory alkalosis manifestations
rapid respirations
accessory muscle usage
paresthesias
160
Respiratory acidosis manifestations
bradypnea
shallow breaths
lethargy
161
Mechanism for respiratory acidosis
hypoventilation leads to excess CO2 in blood
162
Mechanism for respiratory alkalosis
hyperventilation --> reduced serum CO2
