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