Exam 2 part 1 Flashcards
1
Q
Stress?
A
A perceived or anticipated threat that disrupts a persons well being
2
Q
Stress begins with a stimulus that the brain a)_________ as stressful and in turn promotes adaptational and survival-related physiologic responses.
A
a) perceives
3
Q
1950s research showed a)_________stressors as effective as a)_________stressors in activating hormone secretion
A
a) psychologic
b) physical
4
Q
1970s research confirmed sensitivity of a)_________ and b)_________to influences reactive physiologic response Anticipatory response
A
a) central nervous
b) endocrine systems
5
Q
Adrenal gland responses to stress as well as a)_________ and b)_________responses, respectively
A
a) CNA
b) Endrocrine
6
Q
What is Allostasis definition?
What is characteristic according the graph?
A
Stability through change
Rather than homeostasis that returns the person to the original homeostasis baseline
Allostasis 適応反応
7
Q
Allostasis
Brain continuously a)_________ for future events and anticipates what is required from b)_________ and c)_________systems.
Allostatic overload may lead d)_________
A
a) monitors
b) neuroendocrine
c) autonomic
d) disease
8
Q
What is the anticipatory response?
Example
A
Generated potential encounter of danger
A child history of parent abuse, may show phycological stress response response anticipate in further abuse
9
Q
a) What is the CNS
b) What kind of stress detect?
Central nervous system
A
a) Consists of brain and spinal cord
b) Percieved(threat)
10
Q
What is the SNS?
Sympathetic nervous system
A
“Fight or Flight”
Rapid
11
Q
What substances are released by the sympathetic nervous system during stress?
A
Norepinephrine
Epinephrine
12
Q
What does norepinephrine do to the body?
A
Increases blood pressure
Increases sweat gland action
Increases pupil dilation
Increases arterial smooth muscle contraction
13
Q
What does Epinephrine do?
A
Increases BP and HR
Increases glucose level
it affects the pancreas and the liver.
14
Q
How does Epinephrine affect the liver?
A
It decreases glycogen synthesis
It increases glucogenesis, and increased blood glucose
=Produce energy
15
Q
What is the hypothalamus?
A
A gland in the brain
Controls hormone system
16
Q
the HPA axis is the ____ to a stressor
A
hormonal response
17
Q
Think of Cortisol as THE a)_________ !
A
Stress hormone
18
Q
What does the SNS function?
What increase?
What decrease?
A
Increased lipolysis
-breakdown of fats and lipids into fatty acids for circulation
Increased glycogenolysis
-breaks down glycogen stores into glucose
Increased gluconeogenesis
-synthesis of glucose from non-carbohydrate sources such as amino acids and free fatty acids)
Decreased glycogen synthesis (prevents storage of glucose)
19
Q
What do we expecting to administer hydrocortisone?
A
Blood glucose level increase
Cortisol release
↓
Mobilize energy
↓
Dump glucose in blood
↓
Blood glucose increase
20
Q
Glycogen?
A
a) liver
b) glucose
21
Q
What is the goal of stress response?
A
The emergency reaction system of the body
Energy mobilization
22
Q
cortisol release from where?
A
Arenal glands
23
Q
Epinephrine and Norepinephrine
Produce where?
A
Adrenal medulla
24
Q
The anterior pituitary produces what hormone?
A
ACTH
25
What is Addison's disease?
Too little cortisol is secreted
Hypotension, hypoglycemia, fatigue, poor cardiac output
26
What is the ACTH function?
Stimulate the production and release of cortisol from the cortex (outer part) of the adrenal gland.
27
Risk for “Chronic Stress at Early Age”
Increased risk of later disease
-Stress system and brain development are impacted (child abuse)
Prenatal stress
- premature baby
- low-birthweight baby
- fetal malformations
28
Disease-related Long-Term Stress? 10
| (Chronic, abnormal elevations of cortisol)
Cardiovascular disease
COPD
Type 2 diabetes
Cancer
Arthritis
Obesity
Osteoporosis
Sleep deprivation
Hypertension
Burnout
29
The immune system affects the Neuro and Endocrine systems, release what?
Cytokines
- signaling molecules
- secreted and bind to specific cell membrane
Osteoporosis
Sleep deprivation
Hypertension
Burnout
30
Chronic stress/ beneficial or harmful?
* *Harmful**
* *long-term stress weakens the responses of your immune system!**
- induced release of cortisol
- increased risk for infection
- leads to many disease states
- immune dysregulation
- decreased natural killer and T-cell cytotoxicity
- Impaired B-cell function
- Primary tumor growth, metastasis of tumors
31
Acute stress/beneficial or harmful?
**Beneficial**
**Decreased inflammation**
Body fights infections and helps speed up the healing process
No time to heal, tiger chasing you
**fight-or-flight**
32
A patient experiences a stressor that activates the stress response. What is a physiologic effect seen related to the release of catecholamines into the bloodstream?
1: Increased heart rate
2: Bronchoconstriction
3: Increased insulin release
4: Decreased blood pressure
1
33
Examples of maladaptive coping responses to stress that may contribute to serious health problems include:
A: Sleeping less
B: Increased smoking
C: Seeking social support
D: Decreased exercise
E: Eating high caloric comfort foods
maladaptive 不適応
| (Select all that apply)
A, B, D & E
34
Why we get more sick when we under the stress?
Because WBC count decrees
## Footnote
**No time to heal, tiger chasing you**
35
a) Intracellular fluid (ICF)
b) Interstitial fluid (IF)
c) Plasma
a) The fluid contained within cells
b) The space between cells, outside the vessels
c) Liquid portion of blood
36
a) Total body
b) ICF
c) ECF
a) 60%
b) 40%
c) 20%
37
What are the 3 processes that control fluid and electrolyte balance?
1. Filtration
2. Diffusion
3. Osmosis
38
Diffusion?
- Passive movement of solute
- Movement of particle
- From high to low
- Solute across a permeable membrane
39
Osmosis?
- Passive transport
- Movement of water
Low to high solute concentration
40
a) Hydrostatic pressure?
b) Oncotic pressure?
a) The pressure that any fluid in a confined space exerts
b) Pull fluid back into the capillary
41
What is the Forces favoring filtration?
**Capillary** hydrostatic pressure
Interstitial oncotic pressure
42
What is the Forces favoring reabsorption?
**Plasma** oncotic pressure
Interstitial hydrostatic pressure
43
What is the capillaries?
- One layer of simple squamous epithelium
- Everywhere in the body
- Gas exchange
- Selectively permeable
44
What is osmotic pressure?
**=hydrostatic pressure**
The pressure required to prevent the flow of water across a semipermeable membrane via osmosis
45
a) \>
b) \>
c) interstitial space
d) \>
e) \>
f) intravascular space
46
What is the forces favoring filtration?
**Movement of fluid out of the vessel**
1. elevated capillary hydrostatic pressure
2. elevated interstitial oncotic pressure
47
What is the Forces favoring reabsorption?
**Movement of fluid coming back into the vessel**
1. elevated capillary oncotic pressure
2. decrease interstitial hydrostatic pressure
48
What does the cause of edema?
Venous obstruction causes hydrostatic pressure to increase
Pushing fluid from the capillaries into the interstitial spaces
49
Localized Edema
Fluid cannot go forward because of obstruction
50
Systemic/Generalized
How to form?
Albumin decrease(produce, burn, inflammation)
=decrease capillary oncotic pressure
=Fluid cannot come back into capillary
51
52
Intake promoted by a)\_\_\_\_\_\_\_\_\_\_
Thirst center in b)\_\_\_\_\_\_\_\_
Sense c)\_\_\_\_\_\_\_\_ fluid volume
sense d)\_\_\_\_\_\_\_\_ plasma osmolality
Also activated by cellular e)\_\_\_\_\_\_\_\_ from
f)\_\_\_\_\_\_\_\_extracellular osmolality
a) thirst
b) hypothalamic
c) intravascular
d) increased
e) dehydration
f) increased
53
RAAS
Renin-angiotensin-aldosterone
What is it?
a) Kidneys released renin
Response to LOW renal blood flow and LOW BP
54
ADH
a) Where it produce?
b) How does it travel?
a)
1: Made and packaged in hypothalamus
2: Stored in the posterior pituitary
b) via vein to kidney
55
RAAS step 1 and 2
**Step 1**
1: Blood pressure falls
2: The kidneys release the enzyme renin into the bloodstream
**Step2**
1: A large protein angiotensinogen(plasma protein) secreted from the liver
2: Renin splits angiotensinogen
3 Circulates in the bloodstream into pieces(angiotensin I)
56
RAAS step 3 and 4
**Step 3**
Angiotensin 1, which is relatively inactive
So, angiotensin converting enzyme (ACE), convert 1 to 2
(found in high levels in the lung)
* *Step4**
* *Angiotensin II, a hormone, causes**
* *Vasoconstriction(increase BP)**
* *Trigger release aldosterone(from the adrenal glands)**
* *Kidneys to retain salt**
57
ADH function
Response for dehydration
* *1.acts on the kidney:**
- increases the water reabsorption from the collecting ducts
- increases plasma volume
* *2.acts to constrict blood vessels:**
- increases vascular resistance
- increases arterial blood pressure
58
What is the ANP?
**Atrial natriuretic peptide**
- Produce by atrial auricles
- Target: kidneys
- Effect: blocks effect of aldosterone, decreases sodium reabsorption, lowers blood pressure
59
What is the BNP?
**Brain Natriuretic peptide Hormone**
- Made by heart
- Only a low amount of BNP is found in blood
- If heart overload than usual(heart failure) the heart releases more BNP
- Increasing the blood level of BNP
60
What does ANP and BNP do?
Enhance sodium and water excretion = lower BP
61
a) Renin
b) constrictor
c) Na+
d) Water
e) Increased
f) Decreased
g) Water
62
**ADH**
## Footnote
a) Triger?
b) Primary result
a) Decrease plasma volume
Increase Plasm osmolality
b) Renal water retention
63
**ANH (ANP) & BNP**
a) Triger?
b) Primary result
a) Increase total Na volume
Increase plasma volume
b) Sodium and water excretion
Blood volume decrease
BP decrease
64
What is the isotonic solution?
## Footnote
Isotonic fluids(IV) have the same concentration as a)\_\_\_\_\_\_\_
Osmotic pressure = same b)\_\_\_\_\_\_\_ the cells
What mOsm/L?
**280-294mOsm/L**
a) ICF
ICF=intracellular fluid - fluid inside the cell
b) inside & outside
65
What is the Hypertonic solution?
What mOsm/L?
Hypertonic fluids have a higher concentration than a)\_\_\_\_\_\_\_\_\_\_
This higher osmotic pressure shifts fluid from the cells into the b)\_\_\_\_\_\_\_\_
Therefore Cells placed in a hypertonic solution will c)\_\_\_\_\_\_
* *\>294 mOsm/L**
a) ICF
b) ECF
c) shrink
66
What is the hypotonic solution?
## Footnote
This low osmotic pressure shifts fluid from b)\_\_\_\_\_\_\_\_\_\_ into c)\_\_\_\_\_\_\_\_\_\_
What mOsm/L?
\<280 mOsm/L
a) ICF
b) ECF
c) cell
Cell swell
67
**Isotonic fluid IV**
a) what it used for?
b) what is the common one?
Iincrease fluid volume due to blood loss, surgery, or dehydration
0.9% NaCl
68
Hypertonic IV solution
## Footnote
a) what it used for?
b) what is the common one?
a) Temporarily treat hypovolemia
To expand vascular volume
Fosters normal BP
Good urinary output
Monitor for hypervolemia!
b) D5% 0.45% NS
69
Hypotonic IV solution
## Footnote
a) what it used for?
b) what is the common one?
a) dilute plasma particularly in hypernatremia
Treats cellular dehydration
Cells Swell
b) 0.45%NS
0. 33%NS
70
What is the hypovolemia?
A condition in which the liquid portion of the blood (plasma) is too low
Permanent fluid shift from intravascular to interstitial
71
What is the cause of hypovolemia?
-Mental status deterioration
-Thirst
-Tachycardia
-Orthostatic hypotension
-Urine output
\< 30cc/hr
72
What is the hypervolemia?
**A condition in which the liquid portion of the blood (plasma) is too high**
**Excessive administration of IV fluids**
- Fluid or sodium retention
- Renal failure
Can lead heart failure and pulmonary edema
73
What is the Sodium's function?
- Responsible for water balance
- Plasma osmolality
- Stimulates conduction of nerve/muscle impulses
- Neuromuscular irritability
74
Sodium
Normal range ECF
135-145 mEq/L
75
Chloride
Normal range ECF
98-106 mEq/L
76
Potassium
Normal range ECF
140-150 mEq/L
77
What is the hyponatremia?
a) what is the abnormal range?
b) Manifestations?
Level of sodium in the blood is too low
Serum sodium \<135 mEq/L
Rapid brain swelling, which can result in a coma and death
Cerebral Edema
78
What is the cause of Hyponatremia?
- Retention of water
- Heart failure(water gain), ineffective baroreceptors
- Diuretics/meds that increase urine output
- Dehydration
- Burns(fluid loss)
79
What is the hypernatremia?
a) what is the abnormal range?
b) Manifestations
A high concentration of sodium in the blood
Serum sodium \>145 mEq/L
- Too much aldosterone causes the kidneys to retain sodium
- Excess gains of sodium, loss of free water
80
What is the symptoms of hypernatremia?
- Extreme thirst
- Increased fluid retention
- Edema
- Shrinkage of brain cells
- Nervous system instability (seizures)
81
Hyperchloremia
What is that?
This is always occur with?
a) High level of chloride in the blood
b) Hypernatremia
82
Where is sodium normally found?
Extracellular
83
Where is potassium normally found?
Intracellular
Normal range:3.5-5.o mEg/L
84
What is the function of potassium?
- Controlling ICF osmolality and fluid balance
- Regulates action potential of the heart
- Resting membrane potential
85
What is the hypokalemia?
What is the abnormal range?
Manifestations?
**Decrease number of potassium in blood**
Altered membrane potentials and excitability causes delayed ventricular repolarization
**Potassium level \<3.5 mEq/L**
Decrease in neuromuscular excitability
Skeletal muscle weakness
Smooth muscle atony
86
What is the hypekalmia?
- Shift of K from ICF to ECF
- Decreased renal excretion.
87
What is the nurse's primary concern regarding fluid and electrolytes when caring for an elderly patient who is intermittently confused?
* *A) Risk of dehydration**
* *B) Risk of kidney damage**
* *C) Risk of stroke**
* *D) Risk of bleeding**
A
88
The nurse is planning care for a patient with severe burns. Which of the following is this patient at risk for developing? (Select all that apply)
* *A) Intracellular fluid deficit**
* *B) Intracellular fluid overload**
* *C) Extracellular fluid deficit**
* *D) Interstitial fluid deficit**
A, C and D
89
Decreased neuromuscular excitability can be seen in which two electrolyte disorders?
* *A) Hypercalcemia and hypermagnesemia.**
* *B) Hyponatremia and hyperkalemia.**
* *C) Hypocalcemia and hypokalemia.**
* *D) Hypernatremia and hypomagnesemia.**
A
A
90
The most reliable method for measuring a loss or gain of body water is:
* *A) Change in body weight.**
* *B) Serum sodium levels.**
* *C) Intake and output.**
* *D) Skin turgor.**
A
91
Which of the following signs would indicate a fluid deficit?
* *A) Acute weight loss and increase in blood pressure.**
* *B) Tachycardia, acute loss of body weight, weakness, and dry mucous membranes.**
* *C) Physical weakness, weight gain, bradycardia, and decreased urine output.**
* *D) Dry fissured tongue, rapid respirations, weight gain, and confusion or delirium.**
B
92
A patient developed a bowel obstruction after surgery and a nasogastric tube was inserted. The most common electrolyte imbalances secondary to gastric suctioning is what?
* *A) Hyponatremia/hypokalemia**
* *B) Hyponatremia/hyperkalemia**
* *C) Hypernatremia/hypocalcemia D) Hypernatremia/hypokalemia**
A
93
The most appropriate therapy for an individual with hypernatremia is:
* *A) Volume expansion with normal saline.**
* *B) Administration of colloids.**
* *C) Hypotonic fluids.**
* *D) ACE inhibitors.**
C
94
While assessing a patient with heart failure and renal impairment, the nurse notices 3+ pitting edema in his feet, a bounding pulse, and severe shortness of breath. This patient probably experiencing which of the following:
A) Hypokalemia.
B) Hyperkalemia.
C) Fluid volume deficit.
D) Fluid volume excess.
D
95
A patient who has had diarrhea for the last 24 hours is demonstrating ECG changes (below) and complaining of muscle weakness. The nurse realizes this patient is exhibiting signs of which of the following?
* *A) Hyperkalemia**
* *B) Hypokalemia**
* *C) Hypercalcemia**
* *D) Hypocalcemia**
1
## Footnote
Hyperkalemia is serum potassium level greater than 5.0 mEq/L.
96
What is the acid base balance?
a) PH?
b) Acid and basic PH?
c) The body tend to?
a) The body functions within a narrow pH range 7.35 to 7.45.
“perfect pH”: 7.4
b) More H+ ion/PH is low (acidic)
pH \<7.35 acidic
Fewer H+ ions/pH is high
pH \> 7.45 basic
c) The body tends towards acidity due to metabolism
anaerobic respiration, and incomplete oxidation
97
\_\_\_\_\_\_\_\_ is the primary acid in arterial blood.
CO2
98
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ is the major cation stored in the intracellular fluid.
Potassium
99
What body function does potassium play a major role in ?
Cardiac muscle conduction
100
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ rely on regulation of the acid-base mechanism of Extracellular Fluid.
Metabolic activities
101
The pH is the balance between ____________ and \_\_\_\_\_\_\_\_\_\_\_\_.
acids and bases
102
What are 6 kidney issues that can result in hyperkalemia ?
1. Chronic Kidney Disease
2. Autoimmune nephropathy
3. Acidosis
4. Adrenal insufficiency
5. ACEI/ARB's
6. Potassium-sparing diuretics
103
What is an example of how respirations can affect acid-base balance?
Hyperventilation \> Blowing off a lot of CO2 \> Lower CO2 \> Getting rid of acid \> High pH (alkaline)
104
How does decreasing ventilation affect CO2 and pH ?
Hyperventilation \> Blowing off a lot of CO2 \> Lower CO2 \> Getting rid of acid \> High pH (alkaline)
105
A pH \< 7.35 indicates \_\_\_\_\_\_\_\_\_\_\_\_\_\_.
acidosis
106
What are the 4 causes of metabolic acidosis ?
1. Increased metabolic acids
2. Inability of kidneys to excrete acid
3. Excess loss of bicarbonate via kidneys/GI
4. Increased chloride
107
Small changes in H+ dramatically influence
of what?
cellular function
enzyme activity
neuromuscular membrane action potential
ATP generation
108
\_\_\_\_\_\_\_\_\_ represents the partial pressure of carbon dioxide in arterial blood.
PaCO2
35 -45 mmHg
Acid/respiratory
109
What two lab values indicate Respiratory Acidosis ?
High PaCO2 (high acid)
low pH (acidic pH)
110
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ is when there is LOW PaCO2 WITH high pH.
Respiratory alkalosis
Respiratory alkalosis
111
Based on the pH value of 7.53 what state is the body in ?
ALKALOSIS
112
Based on the pH value of 7.23 what state is the body in ?
ACIDOSIS
113
HCO3 can be see as equivalent with?
A base
22-26
Base/Renal Metabolic
114
Based on these lab values, CO2 40, HCO3 18 what is the responsible system ?
A base
22-26
Base/Renal Metabolic
115
Based on these lab values, CO2 55, HCO3 23 what is the responsible system ?
Respiratory
Respiratory
116
What these result indicated?
a) pH 7.3
b) PaCO2 60
c) HCO3 28
Respiratory
117
How buffers prevent a significant change in pH?
- buffers absorb excessive hydrogen ion or hydroxyl ion
- two components (conjugate acid and conjugate base) are both present in appreciable amounts at equilibrium and are able to neutralize small amounts of other acids and bases
- Plasma buffering systems can regulate pH absorbing excessive Hydrogen ion or hydroxyl ion.
118
General Adaptation Syndrome(GAS) 3
1. Alarm stage
2. Resistance/ adaptation stage
3. Exhaustion stage
119
Alarm stage? 5
* Immediate response to stress
* Fight or flight
* Recognition of environmental change
* Triggers the HPA axis
* Activate SNS
120
Resistance/adaptation stage?
* Actions of adrenal hormones (result of HPA axis activation)
* Energy mobilization and delivery (for fight or flight)
121
Exhaustion stage?
122
Effects of stress on inflammatory system.
How?
Inflammation can damage joints and bones
Chemicals related inflammation releases more by stress
Under the stress, increasing the amount of inflammation
Acute
- increased activity of the immune system
Chronic
-low-grade inflammation
123
a) Osmolality increases when?
b) Osmolality decrease when?.
a) dehydrated
b) too much water in the blood
124
Higher osmolality means?
Lower osmolality means?
more particles in the serum
the particles are more diluted.
