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Pathophysiology > Exam 2 part 1 > Flashcards

Exam 2 part 1 Flashcards

1
Q

Stress?

A

A perceived or anticipated threat that disrupts a persons well being

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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

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3
Q

1950s research showed a)_________stressors as effective as a)_________stressors in activating hormone secretion

A

a) psychologic
b) physical

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4
Q

1970s research confirmed sensitivity of a)_________ and b)_________to influences reactive physiologic response Anticipatory response

A

a) central nervous
b) endocrine systems

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5
Q

Adrenal gland responses to stress as well as a)_________ and b)_________responses, respectively

A

a) CNA
b) Endrocrine

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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

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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

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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

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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)

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10
Q

What is the SNS?

Sympathetic nervous system

A

“Fight or Flight”
Rapid

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11
Q

What substances are released by the sympathetic nervous system during stress?

A

Norepinephrine
Epinephrine

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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

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13
Q

What does Epinephrine do?

A

Increases BP and HR

Increases glucose level

it affects the pancreas and the liver.

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14
Q

How does Epinephrine affect the liver?

A

It decreases glycogen synthesis
It increases glucogenesis, and increased blood glucose

=Produce energy

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15
Q

What is the hypothalamus?

A

A gland in the brain
Controls hormone system

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16
Q

the HPA axis is the ____ to a stressor

A

hormonal response

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17
Q

Think of Cortisol as THE a)_________ !

A

Stress hormone

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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)

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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

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20
Q

Glycogen?

A

a) liver
b) glucose

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21
Q

What is the goal of stress response?

A

The emergency reaction system of the body

Energy mobilization

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22
Q

cortisol release from where?

A

Arenal glands

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23
Q

Epinephrine and Norepinephrine

Produce where?

A

Adrenal medulla

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24
Q

The anterior pituitary produces what hormone?

A

ACTH

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25
Q

What is Addison’s disease?

A

Too little cortisol is secreted

Hypotension, hypoglycemia, fatigue, poor cardiac output

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26
Q

What is the ACTH function?

A

Stimulate the production and release of cortisol from the cortex (outer part) of the adrenal gland.

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27
Q

Risk for “Chronic Stress at Early Age”

A

Increased risk of later disease
-Stress system and brain development are impacted (child abuse)

Prenatal stress

  • premature baby
  • low-birthweight baby
  • fetal malformations
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28
Q

Disease-related Long-Term Stress? 10

(Chronic, abnormal elevations of cortisol)

A

Cardiovascular disease
COPD
Type 2 diabetes
Cancer
Arthritis
Obesity
Osteoporosis
Sleep deprivation
Hypertension
Burnout

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29
Q

The immune system affects the Neuro and Endocrine systems, release what?

A

Cytokines

  • signaling molecules
  • secreted and bind to specific cell membrane

Osteoporosis
Sleep deprivation
Hypertension
Burnout

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30
Q

Chronic stress/ beneficial or harmful?

A
  • *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
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31
Q

Acute stress/beneficial or harmful?

A

Beneficial

Decreased inflammation
Body fights infections and helps speed up the healing process
No time to heal, tiger chasing you

fight-or-flight

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32
Q

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

A

1

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33
Q

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

A, B, D & E

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34
Q

Why we get more sick when we under the stress?

A

Because WBC count decrees

No time to heal, tiger chasing you

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35
Q

a) Intracellular fluid (ICF)
b) Interstitial fluid (IF)
c) Plasma

A

a) The fluid contained within cells
b) The space between cells, outside the vessels
c) Liquid portion of blood

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36
Q

a) Total body
b) ICF
c) ECF

A

a) 60%
b) 40%
c) 20%

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37
Q

What are the 3 processes that control fluid and electrolyte balance?

A
  1. Filtration
  2. Diffusion
  3. Osmosis
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38
Q

Diffusion?

A
  • Passive movement of solute
  • Movement of particle
  • From high to low
  • Solute across a permeable membrane
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39
Q

Osmosis?

A
  • Passive transport
  • Movement of water

Low to high solute concentration

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40
Q

a) Hydrostatic pressure?
b) Oncotic pressure?

A

a) The pressure that any fluid in a confined space exerts
b) Pull fluid back into the capillary

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41
Q

What is the Forces favoring filtration?

A

Capillary hydrostatic pressure

Interstitial oncotic pressure

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42
Q

What is the Forces favoring reabsorption?

A

Plasma oncotic pressure

Interstitial hydrostatic pressure

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43
Q

What is the capillaries?

A
  • One layer of simple squamous epithelium
  • Everywhere in the body
  • Gas exchange
  • Selectively permeable
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44
Q

What is osmotic pressure?

A

=hydrostatic pressure

The pressure required to prevent the flow of water across a semipermeable membrane via osmosis

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45
Q
A

a) >
b) >
c) interstitial space
d) >
e) >
f) intravascular space

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46
Q

What is the forces favoring filtration?

A

Movement of fluid out of the vessel

  1. elevated capillary hydrostatic pressure
  2. elevated interstitial oncotic pressure
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47
Q

What is the Forces favoring reabsorption?

A

Movement of fluid coming back into the vessel

  1. elevated capillary oncotic pressure
  2. decrease interstitial hydrostatic pressure
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48
Q

What does the cause of edema?

A

Venous obstruction causes hydrostatic pressure to increase
Pushing fluid from the capillaries into the interstitial spaces

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49
Q

Localized Edema

A

Fluid cannot go forward because of obstruction

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50
Q

Systemic/Generalized

How to form?

A

Albumin decrease(produce, burn, inflammation)

=decrease capillary oncotic pressure

=Fluid cannot come back into capillary

51
Q
A
52
Q

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

a) thirst
b) hypothalamic
c) intravascular
d) increased
e) dehydration
f) increased

53
Q

RAAS

Renin-angiotensin-aldosterone

What is it?

A

a) Kidneys released renin
Response to LOW renal blood flow and LOW BP

54
Q

ADH

a) Where it produce?
b) How does it travel?

A

a)

1: Made and packaged in hypothalamus
2: Stored in the posterior pituitary

b) via vein to kidney

55
Q

RAAS step 1 and 2

A

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
Q

RAAS step 3 and 4

A

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
Q

ADH function

A

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
Q

What is the ANP?

A

Atrial natriuretic peptide

  • Produce by atrial auricles
  • Target: kidneys
  • Effect: blocks effect of aldosterone, decreases sodium reabsorption, lowers blood pressure
59
Q

What is the BNP?

A

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
Q

What does ANP and BNP do?

A

Enhance sodium and water excretion = lower BP

61
Q
A

a) Renin
b) constrictor

c) Na+
d) Water

e) Increased
f) Decreased

g) Water

62
Q

ADH

a) Triger?
b) Primary result

A

a) Decrease plasma volume
Increase Plasm osmolality

b) Renal water retention

63
Q

ANH (ANP) & BNP

a) Triger?
b) Primary result

A

a) Increase total Na volume
Increase plasma volume

b) Sodium and water excretion
Blood volume decrease
BP decrease

64
Q

What is the isotonic solution?

Isotonic fluids(IV) have the same concentration as a)_______

Osmotic pressure = same b)_______ the cells

What mOsm/L?

A

280-294mOsm/L

a) ICF
ICF=intracellular fluid - fluid inside the cell

b) inside & outside

65
Q

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)______

A
  • *>294 mOsm/L**
    a) ICF
    b) ECF
    c) shrink
66
Q

What is the hypotonic solution?

This low osmotic pressure shifts fluid from b)__________ into c)__________

What mOsm/L?

A

<280 mOsm/L

a) ICF
b) ECF
c) cell

Cell swell

67
Q

Isotonic fluid IV

a) what it used for?
b) what is the common one?

A

Iincrease fluid volume due to blood loss, surgery, or dehydration

0.9% NaCl

68
Q

Hypertonic IV solution

a) what it used for?
b) what is the common one?

A

a) Temporarily treat hypovolemia
To expand vascular volume
Fosters normal BP
Good urinary output

Monitor for hypervolemia!

b) D5% 0.45% NS

69
Q

Hypotonic IV solution

a) what it used for?
b) what is the common one?

A

a) dilute plasma particularly in hypernatremia
Treats cellular dehydration
Cells Swell

b) 0.45%NS
0. 33%NS

70
Q

What is the hypovolemia?

A

A condition in which the liquid portion of the blood (plasma) is too low

Permanent fluid shift from intravascular to interstitial

71
Q

What is the cause of hypovolemia?

A

-Mental status deterioration
-Thirst
-Tachycardia
-Orthostatic hypotension
-Urine output
< 30cc/hr

72
Q

What is the hypervolemia?

A

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
Q

What is the Sodium’s function?

A
  • Responsible for water balance
  • Plasma osmolality
  • Stimulates conduction of nerve/muscle impulses
  • Neuromuscular irritability
74
Q

Sodium

Normal range ECF

A

135-145 mEq/L

75
Q

Chloride

Normal range ECF

A

98-106 mEq/L

76
Q

Potassium

Normal range ECF

A

140-150 mEq/L

77
Q

What is the hyponatremia?

a) what is the abnormal range?
b) Manifestations?

A

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
Q

What is the cause of Hyponatremia?

A
  • Retention of water
  • Heart failure(water gain), ineffective baroreceptors
  • Diuretics/meds that increase urine output
  • Dehydration
  • Burns(fluid loss)
79
Q

What is the hypernatremia?

a) what is the abnormal range?
b) Manifestations

A

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
Q

What is the symptoms of hypernatremia?

A
  • Extreme thirst
  • Increased fluid retention
  • Edema
  • Shrinkage of brain cells
  • Nervous system instability (seizures)
81
Q

Hyperchloremia

What is that?
This is always occur with?

A

a) High level of chloride in the blood
b) Hypernatremia

82
Q

Where is sodium normally found?

A

Extracellular

83
Q

Where is potassium normally found?

A

Intracellular

Normal range:3.5-5.o mEg/L

84
Q

What is the function of potassium?

A
  • Controlling ICF osmolality and fluid balance
  • Regulates action potential of the heart
  • Resting membrane potential
85
Q

What is the hypokalemia?

What is the abnormal range?

Manifestations?

A

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
Q

What is the hypekalmia?

A
  • Shift of K from ICF to ECF
  • Decreased renal excretion.
87
Q

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

A

88
Q

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

A, C and D

89
Q

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

A

90
Q

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

A

91
Q

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.**
A

B

92
Q

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

A

93
Q

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.**
A

C

94
Q

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.

A

D

95
Q

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**
A

1

Hyperkalemia is serum potassium level greater than 5.0 mEq/L.

96
Q

What is the acid base balance?

a) PH?
b) Acid and basic PH?
c) The body tend to?

A

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
Q

________ is the primary acid in arterial blood.

A

CO2

98
Q

_____________________ is the major cation stored in the intracellular fluid.

A

Potassium

99
Q

What body function does potassium play a major role in ?

A

Cardiac muscle conduction

100
Q

___________________ rely on regulation of the acid-base mechanism of Extracellular Fluid.

A

Metabolic activities

101
Q

The pH is the balance between ____________ and ____________.

A

acids and bases

102
Q

What are 6 kidney issues that can result in hyperkalemia ?

A
  1. Chronic Kidney Disease
  2. Autoimmune nephropathy
  3. Acidosis
  4. Adrenal insufficiency
  5. ACEI/ARB’s
  6. Potassium-sparing diuretics
103
Q

What is an example of how respirations can affect acid-base balance?

A

Hyperventilation > Blowing off a lot of CO2 > Lower CO2 > Getting rid of acid > High pH (alkaline)

104
Q

How does decreasing ventilation affect CO2 and pH ?

A

Hyperventilation > Blowing off a lot of CO2 > Lower CO2 > Getting rid of acid > High pH (alkaline)

105
Q

A pH < 7.35 indicates ______________.

A

acidosis

106
Q

What are the 4 causes of metabolic acidosis ?

A
  1. Increased metabolic acids
  2. Inability of kidneys to excrete acid
  3. Excess loss of bicarbonate via kidneys/GI
  4. Increased chloride
107
Q

Small changes in H+ dramatically influence

of what?

A

cellular function
enzyme activity
neuromuscular membrane action potential
ATP generation

108
Q

_________ represents the partial pressure of carbon dioxide in arterial blood.

A

PaCO2

35 -45 mmHg

Acid/respiratory

109
Q

What two lab values indicate Respiratory Acidosis ?

A

High PaCO2 (high acid)

low pH (acidic pH)

110
Q

__________________ is when there is LOW PaCO2 WITH high pH.

Respiratory alkalosis

A

Respiratory alkalosis

111
Q

Based on the pH value of 7.53 what state is the body in ?

A

ALKALOSIS

112
Q

Based on the pH value of 7.23 what state is the body in ?

A

ACIDOSIS

113
Q

HCO3 can be see as equivalent with?

A

A base

22-26

Base/Renal Metabolic

114
Q

Based on these lab values, CO2 40, HCO3 18 what is the responsible system ?

A

A base

22-26

Base/Renal Metabolic

115
Q

Based on these lab values, CO2 55, HCO3 23 what is the responsible system ?

Respiratory

A

Respiratory

116
Q

What these result indicated?

a) pH 7.3
b) PaCO2 60
c) HCO3 28

A

Respiratory

117
Q

How buffers prevent a significant change in pH?

A
  • 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
Q

General Adaptation Syndrome(GAS) 3

A
  1. Alarm stage
  2. Resistance/ adaptation stage
  3. Exhaustion stage
119
Q

Alarm stage? 5

A
  • Immediate response to stress
  • Fight or flight
  • Recognition of environmental change
  • Triggers the HPA axis
  • Activate SNS
120
Q

Resistance/adaptation stage?

A
  • Actions of adrenal hormones (result of HPA axis activation)
  • Energy mobilization and delivery (for fight or flight)
121
Q

Exhaustion stage?

A
122
Q

Effects of stress on inflammatory system.

How?

A

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
Q

a) Osmolality increases when?
b) Osmolality decrease when?.

A

a) dehydrated
b) too much water in the blood

124
Q

Higher osmolality means?

Lower osmolality means?

A

more particles in the serum

the particles are more diluted.

Pathophysiology (11 decks)

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