Exam 3 Flashcards
osmosis
movement of WATER down a concentration gradient
-from low solute to high solute across semi permeable membrane
diffusion
movement of molecules from high concentration to low concentration
shifting of water
water follows electrolytes
colloids
substances that increase colloid osmotic pressure (oncotic pressure)
-MOVE FLUID FROM INTERSTITIAL COMPARTMENT TO PLASMA (BLOOD) COMPARTMENT
3 primary colloids: albumin, globulin, fibrinogen
hydrostatic pressure
force of fluid in compartment pushing AGAINST A CELL MEMBRANE, generated by BP, force that pushes water OUT of vascular system into interstitial space
oncotic pressure (colloid osmotic)
caused by plasma colloids (large molecules) in solution, plasma has LOTS of colloids, interstitial space has little, plasma proteins attract water, pulling fluid from tissue space INTO vascular space
electrolytes influence
fluid balance, acid base balance, nerve impulses, muscle contraction, heart rhythm, etc
what are electrolytes
substances that are electrically charged when in solution (K+, Mg+, Na+, Ca+, P-, Cl-, HCO3-)
concentrations of electrolytes are dependent on
electrolyte intake, absorption, distribution, and excretion
hyponatremia
low sodium
hypernatremia
high sodium
sodium
water follows sodium, governs osmolality, influences water distribution, aids in acid-base balance, activates muscle and nerve cells, ion movement important in action potentials
hyponatremia causes
GI losses, renal losses, skin losses, fasting diets, polydipsia, excess hypotonic fluid
S/S: confusion/altered LOC, anorexia, muscle weakness, can lead to seizures/coma
dilutional hyponatremia
hypervolemic, increased BP, weight gain, bounding pulse
depletional hyponatremia
hypovolemic, lower BP, tachy pulse, dry skin, weight loss
treatment of hyponatremia
SLOW sodium replacement, PO/IV, IV NS, fluid restriction, treat underlying problem
hypernatremia causes
IV fluids, tube feeds, near drowning in salt water-> excess sodium intake, not enough water intake or too much water loss-> cognitively impaired, diarrhea, high fever, heat stroke, profound diuresis
-S/S: altered LOC/confusion, seizure, coma, extreme thirst (hyperosmolality), dry sticky mucous membranes, muscle cramps
treatment of hypernatremia
if water loss is cause-> add water
if sodium excess is cause-> remove sodium
GRADUALLY ACHIEVE NORMAL LEVEL
hypokalemia
low potassium
hyperkalemia
high potassium
potassium
intracellular cation, helps regulate cell excitability and electrical status, helps control intracellular osmolality, diet is main source, kidneys main source of K loss-> pee out K
causes of hypokalemia
renal or GI losses, DIURESIS, acid base disorders (K in extracellular space goes into intracellular space)
-S/S: CARDIAC RHYTHM DISTURBANCES-LETHAL, muscle weakness, leg cramps, decreased bowel motility: constipation, nausea, ileus
causes of hyperkalemia
decreased K OUTPUT (renal failure, not peeing), burns, crush injuries, sepsis, anything with massive cell injury, drugs, K sparing diuretics, ACE, ARBs, NSAIDS
-S/S: cardiac rhythm disturbances, muscle weakness, cramps, abdominal cramping, diarrhea, vomiting
hyperkalemia treatment
diuretics
magnesium
helps stabilize CARDIAC muscle cells, blocks/controls movement of K out of cardiac cells, helps stabilize smooth muscle
hypomagnesemia causes
diuresis, GI or renal losses, limited intake (fasting or starvation), alcohol use, pancreatitis, hyperglycemia
-S/S: hyperactive reflexes, confusion, cramps, tremors, seizures
hypomagnesemia treatment
replacement oral or IV, treat cause
nystagmus occurs in what condition
hypomagnesemia
hypermagnesemia causes
increased intake accompanied by renal failure
-S/S: lethargy, floppiness, muscle weakness, decreased reflexes, flushed/warm skin, decrease pulse/BP
treatment: stop replacement, if chronic disease intake-> dialysis
calcium
hormones released by the THYROID AND PARATHYROID GLANDS are controllers of the amount of calcium that is released from and absorbed into the bone, 99% of calcium in bone
calcium facts
enzyme reactions, effects membrane potentials and nerve excitability, helps in release of hormones/neurotransmitters/chemical mediators, influences cardiac contractility and automaticity, necessary for blood clotting
hypocalcemia
unable to mobilize from bone, increased renal loss, increased binding, decreased intake or absorption, acute pancreatitis, thyroid or parathyroid surgery, increased neuromuscular excitability, cardiac insufficiency
-positive chvostek’s sign, positive trousseau’s sign
hypocalcemia treatment
IV calcium or oral (tums)
hypercalcemia causes
hyperparathyroidism, cancers
-S/S: calcium acts like a sedative, fatigue, lethargy, confusion, weakness, leading to seizures, coma, kidney stone
hypercalcemia treatment
adequate hydration, increased urine output, diuretics and NaCl, dialysis in renal failure
phosphorus
85% found in bone and 14% in intracellular, higher levels found in infants and children, organic and inorganic forms, role in bone formation, essential for ATP formation and enzymes needed for glucose/protein/and fat metabolism. acid-base buffer, normal function of WBCs and platelets
CALCIUM AND PHOSPHATE WORK TOGETHER, LOW SERUM CALCIUM= HIGH PHOSPHATE
causes of hypophosphatemia
decreased absorption, antacids overdose, severe diarrhea, increased kidney elimination, malnutrition
-clinical manifestations: tremor, paresthesia, confusion to coma, seizure, muscle weakness, joint stiffness, bone pain, etc
causes of hyperphosphatemia
kidney failure, laxatives/enemas with phosphorus, shift from intra to extra cellular compartment, hypoparathyroidism
-clinical manifestations: asymptomatic, typically symptoms of hypocalcemia: muscle spasms paresthesia, tetany
tinea pedis
athlete’s foot, dry scaling pruritic lesions, web between toes
risk factors: coming into contact with skin or environmental fungus
prevention: use of shower shoes, clean tub, treat with topical antifungals
tinea capitis
hair, can affect scalp, eyebrows, or eyelashes, lesions and hair loss, baldness
treatment: PO systemic antifungals bid for 4-6 weeks, topicals are NOT effective
tinea versicolor
skin on upper chest, back, or arms, caused by type of yeast, looks like acidic bleach causing discoloration, risk factors include hot climate, sweaty, oily skin, weakened immune system, NOT contagious
treatment: topical antifungals
candidiasis
thrush/yeast infections, may appear as white lesions in mouth, beefy red lesions in skin folds, treat with topical antifungal agents
risk factors: immunosuppression and antibiotic use
systemic fungal infections
require aggressive treatment with PO/IV antifungals, affect INTERNAL organs
pigmented lesions
melasma and vitiligo
melasma
characterized by dark macules on the face, more common in women, treat with avoiding sun, bleaching creams, tretinoin/retin-A
vitiligo
acquired condition characterized by abnormalities in the production of melanin, pigment disappears from a patch of skin, occurs suddenly before or around age 21, affected areas spread, no treatments, unknown cause
viral skin infection
herpes zoster
herpes zoster: shingles
varicella zoster virus lies dormant on a dermatome segment after infections with chickenpox, virus becomes reactivated by immunosuppression, stress, or illness
-prodrome: burning/tingling along dermatome and then rash develops with vesicles that dry and crust over
-characteristics: vesicles on red base that follow along dermatomal distribution-asymmetric (does not cross midline), painful, clears in 2-3 weeks, people 50+/anyone who has had chickenpox, most contagious when vesicles are weeping, treat with antivirals, complication of persistent pain where rash was
bacterial skin infections
impetigo, abscess, furuncle, cellulitis, MRSA (staph)
impetigo
organisms carried in the nose, acute and contagious, appears as vesicles, pustules, honey colored crust on red base, treat with topical antibacterial
abscess
skin inflamed and red with collection of pus, area often raised with palpable borders, tender, may drain purulent discharge or feel fluctuant, treat with incision and drainage and antibiotics
furuncle and carbuncle
furcuncle is bacterial infection of HAIR FOLLICLE, carbuncle is painful, deep swelling of skin caused by bacteria, treat with incision and drainage and antibiotics
cellulitis
caused by bacterial infection of skin and surrounding tissues, not contagious, appears red, painful, swollen, warm to touch, blisters, treat with PO systemic antibiotics or IV
MRSA
caused by type of staph bacteria resistant to many antibiotics, hospital or community acquired, warm to touch, purulent drainage, fever, abscess can develop quickly
skin cancers
basal cell, squamous cell, melanoma
precancerous lesions
actinic keratosis: benign lesions, due to damage by sun’s UV rays, common in light skins persons
solar lentigos: benign lesions, also known as liver/age spots
basal cell carcinoma
most common, least often malignant, lighter skin tone, increased risk with sun exposure, most curable
-nodular form that begins as small flesh colored or pink dome shaped bump, translucent, shiny, pearly nodule, shiny border, non metastasizing
squamous cell carcinoma
2nd most frequent, increased risk with sun exposure, curable with early treatment, can metastasize to lymph nodes or internal organs, red and scaling, keratotic, slightly elevated lesion with irregular border
melanoma
malignant cells grow on skin radially spreading in epidermis and vertically spreading deep into dermis, can form in eyes and under nails
-risk factors: family history, blonde/red hair, freckling on upper back, hx of 2+ blistering sunburns before age 20, hx of 3+ years of outdoor job as teenager
-ABCDE, most deadly
misc skin disorders
eczema and psoriasis
eczema
conditions that cause skin to become inflamed or irritated, not contagious
psoriasis
long term chronic condition, not contagious, young adulthood, over-active immune system, link between psoriasis/obesity/CVD
-skin cells grow too quickly causing skin to be thick, white, silvery, or have red patches of skin-> plaques
erythrocytes
red blood cells, most abundant cells of blood, primarily responsible for TISSUE OXYGENATION, Hgb carries these gasses
leukocytes
white blood cells
never let monkeys eat bananas
Neutrophils
lymphocytes
monocytes
eosinophils
basophils
granulocytes
neutrophils
eosinophils
basophils
agranulocytes
lymphocytes
monocytes
neutrophils
first to arrive at site of inflammation, bands and segs, increase with acute bacterial infections and trauma, shift to the left (increase of bands)
lymphocytes
primary cells of immune response, increase with chronic bacterial infection and acute viral infection
-B & T cells
monocytes
phagocytosis, increase with bacterial infections and cancers
eosinophils
increase with allergic reactions or parasitic infections, worms/wheezes/weird diseases
basophils
increase with allergic reactions (hypersensitivities, inflammatory reactions)
hemoglobin
measures amount of hemoglobin in your blood (oxygen carrying capacity)
low: bleeding, folate/B12 deficiencies, cancers, kidney and liver disease
high: polycythemia, COPD, live in high altitude, heavy smoking
hematocrit
percentage of blood that is made up of packed red blood cells, interpreted in percentages
low: anemia, bleeding, bleeding disorders, FLUID IMBALANCES
high: polycythemia, COPD, dehydration, shock, congenital heart disease
red cell count
of erythrocytes in blood
mean corpuscle volume (MCV)
size of erythrocytes
mean corpuscle hemoglobin (MCH)
amount of hemoglobin in erythrocyte by weight
increased WBC count
leukocytosis
decreased WBC count
leukopenia
decreased neutrophils=neutropenia
mononucleosis “mono”
infection of B lymphocytes, acute phase 2-3 weeks, some degree of debility/lethargy, treat symptomatic and supportive, symptoms lymphadenopathy, hepatitis, splenomegaly, etc
myelodysplastic syndrome
group of related hematologic disorders characterized by change in the quality/quantity of bone marrow elements, “bone marrow failure disorder”
CM: cytopenias, anemia, infection/bleeding
treatment: supportive, G-CSF, chemo, bone marrow transplant
leukemias
malignant neoplasms of cells originally derived from a single hematopoietic cell line
cells are: immature and unregulated, proliferate in bone marrow, circulate in blood, infiltrate spleen and lymph nodes, disease of children and adults
leukemia classifications
classified according to their predominant cell type (lymphocytic or myelocytic) and whether it is acute or chronic (ALL, CLL, AML, CML)
leukemia pathogenesis
cells: immature type of WBC, capable of increased rate of proliferation/have prolonged life span, cannot perform function of mature leukocytes (are ineffective as phagocytes), interfere with maturation of normal bone marrow cells
acute leukemia
sudden, stormy onset, S/S related to decreased mature WBC and RBC and platelets
diagnosis based on blood/bone marrow tissue, presence of immature WBC
chronic leukemia
more insidious onset, can be discovered in routine blood count
leukemia treatment
goal is to attain remission, cytotoxic chemotherapy, stem cell transplant, risk of infection/rejection/relapse
malignant lymphomas
neoplasms of cells derived from lymphoid tissue- hodgkin and non-hodgkin disease
hodgkin disease
-characterized by painless, progressive, rubbery enlargement of a single node or group of nodes usually in neck
-REED-STENBERG CELL-distinctive tumor cell found with lymph biopsy
-diagnosis: peripheral blood analysis, lymph node biopsy, bone marrow exam, radiographic evaluation
-treatment: chemo, radiation, stem cell transplant
non-hodgkin disease
-also neoplastic disorder of lymphoid tissue, SPREADS EARLY, also painless, superficial lymphadenopathy, majority of pts have widely spread disease at time of dx
-CM: painless lymph node enlargement also
-dx: similar to hodgkin, increased extranodal sites
-treatment: chemo, radiation, refractory cases-stem cell transplant, mab meds
multiple myeloma
-plasma cell cancer (B cells)
-atypical proliferation of one of immunoglobulins, unable to maintain humoral immunity, characterized by bone fractures/pain
-CM: slow/insidious, skeletal pain, hypercalcemia
-diagnostics: lab, radiographic, bone marrow exam
-treatments: watching, corticosteroids, chemo, biologic therapy, stem cell transplant, biphosphonates, adequate hydration
