exam 3 study guide Flashcards
what are the tests to check for renal function and there normal values
sodium (Na+) levels (135-145 mEq/L)
Blood Urea nitrogen (BUN) (7-20mg/dl) most common
creatinine levels (0.6-1.2 mg/dl)
what are the main causes for hyperglycemia
causes by increases glucose levels (70-100mg/dl)
-type I or II diabetes
-Cushing disease- hormone disorder
-system steroid use
what are cardio biomarkers and what do they tell us?
*B-type naturietic peptide (BNP)- secreted by the ventricles, levels increase as CHF symptoms worsen
<100 pg/ml- no CHF
>500 pg/ml- indicates CHF
* troponin I- protein found primarily in cardiac muscle, when heart muscle is injured troponin is released into blood stream
normal value- <0.04 ng/mL
what is the normal value of anion gap and what do we use it for
normal range- 8-18 mEq/L
helps us determine if metabolic acidosis is caused by an acid gain or a loss of a base
what are the electrolytes that play a major role in neuromuscular function
*calcium (Ca)
*magnesium (Mg++)
what is the primary role of sodium
major extracellular cation (+) that is controlled by kidney function, it is important because it regulates the water in our bodies
what to expect of WBC when an infection is present
WBC also known as leukocytes will increase when indication of infection is present
>11000/mcL
normal range for WBC and what does a left shift indicate regarding WBC
normal range: 5000-11000/mcL
left shift indicates that the body is trying to fight something off (stress, infection, or inflammation) due to increased banded neutrophils in the blood because bone marrow pushes them out in hopes to fight whatever is going on
what is potassiums normal ranges and how is albuterol used regarding there levels
(K+) normal range: 3.5-5 mEq/L
as a temporary fix. albuterol will be given in high doses (typically 10-20 mg) to bring down levels of potassium by moving them from the blood into cells
platelet count normal ranges/names
also known as thrombocytes
normal range: 150,000-400,000/mcL
thrombocytosis- increased platelets (blood clotting)
thrombocytopenia- decreased platelets (increased bleeding/no blood clotting)
roles of albumin
*protein made in the liver
*helps keep fluid inside blood vessels (oncotic pressure)
*low levels lead to fluid leaking into the interstitial space including the lungs
normal value: 3,5-5g/dl
definition of polycythemia and its causes
increased RBC caused by:
*high altitudes
*chronic hypoxia/hypoxemia
*tumors
definition of anemia and its causes
too few red blood cells or not enough hemoglobin caused by:
*blood loss
*iron deficiency
*chronic disease
*bone marrow issues
RT treatment for heart failure
- oxygen therapy- WOB/O2
2.suction- assist in clearing airway - CPAP- improves decreased lung compliance, decreases left and right ventricular preload, enhance gas exchange (don’t use when pt is hypercapnia)
- NIPPV/NIV/BiPAP- improves decreased lung compliance, decreases left and right ventricular preload, reduce WOB, enhance gas exchange
- mechanical ventilation- when pt fails NIPPV, place on vent to prevent respiratory/cardiac arrest
chest X-ray characteristics for heart failure
- pulmonary edema
- batwing/butterfly pattern
- increased vascular markings
- fluffy opacities
- cardiomegaly
- Kelley B lines
what are the roles for the drug inotropic
inotropic drugs are used to reduce cardiac contractility, reduce strain on the heart, improve blood pressure, and improve cardiac output.
Examples: dopamine, dobutamine, and norepinephrine
what is the role of diuretics
loop diuretics- lasik’s, pull off access fluid and salt by increasing urine production
(monitor labs because they can also pull off electrolytes)
respiratory pattern seen in heart failure
Cheyenne stokes respiration- gradual increase of breathing (faster and deeper) followed by sections of apnea, cycle repeats
what are the complications of left sides heart failure
- when the left ventricular fails, it leads to slower CO and pulmonary congestion
- pulmonary venous congestion leads to increased interstitial and pleural fluid retention
- causes issues with systemic circulation, causes fluid back up in the lungs/chest cavity, and causes dyspnea/SOB
what is the role of anti-diuretic hormone ADH
- the kidneys will sense low blood flow and activates a system of hormones and enzymes which cause sodium/water retention
2.this leads to an increase in blood volume which can strain an already weakened pump - the pituitary gland releases an anti-diuretic hormone which causes fluid retention and leads to further fluid overload (the body’s compensation furthers the damage, even though it thinks its helping)
what is the role of nitroglycerin
nitroglycerin- its a vasodilator that increases blood flow to the peripheral veins so less is backing up in the heart
BNP levels in CHF
<100pg/mL is normal
>500pg/mL indicates CHF
electrolytes Na+, Cl-, K+ will be decreased if CHF is present, retaining more water dilutes electrolytes
what 8is the role of CPAP with heart failure
improves decreased lung compliance, decreases left and right ventricular preload enhances gas exchange (by recruiting collapses alveoli)
what is the mechanism behind pulmonary edema
(left ventricular failure only)
1. stability of fluid in pulmonary capillaries is determined by the balance of oncotic and hydrostatic pressures
2. oncotic is normally higher, keeping fluid in capillaries
3. left ventricular failure causes a backup blood in the pulmonary circulation
4. hydrostatic pressure increases as blood backs, causing fluid from the blood to leak into interstitial space
5.interstitial edema leads to alveolar flooding and eventual atelectasis
where is the location of phrenic nerves in the spinal column
phrenic nerves are located- spinal cord C3-C5
what are the characteristics of ALS (Lou Gehrig’s)
amyotrophic lateral sclerosis- fatal neurological disease due to loss of function of the motor neurons on the anterior horn of spinal cord.
1. sporadic- 90-95%
2. genetic 5-10%
3.progressive weakness begins in the periphery(hands/feet) most commonly
4. no treatment/cure
what part of the nervous system is affected by Guillain Barre
autoimmune disease that attacks nerve tissues, resulting in demyelination and inflammation of peripheral nerves. typically follows after a viral or bacterial infection.
(toes to head)
effect of NMD on respiratory system
1.atelectasis
2.impaired cough
3.mucus plugging
4.sleep disordered breathing
5.hypoventilation
6. stiffening rib cage
7. aspiration
8.pneumonia
9.respiratory failure
10.death
(effects breathing muscles, which effects breathing)
how to diagnose myasthenia gravis
-chronic autoimmune disorder resulting from circulating antibodies which block/alter/destroy acetylcholine receptors(muscle contractions) (episodic, head to feet)
1. immunologic studies (antibody tests)
2. eye drooping/double vision
3. positive tensilon test- anticholinesterase inhibitor(if improves muscle strength indicates MG)
general treatment for NMD
1.lung expansion/mucus clearances (no IS)
2. ventilatory support
3.Nutrition (protein calorie malnutrition increases risk for infection)
4.antibiotic therapy (with development of pneumonia)
5. anticoagulant and pneumatic compression sock therapy to prevent blood clots and pulmonary emboli
treatment for Guillain Barre
- plasmapheresis- plasma exchange
- intravenous immune globulin (IVIG)
what are the three ways neuromuscular system contributes to respiratory function
- regulation of respiratory drive
- ventilation
- airway protection
diagnostic testing for tuberculosis
- chest XRAY:
Ghon nodules
enlarged lymph nodes in hilar region
cavitation
fibrosis - AFB sputum culture and smear
used to test for acid-fast bacteria (done in AM) - QuantiFERON-TB gold test
blood test used to test for mycobacterium tuberculosis
isolation procedures
airborne isolation
use of a single patient, negative pressure room
N95 mask
PAPR
PPD test (Mantoux skin testing)
- intradermal injection with a small amount of a purified protein derivative(PPD)
- evaluated after 48-72 hrs
3.positive test does not mean active infection - induration less than 5 mm is neg
- 5-9mm is suspicious, retest needed
- > 10mm considered positive
positive reaction is evidence of recent or past infection or of active disease
risk factors associated with tuberculosis
- immune deficiency
2.close living quarters - homelessness
4.malnutrition
