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Med Surg II - 2120 > Exam II > Flashcards

Exam II Flashcards

1
Q

Which body organ controls bicarbonate (NaHCO3)?

A

Kidneys

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2
Q

Which body organ controls carbon dioxide (CO2)?

A

Lungs

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3
Q

_____ rids the body of excess CO2

A

Breathing

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4
Q

When CO2 raises in the brain blood and tissues central receptors trigger neurons to increase the rate and depth of breathing, causing _____

A

Hyperventilation

When the CO2 is “blown off” ECF decreases

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5
Q

pH below ____ and above _____ is usually fatal

A

6.9, 7.8

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6
Q

What are the health problems that increase acid production?

A

Diabetic ketoacidosis,

Seizures

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7
Q

What are the health problems that decrease acid production?

A

Respiratory impairment,

Kidney impairment

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8
Q

A base deficit is caused by which two functions?

A

Over elimination,
Underproduction of bicarbonate

Overproduction is a result of diarrhea
Underproduction is a result of pancreatitis and dehydration

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9
Q

Which four body systems typically exhibit manifestations of acidosis first?

A

Musculoskeletal,
Cardiac,
Respiratory,
CNS

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10
Q

What are the four process that can result in metabolic acidosis?

A

Overproduction of hydrogen ions,
Under elimination of hydrogen ions,
Under production of bicarbonate ions,
Over elimination of bicarbonate ions

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11
Q

What is the substance that releases hydrogen ions?

A

Acid

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12
Q

What is the substance the takes up hydrogen ions?

A

Base

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13
Q

Acid is produced through ______

A

Cellular metabolism

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14
Q

This occurs when body fluids resist large changes in the pH when acids or bases are added or removed

A

Acid buffering

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15
Q

What are the most common pathological processes disturbed by acid-based imbalance?

A 
COPD,
Acute respiratory distress syndrome,
Acute pneumonia,
Pulmonary edema,
Kidney failure
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16
Q

What are the processes that can cause metabolic acidosis?

A

Overproduction of hydrogen ions,
Under elimination of hydrogen ions,
Under production of bicarbonate ions,
Over elimination of bicarbonate ions

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17
Q

This acid base imbalance occurs when respiratory function is impaired and the exchange of oxygen (O2) and carbon dioxide (CO2) is reduced, causing CO2 retention leading to the same increase in hydrogen ions.

A

Respiratory acidosis

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18
Q

What are the physical results of respiratory acidosis?

A

Respiratory depression,
Inadequate chest expansion,
Airway obstruction,
Reduced alveolar-capillary diffusion

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19
Q

Which specific drugs can impair gas exchange?

A

Diuretics,

Aspirin

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20
Q

Which health problems can lead to acid base imbalance?

A

Cardiac problems
Kidney problems,
Pulmonary impairment

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21
Q

What are the first physical symptoms with mild acidosis?

A

Cardiovascular changes; increased heart rate and cardiac output

With worsening acidosis or acidosis and hyperkalemia, heart rate decreases

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22
Q

Which blood products are produced in bone marrow?

A

Red blood cells (RBCs, erythrocytes),
White blood cells (WBCs, leukocytes),
Platelets

Bone marrow is also involved with immune response

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23
Q

Where is cell producing marrow present?

A 
Flat bones (sternum, skull, pelvic and shoulder girdles),
Ends of long bones
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24
Q

Immature, unspecialized (undifferentiated) cells that are capable of becoming any type of cell, depending on the body’s needs, are_____

A

Blood stem cells

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25
Q

Blood is composed of _____ and _____

A

Plasma,

Cells

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26
Q

____ contains protein and is an Extracellular fluid

A

Plasma

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27
Q

What are the three types of plasma proteins?

A

Albumin,
Globulins,
Fibrinogen

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28
Q

_____ maintains the osmotic pressure of the blood, preventing the plasma from leaking into the tissues

A

Albumin

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29
Q

_____ transport other substances and, as anti-bodies, protect the body against infection

A

Globulins

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30
Q

_____ is critical in the clotting process

A

Fibrinogen

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31
Q

The blood cells include _____, _____, and _____.

A

RBCs,
WBC,
Platelets

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32
Q

_____ compose the largest portion of blood cells

A

Red blood cells (erythrocytes)

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33
Q

What is the lifespan of a red blood cell?

A

120 days

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34
Q

Red blood cells produce ______, which requires iron to transport oxygen.

A

Hemoglobin (Hgb)

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35
Q

Red blood cell production is called _______

A

Erythropoiesis

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36
Q

Where is the RBC growth factor erythropoietin produced?

A

kidneys

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37
Q

What seven substances are needed to form hemoglobin?

A 
Iron,
B12,
Folic acid,
Copper,
Pyridoxine,
Cobalt,
Nickel
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38
Q

What is the growth factor that controls production of platelets?

A

Thrombopoietin

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39
Q

_____% of platelets circulate while _____% are stored in the spleen

A

80% circulate,

20% stored in spleen

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40
Q

Which organ is responsible for producing prothrombin and other blood clotting factors?

A

Liver

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41
Q

What are the white blood cells responsible for inflammation?

A 
Never, Make, Monkies, Eat, Bananas
Neutrophils,
Macrophages,
Monocytes,
Eosinophils,
Basophils
42
Q

What are the functions of each of the white blood cells?

A

Neutrophils: ingestion and phagocytosis
Macrophages: ingestion and phagocytosis
Monocytes: destruction of bacteria and cellular debris
Eosinophils: releases vasoactive amines during allergic reactions
Basophils: releases histamine and heparin

43
Q

When anti clotting factors are deficient there is risk for these three conditions?

A

Pulmonary embolism,
Myocardial infarction,
Stroke

44
Q

What are the Hematologic changes associated with aging?

A

Decreased blood volume (lower levels of plasma proteins),
Decreased RBC and WBC count (platelets remain steady),
Lymphocytes are less reactive and lose immune function,
Decreased hemoglobin

45
Q

Which over the counter herbal supplements inhibit platelet activity?

A

St. John’s wort,

Ginkgo biloba

46
Q

Which vitamin increases the rate of clotting?

A

Vitamin K

leafy green veggies, salads, and raw veggies

47
Q

Where is the liver palpable?

A

RUQ, 4-5 cm below right costal margin

48
Q

_____ is a reduction in RBCs, hemoglobin, or hematocrit

A

Anemia

49
Q

_____ is a genetic disorder that results in chronic anemia, pain, disability, organ damage, increased risk for infection and early death

A

Sickle cell disease

50
Q

What is the lifespan of a RBC when SCD is present?

A

10-20 days

51
Q

This autoimmune Hematologic disorder typically appears in women between the ages of 20-50 years old and involves platelets being coated with an anti platelet antibody, making them easier to destroy by macrophages.

A

Autoimmune thrombocytopenic purpura

Also known as idiopathic thrombocytopenic purpura (ITP)

52
Q

What are the manifestations of ITP?

A

Large bruises (ecchymoses),
Petechial rash on arms, legs, upper chest, and neck,
Mucosal bleeding

53
Q

What is the drug therapy for ITP?

A

Corticosteroids,

Chemotherapy drugs

54
Q

If a patient with ITP doesn’t respond to drug therapy which surgical procedure may be required?

A

Spenectomy

55
Q

This Hematologic disorder results in platelets that clump together abnormally in the capillaries leaving too few platelets in circulation.

A

Thrombotic thrombocytopenic purpura (TTP)

56
Q

With TTP, the patient has inappropriate clotting in the small blood vessels and fail to clot when trauma occurs. This results in four conditions?

A

Ischemic tissues,
Kidney failure,
Myocardial infarction,
Stroke

57
Q

What are the consequences of untreated TTP?

A

Death within 3 month

58
Q

What is the treatment for TTP?

A

Plasma removal and infusion of fresh frozen plasma,

Drugs to inhibit platelet clumping (aspirin)

59
Q

Which acid base imbalance presents with neurologic, respiratory (Kussmaul), gastrointestinal(n/v, diarrhea) and cardiovascular (arrhythmias, hypotension) changes?

A

Metabolic acidosis

60
Q

Which acid-base imbalance presents with slow and shallow respirations, weakness, muscle cramps, hyperactive reflexes, increased glucose, increased keystones, decreased LOC, decreased potassium, confusion, and, in severe cases, seizures, tachycardia and arrhythmias ?

A

Metabolic alkalosis

61
Q

Which acid base imbalance presents with labored breathing, headache, restlessness, blurred vision, lethargy, decreased O2, and muscle twitching, tremors, seizure and coma (in severe cases)?

A

Respiratory acidosis

62
Q

Which acid base imbalance presents with dizziness, confusion, tingling of extremities, increased HR, and seizures and coma (severe cases)?

A

Respiratory Alkalosis

63
Q

A chest X-ray indicates infiltration when….

A

The alveoli are filled with fluid

64
Q

A chest X-ray indicates consolidation when…

A

Lung tissue is filled with fluid, causing swelling or hardening

65
Q

This is a life threatening condition associated with left ventricular failure that severely impairs gas exchange?

A

Pulmonary edema

66
Q

What are the manifestations of pulmonary edema?

A 
Crackles/rails, Dyspnea,
Disorientation,
Tachycardia,
Hypertension or hypotension,
Reduced urinary output,
Cough, pink sputum,
PVCs/dysrhythmias,
Anxiety, restlessness, lethargy
67
Q

_____ is the degree of myocardial fiber stretch at the end of duos told and before contraction

A

Preload

68
Q

_____ is the resistance ventricles overcome to eject blood thru semilunar values into peripheral blood vessels

A

Afterload

69
Q

What are the nursing interventions for pulmonary edema?

A 
Administer nitroglycerin (vasoconstrictor, decreases preload/afterload), diuretics (eliminate fluids to decrease edema), morphine (pain), antidysrhthmic said (prophylaxis)
Monitor/change positions,
Monitor labs (BUN, creatinine, CBC, CMP,
Foley (if needed)
70
Q

This is an acute inflammatory demyelination get disease that affects the peripheral nervous system causing motor weakness and sensory abnormalities. It affects both genders and peaks after 55 years of age

A

Gillian-Barre Syndrome

71
Q

What are the three stages of Guillain-Barre Syndrome?

A

Acute/initial (1-4 weeks),
Plateau (several days-2weeks),
Recovery (gradual, 4-6 months or up to 2 years)

72
Q

What are the clinical manifestations of Guillain-Barre Syndrome?

A

Demyelination,
Ascending weakness,
Partial/total paralysis,
Paralyzed respiratory muscles

73
Q

This intervention removes blood from the body and separates plasma and then returns blood cells w/o plasma to the body

A

Plasmapheresis

74
Q

Which labs/tests are performed for a patient with Gullain-Barre Syndrome?

A

CMP, ABGs (w/ vent or respiratory compromise),
spinal tap (shows point of demyelination),
Mylegram (EMG)-measures nerve activity,
MRI (rule out other causes),
BUN, creatinine (before administration of CT dye)

75
Q

How is oxygen administered for patients w/COPD?

A

28% ventury mask

76
Q

Which COPD disorder affects the alveoli?

A

Emphysema

77
Q

Which COPD disorder affects the bronchioles/airway?

A

Chronic bronchitis

78
Q

What is the most commonly transfused blood component?

A

Packed red blood cells

They restore oxygen carrying capacity primarily from bleeding or severe anemia

79
Q

What is the purpose of washing RBCs to remove traces of plasma, platelets and WBCs?

A

Reduc side effects such ch as fever, chills, or other reaction

80
Q

What reasons might a person receive a platelet transfusion?

A

Thrombocytopenia

81
Q

Why would a person receive single donor platelets rather than pooled platelets?

A

Decrease the chance for rejection/infection

82
Q

Why might a person receive fresh frozen plasma?

A

Bleeding disorders with unknown clotting factors

83
Q

This blood product is prepared from plasma by centrifuging fresh frozen plasma and contains clotting factors such as Fibrinogen, Factor VIII, Von Willebrand’s factor, Factor XIII

A

Cryoprecipitate

84
Q

Why might a person receive antibodies/immunoglobulins?

A

Immunity for those exposed to infection with low levels of antibodies

i.e. Chickenpox, hepatitis, rabbis, tetanus

85
Q

What are the four components required prior to administering a transfusion?

A
  1. Transfusion order from physician
  2. Informed consent from patient
  3. Procedure explained to patient
  4. Cross check the patients name and medical record number with another nurse
86
Q

What information is required on the physician’s transfusion order?

A
  1. Blood type and Rh factor
  2. Patient name, DOB, diagnosis, reason for transfusion
  3. Specified blood product to be administered w/special instructions
  4. Amount of blood product to be administered
87
Q

This diagnostic test assesses the ability of thrombin & plasmin to break down clots

A

D-diner

88
Q

This diagnostic test assesses nutritional status

A

Albumin & Protein

89
Q

This diagnostic test assesses the effectiveness of clotting factors I, II, V, VII, X on ththe extrinsic pathway which is part of the coagulation cascade for converting prothrombin to thrombin.

A

Prothrombin Time (PT)

Decreased PT indicates decreased clotting ability

90
Q

What is the normal range for Prothrombin Time (PT)

A

11-12.5 seconds

Therapeutic range 1.5-2.5 times normal

91
Q

This diagnostic test was established by the World Health Organization (WHO) and measures clotting

A

INR

PT/INR: test performed for patients on Coumadin
Normal range: 1.1-1.2 (w/o medications)
Therapeutic range: 2.5-3-5

92
Q

What diagnostic test measures the effectiveness of clotting factors in the intrinsic pathway for the formation of fibrin that forms mesh that impedes blood flow. It measures the effectiveness of IV heparin

A

Partial Thromboplastin Time (PTT)

Normal range: 30-40 seconds
Therapeutic range: 1.5-2.5 times normal range

93
Q

This diagnostic test provides information about clotting factor I, fibrinogen converted to fibrin in the clotting process

A

Fibrinogen

Normal range 200-400 mg/dL

94
Q

What is the normal range for platelets

A

150,000-400,000

<30,000 susceptible to uncontrolled bleeding with injury
<6,000 susceptible to spontaneous bleeding in the brain

95
Q

What is the normal range for RBCs

A

Men: 4.7-6.1
Women: 4.2-5.4

96
Q

What is the normal range for hemaglobin

A

Men: 14-18
Women: 12-16

97
Q

What is the normal range for hematocrit

A

Men: 40-54%
Women: 36-48%

98
Q

Which diagnostic test assesses hypo/hyper production of RBCs/platelet

A

Bone marrow aspiration

99
Q

Which anticoagulants are commonly used for clotting disorders

A

Heparin,

Coumadin

100
Q

Which anti platelets are commonly used for blood disorders

A

Aspirin,

Clopidogrel (Plavix) - risk for brain bleed

101
Q

Which thrombolytic agent is us d in the ED to reverse the effects of stroke/TIA if used within 3 hours of the event

A

Streptokinase t-PA (tissue plasminogen activator)

Med Surg II - 2120 (3 decks)

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