Exam II Flashcards
Which body organ controls bicarbonate (NaHCO3)?
Kidneys
Which body organ controls carbon dioxide (CO2)?
Lungs
_____ rids the body of excess CO2
Breathing
When CO2 raises in the brain blood and tissues central receptors trigger neurons to increase the rate and depth of breathing, causing _____
Hyperventilation
When the CO2 is “blown off” ECF decreases
pH below ____ and above _____ is usually fatal
6.9, 7.8
What are the health problems that increase acid production?
Diabetic ketoacidosis,
Seizures
What are the health problems that decrease acid production?
Respiratory impairment,
Kidney impairment
A base deficit is caused by which two functions?
Over elimination,
Underproduction of bicarbonate
Overproduction is a result of diarrhea
Underproduction is a result of pancreatitis and dehydration
Which four body systems typically exhibit manifestations of acidosis first?
Musculoskeletal,
Cardiac,
Respiratory,
CNS
What are the four process that can result in metabolic acidosis?
Overproduction of hydrogen ions,
Under elimination of hydrogen ions,
Under production of bicarbonate ions,
Over elimination of bicarbonate ions
What is the substance that releases hydrogen ions?
Acid
What is the substance the takes up hydrogen ions?
Base
Acid is produced through ______
Cellular metabolism
This occurs when body fluids resist large changes in the pH when acids or bases are added or removed
Acid buffering
What are the most common pathological processes disturbed by acid-based imbalance?
COPD, Acute respiratory distress syndrome, Acute pneumonia, Pulmonary edema, Kidney failure
What are the processes that can cause metabolic acidosis?
Overproduction of hydrogen ions,
Under elimination of hydrogen ions,
Under production of bicarbonate ions,
Over elimination of bicarbonate ions
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.
Respiratory acidosis
What are the physical results of respiratory acidosis?
Respiratory depression,
Inadequate chest expansion,
Airway obstruction,
Reduced alveolar-capillary diffusion
Which specific drugs can impair gas exchange?
Diuretics,
Aspirin
Which health problems can lead to acid base imbalance?
Cardiac problems
Kidney problems,
Pulmonary impairment
What are the first physical symptoms with mild acidosis?
Cardiovascular changes; increased heart rate and cardiac output
With worsening acidosis or acidosis and hyperkalemia, heart rate decreases
Which blood products are produced in bone marrow?
Red blood cells (RBCs, erythrocytes),
White blood cells (WBCs, leukocytes),
Platelets
Bone marrow is also involved with immune response
Where is cell producing marrow present?
Flat bones (sternum, skull, pelvic and shoulder girdles), Ends of long bones
Immature, unspecialized (undifferentiated) cells that are capable of becoming any type of cell, depending on the body’s needs, are_____
Blood stem cells
Blood is composed of _____ and _____
Plasma,
Cells
____ contains protein and is an Extracellular fluid
Plasma
What are the three types of plasma proteins?
Albumin,
Globulins,
Fibrinogen
_____ maintains the osmotic pressure of the blood, preventing the plasma from leaking into the tissues
Albumin
_____ transport other substances and, as anti-bodies, protect the body against infection
Globulins
_____ is critical in the clotting process
Fibrinogen
The blood cells include _____, _____, and _____.
RBCs,
WBC,
Platelets
_____ compose the largest portion of blood cells
Red blood cells (erythrocytes)
What is the lifespan of a red blood cell?
120 days
Red blood cells produce ______, which requires iron to transport oxygen.
Hemoglobin (Hgb)
Red blood cell production is called _______
Erythropoiesis
Where is the RBC growth factor erythropoietin produced?
kidneys
What seven substances are needed to form hemoglobin?
Iron, B12, Folic acid, Copper, Pyridoxine, Cobalt, Nickel
What is the growth factor that controls production of platelets?
Thrombopoietin
_____% of platelets circulate while _____% are stored in the spleen
80% circulate,
20% stored in spleen
Which organ is responsible for producing prothrombin and other blood clotting factors?
Liver
What are the white blood cells responsible for inflammation?
Never, Make, Monkies, Eat, Bananas Neutrophils, Macrophages, Monocytes, Eosinophils, Basophils
What are the functions of each of the white blood cells?
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
When anti clotting factors are deficient there is risk for these three conditions?
Pulmonary embolism,
Myocardial infarction,
Stroke
What are the Hematologic changes associated with aging?
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
Which over the counter herbal supplements inhibit platelet activity?
St. John’s wort,
Ginkgo biloba
Which vitamin increases the rate of clotting?
Vitamin K
leafy green veggies, salads, and raw veggies
Where is the liver palpable?
RUQ, 4-5 cm below right costal margin
_____ is a reduction in RBCs, hemoglobin, or hematocrit
Anemia
_____ is a genetic disorder that results in chronic anemia, pain, disability, organ damage, increased risk for infection and early death
Sickle cell disease
What is the lifespan of a RBC when SCD is present?
10-20 days
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.
Autoimmune thrombocytopenic purpura
Also known as idiopathic thrombocytopenic purpura (ITP)
What are the manifestations of ITP?
Large bruises (ecchymoses),
Petechial rash on arms, legs, upper chest, and neck,
Mucosal bleeding
What is the drug therapy for ITP?
Corticosteroids,
Chemotherapy drugs
If a patient with ITP doesn’t respond to drug therapy which surgical procedure may be required?
Spenectomy
This Hematologic disorder results in platelets that clump together abnormally in the capillaries leaving too few platelets in circulation.
Thrombotic thrombocytopenic purpura (TTP)
With TTP, the patient has inappropriate clotting in the small blood vessels and fail to clot when trauma occurs. This results in four conditions?
Ischemic tissues,
Kidney failure,
Myocardial infarction,
Stroke
What are the consequences of untreated TTP?
Death within 3 month
What is the treatment for TTP?
Plasma removal and infusion of fresh frozen plasma,
Drugs to inhibit platelet clumping (aspirin)
Which acid base imbalance presents with neurologic, respiratory (Kussmaul), gastrointestinal(n/v, diarrhea) and cardiovascular (arrhythmias, hypotension) changes?
Metabolic acidosis
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 ?
Metabolic alkalosis
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)?
Respiratory acidosis
Which acid base imbalance presents with dizziness, confusion, tingling of extremities, increased HR, and seizures and coma (severe cases)?
Respiratory Alkalosis
A chest X-ray indicates infiltration when….
The alveoli are filled with fluid
A chest X-ray indicates consolidation when…
Lung tissue is filled with fluid, causing swelling or hardening
This is a life threatening condition associated with left ventricular failure that severely impairs gas exchange?
Pulmonary edema
What are the manifestations of pulmonary edema?
Crackles/rails, Dyspnea, Disorientation, Tachycardia, Hypertension or hypotension, Reduced urinary output, Cough, pink sputum, PVCs/dysrhythmias, Anxiety, restlessness, lethargy
_____ is the degree of myocardial fiber stretch at the end of duos told and before contraction
Preload
_____ is the resistance ventricles overcome to eject blood thru semilunar values into peripheral blood vessels
Afterload
What are the nursing interventions for pulmonary edema?
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)
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
Gillian-Barre Syndrome
What are the three stages of Guillain-Barre Syndrome?
Acute/initial (1-4 weeks),
Plateau (several days-2weeks),
Recovery (gradual, 4-6 months or up to 2 years)
What are the clinical manifestations of Guillain-Barre Syndrome?
Demyelination,
Ascending weakness,
Partial/total paralysis,
Paralyzed respiratory muscles
This intervention removes blood from the body and separates plasma and then returns blood cells w/o plasma to the body
Plasmapheresis
Which labs/tests are performed for a patient with Gullain-Barre Syndrome?
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)
How is oxygen administered for patients w/COPD?
28% ventury mask
Which COPD disorder affects the alveoli?
Emphysema
Which COPD disorder affects the bronchioles/airway?
Chronic bronchitis
What is the most commonly transfused blood component?
Packed red blood cells
They restore oxygen carrying capacity primarily from bleeding or severe anemia
What is the purpose of washing RBCs to remove traces of plasma, platelets and WBCs?
Reduc side effects such ch as fever, chills, or other reaction
What reasons might a person receive a platelet transfusion?
Thrombocytopenia
Why would a person receive single donor platelets rather than pooled platelets?
Decrease the chance for rejection/infection
Why might a person receive fresh frozen plasma?
Bleeding disorders with unknown clotting factors
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
Cryoprecipitate
Why might a person receive antibodies/immunoglobulins?
Immunity for those exposed to infection with low levels of antibodies
i.e. Chickenpox, hepatitis, rabbis, tetanus
What are the four components required prior to administering a transfusion?
- Transfusion order from physician
- Informed consent from patient
- Procedure explained to patient
- Cross check the patients name and medical record number with another nurse
What information is required on the physician’s transfusion order?
- Blood type and Rh factor
- Patient name, DOB, diagnosis, reason for transfusion
- Specified blood product to be administered w/special instructions
- Amount of blood product to be administered
This diagnostic test assesses the ability of thrombin & plasmin to break down clots
D-diner
This diagnostic test assesses nutritional status
Albumin & Protein
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.
Prothrombin Time (PT)
Decreased PT indicates decreased clotting ability
What is the normal range for Prothrombin Time (PT)
11-12.5 seconds
Therapeutic range 1.5-2.5 times normal
This diagnostic test was established by the World Health Organization (WHO) and measures clotting
INR
PT/INR: test performed for patients on Coumadin
Normal range: 1.1-1.2 (w/o medications)
Therapeutic range: 2.5-3-5
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
Partial Thromboplastin Time (PTT)
Normal range: 30-40 seconds
Therapeutic range: 1.5-2.5 times normal range
This diagnostic test provides information about clotting factor I, fibrinogen converted to fibrin in the clotting process
Fibrinogen
Normal range 200-400 mg/dL
What is the normal range for platelets
150,000-400,000
<30,000 susceptible to uncontrolled bleeding with injury
<6,000 susceptible to spontaneous bleeding in the brain
What is the normal range for RBCs
Men: 4.7-6.1
Women: 4.2-5.4
What is the normal range for hemaglobin
Men: 14-18
Women: 12-16
What is the normal range for hematocrit
Men: 40-54%
Women: 36-48%
Which diagnostic test assesses hypo/hyper production of RBCs/platelet
Bone marrow aspiration
Which anticoagulants are commonly used for clotting disorders
Heparin,
Coumadin
Which anti platelets are commonly used for blood disorders
Aspirin,
Clopidogrel (Plavix) - risk for brain bleed
Which thrombolytic agent is us d in the ED to reverse the effects of stroke/TIA if used within 3 hours of the event
Streptokinase t-PA (tissue plasminogen activator)
