Final Exam Flashcards
Normal RBC count
Female: 4.2-5.4
Male 4.5-6.2
Normal WBC count
Female: 4500-11000
male: 5000-10,000
Normal Hematocrit
Female: 37-47%
Male: 42-52%
Normal HDL (protective levels)
Female: >55mg/dL
male> 45 mg/dL
Normal LDL
Beneficial: <100 mg/dL
harmful: >160 mg/dL
Normal Ejection Fraction (EF)
60-80%
Normal Hemoglobin
female: 12-16
male: 14-18
Normal sodium levels
135-145 mEq/L
normal potassium levels
3.5-5.0 mEq/L
normal total cholesterol
<200 mg/dL
Normal Troponin
<0.5 for Troponin 1 and <0.1 for Troponin T
Normal BNP level
<100 pg/mL indicates no heart failure
Normal PaCO2 range
35-45 mm Hg (Acid)
Normal Creatinine (reflects GFR for renal function)
Female: 0.5-1.1 mg/dL
male: 0.6-1.2 mg/dL
Normal pH range
7.35-7.45
Normal Blood Urea Nitrogen (BUN)
10-20 mg/dL (indirect measure of overall hydration)
Absolute pH
7.4
Normal HCO3 range
22-26 mEq/L
Normal SaO2
95-100%
Normal PaO2 levels
80-100 mmHg
normal BP range
120/80-140/90
Normal V/Q ratio
4:5 or 0.8
Diabetes mellitus type 1
Dietary intervention (low carbohydrate) + insulin replacement
- a disease in which body does not make enough insulin to control blood sugar levels.
-Symptoms: increased thirst, frequent urination, hunger, fatigue, blurred vision
treatment: insulin, diet, exercise
- happens mostly in adolescents
Diabetes mellitus type 2
treatment: Dietary intervention, oral hypoglycemics, and insulin (if refractory)
- Body doesn’t produce enough insulin or it resists insulin.
- symptoms: frequent urination, increased thirst, hunger, fatigue, blurred vision
Hypertension
High blood pressure, higher than 140/90
- creates severe complications like heart disease, stroke, and sometimes death.
may sometimes have no symptoms
-Blood Pressure is the force that a persons blood exerts against the walls of their blood vessels.
Acute Kidney Injury (AKI)
rapid loss of renal function due to damage to the kidneys; formerly called acute renal failure
- rapid kidney failure that can happen in hours or days.
- causes a build up of waste products in your blood and makes it hard For your kidneys to keep the right balance of fluid in your body.
Symptoms: decreased urine output, swelling due to fluid retention, nausea, fatigue, and shortness of breath.
heart failure (HF)
- condition in which there is an inability of the heart to pump enough blood through the body to supply the tissues and organs with nutrients and oxygen.
- symptoms: shortness of breath, fatigue, swollen legs, and rapid heartbeat.
- treatment: medicine( beta blocker, ACE inhibitior, vasodilator), less salt, limit fluid intake, exercise, quit smoking.
COPD (chronic obstructive pulmonary disease)
A group of lung diseases that block airflow and make it difficult to breathe.
- Symptoms: shortness of breath, wheezing, chronic cough.
- main cause: smoking, air pollution, chemical fumes, dust
four stages: mild, moderate, severe, very severe
Medicine: bronchodilator, steroid, oxygen therapy
Asthma
A chronic allergic disorder characterized by episodes of severe breathing difficulty, coughing, and wheezing.
- The EPR-3 guideline classification divides asthma severity into four groups: intermittent, persistent-mild, persistent-moderate, and persistent-severe.
- Step 1 - mild intermittent asthma. Symptoms fewer than two times a week. Does not have problems between flare-ups. …
Step 2 - mild persistent asthma. Symptoms more than two times a week, but no more than once a day. …
Step 3 - moderate persistent asthma. Symptoms every day. …
Step 4 - severe persistent asthma. Constant symptoms.
Emphysema
A serious disease that destroys lung tissue and causes breathing difficulties.
- Emphysema is a lung condition that causes shortness of breath. In people with emphysema, the air sacs in the lungs (alveoli) are damaged. Over time, the inner walls of the air sacs weaken and rupture — creating larger air spaces instead of many small ones.
chronic bronchitis
inflammation of the bronchi persisting over a long time.
- Acute bronchitis is often caused by a viral respiratory infection and improves by itself.
Symptoms of bronchitis include coughing up thickened mucus and shortness of breath.
Treatments usually includes soothing remedies to help with coughing, which may last weeks. Antibiotics are not usually recommended.
myocardial infarction
the occlusion of one or more coronary arteries caused by plaque buildup (heart attack).
- The usual cause of sudden blockage in a coronary artery is the formation of a blood clot (thrombus).
Reproductive disorders
FSH and LH
Estrogen
A sex hormone, secreted in greater amounts by females than by males. In nonhuman female mammals, estrogen levels peak during ovulation, promoting sexual receptivity.
- maintains skin and vessel function.
-increase blood coagulation
- exert control over other hormonal development via protein synthesis
progesterone function
- stimulates development and maintenance of endometrium that prepares it for implantation.
- supports pregnancy
- breast development
- lead to increased aldosterone
- increase basal body temp
Vaginitis
inflammation of the lining of the vagina
- brought on by bad hygiene, foreign bodies, intestinal parasites, STI, systemic antibodies.
- signs and symptoms: burning, itching, dysuris,dyspareania(painful sex) and malodorous odor.
vaginal cancer
malignant cells of the vagina
Associated with DES (diethylstilbestrol)administration to mother during pregnancy which ended in the early 1970s; HPV
ii. Genetic risk
iii. Obesity, smoking, estrogen Rx
c. S&S - *abnormal bleeding- most common sign; pain, dysuria, constipation, vaginal discharge
cervical cancer
a. Etiology - strongly linked to HPV!
b. Risk factors - smoking, poor diet, multiple (2 or more) sexual partners, onset of intercourse at a young age.
c. Long latent phase which ↑efficacy of the Pap smear.
d. S&S - abnormal vaginal bleeding and discharge; if advanced disease - pain, fistulas, enlarged local lymph nodes, hematuria
e. Rx - removal of the cancer
i. Electrocautery
ii. Cryosurgery
iii. Laser therapy
iv. Conization
v. Hysterectomy
vi. Radiation if advanced
Pelvic Inflammatory Disease (PID) -Inflammatory disease of the upper reproductive tract - very common
a. Etiology - young age, unmarried status, abortion, multiple sex partners, IUD, failure to use contraception
b. S&S- abdominal pain, purulent discharge, fever, ↑sedrate, ↑WBC
c. DX - C-reactive protein, ultrasound, laparoscopy
phimosis
narrowing of the opening of the prepuce over the glans penis
smegma
thick, cheesy secretion that accumulates under the labia minora or the male foreskin
Epididymis
A long, coiled duct on the outside of the testis in which sperm mature.
*inflammation of the epididymis
cryptorchidism
undescended testicles
myalgia
Muscular pain, “muscle aches”
arthralgia
joint pain
libido
sexual desire
What is the role of the nervous system in male sexual function?
Erection is under the control of the parasympathetic nervous system, Ejaculation and relaxation are under the control of the sympathetic nervous system, Male sexual function depends on intact reflexes, higher neural function, and a working vascular system.
Erectile Dysfunction
a. Define - inability to achieve or maintain an erection for sexual satisfaction
b. Etiology - Psychogenic - anxiety, depression, mood changes: Organic - damage or dysfunction of the nervous system, hormonal imbalances, vascular problems that reduce blood flow to the penis, drug use, direct penile problems: DM, Old age, Atherosclerosis, Hypertension, Cigarette smoke, Heart disease, Alcohol
c. Treatment
i. Determine underlying cause and treat
ii. Counseling for psychogenic issues
iii. Hormone replacement
iv. Drug therapy
v. Prosthesis/implant
Priapism
a. Define - Painful prolonged erection not associated with sexual stimulation.
b. Etiology- Occurs frequently with sickle cell anemia, cancers, sildenafil, and sometimes in newborns: Occurs with alcohol, infection, leukemia, stokes, spinal cord injuries
c. Pathophysiology- Engorgement of penile vasculature with causing hypoxia and ischemia with resultant inflammatory process and scarring
d. Treatment- Medical emergency: Rx - relieve urinary retention, pain control, hydration, sedation, ice packs, local instillation of drugs
Penile Cancer
a. Etiology -Related to poor hygiene, HPV, ultravoiletradiation, immunocompromise
b. Pathophysiology -Chronic irritation leads to chronic inflammation and rebuilding of cells which allows for aberrant DNA and metaplastic cell development
c. Rx - topicals, laser removal, penectomy
Testicular Torsion - Medical Emergency
a. Risk group -Most common in adolescents
b. Patho - Testicles rotate around in the truncia vaginalisand the vasculature twists in the spermatic cord choking off blood supply to the testes.
c. S&S - unilateral pain that radiates to the inguinal canal, swollen, large testicle; also have non symmetrical testes.
d. Rx - surgical correction and possible orchiectomy(removal of testicle(s).
Testicular Cancer - Most common cancer in young males
a. Etiology -Most common in Caucasians, Closelyassociated with cryptorchidism, Familial predisposition
b. Early S&S - enlargement of one testicle which may be associated with abdominal or groin heaviness and ache.
c. Metastasizes quickly
d. S&S of metastatic spread - Lower extremity swelling, back pain, cough, hemoptysis, dizziness, gynecomastia
e. Prevention is the key - STE monthly
f. Rx - good prognosis especially with early surgical excision. Chemotherapy and radiation may also be used based on stage and grade.
Acute Prostatitis
a. Uncommon
b. Bacterial entry into the prostate
c. S&S fever, chills, malaise, myalgia, arthralgia, frequent & painful urination, urethral discharge.
d. DX based on urine characteristics and culture with a manual rectal exam.
e. Rx with antibiotics
Chronic Prostatitis
a. Long term infectious process.
b. S&S frequent UTIs, less likely to produce myalgia and arthralgia than the acute form.
c. RX - requires longer term antibiotic therapy due to poor penetration of the antibiotics into the prostate.
Pain Syndrome
a. Chronic inflammation without infection or chronic pelvic pain
b. S&S - back, rectal, penile, testicular, and scrotal pain; ED; painful ejaculations; ↓libido
c. Rx varies based on the healthcare provider; Symptomatic relief and possibly antibiotics
BPH - This was also discussed in the renal/urinary lecture
a. Very common
b. Unknown cause
c. Risk factors - age, family hx, African American race, dietary fat and meat, estrogen
d. S&S - small weak urinary stream; post void dribbling; frequency; nocturia; retention; frequent UTIs; hydonephrosis; Renal failure
e. Diagnosis
i. ↑PSA
ii. Urine studies
iii. √creatinine as a sign of ↓ GFR and renal failure
f. Treatment
i. Watch and wait
ii. Rx UTIs
iii. Drugs to reduce prostate size and relax smooth muscle
iv. TURP (transurethral resection of the prostate) if severe but not favored due to iatrogenic impotence
Prostate Cancer
a. Most common male cancer
b. Slow growing cancer
c. Risk factors - age; African American race; heredity; ↑fat and meat diet; Androgens
d. Metastasizes to pelvic bones, vertebral column and ribs
e. Pain is the first sign with S&S resembling BPH
f. Routine PSA screenings >50 years
g. Diagnosis is based on PSA level
h. Rx - surgical removal, hormonal therapy, radiation
Condylomata acuminate AKA genital warts
a. Etiology - HPV - 70 strains of the virus
b. Inoculation is followed in 6- 8 weeks by soft fleshy lesions on the external genitalia or cauliflower shaped lesions on the internal portions of the genitalia- lifelong infection- may not be evident for years
c. Most common STI and is oncogenic
d. S&S - dyspareunia (painful intercourse) and the lesions
e. Treatments
i. Topical agents
ii. Cryosurgery - freezing
iii. Laser removal
iv. Electrocautery - burning
v. Surgery
vi. Sexual abstinence during treatment
Genital Herpes
a. Spread via contact
b. Grow in neurons
c. Dormant periods
d. Passed to infant during birth if active (lethal)
e. S&S - tingling; itching; pain, pustules and vesicles that burst and crust; fever, HA, malaise, lymphadenopathy, pain, dysuria, retention
f. S&S may occur in the CNS and throat
g. First infections last 2- 4 weeks with subsequent infections shorter in duration and less severe symptoms
h. Treat symptoms - antiviral agents to reduce viral loads and shorten outbreaks
i. Hand washing imperative
Candidiasis AKA yeast AKA moniliasis
a. Normal vaginal yeast is Candida albicans.
b. Infection is caused by an overgrowth of resident yeast due to
i. Antibiotics
ii. Immunosuppression
iii. Pregnancy
iv. Birth control pills
v. DM
c. S&S
i. Irritation
ii. Itching
iii. Dysuria
iv. Dyspareunia
v. Thick white cheesy discharge
vi. May grow in skin folds
d. Treatment
i. Topical antifungals
ii. Systemic antifungals
iii. Breathable clothing
Trichomoniasis
a. Colonizes in the male urethra and prostate
b. Males are generally asymptomatic
c. Females have foul smelling green-yellow discharge with the general S&S of infection.
d. Increases the risk for HIV and infertility
e. Rx with metronidazole concurrently.
Chlamydia
a. Parasite
b. Causes urethritis, PID, pneumonia
c. S&S in females- range from none to S & S of infection, dysuria, abnormal vaginal discharge, bleeding after intercourse
d. Can be localized near the point of entry or spread into the pelvic and abdominal cavities.
e. S&S in males - urethritis, erythema, tenderness, discharge, dysuria, itching
f. May progress to prostatitis, epididymitis, and infertility
g. Rx with antibiotics simultaneously
h. THE MOST COMMON STD IN THE US.
Gonorrhea
a. N. gonorrhoeae is a pus forming bacterium
b. Prevalent in the Southeastern U.S.
c. May gain access through the GU tract, eyes, mouth, rectum or skin.
d. S&S 2-5 days post exposure
e. The infection spreads through the effected system. Infant eyes if present during childbirth. This is way babies get ointment in their eyes when they are born.
f. Local S & S of infection
g. Males - *yellow green discharge
h. Females - dysuria, dyspareunia, irregular bleeding with increased bleeding around menses
i. Rectal, pharngeal, urethral, & cervical
j. RX with antibiotics
Syphilis - Treponema pallidum causative organism
a. Spread from contact with syphilitic lesion
b. Three stages
c. More common in MSM (Men who have sex with men)
d. More common in African Americans
Stage I - primary
i. Chancre - painless lesion 10-90 days post exposure
ii. Regional lymphadenopathy
iii. Highly contagious
iv. Chancre heals in 3-12 weeks
Stage II - secondary
i. Systemic dissemination - lesions on skin, mucous membranes, lymph nodes, meninges, stomach and liver
ii. Rash development 2 weeks to 3 months post chancre
iii. Hair loss
iv. Secondary lesions are very contagious
Stage III
i. Granulomas (gummas) form in bone, skin, liver, heart, and brain causing necrosis in those who do not heal or remain asymptomatic.
ii. Delayed response after years of latency and multiplication
iii. CV system
- Aneurysms, valvular insufficiency aortic arteritis
iv. CNS
- Blindness, dementia, ataxia, hearing loss
v. Liver
vi. Bones
vii. Testes
Fluid and Electrolytes
the process of regulating the extracellular fluid volume, body fluid osmolality, and plasma concentrations of electrolytes
intracellular
within the cell
Extracellular
outside the cell
interstitial
pertaining to spaces between cells in a tissue or organ
third space fluid
fluid found in the interstitial tissue space
- Third space is also a term used to refer to, for example, the bowel with an ileus, and the collection of fluid therein, usually post-operatively.
Define the factors that influence the movement of fluid and electrolytes (F&E) and describe how each factor influences the movement of F&E. What increases/decreases the impact of these factors?
Hydrostatic pressure
the pressure created by water. Hydrostatic pressure creates a pushing motion of fluid. Anything that increases the amount of water in a container (cell, vascular space) increases the flow of water out of the container. Hydrostatic pressure is increased by adding water to the vascular space via IV for example.
colloidal
pertaining to a gluelike substance
oncotic pressure
The pressure of water to move, typically into the capillary, as the result of the presence of plasma proteins.
capillary permeability
Ability of substances to diffuse through capillary walls into the tissue spaces.
Diffusion
Movement of molecules from an area of higher concentration to an area of lower concentration.
Osmosis
Diffusion of water through a selectively permeable membrane
Isotonic fluid
Any fluid having the same solute concentration as another fluid to which it is being compared.
- Isotonic solutions have a concentration of dissolved particles similar to plasma, and an osmolality of 250 to 375 mOsm/L.
- Common examples of isotonic solutions are 0.9% normal saline and lactated ringers.
a. What impact does isotonic fluid have on fluid shifts?
Because isotonic solutions have the same concentration of solutes as plasma, infused isotonic solution doesn’t move into cells. Rather, it remains within the extracellular fluid compartment and is distributed between the intravascular and interstitial spaces, thus increasing intravascular volume.
b. What impact does isotonic fluid have on cell size?
If a cell is placed in a hypertonic solution, water will leave the cell, and the cell will shrink. In an isotonic environment, the relative concentrations of solute and water are equal on both sides of the membrane. There is no net water movement, so there is no change in the size of the cell.
Where does isotonic fluid stay?
Because isotonic solutions have the same concentration of solutes as plasma, infused isotonic solution doesn’t move into cells. Rather, it remains within the extracellular fluid compartment and is distributed between the intravascular and interstitial spaces, thus increasing intravascular volume.
Name the isotonic fluids.
-0.9% Saline.
-5% dextrose in water (D5W)**also used as a hypotonic solution after it is administered because the body absorbs the dextrose BUT it is considered isotonic)
-5% Dextrose in 0.225% saline (D5W1/4NS)
-Lactated Ringer’s.
Hypotonic fluids
the #of particles in a solution on one side of a membrane is less than the # of particles in a solution on the other side of the membrane
What impact does hypotonic fluid have on fluid shifts?
When a hypotonic solution is administered intravenously, fluid shifts out of the bloodstream to the area of higher concentration in the interstitial and intracellular spaces.
What impact does hypotonic fluid have on cell size?
It also means that the extracellular fluid has a higher concentration of water in the solution than does the cell. In this situation, water will follow its concentration gradient and enter the cell, causing the cell to expand.
Where does hypotonic fluid have the propensity to go/stay?
A hypotonic solution has a low solute concentration than the inside of the cells (solute concentration in the cell is high). Osmotic forces then cause water from a solution to enter the cells. The cell eventually stretches and bursts in the process becoming lysis.
Name the hypotonic fluids:
Hypotonic: D5W (in the body) 0.25% NaCl. 0.45% NaCl (half normal saline) 2.5% Dextrose.
What impact does hypertonic fluid have on fluid shifts?
Hypertonic solutions such as 3% saline solutions contain higher concentrations of solutes than those found in human serum. Because of this discrepancy in concentration, these fluids are osmotically active and therefore, will cause fluid shifts
What impact does hypertonic fluid have on cell size?
Because the cell has a relatively higher concentration of water, water will leave the cell, and the cell will shrink.
Name the hypertonic fluids:
3% Saline.
5% Saline.
10% Dextrose in Water (D10W)
5% Dextrose in 0.9% Saline.
5% Dextrose in 0.45% saline.
5% Dextrose in Lactated Ringer’s.
Dehydration
A serious reduction in the body’s water content
Dehydration causes
Vomiting and diarrhea
Excessive sweating
Untreated diabetes mellitus
No access to water
Lack of thirst in elderly
Dehydration signs and symptoms
-Weight losses of 6-10 pounds in one week
-Tenting
-Filling or emptying of venous filling more than 6-10 seconds
-Flat veins in supine client
-Tongue is dry
-Sunken eyeballs
-Blood pressure decreased with elevated pulse rate
Appropriate fluid types and specific fluids used for patient with dehydration:
Initial management includes placement of an intravenous or intraosseous line and rapid administration of 20 mL/kg of an isotonic crystalloid (eg, lactated Ringer solution, 0.9% sodium chloride). Additional fluid boluses may be required depending on the severity of the dehydration.
Overload
a condition in which a person feels overly pressured by demands
Overload causes
Heart failure.
Cirrhosis.
Kidney failure.
Nephrotic syndrome.
Premenstrual edema.
Pregnancy.
Overload signs and symptoms
Rapid weight gain.
Noticeable swelling (edema) in your arms, legs and face.
Swelling in your abdomen.
Cramping, headache, and stomach bloating.
Shortness of breath.
High blood pressure.
Heart problems, including congestive heart failure.
Overload fluids used
Crystalloid fluids
Low fluid volume
Hypovolemic shock (hemorrhagic shock, non-hemorrhagic shock)
Signs and Symptoms of Fluid Volume Deficit
Postural hypotension
Weight loss/Dryness
Inelastic skin
Increase pulse and respiration
Renal failure
Dizziness (orthostatic/postural hypotension)
Decreased urination (oliguria)
Dry mouth, dry skin.
Thirst and/or nausea.
Weight loss (except in third spacing, where the fluid will still be in the body but inaccessible)
Muscle weakness and lethargy.
Low fluid volume causes
trauma to vessels or tissues, fluid loss from GI tract (vomiting/diarrhea)
What is the best indicator of fluid status? How should this assessment be conducted?
The elasticity of skin, or turgor, is an indicator of fluid status in most patients (Scales and Pilsworth, 2008). Assessing skin turgor is a quick and simple test performed by pinching a fold of skin. In a well-hydrated person, the skin will immediately fall back to its normal position when released.
How does antidiuretic hormone (ADH) effect fluid balance?
Antidiuretic hormone stimulates water reabsorbtion by stimulating insertion of “water channels” or aquaporins into the membranes of kidney tubules. These channels transport solute-free water through tubular cells and back into blood, leading to a decrease in plasma osmolarity and an increase osmolarity of urine.
How does obesity impact fluid balance?
Also, overweight and obese subjects demonstrated a significantly larger decrease in body mass after exercise than lean controls (P<0.05). Conclusion: Obese subjects demonstrate a larger deviation in markers of fluid and sodium balance than their lean counterparts during prolonged moderate-intensity exercise.
What is the recommended amount of daily fluid intake?
About 15.5 cups (3.7 liters) of fluids for men. About 11.5 cups (2.7 liters) of fluids a day for women
What is the volume to weight equivalent of water?
The density of water is 1 kilogram per liter(kg/L) at 39.2°. This means that 1 liter (L) of water weighs 1 kilogram (kg) and 1 milliliter (mL) of water weighs 1 gram (g).
Define obligatory urine output and what is the amount?
700mL per day, 30 mL per hour
Electrolytes listed below
An ionic compound whose aqueous solution conducts an electric current
Sodium
A. Extracellular
B. Movement: If sodium ions are outside of a cell, they will tend to move into the cell based on both their concentration gradient (the lower concentration of Na +start superscript, plus, end superscript in the cell) and the voltage across the membrane (the more negative charge on the inside of the membrane).
C. A normal blood sodium level is between 135 and 145 milliequivalents per liter (mEq/L).
normal anatomy of the renal system
