Patho Exam 2 Flashcards by justin cole

Metabolic Acidosis

Addition of large amounts of fixed acids to body fluids or loss of HC03.
EG Fasting/starvation
DKA
Lactic Acidosis
Alcoholic KA
Salicylate (aspirin) poisoning

ph below 7.35
HCo3 below 24

Comp: Kussmaul breathing
Decreased Pco2
Acid Rain (Urine)
Increased Rain (Urine) ammonia

Lethargy

How well did you know this?

Not at all

Perfectly

Respiratory Alkalosis

Hyperventilation
Over ventilated (respirator)
Response to acidosis

Increased excitability of nervous

+Chvostek’s, Trousseau’s

Increase P02, rebreath expired air

How well did you know this?

Not at all

Perfectly

Metabolic Alkalosis

Retention of base or removal of acid
Gain bicarbonate, ingestion HC03 (antacid)
Vomiting
Gastric drainage
K+ depletion (diuretics)
Burns
Excessive NaHco3 admin

Increased Excitability

Comp: Decreased rate/depth respirations
Ass. Disorders: Hypokalemia & Fluid volume def

How well did you know this?

Not at all

Perfectly

Respiratory Acidosis

Impaired Ventilation: Depr. central nervous syst
O.D. or Head injury
Disease of airways/lungs
Disorders of Chest wall, resp. muscles

Increased C02 inhalation

Comp: Incr. loss of H+ in the urine

Improve ventilation, mechanically ventilate

How well did you know this?

Not at all

Perfectly

Potassium (K+)

Most abundant cation - Intracellular

How well did you know this?

Not at all

Perfectly

Phosphate (P04)-

Most abundant anion - Intracellular

How well did you know this?

Not at all

Perfectly

Sodium (Na+)

Most abundant cation - Extracellular

How well did you know this?

Not at all

Perfectly

Chloride (CL-)

Most abundant anion - Extracellular

How well did you know this?

Not at all

Perfectly

Hypovolemia

Fluid Loss: diarrhea, vomiting, kidney disease, excercise
Treat: IV, PO fluids
Reduce NG suction

How well did you know this?

Not at all

Perfectly

Hypervolemia

First seen in intravascular- hypertension, fast pulse
Moves interstitial- lung crackles, edema
Moves into cells- swelling, affects metabolism

Water retention –> incr. hydrostatic pressure
kidney failure, CHF, increased ADH secretion, incr aldosterone
Over admin IV
Lymphatic obstruction

How well did you know this?

Not at all

Perfectly

Edema

Diminished plasma proteins:
Malnutrition
Cirrhosis
Hemorrhage
Increased Capillary permeability- protein leak:
Buns
Inflammation

Pleural Effusion
Ascites
Ankle Edema
Hydrothorax

How well did you know this?

Not at all

Perfectly

Edema: Treatment

Diuretics
Fluid restriction
I&O
Measure puffy bits
Skin Care
Hose
No dependent positions
ROM

How well did you know this?

Not at all

Perfectly

Isotonic

Goldilocks “Just Right”
NS (0.9% NaCL)
D5W, LR

How well did you know this?

Not at all

Perfectly

Hypertonic

Too Little Water
D10W
3% NaCL
Draws fluid from the cells

How well did you know this?

Not at all

Perfectly

Hypotonic

Too Much Water
1/2 NS (0.45% NaCL)
Replaces cellular fluid

How well did you know this?

Not at all

Perfectly

Hypernatremia

Inadequate H20 Intake
Profuse Sweating
Diarrhea
Causes cellular dehydration
>147 mEq/L & elevated HCT

Convulsions
Pulmonary Edema
Hypovolemia

How well did you know this?

Not at all

Perfectly

Hyponatremia

Sodium loss (more than water)
Diuretics
GI Losses
Burns
Water Excess
Cellular swelling
<135 mEq/L & low HCT

Lethargy
Headache
Confusion
Seizures
Coma, Nausea, Weakness

How well did you know this?

Not at all

Perfectly

Hyperkalemia

Excess intake - salt substitutes
Decreased loss - renal failure, trauma, insulin deficiency
Shift of K+ into cells - metab. acidosis
S/S: Muscle fatigue/weakness/parlysis
CNS- numbness, tingling
Cardiac effects: Increased depolarization and irritablily

Treat: Underlying cause
Calcium gluconate - changes resting membrane potential/ reduces irritability
Glucose w/ insulin IV

How well did you know this?

Not at all

Perfectly

Hypokalemia

Vomiting
Suctioning
Diarrhea
Diuretics
Following acidosis
S/S:  Fatigue/weakness/anorexia
Constipation
Reduced insulin secretion
Arrythmias
Cardiac effects: Hypoexcitable, repol. delayed

Treat: IV replacement (20 mEq/hr)
Oral replacement
Correct acid/base imbalances

How well did you know this?

Not at all

Perfectly

Hypercalcemia

Ca++ > 12 mg/dl
99% in bone
50% bound to plasma proteins
40% ionized form - most important
8.6 - 10.5 mg/dl
S/S: reduced muscle excitability
fatigue, weakness, lethargy, anorexia
Cardiac effects: Bradycardia
Varying Heart block

Treat w/ phosphate
Underlying cause

How well did you know this?

Not at all

Perfectly

Hypocalcemia

Ca++ < 8.5 mg/dl
Causes: Hypoparathyroidism
Osteoperosis
Blood transfusions
Poor diet
S/S: Increased muscle excitability
Chvostek, Trousseau
Confusion
Convulsions
Tetany
Smooth Muscle: Cramping, hyperactive bowel
Cardiac Muscle: Prolonged ventr. depol.

Treat w/ Calcium Gluconate
Oral Calcium
Decrease phosphate

Hypermagnesemia

Mg++ > 2.5 mg/dl
Causes: renal failure, excessive antacids
Symptoms: N/V, weakness, hypotension
Treat: Dialysis, avoid ingestion

Hypomagnesemia

Mg++ < 1.5 mg/dl
Causes: impaired absorption, increased loss, malnutrition
S/S: Depression, weakness, tetany, convulsions
Treat: IV or IM

Hypoventilation

Respiratory Acidosis

Hyperventilation

Respiratory Alkalosis

Acute Renal Failure

Metabolic Alkalosis (bicarb retention, K+ loss, fluid loss)

DKA

Metabolic Acidosis

pH and C02, pH and HC03

pH: concentration of H+, byproduct of metab. C02: acts as acid by contrib. H+; mixes with H20-->H+ and HCO3 formed HC03: acts as base by accepting H+; reacts with H+--> creates water and C02 C02 + H2O --> H2C03 --> H+ + HCO3 <--

Intracellular

K+ and PO4- most abundant cation/anion. 2/3 total body water, supports organelles

Extracellular

Na+ and CL- most abundant cation/anion. 20% fluid body weight

Interstitial Space

2/3 of fluid, very few proteins. Located between tissues and blood vessels

Intravascular

1/3 of fluid, contains plasma proteins. Hydrostatic pressure pushes water out

Hypothalamus

Osmoreceptors respond to increase in osmolality (decrease in fluid) stimulating release of ADH by posterior pituitary, activates kidneys to retain water

Hyper Medulla Function

Increase release of catecholamines | S/S: increased BP, diaphoresis (sweat) tremor, nervousness

Hypo Medulla Function

Decrease catecholamines | S/S: Weakness, lethargy, decreased BP

Hyper Cortex Function

"Cushing's Syndrome", excessive ACTH | S/S: Central trunk obesity, moon face, mood swings, fragile skin

Hypo Cortex Function

"Addisons", deficiency of cortical hormones | S/S: Hyperpigmentation, anorexia, N/V, abd pain, diarrhea, trembling, fluid/electrol. imbalance

PNS Stimulation

HR and BP subside, Breed and Feed, stimulates GI/Bladder

SNS Stimulation

HR and BP increase, dry mouth, sweaty hands, GI decrease

Metaplasia

Replacement of one cell by another

Hyperplasia

Increased number of cells

Dysplasia

Abnormal changes shape, size, org.

Atrophy

Decrease cell size

Hyperkalemia: Electrical Implications

``` Increased depolarization/irritability Decreases repolarization-->arrest Decreased R wave amplitude Tall peaked T wave Depressed ST segment ```

Hypokalemia: Electrical Implications

``` Hypoexcitability Ventricular repolarization delayed AV blocks Depressed ST segment Prominent U waves ```

Norm. Electrolyte Lab Values

``` K= 3.5-5.5 mEq/L Na= 135-147 mEq/L Ca= 8.6-10.5 mg/dl Mg= 1.5-2.5 mg/dl P04= 2.5-4.5 mg/dl ```

Primary Wound Healing

Surgical "clean" incision

Secondary Wound Healing

Infected wound, healed by granulation

Tertiary Wound Healing

Delay between injury and wound closure, gross infection

DKA Lab Imbalances

Metabolic acidosis= pH below 7.35, CO2 below 35, HCO3 below 22. Insulin not available to control BG levels, body starts using fatty acids which creates ketones, who lower pH. Bicarb buffer depletes quickly, resp compensation (Kussmaul breathing) Excess glucose spills into urine, osmotic diuresis