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PATHO EXAM 2
electrolyte
194
Physiology
Undergraduate 3
02/06/2012

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Term
4 things involved in electrolyte balance
Definition
NA, K, Ca, Mg
Term
four processes of electrolytes that maintain
Definition
electrolytes we take in, absorbed, distrbuted and how they're excreted
Term
routes that electrolytes are brought into body
Definition
food, drinks, medications-antacids, iv fluids-Na, K, donated blood
Term
some of the factors that effect absorption of electrolytes
Definition
binding proteins, food in your gut, medications, partial intestinal removal
Term
K is dependent on what in order to be absorbed?
Definition
concentration gradients
Term
how are electrolytes excreted?
Definition
urine, feces, sweat- feces type can effect electrolyte loss, diarrhea- K loss, undigested fat can prevent absorption and gets lost in feces, sweating results in loss of Na.
Term
what are some abnormal routes of loss from the body
Definition
blood loss, vomiting, wound drainage, patients on hemodialysis
Term
Sodium acounts for how much of extracellular electrolytes?
Definition
90%
Term
Sodium..
Definition
regulates osmotic forces and water balance, works with K and Ca for normal conduction of nerve impulses, as well as acid based balance. 130-145 milli equivalents
Term
Potassium is a major...
Definition
intracellular electrolyte, normal level- 3.5-5.0 meql
Term
what is K important for?
Definition
maintenance of cardiac rhythms, skeletal smooth muscle contraction
Term
what is "tilting" your patient?
Definition
take bp while laying down, and sitting up.. see if there's a major difference- postural hypotension
Term
****Chloride normal levels?
Definition
Term
phopshorous normal level???***
Definition
Term
What are the two major fluid compartments of the body?
Definition
ICF and ECF
Term
what is third spacing?
Definition
fluid trapped in one of several possible intracellular spaces. ex: pleural effusion, it is considered fluid loss
Term
what is ascites
Definition
a result of liver damage, and increased pressure. sodium and water is retained therefore an increase in fluids of vascular system. also results in albumin dysfunction.
Term
fluid loss is regulated by...
Definition
the kidneys
Term
the osmoreceptors in the hypothalamus detect...
Definition
a decrease in the osmolarity of the fluids in the body, ADH
Term
the kidneys do two things...
Definition
help control osmolarity and they also control volume.
Term
ADH controls..
Definition
water reabsoption in the kidneys, the more ADH released, the more that is absorbed or retained by the kidneys
Term
there is constant exchange between...
Definition
EXF and ICF, results in normal fluid balance.
Term
the heart beat..
Definition
forces fluid and solutes out of the capillaries through capillary filtration pressure
Term
capillary osmoidal pressure..
Definition
fluids are drawn back into the capillaries
Term
osmosis is..
Definition
the movement of water from lower concentration to a greated concentration of solutes, electrolytes
Term
what is osmolarity?
Definition
osmotic pressure of a fluid is determined by its osmolarity
Term
what plays a key role in osmolarity?
Definition
ALBUMIN
Term
obligatory urine output...
Definition
300-500 ml/24 hour. hourly output may need to be assessed
Term
also lose fluid through..
Definition
skin and lungs
Term
what are some signs of fluid deficits?
Definition
BP decrease with heart rate increase, a depressed fontanel in babies, decreased urine output, dry skin and mucous membranes, turgor
Term
two tests to assess fluid balance
Definition
hematocrit and urine specific gravity
Term
specific gravity of urine is...
Definition
measures density of urine, compared to the density of water, a low SG is seen in dilute urine, a concrentrated form has high SG
Term
what are the ranges of a normal urine SG
Definition
1.010- 1.025
Term
what defines fluid volume excess?
Definition
increased blood pressure, strong bounding pusle, possible shortness of breath, jugular venous distention, and acute weight gain
Term
two other factors in fluid balance...
Definition
aldosterone, and renin-aldosterone system
Term
aldosterone...
Definition
causes kidneys to reabsorb sodium
Term
renin is released...
Definition
when BP drops
Term
if sodium is too low...
Definition
cells will swell
Term
if sodium is too high...
Definition
cells will shrink
Term
nausea, vomiting, intestinal cramps...
Definition
fast bowels, hyperactive bowels= hyperkalemia.
Term
kidneys exchange..
Definition
potassium for sodium
Term
peaked t waves can be seen in...
Definition
what you see in hyperkalemia ****
Term
calcium has a huge effect on the... (initially)
Definition
smooth muscle in the bowels. too much slows everything down.
Term
if anything stops the constant good flow...
Definition
the kidney gets mad, and the bladder will get infected. "wash out phenomenon"
Term
E. coli is really good at..
Definition
gripping cells of bladder wall
Term
three bacteria involved in UTI
Definition
E. Coli, staph, enterobacter
Term
what is a urethrovesical reflux?
Definition
urine from the uretha is drawn back in the bladder due to increase in intradabominal pressure from coughing/sneezing
Term
vesicoureteral reflux is..
Definition
urine from the bladder moves into the ureters due to defects of the URETER,
Term
number one nosocomial infection..
Definition
UTi's caused by urinary catheters
Term
acute pyelonephritis is...
Definition
infection of the kidney, can be caused by toxemia, block in ureters, etc. responds well to 10-14 days of organizm specific antibiotic therapy. much less severe than cystitis.
Term
chronic pyelonephritis...
Definition
persistent or recurrent infection of the kidney associated with inflammation..could be symptomless, can lead to renal failure
Term
what is glomerulonephritis?
Definition
inflammation of glomerlar structures, globs of antibodies reacting with fixed glomerular antigens, or injury resulting from ciruclating antigen-antibody complexes
Term
a classical case of glomerulonephritis can follow a..
Definition
strep infection after 7-12 dys.
Term
symptoms of glomerulonephritis..
Definition
no bacteria, oliguria, proteinuria, and cola colored due to loss of RBCs, edema of face and hands, and HTN; treat with antibiotics
Term
Acute renal failure can be reversed..
Definition
if you quickly reverse the cause, no permanent damage may be done.
Term
what is pre-renal, interrenal, postrenal
Definition
pre- something that happened before the kidney (sig blood loss), inter- the problem is in the actual kidney- caused by a block that prevents blood flow, post renal is any kind of blockage from flow of kidney to urethra (swollen prostrate)
Term
renal stones are..
Definition
Renal calliculi
Term
risk factors of renal stones
Definition
dehydration, sedentary lifestyles, off on calcium, mg, amon, uric acid, and cystine ions
Term
food high in oxalate...
Definition
spinach, swiss chard, cocoa, chocolate, pecans, and peanuts
Term
what is gfr?
Definition
glomerular filtration rate.. 15 is BAD, need a new kidney or be on dialysis.. 15 ml of blood per minute.
Term
ESRD is...
Definition
15 ml per minute, normally >120
Term
impaired phosphate excretion can result in..
Definition
Chronic renal failure and less calcium
Term
main function of kindey..
Definition
maintain how much water and sodium is in the body.
Term
too much water in the body results in..
Definition
edema and hypertension
Term
started with asthma slide
Definition
Term
asthma is..
Definition
airway inflammation
Term
asthma can be triggered by..
Definition
allergens pollutants, etc.
Term
what is extrinsic asthma..
Definition
Atopic, child onset, hay fever, acute phase response- 10-20 minutes release of chemical mediators, bronchospasm and edema, late phase response- 4-8 hrs inflammation
Term
what is intrisic asthma..
Definition
respiratory infections, exercise induced asthma, medication, chemical exposure, and GE reflux. occurs within the 3 minutes, resolves within hour.
Term
asthma is caused by two things..
Definition
inappropriate immune response, and neural response
Term
what are the two main goals for cotnrolling asthma?
Definition
prevention and control of triggers, medications
Term
COPD
Definition
can be caused by airway obsturction of major and small airways, 90% of cases due to ciggy smoking
Term
chronic bronchitiis..
Definition
blue bloater, hypersecretion of bronchial mucus, chronic/recurrent productive cough, decreased Pa02, increased PCO2, polycthemia
Term
people with chronic bronchitis may be..
Definition
barrel chested
Term
Emphysema is a chronic disease at the..
Definition
alveolar level, the walls of the alveoli are destroyed
Term
patients with emphysema have difficulty..
Definition
breathing out. so air becomes trapped in the alveoli
Term
ppl with emphysema exhibit,
Definition
pink puffers, dyspnea on exertion, sputum is mucoid, fatigue and insomnia, pursed lip breathing, decreased breath sounds, barrel chest, thin body fluid
Term
atelectasis is..
Definition
an incomplete expansion of the lung or portion of a lung.
Term
signs of atelectasis..
Definition
tachynpea, tachycardia, dyspnea, cyanosis, hypoxemia, decreased chest expansion, absent breaht sounds, intercostal retraction.
Term
the pleural cavity
Definition
double layer membrane that covers the lungs
Term
penumothorax
Definition
definition- presence of air within the pleural space resulting in partial or complete collapse of the lung
Term
start with cardiac output slide
Definition
Term
how much blood the heart pumps with each beat. a function of preload, afterload, and cardiac contractility
Definition
stroke volume
Term
the amount of volume coming back to the heart from the body
Definition
preload, goes the right atrium
Term
end of cycle, the resistance in the aortic valve in order to pump out blood, the resistance.
Definition
afterload
Term
manifestations of CHF..
Definition
Physiologic effects of the impaired pumping ability of the heart
Decreased renal blood flow
Activation of the sympathetic compensatory mechanisms
Term
causes of heart failure
Definition
Coronary Artery Disease
Cardiomyopathy
Myocardial infarction
Valvular heart disease
Term
symptoms of heart failure..
Definition
Respiratory Manifestations
Fatigue, Weakness, & Mental Confusion
Fluid Retention and Edema
Cachexia and Malnutrition, Cyanosis, Arrhythmias and Sudden Cardiac Death
Term
right heart failure means..
Definition
blood is not being pumped effectively, so it backs up to the right atrium, and out to the body.
Term
right heart failure effects..
Definition
congestions of peripheral tissues, liver congestion/ascites, Gi tract congestion, anorexia, gi distress, weight loss
Term
left heart failure means..
Definition
blood backs up into lungs, pulmonary congestion, they are essentially drowning
Term
left hear failure effects
Definition
decreased tissue perfusion, impaired gas exchange, pulmonary edema, orthopnea, cyanosis, frothy sputum
Term
respiratory manifestations in CHF
Definition
dyspnea (speaking) (exertional), orthopnea, paroxysmal nocturnal dyspnea
Term
diagnostics for CHF
Definition
phy exam, EKG, ECHO, plasma BNP levels
Term
Plasma BNP?
Definition
brain natriuretic peptide, elevated in heart failure
Term
sodium levels
Definition
135-145
Term
potassium levels
Definition
3.5-5
Term
calcium levels (serum)
Definition
8.0-10.5
Term
calcium levels (ionized)
Definition
4.5-5.0
Term
albumin levels
Definition
3.4-4.7
Term
hematocrit levels
Definition
men- 40-50%, women- 37-47%
Term
Urine specific gravity
Definition
1.010-1.025
Term
two other important electrolytes used in clinical setting
Definition
chloride and Phosphorous
Term
symtoms of hypokalemia
Definition
decreased USG, abdominal distention, constipation, low bowel sounds, hypotension, muscle weakness, paralysis, heart dysrhthmias
Term
hypokalemia is caused by...
Definition
anorexia, NPO, unbalanced diet, K wasting diuretics, diarreha, emesis, GI suction
Term
hyponatremia is caused by..
Definition
excessive ADH, GI losses, hypotonic solution, tap water enemas, excessive water
Term
hyponatermia symptoms..
Definition
muscle cramping and weakness, abdominal cramps, headache confusion, lethargy seizures h
Term
hypernatremia causes
Definition
tube feeding, watery diarrhea, hypertonic IV, salt tablets, food intake>fluid intake,
Term
symptoms of hypernatremia
Definition
thrist, oliguria, decreased turgor, headache, agitation, decreased reflexes, seizures
Term
causes of hyperkalemia
Definition
decreased renal function, K fluid, too much, crushing injury, K sparing diuretics, excessive oral ingestion
Term
symptoms of hyperkalemia
Definition
nausea, vomiting, intestinal cramps, diarrhea, heart dysrhthmias, cardiac conduction affected. muscle weakness, decreased neuromuscular excitability.
Term
hypocalcemia causes
Definition
low Vit D, pancreatitis, steatorrhea, chronic diarrhea, hypoparaythyroidism
Term
hypocalcemia symptoms
Definition
neuromuscular irritability, paresthesias, muscle cramping, hyperactive reflexes, tetany, hypotension, cardiac dysrythmias
Term
hypercalcemia causes
Definition
vitamin D overconsumption, hyperparathyroidism, bone tumors
Term
symptoms of hypercalcemia
Definition
anorexia, nausea, emesis, constipation, fatigue, muscle weakness, decreased neuro , headache, stupor, dysrhtmias/venricular
Term
hypomagnesemia causes
Definition
malabsorption, chronic alcoholism, diuretic therapy, hyperparathyroidism, diabetic ketoacidosis, pancreatitis
Term
symptoms of hypomagnesemia..
Definition
tetany, personality changes, nystagmus, choreiform movements, trousseau signs, + babinski
Term
causes of hypermagnesemia..
Definition
excessive IV magnesium fluids, excessive antacids, kidney disease
Term
symptoms of hypermagnesemia
Definition
lethargy, hyporeflexia, confusion, drowsiness, coma, hypotension, respiratory depression, cardiac arrhthmias, cardiac arrest
Term
perfusion?
Definition
pumping a liquid into an organ or tissue (especially by way of blood vessels).
Term
hypercapnia?
Definition
the physical condition of having the presence of an abnormally high level of carbon dioxide in the circulating blood.
Term
lactic acidosis
Definition
low PH with excessive amount of lactate, distinct form of metabolic acidosis
Term
polycythemia/erythrocytosis
Definition
Polycythemia is a disease state in which the proportion of blood volume that is occupied by red blood cells increases...
Term
symptoms of hypoxemia
Definition
heart rate and BP elevates, changes in mental status, hyperventilation, possible cyanosis
Term
causes of hyperpcapnia
Definition
hypoventilation, increased metabolic rate
Term
effects of hypercapnia
Definition
decreased PH, respiratory acidosis, effects kidneys and heart
Term
normal diffusion requires what?
Definition
normal alveoli function, adequate amounts of blood present in the pulmonary circulation to perfuse the alveolar capillaries
Term
ventilation perfusion mismatch
Definition
problems that affect either delivery, oxygen to the alveoli or blood to the alvelolar capillaries
Term
what are some pulmonary diseases?
Definition
obstructive diseases- disorders that limit expiratory airflow.. ex: asthma, COPD, chronic bronchitis, emphysema
Term
disorders of lung inflation
Definition
atelectasis, pneumothorax
Term
spontaneous pneumothorax...
Definition
due to a rupture of a bleb on the surface of the lung, associated with tall young males and heavy smoking
Term
traumatic pneumothorax
Definition
due to injuries, penetrating or not
Term
tension pneuomothorax
Definition
intrapleural pressure exceeds atmospheric pressure, life threatening
Term
signs of pneumothorax...
Definition
increased resp rate, dyspnea, decreased/absent breath sounds on affected sides, increased heart rate, hypoxemia, assymetrical breathing
Term
mediastinal shift can be seen in..
Definition
pneumothorax
Term
pneumonia causes..
Definition
alveolar air spaces to fill with exudate, hypoxemia results due to poor oxygenation, exudate becomes consolidated, difficult to cough up
Term
CAP
Definition
individual has not been in a long term facility within 14 days prior to admission
Term
common CAP culrpits..
Definition
s.pneuomonia, s. aureus, mycoplasma pnemomonia, and chlamydia , viral -influenza
Term
HAP causes..
Definition
occurs 48 hrs or longer after admission, lower RTI, difficult to treat due to resistance to antibiotics
Term
4 stages of Pneumococcal pneuomonia
Definition
edema, red hepatization, gray hepatization, resolution
Term
normal ph
Definition
7.35-7.45
Term
normal pCO2
Definition
35-45 mmhg ventilation
Term
normal HCO3
Definition
22-26 buffer
Term
normal p02
Definition
80-100 mmhg oxygenation
Term
high cholesterol...
Definition
>240
Term
high LDL
Definition
160-189
Term
high triglycerides?
Definition
200-499
Term
high HDL ?
Definition
>60
Term
LDL is the..
Definition
bad cholesterol
Term
HDL's carry..
Definition
cholesterol away from blood vessels, remove excess cholesterol and plaque found in blood vessels
Term
stable plaque..
Definition
obstructs blood flow to heart muscle,
Term
unstable plaque..
Definition
can rupture which results in platelet adhesion and thrombus within the coronary artery, can lead to MI
Term
CAD
Definition
disease of the vessels that carry oxygen to the heart
Term
stable angina =
Definition
fixed coronary obstruction
Term
myocardial ischemia..
Definition
inability to supply adequate amounts of blood to the cardiac tissue, most commonly due to atherosclerosis and vasospasm
Term
frank starling mechanism..
Definition
stroke volume increases in response to an increase in amount of blood filling the heart
Term
signs of acute arterial occlusion..
Definition
7 p"s, a sharp line of demarcation between oxygenated tissue above the line of obstruction and below the obstruction
Term
third leading cause of death..
Definition
stroke, 700,000, 20% die
Term
ischemic strokes?
Definition
thrombotic strokes, result from inadequate blood flow to the brain from partial or complete occlusion of an artery
Term
thrombotic strokes?
Definition
commonly occurs where arthrosclerotic plaques have already narrowed the blood vessel
Term
TSI
Definition
transient ischemic attack, all stroke symptoms but just temporary, less than 24 hours
Term
hemorrhagic strokes?
Definition
usually due to a rupture of a vessel, bleeding in brain tissue
Term
symptoms of hemorrhagic strokes..
Definition
neuro deficits, headache, n/v, decreased consciousness (LOC)
Term
CVA's affect,
Definition
motor, communication, intellectual functions, emotions, spatial-perceptual alterations
Term
emboli(s)??
Definition
thrombus, fat or air embolus, amniotic fluid
Term
lethal PE's usually originate from..
Definition
femoral or iliac veins, most arise from thrombi in the deep veins of legs
Term
other places where PE's arise..
Definition
right side of heart (a-fib), pelvic veins (after chidlbirth or surgery)
Term
PE complications
Definition
venitlation/perfusion mismatch, pulmonary infarction
Term
PE manifestations
Definition
depends on size of embolus, anxiety dyspnea, tachnypea, tachycardia, cough, crackles, sudden change in mental status-- hypoexemia
Term
V-Q scan
Definition
IV injection of a radioisoptope, a scanning device, detects the adequacy of pulmonary circulation
Term
Spiral CT
Definition
allows for visualization of entire lung tissue
Term
drug therapy for PE
Definition
heparin, warfarin, tPA
Term
PTT
Definition
partial thromboplastin time
Term
INR
Definition
international normalized ratio, scale
Term
what is shock?
Definition
syndrome results in hypoperfusion of blood and oxygen, resulting in cellular hypoxia and cell death
Term
what system assists with CV balance?
Definition
renin-angiotensin system
Term
types of low blood flow shock
Definition
hypovolemic and cardiogenic
Term
hypovolemic shock...
Definition
severe trauma with massive blood loss, loss of plasma (burns), severe dehyrdation
Term
cardiogenic shock..
Definition
acute MI, cardiac surgery, arrhythmias
Term
anaphylactic shock caused by..
Definition
maldistribution of blood flow
Term
absolute hypovolemia..
Definition
fluid loss through hemorrhage, GI loss, diabetes insipidus, or diuresis
Term
relative hypovolemia..
Definition
fluid moves out of vascular spaces into the extravascular space- 3rd spacing
Term
symptoms of hypovolemic shock..
Definition
10-25% blood loss- SNS response- increased heart rate, vasoconstriction. 35-45&- diminished cardiac output and arterial pressure
Term
SNS compensatory mechanisms of hypovolemic shock
Definition
SNS- increased heart rate, cardiac contractility, vasoconstriction, and increased venous return
Term
Renin angiotensin aldosterone compensatory mechanism for hypovolemic shock..
Definition
increased sodium absorption by the kidneys
Term
antidiuretic hormone compensatory mechanism for hypovolemic shock..
Definition
constricts peripheral arteries, veins, and increases water retention
Term
late stages of hypovolemic shock..
Definition
vasoconstriction of the skin, muscles, kidneys, abdominal organs
Term
treatment of hypovolemic shock..
Definition
correct the cause (surgery), volume replacement, increase oxygenation, monitor hemodynamics
Term
cardiogenic shock
Definition
occurs when the heart fails to pump sufficiently to meet needs of the body's demands
Term
cardiogenic shock is commonly caused by..
Definition
myocardial infarction (left ventricle)
Term
symptoms of cardio shock
Definition
decreased CO, hypotension, peripheral hypoperfusion- cyanosis, pallor, cool/clammy skin, decreased urine output, decreased mentation
Term
treatment for cardiogenic shock.
Definition
decrease O2 demand, increase 02 delivery by providing supplemental, careful fluid managemnt, use of vasodialotrs, diuresis to optimize fluid status
Term
anaphylactic shock results in
Definition
massive vasodilation, release of vasoactive mediators, increased capillary permeability
Term
symptoms of anaphylactic shock..
Definition
abdominal cramps, sudden hypotension, sudden chest pain tightness, swelling of lips and tongue, airway obstruction, wheezing, stridor, skin changes, panic anxiety confusion
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