NUR 242 EXAM 3 LATEST ACTUAL EXAM 180
QUESTIONS AND CORRECT DETAILED ANSWERS
WITH RATIONALES ALREADY GRADED A+ GALEN
COLLEGE OF NURSING
What is ventilation? - ANSWER>>the movement of air into and out of the lungs
What is perfusion? - ANSWER>>the circulation of blood through the lungs
What are central chemoreceptors responsive to? - ANSWER>>increased H+ in the brain ECF; increased PaCO2; "hypercarbic drive"
What are peripheral chemoreceptors responsive to? - ANSWER>>decreased pH; increased PaCO2; decreased PaO2; "hypoxic drive"
What are elastic forces? - ANSWER>>lungs recoil due to elastin, collagen, fibrin
What are surface forces? - ANSWER>>surface tension due to water-air interface
What is airway resistance? - ANSWER>>opposition to flow caused by the forces of friction; primarily determined by airway radius
What is the distensibility of the lungs? - ANSWER>>ease with which the lungs can be inflated
What is lung distensibility increased in? - ANSWER>>neonates and children; emphysema
What is lung distensibility decreased in? - ANSWER>>elderly; pneumonia, pulmonary edema, ARDS, atelectasis, fibrosis
What is surfactant? - ANSWER>>complex substance lining the alveoli and smallest bronchioles containing phospholipids and a number of apoproteins which reduces surface tension throughout the lungs, thereby contributing to its general compliance; stabilizes the alveoli and keeps them dry
What produces surfactant? - ANSWER>>produced by the Type II alveolar cells
What is Ohm's law? - ANSWER>>velocity = driving force/resistance
What is Poiseuille law? - ANSWER>>resistance = (8 x viscosity x length) / (pi x radius^4)
What happens if the radius in the lungs goes down? - ANSWER>>the resistance goes up
How is the ventilation distributed in the lungs? - ANSWER>>the top of the lungs are more distended and less compliant whereas the lower lung is small and highly compliant
What factors affect lung perfusion? - ANSWER>>lung capacitance; low resistance system; flow influenced by gravity; resistance primarily determined by vessel radius
What does hypoxia lead to? - ANSWER>>vasoconstriction of pulmonary vessels
What does prolonged hypoxia lead to? - ANSWER>>pulmonary hypertension
What factors affect alveolar-capillary diffusion? - ANSWER>>capillary permeability; surface area available for diffusion; concentration gradient for the gas; distance for diffusion
What causes right shifts (decreased affinity) in Hemoglobin-O2 affinity? - ANSWER>>acidemia; hyperthermia; hypercarbia
What causes left shifts (increased affinity) in Hemoglobin-O2 affinity? - ANSWER>>alkalemia; hypothermia; hypocarbia
What is hypoxemia? - ANSWER>>deficient blood oxygen; low PaO2; low O2 saturation
What is hypoxia? - ANSWER>>decreased tissue oxygen
What is hypoxic hypoxia? - ANSWER>>decreased tissue oxygen caused by decreased respirations
What is anemic hypoxia? - ANSWER>>decreased tissue oxygen caused by decreased hemoglobin
What is circulatory hypoxia? - ANSWER>>decreased tissue oxygen caused by decreased blood flow
What is histotoxic hypoxia? - ANSWER>>decreased tissue oxygen caused by increased toxic substance
What is ischemia? - ANSWER>>greatly reduced or interrupted flow through the arterial system, producing significant tissue hypoxia
What is hypercapnia? - ANSWER>>increased level of CO2 in the blood
What are S&S of acute hypoxia? - ANSWER>>dyspnea; restlessness; palpitations; agitation; headache; tremors; diaphoresis; respiratory distress; cyanosis; tachypnea; tachycardia; dysrhythmias; hypertension; lethargy; confusion to coma
What are some effects of hypercapnia? - ANSWER>>respiratory acidosis (decreased pH from increase in CO2); lethargy and confusion; increased HR and BP; flushed skin; arrhythmias; seizures; coma; death
What is dyspnea? - ANSWER>>subjective feeling of being SOB
What does dyspnea lead to? - ANSWER>>decreased sense of wellness which may cause psychological and social consequences
What is the leading cause of cancer death? - ANSWER>>lung cancer
What is lung cancer most likely caused by? - ANSWER>>cigarette smoking; asbestos; familial predisposition
What are the manifestations of lung cancer? - ANSWER>>cough, hemoptysis (blood in cough sputum); hoarseness; chest pain; often disseminated (spread widely) at time of diagnosis
What are the types of bronchogenic carcinomas? - ANSWER>>squamous cell lung carcinoma (25-40%); adenocarcinoma (20-40%); small cell carcinoma (20-25%); large cell carcinoma (10-15%)
What is acute airway obstruction caused by? - ANSWER>>foreign body aspiration; laryngospasm (spontaneous spasm of the vocal cords); trauma
What is complete acute airway obstruction? - ANSWER>>inspiratory chest movements but no air movement; tachycardia, cyanosis, rapid progression to unconsciousness
What is partial acute airway obstruction? - ANSWER>>stridor (harsh vibrating noise), wheezing, dyspnea, tachypnea, tachycardia, retractions (chest moving inward)
What are some respiratory disorders in children? - ANSWER>>upper airway infections: viral croup, spasmodic croup, and epiglotitis;
lower airway infections: acute bronchiolitis
What is croup (laryngotracheobronchitis)? - ANSWER>>inflammation of the larynx with a sudden onset; barking cough with stridor
What are the manifestations of viral croup? - ANSWER>>febrile; upper respiratory infection precedes
What are the manifestations of spasmodic croup? - ANSWER>>afebrile; may be allergic
What is epiglotitis? - ANSWER>>bacterial infection of supraglottic structures; high mortality without treatment
What are the clinical manifestations of epiglottitis? - ANSWER>>fever; dyspnea; dysphagia; drooling; refusal to eat; orthopnea; protruding tongue; wheezing; stridor
What is bronchiolitis? - ANSWER>>viral infection of the lower airways often caused by respiratory syncytial virus (RSV); may lead to respiratory failure
What are the clinical manifestations of bronchiolitis? - ANSWER>>breathlessness; rapid and shallow breathing; wheezing; retractions; cyanosis; pallor
What are the common respiratory infections? - ANSWER>>common cold; influenza; pneumonia; tuberculosis; fungal infections of the lung
What is rhinitis? - ANSWER>>inflammation of the nasal mucosa; infective= rhinovirus, common cold; allergic= hay fever
What is sinusitis? - ANSWER>>inflammation of the paranasal or prenasal sinuses
What are some viral infections of the upper respiratory tract? - ANSWER>>rhinoviruses (most common); parainfluenza viruses; respiratory syncytial virus; coronaviruses; adenoviruses
How is the common cold spread? - ANSWER>>fingers; coughing and sneezing; the nasal mucosa and conjunctival surface of the eyes are the most common portals of entry for the virus
What is type A influenza virus? - ANSWER>>most common (the one we get immunized against); can infect multiple species and causes the most severe disease
What are the subtypes of type A influenza virus? - ANSWER>>hemagglutinin (H); neuraminidase (N)
What is type B influenza virus? - ANSWER>>has not been categorized into subtypes and doesn't make people as sick as Type A
What are the clinical manifestations of influenza? - ANSWER>>headache; fever; extreme tiredness; muscle/joint aches; runny/stuffy nose; sore throat; coughing; vomiting (occasionally)
What is pneumonia? - ANSWER>>respiratory disorders involving inflammation of the lung structures (alveoli and bronchioles)
What are two types of pneumonia? - ANSWER>>community acquired; hospital acquired
What are some causes of pneumonia? - ANSWER>>infectious agents: bacterial
(productive cough) and viral (nonproductive cough);
noninfectious agents: gastric secretions aspirated into the lungs
What is lobar pneumonia? - ANSWER>>can infect one lobe of the lung
What is bronchial pneumonia? - ANSWER>>infection of all lobes
What are some clinical manifestations of pneumonia? - ANSWER>>cough; sputum; dyspnea (may be gasping for breath); fever, chills;
severe fatigue; muscle aches
What factors facilitate the development of pneumonia? - ANSWER>>an exceedingly virulent organism; a large inoculum (exposed to a lot of that organism); impaired host defenses (chronic lung disease, HIV, elderly); present in a lot of hospitalized patients
What are the common causes of community acquired pneumonia? - ANSWER>>streptococus pneumoniae; mycoplasma pneumonia; haemophilus influenzae
What is the mortality rate of community acquired pneumonia? - ANSWER>>1-25%
What are the common causes of hospital acquired pneumonia? - ANSWER>>pseudomonas; other gram negative organisms; staphylococcus aureus (MRSA)
What is the mortality rate of hospital acquired pneumonia? - ANSWER>>20-50%
What are the risk factors of hospital acquired pneumonia? - ANSWER>>mechanical ventilation; chronic lung disease; advanced age; ICU; extended hospitalization
What are the stages of pneumococcal pneumonia? - ANSWER>>1) congestion- purulent fluid collecting in alveoli and bronchioles; 2) red hepatization- lungs start to appear like liver tissue (dark red) and consolidation (becomes semi-solid); 3) gray hepatization- lungs turn a grey appearance; 4) resolution- several weeks to months
What are some complications of pneumonia? - ANSWER>>pleurisy- inflammation of the pleural membrane; pleural effusion- fluid in the pleural space, comprises lung space; abscess- pocket of purulent tissue in the lungs; empyema- purulent tissue in the pleural space; meningitis- bacteria gets into bloodstream; endocarditis
What are some diagnostic studies for pneumonia? - ANSWER>>chest x-ray;
sputum culture; ABG's/pulse oximetry; CBC; blood cultures- suspicion of septicemia
What is tuberculosis? - ANSWER>>infection caused by the mycobacterium tuberculosis bacteria; transmitted airborne and spreads from the blood and lymphs to the lungs; the body forms granulomas to try and contain the infection which leads to caseous necrosis and formation of tubercles; may remain dormant for many years
What are the manifestations of tuberculosis? - ANSWER>>latent= asymptomatic; active= cough, fever, night sweats, weight loss, fatigue, anorexia
What are some complications of TB? - ANSWER>>miliary TB (disseminated all over the body); pleural effusion; tuberculosis pneumonia; involvement of other organs (kidneys, liver)
What are some diagnostic studies used for TB? - ANSWER>>tuberculin skin testing; chest x-ray; sputum smear for AFB; sputum culture
What is severe acute respiratory syndrome? - ANSWER>>a severe form of pneumonia caused by a coronavirus; transmitted person-to-person contact, droplets, and touching objects
How long is the incubation period for acute respiratory syndrome? - ANSWER>>4-6 days
What is the mortality rate for acute respiratory syndrome? - ANSWER>>10%
What are the signs and symptoms of acute respiratory syndrome? - ANSWER>>fever; non-productive cough; dyspnea; lymphopenia (WBC count goes down); hypoxemia
What is histoplasmosis? - ANSWER>>a fungal infection transmitted airborne by soil, bird and bat excreta (midwest); often asymptomatic; severe, disseminated disease in immunosuppressed people
What is coccidiomycosis? - ANSWER>>a fungal infection transmitted by soil (southwest); acute respiratory symptoms; skin and joint involvement
What are some neuromuscular disorders affecting respiration? - ANSWER>>poliomyelitis; amyotrophic lateral sclerosis- aggressive paralysis of the muscular neurons; muscular dystrophies; Guillain-Barre syndrome- type of paralysis; myasthenia gravis- destruction of acetylcholine receptors leading to fatigue
What are some chest wall disorders affecting respiration? - ANSWER>>kyphosis- front to back; scoliosis- side; ankylosing spondylitis- infusion of the spinal column bones; flail chest- person was in trauma, group of ribs broken off from the rest; obesity- abdominal contents pushing up on diaphragm leading to respiratory problems
What are the obstructive pulmonary diseases? - ANSWER>>asthma; COPD (emphysema and chronic bronchitis); cystic fibrosis
What are the restrictive pulmonary diseases? - ANSWER>>chest wall (kyphosis); pleural (effusions and pneumothorax); parenchymal (occupational, ARDS-IRDS, atelectasis)
What are the sources of obstructive pulmonary disease? - ANSWER>>conditions in the airway wall; loss of lung parenchyma- lung tissue actually gets damaged and destroyed; airway lumen obstruction- usually mucus
What is asthma? - ANSWER>>bronchial smooth muscle constriction leading to mucosal inflammation and edema and hyper secretion of mucus; increased airway responsiveness to stimuli
What is airway responsiveness? - ANSWER>>the reaction of the airway to various stimuli that leads to narrowing of the airways
What does the movement of gases through the airways depend on? - ANSWER>>the pressure moving the gases; the radius and patency of the airways
What are the functions of bronchial smooth muscle? - ANSWER>>tone of the bronchial smooth muscles determines airway radius; presence or absence of airway secretions influence airway latency;
bronchial smooth muscle is innervated by the autonomic nervous system
What is the role of inflammatory mediators? - ANSWER>>released from mast cells after contact with IgE; increase airway responsiveness by producing bronchospasm, increasing mucus secretion, and producing injury to the mucosal lining of the airways
What occurs in the early phase of asthma? - ANSWER>>starts in 10-20 minutes (wheezing); chemical mediators from mast cells; parasympathetic stimulation
What occurs in the late phase of asthma? - ANSWER>>starts in 4-8 hrs, may last days or weeks; mediators from various immune cells (release more chemical mediators); epithelial injury and edema
What are the genetic factors involved in the pathophysiology of asthma? - ANSWER>>atopy- familial tendency to have allergies
What are the environmental factors involved in the pathophysiology of asthma? - ANSWER>>viruses; allergens; occupational exposure- molds or chemicals
What is the extrinsic form of asthma? - ANSWER>>IgE mediated; childhood onset; history of atopy; family history of asthma; positive skin tests to various allergens
What is the intrinsic form of asthma? - ANSWER>>not IgE mediated; adult onset; no history of atopy; follows repeated respiratory infections; psychological stress; environmental factors; exercise
What are the diagnostic indicators of asthma? - ANSWER>>cough; wheeze; respiratory distress in association with triggers; decreased peak expiratory flow rate (PEFR)- fastest you can blow air out of the lungs
What are the pulmonary function tests for diagnosing asthma? - ANSWER>>responsiveness to bronchodilators (see if it improves)
What are the characteristics of mild asthma? - ANSWER>>symptoms <2x a week; PEFR > 80% of best
What are the characteristics of moderate asthma? - ANSWER>>symptoms >2x a week; PEFR > 60-80%
What are the characteristics of severe asthma? - ANSWER>>continuous symptoms; PEFR <60%; frequent nocturnal symptoms; hospitalizations
What are the factors contributing to an asthmatic attack? - ANSWER>>allergen exposure; respiratory tract infections; exercise; drugs and chemicals; hormonal changes and emotional upsets; airborne pollutants; temperature changes
What is the 4th leading cause of death? - ANSWER>>COPD
What is emphysema? - ANSWER>>enlargement of air spaces and destruction of lung types
What are the types of emphysema? - ANSWER>>centriacinar- bronchioles destroyed; panacinar- alveoli destroyed
What are the causes of emphysema? - ANSWER>>smoking; a1 (antitrypsin) deficiency (made from liver and released in bloodstream --> lungs, protects lungs from neutrophil elastase which is damaging to lung tissue) --> cystic fibrosis; asthma
What is chronic obstructive bronchitis? - ANSWER>>obstruction of small airways
What is the pathophysiology of emphysema? - ANSWER>>hyperinflation of alveoli- more air in than we should; destruction of alveolar walls by proteolytic enzymes (WBCs: neutrophil elastase) from inflammatory cells; loss of airway elasticity; destruction of alveolar capillaries; airway narrowing and collapse
What are the characteristics of pulmonary emphysema? - ANSWER>>smoking history;
age of onset: 40-50 years;
often dramatic barrel chest; weight loss; decreased breath sounds- air is trapped, smaller airways have been destroyed; normal blood gases until late in disease process; cor pulmonale- right sided heart failure due to pulmonary hypertension; slowly debilitating disease; "pink puffer"- not going to get cyanotic because adequate oxygen is able to enter the capillaries; mild hypoxemia, no hypercarbia; few secretions
What are common ABG results of emphysema? - ANSWER>>pO2- 80; O2 sat- 91% (low); pCO2- 33 (low)- breathing rapid and deeply to get more oxygen in
HCO3- 25
pH- 7.46 (high)
What is the pathophysiology of chronic bronchitis? - ANSWER>>hyperplasia of mucous-secreting glands; disappearance of cilia; chronic inflammation, narrowing and scaring of airways; altered function of alveolar macrophages (damaged by cigarette smoking)
What are the characteristics of chronic bronchitis? - ANSWER>>smoking history;
age of onset: 30-40 years;
barrel chest may be present; SOB predominant early symptom; rhonchi often present; sputum frequent early manifestation; "blue bloaters"; often dramatic cyanosis; hypercapnia and hypoxemia may be present early; frequent cor pulmonale and polycythemia; numerous life threatening episodes due to acute exacerbations; obese
What are the signs and symptoms of hypercapnia? - ANSWER>>increased PCO2; headache; confusion; flushed skin; increasing sedation causing lethargy; tachycardia; diaphoresis; mild to moderate increase one blood pressure
What are some common ABG results of chronic bronchitis? - ANSWER>>pO2- 76 (low); O2 sat- 86% (low); pCO2- 54 (high)- acidosis (usually stop responding to high CO2 level; need low oxygen to stimulate breathing so when in a hospital and they are given too much oxygen they can stop breathing); HCO3- 32 (compensation) pH- 7.33 (acidic)
What is cor pulmonale? - ANSWER>>right sided heart failure resulting from primary lung disease and long-standing primary or secondary pulmonary hypertension; involves hypertrophy and the eventual failure of the right ventricle
What are the manifestations of cor pulmonale? - ANSWER>>S&S of the primary lung disease and the signs of right-sided heart failure
What are some diagnostic studies of COPD? - ANSWER>>chest x-ray; pulmonary function tests; sputum culture- if chronic bronchitis; ABG's/pulmonary oximetry; ECG, echocardiogram; H&H- hemoglobin and hematocrit
What is cystic fibrosis? - ANSWER>>an autosomal recessive disorder involving fluid secretion in the exocrine glands, the epithelial lining of the respiratory, gastrointestinal and reproductive tracts
What is the cause of cystic fibrosis? - ANSWER>>mutations in a single gene on the long arm of chromosome 7 that encodes for the cystic fibrosis transmembrane regulator (CFTR), which functions as a chloride (Cl-) channel in epithelial cell
What are the manifestations of cystic fibrosis? - ANSWER>>thick, tenacious mucus; recurrent pulmonary infections; cor pulmonale; pancreatic exocrine (digestive enzymes) deficiency; pancreatitis; excessive loss of sodium in the sweat; sinus infections; cholelithiasis (gallstones)
What is diffuse interstitial lung disease? - ANSWER>>a diverse group of lung disorders that produce similar inflammatory and fibrotic changes in the interstitium or inter alveolar septa of the lung
What are the types of diffuse interstitial lung disease? - ANSWER>>sarcoidosis;
the occupational lung diseases (asbestosis, pneumoconiosis, silicosis, pneumonitis, etc); hypersensitivity pneumonitis; lung disease caused by exposure to toxic drugs
What is sarcoidosis? - ANSWER>>a disease of unknown origin characterized by the formation of granulomatous lesions that appear especially in the lungs, liver, skin, and lymph nodes
What is the cause of sarcoidosis? - ANSWER>>probably immune or autoimmune
What are the S&S of sarcoidosis? - ANSWER>>may have no S&S; malaise; fever; dyspnea; dry cough
What is pneumoconiosis? - ANSWER>>occupational or "dust" diseases; black lung (coal); silicosis (silicon); asbestosis and mesothelioma; inert particles are walled off by immune cells that lay down fibrin; fibrosis- stiff lung; barrier to diffusion
What are the causes of disorders of lung inflation? - ANSWER>>conditions that produce lung compression or lung collapse; collapse of a segment of the lung as in atelectasis; compression of the lung by an accumulation of fluid in the intrapleural space; complete collapse of an entire lung as in pneumothorax
What is atelectasis? - ANSWER>>the incomplete expansion of a lung or portion of a lung; most common post-operative complication
What are the causes of atelectasis? - ANSWER>>airway obstruction; lung compression such as occurs in pneumothorax or pleural effusion; increased recoil of the lung due to loss of pulmonary surfactant
What is pleural effusion? - ANSWER>>an abnormal collection of fluid in the pleural cavity
What are the S&S of pleural effusion? - ANSWER>>dyspnea; pleuritic pain; dry cough; decreased breath sounds
What are the characteristics of pleural pain? - ANSWER>>unilateral, localized to lower and lateral part of the chest; may be referred to the shoulder; usually made worse by chest movements; tidal volumes are kept small; breathing becomes more rapid; reflex splinting of the chest may occur
How do you diagnose pleural effusion? - ANSWER>>chest radiographs; chest ultrasound; computed tomography (CT)
How do you treat pleural effusion? - ANSWER>>thoracentesis; injection of a sclerosing agent into the pleural cavity; open surgical drainage
What is pneumothorax? - ANSWER>>a collection of air or gas in the pleural space of the lung, causing the lung to collapse
What are the S&S of pneumothorax? - ANSWER>>dyspnea; chest pain on affected side; tachycardia; decreased or absent breath sounds; tracheal shift if severe
What is spontaneous pneumothorax? - ANSWER>>occurs when an air-filled blister on the lung surface ruptures (emphysema)
What is traumatic pneumothorax? - ANSWER>>caused by penetrating or non- penetrating injuries
What is tension pneumothorax? - ANSWER>>occurs when the intrapleural pressure exceeds atmospheric pressure
What is pulmonary hypertension? - ANSWER>>pulmonary arterial pressure > 30 mmHg (normal = 25/8)
What are the types of pulmonary hypertension? - ANSWER>>primary (idiopathic)-rare; secondary
What are the characteristics of pulmonary hypertension? - ANSWER>>usually in women age 30-40; rapidly progressive; poor long-term prognosis
What are the causes of secondary pulmonary hypertension? - ANSWER>>increased pulmonary vascular resistance (vasoconstriction, obstruction, destruction); increased left atrial pressure; increased pulmonary blood flow; increased blood viscosity
What are the S&S of secondary pulmonary hypertension? - ANSWER>>dyspnea and profound fatigue; peripheral edema; ascites; signs of right heart failure (for pulmonale)
How does a pulmonary embolism develop? - ANSWER>>a blood-borne substance lodges in a branch of the pulmonary artery and obstructs the flow
What are the types of pulmonary embolism? - ANSWER>>thrombus- venous blood clot; fat- mobilized from the bone marrow after a fracture; amniotic fluid- enters the maternal circulation after rupture of the membranes at the time of delivery; air
What are the manifestations of pulmonary embolism? - ANSWER>>sudden onset of dyspnea and tachypnea; sudden onset of anxiety; sudden onset of flank or side pain; cough; hemoptysis (blood tinged sputum); cyanosis
What is pulmonary edema? - ANSWER>>accumulation of fluid in the interstitium and alveoli of the lungs; most commonly caused by left heart failure
What does fluid in alveoli cause? - ANSWER>>lung stiffness; difficult expansion; impaired gas exchange
What are the S&S of pulmonary edema? - ANSWER>>severe dyspnea and air hunger (gasping for air); cough productivity of frothy, blood tinged sputum; tachypnea and tachycardia; cold, clammy skin; cyanosis; extreme apprehension; confusion, stupor
What is acute respiratory distress syndrome? - ANSWER>>disorder caused by disseminated pulmonary inflammation and leads to profound hypoxemia and increased work of breathing
What is the cause of acute respiratory distress syndrome (ARDS)? - ANSWER>>shock; major trauma (with or without fat emboli); sepsis secondary to pulmonary or nonpulmonary infections; acute pancreatitis; hematologic disorders; aspiration; reactions to drugs and toxins; inhalation of toxins
What is the pathology of ARDS? - ANSWER>>diffuse epithelial cell injury; increased permeability of alveolar- capillary membrane; fluid collects in interstitium and alveoli; surfactant (helps inflate the alveoli) inactivation (caused by increased fluid); hyaline membrane formation (collection of sloughed off cells and tissue); increased work of breathing; intrapulmonary shunting of blood (constriction of vessels in damaged parts of the lungs to create more oxygen to the healthy part of the lungs); impaired gas exchange
What are the manifestations of ARDS? - ANSWER>>profound hypoxia- PO2 may be in 30s or 40s; tachypnea; severe dyspnea; hypotension- has to do with shunting of the blood; hypercapnia; acidosis- can't get rid of CO2; multiple organ failure; mortality- 30-60%
What is acute respiratory failure? - ANSWER>>state of disturbed gas exchange; PaO2 < 60 mmHg and PaCO2 > 50 mmHg; may involve hypoxemia, hypercapnia; high mortality rate- 30-50%
What are the causes of acute respiratory failure? - ANSWER>>emphysema; pneumonia; asthma; CNS disorders; shock neuromuscular disorders; trauma
What are the manifestations of acute respiratory failure? - ANSWER>>confusion, decreased LOC; tachypnea, tachycardia; tremors; hypotension; cyanosis, retractions, dysrhythmias, cool/clammy skin
What are the functions of water in the body? - ANSWER>>nutrient and waste transport in blood; skin structure and resilience; digestion; temperature maintenance- sweat cools down body; lubrication of joints and membranes; chemical reactions; IgA (helps to protect eyes, throat, mouth from infection) function
What is the total body water composition in adults? - ANSWER>>total = 60% of body weight; 2/3 (40%) intracellular- in the cells; 1/3 (20%) extracellular
What is the composition of extracellular fluid? - ANSWER>>total = 20%; 14%- interstitial (space between the cells and blood vessels); 5%- plasma; 1%- other
What is the composition of the ECF, plasma, and interstitial fluids? - ANSWER>>large amounts of sodium and chloride; moderate amounts of bicarbonate; small quantities of potassium, magnesium, calcium, and phosphorus
What is the composition of the ICF? - ANSWER>>almost no calcium; small amounts of sodium, chloride, bicarbonate, and phosphorus; moderate amounts of magnesium; large amounts of potassium- sodium-potassium pump pushes potassium into the cell while pumping sodium out of the cell
What is the total body water composition of infants, adults, and elderly? - ANSWER>>infants = 75%; adults = 60%; elderly = 50%
What are the mechanisms controlling fluid and electrolyte movement? - ANSWER>>diffusion; active transport; osmosis
What is diffusion? - ANSWER>>the constant movement of molecules across cell membranes along a concentration gradient; required to maintain homeostasis
What is active transport? - ANSWER>>sodium moves out of cell and potassium moves in by sodium/potassium pump (energy dependent)
What is osmosis? - ANSWER>>water pulled to area of higher particle concentration
What are the osmotically active particles? - ANSWER>>sodium; chloride; urea; glucose
What is tonicity? - ANSWER>>the tension that osmotic pressure exerts on a cell
What is isotonic? - ANSWER>>same pressure in and outside the cell
What is hypertonic? - ANSWER>>greater pressure outside the cell (osmotic pull to the outside of the cell leads to cell shrinkage)
What is hypotonic? - ANSWER>>less pressure outside the cell (osmotic pull to the inside of the cell leads to cell rupture)
What is hydrostatic pressure? - ANSWER>>pushing force exerted by fluid; higher at the arterial end; heart failure increases this --> edema; varies throughout the capillaries
What is osmotic pressure? - ANSWER>>pulling force of particles (colloidal osmotic pressure, colloidal oncotic pressure); higher at the venous end; relatively stable
What are lymphatic channels? - ANSWER>>absorb proteins, fats, plasma, and cells from the interstitial fluid and return to the circulatory system; blockage causes increased interstitial osmotic pressure
What is the homeostatic regulation of fluid balance? - ANSWER>>thirst- early symptom of volume deficit; release of ADH (causes water retention) when serum osmolality increases; release of aldosterone (retains sodium and water) when blood volume decreases; natriuretic peptides released when atria are stretched (cause the kidneys to excrete more water)
What is edema? - ANSWER>>palpable swelling by expansion of the interstitial fluid volume
What are the causes of edema? - ANSWER>>increased capillary hydrostatic pressure (heart failure); decreased capillary osmotic pressure (proteins in the interstitial space or not enough proteins in the capillaries); increased capillary permeability (inflammation); obstruction of lymphatic flow
What is 1st spacing? - ANSWER>>normal fluid distribution
What is 2nd spacing? - ANSWER>>edema; increase in intracellular fluid volume
What is 3rd spacing? - ANSWER>>loss of fluid into a non-functional space
What is ascites? - ANSWER>>fluid in peritoneal cavity
What is pleural effusion? - ANSWER>>fluid in pleural membrane around the lung
What is ileus? - ANSWER>>fluid in bowel
What is pericardial effusion? - ANSWER>>fluid around the heart
What are isotonic fluid volume disorders (extracellular fluid volume disorders)? - ANSWER>>saline imbalances; because sodium is confined to the extracellular compartment (not in the cell), loss or gain of saline (and water) does not affect the intracellular compartment
What is volume deficit? - ANSWER>>loss of sodium-containing fluid from the body
What are the manifestations of volume deficit? - ANSWER>>thirst; weight loss; hypotension; dizziness; oliguria- decreased urine output (kidneys trying to hold on to water and sodium)
What is volume excess? - ANSWER>>abnormal increase in sodium-containing fluid
What are the manifestations of volume excess? - ANSWER>>weight gain; edema; neck vein distension (jugular vein is protruding); dyspnea, crackles (fluid leaking into alveoli)
What are the disorders of sodium concentration? - ANSWER>>abnormal osmolality;
abnormal sodium concentration; also called water imbalance; normal serum sodium concentration = 135-145 mEq/L
What is hyponatremia? - ANSWER>>low sodium levels caused by water excess leading to cellular swelling (water moves from EC to IC compartment); serum Na+ < 135 mEq/L
What are the manifestations of hyponatremia? - ANSWER>>headache, lethargy, confusion, seizures; nausea, vomiting, anorexia, diarrhea; muscle cramps, weakness, fatigue
What is hypernatremia? - ANSWER>>high sodium levels caused by water deficit
leading to cellular shriveling (water moves out of cell):
serum Na+ > 145 mEq/L
What are the manifestations of hypernatremia? - ANSWER>>confusion, lethargy, seizures, coma; thirst; dry, flushed skin; tachycardia, hypotension
What is dehydration? - ANSWER>>combination of ECV deficit and hypernatremia
What are the causes of dehydration? - ANSWER>>vomiting and diarrhea; excessive sweating; untreated DM; no access to water; lack of thirst in elderly
What are the manifestations of dehydration? - ANSWER>>sudden weight loss; hypotension; dizziness; sunken fontanels (infants); thirst; decreased skin turgor; dry mouth; lethargy and confusion
What are the characteristics of potassium balance? - ANSWER>>normal level: 3.5-5.0 mEq/L; source= dietary; excreted through kidneys, skin, GI tract; predominates in ICF
What is hypokalemia? - ANSWER>>serum K+ < 3.5; affects resting potential of cells; makes muscles less reactive causing cardiac dysrhythmias, anorexia, vomiting, ileus, weakness, paralysis, CNS depression, polyuria, thirst
What are the causes of hypokalemia? - ANSWER>>vomiting, diarrhea, gastric suction; NPO status, fasting; alkalosis, rapid correction of acidosis; certain diuretics (wasting), renal failure (depends on stage); cushing syndrome, corticosteroids
What is hyperkalemia? - ANSWER>>serum K+ > 5.0; affects resting potential of cells; muscles may be unable to contract resulting in dysrhythmias, cardiac arrest, weakness, flaccid paralysis, nausea, vomiting, diarrhea
What are the causes of hyperkalemia? - ANSWER>>renal failure; certain diuretics; IV infusion, blood transfusion; acidosis; major tissue injury or chemotherapy (lysis of cells releases potassium into the bloodstream)
What are the characteristics of normal calcium balance? - ANSWER>>normal level: 8.5- 10.5 mg/dl; 99% of calcium is in bone; <1% in blood (40% bound to plasma protein); essential for blood clotting
What is hypocalcemia? - ANSWER>>serum Ca++ < 8.5; affects threshold potential of cells; low calcium makes muscles more reactive causing neuromuscular irritability (trousseau & chvostek signs, hyperactive reflexes), tetany (muscle contraction), seizures, cardiac dysrhythmias, hypotension
What are the causes of hypocalcemia? - ANSWER>>insufficient intake, low albumin; chronic diarrhea; hypoparathyroidism; high phosphate (have an inverse relationship); alkalosis; pancreatitis, renal failure; cancer chemotherapy
What is hypercalcemia? - ANSWER>>serum Ca++ > 10.5; affects threshold potential of cells; neural excitability is decreased and kidneys cannot concentrate urine
What are the manifestations of hypercalcemia? - ANSWER>>nausea, vomiting, constipation; polyuria, polydipsia; muscle weakness and atrophy; osteoporosis; hypertension, dysrhythmias, cardiac arrest
What is the cause of hypercalcemia? - ANSWER>>hyperparathyroidism; malignant tumors- cancer tumors release hormone similar to parathyroid hormone; high calcium ingestion- turns or antacids; prolonged immobility- you need weight-bearing to strengthen the bones, if not calcium will leak out; excessive Vitamin D (rare)
What is phosphate? - ANSWER>>an intracellular anion; inverse relationship to calcium; important in energy production
What is magnesium? - ANSWER>>ICF cation; S&S similar to calcium
What is chloride? - ANSWER>>ECF anion; important in pH regulation; HCl acid in stomach
What are the renal functions? - ANSWER>>endocrine functions (activate vitamin D and erythropoietin); regulation of acid-base balance; regulation of water and electrolyte balance; regulation of blood volume and pressure; filtering of waste products
What is the glomerular filtration rate (GFR)? - ANSWER>>amount of blood filtered by the glomeruli (125 ml/min); mostly reabsorbed; circulating blood volume = 1200 ml/min; urine production = 1 cc/min
Why do we need such a high GFR? - ANSWER>>wastes are generally filtered and not secreted; wastes are in low concentration in the blood; strategy is to filter almost everything into the tubule then reabsorb only the wanted substances
What are the characteristics of nutrient reabsorption? - ANSWER>>glucose, amino acids, vitamins, small proteins (urea is a byproduct of protein breakdown); actively transported by carrier proteins or by endocytosis; reabsorption nearly completed in the proximal tubule
What are the hormonal regulations of urine output? - ANSWER>>aldosterone- promotes saline reabsorption; antidiuretic hormone- tells the kidneys to retain water; angiotension II- vasoconstrictor which influences amount of urine produced; atrial natriuretic peptide- influence vessels in kidneys; urodilation- influence vessels in kidneys
How do you assess kidney function? - ANSWER>>urine output should be greater than 30 ml/hr;
urine: dipstick, urinalysis, C&S, 24 hr panel;
serum: BUN (amount of urea in the bloodstream) should be 10-20 mg/dl, creatinine should be 0.5-1.5 mg/dl; cytoscopy- scope through urethra --> bladder; ultrasound, x-ray; intravenous pyelogram (IVP)- inject dye IV --> kidneys --> filtered out; sees if kidneys are functioning properly
What are normal levels from a urinalysis? - ANSWER>>pH (acidic); protein (neg); glucose (neg); ketones (neg); RBC (<5 cells per HPF); nitrites (neg); leukocyte esterase (neg); leukocytes (<5 cells per HPF); casts (neg)
What is the ratio between BUN and creatinine? - ANSWER>>ratio of BUN to creatinine should be 10-20/1; higher ratio may mean dehydration; lower may mean renal disease
What is cystic disease of the kidney? - ANSWER>>fluid-filled sacs or segments of a dilated nephron
What are the causes of cystic disease of the kidney? - ANSWER>>tubular obstructions that increase intratubular pressure; changes in the basement membrane of the renal tubules that predispose to cystic dilation
What are the characteristics of autosomal recessive polycystic kidney disease (PKD)? - ANSWER>>affects infants and children; early death from renal or liver involvement; less common
What are the characteristics of autosomal dominant polycystic kidney disease (PKD)? - ANSWER>>affects children to adults; involves kidneys and several other organs; more common
What are the manifestations of AD PKD? - ANSWER>>microcysts and macrocysts involving whole nephron; repeated UTI's, HTN, hematuria, flank pain; kidneys grossly enlarged; may also have hepatic cysts, intracranial aneurysms, colonic diverticula, mitral valve disease, etc.; eventually requires renal dialysis (kidneys eventually fail)
What are the types of UTI's? - ANSWER>>asymptomatic bacteriuria- common as people age; lower UTI's- cystitis; upper UTI's- pyelonephritis
What is the cause of UTI? - ANSWER>>E. coli
What are the risk factors of UTI? - ANSWER>>female; urine stasis; high pH
What are the manifestations of UTI? - ANSWER>>cystitis- irritative symptoms (burning), urine positive for nitrates and leukocyte esterase, cloudy, foul-smelling urine; pyelonephritis- CVA tenderness, WBC casts, fever, nausea and vomiting
What is the treatment of UTI's? - ANSWER>>antibiotics
What is pyelonephritis? - ANSWER>>infections of the renal pelvis and interstitium
What are the predisposing factors of pyelonephritis? - ANSWER>>vesicoureteral reflux- urine backs up bringing organisms with it; pregnancgy- fetus puts pressure on ureters and bladder sending urine backwards; catheterization- exposure to bacteria; urinary obstruction; female sexual trauma
What are the S&S of acute pyelonephritis? - ANSWER>>fever and chills; flank pain;
dysuria, frequency, urgency
What is the prognosis of acute pyelonephritis? - ANSWER>>renal scaring rare if treated properly
What are the S&S of chronic pyelonephritis? - ANSWER>>often asymptomatic; dysuria, vague flank pain
What is the prognosis of chronic pyelonephritis? - ANSWER>>a leading cause of renal failure
What are the causes of urinary tract obstruction? - ANSWER>>developmental defects; calculi (stones); pregnancy; benign prostatic hyperplasia; scar tissue resulting from infection and inflammation; tumors; neurologic disorders such as spinal cord injury
What are some damaging effects of urinary obstruction? - ANSWER>>stasis of urine; predisposes to infection and stone formation; development of back pressure; interferes with renal blood flow and destroys kidney tissue
What is renal calculi? - ANSWER>>common cause of urinary obstruction that forms when urine volume is low or pH is abnormal; may lead to infection, structural damage, hydronephrosis, and ischemic kidney damage; most stones are calcium oxalate (phosphate)
What are the S&S of renal calculi? - ANSWER>>asymptomatic when in renal pelvis; when in ureter, intense ureteral colic; abrupt onset, becomes increasingly severe; unilateral; may have nausea and vomiting
What is glomerulonephritis? - ANSWER>>inflammation of the glomeruli caused by immune processes (autoimmune, antigen-antibody deposition, toxins); glomerular basement membrane damage causing decreased GFR
What are the causes of glomerulonephritis? - ANSWER>>diseases that provoke a proliferative inflammatory response of the endothelial, mesangial, or epithelial cells of the glomeruli; the inflammatory process (damages the capillary wall, permits RBC's to escape into the urine, produces hemodynamic changes that decrease the GFR)
What are the characteristics of glomerulonephritis? - ANSWER>>hematuria with red cell casts; a diminished glomerular filtration rate (GFR); azotemia (presence of nitrogenous wastes in the blood); oliguria; hypertension
What is nephrotic syndrome? - ANSWER>>collection of S&S caused by increased glomerular capillary wall permeability to proteins
What is the etiology of nephrotic syndrome? - ANSWER>>glomerulonephritis; diabetic nephropathy; minimal change disease; glomerulosclerosis
What are the characteristics of nephrotic syndrome? - ANSWER>>ongoing leaky basement membrane; proteinura > 3.5 g in 24 hr; hypoalbuminemia; generalized edema; hyperlipidemia; usually self-limiting
What is renal failure? - ANSWER>>a condition in which the kidneys fail to remove metabolic end products from the blood and regulate the fluid, electrolyte, and pH balance of the extracellular fluids
What are the characteristics of acute kidney injury (AKI)? - ANSWER>>sudden severe decrease in renal function; abrupt in onset; often is reversible if recognized early and treated appropriately
What are the characteristics of chronic renal failure? - ANSWER>>the end result of irreparable damage to the kidneys; it develops slowly, usually over the course of a number of years
What are the manifestations of acute kidney injury? - ANSWER>>rapidly progressing uremia (50% mortality)
What are the causes of pre renal AKI? - ANSWER>>inadequate blood flow to kidney; shock, hypovolemia, hypotension; cardiac failure; sepsis; trauma, hemorrhage; dehydration
What are the causes of infrarenal and post renal AKI? - ANSWER>>intrarenal: nephrotoxins, ischemic injury, inflammatory insult;
postrenal: obstruction;
BPH; calculi
What are the stages of AKI? - ANSWER>>decreased blood flow to kidney --> pre renal oliguria --> acute tubular necrosis --> oliguric phase --> diuretic phase --> recovery phase
What are the characteristics of the oliguric phase of AKI? - ANSWER>><500 ml/day; 1-2 weeks; 5% normal urine; 10% normal filtration
What are the characteristics of the diuretic phase of AKI? - ANSWER>>large volume dilute urine;
- days-2 weeks;
150-200% normal urine; 10-50% normal filtration
What are the characteristics of the convalescent phase of AKI? - ANSWER>>gradual return to normal function; 3-12 months; 100% of normal urine; 100% of normal filtration
What is chronic renal failure? - ANSWER>>progressive loss of nephron function over months to years
What is the etiology of chronic renal failure? - ANSWER>>glomerulonephritis; diabetic nephropathy; hypertension; pyelonephritis; polycystic kidney disease; nephrotoxic exposure; obstructive nephropathy
What are the stages of chronic renal failure? - ANSWER>>1) 75% nephron loss- decreased renal reserve; no S&S; normal BUN and creatinine; may not be diagnosed 2) 75-90% loss- renal insufficiency; polyuria, nocturne; slight increase in BUN, creatinine; may be diet controlled 3) >90% nephron loss- end-stage failure; uremia
What are the clinical manifestations of chronic renal failure? - ANSWER>>accumulation of nitrogenous wastes;
alterations in water, electrolyte and acid-base balance; mineral and skeletal disorders; anemia and coagulation disorders; HTN and alterations in CV function; GI disorders; neurologic complications; disorders of skin integrity; immunologic disorders
What are retained substances from renal failure? - ANSWER>>urea; creatinine; phenols; hormones; electrolytes; water
What is renal osteodystrophy? - ANSWER>>syndrome of skeletal changes; result of alterations in calcium and phosphate metabolism
What is the trigone? - ANSWER>>the triangular area bounded by the ureters and the urethra
What is cystitis? - ANSWER>>inflammation of the bladder lining
What is the etiology of cystitis? - ANSWER>>infection caused by bacterial invasion from the urethra
What are the risk factors of cystitis? - ANSWER>>female gender; >65 years; catheterization; DM; urinary stasis
What are the manifestations of cystitis? - ANSWER>>dysuria; frequency, urgency; suprapubic pain; cloudy urine; hematuria;
UA: bacteria, WBC's, RBC's
What are the characteristics of incontinence? - ANSWER>>affects 29% of women between 30 and 60 years; affects about 20% of older men, and 35% of older women
What are the types of incontinence? - ANSWER>>urge; stress;
overflow; mixed; nocturnal enuresis
What are some congenital urinary tract disorders? - ANSWER>>vesicoureteral reflex- backword flow of the urine from the bladder to the ureters and renal pelvis, usually diagnosed in child with UTI, often resolves w/o treatment; ureteral ectopy; ureterocele