Exam 2 Flashcards
What percent of blood is water and plasma?
55%
What percent of blood is formed elements?
45%
What are the formed elements of blood?
Rbc, wbc, and platelets
What are the three main plasma proteins?
Albumin, fibrinogen, and globulins
What is the main function of albumin?
It maintains blood osmotic pressure
What does low albumin lead to?
Extra fluid in interstitial spaces and extra fluid in the cells
What are immunoglobulins produced by?
Plasma cells (mature B cells)
What is hematopoesis?
Formation of new blood cells
What is a pluripotent stem cell?
A stem cell that can differentiate into many different types of cells
What are examples of two growth factors that stimulate the differentiation of pluripotent stem cells?
Erythropoetin and granulocyte colony-stimulating factor
What is a progenitor cell?
It is more differentiated than a stem cell but not yet in its “final” form
Do RBCs have a nucleus?
No
What are two reasons that red blood cells have a biconcave disc shape?
To make them more flexible for easy passage thru vessels, and for greater surface area for gas exchange
What is the average amount of RBC?
4 x 10 to the 6/uL of blood
What is erythropoesis?
The formation of new red blood cells
What are the three types of cells in rbc formation?
Erythroblast, reticulocyte, erythrocyte
What is the lifespan of a reticulocyte?
One day
What is the lifespan of an erythrocyte?
120 days
What three nutrients are required for erythropoesis?
Iron, folic acid and vitamin B12
What three parts of the red blood cell are re-used after it is broken down?
Hemoglobin, iron, and globulin
What two organs break down old red blood cells?
The liver and spleen
What is globulin converted to when broken down?
Amino acids
What happens to the portion of the red blood cell that is not re-used?
It is converted to bilirubin and excreted in the stool (as bile) or in the urine
At what rate are red blood cells destroyed?
At the rate they are created
What is hemoglobin composed of?
Heme and the globulin protein
What molecule carries iron to the bone marrow for hemoglobin synthesis?
Transferrin
How many different types of abnormal hemoglobin are there?
Over 100
What is the common, adult type of hemoglobin?
HbA
What is the hematocrit?
The percent of the blood that is taken up by RBCs
What is the average hematocrit?
45%
Is hematocrit alone a good indication of potential anemia?
No - it must be looked at with other lab tests
What is dilutional hematocrit and in what two populations does it occur?
It is a normal hematocrit that looks low because of an abnormally large volume of circulating fluid - occurs in pregnant women and in people with too much IV fluid
What does Mean Corpuscular Volume describe?
The average size of a patient’s red blood cells
How is Mean Corpuscular Volume described?
As normocytic, macrocytic, or microcytic
What does Mean Corpuscular Hemoglobin Concentration describe?
The average hemoglobin weight in a red blood cell, calculated per given volume of rbc’s
How is Mean Corpuscular Hemoglobin Concentration described?
As normochromic, hyperchromic, or hypochromic
What does Mean Corpuscular Hemoglobin describe?
The average weight of hemoglobin in each individual red blood cell
What does Mean Corpuscular Hemoglobin reflect?
Both the size of the RBC and the concentration of hb in the RBC
What is the Red Cell Distribution Width?
The RBW is the standard deviation of the Mean Corpuscular Volume
What type of anemia produces a normal RBW?
Thalassemia
What does the RBW help us understand?
The variation in red blood cell size in a patient
What is the reticulocyte count a reliable measure of?
Red blood cell production
What is anisocytosis? What is it due to?
Abnormally sized RBCs. Due to severe anemia
What is poikilocytosis? What is it due to?
Abnormally shaped RBCs. Due to severe anemia
When does basophilic stippling occur?
With lead poisoning
What three factors can anemia be due to?
Low red blood cell count, low hemoglobin, or low hematocrit
Why are an elevated resp. rate and SOB seen in anemia/hypoxemia?
Because the body is not circulating enough O2, so it is trying to get more O2 into the system
What would be an example of something that could cause a production deficit of RBCs?
A lack of dietary folic acid
What is destroyed in an anemia due to a ‘destruction deficit’?
Either bone marrow or RBCs themselves
What are two examples of microcytic, hypochromic anemia?
Thalassemia, iron deficiency
What are the Mean Corpuscular Volume and the Mean Corpuscular Hemoglobin Concentration in anemia of chronic disease?
Normocytic and normochromic
What are the Mean Corpuscular Volume and the Mean Corpuscular Hemoglobin Concentration in B12 anemia?
Macrocytic and normochromic
What are the Mean Corpuscular Volume and the Mean Corpuscular Hemoglobin Concentration in folic acid deficiency anemia?
Macrocytic and normochromic
What is aplastic anemia caused by?
By the bone marrow not working correctly – can be caused by chemo
What lab result would you expect to see in aplastic anemia?
Low reticulocyte count
What are the Mean Corpuscular Volume and the Mean Corpuscular Hemoglobin Concentration in aplastic anemia?
Macrocytic and normochromic
What are the Mean Corpuscular Volume and the Mean Corpuscular Hemoglobin Concentration in iron deficiency anemia?
Microcytic and hypochromic
What is the most common type of anemia?
Iron deficiency anemia
What is iron deficiency anemia commonly due to?
Chronic blood loss, ie. from heavy menstruation or from a GI bleed
What does the serum iron test measure? What important information does it not tell you?
How much iron is in the blood – but not how much is stored
What are two factors that the serum iron test can be affected by?
Time of day and whether or not a woman is menstruating
What does the serum ferritin test measure?
How much iron is stored in the body
The serum ferritin test is a good marker for what type of anemia?
Iron deficiency anemia
How long does it take to completely replenish the body’s stores of iron thru iron supplementation?
6 months-1 year
What does the transferrin concentration test tell you?
How many binding sites on transferrin are full of iron
How is transferrin related to iron stores?
Inversely – ie, as iron stores increase, transferrin decreases
What does TIBC stand for and what does it mean?
It stands for Total Iron Binding Capacity and it reflects how many places there are on the transferrin for iron to bind
What does hematochromatosis mean?
That there is an overload of iron in the body
What does the transferrin saturation test tell you?
The percent of transferrin that is saturated with iron
What is the average amount of iron in the daily diet?
10-20mg
What is the average amount of stored iron in the body?
500-1500 mg
What are four symptoms of iron deficiency anemia?
Brittle nails, glossitis, pica, and clubbed nails
What is glossitis?
Smooth, red tongue
How should iron deficiency anemia be treated?
By treating the underlying cause (ie, bleeding)
How long after iron deficiency anemia is treated should reticulocytosis begin?
Four to five days after
What is megaloblastic anemia caused by?
A deficiency of Vitamin B12 or folic acid
What two things could a B12 deficiency be due to?
A dietary deficiency or problems with receptors
What type of anemia is megaloblastic anemia?
Macrocytic
Where is B12 stored?
In the liver
What two things could pernicious anemia be caused by?
A deficiency of intrinsic factor or by blockage of the bonding sites by type 1 and type 2 antibodies
What are four symptoms of prolonged B12 deficiency?
Premature gray hair, loss of two-point discrimination, tingling, weakness
Is the Schilling test used today?
No
What type of anemia is produced by B12 deficiency? (MCV and Mean Corpuscular Hemoglobin Concentration)
Macrocytic and normochromic
In what population is folic acid deficiency common?
Pregnant women
What is the MCV and Mean Corpuscular Hemoglobin Concentration of anemia produced by a folic acid deficiency?
Macrocytic and normochromic
What are two symptoms of acute anemia?
Low blood pressure and high heart rate
What is the second most common type of anemia?
Anemia of inflammation and chronic disease
What is anemia of inflammation and chronic disease seen with?
Chronic infection, inflammation and cancer
What is polycythemia?
An excess of red blood cells
How does the blood appear in polycythemia?
Thick and sludgy
What occurs in the blood in relative polycythemia?
The hematocrit rises and there is a loss of plasma volume
What type of polycythemia is polycythemia vera?
Primary polycythemia
What are two factors that secondary polycythemia could be due to?
High altitudes and smoking
What is the main function of the respiratory system?
To provide the body with O2 and remove CO2
Name three secondary functions of the respiratory system
Facilitating smell, producing speech, and maintaining heat balance
Name three structures of the upper resp. tract
Nasal cavity, sinuses, nasopharynx
What do the sinuses do?
Produce speech resonance
What does acinus mean?
This is the term used for all structures that are distal to the terminal bronchiole
How many lobes does the right lung have and how many lungs does the left lung have?
Right has 3; left has 2
What three nerves innervate the lungs?
Phrenic nerve, vagus nerve and thoracic nerve
What nerve innervating the lung controls parasympathetic activity?
The vagus nerve
What happens to the diaphragm during inspiration?
It contracts/flattens
Is inspiration active or passive? What about expiration?
Inspiration is active; expiration is passive
What is atelectasis?
Collapse of the alveoli in the lungs
What does the mucociliary blanket do?
It entraps dust and other foreign particles
What is pleural effusion?
The abnormal collection of fluid in the pleural cavity
What are three risk factors for respiratory disease?
Smoking, allergies, surgery
What is the technical term for an enlarged heart?
Cardiomegaly
What physiologic change occurs with chronic respiratory disease?
Flattening of the diaphragm
What must you ensure the patient can do before performing a chest xray?
Inhale and hold it
What are two ways a sputum sample can be obtained?
Thru expectoration or tracheal suctioning
What time of day is it best to obtain a sputum sample?
In the early morning
What is the minimum amount that must be obtained for a sputum sample?
3 teaspoons (15 mL)
What is a bronchoscopy?
The direct visual examination of the larynx, trachea and bronchi with a scope
How long should the patient be NPO before a bronchoscopy?
The patient should be NPO midnight prior
When is it safe to give foods by mouth following a bronchoscopy?
When the gag reflex has returned
What is one thing that should be done before a bronchoscopy?
Obtain patient’s vital signs
What are four possible complications of a bronchoscopy?
Bronchospasm, bacteremia, bronchial perforation and fever
What is a pulmonary angiography?
An x-ray of the pulmonary vessels taken via catheter inserted via a vein or artery
What allergy should be assessed for prior to a pulmonary angiography?
Iodine
How long should a patient be NPO for before a pulmonary angiography?
For 8 hours prior
What is thoracentesis?
The removal of fluid or air from the pleural space with a needle inserted between the ribs
What type of patients is thoracentesis done for?
Cancer patients
What two things should a patient be monitored for after thoracentesis?
Signs of pneumothorax and air embolism
What is the inspiratory reserve volume?
The amount of air that can be breathed in beyond a normal breath
What is the tidal volume?
The amount of air inhaled and exhaled with each resting breath.
What is the expiratory reserve volume?
The maximum amount of air that can be exhaled from the resting end-expiratory position
What is the total lung capacity for a normal adult?
6 liters
How much of the total lung capacity for a normal adult is used in gas exchange?
4 liters
What does percutaneous mean?
Under the skin
What are two things that a pulmonary function test is used to evaluate?
Lung mechanics and gas exchange
What two drugs should not be used before a pulmonary function test? Why?
An analgesic (can depress lung function) or a bronchodilator (will skew results)
What does the ventilation-perfusion lung scan measure?
The amount of air that reaches the alveoli, as well as the blood flow to the lungs
What is the residual volume?
Amount of air left in the lungs after maximal expiration.
What is the forced vital capacity (FVC)?
Max. amount of air that can be forcefully exhaled from lungs after full inspiration.
What is the Forced Expiratory Volume in 1 second (FEV1)?
The amount of air that can be forcefully expired in the first second of FVC
What happens to the V/Q ratio if there is decreased ventilation?
The ratio decreases
What happens to the V/Q ratio if there is a problem with perfusion?
The ratio increases
How does a bronchography differ from a broncoscopy?
The bronchography uses dye
What does the arterial blood gases test measure?
The O2 and CO2 in arterial blood
What test should be done prior to the arterial blood gases test?
The Allen test
What is the normal pH of the blood?
7.35-7.45
What does the O2 saturation tell you?
The amount of oxygen that is attached to hemoglobin
What test is usually done to measure O2 sat?
Pulse ox (pulse oximetry)
Below what level are pulse ox results usually life-threatening?
Below 70%
What is pneumonia generally defined as?
Acute inflammation of the parenchymal tissues (alveoli and bronchi)
What are the nasopharyngeal defenses affected by? (Name two things)
Colds, hay fever
What is often a first sign of pneumonia in the elderly?
Uncharacteristic falls
What are four possible complications of pneumonia?
Bacteremia, septicemia, abscess in the lungs, and empyema
What is empyema?
Pus in the pleural cavity
What is the difference between bacteremia and septicemia?
Bacteremia stays localized and septicemia is systemic
What is the most common etiology of pneumonia?
Bacteria (both gram positive and gram negative)
Are hospital acquired infections usually gram negative or gram positive?
Gram negative
What’s one example of a gram negative pneumonia?
Legionella pneumonphila
What’s one example of a fungal pneumonia?
Histoplasmosis
What type of pneumonia is either fungal or protozoan and often occurs in AIDs patients?
Pneumocystis carinii
Besides microorganisms, what are two other etiologies of pneumonia?
Smoke inhalation and food aspiration
What kind of sputum does pneumococcal pneumonia produce?
Purulent & rusty
What type of pneumonia produces a red, gelatinous sputum?
Klebsiella
When does the congestion stage of pneumonia occur?
In the first 4-24 hours
When does the red hepatization stage of pneumonia occur?
At 48 hours
What happens in the red hepatization stage of pneumonia?
Red blood cells and granulocytes move into the alveoli
When does the grey hepatization stage of pneumonia occur?
72 hours-one week
What happens in the grey hepatization stage of pneumonia?
Fibrin accumulates and RBC’s and granulocytes start to disintegrate
When does the resolution stage of pneumonia start if the patient is not on antibiotics?
After 1 week to 12 days
When does the resolution stage of pneumonia start if the patient is on antibiotics?
After 48 hours
If the provider doesn’t know the exact cause of a pneumonia, what is their typical course of action?
They will start the patient on either a broad-spectrum anti-b or on the antibiotic that treats what they believe the pneumonia to be caused by
What is obstructive pulmonary disease?
When a patient can get air in and but not get it out
What are two examples of obstructive disease?
Asthma and chronic bronchitis
What is restrictive pulmonary disease?
When the patient can’t get air in but can get it out
What are three examples of restrictive pulmonary disease?
Pleural effusion, hemothorax, and thoracic cage disorders
What does asthma do to the bronchial airways?
Narrows them
What is another name for asthma type I?
Extrinsic atopic
What is extrinsic atopic asthma mediated by?
IgE
What two things increase in asthma type I?
Eosinophils and IgE
What is exercise-induced asthma triggered by?
Cool air with less water vapor
What is ASA triad asthma triggered by?
A delayed hypersensitivity reaction several hours after taking NSAIDs
What are the two broad categories of asthma triggers?
Bronchospastic and inflammatory
When does the early response to asthma begin and when does it end?
It begins within about 10 minutes and ends after about 90 mins
When does the late response to asthma begin and how long can it last for?
Begins after 3-5 hours and can last for days to weeks
What are the two kinds of inhalers used for asthma and how often are each used?
The rescue inhaler (not used daily) and the steroid based inhaler (used daily)
Is asthma obstructive or restrictive?
Obstructive
A peak expiratory flow reading (PEFR) of below what percent indicates a risk for respiratory failure?
Below 25%
What are four symptoms of asthma?
Dyspnea, tachypnea, wheezing and cyanosis
Is asthma more common in boys or in girls?
Boys
What is paresthesia?
Tingling or prickling sensation of the skin
Which type of anemia has paresthesia as a symptom?
B12 deficiency anemia
Is tachycardia a symptom of hypoxemia?
Yes
Is bradypnea a symptom of hypoxemia?
No
What are two symptoms of folic acid deficiency anemia?
Fatigue and dyspnea
What is pernicious anemia caused by?
Autoimmune destruction of the gastric parietal cells
Does bleeding result in a higher or lower reticulocyte count? Why?
Higher, because the body is trying to compensate for a loss of RBC
Is a vegetarian diet likely to result in low folate levels?
No
Which of the lab tests provides the least clinically relevant info?
Mean Corpuscular Hemoglobin
What are the four categories of drugs used to treat asthma?
B2 adrenergic bronchodilators, anticholinergic bronchodilators, corticosteroids, and mast cell stabilizers
What are two examples of B2 adrenergic bronchodilators?
Albuterol and epinephrine
What effect does obstructive pulmonary disease have on vital capacity and FEV?
VC is normal but FEV is low
What effect does restrictive pulmonary disease have on vital capacity and FEV?
VC is abnormal and FEV is normal
What are the requirements for a diagnosis of chronic bronchitis?
Bronchitis present for at least three months out of the year or for 2 months/year for two successive years
What happens to the residual lung volume and the vital capacity during an asthma attack?
Residual lung volume increases and vital capacity decreases
Why does pursed lip breathing improve ventilation?
It increases pressure in the small airways to prevent their collapse
What is a good dietary modification for patients with COPD?
Avoiding foods that require a lot of chewing
In a person with normal lung function, the amount of air forcibly exhaled in 1 second (FEV1) is what percentage of the vital capacity (VC)?
75%
What is vital capacity?
Maximal amount of air that can be taken in and exhaled with forceful expiration.
What is ventilation defined as?
Delivery of air to the alveoli
What effect does a decreased pH have on resp. rate?
It increases the resp. rate
What is destroyed in emphysema?
The alveolar walls
What kind of chest occurs in emphysema?
Barrel chest
Does emphysema produce a lot of coughing and/or sputum?
No
What are two symptoms of emphysema?
Tachypnea and dyspnea
In which disease does weight loss often occur, emphysema or chronic bronchitis?
Emphysema
Are ronchi a symptom of emphysema or chronic bronchitis?
Chronic bronchitis
Is cyanosis a symptom of emphysema or chronic bronchitis?
Chronic bronchitis
What is cor pulmonale?
Enlargement of the right side of the heart due to lung disease
Is cor pulmonale more often a symptom of chronic bronchitis or emphysema?
Chronic bronchitis
What part of the lungs are affected by chronic bronchitis?
The bronchial walls are inflamed
What are two types of COPD?
Emphysema and chronic bronchitis
Which type of COPD is characterized by a productive cough?
Chronic bronchitis
