Exam II Flashcards
1
Q
Which body organ controls bicarbonate (NaHCO3)?
A
Kidneys
2
Q
Which body organ controls carbon dioxide (CO2)?
A
Lungs
3
Q
_____ rids the body of excess CO2
A
Breathing
4
Q
When CO2 raises in the brain blood and tissues central receptors trigger neurons to increase the rate and depth of breathing, causing _____
A
Hyperventilation
When the CO2 is “blown off” ECF decreases
5
Q
pH below ____ and above _____ is usually fatal
A
6.9, 7.8
6
Q
What are the health problems that increase acid production?
A
Diabetic ketoacidosis,
Seizures
7
Q
What are the health problems that decrease acid production?
A
Respiratory impairment,
Kidney impairment
8
Q
A base deficit is caused by which two functions?
A
Over elimination,
Underproduction of bicarbonate
Overproduction is a result of diarrhea
Underproduction is a result of pancreatitis and dehydration
9
Q
Which four body systems typically exhibit manifestations of acidosis first?
A
Musculoskeletal,
Cardiac,
Respiratory,
CNS
10
Q
What are the four process that can result in metabolic acidosis?
A
Overproduction of hydrogen ions,
Under elimination of hydrogen ions,
Under production of bicarbonate ions,
Over elimination of bicarbonate ions
11
Q
What is the substance that releases hydrogen ions?
A
Acid
12
Q
What is the substance the takes up hydrogen ions?
A
Base
13
Q
Acid is produced through ______
A
Cellular metabolism
14
Q
This occurs when body fluids resist large changes in the pH when acids or bases are added or removed
A
Acid buffering
15
Q
What are the most common pathological processes disturbed by acid-based imbalance?
A
COPD, Acute respiratory distress syndrome, Acute pneumonia, Pulmonary edema, Kidney failure
16
Q
What are the processes that can cause metabolic acidosis?
A
Overproduction of hydrogen ions,
Under elimination of hydrogen ions,
Under production of bicarbonate ions,
Over elimination of bicarbonate ions
17
Q
This acid base imbalance occurs when respiratory function is impaired and the exchange of oxygen (O2) and carbon dioxide (CO2) is reduced, causing CO2 retention leading to the same increase in hydrogen ions.
A
Respiratory acidosis
18
Q
What are the physical results of respiratory acidosis?
A
Respiratory depression,
Inadequate chest expansion,
Airway obstruction,
Reduced alveolar-capillary diffusion
19
Q
Which specific drugs can impair gas exchange?
A
Diuretics,
Aspirin
20
Q
Which health problems can lead to acid base imbalance?
A
Cardiac problems
Kidney problems,
Pulmonary impairment
21
Q
What are the first physical symptoms with mild acidosis?
A
Cardiovascular changes; increased heart rate and cardiac output
With worsening acidosis or acidosis and hyperkalemia, heart rate decreases
22
Q
Which blood products are produced in bone marrow?
A
Red blood cells (RBCs, erythrocytes),
White blood cells (WBCs, leukocytes),
Platelets
Bone marrow is also involved with immune response
23
Q
Where is cell producing marrow present?
A
Flat bones (sternum, skull, pelvic and shoulder girdles), Ends of long bones
24
Q
Immature, unspecialized (undifferentiated) cells that are capable of becoming any type of cell, depending on the body’s needs, are_____
A
Blood stem cells
25
Blood is composed of _____ and _____
Plasma,
| Cells
26
____ contains protein and is an Extracellular fluid
Plasma
27
What are the three types of plasma proteins?
Albumin,
Globulins,
Fibrinogen
28
_____ maintains the osmotic pressure of the blood, preventing the plasma from leaking into the tissues
Albumin
29
_____ transport other substances and, as anti-bodies, protect the body against infection
Globulins
30
_____ is critical in the clotting process
Fibrinogen
31
The blood cells include _____, _____, and _____.
RBCs,
WBC,
Platelets
32
_____ compose the largest portion of blood cells
Red blood cells (erythrocytes)
33
What is the lifespan of a red blood cell?
120 days
34
Red blood cells produce ______, which requires iron to transport oxygen.
Hemoglobin (Hgb)
35
Red blood cell production is called _______
Erythropoiesis
36
Where is the RBC growth factor erythropoietin produced?
kidneys
37
What seven substances are needed to form hemoglobin?
```
Iron,
B12,
Folic acid,
Copper,
Pyridoxine,
Cobalt,
Nickel
```
38
What is the growth factor that controls production of platelets?
Thrombopoietin
39
_____% of platelets circulate while _____% are stored in the spleen
80% circulate,
| 20% stored in spleen
40
Which organ is responsible for producing prothrombin and other blood clotting factors?
Liver
41
What are the white blood cells responsible for inflammation?
```
Never, Make, Monkies, Eat, Bananas
Neutrophils,
Macrophages,
Monocytes,
Eosinophils,
Basophils
```
42
What are the functions of each of the white blood cells?
Neutrophils: ingestion and phagocytosis
Macrophages: ingestion and phagocytosis
Monocytes: destruction of bacteria and cellular debris
Eosinophils: releases vasoactive amines during allergic reactions
Basophils: releases histamine and heparin
43
When anti clotting factors are deficient there is risk for these three conditions?
Pulmonary embolism,
Myocardial infarction,
Stroke
44
What are the Hematologic changes associated with aging?
Decreased blood volume (lower levels of plasma proteins),
Decreased RBC and WBC count (platelets remain steady),
Lymphocytes are less reactive and lose immune function,
Decreased hemoglobin
45
Which over the counter herbal supplements inhibit platelet activity?
St. John's wort,
| Ginkgo biloba
46
Which vitamin increases the rate of clotting?
Vitamin K
leafy green veggies, salads, and raw veggies
47
Where is the liver palpable?
RUQ, 4-5 cm below right costal margin
48
_____ is a reduction in RBCs, hemoglobin, or hematocrit
Anemia
49
_____ is a genetic disorder that results in chronic anemia, pain, disability, organ damage, increased risk for infection and early death
Sickle cell disease
50
What is the lifespan of a RBC when SCD is present?
10-20 days
51
This autoimmune Hematologic disorder typically appears in women between the ages of 20-50 years old and involves platelets being coated with an anti platelet antibody, making them easier to destroy by macrophages.
Autoimmune thrombocytopenic purpura
Also known as idiopathic thrombocytopenic purpura (ITP)
52
What are the manifestations of ITP?
Large bruises (ecchymoses),
Petechial rash on arms, legs, upper chest, and neck,
Mucosal bleeding
53
What is the drug therapy for ITP?
Corticosteroids,
| Chemotherapy drugs
54
If a patient with ITP doesn't respond to drug therapy which surgical procedure may be required?
Spenectomy
55
This Hematologic disorder results in platelets that clump together abnormally in the capillaries leaving too few platelets in circulation.
Thrombotic thrombocytopenic purpura (TTP)
56
With TTP, the patient has inappropriate clotting in the small blood vessels and fail to clot when trauma occurs. This results in four conditions?
Ischemic tissues,
Kidney failure,
Myocardial infarction,
Stroke
57
What are the consequences of untreated TTP?
Death within 3 month
58
What is the treatment for TTP?
Plasma removal and infusion of fresh frozen plasma,
| Drugs to inhibit platelet clumping (aspirin)
59
Which acid base imbalance presents with neurologic, respiratory (Kussmaul), gastrointestinal(n/v, diarrhea) and cardiovascular (arrhythmias, hypotension) changes?
Metabolic acidosis
60
Which acid-base imbalance presents with slow and shallow respirations, weakness, muscle cramps, hyperactive reflexes, increased glucose, increased keystones, decreased LOC, decreased potassium, confusion, and, in severe cases, seizures, tachycardia and arrhythmias ?
Metabolic alkalosis
61
Which acid base imbalance presents with labored breathing, headache, restlessness, blurred vision, lethargy, decreased O2, and muscle twitching, tremors, seizure and coma (in severe cases)?
Respiratory acidosis
62
Which acid base imbalance presents with dizziness, confusion, tingling of extremities, increased HR, and seizures and coma (severe cases)?
Respiratory Alkalosis
63
A chest X-ray indicates infiltration when....
The alveoli are filled with fluid
64
A chest X-ray indicates consolidation when...
Lung tissue is filled with fluid, causing swelling or hardening
65
This is a life threatening condition associated with left ventricular failure that severely impairs gas exchange?
Pulmonary edema
66
What are the manifestations of pulmonary edema?
```
Crackles/rails, Dyspnea,
Disorientation,
Tachycardia,
Hypertension or hypotension,
Reduced urinary output,
Cough, pink sputum,
PVCs/dysrhythmias,
Anxiety, restlessness, lethargy
```
67
_____ is the degree of myocardial fiber stretch at the end of duos told and before contraction
Preload
68
_____ is the resistance ventricles overcome to eject blood thru semilunar values into peripheral blood vessels
Afterload
69
What are the nursing interventions for pulmonary edema?
```
Administer nitroglycerin (vasoconstrictor, decreases preload/afterload), diuretics (eliminate fluids to decrease edema), morphine (pain), antidysrhthmic said (prophylaxis)
Monitor/change positions,
Monitor labs (BUN, creatinine, CBC, CMP,
Foley (if needed)
```
70
This is an acute inflammatory demyelination get disease that affects the peripheral nervous system causing motor weakness and sensory abnormalities. It affects both genders and peaks after 55 years of age
Gillian-Barre Syndrome
71
What are the three stages of Guillain-Barre Syndrome?
Acute/initial (1-4 weeks),
Plateau (several days-2weeks),
Recovery (gradual, 4-6 months or up to 2 years)
72
What are the clinical manifestations of Guillain-Barre Syndrome?
Demyelination,
Ascending weakness,
Partial/total paralysis,
Paralyzed respiratory muscles
73
This intervention removes blood from the body and separates plasma and then returns blood cells w/o plasma to the body
Plasmapheresis
74
Which labs/tests are performed for a patient with Gullain-Barre Syndrome?
CMP, ABGs (w/ vent or respiratory compromise),
spinal tap (shows point of demyelination),
Mylegram (EMG)-measures nerve activity,
MRI (rule out other causes),
BUN, creatinine (before administration of CT dye)
75
How is oxygen administered for patients w/COPD?
28% ventury mask
76
Which COPD disorder affects the alveoli?
Emphysema
77
Which COPD disorder affects the bronchioles/airway?
Chronic bronchitis
78
What is the most commonly transfused blood component?
Packed red blood cells
They restore oxygen carrying capacity primarily from bleeding or severe anemia
79
What is the purpose of washing RBCs to remove traces of plasma, platelets and WBCs?
Reduc side effects such ch as fever, chills, or other reaction
80
What reasons might a person receive a platelet transfusion?
Thrombocytopenia
81
Why would a person receive single donor platelets rather than pooled platelets?
Decrease the chance for rejection/infection
82
Why might a person receive fresh frozen plasma?
Bleeding disorders with unknown clotting factors
83
This blood product is prepared from plasma by centrifuging fresh frozen plasma and contains clotting factors such as Fibrinogen, Factor VIII, Von Willebrand's factor, Factor XIII
Cryoprecipitate
84
Why might a person receive antibodies/immunoglobulins?
Immunity for those exposed to infection with low levels of antibodies
i.e. Chickenpox, hepatitis, rabbis, tetanus
85
What are the four components required prior to administering a transfusion?
1. Transfusion order from physician
2. Informed consent from patient
3. Procedure explained to patient
4. Cross check the patients name and medical record number with another nurse
86
What information is required on the physician's transfusion order?
1. Blood type and Rh factor
2. Patient name, DOB, diagnosis, reason for transfusion
3. Specified blood product to be administered w/special instructions
4. Amount of blood product to be administered
87
This diagnostic test assesses the ability of thrombin & plasmin to break down clots
D-diner
88
This diagnostic test assesses nutritional status
Albumin & Protein
89
This diagnostic test assesses the effectiveness of clotting factors I, II, V, VII, X on ththe extrinsic pathway which is part of the coagulation cascade for converting prothrombin to thrombin.
Prothrombin Time (PT)
Decreased PT indicates decreased clotting ability
90
What is the normal range for Prothrombin Time (PT)
11-12.5 seconds
Therapeutic range 1.5-2.5 times normal
91
This diagnostic test was established by the World Health Organization (WHO) and measures clotting
INR
PT/INR: test performed for patients on Coumadin
Normal range: 1.1-1.2 (w/o medications)
Therapeutic range: 2.5-3-5
92
What diagnostic test measures the effectiveness of clotting factors in the intrinsic pathway for the formation of fibrin that forms mesh that impedes blood flow. It measures the effectiveness of IV heparin
Partial Thromboplastin Time (PTT)
Normal range: 30-40 seconds
Therapeutic range: 1.5-2.5 times normal range
93
This diagnostic test provides information about clotting factor I, fibrinogen converted to fibrin in the clotting process
Fibrinogen
Normal range 200-400 mg/dL
94
What is the normal range for platelets
150,000-400,000
<30,000 susceptible to uncontrolled bleeding with injury
<6,000 susceptible to spontaneous bleeding in the brain
95
What is the normal range for RBCs
Men: 4.7-6.1
Women: 4.2-5.4
96
What is the normal range for hemaglobin
Men: 14-18
Women: 12-16
97
What is the normal range for hematocrit
Men: 40-54%
Women: 36-48%
98
Which diagnostic test assesses hypo/hyper production of RBCs/platelet
Bone marrow aspiration
99
Which anticoagulants are commonly used for clotting disorders
Heparin,
| Coumadin
100
Which anti platelets are commonly used for blood disorders
Aspirin,
| Clopidogrel (Plavix) - risk for brain bleed
101
Which thrombolytic agent is us d in the ED to reverse the effects of stroke/TIA if used within 3 hours of the event
Streptokinase t-PA (tissue plasminogen activator)
