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Flashcards in Exam II Deck (101)
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1

Which body organ controls bicarbonate (NaHCO3)?

Kidneys

2

Which body organ controls carbon dioxide (CO2)?

Lungs

3

_____ rids the body of excess CO2

Breathing

4

When CO2 raises in the brain blood and tissues central receptors trigger neurons to increase the rate and depth of breathing, causing _____

Hyperventilation

When the CO2 is "blown off" ECF decreases

5

pH below ____ and above _____ is usually fatal

6.9, 7.8

6

What are the health problems that increase acid production?

Diabetic ketoacidosis,
Seizures

7

What are the health problems that decrease acid production?

Respiratory impairment,
Kidney impairment

8

A base deficit is caused by which two functions?

Over elimination,
Underproduction of bicarbonate

Overproduction is a result of diarrhea
Underproduction is a result of pancreatitis and dehydration

9

Which four body systems typically exhibit manifestations of acidosis first?

Musculoskeletal,
Cardiac,
Respiratory,
CNS

10

What are the four process that can result in metabolic acidosis?

Overproduction of hydrogen ions,
Under elimination of hydrogen ions,
Under production of bicarbonate ions,
Over elimination of bicarbonate ions

11

What is the substance that releases hydrogen ions?

Acid

12

What is the substance the takes up hydrogen ions?

Base

13

Acid is produced through ______

Cellular metabolism

14

This occurs when body fluids resist large changes in the pH when acids or bases are added or removed

Acid buffering

15

What are the most common pathological processes disturbed by acid-based imbalance?

COPD,
Acute respiratory distress syndrome,
Acute pneumonia,
Pulmonary edema,
Kidney failure

16

What are the processes that can cause metabolic acidosis?

Overproduction of hydrogen ions,
Under elimination of hydrogen ions,
Under production of bicarbonate ions,
Over elimination of bicarbonate ions

17

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.

Respiratory acidosis

18

What are the physical results of respiratory acidosis?

Respiratory depression,
Inadequate chest expansion,
Airway obstruction,
Reduced alveolar-capillary diffusion

19

Which specific drugs can impair gas exchange?

Diuretics,
Aspirin

20

Which health problems can lead to acid base imbalance?

Cardiac problems
Kidney problems,
Pulmonary impairment

21

What are the first physical symptoms with mild acidosis?

Cardiovascular changes; increased heart rate and cardiac output

With worsening acidosis or acidosis and hyperkalemia, heart rate decreases

22

Which blood products are produced in bone marrow?

Red blood cells (RBCs, erythrocytes),
White blood cells (WBCs, leukocytes),
Platelets

Bone marrow is also involved with immune response

23

Where is cell producing marrow present?

Flat bones (sternum, skull, pelvic and shoulder girdles),
Ends of long bones

24

Immature, unspecialized (undifferentiated) cells that are capable of becoming any type of cell, depending on the body's needs, are_____

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)