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Flashcards in Med Surg Exam 2 Deck (165):
1

Normal pH

7.35-7.45

2

Acidosis

<7.35

3

Alkalosis

>7.45

4

What do bases bind with?

Free H+ ions

5

What is a buffer?

any mechanism that resists changes in pH by converting a strong acid or base to a weak acid or base

6

What are some examples of chemical buffers?

ammonia
phosphates
carbonic acid-sodium bicarbonate system

7

What is the most active buffer system?

Carbonic acid-sodium bicarbonate system

8

How do you keep acids in balance with bases?

acids must be neutralized and excreted

9

What are two neutralizers?

CO2 (acid) and HCO3 (base) are neutralizers

10

What is normal acid base balance?

20 bicarbonate ions (HCO3) to 1 carbonic acid (H2CO3)

11

What must be controlled to maintain the acid base balance ratio?

Both bicarbonate ions and carbonic acid must be controlled.

12

How is CO2 continuously formed?

intracellular metabolic processes (cellular respiration)

13

Increased respiration means? (resp. compensation)

More CO2 produced

14

Decreased respiration means?(resp. compensation)

Less CO2 produced

15

How quickly does respiratory compensation occur?

within minutes (to preserve acid base balance)

16

How does the respiratory system regulate H+ concentration?

CO2 excretion (exhalation)
CO2 retention (to prevent alkalosis)

17

How does the renal system help acid base balance?

Excrete H+ ions
Reabsorbs (conserves) bicarbonate
Forms new bicarb (carbonic acid loses H+ ions)

18

What is the carbonic acid disassociation formula?

CO2 + H2O↔️H2CO3↔️H+HCO3

19

How do the kidneys compensate in acidosis?

excreting H+ (K+ stays) "If you're staying, I'm outta here"
retains bicarb

20

How do the kidneys compensate in alkalosis?

saves H+ (K+ goes) "i'm staying, get outta here"
excretes bicarb

21

Is renal compensation a stronger or weaker mechanism than respiratory compensation?

Stronger. It takes longer to respond 24-48 hours.

22

When is renal compensation fully stimulated?

When the Acid/Base imbalance lasts for several hours or several days

23

What causes respiratory acidosis?

Accumulation of CO2
COPD with CO2 retention (cant blow off co2)
Hypoventilation due to: sedation, overdose, anesthesia, change in LOC Closed head injury CVA

24

What are signs of respiratory acidosis?

headache, confusion, drowsiness, dyspnea, muscle weakness, elevated blood K+

25

What are causes of respiratory alkalosis?

hyperventilation
Hypoxia (trying to get O2)
fever-tachypnea

26

What are signs of respiratory alkalosis?

lightheaded, dizzy

27

What are causes of metabolic acidosis?

diabetic ketoacidosis, end stage renal disease
lactic acidosis & starvation

28

What are signs of metabolic acidosis?

Nausea
vomiting
disorientation
kussmaul respirations
muscle twitching
changes in LOC

29

What are causes of metabolic alkalosis?

overuse of antacids
vomiting
GI suction
hypokalemia

30

What are signs of metabolic alkalosis?

tingling
numbness
Decrease in Ca++
decrease in respirations
arrythmia r/t decrease in K+

31

How long after exposure does it take for the HIV virus to show up on a diagnostic test?

3 months

32

What is the diagnostic test ELISA used for?

The initial screening for HIV

33

Why is ELISA test used if there is a possibility of a false positive?

Because the test is inexpensive and mostly accurate. Anyone with a positive result must have additional testing to confirm the diagnosis

34

What is the Western Blot test used for?

To confirm the diagnosis of HIV when the results of an ELISA are positive

35

How does the ELISA test work?

Pt's serum is mixed with HIV grown in a culture. If the pt has antibodies to HIV, they bind to the HIV antigens and can be detected (a positive test)

36

How does the Western Blot test work?

Detects serum antibodies to four specific major HIV antigens. The presence of antibodies to at least two major HIV antigens is a positive test.

37

Three ways most common for transmission of HIV

Sexual, parenteral, perinatal

38

What do the results of a bone marrow aspiration or biopsy show?

Reflects degree and quality of bone marrow activity....indicates what different cell types/ quantity / proportion of each are present....can confirm spread of cancer cells from other tumor sites

39

Does bone marrow aspiration or biopsy require informed/signed consent?

Yes

40

What is obtained in a bone marrow aspiration?

Cells and fluid suctioned from the bone marrow

41

What is obtained in a bone marrow biopsy?

Solid tissue and cells obtained by coring out an area of bone marrow with a large bore needle

42

Who can perform a bone marrow aspiration or biopsy?

Physician, advanced practice nurse, or physician assistant

43

What is most common site for bone marrow aspiration/biopsy?

Iliac crest....May use sternum if more marrow is needed

44

What can pt expect to feel during bone marrow aspiration/ biopsy?

Heavy sensation of pressure and pushing, sometimes audible crunching sound can be heard. Painful pulling as the marrow is aspirated into needle. For biopsy, more pressure and discomfort is felt

45

Procedure for bone marrow aspiration

Skin site is cleaned, needle is inserted with twisting motion, marrow is aspirated into needle, needle is rapidly withdrawn, tissue supported at the site

46

Procedure for bone biopsy

Small incision is made in skin, biopsy needle inserted, pressure and several twisting motions are needed to ensure coring, external pressure applied to site until hemostasis is ensured...May use pressure dressing/sandbags to reduce bleeding

47

What is the number 1 nursing priority after bone marrow aspiration/biopsy?

Prevention of excessive bleeding

48

Follow up care for bone marrow aspiration/biopsy

Cover site with dressing, monitor for bleeding, infection, bruising. Avoid contact sports or potential trauma activities for 48 hours, aspirin free pain relievers, ice pack

49

Tissue responsible for blood formation (WBCs, RBCs, platelets)

Bone marrow

50

Immature, unspecialized, undifferentiated cells produced in the bone marrow.

Blood stem cells

51

A growth factor made in the kidneys that is specific for the RBC

erythropoietin

52

The three major types of plasma proteins

Albumin, globulins, fibrinogen

53

A main function of ALBUMIN

Maintains osmotic pressure of the blood, preventing plasma leakage to tissues

54

A main function of GLOBULINS

Transporting substances and functioning as antibodies

55

A main function of FIBRINOGEN

An inactive protein that is activated to form fibrin; important in blood clotting

56

The largest proportion of blood cells.

Red blood cells (erythrocytes)

57

The normal life span of a RBC

120 days

58

Name 2 items recycled items allocated from RBCs

Iron, hemoglobin

59

This substance is essential in hemoglobin, allowing it to transport up to four molecules of oxygen (the heme part transports oxygen).

Iron

60

What is the function of the globin portion of hemoglobin?

Carries carbon dioxide

61

Selective growth of stem cells into mature erythrocytes.

Erythropoiesis

62

What is the trigger for RBC production?

An increase in the need for tissue oxygenation

63

Stimulates increased RBC production in the bone marrow during hypoxia.

Growth factor erythropoietin

64

Substances needed to form hemoglobin and RBCs.

Iron, vitamin B12, folic acid, copper, pyridoxine, cobalt, nickel. A lack of any of these = anemia.

65

Perform actions important for protection through inflammation and immunity.

Leukocytes

66

Stick to injured blood vessel walls and form platelet plugs that can stop the flow of blood from an injured site.

Platelets

67

Bone marrow production of platelets is precisely controlled by this growth factor.

Thrombopoietin

68

Percentage of platelets in circulation/ percentage of platelets stored in the spleen

80%/ 20%

69

Destroys old or imperfect RBCs, breaks down the hemoglobin released from these destroyed cells, stores platelets, and filters antigens.

Spleen

70

Produces prothrombin and most of the blood clotting factors.

Liver

71

The multi-step process of controlled blood clotting.

Hemostasis

72

Three sequential processes result in blood clotting.

Platelet aggregation, blood clotting cascade, fibrin clot formation

73

Substances that cause platelets to clump.

ADP, calcium, thromboxane A2, collagen.

74

Conditions directly in the blood itself that first activate platelets and then trigger the blood clotting cascade.

Intrinsic factors

75

Outside of the blood that can activate platelets.

Extrinsic factors

76

An inactive protein made in the liver, acted on by thrombin to aid in blood clot formation.

Fibrin (converted to fibrinogen)

77

Anti-clotting forces involve two types of actions.

1. activated clotting factors are limited
2. fibrinolysis (prevents over-enlargement of clot)

78

Anti-clotting proteins

Protein C,, Protein S, antithrombin III

79

4 assessments for hematologic disorders

1. capillary refill
2. hair distribution
3. skin moisture
4. skin color

80

Anticoagulants do not break down existing clots. How do they work?

They interfere with one or more steps in the blood clotting cascade.

81

Drugs that selectively break down fibrin threads present in formed blood clots.

Fibrinolytic or thrombolytic drugs

82

The protein plasminogen activated to plasmin does what to fibrin?

Directly attacks and degrades it molecularly.

83

How does aspirin interfere with blood clotting?
a. prevents vitamin K synthesis
b. inhibits the activation of platelets
c. increases the rate of platelet destruction
d. prevents fibrin from assembling into long strands

b. inhibits production of substances that activate platelets such as thromboxane.

84

The single most common symptom of anemia.

Fatigue

85

Petechiae

Pinpoint hemorrhagic lesions in the skin

86

Hematuria

Blood in the urine appearing red or dark brownish gold

87

Is the normal adult spleen palpable?

No

88

Taking a drop of blood and spreading it over a slide.

Peripheral blood smear

89

CBC

Complete blood count: RBC, WBC, hematocrit, hemoglobin level
RBC in 1mm cubed of blood
WBC in 1mm cubed of blood
Hct % of RBCs in total blood volume

90

Reticulocyte count

Determining bone marrow function: a reticulocyte is an immature RBC that still has its nucleus

91

Platelet count

reflects the number of platelets in ciruclation

92

Hemoglobin electrophoresis

Detects abnormal forms of hemoglobin (sickle cell disease)

93

LAP

Leukocyte alkaline phosphatase: enzyme produced by normal mature neutrophils; elevated levels during stress or infection

94

Direct test: detects antibodies against RBCs that may be attached to a persons RBCs
Indirect test: detects presence of circulating antiglobulins

Coombs' test

95

Serum ferritin test

measures amount of free iron in the plasma

96

Transferrin

Protein that transports iron from the intestines to cell storage sites.

97

TIBC

Test measured by taking a sample of blood and adding measured amounts of iron to it (total iron-binding capacity).

98

PT test

Prothrombin time: how long blood takes to clot (normal 11-12.5 seconds)

99

INR

International normalized ration: divide the patient's PT by the established standard PT (normal 0.7-1.8)

100

PTT

Partial thromboplastin time: assesses the intrinsic clotting cascade and the action of factors II, V, VIII, IX, XI, and XII

101

Therapy monitored using PT levels

warfarin (Coumadin)

102

Therapy monitored using PTT or anti-factor Xa tests

unfractionated heparin (Calciparin)

103

Anti-factor Xa test

Measures amount of anti-activated factor X in blood affected by heparin: used mainly to monitor heparin levels

104

Platelet aggregation test

Mix patient's plasma with an agonist substance that should cause clumping (collagen, epinephrine, ADP, ristocetin).

105

Performed to evaluate the patient's hematologic status when other tests show persistent abnormal findings that indicate a possible problem in blood cell production or maturation. Reflects the degree and quality of bone marrow activity present.

Bone marrow aspiration and biopsy

106

hypertensive crisis

BP > 180/120 must be lowered immediately to prevent damage to target organs

107

hypertensive urgency

BP is very high but non evidence of immediate or progressive target organ damage

108

what are the 2 serum markers of myocardial damage

Troponin T and I,
Creatine kinase (CT)

109

What could be cause of bruit heard over an artery?

Aneurysm

110

essential hypertension

caused by things other than disease, examples are family history, over age 60, diet, physical inactivity, obesity, excessive alcohol intake, smoking

111

secondary hypertension

result of specific disease states and drugs, examples are kidney disease (number 1 cause), Cushing's disease, brain tumors, pregnancy, encephalitis

112

atherosclerosis

plaque in artery

113

Where is the major site of antibody production

spleen

114

What is given in case of heparin overdose?

protamine sulfate

115

What is given in case of cumadin or warfarin overdose?

Vitamin K

116

total cholesterol level

less than 200 mg/dL

117

Triglyceride level

less than 150 mg/dL

118

HDL level

greater than 40 mg/dL

119

LDL level for cardio pt's

less than 70 mg/dL

120

ECG

shows electrical activity of heart, detect dysrhythmias, and site and extent of MI...non-invasive and can be performed by nurse

121

ECHO

shows information about structure and movement of heart. useful for assessing heart valves. Uses ultrasound, non-invasive

122

pharmacologic stress echocardiogram pt prep

NPO for 3-6 hours before test and careful monitoring of pt before and after test

123

venous duplex ultrasonography

use of ultrasound to assess flow of blood through veins of arms and legs

124

stress test

shows how heart responds to increased workload...can be done with treadmill or with medicines...resting EKG and then carefully monitored while exercising.

125

what should pt be instructed on before stress test?

have a light meal a few hours prior to test and may have to hold certain meds.

126

What should be in room during a stress test?

emergency equipment and a cardiologist

127

arteriograms/coronary angiography

use of dye injected into arteries to evaluate blood flow in extremeties, mesentery, and brain...invasive and signed consent must be obtained

128

cardiac catheterization

use of contrast dye to evaluate blood flow in heart, invasive and requires signed consent

129

Why is hypertension nicknamed the silent killer?

usually NO symptoms other than elevated blood pressure

130

What are some early symptoms of hypertension?

headaches, facial flushing, dizziness, fainting

131

What are some late and serious symptoms of hypertension related to organ damage?

retinal and other eye changes, renal damage, MI, cardiac hypertrophy, stroke

132

Ischemia

insufficient oxygen supply to meet requirements of myocardium

133

Infarction

necrosis that occurs when severe ischemia is prolonged, irreversible damage to tissue

134

classic symptoms of MI

tightness, choking, or heavy sensation. pain may radiate to neck, jaw, shoulders, back, or arm (usually left), anxiety, dyspnea, SOB, dizziness, nausea, vomiting

135

atypical symptoms of MI (often seen in women)

indigestion, pain between shoulders, aching jaw, chocking sensation that comes with exertion, fatigue, sleep disturbance, dyspnea

136

stable angina

the pain subsides with rest or NGC

137

unstable angina

characterized by increased frequency and severity and is not relieved by rest and NGC...call 911

138

What are the 1st line barriers to infections?

PHYSICAL BARRIERS-Skin, Mucous Membranes, Cilia, Sneeze/Cough reflex, WBC's phagocytosis

CHEMICAL BARRIERS- Enzymes in saliva and tears. HCL acid in GI tract

139

What are the characteristics of active immunity?

It can be natural because the body makes antibodies during an illness.
Or it can be artificial because of vaccines or immunizations to help the body build up antibodies (ex. MMR, small pox, polio).
It is long lasting.
This is the best immunity.
Requires boosters to maintain quick response.

140

What are the characteristics of passive immunity?

Can be natural when passed from mother to fetus or baby through breast milk.
Provides a short-term protection against specific antigens.
Can be artificial if antibodies were produced outside of body and given to pt. via mimmunization. (Used for snake bites, rabies, tetanus).

141

Common agents that cause Anaphylaxis shock

Antibiotics (Penicilin, cephalosporins, tetracycline, streptomycin etc.)
Adrenocorticotropic hormone, insulin, protamine, vasopressin.
Vaccines, lidocaine, procaine, muscle relaxants.
ACE inhibitors, ARBs, Chemotherapy agents, Monoclonal antibodies, Opiates
FOODS
Peanuts, Shellfish, Eggs, legumes, Grains, Berries, Preservatives, Bananas.

Pollens, molds, latex,

Insects- bees, wasps, hornets, Fire ants, Snake venom

142

Common symptoms of Anaphylactic Reactions.

Initially- anxious: stress response.
Pruritus, Hives, Eyes and lips may swell.

Inflammatory response releases bradykinin which
causes- bronchiolar constriction- wheezes, Larynx swelling (hoarsness & stridor)- needs immediate intubation.
Hypotension- because of vasodilation and capillary permeability from histamine and serotonin (causes increase in mucous)

143

How to manage Anaphylactic Reactions

Intubation and ventilation
CPR
Epinephrine (can prevent vasoconstriction and bronchodilator)
Norepinephrine (constrictor)
Antihistamines (benedryl, H2 receptor blocker- ranitidine)
O2
Bronchodialator- Albuterol

144

What is Histamine's function with allergies?

Histamine causes an inflammatory response by opening up capillaries to allow proteins and WBC to travel to a specific location to fight off any infection. Proteins draw in the WBCs to create a more general inflammatory reaction

145

What is the function of T-Cells?

They attack the antigen directly.

146

What is the function of B-Lymphocytes?

They create antibodies that can neutralize, eliminate or destroy a specific antigen/OR they become memory cells that are inactive until the same antigen shows up which stimulate antibody production for a more rapid response.

147

What is the function of Helper T-Cells?

Release cytokines, Simulate B-cell and cytotoxic T-cell activity.
Secrete lymphokines which increases WBC activity.
Secrete immunoglobulins

148

What is the function of Cytotoxic T-Cells?

Recognizes infected "self cells"
Destroys Parasites, viruses, protozoans, bacteria.

149

What is the function of Killer T-Cells?

Respond to "non-self" antigen without being sensitzed.
Used for cancer therapy.
Seek and Destroy- transplants/cancer/ unhealthy tissue.
Bind to surface of invading cell.
Disrupt membrane.
Destroys cell by changing inside of the cell.
It kicks ass!!!!

150

What is the function of Suppressor T-cells?

Has opposite effect of helper T-Cells.
prevents immune system from over reacting.
prevents the formation of antibodies that attach to 'self' proteins. If this doesn't work well then there is an auto-immune disease.
Produce lymphokines that inhibit most of the immune system cells.
Calls of immune response when threat ends.

151

What is a scratch test?

It is a test that shows which allergies a person is vulnerable to (rhinitis, asthma, urticaria ((hives)). It can show an immediate hypersensitivity reaction usually within 15-20 minutes. Wheal show up when a reaction is positive

152

What is an intradermal test?

It's a test that is used for suspected causing allergens which did not test positive on a scratch test. This test has an increased risk of an adverse reaction. Sera is injected intradermally and the pt is observed for erythema and wheal formation. Degree of allergy is estimated by size of response.

It is important to have emergency equipment in case of anaphylaxis.

153

What is the Oral food change test?

It is used for allergic rhinitis when the allergen is eaten. This is used to identify specific allergens if skin testing is not conculsive and if keeping a food diary has failed to determine the offending food items.

154

What is in vitro testing?

Used in pt's who have extensive dermatoses resulting in the inability of skin testing. It produces higher test sensitivity and specificity by using a matrix capsule containing antigen bound to a hydrophilic carrier to produce enhanced specific IgE binding with lower nonspecific IgE binding. Disadvantages are potential decrease in sensitivity, added cost, and lack of immediate and visible response.

155

What are the factors that affect Immunity?

Age- thymus shrinks (T and B cell production slows)
Nutrition- Protein calorie malnutrition (inadequate protein to make cells.
Pre-existing disease- dulls immune response (renal failure, diabetes, burns, etc. causes immunosuppression).
Disease Treatments- Medications (corticosteroids suppress immune function)
Virulence of the organism, Number of Organisms, Innate/species resistance

156

Which statement best exemplifies the client's protection from cancer provided by cell-mediated immunity (CMI) after exposure to asbestos?

A. Cytotoxic and cytolytic T-cells destroy cells that contain the major histocompatibility complex of a processed antigen.

B. Helper and inducer T-cells recognize self-cells versus non-self-cells and secrete lymphokines that can enhance the activity of white blood cells.

C. Suppressor T-cells prevent hypersensitivity when a client is exposed to non-self-cells or to proteins.

D. Balance elicits protection when helper or inducer T-cells outnumber suppressor T-cells by a ratio of 2:1.

D.

Rationale
Optimal function of CMI requires a balance between helper and inducer T-cells and suppressor T-cells. This balance occurs when helper and inducer T-cells outnumber suppressor T-cells by a ratio of 2:1.

157

What are Type 1 Hypersensitivity (allergic) reactions?

acute inflammation in response to a normally harmless antigen
Pollen, Animal dander, Food, Drugs, Anaphylaxis

158

What are Type 2 Hypersensitivity (allergic) reactions?

ABO blood compatibility, Rh incompatibility, Hemolytic anemia's

159

What are Type 3 Hypersensitivity (allergic) reactions?

Immune complexes with antigens attached to the lining of Blood vessels. Autoimmun disorders (Rheumatoid arthritis, Systemic Lupus Erythematosis (SLE).

160

What are Type 4 Hypersensitivity (allergic) reactions?

Delayed reactions- occurs up to 48 hours later.
Most contact dermatitis (Poison Ivy, PPD, T-Cells sensitized by TB).

161

What are Type 5 Hypersensitivity (allergic) reactions?

Fail to recognize 'self' cells.
Immune system is 'on' for specific cell types (Graves Disease- TSH receptors are the target.
Type 1 Diabetes Mellitus)

162

What is the normal range for blood pH?

7.35-7.45

163

What is the normal range for PaCO2?

35-45mm Hg

164

What is the normal range for PaO2?

80-100mm Hg

165

What is the normal range for HCO3

24-30 mEq