U2

Question 1

OSMOSIS

Answer 1

Osmosis: The movement of fluid through a semipermeable membrane, from an area of low solute concentration to an area of higher solute concentration until equilibrium is reached.

Question 2

HYDROSTATIC PRESSURE

Answer 2

Hydrostatic pressure “PUSHES” fluid out of the blood vessel into the tissue on the arterial side of the capillaries.

Question 3

OSMOTIC (ONCOTIC) PRESSURE

Answer 3

Osmotic (oncotic) pressure is the “PULL” that attracts fluid out of the tissue back into the blood vessel on the venous side of the capillaries. Molecules with PULLING POWER are Protein, Glucose, and Sodium..

FYI: Protein and Glucose are big and attract water.
Sodium hangs out in gangs and sucks the water.

Ethiopian kids on commercials that emaciated but have big bellys. This is from hydrostatic pressure and lack of osmotic pressure from lack of protein, glucose or sodium.

Question 4

ISOTONIC

Answer 4

Isotonic: MOST COMMONLY USED. This fluid moves equally back and forth across a membrane without increasing or decreasing the cell size. Preferred for fluid replacement since the tonicity (sodium concentration) is similar to blood. To remember that ISOtonic fluids are used for almost all situations, “I SO perfect”. Examples: 0.9% normal saline (NS) and lactated ringers (LR). STAYS WHERE I PUT IT. * MOST SAFE

Question 5

HYPERTONIC

Answer 5

Hypertonic: fluid is attracted from the tissue into the blood stream by the high concentration of solutes in hypertonic fluid. LARGE molecules like Proteins and Glucose attract water (Examples: Albumin, D50, hetastarch). High concentrations of sodium (higher than 0.9%) also attract water (“SALT SUCKS!”). Hypertonic solution can be given IV when RAPID FLUID REPLACEMENT is needed (usually in an emergency when there is extreme blood loss and the blood vessels need to be filled up with fluid to keep the person from losing blood pressure and dying); OR, when the TISSUE is OVER - HYDRATED (as in edema or Third Spacing) to “pull” or attract fluid out of the tissue. Examples: 3% saline, 6% saline, etc. FLUID ENTERS BLOOD VESSELS **MOST DANGEROUS

Question 6

HYPOTONIC

Answer 6

Hypotonic: fluid moves to area of higher concentration so a hypotonic solution (which is low in solutes) moves toward the higher concentration of solutes outside of the blood stream. Hypotonic solution is given IV when the TISSUE is DEHYDRATED (as in diabetes or burns). Examples: 0.45% NS; D5W. FLUID GOES OUT OF BLOOD VESSELS

Question 7

HYPERTONIC SOLUTION EXAMPLES

Answer 7

Albumin
3% Saline
Hetastarch

Question 8

ISOTONIC SOLUTION EXAMPLES

Answer 8

.9% saline (NS)
D5W (while in bag)
LR
40 eEq K+ in .9% Saline

Question 9

HYPOTONIC SOLUTION

Answer 9

D5W in the body

.45% Saline

Question 10

DAMAGING EFFECTS OF EDEMA

Answer 10

a. Impaired blood flow (and O2 delivery)
b. Reduced local healing of tissue
c. Metabolic wastes cannot easily leave cells so
toxins build up.
d. Increases workload on the heart as it tries to
move fluid through the blood veins. More
pressure is required to push the excess fluid
which raises B/P → chronic hypertension.

Question 11

LIFE THREATENING EDEMA

Answer 11

Laryngeal edema (causes AIRWAY blockage).
b. Pleural edema (BREATHING impaired).
c. Cerebral edema (fluid crushes the brain inside
the skull and then the BRAIN stops working).

Question 12

THIRD SPACING EDEMA

Answer 12

THIRD-SPACING: too much fluid moves from the intravascular space (blood vessels) into the interstitial or “third” Space - the nonfunctional area between cells. This can cause potentially serious problems such as edema, reduced cardiac output, and hypotension (because fluid has moved out of the blood vessels → low blood pressure).

Question 13

CALCIUM

Answer 13

extracellular cation
Calcium “Calms” muscle & nerves
-Affects nerves and muscles
-If too LOW → tetany

positive Chvostek’s sign because muscle cannot calm down.

8.5 - 10.5

Question 14

MAGNESIUM

Answer 14

INTRACELLULAR CATION
Magnesium “Calms”
smooth muscle and DTRs
-Affects deep tendon reflexes (DTR) and smooth muscle (i.e., lungs/ uterus/ heart/intestines)
-If not enough Mg → hyperreflexia because DTRs cannot relax.

1.5 – 3.0

Question 15

POTASSIUM

Answer 15

INTRACELLULAR CATION
Potassium “Excites” Cardiac tissue
-Affects heart (either high or low potassium)
causing dysrhythmias

3.5 – 5.0

Question 16

SODIUM

Answer 16

EXTRACELLULAR CATION
Sodium “Excites” Nervous Syst.
-Affects BRAIN and nervous system = causes changes in level of consciousness (LOC) and seizures.

135 – 145

Question 17

DESICCATION

Answer 17

Desiccation is the state of extreme dryness, or the process of extreme drying.

Question 18

ACIDOSIS

Answer 18

pH of arterial blood is below survival range (7.35-7.45)

Question 19

ALKALOSIS

Answer 19

pH of arterial blood is above survival range (7.35-7.45)

Question 20

CHEMICAL BUFFERS

Answer 20

Bicarbonate buffer, Phosphate buffer, and Protein buffers

Buffers function almost instantaneously

Question 21

3 MECHANISMS THAT MODERATE PH

Answer 21

CHEMICAL BUFFERS
RESPITORY SYSTEM
RENAL SYSTEM

Question 22

RESPITORY SYSTEM

Answer 22

Uses respiration to “blow off” excess carbon dioxide (an acid) to normalize low pH

Respiratory mechanisms take several minutes to hours

Question 23

RENAL SYSTEM

Answer 23

Controls excretion of Hydrogen ions (acid control) and Bicarbonate (base control)

Renal mechanisms may take several hours to days

Question 24

IF PATIENT IS ACIDOTIC

WHAT OCCURS WITH THE RESPIRATORY SYSTEM

Answer 24

If Acidotic: The lungs try to raise pH by “blowing off” CO2 (which makes a weak acid in the body – carbonic acid). This results in a KUSSMAUL breathing pattern - deep rapid breathing).

Question 25

IF PATIENT IS ALKALOTIC WHAT OCCURS WITH THE RESPIRATORY SYSTEM

Answer 25

If Alkalotic: The body will reduce ventilations to conserve CO2. Hyperventilation (which causes respiratory alkalosis) can occur with fever, anxiety, pain, or as a result of ventilator providing too much oxygen.

Question 26

METABOLIC REGULATION (KIDNEYS) REACTION TO ACIDOSIS

Answer 26

If Acidotic: The kidneys will excrete hydrogen ions [H+] to get rid of acid and retain Bicarbonate (a base) to neutralize acid.

Question 27

METABOLIC REGULATION (KIDNEYS) TO ALKALOSIS

Answer 27

If Alkalotic: The kidneys will retain H+ excrete bicarb.

Question 28

NORMAL RANGE FOR PC02 (RESPIRATORY)

Answer 28

35 - 45

Question 29

NORMAL RANGE FOR HCO3 (RENAL)

Answer 29

22 - 26

Question 30

EFFECTS OF ACIDOSIS

Answer 30

Principal effect of ACIDOSIS is DEPRESSION of the Central Nervous System (decrease in synaptic transmission).
Deranged CNS function is the greatest threat
Generalized weakness
Severe acidosis causes: Disorientation - Coma - Death

Question 31

EFFECTS OF ALKALOSIS

Answer 31

Principal effect of ALKALOSIS is EXCITATION of the Central Nervous System.
S/s initially are numbness/lightheadedness
Severe Alkalosis causes: Muscle spasms or tetany - Convulsions - Death

Question 32

ARTERIAL BLOOD GAS

COMPENSATED

Answer 32

Compensated = pH is NORMAL and other two values are abnormal

Question 33

ABG

UNCOMPENSATED

Answer 33

Uncompensated = pH and one other value is abnormal

Question 34

PARTIALLY COMPENSATED

Answer 34

Partially Compensated = all values are abnormal

Question 35

Body Chemistry Involved in the Stress Response

Catecholamines

Answer 35

Body Chemistry Involved in the Stress Response

Catecholamines (epinephrine/norepinephrine) prepare the body to act & cortisol mobilizes energy (glucose) and other substances needed to fuel the action.

1-Epinephrine– exerts its chief effects on the cardiovascular system. This occurs through vasodilation of blood vessels that supply these organs

Increases cardiac output to maintain blood pressure
Increases blood flow to the brain

Increases blood flow to the skeletal muscles
Dilation of the airways– increases delivery of o2 to the bloodstream

2-Norepinephrine– the effects complement those of epinephrine. Works through vasoconstriction
It constricts blood vessels of the viscera and skin–>this shifts blood flow to the vessels dilated by epinephrine.
Also increases mental alertness

Question 36

Body Chemistry Involved in the Stress Response

Cortisol

Answer 36

Cortisol – Corticosteroid that acts as both a mediator and an inhibitor of the stress response to prevent over activation of SNS
Mobilizes glucose, amino acids, lipids and fatty acids and delivers them to the bloodstream
Suppresses immune and inflammatory function
Antagonizes the effects of insulin
Enhances the effects of catecholamine on the cardiovascular system
Suppresses osteoblast activity, hematopoiesis, protein and collagen synthesis.
Glucose increases with stress. Prolonged and unrelenting stress causes a chronic elevation of glucose levels that leads to Diabetes Mellitus

Question 37

Body Chemistry Involved in the Stress Response

Answer 37

Catecholamines
Cortisol
ADH

Question 38

Body Chemistry Involved in the Stress Response

Antidiuretic Hormone

Answer 38

Antidiuretic Hormone (ADH) –
Excreted from the pituitary gland; stimulates the kidneys to RETAIN fluid thereby increasing blood pressure.
Also causes VASOCONSTRICTION which helps to increase blood pressure.
Participates in the Renin-Angiotensin-Aldosterone pathway (to be discussed in the Renal System Unit).

Question 39

Effects of Prolonged Stress

Answer 39

Cardiovascular – Sympathetic Nervous System (SNS) increases heart rate and blood pressure. Prolonged
stress can be a cause of chronic hypertension and cardiovascular disease.

Immune system – Decreased Lymphocyte production. Decreased T cell activity → prone to infections. Increase in proinflammatory processes (via cytokines). Suppresses Natural Killer cell function (NK cells are responsible for killing tumors). Reactivates latent viruses (i.e., herpes virus; Epstein Barr virus).

Gastrointestinal system – is deactivated by the SNS (because the GI tract is not needed for “Fight or Flight” activities. → slow peristalsis, ulcers, constipation, serious bowl problems.

Endocrine system – Release of cortisol from the adrenal glands increases blood sugar for energy needs Hyperglycemia (Diabetes Mellitus Type 2) Hypothalamic/Pituitary Axis effects on reproductive system (in particular the female) Responsible for the "hypothalamic" amenorrhea of stress, depression and eating disorders, and the hypogonadism of Cushing's syndrome. Effects lipid alterations (a cause of obesity).

Central Nervous system
Fatigue & lethargy: protein catabolism
Depression, anxiety, insomnia: activity of neurotransmitters & neurohormones

Cancer
A. Decreased natural killer cell activity
B. Poor repair of damaged DNA
C. Alterations in the rates of apoptosis of immune and cancer cells
D. Psychosocial interventions extended the lives of women with breast cancer.

Autoimmune disorders - Diseases impacted by increased humoral activity. Inflammatory process is triggered – damage to tissue caused by proinflammatory chemicals that then triggers the immune system to fight against the body in genetically susceptible individuals.