Exam 2 Flashcards by Elisa Soto

List normal ranges for the following:

Sodium (Na⁺)
Potassium (K⁺)
Magnesium (Mg²⁺)
Calcium (Ca²⁺)
Phosphate (PO₄³⁻)

Sodium (Na⁺): 135–145 mEq/L
Potassium (K⁺): 3.5–5.0 mEq/L
Magnesium (Mg²⁺): 1.8–3.0 mg/dL (0.75–1.25 mmol/L)
Calcium (Ca²⁺): 8.5–10.5 mg/dL (2.1–2.6 mmol/L)
Phosphate (PO₄³⁻): 2.5–4.5 mg/dL (0.8–1.45 mmol/L)

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What are the major intracellular (IC) and extracellular (EC) cations?

IC = K⁺
EC = Na⁺

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This cation acts as a cofactor for enzymes; influences muscle irritability and cardiac rhythm

Mg²⁺

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This cation is responsible for blood clotting, nerve transmission, muscle contraction.

Ca²⁺

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This anion is vital for ATP, bone, and cell energy metabolism. Also has an inverse relationship with calcium.

Phosphate (PO₄³⁻)

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Low levels of this cation may manifest as tetany, Chvostek & Trousseau signs.

Ca²⁺

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List the % body weight as water for the following populations:
Infants
Children
Adult males; adult females
Seniors

Infants = 75 - 80% (they’re little water balloons)
Children = 65%
Adult males = 60%; adult females 50% (more fat)
Seniors = 45% (they’re dry and dusty)

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___ fluid is high in K⁺, Mg²⁺, PO₄³⁻.

intracellular (ICF)

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____ fluid is high in Na⁺, Cl⁻, HCO₃⁻.

Extracellular (ECF)

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Infants are more susceptible to fluid loss because they are less able to concentrate urine or conserve Na⁺ and water. True or False

True - their little kidneys suck.

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Which populations are more prone to dehydration? Why?

Very old and very young:
Very old = ↓ thirst and renal concentration ability
Very young = higher BMR; greater surface area to mass ratio; stinky little kidneys; rapid respiration.

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What is “third spacing”, what is it’s implication in dehydration, and what are some examples of causes?

Fluid shifts into interstitial or transcellular spaces due to conditions such as ascites or burns.

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T or F: Dehydration leads to reduction in RAAS.

False - RAAS activation is a compensatory mechanism for dehydration.

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In mild dehydration, approx. __% of body mass is water loss. Symptoms include thirst and slight dry ___.

mucosa

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In moderate dehydration, approx __% of body mass is water loss. Symptoms include ↓ skin __, dry membranes, and ____ ____.

turgor

orthostatic hypotension

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In severe dehydration, approx __% of body mass is water loss. Symptoms include rapid pulse, hypotension, ___ (low urine output), confusion, potential ____ shock

oliguria

hypovolemic

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Edema = excess accumulation of fluid in the ____ space

interstitial

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Renal failure, heart failure, corticosteroid excess, or rapid IV infusion can lead to this.

Hypervolemia (fluid volume excess).

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Cardiovascular signs of ____ (AKA FVE) include a ____ rapid pulse; ___ BP and ____ neck veins.

Hypervolemia

Bounding

elevated

distended

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What kind of breathing is associated with hypervolemia?
What do the lungs sound like?
The sputum?

Dyspnea
Crackles/rales
Pink frothy sputum from pulmonary edema

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True or False:
Hypervolemia can cause polyuria initially, but later lead to oliguria.

True - as kidneys become taxed, they work less.

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A __ solution is usually used for hypovolemic shock.

isotonic (normal saline)

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Lactated Ringer’s (LR) is usually used for ____, surgery, GI losses, metabolic ____. Indicate its tonicity.

burns
acidosis

Isotonic

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What is the tonicity of D5W (5% Dextrose in Water)? What is it used for?

Isotonic.
Hypernatremia due to dehydration.

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____% saline, ___% saline, and D___W (___% Dextrose in Water) are all hypotonic solutions used to treat dehydration.

0.45% 0.33% D2.5W or 2.5% Dextrose in Water

__% saline, D_NS (__% Dextrose in ___% NS), D__W (__% Dextrose in Water), and D__LR (__% Dextrose in LR) are all examples of hypertonic solutions.

3% D5NS (5% Dextrose in 0.9% NS) D10W (10% Dextrose in Water) D5LR (5% Dextrose in LR)

Why would hypertonic solutions be used? What about D10W? What about D5LR?

For hyponatremia. Nutritional support. Burns or traumatic injury.

The goal of ___ solutions are to restore blood pressure, expand plasma volume. The goal of ___ solutions are to reduce cerebral edema. The goal of ___ solutions are to rehydrate cells / restore intracellular fluid.

isotonic hypertonic hypotonic

List the normal ranges for: pH HCO₃⁻ PaCO₂

pH = 7.35 - 7.45 HCO₃⁻ = 22 – 26 mEq/L PaCO₂ = 35 – 45 mm Hg

What does the mnemonic ROME stand for? What 2 values are being referenced?

Respiratory = opposite Metabolic = equal Respiratory = pH and PaCO₂ Metabolic = pH and HCO₃⁻

Metabolic acidosis/alkalosis is uncompensated when ___ levels are normal. Respiratory acidosis/alkalosis is uncompensated when ___ levels are normal.

PaCO₂ HCO₃⁻

Metabolic acidosis/alkalosis is partially compensated when ___ levels are abnormal. Respiratory acidosis/alkalosis is partially compensated when ___ levels are abnormal.

PaCO₂ HCO₃⁻

Metabolic acidosis/alkalosis is fully compensated when ___ and ____ levels are not normal, and ____ is within range but below or above the midpoint. Respiratory acidosis/alkalosis is fully compensated when ___ and ____ levels are not normal, and ____ is within range but below or above the midpoint.

Both PaCO₂ and HCO₃⁻ are not normal, and pH is within range but above or below the midpoint for alkalosis and acidosis, respectively. This is true for both metabolic and respiratory alkalosis and acidosis with full compensation.

____ respirations are deep, rapid, labored breathing that occur as a compensatory response to metabolic acidosis, especially in ____ ____ (DKA).

Kussmaul diabetic ketoacidosis

Prolonged vomiting can lead to metabolic ___. COPD can lead to chronic respiratory ___ with ____ renal compensation.

alkalosis acidosis; partial

Give the normal values for: PaO₂ SaO₂

PaO₂ = 80 – 100 mmHg SaO₂ = 95 – 100%

List the metabolic disorders commonly associated with these conditions: 1. COPD, pneumonia, narcotic overdose 2. Anxiety, fear, mechanical ventilation, pain 3. Vomiting, NG suctioning, diuretics 4. DKA, renal failure, diarrhea, lactic acidosis

1. Respiratory acidosis 2. respiratory alkalosis 3. metabolic alkalosis 4. metabolic acidosis

What impact do the following have on serum potassium levels: * Diuretics (loop, thiazide) * GI losses (vomiting, diarrhea, NG suction) * Excess insulin * Alkalosis

Hypokalemia.

What impact do the folowing have on serum potassium levels: * Renal failure (most common) * ACE inhibitors, ARBs * Tissue trauma, burns (cell lysis) * Acidosis

Hyperkalemia

Pyrogens (trigger substances) act on the ____ to raise the set-point above 37 °C (98.6 °F

hypothalamus

interleukin-1 interleukin-6 tumor necrosis factor-α Are all examples of what?

Endogenous pyrogens (induce inflamation)

Put the 4 stages of a fever in order and give a brief description: Chill Flush Defervescence Prodrome

1️⃣ Prodrome (Stage of Onset) 2️⃣ Chill (Stage of Temperature Rise) 3️⃣ Flush (Stage of Fever Plateau) 4️⃣ Defervescence (Stage of Fever Break)

Describe each of these patterns of a fever: Intermittent Remittent Sustained Relapsing

**Intermittent** = Temp returns to normal each day (e.g., septicemia, endocarditis). **Remittent** = Fluctuates > 2 °C daily but never normal (e.g., viral URI). **Sustained** (continuous) = Constant > 38 °C with minimal variation (e.g., drug reaction). **Relapsing** (recurrent) = Fever returns after afebrile period > 1 day (e.g., TB, malaria).

What are the rectal and axillary temperature differences relative to oral temp? What are the disadvantages of temporal temperature?

Rectal = >0.5C than oral Axillary = <0.5C than oral Accuracy varies with sweat or air drafts.

Compare wound regeneration vs. wound repair.

Wound regeneration = replacement with the same cell type. Wound repair = repair with scar tissue when replacement is not possible.

What are the 3 major phases of wound healing?

1. Inflammatory Phase 2. Proliferative Phase (Granulation) 3. Maturation / Remodeling Phase

Describe the process for the 3 major phases of wound healing. 1. Inflammatory Phase 2. Proliferative Phase (Granulation) 3. Maturation / Remodeling Phase

1. Inflammatory Phase = hemostasis and inflammation. 2. Proliferative Phase (Granulation) = Fibroblasts synthesize collagen; Angiogenesis; and Epithelialization: new cells migrate across wound bed. 3. Maturation / Remodeling Phase = Collagen remodeling (Type III collagen replaced by stronger Type I); Contraction by myofibroblasts; Scar formation

Surgical incision is an example of __ intention. A Pressure injury is an example of __ intention. A Wound left open initially and closed later after healing is __ intention.

Primary Secondary Tertiary

1. ____ is when wound edges separate. 2. ____ is protrusion of viscera through incision. 3. ____ excessive collagen → hypertrophic scar. 4. ____ excessive wound contraction. 5. ____ microbial contamination delays healing.

1. Dehiscence 2. Evisceration 3. Keloid 4. Contracture 5. Infection

List and describe the 5 cardinal signs of inflammation. ("Really Tender Calves Don't Function.")

Rubor - redness Tumor - swelling Calor - heat Dolor - pain Functio laesa - loss of function

Components of inflammation: 1. ____ Stage = vasodilation, increased permeability, plasma leakage. 2. Cellular Stage = WBC migration ~Neutrophils (first responders, __-__hrs) → phagocytose debris. ~Macrophages (later) → secrete ____ (IL-1, TNF-α) & promote healing.

1. Vascular 2. 6–12 hrs; cytokines

1. The inflammatory phase begins at injury → lasts __-__ days. 2. The proliferative phase (aka _____) starts day __ or __ and lasts up to ____ weeks. 3. The maturation / remodeling phase starts ___ weeks and lasts for up to ___ ____.

1. 3–5 2. Granulation; days 3 or 4; 3 weeks 3. 3 weeks; one year

What do all of the following have in common: Histamine Prostaglandins Leukotrienes Bradykinin Cytokines (IL-1, TNF-α) Complement system

They are all mediators of inflammation.

List the 6 links in the chain of infection ("I Really Prefer My Probiotic Strong").

1. Infectious Agent 2. Reservoir 3. Portal of Exit 4. Mode of Transmission 5. Portal of Entry 6. Susceptible Host

True or False: P. aeruginosa is a true pathogen.

False - opportunistic

The early clinical manifestations of sepsis ("Warm Stage") include what symptoms of each of the following systems: Cardio Skin Respiratory Neuro Renal

Cardio = tachy; bounding pulse, reduced BP Skin = warm, flushed Respiratory = tachy; poss. resp. alkalosis Neuro = anxious, mild confusion Renal = reduced

The latter signs of sepsis include what symptoms for each of the following: Cardio Skin Respiratory Neuro Renal

Cardio = hypotension Skin = cold, clammy Respirations = tachy Neuro = altered / coma Renal = oliguria or anuria

Complications of sepsis include septic ___; ____ ____ ____ (DIC); ____ ____ ____ ____ (ARDS); and ____ ____ ____ ____ (MODS).

septic shock Disseminated intravascular coagulation (DIC) Acute respiratory distress syndrome (ARDS) Multiple organ dysfunction syndrome (MODS)

What is a "negative" culture test? If multiple organisms are ID'd, what is the likely cause?

"Negative" = NG in 24 - 72 hrs Multiple most likely a contaminated specimen.

Immunoglobulins (antibodies) are ____ produced by activated B lymphocytes (plasma cells) in response to antigens. They bind specifically to antigens and facilitate neutralization, ____, ____ activation, and immune memory.

glycoproteins opsonization (tagging) complement (activation)

This immunglobulin class protects mucosal surfaces (local immunity) and prevents pathogens from adhering to epithelial cells. This immunglobulin class acts as B-cell receptor to activate B cells - its function is not fully understood.

IgA (saliva/tears in mucosa) IgD (B looks like D; and D is dunno)

Put the immunglobulins in order from greatest to least concentration.

IgG, IgA, IgM, IgE-IgD (GAMED)

Which two immune globulins activate compliment?

IgG and IgM

Protection takes approx. ____ weeks post-vaccine (time for active immunity to develop).

These immune cells serve as a "bridge" between innate and adaptive immunity; present antigen to naïve T cells.

Dendritic

These immune cells kill virus-infected or tumor cells with no prior sensitization required.

NK cells

These immune cells secrete cytokines; activate B cells and cytotoxic T cells.

Helper T cells (CD4+)

These immune cells destroy infected or malignant cells after antigen exposure.

Cytotoxic T cells (CD8+)

What are small proteins secreted by immune cells that function as chemical messengers to regulate inflammation, immunity, and hematopoiesis.

cytokines

A ___ is a subclass of cytokines that specifically attract WBCs to the site of infection or injury — the drivers of chemotaxis (cell migration). They are produced by ____, fibroblasts, and endothelial cells.

Chemokines Macrophages

____ directs movement of leukocytes along a chemical concentration gradient toward the site of tissue injury or infection - it's how neutrophils know where to go!

Chemotaxis (taxis take them there!!!)

____ are lipid mediators derived from arachidonic acid (via the cyclooxygenase [COX] pathway) that regulate inflammation, vasodilation, pain, and fever.

Prostaglandins

A ____ is a preformed inflammatory mediator stored in mast cells, platelets, and other cells released during injury or ____ reaction.

histamine allergic

Histamine receptors: ____ induces inflammation, allergy, smooth-muscle contraction ____ increases gastric acid secretion ___ / ___: stimulate CNS & immune modulation

H₁ H₂ H₃/H₄

In general, interleukins are ___ (along with TNF). But IL-8 is a ___ and attracts neutrophils to the site of infection (a process called ____)

cytokines chemokine Chemotaxis

What's the difference between NSAIDs and Corticosteroids (i.e., what do they suppress/block)?

NSAIDs - prostaglandins Corticosteroids - cytokines

Identify the types of pain by their description: 1. Originates in skin, muscles, bones, joints 2. From internal organs; transmitted by C fibers 3. From nerve injury or abnormal sensory processing 4. Felt at site distant from source

1. somatic 2. visceral 3. neuropathic 4. referred

Describe the 4 steps in the pain pathway. ("Turn To Pain Management").

Transduction - stimulus starts electrical impulse Transmission - impulse travels to CNS Perception - CNS interprets stimulus Modulation - inhibitory mechanisms to deal with the pain (endorphins, GABA, etc.)

Which pain scale is used for children or non-verbal adults? For infants or non-verbal adults?

Wong–Baker FACES Scale FLACC Scale

What is the Classic Triad of Opioid Overdose?

Bradypnea (or even apnea), CNS depression, and miosis (pinpoint pupils).

Naloxone / Narcan binds to ____, ____, and ____ receptors in CNS competitively displacing opioids and reversing their effects.

mu, kappa, and sigma

Name the headache: Most common; caused by muscle tension, stress, anxiety, poor posture. Gradual onset. Dull, tight, non-throbbing pain; “tight headband.” No nausea, aura, or photophobia accompanying it.

Tension headache

Name the headache: Neurovascular disorder involving vasodilation, inflammation, and activation of the trigeminovascular system. Nausea, vomiting, photophobia, phonophobia. May include aura.

Migrane

Name the headache: Severe form of headache due to activation of hypothalamus and trigeminal pathways; often seasonal or circadian. Often occurs same time daily for weeks.

Cluster

Name the headache: Chronic daily headache from frequent analgesic use (>10–15 days/mo).

Medication-overuse (rebound)

Hormonal fluctuations, stress, fatigue, skipping meals, bright lights, weather changes, caffeine, chocolate, aged cheese, wine, nitrates are common causes for this type of headache.

Migrane

True or False: Migranes are most often preceded by an aura.

False - Without aura is most common (80–85%).

Describe the 4 phases of a migrane headache (PAHP).

1️⃣ Prodrome: hours–days before, mood changes, food cravings, fatigue. 2️⃣ Aura (20–30%): transient neurologic symptoms (visual flashes, scotoma, tingling). 3️⃣ Headache phase: pain with N/V, photophobia, phonophobia (4–72 hrs). 4️⃣ Postdrome: fatigue, weakness, “migraine hangover.”

What type of headache causes severe stabbing pain behind one eye with tearing and nasal congestion.

cluster

A nurse is explaining the renin–angiotensin–aldosterone system (RAAS) to a student. Which of the following shows the correct sequence of events that occur when blood pressure falls? A. ↓ BP → ACE release → Angiotensin II → Renin → Aldosterone B. ↓ BP → Aldosterone → Renin → Angiotensin I → Angiotensin II C. ↓ BP → Renin → Angiotensinogen → Angiotensin I → ACE → Angiotensin II → Aldosterone → ↑ Na⁺ & H₂O reabsorption → ↑ BP D. ↓ BP → Angiotensinogen → ACE → Angiotensin II → Renin → ↑ BP

✅ Correct Answer: C 💡 Rationale: The correct RAAS order is: ↓ BP = ↓ renal perfusion → Renin release (kidneys) → Angiotensinogen → Angiotensin I → ACE (lungs) → Angiotensin II → Vasoconstriction + Aldosterone release (adrenal cortex) → ↑ Na⁺ & H₂O reabsorption (kidneys) → ↑ Blood pressure & volume 🧠 Mnemonic: “Really Awesome ACE Activates Aldosterone”

Exam 2 Flashcards

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