exam 3 study guide

Question 1

what are the tests to check for renal function and there normal values

Answer 1

1. sodium (Na+) levels (135-145 mEq/L) increeased indicates renal failure
2. Blood Urea nitrogen (BUN) (7-20mg/dl) most common, increased levels indicate decreased kidney filtration
3. creatinine levels (0.6-1.2 mg/dl)
4. potassium (K+) 3.5-5mEq/L decreased indicates renal failure

Question 2

what are the main causes for hyperglycemia

Answer 2

causes by increases glucose levels (70-100mg/dl)
-type I or II diabetes
-Cushing disease- hormone disorder
-system steroid use

Question 3

what are cardio biomarkers and what do they tell us?

Answer 3

*B-type naturietic peptide (BNP)- secreted by the ventricles, levels increase as CHF symptoms worsen
<100 pg/ml- no CHF
>500 pg/ml- indicates CHF
* troponin I- protein found primarily in cardiac muscle, when heart muscle is injured troponin is released into blood stream
normal value- <0.04 ng/mL

Question 4

what is the normal value of anion gap and what do we use it for

Answer 4

normal range- 8-16 mEq/L
helps us determine if metabolic acidosis is caused by an acid gain or a loss of a base

Question 5

what are the electrolytes that play a major role in neuromuscular function

Answer 5

*calcium (Ca)
*magnesium (Mg++)

Question 6

what is the primary role of sodium

Answer 6

major extracellular cation (+) that is controlled by kidney function, it is important because it regulates the water in our bodies

Question 7

what to expect of WBC when an infection is present

Answer 7

WBC also known as leukocytes will increase when indication of infection is present
>11000/mcL

Question 8

normal range for WBC and what does a left shift indicate regarding WBC

Answer 8

normal range: 5000-11000/mcL
left shift indicates that the body is trying to fight something off (stress, infection, or inflammation) due to increased banded neutrophils in the blood because bone marrow pushes them out in hopes to fight whatever is going on

Question 9

what is potassiums normal ranges and how is albuterol used regarding there levels

Answer 9

(K+) normal range: 3.5-5 mEq/L
as a temporary fix. albuterol will be given in high doses (typically 10-20 mg) to bring down levels of potassium by moving them from the blood into cells

Question 10

platelet count normal ranges/names

Answer 10

also known as thrombocytes
normal range: 150,000-400,000/mcL
thrombocytosis- increased platelets (blood clotting)
thrombocytopenia- decreased platelets (increased bleeding/no blood clotting)

Question 11

roles of albumin

Answer 11

*protein made in the liver
that maintains oncotic pressure and keeps fluids inside the blood vessels
normal value: 3.5-5g/dl

Question 12

definition of polycythemia and its causes

Answer 12

increased RBC caused by:
*high altitudes
*chronic hypoxia/hypoxemia
*tumors

Question 13

definition of anemia and its causes

Answer 13

too few red blood cells or not enough hemoglobin caused by:
*blood loss
*iron deficiency
*chronic disease
*bone marrow issues

Question 14

RT treatment for heart failure

Answer 14

1. oxygen therapy- WOB/O2
2. suction- assist in clearing airway
3. CPAP- improves decreased lung compliance, decreases left and right ventricular preload, enhance gas exchange (don’t use when pt is hypercapnia)
4. NIPPV/NIV/BiPAP- improves decreased lung compliance, decreases left and right ventricular preload, reduce WOB, enhance gas exchange
5. mechanical ventilation- when pt fails NIPPV, place on vent to prevent respiratory/cardiac arrest

Question 15

chest X-ray characteristics for heart failure

Answer 15

1. pulmonary edema
2. batwing/butterfly pattern
3. increased vascular markings
4. fluffy opacities
5. cardiomegaly
6. Kelley B lines

Question 16

what are the roles for the drug inotropic

Answer 16

inotropic drugs are used to reduce cardiac contractility, reduce strain on the heart, improve blood pressure, and improve cardiac output.
Examples: dopamine, dobutamine, and norepinephrine

Question 17

what is the role of diuretics

Answer 17

loop diuretics- lasik’s, pull off access fluid and salt by increasing urine production
(monitor labs because they can also pull off electrolytes)

Question 18

respiratory pattern seen in heart failure

Answer 18

Cheyenne stokes respiration- gradual increase of breathing (faster and deeper) followed by sections of apnea, cycle repeats

Question 19

what are the complications of left sides heart failure

Answer 19

1. when the left ventricular fails, it leads to slower CO and pulmonary congestion
2. pulmonary venous congestion leads to increased interstitial and pleural fluid retention
3. causes issues with systemic circulation, causes fluid back up in the lungs/chest cavity, and causes dyspnea/SOB

Question 20

what is the role of anti-diuretic hormone ADH

Answer 20

produced when your body thinks there isnt enough fluid because your heart is not pumping well so it releases ADH but this worsens the problem because it tells our body to hold onto water instead of peeing it out causing more fluid retention.

Question 21

what is the role of nitroglycerin

Answer 21

nitroglycerin- is a vasodilator that increases blood flow to the peripheral veins so less is backing up in the heart and reduces preload and afterload

Question 22

BNP levels in CHF

Answer 22

<100pg/mL is normal
>500pg/mL indicates CHF
electrolytes Na+, Cl-, K+ will be decreased if CHF is present, retaining more water dilutes electrolytes

Question 23

what is the role of CPAP with heart failure

Answer 23

improves decreased lung compliance, decreases left and right ventricular preload, and enhances gas exchange (by recruiting collapses alveoli)

Question 24

what is the mechanism behind pulmonary edema

Answer 24

(left ventricular failure only)
1. LV fails and blood cannot be pumped forward effectively
2. blood backs up into the lungs causing pressure to build in the pulmonary veins and capillaries
3. hydrostatic pressure increases pushing fluid out of the capillaries
4. fluid leaks into the interstitial space, interstitial edema forms
5. alveoli flood causing impaired gas exchange and atelectasis

Question 25

where is the location of phrenic nerves in the spinal column

Answer 25

phrenic nerves are located- spinal cord C3-C5

Question 26

what are the characteristics of ALS (Lou Gehrig's)

Answer 26

amyotrophic lateral sclerosis- fatal neurological disease due to loss of function of the motor neurons on the anterior horn of spinal cord. 1. sporadic- 90-95% 2. genetic 5-10% 3.progressive weakness begins in the periphery(hands/feet) most commonly 4. no treatment/cure

Question 27

what part of the nervous system is affected by Guillain Barre

Answer 27

autoimmune disease that attacks nerve tissues, resulting in demyelination and inflammation of peripheral nerves. typically follows after a viral or bacterial infection. (toes to head)

Question 28

effect of NMD on respiratory system

Answer 28

1.atelectasis 2.impaired cough 3.mucus plugging 4.sleep disordered breathing 5.hypoventilation 6. stiffening rib cage 7. aspiration 8.pneumonia 9.respiratory failure 10.death (effects breathing muscles, which effects breathing)

Question 29

how to diagnose myasthenia gravis

Answer 29

-chronic autoimmune disorder resulting from circulating antibodies which block/alter/destroy acetylcholine receptors(muscle contractions) (episodic, head to feet) 1. immunologic studies (antibody tests) 2. eye drooping/double vision 3. positive tensilon test- anticholinesterase inhibitor(if improves muscle strength indicates MG)

Question 30

general treatment for NMD

Answer 30

1.lung expansion/mucus clearances (no IS) 2. ventilatory support 3.Nutrition (protein calorie malnutrition increases risk for infection) 4.antibiotic therapy (with development of pneumonia) 5. anticoagulant and pneumatic compression sock therapy to prevent blood clots and pulmonary emboli

Question 31

treatment for Guillain Barre

Answer 31

1. plasmapheresis- plasma exchange 2. intravenous immune globulin (IVIG)

Question 32

what are the three ways neuromuscular system contributes to respiratory function

Answer 32

1. regulation of respiratory drive 2. ventilation 3. airway protection

Question 33

diagnostic testing for tuberculosis

Answer 33

1. chest XRAY 2. AFB sputum culture and smear used to test for acid-fast bacteria (done in AM) 3. QuantiFERON-TB gold test blood test used to test for mycobacterium tuberculosis

Question 34

isolation procedures

Answer 34

*airborne isolation* use of a single patient, negative pressure room N95 mask PAPR

Question 35

PPD test (Mantoux skin testing)

Answer 35

1. intradermal injection with a small amount of a purified protein derivative(PPD) 2. evaluated after 48-72 hrs 3. positive test does not mean active infection 4. induration less than 5 mm is neg 5. 5-9mm is suspicious, retest needed 6. >10mm considered positive positive reaction is evidence of recent or past infection or of active disease

Question 36

risk factors associated with tuberculosis

Answer 36

1. immune deficiency 2. close living quarters 3. homelessness 4. malnutrition

Question 37

what is seen in a chest xray for tuberculosis

Answer 37

1. ghon nodules 2. enlarged lymph nodes in hilar regions 3. captivation 4. fibrosis (calcification)

Question 38

what antibiotics are given to tuberculosis patients

Answer 38

1. Isoniazid 2. Rifampin 3. Pyrazinamide 4. Ethambutol 5. Streptomycin

Question 39

how long do you use antibiotics for tuberculosis

Answer 39

2 to 4 drugs given over 6 to 9 months

Question 40

normal range for chloride

Answer 40

98-107mEq/L