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.UNMC Pathophys 2 Exam 4.
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UNMC Pathophys 2 Exam 4.
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UNMC Pathophys 2 Exam 4Alteration due to Renal Failure/Disorders
Hematocrit - ANS-Decreased - Anemia
Due to decreased synthesis of erythropoietin. Erythropoietin stimulates bone marrow to
produce RBC. When nephrons fail, kidneys cannot produce erythropoietin.
Hematocrit - the ratio of the volume of RBCs to the total volume of blood; NOT caused
by Anemia - IS Anemia
Alteration due to Renal Failure/Disorders
Potassium - ANS-Increased - Hyperkalemia
Because Nephrons cannot excrete excess Potassium. Nephron damage or failure leads
to decreased Glomerular Filtration Rate, which leads to the inability to filter out
potassium.
OR
Acidosis can cause Hyperkalemia
Due to cellular ion exchange
Alteration due to Renal Failure/Disorders
Calcium - ANS-Decreased - Hypocalcemia
Due to:
1.) decreased renal synthesis of Vit D, which decreases absorption of calcium
2) high phosphate levels bind more calcium - leaving less active calcium in blood
* Note - phosphate & Calcium are antagonistic = if calcium is low, phosphate is high &
vice versa
Alteration due to Renal Failure/Disorders
Phosphate - ANS-Increased
Because nephrons cannot excrete excess. Nephron damage or failure leads to
decreased Glomerular Filtration Rate, which leads to the inability to filter out Phosphate
* Note - Phos-Lo is a calcium supplement used to lower phosphate. Phosphate &
Calcium are antagonistic = if calcium is low, phosphate is high & vice versa
Alteration due to Renal Failure/Disorders
pH - ANS-Low - Acidosis
1) Kidney is chief regulator of pH. Reduced number of functioning nephrons cannot
clear acid ions. Nephron damage or failure leads to decreased Glomerular Filtration
Rate, which leads to the inability to filter out excess H+.
2) Also less Bicarbonate reabsorption (HCO3-)
,Alteration due to Renal Failure/Disorders
Creatinine - ANS-Increase
Because kidneys are unable to clear excess creatinine from blood. Nephron damage or
failure leads to decreased Glomerular Filtration Rate, which leads to inability to filter out
excess waste products, like Creatinine.
Creatinine - breakdown nitrogenous waste product from muscles. Kidneys normally
excrete virtually all of it.
What is the best indicator of Renal Failure - ANS-Creatinine
Since kidneys normally excrete all of it, a value that changes even a little bit means
something.
ICP - IntraCranial Pressure
Manifestations
Early - ANS-Subtle
Decreased Level of Consciousness - confusion, restlessness, lethargy
Pupil changes - Sluggish reaction
Severe headache
Projectile Vomiting
Seizures - pressing on nerves
Papilledema - edema of optic disc/nerve
ICP - IntraCranial Pressure
Manifestations
Late - ANS-Decreased Level of Consciousness - Loss of consciousness
Pupil changes - dilated and/or fixed
Altered Motor Function - extremity strength & movement, Abnormal Posturing:
Decorticate - abnormal flexion
Decerebrate - abnormal extension
Cushing's Triad
Herniation of Brain
Cushing's Triad - ANS-Sign of very high ICP
1) Widening Pulse Pressure - increased Systolic & decreased Diastolic
2) Bradycardia = slow HR
3) Respirations - slow RR & irregular
Herniation of Brain - ANS-Severe increased ICP
Shifting of brain tissue from one compartment to another
,Places pressure on cerebral blood vessels & vital centers - Medulla
Death results
Aphasia - ANS-Change in speech
Symptom of Stroke - CVA
Types of Aphasia - ANS-1) Expressive - Can NOT express self, CAN understand;
Cannot talk
2) Receptive - Can express, can NOT receive message/understand
3) Global - Can NOT express self AND can NOT receive message/understand
Acid-Base - ANS-Hydrogen Ion - H+ - concentration determine relative acidity of body
fluids.
Acids - ANS-Release Hydrogen Ions in solution
Bases / Alkalis - ANS-Accept Hydrogen Ions in solution
Buffer - ANS-Substance that can absorb excess H+ (acid) or OH- (base)
Can work either way
pH - ANS-H+ concentration of solution
Inverse relationship
* increased H+ = decreased pH = Acidic
* decreased H+ = increased pH = Alkaline / Basic
H+ - ANS-Hydrogen Ion
Think "ACID"
CO2 - ANS-Carbon Dioxide - acid producing
Think "ACID"
HCO3- - ANS-Bicarbonate
Think "BASE"
Mechanisms Regulating Acid-Base Balance - ANS-1) Plasma Buffer Systems
2) Respiratory System
3) Renal system
Regulate Acid-Base Balance
, Plasma Buffer System - ANS-acts FAST
protein buffers - hemoglobin
Phosphate - can bind with 4 H+
Cellular Ion Exchange
Regulate Acid-Base Balance
Respiratory System - ANS-Minutes to Hours - can change direction quickly
Works via CO2 - NOT O2
* Lungs regulate retention or elimination of CO2 through changes in rate of ventilation -
rate & depth of respiration
Regulate Acid-Base Balance
Renal System - ANS-Hours to Days - Slow but powerful
Kidneys reabsorb more HCO3- (base) and excrete more H+ (acid) - correct acidosis
OR
Kidneys excrete more HCO3- (base) and reabsorb more H+ (acid) - correct alkalosis
ABGs - ANS-Arterial Blood Gases
In ARTERY, NOT vein
pH
Normal values - ANS-7.35 - 7.45
pCO2
Normal values - ANS-35 - 45
Acid
Respiratory indicator
HCO3-
Normal values - ANS-22 - 28
Base
Metabolic indicator
Acidosis - ANS-pH < 7.35 of arterial blood
H+ concentration reduced OR HCO3- concentration increased
Respiratory Acidosis - ANS-pH < 7.35
CO2 > 45
Caused by lung problem
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