chp 5 & 6 NR 283 for exam 2

hormone interaction

When blood glucose levels increase after a meal, insulin facilitates the entry of glucose into the cells and stimulates the liver to convert glucose to glycogen for storage. Between meals, as blood glucose levels begin to fall, glucagon is released to suppress insulin and stimulate the conversion of stored glycogen to glucose.​

Properties of Electrolytes

When dissolved in water or bodily fluids, electrolytes will conduct (not diffuse or suppress) electricity. Cations (not pions or avions), such as sodium (Na) and magnesium (Mg), are positively charged ions. Anions (not scions or inions), such as bicarbonate (HCO3) and chloride (Cl), are negatively charged ions. ​

Compensation

When the serum pH is high or low, the lungs can quickly respond to regulate CO2 levels and the kidneys can slowly respond to regulate bicarbonate (HCO3) levels.​

dehydration.

While whole blood is lost due to hemorrhage, plasma is what is reduced when someone does not intake enough fluid to replenish fluid lost from sweat and other sources. ​

Calcium (Ca2+)

a critical extracellular cation whose balance is controlled by parathyroid hormone (PTH) and calcitonin.

Diabetes mellitus type 2

a disorder in which the pancreas secretes inadequate amounts of insulin and/or the body has developed a resistance to the insulin that is secreted.

Diabetic ketoacidosis (DKA)

a result of profound insulin deficiency causing the body to enter a state of metabolic acidosis. It is characterized by:​ high blood glucose levels​ decreased serum pH and bicarbonate​ ketosis​ dehydration​

Latent autoimmune diabetes mellitus in adults

a slowly progressing form of DM1. It presents in adults and is commonly mistaken for type 2 diabetes (DM2).​

Age and Fluid Imbalance

Because of decreased volume of fluid due to body size and weight, children at a young age are much more sensitive to fluid imbalance. A child has much quicker shifts in fluid and an exaggerated response when becoming dehydrated or experiencing excessive vomiting. Therefore, hypovolemia must be found and treated quickly in children.​ Older adults are more likely to have conditions that reduce the body's ability to get rid of fluid. Kidneys become less active, and a less compliant or responsible vascular system makes the older adult less likely to quickly compensate for changes in fluid status.​

blood pressure

Blood pressure is regulated by receptors throughout the body that send signals to the autonomic nervous system to constrict or dilate blood vessels depending on the fluid imbalance it may sense.​

What are some symptoms that a client would have from liver failure?​

Brain fog, anemia, jaundice and fetor hepaticus (corpse-like breath) are symptoms of liver failure.​

Isotonic dehydration

Causes: vomiting, diarrhea, sweating, burns, kidney disease, hyperglycemia, and hypoaldosteronism​ Characterized by: loss of sodium and water in equal amounts (Physiopedia Contributors, 2021) ​Cellular Changes: The amount of water transported into the cell is equal to the amount of water transported out of the cell. Solute concentration inside the cell is equal to the solution outside.

Hypertonic dehydration

Causes: water losses exceed sodium losses through the skin, lung, or kidneys (e.g., fever, increased respiration, and diabetes insipidus) Characterized by: increased serum sodium and osmolality (Physiopedia Contributors, 2021) ​ Cellular Changes: Water is transported out of the cell. Solute concentration inside the cell is lower. The cell shrinks.

In what way does sitting up straight and raising the legs promote effective bowel movements and help prevent bowel obstruction?​

Changes the angle of the colon​

Colonic Peristalsis

Colonic movements are slow (not fast) to allow absorption (not digestion) of fluid and formation of the solid feces

Which underlying conditions increase the risk of edema?

Conditions that increase the risk of edema include vascular disease, chronic kidney disease, and liver failure.​

What steps can be taken to prevent alterations in urinary elimination?

Control chronic medical conditions Eat a well-balanced diet​ Avoid caffeine and alcohol​

measuring serum glucose levels

Fasting Blood Glucose Random Blood Glucose​ 2-Hour Post Prandial Glucose Glucose Tolerance Test Glycosylated Hemoglobin; Hemoglobin A1C

When hormonal alterations are prolonged, what are possible results?

Fatigue Frequent urination​ Increased thirst​ Increased hunger Increased sensitivity to cold ​ Constipation

Fecal Incontinence

Fecal incontinence is the involuntary passage of stool that ranges from the occasional leakage of stool while passing gas to a complete loss of bowel control

Treatment of Fluid Imbalance​: hypovolemia

For hypovolemia, fluids are given. blood, isotonic solution...albumin

In which direction will potassium diffuse through the cell membrane?

From intracellular space to extracellular space

Which symptoms would an individual with hypokalemia exhibit?

anorexia leg cramps

Idiopathic diabetes

another form of DM1 that is inherited but not related to autoimmunity. This type is rare and most commonly affects clients of Hispanic, African, or Asian descent. ​

Digestive Hormones

Gastrin found in gastric cells increases stomach motility and acid production promotes gastric emptying Cholecystokinin (CCK) found in intestinal mucosal cells stimulated by fat and ​amino acids in the duodenum inhibits gastric secretion and motility fuels pancreatic enzyme secretion stimulates ​gallbladder contractions to release bile Secretin found in intestinal mucosal cells stimulated​ by acidic chyme in the duodenum triggers bile and pancreatic ​secretions with bicarbonate content

What are the common signs of liver disease?

Generalized edema Anemia Fatigue Increased bleeding Weight loss

Hyperthyroidism

Graves' disease Toxic adenoma

Hashimoto thyroiditis

Hashimoto thyroiditis is a destructive autoimmune disorder affecting the thyroid gland. The disease usually results in a dec

Stages of Liver Damage​

Healthy liver​ Fatty liver​ Fibrosis liver​ Liver cirrhosis​ Liver cancer

mechanical obstruction

Hernia (external) Intussusception (internal) Growth (internal) Volvulus (external) Adhesions (external)

Which signs or symptoms indicate excessive antidiuretic hormone levels?

High antidiuretic hormone levels are suspected in someone with concentrated urine and hyponatremia.

mechanisims

Hormone levels are primarily controlled through negative feedback loops, in which rising levels of a hormone inhibit its further release.

hormones

Hormones are used to attract fluid or control the pressure of the vascular system. For example, renin, a hormone made by the kidney, is converted to angiotensinogen to cause vasoconstriction. It also stimulates production of aldosterone by the adrenal gland, which helps to keep fluid in the vascular system. ​

Hydrostatic pressure

Hydrostatic pressure is the pressure exerted to push fluid from one compartment to another. For example, when pressure in the blood vessels, or blood pressure, is higher, more fluid may be pushed from the intravascular area to the extracellular spaces where the pressure is lower. ​​

Hyperosmolar hyperglycemia syndrome (HHS)

Hyperosmolar hyperglycemia syndrome (HHS) is an acute, life-threatening complication of type 2 diabetes. HHS is less common than diabetic ketoacidosis (​DKA) and is more common in clients with type 2 diabetes who are older than 60 years.

Which signs or symptoms are common and may be seen after someone experiences a traumatic brain injury?

In a traumatic brain injury, low ADH levels are suspected, which include symptoms of intense thirst, excessive urination, and dilute urine. This condition is also known as diabetes insipidus. ​

How Does Fluid Move?​

In the vascular system, osmotic pressure and hydrostatic pressure work opposite of each other to control the movement of fluid between the blood and interstitial areas. Increased hydrostatic pressure causes fluid to move out of the vascular system, and increased osmotic pressure draws fluid back into the blood.

There are five main factors that contribute to the development of type 2 diabetes.

Insulin resistance - a condition in which the body tissues do not respond to the action of insulin. Insulin receptors are unresponsive or insufficient in number Hyperglycemia ​ Insulin resistance causes the pancreas to produce more insulin in an attempt to correct hyperglycemia. Hyperinsulinemia and hyperglycemia​ Insulin production is decreased. Beta cells in pancreas become fatigued and begin to fail Glucose is not appropriately produced by the liver. Glucose released haphazardly in a manner that does not mean the body's needs Cytokines produced by the adipose tissue cause chronic inflammation Contributes to insulin resistance

Which statement is the best definition of electrolytes?​

Ions in bodily fluids that regulate metabolic processes​

magnesium

It serves many important functions, including taking part in the production of energy (adenosine triphosphate), DNA and protein synthesis, carbohydrate metabolism, nerve transmission, parathyroid hormone production (which regulates calcium), and is important in heart function.​

Treatment of Fluid Imbalance​: Maldistribution

Maldistribution is more about shifting fluids. Certain sodium preparations may be given, and in some cases the best treatment is steroids or other medication used to reduce inflammatory response and shift fluids to the appropriate compartments.​

Maldistribution

Maldistribution of fluid occurs when immune response mediators or other protein or hormone deficits cause a movement of fluid from one compartment to another without a loss of fluid. An example of this is an allergic response where considerable edema may occur.​

posterior pituitary gland hormones

Mammary glands - oxytocin Uterus smooth muscle - oxytocin Kidney - antidiuretic hormone (ADH)

Types of bowel obstruction

Mechanical obstructions result from tumors, adhesions, hernias, or other tangible obstructions. Functional or adynamic obstructions result from a neurologic impairment, such as a spinal cord injury or a lack of propulsion in the intestine, often called paralytic ileus.

endocrine feedback loops

Most endocrine glands use complex feedback loops to decrease or increase the secretion of hormones in response to other hormones.

What clues (symptoms) would alert you that you are dehydrated?

No tears Cracked tongue Dry skin Flaky scalp Dry mucosa Dry lips

Which statement best describes increased permeability?​

A change in the consistency of a wall or membrane allows more fluid to pass through.

Which individuals are at risk for hypocalcemia?

A person with decreased parathyroid hormone production​

Which clinical manifestation is not associated with hyperkalemia?​

A positive Chvostek's sign is associated with hypocalcemia and seen as a twitching of the facial muscles in response to gently tapping on a person's cheek, in front of their ear.​ Decreased blood pressure, muscle twitches and cramps, and a weak and slow heart rate are associated with hyperkalemia.

In hormone regulation, which statement best describes the negative feedback loop?​

A reaction that causes a decrease in function to help maintain homeostasis

Which statements are true about acute renal failure (ARF)?

ARF occurs when the kidneys experience a lack of blood supply. ARF occurs when the kidneys experience episodic interference in the ability to filter blood. ARF remains for a period of weeks or up to a year before returning to normal or near-normal function.

Measuring Serum pH​

Acid-base balance is measured using arterial blood and is known as an arterial blood gas

Which conditions are intrarenal causes of acute kidney injury (AKI)?

Acute tubular necrosis Glomerulonephritis Nephrotoxic drugs

stress hormones

Additional hormones increase glucose levels, including cortisol, growth hormone (GH), norepinephrine, and epinephrine. Because these hormones are released during times of physical and emotional stress, they are often referred to as the "stress hormones."

What is Alkalosis?

Alkalosis, an increase in the serum pH, results from hyperventilation leading to a loss of CO2- (respiratory alkalosis) or an increase in serum HCO3-, loss of serum potassium, or overuse of antacids (metabolic alkalosis).

too little Follicle stimulating hormone (FSH) and luteinizing hormone (LH)​

Amenorrhea, infertility, erectile dysfunction (in men), delayed puberty​

Arterial Blood Gas Interpretation​

An alteration in serum bicarbonate levels indicates a/n unknown cause of acid-base imbalance.​

Which statement describes a secondary endocrine disorder

An endocrine gland does not secrete enough hormones to stimulate another endocrine gland to secrete a different hormone.​

Physical Changes of hyperkalemia

An individual with hyperkalemia may have alterations in their heart (respiratory) rate and rhythm (not appearance). ​

Which individual is likely to be experiencing metabolic acidosis?

An older adult who has been vomiting with diarrhea for 26 hours

Symptoms of Chronic Renal Failure​

Anemia results from decreased production of renal erythropoietin. Uremic frost on the skin results from an accumulation of urates. Azotemia is a result of nitrogenous compounds built up in the blood. Hypoglycemia results from increased production of renal erythropoietin.

Symptoms of Altered Bowel Elimination

Anorexia (loss of appetite), nausea (the feeling of needing to vomit), and vomiting

Antidiuretic Hormone Imbalances​

Antidiuretic hormone (ADH) helps to maintain fluid homeostasis in the body by changing the osmolality of the urine and the blood to adjust for hypovolemia or hypervolemia.​

Hormones That Change Fluid Levels​

Antidiuretic hormone (ADH) signals the kidneys to promote reabsorption of water. ​​ Aldosterone signals the kidneys for reabsorption of sodium ions and water. ​​ Atrial natriuretic peptide (ANP) and B-type natriuretic peptide (BNP) are secreted by the heart to assist with fluid level maintenance. ​

Which hormones will the body use when there is too much fluid (fluid overload) or too little fluid (dehydration)?

Antidiuretic hormone, aldosterone, atrial natriuretic peptide are triggered for release by the hypothalamus with changes in osmotic or hydrostatic pressure.

hyperkalemia

As the sodium level increases, fluid shifts out of the cells into the interstitial fluid. This leads to weakness, agitation, increased thirst with dry, rough mucous membranes, and decreased urine output due to the secretion of antidiuretic hormone (ADH). ​

Effects of Aging on Potassium​

Older adults are more likely to have high or low potassium levels. Low levels are usually caused by conditions that require diuretics (medicine that makes people urinate), or hormone imbalances

glucagon

One of several hormones released in response to lack of glucose in cells​. Suppresses insulin​. Stimulates liver to convert glycogen to glucose​. When both glucose and glycogen are depleted, it stimulates gluconeogenesis (creation of glucose from protein or fat).

Osmotic pressure

Osmotic pressure draws fluid from an area of higher concentration to one of lower concentration. Osmolarity is a value used to describe the concentration (number of particles) within a fluid. Osmolarity determines osmotic pressure. ​

anterior pituitary gland hormones

Ovaries - gonadotropins (follicle stimulating hormone [FSH] and luteinizing hormone [LH]) Testis - gonadotropins (FSH & LH) Bones, tissues - growth hormone (GH) Skin - melanocyte-stimulating hormones (MSH) Mammary glands - prolactin (PRL) Adrenal cortex - adrenocorticotropic hormone thyroid gland-tsh

Which treatment for urinary incontinence will strengthen the muscles that control urination?

Pelvic floor muscle exercises​

Hyperosmolar state (sodium concentration is high in the ECFV)​

Sodium high​ Water loss ​ Dehydration​ The body's mechanisms are activated to:​ Conserve water + Increase the secretion of sodium = Lower urine volume with higher urine concentration​ The size of ECFV should increase to return the serum osmolality to normal.​

Compensatory Mechanisms

The body has three ways to control or compensate for the serum pH when it is outside the normal range: the buffer systems, the lungs, and the kidneys. These three systems work together to maintain a normal acid-base balance within the body at all times.

chloride

The brain uses sodium chloride, the salt made when sodium and chloride bind, to attract water and make cerebrospinal fluid (CSF). In the stomach, hydrogen binds to chloride to make hydrochloric acid, a chemical critical to digestion.

Classic Signs of Type 1 Diabetes

The classic signs of diabetes mellitus type 1 are referred to as the 3Ps: polyuria,polydipsia and polyphagia

Diagnosing Liver Disease​

The most common laboratory tests that are used to diagnose liver inflammation are the aspartate transaminase (AST) and alanine transaminase (ALT).​

insulin

The only hormone that lowers serum glucose levels​. Released when serum glucose levels rise​. Binds to insulin receptor on the cell wall, signaling glucose transporter molecules to facilitate glucose entry into cells​. Insulin suppresses glucagon secretion and increases glycogen storage​.

Liver Disease: Phases of Hepatitis

The stages of infectious diseases include incubation, prodromal, illness (increasing symptoms​), convalescence (decreasing symptoms), and health. Symptoms increase slowly starting from incubation and rapidly reach a peak during the illness phase, and then decrease during the convalescence phase and become minimal or none after the patient is healed.

hyperglycemia symptoms

Thirst Weakness Headache Frequent urination

Thyroid Deficit​

Thyroid hormone deficit decreases metabolism, which alters the function of all major organs in the body.​

thyroid secretion

Thyroid-stimulating hormone is secreted by the anterior pituitary to stimulate the production of T4 in the thyroid. T4 is secreted by the thyroid and converted to T3 (active thyroid). Hypothyroidism is usually measured by a high thyroid-stimulating hormone level.

Tonicity

Tonicity is the concentration of solutes, or stuff, dissolved in a solution. ​On a cellular level, tonicity refers to the amount of stuff (electrolytes or other solids) on the inside or outside of the cell relative to the fluid. ​In short, tonicity measures if there is more stuff than water outside the cell or if there is more stuff than water inside of the cell.

growth hormone

Too much growth hormone in an adult can lead to acromegaly. In a child, too much growth hormone can lead to gigantism. Too little growth hormone in a child leads to proportional dwarfism, whereas too little growth hormone in an adult can lead to fatigue.​

Viral Hepatitis

Viral hepatitis is inflammation of the liver caused by a specific viral infection. The most common forms are designated as hepatitis A, B, and C.

Liver Disease/Hepatitis

Viral hepatitis is preventable and can be treated. Viral hepatitis B and C affect over 325 million people worldwide, causing 1.4 million deaths a year.

Which signs or symptoms indicate a potential intestinal obstruction?

Vomiting Abdominal distention Borborygmi Abdominal pain Fluid and electrolyte imbalances

Which conditions result in a serum pH of greater than 7.45?

Vomiting Hyperventilation Excessive antacid intake

What occurs during osmosis?

Water moves from an area of lower solute concentration to an area of higher solute concentration.

Effects of liver cell failure:

brain fog jaundice fetor hepaticas (corpse-like breath) spider nevi gynecomastia ascites loss of sexual hair testicular atrophy liver "flap" (coarse hand tremor) bleeding tendency anemia ankle edema

Thyroid hormones influence the metabolic rate in two ways:​

by stimulating almost every tissue in the body to produce proteins​ by increasing the amount of oxygen that cells use​

Risk Factors for Bowel Obstruction

cancer, especially in the abdomen​ Crohn's disease​ ulcerative colitis​ previous abdominal or pelvic surgery, which may increase the risk of adhesions​ radiation therapy​

A client who had been experiencing vomiting and diarrhea for 2 days is feeling well enough to eat. Which foods are the best choice to replace the potassium that has been lost? ​

cereal and dried apricots

Too little ADH:

diabetes insipidus fluid volume deficit (dehydration) dilute urine electrolyte imbalance (especially high sodium)

Which clinical manifestation distinguishes hypoglycemia from diabetic ketoacidosis (DKA)?

diaphoresis

Signs and Symptoms of Fluid Imbalance​: Hypovolemia

dizziness​ lightheadedness​ syncope (passing out)​ low blood pressure​ high heart rate​ weight loss​ oliguria or anuria (scant or no urine output)​ hypernatremia​

Effects of portal hypertension:

esophageal varices splenomegaly ascites dilated abdominal veins gastropathy and melena rectal varices (hemorrhoids)

Acromegaly

excessive GH

Polycystic ovary syndrome (PCOS)

excessive androgens

Risk Factors for Diabetes Mellitus Type 1

family hx/genetics Environmental Factors Presence Autoantibodies Geography

too much ADH

fluid volume excess (fluid retention​) concentrated urine​ syndrome of inappropriate antidiuretic hormone secretion (SIADH)​ electrolyte imbalance (especially low sodium

graves disease

form of hyperthyroidism

Signs and Symptoms of Fluid Imbalance​: Hypervolemia

generalized edema​ weight gain​ shortness of breath​ reduced oxygen saturation​ increased respiratory rate​ oliguria or anuria (scant or no urine output)​ hyponatremia​

Signs and Symptoms of Fluid Imbalance​: Maldistribution

generalized or site-specific edema (swelling)​ shortness of breath​ reduced oxygen saturation​ increased respiratory rate​ low protein or albumin levels​

Liver Disease Risk Factors

heavy alcohol use​ obesity​ type 2 diabetes​ tattoos or body piercings​ injecting drugs using shared needles​ blood transfusion before 1992​ exposure to other people's blood and body fluids​ unprotected sex​ exposure to certain chemicals or toxins​ family history of liver disease

An older adult experiencing tachycardia, cold and clammy skin, tremors, dizziness, and slurred speech is most likely having which alteration in glucose regulation?​

hypoglycemia

Which phase is the actual phase of illness?

icteric

Which phase lasts 2-6 weeks with symptoms of clay-colored stools, enlarged and painful liver?

icteric

If calcium gets too high (hypercalcemia)

it can cause muscle weakness, lack of reflexes, confusion, fatigue, and memory loss.

If calcium gets too low (hypocalcemia)

it can cause tremors, muscle cramps, paresthesia (numbness/tingling), and twitching. Muscles may even lock up (tetany).​

When magnesium levels get too high (hypermagnesemia)

it can depress the central nervous system (CNS). This can cause lethargy, muscle weakness, loss of reflexes, low blood pressure, and heart rhythm problems.

When magnesium levels get too low (hypomagnesemia)

it can lead to respiratory muscle paralysis, coma, and heart arrest. Symptoms aggravate the central nervous system (CNS) and can include confusion, reduced consciousness, muscle lock-up (tetany), muscle cramps, and strong reflexes (nerve excitability).​

Which hormonal alterations can be considered age related?

menopause type 2 dm

Which is the most common cause of a pituitary disorder?​

non-cancerous brain tumor

Hashimoto's thyroiditis.

occurs after pregnancy when antibodies produced by the body attack the thyroid gland and eventually cause hypothyroidism.

Generalized edema

occurs all over the body and can include the arms, legs, trunk, torso, and face.

What type of regulation causes insulin to be released after eating a high carbohydrate meal?

positive feedback loop

What type of acute kidney injury (AKI) results from kidney stones?

postrenal

What alteration is present in a person with hyperkalemia

they have too much potassium

Types of Hyperglycemia

type 1 and 2 dm and gestational dm

Which stimulates increased peristalsis and secretions in the digestive tract?

vagus nerve

Other than measuring fluid intake and output, how can fluid changes be accurately measured in the body?

weight urinary frequency

Diagnostic Testing for Fluid Imbalance​

weight urine output and input lab tests (electrolytes, kidney function, liver enzymes, urinalysis, urine specific gravity, and b-type natriuretic peptide) vital signs

An adult has lost water through sweating while mowing the yard in the middle of a hot summer day. Unfortunately, the person did not keep water nearby to replace what was being lost. Based on this history, which serum sodium level would most likely be found if tested?​

155 mEq per liter​ a high level

Who is at higher risk for complications of diarrhea?

A breastfeeding infant with lactose intolerance​ An adolescent with celiac disease​ A school-aged child living with cystic fibrosis​

ph level

A person cannot survive if pH drops below 6.8 or rises to 7.8 for more than a brief time. When the serum pH gets too high or too low, the effects on the central nervous and cardiovascular systems can be catastrophic, leading to death.

What is Acidosis?

Acidosis, or a decrease in the serum pH, results from either an increase in CO2- (respiratory acidosis) or a decrease in HCO3- (metabolic acidosis) within the blood.

Which finding is the most common cause of hypothyroidism?​

Autoimmune thyroiditis​

In what way does insulin facilitate glucose entry into the cell?​

Binds to cell membrane receptors​

Calcium

Calcium has many different jobs. It helps form and maintain bones, teeth, and cells. It helps with nerve impulse transmission, muscle contraction, and even helps with blood clotting. The thyroid and parathyroid glands can adjust the calcium levels by sending hormones to grab extra calcium from the bone or sending calcium back to the bone for reabsorption.​

Which items should be included in the diet of a person who wants to increase their calcium intake?

Calcium is found naturally in dairy products, such as milk and cheese, green, leafy vegetables, and almonds.

Hypotonic dehydration

Causes: loss of more sodium than water, most often due to diuretic use Characterized by: low sodium and osmolality due to increased ratio of water to sodium (Physiopedia Contributors, 2021) ​ Cellular Changes: during hypotonic dehydration, water moves into the cell due to a higher concentration of solutes in the cell. This results in cellular swelling. If not corrected, the cell will eventually burst.

Which situation or condition is likely to result in an increased production of thyroid hormones?​

Cold environmental exposure

Which clients are at risk for hypomagnesemia due to preexisting alterations in health?

Conditions that place a person at high risk for hypomagnesemia include diuretic use, diabetic ketoacidosis (high blood sugar leading to ketone formation), hypoparathyroidism, malnourishment, and alcohol use disorder.​

How do the kidneys respond to an increase in serum pH (alkalosis)?

Decrease tubular excretion of H+ ions Decrease tubular reabsorption of HCO3-

Magnesium - Pathophysiology

Decreased magnesium levels interfere with the enzyme reactions required for many bodily functions, including protein and DNA synthesis. Low magnesium increases cardiac muscle irritability. Because potassium, calcium, and magnesium work together to maintain a neutral intracellular electrical charge, it is difficult to maintain a normal potassium level when the serum magnesium level is low.​

too little prolactin causes

Decreased milk production after childbirth (no known effect on men)​

Hypothyroidism or Hyperthyroidism

Decreased or increased thyroid production​

A client with a diagnosis of diabetic ketoacidosis (DKA) is being treated in the emergency room (ER). Which findings confirm this diagnosis?

Decreased serum pH Increased respiration Elevated blood glucose level

addisons disease

Deficiency of cortisol and aldosterone​ Addison's disease is most often caused by an autoimmune reaction that destroys the gland. This results in decreased cortisol and aldosterone production (deficiency).

If a client has a low dietary intake of iodine (iodide), which hormone would be most profoundly affected and how would it be affected?​

Deficiency of thyroid hormones​

Which conditions result in a serum pH of less than 7.35?

Diabetic ketoacidosis Renal failure Aspirin overdose Shock Respiratory congestion

Which conditions can cause metabolic alkalosis?

Diuretic therapy​ Nasogastric suctioning​ Mineralocorticoid use​ Vomiting Excessive use of antacids​

Which action by the student could have prevented them from becoming hyponatremic?

Drank an isotonic sports drink instead of water​

Liver Disease Prevention

Drink alcohol in moderation​. Avoid risky behavior (e.g., unprotected sex and sharing needles​). Get vaccinated (hepatitis A, B)​. Use medication wisely​. Avoid contact with other people's blood and body fluids​. Keep your food safe (e.g., unclean conditions for preparing food​). Avoid toxins like aerosols (e.g., breathing in toxic chemicals​). Protect your skin from toxins​. Maintain a healthy weight and eat healthy foods.

positive feedback loop

During labor, cortisol is released from the posterior pituitary gland is an example of a positive feedback loop.​

too little GH causes

Dwarfism (children), nonspecific symptoms in adults (fatigue, body composition changes)​

Signs of Chronic Kidney Disease

Early signs and symptoms of chronic kidney disease (CKD) are nonspecific (not unique) and often associated with other alterations in health. These early symptoms include loss of appetite (not consciousness), increased (not decreased) fatigue, and muscle cramps (not paralysis). ​

What Is Edema?​

Edema is the accumulation of excess fluid in the interstitial spaces. Edema can be classified as generalized edema or localized edema.

Electrolytes

Electrolytes are used by the body to adjust fluid levels.

Environment and Fluid Imbalance​

Environments that do not have enough potable (drinkable) water can put people at risk for dehydration.​ The type of climate someone is exposed to along with the amount of activity within that climate can put someone at a higher risk for hypovolemia due to dehydration. According to Kataria et al. (2015), chemicals found in the environment can target both the liver and the kidneys, potentially leading to chronic kidney disease or liver failure. Regulators continue to identify potentially harmful chemicals and define safe levels to reduce fluid imbalances caused by kidney or liver failure.

What are some effects of portal hypertension caused by liver disease?​

Esophageal varices, splenomegaly, ascites, and hemorrhoids are all effects of portal hypertension.​

Cushing syndrome

Excess cortisol and increased secretion of adrenocorticotropin hormone (ACTH)​

Hypervolemia

Hypervolemia happens when too much fluid accumulates and/or organs in the body are unable to manage or excrete this extra fluid. For example, when someone experiences a myocardial infarction, the heart is incapable of pumping the amount of blood in the system, which causes a backup in the venous system and subsequent edema from excessive hydrostatic pressure.​

Hypochloremia

Hypochloremia rarely occurs alone; most often, changes happen with parallel shifts in sodium or bicarbonate levels.​

Which part of the body is the main control center for hormonal regulation?​

Hypothalamus​

After being out at the beach for hours, an adult suffered from an extensive sunburn covering their back, arms, and legs. Which fluid imbalance is this person most likely experiencing?​

Hypovolemic fluid imbalance​

location of potasium

In a healthy person, most of the potassium in the body is located inside the cells

What are the risk factors for type 2 diabetes?​

Inactivity Insulin resistance Metabolic syndrome​ Diet high in simple carbohydrates

What Causes Edema?​

Increased vascular permeability Increased hydrostatic pressure Change in osmotic pressure lymph node dysfuntion

Why are infants and older adults at higher risk of dehydration?

Infants' bodies are made up of a larger percentage of water. Infants are unable to vocalize if they are thirsty. As we age, our thirst sensation diminishes. Older adults and infants also lack fluid reserves.

Which hormones alter glucose regulation?

Insulin Cortisol Glucagon Epinephrine

hypothyroidism

Iodine deficiency Thyroid cancer Hashimoto's thyroiditis

Which risk factors make older adults and children more sensitive to fluid imbalances?

Kidney function​ Weight and height​ Total body water differences​

Diabetes mellitus

Lack of insulin or insufficient use of insulin​

polyuria

Loss of tubule function causes polyuria during renal insufficiency.

A high potassium level can lead to which condition(s)?

Low blood pressure Weakness Low heart rate Decreased reflexes

Hypoparathyroidism

Low levels of parathyroid hormone (PTH)​

Which statements best describe edema?

Not all edema is visible in the body.​ Persistent edema can eventually lead to skin breakdown and delayed wound healing​. Edema can be classified as generalized or localized​. Edema is an accumulation of excess fluid in the interstitial spaces​. Edema may be classified by the cause​.

You suspect someone may have hypervolemia. Which tests would most accurately support this?​

One of the most accurate ways to monitor for hypervolemia is a daily weight.​

alkalosis stages

Restless, tingling arms: 7.55 pH Seizing, breathing deep and slow: 7.7 pH Healthy: 7.5 pH Coma: 7.8 pH

Hyperchloremia

Serum chloride levels greater than 106 mEq/L​

sodium

Sodium (Na+) is the major cation in extracellular fluid and the concentration of sodium is regulated by aldosterone acting on the kidneys. A decrease in sodium levels is hyponatremia, while an increase is hypernatremia. A normal serum sodium level is 135-145 milliequivalents per liter (mEq/L).​

Which external factors can affect hormone secretion in all systems?

Stress, sunlight, pollution, and chemicals are all external factors that can affect various hormone levels, including cortisol, thyroid, testosterone, and more.

hpyogylcemia sxs

Sweating Sleepiness Irritability Hunger

Which are possible signs or symptoms of edema?

Swelling of lower extremities Weight gain

Chemical Combinations

Symbol Chemical Compound Function K+ Potassium chloride Helps regulate heart rhythm H+ Hydrochloric acid Digestion Na+ Sodium chloride Regulates osmotic pressure Ca+ Calcium chloride Important for bone regulation Mg+ Magnesium chloride Works with muscle and nerves

There are two types of thyroid hormones:

T4 - thyroxine (also called tetraiodothyronine)​ T3 - triiodothyronine​

ways to control or compensate for the serum pH

The buffer systems continue to work as normal but are not able to keep up with the shifting pH.​ The lungs quickly increase or decrease breathing to regulate CO2 levels. The kidneys respond slowly to regulate bicarbonate (HCO3) and H ions.

Which commonly occurs with hepatitis B?

The liver is inflamed and enlarged.

What is the most likely cause of hyperkalemia in an older adult?​

The most common cause of hyperkalemia in older adults is chronic kidney disease. As the kidneys fail, they stop filtering potassium well and the potassium levels in the blood increase.

What are the three phases of hepatitis that a client may experience after exposure?​

The three phases are hepatitis prodromal, icteric and recovery phases. ​

Which statement best describes insulin resistance?​

There is insulin in the blood, but insulin receptors do not respond to it.​

Hormones Versus Environment

Thyroid - Radiation​ Cortisol - Sleep schedule​ Glucocorticoids - Arsenic​ Estrogen - BPA Plastic

Type 1 Diabetes

Type 1 diabetes is a disease that occurs when the pancreas produces no insulin.

liver cirrhosis

When liver cells die, liver cirrhosis occurs. Liver cirrhosis is the destruction of the liver with replacement of scar tissue. At this point, the liver is no longer enlarged or inflamed, it is small and scarred.​ With liver cirrhosis, the risk of liver cancer increases as well.

Potassium supports many bodily functions, including​

acid-base balance​ intracellular fluid volume​ metabolic processes​ nerve conduction​ muscle contraction​ cell membrane potential​ Most importantly, abnormal potassium levels, both high and low, have a significant and serious effect on the heart muscle and conduction of electrical impulses that stimulate cardiac contraction and regulate heart rate. ​

Risk Factors for Altered Bowel Elimination

ack of dietary fiber ​ lack of exercise​ family history/genetics​ obesity​ increased stress​ pregnancy​

Which findings increase Rita's risk of diabetes?

body mass index (BMI) of overweight or obese​​ both parents have diabetes​​ takes medication for high blood pressure​ vitamin D deficiency

too little Anti-diuretic hormone (ADH)​

causes diabetes insipidus

Which part of the gastrointestinal system absorbs the water and electrolytes from digested food?​

colon

What are the common causes of chronic kidney disease (CKD)?

diabetes hypertension

individual risk factors for impaired glucose

genetics - over 120 known genetic markers are linked to the risk of type 2 diabetes family history of type 2 diabetes obesity lack of physical activity poor diet high intake of saturated and trans-fatty acids low fiber intake high calorie intake medications - insulin and oral hypoglycemic agents, corticosteroids (prednisone), estrogen, and angiotensin converting enzyme (ACE) inhibitors

Which substance is the primary source of energy within the cells?​

glucose

Based on what you know about tonicity, what type of dehydration will occur in the body if you were to consume salt water from the ocean?

hypertonic

Altered Serum Glucose Levels

hypoglycemia/ hpyerglycemia

Magnesium (Mg2+)

is an intracellular ion with about 50% stored in bone. Changes in serum magnesium levels are linked to both potassium and calcium levels. Magnesium is a component of many enzyme reactions and in protein and DNA synthesis.

Hormonal stimuli

is the release of hormones in response to hormones released by other endocrine glands​.

neural stimuli

is the release of hormones in response to neural stimulation​.

Which factor places a person at risk of developing diabetes mellitus type 1? ​

presence of antibodies

Which phase begins after about 2 weeks of exposure and ends with the appearance of jaundice?

prodromal

Which phase is when the infection is highly transmissible?

prodromal

A lack of which of the following can cause an increase in edema?

protein and albumin

Which phase does the symptoms diminish, but the liver remains enlarged?

recovery phase

Humoral stimuli

refers to the control of hormonal release in response to changes in extracellular fluid levels or ion levels​.

Changes in carbon dioxide (CO2) that cause alterations in the serum pH are caused by which mechanism?

respiratory system

A person with a low magnesium level is most likely to experience which symptoms?

seizures tetany tremors

localized edema

specific to a body part or organ. ​

An individual with high serum creatinine and urea levels, an estimated glomerular filtration rate (eGFR) of 20 mL/min, and a decrease in red blood cell production is at which stage of chronic kidney disease (CKD)?

stage 4 out of 5

When the osmoreceptors detect a decreased blood volume and increased blood concentration of salt, what function increases in the body?

thirst

Hypovolemia

traumatic blood loss is one of the most common causes of fluid imbalance.

Which are increased risk factors for a pituitary disorder?​

traumatic brain injury not wearing a helmet

Risk Factors for Pituitary Disorders

tumor head injury

What is the result of long-term exposure to a hepatotoxin?

​Gradual irreversible damage to the liver

hyperkalemia causes

Excess intake of potassium or loss of water from the body without replacement Renal (kidney) failure Potassium-sparing diuretics Traumatic crush injuries or burns (intracellular potassium moves into the blood) Prolonged or severe acidosis (forces potassium out of the cells) Overuse of potassium containing salt substitutes

Hypoosmolar state (sodium concentration is low in the ECFV) ​

Excess water​ Sodium low ​ Fluid overload​ The body's mechanisms are activated to:​ Increase sodium conservation + Increase water excretion = Higher urine volume with lower urine concentration ​ The size of ECFV decreases to return the serum osmolality to normal.​

hypokalemia causes

Excessive loss due to diarrhea Lost in urine when on certain diuretic drugs, like furosemide Excessive aldosterone or glucocorticoids in the body (Cushing syndrome) Decreased dietary intake (associated with alcoholism, eating disorders, and starvation) Treating diabetic ketoacidosis with insulin (forces potassium back into the cell, lowering the serum potassium level)​

Risk Factors for Altered Glucose Regulation

Pregnant Women The hormones produced by the placenta cause insulin resistance. Infants Infants who are large for gestational age and those born to mothers who had diabetes during pregnancy are at risk. Older Adults Older adults are at risk due to increased visceral (abdominal) fat, decreased lean muscle mass, and age-related reduced insulin production. Racial and Ethnic Groups People from certain racial and ethnic populations have a greater genetic predisposition to insulin resistance and higher rates of type 2 diabetes when compared to whites. These populations include American Indians/Alaska natives, African Americans, Hispanic/ Latinos (especially Puerto Ricans and Mexican Americans), and Asian Americans.

A nurse is caring for a client who is hypotensive due to hemorrhage. What type of acute kidney injury (AKI) will this likely cause and why?

Prerenal injury due to decreased perfusion to the kidney

Which statement best describes hydrostatic pressure?​

Pressure against the wall of a vessel is caused by the force of fluid traveling through a vessel.

Which statement best describes osmotic pressure?​

Pressure is caused by the differences in the concentrations of two solutions.

Hypokalemia

Prolongs repolarization of cardiac muscles due to loss of intracellular potassium This may lead to cardiac arrest.

proteins

Proteins maintain fluid balance by attracting additional water to increase fluid balance. Low protein levels can cause movement of fluid into interstitial areas, causing edema.

Which conditions can contribute to the development of respiratory acidosis?

Pulmonary edema​​ Respiratory muscle weakness​ Chest wall abnormality​ Central nervous system (CNS) depression​ Atelectasis

Which environmental sources of potassium should a person avoid who follows a low potassium diet

Salt substitutes​ Home water filters​ Fertilizer

Where is the pituitary gland located?​

Sella turcica of the brain​

What are some signs and symptoms of dehydration?

Signs of dehydration include fatigue, decreased urine output, dry mucosal membranes, and confusion.​