Pathophysiology EXAM 1

Crystalloids

-contains electrolytes and are distributed primarily to the interstitial spaces -used to replace fluids and promote urine output and can expand the circulating intravascular fluid volume without causing major fluid shifts between compartments -capable of leaving plasma and moving to the interstitial spaces and intracellular fluid -compartment entered depends on tonicity of IV fluid

A patient has a vitamin K deficiency. Which assessment is priority?

-hemorrhage (Most individuals with a vitamin K deficiency will experience easy bruising and excessive bleeding.)

iron deficiency anemia - S/S & treatment

-iron required for hemoglobin production -fatigue/lethargy, pallor of skin and mucous membranes, cold intolerance, gastritis, sore, red tongue, spoon-shaped, brittle ridged nails, brittle hair; numbness, tingling of extremities; stomatitis, irritability due to hypoxia, menstrual irregularities; delayed healing, tachycardia, dyspnea, syncope Tx: iron rich foods (liver, clams, shrimp, sardines, enriched foods), iron supplements (ferrous sulfate)

liquefactive necrosis

-ischemic injury to neurons and glial cells in the brain. -the cells are digested by thier own hydrolases, so the tissue becomes soft, liquefies and segregates from normal tissue forming cysts. -caused by bacterial infection, especially staphylococci, streptococci & E. Coli

coagulative necrosis

-kidneys, heart and the adrenal glands -results from hypoxia caused by severe ischemia or chemical injury. -the coagulation occurs as a result of protein denaturing of protein albumin changing from a gelatenous state to a firm opaque state

Colloids

-large molecules that are too large to easily cross the capillary membrane -they stay in the intravascular space to rapidly expand plasma volume -draw water from the intracellular fluid and interstitial spaces into the plasma, thereby increasing osmotic pressure -important in treating hypovolemic shock due to burns, hemorrhage, or surgery

Sickle Cell disease

-one of the most important inherited types of hemolytic anemia, is an autosomal recessive disorder that causes an abnormality in hemoglobin synthesis. -a recessive disorder inherited from both parents. -Infection is the most common cause of death related to sickle cell disease.

Atrophy is most common in

-skeletal muscle -heart -secondary sex organs -brain

Thromboembolic disease

-thrombus = a stationary clot adhering to vessel wall -embolus = a floating clot within blood -virchow's triad = factors favoring clot formation

Ischemic injury is often caused by 2 things

1) Arteriosclerosis: gradual narrowing of arteries 2) Thrombosis: blockage by blood clots

Virchow's Triad

1) Hypercoagulable state (thrombocytosis) 2) endothelial injury (vascular injury = surgery) 3) circulatory status (bed bound, immobile patient)

List some causes of anemia:

1) Inadequate hemoglobin synthesis 2) Hemorrhage 3) Increased hemolysis

List in order the events of platelet plug formation:

1) Upon contact with collagen of a broken vessel, platelets grow long spiny pseudopods. 2) Platelets adhere to exposed collagen and other platelets. 3) The pseudopods then contract and draw the vessel walls together. 4) This mass of platelets forms a platelet plug.

6 common themes in cell injury and cell death

1. ATP depletion--> loss of integrity of plasma membrane 2. Reactive oxygen species 3. Calcium entry (normally decreased Ca inside cell) into the cell 4. Mitochondrial damage by increased Ca and decreased ATP 5. Membrane damage, early loss of selective permeability, lysosomal membrane damage and cellular digestion 6. Protein misfolding, DNA damage which can activate apoptosis

Hyperplasia physiologic

1. Hormonal- breast and uterine enlargement during pregnancy 2. Compensatory- regeneration of certain organs (liver), bone marrow, epidermal and intestinal epithelia

Chemical Buffer System

1. Major extracellular chemical buffer is the bicarbonate- carbonic acid buffer system (20-1 ratio). bicarbonate (HCO3) is a/an base. carbonic acid (H2CO3) is a/an acid. 2. These buffers are first to react to pH change (amount of time? A fraction of a second). The ability to maintain pH is limited. 3. Other buffer systems include the protein buffer system and the phosphate buffer system.

What are the most significant adaptive changes in cells?

1. atrophy 2. hypertrophy 3. hyperplasia 4. dysplasia 5. metaplasia

Normal ratio of carbonic acid to bicarbonate

1:20

HCO3

22-26

CO2 range

35-45

As ATP declines there is

A decreased sodium pump activity which leads to a decreased intracellular potasium level and an increase in sodium and H2O in the cell which leads to dilation of the endoplasmic reticulum, increased membrane permeability and decreased mitochondrial function and eventually cell lysis

Which condition is characterized by an abnormal increase in red blood cell count? A) polycythemia B) anemia C) leukemia D) porphyria

A. Polycythemia

Which type of condition is directly related to bone marrow suppression? A) aplastic anemia B) anemia C) sickle cell anemia D) megaloblastic anemia

A. aplastic anemia

Which factor promotes the appearance of the platelet plug? A) collagen B) serotonin C) fibrinogen D) vasodilation

A. collagen

_____ are blood cells that differentiate into macrophages. a. Monocytes b. Neutrophils c. Eosinophils d. Basophils

A. monocytes

During an infection, lymph nodes enlarge and become tender because: a. of the proliferation of B lymphocytes. b. the nodes are inflamed. c. the nodes are filled with purulent exudate. d. the nodes are not functioning properly.

A. of the proliferation of B lymphocytes.

Which arterial pH will initiate the formation of ammonium (NH4) from ammonia (NH3), referred to as academia, in the tubular lumen of the kidney? a. 7.25 c. 7.55 b. 7.35 d. 7.65

ANS: A Pathophysiologic changes in the concentration of hydrogen ion or base in the blood lead to acid-base imbalances. Acidemia is a state in which the pH of arterial blood is less than 7.35. NH3 is produced from glutamine in the epithelial cell and diffuses to the tubular lumen, where it combines with H+ to form NH4.

Insulin is used to treat hyperkalemia because it: a. Stimulates sodium to be removed from the cell in exchange for potassium. b. Binds to potassium to remove it through the kidneys. c. Transports potassium from the blood to the cell along with glucose. d. Breaks down the chemical components of potassium, causing it to be no longer effective.

ANS: C Insulin contributes to the regulation of plasma potassium levels by stimulating the Na+, potassium-adenosine triphosphatase (K+-ATPase) pump, thereby promoting the movement of potassium simultaneously into the liver and muscle cells with glucose transport after eating. The intracellular movement of potassium prevents an acute hyperkalemia related to food intake. The other options do not accurately describe how insulin is used to treat hyperkalemia.

Vomiting-induced metabolic alkalosis, resulting in the loss of chloride, causes: a. Retained sodium to bind with the chloride b. Hydrogen to move into the cell and exchange with potassium to maintain cation balance c. Retention of bicarbonate to maintain the anion balance d. Hypoventilation to compensate for the metabolic alkalosis

ANS: C When vomiting with the depletion of ECF and chloride (hypochloremic metabolic alkalosis) causes acid loss, renal compensation is not effective; the volume depletion and loss of electrolytes (sodium [Na+], potassium [K+], hydrogen [H+], chlorine [Cl-]) stimulate a paradoxic response by the kidneys. The kidneys increase sodium and bicarbonate reabsorption with the excretion of hydrogen. Bicarbonate is reabsorbed to maintain an anionic balance because the ECF chloride concentration is decreased. The other options do not accurately describe the mechanism that results from vomiting-induced metabolic alkalosis.

Hyperplasia pathologic

Abnormal increase in number of cells i.e. endometriosis

Ischemia-reperfusion injury

Additional injury that can be caused by restoration of blood flow & oxygen (when cell bursts & blood flows through, it carries the toxins to a new location and does more damage)

ECF

All fluid outside of cells: -interstitial fluid (IF) = outside and between the tissues - between cells and outside blood vessels -intravascular or plasma = inside blood vessels (liquid part of blood) -transcellular = CSF, fluid in peritoneal, pleural, and pericardial cavities and join spaces

The concentration of potassium in the ECF is controlled by adjustments in the rate of active secretion:

Along the convoluted tubule in the nephron

What is the most common cause of an electrolyte balance?

An imbalance between sodium gains and losses

A generalized condition in which there is too little hemoglobin or too few erythrocytes is _____.

Anemia

An embolus or blood clot is an example of what?

Anoxia

A 6-year-old male presents with fatigue, jaundice, and irritability. A blood smear shows the presence of sickled cells. Erythropoiesis is compromised in this child; which crisis should the nurse monitor the patient for?

Aplastic crisis -Aplastic anemia is caused by diminished erythropoiesis despite an increased need for new erythrocytes. (caused by exposure to cetain chemicals,x-rays, drugs, and chemotherapy)

What type of progressive cell injury response is: Cellular self-destruction for elimination of unwanted cell populations?

Apoptosis, or programmed cell death

The following is a list of the steps involved in the process of hemostasis 1. Coagulation 2. Fibrinolysis 3. Vascular spasm 4. Retraction 5. Platelet plug phase The correct sequence of these steps would be: A. 5, 1, 4, 2, 3 B. 3, 5, 1, 4, 2 C. 2, 3, 5, 1, 4 D. 3, 4, 5, 2, 1 E. 4, 3, 5, 2, 1

B. 3, 5, 1, 4, 2

A 5-year-old male was diagnosed with normocytic-normochromic anemia. Which of the following anemias does the nurse suspect the patient has? a. Sideroblastic anemia b. Hemolytic anemia c. Pernicious anemia d. Iron deficiency anemia

B. Hemolytic anemia

Which of the following might trigger erythropoiesis? A. An increase in blood oxygen levels B. A decrease in blood oxygen levels C. An increased number of RBCs D. A decreased number of RBCs E. Moving from a high altitude to a low altitude

B. a decrease in blood oxygen levels

The most abundant class of plasma protein is: a. globulin. b. albumin. c. clotting factors. d. complement proteins.

B. albumin

Hypernatremia

BASIC CAUSES- Occurs when Serum Sodium levels exceed 147 mEq/L, loss of water or acute gain in sodium. CLINICAL MANIFESTATIONS- water is redistributed back to the ECF and ICF dehydration ensues. Thirst, dry mucous membranes, hypotension, tachycardia, low jugular venous pressure, and restlessness may occur as a result of water loss. Pulmonary edema - when water shifts from ICF to interstitial space. CNS symptoms- muscle twitching, hyperflexia, confusion, coma, convulsions, cerebral hemorrhage. EVALUATION/TREATMENT- Evaluated through bloodwork, urine analysis. Treatment is to give an isotonic salt-free fluid slowly until the serum sodium levels return to normal.

hypercalcemia

BASIC CAUSES- hyperparathyroidism, bone metastases with calcium resorption from breast, prostate/renal/cervical cancer, sarcoidosis, excess vit d, many pth producing tumors, calcium-containing antacids. CLINICAL MANIFESTATIONS- fatigue, weakness, lethargy, anorexia, nausea, constipation. Impaired renal function: kidney stones, dysrhythmias, bradycardia, cardiac arrest, bone pain, osteoporosis, and fractures.

hypocalcemia

BASIC CAUSES- occurs when blood serum total concentration is less than 8.5 mEq/L. removal of parathyroid glands, vit D deficiency, blood transfusions can cause hypocalcemia. CLINICAL MANIFESTATIONS- caused primarily by an increase in neuromuscular excitability. Neuromuscular irritability, chvostek sign and Trousseau sign, convulsions, tetany.

hypermagnesemia

BASIC CAUSES- occurs when magnesium concentration is greater than 2.5 mEq.L,. Rare, usually caused by renal failure. CLINICAL MANIFESTATIONS- nausea, vomiting, muscle weakness, hypotension, bradycardia, and respiratory depression.

hypomagnesemia

BASIC CAUSES- occurs when serum magnesium concentration is less than 1.5 mEq/L and increases in neuromuscular excitability and tetany are present. Malnutrition, malabsorption, alcoholism, urinary losses. CLINICAL MANIFESTATIONS- depression, confusion, irritability, increased reflexes, muscle weaknesses, ataxia, hypotension, tetany.

Hyponatremia

BASIC CAUSES- when serum sodium concentration decreases to less than 135 mEq/L. Due to sodium loss, inadequate sodium intake, or dilution to the body's sodium level. CLINICAL MANIFESTATIONS- celllular swelling and deficits of ICF sodium alter the ability of cells to depolarize and repolarize normally. Neurological changes- lethargy, headache, confusion, apprehension, seizures, and coma. Hypovolemia symptoms- hypotension, tachycardia, and decreased urine output. Hyponatremia symptoms- weight gain, edema, ascites, and JVD EVALUATION/TREATMENT- Bloodwork and urinalysis. Treatment is related to the contributing disorder. Loss of sodium and water volume gets replaced. Restriction of water intake is required.

What is the life span of an erythrocyte? a. 20 to 30 days b. 60 to 90 days c. 100 to 120 days d. 200 to 240 days

C. 100-120 days

A nurse plans care for a client with COPD, understanding that the client is most likely to experience that type of acid-base imbalance? a. Metabolic acidosis b. Metabolic alkalosis c. Respiratory acidosis d. Respiratory alkalosis

C. Respiratory acidosis

Which of these is a procoagulant? A) heparin B) antithrombin C) vitamin K D) prostacyclin

C. Vitamin K

Retention of sodium and water is a cause of edema because of an increase in which pressure?

Capillary hydrostatic pressure -An increase in hydrostatic pressure can result from venous obstruction or salt and water retention. Venous obstruction can increase the hydrostatic pressure of fluid within the capillaries enough to cause fluid to escape into the interstitial spaces.

At the arterial end of capillaries, fluid moves from the intravascular space into the interstitial space because the:

Capillary hydrostatic pressure is higher than the capillary oncotic pressure -At the arterial end of capillaries, fluid moves from the intravascular space into the interstitial because capillary hydrostatic pressure is higher than the capillary oncotic pressure.

Low plasma albumin causes edema as a result of a reduction in which pressure?

Capillary oncotic pressure -Losses or diminished production of plasma albumin contributes to a decrease in plasma oncotic pressure.

In hyperkalemia, cardiac rhythm changes are a direct result of:

Cardiac cell hypopolarization

What type of necrosis is often associated with pulmonary tuberculosis?

Caseous necrosis

Metaplasia usually happens in response to:

Chronic irritation i.e. chronic bronchitis from cigarette smoking. Squamous cells replace columnar cells, which are better able to withstand irritation. -Reprogramming of stem cells.

What nutrients are necessary for synthesis of DNA and maturation of erythrocytes?

Cobalamin (b12) and folate

A 40-year-old female develops disseminated intravascular coagulation (DIC). Upon obtaining the history, which finding is the most likely cause of this condition?

Correct Answer: Sepsis Response Feedback: Sepsis is one of the most common conditions associated with DIC.

Which of the following shows a correct sequence in the development of erythrocytes? a. Normoblast, reticulocyte, and basophilic erythroblast b. Basophilic erythroblast, normoblast, and reticulocyte c. Normoblast, committed proerythroblast, and reticulocyte d. Committed proerythroblast, normoblast, and reticulocyte

D. Committed proerythroblast, normoblast, and reticulocyte

Increased sodium into a cell directly results in:

Depolarization

Which of the following are plasma proteins that are made by the liver A. Albumins B. Fibrinogen C. Globulins D. Immunoglobulins E. All except D are correct

E. All except D are correct

The level of erythropoietin in the blood would rise A. During anemia B. At high altitudes C. As a consequence of hemorrhage D. When blood flow to the kidneys is disrupted E. All of the above

E. All of the above

Which of the following indices tells you whether the red cells are normochromic or hypochromic? A. Red blood cell count (RBC) B. Mean cell volume (MCV) C. Hemoglobin D. Hematocrit E. Mean cell hemoglobin concentration (MCHC)

E. MCHC

Which of the following indices tells you whether a patient's red cells are microcytic, normocytic, or macrocytic? A. Mean cell hemoglobin concentration (MCHC) B. Red blood cell count (RBC) C. Hematocrit D. Hemoglobin E. Mean cell volume (MCV)

E. MCV

Describe the causation, pathophysiologic process and clinical manifestations of edema (include the most common mechanisms involved, capillary filtration forces)

Edema- the excessive accumulation of fluid within the interstitial spaces • It is often the problem of fluid distribution and doesn't necessarily indicate a fluid excess. • The pathophysiological process is related to an increase in the forces favoring fluid filtration from the capillaries or lymphatic channels into the tissues. The 4 common mechanisms are: a) increased capillary hydrostatic pressure, b) decreased plasma oncotic pressure, c) increased capillary membrane permeability, and d) lymphatic obstruction.

What is the hormone that the kidney produces to stimulate the red bone marrow to produce RBCs?

Erythropoietin

Which substance is used to correct the chronic anemia associated with chronic renal failure?

Erythropoietin

A 52-year-old male suffered a myocardial infarction secondary to atherosclerosis and ischemia. Once oxygen returned to the damaged heart, reperfusion injury occurred as a result of:

Free radical formation

What is an example of hypertrophy?

Heart enlargement in high BP. It is required to work harder and cells can't reproduce; therefore they get larger

A 5-year-old male was diagnosed with normocytic-normochromic anemia. Which of the following anemias does the nurse suspect the patient has?

Hemolytic anemia

A condition in which red blood cells are destroyed and removed from the bloodstream before their normal lifespan is over is called...

Hemolytic anemia

A 34-year-old male presents in the emergency room with extreme fatigue and shortness of breath. His skin and sclera appear to have a yellowish discoloration. These assessment findings are consistent with which type of anemia?

Hemolytic anemia -A yellow appearance to the skin and sclera are consistent with hemolytic anemia.

Hyperkalemia (peaked T waves)

(potassium levels > 5.5 mEq/L) may be caused by increased potassium intake, a shift from ICF to ECF potassium, or decreased renal excretion. -causes: efficient renal excretion, excessive intake of K+, change in cell membrane permeability, hypoxia, acidosis, insulin deficits, decreased renal secretion of K+ -treatment: treat the contributing cause, correcting K+ excess, administer calcium gluconate, glucose, insulin, oral or rectal administration of cation exchange resins, dialysis

Define hypotonic and know diseases and disorders associated with it.

- Solute concentration greatest inside the cell -Solute pulls water into the cell -Cell enlarges and eventually bursts -most common causes: sodium deficit (HYPONATREMIA <0.9% sodium) or free water excess (water intoxication) -leads to cellular edema and swelling when water moves into the cell and there is great osmotic pressure. -Diseases: Hyponatremia (low sodium levels), hypochloremia (low serum chloride levels), and water intoxication.

Hypertonic mechanisms

-(High sodium, low water) The hypertonicity of the ECF attracts water from the intracellular space, causing ICF dehydration. -H2O concentration > inside the cell; solute concentration > outside the cell; H2O drawn out of the cell

Isotonic mechanisms

-(balanced) changes in TBW occur in proportional amounts of electrolytes and water H2O concentration is equal on both sides of the membrane; no H2O movement across the membrane

hypotonic mechanisms

-(low sodium, high water) Intracellular overhydration and cell swelling when water moves into the cell, where osmotic pressure is greater. Edema occurs in conjunction with fluid shifts. -H2O concentration > outside the cell; solute concentration > inside the cell; H2O is drawn into the cell

A 30-year-old female presents with hematuria, menorrhagia, and bleeding gums. She is diagnosed with immune thrombocytic purpura (ITP). A nurse realizes the most likely cause is:

-Antibody destruction of platelets -The majority of cases of ITP are due to immune driven destruction of platelets.

Transcellular H+/K+ exchange system

-Both H+ and K+ move freely b/t ICF and ECF excess H+/K+ in ECF moves into ICF in exchange for the other

what is respiratory alkalosis? -symptoms -causes -treatment

-CO2 decreases, pH increases -symptoms: increased rate and depth of breathing, numbness, light-headedness, tetany, hyperventilation, dizziness, tachypnea, mental status changes, pallor around mouth, dizziness, tingling of fingers and toes, spasms of muscles of hands, HYPOkalemia -causes: hyperventilation because of anxiety (MAIN CAUSE), hysteria, fever, exercise; reaction to drugs such as salicylate, quinine, and antihistamines; conditions causing hypoxia (e.g. pneumonia, pulmonary edema, heart disease) early stages of salicylate poisoning -treatment: elimination of anxiety-producing state, rebreathing into a paper bag

What is respiratory acidosis? -symptoms -causes -treatment

-CO2 increases, pH decreases -symptoms: failure to ventilate, suppression of breathing, disorientation, weakness, coma, SOB, wheezing, high pitched breath sounds, cough HYPERkalemia -causes: lung disease blocking gas diffusion (e.g. emphysema, pneumonia, bronchitis, asthma); depression of respiratory center by drugs, cardiopulmonary arrest, stroke, poliomyelitis, or nervous system disorders -treatment: correction of disorder, infusion of bicarbonate, steroids, bronchodilators

Normocytic-Normochromic Anemias

-Characterized by RBC's that are relatively normal in size and hemoglobin content but insufficient in number. -Some of these anemias are the result of hemolysis of erythrocytes and may be characterized by specific abnormal red cell shapes.

A nurse is teaching the staff about disseminated intravascular coagulation (DIC). Which information should the nurse include? The sequence of events in DIC is initiated by the release of:

-Clotting factors are depleted. -Intravascular clotting leads to depletion of clotting factors.

Respiratory Buffering

-Compensates for Metabolic acidosis & alkalosis RAPID -Dissolved CO2 produced by metabolism of Carbs and Fats -CO2 combines with H2O in lungs to form carbonic acid -CARBONIC ACID is key regulatory factor

Renal Buffering

-Compensates for Respiratory acidosis and alkalosis -H2CO3 counters alkalosis -HCO3 counters acidosis

formation of RBC's

-Erythropoietin: hormone released by kidney, stimulates production in the RBCs if in hypoxic state or RBCs are low (inadequate O2 available to cells) -Adequate production and maturation of RBC's depends on availability of amino acids, iron, vitamin B12, vitamin B6 and folic acid.

Folate deficiency anemia

-Folate (folic acid) required for RNA & DNA synthesis in erythrocyte, comes from dietary intake -S/S: similar to pernicious anemia minus neuro symptoms, more often in alcoholics and malnourished people

what is metabolic alkalosis? -symptoms -causes -treatment

-H+ decreases, accumulation of HCO3, pH increases -symptoms: depressed breathing, apathy, confusion -causes: vomiting, diseases of the adrenal glands, ingestion of excess alkali -treatment: Administer IV fluids (NS) and potassium chloride to restore normal fluid and electrolyte balance

what is metabolic acidosis? -symptoms -causes -treatment

-H+ increases, pH decreases -symptoms: increased ventilation, fatigue, confusion -causes: renal disease, including hepatitis and cirrhosis; increased acid production in diabetes mellitus, hyperthyroidism, alcoholism, and starvation; loss of alkali in diarrhea; acid retention in renal failure -treatment: sodium bicarbonate given orally, dialysis for renal failure, insulin treatment for diabetic ketosis

What are some examples of hypoxic injury?

-Lack of sufficient O2- Can result from decreased oxygen in the air, loss of Hb or decreased efficiency of Hb, decreased RBCs, diseases of the CVS or respiratory system, poisoning of oxidative enzymes within cells. Hypoxia--> Inflammation-->Even worse hypoxia

What is apoptosis?

-Normal, expected death. -Programmed cell death. Cell shrinkage and taken apart and phagocytized. No swelling.

Intracellular calcium and loss of calcium steady state

-Normally intracellular cytosolic calcium concentrations are very low. -ischemia and certain chemicals cause and increase in cytosolic Ca++ -sustained levels of Ca++ continue to increase with damage to plasma membrane

During acidosis, the body compensates for the increase in serum hydrogen ions by shifting hydrogen ions into the cell in exchange for which electrolyte?

-Potassium -In states of acidosis, hydrogen ions shift into the cells in exchange for intracellular fluid potassium; hyperkalemia and acidosis therefore often occur together.

Metaplasia

-Reversible replacement of one mature cell type by another, sometimes less differentiated, cell type -Replacement of normal bronchial columnar ciliated epithelial cells by stratified squamous epithelial cells

A nurse is describing Virchow Triad. Which of the following is an example of endothelial injury?

-Smoking (Endothelial injury is caused by radiation injury, exogenous chemical agents (e.g., toxins from cigarette smoke), endogenous agents (e.g., cholesterol), bacterial toxins or endotoxins, or immunologic mechanisms.)

Define Hypertonic and know diseases associated with it.

-Solute concentration is greatest outside the cell -Solute pulls water out of the cell -Cell shrinks -most common causes: increased concentration of ECF (HYPERNATREMIA >0.9% sodium) or a deficit of ECF free water. -leads to ICF dehydration. Cells shrink. -Diseases: Hypernatremia (increased sodium), hyperchloremia (elevated serum chloride levels), and dehydration.

Which of the following clusters of symptoms would lead the nurse to suspect a child has idiopathic thrombocytopenic purpura (ITP)?

-Spontaneous nosebleeds, bruising, petechiae -Nosebleeds, bruising, and petechiae are signs of a lack of clotting due to low platelets and ITP.

What is necrosis?

-Unexpected cell death -The sum of cellular changes after local cell death by nonspecific trauma or injury. Different types of necrosis tend to occur in different organs. There are 4 main types: coagulative, liquefactive, caseous, fatty.

Cell atrophy occurs ________________

-With early development (similar to the thymus) -Results from decreases in workload, use, pressure, blood supply, nutrition, hormonal stimulation, and nervous stimulation -Disuse -Decreased protein synthesis, increased protein catabolism, or both

How does calcium influence cellular injury in hypoxia?

-With plasma membrane damage, extracellular calcium readily moves into the cell & intracellular calcium stores are released. -increased intracellular calcium levels activate cell enzymes (capases) that promote cellular death by apoptosis.

Define Isotonic and know diseases associated with it.

-a solution that has the same concentration of solutes as the plasma. Occurs when changes in TBW are accompanied by proportional changes in the amounts of electrolytes and water. -normal 0.9% sodium concentration -no shrinking or swelling of the cells

oxygen free radicals

-an oxygen atom carrying an unpaired electron and no charge. -unpaired electron that makes the molecule unstable=cellular injury

Iron deficiency anemia

-blood loss is the most common cause -poor iron (ferritin) intake, duodenal absorption of iron is impaired (malabsorption syndromes), severe liver disease, -lab: low hgb, hct and iron, microcytic (small cell), hypochromic (less color) erythrocytes

fatty necrosis

-breasts, pancreas and other abdominal structures. -lipase breaks down triglycerides releasing fatty acids that then combine with calcium, magnesium and sodium ions creating soaps (saponification). -tissue appears opaque and chalk-like

Four major types of necrosis

-coagulative necrosis -liquefactive necrosis -caseous necrosis -fatty necrosis (gangrenous necrosis is not a distinct type of necrosis but refers to large areas of necrotic tissues)

caseous necrosis

-combination of coagulative and liquefactive necrosis that results from TB -the dead cells are not completely digested by hydrolases, so the tissue resemble clumped cheese in that they are granular and soft.

Arterial thrombosis

o Atherosclerosis: plaque rupture and thrombus formation leading to myocardial infarction or ischemic stroke o Atrial fibrillation: stasis in left atrial appendage leading to thrombus formation. Embolization of this thrombus leads to cardioembolic stroke. o Prosthetic heart valve: thrombus around prosthetic valve leading to cardioembolic stroke. o Peripheral arterial injury/hypercoagulability: acute limb ischemia

Interstitial oncotic pressure

osmotically attracts water from the capillary into the interstitial space.

Capillary oncotic pressure

osmotically attracts water from the interstitial space back into the capillary.

Why is Vitamin K important?

raw material needed to create prothrombin

Overhydration (Hypervolemia)

total volume of body fluids larger than normal; overhydration occurs when fluid intake exceeds output; various factors may cause this (ex. giving IV fluids too rapidly) -edema, crackles, tachycardia, decreased hematocrit, bulging fontanelle, increased BP

Dehydration (Hypovolemia)

total volume of body fluids smaller than normal; -If volume shrinks first, and then if treatment is not given, ICF volume and plasma volume decrease; dehydration occurs when fluid output exceeds intake for an extended period of time -signs: decrease in urination, sunken eyes, no tears when child cries, extreme thirst, unusual drowsiness or fussiness, dry & sticky mouth

DIC Tx:

• Administer blood products for specific deficiencies and for bleeding o Platelets o Fresh frozen plasma o Cryoprecipitate • Heparin therapy • Other drugs: Epsilon-aminocaproic acid - an inhibitor of fibrinolysis (used with heparin) or Activated protein C

Nursing Care for DIC

• Ineffective tissue perfusion • Maintain oxygenation- airway & respiratory care • Pain • Decreased CO related to bleeding, fluid loss, low BP • Protection from injury- potential for bleeding

Venous Thrombosis

• Predominantly composed of fibrin and erythrocytes with small platelet head • Can occur anywhere in the venous system, deep veins of the lower extremities are common. • Embolization results in pulmonary embolism (PE). • Signs/symptoms of DVT: unilateral edema, tenderness, pain, erythema, warmth, palpable cord, positive Homan sign (dorsiflexion of the foot, positive with sharp calf pain) • Signs/symptoms of PE: dyspnea, tachypnea, tachycardia, pleuritic chest pain, hemoptysis • PE complications: death, pulmonary hypertension, cor pulmonale, recurrent VTE • DVT complications: PE, post-thrombotic syndrome, recurrent VTE, chronic venous insufficiency

Vomiting and diuretic therapy lead to loss of what (2)?

Hydrogen and chloride

What mechanisms cause hypernatremia?

Hyperaldosteronism -More commonly, high sodium levels occur because (1) inadequate free water intake; (2) inappropriate administration of hypertonic saline solution (e.g. sodium bicarbonate for treatment of acidosis during cardaic arrest; (3) high sodium levels as a result of oversecretion of aldosterone (as in primary hyperaldosteronism) or; (4) cushing syndrome (caused by excess secretion of adrenocorticotropic hormone (ACTH), which also causes increased secretion of aldosterone.

An excessive use of magnesium-containing antacids and aluminum-containing antacids can result in:

Hypophosphatemia

What is the most common cause of cellular injury?

Hypoxia

Differences in cardiac dysrthymias between hyperkalemia and hypokalemia include:

In hyperkalemia there is a slowed heart rate and muscle weakness whereas in hypokalemia there is an elevation in blood pressure and diminished deep tendon reflexes

Hypokalemia (U waves)

In hypoalkemia, (serum potassium < 3.5 mEq/L) indicates loss of total body potassium -causes: reduced K+ intake, increased ICF-ECF K+ concentration, loss of potassium from body stores, increased aldosterone secretion or increased renal secretion -treatment: eat foods rich in K+ or an IV replacement

Secretion of ADH and the perception of thirst are stimulated by a(n)

Increase in plasma osmolality -Secretion of ADH and perception of thirst are primary factors in the regulation of water balance. Thirst is a sensation that stimulates water-drinking behavior. Thirst is experienced when water loss equals 2% of an individual's body weight or when there is an increase in osmolality.

Hyperplasia

Increase in the# of normal cells resulting from an increased rate of cellular division (mitosis)

Following ischemia and hypoxic cellular injury, which of the following would you expect to find in the injured cells?

Increased intracellular levels of Ca2+

Damage to the mitochondrial membrane will most likely result in which of the following events? a. Enzymatic digestion halts DNA synthesis. b. Influx of calcium ions halts ATP production. c. Reduction in ATP production caused by edema from an influx in sodium d. Shift of potassium out of the mitochondria, which destroys the infrastructure

Influx of calcium ions halts ATP production.

If adaption is not enough what does it lead to?

Injury

A major determinant of the resting membrane potential necessary for the transmission of nerve impulses is the ratio between:

Intracellular and extracellular K+

What is the most common cause of hypoxia?

Ischemia, reduced blood supply can be caused by atherosclerosis or thrombosis

Fluid Compartments: ICF

Largest volume of fluid is contained inside the cells -all the fluid within cells - approx. 2/3 of body's water

Cellular injury

Leads to injury of tissues and organs, determining structural patterns of disease.

Where are Kupffer cells located?

Liver

Which patient should the nurse assess first for bleeding problems? A patient with:

Liver disease

ATP Depletion definition and Results

Loss of mitochondrial ATP and decreased ATP synthesis. Results: - cellular swelling - decreased protein synthesis - decreased membrane transport - lipogenesis - all change that contribute to loss of integrity of plasma membrane

The pathophysiologic process of edema is related to which mechanism

Lymphatic obstruction

How do the kidney's maintain ABB?

Maintain bicarbonate levels, excrete H+, conserve bicarbonate

How do the lungs maintain ABB?

Maintain carbonic acid levels

A patient has a heart attack that leads to progressive cell injury that causes cell death with severe cell swelling and breakdown of organelles. What term would the nurse use to define this process?

Necrosis

When hypoxemia is detected, a mechanism of correction is initiated: erythropoietic is secreted by the kidneys and liver and the rate of erythropoiesis accelerates. This is an example of a(n):

Negative feedback control

The exchange between interstitial fluid and plasma is determined by the relationship between the:

Net hydrostatic and net colloid osmotic pressures

Discuss the regulatory processes for sodium, chloride and water hgt/, rennin-angiotensin-aldosterone, and atrial natriuretic hormone, baroreceptors.

Osmoreceptors cause thirst. -ADH is released by the posterior pituitary and it increases the permeability of renal tubular cells to water, increasing water reabsorption and promoting the restoration of plasma volume and blood pressure. Atrial natriuretic hormone is involved in decreasing tubular reabsorption and promoting urinary excretion of sodium. -Baroreceptors signal the hypothalamus the release ADH if arterial and atrial pressure drops.

Water movement between the intracellular fluid compartment and the extracellular compartment is primarily a function of:

Osmotic Forces -the movement of water between ICF and ECF compartments is primarily a function of osmotic forces

When water is lost but electrolytes are retained, the osmolarity of the ECF rises and osmosis then moves water:

Out of the ICF and into the ECF until isotonicity is reached

The calcium and phosphate balance is influenced by which three substances?

Parathyroid hormone, calcitonin, and vitamin D

Necrosis is _________ and apoptosis is __________.

Pathologic/ Physiologic

The absence of parietal cells would prevent the absorption of an essential nutrient necessary to prevent which type of anemia?

Pernicious anemia -Vitamin b12 is a large molecule that requires a protein secreted by parietal cells into the stomach (intrinsic factor [IF]) to transport across the ileum. Defects in IF production lead to deceased b12 absorption and pernicious anemia.

A child is admitted with acute idiopathic thrombocytopenic purpura (ITP). Which history data is significant for ITP?

Recently had a viral infection (Acute ITP is usually secondary to infections (particularly viral)

Hypermagnesemia is usually caused by:

Renal Failure

Hypermagnesemia is usually caused by:

Renal Failure -Hypermagnesemia, in which magnesium concentration is greater than 2.5 mEq/L is rare and usually is caused by renal failure.

Erythroblastosis fetalis, also known as hemolytic disease of the newborn, most often occurs in ______________ mothers carrying ______________ fetuses.

Rh- , Rh+

For which type of sickle cell crisis should the nurse assess for in young children?

Sequestration crisis -Sequestration occurs when large amounts of blood become acutely pooled in the liver and spleen. This type of crisis is seen only in a young child.

A 12-year-old male is diagnosed with sickle cell anemia. A blood smear reveals severely sickled cells. A nurse recalls the sickled cells will be removed from circulation mostly by the:

Spleen -Sickled cells undergo hemolysis in the spleen or become sequestered there, causing blood pooling and infarction of splenic vessels.

A nurse is preparing to teach the staff about aplastic anemia. Which information should the nurse include? Aplastic anemia is caused by:

Stem cell deficiency -In aplastic anemia, erythrocyte stem cells are underdeveloped, defective, or absent.

Which are indications of dehydration?

Tachycardia and weight loss -Marked water deficit is manifested by symptoms of dehydration: headache, thirst, dry skin and mucous membranes, elevated temperature, weight loss, and decreased or concentratd urine (with the exception of diabetes inspidus). Skin turgor may be normal or decreased. Symptoms of hypovolemia, including tachycardia, weak pulses, and postural hypotension, may be present.

How does SIADH cause excess water?

The increase in antidiuretic hormone causes retention of water in the renal tubules. -SIADH is not caused by excess water intake but by increased renal absorption of water as a result of inappropriate increases in ADH. Serum sodium and osmolality are reduced by dilution. The kidney continues to excrete sodium, and urine sodium and urine osmolality are elevated; water is reabsorbed, increasing body fluid volume, and urine volume is decreased.

A patient is admitted to the Emergency department with thrombotic thrombocytopenic purpura (TTP). Which principle should guide nursing care?

This is a life-threatening multisystem disorder

What term should the nurse document for a detached blood clot?

Thromboembolus

Free Radicals and cell death

To stabilize, the molecule either donates or accepts an e- from another molecule = forms injurious chemical bonds with proteins, lipids and carbs

Anoxia

Total lack of oxygen

Erythrocytes and platelets lack cell nuclei

True

Platelets are not cells; they are disk-shaped cytoplasmic fragments.

True

T or F: Cell types conversion will not overstep the boundaries of primary type of tissue.

True (an epithelial cell will not become connective tissue or muscle cell)

Nutritional imbalances that cause cell injury

Vitamin A, B & C

How does the body reestablish equilibrium when solute is added to extracellular fluid making it hypertonic?

Water is drawn from the intracellular space to the extracellular. -ECF volume deficit increases the ECF osmotic pressure, and intracellular water is attracted to the ECF space. Water from the intracellular space has moved to the extracellular space until the osmotic forces are equal. The consequence is a decrease in ICF water volume and cell size.

Discuss the ways water moves between plasma and interstitial fluid:

Water moves between plasma and interstitial fluid occurs as a result of changes in hydrostatic pressure and osmotic forces at the arterial and venous ends of the capillary.

Is dysplasia reversible?

Yes, if the irritation is removed -does NOT indicate cancer, but could be a precursor

cachexia

a condition of physical wasting away due to the loss of weight and muscle mass that occurs in patients with diseases such as advanced cancer or AIDS

What is alkalosis?

a decrease in the CO2 level leads to a high blood pH

Cellular adaptation:

a reversible, structural, or functional response to both normal or physiologic conditions and to adverse or pathologic conditions

When analyzing an arterial blood gas report of a pt with COPD & respiratory acidosis, the nurse anticipates that compensation will develop through which of the following mechanisms? a) The kidneys retain bicarbonate. b) The kidneys excrete bicarbonate. c) The lungs will retain carbon dioxide. d) The lungs will excrete carbon dioxide.

a) The kidneys retain bicarbonate.

The nurse is caring for a pt diagnosed with renal failure. Which of the following does the nurse recognize as compensation for the acid-base disturbance found in pts with renal failure? a) The pt breathes rapidly to eliminate carbon dioxide. b) The pt will retain bicarbonate in excess of normal. c) The pH will decrease from the present value. d) The pt's oxygen saturation level will improve.

a) The pt breathes rapidly to eliminate carbon dioxide.

An elderly postoperative pt is demonstrating lethargy, confusion, & a resp rate of 8 per minute. The nurse sees that the last dose of pain medication administered via a pt controlled anesthesia (PCA) pump was within 30 minutes. Which of the following acid-base disorders might this pt be experiencing? a) respiratory acidosis b) metabolic acidosis c) respiratory alkalosis d) metabolic alkalosis

a) respiratory acidosis

The nurse is reviewing a pt's blood pH level. Which of the systems in the body regulate blood pH? Select all that apply. a) renal b) cardiac c) buffers d) respiratory

a, c, d

What is the life span of platelets? a. 10 days b. 30 days c. 90 days d. 120 days

a. 10 days

Which characteristic of albumin is false? a. Albumin retains sodium to maintain water balance. b. Albumin provides colloid osmotic pressure. c. Albumin is synthesized in the liver. d. Albumin is a carrier for calcium and some drugs.

a. Albumin retains sodium to maintain water balance.

A 45-year-old male is diagnosed with macrocytic, normochromic anemia. The nurse suspects the most likely cause of this condition is: a. Defective DNA synthesis b. Abnormal synthesis of hemoglobin c. Defective use of vitamin C d. Blocked protein synthesis

a. Defective DNA synthesis -These anemias are the result of ineffective erythrocyte deoxyribonucleic acid (DNA) synthesis.

Which of the following may occur with respiratory acidosis? a. Increased intracranial pressure b. Mental alertness c. Decreased pulse d. Decreased blood pressure

a. Increased intracranial pressure

A nurse caring for a client with an ileostomy understands that the client is most at risk for developing which acid-base disorder? a. Metabolic acidosis b. Metabolic alkalosis c. Respiratory acidosis d. Respiratory alkalosis

a. Metabolic acidosis

A nurse notes that a client's arterial blood gas results reveal a pH of 7.50 and a PCO2 of 30 mm Hg. The nurse monitors that client for which clinical manifestations associated with these ABG results? Select all the apply. a. Nausea b. Confusion c. Bradypnea d. Tachycardia e. Hyperkalemia 6. Lightheadedness

a. Nausea b. Confusion d. Tachycardia 6. Lightheadedness

A nurse reviews the blood gas results of a client with atelactasis. The nurse analyzes the results and determines that the client is experiencing respiratory acidosis. Which of the following validates that nurse's findings? a. pH 7.25, PCO2 50 mm Hg b. 7.35, PCO2 40 mm Hg c. pH 7.50, PCO2 52 mm Hg d. pH 7.52, PCO2 28 mm Hg

a. pH 7.25, PCO2 50 mm Hg

Recycling of iron from erythrocytes is made possible by: a. transferrin. b. hemosiderin. c. apoferritin. d. erythropoietin

a. transferrin

Dysplasia

abnormal changes in the size, shape and organization of mature cells

All forms of disease begin with ______________ in cells.

alterations; therefore cells must adapt to their environment to escape and protect themselves from injury

Hypertrophy

an increase in the size of cells

Aplastic anemia S/S & treatment

anemia (pallor, weakness, dyspnea), leukopenia, thrombocytopenia treatment: remove cause, blood transfusions, bone marrow transplant

Where do arterial thrombi usually occur?

at sites of endothelial injury

A client in the emergency department reports that he has been vomiting excessively for the past 2 days. His arterial blood gas analysis shows a pH of 7.50, PaCO2 of 43 mm Hg, PaO2 of 75 mm Hg, and HCO3− of 42 mEq/L. Based on these findings, the nurse documents that the patient is experiencing which type of acid-base imbalance?

b) Metabolic alkalosis

The nurse observes a pt's respirations & notes that the rate is 30 per minute & the respirations are very deep. The metabolic disorder this pt might be demonstrating is which of the following? a) hypernatremia b) increasing carbon dioxide in the blood c) hypertension d) pain

b) increasing carbon dioxide in the blood

A pt is prescribed 20 mEq of potassium chloride. The nurse realizes that the reason the pt is receiving this replacement is a) to sustain respiratory function. b) to help regulate acid-base balance. c) to keep a vein open. d) to encourage urine output.

b) to help regulate acid-base balance.

Which nutrients are necessary for hemoglobin synthesis? a. Protein and niacin b. Iron and vitamin B6 c. (pyridoxine) Cobalamin (vitamin B12) and folate d. Pantothenic acid and vitamin C

b. Iron and vitamin B6

A nurse is caring for a client with a nasogastric tube that is attached to low suction. The nurse monitors the client, knowing that the client is at risk for which acid-base disorder. a. Metabolic acidosis b. Metabolic alkalosis c. Respiratory acidosis d. Respiratory alkalosis

b. Metabolic alkalosis

A nurse is caring for a client who is on a mechanical ventilator. Blood gas results indicate a pH of 7.50 and a PCO2 of 30 mm Hg. The nurse has determined that the client is experiencing respiratory alkalosis. Which laboratory value would most likely be noted in this condition? a. Sodium level of 145 mEq/L b. Potassium level of 3 mEq/L c. Magnesium level of 2 mg/dL d. Phosphorus level of 4 mg/dL

b. Potassium level of 3 mEq/L

A nurse reviews the arterial blood gas results of a client and notes the following: pH 7.45, PCO2 of 30 mm Hg, and HCO3 of 22 mEq/L. The nurse analyzes these results as indicating which condition? a. Metabolic acidosis, compensated b. Respiratory alkalosis, compensated c. Metabolic alkalosis, uncompensated d. Respiratory acidosis, uncompensated

b. Respiratory alkalosis, compensated

The blood pH is maintained near 7.4 by buffering systems. The sequence from the fastest-acting to the slowest-acting system is:

b. blood buffers, lungs, kidneys

When caring for a group of pts, the nurse realizes that which of the following health problems increases the risk for metabolic alkalosis? a. COPD b bulimia c. dialysis d. venous stasis ulcer

b. bulimia

Pathophysiology of DIC

bodys attempts to prevent excessive blood loss putting stress on the coagulation process. body produces excessive thrombin stimulating fibrinogen to fibrin. elevated fibrin results in multiple small clots forming in small blood vessels. patient will have petachiae

How does Ca++ cause intracellular damage?

by activating a number of enzymes

The nurse is caring for a pt who is anxious & dizzy following a traumatic experience. The arterial blood gas findings include: pH 7.48, PaO2 110, PaCO2 25, & HCO3 24. The nurse would anticipate which initial intervention to correct this problem? a) Immediately administer oxygen via a mask & monitor oxygen saturation. b) Prepare to start an intravenous fluid bolus using isotonic fluids. c) Encourage the pt to breathe in & out slowly into a paper bag. d) Anticipate the administration of intravenous sodium bicarbonate.

c) Encourage the pt to breathe in & out slowly into a paper bag.

The blood gases of a pt with an acid-base disorder show a blood pH outside of normal limits. The nurse realizes that this pt is a) fully compensated. b) demonstrating anaerobic metabolism. c) partially compensated. d) in need of intravenous fluids

c) partially compensated.

Erythrocytes: a. contain a nucleus, mitochondria, and ribosomes. b. synthesize proteins. c. change shape to squeeze through microcirculation. d. are stimulated by erythrocyte colony-stimulating factor (E-CSF).

c. change shape to squeeze through microcirculation.

Giving hypertonic IV solution to a patient may cause too much fluid to be: a. pulled out of the bloodstream into the cells b. pushed out of the bloodstream into the extravascular spaces c. pulled from the cells into the bloodstream, which may cause cells to shrink d. pulled from the cells into the bloodstream, which may cause the cells to increase in size

c. pulled from the cells into the bloodstream, which may cause cells to shrink

Hypertrophy is seen in ______________ and _______ muscle, which cannot reproduce through mitosis; therefore the must work harder.

cardiac; skeletal

Disseminated intravascular coagulation DIC syndrome

characterized by widespread intravascular clotting and bleeding, can be severe and life threatening or very mild common etiology is sepsis beginning with endotheilal drainage, initiates clotting cascade, clotting factors are depleted, hemorrhage occurs

A pt's blood gases show a pH greater of 7.53 & bicarbonate level of 36 mEq/L. The nurse realizes that the acid-base disorder this pt is demonstrating is which of the following? a) respiratory acidosis b) metabolic acidosis c) respiratory alkalosis d) metabolic alkalosis

d) metabolic alkalosis

A client with a 3-day history or nausea and vomiting presents to the emergency department. Arterial blood gases are drawn and the nurse reviews the results, expecting to note which of the following? a. A decreased pH and an increased CO2 b. An increased pH and a decreased CO2 c. A decreased pH and a decreased HCO3- d. An increased pH with an increase HCO3-

d. An increased pH with an increase HCO3-

Which of the following would be a potential cause for respiratory acidosis? a. Diarrhea b. Vomiting c. Hyperventilation d. Hypoventilation

d. Hypoventilation

which statement about plasma proteins is false? a. Plasma proteins provide clotting factors. b. Plasma proteins transport triglycerides and cholesterol. c. Plasma proteins synthesize complement proteins. d. Plasma proteins create hydrostatic pressure.

d. Plasma proteins create hydrostatic pressure.

A client who is found unresponsive has arterial blood gases drawn and the results indicate the following: pH is 7.12, PCO2 is 90 mm Hg, and HCO3- is 22 mEq/L. The nurse interprets the results as indicating which condition? a. Metabolic acidosis with compensation b. Respiratory acidosis with compensation c. Metabolic acidosis without compensation d. Respiratory acidosis without compensation

d. Respiratory acidosis without compensation

The effect of low albumin in plasma is: a. clotting factors decrease, thus increasing the chance of prolonged bleeding. b. fewer immunoglobulins are synthesized, thus impairing the immune function. c. less iron is stored, thus increasing the incidence of iron deficiency anemia. d. osmotic pressure decreases, thus water moves from the capillaries to the interstitium

d. osmotic pressure decreases, thus water moves from the capillaries to the interstitium

Atrophy

decrease or shrinkage in cell SIZE

What are some of the changes at the cellular level in response to hypoxia?

decreased ATP-> decreased Na pump-> increased intracellular Na, extracellular K, intracellular Ca. Increased water in the cell and acute cellular swelling

pernicious anemia

deficiency of RBCs that results in the failure of the stomach lining to produce "intrinsic factor" , the substance that allows vit. B12 to be absorbed from the foods we eat.

Sodium ions enter the ECF by crossing the digestive epithelium via:

diffusion and active transport

Dysplasia often occurs in

epithelial tissue of cervix and respiratory tract, where they are strongly associated with neoplastic growths and often are found adjacent to cancerous cells.

Interstitial hydrostatic pressure

facilitates the inward movement of water from the interstitial space into the capillary

Capillary hydrostatic pressure (blood pressure)

facilitates the outward movement of water from the capillary to the interstitial space.

Hypertrophy is most common in the cells of

heart kidney

Can't treat metabolic alkalosis if still....

hypokalemic

When pure water is consumed, the ECF becomes

hypotonic with respect to the ICF

What is acidosis?

if the CO2 level increases, it produces more H2CO3 and more H3O+, lowering the pH

Cells hypertrophy with ____________

increased work demand or hormones (increased workload) -Trigger signals: Mechanical (stretch) and trophic (GF, vasoactive agents)

An elevated anion gap is associated with an accumulation of:

lactate anion

Anaplasia

loss of differentiation of cells and their orientation to each other; cancer cells that divide rapidly and have little or no resemblance to normal cells

Virchow's triad factors

loss of integrity of vessel wall (atherosclerosis) abnormalities of blood flow (slugglish or turbulent blood flow) alterations in the blood constituents (thrombocytosis)

Dysplasia can cause ________________ (atypical hyperplasia)

loss of natural orientation and chronic irritation especially in epithelial tissue (respiratory tract and cervix)