Exam 1 1443

• released by thyroid
• increases blood flow leading to increased renal circulation & increased renal circulation

• mineralcorticoid hormone
• secreted by adrenal glands
• conserves sodium, chloride, water
• excretes K

• secreted by parathyroid glands
• draws Ca from bones into blood
• moves phosphorus from blood to kidneys

• made by hypothalmus
• stored in pituitary gland (posterior lobe)

• neurons
• sensitive in changes in concentration of ECF
• send impulses to pit. gland to release ADH

• 275-295
• remains in intravascular compartment

• >295
• draws water out of cells & into intravascular compartment
• cells shrink

• <275
• fluid moves into cells
• cells swell and potentially burst

"pushing" force in filtration

"pulling force" in filtration

substance containing H+ that can be released

• H₂CO₃ --> H+ + HCo₃-
• (carbonic acid) (bicarbonate base)

substance that can trap H+ ions

HCO₃- + H+ --> H₂CO₃

(bicarbonate base) (carbonic acid)

as H+ increases --> substance becomes more acid (less than 7)

as H+ decreases --> substance becomes more basic (greater than 7)

7.35 - 7.45

excess of H+ or loss of base ions

pH <7.35

lack of H+ or gain of base ions

pH >7.45

H₂CO₃

HCO₃-

normal ECF ratio: 20bicarb:1 carbonic acid

• ICF (esp. renal tubules)
• converts alkaline sodium phosphate (Na₂HPO₄) to acid sodium phosphate (NaH₂PO₄)

• carbonic acid --> CO₂ + H₂0
• (H₂CO₃)

• fluids move into transcellular compartment (ascities, etc.)
• not easily exchanged with ECF
• caused by: low albumin, increased fluid volume, heart failure, hyponatremia

• Na <135
• caused by: vomitting, diarrhea, fistulas, sweating, diuretics
• fluid moves into ICF & cells swell
• signs: hypotension, confusion, edema, muscle cramps, weakness, dry skin

• Na >145
• cells shrink
• caused by: lack of fluid intake
• signs: neurological impairment, restlessness, weakness, disorientation, delusion, hallucinations

• K <3.5
• caused by: vomiting, gastric suction, alkalosis, diarrhea, diuretics
• signs: muscle weakness, leg cramps, fatigue, dysrhythmias

• K >5
• caused by: renal failure, hypoaldosteronism
• signs: weakness & paralysis

• serum Ca< 8.9
• ionized Ca < 4.5
• causes: inadequate indate, impaired absorption, excessive loss
• signs: numb & tingling fingers/mouth/feet, tetany, muscle cramps, seizure

• serum Ca > 10.1
• ionized Ca > 5.1
• causes: cancer & hyperparathyroidism
• signs: nausea, vomiting, constipation, bone pain, excessive uriniation, thirst, confusion, lethargy, slurred speech

• 1. unrestricted area - street clothes & scrubs
• 2. semirestricted area - surrounding support areas & corridors - authorized staff only in surgical attire & with hair covered
• 3. restricted area - masks requried - OR, scrub sinks, clean core

• patient warmng
• prophylactic anitbiotics
• SCDS
• IVs
• casts
• epidurals

• positive air pressure to prevent air in hallways from entering
• UV light to kill microorganisms in air
• no dust collecting surfaces
• corrosion resistant materials

• 1. RN - patient advocate - can be circulating (unsterile) or scrubbed (sterile)
• 2. LPN/surgical technologist - can perform circulating or scrubbed nurse function under RN supervision
• 3. surgeon & assisant (non always a physician)
• 4. RN 1st assistant (RNFA) - can handle tissue, use instruments, suture
• 5. anesthesia care provider (ACP)

preventing wrong site, wrong procedure, and wrong surgery

time to verify patient, procedure, site right before procedure

• loss of sensation w/ loss of consciousness
• skeletal muscle relaxation
• possible impaired ventilatory & cardiovascular function
• elimination of coughing, gagging, vomiting response
• use IV agents, inhalation agents, adjuncts, or dissociative anesthesia

preinduction, induction, maintenance, emergence

interrupts generation of nerve impulses by altering flow of Na into nerve cells

local anesthesia injected into central nerve or group of nerves

injection of local anesthesia into cerebrospinal fluid in the subarachnoid space

injection of local anesthetic into epidural (extradural) space

does not enter CSF

• hyperthermia with rigidity of skeletal muscles that can result in death
• succinylcholine (anectine) can be trigger
• treatment is dantrolene (dantrium)

• cells divide indiscriminately and haphazardly
• can produce more than two cells at mitosis

• loss of intracellular control of proliferation results from mutation of stems cells
• once cell has mutated, 3 things can happen
• 1. cell dies
• 2. cell repairs itself
• 3. mutated cell survives & passes damage along

programmed cellular suicide

• normal cellular genes that regulate normal cellular processes
• promote growth

suppress growth

mutations that alter the expression of protooncogenes can make them oncogenes

• initiation - mutation in cell's genetic structure
• promotion - reversible proliferation of altered cells
• progression - increased growth rate of tumor, increased invasiveness, metastasis

• enzymes capable of destroying the basement membrane of the tumor, lymph & blood vessels
• some cancer cells produce this enzyme

• carcinoma - from ectoderm (skin & glands)
• endoderm - from endoderm (mucous membrane linings)
• sarcoma - from mesoderm (conn. tissue, muscle, bone, fat)
• lymphoma & leukemia - from hematopoietic system

• appearance of cells & degree of differentiation graded
• I - differ slightly from normal cells (mild dysplasia) & are well differentiated (low grade)
• II - more abnormal (moderate dysplasia) & moderately differentiated (intermediate grade)
• III - very abnormal (severe dysplasia) & poorly differentiated (high grade)
• IV - immature & primitive cells (anaplasia) & undifferentiated (high grade)
• X - cannot be assessed

• 0 - cancer in situ
• I - localized tumor growth
• II - limited local spread
• III - extensive local & regional spread
• IV - metastasis

• tumor size & invasiveness (T)
• 0 - no evidence of primary tumor
• 1 - carcinoma in situ
• 1-4 - ascending degrees of increase in size
• X - cannot be measured or found

• regional lymph nodes (N)
• 0 - no evidence of disease in lymph nodes
• 1-4 - ascending degrees of nodal involvement
• X - cannot be assessed clinically

• distant metastases (M)
• 0 - no evidence of distant metastases
• 1-4 - ascending degrees of metastasis
• X - cannot be determined