Exam 1 1443

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Author:
sarahlopez84
ID:
127566
Filename:
Exam 1 1443
Updated:
2012-02-05 15:41:04
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acid base
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Description:
Acid-base, perioperative, cancer
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  1. thyroxine
    • released by thyroid
    • increases blood flow leading to increased renal circulation & increased renal circulation
  2. aldosterone
    • mineralcorticoid hormone
    • secreted by adrenal glands
    • conserves sodium, chloride, water
    • excretes K
  3. parathyroid hormone
    • secreted by parathyroid glands
    • draws Ca from bones into blood
    • moves phosphorus from blood to kidneys
  4. antidiuretic hormone (ADH)
    • made by hypothalmus
    • stored in pituitary gland (posterior lobe)
  5. osmoreceptors
    • neurons
    • sensitive in changes in concentration of ECF
    • send impulses to pit. gland to release ADH
  6. isotonic solution
    • 275-295
    • remains in intravascular compartment
  7. hypertonic solution
    • >295
    • draws water out of cells & into intravascular compartment
    • cells shrink
  8. hypotonic solution
    • <275
    • fluid moves into cells
    • cells swell and potentially burst
  9. hydrostatic pressure
    "pushing" force in filtration
  10. colloid osmotic pressure
    (oncotic pressure)
    "pulling force" in filtration
  11. acid
    substance containing H+ that can be released

    • H2CO3 --> H+ + HCo3-
    • (carbonic acid) (bicarbonate base)
  12. base
    substance that can trap H+ ions

    HCO3- + H+ --> H2CO3

    (bicarbonate base) (carbonic acid)
  13. pH
    as H+ increases --> substance becomes more acid (less than 7)

    as H+ decreases --> substance becomes more basic (greater than 7)
  14. pH of blood plasma
    7.35 - 7.45
  15. acidosis
    excess of H+ or loss of base ions

    pH <7.35
  16. alkalosis
    lack of H+ or gain of base ions

    pH >7.45
  17. carbonic acid
    H2CO3
  18. bicarbonate
    HCO3-
  19. carbonic-acid-sodium bicarbonate buffer system
    normal ECF ratio: 20bicarb:1 carbonic acid
  20. phosphate buffer system
    • ICF (esp. renal tubules)
    • converts alkaline sodium phosphate (Na2HPO4) to acid sodium phosphate (NaH2PO4)
  21. carbon dioxide
    • carbonic acid --> CO2 + H20
    • (H2CO3)
  22. third-space fluid shift
    • fluids move into transcellular compartment (ascities, etc.)
    • not easily exchanged with ECF
    • caused by: low albumin, increased fluid volume, heart failure, hyponatremia
  23. 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
  24. hypernatremia
    • Na >145
    • cells shrink
    • caused by: lack of fluid intake
    • signs: neurological impairment, restlessness, weakness, disorientation, delusion, hallucinations
  25. hypokalemia
    • K <3.5
    • caused by: vomiting, gastric suction, alkalosis, diarrhea, diuretics
    • signs: muscle weakness, leg cramps, fatigue, dysrhythmias
  26. hyperkalemia
    • K >5
    • caused by: renal failure, hypoaldosteronism
    • signs: weakness & paralysis
  27. hypocalcemia
    • 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
  28. hypercalcemia
    • serum Ca > 10.1
    • ionized Ca > 5.1
    • causes: cancer & hyperparathyroidism
    • signs: nausea, vomiting, constipation, bone pain, excessive uriniation, thirst, confusion, lethargy, slurred speech
  29. surgical suite
    • 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
  30. holding area
    AOD area (admission, observation, discharge)
    • patient warmng
    • prophylactic anitbiotics
    • SCDS
    • IVs
    • casts
    • epidurals
  31. OR - operating room
    • positive air pressure to prevent air in hallways from entering
    • UV light to kill microorganisms in air
    • no dust collecting surfaces
    • corrosion resistant materials
  32. surgical team
    • 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)
  33. universal protocol
    preventing wrong site, wrong procedure, and wrong surgery
  34. surgical time-out
    time to verify patient, procedure, site right before procedure
  35. general anesthesia
    • 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
  36. phases of general anesthesia
    preinduction, induction, maintenance, emergence
  37. local anesthesia
    interrupts generation of nerve impulses by altering flow of Na into nerve cells
  38. regional anesthesia (block)
    local anesthesia injected into central nerve or group of nerves
  39. spinal anesthesia
    injection of local anesthesia into cerebrospinal fluid in the subarachnoid space
  40. epidural block
    injection of local anesthetic into epidural (extradural) space

    does not enter CSF
  41. malignant hyperthermia
    • hyperthermia with rigidity of skeletal muscles that can result in death
    • succinylcholine (anectine) can be trigger
    • treatment is dantrolene (dantrium)
  42. defect in cellular proliferation
    • cells divide indiscriminately and haphazardly
    • can produce more than two cells at mitosis
  43. stem cell theory
    • 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
  44. apoptosis
    programmed cellular suicide
  45. protooncogenes
    • normal cellular genes that regulate normal cellular processes
    • promote growth
  46. tumor supressor genes
    suppress growth
  47. oncogenes
    mutations that alter the expression of protooncogenes can make them oncogenes
  48. development of cancer
    • initiation - mutation in cell's genetic structure
    • promotion - reversible proliferation of altered cells
    • progression - increased growth rate of tumor, increased invasiveness, metastasis
  49. metalloproteinase enzymes
    • enzymes capable of destroying the basement membrane of the tumor, lymph & blood vessels
    • some cancer cells produce this enzyme
  50. anatomic site classification
    • carcinoma - from ectoderm (skin & glands)
    • endoderm - from endoderm (mucous membrane linings)
    • sarcoma - from mesoderm (conn. tissue, muscle, bone, fat)
    • lymphoma & leukemia - from hematopoietic system
  51. histologic classification
    • 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
  52. clinical staging
    • 0 - cancer in situ
    • I - localized tumor growth
    • II - limited local spread
    • III - extensive local & regional spread
    • IV - metastasis
  53. TNM classification
    • 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

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