-
thyroxine
- released by thyroid
- increases blood flow leading to increased renal circulation & increased renal circulation
-
aldosterone
- mineralcorticoid hormone
- secreted by adrenal glands
- conserves sodium, chloride, water
- excretes K
-
parathyroid hormone
- secreted by parathyroid glands
- draws Ca from bones into blood
- moves phosphorus from blood to kidneys
-
antidiuretic hormone (ADH)
- made by hypothalmus
- stored in pituitary gland (posterior lobe)
-
osmoreceptors
- neurons
- sensitive in changes in concentration of ECF
- send impulses to pit. gland to release ADH
-
isotonic solution
- 275-295
- remains in intravascular compartment
-
hypertonic solution
- >295
- draws water out of cells & into intravascular compartment
- cells shrink
-
hypotonic solution
- <275
- fluid moves into cells
- cells swell and potentially burst
-
hydrostatic pressure
"pushing" force in filtration
-
colloid osmotic pressure
(oncotic pressure)
"pulling force" in filtration
-
acid
substance containing H+ that can be released
- H2CO3 --> H+ + HCo3-
- (carbonic acid) (bicarbonate base)
-
base
substance that can trap H+ ions
HCO3- + H+ --> H2CO3
(bicarbonate base) (carbonic acid)
-
pH
as H+ increases --> substance becomes more acid (less than 7)
as H+ decreases --> substance becomes more basic (greater than 7)
-
pH of blood plasma
7.35 - 7.45
-
acidosis
excess of H+ or loss of base ions
pH <7.35
-
alkalosis
lack of H+ or gain of base ions
pH >7.45
-
-
-
carbonic-acid-sodium bicarbonate buffer system
normal ECF ratio: 20bicarb:1 carbonic acid
-
phosphate buffer system
- ICF (esp. renal tubules)
- converts alkaline sodium phosphate (Na2HPO4) to acid sodium phosphate (NaH2PO4)
-
carbon dioxide
- carbonic acid --> CO2 + H20
- (H2CO3)
-
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
-
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
-
hypernatremia
- Na >145
- cells shrink
- caused by: lack of fluid intake
- signs: neurological impairment, restlessness, weakness, disorientation, delusion, hallucinations
-
hypokalemia
- K <3.5
- caused by: vomiting, gastric suction, alkalosis, diarrhea, diuretics
- signs: muscle weakness, leg cramps, fatigue, dysrhythmias
-
hyperkalemia
- K >5
- caused by: renal failure, hypoaldosteronism
- signs: weakness & paralysis
-
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
-
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
-
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
-
holding area
AOD area (admission, observation, discharge)
- patient warmng
- prophylactic anitbiotics
- SCDS
- IVs
- casts
- epidurals
-
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
-
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)
-
universal protocol
preventing wrong site, wrong procedure, and wrong surgery
-
surgical time-out
time to verify patient, procedure, site right before procedure
-
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
-
phases of general anesthesia
preinduction, induction, maintenance, emergence
-
local anesthesia
interrupts generation of nerve impulses by altering flow of Na into nerve cells
-
regional anesthesia (block)
local anesthesia injected into central nerve or group of nerves
-
spinal anesthesia
injection of local anesthesia into cerebrospinal fluid in the subarachnoid space
-
epidural block
injection of local anesthetic into epidural (extradural) space
does not enter CSF
-
malignant hyperthermia
- hyperthermia with rigidity of skeletal muscles that can result in death
- succinylcholine (anectine) can be trigger
- treatment is dantrolene (dantrium)
-
defect in cellular proliferation
- cells divide indiscriminately and haphazardly
- can produce more than two cells at mitosis
-
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
-
apoptosis
programmed cellular suicide
-
protooncogenes
- normal cellular genes that regulate normal cellular processes
- promote growth
-
tumor supressor genes
suppress growth
-
oncogenes
mutations that alter the expression of protooncogenes can make them oncogenes
-
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
-
metalloproteinase enzymes
- enzymes capable of destroying the basement membrane of the tumor, lymph & blood vessels
- some cancer cells produce this enzyme
-
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
-
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
-
clinical staging
- 0 - cancer in situ
- I - localized tumor growth
- II - limited local spread
- III - extensive local & regional spread
- IV - metastasis
-
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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