Download Cardiovascular and Renal Physiology and more Exams Nursing in PDF only on Docsity!
NR507 Midterm Exam 2024 / NR 507 Week 4
Midterm Advanced Pathophysiology Midterm Exam
Latest Chamberlain College Of Nursing(VERSION A)
What can uncontrolled tachycardia lead to? - ...ANSWER...reduced stroke volume and fatigue What are the two parts of the cardiac cycle? - ...ANSWER...diastole and systole What causes blood to move from the atria to the ventricles - ...ANSWER...gravity and atriole systole What causes the S1 heart sound? - ...ANSWER...Bicuspid/Mitral and Tricuspid valves closing What are the atrioventricular valves? - ...ANSWER...tricuspid and bicuspid (mitral) valves What are the semilunar valves? - ...ANSWER...pulmonary and aortic valves What causes the semilunar valves to open? - ...ANSWER...As ventricles contract and intraventricular pressure rises, blood is pushed up against the SL valves, forcing them to open ejection fraction - ...ANSWER...measurement of the volume percentage of left ventricular contents ejected with each contraction
What causes the semilunar valves to close? - ...ANSWER...ventricles relax and intraventricular pressure falls, blood flows back from the arteries, and fill the cusps of the semilunar valves What causes the S2 heart sound? - ...ANSWER...closing of semilunar (aortic and pulmonary) valves What prevents the backflow into the ventricles - ...ANSWER...semilunar valves Stenosis of heart valve - ...ANSWER...A narrowing of the valve opening, causing turbulent flow and enlargement of the emptying chamber Stenosis of a heart valve, may result in what? - ...ANSWER...Narrowing of the heart valves means that blood moves with difficulty out of the heart. Results may include chest pain, edema in the feet or ankles, and irregular heartbeat. and hypertrophy heart failure - ...ANSWER...cardiac dysfunction caused by the inability of the heart to provide adequate CO resulting in inadequate tissue perfusion Left sided heart failure characteristic - ...ANSWER...inability of the left ventricle to provide adequate blood flow into systemic circulation Causes of left sided heart failure - ...ANSWER...systemic hypertension left ventricle MI LV hypertrophy
- increased pressure will force fluid from the pulmonary capillaries into the pulmonary tissues What does fluid in the pulmonary tissue result in - ...ANSWER...the areas are flooded and results in pulmonary edema and dyspnea cor pulmonale - ...ANSWER...right-sided heart failure right sided heart failure - ...ANSWER...inability of the right ventricle to provide adequate blood flow into the pulmonary circulation Causes of right sided heart failure - ...ANSWER...- pulmonary disease
- pulmonary hypertension
- RV MI
- RV Hypertrophy
- pulmonary SLV or tricuspid valve damage
- secondary to left heart failure What is the most common cause of right sided heart failure - ...ANSWER...pulmonary hypertension Progression of right sided heart failure - ...ANSWER...- damage causes the right ventricle to increase contraction force to eject/unload the blood
- over time EF is reduced and right ventricle us unable to eject the normal amount of blood
- the blood remaining in the RV increases and RA preload increases until the RA is unable to eject the normal amount of blood into the RA
- the amount of blood remaining in the right atrium increases causing an increase in RA preload
- blood volum enad pressure then backs up into the vena cava and systemic veins signs and symptoms of right sided heart failure - ...ANSWER...jugular vein distension hepatosplenomegaly peripheral edema Why does hepatosplenomegaly develop in right sided heart failure - ...ANSWER...the large volume of blood flow through the liver and spleen causes these areas to be engorged why does peripheral edema occur in right sided heart failure - ...ANSWER...Increased pressure forces fluid from the systemic capillaries into the peripheral tissues and flood those areas High output failure - ...ANSWER...inability of the heart to pump sufficient amounts of blood to meet the circulatory needs of the body despite normal blood volume and cardiac contractility causes of high output failure - ...ANSWER...Severe anemia Nutritional deficiencies Hyperthyroidism Sepsis
Erythropietin - ...ANSWER...Produce: Kidney (small amount in liver) Released: Kidney Target: Bone Marrow Functions: Stimulates bone marrow to produce more red blood cells hematopoietic stem cells - ...ANSWER...The stem cells that give rise to RBC WBC and platelets through the process of haematopoiesis. How does a hematopoietic stem cell produce a red blood cell - ...ANSWER...hematopoietic stem cells produces an unndifferentiated hemocytoblast
- erythropoietin binds to it and createsa a proerythroblast
- cell develops into an erythrocyte 7 days later Erythrocyte function - ...ANSWER...transport oxygen and carbon dioxide Erythrocyte life span - ...ANSWER...120 days anemia risk factors - ...ANSWER...acute or chronic blood loss, increased hemolysis, inadequate dietary intake or malabsorption, bone marrow suppression, age function of hemoglobin - ...ANSWER...In red blood cells, carries oxygen from the lungs to body's tissues and returns carbon dioxide from tissues back to lungs. It also maintains the shape of red blood cells.
causes of anemia - ...ANSWER...- impaired RBC production
- excessive blood loss
- increased RBC destruction hemolytic anemia - ...ANSWER...premature destruction of RBCs causes of hemolytic anemia - ...ANSWER...infection transfusion reaction hemolytic disease of the newborn (Rh incompatibility) autoimmune reaction drug induced development of anemia due to gastrectomy - ...ANSWER...loss of intrinsic factor from surgery results in the loss of protein necessary for vitamin B12 absorption an can lead to anemia what kind of anemia can result from incorrect blood transfusion - ...ANSWER...hemolytic anemia normocytic normochromic anemia - ...ANSWER...Characterized by red cells that are relatively normal in size and hemoglobin content but insufficient in number hemolytic anemia is what kind of anemia - ...ANSWER...normocytic normochromic anemia polycythemia vera - ...ANSWER...condition characterized by too many erythrocytes; blood becomes too thick to flow easily through blood vessels
what is secreted into the tubule depends on what the body needs at that time ex. eating a lot of protein nitrogen waste is a product of protein metabolism (ammonia) liver converts ammonia to urea and the kidneys secreted urea into the tubule for secretion also possible to eliminate products that are in excess in the blood -- potassium, hydrogen, metabolites or medications can secrete things that were too larger to fit through the glomerulus's pore filtration (kidney) - ...ANSWER...movement of solutes from blood to filtrate at bowman's capsule 20% of the blood that goes through the glomerulus is passed as filtrate into the bowman's capsule depends on the hydrostatic and oncotic pressures/ starling forces between the glomerulus and bowman's capsule hydrostatic pressure: a lot higher in the glomerulus (move into the nephron/bowman's capsule) oncotic pressure: higher in the blood/glomerulus than in the bowman's capsule (move into the blood/glomerulus) hydrostatic pressure is greater so there will be movement into bowman's capsule
usually favors the filtrate to go into the bowman's capsule each persons full body is filtered about every 40 minutes Conditions associated with renal failure - ...ANSWER...- congenital abnormalities in the urethral tract development
- kidney and bladder cancer
- infections
- glomerulonephritis
- acute/ tubular necrosis
- AKI vesicoureteral reflux - ...ANSWER...Abnormal ureter-bladder connection allowing retrograde flow of urine from bladder to ureters and/or kidneys renal agenesis - ...ANSWER...unilatral or bilateral failure of the kidneys to develop in utero Potter syndrome - ...ANSWER...Syndrome characterized by bilateral renal agenesis and incompatibility of live birth Wilms tumor - ...ANSWER...- Embryonal kidney tumor associated with defective tumor (WT) genes
- Tumors are typically not clinically diagnosable until age 1- even though they are present at birth polycystic kidney disease - ...ANSWER...- Mutant PKD genes cause fluid accumulation in kidney tubules "cysts"
- The cysts can be the size of grapes or oranges and compress and destroy nephrons
Bronchioles - ...ANSWER...smaller passageways that originate from the bronchi that become the alveoli 3 layers of the bronchioles - ...ANSWER...innermost layer middle layer - lamina propria outermost layer lamina propria - ...ANSWER...the middle layer of the bronchioles structure of the lamina propria - ...ANSWER...embedded with connective tissue cells and immune cells purpose of the lamina propria - ...ANSWER...white blood cells are present to help protect the airways How does the lamina propria effect the lungs in regards to asthma - ...ANSWER...the WBCs protective feature goes into overdrive causing an inflammatory response that damages host tissue What does the innermost layer of the bronchioles contain - ...ANSWER...columnar epithelial ells and mucus producing goblet cells What does the outermost layer of the bronchioles contain - ...ANSWER...smooth muscle cells what does the outermost layer of the bronchioles do - ...ANSWER...control the airways ability to constrict and dilate
alveolar hyperinflation - ...ANSWER...When air is unable to move out of the alveolar like it should due to bronchial walls collapsing around possible mucus plug thus trapping air inside how does hyperinflation occur? - ...ANSWER...the ongoing inflammatory process of asthma produces mucus and pus plug that the bronchial walls collapse around Effect of hyperinflation of the alveolar - ...ANSWER...- expanded thorax and hypercapnia (retention of CO2)
- respiratory acidosis What are two anticholinergic drugs used for asthma - ...ANSWER...tiotropium and ipratropium What do anticholinergics do in the lungs? - ...ANSWER...These drugs block the effects of the parasympathetic nervous system
- increasing bronchodilation MOA of anticholinergic drugs for asthma - ...ANSWER...the parasympathetic system is stimulated by the vagal nerve to release acetylcholine which binds to the cholinergic receptors of the respiratory tract to cause bronchial constriction = decreased airflow
- blocking the cholinergic receptors prevents acetylcholine binding preventing the bronchial constriction bronchitis - ...ANSWER...inflammation of the bronchial tubes 3 characteristics of bronchitis - ...ANSWER...bronchial inflammation
- Triggers release of inflammatory mediators from immune cells located in the lamina propria most common irritant with bronchitis is? - ...ANSWER...tobacco product smoke what does long term exposure to irritants promote in bronchitis? (5) - ...ANSWER...- smooth muscle hypertrophy
- hypertrophy and hyperplasia of goblet cells
- epithelial cell metaplasia
- migration of more WBC to site
- thickening and rigidity of bronchial basement membrane What does smooth muscle hypertrophy do in lungs? - ...ANSWER...causes increased bronchoconstriction Hypertrophy and hyperplasia of goblet cells do what in the bronchials - ...ANSWER...promotes hypersecretion of mucus What are characteristics of epithelial cell metaplasia? - ...ANSWER...squamous cells become nonciliated and are less protective; allow passage of toxins and WBCs What does the migration of WBCs to the bronchials do? - ...ANSWER...increases inflammation of the cite and causes fibrosis in the bronchial wall How does the thickening and rigidity of bronchial basement membranes effect the lungs? - ...ANSWER...leads to further narrowing of the bronchial passageways What acid-base disorder is seen in chronic bronchitis? - ...ANSWER...respiratory acidosis
how does chronic bronchitis lead to respiratory acidosis? - ...ANSWER...hyperinflation of the alveoli causes CO retention Where does air enter the body? - ...ANSWER...naso and oropharynx (mouth and nose) Where does air go after it passes through the nose and mouth?
- ...ANSWER...it passes through the trachea After air passes through the trachea where does it go? - ...ANSWER...goes into the left or right bronchi Where does air flow after the bronchi? - ...ANSWER...into the smaller bronchioles Where does air flow after the bronchioles? - ...ANSWER...into the alveoli Describe how blood flows to become oxygenated - ...ANSWER...- deoxygenated systemic blood flows from the vena cava to R atrium
- Tricuspid valve opens to flow to R ventricle -Pulmonary semilunar valve opens and blood flows to the alveolar capillaries for gas exchange from the pulmonary trunk and L & R pulmonary arteries
- blood goes from alveolar capillaries to pulmonary veins to return oxygenated blood to the left atrium
- bicuspid valve opens to allow blood to go to left ventricle
- aortic semilunar valve opens and blood goes to the aorta
- aorta pushes oxygenated blood out to the body
Afterload - ...ANSWER...the amount of resistance to open the semilunar valves and eject of blood from the ventricle what influences afterload (3) - ...ANSWER...ventricle wall thickness (muscle strength) arterial pressure (resistance to ejection) ventricle chamber size (blood volume capacity) what can cause an increase in afterload - ...ANSWER...systemic hypertension valve disease COPD (pulmonary hypertension) what can decrease afterload - ...ANSWER...hypotension or vasodilation what influences cardiac contractility (inotropic state) - ...ANSWER...levels of electrolytes High levels of ATP level of oxygen available synchronous muscle contraction What electrolytes are used for cardiac muscle contraction? - ...ANSWER...sodium potassium and calcium What increases cardiac muscle contraction - ...ANSWER...sympathetic stimulation; fear anxiety and increased thyroxine what decreases cardiac muscle contraction - ...ANSWER...low ATP levels; ischemia hypoxia or acidosis
Stimulation of what set a resting HR (chronotropic state) - ...ANSWER...parasympathetic system what stimulates the parasympathetic system - ...ANSWER...the vagus nerve What does the parasympathetic system do? - ...ANSWER...It releases acetycholine which decreases heart rate and causes vasodilation What can extreme vagal response result in? - ...ANSWER...life threatening bradycardia What mediates the sympathetic system - ...ANSWER...epinephrine and norepinephrine What does the sympathetic system promote in the cardiac system - ...ANSWER...vasoconstriction and increased HR tubular necrosis - ...ANSWER...the renal tubules cells are highly sensitive to low oxygen levels or presence of toxins and leads to tubular necrosis Causes of tubular necrosis - ...ANSWER...- being post operative
- severe sepsis
- burns
- trauma
- contrast chemical use in medical imaging procedures Pathophysiology of tubular necrosis - ...ANSWER...- ischemia or nephrotoxin exposure occurs to the renal tubules
