NR 224 EXAM 3 STUDY GUIDE / NR224 EXAM 3 STUDY GUIDE: 100% CORRECT,CHAMBERLAIN COLLEGE OF NURSING
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Course
NR 224 (NR224)
Institution
CHAMBERLAIN COLLEGE OF NURSING
NR 224 EXAM 3 STUDY GUIDE / NR224 EXAM 3 STUDY GUIDE: 100% CORRECT,CHAMBERLAIN COLLEGE OF NURSINGNR 224 EXAM 3 STUDY GUIDE / NR224 EXAM 3 STUDY GUIDE: 100% CORRECT,CHAMBERLAIN COLLEGE OF NURSINGNR 224 EXAM 3 STUDY GUIDE / NR224 EXAM 3 STUDY GUIDE: 100% CORRECT,CHAMBERLAIN COLLEGE OF NURSING
GOLDFARB SCHOOL OF NURSING
AT BARNES-JEWISH COLLEGE
STUDY GUIDE FOR TEST III – PATHOPHYSIOLOGY
Vocabulary:
• Idiopathic: adjective used primarily in medicine meaning "a disease or condition the cause of which is not
known or that arises spontaneously"
• Petechiae – pinpoint, round spots that appear on the skin as a result of bleeding under the skin
24 February
Explain blood gas levels for acute respiratory failure.
• Occurs when the lungs can no longer perform gas exchange
• PO2 < 50 – with or without PCO2 > 50 and pH < 7.25
o Speaking of measuring partial pressures of a gas free floating in the blood stream
▪ Partial pressure is used because you can’t weigh or see gases so the only way we have to
assess a gas is to assess a pressure that gas creates
▪ Partial pressure is no way giving you the whole picture because of the small percentages
because partial pressure is only measuring the free floating
o Only 3% of O2 is free floating ! the rest is in the RBCs
o Only 20% of CO2 is free floating ! the rest is in the RBCs
o CO2 – is a gas that causes the blood stream to become acidic due to the reaction of CO2 + H2- !
H2CO3 (bicarbonate) ! H+ + HCO3
▪ Hypercapnia = acidic = too much CO2 in the blood
o Kidney and lungs can both change the pH
▪ But lungs change the pH most quickly (breath > peeing)
Give 5 conditions likely to lead to respiratory failure.
• Any scenario that causes hypoventilation will cause respiratory acidosis
o COPD, emphysema, chronic bronchitis, asthma, obesity, ALS, drug overdose, etc.
Explain the relationship of decreased ventilation of respiratory acidosis.
• Most common cause is airway obstruction
• Hypoventilation ALWAYS causes respiratory acidosis
o The body is not pushing out the required amount of CO2, causing an acidic buildup in the blood
o CO2 + H2O = Carbonic Acid which dissociates into H+ and Bi Carb
▪ H+ ions is causing the acidic envrionment
• Can be also due to drugs, ALS, etc
• If pH is going down (more H+) then K is going up
o Occurs because the RBCs are sucking in the H+ out of the vascular system trying to equalize the pH,
and kicking K+ out of the cells because RBC aren’t neutral anymore !
• Seen in patients with respiratory problems who cannot take in full breaths
o COPD, chronic bronchitis, etc
SIDE NOTE – respiratory alkalosis
• Hyperventilation ALWAYS causes respiratory alkalosis
o Because we are making less carbonic acid and therefore less H+
o Due to the fact that excess CO2 is being exhaled
• Decreasing H+ (increasing pH) pH then causes K+ to drop
Explain renal compensation to respiratory acidosis.
• Kidneys are the other organs that can alter the pH but can’t work as quick as the lungs – we breath more than
we pee
• Is not beneficial for acute respiratory acidosis as it takes several days for results of renal compensation to be
seen
• Chronic respiratory acidosis is commonly associated with chronic obstructive pulmonary disease and
deformities of the chest wall or neuromuscular disorders
o Renal compensation is effective and is established over several days
▪ The acidosis produced from CO2 retention stimulates the kidney to secrete hydrogen ions and
regenerate bicarbonate. Serum bicarbonate and arterial PCO2 are elevated, and pH is restored
toward normal
,Primary lung cancer is classified according to histologic types. Therefore, explain the following (listed from MOST
common – LEAST common):
• General information on lung cancer:
o Over 90% of primary lung tumors are malignant
o About 95% of these tumors are broncheogenic carcinomas
▪ Originating cancer was in the epithelium and is now sitting in the bronchial tree
o Slightly more common in R lung then the L lung
o Slightly more common in the Upper Lobes then in the anterior segments
o Correlated with smoking and air pollution
• Squamous Cell Carcinoma
o Centrally located in the bronchial tree
o Most Common
o Present with persistent cough, slow growing malignancies (not dramatically young) and metastasize
late
o VERY GOOD prognosis with early diagnosis
• Adenocarcinomas
o Glandular epithelial tissue
o Metastasize early and quickly because the glands secrete stuff all throughout the body
o Often times, metastasizing site is picked up before the primary site (Don’t opt for this cancer)
• Large Cell Carcinoma
o 5% of lung cancers
o Develops in peripheral lung tissue
o Malignant cells are big and immature
▪ Quick spread, early metastasize
▪ NOT a good prognosis (Don’t opt for this cancer)
• Small Cell Carcinoma/Oat Cell Carcinoma
o Malignant cells
▪ Look like Oat seeds (GOOD TQ)
o Develop in the center of the bronchi, very immature cells, very quickly doubling times
▪ Quickest doubling time (most immature cells)
o WORST prognosis of all
▪ 5 year survival rate is less then 5%
Explain the following about pulmonary tuberculosis:
• TB used to be called consumption
• Pulmonary TB is the most common and is very common
o A “hearty” bacteria – infectious TB on the table top will still be there and infectious days later
• Causative organism
o Mycobacterium tuberculosis
▪ An acid-fast bacillus that usually affects the lungs but may invade other body systems
o Has a lot of the similar characteristics of a fungus which is why it is mostly found in the lungs
▪ Grows slowly and loves warm, moist environments
▪ Difficult to see from chest x-ray if its TB or another fungus – they look identical on x-ray
o Increased incidence in AIDS patients – opportunist infection
o TB is the leading cause of death from a curable, infectious disease world wide
• Cavity formation
o Microorganisms lodge in the lung periphery, usually in the upper lobe
o Once the bacilli are inspired into the lung, they multiply and cause nonspecific pneumonitis (lung
inflammation)
• Tuberculin skin test
o Skin testing is always based on antigen/antibody reactions
▪ Introducing tuberculin into skin ! body produces antibody to tuberculin ! checking for
antibody/antigen reaction
o Tuberculin – about 90% of the population develops antibody against this if one has already been
exposed to TB
o Exposure does NOT means that you have TB even though your test will show as POSITIVE
▪ If you have been exposed, you have the antibody for it and will get a positive antibody/
antigen reaction
o Negative Skin Test means you most likely not been exposed to the bacteria and therefore don’t have
an antibody against it
o Many countries immunize against TB, USA does not
!2
, ▪ Pts from other countries may have a positive TB skin test but they do not necessarily have TB
(but they might)
▪ Get them a chest x-ray
• Diagnosis
o If positive for the first time, do chest x-ray, give INH (not an antibiotic) and then give B6 as well to
minimize peripheral neuropathy
o TB is diagnosed by:
▪ A positive tuberculin skin test (PPD), sputum culture, immunoassays, and chest radiographs
o A positive tuberculin skin test indicates that an individual has been infected and has mounted an
immune response against the bacillus; however, the skin test does not differentiate between past,
latent, or active disease.
o As well, some can show positive if they have gotten the immunization for TB without ever contracting
the bacteria
Know normal blood values for the following: KNOW RANGE
• Overview
o Granulocyte series: SEGS (neutrophils), eosinophils, basophils, and BANDs (immature neutrophils)
o Non-Ganulocyte Series: Lymphocytes and Monocytes
• RBC (Red Blood Corpuscle; not truly a cell bc they do NOT have a nucleus)
o Males – 4.7 – 6.1
▪ Higher because of higher testosterone (related to muscle mass) and they do not menstruate
• Have more RBC per 100mL of blood, they do not have more hemoglobin or a higher
saturation % per RBC (just more cells overall)
▪ Although this number is higher than in females, it does NOT mean that they have more
hemoglobin
o Females – 4.2 – 5.2
o Function – ONLY function is to carry O2 and CO2
▪ Structure makes it easy to carry out their function
o Hemoglobin in RBCs is located within its periphery, making it easy for O2 to hold onto RBCs
o Lifespan – 80 – 120 days
▪ You lose 1% of RBCs per day – 50,000 lost a day and 50,000 made a day
o The ONLY things RBC do is carry CO2 and O2 ! hemoglobin
o Body produces about an ounce (30mL) of blood per day
o Erythropoietin – kidneys releases this when they are not properly profuse
▪ Erythropoietin produces more RBCs
▪ Hemoglobin, hematocrit, and RBC count would be low if you have renal failure (bc kidneys no
longer secrete erythropoietin)
o Blood donations (red cross) –
▪ Body then replaces this body
▪ Body knows to replace it because of kidneys, as they signal that they are not being profused
• They secrete erythropoietin when they are not profused, stimulating bone marrow to
increase RBCs production which allows more O2 to reach the kidneys and therefore the
kidneys stop secreting erythropoietin
o Runners – blood doping
▪ Can be checked by reviewing RBC, Hgb, HCT to see if they are above a certain level
!3
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