PATHOPHYSIOLOGY EXAM #3 - UNIVERSITY OF CINCINNATI | QUESTIONS
AND ANSWERS | 100% VERIFIED
How does fluid movement work? - ANS-- Arterial end = capillary hydrostatic pressure = pushing
pressure ---> filtration
- Venous end = higher capillary oncotic pressure --> pulling pressure ---> reabsorption
What is edema? - ANS-accumulation of fluid into interstitial space
What causes edema? - ANS-1. increased capillary hydrostatic pressure (venous obstruction)
2. Decreased plasma oncotic pressure (losses or diminished production of albumin)
3. Increased capillary permeability (inflammation and immune response)
4. Lymph obstruction (lymphedema)
5. Sodium retention
Pathophysiology = increase in forces favoring fluid filtration from the capillaries or lymphatic
channels into the tissues.
A person with heart failure has edema in the lower legs and sacral area. The nurse suspects
this condition is due to a(n): - ANS-Increase in capillary hydrostatic pressure
What is the role of sodium in fluid balance? - ANS-Is the primary ECF cation.
Regulates the fluid balance
Key ion in transport of other ions across the membrane
Sodium and Chloride react the same (both go up, both go down) EXCEPT for bicarb
Regulates osmotic forces, thus water
Roles include: Neuromuscular irritability, acid-base balance, cellular reactions, and transport of
substances Is regulated by aldosterone and natriuretic peptides.
• 136-145mEq/L
What is the hormonal regulation of fluids? - ANS--It is mediated by aldosterone (first control of
sodium in the body)
-A mineralocorticoid steroid synthesized and secreted from the adrenal cortex
-increases the blood pressure and volume
• Influenced by both plasma concentrations of sodium and potassium in circulating blood
• Secreted when sodium levels are depressed, potassium levels increases, or renal perfusion is
decreased
• Acts on the distal tubule of the kidney to increase reabsorption of sodium.
• Leads to sodium and water reabsorption back into the circulation and potassium and hydrogen
secretion to be lost in urine
Explain the Renin-Angiotensin-Aldosterone System. - ANS-A negative feedback system
The second control of sodium in the body
,• Sympathetic Bnerve Bstimulation Band Bdecreased Bperfusion/blood Bpressure Bin Bthe
Brenal Bvasculature Bleads Bto Bthe Brelease Bof Bthe Benzyme Brenin Bjuxtaglomerular Bcells Bof
Bthe Bkidney
• Renin Bstimulates Brelease Bof Bangiotensin BI, Binactive Bpolypeptide, Bwhich Bis Bthen Bconverted
Bto Bangiotensin BII Bby BACE Bin Bpulmonary Bvessels
• 2 Bmajor Bfunctions Bof Bangiotensin BII
1. Stimulates Bthe Bsecretion Bof Baldosterone
- Aldosterone Bstimulates Breabsorption Bof Bsodium Band Bwater Brestoring Bfluid Bbalance
2. Causes Bvasoconstriction
- Vasoconstriction Brises Bsystemic Bblood Bpressure Brestoring Brenal Bperfusion
• Restoration Bof Bsodium Blevels, Bfluid Bvolume, Band Brenal Bperfusion Bleads Bto Binhibition Bof Bthe
Brelease Bof Brenin B= Bnegative Bfeedback Bbecause Bend Bresult Bis Bopposite Bof Binitiating Bstimulus
What Bare Bnatriuretic Bpeptides? B- BANS-Third Bregulation Bof Bsodium Bin Bthe Bbody
They Bwork Bopposite Bof BRAAS Bsystem
B
Negative Bfeedback Bsystem
• Hormones Bthat Binclude Batrial Bnatriuretic Bpeptide B(ANP) Band Bbrain Bnatriuretic Bpeptide
1. ANP Bproduced Bby Bmyocardial Batria
- Urodilatin Bis BANP Banalog Bthat Bis Breleased Bby Bkidney Bcells Bwith Bincreased Brenal Bblood Bflow
2. BNP Bproduced Bby Bmyocardial Bventricles, Band
• Natural Bantagonist Bto BRAAS
1. Decreases Bblood Bpressure
2. Increase Bsodium Band Bwater Bexcretion
• Released Bwhen Bthere Bis Bincreased Batrial Bpressure B(increased Bvolume); Be.g.. BCHF
• Decrease Bin BBP Bdecrease Batrial Bpressure Btherefore Binhibiting Brelease Bof BANP Band
BNP BWhat Bis Bthe Brole Bof Bthe Bantidiuretic Bhormone B(ADH)? B- BANS-- BIs Breleased Bwhen
B
Bthere Bis Ban
increase Bin Bplasma Bosmolality, Bdecrease Bin Bcirculating Bblood Bvolume, Bor Bdecrease Bin BBP Bwhich
Ball Bresult Bin Bdecrease Batrial Bpressure Band Bultimately Bsecretion Bof BADH
• Is Balso Bcalled Barginine Bvasopressin.
• Increases Bwater Breabsorption.
1. Increases Bpermeability Bof Brenal Btubules Band Bcollecting Bducts Bof Bkidneys
2. Reabsorption Bof Bwater Bmediated Bby BADH Bthen Bpromotes Brestoration Bof Bblood Bvolume
• Increase Bin Bblood Bvolume Breturns Bto Bheart, Bincreasing Batrial Bpressure, Bultimately
Bstopping Brelease Bof BADH
,A Bperson Breports Bsevere Bdiarrhea Bfor B2 Bdays. BThe Bpractitioner Bunderstands Bthis Bstimulates
Ba(n): B- BANS-Increase Bin Bantidiuretic Bhormone Bsecretion
What Bis Ban Bisotonic Bsolution? B- BANS-Contains Bequal Bconcentrations Bof Bsolutes Bon Bboth
sides. BWhat Bis Ba Bhypotonic Bsolution? B- BANS-the Bsolution Bhas Ba Blower Bsolute Bconcentration
B
Bthan Bthe Bcell
-lysed Bcells
What Bis Ba Bhypertonic Bsolution? B- BANS-The Bsolution Bhas Ba Bhigher Bsolute Bconcentration Bthan
Bthe Bcell
-shriveled Bcells
What Bare Bisotonic Balterations? B- BANS-Total Bbody Bwater Bchange Bwith Bproportional Belectrolyte
Bchange B(no Bchange Bin Bconcentration)
- Isotonic Bvolume Bdepletion B(hypovolemia)
- Isotonic Bvolume Bexcess B(hypervolemia)
What Bare Bhypertonic Balterations? B- BANS-1. BHypernatremia
• Serum Bsodium B>147 BmEq/L
• Related Bto Bsodium Bgain Bor Bwater Bloss
• Water Bmovement Bfrom Bthe BICF Bto Bthe BECF
• Intracellular Bdehydration
• Manifestations: BIntracellular Bdehydration, Bconvulsions, Bpulmonary Bedema,
Bhypotension, Btachycardia
2. Hyperchloremia
• Serum Bchloride Blevels Bexceed B105mEq/L
• Occurs Bwith Bhypernatremia Bor Ba Bbicarbonate Bdeficit.
• Is Busually Bsecondary Bto Bpathophysiologic Bprocesses.
• No Bspecific Bsymptoms Bare Bassociated Bwith Bhyperchloremia
3. Water Bdeficit
• Dehydration- Bisotonic Bdehydration
• Pure Bwater Bdeficits
-Are Bhypertonic Bdehydration. BIt Bis Brare Band Bseen Bin Bcomatose Band Bparalyzed Bpatients
• Renal Bfree Bwater Bclearance
-Common Bcause Bis Bresult Bof Bimpaired Btubular Bfunction Bor Binability Bto Bconcentrate Burine, BDI
• Manifestations B= BTachycardia, Bweak Bpulse, Band Bpostural Bhypotension, BElevated Bhematocrit
Band Bserum Bsodium Blevels, BHeadache, Bdry Bskin, Band Bdry Bmucous Bmembranes
What Bare Bhypotonic Balterations? B- BANS-Decreased Bosmolality Bin BECF
Hyponatremia Bor Bfree Bwater Bexcess
B
, Hyponatremia Bdecreases Bthe BECF Bosmotic Bpressure, Band Bwater Bmoves Binto Bthe Bcell
1. Hyponatremia
-Serum Bsodium Blevel B<135 BmEq/L
• Sodium Bdeficits Bcause Bplasma Bhypoosmolality Band Bcellular Bswelling
• Pure Bsodium Bdeficits; Blow Bintake
• Dilutional Bhyponatremia B- Bexcess BTBW Bin Brelation Bto Btotal Bbody Bsodium Bor Bshift Bof Bwater
Bfrom BICF Bto BECF B= Bmannitol
• Hypotonic Bhyponatremia B- BTBW Bexceeds Bincrease Bin Bsodium Balthough Bboth Bare
Bincreased; Bsevere Bcongestive BHF, BARF
• Hypertonic Bhyponatremia B- Bshift Bof Bwater Bfrom BICF Bto BECF Bin Bcases Bof
Bhyperglycemia, Bhyperlipidemia, Band Bhyperproteinemia
-Manifestations: BLethargy, Bheadache, Bconfusion, Bapprehension, Bseizures, Band Bcoma
2. Hypochloremia
- Is Busually Bthe Bresult Bof Bhyponatremia Bor Belevated Bbicarbonate Bconcentration
• Serum B<97mEq/L
- Some Bcauses Bare: BVomiting, BMetabolic Balkalosis, BCystic Bfibrosis
3. Water BExcess
• Caused Bby: BCompulsive Bwater Bdrinking, Bcausing Bwater Bintoxication, BDecreased Burine
Bformation, BSyndrome Bof Binappropriate BADH B(SIADH), BADH Bsecretion Bcauses Bwater
Breabsorption
• Normally Bassociated Bwith Bhyponatremia B(dilutional)
• Manifestations: BCerebral Bedema, Bmuscle Btwitching, Bheadache, Band Bweight Bgain
What Bis Bhypokalemia? B- BANS-A Bserum Bpotassium Blevel Bless Bthan B3.5 BmEq/L.
Causes:
B
• Reduced Bpotassium Bintake
• Increased Bpotassium Bentry Binto Bcell B(like Binsulin)
• Increased Bpotassium Bloss B(like Bhigh Baldosterone)
• Hyperaldosterone Bstate
• Commonly Bseen Bwith Brespiratory Balkalosis
Manifestations:
• Membrane Bhyperpolarization Bcauses: B(making Bthe Binside Bof Bthe Bcell Bmore Bnegative)
-Decreased Bneuromuscular Bexcitability
-Skeletal Bmuscle Bweakness
-Smooth Bmuscle Batony
-Cardiac Bdysrhythmias
-U Bwave Bon Belectrocardiogram B(ECG)
What Bis Bhyperkalemia? B- BANS-A Bserum Bpotassium Blevel Bthat Bexceeds B5.1 BmEq/L.
-Rare Bas Ba Bresult Bof Befficient Brenal Bsecretion
