Chapter 5B - Applied Physiology Flashcards

0
Q

Filtration – definition

A

Involves passing body fluids and other dissolved elements through a selectively permeable membrane (like the capillary wall) that allows some things, such as water, sugar and protein to pass, but keeps the red blood cells inside the capillary

requires hydrostatic pressure like perfusion pressure, or blood pressure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
1
Q

Perfusion – definition

A

To pour through – so it refers to the pumping of blood through blood vessels under pressure (perfusion pressure)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Osmosis – definition

A

The process by which water is pulled towards a crystalloid (a salt or sugar)

– the water (a solvent) is pulled towards a salt or sugar (a solute)

usually across a semi-permeable membrane

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Diffusion- definition

A

The process by which a gas, or a substance in solution, spreads (because of the moment of its particles) from areas where there are a lot of them to areas where there are less, to evenly fill all the available space

Molecules are in continuous random movement
– he speeds up this movement
– cold slows it down

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Ischemia - definition

A

The lack of perfusion. An area of tissue is not getting supplied with enough blood

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Homeostasis- definition

A

The process by which the body maintains balance and equilibrium between all body parts – maintaining the internal environment

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Edema – definition

A

The buildup of fluid in the tissues usually interstitial

sometimes called third spacing because the interstitial space is the third space, after intravascular and intracellular

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

List the important electrolytes (7)

A
  1. Sodium Na+
  2. Potassium K+
  3. Calcium Ca++
  4. Bicarbonate HCO3-
  5. Magnesium Mg++
  6. Chloride Cl-
  7. Phosphate PO4—
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Sodium – describe

A

Most common electrolyte, is important in the cellular depolarization, nerve conduction, muscle contraction (including the heart and brain) important in control of water balance

– attracts and hold water so it tends to increase BP

most common extracellular ion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Potassium – describe

A

Important in cellular depolarization, nerve conduction, muscle contraction (including the heart and brain), and the electrical stability of the heart
– intake tends to lower BP
– most common intracellular
– often lost with diuretic use
– vital to normal heart function
– too much or too little will cause cardiac dysrhythmias

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Calcium - describe

A

Important in the mechanical contraction of muscles, and nerve conduction of signals

To little –> tetany
Too much -> muscle weakness

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Bicarbonate – describe

A

Important in maintaining acid – base balance

-it will buffer acids

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

pH – define

A

is a unit of measurement of acid/base balance – it is a scale of 1 to 14 where 1 is the strongest acid, and 14 is the strongest alkali (base) and 7 is neutral (the pH of water). The pH of blood is 7.4, so we are slightly alkaline

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Acidosis – describe the effects on the body

A

Causes cells to become permeable, and leak fluids. It causes cells to depolarize and relax, being unable to repolarize.

This will also lead to vasodilation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Alkalosis – describe the effects on the body

A

Is also bad for cells, causing them to become irritable. This may lead to twitching or cramping.

This will also lead to vasoconstriction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

List and describe the three major body fluid compartments

A
  1. Intravascular = within the vessels
  2. Interstitial = between the cells
  3. Intracellular = within the cells
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What is the percentage of water for the 3 major body fluid compartments

A

Intravascular = 10% of body water (this determines tissue perfusion)

interstitial = 25% of body water (16% of body weight)

intracellular = 65% the body water (40% of body weight)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Describe how fluid moves across the three body fluid compartments

A

Fluid moves by perfusion (pressure filtration), then by osmosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Describe “body fluids” and list the components

A

Body fluids are composed of water and substances dissolved in it: electrolytes (charged ions), and non-electrolytes such as glucose, proteins, urea, etc.

60% of the bodyweight is water
– the loss of 1% will cause a compensation effort to begin
- loss of 10% will cause a risk of collapse and possible death

Water acts a lubricant, assists temperature regulation and the transportation of nutrients, wastes, and hormones.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Describe the bodies process for maintaining water balance

A

The hypothalamus helps regulate water balance by containing the body’s thirst center. It also communicates with the pituitary gland which causes the kidneys to save or eliminate water

Thirst cannot be relied upon to maintain fluid balance – you are usually a quart low before thirst kicks in to help you drink

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Acute volume loss - causes (4)

A
  • Hemorrhage
  • diarrhea
  • vomiting
  • burns

Occurs in minutes to hours

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Acute volume loss – signs and symptoms (7)

A
  • Tachycardia
  • pale, cool, diaphoretic skins
    – delayed capillary refill
    – Thirst
    – hypertension
    – nausea
    – altered level of consciousness
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Chronic volume loss (dehydration) – causes (3)

A

– Poor intake
– fever
– chronic illnesses

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Chronic volume loss (dehydration) – signs/symptoms (7)

A
– Dry mucous membranes 
– poor skin turgor (tenting)
– increased thirst 
– decreased urine output 
– hypertension 
– altered level of consciousness
- sunken fontanelles (in infants)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Hypervolemia (overhydration) – causes (4)

A
  • CHF
    – liver disease
    – kidney failure
    – drinking too much water
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Hypervolemia (overhydration) – signs/symptoms (6)

A
– Rapid weight gain 
– JVD 
– peripheral Edema 
– ascites 
– SOB 
– crackles
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Metabolism – define

A

The process where the cells of the body take in fuel and oxygen and “burn” it, creating energy for body processes, and releasing heat and other by-products such as carbon dioxide (CO2) H2O and possibly other waste products also

– We use oxygen to oxidize carbohydrates, proteins and fats to produce the energy needed for life processes (in the form of high energy packets called ATPs = that is a triphosphate)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Describe the function of the cell as it applies to metabolism

A

The Cells take up oxygen from the blood (and interstitial fluid) by diffusion, and sugar and nutrients by active transport (usually using insulin). The mitochondria oxidize the sugar producing energy (in the form of ATP’s) and waste products such as heat and carbon dioxide. ATPs are necessary for all bodily functions, from muscle contractions (think diaphragm and heart) and nerve conduction, etc.

  • this is called the critic acid or Krebs cycle
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Mitochondria – describe

A

Are small organelles found inside the cells that operate as small energy factories. The sugar and oxygen go here, and the mitochondria manufacturer Adenosine triphosphates (provides the energy to make the nerves and muscles work).

  • we give the patient oxygen so that the mitochondria can make ATP’s
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Lysosomes – describe

A

Are small organelles found inside cells that contain enzymes that will dissolve the cells and completely destroy it if they are released. They are there to erase the cell from existence upon its death. Otherwise we would clog up with a dead cell debris.

  • These cause problems in cases of prolonged anoxia, as they burst and release the enzymes, tearing apart surrounding cells
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

Cell membrane – describe

A

The outer wrapper on a cell keeps the right things in, and prevents the wrong things from coming in. It has pores or openings like doors through which it’s food enters, or wastes exit. Acidosis makes this membrane very leaky, basically leaving all the doors open

– high levels of oxygen or lowering carbon dioxide levels by hyperventilation of patients helps stabilize of these so membranes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

Catabolism - describe

A

Is the process described where foods are broken down to liberate or produce energy, or is the wasting process of breaking down tissues and muscles

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

Animalism – describe

A

Is the process of building up or storing things for later use. So, the making of fat or glycogen (the end storage forms for foods we eat, or the building of muscle, etc. Is an anabolic process) any excess calories eating get stored as fats

  • insulin is anabolic
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

Describe the dietary food sources and their energy amounts

A

Carbohydrates = 4 kcal/Gram = sugars and starches
= simple = various types of sugars
= complex = starches

Proteins = 4kcal/gram = amino acids

Fats (lipids) = 9 kcal/gram = fatty acids

Alcohol = 7 kcal/gram = ethanol

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

Aerobic metabolism – defined

A

Metabolism in the presence of oxygen

35
Q

Aerobic metabolism – list the end products

A

End products are ATPs (Energy units), carbon dioxide and water and other cellular wastes depending on the energy substrate (whether carbohydrates were burned or proteins or fats) energy produced per unit of sugar is 38 ATPs

36
Q

Anaerobic- define

A

Metabolism without the presence of oxygen

37
Q

Anaerobic metabolism – list the end products

A

End products are ATPs (only 2), lactic acid and other cellular waste
– the lactic acid waste cannot be breathed off in the lungs and therefore is very difficult to eliminate
- it takes the kidneys much longer to do it, and therefore is considered a strong acid
– it will need to be buffered (neutralized) by bicarbonate

38
Q

Describe the unique metabolism of the brain

A

Because the capillaries of the brain are glued together especially tightly, they create something called the blood brain barrier that prevents most things, including dangerous ones, from getting into the brain.

The brain thus relays on sugar and oxygen for metabolism – it is unable to burn protein or fat for energy

Vulnerable to extreme low blood sugar levels

39
Q

Which neurologic function is the earliest to be adversely affected by a lack of oxygen

A

Level of consciousness becomes quickly depressed

the brain is very sensitive to hypoxia

40
Q

Biological death - define

A

Is irreversible/permanent brain death due to a lack of oxygen
– it occurs 4-6 minutes after clinical death
50% chance of rain damage at four minutes
87% chance of brain damage at six minutes

41
Q

Clinical death

A

Occurs the moment the heart and lungs stop functioning

– it may be reversible with CPR

42
Q

How long can the brain survive without oxygen

A

4 to 6 minutes

but actually four minutes is a 50-50 chance of permanent brain damage

43
Q

How long can the heart survive without oxygen

A

1-2 hours

44
Q

How long can the kidneys survive without oxygen

A

One to two hours

45
Q

How long can the muscles survive without oxygen

A

1-2 hours

46
Q

Cold – describe the effects body temperature has on oxygen consumption but the tissues

A

Cold slows consumption of oxygen as metabolism is turned down

47
Q

Cold - effects on O2 consumption by the tissues

A

In hypothermia states, as in drowning and other cold related situations the brain can last much longer than 4 to 6 minutes without oxygen. There have been successful after 40 minute with no oxygen reaching the brain in Cold water drowning

48
Q

Heat – describe effect temperature has on oxygen consumption by the tissues

A

Heat increases oxygen consumption

49
Q

Heat – significance of effect on oxygen consumption by the tissues

A

Fevers often present with increased pulses and increased respiratory rates due to higher oxygen burn rates

50
Q

Osmotic pressure – defined

A

The theoretical amount of pressure it would take to prevent this water movement

51
Q

Oncotic pressure

A

The process by which water is pulled towards a colloid (protein and starch)

just like osmosis, except it involves colloids instead of crystalloids

52
Q

Glycolysis

A

The breakdown of glucose (sugar) to produce energy

53
Q

Glycogenesis

A

The process of creating glycogen for storage in the liver and muscle tissue

54
Q

Glycogenolysis

A

The process of breaking down glycogen to release sugar

the pancreatic hormone glucagon does this

55
Q

Gluconeogenesis

A

The process by which proteins can be converted to sugar for energy release

56
Q

Oral intake – described in the fluid intake

A

60% in the form of fluids
30% in foods (solids)
10% as a result of metabolism

57
Q

Describe daily fluid elimination

A

60% in urine
6% in feces
6% in sweat
28% in respiratory losses

58
Q

Describe

A

Fluid in jested daily into G.I. tract = 2000 mL
Endogenous secretion into G.I. tract = 7000 mL
-Salivary glands = 1500 mL
-stomach secretions = 2500 mL
-bile = 500 mL
-pancreatic juice = 1500 mL
-intestinal secretions = 1000 mL

59
Q

Describe daily gastrointestinal elimination

A

Reabsorbed from Jejunum = 5,500 mL
- from ileum = 2,000 mL
- from colon = 1,300 mL
Fluid lost in stools = 200 mL

60
Q

What does pH stand for

A

Power of hydrogen

61
Q

State the significance of pH

A

Your body, your nerves, your muscles, your cells will not function properly unless they are in a balanced pH solution

62
Q

What is the pH of blood

A

7.35–7.45

63
Q

Describe a pH balance is maintained or how it can be restored to If altered

A

Primary control through chemoreceptors and respiratory elimination of carbonic acid
- Respiratory buffering is very rapid - in minutes

secondary control is through a buffering system involving the kidneys in bicarbonate (sponging of hydrogen ions)
- kidney buffering is very slow – in hours or delays

64
Q

Explain how bicarbonate helps eliminate acidosis

A

Acidosis in the body is in actuality in excess of free hydrogen ions in solution. Bicarbonate can sponge them up by combining with them to form carbonic acid which is then breathed off

the kidneys can make bicarbonate and use it to buffer acidosis, but that would take all day, excreting the hydrogen (acid) and bicarbonate in the urine. (If the lungs cannot breathe it off)

65
Q

Magnesium – describe

A

Important in activating many enzymes also works opposite calcium in electrical conduction and depolarization of nerves and muscles

so magnesium sulfate is sometimes used to stop muscular contractions, as in premature labor

66
Q

Chloride – describe

A

Combined with sodium and helps maintain water balance and osmotic pressure in the body

67
Q

Phosphate – describe

A

Important in high-energy bonds as in there is interest phosphate, also has some pH buffer ability

68
Q

Potassium - clinical significance

A

The magnitude of potassium gradient across cell membranes determines excitability of nerve and muscle cells, including the myocardium. Minor changes in serum potassium concentration can have major effects on cardiac rhythm and function. Of all the electrolytes, rapid changes in potassium concentration can cause the most immediate life threatening consequences

Changes in pH inversely affect serum potassium. Acidosis (low pH) leads to an extra cellular shift of potassium, thus raising serum potassium. Conversely, high pH (alkalosis) shifts potassium back into the cell, lowering serum potassium

69
Q

Hyperkalemia – physical symptoms

A

Includes ECG changes, weakness, ascending paralysis, and respiratory failure. ECG changes suggestive of hyperkalemia include Peaked T waves, flattened P waves, prolonged PR interval is (1st° heart blocks), widened QRS complex and others. Tenting of T waves is one of the prominent early ECG changes. If untreated, hyperkalemia causes progressive heart dysfunction, leading eventually to asystole.

70
Q

Hypokalemia – physical symptoms

A

Include weakness, fatigue, paralysis, and respiratory difficulty. ECG changes suggestive of hypokalemia include the presence of U waves, T wave flattening, and other dysrhythmias including PEA or asystole

71
Q

Sodium – clinical significance

A

Is the major positively charged ion in the extracellular space and the major intravascular ion that influences serum osmolality. Acute changes in serum sodium will produce acute free water shifts into and out of the vascular space until osmolality equilibrates in these compartments. An acute fall in the serum sodium and an acute fluid shift into the interstitial space may cause cerebral edema

72
Q

Magnesium – clinical significance

A

Is the fourth most common mineral in the human body. It is required for the action of many important enzymes and hormones. It is necessary for the movement of sodium, potassium, and calcium into and out of the cells. It is also important in stabilizing excitable membranes and useful for atrial and ventricular of arrhythmias

73
Q

Calcium – clinical significance

A

Is the most abundant mineral in the body. It is essential for bone strength and neuromuscular functions and plays a major role in myocardial contractions. Half of all calcium in the ECF is bounded to albumin; the other half is in the biologically active, Ionized form

Serum ionized calcium is pH depended. Alkalosis reduces serum calcium levels. Conversely, the development of acidosis will produce an increase in serum calcium.

Calcium antagonizes the effects of both potassium and magnesium at the cell membrane. Therefore, it is extremely useful for treating the effects of hyperkalemia and hypermagnesemia

74
Q

Tonicity – describe

A

The osmolality of a solution in relation to plasma

75
Q

Hypotonic solutions - examples

A

0.45% NS (half normal saline)

D5W

76
Q

Hypotonic solutions – use

A

As a lifeline for later drug administration, the Florida will not remain in the vascular compartment and will therefore not predispose to fluid overload

if very hypotonic, may cause hemolysis

Has fewer particles than plasma

77
Q

Isotonic solutions – example

A

Normal saline

Lactated Rangers solution

78
Q

Isotonic solution – use

A

For fluid volume replacement and hypovolemia,the fluid will tend to remain in the vascular compartment at least for an hour

equal particles to plasma

at a TKO rate, this adds a tiny amount of fluid volume – so it is not a problem in CHF

79
Q

Hypertonic solutions – examples

A
D50W
D5 in the 0.45% normal saline 
Mannitol
Sorbitol
7.5% saline with the dextran
80
Q

Hypertonic solution - use

A

osmotically or oncotically pulls fluid across membranes D50W to replace sugar in hyperglycemia – but may cause necrosis if it extravasates

More particles than plasma

Can cause crenation of RBCs

81
Q

Mannitol

A

Is used in cerebral edema to pull water out of the brain for elimination

82
Q

Sorbitol

A

Is used as a cathartic with activated charcoal as it holds water in the bottle, increasing bowl elimination of the charcoal and therefore the toxin

83
Q

7.5% saline with Dextran

A

Is highly hypertonic and provides osmotic and oncotic pull of physiologic body fluids into the vascular space for volume expansion

84
Q

Alpha cells

A

Of the islets of langerhans secrete a hormone called the glucagon which, when released from the pancreas flows to the liver and causes the liver to convert glycogen, storage form polysaccharide to simple glucose, a monosaccharide – raising blood sugar levels.

This function is dependent upon there being adequate amounts of glycogen stored. If the patient has not eaten in sometime, such as following prolonged vomiting, they will have depleted their glycogen stores, and glucagon won’t work

85
Q

Beta cells

A

Of the islet of langerhans secrete a hormone called insulin which, when released from the pancreas flow throughout the body and causes cells to take up sugar from the bloodstream

86
Q

Delta cells

A

Of the islet of langerhans secrete hormones called somatostatin which, when released inhibit pancreatic function – that is, it inhibits the secretion of insulin, Glucagon, and pancreatic polypeptide (use indigestion)

hypersecretion of somatostatin from a pancreatic tumor can create hyperglycemia – and look like diabetes