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255 Cards in this Set
- Front
- Back
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what is the most accurate measurement of fluid gains and losses
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daily weights
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one liter of water equals how many pounds
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2.2
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osm
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amount of substance that dissociates in solution to form one mole of osmotically active particles
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osmolality is measured in
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milliosmols/kg
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osmolarity is measured in
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milliosmols/L
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normal serum osmolality
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280-295 mOsm/K
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isotonic
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same osmolarity as blood plasma, no osmotic pull
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hypotonic
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less concentration than blood plasma, lower osmotic pressure
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hypertonic
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more concentration than blood plasma, higher osmotic pressure
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osmosis
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movement of water only across a semipermeable membrane
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the speed of osmosis is affected by
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temp of fluid, concentration of fluid, electrical charges of particles in solution
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diffusion
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solute (or gas) moves from area of higher concentration to area of lower concentration
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facilitated diffusion
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solute moves against concentration gradient (passive transport)
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active transport
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solute moved against concentration gradient using energy
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filtration
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solutes and solvent move together in response to water pressure; moves from an area of high pressure (hydrostatic pressure) to area of low pressure
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hydrostatic pressure
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force within a fluid compartment (as in the vascular system)
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we lose fluid from where
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kidneys, lungs, GI tract, skin
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describe the role of the kidneys in fluid regulation
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filters blood, filters urine, absorbs or excretes water from filtrate
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a ____ in osmolality will cause the release of adh
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increase
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what does anti diuretic hormone do
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prevents diureses, water saving
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describe what happens if extracellular volume is decreased
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renal perfusion decreases
renin secreted by the kidneys renin acts to produce angiotensin I angio 1 converts to angio 2 massive vasoconstriction results renal arterial perfusion is increased thirst is increased |
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describe the function of aldosterone as related to body fluids
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angio 2 causes release
aldosterone causes kidneys to retain NA+ and water released if NA is low and K is high increases reabsorption of na and excretion of k |
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functions of atrial natriuretic peptide
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secreted from atrial cells of heart
acts as diuretic, inhibits thirst mechanism, suppresses RAA cascade |
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what regulates the thirst mechanism
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hypothalamus
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what stimulates thirst
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increased osmolality of ECF, decreased ECF, dry mucous membranes
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baroreceptors
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nerve receptors that sense pressure in the blood vessels
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if low bp is sensed by the baroreceptors what happens
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stimulate SNS and inhibit PSNS
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if high bp is sensed by baroreceptors what happens
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stimulates PSNS and inhibits SNS
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baroreceptors are located where
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cardiac atria, aortic arch, carotid sinus, juxtaglomerular apparatus in kidney
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what do osmoreceptors do
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sense na+ concentration
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where are osmoreceptors
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surface of hypothalamus
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an increase in na+ concentration stimulates the release of what
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adh
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cations
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positively charged; include sodum, potassium, magnesium, calcium
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major cation in ecf
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sodium
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major cation in icf
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potassium
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anions
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negatively charged; include chloride, bicarbonate, sulfate
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normal extracellular levels of sodium
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135-145 meq/l
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normal extracellular levels of potassium
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3.5-5.0 meq/l
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normal extracellular levels of ionized calcium
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4.5-5.5 mg/dl
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normal extracellular levels of bicarbonate
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22-26 (arterial) meq/l
24-30 (venous) meq/l |
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normal extracellular levels of chloride
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95-105 meq/l
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normal extracellular levels of magnesium
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1.5-2.5 meq/l
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normal extracellular levels of phosphate
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2.8-4.5 mg/dl
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causes of hyponatremia
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salt wasting from kidney; adrenal insufficiency; GI losses; profuse sweating; diuretics; SIADH; inadequate intake
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signs of hyponatremia
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apprehension, personality change, postural hypotension, tachycardia, convulsions/coma, n,v,d; anorexia
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treatment of hyponatremia
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restrict water
sodium replacement |
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causes of hypernatremia
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increased ingestion of salt; iatrogenic; increased aldosterone; water deprivation
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signs of hypernatremia
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thirst, sticky tongue; dry, flushed skin; fever; convulsions, irritability
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treatment of hypernatremia
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hypotonic IV solution or D5W
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urine na+ is used for what
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assesses volume status; aids in diagnosing hyponatremia and acute renal failure
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random normal range of urine na
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50-130 meq/l
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24 hour urine na normal range
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75-200 meq/l
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causes of hypokalemia
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diuretics that waste potassium; d, v, and gastric suction; increased aldosterone; polyuria, sweating; iatrogenic - K poor solutions
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signs of hypokalemia
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weakness, fatigue, decreased muscle tone, hypoactive bowel sounds and distension, constipation, weak irregular pulse; paresthesias; orthostatic hypotension; nausea and vomiting; polyuria
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treatment of hypokalemia
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oral k or iv solution w K; increased dietary K
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causes of hyperkalemia
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renal failure; fluid volume deficit; massive cellular injury; iatrogenic; potassium sparing diuretics; addison's disease
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signs of hyperkalemia
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anxiety/irritability; dysrrhythmias; paresthesia; muscle weakness; diarrhea/nausea
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treatment of hyperkalemia
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kayexalate; iv na bicarb; iv ca gluconate; regular insulin and hypertonic dextrose iv; limit via diet; possible dialysis
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how does insulin help hyperkalemia
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helps piggyback potassium back into the cell
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causes of hypocalcemia
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rapid admin of blood with citrate; hypoalbuminemia; hypoparathyroidism; vit d deficiency; pancreatitis
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signs of hypocalcemia
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numbness, tingling of fingers and mouth; hyperactive reflexes; tetany; muscle cramps; pathological fractures
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treatment of hypocalcemia
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increase dietary intake; iv calcium gluconate; ca and vit d supplements
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causes of hypercalcemia
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hyperparathyroidism; osteometastasis; paget's disease; osteoporosis; prolonged immobilization
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treatment of hypercalcemia
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lasix, increased fluids
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causes of hypomagnesia
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inadequate intake; inadequate absorption; loss from diuretics; polyuria
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signs of hypomagnesia
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tremors and weakness; hyperactive deep tendon reflexes; confusion and delirium; dysrhythmias, causes cardiac irritability
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treatment of hypomagnesia
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mag sulfate iv; oral replacement; increase dietary intake
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causes of hypermagnesia
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renal failure; excess intake of magnesium (antacids)
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signs of hypermagnesia
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hypoactive deep tendon reflexes; decreased depth and rate of resp; hypotension; flushing; slows cardiac conduction
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treatment of hypermagnesia
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iv calcium gluconate; loop diuretics; ns or lr iv solutions; dialysis
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hematocrit
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measures the volume % of RBCs in whole blood
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normal hematocrit
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males = 40-50%; females =37-47%
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hematocrit increases with _____ and decreases with _____
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dehydration; overhydration
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BUN
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blood urea nitrogen; measures kidney function; varies with protein intake, fever, dehydration, GI bleeding, liver failure
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normal levels of BUN
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7-20 mg/dl
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creatinine
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end product of muscle metabolism; better indicator of renal function than BUN
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normal range serum creatinine
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adult female 0.5 to 1.1 mg/dl
adult male 0.6 to 1.2 mg/dl |
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urine specific gravity
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measures ability of kidney to excrete or conserve water
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normal range of urine specific gravity
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1.010 to 1.025
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serum osmolarity is the most accurate measurement of what function
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kidney
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if you are hypotonic water, electrolytes and solutes are _____ in equal proportion to body solutions
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lost
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if you are hypertonic, water, electrolytes and solutes are ____ in equal proportions to body solution
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gained
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fluid volume deficit aka
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hypovolemia
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fluid volume excess aka
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hypervolemia
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hyperosmolarity results from
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dehydration
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hypoosmolarity results from
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water excess
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how are water and solutes lost to result in hypovolemia
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diarrhea, vomiting, fistulas, drains, bleeding, burns, fever, excessive perspiration, inadequate fluid intake, diuretics, gi suctioning
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signs of mild hypovolemia
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dry mouth, furrowed tongue, orthostatic hypotension, restlessness and anxiety; tachycardia; less thn 5% weight loss
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signs of moderate hypovolemia
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confusion, irritability, thirst, cool and clammy; urine output 30cc/hr or less; rapid weight loss; slowed vein filling
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signs of severe hypovolemia
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pale; flattened neck veins; delayed capillary refill; urine output less than 10cc/hr; marked hypotension, tachycardia; weak or absent pulses; can lead to unconsciousness
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lab finding with hypovolemia
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decreased h/h with hemorrhage; increased hct; elevated bun; urine specific gravity greater than 1.030
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interventions for hypvolemia
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treat cause; replace fluids IV; encourage fluids; ensure adequate oxygen and perfusion; increase blood counts, bp and albumin levels
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when replacing fluids intravenously for hypovolemia how do we know which fluids to use
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isotonic if hypotensive; hypotonic if normotensive
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causes of hypervolemia
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isotonic fluid overload; excess sodium intake; chf; renal failure; cirrhosis; increase in steroids or serum aldosterone
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signs of hypervolemia
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acute weight gain; edema; tachycardia; bounding pulse; distended neck veins; increasede bp; dyspnea; tachypnea; crackles; frothy cough
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lab values to look for with hypervolemia
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decreased hematocrit; decreased bun; low o2 levels
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interventions for hypervolemia
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restrict na and fluid intake; watch for edema; provide measures to facilitate breathing; provide skin care for weeping and edema; monitor response to meds; accurate I/O, consistent daily weight, VS, monitor labs; if poor response hemodialysis may be needed
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describe the compensatory mechanism for dehydration (hyperosmolar)
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water shifts out of cells into ECF; causes the cells to shrink and they will eventual not functin properlly
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causes of dehydration
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diabetes insipidus, prolonged fever, water diarrhea, hyperglycemia, failed thirst drive, diuresis of water alone; iatrogenic (hypertonic solutions, IV and tube feeding)
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signs of dehydration
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irritability; confusion; weakness; dizziness; decreased urine output; darkened urine; dry sticky mucous membranes; sunken eyeballs; poor turgor; extreme thirst; fever; coma; tachycardia; weak thready pulse; hypotension
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labs to monitor for dehydration
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elevated hematocrit; elevated serum osmolarity; elevated serum sodium; urine specific gravity > 1.030
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interventions for dehydration
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replace fluids by po route first; slow admin of salt free iv solution; monitor s/s of cerebral and pulmonary edema; monitor accurate i/o, vs, daily weights; monitor labs; provide skin and mouth care
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causes of hypoosmolar or water excess
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siadh or excess water intake
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signs of hypoosmolar or water excess
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decreased LOC, convulsions, coma
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labs to monitor for hypoosmolar
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low serum na and low serum osmolality
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clients most at risk for F&E imbalances
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very young, very old, cancer, cardio disease, endocrine disease, malnutrition, COPD, renal disease, changes in LOC, trauma, gastrointestinal losses; diuretic, steroid, iv or tpn therapies
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describe isotonic iv solutions and give examples
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same osmolarity as body fluids; expands IVC without pulling fluids from other compartments; EX: normal saline, lactatd ringers
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describe normal saline
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isotonic iv solution; 0.9% NaCl
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describe lactated ringers
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isotonic iv solution; contains na, cl, ka, ca in sterile water
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describe hypotonic iv solutions and give examples
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osmolarity less than serum; pulls fluid from IVC into ICC causing cells to expand; EX: 1/2 NS and D5W
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describe dextrose iv solutions
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added to ns or lr; different concentraton; 5% in water (hypotonic after enters body)
10% in water (hypertonic) 50% in water (rescue solution, small volume) |
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describe hypertonic iv solutions and give examples
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osmolarity of solution is higher than serum osmolarity
> 300 mOsm/kg pulls fluid from ICC into IVC causing cells to shrink; EX: d51/2ns, d5ns, d5lr, 3% ns |
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list some common additives to iv solutions
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potassium, multivitamins
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what should you never do with potassium iv additives
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NEVER ADD TO BAG!
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additives make the iv solution _____
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hypertonic to some extent; depends on amount
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how is potassium iv additive available
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as potassium chloride
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list some meds with other uses that are commonly used for f&e disorders
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antidiarrheals; antiemetics; diuretics; potassium, kayexelate
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what forms is potassium offered in
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tablets (SR); effervescent, EC, IV
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what are some considerations when giving potassium supplements
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give on full stomach; NEVER give as bolus with IV; dilute with iv admin
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what does kayexelate do
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removes K from system
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what forms is kayexelate administered in
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po, enema
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define aging
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time-dependent loss of structure and function that proceeds very slowly and in such increments that is appears to be the result of the accumulation of small, imperceptible injuries; gradual result of wear and tear
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maximal life span
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80-100 years
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life expectancy
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74.8 for males; 80.4 females
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where do the majority of older adults live
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NOT in facilities
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geriatrics
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focuses on the diagnosis and treatment of diseases
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gerontology
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study of all aspects of the aging process and its consequences
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gerontological nursing
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assessment of health and functional status
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gerontic nursing
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emphasizes nurturing, caring, and comforting more than treatment of disease
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list the theories of agins
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biological = stochastic or non stochastic
psychosocial = disengagement, activity, continuity |
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what do we need to consider when assessing the needs of older adults
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interrelation bw physical and psychosocial aspects of aging; effects of disease and disability on functional status; decreased efficiency of homeostatic mechanisms; lack of standards for defining health/illness norms; altered presentation and response to specific disease
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list the two divisions of the nervous system
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central nervous system
peripheral nervous system |
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divisions of the peripheral nervous system
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somatic nervous system
autonomic nervous system |
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divisions of autonomic nervous system
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sympathetic nervous
parasympathetic nervous |
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peripheral nervous system consists of
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cranial and spinal nerves
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afferent nerves
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ascending; carrying impulses toward central nervous system
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efferent nerves
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descending, carry impulses from brain to periphery
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somatic nervous system consists of
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pathways that regulate voluntary motor control
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autonomic nervous system consists of
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involuntary motor control
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which division of the nervous system controls fight or flight
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parasympathetic
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classes of nervous system cells
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nerve cells or neurons and neuroglial cells(cns) and swann cells (pns)
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function of glial cells
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support cells in cns
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function of schwann cells
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support cells in pns
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define neuron
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functional unit of cns tissue
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list parts of the neuron
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cell body (soma), dendrites, axon
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the nucleus of a neuron is located
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in the cell body
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dendrites
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extensions of neuron that carry impulses into the cell body
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axon
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carry impulses from one cell body to the next cell body
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axon hillock
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exits soma (cell body) and connects axons to it
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purpose of the myelin sheath
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insulation; allows impulse to travel quickly down nerve
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what does conduction of the nerve impulse depend on
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size of the neuron, myelin sheath
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describe the flow of information in the nervous system
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dendrite
soma (cell body) axon terminal button jump across the synapse |
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three types of neurons
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sensory (afferent)
motor (efferent) interneurons (intrinsic) |
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what do interneurons do
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carry impulses from one neuron to another
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neurotransmitters
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chemical signals that cause excitation or inhibition
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describe the all or none principal of nerve transmission
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each neuron has a resting membrane potential; if you don't reach the potential you don't get a response
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synapse
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small area between neurons; neurotransmitters are released into synapse and bind to neurotransmitters of next cell
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which diseases are related to acetylcholine
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decrease in acetylcholine secreting neurons is one of the causes of alzheimers; myasthenis gravis is a reduction in acetylcholine receptors
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function of norepinephrine as a neurotransmitter
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mood regulation, maintaining arousal
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what causes parkinsons
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destruction of dopamine secreting neurons
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serotonin is involved with
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mood, anxiety, sleep induction; increased levels are related to schizophrenia
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under what circumstances can peripheral nerves regenerate
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if nerve cell body and schwann cell are not damaged
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how quickly do peripheral nerves regenerate
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1cm per year
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what does nerve regeneration depend on
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location of injury, type of injury, inflammatory responses, scarring
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do mature nerve cells divide
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no
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the cns consists of
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brain and spinal cord
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function of cns
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body's control center
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where is csf made and destroyed
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ventricles
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csf is composed of
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water, protein, glucose, minerals
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function of cns
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protect brain and spinal tissue from jolts/blows
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hydrocephalus results when
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the reabsorption and breaking down of csf does not occur properly
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csf
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clear colorless fluid similar to blood plasma
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three membranes protecting the brain
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dura mater
arachnoid membrane pia mater |
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three membrane spaces of the brain
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epidural space
subdural space subarachnoid space |
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epidural space
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space between skull and dura mater
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subdural space
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space between dura mater and arachnoid membrane
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subarachnoid space
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space between arachnoid membrane and pia mater; contains csf
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the brain is composed of
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cerebrum
cerebellum brain stem |
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parts of the brain stem
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midbrain, medulla oblongata, pons
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largest part of the brain
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cerebrum
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functions of the cerebrum
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controls sensory and motor activities and intelligence
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corpus callosum
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connects two halves of the brain
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cerebrum is composed of
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frontal lobe, temporal lobe, parietal lobe, occipital lobe, thalamus, hypothalamus
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frontal lobe of cerebrum controls
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voluntary muscle movement, speech, personality, intellect, emotion, short term or recall memory
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temporal lobe of cerebrum controls
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taste, hearing, smell, interpretation of spoken language, long term memory
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parietal lobe of cerebrum controls
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coordinates and interprets sensory informatin from opposite sides of body
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occipital lobe controls
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vision
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thalamus is where and controls what
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relay center of cerebrum; primitive emotional responses; pleasant vs unpleasant stimuli; fear
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hypothalamus controls
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body temp, endocrine and ANS functions
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where is the cerebellum
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lies beneath cerebrum at base of brain
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functions of cerebellum
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coordinates and controls reflexive, involuntary motor movement, posture, equilibrium
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ataxia
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problems with gait, posture and equilibrium
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describe the midbrain of the brain stem
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reflex center; 3rd and 4th cranial nerve; contains auditory and visual reflex centers; composed of three structures that are involved in voluntary and involuntary visual and auditory motor movements
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describe medulla oblongata of brain stem
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relay station for crossing motor tracts; controls vital cardiac and respiratory functions; reflex activities; lowest part of the brain; injury will probably kill you
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describe pons of brain stem
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reflex center of 5th-8th cranial nerves; chewing, taste, salivation, hearing and equilibrium; transmites info from cerebellum to brain stem and between the two cerebral hemispheres
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what is the reticular activating system
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large network of connected tissue nuclei located within the brain stem; regulates vital reflexes (cardiovascular function, respiration); maintains wakefulness
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the brain vasculature consumes _____ of body's oxygen requirement
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20%
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where do most aneurysms occur
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circle of willis or directly off of it
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how does co2 ensure adequate cerebral blood supply
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it is a potent vasodilator
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what does the blood brain barrier do
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selectively inhibits certain substances in the blood from entering the interstitial spaces of the brain or CSF
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where is the spinal cord
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from the medulla oblongata to the level of the 1st or 2nd lumbar vertebra
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functions of the spinal cord
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two way conductor pathway between the brain stem and pns; motor and sensory tracts; controls body movement; regulates visceral function
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the spinal cord consists of
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vertebrae, intervertebral discs
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dermatomes
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area of skin that is mainly supplied by a single spinal nerve
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how many spinal nerves are there
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(31 pairs) 8 cervical, 12 thoracic, 5 lumbar, 5 sacral
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sensory somatic nervous system function
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regulates voluntary motor control through our conscious awareness of the external environment
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autonomic nervous system function
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regulates body's internal environment through involuntary control of organ systems
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how many pairs of cranial nerves are there
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12
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the sensory somatic nervous system contains _____ that goes from the spinal cord to the skeletal muscle
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one single neuron
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the autonomic nervous system contains _____ that go from spinal cord to the target tissue and they are called
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two neuron; preganglionic and postganglionic
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what controls the rest and relax response
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parasympathetic nervous system
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most common disorders of the elderly
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delirium and dementia
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delirium
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acute confusional state; fluctuating mental state
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dementia
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chronic and progressive; usually alert and aware; usually irreversible
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epilepsy
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abnormal electrical discharge
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characteristics of seizure depend on what
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how much of cerebral cortex is involved; where seizure originates; pattern of spread; extent of involvement
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classifications of epileptic seizures
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partieal, generalized, unclassified
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types of partial seizures
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simple, complex, partial with generalization
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types of generalized sseizures
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absence, myoclonic, tonic-clonic, atonic
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characteristics of status epilepticus
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medical emergency; most frequent in infants and elderly; may result in permanent damage or death; seizure lasts more than 10 mins or more than 1 seizure in a row without regaining consciousness
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three goals of epilepsy treatment
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eliminate or reduce frequency to the maximum extent possible; avoid side effects assoc with long term treatment; assist patient in maintaining or restoring normal vocational adjustment
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spondylolysis
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structural defect; forward displacement; heredity;progressive deterioration of intervertebral discs and supporting tissues of the spine allowing for forward displacement
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spondylolysis allows damage to the spinal cord these 3 ways
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direct compression of the spinal cord by the bones; ischemia caused by compromise of the vascular supply to the cord; repeated trauma in the course of natural flexion and extension
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spondylolisthesis
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vertebra slides forward
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spinal stenosis
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entrapment of single nerve route; acquired or developmental;
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cervical disc disease
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frequent sites, wear and tear, paresthesias, muscle atrophy
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kinesthetic
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sense that enables a person to be aware of the position and movement of body parts without seeing them
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stereognosis
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sense that allows a person to recognize an object's size, shape and texture
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language
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the ability to speak
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three components of sensory experience
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reception, perception, reaction
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most common types of sensory alterations
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sensory defecits, sensory deprivation, sensory overload
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three types of sensory deprivation
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reduced sensory input, elimination of order or meaning from input; restriction of the environment
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characteristics of sensory overload
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multiple sensory stimuli; increased quantity of internal stimuli; increased quantity of external stimuli; person receives multiple sensory stimuli
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s/s of sensory overload
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racing thoughts, short attention span, irritability, restlessness, inability to concentrate, decreased problem solving performance
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factors affecting sensory function
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age, persons at risk, meaningful stimuli, amount of stimuli, family factors, social interaction, environmental factors, cultural factors
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MMSE
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mini mental status examination; tool used to measure disorientation, altered conceptualization and abstract thinking and change in problem solving
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aphasia
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inability to understand language or communicate orally
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expressive aphasia
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inability to name common objects or express simple ideas
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receptive aphasia
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inability to understand written or spoken language
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how is central visual acuity -distance vision measured
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snellen eye chart
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how is central visual acuity-near vision
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jaeger card
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myopia
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nearsightedness
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hyperopia
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farsightedness
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parts of external ear
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auricle, outer ear canal, tympanic membrane
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parts of middle ear
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malleus, incus, stapes
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structures of inner ear
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cochlea, vestibule, semicircular canals
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three types of hearing loss
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conduction, sensorineural, mixed
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conduction hearing loss
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interrupts sound waves as they travel from the outer ear to the inner ear such as swelling or wax build up
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sensorineural hearing loss
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interruption from inner ear, nerve or brain
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dysphagia
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difficulty swallowing
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s/s of dysphagia
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cannot imagine oral secretions; difficulty chewing, prolonged chewing; pocketing of food in buccal cavities; holding food in mouth for long periods; excessive drooling during meals; absent swallow; coughing/choking or throat clearing after swallows; wet, gurgly voice after swallows; pain with swallowing; swallowing many times for small bolus; aspiration pneumonia suspected; recurrent pneumonia; weight loss; chronic dehydration or malnutrition
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top three risk factors for aspiration pneumonia
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dependence on others for feeding; dependence on others for oral care; missing or decaying teeth
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what is the best therapy for dysphagia
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practicing swallowing
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dysarthria
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can use words and put sentences together but making it come out clear is hard
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apraxia
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problems with motor planning (sticking out tongue and opening mouth simultaneously doesn't occur spontaneously)
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