NUR 529 EXAM 1 ACTUAL QUESTIONS WITH

NUR 529 EXAM 1 (ACTUAL ) QUESTIONS WITH

CORRECT ELABORATED ANSWERS LATEST ALREADY GRADED

A+

effeects of chronic stress - ---Answers-----The stress response is designed to be an acute self-limited response in which activation of the ANS and the HPA axis is controlled in a negative feedback manner. As with all negative feedback systems, pathophysiologic changes can occur in the stress response system. Function can be altered in several ways, including when a component of the system fails; when the neural and hormonal connections among the components of the system are dysfunctional; and when the original stimulus for the activation of the system is prolonged or of such magnitude that it overwhelms the ability of the system to respond appropriately. In these cases, the system may become overactive or underactive.

Chronicity and excessive activation of the stress response can result from chronic illnesses as well as contribute to the development of long-term health problems. Chronic activation of the stress response is an important public health issue from both a health and a cost perspective. Stress is linked to a myriad of health disorders, such as diseases of the cardiovascular, gastrointestinal, immune, and neurologic systems, as well as depression, chronic alcoholism and drug abuse, eating disorders, accidents, and suicide.

edema assessment and tx - ---Answers-----The effects of edema are determined largely by its location. Edema of the brain, larynx, or lungs is an acute, life-threatening condition. 1 / 4

Although not life threatening, edema may interfere with movement, limiting joint motion. Swelling of the ankles and feet often is insidious in onset and may or may not be associated with disease. At the tissue level, edema increases the distance for diffusion of O2, nutrients, and wastes.Edematous tissues usually are more susceptible to injury and development of ischemic tissue damage, including pressure ulcers. Edema can also compress blood vessels. The skin of a severely swollen finger can act as a tourniquet, shutting off the blood flow to the finger. Edema can also be disfiguring, causing psychological effects and disturbances in self- concept. It can also create problems with obtaining proper- fitting clothing and shoes.Pit Methods for assessing edema include daily weight, visual assessment, measurement of the affected part, and application of finger pressure to assess for pitting edema.Daily weight performed at the same time each day with the same amount of clothing provides a useful index of water gain (1 L of water weighs 1 kg [2.2 lb]) because of edema.

Distinguishing lymphedema from other forms of edema can be challenging, especially early in its course. Papillomatosis, a characteristic honeycomb appearance of the skin b

lungs in acid base regulation - ---Answers-----The second line of defense against acid-base disturbances is the control of extracellular CO2 by the lungs.45,49 Respiratory regulation only comes into play when the chemical buffers do not minimize H+ changes.45 Increased ventilation decreases 2 / 4

PCO2, whereas decreased ventilation increases PCO2. The blood PCO2 and pH are important regulators of ventilation.

Chemoreceptors in the brain stem and peripheral chemoreceptors in the carotid and aortic bodies sense changes in PCO2 and pH and alter the ventilation rate.When the H+ concentration is above normal, the respiratory system is stimulated resulting in increased ventilation. This control of pH is rapid, occurring within minutes, and is maximal within 12 to 24 hours. Although the respiratory response is rapid, it does not completely return the pH to normal. It is only about 50% to 75% effective as a buffer system.44,45 This means that if the pH falls from 7.4 to 7.0, the respiratory system can return the pH to a value of about 7.2 to

7.3.44 In acting rapidly, however, it prevents large changes in

pH from occurring while waiting for the much more slowly reacting kidneys to respond.

Although CO2 readily crosses the blood-brain barrier, there is a lag for entry of HCO3−. Thus, blood levels of HCO3− change more rapidly than CSF levels. In metabolic acidosis, for example, there is often a primary decrease in pH of the cerebral fluids and a slower decrease in HCO3−. When metabolic acid-base disorders are corrected rapidly, the respiratory response may persist because of a delay in adjustment of CSF HCO3− levels.

kidney is acid base regulation - ---Answers-----The kidneys are the third line of defense in acid-base disturbances and play three major roles in regulating acid-base balance.45,46 The first is through the excretion of H+ from fixed acids that 3 / 4

result from protein and lipid metabolism. The second is accomplished through the reabsorption of the HCO3− that is filtered in the glomerulus, so this important buffer is not lost in the urine. The third is the production of new HCO3− that is released back into the blood.44-46 The kidneys also play a

role in controlling pH: in conditions of acid load, ammonium

(NH4+) production and excretion allows for acid secretion and pH normalization.45 The renal mechanisms for regulating acid-base balance cannot adjust the pH within minutes, as respiratory mechanisms can, but they begin to adjust the pH in hours and continue to function for days until the pH has returned to normal or near-normal range.

acid base balance- compensatpru mechanisms - ---Answers- ----Acidosis and alkalosis typically involve a primary or initiating event and a compensatory or adaptive state that results from homeostatic mechanisms that attempt to correct or prevent large changes in pH. For example, a person may have a primary metabolic acidosis as a result of overproduction of ketoacids and respiratory alkalosis because of a compensatory increase in ventilation (see Table 8.16).Compensatory mechanisms provide a means to control pH when correction is impossible or cannot be achieved immediately. Often, compensatory mechanisms are interim measures that permit survival while the body attempts to correct the primary disorder. Compensation requires the use of mechanisms that are different from those that caused the primary disorder. For example, the lungs cannot compensate for respiratory acidosis that is caused by lung disease, nor can the kidneys compensate for metabolic acidosis that occurs because of chronic kidney disease. The body can, however, use renal mechanisms to compensate for respiratory-induced

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