Anaphy Lab - Final Notes PDF

ANAPHY LAB – FINAL NOTES URINARY FORMATION SECRETION Urine forms in kidneys and leaves body through Substances not already filtered are secreted into urethra urine through distal convoluted tub...

ANAPHY LAB – FINAL NOTES URINARY FORMATION SECRETION Urine forms in kidneys and leaves body through Substances not already filtered are secreted into urethra urine through distal convoluted tubule Hydrogen and ammonium ion may be secreted into urine in exchange of sodium Know the major functions of the urine URINE COMPOSITION After passing through kidney, urine is 96% water and 4% dissolved substances (urea, salt, sulfate, phosphate) Abnormal constituents of urine ○ WBS ○ Fat ○ Glucose ○ Casts ○ Bile ○ Hemoglobin and RBC Changes in urine production ○ Amount of urine excreted can rise or fall ○ Urine color can change How body excretes water and gets rid of waste ○ Urine appearance can vary ○ Waste can become toxic if not removed Patients with tuberculosis could Two kidneys eliminate soluble waste products of have orange urine metabolism rifampin/rifampicin Isoniazid FILTRATION ethambutol Glomerulus filters waste products, salts, and ○ Urine odor can change excess fluid from blood ○ Cells can be present in urine Tubule concentrates filtered material ○ Chemical constituents in urine can change Nephron ○ Urine concentration (specific gravity) may ○ Combination of glomerulus and tubules vary One million nephrons in each kidneys SAFETY Substances filtered out from body Standard precautions ○ Water Transmission-based precautions ○ Ammonia Biohazard precautions ○ Electrolytes Proper disposal of urine ○ Glucose ○ Amino acids QUALITY CONTROL ○ Creatinine Regulatory agencies ○ urea Written testing protocols Diabetes diagnosis Maintained testing records Routine urinalysis testing Recalibration of instruments REABSORPTION URINE CONTAINERS About 180 liters of filtrate produced daily Types Only 1-2 liters of urine eliminated ○ Non Sterile containers for cultures Much filtrate reabsorbed into body ○ 24 hour collection containers with added Blood cells and most proteins stay in blood preservative Concentration of glucose in blood below 180 mg/dl will be reabsorbed Glucose is a threshold substance  ANAPHY LAB – FINAL NOTES Label container immediately after specimen collection ○ Patient’s name, age, gender, identifying Refractometer number ○ Most common tool for ○ Date and time of collection measuring specific gravity of ○ Physician’s name liquids ○ Label the cup, not the lid ○ Measures refractive index of urine URINE COLLECTION ○ Reads about 0.002 below that of Urine specimen types true specific gravity ○ Random (spot) specimen ○ Needs 1 drop of urine Obtained at any time ○ Easy to use but more expensive Most common If concentrated specimen preferred, first specimen of day is most concentrated MIDSTREAM CATCH ○ Fasting/timed specimens Used when physician wants to measure substance without interference from food intake Length of fast varies Give patient written directions Chemical examination of urine Use regular urinalysis container ○ Use of multistix reagent strips with ○ Catheterized specimen color-coded charts Insert sterile tube directly into ○ Chemical testing available on urine bladder through urethra reagent test strips Not contaminated ○ See table 30-3, 30-4 Can cause infection if not done correctly PREPARING FOR MICROSCOPIC EXAMINATION Use only when other methods are contraindicated or show repeated Centrifuge 10-15 mL of urine positive testing for bacteria Pour off supernatant urine Resuspend sediment by tapping EXAMINATION OF URINE Stain (optional) >> Best when fresh, even still warm Put drop of sediment on slide Test within 30 minutes, or refrigerate ROUTINE URINALYSIS PROCEDURE Physical examination of urine ○ Observe and record color and transparency of specimen  ANAPHY LAB – FINAL NOTES 2. Digestion - breakdown of ingested material 3. Secretion - production and release of fluids and enzymes associated with digestive activity 4. Mixing and propulsion - mixing with secretion and moving through digestive system 5. Absorption - absorbing nutrients in ingested material into the blood 6. Excretion - elimination of waste via fecal material ORGANS OF THE DIGESTIVE SYSTEM Digestive (GI) tract ○ Series of organs through which ingested material moves URINE SEDIMENT CELLS AND MICROSCOPIC ○ Breaks down and absorbs nutrients … Accessory digestive organs ○ Not part of GI tract ○ Have functions associated with digestive RBC Parasite-most common is activity trichomonas ○ Liver, pancreas, gallbladder, salivary WBC sperm glands Renal epithelial cells artifacts Bacteria Squamous epithelial cells-skin cells; normal; report as few, moderate, or many Yeast-most common is candida albicans CRYSTALS IN URINE SEDIMENTS Require little attention Forms as urine specimens stands Uric acid, crystine, and sulfa drug crystals can indicate disease state URINALYSIS REPORT Include patient’s name, type of specimen, collection method, ordering provider, MA name, date and time of collection, date and time of CONNECTIONS TO OTHER BODY SYSTEM testing, findings Digestive system works cooperatively with other systems DRUG SCREENING ○ Cardiovascular system absorbs nutrients Becoming more common for employment and circulates them following digestion Test itself is CLIA waived, but detailed protocols ○ Specific endocrine cells secrete hormones must be followed that regulate digestive activity Chain of custody ○ Skin is involved in production of vitamin D DIGESTIVE SYSTEM GASTROINTESTINAL (GI) TRACT FUNCTIONS OF THE DIGESTIVE SYSTEM Continuous tube divided into different organs 1. Ingestion - intake of food and drink Secretions of GI tract:  ANAPHY LAB – FINAL NOTES ○ Mouth Sequential, alternating waves of contraction and ○ Pharynx relaxation by layers of muscularis ○ Esophagus Propels food forward within tract ○ Stomach Helps mix food with digestive juices ○ Small intestines ○ Large intestines (colon) ○ Anus NERVE SUPPLY Central nervous system initiates activities such as salivation ○ Also responsible for sight, taste, smell, and feel of ingested materials Enteric nervous system innervates GI tract ○ Myenteric plexus controls movements of muscularis ○ Submucosal plexus controls digestive secretions Autonomic nervous system ○ Sympathetic - decreases GI motility and secession ○ Parasympathetic - increases GI motility ACCESSORY ORGANS and secretion Aid in breakdown of ingested material Accessory organs include: BLOOD SUPPLY ○ Teeth Provides nutrients and removes wastes from GI ○ Tongue tract and accessory organ ○ Salivary glands Absorbs proteins and carbohydrate nutrients ○ Pancreas ○ Lipids absorbed by unsur lymphatic ○ Liver capillaries called lacteals ○ Gallbladder Hepatic portal system ○ Veins that drain intestine carry absorbed MECHANICAL VS CHEMICAL DIGESTION nutrients to liver first 1. Mechanical digestion - uses force generated by ○ Liver processes and detoxifies incoming muscles to digest nutrients nutrients before they enter general Begins with chewing (mastication) in the circulation mouth THE PERITONEUM Muscularis layer is involved in mechanical Serous membrane that holds abdominal organs in digestion position 2. Chemical digestion - utilizes enzymes and other ○ Composed of parietal and visceral layers secretions to break down ingested material ○ Peritoneal cavity contains peritoneal fluid Other secretions come from salivary to reduce friction between the layer glands, stomach, liver, pancreas, and Intraperitoneal = organs within peritoneum gallbladder Retroperitoneal = organs behind peritoneum PERISTALSIS  ANAPHY LAB – FINAL NOTES Four major folds = less omentum, greater omentum, transverse mesocolon, mesentery proper THE MESENTERIES Helps hold abdominal organs in palace Contains blood vessels, nerves, and lymphatics for abdominal organs Lesser omentum = connects stomach to liver Greater omentum = hangs over abdominal organs Mesentery (proper) = anchors small intestines SALIVARY GLANDS to posterior abdominal wall Secrete saliva into oral cavity Transverse mesocolon = anchors transverse ○ Watery secretion that contains enzymes colon to posterior abdominal wall Three pairs of salivary glands ○ Parotid glands THE MOUTH, PHARYNX, AND ESOPHAGUS ○ Submandibular gland ○ Sublingual glands MOUTH Also known as oral cavity ○ Framed by cheeks, tongue, and palate Entrance to GI tract bordered by lips (labia) Muscles involved in mastication (chewing) begin mechanical digestion Hard palate made of bone provides hard surface to push food during swallowing Soft palate made of skeletal muscles elevates during swallowing Uvula directs ingested materials inferiorly SALIVA Beings chemical digestion and moistens foods ○ Secretion regulated by autonomic nervous system (ANS) Salivary amylase breaks down carbohydrates ○ Infants secrete salivary lipase to break down lipids in breastmilk Bicarbonate and phosphate ions buffer acidic foods IgA and lysozyme prevent microbial infection in mouth Histostatin helps speed wound healing TONGUE TEETH Made of skeletal muscles Organs similar to bones, used to tear, grind, and Functions in ingestion, sensation, swallowing, and mechanically break down food speech Deciduous (baby) teeth are replaced by permanent Papillae contain taste buds (adult) teeth Lingual frenulum anchors tongue ○ With incisors - used for bing and cutting (BUNNY TOOTH) ○ Four cuspids (canines) - used frog piercing (VAMPIRE TOOTH) ○ Eight premolars - used for mashing and grinding  ANAPHY LAB – FINAL NOTES ANATOMY OF A TOOTH Pharyngea; and esophageal phases are involuntary Socket lined by gingivae (gums) controlled Periodontal ligaments anchor teeth in sockets Crown above gumline; root embedded within ESOPHAGUS socket 10 inches long Pulp cavity contains nerves and blood vessels that Flat, muscular tube that connects pharynx to run through root canal to bone stomach Bone-like dentin covers pulp cavity Upper esophageal sphincter relaxes to allow In crown, dentin is covered by enamel movement into esophagus Peristalsis moves bolus through esophagus allow entry in stomach Lower esophageal sphincter relaxes to allow entry into stomach ○ Fails when gastroesophageal reflux disease (GERDZ) occurs HISTOLOGY OF THE ESOPHAGUS Mucosa contains non-keratinized stratified squamous epithelium ○ Protects against friction from food moving through esophagus Muscularis varies in composition throughout the PHARYNX esophagus Funnel-like passageway for food and air ○ Upper third: skeletal muscle Sectioned into nasopharynx (not involved in the ○ Middle third: combination of skeletal digestive tract), oropharynx, and laryngopharynx and smooth muscles Oropharynx is lined by stratified squamous ○ Lower third: smooth muscles epithelium Outer adventitia due to esophagus located outside of abdominal cavity STOMACH Hollow, muscular organ that continues chemical and mechanical digestion ○ Very little absorption occurs in stomach Regions of stomach ○ Carida, fundus, body, antru, pylorus ○ Pylorus divided into antrum and canal ○ Pyloric sphincter regulates movement into small intestines Muscularis contains additional oblique layer ○ Mixed food with gastric juice to become chyme Cardia = region where food enters stomach SWALLOWING Fundus = increases food enters stomach Voluntary phase - tongue moves up and back; Pylorus = connects stomach to duodenum pushes bolus into oropharynx; can be consciously Gastric rugae (folds) = allows stomach to controlled expand Pharyngeal phase - uvula and soft palate Mucosa contains gastric pits reflexively elevate to close nasopharynx Gastric glands secrete gastric juice Esophageal phase - bolus enters esophagus and ○ Parietal cells secrete hydrochloric acid peristalsis begins and intrinsic factor ○ Chief cells secrete pepsinogen  ANAPHY LAB – FINAL NOTES ○ Mucous neck cells secrete mucus Empties bile and pancreatic juice into duodenum ○ Enteroendocrine cells – secrete hormones ○ Sphincter of Oddie regulates release into duodenum PHASES OF GASTRIC SECRETION Cephalic phase - begins when body is alerted by THE BILIARY APPARATUS the smell, taste, sight, or thought of food Liver and gallbladder contribute bile to duodenum Gastric phase - activated by nervous and Head of pancreas is in curve of duodenum endocrine system when food enters stomach Secretions from all three accessory organs empty ○ Results in increased gastric secretion and into duodenum motility Intestinal phase ○ Excitatory - duodenum increases gastric secretion ○ Inhibitory enterogastric reflex inhibits gastric secretion and movement when small JEJUNUM AND ILEUM Jejunum is the middle segment of small intestine ○ No clear border separates it from ileum Ileum is longest, terminal segment of small intestine ○ Thicker and more vascular than other segments ○ Joins the cecum at the ileocecal SMALL INTESTINES junction/sphincter Chyme enters from stomach Site of most digestion and absorption of nutrients Divided into three sections ○ Duodenum - receives secretions from biliary apparatus ○ Jejunum ○ Ileum Ileocecal sphincter regulates movements into large intestines THE DUODENUM Site of majority of chemical digestion Receives secretion from gallbladder, pancreas, and liver Liver produces bile that drains from hepatic ducts into common hepatic duct MECHANICAL DIGESTION IN THE SMALL Common hepatic duct unites with cystic duct of INTESTINE gallbladder to form common bile duct Two motility patterns of small intestine Common bile duct unites pancreatic duct to form ○ Peristalsis - pushes contents forward hepatopancreatic ampulla (ampulla of vater) ○ Segmentation - mixes contents locally  ANAPHY LAB – FINAL NOTES Does not propel them forward Simple columnar epithelium primarily line the Gastroileal reflex - increased stomach activity mucosa leads to increased contraction of ileum Absorbs water, salts, and vitamins ○ Pushes intestinal content forward into Mucosa contains deep intestinal glands cecum to allow further gastric emptying Each person contains unique bacterial composition within large intestine ACCESSORY ORGANS IN DIGESTION: THE LIVER, PANCREAS, AND GALLBLADDER FUNCTIONS OF LIVER Detoxifies nutrients brought to liver from absorbing digestive organs Processes drugs toxins within body Stores iron Produces bile Produces plasma proteins Breaks down RBS, decomposes hemoglobin, and excretes the bilirubin (yellow) waste in the bile LARGE INTESTINES Completes absorption of nutrients and water, LIVER forms fecal materials, and helps synthesize some Located in the right upper quadrant of abdomen vitamins 2nd largest organ of adult human body Contains bacteria that aid in function Divided into right, left, caudate, and quadrate Frames the small intestines within abdomen lobes Regions of the large intestines Anchored to abdominal wall by ligamentum teres ○ Cecum, ascending colon, transverse and falciform, coronary, and lateral ligaments colon, descending colon, sigmoid colon, Porta hepatis = site of hepatic artery, hepatic rectum, and anus portal vein, and common bile duct ○ Appendix is attached to cecum Flexures are bends in the large intestine ○ Left colic and right splenic flexures Rectum hold fecal material until eliminated ○ Internal and external anal sphincters regulate release of feces ○ Internal anal sphincter is smooth muscle; external anal sphincter is skeletal muscles Tenia coli extend the length of large intestine ○ Contractions forms haustra Motility in large intestine ○ Haustral contractions - aid in water GALLBLADDER absorption Located on posterior surface of liver ○ Mass movement - forces contents Stores and concentrates bile towards rectum Releases bile when necessary via cystic duct Gastrocolic reflex - gastric activity increases colon activity ○ Valsalva’s maneuver - increased abdominal pressure aids in fecal elimination WALLS OF THE LARGE INTESTINES  ANAPHY LAB – FINAL NOTES DIGESTIVE ENZYMES PANCREAS Retroperitoneal organ at posterior of abdomen Both endocrine and exocrine gland Head is nestled into C-shaped duodenum Pancreatic acini secrete digestive enzymes ○ Released via pancreatic and accessory CARBOHYDRATE DIGESTION ducts Carbohydrate must be digested into Trypsin and chymotrypsin are for your protein monosaccharides for absorption digestion ○ Common monosaccharides: glucose, Amylase is for your carbohydrate digestion fructose or galactose Lipase is for your fat breakdown or fat lipids Enzymes involved in carbohydrate digestion ○ Amylases in saliva and pancreatic juice BILIARY SYSTEM help digest starch Vessels that carry secretion of pancreas and bile Cannot digest cellulose (fiber) from liver and gallbladder ○ Brush border enzymes in wall of small Right and left pancreatic ducts of liver carry bile intestine ○ Unite to form common hepatic duct Alpha-dextrinase, lactase, Common hepatic duct mergers with cystic duct to maltase, and sucrase form common bile duct Common bile duct unites with pancreatic duct to PROTEIN DIGESTION form hepatopancreatic ampulla Begins with acid in stomach Release of bile and digestion enzymes occurs at Most enzymes are produced in an inactive state to major duodenal papilla prevent self-digestion ○ Pepsin - produced by stomach DIGESTION AND ABSORPTION ○ pancreatic enzymes: Digestion begins in the mouth Trypsin, carboxypeptidase, Continue as food moves through GI tract chymotrypsin, elastase Most absorption (~90%) occurs in the small ○ Brush border enzymes intestines Indigestible food may be eliminated as feces or LIPID DIGESTION metabolized by bacteria within GI tract Bile aids in lipid digestion by emulsifying lipids ○ Provides nutrients for both bacteria and ○ Break them up to allow faster digestion human body Enzymes involved in lipid digestion: ○ Lingual lipase begins process in mouth ○ Gastric lipase continues in stomach ○ Pancreatic lipase accomplishes most lipid digestion Breaks triglycerides into monoglycerides and two fatty acids  ANAPHY LAB – FINAL NOTES ABSORBABLE FOOD SUBSTANCES 1. Crystalloid a. Isotonic b. Hypotonic c. hypertonic 2. Colloid a. Blood b. Albumin ELECTROLYTES ABSORPTION 1. Na+ = Sodium Digestion converts ingested materials into 2. Ca = Calcium molecules small enough for absorption 3. K = Potassium Absorption occurs through 4. Mg = Magnesium ○ Active transport, simple diffusion, 5. P = Phosphorus facilitate diffusion, secondary active transport, and endocytosis IV INSERTION ★ Oh Great God Please Bless Your People Monomers of carbohydrates, proteins, and nucleic acids are absorbed via blood capillaries G14 – surgery/rapid fluid transfusion – orange Monomers of lipids are absorbed through lacteals (lymphatic systems) G16 – rapid fluid/trauma/surgery – grey Minerals and electrolytes are absorbed almosts G18 – blood transfusion/trauma – green completely G20 – general fluid – pink ○ Calcium absorption is regulated by PTH G22 – general fluid – blue ○ Iron absorption is dependent on the G24 – neonates, children, elderly – yellow body’s need for iron G26 –neonate/infant/newborn – purple Fat-soluble vitamins A, D, E, and K are absorbed by lacteals along with lipids COMMON SITES FOR IV INSERTION Walter-soluble vitamins absorbed by blood 1. Cephalic vein 2. Basilic vein Water absorption occurs primarily in small 3. Metacarpal vein intestines and remaining occurs in large intestines 4. Antebrachial vein ○ Lack of water reabsorption leads to diarrhea MICROSET VS MACROSET 1. Microset IV FLUIDS AND THEIR CLASSIFICATION - Delivers 60 drops per milliliter (gtt/mL), ★ A VEIN IS A VEIN! making it ideal for precise drip rates and smaller amounts of fluid 1. PNSS – green – isotonic (fluid of choice for - Often used for pediatric and neonatal blood transfusion) patients, or for medications that require a 2. D5LR – pink – hypertonic precise flow rate 3. PLR – blue – isotonic (fluid of choice for emergency fluid resuscitation) 2. Macroset 4. D5NSS – yellow – hypertonic - Delivers 10-15-20 gtt/mL, making it 5. D5W – red – hypotonic/isotonic better for delivering larger doses of fluid at a rapid rate Fluid replenishment - Often used for infusing saline solution or Medications blood products Administration of blood Calcium → clots FORMULA FOR IV FLUIDS 𝑡𝑜𝑡𝑎𝑙 𝑣𝑜𝑙𝑢𝑚𝑒 𝑥 𝑑𝑟𝑜𝑝 𝑓𝑎𝑐𝑡𝑜𝑟 = # 𝑜𝑓 ℎ𝑟𝑠 𝑜𝑓 𝑖𝑛𝑓𝑢𝑠𝑖𝑜𝑛 𝑥 60 𝑚𝑖𝑛𝑠  ANAPHY LAB – FINAL NOTES FLUIDS AND ELECTROLYTES: THE BASICS OF Plain Normal Saline Solution (Green) ELECTROLYTES ○ Fluid resuscitation for hemorrhaging, POTASSIUM severe vomiting, diarrhea, HI suctioning K+ is the major intracellular cation losses, wound drainage, mild 3.5-3.5 mEq/L hyponatremia, or blood transfusions Potassium moves in and out of the cells under the ○ Fluid of choice before the blood influence of the potassium-sodium pump transfusion Daily dietary intake is necessary because Palin Lactated Ringer’s Solution (Dark Blue) potassium is poorly stored in the body ○ Fluid resuscitation, GI tract fluid losses, Hypokalemia = decreased serum K+ levels burns, traumas, or metabolic acidosis. Hyperkalemia = increased serum K+ levels Often used during surgery ○ Used in the emergency department for SODIUM fluid resuscitation Na+ is the major extracellular cation 135-145 mEq/L HYPOTONIC Combines with chloride (Cl) or bicarbonate Dextrose 5% in Water (Red) (HCO3) to promote acid-base balance ○ Provides free water to promote renal Hyponatremia = decreased serum Na+ levels excretion of solutes and teat Hypernatremia = increased serum K+ levels hypernatremia, as well as some dextrose supplementation CALCIUM ○ Isotonic in bag, hypotonic once Calcium is found in approximately equal absorbed in the body proportions in ICF and ECF 90% of Calcium = teeth HYPERTONIC Remaining blood: 50% - albumin Dextrose 5% in Normal Saline Solution 22 to 25 mEq/L or 4.25 to 5.25 mg/dL (Yellow) Hypocalcemia = decreased serum Calcium levels ○ Initial fluid & electrolyte replacement therapy in conditions with combined Hypercalcemia = increased serum Calcium levels water & Na depletion MAGNESIUM ○ Slightly hypertonic Most plentiful in the ICF ○ Quickly metabolized 1.5 to 2.5 mEq/L Dextrose 10% in Water Promotwa transmission of neuromuscular activity ○ Provides calories (380 kcal/L), free water, and no electrolytes. It should be Hypomagnesemia = decreased serum administered using a central line (if Magnesium levels possible) Hypermagnesemia = increased serum ○ It should NOT be infused with the same magnesium levels line as your blood products since it can cause your RBC’s to embolize CHLORIDE & PHOSPHORUS Dextrose 50% in Water Chloride is the principle anion of ECF ○ Treatment of choice for severe Phosphorus is the principle anion of ICF hypoglycemia Hypochloremia and hyperchloremia = chloride ○ Administered rapidly levels Hypophosphatemia and hyperphosphatemia = phosphorus levels NOTES BY: JAN KESSE E. WRIGHT BLOCK: BSN 1E INTRAVENOUS FLUIDS A crystalloid solution Intravenous fluids = parental administration of fluids Categorized into three = isotonic fluids, hypotonic fluids, and hypertonic fluids ISOTONIC