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Chapter 25
Fluid, Electrolyte, and Acid-Base Balance
| Question | Answer |
|---|---|
| What are the four main function of water in the body? | -act as a vehicle for transport -aid heat regulation by providing perspiration -assist in maintenance of hydrogen balance in the body -serve as a medium for enzymatic action of digestion |
| Electrolytes | minerals or salts that are dissolved in body fluid |
| Sodium normal range | 135-145 mEq/L |
| Potassium normal range | 3.5-5 mEq/L |
| Calcium normal range | 8.4-10.6 mg/dL |
| Magnesium normal range | 1.3-2.1 mg/dL |
| Phosphate normal range | 2.7-4.5 mg/dL |
| Chloride normal range | 96-106 mEq/L |
| Bicarbonate normal range | 22-26 mEq/L |
| Extracellular fluid | -1/3 of total body water -transports water, nutrients, oxygen, waste to and from cells -High in sodium content |
| Intravascular fluid | -fluid within blood vessels -contains large amounts of protein/electrolytes |
| Interstitial fluid | -fluid in spaces surrounding the cells -high in sodium content |
| Transcellular fluid | -includes aqueous humor, saline, cerebrospinal, pleural, peritoneal, synovial, and pericardial fluids & urinary/lymphatic systems |
| Intracellular fluid | -2/3 of total body fluid -contained within cell walls, most permeable to water -high in potassium |
| Diffusion | process by which substances freely move back and forth across the membrane until they are evenly distributed throughout the available space |
| Osmosis | movement of a pure solvent (liquid) across a membrane |
| Isotonic | concentration outside of cells is equal to concentration inside of cells |
| Hypertonic | Concentration outside of cells is greater than the concentration within the cells |
| Hypotonic | Concentration outside of cells is lesser than the concentration within the cells |
| Filtration | movement of water and suspended substances outward through a semipermeable membrane |
| Hydrostatic pressure | pressure exerted by fluid -causes fluid to press outward on the vessel |
| Active transport | -requires cellular energy -may move substances from an area of lower concentration to an area of higher concentration |
| How does the healthy kidney regulate fluid and electrolyte balance? | by regulating the volume and composition of ECF |
| Who is at risk for deficient fluid volume? | -patients unable to take in sufficient fluid due to impaired swallowing, weakness, disorientation, coma, unavailable water -patients who lose excessive fluid through prolong vomiting, diarrhea, hemorrhage, diaphoresis, or excessive wound drainage |
| Turgor | degree of elasticity |
| Dehydration | loss of water from the cells |
| Edema | excessive accumulation of interstitial (tissue) fluid |
| What are the causes of generalized edema? | -kidney failure -heart failure -liver failure -hormonal disorders - overproduction of aldosterone & ADH |
| Hyponatremia | -deficit of sodium in blood -most common electrolyte imbalance |
| Hyponatremia causes | -sodium loss/excess of water -excessive vomiting, diarrhea when replaced with plain water -decreased secretion of aldosterone -heart failure, liver disease, chronic renal failure, ascites |
| Ascites | abnormal accumulation of fluid within the peritoneal cavity |
| Hyponatremia signs/symptoms: | Sodium less than 135 mEq/L CNS/neuromuscular changes, mental confusion, headache, altered level of consciousness, anxiety, coma, anorexia, nausea, vomiting, muscle cramps, seizures, decreased sensation |
| Hypernatremia signs/symptoms: | Sodium greater than 145 mEq/L dry mucous membranes, loss of skin turgor, intense thirst, flushed skin, oliguria, possible elevated temp, weakness, lethargy, irritability, twitching, seizures, coma, intracranial bleeding |
| Hypokalemia sings/symptoms: | Potassium less than 3.5 mEq/L abdominal pain, gaseous distention of intestines, cardiac arrhythmias, muscle weakness, decreased reflexes, paralysis, paralytic ileum, urinary retention, lethargy, confusion, ECG changes, increased urinary pH |
| Hyperkalemia signs/symptoms: | Potassium greater than 5.0 mEq/L muscle weakness, hypotension, paresthesias, paralysis, cardiac arrhythmias, ECG changes |
| Hypocalcemia signs/symptoms: | Calcium less than 8.4 mg/dL paresthesias, seizures, muscle spasms, tetany, hand spasms, positive Chvostek sign, positive Trousseau sign, cardiac arrhythmia, wheezing, dyspnea, difficulty swallowing, colic, cardiac failure |
| Hypercalcemia signs/symptoms: | Calcium greater than 10.6 mg/dL anorexia, abdominal pain, constipation, polyuria, confusion, renal calculi, pathologic fractures, cardiac arrest |
| Hypomagnesemia signs/symptoms: | Magnesium less than 1.3 mEq/L insomnia, hyperactive reflexes, leg/foot cramps, twitching, tremors, seizures, cardiac arrhythmia, positive Chvostek sign, positive Trousseau sign, vertigo, hypocalcemia, hypokalemia |
| Hypermagnesemia signs/symptoms: | Magnesium greater than 2.1 mEq/L hypotension, sweating/flushing, nausea/vomiting, muscle weakness, paralysis, respiratory depression, cardiac dysrhythmias |
| Hypophosphatemia signs/symptoms: | Phosphate less than 2.7 mg/dL confusion, numbness, weakness, possible come, chronic state my cause rickets & osteomalacia |
| Hyperphosphatemia signs/symptoms: | Phosphate is greater than 4.5 mg/dL anorexia, nausea, vomiting |
| Alkalosis | excess of alkaline or decrease of acid substances in the blood and body fluids |
| What ist he normal serum pH? | 7.35-7.45 |
| What is the normal range of Bicarbonate (HCO3)? | 22-25 mEq/L |
| What are the three control mechanisms for pH? | -blood buffer system -lungs -urinary system |
| Acidosis | increase in hydrogen ions, decrease in pH |
| Respiratory acidosis causes: | hypoventilation, resp. congestion/obstruction, COPD, severe pneumonia, excessive sedation, respiratory muscle weakness |
| Respiratory acidosis signs/symptoms: | hypoventilation, dyspnea, anxiety, confusion |
| Metabolic acidosis causes: | shock, diabetic ketoacidosis, lactic acidosis, renal failure, diarrhea, starvation |
| Metabolic acidosis signs/symptoms: | Kussmaul respirations, headache, confusion, malaise |
| Respiratory alkalosis causes: | hyperventilation due to pain or anxiety, mechanical ventilation, high fever, ASA overdose, encephalitis |
| Respiratory alkalosis signs/symptoms: | hyperventilation, confusion, lightheadedness |
| Metabolic alkalosis causes: | vomiting, prolonged gastric suction, hypokalemia, medications, diuretics, antacids or bicarbonate, mineralocorticoids |
| Hyperventilation | a rapid respiratory rate -results in respiratory alkalosis |
| Tetany | characterizes by severe muscle cramps, carpopedal spasms, laryngeal spasms, and stridor |
| Why are changes in vital signs pertinent when assessing fluid and electrolyte imbalances? | -fever increase fluid loss -PR greater than 100bpm can be early sign of decreased vascular volume -weak, thready pulse - volume deficit -bounding, full pulse - fluid volume overload -Irregular PR - Magnesium/Potassium |
| Sodium: | water regulation and balance |
| Potassium | nerve impulse transmission, muscle contraction, plasma, acid-base balance |
| Calcium | muscle activity, blood coagulation |
| Magnesium | nerve impulse transmission, muscle contraction |
| Phosphate | ATP production |
| Chloride | hydrochloric acid production, acid-base balance |
| Bicarbonate | Acid-base balance |
| Why is bicarbonate necessary for acid-base balance? | buffer that neutralizes excess acids in the body, helps regulate acid-base balance |
| Nonelectrolytes | amino acids (proteins), glucose, and fatty acids remain bound together when dissolved in body fluid |
| What is the normal circulating blood volume? What is it composed of? | 4-6L erythrocytes - 44% platelets/leukocytes - 1% plasma 55% |
| Why is increased production of ADH a compensatory response? | because volume is decreases, urinary output will be decreased |
| Signs/symptoms of dehydration: | thirst, weakness, dizziness, postural hypotension, decreased urine production, concentrated urine, dry cracked lips, dry mucous membranes, thick saliva, dry scaly skin, poor tissue turgor, flat neck veins, increased bpm, weak, thready pulse, high temp |
| Signs of fluid volume excess: | weight gain, crackles in the lungs, slow bounding pulse, elevated blood pressure, possibly edema |
| Why is the pulse rate increased with dehydration? | decreased fluid/plasma volume |
| Why is the blood pressure increased with fluid volume excess? | increased fluid/plasma volume |
| Hyponatremia causes: | sodium deficit, can be from decreased sodium or increased water intake and retention -may be caused by excessive vomiting and diarrhea |
| Hypernatremia causes: | sodium excess, commonly from water loss from fever or respiratory infection |
| Hypokalemia causes: | excess potassium or loss of body water -may be from poor diet, vomiting, diarrhea, excessive sweating, diuretic therapy |
| Hyperkalemia causes: | occurs with burns, crash injuries, uncontrolled diabetes mellitus, renal failure |
| Hypocalcemia causes: | nutritional deficiency of calcium or vitamin D or in bone disorders such as metazoic cancer of the bone |
| Hypercalcemia causes: | most cases related to hyperparathyroidism or malignancy such as multiple myeloma |
| Hypomagnesemia causes: | malabsorption, malnutrition, renal tubular dysfunction, thiazide diuretic, extensive gastric suction, or diarrhea |
| Hypermagnesemia causes: | occurs only in presence of renal failure |
| Hypochloremia cause | low chloride level associated with hyponatremia |
| Hyperchloremia cause | high chloride level occurs along with hypernatremia and a form of metabolic acidosis |
| Hypophosphatemia causes: | may result from aluminum containing antacids, vitamin D deficiency, or hyperparathyroidism |
| Hyperphosphatemia causes: | occurs in renal failure |
| Balance between bicarbonate and carbonic acid | carbonic acid retained or removed by respiratory system bicarbonate retained or removed by kidneys |
| Control mechanisms: Blood buffer system | consists of weak acids and weak bases |
| Control mechanisms: Lungs | carbon dioxide and water are expired from the lungs |
| Control mechanisms: Urinary system | enzymes promote the dissociation of carbonic acid to free hydrogen ions |
| Increases carbon dioxide levels cause: | airway obstruction, pneumonia, asthma, chest injuries, opiate intake, chronic obstructive lung diseases |
| Excessive loss of bicarbonate ions caused by: | kidney disease, diabetic ketoacidosis, circulatory failure, shock states |
Created by:
ahoyyitbeaddi
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