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NUR 104- Chpt 37
Fluid & Electrolytes
| Question | Answer |
|---|---|
| What does the hormonal regulation of fluid, electrolytes, and acid base balance consist of? | -Hypothalamus -ADH -RAAS (renin angiotensin aldosterone system) -natriuretic peptide hormonal system |
| What is the purpose of the hypothalamus? | makes you thirsty synthesizes ADH |
| What does ADH do? | stops fluid from being lost (causing retention) so the body reabsorbs H2O |
| If you have an increase in fluid loss or a decrease in fluid intake, what happens to Osmolarity? Thus causing? Which then causes what? | -Increases -ADH to release into circulation -more water reabsorbed in the kidneys (thus decreasing urine output) |
| If you have a decrease in fluid loss or an increase in fluid intake, what happens to Osmolarity? Thus causing? Which then causes what? | -decreases -ADH blocked from being released into circulation -less water reabsorbed in the kidneys (thus increasing urine output) |
| ADH is sent out based on what? | Osmolarity of blood |
| What is Osmolarity? An increase in osmolarity means what? | -Solute concentration in the blood -a fluid volume deficit (blood flows slower) |
| The RAAS cycle is activated in response to what? | blood volume |
| IF the blood volume drops what is the first step of the RAAS cycle? | Renin is released from kidneys and stimulates the release of Angiotensin I |
| When Angiotensin I is released in response to a blood volume drop, what happens next? | Angiotensin I quickly converts to Angiotensin II (potent vasoconstrictor) Angiotensin II causes vasoconstriction, thus increasing the blood flow so that it will flow faster. |
| Once Angiotensin II responds to a blood volume drop by vasodialating, what happens next? | Angiotensin II stimulates the secretion of aldosterone (helps retain Sodium in the kidneys, therefore retains H2O also) This pulls in H2O from the tissues to balance fluid volume |
| The Natriuretic peptide hormone system is excreted from where? why? | -Heart muscle -increase fluid volume |
| If high fluid volume pressure in increased on the heart what happens? | -ANP (atrial natriuretic peptide) is released, thus causing sodium excretion (and H2O goes with via urine, perspiration, etc |
| IF low fluid volume pressure, there is no pressure on the heart, what happens? | ANP is not released thus causing Sodium retention (H20 stays in) |
| If Carbon Dioxide combines with water it becomes what? | ACID- Carbonic Acid H2CO3 |
| Increased H+ = more_____ Decreased H+ = less ______ | -acidic -acidic |
| Increased CO2= more _____ Decreased CO2= less _____ | -acidic -acidic |
| Since Bicarbonate is a base (buffer) What happens if we increase HCO3-? What if we decrease HCO3-? | -more alkaline -less alkaline |
| Carbon Dioxide, Hydrogen, and Bicarbonate are all contolled by what systems? | Repiratory and Renal |
| A patient has been vomiting for 4 days. What type of acid base balance is this. | -Metabolic (not respiratory) -alkalosis |
| Nursing student begins to hyperventilate while taking his final exam. What type of acid base imbalance is this? | -Respiratory -Alkalosis (bc exhaling CO2 quickly-expelling acid) |
| A 79 year old pt experiencing renal failure. What type of acid base imbalance is this? | -Metabolic (not respiratory) -Acidosis (losing bicarbonate-making it more acidic) |
| A 19 year old pt overdoses on Oxycontin, a narcotic. What type of acid base imbalance is this? | -Repiratory (narcotics slow respirations) -acidosis (slowly expelling CO2-acid) |
| pH 7.48, PaCO2 36 mmHg, HCO3- 32mEq/L | -Metabolic -alkalosis |
| pH 7.32, PaCO2 47 mmHg, HCO3- 25mEq/L | -Repiratory -acidosis |
| If a patient has diarrhea, they are getting rid of what? | HCO3- (bicarb) |
| If a patient is vomiting, they are getting rid of what? | acids |
| How does the body compensate for Acid Base imbalances? | If its a respiratory problem, kidneys compensate by regulating HCO3- If its a metablic problem, respiratory system compensate w/ CO2 |
| How will the body compensate for severe diarrhea? | -metabolic acidosis -resp sys will try to fix bc of low pH, thus increasing breathing to get rid of CO2 (acid) |
| How will the body compensate for Repsiratory weakness | -respiratory acidosis (retaining C02) -renal tries to fix by retaining bicarb (HCO3-) |
| How will the body compensate for Starvation? | -metabolic acidosis (pH level is lower) -resp sys will try to fix by increasing respirations to get rid of acid (CO2) |
| An increase or decrease of sodium from the norm can cause what? What type of assessment would you do? | neuroligical problems neuro focused assessment |
| An increase or decrease in potassium causes what? What type of assessment would you do? | -cardiac porblems -cardiac focused assessment |
| If potassium is increase, what happens to glucose? If potassium is decreased what happens to glucose? | -decreases -increases |
| An increase of decrease in Calcium causes what? What type of assessment would you do? | -muscular problems -muscular focused assessment |
| If you have hypercalcemia, what type of reflexes would you have? | hyporeflex |
| If you have hypocalcemia, what type of reflexes would you have? | hyperreflex (seizure, tetany) |
| Chvostek's sign | tap on face, it will twitch if hypocalcemic |
| Trousseau sign | tighten bp cuff, hand tightens if hypocalcemic |
| If calcium levels are increased, what happens to phosphorous levels? If calcium levels are decreased, what happens to phosphorous levels? | -decrease -increase |
| What does a BMP (basal metabolic panel) measure? | electolyte levels (Na, K, CL, O2) |
| What does a CMP (complete metabolic panel) measure? | electrolyte levels but more detailed with BUN, albuin, creatinine, etc |
| What does Urine specific Gravity measure? | concentration of urine solutes the higher the number, the more concentrated the lower the number, the less concentrated |
| What are some nursing diagnoses related to Fluid, Electrolyte, Acid Base balance? | 1. Deficient Fluid Volume 2. Excess Fluid Volume 3. Risk for deficient fluid volume 4. risk for imbalance of fluid volume 5. ECF volume excess/ deficit 6. water excess/deficit 7 fluid volume deficit 8 fluid volume excess 9 risk for electrolyte i |
| An isotonic solution has -normal saline (.9% Na CL) -LR (lactated ringers) (volume expanders) -D5 .25% Na CL So if the numbers increase, what type of solution is it? If the numbers decrease what type of solution is it? | -hypertonic -hypotonic |
| Vascular fluid is located where? | inside blood and lymph vessels |
| Interstitial fluid is located where? | between cells |
| Intracellular fluid is located where? | in cells |
| extracellular fluid is what? | includes intravascular and intersitial fluid (not in cells) |
| What is the difference in hydrostatic pressure and osmotic pressure? | hydro-outward pressure osmotic- inward pressure |
| If hydrostatic pressure is 32 mm Hg and osmotic pressure is 22 mm Hg filtration is + 10mm what does this mean? | since this is + fluid filters OUT of the vessel into interstitial fluid |
| If hydrostatic pressure is 12 mm Hg and osmotic pressure is 22 mm Hg filtration is -10 mm What does this mean? | since this is - fluid filters FROM interstitial fluid |
| Hypovolemia, saline deficit, or isotonic dehydration indicate what? | ECF volume deficit |
| Often people with caridac failure or renal failure or liver disease have what type of fluid volume? | ECF volume excess |
| Hyperosmolarity is AKA? | Water Deficit |
| Hypoosmolarity is AKA? | Water Excess |
| You have someone with increased blood sugar. You want to move fluids from cells to vasculature. 3%NaCl, 5% NaCl, D5 .45% NaCl, D5 .9% NaCl The nurse know that what type of IV fluid will be used in this situation? | Hypertonic |
| You have somewone with tissue that looks dry and wrinkly with poor skin turgor, they need more fluid. .45% NaCl The nurse knows that what type of IV fluid will be used in this situation? | Hypotonic |
| If you assess an irregular heartbeat, what in terms of elecrolytes is going on? | potassium issue |
| What is the most critical volume imbalance? Why? | -ECF deficit -leads to low BP, shock, death |
| What are some signs and symptoms of ECF deficit? | -weight loss -thirst -weak rapid pulse |
| How would you treat an ECF deficit, oral or IV replacement of what???? give an example of what to give a patient orally. Give an example of what to give a patient via IV. | -sodium, chloride, H20 in the same concentrations as found in body fluid -tomato juice -normal saline |
| What are signs and symptoms of ECF excess? | -rapid weight gain -increased BP -bounding pulse -full thickness neck veins |
| How can ECF excess cause pulmonary edema? And characterized by? | -by filtering across the alveoli into the lungs -dyspnea, orthopnea, crackles/rales |
| How would you treat ECF excess? | -low sodium diet -administer diuretics |
| Any solution that has a higher osmotic pressure than another solution (draws fluid out of the cell and into the extra cellular space) | hypertonic solutions |
| Any solution that has a lower osmotic pressure than another solution (pushes fluid into the cell) | hypotonic solution |
| Any solution that has the same osmotic pressure as another solution (fluid flows in and out equally) | isotonic solution |
| A patient comes into the ER after a motor vehicle accident. Respirations are 6, shallow but slow breathing. The nurse anticipates what type of acid base imbalance? | Respiratory Acidosis (breathing is slow, therefore less CO2 (acid) being expelled, therefore its being retained causing an acidic enviornment |
| A patient has COPD and is breathing fast and shallow, 32 respirations. The nurse anticipates what type of acid base imbalance? | Respiratory Alkalosis-the pt is breathing fast, therefore they are expelling CO2 (acid) therefore its making an alkolitic enviornment. |
| Used to replace extracellular fluid & electrolyte losses and to expand vascular volume quickly | Isotonic IV fluids |
| Used to prevent or treat cellular dehydration by providing free H20 to cells or to restore renal function | Hypotonic IV fluids |
| Pulls excess fluid from the celss, treatment is for very specific problems | Hypertonic IV fluids |
| Which IV fluid requires frequent monitoring of vitals and level of consciousness? | Hypotonic IV fluids |
| If you have an isotonic solution and you remove solutes, what does this do to osmolarity? Causing what? | -decreases it -Hypotonic Solution |
| If you have an isotonic solution and you add solutes, what does this do to osmolarity? Causing what? | -increases it -Hypertonic Solution |
Created by:
jessicaspring
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