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Pharm1 Chapter26D
Pharm1 Chapter26 Dawn
| Question | Answer |
|---|---|
| What is a substance in a solution that diffuses through a semipermiable membrane called? | Crystalloid |
| Dehydration is typically accompanied by an imbalance in which essential electrolyte concentrations? | Sodium, potassium, and chloride |
| What is a difference in the concentration of a substance on two sides of a permiable barrier called? | gradient |
| What is hypernatremia? | Abrnormally high sodium. Usually caused by defective renel excretion, but more commonly from aggressive therapy. |
| What is hyponatremia? | Not having enough sodium. Caused by too much water (either not urinating enough or too much water intake) |
| What is the major extracellular cation? | Sodium |
| What is the major intracellular cation? | potassium |
| What is hypokalemia? | Not enough potassium in the bloodstream. |
| What is the usual cause of hyperkalemia? | High sodium concentration in the blood is usually caused by defective renal function, but can also be due to excessive dietary potassium. |
| What are the 3 major solid components of the blood? | erythrocytes (red blood cells), leukocytes (white blood cells), and platelets |
| What is an interstice? | A small space within a tissue |
| How does the term "isotonic" relate to osmotic pressure? | If the solutions on either side of a semipermiable membrane are isotonic (because they have equal concentrations of solutes), then they are exerting the same osmotic pressure against each other. Isotonic means equal osmotic pressure. |
| Osmotic pressure defined? | The pressure exerted on a semipermiable membrane separating a solution from a solvent; the membrane being impermeable to the solutes in the solution and permeable to only the solvent. |
| Where is plasma located, and what does it consist of? | It's found in the blood and the lymph. It contains leukocytes,erythrocytes, and platelets. |
| What is the clear, cell free portion of blood from which fibrinogen also has been separated from during the clotting process, as typically carried out with a lab sample? | serum |
| What % of the adult human body is water? And how is that water divided up in the body? | 60%--referred to as Total Body Water (TBW) Intracellular fluid (ICF) 67%, Interstitial fluid (ISF) 25%, and plasma volume (8%) |
| If the point of reference is the cells, how is TBW divided, and what are the volumes? | It's divided into Intracellular and Extracellular fluid, and there's appx 28,000 mL (ICF) and 14,000 mL (ECF, which includes plasma and interstitial fluid) for a total of 42,000 mL for a 70 kg man with 60% body weight. |
| If the point of reference is the blood vessels, how is TBW divided, and what are the volumes? | Intravascular fluid(ISF) or plasma volume(PV)- 3,500 mL. Extravascular fluid (EVF)--38,500 mL. for a total of 42,000 mL for a 70 kg man with 60% body weight. |
| What does the prefix "-inter" mean? | between |
| Name four examples of extravascular fluid (EVF)? | Lymph, cerebrospinal fluid, ISF, and ICF |
| What keeps the fluid inside the blood vessels? | The concentration of plasma proteins in the blood. Fluid flows from the area of low protein concentration in the interstitial compartment to the area of high concentration in the blood vessel to try and creat and isotonic environment. |
| What prevents the leakage of too much plasma through the capillaries into the tissues? | the protein in the blood vessels that exerts a contant osmotic pressure that prevents the leakage |
| Why is the balance of fluid and electrolytes so critical? | the regulation of the volume and the composition of body water is essential for life b/c it is the medium in which all metabolic reactions occur |
| What is the principal extracellular electrolyte? | Sodium |
| Where is water lost from in the initial stages of dehydration? | The extracellular compartments |
| Hyperonic Dehydration is caused by what? And what is it? | CELLULAR DEHYDRATION:When water loss is greater than sodium loss so there is a higher concentration of solutes outside the cells. Fluid leaves the cells making the cells dehydrated. CAUSED BY: Sweating b/c of elevated temp. |
| Hypotonic Dehydration is caused by what? And what is it? | EXTRACELLULAR DEHYDRATION: When sodium loss > water loss, resulting in higher concentrations of solute inside the cells, thus pulling fluid from outside the cells into the cells. CAUSED BY: Renal insufficiancy and inadequate aldosterone secretion. |
| Isotonic dehydration is caused by a loss of sodium and water from the body, resulting in a loss of extracellular fluid. What causes it? | Diarrhea and vomiting. |
| What symptoms are associated with: Bleeding? | Tachycardia and hypotension |
| What symptoms are associated with: Bowel obstruction? | Reduced perspiration and mucous secretions |
| What symptoms are associated with: Diarrhea? | Reduced urine output (oliguria) |
| What symptoms are associated with: Fever? | Dry skin and muccous membranes |
| What symptoms are associated with: Vomiting? | Reduced lacrimal (tears) and salivary secretions |
| When fluids need to be replaced, what are your 3 basic options? | Crystalloids, colloids, and blood products |
| When are isotonic solutions typically used? | They are normally used to change extracellular volume in pt's experiencing blood loss, severe vomiting, or any condition that leads to a chloride loss equal to or greater than the sodium loss. |
| What does 5% dextrose in water (D₅W) do when mixed with RBCs? | It causes hemolysis. |
| What should be assessed before administering fluids/electrolytes? | Double check the order, the chart, make sure it makes sense, remember the 5+ rights, medication history, medical hx esp Gi, renal, cardiac, and hepatic. Dietary history. Fluid volume and electrolyte status. The PTs current hydration status. |
| When should a PTs Tartrazine sensitivity be checked? | When they are on potassium chloride and have a sensitivity to aspirin there is risk for cross-sensitiviy. |
| When should potssium supplementation be avoided or used with extreme caution? | When the PT is taking ACE inhibitors or potassium sparing diuretics (such as spironolactone) as these drugs are associated with adverse effects of hyperkalemia and worst case scenario could lead to sever cardiac compromise and possible cardiac arrest. |
| What are some important factors to consider for peripheral venous access when giving meds via iv? | 1. try to use distal veins first. 2. Know the purpose of using potassium and other electrolytes. 3. Set rate as ordered. 4. Know the anticipated duration of tx. 5. Assess overall condition of veins. 6. Know restrictions imposed by the pts history |
| What may happen if hyponatremia is treated to quickly and leads to hypernatremia? | Fluid overload, edema, worsening of HF, dypnea, and rales, hydration status of skin and moucus membranes, and level of consciousness |
| Who is at risk for hypernatremia? | The elderly, those with renal and cardiovascular diseases, PTs receiving sodium supplements, or with increased sodium intake, and those with decreased fluid intake. |
| What are the signs of an adverse reaction that must be watched for when giving blood components? | Fever and chills, and blood in the urine--both are signs of an adverse reaction. Apprehension, restlessness, flushed skin, increased pulse and respiration rate, dyspnea, rash, joint or lower back pain, swelling, nausea, weakness, and jaundice. |
| What are the adverse effects of colloids? | They can alter the coagulation system, which results in impaired coagulation and possibly bleeding. They have no oxygen-carrying ability and contain no clotting factors. |
| A pt has been "on some sort of fad diet," admits to using laxatives and eating very little in the past few weeks. They are tired and weak. What electrolyte imbalace is the pt probably experiencing? | The pt shows early signs of hypokalemia. Other signs of hypokalemia include: alkalosis, inc secretion of mineralcorticoids (from the adrenal cortex), corticosteroids, diahrrea, hyperaldosteronism, ketoacidosis, lg amnts of licorice, and vomiting. |
| What are the disadvantages of using crystalloids? | Fluids can leak out of the plasma into the cells, which resuls in edema. They may dilute plasma proteins, r/i lower colloid oncotic pressure (COP), & dilute erythrocyte concentration, r/i decreased oxygen tension. Lg. volumes are needed to be effective. |
| Which iv fluid is brown? | Albumin |
| What are the signs to look for that would indicate iv infiltration? | swelling, cool to the touch around the iv site, no or decreased flow rate and no blood return from iv catheter |
| What are the s/s of thrombophebitis, which can happen with the administration of meds/fluids by iv? | swelling, redness, heat, and pain at the site |
| Which electrolyte, when taken orally, is a known ulcerogenic? | potassium--always educated pts to take with food or a snack |
| What is the minimum daily requirement for potassium for adults, infants? | between 40 and 50 mEq and 2 to 3 mEq/kg of body weight for infants |
| What foods should a hyperkalemic pt avoid? | bananas, OJ, dried apricots, salt substitute (KCl), potatos, lentils, fish, chicken, turkey, ham, beef, and milk.--however if the pt is HYPOkalemic recommend these foods. |
| What is the salt customarily used in iv solutions for potassium? | Potassium chloride |
| What is undiluted potassium associated with? | cardiac arrest |
| Would you ever administer potasium via IV bolus or iv push? | Hell no, unless of course you want to kill them. |
| What is Kayexylate used for? | to treat hyperkalemia |
| How should iv albumin be administered? | Slowly and cautiously and with careful monitoring to prevent fluid overload and HF. And remember to always give albumin at room temp. |
| S/S of hyponatremia (low sodium)? | lethargy, hypotension, stomach cramps, vomiting,diahrrea, and possibly seizures |
| S/S of HYPERnatremia (high sodium)? | red, flushed skin, dry, sticky mucous membranes; increased thirst, tempurature elevation, decrease or absence of urination |
| PTs taking potassium supplements should inform their doc right away if they experience what? | GI upset, abdominal pain, muscle cramps/ weakness, fatigue, or irregular heartbeat. Also be sure to advise pts of their many drug interactions: antacids, diuretics, and digitalis drugs. |
| What should you always advise your patients to tell you about their iv site? | It they experience any feelings of irritation (ie burning) at any time. |
| What is Chvostek's sign? What is it used for? | A neuromuscular test for hypocalcemia. It's done by tapping the face at a point just anterior to the ear and below the zygomatic bone w/blunt end of a reflex hammer. Positive response for hypercaclemia = twitching of the psilateral facial muscles. |
| What is Trousseau's sign? What's it used for? | A neuromuscular test for hypocalcemia. Elicited by inflating a (blood pressure cuff) for several minutes. Positive response = muscular contraction with flexion of the wrist and metacaprophalangeal jointrs, hyperextension of fingers |
| What is the major extracellular anion (negatively charged)? | Chloride |
| What pt's should not receive potassium? | pt's with renal disease, severe hemolytic disease, or Addison's disease and in those suffering from hyperkalemia, acute dehydration, or tissue breakdown stemming from multiple traumas |
| What may be used to treat thallium poisoning and to help increase muscular strength in myathenia gravis pts? | potassium |
Created by:
cspearsall
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