Acid Base, Fluids, and Electrolytes 2
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| Carbonic acid mixes with __ and is expelled by the lungs. | carbon dioxide
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| Carbonic acid concentration is controlled by? | excreting carbon dioxide by exhaling.
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| In __, our pH is low and so our body tries to buffer it by doing deep breathing and increased respiratory rate. | acidosis
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| The two physiological buffers in the body are? | The lungs and the kidneys.
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| Hyponatremia | lower-than-normal concentration of sodium in the blood (serum), which can occur with a net sodium loss or net water excess.
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| Hypernatremia | a greater-than-normal concentration of sodium in ECF that can be caused by excess water loss or an overall sodium excess.
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| When the cause of hypernatremia is increased aldosterone secretion, sodium is | retained and potassium is excreted.
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| When hypernatremia occurs, the body conserves | as much water as possible through renal reabsorption.
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| Hypokalemia | one of the most common electrolyte imbalances, in which an inadequate amount of potassium circulates in ECF.
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| Hypokalemia affects | cardiac conduction and function.
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| The most common cause of hypokalemia is? | vomiting and the use of potassium-wasting diuretics.
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| Hyperkalemia is | a greater-than-normal amount of potassium in the blood.
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| Severe hyperkalemia produces | marked cardiac conduction abnormalities (see Table 41-3).
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| The primary cause of hyperkalemia is | renal failure, because any decrease in renal function diminishes the amount of potassium the kidney can excrete.
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| Hypocalcemia represents | a drop in total serum and/or ionized calcium and results from illness, which directly affects the thyroid and parathyroid glands or renal insufficiency (in which the kidneys' inability to excrete phosphorus causes the phosphorus level to rise and the calc
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| Signs and symptoms of Hypocalcemia are often related to | diminished function of the neuromuscular and cardiac systems.
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| Hypercalcemia is | an increase in the total serum concentration of calcium and/or ionized calcium.
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| Hypercalcemia is frequently a symptom of an underlying disease such as | hyperpara thyroidism or neoplasm, resulting in excess bone reabsorption with release of calcium.
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| In alkalosis, our pH is high and so our lungs attempt to compensate by | shallow breathing to retain carbon dioxide (hypoventilate) so as to keep some of the acids.
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| In acidosis, you will see higher __ levels | potassium
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| A person with alkalosis will be | Hypokalemic because their body is retaining the potassium ions - Hydrogen ions are moved out of the cell and into the body, but has to absorb potassium to do so.
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| Chemical buffer system | Carbonic acid and bicarbonate buffer system
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| Biological buffer system | Occurs when hydrogen ions are absorbed or released by cells.
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| Physiological buffer system | In lungs and kidneys Kick in before chemical does – our respiratory rate increase to blow off more CO2 or slows to retain CO2 to maintain proper pH. Kidney regulation is slow and takes hours or days to kick in.
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| ABG Interpretation | We look at pH to see if it is high or low, identify the cause, and then see if they body is attempting to compensate.
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| What are the signs of hypovolemic? | Confusion, low BP (postural hypotension), dizzy - fluid volume deficit - heart rate will go up to compensate & urine output would decrease (Oliguria - urine output less than 400 mL in less than 24 hours) Dehydration, weak pulse.
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| What causes hypervolemia? | Renal failure, heart failure, problems with liver like cirrosis, increased aldosterone production, increase sodium intake, water intoxication.
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| Symptoms of hypervolemia? | Increased weight, edema – especially in dependent areas, fluid in the lungs, JVD, rhales, blood pressure increase – hypertension – Polyuria.
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| The fluid in the specialized cavities is sometimes referred to as | transcellular fluid.
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| In the blood vessels, hydrostatic pressure is the blood pressure generated by the | contraction of the heart.
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| ___ is the major force that pushes water out of the vascular system at the capillary level. | Hydrostatic pressure
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| Oncotic pressure | (colloidal osmotic pressure) is osmotic pressure exerted by colloids in solution.
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| The major colloid in the vascular system contributing to the total osmotic pressure is __ | protein. Protein molecules attract water, pulling fluid from the tissue space to the vascular space.
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| Water deficit (Increased ECF osmolarity) is associated with symptoms that result from | cell shrinkage as water is pulled into the vascular system. Ex - neurologic symptoms are caused by altered central nervous system (CNS) function as brain cells shrink.
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| Decreased ECF osmolality (water excess) develops as the result of | gain or retention of excess water. Cells swell. Symptoms are neurologic as a result of brain cell swelling as water shifts into the cells.
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| Under hypothalamic control, the __ releases ADH, which regulates water retention by the kidneys. | posterior pituitary
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| Other factors that stimulate ADH release include | stress, nausea, nicotine, and morphine.
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| It is common for the postoperative patient to have a lower serum osmolality after surgery, possibly because of the | stress of surgery and narcotic analgesia.
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| Causes of SIADH include | abnormal ADH production in CNS disorders (e.g., brain tumors, brain injury) and certain malignancies (e.g., small cell lung cancer).
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| The inappropriate ADH causes | water retention, which produces a decrease in plasma osmolality below the normal value and a relative increase in urine osmolality with a decrease in urine volume.
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| The patient with diabetes insipidus exhibits | extreme polyuria and, if the patient is alert, polydipsia (excessive thirst).
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| While ADH affects only water reabsorption, glucocorticoids and mineralocorticoids secreted by the adrenal cortex help regulate both | water and electrolytes. (e.g., cortisol) primarily have an antiinflammatory effect and increase serum glucose levels, whereas the mineralocorticoids (e.g., aldosterone) enhance Na retention and K+ excretion.
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| Aldosterone is a mineralocorticoid with potent __-retaining and potassium-excreting capability. | sodium
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| The secretion of aldosterone may be stimulated by | decreased renal perfusion or decreased sodium delivery to the distal portion of the renal tubule. - The kidneys respond by secreting renin into the plasma.
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| Angiotensinogen, produced in the liver and normally found in blood, is acted on by the renin to form angiotensin I, which converts to angiotensin II, which stimulates the __ to secrete aldosterone. | adrenal cortex
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| The __ are the site for the actions of ADH and aldosterone. | renal tubules
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| Atrial natriuretic peptide (ANP) are produced in response to | increased atrial pressure (increased volume) and high serum sodium levels.
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| ANP suppress secretion of | aldosterone, renin, and ADH, and the action of angiotensin II and promote excretion of Na & water, resulting in a decrease in blood volume and BP.
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| Only __ is lost by insensible perspiration. | water – not electrolytes
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| Dehydration refers to loss of | pure water alone without corresponding loss of sodium.
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| Signs and symptoms of ECF volume excess and deficit are reflected in changes in | bp, pulse force, and jugular venous distention.
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| In fluid volume excess, the pulse is __ | full and bounding
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| Severe fluid volume deficit can cause a ___ pulse | weak, thready - easily obliterated and flattened neck veins.
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| Severe, untreated fluid deficit will result in | shock
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| ECF excess results in | pulmonary congestion and pulmonary edema as increased hydrostatic pressure in the pulmonary vessels forces fluid into the alveoli.
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| Sodium is the primary determinant of __ osmolality. | ECF
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| The __ are the primary regulator of sodium balance. | kidneys
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| The kidneys regulate the ECF concentration of sodium by excreting or retaining water under the influence of | ADH.
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| Hypernatremia causes __osmolality | hyper
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| ECF hyperosmolality causes a shift of water | out of the cells, which leads to cellular dehydration.
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| A deficiency in the synthesis or release of ADH from the posterior pituitary gland (central diabetes insipidus) or a decrease in kidney responsiveness to ADH (nephrogenic diabetes insipidus) can result in profound | diuresis resulting in a water deficit and hypernatremia.
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| Examples of sodium gain include | iv administration of hypertonic saline or sodium bicarbonate, use of Na-containing drugs, concentrated enteral tube feedings, excessive oral intake of Na (ingestion of seawater), and primary aldosteronism (hypersecretion of aldosterone) caused by a tumor
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| Patients with hypernatremia will also exhibit the symptoms of any accompanying ECF volume deficit, such as | postural hypotension, weakness, and decreased skin turgor.
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| Potassium (K+) | Most found inside the cells - major intracellular cation. Most frequent imbalance. 3.5 – 5.0 (or 5.5) mg/dL.
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| Potassium is important because it is used for | muscle, cardiac function, heart potential conduction.
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| Sodium/Potassium pump – each cell has to control sodium and potassium levels – removes 3 sodium ions for each potassium. Fuled by ATP. Also for acid/base imbalance. | (blank)
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| Hyperkalemic | above 5.0 or 5.5 – Kidney failure is number 1 reason because it cannot remove potassium when not working – burn/crush injuries – rapid transfusion.
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| What moves out of the cell when hydrogen atoms move in? | potassium – results in hyperkalemia.
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| Hypokalemic | below 3.5 – sweating, diuretics, vomiting – Mg deficiency may contribute to this – laxative abuse, vomiting.
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| Metabolic alkalosis can cause a shift of potassium | into cells in exchange for hydrogen, thus lowering the potassium in the ECF and causing symptomatic hypokalemia.
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| __ muscle function is also altered by hypokalemia. | Smooth
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| About two thirds of hypercalcemia cases are caused by | hyperparathyroidism and one third are caused by malignancy, especially from breast cancer, lung cancer.
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| Manifestations of hypercalcemia include | decreased memory, confusion, disorientation, fatigue, muscle weakness, constipation, cardiac dysrhythmias, and renal calculi.
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| Trousseau's sign refers to | carpal spasms induced by inflating a blood pressure cuff on the arm – hypocalcemia.
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| Chvostek's sign is | contraction of facial muscles in response to a tap over the facial nerve in front of the ear – hypocalcemia.
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| Magnesium is regulated by | GI absorption and renal excretion.
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| Hypermagnesemia | Too much magnesium – renal insufficiency – letharegy, drowsiness, nausea and vomiting, loss of deep tendon reflexes, cardiac arrest.
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| Hypomagnesemia | Too little mg – diuretics, fasting, starvation, high glucose levels due to diabetes mellitus – confusion, hyperactive tendon reflexes, seizures, cardiac dysrhythmias – can be confused with hypocalcemia.
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| Respiratory acidosis | occurs when PCO2 is high (greater than 45) and your pH is low. Occurs when CO2 is retained. Typically occurs when we hypoventilate – COPD – don’t have great chest expansion and cannot blow off the CO2 that they need to.
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| Atalectasis – interference in the alveoli that cause impairment of the gas exchange. This causes retention of CO2 and respiratory acidosis. | (blank)
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| What is a fix for respiratory acidosis? | increase rate and depth to blow off more CO2. Kidneys help by eliminating hydrogen ions out of the body. Mechanically ventilating them to get the carbon dioxide out helps. Supplemental oxygen can help. Adequate fluid intake helps to liquefy the secreti
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| Causes of Respiratory Acidosis | hypoventilation because they can’t exhale and get the acid out of their system: COPD, emphysema, pain, Atelectasis, asthma, common in post-op patients because they aren’t coughing it out, one of the nursing interventions we do is to cause them to take nic
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| Signs and symptoms of respiratory acidosis | Respiratory depth and rate would increase to hyperventilate to blow of carbon dioxide, get drowsy, potassium levels get too high, confusion, due to hyperkalemia we would see tachycardia and you would see irregular rhythms.
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| Respiratory alkalosis | pH is high and PCO2 is low – blowing off too much carbon dioxide. Hyperventilating. Anxiety, infection.
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| Signs and symptoms of respiratory alkalosis | rapid, shallow breathing - hypoventilation, decreased potassium, pH high, shallow breathing, confusion, hypokalemia which would cause bradycardia, headache,
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| How to fix respiratory acidosis | blow into a paper bag in order to retain carbon dioxide. Deficiency of carbonic acid and a decrease of hydrogen ions that results from accumulation of base.
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| Causes of respiratory alkalosis | Hyperventilation because we are blowing of CO2, hysteria and anxiety, over-ventilated on a ventilation machine, hypoxia. Body tries to hypoventilate in order to retain carbon dioxide and acids.
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| Metabolic acidosis | our pH is less than 7.35 and our bicarb (HCO3) is low (less than 22). Occurs when acids other than carbonic acid accumulate in our fluids. renal failure because they cannot eliminate the waste products.
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| How body tries to compensate for metabolic acidosis | through Kussmal’s respirations – by blowing off acids. Diabetic Ketoacidosis. Confusion can occur.
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| What causes metabolic acidosis? | When acids accumulate in our extracellular fluids - Renal failure because kidneys cannot excrete, malnutrition which leads to build up of ketones in our body, DKA – Diabetic Ketoacidosis. Ketones are acid products.
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| Signs and symptoms of metabolic acidosis | confusion, Kussmaul’s because their trying to blow off acids, potassium levels would increase because the body is acidotic and the body will try to accommodate by moving potassium out of the cell to pull in hydrogen ions.
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| Metabolic alkalosis | high pH (more than 7.45) and bicarb high - excessive vomiting will do this and diarrhea, nasal gastric (NG) tube suctioning, diuretics because as we lose water, we lost hydrogen ions.
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| Signs and symptoms of metabolic alkalosis would be | shallow breathing (hypoventilating), Decreased levels of hydrogen ions in system, repiratory rate would decrease, potassium would go down and we would be Hypokalemic.
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