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N306 E4 F&E Part 1
N306 Fluid Balance, Electrolytes, Acid-Base [Ch 31] Pt 1
| Question | Answer |
|---|---|
| What type of ion is released by the lungs to help maintain the correct pH level in the body? | Carbon dioxide |
| Who has more water content: adults or peds? | Peds |
| Do fluids and molecules move easily cross between the ECF and ICF? | Water does, but NOT large molecules or ions |
| Excess fluid volume can lead to _____.(3) | HTN, CHF, and peripheral edema |
| Fluid volume depletion can lead to ______. (3) | dehydration and shock |
| intracellular space | contains water inside the cells |
| extracellular space | contains water outside the cells |
| Identify the 2 parts of the ECF. | intravascular space (fluid in the plasma); interstitial space (fluid between cells) |
| Adults have more fluid in the ______ and peds have more fluid in the ______. | Adults have more fluid in the ICF; peds more in the ECF |
| fluid balance | continuous exchange and mixing of fluids occurs between various compartments, which are separated by membranes |
| Describe the fluid movement within the capillary beds. | Constant movement of fluids between ECF fluids, interstitial and intravascular |
| Identify the 2 processes that govern the movement of large molecules and ions between compartments. | Diffusion and active transport |
| TRUE/FALSE: The older you get, the less water body weight. | TRUE |
| Identify the most important physiologic regulator of fluid intake. | Thirst mechanism |
| thirst mechanism | Osmoreceptors in the hypothalamus sense that the ECF has become hypertonic |
| Fluid intake must be ______ before reaching vascular compartment, due to ______> | must be absorbed; due to osmotic forces |
| How is water output achieved? (5) | Through the kidneys, lungs, skin, feces, sweat |
| intercellular | movement of fluid between cells |
| intracellular | movement of fluid inside cells |
| osmolality | concentration of particles (solutes) dissolved in fluid |
| Identify the three solutes that determine osmolality. | Sodium, glucose, and urea |
| tonicity | ability of a solution to cause change in water movement across a membrane due to osmotic forces |
| Normal plasma is considered ______. [hypertonic/hypotonic/isotonic] | isotonic |
| _____ solutions have the same concentration of solutes as plasma. | Isotonic |
| _____ solutions have a greater concentration of solutes than plasma. | Hypertonic |
| _____ solutions have a lesser concentration of solutes than plasma. | Hypotonic |
| If you give a hypotonic soln, where does the fluid go and how does it affect the cell? | Hypotonic: Fluid goes INTO THE CELL; makes the cell bigger; make them burst |
| If you give a hypertonic soln, where does the fluid go and how does it affect the cell? | Hypertonic: Fluid will move OUT OF CELL into the ECF; cells will shrink |
| Identify fluid loss through abnormal routes. (7) | Vomiting, NGT, bleeding, wounds, burns, 3rd space fluid accumulation (e.g. ascites), paracentesis |
| paracentesis | perforation of a cavity of the body or of a cyst or similar outgrowth, esp. with a hollow needle to remove fluid or gas |
| During what period is ADH released? | Periods of high osmolality |
| How are fluid deficit disorders treated? | oral of IV fluids |
| How are fluid excess disorders treated? | Diuretics |
| electrolytes | are minerals in your blood and other body fluids that carry an electric charge |
| Are electrolytes located in the ICF or ECF? | Both |
| What are sources of electrolyte intake? (3) | Diet, medications, blood tranfusion |
| Where are electrolytes absorbed? | GI tract |
| Can drug therapy cause electrolyte imbalance? | Yes |
| What affects electrolyte distribution? (4) | Medications, hormones, cells, bones |
| Identify 3 methods in which electrolytes are excreted. | Urine, feces, sweat |
| Aggressive therapy with loop diuretics can rapidly deplete _______ and _______. | sodium and potassium |
| hyponatremia | less salt in ECF, water excess in ECF |
| Hyponatremia causes ________. | water to move into cells, causing swelling of cells |
| What 3 process does sodium have a central role in? | Neuromuscular physiology, acid-base balance, overall fluid distribution |
| When sodium increases, osmolality _______. | increases |
| Identify early signs of hyponatremia. | n/v, anorexia, abdominal cramping |
| Identify late signs of hyponatremia. | altered neurological function, i.e. confusion, irritability, lethargy, convulsions, coma, muscle twitching, tremors |
| How is hyponatremia treated? | Oral or IV sodium chloride; or with IV fluids containing salt, e.g. normal salie or lactated ringer's |
| hypernatremia | more salt in ECF; less water in ECF |
| Hypernatremia causes ________. | Water moves OUT of cells leading to cellular dehydration and shrinkage |
| hypovolemic | of or relating to a decrease in the volume of circulating blood |
| hypervolemic | condition consisting of an increase in the volume of circulating blood |
| How do you treat a pt with hypernatremia who is hypovolemic? | Infuse hypotonic fluids such as dextrose 5% or 1/2 NS, which will increase plasma volume while reducing plasma osmolality |
| How do you treat a pt with hypernatremia who is hypervolemic? | Diuretics to remove sodium and fluid from the body |
| Edema is fluid _______. | between cells (interstitial compartment) |
| What conditions or diseases cause edema? (5) | Burns, CHF, cancer, lymphatic problems, liver problem |
| Clinical manifestations of edema include ________. (2) | puffy extremities, pitting edema |
| Treatment for edema is ________. | diuretics |
| What processes require potassium? (2) | Proper nerve and muscle functioning; maintaining acid-base balance |
| What organ will be majorly affected by high or low potassium? | Heart |
| hypokalemia | low potassium in the ECF |
| Identify the etiology/pathogenesis of hypokalemia. | Diet (low potassium intake) and use of loop diuretics |
| Both hyper- and hypokalemia are associated with ____________. | Fatal dysrhythmias and serious neuromuscular disorders |
| Why is adequate daily intake of potassium necessary? | Body does not have large stores of it |
| Identify the clinical manifestations of hypokalemia. | Muscle weakness, lethargy, anorexia, DYSRHYTHMIAS, IRREGULAR HEART BEAT, palpitations, cardiac arrest, HIGH/LOW HR [Note: Heart and muscle related] |
| Treatment for MILD hypokalemia includes _______. | Increase in dietary intake of potassium-rich foods |
| Treatment for moderate/severe hypokalemia includes _______. | Oral or parenteral potassium supplements |
| Why can't potassium be given IV push? | It will stop the heart |
| Why must IV doses of potassium be small and delivered through a pump? | Needs to be controlled because of effects on heart; potassium is irritating to veins, must check for phlebitis |
| phlebitis | inflammation of walls of a vein |
| hyperkalemia | high potassium in the ECF |
| Identify the etiology/pathogenesis of hyperkalemia. | Diet, medications (potassium sparing diuretics), CHF, renal failure |
| Identify the clinical manifestations of hyperkalemia. | DYSRHYTHMIAS, HEART BLOCK, fatigue, twitching, cramping, dyspnea |
| Identify the treatment option(s) for moderate/severe hyperkalemia. | Glucose and insulin; sodium bicarbonate (for concurrent acidosis); polystyrene sulfonate (Kayexalate) orally or rectally |
| Polystyrene sulfonate (Kayexalate) for treatment of hyperkalemia must be given concurrently with _______. Why? | laxative, such as sorbitol, to promote rapid evacuation of potassium |
| ______ or _______ may be administered to counteract potassium toxicity to the heart. | Calcium gluconate or calcium chloride |
| A pt is on digoxin and potassium is low, what is the nurse's first action? | Notify the doctor |
| hypocalcemia` | low calcium in the ECF |
| Identify the etiology/pathogenesis of hypocalcemia. | Insufficient intake or absorption, renal failure |
| Identify the clinical manifestations of hypocalcemia. | Neuromuscular excitability (tingling, spasms), intestinal cramping, MUSCLE AND BONE PAIN DUE TO SOFTENING |
| Identify the function(s) of calcium. | Metabolic processes, bone and teeth, hormone regulator, plasma membrane stability/permeability |
| Where does the body get calcium when the conc. is too low in the blood? | Blood will get calcium from bones, thus making them soft and eventually causing hypocalcemia |
| Identify calcium-rich foods. | Dairy products, milk, cheese, yogurt, fortified cereals/OJ, green leafy vegetables, sardines, soybeans |
| hypercalcemia | high calcium in ECF |
| Identify the etiology/pathogenesis of hypercalcemia. | DIET, excess vit D, cancer, endocrine problems, low phosphate |
| Identify the clinical manifestations of hypercalcemia. | KIDNEY STONES, impaired renal function, bone pain, cardiac problems, many nonspecific |
| ______ has an inverse relationship with ______. | PHOSPHATE has an inverse relationship with CALCIUM. |
| S/s of hypophosphatemia are the same as with ________. | hypercalcemia [Note: The inverse relationship] |
| hypophosphatemia | low phosphate in ECF |
| Identify the etiology/pathogenesis of hypophosphatemia. | Hypercalcemia, resp. alkalosis, s/t cancer, thyroid problems, renal impairment |
| Identify the clinical manifestations of hypophosphatemia. | Similar to hypercalcemia: KIDNEY STONES, impaired renal function, bone pain, cardiac problems, many nonspecific |
| hyperphosphatemia | high phosphate in ECF |
| Identify the etiology/pathogenesis of hyperphosphatemia. | Excretion problems, renal failure |
| Identify the clinical manifestations of hyperphosphatemia. | Similar to hypocalcemia: nerve/muscle function, irritability, confusion, possible resp. failure; Neuromuscular excitability (tingling, spasms), intestinal cramping, MUSCLE AND BONE PAIN DUE TO SOFTENING |
| hypomagnesemia | low magnesium in ECF |
| Identify the clinical manifestations of hypomagnesemia. | Diet, alcoholism, s/t heart disease, cancer, MSK probs |
| Identify the etiology/pathogenesis of hypomagnesemia. | DYSRHYTHMIAS, SEIZURE, TUMORS, MUSCLE WEAKNESS, |
| torsades de pointes | ventricular tachycardia that is characterized by fluctuation of the QRS complexes around the electrocardiographic baseline and is typically caused by a long QT interval |
| hypermagnesia | high magnesium in ECF |
| Identify the etiology/pathogenesis of hypermagnesia. | renal failure |
| Identify the clinical manifestations of hypermagnesia. | Cardiac problems (hypotension, bradycardia), muscle weakness, decreased reflex in deep tendons, |
Created by:
nikkirosety
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