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AcidBase CCC 105

AcidBase Ch 25 CCC PN105

Two largest constituents of body fluids water and electrolytes
Four main functions of water in body vehicle for transportation of substances to/from cells; perspiration evaporates to aid heat regulation; assist maintenance of H+ balance; medium for digestion enzyme action
Over half of the body's weight is _____ water
These 3 things vary the amount of water in the body age, sex, and health status
Adult male body is _____% water 60%
Adult female body is ____% water 50%
These people are more quickly and serioulsy affecty by minor changes in fluid balance resulting in rapid dehydration infants and the elderly
Infants and the elderly can rapidly become ______ due to faster and more serious affection of minor fluid balance changes dehydrated
How infant loses more fluids than adult through SKIN due to larger body surface compared to body weight and less effective KIDNEYS reabsorbing less fluid
Elderly people lose more fluids due to _____ diminished thirst sensation, decreased kidney output, decreased effectiveness of ADH
Dehydration causes hypovolemia (decreased volume of plasma)
Excess fluid in body causes hypervolemia (increased bolume of plasma)
What is most critical in maintaining homeostasis in body? water
Why is water most critical for maintaining homeostasis in body? cells cannot function and death results; it is the medium in which most metabolic and chemical reactions in the body take place
Sources of water into body oral fluids, food, metabolism
Sources of water loss from body urine, perspiration, feces, expired air
What are electrolytes? minerals or salts that are dissolved in body fluid that break into ion particles
Positively charged ion cation
Negatively charged ion anion
For each cation in fluid, there must be ____ an anion to maintain balance
Major source of electrolytes diet
Amount of circulating blood volume in body 4-6L
Any condition that alters body fluid volume also alters_______ plasma volume of blood and affects BP and circulation
Cells carried in plasma erythrocytes, leukocytes, and platelets
Nonelectrolyte products of metabolism proteins (amino acids), glucose, fatty acids
Two types of body fluids intracellular and extracellular
Three types of extracellular fluid intravascular, interstitial, and transcellular
Extracellular fluid (high in sodium content) 1/3 of total body water; transports water, nutrients, oxygen, and water to and from cells
Intravascular fluid fluid and plasma within blood vessels with large amounts of protein and electrolytes
Interstitial fluid (high in sodium content) fluid in spaces surrounding cells
Transcellular fluid saliva, cerebrospinal fluid, GI secretions, peritoneal fluid, urinary system fluids, lymphatic system fluids
Results of plasma moving from intravascular fluid to interstitial fluid blood volume drops and dehydration and hypovolemia occur
What mechanism helps control fluid balance in body? thirst mechanism in hypothalamus
Main organ through which fluid excretion is achieved? kidneys
Hormones affecting urine output ADH, aldosterone, and ANP
Types of passive transport diffusion, osmosis, filtration
Diffusion small substances move from high to low concetration until concentration is equal on both sides of membrane; "movement down a concentration gradient"
Osmosis liquid moves from low to high concentration until concentreation is equal on both sides via semipermeable membrane; essential to life of cells and water/electrolyte balance in body
Filtration forced movement of water and substances outward through semipermeable membrane; hydrostatic pressure within capillaries uses this to create pumping action
Isotonic solution water concentration of intracellular and extracellular fluids is equal
Hypertonic solution cells surrounded by solution with greater concentration than cells, cells dehydrate
Hypotonic solution cells surrounded by solution with less cencentration than cells, cells swell and overhydrate
Water passes freely across cell membranes by process of ______________ osmosis
Active transport require energy (ATP) to move molecules regardless of electrical charge or concentration gradient
_________ can move substances from area of low concentration to area of high contration active transport
Energy source for active transport ATP
Any patient over 65 is at risk for ____________ from electrolyte imbalance confusion
How illness affects fluid balance inability to injest food/liquids, intestinal absorption problems, kidney impairment affecting excretion/absorption, circulation problems, burns, open wounds
Consideration during sodium imbalances water will follow the sodium concentation is the highest
People at risk for deficient fluid volume unable to take fluids in sufficient quantities (impaired swallowing, weakness, coma); excessive loss of fluid (vomiting, diarrhea, homorrhage, sweating, wound drainage)
Treatment for dehydration fluid administration, either orally or IV
How to check turgor gently pinching up the skin over the abdomen, forearm, sternum, forehead, or thigh; dehydration present if skin stays elevated for several seconds
Turgor and the elderly not a good indication of dehydration
Signs/Symptoms of dehydration increaced Hct, dizziness, dark urine, decreased urine, dry mucous membranes, dry lips/tongue, dry skin, eleveated temp, fat neck veins when lying, increased pulse, poor turgor, postural hypotension, thick saliva, thirst, weak pulse, weakness
Causes of fluid volume excess (overhydration) IV fluids received too quickly, tap water enema, drink more fluids than can be eliminated, impaired elimination (renal failure), CHF, high sodium foods, septisemia
Signs/Symptoms of overhydration low Hct, weight gain, crackles in lungs, slow bounding pulse, elevated BP, edema, hypervolemia
Edema excessive accumulation of interstitial fluid
Where edema accumulates in ambulatory patients lower extremities
Where edema accumulates in bedridden patients sacral region
Dependent edema excess interstitial fluid concentrated in specific body region
Generalized edema excess interstitial fluid spread throughout body, more visible in face and hands
Causes of generalized edema kidney failure, heart failure, hormonal disorders of aldosterone and ADH
Local edema excess interstitial fluid caused by infestion or injury and results in inflammation
Edema treatment correct underlying cause and assist body to rebalance fluid content
Hyponatremia (sodium <135) excessive vomiting/diarrhea where fluids are replaced with plain water, CHF, liver disease chronic renal failure
Most common electrolyte imbalance hyponatremia
Average daily sodium intake 6-12 g/day
Patients more susceptible to hyponatremia elderly, thiazide diuretics, SSRI inhibitors, long-term care residents
Hypernatremia (sodium >145) excessive antacid use; more commonly water loss from fever, respiratory infection, diarrhea; restrict sodium intake
Hypokalemia (potassium <3.5) poor diet, illness, vomiting, diarrhea, GI suction, excessive sweating, diuretics
Hypokalemia falls below 2.5 possible cardiac arrest
Hyperkalemia (potassium >5.0) renal failure, overuse of diuretics, severe burns/crush injuries, salt substitutes, uncontrolled diabetes; can cause life threatening cardia arrhythmias
Hypocalcemia (calcium <8.4) vitamin D deficeincy, disorders shifting calcium into bone, parathyroid removal, excessive alkalosis, blood transfusions, hypoparathyroidism
Hypercalcemia (calcium >10.6) long periods of immobilization, excess calcium or vitamin D, hyperparathyroidism, muliple myeloma, lung/renal cancer
Hypomagnesemia (magnesium <1.3) renal tubular dysfunctions, thiazide diuretics, extensive gastric suction
Hypermagnesemia (magnesium >2.1) rare, usually with renal failure
Hypophosphatemia (phosphate <3.0) use of aluminum-containing antacids, vitamin D deficiency, hyperparathyroidism
Hyperphosphatemia (phosphate >4.5) often in renal failure
Acid-base balance is important in maintaining homeostasis because ________________ body cell enzymes only function with a very narrow pH range
Acid-base balance is balance between what two things bicarbonate (HCO3) and carbonic acid (PaCO2)
pH measure of degree to which solution is acidic or alkaline
What determine pH? concentration of H+ ions
Normal pH 7.35-7.45
Death occurs if pH is _____ <6.8 >7.8
Normal bicarbonate range 22-26 mEq/L
Bicarbonate is controlled by the ___________ kidneys/urinary system
What does bicarbonate do? acts as buffer to neutralize excess acids in body
Mandatory bicarbonate/carbonic acid ratio 20:1
Carbonic acid is controlled by the ________ lungs/respiratory system
Kidneys selectively reabsorb or excrete bicarbonate to ________________ regulate serum levels and maintain balance
Acid-Base control mechanisms blood buffer, lungs, urinary system
Blood buffer system consists of weak acids and weak bases, can stablize levels quickly
Lungs buffer system adds or removes carbonic acid (PaCO2) as carbon dioxide and water are exired from the lungs; faster rate
Urinary buffer system adds or removes bicarbonate (HCO3) as enzymes promote the dissociation of carbonic acid to free H+ ions; slower rate
Carbonic acid range 35-45 mEq/L
Weight gain or loss of 2.2lbs/1kg in 24 hour period indicates loss of _____________ 1L fluid
Average urine output volume 1500mL daily
Urine specific gravity ranges 1.003-1.030, average 1.010-1.025
Respiratory acidosis increased carbon dioxide levels, lungs not working well
Metabolic acidosis excessive loss of bicarbonate or retention of H+ ions, kidneys not working well
Respiratory alkalosis decreased carbon dioxide levels, lungs overworking
Metabolic alkalosis increased bicarbonate or excessive loss of H+ ions, kidneys overworking
Causes of respiratory acidosis airway obstruction, pneumonia, asthma, chest injury, opiates, COPD
Causes of metabolic acidosis kidney disease/disorders, diabetic ketoacidosis, circulatory failure, shock states, diarrhea, starvation,
Causes of respiratory alkalosis anxiety, high fever, hyperventilation, ASA overdose, encephalitis
Causes of metabolic alkalosis vomiting, gastric suctioning, excessive antacid consumption, diuretic therapy, potassium deficit
pH below 7.35 HCO3 normal PaCO2 below 35 or above 45 respiratory acidosis
pH below 7.35 HCO3 below 22 or above 26 PaCO2 normal metabolic acidosis
pH above 7.45 HCO3 normal PaCO2 below 35 or above 45 respiratory alkalosis
pH above 7.45 HCO3 below 22 or above 26 PaCO2 normal metabloic alkalosis
Signs and symptoms hyponatremia MENTAL CONFUSION, ALTERED CONSCIOUSNESS, anxiety, coma, anorexia,l nausea, vomiting, cramping, seizures, decreased sensation
Signs and symptoms hypernatremia DRY MUCOUS MEMBRANES, IMPAIRED TURGOR, intense thirst, flushed skin, oliguria, elevated temp, weakness, lethary, irritability, twitching, seizures, coma, intracranial bleeding
Signs and symptoms hypokalemia ABDOMINAL PAIN, INTESTINAL DISTENSION, CARDIAC DYSRHYTHMIAS, muscle weakness, decreased reflexes, paralysis, urinary retention, lethargy, confusion
Signs and symptoms hyperkalemia muscle weakness, HYPOTENSION, CARDIAC DYSRHYTHMIAS, paralysis
Signs and symptoms hypocalcemia seizures, MUSCLE SPASMS, positive Chvostek/Trousseau signs, cardiac dysrhythmia, wheezing, dyspnea, cardiac failure
Signs and symptoms hypercalcemia anorexia, ABDOMINAL PAIN, constipation, polyuria, confusion, renal calculi, cardia arrest
Signs and symptoms hypomagnesemia insomnia, hyperactive reflexes, leg cramps, twitching, tremors, seizures, cardiac arrhythmia, positive Chevostek/Trousseau signs, vertigo, hypocalcemia, hypokalemia
Signs and symptoms hypermagnesemia hypotension, flushing, sweating, nausea, vomiting, muscle weakness, respiratory depression, cardiac dysrhythmia
Signs and symptoms hypophosphatemia confusion, seizures, numbness, weakness, coma, rickets, osteomalacia
Signs and sumptoms hyperphosphatemia anorexia, nausea, vomiting
Created by: cmp12345