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NUR 311 Exam 1
Chapter 17 Lewis
| Question | Answer |
|---|---|
| Intracellular Fluid Electrolytes | Potassium Phosphate Sulfate |
| Extracellular Fluid Electrolytes | Sodium Chloride Bicarbonate |
| EFC made up of | Intravascular Fluid (1/3 volume) Inside blood and lymphatic vessels Interstitial Fluid (2/3 volume) Fluid between the cells |
| What mechanism pushes fluid out of the vessels | Hydrostatic pressure |
| If a person has low EFC, how does if effect BP? | Low |
| What is the result of Low BP for too long? | Shock |
| What is the mechanism that monitors for balance | Stretch baroreceptors |
| What are the electrolyte cations? | Na+ K+ Ca++ Mg++ |
| What are the electrolyte Anions (-) ? | Cl - HPO4-, H2PO4- SO4- HCO3- |
| Normal Sodium (Na+) range? | 135-155 mEq/L |
| What do sodium plasma changes reflect? | Changes reflect fluid volume changes Does not reflect Na+ intake/output Moves H2O in and out of cells |
| Diet Source of Na+? | table salt, dairy, poultry,meat eggs, processed foods |
| Potassium K+ Normal range? | Normal Range: 3.5 to 5.0 mEq/L |
| In the kidneys, what electrolyte has an inverse relationship with K+? | Sodium |
| What factors cause K+ to move from ECF to ICF? | Insulin, Alkalosis, stress, coronary ischemia, |
| What factors cause K+ to move from ICF to ECF? | Acidosis, trauma to cells, exercise, digoxin-like drugs |
| Causes of hyporkalemia | GI losses:V &D Renal losses: diuretics, hyperaldosteronism, Other: Diaphoresis, dialysis |
| Effect of insulin on K+? | Insulin: transfer K+ into skeletal and liver cells |
| Effect of aldosterone on K+? | Aldosterone: enhances renal excretion of K+ |
| Replacement of K+ ? | Diet: appx 100mEq/day in diet Replacement: IV K+ |
| Causes of hyperkalemia? | excessive or rapid parenteral administrations Drugs: penicillin salt substitutes |
| Causes of K+ shifting out of cells? | Acidosis, fever Tissue catabolism: fever, sepsis, burns Crush ingury Tumor lysis syndrome |
| Failure to eliminate K+ causes? | Renal disease Potassium-sparing diuretics (spironolactone Aldactone) Adrenal insufficiency ACE inhibitors |
| Clinical manifestations of hyperkalemia? | Irritability, anxiety, abdominal cramping, diarrhea, weakness of lower extremities, paresthesias, irregular pulse, cardiac arrest |
| Calcium Ca++ Normal Range | Normal Range: 4.3 – 5.3 mEq/L (serum), 8.9 – 10.1 mEq/dL |
| Why Ca ++ ? | Cell membrane health Wound Healing Nerve synapse Teeth and bone strength Blood Clotting Glycolysis |
| Calcium Ca++ Regulation | Parathyroid Hormone (PTH), Vitamin D: Increases intestinal & renal reabsorbtion Releases Ca++from the bones ( Ca++, HPO4-, H2PO4- Decreases Ca++ levels and HPO4-, H2PO4- |
| Causes of hypercalcemia | Multiple myeloma, malignancies w/bone metastasis, prolonged immobilization, hyperparathyroidism, Vit D overdose, thiazide diuretics, milk-aldali syndrome |
| Clinical manifestations of hypercalcemia | lethargy, weakness, depressed reflexes, decreased memory, confusion, personality changes, psychosis, anorexia, nausea, vomiting, bone pain, fractures, polyuria, dehydration, nephrolithiasis, stupor, coma |
| Causes of hypocalcemia | chronic renal failure, elevated phosphorus, primary hypoparathyrodism, Vitman D deficency, magnesium deficiency, Acute pancreatitis, loop diuretics (furosemide:Lasix), chronic alcoholism, diarrhea |
| Clinical manifestations of hypocalemia | easy fatigability, depression, anxiety, confusion, numbness/tingling in extremities and around mouth, hyperreflexia, muscle cramps, Chvostek's sigh, laryngeal spasm, tetany, seziures |
| Tests for hypocalcemia | Chevostek's sign Trousseaus sign :inflate BP cuff over systolic pressure for a few minutes-->carpal tetany |
| Treatment for hypercalcemia | loop diuretic & hydration w/saline; must drink 3000-4000ml of fluid daily to promote renal excretion of Ca++ |
| Low Ca++: impact on action potentials | Lo Ca++ allows sodium to move into excitable cells, decreasing the threshold of action potentials--> tetany |
| Treatment of hypocalcemia | IV calcium supplements (DO NOT GIVE IM), Diet, oral supplements; Thyroid or neck surgery may cause hypocalemia |
| Magnesium Mg++ Normal Range | Normal Range: 1.5-1.9 mEq/L Why Mg++ ? |
| Function of Mg++? | Regulates neuromuscular function and cardiac activity |
| What organ regulates Mg++? | Kidneys |
| Mg++ flows with what other electrolyte | K+ |
| Dietary sources of Mg+ | Leafy Greens, Legumes, Citrus, Peanut Butter, Chocolate |
| Phosphorus HPO4-, H2PO4- Normal Range | Normal Range: 1.7 – 2.6 mEq/L, ranges are higher in children and highest in infants. |
| Phosphorus is found primarily in what tissue? | Primarily found in bone (85%), then ICF (14%), |
| Phosphorus is regulated in what organ? | Regulated in kidneys though Vitamin D and PTH |
| Dietary sources of Phosphorus? | Dietary Sources: dairy, meats, veggies, fruits, cereals |
| Causes of hypophosphatemia | Malabsorption syndrome, glucose administration,parenteral nutrition, alcohol withdrawal, phosphate-binding antacids, recovery from diabetic ketoacidosis, respiratory alkalosis |
| Clinical manifestations of hypophosphatemia | CNS dysfunction (confusion, coma), Muscle weakness (including respiratory, weaning from ventilator), Renal tubular wasting, cardiac dysrythmias, decreased stroke volume, osteomalacia, rhadomyolysis |
| Causes of hyperphosphatemia | Renal failure, Chemotherapeutic agents, Enemas containing phosphorus (fleet), Excessive ingestion, Large vitamin D intake, Hypoparthyroidism |
| Clinical manifestations of hyperphosphatemia | Hypocalcemia, muscle problems, tetany, deposition of calcium-phosphate precipitates in skin, soft tissue, cornea, viscera, blood vessels. |
| Glucose Normal Range | Normal Range 70-110 |
| S/S of Hyperglycemia | Polyphagia (frequently hungry) Polyuria (frequently urinating) Polydipsia (frequently thirsty) Blurred vision Fatigue ……. ………Coma |
| S/S of Hypoglycemia | Shaky/Nervous Tired/Sleepiness Sweaty Hungry Irritable/Impatient Strange behavior Lack of coordination Cold Confusion/Delirum Coma |
| Treatment Hyperglycemia | Diet Exercise Medication (PO) Insulin |
| Treatment Hyperglycemia | Eat Carbohydrates Hard candy A regular not diet soft drink. 4 ounces of orange juice. Two large lumps or teaspoons of sugar. Glucose tablets Glucose gel |
| S/S of hypovolemia | Postural hypotension, tachycardia, absence of JVP @45 degrees, decreased skin turgor, dry mucosa, supine hypotension, oliguria, organ failure |
| S/S of hypervolemia | HTN, tachycardia, raised JVP/fallop rythm & edema, pleural effusions, pulmonary edema, ascites, organ failure |
| Measurable losses | urine ( measure hourly if necessary ) GI ( stool, stoma, drains, tubes ) |
| Insensible losses | sweat exhaled |
| Hypervolemia Would you expect a patient’s BUN level to be high or low? | Low |
| Hypervolemia, What other symptoms would someone have? | HTN, ascites, peripheral edema, pulmonary edema |
| Hypervolemia, Would pulse be bounding or thready? | Bounding |
| How would you treat fluid volume excess? | Low sodium diet Diuretics |
| Causes of hypovolemia? | Blood loss, fluid lost into the interstitial space (burns), excess water loss |
| Clinical manifestations of hypovolemia? | Low: BP, Pulse is fast & weak, body temp is low |
| Treatment for hypovolemia? | Isotonic solutions |
| Third space refers to: A. Vascular B. Interstitial C. Intracellular | Interstitial |
| Soduim imbalances are primarily seen in: Kidney kidney function Cardiac function Neuromuscular function CNS function | CNS function |
| The amount and direction of movement between the interstitium and the capillary are determined by the interaction of | (1) capillary hydrostatic pressure, (2) plasma oncotic pressure, (3) interstitial hydrostatic pressure, and (4) interstitial oncotic pressure. |
| First spacing | the normal distribution of fluid in the intracellular fluid (ICF) and extracellular fluid (ECF) compartments |
| Second spacing refers to | an abnormal accumulation of interstitial fluid (i.e., edema |
| Third spacing occurs when | Third spacing occurs when fluid accumulates in a portion of the body from which it is not easily exchanged with the rest of the ECF. |
| The patient who cannot recognize or act on the sensation of thirst is at risk for | An intact thirst mechanism is important for fluid balance. The patient who cannot recognize or act on the sensation of thirst is at risk for fluid deficit and hyperosmolality. |
| An increase in plasma osmolality or a decrease in circulating blood volume will stimulate | An increase in plasma osmolality or a decrease in circulating blood volume will stimulate antidiuretic hormone (ADH) secretion. Reduction in the release or action of ADH produces diabetes insipidus. |
| The primary organs for regulating fluid and electrolyte balance | kidneys, lungs, and gastrointestinal tract |
| Insensible water loss, which is invisible vaporization from the lungs and skin, assists in regulating what? | Insensible water loss, which is invisible vaporization from the lungs and skin, assists in regulating body temperature. |
| With severely impaired renal function, the kidneys cannot maintain fluid and electrolyte balance. This condition results in | With severely impaired renal function, the kidneys cannot maintain fluid and electrolyte balance. This condition results in edema, potassium, and phosphorus retention, acidosis, and other electrolyte imbalances. |
| Fluid volume deficit can occur with | Fluid volume deficit can occur with abnormal loss of body fluids (e.g., diarrhea, fistula drainage, hemorrhage, polyuria), inadequate intake, or a plasma-to-interstitial fluid shift. |
| What is the easiest measurement of volume status? | Accurate daily weights provide the easiest measurement of volume status. Weight changes must be obtained under standardized conditions |
| How is edema assessed? | Edema is assessed by pressing with a thumb or forefinger over the edematous area. |
| acidosis | process that adds acid or eliminates base from body fluids. |
| active transport | process in which molecules move across a membrane against a concentration gradient. |
| alkalosis | process that adds base or eliminates acid from body fluids. |
| anions | negatively charged ions. |
| buffer | a substance that acts chemically to change strong acids into weaker acids or to bind acids to neutralize their effect. |
| cations | positively charged ions. |
| diffusion | the process in which particles in a fluid move from an area of higher concentration to an area of lower concentration. |
| electrolyte | an element or compound that, when melted or dissolved in water or another solvent, dissociates into ions and is able to conduct an electric current. |
| facilitated diffusion | the movement of molecules from an area of high concentration to one of low concentration at an accelerated rate with the assistance of a specific carrier molecule. |
| fluid spacing | the distribution of water in the body. |
| homeostasis | the state of equilibrium in the internal environment of the body, naturally maintained by adaptive responses that promote healthy survival. |
| hydrostatic pressure | the force that fluid exerts within a compartment. |
| hypertonic | solutions that increase the degree of osmotic pressure on a semipermeable membrane. |
| hypotonic | solutions that have a lower concentration of solute than another solution, thus exerting less osmotic pressure on a semipermeable membrane. |
| ion | an atom or group of atoms that has acquired an electrical charge through the gain or loss of an electron or electrons. |
| isotonic | fluids having the same concentration of solute particles as another solution, thus exerting the same osmotic pressure on a semipermeable membrane. |
| oncotic pressure | he osmotic pressure of a colloid in solution, such as when there is a higher concentration of a protein in the plasma on one side of a cell membrane than in the neighboring interstitial fluid. |
| osmolality | the measure of the osmotic force of solute per unit of weight of solvent (mOsm/kg or mmol/kg). |
| osmosis | the movement of water between two compartments separated by a membrane permeable to water but not to a solute. |
| osmotic pressure | amount of pressure required to stop the osmotic flow of water. |
| pH | abbreviation for potential hydrogen, a scale representing the relative acidity (or alkalinity) of a solution, in which a value of 7.0 is neutral, below 7.0 is acid, and above 7.0 is alkaline. |
| tetany | increased nerve excitability and sustained muscle contraction that results from low calcium levels that allow sodium to move into excitable cells, increasing depolarization; low calcium levels affect the membrane potential. |
| valence | the electrical charge of an ion that is a numeric expression of the capability of an element to combine chemically with other elements. |
Created by:
daledee
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