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NUR 311 Exam 1

Chapter 17 Lewis

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