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F & E / Acid Base
Kamhoot lecture: NP2
| Question | Answer |
|---|---|
| What percentage of our body weight is fluids? | 60% |
| Of our body fluids, ___% are extracellular, while ___% are intracellular | 34% ECF 66% ICF |
| List some interstitial fluids and the percentage that makes up our body fluids. Is interstitial fluid intra or extracellular? | * ISF includes lymph, CSF, GI secretions * 27% of our total body fluids * extracellular |
| What fluid comprises the plasma within our blood vessels? What percentage of our body fluids is this? | Intravascular fluid * 7% |
| Edema usually involves which body fluid? What can it caused by? | *Interstitial fluid (ECF) * Caused by venous hydrostatic pressure... pooling |
| List 5 functions of water. | * transportation of nutrients * maintenance of blood volume * lubrication of tissues * maintenance of acid-base balance * heat regulation via evaporation |
| What is the daily water intake & output? | 2500 mL |
| How is water loss replenished? | * by ingestion of food/fluids * metabolism of food/body tissues |
| If total water intake is 2500 mL, how many mL can be accounted for in food, from oxidation, & as liquid? | * FOOD: 1000 mL * OXIDATION: 300 mL * LIQUID: 1200 |
| What is the removal of electrons from an atoms or molecules? | oxidation |
| Fluid output includes sensible & insensible loss. In what 4 ways can water be lost via those regular pathways and how many mL are lost via each? (Remember: 2500 mL lost total) | Insensible: * SKIN: 500 mL * LUNGS: 350 mL Sensible: * FECES: 150 mL * URINE: 1500 mL |
| Infants are ___-___% water & ___-___% solids. | 70-80% water 20-30% solids |
| Adults are ___-___% water & ___-___% solids. | 50-60% water 40-50% solids |
| Geriatrics are ___-___ water & ___-___% solids. | 45-55% water 45-55% solids |
| Fluid Volume Deficit is often called what? Fluid lost is mainly from what type of fluid? | * Hypovolemia * Intravascular fluid |
| Fluid volume deficit is hypo/hyper/iso(tonic)? | isotonic: the body loses electrolytes and water in similar proportions |
| Causes of Hypovolemia? | * abnormal water loss thru the skin, GI tract, or kidneys * decreased intake of fluid * bleeding * movement of fluid into a 3rd space (unavailable for use: may shift back and risk hypervolemia: not often evident) |
| Signs & symptoms of fluid volume deficit? | * thirst * dizziness * weakness * poor skin turgor * weight loss * elevated, weak heart rate * postural hypotension * decrease urine output * mental status change * dry mucous membranes * flat neck veins * increased BUN * increased specific gr |
| How does one measure postural hypotension? | * Take B/P of client while laying down, and then after standing them up. * A positive result: - decrease in systole: > 20 mm Hg - decrease in diastole: 10 mm Hg - 10-20% decrease in heart rate |
| Treatment/Nursing Interventions for Fluid Volume Deficit: | * Assess for FVD evidence * Monitor weight & V/S * Assess neuro status (LOC) * Assess turgor * Monitor I & Os * Monitor lab findings: Na, BUN, Hct * Admin IV & oral fluids * Mouth care * Blood transfusion? * Address safety issues: decub/fall risk |
| Fluid volume excess, also known as ___, is hypo/hyper/isotonic? | * Hypervolemia * isotonic |
| Causes of hypervolemia: | * excessive intake of fluids * excessive intake of NaCl * abnormal retention of fluids * interstitial to plasma fluid shift * admin of sodium-containing infusions too rapidly * dz processes that alter regulatory mechs (heart/renal/liver failure) |
| Signs & symptoms of FVE (hypervolemia): | * edema * increased heart rate & B/P * tachypnea, dyspnea * distended veins * weight gain * I>O * crackles in lungs * pulmonary edema |
| Treatment/Implementation for fluid volume excess: | * Diuretics * Fluid restriction * Sodium restriction * Monitor weight & V/S * Assess for edema * Assess/monitor breath sounds * Place in Fowler's position |
| List reasons geriatrics are at increased risk for dehydration: | * fat replaces lean muscle * decreased fxn of thirst mechanism * kidney fxn for concentrating urine decreases * incontinent * over salt foods * mild disorientation * orthostatic hypotension * constipation * decrease in mobility decreases thirst |
| What is the glomerular filtration rate? How many L of urine are excreted per day? | * nephrons filter blood at a rate of 125 mL / min or about 180 L / day * 1-2 L / day |
| The kidneys must excrete a minimum of ___mL/hr of urine to eliminate waste products from the body | 30 |
| The kidneys react to fluid excesses by excreting a more or less dilute urine to rid the body of excess fluid & conserve electrolytes? | more |
| A weight loss/gain of 1 kg (2.2 lbs) will reflect a loss/gain of ___L of body fluid? | 1 |
| When a substance enters the body, the first fluid it travels through is intra or extracellular? | extracellular |
| Diffusion, osmosis, and filtration are all active/passive transport processes? | passive transport |
| When osmolality and osmolarity are high, there are more or less particles than water? | more |
| When osmolality and osmolarity are low, there are more or less particles than water? | less |
| Osmolality or osmolarity is used to describe fluids inside the body? i.e. serum | Osmolality |
| Osmolality or osmolarity is used to describe fluids outside the body? i.e. urine | Osmolarity |
| A ____ is a substance dissolved in a liquid. | solute |
| A ____ is a component of solution that dissolves a solute. | solvent |
| The movement of particles (solutes) in all directions thru a solution or gas from areas of high concentration to low concentration, resulting in equal distribution of solutes w/i the 2 areas is... and give one example | Diffusion; Oxygen |
| What is the movement of water from an area of lower concentration to an area of higher concentration thru a semipermeable membrane? | Osmosis |
| One type of diuretic that works by osmosis and is assisted by osmotic pressure is...? | Lasix (Furosemide) |
| What type of solution (hyper/hypo/isotonic) pulls fluid from cells, causing cells to crenate, and has a higher osmolality (solute concentration) than body fluids? | Hypertonic solution |
| What type of solution (hyper/hypo/isotonic) has the same osmolality of body fluids & has capacity to expand body's fluid volume w/o causing a fluid shift? | Isotonic solution |
| What type of solution has a lower osmolality (solute concentration) than body fluids & causes fluid to move into cells, causing them to swell & eventually lyse? | Hypotonic solution |
| D5W: 5% dextrose in water, LR: lactated ringers NS: 0.9% NaCl - all examples of what type of solution? | Isotonic solution |
| D10W: 10% dextrose D5LR: 5% dextrose in lactated ringers D5NS: 5% dextrose in 0.9% NaCl D5 1/2NS: 5% dextrose in 0.45% NaCl - all examples of what type of solution? | Hypertonic solution |
| D2.5W: 2.5% dextrose 1/2NS: 0.45% NaCl - all examples of what type of solution? | Hypotonic solution |
| This describes the power of a solution to draw water across a semipermeable membrane. This force PULLS fluid toward higher concentrated compartments. (esp toward the vascular space) | Osmotic pressure |
| Pressure exerted by a fluid within a fluid compartment: i.e. the force exerted by blood against vascular walls: fluids move from areas of greater pressure to those of lesser pressure; PUSHES fluid out of vascular space | Hydrostatic pressure |
| This pressure, exerted by plasma proteins, pulls water from the interstitial space into the vascular compartment... maintains vascular volume. | Oncotic/Colloid osmotic pressure |
| This type of diffusion involves carrier molecules, but requires no ATP. | Facilitated diffusion |
| This is the passive transfer of H2O & dissolved substances from an area of higher pressure to one of lower pressure (via hydrostatic pressure)... Heart pump causes H2O & electrolytes to move from capillaries to interstitial fluid. | Filtration |
| On the arterial side, ____ pressure moves fluid/particles out, while on the venous side, ____ pressure moves fluid/particles back in. | hydrostatic, osmotic |
| This hormone, synthesized by the hypothalamus and secreted by the posterior pituitary, is released when a decrease in B/P decreases water volume in body. | Antidiuretic hormone (ADH) |
| When B/P increases, too much water inhibits this hormone, thus less water is reabsorbed & urine is dilute... this causes a drop in B/P (protective). | Antidiuretic hormone (ADH) |
| This hormone, released from the adrenal cortex promotes sodium (and thus H2O) retention (reabsorption)... K+ is secreted in return. | Aldosterone |
| This diuretic inhibits aldosterone by preventing the conversion of angiotensin I to angiotensin II. | Lasix (Furosemide) |
| This hormone is produced and released from the adrenal cortex when the body is under stress: it promotes renal retention of Na & H2O. | Glucocorticoids (cortisol) |
| This cardiac hormone is released when the atria are stretched by high blood volume or high B/P. | Atrial Natriuretic Peptide (ANP) |
| ANP lowers blood pressure & B/P by: * causing vasoconstriction or dilation? * decreasing/increasing aldosterone? * decreasing/increasing ADH release? * decreasing/increasing GFR? | * vasodilation * decreasing aldosterone * decreasing ADH release * increasing GFR |
| This cardiac hormone is secreted by the ventricles & decreases blood volume & pressure by: * vasoconstriction or dilation? * decreasing/increasing aldosterone? * causing diuresis with retention/excretion of Na & H2O? | Brain natriuretic peptide (BNP) * vasodilation * decreasing aldosterone * causing excretion of Na & H2O |
| This type of transport of fluid/ electrolytes requires ATP & moves things w/o regard for charge or concentration gradient factors that might prevent entry via diffusion. | Active Transport |
| Active transport moves fluids/ electrolytes from an area of ____ concentration to those of ____ concentration. List 5 electrolytic substances, 1 molecule, & 1 other substance transported actively. | * Na, Fe, K, Ca, H * glucose * amino acids |
| When dehydrated, serum osmolality increases/decreases? When overhydrated, serum osmolality increases/decreases? | * increases: dehyd * decreases: overhyd |
| The following diseases show evidence that osmolality is increased when measuring it in serum: | * dehydration * diabetes insipidus * diabetic ketoacidosis * hypercalcemia * hypernatremia |
| The following diseases show evidence that osmolality is increased when measuring it in urine: | * congestive heart failure * dehydration * hyponatremia * syndrome of inappropriate ADH: SIADH |
| The following diseases show evidence that osmolality is decrease when measuring it in serum: | * hyponatremia * SIADH * water intoxication |
| The following diseases show evidence that osmolality is decreased when measuring it in urine: | * diabetes insipidus * hypernatremia * hypokalemia |
| Which part of the brain senses fluid deficit/increase in plasma osmolality? * Decrease in volume stimulates thirst --> increased water & decreased plasma osmolality | Hypothalamus |
| The normal function of this type of regulation is to store/release ADH. The normal release is caused by... | * Pituitary regulation * Increased osmolality * Stress * Nausea * Nicotine * Morphine |
| The pathological action of pituitary regulation causes what in SIADH and what in Diabetes insipidus? | * SIADH: increased ADH, water retention * DI: decreased ADH, dehydration, increased Na+ |
| Glucocorticoids and Mineralocorticoids are hormones released to help regulate both water & electrolytes & are part of what type of regulation? | Adrenal cortical regulation |
| This category of hormones enhances sodium retention & potassium excretion (aldosterone is one) | Mineralocorticoids |
| This category of hormones is an anti-inflammatory that increases serum glucose (cortisol is one) | Glucocorticoids |
| This type of regulation involves the kidneys & includes the primary regulators of fluid & electrolytes. | Renal regulation |
| In renal regulation, ___ L plasma/day are filtered, yet only ___ L urine is excreted. | 180, 1.5 |
| Which 2 hormones work on the renal tubules to selectively retain & excrete water & electrolytes? | ADH, aldosterone |
| Urine specific gravity measures ___. What is the normal level? | * concentration of urine * 1.010-1.030 |
| If urine is too dilute, what might be the level? This would indicate deficient/excess fluid intake & an inability to concentrate urine. | <1.010, excess fluid intake |
| If urine is over-concentrated, this indicates _____, another word for excess solutes in the urine and a specific gravity of ____. | dehydration, >1.030 |
| This type of regulation involves ____, which is released from cells in the heart atria in response to excessive blood volume. | Cardiac, ANP |
| When ANP is released, what hormones are suppressed? Further, what happens with Na+ & water, blood vessel width, & thirst? | * Renin, aldosterone, ADH are suppressed * Na+ & water are excreted * Vasodilation occurs * Thirst is inhibited |
| Most of the water intake occurs thru the ___ tract and accounts for __-__L/day. ___mL are eliminated in feces. Not so elegant ways to eliminate greater amounts of water from the GI tract are ___ & ___. | 2-3 L/day intake 100 mL feces diarrhea, vomiting |
| Are electrolytes lost during insensible water loss? How many mL or water is lost/ day this way (sweat, breath)? | Electrolytes typically are not lost, except with excessive sweating. 600-800 mL of water account for insensible water loss. |
| Electrolytes break up into particles called ___ when they dissolve in water and develop an electrical ___. | ions, charge |
| For each positively charged ___ion, there must be a negatively charged ___ion. | cation, anion |
| By what means of transport to electrolytes move? | active transport |
| Which ion determines the acidity or alkalinity of body fluids? | * The more H+, the more acidic a solution * The more OH-, the more basic a fluid. |
| In a solution, acids accept/give up H+, while bases accept/give up H+. | * Acids give up H+ (they have more H+ than bases... makes sense) * Bases accept H+ |
| List 3 cations & 5 anions found in ICF (2/3 body's water). | Cations: Mostly K+, some Na+, some Mg++ Anions: Mostly PO4---, some HCO3-, protein, Cl-, SO4-- |
| List 4 cations & 4 anions found in ECF (1/3 body's water). | Cations: Mostly Na+, some K+, Ca++, Mg++ Anions: Mostly Cl-, Some HCO3-, SO4--, PO4--- |
| The greatest concentration of sodium is found in the ICF/ECF? Sodium moves with ___. Normal level: ___-___mEq/L | * ECF * water * 135-145 |
| List 3 functions of sodium. | * Regulates volume & osmolality of the ECF * Involved in nerve impulse transmission * Involved in muscle contraction * Maintains blood volume |
| Causes of hyponatremia related to sodium loss: | * GI loss: diarrhea, vomiting, fistula, NG suction * Renal loss: SIADH, diuretics, adrenal insufficiency, Na+ wasting renal disease * Skin loss: burns, wound drainage |
| Causes of hyponatremia related to water gain (sodium dilution): | * Congestive heart failure * excessive hypotonic IV fluids * Primary polydipsia (excessive fluid intake caused by dry mouth feeling) * SIADH |
| A decrease in ECF volume indicates ____ loss, while increased ECF volume indicates ___ gain. | * sodium * water |
| Clinical manifestations of what electrolyte imbalance? * tachycardia * tremors, seizure, coma * postural hypotension * irritability, apprehension, confusion * rapid, thready pulse * JV filling * nausea * dry mucous membranes * weight loss * emin | Hyponatremia: sodium loss (Decreased ECF volume) |
| Clinical manifestations of what electrolyte imbalance: * weight gain * nausea, vomiting * muscle spasms, seizure, coma * postural hypotension * headache, fatigue, apathy, weakness, confusion | Hyponatremia: water gain (Increased ECF volume) |
| List possible causes of hypernatremia related to water loss. | * Insensible water loss (perspiration thru heat stroke, high fever) * Diabetes insipidus * Osmotic diuresis * Diarrhea * Water deprivation |
| Causes of hypernatremia related to sodium gain. | * IV hypertonic D5NS * IV sodium bicarbonate * IV excessive isotonic NS * Primary hyperaldosteronism * Saltwater drowning |
| Clinical manifestations of what electrolyte imbalance: * intense thirst * peripheral/pulmonary edema * weight gain * seizure, coma * flushed skin * restlessness, agitation, twitching | Hypernatremia: sodium gain (Normal or increased ECF volume) |
| Clinical manifestations of what electrolyte imbalance: * Intense thirst * Dry, swollen tongue * Restlessness, agitation, twitching * Confusion * Seizure, coma * Postural hypotension * Low urinary output * Weight loss * Weakness | Hypernatremia: water loss (Decreased ECF volume) |
| What can be done to treat water/sodium imbalances? | * Treat the cause * Adjust the diet * Treat fluid loss |
| What percentage of potassium is intracellular? What is the normal serum potassium range? | 98%; 3.5-5.0 mEq/L |
| In hyponatremia, cells ____, while in hypernatremia, cells ____. Severe hyponatremia, serum levels below ____mEq/L is a medical emergency & can lead to permanent brain damage. | * Cells swell in hyponatremia * Cells shrink in hypernatremia * below 110 mEq/L = severe |
| Cells become dehydrated in hypo/hypernatremia? Normally, sense of thirst helps correct this disorder, but thirst mechanism may not be in tact or water may not be available. | hypernatremia (excess sodium in ECF) |
| Potassium must be replaced in the diet because __% is excreted by the kidneys. | 80% |
| Is hyper/hypokalemia more dangerous? Why? | hyperkalemia is more dangerous b/c it can lead to cardiac arrest |
| Normal functions of potassium? | * Maintains ICF osmolality * Transmits nerve impulses * Regulates cardiac impulse transmission (rhythm) * Regulates muscle contraction of smooth/skeletal muscle * Regulates acid-base balance * Promotes cell growth * Leaves cells during tissue breakd |
| Potassium is the major extra/intracellular cation? | intracellular |
| Sources of Potassium: | * Dark yellow & orange fruits * Avocados * Dark green leafy veggies * Sweet potatoes * Meat: beef, chicken, liver, pork, veal, turkey * Nuts, peanut butter * Cocoa, soda * Instant tea, coffee |
| Causes of what electrolyte imbalance: * Abnormal fluid loss (vomiting, diarrhea, fistulas, NG suctioning, ileostomy) * Metabolic alkalosis | hypokalemia |
| SxS of what electrolyte imbalance: * fatigue * leg cramps * decreased deep tendon reflexes * polyuria * ventric arrhythmias * enhanced digitalis effect * myasthenia * N, V, ileus * paresthesia * weak, irreg pulse * hyperglycemia * bradycardia | Hypokalemia |
| List treatments for hypokalemia: | * prevention of metabolic acidosis * treat diarrhea, vomiting * adequate dietary intake * give K+ supplements * monitor med side effects |
| List several causes of hyperkalemia. | * Usually renal failure * Hypoaldosteronism * potassium-conserving diuretics * massive cell damage * rapid K+-containing IV infusions * catabolism * metabolic acidosis, burns, infections (moves K+ out of cells) * adrenal insufficiency |
| What hormone helps move K+ into cells? | insulin |
| Clinical manifestations of what electrolyte imbalance: * irritability * anxiety * abd cramping, diarrhea * myasthenia (legs) * paresthesias * irreg pulse * cardiac standstill * ventric fibrillation | hyperkalemia |
| List some treatments for hyperkalemia. | * calcium gluconate IV * regular insulin & glucose admin IV * sodium bicarbonate * dialysis * sodium polystyrene sulfonate (Kayexalate: trades Na+ for K+, elim in feces) |
| Hypo and hyperkalemia refer to deficiencies in extra/intracellular potassium? | extracellular |
| Chloride is the major intra/extracellular anion? Normal level: ___-___mEq/L | extracellular; 95-108 |
| Functions of chloride? | * major component in formation of HCl in gastric juices * regulates acid-base balance * chloride shift in RBCs |
| Clinical manifestations of what electrolyte imbalance? * stupor * rapid, deep breathing * muscle weakness | Hyperchloremia |
| Clinical manifestations of what electrolyte imbalance? * increased muscle excitability * tetany * decreased respirations | Hypochloremia |
| Chloride deficiencies/excesses are also associated with similar deficiencies/excesses of which electrolyte? | Na+ |
| Functions of Calcium | * forming bones/teeth * nerve impulse transmission * muscle contrxn * cardiac pacemaker * blood clotting * activates fat-digesting enzymes * normal cell fxn/membrane stability * hormone secretion (PTH, Vit D is necessary for Ca++ absorption) |
| Disorders of calcium in ECF account for only ___% of total body calcium, but this amount is vital. | 1% |
| 50% of ECF calcium circulates in a free, ionized, unbound form, range is ___-___mg/dL. The other 50% is bound to proteins (albumin) or other ions (PO4, carbonate). The total serum calcium level including both bound & unbound calcium is ___-___mg/dL | 4.0-5.0mg/dL Total: 8.5-10.5 mg/dL |
| ___% calcium is in bones/teeth. | 99% |
| What is a normal APTT level? What should the level be if on heparin? | 14-20... If on heparin, level should be twice the normal level (30-40) |
| List some sources of Calcium: | * milk products * dark green leafy veggies * canned salmon * beans * nuts * cauliflower * egg yolk |
| Clinical manifestations of what electrolyte imbalance: * lethargy * depressed reflexes * anorexia, N, V * stupor, coma * paresthesia * bone pain, fractures * psychosis * polyuria, dehydration * muscle tremors * ventric arrhythmias | Hypercalcemia (> 5 mEq/L) |
| The following are causes of what electrolyte imbalance? * multiple myeloma * prolonged immobilization * hyperparathyroidism * Vit D OD * thiazide diuretics * increased intest absorp * high bone turnover * ESRD (end-stage renal dz) * drugs * acid | Hypercalcemia |
| Clinical manifestations of what electrolyte imbalance: * fatigue * depression, anxiety, confusion * numbness, tingling around mouth, arms/legs * hyperreflexia, muscle cramps * Trousseau's sign * laryngeal spasm* * Chvostek's sign * tetany, seizure | Hypocalcemia |
| What is Chvostek's sign? | Contraction of facial muscles produced by tapping the facial nerve in front of the ear. Indicates hypocalcemia |
| What is Trousseau's sign? | A carpal spasm that occurs by inflating a B/P cuff on upper arm to 20 mmHg higher than systole for 2-5 mins: indicates hypocalcemia (wrist is curled up |
| The following are causes of what electrolyte imbalance? * chronic renal failure, * primary hypoparathyroidism * Vit D deficiency * Mg loss * high phosphorus * #1: acute pancreatitis * alcoholism * hypothermia * alkalosis * low PTH * rhabdomyol | hypocalcemia: < 4 mEq/L |
| Phosphorus is chiefly an extra/intracellular anion? Normal level is ___-___ mg/dL. | intracellular; ECF level: 2.8-4.5 |
| Phosphorus and ____ have an inverse relationship in the body. | Calcium |
| The majority of phosporus is found with calcium in the ___ & ___. Phosphorus also relies on ___ for absorption. | bones, teeth; vit D |
| Functions of phosphorus: | * forms bones, teeth * digests carbs, proteins, fats * produces ATP, DNA * muscle, nerve, RBC fxn * acid-base balance * regulates Ca++ levels |
| The following are causes of what electrolyte imbalance? * diabetic ketoacidosis * dietary insufficiency * impaired kidney fxn * misdistribution of this electrolyte | Hypophosphatemia |
| Treatment for hypophosphatemia: | * oral supplements * foods high in phosphorus * may need IV of Na or K phosphate |
| SxS of hypophosphatemia: (do not usually occur unless level is below __ mg/dL) | * muscle weakness/pain * paresthesia * confusion 1mg/dL |
| The following are causes of what electrolyte imbalance? * renal insufficiency * increased intake of this mineral or vit D * chemotherapy | Hyperphosphatemia |
| SxS of hyperphosphatemia: | * tetany * paresthesia around mouth * muscle spasms |
| Treatment for hyperphosphatemia: | * treat cause * restrict phosphate-containing foods * give Basajel, Amphogel, Aluminet (phosphate-binding agents) |
| The following are functions of what electrolyte? * Relaxes muscle contrxns * Active transport: operates Na+-K+ pump * Cell signaling/nerve impulse transmission * Cell migration/wound healing * regulates cardiac fxn * intracellular metabolism | Magnesium |
| List the 1% level found in ECF: ___-___mEq/L | 1.5-2.5 mEq/L |
| More than half of Mg++ is found in ___ & ___ and 40-50% is in the extra/intracellular fluid compartment? | bone, muscle; intracellular |
| You would supplement magnesium if the level is about ___ even if it isnt quite to the bottom range of deficiency... b/c it is dangerous. | 1.7-1.8 |
| The following are causes of what electrolyte imbalance? * renal insufficiency * meds like Lithium, laxatives, antacids with Mg+ * volume depletion * rhabdomyolysis * hypothyroidism * hypomotility disorders * hyperparathyroidism * bowel obstruction | hypermagnesemia |
| Clinical manifestations of what electrolyte imbalance: * lethargy * drowsiness * impaired reflexes * N,V * Somnolence * Bradycardia * Cardiac arrest * Hypotension * EKG changes * Resp arrest | hypermagnesemia |
| Treatment/interventions for hypermagnesemia? | * Monitor EKG * Prevent/identify/eliminate cause * IV CaCl, Ca gluconate * fluids * neuro assessment * discontinue contributing meds |
| The following are causes of what electrolyte imbalance? * diet: malnutrition * drinking ETOH * diuretics * drugs * diarrhea, malabsorption * diabetes mellitus | hypomagnesemia |
| Clinical manifestations of what electrolyte imbalance: * hyperactive deep tendon reflexes * tremors * seizures * cardiac arrhythmias * confusion | hypomagnesemia |
| Treatment for hypomagnesemia? | * oral supplements * increased in diet * if severe: parenteral IV or IM Mg++ |
| The following are causes of what imbalance? * anorexia * malnutrition * starvation * fad dieting * poorly balanced veg diets * hemorrhage * nephrotic syndrome * may shift out of intravascular space with inflammation | Hypoproteinemia |
| What proteins are a significan determinant of blood volume? | Plasma proteins, such as albumin |
| This protein imbalance is rare, but may occur with dehydration. | hyperproteinemia |
| Clinical manifestations of what imbalance: * edema * slow healing * anorexia * fatigue * anemia * muscle wasting * ascites | Hypoproteinemia |
| Treatment for hypoproteinemia | * high protein diet * supplements * enternal nutrition or TPN |
| Bicarbonate is a main anion of the E/ICF? Normal level is ___-___mEq/L | 22-26 |
| Is bicarbonate a major acidic or alkaline electrolyte? | alkaline |
| Ratio for homeostasis of acid-base regulation is ___ part(s) carbonic acid to ___ part(s) bicarbonate. | 1, 20 |
| What blood test determines whether a solution is acidic, neutral, or alkaline? | ABG: taken at wrist |
| List what gases are measured by ABG. | * pH (7.35-7.45 normal) * PaCO2 * HCO3 * PaCO2 * SaO2 |
| List normal range for PaCO2. | 35-45 mm Hg |
| Normal range for HCO3. | 22-26 mEq/L |
| Normal range for PaO2: | 80-100 mm Hg |
| Normal range for SaO2: | 95-100% |
| 2 types of acid-base imbalances: | metabolic, respiratory |
| Metabolic imbalances involve deficiency/excess of what ion? | bicarbonate |
| Respiratory imbalances involve deficiency/excess of what ion? | carbonic acid |
| 3 systems in the body that regulate acid-base balance: | * blood buffers * kidneys * lungs |
| These buffers circulate in pairs, neutralizing acids/bases by donating or accepting H+... act immediately | Blood buffers |
| The buffers speed up or slow down respirations, can incrase or decrease amount of CO2 in blood: respond in minutes to hours | Lungs |
| These buffers excrete varying amts of acid/base; respond in hours-days * Reabsorbs or secretes H+ and HCO3 | Kidneys |
| This is caused by any condition that impairs normal ventilation, perfusion or diffusion. (too much carbonic acid in blood, CO2 retention) | Respiratory acidosis |
| This is caused by losses of excessive amounts of CO2.. causing a decrease in carbonic acid in the blood. Respirations that increase in rate, depth, or both may also cause this. | Respiratory alkalosis |
| List pH level, PaCO2 level, and what happens to bicarbonate in respiratory acidosis. | ph: < 7.35 PaCO2: > 45 mmHg bicarbonate stays normal, before it increases b/c it takes a bit for kidneys to retain it to compensate |
| List pH level, PaCO2 level, & what happens to bicarbonate in respiratory alkalosis. | pH: > 7.45 PaCO2: < 35 mm Hg bicarbonate stays normal until kidneys compensate by excreting it |
| The following are causes of what acid-base imbalance? * aspiration * cardiac arrest * severe pneumonia * emphysema * pulmonary edema * pneumothorax * obesity * stroke * head injury * COPD * asthma * resp infection | Respiratory acidosis |
| The following are causes of what acid-base imbalance? * hyperventilation * anxiety * fear * head injury * ASA (aspirin) overdose * pneumonia * CNS disorders * hypoxia * high fever * pulmonary emboli | Respiratory alkalosis |
| Clinical SxS of what acid-base imbalance? * lethargy * disorientation * dizziness * tremors * weakness * tachycardia * HTN * dyspnea * decrease LOC * occipital H/A (headache) | Resp acidosis |
| Clinical SxS of what acid-base imbalance? * anxious appearance * irritability * paresthesias of hands/toes * fainting * dizziness * tachypnea * cardiac arrhythmias * tetany * muscle weakness * chest tightness/palpitations | Resp alkalosis |
| The following is treatment for what acid-base imbalance? * treat source of anxiety * breathe into paper bag * admin sedatives | resp alkalosis |
| The following is treatment for what acid-base imbalance? * improve ventilation * use bronchodilators * administer O2 * administer fluids * medicate: anit-infectives? | resp acidosis |
| This acid-base imbalance can result from a gain of H+ or a loss of HCO3 | metabolic acidosis |
| List the pH value, PaCO2 value, HCO3 value and lung compensation associated with metabolic acidosis. | pH: <7.35 PaCO2: normal HCO3: < 22 mEq/L Lungs compensate by excreting CO2 |
| This acid-base imbalance results when a significant amount of acid is lost from the body or an increase in bicarbonate (base) occurs: | metabolic alkalosis |
| List the pH value, PaCO2 value, HCO3 value and lung compensation associated with metabolic alkalosis. | pH: >7.45 HCO3: >24 mEq/L PaCO2: normal Lungs compensate by retaining CO2 |
| The following are causes of what acid-base imbalance? * Starvation * dehydration * ketoacidosis * renal failure * shock * diarrhea * aspirin * acid ingestion * fistulas * severe infection * excessive GI loss | metabolic acidosis |
| The following are causes of what acid-base imbalance? * excessive vomiting * prolonged NG suctioning * electrolyte disturbance (hypokalemia) * Cushing's dz * drugs (steroids, diuretics, antacids) * hyperaldosteronism: too much Na+ & H2O buildup in b | Metabolic alkalosis |
| Clinical SxS of what acid-base imbalance? * headache * lethargy * irritability * decreased LOC * tachycardia * slow, shallow resp * N,V * paresthesia in extremeties * tetany | metabolic alkalosis |
| Clinical SxS of what acid-base imbalance? * headache * N,V * Kussmaul's breathing (shallow, rapid) * drowsiness * increased breathing * diarrhea * lethargy * decreased LOC * cardiac arrhythmias | metabolic acidosis |
| The following is treatment for what acid-base imbalance? * Reverse underlying cause * Administer Na HCO3- * Insulin to move K+ into cells | Metabolic acidosis |
| The following is treatment for what acid-base imbalance? * Reverse cause (thiazide diuretics, NG suctioning discontinued) * admin antiemetic * restore normal fluid volume | Metabolic alkalosis |
| How to know whether the body is compensating for an acid-base disorder: | pH is normal |
| Degree of compensation? * pH is normal but neither CO2 nor HCO3 is normal | complete compensation |
| Degree of compensation? * CO2 & HCO3 are moving in the same direction, but pH is not normal yet. | partial compensation |
| Degre of compensation? * One component is normal CO2 or HCO3), the pH is abnormal and 3rd component is abnormal. | uncompensated |
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