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NUR 104- Chpt 37

Fluid & Electrolytes

QuestionAnswer
What does the hormonal regulation of fluid, electrolytes, and acid base balance consist of? -Hypothalamus -ADH -RAAS (renin angiotensin aldosterone system) -natriuretic peptide hormonal system
What is the purpose of the hypothalamus? makes you thirsty synthesizes ADH
What does ADH do? stops fluid from being lost (causing retention) so the body reabsorbs H2O
If you have an increase in fluid loss or a decrease in fluid intake, what happens to Osmolarity? Thus causing? Which then causes what? -Increases -ADH to release into circulation -more water reabsorbed in the kidneys (thus decreasing urine output)
If you have a decrease in fluid loss or an increase in fluid intake, what happens to Osmolarity? Thus causing? Which then causes what? -decreases -ADH blocked from being released into circulation -less water reabsorbed in the kidneys (thus increasing urine output)
ADH is sent out based on what? Osmolarity of blood
What is Osmolarity? An increase in osmolarity means what? -Solute concentration in the blood -a fluid volume deficit (blood flows slower)
The RAAS cycle is activated in response to what? blood volume
IF the blood volume drops what is the first step of the RAAS cycle? Renin is released from kidneys and stimulates the release of Angiotensin I
When Angiotensin I is released in response to a blood volume drop, what happens next? Angiotensin I quickly converts to Angiotensin II (potent vasoconstrictor) Angiotensin II causes vasoconstriction, thus increasing the blood flow so that it will flow faster.
Once Angiotensin II responds to a blood volume drop by vasodialating, what happens next? Angiotensin II stimulates the secretion of aldosterone (helps retain Sodium in the kidneys, therefore retains H2O also) This pulls in H2O from the tissues to balance fluid volume
The Natriuretic peptide hormone system is excreted from where? why? -Heart muscle -increase fluid volume
If high fluid volume pressure in increased on the heart what happens? -ANP (atrial natriuretic peptide) is released, thus causing sodium excretion (and H2O goes with via urine, perspiration, etc
IF low fluid volume pressure, there is no pressure on the heart, what happens? ANP is not released thus causing Sodium retention (H20 stays in)
If Carbon Dioxide combines with water it becomes what? ACID- Carbonic Acid H2CO3
Increased H+ = more_____ Decreased H+ = less ______ -acidic -acidic
Increased CO2= more _____ Decreased CO2= less _____ -acidic -acidic
Since Bicarbonate is a base (buffer) What happens if we increase HCO3-? What if we decrease HCO3-? -more alkaline -less alkaline
Carbon Dioxide, Hydrogen, and Bicarbonate are all contolled by what systems? Repiratory and Renal
A patient has been vomiting for 4 days. What type of acid base balance is this. -Metabolic (not respiratory) -alkalosis
Nursing student begins to hyperventilate while taking his final exam. What type of acid base imbalance is this? -Respiratory -Alkalosis (bc exhaling CO2 quickly-expelling acid)
A 79 year old pt experiencing renal failure. What type of acid base imbalance is this? -Metabolic (not respiratory) -Acidosis (losing bicarbonate-making it more acidic)
A 19 year old pt overdoses on Oxycontin, a narcotic. What type of acid base imbalance is this? -Repiratory (narcotics slow respirations) -acidosis (slowly expelling CO2-acid)
pH 7.48, PaCO2 36 mmHg, HCO3- 32mEq/L -Metabolic -alkalosis
pH 7.32, PaCO2 47 mmHg, HCO3- 25mEq/L -Repiratory -acidosis
If a patient has diarrhea, they are getting rid of what? HCO3- (bicarb)
If a patient is vomiting, they are getting rid of what? acids
How does the body compensate for Acid Base imbalances? If its a respiratory problem, kidneys compensate by regulating HCO3- If its a metablic problem, respiratory system compensate w/ CO2
How will the body compensate for severe diarrhea? -metabolic acidosis -resp sys will try to fix bc of low pH, thus increasing breathing to get rid of CO2 (acid)
How will the body compensate for Repsiratory weakness -respiratory acidosis (retaining C02) -renal tries to fix by retaining bicarb (HCO3-)
How will the body compensate for Starvation? -metabolic acidosis (pH level is lower) -resp sys will try to fix by increasing respirations to get rid of acid (CO2)
An increase or decrease of sodium from the norm can cause what? What type of assessment would you do? neuroligical problems neuro focused assessment
An increase or decrease in potassium causes what? What type of assessment would you do? -cardiac porblems -cardiac focused assessment
If potassium is increase, what happens to glucose? If potassium is decreased what happens to glucose? -decreases -increases
An increase of decrease in Calcium causes what? What type of assessment would you do? -muscular problems -muscular focused assessment
If you have hypercalcemia, what type of reflexes would you have? hyporeflex
If you have hypocalcemia, what type of reflexes would you have? hyperreflex (seizure, tetany)
Chvostek's sign tap on face, it will twitch if hypocalcemic
Trousseau sign tighten bp cuff, hand tightens if hypocalcemic
If calcium levels are increased, what happens to phosphorous levels? If calcium levels are decreased, what happens to phosphorous levels? -decrease -increase
What does a BMP (basal metabolic panel) measure? electolyte levels (Na, K, CL, O2)
What does a CMP (complete metabolic panel) measure? electrolyte levels but more detailed with BUN, albuin, creatinine, etc
What does Urine specific Gravity measure? concentration of urine solutes the higher the number, the more concentrated the lower the number, the less concentrated
What are some nursing diagnoses related to Fluid, Electrolyte, Acid Base balance? 1. Deficient Fluid Volume 2. Excess Fluid Volume 3. Risk for deficient fluid volume 4. risk for imbalance of fluid volume 5. ECF volume excess/ deficit 6. water excess/deficit 7 fluid volume deficit 8 fluid volume excess 9 risk for electrolyte i
An isotonic solution has -normal saline (.9% Na CL) -LR (lactated ringers) (volume expanders) -D5 .25% Na CL So if the numbers increase, what type of solution is it? If the numbers decrease what type of solution is it? -hypertonic -hypotonic
Vascular fluid is located where? inside blood and lymph vessels
Interstitial fluid is located where? between cells
Intracellular fluid is located where? in cells
extracellular fluid is what? includes intravascular and intersitial fluid (not in cells)
What is the difference in hydrostatic pressure and osmotic pressure? hydro-outward pressure osmotic- inward pressure
If hydrostatic pressure is 32 mm Hg and osmotic pressure is 22 mm Hg filtration is + 10mm what does this mean? since this is + fluid filters OUT of the vessel into interstitial fluid
If hydrostatic pressure is 12 mm Hg and osmotic pressure is 22 mm Hg filtration is -10 mm What does this mean? since this is - fluid filters FROM interstitial fluid
Hypovolemia, saline deficit, or isotonic dehydration indicate what? ECF volume deficit
Often people with caridac failure or renal failure or liver disease have what type of fluid volume? ECF volume excess
Hyperosmolarity is AKA? Water Deficit
Hypoosmolarity is AKA? Water Excess
You have someone with increased blood sugar. You want to move fluids from cells to vasculature. 3%NaCl, 5% NaCl, D5 .45% NaCl, D5 .9% NaCl The nurse know that what type of IV fluid will be used in this situation? Hypertonic
You have somewone with tissue that looks dry and wrinkly with poor skin turgor, they need more fluid. .45% NaCl The nurse knows that what type of IV fluid will be used in this situation? Hypotonic
If you assess an irregular heartbeat, what in terms of elecrolytes is going on? potassium issue
What is the most critical volume imbalance? Why? -ECF deficit -leads to low BP, shock, death
What are some signs and symptoms of ECF deficit? -weight loss -thirst -weak rapid pulse
How would you treat an ECF deficit, oral or IV replacement of what???? give an example of what to give a patient orally. Give an example of what to give a patient via IV. -sodium, chloride, H20 in the same concentrations as found in body fluid -tomato juice -normal saline
What are signs and symptoms of ECF excess? -rapid weight gain -increased BP -bounding pulse -full thickness neck veins
How can ECF excess cause pulmonary edema? And characterized by? -by filtering across the alveoli into the lungs -dyspnea, orthopnea, crackles/rales
How would you treat ECF excess? -low sodium diet -administer diuretics
Any solution that has a higher osmotic pressure than another solution (draws fluid out of the cell and into the extra cellular space) hypertonic solutions
Any solution that has a lower osmotic pressure than another solution (pushes fluid into the cell) hypotonic solution
Any solution that has the same osmotic pressure as another solution (fluid flows in and out equally) isotonic solution
A patient comes into the ER after a motor vehicle accident. Respirations are 6, shallow but slow breathing. The nurse anticipates what type of acid base imbalance? Respiratory Acidosis (breathing is slow, therefore less CO2 (acid) being expelled, therefore its being retained causing an acidic enviornment
A patient has COPD and is breathing fast and shallow, 32 respirations. The nurse anticipates what type of acid base imbalance? Respiratory Alkalosis-the pt is breathing fast, therefore they are expelling CO2 (acid) therefore its making an alkolitic enviornment.
Used to replace extracellular fluid & electrolyte losses and to expand vascular volume quickly Isotonic IV fluids
Used to prevent or treat cellular dehydration by providing free H20 to cells or to restore renal function Hypotonic IV fluids
Pulls excess fluid from the celss, treatment is for very specific problems Hypertonic IV fluids
Which IV fluid requires frequent monitoring of vitals and level of consciousness? Hypotonic IV fluids
If you have an isotonic solution and you remove solutes, what does this do to osmolarity? Causing what? -decreases it -Hypotonic Solution
If you have an isotonic solution and you add solutes, what does this do to osmolarity? Causing what? -increases it -Hypertonic Solution
Created by: jessicaspring