| 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 |
