Question | Answer |
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 |