N306 Fluid Balance, Electrolytes, Acid-Base [Ch 31] Pt 1
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What type of ion is released by the lungs to help maintain the correct pH level in the body? | Carbon dioxide
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Who has more water content: adults or peds? | Peds
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Do fluids and molecules move easily cross between the ECF and ICF? | Water does, but NOT large molecules or ions
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Excess fluid volume can lead to _____.(3) | HTN, CHF, and peripheral edema
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Fluid volume depletion can lead to ______. (3) | dehydration and shock
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intracellular space | contains water inside the cells
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extracellular space | contains water outside the cells
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Identify the 2 parts of the ECF. | intravascular space (fluid in the plasma); interstitial space (fluid between cells)
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Adults have more fluid in the ______ and peds have more fluid in the ______. | Adults have more fluid in the ICF; peds more in the ECF
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fluid balance | continuous exchange and mixing of fluids occurs between various compartments, which are separated by membranes
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Describe the fluid movement within the capillary beds. | Constant movement of fluids between ECF fluids, interstitial and intravascular
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Identify the 2 processes that govern the movement of large molecules and ions between compartments. | Diffusion and active transport
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TRUE/FALSE: The older you get, the less water body weight. | TRUE
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Identify the most important physiologic regulator of fluid intake. | Thirst mechanism
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thirst mechanism | Osmoreceptors in the hypothalamus sense that the ECF has become hypertonic
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Fluid intake must be ______ before reaching vascular compartment, due to ______> | must be absorbed; due to osmotic forces
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How is water output achieved? (5) | Through the kidneys, lungs, skin, feces, sweat
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intercellular | movement of fluid between cells
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intracellular | movement of fluid inside cells
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osmolality | concentration of particles (solutes) dissolved in fluid
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Identify the three solutes that determine osmolality. | Sodium, glucose, and urea
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tonicity | ability of a solution to cause change in water movement across a membrane due to osmotic forces
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Normal plasma is considered ______. [hypertonic/hypotonic/isotonic] | isotonic
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_____ solutions have the same concentration of solutes as plasma. | Isotonic
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_____ solutions have a greater concentration of solutes than plasma. | Hypertonic
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_____ solutions have a lesser concentration of solutes than plasma. | Hypotonic
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If you give a hypotonic soln, where does the fluid go and how does it affect the cell? | Hypotonic: Fluid goes INTO THE CELL; makes the cell bigger; make them burst
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If you give a hypertonic soln, where does the fluid go and how does it affect the cell? | Hypertonic: Fluid will move OUT OF CELL into the ECF; cells will shrink
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Identify fluid loss through abnormal routes. (7) | Vomiting, NGT, bleeding, wounds, burns, 3rd space fluid accumulation (e.g. ascites), paracentesis
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paracentesis | perforation of a cavity of the body or of a cyst or similar outgrowth, esp. with a hollow needle to remove fluid or gas
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During what period is ADH released? | Periods of high osmolality
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How are fluid deficit disorders treated? | oral of IV fluids
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How are fluid excess disorders treated? | Diuretics
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electrolytes | are minerals in your blood and other body fluids that carry an electric charge
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Are electrolytes located in the ICF or ECF? | Both
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What are sources of electrolyte intake? (3) | Diet, medications, blood tranfusion
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Where are electrolytes absorbed? | GI tract
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Can drug therapy cause electrolyte imbalance? | Yes
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What affects electrolyte distribution? (4) | Medications, hormones, cells, bones
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Identify 3 methods in which electrolytes are excreted. | Urine, feces, sweat
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Aggressive therapy with loop diuretics can rapidly deplete _______ and _______. | sodium and potassium
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hyponatremia | less salt in ECF, water excess in ECF
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Hyponatremia causes ________. | water to move into cells, causing swelling of cells
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What 3 process does sodium have a central role in? | Neuromuscular physiology, acid-base balance, overall fluid distribution
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When sodium increases, osmolality _______. | increases
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Identify early signs of hyponatremia. | n/v, anorexia, abdominal cramping
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Identify late signs of hyponatremia. | altered neurological function, i.e. confusion, irritability, lethargy, convulsions, coma, muscle twitching, tremors
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How is hyponatremia treated? | Oral or IV sodium chloride; or with IV fluids containing salt, e.g. normal salie or lactated ringer's
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hypernatremia | more salt in ECF; less water in ECF
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Hypernatremia causes ________. | Water moves OUT of cells leading to cellular dehydration and shrinkage
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hypovolemic | of or relating to a decrease in the volume of circulating blood
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hypervolemic | condition consisting of an increase in the volume of circulating blood
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How do you treat a pt with hypernatremia who is hypovolemic? | Infuse hypotonic fluids such as dextrose 5% or 1/2 NS, which will increase plasma volume while reducing plasma osmolality
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How do you treat a pt with hypernatremia who is hypervolemic? | Diuretics to remove sodium and fluid from the body
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Edema is fluid _______. | between cells (interstitial compartment)
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What conditions or diseases cause edema? (5) | Burns, CHF, cancer, lymphatic problems, liver problem
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Clinical manifestations of edema include ________. (2) | puffy extremities, pitting edema
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Treatment for edema is ________. | diuretics
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What processes require potassium? (2) | Proper nerve and muscle functioning; maintaining acid-base balance
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What organ will be majorly affected by high or low potassium? | Heart
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hypokalemia | low potassium in the ECF
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Identify the etiology/pathogenesis of hypokalemia. | Diet (low potassium intake) and use of loop diuretics
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Both hyper- and hypokalemia are associated with ____________. | Fatal dysrhythmias and serious neuromuscular disorders
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Why is adequate daily intake of potassium necessary? | Body does not have large stores of it
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Identify the clinical manifestations of hypokalemia. | Muscle weakness, lethargy, anorexia, DYSRHYTHMIAS, IRREGULAR HEART BEAT, palpitations, cardiac arrest, HIGH/LOW HR [Note: Heart and muscle related]
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Treatment for MILD hypokalemia includes _______. | Increase in dietary intake of potassium-rich foods
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Treatment for moderate/severe hypokalemia includes _______. | Oral or parenteral potassium supplements
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Why can't potassium be given IV push? | It will stop the heart
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Why must IV doses of potassium be small and delivered through a pump? | Needs to be controlled because of effects on heart; potassium is irritating to veins, must check for phlebitis
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phlebitis | inflammation of walls of a vein
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hyperkalemia | high potassium in the ECF
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Identify the etiology/pathogenesis of hyperkalemia. | Diet, medications (potassium sparing diuretics), CHF, renal failure
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Identify the clinical manifestations of hyperkalemia. | DYSRHYTHMIAS, HEART BLOCK, fatigue, twitching, cramping, dyspnea
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Identify the treatment option(s) for moderate/severe hyperkalemia. | Glucose and insulin; sodium bicarbonate (for concurrent acidosis); polystyrene sulfonate (Kayexalate) orally or rectally
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Polystyrene sulfonate (Kayexalate) for treatment of hyperkalemia must be given concurrently with _______. Why? | laxative, such as sorbitol, to promote rapid evacuation of potassium
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______ or _______ may be administered to counteract potassium toxicity to the heart. | Calcium gluconate or calcium chloride
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A pt is on digoxin and potassium is low, what is the nurse's first action? | Notify the doctor
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hypocalcemia` | low calcium in the ECF
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Identify the etiology/pathogenesis of hypocalcemia. | Insufficient intake or absorption, renal failure
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Identify the clinical manifestations of hypocalcemia. | Neuromuscular excitability (tingling, spasms), intestinal cramping, MUSCLE AND BONE PAIN DUE TO SOFTENING
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Identify the function(s) of calcium. | Metabolic processes, bone and teeth, hormone regulator, plasma membrane stability/permeability
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Where does the body get calcium when the conc. is too low in the blood? | Blood will get calcium from bones, thus making them soft and eventually causing hypocalcemia
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Identify calcium-rich foods. | Dairy products, milk, cheese, yogurt, fortified cereals/OJ, green leafy vegetables, sardines, soybeans
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hypercalcemia | high calcium in ECF
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Identify the etiology/pathogenesis of hypercalcemia. | DIET, excess vit D, cancer, endocrine problems, low phosphate
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Identify the clinical manifestations of hypercalcemia. | KIDNEY STONES, impaired renal function, bone pain, cardiac problems, many nonspecific
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______ has an inverse relationship with ______. | PHOSPHATE has an inverse relationship with CALCIUM.
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S/s of hypophosphatemia are the same as with ________. | hypercalcemia [Note: The inverse relationship]
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hypophosphatemia | low phosphate in ECF
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Identify the etiology/pathogenesis of hypophosphatemia. | Hypercalcemia, resp. alkalosis, s/t cancer, thyroid problems, renal impairment
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Identify the clinical manifestations of hypophosphatemia. | Similar to hypercalcemia: KIDNEY STONES, impaired renal function, bone pain, cardiac problems, many nonspecific
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hyperphosphatemia | high phosphate in ECF
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Identify the etiology/pathogenesis of hyperphosphatemia. | Excretion problems, renal failure
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Identify the clinical manifestations of hyperphosphatemia. | Similar to hypocalcemia: nerve/muscle function, irritability, confusion, possible resp. failure; Neuromuscular excitability (tingling, spasms), intestinal cramping, MUSCLE AND BONE PAIN DUE TO SOFTENING
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hypomagnesemia | low magnesium in ECF
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Identify the clinical manifestations of hypomagnesemia. | Diet, alcoholism, s/t heart disease, cancer, MSK probs
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Identify the etiology/pathogenesis of hypomagnesemia. | DYSRHYTHMIAS, SEIZURE, TUMORS, MUSCLE WEAKNESS,
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torsades de pointes | ventricular tachycardia that is characterized by fluctuation of the QRS complexes around the electrocardiographic baseline and is typically caused by a long QT interval
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hypermagnesia | high magnesium in ECF
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Identify the etiology/pathogenesis of hypermagnesia. | renal failure
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Identify the clinical manifestations of hypermagnesia. | Cardiac problems (hypotension, bradycardia), muscle weakness, decreased reflex in deep tendons,
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