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N306 Fluid Balance, Electrolytes, Acid-Base [Ch 31] Pt 1

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Question
Answer
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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