Chapter 17 Lewis
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| Intracellular Fluid Electrolytes | Potassium
Phosphate
Sulfate
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| Extracellular Fluid Electrolytes | Sodium
Chloride
Bicarbonate
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| EFC made up of | Intravascular Fluid (1/3 volume)
Inside blood and lymphatic vessels
Interstitial Fluid (2/3 volume)
Fluid between the cells
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| What mechanism pushes fluid out of the vessels | Hydrostatic pressure
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| If a person has low EFC, how does if effect BP? | Low
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| What is the result of Low BP for too long? | Shock
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| What is the mechanism that monitors for balance | Stretch baroreceptors
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| What are the electrolyte cations? | Na+ K+ Ca++
Mg++
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| What are the electrolyte Anions (-) ? | Cl -
HPO4-, H2PO4-
SO4-
HCO3-
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| Normal Sodium (Na+) range? | 135-155 mEq/L
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| What do sodium plasma changes reflect? | Changes reflect fluid volume changes
Does not reflect Na+ intake/output
Moves H2O in and out of cells
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| Diet Source of Na+? | table salt, dairy, poultry,meat eggs, processed foods
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| Potassium K+ Normal range? | Normal Range: 3.5 to 5.0 mEq/L
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| In the kidneys, what electrolyte has an inverse relationship with K+? | Sodium
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| What factors cause K+ to move from ECF to ICF? | Insulin, Alkalosis, stress, coronary ischemia,
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| What factors cause K+ to move from ICF to ECF? | Acidosis, trauma to cells, exercise, digoxin-like drugs
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| Causes of hyporkalemia | GI losses:V &D
Renal losses: diuretics, hyperaldosteronism,
Other: Diaphoresis, dialysis
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| Effect of insulin on K+? | Insulin: transfer K+ into skeletal and liver cells
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| Effect of aldosterone on K+? | Aldosterone: enhances renal excretion of K+
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| Replacement of K+ ? | Diet: appx 100mEq/day in diet
Replacement: IV K+
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| Causes of hyperkalemia? | excessive or rapid parenteral administrations
Drugs: penicillin
salt substitutes
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| Causes of K+ shifting out of cells? | Acidosis, fever
Tissue catabolism: fever, sepsis, burns
Crush ingury
Tumor lysis syndrome
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| Failure to eliminate K+ causes? | Renal disease
Potassium-sparing diuretics (spironolactone Aldactone)
Adrenal insufficiency
ACE inhibitors
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| Clinical manifestations of hyperkalemia? | Irritability, anxiety, abdominal cramping, diarrhea, weakness of lower extremities, paresthesias, irregular pulse, cardiac arrest
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| Calcium Ca++ Normal Range | Normal Range: 4.3 – 5.3 mEq/L (serum), 8.9 – 10.1 mEq/dL
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| Why Ca ++ ? | Cell membrane health
Wound Healing
Nerve synapse
Teeth and bone strength
Blood Clotting
Glycolysis
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| Calcium Ca++ Regulation | Parathyroid Hormone (PTH), Vitamin D:
Increases intestinal & renal reabsorbtion
Releases Ca++from the bones ( Ca++, HPO4-, H2PO4-
Decreases Ca++ levels and HPO4-, H2PO4-
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| Causes of hypercalcemia | Multiple myeloma, malignancies w/bone metastasis, prolonged immobilization, hyperparathyroidism, Vit D overdose, thiazide diuretics, milk-aldali syndrome
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| Clinical manifestations of hypercalcemia | lethargy, weakness, depressed reflexes, decreased memory, confusion, personality changes, psychosis, anorexia, nausea, vomiting, bone pain, fractures, polyuria, dehydration, nephrolithiasis, stupor, coma
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| Causes of hypocalcemia | chronic renal failure, elevated phosphorus, primary hypoparathyrodism, Vitman D deficency, magnesium deficiency, Acute pancreatitis, loop diuretics (furosemide:Lasix), chronic alcoholism, diarrhea
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| Clinical manifestations of hypocalemia | easy fatigability, depression, anxiety, confusion, numbness/tingling in extremities and around mouth, hyperreflexia, muscle cramps, Chvostek's sigh, laryngeal spasm, tetany, seziures
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| Tests for hypocalcemia | Chevostek's sign
Trousseaus sign :inflate BP cuff over systolic pressure for a few minutes-->carpal tetany
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| Treatment for hypercalcemia | loop diuretic & hydration w/saline; must drink 3000-4000ml of fluid daily to promote renal excretion of Ca++
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| Low Ca++: impact on action potentials | Lo Ca++ allows sodium to move into excitable cells, decreasing the threshold of action potentials--> tetany
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| Treatment of hypocalcemia | IV calcium supplements (DO NOT GIVE IM), Diet, oral supplements;
Thyroid or neck surgery may cause hypocalemia
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| Magnesium Mg++ Normal Range | Normal Range: 1.5-1.9 mEq/L
Why Mg++ ?
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| Function of Mg++? | Regulates neuromuscular function and cardiac activity
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| What organ regulates Mg++? | Kidneys
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| Mg++ flows with what other electrolyte | K+
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| Dietary sources of Mg+ | Leafy Greens, Legumes, Citrus, Peanut Butter, Chocolate
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| Phosphorus HPO4-, H2PO4- Normal Range | Normal Range: 1.7 – 2.6 mEq/L, ranges are higher in children and highest in infants.
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| Phosphorus is found primarily in what tissue? | Primarily found in bone (85%), then ICF (14%),
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| Phosphorus is regulated in what organ? | Regulated in kidneys though Vitamin D and PTH
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| Dietary sources of Phosphorus? | Dietary Sources: dairy, meats, veggies, fruits, cereals
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| Causes of hypophosphatemia | Malabsorption syndrome, glucose administration,parenteral nutrition, alcohol withdrawal, phosphate-binding antacids, recovery from diabetic ketoacidosis, respiratory alkalosis
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| Clinical manifestations of hypophosphatemia | CNS dysfunction (confusion, coma), Muscle weakness (including respiratory, weaning from ventilator), Renal tubular wasting, cardiac dysrythmias, decreased stroke volume, osteomalacia, rhadomyolysis
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| Causes of hyperphosphatemia | Renal failure, Chemotherapeutic agents, Enemas containing phosphorus (fleet), Excessive ingestion, Large vitamin D intake, Hypoparthyroidism
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| Clinical manifestations of hyperphosphatemia | Hypocalcemia, muscle problems, tetany, deposition of calcium-phosphate precipitates in skin, soft tissue, cornea, viscera, blood vessels.
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| Glucose Normal Range | Normal Range 70-110
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| S/S of Hyperglycemia | Polyphagia (frequently hungry)
Polyuria (frequently urinating)
Polydipsia (frequently thirsty)
Blurred vision
Fatigue …….
………Coma
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| S/S of Hypoglycemia | Shaky/Nervous
Tired/Sleepiness
Sweaty
Hungry
Irritable/Impatient
Strange behavior
Lack of coordination
Cold
Confusion/Delirum
Coma
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| Treatment Hyperglycemia | Diet
Exercise
Medication (PO)
Insulin
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| Treatment Hyperglycemia | Eat Carbohydrates
Hard candy
A regular not diet soft drink.
4 ounces of orange juice.
Two large lumps or teaspoons of sugar.
Glucose tablets
Glucose gel
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| S/S of hypovolemia | Postural hypotension, tachycardia, absence of JVP @45 degrees, decreased skin turgor, dry mucosa, supine hypotension, oliguria, organ failure
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| S/S of hypervolemia | HTN, tachycardia, raised JVP/fallop rythm & edema, pleural effusions, pulmonary edema, ascites, organ failure
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| Measurable losses | urine ( measure hourly if necessary )
GI ( stool, stoma, drains, tubes )
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| Insensible losses | sweat
exhaled
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| Hypervolemia Would you expect a patient’s BUN level to be high or low? | Low
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| Hypervolemia, What other symptoms would someone have? | HTN, ascites, peripheral edema, pulmonary edema
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| Hypervolemia, Would pulse be bounding or thready? | Bounding
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| How would you treat fluid volume excess? | Low sodium diet
Diuretics
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| Causes of hypovolemia? | Blood loss, fluid lost into the interstitial space (burns), excess water loss
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| Clinical manifestations of hypovolemia? | Low: BP, Pulse is fast & weak, body temp is low
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| Treatment for hypovolemia? | Isotonic solutions
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| Third space refers to: A. Vascular B. Interstitial C. Intracellular | Interstitial
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| Soduim imbalances are primarily seen in: Kidney kidney function Cardiac function Neuromuscular function CNS function |
CNS function
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| The amount and direction of movement between the interstitium and the capillary are determined by the interaction of | (1) capillary hydrostatic pressure, (2) plasma oncotic pressure, (3) interstitial hydrostatic pressure, and (4) interstitial oncotic pressure.
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| First spacing | the normal distribution of fluid in the intracellular fluid (ICF) and extracellular fluid (ECF) compartments
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| Second spacing refers to | an abnormal accumulation of interstitial fluid (i.e., edema
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| Third spacing occurs when | Third spacing occurs when fluid accumulates in a portion of the body from which it is not easily exchanged with the rest of the ECF.
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| The patient who cannot recognize or act on the sensation of thirst is at risk for | An intact thirst mechanism is important for fluid balance. The patient who cannot recognize or act on the sensation of thirst is at risk for fluid deficit and hyperosmolality.
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| An increase in plasma osmolality or a decrease in circulating blood volume will stimulate | An increase in plasma osmolality or a decrease in circulating blood volume will stimulate antidiuretic hormone (ADH) secretion. Reduction in the release or action of ADH produces diabetes insipidus.
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| The primary organs for regulating fluid and electrolyte balance | kidneys, lungs, and gastrointestinal tract
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| Insensible water loss, which is invisible vaporization from the lungs and skin, assists in regulating what? | Insensible water loss, which is invisible vaporization from the lungs and skin, assists in regulating body temperature.
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| With severely impaired renal function, the kidneys cannot maintain fluid and electrolyte balance. This condition results in | With severely impaired renal function, the kidneys cannot maintain fluid and electrolyte balance. This condition results in edema, potassium, and phosphorus retention, acidosis, and other electrolyte imbalances.
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| Fluid volume deficit can occur with | Fluid volume deficit can occur with abnormal loss of body fluids (e.g., diarrhea, fistula drainage, hemorrhage, polyuria), inadequate intake, or a plasma-to-interstitial fluid shift.
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| What is the easiest measurement of volume status? | Accurate daily weights provide the easiest measurement of volume status. Weight changes must be obtained under standardized conditions
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| How is edema assessed? | Edema is assessed by pressing with a thumb or forefinger over the edematous area.
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| acidosis | process that adds acid or eliminates base from body fluids.
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| active transport | process in which molecules move across a membrane against a concentration gradient.
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| alkalosis | process that adds base or eliminates acid from body fluids.
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| anions | negatively charged ions.
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| buffer | a substance that acts chemically to change strong acids into weaker acids or to bind acids to neutralize their effect.
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| cations | positively charged ions.
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| diffusion | the process in which particles in a fluid move from an area of higher concentration to an area of lower concentration.
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| electrolyte | an element or compound that, when melted or dissolved in water or another solvent, dissociates into ions and is able to conduct an electric current.
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| facilitated diffusion | the movement of molecules from an area of high concentration to one of low concentration at an accelerated rate with the assistance of a specific carrier molecule.
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| fluid spacing | the distribution of water in the body.
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| homeostasis | the state of equilibrium in the internal environment of the body, naturally maintained by adaptive responses that promote healthy survival.
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| hydrostatic pressure | the force that fluid exerts within a compartment.
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| hypertonic | solutions that increase the degree of osmotic pressure on a semipermeable membrane.
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| hypotonic | solutions that have a lower concentration of solute than another solution, thus exerting less osmotic pressure on a semipermeable membrane.
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| ion | an atom or group of atoms that has acquired an electrical charge through the gain or loss of an electron or electrons.
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| isotonic | fluids having the same concentration of solute particles as another solution, thus exerting the same osmotic pressure on a semipermeable membrane.
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| oncotic pressure | he osmotic pressure of a colloid in solution, such as when there is a higher concentration of a protein in the plasma on one side of a cell membrane than in the neighboring interstitial fluid.
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| osmolality | the measure of the osmotic force of solute per unit of weight of solvent (mOsm/kg or mmol/kg).
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| osmosis | the movement of water between two compartments separated by a membrane permeable to water but not to a solute.
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| osmotic pressure | amount of pressure required to stop the osmotic flow of water.
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| pH | abbreviation for potential hydrogen, a scale representing the relative acidity (or alkalinity) of a solution, in which a value of 7.0 is neutral, below 7.0 is acid, and above 7.0 is alkaline.
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| tetany | increased nerve excitability and sustained muscle contraction that results from low calcium levels that allow sodium to move into excitable cells, increasing depolarization; low calcium levels affect the membrane potential.
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| valence | the electrical charge of an ion that is a numeric expression of the capability of an element to combine chemically with other elements.
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