Physiologic Mode
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| Homeostasis | state of equilibrium
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| Physiologic homeostasis: | state of balance within the body
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| These changes have to be equalized for Fluid & Electrolyte balance to occure: | Water & various substances are constantly passing into and out of the body
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| 45-75% of body fluid is? | Water
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| Primary body fluid and major solvent is? | Water
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| Solutes? | particles or electrolytes and non-electrolytes
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| Most important nutrient of life? | Water
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| ICF-40% of body water? | Intracellular fluid
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| ECF-Saline? | extracellular fluid - has two compartments.
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| What maintains blood volume? | Water
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| What regulates temperature? | Water
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| What aids in digestion? | Water
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| Which solutes have electrical charge to them (-/+) and are measured in mEq/L? | electrolytes.
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| 75% of extracellular fluid? | Interstitial fluid - in between cells, bathes cell, includes lymph.
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| 25% of extracellular fluid? | Intravascular fluid - plasma, liquid part of blood (contains leukocytes, erythrocytes & platelets) = 3 Liters.
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| 1 Liter of fluid = 1 Kg of body weight = ? | Equals to 2.2 pounds.
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| What does sudden increase in weight might indicate? | Sudden increase in weight probably means fluid gain & usually happens to cardiac or kidney patients.
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| First fluid spacing means: | normal distribution of fluids.
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| Second fluid spacing means: | abnormal accumulation of interstitial fluid (edema).
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| Third fluid spacing means: | fluid trapped & cannot easily move back into ECF (that's edema associated with burns or ascites).
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| What active chemicals are present in all body fluids? | Electrolytes.
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| What separates fluids in different compartments? | semi-permeable membrane.
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| Why does change in one compartment produces change in other compartments of the body fluids? | Because body always tries to maintain homeostasis (balance).
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| Fluids have different components in each compartment. | True.
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| How many solute types are there? | Two.
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| How many electrolyte types are there? | Two.
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| First solute type is? | non-ionized substances (glucose, creatinine, urea). They have no electrical charge when dissolved in a solution.
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| Second type of solutes are? | electrolytes: potassium, sodium, chloride - they carry an electrical current & dissociate into ions when dissolved in a solvent.
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| Define two types of electrolytes: | cations+ = possitive charge
anions- = negative charge
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| Primary IC cation is: | Potassium (K+)
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| Primary EC cation is: | Sodium (Na+)
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| Primary IC anion is: | Phosphate (PO4-)
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| Primary EC anion is: | Chloride (Cl-)
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| What are two identical composites of ECF compartments? | 154 cations + 154 anions = 308mEq/L
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| In what way are the two ECF compositions different? | Intravascular fluid has proteins which cannot pass thru the capillary walls, but interstitial fluid doesn't have those proteins.
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| What is the smallest protein molecule that holds the fluid in the vascular space? | albumin
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| Chem 7 OR (SMA7) OR BMP | test of electrolytes => Na|Cl|Gluc|creatinine (0.7-1.2)|K+|CO2|BUN
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| What does BUN indicate? | hydration of the body
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| Define concentration of body fluids: | it's determined by the number of particles dissolved in a unit of solvent & is expressed as OSMOLARITY (the number of milliosmols per liter of fluid (mOsm).
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| What osmolarity do ICF and ECF have? | Both have osmolarity of approximately 300mOsm/L.
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| What terms are used interchangeably? | osmolarity and osmolality
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| What determines osmolarity? | it's determined by weight or how how many particles are there. Serum osmolarity reflects total body hydration.
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| What determines osmolality? | it's determined by volume.
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| Do solutes and fluids move from compartment to compartment? | Yes, they move to meet metabolic needs, acid-base disturbances & in response to drug therapy.
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| What are two transport systems? | Active and Passive.
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| Define Active transport system? | It requires energy (ATP) to Pump particles (ex. Sodium or Potassium) across cell membranes from levels of low concentration to high concentration.
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| What is Passive transport system? | No energy needed to transport particles. Instead it uses processes of osmosis, diffusion, & filtration to transport.
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| Define Osmosis: | Water goes to salt = movement of fluid from an area of lesser solute concentration to an area of greater solute concentration.
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| Define Diffusion: | The movement of solute from an area of greater solute concentrationto an area of lesser solute concentration.
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| Define Filtration: | the movement of water and small particles by hydrostatic pressure.
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| Define Osmotic Pressure: | Drawing or pulling of water, depends on the number of molecules in the solution. A solution with a high solute concentration has a high osmotic pressure.
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| What are the two divisions of osmotic pressure: | crystalloid & colloid
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| Define crystalloid: | non-proteins = dissolved ions that can pass through a membrane.
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| Define colloid: | gelatinous substances which do not pass through a membrane because they are bigger (ex. plasma proteins).
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| What's a good friend of Albumin? | Calcium = it behaves like albumin - if albumin is low, calcium will also be low.
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| Define albumin: | It's a smallest blood plasma protein.
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| What does albumin affect? | It affects osmotic pressure of blood by exerting a colloid osmotic pressure or oncotic pressure which tends to keep fluid in the capillaries.
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| What should you do if the albumin levels are decreased? | assess the patient for edema (it means that the fluid leaks out of capillaries into the interstitial spaces).
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| Define Iso-osmolar: | it has same osmolarity as body fluids. Patients with hypovolimia or low blood pressure are given these kind of fluids.
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| Define hypo-osmolar: | Less osmolarity than body fluids - solution will cause cells to inlarge. So, fluids shift from intravascular to interstitial <- inside of cells.
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| Define hyper-osmolar: | greater osmolarity than body fluids - given to edema patients to move interstitial fluid to intervascular space.
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| Define isotonic: | solution with the same osmolarity as the cell interior.
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| What will hypotonic solution do? | it will increase cell's volume because this solution has a lesser concentration of solutes than the cell interior.
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| What will hypertonic solution do? | will decrease cell's volume because this solution has a greater concentration of solutes than the cell interior.
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| Define Iso-osmolar fluid deficit: | decreased body water & electrolytes. EC fluid remains iso-osmolar but volume decreases.
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| What will be assessment findings in case of iso-osmolar fluid deficit? | hypotension, increased pulse & respiratory rate, cool skin, delayed vein filling, decreased urine output & shock can develop.
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| How would you treat a patient in case of iso-osmolar fluid deficit? | replace losses with water and sodium (0.9%NS, isotonic).
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| Define hyper-osmolar fluid deficit: | more of a decrease in body water than electrolytes. Water moves out of the cells to dilute ECF.
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| What will be assessment findings in case of hyper-osmolar fluid deficit? | thirst, flushed skin, poor skin turgor, dry tongue, increased temp, increased Hct, increased BUN, and restlessness.
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| How would you treat a patient in case of hyper-osmolar fluid deficit? | Replace water orally or I/V (5% D/W).
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| Define hypo-osmolar fluid excess: | excess body water without excess electrolytes. Water moves into the cells causing them to swell.
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| What will be assessment findings in case of hypo-osmolar fluid excess? | behavioral changes, confusion, sudden weight gain, warm moist skin, lethargy & convulsions.
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| How would you treat a patient in case of hypo-osmolar fluid excess? | replace with hypertonic saline I/V (5%D & 0.9NS) and restrict water
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| Define iso-osmolar fluid excess: | excess body water and sodium. The excess fluid moves into the extracellular spaces.
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| What will be assessment findings in case of iso-osmolar fluid excess? | weight gain, edema of dependent parts (lower extremity and sacral area), pitting edema over body prominences, pulmonary edema, dyspnea, and cyanosis.
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| How would you treat a patient in case of iso-osmolar fluid excess? | restrict salt, diuretics, elevate extremities & oxygen therapy.
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| What does Hypothalamus regulate? | Thirst mechanism, but it doesn't work very well for elderly.
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| What does Pituitary gland regulate? | It stores and secretes ADH (anti-diuretic hormone) and vasopressin which regulates water retention by the kidneys.
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| What does Adrenal gland regulate? | secretes aldosterone (mineralocorticoid) and regulates sodium and potassium balance.
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| What does Parathyroid gland regulate? | secretes PTH, which drops C++ levels & raises P- levels (inverse relationship). As PTH increases, Calcium reabsorption is increased & P- excretion is increased. So, if PTH decreases, then the process reverses.
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| What does Lymphatic system do for regulation of Body Fluids? | It brings fluid back to the heart.
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| What do Lungs do for regulation of Body Fluids? | They regulate Acid/Base balance.
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| What do kidneys do for regulation of Body Fluids? | They respond to our blood volume. Also, they reabsorb and secrete Fluids and Electrolytes.
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| In terms of kidneys and fluid regulation, what happens when blood volume drops? | Renal perfusion also drops, then kidneys release renin. Renin combines with angiotenogen to form Angiotension 1.
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| What happens in the lungs with angiotension 1? | It's converted to angiotension 2.
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| What does Angiotension 2 does? | It stimulates adrenal cortex to release aldosterone. Aldosterone directs kidneys to reabsorb Sodium; water follows Sodium back to ECF.
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| What will decrease in cardiac output do to kidney perfusion? | It will decrease kidney perfusion. So, cardiovascular function maintains blood pressure to ensure adequate renal perfusion.
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| What will be released from atrium when the heart is in fluid overload? | Atrial Natriuretic Peptide.
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| What will Atrial Natriuretic Peptide do? | It will decrease fluid retention by blocking secretion and action of Aldosterone and inhibit renin secretion.
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| Define Anasarca: | It's when organ systems are shutting down and fluid occumulates in all of the compartments of the body. Also known as "extreme generalized edema".
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| Define term "Intake": | Normal 24hr Intake is 2500-3000ml. Intake comes from fluids we ingest, solid foods & from metabolism. Intake & Output should balance out.
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| Define term "Output": | Normal 24hr fluid Output is 2500-3000ml. Output is through sensible & insensible losses.
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| Define Sensible losses: | those that can be measured. Ex.: Urine, secretion of drainage tubes (wound drain or GI tube drain), or vomit=emesis
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| Define Insensible losses: | those that cannot be measured.
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| Define Insensible loses: | They cannot be accurately measured, ex.: perspiration (usualy 600ml), fluid lost with respiration (usually 300ml), fluid loss in feces (usually 100ml), fever & increased environmental temp, thus increased fluid loss thru lungs & skin.
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| Signs & sypmtoms of (FVD) Hypervolemia (ECF excess) = Circulatory Overload: | Acute weight gain; ↑ interstial vol. (edema); ↑ vascular vol; ↑ JVD, pulmonary edema, SOB, tachypnea, crackles, cough, ↑ B/P, bounding pulse, confusion, lethargy, pitting edema; ↑ Na, Hct, BUN, urine specific gravity; ↓ O2 levels.
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| Treatment of (FVD) Hypervolemia (ECF excess) = Circulatory Overload: | Watch Vital Signs & lung sounds often; Maintain IV access; Strict I & O; Fluid restrictions; Foley-hourly o/p; O2; Diuretics-daily weights; watch lab data; Watch for signs & symptoms of hypovolemia; watch cerebro-osmotic diuretics to prevent neuro-damage.
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| Signs & sypmtoms of (FVD) Hypovolemia (ECF deficit) = Loss of fluids & solutes: | Change in mental status, anxiety, restlessness, thirst; tachycardia, delayed capillary refill, orthostatic B/P; Urine o/p<300ml/hr; cool, pale skin; weak or absent pulses; ↑ Hct, BUN, urine specific gravity.
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| Treatment of (FVD) Hypovolemia (ECF deficit) = Loss of fluids & solutes: | Watch vital signs, lung sounds, & mental status; O2, watch ABG's, EKG; Maintain IV (isotonic=↑ bld vol); strict I&O, Foley-hourly if necessary; Daily wght; watch peripheral pulses & skin temp; change position slowly.
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| Changes in which of the major cations IC will affect cardiac function? | Potassium (K+).
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| What is the normal serum value for (K+)? | 3.5 - 5.0mEq/L
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| List 4 major functions of (K+)? | regulation of all types of neuromuscular activity; aids in regulation of acid-base balance; maintains osmotic pressure of ICF; aids in promotion of cardiac muscle activity.
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| What is the primary way thru which (K+) is regulated? | It is primarily regulated by kidneys (80%), although some excretion occurs via the feces (20%).
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| When does K+ move into cells? | When glucose is metabolized.
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| When does K+ move out of cells? | Via strenuous exercises; impaired cellular metabolism; or when cell dies.
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| Values of Hyperkalemia? | serum K+ are above 5.0mEq/L = acidosis.
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| Values of Hypokalemia? | serum K+ are below 3.5mEq/L = alkalosis
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| K+ should never be administered at a rate greater than? | 10mEq/hour I/V. Use extreme caution when administering to patients with renal disease.
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| What should you monitor for in patients with abnormal K+ levels? | Cardiac dysrhythmias.
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| What is the major EC cation? | Sodium (Na+)
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| What is the normal serum value for (Na+)? | 135-145mEq/L.
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| List 4 major functions of (Na+)? | Generation & transmission of nerve impulses; regulation of osmotic pressure; aids in regulation of Acid/Base balance; regulates fluids in ECF.
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| What is the primary way Sodium (Na+) is regulated? | Intake; aldosterone level; & urine output.
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| Serum values for Hypernatremia? | Na+ above 145mEq/L = patient may actually halucinate.
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| Serum values for Hyponatremia? | Na+ level below 135mEq/L.
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| What do serum Na+ levels primarily indicate? | body water distribution.
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| What is Osteomalacia? | It's softening of bones due to decrease in calcium & other necessary minerals. Calcium follows Vitamin D, thus Osteomalacia is usually caused by deficiency in Vitamin D, which in turn brings about demineralization of bones.
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| What is distribution of Calcium (Ca+) would be like in a human body? | It can be found in ICF & ECF, 99% in bones & 1% in blood plasma.
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| Normal serum values for Ca+? | 8.4-10.5mg/dl.
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| What are the functions of Ca+? | Initiation of muscle contraction; aids in blood coagulation; aids in the formation of bones and teeth.
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| How is Ca+ regulated? | It's primarily regulated by parathyroid (PTH).
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| What is necessary for Ca+ absorption from the GI tract? | Vitamin D.
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| Serum values for Hypercalcemia? | Above 10.5mg/dl.
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| Serum values for Hypocalcemia? | Below 8.4mg/dl = may lead to tetany, which is a clinical neurological syndrome characterized by muscular twitching and cramps and (when severe) seizures.
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| Describe Chvosek's sign: | tapping of the facial nerve elicits twitching of the nose, face or mouth.
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| Describe Trousseau's sign: | inflation of B/P cuff for 1-5 min. elicits a spasm of the fingers and hand.
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| Define positive Trousseau's or Chvosek's sign: | indicates neuromuscular excitability.
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| What is Mg+? | Magnesium is an IC cation.
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| Normal serum values for Mg+? | 1.3-2.1 mEq/L.
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| What are the functions of Mg+? | It aids in carbohydrate (CHO) & protein metabolism; influences muscular activity; aids in clotting mechanism; produces cellular energy.
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| How is Mg+ primarily regulated? | By kidneys.
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| Serum values for Hypermagnesmia? | Above 2.1mEq/L.
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| Serum values for Hypomagnesemia? | Below 1.3mEq/L.
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| What is a major EC anion? | Chloride (Cl-).
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| Normal serum values for Cl-? | 95-100mEq/L.
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| What are the functions of Cl-? | Helps to maintain osmotic pressure; participates in maintaining water balance; participates in maintaining Acid-Base balance; participates in gastric digestion.
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| How is Cl- primarily regulated? | Primarily by kidneys & according to Acid/Base balance, aldosterone secretion and dietary intake.
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| Serum levels for Hyperchloremia? | Above 100mEq/L.
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| Serum levels for Hypochloremia? | Below 95mEq/L.
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| What is the major IC anion? | Phosphate (PO4-).
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| Normal serum values for PO4-? | 2.5-4.5mg/dl.
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| What are the functions of PO4-? | Aids in metabolism of carbohydrates (CHO), proteins, & fat; helps in maintaining Acid/Base balance; helps to store & transfer energy from one size in the body to another; helps to form bones.
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| What primarily regulates PO4-? | The kidneys, parathormone & activated vitamin D.
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| Ca+ & PO4- have a reciprocal relationship, thus increase in serum Ca+ levels will cause a: | decrease in the serum PO4-.
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| Serum levels for Hyperphosphatemia? | Above 4.5mg/dl.
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| Serum leves for Hypophosphatemia? | Below 2.4mg/dl.
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| What is a major buffer within the body? | Bicarbonate (HCO3-).
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| Normal serum values for HCO3-? | **Arterial = 22-26mEq/L(HCO3)
**Venous = 24-30mEq/L(TCO2)
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| What is a function of HCO3-? | Essential in the regulation of acid-base balance.
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| How is HCO3- regulated in the body? | Primarily by the hemoglobin-oxyhemoglobin system, potassium-hydrogen exchange, & by the kidney & lungs physiologically.
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| List 8 variables affecting Fluid & Electrolyte balance: | Age; Pregnancy; Older; Body size; Environmental temp; Diet; Stress; Exercise.
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| How does age affect F&E balance? | Elderly take longer to correct F&E imbalances; decrease in kidney perfussion; usually have lower consumption of food; 2Gm Na+ diets (Na+ & H2O go together); ↓thirst.
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| How does body size affect F&E balance? | Fat has less water; lean tissue (muscles) have lots of H2O. Females have more fat.
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| What does ECF imply? | Pitting Edema.
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| How would you assesss F&E imbalance? | History of F&E problems or renal disease; Diuretic use; Electrolyte supplements; Chronic diarrhea or excessive vomitting; Sudden weight gain.
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| During inspection - what's the best indicator for fluid assessment? | Weight: (EC). 1L = 2.2lbs.
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| During inspection - what does dyspnea EC/FVE (Fluid Volume Excess) indicate? | Pulmonary Edema.
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| What are other signs of F&E imbalance upon inspection? | Edema (EC); neck vein distention (EC); mucous membranes dry; abdominal girth (EC)=3d spacing; intake & output=urine<30ml/hr.
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| What does skin turgor indicate for Fluid Volume Deficit:Intracellular (FVD:IC) upon inspection? | pinch test; dehydration; B/P narrow; pulse pressure; increased temp; decreased pulse; sunken eyeballs; decreased tears.
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| What lab results would you need to check for F&E imbalance? | -Na+, K+, Cl-, CO2-
-PO4-, Mg+, Ca+
-BUN, protein, albumin
-Hematocrit
-serum & urine osmolarity (↑ if ECF)
-Anion Gap
-ABG's
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| Would would confusion indicate upon inspection of (FVE/FVD)? | Neurological problem. Dizziness may also be a problem.
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| What is orthostatic hypotension? | If B/P drops more than 20mm/Hg when rising from lying to upright position. B/P has to be measured in lying, sitting, and standing position to determine orthostatic hypotention.
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| List possible nursing diagnoses for F&E imbalance? | Fluid Volume Deficit; Fluid Volume Excess; Risk for FVD; Risk for FVE; Impaired mucous membranes; Altered cardiac output.
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| List desirable outcomes in case of F&E imbalance: | Balanced I/O; Urine output>30cc/hr; moist mucous membranes; No tenting or edema; normal electrolytes; 2+ pulses; normal B/P; no weight gain; no elevated temp.
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| Possible interventions in case of F&E imbalance? | Watch B/P & HR; orthostatic hypotension; watch pulse strength; temp; weigh daily; assess mucous membranes q shift; skin turgor; I&O, especially urine output<30ml/hr; give diuretics or restrict fluids; admin. IV therapy; admin. electrolytes & watch results
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| How does term pH used? | It refers to Acid/Base balance.
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| What determines the acidity of the blood? | Hydrogen ions (H+) concentration. The number of ions H+ ions will determine the strength of the acid.
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| What's the scale of pH? | pH of 1.00-7.00 = acidic
pH of 7.00 = neutral
pH of 7.01-14.00 = alkaline
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| What do acids do to neutralize alkalosis? | They give up H+ ions.
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| What do bases do to neutralize acidosis? | They accept H+ ions.
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| How are Acid/Base measurements are done? | By measuring Arterial Blood Gases (ABG's).
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| What is a principal alkaline substance in the plasma? | HCO3 = 22-26 (base).
HCO3 < 22 = acidosis
HCO3 > 26 = alkalosis
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| ABG values? | pH < 7.35 = acidosis
pH > 7.45 = alkalosis
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| How is partial pressure exerted by the CO2 in arterial blood measured? | PaCO2 35-45 = normal
PaCO2 < 35 = alkalosis
PaCO2 > 45 = acidosis
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| What is CO2? | It's an acid.
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| How is carbonic acid formed? | CO2 combines with H2O in the blood to form it.
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| What indicates partial pressure of O2 in the blood? | PaO2 = 80-100mmHg -> indicative of oxygenation, which is a respiratory parameter.
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| What indicates amount of O2 bound to Hgb? | SaO2>95%.
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| What is the function of chemical buffers in the blood (Hgb, proteins & HCO3)? | They are mechanisms to maintain Acid/Base balance.
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| How do cells help in the process of maintanance of Acid/Base balance? | They soak up or release H+ ions.
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| How can lungs help to maintain Acid/Base balance? | They will convert carbonic acid to CO2 & H2O, which is exhaled. Respiratory rate will adjust as needed.
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| What will regulate the amount of HCO3 that is going to be reabsorbed? | Kidneys.
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| What is acidosis? | It is the total number of buffer base has dropped below normal leaving a higher concentration of H+ ions.
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| What causes acidosis? | It is cased by losing too much base or gaining too much acid. The ration of carbonic acid to carbonate increases (normal ration is 1:20), thus patiet's pH decreases below 7.35.
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| What is alkalosis? | The total concentration of buffer base has increased or the total number of H+ ions has dropped.
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| What causes alkalosis? | It's caused by gaining too much base or losing too much acid. The ratio of carbonic acid to bicarbonate decreases below 1:20, thus pH goes above 7.45.
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| Name imbalance caused by an increase of PCO2: | Respiratory acidosis.
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| Name imbalance caused by a decrease of HCO3: | Metabolic acidosis.
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| What causes respiratory acidosis and what are the signs and symptoms of it? | Causes: Excess carbonic acid; COPD; drug overdose; hypoventilation.
S/S: cerebral edema; decreased CNS activity; restlessness; confusion; anxiety; SOB; flapping tremors (asterixis).
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| What causes metabolic acidosis and what are the signs and symptoms of it? | Causes: Bicarbonate deficit; sepsis; RF, starvation.
S/S: headache, malaise, lethargy, EKG changes, CNS depression, NVD, hypotension, kussmauls respirations.
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| What causes respiratory alkalosis and what are the signs and symptoms of it? | Causes: Carbonic acid deficit; pulmonary edema, hyperventilation.
S/S: hypoxemia - deep rapid breathing>40; decreased cerebral blood flow - dizzy, agitated, circumoral & peripheral paresthesia, muscle weakness.
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| Name imbalance caused by a decrease in PCO2: | Respiratory Alkalosis.
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| Name imbalance caused by an increase in HCO3: | Metabolic Alkalosis.
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| What causes metabolic alkalosis and what are the signs and symptoms of it? | Causes: Bicarbonate excess; overuse of antiacids; loss of gastric secretions.
S/S: decreased cerebral perfusion - irritablity, picking at bedclothes, twitching, convulsions, seizures, hypokalemia, arrhythmias, slow respirations; trousseau's sign.
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| What if patient's body compensates for Acid/Base imbalance? | The pH will be normal, but PCO2 or HCO3 will usually be slightly abnormal.
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| Older adults are at increased risk for electrolye imbalances because with age kidneys have: | Fewer functioning nephrons.
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| If you were walking along the Sahara Desert with an empty canteen, the amount of antidiuretic Hormone (ADH) secreted would be: | Increased.
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| Which process requires energy to maintain the unique composition of extracellular adn intracellular compartments? | Active Transport.
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| Hydrostatic pressure, which pushes fluid out of the capillaries, is opposed by colloid osmotic pressure, which involves: | The pulling power of albumin to reabsorb water.
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| When a person's blood pressure drops, the kidneys respond by: | Secreting renin.
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| The main extracellular cation is: | Sodium.
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| PaCO2 level indicates the effectiveness of: | Lung ventilation.
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| If your patient is breathing rapidly, his body is attempting to: | Get rid of excess carbon dioxide.
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| Which body fluid lies in the spaces between the body cells? | Interstitial.
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| The principle site for regulation of fluid & electrolyte balance is: | Kidneys.
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| In a healthy adult, which of the following regulates body fluids? | Hormonal regulation, fluid intake, and kidney function.
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| Chloride, bicarbonate, phosphate, and sulfate are examples of: | Anions, because they carry a negative charge.
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| Identify the mechanism(s) involved in acid/base balance. | Buffer, respiratory, and renal.
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| What is the correct term to describe a Potassium level of 6.0mEq/L? | Hyperkalemia.
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| The nurse notes patient has had an elevated temp for two days, skin turgor poor, & dry mouth. What would the nurses best response be? | a. Call MD, request IV fluid bolus
b. Place pt on I&O measurements
c. Restrict fluid intake to 600ml for the rest of the shift
d. Encourage pt to drink at least 1L of fluid during rest of shift. ←
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| Which of the following patients is at high risk for developing a FVD? | a. 68 yr old male paralyzed from a stroke ←
b. 23 yr old female with renal failure
c. 13 yr old male playing chess
d. 83 yr old female with congestive heart failure.
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