fundamentals
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| where is the majority of body fluid found? | vascular fluid(inside the blood and lymph vessels), interstitial fluid (between cells), intracellular(within cells).
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| Why is vascular fluid essential? | For the maintenance of adequate blood volume, blood pressure, and cardiovascular system functioning.
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| Why is interstitial fluid important | Interstitial fluid that surrounds the body's cells is important for the transportation of oxygen, nuttrients, hormones, and other essential chemicals between the blood and the cell cytoplasm.
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| Why are vascular and interstitual fluid important? | They are important for waste removal
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| Why is intracellular fluid important? | to maintain cell size and function.
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| what does cell function depend on? | maintaining the volume and composition of body fluids with a narrow, normal range.
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| what is the balance of fluid, electrolytes, acids, and bases in the body regulated by? | physiologic control mechanisms.
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| On a hot summer day what increases in a person and what decreases? | fluid intake increases and urine output decreases. (at the same time change in RR and urine composition play an important role in regulating acid-base balance).
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| what are some issues that may temporarily disrupt fluid, electrolyte, and acid-base homeostatis? | vomiting, diarrhea, or therapies such as surgery even though someone has general good health.
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| what are some diseases that seriously disrupt the body's ability to maintain F, E, and acid-base balance | heart failure, kidney impairment, or liver dysfunction.
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| the body is water containing chemical compounds called... | electrolytes plus blood cells and other soluble molecules.
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| the body monitors and controls two aspects of the body fluid balance: | 1. the volume of fluid in the extracellular space, particualarly vascular volume 2. The water concentration (osmolarity) of all body fluids, which influences the volume of extracellular and intracellular fluid.
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| how much of body weight is fluid? | 45-80%(also depends on age, body fat, gender
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| newborn(premature) total body fluid (%body weight) | 85%
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| newborn(fullterm) total body fluid (%body weight) | 70-80%
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| child 1-12years of age total body fluid (%body weight) | 64%
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| puberty to 39 years of age total body fluid (%body weight) | male-60% female-52%
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| 40-60 years of age total body fluid (%body weight) | male-55% female-47%
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| older than 60 years of age total body fluid (%body weight) | male-52% female-46%
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| what are the two types of body fluid? | intracellular fluid and extracellular fluid
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| where is intracellular located? | within the cell
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| where is extracellular located? | is all the fluid outside of the cell
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| what are the primary intracellular electrolytes? | potassium, phosphate, and sulfate (soda, produces, pee)
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| what are the primary extracellular electrolytes? | sodium, choloride, and bicarbonate (soda, causes, burps)
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| adults have about ____ of their total within ICF and ____ in the ECF | 2/3, 1/3
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| newborns have more ______ than _______ | ECF, ICF
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| by 3 months of age newborns ICF and ECF are... | equal
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| By the age of 1 babies ICF and ECF.... | approach the same distribution as adults
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| The maintenance of proportional distribution of ECF between vascular and interstitual spaces depends on 3 factors??? | protein content of the blood (serum protein, mainly albumin and globulin), integrity of the vascular endothelium (the layer of cells lining blood vessels), and hydrostatic pressure inside the blood vessels.
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| what keeps fluid within the blood vessels? | protein content of the blood and the intact vascular endothelium
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| what forces the fluid out of the vessels? | hydrostatic pressure
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| In heathly people how do the protein content of the blood, the intact vascular endothelium, and the hydrostatic pressure work together? | they are equally balanced so that approx. 1/3 of the ECF is intravascular and 2/3 is interstitial.
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| what is the most important and regulated aspect of fluid balance? | the volume of ECF, particularly vascular volume.
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| why is it important to regulate the fluid balance of ECF vascular volume? | bc w/o adequate vascular volme, BP cannot be maintained. and prolonged periods of low BP are known as shock.
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| what are stretch receptors or pressure receptors? and what do they do? | they are baroreceptors; located in the major arteries and veins and monitor vascular volume.
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| What do the renin-angiotensin-aldosterone and natriuretic peptide hormone system do? | regulate the volume within narrow limits by adjusting fluid intake and the urinary excretion of sodium, cholride, and water.
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| what can stimulate renin release? | decreased arterial BP, decreased renal blood flow, increased renal smpathetic nerve activity, or a low-salt diet
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| what is the second regulated aspect of body fluid? | osmolarity
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| what are electrolytes? | they are chemical compounds that partially dissociate(seperate) in solution into seperate particles
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| what are ions? | electrical charges that are in electrolytes
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| what are positively charged ions referred as? | cations
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| what are negatively charged ions referred as? | anions
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| biologically what are the important cations called? | sodium, potassium, calcium, and magnesium
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| what are common anions? | chloride, bicarbonate, phosphate
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| what is the serum value of sodium? | 135-145 mEq/L
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| what is the serum value of K? | 3.5-5.0 mEq/L
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| what is the serum value of Ca (8.9-10.1 mg/dL? | 4.3-5.3 mEq/L
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| what is the serum value of Mg (1.8-2.3 mg/dL)? | 1.5-1.9 mEq/L
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| what is the serum value of chloride? | 95-108 mEq/L
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| what is the serum value of Bicarbonate(HCO-3)? | 22-26 mEq/L
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| what is the serum value of Phosphate (2.5-4.5 mg/dL)? | 1.7-2.6 mEq/L
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| how are electrolyte concentrations expressed? | in terms of their combining power or the ability of cations to combine with anions rather than by their absolute weight in solution.
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| how is electrolyte balance maintained? | by keeping the concentration of each electrolyte in the serum within normal limits
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| what is electrolyte imbalance referred to as? | an increase or decrease of the concentration of ions within the serum.
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| what is the most abundant cation in the ECF? | Sodium
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| changes in the serum sodium level reflect... | changes in body water balance or osmolarity and therefore do no reflect sodium intake and output directly.
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| what organ excretes sodium from the body? | kidney
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| how is sodium regulated? | sodium along with chloride and a proportionate volume of water(normal saline) are regulated by the renin-angiotensin-aldosterone system and natriuretic peptides
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| where can sodium be found? | table salt, dairy products, meat, eggs, and certain vegetables. food perservatives, and medications
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| what is potassium essential for? | normal cardiac, neural, and muscle function and contractility of all muscles.
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| what important role does postassium play? | in cellular functions, such as protein and glycogen synthesis
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| what two hormones exert major control over extracellular concentration of potassium? | insulin and aldosterone
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| what role does potassium play with insulin? | insulin is a pancreatic hormone, promotes transfer of potassium(also glucose) from the ECF into skeletal muscle and liver cells.
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| what role does aldosterone place with potassium? | enhances renal excretion of K.
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| an increase in serum potassium does what? | stimulates the release of insulin and aldosterone to lower the concentration of the ion
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| a decrease in serum potassium does what? | inhibits the release of aldosterone and insulin to reduce excertion of the ion
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| a person loses about how much potassium a day? | 30mEq
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| A typical western diet contains about how much potassium a day? | 100mEq/day
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| what organ play an important role in the maintenance of potassium balance | kidneys
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| Potassium is also excreted from the body in? | stool and perspiration
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| approx. 99% of calcium is found where in the body? | in the bones and teeth, and the remainder is in the serum
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| calcium is present in the blood primarily in what two states? | ionized and bound to protein.
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| approx. what percent of calcium is ionized? | 50% is ionized and the remainder is bound to proteins, mainly albumin.
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| The level of ionized calcium determines what? | physiological function
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| Only changes in the ionized calcium levels can cause.... | s/s associated with calcium imbalances.
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| Because a large portion of the calcium is bound to albumin, what should be checked? | the serum albumin levels should be checked when lab data is evaluated.
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| when can serum albumin levels decrease? | liver disease or wasting
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| what happens if serum albumin levels decrease? | the total calcium level probably also will be decreased, but the ionized calcium level may be within normal limits.
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| calcium usually has a reciprocal relationship with... | phosphorus
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| why does the cell membrane structure depend on calcium? | bc it promotes cell-to-cell adhesion
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| what are some things that calcium are important for? | wound healing, synaptic transmission in nervous tissue, membrane excitability, muscle contractility, and teeth and bone structure.
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| what is calcium essential for? | blood clotting and is critical in metabolic reactions involed in energy production (glycolysis)
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| what regulates calcium and phosphate balance? | parathyroid hormone(PTH), vit D, and to some extent calcitonin
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| what does PTH do to serum calcium levels? | causes an increase by increasing intestinal and renal reabsorption of calcium and releasing calcium from bone
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| PTH increases calcium levels but... | decreases serum phosphate levels.
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| The decreased secretion of PTH levels... | lowers serum calcium levels and increases serum phosphate concentration
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| in what foods can you find a good source of calcium? | dairy is a great source. also sardines, whole grains, leafy green vegetables.
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| where is magnesium found in the body | 50-60% is found in bone and the rest is in soft tissue and body fluids
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| Is magnesium an intracellular or extracellular ion? | intracelllar ion with only 2% in the ECF
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| What is magnesium important for? | regulating neuromuscular function and cardiac activity
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| what are changes in magnesium paralleled by? | changes in potassium
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| what is magnesium deficiency often accompanied by? | hyocalcemia
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| What organ regulates magnesium levels? | the kidney by reabsorbing the ion when serum levels are low and excreting it when serum levels are high
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| Which hormones regulate magnesium levels in the body? | none
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| What are some good dietary sources of magnesium? | green leafy vegetables, legumes, citrus fruit, peanut butter, and chocolate
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| Describe the serum levels of phosphorus in children and infants. | The serum levels are higher in children and even higher in infants, than that of an adult
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| Where is phosphorus found in the body? | 85%bone, 14% ICF, 0.1% ECF
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| why is phosphorus important? | energy metabolism, structure of bones, and membranes, and synthesis of nucleic acids (RNA and DNA)
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| What are good dietry sources of phosphorus? | dairy products, meats, vegetables, fruits, and cereals.
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| Diffusion | is the movement of a solvent of solutes from an area of higher solvent or solute concentration to an area of lower solvent or solute concentration.
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| osmosis | refers to the movement of a fluid through a semipermeable membrane
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| active transport | is the process by which ions and other molecules are moved across membranes from an area of lesser concentration to an area of greater concentration.
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| filteration | involves the transfer of water and dissolved substances through a permeable membrane from a region of high pressure to a region of low pressure
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| filteration occurs within the ______ _________ capillaries and in the ________ capillaries | kidney's glomerular; blood
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| who is at greater risk of fluid and electrolyte imbalances? | the very young and older adults
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| Because babies have a greater surface arein in relation to weight, how do they lose most of their volume of fluid? | through their skin
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| why do newborns and infants lack the ability to concentrate urine fully? | because their kidneys are immature
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| what are the general fluid requirements for toddlers and preschoolers? | 1000-1200 mL for a 24 hour period
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| What is the urine output for a 2 year old? | increases from 500 to 700mL/day
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| what is the urine outpt for a 5 year old? | increases from 600-850mL/day
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| In middle age adipose tissue tends to increase, resulting in a continual decline in the percentage of body weight that is fluid after _____ years of age? | 40
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| At what age to the nephrons in the kidney begin to decrease? | 25 years of age
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| when are adults most likely to experience fluid and electrolyte imbalances? | After acute illness or elective surgery. (older adults can experience this after a chronic disease;renal failure, heart failure)
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| Diuretics commonly given to treat high BP and heart failure can cause ECF deficit or loss of electrolytes that include... | Potassium, calcium, and magnesium
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| Excessive use of laxatives can reduce gastrointestinal absorption.... | of postassium, promoting hypokalemia and loss of ECF
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| The use of what oral solution in clients older than 65 years was associated with vascular volume deficit, hyperphosphatemia, hypokalemia, and hypocalcemia? | Oral Sodium Phosphate Solution
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| what are vital functions that depend on a stable acid-base enviroment? | nerve conduction, hormonal activity, and cardiac rhythm
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| Any substance that can donate free H+ ions to a solution is called? | acid
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| Any substance that can decrease H+ in a solution is called? | Base
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| How are acids and bases categorized? | strong or weak
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| Where is Hydrochloric acid(HCL) secreted? and what type of acid is it? | by cells in the stomach lining;strong
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| Is Sodium Hydroxide (lye) a base or an acid? | strong base
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| In the body pH is normally very close to? | 7.4; it is rarely less than 7.0 or greater than 7.8
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| what is the pH of ECF normally? | 7.37-7.43
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| what is a very important acid in the body? | carbonic acid
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| together carbonic acid and bicarbonate ion form? | buffer pair; and are most important in clinical setting
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| Since bicarbonate and carbonic acid system mirro changes in all other systems they need to maintain what? | equilibrium
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| The body regulates the carbon dioxide level by changes in the .... | respiratory rate(ventilation) and bicarbonate level by adjustments in the amount of bicarbonate lost in the urine or the amount regenerated by the kidneys
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| Death ususally occurs when the pH falls below... | 6.8-7.8
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| buffers allow acids or bases to be transported from... | where they are produced to where they are excreted without causing a large swing in pH. With compensation the body either excretes or retains acids or bases to compensate for loss.
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| acid-base balance is commonly evaluted by measuring? | arterial blood gases
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| (normal art.blood gas values) pH-normal 7.37-7.43 | reflects the hydrogen ion concentration of arterial blood. acidosis: <7.37, alkalosis: >7.43
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| (normal art.blood gas values) PaCO2-normal 36-44mm Hg | reflects partial pressure of carbon dioxide in arterial blood. Hypocapnia: low partial pressure of carbon dioxide in arterial blood, <35mm Hg; Hypercapnia: High partial pressure of carbon dioxide in arterial blood, > mmHg
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| (normal art.blood gas values) PaO2-normal 80-100 mm Hg | partial pressure of O2 in arterial blood
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| (normal art.blood gas values) HCO3- normal | 22-26 mEq/L and it is the amount of bicarbonate in arterial blood
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| what is buffering? | it is substances that help prevent large changes in pH by absorbing or releasing H+ ions
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| what are the four main buffer pairs in the body? | hemoglobin, carbonic acid-bicarbonate, proteins, and phosphates.
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| what is the isohydric principle? | Bc the activity of all buffer pairs is inter-related, if a clinician knows what is happening with one buffer pair, then they can predict what is happening with the others. This is also why clinicians usually only monitor acid-bicarbonate buffer system
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| how long does it take for the lungs to compensate for an imbalances? | instantly
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| how long does it take for the kidneys to compensate for an imbalances? | hours to days to respond
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| what is the typical intake for an adult in 24 hour period? break it down. | oral fluids-1300mL, fluid in food 1000mL, oxidation of food 300mL=total=2600mL
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| what is the typical output for an adult in 24 hour period? break it down. | urine-1500mL, feces-200mL, perspiration 100-200mL, insensible loss-skin-300-400mL and respiration-300mL=total=2400-2600mL
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| how much water is in fruits and vegetables? | 80-90%
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| thirst mechanism helps regulate.. | fluid intake
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| where is the thirst center located? and what stimulates it? | hypothalamus; by an increase in plasm osmolarity, and also by decrease in blood volume
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| what are the four ways that electrolytes can be lost from the body? | from kidneys as urine, from skin as perspiration, from GI in stool or vomit, and from lungs as insensible water loss
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| what is the main organ regulating fluid balance? | kidney
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| what permits the kidney to conserve or excrete water and electrolytes as necessary to maintain homeostasis? | glomerular filtration and tubular reabsorption
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| what type of fluid is diaphoresis or sweat? | hypotonic
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| (vomiting) if sufficient gastric juice is lost from the stomach what can occur? | hydrogen, sodium, and chloride ions are depleated, increasing the risk for ECF deficit and METABOLIC ALKALOSIS.
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| (vomiting) since gastric fluid is also high in potassium, what can excessive loss contribute to? | hypokalemia
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| intestinal secretions contain bicarbonate, for this reason diarrhea may result in? | metabolic acidosis
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| Diarrhea can also contribute to ECF deficit and cause? | hypokalemia
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| Diaphoresis contains which electrolyes? | sodium, potassium, and chloride
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| diuretics are prescribed to increase? | excretion of sodium, chloride, and water in clients with high BP or with chronic heart, renal, or liver problems
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| Diuretics promote what? | excretion of potassium and magnesium increasing the risk for electrolyte imbalances. (except potassium sparing diuretics)
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| What happens when stress occurs? | aldosterone production increases causing ECF retention. It also increases ADH production, resulting in decreased renal excretion of water
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| when renal failure occurs, what happens to electrolyte balance? | abnormal loss or accumulation of sodium, chloride, potassium, and fluid in the body can result in ECF and water excessess or even deficits. Since the kidneys are no able to regulate as well
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| what is common with renal failure? | hyperkalemia and hypocalcemia
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| ____________ _____________ occurs when the kidneys fail. | metabolic acidosis
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| when cardiac failure occurs what happens to the body? | it secrets aldosterone and ADH and results in ECF and water excess. The fluid collects in lungs>increasing risk of pulmonary edema>and rest of the body>and it appears as pitting or dependent edema
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| what occurs with liver failure? | people with liver failure present w/ a water excess thought to be relate3d to increased plasma levels of ADH.
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| what increases and decreases with liver failure? | albumin decreases, vascular decreases, interstitial volume increases.
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| When is ascites present? | liver failure
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| How much and when should a lactate raner be given? | surgery, usually 1000mL
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| what usually decreases after surgery? | potassium
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| what is the treatment for ECF volume deficit? | either oral or IV replacement of sodium, chloride, and water in the same concentration found in body fluids.
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| what should you give a patient who has ECF deficit? | salty liquids such as broth, tomato juice or normal saline.
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| what is a safety alert for patients with ECF deficit? | monitor postural HR and BP when getting them OTB. Have them take several minutes to get up, going in slow steps from lying to a sitting to a standing postion. Make sure someone is present
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| When does ECF excess usually occur? | cardiac failure, renal failure, or liver disease
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| when excess fluid cannot be eliminated what happens? | hydrostatic pressureforces some of it into interstitial space as edema
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| what are symptoms of ECF excess? | increased BP, bounding pulse, and fullness of neck veins.
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| changes in mental status? | hyponatremia
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| When does metabolic acidosis occur? | either when excess acid is ingested or created or when the kidneys are unable to retain enough bicarbonate ions to buffer freee hydrogen ions in the blood. charac. as a pH lower than 7.37 and plasma concentration lower than 22mEq/L
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| when does respiratory acidosis occur? | low pH accompanied by an increased arterial concentration of carbon dioxide. PaCO2 of 44mm Hg.
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| people with damaged lungs may have? | respiratory acidosis
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| Hyperventilation causes... | respiratory alkalosis
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| when does metabolic alkalosis occur? | when there is excessive loss of body acids or with unusual intake of alkaline substances. or K deficit. vomiting or NG suction
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| is Pureed food considered fluid intake? | no
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| neck veins should not extend more than.. | 2cm above sternal angle
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| what foods contain sodium? | salt, msg, soy sauce, dairy products, processed foods, snack foods, bouillon, canned or packaged soup, pickles, olives, sauerkraut, tomato juice
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| what foods contain potassium? | banana, cantaloupe, apricots, peaches, dates, raisins, vegetables avocado, navy beans, potatoes, squash, carrots, cauliflower, orange juice tomato juice
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| What foods contain Magnesium? | nuts peanut butter, egg yolk, milk, whole grain cereals, bananas, citrus fruit, dark green vegetables, legumes, seafood, chocolate
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| what foods contain Phosphorus? | dairy products, meats, fish, bran an wheat cereals, nuts
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