Fluid & Electrolytes
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| What does the hormonal regulation of fluid, electrolytes, and acid base balance consist of? | -Hypothalamus
-ADH
-RAAS (renin angiotensin aldosterone system)
-natriuretic peptide hormonal system
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| What is the purpose of the hypothalamus? | makes you thirsty
synthesizes ADH
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| What does ADH do? | stops fluid from being lost (causing retention)
so the body reabsorbs H2O
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| If you have an increase in fluid loss or a decrease in fluid intake, what happens to Osmolarity? Thus causing? Which then causes what? | -Increases
-ADH to release into circulation
-more water reabsorbed in the kidneys (thus decreasing urine output)
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| If you have a decrease in fluid loss or an increase in fluid intake, what happens to Osmolarity? Thus causing? Which then causes what? | -decreases
-ADH blocked from being released into circulation
-less water reabsorbed in the kidneys (thus increasing urine output)
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| ADH is sent out based on what? | Osmolarity of blood
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| What is Osmolarity? An increase in osmolarity means what? | -Solute concentration in the blood
-a fluid volume deficit (blood flows slower)
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| The RAAS cycle is activated in response to what? | blood volume
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| IF the blood volume drops what is the first step of the RAAS cycle? | Renin is released from kidneys and stimulates the release of
Angiotensin I
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| When Angiotensin I is released in response to a blood volume drop, what happens next? | Angiotensin I quickly converts to Angiotensin II (potent vasoconstrictor)
Angiotensin II causes vasoconstriction, thus increasing the blood flow so that it will flow faster.
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| Once Angiotensin II responds to a blood volume drop by vasodialating, what happens next? | Angiotensin II stimulates the secretion of aldosterone (helps retain Sodium in the kidneys, therefore retains H2O also)
This pulls in H2O from the tissues to balance fluid volume
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| The Natriuretic peptide hormone system is excreted from where? why? | -Heart muscle
-increase fluid volume
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| If high fluid volume pressure in increased on the heart what happens? | -ANP (atrial natriuretic peptide) is released, thus causing sodium excretion
(and H2O goes with via urine, perspiration, etc
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| IF low fluid volume pressure, there is no pressure on the heart, what happens? | ANP is not released thus causing Sodium retention
(H20 stays in)
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| If Carbon Dioxide combines with water it becomes what? | ACID- Carbonic Acid H2CO3
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| Increased H+ = more_____ Decreased H+ = less ______ | -acidic
-acidic
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| Increased CO2= more _____ Decreased CO2= less _____ | -acidic
-acidic
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| Since Bicarbonate is a base (buffer) What happens if we increase HCO3-? What if we decrease HCO3-? | -more alkaline
-less alkaline
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| Carbon Dioxide, Hydrogen, and Bicarbonate are all contolled by what systems? | Repiratory and Renal
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| A patient has been vomiting for 4 days. What type of acid base balance is this. | -Metabolic (not respiratory)
-alkalosis
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| Nursing student begins to hyperventilate while taking his final exam. What type of acid base imbalance is this? | -Respiratory
-Alkalosis (bc exhaling CO2 quickly-expelling acid)
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| A 79 year old pt experiencing renal failure. What type of acid base imbalance is this? | -Metabolic (not respiratory)
-Acidosis (losing bicarbonate-making it more acidic)
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| A 19 year old pt overdoses on Oxycontin, a narcotic. What type of acid base imbalance is this? | -Repiratory (narcotics slow respirations)
-acidosis (slowly expelling CO2-acid)
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| pH 7.48, PaCO2 36 mmHg, HCO3- 32mEq/L | -Metabolic
-alkalosis
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| pH 7.32, PaCO2 47 mmHg, HCO3- 25mEq/L | -Repiratory
-acidosis
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| If a patient has diarrhea, they are getting rid of what? | HCO3- (bicarb)
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| If a patient is vomiting, they are getting rid of what? | acids
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| How does the body compensate for Acid Base imbalances? | If its a respiratory problem, kidneys compensate by regulating HCO3-
If its a metablic problem, respiratory system compensate w/ CO2
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| How will the body compensate for severe diarrhea? | -metabolic acidosis
-resp sys will try to fix bc of low pH, thus increasing breathing to get rid of CO2 (acid)
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| How will the body compensate for Repsiratory weakness | -respiratory acidosis (retaining C02)
-renal tries to fix by retaining bicarb (HCO3-)
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| How will the body compensate for Starvation? | -metabolic acidosis (pH level is lower)
-resp sys will try to fix by increasing respirations to get rid of acid (CO2)
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| An increase or decrease of sodium from the norm can cause what? What type of assessment would you do? | neuroligical problems
neuro focused assessment
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| An increase or decrease in potassium causes what? What type of assessment would you do? | -cardiac porblems
-cardiac focused assessment
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| If potassium is increase, what happens to glucose? If potassium is decreased what happens to glucose? | -decreases
-increases
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| An increase of decrease in Calcium causes what? What type of assessment would you do? | -muscular problems
-muscular focused assessment
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| If you have hypercalcemia, what type of reflexes would you have? | hyporeflex
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| If you have hypocalcemia, what type of reflexes would you have? | hyperreflex
(seizure, tetany)
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| Chvostek's sign | tap on face, it will twitch if hypocalcemic
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| Trousseau sign | tighten bp cuff, hand tightens if hypocalcemic
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| If calcium levels are increased, what happens to phosphorous levels? If calcium levels are decreased, what happens to phosphorous levels? | -decrease
-increase
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| What does a BMP (basal metabolic panel) measure? | electolyte levels (Na, K, CL, O2)
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| What does a CMP (complete metabolic panel) measure? | electrolyte levels but more detailed with BUN, albuin, creatinine, etc
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| What does Urine specific Gravity measure? | concentration of urine solutes
the higher the number, the more concentrated
the lower the number, the less concentrated
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| What are some nursing diagnoses related to Fluid, Electrolyte, Acid Base balance? | 1. Deficient Fluid Volume
2. Excess Fluid Volume
3. Risk for deficient fluid volume
4. risk for imbalance of fluid volume
5. ECF volume excess/ deficit
6. water excess/deficit
7 fluid volume deficit
8 fluid volume excess
9 risk for electrolyte i
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| An isotonic solution has -normal saline (.9% Na CL) -LR (lactated ringers) (volume expanders) -D5 .25% Na CL So if the numbers increase, what type of solution is it? If the numbers decrease what type of solution is it? | -hypertonic
-hypotonic
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| Vascular fluid is located where? | inside blood and lymph vessels
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| Interstitial fluid is located where? | between cells
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| Intracellular fluid is located where? | in cells
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| extracellular fluid is what? | includes intravascular and intersitial fluid
(not in cells)
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| What is the difference in hydrostatic pressure and osmotic pressure? | hydro-outward pressure
osmotic- inward pressure
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| If hydrostatic pressure is 32 mm Hg and osmotic pressure is 22 mm Hg filtration is + 10mm what does this mean? | since this is +
fluid filters OUT of the vessel into interstitial fluid
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| If hydrostatic pressure is 12 mm Hg and osmotic pressure is 22 mm Hg filtration is -10 mm What does this mean? | since this is -
fluid filters FROM interstitial fluid
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| Hypovolemia, saline deficit, or isotonic dehydration indicate what? | ECF volume deficit
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| Often people with caridac failure or renal failure or liver disease have what type of fluid volume? | ECF volume excess
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| Hyperosmolarity is AKA? | Water Deficit
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| Hypoosmolarity is AKA? | Water Excess
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| You have someone with increased blood sugar. You want to move fluids from cells to vasculature. 3%NaCl, 5% NaCl, D5 .45% NaCl, D5 .9% NaCl The nurse know that what type of IV fluid will be used in this situation? | Hypertonic
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| You have somewone with tissue that looks dry and wrinkly with poor skin turgor, they need more fluid. .45% NaCl The nurse knows that what type of IV fluid will be used in this situation? | Hypotonic
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| If you assess an irregular heartbeat, what in terms of elecrolytes is going on? | potassium issue
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| What is the most critical volume imbalance? Why? | -ECF deficit
-leads to low BP, shock, death
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| What are some signs and symptoms of ECF deficit? | -weight loss
-thirst
-weak rapid pulse
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| How would you treat an ECF deficit, oral or IV replacement of what???? give an example of what to give a patient orally. Give an example of what to give a patient via IV. | -sodium, chloride, H20 in the same concentrations as found in body fluid
-tomato juice
-normal saline
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| What are signs and symptoms of ECF excess? | -rapid weight gain
-increased BP
-bounding pulse
-full thickness neck veins
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| How can ECF excess cause pulmonary edema? And characterized by? | -by filtering across the alveoli into the lungs
-dyspnea, orthopnea, crackles/rales
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| How would you treat ECF excess? | -low sodium diet
-administer diuretics
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| Any solution that has a higher osmotic pressure than another solution (draws fluid out of the cell and into the extra cellular space) | hypertonic solutions
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| Any solution that has a lower osmotic pressure than another solution (pushes fluid into the cell) | hypotonic solution
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| Any solution that has the same osmotic pressure as another solution (fluid flows in and out equally) | isotonic solution
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| A patient comes into the ER after a motor vehicle accident. Respirations are 6, shallow but slow breathing. The nurse anticipates what type of acid base imbalance? | Respiratory
Acidosis (breathing is slow, therefore less CO2 (acid) being expelled, therefore its being retained causing an acidic enviornment
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| A patient has COPD and is breathing fast and shallow, 32 respirations. The nurse anticipates what type of acid base imbalance? | Respiratory
Alkalosis-the pt is breathing fast, therefore they are expelling CO2 (acid) therefore its making an alkolitic enviornment.
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| Used to replace extracellular fluid & electrolyte losses and to expand vascular volume quickly | Isotonic IV fluids
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| Used to prevent or treat cellular dehydration by providing free H20 to cells or to restore renal function | Hypotonic IV fluids
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| Pulls excess fluid from the celss, treatment is for very specific problems | Hypertonic IV fluids
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| Which IV fluid requires frequent monitoring of vitals and level of consciousness? | Hypotonic IV fluids
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| If you have an isotonic solution and you remove solutes, what does this do to osmolarity? Causing what? | -decreases it
-Hypotonic Solution
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| If you have an isotonic solution and you add solutes, what does this do to osmolarity? Causing what? | -increases it
-Hypertonic Solution
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