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N216 > Elimination > Flashcards

Elimination Flashcards

1
Q

Fluid & Electrolyte Balance

A

The process of regulating the extracellular fluid volume, body fluid osmolality, and plasma concentrations of electrolytes

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2
Q

Pediatrics Distribution of Body Fluid

A

75%-80% of body weight
Susceptible to significant changes in body fluids
Dehydration

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3
Q

Aging Distribution of Body Fluids

A

decreased percent of total body water

  • decreased free fat mass and decreased muscle mass
  • Renal decline
  • Diminished thirst perception
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4
Q

Net Filtration

A

Forces favouring filtration minus forces opposing filtration

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5
Q

Forces Favouring filtration

A

Capillary hydrostatic pressure (BP)

Interstitial Oncotic pressure (water-pulling)

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6
Q

Forces favouring reabsorption

A

Plasma (capillary) oncotic pressure (water-pulling)

Interstitial hydrostatic pressure

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7
Q

Principal ECF electrolytes

A 
Sodium cations (Na+)
Chloride anions (Cl-)
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8
Q

Principlal intracellular fluid electrolyte

A

Potassium cation (K+)

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9
Q

Cosequences of Impaired Fluid and electrolyte imbalance

A

Impaired perfusion
Impaired gas exchange oxygenation
Impaired cerebral function
Impaired neuromuscular function

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10
Q

Populations at greatest risk for fluid and electrolyte balance problems

A

Very young and very old

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11
Q

Symptoms of fluid and electrolyte imbalance are..

A

non specific

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12
Q

Red flags for fluid and electrolyte imbalance include a history of …

A 
vomiting
diarrhea
organ failure
unexplained nausea
fatigue
dizziness
SOB
muscle cramping
edema
sudden changes in weight
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13
Q

Edema

A

Accumulation of fluid in the interstitial spaces

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14
Q

Causes of edema

A

Increase in capillary hydrostatic pressure
Decrease in plasma oncotic pressure
Increase in capillary permeability
Lymph obstruction (lymphedema)

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15
Q

Potassium

A

Most abundant positively charged (cationic) electrolyte inside cells

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16
Q

What percent of the body’s potassium is intracellular

A

95%

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17
Q

Potassium content outside of cells ranges from….

A

3.5-5 mmol/L

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18
Q

Potassium levels are critical to…

A

normal body function

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19
Q

Potassium is obtained from which kind of foods

A 
Bananas
Oranges
Apricots
Dates
Raisins
Broccoli
Green beans
Potatoes
Tomatoes
meats
Fish
wheat bread
legumes
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20
Q

Excess dietary potassium is excreted via..

A

Kidneys

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21
Q

Impaired kidney function leads to…

A

Higher serum levels, possibly toxicity

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22
Q

Potassium is responsible for…

A 
Muscle contraction
Transmission of nerve impulses
Regulation of heart beat 
Maintenance of acid-base balance
Isotonicity
Electrodynamic characteristics of the cell
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23
Q

Sodium

A

Most abundant positively charged electrolyte outside cells

Primary ECF cation

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24
Q

Normal Concentration of sodium outside the cells is…

A

135-145mmol/L

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25
Q

Sodium is maintained through …

A

dietary intake of sodium chloride

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26
Q

Sodium comes in through which foods

A

Salt
Fish
meats
Foods flavoured or preserved with salt

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27
Q

Sodium is responsible for…

A

Control of water distribution
Fluid and electrolyte balance
Osmotic pressure of body fluids
Participation is acid-base balance

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28
Q

Sodium regulates

A

osmotic forces like water

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29
Q

Chloride (Cl-) is a

A

Primary ECF anion

Provides electroneutrality

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30
Q

RAAS

A

Renin angiotensin aldosterone system

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31
Q

Aldosterone

A

leads to Na+ and water reabsorption back into the circulation and excretion of potassium (K+)

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32
Q

RAAS causes

A

Na+ and water excretion

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33
Q

Antidiuretic hormone (ADH) secretion

A

Increases water reabsorption into the plasma

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34
Q

Thirst perception is due to

A

Osmolality receptors

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35
Q

Osmolality receptors control

A

Hyperosmolality and plasma volume depletion

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36
Q

Isotonic alterations

A

TBW change with no proportional electrolyte and water change (no change in concentration)
Isotonic fluid loss
Isotonic fluid excess

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37
Q

Hypertonic Alterations

A

Hypernatremia

Hyperchloremia

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38
Q

Hypernatremia

A

Related to Na+ gain or water loss

Water movement from the ICF to the ECF

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39
Q

Hypernatremia serum Na+ level

A

> 145mmol/L

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40
Q

Clinical manifestations of hypernatremia

A

Thirst
Weight gain
Bounding pulse
Increased BP

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41
Q

CNS manifestations of Hypernatremia

A 
Muscle twitching
Hyper-reflexia
Confusion
coma
convulsions
cerebral hemorrhage
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42
Q

Hyperchloremia

A

Occurs with hypernatremia or a bicarbonate deficit

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43
Q

Hypotonic alterations

A

Decreased osmolality

Hyponatremia or free water excess

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44
Q

Hyponatremia decreases the…

A

ECF osmotic pressure, and water moves into the cell via osmosis
Cells expand

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45
Q

Hypotonic alteration types

A

Hyponatremia

Hypochloremia

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46
Q

Hyponatremia serum Na+ level

A

<135mmol/L

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47
Q

Na+ deficits cause…

A

plasma hypo osmolality swelling

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48
Q

Hyponatremia causes

A

Pure Na+ loss
Low sodium intake
Dilutional hyponatremia

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49
Q

Manifestations for Hyponatremia

A 
Cerebral edema
Increased intracranial pressure
Lethargy
Confusion
Decreased reflexes
Seizures
Coma
Loss of ECF
Hypovolemia
Weigh gain
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50
Q

Main Indication of Hyponatremia

A

Sodium depletion when dietary measures are inadequate

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51
Q

Mild treatment of hyponatremia

A

Treated with oral sodium chloride, fluid restriction or both

52
Q

Severe treatment of hyponatremia

A

Treated with IV Ns or lactated Ringer’s Solution

53
Q

Water Excess

A

Compulsive water drinking

Decreased urine formation

54
Q

Syndrome of inappropriate ADH (SIADH)

A

ADH secretion in the absence of hypovolemia or hyperosmolality
Hyponatremia with hypervolemia

55
Q

Manifestations of water excess

A 
Cerebral edema
weakness
muscle twitching
nausea
headache
weight gain
56
Q

Hypochloremia

A

Usually the result of hyponatremia or elevated bicarbonate concentration

57
Q

Hypochloremia develops because…

A

as a result of vomiting and the loss of HCl

58
Q

Hypochloremia occurs in…

A

Cystic fibrosis

59
Q

With Hypocholremia treatment of the underlying cause is…

A

required

60
Q

Potassium concentration is maintained by..

A

Na+/K+ pump

61
Q

Potassium regulates…

A

Intracellular electrical neutrality in relation to Na+ and H+

62
Q

Potassium is essential for…

A

Transmission and conduction of nerve impulses, Normal cardiac rhythms, and skeletal and smooth muscle contraction

63
Q

Changes in what affect K+ balance

A

PH

64
Q

Which hormones influence serum K+ levels

A

Aldosterone, Insulin & epinephrine

65
Q

Hypokalemia K+ level

A

<3.5mmol/L

66
Q

causes of hypokalemia

A

Reduced intake of K+
Increased entry of K+ into cells
Increased loss of K+

67
Q

Manifestations of hypokalemia

A

decrease in neuromuscular excitability
skeletal muscle weakness
smooth muscle atony
Cardiac dysthymias

68
Q

Main indication of hypokalemia

A

Treatment or prevention of potassium depletion when dietary means are inadequate

69
Q

Hypokalemia adverse effects oral preparations

A 
Diarrhea
Nausea
Vomiting
GI bleeding
Ulceration
70
Q

Hypokalemia adverse effects IV administration

A

Pain at injection site

phlebitis

71
Q

Hypokalemia adverse effects Excessive adminstration

A

Hyperkalemia
Toxic effects
Cardiac arrest

72
Q

Hyperkalemia serum level

A

> 5.5mmol/L

73
Q

Why is hyperkalemia rare

A

Because of efficient renal excretion

74
Q

Hyperkalemia is caused by

A 
Increased intake of K+
Shift of K+ from ICF to ECF
Decreased Renal excretion
Insulin deficiency
Cellular trauma
75
Q

Manifestations of Hyperkalemia

A

Muscle weakness
Paresthesia
paralysis
Cardiac rhythm irregularities

76
Q

Mild attack of hyperkalemia

A

Increased neuromuscular irritability

Restlessness, intestinal cramping and diarrhea

77
Q

Severe attack of hyperkalemia

A

Decreases the resting membrane potential

Muscle weakness, loss of muscle tone and paralysis

78
Q

Treatment of severe hyperkalemia

A 
IV sodium bicarbonate
Calcium glutinate
Calcium chloride
Dextrose with insulin
Sodium polystyrene sulphate (Kayexalate)
Hemodialysis to remove excess potassium
79
Q

Hypocalcemia Causes

A

Inadequate intestinal absorption, deposition of ionized Ca++ into bone or soft tissue, blood administration
Decreases in PTH and Vit D
Nutritional deficiencies occur with inadequate sources of dairy products or green leafy vegetables

80
Q

Hypocalcemia effects

A

Increased neuromuscular excitability
Severe cases show convulsions and tetany
Prolonged QT interval, cardiac arrest

81
Q

Hypercalcemia causes

A 
Hyperparathyroidism
Bone metastases with Ca++ resorption from breast, prostate, renal and cervical cancer
Sarcoidosis
Excess Vit D
Many tumours that produce PTH
82
Q

Hypercalcemia Effects

A

Many non specific: Fatigue, weakness, lethargy, anorexia, nausea, constipation
Impaired renal function, kidney stones
Dysrhythmias, bradycardia, cardiac arrest, Bone pain, osteoporosis

83
Q

Hypophosphatemia causes

A

Intestinal malabsorption
Respiratory alkalosis
Increased renal excretion of PO4 associated with hyperparathyroidism

84
Q

Hypophosphatemia Effects

A

Reduced capacity for oxygen transport by RBC, thus distributed energy metabolism
Leukocyte and platelet dysfunction
Deranged nerve and muscle function

85
Q

Hypophosphatemia effects is severe cases

A 
Irritability
Confusion
Numbness
Coma,
Convulsions
Respiratory failure
Cardiomyopathies
Bone resorption
86
Q

Hyperphosphatemia Causes

A

Acute or chronic kidney failure with significant loss of glomerular filtration
Treatment of metastatic tumours with chemotherapy that releases large amounts of PO4 into serum
Long term use of laxatives or enemas containing phosphates
Hypoparathyroidism

87
Q

Hyperphosphatemia Effects

A

Symptoms primarily related to low serum Ca++ levels similar to the results of hypocalcemia
When prolonged calcification of soft tissues in lungs, kidneys, joints

88
Q

Magnesium

A

Intracellular cation
Acts as a cofactor in intracellular enzymatic reactions
Increases neuromuscular excitability

89
Q

Magnesium Serum concentrations normal for adults

A

0.75-0.95 mmol/L

90
Q

Hypomagnesemia Causes

A

Malnutrition
Malabsorption syndromes
Alcoholism
Urinary losses

91
Q

Hypomagnesemia Effects

A 
Behavioural Changes
Irritability
Increased reflexes
Muscle cramps
Ataxia
Nystagmus
Tetany
Convulsions
Tachycardia
Hypotension
92
Q

Hypermagnesemia Causes

A

Usually renal insufficiency or failure
Excessive intake of magnesium-containing antacids
Adrenal insufficiency

93
Q

Hypermagnesemia Effects

A 
Skeletal smooth muscle contraction
Excess nerve function
Loss of deep tendon reflexes
Nausea and vomiting
Muscle weakness
Hypotension
Bradycardia
Respiratory distress
94
Q

Acid base balance

A

Carefully regulated to maintain a normal PH via multiple mechanisms

95
Q

If the H+ are high in numbers the pH is …

A

low (acidic)

96
Q

If the H+ are low in numbers the pH is….

A

High (alkaline)

97
Q

What is the body’s regular pH

A

7.35-7.45

98
Q

to maintain the body regular pH the H+ must be…

A

Neutralized or excreted

99
Q

What are the major organs involved in acid base balance

A

Bones
Lungs
Kidneys

100
Q

Two forms of body acids

A

Volatile

Non- Volatile

101
Q

Volatile acids

A

Carbonic acid (H2CO3) can be eliminated as CO2 gas and water

102
Q

Nonvolatile acids

A

Sulfuric, phosphoric, and other organic acids

Eliminated by the renal tubules with the regulation of bicarbonate (HCO3-)

103
Q

Buffer

A

A chemical that can bind excessive H+ or OH- without a significant change in pH

104
Q

The most important plasma buffering system is

A

Carbonic acid- bicarbonate pair

105
Q

Protein buffering (hemoglobin)

A

Proteins have negative charges, so they can serve as buffers for H+

106
Q

Renal buffering

A

Secretion of H+ in the urine and reabsorption of HCO3-

107
Q

Carbonic acid- bicarbonate pair happens in the…

A

lung and the kidney

108
Q

In the carbonic acid- bicarbonate pair the greater the partial pressure of CO2, the more….

A

Carbonic acid (H2CO3) is formed

109
Q

Bicarbonate and carbonic acid ratio must be ….

A

Maintained

110
Q

Acidosis

A

Systemic increase in H+ concentration or decrease in bicarbonate (base)

111
Q

Alkalosis

A

Systemic decrease in H+ concentration or increase in bicarbonate

112
Q

PCO2 normal

A

35-45 mmHG

113
Q

HCO3 normal

A

22-26 mmol/L

114
Q

Respiratory acidosis

A

elevation of PaCO2 as a result of ventilation depression

pH is low and PCO2 is high

115
Q

Respiratory Alkalosis

A

Depression of PaCO2 as a result of alveolar hyperventilation

pH high and PCO2 low

116
Q

Metabolic acidosis

A

Depression of HCO3- or an increase in non carbonic acids

pH low HCO3 low

117
Q

Metabolic Alkalosis

A

Elevation of HCO3- usually caused by an excessive loss of metabolic acids
pH high & HCO3 high

118
Q

Direct Measurements of serum levels

A 
Osmolality
Sodium
Potassium
Calcium
Magnesium
119
Q

Treatment strategies for acid- base imbalance

A

water replacement therapy
Electrolyte supplements and replacement
Pharmacotherapy

120
Q

Water replacement therapy

A

Oral fluids, IV fluids

121
Q

Electrolyte supplements and replacement

A

Potassium
Sodium
Magnesium
Calcium

122
Q

Pharmacotherapy for acid- base imbalance

A

Diuretics
Insulin
Vasopressin

123
Q

IV potassium must not be given at a rate faster than …

A

10mmol/Hr

124
Q

If patients are critically ill or on cardiac monitors rates of ______ can be used

A

20mmol/Hr

125
Q

Oral forms of potassium must be…

A

Diluted in water or juice and taken with food

N216 (5 decks)

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