224 unit 1 Flashcards
(80 cards)
1
Q
Hypertonic Solution
A
A solution with an osmolality higher than that of serum
2
Q
Hypotonic Solution
A
A solution with an osmolality lower than that of serum
3
Q
Isotonic Solution
A
A solution with the same osmolality as serum and other body fluids
4
Q
Osmosis
A
The process by which fluid moves across a semipermeable membrane from an area of low solute concentration to an area of high solute concentration
5
Q
Tonicity
A
Fluid tension or the effect that osmotic pressure of a solution with impermeable solutes exerts on cell size because of water movement across the cell membrane
6
Q
Active Transport
A
hysiologic pump that moves fluid from an area of lower concentration to one of higher concentration; active transport requires ATP for energy
7
Q
Diffusion
A
The process by which solutes move from an area of higher concentration to one of lower concentration; does not require energy
8
Q
Homeostasis
A
maintenance of a constant internal quilibrium in a biologic system that involves positive and negative feedback mechanisms
9
Q
Hydrostatic Pressure
A
The pressure created by the weight of fluid against the wall that contains it.
10
Q
acidosis
A
imbalance with increase H+ concentration
11
Q
alkalosis
A
imbalance with reduce H+ concentration
12
Q
Kidney Functions
A
- regulation of ECF volume and osmolality by selective retention and excretion of body fluids
- regulation of normal electrolyte levels in the ECF by selective electrolyte retention and excretion
- regulation of pH of the ECF by retention of hydrogen ions
- excretion of metabolic wastes and toxic substances
13
Q
Hypovolemia (Fluid Volume Defecit)
A
This occurs when loss of ECF volume exceeds the intake of fluid; occurs when water and electrolytes are lost in the same amount as they exist in normal body fluids
14
Q
Hypovolemia Signs & Symptoms
A
- acute weight loss
- decreased skin turgor
- oligoria (abnormally small amounts of urine)
- low CVP
- low BP
- dizziness
- weakness
- thirst/confusion
- increased pulse
- muscle cramps
- sunken eyes
- nausea
- increased temp.
- cool, clammy, pale skin
15
Q
Hypovolemia Contributing Factors
A
- vomiting
- diarrhea
- fistulas
- fever
- excess sweating
- burns
- blood-loss
- GI suction
- anorexia
- nausea
- diabetes insipidus
16
Q
Hypovolemia Lab Findings
A
- increased hgB
- increased hematocrit
- increased BUN
- increased creatinine
17
Q
Hypovolemia Management
A
- monitor daily weights
- intake/output
- vital signs
- skin turgor
- mucous membrane assessments
18
Q
Hypervolemia (Fluid Volume Excess)
A
Abnormal retention of water and sodium; mostly secondary to increase in the total body sodium content
19
Q
Hypervolemia Signs & Symptoms
A
- acute weight gain
- peripheral edema and ascites
- distended jugular veins
- crackles
- elevated CVP
- shortness of breath
- increased BP
- bounding pulse/cough
- increased respiratory rate
- increased urine output
20
Q
Hypervolemia Lab Findings
A
- decreased hgB
- decreased hematocrit
21
Q
Hypervolemia Management
A
- restricted sodium diet
- intake/output
- promote rest
- diuretics
- daily weight
22
Q
Serum Sodium Level
A
135-145
- sodium is the primary determinant of ECF volume and osmolality
- major role in controlling water distribution throughout the body
- regulated by ADH, thirst, and the renin-angiotensin-aldosterone system
23
Q
Patients at risk for sodium imbalance
A
older patients, patients with AIDS, those on mechanical ventilation
24
Q
Hyponatremia (Sodium Defecit)
A
Serum sodium level less than 135
25
Hyponametria Contributing Factors
- loss of sodium as in use of diuretics
- loss of GI fluids
- renal disease
- adrenal insufficiency
- gain of water; excessive admin of D5W and hypotonic feedings
- head trauma
- oat-cell lung tumor
- meds assoc. with water retention (oxytocin)
- hyperglycemia
- heart failure
26
Hyponametria Signs & Symptoms
- anorexia
- nausea/vomiting
- headache
- lethargy
- dizziness
- confusion
- muscle cramps/weakness
- muscular twitching
- seizures
- dry skin
- increased pulse
- low BP
- weight gain
- edema
27
Hyponatremia Management
- sodium PO if tolerable
- lactated ringer's solution; isotonic saline (0.9%)
- restricting fluid
- foods/fluids w/ high sodium content
28
Hypernatremia (Sodium Excess)
Sodium level higher than 145
29
Hypernatremia Contributing Factors
- water deprivation in patients unable to drink at will
- hypertonic tube feedings w/o adequate water supplements
- diabetes insipidus
- heatstroke
- hyperventilation
- watery diarrhea
- burns
- diaphoresis (excessive sweating)
- excess sodium bicarbonate
- excess sodium chloride administration
- excess corticosteroids
30
Hypernatremia Signs & Symptoms
- thirst
- elevated temp.
- swollen dry tongue; sticky mucous membranes
- hallucinations
- lethargy
- restlessness
- irritability
- seizures
- pulmonary edema
- twitching
- nausea
- vomiting
- anorexia
- increased pulse
- increased BP
31
Hypernatremia Interventions
- hypotonic solution (0.3% sodium chloride)
- isotonic non-saline solution D5W
- diuretics
32
Serum Potassium Level
3. 5-5
- potassium is important neuromuscular function
- influences both skeletal and cardiac muscle activity
33
Hypokalemia (Potassium Deficit)
-lower than 3.5
34
Hypokalemia Contributing Factors
- diarrhea
- vomiting
- gastric suction
- corticosteroid administration
- bulemia
- osmotic diuresis
- alkalosis
- starvation
- diuretics
- digoxin toxicity
35
Hypokalemia Signs & Symptoms
- fatigue
- anorexia
- nausea/vomiting
- muscle weakness
- polyuria (large volumes of urine)
- decreased bowel motility
- parasthesia
- leg cramps
- decreased BP
- abdominal distention
- irritability
- anxiety
- ECG--tall T waves; prolonged PR interval; absent P waves; ST depression
36
Hypokalemia Interventions
- diets with high potassium content
- IV therapy
- potassium supplements
37
Hyperkalemia (Potassium Excess)
-serum potassium level higher than 5
38
Hyperkalemia Contributing Factors
- oliguric renal failure
- Addison's disease
- burns
- stored blood bank transfusions
- rapid IV admin of potassium
- NSAIDs, ACE inhibitors
39
Hyperkalemia Signs & Symptoms
- muscle weakness
- tachycardia--bradycardia
- dysrhythmia
- flaccid paralysis
- parasthesia
- intestinal colic
- cramps
- abdominal distention
- irritability; anxiety
40
Hyperkalemia Interventions
- intake/output
- IV therapy
- monitor vital signs
- avoid salt substitutes
41
Serum Calcium Levels
8.2-10.2
42
Hypocalcemia (Calcium Deficit)
serum calcium level lower than 8.6
-calcium plays a major role in transmitting nerve impulses and helps regulate muscle contraction, relaxation, including cardiac muscle
43
Hypocalcemia Contributing Factors
- hypoparathyroidism
- malabsorption
- pancreatitis
- alkalosis
- vitamin D deficiency
- massive subcutaneous infection
- generalized paratonitis
- diuretic phase of renal failure
- chronic diarrhea
- fistulas
- burns
- alcoholism
44
Hypocalcemia Signs & Symptoms
- numbness
- tingling of fingers; toes
- positive Trousseau's signs; Chvostek's sign (contraction of the facial muscles with a light tap)
- seizures
- carpopedal spasms
- hyperactive deep tendon reflexes
- irritability
- bronchospasm
- impaired clotting time
- decreased prothrombin
- diarrhea
- decreased BP
45
Hypocalcemia Lab Findings
decreased Magnesium levels
46
Hypocalcemia Management
- IV administration
- monitor BP
- vitamin D therapy
- safety precautions for those at risk for seizures
- avoid cigarette smoking
- avoid alcohol; caffeine
47
Hypercalcemia (Calcium Excess)
-serum calcium levels higher than 10.2
48
Hypercalcemia Contributing Factors
- hyperparathyroidism
- malignant neoplastic disease
- prolonged immobilization
- overuse of calcium supplements
- vitamin D excess
- acidosis
- digoxin toxicity
49
Hypercalcemia Signs & Symptoms
- muscular weakness
- constipation
- anorexia
- nausea/vomiting
- polyuria; polydipsia (extreme thirst)
- dehydration
- flank pain
- calcium stones
- deep bone pain
- hypertension
50
Hypercalcemia Management
- administering fluids to dilute serum calcium and promote excretion by the kidneys
- IV admin of 0.9% sodium chloride
- Lasix
- increasing patient mobility
- fiber in the diet
- encouraging fluid intake
51
Serum Magnesium Level
1. 3-2.3
- magnesium plays a role in both carb and protein metabolism
- ionized or bound to albumin
52
Hypomagnesia (Magnesium deficit)
-serum magnesium level lower than 1.3
53
Hypomagnesia Contributing Factors
- chronic alcoholism
- malabsorptive disorders
- hyperparathyroidism
- diabetic ketoacidosis
- refeeding after starvation
- parenteral nutrition
- diarrhea
- chronic laxative use
- acute myocardial infarction
- heart failure
54
Hypomagneisa Signs & Symptoms
- neuromuscular irritability
- positive Trousseau's sign; Chvostek sign
- insomnia
- mood changes
- anorexia
- vomiting
- increased tendon reflexes
- increased BP
55
Hypomagnesia Management
- diet of green leafy vegetables, nuts, seeds, legumes, whole grains, seafood, peanut butter and cocoa
- magnesium salts PO
- parenteral admin of magnesium
- vital signs assessment during therapy (changes in cardiac rate; rhythm
- screened for dysphasia
56
Hypermagnesia (Magnesium Excess)
serum magnesium level higher than 2.3
57
Hypermagnesia Contributing Factors
- oliguric phase of renal failure
- adrenal insufficiency
- diabetic ketoacidosis
- hypothyroidism
58
Hypermagnesia Signs & Symptoms
- flushing
- hypotension
- muscle weakness
- drowsiness
- hypoactive reflexes
- depressed respirations
- cardiac arrest; and coma
- diaphoresis
- tachycardia--bradycardia
59
Hypermagnesia Management
- ventilatory support, IV calcium gluconate
- loop diuretics, sodium chloride or lactated ringer's IV solution enhances Mg excretion in patients with adequate renal function
- monitor vital signs, noting hypotension and shallow respirations
- observe for DTRs, changes in level of consciousness
60
Phosphorous Normal Serum Level
2. 5-4.5
- phosphorous is essential to the function of muscle and RBC
- formation of ATP
- maintenance of acid-base balance
- metabolism of carbs, proteins, and fat
61
Hypophosphatemia (Phosphorous Deficit)
Phosphorous level lower than 2.5
62
Hypophosphatemia Contributing Factors
- can be caused by an intracellular shift of potassium from serum into cells, increased urinary excretion of potassium, or by decreased intestinal absorption of potassium
- refeeding after starvation
- alcohol withdrawal
- diabetic ketoacidosis
- respiratory and metabolic alkalosis
- decreased magnesium
- decreased potassium
- hyperparathyroidism
- vomiting
- diarrhea
- hyperventilation
- vitamin D deficiency associated with malabsorptive disorders
- burns
- acid-base disorders
- parenteral nutrition
- diuretic and antacid use
- heat stroke
- poor dietary intake
- respiratory alkalosis
63
Hypophosphatemia Lab Findings
- glucose/insulin may slightly decrease serum levels
- PTH increased in hyperparathyroidism
- serum Mg may decrease due to increased urinary secretions
64
Hypophosphatemia Signs & Symptoms
- paresthesias
- muscle weakness
- bone pain/tenderness
- chest pain
- confusion
- cardiomyopathy
- respiratory failure
- seizures
- tissue hypoxia
- increased susceptibility to infection
- nystagmus "dancing eyes"
65
Hypophosphatemia Management
-encourage foods such as milk/milk products, organ meats, fish, nuts, poultry, and whole grains
66
Hyperphosphatemia (Phosphorous Exces
Serum level that exceeds 4.5
67
Hyperphosphatemia Contributing Factors
- renal failure
- increased intake, decreased output
- shift from the intracellular to extracellular space
- excessive vitamin D intake
- admin. of total parenteral nutrition
- chemotherapy for neoplastic disease
- hypoparathyroidism
- metabolic/respiratory acidosis
- diabetic ketoacidosis
- acute hemolysis
- high phosphate intake
- profound muscle necrosis
68
Hyperphosphatemia Signs & Symptoms
- tetany
- tachychardia
- anorexia
- nausea/ vomiting
- muscle weakness
- signs/symptoms of hypocalcemia
- hyperactive reflexes
- tissue calcifications in lungs, heart, kidneys, and cornea
69
Hyperphosphatemia Management
- avoid hard cheeses, cream, nuts, meats, whole-grain cereals, dried fruits, dried vegetables, kidneys, sardines, sweetbreads, and foods made with milk
- monitor for changes in urine output
70
Chloride Normal Serum Level
97-107
- chloride is contained in gastric and pancreatic juices
- produced in the stomach
71
Hypochloremia (Chloride Deficit)
-serum chloride level below 97
72
Hypochloremia Contributing Factors
- GI tube drainage
- gastric suctioning
- gastric surgery
- severe vomiting
- diarrhea
- low sodium intake
- metabolic alkalosis
- massive blood transfusions
- diuretic therapy
- burns
- fever
- admin. of ACTH, corticosteroids, bicarbonate, or laxatives
73
Hypochloremia Signs & Symptoms
- agitation
- irritability
- tremors
- muscle cramps
- hyperactive deep tendon reflexes
- hypertonicity
- tetany
- slow shallow respirations
- seizures
- dysrhythmias
- coma
74
Hypochloremia Lab Findings
- low serum sodium levels
- increased pH
- increased bicarbonate
- increased total carbon dioxide content
- decreased serum potassium
75
Hypochloremia Management
- 0.9% sodium chloride
- 0.45% sodium chloride
- monitor intake/output
- arterial blood gas values
- changes in consciousness
- muscle strength/movement
- vital signs and respiratory rate
- high chloride content foods
76
Hyperchloremia (Chloride Excess)
-serum chloride level higher than 107
77
Hyperchloremia Contributing Factors
- excessive sodium chloride infusions w/ water loss
- head injury
- hypernatremia
- renal failure
- corticosteroid use
- dehydration
- severe diarrhea (loss of bicarbonate)
- respiratory alkalosis
- administration of diuretics
- overdose of salicylates
- metabolic acidosis
78
Hyperchloremia Signs & Symptoms
- tachypnea
- lethargy
- weakness
- deep rapid respirations
- decline in cognitive status
- decreased cardiac output
- dyspnea
- tachycardia
- pitting edema
- dysrhythmia
- coma
79
Hyperchloremia Lab Findings
- increased serum potassium
- increased serum sodium
- decreased pH
- decreased bicarbonate
80
Hyperchloremia Management
- admin hypotonic solutions
- monitor vital signs
- monitor ABG
- intake/output
