Chapter 17 exam 1 Flashcards
(219 cards)
1
Q
What is Homeostasis? (3)
A
- State of equilibrium in body
- Naturally maintained by adaptive responses
- Body fluids and electrolytes are maintained within narrow limits
2
Q
Body fluids and electrolytes are maintained within narrow limits. Definition of…?
A
Homeostasis
3
Q
Naturally maintained by adaptive responses. Definition of…?
A
Homeostasis
4
Q
State of equilibrium in the body. Definition of…?
A
Homeostasis
5
Q
Water content of the body weight in ADULTS is how much % ?
A
50 - 60%
6
Q
Water content of the body weight in OLDER ADULTS is how much % ?
A
45 - 55%
7
Q
Water content of the body weight in INFANTS is how much % ?
A
70 - 80%
8
Q
Who has the most WATER CONTENT of the body? Adult, Older Adult, or Infant
A
Infant, 70 - 80%
9
Q
Who has the least WATER CONTENT of the body? Adult, Older Adult, or Infant
A
Older Adult, 45 - 55%
10
Q
Intracellular fluid (ICF) which takes place INSIDE the cell makes up how much of body fluid?
A
2/3 of body fluid
11
Q
Extracellular fluid (ECF) which takes place OUTSIDE of the cell makes up how much of body fluid?
A
1/3 of body fluid
12
Q
Intravascular (plasma) vs Interstitial fluid make up how much of Extracellular fluid (ECF)?
A
- Intravascular fluid makes up 1/3 of ECF
- Interstitial fluid makes up 2/3 of ECF
13
Q
Substances whose molecules dissociate into ions (charged particles) when placed into water are…?
A
Electrolytes
14
Q
Cations are positively (+) or negatively (-) charged?
A
Positively (+) charged
15
Q
Anions are positively (+) or negatively (-) charged?
A
Negatively (-) charged
16
Q
What is the type of measurement/ standard we use in the U.S. for Electrolytes?
A
Milliequivalent per liter (mEq)
17
Q
mEq means…
A
Milliequivalent
18
Q
What is the International standard of measurement for electrolytes?
A
Millimoles per liter (mmol/L)
19
Q
Electrically charged particles are?
A
Ions
20
Q
Sodium (Na), Potassium (K), Calcium (Ca2), Magnesium (Mg2) are examples of… Cations (+) or Anions (-) ?
A
Cations (+)
21
Q
Bicarbonate (HCO3), Chloride (Cl), Phosphate (PO4) are examples of… Cations (+) or Anions (-) ?
A
Anions (-)
22
Q
What are the PRIMARY prevalent Cation and Anions for Intracellular Fluid (ICF)?
A
Potassium (K+) & Phosphate (PO4 3-)
23
Q
What are the PRIMARY prevalent Cation and Anions for Extracellular Fluid (ECF)?
A
Sodium (Na+) & Chloride (Cl-)
24
Q
Another name for NaCl is? Table _______
A
Salt
25
6 Mechanisms for Controlling Fluid & Electrolyte Movement
1. Diffusion
2. Facilitated diffusion
3. Active transport
4. Osmosis
5. Hydrostatic pressure
6. Oncotic pressure
26
Normal serum level for anion, Bicarbonate (HCO3-) is _____?
22-26 mEq/L
27
Normal serum level for anion, Chloride (Cl-) is _____?
96-106 mEq/L
28
Normal serum level for anion, Phosphate (PO4 3-) is _____?
2.4- 4.4 mg/dL
29
Normal serum level for cation, Sodium (Na+)
135-145 mEq/L
30
Normal serum level for cation, Magnesium (Mg2+)
1.5-2.4 mEq/L
31
Normal serum level for cation, Calcium (Ca2+)
8.5-10.5 mg/dL
32
Does Solute dissolve into Solvent or does Solvent dissolve into Solute?
Solute dissolves into solvent. Ex. Sugar into water.
33
Movement of molecules from high to low concentration
- Occurs in liquids, solids, and gases
- Membrane separating two areas must be permeable to diffusing substance.
- Requires NO ENERGY
... is what type of mechanism for controlling Fluid & Electrolytes?
Diffusion
34
Movement of molecules from high to low concentration without energy
Uses SPECIFIC CARRIER molecules to accelerate diffusion
... is what type of mechanism for controlling Fluid & Electrolytes
Facilitated Diffusion
35
Process in which molecules move AGAINST concentration gradient
Example: sodium–potassium pump
External energy required (ATP)
... is what type of mechanism for controlling Fluid & Electrolytes
Active Transport
36
Movement of WATER between two compartments by a membrane permeable to water but not to solute
Moves from low solute to high solute concentration
Requires no energy
Note: WATER is moving and not SOLUTE
... is what type of mechanism for controlling Fluid & Electrolytes
Osmosis
37
In IMPORTANT ion is involved in Active Transport (ATP) ?
Phosphate
38
Amount of pressure required to stop osmotic flow of water is determined by....?
Concentration of solutes in solution
39
The osmotic pressure is...
- minimum pressure needed to maintain equilibrium, with no net movement of solvent.
- It depends on the molar concentration of the solute but not on what it is (e.g., sodium, glucose, etc.)
40
When you dissolve a solute in a solvent it makes a ________ ?
Solution
41
The pressure of osmosis is ______ pressure?
Osmotic Pressure
42
What are great big protein molecules that suck up all the water and have high oncotic pressure they pull water out of everything? Colloids or Cystalloids?
Colloids
43
Osmotic Pressure:
Osmolality vs. Osmolarity?
- Measure of the number of particles in the unit weight (e.g., Kg) of a SOLVENT
- Total volume of SOLVENT is precise, final volume of SOLUTION is not.
- MEASURED with an osmometer; typically a LAB value
- fluids INSIDE the body
- Examples: concentration of plasma, urine for diagnosing DM, dehydration, shock
Osmolality
44
Osmotic Pressure:
Osmolality vs. Osmolarity?
- Total mOsm of SOLUTE per unit of total volume of SOLUTION
- Total volume of SOLUTION is precise, final volume of SOLVENT is not. (e.g., Add solvent up to a final volume of 1 L.)
- CALCULATED based on solution contents; common bedside calculation in a clinical setting for osmotic activity
- fluids OUTSIDE of the body Ex. IV
- This value changes with Temperature & pressure (It’s difficult to estimate w/in a dynamic system.
Osmolarity
45
When you increase in pressure you increase in _____?
Temperature
46
Recall that _______ is that substance that is dissolved by SOLVENT in SOLUTION
Solute
47
Osmolality (Call me Al) takes place INSIDE or OUTSIDE the body?
Inside
48
Osmolarity (Call me Larry) takes place INSIDE or OUTSIDE the body?
Outside
49
The amount of sugar in urine is an example of Osmolality or Osmolarity?
Osmolality
50
Pressure from an IV fluid is an example of Osmolality or Osmolarity?
Osmolarity
51
of m0sm (Solute) divided by total Liters of solution is, and takes place outside of the body is Osmolality or Osmolarity?
Osmolarity
52
What is produced inside the body, in which you are measuring it? Osmolality or Osmolarity?
Osmolality
53
What type of solution has low energy on the outside of the cell that pulls fluid inside the cell making it bigger and bigger until it breaks (lysis)? Hypertonic, Isotonic, or Hypotonic
Hypotonic
54
What type of solution has high energy to pull fluid out of the cell? Hypertonic, Isotonic, or Hypotonic
Hypertonic
55
Fluids with same osmolality as the cell interior (equal distribution) are termed ____? Hypertonic, Isotonic, or Hypotonic.
Isotonic
56
_____ are syrups that pull fluid into them.
Colloid
57
Hydrostatic Pressure
- Force within a fluid compartment
| - Major force that pushes water out of vascular system at capillary level
58
Oncotic Pressure
Osmotic pressure exerted by colloids in solution
| - Protein is a major colloid
59
What type of IV Fluid is this? Colloid or Crystalloid
- Like syrup
- High osmotic pressure
- Contains large insoluble molecules that cannot pass through capillary -membranes
- Used to draw fluid from interstitial & intracellular spaces
- Disadvantage: allergic reaction
- Examples: albumin, blood, dextran, starches, gelatins
Colloid
60
What type of IV Fluid is this? Colloid or Crystalloid
- Like water
- Closest to ECF
- Used to expand intracellular and extracellular volume
- Can be isotonic, hypertonic, hypotonic
- Isotonic: expansion without altering plasma electrolyte concentrations
- Disadvantage: YOU CAN GET FLUID OVERLOAD
- Examples: NS, LR Saline
Cystalloid
61
What is the BIG difference between Crystalloids and Colloids?
Crystalloids are going to be thinner and Colloids are going to be thicker.
62
What two pressures cause the movement of water out of the capillaries?
Capillary hyrdrostatic pressure and interstitial oncotic pressure.
63
What two pressures cause the movement of fluid into the capillary?
Plasma oncotic pressure and interstitial hyrdostatic pressure.
64
At the venous end of the capillary, the capillary hyrdrostatic pressure is (LOWER or HIGHER) than oncotic pressure, and fluid is drawn back into the capillary by the oncotic pressure created by plasma proteins.
LOWER
65
At the arterial end of the capillary, capillary hydrostatic pressure ______ plasma oncotic pressure, and fluid is moved into the interstitium.
EXCEEDS
66
What has to happen in the fluid shift of plasma-to-interstitial (Blood to tissue)?
- Elevation of hydrostatic pressure
- Decrease in plasma oncotic pressure
- Elevation of interstitial oncotic pressure
- Results in edema
67
What has to happen in the fluid shift of Interstitial-to-plasma (Tissue to Blood)?
- Fluid drawn into plasma space with increase in plasma -- osmotic or oncotic pressure
- Compression stockings
- Results in decrease of edema
68
What is the pressure that attracts water called?
Oncotic Pressure
69
Associated with symptoms that result from cell shrinkage as water is pulled into vascular system is... Water Defecit (increased ECF) or Water Excess (decreased ECF)
Water Defecit (increased ECF)
70
Develops from gain or retention of excess water is... (increased ECF) or Water Excess (decreased ECF)
Water Excess (decreased ECF)
71
What is First Spacing?
Normal distribution of fluid in ICF and ECF
72
What is Second Spacing?
Abnormal accumulation of interstitial fluid (edema)
73
What is Third Spacing?
Fluid accumulation in part of body where it is not easily exchanged with ECF
74
Regulation of Water Balance consists of?
- Hypothalamic regulation
- Pituitary regulation
- Adrenal cortical regulation
- Renal regulation
- Cardiac regulation
- Gastrointestinal regulation
- Insensible water loss
75
The ability to attract water is Hydrostatic pressure or Oncotic pressure?
Oncotic pressure
76
The ability to push water is Hydrostatic pressure or Oncotic pressure?
Hydrostatic pressure
77
What type of regulation of water consists of Osmoreceptors in hypothalamus sense fluid deficit or increase, stimulates thirst and antidiuretic hormone (ADH) release, and result in increased free water and decreased plasma osmolarity?
Hypothalamic Regulation
78
What type of regulation of water is Under control of hypothalamus, posterior pituitary releases ADH, and stress, nausea, nicotine, and morphine also stimulate ADH?
Pituitary Regulation
79
What type of regulation of water consists of;
Releases hormones to regulate water and electrolytes
Glucocorticoids
- Cortisol regulates water and electrolytes, conserves them
Mineralocorticoids
- Aldosterone
Adrenal Cortical Regulation
80
Factors affecting aldosterone secretion?
Check Fig. 17-9
81
Effects of stress on fluid an electrolyte balance?
Check Fig. 17-10
82
What type of regulation of water consists of;
Primary organs for regulating fluid and electrolyte balance
Adjusting urine volume
- Selective reabsorption of water and electrolytes
- Renal tubules are sites of action of ADH and aldosterone.
Renal Regulation
83
What type of regulation of water consists of;
Natriuretic peptides are antagonists to the RAAS.
- Produced by cardiomyocytes in response to increased atrial pressure
- Suppress secretion of aldosterone, renin, and ADH to decrease blood volume and pressure
Cardiac Regualtion
84
What type of regulation of water consists of;
- Oral intake accounts for most water.
- Small amounts of water are eliminated by gastrointestinal tract in feces.
- Diarrhea and vomiting can lead to significant fluid and electrolyte loss.
Gastrointestinal Regulation
85
What is Insensible Water Loss?
Invisible vaporization from lungs and skin to regulate body temperature
- Approximately 600 to 900 mL/day is lost.
- No electrolytes are lost.
86
What are some Gerontologic Considerations?
- Structural changes in kidneys decrease ability to conserve water.
- Hormonal changes lead to increase in ADH and ANP.
- Loss of subcutaneous tissue leads to increased loss of moisture. Skin gets thinner
- Reduced thirst mechanism results in decreased fluid intake. Lose moisture quicker
- Nurse must assess for these changes and implement treatment accordingly.
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87
Fluid and Electrolyte imbalances are common in most patient with...?
Common in most patients with major illness or injury
88
Fluid and Electrolyte Imbalances
Common in most patients with major illness or injury
- Directly caused by illness or disease (burns or heart failure)
- Result of therapeutic measures (IV fluid replacement or diuretics)
89
What are other names for (ECF volume deficit) and (Fluid volume excess)?
Hypovolemia and Hypervolemia
90
Abnormal loss of normal body fluids (diarrhea, fistula drainage, hemorrhage), inadequate intake, or plasma-to-interstitial fluid shift is... Hypervolemia or Hypovolemia
Hypovolemia
91
What kind of TREATMENT is used for Hypovolemia?
Treatment: Replace water and electrolytes with balanced IV solutions
92
XS fluid intake, abnl fluid retention, or interstitial-to-plasma fluid shift is... Hypervolemia or Hypovolemia?
Hypervolemia
93
What kind of TREATMENT is used for Hypervolemia?
Treatment: Remove fluid without changing electrolyte composition or osmolality of ECF
94
What are some NURSING DIAGNOSES for HYPOVOLEMIA?
- Deficient fluid volume
- Decreased cardiac output
- Risk for deficient fluid volume
- Potential complication: Hypovolemic shock
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95
What are some NURSING DIAGNOSES for HYPERVOLEMIA?
- XS fluid volume
- Risk for imbalanced fluid volume
- Ineffective airway clearance
- Risk for impaired skin integrity
- Disturbed body image
- Potential complications: Pulmonary edema, ascites
96
In checking I&O reading of greater than 1.025 indicate?
concentrated urine
97
In checking I&O reading of less than 1.010 indicate?
dilute urine
98
Changes in blood pressure, pulse force and jugular vein distention help identify?
Signs and symptoms of ECF volume excess and deficit
99
ECF excess can result in ?
pulmonary congestion and pulmonary edema as increased hydrostatic pressure in the pulmonary vessels forces fluid into the alveoli .
100
Pulmonary congestion and pulmonary edema as increased hydrostatic pressure in the pulmonary vessels forces fluid into the alveoli is a result of? Fluid excess or Fluid deficit?
ECF excess
101
An increase of 1 kg (2.2 lb) is equal to how man mL of fluid retention?
1000 mL = 1 L of fluid retention
102
What type of assessments should the nurse implement in checking Neurologic Function?
- LOC
- PERLA
- Voluntary movement of extremities
- Muscle strength
- Reflexes
103
Why is decreased skin turgor less predictive of fluid deficit in older persons/ adults?
Because of the loss of tissue elasticity. This is a result of aging.
104
In performing a skin assessment what are usual sites for evaluation of skin turgor?
: Skin areas over the sternum, abdomen, and anterior forearm are the usual sites for evaluation of tissue turgor.
105
What is invisible vaporization from the lungs and skin, that assists in regulating body temperature? Normally about 600 to 900 mL/day is lost.
Insensible water loss
106
What is another name for excessive sweating and what causes it?
Sensible perspiration and it is caused by exercise, fever, or high environmental temperatures that may lead to large losses of water and electrolytes.
107
Normal serum level for Potassium (K+)
3.5 - 5 mEq/L
108
Normal serum level for Calcium (Ca2+)
8.5 - 105 mEq/L
109
What electrolyte is this?
Normal serum level: 135-145 mEq/L
- Imbalances typically associated with parallel changes in osmolality
Sodium (Na+) Cation
110
What are the major roles of Sodium (Na+) Cation?
Plays a major role in
- ECF volume and concentration
- Generation and transmission of nerve impulses
- Acid-base balance
111
Hyponatremia or Hypernatremia?
-Elevated serum sodium occurring with water loss or sodium gain
-Causes hyperosmolality leading to cellular dehydration
Primary protection is thirst from hypothalamus.
Hypernatremia
112
What are manifestations of Hypernatremia?
Manifestations:
Thirst, lethargy, agitation, seizures, and coma
Impaired LOC
113
What clinical states produce Hypernatremia?
Central or nephrogenic Diabetes insipidus
114
Nursing Diagnoses for Hypernatremia?
- Risk for injury
- Risk for electrolyte imbalance
- Potential complication: Seizures and coma leading to irreversible brain damage
115
Nursing Implementation for Hypernatremia?
- Treat underlying cause.
- If oral fluids cannot be ingested, IV solution of 5% dextrose in water or hypotonic saline
- Diuretics
116
Results from loss of sodium-containing fluids or from water excess is Hypernatremia or Hyponatremia?
Hyponatremia
117
Manifestations of Hyponatremia?
Manifestations
| Confusion, nausea, vomiting, seizures, and coma
118
Nursing Diagnoses for Hyponatremia?
- Risk for injury
- Risk for electrolyte imbalance
- Potential complication: Severe neurologic changes
119
Nursing Implementation for Hyponatremia?
```
Caused by water excess
- Fluid restriction is needed.
Severe symptoms (seizures)
- Give small amount of IV hypertonic saline solution (3% NaCl).
- Abnormal fluid loss
Fluid replacement with Na+ solution
Vasopressins
```
120
What electrolyte is a MAJOR ICF Cation?
Potassium (K+) Cation
121
Potassium (K+) is necessary for...
Necessary for
- Transmission and conduction of nerve & muscle i--impulses
- Cellular growth
- Cardiac rhythms
- Acid-base balance
122
What are some sources of Potassium (K+) Cation?
- Fruits and vegetables
- Salt substitutes
- Potassium medications (PO, IV)
- Stored blood
123
Hyperkalemia is most common in what type of failure?
Renal failure
124
```
Hyperkalemia or Hypokalemia?
High serum potassium caused by
-Massive intake
-Impaired renal excretion
-Shift from ICF to ECF
```
Hyperkalemia
125
What are some manifestations of Hyperkalemia?
- Cramping leg pain
- Weak or paralyzed skeletal muscles
- Ventricular fibrillation or cardiac standstill
- Abdominal cramping or diarrhea
126
Nursing Diagnoses for Hyperkalemia?
- Risk for electrolyte imbalance
- Risk for injury
- Potential complication: Dysrhythmias
127
Nursing Implementation for Hyperkalemia?
- Eliminate oral and parenteral K intake.
- Increase elimination of K (diuretics, dialysis, Kayexalate).
- Force K from ECF to ICF by IV insulin or sodium bicarbonate.
- Reverse membrane effects of elevated ECF potassium by administering calcium gluconate IV
128
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Hyperkalemia or Hypokalemia?
Low serum K+ caused by
-Abnormal losses of K+ via the kidneys or gastrointestinal tract
-Magnesium deficiency
-Metabolic alkalosis
```
Hypokalemia
129
Manifestations of Hypokalemia
- Most serious are cardiac.
- Skeletal muscle weakness (legs)
- Weakness of respiratory muscles
- Decreased gastrointestinal motility
- Impaired regulation of arteriolar blood flow
130
Nursing Diagnoses for Hypokalemia?
- Risk for electrolyte imbalance
- Risk for injury
- Potential complication: Dysrhythmias
131
Nursing implementations for Hypokalemia?
-KCl supplements orally or IV
-Should not exceed 10 to 20 mEq/hr
To prevent hyperkalemia and cardiac arrest
132
What electrolyte is this?
- Obtained from ingested foods
- More than 99% combined with phosphorus and concentrated in skeletal system
- Inverse relationship with phosphorus
- Bones are readily available store.
- Blocks sodium transport and stabilizes cell membrane
- Ionized form is biologically active
Calcium (Ca2+) Cation
133
What has electrolyte has an inverse relationship with Phosphorus?
Calcium (Ca2+) Cation
134
What are the function of Calcium (Ca2+)
Functions
- Nerve impulse transmission
- Myocardial contractions
- Blood clotting
- Formation of teeth and bone
- Muscle contractions
135
The balance of Calcium is controlled by?
- Parathyroid hormone
- Calcitonin
- Vitamin D
136
```
Is this Hypercalcemia or Hypocalcemia?
High serum calcium levels caused by
-Hyperparathyroidism (two thirds of cases)
-Malignancy
-Vitamin D overdose
-Prolonged immobilization
```
Hypercalcemia
137
Manifestations of Hypercalcemia?
Manifestations
- Decreased memory
- Confusion
- Disorientation
- Fatigue
- Constipation
138
Nursing Diagnoses of Hypercalcemia?
- Risk for electrolyte imbalance
- Risk for injury
- Potential complication: Dysrhythmias
139
Nursing Implementation of Hypercalcemia?
- Excretion of Ca with loop diuretic
- Hydration with isotonic saline infusion
- Synthetic calcitonin
- Mobilization
140
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Is this Hypercalcemia or Hypocalcemia?
Low serum Ca caused by
-decrease production of PTH
-Acute pancreatitis
-Multiple blood transfusions
-Alkalosis
-decreased intake
```
Hypocalcemia
141
Manifestations of Hypocalcemia?
- Positive Trousseau’s or Chvostek’s sign
- Laryngeal stridor
- Dysphagia
- Tingling around mouth or in the extremities
142
What is Trousseau's sign? This is a manifestation of what?
Is a carpal spasm induced by inflating a blood pressure cuff above the systolic pressure for a few minutes. Hypocalcemia
143
What is Chvosteks sign? This is a manifestation of what?
Is a contraction of facial muscles in response to a light tap over the facial nerve in front of the ear? Hypocalcemia
144
Nursing DIagnoses of Hypocalcemia?
- Risk for electrolyte imbalance
- Risk for injury
- Potential complication: Fracture or respiratory arrest
145
Nursing Implementations of Hypocalcemia?
-Treat cause.
-Oral or IV calcium supplements
Not IM to avoid local reactions
-Treat pain and anxiety to prevent hyperventilation-induced respiratory alkalosis.
146
What electrolyte is this?
- Normal serum Mg: 1.5-2.4 mEq/L
- 50% to 60% contained in bone.
- Coenzyme in metabolism of protein and carbohydrates
- Factors that regulate calcium balance appear to influence magnesium balance.
- Acts directly on myoneural junction
- Important for normal cardiac function
Magnesium (Mg2+) Cation
147
What electrolyte is a coenzyme in metabolism of protein and carbohydrates?
Magnesium (Mg2+) Cation
148
This electrolyte acts directly on myoneural junction and is important for normal cardiac function.
Magnesium (Mg2+) Cation
149
What is Hypermagnesemia, High serum Mg caused by?
Increased intake or ingestion of products containing magnesium when renal insufficiency or failure is present
150
What are manifestations of Hypermagnesemia?
- Lethargy or drowsiness
- Nausea/vomiting
- Impaired reflexes
- Somnolence
- Respiratory and cardiac arrest
151
What management can nurses provide for a patient with Hypermagnesemia?
-Prevention
-Emergency treatment
IV CaCl or calcium gluconate
-Fluids to promote urinary excretion
152
Is this Hypermagnesemia or Hypomagnesemia?
Low serum Mg caused by
- Prolonged fasting or starvation
- Chronic alcoholism
- Fluid loss from gastrointestinal tract
- Prolonged parenteral nutrition without supplementation
- Diuretics
153
What are manifestations of Hypomagnesemia?
- Confusion
- Hyperactive deep tendon reflexes
- Tremors
- Seizures
- Cardiac dysrhythmias
154
Management for Hypomagnesemia?
- Oral supplements
- Increase dietary intake.
- Parenteral IV or IM magnesium when severe
155
This electrolyte normal serum level is 2.4-4.4 mg/dL and is the a PRIMARY anion in ICF.
Phosphate (PO4 3-) Anion
156
What electrolyte is this?
- Essential to function of muscle, red blood cells, and nervous system
- Deposited with calcium for bone and tooth structure
- Involved in acid-base buffering system, ATP production, and cellular uptake of glucose
- Maintenance requires adequate renal functioning.
- A reciprocal relationship exists between phosphorus and calcium in that a high serum phosphate level tends to cause a low calcium concentration in the serum.
Phosphate (PO4 3-) Anion
157
```
Hyperphosphatemia or Hypophosphatemia?
High serum PO43- caused by
-Acute or chronic renal failure
-Chemotherapy
-Excessive ingestion of phosphate or vit D
```
Hyperphosphatemia
158
Manifestations of Hyperphosphatemia?
- Calcified deposits in soft tissue such as joints, arteries, skin, kidneys, and corneas
- Neuromuscular irritability and tetany
159
Management of Hyperphosphatemia?
- Identify and treat underlying cause.
- Restrict foods and fluids containing phosphorus.
- Adequate hydration and correction of hypocalcemic conditions
160
What is Hypophosphatemia (Low serum P04 3- caused by...)?
- Malnourishment/malabsorption
- Alcohol withdrawal
- Use of phosphate-binding antacids
- During parenteral nutrition with inadequate replacement
161
Manifestations of Hypophasphatemia?
- CNS depression
- Confusion
- Muscle weakness and pain
- Dysrhythmias
- Cardiomyopathy
162
Management of Hyphosphatemia?
- Oral supplementation
- Ingestion of foods high in phosphorus
- IV administration of sodium or potassium phosphate
163
What are TWO purposes for IV FLUIDS?
1. Maintenance: When oral intake is not adequate
| 2. Replacement: When losses have occurred
164
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Hypotonic, Isotonic, or Hypertonic IV Fluid?
-More water than electrolytes
Pure water lyses RBCs.
-Water moves from ECF to ICF by osmosis.
-Usually maintenance fluids
```
Hypotonic IV Fluid
165
Hypotonic, Isotonic, or Hypertonic IV Fluid?
- Expands only ECF
- No net loss or gain from ICF
Isotonic IV Fluid
166
Hypotonic, Isotonic, or Hypertonic IV Fluid?
-Initially expands and raises the osmolality of ECF
-Require frequent monitoring of
Blood pressure
Lung sounds
Serum sodium levels
Hypertonic IV Fluid
167
D5W is?
5% dextrose in water
168
This IV Fluid is used to replace water losses and treat hyponatremia and does not provide electrolytes.
D5W 5% dextrose in water
169
What IV Fluid is this?
- Isotonic
- Provides 170 cal/L
- Free water, Moves into ICF, Increases renal solute excretion
D5W 5% dextrose in water
170
Normal Saline (NS) is made up of what?
0.9% sodium chloride in water
171
```
What IV Fluid is this?
-No calories
-More NaCl than ECF
-30% stays in IV (most)
70% moves out of IV
-Compatible with most medications
```
Normal Saline (NS) 0.9% Sodium Chloride in water
172
What IV Fluid is this?
Expands IV volume
-Preferred fluid for immediate response
-Risk for fluid overload higher
Normal Saline (NS) 0.9% Sodium Chloride in water
173
What IV Fluid is this?
Does not change ICF volume
Use with blood products
Normal Saline (NS) 0.9% Sodium Chloride in water
174
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What IV Fluid is this?
-Isotonic
-More similar to plasma than NS
Has less NaCl
Has K, Ca, PO43-, lactate (metabolized to HCO3)
-Expands ECF
```
Lactated Ringer's
175
D5 1/2 NS is made up of?
5% dextrose in 0.45% (half) normal saline
176
What IV Fluid is this?
- Hypertonic
- Common maintenance fluid
- KCl added for maintenance or replacement
D5 1/2 NS
177
D10W is?
10% dextrose in water
178
What IV Fluid is this?
- Hypertonic
- Provides 340 kcal/L
- Free water
- Limit of dextrose concentration may be infused -peripherally.
D10W
179
Plasma expanders do what?
- stay in vascular space
| - increase osmotic pressure
180
Colloids (protein solutions) are?
- Albumin
- Plasma
- Commercial plasmas
- Packed RBCs
181
What is the purpose of Acid-Base Balance and Arterial Blood Gases
-Maintain a steady balance between acids and bases to achieve homeostasis
-Health problems lead to imbalance
Diabetes mellitus
Vomiting and diarrhea
Respiratory conditions
182
What is the normal range of pH and blood is slightly alkaline at?
7.35 to 7.45
183
What is the ratio of Carbonic acid to Base Bicarbonate
1:20
184
Acidosis is?
less than <7.5 pH
185
Alkalosis is?
greater than >7.5 pH
186
pH is the measure of?
H+ ion concentration
187
What is the system at work to buff pH?
CO2+H20 H2CO3 H+ + HCO3-
188
Regulators of Acid/Base
| Metabolic processes produce acids that must...?
be neutralized and excreted
189
Regulators of Acid/Base mechanisms are? (3)
- Buffers
- Respiratory System
- Renal System
190
Act chemically to neutralize acids or change strong acids to weak acids. What type of regulator of Acid/Base is this?
Buffers
191
What 3 characteristics do Buffers have?
- Primary regulators
- React immediately
- Cannot maintain pH without adequate respiratory and renal function
192
Regulators of Acid/Base
| Respiratory system eliminates what?
CO2
193
Regulators of Acid/Base
| The respiratory center in the ______ controls breathing?
Medulla
194
Regulators of Acid/Base
| Respiratory system responds within _____ to _____ to changes in acid and base.
minutes/hours
195
Regulators of Acid/ Base
Respiratory system ______ (increased/decreased) respirations lead to _______ (increased/decreased) CO2 elimination and ________ (increased/decreased) CO2 in blood.
Increased
Increased
Decreased
196
Regulators of Acid/Base
| The Slower Response (metabolic) Renal System does what?
Eliminates H+ and reabsorbs HC03-
197
Regarding regulation of Acid/ Base Is this Respiratory system or Renal System?
- Reabsorption and secretion of electrolytes (e.g., Na+, Cl-)
- Responds within hours to days
Renal System (Slower Response)
198
What are Alterations in Acid-Base balance?
Imbalances occur when compensatory mechanisms fail.
Classification of imbalances
Respiratory: Affect carbonic acid concentration
Metabolic: Affect bicarbonate
199
What are the classifications of imbalances in Acid-Base?
Respiratory: Affect carbonic acid concentration
Metabolic: Affect bicarbonate
200
Respiratory Acid-Base imbalance affect?
Carbonic acid concentration
201
Metabolic Acid-Base imbalance affect?
Bicarbonate
202
Regarding to alterations in Acid-Base Balance what does it mean to be compensated?
pH is in normal range but tends toward the extreme end of normal range for the condition
203
Regarding to alterations in Acid-Base Balance this is an example of what?
Example: pH = 7.35 is normal, but if PaCO2 = 48 mm Hg, we have compensated respiratory acidosis
Compensated.
204
Respiratory imbalances caused by carbonic acid (CA) _____(excess/deficit) and carbonic acid ______. (excess/defecit).
excess
| defecit
205
Metabolic imbalances caused by base bicarbonate (BB) _____(excess/deficit) and base bicarbonate ______(excess/defecit).
defecit
| excess
206
```
Is this Respiratory Acidosis or Alkalosis?
Carbonic acid XS caused by
-Hypoventilation
-Respiratory failure
Compensation in Kidneys
-conserve HCO3-
-secrete H+ into urine
```
Respiratory Acidosis
207
Is this Respiratory Acidosis or Alkalosis?
Carbonic acid deficit causes
-Hyperventilation
-Hypoxemia from acute pulmonary disorders
Compensation
-Rarely occurs because of aggressive treatment of causes of hypoxemia
Respiratory Alkalosis
208
```
Is this Metabolic Acidosis or Alkalosis?
Base bicarbonate deficit caused by, Ketoacidosis, Lactic acid accumulation (shock), Severe diarrhea, Kidney disease
Compensation
-Increased CO2 excretion by lungs
-Kussmaul respirations (deep and rapid)
-Kidneys excrete acid
```
Metabolic Acidosis
209
Is this Metabolic Acidosis or Alkalosis?
Base bicarbonate XS caused by Prolonged vomiting or gastric suction, Gain of HCO3-
Compensation
-Decreased respiratory rate to increase plasma CO2
-Renal excretion of HCO3-
Metabolic Alkalosis
210
Arterial blood gas (ABG) values provide information about?
- Acid-base status
- Underlying cause of imbalance
- Body’s ability to regulate pH
- Overall oxygen status
211
Interpretation of ABG's?
| What are the 6 steps of Diagnosis
1. Evaluate pH: NL, Acidotic, Alkylotic?
2. Analyze PaCO2 = respiratory component
3. Analyze HCO3- = metabolic component
4. If CO2 or HCO3- are within NL range, ABGs are considered NL if pH is also within NL range
5. Determine if CO2 or HCO3- matches the alteration.
6. Decide if the body is attempting to compensate.
212
pH 7.36
PaCO2 67 mm Hg
PaO2 47 mm Hg
HCO3 37 mEq/L
What is this?
Respiratory Acidosis
213
pH 7.18
PaCO2 38 mm Hg
PaO2 70 mm Hg
HCO3- 15 mEq/L
What is this?
Metabolic Acidosis
214
pH 7.60
PaCO2 30 mm Hg
PaO2 60 mm Hg
HCO3- 22 mEq/L
What is this?
Respiratory Alkalosis
215
pH 7.58
PaCO2 35 mm Hg
PaO2 75 mm Hg
HCO3- 50 mEq/L
What is this?
Metabolic Alkalosis
216
What is the Acid-Base Mnemonic?
```
ROME
R espiratory
O pposite
M etabolic
E qual
```
217
What does Respiratory Opposite mean?
Alkalosis INCREASE in pH DECREASE in PaC02
| Acidosis DECREASE in pH INCREASE in PaC02
218
What does Metabolic Equal mean?
Acidosis DECREASE in pH DECREASE in HC03
| Alkalosis INCREASE in pH INCREASE in HC03
219
This is what type of pressure?
- minimum pressure needed to maintain equilibrium, with no net movement of solvent.
- It depends on the molar concentration of the solute but not on what it is (e.g., sodium, glucose, etc.)
Osmotic Pressure
