Chapter 41: Fluid and Electrolyte Practice Test Flashcards Preview

Block One Exam 4 Practice Test > Chapter 41: Fluid and Electrolyte Practice Test > Flashcards

Flashcards in Chapter 41: Fluid and Electrolyte Practice Test Deck (97):
1

Fluids & electrolytes help to maintain ______ in body

homeostasis

2

State of equilibrium

homeostasis

3

Chemical reactions dependent on _______

F & E balance

4

Normal water content in an Adult Male is?

60% of TBW

5

Normal water content in an Adult female is?

50-55% of TBW

6

Normal water content in the elderly is?

45-55% of TBW

7

Normal water content in an infant is?

70-80% of TBW

8

What is the solvent in which body salts, nutrients, and wastes are dissolved and transported?

water

9

______ need to be in correct balance for cells to function properly

Electrolytes

10

What are the Primary electrolytes in body

Na+, K+, Ca2+
Other: Cl, Mg, Bicarb (HCO3), Phosphates (PO4), Sulfates (SO4)

11

Name 2 functions of electrolytes

1. substances which split into ions when dissolved in water
2. able to carry an electrical current

12

Has About 40% of total body weight (TBW) &
Maintains cell size & function

Intracellular fluid (ICF)

13

Name 2 body fluid compartments

intracellular fluid and extracellular fluid

14

Name the fluid inside blood (plasma) (5%)

Intravascular fluid

15

ISF (interstitial fluid) includes what components and functions?

lymph, transports O2, nutrients, hormones, & other chemicals between blood & cell cytoplasm

16

The fluid between cells, outside vascular space is?

Interstitial fluid (ISF)

17

The small amount of fluid in GI tract, cerebrospinal fluid, pleural, synovial, & peritoneal fluids

Transcellular space

18

Extracellular fluid contains _____,_______,_____:

intravascular, interstitial and the transcellular space

19

Body shifts fluid to keep osmolality (concentration of dissolved substances) balanced between 3 fluid spaces. What are those spaces?

plasma, interstitial fluid and intracellular fluid

20

Fluids & electrolytes (solutes) constantly shift between compartments by 4 processes. What are they:

Osmosis
Diffusion
Filtration
Active Transport

21

Body tries to keep osmolality balanced in the 3 fluid compartments by?

shifting fluid or solutes

22

Kussmaul respirations
Changes in LOC
Disorientation
Muscle twitching
Low PH
Low HCO3

What acid-base imbalance is this?

Metabolic Acidosis

23

Rapid, shallow respirations
Dyspnea
Muscle weakness
Low pH
High CO2

What acid-base imbalance symptoms are these?

Respiratory Acidosis

24

Slow respirations
Restlessness
Diarrhea
Nausea & Vomiting
Arrhythmias
High PH
High HCO3
What acid-base imbalance symptoms are these?

Metabolic Alkalosis

25

Deep rapid breathing
Seizures
Confusion
Tingling of Extremities
High pH
Low CO2
What acid-base imbalance symptoms are these?

Respiratory Alkalosis

26

movement of solvent (water) across semi-permeable membrane from area of lower concentration to higher

Osmosis

27

a higher solute concentration pulls fluid into that space

Osmotic pressure

28

Blood has _____________ due to plasma proteins

colloid osmotic pressure AKA oncotic pressure

29

Keeps fluid from leaking out of vascular space

colloid osmotic pressure AKA oncotic pressure

30

_______ is especially important to keep fluid from shifting out of intravascular space

Albumin

31

If pancreas doesn’t produce enough insulin or if body is resistant to using insulin, glucose is not able to diffuse across cell membrane to be utilized.
Which disease does this cause?

Diabetes

32

movement of solutes from higher concentration to lower

Diffusion

33

movement of glucose across cell membrane requires carrier molecules which bind to receptors and make the membranes more permeable to glucose

Facilitated diffusion

34

Movement of O2 & CO2 between alveoli & capillaries

diffusion

35

molecules move from area of lower to higher concentration, requires energy

Active transport –
e.g. sodium-potassium pump allows a higher concentration of K+ in ICF & higher concentration of Na+ in ECF

36

______and _____ are processes used to balance osmolality or solute concentration

Diffusion and osmosis

37

_____ is movement of fluid to balance solute concentration

Osmosis

38

____ is movement of both fluid and solutes to equalize solute concentration

Diffusion

39

transfer of water & dissolved substances through membrane from region of high pressure to region of lower pressure.

Filtration –
ex: Occurs in kidney glomerular capillaries & in blood capillaries

40

____ ____ is generally higher on arterial side & lower on venous side of capillaries

Hydrostatic pressure
ex: In CHF, hydrostatic pressure higher on venous side of capillary beds

41

Fluid moves out of vascular space into interstitial space causing what sx?

edema

42

Force within a fluid compartment which includes: Vascular space or tissues

Hydrostatic Pressure

43

Osmotic pressure exerted by proteins, (especially albumin)
Large molecules hold fluid in vascular space

Oncotic Pressure

44

Total milliosmoles of solute per unit of volume of solution mOsm/L
Describes fluids outside the body

Osmolarity

45

Osmotic force of solute per unit of wt. of solvent mOsm/kg or mmol/kg
Describes fluids inside the body

Osmolality

46

same concentration of particles as plasma

Isotonic -

47

greater concentration of particles than plasma

Hypertonic -

48

lesser concentration of particles than plasma

Hypotonic -

49

What are the 2 primary body fluid compartments?

intracellular and extracellular fluid

50

Fluid & electrolytes shift between compartments via which 4 processes?

Osmosis
Diffusion
Filtration
Active Transport

51

____ transport keeps K+ higher in ICF & Na + higher in ECF

Active

52

Active transport requires energy in the form of _____ _____ to move electrolytes across cell membranes against the concentration gradient

adenosine triphosphate (ATP)

53

fluid shift from vascular space to interstitial space

Edema –

54

A ↓plasma oncotic pressure due to low protein would cause

Renal disorders, liver disease, malnutrition

55

What causes ↑ pressure in the vascular space?

fluid overload, CHF, liver failure, obstruction of venous return, venous insufficiency

56

damage to capillary walls from trauma (e.g. crushing injury), burns, inflammation
Plasma proteins leak into interstitial space causes...

↑interstitial oncotic pressure

Oncotic pressure R/T protein molecules holds fluid in the vascular space

57

loss of extracellular fluid from the vascular to other body compartments.

Third spacing

ex: Occurs with extensive surgical procedures, burns, septic shock, liver disease
Ascites in liver disease, severe edema with burns, peritonitis

58

Define Third spacing

Major fluid shift from intravascular to interstitial space.

Ex: Occurs with extensive surgical procedures, burns, septic shock, liver disease
Ascites in liver disease, severe edema with burns, peritonitis

59

fluid in abdominal intersitial (IS) space

Ascites

60

Problems that may with Third spacing are?

Causes hypovolemia, hypotension, tachycardia, ↓UOP due to insufficient fluid in vascular space
During surgical recovery, fluid shifts back into vascular space and can cause fluid overload

61

Beer and soda are _____ fluids

hypertonic

62

Fluid Shift from Interstitial
Space to Plasma (vascular space) is caused by?

Caused by increase in plasma osmotic or oncotic pressure R/T:
Administration of colloids (blood products), dextran, mannitol, or hypertonic solutions

63

Major illness or injuries may result in _____ and ______ _____.

F & E imbalance

64

___ ____ ____ regulated by intake, output, & hormonal controls

Body fluid volume

65

Thirst control center in ____ stimulated when serum osmolality increases

hypothalmus

66

Regulation of Fluid Input values per day are?

Need ~ 2200-2700ml fluid input per day
1500+ from fluids
1000 from solid food
300 from metabolism
2800+ mL TOTAL

67

Sweat regulated by ?

sympathetic nervous system

68

Fluid output primarily through ?

kidneys

69

Insensible (not noticeable) loss occurs through ?

skin, lungs, GI tract
Note: Insensible loss ↑ w/ fever or burns
GI tract loses additional fluid through vomiting or diarrhea, use of laxatives and stool softners

70

What would a nurse Assess for Fluid Balance?

History
Vital signs
I&O balance
Weight
Skin turgor/moisture
Mucous membranes
Lung sounds
JVD
Edema
LOC
Labs

71

1 Liter H20 =

2.2 lb or 1 kg

72

who are at HIGH risk for fluid imbalances?

infants
elderly- impaired thirst mechanism →dehydration & ↑Na
↑ risk of FVE
Post-op and/or NPO
anyone Vomiting / Diarrhea
Diuretics
Chronic Disease- renal,cardiac, endocrine

73

what labs would be assessed for fluid imbalances?

H&H: Hemoglobin (Hgb) & Hematocrit (HCT)
Electrolytes
BUN
Urine specific gravity
concentrated (>1.025)
dilute (<1.01)
Serum Osmolality - FYI
275-295 mOsm/kg
not a routine lab
BNP
Electrolytes & BUN will appear more concentrated if someone is dehydrated or hypovolemic

74

what is the function of BNP = brain natriuretic peptide?

Secreted in response to increase blood volume & blood pressure, which stretch heart tissue. Binds to receptor in nephrons and inhibits reabsorption of Na and water. This value is increased in CHF.

75

What are the Collaborative Goals for Treating
any F & E Imbalance?

Determine underlying cause through physical assessment & diagnostic testing
Correct the underlying cause
Replace deficient F & E or remove excess
Stabilize pH (acid-base balance)

76

What is the etiology of Hypervolemia, over-hydration

Etiology
Excessive Na intake (PO or IV)
Compromised regulatory systems
Renal insufficiency
Congestive Heart Failure (CHF)
Cirrhosis
Endocrine Disorders (SIADH)

77

What are the signs and sx of hypervolemia

Signs & Symptoms
*Weight gain
VS - ↑ BP, ↑ HR, & ↑RR Pulse quality?
dyspnea, orthopnea
Pitting edema w/ tight, shiny skin
JVD @45 degrees
Moist crackles
cough
Headache, agitation, confusion R/T brain cell swelling
Labs – blood volume is diluted, what happens?
electrolytes, H&H, Urine specific gravity
BNP – increased in CHF

78

What is the etiology of AKA Hypovolemia or dehydration (water loss only)

Loss of water and Na
Vomiting, diarrhea, diaphoresis, diuretics
Hemorrhage, burns cause loss of water, electrolytes, protein, RBCs
Decreased intake
NPO, anorexia, dysphagia, altered perception of thirst, unable to reach water

79

What are the signs/sx of hypovolemia?

Negative balance of intake/output
Concentrated urine, ↑specific gravity
Weight loss
Dry skin/mucous membranes
Poor skin turgor, tenting >20-30sec
*Weakness, restlessness, confusion
Concentrated Hct. & electrolytes
Severe FVD → dec. cardiac output, possible shock

80

Intracellular fluid is made up of...

Cations (+) – mostly potassium & small amts. of magnesium & sodium
Anions (-) – mostly phosphate & protein w/ small amts. chloride & bicarb

81

extracellular fluid is made up of

Cations – mainly sodium w/ small amts of potassium, calcium, & magnesium
Anions – mostly chloride, some protein, w/small amts of bicarb, sulfate, & phosphate

82

Sodium Na+ (fyi)

Na+ aids in generation & transmission of nerve impulses and fluid balance
Main cation in ECF
Range 135-145 mEq/L
effects osmolality & water distribution between ECF & ICF
Kidneys regulate Na levels by excreting/retaining water
Aldosterone promotes Na reabsorption by renal tubules

Regulation of Electrolytes SODIUM
Plasma Na levels reflect % concentration
Abnormal Na levels may indicate water imbalance or sodium imbalance or both
Water Excess &/or Hyponatremia
(145mEq/L)
Treatment depends on cause & fluid status

83

potassium (fyi)

Potassium is major cation in ICF
Labs: 3.5-5.0 (slightly higher some places)
Potassium needed for conduction of nerve impulses, normal cardiac rhythm, & muscle contraction
Potassium must be obtained through diet or supplements
drops quickly if not replaced
Potassium excreted by kidneys, stool, sweat
If kidney function impaired, K+ rises

84

Calcium (fyi)

Ca obtained from food, combined with phosphorus & stored in bone
Ca aids in transmission of nerve impulses, myocardial contractions, blood clotting, formation of teeth & bone, muscle contractions
Serum Ca levels usually show total of 3 types
Ionized (free), bound w/protein (albumin), & complexed w/ phosphate, citrate, or carbonate
Ionized is sometimes measured separately – most important in neuromuscular functioning

85

Calcium balance controlled by:

Parathyroid hormone (PTH)
Stimulated by low serum Ca levels to move Ca out of bone, ↑GI absorption, & renal tubule reabsorption
Calcitonin – Produced by thyroid gland. Responds to ↑Ca. Opposite effects of PTH listed above.
Vitamin D – stimulates absorption of Ca from GI tract

86

protein imbalances are:

Plasma proteins (esp. albumin) are indicative of plasma volume
Protein increases oncotic pressure and pulls fluid inward into vascular space
Causes of imbalance include malnutrition, starvation, fad diets or vegetarian diets w/ insufficient protein, massive burns, liver disease, major infection, loss of albumin in renal disease, hemorrhage
S/SX: edema from ↓oncotic pressure, slow healing, anorexia, fatigue, anemia, muscle loss

87

Acid-Base Balance info:

Hydrogen ion concentration in the cellular environment is regulated within extremely narrow limits. This is called acid-base balance

For optimum cell functioning, body must maintain acid-base balance

Body metabolism produces acids which are buffered by body systems

88

What are the Factors Affecting Fluid, Electrolyte, and Acid-Base Balance?

Thirst
Vomiting
Diarrhea
Diaphoresis
Diuretic use
Stress
Chronic illness
Renal failure
Cardiac failure
Respiratory failure
Surgery
Pregnancy

89

What are the sign/sx of Respiratory Acidosis

Carbonic acid & PCO2 excess:
Anything which causes hypoventilation which leads to ↑CO2
patient cannot catch breath
hypoventilation
rapid, shallow respirations
increase BP
dyspnea
headache
hyperkalemia
disorientation
muscle weakness
hypoxemia
low pH below 7.35
high pCO2 above 45
increase cardiac output

90

what are the sign/sx of Respiratory Alkalosis?

Carbonic acid & CO2 deficit
Anything causing hyperventilation or “blowing off” too much CO2; due to respiratory problem or other event
pH often corrects self before kidneys need to compensate (would excrete HCO3)
seizures
deep, rapid breathing
hyperventilation
confusion
hypokalemia
lightheadedness
tingling of extremities
increase pH above 7.45
low PCO2 35

91

what are the sign/sx Metabolic Acidosis?

Acids accumulate OR bicarbonate is lost
e.g. Ketoacid accumulation in diabetic ketoacidosis or starvation, ASA overdose
↑lactic acid in shock, heavy exercise
HCO3 loss in severe diarrhea or renal failure
headache
disorientation
hyperkalemia
muscle twitching
changes in loc
Kussmaul Respirations (compensatory hyperventilation)
pH below 7.35
HCO3 below 22

92

what are the sign/sx Metabolic Alkalosis
Base Bicarbonate Excess

Occurs w/a loss of acid or gain in bicarbonate
prolonged vomiting or gastric suction (lose stomach acid)
Excess ingestion of baking soda or IV bicarb
restlessness followed by lethargy
dysrhythmias
diarrhea
confusion
nausea and vomiting
slow respirations
hypokalemia
increase pH above 7.45
increase HCO3 above 26
compensatory hypoventilation

93

What are the signs/sx of Respiratory Compensation:

Lungs control amount of CO2 in blood
Consider CO2 an acid (carbonic acid is formed by H20 & CO2)
Hyperventilation blows off more CO2 and increases pH to compensate for metabolic acidosis
Hypoventilation retains CO2, decreases pH to compensate for metabolic alkalosis

94

What are the signs/sx of Renal Compensation

Renal Compensation: Kidneys help to maintain normal acid-base balance by changing rate of excretion or retention of hydrogen and HCO3 ions.
Kidneys are slower than lungs to compensate for sudden changes in acid-base status
Kidneys handle increase in blood acids by:
Increasing excretion of H+ ions into the urine and returning HCO3 ions to the blood
Additional serum bicarbonate is made available to absorb more free H+ ions, and normal pH can be reestablished

95

What do the blood gases mean? (fyi)

ABGs best way to determine acid-base balance
pH – hydrogen ion (H+) concentration
PaCO2 – partial pressure of CO2
reflects depth & rate of ventilation
compensates for metabolic acidosis or alkalosis
HCO3- - Bicarb is major renal component of acid-base balance & principle buffer of ECF
ECF is 20:1 bicarb to carbonic acid
PaO2 – partial pressure of O2
doesn’t affect acid-base if normal
Normal 80-100mm Hg
If < 60, leads to anaerobic metabolism, lactic acid production, & metabolic acidosis
e.g. occurs during cardiac arrest
give bicarb as part of resuscitation effort
O2 Saturation - Normal 95-99%
point at which hemoglobin is saturated by O2
If PaO2<90%, cause for concern


96

how do you determine Respiratory or Metabolic Imbalance?

1.Check pH (normal 7.35-7.45) to determine if patient is acidotic or alkalotic
Acidosis 7.45
7.8 = death

If full compensation is occurring, pH will be normal

2.Analyze PCO2 & HCO3 to determine if caused by respiratory or metabolic problem (can be both)

Normal PCO2 is 35-45mm Hg arterial
↑ = resp. acidosis ↓= resp. alkalosis

Normal HCO3 is 22-26mEq/L arterial
↑ = metabolic alkalosis ↓ = metabolic acidosis

97

Define ROME

Respiratory
Opposite
pH high PCO2 low = alkalosis
pH low PCO2 high= acidosis
Metabolic
Equal
pH high HCO3 high= alkalosis
pH low HCO3 low= acidosis