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D & D Exam 2 > Chapter 8 > Flashcards

Chapter 8 Flashcards

1
Q

Sodium (NA+)

A

Check in blood only

Most of body’s NA is in blood and lymph fluid

Helps maintain water balance

Is the major positive ion in the fluid OUTSIDE of the cells

Important for NERVE & MUSCLE function

Major determinant of osmolality

Normal range: 135-145 mEq/L

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2
Q

Hyponatremia

A

Low NA

Confusion, irritable, tachycardia, weight loss, dry mouth, postural hypotension (stand up results in dizzy), hypotonicity (less parts per million) caused by water retention

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3
Q

Hypernatremia

A

High NA

Symptoms:
Fever
flushed, 
restless
fluid retention,
edema
decreased urine output
decreased skin turgor
intense thirst
Agitated
hypertension
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4
Q

When you think of sodium (NA+) think…

A

Brain Function

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5
Q

Potassium (K+)

A

Causes heart to pump
Major positive ion found INSIDE of cells
Normal range: 3.5 - 5.0

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6
Q

When dealing with potassium (K+) think…

A

HEART

too low/too high = death

People with potassium problems should be put on a heart monitor

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7
Q

Hypokalemia

A

Too low K+ in blood

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8
Q

Hyperkalemia

A

Too high K+ in blood

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9
Q

Symptoms of Hypokalemia

A

Changes in heart rhythm

Muscle cramps, weakness, paralysis

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10
Q

Symptoms of Hyperkalemia

A

abdominal cramps, diarrhea

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11
Q

Causes of Hyperkalemia

A

Major causes:
renal dysfunction
-acute: heart attack; kidneys not profused during the heart attack
-chronic: diabetes

Other causes of hyperkalemia: eating disorders, too much laxatives

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12
Q

What is hypotonicity?

A

Less parts per millionth

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13
Q

Calcium (Ca)

A

99% in bones and teeth

The remaining 1% in blood and muscle plays a vital role in:

  • blood clotting
  • muscle contraction
  • messages through nervous system
  • regulate blood pressure

Vitamin D is needed for Ca to transport into bones

Normal range: 8.5-11

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14
Q

What is the major gland involved with Calcium level regulation?

A

Parathyroid gland

If a patient has hypoparathyroidism: blocks bone from releasing Ca+ which can cause hypocalcemia

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15
Q

Hypocalcemia

A

Too low Ca in blood

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16
Q

Symptoms of Hypocalcemia

A 
Convulsions
arrhythmias
tetany
muscle spasms (Chovestek's and Trousseau's sign)
laryngeal stridor
tingling mouth/extremities

Can treat with Calcium tablets

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17
Q

Hypercalcemia

A

Too high Ca in blood

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18
Q

Symptoms of Hypercalcemia

A 
Neuro-muscular
personality changes
weakness 
confusion 
decreased reflexes 
memory changes
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19
Q

Chvostek’s sign

A

Associated with hypocalcemia

Abnormal spasms of facial muscles which is elicited from lightly tapping on jaw

This can naturally occur in 25% of people though\

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20
Q

Trousseau’s sign

A

Associated with hypocalcemia

Hold blood pressure cuff for 3 minutes induces muscle spasms

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21
Q

Magnesium (Mg)

A

50% found in the bone, 49% inside cells and tissue

Other 1% found in blood

Important for:

  • DNA replication / transcription
  • normal BP
  • steady heart rate
  • regulate blood sugar levels
  • keeps bones strong
  • immune system health

Normal range: 1.3 - 3.5

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22
Q

Hypophosphatemia

A

Low phosphates

S/S:
confusion
seizures
numbness
muscle weakness
coma
anemia/bruising

Causes:

  • vitamin D deficiency
  • overuse of antacids
  • re-feeding syndrome
  • alcoholism
  • respiratory alkalosis
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23
Q

Hyperphosphatemia

A

Too high phosphates

Kidney failure results in phosphates being held on to resulting in hyperphosphatemia

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24
Q

Foods high in phosphates

A
  • liver
  • kidney
  • gizzards
  • sodas
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25
Q

Normal blood pH

A

7.35-7.45

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26
Q

Bicarbonate (HCO3)

A

Buffering agent

If blood pH level drops, HCO3 is absorbed by the kidneys and returned to the blood instead of passing out of the body in the urine

Normal range: 22-26 mmol/L

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27
Q

Normal fluid loss

A

Insensible water loss-not measurable

Lungs - water loss averages 400 ml/day from simple evaporation (constant / unaffected by other factors)

Skin-water loss as perspiration in order to “air condition” the body
-Salt and urea also leave with water

GI tract - daily secretions may reach volume of 8,200 ml/day. All but 150 ml is reabsorbed in the intestines

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28
Q

What is a concern of chronic dehydration?

A

Effect of cardiac/circulatory systems

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29
Q

What should you worry about with throwing up besides fluid loss?

A

Electrolytes and sodium

Think brain function

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30
Q

Hypovolemia

A

Decreased blood volume

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31
Q

What causes Hypovolemia?

A

Dehydration
bleeding
severe burns
medications: specifically diaretics

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32
Q

Hypovolemia S/S

A
  • Thirst
  • Confusion
  • Hypernatremia (b/c its parts per millionths in the blood, so the blood volume is less means the ratio is more Na+ to water)
  • BP low (empty pipes)
  • constipation
  • increased heart rate
  • pulse will be weak and thready
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33
Q

How do severe burns cause hypovolemia?

A

inflammatory response

  • vascular stage: vasodilation
  • plasma goes outside of the tubing
  • relocation of volume, pipes are empty
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34
Q

Hypervolemia

A

increased blood volume

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35
Q

Hypervolemia causes

A
  • excessive oral intake of fluids
  • rapid infusion IVF
  • over infusion IVF
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36
Q

S/S Hypervolemia

A 
Edema
distend hand veins (popping out)
heart failure
changes in BP (initially increase but then decrease)
distended neck veins (JVD)
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37
Q

JVD

A

Jugular vein distention

38
Q

Causes of dehydration

A 
GI disorders
heart exhaustion
burns 
shock
medications
fevers
insufficient water intake
39
Q

What is the most accurate way to measure insensible water loss?

A

Weigh patients daily around the same time to compare weights to check fluid intake/outtake

40
Q

Fluid compartments

A 
ICF
ECF
interstitial
plasma
TCF
and a liter of fluid in...
CSF
GI
synovial fluid
paratenial fluid combined
41
Q

ICF

A 
intracellular fluid 
(in the cell)
42
Q

ECF

A

extracellular fluid

43
Q

Interstitial

A

in between and around cells

44
Q

TCF

A

Epithelial lined spaces cellular fluid

45
Q

CSF

A

Cerebrospinal fluid

46
Q

What separates the fluid compartments?

A

Semi-permeable membranes

Fluid is always moving

47
Q

Body fluid regulation/maintain

A
  1. filtration/hydrostatic pressure
  2. Colloid (osmotic/oncotic pressure)
  3. active transport (ATP)
48
Q

Filtration

A

movement by hydrostatic pressure

49
Q

Hydrostatic pressure

A

Pressure against vascular walls from fluid

Contraction of heart increase hydrostatic pressure of the arteries

50
Q

Diffusion

A

Passive movement of molecules (or solvents) from a higher concentration to lower concentration until equally distributed

51
Q

Osmosis

A

movement of water through a semi-permeable membrane from low solute concentration

52
Q

Osmotic pressure

A

Colloid (osmotic/oncotic pressure)

Pressure created by differences in the concentration of particles on each side of a membrane

determined by concentration by solutes - solid particles

Expressed in terms of osmolality

Generally higher oncotic pressure will pull water back into concentration

53
Q

Oncotic pressure

A

Osmotic pressure exerted by colloids in solution

Major protein - the colloid
Albumin (made in the liver)

Attract water, pull fluid from tissue to vascular space

Large proteins = prevented from leaving the vasculature through capillaries b/c of size

54
Q

Edema

A

fluid in the 3rd interstitial space, outside of vasculature

can happen when there is no injury

interstitial edema is a result of colloidal osmotic pressure

generally low albumin levels

55
Q

Movement in capillaries at the arterial end

A

hydrostatic pressure is more than oncotic pressure

fluid moves into the interstitium

56
Q

Movement in the capillaries at the venous end

A

Hydrostatic pressure is less than oncotic pressure

fluid drawn into capillary

57
Q

Active transport

A

(sodium/potassium pump)

contrary to diffusion, osmosis and filtration

requires cellular energy

forces can move molecules into cells regardless of their concentration

58
Q

ADH

A

Antidiuretic hormone - from hypothalamus

regulates water by tubules in kidneys

released in response to low blood pressure or blood volume

inhibited by the rise of blood pressure or blood volume - kidneys increase urine output

59
Q

SIADH

A

syndrome of inappropriate ADH

Dilutional hyponatremia - sodium remains normal but total body fluid increases

Excessive ADH holds onto water

60
Q

Diabetes insipidous

A

Nothing to do with regular diabetes

Deficient ADH, inability to concentrate urine and there is a large amount of urine excreted and also excessive thirst

61
Q

Aldosterone

A

released in response to low blood pressure, blood volume or NA and high K

Inhibited by rise in blood pressure, blood volume, or NA and drop K

62
Q

Cortisol

A

Enhance sodium and water retention

63
Q

Atrial natriuretic peptide

A

APN

lowers blood volume and blood pressure by:

  • vasodilation of blood vessels
  • decreasing aldosterone
  • decreasing ADH
  • increasing glomerular filtration rate (urine output and production increase)
64
Q

Brain natriuretic peptide

A

BP - cardiac hormone found in ventricles

Decreases blood volume and blood pressure by:

  • vasodilates arteries and veins
  • decreases release of aldosterone
  • excretes sodium and water
65
Q

Thirst mechanism

A

stimulates ADH and aldosterone release

Depressed in elderly so increased risk of dehydration and kidney / bladder infections

66
Q

Renal regulatory system

A

kidney

urinary elimination adjusts so the electrolytes are maintained

plasma filtered several times a day

67
Q

GI regulatory system

A

accounts for intake

small amount eliminated in feces

diarrhea and vomiting lead to significant loss

68
Q

Insensible fluid loss

A

increased by fever and exercise

up to a liter in water a day

69
Q

acid-base imbalance

A

a significant insult causes pH to go out of Normal range (7.35 - 7.45)

70
Q

The process that causes the imbalance is classified based on?

A

The etiology of the disturbance (respiratory or metabolic)

The direction of change in pH (acidosis or alkalosis)

71
Q

The four main processes of acid-base imbalance

A
  1. Metabolic acidosis
  2. Respiratory acidosis
  3. Metabolic alkalosis
  4. Respiratory alkalosis
72
Q

Compensated/uncompensated

A

Normal range blood pH: compensated

Our of range blood pH: uncomplicated

73
Q

Alkalotic

A

above 7. 45

74
Q

Acidotic

A

below 7.35

75
Q

Bicarbonate normal range

A

22-26

out of range: metabolic

76
Q

PaCO2 normal range

A

35 - 45

out of range: respiratory

77
Q

Respiratory acid-base balance

A

Breathe oxygen in

Carbon dioxide out

CO2 mixes with H2O in ??? bloodstream to make ???

78
Q

Renal acid-base balance

A

H2CO3 (carbonic acid) breaks down into 2 molecules

HCO3 - bicarbonate + hydrogen

Both are excreted by kidneys

79
Q

Respiratory acidosis

A

Blood pH below 7.35

Retaining too much CO2

80
Q

What causes respiratory acidosis?

A
  • impaired alveolar ventilation (the major cause of acute primary RA)
  • Upper airway obstruction pulmonary edema
  • Hypoventillation
  • Head trauma (not breathing as frequently)
  • Chest trauma
  • pneumonia
  • COPD
  • Narcotic overdose (narcotics suppress respiratory rate)
81
Q

S/S respiratory acidosis

A 
Tachycardia
headache
confusion
weakness
coma
cyanosis
bradypnea
paralysis
respiratory arrest
82
Q

respiratory alkalosis

A

loosing too much CO2

83
Q

Causes of respiratory alkalosis

A 
hyperventilation
pain
anxiety
pulmonary embolus
hypoxia
high altitude 
drug toxicity (adult overdose of salicylate - aspirin)
3rd trimester pregnancy
fever
84
Q

S/S respiratory alkalosis

A 
tetany (muscle spasms) or seizures
tingling in extremities
Dizziness
altered mental state
anxiety
parathesias (tingling/numbness)
palpations
tachycardia
hyperventilation
85
Q

Causes of Metabolic acidosis

A

diabetic ketoacidosis (blood sugar high)
renal disease (can’t get rid of potassium)
starvation
shock or sepsis
loss of bicarbonate associated with diarrhea

86
Q

S/S of metabolic acidosis

A 
altered mental status
hypotension
abdominal pain
diarrhea
Kussamaul respirations (only with diabetic ketoacidosis)
hyperventilation (compensatory mechanism)
hyperkalemia
flushed, warm skin
bradycardia
muscle weakness
87
Q

Causes of Metabolic alkalosis

A 
loss of stomach acid (vomiting)
excessive ingestion of alkali products (antacids, milk of magnesia, baking soda)
diuretics
hypokalemia
cushing's syndrome (hypothyroidism)
88
Q

S/S metabolic alkalosis

A 
tetany or twitching
confusion
seizures
nausea/vomiting
bradypnea
muscle weakness
polyuria (excessive urination)
coma
89
Q

Which electrolyte disorder is associated with metabolic alkalosis?

A

Hypokalemia

90
Q

Chvostek and Trousseau signs are associated with what electrolyte disorder?

A

Hypocalcemia

D & D Exam 2 (4 decks)

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