Class 5- Alterations in Fluid and Electrolytes Acid-Base

Question 1

Fluid % of…

1. Intracellular
2. Interstitial
3. Intravascular
4. Transcellular

Answer 1

1. 66%
2. 24%
3. 7%
4. 2%

Question 2

Isotonic Loss

Answer 2

• water and sodium are lost in proportion

- from vomiting, diarrhea, bleeding, diuretic therapy, hyperaldosterone

Question 3

Isotonic Loss causes…

Answer 3

• increased thirst
• decreased urine
• flat neck veins
• decreased weight
• decreased BP
• lethargy
• tenting skin (poor turgor)
• increased HR
• increased antidiuretic
• less responsive
• increased aldosterone
• sunken eyes in elderly and babies

Question 4

Treatment for Isotonic Loss

Answer 4

• replace isotonic fluid

- eg. saline IV

Question 5

Intravascular Fluid Volume Excess: Fluid Overload

Answer 5

• isotonic gained
• water and sodium gained in proportion
• not usually an issue in people with normal heart, liver, and kidneys

Question 6

What is Intravascular Fluid Volume Excess (Fluid Overload) caused by?

Answer 6

• heart failure
• too much isotonic solution uptake
• kidney failure

Question 7

Signs and Symptoms of Intravascular Fluid Volume Excess

Answer 7

• increased weight
• increased neck vein distention
• increased BP (depending on organ function)
• decreased HR (depending on organ function)

Question 8

Treatment for Intravascular Fluid Volume Excess

Answer 8

• medication

- dialysis

Question 9

Edema: Interstitial Space

Answer 9

• swelling

- fluid always remains in interstitial space to be drained by lymph

Question 10

Edema is caused by…

Answer 10

• increased capillary hydrostatic pressure
• decreased capillary oncotic pressure d
• increased capillary permeability
• increased interstitial oncotic pressure
• lymphatic obstruction

Question 11

Manifestations of Edema

Answer 11

• localized edema
• dependent areas
• pulmonary edema
• pitting edema
• generalized edema

Question 12

Describe Pulmonary Edema Symptoms

Answer 12

• difficulty breathing
• abnormal breath sounds
• increased resp rate
• increased fluid in lungs
• abnormal breath sounds

Question 13

Edema Treatment

Answer 13

• elevating swollen limb
• elastic support stockings
• diuretic drug
• intravenous albumin

Question 14

What changes fluid in intracellular space?

Answer 14

Na imbalances which regulates osmotic forces

Question 15

Hypertonic Imbalances

Answer 15

• increased concentration of extracellular fluid
• water shifts out of cells
• serum sodium is greater than 145mEq/L

Question 16

What is Hypertonicity caused by?

Answer 16

• sodium excess
• water deficit
• decreased ADH

Question 17

What are the clinical manifestations of hypertonicity?

Answer 17

• cell dehydration
• dry skin
• thirst
• agitation
• restlessness
• headache
• seizures
• coma
• increased reflexes

Question 18

What is most dangerously effected by hypertonicity?

Answer 18

• dehydrated neurons

- cause dangerous neurological symptoms

Question 19

Hypotonic Imbalances

Answer 19

• concentration of extracellular fluid is decreased
• water moves into cells
• cellular edema
• serum sodium is less than 135mEq/L

Question 20

What is hypotonicity caused by?

Answer 20

• sodium deficit

- water excess

Question 21

What are the clinical manifestations of hypotonicity?

Answer 21

• primarily related to cell swelling
• neurological (headache, seizures, lethargy, coma)
• decreased reflexes
• muscle cramps
• weakness

Question 22

Electrolyte Imbalances

Answer 22

• potassium is mostly intracellular (THE most dominant intracellular cation)
• sodium is mostly extracellular
• concentrations maintained by sodium potassium pump and ion channels

Question 23

Sodium

1. Two Imbalance Conditions
2. Systems Affected

Answer 23

1. • Hypernatremia (hypertonic)
   • Hyponatremia (hypotonic)
2. • neuromuscular
   • CNS- consciousness level
   • MSK- muscle cramps and weakness

Question 24

Potassium: Hyperkalemia

Answer 24

• renal disease
• cell injury (crush injury)
• too much intake
• acidosis
• hypoaldosteronism
• medications: ACE inhibitors

Question 25

Potassium: Hypokalemia

Answer 25

- diarrhea - NG suction - too little intake - starvation not replacing K - alkalosis - hyperaldosteronism - medications: some diuretics

Question 26

Major systems affected by potassium imbalances

Answer 26

- cardiac - neurological - cardiac show dysrhythmias and cardiac arrest - CNS reflexes and LOC affected

Question 27

Calcium

Answer 27

- parathyroid disease - Vitamin D imbalance - malignancies - musculoskeletal and cardiac show manifestations - BP - muscle tone

Question 28

H+ Imblanaces

Answer 28

- required to maintain membrane potential integrity - regulates speed of nerve impulse conduction and muscle fibre contraction - maintains speed of enzyme reactions

Question 29

Normal pH in arterial blood

Answer 29

- 7.35-7.45

Question 30

Volatile Secretion of Acids

Answer 30

- carbonic acid - eliminated by the lungs as CO2 - resp system excretes CO2 by increasing or decreasing ventilation rate

Question 31

Nonvolatile Secretion of Acids

Answer 31

- sulfuric, phosphoric, and other organic acids | - eliminated by renal tubules

Question 32

How does the renal system control pH?

Answer 32

excreting or conserving H+ or HCO3-

Question 33

What compensates for Respiratory Alkalosis or Acidocis?

Answer 33

kidneys

Question 34

What compensates for metabolic alkalosis or acidosis?

Answer 34

lungs

Question 35

Respiratory Acidosis

Answer 35

- too much CO2 | - CO2 converted to carbonic acid (pH<7.35)

Question 36

What is Respiratory Acidosis caused by?

Answer 36

- slow/shallow breathing - head injury - spinal cord injury - drug overdose - poor gas exchange due to lung disease

Question 37

Respiratory Alkalosis

Answer 37

- too little CO2 (PCO2 <35mmHg) - less carbonic acid - pH> than 7.45

Question 38

What is Respiratory Alkalosis caused by?

Answer 38

- rapid deep breathing - respiratory failure - anxiety - some neuro disorders

Question 39

Metabolic Acidosis

Answer 39

- not enough bicarbonate ion (HCO3-) to counteract acid

Question 40

Metabolic Alkalosis

Answer 40

- too much bicarbonate ion (HCO3-) or not enough acid - pH>7.45 - HCO3>26mEq/L

Question 41

What is Metabolic Alkalosis caused by?

Answer 41

- excess acid loss (kidney, vomiting, gastric suction) | - excessive base intake (antacid OD)

Question 42

Partial Compensation

Answer 42

pH will move towards normal but not within normal range

Question 43

Full Compensation

Answer 43

pH will become fully within normal range