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N216 > Elimination > Flashcards

Elimination Flashcards

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1
Q

Fluid & Electrolyte Balance

A

The process of regulating the extracellular fluid volume, body fluid osmolality, and plasma concentrations of electrolytes

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2
Q

Pediatrics Distribution of Body Fluid

A

75%-80% of body weight
Susceptible to significant changes in body fluids
Dehydration

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3
Q

Aging Distribution of Body Fluids

A

decreased percent of total body water

  • decreased free fat mass and decreased muscle mass
  • Renal decline
  • Diminished thirst perception
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4
Q

Net Filtration

A

Forces favouring filtration minus forces opposing filtration

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5
Q

Forces Favouring filtration

A

Capillary hydrostatic pressure (BP)

Interstitial Oncotic pressure (water-pulling)

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6
Q

Forces favouring reabsorption

A

Plasma (capillary) oncotic pressure (water-pulling)

Interstitial hydrostatic pressure

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7
Q

Principal ECF electrolytes

A 
Sodium cations (Na+)
Chloride anions (Cl-)
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8
Q

Principlal intracellular fluid electrolyte

A

Potassium cation (K+)

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9
Q

Cosequences of Impaired Fluid and electrolyte imbalance

A

Impaired perfusion
Impaired gas exchange oxygenation
Impaired cerebral function
Impaired neuromuscular function

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10
Q

Populations at greatest risk for fluid and electrolyte balance problems

A

Very young and very old

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11
Q

Symptoms of fluid and electrolyte imbalance are..

A

non specific

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12
Q

Red flags for fluid and electrolyte imbalance include a history of …

A 
vomiting
diarrhea
organ failure
unexplained nausea
fatigue
dizziness
SOB
muscle cramping
edema
sudden changes in weight
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13
Q

Edema

A

Accumulation of fluid in the interstitial spaces

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14
Q

Causes of edema

A

Increase in capillary hydrostatic pressure
Decrease in plasma oncotic pressure
Increase in capillary permeability
Lymph obstruction (lymphedema)

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15
Q

Potassium

A

Most abundant positively charged (cationic) electrolyte inside cells

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16
Q

What percent of the body’s potassium is intracellular

A

95%

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17
Q

Potassium content outside of cells ranges from….

A

3.5-5 mmol/L

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18
Q

Potassium levels are critical to…

A

normal body function

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19
Q

Potassium is obtained from which kind of foods

A 
Bananas
Oranges
Apricots
Dates
Raisins
Broccoli
Green beans
Potatoes
Tomatoes
meats
Fish
wheat bread
legumes
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20
Q

Excess dietary potassium is excreted via..

A

Kidneys

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21
Q

Impaired kidney function leads to…

A

Higher serum levels, possibly toxicity

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22
Q

Potassium is responsible for…

A 
Muscle contraction
Transmission of nerve impulses
Regulation of heart beat 
Maintenance of acid-base balance
Isotonicity
Electrodynamic characteristics of the cell
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23
Q

Sodium

A

Most abundant positively charged electrolyte outside cells

Primary ECF cation

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24
Q

Normal Concentration of sodium outside the cells is…

A

135-145mmol/L

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25
Sodium is maintained through ...
dietary intake of sodium chloride
26
Sodium comes in through which foods
Salt Fish meats Foods flavoured or preserved with salt
27
Sodium is responsible for...
Control of water distribution Fluid and electrolyte balance Osmotic pressure of body fluids Participation is acid-base balance
28
Sodium regulates
osmotic forces like water
29
Chloride (Cl-) is a
Primary ECF anion | Provides electroneutrality
30
RAAS
Renin angiotensin aldosterone system
31
Aldosterone
leads to Na+ and water reabsorption back into the circulation and excretion of potassium (K+)
32
RAAS causes
Na+ and water excretion
33
Antidiuretic hormone (ADH) secretion
Increases water reabsorption into the plasma
34
Thirst perception is due to
Osmolality receptors
35
Osmolality receptors control
Hyperosmolality and plasma volume depletion
36
Isotonic alterations
TBW change with no proportional electrolyte and water change (no change in concentration) Isotonic fluid loss Isotonic fluid excess
37
Hypertonic Alterations
Hypernatremia | Hyperchloremia
38
Hypernatremia
Related to Na+ gain or water loss | Water movement from the ICF to the ECF
39
Hypernatremia serum Na+ level
>145mmol/L
40
Clinical manifestations of hypernatremia
Thirst Weight gain Bounding pulse Increased BP
41
CNS manifestations of Hypernatremia
``` Muscle twitching Hyper-reflexia Confusion coma convulsions cerebral hemorrhage ```
42
Hyperchloremia
Occurs with hypernatremia or a bicarbonate deficit
43
Hypotonic alterations
Decreased osmolality | Hyponatremia or free water excess
44
Hyponatremia decreases the...
ECF osmotic pressure, and water moves into the cell via osmosis Cells expand
45
Hypotonic alteration types
Hyponatremia | Hypochloremia
46
Hyponatremia serum Na+ level
<135mmol/L
47
Na+ deficits cause...
plasma hypo osmolality swelling
48
Hyponatremia causes
Pure Na+ loss Low sodium intake Dilutional hyponatremia
49
Manifestations for Hyponatremia
``` Cerebral edema Increased intracranial pressure Lethargy Confusion Decreased reflexes Seizures Coma Loss of ECF Hypovolemia Weigh gain ```
50
Main Indication of Hyponatremia
Sodium depletion when dietary measures are inadequate
51
Mild treatment of hyponatremia
Treated with oral sodium chloride, fluid restriction or both
52
Severe treatment of hyponatremia
Treated with IV Ns or lactated Ringer's Solution
53
Water Excess
Compulsive water drinking | Decreased urine formation
54
Syndrome of inappropriate ADH (SIADH)
ADH secretion in the absence of hypovolemia or hyperosmolality Hyponatremia with hypervolemia
55
Manifestations of water excess
``` Cerebral edema weakness muscle twitching nausea headache weight gain ```
56
Hypochloremia
Usually the result of hyponatremia or elevated bicarbonate concentration
57
Hypochloremia develops because...
as a result of vomiting and the loss of HCl
58
Hypochloremia occurs in...
Cystic fibrosis
59
With Hypocholremia treatment of the underlying cause is...
required
60
Potassium concentration is maintained by..
Na+/K+ pump
61
Potassium regulates...
Intracellular electrical neutrality in relation to Na+ and H+
62
Potassium is essential for...
Transmission and conduction of nerve impulses, Normal cardiac rhythms, and skeletal and smooth muscle contraction
63
Changes in what affect K+ balance
PH
64
Which hormones influence serum K+ levels
Aldosterone, Insulin & epinephrine
65
Hypokalemia K+ level
<3.5mmol/L
66
causes of hypokalemia
Reduced intake of K+ Increased entry of K+ into cells Increased loss of K+
67
Manifestations of hypokalemia
decrease in neuromuscular excitability skeletal muscle weakness smooth muscle atony Cardiac dysthymias
68
Main indication of hypokalemia
Treatment or prevention of potassium depletion when dietary means are inadequate
69
Hypokalemia adverse effects oral preparations
``` Diarrhea Nausea Vomiting GI bleeding Ulceration ```
70
Hypokalemia adverse effects IV administration
Pain at injection site | phlebitis
71
Hypokalemia adverse effects Excessive adminstration
Hyperkalemia Toxic effects Cardiac arrest
72
Hyperkalemia serum level
>5.5mmol/L
73
Why is hyperkalemia rare
Because of efficient renal excretion
74
Hyperkalemia is caused by
``` Increased intake of K+ Shift of K+ from ICF to ECF Decreased Renal excretion Insulin deficiency Cellular trauma ```
75
Manifestations of Hyperkalemia
Muscle weakness Paresthesia paralysis Cardiac rhythm irregularities
76
Mild attack of hyperkalemia
Increased neuromuscular irritability | Restlessness, intestinal cramping and diarrhea
77
Severe attack of hyperkalemia
Decreases the resting membrane potential | Muscle weakness, loss of muscle tone and paralysis
78
Treatment of severe hyperkalemia
``` IV sodium bicarbonate Calcium glutinate Calcium chloride Dextrose with insulin Sodium polystyrene sulphate (Kayexalate) Hemodialysis to remove excess potassium ```
79
Hypocalcemia Causes
Inadequate intestinal absorption, deposition of ionized Ca++ into bone or soft tissue, blood administration Decreases in PTH and Vit D Nutritional deficiencies occur with inadequate sources of dairy products or green leafy vegetables
80
Hypocalcemia effects
Increased neuromuscular excitability Severe cases show convulsions and tetany Prolonged QT interval, cardiac arrest
81
Hypercalcemia causes
``` Hyperparathyroidism Bone metastases with Ca++ resorption from breast, prostate, renal and cervical cancer Sarcoidosis Excess Vit D Many tumours that produce PTH ```
82
Hypercalcemia Effects
Many non specific: Fatigue, weakness, lethargy, anorexia, nausea, constipation Impaired renal function, kidney stones Dysrhythmias, bradycardia, cardiac arrest, Bone pain, osteoporosis
83
Hypophosphatemia causes
Intestinal malabsorption Respiratory alkalosis Increased renal excretion of PO4 associated with hyperparathyroidism
84
Hypophosphatemia Effects
Reduced capacity for oxygen transport by RBC, thus distributed energy metabolism Leukocyte and platelet dysfunction Deranged nerve and muscle function
85
Hypophosphatemia effects is severe cases
``` Irritability Confusion Numbness Coma, Convulsions Respiratory failure Cardiomyopathies Bone resorption ```
86
Hyperphosphatemia Causes
Acute or chronic kidney failure with significant loss of glomerular filtration Treatment of metastatic tumours with chemotherapy that releases large amounts of PO4 into serum Long term use of laxatives or enemas containing phosphates Hypoparathyroidism
87
Hyperphosphatemia Effects
Symptoms primarily related to low serum Ca++ levels similar to the results of hypocalcemia When prolonged calcification of soft tissues in lungs, kidneys, joints
88
Magnesium
Intracellular cation Acts as a cofactor in intracellular enzymatic reactions Increases neuromuscular excitability
89
Magnesium Serum concentrations normal for adults
0.75-0.95 mmol/L
90
Hypomagnesemia Causes
Malnutrition Malabsorption syndromes Alcoholism Urinary losses
91
Hypomagnesemia Effects
``` Behavioural Changes Irritability Increased reflexes Muscle cramps Ataxia Nystagmus Tetany Convulsions Tachycardia Hypotension ```
92
Hypermagnesemia Causes
Usually renal insufficiency or failure Excessive intake of magnesium-containing antacids Adrenal insufficiency
93
Hypermagnesemia Effects
``` Skeletal smooth muscle contraction Excess nerve function Loss of deep tendon reflexes Nausea and vomiting Muscle weakness Hypotension Bradycardia Respiratory distress ```
94
Acid base balance
Carefully regulated to maintain a normal PH via multiple mechanisms
95
If the H+ are high in numbers the pH is ...
low (acidic)
96
If the H+ are low in numbers the pH is....
High (alkaline)
97
What is the body's regular pH
7.35-7.45
98
to maintain the body regular pH the H+ must be...
Neutralized or excreted
99
What are the major organs involved in acid base balance
Bones Lungs Kidneys
100
Two forms of body acids
Volatile | Non- Volatile
101
Volatile acids
Carbonic acid (H2CO3) can be eliminated as CO2 gas and water
102
Nonvolatile acids
Sulfuric, phosphoric, and other organic acids | Eliminated by the renal tubules with the regulation of bicarbonate (HCO3-)
103
Buffer
A chemical that can bind excessive H+ or OH- without a significant change in pH
104
The most important plasma buffering system is
Carbonic acid- bicarbonate pair
105
Protein buffering (hemoglobin)
Proteins have negative charges, so they can serve as buffers for H+
106
Renal buffering
Secretion of H+ in the urine and reabsorption of HCO3-
107
Carbonic acid- bicarbonate pair happens in the...
lung and the kidney
108
In the carbonic acid- bicarbonate pair the greater the partial pressure of CO2, the more....
Carbonic acid (H2CO3) is formed
109
Bicarbonate and carbonic acid ratio must be ....
Maintained
110
Acidosis
Systemic increase in H+ concentration or decrease in bicarbonate (base)
111
Alkalosis
Systemic decrease in H+ concentration or increase in bicarbonate
112
PCO2 normal
35-45 mmHG
113
HCO3 normal
22-26 mmol/L
114
Respiratory acidosis
elevation of PaCO2 as a result of ventilation depression | pH is low and PCO2 is high
115
Respiratory Alkalosis
Depression of PaCO2 as a result of alveolar hyperventilation | pH high and PCO2 low
116
Metabolic acidosis
Depression of HCO3- or an increase in non carbonic acids | pH low HCO3 low
117
Metabolic Alkalosis
Elevation of HCO3- usually caused by an excessive loss of metabolic acids pH high & HCO3 high
118
Direct Measurements of serum levels
``` Osmolality Sodium Potassium Calcium Magnesium ```
119
Treatment strategies for acid- base imbalance
water replacement therapy Electrolyte supplements and replacement Pharmacotherapy
120
Water replacement therapy
Oral fluids, IV fluids
121
Electrolyte supplements and replacement
Potassium Sodium Magnesium Calcium
122
Pharmacotherapy for acid- base imbalance
Diuretics Insulin Vasopressin
123
IV potassium must not be given at a rate faster than ...
10mmol/Hr
124
If patients are critically ill or on cardiac monitors rates of ______ can be used
20mmol/Hr
125
Oral forms of potassium must be...
Diluted in water or juice and taken with food

N216 (5 decks)

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