FLUID AND ELECTROLYTE IMBALANCES Flashcards
(138 cards)
1
Q
y constantly adjusting to
internal and external stimuli.
A
Homeostasis
2
Q
EXAMPLES OF HOMEOSTASIS IN THE BODY
A
Thermoregulation
● Blood glucose regulation
● Baroreflex in blood pressure
3
Q
property of particles in a solution to
dissociate into ions
A
OSMOLARITY
4
Q
Enhances or intensifies the original stimulus
A
POSITIVE FEEDBACK
5
Q
reverses an original stimulus
for the body to regain physiologic balance.
A
NEGATIVE FEEDBACK
6
Q
Maintains homeostasis through feedback loops. Using
A
nerves and neurotransmitters
7
Q
Blood clotting after an injury -
what kind of feedback?
A
positive
8
Q
Blood pressure control
-Maintenance of normal body
temperature
kind of feedback?
A
Negative
9
Q
major cations in the body fluid are
A
sodium, potassium, calcium, magnesium,
and hydrogen ions
10
Q
major anions are
A
chloride,
bicarbonate, sulfate, and proteinate ions.
11
Q
intracellular fluid refers to all fluids including
A
cytosol as well as fluid in the cell
nucleus.
12
Q
stimulates or
inhibits the desire for a person to drink
A
thirst center in the hypothalamus
13
Q
regulates the amount of water the kidney tubules
absorb and is released in response to low blood
volume
A
ADH ANTIDIURETIC HORMONE
14
Q
controls fluid volume, in which when
the blood volume decreases
A
RENIN ANGIOTENSIN ALDOSTERONE SYSTEM (RAA SYSTEM)
15
Q
heart also plays a role in correcting overload
imbalances by releasing
A
ANP from the right atrium.
16
Q
series of
interconnected brain structures that act as a central
hub to control fluid levels in the body
A
lamina terminalis (yellow)
17
Q
fluid-filled compartments in the brain, called
A
ventricles (blue).
18
Q
ADH known as
A
VASOPRESSIN
19
Q
ability of a membrane to allow molecules to pass
through.
A
PERMEABILITY
20
Q
membranes allow almost any food or waste
substance to pass through.
A
PERMEABILITY OF MEMBRANES FREELY PERMEABLE MEMBRANES
21
Q
only certain specific
substances to pass through.
A
SELECTIVELY PERMEABLE
22
Q
from an area of higher
concentration to an area of lower concentration.
A
DIFFUSION
23
Q
transport of water and dissolved materials
concentration already exists in the cell.
A
FILTRATION
24
Q
ACTIVE TRANSPORT MECHANISMS examples
A
Phagocytosis of bacteria by Macrophages.
● Movement of Ca?* ions out of cardiac muscle cells.
● Transportation of amino acids across the intestinal
lining in the human gut.
25
urine output of male, female and infant
Male void - 300 - 500ml/day
● Female void - 250 ml/day
● Infants void - 5-40 Xa day
● Preschool children are void - every 2 hrs.
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are the
body's major chemical buffers.
Sodium bicarbonate and carbonic acid a
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e basic components in the body,
and the kidneys
Bicarbonate ions
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change in the pH of a solution by one pH unit
means a
tenfold change in hydrogen
concentration.
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causes high anion gap metabolic
acidosis and respiratory alkalosis.
Aspirin
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CO2 or HCO3 normal
Uncompensated:
31
: Nothing is normal in abg
Partially Compensated:
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pH is normal (7.4 baseline/neutral)
Compensated
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values for
Sodium
Potassium
Calcium
Magnesium
Phosphate
S: 135-145 mEq/L
P: 3.5-5.0 mEq/L
C: 8.8.-10.4 mg/dL
M: 1.8-2.6 mg/dL
P: 3.4-4.5 mg/dL
34
SIADH means
/ SYNDROME OF INAPPROPRIATE SECRETION OF ANTIDIURETIC
HORMONE
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DISORDER OF IMPAIRED WATER EXCRETION CAUSED BY THE
INABILITY TO SUPPRESS THE SECRETION OF ANTIDIURETIC HORMON
SIADH
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treat hyponatremia by
stimulating free water excretion.
AVP receptor agonists.
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decrease fluid volume in FVE,
Diuretics.
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If serum potassium levels are
dangerously elevated, it may be necessary
IV calcium gluconate
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used to lower the
serum calcium level and is particularly useful for
patients with heart disease
Calcitonin.
40
enhance
conservation of water by increasing the
permeability of collecting ducts to water
Avp/ Vasopressin is a vasopressin receptor
agonist
41
predisposing factors of FLUID VOLUME DEFICIT (FVD)
Diabetes Insipidus
● Adrenal insufficiency
● Osmotic diuresis
● Hemorrhage
● Coma
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movement of fluid from
the vascular system to other body spaces f
Third-space fluid shifts o
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SIGNS AND SYMPTOMS of FVD (INFANT AND YOUNG CHILDREN)
Crying without tears
● No wet diapers for three hours or more
● Being unusually sleepy or drowsy
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Decreased ability to concentrate urine due to
ADH deficit or nephron resistance to ADH
Diabetes Insipidus
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decreased
PLASMA VOLUME and makes the RBCs
concentrated
increase Hematocrit level
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Elevated BUN indicates?
out of proportion with
creatinine Because Urea
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Appearance of wakefulness, awareness of the self
and environment
ALERT (CONSCIOUS)
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mild reduction in alertness
LETHARGY
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moderate reduction in alertness. Increased response
time to stimuli
OBTUNDATION
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aroused only by vigorous
and repetitive stimulation.
STUPOR
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(Unarousable unresponsiveness,
eyes closed)
COMA (UNCONSCIOUS)
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a measure of pressure in the vena cava, can
be used as an estimation of preload and right atrial
pressure.
CENTRAL VENOUS PRESSURE
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NORMAL Central venous pressure?
2-5 mmHg
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3 STAGES OF HYPOVOLEMIC SHOCK
Stage 1: 15% blood loss
(750 mL or about 25 ounces).
● Stage 2: 15% to 30%
(750 mL to 1,500 mL or up to almost 51 ounces)
● Stage 3: 30% to 40% of your blood
(1,500 to 2,000 mL or up to 68 oz.)
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caused by
the abnormal retention of water and sodium
HYPERVOLEMIA
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SIGNS & SYMPTOMS (PULMONARY)
of FVE
Pulmonary Congestion: crackles, rales
● Change in respiratory pattern
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buildup of,
nitrogenous products
Azotemia
58
Normal urine specific gravity levels are
1.010 and 1.020
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right ventricular third heart sound. It is
usually heard best where
right or left lower sternal edge, in the
epigastrium, or rarely over the jugular veins
60
swelling that occurs prior to
a woman's menstrual cycle
Premenstrual edema
61
disorder that causes excess
excretion of protein in the urine
Nephrotic syndrome
62
major extracellular fluid cation.
Sodium (Na)
63
urine specific gravity of hypernatremia
>1.025
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SIGNS AND SYMPTOMS (TOO MUCH SALT)
Skin flushed
● Agitation
● Low grade fever
● Thirst
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NURSING MANAGEMENT of hypernatremia
Monitor level of consciousness, muscular strength,
tone, & movement
66
very brisk, hyperactive, with
clonus
4+
67
3+ DTR RESPONSE
Brisker than average, slightly
hyperreflexic
68
2+ DTR
Average, expected response;
normal
69
Somewhat diminished, low
normal DTR
1+
70
No response, absent
0
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SIGNS AND SYMPTOMS (LOSS) FOR HYPONATREMIA
Limp muscles
● Orthostatic hypotension
● Seizures
● Stomach cramping
72
Hypertonic 0.3% NS - slow IV infusion via central
line.
***Watch out for fluid overload!
Nursing managment for what type of hyponatremia
HYPOVOLEMIC HYPONATREMIA
73
Caused by SIADH antidiuretic hormone problems:
fluid restriction or treated with antidiuretic hormone
EUVOLEMIC HYPONATREMIA
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Restrict fluid intake and in some cases administer
diuretics to excretion the extra water
nursing management for what type of hyponatremia
. FOR HYPERVOLEMIC HYPONATREMIA
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antidiuretic hormone
antagonists called
Declomycin (don’t give with food
especially dairy or antacids
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e major cation in the intracellular
fluid (ICF)
Potassium K+.
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= mild hyperkalemia
5.1 mEq/L to 6.0 mEq/L
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moderate hyperkalemia
6.1 mEq/L to 7.0 mEq/L =
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severe hyperkalemia
● above 7 mEq/L
80
increased when potassium
is lost from the tissue
glycogen
synthesis
81
SIGNS AND SYMPTOMS for Hyperkalemia
MURDER
Muscle weakness/cramps
● Urine, oliguria, anuria
● Respiratory distress
● Decrease cardiac contractility
● EKG changes
● Reflexes ( hyper or areflexia)
82
Treatment for Hyperkalemia
“C BIG K DROP”
Calcium gluconate (stabilizes cardiac membrane)
● Beta-2-agonist(albuterol neb q2-4hrs), Bicarb (shift
K+ to the cell)
● Insulin
● Glucose
● Kayexalate(Na polystyrene sulfonate)- to excrete K+
out
● Drop
- DIURETICS(Furosemide) - to excrete K+
83
SEVERE HYPERKALEMIA IS TREATED IN 3 STEPS
CIH:
Calcium infusion
Insulin
Hemodialysis
84
associated with shifting of K+ into cells, K+ loss
from GI and biliary tracts, renal K+ excretion and
reduced K+ intake
HYPOKALEMIA
85
causes kidneys to excrete
K
CUSHING’S SYNDROME
86
SIGNS & SYMPTOMS (7L’S) of hypokalemia
Lethargy
● Low, shallow breathing
● Lethal cardiac arrest
● Loss of urine
● Leg cramps
● Limp muscles
● Low BP & HR
87
TREATMENT (STOP K+ LOSSES!)
for Hypokalemia
Discontinue diuretics, laxatives
● Don’t give LASIX
Use rather potassium-sparing diuretics /Aldactone,
88
T (PREVENTION AND CORRECTION OF POTASSIUM DEFICIENCY;)
● with alkalosis
use potassium chloride
89
PREVENTION AND CORRECTION OF POTASSIUM DEFICIENCY; acidosis
use potassium acetate,
90
Serum calcium is regulated by?
PTH and Calcitonin
91
important for neuromuscular activity &
blood coagulation
Ionized calcium
92
plasma calcium is bound to serum proteins -
albumin
Bound calcium
93
the remaining plasma is combined with
nonprotein ions: phosphate, citrate, & carbonate.
Complex calcium
94
SIGNS & SYMPTOMS (BACKME)
hypercalcemia
BACKME
Bone Pain
● Arrhythmias
● Cardiac Arrest
● Kidney Stones
● Muscle Weakness
● Excessive Urination
95
S/S of Hypercalcemia too weak
Absent reflexes, disorientated, abdominal distention
from constipation
● Kidney Stone formation
96
most common ECG findings
of hypercalcemia are
a short QT interval secondary
to a shortened ST segment. There may also be a
widened or flattened T wave
97
hypercalcemia can cause ECG changes that mimic
acute myocardial infarction.
98
Hypercalcemia has also been known to cause an
ECG finding mimicking hypothermia
known as an
Osborn wave ( J wave). Ventricular fibrillation and
arrest for extreme hypercalcemia.
99
adrenal
glands above the kidneys, produces too little
cortisol and too little aldosterone.
Adrenal insufficiency (Addison’s Disease)
100
decreased with Thiazide*
diuretics & renal failure, cancer of the bones
Calcium excretion
101
causes
phosphate to decrease and calcium to increase
Lithium usage (affects the parathyroid
102
COMMON MEDICATIONS AND SUPPLEMENTS THAT CAN CAUSE
HYPERCALCEMIA
Hydrochlorothiazide
Lithium.
● Excessive intake of vitamin D
103
treatment for hypercalcemia
Forced Diuresis
Loop DIURETICS
Glucocorticoids:
104
Saline administration will cause
renal elimination/ to decrease calculi formation.
Forced Diuresis
105
reduces intestinal absorption and
tubular reabsorption of calcium
Glucocorticoids:
106
refers to the total
concentration of dissolved substances in drinking
water
– TOTAL DISSOLVED SOLIDS TDS
107
calcium deposits in the kidney that
causes poor kidney function
Nephrocalcinosis -
108
COMPLICATIONS OF LONG-TERM HYPERCALCEMIA
Nephrocalcinosis -
Kidney failure.
● Kidney stones.
● High blood pressure (hypertension).
109
determines a reduction of calcium
due to a decrease in the fraction bound to proteins
Hypoalbuminemia
110
reduced response of the target tissues
to parathyroid hormone (PTH) and /
reduction in ionized calcium
111
SIGNS & SYMPTOMS of hypocalcemia
TCT
Tetany
● Chvostek’s sign
● Trousseau’s sign
112
symptom characterized by the
involuntary contraction of muscles
Tetany i
113
Common symptoms of tetany
umbness around the mouth, muscle
cramps, a
114
hallmark of acute hypocalcemia is
neuromuscular irritability
115
TAPPING ON THE COURSE OF FACIAL NERVE,
BETWEEN ZYGOMATIC ARCH & ANGLE OF
MANDIBLE
chvostek sign
116
BP CUFF WHEN INFLATED HIGHER THEN
PERSON'S SYSTOLIC BP FOR ____ minutes
2 minutes: Trousseau’s sign
117
SIGNS & SYMPTOMS ("CATS GO NUMB" MNEMONIC) HYPOCALCEMIA
Convulsions (seizures)
● Arrhythmias (prolonged QTc)
● Tetany
● Spasms, Stridor (laryngospasm)
● Numbness [perioral, acral (hands, feet)
118
might be a collapsing of the larynx
most likely caused by decalcification. I
STRIDOR
119
refers to a burning or prickling
sensation that is usually felt in the hands, arms,
legs, or feet, b
Paresthesia
120
Hypocalcemia may lead to what ecg finding also refers to complete heart block
torsades de pointes
120
Hypocalcemia may lead to what ecg finding also refers to complete heart block
torsades de pointes
121
CAUSES (POSSIBLE CAUSES) of hypocalcemia
Hyperparathyroidism
Vitamin D deficiency:
Kidney failure:
122
CAUSES (CERTAIN MEDICATIONS) Hypocalcemia
Pseudohypoparathyroidism:
Bisphosphonates,
Hypomagnesemia:
Pancreatitis:
122
CAUSES (CERTAIN MEDICATIONS) Hypocalcemia
Pseudohypoparathyroidism:
Bisphosphonates,
Hypomagnesemia:
Pancreatitis:
123
an inherited
disorder that causes your body to not respond
properly to the normal amount of parathyroid hormone
(PTH)
Pseudohypoparathyroidism:
124
abundant intracellular cation.
Mg++
125
MAGNESIUM
function
CONSTIPATION RELIEF
REDUCES ECLAMPTIC SEIZURES
126
Significant symptoms and signs are seen when serum
Mg is
s < 1.2 mg/dl (0.5 mmol/l)
127
Significant symptoms and signs are seen when serum
Mg exceeds
4.8 mg/dl (2 mmol/l)
128
relationship of DTR and Magnesium
High DTR = Low magnesium
129
phosphorus found in the extracellular fluid
space is in the form of
form of inorganic phosphate.
130
HYPOPHOSPHATEMIA
SIGNS & SYMPTOM
Anemia, bruising
● SZ, Coma
● Constipation
● Muscle weakness
● Hypoactive bowel sounds
● Mild: asymptomatic
131
DIAGNOSIS (LAB RESULTS) phosphate
↓ phosphate
● ↑ calcium
● ↓ vitamin D
● ↑ parathyroid hormone
132
causes of hypophosphatemia
Increased kidney excretion
Decreased intake, absorption through GI tract
Transcellular shift
Insulin treatment in diabetic ketoacidosis;
133
COMPLICATIONSHYPOPHOSPHATEMIA
Rhabdomyolysis, kidney dama
134
when damaged muscle tissue
releases its proteins and electrolytes into the blood.
Rhabdo
135
occurs when the pituitary gland
produces too much growth hormone (GH)
Acromegaly
136
TREATMENT hyperphospatemia
Calcium carbonate and calcium citrate
Fluid resuscitate
For acute or chronic Hyperphosphatemia: consider
forced diuresis
