Fluid And Electrolytes Flashcards
1
Q
normal sodium
A
135-145 mEq/L
2
Q
normal potassium
A
3.5-5 mEq/L
3
Q
normal BUN
A
7-20 mg/dl
4
Q
normal hematocrit
A
40-50%
5
Q
normal urine specific gravity
A
1.002-1.030
6
Q
normal glucose
A
60-110 mg/dl
7
Q
normal osmolality
A
275-295
8
Q
FVD classic sign
A
dry mucous membranes, comes later
9
Q
FVD late sign
A
hypotension
10
Q
FVD, temp changes
A
decreased temp, blood shunted to central area
11
Q
FVD, respiratory
A
increased respiratory rate bc acidotic, blowing of CO2; thick and sticky secretions
12
Q
anasarca
A
severe, generalized third spacing
13
Q
most common site, 3rd spacing
A
abdomen (ascites, in peritoneal cavity?)
14
Q
primary mediator of fluids
A
hypothalamus
15
Q
2nd spacing
A
stage where fluid moves from one space to another
16
Q
3rd spacing
A
fluid in interstitial compartments
17
Q
FVD sodium
A
normal to high (hemoconcentration)
18
Q
FVD potassium
A
normal to high (is intracellular, if enough cell death –or sodium levels – could be high)
19
Q
FVD BUN
A
high (hemoconcentration); in children may be low but not pathologic
20
Q
FVD glucose
A
normal to high (stress response, >120)
21
Q
FVD urine specific gravity
A
high >1.030
22
Q
FVD osmolality (serum)
A
> 300, more particles ↑ number of particles, concentration
23
Q
FVE hemodynamic signs
A
full bounding pulses, hypertension, increased CVP, neck vein distension, CHF
24
Q
cerebral edema
A
seen with FVE, Confusion, dizziness, convulsions, coma
25
pulmonary edema
seen with FVE, Dyspnea, tachypnea, hacking cough, crackles, o2 sat down
26
FVE general signs
weight gain, nonpitting interstitial edema, hepatomegaly/splenomegaly
27
FVE first sign seen
pulmonary edema
28
neck vein distension
sign of FVE but not seen in kids, make sure know baseline for adults
29
goal of Rx for FVE
prevent cerebral edema
30
>>> causes of FVE (10)
renal failure, heart failure, excess fluid intake (without electrolytes), high corticosteroids, high aldosterone, plain water enema, NG irrigations, excess hypotonic IV fluids, SIADH, inappropriately prepared formula (dilute formula)
31
>>> excess fluid intake examples
excessive hypertonic fluids, binge drinking contest, psych disorders, drowning in fresh water, inappropriate dialysis
32
FVE, potassium
normal to high (potassium shift out of cells, rasing levels)
33
FVE, sodium
very low, <125
34
FVE, BUN
low (hemodilution)
35
FVE, urine spec gravity
low, <1.005
36
FVE, glucose
normal to high (stress response, >120)
37
decreased sodium and potassium signs
lethargy, weakness
38
increased sodium and potassium signs
increased excitability
39
acid
releases H+ ions in water
40
base
binds to H+ ions in water
41
buffers
prevent major acid-base changes; carbonic acid-bicarbonate, protien, and phosphate buffer system
42
carbonic acid
measured as CO2
43
acid-base homeostasis
bicarb: carbonic acid = 20:1
44
carbonic acid-bicarb system
primary system, 50% of activity, to maintain balance l/t have to also use protein and phosphate buffer systems, 1-2 hours to kick in, bicarb is the major ECF buffer
45
alkaline environment
hard for cells to grow
46
>>> Respiratory buffer system, carbonic acid
carbonic acid compensates and dissociates into CO2 and H20, CO2 exhaled by lungs, system activates rapidly but exhausted quickly
47
respiratory buffer system, breathing changes
changes in depth/rate of resp alters it: hypoventilation retains CO2/carbonic acid and causes acidosis, hyperventilation loses CO2 and causes alkalosis
48
renal buffer system: time and effectiveness
works w/in hours/days, more efficient than respiratory can go for longer periods of time
49
renal buffering system, bicarbonate
primary renal component, can be absobed as needed, combines HCl with ammonia to make ammonium, which is easily excreted by kidneys into urine
50
compensation
regulatory mechanism to return pH to normal level by transforming acids and bases within the body
51
primary metabolic disturbance
causes a respiratory compensation
52
acute primary respiratory disturbance
causes an acute metabolic response
53
complete compensation
pH is fully corrected (normal)
54
partial compensation
buffers are in the process of working; pH is low but the bicarb is elevating to compensate (or pH is high but CO2 is elevating to compensate)
55
pH
*negative logarithm of H+ ion concentration in mEq/L (as H+ ion concentration increases, pH decreases) *normal values 7.35 -7.45 (less is acidotic, more is alkalotic)
56
HCO3- (bicarb)
*normal 22-26 mEq/L (decreased in acidosis, increased in alkalosis)
57
BE "base excess"
indicates the amount of bicarb available in the ECF normal value: +/- 2 mEq/L
58
serum anion gap
*Concentration of anions (HCO3- , Cl-, protein, phosphate, & sulfates) and cations (Na+, K+, MG++, & Ca++) *10-12 mEq/L normal *increased in metabolic acidosis (but can be normal) *calculated by Na - Cl + bicarb
59
SaO2
the percent of Hb saturated with O2, a calculated value (indirect measurement), calculated with pH and PaO2 (combination of O2 sat, PaO2, and Hb), indicates tissue oxygenation
60
PaO2
amount of oxygen available to bind with hemoglobin, amount of pressure exerted on O2 by plasma
61
the lower teh PaO2 pressure, the ....
less oxygen available to bind with Hb
62
dramatic drops in PaO2
correlate with dramatic drops in oxygen saturation
63
PaO2 normal values
75-100 mmHg (for every year above 60 drop 1mmHg)
64
PaCO2
*partial pressure of CO2 *reflects adequacy of alveolar ventilation, regulated by lungs, alterations indicate resp disturbance *normal values 35-45 mmHg (less is alkalotic, more is acidotic)
65
respiratory alkalosis managment (4)
correct cause, rebreathe CO2 as needed, alter ventilation rate, sedatives (for anxiety)
66
respiratory alkalosis assessment (7)
VS, ABGs, RR/depth, LOC/anxiety, neuro checks, injury potential, I&O
67
respiratory alkalosis CV signs
tachycardia, palpitations, increased myocardial irritability
68
respiratory alkalosis respiratory signs
rapid shallow breathing (trying to retain CO2, oxygenate), chest tightness
69
respiratory alkalosos CNS signs (10)
paresthesia, dizzyness, confusion, tetany, convulsion, numb/tingling, light headed, anxiety/panic, Loss of consciousness, hyperactive reflexes
70
respiratory alkalosis causes (4)
hyperventilation, sepsis/infection, over ventilation, hepatic cirrhosis
71
respiratory alkalosis: labs
low CO2, pH high >7.45, bicarb normal if no compensation or decreased if compensation, hypokalemia, hypocalcemia
72
respiratory acidosis management (7)
correct cause, CPT, TCDB if able, suction as needed, semi-Fowlers, fluids to thin secretions, low-flow O2 as needed
73
respiratory acidosis assessment (8)
VS, ABGs, RR/depth, apical pulse, LOC, EKG, skin color/nail beds/mucous membranes, I&O
74
respiratory acidosis cardiac signs
hypotension, peripheral vasodilation weak thready pulse, tachycardia, warm flushed skin
75
respiratory acidosis respiratory signs
dyspnea, slow shallow respirations, hypoxia and hypoventilation, cyanosis
76
respiratory acidosis CNS signs (6)
HA, seizures, altered LOC, papilledema, twitching/tremors, drowsy --> coma
77
respiratory acidosis causes (4)
respiratory depression/arrest, inadequate chest expansion, airway obstruction, interference with alveolar capillary exchange
78
respiratory acidosis: labs
pH low <7.35, PaCO2 high >42, HCO3- normal (or elevated with compensation), hyperkalemia
79
metabolic alkalosis mgmnt (3)
correct cause, restore normal fluid balance, adequate chloride (enhance renal absorption of sodium and excretion of bicarb)
80
metabolic alkalosis assessment (6)
VS, ABGs, RR/depth, LOC, I&O, ECG
81
metabolic alkalosis GI signs (3)
n/v, anorexia, paralitic ileus (hypokalemia)
82
metabolic alkalosis CNS signs (10)
dizzy, nervous, tremors, hyperreflexia, paresthesias, irritability, confusion/apathy/stupor, cramps, tetany, seizures
83
met alkalosis respiratory signs (2)
hypoventilation, respiratory failure
84
met alkalosis CV signs (5)
tachycardia, HTN, PVC, atrial tachycardia, dysthrythmias (from FVE)
85
met alkalosis causes (4)
vomiting, NG suctioning, eating bicarb-based antacids, diuretics
86
met alkalosis: labs
increased pH, increased BE, increased bicarb, decreased anion gap (low K and Na)
87
met acidosis mgmnt (6)
correct cause, treat ketoacidosis (fluids, insulin), give alkaline fluids, hydrate, mechanical ventilation if needed, possible dialysis
88
insulin
used to treat metabolic acidosis (ketoacidosis), forces potassium back into cells
89
alkaline fluids for met acidosis
if severe, sodium bicarb if pH<7.20, salts of organic acid (lactate, citrate), tromethamine THAM
90
met acidosis assessment (7)
VS, ABGs, RR/depth, apical and peripheral pulses, ECG (bc of dramatic K changes), LOC, I&O
91
metabolic acidosis CV signs (4)
dramatic affects: hypotension, dysrhythmias, peripheral vasodilation, warm flushed skin (from dilation, leaking of capillaries)
92
metabolic acidosis resp signs
Kussmaul/deep/rapid respirations, trying to blow off CO2
93
metabolic acidosis CNS signs (6)
think of septic patient: drowsy, HA (from cerebral edema), lethargy, coma, confusion/restless, weakness
94
metabolic acidosis GI signs (3)
n/v, diarrhea, abdominal pain
95
causes of metabolic acidosis
chronic diarrhea, malnutrition, starvation, renal failure, DKA, trauma, shock, sepsis, fever, salicylate toxicity
96
metabolic acidosis: labs
low bicarb, decreased BE, increased anion gap, hyperkalemia (from breakdown of cells from acidosis), high metabolic acids (lactic acids, ketoacids)
