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Nursing School > Fluids, electrolytes, acid-base disorders > Flashcards

Fluids, electrolytes, acid-base disorders Flashcards

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1
Q

Is water polar or nonpolar? What does it mean?

A

Water is polar; can dissolve charged or polar molecules

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2
Q

What role does water play?

A

Water is a transport for nutrients and waste products

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3
Q

What role do electrolytes play?

A

Conduct electricity, aid in regulation of fluid, acid-base balance, and are cofactors for enzymes (speed up reactions)

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4
Q

Why are babies more susceptible to fluid imbalance?

A

Lose more fluid through their skin, kidneys aren’t fully developed so there’s an increase in fluid loss

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5
Q

Why are older adults more susceptible to fluid imbalance?

A

Thin skin, decline in kidney function, aren’t as thirsty

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6
Q

What are some risk factors for fluid imbalance?

A

Kidney function (regulates fluid), overweight individuals (more fat=less water), being female

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7
Q

Where is most of our bodies water found?

A

Intracellular space (40% of body weight)

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8
Q

What is the most abundant cation in the intracellular fluid?

A

Potassium

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9
Q

What CAN pass through the capillary membrane? (more permeable; located between plasma fluid and interstitial fluid)

A

Water, glucose, sodium, potassium (electrolytes move freely here)

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10
Q

What CANT pass through the capillary membrane? (located between plasma fluid and interstitial fluid)

A

Albumin (blood protein) and RBC’s

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11
Q

What CAN pass through the plasma membrane? (located between the interstitial fluid and intracellular fluid)

A

Oxygen

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12
Q

What CANT move freely through the plasma membrane? (located between the interstitial fluid and intracellular fluid)

A

Glucose (needs channel), sodium, potassium (charged ions)

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13
Q

What three things control capillary hemodynamics?

A

Hydrostatic pressure, osmotic pressure, capillary permeability

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14
Q

What is hydrostatic pressure?

A

Pressure that the fluid exerts on walls of blood vessels; contributes to movement of water into interstitial space (ex: heart beats increase hydrostatic pressure)

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15
Q

What is osmotic pressure?

A

Pulls water back into capillary; drives reabsorption

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16
Q

What plays a big role in osmotic pressure?

A

Albumin, pulls water back in

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17
Q

What is capillary permeability?

A

What is allowed in and out of the cell
Example: if permeability was increased (inflammation) proteins and large particles are lost in interstitial fluid, causing a decrease in osmotic pressure, hydrostatic forces water out increasing the production of tissue fluid

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18
Q

If you lose fluid what happens to pressure?

A

It drops

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19
Q

Where is hydrostatic pressure the greatest?

A

Arterial end; favors moving out into interstitial space

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20
Q

Where does excess fluid go if it’s not reabsorbed into capillaries?

A

Lymphatic system to then be fed back to venous system

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21
Q

Where does most of the water get reclaimed in the capillary?

A

Venous end

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22
Q

True or false: under normal circumstances osmotic pressure should not change?

A

True

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23
Q

Clinical question: A person develops a blood clot in a deep vein of their left leg. The clot is blocking most of the veins diameter. How will capillary filtration pressure be affected?

A

There will be a compromised flow, hydrostatic pressure increases (moves water into interstitial space)

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24
Q

What is edema?

A

Abnormal infiltration of fluid; can be caused by decrease in albumin

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25
What is transudate in regards for edema?
Clear fluid leaking out
26
What is exudate in terms of edema?
Proteins, WBC leaking out
27
What is pitting edema?
Too much fluid in interstitial space; gravity aids in this
28
How can you get edema?
Increased capillary pressure, decreased osmotic pressure, increased capillary permeability, lymphedema
29
How can an increase in capillary (hydrostatic) pressure contribute to edema?
Too much fluid leaks out Examples: increased vascular volume (heart failure affects pump/flow; kidney disease holds onto too much water), venous obstruction (blood clot formation - thrombophlebitis), liver disease with portal vein obstruction (blockage or narrowing of portal vein leads to back pressure), acute pulmonary edema (excess fluid in lungs)
30
How can a decrease in osmotic pressure contribute to edema?
Increase loss of plasma proteins (protein-wasting kidney diseases, burns - fluid leaks from blood vessels and collects around damaged areas), decreased production of plasma proteins (liver disease, malnutrition - not enough protein = fluid leaking out bc proteins help to hold salt and water inside)
31
What is Kwashiorkor?
Extreme protein (albumin) malnutrition; fluid is suppressed bc of a lack of albumin
32
How does increased capillary permeability contribute to edema?
Increased capillary permeability allows capillaries to become very leaky Examples: inflammation, allergic reactions, malignancy, tissue injury and burns
33
How does the obstruction of lymphatic flow (lymphedema) contribute to edema?
malignant obstruction of lymphatic structures, surgical removal of lymph nodes (compromises ability to remove fluids)
34
What is third spacing?
Problem with fluid distribution; fluids shift to areas where they don't normally belong Examples: pericardial sac, pleural space, peritoneal space Cancer can cause third space shifts
35
What are ways someone can get a fluid imbalance?
Problems with intake (too much fluid) Problems with output (too much fluid out) Problems with distribution (not in right place)
36
What are some sources of fluid loss?
GI loss Bleeding Endocrine dysfunction (aldosterone and ADH) Fever (increase in breathing=fluid loss) Hyperventilation Osmotic diuresis (increase urination) Medication therapies Recreational drugs (caffein, coffee=increase in urination)
37
Causes of fluid gain?
Over-hydration (too much fluid= hypervolemia) Increased sodium intake (where sodium goes water follows) Kidney disease Liver disease Heart failure Endocrine disorders (Cushing's disease - hyperaldosterone, SIADH) Too much ADH = hold onto excess fluid
38
Where are baroreceptors found?
Carotid arteries and aortic arch
39
What are the components of arterial pressure?
Fluid volume (blood plasma) Cardiac pump Blood vessels
40
Give an example of how a change in one component of arterial pressure can lead to compensatory response in other components?
Ex: lose blood volume = heart beats faster, kidneys conserve fluid, vasoconstriction
41
What does hypovolemia and hypervolemia refer to?
How much plasma (volume of liquid) is in the blood vessels
42
Hypovolemia causes
Hypovolemia is when theres not enough plasma in blood vessels Causes: fluid loss, diabetes, burns or wounds, sweating (diaphoresis), diarrhea, vomiting, hypothalamic lesions
43
Clinical manifestations of hypovolemia
Weight loss, hypotension, tachycardia, thirst, skin tenting, increased hematocrit, BUN, electrolytes, increased urine concentration, increased temperature w/o infection
44
Hypervolemia causes
Hypervolemia is when there's too much plasma volume in blood vessels Causes: fluid excess due to increased intake, renal failure, hyperaldosteronism (hold onto salt and water), steroid therapy
45
Hypervolemia clinical manifestations
Weight gain, hypertension (too much blood), bradycardia, edema, decreased hematocrit (ratio of RBC to fluid)
46
What does aldosterone do to BP and sodium?
Increases BP and holds onto sodium
47
Role of aldosterone
Helps control the balance of salt and water, regulation of blood pressure and blood volume
48
What is shock?
Decreased arterial flow and oxygenation of cells, tissues, and organs, usually due to marginal or markedly lowered blood pressure
49
4 broad types of shock
Hypovolemic (loss of volume) Cardiogenic (pump failure) Distributive (fluid in wrong place) Obstructive (obstruction to flow)
50
What releases aldosterone?
Adrenal glands
51
Role of the Renin-angiotensin-aldosterone system
Regulates blood volume, blood pressure, fluid and electrolyte balance
52
Which organ metabolizes aldosterone?
Liver Clinical relevance: severe liver disease can't breakdown aldosterone therefore the person is at risk for hypervolemia (hold onto fluid) and weight gain
53
True or False? Sodium is more abundant outside the cell?
True; remember where sodium goes water follows, sodium can freely cross capillary membrane
54
What is diffusion?
movement of molecules from high concentration to low concentration; both solvent and solute move
55
What is osmosis?
movement of solvent (water) across a semipermeable membrane from high to low solvent concentration; only solvent moves
56
Isotonic?
same concentration as fluid in cell, no reason for water to move
57
Hypotonic?
Cell swells
58
Hypertonic?
Cell shrinks, pulls fluid out; very concentrated around RBC pulling fluid out
59
Atrial natriuretic peptide (ANP)
causes you to pee out sodium and therefore water too (where sodium goes, water follows)
60
What organs regulate sodium?
kidney and hypothalamus
61
Function of kidneys
monitors arterial pressure, retains sodium when arterial pressure decreases and eliminates when arterial pressure increases
62
What coordinates sodium function and the kidneys?
Sympathetic nervous system and renin-angiotensin-aldosterone system (RAAS)
63
How does the hypothalamus regulate sodium?
Via the anti-diuretic hormone (ADH); ONLY moves fluid; reclaims fluid from urine
64
What produces ADH? Why is it released?
Hypothalamus; released in response to osmolality (concentration)
65
What is the most common electrolyte imbalance?
Sodium
66
What is hyponatremia?
Too low of sodium concentration in blood; water will shift into cells
67
What is hypernatremia?
toomuchsodium concentration in blood; water will shift out of cells
68
Diabetes insipidus (DI)
low levels of ADH or inability for kidneys to respond to ADH Causes: brain lesions, cranial surgery, or head injury, some medications, certain renal disorders
69
Syndrome of inappropriate ADH (SIADH)
Too much ADH Common causes: cancer, pituitary tumor, neurologic infections (elevated levels of ADH), HIV infection
70
What may cause hyponatremia? Diabetes insipidus or SIADH?
SIADH (syndrome of inappropriate ADH); holding onto free water
71
Where do sodium imbalances manifest?
Nervous system
72
What is hyponatremia?
Low blood sodium levels; decrease in intake of sodium Clinical application: Addison's disease causes low aldosterone which then causes kidneys to hold onto water, decrease sodium reabsorption and excrete potassium, cellular swelling, chronic alcoholism, see slide 40
73
What is hypernatremia?
increase in blood sodium levels Clinical application: Cushings syndrome causes increase in sodium and wastes potassium, increased thirst, see slide 40
74
What electrolyte is the heart more sensitive to and which is the brain more sensitive to?
Brain: sodium Heart: potassium
75
What organ makes albumin?
Liver
76
What type of solution would you give to someone with cerebral edema?
Hypertonic solution
77
What is an iatrogenic injury?
Adverse mental or physical condition induced in a patient through the effects of treatment Examples: rapid infusion of IV fluids can lead to heart failure and pulmonary edema
78
What organ plays a big role in the regulation of potassium?
Kidneys
79
Where is aldosterone produced and where is it metabolized?
Produced in adrenal glands, metabolized by liver
80
What is the role of aldosterone?
helps control the balance of water and salts in the kidney by keeping sodium in and releasing potassium from the body
81
How does liver disease cause hyperkalemia?
if the liver can't metabolize aldosterone then potassium will accumulate
82
Where do symptoms appear in potassium balance?
Heart and muscle
83
What is hypokalemia?
decrease in potassium in the blood; caused by a decreased intake, vomiting, alkalosis, see slide 50 Clinical application: cardiac arrhythmia (low T wave)
84
What is hyperkalemia?
High levels of potassium in blood; caused by increased intake, renal failure (can't get rid of potassium through kidneys), acidosis, see slide 50 Clinical application: Peaked T wave
85
Acidosis
High potassium, hyperkalemia; bicarbon is lost, high acid
86
Alkalosis
Low potassium, hypokalemia; increase in bicarb
87
What causes a peaked T wave?
Hyperkalemia
88
What can cause a transcellular shift?
trauma (cells damaged), acid-base disorders, catecholamine release (epinephrine drive potassium into cells), action of insulin (drive potassium into cells), medications
89
Addisons disease
adrenal insufficiency, abnormally low levels of adrenal hormones, don't produce aldosterone (keeps sodium in, pee out potassium), can lead to hypovolemia, hyperkalemia, and acidosis
90
Cushing's disease
excess aldosterone
91
What role does calcium play in the body?
muscle contraction, blood clotting, bone formation, enzyme function, heart rhythm
92
What acts on the kidneys and bone to remove calcium from the extracellular circulation?
calcitonin (tones calcium down)
93
What organs are responsible for the activation of vitamin D?
skin, kidneys, liver
94
What is the relationship between calcium and phosphorus?
inverse relationship; one goes up other goes down
95
Hypocalcemia
decrease in calcium in the blood; caused by decreased intake, vit D deficiency, liver disease, see slide 60 Clinical application: increased neuromuscular activity, muscle twitch
96
Hypercalcemia
increase of calcium levels in blood; caused by increased intake, immobility, bone malignancies, hyperparathyroidism, see slide 60 Clinical application: decreased neuromuscular activity, increased fracture risk
97
True or False: acids tend to donate protons and bases tend to accept protons
True
98
Definition of ph and Normal pH range
How many hydrogen ions in a solution 7.35-7.45
99
What happens to pH when theres more hydrogen? less?
More hydrogens = pH down Less hydrogens = pH up
100
role of buffer systems
resist big changes in pH; absorb excess hydrogens or give up hydrogens
101
Normal PaCO2 range
35-45 mmHg
102
Normal HCO3 range
22-26 mEq/L
103
What metabolic exhaust is produced by aerobic metabolism?
Water, CO2
104
What metabolic exhaust is produced by anaerobic metabolism?
lactic acid
105
Low CO2 = (Hint replace CO2 with acid)
Basic
106
High CO2 = (Hint replace CO2 with acid)
Acidic
107
Low HCO3 = (Hint replace HCO3 with base)
Acidic
108
High HCO3 = (Hint replace HCO3 with base)
Basic
109
What does it mean to be uncompensated?
pH and 1 other value are outside of normal range
110
What does it mean to have partial compensation?
When all 3 values (pH, CO2, HCO3) are outside normal range
111
What does it mean to be fully compensated?
When pH is within normal range but CO2 and HCO3 are outside normal
112
If there’s a problem with CO2 does that indicate a respiratory or metabolic issue?
Respiratory
113
Acidosis leads to too many hydrogen ions or too little?
Too many
114
Alkalosis leads to too many hydrogen ions or too little?
Too little

Nursing School (9 decks)

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