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Nursing 2005: Clinical Pathophysiology > Fluids & Electrolytes/Acid Base Imbalances > Flashcards

Fluids & Electrolytes/Acid Base Imbalances Flashcards

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1
Q

Total Body Water (TBW)

A
  • varies w/ age, weight, etc

- 60% of weight

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2
Q

Extracellular

  1. def
  2. What are the 2 types?
A
    • outside the cell
      - 20% of body weight

2a. Interstitial fluid
- around the cell

2b. Intravascular fluid
- blood plasma

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3
Q

Intracellular

A
  • inside cell

- 40% of body weight

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4
Q

Movement of Water:

  1. Diffusion
A
  • movement of charged and noncharged particles along concetration gradiant
  • moves from HIGH –> LOW concentration
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5
Q
  1. Osmosis
A
  • movement of water acros semi-permiable membrane

- Moves from LOW –> HIGH concentration

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6
Q
  1. Osmotic Pressure

a. osmality

A
  • pressure required to stop osmotic flow of water
  • determined by osmality

a. osmality:
- concentration of molecules/particles per kilo

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7
Q
  1. Hydrostatic Pressure
A
  • force of water pushing against cellular membranes

- pushes water our of vascular space

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8
Q
  1. Onoctic Pressure
A
  • pressure exerted by colliods (proteins)

- draws water in d/t plasma proteins

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9
Q

Between Intracellular and Extracellular Fluids

  1. osmotic balance
A
  • func of osmotic forces
  1. Osmotic balance:
    - water moves until osmotic equilibrium balanced
  • ECF = Na
  • ICF = K
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10
Q

Between Plasma and Interstitial Fluid

A
  • movement d/t changes in hydrostatic pressure
    • pushes water out of capillaries
  • osmotic forces pull water in at capillaries
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11
Q

Alterations in Water Movement:

Edema

  1. def
A
  • accumulation of fluid in interstitial places
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12
Q

What is the cause of edema?

A
  1. Cause:

a. inc hydrostatic pressure
- d/t inc fluid

b. dec plasma oncotic pressure
- d/t leakage because of poor albumin

c. inc capillary permeability
- d/t trauma, injury

d. obstructive lymph flow
- tumor

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13
Q

What are the types of treatment for edema?

A
  1. diuretics
    - dec hydrostatic pressure d/t less fluid

2 albumin
- pulls water into blood stream

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14
Q

Regulation of Body Water:

A. Thirst

  • What stimulates it?
A

a. Hyperosmolaity
- stimulates osmo receptors to make you drink

b. low K

c. Dec in blood vol
- stimulates osmo receptors

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15
Q

B. Renal Concentration Mechanism- ADH

A
  • ADH causes kidneys to retain water
    • antidiuretic to keep in water
  • controlled by osmolality and vol
  • osmolality inc = ADH secreted
  • blood vol dec
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16
Q

What are the normal values of osmoality?

A

280-294

294 = dehydrated, not enough particles

  • found in blood sample
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17
Q

ECF Imbalances

A. ECF DEFICIT

A
  • dec intake
- inc loss
   d/t:
- diarrhea
- vomit
- diuretics
- burn victims
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18
Q

What are S/S of ECF DEFICIT?

A
  • thirst
  • weight loss = measure fluid vol
  • dec urine output = dark
  • dec BP
  • inc HR
  • inc serum osmality
  • shock
  • weakenss
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19
Q

B. ECF EXCESS

A
  • inc intake

- dec loss

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20
Q

What are S/S of ECF EXCESS?

A
  • weight gain
  • edema
  • SOB = fluid in lungs
  • ab distention = fluid in cavit
  • Na retention
  • swollen brain cells = seizures, coma
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21
Q

What are sodiums func?

A
  • osmolality of ECF
  • neuromuscular func
  • acid base
  • regulated by aldosterone
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22
Q

Where is sodium lossed?

A
  • urine
  • skin
  • GI tract
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23
Q

Hyponatremia

A
  • excess water intake
    • dilutes Na level
  • dec water loss
    • dilutes Na level
  • inc Na loss
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24
Q

What are clinical manifestations of hyponatremia?

A
  • CNS symptoms
  • GI disturbances
  • inc intracellular
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25
What are S/S of hyponatremia?
- weight gain - neuro changes - confusion - lethargy - coma - seizure
26
Hypernatremia
- inc water loss - dec intake of water - excess Na - inc Na intake d/t diet, IV solution
27
What are S/S of hypernatremia
- thirst - dry mucous membranes - inc HR - restlessness
28
Potassium - Func?
- get potassium from diet and excreted through urine - osmolarity of ICF - neuromuscular control and regulation - acid base balance - enzyme reaction - HR
29
How is potassium regulated?
1. change of K in distal tubules, serum - inc K = excretion 2. adosterone - promotes excretion - inc K = inc aldosterone = loss of K 3. potassium hydrogen ion exchange - acidosis = hyperkalemia - K leaves cell - alkalosis= hypokalemia - K enters cell
30
What is hypokalemia caused by?
-*deficit 1. dec intake 2. excess GI loss 3. excess renal loss 4. intrcellular shift = alkalosis
31
What are S/S of hypokalemia?
- cardiac dysrhythmias - weakness - dec GI motility - loss in vomit, diuretics - cramping os skeletal muscles - skeletal muscle weakness - smooth muscle weakness = slows GI tract → constipation - CNS depression
32
What type of treatment is used for hypokalemia?
- diet inc K | ex: banana, nuts, some fruits
33
What is hyperkalemia caused by?
*excess 1. excess intake/gain 2. dec renal loss 3. extracellular shifts - acidosis - massive cell destruction
34
What are S/S of hyperkalemia?
- abnormal conduction pathways - smooth muscle = inc activity - EKG changes - cardiac arrest - muscle weakenss
35
What is used to treat hyperkalemia?
1. diet to dec intake 2. diuretics to de K (if no renal problem) 3. resin - drink called Kexalate - eliminates through stool 4. emergency - insulin to remove K into liver --> muscle - also give glucose
36
What is the func of calcium?
- transmits nerve impulses and muscle contractions - enzyme reactions - maintains cell membrane perm - inverse relation w/ phosphate
37
What is hypocalcemia caused by?
1. hypoparathyroidism 2. pancreatitis 3. renal failure 4. lack of vit D 5. low magnesium
38
What are S/S of hypocalcemia
* deficit - inc nerve excitability - tingling - numbness - tetany - hyperreflex - cramps - seizures
39
What is hypercalcemia caused by?
* excess 1. bone tumor 2. hyperparthyroidism 3. prolonged immobility
40
What are S/S of hypercalcemia?
- dec neuromuscular activity - weakness - constipation - dysrrhytmias
41
What is the func of phosphate?
- bone formation - metabolic processes (ATP) - essential part of nucleic acids and membrane - normal func of WBC and platelets - deliver O2 to cells
42
What is the cause of hypophosphatemia?
1. antacid use 2. malnutrition 3. diarrhea 4. lack of vit D
43
What are S/S of hypophospatemia?
- tremos - hypoflexia - confusion - sezures - numbness - dysfunc of WBC and platelets
44
What is hphyerphosphatemia caused by?
1. renal faulure | 2. hypoparathyroidism
45
What are the S/S of hyperparathyrodism?
- like low Ca
46
What is the func of magnesium?
- cofactor in enzyme reactions | - affects neuromuscular func
47
What is hypomangnesia caused by?
1. imparited intake/absorption | 2. inc loss
48
What are S/S of hypomangnesmia?
* deficit - CNS hyperirritability - tremors - inc HR
49
What are the func of hypermagnesemia?
- rare | - d/t intake or renal insufficiency
50
What are S/S of hypermagnesmia?
- sedation of CNS - muscle weakness - confusion - dec BP
51
Acid/Base - normal ph? - equation?
ph = 7.35-7.45 CO2 + H2O → H2CO3→ H+ HCO3
52
Acidosis
- process causes acidemia | - acid condition of blood ph = < 7.35
53
Alkalosis
- process causing alkalemia | - alkaline condition of blood ph = >7.45
54
Regulation of pH: 1. Carbonic acid-bicarbonate buffering a. respiratory b. renal
a. resp = regulated CO2 level = acid - CO2 inc = acidosis = hypoventilation - CO dec = alkalosis = hypoventilation b. renal = metabolic - regulate HCO3 = base - produce either acid/base urine -HCO3 inc = alkalosis HCO3 dec = acidosis
55
Acid/Base Imbalance: A. Resp Acidosis
- retain CO2 = accumulate | - ph <7.335
56
What is resp acidosis caused by?
- hypoventilation - pneumonia - NM disease - CNS depression - lethargy, confusion, coma - COPD
57
What are S/S of resp acidosis?
- depressed CNS - headache - weakness - twitch - deep,shallow resp - acidic urine
58
B. Resp Alkalosis
- blow off CO2 = loss | - ph >7.45 = less acidic (more base)
59
What is resp alkalosis caused by? - compensation?
- hyperventilation | - compensation = alkaline urine
60
What are S/S of resp alkalosis?
- excited CNS - numb, tingly fingers/toes - palpations - sweating
61
C. Metabolic acidosis
- retain acid - HCO3 dec - ph <7.35
62
What is metabolic acidosis caused by?
- renal failure = dec urine ouput - incr acid levels - diarrhea - loss of bicarb - shocks - lactic acid
63
What are S/S of metabolic acidosis? - compensation?
- depression of CNS - weak, fatigue - confusion - compensation: - inc RR - Kussmaul resp - acidic urine
64
What is treatment for metabolic acidosis?
- give sodium bicarb
65
D. Metabolic alkalosis
- loss of acid - HCO3 inc - ph > 7.45 - excess base or loss of acid
66
What is metaboli alkalosis caused by?
- ingestion of base = anacids - vomit - excess aldosterone - diuretic therapy = alkalosis
67
What are S/S of metabolic alkalosis? Compensation
- Excited CNS - hyperreflexes - convulsions - weakness - confusion Compensation: - dec RR - retain acid - alkaline urin
68
What is tx for metabolic alkalosis
- id reason
69
Analysis of Arterial Blood Gases Test 1. ph
7.35-7.45
70
2. PaCo2
35-45 - CO2 level is high = acidosis
71
PaO2
80-100
72
HCO2
22-26 - high bicarb = alkalotic - low bicarb = acidic
73
How to figure our ABG
1. look at pH = acidemia/alkalemia? 2. find primary cause - look at PCO2 and HCO3 a. CO2 abnormal and matches pH problem = respiratory - if HCO3 off and matches ph change b. inverse match = metabolic - if HCO3 and matches pH changes 3. look at other values to see if compensation

Nursing 2005: Clinical Pathophysiology (9 decks)

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