Test 1 - 71B Flashcards
1
Q
Normal pH range:
A
7.35-7.45
2
Q
Normal PCO2 range:
A
35-45 mm Hg
3
Q
Normal HCO3 range:
A
22.26 mEg/L
4
Q
Normal PO2 range:
A
80-100 mm Hg
5
Q
Normal SO2 range:
A
95-100%
6
Q
Normal Sodium range:
A
135-145 mEq/L
7
Q
Normal Calcium range:
A
8.5-10.5 mEq/L
Ionized: 4.5-5.5 mg/dL
8
Q
Normal Potassium range:
A
3.5-5.0 mEq/L
9
Q
Normal Magnesium range:
A
1.5-2.5 mEq/L
10
Q
Normal Chloride range:
A
95-105 mEq/L
11
Q
Normal Phosphate range:
A
2.5-4.5 mg/dL
12
Q
What are electrolytes?
A
Charged ions dissolved in body fluids.
13
Q
Cations
A
positively charged ions
14
Q
Anions
A
negatively charged ions
15
Q
What do sodium levels maintain?
A
(Bones, blood clotting factors, beats) skeletal muscle contraction, cardiac contraction, and nerve impulse transmission
16
Q
Hyponatremia
A
decreased sodium levels; net gain of water or loss of sodium-rich fluids that results in sodium levels less than 136 mEq/L
17
Q
Hypernatremia
A
elevated sodium levels; serum sodium level greater than 145 mEq/L
18
Q
What electrolytes are cations?
A
magnesium, potassium, sodium, calcium, and hydrogen
19
Q
What electrolytes are anions?
A
phosphate, sulfate, chloride, bicarbonate, and proteinate
20
Q
What are the symptoms of hyponatremia?
A
Depressed and Deflated: Seizures/coma, tachycardia with weak, thready pulse, respiratory arrest
21
Q
What are sodium levels regulated by?
A
the kidneys
22
Q
What type of solution is hyponatremia treated with?
A
lactated ringers or 0.9% isotonic saline
hypertonic sodium solution may be used to decrease cerebral edema
23
Q
How is acute hyponatremia treated?
A
- administer hypertonic oral and IV fluids as prescribed.
- Administer 3% sodium chloride slowly
- Encourage high sodium foods
- monitor I&O and daily weight
- monitor vital signs and level of consciousness
24
Q
What are the complications of acute hyponatremia?
A
coma, seizures, respiratory arrest
25
What are the symptoms of hypernatremia?
Big and Bloated: Rosy and red cheeks (santa), edema, low grade fever
polydipsia
(late signs: swollen dry tongue, N&V, increased muscle tone)
26
What type of fluid might be given to a patient with hypernatremia and water loss?
5% dextrose and 0.45% sodium chloride solution;
| Isotonic non saline IV fluids (5% dextrose in water)
27
What is the major cation in the ECF?
Sodium (Na+-K+ pump)
28
What is the major cation in the ICF?
Potassium (Na+-K+ pump)
29
What does potassium play a vital role in?
cell metabolism, transmission of nerve impulses, functioning of cardiac, lung, and muscle tissues, and acid-base balance.
30
Potassium has a reciprocal action with what other electrolyte?
sodium
31
Hypokalemia
decreased potassium levels
32
What are the symptoms of hypokalemia?
Low and Slow:
Flat T waves, ST depression
Decreased reflexes, cramping muscles, paralyzed limbs
Constipation, hypoactive BS, paralytic ileum (Can lead to SBO)
33
What should be monitored in patients with hypokalemia?
Urine output
Shallow respirations/diminished breath sounds
Cardiac rhythm
Level of consciousness
34
What foods are high in potassium?
avocados, broccoli, dairy, dried fruit, cantaloupe, bananas, juices, melon, lean meats, milk. whole grains, citrus fruits
35
hyperkalemia
increased potassium levels
36
hyperkalemia increases the risk of what?
cardiac arrest
37
What are the symptoms of hyperkalemia?
Tight and Contracted (cramp)
Hyper heart - ST elevation, Vfib/Asystole, Hypotension, Bradycardia
Diarrhea/Hyperactive bowel sounds
Muscle paralysis/weakness, increased DTRs
38
What action do loop diuretics have on potassium?
increase the depletion of potassium in the renal system
39
What lab tests are associated with hyponatremia?
```
serum sodium (decreased)
serum osmolarity (decreased)
```
40
What lab tests are associated with hypernatremia?
```
serum sodium (increased)
serum osmolarity (increased)
Urine sodium (decreased urine)
Urine specific gravity and osmolarity (increased)
```
41
What lab tests are associated with hypokalemia?
serum potassium (decreased)
42
What lab tests are associated with hyperkalemia?
serum potassium (increased)
Hemoglobin and hematocrit (increased w/dehydration, decreased w/kidney failure)
BUN and creatinine (increased w/kidney failure)
Arterial blood gases (metabolic acidosis - pH less than with kidney failure)
43
hypocalcemia
decreased sodium levels
44
symptoms of hypocalcemia
Trosseus - arm twerk w/BP cuff
Chvostek sign - smile stroke cheek
Diarrhea, circumoral tingling
Weak bones, weak blood clotting, weak heart beating
45
hypercalcemia
increase in sodium levels
46
symptoms of hypercalcemia
Swollen and Slow (moans, groans, stones)
| Constipation, bone pain, kidney stones, decreased DTRs
47
hypomagnesemia
decreased magnesium levels
48
symptoms of hypomagnesemia
Buck Wild
Vfib, tachycardia, ST depression, hyperreflexia
Nystagmus, Diarrhea
49
hypermagnesemia
increased magnesium levels
50
symptoms of hypermagnesemia
Calm and Quiet
Heart blocks, bradycardia, hypotension
Decreased DTRs, Low RR, hypoactive bowel sounds.
51
What foods contain high magnesium?
dark green vegetables, nuts, whole grains, seafood, peanut butter and cocoa.
52
symptoms of hypochloremia
diarrhea, vomit, sweating, fever
53
symptoms of hyperchloremia
N&V, swollen dry tongue, confusion
54
What electrolytes are dominant in the ECF?
Cl-, CA++, HCO3-, Na+
55
What electrolytes are dominant in the ICF?
K+, Mg++, PO4(3-)
56
What is the major anion in the ECF?
Cl- (Cl- follows Na+)
57
What is the major anion in the ICF?
PO4(3-) (needed to form ATP)
58
Which is more acidic? ECF or ICF?
ICF is more acidic because metabolism produces acids and metabolism takes place in the ICF.
59
What happens with decreased phosphate levels?
```
decreased phosphate PO4(3-) = decreased ATP = decreased enzyme activity which causes:
Decreased O2 transport (hypoxia)
Decreased WBC function (infection)
Decreased metabolism (starvation)
Decreased blood clotting (bleeding)
"Refeeding Syndrome"
```
60
Normal sodium function is related to:
fluid regulation
| "Sodium: CNS" -> mental status disorder
61
Normal potassium function is related to:
Resting membrane potential
| "Kalium - Kardiac" -> arrhythmia
62
Normal calcium function is related to:
permeability of Na+ (excitability)
"ContrA exCitAbility": decrease Ca/increase excitability (confusion, spasm, seizures); increase Ca/decrease excitability (fatigue, lethargy, constipation)
63
What other electrolytes does Mg++ affect?
the active transport of Na+ and K+
64
What are the Isotonic Fluid types?
0.9% Saline
5% Dextrose in Water (D5W)
5% Dextrose in 0.225% Saline
Lactated Ringers
65
Why are isotonic fluids used?
to increase ECF volume loss from: blood loss, dehydration (vomiting and diarrhea), surgery
66
What are the Hypotonic Fluid types?
0. 45% Saline (1/2NS)
0. 225% Saline (1/4NS)
0. 33% Saline (1/3NS)
67
Why are hypotonic fluids used?
to hydrate the cell (to "dilute" plasma particularly in hypernatremia)
68
What conditions are hypotonic fluids used to treat?
DKA (diabetic ketoacidosis)
| Hyperosmole hyperglycemia
69
What are the side effects of hypotonic fluids?
Hypovolemia
Cell Lysis
Depletes circulatory system fluid
70
When should hypotonic solutions NOT be used?
On patients w/intracranial pressure (shifts fluid to brain tissue), third spacing risk (edema), burns, trauma
71
What are Hypertonic Fluid types?
```
3% Saline
5% Saline
10% Dextrose in water
5% Dextrose in 0.9% Saline
5% Dextrose in 0.45% Saline
5% Dextrose in LR
```
72
What do hypertonic fluids treat?
```
Hyponatremia (pulls Na back into intravascular system)
Cerebral edema (decreases swelling by removing fluid off brain)
Severe hypovolemia (temporarily)
```
73
What can hypertonic fluids cause?
fluid overload with pulmonary edema
74
What are hypertonic fluids NOT used for?
renal or cardiac disease
75
What is potassium chloride (KCl) used for?
to treat or prevent low levels of potassium in the blood
76
What is sodium phosphate used for?
to empty the colon before a colonoscopy
77
What are the two major fluid body compartments?
intracellular and extracellular
78
which body compartment contains more water?
ICF contains 2/3 water
| ECF contains 1/3 water
79
What is a comprehensive metabolic panel?
a blood test that measures glucose level, electrolyte and fluid balance, kidney function, and liver function
80
What is a basic metabolic panel (BMP)?
a blood test consisting of a set of seven or eight biochemical tests and is one of the most common lab tests ordered by the health care providers
81
What does the anion gap blood test check?
the levels of acid in your blood
82
What is the average amount of fluid lost per day?
2-3L
83
What is sensible fluid loss?
fluid loss that can be seen such as urine or sweat
84
What is insensible fluid loss?
fluid loss that is not visible such as skin, lungs, saliva, feces
85
What are the three types of ECF?
interstitial (fluid around/between cells
intravascular (plasma - fluid in blood vessels - rich in protein)
Trans-cellular (CSF, GI tract, peritoneum, pleural, synovial fluids, aqueous humor, etc)
86
What percentage of an infants total weight does body fluids account for?
80% (60% in ECF, 40% in ICF)
87
What percentage of an adults total weight does body fluids account for?
50-60%
88
What percentage of an obese person's total weight does body fluids account for?
45-50%
89
What do antidiuretic hormones do?
reduces the excretion of water
90
What does angiotensin II do?
vasoconstrictor and stimulates aldosterone
91
What does Aldosterone do?
reduces excretion of sodium and water
92
What does Atrial natriuretic peptide do?
increases excretion of sodium and water
93
What does bicarbonate do?
major buffer in regulating pH in the ECF
94
What is the best way to determine the need for O2 therapy?
ABG and VBG analysis
| also measure the balance of acids and bases in your blood
95
What does the ABG test measure?
O2, and carbon dioxide and acids in the blood
96
What does the VBG test measure?
carbon dioxide and acids in the blood
97
What is a VBG normal range?
35-45 mmHg
98
Hypoventilation
breathing at an abnormally slow rate, resulting in an increased amount of carbon dioxide in the blood.
99
hyperventilation
is rapid and deep breathing. ... You breathe in oxygen and breathe out carbon dioxide. Excessive breathing creates a low level of carbon dioxide in your blood.
100
hypoxia
a condition in which the body or a region of the body is deprived of adequate oxygen supply at the tissue level. Hypoxia may be classified as either generalized, affecting the whole body, or local, affecting a region of the body.
101
hypoxemia
having low oxygen levels in your blood
102
What are the first signs of hypoxia?
anxiety, restlessness, and/or confusion
103
What are the late signs of hypoxia?
blue tint to the skin, cyanosis, clubbing of fingers
104
Respiratory failure:
PO2 less than 50 mmHg and PCO2 greater than 50 mmHg
105
What are the 5 conducting systems of the heart?
```
Sinoatrial (SA) node "pacemaker of the heart"
Intra-atrial pathways
Atrioventricular node
Bundle of HIS
Purkinje network
```
106
What is the job of the Sinoatrial (SA) node?
"pacemaker of the heart" - impulses are initiated at the SA node at an intrinsic rate of 60-100 cardiac action potentials per minute in an adult at rest.
107
What is the job of the Atrioventricualr node?
The AV node mediates impulses between the atria and the ventricles; delays impulse before transmitting to assist atrial emptying.
108
cardiac output
the amount of blood ejected from the left ventricle each minute
109
Stroke volume
the volume of blood ejected from the ventricles during systole
110
Preload
the amount of blood in the left ventricle at the end of diastole (end-diastolic volume)
111
afterload
the resistance to left ventricular ejection
112
surfactants
chemical produced in the lungs to maintain the surface tension of the alveoli and keep them from collapsing.
113
diffusion
the process for the exchange of respiratory gases in the alveoli of the lungs and the capillaries of the body tissues.
114
About how much oxygen is contained in dry atmospheric air?
21%
115
hypercapnia
a condition of abnormally elevated carbon dioxide (CO2) levels in the blood.
116
cyanosis
blue discoloration of the skin and mucous membranes
117
What are the major causes of hypoxemia?
1. poor alveolar ventilation
| 2. decreased diffusion of oxygen from alveoli to pulmonary capillaries
118
Atmospheric pressure
760 mmHg
119
what is hypoxemia defined/diagnosed as?
PO2 of less than 60 mmHg or O2 saturation of less than 90%
120
prolonged vomiting or gastric suctioning can result in what?
metabolic alkalosis
121
ventilation
the process of moving gases into and out of the lungs
122
perfusion
the ability of the cardiovascular system to pump oxygenated blood to the tissues and return deoxygenated blood to the lungs.
123
Diffusion
exchange of respiratory gases in the alveoli and capillaries
124
hypovolemia
a decreased volume of circulating blood in the body.
125
Blood and tissue oxygenation is via the process of:
Ventilation
Perfusion
diffusion
126
Diffusion
movement of molecules from an area of higher concentration to one of lower concentration
127
Facilitated diffusion
addition of specific carrier molecules to aid/accelerate diffusion
128
Osmosis
movement of water from areas of lower concentration to higher concentration
129
active transport
molecules move from area of low to higher concentrations through the use of external ATP
130
Osmotic pressure
a tendency of water moving from one compartment into another
131
how is osmotic pressure measured?
osmolarity (mOsm/L) and osmolality (mOsm/kg)
132
how is osmolality determined?
by the number of dissolved particles, mainly Na, urea and glucose per kg of H2O
133
What is normal body osmolality?
275-295 mOsm/kg
134
What organ is mainly responsible for maintaining concentration of body fluids within normal range of osmolality?
kidneys
135
How do the kidneys maintain concentration of body fluids?
through changes in antidiuretic hormone (ADH), R-A-S systems, solutes/water filtrations, excretions, and secretion
136
First spacing
describes normal distribution of fluid in the body in both the intracellular and extracellular fluid compartments.
137
Second spacing
describes the excess accumulation of fluid in the interstitial spaces, which we also call edema.
138
Third spacing
occurs when fluid accumulates in areas that normally have no fluid or minimal amount of fluid, such as with ascites, and edema associated with burns. In extreme cases third spacing can cause a relative hypovolemia.
139
how much does 1L of water weigh?
2.2 lbs
140
what is the minimum output per hour necessary to maintain renal function?
30mL/h
141
How much of a average person's body weight and total body water is contained in the ICF?
40% of body weight and 70% of total body water
142
How much of a average person's body weight and total body water is contained in the ECF?
20% of total body weight and 30% of total body water
143
What are the three types of ECF?
interstitial - fluid around/between cells
Intravascular - (plasma) fluid in blood vessels (rich in proteins)
trans-cellular - CSF, GI tract, synovial fluids, etc.
144
How much of an infants total weight is body fluids?
80%
145
How much of an adults total weight is body fluids?
50-60%
146
How much of an obese persons total weight is body fluids?
45-50%
147
What is the concentration of hypertonic solutions compared to the ICF?
they have a higher concentration of particles (high osmolarity) than ICF
148
What is hypertonic solution used for?
to expand vascular volume
149
What is hypotonic solution used for?
to "dilute" plasma particularly in hypernatremia
| treats cellular dehydration
150
Isotonic dehydration
H2O and electrolyte loss in equal amounts: diarrhea and vomiting
151
hypertonic dehydration
H2O loss is greater than electrolyte loss; excessive perspiration, diabetes insipidus
152
hypervolemia
fluid volume excess (FVE)
153
A solution that has HIGH osmolarity
hypertonic
154
A solution that has LOW osmolarity
hypotonic
155
A solution that has equal osmolarity as serum
isotonic
