Unit Exam 1 Flashcards by Jeon Jeon

Are Dependent on dynamic processes that are crucial for life and homeostasis

Fluid and electrolyte balance

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Plasma composed of how many percent

92%

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Body fluid is located into fluid compartments

Intracellular space and extracellular space

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2/3 of body fluid is in the

Intracellular fluid (ICF)

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1/3 of body fluid is in the

Extracellular fluid (ECF)

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The ECF compartment is further divided into

Intravascular, interstitial and transcellular fluid

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Space that contains plasma, the effective circulating volume

~3L of the average 6L of blood volume in adults is made up of plasma

Intravascular space

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A space that contains the fluid that surrounds the cell and totals about 11 to 12 L in an adult

Interstitial space

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A space that is the smallest division of the ECF compartment and contains approximately 1 L

Transcellular space

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What are the two major compartments

ICF and ECF

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Sodium, potassium, calcium, magnesium, and hydrogen ions

Major cations in the body

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Chloride, bicarbonate, phosphate, sulfate and negatively charged protein ions

Major anions in the body

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The diffusion of water caused by fluid and solute concentration gradients is known as

Osmosis

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Is the number of Miliosmoles of solute per kilogram of solvent

Osmolality

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Is the number of Miliosmoles per liter of solution

Osmolarity

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Is the pressure exerted by fluid on the walls of the blood vessel

Hydrostatic pressure

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Is the pressure exerted by the solute’s with in the plasma

Osmotic pressure

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Is fluid consisting of non-soluble substances that are evenly distributed within a solvent

Colloid

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Are mineral ions dissolved in water

Crystalloid solutions

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Normal Saline (0.9 % NaCl)
Half Normal Saline (0.45 % NaCl)
Lactated Ringer’s solution (Plasma-Lyte)

Examples of crystalloid solutions

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Albumin Solutions
Hyperoncotic starch
Dextran

Examples of colloid solutions

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Is the ability of solutes to cause an osmotic driving force that promotes water movement from one compartment to another

Tonicity

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Are composed of 0.9% NaCl
The same sodium and chloride concentration as the bloodstream and the same water concentration as the bloodstream
Do not provoke water movement between ICF or ECF compartments
Expand the plasma volume of the blood

Isotonic solutions

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Are composed of less sodium chloride concentration compared to the blood
0.45% NaCl or 0.225% NaCl
Contain less solute but more water than the bloodstream

Hypotonic solutions

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Are composed of greater concentration of NaCl Compared to blood Contain more solute concentration and less water than the bloodstream

Hypertonic solutions

Is the increase in urine output caused by the excretion of solutes such as glucose or mannitol

Osmotic diuresis

Is a laboratory value that measures the amount of urea in the bloodstream

BUN

Is a breakdown Product of muscle metabolism that is almost totally cleared from the bloodstream and excreted by the kidneys

Creatinine

Measures the percentage of red blood cells

Hematocrit

Is the rapid loss of body weight due to the loss of either water or sodium

Dehydration

Other term for hypovolemia

Fluid volume deficit

Occurs when loss of ECF volume exceeds the intake of fluid

Hypovolemia

Normal BUN to and creatinine concentration ratio

10:1

Refers to an expansion of the ECF caused by the abnormal retention of water and sodium in approximately the same proportions in which they normally exist in the ECF

Hypervolemia or FVE

The most abundant electrolyte in the ECF

Sodium

Normal values of sodium

135-145 mEq/L

Earliest manifestation of hypovolemia

Thirst

What is CVP

Central venous pressure

Normal CVP

8-12 mmHg

It is the pressure of your vena cava; reflects your right atrium perfusion

CVP

What should you give If the patient experiencing cramping during dialysis

Give Chippy or food that is high in sodium

An emergency situation where the heart is unable to pump enough blood to the body due to significant blood or other fluid loss

Hypovolemic shock

Where is the site of absorption of potassium in the body

Small intestine (duodenum)

Site of obstruction of sodium in the body

jejunum

Other term for generalized edema

Anasarca

Medical term for swelling brought on by fluid entrapment in human tissues

Edema

Famous colloid solutions

BLOOD BYPRODUCT -Fresh whole blood -Platelet concentration -Plasma expander

Give crystalloid when patient is

Unable to eat and cannot absorb food

Water intoxication Consumes too much water without electrolytes

Dilutional Hyponatremia

3 factors that lead to hyponatremia

Excessive diarrhea Excessive vomiting Diaphoresis

What is ICP

intracranial pressure

How to determine hyponatremia

Diagnostic test: BUN Potassium Calcium Magnesium Phosphate

How to treat hyponatremia

Give hypertonic solution

contraindicated for patients with seizure

Vaprisol

Safe to give to Seizure patients

tolvaptan

Prominent cause of hypernatremia

Crackles

Normal value of Potassium

3.5-5.0 mEq/L

Three components of sweat

Sodium Potassium Chloride

Accounts 98% in ICF 2% in ECF

Potassium

Percent of potassium excreted daily

80%

Potassium imbalances that is caused from medications

NSAIDS and ACE inhibitors

Normal Value of Calcium

8.5-10.2 mEq/L

Normal Value of Magnesium

1.3-2.3 mEq/L

Magnesium salt includes

Calcium Oxide

Normal Value of Phosphorus

2.5-4.5 mEq/L

Normal Value of Chloride

97-107 mEq/L

Major anion in ECF

Chloride

7.35 - 7.45 Acid < > Alklaline

PaCO2

35 - 45 mmHg Alkaline < > Acidosis

HCO3

22 - 26 mEq/L Acid < - > Alkali

Two problems in hypovolemia

Sodium and potassium

Responsible for stress responses

Adrenal

The specific urine gravity of hypovolemia increases or decreases?

Increases

A good provider of sodium balance

Adrenal

HYPOVOLEMIA: BUN + Creatinine ratio

High; 1:1

HYPOVOLEMIA: Hematocrit is…

Declined

Major electrolyte inside and outside

Sodium and potassium

Hypovolemia Gerontologic Considerations

I and O -1000 ml intake; output 980-1000 ml Weight Filling of the veins assessment Functional ability Verbalization of feelings Fluid intake

What solution expands plasma volume

Isotonic solution (LR and 0.9% NaCl)

HYPOVOLEMIA: What is your first line of defense if there is an increased blood pressure

LR and 0.9% NaCl

What solution would you give if blood pressure is within normal limits

0.45% NaCl

Restlessness, Agitation, anxiety, Pallor, Clammy skin

Compensated shock

Alterations in mental status Tachycardia Tachypnea Labored and irregular breathing Week to absent peripheral pulses A decrease in body temperature Cyanosis

Decompensated shock

A shock that is in Terminal stage Compensatory mechanism is failed

Irreversible shock

A mask that is good for emergency situation

Rebreather mask

Retains water and sodium that cause swelling

Hypervolemia

Medication that causes edema

Nephrotoxic medication NSAIDs Corticosteroid Antihypertensive medication

This is to generate the oncotic pressure to prevent swelling in spaces

Expander or 20% human albumin

What do you mean by settling of blood

Set aside the blood in room temperature aron mosaka ang plasma

What type are electrolytes

Isotonic

Decrease in sodium and extra cellular spaces

Aldosterone deficiency

ICP normal Value

10 to 20 mmHg

Why is water supplement avoided

To prevent congestion of lungs

2 T as Early signs of hypernatremia

Elevated temperature Elevated thirst

Late signs of hypernatremia

Cognitive impairment

Medical management for hypernatremia

-Hypotonic solution (or isotonic D5W When water is replaced alone) -Diuretics -Desmopressin

Fatigue Sluggish bowel syndrome or decreased bowel mobility Paresthesia Ventricular asystole or flatline

Clinical signs of hypokalemia

Conventional treatment for hypokalemia

Daily diet intake Oral potassium

If hypokalemia is not treated with conventional treatment

Have an IV replacement therapy

Do not give IV push when giving potassium instead…

Use infusion pump

First assessment for hyperkalemia

ECG

Emergency drug for hyperkalemia

Calcium gluconate

ECG

Atrial depolarization Ventricular depolarization Atrial repolarization Ventricular repolarization

Calcium percentage

99% located in skeletal system long bones and teeth 1% skeletal calcium

Emergency drug for hypercalcemia

Calcitonin

Hypocalcemia is prone to

Elderly people —because of decreased calcium and prolonged bed rest

Early signs of hypocalcemia

Tetany (Chvostek & Trousseau)

Torsades de pointes means

Tachycardia or fast heart rhythm

Pharmacological treatment for hypocalcemia

Calcium chloride Calcium gluconate

What should not be given to hypocalcemia patients

0.9% sodium chloride

Develop renal stones inside the kidneys

Hypercalcemia

Common predisposing factors of hypercalcemia

Grave’s disease Malignant bone tumor

Emergency drugs for hypercalcemia

Calcium gluconate and potassium chloride

Long-term drug for hypercalcemia

Biphosphate

Short term drug for hypercalcemia

Calcitonin

ABG of patient if calcium is decreased

Acidotic

Last resort for hypercalcemia

Dialysis

Prevention for hypercalcemia

Hydration Safety Avoid calcium medications Avoid foods high in Calcium

Can occur with GI and renal losses as these organs are major regulators of potassium

Hypokalemia

Can occur with adrenal insufficiency due to aldosterone deficiency which causes lack of potassium excretion

Hyperkalemia

Can occur with increased thirst and ADH release, which increases water content of the bloodstream

Hyponatremia

Can result from increased insensible water losses and diabetes insipidus

Hypernatremia

A hormone in the hypothalamus that prevents increased ECF osmolarity

Vasopressin

Etiologies associated with hypocalcemia except

Metastatic bone lesions

Clinical signs of hyponatremia/ low sodium

Dry skin Nausea Orthostatic hypotension

Foods that are rich in magnesium

Cauliflower (green leafy veggies) Peanut butter Canned tuna Beans Lentils White potatoes Wheat bran Dry roasted almonds

High-risk for fluid volume deficit

Low suction

What to anticipate after giving 25% albumin with hypovolemic shock

Increased BP

FVE neck appears to be

Distended

Following hormones that Don’t help in the balance of fluid

PTH

Assessing electrolyte imbalance of low potassium may cause

Hyporeflexia

Not a manifestation of fluid volume congestion

Capillary refill six seconds

Normal Urea

6-24 mg/dl

Normal Creatinine in Male

0.6-1.04 mg/dl

Normal Creatinine in Female

0.1-1.25 mg/dl

Uric acid male

3.4-7 mg/dl

Uric acid Female

2.4-6 mg/dl

Urine Specific Gravity

1.010-1.025

Lithium Toxicity

0.6-1.2 mEq/L

An isotonic solution that expands extracellular Fluid volume; used in hypovolemic states, resuscitative efforts, Shock, DKA, Metabolic alkalosis, hypercalcemia, mild sodium deficit

0.9% NaCl

An isotonic solution used in the treatment of hypovolemia, burns, fluid loss as bile or diarrhea, and for acute blood loss replacement Should not Be used in kidney injury because it contains potassium and can cause hyperkalemia

Lactated Ringer’s Solution

An isotonic solution used in treatment of hypernatremia, fluid loss, and dehydration

D5W

A hypertonic solution used to increase ECF volume, decrease cellular swelling Highly hypertonic solution used only in critical situations to treat hyponatremia

3% NaCl

Four types of stones in hypercalcemia

Calcium oxalate Uric acid Struvite Cystine

A stone that is commonly present in all calcium foods

Calcium oxalate

Stone that is a breakdown of urine and causes arthritis

Uric acid

A stone that is less common and prone to UTI patients

Struvite

A stone that is hereditary and the primary assessment is Genogram

Cystine

It is a test to get urine specimen to assess ability of kidney to excrete calcium

Sulkowitch Test

Normal urine color

Pale to dark amber

Abnormal urine color

Darker amber

Route of administration for calcitonin

Intramuscular

Why wouldn’t you give calcitonin to subcutaneous route

SubQ doesn’t absorb calcium

When should you ambulate a patient with hypercalcemia

Ambulate as soon as possible

Food for hypercalcemia that is high in enzyme and fiber

Papaya

Most abundant cation inside the cell

Magnesium

Magnesium helps in synthesis of two products

Protein and carbohydrates

Common problem of magnesium deficit

Muscle wasting

Associated with hypokalemia and hypocalcemia Causes significant decline of albumin

Hypomagnesemia

Antidote for digoxin toxicity

Digibind

Determines the quantity of magnesium

NMR Spectrometer

Where to administer magnesium sulfate

Eclamptic -outer quadrant sa lobot Dili eclamptic -IV infusion

What combats magnesium toxicity

Calcium gluconate

Most common problem for hypermagnesemia

Renal failure

Common problem for hypomagnesemia

Alcoholism

Flushing Hypotension Weakness Drowsiness Hypoactive reflexes Depressed respiration

Clinical manifestation of hypermagnesemia

Risk for thrombocytopenia

Something of platelet

Normal creatinine clearance

Male: 97-137 Female: 88-128

Emergency drug for hypermagnesemia

Calcium gluconate

Cause fluid transhifting

Burns

Good source of chloride

Tomato juice

Two sites that determines arterial and circumflex assessment

Radial and femoral Last resort: Brachial

Radial gauge

Gauge 22

Femoral gauge

Gauge 20

Repercussions to acid-base

Bruising/Hematoma Increased bleeding

ABG contraindication

Peripheral vascular disease Cellulitis and low platelet Heparin medication

What test should you perform before taking ABG

Modified Allen test

A test to determine collateral arterial supply of four major arteries of the heart

Allen test

SIADH

Syndrome of inappropriate secretion of antidiuretic hormone

Primarily occurs due to an imbalance of water rather than sodium

Hyponatremia

The ECF volume has excess water but there is no EDema and the excess water dilutes the sodium

Dilutional hyponatremia

Although the patient with SIADH retains water abnormally there is no Peripheral Edema; instead, Fluid accumulates inside the cells. This phenomenon sometimes manifests as

Pitting Edema

Hyponatremia Sodium Replacement: For patients who can eat and drink sodium can be easily replaced through

Normal diet

Hyponatremia Sodium Replacement: What should you give for those who cannot consume sodium

LR or 0.9% NaCl

A common cause of hypernatremia

Fluid deprivation in patients who do not respond to thirst

Clinical manifestations of hypernatremia are due to

Increased plasma osmolality caused by an increase in plasma sodium concentration

A primary characteristic of hypernatremia

Thirst

What potassium losing diuretics can induce hypokalemia

Thiazides Loop Diuretics

A treatment for seizure that have side effects that increase the risk of hyponatremia

Anticonvulsant

Flat or inverted T-wave Prominent U wave Depressed ST segment Prolong PR interval Wide QRS

Hypokalemia

Hyperkalemia increases sensitivity to

Digitalis

Commonly associated with hypokalemia

Metabolic alkalosis

Foods high in potassium

Banana Melon, citrus fruits Legumes Whole grains Milk Lean Meat

A potassium imbalance that seldom occurs in patients with normal renal function

Hyperkalemia

What causes hyperkalemia

Iatrogenic causes

Who are at risk for hyperkalemia because of a lack of aldosterone

Hypoaldosteronism or Addison disease

Major causes of hyperkalemia

Decreased renal excretion of K Rapid administration of K Movement of K from the ICF to the ECF compartment

What do you call a false hyperkalemia Extraction of blood is improper

Pseudohyperkalemia

Tall/narrow T-wave Prolong PR interval Prolong/wide QRS Absent P-wave Depressed ST segment

Hyperkalemia

Emergency drug for hyperkalemia

Calcium gluconate

Foods with minimal potassium content

Butter/margarine Cranberry juice or sauce Ginger ale Gum drops/jellybeans Root beer Sugar and honey

Percent in calcium

99% skeletal system (bones&teeth) 1% skeletal calcium/blood calcium

Prolong QT interval Prolong ST segment Torsades de pointes

Hypocalcemia

Is associated with the prolongedLow intake of calcium and represents a total body calcium deficit even if calcium levels are usually normal

Osteoporosis

IV administration of calcium is dangerous in patients receiving

Digitalis medications

Foods rich in calcium

Milk products Green leafy vegetables Canned salmon/sardines Fresh oysters

Common causes of hypercalcemia

Malignancies Hyperparathyroidism

Refers to an acute rise in the serum calcium level Severe thirst and Polyuria are often present

Hypercalcemic crisis

Short QT interval Short ST segment

Hypercalcemia

HYPERCALCEMIA: 2 Cs to find during xray

Calcification of bones Calculi (stones)

Abundant intracellular cation

Magnesium

Major cause of symptomatic hypomagnesemia

Chronic alcoholism

Hypomagnesemia is associated with

Hypocalcemia and hypokalemia

Tetany can also occur in

Hypomagnesemia

1/3 & 2/3 of Mg goes into

1/3 goes into protein 2/3 are excreted

Common signs of hypomagnesemia

G.I. dysfunctioning Excessive diarrhea Fistula

Tall/inverted T-wave Depressed ST segment Prolonged PR Wide QRS

Hypomagnesemia

What may help identify the cause of magnesium depletion

Urine magnesium

Common cause of hypermagnesemia

Kidney injury or renal failure

If patient has severe hypermagnesemia

Discontinue oral medication

Primary anion of the ICF

Phosphorous

Less common electrolyte imbalance is

Hypophosphatemia and hyperphosphatemia

Malabsorption of phosphorus

RESIN

Signs and symptoms of phosphorus deficiency result from a deficiency of

ATP 2,3-diphosphoglycerate Rhabdomyolysis

Impairs cellular energy resources

ATP deficiency

Impairs oxygen delivery to tissues, resulting in generalized weakness and neurologic manifestations

Diphosphoglycerate deficiency

Foods high in phosphorus

Dairy foods Organ Meat Beans Nuts Fish Poultry Whole grains

TRUE OR FALSE Calcium and phosphorus are inversely related

True

Most common condition that can lead to hyperphosphatemia which diminishes urinary phosphate excretion

Kidney injury or renal failure

Phosphate binders that can be used to lower blood phosphate levels

Calcium carbonate or calcium citrate

Can occur with G.I. tube drainage, gastric suctioning, gastric surgery, and severe vomiting and diarrhea

Hypochloremia

Signs and symptoms of hypochloremia

Hyponatremia Hypokalemia Metabolic alkalosis

What are lost along with chloride

Sodium and potassium

What are given by IV to replace the chloride

0.9% or 0.45% NaCl

And acidifying IV agent that may be prescribed to treat metabolic alkalosis and hypochloremia

Ammonium chloride

Foods with high chloride

Tomato juice Bananas Dates Eggs Cheese Milk Salty broth Canned vegetables Processed meat

Signs and symptoms of hyperchloremia

Hypervolemia Hypernatremia Metabolic acidosis

And IV solution that may be given to restore balance in chloride

Hypotonic solution

An indicator of hydrogen ion concentration and measures the acidity or alkalinity of the blood

Plasma pH

Prevent major changes in the pH of body fluids by removing or releasing hydrogen They can act quickly to prevent excessive changes in hydrogen concentration

Buffer System

The body’s major extracellular buffer system

Bicarbonate-carbonic acid

It is a potential acid When dissolved in water, it becomes carbonic acid

CO2

What organ is under the control of medulla

Lungs

The substances that yield hydrogen

Acid

When hydrogen interacts with water

Protons

Centrifuge tube Naay gel Naay potassium

Yellow

Not a centrifuge type Walay gel Walay potassium

Red

The one that would accept hydrogen

Base

4 integral elements of acids and bases

HCl Carbonic acid PCO2 Bicarbonate

Associated with preventing doing everything right Maintains balance of PCO2 and HCO3

Buffer system

What are the three buffer systems

Bicarbonate buffer Phosphate buffer Bone buffer

Tenacious to nature Responsible for 80% in intracellular system; plasma and bicarbonate

Bicarbonate buffer

Buffer means

Mediator

What percent accounts to protein buffer

75%

Has a role in intracellular buffering One present in tubular Enables to excrete hydrogen

Phosphate buffer

Without phosphate buffer urine would be

Acidic

40% in acid and base environment For chronic loading cell use for loading system for interstitial compartment

Bone buffer

What is the master gland responsible for PCO2

Medulla oblongata

Two types of buffer system

Lungs Kidneys

Hypocapnia

Hyperventilation Alkalosis

Hypercapnia

Hypoventilation Acidosis

Common factor of respiratory acidosis

Respiratory failure

Result in hypoventilation thus naay hypercapnia

Acidotic

Management of care for respiratory acidosis

Identify predisposing factor Assess airway and ABG Chest physiotherapist ET tube attached to mechanical ventilation Supplemental oxygen Antibiotics

Nursing care plan for respiratory acidosis

Impaired gas exchange

Airway management position

Semi Fowler position Side lying position

Position best for collapsed lung

Side lying position

The most common cause of respiratory alkalosis

Anxiety

More crucial because it revamps in just minutes (10 minutes)

Respiratory alkalosis

What would you do if patient has memory loss

Notify the physician

Respiratory alkalosis nursing care plan

Ineffective breathing pattern

What would you do if ST is depressed

Notify the physician

A sedative medication for respiratory alkalosis

Benzodiazepine

A nonchalant problem Silent but disorganized problem Escalation of Ketones and excess of hydrogen

Metabolic acidosis

Identifier of metabolic acidosis or the common cause

Renal failure

Metabolic acidosis nursing care plan

Decreased cardiac output

Common cause of metabolic alkalosis

G.I. suctioning

Buzzing or deafening There is excess sodium bicarbonate

Metabolic alkalosis

Fecal test that determine GI bleeding

Occult test

Conventional treatment for metabolic alkalosis

K supplement

Isotonic therapy for metabolic alkalosis

KCl

Indication for congestive heart failure

Acetazolamide

Unit Exam 1 Flashcards

(282 cards)