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Flashcards in Unit one and Two Deck (153):
1

Normal Sodium Levels

135-145 MEq/L

2

Critical values for sodium

less than 120 or greater than 160 mEq/L

3

Where is sodium normally found?

main cation of the ECF

4

How does sodium move in the body

active transport

5

What hormones influence sodium

aldosterone and antidiuretic hormone

6

what is the primary source of sodium

diet

7

What are the most dangerous problems with sodium imbalances

cerebral dehydration and seizure

8

Serum levels for Hyponaturemia

less than 135mEq/L

9

causes of Hyponatremia

vomiting
Nasogastric suctioning
diarrhea
excessive diaphoresis
wound drainage
medication
renal disease

10

Serum levels for hypernaturemia

greater than 146 mEq/L

11

Common cause of sodium gain

excessive sodium intake
inability to ingest water
hypertonic tube feeding w/o hypertonic IV fluids

12

Consequences of sodium retention

Hyperaldosteronism
Cushing's syndrome
Corticosteroids
acute renal failure

13

Common assessment of sodium imbalances

confusion, coma, seizures, orthostatic hypotension, muscle weakness,

14

Common assessment findings of hyponatremia

headache, fatigue, apathy, respiratory distress, anorexia, weight loss, nausea, vomiting, abdominal cramps

15

Common assessment findings of hypernatremia

restlessness, irritability, lethargy, dyspnea, tachycardia, dry mucous membranes, dehydration, flushed skin, low urine output

16

How much of an adult body mass is water?

50-60% weight in adults

17

What affects water content

gender (greater in males), body mass( more fat, less water), age

18

How much water is in the ICF

2/3

19

what is interstitial fluid

fluid in spaces between cells

20

what is plasma

liquid part of blood

21

Transcellular fluid

small amount of fluid contained within specialized cavities of the body- CFS, GI tract, pleural

22

what are electrolytes

substances that when dissolved in water separate into charged particle

23

What are the cations in the body

sodium, potassium, calcium, magnesium

24

what are the anions of the body

chloride, phosphate, bicarbonate

25

What are the major functions of electrolytes

regulate water distribution, muscle contraction, nerve impulse transmission, blood clotting, regulate enzyme reactions, regulate acid-base balance

26

How does ICF and ECF transportation occurs

filtration
diffusion
facilitated diffusion
osmosis
active transport

27

Diffusion

passive movement of particles across a permeable membrane from a higher concentration to a lower concentration

28

Example of diffusion

gas exchange in the alveoli

29

Facilitated Diffusion

movement of specific particles across a cell membrane by a protein carrier
passive

30

Examples of facilitated diffusion

glucose and amino acids entering or leaving the cell

31

Active Transport

movement of particles across a cell membrane from areas of low concentration to areas of higher concentration by combining with a carrier on the outside of the cell membrane and moving the inside of cells
requires energy

32

Example of active transport

sodium/potassium pump

33

Normal potassium values

3.5-5.0 mEq/L

34

critical value of potassium

2.5-6.5 mEq/L

35

Role of potassium

significant role in cardiac muscle, skeletal muscle and smooth muscle activity

36

How does potassium move

active transport with sodium-potassium pump

37

What hormone enhances kidney excretion of potassium

aldoserone

38

what is the primary source of potassium

diet

39

causes of Hypokalemia (less than 3.5)

vomiting
prolonged gasrtic suctioning
chronic diarrhea
eating disorders
hemorrhage
medication

40

causes of hyperkalemia (greater than 5.5)

acute renal failure
chronic kidney disease
glomerulonephritis
addison's disease
medication
excessive of potassium intake

41

What is calcium

the most abundant mineral in human body

42

where is calcium found

99% in bones and teeth
1% in blood stream in bound form and ionized form

43

What is ionized calcium

is the active form of calcium and must be maintained in a narrow range

44

what is calcium bound to

serum proteins, especially albumin

45

where does calcium get absorped

in the intestines and requires active form of vitamin D

46

What is calcium required for

transmission of nerve impulses, cardiac muscle contractility
clotting mechanism
teeth and bone formation

47

Hypocalcemia serum levels

total- < 8.5mg/dl
ionized- < 4.9 mg/dl

48

what causes hypocalcemia

any condition that decreases the production of parathyroid hormone
surgical removal or injury
pancretitis
multiple blood transfusion
laxative abuse

49

what happens when serum calcium levels is low?

calcium is borrowed from the bones

50

Why can pancreatitis cause hypocalcemia

lipolysis produces fatty acid that combine with calcium ions decreasing serum calcium levels

51

Why does multiple blood transfusions cause hypocalcemia

the citrate use to anticoaguleate blood binds with the calcium

52

Consequence of hypocalcemia

increased nerve excitability and sustained muscle contraction- tetany
- due to decreased calcium level, decreases threshold levels

53

Consequence of Hypocalcemia

Chvostek
Trousseau
Laryngeal strigor
Dysphagia
numbness and tingling around mouth

54

Chvostek sign

twitching of the lip and muscles on the side of the face stimulated from a tap over the facial nerve in front of the ear
(cranial nerve VII)

55

Trousseas sign

carpel spasms produced by inflating a blood pressure cuff on the arm

56

Treatment of hypocalcemia

oral/ IV replacement (calcium gluconate or calcium chloride)
Vitamin D
Aluminum hydroxide gel- hyperphosphatemia
Mg for Hypomagnesemia

57

Hypercalcemia serum levels

> 10.5 mg/dL- total
> 5.0 mg/dL - ionized

58

Critical calcium values

12 mg/dL

59

Causes of hypercalcemia

excess intake
loss from bones, increased mobilization from bones
steroid therapy
hyperthyroid
Metastatic Cancer

60

Treatment of hypercalcemia

volume expansion with NS
loop diuretics or corticosteroids
calcitonin and/or mithramycin (prevent bone reabsorption

61

Phosphorus serum levels

2.5-4.5 mg/dL

62

what does phosphorus assist with

muscle contraction, maintaining heart rhythm, kidney function, nerve conduction, acid-base balance, functioning of RBC
metabolism of protein, fat and carbs

63

Phosphorus is a major component of what

ATP, DNA, RNA

64

where is most of the phosphorus found

85% bound to teeth and bones
rest in cells

65

what regulates phosphorus

parathyroid hormone

66

What are phosphorus levels related to

glucose intake, insulin administration, hyperventalation

67

Hypophosphatemia serum levels

< 2.4mg/dL

68

causes of hypophosphatemia

malabsorption syndrome
recovery from malnutrition or refeeding syndrome
glucose or insulin therapy
TPN
alcohol withdraw
phosphate-binding antacids
respiratory alkalosis

69

serum levels of hyperphosphatemia

level greater than 4.4 mg/dL

70

causes of hyperphosphatemia

chemotherapy for leukemia or lymphoma
excessive milk injetion
excessive use of phosphate containing laxative or enemas
vitamin D excess
chronic kidney disease
acute renal failure
hypoparathyroidism
sickle cell anemia

71

Normal magnesium serum levels

1.6-2.6 mg/dL

72

what is the major role of magnesium

major role in 300 fundamental enzymatic reactions
powers the sodium-potassium pump
aids converting ATP to ADP
transmits electrical impulses
important in skeletal muscle relaxation
maintains heart rate
Necessary for release of PTH

73

Hypomagnesemia serum level

1.5 mEq/L

74

Hypomagnesemia causes

nutritional or metabolic abnormalities
fluid loss form GI tract
redistribution of body magnesium

75

What inhibits magnesium absorption

phytates
oxalates
fat

76

Assessment findings of hypomagnesemia

similar to hypocalcemia or hypokalemia
muscle twitching
tremors
hyperreactive reflexes
mood changes
nausea, vomiting, diarrhea
seizures, hallucinations

77

What is SIADH

syndrome of inappropriate antidiuretic hormone
results in water intoxication and hyponatremia

78

characteristics of SIADH

fluid retention
serum hypoosmolality
dilutional hyponatremia
hypochloremia
concentrated urine
common in elderly

79

causes of SIADH

Malignant tumor
central nervous system disorders
drug therapy
miscellaneous condition

80

Signs and Symptoms of SIADH

clinical signs and symptoms related to hypovolemia dn hyponatremia are present as mild to severe
low urine output
dark concentrated urine
thirst
dulled sensorium
dyspnea
hypertension

81

Osmosis

a process by which molecules of solvent tend to pass through a semipermeable membrane from a less concentrated solution into a more concentrated one, thus equalizing the concentrations on each side of the membrane

82

Osmolality

concentration of solute per kilogram of water

83

Osmolarity

concentration of solutes per liter of solution

84

Serum osmolality

measures the body's water balance

85

Normal values of osmolality

275-295 mOsm/Kg

86

Water deficit osmolality

value higher than 295 mOsm/kg- concentration of particles is too great or the water is too low

87

Water excess osmolality

values lower than 275 mOsm/kg- too little solute for the amount of water or too much water for the amount of solute

88

Conditions that increase serum osmolality-

dehydration/sepsis/fever/ sweating burns
Diabetes mellitus
Diabetes Insipidus
Uremia
Hypernatremia
Ethanol, methonal or ethylene glycol ingestion
mannitol therapy

89

Conditions that increase urine osmolaity

dehydration
SIADH
adrenal insufficiency
glycosuria
Hypernatremia
High protein diet

90

Conditions that decrease serum osmolality

excess hydration
hyponatremia
SIADH

91

Conditions that decrease urine osmolality

diabetes insipidus
Excess fluid intake
acute renal insufficiency
glomerulonephritus

92

Tonicity

refers to the osmolality of a solution

93

Isotonic solution

fluids with the same osmolality of the cell interior. Remains in the vascular compartment
expanding vascular volume
Normal Saline 0.9%

94

Hypertonic Solutions

fluids with solutes more concentrated than in the cell (increased osmolality)
causes a shift from cells into the vascular space, expanding vascular volume
- 3% Normal Saline

95

Hypotonic Solution

solutes are less concentrated than in the cell. Helps to move cellular dehydration through shifting out of blood vessels into the cells promotes elimination by kidneys
0.45% normal saline

96

Oncotic Pressure

Pressure caused by plasma colloids in a solution
protein is the major colloid in the vascular system
plasma proteins attract water pulls from tissue to vascular space

97

What is the capillary fluid movement determined by?

Capillary Hydrostatic Pressure
Plasma Oncotic pressure
Interstitial hydrostatic pressure
Interstitial oncotic pressure

98

Which pressures move water out of the capillaries

capillary hydrostatic pressure and interstitial oncotic pressure

99

Which pressures moves fluid into the capillaries

Plasma oncotic pressure and interstitial hydrostatic pressure

100

Distribution of water
First spacing

normal distribution in ICF and ECF

101

Distribution of water
Second Spacing

Abnormal accumulation of interstitial fluid

102

Distribution of Water
Third Spacing

accumulation of fluid in a part of the body where it cannot be use- fluid is trapped

103

what controls the body's water balance

Needs access to water
Normal thirst and ADH mechanism
Normal functioning kidneys

104

What is the primary protection of hyperosmolality

the thirst mechanism

105

How is the thirst mechanism stimulated

Stimulated by fluid loses or increases by thirst receptors in the hypothalamus
stimulates ADH and aldosterone release

106

Where are glucocorticoids and mineralcorticoids secreted?

by the adrenal cortex

107

What is the function of glucocorticoids and mineralcorticoids

regulate water and electrolytes

108

function of glucocorticoids (cortisol)

anti-inflammatory effect and increase serum glucose levels
response to physical stress

109

Function of Mineralcorticoidis (aldosterone)

enhance sodium retention and potassium excretion

110

What triggers aldosterone release?

drop in blood pressure or blood volume

111

action of aldosterone

causes kidneys to reabsorb more sodium into the blood increasing serum sodium levels- water follows
- lowers serum potassium levels

112

Atrial Natriurtic Peptide (ANP)
Characteristic

Cardiac Hormone found in the atria
released by high blood volume and high blood pressure

113

How does ANP lower blood pressure

causes vasodilation and suppressing the RAAS
decreases ADH
Increases GFR

114

Brain Natriuretic Peptide characteristics

cardiac hormone, within the ventricles released with increased blood volume and pressure when ventricles are stretched

115

How do BNP decrease blood volume and pressure

vasodilation of Arteries and veins
Decrease release of aldosterone
Diuresis- resulting in excretion of both sodium and water

116

What causes fluid deficit?

diarrhea
fistula drainage
hemorrhage
Polyuria
inadequate intake

117

What is the goal of treatment for fluid volume deficit

correct cause
replace water and electrolytes
IV fluids 0.9 NS or LR
Blood

118

How is SIADH diagnosed

low urine output
high specific gravity
sudden weight gain without edema
decreased serum sodium level

119

What is the treatment of SIADH

Treatment of underlying cause
Fluid restriction
gradual weight loss
progressive rise in serum sodium concentration and osmolality, symptom improvement
head of bed flat or no more than 10 degrees- enhance venous return

120

What results in an over production of ADH

Syndrome of inappropriate antidiuretic hormone

121

what results in an underproduction of ADH

diabetes insipidus

122

What is the osmolarity of patients with SIADH

lows osmolarity

123

What are the characteristics of SIADH

fluid retention, serum hypoosmolality, dilutional hyponatremia, hypochloremia, concentrated urine in the presence of normal or increased intravascular volume and normal renal function

124

what population is SIADH more common?

older adults

125

what are the Causes of SIADH

malignant tumors, drug therapy, CNS disorders, hypothyroidism, lung infection, COPD

126

what are the affects of ADH

increase the permeability of renal distal tubule and collecting duct- leads to reabsorption of water , ECF volume increases, GFR increases, sodium levels decline

127

how is the diagnosis of SIADH made

by the simultaneous measurements of urine and serum osmolality

128

what should a nurse look for in patients at risk for SIADH?

low urine output with high specific gravity
sudden weight gain without edema
decreased serum sodium levels
Monitor I&O, vital signs, heart and lung sounds
signs of hyponatremia

129

What is the treatment of SIADH

- avoid medications that stimulate ADH release
fluid restriction
position the head of bed flat or elevated 10 degrees

130

why would you position the bed of a patient with SIADH at 10 degrees or flat?

because it enhances venous return to the heart and increase left atrial filling pressure, thereby reducing the release of ADH

131

what is the fluid restriction of a patient with chronic SIADH

800-100 mL of water daily

132

What medication is often given to patients with chronic SIADH

Demeclocycline

133

what are the actions of demeclocycline

blocks the effects of ADH on the renal tubules resulting in more dilute urine

134

What causes diabetes insipidus(DI)?

caused by a deficiency of production or secretion of ADH or decreased response to ADH

135

what is the most common cause of DI?

central DI

136

What is the etiology of central DI

results from an interference with ADH synthesis, transport or release
-brain tumor, head injury

137

what is the etiology of nephrogenic DI

results from inadequate renal response to ADH despite presence of adequate ADH

138

primary DI

results from excessive water intake

139

what are the clinical manifestation of DI

polyuria and polydipsia

140

what are the phases of onset for central DI

acute phase- polyuria
interphase- urine volume normalize
third phase- central DI is permanent- 10-14 days after surgery

141

what is the nursing management of DI

early detection
maintenance of adequate hydration
patient teaching

142

what is the treatment of central DI

fluid and hormone therapy
- IV hypotonic saline or dextrose 5%

143

What is the treatment of nephrogentic DI

dietary measures and thiazide diuretics, and in some cases taking indomethacin (NSIAD that increases sensitivity to ADH)

144

When does hypovolemic shock occur?

after a loss of intravascular fluid volume

145

what is absolute hypovolemia

results when fluid is lost through hemorrhage, gastrointestinal loss, fistula drainage, diabetes insipidus, or diuresis

146

what is relative hypovolemia

fluid volume moves out of the vascular space into extravascular space (third spacing) burns.

147

what is a consequence of decreased intravascular volume

decreased venous return
decreased preload
decreased stroke volume
decreased CO
decreased tissue perfusion and impaired cellular metabolism

148

What is the clinical presentation of hypovolemic shock?

tachypnea -> bradypnea
decreased urine output
pallor, cool clammy skin
Decreased cerebral perfusion (anxiety, confusion, agitation)
Absent bowel sounds

149

Diagnostic lab findings of hypovolemic shock

hematocrit
hemoglobin
lactate
urine specific gravity
changes in electrolytes

150

How much fluid may a patient compensate for?

up to 15% of total blood volume

151

A loss of 15-30% of total blood loss results in what?

sympathetic nervous system mediated response

152

What happens in a sympathetic nervous system mediated response?

increased HR
Increased CO
Increased respiratory rate and depth
The stroke volume, central venous pressure is decreased

153

How is hypovolemia corrected?

by crystalloid fluid replacement