Week 3 Flashcards
(98 cards)
1
Q
What is homeostasis?
A
State of equilibrium in the internal environment of the body, naturally maintained by adaptive responses.
2
Q
What are the 2 major fluid compartments in the body?
A
Extracellular spaces (outside the cells) Intracellular spaces (inside the cells)
3
Q
where is most of the fluid in the body found?
A
Intracellular spaces. Approx 2 thirds.
4
Q
What are electrolytes?
A
Substances whose molecules dissociate or split into ions when placed in solution.
5
Q
What cation/anion is most abundant in the intracellular space?
A
K+, PO43-.
6
Q
What is osmotic pressure?
A
Amount of pressure necessary to stop the osmotic flow of water.
7
Q
What is osmolarity?
A
Measure of the total milliosmoles of solute per unit of total volume of solution.
8
Q
What is osmolality?
A
Measure of osmotic force of solute per unit of weight of solvent.
9
Q
What is hydrostatic pressure?
A
Force within fluid compartment.
10
Q
What is oncotic pressure?
A
Osmotic pressure exerted by colloids in solution.
11
Q
How is water regulated in the body?
A
6 types: Hypothalamic regulation pituitary regulation Adrenal cortical regulation Renal Regulation Cardiac Regulation Gastro-intestinal Regulation
12
Q
What is hypernatremia?
A
Excess sodium due to water loss or sodium gain.
13
Q
What can cause hypernatremia?
A
- Deficiency of ADH synthesis
- Decrease in kidney responsiveness to ADH
- GI tube feedings
- Hyperglycemia
14
Q
What is the treatment for hypernatremia?
A
Rapid fluid replacement using isotonic solutions.
15
Q
What are the symptoms of hypernatremia?
A
Fever and flushed skin Restlessness Increased fluid retention Edema and extreme confusion Decreased urine output and dry mouth
16
Q
What is hyponatremia?
A
Low serum sodium, occuring from loss of sodium, fluids leave the cells leading to cellular edema. Can be caused by IV hypotonic solutions.
17
Q
what are treatments for hyponatremia?
A
Fluid restriction, hypertonic IV solutions.
18
Q
What is euvolemic hypernatremia?
A
Water increase, but salt doesn’t.
19
Q
What is hypovolemic natremia?
A
dehydration due to excessive fluid loss.
20
Q
What is hypervolemic natremia?
A
Sodium is diluted due to increased sodium and water, but more water than Na.
21
Q
What are the symptoms of hyponatremia?
A
Seizures and stupor Ab cramps, altered mental state Lethargy Tendon reflexes decreased Loss of appetite Orthostatic hypertension Shallow resps Spasms of muscles.
22
Q
What is hyperkalemia?
A
High serum levels of K+. Cause by high K+ intake, impaired renal function, fluid shift to ECF, or combo with metabolic acidosis.
23
Q
What are the treatment options for hyperkalemia?
A
Nutritional therapy, increase K+ excretion, IV insulin, admin calcium gluconate IV.
24
Q
What are the symptoms of hyperkalemia?
A
Muscle weakness Urine production low Resp failure due to muscles Diminished cardiac contractibility Early signs of muscle cramps Rhythm changes
25
What is hypokalemia?
Low serum levels of K+, from loss of excretion, deficient K+ intake, diarrhea, laxative abuse, vomiting, ileostomy drainage.
26
What are some treatments for hypokalemia?
Admin KCl, increase K in diet.
27
What are the symptoms of hypokalemia?
```
Lethargic
Low shallow resps
Loss of urine
Lethal cardiac changes
Leg cramps
Limp muscles
Low BP and HR.
```
28
What is hypercalcemia?
High serum Ca. Caused by hyperparathyroidism and cancers.
29
What is the treatment for hypercalcemia?
Adim loop diuretic and hydration from IV saline.
30
What are the symptoms of hypocalcemia?
```
Confusion
Hyperactive reflexes
Arrhythmias
Muscle Cramps
Positive trousseaus
Sign of Chvoski's
```
31
What is hypocalcemia?
low serum Ca. Decrease in PTH from damage to parathyroid which increases blood pH.
32
What is the treatment of hypocalcemia?
change in diet, correct cause, Ca infussion, solutions and supplements.
33
What are the symptoms of hypercalcemia?
Weakness of muscle
EKG changes
Absent reflexes
Kidney stone formation
34
What is hypophosphatemia?
Low serum phosphate. Caused by. malnourishment, alcohol withdrawal, poor O2 delivery
35
What is hyperphosphatemia?
High serum phosphate, result of chemotherapy. Causes neuro-muscular irritability. Treat underlying cause, and change diet.
36
What is hypermagnesemia?
High serum mag. CAused by increased intake and renal insufficiency.
37
What are the symptoms of hypermagnesemia?
```
Lethargic
EKG changes
Tendon reflexes diminished
Hypotension
Arrhythmias
Resp arrests
GI issues
Impaired breathing
Cardiac arrest
```
38
What is hypomagnesemia?
Low serum mag. Caused by poor diet, GI problems, fasting, similar to hypocalcemia.
39
What are the symptoms of hypomagnesemia?
```
Trouseaus +
Weak resps
Irritable
Trouseaus +
Cardiac changes
Hypertension
Involuntary movements
Nausea
GI issues
```
40
What is hyperproteinaemia?
Caused by high protien levels, rare. Dehydration symptoms
41
What is hypoproteinemia?
Caused by decreased food intake, starvation, diseased liver, massive burns, loss of albumin.
42
What are the S and S of hypoproteinemia?
Edema, slow healing, anorexia, fatigue, anemia, low BP, muscle loss.
43
What are the interventions for hypoproteinemia?
High protein diet, increase carb intake, vitamins.
44
What are the body's 3 mechanisms that regulate the pH??
The buffer system, the respiratory system, and the renal system.
45
What does the buffer system do?
Act chemically to change strong acids into weaker acids or to bind acids to neutralize their effect.
46
What is the major buffer system in the ECF?
Carbonic acid bicarbonate, phosphate, protein, hemoglobin.
47
How does the respiratory system act as a buffer system?
Lungs help by excreting CO2 and water. Decreased resps more CO2 in blood. Resps controlled by medulla. The body will either try to retain acid (hypoventilation) or get rid of acid (hyperventilation).
48
How does the renal system eliminate acids?
a) Secretion of H+ in renal tubule.
b) Combination of H+ with ammonia
c) Excretion of weak acids
49
What are the S/S of respiratory acidosis?
- Major neuro changes: Confused, very drowsy, and reports a headache
- respiration rate less than 12
- low blood pressure
50
what are the nursing interventions for respiratory acidosis?
- Administer oxygen
- encourage coughing and deep breathing
- suction (pneumonia)
- may need respiratory treatment (asthma)
- hold respiratory depression drugs (know the category of drugs used opiods, sedatives etc)
* ***Watch potassium levels that are >5.1
- administer antibiotics for infection
- may need endotracheal intubation if CO2 rise above 50 mmhg or respiratory distress is present
51
What are the S/S of respiratory alkalosis?
- TACHYPNEA
- Neuro changes: Tired, lethargy, fast heart rate
- Tetany, dysrhythmias, muscle cramps, positive Chvostek’s sign due to hypocalcemia and hypokalemia
52
What are the nursing interventions for respiratory alkalosis?
- Teach patient breathing techniques to slow down breathing, holding breath…”rebreathing into a paper bag or re-breather mask
- Watch potassium levels (hypokalemia..remember hyperkalemia in respiratory acidosis & hypocalcemia) and for signs and symptoms of low calcium and potassium levels.
- Closely watch patients on mechanical ventilation to ensure breaths are not hyperventilating the patient
53
What is metabolic acidosis?
metabolic problem due to build-up of acid in the body via increased acid production, decreased acid elimination, loss of bicarb.
54
what are the S/S of metabolic acidosis?
- Kussmaul’s respiration
- Confused,
- weak, low blood pressure,
- cardiac changes,
- nausea and vomiting
55
What are the nursing interventions for metabolic acidosis?
- Watch respiratory system and ABGs closely
- Assess other electrolyte levels (esp. potassium because during active acidosis it will be high…however when it resolves there is an extracellular to intracellular shift of K+ back into the cell which will causes hypokalemia)
- Watch neuro status, safety, and place in seizure precaution
- Dialysis may be needed if they patient is experiencing acidosis (high anion gap issue ex: renal failure)
- Diabetic ketoacidosis: administer prescribed insulin to help glucose go back into cell which will help the body start regulating how it metabolizes glucose…hence not more ketones (acids)
56
what are the s/s metabolic alkalosis?
- Bradypnea (hypoventilation) <12 bpm
- Many symptoms due to low potassium (dysrhythmia), tetany, tremors, muscle weakness/cramping, tired, irritable, vomiting, Depression ST, flat or inverted T wave and prominent u-wave)
57
What are the nursing interventions for metabolic alkalosis?
- Watch ABGs
- Monitor K+, Cl
- Treat symptoms (like vomiting)
- Administer ordered meds
58
What is the normal range for pH?
7.35-7.45
59
what is the normal range for PCO2?
35-45 mmHg
60
what is the normal range for HCO3?
21-28 mmol/L
61
How do hypotonic solutions work?
Dilute the ECF, causing a shift in the ICF and ECF, expanding both compartments.
62
What are some examples of hypotonic solutions?
0.45% Saline
| 5% D5W- physiologically hypotonic
63
What are isotonic solutions?
Expands only ECF. Used for fluid replacement. Ideal for pts with an ECF deficit.
64
What are some examples of isotonic solutions?
0.9% Saline
5% Dextrose in Saline
Ringers Solution
Lactated Ringers
65
What are some examples of hypertonic solutions?
- D10W
- 3.0% Saline
- 5% in 0.45% Dextrose in Saline
- 5% in 0.9% Dextrose in Saline
66
What are plasma expanders and what are they used for?
Stay in vascular space, increase osmotic pressure.
67
what are some examples of plasma expanders?
Colloids like plasma, albumin.
68
what is diabetic ketoacidosis?
An acute metabolite complication of DM occuring when fats are metabolized in the absence of insulin.
69
What are the characteristics of DKA?
Hyperglycemia, ketosis, metabolic acidosis, dehydration.
70
What are precipitating factors of DKA?
Illness, infection, inadequate insulin dosage, insulin omission, undiagnosed 1 DM, poor self-management.
71
What happens in DKA?
When the circulating supply of insulin is insufficient, glucose cannot be used for energy, so the body metabolizes fats instead.
72
What are ketones?
Acidic by-products of fat metabolism that cause problems when they become excessive in the blood.
73
What do ketones alter?
The blood's pH. Causes metabolic acidosis.
74
What is ketonuria?
The process that begins when ketones enter the urine.
75
What happens when ketonuria begins?
The electrolytes become depleted as cations are eliminated along with anionic ketones to maintain balance in the body.
76
How does insulin deficiency affect protein?
It impairs protein synthesis and causes excessive protein degeneration.
77
What does insulin deficiency stimulate?
Stimulates the production of glucose from amino acids in the liver and leads to hyperglycemia.
78
What happens if DKA is not treated?
It causes a severe depletion of sodium, potassium, chloride, magnesium, and phosphate.
79
What does acidosis cause hydrogen ions to do?
It causes H+ ions to move from extracellular fluid to intracellular fluid. This promotes K+ movement out of the cell.
80
What happens to the extracellular potassium as a result of the shift from DKA?
Most of it is lost in the urine because of osmotic diuresis. Serum K+ can appear normal or high, but this finding is misleading.
81
What are the CM of DKA?
Polyuria, polydipsia, dehydration, lethargy, weakness, nausea, vomiting, Kussmaul's respiration.
82
What are the diagnostic tests for DKA?
History and physical
Blood studies: blood glucose, CBC, ketones, pH, electrolytes, blood urea nitrogen, arterial blood gases.
Urinalysis: specific gravity, pH, glucose, ketones.
83
What is the collaborative therapy for DKA?
Admin: IV fluids, electrolyte replacement, short-acting insulin.
Assess and monitor: blood and urine for ketones, glucose levels, vitals, mental status, ECG, intake and output.
84
What is hyperosmolar hyperglycemic state (HHS)?
A life-threatening syndrome that can occur with DM, when a pt is able to produce enough insulin to prevent DKA, but not enough to prevent severe hyperglycemia, osmotic diuresis, and extracellular fluid depletion.
85
Describe the pathophys map of HHS.
Extreme hyperglycemia- severe osmotic diuresis- fluid volume deficit-electrolyte imbalances- severe dehydration-hyperosmolality-hypovolemia-decreased renal perfusion, hypotension, hemoconcentration- seizures, shock, coma, death.
86
What are some nursing interventions for HHS?
- IV admin of NS or 1/2 NS.
- IV bolus of insulin
- Electrolyte therapy if needed.
87
What is hypoglycemia?
Low blood sugar, occurs when there is too much insulin to available glucose in the blood. Less than 4 mmol/L.
88
What are some S/S of hypoglycemia?
-Irritability, visual disturbances, difficulty speaking, stupor, confusion, coma.
89
How is hypoglycemia treated?
With glucose replacement. Candy, dextrose tabs, juice/pop. Avoid foods containing fat.
90
What is the normal range for sodium?
135-145 mEq/L.
91
What is the normal range for potassium?
3.5- 5 mEq/L.
92
What is the normal range for calcium?
8.5-10.5 mg/dL
93
What is the normal range for phosphorus?
2.5-4.5 mg/dL
94
What is the normal range for magnesium?
1.5-2.4 mg/dL
95
what does neuroglycopenic symptoms in diabetes mean?
Brain glucose deprivation, perception of physiological change is caused by sympathoadrenal epinephrine secretion.
96
What is the 15/15 rule?
15 grams of fast acting carbs, check glucose in 15 min
97
What are the 5 actions of insulin?
a) Drive glucose into cells
b) Drive potassium into cells
c) Create an anabolic environment
d) Inhibit breakdown of fat
e) Block breakdown of proteins
98
What are the 3 mandatory therapies for DKA and HHS?
a) IV fluid resuscitation
b) IV insulin
c) IV potassium
