Week 6: Ch. 2- Fluid/Electrolytes Flashcards
1
Q
The major component of the body is __________ in
these compartments:
- Intercellular fluid (ICF) compartment
- Extracellular fluid (ECF) compartment
A
water
2
Q
Balance of water in the compartments
essential for:
A
homeostasis
3
Q
About ____ of an adult’s body weight is water.
About____ of an infant’s body weight is
water.
A
About 60% of an adult’s body weight is water.
About 70% of an infant’s body weight is
water.
4
Q
Females―higher percentage of _______________,
lower water content than males
A
fatty tissue
5
Q
Older adults and obese persons have lower
proportion of:
A
water
6
Q
individuals with less fluid reserve are more likely to be adversely affected by: ?
A
any fluid or electrolyte imbalance.
7
Q
The amount of water entering the body
should equal:
A
the amount of water leaving the
body
8
Q
Fluid circulates throughout the body via:
A
filtration and osmosis.
9
Q
Water moves between compartments via:
- _____________ pressure
- _____________ pressure
A
-Hydrostatic pressure
-Osmotic pressure
10
Q
Thirst mechanism
- __________ in the hypothalamus
A
Osmoreceptors
11
Q
Antidiuretic hormone
-Promotes resorption of water into :
A
blood from kidney tubules
12
Q
Aldosterone
-Determines resorption of :
A
sodium ions and water
13
Q
Atrial natriuretic peptide
-Regulates fluid, sodium, and __________ levels
A
potassium
14
Q
Edema―excessive amount of fluid in the: __________________________
- Causes swelling or enlargement of tissue
- May be localized or throughout the body
- May impair tissue perfusion
- May trap drugs in ISF
A
interstitial compartment
15
Q
Causes of Edema
A
- Obstruction of lymphatic circulation
- Increased capillary permeability
- Swelling
- Pitting edema
- Increase in body weight
16
Q
Effects of Edema
A
- Functional impairment
- Pain
- Impaired arterial circulation
- Dental
17
Q
Causes of Dehydration
A
- Vomiting and diarrhea
- Excessive sweating with loss of sodium and water
- Diabetic ketoacidosis
- Loss of fluid, electrolytes, and glucose in the urine
- Insufficient water intake in older adults/ unconscious persons
- Use of concentrated formula in infants
18
Q
Effects of Dehydration
A
- Dry mucous membranes in the mouth
- Decreased skin turgor or elasticity
- Lower blood pressure, weak pulse, fatigue
- Decreased mental function, confusion, loss of
consciousness
18
Q
Manifestations of Dehydration
A
- Decreased skin turgor and dry mucous membranes
- Sunken eyes
- Sunken fontanelles in infant
- Lower blood pressure, rapid weak pulse
- Increased hematocrit
- Increased temperature
- Decreasing level of consciousness
- Urine―low volume and high specific gravity
18
Q
Attempts to Compensate for Fluid Loss
A
- Increasing thirst
- Increasing heart rate
- Constriction of cutaneous blood vessels
- Producing less urine
- Concentration of urine
19
Q
Primary cation in ECF:
A
sodium
19
Q
Sodium diffuses between _____________________
fluids.
A
vascular and interstitial
20
Q
Transport of sodium into and out of cells by:
A
sodium potassium pump
21
Q
Sodium is a actively secreted into _____ and other secretions
A
mucus
22
Sodium exists in forms of sodium chloride and sodium:
bicarbonate
23
Hyponatremia is low
blood sodium
24
Casues of hyponatremia
-Losses from excessive sweating, vomiting, diarrhea
-Use of some diuretic drugs combo with low salt diet
-Hormonal imbalances
* Insufficient aldosterone
* Adrenal insufficiency
* Excess ADH secretion
-Diuresis
-Excessive water intake
25
Effects of Hyponatremia
Low sodium levels cause fluid imbalance in compartments
* Fatigue, muscle cramps, abdominal discomfort or
cramps, nausea, vomiting
Decreased osmotic pressure in ECF compartment
Fluid shift into cells
* Hypovolemia and decreased blood pressure
Cerebral edema
* Confusion, headache, weakness, seizures
26
Hypernatremia
-Cause is imbalance in:
sodium and water
- Insufficient ADH (diabetes insipidus)
* Results in large volume of dilute urine
27
Hypernatremia
- Loss of the _______ mechanism
- Loss of the thirst mechanism
28
Hypernatremia
- Watery __________
- Prolonged periods of rapid ___________
- Ingestion of large amounts of ________________________________
- Watery diarrhea
- Prolonged periods of rapid respiration
- Ingestion of many sodium w/o enough water
29
Potassium is a major intracellular:
cation
30
Potassium is excreted primarily in:
urine
31
____________ promotes movement of potassium into cells
Insulin
32
Potassium level influenced by ___________ balance
acid-base
33
Excess potassium ions in interstitial fluid may lead to :
hyperkalemia.
34
Abnormal potassium levels cause changes in ______________________ and are life-threatening!
cardiac conduction
35
Definition of hypokalemia- Serum K+ < _____ mEq/L
3.5
36
Causes of Hypokalemia
-Excessive losses caused by diarrhea
-Diuresis associated with some diuretic drugs
-Excessive aldosterone or glucocorticoids
* Example: Cushing syndrome
-Decreased dietary intake
* May occur w/ alcoholism, eat. disorder, starvation
-Treatment of diabetic ketoacidosis with insulin
37
Effects of Hypokalemia
-Cardiac dysrhythmias caused by impaired repolarization leading to cardiac arrest
-Interference with neuromuscular function; Muscles less responsive to stimuli
-Paresthesias―“pins and needles”
-Decreased digestive tract motility
-Severe hypokalemia: Shallow respirations; Failure to concentrate urine―polyuria
38
Effects of Hypernatremia
- Weakness, agitation
- Dry, rough mucous membranes
- edema
- Increased thirst (if thirst mechanism is functional)
- Increased blood pressure
39
Definition of hyperkalemia- Serum K+
> ____ mEq/L
5
40
Causes of Hyperkalemia
-Renal failure
-Deficit of aldosterone
-“Potassium-sparing” diuretics
-Leakage of intracellular potassium into extracellular fluids
* In patients with extensive tissue damage
-Displacement of potassium from cells by prolonged or severe acidosis
41
Effects of Hyperkalemia
-Cardiac dysrhythmias; may progress to cardiac arrest
-Muscle weakness common
---Progresses to paralysis
---May cause respiratory arrest
---Impairs neuromuscular activity
-Fatigue, nausea, paresthesias
42
Calcium is an Important extracellular:
cation
43
Calcium is
Ingested in :
Stored in :
Excreted in :
Ingested in food
Stored in bone
Excreted in urine and feces
44
Calcium balance controlled by : 2 things
parathyroid hormone (PTH) and calcitonin
45
Vitamin D promotes __________ absorption from
intestine
* Ingested or synthesized in skin in the presence of
ultraviolet rays
* Activated in kidneys
calcium
46
Functions of Calcium
Structural strength for bones and teeth
Maintains stability of nerve membranes
Required for muscle contractions
Necessary for many metabolic processes &
enzyme reactions
Essential for blood clotting
47
Causes of Hypocalcemia
- Hypoparathyroidism
- Malabsorption syndrome
- Deficient serum albumin
- Increased serum pH level
- Renal failure
48
Effects of Hypocalcemia
Increase in the permeability and excitability of
nerve membranes
-Spontaneous stimulation of skeletal muscle
* Muscle twitching
* Carpopedal spasm
-Tetany
Weak heart contractions
-Delayed conduction
-Leads to dysrhythmias and decreased blood
pressure
49
Causes of Hypercalcemia
Uncontrolled release of calcium ions from bones
-Neoplasms―malignant bone tumors
Hyperparathyroidism
Demineralization caused by immobility- decrease stress on bone
Increased calcium intake
-Excessive vitamin D
-Excess dietary calcium
Milk-alkali syndrome
50
Effects of Hypercalcemia
Depressed neuromuscular activity
- Muscle weakness, loss of muscle tone
- Lethargy, stupor, personality changes
- Anorexia, nausea
Interference with ADH function
- Less absorption of water
- Decrease in renal function
increased strength in cardiac contractions
- Dysrhythmias may occur.
51
Hypomagnesemia results from ____________ or ______________ ; often associated with alcoholism
malabsorption or malnutrition
52
Hypomagnesemia is caused by
use of :
diabetic :
hyper:
hyper:
use of diuretics
diabetic ketoacidosis
hyperthyroidism
hyperaldosteronism
53
Hypermagnesemia
* Occurs with _________ failure
* Depresses ______________ function
* Decreased ____________
* Occurs with renal failure
* Depresses neuromuscular function
* Decreased reflexes
54
Phosphate
- Bone and tooth _____________
mineralization
55
Phosphate
Important in ______________ ―ATP
metabolism
56
Phosphate is an Integral part of the :
cell membrane
57
Phosphate - Reciprocal relationship with serum ____________
calcium
58
Hypophosphatemia
* Malabsorption syndromes, diarrhea, excessive antacids
59
Hyperphosphatemia
* From _______ failure
renal
60
Chloride is a major extracellular _______
anion
61
Chloride levels related to ___________ levels
sodium
62
Chloride and bicarbonate ions can shift in
response to :
acid-base imbalances.
63
Hypochloremia
* Usually associated with ___________
-Early stages of ____________ ―loss of hydrochloric acid
* Usually associated with alkalosis
Early stages of vomiting―loss of hydrochloric acid
64
Hyperchloremia
* Excessive _______ __________ intake pH.
sodium chloride
65
Respiratory system can alter carbonic acid
levels to change:
pH.
66
Kidneys can modify the excretion rate of acids and absorption of bicarbonate ions to:
regulate pH.
- Most significant control mechanism
- Slowest mechanism
67
Buffer Systems
Sodium bicarbonate–carbonic acid system
- Major ECF buffer
- Controlled by the respiratory system and kidneys
Other buffering systems:
- Phosphate
- Hemoglobin
- Protein
68
Decompensation occurs when:
- Causative problem becomes:
- Additional:
- Compensation mechanisms are:
- Causative problem becomes more severe
- Additional problems occur
- Compensation mechanisms are exceeded or fail
69
Decompensation
Requires: ?
Requires intervention to maintain
homeostasis
- LIFE-THREATENING!
70
Acidosis
Excess:
Decrease:
Excess hydrogen ions
Decrease in serum pH
71
Alkalosis
Deficit of:
Increase:
Deficit of hydrogen ions
Increase in serum pH
72
Respiratory Acidosis
Acute problems
- Pneumonia, airway obstruction, chest injuries
- Drugs that depress the respiratory control center
73
Chronic respiratory acidosis is common with chronic:
obstructive pulmonary disease
74
________________ respiratory acidosis may develop if impairment becomes severe or if compensation mechanisms fail
Decompensated
75
Metabolic Acidosis
Excessive loss of ...
Increased use of .....
Excessive loss of bicarbonate ions to buffer
hydrogen
-Diarrhea―loss of bicarbonate from intestines
Increased use of serum bicarbonate
76
Effects of Acidosis
Impaired nervous system function
-Headache, lethargy, weakness, confusion, coma and death
Compensation
-Deep rapid breathing
-Secretion of urine with a low pH
77
Respiratory alkalosis
-Hyperventilation
* Caused by ?
* ______________ tumor
Hyperventilation
* Caused by anxiety, high fever, overdose of aspirin
* Head injuries
* Brainstem tumor
78
Metabolic alkalosis - Increase in ...?
* Loss of _____________ from stomach
* Hypokalemia
* Excessive ingestion of:
Increase in serum bicarbonate ion
* Loss of hydrochloric acid from stomach
* Hypokalemia
* Excessive ingestion of antacids
79
Effects of Alkalosis
Irritability of the:
Increased irritability of the nervous system causes:
Restlessness
Muscle twitching
Tingling and numbness of the fingers
Tetany
Seizures
Coma
80
Treatment of Imbalances
-Treatment of underlying cause
-Immediate corrective measures to include fluid and electrolyte replacement or removal
-Caution is required when adjusting fluid levels to
ensure appropriate electrolyte balance.
-Addition of bicarbonate to the blood to reverse acidosis
-Modification of diet to maintain better electrolyte balance
81
Buffers are like hydrogen ion sponges-
they will
soak up or release hydrogen ions depending on pH
[resists changes in pH]
82
Potassium's function is to maintain :
heart and muscle contraction
83
With hyperkalemia, heart will be:
tight and contracted
[as well as GI tract & neuromuscular]
84
With hypokalemia, heart will be:
low and slow
[as well as muscular and GI]
85
3 functions of sodium
maintain blood __________
maintain blood __________
___ balance
maintain blood pressure
maintain blood volume
pH balance
86
Main signs of hypernatremia (high blood sodium) include
Flushed skin + edema
Polydipsia (thirst)
Late serious sign- swollen dry tongue, GI sx + increased muscle tone
87
Main signs of hyponatremia (low blood sodium)
Depressed & Deflated
Neuro= Seizures/coma
Heart- Tachycardia/ weak pulse
respiratory arrest
88
Symptoms of hyperchloremia (high chloride) are very similar to those of
high sodium
[same with hypo - low]
89
Magnesium function is to maintain law and order in the :
muscles
90
Calcium is important for: (3)
blood
bones
heart beat
91
Phosphate works inversely to
calcium
92
what are the 3 major triggers for renin release?
RAAS
decreased blood pressure
sympathetic nerves
low salt in DCT
93
Angiotensinogen is a precursor for
angiotensin 1 > 2
94
______________ is the final hormone that gets your blood pressure to go up
Aldosterone
95
Aldosterone comes from the _________ glands
adrenal
[sits on top of kidneys]
96
Triggers for aldosterone production
angiotensin 2
dehydrated > decreased urination
~low blood volume
~elevated potassium K+ (hyperkalemia)
