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whylove0001
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146455
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study
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2012-04-11 10:51:46
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25 NPN 105
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acid base balance
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  1. what are the two largest constituents of the body
    • -water
    • -electrolytes
  2. what are the four functions of water
    • -vechicle for transporting substance to and from cells
    • -aids in heat regulation
    • -assist in hydrogen (H+) balance in the body
    • -Is a medium for enzymatic action of digestion
  3. more than half of the body weight is _______.
    water
  4. what are the factors that affect the amount of water in the body
    • -age
    • -sex
    • -health
  5. dehydration causes
    hypovelemia
  6. excess of fluid volume in the body causes
    hypervolemia
  7. water is critical to maintaing
    homeostasis
  8. what is the sources of water and the volumes
    • Intake
    • -oral 1500mL
    • -food 800mL
    • -metabolism 200mL
    • Total 2500mL
  9. what is the avenues of loss of water and volume?
    • Output
    • -urine 1500mL
    • -perspiration 400mL
    • -feces 200mL
    • -expired air 400mL
    • Total 2500mL
  10. what are electrolytes?
    • -minerals or salts dissolved in body fluids
    • -in solution, they break up into ions
    • -ions have electrical charges
  11. postive charged ions are
    cations
  12. negative charged ions are
    anions
  13. each _____ must be balanced by an ______
    cation, anion
  14. what is the major source of electrolyes
    diet
  15. name the electrolytes in the body
    • -sodium
    • -potassium
    • -calcium
    • -magnesium
    • -phosphate
    • -chloride
    • -bicarbonate
  16. what is the function of sodium (Na+) in the body, what is the normal range
    • -water regulation and balance
    • -135-145 mEq/L
  17. what is the function of potassium (K+) in the body, what is the normal range
    • -nerve impulse transmission
    • -muscle contractions
    • -plasma
    • -acid-base balance
    • -3.5-5 mEq/dL
  18. what is the function of calcium (Ca+) in the body and what the normal range
    • -muscle activity
    • -clood coagulation
    • -8.4-10.6 mg/dL
  19. what is the function of magnesium (Mg+2) in the body, what is the normal range
    • -nerve impluse transmission
    • -muscle contraction
    • -1.3-2.5 mg/dL
  20. what is the function of phosphate (PO4 3-), what is the normal range
    • -ATP production
    • -2.5-4.5 mg/dL
  21. what is the function of chloride (cl-) in the body, what is the normal range
    • -hydrochloric and production
    • -acid-base balance
    • -96-106 mEq/dL
  22. what is the function of bicarbonate (HCO3-) in the body, what is the normal range
    • -acid-base balance
    • -22-26 mEq/L
  23. name the non-electrolytes of the body
    • -amino-acids (protein)
    • -glucose
    • -fatty acids
  24. how do non-electrolytes remain in the body
    they remain bound together when dissolved in body fluid
  25. what is the normal volume of circulating blood in the body
    4 to 6 L
  26. what is the blood composed of
    • -erythrocytes (red blood cells)
    • -leukocytes (white blood cells)
    • -platelets (thrombocytes)
    • -carried in plasma (water portion of blood)
  27. any condition that alters _______ also alters _______ of the blood and can affect _______
    • body fluid volume, plasma volume
    • affect blood pressure and circulation
  28. what contribute to to plasma colloid osmotic pressure and what does it do?
    the plasma protiens and colloids, helps keep fluid in the vascular compartment
  29. name the body fluids distribution and where are the located
    • -Intracellular (within the cell)
    • -Extracellular fluid (outside the cell)
    • 1.)Intravascular (fluid within the blood vessels)
    • 2.)Interstitial (fluid in the spaces surrounding the cell)
    • 3.)Transcellular (aqueous humor (in the eye), saliva, cerebrospinal fluid, plueural, peritoneal, synovial, and pericardial fluids, GI secretions, fluid in the urinary tract, lymphatic system fluid)
  30. name some properties of the extracellular fluid
    • -makes up approx. 1/3 of the total body water
    • -transports nutrients, oxygen, and waste products to and from the cells
    • -is regulated by renal, metabolic, and neurologic factors
    • -is high in sodium (Na+) content
  31. what is some properties of the intravascular fluid
    • -the fluid within the blood vessel
    • -consists of plasma and fluid within the blood cells
    • -contains large amounts of protein and electrolytes, which help maintain intravascular volume
  32. name some properties of the transcellular fluid
    • -aqueous humor (in the eye)
    • - saliva
    • - cerebrospinal fluid
    • - plueural, peritoneal, synovial, and pericardial fluids
    • - GI secretions
    • - fluid in the urinary tract
    • - lymphatic system fluid
  33. name some properties of interstitial fluid
    • -fluid in the spaces surrounding the cells
    • -High in sodium (Na+) content
  34. name some properties of the intracellular fluid
    • -about 2/3 of total body fluid
    • -fluid contained within the cell walls
    • - most cells are permable to water
    • -high in potassium (K+) content
  35. name the three types of extracellular fluid (ECF)
    • -intravascular
    • -interstitial
    • -transcellular
  36. what can happen when fluid shifts from the plasma in the vascular space out into the interstitial space
    blood volume drops and dehydration and hypovolemia may occur
  37. define dehydration
    removal of water from a tissue
  38. define hypovolemia
    decreased volume of plasma
  39. how is water taken in, and how is it produced
    • -water is taken in through ingestion of fluids and food
    • -it is produced by cell metabolism
  40. where is the thirst mechanism located and what do it control
    • located in the hypothalamus
    • - it helps control fluid balance in the body
    • -monitor fluid volume and concentration
  41. what is the main organ through which fluid excretion is achieved
    kidney
  42. how is fluid lost
    • -urine
    • -feces
    • -exhaled air
    • -perspiration
  43. what are the hormones that affect urine output?
    • -antidiuretic hormone (ADH)
    • -aldosterone
    • -atrial natriuretic peptide (ANP)
  44. Explain ADH
    • antidiuretic hormone
    • -secreted by the hypothalamus, stored and released by the posterior pituitary
    • -more ADH is released when blood becomes more concentrated or decreased circulating blood volume, during times of pain and stress
    • (renal tubles reabsorb more water, and urine output decrease)
  45. Explain Aldosterone
    • -is released by the adrenal cortex, when ECF volume is low or sodium concentration is elevated
    • (cause reabsorption of sodium from the kidney tubules)
    • -creates on osmotic gradient by which more water is retained)
    • -release of aldosterone is stimulated by the renin-angiotensin-aldosterone system
  46. explain ANP
    • Atrial natriuretic peptide
    • -released from site in the myocardium and the brain
    • -acts to protect the body from fluid overload
  47. blood volume and pressure also affect
    • -the glomerular filtration rate
    • -urine output
  48. define diffusion
    the process by which substances move back and forth acroos the membrane until evenly distributed throughout the available space
  49. glucose, oxygen, carbon dioxide, water, and other small ions and molecules move by ________.
    diffusion
  50. glucose, oxygen, carbon dioxide, water, and other small ions and molecules move by diffusion. what is this process called
    equalization
  51. osmosis is _____ transport
    active
  52. filtration is _______ transport
    passive
  53. a semipermeable membrane is a membrane that allows
    some substances to pass through, but prevents the passage of other substances
  54. osmosis takes place via a _________ membrane
    semipermeable
  55. isotonic
    of equal solute concentration
  56. hypertonic
    of greater concentration
  57. hypotonic
    of less concentration
  58. pumping action of the heart creates
    hydrostatic pressure within the capillaries
  59. define edema
    an excessive accumulation of interstitual fluid
  60. the fluid that accumulate in the sacral region is termed
    dependent edema
  61. edema that occurs when excess interstitial fluid is spread throughout the body
    generalized edema
  62. what are some causes are generalized edema
    • -kidney failure
    • -heart failure
    • -liver failure
    • -hormone disorder involving the overproduction of aldosterone and ADH
  63. local edema may be caused by
    • -infection
    • -injury
    • -the resulting inflammation
  64. A diuretic is
    a drug that causes the kidneys to increase the excretion of fluid
  65. hyponatremia
    • a deficit of sodium in the blood
    • (sodium Na+ is under 135 mEq/L)
    • -can occur from a sodium loss or an excess of water
    • -the most common electrolyte imbalance patients experience
  66. sodium loss may occur from
    • -excessive vomiting
    • -diarrhea
    • (in which fluid is replaced with plain water)
  67. ascites
    abnormal accumulation of fluid within the peritoneal cavity
  68. when living cells are surrounded by a solution that has the same concentration of particles, the water concentration of the extracellular fluids will be equal the term for this is
    isotonic
  69. if cells are surrounded by a solution that has a greater concentration of solute than the cells, the water in the cells will move to more concentrated solution and the cells will dehydrate and shrink. The _____ is ______ in relation to the cells.
    solution, hypertonic
  70. if the cells are surrounded by a solution that has less solute than the cell. the ________ is ________ in relation to the cells.
    solution, hypotonic
  71. solution are classified as________, according to their concentration of elecrolytes and other solutes.
    • -isotonic
    • -hypertonic
    • -hypotonic
  72. ________ within vessels helps to keep fluid from leaking out into the _________
    osmotic pressure, interstitial spaces
  73. active transport
    • -requires cellular energy
    • -can move molecules into cells regardless of their electrical charge or the concentration already in the cell
  74. what is th energy source for active transport called
    adenosine triphosphate (ATP)
  75. what are signs of overhydration
    • -weight gain
    • -crackles in the lungs
    • -slow bounding pulse
    • -elevated blood pressure
    • -edema
  76. What can happen if fluid volume excess occurs
    hypervolemia
  77. What is hypervolemia
    excessive blood volume
  78. any patient over what age is at risk for fluid and electrolyte imbalance?
    age 65
  79. what regulates fluid and electrolyte balance by regulating the volume and the compostion of extracellular fluid
    the healthy kidney
  80. any disease that affect circulation will ultimatley affect
    the distribution of body fluids
  81. what type of patients is at risk for deficient fluid volume
    • -patients unable to take in sufficient quantities of fluid because of impaired swallowing, extreme weakness, disoriented or coma, or the unavailabilty of water
    • -patients who lose excessive amounts of fluids through prolonged vomiting, diarrhea, hemorrhage, diaphoresis (sweating), or excessive wound drainage
  82. what are some treatments that can cause fluid defict
    • -diuretic therapy
    • -gastrointestinal suction
    • (without fluid replacement)
  83. how is dehydration treated
    • -fluid administration
    • (orally or intravenously)
  84. what are some sign and symptoms of dehydration
    • -thrist -dry mucous membranes
    • -weakness -thick saliva
    • -dizziness -dry,- scaly skin
    • -postural hypotension -poor tissue turgor
    • -decreased urine production
    • -flat neck veins -increased pulse rate
    • -concentrated urine -weak, thready pulse
    • -dry, cracked lips -elevated tempertue
  85. whats another sign for dehydration
    weight loss
  86. what is the average intake of sodium per day
    6 to 12 g/day
  87. define hypernatremia
    when the serum sodium concentration rises above 145 mEq/L
  88. when do hypernatremia occur and what are some causes
    • when there is an excess of sodium or a loss of body water
    • -excessive administration of sodium bicarbonate for the treatment of acidosis

    • more common causes
    • -water loss from fever, respiratory infection, or watery diarrhea
  89. acidosis
    excess of acid or depletion of alkaline substances in the blood and body tissues
  90. define hypokalemia
    when the potassium levels fall below 3.5 mEq/L
  91. define hyperkalemia
    when serum potassium levels rise above 5.0 mEq/L
  92. hypokalemia may occur
    • -due to poor diets
    • -illness causing a shift of K+ from ECF to ICF
    • -increased K+ loss (vomiting, diarrhea, GI suction, excessive sweating and diuretic therapy)
  93. what type of patients are at risk for hyperkalemia
    • -severe burns or crush injuries
    • -pts undergoing major surgerys
    • (mechanical disruption of cell membrane causes a shift of potassium from ICF to the ECF)
  94. hyperkalemia occur in
    • -renal faliure
    • -over-use of K+ sparing diuretics
    • -digitalis toxicity
    • -over use of K+ containing salt substitutes
    • -uncontrolled DM
    • -
  95. Hyperkalemia can cause life threatening _________
    • cardiac arrhythmia
    • (tall or peaked T waves may be seen on the ECG. P waves may be small)
  96. define hypocalcemia
    • when the calcium level drop below 8.4 mg/dL
    • (can occur from nutritional deficiency of calcium or vitamin D)
  97. define alkalosis
    excess of alkaline or decreased of acid substance in the blood and body fluids
  98. what are some causes of hypocalcemia
    • hypocalcemia occurs in disorders in which there is a shift of calcium into the bone
    • -metastatic cancer invading bone
    • -removal or injury of the parathyroid gland
    • -excessive infusion of bicarbonate solution
    • -alkalosis
    • -blood transfusion
    • -hypoparathyrodism
  99. define hypercalcemia
    • a serum calcium level above 10.6 mg/dL
    • -can occur during periods of lenghty immobilization when calcium is mobilized from the bone or when an excess of calcium or vitamin D is taken into the body
  100. most causes of hypercalcemia is related to
    hyperparathyroidism or malignancy in which there is metastasis with bone resorption
  101. define hypomagnesemia
    • a serum level below 1.3 mEq/L
    • -results from malabsorption, malnutrition, or increased loss from renal tubular dysfunction or thiazide diuretic use. extensive gastric suction or diarrhea can also cause hypomagnesemia
  102. define hypermagnesemia
    • a serum level above 2.1 mEq/L
    • -occurs rarely and usually in the presence of renal failure, although magnesium-containing laxatives or antacids
    • or severe dehydration can cause it
  103. define hypochloremia
    • a chloride level below 96 mEq/ L, is associated with hyponatremia
    • -can occur with severe vomiting and is seen as a compensatory decrease in acid-base disorders
  104. define hyperchloremia
    a chloride level above 106 mEq/L, occurs along with hypernatremia and a form of metabolic acidosis.
  105. define hypophosphatemia
    • occurs when the levels of phosphate falls below 3.0 mg/dL
    • -may results from use of aluminum-contaning antacids that bind phosphate, from vitamin D deficiency, or from hyperthryodism
  106. define hyperphosphatemia
    • a phosphate level above 4.5 mg/dL
    • -commonly occurs in renal failure
  107. pH
    a measure of the degree to which a solution is acidic or alkaline
  108. what two element form together to make carbonic acid
    • carbon dioxide and water
    • (H2CO3)
    • -immediately breaks down into hydrogen ions and bicarbonate ions
  109. what determin the pH reading
    the concentration of hydrogen (H+) ions determines the pH reading
  110. what is the normal range of pH
    7.3-7.45
  111. death may occur if pH
    • -falls below 6.8
    • -greater than 7.8
  112. what is the normal range of bicarbonate (HCO 3-)
    22-26 mEq/L
  113. what is the major function of HCO 3-
    • the major function of this alkaline electrolytes is the regulation of the acid base balance in the body
    • -HCO 3- acts a buffer to neturalize the excess acid in the body and maintain the bicarbonate-to-carbonic acid ratio at 20:1
  114. what is the ratio of bicarbonate ions to carbonic acid, for the serum levels of pH to remain in the normal range of 7.35-7.45
    20:1
  115. carbonic acid is
    retained or removed by the respiratory system
  116. bicarbonate is
    retained or removed by kidneys
  117. what are the three control mechanism for pH
    • -blood buffer system
    • consists of weak acids and weak bases
    • -lungs
    • cardon dioxide and water are expired from the lungs
    • -urinary system
    • enzymes promote the dissociation of carbonic acid to free hydrogen ions
  118. usually ___ days are needed for the kidneys to stabilize normal range
    3 days
  119. an increase in hydrogen ions results in
    acidosis (decrease in pH)
  120. a decrease in hydrogen ions results in
    alkalosis (increase in pH)
  121. an intial change in carbon dioxide is nearly always due to
    a respiratory disorder
  122. disorders that show an intial change in bicarbonate ions
    are metabolic
  123. when an imbalance occurs
    the lungs and kidneys try to compenstate by working together to bring the pH back to normal limits
  124. increased carbon dioxide levels
    respiratory acidosis is seen in
    • -airway obstruction
    • -pneumonia , asthma
    • -chest injuries
    • -opiate intake (depress the respiratory rate)
    • -chronic odstructive lung disease
  125. arterial blood gases performed on a sample of arterial blood measures
    • -pH
    • -arterial CO 2
    • -partial pressure (PaCO 2)
    • -HCO 3-
  126. CAL
    chronic airflow limitation
  127. what leads to metabolic acidosis
    • -an excessive loss of bicarbonate ions
    • -increased production or retention of hydrogen ions
    • -shock (poor circulation)
    • -Diebetic ketoacidosis
    • -renal failure
    • -diarrhea
  128. acidosis depresses the nervous system causing
    • -headaches
    • -lethargy
    • -weakness
    • -confusion
    • (if unrelieved, coma death can ensue)
  129. what is evidence that the compensatory mechanisms are at work in metabolic acidosis
    • -deep rapid breathing (kussmaul's respirations)
    • -secreation of urine with low pH
  130. hyperventilation
    a rapid respiratory rate
  131. hyperventilation is usually caused by
    • -anxiety
    • -high fever
    • -or an overdose of asprin
    • -head injuries
  132. what are some factors that may cause metabolic alkalosis
    • -vomiting resulting in loss of hydrochloric acid from the stomach
    • -GI suctioning
    • -excessive antacid intake
    • -hypokalemia
  133. some causes of respiratory acidosis is
    • -slow, shallow respirations
    • -respiratory congestion/obstruction
  134. metabolic acidosis can also occur when
    large amounts of acids are produced in the body
  135. hypokalemia (low serum K+) is another cause of metabolic alkalosis because
    the kidney retain more K+ while excreting H+
  136. irritability of the nervous system occur when, what are some signs that the patient might display
    -the pH balace shifts to alkalosis
  137. pt might display
    • -restlessness
    • -muscle twitching
    • -numbness of fingers

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