Level III / test I
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2/3 of the bodies fluids are located where?
Contains solutes and is a medium for cell processes
1/3 of the bodies fluids are located where?
The ECF is divided into what 3 spaces?
- Intravascular (blood vessels)
- Interstitial (fluid surrounding cells)
- Transcellular (pericardial, cerebrospinal,...)
Hypovolemia is the loss of what?
Water and electrolytes from the ECF in similar proportions
Colloids are used as volume ________.
EX: Albumin, lipids, Dextran 40, hetastarch
Colloids shift fluids from ______ to ______ .
Interstitial to Intravascular
What type of fluids are crystalloids?
Salts that dissolve in fluid
Name the 3 types of Crystalloids:
What type of fluid is NS ?
Isotonic or same as body fluids
What type of fluid is 1/2 NS ?
Hypotonic - pulls fluid into the cell
What type of fluid is 3% NaCl ?
N/S, LR, and D5W are what type of fluids?
Isotonic - they will remain in the vascular, but may cause excess fluid volume if not monitored
Hypotonic solutions include, are used for and contraindicated in what patients?
- 1/2 NS
- 0.45% NaCl
- 0.33% NaCl
- D 2.5 in water
moves water from the intravascular to the cells
Contraindicated with ICP or cardiac compromise
S/S of FVD:
- Decreased skin turgor
- Acute weight loss
- Concentrated urine
- Orthostatic Hypotension
- Weak, rapid pulse
- Flattened neck veins
- Increased temp., thirst
- Cool, Clammy, pale skin
- Weakness and cramps
Lab assessments for FVD would include:
Bun out of proportion with Creatinine
Electrolytes Na /K
Increased urine specific gravity
Normal Sodium level:
Sodium is regulated by the ______ system.
- Renin Angiotensin Aldosterone System
- Sodium is found in extracellular fluid
Normal Potassium level:
3.5 - 5.3 MEQ/L
Potassium is essential to maintain what functions?
Cellular, neural, & cardiac muscle fxn and contractility
Found in intracellular fluid
K is regulated by ____ and _____.
Aldosterone and Insulin
Common clinical manifestations of low K level :
- Cardiac dysrhythmias
- Muscle weakness
- Leg cramps
- Decreased bowel motility
Aldosterone triggers the retention of ____ and excretion of _______.
Retains water & sodium
An ECG would show what if a patient was hypokalemic?
Flat T wave and Prominent U wave
Hyperkalemia would show what on an ECG?
Peaked T in moderate case
- Sever = No P wave & widening QRS
- decreased HR
What is Keyexolate and how is it given?
Cation exchange resin - binds with potassium for excretion
Given PO or retention enema
Often used in Burn patients
Normal Calcium level
8.9 - 10.1 MG/DL
Signs of Hypocalcemia ?
- Trousseu's - carpal spasm
- Chvostek's - twitching of facial nerve
- Mental status changes
- Hyperactive DTR's
Low albumin may indicate low ______ and ______.
Low calcium & magnesium
Calcium in regulated by:
Parathyroid hormone, Vitamin D, & Calcitonin
Normal Magnesium level:
1.8 - 2.3 MG/DL
Magnesium is essential for :
- Neuromuscular - reflexes
- Carb & protein metabolism
- Cardiac activity
Found in bone & soft tissues
30% of Magnesium is protein bound making its levels associated with what other electrolytes?
Calcium & potassium
Hypocalcemia & Hypokalemia
Normal Phosphate level:
2.5 - 4.5 Mg/DL
What is phosphate essential for?
- ATP formation
- Muscle and RBC fxn
- Acid-Base balance
Phosphate is regulated by the _______ and ______.
- Parathyroid Hormone
Normal Chloride Level:
97 -107 MEQ/L
Chloride's fxn in the body is what?
works with Sodium to regulate serum osmolality and blood volume
- Hydrochloric Acid
- Regulated by the kidneys & Aldosterone
Normal ABG levels:
pH 7.35 -7.45
Respiratory Alkalosis is always due to _______.
- blowing off too much co2
Treatment for Respiratory ACIDosis:
- improve ventilation
- oxygen therapy
- narcotic antagonist (ex: Narcan)
Define depolarization :
Electrical activation of a cell due to ion exchange
Define Repolarization :
Return to a resting state, which follows depolarization
Define Refractory Period:
Absolute or Effective refractory is when the cells are not capable of depolarization (unresponsive)
Relative refractory is when a stimulus is strong enough to cause depolarization (this is a vulnerable period)
Cardiac Output is defined as :
Amount of blood pumped from Left ventricle in L/minute
CO = SV x HR
amount of blood ejected with each heartbeat
What is automaticity?
ability to initiate an electrical impulse - this is protective measure specific to the heart, in case one part fails, the others may initiate the impulse to keep the heart beating.
Advanced cardiac assessment includes what?
Listening for = S1, S2, S3, S4
Murmurs or Friction Rubs
S1 & S2 indicate what?
"lub" closing of AV valves (tri & bicuspid) at beginning of ventricle systole
"dub" closing of semi-lunar valves (aortic & pulmonic) at the of systole and beginning of ventricular diastole
S1 is best heard where?
S2 is best heard where?
- Aortic (2nd intercostal space right side)
- Pulmonic (2nd intercostal space left side)
S3 indicates what?
- Occurs early in diastole - volume overload of one or both ventricles
- "lub, dub, dub"
S4 indicates what?
- Occurs late in diastole, before S1 - this is blood meeting resistance due to left ventricle hypertrophy
Friction rubs are caused by what?
Pericarditis - can be heard best with patient sitting upright and leaning forward - should be heard both in systole and diastole
What are CK & CK-MB labs used to monitor?
Specific cardiac enzymes only found in cardiac cells - if these are not present, may help to rule out cardiac involvement.
CK= Creatine Kinase
What is Myoglobin?
Heme protein found in cardiac & skeletal muscle - if negative will help rule out MI - if present further testing will be needed
What is Troponin I & T ?
Critical markers for an MI because they are specific cardiac muscle - can detect within a few hours - BUT also last up to 3 weeks
If < 0.2 no myocardial involvement
What is BNP?
- B-type natriuretic peptide
- Neurohormone primarily secreted by the ventricles with increased preload - used to aide in diagnosis of heart failure if >100
C-reactive protein levels indicate what?
- > 3.0 mg/dL= great risk for CVD
- Patients with ACS (acute coronary syndrome) may be at great risk for long term cardiac issues if these levels are elevated
Hemocysteine levels are used to assess what?
- Patient risk for CVD - they are amino acids when in high levels damage the lining of arteries and promotes clot formation
- Optimal is <12 / high risk >15
What is the purpose of Cardiac Catheterization?
Measure heart chamber pressures and assess coronary arteries
Most significant complication of cardiac catheterization?
- contrast agent-induced nephropathy
- seen by increased creatinine by more than 25%
Affects of the sympathetic nervous system on the heart:
- Increased heart rate
- "Fight or Flight"
An ECG that has no defined P waves, unmeasureable PR waves and a QRS WNL =
Atrial Flutter is characterized as ...
- Unable to determine PR interval, QRS WNL
- Saw Tooth appearance
Loss of SA node dominance in conduction
Pharmacologic treatment of A-Fib would include:
- Warafrin / Aspirin
- Calcium Channel Blockers (diltazem or verapamil)
Name a calcium channel blocker and its therapeutic action:
- Diltazem (Cardizem)
- Verapamil (Calan)
- slows automaticity and conduction by blocking the movement of calcium across the cell membrane
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