Nur 105

Card Set Information

Nur 105
2011-07-30 15:12:59
Final Prep

Fluids & Electrolytes
Show Answers:

  1. Fluids OUTSIDE the cells is called ____________. The primary electrolyte is __________
    • Extracellular
    • Sodium (Na)
  2. The space between The cells (aka) thirdspace
  3. Fluid withing the blood vessels (veins, arteries and/or capillaries)
  4. Fluid within the cell itself is called _______and the primary electrolyte is _________
    • intercellular
    • Potassium (K+)
  5. _______% of our body weight is made up of water.
    _____% intercellular
    _____% extracellular
    • 60%
    • 40%
    • 20%
  6. This transport consists of movement against concentraction. Ex: Na/K+ pump which requires ATP
    Active transport
  7. Movement of FLUID across a semi-permeable membrane from an area of low concentration to an area of higher concentration
  8. Movement of fluid thru a selectively permeable membrane from an area of higher hydrostatic pressure to an area of lower hydrostatic pressure
  9. Solute Movement from higher to lower concentraction..until concentration is equal in both.____________________
    ________requires no energy
    ________involves carrier that moves substances across a membrance faster
    • diffusion
    • passive
    • facilitated
  10. Use of proteins (venous pulls F & E and waste) back into the capillary through the capillary walls
    • colloid
    • *need for protein (albumin)
  11. Normal Sodium level: ______ to ______
    135 to 145
  12. HYPERnatremia levels _____________
    • levels >135
    • *>na intake or >water loss = serum osmolality to increase. Through osmosis...fluid moves from cells to ECF to balance osmolality..Then the CELLS become dehydrated causing Neurologic impairment & ECF in vessels increases cause hypervolemia*
    • *S/S = restlessness, agitation, intense thirst, peripheral edema
    • *Treatment = diuretics, 5% dextrose in water
  13. List some causes of HYPERnatremia
    due to water deficit:
    due to excessive Na+:
    Water deficit: diabetes incipidus (excessive urination) fever, heat stroke, burns, V/D

    Excessive Na+: overintake of Na, near drowning in salt water, cushings syndromf
  14. HYPOnatremia levels: __________
    • Levels <135
    • *Sodium loss or water gain....fluids by OSMOSIS FROM ECF move to a MORE concentrated ICF causing the cells to swell (cerebral edema) & blood vessel fluid to decrease (hypovolemia)
    • S/S: Related to cellular swelling first..CNS...irritability, apprehension, confusion, seizures
    • *Treatment=small amounts of hypertonic saline solution (3%NaCl) to pull fluid back into ECF from cells
  15. Normal Potassium levels = __________
    3.5 - 5.0
  16. HYPERkalemia levels ____________
    • levels >5.0
    • *potassium levels increase or potassium excretion decreases (renal failure)...K+ shifts out of ICF into ECF. Pt develops neuromuscular & cardiac s/s.
    • *s/s: irritability, anxiety, ab & lower extremity cramping, tall tented ECG waves
    • *Treatment: >k+ elimination via diuretics, dialysis
  17. List some causes of HYPOnatremia
    due to sodium loss:
    due to water gain:
    sodium loss: diuresis, diuretic use, V/D, gastric suctioning, burns, third-space fluid shifting, metabolic acidosis, excessive diaphoresis

    water gain: heart or liver failure, nephrotic syndrom, excessive use of hypotonic fluids....renal failure
  18. HYPOkalemia levels: __________
    • Levels <3.5
    • *potassium intake decreases OR potassium loss increases.....potassium shifts from ECF to ICF...ICF potassium levels rise and cells can't function properly, muscular, GI & cardiac dysfuntions occur
    • *S/S: fatique, muscle weakness, leg cramps
    • *Treatment: potassium chloride supplements
    • NOTE: KCI should be given at a rate not to exceed 10 - 20mEq/hr to prevent cardiac arrest.
  19. List some causes of hypokalemia:
    • inadequate potassium intake
    • potassium deficient IV fluids
    • Excessive potassium output d/t
    • *suction, lavage, V/D, severe diaphoresis
  20. Normal calcium levels:___________
    9 - 11
  21. HYPERcalcemia levels:______________
    • Levels <11
    • Explain: Calcium REABSORPTION from bone increases, Ca enters ECF at increased rates that exceed kidneys ability to excrete therefore, calcium enters the cells and decreases cell membrane excitability affecting skeletal & cardiac muscles and the nervous system
    • *S/S: fatigue, confusion, decreased LOC
    • *Treatment: promote excretion through lasix, drink lots of fluid to promote renal excretion to <kidney stone formation
  22. List some causes of hypercalcemia:
    • Cancer
    • multiple fractures
    • prolonged immobilization
    • hypophosphatemia
  23. HYPOcalcemia levels: _________
    • levels <9
    • *calcium or vit. D intake or absorption decreases.....parathyroid releases PTH to draw calcium from bones & promote absorption from renal & intestines...BUT..lack of calcium outstrips comp mech & Ca is no longer available to maintain cell structure & develops neuromuscular & cardiac symptoms & decreased LOC
    • *S/S: easy fatigability, depression, tingling in extremities & around mouth..TETANY; Trousseau's sign; Chvosteks sign
    • *Treatment: IV calcium
  24. Any pt who has had a thyroid or neck surgery must be observed closely in the immediate post op period for manifestations of ___________ b/c of the proximity of the surgery to parathyroid glands
  25. Normal magnesium levels: __________
    1.5 - 2.5
  26. HYPERmagnesemia levels: ________
    • levels > 2.5
    • *to much magnesium d/t a decrease in excretion or and increase in intake...supresses acetylcholine release and block neuromuscular transmission...reducing cell excitability...which causes neuromuscular & CNS to become depressed causing a decrease in LOC and respiratory distress. Arrhythmias & cardiac comps may occur
    • *S/S: lethargy, drowsiness, n/v, loss of DTR, resp & cardiac arrest
    • *Treatment: should focus on PREVENTION...ppl w/kidney disease should not take magnesium containing drugs. Calcium gluconate opposes affects of magnesium on cardiac muscle & promote excretion
  27. HYPOmagnesemia levels: ________
    • levels: <1.5
    • *magnesium intake/absorption decreases or magnesium loss increases....Mg moves out of cells into ECF to compensate...cells become Mg starved causing skeletal muscle weakness & nerves & muscles become hyperirritable
    • *S/S: confusion, hyperactive DTR, tremors
    • *treatment: oral supps/ foods high in Mg.
    • ****note most often caused by fasting/starvation/chronic alcoholism
  28. Normal phosphate levels ____________
    2.8 - 4.5
  29. HYPERphosphatemia levels _________
    • levels >4.5
    • Explain: intake of PO4 is excessive OR renal insult or failure....kidneys can't filter excess phosphorus adequatly....shift from ICF to ECF...serum levels rise...binding with calcium, forming an insoluable compound which is deposited in lungs, heart, kidneys, eyes and skin
    • *S/S: neuromuscular irritabilty & tetany (r/t hypocalcemia)
    • *Treatment:restriction of foods high in phosphorus & calcium (dairy products)
  30. HYPOphosphatemia levels _________
    • levels: <2.8
    • *PO4 absorption decreased, renal eliminaton increases, ECF to ICF movement.....ECF PO4 levels decrease, cellular energy stores decrease d/t ATP develops musculockeletal, neurologic, cardiac & hematologic effects
    • *S/S: mild to moderate often asymptomatic Confusion mental changes
    • *treatment oral supps w/foods high in phosphate (dairy products)
  31. Normal chloride levels: ___________-
    95 - 105
  32. HYPERchloremia levels __________
    • levels >105
    • *chloride intake, absorption increases or excretion much chloride in ECF...bicarb levels fall & sodium levels develops s/s of metabolic acidosis
    • *S/S: arrhythmais, decreased LOC, dyspnea, kussmauls resp
    • *treatment: treat underlying cause..maintain adequate hydration
  33. HYPOchloremia levels: ___________
    • levels <95
    • *chloride intake or absorption decreases...kidneys retain sodium & bicarb...bicarb accumulates in ECF raising PH...metabolic alkalosis can occur
    • *S/S arrhythmais, seizures, coma, resp arrest
    • *Treatment: treat underlying cause
  34. Name some signs you would expect to see with HYPERVOLEMIA:
    • Fluid volume excess:
    • pitting edema, bounding pulse, shift of interitial fluid to plasma, hypertension, SOB, crackles, confusion, irritabiltiy, sodium & Potassium deficit
  35. Name some signs seen with HYPOVOLEMIA:
    fluid volume deficit: poor skin turgor, rapid, weak thready pulse, hypotension, shift of plasma to interstitial fluid, can cause sodium deficit
  36. Excess of isotonic fluid (water & sodium) in the extracellular compartment _________________

    Treatment: restrict pt sodium & fluid intake...admin diuretics
  37. Isotonic fluid loss - including the loss of fluids & solutes from EC space

    treatment: replace with isotonic fluids
  38. What are factors that can disrupt homeostasis
    • increasing solute (diet)
    • disease states that decreases absorption or excretion of substances
    • certain drugs
  39. Anti-diuretic Hormone (ADH)
    Made by:
    Stored where:
    Influenced by:
    Acts on the:
    • ADH is MADE by the hypothalamus and
    • STORED in the pituitary gland. It is
    • INFLUENCED directly by blood osmolality
    • and ACTS on the renal collecting tubules to regulate reabsorption/elimination of water.
    • Ex: if receptors indicate a high osmolality of Na, ADH is released and water is held on to and reabsorbed to balance out Na ratio to H20
  40. Aldosterone:
    Released as part of the RAA mechanism
    Acts on the _________
    regulating _______ by increasing ____ uptake.
    This ______ (increases or decreases) ECF resulting in ______(increase or decrease) of blood volume/pressure
    • Distal convoluted tubules
    • regulating water
    • by holding onto water & sodium
    • this increases ECF
    • resulting in Increase in blood volume/pressure
  41. This is pronounced when the ratio 1:20 between acid and base content is altered
    Acid-base imbalance
  42. Name some causes of RESPIRATORY ACIDOSIS:
    • hypoventilation
    • copd
    • drug overdose (reducing resp function)
    • chest wall abnormality
  43. In ___________ the pulmonary system can't rid the body of enough carbon dioxide to maintain a healthy pH balance
    respiratory acidosis
  44. Treatment for respiratory acidosis:
    • maintain a patent airway
    • give a bronchodilator to open constricted airways
    • admin supp H20
  45. pH <7.35
    Paco2 >45
    HC03 norm
    respiratory acidosis
  46. pH>7.45
    Paco2 <35
    HCo3 norm
    respiratory alkalosis
  47. Causes of respiratory alkalosis:
    • hyperventilation
    • pain
    • anxiety
    • fever
  48. ph <7.35
    Paco normal
    HCO3 <22
    metabolic acidosis
  49. Causes of metabolic acidosis:
    • diabetes mellitus
    • starvation/malnutrition/alchoholism
    • many others :)
  50. pH >7.45
    Paco2 normal
    HCO3 >26
    metabolic alkalosis
  51. Causes of metabolic alkalosis
    • hypokalemia
    • excessive acid loss from GI tract
  52. Solutions on both sides of selective permeable membrance have established equilibrium
    isotonic solution

  53. a _______ solution has a lower solute concentration that another solution
  54. a _______ solution has a higher concentration of solute