25 Fluid, electrolye, and acid-base balance Flashcards
A constant _____ between bicarbonate and carbonic acid; bicarbonate acts as a b______ to neutralize excess acid in the body and maintain balance
balance; buffer
Produce acid during any type of (m)____
metabolism
Anytime carbonic acid goes up, bicarb should ___; what’s the ratio
go up; 20:1 bicarb to carbonic
Isotonic equal what’s in the cell and
what’s out of the cell
why are infants more at risk for dehydration; elderly
they are mostly water, kidney function has not as efficient as adults- doesn’t reabsorb fluid; kidney function, thirst mechanism has decreased, ADH has decreased (that holds the water in)
COPD more at risk for what type of acid-base imbalance: respiratory or metabolic
respitory- they are not breathing adequately, they are holding in CO2
severe diarrhea and lost bicarb, they would be metabolic or respiratory acidosis or alkalosis
metabolic acidosis
normal potassium level; hypokalemia; hyperkalemia
3.5-5; <3.5; >5
aldosterone regulates this electrolyte; secreted by which glands
potassium; adrenal
hyperkalemia causes more or less K+ to be excreted in the urine
more
main way K+ is excreted from body; other ways K+ can be lost
urine; excess vomiting and diarrhea
K+ is intracellular or extracellular; important for _____ transmission and _____ contraction; Helps maintain normal ______ rhythm; essential element in ____ potentials (nerve conduction and muscle contractility)
intracellular; nerve transmission and muscle contraction; heart rhythm; action potentials (or impulses)
hypokalemia will cause decreased excitability in cells, and hyperkalemia will cause _____ excitability in cells
increased
Hyperaldosteronism causes high or low K+ levels; why
low; aldosterone increases the amount of K+ that is excreted in the urine
Disorder of this organ can cause hypokalemia
kidney
Dehydration my cause hyper or hypovolemia
hypovolemia (decreased volume of plasma)
Hypervolemia inhibits (3)
ADH release, Aldosterone release, thirst
Inhibition of ADH and Aldosterone release contributes to
Increased urination of dilute urine
Hypovolemia stimulates (3)
thirst, ADH release, Aldosterone release
Release of ADH and aldosterone contribute to
decreased urination of concentrated urine
for every positive cation there is an; why
negatively charged anion; to maintain balance
fluid moves from compartment to compartment in the body trying to maintain this; why
homeostasis; balancing the anions and cations so there is electrical neutrality
disturbances in homeostasis upset the normal balance of
electrolytes
major source of electrolytes comes from
diet
amino acids (proteins), glucose, and fatty acids are these
products of metabolism/ nonelectrolytes
Do the products of metabolism, amino acids, glucose and fatty acids remain bound together when dissolved or break apart
remain bound
In a healthy individual (who is eating normally) the nonelectrolytes are doing what
circulating the body and remaining stable
Any condition that alters body fluid and volume also alters the ____ volume, and can affect (b)____ (p)____ and (c)_____
blood; blood pressure, circulation
plama proteins and colloids contribute to (p)____ (c)_____ (o)_____ (p)______; which heps keep fluid in the (v)______ (c)______
plasma colloid osmotic pressure; vascular compartment
Body fluids are either ______ or ______
intracellular or extracellular
Types of extracellular fluid (i____, i____, t_____)
intravascular, interstitial, and transcellular
What happens when fluid shifts from the plasma in the vascular space out to the interstitial space
blood volume drops and dehydration (removal of water from a tissue), and hypovolemia (decreased volume of plasma) may occur
thirst mechanism located
hypothalamus
Urine output is affected by several hormones- 3 in particular; which the posterior pituitary gland secretes this one
ADH, ANP (atrial natriuretic peptide), and aldosterone; ADH
When would more ADH be secreted
when circulating blood volume is decreased, the blood becomes more concentrated, or the person is experiencing pain, nausea or stress
When would more ADH be secreted; what do the kidney tubules do
when circulating blood volume is decreased, the blood becomes more concentrated, or the person is experiencing pain, nausea, or stress; reabsorb more water
What releases aldosterone and when; aldosterone is released how; causes reabsorption of what; which pressure is being used and why
the adrenal cortex, when ECF volume is low or when sodium concentration is decreased; stimulation by the renin-angiotensin-aldosterone system; sodium by kidney tubules; osmotic gradient by which more water is retained
ANP- released from sites where; what is the main function to protect
myocardium and the brain; protect the body from fluid overload
When intracellular fluid and extracellular fluid are equal the solution is _____
isotonic (equal solute concentration)
Cells that are surrounded by a solution that has a greater concentration of solute than cells have, the water in the cells moves to the more concentrated solution and the cells dehydrate and shrink, the solution is _____
hypertonic (of greater concentration) in relation to the cells
Cells are surrounded by a solution that has less solute than the cells have, cells swell and over hydrate, the solution is ______
hypotonic (of less concentration)
Solutions are classified as _______, ______, and _______ according to their concentration of electrolytes and other solutes
isotonic, hypotonic, and hypertonic
What pressure keeps fluid from leaking out
osmotic
Any disease that affects circulation ultimately affects the distribution and composition of (b)____ (f)_____
body fluids
Any seriously ill pt is at risk for
fluid imbalance (body has too much or too little water)
Sodium concentration causes an osmotic pull, and water goes to where that concentration is highest because
water follows sodium in the body
Which pt is at risk for fluid volume deficit
pt’s unable to take in sufficient quantities of fluid because of impaired swallowing, extreme weakness, disorientation, coma, or the unavailability of water and pt’s who lose excessive amounts of fluid through prolonged vomiting, diarrhea, hemorrhage, diaphoresis, or excessive wound drainage, pt’s who are on diuretics or pt’s with GI suctioning without fluid replacement, burn pt’s
how dehydration works
Too little water in plasma water is drawn out of the cells by osmosis to equalize the concentration and the cells shrivel
signs of overhydration (work from head down- w___ g____, c____ in l_____, slow b_____ p______, e_____ b_____ p_____, and possible)
weight gain, crackles in lungs, slow bounding pulse, elevated blood pressure, possibly edema
Generalized edema most visible in
hands and face
Causes of generalized edema
kidney failure, heart failure, liver failure, hormonal disorders involving overproduction of aldosterone and ADH
Local edema may be caused by
infection or injury and the resulting inflammation
What’s in the vascular space determines fluid
volume deficit vs overload, or balance
What type of protein is responsible for maintaining colloid osmotic pressure (and keeping fluid in the vascular compartment)
plasma proteins
In cases of severe protein deficiency, it’s possible to see peripheral (e)_____ in the presence of a fluid volume deficit due to decreased colloid osmotic pressure
edema
Hyponatremia can occur from (s)_____ loss or an excess of (w)______ and when fluid loss is replaced with p_____ w____; decreased secretion of (a)_____ can result in hyponatremia; is this the most common electrolyte imbalance?
sodium, water, and excessive vomiting or diarrhea when the fluid loss is replaced with plain water; aldosterone; yes
Heart failure, liver disease with ascites, and sometimes chronic kidney failure result in excessive water retention without concurrent sodium retention resulting in
hypervolemia combined with hyponatremia
Sodium function (think head down-transmission of n____ i_____ + 5 ; intra or extracellular
neuromuscular irritability, the transmission of nerve impulses, a major role in the regulation of water balance, contractility of the heart, acid-base balance, electroneutrality; extracellular cation
Potassium intra or extracellular
intracellular cation
Calcium function (formation of (2), b____ c_____, normal n_____ and m_____ activity)
formation of bone and teeth, blood coagulation, normal nerve, and muscle activity
Magnesium
building bones and teeth, nerve transmission, muscle contraction, metabolic creation acting as cofactor to cellular enzymes
Phosphate
formation of ATP, cofactor in carbohydrate, protein, and lipid metabolism, activates B-complex vitamins
Chloride
acid-base balance, important in formation of hydrochloric acid for secretion to the stomach, plasma electroneutrality
Bicarbonate
buffer that neutralizes excess acids in body, acid-base balance
Who is more susceptible to hyponatremia older or younger patient; SSRIs and which diuretics put pt’s more at risk
older, and in long-term care; thiazide
Foods high in potassium
Apricots, avocados, bananas, cantaloupe, codfish dates, meat, milk, orange juice, oranges, potatoes, raisins, salmon, and tuna
And balances of chloride, phosphate, and bicarbonate accompany (c)________ imbalances, because of the principle of electronneutrality
Cation
Hypochloremia is associated with
Hyponatremia
Hyperchloremia occurs along with_______ , and is a form of metabolic acidosis
Hypernatremia
HyperphosphatemIa commonly occurs in this type of organ failure
Commonly occurs in kidney failure