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
Patient undergoing diuretic therapy will be at risk for what type of fluid and electrolyte imbalance
Hypomagnesemia, hyperkalemia, when using potassium sparing diuretics, hypokalemia due to improper use of diuretics
(mechanisms of edema formation ) Fluid overload: increased hydrostatic pressure in arterial end of capillary: will cause fluid movement into tissues, causing (e)______, and increased peripheral vascular resistance, which will cause increased left ventricular pressure, which will cause increased, left arterial pressure, which will cause pulmonary (e)______
Edema; edema
Mechanisms of edema formation (4)
Fluid overload, decreased plasma in albumin, altered, lymphatic, function, tissue injury
(Mechanisms of a edema formation): decreased plasma and albumin: decreased production of plasma proteins causes, decreased capillary, oncotic, pressure, causing decreased reabsorption of venous end resulting in
Edema
(Mechanisms of edema formation): altered lymphatic function: lymphatic obstruction, decreases absorption of interstitial fluid, leading to decreased transport of capillary, filtered proteins, leading to increase tissue oncotic pressure which pulls fluid towards, leading to
Edema
(Mechanisms of edema formation): tissue injury: increased capillary, permeability, leading to movement of plasma, protein in the tissues, leading to increase tissue, oncotic pressure reading to
Edema
Acid-base balance is important to maintaining homeostasis in the body, because cell enzymes can function only within a very narrow range of
pH
Cell metabolism constantly produces (c)_______ (d)_______, which combines with water to form carbonic acid, which immediately breaks down into hydrogen ions and bicarbonate ions
Carbon dioxide
Concentration of hydrogen ions determines
pH reading
Because of the production of asses by the body’s metabolic systems in the body tends to become ______ if homeostasis is upset
Acidic
Three control mechanisms for maintaining pH balance
Blood buffer system, lungs, urinary system
Blood buffer system consists of weak _____ & weak ______
Acids and bases
In the lungs, hydrogen ion and bicarbonate ion dissociation reaction can be reversed, water, and CO2 are reformed, carbon dioxide and water are expired from the lungs, decreasing the amount of ______ from the body
Acid
Lungs can either expel more carbon dioxide or conservate to help b_____ the pH
Balance
In the kidney, enzymes promote the dissociation of carbonic acid to free hydrogen ions, which can be___; bicarbonate ions are then returned to the blood…
excreted in the urine ; I to restore the levels of buffer
Kidney reduce the acid content of the serum by
Exchanging hydrogen for sodium with the help of aldosterone
Kidneys can neutralize acids by combining them with
Ammonia and other chemicals
Four types of acid-base imbalances
Respiratory acidosis, metabolic acidosis, respiratory alkalosis, metabolic alkalosis
What is measured to determine an acid-base imbalance?
pH, arterial carbon dioxide partial pressure and bicarbonate ion
An increase in hydrogen ions results in _____; decrease in hydrogen ion results in _______
Acidosis (decrease in pH); alkalosis (increase in pH)
Acid - base imbalances maybe acute or
Chronic
Initial change in carbon dioxide is nearly always, the result of a
Respiratory disorder
Disorders that show an initial change in bicarbonate ions are
Metabolic
Causes of respiratory acidosis
slow shallow respirations/ hypoventilation; respiratory congestion, or obstruction;(chronic respiratory acidosis) COPD, severe pneumonia, or excessive sedation (opioid medication’s); respiratory muscle weakness; asthma, or chest injuries
Respiratory acidosis s/s
Hypoventilation, dyspnea, anxiety, confusion
Metabolic acidosis causes
Shock (lactic acidosis), diabetic ketoacidosis, lactic acid (due to faulty metabolism), kidney failure (decreased excretion of acids and decreased production of bicarbonate), diarrhea, starvation;
Excessive loss of bicarbonate ions, or increased production or retention of hydrogen ions. (Also occurs when large amounts of acid are produced within the body due to more energy than usual being extended in lactic acid building up = lactic acidosis)
Metabolic acidosis s/s
Kussmaul respirations, headache, confusion, malaise
Respiratory alkalosis causes
Hyperventilation caused by anxiety or pain, mechanical ventilation
Respiratory alkalosis s/s
Hyperventilation, confusion, lightheadedness
Metabolic alkalosis causes
Vomiting, prolonged, gastric section, hypocalemia, medications, diuretics, antacids or bicarbonate, mineralocorticoids
Metabolic alkalosis s/s
Hypoventilation, confusion, numbness, or tingling, decreased LOC
Effects of acidosis; evidence that the compensatory mechanisms at work and metabolic acidosis (what breath) and secretion of urine with a high or low pH
Depresses the nervous system, causing headache, lethargy, weakness, and confusion. If unrelieved, and death; Kussmaul, respirations and secretion of urine with low pH
Kussmaul’s respiration is the body’s attempt to correct acidosis by
“Blowing off” carbon dioxide, which is an acid
Hyperventilation results in this; caused by; treatment
respiratory alkalosis; usually caused by anxiety, high fever, OD on aspirin, or head injuries; pt may temporarily breathe through a rebreather mask that mixes the excessive exhaled CO2 with O2 so that more CO2 is inhaled
most common reason for metabolic alkalosis
diuretic administration, also vomiting, GI suctioning, and excessive antacid use
Hypokalemia is associated with metabolic alkalosis or metabolic acidosis
metabolic alkalosis
Effects of alkalosis
irritability of the nervous system, restlessness, muscle twitching, tingling, and numbness of fingers. If progression occurs, tetany (severe muscle cramps, carpopedal spasms, laryngeal spasm, and stridor) occurs, and seizures and coma results
Daily way of tracking alterations in fluid balance
tracking daily weight- gain or loss of 1kg in 24 hrs indicates gain or loss of 1 L of fluid
A weak thready pulse of >100 may be an early sign of
decreased vascular volume from fluid volume deficit
severe fluid volume deficit decreases blood flow to the brain and results in decreased
sensorium and confusion
Assessing vital signs for fluid volume deficit
measure bp and pulse lying, sitting and standing. Orthostatic pressure.
Neuromuscular irritability is assessed when imbalances in c______ and m_______ are suspected
calcium and magnesium
Check for Chvostek and Trousseau signs when c______ or m______ deficit is a possibility
calcium or magnesium
In suspicion of dehydration in older adults check these instead of skin turgor
dry mucous membranes, concentrated urine
Giving K+ when urine output is inadequate could cause
kidney damage
which part of the brain helps control fluid balance in the body
hypothalamus
Condition caused by inadequate intake of calcium and possible overuse of laxatives containing phosphates
hypocalcemia
Intravascular fluid is found at which site in the body
within the blood vessels and consists of plasma and fluid
Interstitial fluid is found at which site in the body
found in the space surrounding the cells
transcellular fluid is found at which site in the body
the fluid found in the urinary system and lymphatics
Which type of IV fluid is used for fluid loss from vomiting and diarrhea, for those waiting for blood products, and for fluid loss during surgery
Isotonic
Pt with chronic COPD might have which acid-base imbalance
Respiratory acidosis
Pt with renal failure may have which acid-base imbalance
metabolic acidosis
Pt who is vomiting may be at risk for this acid-base imbalance
metabolic alkalosis
Pt with a head injury may be at risk for this acid-base imbalance
respiratory alkalosis
Thirst mechanism found in which location & helps control fluid balance in the body
hypothalamus
Example of local edema
inflammation after infection or injury
Hyperventilation occurs in respiratory alkalosis or acidosis
alkalosis
which kind of movement would describe raisins becoming larger in size after being left in water overnight
osmosis: water moving through a semipermeable membrane from the area of less solute concentration to an area of greater concentration until the solutions are of equal concentration
What organ secrets Renin and why
Kidneys because of a blood volume issue, and convert angiotensinogen into angiotensin 1
Renin secreted by kidneys converts to Angiotension 1 and can not be converted to Angiotension 2 by this enzyme
angiotensin-converting-enzyme
Angiotensinogen secreted by which organ
Liver in response to low bp or low sodium
further converting of the angiotensin enzyme into angiotensin 2 is done by what enzyme; where is this enzyme found
angiotensin-converting enzyme (ACE); pulmonary circulation, adrenal gland, brain, and heart
Ace converting enzyme changes angiotensin1 to angiotensin 2, this is a vaso_____
vasoconstrictor
When angiotensin 2 is secreted signals kidney to increase Na+/H+ activity (water retention), posterior pituitary to secrete A______, vascular smooth muslce h______, hypothalamus stimulates t______, adrenal cortex secretes a______
ADH, hypertension, thirst, aldosterone
Na+ function
water regulation, balance
K+ function
nerve impulse transmission, muscle contraction, plasma, acid-base balance
Ca+ function
muscle activity, blood coagulation
Magnesium
nerve impulse transmission. muscle contraction
Chloride
hydrochloric acid production, acid-base balance
Bicarbonate
acid-base balance
acid-base balance electrolytes
bicarb, chloride, potassium, sodium
Phosphate
ATP production
Nerve impulse transmission electrolytes
magnesium. potassium,
These substances dissociate into ions when dissolved in water
electrolytes
These substances do not form ion sand do not conduct electricity when placed in water
non-electrolytes
Approx 1/3 of total body water, transports water, nutrients, oxygen, and waste to and from the cells. Regulated by renal, metabolic, and neurologic factors. High in sodium content - what type of fluid
extracellular fluid
Fluid within the blood vessels consists of plasma and fluid within blood cells, and contains large amounts of protein and electrolytes- what type of fluid
intravascular fluid
Fluid in the spaces surrounding the cells, high in sodium content -what type of fluid
interstitial fluid
includes aqueous humor, saliva, cerebrospinal, pleural, peritoneal, synovial, and pericardial fluids, gi secretions, and fluid in the urinary system and lymphatics -what type of fluid
transcellular fluid
about 2/3 of total body fluid, contained within the cell walls, most cell walls are permeable to water, high in potassium content- what type of fluid
intracellular fluid
Composed of erythrocytes, leukocytes, platelets, carried in plasma
blood
anything that alters body fluid also alters p_____ v_______, and can affect circulation, and bp
plasma volume
Distribution of body fluids:
Intracellular (within cell body)
Extracellular (outside cell body): interstitial, intravascular, transcellular
Glucose, oxygen, carbon dioxide, water, and other small ions and molecules by d_____
diffusion; substance moves from high to low concentration until concentration on both sides of the membrane are equal
Hydrostatic pressure causes fluid to press outward on the vessel, promoting filtration and forcing m______ of water and electrolytes through the capillary wall to the interstitial fluid
movement
Signs of d_____: thirst, weakness, dizziness, postural hypotension, decreased urine, dry mucous membranes, thick saliva, dry and scaly skin, poor tissue turgor, concentrated urine, dry and cracked lips, flat neck veins, increased pulse rate, weak and thread pulse, elevated temp
dehydration
Signs of o______: weight gain, crackles in lungs (wet lungs), slow bounding pulse, elevated bp, possible edema
overhydration
hypernatremia: most commonly from water loss from fever or r____ i_____; MODEL
respiratory infection; Medications, meals (too much salt), Osmotic diuretics, Diabetes insipidus, Excessive water loss, Low water intake
Hyponatremia: s/s; causes
(in the mind) lethargy, headache, confusion, apprehension, seizures, coma; dilution as a result of excess water, or sodium loss- situational: GI suctioning, diarrhea, inadequate salt intake, vomiting, diuretics, fluid shift from ICF to ECF by hypertonic solutions (which leads to dilutional hyponatremia)
Hypokalemia: s/s (A SIC WALT); causes
Alkalosis, Shallow respirations, Irritability, Confusion/drowsiness, Weakness/fatigue, Arrhythmias/tachycardia, Lethargy, and Thready pulse. Decreased intestinal motility, n/v; excess potassium or loss of body water maybe from poor diet, vomiting, diarrhea, excessive sweating or diuretic therapy
Hyperkalemia: s/s (MADE O low); causes
Muscle cramps/ weakness/paralysis, Abdominal cramping, Drowsiness, dysrhythmias, diarrhea, EKG changes, oliguria, low bp ; burns, crush injuries, uncontrolled diabetes mellitus, and renal failure
Hypocalcemia: s/s (CATS); occurs
Convulsion, Arrhythmias, Tetany, Spasm and stridor; nutritional deficiency or ca or vit D, disorders in which there is a shift of ca into bone
Hypercalcemia: s/s (BACK ME); causes
most cases related to hyperparathyroidism, or malignancy with bone reorption; Bone pain, Arrhythmias, Cardiac arrest, Kidney stones, Muscle weakness, Excessive urination;
Hypomagnesemia: causes
malabsorption, malnutrition, renal tubular dysfunction, thiazide diuretic use, and extensive gastric suction, or diarrhea
Hypermagnesemia: causes
only in presence of renal failure
intracellular electrolytes
potassium, magnesium
Extracellular electrolytes
sodium
Carbonic acid retained or removed by r______ s_______
respiratory system
Bicarbonate retained or removed by k_______
kidneys
Bicarbonate = buffer, what does this buffer
buffer to neutralize excess acids in the body
K______ selectively reabsorb or excrete bicarbonate to regulate serum levels and help maintain acid-base balance
kidneys
Increased carbon dioxide levels come from:
airway obstruction, pneumonia, asthma, chest injuries, opiate intake, chronic obstructive lung disease
Metabolic acidosis: Excessive loss of bicarbonate ions or retention of hydrogen ions caused by
kidney disease, diabetic ketoacidosis, circulatory failure, shock states
Respiratory alkalosis: caused by
anxiety, high fever, hyperventilation, salicylate poisoning (ASA overdose), encephalitis
Metabolic alkalosis: caused by
vomiting, GI suctioning, excessive antacid consumption, diuretic therapy, K+ deficit
