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NSG 2321 > Balanced: Fluid & Electrolyte, Acid Base > Flashcards

Balanced: Fluid & Electrolyte, Acid Base Flashcards

1
Q

Homeostasis

A

The state of equilibrium in the internal environment of the body, naturally maintained by adaptive responses that promote healthy survival

Maintenance of the composition and volume of body fluids, electrolytes and acid base concentrations within normal limits is necessary to maintain homeostasis

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2
Q

When drawing blood for an ABG what indicates that the blood is high in oxygen?

A

Bright Red blood when taking an ABG indicates that it is high in oxygen saturation

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3
Q

What are buffers in acid-base balance?

A

Buffers- Change strong acids into weaker acids

  • Respiratory rate will respond by either increasing or decreasing the rate
  • The kidney will either excrete or reserve
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4
Q

Mechanisms of Controlling Fluid and Electrolyte Movement: Diffusion

A

The movement of molecules from an area of high concentration to one of low concentration

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5
Q

What must be in place for diffusion to occur?

A

The membrane separating the two areas must be permeable by the diffusing substance for the process to occur

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6
Q

Mechanisms of Controlling Fluid and Electrolyte Movement: Facilitated Diffusion

A

Involves a protein carrier in the cell membrane

The protein carrier combines with a molecule, especially one to large to pass easily through the cell membrane, and assists in moving the molecule across the membrane from an area of high concentration to one of low concentration

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7
Q

What is an example of facilitated diffusion?

A

Glucose transport into the cell

If a person has meningitis and to get the ABX past the blood brain barrier they bind it with a protein so the medication can reach its desired location in the brain to treat it

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8
Q

Does facilitated diffusion require external energy?

A

No

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9
Q

Mechanisms of Controlling Fluid and Electrolyte Movement: Active Transport

A

Process requiring energy in which molecules move against the concentration gradient

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10
Q

What is an example of active transport?

A

Ex. Sodium Potassium pump → The intracellular and extracellular pressure differ greatly but to maintain the concentration difference, the cells use active transport to move sodium out of the cell and potassium into the cell.

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11
Q

Mechanisms of Controlling Fluid and Electrolyte Movement: Osmosis

A

Movement of water between two compartments separated by a semipermeable membrane, one that allows the movement of water but not solute.

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12
Q

What is an example of osmosis?

A

Isotonic, Hypotonic, and Hypertonic IV solutions

This applies to IV fluids because administering them could cause a fluid shift

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13
Q

What is osmosis and diffusion important in maintaining?

A

Diffusion and osmosis are important in maintaining the fluid volume of body cells and the concentration of solute

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14
Q

Mechanisms of Controlling Fluid and Electrolyte Movement: Hydrostatic Pressure

A

Force within a fluid compartment (Blood Pressure- force). Referred to as pushing pressure. Giving IV Bolus can increase their hydrostatic pressure.

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15
Q

Mechanisms of Controlling Fluid and Electrolyte Movement: Oncotic Pressure

A

Osmotic pressure exerted by colloids (proteins) in a solution (referred to as pulling pressure, it can pull fluid from tissue)

Ex: ETOH or Liver Failure and malnutrition. This is where you would give Albumin.

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16
Q

Fluid Movement in Capillaries: Fluid Shifts

A

If capillary or interstitial pressures are altered, fluid may abnormally shift from one compartment to another which results in edema OR dehydration

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17
Q

Fluid Movement in Capillaries:

Shifts of Plasma to Interstitial Fluid

A

Accumulation of fluid in the interstitial (edema) occurs if venous hydrostatic pressure rises, plasma oncotic pressure decreases, or interstitial oncotic pressure rises

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18
Q

What can cause fluid shifts of plasma to interstitial fluid?

A

Can also be a result of renal disorders, liver disease, malnutrition, trauma, burns or inflammation

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19
Q

How can you treat or decrease edema?

A

Compression Stockings

Elevation of Legs

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20
Q

Fluid Movement in Capillaries:

Shifts of Interstitial Fluid to Plasma

A

This can occur due to hypertonic solutions

Increasing the tissue hydrostatic pressure is another way of causing a shift in fluid into the plasma

Can be done through IV fluids, specifically hypertonic solutions so that the body can excrete that excess fluid from the kidney’s

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21
Q

What is the result of shifting interstitial fluid to plasma with hypertonic solutions?

A

When we pull that fluid with hypertonic solutions we increase our intravascular pressure (BP), if the kidneys are not functioning properly the patient is at risk of getting JVD or crackles to lungs

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22
Q

Fluid Movement in Capillaries:

Isotonic Solutions (=)

A

% of the fluid that we will use the majority of the time

Maintaining- there should be no shift with the fluid. If there is, it will be minimal

0.9% NaCl, D5W (monitor blood sugars), Lactated Ringers (has more mg, K, phos)

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23
Q

Fluid Movement in Capillaries:

Hypotonic (-)

A

Intravascular to interstitial

Extracellular to intracellular

The fluid is leaving the vein and going into the interstitial compartment

These patients are dehydrated and need to be hydrated- the fluid needs to move into the cells
0.45% NaCl

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24
Q

What is scenario that we would typically give hypotonic solutions for?

A

These patients are dehydrated and need to be hydrated- the fluid needs to move into the cells

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25
Q

Fluid Movement in Capillaries:

Hypertonic (+)

A

Interstitial to intravascular

Intracellular to extracellular

Caution in regards to patients kidneys and their hearts because patients can be placed into fluid overload

3% NaCl

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26
Q

What does the nurse need to be cautious about when administering hypertonic solutions

A

Caution in regards to patients kidneys, serum sodium, and their hearts (BP) because patients can be placed into fluid overload

27
Q

What is fluid spacing?

A

a term used to describe the distribution of body water

28
Q

What is first spacing?

A

regular, the person is doing what they need to do

29
Q

What is second spacing?

A

abnormal accumulation of interstitial fluid, you will see edema here

30
Q

What is third spacing?

A

fluid is accumulating in an area that we cannot easily exchange

ex. Ascites - the third spacing is sitting in their abdomen- mitigated through giving albumin or by a paracentesis

31
Q

Regulation of Water Balance in the body:

Hypothalamic and Pituitary Regulation

A

A fluid deficit or an increase in plasma osmolarity is sensed by the hypothalamus which in turn stimulates THIRST which causes the patient to drink more water

The posterior pituitary gland releases ADH, which induces WATER REABSORPTION which causes more free water in the blood and is not excreted in the urine

32
Q

Regulation of Water Balance in the body:

Adrenal Cortical Regulation

A

Hormonal influences regulate both water and electrolytes in the body

Glucocorticoids- Increase glucose level, glucose drives us to drink

Mineralocorticoids - Aldosterone

Ie., Aldosterone which is a hormone that retains sodium and excretes potassium which in turn causes water reabsorption

Cortisol (Gluco and mineral)- drives you not to drink and not to pee because it is in flight or fight

33
Q

Regulation of Water Balance in the body:

Renal Regulation

A

Primary organs for regulating fluid and electrolytes are the kidneys

The kidneys regulate water balance through adjustments in urine volume

Decides based on the hypothalamus

How much fluid do the kidney’s reabsorb? 99%. 1.5L is the average urine output/daily

34
Q

Regulation of Water Balance in the Body:

Cardiac Regulation

A

A hormone called ANF/ANP causes vasodilation and increased urinary excretion of sodium and water, which decreases blood volume

35
Q

Regulation of Water Balance in the Body:

Gastrointestinal Regulation

A

The GI tract accounts for most of the water intake

Small amount of water is eliminated by the feces

2000-3000mL a day the gastrointestinal keeps

36
Q

Regulation of Water Balance in the Body:

Insensible Regulation

A

The invisible vaporization from the lungs and the skin

Cannot be measured - estimation

It is different from perspiration

Approximately 900mL of fluid is lost each day

Fever causes a client to lose more water as well as increased respiratory rate

37
Q

Which disease process is the Atrial Natriuretic Peptide Hormone (ANF/ANP) greatly increased in?

A

Circulating atrial natriuretic peptide is greatly increased in congestive heart failure as a result of increased synthesis and release of this hormone.

Atrial natriuretic peptide has emerged as an important diagnostic and prognostic serum marker in congestive heart failure.

38
Q

Where is ANP released from the heart?

A

By the atria

Atrial natriuretic peptide hormone of cardiac origin, which is released in response to atrial distension and serves to maintain sodium homeostasis and inhibit activation of the renin-angiotensin-aldosterone system

39
Q

What is the therapeutic range for Sodium (Na+)?

A

135-145 mmol/L

40
Q

Extracellular Fluid

A
  • Intravascular (plasma)
  • Interstitial
  • Transcellular
41
Q

Fluid Volume Deficit (Hypovolemia)

A
  • Abnormal loss of normal body fluids (diarrhea, fistula drainage, hemorrhage), inadequate intake, OR plasma to interstitial fluid shift
  • Treatment: Replace water and electrolytes with balanced IV solutions
42
Q

Fluid Volume Excess
(Hypervolemia)

A
  • Excess intake of fluids, abnormal retention of fluids (HF), interstitial to plasma fluid shift
  • Treatment: Remove Fluid without changing electrolyte composition or osmolarity of ECF
43
Q

Respiratory Acidosis

A

Occurs when there is hypoventilation

44
Q

Respiratory Alkalosis

A

Occurs whenever there is hyperventilation

45
Q

Metabolic Acidosis

A

Occurs when an acid other than carbonic acid accumulates in the body or when bicarbonate is lost from body fluids

46
Q

Metabolic Alkalosis

A

Occurs when a loss of acid (prolonged vomiting or gastric suction) or gain in bicarbonate occurs

47
Q

Hypernatremia

A

Not typically a problem in an alert person who has access to water, can sense thirst, and is able to swallow

Some causes are excessive sweating and increased sensible losses from high fever

Symptoms are primarily the result of dehydration of the neurons which leads to neurological manifestations such as intense thirst, lethargy, agitation, seizures, and even coma

48
Q

Hyponatremia

A

Can be caused by water excess in relation to the amount of sodium in the body

Can be a result of the inappropriate use of hypotonic IV solutions

Result in restlessness, agitation, twitching, seizures, coma, weakness

49
Q

What is the therapeutic range of potassium?

A

3.5-5.0 mmol/L

50
Q

What is the role of potassium?

A

Critical for many cellular and metabolic functions - it is necessary for the transmission and conduction of nerves impulses, maintenance of normal cardiac rhythms, and skeletal and smooth muscle contraction.

51
Q

Hyperkalemia

A

Most common cause is renal failure

Can be caused by burns or crush injuries

Symptoms are anxiety, irritability, abdominal cramping, diarrhea, irregular pulse, cardiac standstill if hyperkalemia is sudden or severe

52
Q

Hypokalemia

A

The most common cause are abnormal losses, via either the kidneys or the GI tract (ie., diuretics)

Symptoms can be fatigue, muscle weakness, leg cramps, weak or irregular pulse, Decreased reflexes

53
Q

What is the therapeutic range of Magnesium (Mg+)?

A

0.74-1.07 mmol/L

54
Q

Hypomagnesemia

A

Caused by chronic alcoholism, diarrhea, vomiting, prolonged malnutrition, poorly controlled diabetes, large urine output

Neuromuscular manifestations such as cramps or tremors, confusion, seizures, cardiac dysrhythmias such as ventricular fibrillation

55
Q

Hypermagnesemia

A

Renal failure or Adrenal insufficiency

Symptoms - hypotension, facial flushing, lethargy, urinary retention, nausea, and vomiting

56
Q

What is the therapeutic range of Calcium (Ca+)?

A

2.25-2.75 mmol/L

57
Q

Which other electrolyte does calcium have a partnership with?

A

Usually calcium and phosphorus have an inverse relationship where when one increases the other decreases

58
Q

Hypocalcemia

A

Typically caused by acute pancreatitis, chronic renal failure, elevated phosphorus, chronic alcoholism

Muscle cramps, laryngeal spasms, numbness and tingling in extremities and region around the mouth

59
Q

Hypercalcemia

A

Typically caused by Hyperparathyroidism and malignancy (malignancies lead to hypercalcemia through bone destruction from tumour invasion

Symptoms → impaired memory, confusion, disorientation, fatigue, muscle weakness, constipation, cardiac dysrhythmias, and renal calculi

60
Q

What is the therapeutic range for phosphate (PO)

A

1.12-1.45 mmol/L

61
Q

What is the role of phosphate?

A

Essential to the function of muscle, RBCs, and the nervous system

Involved in acid base balance

62
Q

Hyperphosphatemia

A

Major cause is acute or chronic renal failure that results in the inability of the kidneys to excrete phosphorus

Symptoms- Hypocalcemia, muscle problems like tetany, deposition of calcium phosphate precipitates in the skin, soft tissue, corneas, viscera and blood vessels

63
Q

Hypophosphatemia

A

Typically in patients who are malnourished or have malabsorption syndromes or alcohol withdrawal

CNS dysfunction

Rhabdo

Muscle weakness, including respiratory weakness

Cardiac problems (dysrhythmias)

NSG 2321 (6 decks)

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