Balanced: Fluid & Electrolyte, Acid Base

Question 1

Homeostasis

Answer 1

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

Question 2

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

Answer 2

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

Question 3

What are buffers in acid-base balance?

Answer 3

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

Question 4

Mechanisms of Controlling Fluid and Electrolyte Movement: Diffusion

Answer 4

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

Question 5

What must be in place for diffusion to occur?

Answer 5

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

Question 6

Mechanisms of Controlling Fluid and Electrolyte Movement: Facilitated Diffusion

Answer 6

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

Question 7

What is an example of facilitated diffusion?

Answer 7

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

Question 8

Does facilitated diffusion require external energy?

Answer 8

No

Question 9

Mechanisms of Controlling Fluid and Electrolyte Movement: Active Transport

Answer 9

Process requiring energy in which molecules move against the concentration gradient

Question 10

What is an example of active transport?

Answer 10

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.

Question 11

Mechanisms of Controlling Fluid and Electrolyte Movement: Osmosis

Answer 11

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

Question 12

What is an example of osmosis?

Answer 12

Isotonic, Hypotonic, and Hypertonic IV solutions

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

Question 13

What is osmosis and diffusion important in maintaining?

Answer 13

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

Question 14

Mechanisms of Controlling Fluid and Electrolyte Movement: Hydrostatic Pressure

Answer 14

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

Question 15

Mechanisms of Controlling Fluid and Electrolyte Movement: Oncotic Pressure

Answer 15

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.

Question 16

Fluid Movement in Capillaries: Fluid Shifts

Answer 16

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

Question 17

Fluid Movement in Capillaries:

Shifts of Plasma to Interstitial Fluid

Answer 17

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

Question 18

What can cause fluid shifts of plasma to interstitial fluid?

Answer 18

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

Question 19

How can you treat or decrease edema?

Answer 19

Compression Stockings

Elevation of Legs

Question 20

Fluid Movement in Capillaries:

Shifts of Interstitial Fluid to Plasma

Answer 20

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

Question 21

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

Answer 21

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

Question 22

Fluid Movement in Capillaries:

Isotonic Solutions (=)

Answer 22

% 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)

Question 23

Fluid Movement in Capillaries:

Hypotonic (-)

Answer 23

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

Question 24

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

Answer 24

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

Question 25

Fluid Movement in Capillaries: Hypertonic (+)

Answer 25

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

Question 26

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

Answer 26

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

Question 27

What is fluid spacing?

Answer 27

a term used to describe the distribution of body water

Question 28

What is first spacing?

Answer 28

regular, the person is doing what they need to do

Question 29

What is second spacing?

Answer 29

abnormal accumulation of interstitial fluid, you will see edema here

Question 30

What is third spacing?

Answer 30

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

Question 31

Regulation of Water Balance in the body: Hypothalamic and Pituitary Regulation

Answer 31

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

Question 32

Regulation of Water Balance in the body: Adrenal Cortical Regulation

Answer 32

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

Question 33

Regulation of Water Balance in the body: Renal Regulation

Answer 33

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

Question 34

Regulation of Water Balance in the Body: Cardiac Regulation

Answer 34

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

Question 35

Regulation of Water Balance in the Body: Gastrointestinal Regulation

Answer 35

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

Question 36

Regulation of Water Balance in the Body: Insensible Regulation

Answer 36

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

Question 37

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

Answer 37

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.

Question 38

Where is ANP released from the heart?

Answer 38

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

Question 39

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

Answer 39

135-145 mmol/L

Question 40

Extracellular Fluid

Answer 40

- Intravascular (plasma) - Interstitial - Transcellular

Question 41

Fluid Volume Deficit (Hypovolemia)

Answer 41

- 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

Question 42

Fluid Volume Excess (Hypervolemia)

Answer 42

- 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

Question 43

Respiratory Acidosis

Answer 43

Occurs when there is hypoventilation

Question 44

Respiratory Alkalosis

Answer 44

Occurs whenever there is hyperventilation

Question 45

Metabolic Acidosis

Answer 45

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

Question 46

Metabolic Alkalosis

Answer 46

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

Question 47

Hypernatremia

Answer 47

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

Question 48

Hyponatremia

Answer 48

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

Question 49

What is the therapeutic range of potassium?

Answer 49

3.5-5.0 mmol/L

Question 50

What is the role of potassium?

Answer 50

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.

Question 51

Hyperkalemia

Answer 51

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

Question 52

Hypokalemia

Answer 52

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

Question 53

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

Answer 53

0.74-1.07 mmol/L

Question 54

Hypomagnesemia

Answer 54

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

Question 55

Hypermagnesemia

Answer 55

Renal failure or Adrenal insufficiency Symptoms - hypotension, facial flushing, lethargy, urinary retention, nausea, and vomiting

Question 56

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

Answer 56

2.25-2.75 mmol/L

Question 57

Which other electrolyte does calcium have a partnership with?

Answer 57

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

Question 58

Hypocalcemia

Answer 58

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

Question 59

Hypercalcemia

Answer 59

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

Question 60

What is the therapeutic range for phosphate (PO)

Answer 60

1.12-1.45 mmol/L

Question 61

What is the role of phosphate?

Answer 61

Essential to the function of muscle, RBCs, and the nervous system Involved in acid base balance

Question 62

Hyperphosphatemia

Answer 62

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

Question 63

Hypophosphatemia

Answer 63

Typically in patients who are malnourished or have malabsorption syndromes or alcohol withdrawal CNS dysfunction Rhabdo Muscle weakness, including respiratory weakness Cardiac problems (dysrhythmias)