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NSG 250 > Ch 39 > Flashcards

Ch 39 Flashcards

1
Q

Electrolytes

A
  • Substances that develop an electrical charge when dissolved in water
  • Responsible for maintaining the fluid balance between intracellular and extracellular. Important because it helps with hydration, nerve impulses, muscle function, pH level
  • Important because cells, tissues, and fluids thrive in a homeostatic environment
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2
Q

Cation

A

Electrolytes that carry a positive charge

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3
Q

Anion

A

Electrolytes that carry a negative charge

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4
Q

Interstitial fluid

A

lies between the spaces in the blood

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5
Q

Intravascular fluid

A

lies in the plasma within the blood

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6
Q

Transcellular fluid

A

includes specialized fluids like cerebrospinal, pleural, peritoneal, and synovial fluid

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7
Q

Active transport

A
  • movement of fluid and solutes that requires energy
  • Molecules (solute)
  • low concentration to high concentration
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8
Q

Passive transport

A
  • movement of fluid and solutes that does not require energy.
  • 3 types: osmosis, diffusion, filtration
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9
Q

Osmosis

A

Water

low concentration to high concentration

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10
Q

Diffusion

A

Molecules (solute)

high concentration to low concentration

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11
Q

Filtration

A

Water and small particles

high pressure to low pressure

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12
Q

Sensible fluid loss

A

measurable and perceived

urine, diarrhea, ostomy, gastric drainage

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13
Q

Insensible fluid loss

A

not perceived and not easily measured

evaporated from the skin and lungs

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14
Q

Sodium (Na+)

A
  • Major cation in the ECF
  • Normal serum level is 135-145 mEq/L

Function:

  • Regulates fluid vol.
  • Maintains blood vol.
  • Interacts with calcium to maintain muscle contraction
  • Stimulates conduction of nerve impulses

Regulation:

  • Moves by Active transport
  • Regulates aldosterone and ADH levels
  • Reabsorbed and excreted through kidneys
  • Minimal loss through perspiration and feces
  • Low sodium may be caused by excess water intake

Sources:
Table salt, soy sauce, cured pork, cheese, milk, processed foods, canned products, foods preserved with salt

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15
Q

Potassium (K+)

A
  • Major cation in ICF
  • Normal serum level 3.5-5 mEq/L

Function:

  • Maintains ICF osmolality
  • Regulates conduction of cardiac rhythm
  • Transmits electrical impulses in multiple body systems
  • Assists with acid-base balance

Regulation:

  • Regulated by aldosterone
  • Excreted and conserved through the kidneys
  • Lost through vomiting and diarrhea
  • Lost triggered by many diuretics

Sources:
bananas, oranges, apricots, figs, dates, carrots, potatoes, tomatoes, spinach, dairy products, and meats

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16
Q

Calcium (Ca2+)

A
  • Most abundant electrolyte in the body
  • Normal serum level 8.5-10.5 mg/dL

Function:

  • Promotes transmission of nerve impulses
  • Major component of bone and teeth
  • Regulates muscle contraction
  • Maintains cardiac automaticity
  • Essential factor in the formation of blood clots
  • Catalyst for many cellular activities

Regulation:

  • Combines with phosphorus to form the mineral salts of the teeth and bone
  • Calcium and phosphorus levels inversely proportional
  • Parathyroid hormone (PTH) stimulates release from bone and reabsorption for kidneys and intestines
  • Calcitonin (from the thyroid) blocks bone breakdown and lowers calcium levels
  • Absorption stimulated by vitamin D

Sources:
-Milk, milk products, dark green veggies, salmon, breads and cereals

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17
Q

Magnesium (Mg2+)

A
  • Presents in skeleton and ICF
  • Second most abundant cation in ICF
  • Normal serum level is 1.6-2.6 mEq/L

Function:

  • Involved in protein and carbohydrate metabolism
  • Necessary for protein and DNA synthesis within the cell
  • Maintains normal intracellular levels of potassium
  • Involved in electrical activity in nerve and muscle membranes, including the heart
  • May have a role in regulating BP and may influence the release and activity of insulin

Regulation:

  • Ingested in the diet and absorbed through the small intestine
  • Excreted by kidneys
  • Loss may be triggered by diuretics, poorly controlled DM, and excess alcohol intake

Sources:

  • Average daily requirement is 18-30 mEq
  • most foods, high levels present in green veggies, cereal, grains, and nuts
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18
Q

Chloride (CI-)

A
  • Major anion in the ECF
  • Normal serum level is 95-105 mEq

Function:

  • Works with Na+ to maintain osmotic pressure between fluid compartments
  • Essential for production of HCI for gastric secretions
  • Functions as buffer in oxygen-carbon dioxide exchange in RBCs
  • Assists with acid-base balance

Regulation:

  • Reabsorbed and excreted through the kidneys along with sodium
  • Regulated by aldosterone and ADH levels
  • Deficits lead to potassium deficits; potassium deficits lead to chloride deficits

Sources:
-foods high in sodium

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19
Q

Phosphate (PO4-)

A
  • Major anion in the ICF
  • Normal serum level is 1.7-2.6 mEq/L

Function:

  • Serves as a catalyst for many intracellular activities
  • Promotes muscle and nerve action
  • Assists with acid base balance
  • Important for cell division and transmission of hereditary traits

Regulation:

  • Combines with calcium to form the mineral salts of the teeth and bones
  • Calcium and phosphorus levels inversely proportional
  • Regulated by PTH; has inverse response to calcium
  • Excreted and reabsorbed by the kidneys

Sources:

  • meat, fish, poultry, milk products, carbonated beverages, legumes
  • Readily available in body as a result of metabolism
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20
Q

Bicarbonate (HCO3-)

A
  • Major buffer in the body
  • In ECF and ICF
  • Normal serum level is 22-26 mEq/L

Function:
-Maintains acid-base balance by functioning as the primary buffer in the body

Regulation:

  • Lost through diarrhea, diuretics, renal insufficiency
  • Excess possible if person ingests quantities of acid neutralizers
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21
Q

Hydrostatic pressure

A
  • The force created by fluid within a closed system

- It is responsible for normal circulation of blood

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22
Q

Osmotic pressure

A

the power of a solution to draw water

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23
Q

The IOM recommends a total fluid intake of

A

women- 2700ml/day

men- 3700 ml/day

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24
Q

What is the principal regulator of fluid and electrolyte balance

A

the kidneys

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25
Q

Renin

A

enzyme responsible for the chain of reactions that converts angiotensinogen to angiotensin II

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26
Q

Angiotensin II

A

Acts on the nephrons to retain sodium and water and directs the adrenal cortex to release aldosterone

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27
Q

Thyroid hormone affects fluid volume by?

A

influencing cardiac output

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28
Q

Natriuresis

A

The discharge of sodium through urine

29
Q

Acid

A
  • Any compound that contains hydrogen ions (H+) that can be released
  • Referred to as cation donors
30
Q

Base

A
  • A compound that combines with hydrogen ions in solution

- Referred to as cation acceptors

31
Q

pH

A
  • The amount of acid or base present in a solution
  • The stronger an acid is the lower the pH will be, in contrast a strong base has a high pH
  • Reported on a 1-14 scale
  • 1 to 6.9 is acidic
  • 7 is neutral
  • 7.1 to 14 is basic or alkaline
32
Q

Buffers

A
  • Anything that works to restore balance
  • Prevents wide swings in pH
  • Consists of a weak acid and a weak base
33
Q

Acidosis

A

-If bicarbonate is depleted while neutralizing a strong acid and the pH drops below 7.35

34
Q

Alkalosis

A

-If a strong base is added to extracellular fluid and depletes carbonic acid and the pH rises above 7.45

35
Q

Deficient fluid volume (hypovolemia)

A
  • Occurs when there is a proportional loss of fluid and electrolytes from the ECF
  • May occur with surgery, trauma, or uterine rupture
36
Q

Dehydration

A

-A state of negative fluid balance in which there is loss of water from the intracellular, extracellular, or intravascular space
-3 causes:
Insufficient intake of fluids
Excessive fluid loss
Fluid shifts

37
Q

Excessive fluid volume (hypervolemia)

A
  • Involves excessive retention of sodium water in the ECF

- Results from excessive salt intake, disease affecting kidney or liver function, or poor pumping action of the heart

38
Q

Hyponatremia

A

-Na+

39
Q

Hypernatremia

A

-Na+>145 mEq/L

Common causes:
-Excessive sodium intake, water deprivation, increased water loss through profuse sweating, heat stroke, or diabetes insidious, administration of hypertonic tube feeding

Signs and symptoms:
-Thirst, elevated temp., dry mouth and sticky mucous membranes. Sever signs and symptoms include hallucinations, irritability, lethargy, seizures

Treatment:
- Monitor I&O, sodium levels, vital signs, LOC, restrict sodium in the diet, beware of hidden sodium in foods and medications, increase water intake, administer IV solutions that do not contain sodium

40
Q

Hypokalemia

A

-K+

41
Q

Hyperkalemia

A

-K+>5.0 mEq/L

Common causes:
-Renal failure, potassium-sparign diuretics, hypoaldosteronism, high potassium intake coupled with renal insufficiency, acidosis, major trauma

Signs and symptoms:
-Muscle weakness, dysrhythmias, flaccid paralysis, intestinal colic, tall T waves on ECG

Treatment:
-Monitor I&O, monitor potassium level, caution about potassium-rich food intake in patients with elevated creatinine levels.

42
Q

Hypocalcemia

A

-Ca2+

43
Q

Hypercalcemia

A
  • Ca2+>10.5 mq/dL

Common causes:
-Hyperparathyroidism, malignant bone disease, prolonged immobilization, excess calcium supplementation, thiazide diuretics

Signs and symptoms:
-Muscle weakness, constipation, anorexia, nausea, vomiting, polyuria and polydipsia, kidney stones, bizarre behavior, bradycardia

Treatment:
- Monitor I&O, encourage fluid intake to prevent stone formation, encourage fiber to prevent constipation, eliminate calcium supplements and limit calcium-rich foods, avoid calcium-based antacids, renal dialysis may be required

44
Q

Hypomagnesemia

A

-Mg2+

45
Q

Hypermagnesemia

A

-Mg2+>2.1 mEq/L

Common causes:
-Renal failure, adrenal insufficiency, excess replacement

Signs and symptoms:
-Flushing and warmth of skin, hypotension, drowsiness, lethargy, hypoactive reflexes, depressed respirations, bradycardia

Treatment:
-Monitor vital signs and airway, monitor reflexes, avoid magnesium-based antacids and laxatives, restrict dietary intake of foods high in magnesium

46
Q

Hypophosphatemia

A

-PO4-

47
Q

Hyperphosphatemia

A

-PO4-2.6 mEq/L

Common causes:
-Renal failure, hyperthyroidism, chemotherapy, excess use of phosphate-based laxative

Signs and symptoms:
-short term: tetany symptoms- tingling of extremities and cramping, long term- calcification in soft tissue

Treatment:
-Monitor serum phosphorus level, monitor for tetany, if severe administer aluminum hydroxide with meals to bind phosphorus

48
Q

CO2

A

35-45

49
Q

Acceptable range of pH for serum

A

7.35-7.45

50
Q

If you have a metabolic problem ….

A

respiratory system will compensate and vice versa

51
Q

CO2 HIGH

A

respiratory acidosis

52
Q

CO2 LOW

A

respiratory alkalosis

53
Q

HCO3 HIGH

A

metabolic alkalosis

54
Q

HCO3 LOW

A

metabolic acidosis

55
Q

Nursing assessment: fluid, electrolyte, acid-base imbalances

A
  • Head to toe
  • vital signs
  • daily weights
  • fluid I&O
  • Labs
56
Q

Urine output

A

1500 mL/day

30 mL/hour

57
Q

Feces output

A

100-200 mL/day

58
Q

Acceptable range for serum

A

7.35-7.45

59
Q

CO2 is high

A

respiratory acidosis

60
Q

CO2 is low

A

respiratory alkalosis

61
Q

HCO3 is high

A

metabolic alkalosis

62
Q

HCO3

A

metabolic acidosis

63
Q

Hypertonic

A

high concentration 375

64
Q

Isotonic

A

blood plasma 290

65
Q

Hypotonic

A

low concentration 250

66
Q

water is ______% of body weight

A

60

67
Q

Arterial blood sample

A
  • pH 7.35-7.45
  • PCO2 35-45 mm Hg
  • HCO3- 22-26 mEq/L
68
Q

Freshly voided urine sample

A

pH 5.0-9.0

Specific gravity 1.001-1.029

NSG 250 (4 decks)

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