Ch 45. Agents Affecting the Volume and Ion Content of Body Fluids

Question 1

What is the decrease in total body water?

Answer 1

vol contraction

Question 2

What is the increase in total body water?

Answer 2

volume expansion

Question 3

What are the causes of isotonic contraction?

Answer 3

vomiting, diarrhea, kidney disease, and misuse of diuretics

Question 4

What is isotonic contraction?

Answer 4

Volume contraction in which Na and H2O are lost in isotonic proportions

Decrease in total volume but no change in osmolarity

Question 5

Treatment for isotonic contraction?

Answer 5

fluids isotonic to plasma
.9% NS
give fluids slowly

Question 6

What is hypertonic contraction?

Answer 6

• loss of water exceeds loss of Na
• reduced ECF volume and increase in osmolarity

Question 7

What are the causes of hypertonic contraction?

Answer 7

• excessive sweating, osmotic diuresis.
• secondary to extensive burns or CNS disorders that interfere with thirst.

Question 8

Treatment for hypertonic contraction?

Answer 8

hypotonic fluids (.45% NaCl) or fluids that contain no solutes

intial therapy: drink water

Question 9

What is hypotonic contraction?

Answer 9

= loss of Na exceeds loss of H2O
= both volume and osmorality of ECF are reduced

Question 10

Causes of hypotonic contraction?

Answer 10

excessive loss of Na through kidney

Question 11

Tx for hypotonic contraction?

Answer 11

Mild: infusing isotonic NaCl solution for injection
Severe: hypertonic solution 3% NaCl

Question 12

What is the cause of volume expansion?

Answer 12

• overdose with therapeutic fluids
• disease states

Question 13

What are acid-base disturbances?

Answer 13

• respiratory alkalosis
• respiratory acidosis
• metabolic alkalosis
• metabolic acidosis

Question 14

Tx for volume expansion

Answer 14

diuretics and agents used for heart failure

Question 15

What is the cause of respiratory alkalosis?

Answer 15

hyperventilation causes decrease in CO2

Question 16

Treatment for respiratory alkalosis?

Answer 16

Mild: none
Severe: rebreathe CO2 laden expired breath

Question 17

What is the cause of respiratory acidosis?

Answer 17

retention of CO2 secondary to hypoventilation

Question 18

Tx for respiratory acidosis?

Answer 18

• correction of respiratory impairment
• infusion of NaHCO3 if severe

Question 19

What is the cause of metabolic akalosis?

Answer 19

• excessive loss of gastric acid
• administration of alkalinizing salts.

Question 20

Tx for metabolic alkalosis?

Answer 20

solution of NaCl + KCl

Question 21

What are the causes of metabolic acidosis?

Answer 21

• chronic renal failure
• loss of bicarbonate during severe diarrhea
• metabolic disorders
• poisoning by methanol and certain medications.

Question 22

Tx of metabolic acidosis?

Answer 22

correction of the underlying cause of acidosis
alkalinizing salt if severe

Question 23

What is the most abundant intracellular cation?

Answer 23

Potassium

Question 24

What are the major role of K+?

Answer 24

conduction nerve impulses
maintaining the electrical excitability of muscle
regulating acid-base balance

Question 25

What is HYPOkalemia?

Answer 25

serum potassium levels are less than 3.5

Question 26

Tx for hypokalemia?

Answer 26

thiazide or loop diuretic

Question 27

Consequences of hypokalemia?

Answer 27

adverse effects on skeletal & smooth muscles, b.p. and heart

Question 28

Hypokalemia increases risk for ______ and ______

Answer 28

hypertension and stroke

Question 29

___ Deficiency frequently coexists with hypokalemia?

Answer 29

Chloride

Question 30

What is the tx for mild hypokalemia?

Answer 30

oral potassium chloride (KCl)

Question 31

What is the tx for severe hypokalemia or if client cannot take oral meds?

Answer 31

IV potassium chloride

Question 32

What is hyperkalemia?

Answer 32

excessive elevation of serum potassium

Question 33

What causes hyperkalemia?

Answer 33

- severe tissue trauma, untreated Addison's disease - acute acidosis - potassium-sparing diuretics or OD with oral or IV potassium

Question 34

What are some consequences of hyperkalemia?

Answer 34

- disruption of electrical activity of the heart

Question 35

What is the mild elevation of hyperkalemia?

Answer 35

5-7 mmol/L

Question 36

What is the consequence of mild elevation hyperkalemia?

Answer 36

T wave heightens; PR prolonged

Question 37

What is the severe elevation for hyperkalemia?

Answer 37

8-9 mmol/L

Question 38

What is the consequence of severe elevation hyperkalemia?

Answer 38

cardiac arrest

Question 39

What are the noncardiac signs consequences for hyperkalemia?

Answer 39

- confusion, anxiety, dyspnea, weakness or heaviness of legs, numbness/tingling of hands/feet/lips

Question 40

Tx for hyperkalemia?

Answer 40

- withholds foods that contain potassium - withholds meds that promote potassium accumulation: potassium supplements, potassium- sparing diuretics - lower extracellular levels of potassium

Question 41

Causes of hypomagnesemia?

Answer 41

- diarrhea - hemodialysis - kidney disease - prolonged IV feeding - chronic alcoholism - hypermagnesemia

Question 42

What are the adverse effects for hypomagnesemia?

Answer 42

- respiratory paralysis at 12-15 mEq/L - cardiac arrest when Mg levels exceed 25 mEq/L

Question 43

Prevention & Tx for hypomagnesemia?

Answer 43

- magnesium oxide - magnesium sulfate - IM o r Iv

Question 44

Who are susceptible to hypermagnesemia?

Answer 44

pts with renal insufficiency esp when pt uses magnesium- containing antacids or cathartics

Question 45

What are the symptoms of mild intoxication for hypermagnesemia?

Answer 45

muscle weakness, hypotension, sedation and ECG changes

Question 46

What is the consequence for higher magnesium concentrations?

Answer 46

risk of cardiac arrest.