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Pathophysiology for PN > Ch 8: Altered Fluid and Electrolyte > Flashcards

Ch 8: Altered Fluid and Electrolyte Flashcards

1
Q

Body fluids are solutions composed of:

A

▫️water
▫️electrolytes
▫️non electrolytes

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2
Q

Electrolytes:

▫️cations: Na+; K+; anions: Cl-

A

Nonelectrolytes - glucose, urea

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3
Q

Plasma proteins:

A

▫️Albumin
▫️globulins
▫️prothrombin
▫️fibrinogen

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4
Q

Intracellular proteins: large quantity

A

▫️Myoglobin
▫️Hormones
▫️NT
▫️Enzymes

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5
Q

Electrolytes Imbalances

🔘Major ions:

A 
▫️sodium
▫️potassium 
▫️chloride
▫️calcium
▫️magnesium
▫️phosphate
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6
Q 
Variations in distribution of body fluids
▫️infants
▫️childhood 
▫️adolescents 
▫️adults
▫️elderly
A 
▫️infants: 75-85% TBW
▫️childhood: 60-65%
▫️adolescence: similar to adults
▫️adults: lean and muscular frame 70%
                   Female 50%
                   Male 60%
                   Obese 40-45%
▫️elderly: 45%
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7
Q

Function of water:

A

▫️solvent/transporter of nutrients, gases and wastes
▫️cushioning
▫️major components of mucus
▫️body temperature regulation (evaporative heat loss)
▫️medium for chemical reactions

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8
Q

Function of electrolytes: concentration must be tightly regulated

A

▫️Na+ and K+ for action potentials along neurons and muscle cells (♥️ and brain)
▫️Zn, Cu and Mg2+ are co-factors for enzymes
▫️Ca2+ for blood clotting, muscle contraction, bone and teeth mineralization, and neurotransmission.

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9
Q

Water movement occurs by osmosis- passive transport

A

▫️Na+

▫️Albumin

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10
Q

Hormonal Regulation of fluid and electrolytes:

A

▫️ADH (act on kidneys ⬆️H20 absorption)
▫️Aldosterone (stimulates reabsorption of Na+ as well as secretion of K+ and H+)
▫️ANP-Atrial natriuretic peptide (Adrenal medulla inhibits aldosterone release)

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11
Q

Body fluids are divided between two main compartments:

A

▫️ICF - fluid inside cells, about 1/2 to 2/3 of total body fluids
Helps maintain cell shape. Assists with transport of nutrients across cell membrane, in and out of the cell.
Major ions are: K+, Mg and phosphate (and proteins)

▫️ECF -fluid outside cell, 1/3 of body fluid. Mostly as interstitial fluid and intravascular (plasma).
Major ions are: Na+, Cl- and carbonate

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12
Q

The watery fluid in blood known as plasma

A

Intravascular fluid

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13
Q

The volume of ECF is the most important regulated aspect of body fluid balance. Without adequate ECF, the body cannot maintain _______

A

Normal blood pressure

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14
Q

Too much ECF can place a person in a fluid overload state, leading to a ______

A

HBP and risk for CHF

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15
Q

_____is the fluid that is that is most important in fluid balance

A

ECF

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16
Q

Factors which move fluid from plasma to interstitial space:

A

▫️blood hydrostatic pressure

▫️increased capillary permeability (inflammation)

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17
Q

Factors which move fluid from interstitial space to plasma:

A

▫️Blood osmotic pressure

- plasma proteins, mainly albumin

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18
Q

Excess fluid in interstitial space

A

▫️Edema

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19
Q

Mechanism involved in the development of edema can also lead to:

A

▫️third-space shifts

20
Q

Fluid in the peritoneal cavity

A

Ascites

21
Q

Fluid in interstitial space of respiratory or in alveoli

A

Pulmonary edema

22
Q

Fluid in pleural space

A

Pleural effusion

23
Q

Fluid in the pericardial space

A

Pericardial effusion

24
Q

Four major processes in the development of edema

A
  1. Increase in capillary hydrostatic pressure
  2. Increase in capillary permeability
  3. decrease in colloid onconic pressure (loss of albumin)
  4. Obstruction in lymphatic drainage
25
Q

Consequences of edema:

A

▫️increased distance for diffusion of nutrients, oxygen, and wastes between tissue cells and circulatory system
▫️compression of nerves, blood vessels, other hollow tubes
▫️can be disfiguring

26
Q

Alteration in fluid and electrolyte balance

A

▫️sodium imbalance - hyponatremia and hypernatremia

▫️negative fluid balance - hypovolemia

27
Q

Causes of Dehydration:

A

▫️⬇️fluid intake
▫️⬆️fluid output (heat exposure/ heavy exercise)
▫️extreme Na+ loss or lack of Na+ intake (hyponatremia)
▫️excessive Na+ intake (hypernatremia)
▫️fluid shift between compartments
▫️SIADH-syndrome of inappropriate antidiuretic hormone secretion

28
Q

Manifestation of Dehydration:

A 
▫️thirst
▫️dry mucous membranes 
▫️decreased or absent tears
▫️change in vital signs
       ⬆️ respiration rate
       ⬇️ blood pressure 
        Weak pulse
▫️prolonged capillary refill time
▫️depressed fontanels
▫️⬇️ or absent urine output
▫️⬇️level of consciousness
29
Q

Attempts to compensate for fluid loss:

A 
▫️⬆️ing thirst
▫️⬆️ing ♥️ rate
▫️constriction of cutaneous blood vessels
▫️producing less urine
▫️concentrating urine
30
Q

Dehydration treatment:

A

▫️rehydration
Oral
Intravenous
▫️correction of electrolyte imbalances

31
Q

Causes of hyponatremia:

A 
▫️losses from excessive sweating, vomiting, diarrhea
▫️use of certain diuretic drugs combined with low-salt diets
▫️hormonal imbalances
       🔸insufficient aldosterone 
       🔸adrenal insufficiency 
       🔸excess ADH secretion
▫️Diuresis
▫️Excessive water intake
32
Q

Effects of hyponatremia:

A

▫️low Na+ levels

▫️decreased osmotic pressure in ECF compartment

33
Q

▫️cause is balance in Na+ and water
🔸insufficient ADH (diabetes insipidus)
-results in large volume of dilute urine
🔸loss of the thirst mechanism
🔸watery diarrhea
🔸prolonged periods of rapid respiration
🔸ingestion of large amounts of sodium without enough water.

A

Hypernatremia

34
Q

Effects of hypernatremia..

A 
▫️weakness, agitation 
▫️dry, rough mucous membranes 
▫️edema
▫️⬆️thirst 
▫️⬆️ BP
35
Q

K+ has two main roles:

A
  1. Nerve impulse conduction and muscle contraction

2. Maintain acid-base balance

36
Q

Acidemia leads to ______

Alkalemia leads to ______

A

Hyperkalemia

Hypokalemia

37
Q

Common causes of hyperkalemia:

A

▫️released from ICF to ECF
🔺injury to cells: burns, trauma
🔺acidosis
▫️inadequate elimination
🔺kidney failure: no longer able to excrete K+ ions
▫️excessive intake
🔺K+ supplements or too much dietary K+
🔺use of salts substitutes (contain K+)
▫️K+ sparring diuretics
▫️deficit of aldosterone

38
Q

Common causes of Hypokalemia:

A

▫️excessive losses
🔺vomiting, diarrhea
🔺abnormal loss through kidneys: diuretics or tubular disease.
▫️Excessive aldosterone or glucocorticoids (I.e. Cushing syndrome)
▫️Decreased dietary intake
🔺alcoholism, eating disorders, starvation
▫️treatment of diabetic ketoacidosis with insulin (insulin causes increased K+ uptake by the Na+ pump)

39
Q

Effects of hypercalcemia

A

▫️depressed neuromuscular activity

▫️interference with ADH function

▫️Increased strength in cardiac contractions

40
Q

Four main functions of Magnesium

A
  1. enzyme activity [co-factor]
  2. energy production and ATP - cofactor
  3. DNA and RNA protection and repair
  4. Mineral balance - regulates other ions
41
Q

▫️results from malabsorption or malnutrition often associated with alcoholism
▫️use of diuretics, diabetic ketoacidosis, hyperthyroidism, hyperaldosteronism

A

Hypomagnesimia

42
Q

▫️Occurs with renal failure
▫️depresses neuromuscular function
▫️decreased reflexes

A

Hypermagnesemia

43
Q

Numerous phosphate functions

A

▫️ bone and tooth mineralization
▫️important in metabolism of ATP
▫️phosphate buffer System - acid base balance
▫️integral part of the cell membrane
▫️reciprocal relationship with serum calcium

44
Q

Malabsorption syndromes, diarrhea, excessive antacids

A

Hypophosphatemia

45
Q

This phosphate imbalance is caused by renal failure… others: hypocalcemia,

A

Hyperphosphatemia

46
Q

Chloride imbalance usually associated with alkalosis. 🔺early stages of vomiting - loss of hydrochloric acid

A

Hypochloremia

47
Q

Is an excessive sodium chloride intake

A

Hyperchloremia

Pathophysiology for PN (14 decks)

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