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Adult Health > Chapter 17 exam 1 > Flashcards

Chapter 17 exam 1 Flashcards

1
Q

What is Homeostasis? (3)

A
  • State of equilibrium in body
  • Naturally maintained by adaptive responses
  • Body fluids and electrolytes are maintained within narrow limits
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2
Q

Body fluids and electrolytes are maintained within narrow limits. Definition of…?

A

Homeostasis

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3
Q

Naturally maintained by adaptive responses. Definition of…?

A

Homeostasis

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4
Q

State of equilibrium in the body. Definition of…?

A

Homeostasis

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5
Q

Water content of the body weight in ADULTS is how much % ?

A

50 - 60%

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6
Q

Water content of the body weight in OLDER ADULTS is how much % ?

A

45 - 55%

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7
Q

Water content of the body weight in INFANTS is how much % ?

A

70 - 80%

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8
Q

Who has the most WATER CONTENT of the body? Adult, Older Adult, or Infant

A

Infant, 70 - 80%

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9
Q

Who has the least WATER CONTENT of the body? Adult, Older Adult, or Infant

A

Older Adult, 45 - 55%

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10
Q

Intracellular fluid (ICF) which takes place INSIDE the cell makes up how much of body fluid?

A

2/3 of body fluid

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11
Q

Extracellular fluid (ECF) which takes place OUTSIDE of the cell makes up how much of body fluid?

A

1/3 of body fluid

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12
Q

Intravascular (plasma) vs Interstitial fluid make up how much of Extracellular fluid (ECF)?

A
  • Intravascular fluid makes up 1/3 of ECF

- Interstitial fluid makes up 2/3 of ECF

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13
Q

Substances whose molecules dissociate into ions (charged particles) when placed into water are…?

A

Electrolytes

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14
Q

Cations are positively (+) or negatively (-) charged?

A

Positively (+) charged

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15
Q

Anions are positively (+) or negatively (-) charged?

A

Negatively (-) charged

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16
Q

What is the type of measurement/ standard we use in the U.S. for Electrolytes?

A

Milliequivalent per liter (mEq)

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17
Q

mEq means…

A

Milliequivalent

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18
Q

What is the International standard of measurement for electrolytes?

A

Millimoles per liter (mmol/L)

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19
Q

Electrically charged particles are?

A

Ions

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20
Q

Sodium (Na), Potassium (K), Calcium (Ca2), Magnesium (Mg2) are examples of… Cations (+) or Anions (-) ?

A

Cations (+)

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21
Q

Bicarbonate (HCO3), Chloride (Cl), Phosphate (PO4) are examples of… Cations (+) or Anions (-) ?

A

Anions (-)

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22
Q

What are the PRIMARY prevalent Cation and Anions for Intracellular Fluid (ICF)?

A

Potassium (K+) & Phosphate (PO4 3-)

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23
Q

What are the PRIMARY prevalent Cation and Anions for Extracellular Fluid (ECF)?

A

Sodium (Na+) & Chloride (Cl-)

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24
Q

Another name for NaCl is? Table _______

A

Salt

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25
Q

6 Mechanisms for Controlling Fluid & Electrolyte Movement

A
  1. Diffusion
  2. Facilitated diffusion
  3. Active transport
  4. Osmosis
  5. Hydrostatic pressure
  6. Oncotic pressure
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26
Q

Normal serum level for anion, Bicarbonate (HCO3-) is _____?

A

22-26 mEq/L

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27
Q

Normal serum level for anion, Chloride (Cl-) is _____?

A

96-106 mEq/L

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28
Q

Normal serum level for anion, Phosphate (PO4 3-) is _____?

A

2.4- 4.4 mg/dL

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29
Q

Normal serum level for cation, Sodium (Na+)

A

135-145 mEq/L

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30
Q

Normal serum level for cation, Magnesium (Mg2+)

A

1.5-2.4 mEq/L

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31
Q

Normal serum level for cation, Calcium (Ca2+)

A

8.5-10.5 mg/dL

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32
Q

Does Solute dissolve into Solvent or does Solvent dissolve into Solute?

A

Solute dissolves into solvent. Ex. Sugar into water.

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33
Q

Movement of molecules from high to low concentration

  • Occurs in liquids, solids, and gases
  • Membrane separating two areas must be permeable to diffusing substance.
  • Requires NO ENERGY

… is what type of mechanism for controlling Fluid & Electrolytes?

A

Diffusion

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34
Q

Movement of molecules from high to low concentration without energy
Uses SPECIFIC CARRIER molecules to accelerate diffusion

… is what type of mechanism for controlling Fluid & Electrolytes

A

Facilitated Diffusion

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35
Q

Process in which molecules move AGAINST concentration gradient
Example: sodium–potassium pump
External energy required (ATP)

… is what type of mechanism for controlling Fluid & Electrolytes

A

Active Transport

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36
Q

Movement of WATER between two compartments by a membrane permeable to water but not to solute
Moves from low solute to high solute concentration
Requires no energy

Note: WATER is moving and not SOLUTE

… is what type of mechanism for controlling Fluid & Electrolytes

A

Osmosis

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37
Q

In IMPORTANT ion is involved in Active Transport (ATP) ?

A

Phosphate

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38
Q

Amount of pressure required to stop osmotic flow of water is determined by….?

A

Concentration of solutes in solution

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39
Q

Theosmotic pressureis…

A
  • minimumpressure needed to maintain equilibrium, with no net movement of solvent.
  • It depends on themolar concentrationof the solute but not on what it is (e.g., sodium, glucose, etc.)
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40
Q

When you dissolve a solute in a solvent it makes a ________ ?

A

Solution

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41
Q

The pressure of osmosis is ______ pressure?

A

Osmotic Pressure

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42
Q

What are great big protein molecules that suck up all the water and have high oncotic pressure they pull water out of everything? Colloids or Cystalloids?

A

Colloids

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43
Q

Osmotic Pressure:
Osmolality vs. Osmolarity?

  • Measure of the number of particles in the unit weight (e.g., Kg) of a SOLVENT
  • Total volume of SOLVENT is precise, final volume of SOLUTION is not.
  • MEASURED with an osmometer; typically a LAB value
  • fluids INSIDE the body
  • Examples: concentration of plasma, urine for diagnosing DM, dehydration, shock
A

Osmolality

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44
Q

Osmotic Pressure:
Osmolality vs. Osmolarity?

  • Total mOsm of SOLUTE per unit of total volume of SOLUTION
  • Total volume of SOLUTION is precise, final volume of SOLVENT is not. (e.g., Add solvent up to a final volume of 1 L.)
  • CALCULATED based on solution contents; common bedside calculation in a clinical setting for osmotic activity
  • fluids OUTSIDE of the body Ex. IV
  • This value changes with Temperature & pressure (It’s difficult to estimate w/in a dynamic system.
A

Osmolarity

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45
Q

When you increase in pressure you increase in _____?

A

Temperature

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46
Q

Recall that _______ is that substance that is dissolved by SOLVENT in SOLUTION

A

Solute

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47
Q

Osmolality (Call me Al) takes place INSIDE or OUTSIDE the body?

A

Inside

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48
Q

Osmolarity (Call me Larry) takes place INSIDE or OUTSIDE the body?

A

Outside

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49
Q

The amount of sugar in urine is an example of Osmolality or Osmolarity?

A

Osmolality

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50
Q

Pressure from an IV fluid is an example of Osmolality or Osmolarity?

A

Osmolarity

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51
Q

of m0sm (Solute) divided by total Liters of solution is, and takes place outside of the body is Osmolality or Osmolarity?

A

Osmolarity

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52
Q

What is produced inside the body, in which you are measuring it? Osmolality or Osmolarity?

A

Osmolality

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53
Q

What type of solution has low energy on the outside of the cell that pulls fluid inside the cell making it bigger and bigger until it breaks (lysis)? Hypertonic, Isotonic, or Hypotonic

A

Hypotonic

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54
Q

What type of solution has high energy to pull fluid out of the cell? Hypertonic, Isotonic, or Hypotonic

A

Hypertonic

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55
Q

Fluids with same osmolality as the cell interior (equal distribution) are termed ____? Hypertonic, Isotonic, or Hypotonic.

A

Isotonic

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56
Q

_____ are syrups that pull fluid into them.

A

Colloid

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57
Q

Hydrostatic Pressure

A
  • Force within a fluid compartment

- Major force that pushes water out of vascular system at capillary level

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58
Q

Oncotic Pressure

A

Osmotic pressure exerted by colloids in solution

- Protein is a major colloid

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59
Q

What type of IV Fluid is this? Colloid or Crystalloid

  • Like syrup
  • High osmotic pressure
  • Contains large insoluble molecules that cannot pass through capillary -membranes
  • Used to draw fluid from interstitial & intracellular spaces
  • Disadvantage: allergic reaction
  • Examples: albumin, blood, dextran, starches, gelatins
A

Colloid

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60
Q

What type of IV Fluid is this? Colloid or Crystalloid

  • Like water
  • Closest to ECF
  • Used to expand intracellular and extracellular volume
  • Can be isotonic, hypertonic, hypotonic
  • Isotonic: expansion without altering plasma electrolyte concentrations
  • Disadvantage: YOU CAN GET FLUID OVERLOAD
  • Examples: NS, LR Saline
A

Cystalloid

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61
Q

What is the BIG difference between Crystalloids and Colloids?

A

Crystalloids are going to be thinner and Colloids are going to be thicker.

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62
Q

What two pressures cause the movement of water out of the capillaries?

A

Capillary hyrdrostatic pressure and interstitial oncotic pressure.

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63
Q

What two pressures cause the movement of fluid into the capillary?

A

Plasma oncotic pressure and interstitial hyrdostatic pressure.

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64
Q

At the venous end of the capillary, the capillary hyrdrostatic pressure is (LOWER or HIGHER) than oncotic pressure, and fluid is drawn back into the capillary by the oncotic pressure created by plasma proteins.

A

LOWER

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65
Q

At the arterial end of the capillary, capillary hydrostatic pressure ______ plasma oncotic pressure, and fluid is moved into the interstitium.

A

EXCEEDS

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66
Q

What has to happen in the fluid shift of plasma-to-interstitial (Blood to tissue)?

A
  • Elevation of hydrostatic pressure
  • Decrease in plasma oncotic pressure
  • Elevation of interstitial oncotic pressure
  • Results in edema
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67
Q

What has to happen in the fluid shift of Interstitial-to-plasma (Tissue to Blood)?

A
  • Fluid drawn into plasma space with increase in plasma – osmotic or oncotic pressure
  • Compression stockings
  • Results in decrease of edema
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68
Q

What is the pressure that attracts water called?

A

Oncotic Pressure

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69
Q

Associated with symptoms that result from cell shrinkage as water is pulled into vascular system is… Water Defecit (increased ECF) or Water Excess (decreased ECF)

A

Water Defecit (increased ECF)

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70
Q

Develops from gain or retention of excess water is… (increased ECF) or Water Excess (decreased ECF)

A

Water Excess (decreased ECF)

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71
Q

What is First Spacing?

A

Normal distribution of fluid in ICF and ECF

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72
Q

What is Second Spacing?

A

Abnormal accumulation of interstitial fluid (edema)

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73
Q

What is Third Spacing?

A

Fluid accumulation in part of body where it is not easily exchanged with ECF

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74
Q

Regulation of Water Balance consists of?

A
  • Hypothalamic regulation
  • Pituitary regulation
  • Adrenal cortical regulation
  • Renal regulation
  • Cardiac regulation
  • Gastrointestinal regulation
  • Insensible water loss
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75
Q

The ability to attract water is Hydrostatic pressure or Oncotic pressure?

A

Oncotic pressure

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76
Q

The ability to push water is Hydrostatic pressure or Oncotic pressure?

A

Hydrostatic pressure

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77
Q

What type of regulation of water consists of Osmoreceptors in hypothalamus sense fluid deficit or increase, stimulates thirst and antidiuretic hormone (ADH) release, and result in increased free water and decreased plasma osmolarity?

A

Hypothalamic Regulation

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78
Q

What type of regulation of water is Under control of hypothalamus, posterior pituitary releases ADH, and stress, nausea, nicotine, and morphine also stimulate ADH?

A

Pituitary Regulation

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79
Q

What type of regulation of water consists of;

Releases hormones to regulate water and electrolytes

Glucocorticoids
- Cortisol regulates water and electrolytes, conserves them
Mineralocorticoids
- Aldosterone

A

Adrenal Cortical Regulation

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80
Q

Factors affecting aldosterone secretion?

A

Check Fig. 17-9

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81
Q

Effects of stress on fluid an electrolyte balance?

A

Check Fig. 17-10

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82
Q

What type of regulation of water consists of;

Primary organs for regulating fluid and electrolyte balance

Adjusting urine volume

  • Selective reabsorption of water and electrolytes
  • Renal tubules are sites of action of ADH and aldosterone.
A

Renal Regulation

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83
Q

What type of regulation of water consists of;
Natriuretic peptides are antagonists to the RAAS.
- Produced by cardiomyocytes in response to increased atrial pressure
- Suppress secretion of aldosterone, renin, and ADH to decrease blood volume and pressure

A

Cardiac Regualtion

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84
Q

What type of regulation of water consists of;

  • Oral intake accounts for most water.
  • Small amounts of water are eliminated by gastrointestinal tract in feces.
  • Diarrhea and vomiting can lead to significant fluid and electrolyte loss.
A

Gastrointestinal Regulation

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85
Q

What is Insensible Water Loss?

A

Invisible vaporization from lungs and skin to regulate body temperature

  • Approximately 600 to 900 mL/day is lost.
  • No electrolytes are lost.
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86
Q

What are some Gerontologic Considerations?

A
  • Structural changes in kidneys decrease ability to conserve water.
  • Hormonal changes lead to increase in ADH and ANP.
  • Loss of subcutaneous tissue leads to increased loss of moisture. Skin gets thinner
  • Reduced thirst mechanism results in decreased fluid intake. Lose moisture quicker
  • Nurse must assess for these changes and implement treatment accordingly.

�

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87
Q

Fluid and Electrolyte imbalances are common in most patient with…?

A

Common in most patients with major illness or injury

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88
Q

Fluid and Electrolyte Imbalances

A

Common in most patients with major illness or injury

  • Directly caused by illness or disease (burns or heart failure)
  • Result of therapeutic measures (IV fluid replacement or diuretics)
89
Q

What are other names for (ECF volume deficit) and (Fluid volume excess)?

A

Hypovolemia and Hypervolemia

90
Q

Abnormal loss of normal body fluids (diarrhea, fistula drainage, hemorrhage), inadequate intake, or plasma-to-interstitial fluid shift is… Hypervolemia or Hypovolemia

A

Hypovolemia

91
Q

What kind of TREATMENT is used for Hypovolemia?

A

Treatment: Replace water and electrolytes with balanced IV solutions

92
Q

XS fluid intake, abnl fluid retention, or interstitial-to-plasma fluid shift is… Hypervolemia or Hypovolemia?

A

Hypervolemia

93
Q

What kind of TREATMENT is used for Hypervolemia?

A

Treatment: Remove fluid without changing electrolyte composition or osmolality of ECF

94
Q

What are some NURSING DIAGNOSES for HYPOVOLEMIA?

A
  • Deficient fluid volume
  • Decreased cardiac output
  • Risk for deficient fluid volume
  • Potential complication: Hypovolemic shock
    �
95
Q

What are some NURSING DIAGNOSES for HYPERVOLEMIA?

A
  • XS fluid volume
  • Risk for imbalanced fluid volume
  • Ineffective airway clearance
  • Risk for impaired skin integrity
  • Disturbed body image
  • Potential complications: Pulmonary edema, ascites
96
Q

In checking I&O reading of greater than 1.025 indicate?

A

concentrated urine

97
Q

In checking I&O reading of less than 1.010 indicate?

A

dilute urine

98
Q

Changes in blood pressure, pulse force and jugular vein distention help identify?

A

Signs and symptoms of ECF volume excess and deficit

99
Q

ECF excess can result in ?

A

pulmonary congestion and pulmonary edema as increased hydrostatic pressure in the pulmonary vessels forces fluid into the alveoli .

100
Q

Pulmonary congestion and pulmonary edema as increased hydrostatic pressure in the pulmonary vessels forces fluid into the alveoli is a result of? Fluid excess or Fluid deficit?

A

ECF excess

101
Q

An increase of 1 kg (2.2 lb) is equal to how man mL of fluid retention?

A

1000 mL = 1 L of fluid retention

102
Q

What type of assessments should the nurse implement in checking Neurologic Function?

A
  • LOC
  • PERLA
  • Voluntary movement of extremities
  • Muscle strength
  • Reflexes
103
Q

Why is decreased skin turgor less predictive of fluid deficit in older persons/ adults?

A

Because of the loss of tissue elasticity. This is a result of aging.

104
Q

In performing a skin assessment what are usual sites for evaluation of skin turgor?

A

: Skin areas over the sternum, abdomen, and anterior forearm are the usual sites for evaluation of tissue turgor.

105
Q

What is invisible vaporization from the lungs and skin, that assists in regulating body temperature? Normally about 600 to 900 mL/day is lost.

A

Insensible water loss

106
Q

What is another name for excessive sweating and what causes it?

A

Sensible perspiration and it is caused by exercise, fever, or high environmental temperatures that may lead to large losses of water and electrolytes.

107
Q

Normal serum level for Potassium (K+)

A

3.5 - 5 mEq/L

108
Q

Normal serum level for Calcium (Ca2+)

A

8.5 - 105 mEq/L

109
Q

What electrolyte is this?
Normal serum level: 135-145 mEq/L
- Imbalances typically associated with parallel changes in osmolality

A

Sodium (Na+) Cation

110
Q

What are the major roles of Sodium (Na+) Cation?

A

Plays a major role in

  • ECF volume and concentration
  • Generation and transmission of nerve impulses
  • Acid-base balance
111
Q

Hyponatremia or Hypernatremia?
-Elevated serum sodium occurring with water loss or sodium gain
-Causes hyperosmolality leading to cellular dehydration
Primary protection is thirst from hypothalamus.

A

Hypernatremia

112
Q

What are manifestations of Hypernatremia?

A

Manifestations:
Thirst, lethargy, agitation, seizures, and coma
Impaired LOC

113
Q

What clinical states produce Hypernatremia?

A

Central or nephrogenic Diabetes insipidus

114
Q

Nursing Diagnoses for Hypernatremia?

A
  • Risk for injury
  • Risk for electrolyte imbalance
  • Potential complication: Seizures and coma leading to irreversible brain damage
115
Q

Nursing Implementation for Hypernatremia?

A
  • Treat underlying cause.
  • If oral fluids cannot be ingested, IV solution of 5% dextrose in water or hypotonic saline
  • Diuretics
116
Q

Results from loss of sodium-containing fluids or from water excess is Hypernatremia or Hyponatremia?

A

Hyponatremia

117
Q

Manifestations of Hyponatremia?

A

Manifestations

Confusion, nausea, vomiting, seizures, and coma

118
Q

Nursing Diagnoses for Hyponatremia?

A
  • Risk for injury
  • Risk for electrolyte imbalance
  • Potential complication: Severe neurologic changes
119
Q

Nursing Implementation for Hyponatremia?

A 
Caused by water excess
- Fluid restriction is needed.
Severe symptoms (seizures)
- Give small amount of IV hypertonic saline solution (3% NaCl).
- Abnormal fluid loss
Fluid replacement with Na+ solution
Vasopressins
120
Q

What electrolyte is a MAJOR ICF Cation?

A

Potassium (K+) Cation

121
Q

Potassium (K+) is necessary for…

A

Necessary for

  • Transmission and conduction of nerve & muscle i–impulses
  • Cellular growth
  • Cardiac rhythms
  • Acid-base balance
122
Q

What are some sources of Potassium (K+) Cation?

A
  • Fruits and vegetables
  • Salt substitutes
  • Potassium medications (PO, IV)
  • Stored blood
123
Q

Hyperkalemia is most common in what type of failure?

A

Renal failure

124
Q 
Hyperkalemia or Hypokalemia?
High serum potassium caused by
-Massive intake
-Impaired renal excretion
-Shift from ICF to ECF
A

Hyperkalemia

125
Q

What are some manifestations of Hyperkalemia?

A
  • Cramping leg pain
  • Weak or paralyzed skeletal muscles
  • Ventricular fibrillation or cardiac standstill
  • Abdominal cramping or diarrhea
126
Q

Nursing Diagnoses for Hyperkalemia?

A
  • Risk for electrolyte imbalance
  • Risk for injury
  • Potential complication: Dysrhythmias
127
Q

Nursing Implementation for Hyperkalemia?

A
  • Eliminate oral and parenteral K intake.
  • Increase elimination of K (diuretics, dialysis, Kayexalate).
  • Force K from ECF to ICF by IV insulin or sodium bicarbonate.
  • Reverse membrane effects of elevated ECF potassium by administering calcium gluconate IV
128
Q 
Hyperkalemia or Hypokalemia?
Low serum K+ caused by
-Abnormal losses of K+ via the kidneys or gastrointestinal tract
-Magnesium deficiency
-Metabolic alkalosis
A

Hypokalemia

129
Q

Manifestations of Hypokalemia

A
  • Most serious are cardiac.
  • Skeletal muscle weakness (legs)
  • Weakness of respiratory muscles
  • Decreased gastrointestinal motility
  • Impaired regulation of arteriolar blood flow
130
Q

Nursing Diagnoses for Hypokalemia?

A
  • Risk for electrolyte imbalance
  • Risk for injury
  • Potential complication: Dysrhythmias
131
Q

Nursing implementations for Hypokalemia?

A

-KCl supplements orally or IV
-Should not exceed 10 to 20 mEq/hr
To prevent hyperkalemia and cardiac arrest

132
Q

What electrolyte is this?

  • Obtained from ingested foods
  • More than 99% combined with phosphorus and concentrated in skeletal system
  • Inverse relationship with phosphorus
  • Bones are readily available store.
  • Blocks sodium transport and stabilizes cell membrane
  • Ionized form is biologically active
A

Calcium (Ca2+) Cation

133
Q

What has electrolyte has an inverse relationship with Phosphorus?

A

Calcium (Ca2+) Cation

134
Q

What are the function of Calcium (Ca2+)

A

Functions

  • Nerve impulse transmission
  • Myocardial contractions
  • Blood clotting
  • Formation of teeth and bone
  • Muscle contractions
135
Q

The balance of Calcium is controlled by?

A
  • Parathyroid hormone
  • Calcitonin
  • Vitamin D
136
Q 
Is this Hypercalcemia or Hypocalcemia?
High serum calcium levels caused by
-Hyperparathyroidism (two thirds of cases)
-Malignancy 
-Vitamin D overdose
-Prolonged immobilization
A

Hypercalcemia

137
Q

Manifestations of Hypercalcemia?

A

Manifestations

  • Decreased memory
  • Confusion
  • Disorientation
  • Fatigue
  • Constipation
138
Q

Nursing Diagnoses of Hypercalcemia?

A
  • Risk for electrolyte imbalance
  • Risk for injury
  • Potential complication: Dysrhythmias
139
Q

Nursing Implementation of Hypercalcemia?

A
  • Excretion of Ca with loop diuretic
  • Hydration with isotonic saline infusion
  • Synthetic calcitonin
  • Mobilization
140
Q 
Is this Hypercalcemia or Hypocalcemia?
Low serum Ca caused by
-decrease production of PTH
-Acute pancreatitis 
-Multiple blood transfusions 
-Alkalosis
-decreased intake
A

Hypocalcemia

141
Q

Manifestations of Hypocalcemia?

A
  • Positive Trousseau’s or Chvostek’s sign
  • Laryngeal stridor
  • Dysphagia
  • Tingling around mouth or in the extremities
142
Q

What is Trousseau’s sign? This is a manifestation of what?

A

Is a carpal spasm induced by inflating a blood pressure cuff above the systolic pressure for a few minutes. Hypocalcemia

143
Q

What is Chvosteks sign? This is a manifestation of what?

A

Is a contraction of facial muscles in response to a light tap over the facial nerve in front of the ear? Hypocalcemia

144
Q

Nursing DIagnoses of Hypocalcemia?

A
  • Risk for electrolyte imbalance
  • Risk for injury
  • Potential complication: Fracture or respiratory arrest
145
Q

Nursing Implementations of Hypocalcemia?

A

-Treat cause.
-Oral or IV calcium supplements
Not IM to avoid local reactions
-Treat pain and anxiety to prevent hyperventilation-induced respiratory alkalosis.

146
Q

What electrolyte is this?

  • Normal serum Mg: 1.5-2.4 mEq/L
  • 50% to 60% contained in bone.
  • Coenzyme in metabolism of protein and carbohydrates
  • Factors that regulate calcium balance appear to influence magnesium balance.
  • Acts directly on myoneural junction
  • Important for normal cardiac function
A

Magnesium (Mg2+) Cation

147
Q

What electrolyte is a coenzyme in metabolism of protein and carbohydrates?

A

Magnesium (Mg2+) Cation

148
Q

This electrolyte acts directly on myoneural junction and is important for normal cardiac function.

A

Magnesium (Mg2+) Cation

149
Q

What is Hypermagnesemia, High serum Mg caused by?

A

Increased intake or ingestion of products containing magnesium when renal insufficiency or failure is present

150
Q

What are manifestations of Hypermagnesemia?

A
  • Lethargy or drowsiness
  • Nausea/vomiting
  • Impaired reflexes
  • Somnolence
  • Respiratory and cardiac arrest
151
Q

What management can nurses provide for a patient with Hypermagnesemia?

A

-Prevention
-Emergency treatment
IV CaCl or calcium gluconate
-Fluids to promote urinary excretion

152
Q

Is this Hypermagnesemia or Hypomagnesemia?

A

Low serum Mg caused by

  • Prolonged fasting or starvation
  • Chronic alcoholism
  • Fluid loss from gastrointestinal tract
  • Prolonged parenteral nutrition without supplementation
  • Diuretics
153
Q

What are manifestations of Hypomagnesemia?

A
  • Confusion
  • Hyperactive deep tendon reflexes
  • Tremors
  • Seizures
  • Cardiac dysrhythmias
154
Q

Management for Hypomagnesemia?

A
  • Oral supplements
  • Increase dietary intake.
  • Parenteral IV or IM magnesium when severe
155
Q

This electrolyte normal serum level is 2.4-4.4 mg/dL and is the a PRIMARY anion in ICF.

A

Phosphate (PO4 3-) Anion

156
Q

What electrolyte is this?

  • Essential to function of muscle, red blood cells, and nervous system
  • Deposited with calcium for bone and tooth structure
  • Involved in acid-base buffering system, ATP production, and cellular uptake of glucose
  • Maintenance requires adequate renal functioning.
  • A reciprocal relationship exists between phosphorus and calcium in that a high serum phosphate level tends to cause a low calcium concentration in the serum.
A

Phosphate (PO4 3-) Anion

157
Q 
Hyperphosphatemia or Hypophosphatemia?
High serum PO43- caused by 
-Acute or chronic renal failure
-Chemotherapy
-Excessive ingestion of phosphate or vit D
A

Hyperphosphatemia

158
Q

Manifestations of Hyperphosphatemia?

A
  • Calcified deposits in soft tissue such as joints, arteries, skin, kidneys, and corneas
  • Neuromuscular irritability and tetany
159
Q

Management of Hyperphosphatemia?

A
  • Identify and treat underlying cause.
  • Restrict foods and fluids containing phosphorus.
  • Adequate hydration and correction of hypocalcemic conditions
160
Q

What is Hypophosphatemia (Low serum P04 3- caused by…)?

A
  • Malnourishment/malabsorption
  • Alcohol withdrawal
  • Use of phosphate-binding antacids
  • During parenteral nutrition with inadequate replacement
161
Q

Manifestations of Hypophasphatemia?

A
  • CNS depression
  • Confusion
  • Muscle weakness and pain
  • Dysrhythmias
  • Cardiomyopathy
162
Q

Management of Hyphosphatemia?

A
  • Oral supplementation
  • Ingestion of foods high in phosphorus
  • IV administration of sodium or potassium phosphate
163
Q

What are TWO purposes for IV FLUIDS?

A
  1. Maintenance: When oral intake is not adequate

2. Replacement: When losses have occurred

164
Q 
Hypotonic, Isotonic, or Hypertonic IV Fluid?
-More water than electrolytes
Pure water lyses RBCs.
-Water moves from ECF to ICF by osmosis.
-Usually maintenance fluids
A

Hypotonic IV Fluid

165
Q

Hypotonic, Isotonic, or Hypertonic IV Fluid?

  • Expands only ECF
  • No net loss or gain from ICF
A

Isotonic IV Fluid

166
Q

Hypotonic, Isotonic, or Hypertonic IV Fluid?
-Initially expands and raises the osmolality of ECF
-Require frequent monitoring of
Blood pressure
Lung sounds
Serum sodium levels

A

Hypertonic IV Fluid

167
Q

D5W is?

A

5% dextrose in water

168
Q

This IV Fluid is used to replace water losses and treat hyponatremia and does not provide electrolytes.

A

D5W 5% dextrose in water

169
Q

What IV Fluid is this?

  • Isotonic
  • Provides 170 cal/L
  • Free water, Moves into ICF, Increases renal solute excretion
A

D5W 5% dextrose in water

170
Q

Normal Saline (NS) is made up of what?

A

0.9% sodium chloride in water

171
Q 
What IV Fluid is this?
-No calories
-More NaCl than ECF
-30% stays in IV (most)
70% moves out of IV
-Compatible with most medications
A

Normal Saline (NS) 0.9% Sodium Chloride in water

172
Q

What IV Fluid is this?
Expands IV volume
-Preferred fluid for immediate response
-Risk for fluid overload higher

A

Normal Saline (NS) 0.9% Sodium Chloride in water

173
Q

What IV Fluid is this?
Does not change ICF volume
Use with blood products

A

Normal Saline (NS) 0.9% Sodium Chloride in water

174
Q 
What IV Fluid is this?
-Isotonic
-More similar to plasma than NS
Has less NaCl
Has K, Ca, PO43-, lactate (metabolized to HCO3)
-Expands ECF
A

Lactated Ringer’s

175
Q

D5 1/2 NS is made up of?

A

5% dextrose in 0.45% (half) normal saline

176
Q

What IV Fluid is this?

  • Hypertonic
  • Common maintenance fluid
  • KCl added for maintenance or replacement
A

D5 1/2 NS

177
Q

D10W is?

A

10% dextrose in water

178
Q

What IV Fluid is this?

  • Hypertonic
  • Provides 340 kcal/L
  • Free water
  • Limit of dextrose concentration may be infused -peripherally.
A

D10W

179
Q

Plasma expanders do what?

A
  • stay in vascular space

- increase osmotic pressure

180
Q

Colloids (protein solutions) are?

A
  • Albumin
  • Plasma
  • Commercial plasmas
  • Packed RBCs
181
Q

What is the purpose of Acid-Base Balance and Arterial Blood Gases

A

-Maintain a steady balance between acids and bases to achieve homeostasis
-Health problems lead to imbalance
Diabetes mellitus
Vomiting and diarrhea
Respiratory conditions

182
Q

What is the normal range of pH and blood is slightly alkaline at?

A

7.35 to 7.45

183
Q

What is the ratio of Carbonic acid to Base Bicarbonate

A

1:20

184
Q

Acidosis is?

A

less than <7.5 pH

185
Q

Alkalosis is?

A

greater than >7.5 pH

186
Q

pH is the measure of?

A

H+ ion concentration

187
Q

What is the system at work to buff pH?

A

CO2+H20 H2CO3 H+ + HCO3-

188
Q

Regulators of Acid/Base

Metabolic processes produce acids that must…?

A

be neutralized and excreted

189
Q

Regulators of Acid/Base mechanisms are? (3)

A
  • Buffers
  • Respiratory System
  • Renal System
190
Q

Act chemically to neutralize acids or change strong acids to weak acids. What type of regulator of Acid/Base is this?

A

Buffers

191
Q

What 3 characteristics do Buffers have?

A
  • Primary regulators
  • React immediately
  • Cannot maintain pH without adequate respiratory and renal function
192
Q

Regulators of Acid/Base

Respiratory system eliminates what?

A

CO2

193
Q

Regulators of Acid/Base

The respiratory center in the ______ controls breathing?

A

Medulla

194
Q

Regulators of Acid/Base

Respiratory system responds within _____ to _____ to changes in acid and base.

A

minutes/hours

195
Q

Regulators of Acid/ Base
Respiratory system ______ (increased/decreased) respirations lead to _______ (increased/decreased) CO2 elimination and ________ (increased/decreased) CO2 in blood.

A

Increased
Increased
Decreased

196
Q

Regulators of Acid/Base

The Slower Response (metabolic) Renal System does what?

A

Eliminates H+ and reabsorbs HC03-

197
Q

Regarding regulation of Acid/ Base Is this Respiratory system or Renal System?

  • Reabsorption and secretion of electrolytes (e.g., Na+, Cl-)
  • Responds within hours to days
A

Renal System (Slower Response)

198
Q

What are Alterations in Acid-Base balance?

A

Imbalances occur when compensatory mechanisms fail.
Classification of imbalances
Respiratory: Affect carbonic acid concentration
Metabolic: Affect bicarbonate

199
Q

What are the classifications of imbalances in Acid-Base?

A

Respiratory: Affect carbonic acid concentration
Metabolic: Affect bicarbonate

200
Q

Respiratory Acid-Base imbalance affect?

A

Carbonic acid concentration

201
Q

Metabolic Acid-Base imbalance affect?

A

Bicarbonate

202
Q

Regarding to alterations in Acid-Base Balance what does it mean to be compensated?

A

pH is in normal range but tends toward the extreme end of normal range for the condition

203
Q

Regarding to alterations in Acid-Base Balance this is an example of what?
Example: pH = 7.35 is normal, but if PaCO2 = 48 mm Hg, we have compensated respiratory acidosis

A

Compensated.

204
Q

Respiratory imbalances caused by carbonic acid (CA) _____(excess/deficit) and carbonic acid ______. (excess/defecit).

A

excess

defecit

205
Q

Metabolic imbalances caused by base bicarbonate (BB) _____(excess/deficit) and base bicarbonate ______(excess/defecit).

A

defecit

excess

206
Q 
Is this Respiratory Acidosis or Alkalosis?
Carbonic acid XS caused by
-Hypoventilation
-Respiratory failure
Compensation in Kidneys 
-conserve HCO3- 
-secrete H+ into urine
A

Respiratory Acidosis

207
Q

Is this Respiratory Acidosis or Alkalosis?
Carbonic acid deficit causes
-Hyperventilation
-Hypoxemia from acute pulmonary disorders
Compensation
-Rarely occurs because of aggressive treatment of causes of hypoxemia

A

Respiratory Alkalosis

208
Q 
Is this Metabolic Acidosis or Alkalosis?
Base bicarbonate deficit caused by, Ketoacidosis, Lactic acid accumulation (shock), Severe diarrhea, Kidney disease
Compensation
-Increased CO2 excretion by lungs
-Kussmaul respirations (deep and rapid)
-Kidneys excrete acid
A

Metabolic Acidosis

209
Q

Is this Metabolic Acidosis or Alkalosis?
Base bicarbonate XS caused by Prolonged vomiting or gastric suction, Gain of HCO3-
Compensation
-Decreased respiratory rate to increase plasma CO2
-Renal excretion of HCO3-

A

Metabolic Alkalosis

210
Q

Arterial blood gas (ABG) values provide information about?

A
  • Acid-base status
  • Underlying cause of imbalance
  • Body’s ability to regulate pH
  • Overall oxygen status
211
Q

Interpretation of ABG’s?

What are the 6 steps of Diagnosis

A
  1. Evaluate pH: NL, Acidotic, Alkylotic?
  2. Analyze PaCO2 = respiratory component
  3. Analyze HCO3- = metabolic component
  4. If CO2 or HCO3- are within NL range, ABGs are considered NL if pH is also within NL range
  5. Determine if CO2 or HCO3- matches the alteration.
  6. Decide if the body is attempting to compensate.
212
Q

pH 7.36
PaCO2 67 mm Hg
PaO2 47 mm Hg
HCO3 37 mEq/L

What is this?

A

Respiratory Acidosis

213
Q

pH 7.18
PaCO2 38 mm Hg
PaO2 70 mm Hg
HCO3- 15 mEq/L

What is this?

A

Metabolic Acidosis

214
Q

pH 7.60
PaCO2 30 mm Hg
PaO2 60 mm Hg
HCO3- 22 mEq/L

What is this?

A

Respiratory Alkalosis

215
Q

pH 7.58
PaCO2 35 mm Hg
PaO2 75 mm Hg
HCO3- 50 mEq/L

What is this?

A

Metabolic Alkalosis

216
Q

What is the Acid-Base Mnemonic?

A 
ROME
R espiratory
O pposite
M etabolic
E qual
217
Q

What does Respiratory Opposite mean?

A

Alkalosis INCREASE in pH DECREASE in PaC02

Acidosis DECREASE in pH INCREASE in PaC02

218
Q

What does Metabolic Equal mean?

A

Acidosis DECREASE in pH DECREASE in HC03

Alkalosis INCREASE in pH INCREASE in HC03

219
Q

This is what type of pressure?

  • minimum pressure needed to maintain equilibrium, with no net movement of solvent.
  • It depends on the molar concentration of the solute but not on what it is (e.g., sodium, glucose, etc.)
A

Osmotic Pressure

Adult Health (9 decks)

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