Chapter 3 Review Q&A Flashcards
***Infants are more susceptible to significant losses in TBW
Kidney are not mature enough to deal with fluid losses
Infants are more susceptible to change in water because they have
High metabolic rate
Greater total body surface area in proportion to total body size
**Obesity creates a greater risk for dehydration in people because
Adipose cells contain little water because Fat is WATER REPELLANT
There is a lot/little body water in adipose tissue
Little
***Water movement between the intracellular fluid compartment and the extracellular fluid compartment is primarily function of
OSMOTIC forces
***In addition to OSMOSIS, what is the force involved in the movement of water between the plasma and interstitial fluid space?
HYDROSTATIC PRESSURE
Water moves between the plasma and interstitial fluid through the forces of ________and _______Accross the ________ ________
Osmosis
Hydrostatic pressure
Capillary membrane.
What does oncotic pressure do?
encourage water to cross the barrier of capillaries to enter the circulatory system.
**Venous obstruction is a cause of edema because of an increase in which pressure?
CAPILLARY HYDROSTATIC PRESSURE
Venous obstruction can increase the hydrostatic pressure of fluid in the ________enough to cause fluid to escape into the ________Space
Capillaries; interstitial spaces
***At the arterial end of capillaries , fluid moves from the intravascular space into the interstitial space because the
Capillary HYDROSTATIC pressure is HIGHER than the capillary ONCOTIC PRESSURE
***Low plasma albumin causes edema as a result of a reduction in which
PLASMA ONCOTIC pressure
What is the ONLY thing that leads to a decreased in plasma oncotic pressure?
Decrease ALBUMIN
***Secretion of the ADH hormone and the perception of thirst are stimulated by?
INCREASED IN PLASMA OSMOLALITY
***Thirst activates osmoreceptors by an increase in which in BLOOD PLASMA?
OSMOTIC PRESSURE
Thirst is experienced when water loss equals ____% of body weight or when ______ ______Increases
2%; Osmotic pressure
What are the osmo-receptors? what are they stimulated by ?
Neurons in the hypothalamus stimulated by INCREASED IN OSMOTIC PRESSURE
***It is true that natriuretic peptides: { in/de BP, water and sodium retain/excrete)
Decreased BP and Increase sodium and water EXCRETION
What are the 3 different natriuretic peptides and where are they produced?
Atria natriuretic peptide : atria of myocardium
BRAIN natriuretic peptide (BNP) produced in ventricles of myocardium
URODilatin: Produced in the kidneys.
***When changes in total body water are accompanied by proportional change in electrolytes, what type of alteration occurs?
ISOTONIC
**Which enzymes is secreted by the JUXTAGLOMERULAR Cells of the kidney when circulating blood volume is reduced?
RENIN
RENIN is released in response to (para/symp) _________ nerve stimulation and (incre/decr) __________ perfusion to the renal vasculature.
Sympathetic
decreased
**What mechanism cause hypernatremia?
HYPERSECRETION OF ALDOSTERONE
Cushing syndrome can also cause hypernatremia because of the oversecretion of ________hormone which also leads to oversecretion of _________
ACTH; ALDOSTERONE
For hypernatremia, during cardiac arrest, the inappropriate administration of ________Saline solution such as _____ ______may lead to ___________
Hypertonic
Sodium bicarbonate
Hypernatremia
***What causes the clinical manifestations of confusion, convulsion, cerebral hemorrhage and coma in hypernatremia?
HIGH SODIUM in the blood vessels pulls water OUT OF THE BRAIN CELLS, causing BRAIN CELLS TO SHRINK.
Water follows
SODIUM
***Vomiting induced metabolic alkaloiss, resulting in the loss of chloride causes
RETENTION of sodium bicarbonate to maintain the anion balance
When vomiting with the depletion of ECF and chloride causes ACID LOSS, renal compensation is
NOT effective
Loss of electrolytes such as Na+, K+, H+ and Cl- stimulate a paradoxic response by the ______. What does the kidney do?
kidneys ; it increases sodium and bicarbonate reabsorption with the excretion of HYDROGEN
***The PATHOPHYSIOLOGIC process of edema is related to which mechanism
LYMPHATIC OBSTRUCTION
***Insulin is used to treat HYPERKALEMIA because it:
Transport potassium from the blood to the cell along with
What does insulin do to regulate potassium?
stimulate the sodium-potassium pump.
***A major determinant of the resting membrane potential necessary fro the transmission of nerve impulse is the ration between
INTRACELLULAR and EXTRACELLULAR POTASSIUM
*** During acidosis (ELEVATED HYDROGEN IONS), the body compensates for the increase in serum HYDROGEN IONS by shifting hydrogen ions into the cell in exchange for which electrolyte
POTASSIUM
therefore, because of the shift of electrolyte during acidosis: ACidosis and ______ often occur together
HYPERKALEMIA
**2 Causes of hyperkalemia include?
Renal Failure and Addison disease
*** In hyperkalemia, what change occurs to the cell’s resting membrane
HYPOPOLARIZATION (depolarization)
**The Calcium and phosphate balance is influenced by which three substances?
Parathyroid hormone
Calcitonin
Vitamin D
** It is true that kussmaul respiration indicate
a compensatory mechanism is needed to correct metabolic acidosis.
**Chvostek and trousseau sing indicate which electrolyte imbalance
HYPOCALCEMIA
*** An excessive use of magnesium-containing antacids and aluminum containing antacids can results in
HYPOPHOSPHOTEMIA
What are the most common cause of hypophosphatemia
Intestinal malabsorption
Increased renal excretion of phosphate
**the most common cause HYPERMAGNESEMIA is
Renal Failure
***Physiologic pH is maintained at approximately 7.4 because bicarbonate (HCO3) and carbonic acid exist in a rtion of
20:1
***Which arterial pH will initiate the formation of ammonium (NH4) from ammonia (NH3) referred to ACADEMIA, in the tubular lumen of the kidney
7.25
***Two thirds of the body’s water is found in its
INTRACELLULAR FLUID Compartments
One third of the body’s water is in
extracellular fluid
What are the 2 main ECF compartments
Interstitial
Intravascular
***It is true that when insulin is administered
the liver increases its potassium levels
*** Increased capillary hydrostatic pressure results in edema because of
SODIUM and WATER RETENTION
INCREASED CAPILLARY HYDROSTATIC PRESSURE is a result of
VENOUS OBSTRUCTION
SODIUM AND WATER RETENTION
***The existence of hyperkalemia is likely to result in which changes to a patient’s ECG?
Peaked T-waves
ECG changes in hyperkalemia
Peaked Twaves
Prolonged PR interval
Absent p-wave widened QRS
***Which groups are at risk for sodium imbalanced (select all that apply)
Infant
Obese
Older adults
**3 Dehydration can cause which result?
Weak pulses
Tachycardia
weight loss
*** 2 Causes of Hypocalcemia included
Repeated blood administration
Pancreatitis
What is a common cause of hypocalcemia? Why?
Blood transfusion ; because the citrate solution used in storing whole blood binds with calcium.
How does pancreatitis cause HYPOCALCEMIA?
it causes a release of lipase into the soft tissue spaces; the free fatty acids that are formed bind calcium, causes a decrease in ionized calcium.
**The electrolyte imbalance called hyponatremia exhibits which clinical manifestations?
Headache
Seizure
Confusion
Lethargy
**The electrolyte imbalance called HYPERCALCEMIA exhibits which clinical manifestations?
Calcium based kidney stones
Lethargy
Bradycardia
ECG changes with HYPERCALCEMIA
Shortened QT segment
Depressed widened T Waves
****The electrolyte imbalance called HYPOKALEMIA exhibits which clinical manifestations? (PAS)
Paralytic Ileus
SInus Bradycardia
AV block
**A third of the body’s fluid is contained in the extracellular interstitial fluid spaces that include (select all that apply):
Urine
Intraocular fluids
Lymph
Sweat
**An imbalance of potassium can produce with dysfunction?
Weakness skeletal muscles
Cardiac dysrhythmias
Smooth muscle atony
***Which statement regarding total body water are true? (select all that apply)
During childhood, TBW slowly decreases in relationship to body weight
Men tend to have greater TBW as a result of their muscle mass
Estrogen plays a role in female TBW
Older adults experience a decrease in TBW as a result of decreased muscle mass
**__________Regulates osmolality in the ECF space
Sodium
**________Is inversely related to HCO3 concentration
Chloride
**_________is a major determinant of resting membrane potention
Potassium
Chloride levels are _______related to HCO3 concentration
Inversely
***_________ an intracellular metabolic form is ATP
Phosphate
**Changes in Hydrogen ion concentration affects this electrolyte
Potassium
THE MOST DANGEROUS EFFECT OF HYPERKALMIA is on which organ
HEART
Categorize causes of edema: Tumor grows in lymph node
Lymphatic obstruction
Categorize causes of edema: Right HF
Increased Capillary hydrostatic pressure
Categorize causes of edema: Infected wound
Increased CAPILLARY PERMEABILITY
Categorize causes of edema: CLOT In vein
INCREASED HYDROSTATIC PRESSURE
Categorize causes of edema: PROTEIN MALNUTRITION
Decreased Plasma oncotic pressure
Categorize causes of edema: Bee sting
INCREASED CAPILLARY PERMEABILITY
Categorize causes of edema: ESRD
INCREASED CAPILLARY HYDROSTATIC PRESSURE
The renal compensation for an acid-base balance is
SLOW
The pulmonary compensation for an acid-base balance is
FAST
Acid-base imbalance correction
returns HCO3 and carbonic acid buffers to normal levels.
Acid-base imbalance compensaiton
returns HCO3 and carbonic acid buffers to the 20:1 ratio but BOTH MAY STILL BE ABNORMAL.
A buffer is a _____ and its _____
weak acid; conjugate base
When pH is 7.40 , the bicarb to carbonic acid ratio is
20:1
***paCO 2 is proportional to is proportional to
VCO2 / VA
• where:
VCO2 is CO2 production by the body
VA is Alveolar ventilation
Calculate AG with this formula
Na- (Cl+HCO3)
Calcitonin, secreted with _____calcium and what does it do in bone?
HIGH; inhibits osteoclasts in bone.
What stimulates increase secretion of ADH:
Increased plasma osmolality
decreased arterial blood pressure
INCREASES renal water reabsoprtion, vasoconstriction
Angiotensin II and increased plasma potassium stimulates
increase renal sodium and water reabsorption
increase renal excretion of potassium and hydrogen ions.
In adult female percentage of water is
50
Not a component of ECF
RBCs
In adult male percentage of water is
60
Major INTRACELLULAR cation
Potassium
Anions in HIGHEST concentration in the EXTRACELLULAR
Proteins
Bicarbonate
Chloride
Which hormones plays a CENTRAL role in rate of SODIUM REABSORPTION and POTASSIUM SECRETION?
ALDOSTERONE>
Which hormone MOST affects OSMOLARITY of BLOOD
ADH
Hormones released by heart muscles in response to EXCESSIVE CHAMBER VOLUME
Natriuretic Peptides
_____ECF fluid and __/3 ICF
1 third
2 thirds
The release of ATRIAL NATURETIC PEPTIDES from the heart will cause the body to
Excrete sodium ions and decreases ECF.
Angiotensin II produces a coordinated elevation in ECF by: 4 mechanisms
NOT BY : INcreasing
1.Stimulate thirst
2.Causing release of ADH
3.trigger production and secretion of Aldosterone
4.Stimulate kidney to conserve sodium
NOT BY INCREASING PNS ACTIVITY.
ALDOSTERONE does what?
promote sodium retention in the kidneys
Principal ions in ECF are (3)
Sodium
Chloride
Bicarbonate
Promotes WATER REABSORPTION at the kidneys and STIMULATES THIRST
ADH
Principal ions in ICF are (3)
Potassium
Magnesium
Phosphate
When water is lost, but electrolytes are retained?
OSMOSIS moves water from the ICF to the ECF.
When pure water is consumed
OSMOLARITIES of the ICF and ECF fall.
Exchanged between 2 main subdivisions of ECF occurs primarily at the
CAPILLARIES
Typical water losses and gains each day
2500ml
Calcium reabsorption by the kidneys is promoted by the hormone
PTH
Chemical that minimizes changes in pH of a body by releasing or binding HYDROGEN ions
Buffer
Excess hydrogen ions is eliminated from the body largely by
KIDNEYS
Primary role of Carbonic acid bicarbonate buffer system
Limit pH changes caused metabolic and fixed acids
Hypoventilation leads to
respiratory acidosis
What does the kidney do in response to RESPIRATORY ALKALOSIS
Kidney retain more hydrogen ions.
A person with emphysema with exhibit sings of
Chronic respiratory acidosis
Poorly controlled DM- acid base balance
Metabolic acidosis
Which best fits acid-base metabolic alkalosis
PROLONGED VOMITING
A person consuming large amount of sodium bicarbonate to settle upset stomach is at risk for
METABOLIC ALKALOSIS
Severe Kidney damage often leads to
Metabolic acidosis
Which best fits acid-base RESPIRATORY ACIDOSIS
Reduced Alveolar ventilation
When the pH of the ECF drops, kidney will
secretes more hydrogen ions, and fewer bicarbonate
Which best fits acid-base RESPIRATORY ALKALOSIS
Cause by HYPERVENTILATION
A drowinng victim will most likely experience
ACute RESPIRATORY ACIDSOSIS
Excessive loss of bicarb such as diarrhea
Metabolic acidosis
The elderly have ____water content in the body
less
Potassium rise in ______ patients. As potassium rise, Hydrogen secretions rises
Acidosis
In which body fluid do the phosphate and protein buffer system help regulate the ph
INTRACELLULAR
What is the kidney response to alkalosis caused by the removal of H+?
What is the lung response to Metabolic acidosis ?
CONSERVE H+
SECRETE HCO3
-Lung increase respiratory rate.
