Disease

Question 1

Fluid volume deficit

Answer 1

Cause- endocrine, kidney problems, excessive fluid loss - diarrhoea, insufficient intake, diuretics, haemorrhage, laxatives, heat, exercise, oral trauma

S&S-
Metabolic- rapid wt loss (1ltr=1kg)- mild loss 2-5%, mod loss 6-9%, lrg loss >10%, dry mucous membranes, increased temp, thirst
Cardiovascular- orthostatic hypotension, increased haemocrit, flat neck veins, tachycardia
Renal- oliguria, increased urine specific gravity
Skin- cool, pale, decreases turgor
Musculoskeletal- fatigue
Neurological- altered mental state, restlessness, anxiety

Question 2

Fluid overload

Answer 2

Causes- Retention of sodium and water, Heart failure, cirrhosis of liver, renal failure, adrenal glands disorders, corticosteroid administration and stress conditions releasing ADH/aldosterone, excessive intake sodium, drugs that cause sodium retention, excess IV fluid

Serum sodium remains normal as sodium and water intake match

Third spacing (fluid in interstitial/bowel/abdomen thy does not contribute to body functions but counted as a loss), likely after surgery but gets reabsorbed 48-72hrs and can put them in overload

S&S- peripheral oedema, bounding pulse, distended neck/peripheral veins, cough, dyspnoea, orthopnoea, tachycardia, hypertension, reduced O2, lung crackles, polyuria, ascites, decreased haemocrit, altered LOC (cerebral oedema), pulmonary oedema

Question 3

Metabolic acidosis

Answer 3

Accumulation acids, excess loss bicarb a, increase in chloride levels

Caused by increased acid production, lactic acidosis (anaerobic metabolism), keto acidosis, salicylate toxicity (aspirin breaks down into acids), decreased acid secretion, increased bicarb loss, renal failure, diarrhoea (pancreas releases bicarbs into small intestines), increased chloride

Risk factors- tissue hypoxia, diabetes, renal failure

Can cause electrolyte imbalances such as high potassium from kidneys excreting hydrogen ions instead of potassium and hydrogen ions push potassium out of cells. Calcium is released from it’s bonds and increased free calcium in blood

S&S- (<7 depresses myocardial contractility leading to fall in CO), weakness, fatigue, headache, anorexia, nausea/vomiting, abdo pain, declined LOC, arrhythmias, warm/flushed skin, deep rapid resps if compensating (kussmauls resps), SOB, dyspnoea

Treat- sodium bicarb, citrate/lactate/acetate (metabolised you bicarb),- bicarb increases risk of hypernatraemia, hyperosmolality and fluid volume excess

Question 4

Metabolic alkalosis

Answer 4

Risk factors- hypokalaemia (body tries to conserve potassium and thus excretes hydrogen ions. Also potassium shifts into ECF to maintain potassium levels and hydrogen ions shift into cells), increased acid loss (when chloride is lost from ECF it gets replaced with bicarb), vomiting (as stomach content highly acidic), excess bicarb administration, calcium combines with serum proteins reducing ionised calcium in blood

S&S- confusion, decreased LOC, hyperreflexia, tetany, arrhythmias, hypotension, seizures, resp failure with hypoxaemia and resp acidosis (due to depressed resps to compensate for alkalosis)

Treat- potassium chloride (restores normal potassium levels so kidneys can conserve hydrogen) and sodium chloride (promotes renal excretion of bicarb), in severe case can have dilute hydrochloric acid

Question 5

Respiratory acidosis

Answer 5

Risk factors- lung disease, narcotics (depresses resp system), airway obstruction, neuromuscular disease

Acute- aspiration of foreign body, chest trauma, overdose.
S&S- hypercapnia=intracranial pressure increases as CO2 crosses brain barrier and dilated vessels, tachycardia, headache, blurred vision, irritability, decreased LOC, BF, warm/flushed skin

Chronic- COPD, asthma, structural changes, CO2 and bicarb rise but pH may be close to normal
S&S- weakness, dull headache, sleep disturbances, daytime sleepiness, impaired memory, personality changes

Diagnose- ABG, serum electrolytes, pulmonary function tests

Treat- bronchodilator, O2, antibiotics if chest infection, naloxone if from drugs

Question 6

Respiratory alkalosis

Answer 6

Anxiety leading to hyperventilation, fever, hypoxia, thyrotoxicosis, aspirin overdose/encephalitis/high progesterone levels in pregnancy (directly stimulate resp centre)

S&S- lightheaded, panic, difficulty concentrating, distal extremity parasthesia, tremors, positive chvostek/trousseaus sign, tinnitus, chest tightness, palpitations, seizures, LOC

Treat- manage anxiety, instructive breathing, breath into paper bag/rebreather mask