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EXAM 1: Pathophysiology > Electrolytes & Fluids & Hypovolemic Shock > Flashcards

Electrolytes & Fluids & Hypovolemic Shock Flashcards

Chapter 8 + Chapter 27

1
Q

fluid contained within all the cells in the body

A

intracellular fluid (ICF)

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2
Q

ICF is ___ of the total body fluid in a healthy body

A

2/3

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3
Q

what is ICF volume regulated by?

A

proteins, organic compounds, water, and solutes

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4
Q

contains all the fluids outside of cells

A

extracellular fluid (ECF)

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5
Q

_____ + _____ + _________ = ECF

A

vascular, interstitial, transcellular

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6
Q

ECF is ___ of the total body fluid in a healthy body

A

1/3

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7
Q

where is the interstitial fluid found?

A

spaces between cells, outside of BVs

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8
Q

___ liters of ICF (40%)

A

28

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9
Q

___ liters of interstitial fluid (14%)

A

10

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10
Q

___ liters of plasma (5%)

A

3.5

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11
Q

____ liters of transcellular (1%)

A

1

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12
Q

“third space” fluid

A

transcellular

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13
Q

what serves as the primary barrier between ECF and ICF and regulates movement ?

A

cell membrane

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14
Q

how do lipid-soluble substances cross the membrane (CO2/O2)

A

diffuse (passive process)

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15
Q

how do ions cross the cell membrane

A

via transport systems (active) ex: Na/K pumo , channels

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16
Q

cation

A

positively charged ions

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17
Q

anion

A

negatively charged ions

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18
Q

diffusion: movement of charged or uncharged particles _______ a concentration gradient

A

along

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19
Q

diffusion: areas from ____ concentration to ____ concentration

A

high, low

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20
Q

osmosis: movement of ______ across a semipermeable membrane

A

water

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21
Q

osmosis: water moves to side with _______ particles and ______ water

A

greater, less

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22
Q

osmosis: water moves from side with _______ particles and ______ water

A

less, more

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23
Q

fluids inside body

A

osmolality

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24
Q

fluid outside of the body

A

osmolarity

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25
Q

1L of water = 1 __ of water

A

kg

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26
Q

______tonic solution: water moves into the cell and it swells because there are more solutes in the cell than in the solution

A

hypo

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27
Q

_______tonic solution: water moves OUT of cell and shrinks

A

hyper

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28
Q

tonicity is determined by the effective ______ (like glucose) that cannot penetrate the cell membrane = creates an ______ force that _____ water OUTSIDE of the cell

A

solutes
osmotic
pulls

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29
Q

transfer of water between the vascular and _________ compartments occurs at the _________ level which is needed for ________/gas exchange

A

interstitial
capillary
nutrient

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30
Q

_____ ______ pressure, which pushes water out of the capillary into the interstitial spaces

A

capillary filtration

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31
Q

_____ ______ __________pressure which pulls water back into the capillary

A

capillary colloidal osmotic

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31
Q

_____ ______ pressure which opposes the movement of water out of the capillary

A

interstitial hydrostatic

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32
Q

_____ ______ __________ pressure which pulls water out of the capillary into the interstitial spaces

A

tissue colloidal osmotic

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33
Q

give _____ for swelling to create a ________ concentration gradient to _____ H2O/fluid into vasculature from body spaces

A

albumin
vascular
pull

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34
Q

what are the 3 systems that control the distribution of body fluids and electrolytes

A
  1. sympathetic NS
  2. renin-angiotensin-aldosterone system
  3. antidiuretic hormone
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35
Q

water follows ____

A

Na+

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36
Q

the __________ NS: a major regulator of _______ and ________ balance is the maintenance of the effective ____________ volume (vascular amount that _________ the body)

A

sympathetic
water and sodium
circulating
perfuses

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37
Q

LOW effective circulating volume –> activation of _________ mechanisms that produce an _______ is sodium and water __________

A
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38
Q

HIGH effective circulating volume –> activation of feedback mechanisms that produce an _______ is sodium and water __________

A

decrease
excretion

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39
Q

_________ the sensors that respond to pressure-induced stretch of the vessel walls

A

baroreceptors

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40
Q

SNS responds to ______ changes and blood volume by adjusting the ________ filtration rate and thus the rate at which ______ is filtered in the blood

A

pressure
glomerular
sodium

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40
Q

pressure-sensitive receptors in the _____ respond _____ to changes in ______ pressure through the stimulation of the _____ and release of ________ with the activation of ____

A

kidney
directly
arterial
SNS
renin
RAAS

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41
Q

HOSE ANALOGY for BP
keep Na+ (and water) = ________
narrow BVs = _______________

A

turn up water
put finger on end of hose

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42
Q

antidiuretic hormone = _______

A

vasopressin

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43
Q

ADH regulates ____________ of water by the _______

A

reabsorption
kidneys

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44
Q

ADH is controlled by ____ volumes and osmolality

A

ECF

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44
Q

ADH V1 receptors are located in ________ _______ muscle –> ______________ of BVs –> increased _____ pressure

A

vascular smooth
vasoconstriction
arterial

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45
Q

ADH: V2 receptors located on the _____ cells in the ________ –> control water _________ by the kidneys –> increased _____ pressure

A

tubular
kidney
reabsorption
arterial

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45
Q

ADH is released from the ______ _______

A

posterior pituitary

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46
Q

water and electrolytes are gained in the same proportion

A

hypervolemia

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46
Q

4 causes of hypervolemia

A

increase of IV fluid
increase of Na+ in diet
diseases (renal or heart failure)
hyperaldosteronism

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46
Q

hypervolemia ________ cardiac workload

A

increases

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47
Q

palpable swelling produced by the expansion of interstitial fluid volume into tissues ( ___ _____ shirt)

A

edema
3rd space

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48
Q

EDEMA
Factors that __________ capillary filtration pressure

____________ capillary colloidal osmotic pressure

_________ capillary permeability (inflammation)

obstruction to _______ flow

increased blood _______ (across capillary membrane)

________ obstruction

decreased serum_________

A

increase
decrease
increase
lymph
volume
venous
albumin

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49
Q

lymph edema is _________

A

lumpy

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50
Q

edema may limit adequate __________ –> tissue death or pressure injuries

A

perfusion

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51
Q

edema of the ______, ______ and _____ can be life threatening

A

brain, larynx, lungs

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52
Q

assessment of edema (3)

A

daily weight
visual assessment
measurement of the affected part

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53
Q

pitting edema

A

fingerprint dent stays

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54
Q

nonpitting edema

A

bounces back

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55
Q

treatment (3)

A

maintaining life
correcting or controlling the cause
prevent tissue injury

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56
Q

dehydration of cells and tissues
see tenting with skin turgor

A

hypovolemia

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57
Q

S/S of hypovolemia

A

dry mucous membranes
decreased BP (decreased blood volume)
decreased urine output
increase HR
decreased perfusion (capillary refill)

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58
Q

diminished blood volume causing inadequate filling of the vascular compartment

A

hypovolemic shock

58
Q

what causes hypovolemic shock (aka acute loss of circulating blood volume) (4)

A

whole blood (hemorrhage)

plasma (severe burns)

extracellular fluid (severe dehydration or loss of GI fluids)

extracellular fluid shifting to the interstitial compartment (swelling)

59
Q

clinical manifestations of hypovolemic shock (7)

A

thirst

increased HR

cool/clammy skin (no blood)

decreased BP + urine output

changes in mentation

changes in labs

60
Q

mechanisms to maintain cardiovascular function in response to hypovolemic shock (2)

A

increased HR and cardiac contractility

widespread vasoconstriction

60
Q

mechanisms to maintain blood volume in response to hypovolemic shock (3)

A

ADH release –> kidneys keep water and Na+ –> decreased urine output

RAAS –> aldosterone –> decreased urine output

constriction of veins near liver and mobilization of blood stored in liver

60
Q

treatment of hypovolemic shock (4)

A

control the cause
O2 admin
IV admin of fluids
meds to increase BP

60
Q

causes of hypo-osmolar imbalance (3)

A
  1. excess water intake WITHOUT electrolytes
  2. end-stage renal failure
  3. inappropriate ADH release (kidneys retain water)
61
Q

manifestations of hypo-osmolar imbalance (4)

A
  1. decreased serum osmolality (dilute blood –> low Hb)
  2. decreased hematocrit
  3. low urine specific gravity (clear urine)
  4. CNS changes due to brain swelling (headaches, confusion)
62
Q

causes of hyper-osmolar imbalance (5)

A
  1. decrease in oral water intake
  2. insufficient intake of free water (tube feeding diet)
  3. increased loss of free water
  4. diseases that cause an increase in urine output
  5. excess intake of hypertonic fluid intake (high glucose solution)
63
Q

manifestations of hyper-osmolar imbalance

A
  1. elevated serum osmolarity
  2. increase in hematocrit
  3. high urine specific gravity (dark, concentrated)
  4. polydipsia (THIRSTY)
  5. CNS changes
64
Q

during a hyper-osmolar imbalance, cells _______ because they are trying to get rid of their fluid to balance the ______ environment and become _____ efficient

A

shrink
outside
less

65
Q

what is the most abundant cation in the body? (mostly found in ECF)

66
Q

Na accounts for __-__% of the osmotic activity in the ECF

67
Q

normal Na for blood work

A

135-145 mEq/L

68
Q

how is Na transported across the cell membrane?

A

Na/K ATPase pump

69
Q

hypo/hypernatremia is caused by disproportionate losses or gains in sodium and water in the ____ compartment

70
Q

how do we normally get Na?

A

GI tract (diet)

71
Q

how do we get rid of Na?

A

kidneys (90%), GI tract or skin (sweating)

72
Q

3 methods for the regulation of Na

A

baroreceptors (SNS, RAAS)
thirst
ADH

73
Q

polydipsia

A

excessive thirst

74
Q

hypodipsia

A

decrease in the ability to sense thirst (common in older adults)

75
Q

____ regulates the reabsorption of water by the kidneys depending on the circulating volume

76
Q

diabetes insipidus patients are at risk for _____ ______

A

hypertonic dehydration

77
Q

what is diabetes insipidus caused by?

A

deficiency of or decreased response to ADH

78
Q

DI: unable to concentrate urine during periods of water ______ = excrete _____ volumes of urine –> __________ thirst

A

retention
large
excessive

79
Q

what is the syndrome of inappropriate ADH caused by?

A

failure of the negative feedback system that regulates the release and inhibition of ADH

80
Q

SIADH leads to dilutional _______

A

hyponatremia

81
Q

SIADH: urine output _______ despite adequate fluid intake

82
Q

SIADH: at risk for water ____________

A

intoxication

83
Q

isotonic fluid volume deficit = ______

A

hypovolemia

84
Q

isotonic fluid volume excess = ________

A

hypervolemia

85
Q

causes of isotonic fluid volume deficit: (6)

A

inadequate fluid intake
excessive GI fluid loss
excessive renal losses
hyperglycemia
excessive skin losses
third-space losses

86
Q

manifestations of isotonic fluid volume deficit: (6)

A

acute weight loss
compensatory increase in ADH
increased serum osmolarity
decreased vascular volume
decreased extracellular fluid volume
impaired temperature regulation

86
Q

causes of isotonic fluid volume excess: (3)

A

inadequate Na and H2O elimination
excessive Na intake in relation to output
excessive fluid intake in relation to output

86
Q

manifestations of isotonic fluid volume excess: (3)

A

acute wight gain
increased interstitial fluid volume
increased vascular volume

87
Q

hyponatremia lab value

A

< 135 mEq/L

88
Q

manifestations of hyponatremia (3)

A
  1. less fluid in brain cells and neuromuscular tissues (muscle cramps, weakness, stupor, coma)
  2. GI issues (anorexia, N,V,D)
  3. increased ICF (fingerprint edema)
89
Q

hypernatremia lab value

A

145 + mEq/L

90
Q

causes of hypernatremia (3)

A

excessive water losses
decreased water intake
excessive Na intake

91
Q

manifestations of hypernatremia (4)

A
  1. thirst and signs of increased ADH levels (polydipsia)
  2. intracellular dehydration
  3. hyperosmolality of ECFs and movement of water OUT of brain cells (agitation, restlessness, seizures, coma)
  4. extracellular dehydration and decreased vascular volume (tachycardia, decreased BP)
92
Q

what is the second most abundant cation?

92
Q

normal K+ values:

A

3.5 - 5 mEq/L (ECF)

92
Q

what is the major cation in the ICP compartment? (98% INSIDE cells)

93
Q

how is K+ transported across the cell membrane?

A

Na/K ATPase pump

93
Q

where is K+ derived from?

94
Q

regulation of _____ is VERY important because changes in _____ of 0.3 - 0.4 mEq/L can cause serious cardiac __________

A

K+
ECF
dysrhythmias

95
Q

what is the major route for K+ elimination?

A

kidneys (filtered in the glomerulus)

96
Q

too much ______ potassium, excess is temporarily shifted INTO _____ and other cells

97
Q

distribution of K+ between intracellular and extracellular compartments regulates _________ membrane potential –> excitability of _______ and muscle cells & contractility of skeletal, _______, and smooth muscle tissue

A

electrical
nerve
cardiac

98
Q

How does K+ regulate nerve impulses and muscle excitability? (3)

A
  1. resting membrane potential
  2. opening of Na channels that control the flow of current during the AP
  3. rate of membrane repolarization
99
Q

causes of hypokalemia (4)

A
  1. inadequate intake
  2. excessive renal losses
  3. excessive GI losses
  4. transcompartmental shift
100
Q

hypokalemia lab value

A

< 3.5 mEq/L

101
Q

normal Na value

A

135 - 145 mEq/L

102
Q

hyperkalemia lab value

103
Q

manifestations of hyperkalemia (3)

A
  1. GI issues (N, V, D)
  2. neuromuscular issues (parathesis, weakness, dizziness, muscle cramps)
  3. cardiovascular (changes in electrocardiogram, cardiac arrest risk)
104
Q

cardiac _______ changes with hypo and hyperkalemia

A

conduction

105
Q

hyperkalemia:
1. ____ P wave
2. ______ QRS
3. ________ T

A

low
widening
peaked

106
Q

hypokalemia
1. PR ________________
2. ______________ ST segment
3. _____ T
4. prominent ____ wave

A

prolongation
depressed
low
U

107
Q

Ca, P, and Mg are ingested in the ______, absorbed from the ________, filtered in the _________ of the kidney, reabosorbed in the _______ tubules, and eliminated in the ______

A

diet
intestines
glomerulus
renal
urine

108
Q

Ca+ distribution: 99% in ____, 1% in _____, small amt in _____

A

bone
cells
ECF

109
Q

P+ distribution: 85% in ____, 14% in _____, small amt in _____

A

bone
cell
ECF

110
Q

Mg+ distribution: 50 - 60 % in ____, 40 - 50% in _____, small amt in _____

A

bone
cell
ECF

111
Q

ECF, Ca, P, Mg are regulated by ______ and ______

112
Q

vitamin D acts as a hormone to keep normal ___ and ___ levels by increased ____________ absorption

A

Ca, P
intestinal

113
Q

parathyroid hormone regulates release of ____ from ______

114
Q

PTH action is influenced by ____

115
Q

if there is a Mg2+ deficincy = no ____

116
Q

hypoparathyroidism: deficient PTH secretion = _________

A

hypocalcemia

117
Q

what causes hypoparathyroidism (3)

A

thyroid surgery
autoimmune disorder
Mg2+ deficiency

118
Q

manifestations of hypoparathyroidism mimic ________

A

hypocalcemia

119
Q

hyperparathyroidism: hypersecretion of PTCH = _______________

A

hypercalcemia

120
Q

causes of hyperparathyroidism (4)

A
  1. hyperplasia (rapid production of PT cells = more workers = big response)
  2. cancers
  3. secondary disorder with renal failure
  4. malabsorption of Ca
121
Q

normal calcium levels

A

8.5 - 10.5 mg/dL

122
Q

hypocalcemia lab value

A

< 8.5 mg/dL

123
Q

causes of hypocalcemia (5)

A
  1. impaired ability to mobilize Ca from bone (resistant to PTH)
  2. decreased intake/absorption (kidney disease)
  3. abnormal renal losses
  4. increased protein binding
  5. increased sequestration (there but walled off, unable to use)
124
Q

manifestations of hypocalcemia (3)

A
  1. increase neuromuscular excitability (paresthesias, hyperactive reflexes, tetany, positive chvostek, and trousseau)
  2. cardiovascular (hypotension)
  3. skeletal issues
125
Q

trousseau sign

A

hand curl up/in with BP cuff

126
Q

chvostek sign

A

Hit lip and twitch

127
Q

hypercalcemia lab value

A

> 10.5 mg/dL

128
Q

causes of hypercalcemia (3)

A

increased intestinal absorption
increased bone resorption
decreased elimination

129
Q

manifestations of hypercalcemia (5)

A
  1. impaired ability to concentrate urine ( kidney stones)
  2. GI issues (N, V, constipation)
  3. neuromuscular issues (m. weakness, ataxia)
  4. CNS issues (lethargy, stupor, coma)
  5. cardiovascular issues (hypotension)
130
Q

hypophosphatemia blood levels

A

< 2.5 mg/dL

131
Q

causes of hypophosphatemia (3)

A

decreased intestinal absorption
increased renal elimination
malnutrition and intracellular shifts

132
Q

manifestations of hypophosphatemia (3)

A
  1. neural (confusion, stupor, coma, seizures)
  2. musculoskeletal (muscle weakness)
  3. blood disorders
133
Q

manifestations of hyperphosphatemia (2)

A
  1. neuromuscular (paresthesias)
  2. cardiovascular (hypotension)
134
Q

causes of hyperphosphatemia (4)

A

acute phosphate overload
intra to extracellular shift
rhabdomyolysis
impaired elimination

135
Q

hyperphosphatemia lab value

A

> 4.5 mg/dL

136
Q

normal Mg blood level

A

1.8 - 3 mg/dL

137
Q

causes of hypomagnesemia (2)

A

impaired intake or absorption
increased losses

138
Q

hypomagnesemia level

A

< 1.8 mg/dL

139
Q

manifestations of hypomagnesemia (2)

A
  1. neuromuscular (tetany, positive Babinski, chvostek, trousseau)
  2. cardiovascular (tachycardia, hypertension, cardiac arrhythmias)
140
Q

hypomagnesemia –> no ____ –> hypoparathyroidism —> ________

A

PTH
hypocalcemia

141
Q

hypermagnesemia levels

142
Q

causes of hypermagnesemia (2)

A

excessive intake
decreased excretion

143
Q

manifestations of hypermagnesemia (2)

A
  1. neuromuscular (lethargy, hyporeflexia, confusion, coma)
  2. cardiovascular (hypotension, cardiac arrhythmias)

EXAM 1: Pathophysiology (9 decks)

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