Electrolytes & Fluids & Hypovolemic Shock Flashcards
Chapter 8 + Chapter 27
1
Q
fluid contained within all the cells in the body
A
intracellular fluid (ICF)
2
Q
ICF is ___ of the total body fluid in a healthy body
A
2/3
3
Q
what is ICF volume regulated by?
A
proteins, organic compounds, water, and solutes
4
Q
contains all the fluids outside of cells
A
extracellular fluid (ECF)
5
Q
_____ + _____ + _________ = ECF
A
vascular, interstitial, transcellular
6
Q
ECF is ___ of the total body fluid in a healthy body
A
1/3
7
Q
where is the interstitial fluid found?
A
spaces between cells, outside of BVs
8
Q
___ liters of ICF (40%)
A
28
9
Q
___ liters of interstitial fluid (14%)
A
10
10
Q
___ liters of plasma (5%)
A
3.5
11
Q
____ liters of transcellular (1%)
A
1
12
Q
“third space” fluid
A
transcellular
13
Q
what serves as the primary barrier between ECF and ICF and regulates movement ?
A
cell membrane
14
Q
how do lipid-soluble substances cross the membrane (CO2/O2)
A
diffuse (passive process)
15
Q
how do ions cross the cell membrane
A
via transport systems (active) ex: Na/K pumo , channels
16
Q
cation
A
positively charged ions
17
Q
anion
A
negatively charged ions
18
Q
diffusion: movement of charged or uncharged particles _______ a concentration gradient
A
along
19
Q
diffusion: areas from ____ concentration to ____ concentration
A
high, low
20
Q
osmosis: movement of ______ across a semipermeable membrane
A
water
21
Q
osmosis: water moves to side with _______ particles and ______ water
A
greater, less
22
Q
osmosis: water moves from side with _______ particles and ______ water
A
less, more
23
Q
fluids inside body
A
osmolality
24
Q
fluid outside of the body
A
osmolarity
25
1L of water = 1 __ of water
kg
26
______tonic solution: water moves into the cell and it swells because there are more solutes in the cell than in the solution
hypo
27
_______tonic solution: water moves OUT of cell and shrinks
hyper
28
tonicity is determined by the effective ______ (like glucose) that cannot penetrate the cell membrane = creates an ______ force that _____ water OUTSIDE of the cell
solutes
osmotic
pulls
29
transfer of water between the vascular and _________ compartments occurs at the _________ level which is needed for ________/gas exchange
interstitial
capillary
nutrient
30
_____ ______ pressure, which pushes water out of the capillary into the interstitial spaces
capillary filtration
31
_____ ______ __________pressure which pulls water back into the capillary
capillary colloidal osmotic
31
_____ ______ pressure which opposes the movement of water out of the capillary
interstitial hydrostatic
32
_____ ______ __________ pressure which pulls water out of the capillary into the interstitial spaces
tissue colloidal osmotic
33
give _____ for swelling to create a ________ concentration gradient to _____ H2O/fluid into vasculature from body spaces
albumin
vascular
pull
34
what are the 3 systems that control the distribution of body fluids and electrolytes
1. sympathetic NS
2. renin-angiotensin-aldosterone system
3. antidiuretic hormone
35
water follows ____
Na+
36
the __________ NS: a major regulator of _______ and ________ balance is the maintenance of the effective ____________ volume (vascular amount that _________ the body)
sympathetic
water and sodium
circulating
perfuses
37
LOW effective circulating volume --> activation of _________ mechanisms that produce an _______ is sodium and water __________
38
HIGH effective circulating volume --> activation of feedback mechanisms that produce an _______ is sodium and water __________
decrease
excretion
39
_________ the sensors that respond to pressure-induced stretch of the vessel walls
baroreceptors
40
SNS responds to ______ changes and blood volume by adjusting the ________ filtration rate and thus the rate at which ______ is filtered in the blood
pressure
glomerular
sodium
40
pressure-sensitive receptors in the _____ respond _____ to changes in ______ pressure through the stimulation of the _____ and release of ________ with the activation of ____
kidney
directly
arterial
SNS
renin
RAAS
41
HOSE ANALOGY for BP
keep Na+ (and water) = ________
narrow BVs = _______________
turn up water
put finger on end of hose
42
antidiuretic hormone = _______
vasopressin
43
ADH regulates ____________ of water by the _______
reabsorption
kidneys
44
ADH is controlled by ____ volumes and osmolality
ECF
44
ADH V1 receptors are located in ________ _______ muscle --> ______________ of BVs --> increased _____ pressure
vascular smooth
vasoconstriction
arterial
45
ADH: V2 receptors located on the _____ cells in the ________ --> control water _________ by the kidneys --> increased _____ pressure
tubular
kidney
reabsorption
arterial
45
ADH is released from the ______ _______
posterior pituitary
46
water and electrolytes are gained in the same proportion
hypervolemia
46
4 causes of hypervolemia
increase of IV fluid
increase of Na+ in diet
diseases (renal or heart failure)
hyperaldosteronism
46
hypervolemia ________ cardiac workload
increases
47
palpable swelling produced by the expansion of interstitial fluid volume into tissues ( ___ _____ shirt)
edema
3rd space
48
EDEMA
Factors that __________ capillary filtration pressure
____________ capillary colloidal osmotic pressure
_________ capillary permeability (inflammation)
obstruction to _______ flow
increased blood _______ (across capillary membrane)
________ obstruction
decreased serum_________
increase
decrease
increase
lymph
volume
venous
albumin
49
lymph edema is _________
lumpy
50
edema may limit adequate __________ --> tissue death or pressure injuries
perfusion
51
edema of the ______, ______ and _____ can be life threatening
brain, larynx, lungs
52
assessment of edema (3)
daily weight
visual assessment
measurement of the affected part
53
pitting edema
fingerprint dent stays
54
nonpitting edema
bounces back
55
treatment (3)
maintaining life
correcting or controlling the cause
prevent tissue injury
56
dehydration of cells and tissues
see tenting with skin turgor
hypovolemia
57
S/S of hypovolemia
dry mucous membranes
decreased BP (decreased blood volume)
decreased urine output
increase HR
decreased perfusion (capillary refill)
58
diminished blood volume causing inadequate filling of the vascular compartment
hypovolemic shock
58
what causes hypovolemic shock (aka acute loss of circulating blood volume) (4)
whole blood (hemorrhage)
plasma (severe burns)
extracellular fluid (severe dehydration or loss of GI fluids)
extracellular fluid shifting to the interstitial compartment (swelling)
59
clinical manifestations of hypovolemic shock (7)
thirst
increased HR
cool/clammy skin (no blood)
decreased BP + urine output
changes in mentation
changes in labs
60
mechanisms to maintain cardiovascular function in response to hypovolemic shock (2)
increased HR and cardiac contractility
widespread vasoconstriction
60
mechanisms to maintain blood volume in response to hypovolemic shock (3)
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
treatment of hypovolemic shock (4)
control the cause
O2 admin
IV admin of fluids
meds to increase BP
60
causes of hypo-osmolar imbalance (3)
1. excess water intake WITHOUT electrolytes
2. end-stage renal failure
3. inappropriate ADH release (kidneys retain water)
61
manifestations of hypo-osmolar imbalance (4)
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
causes of hyper-osmolar imbalance (5)
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
manifestations of hyper-osmolar imbalance
1. elevated serum osmolarity
2. increase in hematocrit
3. high urine specific gravity (dark, concentrated)
4. polydipsia (THIRSTY)
5. CNS changes
64
during a hyper-osmolar imbalance, cells _______ because they are trying to get rid of their fluid to balance the ______ environment and become _____ efficient
shrink
outside
less
65
what is the most abundant cation in the body? (mostly found in ECF)
Na
66
Na accounts for __-__% of the osmotic activity in the ECF
90-95
67
normal Na for blood work
135-145 mEq/L
68
how is Na transported across the cell membrane?
Na/K ATPase pump
69
hypo/hypernatremia is caused by disproportionate losses or gains in sodium and water in the ____ compartment
ICP
70
how do we normally get Na?
GI tract (diet)
71
how do we get rid of Na?
kidneys (90%), GI tract or skin (sweating)
72
3 methods for the regulation of Na
baroreceptors (SNS, RAAS)
thirst
ADH
73
polydipsia
excessive thirst
74
hypodipsia
decrease in the ability to sense thirst (common in older adults)
75
____ regulates the reabsorption of water by the kidneys depending on the circulating volume
ADH
76
diabetes insipidus patients are at risk for _____ ______
hypertonic dehydration
77
what is diabetes insipidus caused by?
deficiency of or decreased response to ADH
78
DI: unable to concentrate urine during periods of water ______ = excrete _____ volumes of urine --> __________ thirst
retention
large
excessive
79
what is the syndrome of inappropriate ADH caused by?
failure of the negative feedback system that regulates the release and inhibition of ADH
80
SIADH leads to dilutional _______
hyponatremia
81
SIADH: urine output _______ despite adequate fluid intake
decreases
82
SIADH: at risk for water ____________
intoxication
83
isotonic fluid volume deficit = ______
hypovolemia
84
isotonic fluid volume excess = ________
hypervolemia
85
causes of isotonic fluid volume deficit: (6)
inadequate fluid intake
excessive GI fluid loss
excessive renal losses
hyperglycemia
excessive skin losses
third-space losses
86
manifestations of isotonic fluid volume deficit: (6)
acute weight loss
compensatory increase in ADH
increased serum osmolarity
decreased vascular volume
decreased extracellular fluid volume
impaired temperature regulation
86
causes of isotonic fluid volume excess: (3)
inadequate Na and H2O elimination
excessive Na intake in relation to output
excessive fluid intake in relation to output
86
manifestations of isotonic fluid volume excess: (3)
acute wight gain
increased interstitial fluid volume
increased vascular volume
87
hyponatremia lab value
< 135 mEq/L
88
manifestations of hyponatremia (3)
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
hypernatremia lab value
145 + mEq/L
90
causes of hypernatremia (3)
excessive water losses
decreased water intake
excessive Na intake
91
manifestations of hypernatremia (4)
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
what is the second most abundant cation?
potassium
92
normal K+ values:
3.5 - 5 mEq/L (ECF)
92
what is the major cation in the ICP compartment? (98% INSIDE cells)
K+
93
how is K+ transported across the cell membrane?
Na/K ATPase pump
93
where is K+ derived from?
diet
94
regulation of _____ is VERY important because changes in _____ of 0.3 - 0.4 mEq/L can cause serious cardiac __________
K+
ECF
dysrhythmias
95
what is the major route for K+ elimination?
kidneys (filtered in the glomerulus)
96
too much ______ potassium, excess is temporarily shifted INTO _____ and other cells
ECF
RBCs
97
distribution of K+ between intracellular and extracellular compartments regulates _________ membrane potential --> excitability of _______ and muscle cells & contractility of skeletal, _______, and smooth muscle tissue
electrical
nerve
cardiac
98
How does K+ regulate nerve impulses and muscle excitability? (3)
1. resting membrane potential
2. opening of Na channels that control the flow of current during the AP
3. rate of membrane repolarization
99
causes of hypokalemia (4)
1. inadequate intake
2. excessive renal losses
3. excessive GI losses
4. transcompartmental shift
100
hypokalemia lab value
< 3.5 mEq/L
101
normal Na value
135 - 145 mEq/L
102
hyperkalemia lab value
> 5 mEq/L
103
manifestations of hyperkalemia (3)
1. GI issues (N, V, D)
2. neuromuscular issues (parathesis, weakness, dizziness, muscle cramps)
3. cardiovascular (changes in electrocardiogram, cardiac arrest risk)
104
cardiac _______ changes with hypo and hyperkalemia
conduction
105
hyperkalemia:
1. ____ P wave
2. ______ QRS
3. ________ T
low
widening
peaked
106
hypokalemia
1. PR ________________
2. ______________ ST segment
3. _____ T
4. prominent ____ wave
prolongation
depressed
low
U
107
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 ______
diet
intestines
glomerulus
renal
urine
108
Ca+ distribution: 99% in ____, 1% in _____, small amt in _____
bone
cells
ECF
109
P+ distribution: 85% in ____, 14% in _____, small amt in _____
bone
cell
ECF
110
Mg+ distribution: 50 - 60 % in ____, 40 - 50% in _____, small amt in _____
bone
cell
ECF
111
ECF, Ca, P, Mg are regulated by ______ and ______
vit D
PTH
112
vitamin D acts as a hormone to keep normal ___ and ___ levels by increased ____________ absorption
Ca, P
intestinal
113
parathyroid hormone regulates release of ____ from ______
Ca
bones
114
PTH action is influenced by ____
Mg2+
115
if there is a Mg2+ deficincy = no ____
PTH
116
hypoparathyroidism: deficient PTH secretion = _________
hypocalcemia
117
what causes hypoparathyroidism (3)
thyroid surgery
autoimmune disorder
Mg2+ deficiency
118
manifestations of hypoparathyroidism mimic ________
hypocalcemia
119
hyperparathyroidism: hypersecretion of PTCH = _______________
hypercalcemia
120
causes of hyperparathyroidism (4)
1. hyperplasia (rapid production of PT cells = more workers = big response)
2. cancers
3. secondary disorder with renal failure
4. malabsorption of Ca
121
normal calcium levels
8.5 - 10.5 mg/dL
122
hypocalcemia lab value
< 8.5 mg/dL
123
causes of hypocalcemia (5)
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
4. increased sequestration (there but walled off, unable to use)
124
manifestations of hypocalcemia (3)
1. increase neuromuscular excitability (paresthesias, hyperactive reflexes, tetany, positive chvostek, and trousseau)
2. cardiovascular (hypotension)
3. skeletal issues
125
trousseau sign
hand curl up/in with BP cuff
126
chvostek sign
Hit lip and twitch
127
hypercalcemia lab value
> 10.5 mg/dL
128
causes of hypercalcemia (3)
increased intestinal absorption
increased bone resorption
decreased elimination
129
manifestations of hypercalcemia (5)
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
hypophosphatemia blood levels
< 2.5 mg/dL
131
causes of hypophosphatemia (3)
decreased intestinal absorption
increased renal elimination
malnutrition and intracellular shifts
132
manifestations of hypophosphatemia (3)
1. neural (confusion, stupor, coma, seizures)
2. musculoskeletal (muscle weakness)
3. blood disorders
133
manifestations of hyperphosphatemia (2)
1. neuromuscular (paresthesias)
2. cardiovascular (hypotension)
134
causes of hyperphosphatemia (4)
acute phosphate overload
intra to extracellular shift
rhabdomyolysis
impaired elimination
135
hyperphosphatemia lab value
> 4.5 mg/dL
136
normal Mg blood level
1.8 - 3 mg/dL
137
causes of hypomagnesemia (2)
impaired intake or absorption
increased losses
138
hypomagnesemia level
< 1.8 mg/dL
139
manifestations of hypomagnesemia (2)
1. neuromuscular (tetany, positive Babinski, chvostek, trousseau)
2. cardiovascular (tachycardia, hypertension, cardiac arrhythmias)
140
hypomagnesemia --> no ____ --> hypoparathyroidism ---> ________
PTH
hypocalcemia
141
hypermagnesemia levels
> 3 mg/dL
142
causes of hypermagnesemia (2)
excessive intake
decreased excretion
143
manifestations of hypermagnesemia (2)
1. neuromuscular (lethargy, hyporeflexia, confusion, coma)
2. cardiovascular (hypotension, cardiac arrhythmias)
