Electrolytes. Patho and Adult Exam Flashcards
functions of water in the body:
transport nutrients to cells
transport hormones enzymes, blood (red and white blood cells),
cellular metabolism
acts as a solvent for both non electrolytes and electrolytes
Maintains normal body temp
facilitates digestion and promotes elimination
acts as a tissue lube
Intracellular fluid makes up
70% of fluid within cells
Extracellular fluid makes up
30% of fluid outside cells
Who has less body water?
women and obese
healthy people have a total body water of:
50-60% of their body weight
Cations:
positive
Anions
Negative
Osmosis is when
water passes from an area of lesser solute to greater concentration
Diffusion is when
solutes more freely throughout a solvent (“downhill”)
Active transport:
requires energy for movement from lesser solute concentration to higher solute concentration
Filtration:
passage of fluid through permeable membrane from higher to lower.
Isotonic solutions:
same concentration of particles as there is plasma. Remains in intravascular compartment without net flow
I-SO-PERFECT
Hypertonic solutions:
greater concentrations are in the plasma (extracellular)
water moves out of the cell and drawn intravascular causing cells to SHRINK
HYPER people skinny (SHRINK)
Hypotonic solutions
lesser concentration of particles than plasma.
Fluid in intravascular space move into intracellular fluid causing cells to SWELL
HIPPO SWOLLEN
which system pumps and carries nutrients and water in the body..
cardiovascular
what regulates carbon and oxygen levels in the blood
lungs
What helps conserve sodium, save chloride and water and excrete potassium
Adrenal Glands
What stores and releases ADH
pituitary gland
What increases blood flow in the body and increases renal circulation:
thyroid gland
What inhibits and stimulates mechanism of influencing fluid balance
nervous system
What regulates the level of calcium in ECF
parathyroid gland
What absorbs water and nutrients that enter the body through this route
GI tract
hypovolemia
deficiency in the amount of water and electrolytes in ECF with near-normal water and electrolyte proportions
Dehydration
decrease volume of water and electrolyte change
Hypervolemia
excessive retention of water and sodium in ECF
overhydration
above normal amounts of water in extracellular spaces
Edema
excessive ECF accumulates in tissue spaces
Interstitial to plasma shift
movement of fluid from the space surrounding cells to blood
BUN level
5-25
CREAT. CLEARANCE LEVEL
1-2mgs/dl
SERUM OSMOLARITY LEVEL
280-295
URINE SG LEVEL
1.005 TO 1.050
Phosphorus level
2.5-4.5
Magnesium level
1.5-2.5
potassium level
3.5-5
a loss or gain of equal amount of Na and H2O is..
isotonic
Remember no net change!
loss or gain of Na in excess of H20 or H20 in excess of Na:
Hypotonic or Hypertonic
Isotonic loss causes:
Fluid volume deficit
renal disease with polyuria, excess diuretic use, aldosterone deficiency (addisons), hemorrhage, vomiting, diarrhea, burns, excess sweating, 3rd spacing
Fluid volume deficit S/S:
tachycardia, hypotension, dry mucus membranes, tenting skin
Fluid volume deficit labs:
increased Hct (due to loss of plasma), BUN and NORMAL SERUM OSMO!!!
Treatment for fluid volume deficit:
give isotonic solution, replace blood loss and remove 3rd spacing fluid
Isotonic gain of Na &H20 :
Fluid Volume Excess!
decreased Na and H20 elimination by kidneys
Causes of Fluid volume excess
renal failure, heart failure, increased aldosterone (cushings syndrome)
S/S of fluid volume excess
edema, weight gain, JVD, crackles in lungs
labs indicating fluid volume excess:
Decreased Hct and BUN, NORMAL SERUM OSMO
Treatment for fluid volume excess
diuretics, decrease fluid intake
Hyponatremia:
Less Na and more H20 (hypoosmolar)
Hyponatremia causes:
loss of sodium: GI losses like vomiting, diarrhea, GI suction, Excess diuretics, Decreased aldosterone levels (addisons)
Gain of water: renal and heart failure, excess hypotonic solutions, SIADH (too much ADH) increase H20 intake
S/S of hyponatremia:
neuromuscular:
think salt loss
S- seizures A- abdominal cramping L- LOC decreased T- tachycardia L- lab Na and serum osmo decreased O- orthostatic hypotension S- swollen cell S-
Nursing interventions for hyponatremia:
3% hypertonic solution, decrease water intake, consume sodium rich foods or Na supplements
Hypernatremia:
More Na than H20–hypertonic
Causes of Hypernatremia:
Gain of Na: IV fluids with Na, excess tube feedings
Not enough water: insufficient intake or excess loss from skin, renal (DIABETES INSIPIDUS, OSMOTIC DIURESIS) and diarrhea
S/S of hypernatremia:
Think: “no fried foods for you model:
F-Fever, flushed R-restless I-irritability E-excessive thirst D-dry mucus membranes, dehydrated
Which type of solution would you give for hypernatremia:
hypotonic solution
What is the key electrolyte for cell excitability and muscle function (contraction)
Potassium
S/S of BOTH hypokalemia and hyperkalemia
muscle weakness, spasms, paralysis, paresthesia, orthostatic hypotension, arrhythmia, nausea, vomiting, cramping
Hypokalemia causes:
Excess urine loss, diabetes insipidus, high aldosterone, excess GI loss through vomiting, GI suction and inadequate intake of K
Treatment for Hypokalemia:
give K foods or K supplements
Give through IV slowly and carefully but NEVER IV PUSH
When giving potassium replacement you can give up to..
40meq/hr if severe
Check serum every 4-6 horus
What function must you check before administering potassium supplements
Kidney function
Should IV solution of potassium be diluted?
YES 10ml IV solution per 1meq
Hyperkalemia causes:
increased K intake through po source, IV or meds, decreased loss of K through renal failure and decreased aldosterone (addisons) and cell destruction through trauma or burns
Hyperkalemia treatment
Insulin & Dextrose or sodium bicarb to shift into cells
Dialysis, sodium polystyrene (Kavexalate), and exchange resin (diarrhea)
Stabilize cell excitability with Calcium iv
ECF includes large amounts of___ and small amounts of___
Large amounds of NA and Cl
Small amounts of K,Ca, Mg, phosphate
ICF includes large amounts of ___ and small amounts of__
Large amounts of K and small amounts of Ca, Mg, phostphage, Na and Cl and bicarb
Total body water is lower or higher in adults?
LOWER (45-47%)
Average urine output should be
60ml/hr (
List of Cations:
Na, K, Ca, Mg, H
List of Anions
Cl, P04, HC03
What is the key function of electrolytes?
water balance,
nerve impulses & muscle contraction (NA, K, Ca)
Acid based balance (H, HC03, K)
Blood clotting (Ca)
What is the movement of water from lower concentration to higher concentration through semi-permeable membrane
Osmosis
Tonicity
tension or effect that osmotic pressure of solution with impermeable solutes exerts on cell size because of H20 movements across the cell membrane
Give an example of a hypertonic solution..
Powerade
Give an example of an isotonic solution
Gatorade
If a client is admitted with CHF what tonicity might they have?
Hypotonic– more dilute since there is less fluid in the cell
capillary colloidal osmotic pressure
pulls fluid into the capillaries (prevent too much fluid from being lost)
generated by plasma proteins too large to pass through pores
Capillary filtration pressure-capillary hydrostatic pressure (HP)
reflects BP,
pressure pushes water out of the capillary into the interstitial spaces
higher at the arterial end and lower at venous end
Water moves out of the capillaries at the arterial end and into the venous end
If there is a hydrostatic pressure that is higher at the COP of an aterial end, the net flux goes out to..
the tissues
If there is a hydrostatic pressure that is lower at the COP of a venous end, the net flux goes into
plasma
Edema can be caused by
increased capillary filtration pressure, decreased capillary colloidal osmotic pressure, increased capillary permeability and obstuction to lymph flow
Capillary filtration pressure is increased by…
decrease in resistance to outflow, an increase in venous pressure
Magnesium- how does this react in related to K and Ca
maintains homeostasis bewteen K and Ca
Hypomagnesemia
similar to hypocalcemia- increase in neuromuscular excitability, tachycardia, hypertension, ventricular dysrhythmias
hypermagnesemia
muscle weakness, decreased reflexes, lethargy, confusion, no DTR and low RR
Creatinine is used to estimate
GFR
Creatinine is increased with
decreased renal function and BUN increase
What causes there to be a slight age related increase in creatinine
the decreased muscle mass
if you are dehydrated it does not affect the serum creatinine levels. True or false?
True
name inverse relationships with calcium
hyperphosphatemia and hypocalcemia
hypophosphatemia and hypercalcemia
calcium
blocks Na gates in nerve and muscle cells
Calcium is important for..
Extracellular: clotting– there may be a problem if there is a lack of calcium
Intracellular: needed for all muscle contraction and acts as a second messenger in many hormone and neurotransmitter pathways.
Calcium actions are opposite of that of…
K–low calcium makes more cells excitable whereas high calcium makes cells less excitable.
What is calcium regulated by
PTH and Vitamin D
Calcium has an inverse relationship with..
Phosphate
hypercalcemia
Causes: increased bone release of Ca due to immobility, neoplasms, hyperparathyroidism, renal disease
Increased calcium gains: excessive Ca or Vit D in diet
Hypercalcemia manifestations:
decreased neuromuscular activity, weakness, lethargy, nausea, vomiting, coma, pain, kidney stones, fractures
How to treat hypercalcemia:
correct cause, weight bearing activities, loop diuretics, phosphate meds to bind PO4 and Ca and lower Ca
Hypocalcemia is caused ffrom:
increased bone resorption (bones holding onto more calcium), hypoparathyroidism
Manifestations of hypocalcemia are:
increased n-m activity, tetany, twitching, hyperreflexia, parasthesias, CV arrhythmias
+chovsteks sign
+Trusseaus sign
Treating hypocalcemia:
give calcium or vit d supplement, decrease the use of phosphate containing antacids and laxatives.
Chloride is a major key role in…
osmotic balance with Na and acid base balance.
Low sodium levels will also have low..
chloride levels
Hypochloremia S/S:
same as hyponatremia
Phosphorus is a key role in
acid base balance and ATP relationship with calcium
