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NRSG 102: Med Surg 1 > Exam 1: Fluids and Electrolyes > Flashcards

Exam 1: Fluids and Electrolyes Flashcards

1
Q

What two compartments are body fluid located in?

A

Intracellular Space (Fluid in cells) and Extracellular Space (Fluid outside of cells)

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2
Q

What percentage of body is in ICF?

A

2/3’s

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3
Q

What is the ECF divided into?

A

Intravascular, Interstitial, and TRanscellular

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4
Q

Whats the Intravascular Space contain??

A

It contains plasma, with 3 L out of 6 L of blood made up of this. Remaining 3L made up of erythrocytes, leukocytes, and thrombocytes

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5
Q

Whats the Interstitial Space?

A

FLuid that surrounds the cell and totals about 11 to 12 L in an adult. Such as Lymph

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6
Q

WHat is TRanscellular Space?

A

Smallest division. 1 L. Cerospinal , Synovial, Intraocular, and PLeural Fluids

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7
Q

What is Third-Space Fluid Shift?

A

Loss of ECF into a space that does not contribute to equilibrium between ICF and ECF

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8
Q

Early evidence of third-space fluid shift?

A

Decrease in urine output despite adequate fluid intake. Kdineys recieve less blood and compensate by decreasing urine output.

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9
Q

Other signs and symptoms of third-space fluid shift?

A

Increased heart rate, decreased blood pressure, decreased central venous pressure, edema, increased body weight

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10
Q

Main cation in ECF?

A

Sodium ions. Retention of this is associated with fluid retention. Excessive loss of sodium is usually associated with decreased volume of body fluid

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11
Q

Main cation in ICF?

A

Potassium and Phosphate. ECF has low concentration of potassuium. This can cause trauma to ECF if released.

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12
Q

Sodium ECF Conventional Units?

A

135 - 145

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13
Q

Potassium ECF Conventional Units?

A

3.5-5.0

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14
Q

Chloride ECF Conventional Units?

A

98-106

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15
Q

Bicarbonate ECF Conventional Units?

A

24-31

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16
Q

CAlcium ECF Conventional Units?

A

8.5-10.5

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17
Q

Phosphorus ECF Conventional Units?

A

2.5-4.5

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18
Q

Magnesium ECF Conventional Units?

A

1.8-3.0

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19
Q

Sodium ICF Conventional Units?

A

10-14

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20
Q

Potassium ICF Conventional Units?

A

140-150

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21
Q

Chloride ICF Conventional Units?

A

3-4

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22
Q

BicarbonateICF Conventional Units?

A

7-10

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23
Q

Calcium ICF Conventional Units?

A

<1 mEq./L

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24
Q

Phosphorus ICF Conventional Units?

A

Variable

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25
Q

Magnesium ICF Conventional Units?

A

40 mEq/kg

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26
Q

What is Osmotic Pressure?

A

Amount of hydrostatic pressure needed to stop the flow of water by osmosis. Primarily determined by the concentration of solutes

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27
Q

What is Oncotic Pressure?

A

Is the osmotic pressure exeted by proteins

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28
Q

What is Osmotic Diuresis

A

Increase in urine output caused by the excretion of substances, such as glucose

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29
Q

General rule for urine output?

A

1 mL of urine per kilogram of body weight per hour

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30
Q

What is Osmolality?

A

The concentration of fluid that affects the movement of water between fluid compartments by osmosis

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31
Q

Factors Increase Serum Osmolality?

A 
SevereDehydration
Free Water Loss
Diabetes Insipidus
Hyperglycemia
Stroke or Head Injury
Alcholism
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32
Q

Factors Decreasing Serum Osmolality?

A 
FVE
SIADH
Acute Kidney Injury
Hyponatremia
Overhydration
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33
Q

Factors Increasing Urine Osmolality?

A

FVD
DIADH
HEart Failure

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34
Q

Factors Decreasing Urine Osmolality

A

FVE
Diabetes Insipidus
Hyponatremia

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35
Q

What is BUN made up of?

A

Urea, which is the end product of the metabolism of protein by the liver

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36
Q

How is Urea made?

A

Amino acid breakdown produces large amounts of ammonia molecules, which are absorbed into the blood stream and converted to Urea

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37
Q

Normal BUN level?

A

10 to 20 mg/dL

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38
Q

Factors trhat increase BUN?

A

Decreased renal function, GI bleeding, Dehydration, increased protein intake, fever, sepis

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39
Q

Factors trhat decrease BUN?

A

End-stage liver disease, a low-protein diet, starvation

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40
Q

What is Creatine?

A

The end product of muscle metabolism. BEtter indicator of renal function

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41
Q

Normal serum creatinine?

A

0.7-1.4 mg/dL

42
Q

Normal Hematocrit range?

A

42-52% for men, 35-47% for women

43
Q

Conditions that increase Hematocrit?

A

Dehydration and polycythemia

44
Q

Conditions that decrease Hematrocrit?

A

Overhydration and Anemia

45
Q

What happens as sodium intake increases?

A

Urine excretion increases.

46
Q

Normal Sodium levels?

A

75 to 200 mEq/24 hours.

47
Q

How much fluid do kidneys filter on a normal day?

A

180 L

48
Q

How much urine excreted in normal day?

A

1-2 L

49
Q

Major functions of kidneys in maintaining normal fluid balance?

A

Regulation of ECF volume by selective retention
REgulation of normal electrolyte levels in ECF by selective electrolyte retention
Regulation pH by retention of hydrogen ions

50
Q

Functions of ADH?

A

Maintaining osmotic presure of the cells by controlling the retention or excretion of water by the kidneys and by regulating blood volume

51
Q

What happens with increased secretion of aldosterone?

A

Causes sodium retention, (this water retention) and potassium loss.

52
Q

What does Cortisol do?

A

When secreted in large quantities, it can also produce sodium and fluid retention

53
Q

What do Parathyroid Hormone do?

A

Influences bone reabsorption, calciun absorption from teh intenstines, and calcium reabsorption.

54
Q

What does Renin do?

A

An enzyme that converts ANgiotensinogen, substance formed by liver, into angiotensin I. THis is due to decreased renal perfusion.

55
Q

What convers Angiotensin I to Angiotensin II?

A

ACE

56
Q

What does Angiotensin II do?

A

increases arterial perfusion pressure and stimulates thirst.

57
Q

What do Osmoreceptors do?

A

Sense changes in sodium concentration. AS this pressure increases, neurons become dehydrated and quickly release impulses to the posterior pituitary which increases release of ADH

58
Q

How many Natriuretic Peptides are tehre?

A

Four

59
Q

What are the four Natiuretic Peptides?

A

Atrial Natriuretic Peptide (ANP)
Brain Natriuretic Peptide (BNP)
C-Type Natriuretic Peptide (CNP)
D-Type Natriuretic Peptide (DNP)

60
Q

What actives ANP?

A

Any condition that results in volume expansion, calorie restriction.

61
Q

What does ANP do?

A

Its action decreases water, sodium, adipose loads. Directly opposite of RAAS .

62
Q

Alternate name for FVD?

A

Hypovolemia

63
Q

When does Hypovolemia occur?

A

When loss of ECF volume exceeds the intake of fluid. Water and electrolytes are lost in the same proportion as they exist in nrmal body fluids

64
Q

Causes of FVD?

A

Abnormal fluid losses, GU Suctioning, and Sweating, Third-Space fluid shifts, or edemas.

65
Q

FVD contributing factors

A

Loss of water and electrolytes such as vomiting, diarrhea, gi suctioning,
decreased intake as in anorexia, nausea,
diabetes insipidus and uncontrolled diabete

66
Q

FVD Signs/Symptoms

A

Acute weight loss, decreased skin turgor, capillary filling time prolonged, decreased bp, flattened neck veins

67
Q

FVD Labs

A

Increased hemoglobin and hematocrit
Increased serum and urine osmolality and SpG
Decreased urine sodium
Increased BUN and Creatinine

68
Q

FVE altername name?

A

Hypervolemia

69
Q

FVE Contributing FActors

A

Compromised regulatory mechanisms such as Kidney injury, heart failure
Over-administration of sodium-containing fluids and fluid shifts. Severe Stress

70
Q

FVE Signs/Symptoms

A

Acute weight gain, peripheral edema, distended jugular veins, cracjkes, increased bp, bounding pulse, increased respiratory rate and cough

71
Q

FVE Labs

A

Decreased hemoglobin and hematocrit, decreased serum and urine osmolality.
Decreased urine sodium and SpG

72
Q

Normal BUN to serum creatinine concentration?

A

10:1

73
Q

What happens to a BUN to serum creatinine concentration in a volume-depleted patient?

A

BUN elevated out of proportion, greater than 20:1

74
Q

Hematocrit level in hypovolemia?

A

Increased, because there is a decreased plasma volume

75
Q

When does Hypokalemia occur?

A

With GI and Renal Losses

76
Q

When does Hyperkalemia occur?

A

With adrenal insufficiency

77
Q

When does Hyponatremia occur?

A

With increased thirst and ADH release

78
Q

When does Hypernatremia occur?

A

Results from increased insensible losses and diabetes insipidus

79
Q

First choice for treating those with FVD?

A

If fluid losses acute or severe, IV route required. Isotonic solutions, such as 0.9% NaCl are the first-line choice because they expand plasma volume.

80
Q

FVD - What happens if patient becomes normotensive, ?

A

Administer a hypotonic electrolyte solution (0.45% NaCl) Used to provide both electrolytes and water for renal excretion of metabolic wastes.

81
Q

Test administered to patient with severe FVD when oliguric?

A

Fluid Challenge Test. 100-200 mL of normal saline solution given over 15 minutes. The goal is to have increased urine output and blood pressure and central venous pressure

82
Q

Alternate name for FVE?

A

Hypervolemia

83
Q

What is FVE?

A

REfers to an isotonic expansion of the ECF caused by the abnormal retention of water and sodium in approximately the same proportions in which they normally exist in ECF

84
Q

FVE may be related to?

A

Simple fluid overload or diminished function of the homeostatic mechanisms responsible for regulating fluid balance

85
Q

Contributing factors of FVE?

A

Heart Failure, Kidney Injury, and Cirrhosis of the liver

86
Q

Clinical Manifestations of FVE?

A

Edema, Distended neck veins and crackles

87
Q

BUN and Hematocrit levels in FVE?

A

Decreased because of plasma dilution, low protein intake, and anemia

88
Q

When are thiazide diuretics typically prescribed?

A

Prescribed for mild to moderate hypervolemia

89
Q

When are loop diuretics typicaly assigned?

A

For severe hypervolemia

90
Q

HYpokalemia can occur with all diuretics except those that work in

A

the last distal tubule of the neprhons. Potassium supplements can be prescribed to avoid this complication

91
Q

FVE - When can Hyperkalemia occur?

A

This can occur with diuretics that work in the distal tubes, especially those with decreased renal function

92
Q

When does Hyponatremmia occur?

A

With administration of loop and thiazide duretics due to decreased reabsorption and increased excretion of magnesium by the kidney

93
Q

What is Azotemia?

A

Increase nitrogen levels in blood, that can occur withFVE when urea and creatinine are not excreated

94
Q

When is Dialysis used?

A

When other things don’t work, this is used to remove nitrogenous wastes and control potassium and acid-base balance and to remove sodium and fluid

95
Q

Treatment of FVE usually involves dietary restriction of

A

sodium

96
Q

What is a frequent cause of the increased ECF volume?

A

Sodium retention

97
Q

wHAT IS Sodium responsible for?

A

Water regulation and balance

98
Q

What is potassium responsible for?

A

nerve impulse transmission, muscle contraction, plasma, acid-base balance, normal heart rhyth,

99
Q

what is calcium responsible for?

A

Muscle activity, blood coagulation

100
Q

What is magnesium responsible for?

A

nerve impulse transmission and muscle contraction

101
Q

What is phosphate responsible for?

A

ATP production

102
Q

What is chloride responsible for?

A

hychloric acid production, acid-base balance

NRSG 102: Med Surg 1 (52 decks)

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