Exam 2 Flashcards
Major cation in ECF
Major anion in ECF
Cation: Sodium
Anion: Chloride
Major cation in ICF
Major anion in ICF
Cation: Potassium
Anion: Phosphate
Hydrostatic Pressure
(Pushing) pressure exerted on the walls of the blood vessels
Osmotic Pressure
(Pulling) pressure exerted by the protein in the plasma
What is -pheresis
takes blood out, filters it, and puts it back in (aquapheresis is taking blood out, filtering out the water, then putting the blood back in)
Fluid spacing: First spacing
Normal distribution of fluid in ICF & ECF
Fluid spacing: Second spacing
abnormal accumulation of interstitial fluid (edema-treatment TED hose, compression stockings)
Fluid spacing: Third spacing
fluid accumulation in part of body where it is no easily exchanged with ECF (ascites - treatment poke a hole & drain)
Regulation of Water Balance Step 1
Hypothalamic Regulation - Stimulates thirst and antidiuretic hormone (ADH) release. ADH goes to Pituitary where it is stored
Regulation of Water Balance Step 2
(posterior) Pituitary Regulation - pituitary releases ADH which tells us to hang on to fluids; regulates water retention by the kidneys
* SIADH-Symptom of Inappropriate ADH (too much)
* DI-Diabetes Insipidus (too little ADH)
Regulation of Water Balance Step 3
Adrenal Cortical Regulation (adrenals control our energy source) - Releases hormones to regulate water & electrolytes
Aldosterone - hold on to salt (where salt goes water follows)
Regulation of Water Balance Step 4
Renal Regulation - primary organs for regulating fluid & electrolyte balance - selective reabsorption of water & electrolytes
Regulation of Water Balance Step 5
Cardiac Regulation - Natriuretic peptides are antagonists to RAAS. BNP-Brain Natriuretic Peptide: enzymes that turn off Aldosterone
Regulation of Water Balance Step 6
Gastrointestinal Regulation - Diarrhea & vomiting can lead to significant fluid & electrolyte loss b/c body can’t control what is being lost
Regulation of Water Balance Step 7
Insensible water loss-invisible vaporization from lungs and skin to regulate body temp. Approx 600-900 ml/day lost; no electrolytes are lost, only pure water
Hypotonic
solutes are less concentrated than in the cells (cell swells)
Hypertonic
solutes more concentrated than in cells (water leaves cell to dilute ECF; cell shrinks)
IV Fluids Replacement therapy Hypotonic
- More water than electrolytes
- Pure water lyses RBC’s
- Water moves from ECF to ICF by osmosis
- Maintenance fluids
IV Fluids Replacement therapy Isotonic
- Expands only ECF
* No net loss or gain from ICF
IV Fluids Replacement therapy Hypertonic
- Initially expands and raises the osmolality of ECF
* Require frequent monitoring of BP, lung sounds, serum sodium levels
Normal Saline (NS) IV Fluids Replacement therapy
Expands IV volume (preferred fluid)
Risk for fluid overload higher
Does not change ICF volume
*compatible with most medications
Lactated Ringers IV Fluids Replacement therapy
- Isotonic
- More similar to plasma than NS
- Has less NaCl
- Has K, Ca, PO4 lactate (metabolized to HCO3)
- Expands ECF
D5 1/2 NS IV Fluids Replacement therapy
*Hypertonic
*Common maintenance fluid
KCl added for maintenance or replacment
D10W IV Fluids Replacement therapy
- Hypertonic
- Provides 340kcal/L
- free water
- limit of dextrose concentration may be infused peripherally
Plasma Expanders IV Fluids Replacement therapy
- Stay in vascular space and increase osmotic pressure
- Colloids (Protein solutions)
- *Packed RBCs
- *Albumin
- *Plasma
TPN Therapy
*throw out everything Q 24 hours
Hiatal hernia: sliding
Portion of stomach herniates through weakened diaphragm wall, heartburn after meals, burning pain w bending over or lying down, relieved by standing or sitting
Hiatal hernia: paraesophageal (rolling)
Portion of stomach herniates through weakened diaphragm wall then rolls over
Gastrectomy (Bilroth)
Removal of bottom portion of stomach
- Instrinsic factor (needed for absorption of B12) no longer released from stomach; therefore, B12, folic acid, and iron deficiencies result
- Pt will need B12 shots
Diverticulosis
presence of many abnormal pouchlike herniations in the wall of the intestine
- High fiber
- 95% sigmoid
- asymptomatic
Diverticulitis
inflammation of one or more of the diverticula
- cramps, pain over site
- could lead to peritonititis
- low fiber & clear liq until inflammation subsides
- antibiotics
normal appearance of colostomy stoma
beefy red; if it’s less than beefy red, indicated decreased blood flow; if it’s black, call dr immediately
pernicious anemia
caused by absence of IF due to gastric mucosal atrophy or autoimmune destruction of parietal cells; decrease in HCl
IV K should not exceed
10-20 mEq/hr & should be on pump
do not give > 40mEq at a time
