Final exam Flashcards
Surgical body position
lithotomy
Surgical body position
Reverse Trendelenburg
Surgical body position
Orthopneic
Surgical body position
Trendelenburg
Surgical body position
Sims
Surgical body position
Fowler’s
Surgical body position
Semi-Fowler’s
Surgical body position
Kraske or Jackknife
Urine osmolality
50 -1200 osmos per kg (the higher, the more dehydrated)
Urine specific gravity norm
1.010 to 1.020
Controls/regulates volume of body fluids
Na+ (sodium)
Regulator of enzymes & H2O content
K+ (potassium)
Controls nerve impulse, blood clotting, muscle contraction, B12 absorption
Ca2+ (calcium ion)
Controls metabolism of carbohydrates & proteins, vital actions involving enzymes
Mg2+ (Magnesium ion)
Maintains osmotic pressure in blood, produces hydrochloric acid
Cl- (chloride ion)
Body’s primary buffer system
HCO3- (bicarbonate ion)
chemical involving cell division, energy metabolism, and hereditary traits
Phosphate
Normal sodium level is
135 to 145 mEq/L
Na+
Sodium
Normal potassium level is
3.5 to 5.0 mEq/L
K+
Potassium
Normal calcium level is
8.9 to 10.1 mEq/L
Ca2+
Calcium
Normal magnesium level is
1.4 to 1.75 mEq/L
Mg2+
Magnesium
Normal Chloride level is
96 to 106 mEq/L
Cl-
Chloride
Normal Bicarbonate level is
22 to 26 mEq/L
HCO3-
Bicarbonate
Normal Phosphate level is
2.5 to 4.5 mEq/L
Insulin transports
potassium
Diabetics may have too much
potassium
Fluid movement occurs primarily by
Osmosis & Filtration
Osmosis & Filtration goes from
lower to higher
Electrolytes move via
diffusion, filtration & active transport
diffusion, filtration & active transport goes from
higher to lower
Types of passive transport
diffusion, filtration, and osmosis
Movement of solvent or solutes (molecule) move from an area of higher concentration to lesser concentration
Diffusion
Movement of fluid through a semi permeable membrane
Osmosis
A condition in which the blood has a high concentration of salt (sodium), glucose, and other substances.
Hyperosmolar
An abnormal decrease in the osmolarity of the body fluids.
Hypoosmolar
Transfer of water and dissolved substances through a permeable membrane
Filtration
Occurs within the kidney’s glomerular capillaries
Filtration
This is the energy required to move substances through the membrane(lesser to greater concentration- the Na K in the cell( sodium –potassium pump)
Active Transport
Prevents too much sodium in the cell so the cell won’t burst
Active transport
Force of attraction for water by undissolved particles helps keep fluid within blood vessels
Osmotic Pressure
Plasma proteins help osmotic pressure
– they attract water
_____, ______, and ______are major Extracellular substances that help move water between ECF and Cell
Sodium, chloride, & Glucose
Fluids affect on cell wall
Tonicity
_______ ________ enters- there is no movement of water across membranes …so cells maintain their normal size
Isotonic Solution
NORMAL SALINE IS
ISOTONIC (0.9% NaCl)
NORMAL SALINE causes
Vascular expansion, electrolyte replacement
concentration is less than blood plasma
HYPOTONIC SOLUTION
Moves fluid into cells & interstitial space
Cellular dehydration
Hypotonic solution
Isotonic, Hypotonic, & Hypertonic are
Crystalloid Solutions
Increase intravascular osmotic pressure (pressure of plasma proteins) within the intravascular space
Colloid Solutions
Restores serum protein
Colloid solutions
The pressure gradient pulls fluids into the vascular space.
Colloid solutions
Normal saline is a
Volume expander
Saline and electrolyte IV
Lactated Ringer
IV solution ordered when you lose extracellular volume
Lactated ringer
Isotonic solution but sugar metabolizes making it a hypotonic solution
D5 Water
Solution that is given for cerebral edema
Hypertonic
Causes filtration from an area of higher pressure to an area of lower pressure
Hydrostatic Pressure
Is created by the weight or force of a solution e.g.. The pressure caused by BP against the walls of vessels causes fluid to move out depending on the BP
Hydrostatic Pressure
Hydrostatic pressure minus osmotic pressure and tries to push fluids into tissue spaces
Filtration Pressure
ECF is a ____% solution
0.9%
Signs and symptoms of ECF Volume Deficit
Orthostatic/postural changes in Pulse &BP.
Decreased Urine Output
Signs and symptoms of decreased interstitial volume
Dry mucous membranes & poor skin turgor
Thirst
Treatment for ECF Volume Deficit
Oral Replacement
IV replacement
Safety
Treatment of of Fluid volume excess
Restrict NA & saline & diuretics, find cause
Happens when water intake is increased or decreased
Or when water is retained or excreted excessively
Water or Osmolality Imbalance
Occurs when decrease in H2o intake, an increase in water loss, or excess intake of solute
Serum Na greater than 145 mEq/L
Water deficit (ICF Deficit) or Hyperosmolaltiy or Hypernatremia
Signs and Symptoms of Hyperosmolality or Hypernatremia
Confusion, agitation Seizures, coma maybe death,
SIADH
Syndrome of inappropriate ADH
Treatment for Hyperosmolality or Hypernatremia
Replace orally or IV D5W
Happens when there is an increase in water intake, abnormal secretion of ADH, or decreased urinary output of water
Serum Na of less than 135 mEq/L
Water Excess or Hypoosmolality or Hypnotremia
Treatment of Water Excess or Hypoosmolality or Hypnotremia
water restriction
Potassium is maintained by
sodium-potassium pump in the cells
K+ changes lead to
altered excitability of muscles, cardiac cells and neuro
Potassium is eliminated by
The kidneys
______ causes K+ to move out of ECF & into cells esp. skeletal muscle & liver cells!!!
Insulin
Potassium higher than 5 mEq/L is called
Hyperkalemia
Hyperkalemia is caused by:
renal failure, acidosis, massive tissue injury e.g. burns, self med errors, rapid IV infusion
Hyperkalemia signs and symptoms
muscle irritability, EKG changes
Treatment for Hyperkalemia
low Na+ diet, Kayexalate enemas or by po. IV Calcium Gluconate, IV Insulin. Can give diuretics if moderately elevated
Hypokalemia is
Potassium below 3.5 mEq/L
Hypokalemia can be caused by
vomiting, diarrhea, diuretics, aldostreone, alkalosis
Signs and symptoms of Hypokalemia
Impaired neuromuscular transmission which leads to decrease in reflexes, muscle weakness which can lead to muscle paralysis, anorexia, N/V, EKG changed, greater risk of digoxin toxicity
Treatment of Hypokalemia
Orally with Foods 2000-5500mg daily
Po supplements
IV
Phosphorus level below 2.5 is called
Hypophosphatemia
Hypophosphatemia is caused by
Alcoholism, Renal wasting, Uncontrolled diabetes Mellitus
Hypophosphatemia signs and symptoms
Neuromuscular dysfunction, weakness (especially respiratory muscles), Fatigue, Ventricle dysrhythmias, confusion
Hypophosphatemia treatment
Treat underlying cause, foods high in phosphorous, oral phosphorous replacement
Major functions of Calcium
Transmission of nerve impulses, cardiac contractions, blood clotting, formation of teeth & bone, and muscle contraction
Calcium is controlled by
Vit D, parathyroid hormone, and Calcitonin
Patients who’ve had thyroidectomy have problems
with calcium
Improper absorption from the GI tract, decreased fat soluble vitamins. Pancreatitis no parathyroids renal disease, & massive transfusions
Hypocalcemia
cells increased excitability- which leads to muscle twitching , tingling & parasthesias of face fingers & toes increased reflexes, chvostek’s sign & tetany
Signs and symptoms of hypocalcemia
Bone cancer, immobility, excessive antacid use hyperparathyroidism, and increase in Vit D
Causes of hypercalcemia
impaired nerve and muscle conduction, decreased tone, bone pain, kidney stones(calculi), confusion, memory impairment & lethargy
Signs and symptoms of hypercalcemia
Causes: prolonged malnutrition, surgery, alcohol abuse
hypomagnesium
tremors, cramps, increased BP, tachycardia, confusion & convulsions
Signs and symptoms of hypomagnesium
60% of this goes to the bones and the rest in tissues
Magnesium
Causes: kidney failure, excess ingestion of laxatives/ antacids
Hypermagnesium
lethargy, coma when > 2.5, weak, paralysis, decreased reflexes, bradycardia
Signs and symptoms
Plasma osmolality norm
280-300 osmos per kg