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Fluid Volume > Fluid And Electrolytes > Flashcards

Fluid And Electrolytes Flashcards

1
Q

normal sodium

A

135-145 mEq/L

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2
Q

normal potassium

A

3.5-5 mEq/L

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3
Q

normal BUN

A

7-20 mg/dl

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4
Q

normal hematocrit

A

40-50%

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5
Q

normal urine specific gravity

A

1.002-1.030

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6
Q

normal glucose

A

60-110 mg/dl

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7
Q

normal osmolality

A

275-295

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8
Q

FVD classic sign

A

dry mucous membranes, comes later

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9
Q

FVD late sign

A

hypotension

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10
Q

FVD, temp changes

A

decreased temp, blood shunted to central area

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11
Q

FVD, respiratory

A

increased respiratory rate bc acidotic, blowing of CO2; thick and sticky secretions

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12
Q

anasarca

A

severe, generalized third spacing

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13
Q

most common site, 3rd spacing

A

abdomen (ascites, in peritoneal cavity?)

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14
Q

primary mediator of fluids

A

hypothalamus

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15
Q

2nd spacing

A

stage where fluid moves from one space to another

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16
Q

3rd spacing

A

fluid in interstitial compartments

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17
Q

FVD sodium

A

normal to high (hemoconcentration)

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18
Q

FVD potassium

A

normal to high (is intracellular, if enough cell death –or sodium levels – could be high)

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19
Q

FVD BUN

A

high (hemoconcentration); in children may be low but not pathologic

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20
Q

FVD glucose

A

normal to high (stress response, >120)

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21
Q

FVD urine specific gravity

A

high >1.030

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22
Q

FVD osmolality (serum)

A

> 300, more particles ↑ number of particles, concentration

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23
Q

FVE hemodynamic signs

A

full bounding pulses, hypertension, increased CVP, neck vein distension, CHF

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24
Q

cerebral edema

A

seen with FVE, Confusion, dizziness, convulsions, coma

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25
Q

pulmonary edema

A

seen with FVE, Dyspnea, tachypnea, hacking cough, crackles, o2 sat down

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26
Q

FVE general signs

A

weight gain, nonpitting interstitial edema, hepatomegaly/splenomegaly

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27
Q

FVE first sign seen

A

pulmonary edema

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28
Q

neck vein distension

A

sign of FVE but not seen in kids, make sure know baseline for adults

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29
Q

goal of Rx for FVE

A

prevent cerebral edema

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30
Q

> > > causes of FVE (10)

A

renal failure, heart failure, excess fluid intake (without electrolytes), high corticosteroids, high aldosterone, plain water enema, NG irrigations, excess hypotonic IV fluids, SIADH, inappropriately prepared formula (dilute formula)

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31
Q

> > > excess fluid intake examples

A

excessive hypertonic fluids, binge drinking contest, psych disorders, drowning in fresh water, inappropriate dialysis

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32
Q

FVE, potassium

A

normal to high (potassium shift out of cells, rasing levels)

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33
Q

FVE, sodium

A

very low, <125

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34
Q

FVE, BUN

A

low (hemodilution)

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35
Q

FVE, urine spec gravity

A

low, <1.005

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36
Q

FVE, glucose

A

normal to high (stress response, >120)

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37
Q

decreased sodium and potassium signs

A

lethargy, weakness

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38
Q

increased sodium and potassium signs

A

increased excitability

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39
Q

acid

A

releases H+ ions in water

40
Q

base

A

binds to H+ ions in water

41
Q

buffers

A

prevent major acid-base changes; carbonic acid-bicarbonate, protien, and phosphate buffer system

42
Q

carbonic acid

A

measured as CO2

43
Q

acid-base homeostasis

A

bicarb: carbonic acid = 20:1

44
Q

carbonic acid-bicarb system

A

primary system, 50% of activity, to maintain balance l/t have to also use protein and phosphate buffer systems, 1-2 hours to kick in, bicarb is the major ECF buffer

45
Q

alkaline environment

A

hard for cells to grow

46
Q

> > > Respiratory buffer system, carbonic acid

A

carbonic acid compensates and dissociates into CO2 and H20, CO2 exhaled by lungs, system activates rapidly but exhausted quickly

47
Q

respiratory buffer system, breathing changes

A

changes in depth/rate of resp alters it: hypoventilation retains CO2/carbonic acid and causes acidosis, hyperventilation loses CO2 and causes alkalosis

48
Q

renal buffer system: time and effectiveness

A

works w/in hours/days, more efficient than respiratory can go for longer periods of time

49
Q

renal buffering system, bicarbonate

A

primary renal component, can be absobed as needed, combines HCl with ammonia to make ammonium, which is easily excreted by kidneys into urine

50
Q

compensation

A

regulatory mechanism to return pH to normal level by transforming acids and bases within the body

51
Q

primary metabolic disturbance

A

causes a respiratory compensation

52
Q

acute primary respiratory disturbance

A

causes an acute metabolic response

53
Q

complete compensation

A

pH is fully corrected (normal)

54
Q

partial compensation

A

buffers are in the process of working; pH is low but the bicarb is elevating to compensate (or pH is high but CO2 is elevating to compensate)

55
Q

pH

A

*negative logarithm of H+ ion concentration in mEq/L (as H+ ion concentration increases, pH decreases) *normal values 7.35 -7.45 (less is acidotic, more is alkalotic)

56
Q

HCO3- (bicarb)

A

*normal 22-26 mEq/L (decreased in acidosis, increased in alkalosis)

57
Q

BE “base excess”

A

indicates the amount of bicarb available in the ECF normal value: +/- 2 mEq/L

58
Q

serum anion gap

A

*Concentration of anions (HCO3- , Cl-, protein, phosphate, & sulfates) and cations (Na+, K+, MG++, & Ca++) *10-12 mEq/L normal *increased in metabolic acidosis (but can be normal) *calculated by Na - Cl + bicarb

59
Q

SaO2

A

the percent of Hb saturated with O2, a calculated value (indirect measurement), calculated with pH and PaO2 (combination of O2 sat, PaO2, and Hb), indicates tissue oxygenation

60
Q

PaO2

A

amount of oxygen available to bind with hemoglobin, amount of pressure exerted on O2 by plasma

61
Q

the lower teh PaO2 pressure, the ….

A

less oxygen available to bind with Hb

62
Q

dramatic drops in PaO2

A

correlate with dramatic drops in oxygen saturation

63
Q

PaO2 normal values

A

75-100 mmHg (for every year above 60 drop 1mmHg)

64
Q

PaCO2

A

*partial pressure of CO2 *reflects adequacy of alveolar ventilation, regulated by lungs, alterations indicate resp disturbance *normal values 35-45 mmHg (less is alkalotic, more is acidotic)

65
Q

respiratory alkalosis managment (4)

A

correct cause, rebreathe CO2 as needed, alter ventilation rate, sedatives (for anxiety)

66
Q

respiratory alkalosis assessment (7)

A

VS, ABGs, RR/depth, LOC/anxiety, neuro checks, injury potential, I&O

67
Q

respiratory alkalosis CV signs

A

tachycardia, palpitations, increased myocardial irritability

68
Q

respiratory alkalosis respiratory signs

A

rapid shallow breathing (trying to retain CO2, oxygenate), chest tightness

69
Q

respiratory alkalosos CNS signs (10)

A

paresthesia, dizzyness, confusion, tetany, convulsion, numb/tingling, light headed, anxiety/panic, Loss of consciousness, hyperactive reflexes

70
Q

respiratory alkalosis causes (4)

A

hyperventilation, sepsis/infection, over ventilation, hepatic cirrhosis

71
Q

respiratory alkalosis: labs

A

low CO2, pH high >7.45, bicarb normal if no compensation or decreased if compensation, hypokalemia, hypocalcemia

72
Q

respiratory acidosis management (7)

A

correct cause, CPT, TCDB if able, suction as needed, semi-Fowlers, fluids to thin secretions, low-flow O2 as needed

73
Q

respiratory acidosis assessment (8)

A

VS, ABGs, RR/depth, apical pulse, LOC, EKG, skin color/nail beds/mucous membranes, I&O

74
Q

respiratory acidosis cardiac signs

A

hypotension, peripheral vasodilation weak thready pulse, tachycardia, warm flushed skin

75
Q

respiratory acidosis respiratory signs

A

dyspnea, slow shallow respirations, hypoxia and hypoventilation, cyanosis

76
Q

respiratory acidosis CNS signs (6)

A

HA, seizures, altered LOC, papilledema, twitching/tremors, drowsy –> coma

77
Q

respiratory acidosis causes (4)

A

respiratory depression/arrest, inadequate chest expansion, airway obstruction, interference with alveolar capillary exchange

78
Q

respiratory acidosis: labs

A

pH low <7.35, PaCO2 high >42, HCO3- normal (or elevated with compensation), hyperkalemia

79
Q

metabolic alkalosis mgmnt (3)

A

correct cause, restore normal fluid balance, adequate chloride (enhance renal absorption of sodium and excretion of bicarb)

80
Q

metabolic alkalosis assessment (6)

A

VS, ABGs, RR/depth, LOC, I&O, ECG

81
Q

metabolic alkalosis GI signs (3)

A

n/v, anorexia, paralitic ileus (hypokalemia)

82
Q

metabolic alkalosis CNS signs (10)

A

dizzy, nervous, tremors, hyperreflexia, paresthesias, irritability, confusion/apathy/stupor, cramps, tetany, seizures

83
Q

met alkalosis respiratory signs (2)

A

hypoventilation, respiratory failure

84
Q

met alkalosis CV signs (5)

A

tachycardia, HTN, PVC, atrial tachycardia, dysthrythmias (from FVE)

85
Q

met alkalosis causes (4)

A

vomiting, NG suctioning, eating bicarb-based antacids, diuretics

86
Q

met alkalosis: labs

A

increased pH, increased BE, increased bicarb, decreased anion gap (low K and Na)

87
Q

met acidosis mgmnt (6)

A

correct cause, treat ketoacidosis (fluids, insulin), give alkaline fluids, hydrate, mechanical ventilation if needed, possible dialysis

88
Q

insulin

A

used to treat metabolic acidosis (ketoacidosis), forces potassium back into cells

89
Q

alkaline fluids for met acidosis

A

if severe, sodium bicarb if pH<7.20, salts of organic acid (lactate, citrate), tromethamine THAM

90
Q

met acidosis assessment (7)

A

VS, ABGs, RR/depth, apical and peripheral pulses, ECG (bc of dramatic K changes), LOC, I&O

91
Q

metabolic acidosis CV signs (4)

A

dramatic affects: hypotension, dysrhythmias, peripheral vasodilation, warm flushed skin (from dilation, leaking of capillaries)

92
Q

metabolic acidosis resp signs

A

Kussmaul/deep/rapid respirations, trying to blow off CO2

93
Q

metabolic acidosis CNS signs (6)

A

think of septic patient: drowsy, HA (from cerebral edema), lethargy, coma, confusion/restless, weakness

94
Q

metabolic acidosis GI signs (3)

A

n/v, diarrhea, abdominal pain

95
Q

causes of metabolic acidosis

A

chronic diarrhea, malnutrition, starvation, renal failure, DKA, trauma, shock, sepsis, fever, salicylate toxicity

96
Q

metabolic acidosis: labs

A

low bicarb, decreased BE, increased anion gap, hyperkalemia (from breakdown of cells from acidosis), high metabolic acids (lactic acids, ketoacids)

Fluid Volume (3 decks)

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