Fluid, Electrolyte, & Acid-Base Regulation (Page 1 🥲) Flashcards
1
Q
Minerals in the body that are able to conduct electrical charges =
A
Electrolytes
2
Q
Are electrolytes essential to sustain life?
A
Yes
3
Q
Electrolytes are found in-
A
The blood, urine, tissues, and other body fluids
4
Q
Common electrolytes include-
A
Potassium, Sodium, Calcium, & Magnesium
5
Q
How can electrolyte levels be evaluated?
A
By performing metabolic panels like the BMP or CMP
6
Q
A blood test that gives info like electrolyte + fluid balance. Also gives info about renal function + glucose levels =
A
Basic Metabolism Panel (BMP)
7
Q
A blood test that gives info like electrolyte + fluid balance. Also gives info about the body’s metabolism + protein & liver function =
A
Complete Metabolic Panel (CMP)
8
Q
What tests does a BMP provide?
A
Blood Urea Nitrogen (BUN), Carbon Dioxide (C02), Creatinine (CR), Glucose, Chloride (Cl- ), Potassium (K+), and Calcium (Ca+) tests
9
Q
What tests does a CMP provide?
A
All of the tests a BMP provides, also provides Liver Enzyme , Alkaline Phosphate (ALP), Alanine Transaminase (ALT), Aspartate Aminotransferase (AST), Bilirubin (total), Protein (total), and Albumin tests
10
Q
The indication that the Blood Urea Nitrogen test looks into is-
A
Kidney Function
11
Q
The indication that the Carbon Dioxide (C02) test looks into is-
A
Blood Bicarbonate Level
12
Q
The indication that the Creatinine (CR) test looks into is-
A
Kidney Function
13
Q
The indication that the Glucose test looks into is-
A
Blood Sugar Level
14
Q
The indication that the Chloride (Cl-) test looks into is-
A
Blood Chloride Level
15
Q
The indication that the Potassium (K+) test looks into is-
A
Blood Potassium Level
16
Q
The indication that the Sodium (Na+) test looks into is-
A
Blood Sodium Level
17
Q
The indication that the Calcium (Ca+) test looks into is-
A
Liver Function
18
Q
The indication that the Liver Enzymes test looks into is-
A
Liver Function
19
Q
The indication that the Alkaline Phosphate (ALP) test looks into is-
A
Liver Function
20
Q
The indication that the Alanine Transaminase (ALT) test looks into is-
A
Liver Function
21
Q
The indication that the Aspartate Aminotransferase (AST) test looks into is-
A
Liver Function
22
Q
The indication that the Bilirubin (total) test looks into is-
A
Liver Function
23
Q
The indication that the Protein (total) test looks into is-
A
Total Blood Protein
24
Q
The indication that the Albumin test looks into is-
A
Liver Function
25
Electrolytes are responsible for maintaining-
The balance of water in the body
26
Electrolytes are responsible for balancing-
The blood pH (acid-base) level
27
Electrolytes are responsible for moving nutrients-
Into the cells
28
Electrolytes are responsible for moving wastes-
Out of the cells
29
Electrolytes are responsible for maintaining proper function of the body’s-
Muscles, heart, nerves, and brain
30
The average person’s weight consists of how much water?
One-half to two-thirds water
31
For males, water makes up what percentage of weight?
~60% of weight
32
For females, water makes up what percentage of weight?
~54 %
33
For babies/ children, water makes up what percentage of weight?
~70 %
34
A poor balance of water can lead to-
Hypovolemia, Dehydration, Tachycardia, Tachypnea, Confusion, Headache, Kidney Stones, etc.
35
Heart rate above expected range =
Tachycardia
36
Respiratory rate above expected range =
Tachypnea
37
Organs that filter blood + excrete waste as urine =
Kidneys
38
Excess water loss without a loss of sodium =
Dehydration
39
Decrease in blood volume due to body fluid / blood loss =
Hypovolemia
40
Homeostasis =
Body’s natural balance
41
Measurements of the solutes within a solution =
Osmolality
42
How does the body work to maintain homeostasis?
By keeping water + electrolytes at a constant level in the blood
43
How can the level of water + electrolytes in the blood be monitored?
Determining the Serum Osmolality of the blood
44
The most frequently used laboratory indicator of the body’s fluid status =
Serum Osmolality
45
Expected range of Serum Osmolality =
285 - 295 m0sm / kg
46
As body water decreases, what increases?
The concentration of solutes
47
Whenever body water decreases and the concentration of solutes increases, this leads to an increase in-
Serum Osmolality and indicates decreases in hydration
48
Osmolality can’t be determined using urine.
True or false?
False
49
Urine can be used to measure Osmolality and what else?
Renal Function + Hydration Status
50
The expected range for urine Osmolality is -
50 - 1,200 m0sm/kg for a random specimen
51
Is the body’s water located within cells or outside cells?
Both
52
The body has how many main fluid compartments?
3
53
What’s the body’s largest fluid compartment?
The Intracellular Space
54
The Intracellular Space holds what percentage of the body’s water?
67 %
55
Aside from the Intracellular Space, there is also the other two compartments, which collectively come together to create the-
Extracellular Space
56
The two compartments that make up the extracellular space are called the-
Interstitial Space + Intravascular Space
57
The Intravascular Space holds what percentage of the body’s water?
8%
58
The Interstitial Space holds what percentage of the body’s water?
25 %
59
How does the water pass through the various fluid compartments in the body?
The process of Osmosis
60
The movement of water from an area of higher concentration to an area of lower concentration. An example is fluid moving into or out of a cell to maintain homeostasis =
Osmosis
61
What can Osmoreceptors detect?
Increased Osmotic Pressure
62
What can Baroreceptors (aortic arch, carotid sinus) detect?
Decreased Blood Pressure
63
Whenever osmoreceptors detect increased osmotic pressure or baroreceptors detect decreased BP, what happens next?
The Hypothalamic Neuron sends some ADH to the kidneys + blood vessels
64
Where is the hypothalamic neuron located?
In the Posterior Pituitary
65
What does the ADH do to the kidneys?
Causes an increase in the reabsorption of water
66
What does the ADH do to the blood vessels?
Causes Vasoconstriction
67
An increased reabsorption of water + vasoconstriction =
Increased Blood Volume + Increased Blood Pressure
68
The narrowing (constriction) of blood vessels by small muscles in their walls =
Vasoconstriction
69
The most obvious homeostatic mechanism to increase / retain water is the-
Thirst Response
70
How does the body monitor its own water balance?
The Lamina Terminalis
71
The Lamina Terminalis is located where?
The edge of the Hypothalamus
72
How does the lamina terminalis monitor the body’s water balance?
It monitors the osmolality in the ventricles of the brain
73
How much of a percentage increase in serum osmolality does it take to alert the brain’s sensors to a decrease in the body’s fluid volume?
A 1% increase in serum osmolality
74
Whenever the neurons of the laminate terminalis need to increase the body’s supply of water, they send out signals that signify -
Thirst
75
Whenever the brain senses excess body water, the thirst sensation-
Stops
76
As serum osmolality rises, what stimulates the posterior pituitary to release ADH?
The Hypothalamus
77
What does ADH stand for?
Antidiuretic Hormone
78
ADH can also be called-
Vasopressin
79
What does ADH act on?
The Nephrons of the Kidneys
80
The collecting ducts of nephrons respond to ADH by -
Increasing water absorption + decreasing urine excretion + increasing the body’s fluid volume
81
How does urination help the body retain water?
Urination filters the blood, which lets the blood return to circulation (the blood holds water and electrolytes so it essentially reintroduces or “recycles” water/ electrolytes)
82
Certain meds, dehydration, hypovolemia, overhydration can all lead to -
Fluid + Electrolyte Imbalances
83
The wrong IV fluids or feedings can lead to -
Fluid + Electrolyte Imbalances
84
Sweating, diarrhea, and vomiting can all lead to-
Fluid + Electrolyte Imbalances
85
What disorders can lead to Fluid + Electrolyte Imbalances?
Heart, Kidney, or Liver Disorders
86
What’s the expected electrolyte value range for Potassium (K+)?
3.5 to 5 mEq/L
87
What’s the expected electrolyte value range for Sodium (Na+)?
136 to 145 mEq/L
88
What’s the expected electrolyte value range for Calcium (Ca 2+)?
9 to 10.5 mg/dL
89
What’s the expected electrolyte value range for Magnesium (Mg 2+)?
1.3 to 2.1 mEq/L
90
Nurses must be able to recognize abnormalities in laboratory findings, and report these findings to the-
Provider
91
Can electrolytes and other substances that make up the solutes within a solution such as blood move across semi-permeable membranes like water can using osmosis?
No
92
How do electrolytes and other substances that make up the solutes within a solution move across semi-permeable membranes?
Diffusion + Active Transport
93
The movement of solutes (like electrolytes) from an area of high concentration (Like within a cell) to an area of low concentration (Like the intravascular area) =
Diffusion
94
When does diffusion stop?
When the number of solutes inside and outside of a cell are equal
95
A Passive Process =
No use of energy
96
Diffusion is a -
Passive Process
97
Does Active Transport need energy, or is it a passive process?
It needs energy
98
Give an example of electrolyte movement via active transport =
The movement of sodium and potassium into / out of cells through the sodium–potassium pump
99
Does Active Transportation move solutes from an area of higher concentration to one of lower concentration like diffusion does?
No, Active Transportation carries solutes from an area of lower concentration to one of higher concentration
100
Active Transportation moves electrolytes / molecules with the use of energy in the form of-
Enzymes
101
The body’s largest Intracellular electrolyte =
Potassium
102
Supports the transmission of electrical impulses of the body’s nerves + muscles =
Potassium
103
Potassium plays a major role in the conduction of -
Nerve cells in the heart
104
Does the body maintain potassium levels in a narrow range or a wide range?
Narrow Range
105
Potassium intake occurs through-
Food + Drinks + Supplements
106
Electrolyte for nerve + muscle function, especially for the heart =
Potassium
107
The recommended daily allowance (RDA) for daily intake of potassium is how many mg for adult males?
3,400 mg
108
The recommended daily allowance (RDA) for daily intake of potassium is how many mg for adult females?
2,600 mg
109
Responsible for the primary excretion of potassium =
Kidneys
110
What percentage of potassium is excreted by the kidneys?
90%
111
What percentage of potassium is excreted via sweat / the digestive tract =
10%
112
Potassium has an expected reference range in the blood of how many mEq/L?
3.5 - 5 mEq/L
113
Hypokalemia occurs when levels of potassium fall below -
3.5 mEq/L
114
Critical values occur for adults at less than how much potassium?
3 mEq/L
115
Critical values occur for newborns at less than how much potassium?
2.5 mEq/L
116
Are PN’s allowed to view laboratory values?
Yes
117
If the lab results are out of range, a PN must tell the-
RN or the Provider
118
Causes of Hypokalemia?
Excessive sweating
Meds
Certain cardiac conditions
GI losses
Metabolic alkalosis
Decreased oral intake of potassium
Excessive alcohol use
Chronic kidney disease
Diabetic ketoacidosis
Folic acid deficiency
119
If a client is exhibiting signs of hyperkalemia, hospitalization may be required to remove excess potassium from the -
Blood
120
If an elevated potassium level is due to renal failure, what may be required?
Hemodialysis
121
Hemodialysis =
Filtering waste from blood using a machine
122
In terms of alternatives to hemodialysis, what are some meds that can be used to treat hyperkalemia?
Calcium Gluconate + Diuretics + Resin Medications
123
Calcium Gluconate or Calcium Chloride can be used to-
Lower the effect of excess potassium levels on the heart
124
Loop and thiazide diuretics cause the body to excrete excess potassium through-
Urination
125
Sodium polystyrene sulfonate is a-
Resin Medication
126
Resin Medications (like sodium polystyrene sulfonate) can help decrease potassium levels via-
Bowel Movements
127
How do resin meds decrease potassium levels via bowel movements?
Resins bind to the potassium in the body, then are excreted via stool
128
Can the administration of insulin help lower potassium levels?
Yes
129
How does the administration of insulin help lower potassium levels?
Insulin causes the potassium to enter cells, thus lowering the serum potassium level
130
Clients receiving insulin to treat hyperkalemia should have what kind of monitoring?
Blood Glucose Monitoring
131
Why should clients receiving insulin to treat hyperkalemia have their blood glucose monitored?
Because of increased risk of hypoglycemia
132
Blood glucose level expected range =
74 - 106 mg/dL
133
A blood glucose level lower than the expected range (74 - 106 mg/dL)
Hypoglycemia
134
The provider may instruct the client with hyperkalemia to lower potassium levels by decreasing -
Dietary Consumption
135
Some salt substitutes can contain-
Potassium
136
Salt substitutes are commonly used by clients who have to limit their-
Sodium Intake
137
Does potassium chloride (contained in certain salt substitutes) raise potassium levels?
Yes
138
The body’s most common extracellular electrolyte =
Sodium
139
Supports functioning of muscles + nerves, maintaining a normal BP, regulates fluid balance in the body =
Sodium
140
Sodium is ingested into the body through-
Food + drink
141
Sodium is excreted primarily through -
Urine + Sweat
142
The RDA for sodium is less than how many mg per day?
Less than 2,300 mg (~1 Teaspoon)
143
Do most Americans get more sodium than they actually need?
Yeah
144
The expected reference range of sodium is -
136 - 145 mEq/L
145
Sodium level below expected reference range (136 - 145 mEq/L) =
Hyponatremia
146
The most common cause of hypokalemia is loss of potassium from the -
Kidneys or GI Tract
147
A category of medications that cause increased urination =
Diuretics
148
Name off 3 potassium-wasting diuretics =
Loop Diuretics, Osmotic Diuretics, Thiazide Diuretics
149
Meds that most commonly result in hypokalemia through urinary loss =
Diuretics
150
Amphotericin B, high doses of penicillin, and theophylline all can lead to-
Hypokalemia
151
Decreased potassium from GI losses may result from -
Diarrhea or vomiting, Chronic laxative use, bowel diversion, or gastric suctioning
152
A potassium level of 3 to 3.5 mEq/L is classified as-
Mild Hypokalemia
153
Common manifestations that can be seen with hypokalemia of less than 3 mEq/L include -
Muscle Weakness, Cardiac Arrhythmias, Constipation, Fatigue
154
Defined as a potassium level less than 2.5 mEq/L =
Life-threatening Hypokalemia
155
What can cause respiratory paralysis and failure to occur?
Severe life-threatening hypokalemia
156
Paralytic Ileus, Hypotension, Tetany, Rhabdomyolysis, and Life-Threatening Cardiac Arrhythmias can all be caused by-
Severe Life-Threatening Hypokalemia
157
Repeated episodes of hypokalemia can affect -
Renal Function
158
The provider may order an electrocardiogram (ECG) to determine -
If the level of potassium is affecting the rhythm of the heart
159
Arrhythmias =
Abnormal Heart Rhythm
160
Paralysis =
Loss of muscle functioning
161
Cessation of intestinal motility =
Paralytic Ileus
162
Hypotension =
BP below expected range
163
Rhabdomyolysis =
Muscle Breakdown
164
What does muscle breakdown result in?
The release of the protein myoglobin into the bloodstream
165
Whenever muscle breakdown causes the release of myoglobin into the bloodstream, what does this cause damage to?
The Kidneys
166
Rhabdomyolysis is characterized by-
Red-colored urine, low urine output, weakness, and muscle pain
167
A test to check heart activity including heart rate and rhythm =
Electrocardiogram (ECG)
168
Treatment of hypokalemia starts with
Identifying the underlying cause
169
The provider may prescribe what to restore potassium levels to the expected reference range?
Potassium Supplementation
170
Potassium supplements can be in the form of-
PO Meds or IV Infusion
171
Why should PO supplements be administered with or following a meal?
They can cause GI distress
172
Potassium is considered to be a high-alert medication whenever given by-
IV
173
If something is a high-alert medicine, then that means that-
If given incorrectly, the client can suffer great harm
174
When potassium is administered via IV, how many mL of a compatible solution must it be diluted?
Potassium should be diluted in 100 to 1,000 mL of a compatible solution
175
When administering potassium via IV, should Potassium ever be administered directly from the vial?
No
176
The dose of potassium (given via IV) shouldn’t go over-
40 mEq/L
177
When is the only time that a dose of potassium (given via IV) can go over 40 mEq/L?
Whenever severe hypokalemia is being treated
178
The rate of potassium administration is commonly set to how many mEq/hour to prevent adverse outcomes?
10 - 20 mEq/L
179
When receiving IV potassium, the client should be on continuous-
ECG Monitoring
180
When administering Potassium intravenously, the client’s potassium level should be checked periodically to ensure that they -
Don’t receive too much potassium
181
If hypokalemia is the result of diuretic use, the provider may prescribe -
Routine PO potassium supplements as an adjunct treatment
182
If hypokalemia is the result of diuretic use, the provider may prescribe routine oral potassium supplements as an adjunct treatment or -
Switch the PT to a Potassium-Sparing Diuretic
183
If hypokalemia is the result of diuretic use, the provider may instruct the client to raise the potassium level by -
Increasing Dietary Consumption of Potassium
184
Are nurses allowed to instruct clients in increasing potassium intake by teaching about foods that have a high potassium content?
Yes
185
Most potassium-rich vegetable?
Baked Potato
186
Most potassium-rich fruit juice?
Prune Juice
187
Most potassium-rich dairy product?
Plain, Non-Fat Yogurt
188
Most potassium-rich fish?
Salmon
189
Most potassium-rich fruit?
Bananas
190
Amount of potassium per serving of baked potato =
191
Amount of potassium per serving of prune juice =
192
Amount of potassium per serving of carrot juice =
193
Amount of potassium per serving of white beans =
194
Amount of potassium per serving of plain, nonfat yogurt?
195
Amount of potassium per serving of sweet potato?
196
Amount of potassium per serving of salmon?
197
Amount of potassium per serving of banana?
198
Amount of potassium per serving of spinach?
199
Amount of potassium per serving of avocado?
200
Following intervention, a repeat BMP or CMP should be evaluated to determine if the client’s potassium levels are -
Within the expected reference range
201
When a PT experiences potassium levels above the expected reference range =
Hyperkalemia
202
Hyperkalemia is defined as a potassium value greater than-
5 mEq/L
203
Critical values of hyperkalemia occur at levels greater than -
6.1 mEq/L
204
The body maintains the potassium level within a narrow range, and deviations can lead to significant -
Neurologic, Respiratory, or Cardiac Consequences
205
Causes of Hyperkalemia include =
Renal Failure + Dehydration + Diabetes Mellitus + Meds + Trauma + Excess Potassium Intake + Burns + Transfusions of Packed Red Blood Cells + Acidosis + Sepsis
206
The most common cause of hyperkalemia is-
Renal Failure
207
The meds that most commonly result in hyperkalemia are-
Potassium-Sparing Diuretics + Non-Steroidal Anti-Inflammatory Meds (NSAIDs) + Angiotensin-Converting Enzyme (ACE) Inhibitors
208
Does mild hyperkalemia present any manifestations?
It may or may not
209
Common manifestations that can be seen with hyperkalemia greater than 5 mEq/L include -
Nausea, vomiting, muscle aches + weakness, decreased deep tendon reflexes, paralysis, dysrhythmias or palpitations
210
Severe life-threatening hyperkalemia is defined as a potassium level greater than-
7 mEq/L
211
Severe hyperkalemia can cause -
Paralysis + Heart Failure
212
Routine blood tests such as the BMP or CMP are used to measure -
Potassium Levels
213
What may a provider prescribe to determine if the level of potassium is affecting the rhythm of the heart?
An ECG
214
As with hypokalemia, treatment of hyperkalemia begins with -
Identifying and treating the cause
215
What is your goal whenever treating hyperkalemia?
Removing excess potassium and stabilizing the heart
216
Factors that can place a client at risk for developing hyponatremia =
Meds + Chronic / Severe Vomiting or Diarrhea + Drinking Excess Amounts of Water + Excess Alcohol Intake + Heart, Kidney, Liver Problems, Severe Burns
