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NURS 301 > Fluid, Electrolyte, and Acid/Base Balances > Flashcards

Fluid, Electrolyte, and Acid/Base Balances Flashcards

1
Q

Composition of body fluids

A
  • As water moves through the compartments of the body, it contains substances that are sometimes called minerals or salts but are technically known as electrolytes
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2
Q

Movement of body fluids

A
  • Solutions are classified as hypertonic, isotonic, or hypotonic
  • A solution with the same osmolarity as blood plasma is called isotonic
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3
Q

A hypertonic solution…

A

Pulls fluid from the cells

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4
Q

An isotonic solution…

A

Expands the body’s fluid volume

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5
Q

A hypotonic solution…

A

Moves fluid into the cells, causing them to enlarge

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6
Q

Fluid output regulation

A

Fluid output occurs through four organs of water loss: the kidneys, the skin, the lungs, and the gastrointestinal tract

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7
Q

Insensible water loss

A

Continuous and is not perceived by the person (exhaling from the lungs, fever, GI tract) but can increase significantly with fever or burns

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8
Q

Sensible water loss

A

Occurs through excess perspiration and can be perceived by the client or by the nurse through inspection

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9
Q

Regulation of electrolytes

A
  • Electrolytes are mineral or salts distributed in the body fluid, may be positively charged (cation) or negatively charged (anion)
  • Major cations within the body fluids include sodium (Na+), potassium (K+), calcium (Ca 2+), and magnesium (Mg2+)
  • Cations interchange when one cation leaves the cell and is replaced by another. This occurs because cells tend to maintain electrical neutrality
  • Cations are acidotic
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10
Q

Sodium regulation

A
  • Sodium is the most abundant cation (90%) in ECF (extracellular fluid)
  • Sodium ions are the major contributors to maintaining water balance through their effect on serum osmolality, nerve impulse transmission, regulation of acid-base balance, and participation in cellular chemical reactions
  • It is regulated by dietary intake and aldosterone secretion
  • Deficit = risk of alkalosis, Excess = risk of acidosis
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11
Q

The normal range for sodium level is…

A

135-145 mEq/L

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12
Q

Hyponatremia

A

(below 135) – lower-than-normal concentration of sodium in the blood

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13
Q

Hypernatremia

A

(above 145) is a greater-than-normal concentration of sodium

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14
Q

Potassium regulation

A
  • Potassium is the major electrolyte and principle cation in the intracellular compartment
  • It regulates many metabolic activities and is necessary for glycogen deposits in the liver and skeletal muscle, transmission and conduction of nerve impulses, normal cardiac conduction, and skeletal and smooth muscle contraction -Potassium is regulated by dietary intake and renal excretion
  • The body conserves potassium poorly, so any condition that increases urine output decreases the serum potassium concentration
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15
Q

The normal range for potassium level is…

A

3.5 to 5 mEq/L

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16
Q

Hypokalemia

A

One of the most common electrolyte imbalances, in which an inadequate amount of potassium circulates in ECF. When severe, hypokalemia can affect cardiac conduction and function

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17
Q

Causes of hypokalemia

A

Treatment with diuretics, excessive insulin, alkalosis, vomiting, diarrhea, abuse of laxatives, eating disorders

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18
Q

Treatment for hypokalemia

A

IV or PO Potassium Chloride

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19
Q

Adverse effects associated with treatment of hypokalemia

A

GI irritation give with meals or full glass of water, IV irritating dilute infusion and infuse slowly (using a piggyback setup – fluid status, patient’s condition will determine the bag size to use), monitor potassium levels closely

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20
Q

Hyperkalemia

A

A greater-than-normal amount of potassium in the blood. Severe hyperkalemia produces marked cardiac conduction abnormalities

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21
Q

Causes of hyperkalemia

A

Severe tissue trauma, misuse of potassium sparing diuretics, untreated Addison’s disease, overdose of IV potassium

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22
Q

Treatment for hyperkalemia

A

Stop all potassium foods and medications, infusion of calcium salt, infusion of insulin and glucose (carries the potassium back into the cell and out of the blood), infusion of sodium bicarbonate, administer prototype drug Kayexalate (sodium polystyrene sulfonate) – can be PO or PR route

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23
Q

Calcium regulation

A
  • Calcium is stored in bone, plasma, and body cells
  • Ninety-nine percent of calcium is located in bone - Calcium is necessary for bone and teeth formation, blood clotting, hormone secretion, cell membrane integrity, cardiac conduction, transmission of nerve impulses, and muscle contraction
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24
Q

The normal range for calcium level is…

A
  • Normal serum ionized (in the blood) calcium is 4 to 5 mEq/L
  • Normal total calcium is 8.5 to 10.5 mg/100ml – routinely ordered by the provider
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25
Q

Hypocalcemia

A

Can result from several illnesses, some of which directly affect the thyroid and parathyroid glands – endocrinology specialty

26
Q

Hypercalcemia

A

Frequently a symptom of underlying disease resulting in excess bone resorption with release of calcium – ortho specialty

27
Q

Magnesium regulation

A
  • Magnesium is essential for enzyme activities, neurochemical activities, and cardiac and skeletal muscle excitability
  • Serum magnesium is regulated by dietary intake, renal mechanisms, and actions of the parathyroid hormone
  • Magnesium acts as membrane stabilizer
28
Q

The normal range for magnesium level is…

A

1.5 to 2.5 mEq/L

29
Q

Hypermagnesemia

A
  • Occurs when the serum magnesium level exceeds 2.6 mg/dL
  • Manifestations occur as a result of alterations in excitability: neurons are depressed in their level of activity
  • Cardiovascular, central nervous, neuromuscular and respiratory muscles may be affected – worst case scenario: respiratory arrest
30
Q

Causes of hypermagnesemia

A

Renal failure (either acute or chronic renal failure)

31
Q

Treatment of hypermagnesemia

A

Discontinuation of oral and parenteral magnesium, administration of magnesium-free IV fluids, loop diuretics, calcium supplementation for cardiac effects

32
Q

Hypomagnesemia

A
  • Occurs when the serum magnesium level decreases below 1.6 mg/dL
  • Magnesium imbalance causes alteration in excitability of neurons
  • Neuromuscular, central nervous, and GI manifestations
33
Q

Causes of hypomagnesemia

A

Diarrhea, hemodialysis, kidney disease, and prolonged intravenous feeding with magnesium-free solutions, chronic alcoholism, diabetes, and pancreatitis

34
Q

Prevention and treatment of hypomagnesemia

A

magnesium gluconate, magnesium hydroxide, magnesium sulfate (check deep tendon reflexes)

35
Q

The major anions of the body

A

chloride (Cl-), bicarbonate (HCO3-) and phosphate (PO43-)

36
Q

Chloride regulation

A
  • Chloride is the major anion in the ECF
  • The transport of chloride follows sodium
  • Serum chloride is regulated by dietary intake and the kidneys
37
Q

The normal range for chloride level is…

A

95 to 108 mEq/L

38
Q

Chloride Imbalance

A
  • Vomiting or prolonged and excessive nasogastric or fistula drainage can result in hypochloremia because of the loss of hydrochloric acid
  • The use of loop and thiazide diuretics also results in increased chloride loss as sodium is excreted
  • When serum chloride levels fall, metabolic alkalosis results as the body adapts by increasing reabsorption of the bicarbonate ion to maintain electrical neutrality
  • Hyperchloremia usually occurs when the serum bicarbonate value falls or sodium level rises
  • Hypochloremia and hyperchloremia rarely occur as single disease processes
  • Chloride imbalances are generally caused by losses in the GI tract (not a disease process or endocrine issue)
39
Q

Bicarbonate regulation

A
  • Bicarbonate is the major chemical base buffer within the body
  • The bicarbonate ion is an essential component for acid-base balance
40
Q

Phosphorus-Phosphate Regulation

A
  • Phosphate is a buffer anion found primarily in ICF. It assists in acid-base regulation
  • Calcium and phosphate are inversely proportional; if one rises, the other falls
  • It is regulated by dietary intake, renal excretion, intestinal absorption, and PTH
41
Q

The normal range for phosphorus level is…

A

2.5 to 4.5 mg/100ml

42
Q

Regulation of acid-base balances

A
  • Metabolic processes maintain a steady balance between acids and bases
  • Arterial pH is an indirect measurement of hydrogen ion (H+) concentration; reflection of the balance between carbon dioxide and bicarbonate
43
Q

Carbon dioxide is regulated by…

A

The lungs

44
Q

Bicarbonate is regulated by…

A

The kidneys

45
Q

Normal pH values in arterial blood

A

7.35-7.45

46
Q

Three general types of acid-base regulators in the body

A

Chemical, Biological, Physiological

47
Q

What is a buffer?

A

A substance that can absorb or release H+ to correct an acid-base imbalance

48
Q

Chemical regulation

A
  • The largest chemical buffer in ECF is the carbonic acid and bicarbonate buffer system
  • It’s the first buffering system to act, and it acts in seconds
  • Whenever carbon dioxide is made to increase in the arterial blood, there is an increase in hydrogen ions produced, and whenever hydrogen ions are produced, there is more carbon dioxide produced → more acidotic
49
Q

Biological regulation

A
  • Biological buffering occurs when hydrogen ions are absorbed or released by cells
  • It occurs after chemical buffering and takes 2 to 4 hours – much slower than the chemical regulation
50
Q

Physiological regulation

A
  • The two physiological buffers in the body are the lungs and the kidneys
  • When the concentration of hydrogen ions is altered, the lungs react to correct the imbalance by altering the rate and depth of respiration; lungs are going to impact CO2 which acts like an acid
  • The lungs are the quickest and the fastest to respond
  • The kidneys take from a few hours to several days to regulate acid-base imbalance. They reabsorb bicarbonate in cases of acid excess and excrete it in cases of acid deficit.
51
Q

Acid-Base balance evaluation

A
  • Arterial blood gas (ABG) analysis is the best way to evaluate acid-base balance
  • Measurement of ABGs involves analysis of six components
  • These components are pH, PaCO2, PaO2, oxygen saturation, base excess, and HCO3-
52
Q

pH

A
  • pH measures hydrogen ion (H+) concentration in the body fluids
  • Even a slight change can be potentially life threatening
  • An increase in concentration of H+ makes a solution more acidic; a decrease makes the solution more alkaline
  • Normal pH value is 7.35 to 7.45 (acidic is 7.45)
53
Q

PaCO2

A

partial pressure of carbon dioxide in arterial blood and is a reflection of the depth of pulmonary ventilation

  • The normal range is 35 to 45 mm Hg
    • Above 45, acidotic pH → respiratory acidosis
    • Below 35, alkolotic pH → respiratory alkalosis
54
Q

PaO2

A
  • PaO2 is the partial pressure of oxygen in arterial blood
  • It has no primary role in acid-base regulation if it is within normal limits
  • A PaO2 less than 60 mm Hg can lead to anaerobic metabolism, resulting in lactic acid production and metabolic acidosis → patient will become acidotic
  • Normal range is 80 to 100 mm Hg
55
Q

Oxygen saturation

A
  • Saturation is the point at which hemoglobin is saturated by oxygen (O2)
  • When a client is hypoxic and uses up readily available oxygen, the reserve oxygen (oxygen attached to hemoglobin) is drawn upon to provide oxygen to the tissues
  • When the PaO2 falls below 60mm Hg, there is a large drop in saturation
  • Normal range is 95% to 99%
56
Q

Base excess

A

The amount of blood buffer (hemoglobin and bicarbonate) that exists

57
Q

Bicarbonate

A

Serum bicarbonate (HCO3-) is the major renal component of acid-base balance and is excreted and reproduced by the kidneys to maintain a normal acid-base environment

58
Q

Respiratory Acidosis

A

Respiratory acidosis is marked by an increased arterial carbon dioxide concentration (PaCO2), excess carbonic acid (H2CO3), and an increased hydrogen ion concentration (decreased pH)

59
Q

Respiratory Alkalosis

A

Respiratory alkalosis is marked by decreased PaCO2 and increased pH

60
Q

Metabolic Acidosis

A

Metabolic acidosis results because of the high acid content of the blood, which also causes a loss of sodium bicarbonate, the alkaline half of the carbonate buffer system

61
Q

Metabolic Alkalosis

A

Metabolic alkalosis is marked by the heavy loss of acid from the body or increased levels of bicarbonate

NURS 301 (5 decks)

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