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N398 Exam 1 > Fluid, Electrolytes, Acid Base Patho > Flashcards

Fluid, Electrolytes, Acid Base Patho Flashcards

1
Q

Capillary Hydrostatic Pressure

A
  • Facilitates outward movement of water from capillary to interstitial space
  • Blood pressure
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2
Q

Capillary oncotic pressure

A
  • Osmotically attracts water from interstitial space back into capillary
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3
Q

Interstitial hydrostatic pressure

A
  • Facilitates inward movement of water from interstitial space into capillary
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4
Q

Interstitial oncotic pressure

A
  • Osmotically attracts water from capillary into the interstitial space
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5
Q

What is edema/hypervolemia?

A
  • Excessive accumulation of fluid within interstitial space
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6
Q

What forces are involved with edema?

A
  • Increased capillary hydrostatic pressure (renal failure, heart failure)
  • Decreased plasma/capillary oncotic pressure (kidney disease, malnutrition, burns)
  • Increased capillary membrane permeability (inflammation)
  • Lymphatic channel obstruction (inflammation, cancer)
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7
Q

What are localized clinical manifestations of edema?

A

Limited to site of trauma or within particular organ system

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8
Q

What are generalized clinical manifestations of edema?

A

Uniformed distribution-dependent

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9
Q

What are other clinical manifestations of edema?

A
  • Weight gain
  • Swelling
  • Puffiness
  • Limited ROM
  • Crackles
  • Bounding pulse
  • Could be tachycardic
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10
Q

How do we evaluate edema?

A
  • History and physical
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11
Q

How do we treat edema?

A
  • Treat underlying condition
  • Supportive care and education
  • Diet
  • Diuretics
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12
Q

What is Clinical dehydration/hypovolemia?

A

Too small of a volume of fluid in the extracellular compartment (vascular and interstitial)
- Body fluids are too concentrated

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13
Q

What are forces of clinical dehydration?

A
  • Fluid loss (burns, diarrhea, vomiting, blood loss, sweating, polyuria)
  • Reduced fluid intake
  • Fluid shifts (burns, have edema in some spaces but not in the right spaces)
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14
Q

Clinical Manifestations of clinical dehydration

A
  • Tachycardia
  • Poor skin turgor
  • Dry mucous membranes
  • No tears
  • Hypotension
  • Weight loss (major in peds)
  • Depressed fontanels
  • Decreased amount of urine (and dark color)
  • Thirsty
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15
Q

Evaluation of clinical dehydration

A
  • History and physical

- Labs

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16
Q

Treatment of clinical dehydration

A
  • Give fluids slowly
  • Stop fluid loss (treat burns, diabetes, etc)
  • Is and Os are important
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17
Q

Sodium

A
  • Normal level: 135-145 mEq/L
  • Major ECF cation
  • Acid-base balance
  • Nerve conduction and neuro-muscular function
  • Water balance
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18
Q

Hyponatremia

A
  • Serum sodium concentration below 135 mEq/L
  • ECF has too much water for amount of Na present (dilute)
  • Gain of water: inappropriate fluid admin, tap water enema, excess of ADH
  • Loss of salt: diuretics, renal disease, replace H2O without replacing Na
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19
Q

Hyponatremia Clinical Manifestations

A
  • Nonspecific CNS dysfunction
  • Malaise, anorexia, N/V, HA
  • Confusion, lethargy, seizures, coma
  • Fatal cerebral herniation
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20
Q

Hyponatremia Treatment

A
  • Determine underlying cause and fix it
  • Restrict water intake
  • Hypertonic saline solution w/ caution
21
Q

Hypernatremia

A
  • Sodium conc above 145
  • ECF has too little water for Na present (concentrated)
  • Gain of sodium: tube feedings, overusing salt tabs, no access to water
  • Loss of water: emesis, diarrhea, diaphoresis, tube feedings
22
Q

Hypernatremia Clinical manifestations

A
  • Thirst, dry mucous membranes
  • Hypotension, tachycardia
  • Oliguria
  • Muscle irritability
  • Agitation
  • Confusion, lethargy…seizure coma death
23
Q

Hypernatremia Treatment

A
  • Find underlying condition and treat

- Oral or IV fluids (D5W) slowly

24
Q

Potassium

A
  • Normal level: 3.5-5.0 mEq/L
  • Major ICF cation
  • Neuromuscular transmission of nerve impulses
  • Cardiac muscle contraction and electrical conductivity
25
Q

Hypokalemia

A
  • Less than 3.5 mEq/L in ECF
  • Decreased K+ intake (NPO, fasting, diet, anorexia)
  • Shifts into cell (alkalosis)
  • Increase in K+ excretion or loss (diuretics, d/v, gastric suctioning)
26
Q

Hypokalemia clinical manifestations

A
  • Smooth muscle: hyperpolarized (less responsive to stimuli), abdomincal distension, diminished bowel sounds, ileus
  • Skeletal muscle: hyperpolarized, general weakness…paralysis
  • Cardiac muscle: dysrythmias
27
Q

Hypokalemia treatment

A
  • Replace orally and IV

- Watch for signs of hyperkalemia

28
Q

Hyperkalemia

A
  • More than 5.0 conc in ECF
  • Increased intake (diet, blood transfusions)
  • Shifts in ECF (acidosis, crushing injuries)
  • Decreased excretion (oliguria, pharm)
29
Q

Hyperkalemia clinical manifestations

A
  • Smooth muscle: hypopolarized (can’t fire again after discharge), mild intestinal cramping and diarrhea
  • Skeletal muscle: hypopolarized, weakness and paralysis
  • Cardiac muscle: dysrhythmias
30
Q

Hyperkalemia treatment

A
  • Fix underlying cause
  • Pharm
  • Dialysis (extreme)
31
Q

Calcium

A
  • Normal level 9-11 mg/dl
  • Bone/teeth formation, blood coagulation
  • Nerve impulse transmission
  • Normal muscle contractions
  • Cardiac action potential and pacemaker automaticity
32
Q

Hypocalcemia

A
  • Serum calcium below 9
  • Decreased intake/absorption (diet, diarrhea, chronic renal disease)
  • Decrease in physiologic availability (alkalosis)
  • Increase excretion (pancreatitis, steatorrhea = fatty stools)
33
Q

Hypocalcemia clinical manifestations

A
  • Increased neuromuscular excitability

- Muscle twitching, cramping, hyperactive reflexes, tetany, seizures, dysrhythmias

34
Q

Hypocalcemia treatment

A
  • Treat underlying cause

- Replace calcium

35
Q

Hypercalcemia

A
  • Serum conc over 11
  • Increased intake or absorption (excess vitamin D)
  • Shift from bone to ECF (tumor, leukemia, immobile from not bearing weight)
  • Decrease excretion (calcium retaining diuretic)
36
Q

Hypercalcemia clinical manifestations

A
  • Decreased neuromuscular excitability

- Decreased reflexes, weakness, fatigue, headache, lethargy, dysrhythmias, kidney stones

37
Q

Hypercalcemia treatment

A
  • Treat underlying cause

- Remove excess with pharm

38
Q

Respiratory Acidosis

A
  • Excess of carbonic acid (breathe too slowly)
  • Impaired gas exchange (asthma, COPD, pneumonia)
  • Inadequate neuromuscular function (Guillian-Barre, chest injury, pain)
  • Impairment of resp control in brainstem (resp depressants)
39
Q

Respiratory Acidosis clinical manifestations

A
  • HA, tachycardia, cardiac dysrhythmias
  • Neuro: blurred vision, tremors, vertigo, disorientation, lethargy, somnolence
  • ABG: increased PaCO2 and decreased pH
40
Q

Respiratory Alkalosis

A
  • Deficit of carbonic acid (Breathe too fast)

- Hyperventilation (anxiety, crying, acute pain, hypoxemia, brainstem injury)

41
Q

Respiratory Alkalosis clinical manifestations

A
  • increased neuromuscular excitability
  • numbness, tingling, feet, hand spasms
  • excitation or confusion
  • cerebral vasoconstriction
  • ABG: low PaCO2 and increased pH
42
Q

Metabolic acidosis

A
  • excess of any acid except carbonic acid
  • Increase in metabolic acid (ketoacidosis in diabetics, burn, circulatory shock)
  • Decrease in base = bicarb (diarrhea, intestinal decompression)
  • Combo of above
43
Q

Metabolic acidosis clinical manifestations

A
  • GI: N/V/D, dehydration
  • CNS depression: HA, confusion, lethargy, stupor, coma
  • Cardiac: tachycardia, dysrhythmia
  • Fruity smelling breath
  • ABG: low pH, low bicarb
44
Q

Metabolic Alkalosis

A
  • relative deficit of acid except carbonic acid
  • Increase in base (overuse antacids, hypovolemic)
  • Decrease in acid (emesis, removing gastric secretions)
  • Combo of above (hypokalemia, diuretics)
45
Q

Metabolic Alkalosis clinical manifestations

A
  • ECF volume depletion: postural hypotension, N/V/D
  • TIngling, tetany, seizures
  • Hypokalemia with muscle weakness
  • Irritability and CNS depression
  • ABG: high pH and high PCO3-
46
Q

What are the normal PaCO2 levels?

A

36-44 mmHg

47
Q

What are the normal HCO3- levels?

A

22-26 mEq/L

48
Q

What are the normal pH levels?

A

7.35-7.45

N398 Exam 1 (12 decks)

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