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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
Hypokalemia
- 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
Hypokalemia clinical manifestations
- Smooth muscle: hyperpolarized (less responsive to stimuli), abdomincal distension, diminished bowel sounds, ileus - Skeletal muscle: hyperpolarized, general weakness...paralysis - Cardiac muscle: dysrythmias
27
Hypokalemia treatment
- Replace orally and IV | - Watch for signs of hyperkalemia
28
Hyperkalemia
- More than 5.0 conc in ECF - Increased intake (diet, blood transfusions) - Shifts in ECF (acidosis, crushing injuries) - Decreased excretion (oliguria, pharm)
29
Hyperkalemia clinical manifestations
- Smooth muscle: hypopolarized (can't fire again after discharge), mild intestinal cramping and diarrhea - Skeletal muscle: hypopolarized, weakness and paralysis - Cardiac muscle: dysrhythmias
30
Hyperkalemia treatment
- Fix underlying cause - Pharm - Dialysis (extreme)
31
Calcium
- Normal level 9-11 mg/dl - Bone/teeth formation, blood coagulation - Nerve impulse transmission - Normal muscle contractions - Cardiac action potential and pacemaker automaticity
32
Hypocalcemia
- Serum calcium below 9 - Decreased intake/absorption (diet, diarrhea, chronic renal disease) - Decrease in physiologic availability (alkalosis) - Increase excretion (pancreatitis, steatorrhea = fatty stools)
33
Hypocalcemia clinical manifestations
- Increased neuromuscular excitability | - Muscle twitching, cramping, hyperactive reflexes, tetany, seizures, dysrhythmias
34
Hypocalcemia treatment
- Treat underlying cause | - Replace calcium
35
Hypercalcemia
- 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
Hypercalcemia clinical manifestations
- Decreased neuromuscular excitability | - Decreased reflexes, weakness, fatigue, headache, lethargy, dysrhythmias, kidney stones
37
Hypercalcemia treatment
- Treat underlying cause | - Remove excess with pharm
38
Respiratory Acidosis
- 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
Respiratory Acidosis clinical manifestations
- HA, tachycardia, cardiac dysrhythmias - Neuro: blurred vision, tremors, vertigo, disorientation, lethargy, somnolence - ABG: increased PaCO2 and decreased pH
40
Respiratory Alkalosis
- Deficit of carbonic acid (Breathe too fast) | - Hyperventilation (anxiety, crying, acute pain, hypoxemia, brainstem injury)
41
Respiratory Alkalosis clinical manifestations
- increased neuromuscular excitability - numbness, tingling, feet, hand spasms - excitation or confusion - cerebral vasoconstriction - ABG: low PaCO2 and increased pH
42
Metabolic acidosis
- 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
Metabolic acidosis clinical manifestations
- GI: N/V/D, dehydration - CNS depression: HA, confusion, lethargy, stupor, coma - Cardiac: tachycardia, dysrhythmia - Fruity smelling breath - ABG: low pH, low bicarb
44
Metabolic Alkalosis
- 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
Metabolic Alkalosis clinical manifestations
- 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
What are the normal PaCO2 levels?
36-44 mmHg
47
What are the normal HCO3- levels?
22-26 mEq/L
48
What are the normal pH levels?
7.35-7.45

N398 Exam 1 (12 decks)

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