FLUIDS AND ELECTROLYTES

Question 1

VOLUME COMPOSITION

Answer 1

Body Fluids

• water
• electrolytes
• non electrolytes
  
  • dextrose
  • urea
  • creatine

Question 2

FLUID COMPARTMENTS

Answer 2

INTRACELLULAR (within cells)

EXTRACELLULAR (outside of cell membrane)

• Plasma
• Interstitial
• Lymphatics

Question 3

FLUID MOVEMENT

Answer 3

Permeability of cell membrane
OSMOSIS - movement of fluid from an area of higher H2O concentration to lower H2O concentration

Terms applied to Particle Concentration (these are particles and not fluid)

• Hypertonic
• Hypotonic
• Isotonic

Question 4

MOLECULE/PARTICLE MOVEMENT

Answer 4

DIFFUSION
FACILLITATED DIFFUSION
PASSIVE TRANSPORT
ACTIVE TRANSPORT

Question 5

DIFFUSION

Answer 5

-Molecules Dispose and reach uniform concentration
(across cellular membrane CO2 + O2 cross membrane across capillaries)
ex. blood gases

Question 6

FICILLITATED DIFFUSION

Answer 6

carrier molecule (lipid) moves particle

-lipid = fat

Question 7

PASSIVE TRANSPORT

Answer 7

ions cross influenced by chemical or electrical gradients = electrochemical gradients

ex. ions cross a cellular membrane
Na/K+ pump

Question 8

ACTIVE TRANSPORT

Answer 8

• requires energy
• primary requires ATP directly (mitochondria)
• secondary involves co-transport or counter-transport

ADENOTRIPHOSPHATE = ATP

Question 9

HYPOKALEMIA

Answer 9

cause: vomiting, NG suction, dirrhea, incresed renal loss of water
s/s: fatigue, anorexia, N/V, muscle wasting, decreased GI activity, Fla Twave, dysrhythmia

tx: prevention, dietary intake, IV supplement

K+ cant get reabsorbed d/t water taking K+ away (when water leave K+ leaves also)
EKG see flat Twaves then dysrhythmia
OJ, Bananas, Brazil nuts, processed meats, dried apricots, dried peaches and preservatives have a lot of K+ in them

Question 10

HYPERKALEMIA > 5mEq/l

Answer 10

CAUSES: increased dietary intake, decreased renal output (K+ >8 chronic or acute renal failure)

s/s: muscle weakness, N/V, diarrhea, peaked T waves, dysrhythmias

Tx: dietary restriction, Kayexalate, CA gluconate, NAHCO3 (sodium hydroxide)
(forcing the K+ back into the cell)

EKG - peaked Twaves and dysrhythmias

• Chronic renal failure pts have this
• Eating a lot of bananas

Question 11

HYPONATREMIA

Answer 11

cause is DILUTIONAL PERCEPTION of body (body perceives it don’t have enough Na in it)

s/s: anxiety, anorexia, muscle cramps, exhaustion, Severe: lethargy, confusion, muscle twitching, convulsions, sternal edema,
decreased BP and increased P
Tx: normal volume or hypervolemia, H2O restrictions and diuretics
-Neurologic symptoms - 3% NaCL IV (this % is very dangerous have to watch your pts when this is infusing)

sodium concentration, concentration of Na and H2O in the body

Question 12

HYPERNATREMIA >145 mEq/l

Answer 12

Causes: deprivation of water, patients cannot perceive or respond to thirst

S/S: restlessness, weakness, disorientation, hallucinations, swollen tongue, sticky mucosa, increased T waves, increased BP, increased weight, increased urine SG, rubbery firm skin, as brain shrinks - subarachnoid hemorrhage

TX: gradual decrease in Na, D5W or D51/4NS

**pt very dehydrated

Question 13

SIADH

Answer 13

Metabolic Problem
Cause: neurologic, pulmonary, excess hypotonic IV fluids, stress, medication, psychogenic polydipsia, edematous states (CHF)

s/s: s/s: anxiety, anorexia, muscle cramps, exhaustion, Severe: lethargy, confusion, muscle twitching, convulsions, sternal edema, decreased BP and increased P

Tx: underlying cause, normal volume or hypervolemia, H2O restrictions and diuretics
-Neurologic symptoms - 3% NaCL IV (this % is very dangerous have to watch your pts when this is infusing)

*neurologic and pulmonary

Question 14

HYPOCALCEMIA

Answer 14

Thyroid glands control Ca
causes: parathyroid disease, thyroid disease
s/s: Positive Chvostek’s and Trousseau’s
Tx: calcium replacement
Vitamin D

*Ca stored in bones, teeth, serum
parathyroid being removed

Question 15

CHVOSTEK’S

TROUSSEAU’S

Answer 15

• CHVOSTEK = taping on cheek 5th cranial nerve facial nerves twitching

TROUSSEAU = BP cuff on blown up and spasms occur with cuff being blown up

Question 16

HYPERMAGNESEMIA > 2.5mEq/l

Answer 16

cause: excessive intake, impaired excretion, endocrinopathies

s/s: much like hypokalemia; s/s: fatigue, anorexia, N/V, muscle wasting, decreased GI activity, Fla Twave, dysrhythmia

Tx: withhold source, promote excretion, calcium salts, hemodialysis

Question 17

HYPOMAGNESEMIA

Answer 17

causes: impaired absorption, increased loss, renal, diuretics, endocrinopthies, hypercalcemia

s/s: much like hypokalemia ;s/s: fatigue, anorexia, N/V, muscle wasting, decreased GI activity, Fla Twave, dysrhythmia

tx: magnesium salts

Question 18

CELLULAR HOUSEKEEPING

ENDOCYTOSIS AND EXOCYTOSIS

Answer 18

ENDOCYTOSIS: cells engulf materials from surroundings areas

• PINOCYTOSIS = small particles “drinked”
• PHAGOCYTOSIS = large particles “eaten”

EXOCYTOSIS: secretion of intracellular substances into the extracellular spaces (waste removal)

Question 19

ONCOTIC PRESSURE

Answer 19

Omolarity of a particular body fluid. The amount of pressure a molecule exerts in a space. Regarding particles when you have a lot of particles you don’t have a lot of water.

Question 20

OSMOTIC PRESSURE

Answer 20

ex. DKA pt with sugar in blood stream and the osmotic pressure is elevated 300 -400 glucose particles in blood stream is dense, water moves in from interstitial spaces and dehydrates the tissues the pt then goes into a hyperosmolar state.

Question 21

HYDROSTATIC PRESSURE

Answer 21

Venus and arterial state. Pump pressure away from the heart pump.

The closer you are to pump pressure the higher the arterial pressure.

The further away you are from the pump pressure the lower the arterial pressure.

Question 22

PRESSURE GRADIENTS/FLUID MOVEMENT

Answer 22

ARTERIAL LEVEL
-Heart pump = 32 mmHg force
-Albumin (Fat) pressure = 22 mmHg
-Pressure difference +10 mmHg...fluid leaves the vascular tree
(these are normal values)

CAPILLARY LEVEL

• Heart pump 12 mmHg
• Albumin 22mmHg
• Pressure difference -10mmHg…fluid retuns to vascular tree

*Albumin = Fat molecule used a sponge (pulls in fluid)
22mmHg is normal value

ex.