fluids and electrolytes

Question 1

what is the path of extracellular volume regulation

Answer 1

BARORECEPTORS
• SYMPATHETIC NERVOUS SYSTEM
• RENIN ANGIOTENSIN SYSTEM
• VASOCONSTRICTION AND RELEASE OF ALDOSTERONE
• ALDOSTERONE (CONSERVES NA++ AND WATER)
• ANTIDIURETIC HORMONE
• ATRIAL NATRIURETIC PEPTIDE (ANP)
• THIRST- WATER LOSS >2%

Question 2

Thirts mechanism kicks in at what point

Answer 2

water loss great than 2%

Question 3

hypovolemia know diffrence in subjective and objective finding

Answer 3

Ojective

Question 4

vomting and diuretics can lead to meabolic shift

Answer 4

Alkalosis

Question 5

diarrhea, DKA, shock can lead to what type of metabolic shift

Answer 5

acidosis

Question 6

Patient with WEIGHT GAIN
• INCREASED BP
• EDEMA
• ASCITES
• DECREASED HG, HCT, RBC
• RESPIRATORY ALKALOSIS (PH >7.45, PACO2 < 35)
• CHEST X-RAY-PULMONARY CONGESTION you suspect what type of fluid volume and treat with

Answer 6

hypervolemia
FLUID AND NA RESTRICTION
• DIURETICS
• DIALYSIS
• OXYGEN VIA NASAL CANNULA
• FOLLOWING SUCCESSFUL TREATMENT
• CLEAR LUNGS
• NO S3 OR S4
• NORMAL URINARY OUTPUT
• NORMAL URINE SPECIFIC GRAVITY
• NO EDEMA, NORMAL BP, HR, CVP, AND PCWP

Question 7

FIRST STEP IN MANAGEMENT hyponatremia

Answer 7

URINE SODIUM (NORMAL 10-20 MEQ/L)
• SERUM OSMOLALITY (USUALLY 2X NA = 280)
• CLINICAL STATUS
• MEASURING URINE SODIUM HELPS TO DETERMINE RENAL FROM NONRENAL
CAUSES

Question 8

Monitor serum Na how often in symptomatic patients needing sodium correction

Answer 8

every 2-4 hours

Question 9

normals for urine osmolality

Answer 9

URINE SODIUM (NORMAL 10-20 MEQ/L)
•

Question 10

Normals for serum osmolality

Answer 10

SERUM OSMOLALITY (USUALLY 2X NA = 280)

Question 11

Management of Hypernatremia SEVERE HYPERNATREMIc HYPOVOLEMIa

Answer 11

NS iv

Question 12

1/2 ns and or D5W will allow for what

Answer 12

fluid into cells

Question 13

treatment for hypervolemic hypernatriemia

Answer 13

TREAT WITH D5W AND LOOP DIURETICS

Question 14

which has the highest potassium; 
Seaweed
avocado
bananas
tomatoes 
lamb

Answer 14

seaweed

Question 15

normal calcim

Answer 15

8.5 to 10.5mg/dL

Question 16

normal ionized Ca

Answer 16

4.5 to 5.5mg/dL

Question 17

elderly person comes in with low albumin what else would you expect ot be low and what the best way to check this level

Answer 17

Ca will be low so need to check ionized ca

Question 18

Acidemia increase or decrease ionized calcium

Answer 18

increases ionized calcium

Question 19

patient getting multiple blood transfusions you expect ca to go

Answer 19

low

Question 20

Over use of thiazide diuretics affect ca in what way

Answer 20

hypercalcemia

Question 21

ca greater than 12mg?dl

Answer 21

IF >12 MG/DL –NS INFUSION WITH LOOP DIURETICS
• TEACHING ABOUT DIET, FLUID INTAKE, SIGNS AND SYMPTOMS, PAIN
CONTROL

Question 22

Hypercalcemia management medication for impaired renal or cardiovascular problem

Answer 22

calcitonin

Question 23

Hypercalcemia can be managed with Dialysis true or False

Answer 23

True

Question 24

chronic alcoholic suspect impaired intestinal absorbtion leading to low VitD and lead you to suspect low

Answer 24

phosphorus, Hypophosphatemia

Question 25

Causes of hypophosphatemia

Answer 25

phosphorus <2.8mg/dL refeeding syndrome ( insulin spike hungrey bone syndrome ``` Increased renal secreation with high PTH osmotic diuretic rickets renal proximal tubular disorder Fanconi syndrome inpaired intestinal absorption vit D deficiency chronic alcoholism ```

Question 26

Phosphorus level <1mg/dL cause end organ effects due to lack of

Answer 26

adenosin triphosphate; effects all muscles

Question 27

urine phosphorus excretion of >100mg in 24 hours mean

Answer 27

high loss of phosphorus hypophosphatemia

Question 28

what is molarity

Answer 28

moles per liter of solution

Question 29

what is molality

Answer 29

moles per liter of solvent

Question 30

what is diffusion

Answer 30

movement of particles or molecules from an area of high concentration to an area of low concentration

Question 31

Membrane that allows certan materials to pass throughbut not other

Answer 31

selective permeable membrane

Question 32

A dexcription of the relative solute concentration in a soultion as compred to another solution

Answer 32

tonicity

Question 33

solution with higher concentratoin than other

Answer 33

hypertonic

Question 34

solution with lower concentration than other

Answer 34

hypotonic

Question 35

diffusion regulated by protein channels in the membran and requires no energy input from cell

Answer 35

facilitate diffusion

Question 36

movement of molecules or ion into or out of cells against it concentration gradietn from low to high and requires an input of enrey

Answer 36

active transport