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Nursing School > Fluids, electrolytes, acid-base disorders > Flashcards

Fluids, electrolytes, acid-base disorders Flashcards

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1
Q

Is water polar or nonpolar? What does it mean?

A

Water is polar; can dissolve charged or polar molecules

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2
Q

What role does water play?

A

Water is a transport for nutrients and waste products

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3
Q

What role do electrolytes play?

A

Conduct electricity, aid in regulation of fluid, acid-base balance, and are cofactors for enzymes (speed up reactions)

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4
Q

Why are babies more susceptible to fluid imbalance?

A

Lose more fluid through their skin, kidneys aren’t fully developed so there’s an increase in fluid loss

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5
Q

Why are older adults more susceptible to fluid imbalance?

A

Thin skin, decline in kidney function, aren’t as thirsty

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6
Q

What are some risk factors for fluid imbalance?

A

Kidney function (regulates fluid), overweight individuals (more fat=less water), being female

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7
Q

Where is most of our bodies water found?

A

Intracellular space (40% of body weight)

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8
Q

What is the most abundant cation in the intracellular fluid?

A

Potassium

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9
Q

What CAN pass through the capillary membrane? (more permeable; located between plasma fluid and interstitial fluid)

A

Water, glucose, sodium, potassium (electrolytes move freely here)

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10
Q

What CANT pass through the capillary membrane? (located between plasma fluid and interstitial fluid)

A

Albumin (blood protein) and RBC’s

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11
Q

What CAN pass through the plasma membrane? (located between the interstitial fluid and intracellular fluid)

A

Oxygen

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12
Q

What CANT move freely through the plasma membrane? (located between the interstitial fluid and intracellular fluid)

A

Glucose (needs channel), sodium, potassium (charged ions)

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13
Q

What three things control capillary hemodynamics?

A

Hydrostatic pressure, osmotic pressure, capillary permeability

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14
Q

What is hydrostatic pressure?

A

Pressure that the fluid exerts on walls of blood vessels; contributes to movement of water into interstitial space (ex: heart beats increase hydrostatic pressure)

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15
Q

What is osmotic pressure?

A

Pulls water back into capillary; drives reabsorption

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16
Q

What plays a big role in osmotic pressure?

A

Albumin, pulls water back in

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17
Q

What is capillary permeability?

A

What is allowed in and out of the cell
Example: if permeability was increased (inflammation) proteins and large particles are lost in interstitial fluid, causing a decrease in osmotic pressure, hydrostatic forces water out increasing the production of tissue fluid

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18
Q

If you lose fluid what happens to pressure?

A

It drops

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19
Q

Where is hydrostatic pressure the greatest?

A

Arterial end; favors moving out into interstitial space

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20
Q

Where does excess fluid go if it’s not reabsorbed into capillaries?

A

Lymphatic system to then be fed back to venous system

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21
Q

Where does most of the water get reclaimed in the capillary?

A

Venous end

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22
Q

True or false: under normal circumstances osmotic pressure should not change?

A

True

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23
Q

Clinical question: A person develops a blood clot in a deep vein of their left leg. The clot is blocking most of the veins diameter. How will capillary filtration pressure be affected?

A

There will be a compromised flow, hydrostatic pressure increases (moves water into interstitial space)

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24
Q

What is edema?

A

Abnormal infiltration of fluid; can be caused by decrease in albumin

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25
Q

What is transudate in regards for edema?

A

Clear fluid leaking out

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26
Q

What is exudate in terms of edema?

A

Proteins, WBC leaking out

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27
Q

What is pitting edema?

A

Too much fluid in interstitial space; gravity aids in this

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28
Q

How can you get edema?

A

Increased capillary pressure, decreased osmotic pressure, increased capillary permeability, lymphedema

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29
Q

How can an increase in capillary (hydrostatic) pressure contribute to edema?

A

Too much fluid leaks out
Examples: increased vascular volume (heart failure affects pump/flow; kidney disease holds onto too much water), venous obstruction (blood clot formation - thrombophlebitis), liver disease with portal vein obstruction (blockage or narrowing of portal vein leads to back pressure), acute pulmonary edema (excess fluid in lungs)

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30
Q

How can a decrease in osmotic pressure contribute to edema?

A

Increase loss of plasma proteins (protein-wasting kidney diseases, burns - fluid leaks from blood vessels and collects around damaged areas), decreased production of plasma proteins (liver disease, malnutrition - not enough protein = fluid leaking out bc proteins help to hold salt and water inside)

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31
Q

What is Kwashiorkor?

A

Extreme protein (albumin) malnutrition; fluid is suppressed bc of a lack of albumin

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32
Q

How does increased capillary permeability contribute to edema?

A

Increased capillary permeability allows capillaries to become very leaky
Examples: inflammation, allergic reactions, malignancy, tissue injury and burns

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33
Q

How does the obstruction of lymphatic flow (lymphedema) contribute to edema?

A

malignant obstruction of lymphatic structures, surgical removal of lymph nodes (compromises ability to remove fluids)

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34
Q

What is third spacing?

A

Problem with fluid distribution; fluids shift to areas where they don’t normally belong
Examples: pericardial sac, pleural space, peritoneal space
Cancer can cause third space shifts

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35
Q

What are ways someone can get a fluid imbalance?

A

Problems with intake (too much fluid)
Problems with output (too much fluid out)
Problems with distribution (not in right place)

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36
Q

What are some sources of fluid loss?

A

GI loss
Bleeding
Endocrine dysfunction (aldosterone and ADH)
Fever (increase in breathing=fluid loss)
Hyperventilation
Osmotic diuresis (increase urination)
Medication therapies
Recreational drugs (caffein, coffee=increase in urination)

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37
Q

Causes of fluid gain?

A

Over-hydration (too much fluid= hypervolemia)
Increased sodium intake (where sodium goes water follows)
Kidney disease
Liver disease
Heart failure
Endocrine disorders (Cushing’s disease - hyperaldosterone, SIADH)
Too much ADH = hold onto excess fluid

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38
Q

Where are baroreceptors found?

A

Carotid arteries and aortic arch

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39
Q

What are the components of arterial pressure?

A

Fluid volume (blood plasma)
Cardiac pump
Blood vessels

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40
Q

Give an example of how a change in one component of arterial pressure can lead to compensatory response in other components?

A

Ex: lose blood volume = heart beats faster, kidneys conserve fluid, vasoconstriction

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41
Q

What does hypovolemia and hypervolemia refer to?

A

How much plasma (volume of liquid) is in the blood vessels

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42
Q

Hypovolemia causes

A

Hypovolemia is when theres not enough plasma in blood vessels
Causes: fluid loss, diabetes, burns or wounds, sweating (diaphoresis), diarrhea, vomiting, hypothalamic lesions

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43
Q

Clinical manifestations of hypovolemia

A

Weight loss, hypotension, tachycardia, thirst, skin tenting, increased hematocrit, BUN, electrolytes, increased urine concentration, increased temperature w/o infection

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44
Q

Hypervolemia causes

A

Hypervolemia is when there’s too much plasma volume in blood vessels
Causes: fluid excess due to increased intake, renal failure, hyperaldosteronism (hold onto salt and water), steroid therapy

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45
Q

Hypervolemia clinical manifestations

A

Weight gain, hypertension (too much blood), bradycardia, edema, decreased hematocrit (ratio of RBC to fluid)

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46
Q

What does aldosterone do to BP and sodium?

A

Increases BP and holds onto sodium

47
Q

Role of aldosterone

A

Helps control the balance of salt and water, regulation of blood pressure and blood volume

48
Q

What is shock?

A

Decreased arterial flow and oxygenation of cells, tissues, and organs, usually due to marginal or markedly lowered blood pressure

49
Q

4 broad types of shock

A

Hypovolemic (loss of volume)
Cardiogenic (pump failure)
Distributive (fluid in wrong place)
Obstructive (obstruction to flow)

50
Q

What releases aldosterone?

A

Adrenal glands

51
Q

Role of the Renin-angiotensin-aldosterone system

A

Regulates blood volume, blood pressure, fluid and electrolyte balance

52
Q

Which organ metabolizes aldosterone?

A

Liver
Clinical relevance: severe liver disease can’t breakdown aldosterone therefore the person is at risk for hypervolemia (hold onto fluid) and weight gain

53
Q

True or False? Sodium is more abundant outside the cell?

A

True; remember where sodium goes water follows, sodium can freely cross capillary membrane

54
Q

What is diffusion?

A

movement of molecules from high concentration to low concentration; both solvent and solute move

55
Q

What is osmosis?

A

movement of solvent (water) across a semipermeable membrane from high to low solvent concentration; only solvent moves

56
Q

Isotonic?

A

same concentration as fluid in cell, no reason for water to move

57
Q

Hypotonic?

A

Cell swells

58
Q

Hypertonic?

A

Cell shrinks, pulls fluid out; very concentrated around RBC pulling fluid out

59
Q

Atrial natriuretic peptide (ANP)

A

causes you to pee out sodium and therefore water too (where sodium goes, water follows)

60
Q

What organs regulate sodium?

A

kidney and hypothalamus

61
Q

Function of kidneys

A

monitors arterial pressure, retains sodium when arterial pressure decreases and eliminates when arterial pressure increases

62
Q

What coordinates sodium function and the kidneys?

A

Sympathetic nervous system and renin-angiotensin-aldosterone system (RAAS)

63
Q

How does the hypothalamus regulate sodium?

A

Via the anti-diuretic hormone (ADH); ONLY moves fluid; reclaims fluid from urine

64
Q

What produces ADH? Why is it released?

A

Hypothalamus; released in response to osmolality (concentration)

65
Q

What is the most common electrolyte imbalance?

A

Sodium

66
Q

What is hyponatremia?

A

Too low of sodium concentration in blood; water will shift into cells

67
Q

What is hypernatremia?

A

toomuchsodium concentration in blood; water will shift out of cells

68
Q

Diabetes insipidus (DI)

A

low levels of ADH or inability for kidneys to respond to ADH
Causes: brain lesions, cranial surgery, or head injury, some medications, certain renal disorders

69
Q

Syndrome of inappropriate ADH (SIADH)

A

Too much ADH
Common causes: cancer, pituitary tumor, neurologic infections (elevated levels of ADH), HIV infection

70
Q

What may cause hyponatremia? Diabetes insipidus or SIADH?

A

SIADH (syndrome of inappropriate ADH); holding onto free water

71
Q

Where do sodium imbalances manifest?

A

Nervous system

72
Q

What is hyponatremia?

A

Low blood sodium levels; decrease in intake of sodium
Clinical application: Addison’s disease causes low aldosterone which then causes kidneys to hold onto water, decrease sodium reabsorption and excrete potassium, cellular swelling, chronic alcoholism, see slide 40

73
Q

What is hypernatremia?

A

increase in blood sodium levels
Clinical application: Cushings syndrome causes increase in sodium and wastes potassium, increased thirst, see slide 40

74
Q

What electrolyte is the heart more sensitive to and which is the brain more sensitive to?

A

Brain: sodium
Heart: potassium

75
Q

What organ makes albumin?

A

Liver

76
Q

What type of solution would you give to someone with cerebral edema?

A

Hypertonic solution

77
Q

What is an iatrogenic injury?

A

Adverse mental or physical condition induced in a patient through the effects of treatment
Examples: rapid infusion of IV fluids can lead to heart failure and pulmonary edema

78
Q

What organ plays a big role in the regulation of potassium?

A

Kidneys

79
Q

Where is aldosterone produced and where is it metabolized?

A

Produced in adrenal glands, metabolized by liver

80
Q

What is the role of aldosterone?

A

helps control the balance of water and salts in the kidney by keeping sodium in and releasing potassium from the body

81
Q

How does liver disease cause hyperkalemia?

A

if the liver can’t metabolize aldosterone then potassium will accumulate

82
Q

Where do symptoms appear in potassium balance?

A

Heart and muscle

83
Q

What is hypokalemia?

A

decrease in potassium in the blood; caused by a decreased intake, vomiting, alkalosis, see slide 50
Clinical application: cardiac arrhythmia (low T wave)

84
Q

What is hyperkalemia?

A

High levels of potassium in blood; caused by increased intake, renal failure (can’t get rid of potassium through kidneys), acidosis, see slide 50
Clinical application: Peaked T wave

85
Q

Acidosis

A

High potassium, hyperkalemia; bicarbon is lost, high acid

86
Q

Alkalosis

A

Low potassium, hypokalemia; increase in bicarb

87
Q

What causes a peaked T wave?

A

Hyperkalemia

88
Q

What can cause a transcellular shift?

A

trauma (cells damaged), acid-base disorders, catecholamine release (epinephrine drive potassium into cells), action of insulin (drive potassium into cells), medications

89
Q

Addisons disease

A

adrenal insufficiency, abnormally low levels of adrenal hormones, don’t produce aldosterone (keeps sodium in, pee out potassium), can lead to hypovolemia, hyperkalemia, and acidosis

90
Q

Cushing’s disease

A

excess aldosterone

91
Q

What role does calcium play in the body?

A

muscle contraction, blood clotting, bone formation, enzyme function, heart rhythm

92
Q

What acts on the kidneys and bone to remove calcium from the extracellular circulation?

A

calcitonin (tones calcium down)

93
Q

What organs are responsible for the activation of vitamin D?

A

skin, kidneys, liver

94
Q

What is the relationship between calcium and phosphorus?

A

inverse relationship; one goes up other goes down

95
Q

Hypocalcemia

A

decrease in calcium in the blood; caused by decreased intake, vit D deficiency, liver disease, see slide 60
Clinical application: increased neuromuscular activity, muscle twitch

96
Q

Hypercalcemia

A

increase of calcium levels in blood; caused by increased intake, immobility, bone malignancies, hyperparathyroidism, see slide 60
Clinical application: decreased neuromuscular activity, increased fracture risk

97
Q

True or False: acids tend to donate protons and bases tend to accept protons

A

True

98
Q

Definition of ph and Normal pH range

A

How many hydrogen ions in a solution
7.35-7.45

99
Q

What happens to pH when theres more hydrogen? less?

A

More hydrogens = pH down
Less hydrogens = pH up

100
Q

role of buffer systems

A

resist big changes in pH; absorb excess hydrogens or give up hydrogens

101
Q

Normal PaCO2 range

A

35-45 mmHg

102
Q

Normal HCO3 range

A

22-26 mEq/L

103
Q

What metabolic exhaust is produced by aerobic metabolism?

A

Water, CO2

104
Q

What metabolic exhaust is produced by anaerobic metabolism?

A

lactic acid

105
Q

Low CO2 =
(Hint replace CO2 with acid)

A

Basic

106
Q

High CO2 =
(Hint replace CO2 with acid)

A

Acidic

107
Q

Low HCO3 =
(Hint replace HCO3 with base)

A

Acidic

108
Q

High HCO3 =
(Hint replace HCO3 with base)

A

Basic

109
Q

What does it mean to be uncompensated?

A

pH and 1 other value are outside of normal range

110
Q

What does it mean to have partial compensation?

A

When all 3 values (pH, CO2, HCO3) are outside normal range

111
Q

What does it mean to be fully compensated?

A

When pH is within normal range but CO2 and HCO3 are outside normal

112
Q

If there’s a problem with CO2 does that indicate a respiratory or metabolic issue?

A

Respiratory

113
Q

Acidosis leads to too many hydrogen ions or too little?

A

Too many

114
Q

Alkalosis leads to too many hydrogen ions or too little?

A

Too little

Nursing School (9 decks)

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