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Nursing 2005: Clinical Pathophysiology > Fluids & Electrolytes/Acid Base Imbalances > Flashcards

Fluids & Electrolytes/Acid Base Imbalances Flashcards

1
Q

Total Body Water (TBW)

A
  • varies w/ age, weight, etc

- 60% of weight

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2
Q

Extracellular

  1. def
  2. What are the 2 types?
A
    • outside the cell
      - 20% of body weight

2a. Interstitial fluid
- around the cell

2b. Intravascular fluid
- blood plasma

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3
Q

Intracellular

A
  • inside cell

- 40% of body weight

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4
Q

Movement of Water:

  1. Diffusion
A
  • movement of charged and noncharged particles along concetration gradiant
  • moves from HIGH –> LOW concentration
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5
Q
  1. Osmosis
A
  • movement of water acros semi-permiable membrane

- Moves from LOW –> HIGH concentration

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6
Q
  1. Osmotic Pressure

a. osmality

A
  • pressure required to stop osmotic flow of water
  • determined by osmality

a. osmality:
- concentration of molecules/particles per kilo

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7
Q
  1. Hydrostatic Pressure
A
  • force of water pushing against cellular membranes

- pushes water our of vascular space

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8
Q
  1. Onoctic Pressure
A
  • pressure exerted by colliods (proteins)

- draws water in d/t plasma proteins

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9
Q

Between Intracellular and Extracellular Fluids

  1. osmotic balance
A
  • func of osmotic forces
  1. Osmotic balance:
    - water moves until osmotic equilibrium balanced
  • ECF = Na
  • ICF = K
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10
Q

Between Plasma and Interstitial Fluid

A
  • movement d/t changes in hydrostatic pressure
    • pushes water out of capillaries
  • osmotic forces pull water in at capillaries
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11
Q

Alterations in Water Movement:

Edema

  1. def
A
  • accumulation of fluid in interstitial places
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12
Q

What is the cause of edema?

A
  1. Cause:

a. inc hydrostatic pressure
- d/t inc fluid

b. dec plasma oncotic pressure
- d/t leakage because of poor albumin

c. inc capillary permeability
- d/t trauma, injury

d. obstructive lymph flow
- tumor

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13
Q

What are the types of treatment for edema?

A
  1. diuretics
    - dec hydrostatic pressure d/t less fluid

2 albumin
- pulls water into blood stream

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14
Q

Regulation of Body Water:

A. Thirst

  • What stimulates it?
A

a. Hyperosmolaity
- stimulates osmo receptors to make you drink

b. low K

c. Dec in blood vol
- stimulates osmo receptors

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15
Q

B. Renal Concentration Mechanism- ADH

A
  • ADH causes kidneys to retain water
    • antidiuretic to keep in water
  • controlled by osmolality and vol
  • osmolality inc = ADH secreted
  • blood vol dec
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16
Q

What are the normal values of osmoality?

A

280-294

294 = dehydrated, not enough particles

  • found in blood sample
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17
Q

ECF Imbalances

A. ECF DEFICIT

A
  • dec intake
- inc loss
   d/t:
- diarrhea
- vomit
- diuretics
- burn victims
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18
Q

What are S/S of ECF DEFICIT?

A
  • thirst
  • weight loss = measure fluid vol
  • dec urine output = dark
  • dec BP
  • inc HR
  • inc serum osmality
  • shock
  • weakenss
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19
Q

B. ECF EXCESS

A
  • inc intake

- dec loss

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20
Q

What are S/S of ECF EXCESS?

A
  • weight gain
  • edema
  • SOB = fluid in lungs
  • ab distention = fluid in cavit
  • Na retention
  • swollen brain cells = seizures, coma
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21
Q

What are sodiums func?

A
  • osmolality of ECF
  • neuromuscular func
  • acid base
  • regulated by aldosterone
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22
Q

Where is sodium lossed?

A
  • urine
  • skin
  • GI tract
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23
Q

Hyponatremia

A
  • excess water intake
    • dilutes Na level
  • dec water loss
    • dilutes Na level
  • inc Na loss
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24
Q

What are clinical manifestations of hyponatremia?

A
  • CNS symptoms
  • GI disturbances
  • inc intracellular
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25
Q

What are S/S of hyponatremia?

A
  • weight gain
  • neuro changes
    • confusion
    • lethargy
    • coma
    • seizure
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26
Q

Hypernatremia

A
  • inc water loss
  • dec intake of water
  • excess Na
  • inc Na intake d/t diet, IV solution
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27
Q

What are S/S of hypernatremia

A
  • thirst
  • dry mucous membranes
  • inc HR
  • restlessness
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28
Q

Potassium

  • Func?
A
  • get potassium from diet and excreted through urine
  • osmolarity of ICF
  • neuromuscular control and regulation
  • acid base balance
  • enzyme reaction
  • HR
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29
Q

How is potassium regulated?

A
  1. change of K in distal tubules, serum
    • inc K = excretion
  2. adosterone
    - promotes excretion
    - inc K = inc aldosterone = loss of K
  3. potassium hydrogen ion exchange
    - acidosis = hyperkalemia
    - K leaves cell
    - alkalosis= hypokalemia
    - K enters cell
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30
Q

What is hypokalemia caused by?

A

-*deficit

  1. dec intake
  2. excess GI loss
  3. excess renal loss
  4. intrcellular shift = alkalosis
31
Q

What are S/S of hypokalemia?

A
  • cardiac dysrhythmias
  • weakness
  • dec GI motility
  • loss in vomit, diuretics
  • cramping os skeletal muscles
  • skeletal muscle weakness
  • smooth muscle weakness = slows GI tract → constipation
  • CNS depression
32
Q

What type of treatment is used for hypokalemia?

A
  • diet inc K

ex: banana, nuts, some fruits

33
Q

What is hyperkalemia caused by?

A

*excess

  1. excess intake/gain
  2. dec renal loss
  3. extracellular shifts
    - acidosis
    - massive cell destruction
34
Q

What are S/S of hyperkalemia?

A
  • abnormal conduction pathways
  • smooth muscle = inc activity
  • EKG changes
  • cardiac arrest
  • muscle weakenss
35
Q

What is used to treat hyperkalemia?

A
  1. diet to dec intake
  2. diuretics to de K (if no renal problem)
  3. resin
    - drink called Kexalate
    - eliminates through stool
  4. emergency
    - insulin to remove K into liver –> muscle
    - also give glucose
36
Q

What is the func of calcium?

A
  • transmits nerve impulses and muscle contractions
  • enzyme reactions
  • maintains cell membrane perm
  • inverse relation w/ phosphate
37
Q

What is hypocalcemia caused by?

A
  1. hypoparathyroidism
  2. pancreatitis
  3. renal failure
  4. lack of vit D
  5. low magnesium
38
Q

What are S/S of hypocalcemia

A
  • deficit
  • inc nerve excitability
    • tingling
    • numbness
    • tetany
    • hyperreflex
    • cramps
    • seizures
39
Q

What is hypercalcemia caused by?

A
  • excess
    1. bone tumor
    2. hyperparthyroidism
    3. prolonged immobility
40
Q

What are S/S of hypercalcemia?

A
  • dec neuromuscular activity
  • weakness
  • constipation
  • dysrrhytmias
41
Q

What is the func of phosphate?

A
  • bone formation
  • metabolic processes (ATP)
  • essential part of nucleic acids and membrane
  • normal func of WBC and platelets
  • deliver O2 to cells
42
Q

What is the cause of hypophosphatemia?

A
  1. antacid use
  2. malnutrition
  3. diarrhea
  4. lack of vit D
43
Q

What are S/S of hypophospatemia?

A
  • tremos
  • hypoflexia
  • confusion
  • sezures
  • numbness
  • dysfunc of WBC and platelets
44
Q

What is hphyerphosphatemia caused by?

A
  1. renal faulure

2. hypoparathyroidism

45
Q

What are the S/S of hyperparathyrodism?

A
  • like low Ca
46
Q

What is the func of magnesium?

A
  • cofactor in enzyme reactions

- affects neuromuscular func

47
Q

What is hypomangnesia caused by?

A
  1. imparited intake/absorption

2. inc loss

48
Q

What are S/S of hypomangnesmia?

A
  • deficit
  • CNS hyperirritability
  • tremors
  • inc HR
49
Q

What are the func of hypermagnesemia?

A
  • rare

- d/t intake or renal insufficiency

50
Q

What are S/S of hypermagnesmia?

A
  • sedation of CNS
  • muscle weakness
  • confusion
  • dec BP
51
Q

Acid/Base

  • normal ph?
  • equation?
A

ph = 7.35-7.45

CO2 + H2O → H2CO3→ H+ HCO3

52
Q

Acidosis

A
  • process causes acidemia

- acid condition of blood ph = < 7.35

53
Q

Alkalosis

A
  • process causing alkalemia

- alkaline condition of blood ph = >7.45

54
Q

Regulation of pH:

  1. Carbonic acid-bicarbonate buffering

a. respiratory
b. renal

A

a. resp = regulated CO2 level = acid
- CO2 inc = acidosis = hypoventilation
- CO dec = alkalosis = hypoventilation

b. renal = metabolic
- regulate HCO3 = base
- produce either acid/base urine

-HCO3 inc = alkalosis

HCO3 dec = acidosis

55
Q

Acid/Base Imbalance:

A. Resp Acidosis

A
  • retain CO2 = accumulate

- ph <7.335

56
Q

What is resp acidosis caused by?

A
  • hypoventilation
  • pneumonia
  • NM disease
  • CNS depression
    • lethargy, confusion, coma
  • COPD
57
Q

What are S/S of resp acidosis?

A
  • depressed CNS
  • headache
  • weakness
  • twitch
  • deep,shallow resp
  • acidic urine
58
Q

B. Resp Alkalosis

A
  • blow off CO2 = loss

- ph >7.45 = less acidic (more base)

59
Q

What is resp alkalosis caused by?

  • compensation?
A
  • hyperventilation

- compensation = alkaline urine

60
Q

What are S/S of resp alkalosis?

A
  • excited CNS
  • numb, tingly fingers/toes
  • palpations
  • sweating
61
Q

C. Metabolic acidosis

A
  • retain acid
  • HCO3 dec
  • ph <7.35
62
Q

What is metabolic acidosis caused by?

A
  • renal failure = dec urine ouput
    • incr acid levels
  • diarrhea
    • loss of bicarb
  • shocks
    • lactic acid
63
Q

What are S/S of metabolic acidosis?

  • compensation?
A
  • depression of CNS
  • weak, fatigue
  • confusion
  • compensation:
    • inc RR
    • Kussmaul resp
    • acidic urine
64
Q

What is treatment for metabolic acidosis?

A
  • give sodium bicarb
65
Q

D. Metabolic alkalosis

A
  • loss of acid
  • HCO3 inc
  • ph > 7.45
  • excess base or loss of acid
66
Q

What is metaboli alkalosis caused by?

A
  • ingestion of base = anacids
  • vomit
    • excess aldosterone
  • diuretic therapy = alkalosis
67
Q

What are S/S of metabolic alkalosis?

Compensation

A
  • Excited CNS
  • hyperreflexes
  • convulsions
  • weakness
  • confusion

Compensation:

  • dec RR
  • retain acid
  • alkaline urin
68
Q

What is tx for metabolic alkalosis

A
  • id reason
69
Q

Analysis of Arterial Blood Gases Test

  1. ph
A

7.35-7.45

70
Q
  1. PaCo2
A

35-45

  • CO2 level is high = acidosis
71
Q

PaO2

A

80-100

72
Q

HCO2

A

22-26

  • high bicarb = alkalotic
  • low bicarb = acidic
73
Q

How to figure our ABG

A
  1. look at pH = acidemia/alkalemia?
  2. find primary cause
    - look at PCO2 and HCO3

a. CO2 abnormal and matches pH problem = respiratory
- if HCO3 off and matches ph change

b. inverse match = metabolic
- if HCO3 and matches pH changes

  1. look at other values to see if compensation

Nursing 2005: Clinical Pathophysiology (9 decks)

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