Intro - Full Flashcards
What makes 42% of our total body weight?
Intracellular
What makes 17% of our body weight?
Extra cellular fluid?
What provides the cells with nutrients?
Intracellular
What transports chemicals across the cell membrane?
Intracellular
What includes interstitial fluid?
Extra cellular
Included intracellular vascular fluid?
Extra cellular
How much fluid is in the human body?
60% 4L of fluid
What is the interstitial space?
Space bw cells
What is intravascular space?
Space between bw blood vessels
What is trans cellular fluid?
All other fluid in the body
What does 1st, 2nd and 3rd spacing mean?
1st: Normal fluid
2nd: too much fluid in Interstitial space (edema usually)
3rd: fluid residing in abdominal space that can’t be used in the body
What is the best way to measure a change in a persons fluid status?
Weighing them. 1L = 1kg of weight
What is diffusion? What kind of a process is it?
Moving molecules from areas of high to low concentration. It’s a passive process, meaning it requires no energy
What is osmosis? What kind of a profess is it?
Movement of water across a cell from a low concentration to a high concentration of solutes across a semi permeable membrane. It is a passive process.
What are sterling forces?
Forces that control movement of fluids between compartments and help keep fluids where they belong.
What types of pressure is exerted inside capillaries?
- capillary hydrostatic pressure: blood pressure
- capillary oncotic pressure (pressure exerted by solute concentrations in fluid)
What types of pressure are exerted outside the capillaries ?
Interstitial hydrostatic pressure: pressure from fluid itself
Interstitial oncotic pressure
What are the two main types of IV fluids?
Crystalloids and colloids
What kind of molecules are in crystaloids?
Small that are easily dissolved in a solution
How do crystalloids vary in solutes?
They can be electrolytes (sodium) or non electrolytes (dextrose)
What are crystalloids relationship with semi permeable membrane?
Move easily across it
What’s an example of a crystalloid?
NS, RL
What kind of molecules do colloids have and what is their rs with semi permeable membrame?
Large molecules that can’t pass thru semi permeable membranes
Where do colloids reside?
In intravascular space
Example of colloid
Albumin and fresh frozen plasma
How do isotonic solutions affect the cell?
Osmotic pressure inside and outside the cell remains constant so size of cell is not affected
Where do isotonic solutions reside and how are they distributed?
In extracellular space and is distributed bw intravascular and interstitial compartments
How do isotonic solutions affect the intravascular blood volume?
Increases it
What are example of isotonic solutions?
0.9 NaCl
RL
D5W
When should isotonic solutions be used?
Hemorrhage GI losses Shock Burns Trauma Any fluid resuscitation Fluid volume deficit
What is a hypotonic solution
Caused fluid to shift out of vascular space and into the interstitial and intracellular spaces.
Hydrates cells
What are examples of hypotonic solutions?
- 45% sodium chloride
- 5 dextrose in water
- 33% sodium chloride
When should hypotonic solutions be used?
Intracellular dehydration
Diabetic ketoacidosis
Promote renal excretion when there is excess water and electrolytes
What is a hypertonic solution?
Pulls fluid out of the cells
How does a hypertonic solution affect intravascular space?
Expands it, volume expander
What are examples of hypertonic solutions?
5% dextrose in 0.45% NaCl and 0.9% NaCl
25% albumin
3% NaCl
10% dextrose
When should hypertonic solutions be used?
Cerebral edema, severe hyponatremia
What is hypovolemia?
Low circulating blood volume in intravascular and interstitial spaces from loss of sodium or fluid
How do pt lose fluid?
GI: diarrhea, vomiting, NG suction, bleeding p
Urinary: drug therapy, hyperglycaemia, diabetes
Integumentary: burns, diaphoresis, increased capillary permeability
Other: hemorrhage, wound drainage
What is fluid volume deficit (fvd)
Volume within the vessels is low
What happens to cells during a state of hypovolemia
Intracellular dehydration bc fluid shifts out of the cells to increase intravascular volume
What is fluid volume excess?
Hypervolemia or fluid overload. It is over hydration of the intravascular compartment.
What happens to fluid as a result of fluid volume excess?
Fluid is pushed out from vascular space and into interstitial spaces
How do we know FVE has resolved?
Stable CV with low BP Dieresis Balanced intake and output, weight loss Decreased edema Improving lung sounds Improved mental status Stabilizing blood work
What is included in a CBC?
RBC count Hemoglobin Hematocrit WBC Platelet count
What is RBC primary function?
Carry o2 in the bloodstream
How does a hemorrhage relate to RBC count?
Low RBC value
How does hemolysis relate to RBC value? And what is it
Hemolysis: rupturing of RBC
Low RBC value
How does bone marrow failure relate to RBC value?
Low RBC value
How does hemoconcentration relate to RBC value?
High RBC value
How does hypoxia relate to RBC value and why?
High blood count bc hypoxia increases of EPO levels which stimulate the production of mature RBC from the bone marrow
How do ingestion of drugs affect RBC count?
Low RBC value
How do dietary deficiencies relate to RBC value?
Low RBC Value
How does hemodilution relate to RBC value? Why
Low RBC value. Hemodilution means to remove RBC.
What is hemoglobin?
The protein in RBC that carries O2 around the body and it carries iron.
What happens when hemoglobin is too low?
CV system is strained leading to risk of angina, MI, HF and stroke
What happens when hemoglobin is too high?
Risk of stroke and organ infarction
What is hematocrit?
Total volume percentage of RBC in blood
What are the five types of WBC?
Lymphocytes Neutrophils Monocytes Eosinophils Basophils
What do neutrophils relate to?
Bacterial infections
What d lymphocytes relate to?
Chronic infections and viral infections
What do monocytes relate to?
Acute infections and chronic inflammatory conditions
What do eosinophils relate to?
Allergic reactions
What do basophils relate to?
Thyroid disorders
Why would WBC levels be low?
Drug toxicity Overwhelming infections Dietary deficiency Autoimmune disease Stress
What are platelets ? What are they also called?
Thrombocytes. They circulate in the blood and bind together to form a clot over the damaged blood vessel.
What is it called when there are low levels of platelets?
Thrombocytopenia
Where is thrombocytopenia found in?
Hemorrhage, leukemias, lupus, pernicious, hypersplenism, cancer chemotherapy
What is it called when platelet levels are too high?
Thrombocytosis?
What are electrolytes?
Positive and negative electrically charged ions/salts dissolved in bodily fluids and dispersed throughout the body into all compartments
What do electrolytes do?
Produce energy
Help with electrical conduction
Help your nerves and muscles to function
Regulate acid base balance
Help to regulate the extracellular and intracellular fluid balance
What happens when there is an electrolyte imbalance?
Negative effects on all body systems
Our cells won’t function without them
What are the main extracellular electrolytes?
Sodium
Chloride
Calcium
What are the main intracellular electrolytes?
Potassium
Magnesium
Phosphorus
What is the most abundant cation in extracellular fluid?
Sodium
What is sodium’s relationship with volume and how does it affect ECF volume?
Attracts water
Sodium imabalances mean
Fluid imbalance
Where is sodium absorbed? Excreted?
Intestines
Kidneys
What does sodium work with? And what do they do?
Works with potassium to maintain electrolyte balance between inside and outside of cells (sodium potassium pump)
What is the most common electrolyte disorder in hospitalized pts and post ops?
Hyponatremia
What is hyponatremia?
Pt has too much fluid in the vessels and thus sodium is over diluted and low. Now there’s a higher concentration of sodium in the cells and water will flow where salt is causing edema.
What is the goal for treating hyponatremia?
Replace and normalize serum sodium.
How is mild hyponatremia treated?
Dietary sources
What kind of fluid is given to hyponatremia pts? Why
Isotonic bc it encourages salt to enter the vessel.
How is a pt with severe hyponatremia treated?what are they at risk for?
Given hypertonic saline that is used for limited time with extreme caution. Risk for osmotic demyelination syndrome.
What do you closely monitor in hyponatremia pts?
I and Os
Neuralgic status
Bloodwork
What is hypernatremia?
Fluid volume in the vessels in low (dehydration). Therefore sodium is over concentrated. Water shifts from intracellular to extracellular space and cells shrink.
What are the clinical manifestations of hypernatremia?
Neurological, thirst, dry mucous membranes
In treatment, what is the goal for hypernatremia?
To replace water and normalize serum sodium
What type of fluids are given hypernatremia pts?
Hypotonic
What kind of pills can be given to hypernatremia pts?
Diuretics: pills that help excrete water and sodium as urine
Where is calcium mostly stored?
Bones
What are the primary functions of calcium?
Regulation of muscle
Nerve impulse transmission
Component in final coagulation pathway
What is hypocalcemia?
Low levels of calcium in the liquid of blood.
What are primary clinical manifestations of hypocalcemia?
Irritability, parasthesia (pricking sensations in hands), tetany (involuntary muscle contraction), ECG changes, dysrhymias, hypotension
What’s chvosteks sign?what does it indicate?
Twitching of the facial muscles in respond to tapping over the area of the facial nerve.
Indicates hypocalcemia
What is trousseus sign? What does it indicate?
The hand twitches toward the elbow when BP cuff is on. Indicates hypocalcemia.
What do you treat hypocalcemia with?
IV calcium gluconate, IV calcium chloride
What is hypercalcemia?
Calcium in blood is above normal
In hypercalcemia, what conditions cause calcium to enter the ECF faster than the kidneys can excrete?
Hyperparathyroidism
Many malignancies
What are the primary clinical manifestations of hypercalcemia?
Low neuromuscular action
Low gastric motility
Low HR
List three ways to treat hypercalcemia
Isotonic IV (NS) to dilute calcium concentration and promote renal excretion
Diuretics
Use of bio phosphates
What is the most abundant cation in intracellular fluid?
Potassium
What is hypokalemia?
Low K+ levels
Common causes of hypokalemia?
GI loss
Dieuretics
Insulin
What number is considered hypokalemic?
Less than 3.5 mmol/L
What bodily changes are expected at less than 2.5 mmol/ Lof potassium?
ECG changes
New irregular HR
Cardiac arrest
What bodily changes are expected at 2.5 to 3.5 mmol/L of potassium?
Muscle weakness and cramps
What bodily changes are expected at 3.0 to 3.5 mmol/ Lof potassium?
Asymptomatic
What is the goal with treatment for hypokalemia?
Restore serum potassium level and rule out emergencies like cardiac dysthymias
What are ways to orally treat hypokalemia?
Dilute liquid form in water or juice
Give pills with food
Potassium rich foods
What are ways to treat hypokalemia with IV?
K+ by infusion pump
Monster iv site as it’s very irritating to veins
What is hyperkalemia? And what it’s minimum value?
Higher than normal levels of potassium in the blood, greater than 5.3 mmol/L
What medications cause hyperkalemia?
Beta adrenergic blockers
NSAIDS
Ace Inhibitors
At what level of potassium for hyperkalemia do clinical manifestations show?
Greater than 6 mmol/L
How is mild hyperkalemia treated?
Removal of K with furosemide. Medication that expels K in urine
How do we treat moderate hyperkalemia?
Removal with cation exchange resins like kayaexelate to promote GI excretion
How to treat severe hyperkalemia?
Stabilize cardiac tissue then try to move K back into cells and promote renal excretion
What are normal levels of magnesium?
Small amount is found in vascular space so normal serum magnesium level is low
What role does magnesium play in the body?
Neuromuscular and cardiovascular activities
Enzymatic and metabolic functions
Where is magnesium absorbed and excreted?
Intestines
Kidneys
What is hypomagnesemia?
Low magnesium levels in the blood
Hypomagnesemia is seen often in patients with…
GI loss
Malabsorption
Alcoholism
What are primary clinical manifestations of hypomagnesemia?
Tremors Tetany (involuntary contraction of muscles) Positive chvosteks and troussues sign ECG changes Primarily neuromuscular and cardiac
How to treat asymptomatic pt with hypomagnesemia?
Oral Mg supplements
How to treat pt with hypomagnesemia with cardiac or neurological symptoms?
IV mg sultans administered slowly
When administering meds for pts with cardiac or neurological symptoms, what should you monitor?
BP, heart rhythm, ECG changes, other electrolytes (low K is normal alongside low Mg)
What is hypermagnesemia
Too much magnesium in the blood
In what kind of pts is hypermagnesemia seen?
Pts with renal insufficiency/failure or with excess Mg intake
What are the primary clinical manifestations of hyoermagnesemia?
Think understimulation of heart and neurological system Low DTR Lethargy Weakness Maybe resp depression ECG chnages Bradycardia Cardiac arrest HTN with n & v
How is mild hypermagnesemia treated?
Not treated unless underlying renal disease
How is sever hypermagnesemia treated?
Continuing cardiac monitoring IV calcium gluconate Monitor for resp depression Assess neurological function frequently May require dialysis
Where is urea and creatinine excreted by?
Kidneys
What do urea and creatinine levels determine? High creatinine means?
Determine renal function
If increased, reduced renal function
