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N212 Final > L13: Fluid, Electrolytes, and Acid-Base Balance > Flashcards

L13: Fluid, Electrolytes, and Acid-Base Balance Flashcards

1
Q

what are the characteristics of body fluids that affect cell function(4)?

A

1) volume (amount)
2) osmolarity (concentration)
3) electrolyte concentration (composition)
4) pH (degree of acidity)

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2
Q

how much total body water is in intracellular fluid (ICF) in adults?

A

about 2/3

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3
Q

how much total body water is in extracellular fluid (ECF) in adults?

A

about 1/3

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4
Q

what are the two major divisions of extracellular fluid?

A

1) intravascular fluid (liquid part of blood-plasma)
2) interstitial fluid (between cells and the outside of blood vessels

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5
Q

what is the minor division of extracellular fluid?

A

transcellular fluid (cerebrospinal fluid, pleural, peritoneal, and synovial fluids)

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6
Q

fluid that contains a large number of dissolved particles is _________ than the same fluid that contains only a few particles

A

more concentrated

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7
Q

what is the osmolarity of a fluid?

A

a measure of the number of particles per kg of water

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8
Q

Can sodium cross easily through cell membranes?

A

it can but not easily

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9
Q

what sets the tonicity of a fluid?

A

presence of particles that can not cross easily across cell membranes

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10
Q

what is tonicity?

A

the effective concentration of a fluid. A measure of how a solution affects the volume and pressure of a cell’s fluid

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11
Q

what is an isotonic fluid?

A

having equal osmotic pressure or concentration of water and solutes.
e.g. blood

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12
Q

what is a hypertonic solution?

A

a solution with a higher concentration of solutes than another solution, or than the inside of a cell. Water moves out of the cell into the hypertonic solution, causing the cell to shrink or shrivel

a solution that is more concentrated than blood

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13
Q

what is a hypotonic solution?

A

a solution that has a lower concentration of solute compared to the cell.

a solution that is more dilute than blood

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14
Q

what is fluid homeostasis?

A

the dynamic interplay of three processes:
1) fluid intake and absorption
2) fluid distribution
3) fluid output

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15
Q

what is fluid intake?

A

drinking and eating

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16
Q

what is fluid distribution?

A

the movement of fluid among its various compartments and between the intracellular and extracellular compartments

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17
Q

how does fluid distribution between intracellular and extracellular compartments occur?

A

by osmosis

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18
Q

how does fluid distribution between vascular and interstitial portions of the ECF occur?

A

by filtration

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19
Q

what are examples of fluid output?

A

urine and sweat

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20
Q

to maintain homeostasis, intake and output have to be…

A

equal to each other

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21
Q

how much is the average fluid intake via eating and drinking?

A

2300mL for healthy adults

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22
Q

describe thirst(2)

A

1) the conscious desire for water, regulates fluid intake when plasma osmolarity increases
2) thirst-control mechanism is located in the hypothalamus

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23
Q

what are osmoreceptors?

A

receptors that continuously monitor plasma osmolarity. when it increases, they cause thirst by stimulating neurons in the hypothalamus

osmoreceptors-mediated thirst

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24
Q

baroreceptor-mediated thirst

A

Changes in arterial blood pressure, sensed by arterial baroreceptors, influence drinking behavior. Decreases in ABP stimulate fluid intake, an effect that appears to be mediated entirely via arterial baroreceptor-evoked renin secretion with the resulting increase in blood levels of angiotensin II acting on the brain to stimulate drinking

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25
Q

Angiotensin II- and III-mediated thirst

A

refers to the physiological mechanism where the hormones angiotensin II and, to a lesser extent, angiotensin III, directly stimulate the sensation of thirst by acting on specific receptors in the brain, primarily within the subfornical organ (SFO), leading to an increased urge to drink water when the body detects low blood volume or dehydration

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26
Q

what is angiotensin II’s role in the thirst response?

A

binds to the hypothalmus in the brain, stimulating thirst

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27
Q

describe the relationship between hormones and the kidneys when it comes to fluid output

A

the kidneys respond to some hormones that influence urine production

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28
Q

which hormones influence urine production in the kidneys(3)?

A

1) antidiuretic hormone (ADH)
2) renin-angiotensin-aldosterone mechanism
3) atrial natriuretic peptides (ANPs)

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29
Q

what are the avenues of fluid output(4)?

A

1) kidneys
2) skin
3) lungs
4) GI tract

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30
Q

what is insensible fluid output?

A

fluid output that is not visible
1) skin (sweat)
2) lungs

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31
Q

what is sensible fluid output?

A

visible fluid output
1) kidneys
2) GI tract

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32
Q

how much fluid moves into the GI tract then returns to the ECF?

A

3 - 6 L

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33
Q

the average adults excretes how much fluid each day through feces?

A

100mL

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34
Q

what are S/Sx of clinical dehydration(2)?

A

1) ECV deficit
2) hypernatremia

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35
Q

what is another name for ADH?

A

vasopressin

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36
Q
  1. A patient is diaphoretic and has an oral temperature of 104° F. These are classic signs of:
    A. ADH deficit.
    B. extracellular fluid loss.
    C. insensible water loss.
    D. sensible water loss.
A

C

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37
Q

Fluid and Electrolytes for Nursing Students YouTube Videos

A

https://www.youtube.com/watch?v=7piicQkfauk

https://www.youtube.com/watch?v=Xdf7jutmSvg

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38
Q

what are normal sodium (Na+) lab values?

A

136-145mEq/L

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39
Q

what are normal potassium (K+) lab values?

A

3.5-5.0 mEq/L

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40
Q

what are normal chloride (Cl-) lab values?

A

98-106 mEq/L

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41
Q

what are normal total CO2 lab values?

A

22-30 mEq/L

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42
Q

what are normal bicarbonate (HCO3) lab values?

A

arterial: 21-28 mEq/L
venous: 24-30 mEq/L

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43
Q

what are normal total calcium (Ca2+) lab values?

A

9-10.5 mg/dL

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44
Q

what are normal **ionized calcium (Ca2+) lab values?

A

4.5-5.6 mg/d

45
Q

what are normal magnesium (Mg2+) lab values?

A

1.3-2.1 mEq/L

46
Q

what are normal phosphate lab values?

A

3.0-4.5 mEq/L

47
Q

what are normal anion gap lab values?

A

6+/-4 mEq/L

48
Q

what are the different types of ECF imbalances(2)?

A

1) volume
2) osmolarity

49
Q

what are the types of osmolarity imbalances?

A

1) hypertonic (hypernatremia, water deficit)
2) hypotonic (hyponatremia, water excess)

50
Q

what is clinical dehydration?

A

ECV deficit and hypernatremia combined

51
Q

Acid-base balance & blood Gas Interpretation You tube video

A

https://www.youtube.com/watch?v=kh62SRovgrI

52
Q

what are ABGs measure?

A

1) paCO2 (partial pressure of carbon dioxide)
2) HCO3 (concentration of the base bicarbonate)
3) PaO2 (partial pressure of oxygen)
4) SaO2 (oxygen saturation)
5) pH (acid/base)

53
Q

describe PaCO2

A

partial pressure of carbon dioxide - a measure of how well the lungs are excreting CO2 produced by the cells

54
Q

describe HCO3

A

bicarbonate - a measure of how well the kidneys are excreting metabolic acids

55
Q

describe PaO2

A

partial pressure of oxygen - a measure of how well gas exchange is occurring the the alveoli

56
Q

describe SaO2

A

oxygen saturation - percentage of hemoglobin that is carrying as much oxygen as possible

57
Q

describe what deviations in normal PaCO2 readings mean

A

increased levels - indicates CO2 accumulation in the blood (more carbonic acid) caused by hypoventilation

decreased levels - indicate excessive CO2 excretion (less carbonic acid) through hyperventilation

58
Q

describe what deviations in normal HCO3 readings mean

A

increased levels - indicates blood has too few metabolic acids

decreased levels - indicates that the blood has too many metabolic acids

59
Q

describe what deviations in PaO2 readings mean

A

values below normal - indicates poor oxygenation of the blood

60
Q

what is SaO2 influenced by?

A

pH, PaCO2, and body temperature

61
Q

what is base excess?

A

observed buffering capacity minus the normal buffering capacity. its a measure of how well the blood buffers are managing metabolic acids

62
Q

what are normal PaCO2 lab values?

A

35-45 mmHg

63
Q

what are normal HCO3 lab values?

A

21-28 mEq/L

64
Q

what are normal PaO2 lab values?

A

80-100 mmHg

65
Q

what are normal SaO2 lab values?

A

95-100%

66
Q

what are normal base excess lab values?

A

-2 - +2 mEq/L

67
Q

describe what deviations in normal base excess readings mean

A

values below -2 mEq/L - indicate excessive metabolic acids

values above +2 mEq/L - indicate excessive amounts of bicarbonate (acid production)

68
Q

What’s is normal blood pH

A

7.35 - 7.45

Values below 7.35 indicate abnormally acid; above 7.45 they indicate abnormally alkaline.

69
Q

what is respiratory acidosis?

A

the lungs are unable to excrete enough CO2

70
Q

what is respiratory alkalosis?

A

the lungs excrete too much carbonic acid

71
Q

what is metabolic acidosis?

A

occurs from an increase of metabolic acid or a decrease in base

72
Q

what is metabolic alkalosis?

A

occurs from a direct increase of base (HCO3-) or a decrease in metabolic acid

73
Q

what are some things that cause respiratory acidosis(3)?

A

1) COPD
2) respiratory failure
3) drug overdose

74
Q

what are some things that cause respiratory alkalosis(4)?

A

1) hypoxemia
2) acute pain
3) anxiety
4) sobbing

75
Q

what are some things that cause metabolic acidosis(3)?

A

1) ketoacidosis
2) circulatory shock
3) end stage renal disease

76
Q

what are some things that cause metabolic alkalosis(3)?

A

1) excessive sodium bicarbonate
2) excessive vomiting
3) hypokalemia

77
Q

infants and young children are at risk for which fluid, electrolyte, and acid-base imbalances and why?

A

ECV deficit and hypernatremia because body water loss is proportionally greater per kg of weight than older children and adults

78
Q

An infant’s proportion of total body water (________% total body weight) is greater than that of children or adults.

A

70% to 80%

79
Q

what is involved with a nursing history related to fluid, electrolyte, and acid-base balance?

A

age - very young and old at risk
environment - excessively hot?
dietary intake - fluids, salts, foods rich in potassium, calcium, and magnesium
lifestyle - alcohol intake history
medications - OTC, Herbals, Prescriptions

80
Q

what age group frequently responds to illnesses with fevers of higher temps and longer duration?

A

children 2-12YO

81
Q

what kind of water loss does fever increase the rate of?

A

insensible water loss

82
Q

describe adolescent fluid balance

A

1) increased metabolism and increased water production due to rapid growth changes

2) fluctuations in fluid balance greater in adolescent girls due to hormonal changes associated with the menstrual cycle

83
Q

what can excessive sweating lead to?

A

without replacement of salt and water it can lead to:
1) EVC deficit
2) hypernatremia
3) clinical dehydration

84
Q

starvation diets and those with high fat and no carbs can lead to…

A

metabolic acidosis

85
Q

what can chronic alcohol consumption do to your electrolytes?

A

it can cause hypomagnesemia due to excessive renal magnesium excretion

86
Q

what items are looked at in medical history related to fluid, electrolyte, and acid-base balance(4)?

A

1) recent surgery (physiological stress)
2) GI output
3) acute illness or trauma
4) chronic illness

87
Q

what type of acute illness can be related to fluid, electrolyte, and acid-base balance(4)?

A

1) respiratory disorders
2) burns
3) trauma
4) GI issues
5) acute oliguric renal disease

88
Q

what kinds of chronic illness can be related to fluid, electrolyte, and acid-base balance?

A

1) cancer
2) heart failure
3) oliguric renal disease

89
Q

what can happen to a patient’s ECV between the second to fifth postop day?

A

increased aldosterone, glucocorticoids, and ADH can cause increased ECV

90
Q

head injuries typically alters ADH secretion. what does that do to someone?

A

scenario #1 - can cause diabetes insipidus (ADH deficit) which causes excessive dilute urine output which leads to hypernatremia

scenario #2 - can cause excessive release of ADH which causes retention of of urine and hyponatremia

91
Q

what occurs to a patient’s fluid and electrolyte balance when they experience hemorrhage(2)?

A
  • ECV deficit and blood loss
  • severe trauma such as crush injuries can cause hyperkalemia due to cell destruction causing the release of K+ into the blood
92
Q

what can cancer do to fluid and electrolyte balance(3)?

A

1) hypercalcemia

2) metabolic and endocrine abnormalities

3) at risk for fluid and electrolyte imbalances due to side effects of chemotherapy, biological response modifiers, or radiation

93
Q

what happens to fluid and electrolyte balance in chronic heart failure?

A

1) diminished CO activates RAAS
2) aldosterone action on the kidneys causes excessive ECV and hypokalemia

3) diuretics used to treat HF increases risk of hypokalemia

94
Q

what is oliguria?

A

reduced unrination

95
Q

what does chronic nephritis do to urination?

A

causes sudden onset of oliguria

96
Q

what does chronic kidney disease do to urination?

A

leads to chronic oliguria

97
Q

what does oliguric renal disease(5 S/Sx)?

A

prevents normal excretion of fluid, electrolytes, and metabolic acids, resulting in:
1) excess ECV
2) hyperkalemia
3) hypermagnesemia
4) hyperphosphatemia
5) metabolic acidosis

98
Q

each kg (2.2 lb) lost or gained overnight is equal to how much fluid?

A

1L of fluid retained or lost

99
Q

intake includes:

A

all liquids eaten, drunk, received through IV

100
Q

output includes:

A

urine, diarrhea, vomit, gastric suction, wound drainage

101
Q

how should you weight a patient when assessing for fluid retention or loss?

A

use same scale every day at the same time (preferably in morning) after pt voids

102
Q

A senior student nurse delegates the task of intake and output to a new nursing assistant. The student will verify that the nursing assistant understands the task of I&O when the nursing assistant states,
A. “I will record the amount of all voided urine.”
B. “I will not count liquid stools as output.”
C. “I will not record a café mocha as intake.”
D. “I will notate perspiration and record it as a small or large amount.”

A

A

103
Q

can I&O be delegated to NAPs?

A

after they are stable, yes

104
Q

what are health promotion activities associated with fluid and electrolyte balance?

A
  • Fluid replacement education
  • Teach patients with chronic conditions about risk factors and signs and symptoms of imbalances.
105
Q

what are some interventions related to electrolyte imbalances?

A

1) support prescribed medical therapies
2) aim to reverse existing acid-base imbalance
3) provide patient safety

106
Q

what are interventions related to acid-base imbalances

A

regular arterial blood gas analysis

107
Q

what are some restorative care implementations related to fluid and electrolyte balance(3)?

A

1) Home IV therapy
2) Nutrition support
3) medication safety

108
Q
A
109
Q
A

N212 Final (4 decks)

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