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NURS 212 final > Lecture 13 (Fluid, Electrolytes, and Acid-Base Balance) > Flashcards

Lecture 13 (Fluid, Electrolytes, and Acid-Base Balance) Flashcards

1
Q

fluid, electrolyte, and acid-base balance within the body maintain the health and function of which body system?

A

all of them

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2
Q

why does the characteristics of body fluids influence body system function why?

A

because of their effects on cell function

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3
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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4
Q

how much total body water is in intracellular fluid in adults?

A

about 2/3

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5
Q

how much total body water is in extracellular fluid in adults?

A

about 1/3

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6
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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7
Q

what is minor division of extracellular fluid?

A

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

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8
Q

fluid that contains a large number of dissolved particles is (BLANK) than the same fluid that contains only a few particles

A

more concentrated

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9
Q

what is the osmolarity of a fluid?

A

a measure of the number of particles per kg of water

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10
Q

some particles can cross easily through cell membranes. can sodium?

A

it can but not easily

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11
Q

what sets the tonicity of a fluid?

A

presence of particles that can not cross easily across cell membranes

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12
Q

what is tonicity?

A

the effective concentration of a fluid

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13
Q

what is an isotonic fluid?

A

a fluid with the same tonicity as blood
e.g. blood

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14
Q

what is a hypertonic solution?

A

a solution that is more concentrated than blood

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15
Q

what is a hypotonic solution?

A

a solution that is more dilute than blood

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16
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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17
Q

what is fluid intake?

A

drinking and eating

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18
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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19
Q

how does fluid distribution between intracellular and extracellular compartments occur?

A

by osmosis

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20
Q

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

A

by filtration

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21
Q

what are examples of fluid output?

A

urine and sweat

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22
Q

to maintain homeostasis, intake and output have to be…

A

equal to each other

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23
Q

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

A

2300mL for healthy adults

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24
Q

describe thirst(2)

A

1) regulates fluid intake when plasma osmolarity increases
2) thirst-control mechanism is located in the hypothalamus

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25
Q

what are osmoreceptors?

A

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

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26
Q

what is angiotensin 2’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

A

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37
Q

what are normal sodium (Na+) lab values?

A

135-145mEq/L

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38
Q

what are normal potassium (K+) lab values?

A

3.5-5.0 mEq/L

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39
Q

what are normal chloride (Cl-) lab values?

A

95-105 mEq/L

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40
Q

what are normal total CO2 lab values?

A

22-30 mEq/L

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41
Q

what are normal bicarbonate (HCO3) lab values?

A

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

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42
Q

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

A

8.5-10.5 mg/dL

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43
Q

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

A

4.5-5.6 mg/d

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44
Q

what are normal magnesium (Mg2+) lab values?

A

1.5-2.5 mEq/L

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45
Q

what are normal phosphate lab values?

A

2.5-4.5 mEq/L

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46
Q

what are normal anion gap lab values?

A

6+/-4 mEq/L

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47
Q

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

A

1) volume
2) osmolarity

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48
Q

what are the types of osmolarity imbalances?

A

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

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49
Q

what is clinical dehydration?

A

ECV deficit and hypernatremia combined

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50
Q

what do 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)

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51
Q

describe PaCO2

A

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

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52
Q

describe HCO3

A

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

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53
Q

describe PaO2

A

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

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54
Q

describe SaO2

A

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

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55
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

56
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

57
Q

describe what deviations in PaO2 readings mean

A

values below normal - indicates poor oxygenation of the blood

58
Q

what is SaO2 influenced by?

A

Ph, PaCO2, and body temperature

59
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

60
Q

what are normal PaCO2 lab values?

A

35-45 mmHg

61
Q

what are normal HCO3 lab values?

A

21-28 mEq/L

62
Q

what are normal PaO2 lab values?

A

80-100 mmHg

63
Q

what are normal SaO2 lab values?

A

95-100%

64
Q

what are normal base excess lab values?

A

-2 - +2 mEq/L

65
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

66
Q

what is respiratory acidosis?

A

the lungs are unable to excrete enough CO2

67
Q

what is respiratory alkalosis?

A

the lungs excrete too much carbonic acid

68
Q

what is metabolic acidosis?

A

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

69
Q

How does metabolic alkalosis occur?

A

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

70
Q

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

A

1) COPD
2) respiratory failure
3) drug overdose

71
Q

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

A

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

72
Q

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

A

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

73
Q

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

A

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

74
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

75
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

76
Q

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

A

children 2-12YO

77
Q

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

A

insensible water loss

78
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

79
Q

what can excessive sweating lead to?

A

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

80
Q

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

A

metabolic acidosis

81
Q

what can chronic alcohol consumption do to your electrolytes?

A

it can cause hypomagnesemia due to excessive renal magnesium excretion

82
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

83
Q

what type of acute illness can be related to fluid, electrolyte, and acid-base balance(5)?

A

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

84
Q

what kinds of chronic illness can be related to fluid, electrolyte, and acid-base balance(3)?

A

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

85
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

86
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

87
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
88
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

89
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

90
Q

what is oliguria?

A

reduced unrination

91
Q

what does chronic nephritis do to urination?

A

causes sudden onset of oliguria

92
Q

what does chronic kidney disease do to urination?

A

leads to chronic oliguria

93
Q

what does oliguric renal disease cause(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

94
Q

each kg lost or gained overnight is equal to how much fluid?

A

1L of fluid retained or lost

95
Q

intake includes:

A

all liquids eaten, drunk, received through IV

96
Q

output includes:

A

urine, diarrhea, vomit, gastric suction, wound drainage

97
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

98
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

99
Q

can I&O be delegated to NAPs?

A

after they are stable, yes

100
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.
101
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

102
Q

what are interventions related to acid-base imbalances

A

regular arterial blood gas analysis

103
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

104
Q

what are crystalloid IV solutions?

A

IV solutions with solutes that are water soluble and easily pass through cell membranes and into body tissues

105
Q

what are three common isotonic IV solutions?

A

1) NS - 0.9% NaCl
2) LR - lactated ringers
3) D5W - 5% dextrose in water

106
Q

what is the only IV solution that is used when administering blood products?

A

NS

107
Q

what is the choice IV fluid for resuscitation ?

A

NS

108
Q

what does lactated ringer contain(4)?

A

1) sodium
2) potassium
3) calcium
4) chloride

109
Q

when are lactated ringers used?

A

1) good choice for resuscitation
2) beneficial for surgical and burn patients (replaces electrolytes)

110
Q

what IV solution has an electrolyte content most closely related to the body’s blood and serum makeup?

A

lactated ringers

111
Q

what is D5W?

A

5% dextrose in water
provides 170 calories per L but doesn’t replace electrolytes

112
Q

what are examples of hypotonic IV solutions?

A

1) 0.45% saline
2) D5W (after metabolism)

113
Q

what do hypotonic IV solutions do?

A

hydrates cells but may deplete fluid within the circulatory system

114
Q

what are hypotonic IV solutions used to treat(2)?

A

intracellular dehydration such as:
1) diabetic ketoacidosis
2) hypernatremia

115
Q

what are hypertonic IV solutions used as?

A

volume expanders

116
Q

what are hypertonic IV solutions used to treat?

A

patients with severe hyponatremia

117
Q

what are some examples of hypertonic IV solutions(3)?

A

1) D10W
2) D5NS
3) D5 1/2 saline

118
Q

what are the major ICF and ECF electrolytes?

A

ICF - potassium and magnesium
ECF - sodium and chloride

119
Q

electrolyte imbalances can occur due to(7):

A

1) vomiting
2) dehydration
3) surgery
4) trauma
5) burns
6) bleeding
7) liver or kidney problems

120
Q

electrolytes are regulated by(4):

A

1) endocrine system
2) vascular system
3) GI system
4) kidneys

121
Q

what is the basic function of magnesium?

A

muscle relaxation

122
Q

what occurs in hypermagnesemia(4)?

A

1) muscle relaxation and weakness
2) vasodilation/hypotension
3) respiratory arrest
4) cardiac arrest

123
Q

what are four S/Sx that occur in hypomagnesemia(4)?

A

1) muscle excitation and tremors
2) neuromuscular irritability
3) tachycardia
4) seizures

124
Q

what is potassium’s function in the body?

A

intracellular excitation - critical for heart function and the conduction of nerve impulses and skeletal muscle activity

125
Q

what are four S/Sx that occur in hyperkalemia(4)?

A

1) tall peaked T waves
2) muscle twitching/cramps (early)
3) muscle weakness/paralysis (late)
4) cardiac dysrhythmias

126
Q

what are five S/Sx that occur in hypokalemia?

A

1) muscle weakness/spasms/leg cramping
2) numbness/tingling
3) fatigue
4) heart palpitations
5) flattened T waves or U wave

127
Q

what are some possible causes of hyperkalemia(3)?

A

1) renal disease
2) salt substitutes
3) potassium sparring diuretics

128
Q

what are treatments for hyperkalemia(3)?

A

1) dialysis
2) medications
3) restricting potassium intake

129
Q

what foods is potassium found in(3)?

A

1) bananas
2) melons
3) raw spinach

130
Q

what are treatments for hypokalemia(4)?

A

1) increase intake
2) potassium sparring diuretics
3) IV fluids
4) supplements

131
Q

what symptoms occur in hypocalcemia?

A

pts w/ decreased albumin = low serum calcium without symptoms

pts w/ low ionized calcium = symptomatic

132
Q

what are three S/Sx that occur with hypercalcemia?

A

1) decreased muscle contraction
2) constipation
3) heart dysrhythmias

133
Q

what are three S/Sx that occur in hypocalcemia?

A

1) increased muscle contraction/spasms
2) tetany
3) heart dysrhythmias

134
Q

trousseau’s sign and chvostek’s sign are signs of what?

A

hypocalcemia

135
Q

what is the function of sodium in the body?

A

extracellular excitation - impacts fluid balance and functioning of muscles and the central nervous system

136
Q

what are five S/Sx that occur with hyponatremia?

A

1) headaches
2) confusion
3) seizures
4) muscle weakness
5) fatigue

137
Q

what are three S/Sx that occur with hypernatremia?

A

1) thirst
2) dry mucous membranes and skin
3) edema

NURS 212 final (7 decks)

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