Nx 102 Fluid, Electrolyte, and Acid-Base Balance Flashcards
1
Q
Water makes up what percent of total adult body weight?
A
60%
2
Q
Functions of water
A
- transport nutrients and wastes
- transport hormones, enzymes, and all blood cells
- facilitate cellular metabolism/functioning
- acts as solvent for electrolytes and nonelectrolytes
- helps maintain body temp
- helps in digestion and elimination
- acts as a tissue lubricant
3
Q
2 body compartments for fluids
A
Intracellular: 70%
Extracellular:interstial, intravascular, and transcellular = 30%
4
Q
Older people have more/less water than infants
A
older people have lower water content
5
Q
fat cell contain a lot/little water
A
fat cells contain little water
-this is why older people have less water than infants, they have more fat
6
Q
women have more/less water than men
A
women typically have less water bc of higher fat content
7
Q
infants dehydrate more/less easily than older people
A
More easily - they have higher water content therefore it is easier to upset their balance
8
Q
lean people have more/less water than obese people
A
More water - lean muscle has more water content than fat cells
9
Q
Most common electrolytes
A
Na, K,. Ca, Mg, Cl, PO4, Bicarb
10
Q
Nonelectrolytes
A
Required for proper functioning but only found in trace amounts - i.e. urea and glucose
Do NOT dissociate into ions
11
Q
solvent
A
the liquid portion of a solution
water is the body’s major solvent
12
Q
solute
A
substances dissolved in a solution - electrolytes and nonelectrolytes
13
Q
electrolytes are measured in
A
mEq/L
-a measure of an electrolytes chemical activity
14
Q
1 mEq =
A
the chemical activity of 1 mg H
15
Q
in homeostasis, total cations should equal….
A
total anions
16
Q
fluid movement is
A
constantly in motion
method by which nutrients, wastes, and other substances are transported throughout the body
17
Q
cell membranes are permeable to…
A
water and fluids
18
Q
cell membranes are semipermeable to
A
some solutes
19
Q
fluids move between compartments by (2)
A
filtration and osmosis
20
Q
solutes move between compartments by (2)
A
diffusion and active transport
21
Q
osmosis
A
-water moves from areas of lower solute conc and more water, to areas of higher solute conc and less water (stops when both sides are equal)
22
Q
the pulling power of a solution is its…
A
osmolarity - the greater the number of solute particles the higher that solutions osmolarity
23
Q
the greater a solutions osmolarity the greater the _____ ______ it exerts on surrounding solutions
A
osmotic pressure
24
Q
isotonic
A
a solution with osmolarity = to plasma (275 - 295 mOsm/L)
25
hypertonic
greater osmolarity than plasma (>295)
26
hypotonic
lower osmolarity than plasma (<275)
27
diffusion
movement of particles from areas of high conc to lower, due to random particle motion
doesnt require energy
also called passive transport
28
active transport
movement of solutes from areas of low con to higher
requires energy (ATP)
amino acids, glucose, Na, K, Cl, H, PO4, and Ca all require active transport
29
filtration
movement of fluid from high pressure to low
30
hydrostatic pressure
the driving force behind filtration; the force of a fluid against the walls of its container
31
Under normal conditions, hydrostatic pressure is greater/less than plasma colloid pressure at arterial end
greater than (fluids move out of capillaries)
32
at venous end, hydrostatic pressure is greater/less than plasma colloid pressure
less than (fluid moves back into capillaries)
33
filtration pressure
the difference between colloid osmotic pressure and blood hydrostatic pressure
34
colloid osmotic pressure
also known as oncotic pressure; the osmotic pressure exerted by albumin as fluid moves out of the capillaries - eventually it becomes concentrated enough that it overpowers hydrostatic pressure and fluid move back into capillaries
35
desired fluid intake and output
1500-3500 mL/day
36
average fluid I
2600 mL/day
- 1300 from fluids
- 1000 from food
- 300 from metabolism
37
urine output should be roughly equal to...
fluid intake
38
water gained from food and metabolism is roughly balanced by...
that lost through feces, skin, and respirations
39
thirst control center
hypothalamus
40
average fluid O
2600 mL/day
- 1500 urine
- 200 feces
- 600 skin
- 300 lungs
41
kidneys role in homeostasis
filters 180 L plasma and make 1-2 L urine per day, retains or excretes water and electrolytes
42
cardiovascular role in homeostasis
pumps water and nutrients, creates hydrostatic pressure
43
lungs role in homeostasis
regulates O2 and CO2 levels in blood
44
Adrenal glands role in homeostasis
aldosterone helps body conserve Na, Cl, and water and excrete potassium
45
what 2 things follow Na
Cl and water
46
What is the relationship between Na and K
they are reciprocal - gain one and lose the other and vice versa
47
Thyroid glands role in homeostasis
thyroxine increases blood flow leading to increased renal circulation (and increased urine output)
48
Parathyroid glands role in homeostasis
PTH draws Ca into the blood (bone reabsorption) and moves phosphorus
49
Pituitary glands role in homeostasis
ADH retains Na and water, excretes potassium
50
Osmoreceptors
neurons sensitive to changes in ECF - inhibits or stimulates secretion of ADH
51
fluid imbalances occur when...
volume or distribution of water or electrolytes are altered
52
fluid volume deficit/hypovolemia/isotonic fluid loss
loss of water and electrolytes in same proportion as ECF
53
Causes of FVD
loss of body fluids, esp when intake is low
54
Sx of FVD
weight loss, thready pulse, decreased BP, sunken eyes, few tears and salivation, poor skin turgor, pale cool skin, dry cracked lips, decreased urine output
55
FVD: weight loss of ___% in adults and ___% in infants can occur rapidly
5%, 10%
56
pronounced fluid deficit
5% weight loss
57
severe fluid deficit
8% or more weight loss
58
life threatening fluid deficit
+ 15% weight loss
59
third space shift defined
movement of fluids to peritoneal, pleural, pericardial, joints, bowel, interstitial spaces
60
characteristics of 3rd space shift
trapped, unavailable fluids
no decrease in body weight
caused by decrease in colloid osmotic pressure or increased capillary permeability (burns, bowel obstruction, hypoalbuminemia)
61
Fluid volume excess/hypervolemia defined
excessive retention of water and Na in near equal proportions
62
FVE is often caused by
malfunctioning kidneys and heart failure
63
FVE may accumulate in
intravascular or interstitial spaces
64
Sx of FVE
weight gain, bounding pulse, >BP, periorbital edema, > resps, crackles, ronchi, edema, jugular vein distention
65
edema
accumulation of fluid in interstitial space; most observable around eyes, fingers, ankles, and sacrum; may result in 5% weight gain
66
Major electrolytes (as opposed to most common)
Na, K, Cl, Ca, Mg
67
Na
chief electrolyte in ECF
moves easily between interstitial and intravascular spaces
moves by active transport
68
functions of Na
```
controls/regulates fluid volume
maintains water balance
primary regulator of ECF volume
generation and transmission of nerve impulses
Na/K pump
```
69
normal Na levels
135 - 145 mEq/L
70
hyponatremia
<135
loss of sodium or gain of water
when ECF NA drops, fluid moves into ICF (more concentrated)
cells swell
71
causes of hyponatremia
IV overload, fluid overload, hyperglycemia and SIADH (dilution of Na), diuretics, GI drainage, diarrhea, vomiting, excessive sweating
72
Sx of hyponatremia
Confusion, Nausea, Lethargy, Vomiting, Seizures, Hyperactive Bowel Sounds
(CaN LoVe Save Humanity)
73
Labs of hyponatremia
74
hypernatremia
surplus of Na in ECF caused by excess water loss or Na excess
>145
cells crenate (especially nerves)
75
Causes of hypernatremia
```
MODEL
M: meds, meals
O: osmotic diuretics
D: diabetes insipidus
E: excessive water loss
L: low fluid intake
```
76
Sx of hypernatremia
thirst, irritability, dry mucous membranes, weakness, coma (TIDWC)
FRIED - fever, restless, increased fluid retention, edema, decreased urine output and dry mouth
77
labs of hypernatremia
>serum Na
| urine specific gravity and osmolarity
78
Potassium (K)
major cation of ICF
| reciprocal with Na
79
functions of K
regulates enzyme activity and ICF volume
vital to electrical impulse transmission (heart, skeletal, nerve, lung, GI)
assists in acid-base balance by exchanging w/ H
80
Normal K values
3.5 - 5 mEq/L
81
hypokalemia
most dangerous electrolyte imbalance
<3.5
when ECF K falls, K moves out of cell to balance, cell retains Na and H to maintain isotonicity
82
causes of hypokalemia
GI losses, Meds (diuretics, aminoglycosides), metabolic alkalosis, GI suction, hyperaldosteronism
poor dietary intake
severe diaphoresis
83
dietary sources of K
bananas, potatoes w skin, plain yogurt
84
Sx of hypokalemia
fatigue, nausea, vomiting, dyshythmias (flat T), muscle weakness, leg cramps, decreased reflexes
85
hyperkalemia
excess of K in ECF
>5
rare but hazardous
affects nerve conduction and muscle contractility
86
causes of hyperkalemia
```
MACHINE
M: meds (hyperK is usually tx related)
A: acidosis & addisons
C: cell destruction
H: hypoaldosteronism, hemolysis
I: intake (too much salt substitute)
N: nephrons (renal failure)
E: excretion (decreased)
```
87
Sx of hyperkalemia
muscle weakness, oliguria, cardiac irregularities
88
hyperkalwmia is MURDER
```
M:muscle weakness
U: urine (oliguria)
R: respiratory distress
D: decreased cardiac contractility (irregularities)
E: ECG changes
R: reflexes (hyperreflexia, areflexia)
```
89
Calcium Ca
most abundant electrolyte in the body
99% found in bones and teeth
close link between calcium and phosphorous
controlled by PTH, Vit D, and calcitonin
90
Normal Ca levels
9 to 10.5
91
functions of Ca
nerve impulse transmission and blood clotting
muscle contractions
B12 absorption and usage
catalyst for many chemical activities
strong bones and teeth
determines thickness and strength of cell membranes
92
hypocalcemia
< 9
93
causes of hypocalcemia
low intake, impaired absorption, increased phosphorus (antacids), calcium loss (diuretics), removal of the parathyroid, renal failure hypoparathyroidism, dilantin
94
dietary sources of Ca
spinach, dairy, sardines
95
Sx of hypocalcemia
```
CATS
C:convulsions, confusion, paresthesias
A: arryhythmias
T: tetany, hyperreflexia
S: seizures, spasms
also + Chvostek's and Trousseaus
```
96
hypercalcemia
>10.5
>12 = coma
>13 = possibly fatal
Emergency situation - can lead to cardiac arrest
97
causes of hypercalcemia
* cancer
* hyperparathyroidism
* increased intake of Vit D & A
* bone loss related to immobility
98
Sx of hypercalcemia
muscle weakness, lethargy, dysrhythmias, kidney stones,
99
Magnesium Mg
mostly found in heart, bone, nerves, and muscles
| second most important cation in ICF
100
Normal Mg levels
1.8 - 3 mEq/L
101
function of Mg
metabolism of protein and carbs
enzymatic reactions
*necessary for DNA and protein synthesis, DNA and RNA transcription, RNA translation
maintains normal potassium levels
helps maintain electrical activity in nervous and muscle membranes
102
hypomagnesemia
*DTR, resp paralysis
103
causes of hypomagnesemia
malabsorption disorders (inflammatory bowel disease, bowel resection, gastric bypass)
alcoholics in withdrawal
clients receiving insulin, diuretics, aminoglycosides (neprhotoxic)
104
Sx of hypomagnesemia
leg and foot cramps, twitching, dysrhythmias, difficulty swallowing, alterations in mood and LOC (level of consciousness), >DTR
105
hypermagnesemia
> 3
| occurs in end stage renal failure, in pts w/ DM or leukemia, or excessive Mg intake (antacids or laxatives w/ magnesium)
106
Sx of hypermagnesemia
hypotension,
107
Phosphate PO4
major anion in ICF
| buffers both ECF and ICF
108
normal PO4 levels
2.5 - 4.5
109
functions of PO4
helps maintain acid-base balance
| important for cell division and transmission of hereditary traits
110
hypophosphatemia
<2.5
may indicate phosphorous deficiency (lower serum concentrations but normal total-body stores)
-occurs often w/ hyperventilation
111
causes of hypophosphatemia
alcoholism, refeeding pts after starvation, chronic diarrhea, vitamin D deficiency
112
dietary sources of PO4
fish, meat, whole grains, buttermilk, swiss cheese
113
Sx of hypophosphatemia
neurologic:acute: confusion, anxiety
neurologic:chronic: lethargy
decreased strength - difficulty speaking
decreased myocardial contractility
muscle weakness
114
hyperphosphatemia
>4.5
| reciprocal relationship to calcium - as P goes up Ca goes down
115
causes of hyperphophatemia
kidney failure, chemotherapy, large intake of milk (vit D), excessive use of laxatives or enemas containing phosphate
116
Sx of hyperphosphatemia
short term: tingling in fingertips and around mouth, muscle spasms, seizures
long term - calcium deposits
inc PO4 = dec Ca = + chvosteks and trousseaus
117
chloride Cl
chief anion in ECF
found in blood, lymph, and interstitial fluid
attracted to sodium - if Na drops so to will Cl
118
normal Cl levels
98 - 106
119
functions of Cl
acts w/ Na to maintain blood osmotic pressure
acid-base balance
buffers exhange of O2 and CO2 in RBCs
essential for HCL production in stomach
120
hypochloremia
<98
121
causes of hypochloremia
hyponatremia or increased bicarb
vomiting, GI suctioning, prolonged diarrhea, excessive administration of bicarbs, excessive sweating, fever, burns, or basically anything that can cause hyponatremia
122
dietary sources of Cl
table salt, tomatoes, olives, fruits & veggies
123
Sx of hypochloremia
mirror those of hyponatremia
| agitation, irritability, weakness, hypeexcitability of muscles, dysrhythmias, seizures, coma
124
hyperchloremia
>106
may occure with bicarb deficiency and dehydration (increased Na levels)
Cl levels controlled by kidneys
125
causes of hyperchloremia
dehydration, high levels of blood sodium, kidney failure, androgens, estrogens, diabetes insipidus
126
1 L of fluid = how much body weight?
2.2. lbs
127
Sx of hyperchloremia
tachycardia, lethargy, weakness, cognitive changes
128
acid
releases H ions
129
base
accepts H ions
130
pH is the measure of what?
hydrogen ion concentration
-a negative algorithm - as H increases, pH drops
1-14
131
pH of gastric juices
1 - 1.3
132
pH of plasma
7.35 - 7.45
133
pH of pancreatic secretions
10
134
acidosis
excessive H ions or loss of base (bicarb); pH drops below 7.35
135
alkalosis
lack of H ions or excessive base (bicarb); pH beyond 7.45
136
carbonic acid - sodium bicarb buffer system
buffers 90% of H of ECF
most important buffer system
lungs regulate carbonic acid
kidneys regulate bicarb
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