TERM 3- MY NOTES FOUNDATIONS OF NURSING CH.22 "Fluids and Electrolytes " Flashcards by Scott Huggins

FLUIDS {WATER) _

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Fluids and Electrolytes

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Water has many functions. It provides an extracellular transportation route to deliver nutrients to the cells and carry waste products from the cells. Once inside the cells, it provides a medium in which chemical reactions, or metabolism, is able to occur.
A)true
B)false

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Water also acts as a lubricant for tissues
A)true
B)false

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Two other important functions of water are to aid in the maintenance of acid-base balance and to assist in heat regulation by evaporation.
A)true
B)false

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Water constitutes the largest percentage of body weight. This percentage depends on several factors and varies with each individual. First, age affects the amount of water in the body.
A)true
B)false

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A newborn’s body weight is comprised of 70% to 80% water. That percentage increases in a premature infant to as high as 90%. The infant begins to lose body fluid most rapidly in the first 6 months, and by 12 years the proportion approaches that of an adult.
A)true
B)false

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Another important influence on the amount of water in the body is the amount of fat in the individual. There is a correlation between water content and fat content; fat contains relatively little water.
A)true
B)false

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A woman has proportionately more body fat than a man, which means the woman has less body fluid than the man.
A)true
B)false

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The more obese an individual, the smaller the percenttage of body water.
A)true
B)false

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Both obese and older adults are at risk for complications of illness from dehydration or fluid shifts because they have less fluid reserve in their bodies .
A)true
B)false

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Infants are also at risk for dehydration. More than half of an infant’s fluid is extracellular (outside the cells) .
A)true
B)false

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Extracellular fluid is lost from the body more rapidly than intracellular (inside the cells) fluid
A)true
B)false

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Very young, very old, and obese patients are at a higher risk for developing a deficient fluid volume.
A)true
B)false

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A loss of 10% of body fluid is serious in an adult, and a 20% loss is fatal.
A)true
B)false

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In an infant those figures are even more significant. A loss of 5% is serious, 10% is very serious, and 15% is fatal.
A)true
B)false

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Life Span Considerations
Older Adults Dehydration
Older adults are at increased risk of dehydration because of
the following factors:

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Fat replaces lean muscle as aging progresses, leading to a decrease in total body fluid.
The aging kidney is less able to concentrate urine, so more fluid is lost.
Decreases in mobility and diminished sense of thirst often result in decreased fluid intake.
Incontinent older individuals sometimes restrict fluid intake to reduce the frequency of urination.
To compensate for changes in taste, older adults often oversalt their food, resulting in electrolyte and fluid imbalances.
Physiologic changes in the skin and mucous membranes make them less reliable indicators of dehydration.
Dehydration will sometimes first manifest as mild disorientation.

True

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Signs and symptoms of dehydration include thirst, dry mucous membranes, increased heart rate, decreased blood pressure, poor skin turgor, and flat neck veins.
Dehydration increases the risk of orthostatic hypotension.
Decreased fluid intake increases the likelihood of constipation.
Because the aging kidney is less efficient at excretion, giving intravenous (IV) infusions or supplements containing sodium or potassium increases the risk of electrolyte imbalance.
Monitor the complete blood count carefully to detect changes in the hematocrit as it relates to hemoglobin. Decreased plasma volume elevates the hematocrit, whereas the hemoglobin level remains constant.

True

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FlUID COMPARTMENTS

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The body has two primary fluid compartments: intracellular and extracellular
A)true
B)false

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The fluid compartments are -as follows:

Intracellular
Extracellular
a. Interstitial
b. Intravascular

True

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The intracellular fluid compartment is the larger of the two compartments, comprising 66% of the body’s fluid. It contains the fluid inside the billions of cells within the body.
A)true
B)false

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The extracellular compartment contains any fluid outside the cells (34%). This compartment is further divided into the interstitial and the intravascular fluid comparhnents.
A)true
B)false

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(Extracelluar compartment) Interstitial fluid is betvveen the cells, or in the tissues. It accounts for approximately 27% of the fluid in the patient's body. A)true B)false

Examples of interstitial fluid include lymph, cerebrospinal fluid, and gastrointestinal (GI) secretions. A)true B)false

(Extracelluar comparment) Intravascular fluid is the plasma within the vessels. The cells of the blood are considered solid particles. After the cells are removed, the liquid that remains is the plasma. It makes up the remaining 7% of fluid volume A)true B)false

The intracellular and extracellular compartments are separated by a semipermeable membrane. This membrane allows for a constant back-and-forth flow as nutrients are taken into the cell and waste products are carried out. A)true B)false

BODY FLUID DISTRIBUTION

Intracellular means Fluid within cells A)true B)false

Extracellular means Fluid outside cells A)true B)false

Intravascular means Fluid within blood vessels; examples plasma A)true B)false

Interstitial means Fluid in tissues (between cells or in body spaces); Examples: interstitial fluid, lymph, cerebrospinal fluid, intraocular fluid, gastrointestinal (GI) secretions, urine, perspiration, exudates A)true B)false

``` Interstitial fluid (27%of total fluid in the body / 11.2L fluid volume) A)true B)false ```

``` Intravascular fluid (plasma) (7% of total body fluid/2.8L fluid volume in the body) A)true B)false ```

``` Intracellular fluid (66% of total fluid in the body/42L of fluid volume in the body) A)true B)false ```

INTAKE AND OUTPUT

Fluid leaves the body through the kidneys, the lungs, the skin, and the GI tract. To maintain homeostasis, the normal daily loss must be met by the normal daily intake A)true B)false

Homeostasis is a relative constancy in the internal environment of the body, naturally maintained by adaptive responses that promote healthy survival. In order to maintain homeostasis, it is necessary that bodily fluids and electrolytes remain within the exact limits of normal A)true B)false

Daily water intake and output (I&0) is approximately 2500 mL A)true B)false

Water loss is replenished in two ways-first, by ingestion of liquids and food, and second, by metabolism, both of food and in body tissues. A)true B)false

Intake includes all fluids entering the body. Fluids are either liquids taken orally or those consumed in food, including foods that assume a liquid consistency at room temperature. A)true B)false

Additional intake includes tube feedings and parenteral intake such as intravenous (IV) fluids, blood components, and total parenteral nutrition (TPN). A)true B)false

Liquid output includes all fluids leaving the body, including those lost through perspiration and expiration. A)true B)false

Urine, diarrhea, vomitus, nasogastric suction, and chest tube drainage are examples of measurable outtput. A)true B)false

Drainage from surgical wounds and drainage collected in surgical receptacles such as the Jackson-Pratt, Davol, or Hemovac systems are also considered liquid output. A)true B)false

The determination of exact amounts of fluid loss and fluid replacement is not possible as part of nursing interventions, so you will use approximations. A)true B)false

Because it is possible to measure fluid I&O, the importance of accurate record keeping cannot be overemphasized when determining a patient's fluid needs A)true B)false

The kidneys play an extremely important role in fluid balance. If the kidneys are not functioning properly, the body has great difficulty with regulating fluid balance. A)true B)false

The nephrons are the functioning units of the kidney. A)true B)false

The nephrons filter blood at a rate of 125 mL/min, or about 180 L/ day. This is called the glomerular filtration rate and leads to an output of 1 to 2 L (1000 to 2000 mL) of urine per day. The nephrons reabsorb the remaining 178 L or more of fluid. A)true B)false

If the body loses even 1% to 2% of its fluid, the kidneys conserve fluid by reabsorbing more water from the renal filtrate, which results in a more concentrated urine. A)true B)false

It is necessary for the kidneys to excrete a minimum of 30 mL/ hr of urine (720 mL/ 24 hr) to eliminate waste products from the body. A)true B)false

The kidneys react to fluid excesses by excreting a more dilute urine; this rids the body of excess fluid and conserves electrolytes. A)true B)false

A simple and accurate method of determining water balance is by weighing the patient under exact conditions, for example, same time of day, same amount of bed clothing, same type of gown, and same attached equipment, such as electrodes. Empty all drainage bags before weighing the patient A)true B)false

Because 1 L of fluid equals 2.2 pounds (1 kg), a weight change .of 2.2 pounds will reflect a loss or gain of 1 L of body fluid A)true B)false

To determine a patient's hydration or dehydration levels, performance of urine specific measurements is appropriate. A urine specific gravity of more than 1.030 indicates concentrated urine (seen in conditions of dehydration), whereas a measurement of less than 1.010 indicates dilute urine (seen in conditions of hydration) A)true B)false

Specific Gravity-measures hydration of a patient A)true B)false

A urine specific gravity of more than 1.030 indicates concentrated urine (seen in conditions of dehydration), whereas a measurement of less than 1.010 indicates dilute urine (seen in conditions of hydration) A)true B)false

Normal Fluid Intake and Output in an Adult Eating 2500 Calories per Day (Approximate Figures)

Water in food Gain:1000 Route:Skin Loss:500

True

Water from oxidation Gain:300 Route:Lungs Loss:350

True

Water as liquid Gain:1200 Route:Feces Loss:150

True

Water as liquid Gain:1200 Route:Kidney Loss:1500

True

Total 2500mL A)true B)false

``` Measuring Intake and Output {1&0) Nursing Action (Rationale) ```

Measure and record output in Foley drainage system, diarrhea stools, nasogastric suction, emesis, ileostomy, and output in surgical wound receptacles such as Davol, Jackson-Pratt, and Hemovac. Measure and record output from chest tube drainage in water-sealed container by marking with felt-tip pen. (Ensures accurate mea. surement and proper disposal of output.) A)true B)false

MOVEMENT OF FLUID AND ELECTROLYTES

Substances entering the body begin their journey in the extracellular fluid. However, to carry out their functions, they have to cross the semipermeable membrane surrounding each body cell and enter the cell. The fat and protein molecules that make up the membrane are arranged so that some substances can enter the cells and others cannot. A)true B)false

A number of processes allow this mass movement of substances into and out of cells. These transport processes are classified under two general headings: 1. Passive transport processes 2. Active transport processes

True

active transport processes necessitate the expenditure of energy by the cell, and passive transport processes do not. A)true B)false

The energy required for active transport processes is obtained from an important chemical substance called adenosine triphosphate (ATP). ATP is produced in the mitochondria from nutrients and is capable of releasing energy that in turn enables the cell to work. A)true B)false

For active transport processes to occur, the breakdown of ATP and the use of the related energy are required. A)true B)false

The details of active and passive transport of substances across cell membranes is much easier to understand if you keep in mind the following two key facts:

1) in passive transport (the movement of small molecules by diffusion across a cell membrane) processes, no cellular energy is required to move substances from a high concentration to a low concentration; A)true B)false

(2) in active transport processes, cellular energy is required to move substances from a low concentration to a high concentration. A)true B)false

PASSIVE TRANSPORT

The primary passive transport processes that move substances through the cell membranes include the following: • Diffusion • Osmosis • Filtration

True

DIFFUSION

Water is able to move freely from one compartment to another by diffusion. Diffusion is the movement of particles in all directions through a solution or gas. A)true B)false

ln diffusion, solutes move from an area of higher concentration to an area of lower concentration, which eventually results in an equal distribution of solutes within the two areas. A)true B)false

Diffusion occurs, for example, when ink is dropped into a glass of water. The ink will disperse in all directions until it is evenly distributed throughout the fluid. When diffusion occurs in the body, the molecules have the same action as the ink spreading through the water. A)true B)false

With each inhalation by the patient, oxygen enters the lungs and moves into the intravascular compartment and into the cells by diffusion. Gases, including oxygen, nitrogen, and carrbon dioxide, leave the capillaries and diffuse into the cell membrane and become distributed throughout the body . A)true B)false

OSMOSIS

Osmosis is the movement of water from an area of lower concentration to an area of higher concentration. Osmosis equalizes the concentration of ions or molecules on each side of the membrane. The flow of water will continue until the number of ions or molecules on both sides of the membrane is equal. A)true B)false

What happens when you boil a hot dog in water is an example of osmosis. The water passes through the hot dog skin, which is a semipermeable membrane, in an attempt to equalize the number of molecules on both sides of the membrane. Finally, when the hot dog is able to hold no more water, the skin, or semipermeable membrane, ruptures. A)true B)false

OSMOSIS

The red blood cells offer an example of the osmotic process in the body. If extracellular fluid is more concentrated than intracellular fluid, the fluid from inside the cell moves out to the extracellular fluid, causing the red blood cell to shrink. If the fluid among the compartments is in equilibrium, fluid will enter and leave the cell at the same rate and the cell size will not change. Another example is when extracellular fluid is less concentrated than the fluid in the red blood cells. Fluid moves into the cell, causing it to enlarge. The process will sometimes continue until the cell ruptures

Osmosis | True

Solutions are classified in the body as hypertonic, isotonic, or hypotonic according to the electrolyte concentration. The concentration of the solution will cause the cells of the body to react the same way the red blood cell does. A)true B)false

Hypertonic (a solution of higher osmotic pressure) solutions pull fluid from the cells; which makes them shrink A)true B)false

isotonic (a solution of same osmotic pressure) solutions expand the body's fluid volume without causing a fluid shift from one compartment to another; equal A)true B)false

A osmosis

hypotonic (a solution of lower osmotic pressure) solutions move into the cells, causing them to enlarge. Each of these actions occurs through the mechanism of osmosis. A)true B)false

FILTRATION

Filtration is the transfer of water and dissolved substances from an area of higher pressure to an area of lower pressure. An example of filtration occurs at the capillary level of the circulation. A)true B)false

A force behind filtration is called hydrostatic pressure, which is the force of fluid pressing outward on a vessel wall. The pumping action of the heart is responsible for the amount of force, the hydrostatic pressure, that causes water and electrolytes to move from the capillaries to the interstitial fluid. A)true B)false

Passive Transport Processes

Diffusion Movement of particles through a membrane from an area of high concentration to an area of low concentration-that is, down the concentration gradient EXAMPLE; Movement of carbon dioxide out of all cells; movement of sodium ions into nerve cells as they conduct an impulse

True

Osmosis Diffusion of water through a selectively permeable membrane in the presence of at least one impermeable solute EXAMPLE; Diffusion of water molecules into and out of cells to correct imbalances in water concentration

True

Filtration Movement of water and small solute particles, but not larger particles, through a filtration membrane; movement occurs from area of high pressure to area of low pressure EXAMPLE; In the kidney, water and small solutes move from blood vessels but blood proteins and blood cells do not, thus beginning the formation of urine

True

ACTIVE TRANSPORT

Active transport requires energy; it is a force that moves molecules into cells without regard for their positive or negative charge and against concentration factors that will prevent entry into the cell via diffusion. A)true B)false

Active transport moves fluid and electrolytes from an area of lower concentration to an area of higher concentration. A)true B)false

Substances actively transported through the cell membrane include sodium, potassium, calcium, iron, hydrogen, and amino acids. A)true B)false

The movement of glucose into the cells occurs through the process of active transport. Insulin provides the transport for glucose to leave the intravascular compartment and move into the cells, where the glucose can then be used for energy. A)true B)false

ELECTROLYTES

As water moves through the compartments of the body, it contains substances that are sometimes called minerals or salts but which are technically known as electrolytes A)true B)false

Electrolytes are substances that when in solution, separate (or dissociate) into electrically charged particles. A)true B)false

Electrolytes develop tiny electrical charges when they dissolve in water and break up into particles known as ions. A)true B)false

Ions develop either a positive or negative electrical charge. Ions with a positive charge are caLled cations. Ions with a negative charge . are called anions. A)true B)false

Ions with a positive charge are caLled cations. A)true B)false

Ions with a negative charge . are called anions. A)true B)false

``` The following are examples of cations: • Sodium (Na+) • Potassium (K+) • Calcium (Ca++) • Magnesium (Mg++) ```

True

``` The foLlowing are examples of anions: • Chloride (Cl-) - • Bicarbonate (HC03 - ) - • Sulfate (S04 -) 4 - • Hydrogen phosphate (HP04 - ) - ```

True

The princiipal electrolytes must be present in proper quantities for normal metabolism and function in the body. For this balance to occur, there must be a negatively charged anion for each positively charged cation. A)true B)false

A sample of plasma is taken to measure the electrolytes. The measurement is expressed in milliequivalents (mEq). Rather than electrolytes being measured by their weights, they are measured by their electrical activity. A)true B) false

``` A milliequivalent (mEq) is a measure of the chemical activity or chemical combining power of an ion. The chemical activity of an electrolyte is compared with the chemical activity of hydrogen. One milliequivalent of any electrolyte has the same chemical combining power as 1 mEq of hydrogen. In each fluid compartment in the body, the cations and anions balance each other with their chemical combining power to maintain electrical neutrality, which again keeps the body in homeostasis. A)true B)false ```

The location and the function of each electrolyte become important in Understanding disease processes. The healthy body maintains homeostasis by correcting any excesses or deficiencies of the electrolytes. A)true B)false

Sodium (cation)

The normal blood level of sodium (Na+), a cation and the most abUndant electrolyte in the body, is 134 to 142 mEq/ L. A)true B)false

It is the major extracellular electrolyte, and because the plasma sample used to measure electrolyte levels comes from the extraceLlular fluid, the level is high. In contrast, the intracellular level of sodium is approximately 10 mEq. A)sodium B)potassium

The major source of sodium comes from the diet. That is true of all the electrolytes. A)true B)false

However, unlike the other electrolytes, sodium is a substance that it is frequently necessary to limit in the diet rather than encourage. A)true B)false

The kidneys are the primary excretion route for sodium. It is important to know that many electrolytes, such as sodium, not only pass into and out of the body, but also move back and forth between a number of body fluids during each 24-hour period. A)true B)false

During a 24-hour period, more than 8 L of fluid containing 1000 to 1300 mEq of sodium are poured into the digestive system. This sodium, along with most of that contained in the diet, is almost completely reabsorbed. A)true B) false

Some major dietary sources of sodium are cheese, table salt, seafood, processed meat, caru1ed vegetables, canned soups, ketchup, and snack foods, such as pretzels and potato chips. Precise regulation and control of sodium levels is required for survival. A)true B)false

The functions of sodium include regulation of the water balance. A)true B)false

Sodium controls the extracellular fluid volume mainly through osmotic pressure, because water follows the sodium in the body (where sodium is, water will follow). It also increases cell membrane permeability. A)true B)false

Sodium stimulates conduction of nerve impulses and helps maintain neuromuscular irritability. Sodium is important in controlling contractility of muscles, especially the heart. A)true B)false

Hyponatremia

A less-than-normal concentration of sodium in the blood is called hyponatremia. This is possible when there is a sodium loss or a water excess. A)true B)false

Hyponatremia occurs when the sodium drops to less than 134 mEq/ L in the extracellular fluid. A)true B)false

When a deficiency results from sodium loss, the body attempts to compensate by decreasing water excretion. A)true B)false

Hyponatremia occurs because water is being retained in the body, which has a diluting effect on all of the blood components A)true B)false

The signs and symptoms of hyponatremia depend on the cause and also on how rapid and severe the sodium loss is. A)true B)false

As sodium levels decrease in the extracellular fluid, water is pulled into the cells, causing them to become edematous, and as the fluid moves into the cells, potassium is shifted out; therefore the patient is likely to also have a potassium imbalance. A)true B)false

Hyponatremia: Causes, Signs and Symptoms, and Nursing Interventions

``` CAUSES • Inadequate sodium intake • Loss of Gl fluids • Vomiting • Diarrhea • Gl or biliary drainage via nasogastric tube or T-tube • Fistulas • Loss through skin • Diaphoresis • Large open lesions (burns) • Shifting of body fluids • Massive edema • Ascites • Burns • Small bowel obstruction • Lengthy hydrotherapy ```

True hyponatremia

``` SIGNS AND SYMPTOMS • Headache* • Irritability • Muscle weakness, muscle twitching, tremors • Fatigue· • Apathy • Postural hypotension· • Nausea and vomiting • Abdominal cramps • Apprehension ```

True hyponatremia

Severe or Prolonged Deficit • Shock • Altered level of consciousness {lethargy, confusion) • Seizures • Coma • Altered level of consciousness usually accompanies a serum sodium level less than 125 mEq/L and indicates that the patient's condition is deteriorating

True hyponatremia

NURSING INTERVENTIONS * Monitor 1&0 of patients receiving diuretic medications * Monitor and record vital signs, especially blood pressure and pulse * Monitor neurologic status frequently; report any change in level of consciousness * Weigh patient daily * Monitor skin turgor at least every 8 hours * Restrict fluid intake as ordered, because this is primary treatment for dilutional hyponatremia; post a sign about fluid restriction in the patient's room * Observe for abnormal Gl, renal, or skin losses * Replace fluid loss with fluids containing sodium, not plain water

True hyponatremia

Hypernatremia

Hypernatremia is a greater-than-normal concentration -of sodium. The sodium level exceeds 145 mEq/ L. It is caused by an excess of sodium or a decrease in body water. The body attempts to correct the imbalance by conserving water through renal reabsorption. A)true B)false

Hypernatremia causes fluid to shift from the cells to the interstitial spaces, resulting in cellular dehydration and an interruption in cellular processes. Again, a potassium imbalance frequently occurs. In sodium retention, potassium is excreted. A)true B)false

Hypernatremia: Causes, Signs and Symptoms, and Nursing Interventions

``` CAUSES • More water than sodium is lost from the body • Abnormally large intake of sodium -Taking too many salt tablets -Overuse of table salt -IV saline infused too rapidly -Prepared foods: frozen, canned, smoked -Dairy products in large amounts -Consumption of antacids containing sodium ```

True hypernatremia

``` SIGNS AND SYMPTOMS • Dry, tenacious mucous membranes • Low urinary output • Firm, rubbery tissue turgor • Restlessness, agitation, confusion, flushed skin ```

True hypernatermia

Severe or Prolonged Excess • Manic excitement • Tachycardia • Death

True hypernatermia

NURSING INTERVENTIONS • Monitor and record vital signs, especially blood pressure and pulse • Provide a safe environment for confused or agitated patient • Monitor 1&0 • Weigh daily to check for body fluid loss • Decrease sodium intake in diet • Monitor water loss from fever, infection, increased respiratory rate • Monitor serum sodium level

True | Hypernatermia

Potassium (cation)

The routes of potassium excretion are the kidneys (80% to 90%) and in the feces and perspiration (10% to 20%). A)true B)false .

The kidneys control the excretion of potassium A)true B)false

Sodium and potassium seem to pair off against each other, and the kidneys prefer to conserve sodium, even when both electrolytes are depleted. In both normal and abnormal situations, sodium will be reabsorbed and potassium will be excreted A)true B)false

Because the major route of excretion of potassium is the kidneys, any condition that causes a decrease in urine output also causes potassium retention. A)true B)false

Serum potassium levels increase in kidney failure. A rise in potassium necessitates continuous monitoring. An important consideration in homeostasis is that kidney function will determine the potassium level in the body. A)true B)false

Too little or too much potassium affects the heart muscle and has potential to result in a life-threatening -disturbance in cardiac rhythm (dysrhythmia). A)true B)false

The main function of potassium is regulation of water and electrolyte content within the cell. With sodium and calcium, it promotes transmission of nerve impulses and also skeletal muscle hmction. A)true B) false

Potassium assists in the cellular metabolism of carbohydrates and proteins. A)true B)false

Another function of potassium is to control the hydrogen ion concentration. When potassium moves out of the cell, sodium and hydrogen ions move in. The result is the regulation of acid-base balance. A)true B)false

Hypokalemia

A decrease in the body's potassium to a level less than 3.5 mEq/L is known as hypokalemia. Because the normal range for a serum potassium level is narrow (3.5 to 5 mEq/ L), a slight decrease has profound consequences. A)true B)false

The major cause of potassium Loss is renal excretion. A)true B)false

The kidneys do not conserve potassium and excrete it even when the body needs the potassium. A)true B)false

Intestinal fluids contain large amounts of potassium. A)true B)false

In excessive GI losses from gastric suctioning or prolonged vomiting, potassium tends to become depleted. A)true B)false

Severe diarrhea, fistulas, ileostomy, villous adenoma (tumor of the intestine that produces potassium-containing mucus), and excessive diaphoresis will also sometimes result in potassium loss. A)true B)false

The use of diuretics, such as thiazides or furosemide (Lasix), promotes hypokalemia A)true B)false

Conditions that cause injury to the cells in turn cause the release of potasium from the cells to the interstitial spaces and ultimately to the kidneys. A)true B)false

If renal function is normal, the potassium will be excreted. Because the normal amounts of potassium are so small, fluctuations have the potential to develop into serious problems. A)true B)false

Hypokalemia has the capacity to affect skeletal and cardiac function. The resulting muscle weakness causes lifethreatening cardiac conduction abnormalities. A)true B)false

Foods Rich in Potassium

``` FRUITS (INCLUDING JUICES) • Apricots • Bananas • Grapefruit • Melon • Cantaloupe • Honeydew • Dried fruits, figs, dates, raisins • Oranges ```

Potassium

``` PROTEIN FOODS • Beef • Chicken • Liver • Pork • Veal • Turkey • Milk • Nuts, peanut butter ```

Potassium

``` VEGETABLES • Asparagus • Dried beans • Broccoli • Cabbage • Carrots • Celery • Mushrooms • Dried peas • Potatoes (especially skins): white, sweet • Spinach • Squash • Tomatoes ```

Potassium

BEVERAGES • Cocoa • Cola drinks • Instant tea and coffee

Potassium

Hypokalemia: Causes, Signs and Symptoms, and Nursing Interventions

CAUSES • Decreased potassium intake • Increased potassium loss - Increased aldosterone activity -GI losses (vomiting, diarrhea, Gl suctioning) -Ileostomy -Potassium -losing diuretics -Loss from cells, as in trauma, burns, fistulas - Skin losses, diaphoresis • Conditions causing very large urine output • Potassium shift into cells -Treatment of acidosis -Metabolic alkalosis - Villous adenoma (tumor of the intestine that produces potassium-containing mucus)

True hypokalemia

SIGNS AND SYMPTOMS • Skeletal muscle weakness (especially in lower extremities), leg cramps* • Paresthesias, hyporeflexia • Decreased bowel sounds, cramps, and constipation, anorexia, nausea, vomiting• • Diminished deep tendon reflexes, lethargy, confusion; paralysis involving the respiratory muscles; coma • Orthostatic hypotension • Cardiac dysrhythmias; weak, irregular pulse • ECG changes • Polyuria

True hypokalemia

``` Severe or Prolonged Deficit • Flaccid paralysis • Kidney damage • Paralytic ileus • Cardiac or respiratory arrest ```

True | Hypokalemia

NURSING INTERVENTIONS • Carefully assess patients taking digitalis glycosides, especially if also taking a diuretic, for hypoglycemia, which has capacity to potentiate the action of the digitalis glycoside medication and cause toxicity • Administer potassium chloride (KCI) supplement as prescribed by the physician (oral or IV) • Whether through a peripheral or central catheter, it is necessary to administer IV potassium with care to prevent serious complications • IV potassium is always diluted and delivered using an infusion controller • Encourage increased intake of foods high in potassium • Monitor bowel sounds • Monitor serum potassium level • Monitor 1&0 (about 40 mEq of potassium is lost in each liter of urine; diuresis has potential to put the patient at a risk for potassium loss) • During treatment with potassium, it is necessary for the patient's urinary output to be at least 600 mL/day. If urinary output is less than 20 mL/hr for 2 consecutive hours, interrupt the infusion and immediately notify the physician. If renal function is impaired, there is a significant risk of hyperkalemia. • Monitor telemetry

True hypokalemia

Hyperkalemia

An increase in the body's serum potassium level greater than 5 mEq/ L is known as hyperkalemia. Because the normal range for a serum potassium level is narrow (3.5 to 5 mEg/ L), a slight increase poses the risk of serious consequences. A)true B)false

Potassium is gained through intake and lost by excretion. This condition is not as common as hypokalemia as long as renal function is normal. The major cause of potassium excess is renal disease, in which potassium is not excreted adequately. A)true B)false

When severe tissue damage occurs, potassium is released from the cells. Shock often accompanies this damage, resulting in reduced kidney output. The result is an elevated potassium level. A)true B)false

A hyperkalemia

Excessive intake of foods high in potassium, espeecially with decreased urine output, may cause an increased serum potassium level. A)true B)false

Other causes of hyperrkalemia include (1) excessive use of salt substitutes (most of which use potassium as a substitute for sodium); (2) potassium supplements (oral or IV); (3) infusion of a large volume of blood nearing its expiration date (serum concentration increases the longer donated blood is stored); (4) drugs such as beta blockers, which inhibit potassium shifts into cells; (5) potassium-sparing diuretics such as spironolactone; (6) chemotherapy, which causes cell death or lysis with release of high levels of intracellular potassium into the blood; (7) angiotensin converting enzyme inhibitors; (8) nonsteroidal antiinflammatory drugs; (9) aminoglycosides.

True

Although hyperkalemia is less common than hypokalemia, it is often more dangerous because of cardiac arrest, which is caused by overstimulation of the carrdiac muscle. A serum potassium level of 7 mEq/ L or greater risks serious cardiac dysrhythmias. A)true B)false

Hyperkalemia: Causes, Signs and Symptoms, and Nursing Interventions

CAUSES NoTE: Hyperkalemia may be the most dangerous of the electrolyte disorders. * Potassium intake (parenteral or oral) in excess of kidney's ability to excrete * Excessive use of salt substitutes * Renal failure * Adrenal insufficiency * Potassium enters the bloodstream from injured cells with extensive trauma (shift of potassium out of the cells into extracellular fluid) * Metabolic acidosis * Infusion of large volume of blood nearing expiration date * Beta blockers * Potassium-sparing diuretics * Tumor lysis syndrome after chemotherapy * Angiotensin-converting enzyme inhibitors * Nonsteroidal antiinflammatory drugs * Aminoglycosides

True hyperkalemia

``` SIGNS AND SYMPTOMS* • Signs and symptoms are often nonspecific; serum potassium level and electrocardiogram (ECG) tracings are often the best clinical indicators • Irritability • Nausea, vomiting • Diarrhea, colic • Cardiac dysrhythmias • ECG changes • Irregular pulse rate • Hypotension • Numbness, tingling ```

True hyperkalemia

Severe or Prolonged Excess • Flaccid paralysis • Cardiac arrestt (serious dysrhythmias become especially dangerous when the serum potassium level reaches 7 mEq/L or more [normal serum potassium level ranges from 3.5 to 5 mEq/L]) • Anuria

True hyperkalemia

NURSING INTERVENTIONS • Decrease intake of foods high in potassium • Administer Kayexalate (sodium polystyrene sulfonate) as prescribed by the physician (Kayexalate is possible to give orally, through a nasogastric tube, or as a retention enema); keep in mind when giving Kayexalate that serum sodium level will sometimes rise-watch for congestive heart failure • Loop diuretics • Decrease or stop medications associated with high potassium level • Monitor underlying disorders leading to high potassium level • Assess vital signs • Monitor telemetry to detect dysrhythmias • Monitor 1&0 (report an output of less than 30 ml/hr; an inability to excrete potassium in the urine will potentially lead to dangerously high potassium level) • Hemodialysis in acute symptomatic hyperkalemia • Monitor bowel sounds and number and character of bowel movements • Monitor serum potassium level

True hyperkalemia

Chloride (anion)

The normal blood level of chloride (CI-), an extracellular anion, is 96 to 105 mEg/L. It is the chief anion in interstitial and intravascular fluid. Even though chloride accounts for more than two thirds of the anions in the body, it is usually not considered alone. A)true B)false

Chloride has the ability to diffuse quickly between the intracellular and extracellular compartments and combines easily with sodium to form sodium chloride or with potassium to form potassium chloride. It is more often linked with sodium. A)true B)false

The daily requirement of chloride is equal to that of sodium (3.65 to 10.85 g/ day). Foods containing sodium also contain chloride. The main route of excretion is through the kidneys. A)true B)false

Chloride is necessary for the formation of hydrochloric acid in gastric juice. It is also a valuable electrolyte in regulating the osmotic pressure between the compartments and assisting in the regulation of acid-base balance. A)true B)false

Hypochloremia

Hypochloremia usually occurs when sodium is lost, because sodium and chloride are frequently paired. A)true B)false

The most common causes of hypochloremia are vomitting and prolonged nasogastric or fistula drainage. A)true B)false

Hyperchloremia

Hyperchloremia rarely occurs but is possible when biicarbonate levels fall. The increase in chloride anions represents all attempt to compensate and maintain equal numbers with the cations in the body fluid. Because chloride imbalances rarely occur independently of other electrolytes, there are no specific signs and symptoms to identify a chloride imbalance. A)true B)false

Calcium (cation)

The normal blood level of calcium (Ca++), a positively charged ion, is approximately 4.5 mEq/ L. Of the 1200 g of calcium in the body, 99% is concentrated in the bones and the teeth, where it is physiologically inactive. The remaining 1% is found in the soft tissue and the extracellular fluid. A)true B)false

Calcium is deposited in the bones and mobilized as needed to keep the blood level constant during any period of insufficient intake. A)true B)false

Three considerations are important in the blood calcium level: 1. Deposition and resorption of bone 2. Absorption of calcium from the GI tract 3. Excretion of calcium in urine and feces

True

Vitamin D, calcitonin, and parathyroid hormone (parathormone) are necessary for the absorption and utilization of calcium. A)true B)false

The best food sources of calcium are milk and cheese. Other sources include beans, nuts, cauliflower, lettuce, and egg yolks. A)true B)false

The average daily intake for calcium is 200 to 2500 mg. a)TURE B)false

CALCIUM The dietary reference intakes (DRis) vary from -360 mg for infants -1200 mg for females 15 to 18 years of age. -During pregnancy and lactation, 1300 mg is required.

True

Prevention of osteoporosis focuses on adequate calcium intake (1000 mg/ day in premenopausal women and postmenopausal women taking estrogen and 1500 mg/day in postmenopausal women who are not receiving supplemental estrogen). A)true B)false

Calcium is removed from the body via the urine and feces. A)true B)false

Calcium is required for the formation and maintenance of strong bones and teeth. It is also necessary for normal blood clotting. A)true B)false

Calcium has a depressing or sedative effect on neuromuscular irritability and thus promotes normal transmission of nerve impulses; it also helps regulate normal muscle contraction and relaxation. It helps bold body cells together by establishing the thickness and strength of cell membranes. A)true B) false

One of its most important functions of calcium is to act as an enzyme activator for chemical reactions in the body. A)true B)false

Hypocalcemia

Hypocalcemia develops when the serum level is less than 4.5 mEq/L. Possible deficiencies arise from a variety of problems: • Infusion of excess amounts of citrated blood (cittrates bind to the calcium) • Excessive loss through diarrhea • Inadequate dietary intake of calcium or vitamin D • Surgical removal of parathyroid glands • Decreased parathyroid function • Pancreatic disease • Small bowel disease

True

The signs and symptoms of hypocalcemia are neuromuscular irritation and increased excitability. As neuromuscular signs and symptoms increase, tetany is possible. A)true B)false

Tetany is a condition characterized by excessive muscle cramps, laryngeal spasms, stridor, carpal spasms (Trousseau's sign), pedal spasms, and contraction of facial muscles A)true B)false

Tests for hypocalcemia. A, Chvostek's sign is a contraction of facial muscles in response to a light tap over the facial nerve in front of the ear. B, Trousseau's sign is a carpal spasm induced by C, inflating a blood pressure cuff above the systolic pressure for a few minutes.

True

Hypocalcemia: Causes, Signs and Symptoms, and Nursing Interventions

CAUSES • Excess binding of calcium ions • Large amount of citrated blood • Excess alcohol • Alkalosis • Dietary deficiency of calcium and vitamin D • Chronic renal failure • Pancreatic disease • Disease of small bowel; malabsorption • Severe diarrhea • Anticonvulsants, such as phenobarbital and phenytoin (Dilantin) • Diuretics (Lasix, Edecrin) • Draining intestinal fistulas • Deficiency of parathyroid hormone or vitamin D • Increased magnesium • Thyroid surgery (surgical removal of parathyroid glands, removal of parathyroid tumor) • Injury or disease of parathyroid gland • Severe burns • Low serum albumin levels

True hypocalcemia

``` SIGNS AND SYMPTOMS • Anxiety, confusion, irritability • Osteoporosis, pathologic fractures • Tingling around nose, mouth, ears, fingers, toes* • Twitching • Muscle spasm of feet and hands* • Tetany (note positive Trousseau's or Chvostek's sign) • Laryngeal spasms • Nausea, vomiting* • Hyperactive deep tendon reflexes • Diarrhea• • Cardiac dysrhythmias, cardiac arrest • Calcium deposits in body tissues • Diminished response to digitalis glycosides ```

True hypocalemia

NURSING INTERVENTIONS • Monitor vital signs; monitor respiratory status, including rate, depth, and rhythm; be alert for stridor, dyspnea, or crowing (laryngeal spasms) • Monitor pertinent laboratory values including calcium, albumin, and magnesium • Encourage intake of a diet high in calcium-rich foods, vitaminD, and protein • Administer calcium and vitamin D as prescribed by the physician • Monitor treatment of underlying causes • Acute hypocalcemia necessitates either IV calcium gluconate or calcium chloride • For acute hypocalcemia, keep a tracheotomy tray and resuscitation bag at bedside in case of laryngeal spasms • Monitor telemetry • Monitor serum calcium, albumin, and magnesium levels • Monitor 1&0

True hypocalemia

Hypercalcemia

Hypercalcemia occurs when calcimn levels exceed 5.8 mEq/L. It may occur when calcium stored in the bone enters the circulation, for example, in patients who are immobilized. A)true B)false

An increased intake of calcium or vitamin D also causes hypercalcemia. A)true B)false

Hypercalcemia: Causes, Signs and Symptoms, and Nursing Interventions

``` CAUSES • Loss from bone • Immobilization • Metastatic bone cancer • Multiple myeloma • Excess intake • Dietary • Antacids containing calcium • Increased absorption • Increased parathyroid hormone • Increased vitamin D ```

True hypercalemia

``` SIGNS AND SYMPTOMS • Anorexia, nausea, vomiting • Behavioral changes, including confusion • Thirst, polyuria* • Renal calculi • Decreased deep tendon reflexes • Constipation • Paralytic ileus • Lethargy, coma • Cardiac dysrhythmias, cardiac arrest • Hypertension • Decreased muscle tone* • Decreased Gl motility • Bone pain ```

True hypercalemia

NURSING INTERVENTIONS • Assist in the promotion of excretion of calcium in the urine • Administer diuretics as ordered by the physician • Encourage drinking 3000 to 4000 L of fluids per day • Monitor 1&0 • Be aware that in life-threatening hypercalcemia, measures to increase calcium secretion will sometimes include hemodialysis or peritoneal dialysis

True hypercalemia

Phosphorus (anions)

The normal blood level of phosphorus, chiefly present as hydrogen phosphate (HP04 -), an intracellular anion, -is approximately 4 mEq/ L. A)true B)false

Phosphorus and calcium have an inverse relationship in the body: An increase in one causes a decrease in the other. As blood calcium levels increase, a decrease in phosphorus levels is necessary, and vice versa. A)true B)false

``` The majority (70% to 80%) of phosphorus is found combined with calcium in an individual's bones and teeth, 10% is in an individual's muscle, and the remaining 10% is in the nerve tissue of the body. A)true B)false ```

Dietary intake of phosphorus is usually 800 to 1500 mg/ day. A)true B)false

The minimum daily requirement of phosphorus is 800 mg. A)true B)false

Higher intake of phosphors during pregnancy and lactation is needed. An adequate intake of vitamin D is necessary for the absorption of both calcium and phosphorus. A)true B)false

Because a generous amount of phosphorus is present in many foods, a deficiency seldom(rarely) occurs. Foods especially high in phosphorus include beef, pork, fish, poultry, milk products, and legumes. A)true B)false

The kidneys are responsible for approximately 90% of the excretion of phosphorus. The remainder is excreted in the feces. A)true B)false

With calcium, phosphorus contributes to the support and maintenance of bones and teeth. A)true B)false

Phosphors important in many chemical reactions and acts as a buffer to regulate the body's acid-base balance. It promotes the -effectiveness of many of the B vitamins, assists in norrmal nerve and muscle activity, and participates in carbohydrate metabolism. A)true B)false

Hypophosphatemia

Hypophosphatemia is possible as a result of a dietary insufficiency, impaired kidney function, or maldistribution of phosphate. Muscle weakness, especially affecting the respiratory muscles, sometimes occurs. A)true B)false

Hyperphosphatemia

Hyperphosphatemia most commonly occurs as a result of renal insufficiency. Another cause is increased intake of phosphate or vitamin D. Signs and symptoms of tetany, numbness and tingling around the mouth, and muscle spasms develop A)true B)false

Magnesium (cation)

The normal blood level of magnesium (Mg++), the second most abundant cation in the intracellular fluid, is 1.5 to 2.4 mEq/ L. Although only small amounts of magnesium are in the blood, it is important in maintaining normal body function. A)true B)false

The majority of Magnesium (60%) is found in the bone, 39% in the muscle and the soft tissue, and 1% in the extracellular fluid, most of which is in the cerebrospinal fluid. A)true B)false

Magnesium Dietary intake is usually 200 to 400 mg daily. A)true B)false

The minimum magnesium daily requirement is 250 mg for the average adult, 150 mg for an infant, and 400 mg for a female during pregnancy and lactation. A)true B)false

Magnesium is annother electrolyte commonly distributed in foods. Whole grains, fruits, vegetables, meat, fish, legumes, and dairy products are dietary sources. A)true B)false

The major route of magnesium excretion is the kidneys. There is a correlation between the amount of magnesium and the amount of potassium excreted. The kidneys do not conserve potassium, but they do conserve magnesium; therefore if a magnesium deficiency develops, the body will conserve magnesium at the expense of excreting potassium. A)true B)false

Magnesium is now linked as a cofactor in the activation of many enzymes. It also promotes regulation of serum calcium, phosphate, and potassium levels and is essential for integrity of nervous tissue, skeletal muscle, and cardiac functioning A)true B)false

Diets low in magnesium may create a risk for hyperrtension, cardiac dysrhythmias, ischemic heart disease, and sudden cardiac death. A)true B)false

Decreased intracellular magnesium levels may contribute to the hypertension, abnormal glucose tolerance, and insulin resistance common in diabetics. A)true B)false

Hypomagnesemia

Hypomagnesemia develops when blood levels fall to less than 1.5 mEq/L. A decrease in magnesium often parallels decreased potassium, because if the magnesium level is low, the kidneys tend to excrete more potassium. A)true B)false

Hypomagnesemia causes signs and symptoms of increased neuromuscular irritability similar to those observed with hypocalcemia. The major causes of low magnesium are increased excretion by the kidneys, impaired absorption of the GI tract, and prolonged malnutrition. A)true B)false

Hypomagnesemia: Causes, Signs and Symptoms, and Nursing Interventions

``` CAUSES • Decreased intake -Prolonged malnutrition -Starvation • Impaired absorption from Gl tract - Alcoholism -Hypercalcemia -Diarrhea -Draining intestinal fistulas • Conditions causing large losses of urine • Prolonged IV feedings without magnesium supplementation ```

True hypomagnesiema

``` SIGNS AND SYMPTOMS • Anorexia • Mental changes • Agitation, depression, confusion • Dysphagia • Hyperactive deep tendon reflexes • Nausea and vomiting • Paresthesias* • Tetany -Tremor -Seizures -Ataxia Cramps, spasticity, tetany -Tachycardia -Hypotension -Cardiac dysrhythmias ```

True hypomagnesiema

``` NURSING INTERVENTIONS • Monitor vital signs • Assess neuromuscular status • Assess dysphagia • Increase intake of magnesium-rich foods • Administer magnesium supplements as prescribed by the physician • Monitor 1&0 • Monitor telemetry • Institute seizure precautions • Monitor respiratory status ```

True hypomagnesiema

Hypermagnesemia

Hypermagnesemia develops when blood levels exceed 2.5 mEq/ L. It rarely occurs when kidney function is normal. The three major causes are impaired renal function, excess magnesium administration, and diabetic ketoacidosis when there is severe water loss. A)true B) false

An excess of magnesium severely restricts nerve and muscle activity. A)true B)false

Hypermagnesemia: Causes, Signs - and Symptoms, and Nursing Interventions

CAUSES • Renal failure • Diabetic ketoacidosis with severe water loss ``` SIGNS AND SYMPTOMS • Hypotension* • Vasodilation .. • Heat • Thirst • Nausea and vomiting • Loss of deep tendon reflexes • Respiratory depression Prolonged or Severe Excess • Coma • Cardiac arrest ``` NURSING INTERVENTIONS • Promote urine excretion • Administer diuretics as prescribed by the physician • Decrease intake of foods or medications high in magnesium • Monitor 1&0

True hypermagnesemia

Bicarbonate (anions)

The normal level of bicarbonate (HC03 - ), one of the main anions in the extracellular fluid, is 22 to 24 mEq/L. It is an alkaline electrolyte whose major function is the regulation of the acid-base balance, also called acidalkaline balance. A)true B)false

Bicarbonate acts as a buffer to neutralize acids in the body and maintain the 20:1 bicarbonate to carbonic acid ratio needed to keep the body in homeostasis. The kidneys selectively regulate the amount of bicarbonate retained or excreted. A)true B)false

ACID-BASE BAlANCE

Acid-base balance means homeostasis of the hydrogen ion (H+) concentration in the body fluids. The hydrogen ion concentration is determined by the ratio of carbonic acid (H2C03) to bicarbonate (HC03 - ) in the - extracellular fluid. The ratio needed for homeostasis is 1 part carbonic acid to 20 parts bicarbonate. The symbol used to indicate hydrogen ion balance is pH. A)true B)false

When pH is measured, it is actually the hydrogen ion concentration in the patient's body that is measured. A sample of extracellular fluid, specifically arterial blood, is used to determine the body's pH. A)true B)false

Arterial blood gases will reveal whether the blood is acid, neutral, or alkaline. The more hydrogen ions in a solution, the more acid the solution. The fewer hydrogen ions in a solution, the more alkaline the solution. A)true B)false

The terms base and alkaline are interchangeable; a base is an alkaline substance. An inverse relationship exists between hydrogen ion concentration and the pH level: As the numbers of hydrogen ion increase, the acidity of the solution increases and the pH decreases. The opposite happens with alkalinity-the number of hydrogen ions decreases and the pH increases. A)true B)false

A pH of less than 7.35 is acid. A pH of greater than 7.45 is alkaline. A)true B)false

The normal pH of arterial blood is approximately 7.45, whereas the normal pH of venous blood and interstitial fluid is approximately 7.35. A)true B)false

Between 7.35 and 7.45 is considered normal blood pH. A pH lower than 6.8 or higher than 7.8 is usually fatal . A)true B)false

Two general types of disturbances can cause a pH imbalance. One imbalance arises from an increase or a decrease in the base substance-bicarbonate. The other imbalance results from adding or subtracting the acid substance-carbonic acid. A)true B)false

The body's metabolism affects the base side of balance-so a bicarbonate imbalance causes metabolic acidosis or alkalosis. A)true B)false

The body's respiratory system affects the acid side of the balance so a carbonic acid imbalance causes respiratory acidosis or alkalosis. A)true B)false

The four primary types of acid-base imbalance are respiratory acidosis, respiratory alkalosis, metabolic acidosis, and metabolic alkalosis A)true B)false

The body has three systems that work to keep the pH in the narrow range of normal: the blood buffers, the respiratory system, and the kidneys. These systems are the body's true lines of defense that are constantly working to maintain a normal pH. A)true B)false

Try thinking of the blood buffers as chemical sponges. They circulate throughout the body in pairs, neutralizing excess acids or bases by contributing or accepting hydrogen ions. One buffer will dominate if the solution is too acid; the other if the solution is too alkaline. They work within a fraction of a second to prevent an excessive change in the hydrogen ion concentration. A)true B)false

The body has four major buffer systems;

The bicarbonate-carbonic acid system is the most important. It is responsible mainly for buffering blood and interstitial fluid. Decreasing the strength of potentially damaging acids and bases reduces the danger these chemicals pose to pH balance. A)true B)false

The kidneys assist the bicarbonate buffer system in regulating production of bicarbonate. A)true B)false

The lungs assist by regulating the production of carbonic acid, which results from combining carbon dioxide and water. The other systems are the phosphate, protein, and hemoglobin buffer systems. A)true B)false

For every 1 million hydrogen ions that enter the body, the buffer systems are able to neutralize all but five. Once the buffer systems are exhausted, the body calls on the second line of defense: the lungs. A)true B)false

By speeding up or slowing down respirations, the lungs have the capacity to increase or decrease the amount of carbon dioxide in the blood. Removing carbon dioxide from the blood lowers the carbonic acid level; this is the mechanism by which the respiratory system regulates pH. Whereas it took seconds for the buffer systems to work, it takes minutes for the lungs to begin to adjust the pH. Even though the respiratory system is slower than the buffers, however, the lungs are able to eliminate large amounts of acid (in the form of carbon dioxide) from the body. A)true B)false

the respiratory system is able to return the pH to about 7.2 to 7.3 within 1 minute. A)true B)false

Chemoreceptors in the medulla of the brainstem provide the stimulus to increase respirations; however, as the hydrogen ion concentration approaches normal, the stimulus is lost. The buffers will accomplish the remaining adjustments needed to retum the level to normal. A)true B)false

The third line of defense is the kidneys. The action of the lungs in coping with an imbalance is simple: We breathe more slowly or more quickly. The kidneys have much more selective control. They are able to excrete varying amounts of acid or base into the urine. lf the acidity of blood rises above normal, the kidneys will selectively eliminate more acids so the hydrogen ion concentration inCreases in the blood. If the blood becomes too alkaline, the kidneys will selectively eliminate more bases, especially bicarbonate. A)true B)false

Normal urine is acidic because the body produces excess acids in the metabolic processes that occur continuously in the body. A)true B)false

The kidneys are the slowest of the systems, but they are efficient enough to return the pH to exactly normal. Their response takes hours to days. A)true B) false

The three systems work closely together to maintain a normal hydrogen ion concentration. The buffers are immediate and continuous in contributing or accepting hydrogen ions. The respiratory system has the capacity to come into play within minutes, regulating the carbon dioxide level in the blood and thus controlling carbonic acid. The kidneys are the third line of defense, and although they work more slowly than the other two systems, they are able to eliminate either hydrogen ions or bicarbonate ions, which means they can either increase or decrease pH.

True

ACID-BASE IMBALANCE

Acid-base balance means homeostasis of the hydrogen ion concentration. A steady acid-base balance is normally maintained in the body. A)true B)false

An upset in acid-base balance results in either acidosis (when blood pH is less than 7.35), or alkalosis (when .blood pH is greater than 7.45). A)true B)false

The lungs and the kidneys are the two major organs responsible for regulation of the acid and base substances in the body. When imbalances occur, they represent an imbalance in the function of the lungs, the kidneys, or both. A)true B)false

Many diseases create a potential for acid-base imbalances as well as fluid and electrolyte problems. Diseases that pose a risk for these imbalances include diabetes mellitus, chronic obstructive pulmonary disease (COPD), and end-stage renal disease, as well as severe vomiting and diarrhea . A)true B)false

There are four primary types of acid-base imbalances: respiratory acidosis, respiratory alkalosis, metabolic acidosis, and metabolic alkalosis A)true B)false

Acid-Base Imbalances and Compensatory Mechanisms

Respiratory acidosis mode of compensation would be: Kidneys will retain increased amounts of HC03(bicarbonate) - to - increase pH.

True

Respiratory alkalosis mode of compensation would be; Kidneys will excrete increased amounts of HC03(bicarbonate) to lower pH

True

Metabolic acidosis mode of compensation would be; Lungs "blow off" C02 (carbon dioxide) to raise pH

True

Metabolic alkalosis mode of compensation would be; Lungs retain C02 (carbon dioxide) to lower pH

True

RESPIRATORY ACIDOSIS

Any condition that impairs normal ventilation causes respiratory acidosis. Retention of carbon dioxide occurs with a resultant increase of carbonic acid in the blood. As pH falls and the normal 20: 1 bicarbonate to carbonic acid ratio is upset, the Pco2 (partial carbon dioxide) level increases. Shallow respirations result because of the retained carbon dioxide. The patient will also experience a depression of central nerrvous system activity. A)true B)false

Because the lungs are responsible for the respiratory parameters of the acid-base balance, -the kidneys, which are responsible for the metabolic parameters, will attempt to compensate by retaining the base substance bicarbonate. During respiratory acidosis, it takes 24 hours for the kidneys to respond in a compensatory mechanism by retaining bicarbonate. A)true B)false

Treatment for respiratory acidosis is aimed at improving ventilation. The primary goal is to support the patient's respirations. Intermittent positive-pressure breathing (IPPB) to promote exhalation of carbon dioxxide, antibiotic administration for any respiratory infection, adequate hydration (2 to 3 L/ day) to keep the muucous membranes moist and aid in removal of secretions, and use of bronchodilators to help reduce bronchial spasms will be possible elements of the treatment regimen. Therapy is also directed at correcting the primary condition responsible for the imbalance.

True respiratory acidosis

Respiratory Acidosis: Causes, Common Clinical Signs and Symptoms, and Laboratory Data

``` CAUSES • Compromise in any of the three essential parts of breathing-ventilation, perfusion, or diffusion • Chronic obstructive pulmonary disease • Pneumonia • Respiratory failure • Atelectasis • Barbiturate or sedative overdose • Paralysis of respiratory muscles (Guillain-Barre syndrome, poliomyelitis, myasthenia gravis) • Traumatic injuries to the thorax (flail chest) • Obesity • Airway obstruction • Head injuries • Stroke (CVA) • Drowning • Cystic fibrosis ```

Respiratory acidosis

COMMON CLINICAL SIGNS AND SYMPTOMS ``` Central Nervous System • Lethargy • Disorientation • Occipital headache • Decreased deep tendon reflexes • Dizziness • Decreasing level of consciousness • Seizures • Coma ``` ``` Cardiopulmonary System • Dyspnea • Tachycardia • Hypotension • Cardiac dysrhythmias ``` Musculoskeletal System • Tremors • Weakness

True respiratory acidosis

LABORATORY DATA • pH less than 7.35 • Paco2 greater than 45 mm Hg (unless the patient has chronic obstructive pulmonary disease) • Pao2 normal or less than 80 mm Hg, depending on severity of acidosis • 0 2 saturation normal or less than 95%, depending on severity of acidosis • HC03 - normal in early respiratory acidosis • K+ greater than 5 mEq/L

True respiratory acidosis

RESPIRATORY ALKALOSIS

Respiratory alkalosis is caused by hyperventilation. Respirations that increase in rate, depth, or both have the potential to result in the loss of excessive amounts of carbon dioxide with a resultant lowering of the carbonic acid level in the blood. The pH rises because of the decrease in carbonic acid, which is blown off with each exhalation. A)true B)false

The common treatment for respiratory alkalosis is sedation and reassurance. If the cause is anxiety, it helps to make the patient aware of the abnormal breathing pattern. Instruct the patient to breathe slowly to retain and accumulate carbon dioxide in the body. Another effective treatment is for the patient to breathe into a paper bag, which will cause rebreathing of the exhaled carbon dioxide. A)true B)false

Respiratory Alkalosis: Causes, Common Clinical Signs and Symptoms, and Laboratory Data

CAUSES • Hyperventilation (caused by hypoxia, pulmonary emboli, anxiety, fear, pain, exercise, fever) • Anemia • Hypermetabolic states • Disorders of the central nervous system (head injuries, infections) • Drugs (aspirin overdose) • Asthma • Pneumonia • Inappropriate mechanical ventilator settings COMMON CLINICAL SIGNS AND SYMPTOMS ``` Central Nervous System • Anxious appearance • Irritability • Confusion • Tingling of the extremities • Fainting • Dizziness • Seizures ``` Cardiopulmonary System • Tachypnea • Cardiac dysrhythmias Musculoskeletal System • Tetany • Muscle weakness ``` LABORATORY DATA • pH 7.45 or greater • Paco2 less than 35 mm Hg • Pao2 normal • 02 saturation normal • HC03 - 22 to 24 mEq/L (normal) • K+ less than 3.5 mEq/L ```

True

METABOLIC ACIDOSIS

Metabolic acidosis is possible as a result of either a gain of hydrogen ions or a loss of bicarbonate-in other words, retaining too many acids (H+ ions) or losing too many bases (HC03- ). A)true B)false

Examples of metabolic acidosis include diabetic ketoacidosis from ketone accumulation, lactic acid elevation (seen in shock), and acidosis from loss of too many bases (as in severe diarrhea or renal failure) A)true B)false

The effect of metabolic acidosis is hyperventilation, occurring as the lungs attempt to compensate by blowing off carbon dioxide to lower the Pco2 level. A)true B)false

A patient with diabetic ketoacidosis will often develop Kussmaul's respirations (deep, rapid breathing), which serve to blow off carbon dioxide in an attempt to reverse the condition of metabolic acidosis. A)true B)false

Administration of sodium bicarbonate is the usual treatment for acidosis. A)true B)false

Metabolic Acidosis: Causes, Common , Clinical Signs and Symptoms, and Laboratory Data

``` CAUSES • Starvation • Dehydration • Diabetic ketoacidosis • Lactic acidosis • Renal failure • Shock • Severe diarrhea • Drugs (methanol, ethanol, formic acid, paraldehyde, aspirin) • Renal tubular acidosis • Renal failure ``` COMMON CLINICAL SIGNS AND SYMPTOMS ``` Central Nervous System • Lethargy • Headache • Decreasing level of consciousness • Coma ``` Cardiopulmonary System • Kussmaul's respirations (deep, rapid respirations) • Dysrhythmias • Warm, flushed skin ``` Gastrointestinal System • Anorexia • Nausea • Vomiting • Diarrhea • Abdominal pain ``` Musculoskeletal System • Weakness ``` LABORATORY DATA • pH less than 7.35 • Paco2 normal, or less than 35 mm Hg if lungs are compensating • Pao2 normal, or less than 35 mm Hg if lungs are compensating • 02 saturation normal • HC03 - less than 22 mEq/L • K+ greater than 5 mEq/L ```

True

METABOLIC ALKALOSIS

Metabolic alkalosis results when a significant amount of acid is lost from the body or an increase in the bicarbonate level occurs. A)true B)false

The most common causes of metabolic alkalosis are vomiting gastric content (normally high in acid) and gastric suction. A)true B)false

Metabolic alkalosis is also possible in patients who ingest excess amounts of alkaline agents, such as bicarbonate containing antacids (e.g., Alka-Seltzer, soda bicarbonate). A)true B)false

Metabolic alkalosis depresses the central nervous system. The respiratory rate is decreased, thus decreasing the amount of carbon dioxide exhaled and raising the level of plasma C02. Again, as with the other acid-base imbalances, treattment is aimed at the cause. A)true B)false

Metabolic Alkalosis: Causes, Common Clinical Signs and Symptoms, and Laboratory Data

``` CAUSES • Excessive vomiting • Prolonged gastric suctioning • Electrolyte disturbance • Cushing's disease • Drugs (steroids, sodium bicarbonate, diuretics); overdose of baking soda, excessive use of antacids such as Mylanta • Hyperaldosteronism ``` COMMON CLINICAL SIGNS AND SYMPTOMS ``` Central Nervous System • Headache • Irritability • Lethargy • Decreases in level of consciousness • Seizures ``` Cardiopulmonary System • Atrial tachycardia • Slow, shallow respirations with periods of apnea • Cardiac dysrhythmias (related to hypokalemia) ``` Gastrointestinal System • Nausea • Vomiting • Anorexia Musculoskeletal System • Numbness and tingling of extremities • Tremors • Hypertonicity of muscles, muscle cramps • Tetany ``` ``` LABORATORY DATA • pH greater than 7.45 • Paco2 normal or greater than 45 mm Hg if lungs are compensating • normal • 02 saturation normal • HC03 - greater than 26 mEq/L - • K+ less than 3.5 mEq/L ```

True

Nursing Diagnosis

Use the following nursing diagnoses for fluid, electrolyte, and acid-base alterations: * Risk for deficient fluid volume * Imbalanced nutrition: less than body requirements * Deficient fluid volume * Risk for imbalanced fluid volume * Excess fluid volume * Impaired or risk for impaired skin integrity * Impaired tissue integrity * Impaired oral mucous membrane * Ineffective tissue perfusion * Decreased cardiac output * Impaired gas exchange * Ineffective breathing pattern

True

Key Points

* Water is the primary fluid in the body. * The two fluid compartments are the intracellular and extracellular compartments. The extracellular compartment is composed in turn of the interstitial and intravascular areas. * Fluid movement takes place by means of three passive transport systems-diffusion, osmosis, and filtration and one active transport system-active transport by ATP energy. * Electrolytes are chemical compounds that carry either a positive or negative charge. Positive ions are called cations; negative ions are called anions. To maintain homeostasis, it is necessary for the cations and the anions to balance each other in the body fluids. * Sodium is the major extracellular cation in the body. Water follows sodium as it moves from one fluid compartment to another. * Potassium is the major intracellular cation in the body. Imbalances in potassium, either high or low levels, have potential to cause life-threatening cardiac conditions.

True

* The four types of acid-base imbalance are respiratory acidosis, respiratory alkalosis, metabolic acidosis, and metabolic alkalosis. * Arterial blood has a normal pH range of 7.35 to 7.45. A pH less than 7.35 is considered abnormally acidic; a pH greater than 7.45 is considered abnormally alkaline. A pH lower than 6.8 or higher than 7.8 is usually fatal. * Any process that interferes with normal ventilation and causes a decrease or an increase in the excretion of volatile acids poses the risk of causing respiratory acidosis or respiratory alkalosis. * Any process that interferes with normal production or excretion of nonvolatile hydrogen ions poses the risk of causing metabolic acidosis or metabolic alkalosis. * Respiratory acidosis or alkalosis will result when the lungs fail to regulate the carbonic acid concentration in the blood. Metabolic acidosis or alkalosis will result when the kidneys fail to regulate the bicarbonate concentration in the blood. * If the lungs are unable to reassert their function and correct respiratory acidosis, the kidneys will respond in an attempt to correct the imbalance. If the kidneys are unable to reassert their function and correct metabolic acidosis, the lungs will respond in an attempt to correct the imbalance.

True

NCLEX PREP

True

A 60 yr-old patient has recently been experiencing excessive edema in his feet. The nurse discusses with the patient the dietary changes that are perhaps causing the water retention associated with the patient's edema. Which electrolyte has the greatest influence on water balance in the body? 1. Sodium (Na+) 2. Potassium (K+) 3. Chloride (CI-} 4. Calcium (Ca++)

2. Which regulatory system is the body's first line of defense in keeping the pH within normal limits? 1. Buffers in the blood 2. Respiratory system 3. Renal system 4. Blood pressure

3. The most accurate method to use in determining water balance in the body is to: 1. weigh the patient daily at the same time each day. 2. record an accurate 24-hour 1&0. 3. ask the patient to document on an 1&0 form left at the bedside. 4. have the same nurse care for the patient each day.

4. A patient is concerned about giving her family adequate amounts of potassium in their diets. She asks the nurse to help plan a meal containing foods with potassium. Which diet contains foods with the most potassium? 1. Baked chicken, green salad, and fresh fruit plate 2. Macaroni and cheese, cornbread, and gelatin 3. Tacos, chips and salsa, and ice cream 4. Seafood plate, marinated vegetables, sponge cake

5. The major route of excretion of all electrolytes from the body is via the: 1. skin. 2. lungs. 3. kidneys. 4. feces.

6. Fluid movement in the cells equalizes the ions or the molecules on each side of the semipermeable membrane. The movement of water from an area of lower concentration to an area of higher concentration occurs through: 1. diffusion. 2. filtration. 3. active transport. 4. osmosis.

7. The largest fluid compartment in the body is the: 1. intracellular. 2. extracellular. 3. interstitial. 4. intravascular.

8. Diffusion, osmosis, and filtration are all examples of: 1. active transport. 2. passive transport. 3. ATP energy. 4. Krebs cycle.

9. The term used to indicate hydrogen ion concentration in the body is: 1. mEq. 2. ATP. 3. pH. 4. mL.

10. The most common cause of hypocalcemia involves a dysfunction of: 1. antidiuretic hormone. 2. growth hormone. 3. parathyroid hormone. 4. thyroid hormone.

11. A patient has a positive Chvostek's sign. The nurse will expect laboratory tests to reveal: 1. total serum calcium of less than 8.9 mEq/L. 2. total serum calcium of greater than 1 0.1 mEq/L. 3. ionized calcium of greater than 5.1 mg/dl. 4. total serum potassium of less than 3 mEq/L.

12. Potassium is responsible for: 1. building muscle mass. 2. building bone structure and strength. 3. neuromuscular and cardiac function. 4. maintaining normal blood glucose levels.

13. Neuromuscular signs and symptoms of hypokalemia include: 1. confusion and irritability. 2. diminished deep tendon reflexes. 3. parkinsonian type of tremors. 4. carpopedal spasms.

14. Medications to be given when treating hyperkalemia include: 1. sodium succinate and mannitol. 2. mannitol and regular insulin. 3. sodium polystyrene sulfonate (Kayexalate). 4. antacids.

Because 1 L of fluid equals 2.2 lb (1 kg), a weight change of 2 kg (4.4 lb) will reflect a loss or gain of _______ body fluid

1 liter

When the body senses hypoxemia or hypercapnia (greater than normal amounts of carbon dioxide in the blood), the chemoreceptors in the medulla of the brainstem respond by: 1. slowing the respiratory rate. 2. decreasing the heart rate. 3. increasing the depth and rate of respirations. 4. lowering the blood pressure.

17. Which statements concerning a patient with severe hyperkalemia are correct? (Select all that apply) 1. Cardiac arrest is possible, especially when serum potassium levels reach 7 mEq/L. 2. Administer Kayexalate as prescribed by the physician. 3. Report a urinary output less than 30 mUhr. 4. Monitor vital signs every 12 hours.

1 2 3

18. In acute respiratory acidosis, the renal compensatory mechanisms begin to operate within: 1. 4 to 6 hours. 2. 24 hours. 3. 2 to 3 days. 4. 1 to 2 hours.

19. Daily water intake and output (1&0) is approximately how many ml? 1. 1500 2. 3500 3. 6500 4. 2500

20. It is necessary for the kidneys to secrete a minimum of how many mL/hr of urine to eliminate waste products from the body? 1. 30 mL/hr 2. 60 mL/hr 3. 20 mL/hr 4. 100 mL/hr

The normal pH of blood is approximately _ __ _

7. 35 venous | 7. 45 arterial

Ketoacid accumulation in diabetic ketoacidosis often results in which type of respirations? 1. Cheyne-Stokes respirations 2. Kussmaul's respirations 3. Bradypnea 4. Apnea

STUDY GUIDE

The two fluid compartments in the body are extracellular (interstitial and intravascular) and intracellular. A)true B)false

The majority of fluid in the body is contained in the intracellular compartment. A)true B)false

True

1 L of fluid = 1 kg of body weight A)true B)false

Hypertonic–pulls fluid from cells (shrinks cells) A)true B)false

Hypotonic–fluid moves into the cells (enlarges cells) A)true B)false

Example of Diffusion–Carbon dioxide moves out of cells; sodium moves into nerve cells. A)true B)false

Example of Filtration–kidney function; water and small solutes move out. A)true B)false

Example of Osmosis–maintenance of blood components and plasma A)true B)false

Example of Active transport–Glucose moves into the cells. A)true B)false

The minimum hourly rate for urine output is 30 mL. A)true B)false

The minimum daily urinary output is 600 mL. A)true B)false

Sodium is the major extracellular electrolyte. A)true B)false

Potassium is the major intracellular electrolyte. A)true B)false

Common signs and symptoms of hyponatremia include headache, fatigue, and postural hypotension. Interventions include: measuring I&O, replacing sodium and fluids, and monitoring fluid losses

True

Common signs and symptoms of hypokalemia include muscle weakness, leg cramps, nausea, vomiting, and reduced gastrointestinal function. Interventions include measuring I&O, monitoring patients on digoxin and diuretics, monitoring cardiac status, checking laboratory results, and administering supplements (diet, medications, IV).

True

The most serious problems associated with hyperkalemia are flaccid paralysis, anuria, and cardiac arrest. Interventions include restricting potassium intake, monitoring cardiac status, measuring I&O, auscultating bowel sounds, administering Kayexalate, and checking lab results.

True

Calcium is important for the formation of bones and teeth, blood clotting, neuromuscular activity, and enzyme activation. A)true B)false

Common signs and symptoms of hypocalcemia include nausea, vomiting, diarrhea, tingling, and muscle spasms. Interventions include monitoring vital signs, checking laboratory results, supplementing calcium (diet, medications), and implementing safety measures (seizure precautions, tracheostomy set at bedside).

True

Hypocalcemia Chvostek’s sign Is postive when face twitches A)true B)false

Hypocalcemia Trousseau’s signs is positive when carpal spasms are present A)true B)false

Possible causes of hypomagnesemia include reduced intake, large urinary losses, and impaired absorption (e.g., in alcoholism). Common signs and symptoms of hypomagesemia include mental changes and paresthesias. Interventions include monitoring vital signs, implementing safety measures (seizure precautions), and observing neuromuscular status.

True

Abnormal sensations usually tingling or pricking (pins and needles) A) paresthesias B)false

What is the imbalance of Serum sodium 127 mEq/L called ___________

Hyponatremia 134-142 normal sodium level

What imbalance serum potassium 5.6 mEq/L called _______

Hyperkalemia Normal 3.5-5

What imbalance serum calcium 3.8 mEq/L called _______

Hypocalemia Normal 4.5

What imbalance serum magnesium 2.7 mEq/L called ________

Hypermagnesiema Normal 1.5-2.4

The following factors contribute to hypokalemia: - vomiting - diarrhea - diuretics

True

The patient is experiencing hyperkalemia. The nurse anticipates that the treatment will include A) Fluid restrictions B) Administration of diuretics

Following an auto accident and a significant hemorrhage, the patient was given a large infusion of citrated blood. The patient is assessed for the development of A) Poor skin turgor B) positive chvosteck's sign

Good food sources for both calcium and potassium are A) Green, leafy vegetables B) Whole-grain

Base substance–bicarbonate A)true B)false

Acid substance–carbonic acid A)true B)false

Ratio–20 bicarbonate to 1 carbonic acid A)true B)false

Acid-base balance is regulated by the blood buffers, respiratory system, and kidneys. A)true B)false

The pH goes down if carbonic acid is increased. The respiratory system will respond by increasing the rate and depth of respirations. To balance ph level A)true B)false

The kidneys will eliminate bicarbonate if the pH of the blood increases to a more alkaline state. A)true B)false

The patient has experienced a prolonged episode of diarrhea. The nurse is observing the patient for signs of A) Metabolic acidosis B) Respiratory acidosis

The patient has had emphysema for a number of years. Which of the following arterial blood gas values indicate that the patient is in respiratory acidosis A)pH 7.30, Paco2 50, HCO3 24 B)pH 7.35, Paco2 40, HCO3 22

While in delivery room with his wife, the father to be begins to develop anxiety reaction. Nursing interventions to prevent respiratory alkalosis is to A) Have him breathe into a paper bag B) Lay him down

The child has gotten into the medicine cabinet in the home and ingested the remaining contents of an aspirin bottle. The problem that may occur as a result of this ingestion is A) Metabolic acidosis B) Metabolic alkalosis

The patient has had continuous gastric suction. The nurse suspects a specific acid-base imbalance that can occur with this treatment. This is confirmed by following findings A)pH elevated, Paco2 normal, and HCO3 elevated B)pH elevated, Paco2 elevated, and HCO3 decreased

Newborns have 70% to 80% fluid. This decreases to 45% to 55% in the older adult. A)true B)false

Older adults have changes in their body fluid amount, reduced kidney function, and may have increased sodium in their diet and decreased fluid intake. These individuals are at a greater risk for dehydration and postural hypotension. A)true B)false

Older adults are at a greater risk for dehydration and postural hypotension A)true B)false

Output includes urine, diarrhea, nasogastric suction, drainage, and emesis. A)true B)false

Signs and symptoms of respiratory acidosis include lethargy, disorientation, headache, decreased level of consciousness, dyspnea, tachycardia, and increased blood pressure A)true B)false

Treatment for respiratory acidosis includes intermittent positive pressure breathing (IPPB), low-flow oxygen, antibiotics (for underlying infections, if present), bronchodilators, hydration, and correction of the underlying problem. A)true B)false

Metabolic acidosis may be caused by: diarrhea, diabetic ketoacidosis, kidney dysfunction, and dehydration. Treatment includes correction of the underlying problem and administration of bicarbonate.

True

Metabolic alkalosis may be caused by: vomiting, excessive antacid intake, and gastric suction. Treatment includes correction of the underlying problem and administration of IV solutions.

True

``` Examples of nursing diagnoses include: • Fluid volume deficit or excess • Impaired skin integrity • Decreased cardiac output • Ineffective breathing pattern ``` Patient outcomes include: • Vital signs return to normal/expected range • Weight is stable • No edema • I&O balanced • Clear breath sounds • Laboratory chemistry and arterial blood gas values within normal/expected range

True

Nursing interventions for fluid, electrolyte, and acid-base imbalances include; - checking vital signs - measuring I&O - taking daily weights - checking laboratory results - observing patient status - monitoring IV infusions - administering medications and treatments - promoting appropriate fluid and nutritional intake.

True

The best way for the nurse to determine the patient fluid balance is too A) Weigh the patients daily B) Assess vital signs

For the patient with intracellular dehydration, the nurse anticipates that the patient will receive a A) Hypotonic solution B) Hypertonic solution

A postoperative patient is receiving isotonic IV solution. The patient asked the nurse why is he receiving this solution. The nurse best response is A) This fluid will expand your body fluid volume that has been lost from your surgery B) This is a solution that will pull fluid from the cells into your circulatory system

The nurse is aware that electrolytes serve a variety of purposes, including;( Select all that apply) A) Maintenance of normal body metabolism B) Regulation of water balance in the body C) Regulation of water and electrolyte contents within cells D) Formation of hydrochloric acid in gastric juice

A B C D

The patient has been placed on low sodium diet to assist the treatment of hypertension. The nurse perceives that the patient has understood diet teaching when the patient states A) I love cooked frozen broccoli. I'm glad I was still be able to eat it B) Cheese is a good between meal snack for me

The nurse realizes that the patient bicarbonate level is significant in maintaining A)acid-base balance B) Electrolyte balance

The level of potassium in the extracellular fluid is low because potassium is an intracellular electrolyte. The intracellular level of potassium (usually not measured) is much higher at 150 mEq/L. Of the body's potassium, 98% is in the cells and 2% is in the extracellular fluid. A)true B)false

Approximately 65 mEq of potassium is required each day. A)true B)false

Potassium is widely distributed in natural foods; fruits, such as oranges, bananas, apricots and cantaloupe; legumes; leafy vegetables; potatoes; mushrooms; tomatoes; carrots; and meat are sources of potassium. A)true B)false

The average daily intake of potassium is 60 to 100 mEq. A)true B)false

EXTRA INFORMATION

The very young, the old, and obese are most at risk for A) Dehydration B) Electrolyte imbalance

A head injury patient has been admitted to ICU with dyspnea, tachycardia, tremors, lethargy, and disorientation. The results of an arterial blood gas showed pH = 7.28, PaCO2 = 60 mm Hg, HCO3 = 22 mEq/L. What condition is suspected? A) Respiratory Acidosis B) Respiratory alkalosis

With respiratory acidosis. the pH is < 7.35, PaCO2 is > 45 mm Hg and the HCO3 is normal. A)true B)false

With respiratory alkalosis, the pH is > 7.45, PaCO2 is < 35mm Hg and the HCO3 is normal. A)true B)false

With metabolic acidosis, the pH is < 7.35, PaCO2 is normal or < 35mm Hg, and the HCO3 is below 22mEq/L. A)true B)false

With metabolic alkalosis, the pH is > 7.45, PaCO2 is normal or > 45 mm Hg, and the HCO3 is > 26 mEq/L. A)true B)false

Of all the electrolyte disorders, which disorder is considered the most dangerous and potentially fatal? A)Hypercalcemia B)Hyperkalemia

Hypernatremia causes cellular dehydration and an interruption in cellular processes A)true B)false

Hypercalcemia can depress neuromuscular activity and lead to the development of renal calculi, A)true B)false

Hyperkalemia is an elevated level of potassium and is considered the most dangerous. It can lead to serious arrhythmias or cardiac arrest. A)true B)false

Hypermagnesemia restricts nerve and muscle activity A)true B)false

Your patient is admitted for dehydration. Which type of IV fluid might the physician order to expand the body's fluid volume? A)Isotonic solution B)Hypotonic solution

Isotonic solution is a solution of the same osmotic pressure that expands the body's fluid volume without causing a fluid shift from one compartment to another A)true B)false

Excretion-Process of eliminating waste matter A)true B)false

NORMAL LAB VALVE Chloride 96-105 Calcium 9-10.5 Magnesium 1.5-2.4 Bicarbonate 22-24 (alkaline)

True

Respiratory acidosis Paco2 >45 mm hg (unless pt has COPD) Pao2 normal or <80 A)true B)false

Respiratory alkalosis- Paco2 <35 mm hg, Pao2 normal A)true B)false

Metabolic acidosis-Sodium bicarbonate is usually used for treatment A)true B)false

Methanol, ethanol, formic acid, paraldehyde, and aspirin are drugs that cause A) Metabolic acidosis B) Metabolic alkalosis

Alka-seltzer, soda Bicarbonate are alkaline, so too much can cause metabolic alkalosis A)true B)false

Excess use of mylanta, over use of baking soda, steriods, sodium bicarbonate, and Diuretics cause metabolic alkalosis A)true B)false

INTAKE MEASURE - Oral fluids - Liquid medications - IV fluids - Enternal nutrition

True

OUTPUT MEASURES - Urinary output - Loose bowel movements - Vomitus - Wound or gastric drainage

True

A full container of urine may prevent your patient from voiding as needed, And can affect the accuracy so be sure to empty the urine collector A)true B)false

Patient with burns, potassium level in blood will rise A)true B)false

If cells are damaged by burns or trauma, etc. potassium will be released into the bloodstream A)true B)false

Changes in pH affects potassium A)true B)false

To aid in control of potassium, which hormonal is essential A) Aldosterone B)false

Vomiting and diarrhea can cause potassium to be lost A)true B)false

Osmotic and prolonged loop diuretics cause K and Na loss A)true B)false

Causes of hypercalcemia include osteoporosis, alkalosis, prolonged use of thiazides diuretics etc. A)true B)false

Loop diuretics may be used for hypercalcemia to increase urine output A)true B)false

Normal serum calcium level is 4.5-5.5 A)true B)false

Low calcium observed patient for muscle twitching A)true B)false

Perform chvostek's sign if parathyroid gland has been injured A)true B)false

Patient who has had a thyroidectomy make sure calcium gluconate (IV) is available A)true B)false

Elevated calcium level can be caused by a bone tumor A)true B)false

Hypercalcemia- Calcium moves into the bloodstream causing bones to be brittle and blood developing calculi A)true B)false

Weight bearing and walking mobility can help treat hypercalcemia (Out of the blood into the bones) A)true B)false

Hypermagnesemia the nurse would treat with calcium gluconate (IV) A)true B)false

Hypermagnesemia-Can occur due to chronic renal failure due to the kidneys not excreting because kidneys absorbed magnesium A)true B)false

Decreased pulse and blood pressure is an assessment finding for hypermagnesemia A)true B)false

Treatment of hypochloremia is IV sodium chloride and ammonium chloride A)true B)false

Treatment of hypercholridemia is to treat the cause not with sodium chloride A)true B)false

Phosphorus helps with bone formation A)true B)false

Renal insufficiency is a cause of hyperphospatemia because the kidney can not clear the body of phosphorus A)true B)false

Water-Provides a medium in which chemical reaction or metabolism can occur within the cell. Provide an extracellular transportation route to deliver nutrients to the cells and carry waste products from the cells A)true B)false

Premature infants have 90% water 12 years old to adult have 50% to 60% A)true B)false

Extracellular fluid is lost from the body more rapidly than intracellular fluid A)true B)false

Interstitial fluid-lymph, cerebrospinal fluid, and gastrointestinal secretion Intravascular fluid-Plasma within the vessels A)true B)false

Glomerular filtration rate - Nephrons filter blood at a rate of 125 mL per minute or about 180 L per day - This leads to output of 1 to 2 L of urine

True

Semipermeable membrane-The fat and protein molecules that make up the membrane are arranged so that some substance can enter the cells and others cannot A)true B)false

Osmosis Hypertonic solutions-a solution of higher osmotic pressure. Pulls fluid from the cells. Isotonic solution-a solution of same osmotic pressure. Expands the body fluid volume without causing a fluid shift Hypotonic solution-a solution of lower osmotic pressure. Move into the cell causing them to enlarge

True

Filtration-This is the transfer of water and dissolve substances from an area of higher pressure to an area lower pressure A)true B)false

Substances actively transported through the cell membrane include sodium, potassium, calcium, iron, hydrogen, amino acid, and glucose A)true B)false

Functions of sodium-Regulates water balance, controls extracellular fluid volume, increases cell membrane permeability, stimulates conduction of nerve impulses and helps maintain neuromuscular irritability, controls contractility of muscles A)true B)false

Hyponatremia - Can occur when there is sodium loss or water excess - Body attempts to compensate by decreasing water excretion - patient likely to also have a potassium imbalance due to fluid being moved into the cells and potassium out of the cells

True

Hypernatermia - Can occur when there is a sodium excess or a water loss - Body attempt to correct the imbalance by conserving water through renal reabsorption - Causes fluid to shift from the cells to the interstitial spaces, resulting cellular dehydration

True

Potassium - The routes of potassium excretion are the kidneys, and the feces, and through perspiration - The kidneys controlled excretion of potassium - The main function is regulation of water and electrolyte content within cell

True

Hypokalemia - The major cause of loss is Renal excretion - The kidneys do not conserve potassium and excrete it even when the body needs - Potassium can be depleted due to excess of G.I. losses from gastric suctioning or vomiting and the use of diuretics - This can affect skeletal and cardiac function

True

Hyperkalemia - The major cause of excess potassium is renal disease, severe tissue damage causes potassium to be released from the cell - This can cause cardiac arrest

True

Chloride - normal level is 96-105 mEq/L - It is the chief anion in interstitial and intravascular fluid - Daily requirement is equal to that of sodium - The mayor of excretion is the kidneys

True

Hypochloremia - It usually occurs when sodium is lost, because sodium and chloride are frequently paired - The most common causes of hypochloremia are vomiting, prolonged nasogastric or fistula drainage

True

Hypercholremia | -It really occurs but maybe seen when bicarbonate level falls

True

Calcium - normal level is 4.5 mEq/L - The best food sources are milk and cheese

True

Hypocalcemia - a deficiency may be caused by infusion of excess amounts of citrated blood, excess loss through diarrhea, inadequate dietary intake, surgical removal of parathyroid function, pancreatic disease, or small bowel disease - Signs and symptoms are neuromuscular irritation and increase excitability and tetany

True

Hypercalcemia - It occurs when calcium level exceeds 5.8 mEq/L - neuromuscular activity is depressed and renal calculi may develop

True

Phosphorus - Normal level is 4 mEq/L - Phosphorus and calcium have an inverse relationship in the body, an increase in one causes a decrease in the other - Dietary intake is usually 800 to 1500 mg per day - An adequate intake of vitamin D is necessary for the absorption of both calcium and phosphorus

True

Neuromuscular activity is depressed, and renal calculi may develop because of the excretion of high levels of calcium by the kidneys. A)hypercalemia B)hyperkalemia

Flaccid-soft and hanging loosely or limply A)true B)false

60% water body for males 50% water body for females A)true B)false

Age and gender affect water volume in body A)true B)false

Laxis is used to treat edema A)true B)false

H+ ions are acidic A)true B)false

Water is the primary fluid in the body A)true B)false

Any process that interferes with normal ventilation and causes a decrease or an increase in the excretion of volatile(easily evaporated) acids can cause respiratory acidosis or respiratory alkalosis A)true B)false

Any process that interferes with normal production or excretion of nonvolatile hydrogen ions can cause metabolic acidosis or metabolic alkalosis A)true B)false

If the lungs are unable to regain their ability to correct respiratory acidosis, the kidneys will respond in an attempt to correct the imbalance A)true B)false

If the kidneys are unable to regain their ability to correct metabolic acidosis, the lungs will respond in an attempt to correct the imbalance A)true B)false

A patient that is dehydrated, is usually given an IV or sometimes dialysis to help the kidneys A)true B)false

Lungs and skin are insensible fluid loss A)true B)false

Food that assume a liquid consistency at room temperature - jello - ice cream - pudding - apple sauce

True

A patient with HTN are usually on salt and sugar diet A)true B)false

Sodium and sugar pulls fluid out of the cell and causes dehydration A)true B)false

TPN (total parental nutrition)- supply all the Nutrition needed for your body and given directly in to up your vein(intravenous) A)true B)false

Urine osmolality is a measure of urine concentration, in which large values indicate concentrated urine and small values indicate diluted urine. A)true B)false

You should only use 2 pounds a week when going on a diet A)true B)false

CO2 liquid state is carbonic acid A)true B)false

Active transport Calcium channel blockers Beta blockers

True

Can't go to surgery if K is off A)true B)false

bulimic people can end up with a CARDIC condition because of the excessive amount of potassium loss due to constantly Vomitting A)true B)false

Hypertonic- 3% (dehydration can kill your patient, cause the cell to shrink) Isotonic- 0.9% (blood and normal saline are the only two isotonic) Hypotonic- 0.45% (can be good if the patient cells are dehydrated because hypotonic causes cells to enlarge)

True

Dextrose is food for the cell(D5+h2O or D5+.45 saline) A)true B)false

Hypertonic solution treated for edematous A)true B)false

Hypotonic solution used to treat for dehydration A)true B)false

Isotonic soultion is used to maintain equilibrium A)true B)false

Calcium depletion can lead to personality changes A)true B)false

Hypophospatemia occurs in alcoholics A)true B)false

Postmenoposual women are greatest risk for calcium deficiency A)true B)false

The percent of body fluid loss that can be lethal to the adult is ________%

20%]

Insensible fluid loss-water loss from the lungs, skin, respiratory tract, as well as water excreted in the feces. Is estimated to be between 40-600mL under normal conditions A)true B)false

Fluid volume discrepancies: fluid volume deficit (FVD) in the elderly may be associated with decrease hepatic blood flow A)true B)false

Orthostatic hypotension-assess by evaluating blood pressure in the supine, followed by radial pulse, BP from lying to sitting, to standing A)true B)false

FVD in older adults

Electrolytes are transported by hydrostatic pressure, a form of active transport A)true B)false

Electrolytes are substances that when in solution separate into electrically charged particles A)true B)false

Function of sodium include water balance A)true B)false

Decrease levels of sodium can cause cognitive impairment and may require seizure precautions. A)true B)false

Diet for sodium may include restricted salt, baked chicken and potatoes A)true B)false

Potassium main function is to regulate water and electrolyte content within the cell. A)true B)false

Foods high in potassium include: - Carrots - Spinach - Potatoes - Avocado

True

Expect an elevation in potassium when patient has a renal failure,because the kidneys secrete potassium when working in normal function A)true B)false

Elevated potassium, kayexalate is given so monitor bowel movements A)true B)false

Food sources for calcium include; - Milk - Cheese - Broccoli - Nuts - Canned Salmon - baked cod - Spinach

True

Immobility may cause calcium levels to rise, leading to kidney stones A)true B)false

Low levels of calcium may cause chovsteck's and trousseau sign A)true B)false

Phlebitis is a local infection at the site of an intravenous catheter. Signs and symptoms include redness, pus, warmth, induration, and pain. A)true B)false

An infiltration involves manifestations such as swelling, coolness, and pallor at the catheter insertion site. A)true B)false

A patient who is NPO prior to surgery is complaining of thirst. What is the physiologic process that drives the thirst factor? A)Increased blood volume and intracellular dehydration B)Decreased blood volume and intracellular dehydration

The kidneys are also responsible for acid–base balance, and in the presence of renal failure, the kidneys cannot regulate hydrogen ions and bicarbonate ions, so the patient develops metabolic acidosis. A)true B)false

Persons with type AB blood are often called universal recipients. A)true B)false

When compensation occurs, PaCO2 and HCO3- trend in the same direction.(increase or decrease) A)true B)false

Peripheral IV sites should be rotated every 72 to 96 hours, depending on the institutional protocol. IV insertion sites are not cleansed daily and flushes are not necessary every 6 hours. Hypertonic solution is not used for IV flushes. The smallest gauge that is practical should be inserted in order to minimize trauma. A)true B)false

INTRAVENOUS FLUID COMPARISON

Isotonic solution Dextrose 5% in water (D5W) Uses; - fluid loss - dehydration - hypernatermia Special considerations; - use cautiously in renal and CARDIC patients - can cause fluid overload

True

Isotonic solution 0.9% sodium chloride (normal saline) (NaCl) Uses; - shock - Hypernatremia - Blood transfusions - Resuscitation - Fluid challenges - Diabetic ketoacidosis Special considerations; - can lead to overload - Use with caution in patients with heart failure of a edema

True

Isotonic solution Lactated ringers (fluid expander) Uses; - Dehydration - Burns - Lower G.I. fluid loss - acute blood loss - Hypovolemia due to third spaceing Special consideration; - Contains potassium, don't use with renal failure patient - Don't use with liver disease, can't metabolize lactate

True

Hypotonic solution 0.45% sodium chloride (1/2 normal saline) Uses; - Water replacement - Diabetic ketoacidosis - gastric fluid loss from NG or vomiting Special consideration; - Use with caution - May cause cardiovascular collapse or increased intracranial pressure - Don't use with liver disease,trauma, or burns

True

Hypertonic solution Dextrose 5% in 1/2 normal saline Uses; -later in DKA treatment Special considerations; -use only when blood sugar falls below 250 mg/dL

True

Hypertonic solution Dextrose 5% in normal saline Uses; - temporary treatment for shock if plasma expanders aren't available - Addison's crisis Special considerations; - dont use in CARDIC or renal patients

True

Hypertonic solution Dextrose 10% in water Uses; - Water replacement - conditions where some nutrition with glucose is required Special considerations -monitor blood sugar levels

True

Extra information part 2

Lungs Respiratory acidosis (CO2 level goes up) PH-7.25 PcO2-47

True normal range of CO2 is 35-45

Lungs Respiratory alkalosis (CO2 level goes down) PH-7.50 Co2-30 Sign would be hyperventilation Interventions - Rise the head of the bed - slow down respirations with paper bag or hand

True

Normal range for CO2 is 35-45 A)true B)false

Kidneys Metabolic acidosis (HCO3 level goes down) PH-7.20 HCO3-7.50

True

Kidneys Metabolic alkalosis (HCO3 goes up) PH-7.50 HCO3-30

True normal range of HCO3 22-26

Normal range for HCO3(bicarbonate) 22-26 A)true B)false

True

The more acid you have the more bicarbonate you need to balance out A)true B)false

Compensated-means that the kidneys or the lungs are compensating for one another, but is only compensating when pH is between 7.35-7.45 and the co2 or the HcO3 levels would be high or low A)true B)false

Uncompensated means that the kidneys or the lungs are unable to compensate the body's pH or Co2 or HcO3 levels and there for would be lower than 7.35-7.45 A)true B)false

PH-7.37 PaCO2-29 HCO3-17 A)compensated metabolic acidosis B)uncompensated metabolic acidosis

K lab value is 2.9, the patient will have metabolic alkalosis because the patient is experiencing nausea, Vomiting, and overall weakness A)true B)false

PaO2 Normal range is from 80-100 A)true B)false

ABG's means arterial blood gas A)true B)false

Signs and symptoms of mild fluid loss includes - orthostatic hypotension - restlessness - anxiety - weight loss - increased heart rate

True

Influences on electrolyte balance - normal cell function - fluid intake and outtake - acid base balance - hormone secretion

True

Immeasurable fluid losses are the skin and the lungs A)true B)false

What excrete sodium, potassium, chloride, and water in sweat A)sweat glands B)false

Influences enzyme reactions, neuromuscular contractions, normal functioning of nervous and cardiovascular system, protein synthesis, and sodium and potassium ion transportation A)magnesium B)potassium

Regulated cell excitability, nerve impulse conduction, resting membrane potential, muscle contraction, myocardial membrane responsiveness and intracellular osmolatiy A)potassium B)sodium

Secrete aldosterone, which influences sodium and potassium balance in the kidneys A)adrenal glands B)false

Regulate sodium and potassium balance A)kidneys B)false

Fluid Types are - Hypertonic - Isotonic - Hypotonic

True

Maintains osmotic pressure and helps gastric mucosal cells produce hydrochloric acid A)chloride B)calcium

Reacts with acids and bases to form compound that alter pH, especially effective in renal tubules. A)phosphate buffer system B)false

Buffers blood and interstitial fluid A)bicarbonate buffer system B)false

Protein buffer systems depend upon proteins, as opposed to nonprotein molecules, to act as buffers and consume small amounts of acid or base. A)true B)false

Sensible fluid losses are measurable and include urination, dedication and wounds A)true B)false

Transcellula fluid-in the CSF column, pleural cavity, lymph system, joints, and eyes, remains relatively constant A)true B)false

The effects of diuretics-treat hypertension, heart failure, electrolyte imbalances and kidney disease, increase urine productions. A)true B)false

Parathyroid glands secrete parathyroid hormone, which draws calcium into the blood and helps move phosphorus to the kidneys for excretion A)true B)false

Kidneys excrete or retain acids or bases A)true B)false

What is plasma A)the liquid portion of the blood B)the amount of blood

Fluid leaves the body by the kidneys,lungs,skin and GI tract A)true B)false

How much fluid intake should a person have each day A)2.5L B)1 L

Hypophospatemia - Can occur from a dietary insufficiency, kidney function, or maldistribution of phosphate - Muscle weakness is possible

True

Hyperphospatemia - Most commonly occurs as a result of renal insufficiency, also can occur with increased intake of phosphate or vitamin D - Signs and symptoms;tetany, Numbness and tingling around the mouth, and muscles spasms

True

Magnesium - The majority is found in bone, muscle, and soft tissue - Dietary intake is usually 200 to 400 mg per day - It is commonly distributed foods; Whole grains, fruits, vegetables, meat, fish, legumes, and dietary products - The major route of excretion is the kidneys

True

Hypomagnesiema - a decreased level often parallels decreased potassium - Signs and symptoms: Increase neuromuscular irritability similar to those observed with hypocalcemia - Major causes are increased excretion by the kidney, impaired absorption from the G.I. tract, and prolonged malnutrition

True

Hypermagnesemia - It rarely occurs when kidney function is normal - Major causes are impaired renal function, excess magnesium administration, and diabetic ketoacidosis when there is severe water loss - An excess of magnesium severely restriction nerve and muscle activity

True

Bicarbonate - a main anion of the extracelluar fluid - Normal level is 22 to 24 mEq/L - It is an alkaline Electrolyte whose major function is the regulation of the acid-base balance - The kidneys selectively regulate the amount of bicarbonate retained or excreted

True

Respiratory acidosis - a retention of carbon dioxide occurs with a resultant increase of carbonic acid in the blood - As the pH falls, the PCO2 level increases - Shallow respirations result because of retained carbon dioxide - Treatment is aimed at improving ventilation and corrected the primary condition responsible for the Imbalance

True

Which of the following is considered in the daily output of a patient A)chest tube drainage B)stools

This occurs when a patient is hypocalcemia A)tetany B)blood loss

A | Because calcium is used for muscle contraction and relaxation

Respiratory alkalosis - This is caused by hyperventilation - respiration that increase in rate, depth, or both can result in loss of excess amounts of carbon dioxide with a resultant lowering of the carbamic acid level blood - PH rises because the decrease in carbonic acid being blown off with each exhalation - Treatment is sedation and reassurance, breathing into a paper bag will cause rebreathing of the exhaled carbon dioxide

True

A pregnant female should increase this nutrient in her diet A)phosphorus B)sodium

Hyperkalemia is treated with kayelate A)true B)false

Chvostek's and trousseau sign tests for hypocalcemia A)true B)false

Metabolic acidosis causes - dehydration - starvation - diabetic ketoacidosis

True

Daily requirement of chloride is equal to that of sodium A)3.65-10.85 g/day B)false

Daily potassium requirement A)65 mEq B)false

Renaming 1% of calcium is found in A)soft tissue, extracelluar fluid B)false

Hypernatermia causes fluid to shift from the cells to the ___________ resulting in cellular dehydration and interruption in cellular process A)interstitial sspaces B)hypertonic

Daily requiment of phosphorus is A)800-1500mg B)false

COPD, pneumonia and compromise to any 3 essential parts of breathing (ventilation,perfusion or diffusion) are causes of what A)respiratory acidosis B)filtration

Hypercalcemia occurs when calcium exceed A)5.8 B)4.5

Lethargy,occipital headache, pH less than 7.5. CARDIC dysrhythmias are s/s of A)respiratory acidosis B)filtration

Respiratory acidosis and respiratory alkalosis share a common name, what is it A)pneumonia B)filtration

Metabolic acidosis - muscle twitching - anorexia - nausea,diarrhea - deep and rapid respiration (lungs trying to compensate by blowing of CO2) - hyperkalemia

True

Metabolic alkalosis - general weakness - muscle cramps - vomiting - hyperactive reflexes - shallow and slow respiration (lungs are trying to compensate CO2, by retaining it)

True

Respiratory acidosis - muscle twitching - tremors - seizures - coma - restlessness

True

Respiratory alkalosis - confusion - tingling in extremities - dizzy

True

Respiratory alkalosis - dizzy - tingling in the extremities - respiration rapid ex:34/min (hyperventilation)

True

Metabolic alkalosis - nausea and Vomiting - slow and shallow respirations - hypokalemia - overall weakness

True

Metabolic acidosis | -diarrhea

True

Respiratory acidosis - shallow and slow respiration (hypoventilation) - rapid HR - profuse bleeding from ears

True

Magnesium measures nerve and muscle activity to much can restrict the activity and to little can cause over excitement seen in hypocalcemia A)true B)false

Sodium,chloride and bicarbonate are all extracelluar fluids A)true B)false

Potassium may be administered through the oral route. Potassium is never administered by IV push or intramuscularly to avoid replacing potassium too quickly A)true B)false

Half-strength saline is hypotonic. Lactated Ringer's solution is isotonic. Normal saline (0.9% NaCl) is isotonic. A solution that is 5% NaCl is hypertonic.

True

Which of the following solutions is hypotonic? ``` Choose one of the following A Lactated Ringer's solution B 0.45% NaCl C 0.9% NaCl D 5% NaCl ```

The management goal in hypervolemia is to reduce fluid volume. For this reason, fluid is rationed and the patient is advised to take a limited amount of fluid when thirsty. Sweet or dry food can increase the patient's desire to consume fluid. A)true B)false

Metabolic acidosis - This can result from a gain of hydrogen ions or a loss of bicarbonate, retaining too many acids or losing too many bases - Without significant bases, the pH of the blood falls below normal, the bicarbonate level will also drop - The effect is hyperventilation, as the lungs attempt to compensate by blowing off carbon dioxide to lower the PCO2 level - Treatment is the administration of sodium bicarbonate

True

Metabolic alkalosis - This results when a significant amount of acid is lost from the body or increase in bicarbonate level occurs - The most common causes vomiting gastric content, normally high and acid - It can also occur in patients who ingest excessive amounts of alkaline agent, such as bicarbonate containing antacids - The central nervous system is depressed

True

Hypokalemia patient will have s/s of diminished deep tendon reflexes A)true B)false