Unit Exam 1 Flashcards
Are Dependent on dynamic processes that are crucial for life and homeostasis
Fluid and electrolyte balance
Plasma composed of how many percent
92%
Body fluid is located into fluid compartments
Intracellular space and extracellular space
2/3 of body fluid is in the
Intracellular fluid (ICF)
1/3 of body fluid is in the
Extracellular fluid (ECF)
The ECF compartment is further divided into
Intravascular, interstitial and transcellular fluid
Space that contains plasma, the effective circulating volume
~3L of the average 6L of blood volume in adults is made up of plasma
Intravascular space
A space that contains the fluid that surrounds the cell and totals about 11 to 12 L in an adult
Interstitial space
A space that is the smallest division of the ECF compartment and contains approximately 1 L
Transcellular space
What are the two major compartments
ICF and ECF
Sodium, potassium, calcium, magnesium, and hydrogen ions
Major cations in the body
Chloride, bicarbonate, phosphate, sulfate and negatively charged protein ions
Major anions in the body
The diffusion of water caused by fluid and solute concentration gradients is known as
Osmosis
Is the number of Miliosmoles of solute per kilogram of solvent
Osmolality
Is the number of Miliosmoles per liter of solution
Osmolarity
Is the pressure exerted by fluid on the walls of the blood vessel
Hydrostatic pressure
Is the pressure exerted by the solute’s with in the plasma
Osmotic pressure
Is fluid consisting of non-soluble substances that are evenly distributed within a solvent
Colloid
Are mineral ions dissolved in water
Crystalloid solutions
Normal Saline (0.9 % NaCl)
Half Normal Saline (0.45 % NaCl)
Lactated Ringer’s solution (Plasma-Lyte)
Examples of crystalloid solutions
Albumin Solutions
Hyperoncotic starch
Dextran
Examples of colloid solutions
Is the ability of solutes to cause an osmotic driving force that promotes water movement from one compartment to another
Tonicity
Are composed of 0.9% NaCl
The same sodium and chloride concentration as the bloodstream and the same water concentration as the bloodstream
Do not provoke water movement between ICF or ECF compartments
Expand the plasma volume of the blood
Isotonic solutions
Are composed of less sodium chloride concentration compared to the blood
0.45% NaCl or 0.225% NaCl
Contain less solute but more water than the bloodstream
Hypotonic solutions
Are composed of greater concentration of NaCl Compared to blood
Contain more solute concentration and less water than the bloodstream
Hypertonic solutions
Is the increase in urine output caused by the excretion of solutes such as glucose or mannitol
Osmotic diuresis
Is a laboratory value that measures the amount of urea in the bloodstream 
BUN
Is a breakdown Product of muscle metabolism that is almost totally cleared from the bloodstream and excreted by the kidneys
Creatinine
Measures the percentage of red blood cells
Hematocrit
Is the rapid loss of body weight due to the loss of either water or sodium 
Dehydration
Other term for hypovolemia
Fluid volume deficit
Occurs when loss of ECF volume exceeds the intake of fluid
Hypovolemia
Normal BUN to and creatinine concentration ratio
10:1
Refers to an expansion of the ECF caused by the abnormal retention of water and sodium in approximately the same proportions in which they normally exist in the ECF
Hypervolemia or FVE
The most abundant electrolyte in the ECF
Sodium
Normal values of sodium
135-145 mEq/L
Earliest manifestation of hypovolemia
Thirst
What is CVP
Central venous pressure
Normal CVP
8-12 mmHg
It is the pressure of your vena cava; reflects your right atrium perfusion
CVP
What should you give If the patient experiencing cramping during dialysis
Give Chippy or food that is high in sodium
An emergency situation where the heart is unable to pump enough blood to the body due to significant blood or other fluid loss
Hypovolemic shock
Where is the site of absorption of potassium in the body
Small intestine (duodenum)
Site of obstruction of sodium in the body
jejunum
Other term for generalized edema
Anasarca
Medical term for swelling brought on by fluid entrapment in human tissues
Edema
Famous colloid solutions
BLOOD BYPRODUCT
-Fresh whole blood
-Platelet concentration
-Plasma expander
Give crystalloid when patient is
Unable to eat and cannot absorb food
Water intoxication
Consumes too much water without electrolytes
Dilutional Hyponatremia
3 factors that lead to hyponatremia
Excessive diarrhea
Excessive vomiting
Diaphoresis
What is ICP
intracranial pressure
How to determine hyponatremia
Diagnostic test:
BUN
Potassium
Calcium
Magnesium
Phosphate
How to treat hyponatremia
Give hypertonic solution 
contraindicated for patients with seizure
Vaprisol
Safe to give to Seizure patients
tolvaptan
Prominent cause of hypernatremia
Crackles
Normal value of Potassium
3.5-5.0 mEq/L
Three components of sweat
Sodium
Potassium
Chloride 
Accounts 98% in ICF
2% in ECF
Potassium
Percent of potassium excreted daily
80%
Potassium imbalances that is caused from medications
NSAIDS and ACE inhibitors
Normal Value of Calcium
8.5-10.2 mEq/L
Normal Value of Magnesium
1.3-2.3 mEq/L
Magnesium salt includes
Calcium Oxide
Normal Value of Phosphorus
2.5-4.5 mEq/L
Normal Value of Chloride
97-107 mEq/L
Major anion in ECF
Chloride
pH
7.35 - 7.45
Acid < > Alklaline
PaCO2
35 - 45 mmHg
Alkaline < > Acidosis
HCO3
22 - 26 mEq/L
Acid < - > Alkali
Two problems in hypovolemia
Sodium and potassium
Responsible for stress responses
Adrenal
The specific urine gravity of hypovolemia increases or decreases?
Increases
A good provider of sodium balance
Adrenal
HYPOVOLEMIA:
BUN + Creatinine ratio
High; 1:1
HYPOVOLEMIA:
Hematocrit is…
Declined
Major electrolyte inside and outside
Sodium and potassium
Hypovolemia Gerontologic Considerations
I and O
-1000 ml intake; output 980-1000 ml
Weight
Filling of the veins assessment
Functional ability
Verbalization of feelings
Fluid intake
What solution expands plasma volume
Isotonic solution (LR and 0.9% NaCl)
HYPOVOLEMIA:
What is your first line of defense if there is an increased blood pressure 
LR and 0.9% NaCl
What solution would you give if blood pressure is within normal limits
0.45% NaCl
Restlessness, Agitation, anxiety, Pallor, Clammy skin
Compensated shock
Alterations in mental status
Tachycardia
Tachypnea
Labored and irregular breathing
Week to absent peripheral pulses
A decrease in body temperature
Cyanosis
Decompensated shock
A shock that is in Terminal stage
Compensatory mechanism is failed
Irreversible shock
A mask that is good for emergency situation
Rebreather mask
Retains water and sodium that cause swelling
Hypervolemia
Medication that causes edema
Nephrotoxic medication
NSAIDs
Corticosteroid
Antihypertensive medication
This is to generate the oncotic pressure to prevent swelling in spaces
Expander or 20% human albumin
What do you mean by settling of blood
Set aside the blood in room temperature aron mosaka ang plasma
What type are electrolytes
Isotonic
Decrease in sodium and extra cellular spaces
Aldosterone deficiency
ICP normal Value
10 to 20 mmHg
Why is water supplement avoided
To prevent congestion of lungs
2 T as Early signs of hypernatremia
Elevated temperature
Elevated thirst
Late signs of hypernatremia
Cognitive impairment
Medical management for hypernatremia
-Hypotonic solution (or isotonic D5W When water is replaced alone)
-Diuretics
-Desmopressin

Fatigue
Sluggish bowel syndrome or decreased bowel mobility
Paresthesia
Ventricular asystole or flatline
Clinical signs of hypokalemia
Conventional treatment for hypokalemia
Daily diet intake
Oral potassium
If hypokalemia is not treated with conventional treatment
Have an IV replacement therapy
Do not give IV push when giving potassium instead…
Use infusion pump
First assessment for hyperkalemia
ECG
Emergency drug for hyperkalemia
Calcium gluconate
ECG 
Atrial depolarization
Ventricular depolarization
Atrial repolarization
Ventricular repolarization
Calcium percentage
99% located in skeletal system long bones and teeth
1% skeletal calcium
Emergency drug for hypercalcemia
Calcitonin
Hypocalcemia is prone to
Elderly people
—because of decreased calcium and prolonged bed rest
Early signs of hypocalcemia
Tetany (Chvostek & Trousseau)
Torsades de pointes means
Tachycardia or fast heart rhythm
Pharmacological treatment for hypocalcemia
Calcium chloride
Calcium gluconate
What should not be given to hypocalcemia patients
0.9% sodium chloride
Develop renal stones inside the kidneys

Hypercalcemia
Common predisposing factors of hypercalcemia
Grave’s disease
Malignant bone tumor 
Emergency drugs for hypercalcemia
Calcium gluconate and potassium chloride
Long-term drug for hypercalcemia
Biphosphate
Short term drug for hypercalcemia
Calcitonin
ABG of patient if calcium is decreased
Acidotic
Last resort for hypercalcemia
Dialysis
Prevention for hypercalcemia
Hydration
Safety
Avoid calcium medications
Avoid foods high in Calcium
Can occur with GI and renal losses as these organs are major regulators of potassium
Hypokalemia
Can occur with adrenal insufficiency due to aldosterone deficiency which causes lack of potassium excretion
Hyperkalemia
Can occur with increased thirst and ADH release, which increases water content of the bloodstream
Hyponatremia
Can result from increased insensible water losses and diabetes insipidus
Hypernatremia
A hormone in the hypothalamus that prevents increased ECF osmolarity
Vasopressin
Etiologies associated with hypocalcemia except
Metastatic bone lesions
Clinical signs of hyponatremia/ low sodium
Dry skin
Nausea
Orthostatic hypotension
Foods that are rich in magnesium
Cauliflower (green leafy veggies)
Peanut butter
Canned tuna
Beans
Lentils
White potatoes
Wheat bran
Dry roasted almonds
High-risk for fluid volume deficit
Low suction
What to anticipate after giving 25% albumin with hypovolemic shock
Increased BP
FVE neck appears to be
Distended
Following hormones that Don’t help in the balance of fluid
PTH
Assessing electrolyte imbalance of low potassium may cause
Hyporeflexia 
Not a manifestation of fluid volume congestion
Capillary refill six seconds
Normal Urea
6-24 mg/dl
Normal Creatinine in Male
0.6-1.04 mg/dl
Normal Creatinine in Female
0.1-1.25 mg/dl
Uric acid male
3.4-7 mg/dl
Uric acid Female
2.4-6 mg/dl
Urine Specific Gravity
1.010-1.025
Lithium Toxicity
0.6-1.2 mEq/L
An isotonic solution that expands extracellular Fluid volume; used in hypovolemic states, resuscitative efforts, Shock, DKA, Metabolic alkalosis, hypercalcemia, mild sodium deficit
0.9% NaCl
An isotonic solution used in the treatment of hypovolemia, burns, fluid loss as bile or diarrhea, and for acute blood loss replacement
Should not Be used in kidney injury because it contains potassium and can cause hyperkalemia
Lactated Ringer’s Solution
An isotonic solution used in treatment of hypernatremia, fluid loss, and dehydration
D5W
A hypertonic solution used to increase ECF volume, decrease cellular swelling
Highly hypertonic solution used only in critical situations to treat hyponatremia
3% NaCl
Four types of stones in hypercalcemia
Calcium oxalate
Uric acid
Struvite
Cystine
A stone that is commonly present in all calcium foods
Calcium oxalate
Stone that is a breakdown of urine and causes arthritis
Uric acid
A stone that is less common and prone to UTI patients
Struvite
A stone that is hereditary and the primary assessment is Genogram
Cystine
It is a test to get urine specimen to assess ability of kidney to excrete calcium
Sulkowitch Test
Normal urine color
Pale to dark amber 
Abnormal urine color
Darker amber
Route of administration for calcitonin
Intramuscular
Why wouldn’t you give calcitonin to subcutaneous route
SubQ doesn’t absorb calcium
When should you ambulate a patient with hypercalcemia
Ambulate as soon as possible
Food for hypercalcemia that is high in enzyme and fiber
Papaya
Most abundant cation inside the cell
Magnesium
Magnesium helps in synthesis of two products
Protein and carbohydrates
Common problem of magnesium deficit
Muscle wasting
Associated with hypokalemia and hypocalcemia
Causes significant decline of albumin
Hypomagnesemia
Antidote for digoxin toxicity
Digibind
Determines the quantity of magnesium
NMR Spectrometer 
Where to administer magnesium sulfate
Eclamptic -outer quadrant sa lobot
Dili eclamptic -IV infusion
What combats magnesium toxicity
Calcium gluconate
Most common problem for hypermagnesemia
Renal failure
Common problem for hypomagnesemia
Alcoholism
Flushing
Hypotension
Weakness
Drowsiness
Hypoactive reflexes
Depressed respiration
Clinical manifestation of hypermagnesemia
Risk for thrombocytopenia
Something of platelet
Normal creatinine clearance
Male: 97-137
Female: 88-128
Emergency drug for hypermagnesemia
Calcium gluconate
Cause fluid transhifting
Burns
Good source of chloride
Tomato juice
Two sites that determines arterial and circumflex assessment
Radial and femoral
Last resort: Brachial
Radial gauge
Gauge 22
Femoral gauge
Gauge 20
Repercussions to acid-base
Bruising/Hematoma
Increased bleeding
ABG contraindication
Peripheral vascular disease
Cellulitis and low platelet
Heparin medication
What test should you perform before taking ABG
Modified Allen test
A test to determine collateral arterial supply of four major arteries of the heart
Allen test
SIADH
Syndrome of inappropriate secretion of antidiuretic hormone
Primarily occurs due to an imbalance of water rather than sodium
Hyponatremia
The ECF volume has excess water but there is no EDema and the excess water dilutes the sodium
Dilutional hyponatremia
Although the patient with SIADH retains water abnormally there is no Peripheral Edema; instead, Fluid accumulates inside the cells. This phenomenon sometimes manifests as
Pitting Edema
Hyponatremia Sodium Replacement:
For patients who can eat and drink sodium can be easily replaced through
Normal diet
Hyponatremia Sodium Replacement:
What should you give for those who cannot consume sodium
LR or 0.9% NaCl
A common cause of hypernatremia
Fluid deprivation in patients who do not respond to thirst
Clinical manifestations of hypernatremia are due to
Increased plasma osmolality caused by an increase in plasma sodium concentration
A primary characteristic of hypernatremia
Thirst
What potassium losing diuretics can induce hypokalemia
Thiazides
Loop Diuretics
A treatment for seizure that have side effects that increase the risk of hyponatremia
Anticonvulsant
Flat or inverted T-wave
Prominent U wave
Depressed ST segment
Prolong PR interval
Wide QRS
Hypokalemia
Hyperkalemia increases sensitivity to
Digitalis
Commonly associated with hypokalemia
Metabolic alkalosis
Foods high in potassium
Banana
Melon, citrus fruits
Legumes
Whole grains
Milk
Lean Meat
A potassium imbalance that seldom occurs in patients with normal renal function
Hyperkalemia
What causes hyperkalemia
Iatrogenic causes
Who are at risk for hyperkalemia because of a lack of aldosterone
Hypoaldosteronism or Addison disease
Major causes of hyperkalemia
Decreased renal excretion of K
Rapid administration of K
Movement of K from the ICF to the ECF compartment
What do you call a false hyperkalemia
Extraction of blood is improper
Pseudohyperkalemia
Tall/narrow T-wave
Prolong PR interval
Prolong/wide QRS
Absent P-wave
Depressed ST segment

Hyperkalemia
Emergency drug for hyperkalemia
Calcium gluconate
Foods with minimal potassium content
Butter/margarine
Cranberry juice or sauce
Ginger ale
Gum drops/jellybeans
Root beer
Sugar and honey
Percent in calcium
99% skeletal system (bones&teeth)
1% skeletal calcium/blood calcium
Prolong QT interval
Prolong ST segment
Torsades de pointes
Hypocalcemia
Is associated with the prolongedLow intake of calcium and represents a total body calcium deficit even if calcium levels are usually normal
Osteoporosis 
IV administration of calcium is dangerous in patients receiving
Digitalis medications
Foods rich in calcium
Milk products
Green leafy vegetables
Canned salmon/sardines
Fresh oysters
Common causes of hypercalcemia
Malignancies
Hyperparathyroidism
Refers to an acute rise in the serum calcium level
Severe thirst and Polyuria are often present
Hypercalcemic crisis
Short QT interval
Short ST segment

Hypercalcemia
HYPERCALCEMIA:
2 Cs to find during xray
Calcification of bones
Calculi (stones)
Abundant intracellular cation
Magnesium
Major cause of symptomatic hypomagnesemia
Chronic alcoholism
Hypomagnesemia is associated with
Hypocalcemia and hypokalemia
Tetany can also occur in
Hypomagnesemia
1/3 & 2/3 of Mg goes into
1/3 goes into protein
2/3 are excreted
Common signs of hypomagnesemia
G.I. dysfunctioning
Excessive diarrhea
Fistula
Tall/inverted T-wave
Depressed ST segment
Prolonged PR
Wide QRS
Hypomagnesemia
What may help identify the cause of magnesium depletion
Urine magnesium
Common cause of hypermagnesemia
Kidney injury or renal failure
If patient has severe hypermagnesemia
Discontinue oral medication
Primary anion of the ICF
Phosphorous
Less common electrolyte imbalance is
Hypophosphatemia and hyperphosphatemia
Malabsorption of phosphorus
RESIN
Signs and symptoms of phosphorus deficiency result from a deficiency of
ATP
2,3-diphosphoglycerate
Rhabdomyolysis
Impairs cellular energy resources
ATP deficiency
Impairs oxygen delivery to tissues, resulting in generalized weakness and neurologic manifestations
Diphosphoglycerate deficiency
Foods high in phosphorus
Dairy foods
Organ Meat
Beans
Nuts
Fish
Poultry
Whole grains
TRUE OR FALSE
Calcium and phosphorus are inversely related
True
Most common condition that can lead to hyperphosphatemia which diminishes urinary phosphate excretion
Kidney injury or renal failure
Phosphate binders that can be used to lower blood phosphate levels
Calcium carbonate or calcium citrate
Can occur with G.I. tube drainage, gastric suctioning, gastric surgery, and severe vomiting and diarrhea
Hypochloremia
Signs and symptoms of hypochloremia
Hyponatremia
Hypokalemia
Metabolic alkalosis
What are lost along with chloride
Sodium and potassium
What are given by IV to replace the chloride
0.9% or 0.45% NaCl
And acidifying IV agent that may be prescribed to treat metabolic alkalosis and hypochloremia
Ammonium chloride
Foods with high chloride 
Tomato juice
Bananas
Dates
Eggs
Cheese
Milk
Salty broth
Canned vegetables
Processed meat
Signs and symptoms of hyperchloremia
Hypervolemia
Hypernatremia
Metabolic acidosis
And IV solution that may be given to restore balance in chloride
Hypotonic solution
An indicator of hydrogen ion concentration and measures the acidity or alkalinity of the blood
Plasma pH
Prevent major changes in the pH of body fluids by removing or releasing hydrogen
They can act quickly to prevent excessive changes in hydrogen concentration
Buffer System
The body’s major extracellular buffer system
Bicarbonate-carbonic acid
It is a potential acid
When dissolved in water, it becomes carbonic acid
CO2
What organ is under the control of medulla
Lungs
The substances that yield hydrogen
Acid
When hydrogen interacts with water
Protons
Centrifuge tube
Naay gel
Naay potassium
Yellow
Not a centrifuge type
Walay gel
Walay potassium
Red
The one that would accept hydrogen
Base
4 integral elements of acids and bases
HCl
Carbonic acid
PCO2
Bicarbonate 
Associated with preventing doing everything right
Maintains balance of PCO2 and HCO3
Buffer system
What are the three buffer systems

Bicarbonate buffer
Phosphate buffer
Bone buffer
Tenacious to nature
Responsible for 80% in intracellular system; plasma and bicarbonate
Bicarbonate buffer
Buffer means
Mediator 
What percent accounts to protein buffer
75%
Has a role in intracellular buffering
One present in tubular
Enables to excrete hydrogen
Phosphate buffer

Without phosphate buffer urine would be
Acidic
40% in acid and base environment
For chronic loading cell use for loading system for interstitial compartment
Bone buffer
What is the master gland responsible for PCO2
Medulla oblongata
Two types of buffer system
Lungs
Kidneys
Hypocapnia
Hyperventilation
Alkalosis
Hypercapnia
Hypoventilation
Acidosis
Common factor of respiratory acidosis
Respiratory failure
Result in hypoventilation thus naay hypercapnia
Acidotic
Management of care for respiratory acidosis
Identify predisposing factor
Assess airway and ABG
Chest physiotherapist
ET tube attached to mechanical ventilation
Supplemental oxygen
Antibiotics
Nursing care plan for respiratory acidosis
Impaired gas exchange
Airway management position
Semi Fowler position
Side lying position
Position best for collapsed lung
Side lying position
The most common cause of respiratory alkalosis
Anxiety
More crucial because it revamps in just minutes (10 minutes)
Respiratory alkalosis
What would you do if patient has memory loss
Notify the physician
Respiratory alkalosis nursing care plan
Ineffective breathing pattern

What would you do if ST is depressed
Notify the physician
A sedative medication for respiratory alkalosis
Benzodiazepine
A nonchalant problem
Silent but disorganized problem
Escalation of Ketones and excess of hydrogen
Metabolic acidosis
Identifier of metabolic acidosis or the common cause
Renal failure
Metabolic acidosis nursing care plan
Decreased cardiac output
Common cause of metabolic alkalosis
G.I. suctioning
Buzzing or deafening
There is excess sodium bicarbonate
Metabolic alkalosis
Fecal test that determine GI bleeding
Occult test
Conventional treatment for metabolic alkalosis
K supplement
Isotonic therapy for metabolic alkalosis
KCl
Indication for congestive heart failure 
Acetazolamide
