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Nursing Science 3 > WEEK 2 - Fluid Electrolyte Balance > Flashcards

WEEK 2 - Fluid Electrolyte Balance Flashcards

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1
Q

What are some functions of calcium? (x5)

A
  1. Normal coagulation
  2. Nerve conduction
  3. Bone density
  4. Contraction/relaxation of muscles
  5. Hormone secretion - insulin
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2
Q

Where is calcium found and in what proportions?

A

99% in bone

1% in plasa

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3
Q

Normal TOTAL calcium concentration?

A

2.1-2.6 mmol/L

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4
Q

Changes in which protein effect calcium levels?

A

Serum albumin

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5
Q

Describe the effects of acid-base balance of calcium?

A
  • In metabolic and respiratory acidosis = increased serum Ca and decreased binding capacity to albumin
  • In metabolic and respiratory alkalosis = decreased serum Ca and increased binding capacity to albumin
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6
Q

What are some causes of hypocalcaemia? (x6)

A
  1. Hypoalbuminaemia
  2. PTH deficiency
  3. Chronic renal failure
  4. Vitamin D deficiency
  5. Excess loss eg. rhabdomyolysis
  6. Drugs
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7
Q

What are some signs and symptoms of hypocalcaemia?

A
  • Irritability, confusion, depression and psychosis
  • Prolonged QT interval on ECG
  • Hypotension that is not responsive to IVF/vasopressors
  • Hyperreflexia
  • Parasthesias, intestinal cramps
  • Tetany
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8
Q

What is Chvostek’s sign and what does it indicate?

A

Contractions of facial muscles in response to a light tap over the facial nerve in front of the ear - indicates hypocalcaemia

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9
Q

What is Trousseau’s sign and what does it indicate?

A

Carpal spasm induced by inflating a BP cuff above systolic pressure for a few mins, hand goes back to normal once cuff is removed - indicates hypocalcaemia

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10
Q

How to treat mild hypocalcaemia?

A
  • Vitamin D preparations
  • Oral Ca
  • Increase dietary intake of Ca
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11
Q

How to treat severe hypocalcaemia?

A
  • Parenteral Ca infusion VIA A CENTRAL LINE ONLY

- Pulmonary and cardiovascular support

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12
Q

Causes of hypercalcaemia?

A
  • Increased intestinal absorption
  • Excessive skeletal calcium release
  • Inadequate Ca excretion
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13
Q

False highs of calcium may be caused by? (x2)

A
  • Hyperalbuminaemia

- Haemoconcentration

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14
Q

What are some signs and symptoms of hypercalcaemia?

A
  • Bone destruction
  • Lethargy and muscle weakness in the lower extremities
  • Impaired kidney function and renal calculi
  • ECG abnormalities - short QT interval, prolonged PR interval, wide QRS, flattened/inverted T waves, arrhythmias
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15
Q

Treatment for hypercalcaemia?

A
  • HYDRATION - dilute serum Ca and promote urinary excretion of Ca
  • IV isotonic saline = 6L/24hrs
  • Loop diuretics
  • Bisphosphonates to decrease bone reabsorption
  • Calcitonin to decrease bone resorption and increase urinary excretion
  • Dialysis for renal failure
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16
Q

How is phosphorus related to calcium?

A

Has an inverse relationship with calcium

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17
Q

Where is P found?

A
  • 1% in blood
  • 10% in muscle
  • 85% combined with calcium in bones and teeth
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18
Q

How is P absorbed and excreted?

A
  • Absorbed via vitamin D

- Excreted via renal clearance (67%) and in faeces (33%)

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19
Q

Role of P in acid-base balance?

A

Binds with H2 in urine to buffer - acidification of urine

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20
Q

What are some causes of hyperphosphataemia?

A
  • Renal insufficiency
  • Increased cell breakdown or cellular injury
  • Endocrine diseases
  • Cancer
  • Acidosis
  • Excessive P intake
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21
Q

What are the signs and symptoms of hyperphosphataemia?

A

Usually asymptomatic!

  • BUT S&S related to drop in Ca (inverse relationship) = tetany, seizures, delirium, tingling, cramps
  • Sharp flexion of the wrist and extension of the feet
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22
Q

Treatment of hyperphosphataemia?

A
  • Wait 4-8 hours before testing levels if pt is on glucose-based fluids
  • Limit intake of P
  • Diuretics
  • Monitor Ca, uric acid and phosphate levels
  • Dialysis if severe
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23
Q

Does low serum P = hypophosphataemia?

A

NOP

Low P does not necessarily mean total body depletion since only 1% of P is in blood

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24
Q

Causes of hypophosphataemia?

A
  • Hypoventilation due to: alkalosis, sepsis, anxiety, pain, heatstroke
  • DKA, decreased P absorption, vitamin . deficiency
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25
Q

Treatment of mild hypophosphataemia?

A

Increase dietary intake of P, oral supplements

26
Q

Treatment of severe hypophosphataemia?

A

IV KPO4 or NaPO4 in dilute concentrations

27
Q

Nursing care for a pt with hypophosphataemia?

A
  • Monitor vitals
  • Monitor pts on TPN (TPN = increase P)
  • Monitor for drug interactions
28
Q

Where is Mg absorbed and stored?

A
  • Absorbed in the ileum

- Stored in bones

29
Q

Normal serum levels of Mg?

A

1.5-2.5 mEq/L

30
Q

Functions of Mg?

A
  • AP conduction, vasodilation and CV regulation, bone metabolism, regulation of [Ca]
  • Activation of cofactors of enzymes
  • Activation of B enzymes
  • Cofactor in DNA and protein synthesis
  • Transporter in Na/K pump
31
Q

Drop in Mg = similar drop in which electrolytes?

A

P
Ca
K
Na

32
Q

Causes of hypomagnesemia?

A
  • Chronic alcoholism
  • Excessive gastric/intestinal drainage
  • Decreased protein intake
  • Renal tubular disease, nephrotoxic drugs
  • Acidosis
33
Q

Signs and symptoms of hypomagnesemia?

A
  • CNS, CVS, GI and neuromuscular irritability

- Positive Chvostek’s and Trousseau’s signs

34
Q

Treatment of hypomagnesemia?

A

Mg replacement - oral or IV

35
Q

Causes of hypermagnesemia?

A
  • Renal failure
  • Untreated DKA
  • Excessive intake of antacids
36
Q

Signs and symptoms of hypermagnesemia?

A
  • Flushing, increased perspiration
  • Muscle weakness
  • Nausea, vomiting
  • Hypotension
  • Dysrrhythmias
37
Q

Functions of Cl?

A
  • Works with Na to maintain osmotic pressure (CSF = NaCl)

- Stomach acid (HCl)

38
Q

Where is chloride found?

A
  • 80% in ECF

- Minimal found in the ICF, found in specialised cells (eg. nerves)

39
Q

How is Cl removed from the body?

A

90% excreted in urine, 10% in faeces and sweat

40
Q

Causes of hyperchloraemia?

A
  • Decrease in intravascular fluid
  • Dehydration
  • DKA
  • Bicarbonate deficiency
  • Hypernatraemia
  • Shock
  • Starvation
41
Q

Signs and symptoms of hyperchloraemia?

A
  • Hyperventilation
  • Decreased CO
  • Compensation for decreased fluid balance
42
Q

Treatment for hyperchloraemia?

A
  • Correct fluid balance
  • Increased blood pH
  • Replace bicarbonate
43
Q

Causes of hypochloraemia?

A

Any drop in Na, K, other cation to which Cl can bind

44
Q

Signs and symptoms of hypochloraemia?

A

Hypoventilation, tetany, muscle cramping, confusion

45
Q

Treatment for hypochloraemia?

A

High Na diet, assess K, Na, Cl, Ca, pH and bicarb levels, emesis control, IVF

46
Q

What is a buffer/buffering pair?

A

Buffer - any chemical that can bind to excessive OH- or H+ without a significant change in pH
Buffering pair - a weak acid and its conjugate base

47
Q

How goes the carbonic acid-bicarbonate pair work?

A

Increase in bicarb = acidosis

When the amount of carbonic acid also decreases = ratio of 20:1 is restored = pH is restored – pH adjustment via compensation

48
Q

Which body systems use the carbonic acid-bicarbonate pair?

A

Lungs - compensates by increasing or decreasing ventilation

Kidneys - compensates by producing acidic or alkaline urine

49
Q

What are the 4 forms of acid base imbalance?

A
  1. Respiratory acidosis
  2. Respiratory alkalosis
  3. Metabolic acidosis
  4. Metabolic alkalosis
50
Q

What is respiratory acidosis?

A

Elevation of PCO2 due to hypoventilation

51
Q

What is respiratory alkalosis?

A

Depression of PCO2 due to hyperventilation

52
Q

What is metabolic acidosis?

A

Depression of HCO3- or an increase in non-carbonic acids

53
Q

What is metabolic alkalosis?

A

Elevation of HCO3- or a decrease in non-carbonic acids

54
Q

What are ABGs used for?

A
  • To determine oxygenation

- To determine acid-base balance

55
Q

Is HCO3- acidic or basic? What about H2CO3?

Why are they important?

A 
HCO3- = basic
H2CO3 = acidic

These two make up a conjugate pair used as a buffer

56
Q

What characteristics of ABGs define COMPENSATED acidosis/alkalosis?

A

NORMAL pH +
ABNORMAL HCO3- and ABNORMAL PaCO2

pH is normal has the body has had time to restore it via compensatory measures

57
Q

What characteristics of ABGs define UNCOMPENSATED acidosis/alkalosis?

A

ABNORMAL pH, HCO3- and PaCO2

There has not been enough time for the body to activate compensatory measures for abnormal pH

58
Q

Explain pH balance in respiratory acidosis

A

pH becomes acidic as the lungs retain CO2

The kidneys counteract and balance this by retaining HCO3-

59
Q

Explain pH balance in respiratory alkalosis

A

pH becomes basic as the lungs expire too much CO2

The kidneys counteract and balance this by increasing their excretion of HCO3-

60
Q

Explain pH balance in metabolic acidosis

A

pH becomes acidic as the kidneys excrete too much HCO3-

The lungs counteract and balance this by expiring more CO2

61
Q

Explain pH balance in metabolic alkalosis

A

pH becomes basic as the kidneys retain too much HCO3-

The lungs counteract and balance this by retaining CO2

Nursing Science 3 (21 decks)

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