Dirk

Front 1

what is homeostasis

Back 1

– maintenance of a constant internal equilibrium in a biological system that involves positive and negative feedback mechanism

Front 2

2. The primary component of the body

Back 2

water and electrolytes (60%). Factors that influence the amount of body fluid are age, gender and body fat. Muscles, skin and blood have the largest amount of water.

Front 3

3. Intracellular fluid

Back 3

fluid in cells (2/3 of body fluid, located primarily in the skeletal muscle mass).

Front 4

4. 5 functions of water in the body:

Back 4

Solvent for nutrients
Intra and extracellular fluid
Lubrication of joints
Amniotic fluid
Thermoregulation of body

Front 5

5. Main cations of intracellular fluid

Back 5

a) ECF (plasma)
- Sodium (Na+) 142
- Potassium (K+) 5
- Calcium (Ca++) 5
- Magnesium (Mg++) 2
- Hydrogen (H+)

Front 6

Main cations of extratracellular fluid

Back 6

- Potassium 150
- Magnesium 40
- Sodium 10

Front 7

what is the function of the Sodium-Potassium Pump

Back 7

Concentration of Na+ in the ECF is greater then in ICF. Because of this Na+
tends to enter the cell by diffusion, Sodium-Potassium pump, located on the cell membrane, offsets this tendency by actively moving Na+ from the cell into the ECF. High intracellular K+ concentration, in its turn, is maintained by pumping K+ into the cell.

Front 8

. What is the purpose of measuring plasma osmolality

Back 8

The number of particles contained in the unit of fluid determines the osmolality of the solution, which influences the movement of fluid between the fluid compartments.

Front 9

Another term for accumulation of fluid in the tissue

Back 9

edema.

Front 10

Processes that can lead to accumulation of fluid in the body

Back 10

ascites, burns, peritonitis, bowel obstruction, and massive bleeding into a joint or body cavity.

Front 11

First spacing

Back 11

icf normal

Front 12

second spacing

Back 12

ecf edema

Front 13

third spacing

Back 13

Sometimes fluid is not lost from the body, but is unavailable for use by either the ICF or ECF. Loss of ECF into the space that does not contribute to equilibrium between the ICF and ECF is referred to as a third-space fluid shift, or “third-spacing” for short.

Front 14

Water balance is regulated in the body by the processes of

Back 14

a) Osmosis: shift of fluid through the impermeable to dissolved substances membrane from the region of low solute concentration to the region of high solute concentration until the solutions are of equal concentration.
b) Diffusion: natural tendency of substance to move from an area of higher concentration to the area of lower concentration. It occurs through the random movement of ions and molecules
c) Filtration: Movement of water and solutes from an area of high hydrostatic pressure to an area of low hydrostatic pressure
d) Sodium-Potassium Pump

Front 15

. SIADH (Syndrome of Inappropriate UntiDiuretic Hormone). Causes and Pathophysiology

Back 15

The basic physiologic disturbances in SIADH are excessive ADH activity, with water retention and dilutional hyponatremia, and inappropriate urinary excretion of Na+ in presence of hyponatremia (People who have SIADH cannot excrete a dilute urine. They retain fluid and develop sodium deficiency - dilutional hyponatremia). SIADH can be the result of either sustained secretion of ADH by hypothalamus (pituitary gland), or production of ADH-like substance from a tumor. Conditions associated with SIADH include severe pneumonia, pneumothorax, oat-cell lung tumors, head injuries, endocrine and pulmonary disorders, physical or psychological stress, meds like oxitocin, cyclophosphamide, vincristine, thioridazine, amyltriptiline.

Front 16

assessment of FVD (fluid volume deficitloss of extracellular fluid volume exceeds intake of fluid. Nurse should assess for:

Back 16

- I/O every hour to every 8 hours
- daily body weights
- VS (weak rapid pulse and postural hypotension, decrease in body temp)
- skin and tongue turgur
- urine specific gravity test (s.b. > 1.020)
- mental function
BUN elevated,(dehydration or decreased renal perfusion., serum electrolyte, potassium and sodium levels reduced( hypokalemia: hyponatremia )or elevated

Front 17

FVE (fluid volume excess) - isotonic expansion of the ECF caused by the abnormal
retention of water and sodium.
Nurse should assess for:

Back 17

- edema;
- distended neck veins
- crackles
- tachycardia
- increased BP, pulse pressure, central venous pressure
- increased weight
- increased urine output
- sob and wheezing

Front 18

signs of Hyponatremia- serum sodium levels is below normal(less than 135);

Back 18

- vomiting,
- diarrhea,
- fistulas,
- sweating
Definition: Hyponatremia is caused by a very low concentration of sodium in extracellular fluid.
A. Signs and symptoms of hyponatremia.
1. Signs and symptoms are the same as those for
extracellular fluid deficiency.
a. Weakness.
b. Restlessness.
c. Delirium.
d. Hyperpnea.
e. Oliguria.
f. Increased temperature.
g. Flushed skin.
h. Abdominal cramps.
i. Convulsions.
j. Nausea, anorexia.
2. If sodium is lost but fluid is not, the following
signs and symptoms will be present (similar to
those of water excess).
a. Mental confusion.
b. Headache.
c. Muscle twitching and weakness.
d. Coma.
e. Convulsions.
f. Oliguria.
B. Causes of hyponatremia.
1. Excessive perspiration.
2. Use of diuretics.
3. Gastrointestinal losses—severe diarrhea, vom¬
iting, pancreatic and biliary fistulas.
4. Lack of sodium in diet.
5. Burns, fibrocystic disease.
6. Excessive IV administration without NaCl.
7. Diabetic acidosis.
8. Adrenal insufficiency

Front 19

signs of Hypernatremia- patients unable to drink (serum level 145)

Back 19

- heart stroke,
- hyperventilation,
- watery diarrhea
Definition: Hypernatremia is caused by a very high concentration of sodium in extracellular fluid.
A. Signs and symptoms of hypernatremia.
1. Signs and symptoms are same as for extracel¬
lular fluid excesses.
a. Pitting edema.
b. Excessive weight gain.
c. Increased blood pressure.
d. Dyspnea.
2. If hypernatremia is due to dehydration, in
which there is a loss of fluid thereby increasing
the number of ions, the signs and symptoms
include:
a. Concentrated urine and oliguria.
b. Dry mucous membranes.
c. Thirst.
d. Flushed skin.
e. Increased temperature.
f. Tachycardia, hypertension.
B. Causes of hypernatremia.
1. Severe diarrhea.
2. Decreased water intake.
3. Febrile states.
4. Ingestion of sodium chloride.
5. Excessive loss of water through rapid and deep
respiration.
6. Renal failure.
C. Nursing management of hypernatremia.
1. Record intake and output.
2. Restrict sodium in diet.
3. Weigh daily.
4. Observe vital signs.
5. Administer fluids orally or I

Front 20

If a patient with hyperkalemia , what meds can be given to force k+ from the extracellular fluid into the intracellular fluid

Back 20

. IV of sodium bicarbonate may be necessary to alkalinize the plasma and cause a temporary shift of potassium into the cells.Regular Insulin and hypertonic dextroxe solution-potassium into cells.
A. Signs and symptoms of hyperkalemia.
1. Weakness, muscle cramp, flaccid paralysis.
2. Hyperreflexia proceeding to paralysis.
3. Bradycardia, arrhythmias.
4. Ventricular fibrillation.
5. ECG changes depict elevated or tented T wave,
widened QRS complex, prolonged P-R interval,
and flattened P wave with depressed S-T seg¬
ment.
6. Oliguria.
7. Diarrhea, nausea.
B. Causes of hyperkalemia.
1. Usually renal disease (cannot excrete potas¬
sium).
2. Burns (due to cellular destruction releasing
potassium from cells into extracellular space).
3. Crushing injuries (due to cellular breakage re¬
leasing potassium from cells).
4. Adrenal insufficiency.
5. Respiratory or metabolic acidosis.
C. Nursing management of hyperkalemia.
1. Administer diuretics if kidney function ade¬
quate.
2. Administer hypertonic IV glucose with

Front 21

causes of Hypocalemia

Back 21

lower than normal (2.1-2.6 normal)serum concentration of calcium. Causes: ,
inflammation of pancreas
chronic renal insufficiency
burns
removal of parathyroid glands
malabsorption syndrone

Front 22

causes of Hypercalcemia- excess of calcium in the plasma

Back 22

Causes: malignancies (tumors) and hyperparathyroidism.
excessive intake of vitamin d
pagets disease
immobilization

Front 23

) Trousseau’s sign

Back 23

a test for latent tetany in which carpal spasm is induced by inflating a sphygmomanometer cuff on the upper arm to a pressure exceeding systolic blood pressure for 3 minutes. A positive test may be seen in hypocalcemia and hypomagnesemia

Front 24

Chvostek’s sign

Back 24

twitching of the muscles supplied by the facial nerve when the nerve is tapped about 2 cm anterior to the earlobe, just below the zygomatic arch. Seizures can occur because of hypocalcemia increases irritability of the CNS and peripheral nerves; mental changes, depression, confusion, impaired memory, delirium, hallucianations.

Front 25

Serum magnesium abnormalities Hypomagnesemia

Back 25

normal is 1.5-2.5.
Deficit of magnesium due to chronic al¬coholism, starvation, malabsorption, or vigorous di¬uresis.
A. Signs and symptoms of hypomagnesemia.
1. Neuromuscular irritability.
a. Jerks, twitches.
b. Hyperactive reflexes.
c. Convulsions.
d. Tetany.
2. Cardiovascular changes.
a. Tachycardia.
b. Hypotension
B. Causes of hypomagnesemia.
1. Low intake.
2. Abnormal loss—diarrhea.
3. Chronic nephritis.
4. Diuretic phase of renal failure.
C. Nursing management of hypomagnesemia.
1- Magnesium sulfate.
a. Administer IV or IM slowly.
b. Observe for adequate urine output.
2. Antidote: calcium gluconate

Front 26

Serum magnesium abnormalities Hypermagnesemia

Back 26

more than normal.
Hypermagnesemia
Definition: An excess of magnesium as a result of renal insufficiency or inability to excrete magnesium absorbed from food.
A. Causes of hypermagnesemia.
1. Renal insufficiency.
2. Overdose.
3. Severe dehydration.
4. Overuse of antacids with magnesium (Gelusil).
B. Signs and symptoms of hypermagnesemia.
1. Hypotension.
2. Curare-like paralysis.
3. Sedation.
4. Decreased respiration function.
5. Cardiac arrhythmias.
6. Warm sensation in body.
C. Nursing management of hypermagnesemia.
1. Administer calcium gluconate IV slowly.
2. Give in peripheral veins (not CVP line).

Front 27

) Respiratory acidosis

Back 27

acidosis (abnormal decrease in the pH of the blood) due to decreased ventilation of the pulmonary alveoli, leading to elevated arterial carbon dioxide entration (PaCO2).) essential components to the physiologic mechanism we call breathing—ventilation, perfusion and diffusion; failure or compromise of any one of the components can result in respiratory acidosis
-Oxygenation, respiratory support
-bronchodilators
-antibiotic therapy
-fluid and electrolyte therapy
CO2 + H2O <> H2CO3 <> H+ + HCO3
Carbon dioxide (lungs) carbonic acid bicarbonate(?) (kidneys

Front 28

Metabolic acidosis

Back 28

acid other then carbonic acid accumulates in the ECF or when there is a loss of HCO3.
Compensation: lungs eliminate CO2; kidneys conserve HCO3. pCO2 decreases.

Front 29

Metabolic alkalosis

Back 29

Increase in base, and decrease in acids.
Compensation: lungs retain CO2, kidneys conserve H+ and excrete HCO3. pCO2 increases.