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86 Cards in this Set

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the primary organ to regulate fluid & electrolyte balance is the ________ which reabsorbs______% of plasma, producing ____ of urine ea day
kidney

99%

1.5 liters
hormone that is a vasodilator & causes excretion of Na+ & H20 to decrease blood volume
ANF
atrial natriuretic factor
Atrial Natriuretic Factor (ANF) is a ______ that causes vaso_____ & excretion of ___& H20 to decrease ______vol.
hormone

vasodilation

Na+

blood volume
The total daily intake & output of fluids is ___ to ___ from which Fluids, solid foods & oxidation account for ______ & insensible fluid, ______ & urine account for output.
2000ml - 3000ml

fluid intake

feces
Therapeutic measures such as IV fluid replacements & diuretics cause & contribute to fluid & _______ imbalances
electrolyte
NG suctioning causes the losses of Na+, ___, ___, ___, creating a ___, & K+ deficiency.
K+

H+

Cl-

Na+
Normal K+ lab values are?
K+ 3.5-5.5
Normal Mg+ lab values are?
Mg+ 1.5-2.5
Normal Na+ lab values are?
Na+ 135-145
Normal Ca++ lab values are?
Ca++ 4.5-5.5
Normal Cl- lab values are?
Cl- 96-106
Normal PO4 lab values are?
PO4 2.8-4.5
Normal Protein lab values are?
Protein 6-8g
Electrolyte that plays a major role in maintaining the concentration & vol of the ECF is?
Na+
Primary roles of Na+ are _____ impulses & ECF _______.
nerve

osmolality
Na+ deficiency is ______.

H20 deficiency is ______.

Na+ imbalances usually occur due to an imbalance of_____.
Hyponatremia (low Na+ <135)

Hypernatrmia (low H20 Na+ >145)

ECF
Na+ is regulated by ________ & ADH (antidiuretic hormone) & reabsorption is regulated by ________.
kidneys

Aldosterone
Na+ < 135 is ________.

Na+ > 145 is ________.
hyponatremia

hypernatremia
Na+ exits the body through _______, _______, ________,
urine

sweat

feces
Because Na+ is the major determinant of ECF osmolality, hypernatremia causes ____ causing a shift of water ___ of the cells leading to cellular _____. What prevents the development of hyperosmolarity?

Primary cause of hyperosmolarity is?
hyperosmolality
(incr body fluids)

out
dehydration

thirst

impaired cognivity & LOC

also: excessive sweating & incr. insensible water loss
Na+ >145 (hypernatremia) due to decreased ECF (loss of water) causes _______, dry, swollen ______ , weakness, _______ hypotension & weight _____; however, when hypernatermia is due to excess Na+ intake (increased ECF vol)weight______, & pulmonary ____ can be expected. In either case, hypernatremia causes agitation, restlessness, _______, seizures & ______.
intense thirst
tongue
postural
loss

gain
edema
twitching
coma
Cellular dehydration affects neurons, therefore hypernatremia causes _________ manifestations such as _______, lethargy, ______ & _______ & even _____. Na+ excess has a direct effect on irritability & _______ of neurons causing them to be more easily _______.
neurological

intense thirst
agitation

seizures
coma

conduction
excited
Treatment of hypernatremia caused by loss of ______ or excess ___ is to treat the _____ cause. If due to water deficit ____ must be replaced orally or IV __% __ in water or hypotonic saline. Na+ levels are reduced ______ to prevent ___ edema. Na+ excess is diluted using 5% dextrose in water & promote excretion using _____.
water
Na+

underlying

water
5% dextrose

gradually
cerebral

diuretics
Hyponatremia causes ________ which is a shift of water ___ cells caused by innapropriate use of Na+ free or hypotonic ____. This occurs after ____, or major trauma during administration of fluids in patients w/ ____ failure or w/psychiatric disorders assoc. w/excessive water intake.
Hypoosmolality

into

IV Fluids

surgery

renal
Symptoms of hyponatremia are cellular ____ & manifested in the CNS. Exess water ______ plasma osmolality shifting fluid into _____ cells. Na+ loss causes ____ losses, ____ losses, _____ losses. Na+ imbalance due to water gain causes ______ & poly___.
swelling

lowers
into
brain

GI
Renal
Skin

CHF
polydipsia
Vomiting, _________, burns, GI tract suctioning, excessive _______, & 3rd space fluid shifts are all causes for ___________. Likewise, renal failure, _____, chronic ______ disease & long term use of _______ & excessive ____ fluids cause ______.
diarrhea
excessive
ECF volume deficit
(hypovolemia)

CHF
liver
corticosteroids
IV
ECF vol. excess
(hypervolemia)
Treatment for hypovolemia (ECF deficit)is to replace ____&____. IV solutions include LR & sodium ______ & ______ when vol loss is due to blood loss. Hypervolemia is treated w/_____ & restriction of ___ & ____.
water
electrolytes

sodium chloride
Blood

diuretics
fluids
Na+
excess fluid volume R/T increased ___ & water ______.
sodium

retention
Ineffective ______ clearance R/T Na+ & ________ retention.
airway
water
Risk for impaired ______ integrity R/T edema.
skin
Disturbed body ______ R/T altered body ______ secondary to edema
image

appearance
Deficient fluid volume R/T ______ ECF losses or _______ fluid intake
excessive

decreased
Decreased cardiac output R/T excessive ______ losses or ______ fluid intake
ECF

decreased
Extracellular fluid volume losses:

potential complications?
pulmonary edema

ascites
Extracellular volume deficit:

potential complications?
hypovolemic shock
Risk for injury R/T altered sensorium & seizures secondary to abnormal ___ function
CNS
Risk for injury R/T altered sensorium & decreased level of consciousness secondary to ______ function
CNS
Nursing implementations for Hyper & Hypovolemia (Na+ & fluid imbalances)are?

I & ___'s
Cardio______ changes
Resp_______ changes
Neur________ changes
Daily ________
Skin ________ & care
I & O's

cardiovascular

respiratory

neurological

daily weights

skin assessment & care
Increased insulin can cause a shift of ___ into cells resulting in hypokalemia.
K+
Low K+ alters resting membrane potential causing excitability problems in _______ tissue potentiating lethal ventricular __________. Patients are at risk for _______ toxicity when K+ is ____.
cardiac

arrhythmias

Digoxin

low
Insulin used to correct diabetic _________ is associated with Hypokalemia due to resulting loss of K+ in urine & shift of K+ _____ cells
ketoacidosis

into
The Na+-K+ pump in cell membranes maintain the [] gradient by pumping K+___ the cell & Na+ out. The ratio of K+ in ECF & ICF is the major factor in resting ______ potential. Therefore, K+ is necessary for ______ & ______ of nerve impulses, cardiac _____ & _______ & _______ muscle contractions.
into

membrane

conduction
transmission

rhythms
skeletal
smooth
Main sources of K+ in our diets is mainly from _____, ______, & ______. Patients receive K+ from ______fluids, _____ transfusions, & K+ -penicillin. K+ is excreted from the _______ & toxic levels of K+ are retained in assoc. with ____ disfunction.
fruits
dried fruits
vegetables

IV
blood

kidneys

kidney
Blood volume & increased Aldosterone cause _______ retention & ___ loss in urine.
Na+

K+
The most common cause of hyperkalemia is ___ failure. Massive cell destruction such as _______, ______injury, & tumor lysis are also associated w. hyperkalemia in addition to some _______.
renal

burns

crush injury

diuretics
Hyperkalemia causes membrane ____, altering cell excitability. _______ muscles become weak or paralyzed, & patient may experience ______ leg pain. Disturbance in ____ conduction occur as K+ level ___ thus ____ fibrillation or cardiac standstill result. Abdominal cramping & ______ occur from hyperactivity of _____ muscles
depolarization

Skeletal
cramping

cardiac
rises
ventricular

diarrhea
smooth
Risk for _____ R/T lower extremity muscle weakness & seizures.

Ptential complications of hyperkalemia is _________.
(hyperkalemia)
injury

arryhthmias
Treatment for hyperkalemia is eliminate oral & _____ K+ intake, increase elimination via diuretics & ______, force K+ from the ECF to the ___ w/ insulin or _____ bicarbonate or administer ___ gluconate, reversing cell excitability.
parenteral

Kayexalate

ICF

sodium

calcium
The most common causes of hypokalemia are abnormal losses either from the ___ or the GI tract. ____ cause ___ retention & loss of K+ in the _______, & Mg ______ also contributes to loss of K+ in urine. Treatment for diabetic _____ can cause hypokalemia from administration of ______.
kidneys

Aldosterone
Na+
urine

deficiency

ketoacidosis
insulin
The most serious clinical problem assoc. w. hypokalemia is ______ with potentially lethal ventricular ______. Digoxin ______ occurs when K+ is low. Cramping in legs, _____ GI motility & impaired ______ production are also s/s of hypokalemia.
cardiac
arrhythmias

toxicity

decreased

urine
Nursing diagnosis for hypokalemia:

Risk for injury R/T muscle _______ & ______reflexia.

Potential complications of hypokalemia are _________.

Nursing implementation is ___ suppliments & increase in _____ intake. IV administration should be ____ to prevent cardiac _____.
weakness
hyporefexia

arrhythmias

K+
dietary

slow
arrest
Teach patient s/s of hypokalemia which are increased urination, weak pulse, fatigue, muscle weakness, decreased reflexes, hyperglycemia. Patients taking diuretics should increase dietary intake of K+ foods such as fruits, _______, _______, & ______. You should explain low K+ inhances action of _______.
fruits, vegetables, dairy
all bran, raisens, bananas
dairy, beef, pork, chicken
chocolate & sunflower seeds

Digitalis
Na+ & Mg deficiency cause hypo________.
Na+ & Mg deficiency cause hypokalemia.
More than 99% of body Ca+ is combined w/____ & [] in _____ system. Ca++ has an inverse relationship w/PO4 & is balanced by PTH, _______& ______. PTH ____ bone reabsorption (Ca++ out of bones) & increases ___ tract & ____ reabsorption of Ca++. ____ is formed by action of UV light & important for absorption of Ca++ from GI tract. Calcitonin opposes PO4 thus ____ Ca++ levels.
PO4

skeletal

calcitonin
Vit D

increases
GI
renal
Vit D

lowers
Fxn of Ca++ is _____ transmission of nerve _____ , myocardial & muscle ______, blood ______, & formation of teeth & bones. PTH ______ GI & renal absorption & calcitonin _______ GI absorption & renal excretion.
nerve

impulses

contractions

clotting

increases

decreases
2/3 of Hypercalcemia >5.5 cases are caused by ____& 1/3 from cancer. Less occurances from Vit D overdose & prolonged _____ & rarely from incr. Ca++ intake such as from Ca+ containing _____ or excessive administration during _____ _____. Excess Ca+ blocks effect of ___ in _____ muscles leading to _____ excitability of both muscles & nerves.
hyperparathyroidism

immobilization

antiacids

cardiac arrest

Na+

skeletal

reduced
Manifestations of Hypercalcemia Ca+ >5.5 include _____ memory, confusion, fatigue, muscle _______, contipation, cardiac _____ & renal ____. Risk for ____ R/T neuromuscular & sensorium changes. Potential complication: _________.
decreased

weakness

arrhythmias

calculi

injury

arrhythmias
Nursing implementation for Hypercalcemia Ca+ >5.5 is to promote _____ of Ca+ in urine w/a ________ diuretic such as _______ & hydration. Patient must drink ______-_____ fluid daily. Synthetic ____ also ____ Ca+ levels. Mobilization w/___ bearing activity is __.
excretion

loop
lasix

3000 -4000ml

synthetic calcitonin

weight

encouraged
Any condition causing decrease in production of ___ may result in hypocalcemia, Ca+ <4.5. Ex: neck surgery, removal or injury of para glands. Pancreatitis, lipolysis, multiple _______ transfusions or ______ abuses are other causes. Ca+ <4.5 decreases cardia ___ & ECG.
PTH

thyroid or neck

blood

laxative

contractility
Hypocalcemia Ca+ <4.5 allows __ to move in to excitable cells resulting in sustained muscle ______ called _____. Clinical signs: Trousseaus ____ spasms occur w/in 3min w/BP cuff inflated ^systolic or ____ ctrxn in face from tap on facial nerve in front of the _____. Other s/s are dyspahgia, stridor, numbness & ______ around ____.
Na+

contraction

tetany

carpal

Chvosteks

ear

tingling

mouth
Treatment for Ca+ <4.5, hypocalcemia, is _____ supp's w/____. IV Ca+ is adminstered in ___ cases. Ca+ is NOT given ___. Treat pain & anxiety adequately b/c ______ alkalosis can precipitate Ca+<4.5. Observe closely for Ca+<4.5 immediately after neck/thyroid surgery
oral

Vit D

severe

IM

respiratory
PO4 is essential to fnxn of muscle, __ __ __, & the ____ system. PO4 is also involved in prod of ATP, cellular uptake, use of ____, & in metabolism of __, ___, & ___. PO4 requires adequate renal fnxn because ___ are the major route of PO4 ___. Small amount of PO4 is excreted in ___. PO4 has a reciprocal relationship w/___. Increased PO4 causes ___ Ca+.
red blood cells
nervous

glucose

carbs, proteins, & fats

kidneys
excretion
feces

Ca+

low
Major condition leading to PO4 >4.5, hyperphosphatemia, is acute/chronic ____ failure causing altered ability to excrete PO4. Other causes are _____, excess milk, ______ w/PO4, & lrg intake of Vit D that ____ GI absorption of PO4.
renal

chemotherapy

laxatives

increases
Increased PO4 can result in ____ deposits in soft tissues such as joints, skin, _____, ____, kidneys, & cornea. PO4 >4.5 causes ____ irritability & tetany r/t to ____ Ca+ assoc. w/____ PO4 level. Treatment of PO4 >4.5 is ___, adequate ___ intake to enhance renal ___ & correct hypocalcemic (Ca+ <4.5). Increased Ca+ ____ PO4.
calcified

arteries
vessels

neuromuscular
decreased
high

diet
fluid
excretion

lowers
PO4 < 2.8, hypophosphotemia, is caused by ____, malabsorption syndromes, ____ withdrawal, PO4 binding ___, & ___ nutrition w/inadequate PO4 replacement. PO4 < 2.8 is r/t impaired delivery of ____ to tissues causing CNS ______ , confusion, & other _____ changes as well as muscle ____ & pain, arrhythemias, & _____
malnourishment
alcohol
antiacids
parenteral

O2

depression
mental

weakness
cardiomyopathy
PO4 < 2.8, hypophosphotemia, is treated by _____ supplimentation in mild cases, increased ______ intake, & in severe cases ___ administration.
oral

dietary

IV
MG {1.5 - 2.5} is the __ most abundant intracelular cation. 50%-60% of Mg is in ____ & function is metabolism of ___, protein, & ___ acids. Mg is regulated by ______ absorption & ____ excretion. Mg balance is related to ___ & ___ balance & should be assessed ______. Mg is important for ____ fxn. & ____ excitability.
second
bone

carbs
nucleic

GI
renal

Ca+ & K+
together

cardiac
neuromuscular
Hypemagnesmia, Mg > 2.5, only occurs w/increase in Mg intake such as from Maalox & ____ _ ____accompanied by ___ insufficiency or failure. Mg excess could develope in pregancy when treated w/Mg ___ for ___. S/s of Mg > 2.5 is lethargy, drowsiness, N&V, & increasing Mg levels cause ____ tendon reflex -> somnolence -> then _____ & cardiac ______.
Milk of Magnesia

renal

Mg sulfate
eclampsia

deep
respiratory
arrest
Treatment for Hypemagnesmia, Mg > 2.5, should focus on _____ & persons with ____ failure should not take Mg containing drugs. Advise patients to read all ___ labels. Emergency treatment is IV of ___ or Ca+ gluconate to ____ effects of Mg on ____ muscle. Promote ___ excretion w/fluids. Patients with impaired renal fxn will require ____.
prevention
renal

OTC

Ca+
oppose
cardiac

urinary
dialysis
Primary cause for Hypomagnesemia, Mg < 1.5 is prolonged ____, starvation, & chronic ____. Prolonged parenteral nutrition w/out Mg supplimentation, _____, & ___ glucose levels in _____. S/s are confusion, _____ deep tendon reflex, ____, & seizures. Mg deficiency predisposes to cardiac ____.
fasting
alcoholism

diuretics
high
diabetes

hyperactive
tremors
arrhythemias
Hypomagnesemia, Mg < 1.5 may contribute to development of _____ & _____ because Mg is critical to Na+ - K+ pump. Treatment is ____ supp's & ___ vegs, nuts, bananas, oranges, ____ butter, & chocolate. Mg should be administered _____ to prevent _____ or cardiac arrest.
hypocalcemia & hypokalemia

oral
green
peanut

slowly

respiratory
NDX:

Hyperkalemia
K+ > 5.5
Risk for _____R/T _____ extremity muscle weakness & seizures.

Potential complication:
arrhythmias
injury

lower
NDX:

Extracellular fluid vol excess

Excess fluid volume R/T increased ___ & ___ retention

Ineffective ____ clearance R/T ___ & ___ retention

Risk for impaired ____ integrity R/T edema

________ body image R/T altered body appearance _______ to edema

Potential complications:
pulmonary edema, ascites
Na+ & water

airway
Na+ & water

skin

Disturbed
secondary
NDX:

Extracellular fluid volume deficit:

Deficient ____ volume R/T _____ ECF losses or decreased fluid _____

Decreased ____ output R/T excessive ___ losses or decreased fluid intake

Potential complication:
________ shock
fluid
excessive
intake

cardiac
ECF

hypovolemic
NDX:
Hypernatremia Na+ > 145

Risk for ____ R/T altered ____ & seizures secondary to abnormal ___ function
injury

sensorium

CNS
NDX:
Hyponatremia Na+ < 135

Risk for ____ R/T altered sensorium & decreased level of _______ secondary to abnormal CNS ______
injury
consciousness
function
Na+ < 135 is?

Na+ > 145 is?

Normal Na+ is?
hyponatremia

hypernatremia

Na+ 135 - 145
Ca+ < 4.5 is?

Ca+ > 5.5 is?

Normal Ca+ is ?
hypocalcemia

hypercalcemia

normal Ca+ is 4.5 - 5.5
Cl- < 96 is ?

Cl- > 106 is?

normal Cl- is?
hypochloremia

hyperchloremia

normal Cl- is 96 - 106
K+ < 3.5 is?

K+ > 5.5 is?

Normal K+ is ?
hypokalemia

hyperkalemia

normal K+ 3.5 - 5.5
Mg < 1.5 is ?

Mg > 2.5 is?

Normal Mg is?
hypomagnesemia

hypermagnesemia

normal Mg 1.5 - 2.5
K+ < 3.5 is ?

K+ > 4.4 is ?

normal K+ is?
hypokalemia

hyperkalemia

normal K+ 3.5 - 5.5
Na+ 127 is?

Na+ 140 is?
hypokalemia

normal
Ca+ 5.6 is?

Ca+ 4.7 is?
hypercalcemia

normal
PO4 < 2.8 is?

PO4 > 4.5 is?

normal PO4 is?
hypophosphatemia

hyperphosphatemia

normal PO4 2.8 - 4.5
Protein norms are?
6 - 8 g