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80 Cards in this Set
- Front
- Back
How much of a fluid loss is fatal?
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20%
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Normal Sodium level
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135-145 mEq/L
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Normal Potassium level
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3.5-5.1 mEq/L
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Normal Chloride level
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96-106 mEq/L
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Normal Calcium level
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8.6-10.0 mg/dl
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Normal Phosphate level
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2.5-4.5 mEq/L
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Normal Magnesium level
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1.5-2.5 mEq/L
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Normal Bicarbonate level
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22-26 mEq/L
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What is the major cation in the interstitial fluid?
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Sodium
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What is the major cation in the intracellular fluid?
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Potassium
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What affect does protein have on edema?
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Capillaries get big and holey. Proteins spill out through the holes and pull fluid with them.
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What does it mean if Creatinine is bad?
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The kidneys are not working
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Increased BUN?
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Dehydrated
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Decreased BUN?
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Overhydrated
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What is diffusion?
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Passive movement of particles. Requires no energy.
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What is osmosis?
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Passive movement of water.
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What is active transport?
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Requires energy to move fluids and electrolytes against a concentration gradient.
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Hydrostatic pressure?
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Pushing pressure
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Oncotic pressure?
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Pulling pressure
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Filtration?
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The sum of hydrostatic and oncotic forces across the capillary into tissues.
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What is osmolality?
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Concentration of body fluids. Affects movement of fluids by osmosis.
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How do you estimate osmolality of blood?
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2 X sodium level
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What is an isotonic solution?
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A solution that contains the same amount of salt and solutes as human cells. Very little osmotic pull.
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Examples of isotonic solutions (3)
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Normal saline 0.9%
5% dextrose in water D5W LR |
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What is a hypotonic solution?
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A solution with a lower concentration of salt than other solutions. Less salt or more water.
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Examples of hypotonic solutions (2)
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0.45% NS
D5 in 0.45% NS |
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What are hypotonic solutions used for?
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To treat cellular dehydration.
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What happens to D5W after it metabolizes?
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It becomes hypotonic.
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What is a hypertonic solution?
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A solution with a higher concentration of solutes. It will draw water into it. It expands intravascular volume.
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Examples of hypertonic solution (5)
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D5LR
D5NS D10W 3% NaCl 5% NaCl |
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What factors increase osmolality?
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Free water loss
Diabetes insipidus Na overload Hyperglycemia Uremia |
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What factors decrease osmolality?
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SIADH - too much ADH
Renal failure Diuretic use Adrenal insufficiency- Not releasing aldosterone |
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What two hormones control fluid?
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ADH and aldosterone
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What does BUN stand for?
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Blood urea nitrogen
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What is hematocrit?
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% of red blood cells
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Normal value of hematocrit?
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37-48%
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Normal value of hemoglobin?
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12-16 g/dL
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Oncotic pressure comes from?
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Proteins
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What happens to the kidneys during diabetes insipidus?
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They cant concentrate urine.
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What is diabetes insipidus caused by?
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A deficiency of ADH.
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What is third spacing?
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Fluid is put into a part of the body that is not an area of use.
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What are some causes of third spacing?
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Burns, peritonitis, bowel obstruction, massive bleeding into joint or cavity, liver or renal failure, lowered plasma proteins, lymphatic blockage
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S/S of third spacing
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Decreased urine with adequate intake, increased HR, Decreased BP or CVP, increased weight, pitting edema, ascities.
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What is dehydration?
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Loss of water only
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What is hypovolemia?
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Water and electrolytes are lost in the same proportion as they exist on normal body fluid (isotonic loss)
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Causes of fluid volume deficit
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V/D, fever, excessive sweating, burns, diabetes insipidus, uncontrolled diabetes, GI suctioning, colostomy, draining wounds or fistulas.
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S/S of dehydration
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Acute wt loss, decreased skin turgor, oliguria, concentrated urine, weak rapid pulse, cap filling longer, decreased BP, thirst, weakness, dizziness, muscle cramps.
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S/S of dehydration in infants
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Sunken eyeballs, depressed fontanels, significant wt loss, low urine output, high specific gravity.
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Lab results in dehydrated patients
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Hct- Increased
BUN- Increased Serum osmo- High Urine osmo- high Urine SG- High Urine volume- decreased |
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What kind of IV fluids would you give someone who is dehydrated?
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Isotonic until BP back to normal, then hypotonic.
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What are some causes of fluid volume excess?
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Heart failure, renal failure, liver failure, irrigation of body cavities, CA, SIADH, thrombus, high sodium intake, protein malnutrition.
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Physical S/S of fluid volume excess
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Wt gain > 2lbs, distended neck veins, increased RR, crackles in lungs, dyspnea, cough, pink sputum, mental status changes d/t brain cells swell, edema.
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VS and Lab values of FVE patient
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CVP- high
CO- Increased Hct- Low Serum osmo- low BUN- low SG- low |
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What does an infiltration look like?
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Pale, cold, swollen
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What does phlebitis look like?
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Red, hard and irritated
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What does an infected IV site look like?
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Red, heat, pain, swelling
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What does sodium do in the body?
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Regulates voltage of action potentials, transmission of impulses in nerve and muscle fibers, one of the main factors in determining ECF volume.
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What helps balance sodium in the body?
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Thirst mechanism, ADH, aldosterone, Glomeruli filtration, RAAS
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Hypernatremia >145 Causes
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Excessive salt intake, decreased loss of salt d/t renal failure, lack of water intake
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S/S hypernatremia
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Red dry swollen tongue, flushed dry firm skin, intense thirst, oliguria, anuria, agitation, lethargy, urine SG > 1.030, high Hct, confusion.
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Why is it important to gradually lower sodium levels with a hypotonic solution?
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Too fast could lead to swelling of the brain cells.
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What are some causes of hyponatremia?
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Dilution from excessive free water, SIADH, Abnormal loss of GI secretions, excessive suctioning.
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S/S of hyponatremia
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Depression of CNS, Generalized weakness, abdominal cramps, urine SG < 1.003, low hct
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What is the purpose of potassium?
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Normal cardiac and neurological functioning, influences nerve impulse conduction, helps maintain acid base balance, controls fluid movement in and out of cell by osmosis.
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What are some foods high in potassium?
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Bananas, dried fruits, green leafy veggies, avocados, all bran, potatoes, tomatoes and mushrooms.
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Causes of hypokalemia
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Loss of GI secretions, potassium wasting diuretics, renal disease, chronic use of steroids, and alkalosis.
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S/S of hypokalemia
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CNS depression, leg and abdominal cramps, constipation, weak shallow resp, weak thready pulse, numbness or tingling in hands or feet.
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Rules of potassium IV supplementation
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No more than 10 mEq/hr
No more than 40 mEq/L |
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Causes of hyperkalemia
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Excessive intake of potassium, burns, tissue trauma, acidosis, kidney failure with oliguria.
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S/S of hyperkalemia
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Irregular heartbeats, hypotension, bradycardia, muscle twitching or cramps, parasthesias, hyperactive bowel tones.
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Oral potassium must be given with ________ because ___________.
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Food, hard on the stomach
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How fast should potassium be ran at?
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No faster than 10-20 mEq/hr
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Calcium is required for ?
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Blood coagulation, neuromuscular contraction, enzymatic activity, and strength and durability of bones and teeth.
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What does calcium do to nerve cells?
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Makes them less excitable, less twitchy, more smoothly.
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How can immobility lead to high calcium levels?
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When a person is immobile calcium can come out of the bones and go into the blood.
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What level should be evaluated with calcium?
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Albumin
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Hypocalcemia causes
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Decreased intake, decreased absorption, pancreatic disease, PTH or Vit D deficiency, hyperphosphatemia
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S/S of hypocalcemia
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Neuronal excitability, numbness, tingling, convulsions, dysrhythmias, N/V/D, muscle spasms, muscle tetany, positive trousseau and chvosteks sign.
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Hypercalcemia causes
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Mobilization of Ca from bone, Cancer, hyperparathyroidism, immobilization, thiazide diuretics, excessive ingestion of Ca or Vit D.
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S/S of hypercalcemia
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Anorexia, constipation, muscle weakness, lethargy, loss of muscle tone, depression, ataxia, altered gait, fatigue, dysrhythmias, deep bone pain, polyuria, renal calculi, bone fractures.
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