Reading...
Play button
Play button
Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
82 Cards in this Set
- Front
- Back
|
*Isotonic solutions
|
-AKA as balanced
-AKA crystalliod solute concentration is SAME between solutions so there is no shift "stay where I put it" USES: fluid lost outside of body ALERT: raises B/P !! -can cause HTN, FVE, hypernatremia -not used w/HTN, cardiac/renal dz EXAMPLES: -NS -LR -D5W and D5 1/2 NS (until sugar used) |
|
|
*Hypotonic solutions
|
HYPO=LESS solutes so fluid moves OUT of this solution into cells
hyOtonic =goes Out of the vessel and DO NOT cause HTN USES: -those w/FVD w/HTN and/or hx of renal/cardiac dz -tx hypernatremia -tx cellular dehydration ALERT: cellular/cerebral edema -can cause FVD and decreased BP -be careful w/head injury and infants EXAMPLES: -tapwater -anything less concentrated than isotonic -also D5W after glucose is used |
|
|
*Hypertonic solutions
|
-AKA Colloid
HYPER=MORE solutes so fluid moves INTO this solution (think packed particles) hypertonic=Enter the vessel -this shrinks cells USES: -tx hyponatremia -tx 3rd space fluid shifts -pt w/FVE but needs electrolytes (ie, HF, edema, etc) ALERT: FVE -monitor in ICU, BP and CVP,etc EXAMPLES: -5% dextrose in normal saline D10W, NS3-5%, D5W in 0.9%NS, D5W in 0.45% NS, D5W in LR, TPN, Albumin |
|
|
Diffusion
|
solutes move from area of high concentration to area of low
-no energy needed=passive transport -SOLUTES move -uses Kinetic energy (Brownian Motion)=the bump |
|
|
Osmosis
|
fluid moves from an area of high fluid concentration to area of low fluid concentration
-no energy needed=passive transport -FLUID moves (the ONLY way ) |
|
|
Active transport
|
energy via adenosine triphosphate (ATP)
moves solutes from an area of lower concentration to an area of higher concentration -and ATP requires O2 |
|
|
Na-potassium pump
|
-There is more NA outside the cell
(ECF) -and more K inside the cell (ICF) -they want to move by diffusion but this pump keeps them in check |
|
|
*what is the minimum amount of urine that should be seen
|
1cc per kg per hour
|
|
|
*ADH
what is it where is it made and stored what triggers release what effects does it have what blocks or stops release |
-AKA vasopressin
-AKA Antidiuretic hormone -peptide hormone -made by hypothalamus -stored in posterior pituitary -released when serum osmolality is high (>300) ....and later by low BP -osmoreceptors in hypothalamus sense the change in osmolality 1)causes distal tubule of nephron to keep WATER 2) also causes peripheral vascular constriction =both increase fluid volume/BP -alcohol, ANP, and angiotensin II block its release |
|
|
thirst
2 types and which is activated 1st and by what |
center located in hypothalamus
2 types: -osmotic thirst-EARLY osmoreceptors/ low osmolality -hypovolemic -LATE baroreceptors/ blood volume |
|
|
*Renin-angiotensin-aldosterone system
|
ALDOSTERONE PRODUCTION
1)Blood flow to glomerulus drops 2)Juxtaglomerular cells secrete renin 3) renin travels in blood to liver 4)Renin - angiotensinogen to angiotensin I 5)Angiotensin I travels to lungs 6)it is converted to angiotesin II by Angiotensin Converting Enzyme (ACE) EFFECTS 1) triggers sympathetic response 2) adrenal glands releases aldosterone 3) posterior pituitary releases ADH Renin-releases w/low BP or osmo =vasonstriction Angiotensin II =vasoconstriction/ thirst/ aldosterone release so......... if kindeys are not getting perfused this system is triggered and will cause BP to increase |
|
|
*ALdoSTerone
where is it made what can mimic it's effects |
steriod, mineralcorticoid produced by....
adrenal glands (cortex) Effects: - Na retention(H20 follows) and K excretion =increases fluid vol and B/P, decreases UO Triggers: -plasma acidosis (high serum K) -increased ACTH -low B/P and/or FVD = stretch receptors/ Renin-angiotensin system -sympathetic response -diurnal cycle (higher at night) *remember it is a steroid so cortisol can have a similar effect |
|
|
Calcitonin
|
a thyroid hormone
lowers serum Ca by inhibiting.. -osteoclasts in bones - intestines in absorbing Ca -kidney Ca reabsorption -kidney Phos reabsorption release stimulated by -increased serum Ca -gastrin |
|
|
*ANP
|
Atrial natriuretic peptide
cardiac hormone found in atria cells, released when BP increases (also when serum Na increased) shuts OFF the renin-angiotensin-aldosterone system -it causes vasodilation (decreased BP) and reduces fluids (increasing Na and H2O excretion) DETAILS: • suppresses serum renin levels • decreases aldosterone release • increases GFR=increases urine excretion of Na/H20 • decreases ADH release from the posterior pituitary gland • reduces vascular resistance by causing vasodilation |
|
|
Anions
list some |
negative charge
• Bicarbonate • Chloride • Phosphorus |
|
|
cations
list some |
positive charge
-remember "t"="+" • Calcium • Magnesium • Potassium • Sodium *all cation end in "ium" |
|
|
milli equivalents per liter (mEq/L),
|
measure of the ion’s chemical activity, or its power
|
|
|
how much sodium do you need a day?
|
1 to 2 mEq/kg/day
recommended = 2g/day |
|
|
how much potassium do you need a day?
|
0.5 to 1 mEq/kg/day
recommended= 40mEq/day |
|
|
pH
what is normal body/serum pH |
calculation based on the percentage of hydrogen ions in a solution
(7.35-7.45) normal in body |
|
|
acid
|
consist of molecules that can give up, or donate, hydrogen ions to other molecules
-more hydrogen ions -lower pH -AKA acidotic -ie carbonic acid -pH below 7 EX: H2CO3 (carbonic acid) - H=HCO3 |
|
|
base
|
consist of molecules that can accept hydrogen ions
-has fewer hydrogen ions -has a higher pH -AKA as alkaline -pH above 7 -ie bicarbonate |
|
|
chemical buffers
is it effective? how does it work/examples |
-combine with xs bases or acids
-most effective defense, 1st LINE *remember CO2 is a potential acid CO2 + H2O =H2CO3 (carbonic acid) The carbonic anhydrase equation AKA the buffer system reverses the process H2CO3 (carbonic acid) - H=HCO3(bicarb) *works either way to keep balance |
|
|
*The respiratory system (pH)
|
-2nd line of defense AKA
COMPENSATORY -acts fast but don't last -regulates blood levels of CO2 -chemoreceptors in medulla respond to changes in pH by changing respiration |
|
|
*Renal system (pH)
|
-also 2nd line COMPENSATORY
-takes a few days but lasts and lasts -can absorb or excrete acids/bases -also can produce bicarbonate |
|
|
*Normal Acid/Base values
pH PO2 PCO2 HCO3 O2 sat. |
pH (7.35-7.45)
PO2 (80-100mmHg) hypoxic if low PCO2 (35-45) -acid /respiratory HCO3 (22-26 meq) -base/metabolic O2 sat. (93-100) R-respiratory O-opposite M-metobolic E- equal |
|
|
how can you test the buffer system
(ratio) |
Normal is 20 base: 1 acid
*compare HCO3 and PCO2 |
|
|
*CVP
what does it measure and what is normal? |
-Central venous pressure
-measured in R atrium -pressure in thoracic vena cava, near R atrium -reflects blood returning to heart -often used to gage PRELOAD -2 to 6 mm Hg (2 to 10 cm H2O) -higher=more fluid/FVE |
|
|
how do you estimate a persons CVP (central venous pressure)
|
-pulsations 3 or more cm above angle of Louis is abnml
with machines: -must be ‘zeroed’ at level of R atrium -usually taken to be level of 4th ICS , mid-axillary line while supine -Each measurement taken at same zero position |
|
|
*Hypovolemia
|
Loss of fluid from ANYWHERE
-V/D, bleeding, etc 3rd space shifting -ascites, burns, etc Diseases w/polyuria -diabetes, particle induced diuresis Labs: -elevated BUN:creatinine -elevated Hct and Hgb -elevated serum osmolality -elevated urine specific gravity -normally decreased urine output w/increased concentration TX: -monitor I/O, daily wt -STOP LOSS,hold diuretics/laxatives -REPLACE fluids PO(mild)/IV (severe) -FALL precautions s/s -increased HR -decreased B/P and CVP -weak, thready pulse -increased RR -orthostatic hypotension -decreased turgor, dry MM, thirst -cool, clammy skin -mental confusion -risk for shock |
|
|
*Hypervolemia
|
cells only hold so much so it FILLS VESSELS 1st then tissues
CAUSES: -THINK HEART 1st then renal F -increased fluid and/or Na intake (Alka-Seltzer, fleet enema, etc) -low dietary protein -prolonged steroid tx/Cushings -hyperaldosteronism S/S: -distended neck/peripheral veins -tachycardia -increased B/P, CVP, weight -increased urine output (unless DI) -full, bounding pulse -pulmonary edema -S3 heart sound -crackles in posterior bases -SOB/ tachypnea -frothy sputum (pink), cough -dependent edema DX: -decreased Hct/ Hg -decreased serum osmolality -decreased urine osmolality -decreased urine Na -decreased urine specific gravity -increased ANP, BNP, etc -other s/s of cause (heart/renal) TX: -Restriction of Na and Fluids -I&Os and daily wts -Diuretics -bedrest |
|
|
*if a pt gains 1 kg in weight how much extra fluid is that
assuming it is all water weight? |
1000ml
|
|
|
*Hypernatremia
causes s/s TX |
CAUSES:
-hyperventilation -heat stroke -DI -V/D, not drinking enough, etc -feeding tube pts (still need H2O) S/S: -thirst -elevated body temp -dry MM, swollen tongue -hallucinations, seizures -anorexia , N/V TX: -fluids, diuretics, Na restriction -daily wts, I&Os |
|
|
*Hyponatremia
causes s/s and tx |
CAUSES:
-XS intake of plain water -psychogenic polydipsia -D5W (sugar and H2O) S/S: of CEREBRAL SWELLING -anorexia, N/V -ABDOMINAL cramps -HA/ seizures/ coma/ death TX: -Na replacement -fluid restriction -IV normal saline or hypertonic |
|
|
*hypokalemia
causes s/s ECG changes tx |
below 3.5 mEq/L
severe if less then 2.5 mEq/L CAUSES: -Vomiting, NG suction (lots in GI) -diuretics -not eating, anorexia S/S: -muscle cramps -muscle weakness -arrythmias ECG: -prominent U waves -PVCs -V-tach TX: um w/K of course -Aldactone |
|
|
why might the serum mag level NOT reflect a true measure?
|
-only 1/2 in free form (IONIZED)-active but unmeasurable
-30% of serum Mg binds to albumin -if albumin low=Mg looks low -20% binds to other stuff |
|
|
*Hypomagnesemia
causes s/s ECG tx |
below 1.2 mEq/L
CAUSES: -diarrhea (lots of Mg in intestines) -alcoholism (suppresses ADH/anorexia) s/s:not enough sedation -muscles tight, rigid -seizures -stridor/laryngospasms -dysphagia (aspiration) -arrhythmias -increased DTRs -Trousseaus and Chvostek’s sign -mind changes (crazy to depressed) ECG: -PVCs -flat/inverted T wave -depressed ST segment -prolonged PR interval -widened QRS TX: mag sulfate -check renal F if given IV -seizure precautions |
|
|
*Hypermagnesemia
causes s/s ECG tx |
serum mag above 2.1 mEq/L
CAUSES: -Renal failure (excretes most) -too much intake, antacids S/S: -warmth/flushing d/t vasodilation -decreased DTRs,pulse,LOC,RR -weak, flaccid muscle tone -arrythmias ECG: -tachycardia to bradycardia -prolonged PR interval and QRS -peaked T waves TX: -calcium gluconate -mech ventilation -dialysis -safety precautions |
|
|
Urine specific gravity
*LEAST accurate measure of urine concentration |
-measure of kidneys’ ability to excrete/conserve urine
-compared to wt of distilled water (1.000) -can be measured at bedside -varies inversely w/urine volume -increased glucose/protein=falsely high -1.010 to 1.025 |
|
|
BUN
*measure of renal function |
made of urea (end product of protein metabolism by liver) from both muscle and dietary intake
-amino acids breakdown into ammonia which is transformed into urea than excreted in urine -elevated in renal failure, dehydration, and hemorrhage -10-20 mg/dL (3.6-7.2 mmol/L) |
|
|
Creatinine
*better measure of renal function than BUN because it does not vary with dietary intake of protein and metabolic state |
creatinine is the end product of muscle metabolism
-depends on lean body mass (individual) -increased levels=decreased renal function, muscle damage, dehydration -approx. 0.7 to 1.4 mg/dL |
|
|
Bun to Creatinine ratio
|
20:1
(BUN about x20 the creatinine) -elevated w/ -decreased renal function -hypovolemia |
|
|
Hematocrit (Hct)
|
-measures % of RBCs in blood
-increased values=FVD -decreased values= FVE -males 42% to 52% -females 37% to 47% normaly 3x the hemoglobin |
|
|
RL
what is it often used for what is in it when should it NOT be given what does the L change into |
-isotonic
-often used as fluid volume expander contains: Na, Chl, K, Ca, and……… Lactate-metabolised into bicarbonate -not given if pH is more than 7.5 -9 cal/L |
|
|
D5
calories per L |
-170 cal/L |
|
|
what pH levels will cause DEATH
|
below 6.8 or above 8.0
|
|
|
s/s respiratory acidosis
causes tx |
too much CO2
-mid abd incision -narcs, sleeping pills, sedatives -pneumothorax -pneumonia -COPD??? -elevated B/P and HR -decreased heart contractibility -HA, confused, lethargy to coma -HYPERKALEMIA -hypoxia=restlessness, increased HR TX: depends on cause -mechanical ventilation -O2 therapy -insulin=pushes K into cells |
|
|
s/s respiratory alkolosis
causes and tx |
CAUSES:
-hyperventilation -acute aspirin OD S/S: -lightheaded, faint -peri-oral numbness -tingling in fingers/toes -HYPOCALCEMIA -HYPOKALEMIA TX: -decrease respirations/calm/sedate -breathe into paper bag -again tx the cause |
|
|
metabolic alkalosis
causes s/s tx |
too many H+ (ions) lost from.....
-diuretics -corticosteriods -aldosteronism -Cushing's Dz -vomiting/suction=lose HCL S/S: -HYPOCALCEMIA -HYPOKALEMIA TX: -Diamox (diuretic) -IV POTASSIUM |
|
|
metabolic acidosis
causes s/s tx |
-seizures/fever
-diarrhea=lose HCO3 -renal failure -starvation and DK, d/t ketones S/S: -elevated B/P, HR, and RR -decreased heart contractibility -lethargy to coma -HYPERKALEMIA TX: the cause -IV NaBicarb |
|
|
*Hyperkalemia
causes s/s ECG tx |
CAUSES:
-renal F (most K excreted in urine) -use of Aldactone S/S: -begins w/muscle twitching -proceeds to weakness -then flaccid paralysis -arrhythmias ECG: -tall tented T waves -widened QRS complex -flat or absent P waves -bradycardia -conduction blocks -V-fib TX: -Kayexalate -insulin =pushes it into cells -calcium gluconate-for heart -diuretics - dialysis, -IV sodium bicarbonate if acidosis |
|
|
*serum Na level
|
135-145
|
|
|
*serum K level
|
3.5-5.5
|
|
|
*serum Ca level
|
8.5-10.5
|
|
|
*serum Mag level
|
1.2-2.1
|
|
|
serum Phosphate level
|
2.5-4.5
|
|
|
serum chloride level
|
96-108
|
|
|
*Hypercalcemia
causes s/s ECG TX |
CAUSES:
-hyperparathyroidism= XS PTH -Thiazide diuretics -immobilization S/S -Bones, brittle -Stones (renal/biliary) -decreased DTRs,pulse,LOC,RR -weak, flaccid muscle tone -arrythmias ECG: -shortened ST segment and QT interval -braycardia TX: -Movement, weight baring -fluids to prevent stones -calcitonin -steroids - phosphate salts /Fleet enema, and other forms phosphorus |
|
|
*Hypocalcemia
causes s/s ECG |
above 10.5mg/dL
CAUSES: -Not enough PTH (hypoparathyroid, thyroidectomy, radical neck) S/S: s/s:not enough sedation -muscles tight, rigid -seizures -stridor/laryngospasms -dysphagia (aspiration) -arrhythmias -increased DTRs -Trousseaus and Chvostek’s sign -mind changes (crazy to depressed) ECG: -prolonged QT interval -lengthened ST TX: -Vit D -Phosphate binders -IV Ca =must use heart monitor |
|
|
*Relationship between Ca and phosphorus
|
Are opposite so when one goes up the other goes down
|
|
|
Tetany
s/s caused by |
-hypocalcemia and hypomagmesemia
-HYPERACTIVE DTR -tingling in fingers,feet,mouth -spasms that may be painful |
|
|
*Trousseau's sign
|
-carpal spasm w/B/P cuff 20mmHg above systole w/n 5 minutes
|
|
|
*Chvostek’s sign
|
-twitching d/t tapping of facial nerve
|
|
|
ways to measure urine concentration
from least to most accurate |
-specific gravity
-osmolarity -OSMOLALITY |
|
|
*concentrated makes the numbers go up............
and dilute makes the numbers go down rule |
ONLY works with:
-urine specific gravity, Na, and Hct remember when looking at labs serum and urine |
|
|
*SIADH
|
-too much ADH
(too many letters=too much H2O) -retains fluid d/t decreased diuresis =increased urine concentration and decreased output =decreased serum concentration and increased volume |
|
|
*DI
|
-diabetes insipidus
D=Diuresis -not enough ADH -urine is dilute -serum is concentrated -may go into hypovolemic shock |
|
|
*where is ADH found
and why is this significant |
-pituitary
potential ADH problem (DI): -craniotomy -head injury -sinus sx -transphenoidal hypophysectomy -or anything that could increase ICP |
|
|
*common drugs used to tx low ADH/ DI
|
-Vasopressin (Pitressin)
-Desmopressin Acetate (DDAVP) |
|
|
*common diuretics used
|
K wasting:
-Furosemide (Lasix), loop -Hydrochlorothiazide (Bumex) K sparing: -Aldactone think about this when making IV and dietary choices about K |
|
|
*test tip
anytime you see assessment or evaluation look for...... |
presence or absence or PERTINENT (focused) s/s
|
|
|
*what effect does bed rest have on fluid volume
|
-it induces diuresis =decreasing vol
-increased fluid in thorax stimulates release of ANP -and causes baroreceptors to trigger decreased ADH production -this may be used to tx FVE -may also cause FVD -increased blood thickness, DVTs, thickness of secretions, constipation etc......................... so PUSH FLUIDS unless in FVE |
|
|
*anecdote to Magnesium
and how is it given |
Calcium gluconate
IVP max rate of 1.5-2mL/min |
|
|
*test tip
Mg and Ca questions, think...... |
muscles 1st
-too much=sedatives -too little=not enough sedatives |
|
|
*dietary sources of phosphorus
|
anything w/protein
|
|
|
*common phosphate binders and use
|
-Renagel, PhosLo, Os-Cal
-brings down serum phosphorus and increases serum Ca |
|
|
* foods high in Mg
|
-spinach and kale
-mustard and turnip greens -broccoli -green beans -celery -summer squash and cucumber -peppermint -pumpkin/flax/sesame/sunflower -halibut |
|
|
*foods high in K
|
-spinach, fennel, and kale
-mustard greens -broccoli -brussel sprouts -bell peppers -cucumber -cauliflower -cabbage -parsley -lima beans -eggplant -halibut and tuna -avocado, banana, kiwi, ginger -strawberries, oranges, apricots -cantaloupe -tomatoes and both potatoes |
|
|
* Kayexalate
used to tx what? |
hyperkalemia
-exchanges Na for K in GI tract -pt may become dehydrated -push fluids |
|
|
*Any time you give IV insulin worry about.......
|
-hypoglycemia
and -hypokalemia |
|
|
*major considerations w/PO and IV K
|
PO= give w/food to avoid GI upset
IV -assess urine output b4 and during (drop in output=increased retention just like w/Mg) -always use a pump -mix well -DILUTE, it BURNS |
|
|
parathyroid hormone
|
PTH=bone resorption
increases serum calcium by .. -kidney keep Ca and Mag -kidneys ditch phos -osteoclasts increased -increased absorption by GI via VitD release stimulated by.... -decreased serum Ca -mildly decreased serum Mag -increased serum Phos inhibited by.... -increased serum Ca -severe decrease in serum Mag |
