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93 Cards in this Set

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What are the functions of body water?
- maintain body temp
- maintain cell shape
- transports nutrients, electrolytes, and oxygen to cells
- excretes waste products
- lubricates joints and membranes
- medium for food digestion
Water accounts for what percentage of the body in adults? infants?
Adults- 60%
Infants- 70-80%

Varies with gender, age, and body mass
Three different fluid compartments of the body
Intracellular Fluid (ICF)- inside cell
Extracellular Fluid (ECF)- outside cell
Trans-cellular Fluid- specialized cavities
Water _____ must equal water _____.
Input, Output
Cation are ____ charged. Anions are ____ charged.
Positive
Negative
Diffusion is?

Give example.
the movement of molecules from an area of high concentration to an area of low concentration. (Water movement)
Ex.- Lump of sugar in water.
Facilitated Diffusion is?

Give example.
Like simple diffusion, however when it is combined with a specific carrier molecule the rate of diffusion accelerates.
Ex.- Glucose transport in a cell
Active transport is?

Give example.
a process in which molecules move against the concentration gradient.
Ex.- Sodium potassium pump
Osmosis is?
the movement of WATER between two comparments seperated by a semipermeable membrane. Water moves through the membrane to the area of low solute concentration to an area of high solute concentration.
What is the normal plasma osmolality range?
275- 295 mOsm/kg
A plasma osmolality of greater than 295 mOsm/kg indicates?
That the concentration of particles is too great or that the water content is too little, termed water deficit.
A plasma osmolality of less than 275 mOsm/kg indicates?
Too little solute for the amount of water or too much water for the solute, termed water excess.
Definition of olutiIsotonic
Fluids with the same osmolality as the cell interior.
Definition of hypotonic.

Effect on cells?
Solutions in which the solutes are less concentrated than the cells.

Water moves into the cell.
Definition of hypertonic.

Effect on cells?
Solutions in which the solutes are more concentrated than the cells.

Water moves out the cell.
Hydrostatic pressure is?
the major force that pushes water out of the vascular system at the capillary level.
Oncotic pressure is?
the force that pulls fluid into the vascular space.
Fluid Spacing
What does each mean?
First Spacing
Second Spacing
Third Spacing
First Spacing- normal distribution of fluid in ICF and ECF
Second Spacing- Abnormal accumulation of interstitial fluid. Edema
Third Spacing- Fluid accumulation in part of the body where it is not easily exchanged with ECF.
Regulation of Water Balance

Describe Hypothalamic Regulation
A body fluid deficit or increase in plasma osmolality is sensed by osmpreceptors which stimulates thirst and antidiuretic hormone (ADH) release. ADH causes water reabsorption resulting in increased free water in body and decreased plasma osmolality.
Regulation of Water Balance

Describe Pituitary regulation
;Releases ADH, regulating water retention. Water is resorbed into the blood and not excreted in the urine.
Regulation of Water Balance

Describe Adrenal Cortical Regulation
Glucocorticoids and mineralocorticoids help to regulate water and electrolytes. Glucocorticoids (Cortisol) have an antiinflammatory effect and increase serum glucose levels. Mineralocorticoids (Aldosterone) enhance sodium retention and potassium excretion. When Sodium is absorbed, water folllows.
Regulation of Water Balance

Describe Renal Regulation
The kidneys regulate water balance by adjusting urine volume.
Regulation of Water Balance

Describe Cardiac Regulation
Natriuretic peptides are natural antagonists to the RAAS. Produced in response to increased atrial pressure and high serum sodium levels. They act on the renal tubules to promote excretion of sodium and water, resulting in a decrease in blood volume and BP.
Regulation of Water Balance

Describe Insensible Water Loss
Is the invisible vaporization from the lungs and skin, assists in regulating body temp.
Changes in the elderly that increase their susceptibility to F& E imbalances.
- decrease in the glomerular filtration rate
- decreased creatinine clearance
- the loss of the ability to concentrate urine and conserve water
- narrowed limits for the excretion of H2O, Na, K, and H
- decrease in renin and aldosterone
- increase in ADH and ANP
- decrease in the thirst mechanism
Factors contributing to F&E Imbalances
- Illness and Conditions: GI issues, CVD, Renal disease, burns, endocrine disorders, cirrhosis of the liver, pulmonary disease
- Interventions and treatments: surgery, medications, IV fluids, NG suctioning, low Na diets, NPO status
- Stress
Who do you assess for F& E imbalances?
EVERYONE
Fluid volume excess is called?
Hypervolemia
Fluid Volume Excess

Results from?
S/S?
Treatment?
- results from excessive intake of fluids, anormal rentention of fluids, or interstitial to plasma fluid shift, HF, Renal failure
- S/S: cough, SOB, JVD, bounding pulse, crackles, weight gain, HTN, change in LOC, peripheral edema, increased BP
- Treatment: diuretics and fluid restriction, Na might also be restricted
Fluid volume deficit is called?
Hypovolemia
Fluid volume deficit

Results from?
S/S?
Treatment?
- results from loss of normal body fluids, decreased intake, plasma to interstitial fluid shift, diabetes insipidus, hemorrhage
- S/S: decreased urine output, concentrated urine, weakness, weight loss, orthostatic hypotension, low BP, poor skin tugor, dry mucous membranes, thirst
- treatment: balanced IV solutions given to replace both water and electrolytes
Normal serum electrolyte values

Bicarbonate
22-26 mEq/L
Normal serum electrolyte values

Chloride
96-106 mEq/L
Normal serum electrolyte values

Phosphate
2.4- 4.4 mg/dL
Normal serum electrolyte values

Potassium
3.5- 5.0 mEq/L
Normal serum electrolyte values

Magnesium
1.5- 2.5 mEq/L
Normal serum electrolyte values

Sodium
135- 145 mEg/L
Normal serum electrolyte values

Calcium
8.5- 10.3 mEq/dl
Hypernatremia is?
an elevated serum sodium may occur with water loss or sodium gain
Hyponatremia is?
a loss of sodium containing fluids, from water excess or combination of both
Causes of hypernatremia
- IV fluids
- hypertonic tube feedings without water supplements
- inadequate water intake
- excessive water loss
- disease states: diabetes insipidus, Cushings, uncontrolled diabetes mellitus
Symptoms of hypernatremia

with decreased ECF volume
- restlessness, agitation, twitching, seizures, coma
- intense thirst, dry, swollen tongue
- postural hypotension, decreased CVP, weight loss
- weakness, lethargy
Symptoms of hypernatremia

with increased ECF volume
- restlessness, agitation, twitching, seizures, coma
- intense thirst, flushed skin
- weight gain, peripheral and pulmonary edema, increased BP and CVP
Treatmeant of hypernatremia
If oral fluids can not be given, IV solutions of 5% dextrose in water or hypotonic solution. Must decrease Na levels gradually to prevent shift in of water back into the cells, it can cause cerebral edema. Diuretics may also be given. Dietary Na intake may be restricted
Causes of hyponatremia
- excessive sodium loss: GI losses, renal losses, skin losses
- inadequate sodium intake: fasting diets
- excessive water gain: excessive hypotonic IV fluids
- disease states: SIADH, HF, primary hyperaldosteronism
Symptoms of hyponatremia

with decreased ECF volume
- irritability, apprehension, confusion, dizziness, personality changes
- dry mucous membranes
- postural hypotension, decreased CVP and jugular venous filling, tachycardia, thready pulse
- cold and clammy skin
Symptoms of hyponatremia

with increased ECF volume
- headache, apathy, confusion, muscle spasms, seizures, coma
- nausea, vomiting, diarrhea, abdominal cramps
- weight gain, increased BP and CVP
Treatment of hyponatremia
Caused by water excess, Fluid restriction is often all that is needed.
For severe symptoms, small amounts of IV hypertonic saline solution (3% NaCl) are given.
For hyponatremia with fluid loss, treatment includes fluid replacement with sodium containing solutions.
Potassium is necessary for what 4 things?
- Transmission and conduction of nerve impulses
- Maintenance of normal cardiac rhythms
- Skeletal muscle contraction
- Acid-base balance
Hyperkalemia is?
high serum potassium
Hypokalemia is?
low serum potassium
Causes of hyperkalemia
- Excess K intake: excessive or rapid parenteral administration, K containing drugs, K containing salt substitute
- Shift of K out of cells: acidosis, tissue catabolism (fever, burns), crush injury, tumor lysis syndrome
- Failure to eliminate K: renal disease, K-sparing diuretics, adrenal insufficiency, ACE inhibitors
Symptoms of hyperkalemia
- Irritability, anxiety
- Abdominal cramping, diarrhea
- Weakness of lower extremities
- Paresthesias
- Irregular pulse, cardiac arrhythmias
- Cardiac arrest if hyperkalemia is sudden or severe
Treatments for hyperkalemia
- Eliminate oral and parenteral potassium intake
- Increase elimination of K: diuretics, dialysis, increased fluid intake
- Force K from the ECF to the ICF: administration of IV insulin with glucose or IV sodium bicarb in the correction of acidosis
- Reverse the membrane potential effects of the elevated ECF K: administering IV calcium gluconate
Causes of Hypokalemia
- Potassium loss: GI losses, renal losses, skin losses, dialysis
- Shift of K into cells: increased insulin, alkalosis, tissue repair
- Lack of K intake: stravation, diet low in K, failure to include potassium in parenteral fluids if NPO
Symptoms of hypokalemia
- Fatigue, muscle weakness, leg cramps, soft, flabby muscles, decreased reflexes
- Nausea, vomiting
- weak, irregular pulse
- polyuria
- Hyperglycemia
Treatments for hypokalemia
- Giving potassium chloride supplements (orally or IV) and increasing dietary intake of potassium
- NEVER give KCl IV push or in concentrated amounts
What are the functions of calcium?
- Blocks sodium transport
- Stabilizes cell membrane
- Transmission of nerve impluses
- Myocardial contractions
- Blood clotting
- Formation of teeth and bone
- Muscle contractions
Hypercalcemia is?
excessive calcium
> 10.2 mg/dL
Hypocalcemia is?
low calcium levels
< 8.6 mg/dL
Causes of hypercalcemia
- Increased total calcium: multiple myeloma, prolonged immobilization, hyperparathyroidism, Vit D overdose, thiazide diuretics, milk-alkali syndrome
Symptoms of hypercalcemia
- Lethargy, weakness, depressed reflexes, bone pain, fractures
- Decreased memory, confusion, personality changes, psychosis
- Anorexia, nausea, vomiting
- Polyuria, dehydration
- Nephrolithiasis
- Stupor, coma
Causes of hypocalcemia
- Decreased total calcium: chronic kidney disease, elevated phosphorus, primary hyperparathyroidism, Vit D deficiency, Mg deficiency, loop diuretics, diarrhea
- Decreased ionized Ca: alkalosis, excess admin of citrated blood
Symptoms of hypocalcemia
- Depression, anxiety, confusion
- Numbness and tingling in extremities and around mouth
- Hyperreflexia, muscle cramps
- Chvostek's sign
- Trousseau's sign
- Tetany, seizures
Chvostek's sign is?
Contraction of facial muscles in response to a light tap over the facial nerve in front of the ear.
Trousseau's sign is?
Refers to carpal spasms induced by inflating a BP cuff on the arm above the systolic pressure. Shows up within 3 minutes.
Treatment of hypocalcemia
- Oral or IV Ca supplements
- Diet high in Ca rich foods
- Vit D supplements
Phosphate main functions are?
- Function of muscle
- RBCs
- Nervous system
- Deposited with Ca for bone and tooth structure
Hyperphosphatemia is?
excess of phosphate

> 4.4 mg/dL
Hypophosphatemia is?
low serum phosphate

< 2.4 mg/dL
Causes of hyperphosphatemia
- Renal failure
- Chemotherapeutic agents
- Enemas containing phosphorus
- Excessive ingestion
- Large Vit D intake
- Hypoparathyrodism
Symptoms of hyperphosphatemia
- Hypocalcemia
- Muscle problems, tetany
- Deposition of Ca
Treatment of hyperphosphatemia
- Dietary phosphate should be restricted
- adequate hypdration and correction of hypocalemia can enhance the renal excretion of phosphate
Phosphate and calcium have a _______ relationship?
Reciprocal

When there are high serum phosphate levels there are low calcium levels
Causes of hypophosphatemia
- Malabsorption syndrome
- Nutritional recovery syndrome
- Glucose admin
- TPN
- Alcohol withdrawal
- Phosphate- binding antacids
- Respiratory alkalosis
Symptoms of hypophosphatemia
- CNS dysfunction
- Muscle weakness
- Renal tubular wasting of Mg, Ca, HCO3
- Cardiac problems
- Osteomalacia
Treatment of hypophosphatemia
- Oral supplements of Phosphate
- Diet high in phosphate
- Severe cases require IV admin of sodium phosphate or potassium phosphate
Functions of Magnesium
- Influences muscle contractions and intracellular activity
- Transmission of neuromuscular activity
- Coenzyme in metabolism of protein and carbohydrates
True or False

Factors that regulate calcium balance appear to influence magnesium balance.
True
Hypermagnesemia is?
high serum Mg levels

>2.5 mEg/L
Hypomagnesemia is?
low serum Mg levels

<1.5 mEg/L
Causes of Hypermagnesemia
- Renal Failure
- Excessive admin of Mg for treatment of eclampsia
- Adrenal insufficiency
Symptoms of Hypermagnesemia
- Lethargy, drowsiness
- Nausea, vomiting
- Deep tendon reflexes are lost, then respiratory and cardiac arrest can occur
Treatment of Hypermagnesemia
- Focus on prevention, people at risk should stay away from Mg containing drugs
- IV admin of CaCl, in severe cases
Causes of hypomagnesemia
- Diarrhea, vomiting, impaired GI absorption, prolonged malnutrition
- large urine output
- NG suction
- Poorly controlled diabetes mellitus
- Hyperaldosteronism
Treatments of hypomagnesemia
- Oral supplements
- Increased dietary intake
- Parenteral IV or IM Mg, in severe cases; can cause cardiac arrest if given too fast
Symptoms of hypomagnesemia
- Confusion
- Hyperactive deep tendon reflexes
- Tremors, seizures
- can resemble hypocalcemia
Lab Data
Hematocrit

What does it mean when it is decreased? increased?
Decreased- dilution of blood from fluid overload

Increased- Fluid or ECF volume depletion
Lab Data
Hemoglobin

What does it mean when it is decreased? increased?
Decreased- hypo-osmolarity

Increased- Hyperosmolarity
What does an increased BUN test mean?
ECF volume depletion
Specific gravity of a urinalysis is increased due to ?
Fluid deficit
Urine osmolality is elevated in fluid deficit or excess?
Deficit
Serum osmolality increase and decrease mean what?
Increase- fluid deficit

Decrease- Overhydration