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242 Cards in this Set

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DEFINE HOMEOSTASIS
A STATE OF EQUILIBRIUM IN THE INTERNAL ENVIRONMENT OF BODY, NATURALLY MAINTAINED BY ADAPTIVE RESONSES THAT PROMOTE HEALTHY SURVIVAL.

**BODY FLUIDS AND ELECTROLYTES PLAY AN IMPORTANT ROLE.
THE WATER CONTENT OF THE BODY ACCOUNTS FOR _____% OF BODY WEIGHT IN AN ADULT?
60%
THE WATER CONTENT OF THE BODY ACCOUNTS FOR _____% OF BODY WEIGHT IN AN INFANT?
70-80%
THE WATER CONTENT VARIES WITH __________, __________, AND ________________.
GENDER
BODY MASS
AGE
FACTORS WHICH AFFECT THE PERCENT OF TOTAL BODY WATER INCLUDE __________ AND ____________________________.
AGE
THE AMOUNT OF LEAN MUSCLE MASS VERSUS FAT
FATTY TISSUE CONTAINS ______ WATER THAN MUSCLE.
LESS
OLDER ADULTS TEND TO LOSE MUSCLE MASS AS THEY AGE, THEREBY DECREASING THE PERCENT OF?
(TBW) TOTAL BODY WATER
TOTAL BODY WATER IS DIVIDED AMONG COMPARTMENTS (SPACES) AND SEPARATED BY ___________.
MEMBRANES
WHAT ARE THE THREE CELLULAR FLUID COMPARTMENTS?
INTRACELLULAR FLUID (ICF)
EXTRACELLULAR FLUID (ECF)
TRANSCELLULAR FLUID
INTRACELLULAR FLUID INCLUDES FLUID IN ALL THE BODY'S CELLS AND IS APPROXIMATELY ______ OF THE TOTAL BODY WEIGHT.
2/3
THE INTRACELLULAR FLUID IS SEPARATED FROM THE OTHER COMPARTMENTS BY THE ________ _________________. FLUID LOCATED WITHIN CELLS.
CELL MEMBRANE
INTRACELLULAR FLUID IS _____-______% IN OLDER ADULT'S BODY WEIGHT?
45-55%
INTRACELLULAR FLUID IS _____-______% IN ADULT'S BODY WEIGHT?
50-60%
INTRACELLULAR FLUID IS _____-______% IN INFANTS BODY WEIGHT?
70-80%
IN INTRACELLULAR FLUID THE MOST PREVALENT ___________ IS POTASSIUM (K+)
CATION
INTRACELLULAR FLUID'S MOST PREVALENT ___________ IS PHOSPHATE (PO4-).
ANION
A CATION CARRIES WHAT TYPE OF CHARGE?
POSITIVE
AN ANION CARRIES WHAT TYPE OF CHARGE?
NEGATIVE
TRUE/FALSE
IS MAGNESIUM FOUND IN THE INTRACELLULR FLUID?
TRUE
EXTRACELLULAR FLUID IS FLUID SPACES BETWEEN CELLS (____________ FLUID) AND THE __________________ SPACE.
INTERSTITIAL
PLASMA
EXTRACELLULAR FLUID (ECF) IS ALL FLUID OUTSIDE THE BODY'S CELLS AND IS APPROXIMATELY _______ OF THE TOTAL BODY WEIGHT. IT IS SUBDIVIDED INTO HOW MANY COMPARTMENTS?
1/3
TWO
WHAT ARE THE TWO (ECF) SUBDIVIDED COMPARTMENTS AND DESCRIBE.
1. INTERSTITIAL FLUID (THE FLUID BETWEEN THE CELLULAR SPACES

2. INTRAVASCULAR FLUID [PLASMA] (THE FLUID IN THE BLOOD VESSELS).

THE INTERSTITIAL & INTRAVASCULAR SPACES ARE DIVIDED BY THE BLOOD VESSEL WALL.
THE INTERSTITAL FLUID WITHIN THE ECF MOST PREVALENT _____ IS CHLORIDE (CL-).
ANION
THE INTERSTITAL FLUID WITHIN THE ECF MOST PREVALENT _____ IS SODIUM (Na+)
CATION
THE INTERSTITIAL FLUID WITHIN THE ECF ____________ AND CONTRACTS
EXPANDS
____________ OF INTERSTITIAL FLUID IS ECF.
1/3
TRANSCELLULAR FLUID WITHIN THE ECF IS _____________ BUT AN IMPORTANT FLUID COMPARTMENT. IT CONTAINS APPROXIMATELY __________ L.
SMALL
ONE
THE TRANSCELLULAR FLUID CONTAINS FLUID IN 5 SPACES WHAT ARE THEY?
CEREBROSPINAL FLUID
GASTROINTESTINAL TRACT (GI)
PLEURAL SPACES
SYNOVIAL SPACES
PERITONEAL FLUID SPACES
THERE ARE 6 MECHANISMS THAT CONTROL FLUID AND ELECTROLYTE MOVEMENT, WHAT ARE THEY?
DIFFUSION
FACILITATED DIFFUSION
ACTIVE TRANSPORT
OSMOSIS
HYDROSTATIC PRESSURE
ONCOTIC PRESSURE
THE ___________ OF SOLUTES (ELECTROLYTES AND PROTEINS, ETC.) IN THE FLUID COMPARTMENTS IS EQUAL EVEN IF THE TYPES OF SOLUTES ARE DIFFRENT.
CONCENTRATION
THE CONCENTRATION OF SOLUTES IS MEASURED BY THE BODY'S ______________ (A LAB VALUE DEFINING SOLUTE CONCENTRATION IN MILLIOSMOLES PER LITER).
OSMOLALITY
THE MORE CONCENTRATED THE SOLUTION, THE ___________ THE OSMOLALITY. THE MORE WATER, THE _______________ THE OSMOLALITY.
HIGHER
LOWER
NORMAL SERUM OSMOLALITY OF AN ADULT IS __________________mOsm/kg.
280-300
NORMAL SERUM OSMOLALITY OF AN CHILD IS __________________mOsm/kg.
270-290
HYPERTONIC IV FLUID HAS A ___________ CONCENTRATION OF SOLUTES IN COMPARISON TO THE SERUM.
GREATER
HYPERTONIC SOLUTIONS WILL PULL WATER _____________ IT TO MAINTAIN EQUILIBRIUM.
TOWARD
HYPOTONIC IV FLUID HAS A _______________ CONCENTRATION OF SOLUTES IN COMPARISON TO THE SERUM (THE SOLUTION IS MORE DILUTED THAN THE PLASMA).
LESSER
HYPOTONIC SOLUTIONS WILL ______________ THE INTRAVASCULAR COMPARTMENT TO MAINTAIN EQUILIBRIUM.
LEAVE
DIFFUSION IS THE MOVEMENT OF MOLECULES FROM AN AREA OF __________ CONCENTRATION TO ___________ CONCENTRATION.
HIGH
LOW
DIFUSSION OCCURS IN ______________, ______________, AND ______________.
LIQUIDS
SOLIDS
GASES
WITH DIFFUSION, MEMBRANES SEPARATING TWO AREAS MUST BE _____________________ TO THE SUBSTANCE FOR DIFUSION TO OCCUR.
PERMEABLE
FACILITATED DIFFUSION IS VERY _____________ TO DIFFUSION.
SIMILAR
WITH FACILITATED DIFFUSION THERE ARE SPECIFIC CARRIER MOLECULES INVOLVED TO _____________ DIFFUSION.
ACCELERATE
ACTIVE TRANSPORT IS THE PROCESS IN WHICH MOLECULES MOVE ___________________ THE CONCENTRATION GRADIENT.
AGAINST

EXAMPLE: THE SODIUM-POTASSIUM PUMP
WHAT IS THE ENERGY SOURCE OF ACTIVE TRANSPORT?
ATP
OSMOSIS IS THE MOVEMENT OF _______________ BETWEEN TWO COMPARTMENTS BY A MEMBRANE PEREABLE TO ______________ BUT NOT TO A _______________.
WATER
WATER
SOLUTE
WITH OSMOSIS WATER MOVES FROM A AREA OF ____________ CONCENTRATION TO AN AREA OF ___________ CONCENTRATION.
LOW
HIGH
DOES OSMOSIS REQUIRE ENERGY?
NO
OSMOTIC PRESSURE IS THE AMOUNT OF PRESSURE REQUIRED TO ____________ OSMOTIC FLOW OF WATER.
STOP
WITH OSMOTIC PRESSURE WATER WILL MOVE FROM A ___________ CONCENTRATED AREA TO A __________ CONCENTRATED AREA.
LESS
MORE
OSMOTIC PRESSURE IS DETERMINED BY THE __________________ OF _________________ IN A SOLUTION.
CONCENTRATION
SOLUTES
HYDROSTATIC PRESSURE IS THE _______________ WITHIN A FLUID COMPARTMENT.
FORCE
WITH HYDROSTATIC PRESSURE THE MAJOR FORCE THAT PUSHES ______________ OUT OF THE VASCULAR SYSTEM AT THE CAPILLARY LEVEL.
WATER
ONCOTIC PRESSURE IS THE ___________ ____________ EXERTED BY COLLOIDS IN A SOLUTION
OSMOTIC PRESSURE
WITH REGARDS TO ONCOTIC PRESSURE, _______________ IS THE MAJOR COLLOID IN THE VASCULAR SYSTEM.
PROTEIN
THE FLUID MOVEMENT IN THE CAPILLARIES IS THE AMOUNT AND ______________ OF MOVEMENT DETERMINED BY: (4 DIFFERENT PRESSURES WHAT ARE THEY?)
DIRECTION

1. CAPILLARY HYDROSTATIC PRESSURE
2. PLASMA ONCOTIC PRESSURE
3. INTERSTITIAL HYDROSTATIC PRESSURE
4. INTERSTITIAL ONCOTIC PRESSURE
WITH FLUID SHIFTS THE PLASMA TO INTERSTITIAL FLUID SHIFT RESULTS IN ______________ AND IS CAUSED BY 3 THINGS, LIST EACH OF THEM.
EDEMA
1. ELEVATION OF HYDROSTATIC PRESSURE
2. DECREASE IN PLASMA ONCOTIC PRESSURE
3. ELEVATION OF INTERSTITIAL ONCOTIC PRESSURE.
IN FLUID SHIFTS THE INTERSTITIAL FLUID TO PLASMA THE FLUID IS DRAWN INTO PLASMA SPACE WHENEVER THERE IS A __________ IN PLASMA OSMOTIC OR ONCOTIC PRESSURE. WHAT WOULD BE THE TREATMENT FOR THIS?
INCREASE

WEARING OF COMPRESSION STOCKINGS OR HOSE IS A THERAPUTIC ACTION ON THIS EFFECT.
IN REGARDS TO FLUID MOVEMENT BETWEEN EXTRACELLULAR AND INTRACELLULAR; A WATER __________ (INCREASED ECF) IS ASSOCIATED WITH SYMPTOMS THAT RESULT FROM CELL SHRINKAGE AS WATER IS PULLED ____ THE VASCULAR SYSTEM.
DEFICIT
INTO
IN REGARDS TO FLUID MOVEMENT BETWEEN EXTRACELLULAR AND INTRACELLULAR; A WATER __________ (DECREASED ECF) DEVELOPS FROM GAIN OR RETENTION OF _____________ WATER.
EXCESS
EXCESS
What is the best site for the nurse to assess skin turgor when the client is in the supine position?
Forehead or chest
What is the priority nursing diagnosis for the adult client with severe cystic acne?
Disturbed Body Image related to presence of facial lesions
The client has frostbite on one cheek. After the frostbite has thawed, a few small blisters appear in the area. What action should the nurse take?
Leave the blisters intact and offer the client an oral analgesic.
Why do older adults generally have less total body water than younger adults?
The muscle mass of older adults is smaller than the muscle mass of younger adults.
What effect would an infusion of 200 mL of albumin have on a healthy client's plasma osmotic and hydrostatic pressures?
Increased osmotic pressure; increased hydrostatic pressure
Which condition is most likely to cause formation of edema?
Decreased plasma osmotic pressure; increased plasma hydrostatic pressure
Why is it important to keep the sodium level of the plasma volume so much higher than the sodium level of the intracellular volume?
Excitable membranes are dependent on sodium concentration differences for depolarization.
What is the priority nursing diagnosis for a bed-fast client with a serum albumin of 7.8 mg/dL?
Risk for Impaired Skin Integrity related to reduced mobility
A new parent asks the nurse how to prevent diaper rash. Which of the following statements is the best practice to tell the parent?
Use superabsorbent disposable diapers, and change diapers as soon as soiled.
The nurse evaluates a new client as having a Braden Scale score of 23. What is the nurse's interpretation of this finding?
The client is at no risk for pressure ulcer development and prevention planning is not needed.
What is the priority nursing diagnosis for a bed-fast client with a serum albumin of 7.8 mg/dL and a prealbumin of 20.?
Risk for Impaired Skin Integrity
A client has just had an abdominal hyterectomy. Staples are in place. No drainage tubes are placed. As the nurse you know that this wound will heal by...
primary intention
How does the syndrome of inappropriate antidiuretic hormone (SIADH) cause hyponatremia?
ADH increases the renal reabsorption of water.
Your patient has a pulmonary embolism. The doctor ordered a heparin drip to run at 1000 units per hour. The pharmacy sent you a 1 liter bag of normal saline with 10,000 units of Heparin in it. How many mls per hour should be set on the IV pump? Please record your answer with amount and the unit of measurement. (Remember that the machine may not score it correctly, math will be individually reviewed on a test.)
1 liter equals 1000mls. 10,000 units divided by 1,000 ml = 10 units of Heparin per every 1 ml. To run at 1,000 units per hour, you would take divide the 1000 units needed by the 10 units per ml; = 100 mls per hour.
Requires _____ energy
NO
WHAT ARE THE 3 FLUID SPACINGS AND DESCRIBE
First spacing:(Normal distribution of fluid in ICF and ECF(equal)
Second spacing:Abnormal accumulation of interstitial fluid
Third spacing:Fluid accumulation in part of body where it is not easily exchanged with ECF(acites, burns,etc)
Normal fluid intake routes: Ingested fluids & foods is _____% of fluid intake (approx. _______mL for adult) Cellular metabolism is remaining ___%
90%
2500mL
10%
WHAT ARE THE TWO FLUID LOSS ROUTES AND DESCRIBE?
1. Sensible loss is visible or measurable in urine, perspiration, and feces

2. Insensible loss is not visible through evaporation and respiration (approx. 500mL/day fluid lost in exhaled vapor in respiration)
What are the 4 Abnormal fluid intake:
And what is the RNs concern?
1. IV solutions
2. Total parenteral nutrition (TPN)
3. Blood volume replacers
4. Colloids (albumin, dextran)
The nurse is always concerned that intake is being regulated. The client must be able to circulate the volume of fluid administered to avoid complications.
What are the three abnormal fluid loss: And the Rns concerns with this?
1. Diseases (vomiting, diarrhea, diuresis, diaphoresis, tachypena)
2. Trauma
3. Medical interventions (diuretics, phlebotomy, surgical procedures, drains)

The nurse is always concerned that losses are controlled to prevent complications of decreased circulation due to excessive loss.
In regards to electrolytes
the cations are ____ and anions _____ and are always __________
positive
negative
equal
What is the most powerful cation?
Hydrogen (H+)
If one electrolyte is disturbed, others are likely ________________.
disturbed
What are the 7 things that regulate the Water Balance?
1. Hypothalamic regulation
2. Pituitary regulation
3. Adrenal cortical regulation
4. Renal regulation
5. Cardiac regulation
6. Gastrointestinal regulation
7. Insensible water loss
Within the Hypothalamic Regulation the Osmoreceptors in hypothalamus sense fluid ______ or __________ in plasma osmolality
deficit
increase
The hypothalamus stimulates _______ and then antidiuretic hormone (ADH) release(ADH (antidiuretic hormone) acts on the _________ renal tubules to increase their membrane permeability to _______ and increases _______ absorption)
thirst
distal
water
water
Hypothalamic Regulation
results in _________ free water and _________ plasma osmolarity
increased
decreased
Pituitary Regulation is under control of ________________,__________ ____________ releases ADH.
hypothalamus
posterior pituitary
Stress, nausea, nicotine, and morphine also stimulate ________ release.
ADH
Adrenal cortex releases hormones to regulate both ______________ and ________________.
water
electrolytes
Name two adrenal cortical hormones
Glucocorticoids
Mineralcorticoids
________________ is a mineralocorticoid with potent sodium-retaining and potassium excreting capability
Aldosterone
Renal Regulation
____________ are primary organs for regulating fluid and electrolyte balance
kidneys
Renal regulation is _____________ in the reabsorption of water and electrolytes.
Selective
Renal Regulation is where excretion of _______________ occurs.
electrolytes
Renal tubules are sites of action of ______ and ___________________.
ADH
Aldosterone
Cardiac Regulation is where the Atrial natriuretic factor (ANF) is released by the cardiac _________ in response to increased atrial ____________.
atria
pressure
Cardiac Regulation is where ANF causes __________ and increased urinary excretion of __________ and __________.
vasodilation
sodium
water
Gastrointestinal tract accounts for most of the ___________ intake
water
Gastrointestinal Regulation is where small amounts of ________ are eliminated by GI tract in feces
water
Insensible Water Loss is where invisible ____________ from lungs and skin.
vaporization
With insensible Water Loss
approximately how much per day is lost?
900mL
With insensible Water Loss
how much electrolytes are lost?

lExcessive sweating, is not an insensible loss, leads to loss of water and electrolytes
None
Is excessive sweating an insensible water loss? And can it lead to loss of electrolytes?
No it is not an insensible water loss and yes it can lead to loss of water and electrolytes,
What is hypovolemia?
Fluid volume deficit
**Can be hypertonic, isotonic or hypotonic
With hypovolemia what conditions must be present?
Fluid loss is greater that fluid intake. Can occur with loss of normal body fluids (diarrhea, fistula drainage, hemorrhage), decreased intake, or plasma-to-interstitial fluid shift.
What is Hypervolemia?
Fluid volume excess
**Can be hypertonic, isotonic, or hypotonic
What can cause hypervolemia?
May result from excessive intake of fluids, abnormal retention of fluids or interstitial-to-plasma fluid shift. Can also be caused by or result in CHF(congestive heart failure).
Treatment for ______volemia is balanced IV solutions, isotonic chloride, or blood
hypo
Treatment for _______volemia is use of diuretics, fluid restriction, and sodium restriction.
hyper
What are the nursing diagnoses for Hypervolemia?
1.Excess fluid volume
2.Ineffective airway clearance
3.Risk for impaired skin integrity
4.Disturbed body image
5.Potential complications: pulmonary edema, ascites and CHF
What are the nursing diagnoses for Hypovolemia?
1.Deficient fluid volume
2.Decreased cardiac output
3.Potential complication: hypovolemic shock
With regards to neurological function what is the nurse responsible for implementing?
1.LOC (level of consciousness)
2.PERLA (pupils, equal, reactive to light accomodation
3.Voluntary movement of extremities
4.Muscle strength
5.Reflexes
With regards to nursing management; what is the nurse responsible in implementing?
1.I&O
2.Monitor cardiovascular changes
3.Assess respiratory status and monitor changes
4.Daily weights
5.Skin assessment
What is the normal lab value for Sodium (Na+)in adults and children?
Adult: 135-145mEq/L
Child: 134-150mEq/L
What is the normal lab value for potassium (K+)in adults and children?
Adult: 3.5-5.3mEq/L
Child: 3.6-5.8mEq/L
What is the normal lab value for Chloride (Cl-)in adults and children?
Adult: 95-105mEq/L
Child:(varies with age)
Infant: 95-110mEq/L
Child: 98-105mEq/L
What is the normal lab value for Calcium (Ca++)in adults and children?
Adult:4.5-5.5mEq/L
Child:(varies with age)
Infant: 5.0-6.0mEq/L
Child: 4.5-5.8mEq/L
What is the normal lab value for Magnesium (Mg++)in adults and children?
Adult: 1.5-2.5mEq/L
Child: 1.6-2.6mEq/L
What is the normal lab value for Phosphorus (HPO4--) in adults and children?
Adult: 1.7-2.6mEq/L (Older slightly lower)
Child:varies with age
Infant: 4.5-6.7mEq/L
Child 4.5-5.5mEq/L
Sodium imbalances typically are associated with parallel changes in _____________.
osmolality
Sodium plays a major role in 4 different roles what are they?
1. ECF volume and concentration (osmolarity)
2. Generation and transmission of nerve impulses
3. Acid-base balance
4. Regulates body water. It is regulated by the skin GI tract, and GU tract
What is hypernatremia
Hypernatremia: serum sodium level above 145mEq/L due to administration of hypertonic IV or tube feedings, improperly mixed formulas, excessive sodium intake, water loss (water stools, insensible water loss, burns, osmotic diuresis, diabetes insipidus)
Hypernatremiat elevated serum sodium occurring with ______ ______ or _______ _________.
water loss
sodium gain
Hypernatremia causes hyperosmolality leading to ___________ ___________.
cellular dehydration
Hypernatremia primary protection is thirst from __________________.
hypothalamus
Hypernatremia manifestations include ___________, lethargy, _____________, seizures, and _______.
thirst
aggitation
coma
Hypernatremia if secondary to water _________, it often results of impaired LOC
deficiency
True or false Hypernatremia can be produced by clinical states such as central or nephrogenic diabetes insipidus?
true
Hypernatremia management includes:
1. Treat underlying cause (why is it high?)
2. If oral fluids cannot be ingested, IV solution of 5% dextrose in water or hypotonic saline
3. Diuretics
4. Monitoring nuerological signs (deficits)
Serum sodium levels must be reduced gradually to avoid _____________ ____________.
cerebral edema
Define hyponatremia
A serum sodium level below 135mEq/L due to excessive loss of sodium (in diuretic therapy, burns, diaphoresis, vomiting, NG suction, diarrhea, laxative abuse, renal disease); or water gain (in administration of water (esp. D5W) compulsive water drinking); inadequate intake of sodium, adrenal insufficiency, SIADH.
Hyponatremia results from?
Results from loss of sodium-containing fluids or from water excess
Hyponatremia clinical manifestations include c______, n_______, v__________, seizures, coma
muscle cramps, twitching, headache, dizziness, convulsions, neurologic symptoms caused by water shifting into the ICF causing cellular swelling.
confusion
nausea
vomiting
Hyponatremia if caused by water excess, fluid restriction is __________.
needed
Hyponatremia if severe symptoms (seizures) occur, small amount of intravenous ______________ saline solution (3% NaCl) is given (too much ____________ solution may cause congestive heart failure due to removal of excessive fluid from cells into vascular space)
hypertonic
hypertonic
Hyponatremia interventions: monitor __________, _____ ______, ______, administer ____________ solutions. Important to prevent hyponatremia by identifying high risk clients (NG suctioning, diuretics, burns, fever, renal disease)
weights
vital signs
labs
hypertonic
True/False Hyponatremia if associated with abnormal fluid loss, fluid replacement with sodium-containing solution is needed
true
_________ is the major ICF cation.
Potassium
Potassium is necessary for?
1. Transmission and conduction of nerve impulses
2. Maintenance of normal cardiac rhythms
3. Skeletal muscle contraction
4. Acid-base balance
Potassium is critical to the _________ __________ potential.
action membrane
Potassium sources are?
1. Fruits and vegetables (bananas and oranges)
2. Salt substitutes
3. Potassium medications (PO, IV)
4. Stored blood
What is Hyperkalemia?
serum potassium level above 5.3mEq/L
Hyperkalemia causes are?
1. Increased retention
Renal failure

Potassium sparing diuretics

2. Increased intake
IV or dietary replacement

3. Mobilization from ICF
Tissue destruction (burns, trauma, cancer chemotherapy)

Acidosis
Hyperkalemia clinical manifestations are: Skeletal muscles _______ or __________

Ventricular fibrillation or ________ __________

Cardiac dysrhythmias(Tall, peaked T waves, wide QRS)

Abdominal cramping or _________
weak
paralyzed
cardiac arrest
diarrhea
Hyperkalemia and the nursing diagnoses are?
Risk for injury

Potential complication: arrhythmias
Hyperkalemia and nursing management implementation is?
1. Eliminate oral and parenteral K intake
2. Increase elimination of K by using diuretics, dialysis, Kayexalate(an enema preparation which binds with GI potassium)
3. Force K from ECF to ICF by IV insulin or sodium bicarbonate
4. Reverse membrane effects of elevated ECF potassium by administering calcium gluconate IV
Define hypokalemia
serum K below 3.5
Hyponatremia clinical manifestations include c______, n_______, v__________, seizures, coma
muscle cramps, twitching, headache, dizziness, convulsions, neurologic symptoms caused by water shifting into the ICF causing cellular swelling.
confusion
nausea
vomiting
Hyponatremia if caused by water excess, fluid restriction is __________.
needed
Hyponatremia if severe symptoms (seizures) occur, small amount of intravenous ______________ saline solution (3% NaCl) is given (too much ____________ solution may cause congestive heart failure due to removal of excessive fluid from cells into vascular space)
hypertonic
hypertonic
Hyponatremia interventions: monitor __________, _____ ______, ______, administer ____________ solutions. Important to prevent hyponatremia by identifying high risk clients (NG suctioning, diuretics, burns, fever, renal disease)
weights
vital signs
labs
hypertonic
True/False Hyponatremia if associated with abnormal fluid loss, fluid replacement with sodium-containing solution is needed
true
_________ is the major ICF cation.
Potassium
Potassium is necessary for?
1. Transmission and conduction of nerve impulses
2. Maintenance of normal cardiac rhythms
3. Skeletal muscle contraction
4. Acid-base balance
Potassium is critical to the _________ __________ potential.
action membrane
Potassium sources are?
1. Fruits and vegetables (bananas and oranges)
2. Salt substitutes
3. Potassium medications (PO, IV)
4. Stored blood
What is Hyperkalemia?
serum potassium level above 5.3mEq/L
Hyperkalemia causes are?
1. Increased retention
Renal failure

Potassium sparing diuretics

2. Increased intake
IV or dietary replacement

3. Mobilization from ICF
Tissue destruction (burns, trauma, cancer chemotherapy)

Acidosis
Hyperkalemia clinical manifestations are: Skeletal muscles _______ or __________

Ventricular fibrillation or ________ __________

Cardiac dysrhythmias(Tall, peaked T waves, wide QRS)

Abdominal cramping or _________
weak
paralyzed
cardiac arrest
diarrhea
Hyperkalemia and the nursing diagnoses are?
Risk for injury

Potential complication: arrhythmias
Hyperkalemia and nursing management implementation is?
1. Eliminate oral and parenteral K intake
2. Increase elimination of K by using diuretics, dialysis, Kayexalate(an enema preparation which binds with GI potassium)
3. Force K from ECF to ICF by IV insulin or sodium bicarbonate
4. Reverse membrane effects of elevated ECF potassium by administering calcium gluconate IV
Define hypokalemia
serum K below 3.5
Hypokalemia causes are?
Increased loss

1. Aldosterone (hyperaldosteronism)
2. Loop diuretics
3. GI losses (vomiting, diarrhea, NG suctioning)
4. Associated with Mg deficiency
5. Movement into cells(fluid and electrolyte shifts
Hypokalemia clinical manifestations are?
1. Potentially lethal ventricular arrhythmias (ST depression, flat T waves)
2. Increased digoxin toxicity in those taking the drug(be aware especially if patient is also taking lasix)
3. Skeletal muscle weakness and paralysis
4. Muscle cell breakdown
Leads to myoglobin in plasma and urine
Hypokalemia clinical manifestations leads to?
1. Decreased GI motility
2. Altered airway responsiveness
3. Impaired regulation of arterial blood flow
4. Diuresis
5. Hyperglycemia
Hypokalemia nursing diagnoses are?
1. Risk for injury
2. Potential complication: arrhythmias
Hypokalemia nursing implementation is?
1. Replacement PO or IV
Never push IV
Painful in peripheral veins
Never give with anuric renal failure

2. Teach prevention methods
What is the major ECF anion absorbed from the diet and works with sodium to maintain osmolarity?
Chloride
Chloride is regulated by the __________, and ________.
Kidneys
Bowel
Chlorides have a vital function in _________/__________ balance.
acid/base
Define hypochloremia
serum chloride below 95mEq/L.
How is hypochloremia caused?
Caused by vomiting, NG suctioning, NG irrigation with plain water, diuretics, chlorideuria, chloridorrhea, excessive water intake.

Symptoms are not observed specific to decreased chloride levels. Subsequent symptoms occur due to acid/base imbalance.
Define hyperchloremia
serum chloride above 105mEq/L
How is hyperchloremia caused?
caused by sodium excess or bicarbonate deficit.

Symptoms are not observed specific to decreased chloride levels. Subsequent symptoms occur due to acid/base imbalance.
How is calcium obtained?
Obtained from ingested foods
Whats happens to the calcium once it is absorbed?
More than 99% combined with phosphorus and concentrated in skeletal system
Calcium is inverse with what?
Phosphorus
What is readily available to store calcium?
bones
Calcium ___________ sodium transport and stabilizes cell membrane
blocks
What is the function of calcium?
Functions include transmission of nerve impulses, myocardial contractions, blood clotting, formation of teeth and bone, and muscle contractions
Only __________ form of calcium is biologically active
ionized
Calcium is controlled by?
1. Parathyroid hormone
2. Calcitonin (releases calcium from the phosphorus bond in the bones)
3. Vitamin D (needed for the absorption of calcium)
Define hypercalcemia
serum calcium levels above 5.5mEq/L
Hypercalcemia causes include:
1. Hyperparathyroidism
2. Bone Malignancy
3. Vitamin D overdose
4. Prolonged immobilization
5. Altered GI system
6. excessive calcium supplements
Hypercalcemia clinical manifestations include:
1. decreased memory
2. confusion
3. disorientation
4. fatigue
5. cardiac dysrhythmias(short QT interval)
6. urinary calculi
7. muscle weakness
Hypercalcemiat management includes:
1. loop diuretic
2. hydration with isotonic saline infusion
3. synthetic calcitonin
4. early mobilization to prevent bone loss.
Hypercalcemia nursing diagnosis:
1. Risk for injury
2. Potential complication: arrhythmias
Define hypocalcemia
Low serum calcium levels below 4.5mEq/L
Hypocalcemia causes include:
1. Decreased production of PTH
2. Acute pancreatitis
3. Multiple drug transfusions
4. Alkalosis
5. Decreased intake
6. Decreased exposure to sunlight or decreased vitamin D intake.
Hypocalcemia clinical manifestations are:
1. positive Trousseau’s sign(inflated BP cuff causes carpal spasm)
2. positive Chvostek’s sign(facial twitching when facial nerve is tapped)
3. hyperactive deep tendon reflexes
4. laryngeal stridor
5. dysphagia
6. numbness, and tingling around the mouth or in the extremities (early signs)
7. muscle cramps or spasms
8. cardiac dsyrhythmias
Hypocalcemia management:
1. Treat cause
2. Oral or IV calcium supplements (be cautious with patients receiving digitalis, calcium makes a person more sensitive to digitalis) also IV calcium replacement requires a large vein because it is very irritating and infiltration can cause tissue necrosis and sloughing
3. Monitor cardiac status
_______________ is the second most abundant cation in the ICF.
Magnesium
What acts directly on the myoneural junction?
Magnesium
Magnesium is important for normal ________ ____________.
cardiac function
Define hypermagnesemia
serum magnesium level above 2.5mEq/L
Hypermagnesemia causes include
1. increased intake or ingestion of products containing magnesium when renal insufficiency or failure is present such as medications and supplemental feedings
2. hypoadrenalism
3. diabetic ketoacidosis
Hypermagnesemia clinical manifestations are?
1. Lethargy
2. Drowsiness
3. N/V
4. Reflexes impaired (hypoactive)
5. Somnolence
6. Respiratory and cardiac arrest can occur
Hypermagnesemia management is?
1. Prevention
2. IV CaCl or calcium gluconate to antagonize the magnesium effects on the cardiac muscle and temporarily relieve symptoms
3. Fluids to promote excretion because the kidneys are the major route of excretion for magnesium
4. Assess nuero function
5. Monitor VS and cardiac status
6. Monitor urinary output (25mL/hr for adequate renal excretion to occur)
Define hypomagnesemia
serum magnesium level below 1.5mEq/L
Hypomagnesemia causes include:
1. Prolonged fasting or starvation
2. Chronic alcoholism
3. Fluid loss…GI fluid loss, burns etc.
4. Renal disease
Prolonged parenteral nutrition without supplementation
5. Diuretics
6. Osmotic diuretics from high glucose levels
Hypomagnesemia clinical manifestations are?
1. Hyperactive deep tendon reflexes
2. Tremors
3. Tetany
4. Seizures
5. Laryngeal stidor
6. Positive Chvostek’s and Trousseau’s sign
7. Cardiac arrhythmias
8. Confusion
Hypomagnesemia management is?
1. Oral supplements
2. Increase dietary intake
3. If severe, parenteral IV or IM magnesium
4. Monitor EKG changes
5. Institute seizure precautions
6. Monitor urinary output
7. Monitor VS…especially respirations and cardiac(BP EKG changes)
WHAT IS THE NAME OF AN EXCESS OF SODIUM AND THE SYMPTOMS OF IT?
HYPERNATREMIA IS THE NAME AND THE SYMPTOMS ARE THIRST, CNS DETERIORATION AND INCREASED INSTITIAL FLUID
WHAT IS THE NAME OF A SODIUM (Na+)DEFICIT AND WHAT ARE THE SYMPTOMS OF IT?
HYPONATREMIA IS THE NAME AND THE SYMPTOMS IS CNS DETERIORATION
WHAT IS THE NAME OF AN EXCESS OF POTASIUM (K+)AND THE SYMPTOMS OF IT?
Hyperkalemia is the name and the symptoms are Ventricular fibrillation, ECG changes, and CNS changes
WHAT IS THE NAME OF A POTASSIUM (K+) DEFICIT AND WHAT ARE THE SYMPTOMS OF IT?
Hypokalemia is the name and the symptoms are: Bradycardia, ECG changes, CNS changes
WHAT IS THE NAME OF AN EXCESS OF CALCIUM (Ca++) AND THE SYMPTOMS OF IT?
HYPERCALCEMIA IS THE NAME AND THE SYMPTOMS ARE: ANOREXIA, NAUSEA, FATIQUE, CONSTIPATION, POLYURIA, DEHYDRATION, EKG CHANGES, BRADYCARDIA, HEARTBLOCKS
WHAT IS THE NAME OF AN DEFICIT OF CALCIUM (Ca++) AND THE SYMPTOMS OF IT?
Hypocalcemia is the name of it. The symptoms are: Tetany, Chvostek’s,Trousseau’s,Muscle twitching,CNS changes,EKG changes,
WHAT IS THE NAME OF AN EXCESS OF MAGNESIUM (Mg+) AND THE SYMPTOMS OF IT?
Hypermagnesemia is the name of it and the symptoms are:
Loss of deep tendon reflexes (DTRs), Depression of CNS,
Depression of neuromuscular function
WHAT IS THE NAME OF AN DEFICIT OF MAGNESIUM (Mg+) AND THE SYMPTOMS OF IT?
Hypomagnesemia is the name of it and the symptoms are: Hyperactive DTRs, CNS changes, EKG changes
_______________ is primary anion in ICF.
PHOSPHORUS
Phosphate is essential to function of muscle, red blood cells, and the ________ ____________.
nervous system
Phosphate is deposited with ____________ for bone and tooth structure.
calcium
Phosphate is involved in acid-base buffering system, ______ production, and cellular uptake of ____________.
ATP
glucose
Phosphate maintenance requires adequate _______ functioning because serum levels are regulated by the ____________ in the kidney
renal
glomerulus
Define hyperphosphatemia
serum phosphorus level above 2.6mEq/L
Hyperphosphatemia causes include:
1. Acute or chronic renal failure(kidneys are major route of excretion for phosphate)
2. Chemotherapy
3. Excessive ingestion of milk or phosphate containing laxatives
4. Large intakes of vitamin D
5. cellular destruction
6. hypoparathyroidism
7. osteoporosis
Hyperphosphatemia clinical manifestations are:
1. Hypocalcemia
2. Muscle problems ..tetany, spasms, positive Chvostek’s sign or Trouseau’s sign
3. Deposition of calcium-phosphate precipitates in skin, soft tissue, cornea, viscera, and blood vessels
Hyperphosphatemia management is:
1. Identifying and treating underlying cause
2. Restricting foods and fluids containing phosphorus
3. Adequate hydration and correction of hypocalcemic conditions
4. Sevelamer (Renagel)- a binding agent that removes phosphate from the GI tract
5. Monitor for signs of Hypocalcemia
Define hypophosphatemia
serum phosphorus level below 1.7mEq/L
Hypophosphatemia causes include:
1. Malnourishment/malabsorption
2. Alcohol withdrawal
3. Use of phosphate-binding antacids
4. During parenteral nutrition with inadequate replacement
5. gout,
6. hyperparathyroidism
7. diabetic ketoacidosis
Hypophosphatemia clinical manifestations are:
1. CNS depression
2. Confusion
3. Muscle weakness and pain
4. Numbness
5. Respiratory weakness
6. Arrhythmias
7. Cardiomyopathy
Hypophosphatemia management is:
1. Oral supplementation
2. Ingestion of foods high in phosphorus
3. May require IV administration of sodium or potassium phosphate
4. Monitor for signs of hypercalcemia
Plasma proteins, particularly ___________, are significant determinants of plasma volume
albumin
Hyperproteinemia is __________, but occurs with dehydration-induced hemoconcentration
rare
Hypoproteinemia is caused by?
1. Anorexia
2. Malnutrition
3. Starvation
4. Fad dieting
5. Poorly balanced vegetarian diets
6. Poor absorption can occur in certain GI malabsorptive diseases
7. Protein can shift out of intravascular space with inflammation
8. Hemorrhage
9. Nephrotic syndrome
Hypoproteinemia clinical manifestations are?
1. Edema
2. Slow healing
3. Anorexia
4. Fatigue
5. Anemia
6. Muscle loss
7. Ascites
Hypoproteinemia management is?
1. High-carbohydrate, high-protein diet
2. Dietary protein supplements
3. Enteral nutrition or total parenteral nutrition
What are the 5 IV fluid types? and describe.
1. Isotonic: same osmolarity as plasma (0.9% sodium chloride[normal saline], Lactated Ringer’s solution)

2. Hypotonic: lower osmolarity than plasma (D5W, 0.45% sodium chloride, 0.33% sodium chloride). When hypotonic solutions are infused, fluid shifts from the extracellular space to the intracellular space and can lead to cellular swelling (water intoxication).

3. Hypertonic: higher osmolarity than plasma (3% sodium chloride, protein solutions, 10% dextrose, 50% dextrose, 70% dextrose

4. Colloids: fluids containing proteins with lots of osmotic activity (salt poor albumin, plasmanate, dextran, hetastarch). They pull fluid from the interstitial and intracellular spaces and are useful in third-spacing, correcting hypotension, expanding intravascular volume, and replenishing protein depletion.

5. Blood: replacement for blood loss or body fluid loss (PRBCS: packed red blood cells, FFP: fresh frozen plasma with plasma and clotting factors, platelets: platelets only, cryoprecipitate: fibrinogen and factors VIII and XIII)
Isotonic has the ___________ osmolarity plasma
same or equal
hypotonic has ______________ than plasma
lower
hypertonic has __________ than plasma
higher
Colloids are fluids containing ___________ with lots if osmotic activity
proteins
Blood replacement for ?
blood loss or body fluid loss
IV Fluids purposes are?
Maintenance: When oral intake is not adequate
Replacement: When losses have occurred
D5W
describe what it is
Isotonic
Provides 170 kcal/L
Free water
Moves into ICF
Increases renal solute excretion
Prevents ketosis
Supports edema formation
Decreased chance of IV fluid overload
Usually compatible with medications
Normal Saline (NS)
describe what it is
Isotonic
No calories
More NaCl than ECF
30% stays in IV (most)
70% moves out of IV
Expands IV volume
Preferred fluid for immediate response
Risk for fluid overload higher
Does not change ICF Volume
blood products
Compatible with most medications
Lactated Ringer’s
describe what it is
Isotonic
More similar to plasma than NS
Has less NaCl
Has K, Ca, PO4, lactate (metabolized to HCO3)
Expands ECF, IV
Common replacement fluid
D5 ½ NS
describe what it is
Hypertonic
Common maintenance fluid
KCl added for maintenance or replacement
Provides calories
Prevents ketosis
Moves into ICF
Usually compatible with medications
D10W
describe what it is
Hypertonic
Provides 340 kcal/L
Free water
Limit of dextrose concentration may be infused peripherally
Plasma Expanders

describe what it is
Pull fluid into IV from interstitium
Colloids
Packed RBCs
Albumin
Plasma