Fluid/electolytes

Front 1

acidosis

Back 1

an acid–base imbalance characterized by an increase in H+ concentration (decreased blood pH). A low arterial pH due to reduced bicarbonate concentration is called metabolic acidosis; a low arterial pH due to increased PCO2 is respiratory acidosis

Front 2

active transport

Back 2

physiologic pump that moves fluid from an area of lower concentration to one of higher concentration; active transport requires adenosine triphosphate (ATP) for energy

Front 3

alkalosis

Back 3

an acid–base imbalance characterized by a reduction in H+ concentration (increased blood pH). A high arterial pH with increased bicarbonate concentration is called metabolic alkalosis; a high arterial pH due to reduced PCO2 is respiratory alkalosis

Front 4

diffusion

Back 4

the process by which solutes move from an area of higher concentration to one of lower concentration; does not require expenditure of energy

Front 5

hemostasis

Back 5

a dynamic process that involves the cessation of bleeding from an injured vessel, which requires activity of blood vessels, platelets, coagulation and fibrinolytic systems

Front 6

homeostasis

Back 6

maintenance of a constant internal equilibrium in a biological system that involves positive and negative feedback mechanisms

Front 7

hydrostatic pressure

Back 7

the pressure created by the weight of fluid against the wall that contains it. In the body, hydrostatic pressure in blood vessels results from the weight of fluid itself and the force resulting from cardiac contraction

Front 8

hypertonic solution

Back 8

a solution with an osmolality higher than that of serum

Front 9

hypotonic solution

Back 9

a solution with an osmolality lower than that of serum

Front 10

isotonic solution

Back 10

a solution with the same osmolality as serum and other body fluids. Osmolality falls within normal range for serum (280–300 mOsm/kg).

Front 11

osmolality

Back 11

the number of osmoles (the standard unit of osmotic pressure) per kilogram of solution. Expressed as mOsm/kg. Used more often in clinical practice than the term osmolarity to evaluate serum and urine. In addition to urea and glucose, sodium contributes the largest number of particles to osmolality.

Front 12

osmolarity

Back 12

the number of osmoles, the standard unit of osmotic pressure per liter of solution. It is expressed as milliosmoles per liter (mOsm/L); describes the concentration of solutes or dissolved particles.

Front 13

osmosis

Back 13

the process by which fluid moves across a semipermeable membrane from an area of low solute concentration to an area of high solute concentration; the process continues until the solute concentrations are equal on both sides of the membrane.

Front 14

tonicity

Back 14

the measurement of the osmotic pressure of a solution; another term for osmolality

Front 15

Osmotic pressure

Back 15

amount of hydrostatic pressure needed to stop the flow of water by osmosis. It is primarily determined by the concentration of solutes.

Front 16

Oncotic pressure

Back 16

osmotic pressure exerted by proteins (eg, albumin

Front 17

Osmotic diuresis

Back 17

the increase in urine output caused by the excretion of substances such as glucose, mannitol, or contrast agents in the urine

Front 18

Organs of fluid loss

Back 18

kidneys, skin, lungs, and GI tract.

Front 19

Thirst Center
Location

Back 19

Hypothalamus

Front 20

FVD
Hypovolemia
Clincal Manifetations

Back 20

acute weight loss; decreased skin turgor; oliguria; concentrated urine; postural hypotension; a weak, rapid heart rate; flattened neck veins; increased temperature; decreased central venous pressure; cool, clammy skin related to peripheral vasoconstriction; thirst; anorexia; nausea; lassitude; muscle weakness; and cramps.

Front 21

Hypokalemia occurs with

Back 21

GI and renal losses.

Front 22

Hyperkalemia occurs with

Back 22

adrenal insufficiency

Front 23

Hyponatremia occurs with

Back 23

increased thirst and ADH release.

Front 24

Hypernatremia results from

Back 24

increased insensible losses and diabetes insipidus

Front 25

fluid replacement for
hypotensive patient with FVD

Back 25

Isotonic electrolyte solutions (eg, lactated Ringer's solution, 0.9% sodium chloride

Front 26

Fluid replacement for
Normotensive pt with FVD

Back 26

a hypotonic electrolyte solution (eg, 0.45% sodium chloride

Front 27

Clinical manifestations of FVE

Back 27

and include edema, distended neck veins, and crackles (abnormal lung sounds), tachycardia; increased blood pressure, pulse pressure, and central venous pressure; increased weight; increased urine output; and shortness of breath and wheezing.

Front 28

anasarca.

Back 28

Severe generalized edema

Front 29

Ascites

Back 29

form of edema in which fluid accumulates in the peritoneal cavity

Front 30

pulmonary edema
clinical manifestations

Back 30

shortness of breath, increased respiratory rate, diaphoresis, and crackles and wheezing on auscultation of the lungs

Front 31

Fluid volume excess (hypervolemia)
Clinical manifestations

Back 31

Acute weight gain, peripheral edema and ascites, distended jugular veins, crackles, and elevated CVP, shortness of breath, ↑ blood pressure, bounding pulse and cough, ↑ respiratory rate
Labs indicate: ↓ hemoglobin and hematocrit, ↓ serum and urine osmolality, ↓ urine sodium and specific gravity

Front 32

Sodium deficit (hyponatremia)
Clnical Manifestations

Back 32

Anorexia, nausea and vomiting, headache, lethargy, dizziness, confusion, muscle cramps and weakness, muscular twitching, seizures, papilledema, dry skin, ↑ pulse, ↓ BP, weight gain, edema
Labs indicate: ↓ serum and urine sodium, ↓ urine specific gravity and osmolality

Front 33

Sodium excess (hypernatremia)
Clinical Manifestations

Back 33

Thirst, elevated body temperature, swollen dry tongue and sticky mucous membranes, hallucinations, lethargy, restlessness, irritability, focal or grand mal seizures, pulmonary edema, hyperreflexia, twitching, nausea, vomiting, anorexia, ↑ pulse, and ↑ BP.
Labs indicate. ↑ serum sodium, ↓ urine sodium, ↑ urine specific gravity and osmolality, ↓ CVP

Front 34

Potassium deficit (hypokalemia)
Clinical Manifestations

Back 34

Fatigue, anorexia, nausea and vomiting, muscle weakness, polyuria, decreased bowel motility, ventricular asystole or fibrillation, paresthesias, leg cramps, ↓ BP, ileus, abdominal distention, hypoactive reflexes. ECG: flattened T waves, prominent U waves, ST depression, prolonged PR interval.

Front 35

Fluid volume deficit (hypovolemia)
Causes

Back 35

Loss of water and electrolytes, as in vomiting, diarrhea, fistulas, fever, excess sweating, burns, blood loss, gastrointestinal suction, and third-space fluid shifts; and decreased intake, as in anorexia, nausea, and inability to gain access to fluid. Diabetes insipidus and uncontrolled diabetes mellitus also contribute to a depletion of extracellular fluid volume.

Front 36

Fluid volume excess (hypervolemia)
Causes

Back 36

Compromised regulatory mechanisms, such as renal failure, heart failure, and cirrhosis; overzealous administration of sodium-containing fluids; and fluid shifts (ie, treatment of burns). Prolonged corticosteroid therapy, severe stress, and hyperaldosteronism augment fluid volume excess.

Front 37

Sodium deficit (hyponatremia)
Causes

Back 37

Loss of sodium, as in use of diuretics, loss of GI fluids, renal disease, and adrenal insufficiency. Gain of water, as in excessive administration of D5W and water supplements for patients receiving hypotonic tube feedings; disease states associated with SIADH such as head trauma and oat-cell lung tumor; medications associated with water retention (oxytocin and certain tranquilizers); and psychogenic polydipsia. Hyperglycemia and heart failure cause a loss of sodium

Front 38

Sodium excess (hypernatremia)
Causes

Back 38

Water deprivation in patients unable to drink at will, hypertonic tube feedings without adequate water supplements, diabetes insipidus, heatstroke, hyperventilation, watery diarrhea, burns, and diaphoresis. Excess corticosteroid, sodium bicarbonate, and sodium chloride administration, and salt water near-drowning victims.

Front 39

Potassium deficit (hypokalemia)
Causes

Back 39

Diarrhea, vomiting, gastric suction, corticosteroid administration, hyperaldosteronism, carbenicillin, amphotericin B, bulimia, osmotic diuresis, alkalosis, starvation, diuretics, and digoxin toxicity

Front 40

Potassium excess (hyperkalemia)
Causes

Back 40

Pseudohyperkalemia, oliguric renal failure, use of potassium-conserving diuretics in patients with renal insufficiency, metabolic acidosis, Addison's disease, crush injury, burns, stored bank blood transfusions, and rapid IV administration of potassium

Front 41

Calcium deficit (hypocalcemia)
Causes

Back 41

Hypoparathyroidism (may follow thyroid surgery or radical neck dissection), malabsorption, pancreatitis, alkalosis, vitamin D deficiency, massive subcutaneous infection, generalized peritonitis, massive transfusion of citrated blood, chronic diarrhea, decreased parathyroid hormone, diuretic phase of renal failure, ↑ PO4, fistulas, burns

Front 42

Calcium deficit (hypocalcemia)
Clinical manifestations

Back 42

Numbness, tingling of fingers, toes, and circumoral region; positive Trousseau's sign and Chvostek's sign; seizures, carpopedal spasms, hyperactive deep tendon reflexes, irritability, bronchospasm, anxiety, impaired clotting time, ↓ prothrombin. ECG: prolonged QT interval and lengthened ST.
Labs indicate. ↓ Mg++

Front 43

Calcium excess (hypercalcemia)
Causes

Back 43

Hyperparathyroidism, malignant neoplastic disease, prolonged immobilization, overuse of calcium supplements, vitamin D excess, oliguric phase of renal failure, acidosis, corticosteroid therapy, thiazide diuretic use, increased parathyroid hormone, and digoxin toxicity

Front 44

Calcium excess (hypercalcemia)
Clinical Manifestations

Back 44

Muscular weakness, constipation, anorexia, nausea and vomiting, polyuria and polydipsia, dehydration, hypoactive deep tendon reflexes, lethargy, deep bone pain, pathologic fractures, flank pain, and calcium stones. ECG: shortened ST segment and QT interval, bradycardia, heart blocks.

Front 45

Magnesium deficit (hypomagnesemia
Causes

Back 45

Chronic alcoholism, hyperparathyroidism, hyperaldosteronism, diuretic phase of renal failure, malabsorptive disorders, diabetic ketoacidosis, refeeding after starvation, parenteral nutrition, chronic laxative use, diarrhea, acute myocardial infarction, heart failure, decreased serum K+ and Ca++ and certain pharmacologic agents (such as gentamicin, cisplatin, and cyclosporine)

Front 46

Magnesium deficit (hypomagnesemia
Clinical Manifestations

Back 46

Neuromuscular irritability, positive Trousseau's and Chvostek's signs, insomnia, mood changes, anorexia, vomiting, increased tendon reflexes, and ↑ BP. ECG: PVCs, flat or inverted T waves, depressed ST segment, prolonged PR interval and widened QRS

Front 47

Magnesium excess (hypermagnesemia)
Causes

Back 47

Oliguric phase of renal failure (particularly when magnesium-containing medications are administered), adrenal insufficiency, excessive IV magnesium administration, DKA, and hypothyroidism

Front 48

Magnesium excess (hypermagnesemia)
Clinical Manifestations

Back 48

Flushing, hypotension, drowsiness, hypoactive reflexes, depressed respirations, cardiac arrest and coma, diaphoresis. ECG: tachycardia ® bradycardia, prolonged PR interval and QRS

Front 49

Sodium Replacement Fluids

Back 49

lactated Ringer's solution or isotonic saline (0.9% sodium chloride

Front 50

Metabolic Acidosis
Symptoms

Back 50

headache, confusion, drowsiness, increased respiratory rate and depth, nausea, and vomiting. Peripheral vasodilation and decreased cardiac output occur when the pH drops to less than 7. decreased blood pressure, cold and clammy skin, dysrhythmias, and shock

Front 51

Metabolic Acidosis
Diagnostic Findings

Back 51

low bicarbonate level (less than 22 mEq/L) and a low pH (less than 7.35). Hyperventilation decreases the CO2 level as a compensatory action

Front 52

Metabolic Alkalosis
Symptoms

Back 52

tingling of the fingers and toes, dizziness, and hypertonic musclesRespirations are depressed as a compensatory action by the lungs. Atrial tachycardia may occur

Front 53

Metabolic Alkalosis
Diagnostic Findings

Back 53

pH greater than 7.45 and a serum bicarbonate concentration greater than 26 mEq/L. The PaCO2 increases as the lungs attempt to compensate for the excess bicarbonate by retaining CO2

Front 54

Respiratory Acidosis
Symptoms

Back 54

Sudden hypercapnia (elevated PaCO2) can cause increased pulse and respiratory rate, increased blood pressure, mental cloudiness, and a feeling of fullness in the head. Ventricular fibrillation may be the first sign of respiratory acidosis in anesthetized patients.

Front 55

Respiratory Acidosis
Diagnostic Findings

Back 55

pH lower than 7.35, a PaCO2 greater than 42 mm Hg, and a variation in the bicarbonate level, depending on the duration of the acute respiratory acidosis. When compensation (renal retention of bicarbonate) has fully occurred, the arterial pH may be within the lower limits of normal.

Front 56

respiratory alkalosis
causes

Back 56

extreme anxiety, hypoxemia, the early phase of salicylate intoxication, gram-negative bacteremia, and inappropriate ventilator settings that do not match the patient's requirements.

Front 57

respiratory alkalosis
symptoms

Back 57

lightheadedness due to vasoconstriction and decreased cerebral blood flow, inability to concentrate, numbness and tingling from decreased calcium ionization, tinnitus, and sometimes loss of consciousness. Cardiac effects of respiratory alkalosis include tachycardia and ventricular and atrial dysrhythmias

Front 58

respiratory alkalosis
diagnostic findings

Back 58

the pH is elevated above normal as a result of a low PaCO2 and a normal bicarbonate level

Front 59

Respiratory Acidosis
Causes

Back 59

inadequate excretion of CO2 with inadequate ventilation, resulting in elevated plasma CO2 concentrations and, consequently, increased levels of carbonic acid

Front 60

Metabolic Alkalosis
causes

Back 60

vomiting or gastric suction with loss of hydrogen and chloride ions. The disorder also occurs in pyloric stenosis

Front 61

Metabolic Acidosis
causes

Back 61

direct loss of bicarbonate, as in diarrhea, lower intestinal fistulas, ureterostomies, and use of diuretics; early renal insufficiency; excessive administration of chloride; and the administration of parenteral nutrition excessive accumulation of fixed acid.

Front 62

Isotonic Solutions
Examples

Back 62

D5W
Normal Saline Solution
Lactated Ringer's
Treats Intravascular Dehydration

Front 63

Normal Saline Solution
Use

Back 63

correct an extracellular volume deficit
with administration of blood transfusions
replace large sodium losses

Front 64

D5W
Use

Back 64

Once administered, the glucose is rapidly metabolized, and this initially isotonic solution then disperses as a hypotonic fluid
supply water and to correct an increased serum osmolality

Front 65

Lactated Ringer's solution
Use

Back 65

correct dehydration and sodium depletion and replace GI losses

Front 66

Hypotonic fluids
Examples

Back 66

0.45% sodium chloride

Front 67

Hypotonic fluids
Uses

Back 67

replace cellular fluid
provide free water for excretion of body wastes
treat hypernatremia and other hyperosmolar conditions
Treats cellular dehydration

Front 68

Fluid Overload
S/S

Back 68

moist crackles on auscultation of the lungs, edema, weight gain, dyspnea, and respirations that are shallow and have an increased rate, and increased BP

Front 69

Air Embolism
S/S

Back 69

dyspnea and cyanosis; hypotension; weak, rapid pulse; loss of consciousness; and chest, shoulder, and low back pain

Front 70

Air Embolism
management

Back 70

clamping the cannula and replacing a leaking or open infusion system, placing the patient on the left side in the Trendelenburg position, assessing vital signs and breath sounds, and administering oxygen

Front 71

Septicemia and Other Infection
S/S

Back 71

abrupt temperature elevation shortly after the infusion is started, backache, headache, increased pulse and respiratory rate, nausea and vomiting, diarrhea, chills and shaking, and general malaise.

Front 72

Isotonic Dehydration

Back 72

water and dissolved electrolytes are lost in equal proportions

Front 73

Hypertonic dehydration
Def and dx finidings

Back 73

water loss is greater than electrolyte loss.
BUN >20, Cr normal, Sodium >150, HCT elevated,