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105 Cards in this Set
- Front
- Back
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What three compartments is extracellular fluid divided into?
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interstitial, intravascular, and transcellular fluids
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Intracellular
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comprises all fluid within the cells of the body; 42% of total body weight
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Osmosis
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movement of a pure solvent across a semipermeable membrane from an area of lesser solute concentration to an area of greater solute concentration
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Osmols
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unit of measurement for concentration of a solution
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Osmotic pressure
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the drawing power of water -- depends of the number of molecules in a solution
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Osmolality
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the osmotic pressure of a solution which is expressed in osmols
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Osmolarity
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reflects osmotic pressure of a solution; reflects the number of molecules in a liter of solution and is measured in milliosmols/L
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Isotonic solution
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has the same osmolarity as blood plasma
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Hypertonic solution
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solution of higher osmotic pressure; pulls fluid from the cells out
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Hypotonic solution
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solution of lower osmotic pressure; moves fluid into the cells from outside of them
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Diffusion
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is the random movement of a solute in a solution across a semipermeable membrane from areas of higher concentration to areas of lower concentration
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Concentration gradient
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difference between two concentrations
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Filtration
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movement across a membrane, under pressure from higher to lower pressure
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Active Transport
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requires metabolic activity and expenditure of energy to move substances across cell membranes; movement of ions against osmotic pressure to an area of higher pressure
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Insensible water loss
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is continuous and occurs through the skin and lungs. A person doesn't perceive the loss but it can significantly increase with fever or burns
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Osmoreceptors
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continually monitor serum osmotic pressure and when osmolality increases, the hypothalamus is stimulated
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Hypovolemia
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occurs when excess fluid is lost through vomiting or hemorrhage
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Antidiuretic hormone (ADH)
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stored in posterior pituitary gland and released in response to changes in blood osmolarity; prevents diuresis, thus causing the body to save water
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Angiotensin I
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produced by renin and causes some vasoconstriction; almost immediately becomes reduced into angiotensin II
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Aldosterone
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released by the adrenal cortex in response to increased plasma potassium levels or as part of the mechanism that counteracts hypovolemia
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Atrial natriuretic peptide (ANP)
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secreted from atrial cells of the heart in response to atrial stretching and increase in circulating blood volume; acts as a diuretic that causes sodium loss and inhibits thirst mechanism
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What are the four organs of water loss?
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kidneys, skin, lungs and GI tract
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SODIUM: Values, Fx, and Regulatory Mechanism
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135-145 mEq/L (normal); <120 or >160 mEq/L (critical values)
most abundant cation in ECF (90%) major contributors in maintaining water balance intake is regulated by dietary intake and aldosterone secretion |
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POTASSIUM: Values and location
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3.5-5.0 mEq/L
Major electrolyte and principal cation in the INTRAcellular compartment; about 2% is located within the ECF |
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POTASSIUM: What is it responsible for?
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necessary for glycogen deposits in the liver and skeletal muscle; transmission & conduction of nerve impulses, normal cardiac conduction and skeletal and smooth muscle contraction; regulates many metabolic activities
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POTASSIUM: What regulates it?
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dietary intake and renal excretion; the body conserves potassium poorly, so any condition that increases urine output, decreases the serum potassium concentration
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CALCIUM: Values and Location
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8.5-10.5 mg/dL (normal total)
4.5-5.5 mg/dL (normal serum ionized) stored in bone, plasma and body cells with 99% located in bone and only 1% in the ECF |
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CALCIUM: What is it responsible for?
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bone and teeth formation, blood clotting (converts prothrombin into thrombin), hormone secretion, cell membrane integrity, cardiac conduction, transmission of nerve impulses and muscle contraction
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MAGNESIUM: Normal values
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1.5-2.5 mEq/L
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MAGNESIUM: What is it responsible for?
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essential for enzyme activities, neurochemical activities and cardiac and skeletal muscle excitability.
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MAGNESIUM: Where is it located?
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50-60% is contained within the bone and only 1% within the ECF compartment. The rest is located inside the cell
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Name the four major cations within the body fluids
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Sodium (Na+)
Potassium (K+) Calcium (Ca 2+) Magnesium (Mg 2+) |
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Name the three major anions of body fluids
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Chloride
Bicarbonate Phosphate |
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CHLORIDE: Normal values, Function, Location
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95-105 mEq/L
the transport of chloride follows sodium regulated by dietary intake and the kidneys; high chloride intake --> higher amount of urine chloride excretion in normal renal fx |
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BICARBONATE: normal values for venous and arterial
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venous: 24-30 mEq/L
arterial: 22-26 mEq/L |
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BICARBONATE: function and location
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is the major chemical base buffer within the body, and an essential component of the carbonic acide-bicarbonate buffering system; found in ECF and ICF
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BICARBONATE: regulated by?
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the kidneys
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PHOSPHORUS-PHOSPHATE: location and normal values
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2.8-4.5 mg/dL
a buffer ion found primarily in ICG with a small amount in the ECF |
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PHOSPHORUS-PHOSPHATE: function
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buffer; assists with acid-base regulation; helps to develop and maintain bones and teeth with calcium; in inversely proportional to calcium -- one rises, the other falls; also promote normal neuromuscular action and participate in carb metabolism.
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PHOSPHORUS-PHOSPHATE: regulation
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normally absorbed through the GI tract; regulated by dietary intake, renal excretion, intestinal absorption and PTH
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What is a buffer?
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a substance or group of substances that can absorb or release hydrogen to correct an acid-base imbalance
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What are the three types of acid-base regulators in the body?
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Chemical (carbonic acid-base buffer)
Biological (absorption/release H+ ions) Physiological (lungs/kidneys) |
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Normal value of arterial blood pH
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7.35-7.45
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Hyponatremia: causes
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GI loss, Renal loss, Skin loss, Psychogenic polydypsia, SIADH
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Hyponatremia: signs and symptoms
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apprehension, personality change, postural hypotension and/or dizziness, abd. cramping, n/v/d, tachycardia, dry mucous membranes, convulsions, coma
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Hypernatremia: causes
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excess salt intake -- ingestion, iatrogenic of hypertonic saline solution parenterally, excess aldosterone secretion, diabetes insipidus, increased water loss, water deprivation
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Hypernatremia: signs and symptoms
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extreme thirst, dry, flushed skin, dry and sticky tongue and mucous membranes, postural hypotension, fever, agitation, convulsions, restlessness, and irritability
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Hypokalemia: causes
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use of potassium-wasting diuretics, diarrhea, vomiting or other GI loss, alkalosis, excess aldosterone secretion, polyuria, extreme sweating, tx of DK with insulin, excessive use of potassium-free IV solutions
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Hypokalemia: signs and symptoms
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weakness, fatigue, n/v, intestinal distention, decreased bowel sounds and deep tendon reflexes, ventricular dysrhythmias, paresthesias and weak, irregular pulse
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Hyperkalemia: causes
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renal failure, fluid volume deficit, massive cellular damage, iatrogenic admin. of large amts. of K+ via IV, adrenal insufficiency, acidosis, especially DK, rapid infusion of stored blood, use of potassium-sparing diuretics, ingestion of potassium salt substitutes
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Hyperkalemia: signs and symptoms
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anxiety, dysrhythmias, parestheisa, weakness, abdominal cramps, diarrhea
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Hypocalcemia: causes
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rapid admin of blood transfusions containing citrate, hypoabluminemia, hypoparathyroidism, vit D deficiency, pancreatitis, alkalosis, chronic alcoholism or renal failure
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Hypocalcemia: signs and symptoms
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numbness/tingling of fingers and around mouth (circumoral); hyperactive reflexes, tetany, muscle cramps, and pathological fractures; +Chvostek's sign, and +Trousseau's sign
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Hypercalcemia: causes
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hyperparathyroidism, osteometastasis, Paget's Disease, Osteoporosis, Prolonged immobilization, acidosis, thiazide diuretics
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Hypercalcemia: signs and symptoms
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anorexia, n/v, weakness, hypoactive reflexes, lethargy, flank pain from kidney stones, decreased level of consciousness, personality changes and cardiac arrest
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Hypomagnesemia: causes
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malnutrition and alcoholism leading to inadequate intake, inadequate absorption or loss (diarrhea, vomiting, NG drainage, fistulas, small intestine diseases), thiazide diuretics leading to excessive loss, aldosterone excess, polyuria
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Hypomagnesemia: signs and symptoms
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muscular tremors, hyperactive deep tendon reflexes, confusion and disorientation, tachycardia, hypertension, dysrhythmias, and +Chvostek's and Trousseau's signs
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Hypermagnesemia: causes
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renal failure and excess oral or parenteral intake of magnesium
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Hypermagnesemia: signs and symptoms
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hypoactive deep tendon reflexes, decreased depth and rate of respirations, hypotension and flushing
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What is the mist effective way to evaluate acid-base balance oxygenation?
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Arterial Blood Gas reading
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What are the six components of the ABG measurement?
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pH
PaCO2 PaO2 oxygen saturation base excess HCO -3 |
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What is pH?
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is is the measurement of hydrogen ion concentration in body fluids. the higher the pH , the more basic and the lower it is, the more acidic
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What is PaCO2?
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the partial pressure of carbon dioxide in arterial blood; it is a reflection of the depth of pulmonary ventilation
Normal Range: 35-45 mmHg (hyperventilation occurs if <35) |
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What is PaO2?
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partial pressure of oxygen in arterial blood
Normal Range: 80-100 mmHg; if <60, it may lead to anaerobic metabolism and eventually metabolic acidosis; declines normally in older adults and when hyperventilation occurs --> may lead to respiratory alkalosis |
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What is oxygen saturation?
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the point at which hemoglobin is is saturated by oxygen. Normal range is 95-99%. Changes in temp, pH, and PaCO2 affect oxygen.
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Base Excess: definition
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amount of blood buffer (hemoglobin and bicarbonate) that exist. The normal range is +/- 2mEq/L; high value indicates alkalosis -- low value indicates acidosis
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Bicarbonate: definition, range and functions
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the major renal component of acid-base balance and the principal buffer of ECF.
Normal Range: 22-26 mEq/L; <22 indicates metabolic acidosis and >26 indicates metabolic alkalosis |
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Respiratory Acidosis
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characterized by increased carbon dioxide and hydrogen ion concentrations; Is the result of hypoventilation; CSF and brain cells become acidic, causing neurological changes
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Respiratory Alkalosis
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marked by a decrease in PaCO2 and increased pH --> decreased carbon dioxide and hydrogen ion concentrations
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Metabolic Acidosis
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characterized by a decrease in bicarb and increase in hydrogen ion concentration; caused by severe diarrhea or renal disease
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Anion Gap
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reflects unmeasurable anions present in plasma; calculated by subtracting the sum of chloride and bicarb from the amt. of plasma sodium concentration
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Metabolic Alkalosis
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characterized by an increase in bicarb and decrease in hydrogen ion concentration
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What are the seven risk factors for fluid, electrolyte, and acid-base imbalances?
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Age, Gender, Environment, Chronic Diseases, Trauma, Therapies, GI losses
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What groups of medications cause fluid, electrolyte and acid-base disturbances?
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Diuretics, Steroids, Potassium Supplements, Respiratory Center Depressants (opiods), Antibiotics, Calcium Carbonate (TUMS), M.O.M., NSAIDs
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What imbalances do diuretics cause?
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Metabolic Alkalosis
Hyper and Hypokalemia |
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What imbalance does steroid use lead to?
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Metabolic alkalosis
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What effect do potassium supplements have on fluids and electrolytes?
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GI disturbances including intestinal and gastric ulcers, and diarrhea
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What imbalance does the use of opioid analgesics lead to?
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respiratory acidosis as brought on y decreased rate and depth of respirations
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What imbalances can antibiotics cause?
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nephrotoxicity, hyperkalemia, hypernatremia,
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What problems do TUMS cause in relation to acid/base imbalances?
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mild metabolic alkalosis with n/v
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What deficiency can MOM lead to?
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hypokalemia
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NSAIDs can severely affect which organ associated with water loss?
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the kidneys (nephrotoxicity)
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What are the four ways in which fluids and solutes move across membranes?
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osmosis
diffusion filtration active transport |
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Serum Calcium
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measures the total amount of calcium in the blood, calcium that is bound to protein and not free to go in and out of cells; DOES NOT enable a reaction; screening (BMP)
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Ionized Calcium
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the active calcium in the blood; not attached to protein and floats freely, moving in and out of cells; DOES enable reactions
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Gerontologic Considerations in Fluid/Electrolyte and Acid-Base Imbalances
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reduced homeostatic mechanisms: cardia, renal and respiratory fx; decreased body fluid percentage, medication use and use of concomitant medications
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What's another term for FVD?
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Hypovolemia
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What's another term for FVE?
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Hypervolemia
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What is FVD?
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when loss of ECF exceeds intake ratio of water and electrolytes are lost in the same proportion as they exist in normal body fluids; may occur in combination with other imbalances
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What causes FVD?
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vomiting, diarrhea, GI suctioning, sweating, decreased intake and inability to gain access to fluid
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Dehydration
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loss of water alone, with increased serum sodium levels
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What are some risk factors for FVD?
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diabetes insipidus, renal insufficiency, osmotic diuresis, hemorrhage, coma and third space shifts
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What are some signs and symptoms of FVD?
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rapid wt. loss, decreased skin turgor, oliguria (no urine), concentrated urine, postural hypotension, rapid and weak pulse, increased temp, cool and clammy skin due to vasoconstriction, lassitude, thirst, nausea, muscle weakness and cramps
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What lab values indicate FVD?
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elevated BUN in relation to serum creatinine, increased hematocrit, and possible serum electrolyte changes
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What causes fluid volume excess (FVE)?
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fluid overload or diminished homeostatic mechanisms
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What are some risk factors for FVE?
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heart or renal failure, liver cirrhosis; excessive dietary sodium or sodium-containing IV fluids may contribute to this condition as well
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What are some signs and symptoms of FVE?
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edema, distended neck veins, abnormal lung sounds (crackles), tachycardia, increased BP, pulse pressure and CVP, increased wt., SOB and wheezing
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Crystalloids
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IV fluids and Electrolyte therapy
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Colloids
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Blood and Blood components
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Vascular Access Devices
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catheters, cannulas or infusion ports designed for repeated access to the vascular system
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Venipuncture
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a technique in which the vein is punctured through the skin by a sharp instrument
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Phlebitis
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inflammation of the vein as a result of the type of cannula material, irritation from the chemicals in the drug being given, and the anatomical position of the cannula
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What are some common complications of IV therapy?
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infiltration, phlebitis, infection, FVE, and bleeding at the infusion site
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Why are blood transfusions given?
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to replace fluid volume loss from hemorrhage, to treat anemia or to replace coagulation factors
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Aside from transfusion reactions, what are some other risks of blood transfusions?
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hypocalcemia, hyperkalemia, FVE and infection
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