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72 Cards in this Set
- Front
- Back
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What is the definition of homeostasis?
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State of equilibrium of internal body; naturally maintain by adaptive response that promote healthy survival
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How can you maintain homeostasis?
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Maintain composition and volume of body fluid
Acid altered internal environment of the body: fluid and electrolyte balance |
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What do you need to do when give IV to dehydration patients
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Monitor fluid for overload
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What are the body fluid compartments?
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Extracellular space
Intracellular space |
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Describe extracellular space?
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Compose of extracellular fluid = 2/3 of the body
Type of Fluid: Interstitial fluid Transcellular fluid Distribute to: Intravascular space (Plasma) Interstitial space Transcellular space |
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What is the best indicator that patient having fluid volume loss?
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Suddenly change in body weight.
1kg = 2.2lbs 240mL (8oz) = .5lbs |
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What is the function of water in the body?
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Transport
Regulate body temperature Lubricate joint Medium for food digestion |
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What is the definition of electrolyte?
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Molecule that dissociate or split into ion when put in water
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What are the anion and cation in ECF? and ICF?
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ECF: Na and Cl
ICF: K and PO and Protein |
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What are the mechanism transport in the body?
Simple diffusion? Facilitated diffusion? Active transport? |
Diffusion - simple diffusion: Low to high concentration
Facilitated diffusion - low to high concentration required carrier Active Transport: move against concentration gradient: Na and K pump = need ATP (mitochondria cells) |
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Definite Osmosis?
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Water movement b/w 2 compartment that are separate by semipermeable membrane
Osmotic pressure: pressure need to stop osmotic flow of water |
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What is the osmolality range
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275-295 mOsm/kg
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What is the range for K in ICF?
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135-145 mEq/L
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What is the range for Na in ECF?
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3.5 -5.0 mEq/L
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What is the urine osmolality ?
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100-1300 mOsm/kg
depend on amount intake and ADH in circulation and how renal respond to it |
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Where and definite Hydrostatic pressure?
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Contraction of the heart created H. pressure.
As the volume decrease H. pressure also decrease |
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What is oncotic pressure?
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Colloid pressure - draw by the large molecule in the problem
Example: Albumin or immuneglobin |
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Describe hypotonic and hypertonic?
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Hypotonic: water move into the cell
Hypertonic: water move out of the cell |
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Capillaries movement :
Amount and direction of movement are base on what interaction? |
Capillary H. pressure
Plasma oncotic pressure Interstitial H. pressure Interstitial oncotic pressure CHP & IOP = move water out of capillarier POP & IHP = move water into capillaries CHP> POP at arterial: fluid move inot interstitium space from plasma CHP<POP at venous: fluid move back into capillaries due to plasma protein |
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What cause shift of plasma move into interstitial fluid?
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Venous hydrostasis pressure rises; plasma Oncotic pressure decrease and interstitial pressure rise.
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What cause fluid from plasma shift into interstitial space? Cause swollen in interstitial fluid.
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1. Increase Capillary Hydrostasis pressure, interstitial oncotic pressure. Decrease plasma oncotic pressure.
2. Obstruction of lympahtic drainage |
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What cause the elevation of venous hydrostatic pressure elevated?
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Increase pressure at the venous due to fluid overload/ HF/ renal failure/ damage venous return to the heart.
Cause Capillary Edema |
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What happen when plasma oncotic pressure decrease?
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Fluid from plasma is diffuse into interstitial space, and won't able to diffuse back into the capillary due to low pressure.
Low pressure is cause by low protein in the plasma Low protein is due to renal disorder, liver disease, malnutrition |
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what happen when you elevated interstitial oncotic pressure? what cause the elevation?
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1. Fluid will diffuse out of the plasma into interstitium space.
2. trauma, burn, inflammation, capillary wall damage which allow protein to to store in interstitial space |
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What cause fluid shift from interstitial space into plasma?
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1. Increase plasma oncotic pressure and interstitial Hydrostasis pressure. Osmotic in plasma
2. Take colloid, dextran, mannitol or hypertonic solution 3. to increase Interstitial H. pressure wear compression gradient stocking/ hose to focus fluid back into plasma when it is swelling. |
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What cause fluid movement b/w ECF and ICF?
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1. Alter osmolality: increase osmolality of ECF (low water outside the cell) fluid will diffuse out of the cell = the cell shrink. Decrease osmolality of ECF= water diffuse out of the cell = cell swell.
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what are the three fluid space/ distribution of body water?
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1. First spacing: normal distribution of fluid b/w ICF & ECF
2. Second spacing: fluid accumulate in interstitial fluid 3. Third spacing: fluid accumulate in transcellular fluid. Difficult exchange fluid with ECF. |
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How does the hypothalamus regulate water balance?
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Compose of osmoreceptor that pick up signal when body fluid deficit or increase.
Stimulate thirst and release of ADH ADH: produce at hypothalamus but store in posterior pituitary gland. ADH: stimulate distal tubule and collecting tubes to reabsorb water Excess water/ decrease plasma osmolality = suppress ADH Thirst mechanism protect hyperosmolality |
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how does the pituitary gland regulated water balance?
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Control by hypothalamus.
Under stress/ nause/ nicotine/ morphine = ADH stimulate Suppress ADH = SIADH/ excess water/ decrease plasma osmolality/ CNS disorder/ malignancies Decrease ADH lead to Diabetes insipidus lead to polyuria and polydispsia |
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how does the adrenal cortical regulate water?
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secrete glucocorticoid and mineralocortoid.
Glucocortocid: cause antiinflammatory effect and increase glucose level in plasma Mineralocortociod = retain Na and water and excreted K into urine. Cortisol = have both gluco and mineralocortocoid function. This release under increase physical and psychologic stress |
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What are the functions of aldosterone in regulation of water balance?
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Aldosterone have mineralocortocoid funtion: retain Na, water and excreted K.
RAAS: retain K and decrease Na and water and ATCH ATCH = anterior pituitary that act directly to adrenal cortex to suppress the release of aldosterone. Decrease Aldosterone lead to decrease renal perfusion or decrease Na deliver to distal tubules. |
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How the cardiac regulation water balance?
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Cardiomyocyte produce atrial natriuretic peptide, Beta-type natriuretic peptide when atrial pressure increase to suppress the secretion of Aldosterone, renin and ADH and action of Angiotensin II
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How does the GI tract regulation water balance?
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GI tract secret ~ 8L of digestive fluid that are reabsorbed.
Daily I&O are 2-3 L |
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What is insensible water loss?
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invisible vaporization from the lungs and skin that help regulate body temperature.
~600 - 900 mL/day is loss Increase water loss when: metabolism increase Exercise excessive sweat due to environment temp, fever, |
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Aging affect fluid and electrolyte balance. how do they effect elder people?
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1. Structure and Renal blood flow decrease = decrease filtration rate = decrease creatinine clearance = concentrate urine
2. Hormonal change = decrease renin, aldosterone; increase ADH & ANP 3.Loss of subcutaneous = loss moisture thru skin; inability to respond to hot and cold 4. Thirst mechanism decrease affect = decrease fluid intake = increase free water loss and cause hypernatremia 5. Musculoskeletal stiffness 6. Mental status change |
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What cause hypovolemia?
what is the solution? what is the sign and symptom? |
1. Abnormal loss of body fluid: vomit, diarrhea, fisula drainage, hemorrhage, polyuria. Inadequate intake or shift in fluid from plasma to interstitial fluid. Use of diuretic, fever, and heart stroke. Third space fluid shift= burn, interstitial obstruction
2. IV: lactate Ringer's solution; Isotonic (0.9% NaCl); blood 3. restlessness, drowsiness, confusion, weakness, dizziness, weight loss, thirst, dry mucous membrane, decrease skin turgor, capillary refill, increase concentrate urine, decrease output urine |
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what cause hypervolemia?
What is the solution? What is the sign and symptom? |
1. HF, RENAL FAILURE, POLYDIPSIA, SIADH, CUSHING SYMPTOM, long use cortisteroid, shift fluid from interstitial to plasma
2. Restrict fluid and Na intake; diuretic, paracentesis or thoracentesis 3. headache, confusion, peripheral and pulmonary edema, JVD, bounding pulse, dyspnea, crackle, muscle spasm, weight gain, seizure and coma |
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What is the nursing implamentation for hyper/ hypovolemia?
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Check I & O
Check skin on edema 1. Cool temperature: accumulation of fluid, renal blood flow decrease 2. press on edema soft tissue to hard. 3. protect edema: hot and cold; prolong pressure; skin breakdown, 4. elevated edematous. 5. nasogastric suction: no water, use isotonic saline prevent electrolyte loss. |
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what are the sign and symptom in cardiavascular of Fluid Volume deficiency?
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Change in BP, Force pulse, JVD,
Bounding pulse = fluid volume excessive Moderate: sympathetic NS stimulate = vasoconstriction of the heart and peripheral = increase heart rate Severe: weak pulse, flatten neck vein, shock |
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What are the sign and symptom in respiratory system for fluid volume excessive? deficiency?
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pulmonary congestion and edema = Hydrostatic pressure in pulmonary vessel increase = force fluid in alveoli = shortness breath, crackle sound, irrigation cough
Increase respiratory rate = decrease tissue perfusion and hypoxia |
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What happen in the neurologic when ECF excess? depletion?
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Cerebral edema = increase Hydrostatic pressure in vessel cerebral
alteration in sensorium secondary to reduce cerebral tissue perfusion Asses: LOC; Pupillary response, voluntary movement of extremities |
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What happen when Na imbalance?
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Na cation
change in osmolality kidney use ADH to regulate Na leave thru sweat, urine, fece Absorb Na from food |
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What cause hypernatremia?
Solution? |
hypertonic and isotonic NaCl solution, Hypertonic feeding tube, water loss (fever, diarrhea, vomit, heartstroke, prolong hyperventilation, diruetic);
Diabetes inspidus, uncontrolled diabetes mellitus, hyperadosteronism, cushing syndrome, hyperosmolality, deficiency in ADH synthesis or release Inadequate intake Dehydrate brain cell Give: IV 5% dextrone or hypotonic saline, Serum Na level, Dilute [Na] w/ sodium free IV fluid 5% dextrone in water |
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What cause hyponatremia?
Solution? |
hypo-osmolality; loss Na retain or too much water; inappropriate use of Na free, hypotonic IV flue
after surgery or major trauma, psychiatric disorder, SIADH, Rich Na from GI tract, Kidney, and Skin, Solution: Restrict fluid; IV hypertonic saline solution (3%NaCl) [severe]; Vasopressin = block ADH Conivaptan = increase urine output Tolvapton for pts with HF, liver cirrhosis, SIADH |
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Some factors about Potassium Imbalances?
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98% K are in ICF
Absorb from diet, IV fluid, Serum Na level, transfusion of stored, hemolyzed blood, medication Regulate osmolallity and cell growth Affect: neuromuscular, and cardiac |
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What cause K move from ECF to ICF?
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Insulin
Beta adrenergic stimulator - stress, cororary ischemia, delirium tremens. Alpha adrenergic blocker (propanolol) Acidosis/ Alkalosis Trauma to cell, exercise, digoxin like drug Folic acid and cobalamin (Vit. B12) = RBC Production |
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What cause hyperkalemia?
Solution? s/s? |
1. Renal failure; massive intake K; shift K from ICF to ECF; massive cell destruction (burn, tumor, crush injury); transfusion of stored, hemolyzed of blood; metabolic acidosis
Drug: Spironolactone, triamterene, ACE (enalapril, lisinopril) Solution: eliminate oral and parenteral K intake, diuretics, dialysis, kayexalate; force K from ECF to ICF = IV insulin, or NaCO2 Reverse membrane effect by elevated ECF K by give Ca Gluconate IV S/S: cramping leg pain; weak or paralyzed skeletal muscle; ventricular fibrillation, cardiac standstill, abdominal cramping or dierrhea. shortening QT interval; T wave narrower, Flat P wave, wide QRS complex Complicate: dysrhythmia |
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Why we need K?
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transmission and conduction of nerve and muscle impulse
cellular growth maintained cardiac rhythms acid base balance |
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Where can you get K?
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fruits and vegetable
salt substitutes Potassium medication stored blood |
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What cause hypokalemia?
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1. Aldosterone increase/ Renin increase/ Mg deficiency/ GI tract loss (diarrhea, laxative abuse, vomit, ileostomy drainage) Metabolic alkolosis, diabetic ketoacidosis (increase urinary K loss, shift K into cell, correct metabolic adosis)
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What are the S/S for hypokalemia? Solution?
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Cardiac: Flat T wave, U wave emerge, P wave increase (Peak)
Skeletal muscle: weakness, paralyzed; respiratory arrest smooth muscle alter Decrease GI mobility; airway responsiveness, impaired regulation of arteriolar blood flow Give: K supplement; IV push or in concentrated amount Caution: KCl must be dilute or give with IV push or in concentrated amount Max: 40 mEq/ L Severe can go up to 80 mEq/L Rate 10-20 mEq/ hours Check IV for phlebitis and inflitration Use Central line for rapid correction |
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Factors about Ca Imbalance?
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Function: Transmission of nerve impulse, myocardial contraction, blood clotting, formation of teeth and bone, muscle contraction
Three Form of Ca: free or ionized: bound to protein (Albumin); Complexes w/ PO4, citrate or carbonate Decrease pH = decrease Ca bind to albumin = more ionized CA Ca control by parathyroid hormone (PTH), calcitonin, Vit. D |
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What is the Function of PTH (parathyroid hormone)?
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Increase bone reabsorption, increase GI absorption of Ca, increase renal tubule reabsorption of
Low Serum Ca level = decrease GI reabsorption but increase deposition Ca in bone Vit D need UV light |
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What cause Hypercalcemia?
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hyperparathyroidism (2/3)
Malignancies (1/3): bone destruction from tumor invasion; tumor secretion of parathyroid related protein = release Ca from bone Overdose of Vitamin D Prolong immobilization |
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What is the solution for Hypercalcemia?
What is the s/s? |
Excretion of Ca w/ loop diuretic; Isotonic saline infusion, synthetic Calcitonin; mobilization
Drug: Plicamycin (stop bone breakdown); Pamidronate (cell breakdown bone to release Ca) decrease memory, confusion, disorientation, fatigues, constipation, Complication: Dysrhythmia |
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What cause hypocalcemia?
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Decrease production of PTH, pancreatitis, lipolysis (fatty acid combine w/ Ca = decrease Ca in serum); multiple blood transfusion; sudden alkalosis; low diet Ca due to malabsorption
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What is the s/s of hypocalcemia?
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Tetnay: trousseau's sign (carpal spasm) or Chvostek's sign (Face muscle contraction)
Cardiac: decrease contractility and ECG change (prolong QT interval = ventricular tachycardia) |
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What is the solution for hypocalcemia?
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oral or IV Ca supplement
treat pain and anxiety prevent hyperventilation |
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Factor about Phosphate imbalance?
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Primary in ICF
Required for muscle. RBC, and NS Deposited with Ca for bone and tooth structure Involved in acide base buffering systme, ATP production, cellular uptake of glucose Maintenance requires adequate renal functioning |
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What care Hyperphosphatemia?
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acute or chronic renal failure; chemotherapy, excessive ingestion of phosphate or vit. D.
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How can you prevent hyperphosphatemia?
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Restrict Ingestion of food and fruit
Adequate hydration and corrections of hypocalcemia condition |
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What is the s/s hyperphosphatemia?
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calcified deposition in soft tissue like joints, arteries, skin, kidney, and corneas
Neuromuscular irritability and tetany |
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What cause hypophosphatemia?
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Malnourishment/ malabsorption;
alcohal withdrawal, use phosphate binding antacids, nutrition w/ inadequate replacement |
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What sign and symptom of hypophosphatemia?
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CNS depression
confusion muscle weakness and pain dysrhythmia cardiomyophthy |
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How can you prevent hypophosphatemia?
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Oral supplement
Ingestion food w/ high phosphate IV administration of Na or KPO |
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Factors of Magnesium imbalance?
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Cation in ICF
Coenzyme in metabolism of Carbohydrate and protien Regulate GI absorption and renal excretion Factor regulate Ca have same affect on Mg Act directly on myoneural junction |
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What cause hypermagnesemia
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increase intake Mg and renal insufficiency or failure
Pregnant women take Mg Sulfate |
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What s/s hypermagnesemia?
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lethargy or dowsiness
nausea/ vomit impaired reflex somnolence respiratory and cardiac arrrest |
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How do you prevent hypermagnesemia?
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Restrict intake Mg w/ pt having RF
Emergency treatment: IV of CaCl or Ca Gluconate Fluid to promote urinary excretion |
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What cause hypomagnesemia
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prolong fasting or starvation
chronic alcoholism fluid loss from GI tract Prolong parenteral nutrition w/o supplementation Diuretic |
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What are the s/s hypomagnesemia?
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confusion, hyperactive deep tendon reflexes, tremors, seizure, cardiac dysrhythmia
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How can you treat hypomagnesemia?
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Oral supplement
Increase dietary intake Parenteral IV or IM magnsesium when severe |
