Intro. To Medical Surgical Nursing (Timby Smith) Ch. 16 Caring For Clients With Fluid, Electrolyte, And Acid-Base Imbalances

Front 1

acids -

Back 1

substances that release hydrogen into fluid

Front 2

bases -

Back 2

substances that bind with hydrogen

Front 3

electrolytes -

Back 3

substances that carry an electrical charge

Front 4

* healthy adult fluid intake

Back 4

2500 mL/day (1800 - 3000 mL/day)

Front 5

primary sources of body fluid (ex.

Back 5

food, liquids

Front 6

fluid loses primarily through...

Back 6

urination, bowel elimination, perspiration, and breathing (insensible losses through sweat and exhaled vapor)

Front 7

* formula for daily fluid intake

Back 7

100 mL/kg for 1st 10 kg + 50 mL/next 10 kg + 15 mL/kg for remaining kg

* x lbs / 2.2

Front 8

translocation of fluid and exchange of chemicals is continuous in and among all area where water is located by means of these physiologic processes

Back 8

osmosis, filtration, passive and facilitated diffusion and active transport

Front 9

osmosis -

Back 9

movement of water through a semipermeable membrane, which allows some but not all substances in a solution to pass through, from a dilute area to one of greater concentration

Front 10

osmotic pressure -

Back 10

power to draw water toward an area toward an area of greater concentration

Front 11

substances which don't easily pass through cell and tissue membranes (ex.)

Back 11

colloids (large sized substances i.e. serum proteins albumin, globulin, fibrinogen and blood cells)

Front 12

colloidal osmotic pressure -

Back 12

contribute to fluid concentration and act as a force for attracting water

Front 13

filtration -

Back 13

promoted movement of fluid and some dissolved substances through a semipermeable membrane according to pressure differences

Front 14

passive diffusion -

Back 14

dissolved substances (e.g. electrolytes) move from an area of high concentration to an area of lower concentration through a semipermeable membrane

Front 15

facilitated diffusion -

Back 15

dissolved substances requires assistance from a carrier molecule to pass through a semipermeable membrane (e.g. insulin facilitates distribution of glucose molecules inside cells)

Front 16

active transport -

Back 16

requires an energy source (ATP) from low concentration to high

Front 17

sodium-potassium pump...

Back 17

moves potassium into the cell and sodium out of the cell

Front 18

under normal conditions, mechanisms maintain normal fluid volume and electrolyte concentrations such as

Back 18

those promoted by osmoreceptors (i.e. the release or inhibition of ADH) the renin-angiotensin-aldosterone system, and the secretion of ANP

Front 19

osmoreceptors -

Back 19

specialized neurons that sense the serum osmolality, when the concentration becomes overly concentrated , the receptors stimulate the hypothalamus to synthesize ADH

Front 20

ADH functions -

Back 20

inhibits urine formation by increasing the reabsorption of water from the distal and collecting tubules in the nephrons of the kidneys

Front 21

reabsorbed water is necessary to...

Back 21

restores serum osmolality, increases circulating blood volume, improves cardiac output and maintains blood pressure (BP)

Front 22

baroreceptors -

Back 22

stretch receptors in the aortic arch and carotid sinus that signal the brain to release ADH when blood volume decreases by 10% =, systolic BP falls below 90 or R atrium is under filled.

Front 23

a person senses thirst when extracellular volume decreases by...

Back 23

approx. 700 mL (2% of body weight)

Front 24

* renin-angiotensin-aldosterone system -

Back 24

increases both BP and blood volume

Front 25

juxtaglomerular apparatus -

Back 25

a ring of pressure sensing cells that surround the arterioles leading to each glomerulus in the kidneys

Front 26

renin catalyzes....

Back 26

angiotensinogen to angiotensin I to angiotensin II

Front 27

angiotensin II causes...

Back 27

vasoconstriction and elevated BP, stimulates release of aldosterone from adrenal cortex

Front 28

aldosterone causes...

Back 28

the kidneys to reabsorb sodium, which increases blood volume and BP

Front 29

natriuretic peptides -

Back 29

hormone-like substances that act in opposition to the renin-angiotensin-aldosterone system

Front 30

the three identified natriuretic peptides are...

Back 30

1) atrial natriuretic peptide (ANP) from the heart's atrial muscle
2) brain natriuretic peptide (BNP) from the ventricles of the heart
3) C-type natriuretic peptide made in the brain

Front 31

natriuretic peptides function to...

Back 31

increase urine production due to excretion of sodium

Front 32

common fluid imbalances include (ex.)

Back 32

hypovolemia, hypervolemia, and third-spacing

Front 33

clients at risk for hypovolemia include those who are...

Back 33

lethargic, depressed, vomiting, have dementia, fever, dysphagia, diarrhea, impaired comm., eat poorly, need assistance to drink, take diuretics, laxatives or drugs that inhibit cell hydration (anticholinergic prop.) tube feed w/o free water

Front 34

difficulty drinking can be related to...

Back 34

weakness, paralysis, or limited ROM

Front 35

hypovolemia vs. dehydration

Back 35

dehy. - all fluid compartments have decreased volume
hypo - only blood volume is low

Front 36

* the most common fluid imbalance in older adults

Back 36

dehydration

Front 37

hemoconcentration -

Back 37

a high ration of blood components in relation to watery plasma

Front 38

hemoconcentration increases the potential for...

Back 38

blood clots and urinary stones and compromises the kidney's ability to excrete nitrogen wastes

Front 39

hypovolemia depletes intracellular fluid which can...

Back 39

affect cellular function (i.e. a change in mentation)

Front 40

factors that contribute to hypovolemia include...

Back 40

inadequate fluid intake, fluid loss in excess of fluid intake (i.e. hemorrhage, prolonged vomiting, diarrhea, wound loss, profuse urination, excessive perspiration, translocation

Front 41

weight

Back 41

FD - loss > 2 lb/24 hr
FE - gain < 2lb/24 hr

Front 42

BP

Back 42

FD - low
FE - high

Front 43

temperature

Back 43

FD - elevated
FE - normal

Front 44

pulse

Back 44

FD - rapid, weak, thread
FE - full, bounding

Front 45

nursing management for hypovolemia

Back 45

plans to restore fluid imbalance
evaluates the outcomes of interventions

Front 46

Nursing education related to hypovolemia

Back 46

- respond to thirst
- 8-10 oz Q daily
- water = cheap
- avoid alcohol/caffeine
- rise slowly to avoid dizziness

Front 47

hypervolemia can occur, due to...

Back 47

excessive salt intake, adrenal gland dysfunction, admin. of corticosteroids (i.e. prednisolone)

Front 48

hypervolemia can lead to...

Back 48

circulatory overload

Front 49

circulatory overload -

Back 49

fluid volume that exceeds intravascular capacity and can compromise cardiopulmonary function

Front 50

early signs of hypervolemia include

Back 50

weight gain, elevated BP, and increased breathing effort

Front 51

excess volume in interstitial spaces may cause...

Back 51

pitting edema, with at least 3L excess fluid

Front 52

dependent edema affects...

Back 52

areas most affected by gravity (sacrum, feet, ankles, buttocks)

Front 53

hemodilution -

Back 53

blood cell count low, hematocrit low, urine specific gravity low, CVP elevated (2-6)

Front 54

third spacing -

Back 54

translocation of intravascular and intercellular fluid to tissue compartments where it becomes trapped and useless

Front 55

third spacing is associated with

Back 55

colloid loss, hypoalbuminemia, burns, severe allergic reactions,

Front 56

if translocation depletes fluid volume in the intravascular space...

Back 56

hypotension, shock, and circulatory failure

Front 57

ascites

Back 57

localized enlargement of organ cavities

Front 58

generalized edema

Back 58

brawny edema/anasarca in all interstitial spaces

Front 59

Medical management to eliminate trapped fluid...

Back 59

admin. IV solutions (colloids, blood product) to restore colloid osmotic pressure, include diuretic to prevent reactionary circulatory overload

Front 60

a loss or gain in fluid is usually accompanied by...

Back 60

a similar loss or gain in electrolytes

Front 61

general causes of electrolyte depletion include...

Back 61

inadequate food intake, infusing inadequate IV solutions, conditions that deplete water and dissolved substances and admin of certain drugs

Front 62

general causes of excess electrolytes include...

Back 62

overabundance of orally consumed or parenterally admin., kidney failure, endocrine dysfunction, (*especially the pituitary gland) or adrenal cortex, result of burns or crushing injuries

Front 63

Sodium Na+ is essential for maintaining

Back 63

normal nerve and muscle function, regulating osmotic pressure, and preserving acid-base balance

Front 64

The principal role of sodium is to...

Back 64

regulate and distribute fluid volume in the body

Front 65

hyponatremia is caused by...

Back 65

profuse diaphoresis, excessive ingestion of plain water, or admin. of nonelectrolyte IV fluids, profuse diuresis, loss of GI secretions, and Addison's diseasae

Front 66

manifestations include

Back 66

mental confusion, muscular weakness, anorexia, restlessness, elevated body temperature, tachycardia, nausea, vomiting, and personality changes...coma

Front 67

correcting hyponatremia can be accomplished with

Back 67

correcting the underlying cause and oral admin. of sodium or severe deficits (admin of IV solutions containing sodium chloride

Front 68

hypernatremia is caused by...

Back 68

profuse watery diarrhea, excessive salt intake, decreased water intake, high fever, decreased water, excessive admin of sodium containing solutions, severe burns

Front 69

hypernatremia results in...

Back 69

thirst, dry, sticky mucous membranes, decreased urine output, fever, a rough, dry tongue and lethargy

Front 70

nursing management for sodium imbalances...

Back 70

early detection, especially in clients at risk for hypo and hypernatremia,

Front 71

hypokalemia is related to

Back 71

potassium-wasting diuretics, such as furosemide (Lasix), large doses or corticosteroids

Front 72

hypokalemia causes...

Back 72

fatigue, weakness, nausea, vomiting, cardiac dysrhythmia, leg cramps, muscle weakness and paresias

Front 73

treatment for hypokalemia includes...

Back 73

elimination of the cause, substituting a potassium-sparring diuretic (Aldactone) potassium rich foods or potassium oral replacement,

Front 74

hyperkalemia can occur with...

Back 74

severe renal failure, severe burns, administration of potassium-sparring diuretics, overuse of potassium supplements, salt substitutes

Front 75

hyperkalemia can be treated...

Back 75

by decreasing oral potassium, dc oral potassium

Front 76

severe hyperkalemia can be treated by...

Back 76

IV admin of regular insulin and glucose, oral/rectal admin of cation-exchange resin, dialysis

Front 77

hypocalcemia causes include

Back 77

Vit D deficiency, hypoparathyroidism, severe burns, rapid blood infusion, accidental removal of parathyroid

Front 78

nursing management for calcium imbalances

Back 78

close monitoring for neuro manifestations (tetany, seizures, spasms) bed rest

Front 79

teaching plan includes

Back 79

instructing client to eat milk, yogurt, hard cheese, greens, broccoli, canned fish with bones

Front 80

magnesium imbalances

Back 80

related to alchoholism, diabetes, renal disease, malnutrition, burns, preg induced hypertension, intestinal malabsorption

Front 81

Chvostek and Trousseau's sign present in...

Back 81

hypocalcemia and hypomagnesium

Front 82

magnesium imbalance -

Back 82

first check for cardiac dysrhythmia

Front 83

Nursing management for magnesium imbalances

Back 83

if admin. mag. sulfate, monitor BP b/c it can cause vasodilation and subsequent hypotension

Front 84

chemical regulation

Back 84

adding hydrogen ions increases acidity, removing them promotes alkalinity

Front 85

bicarbonate-carbonic acid buffer system

Back 85

20 parts bicarbonate to 1 part carbonic acid maintains normal pH

Front 86

the lungs regulate...
the kidneys regulate...

Back 86

acidity
alkalinity

Front 87

Magnesium

Back 87

1.3-2.1

Front 88

Sodium

Back 88

135-145

Front 89

Potassium

Back 89

3.5-5.5

Front 90

Calcium

Back 90

9-11

Front 91

Magnesium

Back 91

1.3-2.1