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273 Cards in this Set

  • Front
  • Back
Alkalosis increases
myocardial irritability, especially when accompanied by hypokalemia
Capillaries in the lungs are lined by a single layer of epithelial cells called
Bicarbonate less than 22 indicative
Metabolic Acidosis
Respiratory Alkalosis is ALWAYS caused by
Magnesium regulated by
dietary intake, renal mechanisms, and actions of the parathyroid hormones
Respiratory Alkalosis
Phosphorous is absorbed
through the GI tract
* may occur with increase sodium loss
* may occur wit increased water loss
Clinical treatment depends on the cause.

Usual loss of sodium without loss of fluid results in decreased OSMALALITY of ECF
Chloride transport follows
sodium (the transport of chloride follows sodium)
Regulated by dietary intake and the kidneys
Low Base Excess
Three types of acid-base regulators in the body
1 - Chemical
2 - Biological
3 - Physiological
Respiratory Acidosis
from higher to lower concentration
Increased fat metabolism may result in metabolic acidosis
Buffer =
substance or group of substance that can absorb or release hydrogen to correct an acid-base imbalance
Metabolic Acidosis (too much H+) caused by gain in
acid or loss of base
Low calcium levels are treated with
calcium pills
Higher than 45 mm/hg PaCO2 indicative of
Respiratory Acidosis
The lower the concentration of hydrogen ions the more ?
alkaline the solution and the higher the pH
The concentration of sodium in the ECF determines whether water is retained, excreted or removed from one body compartment to another
In each fluid compartment the minuses and plusses should be equal
Arterial pH is an indirect measure of
hydrogen ion concentration
Alkalosis effects brain's emetic center
Components of Body Fluids
* - Electrolytes
elements or compounds that when dissolved in water or another solvent separates into ions and not able to carry an electrical current
usually results from renal failure.
* Kidneys are not able to excrete potassium
The greater the concentration of hydrogen ions the ?
acidic the solution and the lower the pH
Signs/Symptons of Metabolic Acidosis
* Increased blood flow to brain
* Neuromuscular depression
* GI (Nausea)
* Deep sighing
Major anion in ECF
Hypernatremia (high sodium levels) occurs when
sodium is retained and potassium is excreted;
it is the body's attempt to hold on to water
Phosphorous is regulated by
dietary intake
renal excretion
parathyroid hormones
Hyper magnesium imbalance
renal failure;
decreased respiration; hypotension and flushing (in the face)
solution of same osmotic pressure; expands the body's fluid volume without causing a fluid shift
Assessments for Metabolic Alkalosis
* Reflexes
* Ventilation
* Hydration
* Serum electrolytes
* Apical Pulse
Metabolic processes maintain a steady balance between acids and bases for
optimal functioning of cells
During Respiratory Acidosis hypoxemia will occur because
of respiratory depression
Active Transport
movement of molecules AGAINST osmotic pressure to an area of higher concentration
Bicarbonate is the major renal component of
acid-base balance. It is excreted and reproduced by the kidney to maintain a normal acid-base environment
Arterial blood gas measurements are the best way to evaluate
an acid-base imbalance
Nausea is a possibility with metabolic alkalosis
4 organs of water loss
* Kidney - major regulatory organs of fluid balance
* Skin - regulated by sympathetic nervous system activating the sweat glands
* Lungs - expire about 400cc of water daily by a change in respiratory rate and depth
* GI tract - 100-200cc/day; site of nearly all fluid gain by regulating through thirst
High Base Excess
pH is a reflection of the balance between CO2 (regulated by the lungs) and bicarbonate (base) (regulated by the kidneys)
Sodium Imbalances
Movement of body fluids constantly shift from compartment to compartment to meet needs of body
(dependent on cell-membrane permeability)
During Respiratory Acidosis there will be a ? in alveolar ventilation resulting in CO2 retention
Acid-base balance exists when the net rate at which the body is producing the acids or bases equals the same rate as the body is excreting the acids or bases
NL Oxygen Saturation
Low Sodium
NL Base Excess
+2 to -2
PaCO2 =
partial pressure of CO2 in arterial blood. It is a reflection of depth of pulmonary ventilation
Base excess = -2
Metabolic acidosis
Two kinds of Electrolytes
* - Cations
* - Anions
Magnesium Imbalance
Hypo - from malnutrition; alcoholics;
inadequate absorption; diarrhea;
thyroid diuretics
NL paCO2 =
Less than 35 = Hyperventilation; more CO2 is exhaled
More than 45 = Hypoventilation; rate and depth of respiration decreases; decreased CO2 is exhaled and more is retained
65-75 above sea level
80-100 @ sea level
Magnesium Regulation essential for
* essential for enzyme activities
* essential for neurochemical activities
* essential for cardiac and skeletal muscle excitability
If pH is normal and other things are outside of NL we know that the body is compensating
Normal hydrogen ion level is necessary to maintain cell membrane integrity and the speed of cell enzyme action
low potassium may cause severe cardiac dysfunction
* may be caused by potassium-wasting diuretics
Calcium Storage
99% of calcium is stored in bones.
Some calcium stored in plasma
When any of these (respiratory acidosis, respiratory alkalosis, metabolic acidosis, metabolic alkalosis) occur the body tries to
if the body successfully compensates then the pH remains normal
NL paO2 =
80-100 sea level
65-75 @ 6000'
- no primary role in acid-base balance
NL O2 saturation
Potassium Regulation
Potassium is predominately intracellular cation (only 2% found in ECF)
Metabolic Acidosis
A heavy loss of acid from body with high levels of bicarbonate.
Ex - people that vomit often
More common than Metabolic Acidosis
Oxygen saturation -
the percent of oxygen in the blood that combines with hemoglobin;
the point at which the hemoglobin is saturated with oxygen
Bicarbonate level greater than 26 indicative
Metabolic alkalosis
Sodium Normal Blood Lab Value
135-145 mEq/ml
Potassium Imbalance
Three types of blood vessels
* Arteries
* Veins
* Capillaries
35-45 mm/hg
higher osmotic pressure; solution pulls fluid from cells
Fluid Disturbances
Two types
1 - Isotonic - deficit in excess exists when water and electrolytes are either gained or lost in equal proportions
2 - Osmolar - losses or excesses of only water
Viscosity =
thickness of a fluid
Calcium Imbalance
Hypo = caused by thyroid and parathyroid problems
Caused by renal insufficiency
Hyper = excess bone re-absorption
High magnesium levels are treated with
a flush (lots of liquids)
Symptons of HYPO magnesium imbalance
muscle tremors and confusion
Hypocholoremic Metabolic Alkalosis Patho
* Decreased serum chloride
* When chloride is lost, the body retains HCO3- to maintain electroneutrality in ECF
* Hyperexcitability of the nervous system
* Retention of CO2 (acid) as a compensatory attempt to restore acid-base balance
* Fluid loss and decreased plasma volume
NDx for Metabolic Alkalosis
* Alteration in nutrition
* Fluid volume deficit
* Potential for injury
* Alteration in comfort
Lowered levels (hypokalemia) are treated with
IV bolus
potassium pills
Increased levels (hyperkalemia) treated with potassium K-Exelate (sp?)
When a patient is on Lasix (or diuretic) they will be excreting potassium
During hyponatremia, initially, the body will hold onto the water and not the sodium and the ECF will become diluted
Cardiovascular system brings CO2 and waste back to lungs for elimination
Base Excess is
the amount of blood buffer hemoglobin and bicarbonate that exist
Components of Extracellular Fluid (ECF)
* Interstitial - between cells and blood vessels.
* Intracellular - blood plasma, lymph, and organ fluids
Patients at risk for Metabolic Acidosis
* GI loss of bicarbonate
* Renal gain of H+ or loss of bicarb
* Cellular shifts
* Acid production in body
Cardiac Output =
amount of blood ejected from the left ventricle per minute (4-6L/minute)
NL Base Excess
-2 - +2
Major chemical base buffer in the body
Found in ECF and ICF
Essential in Carbonic Acid Bicarbonate Buffering System
Essential to acid-base balance
The kidneys regulate the bicarbonate
Lower than 35 mm/hg PaCO2 indicative of
Respiratory Alkalosis
Hypokalemia decreases smooth muscle contractions within the GI, which leads
to decreased peristalsis
NL Bicarbonate
Assist in acid-base regulation
Base excess = +2
Metabolic alkalosis
The LV pumps
oxygenated blood through the systemic circuit
Sodium is also stored in the kidneys
High Sodium levels
Characteristics of Respiratory Alkalosis
* Decrease in PaCO2
pH is increased
* May begin outside respirator system (ex - with an anxiety attack) or within the respiratory system (ex - asthma attack)
Isotonic dehydration =
water and dissolved electrolytes are lost in equal proportions
Characteristics of Respiratory Acidosis
Increase in arterial CO2 concentration
Excess carbonic acid and increase in hydrogen ion concentration
Decreased pH in the CSF and brain cells because acids has neurochanges
Phosphorous NL
3.0-4.5 mg/dL
To maintain electrical balances the concentration of plus charges must be matched with an equal concentration of minus charges
Hyponatremia Pathophysiology
* Decreased serum sodium
* Decreased plasma volume and cardiac output
* Decreased blood flow to kidneys
* Overhydration and swelling of brain cells
* GI changes
NL Bicarbonate
22-26 mEq/mL
Less than 22 = acidosis
Greater than 26 = alkalosis
Phosphorous and Calcium help
to develop and maintain bones and teeth

When one falls the other rises
Four groups at risk for Metabolic Alkalosis
1 - GI loss (acid and Cl-)
2 - Renal gain of bicarbonate
3 - Cellular shifts of positive ions
4 - Excessive intake of Bases into the body
Alterations in Cardiac Function
1) Disturbances in conduction
Ex. - Result of electrical impulses that do not originate from SA Node
2) Altered Cardiac Output
* Failure of heart to eject sufficient blood volume to systemic and pulmonary circulation
Ex - CAD (Coronary Artery Disease)
3) Myocardial Ischemia - the coronary artery doesn't supply enough Oxygen and blood to the myocardium (always results in chest pain)
4) Left sided heart failure
* Left ventricle isn't beating strong enough to eject enough blood resulting in decreased cardiac output
5) Right sided heart failure
* Impaired beating of RV results in
- Venous congestion
- Jugular vein distension
- Peripheral edema
6) Impaired Valvular Function
* Acquired or Congenital
* Characterized by
- Stenosis and obstructed blood flow
- OR - Valvular Degeneration (which is regurgitation and backflow)
Respiratory Acidosis is ALWAYS caused by
the number of molecules in a liter of solution
Chloride Imbalance
Hypo - vomiting and loop thiazide diuretics may cause

Hyper - rarely occurs on its own
Two phases of neuromuscular response to hyperkalemia ...
1) Skeletal muscles twitch in the early stages
2) Smooth muscle of the GI responds to hyperkalemia by increasing peristalsis
Ketones are strong acids

CNS depression is possible during metabolic ?
Regulation of Electrolytes
Interchange with each other; when one leaves the cell it will be replaced by another so the cells can maintain electrical neutrality
Signs and Symptoms of Metabolic Alkalosis
* Things r/t decreased blood flow
- fainting
- blurred vision
* Things r/t neuromuscular irritability
* R/T GI upset
* R/T hypoventilation
Hyponatremia Pathophysiology
* Decreased serum sodium
* Decreased plasma volume and cardiac output
* Decreased blood flow to kidneys
* Overhydration and swelling of brain cells
* GI changes
? is the largest single component of the body
Oxyhemoglobin =
when oxygen combines with hemoglobin
Chloride NL
Hypotonic dehydration =
electrolyte loss is greater than water loss
lower osmotic pressure; solution moves into the cells causing the cells to enlarge
Most cases of hyperkalemia occur in hospitalized clients and in those undergoing medical treatment
Ways of Regulating Body Fluids
1 - Fluid Intake (thirst)
2 - Hormonal regulation (ADH) - stored in posterior pituitary gland. Released in response to changes in blood osmolarity.
- prevents diuresis
- works directly on renal tubules and collecting ducts, making them more permeable to water and causing water to return to the systemic circulation; when blood is sufficiently diluted ADH release is stopped.
3 - Aldosterone - released by adrenal cortex in response to increased plasma potassium levels.
- acts on distal portion of the renal tubules to increase reabsorption of sodium and secretion and excretion of potassium.
- Because sodium retention leads to water regulation, the release of aldosterone acts as a volume regulator
4 - Renin - enzyme
- responds to decreased renal perfusion secondary to a decrease in extracellular volume.
- produces angiotensin I (causes vasoconstriction)
- renin almost immediately converts angiotensin I to angiotensin II
- causing vasoconstriction and an increase in bloodflow to the kidneys to improve renal perfusion
5 - Fluid output regulation occurs through 4 organs of water loss
Functions/Characteristics of of Lungs
Gas Exchange
* Alveoli are the basic unit of gas exchange where lungs and blood exchange Oxygen and CO2.
300 million alveoli in healthy adult lungs.
* Alveoli are surrounded by pulmonary capillaries.
When alveolar surface are is reduced - gas exchange is reduced
Magnesium NL
1.2-2.0 mg/dL
Conditions affecting chest wall movement
* Musculoskeletal abnormalities (thoracic, rib cage)
* nervous system diseases
- diseases impairing nervous/muscle control systems
* Trauma
- Ex. Multiple rib fractures
- Chest wall and upper abdominal incisions
* Pain Management
- Ex. High doses of opioids
* Chronic Diseases
- Ex. COPD; Emphysema; Anemia
movement of water across a semi-permeable membrane from an area of lower solute to higher solute concentration.
Tries to equalize concentration of ions on each side of the cell membrane
Hydrogen ions affect the activity of excitable membranes and acid-base imbalances are associated with altered function of these membranes
Functions of Potassium
* regulates many metabolic activities
* Necessary for glycogen deposits in liver, skeletal muscle and nerve impulses
* concerned with normal cardiac rhythms because it works on the skeletal muscle and smooth muscle.
* Body does not conserve potassium well
* Any increased urinary output will decrease potassium
* Dietary intake
* Renal secretions
Perfusion =
process of circulating oxygen and CO2 between the lungs and tissue cells
Calcium Necessary for -
* bone and teeth formation
* blood clotting
* hormone secretions
* cardiac conduction for transmission of nerve impulses for muscle contraction
Functions of Potassium (major ICF cation)
* Within cells helps to maintain osmotic pressure, fluid and electrolyte balance, and acid-base balance
* In ECF functions with sodium and calcium to regulate neuromuscular excitability
* Required for conduction of nerve impulses and contraction of skeletal and smooth muscles
* Participates in carb and protein metabolism
Low magnesium levels are treated with
magnesium IV bolus
Hypermagnesemia Patho
* Increased serum magnesium
* Depressed effects on CNS and Neuromuscular systems, which block transmission of electrical impulses
main symptom HYPOnutremia
Potassium Functions
1) Regulation of intracellular osmolarity
2) maintenance of electrical membrane excitability
3) maintenance of plasma acid-base balance
4) regulation of protein synthesis
5) regulation of glucose use and storage
6) Maintenance of action potentials in excitable membranes
Anions (negative)
1 - Chloride
2 - Bicarbonate (HCO3-)
3 - Phosphorous
Hypermagnesemia S/S
* Serum magnesium >2.5mEq/L
* Skeletal muscle weakness and paralysis
* Cardiac arrhythmias
* Hypotension
* Respiratory insufficiency
* Drowsiness
* Lethargy
* Coma
Calcium NL
9-10.5 mEq/mL
Osmolarity =
number of milliosmoles in a liter of solution
more fluids
saline solution
Sodium Functions
1) Maintenance of plasma and interstitial osmolarity
2) generation and transmission of action potentials
3) maintenance of acid-base balance
4) maintenance of electroneutrality
5) initiation of skeletal muscle contractions
6) Initiation of cardiac contractions
7) Transmission of nerve impulses
8) Maintenance of ECF osmolarity
9) Maintenance of ECF volume
10) Maintenance of the kidney urine concentrating system
Sodium Regulation
Most abundant cation in the ECF, major contributor to maintaining water balance; regulated by dietary intake and aldosterone secretions
Diffusion =
process of gas exchange between the alveolar air and the blood
Potassium NL
3.5-5 mEq/mL
Proteins are the largest source of ?
Phosphorous participates in carbohydrate
Deep breaths or sighs occur 6 to 10 times per hour
Phosphorous is absorbed
through the GI tract
Active transport =
use of energy by a cell to move a substance across the cell membrane against a concentration gradient
Phosphorous promotes
normal neuromuscular action
Cough is the cardinal sign of respiratory disease
The hallmark of metabolic alkalosis is
an increased bicarbonate level with a rising PaCO2
Acids are substances that release a _____ when the substance is dissolved in water
Hypotonic dehydration involves excessive loss of
sodium and potassium from the ECF
Capillaries connect the arterial and venous portions of the circulation
Hypomagnesemia Patho
* Decreased serum magnesium
* Impaired conduction of nerve impulses and muscle contraction
Hyperkalemia S/S
* Serum potassium > 5mEq/L
* Muscle weakness
* Possible respiratory insufficiency
* Cardiotoxicity with arrhythmias or cardiac arrest
Hyperchloremic Metabolic Acidosis S/S
* Serum chloride >103 mEq/L
* Arterial blood pH <7.35
* Lethargy
* Stupor
* Disorientation
* Coma if acidosis is not treated
* Increased rate and depth of respiration
Functions/Characteristics of the Conduction System
* Generates impulses required to initiate the electrical/mechanical chain of events
* All electrical impulses originate within the SA Node (located in the Right Atrium (RA) next to entrance of the Superior Vena Cava (SVC))
* Impulses are initiated at a intrinsic rate of 60-100 beats per minute.
* The resting pace of adults is 60-80 beats per minute
* Electrical impulses are conveyed along the IntraAtrial (IA) pathways to the AV Node.
* The AV node mediates impulse transmission between atrium and ventricles.
* The impulse then travels to the Bundle of His and Purkinje network (fibers)
* EKGs record this electrical activity
The fluid outside of the cells, ECF, contains almost ten times more sodium ions than the fluid inside the cell (ICF)
Bicarbonate is the primary buffer of the
The ventricles are _____ chambers
Hypokalemia Pathophysiology
* Decreased serum K+
* Impaired cardiac conduction
* Decreased strength of myocardial contraction and decreased cardiac output
* Neurologic changes due to impaired conduction of nerve impulses
* Impaired function of skeletal, smooth and cardiac muscle
* Slowed gastric emptying
* Decreased ability of kidneys to concentrate urine and excrete acid
* Impaired carb metabolism and decreased secretion of insulin
Hypocholoremic Metabolic Alkalosis S/S
* Serum chloride <95mEq/L; arterial blood pH >7.5
* Paresthesias of face and extremities
* Muscle spasms and tetany
* Slow, shallow respirations
* Dehydration
* Hypotension
Blood functions
* to nourish and oxygenate body cells
* protect the body from invading microorganisms
* initiate hemostasis when a blood vessel is injured
Calcium Functions
1) Cofactor in blood-clotting cascade
2) Excitable membrane stabilizer
3) Adds strength/density to bones and teeth
4) Essential element in cardiac, skeletal, and smooth muscle contraction
5) Enhances enzyme activity or reactions
6) Increases skeletal muscle contraction
7) Increases cardiac muscle contraction
8) Regulates nerve impulse transmission
9) Assists in blood clotting
10) Provides bone strength and density
The classic respiratory alkalosis profile is
a reduced bicarbonate level (not usually <15mEq/L) coupled with a very low PaCO2
Functions of Sodium (major ECF cation)
* Assists in regulating osmotic pressure, water balance, conduction of electrical impulses in nerves and muscles, electrolyte and acid-base balance.
* Influences cell membrane permeability
* Participates in many intracellular chemical reactions
If acidosis is respiratory in origin, the effectiveness of respiratory efforts is reduced
Hyperkalemia Patho
* Increased serum potassium
* Impaired conduction of nerve impulses
* Impaired cardiac conduction
The RV sends deoxygenated blood through the pulmonary circulation
Hyperchloremic Metabolic Acidosis Patho
* Increased serum chloride
* In dehydration, kidneys reabsorb water in an attempt to relieve the fluid deficit
* CNS depression
* Increased exhalation of carbon dioxide as a compensatory attempt to restore acid-base balance
Chloride Functions
1) Maintenance of plasma acid-base balance
2) Maintenance of plasma electroneutrality
3) Formation of hydrochloric acid
Chronic met. Acidosis may occur with chronic renal failure
During ventricular diastole,
the valves act as funnels and facilitate the flow of blood from the atria to the ventricles
Active transport systems, or pumps, are usually located in the cell membrane and act as gatekeepers to maintain special environments inside cells
During systole, the valves
close to prevent the backflow (regurgitation) of blood into the atria
Cells use active transport to regulate cell volume and to control the ICF concentration of many substances
Adventitious sounds are additional breath sounds superimposed on normal sounds
The lungs can usually compensate for acid-base imbalances of _____ origin
* Increased serum potassium
* Impaired conduction of nerve impulses and muscle contraction
* Impaired cardiac conduction
Cardiac Lab Values
A unique characteristic of the heart is that each part can generate its own electrical impulse to contract
Oxygen Transport
1) Delivery of oxygen depends on the amount of oxygen entering
* the lungs
* the bloodflow to the lungs
* the tissues
This delivery of oxygen increases Perfusion
2) Oxygen carrying capacity of blood (hemoglobin) - rate of diffusion
3) Amount of CO2 excreted from the lungs (ventilation)
High serum sodium levels inhibit aldosterone secretion and directly stimulate the secretion of ADH and ANP. Together these hormones cause
an increase in kidney excretion of sodium and kidney reabsorption of water
Diffusion =
the process by which O2 and CO2 are transferred between alveoli and blood and between blood and body cells
Ventilation =
the movement of air between the atmosphere and the alveoli of the lungs
Low serum levels of sodium inhibit the secretion of ADH and ANP and stimulate aldosterone secretion. Together these actions...
increase serum sodium concentration by increasing kidney reabsorption of sodium and enhancing kidney loss of water
Ferrous gluconate (Fergon) is an oral preparation for treating
iron deficiency anemia
The kidneys are the third line of defense against fluctuations in pH
Potassium chloride is the drug of choice for preventing
or treating hypokalemia because deficiencies of potassium and chloride often occur together
Ferrous sulfate (Feosol) is the prototype of oral iron preparations and the preparation of choice for prevention or treatment of
iron deficiency anemia
Cardiac Index =
Measure of adequacy of the cardiac output; cardiac index equals cardiac output divided by the client's body surface area (Adult 2.5-4L/min/m3 )
Hypertonic dehydration occurs when water loss from the ECF is greater than the electrolyte loss
Hyperventilation is the only mechanism for respiratory alkalosis
Perfusion =
the delivery of oxygen to the lungs, bloodflow to the lungs, and the tissues
Metabolic Alkalosis
* Values indicating alkalosis are increased pH>7.45 and increased HCO3- (>26mEq/L)
* If hypokalemia and hypochloremia are present, KCl will replace both deficits
Sodium Functions
* Assists in regulating osmotic pressure, water balance, conduction of electrical impulses in nerves and muscles, electrolyte and acid-base balance
* Influences permeability of cell membranes and assists in movement of substances across cell membranes.
* Participates in many intracellular chemical reactions
Stroke Volume =
Amount of blood ejected from the ventricle with each contraction (50-75mL/contraction)
When chemical buffers alone cannot prevent changes in body fluid pH, the respiratory system is the second line of defense against changes
The pulmonic valve separates
the right ventricle and pulmonary artery
Hyponatremia Causes
* Inadequate intake
* Excessive losses (eg vomiting, GI suction, diarrhea, excessive water enemas, excessive perspiration, burn wounds, and adrenal insufficiency
* Excessive water intake
Decreased renal function promotes retention of
magnesium and potassium
Ammonium chloride is contraindicated
in impaired hepatic function
The efficiency of the respiratory system depends on
* the quality and quantity of air inhaled
* the potency of the airway
* the ability of the lungs to expand and contract
* the ability of O2 and CO2 to cross the alveolar-capillary membrane
Heart rate effects blood flow because of
interaction between rate and diastolic filling time
The SL valves prevent blood from flowing back into the ventricles during ventricular diastole
1) is secreted by the adrenal cortex
2) influences sodium balance by preventing sodium loss
3) sodium exerts osmotic (water-pulling) pressure
4) indirectly regulates water balance
The major cellular protein buffer is ?
Hyperkalemia causes
* Excess intake
* Impaired excretion due to renal insufficiency, oliguria, potassium-saving diuretics, aldosterone deficiency, or adrenocortical deficiency
* Movement of potassium from cells into serum with burns, crusting injures, and acidosis
Bicarbonate is the anion most commonly exchanged for
Hypoventilation is the only mechanism for PCO2 accumulation (respiratory acidosis)
The tricuspid valve separates the
RA and RV
Oxygen Transport
1) Delivery of oxygen depends on the amount of oxygen entering
* the lungs
* the bloodflow to the lungs
* the tissues
This delivery of oxygen increases Perfusion
Hypertonic dehydration =
water loss is greater than electrolyte loss
The heart provides the mechanism by which oxygenated blood is sent from lungs to body
Diffusion =
free movement of particles (solute) across a permeable membrane down a concentration gradient
There are two semi lunar valves -
the pulmonic and aortic
The solvent is
the water portion of body fluids
Obligatory urine output =
minimal volume of urine needed per day to dissolve and excrete toxic waste products (400-600 mL)
Increases in the rate and depth of respiration are the main causes of resp
The right atrium receives deoxygenated blood from the upper part of the body
Factors Affecting Oxygenation
* Any condition that affects CP functioning directly affects the body's ability to meet O2 demands.
1) Decreased O2 carrying capacity
* Hemoglobin carries 97% of oxygen to tissues)
* Anemia
2) Inhalation of Toxic Substances
* Toxic substances (instead of oxygen) bind with the hemoglobin
3) Decreased inspired O2 concentration
* caused by upper or lower airway obstruction
* limits delivery of oxygen to alveoli
4) High altitude
5) Hypovolemia = reduced circulatory blood volume
* usually results from ECF losses
* results from diarrhea
* results from vomiting
6) Increased metabolic rate
* increased O2 demand
ex. - pregnancy
* wound healing
* exercise
* fevers increase tissue needs for O2 -
- CO2 increases
- Resp. rate increases
7) Conditions affecting chest wall movement
Osmolality =
number of milliosmoles in a kilogram of solution
The mitral valve separates the
LA and LV
Heart rate effects blood flow because of
interaction between rate and diastolic filling time
The pathologic changes associated with HYPERkalemia are directly related to how rapidly ECF _____ levels increase
Gas Exchange
1) Regulation of respiration provides for adequate supply of oxygen to meet metabolic demands
* Neural (CNS) regulators control
- Resp. rate
- Resp. depth
- Resp. rhythm
* Chemical
including regulation of CO2 and H+ ions ...
this, in turn, controls rate and depth of respirations
Facilitated diffusion (facilitated transport) =
diffusion across a cell membrane that requires the assistance of a transport system or membrane-altering system
Filtration =
movement of fluid though a cell or blood vessel membrane because of hydrostatic pressure differences on both sides of the membrane
Myocardial contractility =
ability of the heart to squeeze blood from the ventricles and prepare for the next contraction
Compliance =
the ability of the lungs to stretch or expand to accommodate incoming air
The oral mucosa may warm and humidify air but cannot
filter it
Nothing functions very well if the body gains or loses 2 liters of blood
Perfusion =
the blood flow through the lungs
Hypomagnesemia S/S
* Serum magnesium < 1.5 mEq/L
* Confusion
* Restlessness
* Irritability
* Vertigo
* Ataxia
* Seizures
* Muscle tremors
* Carpopedal spasm
* Nystagmus
* Generalized spasticity
Oxyhemoglobin is easily reversible so that
oxygen can enter the blood
Hyponatremia S/S
* Serum sodium <135 mEq/L
* Hypotension and tachycardia
* Oliguria and increased BUN
* Headache
* dizziness
* weakness
* lethargy
* restlessness
* confusion
* delirium
* muscle tremors
* convulsions
* ataxia
* aphasia
Three hormones that help control critical electrolyte balances...
1) aldosterone
2) antidiuretic hormone
3) atrial natriuretic peptide
The lungs expand and relax in response to changes in
pressure relationships
Hyperkalemia anesthetizes nerve and muscle cells so electrical current cannot be built up to a sufficient level for impulse conduction
Four Process May Result in Metabolic Acidosis
1) overproduction of H+
2) underelimination of H+
3) underproduction of HCO3-
4) overelimination of HCO3-
Respiratory acidosis results from an impairment in any area of respiratory function causing an inadequate exchange of
O2 and CO2
Sodium bicarbonate has long been used to treat
metabolic acidosis
HYPERNatremia Pathophysiology
* Increased serum sodium
* When due to water deficiency - Decreased fluid volume in ECF and ICF (dehydration)
* When due to sodium gain - increases ECF, decreases ICF
Osmosis and filtration act together in capillary fluid dynamics to regulate both ECF and ICF volumes
The atria are _____ chambers
Hypokalemia Patho
* Decreased serum potassium
* Impaired cardiac conduction
* Decreased strength of myocardial contraction and decreased cardiac output
* Neurologic changes due to impaired conduction of nerve impulses
* Impaired function of skeletal, smooth and cardiac muscle
* Slowed gastric emptying
* Decreased GI motility
* Decreased ability of kidneys to concentrate urine and excrete acid
* Impaired carb metabolism
Hypokalemia causes
* Inadequate (potassium) intake
* Excessive GI losses
* Movement of K+ out of serum and into cells
Hypokalemia S/S
* Serum potassium <3.5 mEq/L
* Arrhythmias and ECG changes (depressed ST segment)
* Postural hypotension
* Confusion
* Memory impairment
* Lethargy
* apathy
* Drowsiness
* Irritability
* Delirium
* Muscle weakness
* Possible paralysis
* Weakness of leg muscles
* Abdominal distention
* Constipation
* Paralytic ileus
* Polyuria
* Polydipsia
* Nocturia
* Hyperglycemia
Sodium bicarbonate has long been used to treat metabolic acidosis, which occurs with severe renal disease, diabetes mellitus, circulatory impairment due to hypotension, shock or fluid volume deficit, and cardiac arrest
The left atrium receives oxygenated blood from the lungs through the pulmonary veins
Osmosis =
process by which only water molecules (solvent) move through a selectively permeable membrane
Solutes are
particles dissolved in the water
In ALKALOSIS the ECF has an excess of bases, especially HCO3-
Carbon Dioxide Transport
- CO2 diffuses into the RBC and is rapidly hydrated into carbonic acid (H2CO3) (H2O+CO2 = H2CO3)
- The H2CO3 dissociates into hydrogen and bicarb (HCO3-)
H+ is buffered by the hemoglobin and the bicarb diffuses into the plasma;
- Hemoglobin combines with CO2 in venous blood and goes back to the lungs for excretion
The greater the amount of membrane available for osmosis, the faster the rate of osmosis
The thirst mechanism is an excellent example of the importance of osmosis in maintaining homeostasis
Respiratory acidosis results from ONLY one mechanism -
retention of CO2
Early Cardiac Manifestations of Acidosis
* increased heart rate
* increased cardiac output
Structure and Function of Cardiopulmonary System (CP)
* Provide O2 to tissuesCO2
* Remove CO2 and waste products from body
Parasympathetic nerves (by way of the vagus nerve) decrease heart rate
If acidosis is metabolic in origin the rate and depth of respirations _____ in proportion to the increase in H+
Bases are substances that bind to free _____ in solution
Magnesium Functions
1) Excitable membrane stabilizer
2) Essential element in cardiac, skeletal, and smooth muscle contraction
3) Cofactor in blood-clotting cascade
4) Cofactor in carbohydrate metabolism
5) Cofactor in DNA and protein synthesis
6) Stimulating skeletal muscle contraction
7) Participating in carbohydrate metabolism
8) Activating ATP
9) Activating B-complex
10) Enhancing DNA synthesis
11) Enhancing protein synthesis
Respiratory ABGs
Preload =
amount of blood in the ventricles at end of diastole
Sympathetic nerves increase heart rate
Afterload =
resistance of the ejection of blood from the left ventricle
Phosphorous Functions
1) Activation of B-complex vitamins
2) Formation of ADP and other high-energy substances
3) Cofactor in carb, protein, and lipid metabolism
4) Assisting in cell divisions
Alterations in Respiratory Functioning
1) Hyperventilation (Alkalosis)
* increase in resp rate
* causes excess CO2 elimination
* causes include Anxiety, Infections, Fever
* May cause unconsciousness
2) Hypoventilation (Acidosis)
* decrease in resp rate
* ventilation is inadequate to meet oxygen demands or eliminate enough CO2
EX - caused by opioids use
Caused by atelectasis (high surgical incisions)
Treatment = put patient on respirator
3) Hypoxia = inadequate tissue oxygenation at cellular level
* Life-threatening condition
* May cause dysrrythmia
Treatment = oxygenate patient...
Then treat the underlying causes...
Electrolyte balance may be more difficult to maintain in the older adults
Hydrostatic pressure is
the force exerted by water molecules against the confining walls of a space