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108 Cards in this Set
- Front
- Back
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homeostasis
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the state of equilibrium in the internal environment of the body, naturally maintained by adaptive responses that promote healthy survival.
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Water; What percentage of total body weight for adult?
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45-55%
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Water; What percentage of total body weight for child?
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78-89%
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What is the term for fluid inside the cells?
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Intracellular
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What is the fluid outside the cells?
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Extracellular
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Extracellular (ECF) fluid is fluid in three areas:
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Interstitial fluid , lymph & Transcellular fluid (in specialized cavities)
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Transcellular fluid is...
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fluid in specialized cavities; cerebrospinal, GI, pueural, synovial, peritoneal
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Interstitial fluid is...
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between the cells;
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ECF is what percentage of ttl body weight?
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20%
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Functions of body fluids
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transport of nutrients, electrolytes, O2 to cells, waste from cells, body temp, lubrication of joints/membranes, medium for food digestion
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Definition of electrolytes
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substances whose molecules dissociate into ions when placed in water.
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valence
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electrical charge of an ion
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buffer
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a substance that acts chemically to change strong acids into weaker acids or to bind acids to neutralize their effect.
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acidosis
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process that adds acid or eliminates base from body fluids.
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The most prevalent cation in the ICF?
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Potassium
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The most prevalent anion in ICF?
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Phosphate
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The most prevalent cation in ECF?
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Sodium
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The most prevalent anion in ECF?
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Chloride
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diffusion
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the process in which particles in a fluid move from an area of higher concentration to an area of lower concentration.
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facilitated diffusion
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the movement of molecules from an area of high concentration to one of low concentration at an accelerated rate with the assistance of a specific carrier molecule.
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active transport
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process in which molecules move across a membrane against a concentration gradient.
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osmosis
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the movement of water between two compartments separated by a membrane permeable to water but not to a solute.
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osmotic pressure
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amount of pressure required to stop the osmotic flow of water.
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osmolality
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the measure of the osmotic force of solute per unit of weight of solvent (mOsm/kg or mmol/kg).
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osmolarity
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measures ttl milliosmoles of solute per unit of total volume of solution
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isotonic
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fluids having the same concentration of solute particles as another solution, thus exerting the same osmotic pressure on a semipermeable membrane.
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hypotonic
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solutions that have a lower concentration of solute than another solution, thus exerting less osmotic pressure on a semipermeable membrane.
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hypertonic
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solutions that increase the degree of osmotic pressure on a semipermeable membrane.
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hydrostatic pressure
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the force that fluid exerts within a compartm
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oncotic pressure
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the osmotic pressure of a colloid in solution, such as when there is a higher concentration of a protein in the plasma on one side of a cell membrane than in the neighboring interstitial fluid.
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Hydrostatic pressure is greater on which end of the capillary?
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arterial end
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Hydrostatic pressure at the arterial end moves fluid into the:
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tissue
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Interstitial oncotic pressure in the tissue moves moves fluid into the:
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Venous end of the capillary
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Causes of increased venous pressure
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fluid overload, heart failure, liver failure, obstruction of venous return, venous insufficiency.
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Decrease in plasma oncotic pressure is caused from...
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renal disorders, liver disorders, malnutrition
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elevation of interstitial oncotic pressure caused by...
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Trauma, burns, inflammaiton
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When plasma or oncotic pressure is increased, fluid is drawn into the plasma, what fluids could be administered that would cause this?
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colliods, dextran, mannitol or hypertonic solutions
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First spacing
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normal distribution of fluids in ICF & ECF
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second spacing
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accumulation of interstitial fluid (edema)
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third spacing
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trapped fluid eg: ascites: fluid in abdominal cavity; peritonitis or edema associated with burns
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Adult normal fluid intake/output
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2500 ml
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Bicarbonate HCO3-
Normal serum electrolyte values |
22-26 mEq/L
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Chloride Cl-
Normal serum electrolyte values |
96-106 mEq/L
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Phosphate (PO4-)
Normal serum electrolyte values |
2.8-4.5 mg/dl
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Potassium (K+)
Normal serum electrolyte values |
3.5-5.0 mEq/L
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Magnesium (Mg++)
Normal serum electrolyte values |
1.5-2.5 mEq/L
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Sodium (Na+)
Normal serum electrolyte values |
135-145 mEq/L
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Calcium (Ca++) (total)
Normal serum electrolyte values |
9-11 mg/dl
4.5-5.5 mEq/L |
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Calcium (Ca++) (ionized)
Normal serum electrolyte values |
4.5-5.5 mg/dl
2.25-2.75 mEq/L |
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Gerontologic F&E considerations
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Ability to urinate, renal blood flow-->decreased gfr & creatinine, hormonal changes, loss of derms/thinning of skin, decrease in thirst mechanism,
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Causes of ECF volume deficit
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increased insensible water loss; diabets insipidus, osmotic diuresis, hemmorhage, GI loses, inadequate fluid intade, 3rd-spacing fluid shifts, overuse of diuretics
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What is the difference between fluid volume deficit and dehydration?
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Dehydration refers to loss of pure water alone without corsponding loss of sodium.
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clinical manifestations fo ECF volume deficit
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restlessness, drowsiness, lethargy, confusion, thirst, dry mouth, decreased skin turgor, decreased capillary refill, postural htn; increased pulse, decreased CVP; decreased urine output; concentrated urine; increased respiratory rate; weakness, dizziness; weight loss; seizures, coma
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Causes of ECF volume excess
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Excessive isotonic or hypotonic fluids; heart failure, renal failure, primary polydipsia, SIADH; Cushing syndrome; long-term use of corticosteroids
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Clinical manifestations of ECF volume excess
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Headache, confusion, lethargy
Peripheral edema Distended neck veins Bounding pulse, ^ BP, ^ CVP Polyuria Dyspnea, crackles, rales, pulmonary edema Muscle spasms Weight gain Seizures, coma |
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Describe the narrow margin of blood pH
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Death below 6.8 Acidosis below 7.35 Normal 7.35 - 7.45 Alkalosis above 7.45 Death above 7.8
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What are the 3 main control systems that regulate acid-base balance to counter acidosis or alkalosis?
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1) The Chemical Buffer System: the bicarbonate-carbonic system is the body's primary defense to fluctuations in pH 2) Respirations (increase or decrease in response to levels of CO2) 3) Renal system (kidneys can increase or decrease levels of bicarbonate concentration by holding back bicarbonate or excreting it)--this takes longer to "kick in"
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Name the 2 most common types of acid-base imbalances indicated by IMBALANCE IN CARBONIC ACID H2CO3
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1) respiratory acidosis: excess carbonic acid, ph decreases
2) respiratory alkalosis: deficit of carbonic acid, pH decreases |
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Name the 2 most common types of acid-base imbalances indicated by IMBALANCE IN BICARBONATE LEVEL
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1) metabolic acidosis: deficit bicarbonate, pH decreases
2) metabolic alkalosis: excess bicarbonate, pH increases |
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Normal Values of pH
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7.35 - 7.45
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Normal values of PcO2 (partial pressure of co2)
What is this a measure of? |
35 - 45 mm Hg
partial pressure of co2 measures the adequacy of alveolar ventilation |
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Normal values of Po2 (partial pressure of oxygen)
What is this a measure of? |
80 - 100
O2 dissolved in plasma |
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Normal values of Hco3 (bicarbonate level)
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22 - 26
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RESPIRATORY ACIDOSIS (retention of carbon dioxide): Common Causes
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HYPOVENTILATION FROM: 1) COPD (Chronic Obstructive Pulmonary Disease), pneumonia, pulmonary edema, pneumothorax, restrictive lung disease 2) Drug Overdose 3) Trauma (chest trauma, spinal cord injury) 4) Cardiac Arrest 5) Neuromuscular (CNS) Diseases (MS, MD)
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RESPIRATORY ACIDOSIS: DESCRIBE HOW THE BODY RESPONDS 1) Acute response to hypoventilation 2) Partial compenstation 3) Full compensation
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1) Acute Response to hypoventilation: Ph low, paO2 low, paco2 high, bicarbonate normal 2) Then the kidneys respond by increasing bicarbonate levels so: ph low still, po2 low, pco2 high, hco3 high 3) The full response is a correction in the pH level: pH normal, pa02 low, paco2 high, hc03 high
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How do you treat Respiratory Acidosis?
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TREAT THE CAUSE (when you can): 1) remove secretions blocking oxygen 2) give oxygen/ventilate 3) semi-fowlers position for optimum lung expansion 4) ventilator when necessary
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RESPIRATORY ALKALOSIS (Hyperventilation): Causes:
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HYPERVENTILATION FROM: 1) Anxiety /Fear 2) Giving too much oxygen (ventilator) 3) CNS disorders 4) COPD 5) Congestive heart failure
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RESPIRATORY ALKALOSIS: DESCRIBE HOW THE BODY RESPONDS 1) Acute response to hyperventilation 2) Partial compensation 3) Full compensation
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1) Acute Response to hyperventilation: pH high, pa02 high, paco2 low, bicarbonate normal 2) Then the kidneys respond by decreasing bicarbonate levels so: pH still high, po2 still high, pco2 low, bicarbonate low 3) The full response is a correction in the pH level: pH normal, pao2 high, paco2 low, bicarbonate low
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How do you treat Respiratory Alkalosis?
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TREAT THE CAUSE: anti-anxiety/ sedative meds, instruct in slow, even breathing, breathe in co2, paper bag / re-breather bag
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METABOLIC ACIDOSIS (gain of metabolic acids or loss of base): Common Causes
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INCREASE IN ACIDS: 1) diabetic ketoacidosis: inability to use glucose results in fat metabolism; ketones/acetone acid are present 2) starvation-lactic acid formation/anaerobic metabolism 3) renal failure: inability to eliminate waste products. LOSS OF BASE 1) diarrhea
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Hyponatremia
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Decreased Sodium (Na+) serum level
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Common causes of hyponatremia due to excessive sodium loss
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GI losses: diarrhea, vomitting, fistulas, NG suction
Renal losses: diuretics, adrenaal insufficency, Na+ wasting renal disease Skin losses: burns, wound drainage |
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Clinical manifestations of hyponatremia w/decreased ECF volume
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Irriability, apprension, confusiion, dizziness, personality changes, tremors, seizures, coma
Dry mucous membranes Postural hypotension, lower CVP, lower jugular venoius filling, tachycardia, thready pulse, cold and clammy skin |
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Clinical manifestations of hyponatremia w/normal increased ECF volume
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Headache, apathy, confusion, muscle spasms, seizures, coma
Nausea, vomiting, diarrhea, abdominal cramps Weight gain, increased BP, increaed CVP |
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Hypernatremia
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Elevated sodium level in the blood
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Causes of Hypernatremia due to excessive sodium intake
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IV fluids; hypertonic NaCl, excessive isotonic NaCl, IV sodium bicarbonate.
Hypertonic tube feedings w/o water supplements. Near drowning in salt water. |
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Causes of Hypernatremia due to inadequate water intake:
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unconscious or cognitively impaired individuals.
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Causes of Hypernatremia due to escessive water loss (increased sodium concentration)
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increased insensible water loss (high fever, heatstroke, prolonged hyperventilation), osmotic diuretic therapy, durrhea
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Causes of Hypernatremia due to disease states
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diabetes insipidus, primary hyperaldosteronism, cushing syndrome, uncontrolled diabetes mellitus
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Common causes of hyponatremia due to Inadequate sodium intake
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fasting diets
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Common causes of hyponatremia due to excessive water gain (raised sodium concentration)
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excessive hypotonic IV fluids, primary polydipsia
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Common causes of hyponatremia due to disease states
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SIADH, heart failure, primary hypoaldosteronism
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Clinical manifestations of Hypernatremia with decreased ECF volume
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Restlessness, agitation; twiching; seizures; coma; intense thirst; dry, swollen tongue, sticky muccous membranes.
Postural hypotension, lowered CVP, weight loss; weakness, lethargy |
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Clinical manifestations of Hypernatremia with normal/increased ECF volume
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Restlessness, agitation, twiching, sezuires, coma, intense thirst, flushed skin, weight gain, peripheral and pulmonary edama, raised BP, raised CVP
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Hypokalemia
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low serum potasium; <3.5 mEq/L
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Hyperkalemia
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high serum potasium >5.0 mEq/L
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Causes of hypokalemia due to potassium loss
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Gi losses: diarrhea, vomiting, fistulas, NG suction.
Renal losses: diuretics, hyperaldosteronism, magnesium depletion. Skin losses: diaphoresis Dialysis |
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Causes of hypokalemia due to shift of potassium into cells
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Increased insulin (e.g., IV dextrose load)
Alkalosis Tissue repair Raised epinephrine (stress) |
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Clinical manifestations of hypokalemia
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Fatigue
Muscle weakness, leg cramps Nausea, vomiting, paralytic ileus Soft, flabby muscles Paresthesias, decreased reflexes Weak, irregular pulse Polyuria Hyperglycemia |
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Electrocardiogram changes due to hypokalemia
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ST segment depression
Flattened T wave Presence of U wave Ventricular dysrythmias (PVC's) Bradycardia Enhanced digitalis effect |
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Hyperkalemia due to excess potassium intake
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Exxissive or rapid parenteral administration.
Potassium-containing drugs (potassium-penicillin) Potassium-containing salt substitute |
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Hyperkalemia due to shift of potassium out of cells
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Acidosis
Tissue catabolism (fever, sepsis, burns) Crush injury Tumor lysis syndrome |
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Hyperkalemia due to failure to eliminate potassium
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Renal disease
Potassium-sparing diuretics Adrenal insufficiency ACE inhibitors |
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Clinical manifestations of hyperkalemia
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irritability
Anxiety Abdominal cramping, diarrhea Weakness of lower extremities Paresthesias Irregular pulse Cardiac arrest if hyperkalemia sudden or severe |
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Electrocardium changes with hyperkalemia
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Tall, peaked T-wave
Prolonged PR Interval ST segment depression Loss of P wave Widening QRS Ventricular fibrillation Ventricular standstill |
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METABOLIC ACIDOSIS
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gain of metabolic acids or loss of base
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METABOLIC ACIDOSIS ; gain of metabolic acids: Common Causes
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INCREASE IN ACIDS: 1) diabetic ketoacidosis: inability to use glucose results in fat metabolism; ketones/acetone acid are present 2) starvation-lactic acid formation/anaerobic metabolism 3) renal failure: inability to eliminate waste products.
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METABOLIC ACIDOSIS ; loss of base: Common Causes
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LOSS OF BASE 1) diarrhea
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METABOLIC ACIDOSIS: DESCRIBE HOW THE BODY RESPONDS; Acute response to inability to decrease acidic levels (bicarbonate deficit)
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Acute response to bicarbonate deficit: pH low, pao2 normal, paco2 normal, bicarbonate low
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METABOLIC ACIDOSIS: DESCRIBE HOW THE BODY RESPONDS; Partial compensation
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The respiratory system is stimulated cause an increase in the rate and depth of respirations (Kussmaul breathing) to lower the acid concentration in the extracellular fluid by increasing the exhalation of co2. pH low, po2 high, pco2 low, hco3 still low
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METABOLIC ACIDOSIS: DESCRIBE HOW THE BODY RESPONDS ; Full compensation
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full compensation is not usually achieved, but if successful would result in pH normal, po2 high, pco2 low, hco3 low ** note the renal compensatory tries to increase the pH by exchanging sodium ions with hydrogen ions.
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METABOLIC ACIDOSIS: NURSING ALERT ABOUT ELECTROLYTE SHIFT
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Metabolic acidosis causes an electrolyte shift: hydrogen and sodium ions move into the cell, and potassium moves into the extracellular fluid. Hyperkalemia may cause ventricular fibrillation and death.
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How do you treat Metabolic Acidosis?
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1) TREAT THE CAUSE...treat blood sugar of a diabetic. 2) Can give sodium bicarbonate (antacids)
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METABOLIC ALKALOSIS ; (gain of base loss of metabolic acids): Common Causes
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Not enough acid caused by: 1) Vomiting 2) Nasal Gastric Tube suctioned and acidic fluids not replaced 3) Taking too many antacids 4) abuse of diuretics or steroids(using uric acid through the kidneys)
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METABOLIC ALKALOSIS: DESCRIBE HOW THE BODY RESPONDS ;Acute response to deficient acids
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Acute Response to deficient acids: pH high, pao2 normal, paco2 normal, bicarbonate high
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METABOLIC ALKALOSIS: DESCRIBE HOW THE BODY RESPONDS ; Partial compensation
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partial compensation: RESPIRATIONS DECREASE pH still high, pa02 low, paco2 high, hco3 high
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METABOLIC ALKALOSIS: DESCRIBE HOW THE BODY RESPONDS ; Full compensation
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full compensation pH normal, pao2 low, paco2 high, hco3 high
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How do you treat Metabolic Alkalosis?
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TREAT THE CAUSE. MAINTAIN FLUID BALANCE Give NaCL--absorption of NaCL allows for excretion of bicarbonate
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