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210 Cards in this Set

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WHAT % OF BODY WEIGHT IS FLUID?
45-80%
WHAT ARE THE PRIMARY ELECTROLYTES IN ICF?
POTASSIUM,
PHOSPHATE,
SULFATE
WHAT ARE THE PRIMARY ELECTROLYTES IN ECF?
SODIUM,
CHLORIDE,
BICARBONATE
WHAT ARE THE 2 FLUIDS THAT ECF CAN BE FURTHER DIVIDED INTO?
INTERSTITIAL,
AND INTRAVASCULAR
WHAT IS A BARORECEPTOR?
A STRETCH RECEPTOR LOCATED IN MAJOR ARTERIES AND VEINS TO MONITOR ECF VOLUME
MAINTENANCE OF PROPORTIONAL DISTRIBUTION OF ECF BETWEEN INTERSTITIAL AND VASCULAR SPACES DEPENDS ON WHAT 3 FACTORS?
1)PROTEIN CONTENT OF BLOOD (ALBUMIN AND GLOBULIN),

2)INTEGRITY OF THE LAYER OF CELLS LINING BLOOD VESSELS,

3)HYDROSTATIC PRESSURE INSIDE VESSELS
IN WHAT CIRCUMSTANCES MIGHT RENIN BE RELEASED?
DECREASED ARTERIAL PRESSURE,
DECREASED RENAL FLOW,

INCREASED RENAL SYMPATHETIC NERVE ACTIVITY,

LOW DIETARY SALT INTAKE(HELPS BODY CONSERVE WATER)
HOW DOES RENIN WORK TO INCREASE CIRCULATING VOLUME?
WHEN SECRETED, MAKES ANGIOTENSINOGEN CONVERT TO ANGIOTENSIN 1. ENZYMES IN LUNGS AND OTHER VASCULAR BEDS CONVERT A1 TO A2. A2 STIMULATES SECRETION OF ALDOSTERONE.
WHAT IS ALDOSTERONE?
PRODUCED IN THE ADRENAL CORTEX, IT REGULATES SODIUM ABSORPTION IN THE DISTAL TUBULES AND COLLECTING DUCTS OF THE KIDNEYS. CHLORIDE AND H2O PASSIVELY ACCOMPANY THE REABSORB SODIUM
WHAT IS ANP?
ATRIAL NATRIURETIC PEPTIDE-- PRODUCED BY CARDIAC ATRIA, VENTRICLES, AND OTHER BODY PARTS IN RESPONSE TO CHANGES IN ECF VOLUME, ACTS ON NEPHRON OF THE KIDNEY TO INCREASE SODIUM EXCRETION WHEN ATRIAL PRESSURE IS INCREASED
WHAT IS OSMOLARITY?
PROPORTION OF DISSOLVED PARTICLES IN A VOLUME OF FLUID--NORMAL RANGE IS 280-300 mOSM/L
WHAT IS OLSOLALITY?
CONCENTRATION OF DISSOLVED PARTICLES IN A GIVEN WEIGHT OF FLUID. OFTEN USED INTERCHANGEABLY WITH OSMOLARITY
WHERE IN THE KIDNEYS DOES ADH ACT?
MAKES DISTAL TUBULES AND COLLECTING TUBULES MORE PERMEABLE TO WATER
WHAT IS AN ELECTROLYTE?
A CHEMICAL COMPOUND IN SOLUTION THAT PARTIALLY SEPARATES INTO PARTICLES. EACH PARTICLE, KNOWN AS AN ION, CARRIES AN ELECTRICAL CHARGE
WHAT IS A CATION?
A POSITIVELY CHARGED ION
WHAT IS AN ANION?
A NEGATIVELY CHARGED ION
WHAT ARE THE MAJOR CATIONS IN THE BODY
SODIUM,
POTASSIUM,
MAGNESIUM,
CALCIUM
WHAT ARE THE MAJOR ANIONS IN THE BODY?
CHLORIDE,
PHOSPHATE,
BICARBONATE,
SULFATE
HOW ARE ELECTROLYTES MEASURED IN THE BODY?
IN TERMS OF THEIR ABILITY TO COMBINE WITH EACH OTHER. AND THEY ARE EXPRESSED IN TERMS OF mEQ/L
WHAT IS THE MOST ABUNDANT CATION IN ECF?
SODIUM
THIS CATION IS EXCRETED BY THE KIDNEYS ALONG WITH CHLORIDE, IS FOUND INTABLE SALT, DAIRY PRODUCTS, EGGS, MEAT, VEGGIES, AND PRESERVED FOODS?
SODIUM
WHAT IS THE NORMAL SERUM LEVEL FOR SODIUM?
135-145 mEQ/L
THIS CATION IS ESSENTIAL FOR CARDIAC, NEURAL, AND MUSCLE FUNCTION; PLAYS AN IMPORTANT ROLE IN PROTEIN AND GLYCOGEN SYSTHESIS, ECF LEVELS ARE CONTROLLED BY INSULIN; KIDNEYS MAINTAIN BALANCE BY EXCRETION AND SOME IS LOST IN STOOL AND PERSPIRATION;ALDOSTERONE ENHANCES RENAL EXCRETION
POTASSIUM
WHAT IS THE NORMAL SERUM LEVEL OF POTASSIUM?
3.5-5.0mEQ/L
99% OF THE BODY'S STORE OF THIS CATION IS IN TEETH AND BONES, FUNCTIONS IN CELL MEMBRANE STRUCTURE, IMPORTANT IN WOULD HEALING, SYNAPTIC TRANSMISSION, MEMBRANE EXCITABILITY, MUSCLE CONTRACTILITY, AND TEETH AND BONE STRUCTURE; REGULATED BY PTH, VITAMIN D, AND CALCITONIN?
CALCIUM
WHAT IS THE NORMAL SERUM LEVEL OF CALCIUM?
8.9-10.1MG/DL
50-60% OF THIS CATION IS IN BONES WITH REMAINDER IN SOFT TISSUE AND BODY FLUIDS; PRIMARILY AN ICF ION; IMPORTANT IN REGULATING NEUROMUSCULAR FUNCTION AND CARDIAC ACTIVITY; REGULATED BY KIDNEYS?
MAGNESIUM
WHAT IS THE NORMAL SERUM OEVEL OF MAGNESIUM?
1.5-1.9 mEQ/L
85% OF THIS ANION IS IN BONE AND 14 % INTRACELLUAR; REGULATED BY KIDNEYS UNDER INFLUENCE OF PTH AND VIT D; IMPORTANT IN ENERGY METABOLISM; STRUCTURE OF BONES AND MEMBRANES, AND SYNTHESIS OF NUCLEIC ACIDS?
PHOSPHATE
WHAT IS THE NORMAL SERUM LEVEL OF PHOSPHATE?
2.5-4.5MG/DL (HIGHER IN CHILDREN)
THIS ANION IS FOUND IN ECF, IS IMPORTANT IN WATER BALANCE, ACID-BASE BALANCE, AND THE PRODUCTION OF HYDROCHLORIC ACID IN THE STOMACH?
CHLORIDE
WHAT IS THE NORMAL SERUM LEVEL FOR CHLORIDE?
9.5-108 mEQ/L
THIS ANION IS FOUND IN ECF AND REGULATES ACID-BASE BALANCE?
BICARBONATE
WHAT IS THE NORMAL SERUM LEVEL FOR BICARBONATE?
22-26 mEQ/L
BY WHAT MEANS DO FLUIDS MOVE ACROSS CELL MEMBRANES?
OSMOSIS
BY WHAT MEANS DO PARTICLES MOVE ACROSS CELL MEMBRANES?
DIFFUSION, FILTRATION, AND ACTIVE TRANSPORT
THIS MEANS OF MOVEMENT OF SOLUTES HAPPENS BY MOVEMENT FROM AN AREA OF HIGH CONCENTRATION TO ONE OF LOW CONCENTRATION?
DIFFUSION
THIS IS THE PROCESS OF MOVEMENT OF A FLUID ACROSS A SEMI-PERMEABLE MEMBRANE WHEN ONE COMPARTMENT CONTAINS A GREATER CONCENTRATION OF SOLUTE(HYPEROSMOLAR) THAN ANOTHER (HYPOOSMOLAR)?
OSMOSIS
THIS THE PROCESS OF IONS AND OTHER MOLECULES MOVING ACROSS MEMBRANES FROM AN AREA OF LESSER CONCENTRATIONTO ONE OF GREATER CONCENTRATION?
ACTIVE TRANSPORT
THE SODIUM-POTASSIUM PUMP IS AN EXAMPLE OF WHAT MEANS OF MOVEMENT OF SOLUTES?
ACTIVE TRANSPORT
THIS ACTION INVOLVES THE TRANSFER OF WATER AND SOLUTES THROUGH A PERMEABLE MEMBRANE FROM REGION OF GREATER PRESSURE TO ONE OF LESSER PRESSURE?
OF
FILTRATION
WHAT PROTEIN PRESENT IN CAPILLARIES PREVENTS TOTAL COLLAPSE OF THE VESSEL?
ALBUMIN
ALBUMIN ACTS AS A WATER MAGNET IN INTRAVASCULAR SPACE AS IT HAS A PULLING FORCE REFERRED TO AS?
PLASMA COLLOID OSMOTIC PRESSURE
___ IS THE FLUID'S EFFECT ON CELL SIZE?
TONICITY
WHEN AN ___ SOLUTION ENTERS CIRCULATION THERE IS NO NET MOVEMENT OF WATER ACROSS MEMBRANES?
ISOTONIC
WHEN A ___ SOLUTION IS INTRODUCED INTO CIRCULATION, WATER WILL CROSS THE MEMBRANE INTO THE CELLS AND THEY WILL SWELL?
HYPOTONIC
WHEN A ___ SOLUTION IS INTRODUCED INTO CIRCULATION, WATER WILL LEAVE THE CELLS AND THEY WILL SHRINK?
HYPERTONIC
IN THE CLINICAL SETTING, WHAT TONICITY OF SOLUTION MIGHT BE ORDERED FOR A HEAD-INJURY PATIENT?
3% SODIUM CHLORIDE FOR PREVENTION OF ICP
___PRESSURE ALLOWS THE BODY TO PROVIDE O2 IN ARTERIOLES AND MOVE WASTES FROM VENULES?
FILTRATION
THIS IS THE MAINTENANCE OF HYDROGEN CONCENTRATION WITHIN AN EXTREMELY NARROW RANGE FOR MAXIMUM EFFICIENCY OF CELL OPERATION?
ACID-BASE BALANCE
WHAT IS CONSIDERED NEUTRAL IN ACID-BASE?
7.0
WHAT IS THE NORMA PH IN BODY'S ECF?
7.37-7.43
AT WHAT PH LEVELS DOES DEATH RESULT?
<6.8 AND >7.8
THESE ARE SUBSTANCES USED TO HELP PREVENT LARGE CHANGES IN PH BY ABSORBING OR RELEASING HYDROGEN IONS?
BUFFERS
WHERE IS THE MAJORITY OF FLUID CONTAINED IN ADULTS---ECF OR ICF?
ICF
WHO HAS A GREATER BODY FLUID LEVEL FAT OR LEAN PEOPLE?
LEAN
APPROXIMATELY HOW MUCH DOES A FEVER INCREASE FLUID REQUIREMENTS FOR ADULTS?
500ML
DO ANESTHETICS, NARCOTICS, AND BARBITUATES INCREASE OR DECREASE THE SECRETION OF ADH?
INCREASE
DO GLUCOCORTICOIDS AND MINERALOCORTICOIDS INCREASE OR DECREASE SODIUM RETENTION?
INCREASE
DOES INSULIN AND ORAL HYPOGLYCEMICS INCREASE OR DECREASE FLUID LOSS?
INCREASE
THIS A SPECIAL TYPE OF ECF VOLUME BALANCE PROBLEM OCCURRING WHEN FLUID LEAVES THE VASCULAR VOLUME AND IS TRAPPED WITHIN THE INTERSTITIAL FLUID VOLUME IN A GIVEN AREA?
THIRD SPACING
___ IS THE COLLECTION OF FLUID IN THE PERTONEAL CAVITY WITHIN THE INTERSTITIAL SPACE?
ASCITES
WHAT ARE 2 SIGNS OF DECREASED INTERSTITIAL VOLUME?
DRY MUCOUS MEMBRANES, POOR SKIN TURGOR
WHAT HAPPENS TO SERUM SODIUM VALUES DURING ECF VOLUME DEFICIT?
NO SIGNIFICANT CHANGE SECONDARY TO LOST FLUID HAS SAME CONCENTRATION OF ELECTROLYTES AS THE SERUM
WHAT ARE SIGNS AND SYMPTOMS OF ECF VOMUME EXCESS?
RAPID WEIGHT GAIN (> .5KG PER DAY), INCREASED BP, BOUNDING PULSE, JVD, DECREASED URINE OUTPUT
WHAT ARE THE MAIN CAUSES OF ECF VOLUME EXCESS?
CARDIAC FAILURE, RENAL FAILURE, LIVER DISEASE
WHAT IS THE FORMULA FOR FIGURING A PT'S SERUM OSMOLARITY?
(SERIUM SODIUM X 2) + ( SERUM GLUCOSE/ 18)
EXPRESSED IN mOSM/L
T/F--SERUM OSMOLARITY ALSO INDICATES INTRACELLULAR OSMOLARITY?
T--BECAUSE WATER MOVES FREELY ACROSS ALMOST ALL CELL MEMBRANES
WHAT IS THE LAB VALUE EXPECTED FOR SERUM OSMOLARITY IF A PT HAS A WATER DEFICIT?
> 300 mOSM/L
WHAT IS THE LAB VALUE EXPECTED FOR SERUM OSMOLARITY IF A PT HAS A WATER EXCESS?
< 275 mOSM/L
WHAT ARE THE MAIN CAUSES OF HYPERKALEMIA?
RENAL FAILURE, CELLULAR DAMAGE IN WHICH POTASSIUM IS RELEASED INTO ECF, INSULIN DEFICIENCY CAUSING LESS POTASSIUM TO MOVE INTO CELLS, ADRENAL DEFICIENCY CAUSING LESS ALDOSTERONE TO BE PRODUCED, RAPID INFUSION OF IV POTASSIUM
WHAT ARE THE SIGNS AND SYMPTOMS OF HYPERKALEMIA?
INCREASED CELL MEMBRANE RESPONSIVENESS, ANXIETY, IRRITABILITY, GI HYPERACTIVITY, EKG CHANGES, AND DYSRHYTHMIAS, EVENTUAL CARDIAC ARREST IF SERUM POTASSIUM > 8mEQ/L
WHAT IS THE TREATMENT FOR HYPERKALEMIA?
IV CALCIUM GLUCONATE TO OPPOSE POTASSIUM'S EFFECT ON MEMBRANE POTENTIAL; INFUSION OF INSULIN AND GLUCOSE TO MOVE POTASSIUM INTO THE CELLS; REMOVING POTASSIUM BY DIALYSIS OR ADMIN OF ION-EXCHANGE RESINS SUCH AS KAYEXALATE. MODERATELY HIGH LEVELS TREATED BY ADMIN OF DIURETICS AND POTASSIUM EXCHANGE RESINS
WHAT IS THE EXPECTED SERUM POTASSIUM LEVEL FOR HYPERKALEMIA?
>5.0 mEQ/L
WHAT IS THE EXPECTED SERUM POTASSIUM LEVEL FOR HYPOKALEMIA?
< 3.5 mEQ/L
WHAT ARE THE CAUSES OF HYPOKALEMIA?
ABNORMAL LOSSES OF POTASSIUM, INADEQUATE REPLACEMENT OF POTASSIUM, INCREASED MOVEMENT OF POTASSIUM INTO CELLS WHEN INSULIN IS GIVEN
WHAT ARE THE SIGNS AND SYMPTOMS OF HYPOKALEMIA?
DECREASED RESPONSIVENESS OF CELLULAR MEMBRANES (LEADING TO MUSCLE WEAKNESS--STARTS IN LOWER EXTREMITIES AND MOVES UP), FATIGUE, ABDOMINAL DISTENTION, N&V, CONSTIPATION, PARALYTIC ILEUS, DECREASED GI RESPONSIVENESS, IMPAIRED RESPIRATORY MUSCLE FUNCTION, POLYURIA, POLYDIPSIA, DYSRHYTHMIA, AND INCREASED BLOOD GLUCOSE LEVELS FROM SUPPRESSION OF INSULIN RELEASE
WHAT IS THE TREATMENT FOR HYPOKALEMIA?
INCREASED INTAKE OF POTASSIUM, USE OF POTASSIUM-SPARING DIURETICS
WHAT IS THE EXPECTED SERUM CALCIUM LEVEL FOR HYPERCALCEMIA?
> 10.1 MG/DL
WHAT ARE THE CAUSES OF HYPERCALCEMIA?
CANCER, EXCESSIVE VITAMIN D INTAKE, EXCESSIVE INTAKE OF MILK OR ALKALINE ANTACIDS, HYPERPARATHYROIDISM, IMMOBILIZATION, DECREASED RENAL FUNCTION
WHAT ARE THE SIGNS AND SYMPTOMS OF HYPERCALCEMIA?
DECREASED NEUROMUSCULAR EXCITABILITY( CAUSING MUSCLES WEAKNESS), LACK OF COORDINATION, CONFUSION, LETHARGY, IMPAIRED MEMORY, N&V, CONSTIPATION, PRURITUS, KIDNEY STONES, BONE PAIN
WHAT IS THE TREATMENT FOR HYPERCALCEMIA?
TX UNDERLYING CAUSE
WHAT IS THE EXPECTED SERUM FOR HYPOCALCEMIA?
<8.9 MG/DL
WHAT ARE THE CAUSES OF HYPOCALCEMIA?
PARATHYROID DEFICIENCY, VITAMIN D DEFICIENCY, RENAL DISEASE, SOME MALIGNANCIES, PANCREATITIS, TX SUCH AS MASSIVE BLOOD TRANSFUSION, ENEMA OR LAXATIVE ABUSE
WHAT ARE THE SIGNS AND SYMPTOMS OF HYPOCALCEMIA?
SPONTANEOUS DISCHARGE OF SENSORY AND MOTOR FIBERS IN PERIPHERAL NERVOUS SYSTEM, PARESTHESIA, TETANY(GRIMACING, TWITCHING), LARYNGOSPASM, SZ, CARDIAC ARREST (LATE)
WHAT IS THE TX FOR HYPOCALCEMIA?
ORAL CALCIUM, SLOW IV CALCIUM, SZ PRECAUTIONS
WHAT IS THE EXPECTED SERUM LEVEL FOR HYPERMAGNESEMIA?
> 1.9 mEQ/L
WHAT ARE THE CAUSES OF HYPERMAGNESEMIA?
RENAL FAILURE, DKA, MAGNESIUM THERAPY, MG-BASED LAXATIVE USE
WHAT ARE THE SIGNS AND SYMPTOMS FOR HYPERMAGNESEMIA?
DEPRESSION OF MUSCLE IRRITABILITY CAUSING HYPOTENSION, WEAKNESS, DEPRESSED REFLEXES, PARALYSIS, BRADYCARDIA, RESPIRATORY FAILURE, CARDIAC ARREST
WHAT IS THE TX FOR HYPERMAGNESEMIA?
TX UNDERLYING CAUSE, ADMIN OF IV CALCIUM, REMOVAL OF PERITONEAL DIALYSIS OR HEMODIALYSIS
WHAT IS THE EXPECTED SERUM LEVEL FOR HYPOMAGNESEMIA?
< 1.5 mEQ/L
WHAT ARE THE CAUSE SOF HYPOMAGNESEMIA?
IMPAIRED INTAKE OR INTESTINAL ABSORPTION, EXCESSIVE URINARY EXCRETION SECONDARY TO DIURETICS OR CHRONIC ALCOHOLISM
WHAT ARE THE SIGNS AND SYMPTOMS OF HYPOMAGNESEMIA?
NEUROMUSCULAR IRRITABILITY SUCH AS TREMORS, CRAMPS, DIFFICULTY SWALLOWING, CARDIOVASCULAR CHANGES
WHAT IS THE TREATMENT FOR HYPOMAGNESEMIA?
TX UNDERLYING CAUSE, INCREASE INTAKE OF FOODS HIGH IN MAGNESIUM, IV MAGNESIUM
WHAT IS THE EXPECTED SERUM LEVEL FOR HYPERPHOSPHATEMIA?
> 4.5MG/DL
WHAT ARE THE CAUSES OF HYPERPHOSPHATEMIA?
RENAL FAILURE, RHABDOMYOLYSIS, TUMOR LYSIS SYNDROME, EXCESS PHOSPHATE INTAKE ( VERY RARE)
WHAT IS THE TX FOR HYPERPHOSPHATEMIA?
TX UNDERLYING CAUSE, RESTRICTION OF PHOSPHATE INTAKE IF RENAL FAILURE PRESENT, ADMIN OF NS IF RENAL FAILURE PRESENT
WHAT IS THE EXPECTED SERUM LEVEL FOR HYPOPHOSPHATEMIA?
< 2.5 MG/DL
WHAT ARE THE CAUSES OF HYPOPHOSPHATEMIA?
INCREASED CARBOHYDRATE CALORIES CAUSING PHOSPHATE REDISTRIBUTION, RESPIRATORY ALKALOSIS, ALCOHOLISM, UNCONTROLLED DM, RENAL PHOSPHATE WASTING
WHAT ARE THE SIGNS AND SYMPTOMS OF HYPOPHOSPHATEMIA?
NEUROMUSCULAR DYSFUNCTION, WEAKNESS, ESPECIALLY OF RESPIRATORY MUSCLES, FATIGUE, MYOCARDIAL DEPRESSION, VENTRICULAR DYSRHYTHMIAS, RHABDOMYOLISIS, CONFUSION, COMA, DECREASED O2 DELIVERY TO TISSUES, RENAL LOSS OF BICARBONATE,CALCIUM, MAGNESIUM, AND GLUCOSE, BONE CHANGES, ENDOCRINE CHANGES(INSULIN RESISTANCE)
WHAT IS THE TX FOR HYPOPHOSPHATEMIA?
TX UNDERLYING CAUSE, INTAKE OF FOODS HIGH IN PHOSPHOROUS, ORAL PHOSPHATE REPLACEMENT
WHAT ARE THE 3 DISTURBANCES CREATED WITHIN THE BODY WHEN ACID-BASE BALANCE IS DISRUPTED?
IMPAIRED BLOOD-OXYGEN TRANSPORT, IMPAIRED NEUROLOGICAL FUNCTION, AND IMPAIRED CARDIAC RHYTHMICITY
DEFINE RESPIRATORY ACIDOSIS?
HYPOVENTILATION---CAUSES LOW PH < 7.35
DEFINE REPIRATORY ALKALOSIS?
HYPERVENTILATION CAUSES INCREASED pH AND BLOOD CO2 LEVELS DECREASED TO < 36mmHg
WHAT IS THE BODY'S COMPENSATORY MECHANISM FOR REPIRATORY ALKALOSIS?
KIDNEYS INCREASE EXCRETION OF BICARBONATE INTO URINE
DEFINE METABOLIC ALKALOSIS?
EXCESSIVE LOSS OF BODY ACIDS OR UNUSUAL INTAKE OF ALKALINE SUBSTANCES
WHAT CAUSES METABOLIC ALKALOSIS?
VOMITTING, VIGOROUS NG SUCTIONING, INGESTING LARGE AMOUNTS OF ANTACIDS, ENDOCRINE DISORDERS
WHAT IS THE BODY'S COMPENSATORY MECHANISM FOR METABOLIC ALKALOSIS?
DECREASED VENTILATION==INCREASED CO2>>>ACID. KIDNEYS RESPOND BY RETAINING HYDROGEN AND EXCRETING BICARBONATE
WHAT ARE THE 2 MOST COMMONLY RESTRICTED ELECTROLYTES DIETARILY?
SODIUM AND POTASSIUM
WHAT LAB SHOULD BE PERFORMED TO CHECK FOR RESPIRATORY ACIDOSIS?
ABG>>>PaCO2,
IF PaCO2 > 44mmHg=
RESPIRATORY ACIDOSIS

*REMEMBER--
INCREASED CO2=DECREASED pH=
ACIDOSIS
WHAT MEDICAL DX MIGHT CAUSE RESPIRATORY ACIDOSIS?
ASTHMA, EMPHYSEMA(COMPROMISE OF BREATHINGABILITY),

DEPRESSED NEURAL OR MUSCLE FUNCTION(NARCOTIC OD, HEAD TRAUMA, POLIO)
WHAT COMPENSATORY MECHANISM DOES THE BODY USE FOR RESPIRATORY ACIDOSIS?
BECAUSE OF HYDROGEN BUILDUP, KIDNEYS INCREASE EXCRETION OF HYDROGEN INTO URINE AND RETURN BICARBONATE TO BLOOD
DEFINE METABOLIC ACIDOSIS?
WHEN EXCESS ACID IS INGESTED OR CREATED CAUSING LOW pH
(<7.35)
WHAT LAB SHOULD BE PERFORMED TO CHECK FOR METABOLIC ACIDOSIS?
BLOOD>>BICARBONATE LEVEL>>
<22mEQ/L
WHAT MEDICAL DX MIGHT CAUSE METABOLIC ACIDOSIS?
DKA OR KIDNEYS UNABLE TO RETAIN ENOUGH BICARBONATE TO BUFFER FREE HYDROGEN IN BLOOD, SEVERE DIARRHEA, ACID ACCUMULATION IN BLOOD ( LACTIC ACID CAUSED BY O2 DEPRIVATION)
WHAT COMPENSATORY MECHANISM DOES THE BODY HAVE TO REVERSE METABOLIC ACIDOSIS?
INCREASED RESPIRATIONS==DECREASED CO2>>TOWARD BASE, BUT NOT COMPLETELY.....KIDNEYS COMPENSATE BY EXCRETING HYDROGEN AND RETAINING BICARBONATE ( TAKES HOURS)
WHAT ARE THE 3 CLASSIFICATION OF IV SOLUTIONS?
1. CHEMICAL NATURE( CRYSTALLOID AND COLLOID)
2. TONICITY
3. INTENDED THERAPEUTIC USE
WHAT IS A CRYSTALLOID SOLUTION?
ONE MADE UP OF WATER AND SOLUTES
WHAT IS A COLLOID?
PLASMA EXPANDER--USED TO EXPANDS INTRAVASCULAR VOLUME. PULLS FLUID FROM INTERSTITIAL SPACES INTO INTRAVASCULAR SPACE
WHAT ARE SOME EXAMPLES OF ISOTONIC SOLUTIONS?
D5W, D5 1/4 NS, NS, LR
WHY CAN'T A PERSON WITH RENAL FAILURE GET LACTATED RINGERS?
BECAUSE OF ITS POTASSIUM CONTENT
WHAT ARE EXAMPLES OF HYPOTONIC SOLUTIONS?
.45NS, ISOLYTE R, NORMOSOL M, PLASMALYTE M
WHAT ARE EXAMPLES OF HYPERTONIC SOLUTIONS?
D5 1/2NS, D5 NS, D10 NS, D5 LR
WHAT IS AN ATTRIBUTE OF HYPEROSMOLAR SALINE?
IT DRAWS FLUID INTO THE BLOODSTREAM AND OUT OF THE CELLS
WHAT ARE EXAMPLES OF HYPEROSMOLAR SALINE?
3% AND 5% NS
HOW ARE DIURETICS CLASSIFIED?
IN TERMS OF THEIR EFFECT ON POTASSIUM LOSS
WHERE DO DIURETICS WORK?
RENAL TUBULES
HOW DO POTASSIUM-WASTING DIURETICS WORK?
MAINTAIN BODY'S CONSERVATION OF SODIUM BUT WASTE POTASSIUM
HOW POTASSIUM-SPARING DIURETICS WORK?
ACT TO CONSERVE POTASSIUM, BUT MAY CREATE DANGEROUSLY HIGH SERUM POTASSIUM LEVELS
WHAT FORMS DO ORAL POTASSIUM SUPPLEMENTS COME IN?
POWDER, TABLET, AND SOLUTION( TASTES BAD)
WHAT IS THE DANGER OF SALT SUBSTITUTES?
INCREASED SERUM POTASSIUM
WHAT MEDICINES MAY CONTRIBUTE TO FLUID AND ELECTROLYTE IMBALANCE?
INSULIN, DIURETICS, STEROIDS, LAXATIVES, ANTACIDS
GAIN OR LOSS OF HOW MUCH WEIGHT PER DAY INDICATES EXCESS FLUID LOSS OR GAIN?
1 LB
ONE LITER OF FLUID LOST OR GAINED BY THE BODY EQUATES TO ___ CHANGE IN BODYWEIGHT?
2.2 LBS
WHAT % OF BODYWEIGHT LOSS INDICATES MILD, MODERATE, AND SEVERE FLUID DEFICIT?
2%, 5%, AND 8% RESPECTIVELY
WHAT IS EXPECTED TO HAPPEN TO THE QUALITY OF PATIENT'S PULSE RATE IF IN FLUID DEFICIT?
INCREASED HR, BUT WITH WEAK PULSE VOLUME,
IF PATIENT HAS FEVER, BY HOW MUCH DO YOU INCREASE THEIR FLUID INTAKE?
101-103---INCREASE BY 500ML
> 103---BY 1,000ML.
NORMAL FLUID INTAKE SHOULD BE 1,500-2000ML/DAY
WHAT IS EXPECTED TO HAPPEN TO THE QUALITY OF THE PATIENT'S PULSE RATE IF IN FLUID VOLUME EXCESS?
INCREASED PULSE VOLUME, 3RD HEART SOUND SOUND(S3)
WHAT KIND OF BOWEL CHANGES MIGHT ONE EXPECT WITH POTASSIUM DEFICIT?
ABDOMINAL DISTENTION, HYPOACTIVE BS, PARALYTIC ILEUS
DEFINE EDEMA?
EXCESSIVE ACCUMULATION OF INTERSTITIAL FLUID
WHAT ARE GOOD PLACES TO CHECK A PATIENT FOR EDEMA?
AROUND EYES, NEAR SACRUM, EXTREMITIES
AT WHAT % INCREASE IN BODY WATER WEIGHT DOES PITTING EDEMA OCCUR?
10%
WHAT IS THE RATING SCALE USED FOR EDEMA?
+ EDEMA JUST PERCEPTIBLE(2MM)
++AND +++ INDICATE MODERATE(4-6)MM
+++ SEVERE EDEMA(8MM OR>)
TRUE OR FALSE-- NECK VEINS MAY BE DISTENDED IN THE NORMAL PT WHEN IN SUPINE POSITION?
T
DESCRIBE KUSSMAUL RESPIRATIONS?
ABNORMALLY RAPID AND DEEP RESPIRATIONS CAUSED BY ACID--BASE IMBALANCE
DURING WHAT CONDITION WOULD YOU EXPECT TO HEAR PLEURAL FRICTION RUB?
INTERSTITIAL FLUID SHIFTS TO RESULT IN COLLECTION OF FLUID IN PLEURAL SACS
WHAT IS ONE OF THE MOST IMPORTANT INDICATORS OF FLUID AND ELECTROLYTE IMBALANCE?
ALOC
WHAT ARE THE DIFFERENCES BETWEEN LETHARGY, STUPOR, AND COMA?
LETHARGY--ALOC BUT EASILY AROUSED
STUPOR--ALOC, BUT MENTAL SLUGGISHNESS AND DECREASED RESPONVSIVENESS
COMA--UNCONSCIOUS
WHAT ARE THE 2 ELECTROLYTES MOST CLOSELY RELATED TO MUSCULOSKELETAL PROBLEMS IN FLUID AND ELECTROLYTE IMBALANCE?
CALCIUM AND POTASSIUM
A DECREASED IN THIS ELECTROLYTE MAY CAUSE MUSCLE WEAKNESS AND VASCULAR AND INTESTINAL MOTILITY PROBLEMS?
POTASSIUM
A DECREASE IN THIS LYTE' LEVEL MAY CAUSE MUSCLE RIGIDITY OR SPASTCITY?
CALCIUM
INCREASE OR DECREASE IN THESE LYTE'S MAY ALL CAUSE REFLEXES TO BE HYPERACTIVE?
HYPOMAGNESEMIA, HYPOCALCEMIA,

HYPERNATREMIA, HYPERKALEMIA
THIS ACID/BASE IMBALANCE MAY CAUSE HYPERACTIVE REFLEXES?
RESPIRATORY AND METABOLIC ALKALOSIS
INCREASE OR DECREASE OF THESE LYTE'S MAY CAUSE HYPOACTIVE REFLEXES?
HYPERMAGNESEMIA,HYPERCALCEMIA

HYPONATREMIA, HYPOKALEMIA
THIS ACID/BASE IMBALANCE MAY CAUSE HYPOACTIVE REFLEXES?
ACIDOSIS
THIS TERM IS AN INDICATION OF TETANY. IT MEANS--A SPASM OF FACIAL MUSCLES IN RESPONSE TO A TAP OVER A FACIAL NERVE?
CHVOSTEK'S SIGN
AN INDICATOR OF TETANY,___ IS A MUSCLE SPASM OCCURRING WHEN PRESSURE IS APPLIED TO NERVES AND VESSELS OF UPPER ARM?
TROUSSEAU'S SIGN
THIS IS THE MEASUREMENT OF PRESSURE IN THE RIGHT ATRIUM OR VENA CAVA AND IS ONE OF THE MORE ACCURATE PREDICTORS OF FLUID STATUS?
CENTRAL VENOUS PRESSURE
NORMAL CENTRAL VENOUS PRESSURE IS ___?
4-11 CM OF WATER
WHAT DIAGNOSTIC TESTS MAY BE USEFUL TO DETERMINE FLUID AND ELECTROLYTE IMBALANCES?
SERUM ELECTROLYTE,
SERUM OSMOLARITY,
URINE OSMOLARITY,
URINE SPECIFIC GRAVITY,
AND ABG'S
___ IS THE NORMAL VALUE FOR SERUM OSMOLARITY?
280-300mOsm/L
SERUM OSMOLARITY___ IN WATER EXCESS AND ___ IN WATER DEFICIT? INCREASES OR DECREASES
DECREASES,

INCREASES
WHEN THERE ARE INCREASED AMOUNTS OF NITROGENOUS WASTES,WILL URINE OSMOLARITY WILL BE INCREASED OR DECREASED?
INCREASED
NORMAL URINE OSMOLARITY IS___?
50-1200mOsm/L WITH THE AVERAGE BEING 200-800
WHAT IS THE NORMAL URINE OSMOLARITY FOR NEWBORNS?
100-600mOsm/L
THE MORE CONCENTRATED THE URINE, THE ___ ITS OSMOLARITY( INCREASED OR DECREASED)?
INCREASED
WHEN KIDNEYS ARE FUNCTIONING NORMALLY IS URINE OSMOLARITY INCREASED OR DECREASED WHEN PLASMA OSMOLARITY IS ELEVATED?
INCREASED
DEFINE SPECIFIC GRAVITY?
IT IS THE WEIGHT OF A SUBSTANCE COMPARED WITH AN EQUAL PART OF WATER
WHAT IS THE NORMAL RANGE OF pH FOR URINE?
4.6-8.0
WHAT GASES DO ABG'S MEASURE?
PaCO2, PaO2, HCO3, AND O2 SAT
TRUE OR FALSE---BLOOD GASES ARE USED TO EVALUATE ACID-BASE BALANCE AND PULMONARY FUNCTION?
TRUE
WHAT ARE THE DIAGNOSES MOST OFTEN IDENTIFIED FOR FLUID AND LYTE' PROBLEMS?
FLUID VOLUME DEFICIT,
FLUID VOLUME EXCESS,
WATER EXCESS,
WATER DEFICIT
THE STAE IN WHICH A CLIENT EXPERIENCES AN EXCESS OF ECF IS CALLED?
FLUID VOLUME EXCESS
WHAT ARE SOME OF THE SIGNS AND SYMPTOMS OF FLUID VOLUME EXCESS?
EDEMA, WEIGHT, SOB, INTAKE>OUTPUT, S3 HEART SOUND, DECREASED HEMATOCRIT, DECREASED SPECIFIC GRAVITY OF URINE, JVD
WHAT PATIENTS ARE AT RISK FOR FLUID VOLUME EXCESS?
HYPERALDOSTERONISM,
EXCESS FLUID INTAKE,
EXCESS SODIUM INTAKE,
RENAL FAILURE,
HEART FAILURE,
LIVER FAILURE
WHAT ARE THE SIGNS AND SYMPTOMS OF WATER EXCESS?
SERUM OSMOLARITY LESS THAN 280 mOsm/L,
CONFUSION, HEADACHE, CRAMPS, DELIRIUM, PERSONALITY CHANGES, CONVULSIONS, COMA, ANOREXIA, N&V,
WEIGHT GAIN,
LOW SPECIFIC GRAVITY OF
URINE
WHAT ARE SOME RELATED FACTORS TO WATER EXCESS?
CARDIAC, HEPATIC, OR RENAL FAILURE; EXCESS WATER INTAKE ORAL OR IV; SYNDROME OF INAPPROPRIATE ADH SECRETION
DEFINE WATER DEFICIT?
THE STATE IN WHICH THE CLIENT HAS A DEFICIT OF BODY WATER IN RELATION TO SOLUTE
DEFINE WATER EXCESS?
THE STATE IN WHICH THE CLIENT HAS AN EXCESS OF BODY WATER IN RELATION TO SOLUTE
WHAT ARE THE SIGNS AND SYMPTOMS OF WATER DEFICIT?
INCREASED SPECIFIC GRAVITY OF URINE, LETHARGY, DISORIENTATION, DELUSIONS, IRRITABILITY, CONVULSIONS, COMA, THIRST, OLIGURIA OR ANURIA, TACHYCARDIA, AND SOMETINES FEVER, AND INADEQUATE WATER INTAKE
WHAT ARE SOME EXAMPLES OF EXPECTED OUTCOMES FOR FLUID VOLUME EXCESS?
DECREASE IN PERIPHERAL EDEMA,
WEIGHT LOSS ,
DECREASING FATIGUE AND WEAKNESS,
DECREASED DYSPNEA,
NORMAL LABS,
PATIENT DEMONSTRATES
KNOWLEDGE OF PREVENTION,
PATIENT WILL DECREASE INTAKE OF FOODS HIGH IN SODIUM
WHAT ARE SOME EXAMPLES OF EXPECTED OUTCOMES FOR CLIENTS WITH HYPOKALEMIA?
SERUM K+ WILL BE WNL,

DECREASE IN CARDIAC

ARRHYTHMIAS,

IMPROVED BOWEL SOUNDS
WHAT ARE SOME EXAMPLES OF EXPECTED OUTCOMES FOR CLIENTS WITH METABOLIC ALKALOSIS?
pH REMAINS BETWEEN 7.35-7.45,

HCO3 BETWEEN 23-26 mEQ/L,

IMPROVED LOC,

DEEP AND REGULAR RESPIRATIONS(16-20 PER MIN)
WHAT ARE SOME EXAMPLES OF EXPECTED OUTCOMES FOR CLIENTS WITH HYPERKALEMIA?
POTASSIUM <5.0mEq/L,

ABSENCE OF TENTED T WAVES,

DECREASE IN NUMBER OF

DIARRHEA STOOLS,
WHAT ARE SOME EXAMPLES OF EXPECTED OUTCOMES FOR CLIENTS WITH METABOLIC ACIDOSIS?
pH BETWEEN 7.35-7.45,

HCO3 23-26mEq/L

IMPROVED LOC
WHAT IS NPO?
NOTHING BY MOUTH-SOMETIMES ALLOWS SMALL AMOUNTS OF ICE CHIPS
WHEN MIGHT NPO BE ORDERED?
1)WHEN CLIENT IS UNCONSCIOUS,
PERIOPERATIVE, AND PREPROCEDURAL TO AVOID ASPIRATION
2)WHEN GI TRACT NEEDS TO REST AND HEAL DUE TO VOMITING, DIARRHEA, OR GI DISORDER
3) TO PREVENT FURTHER LOSS OF GASTRIC JUICES IN CLIENTS ON NASOGASTRIC SUCTIONING
WHEN SHOULD THE NURSE PROVIDE ORAL HYGIENE DURING PERIODS OF NPO STATUS?
Q 1-2 HOURS
WHEN WOULD RESTRICTED FLUIDS BE ORDERED?
FLUID VOLUME EXCESS RELATED TO RENAL OR HEART FAILURE
IV DRIP RATE CALCULATIONS
1) TOTAL VOLUME TO BE INFUSED
---------------------
NUMBER OF HOURS TO RUN =

mL/HOUR

2) mL/h X DROP FACTOR
----------------
60MIN ==

DROPS/MIN
TRUE OR FALSE--PLASMA TO BE INFUSED TO PATIENT CAN BE FROM ANY BLOOD TYPE DONOR?
FALSE--MUST BE FROM THE SAME GROUP AND TYPE
HOW MUST FFP BE PREPARED TO GIVE TO PATIENT?
MUST BE REWARMED PRIOR TO ADMINISTRATION AND HAS TO BE USED WITHIN 6 HOURS B/C CLOTTING FACTORS WILL DEGRADE
WHAT ARE TWO TYPES OF VOLUME EXPANDERS THAT A NURSE MAY BE INVOLVED IN ADMINISTERING?
FFP AND SERUM ALBUMIN
WHAT PROPERTY DOES SERUM ALBUMIN HAVE THAT MAKES IT A GOOD PLASMA PROTEIN REPLACEMENT?
ITS OSMOTIC PROPERTIES HELP CORRECT HYPOVOLEMIA BY CAUSING FLUID SHIFT FROM THE INTERSTITIAL TO THE INTRAVASCULAR COMPARTMENT
WHAT 2 STRENGTHS DO ALBUMIN COME IN?
5% AND 25%
DOES A BLOOD TYPING NEED TO BE PERFORMED PRIOR TO ADMINISTERING SERUM ALBUMIN?
NO
WHAT IS THE NORMAL WATER REQUIREMENT FOR AN ADULT?
2-2 1/2 LITERS PER DAY
WHAT ARE THE PEDIATRIC NEEDS DAILY FOR WATER?
SCHOOL AGE---100-110 mL/KG/DAY

TODDLERS---120-135 mL/KG/DAY

INFANTS---70-100 mL/KG/DAY
WHICH ARE ABSORBED FASTER BY THE STOMACH--COOL OR WARM FLUIDS?
COOL
WHAT SPECIFIC EFFECT DO INOTROPIC DRUGS HAVE ON THE BODY?
ENHANCE MYOCARDIAL CONTRACTILITY
WHY SHOULD ORAL POTASSIUM BE GIVEN WITH FOOD?
IT IS A GI IRRITANT
WHAT ARE THE SPECIAL RULES FOR ADMINISTERING IV POTASSIUM?
1) MUST BE GIVEN IN A DILUTED FORM
2)MUST BE GIVEN USING AN INFUSION PUMP
3)CLOSE CARDIAC MONITORING 2ND TO POSSIBLE CARDIAC ARREST
WHY MIGHT IV GLUCOSE BE ORDERED FOR A PATIENT WITH POTASSIUM LEVELS DANGEROUS ENOUGH TO CAUSE CARDIAC CONDUCTION CHANGES?
THEY CAUSE A TEMPORARY SHIFT OF POTASSIUM FROM PLASMA TO WITHIN CELLS
WHAT IS KAYEXALATE?
A CATION EXCHANGE RESIN THAT IS ORDERED TO FORCE EXCRETION OF POTASSIUM FROM THE BODY
WHAT 2 WAYS MAY KAYEXALATE BE GIVEN?
ORAL OR RECTAL
WHAT IS THE DEFINITION OF HEMATOCRIT?
THE PROPORTION OF RED BLOOD CELLS TO FLUIDS IN THE BLOOD
WHAT IS THE DEFINITION OF HEMOGLOBIN( FOR LAB TEST PURPOSES)?
THE PROTEIN TAHT CARRIES OXYGEN IN THE BLOOD AND ON THE RED BLOOD CELLS
WHAT IS THE NORMAL HGB VALUE?
MALES: 13.8-17.2 GM/DL
FEMALES: 12.1-15.1 GM/DL
WHAT IS THE NORMAL HCT VALUE?
MALE: 40.7 - 50.3%
FEMALE: 36.1 - 44.3%
WHAT DISEASE STATES MIGHT BE EXPECTED WITH AN ABNORMAL VALUE OF HEMATOCRIT?
LOW: ANEMIA, BLOOD LOSS, BONE MARROW FAILURE, DESTRUCTION OF RBCS, LEUKEMIA, MALNUTRITION

HIGH: DEHYDRATION--FROM BURNS OR DIARRHEA