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59 Cards in this Set

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What is HYPOVOLEMIA
and who is at risk?
Decrease of fluid volume,
dehydration. Less solvent (H2O)
and more solutes. Patients at
risk include those who have
n/v/d.
List signs and symptoms
of HYPOVOLEMIA
(fluid volume deficit)
Pts are confused, change in
LOC, HA, dizzy, increased HR,
decreased BP, neck veins flat,
abd sunken, decrease urine
output, poor skin turgor,
diarrhea, mucous membranes dry
What are some
lab values affected
by HYPOVOLEMIA?
Labs will show increase in Na+,
K+, BUN, Urine spec. gravity,
Hgb, Hct (hemoconcentration of
increase in RBC's because of
decrease if fluid volume.
What is HYPERVOLEMIA
and who is at risk?
Increase of fluid volume,
overhydration. More solvent
(H2O) less solutes. Patients
at risk include ones who have
CHF, renal failure, IV at a
rapid rate, overhydration.
List signs and
symptoms of
HYPERVOLEMIA
(fluid overload)
blurry vision, wt gain, edema
(periorbital, faical, pedal,
peripheral), HA, increased BP
and RR, crackles, abd
distended, bounding pulse,
neck veins bulging, S3 sound
due to extra volume.
What are some lab
values affected
by HYPERVOLEMIA?
Decrease in Na+, K+, BUN,
Creatinine, Hgb, Hct, Urine
spec. gravity.
Edema is the
result of_______?
Increase of fluids
The primary organ
responsible for
regulation of body
fluids is the _______?
Kidney
A person with NG suction
with prolonged vomiting
may have a deficit of
______, _______,
and _______.
H2O, Na+, and K+
When fluid volume
decreases what happens
to the electrolyte
concentration?
It increases concentration of
Na+ and other electrolytes.
A fluid volume deficit will do
what to the H and H?
Increase the
Hgb and Hct.
Normal lab value
for Na+:
Na+ = 135-145
What is HYPONATREMIA
and s + s?
Decrease of Na+. Can be due
to too much H2O in system
which decrease Na+ level. S +
S are apprehension, change in
LOC, n/v/d, fever (sweating),
neuro and brain changes, risk
for seizures, decreased
appetite.
What is HYPERNATREMIA
and s + s?
Increase in Na+. S + S are
dehydration, impaired thirst
response, polydipsia, irritable,
restless, dry skin, dry
sticky tongue.
Normal lab value
for K+:
K+ = 3.5-5.3
What is HYPOKALEMIA
and s + s?
Decrease in K+. Leads to
dysrhythmias, heart blocks,
death. Pts with renal
failure= kidneys unable to
excrete K+. S + S include
weakness, fatigue, decreased
b.s., abd cramping, ECG
changes.
What is HYPERKALEMIA
and s + s?
Increase in K+. S + S include
weakness, anxiety, ECG changes,
heart blocks, abd cramps.
Normal lab value
for Ca++:
Ca++ = 8.5-10.5
What is HYPOCALCEMIA
and s + s?
Decrease in Ca+. S + S
include muscles twitch
involuntarily. + Chvostec
sign (contraction of muscle),
+ Trousseau (facial muscle
twitch), depression,
numbness, tingling fingers,
ECG changes
What is HYPERCALCEMIA
and s + s?
Increase in Ca+. S + S include
lethargy, deep tendon reflexes
slow and delayed, cardiac
arrest, decreased LOC, n/v
Normal lab value
for Mg++:
Mg++ = 1.5-2.5
What is HYPOMAGNESIA
and s + s?
Decrease of Mg++. S + S include
muscle tremors, + Chvostec
sign, + Trousseau, drowsy,
weak.
What is HYPERMAGNESIA
and s + s?
Increase of Mg++. S + S
include decreased depth and
rate of respirations.
Lungs and Kidnys
work together
to achieve
__________.
Homeostasis
CO2 + H2O
---H2CO3---
H+ + HCO3
carbon dioxide + water
--- carbonic acid ---
hydrogen ion +
bicarbonate
List the buffer
systems:
(3 lines of
defense for
maintaing pH)
Chemical: occurs in seconds,
in tissues and blood. H2CO3
(carbonic acid) most
important.
Biological: takes 2-4 hrs, K+
and H- ionic shift
Physiological: takes days,
systems come into effect
The lungs and kidneys
play what role in the
buffer system?
Lungs are sensitive to pH
changes and are quick
responders. The kidneys work
within hours to days.
When H+ concentrations
in ECF increase,
RR will _______?
RR will increase
to get rid of CO2
List the types of
compenstion:
Abnormal amounts of CO2 and/or
HCO3 will cause the opposite
system to compensate.
Metabolic
disturbance=respiratory
Repiratory
disturbance=metabolic
Complete: pH is back to norm
7.35-7.45
Partial: buffers are in
process
Decompenstion: worsening
Normal lab values
for pH:
PCO2:
HCO3:
pH: 7.35-7.45
PCO2: 35-45
HCO3: 22-26
If there is a change
in PaCO = partial pressure
carbon dioxide, this
indicates ______.
respiratory problem. Normal
35-45. Increase in CO2 leads
to increase in H+ cause
acidosis.
>45 acidosis
<35 alkalosis decrease in CO2
which means there is a
decrease in H+
A change in
HCO3 = bicarbonate
indicates ________.
Metabolic problem. Norm 22-26.
Decrease in HCO3 leads to
increase H+ cause acidosis.
<22 acidosis
>26 alkalosis
RESPIRATORY ACIDOSIS
and who is at risk?
pH<7.35
CO2>45
HCO3<22 if compensating
retaining CO2. Kidneys excrete H+ and
retain HCO3 (compensation)
Decrease in RR.
Hypoventilation.
Pts at risk: sedated pts,
post op, pna, COPD, emphysema.
Labs=hyperkalemia, hypercalcemia,
urine pH<6
S+S of resp acidosis
and interventions:
S+S: drowsiness,
disorientation, dizzy, HA,
hypotension, hypoxia, warm,
flushed skin. Interventions:
sit pt up, cough, deep
breaths, monitor electrolytes,
hydration,
limit/decrease/stop pain meds
(sedatives)
RESPIRATORY ALKALOSIS
and who is at risk?
pH>7.45
CO2<35
HCO3>26 if compensating
blowing off too much CO2.
Kidneys conserve H+ and
excrete HCO3 (compensation)
Increase in RR.
Hyperventilation. Pts at
risk: anxiety, fear, brain
inj, vent pts. Labs=urine
pH>6, hypokalemia,
hypocalcemia
S+S of resp alkalosis
and interventions:
S+S light-headed, dizzy,
dyspnea, tetany, tachycardic,
n/v. Interventions: brown bag,
focus on breathing (lower RR),
sedation.
METABOLIC ACIDOSIS
and who is at risk?
pH<7.35
CO2<35 if compensating
HCO3<22
Decrease in HCO3. Loosing
alkalinic fluid from intestines.
Pts with diarrhea, anal
fistula, dka, renal failure
S+S of met acidosis
and interventions:
S+S drowsiness, confusion, HA,
hypotension, n/v/d ...
hyperventilation (when
compensating)
Labs=hyperkalemia, urine pH<6.
Interventions: electrolyte
replacement, symptom control
METABOLIC ALKALOSIS
and who is at risk?
pH>7.45
CO2>45 if compensating
HCO3>26
Increase in bicarb.
loosing acidic fluid from
stomach. Pts at risk are
vomiting, NG tube, excessive
HCO3.
S+S of met alkalosis
and interventiosn:
S+S dizzy, irritable, nervous,
confused, tachy, n/v,
tremors. Labs=hypo kalemia,
calcemia, natremia, chloremia,
urine pH>6. Interventions:
treat underlying cause, take
antacid
Common self care
requisites for maintaing
F+E balance:
Control environment
Balance nutrition
Hydration
Decrease stress
Prevent illness
Seek health care early
Risk factors for
imbalance:
Age, chronic disease, trauma,
therapies (meds), GI losses
Changes in
aging:
Decline in kidney and lung
function, size. Decrease in
body water - norm 60% decreases
to 50-40%. Poor response to
early warning signs.
an anxious client would have which lab values
pH>7.45
CO2<35
increase RR
hyperventilation
at risk for resp.
alkalosis
HCO3>26 if compensating
1. pH 7.19
CO2 42.5
HCO3 15.6
pH acidic
CO2 norm
HCO3 acidic
METABOLIC ACIDOSIS
2. pH 7.16
CO2 70
HCO3 25
pH acidic
CO2 acidic
HCO3 norm
RESPIRATORY ACIDOSIS
Describe how body
mechanisms regulate
F+E balance:
FLUID INTAKE -
hypothalamus controls
thirst, influenses
intake
Name the fluid
compartments in
the body:
Intracellular (inside cell)
Extracellular -
Inerstitial
(fluids between cells) Intravascular (blood plasma)
Transcellular (urine, CSF)
What are
electrolytes?
Element or compound that when
melted dissolved and
separated into ions. Charge
particles. Either cations (+)
or anions (-). responsible for
acid-base balance, conduct
electrical current
Major intracellular ion?
Major extracellular ion?
Intracellular - K+
Extracellular - Na+
Describe diffusion:
solutes move from concentration
of high to low across a
semi-permeable membrane in an
attempt to equalize.
Describe
filtration:
process by which H2O and other
diffusible substances move
together in response to fluid
pressure
Describe active
transport:
Na+ K+ pump. As Na+ moves into
the cell, K+ is pumped out of
the cell. To equalize this the
Na+ K+ pump send Na+ back out of
cell and K+ back into cell
Describe
osmosis:
water molecules move through
semi-permeable membrane from are
of low concentration to high.
1. Osmolality:
2. Osmolarity:
3. Osmotic pressure:
1. amount of pressure
per L of H20
2. amount of any fluid
3. drawing power for H20.
depends on # molecules in a
solution
1. Isotonic:
2. Hypertonic:
3. Hypotonic:
1. equal pressure, cell does
not change
2. less solvent (h20) more
solutes: cells shrink
3. more solvent (h20) less
solutes: cells swell
Describe body
fluid composition:
60% H20=total body weight,
solvent, transports
minerals/eletrolytes,
exchanges O2 and CO2
Chemical compounds=solutes,
electrolytes, minerals, cells,
plasma
Describe how body
mechanisms regulate
F+E balance
Hormonal control -
Aldosterone-released by
adrenal cortex causes Na+
retention
Renin - angio 1-2 which
causes vasoconstriction
leads to blood flow to
kidneys and renal perfusion
Describe how body
mechanisms regulate
F+E balance
Fluid output
Kidneys 1500mL
Lungs 400 mL
Skin 500 mL
GI 100-200 mL