Patho Fluids/electrolytes & Acids/bases

Front 1

Total body water is about ___% of body weight.

Back 1

60%

Front 2

intracellular fluid (ICF) is fluid ______and makes up __-% of body wt? the cell whereas extracellular fluid (ECF) is fluid ____ the cell and makes up __% of body wt?

Back 2

Inside, 40% outside. 15%

Front 3

Interstitial fluid is the fluid in the space ______ cells and the outside blood vessels.

Back 3

between

Front 4

intravascular fluid is the _____ ______ and makes up __% of body wt?

Back 4

blood plasma, 5%

Front 5

4 forces determine if fluid moves out if the capillary and into the interstitial space called_______ or if fluid moves back into the capillary from the interstitial space called ______.

Back 5

filtration, reabsorption

Front 6

1 of 4 forces: Capillary hydrostatic pressure (blood pressure)moves water out from______ to and favors which filtration or absorption?

Back 6

moves water out from capillary to interstitial space. filtration

Front 7

2 of 4 forces. Capillary oncotic pressure aka ______-osmotically attracts water from the ___________back into _________. is what type of force-filtration of absorption?

Back 7

colloid osmotic pressure. osmotically attracts water from interstitial space back into capillary. absorption.

Front 8

3 of 4 forces. interstitial hydrostatic pressure aka ___________. moves water from________ back into______.is what type of force-filtration or absorption?

Back 8

tissue hydrostatic pressure. moves water in from interstitial space back into capillary. absorption

Front 9

4 of 4 forces. interstitial oncotic pressure aka ____________. osmotically attracts water from______ out to__________. is what type of pressure-filtration or absorption?

Back 9

tissue oncotic pressures. osmotically attracts water from capillary out to interstitial space. filtration

Front 10

Net filtration

Back 10

= (forces favoring filtration) – (forces opposing filtration).

Front 11

Forces favoring filtration

Back 11

capillary hydrostatic pressure and interstitial oncotic pressure.

Front 12

Forces opposing filtration. (absorption forces)

Back 12

capillary oncotic pressure and interstitial hydrostatic pressure.

Front 13

Sodium is responsible for the ____ osmotic balance, while potassium maintains the ___osmotic balance.

Back 13

ECF, ICF

Front 14

Edema is the excessive accumulation of fluid within the ____________. reasons for edema 1-increased what? 2-lowered what? 3-increased capillary membrane permeability 4-lymphatic channel obstruction.

Back 14

the interstitial spaces1- capillary hydrostatic pressure 2- plasma oncotic pressure

Front 15

reasons for increased capillary hydrostatic pressure 1-what side heart failure? why? 2) venous_________ 3)volume overload-too much blood volume as a resulte of too much _____/water.

Back 15

rt side heart, beacue pump isn't pumping adequately backup itno systemic veins, back up into capillary hence: increased CHP. venous obstruction, salt and water

Front 16

reasons for increased capillary permeability 1)________ and immune responses esp. trauma such as burns, crushing injuries, neoplastic disease2) and _____reactions. what happening is this: slit pores pull apart and allow increased permeability which lets proteins leak out and collect outside and increase IOP making more fluid outside the cells.

Back 16

inflammation, allergic

Front 17

Causes of Lymph obstruction 1-surgical removal of axillary and femoral ____ ____ for tx of carcinoma,2- inflammation, 3-tumors. the real purpose of the lymphatic sys. is to return leaked proteins back into circulation so if there is obstr. then proteins accum. so IOP is increased and filtration is increased so that means _____

Back 17

Lymph nodes, edema

Front 18

reasons for decreased capillary oncotic pressure. due to decreased plasma proteins in the cell. so decreased absorption, will filter, but not absorb so more fluid outside the cell.

Back 18

1) kidney disease, 2) serous drainage from open wounds 3)-hemorrhage 4)-burns, 5)-cirrhosis of liver.

Front 19

Edema may be_______-limited to site of trauma(like a mosquito bite) or________-more uniform distribution of fluid in interstitial spaces(like rt. heart failure). or 3)in pleural spaces-ascities which is edema in what?

Back 19

localized, general, peritoneal cavity due to liver disease.

Front 20

weight gain, swelling and puffiness, limited movement of affected joints. are symptoms of what?

Back 20

edema symptoms

Front 21

Osmoreceptors

Back 21

sensitive to plasma osmolality that are held to exist in the brain and to regulate water balance in the body by controlling thirst and the release of ADH

Front 22

volume sensitive receptors-

Back 22

sensitive to changes in volume

Front 23

baroreceptors-

Back 23

sensitive to changes in blood pressure—called also pressoreceptor

Front 24

sodium accounts for __% of the ECF cations.

Back 24

90%

Front 25

chloride changes are proportional to changes in ______

Back 25

sodium

Front 26

aldosterone secreted by adrenal cortex increases ___ of the ECF and _______is excreted with urine.

Back 26

Na+ potassium

Front 27

Renin enzyme secreted by juxtaglomerular cells of kidney is released when blood vol and BP are _____

Back 27

low.

Front 28

angiotensin I to angiotension II which stims secretion of _____and causes vasoconstriction.

Back 28

aldo

Front 29

natriuretic hormones promote urinary excretion of ____ and ____ and decreases BP.

Back 29

Sodium and water.

Front 30

Isotonic alterations mean a change in TBW but with a _______ change in electrolytes.

Back 30

proportional

Front 31

isotonic fluid loss (isotonic dehydration) causes contraction of ECF volume w/ weight loss, dryness of skin and mucous membranes, decreased urine output and symptoms of hypovolemia. Reasons for isotonic fluid loss include:

Back 31

hemorrhage, severe wound drainage, and excessive sweating.

Front 32

Hypovolemia is a decrease in the ? (decrease in hydrostatic pressure, decrease in renal blood flow, decreased cardiac output.)

Back 32

Volume of circulating blood, it is the isotonic loss of body fluids.

Front 33

rapid heart rate, thirst, flattened neck veins, norm or decreased BP are S&S of what?

Back 33

Hypovolemia.

Front 34

Excessive fluid loss, reduced fluid intake, 3rd space fluid shift are causes of what?

Back 34

Hypovolemia.

Front 35

neck veins may distend, BP increases, rapid breathing, edema are S&S of what?

Back 35

Hypervolemia.

Front 36

Hypertonic alterations include what 3 causes?

Back 36

1) dehydration which leads to Hypernatremia, renal dysfunction, and hyperchloremia.

Front 37

Hypotonic Alterations include what causes?

Back 37

over-hydration

Front 38

what is the normal PCO2 level?

Back 38

35-45

Front 39

what is the normal HCO3 level?

Back 39

22-26

Front 40

Adrenal insufficiency, Hyperparathyroidism,hyperthyroidism, hypervitaminosiss D, Milk alkali syndrome, Multiple fracture and prolonged immobiliztion, multiple myeloma, sarcodoisis, thiazide diuretics, tumors are potential causes of what?

Back 40

hypercalcemia

Front 41

hypomagnesemia, hypoparathyroidism, inadequate intake of calcium, and vitamin D, malabsorption or loss of Ca from the GI tract, over-correction of acidosis, pancreatic insufficiency, pancreatic insufficiency, renal failure, severe burns or infections are potential causes of what?

Back 41

hypocalcemia

Front 42

what electrolyte plays in role in cell permeability, formation of bones, teeth, blood coagulation, transmission of nerve impulses and muscle contraction?

Back 42

calcium

Front 43

what can hypercalcemia lead to?

Back 43

cardiac arrhythmias and coma

Front 44

what can hypocalcemia lead to?

Back 44

tentany and seizures

Front 45

these are S&S of what? Perorbital parentheia, anxiety, irritability and twitching, carpopedal spasm, tetany,, seizures, hypotension and cardiac arrhythemias.

Back 45

hypocalcemia

Front 46

drowsiness, lethargy, headaches, irritability, confusion, depression or apathy due to decreased neuromuscular irritability. Weakness and muscle flaccidity. Bone pain, and pathological fracutres. Heart block. Anorexia, nausea, vomiting, constipation,dehydration due to hyperosmolarity, flank pain due to renal calculi formation.

Back 46

hypercalcemia

Front 47

thirst, fever, dry mucous membranes, restlessness are S&S of what?

Back 47

Hypernatremia

Front 48

water deficit

Back 48

dehydration most common cause is increased renal clearance of free water as a resule of tubular function or inability to concentrate the urine as with diabetes insipidus.

Front 49

Hyperchloremia

Back 49

too much Na or too little bicarbonate.

Front 50

Hyponatremia Na less than ____. causes: 1)pure sodium deficits 2)Inadequate intake of dietary Na 3) dilutional hyponatremias- 4) hypoosmolar hyponatremia- TBW exceeds the increase in Na 5) hypertonic hyponatremia

Back 50

135 mEq/L. 1) vomiting, diarrhea, 3) IV of 5% dextrose in water can cause. 5) plasma proteins and lipids displace water volume and decrease Na

Front 51

water excess

Back 51

compulsive water drinking, decreased urine formation(reanl disease or decreased renal blood flow), syndrome of inappropriate secretion of ADH

Front 52

hypochloremia

Back 52

loss of chloride, usually the result of hyponatremia or high bicarbonate as in metabolic alkalosis., vomiting,

Front 53

Potassium (K)

Back 53

major intracellular e-, essential for normal cellular functions.

Front 54

potassium tolerance

Back 54

body's ability to adapt to increased levels of K over time.

Front 55

Hypokalemia is [K+] less than 3.5 mEq/L. Causes:

Back 55

reduced intake of K, increased entry of K into cells(from respiratory acidosis), increased losses of body K(gastrointestinal and renal dis).

Front 56

Hyperkalemia[K+] more than 5.5 mEq/L causes.

Back 56

causes: increased intake, shift of K from cells to ECF(cell trauma, change in cell permeability, acidosis, insulin deficiency or cell hypoxia) or decreased renal excretion.

Front 57

restlessness, intestinal cramping, diarrhea are Symptoms of what electrolyte alteration?

Back 57

hyperkalemia

Front 58

Hydrogen Ion and pH

Back 58

the greater the [H+] the more acidic the solution and the lower the pH.

Front 59

Body acids exist in 2 forms: volatile which can be eliminated as _________and nonvolatile which can be eliminated by the_______.

Back 59

CO2 gas, kidney

Front 60

Buffering

Back 60

occurs as a response to changes in acid-base staus.

Front 61

Buffers

Back 61

can absorb excessive H+ (acid) or OH- (base) and prevent a significant change in pH.

Front 62

Types of buffers

Back 62

1) (chemical) carbonic-acid bicarbonate buffering operates in both lung and kidney, major extracellular buffer. 2) (respiratory) protein buffering mostly intracellular buffer -Hgb good buffer 3)renal

Front 63

acidemia

Back 63

pH of arterial blood is less than 7.4, too much acid in the blood

Front 64

acidosis

Back 64

systemic increase in H+

Front 65

alkalemia

Back 65

pH of arterial blood is greater than 7.4, blood too alk

Front 66

alkalosis

Back 66

systemic decrease in H+

Front 67

causes of metabolic acidosis

Back 67

excessive fat metabolism in absence of carbs, cardiac pump failure, pulmonary or hepatic disease, anemia, renal insuf/faillure, asprinOD, Addisons, Hypoaldo. Compensatiion for metabolic acidosis

Front 68

What is metabolic acidosis

Back 68

noncarbonic acid increase or bicarbonate is lost from extracellular fluid, can occur quickly (poor oxygenation) or over time(renal failure or diabetic ketoacidosis).

Front 69

S&S of metabolic acidosis

Back 69

headache, lethary, drowsy, CNS depression, Kussmaul's serspirations, hypotension, stupor.

Front 70

Tx of metabolic acidosis

Back 70

tx underlying cause, IV, lactating Ringers

Front 71

causes of metabolic alkalosis

Back 71

Vomiting, diuretics, hyperaldosteronism, NG tube, fistulas, steroid use, massive blood transfusions, cushings dis.

Front 72

Symptoms of metabolic alkalosis:

Back 72

Nausea, diarrhea, weakness, muscle cramps, hyperactive reflexes, tetany, shallow, slow respirations, confusion, convulsions, atrial tachycardia.

Front 73

Tx of metabolic alkalosis

Back 73

IV, d/c diuretics,oral/IV acetasolmide

Front 74

compensation for metabolic alkalosis

Back 74

respiratory- hypoventilation (this is limited tho), Renal-more effective, but slower.

Front 75

Causes of respiratory acidosis

Back 75

Can be acute or chronic. Opioids, anesthetics,hypnotics, injury to medulla, reduced cardiac output, neuromuscular or respiratory disease, sleep apnea

Front 76

S&S of respiratory acidosis

Back 76

Respiratory rate is rapid at first then depressed. Skin may be warm, flushed. Headache, blurred vision, breathlessness, restlessness, apprehension, lethargy

Front 77

compensation for respiratory acidosis

Back 77

renal-increased secretions and excretions of acids, takes 24hrs to begin, respiratory- rate increases to expel CO2.

Front 78

Causes of respiratory alkalosis

Back 78

pulmonary reasons such as: pneumonia, interstitial lung disease, acute asthma. can be chronic or acute.

Front 79

S&S of respiratory alkalosis

Back 79

Tingling of extremities, deep, rapid respiration, lightheaded/dizzy, agitation, parethesia

Front 80

tx of respiratory alkalosis

Back 80

removal of ingested toxins, tx of fever, sepsis, O2, paperbag breathing to tx hyperventilation, adjustment of mechanical ventilation.

Front 81

Compensation of respiratory alkalosis

Front 82

urine formation is done in 3 steps. 1) F_______ 2) A________ 3) S_______

Back 82

filtration, absorption, secretion

Front 83

food proteins are foreign to me. I break them down into ___-____ and absorb the ___-____, then I make proteins from my own _____.

Back 83

Amino acids, amino acids, recipe.

Front 84

every time you have inflammation you have scar tissue formation. over times scars remodel/they twits, shrivel, compresses blood vessels causing ____ ____ which increased hydrostatic pressure and causes _____.

Back 84

venous obstruction, edema

Front 85

fluid compartments include

Back 85

intracellular and extracellular

Front 86

extracellular fluid consists of

Back 86

intravascular and interstitial fluids

Front 87

intracellular fluid contains lots of what electrolytes.

Back 87

Of K, Mg, Ph

Front 88

ECF contains large amounts of what electrolytes?

Back 88

Na, Cl, bicarbonate + oxygen, glucose, fatty acids, and amino acids.

Front 89

what is the normal pH range of the body?

Back 89

7.35-7.45

Front 90

edema is what?

Back 90

excess interstitial fluid

Front 91

indicators of a patients fluid status

Back 91

respiratory rate, pulse, heart rate, urine output, muscle twitching, BP, veins-flat or bulging, change in LOC

Front 92

describe complications of chronic renal failure.

Front 93

Function of each of the following electrolyte: Na: tonicity of ____, acid/base bal and _____balance, nerve conduction. K: cell electricity, acid-base, nerve ____, P:cell metabolism, __Absorption, Ca: cell permeability, ____ and teeth, muscle ______, Cl: acid/water bal, tonicity of ____, Mg: neuromuslcuar communication via _______ secretions.

Back 93

Na: ECF, water, K: impulse, P: Ca; bone, contraction, ECF, Mg:hormone

Front 94

2 categories of IV solutions: 1) crystalloids which can be: isotonic, hypertonic, or hypotonic. And 2) colloids which are always ____tonic.

Back 94

Hypertonic

Front 95

Colloids are used to expand plasma in patients who …...... The effects of colloids can last ____. The types of colloids used: a) albumin, b) Dextran c) hetastarch d) plasma protein factor.

Back 95

Don't respond to crystalloids. Effects can last days.

Front 96

What type of tonicity?? 1) dextrose 5% in water. (D5W) 2) normal saline-0.9% NaCl 3)Lactated Ringers solution

Back 96

Types of Isotonic IV solutions

Front 97

ADH hormone (vasopressin) regulates what? How?

Back 97

Fluid balance. Restores blood volume by reducing diuresis and increased water retention.

Front 98

Explain the Renin-angiotension system

Back 98

it is started by a fluid or [Na} decrease =>> which stims angiotensin to release angiotensin II=>> which stims the adrenal gland to release Aldosterone=>> Aldo causes kidneys to retain Na and water=>> Na & water retention lead to increase in fluid volume and [Na].

Front 99

ANP atrial natriuretic peptide is a cardiac hormone. When BP &BV increase, it stretches the atria where ANP does what?

Back 99

Shuts off renin-angio-aldo system so that BP and BV can stabilize.

Front 100

Bicarbonate (HCO3-), Chloride (Cl)and Phosphorus (P) are which -anions or cations?

Back 100

anions

Front 101

Calcium (Ca), magnesium(Mg), Potassium (K), Sodium (Na) are which-anions or cations?

Back 101

cations

Front 102

Na, Cl, Ca and HCO3 are in larger amounts in which-extracellular or Intracellular?

Back 102

Extracellular

Front 103

K, P, Mg are in larger amounts in which one-extracellular or intracellular?

Back 103

Intracellular

Front 104

Body uses 3 buffer systems to regulate acid/base disturbances. 1) _____, which neutralizes and occurs ______. 2) Respiratory using hyper/hypo-ventilation to change the pH and occurs within _____ and 3)_______ which excrete or retain acids or bases as needed and occurs within _____.

Back 104

1)chemical-instantly 2) minutes, 3) kidneys, hours/days.

Front 105

HCO3 and pH rise/fall _____ whereas PCO2 and pH move in ______ directions.

Back 105

Together, opposite.

Front 106

Excessive IV normal saline, over secretion of Aldosterone are what alteration-isotonic, hypertonic, hypotonic?

Back 106

Isotonic

Front 107

hemorrhage, severe wound drainage and sweating are what alteration-isotonic, hypertonic, hypotonic?

Back 107

Isotonic

Front 108

Hypernatremia, water deficit and hyperchloremia are what alteration-isotonic, hypertonic, hypotonic?

Back 108

Hypertonic

Front 109

hyponatremia, water excess and hypochloremia are what alteration-isotonic, hypertonic, hypotonic?

Back 109

hypotonic

Front 110

Dextrose 5% in ½ normal saline, dextrose 5% in normal saline, dextrose 10% in water (D10W) are what tonicity? Isotonic, hypotonic, hypertonic

Back 110

hypertonic

Front 111

½ normal saline is what tonicity? Isotonic, hypotonic or hypertonic?

Back 111

Hypotonic

Front 112

A hypertonic solution can be used to pull water out of the cells and into the extracellular fluid.

Back 112

It can pretty useful in hypovolemia to increase the vascular volume or hyponatremia if symptoms are serious (i.e confusion,seizures) as a result cerebral edema (fluid shifting into brain cells).

Front 113

A hypotonic solution is given to dilute extracellular fluid and shift water back into the cells via osmosis so that both the ECF and ICF compartments can achieve equal expansion or osmolality.

Back 113

It needs to be given cautiously because hypotonic fluids have the potential to cause fluid overload and cellular swelling if overdone.

Front 114

And isotonic of course only explands the ECF has no effect on the ICF and is administered in the case when a patient has both fluid and sodium losses it is also effective in hypovolemic shock to expand vascular fluid volumes.

Back 114

Keeping in mind that excessive administration of isotonic solutions can also cause fluid overload and hypernatremia.

Front 115

Hypotonic solutions should not be administered to patients with increased intracranial pressure because it can increase

Back 115

cerebral edema