Smeltzer Ch 14 Fluid Electrolyte

Front 1

What is Third Spacing

Back 1

Loss of ECF into space that does NOT affect equilibrium.
* Decrease urine output.

Front 2

Positive electrical charge electrolyte

Back 2

CATION

Front 3

Negative electrical charged electrolyte

Back 3

ANION

Front 4

Major CATIONs

Back 4

Na, K, Ca, Mg, H

Front 5

Major ANIONs

Back 5

Cl- HCO3- HPO4- SO-

Front 6

Transcellular Fluid

Back 6

One Liter. Spinal, pericardial, synovial, intraocular, pleural, sweat digestive secretion.

Front 7

Extracellular fluid

Back 7

ECF 1/3 of fluid. For transport.
*Intravascular
*Interstitial

Front 8

Intravascular fluid

Back 8

3 liters is plasma
Rest is Erythrocyte, Leukocyte, Thrombocyte

Front 9

Interstitial

Back 9

Lymph fluid, about 11-12 L in adult

Front 10

Osmotic Pressure

Back 10

Exerted by protein in plasma

Front 11

Hydrostatic Pressure

Back 11

Exerted on walls of blood vessels

Front 12

Osmosis

Back 12

move from Low to High solute concentration

Front 13

Diffusion

Back 13

Move from High to Low concentration

Front 14

Filtration

Back 14

Movement of water, solute to from High hydrostatic pressure to low hydrostatic pressure.

Front 15

Active Transport

Back 15

PUMP: Requires ATP. Move from low concentration to high concentration

Front 16

Kidney Filters ______

Back 16

180 L per day

Front 17

F V D

Back 17

Fluid Volume Deficit
Hypovolemia

Front 18

F V E

Back 18

Fluid Volume Excess
Hypervolemia

Front 19

FVD causes

Back 19

Fluid loss from vomiting
diarrhea, GI suctioning, sweating,
decreased intake,
no access to fluid.

Front 20

FVD Risk factors

Back 20

Diabetes insipidus
adrenal insufficiency
osmotic diureses
hemorrhage
coma
third space shift

Front 21

Sodium normal serum value

Back 21

135 - 145 mEq/L

Front 22

Potassium normal serum value

Back 22

3.5 - 5 mEq/L

Front 23

Calcium normal serum value

Back 23

8.6 - 10.2 mg/dL

Front 24

Magnesium normal serum value

Back 24

1.3 - 2.3 mg/dL

Front 25

Phosphate normal serum value

Back 25

2.5 - 4.5 mg/Dl

Front 26

Chloride normal serum

Back 26

97 - 107 mEq/L

Front 27

Low Ph

Back 27

Acidosis

Front 28

High Ph

Back 28

Alkalosis

Front 29

Normal Ph

Back 29

7.35 - 7.45

Front 30

Pa CO2 ABG

Back 30

35 - 45 mm Hg

Front 31

HCO3-

Back 31

22 - 26

Front 32

ABC level PaO2

Back 32

80 - 100 mm Hg

Front 33

O2 saturation

Back 33

> 94%

Front 34

Low Ph , 7.35
PaCO2 >42

Back 34

Respiratory Acidosis

Front 35

Hi ph 7.45
paCO2 ,35

Back 35

Respiratory Alkalosis

Front 36

Hyponatremia cause

Back 36

Causes: adrenal insufficiency, water intoxication, SIADH or losses by vomiting, diarrhea, sweating,
MEDS: diuretics , lithium

Front 37

Hyponatremia manifestation

Back 37

Manifestations: poor skin turgor, dry mucosa, headache, decreased salivation, decreased BP, nausea, abdominal cramping, neurologic changes

Front 38

Hypernatremia

Back 38

Causes: excess water loss, excess sodium administration, diabetes insipidus, heat stroke, hypertonic IV solutions, unconsciousness

Front 39

Hypernatremia manifestation

Back 39

Manifestations: thirst; elevated temperature; dry, swollen tongue; sticky mucosa; neurologic symptoms; restlessness; weakness

Front 40

Hyponatremia management

Back 40

Medical management: hypotonic electrolyte solution or D5W

Front 41

HYPO Kalemia cause

Back 41

Causes: GI losses, medications, alterations of acid-base balance, hyper-aldosterism, poor dietary intake

Front 42

HYPO Kalemia manifest

Back 42

Fatigue, anorexia, nausea, vomiting, dysrhythmias, muscle weakness/cramps, paresthesias, glucose intolerance, decreased muscle strength, Deep Tendon Reflex

Front 43

HYPO Kalemia management

Back 43

Management: incr dietary potassium, potassium replacement, IV for severe deficit
monitor ECG and ABGs, dietary potassium, nursing care r/to IV potassium administration

Front 44

HypERkalemia

Back 44

MORE DANGEROUS
Causes: usually treatment related, impaired renal function, hypoaldosteronism, tissue trauma, acidosis

Front 45

HypERkalemia manifestation

Back 45

Manifestations: cardiac changes and dysrhythmias, muscle weakness with potential respiratory impairment, paresthesias, anxiety, GI manifestations, Diabetic ketoacidosis

Front 46

HypERkalemia managment

Back 46

assess serum potassium levels, mix IVs containing K+ well, monitor med affects, dietary potassium restriction/dietary teaching for patients at risk.
**Hemolysis of blood specimen or drawing of blood above IV site may result in false laboratory result

Front 47

HYPO kalemia ECG

Back 47

Flattening of the T wave and the appearance of a U wave. Further flattening, prominent U wave

Front 48

HypERkalemia ECG

Back 48

Wide, flat P wave; wide QRS complex; and peaked T wave.

Front 49

Trousseau sign
Hypocalcemia, hypomagnesemia

Back 49

Carpal spasm(an adducted thumb, flexed wrist and metacarpo-joints, extended interphalangeal joints with fingers to-gether) will occur as ischemia of the ulnar nerve develops.

Front 50

Chvostek's sign
Hypocalcemia, hypomagnesemia

Back 50

Twitching of muscles enervated by the facial nerve when the region that is about 2 cm anterior to the earlobe, just below the zygomatic arch, is tapped

Front 51

FVD signs/symptoms

Back 51

Acute weight loss; decr skin turgor; oliguria; conc. urine; orthostatic hypotension r/t volume depletion; weak, rapid heart rate; flattened neck veins; incr temperature; thirst; decr or delayed capillary refill; decr central venous pressure; cool, clammy, pale skin r/to peripheral vasoconstriction; anorexia; nausea; lassitude; muscle weakness; and cramps.

Front 52

FVE manifestation

Back 52

Edema, distended neck veins, abnormal lung sounds (crackles), tachycardia, increased BP, pulse pressure and CVP, increased weight, increased UO, shortness of breath and wheezing

Front 53

FVE risk, factors

Back 53

*Risk factors: heart failure, renal failure, cirrhosis of liver
•Contributing factors: excessive dietary sodium or sodium-containing IV solutions

Front 54

FVE managemnt

Back 54

I&O and daily weights; assess lung sounds, edema, other symptoms; monitor responses to medications- diuretics
•Promote adherence to fluid restrictions, patient teaching r/to sodium and fluid restrictions
•Monitor, avoid sources of excessive sodium, including medications
•Promote rest
•Semi-Fowler‘s position for orthopnea
•Skin care, positioning/turning

Front 55

PHOSPHATE

Back 55

ATP and of 2,3 diphosphoglycerate; provides structural support to bones and teeth
•Primary anion of ICF
•85% in bones and teeth; 14% soft tissue; < 1% in ECF
•2.5 – 4.5 mg/dL

Front 56

Hypophosphatemia cause

Back 56

Serum level below 2.5 mg/DL
•Causes: alcoholism, refeeding of patients after starvation, pain, heat stroke, respiratory alkalosis, hyperventilation, diabetic ketoacidosis, hepatic encephalopathy, major burns, hyperparathyroidism, low magnesium, low potassium, diarrhea, vit D defic, use of diuretic and antacids

Front 57

Hypophosphatemia manifestation

Back 57

Manifestations: neurologic symptoms, confusion, muscle weakness, tissue hypoxia, muscle and bone pain, incr suscept to infection
•Nursing manage: assessment, encourage foods high in phosphorus, gradually introduce calories for malnourished patients receiving parenteral nutrition

Front 58

Hyper phosphatemia cause

Back 58

Serum > 4.5 mg/DL
•Causes: renal failure, excess phosphorus, excess vitamin D, acidosis, hypoparathyroidism, chemotherapy

Front 59

Hyper phosphatemia manifestation

Back 59

Few symptoms; soft-tissue calcifications, symptoms occur due to associated hypocalcemia

Front 60

Hyper phosphatemia managemnt

Back 60

Assessment, avoid high-phosphorus foods; teaching r/to diet, phosphate-containing substances, signs of hypocalcemia

Front 61

CHLORIDE

Back 61

97-107 serum
Major anion of ECF;
Interstitial/ lymph fluid, gastric, pancreatic jc, sweat/bile/saliva
•Maintain acid-base balance
•Buffer in exchg of O2/CO2 in RBCs

Front 62

Hypo chloremia cause

Back 62

Low chloride intake, GI loss, exces sweating, fever, burns, medications, metabolic alkalosis
•Loss of chloride occurs with loss of other electrolytes, potassium, sodium

Front 63

Hypo chloremia manifest

Back 63

Agitation, irritability, weakness, hyperexcitability of muscles, dysrhythmias, seizures, coma

Front 64

Hypochloremia mgt

Back 64

Assessment, avoid free water, encourage high-chloride foods, patient teaching r/t high chl food.

Front 65

HYPERchloremia cause

Back 65

?107 Exc NaCl infusions with water loss, head injury, dehydration, severe diarrhea, resp alkalosis, metabolic acidosis, hyperparathyroidism, medications

Front 66

Hyperchloremia manifest

Back 66

Tachypnea, lethargy, weakness, rapid, deep respirations, hypertension, cognitive changes

Front 67

Hyperchloremia mangmt

Back 67

Assessment, patient teaching r/to diet and hydration

Front 68

Maintn Acid=Base balance
3 mechanism

Back 68

1) Major ECF buffer system; bicarbonate-carbonic acid buffer system
2) Kidneys regulate bicarbonate in ECF
3) Lungs under control of medulla regulate CO2, carbonic acid in ECF

Front 69

Other Buffer systems,
maintain acid-base balance

Back 69

1) ECF: inorganic phosphates, plasma proteins
2) ICF: proteins, organic, inorganic phosphates
3) Hemoglobin

Front 70

Ratio of bicarb/carb acid

Back 70

20 Bicarbonate: 1 carbonic acid

Front 71

Acidosis ph

Back 71

6.81 - 7.34 ph

Front 72

pH Death

Back 72

less than 6.8
gr than 7.8

Front 73

Alkalosis pH

Back 73

7.45 - 7.8

Front 74

Metabolic ACIDosis

Back 74

*Low pH < 7.35
•Low bicarbonate < 22 mEq/L***cardinal feature
*Low PaCO2 < =35
•Most due to renal failure, also diarrhea and diuretics

Front 75

Metabolic ACIDosis manifestation

Back 75

headache, confusion, drowsiness, increased resp rate/depthh, decr BP, decr cardiac output, dysrhythmias, shock; gradual decr = asymptomatic until bicarbonate is 15 mEq/L or less

Front 76

Metabolic ACIDosis

Back 76

Monitor potassium for hyper/hypo

Front 77

Metabolic ALKAlosis

Back 77

* High pH >7.45
•High bicarbonate >26 mEq/L
•Most due to vomiting, gastric suction, or LT diuretic use

Front 78

Metabolic ALKAlosis manifest

Back 78

*Hypokalemia lead to alkalosis
•Sx r/to decr calcium,
resp depression,
tachycardia, sx of hypokalemia

Front 79

Respiratory ACIDosis

Back 79

* Low pH <7.35
High Bicarb
• High PaCO2 > 42 mm Hg
•Always due to respiratory problem w defic. excretion of CO2

Front 80

Respiratory ALKAlosis

Back 80

* High pH >7.45
* Low HCO3
• Lower PaCO2 < 38 mm Hg
•Always due to hyperventilation
•Causes: anxiety, hypoxemia, gram negative bacteremia

Front 81

Respiratory ALKAlosis manifest

Back 81

Lightheadedness, inability to concentrate, numbness and tingling, sometimes loss of consciousness
•Correct cause of hyperventilation

Front 82

ABG level all normal

Back 82

pH 7.35 - 7.45
•PaCO2 35 - 45 mm Hg
•HCO3ˉ 22 - 26 mEq/L
•PaO2 80 to 100 mm Hg
•Oxygen saturation >94%

Front 83

ABG level of PaCO2

Back 83

35 - 45 mm Hg

PaCO2 (40)

Front 84

ABG level of HCO3-

Back 84

22 - 26 mEq/

HCO3- (24)

Front 85

ABG level of PaO2

Back 85

80 to 100 mm Hg

Front 86

Respiratory ACIDosis

Back 86

PH HCO3 Pa CO2

< 7.35 > = 26 > 45

D up = up

Front 87

Metabolic ACIDosis

Back 87

PH HCO3 Pa CO2

< 7.35 < 22 < = 35

D D D=

Front 88

Respiratory ALKAlosis

Back 88

PH HCO3 Pa CO2

> 7.45 < = 22 < 35

Up D = D

Front 89

Metabolic ALKalosis

Back 89

PH HCO3 Pa CO2

> 7.45 > 26 > = 45

Up up up =

Front 90

Imbalance chart

Back 90

pH HCO Paco2
*Resp acidosis D up = up
•Resp alkalosis up D = D
•Metabolic acidosis D D D =
•Metabolic alkalosis up up up =

Front 91

Creatinine

Back 91

end product of muscle metabolism. Better indicator of renal function than BUN bc does not vary with protein intake/metabolic state. Normal serum 0.7 to 1.4 mg/dL

Front 92

Hematacrit

Back 92

Volume percentage of RBC (erythrocytes) in whole blood and normally Male = 42% to 52%
Female 35% to 47%

Front 93

Increase Hematocrit

Back 93

dehydration and polycythemia,

Front 94

Decrease hematocrit

Back 94

overhydration and anemia.

Front 95

Urine sodium

Back 95

Normal urine sodium levels range from 75 to 200mEq/24 hours

Front 96

Urine sodium indicates

Back 96

hyponatremia and acute renal failure.

Front 97

Urine specimen sodium level

Back 97

more than 40 mEq/L of sodium in random specimen.

Front 98

Function of Kidney

Back 98

Regulation of ECF volume and osmolality by selective retention and excretion of body fluids

Front 99

BUN

Back 99

Amino acid breakdown = ammonia then converted to urea and expeled in urine.

Front 100

Normal BUN

Back 100

normal BUN is 10 to 20 mg/dL

Front 101

Factors that increase BUN

Back 101

decreased renal function,GI bleeding, dehydration, increased protein intake, fever, and sepsis.

Front 102

Factors that decrease BUN

Back 102

end-stage liver disease, a low-protein diet, starvation, expanded fluid volume (pregnancy)

Front 103

Urine Specific Gravity

Back 103

kidneys’ ability to excrete or conserve water. The specific gravity of urine is compared to weight of distilled water, which has a specific gravity of 1.000. The normal range of urine specific gravity is 1.010 to 1.025.

Front 104

Range of Urine Specific Gravity

Back 104

The normal range of urine specific gravity is 1.010 to 1.025

Front 105

Function of Kidney

Back 105

Regulation of normal electrolyte levels in the ECF by selective electrolyte retention and excretion •Regulation of pH of ECF by retention of hydrogen ions
•Excrete of metabolic wastes, toxic substances

Front 106

ALKALOSIS

Back 106

High PH
High bicarbonate
can be produced by a gain of bicarbonate or a loss of H+

Front 107

ACIDOSIS

Back 107

Low PH
Low Bicarbonate
a gain of hydrogen ion or a loss of bicarbonate

Front 108

Respiratory
Acidosis

Back 108

In resp acidosis, excess hydrogen is excreted in the urine in exchg for bicarbonate ions.

Front 109

Respiratory Alkalosis

Back 109

resp alkalo-sis, the renal excretion of bicarbonate increases, and hydrogen ions are retained

Front 110

Metabolic Acidosis

Back 110

In metabolic acidosis, the compensatory mechanisms increase the ventilation rate and the renal retention of bicarbonate.

Front 111

Metabolic Alkalosis

Back 111

In metabolic alkalosis, the respiratory system compensates by decreasing ventilation to conserve CO2 and increase the PaCO2

Front 112

D5W solution

Back 112

has Serum osmolality of 252 mOsm/L

Front 113

Normal saline

Back 113

Normal saline (0.9% sodium chloride) solution has a total osmolality of 308 mOsm/L.

Front 114

Electrolyte solutions:

Back 114

if the total electrolyte content (anions + cations)
ISOTONIC approx 310 mEq/L,

hyPOtonic content < 250 mEq/L,

hypertonic content > 375 mEq/L.

osmolality of plasma is ap-proximately 300 mOsm/L

Front 115

osmolality of plasma

Back 115

300 mOsm/L

Front 116

Respiratory acidosis.

Back 116

Chronic respiratory acidosis occurs with pulmonary diseases such as chronic emphysema and bronchitis, sleep apnea, and obesity.