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46 Cards in this Set

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  • Back
normal intake and output per day
2600 ml
TBW of physiologic person
amt in ECF
amt in ICF
49 L- total
14 L- ECF (20%)
35 L- ICF (50%)
what happens if the concentrations are not equal in each compartment
water rapidly moves to equilibrate by osmosis
of the ecf what percent is plasma, and ISF
plasma - 25%
ISF- 75%
what is the amt of elements within each compartment
composition
Normal composition of ECF for Na, K, HCO3, and CL
Na - 140-145
K 4.0-4.5
HCO3 - 27
Cl - 103
amt of water in each compartment
distribution
what does excess fluid in a compartment cause
edema
either ICF or ECF
What are the abnormalities in water balance (5)
simple water excess
simple water deficit
Isotonic salt water deficit
Isotonic salt water excess
salt water intoxication
What is hyponatremia or milliosmolar dilution syndrome
simple water excess- SIADH
the kidney reabsorbs huge amts of water with decrease urine flow- ECF expands- decrease concentration- water moves into ICF and decreases its concentration= dilution in both compartments
when is simple water excess most common and why
post op surgery pts.- end up secreting too much ADH
symptoms of simple water excess
headache (Increased ICP from cells swelling, can cause seizures)
increase BP
papilla edema
intracellular (fingerprint) edema
Lab findings in simple water excess
Scant amt of urine
Electrolytes in plasma are reduced (dilution)
can have acidosis from diluting bicarb
Treatment of simple water excess
stop fluid intake
treat with hypertonic solutions (.2 or .3 % NS)
draw fluid from ICF to ECF to decrease cell volume
What is hypernatremia or milliosmolar conc. syndrome
simple water deficit- occurs when loss of water exceeds loss of salt
what are common causes of simple water deficit
profuse sweating (sweat is hypotonic)
alcoholism (inhibits ADH, loose lots of water and dont take in much)
Hyperalimentation (causes fluid shift from ECF to intestines- diarrhea)
Diabetics (increased glucose- loose lots of water)
mechanism for simple water deficit
water lost first from ECF which increases concentration- then from ICF to equilibrate. causes intracellular dehydration
symptoms of simple water deficit
Thirst - if concious
if not dry and red membranes
failure to regulate body temp (will have fever from failure of internal thermostat malfunction)
lab findings in simple water deficit
UOP is decreased
Urine conc is increased
(S.G. > thant 1.025)
electrolytes increased in plasma
Treatment of simple water deficit
replenish water PO if possible
Treat with D5W
why do we use D5W when we want hypotonic fluid
liver will take up extra glucose and free water is what is left in the ECF
plain water will hemolyze RBCs
what is isotonic salt water deficit
loss of isotonic body fluids
causes of isotonic salt water deficit
vomiting
diarrhea
fistula (liver or pancreatic)
what is third space syndrome
ascites
mechanism of isotonic salt water deficit
isotonic volume loss from ECF
osmolar conc. remains the same in both ECF and ICF so no water moves
symptoms of isotonic salt water deficit
depression of CNS function (apathy, listless)
Hypothermia (malfunction of therm regulatory center
decrease in skin turgor
hypotension (decreased plasma volume)
lab findings in isotonic salt water deficit
nothing significant
may see slight decrease in K if vomiting
treatment of isotonic salt water deficit
Fluid is replaced with isotonic solutions (NS, LR, Ringers)
what does self treating with tea, sprite, ect... cause when you have fluid loss
worsen the problem - they are hypotonic and can lead to simple water excess on top of salt water deficit and cause HA from intracellular edema
What is isotonic salt water excess
gain of isotonic fluid
cause of isotonic salt water excess
CHF
renal failure
heart fails so GFR decreases causing salt and water retention- or kidney fails and dont filter right
mechanism of isotonic salt water excess
isotonic fluid accumulates in the ECF- no fluid shifts since conc are the same
symptoms of isotonic salt water excess
increased BP
Interstitial edema (pitting)
normal electrolytes
treatment of isotonic salt water excess
correct problem
diuretics to rid excess salt and water
cardiotonic agents (glycosides)
what is salt water intoxication
hyperosmotic intoxification (seawater)
mechanism of salt water intoxication
Expands ECF and superconsentrates it
Water moves from ICF to ECF to equilibrate so ECF volume becomes even more expanded but ICF becomes drastically reduced causing intracellular dehydration
Symptoms of salt water intoxication
Increased BP
Hyperthermia (main problem)
internal thermostat in hypothalamus fails causing irreversible hyperpyrexia and the proteins in the brain starts to coagulate
Treatment of salt water intoxication
lots of fluid- D5W
when will you most often see orthostatic hypotension
isotonic fluid loss
when is K loss at its greatest
with diarrhea and vomiting
urine output should be atleast what to excrete adequate amt of K- what happens if it drops below this
600 ml/day
less than 600 ml/day K will accumulate rapidly- esp in renal failure
symptoms of hypokalemia
muscle weakness
paralysis
some ECG changes
symptoms of hyperkalemia
increased T wave (6-8)
v-fib (9-10)
causes of hyperkalemia
renal failure
addisons disease (decrease aldosterone)
administering KCl
causes of hypokalemia
diuretics
vomiting
diarrhea
iv therapy with saline
where does K move during acidosis.......alkalosis
to ECF- acidosis (fluid excess)
to ICF- alkalosis (fluid deficit)