Shared Flashcard Set

Details

Unit 11 - Fluid and Electrolytes
Test 3
91
Nursing
Undergraduate 3
04/01/2014

Additional Nursing Flashcards

 


 

Cards

Term
What is the ICF?
Definition
Fluids within cells
~2/3 of total body water

28 L
Term
What is the ECF?
Definition
= Fluid outside of cells
~1/3 of total body water
Three divisions:
– Interstitial
– Intravascular
– Transcellular

14 L
Term
What are the cations?
Definition
Sodium, Potassium, Calcium, Magnesium
Term
What are the anions?
Definition
chloride, bicarbonate, sulfate
Term
What are electrolytes?
Definition
Compounds that separate into ions when they are dissolved in water
Term
What is isotonic?
Definition
A fluid with the same concentration of nonpermeant particles as normal blood is called isotonic. Isotonic solutions have the same osmolarity as blood, similar to normal saline (0.9% sodium chloride).
Term
What is hypotonic and hypertonic in comparison to blood?
Definition
A hypotonic solution is more dilute than blood, and a hypertonic solution is more concentrated than normal blood.
Term
What is hypotonic?
Definition
A hypotonic solution such as 0.45% sodium chloride moves fluids into cells, causing them to enlarge
Term
What is hypertonic?
Definition
A hypertonic solution such as 3% sodium chloride pulls fluid from cells, causing them to shrink.
Term
What is active transport?
Definition
Movement of ions against osmotic pressure to an area of higher pressure; requires energy
Term
What is diffusion?
Definition
Passive movement of electrolytes or other particles down the concentration gradient (from higher to lower concentration)
Term
What is osmosis?
Definition
Movement of water (or other solute) from an area of lesser to one of greater concentration
Term
What is filtration?
Definition
Movement across a membrane, under pressure, from higher to lower pressure
Term
What causes filtration?
Definition
Hydrostatic pressure is the force of the fluid pressing outward against a surface. In the process of filtration, hydrostatic pressure differences determine the movement of water. With increased hydrostatic pressure on the venous side of the capillary bed, edema will occur.
Term
What is osmotic pressure?
Definition
exerts osmotic pressure, an inward-pulling force caused by particles in the fluid.
Term
How does capillary filtration work?
Definition
At the arterial end of a normal capillary, capillary hydrostatic pressure is strongest, and fluid moves from the capillary into the interstitial area, bringing nutrients to cells. At the venous end, capillary hydrostatic pressure is weaker, and the colloid osmotic pressure of the blood is stronger. Thus fluid moves into the capillary at the venous end, removing waste products from cellular metabolism. Lymph vessels remove any extra fluid and proteins that have leaked into the interstitial fluid.
Term
What does fluid balance consist of?
Definition
Fluid intake and absorption
Fluid distribution
Fluid output
Term
What is fluid intake?
Definition
Drinking, eating, thirst and habit.
Term
How is fluid primarily obtained?
Definition
Fluid intake occurs orally through drinking but also through eating because most foods contain some water. Food metabolism creates additional water. Average fluid intake from these routes for healthy adults is about 2300 mL, although it varies widely. Other routes of fluid intake include IV, rectal (e.g., enemas), and irrigation of body cavities that can absorb fluid. Although you might think that the major regulator of oral fluid intake is thirst, habit and social reasons actually account for most fluid intake.
Term
What is thirst?
Definition
Thirst, the conscious desire for water, is an important regulator of fluid intake when plasma osmolality increases (osmoreceptor-mediated thirst) or blood volume decreases (baroreceptor-mediated thirst and angiotensin II– and III–mediated thirst).
Term
How does fluid distribution between ECF and intracellular compartments occur?
Definition
Osmosis
Term
How does fluid distribution between blood vessels and ECF occur?
Definition
Filtration
Term
Where is the thirst mechanism located?
Definition
Hypothalamus
Term
What causes the sensation of thirst?
Definition
- Increased plasma osmolality
- Decreased plasma volume
- Angiotensin II
- Angiotensin III
- Dry pharyngeal mucus membranes
- Psychological factors
Term
How is fluid normally output?
Definition
Normally via skin, lungs, GI tract, kidneys
Term
How is fluid abnormally output?
Definition
Abnormally via vomiting, wound drainage, hemorrhage
Term
What influences fluid output?
Definition
Antidiuretic hormone (ADH)
Renin-angiotensin-aldosterone system (RAAS)
Atrial natriuretic peptides (ANPs)
Term
What does ADH do?
Definition
ADH regulates the osmolality of body fluids by influencing how much water is excreted in urine
Term
What does RAAS do?
Definition
The RAAS regulates ECF volume by influencing how much sodium and water is excreted in urine.
Term
What does ANP do?
Definition
Atrial natriuretic peptide (ANP) also regulates ECF volume by influencing how much sodium and water is excreted in urine.
Term
Where is ADH released from?
Definition
Posterior pituitary
Term
Where is Aldosterone released from?
Definition
Adrenal cortex
Term
Where is ANP released from?
Definition
The heart
Term
What is ECVD?
Definition
Extracellular fluid volume (ECV) deficit
Hypovolemia means decreased vascular volume and often is used when discussing ECV deficit.
Term
What is ECFE?
Definition
Hypervolemia
Term
What does hypernatremia lead to?
Definition
Water deficit -> HYPERtonic
Term
What does hyponatremia lead to?
Definition
Water excess -> HYPOtonic
Term
What is clinical dehydration?
Definition
ECV deficit AND hypernatremia.
Term
Plasma concentrations of K+, Ca2+, Mg+, and phosphate (Pi) are very ____ compared with their concentrations in cells and bone.
Definition
Low
Term
How are electrolytes balanced?
Definition
-Intake & Absorption
-Distribution
-Output
Term
How is electrolyte output maintained?
Definition
Electrolyte output occurs through normal excretion in urine, feces, and sweat. Output also occurs through vomiting, drainage tubes, and fistulas. When electrolyte output increases, electrolyte intake must increase to maintain electrolyte balance. Similarly, if electrolyte output decreases, as with oliguria, electrolyte intake must also decrease to maintain balance.
Term
What is hypokalemia?
Definition
is abnormally low potassium concentration in the blood
Term
What causes hypokalemia?
Definition
. Common causes of hypokalemia from increased potassium output include diarrhea, repeated vomiting, and use of potassium-wasting diuretics
Term
What are the symptoms of hypokalemia?
Definition
Hypokalemia causes muscle weakness, which becomes life threatening if it includes respiratory muscles and potentially life-threatening cardiac dysrhythmias.
Term
What is hyperkalemia?
Definition
abnormally high potassium ion concentration in the blood.
Term
What causes hyperkalemia?
Definition
People who have oliguria (decreased urine output) are at high risk of hyperkalemia from the resultant decreased potassium output unless their potassium intake also decreases substantially
Term
What are the symptoms of hyperkalemia?
Definition
Hyperkalemia can cause muscle weakness, potentially life-threatening cardiac dysrhythmias, and cardiac arrest.
Term
What is hypocalcemia?
Definition
Hypocalcemia is abnormally low calcium concentration in the blood
Term
What causes hypocalcemia?
Definition
Factors that cause too much ionized calcium to shift to bound forms cause symptomatic ionized hypocalcemia. People who have acute pancreatitis frequently develop hypocalcemia because calcium binds to undigested fat in their feces and is excreted.
Term
What are the symptoms of hypocalcemia?
Definition
Hypocalcemia increases neuromuscular excitability, which is the basis for its signs and symptoms.
Term
What is hypercalcemia?
Definition
Hypercalcemia is abnormally high calcium concentration in the blood.
Term
What causes hypercalcemia?
Definition
shift of calcium from bones into the ECF, and decreased calcium output. Patients with cancer often develop hypercalcemia
Term
What are the symptoms of hypercalcemia?
Definition
Hypercalcemia decreases neuromuscular excitability, the basis for its other signs and symptoms, the most common of which is lethargy.
Term
What is hypo magnesemia?
Definition
abnormally low magnesium concentration in the blood
Term
What causes hypomagnesemia?
Definition
decreased magnesium intake and absorption, shift of plasma magnesium to its inactive bound form, and increased magnesium output
Term
What are the symptoms of hypomagnesemia?
Definition
Signs and symptoms are similar to those of hypocalcemia because hypomagnesemia also increases neuromuscular excitability.
Term
What is hypermagnesemia?
Definition
Abnormally high magnesium conc in the blood
Term
What causes hypermagnesemia?
Definition
End-stage renal disease causes hypermagnesemia unless the person decreases magnesium intake to match the decreased output
Term
What are the symptoms of hypermagnesemia?
Definition
Signs and symptoms are caused by decreased neuromuscular excitability, with lethargy and decreased deep tendon reflexes being most common.
Term
What do acids release?
Definition
H+
Term
What do bases accept?
Definition
The H+ that acids release
Term
What is the degree of acidity reported as?
Definition
pH
Term
What is the pH range of blood?
Definition
7.35-7.45
Term
What are the metabolic acids?
Definition
Lactic, citric
Term
What do the lungs excrete?
Definition
Carbonic acid
Term
What do the kidneys excrete?
Definition
Metabolic acids
Term
How does the lung excrete carbonic acid?
Definition
Breathing out
Term
How does the kidney excrete metabolic acids?
Definition
They secrete H+ into the renal tubular fluid, putting HCO3− back into the blood at the same time. If too many H+ ions are present in the blood, renal cells move more H+ ions into the renal tubules for excretion, retaining more HCO3− in the process. If too few H+ ions are present in the blood, renal cells secrete fewer H+ ions.
Term
The body’s fluid and electrolyte balance is maintained partially by hormonal regulation. You will express an understanding of this mechanism in which of the following statements?
Definition
D. The pituitary gland secretes antidiuretic hormones
Term
What does respiratory acidosis arise from?
Definition
Hypoventilation. The lungs are unable to secrete enough CO2 which causes a decrease in pH (more acidic)
Term
What does respiratory alkalosis arise from?
Definition
Arises from alveolar hyperventilation
Lungs excrete too much CO2
Deficit of carbonic acid in the blood increases pH.
Term
How do the kidneys compensate for respiratory acidosis?
Definition
. The kidneys compensate by increasing excretion of metabolic acids in the urine, which increases blood bicarbonate.
Term
How do they kidneys compensate for respiratory alkalosis?
Definition
They don't. There isn't enough time.
Term
WHat does metabolic acidosis arise from?
Definition
Arises from increase in metabolic acid or decrease in base (bicarbonate)
Kidneys unable to excrete enough metabolic acids, which accumulate in the blood
Results in decreased level of consciousness
Term
What does metabolic alkalosis arise from?
Definition
Arises from direct increase in base (bicarbonate) or decrease in metabolic acid
Results in increased blood bicarbonate
Term
How do the lungs compensate from metabolic acidosis?
Definition
Compensatory hyperventilation begins in a few minutes and removes carbonic acid from the body. This process does not correct the problem, but it helps limit the pH decrease
Term
How do the lungs compensate for metabolic alkalosis?
Definition
The respiratory compensation for metabolic alkalosis is hypoventilation. The decreased rate and depth of respiration allow carbonic acid to increase in the blood, as can be seen by an increased PaCO2.
Term
What should you consider when assessing for fluid balance?
Definition
Age: very young and old at risk
Environment: excessively hot?
Dietary intake: fluids, salt, foods rich in potassium, calcium, and magnesium
Lifestyle: alcohol intake history
Medications: include over-the-counter (OTC) and herbal, in addition to prescription medications
Term
What should you consider when assessing medical history for fluid imbalance?
Definition
Recent surgery (physiological stress)
Gastrointestinal output
Acute illness or trauma
Respiratory disorders
Burns
Trauma
Chronic illness
Cancer
Heart failure
Oliguric renal disease
Term
What should be looked at lab wise when considering fluid imbalance?
Definition
-Daily weight
-I&O
-Labs
Term
What nursing diagnoses are related to fluid/electrolyte/acid-base imbalance?
Definition
• Decreased cardiac output
Impaired oral mucous membrane
Impaired skin integrity
Risk for injury
Acute confusion
Risk for electrolyte imbalance
Deficient fluid volume
Deficient knowledge regarding disease management
Excess fluid volume
Ineffective tissue perfusion
Impaired gas exchange
Term
What do central lines do?
Definition
Central venous lines deliver intravenous fluid into the superior vena cava near the heart. (CVAD, Central venous access device.)
Term
What are IV solutions considered?
Definition
Crystalloids
Term
What is a VAD?
Definition
Vascular access devices (VADs) are catheters or infusion ports designed for repeated access to the vascular system. Peripheral catheters are for short-term use (e.g., fluid restoration after surgery and short-term antibiotic administration).
Term
What does hypotonic solution do to the body's cells?
Definition
Hypotonic solutions have an effective osmolality less than body fluids, thus decreasing osmolality by diluting body fluids and moving water into cells.
Term
What does hypertonic solution do to the body's cells?
Definition
Hypertonic solutions have an effective osmolality greater than body fluids. If they are hypertonic sodium-containing solutions, they increase osmolality rapidly and pull water out of cells, causing them to shrivel.
Term
What are the complications of IV therapy?
Definition
Fluid overload, infiltration, extravasation, phlebitis, local infection, bleeding at the infusion site
Term
What is blood component therapy?
Definition
IV administration of whole blood or blood component
Term
What is an autologous transfusion?
Definition
Autologous transfusion (autotransfusion) is the collection and reinfusion of a patient’s own blood. Blood for an autologous transfusion most commonly is obtained by preoperative donation up to 6 weeks before a scheduled surgery. Autologous transfusions are safer for patients because they decrease the risk of mismatched blood and exposure to bloodborne infectious agents.
Term
What 3 things should be verified before giving a blood transfusion?
Definition
that blood components delivered are the ones that were ordered; that blood delivered to the patient is compatible with the blood type listed in the medical record; and that the right patient receives the blood.
Term
What is a transfusion rxn?
Definition
A transfusion reaction is an immune system reaction to the transfusion that ranges from a mild response to severe anaphylactic shock or acute intravascular hemolysis, both of which are life threatening.
Supporting users have an ad free experience!