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If H+ is secreted in the distal tubule of nephrons...What (+) ion is no longer secreted there in exchange for Na+?
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What is secreted to correct Acidosis?
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F&E Q & A Cards
fluid and electrolytes question and answer cards
| Question | Answer |
|---|---|
| If H+ is secreted in the distal tubule of nephrons...What (+) ion is no longer secreted there in exchange for Na+? | K+; because the electrical balance will be upset if both K+ & H+ are secreted |
| What is secreted to correct Acidosis? | Acidosis equals excess H+'s, therefore, H+ is secreted to correct Acidosis. |
| In Alkalosis which (+) ion would you expect the kidney to secrete? | K+ |
| Which ion is usually reabsorbed with Na+ to maintain electrical balance? | Cl- |
| In which condition would you expect HCO3- (bicarbonate) to be retained in place of Cl-? | Acidosis |
| Why would the body reabsorb Cl- instead of HCO3- (bicarbonate) in the nephron? | ...to correct Alkalosis by releasing HCO3-'s (bicarbs). |
| What do the kidney's regulate? | The kidneys control both H+ & HCO3-, in order to regulate free H+'s. |
| How do the kidneys ↓ H+'s (Hydrogens)? | ...secretes more H+'s (& less K+); ...reabsorbs more HCO3-'s (& less Cl-'s); ...Note: Excess HCO3- (bicarbonate) binds to free H+ ↓'ing it. |
| What does Hyperventilation always cause? | Alkalosis; Note: anytime breathing & CO2 exchange are the cause...the origin of the imbalance is respiratory. |
| How might hypoxemia such as that with pneumonia result in respiratory alkalosis? | O2 deficits stimulate ↑'d ventilation. |
| When hopoxemia stimulates breathing why is CO2 depleted causing alkalois? | CO2 leaves the body more easily than O2 enters. |
| What is the cause of CNS symptoms such as lightheadedness, faintness, dizziness, and blurred visioin in respiratory alkalosis? | ↓ Ca++; b/c it ↑'s the permeability of nerve membranes. |
| Neuromuscular symptoms of respiratory alkalosis such as tingling & numbness of lips and fingers, muscle cramps, and carpopedal spasms are most directly caused by? | HYPOCALCEMIA |
| How does breathing into a paper bag help alleviate respiratory alkalosis? | ...helps to REBREATHE CO2 that would otherwise be eliminated by the hyperventilation. |
| How does the kidney help correct Alkalosis? | It retains H+'s and eliminates HCO3-'s (bicarbonates)...but is a very slow process. |
| When interpreting ABG's which value should you consider 1st? pH, paCO2, or HCO3- | pH; ... to identify Alkalosis or Acidosis. |
| When interpreting ABG's which value should you consider 2nd? pH, PaCO2, or HCO3- | PaCO2;... a low value would cause alkalosis confirming that the respiratory system is the cause. |
| In uncompensated Respiratory Alkalosis; What would you expect the blood gases to be? | ↑ pH; ↓ pCO2; and a normal HCO3- |
| Why would you expect the HCO3- to be within normal limits in uncompensated respiratory alkalosis? | Because the kidneys take hours to days to respond. |
| In partially compensated Respiratory Alkalosis; What would you expect the ABG's to be? | all values will be abnormal: ↑ pH (but should be returning more to normal); ↓ pCO2; and ↓ HCO3- |
| In fully compensated Respiratory Alkalosis; What would you expect the ABG's to be? | pH = normal; ↓ pCO2; and ↓ HCO3- ... Note: if the pH is still high it indicates a continued respiratory problem. A low CO2 shows the respiratory source & the extremely low HCO3- illustrates a strong kidney compensation. |
| In the partially compensated respiratory alkalosis condition ...Why is the pH not as high as before? | b/c the kidneys are elimiinating more HCO3-...note: The respiratory problem is still present so the CO2 remains low. The pH is returning toward normal but only b/c HCO3- is ↓'ing. |
| Hypoventilation always causes? | Respiratory Acidosis. |
| What are some causes of Hypoventilation(respiratory depression)? | Anesthesia; Pain & rib injury; infection (↓'s gas exchange); Premature lungs (can't ventilate properly) |
| What are symptoms of Respiratory Acidosis? | HA, Confusion, drowsiness or unconsciousness (lack of response to verbal or painful stimuli) |
| What is the cause of CNS symptoms in respiratory Acidosis? | ↑'d blood flow to the brain |
| What would you expect the Neuromuscular symptoms of respiratory acidosis such as ↓'d DTR's & warm flushed skin to be most directly caused by....? | ↑'d H+ = ↑'d Ca++ |
| Why is it important to monitor heart and kidneys with respiratory acidosis; (↑'d H+'s = ↑'d Ca++)? | b/c acidosis causes cellular shifts of K+ and renal secretion of H+ |
| How would you expect the kidneys to compensate for respiratory acidosis? | Retaining HCO3- & secreating H+; ...The PCO2 stays high since the problem remains; ...The pH is heading toward normal b/c of the kidney's compensation; and...The High HCO3- on the ABG reflects the kidney's compensation |
| What ABG indicates a respiratory source? | PCO2 |
| What ABG indicates a non-respiratory source (a metabolic problem)? | HCO3-'s |
| When respiratory depression is chronic,...What is the major stimulus to breathe? | Low O2;...therefore, you nust be careful with supplemental O2 b/c you may actually depress the drive to breathe. |
| What would you predict the pH to be in chronic respiratory acidosis? | pH becomes or returns to near normal range; the ABG allows you to recognize the stress to acid-base balance that is not reflected in the near normal pH;.. |
| CNS, NM & Cardiac symptoms are usually absent with a near normal pH in chronic respiratory acidosis. ...What signs & symptoms remain? | Respiratory distress |
| Who is least likely to suffer a fluid vol., electrolyte, or acid-base imbalance? An infant suffering from gastroenteritis for 3 days; An elderly pt. with a type I decubitus; or Adults with impaired cardiac function or Clients who are confused | An elderly pt. with a type I decubitus; |
| An elderly pt was hydrated with LR in the ED for the last hour. During the most recent evaluation of the pt by the RN, a finding of rapid bounding pulse and SOB were noted. Reporting this episode to the MD, the RN suspects that the pt now shows signs of: | Hypervolemia; Isotonic solns, such as NS & LR, initially remain in the vascular compartment, expanding vascular vol. Isotonic imbalances occur when water and electrolytes are lost or gained in equal proportions, and serum osmolality remains constant. |
| A client taking lasix for CHF is seeing the MD for a K+ value of 3.0. An order for oral K+ taken daily is written. In addition, K+ rich foods should be eaten. All of the following are K+ rich except: Baked potato, White bread, Apricot, or Orange juice | White bread; White bread is known to help meet fiber needs for the body. Potassium is found in many fruits, vegetables, meat, and fish. |
| Edema that forms in clients with kidney disease is due to: | Increased capillary hydrostatic pressure. |
| A pt suffering a narcotic OD is seen in the ED. The client is confused, with warm, flushed skin, headache, and weakness. VS are T 102.6, HR 128, R 24, and BP 130/86. ABG's are as follows: pH 7.33, PaCO2 53, PaO2 72, HCO3 24. This client is at risk for: | Respiratory acidosis; b/c Narcotic OD causes more carbonic acid levels to rise b/c of hypoventilation and carbon dioxode retention. |
| Measurements related to fluid balance of clients that a nurse can initiate without a physician's order include: | Daily weights, vital signs, and fluid intake and output |
| The results of an arterial blood gas are as follows: pH: 7.5, PaCO2: 50, PaO2: 88, HCO3: 28; Base excess: +5. Evaluate the acid-base imbalance. | Metabolic alkalosis; ABG's evaluate acid-base bal. & O2. pH measures relative acidity or alkalinity. PaCO2: measures carbon dioxide. PaO2 is the P exerted by O2, HCO3: measures metabolic component of acid-base bal. Base excess= value of HCO3-'s. |
| What are the Anions in the body? | Chloride (Cl-); Bicarbonate (HCO3-); Phosphate(PO4-); Sulfate (SO3-) |
| Colloid Osmotic or Oncotic Pressure Proteins in the blood plasma exert pressure on the vascular walls to control or prevent the release of fluid from the vascular space. Evaluating Edema... | 1+ barely detectible; 2+ 2-4mm; 3+ 5-7mm; 4+ more than 7mm |
| Filtration changes in a capillary bed Arterial pressure is higher..nutrients flow out Venous pressure is lower..wastes come in. What moves fluid out of the capillaries into the interstitial fluid? | Hydrostatic (blood) pressure and Osmotic (interstitial) pressure: |
| What are the clinical signs of Hypochloremia? | Hypochloremia-related to loss from GI tractcauses muscle twitching, tetany and tremors |
| Isotonic Fluid Volume Imbalances: Fluid Volume Deficit/Hypovolemia Losses can occur from? | GI tract, wound drainage, kidneys, decreased fluid intake, bleeding or third spacing. |
| What are Solutes? | aka electrolytes; crystalloid(like salt) or colloid(like protein); sodium is a solute |
| In evaluating dietary choices of a client on a potassium-restricted diet, which dietary selection indicates the need for further teaching? A. 2 slices whole wheat bread; B. 2 boiled eggs; C. ½ cup raisins; D. 1 cup oatmeal | C. ½ cup raisins |
| What are the clinical findings of Hypomagnesemia: serum level below 1.5mEq/L | serum level below 1.5mEq/L; Seizures; Tetany; Anorexia/arrhythmias; Rapid Heart Rate; Vomiting; Emotional Liability; Deep tendon reflexes increased |
| What are Isotonic IV fluids and what is their Job when administered? Isotonic means that the IV fluid has Osmolality the same as body fluids | 0.9%NS, Lactated Ringers; Stay in vascular compartment and expand vascular volume. |
| What is Third Space Syndrome? | Fluid moves from vasc. space into ECF; get an isotonic FVD. Fluid may move to bowel, peritoneal or pleural space or ICF as edema. Pt may not have visible fl loss & fluid may shift back into vasc compartment causing FVE. Pt’s wt will probably be unchanged. |
| In administering a hypertonic fluid to a client, the nurse recognizes that this will cause fluid to move from: | Interstitial space to intravascular space |
| What is Intravascular Fluid and where is it found? | Found in the vascular compartment. |
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