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ch40fluidelectrolyt
Ch 40fluids electrolytes & acid base imbalance
| Question | Answer |
|---|---|
| What are fluid sources | Ingested liquids, food and by product of metabolism; Liquids provides largest amount |
| What regulates fluid intake | Thirst mechanism in the hypothalamus which is stimulated by intracellular dehydration and decreased blood volume. |
| What is avg fluid intake | 2600mL per day (1300 from ingested water, 1000 from food, 300 from metabolic processes |
| What is sensible fluid loss | Loss that can be measured |
| What is insensible fluid loss | Loss that can’t be measured |
| What is avg fluid output | 2500-2900mL |
| What is the electrolyte sodium (Na+) | Chief electrolyte in ECF |
| What is function of Na+ | Controls & regulates ECF volume; participates in muscle contraction & nerve impulse transmission, helps regulate acid/base balance as sodium bicarbonate; enters thru GI and exits thru GI tract, kidneys & skin |
| What is the electrolyte Potassium (K+) | Major cation in ICF. If something wrong with potassium something wrong with Mg. |
| What is function of K+ | role in transmission of electrical impulses in nerve, heart, skeletal,lung tissue, protein/carb metabolism & cell building;reg of acid/base bal. thru diet (veggies, beans, whole grains, meat, milk) and lost via kidneys, stool, sweat & GI secretions |
| What is the electrolyte Calcium (Ca) | Most abundant electrolyte; 99% stored in bones 1% inside cells |
| What is function of Ca | Major role in transmitting nerve impulses; regulates muscle contraction/relaxation, role in blood coagulation, activates enzymes that stimulate essential chemical reactions |
| What is the electrolyte Magnesium (mg) | Second most abundant in ICF cation |
| What is function of Mg | Metabolism of carbs/proteins; neuromuscular function, CV system to produce vasodilation; Enters body thru GI tract found in green leafy veggies, nuts, seafood, whole grains, cocoa, beans. Lost in urine (loop diuretic use) |
| Which releases H+ ions and which accepts H= ions | Carbonic acid releases H+ ions and bicarbonate accepts H+ ions (lower the Ph, the higher level of free H+ ions; Ph is an expression of H+ ion concentration) |
| What are the three Chemical Buffer systems | Chemical/respiratory/Kidney (kidney slowest to respond but lasts longer) |
| What are some functions Chemical buffers | 1st line of defense; bicarb in both ICF &ECF controls small fluctuations & responds immediately; Proteins found in ICF (hemoglobin) & ECF (albumin/globulin) |
| What is ratio of Bicarbonate to Carbonic acid | 20:1 ratio of normal bicarb to carbonic acid ratio |
| The narrow range of pH is achieved through what homeostatic mechanisms | Respiratory, renal mechanisms and chemical buffer systems |
| What are 3 buffer systems in the body | Carbonic acid-bicarb buffer system, Phosphate buffer system, Protein buffer system |
| How does breathing control amt of free hydrogens | Breathing controls amt of free hydrogen by controlling amt of C02 in blood; rapid response |
| What part in the brain controls respiratory rate | Medulla controls respiratory rate in response to C02 level |
| Nursing intervention for imbalances | treat symptoms |
| True or false: Acid-donates H+ and base accepts H+ | True |
| Explain what pH measures | Ph measure of body’s free H+ level & increases or decreases depending on amount of base or acid |
| What is hypovolemia | Fluid volume deficit (FVD) (loss of isotonic fluid); Fluid moves from ICF to ECF or third space shift dehydrating cells. |
| Who is at risk for FVD | Young children, elderly and ill people |
| What percentage of body weight lost can be caused by FVD | 5% in adults and 10% in infants; 8% is severe, 15% is life threatening |
| What is hypervolemia | Fluid Volume Excess (FVE); increased pressure from retained Na+ & water fluid is pulled from cells |
| What are common causes of Hypervolemia | Kidney malfunction, heart failure |
| What is Edema | Excessive ECF fluid moves into interstitial spaces or intravascular spaces |
| What are the ratings of Edema | 1+ pitting – slight 2mm , 2+ pitting deeper after pressing 4mm, 3+ pitting deep 6mm pit remains several seconds, 4+ pitting deep pit 8mm for long time, Brawny edema fluid can no longer be displaced, no pitting, palpates as hard/firm skin shiny warm moist |
| What causes Hyponatremia | Vomiting/diarrhea, Fistulas, sweating, diuretic use |
| What is S/S of Hyponatremia | Nausea & vomiting, Confusion, Muscle Cramps, Muscle twitching, Hypotension, Edema, Dry skin |
| What causes Hypernatremia | Water deprivation, increased sensible or insensible loss (hyperventilation or burns), too much salt in diet, and excessive parenteral administration of Na containing fluids, profuse sweating, and Diabetes insipidus |
| What is S/S of Hypernatremia | Neurological impairment (damage to cells of CNS), Restlessness, weakness, Disorientation, hallucination |
| What Causes Hypokalemia | Diarrhea, vomiting, Gastric suction, Gastric suction, Alkalosis, Steroid or antibiotics, Poor intake (anorexia nervosa or alcoholism |
| What is S/S of Hypokalemia | Shallow respirations, Irritability, Confusion, drowsiness, fatigue, thready pulse, Cardiac dysrhythmias, decreased intestinal motility, N/V |
| What Causes Hyperkalemia | Decreased K excretion, renal failure, Potassium sparing diuretics, Shift in K out of cells (acidosis, trauma) |
| What is S/S of Hyperkalemia | Muscle twitches-cramps-paresthesias, Irritability & anxiety, Decreased BP, EKG changes, Dysrhythmias, Abdominal cramping, diarrhea |
| What causes Hypocalcemia | Inadequate Ca intake Malabsorption, Excessive Ca loss, Vit D deficiency, Acute pancreatitis, Alkalotic states |
| What is S/S of Hypocalcemia | Trousseau’s or chovstek’s sign, Numbness/tingling in fingers/toes, tetany, Muscle Cramps |
| What causes Hypercalcemia | Cancer, Hyperparathyroidism |
| What is S/S of Hypercalcemia | N/V, Constipation, Bone pain, Excess urination, Thirst, Confusion, lethargy & slurred speech |
| What causes Hypomagnesemia | Nasogastric suction, Diarrhea, Alcohol withdrawal, Tube/parenteral feedings, Sepsis or burns |
| What is S/S of Hypomagnesemia | Hyperactive DTR, Muscle weakness, Tremors, Tetany, Seizures, Heart block, Change in mental status, Respiratory paralysis |
| What causes Hypermagnesemia | Renal failure or excessive magnesium intake (antacids or laxatives) |
| What is S/S of Hypermagnesemia | N/V, Loss of DTR, Respiratory depression, Cardiac arrest, Coma, Weakness, Flushing, Lethargy |
| What is Respiratory Acidosis | Excess of Carbonic Acid; produced by inadequate excretion of CO2; resp acidosis = high PaCO2 (ie opposite low PH # and high CO2) Hypoventilation |
| What is Respiratory Alkalosis | Deficit of Carbonic Acid; hyperventilation; increased elimination of CO2; resp alkalosis = low CO2 (ie opposite: high PH and low CO2) |
| What is Metabolic Acidosis | Metabolic/non respiratory disturbance; metabolic acidosis = low PH & low HCO3 |
| What is Metabolic Alkalosis | High PH and high plasma HCO3 |
| What is range for pH | 7.35-7.45 |
| What is range for PCO2 | 35-45mmHg |
| What is range for HCO3 | 22-26mEq/L |
| What is acronym for remembering Acid base balance | ROME: Respiratory Opposite, Metabolic Equal. |
| True or false - Pulse volume is decreased in FVD and increased in FVE | True |
| What conditions have hyperactive DTR | Hypocalcemia, hypomagnesemia, hypernatremia and alkalosis |
| What conditions have hypoactive DTR | Hypercalcemia, hypermagnesemia, hyponatremia, hypokalemia & acidosis |
| What are guidelines for weighing patient | Same scale, weigh at same time, ensure pt is wearing similar clothing, bed scale if pt unable to stand |
| In taking nursing history, what are some risk factors for Imbalances | Acute or chronic illness, abnormal losses of body fluid, burns, trauma, therapies or drugs that might disrupt balances |
| What is done during physical assessment | Fluid intake/output, daily weights |
| Review pg 1439 sample nanda diagnoses | |
| With Older adults what types of things occur that increase their risk for imbalances | Decreased sense of thirst, medical conditions, loss of nephrons, decreased renal blood flow |
| What are some nursing strategies for older people to prevent imbalances | Ensure oral intake is at least 1500 mL/24hrs, offer fluid at regular intervals, replace as needed, provide assistance or assistive devices for fluid intake, record accurate intake/output, lab values, urine appearance/gravity |
| REVIEW PG 1442-1443 FOR Na+, K+, Ca, Mg | |
| What do you see in respiratory Acidosis | Rapid shallow breathing, decreased BP w/vasodilation, Dyspnea, headache, hyperkalemia, dysrhythmias, disorientation, drowsiness, muscle weakness, hyperreflexia |
| What do you see in respiratory Alkalosis | Seizures, rapid deep breathing, hyperventilation, tachycardia, BP low or normal, hypokalemia, numb or tingling in extremities, N/V, confusion or lethargy |
Created by:
rivabard
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