Adult Health I
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| is responsible for the reduction of urine production | antidiuretic hormone
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| is released in response to decreased blood flow or decreased renal pressure and is sensed by receptors in the nephrons | renin
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| is produced by the adrenal cortex in response to stimulation by angiotensin II causing the tubules to excrete K+ while retaining Na2+, adding to the reabsorption of water back into the vascular system | aldosterone
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| body loses both water and electrolytes from the EFC | hypovolemia
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| water is lost from the body, but there is no loss of electrolytes | dehydration
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| what are 3 risk factors for dehydration? | hyperventilation, diabetic ketoacidosis, and enteral feeding without sufficient water intake
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| what are 6 risk factors for hypovolemia? | GI losses, skin losses, renal losses. third spacing (burns, ascites, obstruction), hemorrhage, and altered intake
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| hgb and hct are ____ during hypovolemia | LOW
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| hgb and hct are ____ during dehydration | HIGH
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| serum osmolarity, sp. gravity, serum sodium are all ___ during dehydration | HIGH
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| common vital signs for hypovolemia and dehydration are: | hyperthermia, tachycardia, thready pulse, hypotension, orthostatic hypotension, < central venous pressure
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| occurs when both water and sodium are retained in abnormally high proportions | hypervolemia
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| occurs when more water is gained than electrolytes | overhydration
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| risk factor for overhydration | water replacement without electrolyte replacement such as strenuous exercise with profuse diaphoresis
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| risk factors for hypervolemia | chronic stimulus to the kidney (heart failure, cirrhosis, glucocorticosteriods), abn renal function, fluid shifts (burns, hypertonic fluids), age-related changes, excessive sodium intake
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| hgb and hct are ___ with overhydration | LOW
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| serum osmolarity and serum sodium are ___ with overhydration | LOW
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| electrolytes, BUN, and creatinine are ___ with hypervolemia | HIGH
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| what are vital signs for overhydration and hypervolemia? | tachycardia, bounding pulse, HTN, tachypnea, > central venous pressure
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| what position is best for pt with overhydration or hypervolemia? | semi-fowler's
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| pt with pulmonary edema should be in what position? | fowler's
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| a pt with hypovolemic shock should be placed in what position? | on back with legs elevated
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| major electrolyte found in EFC | sodium
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| essential for the maintance of acid-base balance, active and passive transport mechanisms, and maintaining irritability and conduction of nerve and muscle tissue | sodium
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| normal sodium values | 135-145
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| is the major cation in ICF | potassium
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| plays vital role in cell metabolism, transmission of nerve impulses, functioning cardiac, lung, and muscle tissues, and acid-base balance | potassium
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| ___ has reciprocal action with sodium | potassium
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| normal potassium values | 3.5-5
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| normal calcium values | 8.5-10.5
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| normal magnesium values | 1.3-2.1
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| is a gain of water or the loss of sodium-rich fluids | hyponatremia
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| delays and slows the depolarization of membranes | hyponatremia
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| water moves from ECF into the ICF | hyponatremia
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| risk factors for hyponatremia | abn GI losses, renal losses, skin losses, > or normal ECF volume, edematous state (heart failure, cirrhosis), excessive hypotonic IV, age-related factors
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| vital signs of hyponatremia | hypothermia, tachycardia, thready pulse, hypotension, orthostatic hypotension
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| is a serious electrolyte inbalance and can cause significant neurological, endocrine, and cardiac disturbances | hypernatremia
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| cells are dehydrated with ___ | hypernatremia
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| risk factors for hypernatremia | water deprivation, excessive Na intake, excessive Na retention, fluid losses, age-related changes
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| vital signs of hypernatremia | hyperthermia, tachycardia, orthostatic hypotension
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| is the result of increased loss of K from the body ot movement of K into the cells | hypokalemia
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| risk factors for hypokalemia | < K thru GI losses, renal losses, skin losses, <intake, ICF shift, age-related factors
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| with hypokalemia the body is in a ____ state | alkalosis state
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| vital signs for hypokalemia | hyperthermia, weak irregular pulse, hypotension, resp distress
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| NEVER PUSH ____ IV | potassium
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| phlebitis | tissue irritant
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| is the result of > intake of K, movement of K out of the cells, or inadequate renal excretion | hyperkalemia
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| risk factors for hyperkalemia | ECF shift (< insulin, acidosis, fever, surgery, sepsis), < excretion (renal failure, dehydration, NSAIDS), age-related factors
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| with hyperkalemia the body is in a ____ state | acidosis
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| vital signs for hyperkalemia | slow, irregular pulse, hypotension
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| foods with potassium | avocado, broccoli, dairy, dried fruit, cantaloupe, bananas
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| risk factors for hypocalcemia | malaborption (chrons disease), end-stage renal disease, post thyroidectomy
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| + chvostek's sign and + trousseau's sign | hypocalcemia and hypomagnesmia
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| vital signs for hypocalcemia | < heart rate, hypotension, dysrhythemia
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| what food has high calcium and magnesium? | dairy and dark green veggies
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| risk factors for hypomagnesmia | malnutrition, alcohol ingestion
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| greater concentration of H+ ions the more ____ the body fluids are with a ___ pH | acidic, LOW
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| lesser concentration of H+ ions the more ____ the body fluids are with a ___ pH | alkaline, HIGHER
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| occurs when the body attempts to correct changes and imbalances in pH levels | compensation
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| occurs when pH returns to normal | full compensation
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| pH is not able to normalize | partial compensation
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| risk factors for respiratory acidosis | resp. depression, inadequate chest expansion, airway obstruction, alveolar-capillary blockage, inadequate mechanical ventilation
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| risk factors for respiratory alkalosis | hyperventilation and hypoxemia
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| risk factors for metabolic acidosis | excess production of H+ (DKA, stravation, heavy exercise, seizures, fever, hypoxia), inadequate elimination of H+ions (renal failure), inadequate production of bicarb (renal failure, pancreatitis, liver failure, dehyration), and excess elim of bicarb
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| risk factors for metabolic alkalosis | base excess, acid def (loss of GI secretions from vomiting or suction and K+ depletion due to diuetics, laxatives, cushings syndrome)
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| vital signs and cardiovascular for resp acidosis | tachycardia and tachypnea, dysrthmias
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| vital signs and cardiovascular for resp alkalosis | tachypnea, palpitations, chest pain, dysrhytmias
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| vital signs and cardiovascular for metabolic acidosis | bradycardia, tachypnea, hypotension, dysrhymias
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| vital signs and cardiovascular for metabolic alkalosis | tachycardia, hypotension,dysrhytmias
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| what are common neurological s/s for resp alkalosis | tetany and convulsions
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| what are common neurological s/s for metabolic alkalosis | tetany and muscle weakness
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| impaired gas exchange or ineffective breathing pattern | respiratory acidosis/alkalosis
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| decreased cardiac OP related to dysrhythmias | metabolic acidosis/alkalosis
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| what is a med that puts older adults at risk for hyperkalemia? | lisinopril (prinivil)
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| normal ionized Ca values | 4.5-5.5
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| normal bicarb (HCO3-) values | 22-26
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| normal CO2 values | 35-45
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| normal base (blood buffer) that exists | + or - 2
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| normal range for PaO2 | 80-100
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| normal O2 sats | 95-100%
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| normal Chloride values | 95-105
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| normal Magnesium values | 1.5-2.5
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| normal Phosphate (PO43-) | 2.8-4.5
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| normal serum osmolality values | 275-295
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| movement of solvent across semipermeable membrane from an area of LOWER concentration to an area of HIGHER concentration | osmosis
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| membrane allows solvent in, but not the solute so there is a fluid shift | osmosis
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| movement of solute in a solution across semipermeable membrane from an area of HIGHER concentration to an area of LOWER concentration | diffusion
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| during diffusion, what effects the movement? | size, concentration, and temp of solution
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| process by which water and diffusible substances move together across a membrane in repsonse to fluid pressure, and area of HIGHER pressure to an area of LOWER pressure | filtration
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| example of filtration? | edema
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| requires metabolic activity and expenditure of energy to move substances across cell membranes | active transport
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| average adult fluid intake | 2200-2700 mL daily
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| where is the antidiuretic hormone stored? | posterior pituitary gland
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| when is the antidiuretic hormone released? | response to changes in blood osmolarity
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| makes renal tubules and collecting ducts more permeable to H2O | antidiuretic hormone
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| what initiates the renin-sngiotensin-aldosterone mechanism? | renal perfusion
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| proteoltic enzyme that responds to decrease renal perfusion secondary to decrease ECF volume | renin
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| what produces angiotension I? | renin
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| what happens when angiotension I turns into angiotension II? | massive vasoconstriction of vessels and relocates and increases blood flow to kidneys to improve perfusion
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| what releases aldosterone and why? | adrenal cortex in response to increase plasma K+ levels ot when helping counteract hypovolema
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| helps maintain vascular tone? | atrial natriuretic peptide
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| where and why is atrial natriuretic peptide secreted? | from atrial cells of heart in response to atrial stretching and an increase in circulating blood vloume
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| average adult fluid loss daily | 2200-2700
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| where are most fluids lost? | kidneys (then lungs, skin, GI)
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| essential for enzyme activities, neurochemical activites, and cardiac and skeletal muscles | magnesium
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| where is 50-60% of Mg found? | bone
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| nescessary for glycogen deposits in liver and muscles, transmission and conduction of nerve impulses | potassium
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| substance or group of substances that can absorb or release H+ to correct acid-base balance | buffer
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| regulated by lungs | CO2
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| regulated by kidneys | HCO3
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| normal pH range | 7.35-7.45
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| what are the 3 acid-base regulators? | chemical, biological, and physiological regulations
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| largest chemical buffer in ECF | carbonic acid and bicarb buffer system
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| when CO2 increases ___ increases | H+ ions
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| when H+ ions increase ____ increasees | CO2
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| what are 2 physiological regulators? | lungs and kidneys
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| pH is ____ during hyperventalation | < 35
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| pH is ____ during hypoventalation | > 45
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| when bicarb is < 22 _____ | metabolic acidosis
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| when bicard is > 26 _____ | metabolic alkalosis
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| metabolic ALKALOSIS takes place when pH _____, PaCO2 ______, PaO2 ______, O2 sats _______, HCO3- ____,ionized Ca _____, and K+ _____ | pH- >7.45-----------PaCO2- norm or >45---------PaO2-norm----------O2 sats-norm------------HCO3---->26-------ionized Ca+----<4.5------------K+- <3.5
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| metabolic ACIDOSIS takes place when pH _____, PaCO2 _____, PaO2 _____, O2 sats _____, HCO3 _____, K+ ______ | pH- <7.35--------PaCO2- norm or <35------PaO2- norm--------O2 sats- norm-----HCO3- <22------K+- >5
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| respiratory ALKALOSIS takes place when pH _____, PaCo2 ____, PaO2 ____, O2 sats ____, HCO3- _____, ionized Ca+ ______, K+ _____ | pH- >7.45------PaCO2- <35-----PaO2-norm-----O2 sats- norm------HCO3- <22----ion Ca+- <4.5-----K+- <3.5
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| respiratory ACIDOSIS takes place when pH _____, PaCO2 _____, PaO2 ____, O2 sats ____, HCO3- ____, K+ _____ | pH- <7.35------PaCO2- >45--------O2 PaO2- norm or <80----sats- norm or <95%-------HCO3- norm or >26-----K+- >5.0
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| aldoserone holds in ___ | Na (sodium)
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| polydipsia | excessive thrist (ex:DM)
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| hormone that prevents from going to BR | antidiuretic hormone
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| diabetes insipidis | go, go, go prob with antidiuretic hormone
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| disorder that holds in too much fluid b/c if inappropriate amount of antidiruetic hormone | SIADH (syndrome of inappropriate ADH)
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