1. What factors can affect homeostasis?
    " Oxygenation, body temperature digestive processes, nutrients, respiration, and medications "
  2. When you have a fever what happens in your body?
    "vasodilation (decreased blood pressure), sweating (Na+ and water loss), evaporation, increase cellular metabolism (increased 13% for every degree Celsius), increased heart rate and respiration rate to meet demands for nutrients and oxygen (and increase respiration rate leads to increased flow of loss), if additional oxygen demand is not met will lead to a hypoxia, increased and products of cellular metabolism "
  3. What are the functions of water in the body?
    " Transport and exchange O2, CO2, nutrients ways; medium metabolic reactions; regulate body temperature through evaporation and perspiration; body structure and shock absorber; insulation; lubricant "
  4. Insensible loss
    " Through the longs skin and feces (can increase significantly and exercise, high environmental temperatures, illnesses that increase respiration, perspiration, GI losses or diarrhea "
  5. Cations
    Positively charged sodium (Na+) & magnesium (Mg2+)
  6. anions
    " Negatively charged, chloride (Cl-) & phosphate (HPO4 2-) "
  7. Function of electrolytes
    " Water balance, acid-base balance, enzyme reactions, neuromuscular activity "
  8. Milliequivalents
    One mEq Of one element has same chemical activity as one mEq of another based on how many Grams are needed to liberate or combine with 1 g of H+
  9. ICF
    " Within cells, 40% total body weight "
  10. ECF
    " Outside cell, 20% total body weight consists of intrstital, Intravascular, Transcellular (urine, digestive secretions, perspiration, cerebrospinal, pleural, synovial, intraocular, gondal, Pericardial) "
  11. Specific electrolytes in ICF
    " K+, Mg2+, PO4 2+ (Phosphate) , Glucose, Oxygen; Potassium is the major cation And phosphate is the major anion "
  12. Specific electrolytes in ECF
    " Na+ (High concentration sodium essential to regulate fluid volume), Cl-, HCO3- (Bicarbonate) , K+ (low in ECF); Sodium is the major cation and bicarbonate is the major anion "
  13. Sodium-potassium (Na-K) pump
    Regulates cell volume and provides potassium and sodium ion gradients for resting membrane potential
  14. allogeneic (homologous) transfusion
    one person to another person
  15. colloids
    "glutinous substances, particles submerged in solvent cannot form true solution, molecules do not dissolve – suspended"
  16. crystalloids
    "solutes, when placed in solvent homogeneously mix, dissolve & cannot distinguish from resultant solution"
  17. Hydrating solutions
    "infusions that supplement caloric intake, supply nutrients, provide free water for maintenance, rehydration & improving output"
  18. Body Fluid Regulation
    "Regulatory mechanisms affect volume, distribution and composition body (thirst, kidneys, Renin-Angiotensin-Aldosterone System, Antidiuretic Hormone, Atrial Natriuretic Peptide)"
  19. Thirst
    "Primary regulator water intake; Thirst center (brain) stimulated (Blood volume drops (water loss), Serum osmolality increases (solute concentration)); Highly effective regulating Na+ level (Increase Na+ stimulates thirst center, Increase fluid intake decreases Na+ concentration, Decrease Na+ inhibits thirst center)"
  20. Kidneys
    Regulate fluid & electrolyte balance; Control excretion water & electrolytes; Filter 170 L plasma/day; Reabsorb 99 %; Only about 1500 mL urine in 24 hours
  21. Renin-Angiotensin-Aldosterone System
    "Decrease blood flow/blood pressure(BP) to kidneys, stimulates nephron to produce Renin (enzyme); Renin converts Angiotensinogen (plasma protein) into Angiotensin I; Angiotensin I travels to lungs – converted into Angiotensin II by Angiotensin-Converting Enzyme (ACE); Angiotensin II – potent vasoconstrictor (Increases BP; Stimulates thirst mechanism, Acts on kidneys to retain water & Na+, Stimulates Adrenal Cortex to release Aldosterone); increase Promotes Na+ & water retention in distal nephron; Restores blood volume"
  22. Antidiuretic Hormone (ADH)
    "Released by posterior pituitary; Regulate water excretion from kidneys; Osmoreceptor – hypothalamus respond to: (Increased serum osmolality, Decrease blood volume, Stimulate ADH release); Acts on distal tubules kidney (More permeable to water, Increased water reabsorption, Decreased urine output); Blood volume restored; *also released in response to stress, pain, surgery, anesthesia, morphine, barbiturates, mechanical ventilation"
  23. Atrial Natriuretic Peptide (ANP)
    "Released by atrial muscle cells in response to distention; Inhibits Renin secretion, blocking Aldosterone secretion; Promotes Na+ wasting & diuresis; Causes vasodilation "
  24. Changes in the older adult
    % of total body water lower; Lean muscle mass lower; % body fat higher; Water decrease to 50% total body weight (TBW) in males; water decrease to 45% TBW in females; Sodium regulation less efficient; Renal blood flow & glomerular filtration decreased; Kidneys less able to concentrate urine and conserve Na+ & water; Perception of thirst decreased (interfering with thirst mechanism); Aging effects temperature regulation; Fear of incontinence (self-limiting fluid intake); Physical disabilities limit access to fluids; Cognitive impairment interfere with recognition thirst & ability to respond
  25. Sodium Imbalance
    "Most abundant cation in extracellular fluids; Dietary requirements: 500 -2400 mg/day; Important in water balance, nerve impulse transmission, regulation of acid-base, cellular chemical reactions; 135-145 mEq/L; Cerebral cells are very sensitive to changes in sodium levels; Regulated by dietary intake and kidney excretion; Posterior pituitary and adrenal gland also help regulate sodium levels; Aldosterone and cortisone increase serum sodium by increasing tubular absorption; ADH (antidiuretic hormone) increases sodium and water reabsorption; Frequently accompanied by decreased chloride levels"
  26. Potassium
    "Principle cation in intracellular fluid; 3.5 – 5.0 mEq/L, small changes can have profound effects; Kidneys eliminate K, do not conserve with decreased intake, must consume 2-20 grams daily; H+ and K+ shift back and forth between ICF and ECF to maintain pH; Maintains action potentials in excitable cells of muscles, neurons and other tissues; Assists in controlling cardiac rate and rhythm, conduction of nerve impulses, skeletal muscle contractions and smooth muscle and endocrine function TOO MUCH OR TOO LITTLE K CAN RESULT IN CARDIAC ARREST; Regulation of protein and glycogen synthesis; Helps regulate ICF osmolarity and fluid volume; Sodium-potassium pump (3 Na ions from cell for 2 K ions that return, fueled by ATP breakdown)"
  27. Calcium
    "Normal serum concentrations 8.5 – 10.5 mg/dL, ionized calcium 4.0 – 6.0 mg/dL; Major cation, found mostly in hard part of bones, kept constant by calcium pump"
  28. "Evaluate calcium and albumin together because changes in protein level can cause changes in calcium level; 3 forms in body: 45% bound to albumin, 40% ionized, 15% bound to phosphate, citrate or carbonate; Some calcium in blood is bound to proteins (usually about ½ the total in the blood); Decrease of 1 gram of Albumin means total Calcium is 0.8 mg less , because it is the ionized calcium that is more active, albumin associated lows do not cause symptoms"""
  29. Functions of calcium
    "Enzyme activation; Skeletal and cardiac muscle relaxation, activation, excitation and contraction; Calming effect on nerve cells; Impulse transmission; Role in blood clotting (esp. conversion of prothrombin to thrombin; Helps with acid-base balance; Firmness and rigidity to teeth and bones"
  30. Calcium System interaction
    "Parathyroid hormone (PTH) raises plasma calcium level by promoting transfer from bones; Calcium is dependent on calcitriol (active form of vitamin D) by promoting absorption and making calcium and phosphate available for new bone formation; Calcitonin - Ca lowering hormone secreted by thyroid, opposite effect of PTH, transfers calcium into bones thereby decreasing serum levels; Calcium interferes with the absorption of iron; Calcium has inverse/reciprocal relationship with phosphorus"
  31. magnesemium
    "Second most abundant cation, absorbed in small intestine; 1.4 – 2.1 mEq/L; Major role in >300 enzyme reactions; Powers sodium-potassium pump; Converts ATP to ADP; Transmits electrical impulses across nerves and muscles; Maintains normal heart rhythm; Fights tooth decay by binding calcium to tooth enamel; Relaxes lungs to open airways and relaxes other smooth muscles by blocking acetylcholine"
  32. phosphorus
    "2.5 – 4.5 mg/dL, levels greater infants & children, level varies throughout day; Most exists PO4- in body; 2nd most abundant mineral, 85% combined with calcium teeth & bones, 14% ICF; Reciprocal balance with calcium, assists to regulate calcium; Essential function of muscles, RBCs, nervous system, involved in metabolism macronutrients; Teeth & bone formation; Role renal regulation of acids/bases – phosphate buffer system; Cell membrane integrity – phospholipids; Excreted kidneys, kidneys can conserve when needed; Found red & organ meats, fish, poultry, eggs, milk, milk products. legumes, whole grains & nuts"
  33. Typical adult fluid gain in 24 hr
    Oral fluid intake 1200 ml; Water in food 1000 ml; Water as by-product food metabolism 300 ml
  34. Typical adult fluid loss in 24 hr
    Urine 1500 ml; Feces 200 ml; Perspiration 300 ml; Respirations 500 ml
  35. Causes of Hyponatremia
    "Hypervolemia; Na losses: GI, renal, diuretics, sweating; Kidney disease; Adrenal insufficiency; Psychogenic polydipsia; Inappropriate ADH (SIADH); CHF, cirrhosis, Hyperglycemia"
  36. Hyponatremia S&S
    "headache, apprehension, lethargy, tachycardia, postural hypotension, dizziness, cramping, N&V, diarrhea, anorexia,, convulsions, muscular weakness, coma"
  37. Hyponatremia LABS
    sodium < 135 mEq/L; serum osmolarity < 275; urine specific gravity < 1.010
  38. serum osmolarity
    275 - 295
  39. urine specific gravity
    1.010 - 1.030
  40. Hypernatremia S&S
    "thirst, dry, flushed skin, dry and sticky tongue & mucous membranes, watery diarrhea, muscle twitching tachycardia, hypertension, decreased cardiac contractility, fever, agitation, convulsions, restlessness & irritability"
  41. Hypernatremia LABS
    sodium > 145 mEq/L; serum osmolarity > 295; urine specific gravity 1.030
  42. Causes of Hypernatremia
    Ingestion large amt of salt; Hypertonic solutions; Excess aldosterone secretion; Diabetes insipidus; Increased sensible & insensible water loss; Water deprivation
  43. Medications that can decrease sodium levels
    "Diuretics; Lithium; Antineoplastic agents; Pschotropic medications; Elavil, mellaril & others; Antidiabetic agents; CNS depressants; Morphine, barbiturates; Motrin"
  44. "Nicotine; Oxytocin"""
  45. Medications that can increase sodium levels
    Corticosteroids; Hypertonic saline solutions; Sodium bicarbonate; Antibiotics; Amphotericin B; Demeclocycline; Lactulose; Darvon
  46. Management of Hyponatremia
    "Replacement; increase sodium foods, salt tablets; Possibly water restriction if euvolemic; LR or NS if hypovolemic; Isotonic solutions for irrig; Possibly 3% hypertonic saline for acute episode; loop diuretics, salt & fluid restrictions, dialysis as dictated by condition; Monitor labs, I/O, wts; Monitor for confusion lethargy, seizures; Safety; Assess muscle strength and DTR"
  47. Management of Hypernatremia
    "Decrease sodium intake; Fluid replacemnt; Promote sodium excretion; Monitor labs, I/O. wt; Monitor CNS/neurological changes: agitation, hallucinations, seizures; Safety; Restore balance; Keep clocks, calendar, familiar objects at bedside to aid orientation; "
  48. Hypokalemia S&S
    "CHANGES CONDUCTION RATE, weak thready pulse, ECG changes (ST depression, Flat T, ventricular dysrhythmias, PVCs), decreased peristalsis (silent ileus), vertigo, decreased breath sounds, dyspnea, polyuria, anxiety, lethargy, leg cramps, N&V, constipation, confusion, muscular weakness & malaise"
  49. Hypokalemia nursing interventions
    "Monitor vitals esp. BP, lab values, heart rate & rhythm, EKG changes, resp rate, depth & pattern, safety, replacement, check metabolic acidosis, I/O "
  50. Causes of Hypokalemia
    "poor intake, potassium wasting diuretics, excessive GI loss (eg. Diarrhea, laxative abuse), diaphoresis, starvation, high glucose, increased secretion aldosterone (adenomas, cirrhosis, nephrosis, CHF & hypertensive crisis), diabetes insipidus, anorexia / bulemia, burns, trauma, surgery"
  51. Hyperkalemia S&S
    "CAUSES IRRITABILIITY, tachycardia changing to irregular slow heart rate, decreased BP, EKG changes (tall T, wide QRS, frequent ectopy, v fib, standstill), muscle weakness, paralysis, twitching, GI hypermotility, abdominal cramping, diarrhea, irritability, anxiety, oliguria"
  52. Hyperkalemia nursing interventions
    "Decrease intake, monitor labs, assess signs & symptoms, monitor heart, EKG, fresh PRBC if blood needed, compliance therapeutic regimen, discontinue KCL in IV, safety"
  53. Causes of Hyperkalemia
    "excessive intake, decreased excretion due to renal failure, adrenal insufficiency, K sparing diuretics, massive tissue trauma, metabolic acidosis, GI bleed, Digoxin use, overdose, insulin deficiency"
  54. Medications that can decrease K levels
    "Corticosteroids; Levodopa; Amphotericin B; Gentamicin; Penicillin, Ampicillin, piperacillin; Alpha adrenergic blockers; Albuterol; Estrogen; K wasting diuretics"
  55. Medications that can increase K levels
    "KCL; K penicillin; ACE inhibiotrs; Cozaar; Beta blockers; Digoxin; Heparin; Low molecular weigh heparin; NSAIDS Barbiturates, sedative, narcotics, amphetamines; K sparing diuretics"
  56. Foods high in potassium
    "Apricots, Avacodos, Bananas, Cantaloupe, Dates, Oranges, Raisons, Carrots, Cauliflower, Mushrooms, Peas, Potatoes (unsoaked), Spinach, Tomatoes, V8 juice, Beef, chicken, liver, lobster, pork loin, tuna+, turkey, salmon, kidney"
  57. "Buttermilk, chocolate and white milk, Evaporated milk, Low fat yogurt"""
  58. hypocalcemia S&S
    "Irritability, apprehension, anxiety, confusion, depression, memory impairment, hallucinations, convulsions; hypotension, decreased myocardial contractility, pulse rate & rhythm changes, cardiac arrest; Respiratory arrest, laryngospasm, bronchialspasms; Oliguria; increased bleeding & bruising, abnormal clotting mechanisms; seizures, tetany, hyperactive deep tendon reflexes, positive Chvostek’s sign, positive Trousseau’s sign; abdominal cramps, hyperactive bowel sounds; paresthesias, tingling in hands & feet, frequent painful muscle spasms at night"
  59. hypocalcemia treatments
    "Treatment aimed restoring normal levels, preventing complications & treating underlying problems; Calcium gluconate 10% solution / Calcium chloride 10% as ordered; Daily oral calcium; Vit D supplements; Phosphate binding antacids; Thiazide diuretics decrease urinary excretion; Monitor labs, EKG, neuro, resp & cardiac status; Monitor magnesium, potassium; Monitor endocrine function & evaluate PTH; Safety"
  60. Causes of hypocalcemia
    "Hypoparathyroidism, hypomagnesemia, alkalotic states, multiple blood transfusion, medications, hypoalbuminemia, acute pancreatitis, hyperphospatemia, vit D deficiency, malabsorption, renal disease, alcoholism, gram-negative sepsis, medullary thyroid carcinoma, & burns"
  61. Risk factors for hypocalcemia
    "post menopausal, post-thyroidectomy, parathyroidectomy, Crohn’s, poor absorption GI, fractures, immobility, osteoporosis / osteopenia, poor calcium & vit D intake, resp alkalosis (Ca binds with becarb)"
  62. hypercalcemia S&S
    "hypertension, depressed ST segment, dysrhythmias; headache, confusion, impaired memory, bizarre behaviors, lethargy, coma, psychosis; hypotonic bowel sounds, constipation, N&V, abd pain, polyuria, polydipsia, renal colic, bone fractures, bone thinning, fatigue, anorexia, deep bone pain"
  63. hypercalcemia treatments
    "Decrease calcium intake; Loop diuretics - increase excretion; Encourage fluids 3-4 liter/day, esp high ash such as cranberry or prune; IV NS 300-500 ml/hr up to 6 liters;Coricosteroids decrease absorption; Parathyroidectomy; Monitor calcium & phosphorus levels; Daily wts, strict I/O; Monitor EKG, neuro status; Possibly dialysis; Highly fatal – 50%"
  64. Causes of hypercalcemia
    "Hyperparathyroidism, metastatic cancer, thiazide diuretics, sarcoidosis, immobility, hypophosphatemia, hyperthyroidism, renal tubular acidosis, milk-alkali syndrome, familial hypcalcuric hypercalcemia, lithium, vit D intoxication"
  65. Risk factors for hypercalcemia
    "cancer / metastasis, post-parathyroidectomy, immoblity, excessive calcium intake, excessive antacids"
  66. Hypomagesemia S&S
    "Muscle twitching, tremors, hyperreactive reflexes, laryngeal stridor, convulsions, tetany, positive Chvostek’s sign can occur; SVT, PVC, VF, increased risk dig toxicity"
  67. "Mood changes, depression, confusion; N&V, diarrhea, anorexia"""
  68. Hypomagesemia management
    "Replacement therapy; IV or IM Magnesium sulfate, oral magnesium salts, dietary intervention; Monitor magnesium levels, along with other electrolytes, neuromuscular function, GI function, bowel sounds, cardiovascular function, EKG"
  69. Causes of Hypomagesemia
    "alcoholism, prolonged IV therapy without supplementation, inflammatory bowel disease, resection, GI cancer, chronic pancreatitis, or some meds (gentamicin, cisplatin, lasix, edecrine), hyeraldosteronism, & diabetes"
  70. Hypermagesemia S&S
    "depressed neuromuscular activity, hypotension, bradycardia, arrhythmias, flushing, warm sensation, cardiac arrest, elevated T, CNS depression, somnolence, weakness & lethargy, respiratory depression"
  71. Hypermagesemia management
    "Decrease intake, stop magnesium containing agents, stop IV infusion; Diuretics to promote excretion; Monitor cardiac, resp, neuro status; Correct underlying ketoacidosis, rehydration; Emergency treatment - IV calcium gluconate 10% to antagonize effect of magnesium – counter cardiac & resp. effect; Dialysis in clients with renal failure"
  72. Causes of Hypermagesemia
    "decreased renal excretion (âoutput or renal failure); increased intake – Mg containing antacids, cathartics, enemas, TPN, hemodialysis solution)"
  73. Risk factors for Hypermagesemia
    "untreated diabetic keoacidosis, adrenal insufficiency, Magnesium treatment, lithium ingestion"
  74. Chloride
    "Major extracellular anion, 95-108 mEq/L, closely associated serum sodium levels & acid-base balance; Help maintain cellular integrity- balance between ICF & ECF; With H ion plays important role digestion - HCL, regulates pH stomach & helps digestion protein; Helps Ca & Mg in nerve transmission, muscle contraction & relaxation"
  75. Hypochloremia S&S
    "slow, shallow respirations; hypotension, muscle tremors and twitching; Decreases usually accompanied by decrease sodium & potassium"
  76. Hypochloremia management
    "Replacement - dietary, IVF if needed; Careful monitoring I/O, labs, vitals - esp. BP, ABG"
  77. Risk factors for Hypochloremia
    "hyponatremia, hypokalemia, COPD, DM, acute infection, vomiting, GI losses, metabolic stress, Addison’s disease, nephropathy, anorexia, CHF, cirrhosis"
  78. Hyperchloremia S&S
    "weakness, lethargy, CNS damage; deep, rapid breathing; cardiac abnormalities, increased aldosterone, FVD, diabetes insipidis, hyperparathyroidism, hypothyroidism, malnutrition, ARF, cystic fibrosis, G6 PD deficiency"
  79. Hyperchloremia management
    "Decrease intake chloride; Promote excretion with diuretics; Correct dehydration; Dietary changes; Monitor closely, treat diseases"
  80. Risk factors for Hyperchloremia
    "hypernatremia, metabolic acidosis, meds that promote chloride retention, diuretics, FVD (dehydration), GI losses, renal tubular acidosis or ARF"
  81. Hypophosphatemia S&S
    "anemia, bruising, bleeding, slurred speech, confusion, seizures, muscle weakness, spasms, tremors, tetany, paresthesias, chest pain, dysrhythmias, heart failure, alkalosis, respiratory muscle fatigue, hypoactive bowel sounds, anorexia, dysphagia, vomiting"
  82. Hypophosphatemia management
    "Replacement – oral supplements or IV; Avoid phosphorus binding antacids; Monitor for & treat underlying conditions; Monitor labs - fluid & associated electrolyte imbalances; Monitor S&S disorientation; Seizure precautions, airway available; Monitor for increase BP, HR & temp; I/O, diet log"
  83. Risk factors for Hypophosphatemia
    "severe malnourishment, decreased intestinal absorption / losses, diabetic ketoacidosis, alcoholism, poor intake, TPN with inadequate phorphorus, increased renal excretion, hyperparathyroidism, hypomagnesemia, hypokalemia, thiazide therapy, renal tubular disorders, polyuria, diuretic phase of acute tubular necrosis, ECF expansion, severe burns, respiratory alkalosis, hypercalcemia"
  84. Causes of Hypophosphatemia
    "transient shift phosphorus into cells - acidosis, increased release PTH, mobilization of calcium, increased renal excretion, increased insulin release - moves glucose & phosphorus into cells"
  85. Hyperphosphatemia S&S
    "most signs relate to hypocalcemia, Metastatic Calcification – oliguria, corneal haziness, conjunctivitis, irreg HR, depostition of calcium-phospate in cardiac tissues, tetany, numbness and tingling, anorexia, N&V, muscle weakness, hyperreflexia"
  86. Hyperphosphatemia management
    Decrease or eliminate intake; Eliminate meds containing phosphorus; Promote excretion – GI & renal; Renal dialysis for CRF clients; Maintain fluid volume – keep hydrated; Monitor labs & S&S; Monitor renal function carefully; Limit Calcium supplements & products; I/O
  87. Risk factors for Hyperphosphatemia
    "renal failure, hypocalcemia, chemotherapy, hypoparathyroidism, prolonged or massive administration of vit D, antacids, heparin, tetracycline, pituitary extract & salicylates, excess growth hormone, excessive intake, decreased urinary loss, massive blood transfusions, hyperthyroidism, hyperparathyroidsim, lg milk intake for peptic ulcers"
  88. Causes of Hyperphosphatemia
    "Phosphate shifts from cells to ECF, acidosis, leukemia, lymphoma, rhabdomyolysis, cellular destruction"
Card Set