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Fluids OUTSIDE the cells is called ____________. The primary electrolyte is __________
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The space between The cells (aka) thirdspace
intersitial
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Fluid withing the blood vessels (veins, arteries and/or capillaries)
intravascular
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Fluid within the cell itself is called _______and the primary electrolyte is _________
- intercellular
- Potassium (K+)
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_______% of our body weight is made up of water.
_____% intercellular
_____% extracellular
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This transport consists of movement against concentraction. Ex: Na/K+ pump which requires ATP
Active transport
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Movement of FLUID across a semi-permeable membrane from an area of low concentration to an area of higher concentration
osmosis
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Movement of fluid thru a selectively permeable membrane from an area of higher hydrostatic pressure to an area of lower hydrostatic pressure
filtration
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Solute Movement from higher to lower concentraction..until concentration is equal in both.____________________
________requires no energy
________involves carrier that moves substances across a membrance faster
- diffusion
- passive
- facilitated
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Use of proteins (venous pulls F & E and waste) back into the capillary through the capillary walls
- colloid
- *need for protein (albumin)
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Normal Sodium level: ______ to ______
135 to 145
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HYPERnatremia levels _____________
Explain:
S/S:
Treatment:
- levels >135
- *>na intake or >water loss = serum osmolality to increase. Through osmosis...fluid moves from cells to ECF to balance osmolality..Then the CELLS become dehydrated causing Neurologic impairment & ECF in vessels increases cause hypervolemia*
- *S/S = restlessness, agitation, intense thirst, peripheral edema
- *Treatment = diuretics, 5% dextrose in water
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List some causes of HYPERnatremia
due to water deficit:
due to excessive Na+:
Water deficit: diabetes incipidus (excessive urination) fever, heat stroke, burns, V/D
Excessive Na+: overintake of Na, near drowning in salt water, cushings syndromf
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HYPOnatremia levels: __________
Explain:
S/S:
Treatment:
- Levels <135
- *Sodium loss or water gain....fluids by OSMOSIS FROM ECF move to a MORE concentrated ICF causing the cells to swell (cerebral edema) & blood vessel fluid to decrease (hypovolemia)
- S/S: Related to cellular swelling first..CNS...irritability, apprehension, confusion, seizures
- *Treatment=small amounts of hypertonic saline solution (3%NaCl) to pull fluid back into ECF from cells
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Normal Potassium levels = __________
3.5 - 5.0
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HYPERkalemia levels ____________
Explain:
S/S:
Treatment:
- levels >5.0
- *potassium levels increase or potassium excretion decreases (renal failure)...K+ shifts out of ICF into ECF. Pt develops neuromuscular & cardiac s/s.
- *s/s: irritability, anxiety, ab & lower extremity cramping, tall tented ECG waves
- *Treatment: >k+ elimination via diuretics, dialysis
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List some causes of HYPOnatremia
due to sodium loss:
due to water gain:
sodium loss: diuresis, diuretic use, V/D, gastric suctioning, burns, third-space fluid shifting, metabolic acidosis, excessive diaphoresis
water gain: heart or liver failure, nephrotic syndrom, excessive use of hypotonic fluids....renal failure
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HYPOkalemia levels: __________
Explain:
S/S:
Treatment:
- Levels <3.5
- *potassium intake decreases OR potassium loss increases.....potassium shifts from ECF to ICF...ICF potassium levels rise and cells can't function properly, muscular, GI & cardiac dysfuntions occur
- *S/S: fatique, muscle weakness, leg cramps
- *Treatment: potassium chloride supplements
- NOTE: KCI should be given at a rate not to exceed 10 - 20mEq/hr to prevent cardiac arrest.
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List some causes of hypokalemia:
- inadequate potassium intake
- potassium deficient IV fluids
- Excessive potassium output d/t
- *suction, lavage, V/D, severe diaphoresis
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Normal calcium levels:___________
9 - 11
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HYPERcalcemia levels:______________
Explain:
S/S:
Treatment:
- Levels <11
- Explain: Calcium REABSORPTION from bone increases, Ca enters ECF at increased rates that exceed kidneys ability to excrete therefore, calcium enters the cells and decreases cell membrane excitability affecting skeletal & cardiac muscles and the nervous system
- *S/S: fatigue, confusion, decreased LOC
- *Treatment: promote excretion through lasix, drink lots of fluid to promote renal excretion to <kidney stone formation
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List some causes of hypercalcemia:
- Cancer
- multiple fractures
- prolonged immobilization
- hypophosphatemia
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HYPOcalcemia levels: _________
Explain:
S/S:
Treatment:
- levels <9
- *calcium or vit. D intake or absorption decreases.....parathyroid releases PTH to draw calcium from bones & promote absorption from renal & intestines...BUT..lack of calcium outstrips comp mech & Ca is no longer available to maintain cell structure & function...pt develops neuromuscular & cardiac symptoms & decreased LOC
- *S/S: easy fatigability, depression, tingling in extremities & around mouth..TETANY; Trousseau's sign; Chvosteks sign
- *Treatment: IV calcium
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Any pt who has had a thyroid or neck surgery must be observed closely in the immediate post op period for manifestations of ___________ b/c of the proximity of the surgery to parathyroid glands
hypocalcemia
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Normal magnesium levels: __________
1.5 - 2.5
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HYPERmagnesemia levels: ________
Explain:
S/S:
Treatment:
- levels > 2.5
- *to much magnesium d/t a decrease in excretion or and increase in intake...supresses acetylcholine release and block neuromuscular transmission...reducing cell excitability...which causes neuromuscular & CNS to become depressed causing a decrease in LOC and respiratory distress. Arrhythmias & cardiac comps may occur
- *S/S: lethargy, drowsiness, n/v, loss of DTR, resp & cardiac arrest
- *Treatment: should focus on PREVENTION...ppl w/kidney disease should not take magnesium containing drugs. Calcium gluconate opposes affects of magnesium on cardiac muscle & promote excretion
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HYPOmagnesemia levels: ________
Explain:
S/S:
Treatment:
- levels: <1.5
- *magnesium intake/absorption decreases or magnesium loss increases....Mg moves out of cells into ECF to compensate...cells become Mg starved causing skeletal muscle weakness & nerves & muscles become hyperirritable
- *S/S: confusion, hyperactive DTR, tremors
- *treatment: oral supps/ foods high in Mg.
- ****note most often caused by fasting/starvation/chronic alcoholism
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Normal phosphate levels ____________
2.8 - 4.5
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HYPERphosphatemia levels _________
Expain:
s/S
Treatment:
- levels >4.5
- Explain: intake of PO4 is excessive OR renal insult or failure....kidneys can't filter excess phosphorus adequatly....shift from ICF to ECF...serum levels rise...binding with calcium, forming an insoluable compound which is deposited in lungs, heart, kidneys, eyes and skin
- *S/S: neuromuscular irritabilty & tetany (r/t hypocalcemia)
- *Treatment:restriction of foods high in phosphorus & calcium (dairy products)
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HYPOphosphatemia levels _________
Explain:
S/S
Treatment:
- levels: <2.8
- *PO4 absorption decreased, renal eliminaton increases, ECF to ICF movement.....ECF PO4 levels decrease, cellular energy stores decrease d/t ATP depletion....pt develops musculockeletal, neurologic, cardiac & hematologic effects
- *S/S: mild to moderate often asymptomatic Confusion mental changes
- *treatment oral supps w/foods high in phosphate (dairy products)
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Normal chloride levels: ___________-
95 - 105
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HYPERchloremia levels __________
Explain:
S/S
Treatment:
- levels >105
- *chloride intake, absorption increases or excretion decreases...to much chloride in ECF...bicarb levels fall & sodium levels rise..pt develops s/s of metabolic acidosis
- *S/S: arrhythmais, decreased LOC, dyspnea, kussmauls resp
- *treatment: treat underlying cause..maintain adequate hydration
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HYPOchloremia levels: ___________
Explain:
S/S
Treatment
- levels <95
- *chloride intake or absorption decreases...kidneys retain sodium & bicarb...bicarb accumulates in ECF raising PH...metabolic alkalosis can occur
- *S/S arrhythmais, seizures, coma, resp arrest
- *Treatment: treat underlying cause
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Name some signs you would expect to see with HYPERVOLEMIA:
- Fluid volume excess:
- pitting edema, bounding pulse, shift of interitial fluid to plasma, hypertension, SOB, crackles, confusion, irritabiltiy, sodium & Potassium deficit
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Name some signs seen with HYPOVOLEMIA:
fluid volume deficit: poor skin turgor, rapid, weak thready pulse, hypotension, shift of plasma to interstitial fluid, can cause sodium deficit
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Excess of isotonic fluid (water & sodium) in the extracellular compartment _________________
Treatment:
_________________
hypervolemia
Treatment: restrict pt sodium & fluid intake...admin diuretics
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Isotonic fluid loss - including the loss of fluids & solutes from EC space
______________________
Treatment:
hypovolemia
treatment: replace with isotonic fluids
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What are factors that can disrupt homeostasis
- increasing solute (diet)
- disease states that decreases absorption or excretion of substances
- certain drugs
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Anti-diuretic Hormone (ADH)
Made by:
Stored where:
Influenced by:
Acts on the:
- ADH is MADE by the hypothalamus and
- STORED in the pituitary gland. It is
- INFLUENCED directly by blood osmolality
- and ACTS on the renal collecting tubules to regulate reabsorption/elimination of water.
- Ex: if receptors indicate a high osmolality of Na, ADH is released and water is held on to and reabsorbed to balance out Na ratio to H20
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Aldosterone:
Released as part of the RAA mechanism
Acts on the _________
regulating _______ by increasing ____ uptake.
This ______ (increases or decreases) ECF resulting in ______(increase or decrease) of blood volume/pressure
- Distal convoluted tubules
- regulating water
- by holding onto water & sodium
- this increases ECF
- resulting in Increase in blood volume/pressure
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This is pronounced when the ratio 1:20 between acid and base content is altered
Acid-base imbalance
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Name some causes of RESPIRATORY ACIDOSIS:
- hypoventilation
- copd
- drug overdose (reducing resp function)
- chest wall abnormality
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In ___________ the pulmonary system can't rid the body of enough carbon dioxide to maintain a healthy pH balance
respiratory acidosis
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Treatment for respiratory acidosis:
- maintain a patent airway
- give a bronchodilator to open constricted airways
- admin supp H20
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pH <7.35
Paco2 >45
HC03 norm
respiratory acidosis
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pH>7.45
Paco2 <35
HCo3 norm
respiratory alkalosis
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Causes of respiratory alkalosis:
- hyperventilation
- pain
- anxiety
- fever
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ph <7.35
Paco normal
HCO3 <22
metabolic acidosis
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Causes of metabolic acidosis:
- diabetes mellitus
- starvation/malnutrition/alchoholism
- many others :)
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pH >7.45
Paco2 normal
HCO3 >26
metabolic alkalosis
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Causes of metabolic alkalosis
- hypokalemia
- excessive acid loss from GI tract
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Solutions on both sides of selective permeable membrance have established equilibrium
isotonic solution
Example:
-
a _______ solution has a lower solute concentration that another solution
hypotonic
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a _______ solution has a higher concentration of solute
hypertonic
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