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Extracellular body fluids

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Is the fluid outside the cell (interstitial, intravascular, and transcellular fluid)

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Intracellular body fluids

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Comprises all fluid within the cells of the body (42% of body weight)

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Cations

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Positively charged electrolytes (sodium, potassium, and calcium)

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Anions

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Negatively charged electrolytes (chloride, bicarbonate, and sulfate)

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meg/L

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Represents the number of grams of the specific electrolyte dissolved in a liter of plasma

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Solute

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Is an electrolyte; oxygen, carbon dioxide, glucose, and proteins

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Osmosis

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Involves the movement of a pure solvent across a semipermeable membrane from an area of lesser solute concentration to an area of greater solute concentration

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Osmols

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The concentration of a solution is measured in osmols, which reflects the amount of a substance in the form of molecules, ions, or both

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Osmotic pressure

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Is the drawing power of water and depends on the number of molecules in solution

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Osmolality

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The osmotic pressure of a solution

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Osmolarity

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Another term that describes the concentration of solution

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Isotonic solution

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The solutions on both sides of the semipermeable membrane are equal in concentration (expand the body's fluid volume without causing a fluid shift from one compartment to another).

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Hypertonic solution

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A solution of higher osmotic pressure (pulls fluid from cells, causing them to shrink)

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Hypotonic solution

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A solution of lower osmotic pressure (moves fluids into the cells, causing them to enlarge)

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Diffusion

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Random movement of a solute in a solution across a semipermeable membrane from an area of higher concentration to an area of lower concentration

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Concentration gradient

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The difference between two concentrations

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Filtration

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Is the process by which water and diffusible substances move together across a membrane, in response to fluid pressure, moving from an area of higher pressure to one of lower pressure

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Active transport

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Requires metabolic activity and expenditure of energy to move substances across the cell membrane

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Three ways that body fluids are regulated

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a. Fluid intake b. Hormonal controls c. Fluid output

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Osmoreceptors

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Continually monitor the serum osmotic pressure

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Hypovolemia

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Excess fluid is lost

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Dehydration

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Risk for clients who are unable to perceive or respond to the thirst mechanism

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Antidiuretic hormone

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Is stored in the pituitary gland and is released in response to changes in the blood osmolarity

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Angiotension I

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Causes vasoconstriction

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Angiotension II

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Causes massive selective vasoconstriction of blood vessels and relocates blood flow to kidneys and stimulates the release of aldosterone (when the sodium is low)

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Aldosterone

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Adrenal cortex releases in response to increased plasma potassium levels

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atrial natriuetic peptide

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Plays a critical role in the balance of fluid and electrolytes and the maintenance of vascular tone

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Four organs of water loss

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a. Kidneys b. Skin c. Lungs d. Gastrointestinal tract

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Insensible water loss

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Is continuous and occurs through the skin and lungs, not perceived by the person

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Sensible water loss

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Occurs through excess perspiration and can be perceived by the client

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Values of Sodium

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135-145 mEq/L

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Values of Potassium

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3.5-5.0 mEq/L

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Values of Calcium

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4.5-5.5 mg/dL

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Values of Magnesium

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1.5-2.5 mEq/L

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Values of Chloride

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95-105 mEq/L

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Values of Bicarbonate

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22-26 (arterial) mEq/L 24-30 (venous) mEq/L

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Values of Phosphate

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2.8-4.5 mg/dL

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Function of Sodium

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Major contributor to maintain water balance

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Function of Potassium

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Is necessary for glycogen deposits in the liver and skeletal muscle, transmission and conduction of nerve impulses, normal cardiac conduction, and skeletal and smooth muscle contraction

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Function of Calcium

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Bone and teeth formation, blood clotting, hormone secretion, cell membrane integrity, cardiac conduction, transmission of nerve impulses, and muscle contraction

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Function of Magnesium

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Essential for enzyme activities, neurochemical activities, and cardiac and skeletal muscle excitability

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Function of Chloride

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Chloride is the major anion in extracellular fluid (ECF). The transport of _______ follows sodium.

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Function of Bicarbonate

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The ________ ion is an essential component of the carbonic acid-bicarbonate buffering system essential to acid-base balance.

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Function of Phosphate

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It assists in acid-base regulation. ______ and calcium help to develop and maintain bones and teeth. ________ also promotes normal neuromuscular action and participates in carbohydrate metabolism.

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Regulatory Mechanism of Sodium

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Dietary intake and aldosterone secretion

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Regulatory Mechanism of Potassium

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Dietary intake and renal excretion regulate this

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Regulatory Mechanism of Calcium

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Absorbed from intestine, excreted by the kidneys and reabsorbed or deposited in bone Regulated by parathyroid hormone, vitamin D, and calcitonin

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Regulatory Mechanism of Magnesium

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regulated by dietary intake, renal mechanisms, and actions of the parathyroid hormone (PTH).

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Regulatory Mechanism of Chloride

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regulated by dietary intake and the kidneys

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Regulatory Mechanism of Bicarbonate

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The kidneys regulate this

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Regulatory Mechanism of Phosphate

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normally absorbed through the gastrointestinal (GI) tract. It is regulated by dietary intake, renal excretion, intestinal absorption, and PTH

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Three types of acid-base regulators in the body

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a. Chemical b. Biological c. Physiological buffering

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Hyponatremia Lab Finding

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Serum sodium level below 135 mEq/L, serum osmolality 280 mOsm/kg, and urine specific gravity below 1.010 (if not caused by syndrome of inappropriate antidiuretic hormone [SIADH])

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Hyponatremia Signs and Symptoms

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Apprehension, personality change, postural hypotension, postural dizziness, abdominal cramping, nausea and vomiting, diarrhea, tachycardia, dry mucous membranes, convulsions, and coma

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Hypernatremia Lab Finding

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Serum sodium levels above 145 mEq/L, serum osmolality 300 mOsm/kg, and urine specific gravity 1.030 (if not caused by diabetes insipidus

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Hypernatremia Signs and Symptoms

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Extreme thirst, dry and flushed skin, dry and sticky tongue and mucous membranes, postural hypotension, fever, agitation, convulsions, restlessness, and irritability

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Hypokalemia Lab Finding

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Serum potassium level below 3.5 mEq/L and electrocardiogram (ECG) abnormalities: flattened T wave; ST segment depression; U wave; potentiated digoxin effects (e.g., ventricular dysrhythmias)

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Hypokalemia Signs and Symptoms

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Weakness and fatigue, muscle weakness, nausea and vomiting, intestinal distention, decreased bowel sounds, decreased deep tendon reflexes, ventricular dysrhythmias, paresthesias, and weak, irregular pulse

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Hyperkalemia Lab Finding

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Serum potassium level above 5.0 mEq/L and ECG abnormalities: peaked T wave and widened QRS complex (bradycardia, heart block, dysrhythmias); eventually QRS pattern widens and cardiac arrest occurs

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Hyperkalemia Signs and Symptoms

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Anxiety, dysrhythmias, paresthesia, weakness, abdominal cramps, and diarrhea

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Hypocalcemia Lab Finding

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Serum ionized calcium level below 4.5 mEq/L or total serum calcium below 8.5 mg/dL and ECG abnormalities: ventricular tachycardia

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Hypocalcemia Signs and Symptoms

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Numbness and tingling of fingers and circumoral (around mouth) region, hyperactive reflexes, positive Trousseau's sign (carpopedal spasm with hypoxia), positive Chvostek's sign (contraction of facial muscles when facial nerve is tapped), tetany, muscle cramps, and pathological fractures (chronic hypocalcemia)

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Hypercalcemia Lab Finding

answer

Serum ionized calcium level above 5.5 mEq/L or total serum calcium level above 10.5 mg/dL; x-ray examination showing generalized osteoporosis, widespread bone cavitation, radiopaque urinary stones; and elevated blood urea nitrogen (BUN) level 25 mg/100 mL and elevated creatinine level 1.5 mg/100 mL caused by fluid volume deficit (FVD) or renal damage caused by urolithiasis; ECG abnormalities: heart block

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Hypercalcemia Signs and Symptoms

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Anorexia, nausea and vomiting, weakness, hypoactive reflexes, lethargy, flank pain (from kidney stones), decreased level of consciousness, personality changes, and cardiac arrest

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Hypomagnesemia Lab Finding

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Serum magnesium level below 1.5 mEq/L

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Hypomagnesemia Signs and Symptoms

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Muscular tremors, hyperactive deep tendon reflexes, confusion and disorientation, tachycardia, hypertension, dysrhythmias, and positive Chvostek's sign and Trousseau's sign

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Hypermagnesemia Lab Finding

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Serum magnesium level above 2.5 mEq/L; ECG abnormalities: prolonged QT interval, AV block

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Hypermagnesemia Signs and Symptoms

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Acute elevations in magnesium levels: hypoactive deep tendon reflexes, decreased depth and rate of respirations, hypotension, and flushing

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pH

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Measures the hydrogen ion concentration in the body fluids (7.35 to 7.45)

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PaCO2

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Is the partial pressure of carbon dioxide in arterial blood (35 to 45 mm Hg)

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PaO2

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Is the partial pressure of oxygen in the blood (80 to 100 mm Hg)

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Oxygen saturation

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Is the point at which hemoglobin is saturated by oxygen (95% to 99%)

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Base excess

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Is the amount of blood buffer (hemoglobin and bicarbonate) that exists (+/- 2 mEq/L)

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Bicarbonate

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Is the major renal component of acid-base balance (22 to 26 mEq/L)

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Respiratory acidosis Lab Findings

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Arterial blood gas alterations: pH 45 mm Hg, PaO2 26 mEq/L (if compensated)

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Respiratory acidosis Signs and Symptoms

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Confusion, dizziness, lethargy, headache, ventricular dysrhythmias, warm and flushed skin, muscular twitching, convulsions, and coma

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Metabolic acidosis Lab Findings

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Arterial blood gas alterations: pH < 7.35, PaCO2 normal (if uncompensated) or < 35 mm Hg (if compensated), PaO2 normal or increased (with rapid, deep respirations), bicarbonate level < 22 mEq/L, and oxygen saturation normal

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Metabolic acidosis Signs and Symptoms

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Headache, lethargy, confusion, dysrhythmias, tachypnea with deep respirations, abdominal cramps, and flushed skin

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Respiratory alkalosis Lab Findings

answer

Arterial blood gas alterations: pH > 7.45, PaCO2 < 35 mm Hg, PaO2 normal, and bicarbonate level normal (if short lived or uncompensated) or < 22 mEq/L (if compensated)

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Respiratory alkalosis Signs and Symptoms

answer

Dizziness, confusion, dysrhythmias, tachypnea, numbness and tingling of extremities, convulsions, and coma

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Metabolic alkalosis Lab Findings

answer

Arterial blood gas alterations: pH > 7.45, PaCO2 normal (if uncompensated) or > 45 mm Hg (if compensated), PaO2 normal, and bicarbonate level > 26 mEq/L

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Metabolic alkalosis Signs and Symptoms

answer

Dizziness; dysrhythmias; numbness and tingling of fingers, toes, and circumoral region; muscle cramps; tetany

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Risk factors for fluid, electrolyte and acid-base imbalances

answer

a. Age—Very young; very old b. Gender—Women c. Environment—Diet, exercise, and hot weather and sweating d. Chronic diseases—Cancer; cardiovascular disease, such as congestive heart failure; endocrine disease, such as Cushing's disease and diabetes mellitus; malnutrition; chronic obstructive pulmonary disease; and renal disease e. Trauma—Crush injuries, head injuries, burns f. Therapies—Diuretics, steroids, intravenous (IV) therapy, and total parenteral nutrition (TPN) g. Gastrointestinal losses - Gastroenteritis; nasogastric suctioning; fistulas

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How can age affect fluid, electrolyte, and acid-base balances?

answer

Infants and children have greater water needs and are more vulnerable to fluid volume alterations; fever in children creates an increase in the rate of insensible water loss; adolescents have increased metabolic processes; older adults have decreased thirst sensation, which often causes electrolyte imbalances

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How can acute illness affect fluid, electrolyte, and acid-base balances?

answer

Surgery, head and chest trauma, shock, and second- and third-degree burns place the clients at risk.

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How can surgery affect fluid, electrolyte, and acid-base balances?

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The more extensive the surgery and fluid loss, the greater the body's response

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How can burns affect fluid, electrolyte, and acid-base balances?

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The greater the body surface burned, the greater the fluid loss

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How can respiratory disorders affect fluid, electrolyte, and acid-base balances?

answer

Predispose to respiratory acidosis and/or respiratory alkalosis

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How can head injury affect fluid, electrolyte, and acid-base balances?

answer

Can result in cerebral edema and diabetes insipidus

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How can chronic illness affect fluid, electrolyte, and acid-base balances?

answer

Cancer, congestive heart failure (CHF), or renal disease

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How can cancer affect fluid, electrolyte, and acid-base balances?

answer

Depends on the type and progression of the cancer and its treatment (diarrhea and anorexia)

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How can cardiovascular disease affect fluid, electrolyte, and acid-base balances?

answer

Diminished cardiac output, which reduces kidney perfusion and decreases urine output

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How can renal disorders affect fluid, electrolyte, and acid-base balances?

answer

Causes an abnormal retention of sodium, chloride, potassium, and water (metabolic acidosis)

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How can gastrointestinal disturbances affect fluid, electrolyte, and acid-base balances?

answer

Gastroenteritis and nasogastric suctioning result in the loss of fluid, potassium, and chloride ions.

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How can environmental factors affect fluid, electrolyte, and acid-base balances?

answer

Vigorous exercise or exposure to extreme temperatures

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How can diet affect fluid, electrolyte, and acid-base balances?

answer

Recent changes in appetite or the ability to chew and swallow (breakdown of glycogen and fat stores, metabolic acidosis, hypoalbuminemia, edema)

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How can lifestyle affect fluid, electrolyte, and acid-base balances?

answer

History of smoking or alcohol consumption (respiratory acidosis)

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How can medication affect fluid, electrolyte, and acid-base balances?

answer

Diuretics—Metabolic alkalosis, hyperkalemia, and hypokalemia Steroids—Metabolic alkalosis Potassium supplements—GI disturbances, including intestinal and gastric ulcers and diarrhea Respiratory center depressants (e.g., opioid analgesics)—Decreased rate and depth of respirations, resulting in respiratory acidosis Antibiotics—Nephrotoxicity (e.g., vancomycin, methicillin, or aminoglycosides); hyperkalemia and/or hypernatremia (e.g., azlocillin, carbenicillin, piperacillin, ticarcillin, or Unasyn) Calcium carbonate (Tums)—Mild metabolic alkalosis with nausea and vomiting Magnesium hydroxide (Milk of Magnesia)—Hypokalemia Nonsteroidal antiinflammatory drugs—Nephrotoxicity

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Imbalances associated with Weight loss of 5% to 8%:

answer

Mild to moderate fluid volume deficit (FVD)

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Imbalances associated with Irritability

answer

Metabolic or respiratory alkalosis, hyperosmolar imbalance, hypernatremia, hypokalemia

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Imbalances associated with Lethargy

answer

FVD, metabolic acidosis or alkalosis, respiratory acidosis, hypercalcemia

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Imbalances associated with Periorbital edema

answer

Fluid volume excess (FVE)

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Imbalances associated with Sticky, dry mucous membranes

answer

FVD, hypernatremia

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Imbalances associated with Chvostek's sign

answer

Hypocalcemia

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Imbalances associated with Distended neck veins

answer

FVE

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Imbalances associated with Dysrhythmias

answer

Metabolic acidosis, respiratory alkalosis and acidosis, potassium imbalance, hypomagnesemia

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Imbalances associated with Weak pulse

answer

FVD, hypokalemia

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Imbalances associated with Low blood pressure

answer

FVD, hyponatremia, hyperkalemia, hypermagnesemia

question

Imbalances associated with Third heart sound

answer

FVE

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Imbalances associated with Increased respiratory rate

answer

FVE, respiratory alkalosis, metabolic acidosis

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Imbalances associated with Crackles

answer

FVE

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Imbalances associated with Anorexia

answer

Metabolic acidosis

question

Imbalances associated with Abdominal cramps

answer

Metabolic acidosis

question

Imbalances associated with Poor skin turgor

answer

FVD

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Imbalances associated with Oliguria or anuria

answer

FVD, FVE

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Imbalances associated with Increased specific gravity

answer

FVD

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Imbalances associated with Muscle cramps, tetany

answer

: Hypocalcemia, metabolic or respiratory alkalosis

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Imbalances associated with Hypertonicity of muscles on palpation

answer

Hypocalcemia, hypomagnesemia, metabolic alkalosis

question

Imbalances associated with Decreased or absent deep tendon reflexes

answer

Hypokalemia, hypercalcemia

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Imbalances associated with Increased temperature

answer

Hypernatremia, hyperosmolar imbalance, metabolic acidosis

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Imbalances associated with Distended abdomen

answer

Third-space syndrome

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Imbalances associated with Cold, clammy skin

answer

FVD

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Imbalances associated with 2+ edema

answer

FVE

Ch. 41 Fluids and Electrolytes Study Guide Questions – Flashcards

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