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intracellular fluid (ICF)

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All fluid within the body cells

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extracellular fluid (ECF)

answer

Fluid outside of cells. Divided into interstitial, intravascular, and transcellular

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interstitial fluid

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Fluid between the cells and outside of blood vessels.

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intravascular fluid

answer

Composed of lymph, transcellular, and organ fluids

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acidosis

answer

Negative value of the blood buffers of hemoglobin and bicarbonate

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active transport

answer

movement of molecules or ions "uphill" against osmotic pressures to an area of higher concentration (sodium, potassium ATPase pump)

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Allogeneic Transfusion

answer

The collection and reinfusion of a donor's blood

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Aldosterone

answer

Adrenal cortex releases to counteract hypovolemia in response to increased plasma potassium levels as part of the rennin-angiotensin-aldosterone mechanism.

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Alkalosis

answer

Positive value of base excess in the blood buffer of hemoglobin and bicarbonate

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Angiotensin

answer

causes some vasoconstriction , gets converted to 2 which causes selective vasoconstriction of many blood vessels to relocate and increase blood flow to the kidneys, improving renal perfusion. Angiotensin 2 also stimulates release of Aldosterone

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Anion Gap

answer

Reflects unmeasurable anions present in the plasma. You calculate by summing the chloride and bicarbonate levels and subtracting this number from the plasma sodium concentration. Helps find the cause of metabolic acidosis by analizing serum electrolytes

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Antidiuretic Hormone (ADH)

answer

Stored in the Pituitary gland and is released in response to changes in blood osmolarity. ADH prevent diuresis, causing body to reabsorb water. Makes renal tubules and collecting ducts more permeable to water, causing water to return to system circulation. Temp urinary output is seen as body tries to compensate. Stops when blood becomes diluted.

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ABGs

answer

These are used in analysis in evaluating acid-base balance and oxygenation. Measurement of ABG levels involve, pH, PaCO2, PaO2, oxygen saturation, base excess, and HCO3. Any deviations from normal values indicate an acid-base imbalance.

question

Atrial Natriuretic Peptide (ANP)

answer

hormone that promotes vasodilation, secreted from cells of the atria of heart in response to atrial stretching and an increase in circulating blood volume. Diuretic, causing sodium loss and diminishes thirst mechanism.

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Autologous Transfusion

answer

Collection and reinfusion of pts own blood. Can be obtained 5 weeks before surgery. Also collected during perioperative blood salvage in orthopedic surgery and reinfused during the same surgery.

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Buffer

answer

A substance or a group of substances that absorb or release hydrogen ion H+ to correct an acid-base imbalance.

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Colloids

answer

blood products, where a substance is microscopically dispersed evenly through another substance

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Concentration Gradient

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The difference in two concentrations of a solution where diffusion takes place.

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Crystalloids

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Aqueous solutions of mineral salts or other water-soluble molecules which is a volume expander in infused IV solutions.

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Dehydration

answer

When the thirst mechanism in infants, pts with neurological or psychological problems, and older adults is not perceived or responded to.

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Electronic Infusion Device (EID)

answer

Ensures constant, regulated drip rate. Important in pts where a prescribed infusion rate and prevent uncontrolled fluid administration, med precise rates, cardiac and renal failure pts.

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Filtration

answer

Process where water and diffusible substances move across a membrane in response of fluid pressure from an area of higher pressure to lower pressure .

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Fluid Volume Deficit (FVD)

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Condition when water and electrolytes are lost in equal or isotonic proportions. Infants are more at risk because the proportions of body water per kilogram is higher.

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Fluid Volume Excess (FVE)

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pts who retain fluids will be on restricted fluid intake.

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Hemolysis

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Breakdown of RBCs - can happen if IV tubing is not primed before a transfusion

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Homeostasis

answer

Body fluid balance throughout the internal environment of the body. Maintained by fluid intake, hormonal controls, and fluid output. Body quickly responds to fluid and electrolyte imbalances in healthy people.

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Hypercalcemia

answer

Increase in total serum concentration of calcium and/or ionized calcium. Excess bone resorption, Depressess neuromuscular excitability (GI disturbances, n/v, lethargy, mental confusion, decalcification of bones- bone pain, osteomalacia, osteoporosis,

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Nursing with Hypercalcemia

answer

1) Safety precautions 2) Force fluids to prevent renal calculi 4,000 cc per day, maintain acid urine by drinking cranberry, prevent FX

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Hypocalcemia

answer

Drop in total serum and/or ionized calcium. Results from illness that affect thyroid or parathyroid glands, also renal insufficiency. Facial spasm, grimacing, Chvostek's sign

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Nursing with Hypocalcemia

answer

1)safety to prevent injury 2) Observe for signs of bleeding because of decrease in clotting, encourage food high in Ca, check pulse frequently

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Functions of Calcium in System

answer

bone and teeth formation, blood clotting, hormone impulses, and muscle contraction

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Functions of Potassium in System

answer

glycogen deposits in liver and skeletal muscles, cardiac cycle, and muscle contraction

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Function of Sodium in System

answer

water balance, nerve impulse transmission, regulates acid-base balance, cellular reactions

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Function of Magnesium in System

answer

Enzyme activities and neurochemical activities, and cardiac and skeletal muscle excitability

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Hyperchloremia

answer

Serum level of chloride rises above normal- mainly when bicarb falls or sodium rises

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Hyperkalemia

answer

Too high Potassium in blood, cardiac abnormalities are Tachycardia with slight excess and Bradycardia with cardiac arrest in severe excess. Also slight excess of neuromuscular irritability and severe produces decreased neuromuscular irritability

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Nursing with Hyperkalemia

answer

Assess for acidosis, Kussmaul's respirations, disorientation, safety precautions, look for arrhythmias, low protein- high carb diet

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Hypermagnesemia

answer

usually result of excess Mg intake, Depression of Neuromuscular activity and Cardiac Depression - Decrease respirations, lethargy, hypotension, bradycardia

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Nursing Implications with Hypermagnesemia

answer

Avoid Mg in foods, Check vitals, Assess meds as 1) Antacids 2) Enemas 3) IV Solutions all contain

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Hypernatremia

answer

Greater than normal Sodium in ECF caused by water loss or overall sodium excess- Decreases conduction so general muscle weakness and Increases irritability so Hyperactive reflexes- Pt will have increased 1) temp 2) poor skin turgor 3) dry skin and mucous membranes 4) eyeballs soft and sunkem w/dark circles around eyes 5) Thirst

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Nursing Implications with Hypernatremia

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1) Record temp frequently 2) maintain skin and mucous membrane integrity 3) Daily Weights!!!- avoid hypertonic or saline IV solution and safety precaution b/c weakness

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Hypochloremia

answer

Freq related to sodium imbalance. Vomitting or fistula drainage results in this because of hydrochloric acid loss. Metabolic Alkalosis results, body will increase absorption of bicarb ions to maintain electrical neutrality.

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Hypokalemia

answer

Most common imbalance from low K in ECF, from vomiting and potassium wasting diuretics- causes reduced neuromuscular activity, decreased smooth muscle activity such as GI ileus, n/v, shallow respirations, apnea, decreased skeletal muscle activity(flabby), and Arrhythmia, heart block, and rapid weak pulse---- metabolic alkalosis

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Nursing Implications with Hypokalemia

answer

1) Assess for metabolic alkalosis 2) Safety Precautions 3) Increase intake of K foods- fish, nuts, vegetables, fruits+juices, relieve GI discomfort 4) Vital signs 5) Bowel Assessment

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Hypomagnesemia

answer

Low due to malabsorption or malnutrition- CNS stimulated causing psychotic behaviors (hallucinations, delusions, combative), Neuromuscular Irritability causing Tetany which causes convulsions, hyperactive reflexes, Facial Twitching, and Cardiac Irritability causing arrhythmias

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Nursing Implications for Hypomagnesemia

answer

1) Protection 2) Seizure precaution 3) Monitor Pulse

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Hyponatremia

answer

occurs when net sodium loss or water excess. 1) Hypotonic ECF causes water to shift into cells which makes an absence of thirst. Cerebral edema causing all the head issues(mental disturbances, disorientation, convulsion, coma with severe) 2) Decreased blood volume b/c of shifting into cells - causes orthostatic hypotension, tachycardia, and hypotension 3) Decreases Neuromuscular contractility so general muscle weakness

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Nursing with Hyponatremia

answer

1) Safety precautions 2) Assess vitals 3) Maintain skin integrity 4) care for mucous membranes 5) weigh pt daily

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Hypotonic

answer

Solutions that have lower-than-normal osmotic pressure moves fluid from intravascular space into the cells causing cells to swell

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Hypovolemia

answer

when excess fluid is lost mainly due to hemorrhage and excessive vomiting

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Infiltration

answer

Occurs when IV fluids seep into the subcutaneous tissue around the venipuncture sight - swelling, pallor, coolness, pain, DISCONTINUE and remove canula

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Infusion Pump

answer

IV pump that uses positive pressure to infuse

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Insensible Water Loss

answer

continuous and occurs through the skin and lungs

question

What is the importance of fluid, electrolyte, and acid-base balances in the body?

answer

Necessary to maintain health and function of all body systems. I&O of water and electrolytes, distribution in the body and regulation of renal and pulmonary function contribute to homeostasis.

question

What is an electrolyte?

answer

An element or compound that can carry an electric current. We have positive charged and negatively charged electrolytes

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What is a cation?

answer

Positively charged electrolyte

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What is an anion?

answer

Negatively charged electrolyte

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What is the commonly used measurement for electrolytes?

answer

mEq/L is measurement assigned to most electrolytes

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Solute

answer

is the specific electrolyte that can be dissolved in plasma

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Solution

answer

homogeneous mixture composed of two or more substances (NaCl in water forms an electrolyte)

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Solvent

answer

liquid, solid, or gas, that dissolves another liquid, solid, or gaseous solute, resulting in a solution that is soluble in a certain volume of solvent at a specific temp.

question

Total Parenteral Nutrition TPN

answer

Feeding person intravenously by giving them nutrients like salts, glucose, amino acids, lipids, and added vitamins. It is a nutritionally adequate hypertonic solution administered via a central venous catheter- used when the GI tract is nonfunctional

question

Transfusion Reaction

answer

Antigen-antibody reactions that ranges from a mild response to a sever anaphylactic reaction

question

Vascular access device (VADs)

answer

catheters or cannulas, or infusion ports inserted into the large veins (PICCs- Peripherally inserted central catheters), (Centrally placed catheters) (Tunneled Catheters) (Implanted Ports) designed for repeated access to the vascular system

question

Venipuncture

answer

technique for accessing a vein by puncture through the skin mainly to collect a blood specimen , instill meds, or start an IV fluid infusion, or contrast fluid

question

Diffusion

answer

gas or liquid moves from an area of greater conc to area of lesser conc. Move across cellular membrane through diffusion. Must have a permeable membrane for this to happen.

question

Osmosis

answer

Involves movement of water from lower to area of higher conc through a semi permeable membrane- KNOWN as Osmotic Pressure,

question

Osmotic Pressure

answer

The pull due to a higher concentration on one side of a permeable membrane and less concentrated on the other side. Water is drawn through the membrane to the more concentrated

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Isotonic

answer

When solution is equal in osmotic pressure on both sides of the semi-perm membrane

question

Hypertonic

answer

Will pull fluid from the cells and the cells will shrink

question

Hypotonic

answer

Solution moves into the cells causing them to enlarge and some cells will burst.

question

Osmolality

answer

Osmotic pressure created by the solution or ability to affect movement of water

question

Osmolarity

answer

Concentration of molecules in a liter of solution

question

Metabolic Acidosis

answer

High acid content in the blood, which decreases sodium bicarbonate levels. Diabetic Ketoacidosis is common cause. Detected by analyzing serum electrolytes to detect anion gap.

question

Metabolic Alkalosis

answer

Heavy acid loss or increases in bicarbonate, commonly caused by vomiting and gastric suction.

question

Milliequivalents per liter

answer

mEq/L What electrolytes are measured in- most of the time

question

Oncotic pressure

answer

Form of osmotic pressure exerted by proteins in blood plasma that tend to pull fluids and some solutes into the circulatory system.

question

Osmoreceptors

answer

A sensory receptor found in the Hypothalamus that detects changes in osmotic pressure, and when osmolality increases, the hypothalamus stimulates thirst

question

Phlebitis

answer

Inflammation of a vein- caused by cannula material, chemical irritation from additives and drugs given, and anatomical position of the cannula. S/S include pain, edema, erythema, increased skin temperature, and sometimes redness traveling along path of vein

question

Renin

answer

A proteolytic enzyme which is released by the body in response to decreased renal perfusion caused by a decrease in extracellular volume. It produces angiotensin which vasoconstricts to help the body's mean arterial blood pressure.

question

Respiratory acidosis

answer

Increase in arterial carbon dioxide concentration PaCO2, excess carbonic acid H2CO3, and increase in Hydrogen ion concentration(pH less than 7.35) Cause is hypoventilation. Causes cerebrospinal fluid and brain cells to become acidic, producing neurological changes. Respiratory depression can also cause hypoxemia, resulting in more neurological problems. Hyperkalemia and Hypercalcemia accompany acidosis,

question

Sensible Water Loss

answer

Visible perspiration, directly related to the stimulation of the sweat glands by the sympathetic nervous system. Total with insensible water loss is 500-600 mL per day.

question

Active Transport

answer

When the molecules or ions move uphill against osmotic pressures in order to get to an area of higher concentration

question

Hydrostatic Pressure

answer

How much pressure is exerted outward against a surface by a fluid. Filtration helps to even out this process.

question

Colloid Osmotic Pressure

answer

Helps move the diffusible solutes out of the capillaries, and into the interstitial space

question

Importance of F&E and Acid Base Balance

answer

F&E and Acid Base balance are vital to sustain life. The functioning of the lungs and the kidneys maintain this delicate balance. Any imbalances can occur through the alterations in the respiratory, renal, metabolic, and CNS.

question

Affects to the renal system

answer

ageing process, alcohol, tobacco, and not drinking good things

question

Homeostastis

answer

Maintained throughout the body with the 4 systems.

question

Thirst mechanism

answer

Responsible for helping us to maintain our fluid intake

question

Hypovolemia

answer

Hemorrhage or diarrhea

question

What hormones help to regulate the body fluids? Antidiuretic hormone ADH

answer

Works directly on the renal tubules and the collecting tubes to make them more permeable.

question

Aldosterone

answer

hormone that regulates the balance of Potassium and Sodium in the cells. Sodium retention is the cause of water retention. Wherever sodium is, so goes water. It releases more potassium (fluid regulating device)

question

Renin

answer

produces antiotensin 1, which causes some vasoconstriction. The antiotensin 1 converts to antiotensin 2 which is responsible for selective vasoconstriction. This way the Kidneys receive some vasodilation which helps them function better.

question

What are responsible for fluid output?

answer

kidneys, lungs, skin, and GI tract. Kidneys are responsible for greatest amount of fluid

question

How much excreted through kidneys

answer

1200-1500 ccs in 24 hours.

question

Insensible Water Loss

answer

Loss is continuous and we can't detect it. Loss that is found in perspiration through stimulation of sweat glands.

question

How much do our lungs expire/release per day?

answer

400 ml of water daily, non measurable- insensible water loss. Release more through a lot of exercise.

question

How much does the GI tract release per day?

answer

100-200 ml daily, but during diseases (diarrhea/hemorrhage) as much as 3000-6000 cc of fluid can be lost in a very short time

question

Input and Output

answer

Oral Fluids- 1100-1400, Solid Food-800-1000 and oxidative metabolism 300ml and OUTPUT- Kidneys 1200-1500, skin 500-600 lungs 400 and GI 100-200----TOTAL IN- 2200-2700 TOTAL LOSSES- 2200-2700 GENERALLY WE WANT THE SAME OUT AS WHAT WE TAKE IN!

question

Single Most Important factor in a person's evaluation of whether they're retaining fluid

answer

Daily Weight is most important factor to see if person is having issues with fluid retention.

question

Major Cations

answer

Sodium (Na) , Potassium (K), Calcium (Ca), Magnesium (Mg)- all floating around in our blood and the bodies cells

question

Sodium

answer

most common at 90% in ECF- major contributor in water balance in body- accomplished by nerve impulse trans, acid base balance, and other chemical reactions,Dietary intake also regulates Sodium-

question

Normal Range of Sodium (Na)

answer

135-145 mEq/L

question

Potassium (K)

answer

Intracellular ion regulated through dietary intake and renal excretion- necessary for glycogen deposits in liver and skeletal muscle, nerve impulse conduction and transmission, and most importantly is a good cardiac rhythm in pts. The smooth and skeletal muscle contractions is also dependent on K.

question

Normal Range for Potassium(K)

answer

3.5-5.0 mEq/L

question

Calcium (Ca)

answer

Stored in bone, plasma, and body cells. Necessary for bone and teeth formation, blood clotting, hormone secretion, cell membrane integrity, cardiac conduction, transmission of nerve impulses, and muscle contractions.

question

Normal Range for Calcium

answer

Serum Calcium is 8.9-10.3 mg/dL

question

Magnesium(Mg)

answer

cardiac and skeletal muscle excitability, neurochemical activities, and enzyme activities. Regulated by diet and kidney function

question

Normal reading for Mg

answer

1.3-2.1 mEq/L

question

3 Anions

answer

Chloride (Cl), Bicarbonate (CO3), and Phosphorous-Phosphate regulation

question

Chloride

answer

97-110 mEq/L- Major ion in ECF - Diet and kidneys are regulators. Twin of Na- where Na goes so does Cl---No added salt if cardiac pts, b/c they'll retain fluid - If they have a water softener and they are cardiac, make sure they have one with potassium chloride salt

question

Bicarbonate (CO3)

answer

Major chemical buffer in system- is in ECF and ICF and is called the "Acid-Base Balance Buffer" Kidneys are the regulators- the arterial range is 22-26 mEq/L and venous bicarbonate level is 24-30 mEq/L

question

Phosphorous-Phosphate regulation

answer

Buffer ion, found in ICF primarily and ECF in small amounts. Ca and Phosphate are twins. Work together for strong bones and teeth. If one rises, the other one falls- THEY HAVE TO BE EQUAL AMOUNTS, promotes neuromuscular function and helps metabolize carbohydrates. Regulated through diet, renal excretion, and GI absorption. Normal level is 2.5-4.6 mg/dL

question

What is an ABG? What information do we obtain from the ABGs?

answer

Arterial Blood Gases obtained by radial or femoral artery which shows pH, PaCO2- partial arterial CO2, PaO2, and O2 Saturation. Base Excess, and Bicarbonate levels are all measured

question

What are some conditions that can cause fluid disturbances within the body?

answer

1) Decreased Cardiac output 2) Diarrhea 3) Medications 4) Trauma/Hemorrhage 5)

question

Respiratory Acidosis Causes

answer

Hypoventilation, atelectasis, pneumonia, respiratory failure, airway obstruction, head injuries

question

S/S of Respiratory Acidosis

answer

Confusion, dizzy, lethargy, headache, dysrhythmias, seizures, and coma

question

Lab findings of Respiratory Acidosis

answer

ABG alterations- pH below 7.35 PaCO2 above 45 mm HG, PaO2 below 80 mm Hg and bicarb above 26 mEq/L when compensated

question

Respiratory Alkalosis Causes

answer

Hyperventilation, Asthma, anxiety, exercise, head injuries, ventilator set wrong

question

S/S of Respiratory Alkalosis

answer

dizziness, confusion, dysrhythmias, tachypnea, tingling of extremities

question

Lab finding of Respiratory Alkalosis-

answer

pH over 7.45, PaCO2 below 35 mm HG, PaO2 normal, and bicarb below 22 mEq/L compensated

question

Metabolic Acidosis Causes

answer

Caused by High Anion Gap, Diabetic ketoacidosis, renal failure, lactic acidosis from exercise, diarrhea

question

S/S of Metabolic Acidosis

answer

headache, lethargy, confusion, dysrhythmias, flushed skin, abdominal cramps

question

Metabolic Alkalosis Causes

answer

Excessive vomiting, prolonged gastric suctioning, Hypokalemia, Hypercalcemia, use of drugs- sodium bicarbonate and diuretics, excessive Aldosterone

question

What are the three general types of acid-base regulators within the body?

answer

3 Types are 1) Chemical(carbonic acid bicarbonate buffer system) 2) Biological (absorption and release of Hydrogen) and 3) Physiological (Kidneys and Lungs)

question

What is the normal metabolism ratio between bicarbonate and carbonic acid?

answer

1 part Carbonic Acid to 20 parts bicarbonate

question

Meds that cause fluid and electrolytes imbalances

answer

1) Diuretics 2) Steroids 3) Opioids- decreased respirations hence respiratory acidosis 4) Calcium Carbonate 5) Potassium Supplements - GI disturbances

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