1
Q
Electrolytes
A
- Substances that develop an electrical charge when dissolved in water
- Responsible for maintaining the fluid balance between intracellular and extracellular. Important because it helps with hydration, nerve impulses, muscle function, pH level
- Important because cells, tissues, and fluids thrive in a homeostatic environment
2
Q
Cation
A
Electrolytes that carry a positive charge
3
Q
Anion
A
Electrolytes that carry a negative charge
4
Q
Interstitial fluid
A
lies between the spaces in the blood
5
Q
Intravascular fluid
A
lies in the plasma within the blood
6
Q
Transcellular fluid
A
includes specialized fluids like cerebrospinal, pleural, peritoneal, and synovial fluid
7
Q
Active transport
A
- movement of fluid and solutes that requires energy
- Molecules (solute)
- low concentration to high concentration
8
Q
Passive transport
A
- movement of fluid and solutes that does not require energy.
- 3 types: osmosis, diffusion, filtration
9
Q
Osmosis
A
Water
low concentration to high concentration
10
Q
Diffusion
A
Molecules (solute)
high concentration to low concentration
11
Q
Filtration
A
Water and small particles
high pressure to low pressure
12
Q
Sensible fluid loss
A
measurable and perceived
urine, diarrhea, ostomy, gastric drainage
13
Q
Insensible fluid loss
A
not perceived and not easily measured
evaporated from the skin and lungs
14
Q
Sodium (Na+)
A
- Major cation in the ECF
- Normal serum level is 135-145 mEq/L
Function:
- Regulates fluid vol.
- Maintains blood vol.
- Interacts with calcium to maintain muscle contraction
- Stimulates conduction of nerve impulses
Regulation:
- Moves by Active transport
- Regulates aldosterone and ADH levels
- Reabsorbed and excreted through kidneys
- Minimal loss through perspiration and feces
- Low sodium may be caused by excess water intake
Sources:
Table salt, soy sauce, cured pork, cheese, milk, processed foods, canned products, foods preserved with salt
15
Q
Potassium (K+)
A
- Major cation in ICF
- Normal serum level 3.5-5 mEq/L
Function:
- Maintains ICF osmolality
- Regulates conduction of cardiac rhythm
- Transmits electrical impulses in multiple body systems
- Assists with acid-base balance
Regulation:
- Regulated by aldosterone
- Excreted and conserved through the kidneys
- Lost through vomiting and diarrhea
- Lost triggered by many diuretics
Sources:
bananas, oranges, apricots, figs, dates, carrots, potatoes, tomatoes, spinach, dairy products, and meats
16
Q
Calcium (Ca2+)
A
- Most abundant electrolyte in the body
- Normal serum level 8.5-10.5 mg/dL
Function:
- Promotes transmission of nerve impulses
- Major component of bone and teeth
- Regulates muscle contraction
- Maintains cardiac automaticity
- Essential factor in the formation of blood clots
- Catalyst for many cellular activities
Regulation:
- Combines with phosphorus to form the mineral salts of the teeth and bone
- Calcium and phosphorus levels inversely proportional
- Parathyroid hormone (PTH) stimulates release from bone and reabsorption for kidneys and intestines
- Calcitonin (from the thyroid) blocks bone breakdown and lowers calcium levels
- Absorption stimulated by vitamin D
Sources:
-Milk, milk products, dark green veggies, salmon, breads and cereals
17
Q
Magnesium (Mg2+)
A
- Presents in skeleton and ICF
- Second most abundant cation in ICF
- Normal serum level is 1.6-2.6 mEq/L
Function:
- Involved in protein and carbohydrate metabolism
- Necessary for protein and DNA synthesis within the cell
- Maintains normal intracellular levels of potassium
- Involved in electrical activity in nerve and muscle membranes, including the heart
- May have a role in regulating BP and may influence the release and activity of insulin
Regulation:
- Ingested in the diet and absorbed through the small intestine
- Excreted by kidneys
- Loss may be triggered by diuretics, poorly controlled DM, and excess alcohol intake
Sources:
- Average daily requirement is 18-30 mEq
- most foods, high levels present in green veggies, cereal, grains, and nuts
18
Q
Chloride (CI-)
A
- Major anion in the ECF
- Normal serum level is 95-105 mEq
Function:
- Works with Na+ to maintain osmotic pressure between fluid compartments
- Essential for production of HCI for gastric secretions
- Functions as buffer in oxygen-carbon dioxide exchange in RBCs
- Assists with acid-base balance
Regulation:
- Reabsorbed and excreted through the kidneys along with sodium
- Regulated by aldosterone and ADH levels
- Deficits lead to potassium deficits; potassium deficits lead to chloride deficits
Sources:
-foods high in sodium
19
Q
Phosphate (PO4-)
A
- Major anion in the ICF
- Normal serum level is 1.7-2.6 mEq/L
Function:
- Serves as a catalyst for many intracellular activities
- Promotes muscle and nerve action
- Assists with acid base balance
- Important for cell division and transmission of hereditary traits
Regulation:
- Combines with calcium to form the mineral salts of the teeth and bones
- Calcium and phosphorus levels inversely proportional
- Regulated by PTH; has inverse response to calcium
- Excreted and reabsorbed by the kidneys
Sources:
- meat, fish, poultry, milk products, carbonated beverages, legumes
- Readily available in body as a result of metabolism
20
Q
Bicarbonate (HCO3-)
A
- Major buffer in the body
- In ECF and ICF
- Normal serum level is 22-26 mEq/L
Function:
-Maintains acid-base balance by functioning as the primary buffer in the body
Regulation:
- Lost through diarrhea, diuretics, renal insufficiency
- Excess possible if person ingests quantities of acid neutralizers
21
Q
Hydrostatic pressure
A
- The force created by fluid within a closed system
- It is responsible for normal circulation of blood
22
Q
Osmotic pressure
A
the power of a solution to draw water
23
Q
The IOM recommends a total fluid intake of
A
women- 2700ml/day
men- 3700 ml/day
24
Q
What is the principal regulator of fluid and electrolyte balance
A
the kidneys
25
Renin
enzyme responsible for the chain of reactions that converts angiotensinogen to angiotensin II
26
Angiotensin II
Acts on the nephrons to retain sodium and water and directs the adrenal cortex to release aldosterone
27
Thyroid hormone affects fluid volume by?
influencing cardiac output
28
Natriuresis
The discharge of sodium through urine
29
Acid
- Any compound that contains hydrogen ions (H+) that can be released
- Referred to as cation donors
30
Base
- A compound that combines with hydrogen ions in solution
| - Referred to as cation acceptors
31
pH
- The amount of acid or base present in a solution
- The stronger an acid is the lower the pH will be, in contrast a strong base has a high pH
- Reported on a 1-14 scale
- 1 to 6.9 is acidic
- 7 is neutral
- 7.1 to 14 is basic or alkaline
32
Buffers
- Anything that works to restore balance
- Prevents wide swings in pH
- Consists of a weak acid and a weak base
33
Acidosis
-If bicarbonate is depleted while neutralizing a strong acid and the pH drops below 7.35
34
Alkalosis
-If a strong base is added to extracellular fluid and depletes carbonic acid and the pH rises above 7.45
35
Deficient fluid volume (hypovolemia)
- Occurs when there is a proportional loss of fluid and electrolytes from the ECF
- May occur with surgery, trauma, or uterine rupture
36
Dehydration
-A state of negative fluid balance in which there is loss of water from the intracellular, extracellular, or intravascular space
-3 causes:
Insufficient intake of fluids
Excessive fluid loss
Fluid shifts
37
Excessive fluid volume (hypervolemia)
- Involves excessive retention of sodium water in the ECF
| - Results from excessive salt intake, disease affecting kidney or liver function, or poor pumping action of the heart
38
Hyponatremia
-Na+
39
Hypernatremia
-Na+>145 mEq/L
Common causes:
-Excessive sodium intake, water deprivation, increased water loss through profuse sweating, heat stroke, or diabetes insidious, administration of hypertonic tube feeding
Signs and symptoms:
-Thirst, elevated temp., dry mouth and sticky mucous membranes. Sever signs and symptoms include hallucinations, irritability, lethargy, seizures
Treatment:
- Monitor I&O, sodium levels, vital signs, LOC, restrict sodium in the diet, beware of hidden sodium in foods and medications, increase water intake, administer IV solutions that do not contain sodium
40
Hypokalemia
-K+
41
Hyperkalemia
-K+>5.0 mEq/L
Common causes:
-Renal failure, potassium-sparign diuretics, hypoaldosteronism, high potassium intake coupled with renal insufficiency, acidosis, major trauma
Signs and symptoms:
-Muscle weakness, dysrhythmias, flaccid paralysis, intestinal colic, tall T waves on ECG
Treatment:
-Monitor I&O, monitor potassium level, caution about potassium-rich food intake in patients with elevated creatinine levels.
42
Hypocalcemia
-Ca2+
43
Hypercalcemia
- Ca2+>10.5 mq/dL
Common causes:
-Hyperparathyroidism, malignant bone disease, prolonged immobilization, excess calcium supplementation, thiazide diuretics
Signs and symptoms:
-Muscle weakness, constipation, anorexia, nausea, vomiting, polyuria and polydipsia, kidney stones, bizarre behavior, bradycardia
Treatment:
- Monitor I&O, encourage fluid intake to prevent stone formation, encourage fiber to prevent constipation, eliminate calcium supplements and limit calcium-rich foods, avoid calcium-based antacids, renal dialysis may be required
44
Hypomagnesemia
-Mg2+
45
Hypermagnesemia
-Mg2+>2.1 mEq/L
Common causes:
-Renal failure, adrenal insufficiency, excess replacement
Signs and symptoms:
-Flushing and warmth of skin, hypotension, drowsiness, lethargy, hypoactive reflexes, depressed respirations, bradycardia
Treatment:
-Monitor vital signs and airway, monitor reflexes, avoid magnesium-based antacids and laxatives, restrict dietary intake of foods high in magnesium
46
Hypophosphatemia
-PO4-
47
Hyperphosphatemia
-PO4-2.6 mEq/L
Common causes:
-Renal failure, hyperthyroidism, chemotherapy, excess use of phosphate-based laxative
Signs and symptoms:
-short term: tetany symptoms- tingling of extremities and cramping, long term- calcification in soft tissue
Treatment:
-Monitor serum phosphorus level, monitor for tetany, if severe administer aluminum hydroxide with meals to bind phosphorus
48
CO2
35-45
49
Acceptable range of pH for serum
7.35-7.45
50
If you have a metabolic problem ....
respiratory system will compensate and vice versa
51
CO2 HIGH
respiratory acidosis
52
CO2 LOW
respiratory alkalosis
53
HCO3 HIGH
metabolic alkalosis
54
HCO3 LOW
metabolic acidosis
55
Nursing assessment: fluid, electrolyte, acid-base imbalances
- Head to toe
- vital signs
- daily weights
- fluid I&O
- Labs
56
Urine output
1500 mL/day
| 30 mL/hour
57
Feces output
100-200 mL/day
58
Acceptable range for serum
7.35-7.45
59
CO2 is high
respiratory acidosis
60
CO2 is low
respiratory alkalosis
61
HCO3 is high
metabolic alkalosis
62
HCO3
metabolic acidosis
63
Hypertonic
high concentration 375
64
Isotonic
blood plasma 290
65
Hypotonic
low concentration 250
66
water is ______% of body weight
60
67
Arterial blood sample
- pH 7.35-7.45
- PCO2 35-45 mm Hg
- HCO3- 22-26 mEq/L
68
Freshly voided urine sample
pH 5.0-9.0
| Specific gravity 1.001-1.029
NSG 250
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