week 2

Question 1

Hydrostatic Pressure

Answer 1

Force within a fluid compartment

Major force that pushes water out of vascular system at capillary level

Question 2

Oncotic Pressure

Answer 2

Osmotic pressure exerted by colloids in solution

Protein is a major colloid.

Question 3

Fluid Shifts AND EDEMA

Answer 3

Plasma-to-interstitial fluid shift results in edema.

Elevation of hydrostatic pressure
Decrease in plasma oncotic pressure
Elevation of interstitial oncotic pressure

Question 4

Effects of Edema (cont’d.)

Answer 4

-Functional impairment:
Restricts range of joint movement
Reduced vital capacity
Impaired diastole

-Pain:
Edema exerts pressure on nerves locally.
Headache with cerebral edema
Stretching of capsule in organs (kidney, liver)

-Dental practice:
Difficult to take accurate impressions
Dentures do not fit well

-Edema in skin:
Susceptible to tissue breakdown from pressure
Impaired arterial circulation
Ischemia leading to tissue breakdown

Question 5

Fluid Movement Between ECF and ICF

Answer 5

-Water deficit (increased ECF)
Associated with symptoms that result from cell shrinkage as water is pulled into vascular system

-Water excess (decreased ECF)
Develops from gain or retention of excess water

Question 6

Fluid Spacing

Answer 6

First spacing
Normal distribution of fluid in ICF and ECF

Second spacing
Abnormal accumulation of interstitial fluid (edema)

Third spacing
Fluid accumulation in part of body where it is not easily exchanged with ECF

Question 7

Hypothalamic Regulation

Answer 7

• Osmoreceptors in hypothalamus sense fluid deficit or increase.
• -Stimulates thirst and antidiuretic hormone (ADH) release
• -Result in increased free water and decreased plasma osmolarity

Question 8

Pituitary Regulation

Answer 8

Under control of hypothalamus, posterior pituitary releases ADH.
Stress, nausea, nicotine, and morphine also stimulate ADH release.

Question 9

Adrenal Cortical Regulation

Answer 9

Releases hormones to regulate water and electrolytes
Glucocorticoids: Cortisol
Mineralocorticoids: Aldosterone

Question 10

Renal Regulation

Answer 10

Primary organs for regulating fluid and electrolyte balance

-Adjusting urine volume: Selective reabsorption of water and electrolytes. Renal tubules are sites of action of ADH and aldosterone.

Question 11

Cardiac Regulation

Answer 11

Natriuretic peptides are antagonists to the RAAS.

• -Produced by cardiomyocytes in response to increased atrial pressure
• -Suppress secretion of aldosterone, renin, and ADH to decrease blood volume and pressure

Question 12

Gastrointestinal Regulation

Answer 12

Oral intake accounts for most water.

Small amounts of water are eliminated by gastrointestinal tract in feces.

Diarrhea and vomiting can lead to significant fluid and electrolyte loss.

Question 13

Insensible Water Loss

Answer 13

Invisible vaporization from lungs and skin to regulate body temperature

• -Approximately 600 to 900 mL/day is lost.
• -No electrolytes are lost.

Question 14

Age-Related Considerations

Answer 14

Structural changes in kidneys decrease ability to conserve water.

Hormonal changes lead to decrease in ADH and ANP.

Loss of subcutaneous tissue leads to increased loss of moisture.

Reduced thirst mechanism results in decreased fluid intake.

Nurse must assess for these changes and implement treatment accordingly.

Question 15

Age-Related Considerations

Answer 15

Structural changes in kidneys decrease ability to conserve water.

Hormonal changes lead to decrease in ADH and ANP.

Loss of subcutaneous tissue leads to increased loss of moisture.

Reduced thirst mechanism results in decreased fluid intake.

Nurse must assess for these changes and implement treatment accordingly.

Question 16

Fluid and Electrolyte Imbalances

Answer 16

Common in most patients with major illness or injury

• -Directly caused by illness or disease (burns or heart failure)
• -Result of therapeutic measures (IV fluid replacement or diuretics)

Question 17

Extracellular Fluid Volume Imbalances

Answer 17

ECF volume deficit (hypovolemia)

• -Abnormal loss of normal body fluids (diarrhea, fistula drainage, hemorrhage), inadequate intake, or plasma-to-interstitial fluid shift
• -Treatment: Replace water and electrolytes with balanced IV solutions.

Fluid volume excess (hypervolemia)

• -Excessive intake of fluids, abnormal retention of fluids (HF), or interstitial-to-plasma fluid shift
• -Treatment: Remove fluid without changing electrolyte composition or osmolality of ECF.

Question 18

Nursing Management Nursing Diagnoses

Answer 18

-Hypovolemia
Deficient fluid volume
Decreased cardiac output
Risk for deficient fluid volume
Potential complication: Hypovolemic shock

-Hypervolemia
Excess fluid volume
Risk for imbalanced fluid volume
Ineffective airway clearance
Risk for impaired skin integrity
Disturbed body image
Potential complications: Pulmonary edema, ascites

Question 19

Fluid Deficit―Dehydration

Answer 19

-Insufficient body fluid
Inadequate intake
Excessive loss
Both

-Fluid loss often measured by change in body weight

-Dehydration more serious in infants and older adults
Water loss may be accompanied by loss of electrolytes and proteins (e.g., diarrhea).

Question 20

Causes of Dehydration

Answer 20

• Vomiting and diarrhea
• Excessive sweating with loss of sodium and water
• Diabetic ketoacidosis (Loss of fluid, electrolytes, and glucose in the urine)
• Insufficient water intake in older adults or unconscious persons
• Use of concentrated formula in infants

Question 21

Effects of Dehydration

Answer 21

• Dry mucous membranes in the mouth
• Decreased skin turgor or elasticity
• Lower blood pressure, weak pulse, and fatigue
• Decreased mental function, confusion, loss of consciousness

Question 22

Manifestations of Dehydration

Answer 22

Decreased skin turgor and dry mucous membranes
Sunken eyes
Sunken fontanelles in infant 
Lower blood pressure, rapid weak pulse
Increased hematocrit
Increased temperature
Decreasing level of consciousness
Urine―low volume & high specific gravity

Question 23

Nursing Management Nursing Implementation

Answer 23

I & O
Monitor cardiovascular changes.
Assess respiratory changes.
Daily weights
Skin assessment

Neurological function:
LOC,PERLA, Voluntary movement of extremities, Muscle strength, Reflexes

Question 24

Calcium (Ca)

Answer 24

Excess:
Hypercalcemia
Thirst
CNS deterioration
Increased interstitial fluid

Deficit:
Hypocalcemia
Tetany
Chvostek’s, Trousseau’s signs 
Muscle twitching
CNS changes
ECG changes

Question 25

Magnesium (Mg)

Answer 25

``` EXCESS: Hypermagnesemia Loss of deep tendon reflexes (DTRs) Depression of CNS Depression of neuromuscular function ``` DEFICIT: Hypomagnesemia Hyperactive DTRs CNS changes

Question 26

Sodium (Na)

Answer 26

``` EXCESS: Hypernatremia Thirst CNS deterioration Increased interstitial fluid ``` DEFICIT: Hyponatremia CNS deterioration

Question 27

Potassium (K)

Answer 27

``` EXCESS: Hyperkalemia Ventricular fibrillation ECG changes CNS changes ``` ``` DEFICIT: Hypokalemia Bradycardia ECG changes CNS changes ```

Question 28

Sodium

Answer 28

-Imbalances typically associated with parallel changes in osmolality - Plays a major role in: - -ECF volume and concentration - -Generation and transmission of nerve impulses - -Acid-base balance

Question 29

Hypernatremia

Answer 29

Elevated serum sodium occurring with water loss or sodium gain Causes hyperosmolality leading to cellular dehydration Primary protection is thirst from hypothalamus. Manifestations Thirst, lethargy, agitation, seizures, and coma Impaired LOC Produced by clinical states Central or nephrogenic diabetes insipidus

Question 30

Hyponatremia

Answer 30

Results from loss of sodium-containing fluids or from water excess. Manifestations Confusion, nausea, vomiting, seizures, and coma

Question 31

Potassium

Answer 31

Major ICF cation ``` Necessary for Transmission and conduction of nerve and muscle impulses Cellular growth Maintenance of cardiac rhythms Acid-base balance ``` ``` Sources Fruits and vegetables (bananas and oranges) Salt substitutes Potassium medications (PO, IV) Stored blood ```

Question 32

Hyperkalemia

Answer 32

High serum potassium caused by Massive intake Impaired renal excretion Shift from ICF to ECF Most common in renal failure ``` Manifestations: Cramping leg pain Weak or paralyzed skeletal muscles Ventricular fibrillation or cardiac standstill Abdominal cramping or diarrhea ```

Question 33

Hypokalemia

Answer 33

Low serum potassium caused by: - Abnormal losses of K+ via the kidneys or gastrointestinal tract - Magnesium deficiency - Metabolic alkalosis ``` Manifestations Most serious are cardiac. Skeletal muscle weakness (legs) Weakness of respiratory muscles Decreased gastrointestinal motility Impaired regulation of arteriolar blood flow ```

Question 34

Calcium

Answer 34

Obtained from ingested foods More than 99% combined with phosphorus and concentrated in skeletal system Inverse relationship with phosphorus Bones are readily available store ``` Functions:: Transmission of nerve impulses Myocardial contractions Blood clotting Formation of teeth and bone Muscle contractions ```

Question 35

Hypercalcemia

Answer 35

``` High serum calcium levels caused by: Hyperparathyroidism (two-thirds of cases) Malignancy Vitamin D overdose Prolonged immobilization ``` ``` Manifestations: Decreased memory Confusion Disorientation Fatigue Constipation ```

Question 36

Hypocalcemia

Answer 36

Low serum Ca levels caused by: ``` Decreased production of PTH Acute pancreatitis Multiple blood transfusions Alkalosis Decreased intake ``` Manifestations: Positive Trousseau’s or Chvostek’s sign Laryngeal stridor Dysphagia Tingling around the mouth or in the extremities

Question 37

Magnesium

Answer 37

50% to 60% contained in bone. Coenzyme in metabolism of protein and carbohydrates Factors that regulate calcium balance appear to influence magnesium balance. Acts directly on myoneural junction Important for normal cardiac function

Question 38

Hypermagnesemia

Answer 38

High serum Mg caused by: Increased intake or ingestion of products containing magnesium when renal insufficiency or failure is present ``` Manifestations: Lethargy or drowsiness Nausea/vomiting Impaired reflexes Somnolence Respiratory and cardiac arrest ```

Question 39

Hypomagnesemia

Answer 39

``` Low serum Mg caused by:: Prolonged fasting or starvation Chronic alcoholism Fluid loss from gastrointestinal tract Prolonged parenteral nutrition without supplementation Diuretics ``` ``` Manifestations:: Confusion Hyperactive deep tendon reflexes Tremors Seizures Cardiac dysrhythmias ```

Question 40

Normal Saline (NS)

Answer 40

``` Isotonic No calories More NaCl than ECF 30% stays in IV (most) 70% moves out of IV ``` ``` Expands IV volume --Preferred fluid for immediate response --Risk for fluid overload higher Does not change ICF volume Blood products Compatible with most medications -- ```

Question 41

Acid-Base Imbalance

Answer 41

Acidosis Excess hydrogen ions Decrease in serum pH Alkalosis Deficit of hydrogen ions Increase in serum pH

Question 42

Respiratory Acidosis –

Answer 42

lungs can not get enough 02 Acute problems Pneumonia, airway obstruction, chest injuries Drugs that depress the respiratory control center Chronic respiratory acidosis Common with COPD

Question 43

Respiratory Alkalosis –

Answer 43

Blowing off too much C02 Hyperventilating Caused by anxiety, high fever, overdose of aspirin Head injuries Brainstem tumor

Question 44

Metabolic Acidosis – 3 D’s

Answer 44

1. Excessive loss of bicarbonate (HCO3) ions to buffer hydrogen - -Diarrhea―loss of HCO3 from intestines 2.Diabetic acidosis 3.Renal disease or failure Dialysis Decreased excretion of acids Decreased production of HCO3 ions

Question 45

Metabolic Alkalosis

Answer 45

Increase in serum bicarbonate ion - Loss of hydrochloric acid from stomach - Hypokalemia - Excessive ingestion of antacids

Question 46

Effects of Acidosis

Answer 46

``` -Impaired nervous system function Headache Lethargy Weakness Confusion Coma and death ``` -Compensation Deep rapid breathing Secretion of urine with a low pH

Question 47

Effects of Alkalosis

Answer 47

Increased irritability of the nervous system causes: ``` Restlessness Muscle twitching Tingling and numbness of the fingers Tetany Seizures Coma ```

Question 48

Treatment of Imbalances

Answer 48

Treatment of underlying cause Immediate corrective measures to include fluid and electrolyte replacement or removal Caution is required when adjusting fluid levels to ensure appropriate electrolyte balance. Addition of bicarbonate to the blood to reverse acidosis Modification of diet to maintain better electrolyte balance

Question 49

Hydrogen Ion and pH Scale

Answer 49

6. 8= DEATH 7. 35=ACIDOSIS AND INCREASE H+ 7. 4= NORMAL 7. 45= ALKALOSIS AND DECREASE H+ 7. 8= DEATH