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76 Cards in this Set
- Front
- Back
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What is body fluid homeostasis? What does it include? |
Maintenance of normal volume and normal composition of the extracellular fluid ■ Fluid Balance ■ Electrolyte Balance ■ Acid-Based Balance |
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Body Fluid Functions |
■ Medium for transport ■ Required for cellular metabolism ■ Acts as a solvent for electrolytes ■ Helps maintain body temp ■ Helps digestion and elimination ■ Acts as lubricant |
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Body Fluids: Mechanisms for fluid gain includes |
■ Fluid intake - 1500ml ■ Food Intake - 750ml ■ Metabolism - 250ml Total 2500ml |
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Body Fluids: mechanisms for fluid loss |
■ Urine -1500ml ■ Sweat - 200ml ■ Faeces - 100ml ■ Skin (evaporation) lungs - 700ml Total 2500ml |
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What controls fluid regulation? |
■ Hypothalmus - thirst receptors (osmoreceptors) continuously monitor serum concentration If it rises, the thirst mechanism is triggered (simplest way to maintain fluid balance) |
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Fluid Balance: Thirst Mechanism |
■ Pituitary Regulation: Posterior pituitary releases ADH (antiduretic hormone) in response to increasing serum concentrations Causes renal tubules to retain water |
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Total Body Fluid: Distribution by weight |
■ 70% of total body weight in infants ■ 60% of total body weight in adult ■ 50-55% of total body weight in older adults (most prone to dehydration). |
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Dehydration: Geriatric Client - Normal physiological ageing results in... |
■ Decreased thirst mechanism ■ Decreased number of sweat glands ■ Decreased renal function ■ Decreased mobility and/or cognitive function |
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Total Body Fluid Loss |
■10% body fluid loss = 8% weight loss (SERIOUS) ■ Loss of 20% body fluid = 15% weight loss (fatal) |
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Body Composition includes |
■ 60% fluid ■ 18% Protein ■ 16% Fat ■ 6% minerals |
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Fluid Compartments includes |
■ Intracellular fluid (65% total body weight or 42L) ■ Interstitial Fluid - around/between cells (28%) ■ Intravascular Fluid - Blood vessels (7%) ■ Transcellular Fluid - CSF/Synovial (negligible) ■ Extracellular Fluid (35% total body weight or14L) |
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What is fluid balance? How is it Acheived? |
Balance between body fluids and electrolytes. ■ Attraction between ions (electrolytes) and water (fluids) causes fluids to move across membranes and leave their compartments. |
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Fluid Balance: Compartmental exchange is regulated by what? |
■ Osmosis - water shifts from low solute to high solute to reach homeostasis ■ Diffusion ■ Filtration |
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IV Solutions include |
■ Hypertonic Solutions ■ Hypotonic Solutions ■ Isotonic Solutions |
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What are Hypertonic Solutions and their result? Examples of Hypertonic Solutions? |
■Contain greater salt concentration (high osmolarity) as cells and blood. RESULT: Hight osmotic pressure shifts fluid from cells into extracellular fluid - cells placed in hypertonic solution will shrink. ■ 5% Dextrose ■ 0.45% Normal Saline ■ 5% dextrose in lactated ringers solution ■ 5% Dextrose in normal saline |
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Hypertonic Solutions: Therapeutic Uses |
■ Temporarily treat hypovolemia ■ Expand Vascular Volume ■ Fosters normal BP and good urine output |
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What are Hypotonic Solutions? Result? Examples? |
Contain a lessor salt concentration (low osmolarity) as cells and blood. Result: low osmotic pressure shifts fluid from extracellular fluid into cells - cells placed in a hypotonic solution will swell. ■ 0.45% Sodium Chloride ■ 0.33% Sodium Chloride |
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Hypotonic Therapeutic Use |
■ Cellular Dehydration ■ To "dilute" plasma particularly in hypernatremia |
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Isotonic Solutions? Result? Examples> |
Contain same amount of salt concentration (equal osmolarity) as cells and blood. ■ Result: osmotic pressure is therefore the same inside and outside cells - cells neither shrink nor swell in an isotonic solution, they stay the same. ■ 0.9% Normal Saline ■ 5% Dextrose in Water ■ Ringers Lactate |
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Fluid Volume Deficit (FVD): Loss of H2O and electrolytes from ECF, causes: |
■ Haemorrhage ■ Vomiting ■ Diarrhoea ■ Burns ■ Fluid Shift out of vascular space into interstitial spaces |
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Fluid volume Excess (FVE): increase of H2O and electrolytes from ECF, causes |
■ Increased Na/H2O retention ■ Excessive intake of NA/H2O (water intoxication) ■ Renal Failure ■ Congestive Heart Failure |
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Introduction to Electrolytes |
■ Ions that work with fluids to control homeostasis ■ Found in various concentrations ■ Can be negatively charges (anions) or positive charged (cations) |
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Electrolytes: Cations (positive) |
■ Sodium Na+ ■ Potassium K+ ■ Calcium Ca2+ ■ Magnesium Mg2+ |
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Electrolytes: Anions (negative) |
■ Chloride Cl- ■ Phosphate PO4- ■ Bicarbonate HCO3- |
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Electrolyte Functions |
■ Regulate water distribution ■ Muscle contraction ■ Nerve impulse transmission ■ Blood clotting ■ Regulate enzyme reactions (ATP) ■ Regulate acid-base balance |
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Sodium - Major Cation - Key Characteristics? |
■ Normal range serum concentration: 135-145 mEq/L ■ Chief Electrolyte of ECF ■ Regulated by kidneys and hormones Chemical Symbol: Na Atomic number: 11 Atomic Mass: 22.989 |
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Sodium Responsibilities |
■ Water and fluid regulation ■ Nerve impulse transmission (Na/K pump) |
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Hypernatraemia? Causes? |
Reflects an abnormal sodium serum concentration greater than 145 mEq/L ■ Inadequate fluid intake ■ GI losses - Diarrhoea ■ DM |
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Hypernatraemia Clinical Manifestations (signs and symptoms) |
■ Thirst ■ Sticky Mucous membranes ■ Flushed Skin ■ Postural Hypotension |
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Hyponatraemia? Causes |
Reflects an abnormal sodium serum concentration less than 134 mEq/L ■ Prolonged Diuretic therapy ■ GI losses - suctioning, laxatives, vomiting ■ Labour induction with oxytocin |
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Hyponatraemia Clinical Manifestations |
■ Nausea ■ Disorientation ■ Apathy ■ Lethargy |
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Potassium Key Characteristics |
■ normal range: 3.6 -2.5 mmol/L ■ Regulated by kidneys / hormones ■ Inversely proportional to NA |
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Potassium Responsibilites |
■ Skeletal Muscle Function ■ Cardiac Muscle Function |
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Hyperkalaemia? Causes? |
Reflects an abnormal potassium serum concentration greater than 5.2mmol/L Causes ■ Burns ■ Impaired renal excretion ■ Depolarising MR |
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Hyperkalaemia clinical manifestations |
■ Muscle weakness (>Crams>Paralysis) ■ Cardiac conduction abnormalities ■ Cardiac Arrhythmias - ECG abnormalities ■ Reduced Urine Excretion (oliguria) ■ Drowsiness ■ decreased BP ■ Diarrhoea |
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Hyperkalaemia Interventions |
■ Diuretics ■ Dialysis ■ Sodium Bicarbonate ■ Insulin ■ Glucose |
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Hypokalaemia? Causes? |
Abnormal serum concentration below 3.6mmol/L ■ Abnormal losses of K via kidneys/GI tract ■ Magnesium deficiency ■ Metabolic alkalosis |
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Hypokalaemia Clinical Manifestations |
■ Alkalosis ■ Shallow respirations ■ Confusion ■ Weakness ■ Arrhythmias ■ Thready pulse |
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Hypokalaemia interventions |
■ Oral Potassium Chloride ■ Potassium-sparing diuretics ■ Angiotensin converting enzyme (ACE) inhibitors |
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Calcium Key characteristics |
■ Normal range: 2.2-2.7mmol/L ■ Most abundant in body (99% teeth/bones) ■ Inverse relationship with Phosphorus ■ Vitamin D required for Ca Absorption |
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Calcium Responsibilities |
■ Control Nerve impulses ■ Muscle contractions ■ Clotting |
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Hypercalcemia Causes? |
reflects abnormal calcium serum level concentration greater than 2.7 mmol/L ■ Hyperparathyroidism ■ Malignancy ■ Vitamin D overdose |
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Hypercalcemia Clinical Manifestations |
■ Muscle weakness ■ Nausea and vomiting ■ Hypertension ■ Cardiac arrhythmia |
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Hypercalcemia Interventions |
■ Diuretics ■ Calcimimetics (mimics calcium in blood) ■ Parathyroidectomy |
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Hypocalcaemia? Causes? |
Reflects abnormal calcium serum level less than 2.1 mmol/L ■ Decreased production of PTH ■ Acute Pancreatitis ■ Multiple blood Transfusions |
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Hypocalceamia Clinical Manifestations |
■ Muscle crams in extremities (Carpal spasm) ■ Cardiac arrythmias ■ Changes in mental status ■ Seizures |
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Hypocalceamia interventions |
■ Increase in dietary calcium ■ Oral calcium and vitamin D Supplements |
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Magnesium key characteristics |
Normal Serum Concen. Level: 1.7-2.2mg/dL ■ Most located within intracellular fluid ■ Regulated by intestinal absorption and kidney |
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Magnesium reponsibilites |
■ Carbohydrate Metabolism
■ Skeletal Muscle Contractions ■ Formation of ATP |
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Hypermagnesaemia? Causes? |
Reflects abnormal magnesium levels greater than 2.2 mg/dL ■ Renal Failure ■ Increased Magnesium intake ■ Untreated diabetic Ketoacidosis |
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Hypermagneseamia Clinical Manifestations |
■ Flushed Face ■ Cardiac Changes ■ Decreased Respiration ■ Loss of deep tendon reflexes |
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Hypermagnesaemia Interventions |
■ Diuretics ■ Dialysis ■ Intravenous calcium gluconate |
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Hypomagesaemia? Causes? |
Reflects serum concentration less than 1.7mg/dL ■ Chemotherapy Agents ■ DM ■ Diuretics |
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Hypomagnesaemia Clinical Manifestaions |
■ Muscle Weakness ■ Cramps ■ Seizures ■ Heart Rhythm abnormalities |
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Hypomagnesaemia Interventions |
■ Oral Magnesium supplement (mild hypomag) ■ IV Magnesium (moderate-life threatening hypomag) |
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Chloride - Key Characteristics |
■ Normal serum range: 96-106 mEq/L ■ Most abundant anion in ECF ■ Combines with Na to form salts ■ Regulated by kidneys |
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Chloride Responsibilities |
■ Water Balance ■ Acid Based Balance ■ Osmotic Pressure |
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Hyperchloremia? Causes? |
Abnormal chloride serum level greater than 106mEq/L. ■ Excessive intake or retention by kidneys - metabolic acidosis. |
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Hyperchloremia - Clinical Manifestations |
■ Arrhythmias ■ Decreased Cardiac output ■ Muscle Weakness ■ Kussmaul's respirations (deep laboured breathing pattern) |
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Hyperchloremia interventions |
■ Restore fluid and electrolyte balance |
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Hypochloremia? Causes? |
Abnormal serum level less than 96mEq/L ■ Prolonged vomiting ■ Continual gastric suctioning |
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Hypochloremia Clinical Manifestations |
■ Metabolic Alkalosis ■ Nerve Excitability ■ Muscle Cramps ■ Hypoventilation |
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Hypochloremia interventions |
■ Hypertonic replacement solution ■ Increase in dietary calcium (inversely proportional) |
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Phosphate - Key Characteristics |
■ Normal serum range: 2.5-4.5 mg/dl ■ Found in the bones ■ Regulated by intake and kidneys ■ Inversely proportional to Calcium |
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Phosphate Responsibilities |
■ Acid Based Balace ■ Muscle Function |
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Hyperphosphatemia Causes |
Abnormal phosphorous serum level greater than 4.5 mg/dl ■ Renal Failure ■ Low intake of calcium ■ Chemotherapy |
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Hyperphosphatemia clinical manifestations |
■ Neuromuscular changes ■ ECG abnormalities ■ Parenthesis-fingertips/mouth |
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Hyperphosphatemia interventions |
■ Phosphate binders - aluminium salts, calcium carbonate ■ Decrease in dietary phosphorous |
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Hypophosphatemia Causes |
Serum concentration less than 2.5mg/dl ■ Malabsorption disease - crohn's ■ Malnutrition (anorexia or alcoholism) |
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Hypophosphatemia - Clinical Manifestations |
■ Bone and muscle pain ■ Mental changes ■ Chest Pain ■ Respiratory Failure |
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Hypophosphatemia Interventions |
■ Oral Phosphate Supplements ■ Increase in dietary phosphorous ■ Feeding and attention to underlying eating disorders or substance abuse. |
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Bicarbonate - Key Characteristics |
■ Normal Range: 18-30 mEq/L ■ Determining the pH of the blood (acid based balance) |
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High bicarbonate levels? Causes? |
Serum concentration greater than 30mEq/L ■ Metabolic Acidosis ■ Lung Diseases - COPD ■ Severe Vomiting |
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High Bicarbonate - Clinical Manifestations |
■ Chest Pain ■ Palpitations ■ Nausea and Vomiting ■ Abdominal Pain |
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Low Bicarbonate Levels Causes |
Serum level less than 18mEq/L ■ Metabolic Acidosis ■ Kidney Disease ■ Chronic Diarrhoea |
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Low Bicarbonate Clinical Manifestations |
■ Acidic Urine ■ Abdominal Pain ■ Nausea and Vomiting ■ Respiratory Depression |
