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137 Cards in this Set
- Front
- Back
ICF
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Intracellular Fluid
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ECF
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Extracellular Fluid
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ISF
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Interstitial Fluid
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Intracellular Fluid:
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maintains cell size and function
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Intravascular fluid:
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inside blood (plasma)
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Interstitial fluid:
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-between cells
-outside vascular space |
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transcellular splace
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small amount of fluid in GI tract, cerebrospinal fluid, pleural, synovial, & peritoneal fluids
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Electrolytes:
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-substance which splits into ions when dissolved in water
-able to carry eletrical current |
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Primary Electrolytes in body
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Na+ (sodium)
K+ (potassium) Ca2+ (calcium) |
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What needs to be in correct balance for cells to function properly?
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electrolytes
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Fluids & electrolytes (solutes) constantly shift between compartments by 4 processes:
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Osmosis
Diffusion Filtration Active Transport |
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Osmosis:
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movement of solvent (water) across semi-permeable membrane from area of lower concentration to higher
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What is albumin important for?
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to keep fluid from shifting out of intravascular space
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colloid osmotic pressure (OR) oncotic pressure
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Keeps fluid from leaking out of vascular space
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Diffusion
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movement of solutes from higher concentration to lower
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Active transport
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molecules move from area of lower to higher concentration, requires energy
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Filtration
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-transfer of water & dissolved substances thru membrane from region of high pressure to region of lower pressure
-Occurs in kidney glomerular capillaries & in blood capillaries |
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What is generally higher on arterial side & lower on venous side of capillaries?
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Hydrostatic Pressure
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Hydrostatic Pressure
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-Force within a fluid compartment
-Vascular space or tissues |
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Oncotic Pressure
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-Osmotic pressure exerted by proteins, especially albumin)
-Large molecules hold fluid in vascular space |
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Osmolality
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-Osmotic force of solute per unit of wt. of solvent mOsm/kg or mmol/kg
-Describes fluids inside the body |
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Osmolarity
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-Total milliosmoles of solute per unit of volume of solution mOsm/L
-Describes fluids outside the body |
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Isotonic
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-same concentration of particles as plasma
-just increase fluids -stays were it is |
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Hypertonic
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-greater concentration of particles than plasma
-post op, fluid into space outside vascular, -pulls fluid out |
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Hypotonic
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-lesser concentration of particles than plasma
-hydrate cells and interstitial space -pulls fluid in |
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What are the 2 primary body fluid compartments?
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Intracellular Fluid
Extracellular Fluid |
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Subcompartments?
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Intravascular fluid
Interstitial fluid |
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Fluid & electrolytes shift between compartments via which 4 processes?
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Osmosis
Diffusion Filtration Active Transport |
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If someone is malnourished, what type of fluid shift may occur?
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Shifts to the interstitial space
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Edema
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– fluid shift from vascular space to interstitial space
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Third Spacing
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Major fluid shift from intravascular to interstitial space
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Elastic hose (TEDs) or ace wrap helps to decrease edema. HOW?
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Fluid shift into intravascular space because hydrostatic pressure in interstitial space in increased. Fluid moves from area of greater pressure to lesser pressure.
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How much fluid input does your body need?
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2200-2700ml per day
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What conditions may increase skin’s insensible loss?
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exercise
pain fever |
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What GI conditions cause increased fluid loss?
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vomiting
diarrhea |
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What factors may cause an increase in plasma osmolality (solute concentration)?
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eating salty foods
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On I & O, should urine output always be exactly equal to oral & IV intake?
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no
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Dehydration
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is the loss of pure water alone without losing Na
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Fluid Volume Deficit (FVD)
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includes the loss of body fluids and electrolytes
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Fluid Volume Excess FVE
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due to fluid retention
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Assessment for Fluid Balance
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History
Vital signs I&O balance Weight Skin turgor/moisture Mucous membranes Lung sounds JVD Edema LOC Labs |
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1 Liter of Water =
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2.2 lb or 1kg
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Urine specific gravity
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concentrated (>1.025)
dilute (<1.01) |
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Goals for treating F& E imbalance:
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-underlying cause
-correct the underlying cause -stabilize pH -replace deficient F & E or remove excess |
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Hypervolemia
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over-hydration
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Fluid volume Excess Etiology:
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-excessive Na intake
-compromised regulatory systems (renal insufficiency, CHF, Cirrhosis, endocrine disorders) |
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S/SX of fluid volume excess
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-weight gain
-VS- increased BP, HR, RR -dyspnea, orthopnea -pitting edema w/tight shiny skin -JVD -moist crackles -cough -headache -agitation -confusion -Labs |
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FVE Interventions:
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-daily weights
-elevate head of bed -elevate affected extremities -skin care to protect areas of edema -meds -monitor I & O -restrict fluid if ordrered -TEDs hose |
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FVE fluid restriction
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-explain to pt
-teach ice chips, icre cream, gelatin are fluids -teach client how to divide fluid throughout day |
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Hypovolemia
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dehydration
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S/SX of FVD
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-Negative balance of intake/output
-Concentrated urine, specific gravity -Weight loss -Dry skin/mucous membranes -Poor skin turgor, tenting >20-30sec -*Weakness, restlessness, confusion -Concentrated Hct. & electrolytes -Severe FVD → dec. cardiac output, possible shock |
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FVD Interventions
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I & O
daily weight VS labs neurological status respiratory status cardiac function renal function |
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FVD Interventions Actions:
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encourage fluids
IV Oral care skin care cover wounds to minimise loss manage V&D with meds pt. education |
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FV Excess
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increase weight
increased BP Bounding Pulse increased RR Urine diluted Skin turgor-edema eye bulging JVD |
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FV Deficit
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decreased weight
decreased BP Weak pulse increased RR Urine Darker skin-tenting Mucous membranes-dry Eye-sunken flat veins |
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Sodium
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aids in generation & transmission of nerve impulses
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What is the normal range for sodium?
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Range 135-145 mEq/L
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How does kidneys regulate sodium?
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by excreting/retaining water
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What effects osmolality & water distribution between ECF & ICF?
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Sodium
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Abnormal Na levels may indicate?
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water imbalance or sodium imbalance or both
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Water Excess (sodium levels)
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<135 mEq/L
Hyponatremia |
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Water Deficit (sodium levels)
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>145mEq/L
Hypernatremia |
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Hyponatremia
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Sodium & fluid Loss
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S/SX Hyponatremia:
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-Na<135mEq/L
-HA, lethargy, irritability, apprehension, confusion, seizures, coma -s/sx dehydration -hypotension, dizziness -N, V, D, cramping -muscle weakness |
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CNS-
Muscle- |
CNS-Sodium
Muscle-Potassium |
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If hyponatremia due to FVE, what s/sx would also be present?
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crackles in lungs
edema bounding pulse |
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Normal labs for potassium
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3.5-5.0
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Potassium is needed for:
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conduction of nerve impulses, normal cardiac rhythm, & muscle contraction
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Hypokalemia
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decreased potassium
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S/SX hypokalemia:
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fatigue
muscle weakness leg cramps N & V ileus paresthesia plyuria hyperglycemia EKG changes weak & irregular pulse ventricular arrhythmias |
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dietary sources of K+
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-Chocolate, dried fruit, nuts, seeds
-Fresh fruits – oranges, bananas, apricots, cantaloupe, tomatoes -Meats & vegetables esp. beans, potatoes, mushrooms, carrots |
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Hyperkalemia is caused by:
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excess intake in IVs, salt substitutes, or meds with K+, hypovolemia, blood transfusions
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Calcium aids in
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transmission of nerve impulses, myocardial contractions, blood clotting, formation of teeth & bone, muscle contractions
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Serum Ca levels usually show total of 3 types
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-Ionized (free)
-bound w/protein (albumin) -complexed w/ phosphate, citrate, or carbonate |
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Calcium balance controlled by:
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Parathyroid hormone (PTH)
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Parathyroid hormone (PTH)
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Stimulated by low serum Ca levels to move Ca out of bone, increased GI absorption, & renal tubule reabsorption
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Calcitonin
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Produced by thyroid gland. Responds to Ca. Opposite effects of PTH listed above.
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Vitamin D
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stimulates absorption of Ca from GI tract
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Hypercalcemia Signs & Symptoms:
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-“Warm milk makes you sleepy”
-Lethargy, weakness, depressed reflexes -Decreased memory, confusion psychosis -Anorexia, N, V, polyuria, dehydration -Bone pain, fractures -Ventricular arrhythmias, digitalis effect |
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Hypercalcemia rates
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-2/3 caused by hyperparathyroidism
-1/3 caused by malignancy breast, lung, multiple myeloma |
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Prolonged immobilization
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results in increased Ca from bone mineral loss
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Hypocalcemia is caused by:
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-Anything that decreased production of -PTH such as trauma or surgery to parathyroid gland, neck
-CRF, acute pancreatitis, loop diuretics -Alcoholism, diarrhea, laxative abuse, decreased albumin |
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decreased ionized Ca
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-Alkalosis
-Multiple blood transfusions of citrated blood |
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Chvostek’s sign for hypocalcemia
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tap on facial nerve in front of ear – muscle contraction occurs
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Trousseau’s sign for hypocalcemia
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-apply BP cuff above systolic pressure for a few min.
-causes carpal spasm |
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Hypocalcemia
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-decreased Ca allows Na to move into cells
-increased nerve excitability & sustained muscle contraction |
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Hypocalcemia S/Sx
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-Fatigue, depression, anxiety, confusion
-Numbness & tingling in extremities & around mouth (early sign) -Dysphagia, Hyperreflexia, muscle cramps |
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Calcium levels are controlled by what 3 things?
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Parathyroid hormone (PTH)
Calcitonin Vitamin D |
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Hypercalcemia is usually caused by
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hyperparathyroidism
cancer |
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High calcium makes the reflexes faster or slower?
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Slower
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Why are fractures more common with high serum Ca levels?
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calcium moves out of the bone
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Chvostek’s & Trousseau’s signs indicate?
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Hypocalcemia
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Hypocalcemia allows ____ to move into cells causing ____ in nerve excitability?
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sodium
increased |
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Protein increases
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oncotic pressure and pulls fluid inward into vascular space
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Albumin indicates
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Plasma proteins (esp. albumin) are indicative of plasma volume
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Protein Imbalances s/sx
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edema from decreased oncotic pressure, slow healing, anorexia, fatigue, anemia, muscle loss
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acid-base balance
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Hydrogen ion concentration in the cellular environment is regulated within extremely narrow limits.
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Acid:
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any substance that can donate H+ ions to other molecules pH<7
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Base (Alkaline):
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any substance that can accept H+ molecules pH>7
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pH scale
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describes the degree of acidity or alkalinity of solutions
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pH of arterial blood should be
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7.35-7.45
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What is the MOST important buffer system in the body ?
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The bicarbonate-carbonic acid buffer system
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Lungs and kidneys regulate
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acid-base balance, but if these organs are diseased won’t respond right
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Lungs
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-react within seconds if a change in pH
-Regulate depth and rate of respiration to retain or excrete CO2 -Compensate for metabolic acidosis or alkalosis |
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Kidneys
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-respond more slowly (Takes hours to days for kidneys to compensate)
-Regulate through excretion or reabsorption of bicarbonate |
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Normal pH levels
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7.35-7.45
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Acidosis
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<7.35
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Alkalosis
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>7.45
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Too much CO2 causes
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Respiratory Acidosis
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Too little CO2 causes
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Respiratory Alkalosis
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Too much bicarb causes
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Metabolic alkalosis
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Too little bicarb causes
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metabolic acidosis
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In arterial blood, which factors cause respiratory acidosis?
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COPD
Drug over dose severe pneumonia |
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In arterial blood, which factors cause respiratory alkalosis?
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Panic attack
pain |
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In arterial blood, which factors cause metabolic acidosis?
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Diabetic ketoacidosis
starvation |
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In arterial blood, which factors cause metabolic alkalosis?
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NG suction
intractable vomiting |
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Respiratory Acidosis
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-anything that causes hypoventilation which leads to increased CO2
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Respiratory Alkalosis
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-anything that causes hyperventilation or blowing off too much CO2
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Hyperventilation
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blows off more CO2 and increases pH to compensate for metabolic acidosis
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Hypoventilation
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retains CO2, decreases pH to compensate for metabolic alkalosis
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Renal Compensation:
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The kidneys influence maintenance of normal acid-base balance by changing rate of excretion or retention of hydrogen and HCO3 ions.
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Kidneys handle increase in blood acids by:
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-Increasing excretion of H+ ions into the urine and returning HCO3 ions to the blood
-Additional serum bicarbonate is made available to absorb more free H+ ions, and normal pH can be reestablished |
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PaCO2
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-partial pressure of CO2
-reflects depth & rate of ventilation -compensates for metabolic acidosis or alkalosis |
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HCO3
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-Bicarb is major renal component of acid-base balance & principle buffer of ECF
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PCO2 normal
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35-45 mm Hg
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HCO3 normal
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22-26mEq/L arterial
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What is the primary collaborative goal if the patient has a fluid and electrolyte imbalance?
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Look for the underline cause
Labs Pt symptoms Look at condition |
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What are major body spaces that contain fluid?
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ICF
ECF |
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Major imbalances in fluid & electrolytes may cause brain cells to shrink or swell which leads to what type of symptoms?
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Neuro symptoms
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What are physiological changes in the elderly that may lead to F&E imbalance?
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Impaired thirst sensation, remind them to drink
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What is the best indication of fluid volume status & changes?
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Weight-take weight at the same time everyday
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With fluid volume deficit (FVD) will electrolyte values appear higher or lower than normal?
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Higher
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Hemoglobin
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will not change dramaticly
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Hematocrit
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will change more dramatic
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How would hypovolemia (dehydration) affect cardiac output?
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lower cardiac output
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How might crushing trauma (cell injury) or burns effect serum K+ levels?
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Increase K+ levels
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How would immobility or malignant tumors affect Ca levels?
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Increase calcium levels
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