Exam 3 prep Flashcards


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1

ions with net positive charge

cations

2

ions with net negative charge

anions

3

includes all fluid present within the cells

intracellular fluids (ICF)

4

includes all fluid being found outside the cell

extracellular fluid (ECF)

5

is considered interstitial fluid, and as it enters the lymphatic system, it returns protein and excess interstitial fluid to the circulatory system

lymph

6

accounts for 8% of total body water and is located in the intravascular system

plasma

7

what makes up the fluid composition in our bodies?

  • cations
  • anions
  • lymph
  • plasma
8

65% of total body water (or 2/3) is found in

ICF

9

35% of total body water is found in

ECF

10

is only 2% of total body water and consists of fluids located in the GI, respiratory, and urinary tract and glandular, intraocular, and cerebrospinal fluids

transcellular fluid

11

area surrounding tissue cells

interstitial spaces

12

the movement of water through a semipermeable membrane from an area of higher water concentration to an area of lower water concentration

osmosis

13

moves solutes, or particles from an area of higher concentration to an area of lower concentration

diffusion

14

is the process by which water and dissolved substances (solutes) cross a membrane as a result of hydrostatic pressure

filtration

15

homeostasis between fluids and regulation of I&O are achieved by the

renal, endocrine, & respiratory systems

16

primary organs in regulating fluid volume and electrolyte balance to maintain homeostasis

kidneys

17

hardening of the glomeruli in the kidney

glomerulosclerosis

18

what are some age related changes seen in the renal system?

  • renal blood flow decreases due to vascular changes
  • kidney size decreases
  • there is a decrease in GFR
19

selective reabsorption of water and electrolytes occurs in the glomeruli, maintaining

homeostasis of plasma osmolality and fluid

20

control of fluid and electrolyte balances is maintained by

the renin-angiotensin-aldosterone system, antidiuretic hormone (ADH), and natriuretic peptides

21

approximately _____ of water is lost through the lungs daily

300mL

22

the amount of water lost through the lungs daily, can be higher during

hyperventilation or tachypnea or if the pt is receiving mechanical ventilation

23

insensible water loss occurs through the

skin, lungs, and stool

24

increased insensible water losses can also be seen in hypermetabolic states such as

trauma, burns, fever, and thyroid crisis

25

what are the indicators of fluid status?

  • BUN
  • creatinine
  • specific gravity
26

normal value for BUN?

8-21

27

normal value for creatinine?

0.5-1.2

28

normal value for specific gravity?

1.005-1.03

29

what is the best indicator of kidney function?

creatinine

30

measures the nitrogen portion of urea and serves as a measure of glomerular function

blood urea nitrogen (BUN)

31

increase in BUN due to decreased perfusion of the kidneys are seen in impaired renal function secondary to

sepsis, shock, stress, and CHF

32

by-product of muscle creatinine phosphate metabolism

creatinine

33

creatinine production is constant as long as __________ remains constant

muscle mass

34

what is the normal ratio of BUN to creatinine?

10:1 to 20:1

35

measurement of dissolved chemicals in urine and reflects the ability of the kidneys to concentrate urine

specific gravity

36

specific gravity is affected by

the number and size of particles (minerals and salts) in urine

37

what impacts the normal range of specific gravity?

  • hydration status
  • urine volume
  • # of particles
38

high values of specific gravity indicate

concentrated urine

39

high values of specific gravity can be seen in patients with

decreased renal perfusion or dehydration or in patients with SIADH

40

lower values of specific gravity indicate

dilute urine

41

lower values of specific gravity are seen with

  • diuretic use
  • diabetes insipidus
  • increased fluid intake
42

what are some age related changes R/T fluid status?

  • decreased taste, thirst, and smell
  • comorbidities
  • medications
  • financial resources
  • cognitive changes
  • immobility
43

decrease in fluid in the body and can occur in the interstitial, intravascular, or intracellular spaces

hypovolemia/fluid volume deficit

44

fluid volume deficits (hypovolemia) occur as a result of

  • excessive loss of fluids
  • insufficient intake of fluid
  • fluid shifts
45

how are fluid lost in GI?

  • vomiting
  • diarrhea
  • NG suction
46

some causes of fluid losses include

  • hemorrhage
  • diabetes insipidus
  • diabetic ketoacidosis
  • adrenal insufficiency
47

fluid shifts into the interstitial space

third spacing

48

occurs when fluid leaves the vascular space and enters the space between cells, becoming unavailable to support normal physiological activities

third spacing

49

how are labs affected with hypovolemia?

K+

Na+

H&H

serum osmolality

BUN: creatinine

urine specific gravity

urine osmolality

K+ decreases

Na+ increases

H&H: dependent on the cause

serum osmolality: increases

BUN: creatinine: increase

urine specific gravity: increase

urine osmolality: increase

50

clinical manifestations of hypovolemia?

  • weight loss
  • loss of skin turgor
  • concentrated UOP
  • oliguria
  • thirst
  • dry mucous membranes
51

low urine output

olguria

52

severe, rapid fluid losses may be seen in

  • hemorrhage
  • burns
  • extensive losses from the GI tract
53

additional clinical manifestations observed with significant fluid loss may include

  • weak, rapid peripheral pulses
  • flattened neck veins
  • hypotension
  • anxiety
  • restlessness
  • cool, clammy, pale skin
54

preferred method of water replacement if the fluid deficit is not severe

intake of oral fluids

55

IV solutions that expand plasma volume and correct hypotension?

0.9% NaCl or LR

56

IV solutions that can replace deficits in total body water and are used as maintenance fluids

D5 0.45% NaCl or 0.45% NaCl

57

physical assessment findings of hypovolemia

  • dry, mucous membranes
  • poor skin turgor
  • weak peripheral pulses
  • changes in VS
  • wt loss
58

what are some signs of correction of fluid deficit?

  • moist mucous membranes
  • improved skin integrity
  • increase in UOP
59

patients with significant hypovolemia are at risk for ____________ or ________ hypotension

orthostatic or postural hypotension

60

what can develop as a complication of fluid volume deficit?

hypovolemic shock

61

________ makes you thirsty

aldosterone

62

occurs as a result of increased water and sodium retention

hypervolemia: fluid volume excess

63

an increase in sodium always results in an increase in

water retention to maintain equilibrium

64

disease processes or conditions that result in retention of sodium and water include

  • cirrhosis
  • heart failure
  • stress conditions causing a release of ADH and aldosterone
  • adrenal gland disorders
  • use of corticosteroids
65

ingestion of excessive amounts of ________ in the diet also contributes to the development of fluid volume excess

salt

66

in fluid volume excess, hematocrit and BUN may be ___ secondary to______

low secondary to dilution

67

how are the following labs effected with hypervolemia?

K+

Na+

serum osmolality
urine specific gravity

urine osmolality

K+: increase

Na+: decrease

serum osmolality: decrease

urine specific gravity: decrease

urine osmolality: decrease

68

manifestations of fluid volume excess?

  • weight gain
  • ascites
  • edema
  • increased UOP
69

cardiac manifestations of fluid volume excess include:

  • hypertension
  • tachycardia
  • elevated central venous pressure
  • development of S3 heart sounds
  • JVD
70

respiratory symptoms of fluid volume excess include:

  • cough
  • tachypnea
  • adventitious breath sounds (crackles, wheezing)
  • orthopnea
  • decreased oxygen saturation
71

in patients at risk for fluid volume excess, what do we need to limit?

daily intake of fluid and sodium

72

use of _____ may be required to promote excretion of excess fluid volume

diuretics

73

worsening heart failure with progressive __________________ is a complication of fluid volume excess

pulmonary edema

74

potentially life threatening condition due to progressive hypoxia that develops as oxygen exchange is compromised because of fluid in the alveoli

pulmonary edema

75

each kg of wt is equivalent to _______ of fluid

1L

76

how can we, as nurses, assist patients in preventing the development of fluid volume excess?

  • limiting intake of sodium and fluid
  • stress the importance of daily weight
77

most prevalent electrolyte in ECF

sodium

78

control the distribution of water within the body

sodium

79

normal value for serum sodium

135-145

80

normal value for serum chloride

97-107

81

normal value for serum potassium

3.5-5

82

normal value for serum magnesium

1.6-2.2

83

normal value for total serum calcium

8.2-10.2

84

normal value for ionized calcium

4.6-5.3

85

normal value for serum phosphorus

2.5-4.5

86

normal value for serum osmolality

275-295

87

normal value for urine osmolality

250-900

88

what are the intracellular electrolytes?

  • potassium
  • magnesium
  • phosphorus
89

what are the extracellular electrolytes?

  • sodium
  • chloride
  • bicarbonate
90

the action potential created by the sodium potassium pump is responsible for

cardiac and skeletal muscle contractions and nerve impulse transmission

91

sodium may be lost secondary to

  • diarrhea
  • vomiting
  • hyperglycemia with glycosuria
  • pesrpiration
92

clinical manifestations of hypovolemic hyponatremia include:

  • weight loss
  • orthostatic hypotension
  • tachycardia
  • abdominal cramping
  • polydipsia
93

increased thirst

polydipsia

94

neurological clinical manifestations of hyponatremia:

  • lethargy
  • headache
  • confusion
  • gait disorders
  • N/V
95

treatment for hyponatremia?

  • fluid restriction
  • in severe neurological symptoms, 3% NaCl
  • oral sodium supplements
  • loop diuretics
96

what IV solution do we use to treat hypovolemic hyponatremia

isotonic solutions (NaCl)

97

complications of hyponatremia include neurological symptoms such as:

  • lethargy
  • confusion
  • weakness
  • fatigue
  • muscle cramps
  • postural hypotension
98

in severe acute hyponatremia, what can occur?

  • seizures
  • coma
  • death
99

often occur as a direct result of water loss and/or the loss of sodium and water

hypernatremia

100

water losses can occur from

  • diabetes insipidus
  • hyperglycemia
  • neoplasm
  • hypercalcemia
  • hyperkalemia
101

determines osmolality of ECF

sodium

102

sodium levels are controlled by:

  • thirst
  • ADH
  • renin-angiotensin-aldosterone system
  • sodium-potassium pump
103

sodium content of common foods

  • frozen pizza, plain cheese: 450-1200mg in 4 oz
  • soup (tomato), reconstituted: 700-1260 mg in 8 oz
  • tomato juice: 340- 1040mg in 8 oz (approximately 1 cup)
104

clinical manifestations of hypernatremia include nonspecific neurological changes such as:

  • neuromuscular irritability
  • agitation
  • restlessness
  • lethargy
  • coma
  • seizures
105

patients with hypernatremia may complain of thirst and demonstrate signs of dehydration, including

  • tachycardia
  • dry mucous membranes
  • flushed skin
  • decreased urine output
  • orthostatic hypotension
106

what serves as the mechanism to prevent the development of hypernatremia?

thirst

107

correction of the water deficit should occur over

48-72 hours

108

what IV solution is used to treat hypernatremia?

0.45% NaCl or D5W (hypotonic fluids)

109

caution should be taken in order to prevent rapid correction of hypernatremia that may lead to fluid shifts into brain tissue, potentially resulting in

cerebral edema

110

if hypernatremia is due to fluid volume deficits, cardiac symptoms such as ______________ may also be present

orthostatic hypotension and tachycardia

111

is found in the ECF and is the major anion as sodium chloride

chloride

112

an important indicator of the nature of acid-base disturbances

relationship between serum chloride and bicarbonate levels

113

the anion most often exchanged with chloride

bicarbonate

114

normal chloride levels are achieved through

excretion and reabsorption of chloride in the kidneys

115

what are some causes of hypochloremia?

  • severe vomiting
  • burns
  • chronic respiratory acidosis
  • NG suctioning
  • metabolic alkalosis
  • Addison's disease (adrenal cortex insufficiency)
116

occurs as a result of increases in plasma bicarbonate concentration due to the loss of hydrogen in the GI tract

hypochloremia in metabolic alkalosis

117

patients with hypochloremia may exhibit:

  • irritability
  • hypotension
  • tetany
  • shallow respirations
  • hyperexcitability of muscles and nerves
118

if hypokalemia is also present with hypochloremia, _____________ may develop

cardiac dysrhythmias

119

what IV solutions do we give to patients with hypochloremia?

0.45% or 0.9% NaCl

120

chloride levels parallel ____________

sodium levels

121

in the presence of hypochloremia, hyponatremia and water excess can result in

seizures and coma

122

what changes should we monitor our hypochloremia patients for?

changes in:

  • LOC
  • respiratory effort
  • muscle control
123

works well with Na to help regulate osmotic pressure

chloride

124

can result in bicarbonate loss, resulting in metabolic acidosis and hypernatremia

hyperchloremia

125

in hypernatremia, chloride is reabsorbed in the kidneys to

maintain ion neutrality

126

clinical manifestations of hyperchloremia include

  • deep and rapid respirations
  • lethargy
  • tachypnea
  • decreased cognitive ability
  • elevated BP
127

what IV solutions do we give to our patients with hyperchloremia?

hypotonic: 0.45% NaCl

128

may be utilized to increase bicarbonate levels to increase the urinary excretion of chloride

a sodimu bicarbonate infusion

129

if left untreated, patients with hyperchloremia can develop

  • cardiac dysrhythmias
  • decreased cardiac output
  • coma
130

potassium is important for the metabolic processes of the body and

protein synthesis

131

can reflect a real loss of potassium stores or a temporary shift of potassium into the cell

hypokalemia

132

GI losses of potassium occur as a result of

  • diarrhea
  • vomiting
  • gastric suctioning
133

hypokalemia secondary to GI losses can also be seen in patients with:

  • anorexia
  • bulimia
  • excessive use of laxatives
134

in patients with hyperinsulin secretion, potassium shifts into hepatic and muscular cells are promoted because

insulin makes cells more permeable to potassium

135

98% in ICF

potassium

136

is essential in neuromuscular function

potassium

137

potassium content of common foods?

  • spinach: 839mg in 1 cup cooked
  • baked potato w/ skin: 738mg in 1 small potato
  • tomato juice: 556mg in 1 cup
  • mushrooms: 555 mg in 1 cup cooked
138

what are some clinical manifestations of hypokalemia?

  • weakness
  • lethargy
  • hyporeflexia
  • N/V
  • constipation
  • abdominal cramping
  • ECG changes (ST depression)
139

in severe hypokalemia, ________ or _____ can occur

cardiac or respiratory arrest

140

daily intake of ________ is essential for normal homeostasis

potassium

141

the total maximum 24-hour dose of potassium is

150mEq

142

complications of hypokalemia can include

  • muscle weakness and cramping
  • decreased GI motility
  • cardiac dysrhythmias
  • respiratory failure
  • cardiac or respiratory arrest
  • death
143

rarely seen in patients with normal kidney function

hyperkalemia

144

hyperkalemia can occur as a result of:

  • acute or chronic renal failure
  • medications
  • excessive intake of potassium rich foods
  • shift of intracellular potassium to the extracellular space
145

occurs as a result of leakage of potassium from the cell, giving a false elevation of serum potassium levels

pseudohyperkalemia

146

patients with hyperkalemia may complain of

  • generalized fatigue
  • muscle cramps
  • palpitations
  • paresthesias
  • weakness
147

the most important and potentially life-threatening consequence of hyperkalemia is its effect on

the cardiac electrical conduction system

148

initial ECG changes with hyperkalemia are

  • narrow and peaked T-waves
  • ST depression
  • shortening of the QT interval
149

once the presence of hyperkalemia is recognized, an ___ should be obtained to asses for

ECG; to assess for changes in cardiac rate and rhythm

150

in metabolic acidosis from acute renal failure or lactic acidosis, the administration of ________ may be required

sodium bicarbonate

151

how can we cause and immediate shift in potassium?

amp of dextrose, 10 u insulin, & calcium gluconate

152

elimination of potassium can also be achieved through the use of

loop diuretics such as furosemide (Lasix) or bumetanide (Bumex)

153

the use of GI cation exchangers such as _________________is another means to lower potassium levels

sodium polystyrene sulfonate (Kayexalate)

154

presence of a U wave

fuck idk

155

has an interrelationship with the sodium-potassium pump

magnesium

156

part of DNA and RNA transcription

magnesium

157

Mg is needed for healthy

  • bones
  • teeth
  • nerve/muscle function
158

magnesium alters the effects of calcium on smooth muscles, causing them to

relax

159

magnesium antagonizes calcium ions at the presynaptic junction, reducing the

release of acetylcholine

160

magnesium is also beneficial in preventing

  • MI
  • stroke
  • osteoporosis
161

is seen in patients with malnutrition and excessive excretion of magnesium via the renal system

hypomagnesemia

162

people who chronically abuse alcohol are at risk for developing hypomagnesemia because of

poor nutritional intake and GI malabsorption issues

163

clinical manifestations commonly seen in hypomagnesemis?

  • muscle weakness and cramping
  • tetany
  • hyperactive reflex
  • tremors
  • Trousseau and Chvostek signs
164

CNS symptoms of hypomagnesemia include:

  • disorientation
  • psychosis
  • vertigo
  • irritability
  • combativeness
165

cardiac symptoms of hypomagnesemia include:

  • increases in BP
  • tachycardia
  • ventricular irritability
166

in patients with severe hypomagnesemia, ________ can develop because of alterations in electrical activity in the CNS

seizures

167

life-threatening complications of hypomagnesemia

cardiac arrest from ventricular fibrillation and seizures

168

what are some nursing interventions for hypmagnesemia?

  • cardiac monitoring b/c of the risk of cardiac dysrhythmias
  • seizure precautions b/c of CNS hyperexcitability
  • fall precautions b/c of muscle weakness and disorientation
169

is uncommon b/x of the effective excretion by the kidneys

hypermagnesemia

170

what are the most common causes of hypermagnesemia?

  • over-replacement of magnesium deficits
  • renal insufficiency or renal failure
171

food sources for magnesium?

  • halibut: 90mg in 3oz cooked
  • almonds, dry roasted: 80mg in 1oz
  • cashews, dry roasted: 75mg in 1 oz
172

breakdown of muscle tissue that leads to the release of muscle fiber contents into the blood

rhabdomyolysis

173

what are some soft tissue injuries?

  • rhabdomyolysis
  • burns
  • sepsis
  • trauma
  • tissue lysis syndrome
174

what are some cardiac symptoms in hypermagnesemia?

  • hypotension due to vasodilation
  • dysrhythmias such as bradycardia
  • atrial fibrillation
  • intraventricular conduction delays exhibited by widening of the QRS complexes
175

CNS clinical manifestations include:

  • drowsiness
  • lethargy
  • muscle weakness
  • loss of deep tendon reflexes
  • paralysis
  • coma