H356 Biophysical Processes: Medsurg 1 Exam Study Guide

fluid/electrolytes help to maintain _______

homeostasis

T/F: fluid/electrolyte has a narrow window for balance

true

water content constitutes for what percent of adult body weight?

50-60%

what group of people have decreased thirst sensation, slowed peristalsis and metabolism that leads to less hydration and water concentration?

older adults

older adults decrease in fluid concentration places them at risk for ____ due to _____

imbalance; slowed metabolism

which gender tends to hold less water content and why?

female- less muscle mass

why do infants have higher fluid content than adults?

higher metabolism and quicker peristalsis

the increased ECF in children makes them more susceptible to

rapid fluid loss

intracellular cation

Potassium (K+)

intracellular anion

Phosphate

extracellular cation

Sodium

extracellular anion

Chloride

diffusion

this is an example of

diffusion

movement of molecules across a permeable membrane from high to low concentration

glucose

example of facilitated diffusion (using carrier to move molecules)

active transport

process in which molecules move against concentration gradient requiring external energy

>295

fluid volume deficit value

fluid volume excess value

280-295 mOsm/kg

normal plasma osmolality value

edema

fluid shifting to interstitial space causes

first spacing

normal distribution of fluid

second spacing

abnormal distribution/edema is what type of spacing?

third spacing

fluid is trapped where its difficult/impossible for it to move back into cells or vessels is what type of fluid spacing?

hypothalamus

what aspect of the brain responsible for sensing fluid deficit/increase?

identify the fluid imbalance based off manifestations:

restlessness, drowsiness, lethargy, confusion, postural hypotension, tachycardia, tachypnea, weakness, dizziness, weight loss, seizure, coma

decreased skin turgor, cap refill and urine output

hypovolemia

identify the fluid imbalance based off manifestations:

headache, confusion, lethargy, peripheral edema, jugular venous distention, bounding pulse, hypertension, dyspnea, crackles, pulmonary edema, muscle spasms, seizures, coma

hypervolemia

diuretics, fluid restriction, sodium restriction

what interventions can be done to treat FVE?

elevated BUN, sodium and urine osmolality indicate what imbalance?

fluid volume deficit

low BUN, sodium and urine osmolality indicate what imbalance?

fluid volume excess

sunken fontanelle

what indicates fluid deficit on infants?

abdomen

when assessing fluid status on children, skin turgor should be checked where?

when patient requires two+ fluids at different rates

when are secondary lines used?

osmolality

sodium changes are typically associated with parallel changes in ______

kidneys

sodium loss is regulated by the

identify the electrolyte imbalance:

thirst, change in mental status, confusion, restlessness, lethargy FVD symptoms

hypernatremia

overload of fluids can cause cerebral edema or neurological issues

why do you have to gradually increase fluids when treating hypernatremia?

identify the imbalance:

headache, irritability, difficulty concentrating, confusion, vomiting, seizures, coma

hyponatremia

diarrhea, N/V, fistula, K+ sparring diuretics, wounds, etc

what are common causes of hyponatremia?

Chloride normal range

98-106 mEq/L

Bicarbonate (HCO3-) normal range

22-26 mEq/L

Phosphate normal range

3.0-4.5 mg/dL

Calcium normal range

9-10.5

Magnesium normal range

1.3-2.1 mEq/L

Potassium normal range

3.5-5.0 mEq/L

Sodium normal range

136-145 mEq/L

interventions for hyponatremia from water excess

fluid restriction, loop diuretics, hypertonic solution (severe)

interventions for hyponatremia from abnormal fluid loss

replace fluids with sodium containing solution, increase oral intake, withhold diuretics

What are the causes of hyperkalemia?

-impaired renal excretion

-ICF--->ECF

-massive intake

identify the imbalance:

cardiac dysrhythmias, cramping leg pain, weak or paralyzed skeletal muscles, abdominal cramping or diarrhea

hyperkalemia

what are the effects on an ECG with hyperkalemia?

peaked T wave

what is a major potential complication of hyperkalemia?

dysrhythmias

normal hemoglobin levels

Male: 14-18 g/dL

Female: 12-16 g/dL

normal hematocrit levels

Male: 41%-50%

Female: 36-48%

medical complications that can cause hypokalemia

medications (hydrochlorothiazide, lasix, loop diuretics, laxative misuse), ileostomy, etc

identify the imbalance:

cardiac dysrhythmias, skeletal muscle weakness, weak respiratory muscles, decrease GI motility, hyperglycemia

hypokalemia

what change on ECG indicates hypokalemia?

prominent U wave

how urine output is required to reach adequate amount?

0.5 mg/kg/hr

what are the safety points for administering KCl IV?

-always dilute

-never push/bolus

-invert bag multiple times for distribution

- do not add to hanging IV bag

- should not exceed 10 mEq/hr unless critical setting

calcium is balanced and controlled by

parathyroid hormone

- calcitonin

what is 2/3 the cause of hypercalcemia?

hyperparathyroidism

identify the imbalance:

fatigue, lethargy, weakness, confusion, bone pain, fractures, polyuria, dehydration, hallucinations, seizure

hypercalcemia

hypercalcemia puts the patient at risk for

pathological fractures

a positive trousseau or chvostek is an indication of

hypocalcemia

what two electrolytes work reciprocal of one another?

phosphate + calcium

(high phosphate = low calcium, vice versa)

what controls phosphate levels?

PTH

what is the most common cause of hyperphosphatemia?

acute kidney injury or CKD

identify the imbalance:

neuromuscular irritability/tetany, calcified deposits in tissue, arteries, skin, kidneys, corneas

asymptomatic unless calcium binding

hyperphosphatemia

identify the imbalance:

CNS depression, muscle weakness/pain, respiratory and heart failure, rickets, osteomalacia

hypophosphatemia

what electrolyte is responsible for metabolism of carbs, cellular health, BP regulation, ATP production, etc?

magnesium

identify the imbalance:

lethargy, N/V, impaired reflexes, muscle paralysis, respiratory and cardiac arrest

hypermagnesemia

identify the imbalance:

hyperactive DTR, muscle cramps, tremors, seizures, cardiac dysrhythmias (v-fib), corresponding hypocalcemia/hypokalemia

- can occur with digoxin toxicity

hypomagnesemia

what type of IV fluids contain more water than electrolytes, moving water from ECF to ICF for maintenance most commonly?

hypotonic fluids

what type of IV fluids only expands ECF and helps to replace and increase fluid volume and urine output?

isotonic

what IV fluid is isotonic, free water w/o electrolytes, provides 170 cal/L, and used to replace water loss, hypernatremia, and prevent ketosis?

D5W

what IV fluid is compatible with blood and most medications?

normal saline

what type of IV fluids expands and raises osmolality of ECF, and requires frequent monitoring of BP, lung sounds and serum sodium levels?

hypertonic

what IV fluid is hypertonic and provides highest dextrose concentration without requiring central line?

D10W

what IV fluids are considered volume expanders that stay in vascular space and increase osmotic pressure?

colloids

what procedure may be indicated when using long term IV therapy, multiple solutions, irritating medications, large volumes fo infusions, TPN?

PICC lines, central Cath

what is the most common location for central lines?

subclavian, internal jugular

what type of infusion is the primary line and/or secondary line with long term infusion?

continuous infusion

what type of infusion has a saline lock (for emergency meds) and IVPB?

intermittent infusion

pH range

7.35-7.45

pH < 7.35

acidosis

pH > 7.45

alkalosis

PaCO2 normal range

35-45 mm Hg

what acid-base imbalance is always due to a respiratory problem with inadequate CO2 excretion (hypoventilation)?

causes: COPD, infection, cardiac disease, pneumonia, atelectasis, drug overdose on respiratory agent, inadequate mechanical ventilation

respiratory acidosis

what acid base imbalance is described:

sudden increased pulse, decreased BP, mental changes, warm/flushed skin, hypoventilation, headache, dyspnea, hyperkalemia, drowsiness, muscle weakness, disorientation

respiratory acidosis

which acid base imbalance is always due to hyperventilation?

causes: pneumonia, embolism, acute anxiety, stimulant medications, neural disorders (stroke)?

respiratory alkalosis

identify the acid-base imbalance described:

lightheadedness, inability to concentrate, numbness/tingling, N/V, rapid deep breathing, tachycardia, hypokalemia, lethargy?

respiratory alkalosis

what is the treatment for respiratory acidosis?

improve ventilation

what is the treatment for respiratory alkalosis?

correct cause of hyperventilation (O2 therapy, rebreathing)

what acid base imbalance is most commonly due to renal failure?

causes: diabetic keto acidosis**, lactic acidosis, severe diarrhea

metabolic acidosis

identify the acid-base imbalance:

headache, confusion, increased respirations, KUSSMAUL RESPIRATIONS, decreased BP + cardiac output, HYPERKALEMIA, warm/flushed skin, changes in LOC, watery diarrhea

metabolic acidosis

what acid base imbalance occurs most commonly due to vomiting, gastric suction or medications (long term diuretics)?

metabolic alkalosis

identify the acid-base imbalance:

dysrhythmias, confusion, HYPOKALEMIA, tachycardia, restlessness followed by lethargy, compensatory hypoventilation, tremors

metabolic alkalosis

Normal BUN range

10-20 mg/dL

Normal creatinine levels

0.8-1.4 mg/dL

process of oxygen transported to cells and carbon dioxide transported from cells

gas exchange

breathing is an involuntary function controlled by the

medulla