!!!!Unit 1: Homeostatic Concepts Exam

Hypophosphatemia

B - bone pain / fractures

O - osteomalacia

N - neuro (irritability, confusion, seizure)

E - erythrocyte destruction (RBC destruction and hemolytic anemia)

hyperphosphatemia

C - convulsions

R - reflexes responsive

A - arrhythmias (prolonged QT)

M - muscle spasms

P - positive trousseaus and Chvostek's

S - sensation of N/T (paresthesia)

Intracellular fluid purpose

help cells maintain their shape and size, and are needed for transport of nutrients, gasses, and waste products

Intracellular fluid AKA

cytosol or cytoplasm

Components of intracellular fluid

proteins, dissolved solutes (potassium, magnesium, and phosphorus)

Interstitial fluid

between cells, not in vascular system, part of ECF

Extracellular fluid

plasma (intravascular); interstitial fluid; CSF, lymph, synovial; dissolved solutes

Osmosis

water moves from low solute concentration to high solute concentration

hydrostatic pressure is...

the force of fluid against the walls of vessels

oncotic pressure is....

the measure of fluid forced from the tissue into the vascular system

Hydrostatic pressure has high utilization in the kidneys to...

filter blood. can cause pulmonary edema when pulmonary artery pressure or left arterial pressure is high

Osmolality

# of solutes per kg of water

Osmolarity

# of solutes per liter of solution

What would you expect the serum osmolarity to be for a CHF patient during exacerbation?

Manifestations = peripheral edema and hypertension. Extra fluid will cause dilutional effect, diluting solutes and lowering osmolarity

First spacing

Normal distribution of fluid in ICF and ECF

Second spacing

Manifests in peripheral edema. Fluid can still be utilized by the body however is trapped in interstitial space.

Third spacing

trapped and inaccessible to maintain fluid balance. ascites, blisters

How is fluid moved from compartment to compartment?

either by osmosis (low solute level to high solute level) or diffusion (high solute concentration to low level)

RAAS system

pituitary gland releases ADH (= vasopressin) when it senses both high osmolarity and low volume

aldosterone = causes kidneys to release potassium and retain salt

Tachycardia is a compensatory mechanism for....

low volume

Someone's blood pressure can be low, and it might be normal, so long as...

they aren't symptomatic

MAP needs to be at least what to retain perfusion to vital organs?

65

MAP formula

(systolic + (diastolic x 2)) / 3

In general, when kidneys sense poor perfusion....

The RAAS system is activated

Angiotensin II....

vasoconstricts and activates aldosterone

How the body gets sufficient water:

blood volume is decreased and osmolality increases

blood pressure decreases, osmoreceptors in the hypothalamus activate dry mouth, thirst is increased

angiotensin II increases

pt takes in water which decreases osmolality and ups volume

higher volume = higher BP

What endocrine hormones are most closely associated with fluid balance?

ADH and aldosterone

Renin (part of the RAAS cycle is a peptide hormone released by the kidneys in response to what?

kidneys sense a drop in blood pressure

Minimum healthy adult I/O ratios

intake 2300 per day, output 1500 per day,

MINIMUM intake 400-600 mL / day

Output ratio

0.5 mL / kg / hr

1 kg = 1 liter of fluid

Renal disease patient

intake is based on output (add 500-800 mL to output)

potassium normal value

3.5-5

potassium function

primary in ICF, cell metabolism and resting potential of nerve and cardiac cells

potassium found in...

bananas, avocado, potatoes, spinach, broccoli

magnesium normal value

1.6-2.6

phosphorus normal value

3.0-4.5

magnesium function

secondary in ICF. skeletal muscle contraction, cardiac cell potential, carbohydrate and protein metabolism, coagulation, generates energy stores

phosphorus function

major anion in ICF. activates vitamins and enzymes, cell growth and metabolism, forms energy supplies

magnesium nutrition

nuts, seeds, legumes, low fat fairy, spinach, bottled electrolyte water

phosphorus nutrition

beef, chicken, fish, lentils, cheese, milk, nuts, eggs

sodium normal

135 - 145

sodium function

primary in ECF. skeletal and cardiac muscle conduction, nerve impulse transmission, acid/base balance, and major determinant in serum osmolaliry

sodium nutrition

prepackaged foods, cold cuts, processed foods, cottage cheese, canned foods

chloride normal value

98 - 106

chloride function

secondary in ECF and a major anion. formation of hydrochloric acid in gut, serum osmolarity

chloride nutrition

table salts, processed foods, sauces

bicarbonate normal value

22-26

bicarbonate function

anion in ECF. assists in electrical neutrality, carbon dioxide movement, and acid base balance

bicarbonate nutrition

diet can contribute but this is not typically guided by diet changes

calcium normal level

8.5 - 10.5

calcium function

secondary in ECF. nerve impulse transmission. skeletal and cardiac muscle conduction, clotting, bone density

calcium nutrition

found in dairy, cheese, orange juice, squash, almonds, salmon, tofu, edamame, figs, canned baked beans, broccoli, kale

What are common medications that have significant impacts on electrolytes?

diuretics and some psych meds

sodium-potassium relationship

inverse

calcium-phosphate relationship

inverse

calcium / vitamin D relationship

direct

magnesium / calcium relationship

direct

magnesium / potassium relationship

direct

magnesium / phosphate relationship

inverse

Possible hypokalemia s/s

headaches, muscle weakness/cramps, lethargy, EKG changes

IV fluid types

crystalloids = hypotonic, isotonic, hypertonic

colloids = blood products, hypertonic solution

hypotonic fluids

fluid goes from plasma into cells, causing cells to swell. known as maintenance fluids because they maintain the CELL and not the vascular system.

hypotonic fluid uses

cellular hydration, decrease B/P, decrease fluid overload

hypotonic cautions

cerebral / peripheral edema, B/P that is already low

hypotonic fluid examples

half normal saline, D5 in 0.45% NS

isotonic fluid

net loss = net gain of fluids, cell stays the same size

isotonic fluid uses

increase BP; trauma, surgery, burns; hydration

isotonic fluid caution

fluid overload

isotonic fluid examples

normal saline and lactated ringers

normal saline is the fluid of choice for...

vascular system replacement. Isotonic fluid = volume resuscitation

hypertonic fluid

fluid goes from cell to plasma...cell is dehydrated and shrinks

hypertonic fluid uses

increase BP, decrease cerebral and peripheral edema

3% NaCl...

this is used for suspicion of / manifestation of neuro symptoms, cerebral edema. THIS IS CONSIDERED A MEDICATION, NOT SOLELY A FLUID. CENTRAL LINE NECESSARY & MONITOR FOR FLUID OVERLOAD

hypertonic fluid caution

patients with renal or cardiac failure

hypertonic fluid example

3% NaCl

hypotonic osmolality

less than 270

isotonic osmolality

308

The nurse is caring for a patient who is experiencing prolonged nausea and vomiting with evidence of dehydration. What fluid intervention should the nurse anticipate?

isotonic; NS or LR

The nurse is caring for a patient who was stabilized with volume resuscitation after significant blood loss from a trauma. It is ordered to discontinue normal saline and begin half normal saline. does the nurse initiate the fluid change?

Yes. Patient is going from vascular rehydration to maintenance fluids

Hypomagnesemia

T - trousseau and Chvostek's

W - weakness

I - increased DTR

T - torsade's and tetany

C - calcium and potassium level consideration

H - hyperactive muscles and HTN

hypermagnesemia

L - lethargic

E - EKG changes, prolonged QTI and wide QRS

T - tendon reflexes absent

H - hypotension

A - arrhythmia

R - red/ hot face - flushed

G - GI issues

I - impaired breathing d/t skeletal weakness

C - confusion - neuro impairment

Hypocalcemia

C - convulsions

R - reflexes hyperactive

A - arrythmias (prolonged QT)

M - muscle spasms

P - positive trousseaus and Chvostek's

S - sensation of N/T (parathesia)

Hypercalcemia

W - weak muscles (profound)

E - EKG short QTI complex

A - absent reflexes / abdominal distention

K - kidney stone formation

Hypokalemia

"all the L"

L - low and slow

L - lethargic and confused

L - low respirations

L - lethal dysrhythmia

L - loss of urine

L - leg cramps

L - limp muscles and less reflexes

L - low BP and low HR

Hyperkalemia

M - muscle weakness

U - urinary output decreased or none

R - respirator failure (very high)

D - decreased cardiac contractility - weak pulse

E - early - muscle twitch cramps

R - rhythm changes - peaked T-waves prolong PRI

hyponatremia

S - seizures and stupor

A - abdominal cramping

L - lethargy

T - tendon reflexes diminished

L - loss of urine and appetite

O - orthostasis and overactive BS

S - shallow respirations (late sign)

S - spasms of muscles

hypernatremia

F - fatigue

R - restless / agitated

I - increased reflexes

E - extreme thirst

D - decreased urine output / dry

Rh-

there is no Rh antigen present on the RBC - needs to always receive Rh - blood

Rh +

there IS Rh antigen present on RBC - can receive either + or - blood

Universal donor

O-

Universal recipient

AB+

Tests underwent before administration

typing for ABO and antigens, blood undergoes a Coombs test-

determines if there are any additional antigens in both the donor and recipient blood; presence of antigens may lead to transfusion reaction

autologous transfusion

patient donates blood to themselves before a pre planned elective surgery. Must have stable lab values. also possible workaround for JW

Auto transfusion

collected and transfused at the same time of blood loss (often in ER or ortho procedures)

donor specific

donor directed and predesignated blood donation, sourced from matching friend or family member. No evidence has shown this to be safer than bank blood

Bank

donated by the public, donor has to meet certain eligibility requirements

Whole blood

rarely used, requires crossmatch and ABO

PRBC tests

requires crossmatch and ABO, leukoreduced to reduce risk of reaction

When are PRBCs given?

to replace blood lost due to trauma, surgery, disorders when H and H are low

can be leukoreduced- "washed" of WBCs to reduce risk of infection

can be completed via massive transfusion protocol- no clotting factors

Platelets test

no crossmatch or ABO required, can be administered quickly