Nursing Skills Exam #1

pH normal range

7.35-7.45

PaCO2 normal range

35-45 mmHg

PaO2 normal range

80-100 mmHg

serum osmolality normal range

280-300 mOsm/kg

pH range for the stomach

1-4

pH range for urine

5-6

pH range for intestines

8-10

Sodium normal serum range

135-145 mEq/L

Potassium normal serum range

3.5-5.0 mEq/L

Calcium normal serum range

8.9-10.1 mg/dL

Magnesium normal serum range

1.8-2.3 mg/dL

Chloride normal serum range

95-108 mEq/L

Bicarbonate normal serum range

22-26 mEq/L

Phosphate normal serum range

2.5-4.5 mg/dL

Amount of fluid found in ICF

2/3

Amount of fluid found in ECF

1/3

Primary Electrolytes of ECF

sodium, chloride, and bicarbonate

What locations does ECF include

intravascular and interstitial fluid

Maintenance of balance of ECF depends on

protein content of the blood (albumin and globulin), integrity of the vascular endothelium, and hydrostatic pressure inside BV

Primary Electrolytes of ICF

potassium, phosphate, and sulfate

Osmolality

the proportion of dissolved particles in a given weight of fluid, mOsm/kg. measurement for body fluids

Normal range and monitoring of osmolality

280-300, monitored by hypothalamus and secretions of ADH in response to low levels

Osmolarity

the concentration of dissolved substances in a given volume of fluid, mOsm/L. measurement for other fluids, like IV fluids.

Phosphorus Normal Serum Range

2.5-4.5 mg/dL

Diffusion

solvent or solutes move from an area of higher concentration to an area of lower concentration, no energy is needed. Common substances= oxygen, nitrogen, and carbon dioxide.

Facilitated Diffusion

the molecule has to attach to a carrier molecule to enter a cell. ex= glucose, whose carrier is insulin

Osmosis

movement of a fluid through a semipermeable membrane, ex= water on one side of a cell with a lower concentration of solute will move to the other side with a higher concentration of solute. no energy is needed

Active Transport

ions and other molecules move across membranes from an area of lower concentration to a higher one. ATP is required. ex= the sodium-potassium pump

Filtration

transfer of water and dissolved substances through a permeable membrane from higher to lower pressure, occurs in capillaries

Colloid Oncotic Pressure

osmotic pressure produced by plasma proteins, attract water and keep it within the blood vessels

Tonicity

a fluid’s effect of cell size

Isotonic solutions

no net movement across membranes, normal saline (0.9% NaCl)

Hypotonic solutions

has a concentration of solute less than that of blood plasma, when it surrounds cells, water crosses into the cells and they swell

Hypertonic solutions

has a concentration of solute greater than that of blood plasma, when it surrounds cells, water leaves the cells and they shrivel

Mechanisms of Edema

increased hydrostatic pressure, decreased colloid oncotic pressure, blockage or removal of lymph nodes, and increased capillary permeability

Causes of Increased Hydrostatic Pressure that causes edema

increased BP, fluid overload, decreased cardiac output with backup of blood

Causes of decreased Colloid Oncotic Pressure that causes edema

malnutrition, liver failure, and nephrosis

Causes of blockage/removal of lymph nodes that causes edema

mastectomy of lymphoma

Causes of increased Capillary Permeability that causes edema

allergies, septic shock, and pulmonary edema

What Changes can Diuretics cause to fluid and electrolytes

ECF deficit or loss of electrolytes such as potassium, calcium, and magnesium

Maintenance of Acids and Bases in the blood

buffers and elimination of acids from the body by the lungs (CO2) and kidneys, the kidneys can also excrete bases if needed

Most Important Buffer Pair and why

carbonic acid and bicarbonate ion. important bc it converts strong acids and bases into weaker ones and it works closely with the lungs and kidneys for long-term balance

Buffers

transport acids and bases to where they are excreted without causing large changes in pH

Compensation (for acid-base regulation)

the body either excretes or retains acids and bases to compensate for losses

Hypocapnia

low partial pressure of CO2, less than 35 mmHg

Hypercapnia

high partial pressure of CO2, greater than 45 mmHg

Respiratory Compensation

responsible for controlling the amount of CO2 in the blood. chemoreceptors provide input to the lungs to increase rate and depth of ventilation or to act oppositely in cases of low CO2 production

Renal Compensation

much slower than respiratory, the kidneys either keep H ions and expel HCO3 or the opposite

When would the kidneys excrete H and retain HCO3

when is a state of acidosis

When would the kidneys excrete HCO3 and retain H

when in an alkalotic state

Factors affecting fluid, electrolyte, and acid-base balance

fluid and food intake and output, vomiting, diarrhea, diaphoresis, use of diuretics, stress, chronic illness, renal failure, heart failure, liver failure, respiratory failure, surgery, and pregnancy

Normal urine output for 24 hours

1500 mL

What could cause decreased fluid/electrolyte intake

starving oneself, dementia, sore throat, older adults avoiding urination, depression, or sickness

Vomiting- how it affects fluid, electrolyte, and acid-base balance

if gastric juice is lost from the stomach, H, Na, Cl, and in excessive cases, K is depleted, increasing the risk for ECF deficit and metabolic alkalosis

Diarrhea- how it affects fluid, electrolyte, and acid-base balance

intestinal secretions contain bicarbonate, so this may result in metabolic acidosis due to loss of the base. it also contain Na, Cl, H20, and K, increasing risk of ECF deficit and hypokalemia

Diaphoresis- how it affects fluid, electrolyte, and acid-base balance

excessive sweating- hypovolemia, Na, Cl, and K lost

Use of Diuretics- how it affects fluid, electrolyte, and acid-base balance

they increase excretion of Na, Cl, and H2O in pts with high BP, chronic heart, renal or liver disease. Some are potassium-sparing, but those that aren’t promote excretion of Mg and K too

Stress- how it affects fluid, electrolyte, and acid-base balance

causes increased production of aldosterone (which causes ECF retention) and ADH (which causes decrease renal excretion of H2O)- this equals excess fluid

Chronic Illness- how it affects fluid, electrolyte, and acid-base balance

many cause imbalances

Renal Failure- how it affects fluid, electrolyte, and acid-base balance

could cause problems excreting or retaining Na, Cl, K, and fluid. common= hyperkalemia and hypocalcemia, when kidneys fail, metabolic acidosis occurs

Heart Failure- how it affects fluid, electrolyte, and acid-base balance

if pumping decreases then so does BP, causing secretions of aldosterone and ADH, resulting in ECF volume and water excesses. fluid collects in lungs and throughout body, increasing risk of pulmonary edema and pitting edema. Also effects kidneys, as heart pumps less effectively the kidneys are less able to excrete fluid

Liver Failure- how it affects fluid, electrolyte, and acid-base balance

plasma levels of albumin decrease causing changes to ECF distribution, decreased vascular volume, and increased interstitial volume. common= ascites, an abnormal collection of fluid within the peritoneal cavity

Respiratory Failure- how it affects fluid, electrolyte, and acid-base balance

respiratory acidosis occurs when functional ability of alveoli to excrete CO2 decreases

Surgery- how it affects fluid, electrolyte, and acid-base balance

NPO, enemas, blood loss in surgery, n/v, stress, and drains

Pregnancy- how it affects fluid, electrolyte, and acid-base balance

increased progesterone causes hyperventilation, therefore increases loss of CO2, resulting in alkalosis

ECF Volume Deficit- AKA? what is it? causes?

hypovolemia, saline deficit, or isotonic dehydration. it is the proportional loss of fluids and electrolytes. occurs because of inadequate intake or abnormal losses- diaphoresis, severe burns, fever, trauma, blood loss, GI losses, diuretics, inadequate fluid intake, and increased urination

ECF Volume Deficit- special type?

Third Spacing- when fluid leaves the vascular volume and is trapped within the interstitial fluid/space

ECF Volume Deficit- s/s for interstitial volume?

dry mucous membranes and poor skin turgor

ECF Volume Deficit- s/s for vascular volume?

orthostatic changes in HR and BP, weak and rapid pulse, decreased urine output, and slow filling peripheral veins

ECF Volume Deficit- Treatment

oral or IV replacement of Na, Cl, and H2O in the same concentrations found in body fluid

ECF Volume Excess- AKA? Occurs when?

Hypervolemia, often in pts with cardiac or renal failure, or liver disease. the excess fluid is forced into interstitial spaces and is seen as edema

ECF Volume Excess- s/s

rapid weight gain of more than 0.5 kg/day, increased BP, bounding pulse, and fullness of neck veins, dyspnea, orthopnea, crackles, and edema

ECF Volume Excess- Pulmonary Edema

excess ECF can filter across the alveoli into lungs, causing pulmonary edema. symptoms= orthopnea, dyspnea, and crackles

ECF Volume Excess- Treatment

restricted Na and saline, and administration of diuretics

Water Deficit or Hyperosmolality- AKA? Occurs when/causes? what happens

hypernatremia, hypertonic dehydrations, and hypertonicity. occurs when there is a decrease in H2O intake, increase in H2O loss or excess intake of solute. as serum osmolality increases, fluid is pulled from ICF causing cellular shrinking. w/ brain cells, confusion, agitation, convulsions, coma and death can occur

Water Deficit or Hyperosmolality- s/s and treatment

decreased urine output with increased concentration, thirst, and dry mucous membranes. treatment- 5% dextrose in water, orally or IV, no faster than 2 mEq/L/h

Water Excess or hypoosmolality- AKA? occurs when/causes?

hyponatremia, and hypotonicity. due to increase in water intake, increased ADH, or decreased urine output. Decreases osmolality causes water to diffuse into cells

Water Excess or Hypoosmolality- s/s normal and for CNS, and treatment

CNS- lethargy, irritability, confusion, personality changes, seizures, coma and death. more s/s- anorexia, n/v, weakness, and cramps. treatment- free water restriction, if pt experiences confusion or seizures, they may be given hypertonic IV solution

Hypokalemia- what is it? causes?

low K in blood, due to K-wasting diuretics, GI losses, metabolic alkalosis, and decrease intake

Hypokalemia- s/s

muscle weakness (beginning in lower extremity and then moving up), leg cramps, fatigue, paresthesia (abnormal skin sensation such as tingling, burning and numbness), constipation, and cardiac arrhythmias

Hypokalemia- treatment

give K and treat the cause, oral or SLOW IV infusion

Hyperkalemia- what is it? Causes?

high K in blood, due to renal failure, dehydration, burns, excessive intake, and PRBC infusions

Hyperkalemia- s/s

n/v, muscles ache or weakness, decreased tendon reflexes, paralysis, and dysrhythmias

Hyperkalemia- treatment

restrict K, diuretics, IV insulin, IV calcium gluconate, or hemodialysis

Hyponatremia- what is it? causes?

low Na in blood, due to chronic or severe vomiting or diarrhea, excessive H2O intake, severe burns, excessive alcohol intake, or medications

Hyponatremia- s/s

cerebral edema leads to confusion, irritability, and lethargy

Hyponatremia- treatment

3% NaCl

Hypernatremia- what is it? causes?

high Na in blood, due to loss of H2O, vomiting, prolonged gastric suctioning, excess sweating and diabetes

Hypernatremia- s/s

confusion, lethargy, irritability, muscle twitching, seizures, and coma

Hypernatremia- treatment

avoid high sodium foods

Hypocalcemia- what is it? causes?

low Ca in blood, due to inadequate vitamin D, menopause, hypoparathyroidism, PRBC transfusion, and low albumin levels

Hypocalcemia- s/s

Chvostek’s sign, Trousseau’s sign, chest pain, dysrhythmias, heart failure, syncope, tingling/muscle cramping, wheezing, itching

Chvostek’s Sign

tap facial nerve 2 cm in front of tragus, if positive- there is a twitching of facial muscles on that side

Trousseau’s Sign

place BP cuff on arm and inflate to 20 mmHg above pt’s systolic BP for 3-5 minutes. if positive you’ll see flexion of the wrist, thumb and 1st joints of the fingers with hyperextension of fingers

Hypocalcemia- treatment

Ca and Vitamin D supplements, dietary changes, and IV calcium gluconate

Sodium- Functions

regulates ECF volume, role in muscle contractions and transmission of nerve impulses

Sodium- sources and losses

normally from dietary sources, lost from GI tract, kidneys, and skin

Sodium- regulation

regulated by RAA system, elimination and reabsorption by the kidneys

Potassium- functions

commonly found in ICF, it’s essential for normal cardiac, neural and muscle function and contractility

Potassium- sources and losses

gained from a balanced diet, and lost via kidneys, stool, sweat