NAT Review Flashcards

NAT Review: Fluids and Electrolytes

Introduction

Review of fluids and electrolytes by Aldrex Clyde Ycaza Veñales, RN, a top 5 placer in the November 2022 PHLE.
Socials: TikTok (@sir.aldrex.rn) and Instagram (@clydeus_).

Fluids

Total Body Water (TBW): Approximately 60% of body weight is fluids (H₂O and electrolytes).
- Higher in younger individuals and males.
- Lower with increased body fat.
Compartments:
- Intracellular (2/3): Primarily potassium.
- Extracellular (1/3): Primarily sodium.
- Intravascular: Blood.
- Interstitial: Fluid around cells in tissues.
Fluid Balance:
- Gains:
- Intake: Beverages, food, oxidation (metabolism).
- Losses:
- Output (Sensible): Kidneys (urine), skin (sweat), GI (stool).
- Output (Insensible): Vapor from skin and lungs.
- Goal: Gain = Loss.

Measurements

Body Weight: Most accurate measure of body fluid.
- $1 \text{ kg} = 1 \text{ L} \text{ of fluid}$
- Consistent conditions: same clothes, time, and scale.
Fluid Intake and Output:
- Normal intake: $2 \text{ L} \rightarrow 2.5 \text{ L/day}$
- Intake = Output.
- Metabolic H₂O: 8% (200 mL) from cellular metabolism.
- Food: 28% (700 mL).
- Beverages: 64% (1600 mL).

Conversions

$1 \text{ kg} = 1000 \text{ g} = 2.2 \text{ lbs}$
$1 \text{ tbsp} = 15 \text{ mL}$
$1 \text{ cup} = 240 \text{ mL}$
$1 \text{ tsp} = 5 \text{ mL}$
$1 \text{ oz} = 30 \text{ mL}$
$1 \text{ L} = 1000 \text{ mL}$

Tonicity

Hypertonic: Causes cells to shrink.
Isotonic: No change in cell size.
Hypotonic: Causes cells to swell.

Volemia

Hypervolemia: Increased fluid volume.
Hypovolemia: Decreased fluid volume.

Electrolytes

1. Sodium (Na+)

Normal Range: $135-145 \text{ mEq/L}$
Location: Abundant extracellularly.
Relationship: Directly proportional to chloride (96-108 mEq/L).
Hormonal Regulation:
- Aldosterone (Mineralocorticoids): Increases Na+ retention.
- ANP (Atrial Natriuretic Peptide): Decreases Na+ retention.
- ADH (Antidiuretic Hormone): Increases H₂O reabsorption. \text{Increased ADH} \rightarrow \text{Decreased Na+} $</li></ul></li><li>Functions:<ul><li>Water retention/distribution.</li><li>Transmission of nerve impulses.</li></ul></li><li>Sources: Soup/broth, snacks/chips, seafood, instant food, processed meat, celery, tomato.</li><li>Hyponatremia (Low Sodium):<ul><li>Symptoms: Edema (cerebral), confusion, headache, seizures (severe), hypotension, shock, increased pulse rate (PR) and respiratory rate (RR).</li><li>Management:</li><li>Restrict fluid intake.</li><li>Increase Na+ intake.</li><li>IV: PNSS (Physiologic Normal Saline Solution), Hypertonic Saline, PLR.</li><li>Diuretics.</li></ul></li><li>Hypernatremia (High Sodium):<ul><li>Symptoms: Dehydration (thirst, dry skin, sticky mucous membranes, restlessness, irritability), pulmonary edema (crackles, dyspnea), pleural effusion (severe).</li><li>Management:</li><li>Increase fluid intake.</li><li>Decrease Na+ intake.</li><li>IV: Hypotonic saline, P5N.</li></ul></li></ul><h5 collapsed="false" seolevelmigrated="true">2. Potassium (K+)</h5><ul><li>Normal Range:$ 3.5-5 \text{ mEq/L} $</li><li>Relationship: Inversely proportional to sodium and pH. Increase K+ decreases pH; Decrease K+ increases pH.</li><li>Regulation: Kidneys/Aldosterone increase K+ excretion.</li><li>Functions:<ul><li>Neuromuscular repolarization.</li><li>Skeletal and cardiac muscle relaxation.</li><li>Regeneration of energy.</li></ul></li><li>Sources: Fruits and vegetables, salt substitutes (e.g., banana, papaya, avocado, strawberry, broccoli, carrots, cabbage).</li><li>Hypokalemia (Low Potassium):<ul><li>Symptoms: Decreased repolarization, decreased energy, muscle weakness, leg cramps, fatigue, shallow breathing, arrhythmias.</li><li>ECG Changes: Inverted/depressed T wave, presence of U wave.</li><li>Management:</li><li>Increase K+ intake.</li><li>Potassium supplements (e.g., Kalium Durule). Concentration: 20-40 mEq/L. Rate: 10 mEq/hr (maintenance), 20 mEq/hr (severe), up to 30 mEq/hr (extreme cases). Incorporate with IV fluids. Bedside: Cardiac monitor.</li><li>Assess urinary output.</li><li>Administer via the largest possible vein due to irritant properties.</li></ul></li><li>Hyperkalemia (High Potassium):<ul><li>Symptoms: Prolonged repolarization, paralysis, respiratory arrest, cardiac arrest.</li><li>ECG Changes: Tall, tented, peaked T wave.</li><li>Management:</li><li>Restrict K+.</li><li>K+ wasting diuretics.</li><li>Medications: Insulin, Sodium Bicarbonate, Calcium Gluconate (to counter effects of K+).</li><li>Procedure: Kayexelate enema (Sodium Polystyrene Sulfonate) - cation exchange resin.</li><li>Dialysis.</li></ul></li></ul><h5 collapsed="false" seolevelmigrated="true">3. Calcium (Ca+)</h5><ul><li>Normal Range:$ 9-11 \text{ mg/dL} \text{ or } 4.5-5.5 \text{ mEq/L} $</li><li>Relationship: Inversely proportional to phosphorus.</li><li>Regulation:<ul><li>Calcitonin (thyroid): Decreases calcium reabsorption in bones.</li><li>PTH (Parathyroid Hormone): Increases calcium resorption from bones.</li><li>Vitamin D: Increases calcium absorption in the intestines.</li></ul></li><li>Sources: Milk, GLV (Green Leafy Vegetables), anchovies, sardines, soya, spinach, butter, cheese, yogurt.</li><li>Function: Neuromuscular excitability</li><li>Hypocalcemia (Low Calcium):<ul><li>Symptoms: Increased neuromuscular excitability, tetany (involuntary contractions).</li><li>Chvostek's sign: Facial muscle twitching upon tapping below the zygomatic arch.</li><li>Trousseau's Sign: Carpal spasm when inflating a blood pressure cuff 20 mmHg above systolic BP for 3-5 minutes.</li><li>ECG Changes: Prolonged QT interval.</li><li>Management:</li><li>Increase calcium intake.</li><li>Calcium gluconate, calcium lactate, calcium chloride (irritant). Administer orally with meals.</li></ul></li><li>Hypercalcemia (High Calcium):<ul><li>Symptoms: Decreased neuromuscular excitability, muscle weakness, constipation, calcium stone formation.</li><li>ECG Changes: Shortened QT interval.</li><li>Management:</li><li>Increase fluid intake.</li><li>Diuretics (loop).</li><li>Calcitonin.</li><li>Exercise.</li><li>Increase fiber intake.</li></ul></li></ul><h5 collapsed="false" seolevelmigrated="true">4. Magnesium (Mg)</h5><ul><li>Normal Range:$ 1.5-2.5 \text{ mEq/L} $</li><li>Sources: Cashew nuts, oatmeal, rice, Swiss chard (dark GLV).</li><li>Effects: Sedation, vasodilation.</li><li>Hypomagnesemia (Low Magnesium):<ul><li>Symptoms: Decreased sedation, increased blood pressure dilation, tremors, hyperactive deep tendon reflexes, athetoid movements (twisting), convulsions.</li><li>Management:</li><li>Increase Mg intake.</li><li>Magnesium sulfate (IV). Monitor for toxicity: Bradycardia, decreased urinary output, decreased respiratory rate.</li></ul></li><li>Hypermagnesemia (High Magnesium):<ul><li>Symptoms: Increased sedation, decreased BP, decreased DTR, dysarthria (difficulty speaking), decreased energy, lethargy, drowsiness, possible respiratory arrest.</li><li>Management:</li><li>Decrease Mg intake.</li><li>Loop diuretics.</li><li>Saline.</li><li>Calcium gluconate (Mg excretion).</li><li>Ventilatory assistance.</li></ul></li></ul><h5 collapsed="false" seolevelmigrated="true">5. Phosphorus</h5><ul><li>Normal Range:$ 2.4-4.5 \text{ mg/dL}$$
- Relationship: Inversely proportional to Calcium & pH.
- Function: ATP energy, oxygenation.
- Source: Poultry, meat, tofu, beans, grains, nuts (high protein foods).
- Hypophosphatemia:
 - Symptoms: Similar to hypercalcemia.
 - Management:
 - Increase Phosphorus.
 - Decrease Calcium.
- Hyperphosphatemia:
 - Symptoms: Similar to hypocalcemia.
 - Management:
 - Decrease Phosphorus.
 - Increase Calcium.
Fluid & Electrolyte Regulation by Kidneys
1. Regulation via Reabsorption:
 - H₂O + Electrolytes
 - Arterial BP
 - Acid-Base Balance: H+ + HCO₃
2. Excretion:
 - Metabolic Waste
 - Chemicals / Toxins
Metabolism
Anabolism vs. Catabolism
Feature
Anabolism
Catabolism
Process
Build up
Break down
Use/Release
Use Energy
Release Energy
Macronutrients
1. Carbohydrates
 - 4 calories/gram
 - Converted to Glucose → ATP
2. Protein
 - 4 calories/gram
 - Amino Acids
3. Fats
 - 9 calories/gram
 - Triglycerides
Micronutrients
1. Vitamins
 - Fat-Soluble:
 - Vit A: Vision
 - Vit D: Immune, Absorb Ca, Bone growth
 - Vit E: Antioxidant, Immune
 - Vit K: Blood Clot
 - Water Soluble:
 - Vit B (1, 2, 3, 5, 6): Energy
 - Vit B6 & B12: RBC Production
 - Vit C: Collagen, Absorb iron
2. Minerals:
 - All Electrolytes
 - Chloride: Digestion (HCl)
 - Iron: RBC + O2
 - Iodine: Thyroid fxn → goiter
 - Zinc: Immune fxto
 - Fluoride: Bone + Teeth Health
Functions of the Digestive System (DARE)
- D - Digestion: Conversion of complex substances to simple forms.
 - Carbohydrates (CHO) → Sugar (glucose)
 - Proteins (CHON) → Amino acids
 - Fats → Lipids (triglycerides)
 - Digestive Enzymes:
 - Salivary amylase (ptyalin)
 - Pancreatic amylase
 - Pepsin
 - Pancreatic trypsin
 - Bile
 - Pancreatic lipase
 - Vitamins & Minerals
- A - Absorption: Nutrients absorbed in the small intestine.
 - Sugar provides energy.
 - Lipids synthesize fat-soluble vitamins (ADEK).
- R - Reabsorption: Fluids & electrolytes reabsorbed in the large intestine.
 - Increases fluid retention.
 - Increases K+ and Na+.
- E - Elimination: Elimination of waste products (digested, absorbed, and reabsorbed).
Anatomy of the Digestive System
- Mouth
- Salivary glands
 - Parotid gland
- Esophagus
- Gallbladder
- Duodenum
- Colon
- Pancreas
- Rectum
- Ileum
- Anus
- Jejunum
Layers of the Digestive Tract
From outer to inner:
- Serosa
- Longitudinal muscle layer
- Circular muscle layer
- Submucosa
- Mucosa
- Myenteric nerve plexus
- Submucosal nerve plexus
Specific Structures
1. Mouth (Oral Cavity): Entry point for food.
 - Tongue: Speech, taste, movement of food (papillae).
 - Teeth: Mechanical breakdown of food.
 - Salivary gland/Parotid gland: Secretes saliva containing amylase (ptyalin) to break down carbs into sugar.
2. Pharynx (Throat):
 - Nasopharynx (respiratory).
 - Oropharynx and Laryngopharynx (GI).
 - Gag reflex (vagus nerve): Prevents aspiration.
3. Esophagus:
 - Start of peristalsis (collapsed appearance).
 - Upper Esophageal Sphincter (UES): Prevents air entry into the stomach.
 - Lower Esophageal Sphincter (LES)/Cardiac Sphincter: Prevents gastric reflux.
4. Stomach:
 - Located in the midline & left upper quadrant.
 - Stores food and fluids.
 - Parts:
 - Cardia (narrow portion).
 - Fundus.
 - Body/Corpus.
 - Antrum (Pylorus).
 - Pyloric sphincter.
 - Specialized Cells:
 - Chief cells: Secrete pepsinogen → pepsin.
 - Parietal cells:
 - Intrinsic factor → Vit B12 absorption.
 - HCl secretion → chyme.
 - Histamine 2: HCl production (triggered by stress), produced by mast cells.
 - Goblet cells: Mucus production (protects stomach from HCl).
5. Pancreas:
 - Located behind the stomach (fish-shaped gland).
 - Endocrine: Islets of Langerhans.
 - Alpha cells → glucagon.
 - Beta cells → insulin.
 - Exocrine: Enzymes.
 - Amylase.
 - Lipase.
 - Trypsin.
 - Parts: Head, neck, uncinate process, body, tail.
6. Liver:
 - Largest internal organ (right upper quadrant).
 - Functions:
 - Storage: Minerals & vitamins (Iron, fat-soluble vits, Vit. B12).
 - Protection: Phagocytic Kupffer cells (engulf harmful cells & anemic RBCs).
 - Metabolism: Proteins are broken down into amino acids to remove ammonia, converted to urea, excreted by kidneys.
7. Small Intestine:
 - Longest & most convoluted (9 to 16 ft -adult).
 - Duodenum:
 - First & to 10 inches.
 - Connections: Hepatic ducts (liver), portal duct (gall bladder), pancreatic duct (pancreas), ampulla of vater.
 - Sphincter of Oddi.
 - Jejunum:
 - 8-foot
 - Most absorption.
 - Ileum:
 - Last 10-foot
 - Ileocecal valve: Separates the entrance of the ileum from the cecum of the large intestine.
 - Vit. B12 absorption (secondary to intrinsic factor).
 - Functions:
 - Movement, mixing & peristalsis (intestinal villi).
 - Digestion (with enzymes).
 - Absorption (simple nutrients).
 - Borborygmi: rumbling or gurgling noise made by the movement of fluid and gas in the intestines (RLQ).
8. Large Intestine:
 - Functions:
 - Reabsorption of F&E.
 - Parts: Cecum, ascending colon, transverse colon, descending colon, sigmoid colon, rectum, anal canal.
 - Cecum: Connected to the appendix
 - Ascending colon → liquid drainage
 - Transverse Colon → mushy drainage
 - Descending Colon → solid
 - Sigmoid colon → well formed
 - Flora → E. coli and other bacteria produces ammonia
9. Rectum:
 - 1 to 1.5 inches.
 - Stores feces.
10. Anus
 Elimination
 - Involuntary - internal sphincter
 - voluntary - external Sphincter

Feature	Anabolism	Catabolism
Process	Build up	Break down
Use/Release	Use Energy	Release Energy

NAT Review Flashcards

NAT Review: Fluids and Electrolytes

Introduction

Fluids

Measurements

Conversions

Tonicity

Volemia

Electrolytes

1. Sodium (Na+)

Fluid & Electrolyte Regulation by Kidneys

Metabolism

Anabolism vs. Catabolism

Macronutrients

Micronutrients

Functions of the Digestive System (DARE)

Anatomy of the Digestive System

Layers of the Digestive Tract

Specific Structures