what is the normal sodium range?
what is the normal potassium range?
what is the normal calcium range?
what is the normal magnesium range?
what is the normal arterial HCO3 range?
what is the normal HCO3 venous range?
what is the normal chloride range?
list the 3 ways that body fluids are regulated
1. fluid intake
2. hormonal controls
__is all the fluid outside a cell, and is divided into three smaller compartments: __,__,__
ECF (extracellular fluid)
minerals maintain __ processes. Minerals also act as catalysts in __, __, and __ of nutrients in food. In addition, they regulate __ balance and __ production and strengthen __ structures. Examples of minerals are __and __
-nerve response; muscle contraction; and metabolism of foods
-iron and zinc
the rate of osmosis depends on the:
-__ of the __ in the __
-the __ of the __
-the __ of the __
-the differences between the__ exerted by the __
-concentration of the solutes in the solution
-temp of the solution
-electrical charges of the solutes
-osmotic pressures exerted by the solutions
the normal serum osmolality is __-__
osmolality is the measure used to evaluate __ and __ in clinical practice and reflects the total solute concentration in a fluid compartment
serum and urine
changes in extracellular osmolality results in changes in both __ and __ volume
ECF & ICF
fluid shifts are important in fluid balance when there is a __ or __ of __ in the 3 types of ECF
deficit or excess of volume
body fluids are made up of __ and __, which help fluids __
fluids and electrolytes;
ATPase pump and sodium-potassium pump are examples of __. In a normal circumstance, this keeps Na __ cell, and K __ cell
isotonic solutions __ __ compartment;
stays in __;
and osmolarity is __ to serum
expands intravascular compartment;
stays in tetravascular;
osmolarity is equal to serum
NS, Ringers Lactate, and DS are types of what kind of solution?
what do isotonic solutions do?
expand circulating volume and replaces fluid losses
osmoreceptors continually monitor the __ __ __
serum osmotic pressure
which clients are most at risk for dehydration?
clients who are unable to perceive or respond to the thirst mechanism
ADH is stored in the __ and is released in response to changes in the __ _-
__ plays a critical role in the balance of fluid and electrolytes and the maintenence of vascular tone
hypertonic solutions have a high __ content, examples would be __; __
isotonic solutions, such as __%__, __ __, and __ __, __ the body's fluid volume without causing a __ __ from one compartment to another
9% sodium chloride (NaCl);
a hypertonic solution (a solution of __ osmotic pressure), such as __% __, __ fluid from cells, causing them to __
pulls fluid from cells;
-hypotonic solution (solution of __ osmotic pressure),
- such as __%__
- moves fluid __ cells,
- causing them to __
enlarge, possibly lyse
the actions of hypo/hypertonic solutions, and isotonic solutions, occurs through __, which is a __ process
plasma proteins, especially __, a serum protein naturally produced by the body, affect the __ of blood
albumin exerts __ __ or __ __, which tends to keep fluid in the intravascular compartment by pulling water from the __ __ back into the __
colloid osmotic or oncotic presure
__this process is active in capillary beds, where hydrostatic pressure differences determine the movement of water
when there is increased hydrostatic pressure on the venous side of the capillary bed, as occurs in __, there is a reversal in the normal movement of water from the __ into the __ by __. This results in an accumulation of excess fluid in the __ __, known as __
interstitial space into the intravascular space;
at the arterial end of the capillary, the hydrostatic pressure is __ the colloid osmotic pressure, causing fluid and diffusable solutes to move __ the capillary and __ the interstitial space
at the venous end of the capillary bed, the hydrostatic pressure is __ the colloid osmotic presure, causing fluids and some solutes to move __ the capillary and __ the interstitial space
what are the four organs of water loss?
__ water loss is continuous and occurs through the skin and lungs; it is not perceived by the person
insensible water loss
__occurs through excess perspiration and can be perceived by the client
sensible water loss
_- is a major contributor for maintaining water balance`
__is necessary for glycogen deposits in the liver and skeletal muscle, transmission and conduction of nerve impulses, normal cardiac conduction, and skeletal and smooth muscle contraction
__bone and teeth formation, blood clotting, hormone secretion, cell membrane integrity, cardiac conduction, transmission of nerve impulses, and muscle contraction
__is essential for enzyme activities, neurochemical activities, and cardiac and skeletal muscle excitability
what is the regulatory mechanisms for sodium? __ and __
dietary intake and aldesterone secretion
what regulates potassium?
what regulates calcium?
-__or __ in __ bone
-regulated by __ __, __ _, and __
-absorbed from intestines
-excreted by the kidneys
-reapsorption or deposition in bone
-regulated by parathyroid hormone (PTH), vitamin D, and calcitonin
what regulates magnesium? (1-3)
1. dietary intake
2. renal mechanisms
-actions of the parathyroid hormone
__is the major anion in ECF. the transport of this follows sodium
what is seruum chloride regulated by?
the bicarbonate ion is an essential component of the __ __- __ __ system essential to the acid-base balance
carbonic acid-bicarbonate buffering system
what regulates HCO3?
what is the nirmal phosphate range?
__it assists in acid-base regulation. with calcium it helps to maintain bones and teeth. It also promotes normal neuromuscular action and participates in carbohydrate metabolism
what is phosphate regulated by?
-normally absorbed through the __
ID the 3 types of acid-base regulators in the body:
3. physiological buffering
hyponatremia is a lower than normal concentration of __ in the blood, which can only occur with a net __ or a net __
-net sodium loss;
-or net water excess
what are some S/S of hyponatremia?
nausea and vomiting
dry mucus membranes
urine spec gravity below 1.010
a hypotonic solution (ie _% NaCl, or _% NaCl with or without K) in low amount can be added for __ from __
0.45%, 0.25% NaCl;
loss from GI tract
__solutions are for short-term use only. Stop when __ fluids can be taken
a __ solution has meds already mixed in IV solution,examples would be __ or __
D10, or TRN
hypertonic solutions are used to correct __ and __ imbalances
electrolyte and acid-base imbalances
check your IV site for __, __, __, and __
-coolness at sight
what are some causes of hyponatremia?
-Gi losses: vomiting, diarrrhea, NG suction
-Renal loss: kidney disease resulting in saly wasting, diuretics, adrenal insufficiency
-skin loss: excessive perspiration; burns
what are some signs of hypernatremia?
-dry and flushed skin
-sticky tongue and mucus membranes
what are some causes of hypernatremia?
-excess salt intakke
-excess aldesterone secretion
-increased sensible/ insensible water loss
what are some causes of hypokalemia?
-use of K wasting diuretics
-diarrhes, vomiting, or other GI losses
-excess aldesterone secretion
-excessive use of K+-free IV solutions
-treatment of diabetic ketoacidosis with insulin
what are some S/S of hyperkalemia?
what are some causes of hypocalemia?
-rapid admin of IV infusions containing citrate
-vitamin D deficiency
-chronic renal failure
what are some S/S of hypocalemia?
numbness/ tingling of fingers/ mouth region
-positive Trousseau's sign
-positive Chvostek's sign
what are some causes of hyperkalemia?
-fluid volume deficit
-massive cellular damage
-rapid infusion of stored blood
-use of K sparing diuretics
-ingestion of K+ salt substitutes
what are some causes of hypercalemia?
what are some S/S of hypercalcemia?
-nausea and vomiting
-flank pain (from kidney stones)
what are some S/S of hypokalemia?
-weakness and fatigue
-nausea and vomitting
-decreased bowel sounds
-decreased deep tendon reflexes
-weak, irregular pulse
what are some causes of hypomagnesemia?
-inadequate intake: malnutrition and alcoholism
-inadequate absorption or loss: diarrhea, vomiting, nasogastric drainage, fistulas, diseases of small intestine
-excessive loss resulting from thiazide diuretica
what are some S/S of hypermagnesemia?
-acute elevations in magnesium lvls: hypoactive deep tendon reflexes, decreased respiratory rate and depth, hypotension, and flushing
what are some causes of hypermagnesemias?
-excess oral or parental intake of magnesium
what are the two types of isotonic imbalances?
1.fluid volume defecit (FVD)- water and electrolytes lost in equal or isotonic porprtions
2. Fluid volume excess (FVE)- water and sodium retained in isotonic proportions
what are some causes of FVD?
-GI losses: diarrhea, vomiting, drainage from fistula or tubes
-loss of plasma or whole blood
-decreased oral intake of flds.
-confusion or depression
-use of diuretics
what are some S/S of FVD?
-dry mucus membranes
-poor skin turgor
-rapid weight loss
-slow vein filling
-flat neck veins
what are some lab findings of FVD?
=urine spec grav >1.030
-increased hematocrit level >50%
-increased BUN level 1.25mg/100ml
what are some causes of FVE?
-increased serum aldesterone and steroid levels
-excessive Na+ intake or admin
what are some S/S of FVE?
-rapid weight gain
-neck vein distension
-increased blood and venous pressure
-crackles in lungs
what are some lab findings of FVE?
-decreased hematocrit level; <38%
-decreased BUN level; <10mg/100ml
what are the two types of osmolar imbalances?
1. hyperosmolar imbalance-dehydration
2. hypoosmolar imbalance-water excess
what are soe causes of hyperosmolar imbalance (dehydration)?
-interruption of neurologically driven thirst drive
-admin of hypertonic parental flds or tube feeding formulas
what are some S/S of hyperosmolar imbalance (dehydration)?
-dry/ sticky mucus membranes
-flushed/ dry skin
what are some lab findings for hyperosmolar imbalance (dehydration)?
-increased sodium level (>145 mEq/L)
-increased serum osmolality (>295 mOsm/kg)
what are some causes of hypoosmolar imbalance (water excess)?
-SIADH (syndrome of innappropriate ADH)
-excess water intake
what are some S/S of hypoosmolar imbalance (water excess)?
what are some lab findings of hypoosmolar imbalance (water excess)?
-decreased Na+ lvls (<135 mEq/L)
-decreased serum osmolality (<280mOsm/kg)
__ is the most effective way to evaluate acid-base balance and oxygenation
arterial blood gas
for acid-base balance, you need a steady state between acids and bases; __ do this by absorbing or releasing __
measures the hydrogen ion concentration in the body fluids (7.35-7.45)
. is the partial pressure carbon dioxide in arterial blood (35-45)
is the partial pressure of oxygen in the blood (80-100)
. is the point at which hemoglobin is saturated by oxygen (95-99% )
is the amount of blood buffer (hemoglobin and bicarbonate) that exists
is the major renal component of acid-base balance (22-26)
arterial pH reflects _ concentration:
-more H+= more __, __pH
-less H+=more __, __pH
-more acidic; lower pH
-more alkaline; higher pH
there are __, __, and __ regulations working together to bring blood pH to normal
CO2 acid is reflected in the __
HCO3 base is reflected in the __
what is the normal pH range?
what is the normal PaCO2 range?
hyperventilation occurs when PaCO2 is < __
hypoventilation occurs when PaCO2 is > __
as rate and depth of respiration decrease, __ CO2 is exhaled, and __ is retained, __ the concentration of CO2
whaqt is the normal range for PaO2?
PaO2 <60mmH leads to anerobic metabolism, resulting in lactic acid production and __
hyperventilation also causes a decrease in PaO2, resulting in __ __
what is a normal HCO3 range?
HCO3 < 22mEq/L usually indicates __ __
HCO3 >26mEq/L usually indicates __ __
what is the normal SaO2 range?
changes in __,__, and __ effect oxygen
temp, pH, and PaCO2
what are some causes of metabolic acidosis?
-treat underlying condition
what are some causes of metaolic alkalosis?
-loss of acid from stomach
-excess NG suction
how do you treat metabolic alkalosis?
Stop weither, alkalosis may resolve itself. IF not give IV fluids, person slow down breathing to conserve C02
what are some situations that require fluids?
restlessness with delerium
high ambient temp
what are some situations that require decreased fluids?
Electrolyte regulation (+ charge):
-__major contributor to fluid balance/ imbalance
-__major electrolyte w/i cells
-__mostly in bones
-__1/2 is in bones
Electrolyte Regulation (-charge):
-__buffer in ICF
what are some S/S of respiratory acidosis?
-warm/ flushed skin
what are some S/S of respiratory alkalosis?
-numbness/ tingling of extremities
what are some S/S of metabolic acidosis?
-tachypnea w/ deep respirations
what are some S/S of metabolic alkalosis?
-numbeness/ tingling of fingers/ toes, and mouth region
__ and __ have greater water needs and are more vulnerable to fld volume alterations
infants and children
fever in children creates an increase in the rate of __ water loss
__have increased metabolic processes
older adults have decreased __, that often causes __ __
renal disorders cause an abnormal retention of __, __, and __ (__ __)
NaCl, K, and water
Hx of smoking or alcohol consumption is associated with __ __
diuretics can cause :
steroids can cause __ __
K+ supplements can cause:
-__ disturbances, incl intestinal and gastric __ and __
GI; ulcers; diarrhea
Respiratory Center Depressants (eg opiod analgesics) can cause:
-__rate and depth of respirations
-results in __ __
antibiotics can cause __,
__and/ or __
hyperkalemia and/or hypernatremia
calciu carbonate (tums) can cause __ __ with __ and __
hypokalemiametabolic alkalosis w/ nausea and vomiting
Magnesium Hydroxide can cause __
NSAIDs can cause __
What is the normal anion gap?
what are some risk factors for fluid, electrolyte, and acid-base imbalances?
what are some possible nursing diagnoses for clients with fluid, electrolyte, or acid-base imbalances?
-deficient fluid volume
-excess fluid volume
-impaired gas exchange
-risk for injury
-deficient knowledge regarding disease management
-impaired oral mucus membrane
-impaired skin integrity
-ineffective tissue perfusion
may be appropriate when the client's GI tract is healthy but the client cannot ingest fluids
enteral replacement of fluids
used for clients who retain fluids and have fluid volume excess require restriction of fluids
restriction of fluids
include TPN, crystalloids, and colloids
parenteral replacement of flds and electrolytes
is a nutritionally adequate hypertonic solution consisting of glucose, nutrients, and electrolytes administered peripherally, percutaneously or implanted or tunneled
is to correct or prevent fluid and electrolyte imbalances
__ are catheters, cannulas, or infusion ports designed for repeated access to the vascular system.
VADs or vascular access devices