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Pathophysiology Week Five - Disorders of Fluid, Electrolyte, and Acid-Base Balance, Stress and Adaptation, Nutritional status

Terms in this set (137)

What is ascites?
the accumulation of fluid in the peritoneal cavity, causing abdominal swelling.
What is emesis?
vomiting
What is effusion?
escape of fluid into a cavity
What is tetany?
muscle spasms
What are renal calculi?
kidney stones
What is hyperlipidemia?
high cholesterol
What are the two major compartments of the body fluids?
Intracellular Fluid
Extracellular Fluid
Of the two major compartments, which has 2/3 of the fluid?
Intracellular fluid
Of the two major compartments, which has 1/3 of the fluid?
Extracellular fluid
Intracellular fluid has large amounts of _________ and small amounts of ___________.
large amounts of potassium
small amounts of sodium
Extracellular fluid has large amounts of _________ and small amounts of ___________.
large amounts of sodium
small amounts of potassium
intracellular fluid
fluid inside cells
extracellular fluid
fluid outside the cell

-vascular space (1/3)
-interstitial space (2/3)
The obese and elderly have (less or more?) body fluids.
LESS
Babies (less or more?) body fluids.
MORE
Who has more body fluids: men or women?
men
The average adult carries ______ L of blood.
5-6
The blood is made up of ___% formed elements and ___% plasma.
45% formed elements and 55% plasma.
What are the formed elements of blood?
erythrocytes, leukocytes, platelets
Average leukocyte count
4,000-10,000 cells/uL
Average erythrocyte count
4.2-6.2 million cells/uL
Average platelet count
150,000-400,000 cells/uL
What is the normal pH of blood?
7.35-7.45
What happens if the blood is not in the right pH range?
can affect cellular function
What is plasma?
liquid portion of blood

-proteins
-Inorganic salts, lipids, enzymes, vitamins, carbohydrates, and hormones (1.5%)
-Water (92%)
What has the most influence in the protein portion of plasma?
ALBUMIN
ALBUMIN
Formed in the liver

Stays in the vascular space, assisting with regulation of blood volume and fluid balance

Pulls fluid OUT of the interstitial space and INTO the vascular space
What are the waste products?
Urea (BUN)

Creatinine

Uric acid

Bilirubin
---Direct (conjugated)
---Indirect (unconjugated)
The transfer of nutrients, water, ions, etc. occurs at the _________ level.
capillary level
What pulls fluid OUT of the interstitial space and INTO the vascular space?
Albumin
A palpable swelling produced by increased interstitial fluid volume is called what?
edema
What are the causes of edema?
Increased Capillary Filtration Pressure: too much vascular volume, venous obstruction, right sided heart failure

Decreased Capillary Colloid Osmotic Pressure: loss or reduced production of albumin

Increased Capillary Permeability: inflammation

Obstruction of lymphatic Flow: lymph node removal or malignancy
Capillary Colloid Osmotic Pressure
PULLS the fluid back into the capillary
======ALBUMIN is of major importance
Capillary Filtration Pressure
PUSHES the fluid out of the capillary into the interstitial space
Stuff that isn't removed by the blood vessels is removed by the_____________.
lymph system
Edema
What is this?
What is third spacing?
When fluid accumulates in a portion of the body from which it is not easily exchanged with the rest of the ECF (e.g., burns, blisters).
What are examples of third spacing?
pericardial sac, peritoneal cavity, and pleural cavity


-Peritoneal Cavity = Ascites
-Pericardial Sac/Pleural Cavity = Effusion
Ascites
What is this?
Pleural effusion
What is this?
Pericardial effusion
What is this?
When sodium is retained, water is _________.
retained
When sodium is lost, water is _________.
lost
What is tonicity?
the amount of sodium in a fluid, which causes the cell to shrink, swell, or stay the same
What does tonicity depend on?
Depends on OSMOSIS... the water will go to whichever area is more concentrated
IV Fluids
hypertonic solution
Enter the the vessel from the cell. Too much hypertonic solution can cause cells to shrivel up and possibly die
hypotonic solution
Out of the vessel to into the cell- too much hypotonic solution can cause cells to increase in size and even burst
What are normal output losses?
Urine (most common)
Bowels
Lungs
Skin (sweat)
What are the abnormal output losses?
Emesis
Hemorrhage
Wound Drainage
What is the primary regulator of water intake?
thirst
Thirst mechanism is diminished in what people?
The elderly
What controls the output by the kidneys?
ADH or Vasopressin
What hormone is secreted by the adrenal cortex and increases sodium reabsorption and potassium excretion by the kidneys?
Aldosterone
What tells the kidneys to RETAIN water?
Antidiuretic hormone
What are the disorders of ADH?
Diabetes Insipidus

Syndrome of Inappropriate Antidiuretic Hormone (SIADH)
What disease happens when the kidneys can't concentrate urine?
This leads to LARGE volume losses of dilute urine and intense thirst
Volume loss places them at risk for hypotension, tachycardia, and cardiovascular collapse
Diabetes Insipidus
What disease is common after a severe traumatic head injury?
Diabetes Insipidus
What is the disease the kidneys retain water, leading to dilution of the blood?

MINIMAL urine output that is very is concentrated, leads to severe edema and expanded blood volume.
Syndrome of Inappropriate Antidiuretic Hormone (SIADH)
What disease is most commonly caused by tumors, specifically bronchial carcinomas among others?
Syndrome of Inappropriate Antidiuretic Hormone (SIADH)
Fluid Volume Deficit: "dehydration"

causes and manifestations?
Causes: emesis, diarrhea, nasogastric suction, excessive use of diuretics

Manifestations: tachycardia, hypotension, syncope, decreased skin turgor (tenting), dry mucous membranes
Fluid Volume Excess: "overhydration"

causes and manifestations?
Causes: excessive IV fluids, congestive heart failure, renal failure, certain medications

Manifestations: edema, "bounding" pulses, jugular venous distension (JVD), pulmonary edema (dyspnea, frothy sputum, rales/crackles on auscultation)
poor skin turgor
What is this?
Hyponatremia:
Low sodium level


Manifestations: Depend on rapidity of onset and severity
Muscle cramps, weakness, fatigue

CEREBRAL EDEMA leads to Lethargy, apathy, headache can progress to disorientation, confusion, depression of deep tendon reflexes, seizure and coma
Hypernatremia
High sodium level

Manifestations: Also depend on rapidity of onset and severity
--Thirst
--The movement of water OUT OF THE BRAIN causes similar symptoms as above
Hypokalemia:
decreased serum potassium

Causes: poor intake, increased excretion

Manifestations: anorexia, constipation, muscle weakness, muscle cramps, electrocardiogram changes, cardiac arrhythmias
Hyperkalemia:
elevated serum potassium

Causes: increased intake with poor renal function, massive cellular death, diminished excretion

Manifestations: nausea, vomiting, diarrhea, muscle weakness, electrocardiogram changes, cardiac arrhythmias
Sodium (Na+) is a major _________ ion.
extracellular
Alteration in Sodium (Na+) = _______ changes.
neuro
Potassium (K+)-major _________ ion
intracellular
Alteration in K+ = __________ changes.
cardiac
____________ & ____________ are deposited in the bone, controlled by Vitamin D and the Parathyroid Hormone and calcitonin.
Calcium and Phosphorus

HAVE AN INVERSE RELATIONSHIP
Hypercalcemia = Hypophosphatemia

Hyperphosphatemia = Hypocalcemia
Serum calcium is mostly bound to ___________.
Albumin
What is required for bones and teeth, plays a major role in the clotting cascade, assists in nerve function?
Calcium
Hypocalcemia
low level of total serum calcium

Causes: low calcium and/or vitamin D intake, chronic kidney disease, pancreatitis

Manifestations: tetany (twitching/cramping), hyperactive reflexes
------Trousseau's and Chvostek's Sign
Hypercalcemia
elevated level of total serum calcium

Causes: over ingestion is very uncommon; hyperparathyroid syndrome, multiple myeloma

Manifestations: decreased neuromuscular excitability, muscle weakness, diminished reflexes, confusion, lethargy, renal calculi
What is contraction of the hand and fingers when arterial blood flow is occluded for 5 minutes?
Trousseau's
Hypercalcemia= decreased _________________
neuroexcitability
Hypocalcemia= ___________ symptoms
twitch
What are the two Hypocalcemia Manifestations?
What is needed for ATP production?
Phosphorus/Phosphate
Hypophosphatemia:
Causes: poor intake, poor absorption (alcoholism, chronic diarrhea)

Manifestations: malaise, muscle weakness, respiratory failure, stupor/coma, hemolytic anemia
Hyperphosphatemia:
Causes: #1 cause is RENAL FAILURE, also caused by tumor lysis syndrome, rhabdomyolysis, crushing injury

Manifestations: S/S of hypocalcemia
What is Required for multiple metabolic reactions in the body?
Magnesium
Hypomagnesemia:
can cause HYPOKALEMIA from an increased excretion of potassium

Causes: low intake or poor absorption

Manifestations: tetany, hyperactive reflexes
What can cause hyperkalemia?
Hypomagnesemia
Hypermagnesemia
Causes: overuse of antacids with renal disease

Manifestations: lethargy, diminished reflexes, confusion, coma
The metabolism of the human body requires a very precise regulation of pH
of __________.
7.35-7.45 normal
<7.35 pH is considered?
Acidosis
>7.45 pH is considered?
>7.45 = Alkalosis
What are the major acids?
Hydrogen and Carbon Dioxide (CO2)
What is the major bases?
bicarbonate (HCO3)
pH is regulated by three mechanisms:
1. Chemical buffer systems in the body fluids
2. The lungs control the elimination of CO2
3. The kidneys control the elimination of Hydrogen and reabsorb and generate HCO3

---These need to be functioning in order for the body to maintain a normal pH
---When one system fails, the other tries to compensate
What is the average PCO2?
35-45
What is PCO2?
partial pressure of carbon dioxide
What is the average HCO3 (bicarbonate)?
22-26
What do you think of when you think of HCO3 (bicarb)?
base- associate it with the kidneys (think metabolic)
What do you think of when you think of CO2?
acid- associate it with the lungs (Respiratory)
pH <7.35, HCO3 <22 is considered what?
Metabolic Acidosis

Decreased serum HCO3 concentration with a decreased pH
Causes and compensation of Metabolic Acidosis
Causes: increased metabolic acids, renal failure

Compensation: LUNGS increase respiratory rate to rid the body of CO2 to counteract the increase in acid
pH >7.45, HCO3 >28 is what?
Metabolic Alkalosis

Loss of metabolic acids causes elevation in free HCO3
Causes and compensation of Metabolic Alkalosis?
Causes: loss of stomach acid through vomiting, nasogastric suction. Loss of chloride through overuse of diuretics.

Compensation: LUNGS decrease respiratory rate to increase the level of CO2 to bring up the amount of acid
pH <7.35, PCO2 >45 is what?
Respiratory Acidosis

Elevation in CO2, usually due to impaired alveolar ventilation
Respiratory Acidosis causes and compensation?
Causes: chest wall disorders, decreased ventilatory drive, lung disease

Compensation: KIDNEYS retain HCO3 and excrete Hydrogen
Respiratory Alkalosis causes and compensation?
Causes: hyperventilation

Compensation: KIDNEYS retain hydrogen and excrete HCO3
pH >7.45, PCO2 <35 is what?
respiratory alkalosis

Decreased CO2
Acid Base Balance Nursing Dx
Impaired Gas exchange
Ineffective Breathing Pattern
Ineffective Tissue Perfusion
Stress linkage is tied to the development of:
Hypertension
Hyperlipidemia
Type II Diabetes
Among other disorders...
What contributes to the development of behaviors such as smoking, overeating, and drug abuse?
stress
Stress is Mediated by what two systems?
Mediated by the Nervous System and Endocrine Systems
Nervous System's Role in stress?
Autonomic Nervous System (ANS): controlling the body's "automatic" functions. Responsible for our "Fight or Flight" response and "Rest and Digest" ****
----The Sympathetic Nervous System (SNS)
----The Parasympathetic Nervous System (PNS)-Rest and digest
The Hormones Involved in the Stress Response:(CAGMA)
Catecholamines (epinephrine, norepinephrine): increases release of glucagon from stores and decreases the effects of insulin along with causes the effects of the "fight or flight response"


Adrenocorticotropic Hormone (ACTH): stimulates the release of cortisol


Glucocorticoid Hormones (CORTISOL): increases the effects of catecholamines on glucagon (raising blood sugar**), inhibits reproductive hormones, decreases inflammatory mediator effects


Mineralcorticoid Horomones (ALDOSTERONE)-helps increase BP****


Antidiuretic Hormone (ADH)- helps increase blood volume and therefore, helps increase BP***
The most rapid of stress responses that represents the basic survival response of our ancestors when confronted with life-threatening situations?
Fight or flight response
_______________ is responsible for controlling the body's normal processes and returning the body to homeostasis after the stressor is removed/controlled.
The Parasympathetic Nervous System
The Adrenal Medulla is stimulated to release what during sympathetic nervous system response?
CATECHOLAMINES and CORTISOL
Long-term Chronic Stress can lead to:
Hyperglycemia (catecholamines and cortisol) from elevated glucose and increased insulin resistance

Impaired immune function (cortisol) increases the risk of disease as well as exacerbations of current illness. Also slows wound healing.

Cardiovascular disease

Depression, alcoholism, drug abuse, eating disorders, and suicide
Stress management:
Relaxation techniques
Guided imagery
Music therapy
Massage therapy
Biofeedback
Potential Nursing Dx for Stress
Ineffective individual coping strategies:
Ineffective Family Coping strategies:
Conflict Decision
Stress overload
Incomplete Proteins are:
beans, nuts, seeds, and grains
Complete Proteins are:
milk, eggs, meat, fish, and poultry
Used for energy when carbohydrates are not available for use?
Fats
Two types of fats?
Saturated Fatty Acids: the "bad" fats responsible for elevating blood cholesterol
Animal fats, some plant fats (SOLID at room temp)


Unsaturated and Polyunsaturated Fatty Acids: the "good" fats responsible for lowering blood cholesterol
Plant oils (LIQUID at room temp)
Carbohydrates information
Simple: empty calories with little to no nutritional value

Complex: rich in fiber and nutrients, extras stored in the liver for later use
-----Fiber: cannot be digested by the GI system. Increases stool bulk, facilitates bowel movements and binds with cholesterol to prevent it from being absorbed by the body.
Out of all the nutrition basics, what does NOT provide energy directly?
vitamins and minerals
What are the BMI levels?
Underweight <18.5
Normal 18.5-24.9
Overweight 25-29.9
Obesity 30-34.9 (class I), 35-39.9 (class II)
Extreme Obesity 40 or greater (class III)
Overweight and Obesity increases the risk of:
Hypertension
Hyperlipidemia
Coronary artery disease (CAD)
Stroke
Type II Diabetes Mellitus
Osteoarthritis
Certain types of cancer
Fatty liver disease
Elevated generalized inflammation
Central Abdominal (Visceral) Obesity
is what shape?
"Apple" shape
Carries higher risk factors for disease development
Gluteal-Femoral Obesity is what shape?
"Pear" shape
What are the details of metabolic syndrome?
Central abdominal obesity

Hypertension

Hyperlipidemia

Increased Risk for Type II diabetes
A person does not receive adequate nutrients for body function is called what?
Malnutrition and Starvation
Causes of Malnutrition and Starvation?
Causes: poverty, lack of knowledge, acute and chronic illness, self-imposed dietary restrictions

May occur in obese individuals

Nursing Dx: Nutrition altered: less than body requirements
Who is at risk for malnutrition and starvation?
The homeless, the elderly, and children are greatly at risk
What are the three eating disorders?
Anorexia Nervosa
Bulimia Nervosa
Binge-eating Disorder
Extreme dieting often accompanied by compulsive exercise, disturbed body image, fear of becoming obese, and obsession with severely restricted caloric intake.

High risk of death secondary to starvation and cardiac arrhythmias
Often an inability of the person to recognize there is a problem
Patients often have a weight less than 85% the norm

What is this disease?
Anorexia Nervosa
Binge eating followed by either vomiting, fasting, excessive exercise and/or the use of diuretics, laxatives or enemas to compensate for the binge eating

Most are normal weight

Vomiting leads to dental abnormalities, esophagitis, and severe gastric reflux

What is this disease?
Bulimia Nervosa
Eating too much in a short period of time, eating when not hungry and feeling uncomfortably full

Do not engage in compensatory behaviors like in Bulimia

Commonly leads to obesity

What is this disease?
Binge-eating Disorder
Potential Nursing Diagnoses of eating disorders?
Disturbance of Body Image
Disturbance of self-esteem
Risk for self harm
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