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Free online NCLEX Review for the Complete Idiot. LVN/LPN. Labs Values #2: Electrolytes and acid base balance. Metabolic & respiratory acidosis & alkalosis, hypo & hyper: Natremia, kalemia, calcemia, magnesemia. K, foods, blood gas values, etc.

Metabolic Acidosis, Metabolic Alkalosis, Respiratory Acidosis, Respiratory Alkalosis. Causes & S/S of: Hyper and Hypernatremia, Hypo and Hyperkalemia, Hypo and Hypercalcemia, Hypo and Hypermagnesemia, pH, Blood gas values, aldosterone, renin.
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Metabolic Acidosis
pH < 7.35 , PaCO3 normal or < 35, HCO3 < 22
Metabolic Alkalosis
pH > 7.45, PaCO2 normal or > 45, HCO3 > 26
Respiratory Acidosis
pH < 7.35, PaCO2 > 45, HCO3 >26
Respiratory Alkalosis
pH > 7.45, PaCO2 < 35, HCO3 < 22
causes of Hyponatremia
GI loss - NG suction, vomit, diarrhea, Renal loss
causes of Hypernatremia
Excess aldosterone secretion, water deprivation or increased water loss.
causes of Hyperkalemia
Fluid Volume Deficit, Renal Failure, Acidosis
causes of Hypokalemia
Diuretics (Lasix), Diarrhea, GI loss, polyuria
causes of Hypercalcemia
Osteoperosis, hyperparathyroidism, immobilization
causes of Hypocalcemia
chronic alcoholism, chronic renal failure, Vitamin D deficiency
Potassium (K)
electrolyte imbalance in which cardiovascular is always a concern.
Signs and symptoms of Fluid volume excess
1)weight gain 2)High BP 3)shallow, rapid respirations 4)crackles 5)Fluid intake > outake 6)weakness, fatigue, dyspnea 7)edema, taut shiny skin 8)JVD 9)bounding pulse
Foods high in potassium
potatoes, raisins, bananas, spinach, avacados, carrots
causes of Hypermagnesemia
Renal failure, excess intake
causes of Hypomagnesemia
Malnutrition, alcoholism, diarrhea, vomiting, polyuria
Hypotonic solution
reverses dehydration.
S&S of Hypokalemia
muscle weakness & cramps, irregular pulse
S&S of Hypocalcemia
pathological fractures, Trousseau's sign, Chvostek's sign
S&S of Hypomagnesemia
hyperactive deep tendon reflexes, muscle tremors
Renal system (kidneys)
3rd line of defense for acid base balance.
S&S of Hypercalcemia
hypoactive reflexes, cardiac arrest
causes Hypervolemia - crackles, SOB
Too much fluid to patient with kidney failure or CHF.
Osmolality
concentration of solutes in a solution.
Lasix (diuretic)
causes loss of potassium. (hypokalemia)
examples of Isotonic solutions
1)Lactaid Ringers 2) NS (0.9% NaCl) 3) 5% Dextrose
pH
measures hydrogen ion concentration in the body fluids.
causes of Fluid Volume Deficit
1) decreased intake 2) increased excretion 3) fluid shift 4) strenuous exercise 5) extreme heat/dryness 6) fever (increased metabolic rate)
Blood gas values - pH, PO2, HCO3, PCO2
1)7.35-7.45 2) 80-100 mm Hg 3) 22-27 mEq/L 4)35-45 mm Hg
Metabolic Imbalance
Bicarbonate (PCO2) concentration corresponds with pH.
Fluid Regulation of GI tract
Absorbs nutrients H2O.
Acid Base regulatory mechanisms
Blood, Lungs, Kidneys
Renin-Angiotensin mechanism initiates
1) low blood volume 2)low serum Na 3) low BP 4)high serum K
5) low cardiac output
Respiratory Alkalosis
Result of hyperventilation.
Metabolic Acidosis
Results from severe diarrhea or renal disease.
Hypotonic solution
Water moves into cell and causes cell to swell. Fluid shift out of blood vessels into interstitial spaces.
Istotonic solution
Expands ECF volume. (same concentrate as plasma.)
Respiratory system (lungs)
2nd line of defense for acid base balance.
Aldosterone
Increases reabsorption of Na and water and excretion of K in kidneys. Causes vasoconstriction, increases BP. (main Na-retaining hormone)
Fluid Volume Excess
Excessive retention of water and Na in extracellular fluid.
Hyponatremia
Net gain of water or loss of Na-rich fluids.
S&S of Fluid Volume Excess
1)weight gain 2)weakness, fatigue 3)dyspnea with exertion 4)pitting edema 4)JVD 5)taut, shiny skin 6)bounding pulse 7)shallow, rapid respiration 8)crackles 9)high BP 10)fluid intake > outake
Fluid Output
Occurs through kidneys, skin, lungs and GI tract.
Respiratory Imbalance
Bicarbonate (PCO2) has opposite response of pH.
Renal System (kidneys)
Primary system in regulating fluid and electrolyte balance.
Fluid Regulation of Nervous System
Hypothalamus controls thirst - thirst center.
Fluid Regulation of Kidneys
1)Filters blood 2)Excretes urine 3)Secretes aldosterone - reabsorbs Na, H2O and Cl and exceretes K.
Fluid Regulation of Lungs
1)Regulates O2 and CO2 2)Eliminates H 3)Acid/Base Balance
Foods high in Magnesium
Vegetables, nuts, fish
serum Magnesium level
1.3 - 2.1 mEq/L
serum Potassium level
3.5 - 5 mEq/ L
serum Calcium level
4.5 - 5.5 mEq/L
Respiratory Acidosis
Result of hypoventilation.
Metabolic Alkalosis
Results from vomiting, gastric suction, K deficiency, increased renal excretion of acid.
S&S of Hypernatremia
Extreme thirst, sticky tongue and mucous membranes, postural hypotension.
Hypernatremia value
serum sodium greater than 145 mEq/L
Hypertonic solution
solution with greater concentration than plasma.
Blood - Bicarbonate
1st line of defense of acid base balance. (immediate response, only small fluctuations)
Fluid Excretion
Vomiting, diarrhea, abnormal drainage, excessive use of laxatives, enema, diuretics, blood loss, diaphoresis, burns
Hypertonic solution
Water moves out of cell and causes cell to shrink.
S&S of Fluid Volume Deficit
1)Increased pulse and respirations 2)decreased BP 3)output > intake 4)dry oral mucosa 5)increased thirst 6)weight loss (5lbs.) 7)scanty or concentrated urine 8)collapsed neck veins
Fluid Regulation of Thyroid Gland
Increases blood flow in the body and increases output.
serum Sodium level
135 - 145 mEq/L
Hyponatremia
serum Sodium level less than 135 mEq/L
Oxygen Saturation
Point at which hemoglobin is saturated by O2.
Sensible Loss
loss that is perceived or is measurable. (wound drainage, GI tract, urine)
S&S of Hyperkalemia
life threatening dysrhythmias
Sodium (Na)
major electrolyte found in extracellular fluid
Dehydration
Water lost from body - no loss of electrolytes.
Insensible Loss
Continuous loss occurring through skin and lungs.
Fluid Regulation of Lungs
Regulates O2 and CO2, Acid/Base Balance and eliminates H+.
Effects of Aldosterone
Excretes K and retains Na.
Hypovolemia
Body loses both water and electrolytes from the ECF.
Fluid Regulation of Cardiovascular system
Distributes nutrients and water throughout the body.
Postassium (K)
Major cation in the intracellular fluid.
reciprocal
potassium has action with sodium.
Renin
Released in response to decreased blood flow or decreased pressure in nephrons.
S&S of Hyponatremia
personality change, postural hypotension
S&S of Hypermagnesemia
hypoactive deep tendon reflexes
cause of decreased excretion
renal disease,cancer
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