Fluid Forces
This is comprised of: blood(vascular fluid), interstitial fluid, and transcellular fluid (CSF, sweat, urine, etc).
ECF-extracellular fluid
What is first spacing?
Normal distribution of fluid in ICF and ECF
Refers to all fluid that is where it is supposed to be, including fluid inside cells and inside the blood vessels.
S/S of hyponatremia vs hypernatremia???
Hypernatremia: Dry mouth, thirst, edema & Lethargy, irritable
Hyponatremia: Lethargy, confusion, seizures- be careful with the brain!! Watch for LOC changes
How does Acidosis affect the body? GENERALLY think systemically.
Decreases neuronal-excitability
Muscle weakness
Weak reflexes
Decreased sodium=vasodilation so increased cerebral blood flow and increased intracranial pressure
Increased ICP- headache, confusion and severe cases=coma.
A 70-year-old male with chronic renal failure presents with edema. Which of the following is most likely the cause of this condition?
Increased capillary hydrostatic pressure
Increased interstitial oncotic pressure
Increased capillary oncotic pressure
Increased interstitial hydrostatic pressure
1 or A is the correct answer
A/An ___ in tissue hydrostatic pressure will push fluid into blood vessels.
Manifestations of Edema are...
Pitting edema (scale 1-4), 1 lb of gain= 1 pt of fluid, SOB, ascites, reduced plasma volume.
Explain how RAAS works.
Renin and angiotensin are enzymes that promote the secretion of aldosterone. Low blood pressure stimulates the release of renin and starts the RAAS = sodium retention = water follows = increased fluid volume = ↑ BP.
More calcium is bound to protein since less H+ ions
Less calcium blocks sodium channels, increasing neuromuscular activity.
Positive Chvostek and Trousseau signs
Hyperactive reflexes
Convulsions, paresthesias, and tetany
vasoconstriction of cerebral vessels and decreased cerebral blood flow.
S/S of Hypocalcemia vs Hypercalcemia and why they happen like this:
HYPERCALCEMIA-- IT CAN BLOCK NA gates- hypercalcemia.Symptoms- due to nerves not firing patients will be lethargic, a stupor. Can lead to a coma and cause muscle weakness.
HYPOCALCEMIA-Lower calcium levels lead to the gate being blocked less, so now the nerves are going to fire fast and easy!! WEAK Bones IS CAUSED BY HYPERCALCEMIA!! That's why Dr. would measure PTH in the blood.
HYPOCALCEMIA- CAUSES BOTH OF THESE SIGNS! SO KNOW THIS- CHVOSTEK SIGN & TROUSSEAU SIGNS!!
Carpopedal spasm
(tetany)--> Low PTH levels, renal failure, ↑ albumin binding
High osmolarity causes... 2 things to happen.
After this what happens if we gain too much water?
1. ADH IS RELEASED when there is INCREASED BLOOD OSMOLARITY. This reabsorbs water from your urine.
2. Thirst (polydipsia) increased water intake
WATER GAIN or fluid overload (edema) can happen if we take in too much water due to high osmolarity. Too much water goes into cells and they swell.
WATER FOLLOWS SALT
When is ADH secreted and what is it??
What substances can inhibit and increase the release of ADH?
Anti-diuretic hormone secreted by the posterior pituitary gland.
ADH is secreted when plasma osmolality increases or circulating blood volume decreases and blood pressure drops.
2. ADH is secreted when plasma osmolality increases, not by an increase in potassium.
NARCOTICS & NICOTINE- increase ADH,
Alcohol inhibits ADH (why you pee when you drink).
What does Potassium do for our body, how does it work with the transcellular shift, and what are the causes of Hypokalemia vs Hyperkalemia ??
Potassium-->maintains the resting membrane potential
Exchanged for H+ to buffer changes in pH (due to both having a +charge)- Transcellular Shift
In the Cell: ↑LA → K+ moves out of the cell to balance cations = ↑ plasma K+
In the Blood: ↑H+ → K+ moves into cell to balance cations = ↓ plasma K+
HYPERKALEMIA: over supplementation, renal failure, acidosis, hypoaldosteronism, crush injury
HYPOKALEMIA: poor eating habits, renal losses, skin losses, increased aldosterone
Respiratory Acidosis. State 3 big things about it that you should know!
Decrease breathing- usually due to OBSTRUCTION in lungs, emphysema, COPD increased CO2 production from fever. DECREASED CENTRAL DRIVE to BREATHE. DAMAGE TO THE MEDULLA OBLONGATA-HYPOVENTILATION-PNEUMONIA.
Low K and phosphate can cause it because of decreased muscle contractility.
S/S; hypoxia, decreased blood oxygen, high fever and these patients may need ventilation to increase oxygen
Metabolic Alkalosis. List 3 things you should know.
patient who is vomiting or doing any gastric procedure→ vomiting or gastrointestinal suctioning or from excessive bicarbonate intake, hyperaldosteronism, and diuretic therapy.
S/S: weakness, cramps, slow respirations
THE LUNGS COMPENSATE! The elimination of CO2 decreases. The serum carbonic acid level increases. The pH decreases back to normal.
TX; fluids (saline and chloride),
What causes Increased Capillary Hydrostatic Pressure & where does the fluid go?
Causes of excess body water and sodium (Fluid volume overload). Or if tissue gets burnt, then inflamm response, and capillaries get leaky- loose proteins- and pull water into tissue spaces
Capillaries to Interstitial fluid (drives the fluid out of capillaries)
Hypervolemia vs Hypovolemia what are some causes and S/S?
Hypervolemia-isotonic volume excess is usually due to decreased excretion of water and sodium by the kidneys. S/S: Weight gain, distended neck veins, decreased plasma protein, and increased BP.
Hypovolemia: isotonic fluid deficits:due to Hemorrhage, Vomiting, Diarrhea, Fever, Excess sweating, Burns, Diabetes insipidus, Uncontrolled diabetes mellitus. S/S: Decreased urine output, Weight loss, Increased hematocrit, Tachycardia, Decreased skin turgor, and blood pressure and potential hypovolemic shock
We know potassium is regulated by what organ and hormone?
What are S/S of hypokalemia?
The kidney, by aldosterone and insulin secretion, and by changes in pH.
increased urine output, polyuria, nausea, skeletal muscle weakness, LOWERS RMP- harder for cells to fire
This affects the heart because now the cardiac muscle cells are delayed in ventricular repolarization (leads to arrhythmias)
Respiratory Alkalosis. State 3 things you need to know.
caused by HYPERVENTILATION GIVE PT paper bag to fix it.
Any condition that affects the respiratory system (medulla) in the brain stem so Hypoxemia, severe hypotension, hypovolemia, or anemia- all lead to resp. Alkalosis. EMOTIONS CAN ALSO TRIGGER IT- like anxiety, fear, rage.
S/S: Constriction of cerebral vessels and increased neuronal excitability, cardiac dysrhythmias→ increased neuromuscular excitability (paresthesia/tetany), headache, disorientation, warm flushed skin BECAUSE OF INCREASE RR- pts can feel SOB and dyspnea.
Body temperature, Metabolic rate and Production of carbon dioxide-Hypoxemia and hypotension, which cause reflex increase in alveolar ventilation Fever, which activates the respiratory center and increases the rate you get rid of CO2
A 25-year-old male is diagnosed with a hormone-secreting tumor of the adrenal cortex. Which finding would the nurse expect to see in the lab results?
a. Decreased blood volume
b. Decreased blood K+ levels
c. Increased urine Na+ levels
d. Increased white blood cells
B. Decreased Blood K+ levels
Hydrostatic pressure is ______at the arterial end of the capillary
vs
At the venous side, osmotic pressure is _____ than hydrostatic pressure
Both answers are greater!
What is the difference between hypotonic hyponatremia and hypertonic hyponatremia??
Hypotonic hyponatremia: Too much water, not enough sodium → diluted blood. Jills example: Gatorade instead of water so you don't dilute more of the sodium.
Hypertonic hyponatremia: Other substances (like sugar-uncontrolled diabetes mellitus) are high, pulling water into the blood and diluting sodium.
What is the main difference between Calcitonin and parathyroid hormone and Vitamin D?
Calcitonin acts on kidney & bone to remove Ca++ from circulation.
PTH releases Ca++ from bone into blood, Activates Vitamin D, Stimulates kidney to conserve Ca++, Thiazide diuretics increase distal convoluted tubule (DCT) Ca++ reabsorption
Vitamin D (calcitriol) increases Ca++ absorption from the intestine.
Metabolic Acidosis. State 3 things you need to know.
CAUSED By INCREASED/excessive production of metabolic acids- lactic acids or ketone acids. Someone in ketosis- KIDNEY failure because the kidney cannot get rid of hydrogen ions. Breathe faster to fix this.
S/S; Decreased neuromuscular excitability, Accelerated heartbeat (tachycardia).Confusion or dizziness.Feeling very tired (fatigue).Loss of appetite.Headache.Rapid breathing or long, deep breathing.Nausea and vomiting.Feeling weak.
Signs of compensation: Increased rate and depth of breathing & Kussmaul respirations in more severe cases- HYPERVENTILATION AND PANTING
For a patient with respiratory acidosis, chronic compensation by the body will include:
a. Kidney excretion of H+
b. Kidney excretion of HCO3
c. Prolonged exhalations to blow off CO2
d. Protein buffering
A. kidney excretion of H+