2501005
| Question | Answer |
| Osmosis | Water moves from a chamber of low solute concentration to one of high solute concentration to establish equilibrium |
| Filtration | Movement of fluid through cell or blood vessel membrane because of differences in water volume pressing against confining walls (hydrostatic pressure) |
| Diffusion | Free movement of particles (solute) across permeable membrane from area of higher to lower concentration - Important in transport of most electrolytes; other particles diffuse through cell membranes |
| Hydrostatic Pressure | “Water-pushing pressure” Force that pushes water outward from a confined space through a membrane |
| What sign develops with changes in normal hydrostatic pressure? | Edema |
| What are the sensible (measurable) means through which fluid is lost? | Kidneys, wound drains, GI tract |
| What are the insensible (immeasurable) means through which fluid is lost? | Lungs (respiration) and skin (evaporation, perspiration) |
| Fluid loss can be increased during a hypermetabolic state. What is a hypermetabolic state? | An abnormally increased rate of metabolism such as a fever, burn, trauma, thyroid crisis, and tachypnea. |
| What is the minimum urine amount needed to excrete toxic waste products? | 400 to 600 mL |
| What role does ADH play in regulating Na+ and water balance? | ADH (antidiuretic hormone) from the posterior pituitary acts on the kidney to promote water reabsorption, thus preventing its loss in the urine |
| What role does aldosterone play in regulating Na+ and water balance? | ↓BP (↓blood volume) causes kidneys to secrete renin – activates angiotensinogen (angiotensin I) – angiotensin converting enzyme activates angiotensin II – vasoconstriction – causes adrenal gland to secrete Aldosterone which acts on the kidney to promote sodium reabsorption, thus preventing its loss in the urine |
| What role does ANH play in regulating Na+ and water balance? | ANH (atrial natriuretic hormone) from the atrium of the heart acts on the kidney to promote sodium excretion so that it is excreted in the urine |
| Which pathway is greatly stimulated with shock, or when stress response is stimulated? | Renin-angiotensin II. This is why urine output is used as an indicator of perfusion adequacy after surgery or any time the patient has undergone an invasive procedure. |
| What is hypovolemic shock? | Vital organ hypoxia/anoxia |
| If a patient is dehydrated but incontinent and a fall risk, is it appropriate to let them decrease their fluid intake before bed? | No. They need to continue to increase their fluids. |
| When a patient is receiving IV therapy for dehydration, what things do you need to be monitoring for? | Pulse quality, urine output, weight (every 8 hours), IV site, and fluid overload (bounding pulse, difficult breathing, JVD in upright position, edema) |
| What are the common causes of fluid overload? | Excess fluid replacement, kidney failure (late stage), heart failure, long term corticosteroid use, SIADH, psych disorders w/ polydipsia, interstitial to plasma fluid shifts (burns, excess Na+ intake) |
| Severe hypervolemia can lead to... | pulmonary edema and heart failure. |
| If your patient has fluid overload, what position should they be placed in? | Semi-Fowler's |
| mannitol (Osmitrol) is an example of what kind of diuretic? | Osmotic diuretic |
| Which drugs are - rarely used in the management of HTN d/t short duration of action & availability of better drugs? | Loop diuretics like Lasix |
| Besides ototoxicity and potasium depletion, what is another possible adverse effect of Lasix? | Precipitation of gout by means of blocking renal excretion of uric acid |
| What is the primary use of mannitol (Osmitrol)? | decrease intracranial pressure (it is not metabolized so it is freely filtered at the glomerulus) |
| What is one of the most common causes of hyponatremia? | Prolonged use/overuse of diuretics |
| What does isotonic mean? | When the concentration of dissolved particles is similar to that of plasma. Isotonic solutions have an osmolality of 250 to 375 mOsm/L. |
| Which solution is the most physiologically adaptable fluid? | Lactated Ringer's Solution |
| What does D5W do? | -Rapidly metabolized by the body. -Provides free unbound water molecules (can pass into cells providing hydration, provides free water to the kidneys which aids renal excretion of solutes) -Treats hypernatremia |
| What is the net result when dextrose is added to isotonic or hypotonic solutions? | a slightly hypertonic solution |
| What are some examples of pH buffers? | -bicarbonate and phosphate together -proteins (albumin, globulin, hemoglobulin) |
| When cells metabolize glucose under anaerobic conditions, this produces... | lactic acid |
| Where does bicarbonate come from? | Ingestion and pancreatic production |
| How do kidneys control acid-base mechanisms? | movement of bicarbonate- either excrete it or reabsorb depending on level of H+ |
| How does ammonium effect acid-base levels? | secreted in urine, traps excess H+, both are excreted |
| When referring to the kidney's role in pH regulation, what does full compensation mean? | If the pH is brought back to normal range |
| When the kidneys bring the pH almost back to a normal range, this is referred to as... | partial compensation. |
| When looking at lab values for respiratory and metabolic pH, which is inversely proportional? | Respiratory |
| What is combined metabolic and respiratory acidosis? | Uncorrected respiratory acidosis leads to poor oxygenation and lactic acidosis |
| Who is at risk for combined respiratory and metabolic acidosis? | Combined problem of Diabetic Ketoacidosis (DKA) and COPD |
| What are some S/S of acidosis? | -Creates imbalance with positive ions – especially K -Disrupts function nerves, cardiac/skeletal muscles(early s/s) -Reduces excitability of membranes -CNS changes; lethargy, confusion to coma -Neuromuscular changes – behavioral changes seen early -↓ muscle tone, deep tendon reflexes |
| What is the hallmark of respiratory acidosis? | Decreased pH, PaO2 with rising PaCO2 |
| What is the hallmark of base excess acidosis? | ABG result with ↑ pH and ↑ bicarbonate level with normal O2 and CO2 levels |
| What is the hallmark of respiratory alkalosis? | -ABG result with ↑ pH coupled with low CO2 level -O2 and bicarbonate usually normal |
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