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67 Cards in this Set
- Front
- Back
When the plasma sodium concentration is lower than normal or renal blood flow is reduced, the juxtaglomerular cells in the kidneys produce _______, which enters the circulation.
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Renin
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In the renin-angiotensin-aldosterone System ___ is excreted in exchange for ___?
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K for NA |
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A hormone that is produced by the cardiac atrium in response to excess blood volume that stretches the atrial wall.
Promotes sodium wasting and acts as a potent diuretic. (exact opposite of angiotensin II) |
Atrial Natriuretic Factor (ANF)
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ANF acts on the nephrons as a potent ________ to ________ blood volume.
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diuretic decrease |
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Risk Factors Affecting Fluid Balance
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•ChronicDiseases
•AcuteConditions •Medications •Treatments •Nutrition •Age |
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Lifespan Considerations
Infants and Children |
Immature Kidneys
Rapid Respiratory Rate = Greater Insensible Losses Thirst Mechanism (cannot express or seek fluids) |
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Lifespan Consideration
Older Adults |
•ThirstSensationdecreased
•Decreased Urine Concentrate •DecreasedICF andTotal Body Fluid •Increaseduse ofDiuretics •DecreasedIntake of Food/Water •ImpairedRenal Function |
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Assessment Interview
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•Current and Past Medical History
•Medications and Treatments •Food and Fluid Intake •Fluid Output •Imbalances |
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Clinical Measurements
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•Daily Weights*
•Vital Signs •Fluid Intake and Output |
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Sodium (Na) |
135-145 mEq/L |
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Magnesium (Mg) |
1.5-2.5 mEq/L |
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Phosphate (PO3-)
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1.8-2.6 mEq/L
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Calcium (Ca)
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4.5-5.5 mEq/L
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Bicarbonate (HCO3-)
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22-26 mEq/L
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Chloride (Cl)
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95-108 mEq/L
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Potassium (k)
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3.5-5.3 mEq/L
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Hematocrit (HCT) men- women- |
40-54% 37-47% |
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________ solution refers to two solutions having the same osmotic pressure across a semipermeable membrane
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isotonic |
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Both fluid and electrolytes are lost in equal proportion. Commonly referred to as hypovolemia. |
fluid volume deficit (FVD) |
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************************************************************************************
Serum Osmolalitycan be estimated by doubling the serum ________ value ************************************************************************************ |
sodium |
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Measures the amount of all chemical particles dissolved in serum (such as Na+, Cl-, bicarbonate, proteins, & glucose)
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Serum Osmolality
280-300 mOsm/kg |
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when serum osmolality _________, ADH is released to retain fluid
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increases |
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Occurs when the body retains both water and sodium in similar proportions to normal ECF, commonly referred to as hypervolemia. |
Fluid volume excess (FVE) |
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when hydration decreases, serum osmolality ________
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increases
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Albumin (Alb)
Protein produced by the liver (Has a sponge like effect) |
35-50 g/L
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Urine Osmolality
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500-800 mOsm/kg
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Urine Specific Gravity
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1.005-1.030 (usually 1.010-1.025)
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Urine pH
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Normal value is 6.0 but a range of 4.6-8.0 is considered normal
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Patient Teaching fluid balance
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Consume 6-8 glasses of water Avoid high salt, sugar, and caffeine Limit alcohol Maintain normal body weight Monitor medication side effects Recognize risk factors (watery stool) |
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Nursing Responsibilities During F & E Replacement
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•Safely administer the replacement
•Measuring fluid intake and output •Monitoring for complications of therapy: weight/VS •Teaching clients and families regarding the therapy •Know the rationale behind why your client is receiving the replacement: A.Treating the underlying cause B. Increasing or decreasing the Fluid C. Shift electrolytes into their appropriate area to decrease plasma concentration |
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********************************************************************************
chief cation within the cell (ICF) ******************************************************************************** |
Potassium (k+)
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major cation+ within the cell (ICF)
major anion- within the cell (ICF) |
Magnesium (Mg+)
Phosphate (PO3-) |
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major anions- in the ECF
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Bicarbonate (HCO3-)
Chloride (Cl-) |
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************************************* ************************************* |
Sodium (Na+)
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Please let the Cat in (_________)
So the Cat wants to go outside (_______) |
Potassium Sodium |
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Is necessary for nerve impulse transmission, regulates cell excitability. Ratio must be maintainedVital for skeletal, cardiac, and smooth muscle activity. (Dysrhythmias, Muscle Cramps, Weakness, Confusion)
Needed for proper heart muscle activity! |
Postassium |
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Foods high in K+
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Oranges, dried fruits, tomatoes, avocados, dried peas, meats, broccoli, bananas, dairy products, whole grains
Licorice in large amounts can cause hypokalemia. |
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Most abundant electrolyte in ECF (90%)
Role in acid/base balance- buffer base Kidneys main regulator of _______ reabsorption or excretion (Hormones) Aids in the conduction of nerve impulses Helps control muscle contractility Obtained via GI intake |
Sodium 135-145 mEq/L |
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Main determinant of serum osmolality
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Sodium |
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Foods high in Na+ |
Foods: Processed/Preserved foods Processed cheese and luncheon meat Snack foods (chips…)Canned foods (meats,soups and vegetables)Bacon, Ham, Sausage Most condiments (Ketchup)Seafood Table salt, etc. |
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Maintains proper blood volume and pressure
Necessary for maintenance of acid-base via the kidneys Mostly comes from the salt that you eat. |
Chloride (Cl) 95-108 mEq/L |
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Forming bones/teethAids in the clotting of bloodTransmitting nerve impulsesRegulates cardiac, skeletal and smooth muscle contraction Decreases neuro-muscular irritabilityAbsorption requires active form of vitamin D
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Calcium 4.5-5.5 mEq/L |
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Sources of Calcium
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•Dairy•Cheese•Yogurt•Broccoli•Kale•Grains•EggYolks
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•Importantforintracellular metabolism in producing and using ATP•Promotescarbohydrate, fat, and protein metabolism•PowersNa-K pump•Regulatescardiac function•Transmitnerve impulses•Relaxesmuscle contractions
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Magnesium(1.5-2.5mEq/L)
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Magnesium rich foods
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Whole grains, nuts, dried fruit, green leafy vegetables, dairy products, tuna fish, chocolate
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Deficient calcium |
Hypocalcemia
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Excessive potasssium |
hyperkalemia |
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Deficient sodium |
hyponatremia |
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Primary Nursing Diagnosis
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•Risk for Electrolyte Imbalance p. 348
•Risk for Imbalanced Fluid Volume p. 397 •Readiness for Enhanced Fluid Balance p.386•Deficient Fluid Volume p. 388 (Ackley) p. 1319 (Krozier) •Excess Fluid Volume p. 393(Ackley) p. 1319 (Krozier) |
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Additional Secondary Nursing Diagnosis
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•Decreased Cardiac Output (dysrhythmia)
•Activity Intolerance (hypovolemia) •Ineffective Tissue Perfusion (cardiac output or edema) •Risk for Injury (calcium shift out of bones) •Impaired Oral Mucous Membrane (FVD) •Impaired Memory/Acute Confusion •Risk for Impaired Skin Integrity (dehydration/edema) •Risk for Falls |
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Diuretics
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Lasix (flurosemide) *Loop Potassium-sparing *DCT |
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is the most important base in the body.
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Bicarbonate (HCO3)
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A pH reflects the ________ ion concentration of a solution.
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hydrogen |
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Lower pH is _______…higher pH is alkaline (base)
Acids release hydrogen ions and bases ________ hydrogen ions. |
acidic absorb |
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Normal blood pH level
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7.35-7.45
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A __________ solution is a particular type of solution that has a greater concentration of solutes on the outside of a cell when compared with the inside of a cell.
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hypertonic |
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any solution that has a lower osmotic pressure than another solution. In the biological fields, this generally refers to a solution that has less solute and more water than another solution.
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Hypotonic |
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Angiostensin II does what |
Causes sodium and water retention (by vasoconstriction, less filtration in kidney) and releases Aldosterone from Adrenal cortex |
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What does aldosterone cause |
Sodium reabsorption and potassium secretion in the distal convoluted tubule |
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If serum osmolality decreases, ADH is _________, the collecting ducts become less permeable to water, and urine output increases. |
suppressed |
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Atrial Natriuretic Factor (ANF) |
Increases excretion of sodium and water
decreases thirst mechanism increases the glomerular filtration rate (GFR) Reduces aldosterone secretion Relaxes arterioles and venules |
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What percent of potassium is excreted by the kidneys? |
80% |
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Regulates water excretion from the kidney, is synthesized in the anterior hypothalamus and acts on the collecting ducts of the nephrons? |
ADH |
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Net result of the RAAS system |
Increased blood volume through sodium and water retention |
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Insulin helps move ____ into cells? |
K+ (potassium) |
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A person who is electrolyte depleted may experience? |
Fatigue, weakness, headache, and GI symptoms such as anorexia or nausea. |
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Stress can release this which lowers urine production. The overall result of stress is increased _____ _________. |
ADH blood volume |