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8/3/2019 Electrolyte Two
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(def)
fluid found within the body cells
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intracellular fluid
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How does being dehydrated affect blood pressure and pul
pressure?
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-Systolic blood pressure decreases
-Diastolic blood presssure increases or stays the same
-Pulse pressure narrows and is severe
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(def)
fluid that surrounds the cells
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interstitial fluid
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How does overhydration affect blood pressure and pulse pres
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-Systolic Blood pressure increases (late sign)
-Diastolic blood pressure decreases
-Pulse pressure widens
8/3/2019 Electrolyte Two
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(def)
plasma; the fluid portion of blood
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intravascular fluid
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How does heart rate (pulse) change due to dehydration?
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It Increases.
8/3/2019 Electrolyte Two
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(def)
atoms or group of atoms that carry a positive or negative cha
electrolytes
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ions
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How does heart rate (pulse) change due to overhydration
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It decreases.
8/3/2019 Electrolyte Two
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(def)
fluid loss that is not perceptible to the individual
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insensible fluid loss
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How does pulse amplitude affected by dehydration?
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It decrease to a +1
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(def)
fluid found outside the body cells
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extracellular fluid
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How does pulse amplitude affected by overhydration?
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It increases to a +3
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(def)
chemical substances that develop an electric charge and are ab
conduct an electric current when placed in water; ions
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electrolytes
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How is the respiration rate affected by dehydration?
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It increases.
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(def)
the presence of excess interstitial fluid in the body
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edema
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How is the respiration rate affected by overhydration?
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It stays the same and a late sign is it increases.
8/3/2019 Electrolyte Two
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(def)
the mixing of molecules or ions of two or more substances as a
of random motion
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diffusion
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How are the neck veins affected by dehydration?
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They are flat.
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(def)
movement of substances across cell membranes against th
concentration gradient
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active transport
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How are the neck veins affected by overhydration?
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They are distended.
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(def)
substances dissolved in a liquid
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solutes
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How does dehydration affect the eyes?
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The eyes have a soft appearance and are sunken.
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(def)
the liquid in which a solute is dissolved
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solvent
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How does overhydration affect the eyes?
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There is periorbital edema.
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(def)
a membrane that prevents the passage of some substances but
the passage of others based on differences in the size, charge
lipid-solubility of the substance
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semipermeable membrane
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How does dehydration affect breath sounds?
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They are clear.
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(def)
pressure exerted by the number of nondiffusible particles in
solution
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osmotic pressure
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How does overhydration affect the breath sounds?
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They can be clear or have adventitious wet sounds.
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(def)
the concentration of solutes in body fluids
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osmolality
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How are the mucus membranes affected by dehydration?
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They are dry.
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(def)
the pressure in a compartment that results in the movement of
and substances dissolved in fluid out of the compartment
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filtration pressure
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How are the mucus membranes affected by overhydration
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They are wet.
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(def)
the pressure a liquid exerts on the sides of the container that ho
also called filtration force
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hydrostatic pressure
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How is the skin affected by dehydration?
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It is dry.
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(def)
a pulling force exerted by colloids that help maintain the wa
content of blood
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colloid osmotic pressure (also known as oncotic pressure
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How is the skin affected by overhydration?
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It is moist or can be taut and shiny.
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(def)
a hormone that decreases the production of urine by increasin
reabsorption of water by renal tubules
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antidiuretic hormone (ADH)
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How does dehydration affect skin temperature?
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It is warm or hot to the touch.
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(def)
an abnormal reduction in blood volume
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hypovolemia
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How does overhydration affect skin temperature?
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It is cool to the touch.
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(def)
insufficient fluid in the body
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dehydration
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What happens to skin turgor in a state of dehydration?
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It is sluggish or tenting.
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(def)
passage of a solvent through a semipermeable membrane fro
area of lesser solute concentration to one of greater solute
concentration
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osmosis
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What happens to skin turgor in a state of overhydration?
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It is supple.
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(def)
a neuron in the hypothalamus that is sensitive to the relativ
fluid/solute concentration in the blood plasma and that regulat
secretion of ADH
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osmoreceptor
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How does capillary refill change during dehydration?
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It is decreased and slower.
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hypernatremia
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How does capillary refill change during overhydration?
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It is good < 3 seconds.
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(def)
deficiency of sodium in the blood plasma
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hyponatremia
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How are the muscles affected by dehydration?
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There is muscle weakness present.
8/3/2019 Electrolyte Two
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(def)
the predominant intracellular cation; helps to regulate neuromu
excitability and muscle contraction
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potassium
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How are the muscles affect by overhydration?
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Muscle cramping.
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(def)
a mineralocorticoid steroid hormone produced by the adrenal c
with action in the renal tubule to retain sodium, conserve wat
reabsorption, and increase urinary excretion of potassium
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aldosterone
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How is the body affected neurologically by marked and sev
dehydration?
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Marked- drowsy, lightheaded, and lethargic
Severe- restlessness, irritability, and seizures
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(def)
a renal proteolytic enzyme, produced by and stored in the
juxtaglomerular apparatus; affects the blood pressure by catal
the change of angiotensinogen to angiotension I, which is th
converted to angiotensin II
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renin
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How is the body affected neurologically by early and progres
overhydration?
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Early- Headache, nausea and vomiting
Progressive- irritability and confusion
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(def)
a polypeptide in the blood that causes vasoconstriction, incre
BP, and the release of aldosterone from the adrenal corte
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angiotensin
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How does thirst change during dehydration?
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It increases.
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Approximately what % of the average healthy adult's weigh
water?
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60%
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How does thirst change during overhydration?
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It decreases.
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How is weight affected by dehydration?
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It decreases.
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Water is vital to health and normal cellular function, serving a
7 things?
- a medium for metabolic reactions within cells
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- a transporter for nutrients, waste products, and other substa- a lubricant
- an insulator and shock absorber
- one means of regulating and maintaining body temperatu
- a medium for food digestion- maintains blood volume
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How is weight affected by overhydration?
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It increases.
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Infants have the highest proportion of water, accounting fo
___-___% of their body weight.
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70-80%
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How is urine output affected by dehydration?
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It decreases.
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Which type of tissue, muscle or fat, requires more water?
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muscle
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How is urine output affected by overhydration?
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It increases.
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The body's fluid is divided into what two major compartmen
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- intracellular fluid
- extracellular fluid
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How does urine concentration change during dehydration
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Its more concentrated.
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Intracellular fluid constitutes what % of total body fluid in an
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40%
(lecture says 40%, book says 2/3rds)
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Extracellular fluid accounts for what % of total body fluid in a
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20%
(lecture says 20%, book says 1/3rd)
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How does urine concentration change during overhydratio
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Extracellular fluid is subdivided into what 2 major compartm
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- intravascular fluid (plasma)
- interstitial fluid
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How does I&O change during dehydration?
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I
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How does I&O change during overhydration?
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I>O
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Intravascular fluid (plasma) accounts for what percentage of E
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25%
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How does Na+ values change during dehydration?
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They increase.
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Interstitial fluid accounts for what percentage of ECF?
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75%
(d f)
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(def)
fluids found in other parts of the body that don't have signifi
gains or losses
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transcellular fluids
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How does Na+ values change during overhydration?
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The decrease.
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How does serum osmolality change during dehydration?
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It is increased >280
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- cerbrospinal fluid
pericardial fluid
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- pericardial fluid- pancreatic fluid
- pleural fluid
- intraocular fluid
- synovial fluids
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How does serum osmolality change during overhydration
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It is decreased
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What is "third spacing"?
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phenomenon of the trapping of fluid in the interstitial spaces; c
caused by trauma to the capillary membrane, protein imbalanc
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How does hemoglobin and hematocrit change during dehydra
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It is increased.
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What is the "fourth compartment" phenomenon?
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fluid where it isn't supposed to be, i.e. an abscess or boil
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How are electrolytes measured?
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in milliequivalents per liter of water (mEq/L)
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How does hemoglobin and hematocrit change during overhydr
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It is decreased.
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How does the albumin levels change during dehydration
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They are the same or increased.
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What is the major electrolyte outside of the cell?
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Sodium (Na+)
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How does the albumin levels change during overhydration
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They are normal or decreased.
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What is the major electrolyte inside of the cell?
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Potassium (K+)
(def)
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a positively charged ion
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cation
H d h BUN l l h i d h d i ?
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How do the BUN levels change in dehydration?
Th i
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They increase.
(def)
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a negatively charged ion
i
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anion
H d th BUN l l h i h d ti ?
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How do the BUN levels change in overhydration?
They are decreased or are in normal range
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They are decreased or are in normal range.
How is the urine specific gravity affected by dehydration
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How is the urine specific gravity affected by dehydration
It increases
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It increases.
What are the principle electrolytes found in extracellular fluid
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What are the principle electrolytes found in extracellular fluid
- sodium- chloride
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- chloride
- bicarbonate
How is the urine specific gravity affected by overhydration
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How is the urine specific gravity affected by overhydration
It decreases
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It decreases.
Which compartment of ECF is considered protein-rich? What
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most abundant protein found in this compartment?
- Plasma, contains large amounts of albumin
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Plasma, contains large amounts of albumin
What are the primary electrolytes found in intercellular fluid
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What are the primary electrolytes found in intercellular fluid
- potassium
- magnesium
h h t
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- phosphate
- sulfate
What type of IV fluids would you give a patient if they we
d h d t d?
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dehydrated?
-Isotonic dehydration (hypovolemia)->Isotonic fluids
H l d h d ti >H t i IV fl id
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-Hyperosmolar dehydration->Hypotonic IV fluids
Each fluid compartment in the body is separated by what
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p y p y
a selectively permeable membrane
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What type of IV fluids would you give a patient if they we
overdehydrated?
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overdehydrated?
-No isotonic fluids-Hyperosmolar overhydration->Hypertonic IV solutions
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-Volume expanders->Albumin
(def)
movement of molecules/solutes in a solvent moving freely in
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directions from an area of high concentration to an area of lo
concentration until there is an equal concentration of solut
diffusion
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What are the nursing interventions that should be done for b
dehydration and overhydration?
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dehydration and overhydration?
Take vital signs, monitor I&O, daily weight (same scale, timeclothes), monitor lab values, skin care, oral care, safe environ
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document neurological problems, and monitor IV fluids
(def)
movement of solutes from an area of lower concentration to a
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movement of solutes from an area of lower concentration to a
of higher concentration; require ATP
active transport
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What are the nursing interventions that should be done fo
dehydration?
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y
Force fluids, clear liquids and a regular diet
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(def)
passive movement of fluid across a membrane from a les
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p
concentrated solution to a more concentrated solution
osmosis
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What are the nursing interventions that should be done fo
overhydration?
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y
Restrict fluids, low sodium diet, loop diuretic therapy
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What are the 3 compartments of body fluids?
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-Intracellular (ICF)-Extracellular (ECF)
-Transcellular
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-Transcellular
When does osmotic pressure develop?
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when two solutions of different concentrations are separated semipermeable membrane
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The osmotic pressure of a solution is called its ________
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osmolality
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What is the composition of Intracellular fluid and it's compartm
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-Fluid within the cells
-42% of body weight-Most prevalent cation is K+
M t l t i i PO4 ( h h t )
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-Most prevalent anion is PO4- (phosphate)
What is the composition of Extracellular fluid and it'scompartments?
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-Fluid in the spaces between cells AKA interstitial fluid
-Most prevalent anion is Cl- (chloride)-Most prevalent cation is Na+ (sodium)
-It expands and contracts
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p
-2/3 of ECF is interstitium
What is the solvent in the body? What are the solutes?
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- water is the solvent- electrolytes, oxygen, carbon dioxide, glucose, urea, amino a
and proteins are the solutes
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p
(def)
the total number of dissolved particles per liter of solven
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osmolality
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What is the composition of Transcellular fluid and it'scompartments?
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-Small, but important fluid compartment
-Approximately 1L-Includes the fluid in: cerebrospinal fluid, GI tract, pleural sp
synovial spaces and peritoneal spaces
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synovial spaces, and peritoneal spaces.
Describe the 2 components in body fluids.
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Electrolytes- element that when dissolved can carry an electr
current, cations (+), anions (-), they affect neuromuscular fun
and acid-base balanceMinerals- ingested compounds, serve as catalysts in nerve resp
muscle contraction and metabolism of nutrients in foods reg
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muscle contraction, and metabolism of nutrients in foods, reg
electrolyte balance
How is osmolality measured/reported?
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in osmols or milliosmols per kg (mOsm/kg)
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The term _________ may be used to refer to the osmolality solution.
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tonicity
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What is diffusion?
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Fluids move from an area of higher concentration to an area ofconcentration till even distribution is attained
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Solutions given in a clinical setting are defined/termed in whcategories?
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1. isotonic solution
2. hypertonic solution
3. hypotonic solution
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What is facilitated diffusion?
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(def)
solution that has the same osmolality as body fluids
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isotonic solution
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What is active transport?
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Able to move larger molecules and go from a lesser concentrata greater concentration using energy
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(def)
solution that has a higher osmolality than body fluids
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hypertonic solution
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What is osmosis?
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Movement of pure solvent through a semipermeable membrana solution of lower concentration to higher.
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(def)
solution that has a lower osmolality than body fluids
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hypotonic solution
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What is hydrostatic pressure?
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It is the force within a fluid compartment, it's the major forcepushes water out of the vascular system at a capillary leve
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Isotonic, Hypertonic, or Hypotonic solution?:
Normal Saline, 0.9%
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Isotonic
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What is colloidal oncotic pressure?
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Osmotic pressure excerted by the colloids in the solution (coll
osmotic pressure), protein is a major colloid (Albumin), it drfluid from the surrounding tissues and extravascular spaces in
blood vessels.
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Isotonic, Hypertonic, or Hypotonic solution?:
3% sodium chloride
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Hypertonic
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What is filtration pressure?
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Water and diffusible substances move together in response topressure
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Isotonic, Hypertonic, or Hypotonic solution?:
one-half normal saline, 0.45% sodium chloride
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Hypotonic
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The amount and direction of fluid movement in capillariesdetermined by what?
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Capillary hydrostatic pressure, plasma ocotic pressure, Intershydrostatic pressure, Interstitial oncotic pressure
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How does Hypothalamic regulation regulate the body's flubalance?
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The osmoreceptors located in the hypothalamus sense a fluid d
or increase in plasma osmolarity, it stimulates thirst and the reof ADH which results in increased free water and decreased p
osmolarity
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Isotonic, Hypertonic, or Hypotonic solution?:
D5W (Dextrose 5%)
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Hypotonic
(Reasoning: Osmolarity of D5W is 252 mOsm/L. The fluidisotonic when in the container. After administration, the dextr
quickly metabolized in the body, leaving only water - a hypo
fluid.)
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How does pituitary regulation affect the body's fluid balanc
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Under control of the hypothalamus it causes the posterior pitui
release ADH. It can be triggered by stress, nausea, nicotine, morphine which also stimulate ADH
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Isotonic, Hypertonic, or Hypotonic solution?:
Lactated ringer's (LR)
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Isotonic
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(def)
the osmotic pressure in the blood vessels exerted by colloids (p
proteins) which holds fluid in the intravascular space
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Colloid Osmotic Pressure (Oncotic Pressure)
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How does adrenal cortical regulation affect the body's fluid ba
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Adrenal cortex releases hormones to regulate both water an
electrolytes: glucocorticoids and mineralcorticoids *Aldosteromineralcorticoid with a potent sodium-retaining and potassi
excreting capability
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(def)
a process whereby fluid and solutes move together across
membrane from one compartment to another
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filtration
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How does renal regulation affect the body's fluid balance
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Kidneys are the primary organs for regulating fluid and electr
balance, selective reabsorption of water and electrolytes, excre
electrolytes occurs here, renal tubules are sites of action of AD
aldosterone
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(def)
the pressure in a compartment that results in the movement of
and substances dissolved in that fluid out of that compartm
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filtration pressure
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How does cardiac regulation affect the body's fluid balanc
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The heart atria release atrial natriuetic factor (ANF) which stim
and increase in atrial pressure because of increased blood volu
targets the blood vessels and kidneys causing vasodilation anincreased excretion of Na+ and water. It effects the plasma vo
osmolarity by decreasing plasma volume and increasing osmo
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How does gastrointestinal regulation affect the body's fluid ba
8/3/2019 Electrolyte Two
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The GI tract accounts for the most of the water intake, and sm
amounts of water are eliminated by the GI tract in feces
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The ________ pressure of blood is the force exerted by blood a
the vascular walls.
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hydrostatic pressure
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Describe insensible water loss and sensible water loss.
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Insensible- invisible vaporization from lungs and skin,
approximately 900 mL lost per day, no electrolytes lostSensible- excessive sweating, leads to water loss and electroly
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If the hydrostatic pressure of blood is higher than that of th
surrounding tissue, why does blood not seep out of the vess
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because the colloid osmotic/oncotic pressure opposes the hydr
pressure and keeps the blood within the vascular compartm
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What body system assists with the return of excess fluid back
circulation?
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Lymphatic system
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What is the etiology, clinical manifestations, and effects of
values caused by hypervolemia?
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Etiology: may result from excessive intake of fluids, abnormretention of fluids (CHF), or interstitial-to-plasma shift
S&S: increased circulating volume (HTN), cough, SOB, JV
bounding pulse, rales or crackles noted on ausculation, feelin
fullness, weight gain, pulmonary edema, pitting edema toextremities, puffy eyelids, tight shiny skin, peripheral edem
restlessness, anxiety, change in LOC
Lab Values: decreased hemoglobin and hematocrit, altere
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electrolytes
How does active transport differ from osmosis and diffusio
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substances are moving to an area of higher concentration A
metabolic energy is expended
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What are the nursing interventions for hypervolemia?
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-Monitor location and extent of edema
-Weigh patient daily
-Assess patient
-Observe V/S changes
-Monitor labs
-Neuro checks
-Provide or teach proper diet
-Administer medication
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Active transport is particularly important in maintaining th
differences of what 2 electrolytes?
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sodium and potassium
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What is the etiology, clinical manifestations, and lab values
hypovolemia?
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Etiology: Can occur with loss of normal body fluids (diarrhea,
drainage, or plasma-to-interstitial fluid shift)S&S: decreased urine output, increased urine concentration, ol
weakness, sudden wieght loss, decreased venous filling, decre
pulse volume/pressure, increased body temp, decreased skin tu
dry mucus membranes, dry skin, thirsty*ORTHOSTATIC HYPOTENSION = HYPOVOLEMIA
**Decreased C/O = Low BP = SHOCK
Lab Values: high urine specific gravity, increased hematoc
i bl l l i bl i l i d
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variable serum electrolytes, variable urine volume, increased urea nitrogen (BUN), increased osmolality
To maintain homeostasis, the body obtains water from wha
sources?
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1. ingested liquids
2. water in food3. water from metabolic oxygenation
8/3/2019 Electrolyte Two
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What are the nursing interventions for hypovolemia?
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-Look for causative factors
-Monitor I&O
-Monitor daily weights
-Observe V/S changes-Assess skin turgor
-Ensure patient safety with position changes
-Administer medication & IVF
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What are 4 sources of water loss in the body?
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1. urine
2. intestinal tract
3. lungs4. skin
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318/561
What is the primary regulator of fluid intake?
8/3/2019 Electrolyte Two
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the thirst mechanism
8/3/2019 Electrolyte Two
320/561
Where is the thirst center located?
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in the hypothalamus of the brain
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What are 3 examples of stimuli that may trigger the thirst cen
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1. increased osmotic pressure
2. low vascular volume
3. the presence of angiotensin (hormone released in responsdecreased blood flow to the kidneys)
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324/561
What is the major avenue of fluid loss in the body?
8/3/2019 Electrolyte Two
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urine
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(def)
fluid loss that occurs through the skin and lungs; usually nnoticeable and cannot be measured
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insensible loss
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328/561
What is the primary regulator of body fluids and electrolyte ba
8/3/2019 Electrolyte Two
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kidneys
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330/561
Approximately how many liters of blood is filtered through
kidneys per day? Of this, what amount is excreted?
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331/561
180 L filtered per day, only 1.5 L of urine is excreted
8/3/2019 Electrolyte Two
332/561
What hormone regulates water excretion from the kidneys
8/3/2019 Electrolyte Two
333/561
ADH (Antidiuretic horomone)
8/3/2019 Electrolyte Two
334/561
Where is ADH synthesized?
8/3/2019 Electrolyte Two
335/561
the hypothalamus
8/3/2019 Electrolyte Two
336/561
What part of the kidney does ADH work on?
8/3/2019 Electrolyte Two
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the collecting ducts of the nephrons
8/3/2019 Electrolyte Two
338/561
What is produced when serum osmolarity rises? What action
this have on the body?
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- ADH is produced, which causes the collecting ducts of the ki
to become more permeable to water. This action allows more
to be reabsorbed in the blood.
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What happens to ADH when serum osmolarity decreases? W
action does this have on the body?
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ADH is suppressed, causing the collecting ducts to become
permeable to water, which increases urine output.
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342/561
In addition to serum osmolality, what are other factors that affe
production and release of ADH?
8/3/2019 Electrolyte Two
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- blood volume
- temperature
- pain
- stress
- drugs (opiates, barbituates, nicotine)
8/3/2019 Electrolyte Two
344/561
The receptors located in the juxtaglomerular cells of the kid
nephrons are responsible for activating what system?
8/3/2019 Electrolyte Two
345/561
the renin-angiotensin-aldosterone system
8/3/2019 Electrolyte Two
346/561
The activation of the renin-angiotensin-aldosterone system
response to what?
8/3/2019 Electrolyte Two
347/561
decreased blood flow/pressure to the kidneys
8/3/2019 Electrolyte Two
348/561
In the renin-angiotensin-aldosterone system, decreased blood f
the kidney prompts the kidney to release what?
8/3/2019 Electrolyte Two
349/561
renin
8/3/2019 Electrolyte Two
350/561
What does renin do?
8/3/2019 Electrolyte Two
351/561
prompts the conversion of angiotensinogen to angiotensin
8/3/2019 Electrolyte Two
352/561
What converts angiotensin I to angiotensin II?
8/3/2019 Electrolyte Two
353/561
angiotensin-converting enzyme
8/3/2019 Electrolyte Two
354/561
What does angiotensin II do?
8/3/2019 Electrolyte Two
355/561
acts directly on nephrons to promote sodium and water reten
AND stimulates the release of aldosterone from the adrenal c
8/3/2019 Electrolyte Two
356/561
What does aldosterone do?
8/3/2019 Electrolyte Two
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promotes sodium retention in the distal nephron
8/3/2019 Electrolyte Two
358/561
What is the net effect of the renin-angiotensin-aldosterone sys
8/3/2019 Electrolyte Two
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restoration of blood volume, thus an increase in blood press
8/3/2019 Electrolyte Two
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(def)
the loss of both water and electrolytes from the ECF in simproportions, thus the decreased volume of fluid remains isot
8/3/2019 Electrolyte Two
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hypovolemia
8/3/2019 Electrolyte Two
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(def)
a water loss greater than that of the solutes
8/3/2019 Electrolyte Two
363/561
hyperosmolar (aka dehydration)
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364/561
Hypovolemia, of Isotonic loss, generally is a result of what?
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- loss of plasma or whole blood (burns, hemmorrhage)
- loss from the GI tract (diarrhea, vomiting, gastric suction, fi
drainage)- fluid movement into body cavities (third space syndrom
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366/561
Hyperosmolarity, or dehydration, is generally a result of wha
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- decreased oral intake of fluids (anorexia, nausea, inability to
access to fluids, inability to swallow)
- loss of water (excessive sweating, fever, diarrhea, polyuria
diuretics, diabetes)- increased solute intake (salt, sugar, protein), the administrati
hypertonic fluids, concentrated tube feedings
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Marked dehydration is identified as a loss of ___-___% of b
weight.
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5-8%
8/3/2019 Electrolyte Two
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Severe dehydration is identified as a loss of > ___% of body w
8/3/2019 Electrolyte Two
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> 8%
8/3/2019 Electrolyte Two
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Marked or Severe dehydration?:
Weakness, drowsiness, and lightheadedness
8/3/2019 Electrolyte Two
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marked
8/3/2019 Electrolyte Two
374/561
Marked or Severe dehydration?:
abnormal thirst
8/3/2019 Electrolyte Two
375/561
marked
8/3/2019 Electrolyte Two
376/561
Marked or Severe dehydration?:
weight loss of 3-5 liters
8/3/2019 Electrolyte Two
377/561
marked
8/3/2019 Electrolyte Two
378/561
Marked or Severe dehydration?:
dry mucous membranes
8/3/2019 Electrolyte Two
379/561
marked
8/3/2019 Electrolyte Two
380/561
Marked or Severe dehydration?:
sluggish skin turgor, dry skin, dry tongue, dry lips
8/3/2019 Electrolyte Two
381/561
marked
8/3/2019 Electrolyte Two
382/561
Marked or Severe dehydration?:
low-grade temperature
8/3/2019 Electrolyte Two
383/561
marked
8/3/2019 Electrolyte Two
384/561
Marked or Severe dehydration?:
weak, rapid pulse
8/3/2019 Electrolyte Two
385/561
marked
8/3/2019 Electrolyte Two
386/561
Marked or Severe dehydration?:
tachypnea
8/3/2019 Electrolyte Two
387/561
marked
8/3/2019 Electrolyte Two
388/561
8/3/2019 Electrolyte Two
389/561
marked
8/3/2019 Electrolyte Two
390/561
Marked or Severe dehydration?:
slow filling of hand veins
8/3/2019 Electrolyte Two
391/561
marked
8/3/2019 Electrolyte Two
392/561
Marked or Severe dehydration?:
sunken, soft eyeballs
8/3/2019 Electrolyte Two
393/561
marked
8/3/2019 Electrolyte Two
394/561
Marked or Severe dehydration?:
fluid intake < output
8/3/2019 Electrolyte Two
395/561
marked
8/3/2019 Electrolyte Two
396/561
Marked or Severe dehydration?:
decreased urine output
8/3/2019 Electrolyte Two
397/561
marked
8/3/2019 Electrolyte Two
398/561
Marked or Severe dehydration?:
weight loss of 5-10 liters
8/3/2019 Electrolyte Two
399/561
severe
8/3/2019 Electrolyte Two
400/561
Marked or Severe dehydration?:
skin flushed
8/3/2019 Electrolyte Two
401/561
severe
8/3/2019 Electrolyte Two
402/561
Marked or Severe dehydration?:
narrowing pulse pressure
8/3/2019 Electrolyte Two
403/561
severe
8/3/2019 Electrolyte Two
404/561
Marked or Severe dehydration?:
decreased systolic BP
8/3/2019 Electrolyte Two
405/561
severe
8/3/2019 Electrolyte Two
406/561
Marked or Severe dehydration?:
electrolyte disturbances
8/3/2019 Electrolyte Two
407/561
severe
8/3/2019 Electrolyte Two
408/561
Marked or Severe dehydration?:
behavioral changes, like restlessness, irritability, disorientat
8/3/2019 Electrolyte Two
409/561
severe
8/3/2019 Electrolyte Two
410/561
Marked or Severe dehydration?:
seizures
8/3/2019 Electrolyte Two
411/561
severe
8/3/2019 Electrolyte Two
412/561
Marked or Severe dehydration?:
coma
8/3/2019 Electrolyte Two
413/561
severe
8/3/2019 Electrolyte Two
414/561
8/3/2019 Electrolyte Two
415/561
- increased serum sodium
- increased serum osmolality
- increased Hgb and Hct
- increased BUN- increased urine specific gravity
8/3/2019 Electrolyte Two
416/561
What type of nursing interventions would you implement fo
patient experiencing dehydration? (8)
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- monitor vital signs
- accurate I & O
- force fluids
- daily weights
- skin and mouth care
- provide a safe environment- monitor diagnostic tests
- document client care
8/3/2019 Electrolyte Two
418/561
(def)
extracellular fluid volume excess; increased body fluid volume
interstitial or intravascular space
8/3/2019 Electrolyte Two
419/561
hypervolemia
8/3/2019 Electrolyte Two
420/561
(def)
gaining of solutes and water in equal proportion
8/3/2019 Electrolyte Two
421/561
isotonic excess
8/3/2019 Electrolyte Two
422/561
What are 2 causes of isotonic excess in the intravascular spa
8/3/2019 Electrolyte Two
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- excessive fluid and sodium (such as rapid administration of is
saline, blood or plasma infusions) (excessive dietary salt inta
(steroid usage)
- decreased function of homeostatic mechanisms (CHF, renal fcirrhosis of the liver)
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What are 4 causes of isotonic excess in the interstitial spac
(edema)?
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- rise in blood hydrostatic pressure (CHF, interference with ve
return)
- damage to capillary walls (tissue injury, allergic reactions, b
- decrease in colloid osmotic pressure and plasma protein
(malnutrition, chronic diarrhea, cirrhosis of liver, burns, los
protein via kidneys)- obstruction in lymphatic drainage (cancer of lymph syste
removal of lymph nodes)
8/3/2019 Electrolyte Two
426/561
What type of assessment findings would you expect to see i
person experiencing isotonic fluid excess? (11)
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- acute weight gain
- distended neck and hand veins
- rapid vital signs- bounding pulse
- increased blood pressure
- tachypnea
- dyspnea
- constant irritated cough
- periorbital edema
- shiny, taut skin
- pale, cool, moist mucous membranes
8/3/2019 Electrolyte Two
428/561
(def)
edema that leaves an indention when pressed
8/3/2019 Electrolyte Two
429/561
pitting edema
8/3/2019 Electrolyte Two
430/561
(def)
edema associated with gravity
8/3/2019 Electrolyte Two
431/561
dependent
8/3/2019 Electrolyte Two
432/561
(def)
non-dependent edema unresponsive to treatment
8/3/2019 Electrolyte Two
433/561
refractory edema
8/3/2019 Electrolyte Two
434/561
(def)
severe generalized edema
8/3/2019 Electrolyte Two
435/561
anasarca
8/3/2019 Electrolyte Two
436/561
(def)
accumulation of fluid in the peritoneal cavity
8/3/2019 Electrolyte Two
437/561
ascites
8/3/2019 Electrolyte Two
438/561
(def)
collection of fluid in the pleural cavity
8/3/2019 Electrolyte Two
439/561
hydrothorax
8/3/2019 Electrolyte Two
440/561
(def)
edema where the skin swells so much that fluid cannot be disp
8/3/2019 Electrolyte Two
441/561
Brawny edema
8/3/2019 Electrolyte Two
442/561
What type of diagnostic test results might you see in a pers
experiencing edema?
8/3/2019 Electrolyte Two
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- decreased HgB and Hct
- serum albumin < 3.5
- serum sodium WNL
8/3/2019 Electrolyte Two
444/561
What type of nursing interventions would you implement fo
person experiencing extracellular fluid volume excess, or
hypervolemia?
8/3/2019 Electrolyte Two
445/561
8/3/2019 Electrolyte Two
446/561
(def)
increased body fluid volume in relation to sodium
8/3/2019 Electrolyte Two
447/561
intracellular fluid volume excess, also called overhydration
hypoosmolar imbalance
8/3/2019 Electrolyte Two
448/561
What are 4 causes of overhydration?
8/3/2019 Electrolyte Two
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1. administration of D5W
2. overproduction of ADH
3. compulsive polydypsia
4. kidney dysfunction
8/3/2019 Electrolyte Two
450/561
What are 3 early signs of overhydration (intracellular fluid vo
excess)?
8/3/2019 Electrolyte Two
451/561
- nausea/vomiting
- excessive perspiration
- acute weight gain
8/3/2019 Electrolyte Two
452/561
What are 3 changes you will see in a person as overhydrati
progresses?
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1. personality changes (apprehension, confusion, irritabilit
2. weight gain
3. muscle cramps
8/3/2019 Electrolyte Two
454/561
What are 3 late signs of overhydration?
8/3/2019 Electrolyte Two
455/561
1. increased BP
2. bradycardia
3. increased respirations
8/3/2019 Electrolyte Two
456/561
What type of diagnostic test findings would you see in a per
experiencing overhydration?
8/3/2019 Electrolyte Two
457/561
- serum sodium
8/3/2019 Electrolyte Two
458/561
What type of nursing interventions would you implement fo
person experiencing overhydration? (10)
8/3/2019 Electrolyte Two
459/561
- monitor vital signs
- accurate I & O
- monitor neurological status- restrict fluid intake
- osmotic diuretics
- daily weight
- careful monitoring of IV fluids- monitor diagnostic tests
- provide safe environment
- document client care
8/3/2019 Electrolyte Two
460/561
Dehydration or Overhydration?:
Low BP
8/3/2019 Electrolyte Two
461/561
Dehydration
8/3/2019 Electrolyte Two
462/561
Dehydration or Overhydration?:
High BP
8/3/2019 Electrolyte Two
463/561
Overhydration
8/3/2019 Electrolyte Two
464/561
Dehydration or Overhydration?:
Weak Pulse
8/3/2019 Electrolyte Two
465/561
Dehydration
8/3/2019 Electrolyte Two
466/561
Dehydration or Overhydration?:
Bounding Pulse
8/3/2019 Electrolyte Two
467/561
Overhydration
8/3/2019 Electrolyte Two
468/561
Dehydration or Overhydration?:
Increased heart rate
8/3/2019 Electrolyte Two
469/561
Dehydration and Overhydration
8/3/2019 Electrolyte Two
470/561
Dehydration or Overhydration?:
Respiratory rate the same or increased
8/3/2019 Electrolyte Two
471/561
Both
8/3/2019 Electrolyte Two
472/561
Dehydration or Overhydration?:
Flat neck veins
8/3/2019 Electrolyte Two
473/561
dehydration
8/3/2019 Electrolyte Two
474/561
Dehydration or Overhydration?:
Distended neck veins
8/3/2019 Electrolyte Two
475/561
overhydration
8/3/2019 Electrolyte Two
476/561
Dehydration or Overhydration?:
Sunken, dry eyes
8/3/2019 Electrolyte Two
477/561
dehydration
8/3/2019 Electrolyte Two
478/561
Dehydration or Overhydration?:
Periorbital edema
8/3/2019 Electrolyte Two
479/561
overhydration
8/3/2019 Electrolyte Two
480/561
Dehydration or Overhydration?:
Dry, pale mucous membranes
8/3/2019 Electrolyte Two
481/561
dehydration
8/3/2019 Electrolyte Two
482/561
Dehydration or Overhydration?:
Moist mucous membranes
8/3/2019 Electrolyte Two
483/561
overhydration
8/3/2019 Electrolyte Two
484/561
Dehydration or Overhydration?:
dry skin
8/3/2019 Electrolyte Two
485/561
dehydration
8/3/2019 Electrolyte Two
486/561
Dehydration or Overhydration?:
shiny, taut skin
8/3/2019 Electrolyte Two
487/561
overhydration
8/3/2019 Electrolyte Two
488/561
Dehydration or Overhydration?:
increased skin temp; warm/hot
8/3/2019 Electrolyte Two
489/561
dehydration
8/3/2019 Electrolyte Two
490/561
Dehydration or Overhydration?:
cool skin
8/3/2019 Electrolyte Two
491/561
overhydration
8/3/2019 Electrolyte Two
492/561
Dehydration or Overhydration?:
sluggish, tented skin turgor
8/3/2019 Electrolyte Two
493/561
dehydration
8/3/2019 Electrolyte Two
494/561
8/3/2019 Electrolyte Two
495/561
overhydration
8/3/2019 Electrolyte Two
496/561
8/3/2019 Electrolyte Two
497/561
dehydration
8/3/2019 Electrolyte Two
498/561
Dehydration or Overhydration?:
capillary refill
8/3/2019 Electrolyte Two
499/561
overhydration
8/3/2019 Electrolyte Two
500/561
Dehydration or Overhydration?:
muscle weakness, fatigue
8/3/2019 Electrolyte Two
501/561
dehydration and overhydration
8/3/2019 Electrolyte Two
502/561
Dehydration or Overhydration?:
muscle cramping
8/3/2019 Electrolyte Two
503/561
overhydration
8/3/2019 Electrolyte Two
504/561
Dehydration or Overhydration?:
drowsy, lightheaded, confused, restless, delirium, disorienta
8/3/2019 Electrolyte Two
505/561
dehydration
8/3/2019 Electrolyte Two
506/561
Dehydration or Overhydration?:
headaches, nausea, vomiting, irritability, confusion
8/3/2019 Electrolyte Two
507/561
overhydration
8/3/2019 Electrolyte Two
508/561
Dehydration or Overhydration?:
weight loss
8/3/2019 Electrolyte Two
509/561
dehydration
8/3/2019 Electrolyte Two
510/561
Dehydration or Overhydration?:
weight gain
8/3/2019 Electrolyte Two
511/561
overhydration
8/3/2019 Electrolyte Two
512/561
Dehydration or Overhydration?:
hyperosmolar urine
8/3/2019 Electrolyte Two
513/561
dehydration
8/3/2019 Electrolyte Two
514/561
Dehydration or Overhydration?:
hypoosmolar urine
8/3/2019 Electrolyte Two
515/561
overhydration
8/3/2019 Electrolyte Two
516/561
8/3/2019 Electrolyte Two
517/561
8/3/2019 Electrolyte Two
518/561
Dehydration or Overhydration?:
intake greater than output
8/3/2019 Electrolyte Two
519/561
overhydration
8/3/2019 Electrolyte Two
520/561
Dehydration or Overhydration?:
sodium usually increased
8/3/2019 Electrolyte Two
521/561
dehydration
8/3/2019 Electrolyte Two
522/561
Dehydration or Overhydration?:
sodium WNL or slightly low
8/3/2019 Electrolyte Two
523/561
overhydration
8/3/2019 Electrolyte Two
524/561
Dehydration or Overhydration?:
serum osmolality increased
8/3/2019 Electrolyte Two
525/561
dehydration
8/3/2019 Electrolyte Two
526/561
Dehydration or Overhydration?:
serum osmolality decreased
8/3/2019 Electrolyte Two
527/561
overhydration
8/3/2019 Electrolyte Two
528/561
Dehydration or Overhydration?:
hemoglobin and hematocrit increased
8/3/2019 Electrolyte Two
529/561
dehydration
8/3/2019 Electrolyte Two
530/561
Dehydration or Overhydration?:
hemoglobin and hematocrit decreased
8/3/2019 Electrolyte Two
531/561
overhydration
8/3/2019 Electrolyte Two
532/561
Dehydration or Overhydration?:
bilateral breath sounds clear (unless secondary cause prese
8/3/2019 Electrolyte Two
533/561
dehydration
8/3/2019 Electrolyte Two
534/561
Dehydration or Overhydration?:
bilateral breath sounds clear or possibly adventitious
8/3/2019 Electrolyte Two
535/561
overhydration
8/3/2019 Electrolyte Two
536/561
Dehydration or Overhydration?:
serum albumin increased or the same
8/3/2019 Electrolyte Two
537/561
dehydration
8/3/2019 Electrolyte Two
538/561
Dehydration or Overhydration?:
serum albumin WNL or decreased
8/3/2019 Electrolyte Two
539/561
overhydration
8/3/2019 Electrolyte Two
540/561
Dehydration or Overhydration?:
BUN increased
8/3/2019 Electrolyte Two
541/561
dehydration
8/3/2019 Electrolyte Two
542/561
Dehydration or Overhydration?:
BUN stays the same
8/3/2019 Electrolyte Two
543/561
overhydration
8/3/2019 Electrolyte Two
544/561
Dehydration or Overhydration?:
urine specific gravity increased
8/3/2019 Electrolyte Two
545/561
dehydration
8/3/2019 Electrolyte Two
546/561
Dehydration or Overhydration?:
urine specific gravity WNL
8/3/2019 Electrolyte Two
547/561
overhydration
8/3/2019 Electrolyte Two
548/561
What type of diet would an overhydrated client likely be o
8/3/2019 Electrolyte Two
549/561
low sodium
8/3/2019 Electrolyte Two
550/561
What type of medication is commonly prescribed to overhyd
clients?
8/3/2019 Electrolyte Two
551/561
diuretics (loop, osmotic)
8/3/2019 Electrolyte Two
552/561
Dehydration or Overhydration?:
Force fluids
8/3/2019 Electrolyte Two
553/561
dehydration
8/3/2019 Electrolyte Two
554/561
Dehydration or Overhydration?:
restrict fluids
8/3/2019 Electrolyte Two
555/561
overhydration
8/3/2019 Electrolyte Two
556/561
What are some contributing factors to fluid and electrolyt
imbalances?
8/3/2019 Electrolyte Two
557/561
-illness and conditons
-interventions and treatment measures
8/3/2019 Electrolyte Two
558/561
What are the common manefestations of electrolytes imbalan
-vital sign changes
cardiac arrhythmias
8/3/2019 Electrolyte Two
559/561
-cardiac arrhythmias-gastrointerstinal S/S
-alteration in muscle function
-neurological S/S
-hyperactice or flaccid reflexes
8/3/2019 Electrolyte Two
560/561
What are the geriactric changes that take place that effect he
and electrolyte balance?
-structural changes to the kidney and decreased renal perfus
decreased glomerular fultration rate and creatinine clearence,
ability to concentrate urine and conserve water
-hormonal changes: decrease in renin and alderosterone, and in
in ADH and ANP
8/3/2019 Electrolyte Two
561/561
in ADH and ANP
-body changes: loss of subq tisue and dermis tissue which caus
of moisture and inability to respond to temperature quickl
-sensory change: decreased thirst mechanism
-musculoskeletal: decresased mobility and stiffness in han-mental status changes: confusion, disorientation and decrea
memory
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