NFDN 2003 --- Final exam with |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\
correct answers |||\\\
Fluid & Electrolyte Needs - - Homeostasis
|||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\
- Affected by digestion, absorption, metabolism of nutrients and excretion of waste
|||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\
Functions of Body Fluids - - Need 1.5 L - 2.5L per day |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\
- 60-70% body weight is fluid [70% intracellular, 30% extracellular]
|||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\
- Transport nutrients and wastes to and from cells
|||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\
- Maintain body temp., acid-base balance, aids in digestion and elimination
|||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\
Assessment of Fluid Balance - - Health history [age, acute illness, environmental factors, diet,
|||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\
medications]
- Physical exam [head to toe, weight [1kg gain = 1L fluid gain], intake/output, assess edema,
|||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\
diagnostic tests] |||\\\
Problems of Fluid Imbalances - - Electrolyte imbalance |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\
- Acid-Base imbalance
|||\\\ |||\\\
- Deficient fluid volume
|||\\\ |||\\\ |||\\\
- Excess fluid volume [edema]
|||\\\ |||\\\ |||\\\ |||\\\
Common Fluid Imbalances - - Dehydration {hypovolemia}: burn victims [3rd degree] are most at
|||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\
risk
|||\\\
Hypovolemia - - Acute weight loss |||\\\ |||\\\ |||\\\ |||\\\ |||\\\
- Rapid & weak pulse
|||\\\ |||\\\ |||\\\ |||\\\
,- Hypotension [bp]
|||\\\ |||\\\
- Dry, sticky mucous membrane
|||\\\ |||\\\ |||\\\ |||\\\
- U/O <30ml/h and constipation
|||\\\ |||\\\ |||\\\ |||\\\
- Thirst and weakness
|||\\\ |||\\\ |||\\\
- Increase Hgb, Hct, urine osmol
|||\\\ |||\\\ |||\\\ |||\\\ |||\\\
Hypervolemia - - Acute weight gain |||\\\ |||\\\ |||\\\ |||\\\ |||\\\
- Bounding full pulse
|||\\\ |||\\\ |||\\\ |||\\\
- Hypertension [bp]
|||\\\ |||\\\
- Moist mucous membrane
|||\\\ |||\\\ |||\\\
- U/O increased, specific gravity <1
|||\\\ |||\\\ |||\\\ |||\\\ |||\\\
- Cough/Dyspnea
|||\\\
- Decreased Hgb, Hct, urine osmol
|||\\\ |||\\\ |||\\\ |||\\\ |||\\\
Electrolytes - - Sodium [135-145 mEq/L] |||\\\ |||\\\ |||\\\ |||\\\ |||\\\
- Potassium [3.5-5 mEq/L]
|||\\\ |||\\\ |||\\\
- Calcium [4.5-5.5 mEq/L]
|||\\\ |||\\\ |||\\\
- Magnesium [1.5-2.5 mEq/L]
|||\\\ |||\\\ |||\\\
- Chloride [98-106 mEq/L]
|||\\\ |||\\\ |||\\\
- Phosphorus [1.2-3 mEq/L]
|||\\\ |||\\\ |||\\\
Hyponatremia - - Na maintains extracellular osmolality, controls body fluids, influences acid- |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\
base balance
|||\\\
- Cause: Excess sweating and increased water intake, GI suction, excess IV, use of diuretics
|||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\
Hypernatremia - - Causes: Decreased water intake, excess saline/salt, profuse diarrhea, |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\
diabetes insipidus, heatstroke, hyperventilation|||\\\ |||\\\ |||\\\
,Fluid Diagnostic Tests - - Plasma sodium, potassium, chloride, calcium, magnesium
|||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\
- Hematocrit
|||\\\
- BUN
|||\\\
- Osmolality
|||\\\
- Urine specific gravity
|||\\\ |||\\\ |||\\\ |||\\\
- ECG
|||\\\
- ABG
|||\\\
Acid-Base Imbalances - - ABG |||\\\ |||\\\ |||\\\ |||\\\
- Based on the carbonic-acid buffer system
|||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\
- Measures 6 components
|||\\\ |||\\\ |||\\\
- pH, PaCO2, PaO2, oxygen saturation, base excess, bicarbonate
|||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\
- Deviation from a normal level is indicated by acid-base imbalance
|||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\
Acid-Base Balance - - Normal pH 7.35 - 7.45 |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\
- < 7.30-7.35 acidotic state
|||\\\ |||\\\ |||\\\ |||\\\
- > 7.45 alkalotic state
|||\\\ |||\\\ |||\\\ |||\\\
PaCO2 - - Partial pressure of carbon dioxide in ARTERIAL blood
|||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\
- Normal range 35-45mmHg
|||\\\ |||\\\ |||\\\
- Less than 35mmHg = hyperventilation
|||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\
- Greater then 45mmHg = hypoventilation [rate and depth of reps. decreases, less carbon
|||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\
dioxide is exhaled, more is retained increasing the concentration
|||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\
PaO2 - - Partial pressure of oxygen in ARTERIAL blood
|||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\
, - Normal range 80-100mmHg
|||\\\ |||\\\ |||\\\ |||\\\
- No real role in acid base imbalance
|||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\
- Less than 60mmHg can lead to anaerobic metabolism, leading to lactic acid production and
|||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\
metabolic acidosis |||\\\
- Reduction in vital capacity can lead to reduction
|||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\
Oxygen Saturation - - Normal range 95-99% |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\
- Hemoglobin saturation
|||\\\ |||\\\
- Clients become hypoxic getting the reserve O2 stored in the Hgb, to provide tissue w/ O2
|||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\
- O2 can be affected by pH and PaCO2
|||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\
- When PaO2 falls below 60mmHg a large saturation results
|||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\
Base Excess - - Normal range of +2 / -2
|||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\
- Base excess reflects deviations of pH [7.4 neutral]
|||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\
- Higher values of base excess indicate alkalosis
|||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\
- Negative values of base excess indicates acidosis which may result in elimination of too many
|||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\
bicarbonate ion |||\\\
Bicarbonates - - Normal range 22-26 mmol/L |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\
- Excreted/retained by the kidneys to maintain normal acid base environment
|||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\
- Also the principle buffer of the ECF's of body
|||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\
- A normal pH is maintained w/ a bicarbonate ratio 20 times that of the fluid concentration of
|||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\
carbonic acid |||\\\
Buffering System - - Plasma |||\\\ |||\\\ |||\\\ |||\\\
- Respiratory system
|||\\\ |||\\\
- Renal system
|||\\\ |||\\\
correct answers |||\\\
Fluid & Electrolyte Needs - - Homeostasis
|||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\
- Affected by digestion, absorption, metabolism of nutrients and excretion of waste
|||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\
Functions of Body Fluids - - Need 1.5 L - 2.5L per day |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\
- 60-70% body weight is fluid [70% intracellular, 30% extracellular]
|||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\
- Transport nutrients and wastes to and from cells
|||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\
- Maintain body temp., acid-base balance, aids in digestion and elimination
|||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\
Assessment of Fluid Balance - - Health history [age, acute illness, environmental factors, diet,
|||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\
medications]
- Physical exam [head to toe, weight [1kg gain = 1L fluid gain], intake/output, assess edema,
|||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\
diagnostic tests] |||\\\
Problems of Fluid Imbalances - - Electrolyte imbalance |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\
- Acid-Base imbalance
|||\\\ |||\\\
- Deficient fluid volume
|||\\\ |||\\\ |||\\\
- Excess fluid volume [edema]
|||\\\ |||\\\ |||\\\ |||\\\
Common Fluid Imbalances - - Dehydration {hypovolemia}: burn victims [3rd degree] are most at
|||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\
risk
|||\\\
Hypovolemia - - Acute weight loss |||\\\ |||\\\ |||\\\ |||\\\ |||\\\
- Rapid & weak pulse
|||\\\ |||\\\ |||\\\ |||\\\
,- Hypotension [bp]
|||\\\ |||\\\
- Dry, sticky mucous membrane
|||\\\ |||\\\ |||\\\ |||\\\
- U/O <30ml/h and constipation
|||\\\ |||\\\ |||\\\ |||\\\
- Thirst and weakness
|||\\\ |||\\\ |||\\\
- Increase Hgb, Hct, urine osmol
|||\\\ |||\\\ |||\\\ |||\\\ |||\\\
Hypervolemia - - Acute weight gain |||\\\ |||\\\ |||\\\ |||\\\ |||\\\
- Bounding full pulse
|||\\\ |||\\\ |||\\\ |||\\\
- Hypertension [bp]
|||\\\ |||\\\
- Moist mucous membrane
|||\\\ |||\\\ |||\\\
- U/O increased, specific gravity <1
|||\\\ |||\\\ |||\\\ |||\\\ |||\\\
- Cough/Dyspnea
|||\\\
- Decreased Hgb, Hct, urine osmol
|||\\\ |||\\\ |||\\\ |||\\\ |||\\\
Electrolytes - - Sodium [135-145 mEq/L] |||\\\ |||\\\ |||\\\ |||\\\ |||\\\
- Potassium [3.5-5 mEq/L]
|||\\\ |||\\\ |||\\\
- Calcium [4.5-5.5 mEq/L]
|||\\\ |||\\\ |||\\\
- Magnesium [1.5-2.5 mEq/L]
|||\\\ |||\\\ |||\\\
- Chloride [98-106 mEq/L]
|||\\\ |||\\\ |||\\\
- Phosphorus [1.2-3 mEq/L]
|||\\\ |||\\\ |||\\\
Hyponatremia - - Na maintains extracellular osmolality, controls body fluids, influences acid- |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\
base balance
|||\\\
- Cause: Excess sweating and increased water intake, GI suction, excess IV, use of diuretics
|||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\
Hypernatremia - - Causes: Decreased water intake, excess saline/salt, profuse diarrhea, |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\
diabetes insipidus, heatstroke, hyperventilation|||\\\ |||\\\ |||\\\
,Fluid Diagnostic Tests - - Plasma sodium, potassium, chloride, calcium, magnesium
|||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\
- Hematocrit
|||\\\
- BUN
|||\\\
- Osmolality
|||\\\
- Urine specific gravity
|||\\\ |||\\\ |||\\\ |||\\\
- ECG
|||\\\
- ABG
|||\\\
Acid-Base Imbalances - - ABG |||\\\ |||\\\ |||\\\ |||\\\
- Based on the carbonic-acid buffer system
|||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\
- Measures 6 components
|||\\\ |||\\\ |||\\\
- pH, PaCO2, PaO2, oxygen saturation, base excess, bicarbonate
|||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\
- Deviation from a normal level is indicated by acid-base imbalance
|||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\
Acid-Base Balance - - Normal pH 7.35 - 7.45 |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\
- < 7.30-7.35 acidotic state
|||\\\ |||\\\ |||\\\ |||\\\
- > 7.45 alkalotic state
|||\\\ |||\\\ |||\\\ |||\\\
PaCO2 - - Partial pressure of carbon dioxide in ARTERIAL blood
|||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\
- Normal range 35-45mmHg
|||\\\ |||\\\ |||\\\
- Less than 35mmHg = hyperventilation
|||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\
- Greater then 45mmHg = hypoventilation [rate and depth of reps. decreases, less carbon
|||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\
dioxide is exhaled, more is retained increasing the concentration
|||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\
PaO2 - - Partial pressure of oxygen in ARTERIAL blood
|||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\
, - Normal range 80-100mmHg
|||\\\ |||\\\ |||\\\ |||\\\
- No real role in acid base imbalance
|||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\
- Less than 60mmHg can lead to anaerobic metabolism, leading to lactic acid production and
|||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\
metabolic acidosis |||\\\
- Reduction in vital capacity can lead to reduction
|||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\
Oxygen Saturation - - Normal range 95-99% |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\
- Hemoglobin saturation
|||\\\ |||\\\
- Clients become hypoxic getting the reserve O2 stored in the Hgb, to provide tissue w/ O2
|||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\
- O2 can be affected by pH and PaCO2
|||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\
- When PaO2 falls below 60mmHg a large saturation results
|||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\
Base Excess - - Normal range of +2 / -2
|||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\
- Base excess reflects deviations of pH [7.4 neutral]
|||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\
- Higher values of base excess indicate alkalosis
|||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\
- Negative values of base excess indicates acidosis which may result in elimination of too many
|||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\
bicarbonate ion |||\\\
Bicarbonates - - Normal range 22-26 mmol/L |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\
- Excreted/retained by the kidneys to maintain normal acid base environment
|||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\
- Also the principle buffer of the ECF's of body
|||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\
- A normal pH is maintained w/ a bicarbonate ratio 20 times that of the fluid concentration of
|||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\
carbonic acid |||\\\
Buffering System - - Plasma |||\\\ |||\\\ |||\\\ |||\\\
- Respiratory system
|||\\\ |||\\\
- Renal system
|||\\\ |||\\\
