NR507 Advanced pathophysiology week two Distribution of body fluids

_________________Is primarily responsible for the plasma oncotic pressure - answer-Albumin " tell me the most common fluid, electrolytes, and acid - base imbalances in oliguric Reno failure patients." Says a nurse, "I am being sent to help on the rental unit this morning." - answer-You can figure out the fluid and electrolyte imbalance is in oliguric renal failure patients if you remember that the kidneys normally excrete water and sodium, potassium, magnesium, phosphate, and metabolic assets. With oliguria, these will not be excreted and will accumulate in the body. Therefore, you can expect isotonic fluid excess, hyperkalemia, metabolic acidosis, possibly hyper magnesemia, and hyperphosphatemia (1) EDEMA - answer-^ Na+ level> ^H2O intake & retention leads to ^blood volume that leads to ^ BP that leads to ^ fluid pushed into IF leading to EDEMA (2)EDEMA - answer-Blood vessel obstruction (clot, plaque)Leads to restricted bloodflow that leads to increased BP that leads to increased fluid pushed into IF (3) EDEMA - answer-Lymph vessel obstruction (infection, resection) leads to decreased ability to reabsorb fluid that leads to ^ fluid in IF (lymphedema) (4) EDEMA - answer-Increased capillary permeability(infection, injuries, burns) leads to increased fluid AND proteins move into IF Leading to decreased OCP that leads to decreased ability to reabsorb fluid (5) EDEMA - answer-Decreased plasma protein level(Malnutrition, liver disease) leads to decreased OCP that leads to decreased ability to reabsorb fluid that leads to increased fluid in IF (ascites) A buffer pair is a weak __________ and it's __________ - answer-acid; conjugate base A person who has a lung disease may develop a primary ____________ acid-base imbalance, but a person who has a kidney disease may develop a primary _______________ acid-base imbalance - answer-respiratory; metabolic A standard 68-kg man has _________ liters of total body water - answer-40.8 ABG - answer-Analysis will help diagnose the category and protect the body's response for compensation Predicted ABG values: PH = 7.35-7.45 PaCO2 = 35 - 45 mm Hg HCO3-= 22-26 nEq/L Acid - base _____________ can occur as the result of______ or _________ Pathological conditions - answer-Imbalances; respiratory; metabolic Acidosis - answer-Decreases CNS responsiveness meeting to headache, confusion, lethargy, coma Acidosis - answer-Systemic increase in H + concentration or decrease in bicarbonate (base) Aldosterone - answer-Angiotensin II, increased plasma potassium; increased renal sodium and water reabsorption; increases renal excretion of potassium and hydrogen ions Alkalosis - answer-Increases CNS responsiveness leading to dizziness, cramping, agitation, seizure Alkalosis - answer-System decrease in H + concentration or increase in bicarbonate(base) An ____________ fluid has the same concentration of solute as the plasma - answer-Isotonic Antidiuretic hormone - answer-Increased plasma osmolality, substantially decreased arterial blood pressure Atrial natriuretic peptide - answer-Increased volume in the cardiac atria ; Increases renal sodium and water excretion Baby Thompson has repeated vomiting from pyloric stenosis - answer-Isotonic fluid deficit, hypokalemia, metabolic alkalosis; Tachycardia;rapid weight loss; decreased urine output; skeletal muscle weakness;slow; shallow respirations, lethargy Bee sting - answer-Increased capillary permeability Buffer systems - answer-Instantly, but temporarily bind excess H+ ions (or OH-) to remove it from ECF Buffer = "sponge" that converts strong acids/based do you prevent rapid or large change in pH of a solution Calcitonin - answer-High plasma calcium; Inhibits osteoclasts in bone Calculating the anion gap may help to differentiate between different causes of metabolic ___________ - answer-acidosis Clot in a vein - answer-Increased capillary hydrostatic pressure CO2 represents lung function - answer-Respiratory component End-stage kidney disease - answer-Increased capillary hydrostatic pressure Excessive fluid within the interstitial space is called ____________ - answer-Edema Fluid moves out of capillaries by ___________ and into or out of cells by - answer-filtration; osmosis Four categories of acid-base imbalances - answer-Respiratory acidosis Respiratory alkalosis Metabolic acidosis Metabolic alkalosis H + ions must be__________ neutralized and/or __________ from the body to maintain the body's normal pH(7.35-7.45) and avoid __________ cellular function - answer-Continually, eliminated, altered H+ changes - answer-Leads to reciprocal[K+/Na+] changes HCO3 represents renal function - answer-Metabolic component HCO3- changes - answer-Leads to reciprocal [Cl-] changes Hydrostatic pressure (HPE ) - answer-Mechanical force of water (driven by heart equals BP )pushing against the capillary membrane to move fluid out = filtration Hypercapnia means an excess of ____________ in the blood - answer-carbon dioxide In which direction does alkalosis move potassium ions? - answer-From ECF into the cell In which direction does epinephrine move potassium ions? - answer-From ECF into the cell In which direction does hypernatremia move water? - answer-From the cell to ECF In which direction does insulin move potassium ions? - answer-From ECF into the cell Infected wound - answer-Increased capillary permeability Isotonic fluid excess causes ____________ - answer-hypervolemia metabolic acidosis - answer-Low blood pH and depression of HCO3- Causes: loss of bicarbonate from intestine (diarrhea) Decreased excretion of H + (renal failure) Excessive production of non-volatile acids (ketosis do to exercise, DM, hypoxia, starvation) Ingestion of exogenous acid (drugs, poisons) Compensation: hyperventilation to increase CO2 release Metabolic alkalosis - answer-High blood pH and elevation of HCO3- Causes: excessive loss of metabolic assets Vomiting, G.I. section, excessive intake of alkaline drugs as in antacids Compensation: hyperventilation to decrease CO2 release Mr. Janus, who is having his first renal dialysis session, says, " I know that my failed kidneys cannot excrete acids, but I did not eat any acids, so why did I get metabolic acidosis?" - answer-Your body makes metabolic acids from the foods that you eat. That is a normal part of what we call cellular metabolism, the processes by which are cells breakdown nutrients and use them for energy. You got metabolic acidosis because your body keeps making these metabolic acid's, even though your kidneys no longer are able to excrete them. That is why you receive dialysis now. Mr. Jenkins is comatose from a heroin overdose - answer-Respiratory acidosis; Slow, shallow respirations; blood pH less than 7.35; blood Paco2 increased Mr. Sheehan has bilateral ankle edema from congestive heart failure. "Are my ankles inflamed?" He asks "I know that inflammation causes swelling." - answer-Inflammation does cause swelling, but that is not the reason your ankles are swollen. They are not inflamed. They are swollen because your body is overloaded with fluid, and that makes extra outward pressure in your smallest blood vessels. Adding the effects of gravity to that outward pressure makes the swelling appear in your ankles. Mr. Wiggins has been sobbing and breathing deeply and rapidly for an hour since his wife died - answer-Respiratory alkalosis; Parasthesias of fingers, lightheadedness, confusion Mrs. Kiley, who is taking care of her husband at home after his hospitalization for a stroke, was told to call the doctor if Mr.Kiley develops dependent edema. She says , " I know what edema looks like, but where is dependent edema located?" - answer-The location varies with body position. Dependent edema and swelling in the lower most portion of the body. If your husband has been walking or sitting in a chair with his feet hanging down, then look at his ankles for swelling. He's been lying on his back in bed all day, then look at the area in the back just above his buttocks Mrs. Singh takes glucocorticoids for a chronic disease - answer-Isotonic fluid excess and hypokalemia Mrs. Smythe has hyperparathyroidism - answer-Hypercalcemia; Fatigue, weakness, anorexia, constipation, lethargy Ms. Winsom, age 16 has diabetic ketoacidosis. "Why is she breathing so fast?" Asks her father. "Does she have pneumonia as well as diabetic ketoacidosis?" - answer-No, she does not have pneumonia. Her fast and deep breathing it's her body protecting her from the effects of the ketoacids. When are kidneys could not get rid of the keto acids fast enough her breathing is better to remove another kind of acid called carbonic acid. The important thing to remember is that her fast breathing means that her body is responding normally to protect her, and it is not a lung problem. Oncotic (colloid) pressure (OCP) - answer-Chemical force exerted by large molecules (e.g. -proteins/albumin) to you pull fluid in = reabsorption One third of body water is in the ___________ fluid, and two thirds is in the. _______________ fluid - answer-Extracellular, intracellular Overuse of phosphate-containing over-the-counter enemas can cause _________________, which in turn will ___________ the plasma calcium concentration - answer-hyperphosphatemia; decrease Parathyroid hormone - answer-Low plasma calcium; Increases resorption of bone; stimulates reabsorption of calcium; inhibits renal reabsorption of phosphate Protein malnutrition - answer-Decreased plasma oncotic pressure Regardless of underlying cause, edema can result in: - answer-IF accumulation that increases distance nutrients and waste must move between capillaries and tissues Decreased blood flow leads to slower healing Fluid "lost" in third spaces = not available for use Decreased dehydration, ascites, lymphedema, & shock (low BP) Remember that changes in H + and OH-/HCO3- levels can not only _________ _____ ________ of body fluids, but can also affect the ______________ balance in those fluids - answer-Change the pH; Electronegativity Why? H + and OH-/HCO3- are also charged particles