JohnO-1610-5
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- Alkalosis increases
- myocardial irritability, especially when accompanied by hypokalemia
- Capillaries in the lungs are lined by a single layer of epithelial cells called
- endothelium
- Bicarbonate less than 22 indicative
- Metabolic Acidosis
- NL pH
- 7.35-7.45
- Respiratory Alkalosis is ALWAYS caused by
- hyperventilation
- Magnesium regulated by
- dietary intake, renal mechanisms, and actions of the parathyroid hormones
- Respiratory Alkalosis
- Hyperventilation
- Phosphorous is absorbed
- through the GI tract
- Hyponatremia
-
* may occur with increase sodium loss
* may occur wit increased water loss
Clinical treatment depends on the cause.
Usual loss of sodium without loss of fluid results in decreased OSMALALITY of ECF - Chloride transport follows
-
sodium (the transport of chloride follows sodium)
Regulated by dietary intake and the kidneys - Low Base Excess
- Acidosis
- Three types of acid-base regulators in the body
-
1 - Chemical
2 - Biological
3 - Physiological - Respiratory Acidosis
- Hypoventilation
- Diffusion
- from higher to lower concentration
- Increased fat metabolism may result in metabolic acidosis
- Buffer =
- substance or group of substance that can absorb or release hydrogen to correct an acid-base imbalance
- Metabolic Acidosis (too much H+) caused by gain in
- acid or loss of base
- Low calcium levels are treated with
- calcium pills
- Higher than 45 mm/hg PaCO2 indicative of
- Respiratory Acidosis
- The lower the concentration of hydrogen ions the more ?
- alkaline the solution and the higher the pH
- The concentration of sodium in the ECF determines whether water is retained, excreted or removed from one body compartment to another
- In each fluid compartment the minuses and plusses should be equal
- Arterial pH is an indirect measure of
- hydrogen ion concentration
- Alkalosis effects brain's emetic center
- Components of Body Fluids
-
* - Electrolytes
elements or compounds that when dissolved in water or another solvent separates into ions and not able to carry an electrical current - Hyperkalemia
-
usually results from renal failure.
* Kidneys are not able to excrete potassium - The greater the concentration of hydrogen ions the ?
- acidic the solution and the lower the pH
- Signs/Symptons of Metabolic Acidosis
-
* Increased blood flow to brain
* Neuromuscular depression
* GI (Nausea)
* Deep sighing - Chloride
- Major anion in ECF
- Hypernatremia (high sodium levels) occurs when
-
sodium is retained and potassium is excreted;
it is the body's attempt to hold on to water - Phosphorous is regulated by
-
dietary intake
renal excretion
parathyroid hormones - Hyper magnesium imbalance
-
renal failure;
decreased respiration; hypotension and flushing (in the face) - Isotonic
- solution of same osmotic pressure; expands the body's fluid volume without causing a fluid shift
- Assessments for Metabolic Alkalosis
-
* Reflexes
* Ventilation
* Hydration
* Serum electrolytes
* Apical Pulse
* ECG
* ABG - Metabolic processes maintain a steady balance between acids and bases for
- optimal functioning of cells
- During Respiratory Acidosis hypoxemia will occur because
- of respiratory depression
- Active Transport
- movement of molecules AGAINST osmotic pressure to an area of higher concentration
- Bicarbonate is the major renal component of
- acid-base balance. It is excreted and reproduced by the kidney to maintain a normal acid-base environment
- Arterial blood gas measurements are the best way to evaluate
- an acid-base imbalance
- Nausea is a possibility with metabolic alkalosis
- 4 organs of water loss
-
* Kidney - major regulatory organs of fluid balance
* Skin - regulated by sympathetic nervous system activating the sweat glands
* Lungs - expire about 400cc of water daily by a change in respiratory rate and depth
* GI tract - 100-200cc/day; site of nearly all fluid gain by regulating through thirst - High Base Excess
- Alkalosis
- pH is a reflection of the balance between CO2 (regulated by the lungs) and bicarbonate (base) (regulated by the kidneys)
- Sodium Imbalances
-
Hyponatremia
Hypernatremia - Movement of body fluids constantly shift from compartment to compartment to meet needs of body
- (dependent on cell-membrane permeability)
- During Respiratory Acidosis there will be a ? in alveolar ventilation resulting in CO2 retention
- Decrease
- Acid-base balance exists when the net rate at which the body is producing the acids or bases equals the same rate as the body is excreting the acids or bases
- NL Oxygen Saturation
- 95-100
- Low Sodium
- Hyponutremia
- NL Base Excess
- -2 - +2
- PaCO2 =
- partial pressure of CO2 in arterial blood. It is a reflection of depth of pulmonary ventilation
- Base excess = -2
- Metabolic acidosis
- Two kinds of Electrolytes
-
* - Cations
* - Anions - Magnesium Imbalance
-
Hypo - from malnutrition; alcoholics;
inadequate absorption; diarrhea;
vomiting;
thyroid diuretics - NL paCO2 =
-
35-45
Less than 35 = Hyperventilation; more CO2 is exhaled
More than 45 = Hypoventilation; rate and depth of respiration decreases; decreased CO2 is exhaled and more is retained - Magnesium Regulation essential for
-
* essential for enzyme activities
* essential for neurochemical activities
* essential for cardiac and skeletal muscle excitability - If pH is normal and other things are outside of NL we know that the body is compensating
- Normal hydrogen ion level is necessary to maintain cell membrane integrity and the speed of cell enzyme action
- Hypokalemia
-
low potassium may cause severe cardiac dysfunction
* may be caused by potassium-wasting diuretics - Calcium Storage
-
99% of calcium is stored in bones.
Some calcium stored in plasma - When any of these (respiratory acidosis, respiratory alkalosis, metabolic acidosis, metabolic alkalosis) occur the body tries to
-
compensate
if the body successfully compensates then the pH remains normal - NL O2 saturation
- 95-100%
- Potassium Regulation
- Potassium is predominately intracellular cation (only 2% found in ECF)
- Metabolic Acidosis
-
A heavy loss of acid from body with high levels of bicarbonate.
Ex - people that vomit often
More common than Metabolic Acidosis - Oxygen saturation -
-
the percent of oxygen in the blood that combines with hemoglobin;
the point at which the hemoglobin is saturated with oxygen - Bicarbonate level greater than 26 indicative
- Metabolic alkalosis
- Sodium Normal Blood Lab Value
- 135-145 mEq/ml
- Potassium Imbalance
-
Hypokalemia
Hyperkalemia - Three types of blood vessels
-
* Arteries
* Veins
* Capillaries - NL PaCO2
- 35-45 mm/hg
- Hypertonic
- higher osmotic pressure; solution pulls fluid from cells
-
Fluid Disturbances
Two types -
1 - Isotonic - deficit in excess exists when water and electrolytes are either gained or lost in equal proportions
2 - Osmolar - losses or excesses of only water - Viscosity =
- thickness of a fluid
- Calcium Imbalance
-
Hypo = caused by thyroid and parathyroid problems
Caused by renal insufficiency
Hyper = excess bone re-absorption - High magnesium levels are treated with
- a flush (lots of liquids)
- Symptons of HYPO magnesium imbalance
- muscle tremors and confusion
- Hypocholoremic Metabolic Alkalosis Patho
-
* Decreased serum chloride
* When chloride is lost, the body retains HCO3- to maintain electroneutrality in ECF
* Hyperexcitability of the nervous system
* Retention of CO2 (acid) as a compensatory attempt to restore acid-base balance
* Fluid loss and decreased plasma volume - NDx for Metabolic Alkalosis
-
* Alteration in nutrition
* Fluid volume deficit
* Potential for injury
* Alteration in comfort - Lowered levels (hypokalemia) are treated with
-
IV bolus
potassium pills
Increased levels (hyperkalemia) treated with potassium K-Exelate (sp?)
When a patient is on Lasix (or diuretic) they will be excreting potassium - During hyponatremia, initially, the body will hold onto the water and not the sodium and the ECF will become diluted
- Cardiovascular system brings CO2 and waste back to lungs for elimination
- Base Excess is
- the amount of blood buffer hemoglobin and bicarbonate that exist
- Components of Extracellular Fluid (ECF)
-
* Interstitial - between cells and blood vessels.
* Intracellular - blood plasma, lymph, and organ fluids - Patients at risk for Metabolic Acidosis
-
* GI loss of bicarbonate
* Renal gain of H+ or loss of bicarb
* Cellular shifts
* Acid production in body - Cardiac Output =
- amount of blood ejected from the left ventricle per minute (4-6L/minute)
- Bicarbonate
-
Major chemical base buffer in the body
Found in ECF and ICF
Essential in Carbonic Acid Bicarbonate Buffering System
Essential to acid-base balance
The kidneys regulate the bicarbonate - Lower than 35 mm/hg PaCO2 indicative of
- Respiratory Alkalosis
- Hypokalemia decreases smooth muscle contractions within the GI, which leads
- to decreased peristalsis
- NL Bicarbonate
-
22-26 mEq/mL
Less than 22 = acidosis
Greater than 26 = alkalosis - Phosphorous
- Assist in acid-base regulation
- Base excess = +2
- Metabolic alkalosis
- The LV pumps
- oxygenated blood through the systemic circuit
- Sodium is also stored in the kidneys
- High Sodium levels
- Hypernutremia
- Characteristics of Respiratory Alkalosis
-
* Decrease in PaCO2
pH is increased
* May begin outside respirator system (ex - with an anxiety attack) or within the respiratory system (ex - asthma attack) - Isotonic dehydration =
- water and dissolved electrolytes are lost in equal proportions
- Characteristics of Respiratory Acidosis
-
Increase in arterial CO2 concentration
Excess carbonic acid and increase in hydrogen ion concentration
Decreased pH in the CSF and brain cells because acids has neurochanges - Phosphorous NL
- 3.0-4.5 mg/dL
- To maintain electrical balances the concentration of plus charges must be matched with an equal concentration of minus charges
- Hyponatremia Pathophysiology
-
* Decreased serum sodium
* Decreased plasma volume and cardiac output
* Decreased blood flow to kidneys
* Overhydration and swelling of brain cells
* GI changes - Phosphorous and Calcium help
-
to develop and maintain bones and teeth
When one falls the other rises - Four groups at risk for Metabolic Alkalosis
-
1 - GI loss (acid and Cl-)
2 - Renal gain of bicarbonate
3 - Cellular shifts of positive ions
4 - Excessive intake of Bases into the body - Alterations in Cardiac Function
-
1) Disturbances in conduction
Ex. - Result of electrical impulses that do not originate from SA Node
2) Altered Cardiac Output
* Failure of heart to eject sufficient blood volume to systemic and pulmonary circulation
Ex - CAD (Coronary Artery Disease)
3) Myocardial Ischemia - the coronary artery doesn't supply enough Oxygen and blood to the myocardium (always results in chest pain)
4) Left sided heart failure
* Left ventricle isn't beating strong enough to eject enough blood resulting in decreased cardiac output
5) Right sided heart failure
* Impaired beating of RV results in
- Venous congestion
- Jugular vein distension
- Peripheral edema
6) Impaired Valvular Function
* Acquired or Congenital
* Characterized by
- Stenosis and obstructed blood flow
- OR - Valvular Degeneration (which is regurgitation and backflow) - Respiratory Acidosis is ALWAYS caused by
- hypoventilation
- Osmolarity
- the number of molecules in a liter of solution
- Chloride Imbalance
-
Hypo - vomiting and loop thiazide diuretics may cause
Hyper - rarely occurs on its own - Two phases of neuromuscular response to hyperkalemia ...
-
1) Skeletal muscles twitch in the early stages
2) Smooth muscle of the GI responds to hyperkalemia by increasing peristalsis -
Ketones are strong acids
CNS depression is possible during metabolic ? - Acidosis
- Regulation of Electrolytes
- Interchange with each other; when one leaves the cell it will be replaced by another so the cells can maintain electrical neutrality
- Signs and Symptoms of Metabolic Alkalosis
-
* Things r/t decreased blood flow
- fainting
- blurred vision
* Things r/t neuromuscular irritability
* R/T GI upset
* R/T hypoventilation - ? is the largest single component of the body
- Water
- Oxyhemoglobin =
- when oxygen combines with hemoglobin
- Chloride NL
- 90-110mEq/mL
- Hypotonic dehydration =
- electrolyte loss is greater than water loss
- Hypotonic
- lower osmotic pressure; solution moves into the cells causing the cells to enlarge
- Most cases of hyperkalemia occur in hospitalized clients and in those undergoing medical treatment
- Ways of Regulating Body Fluids
-
1 - Fluid Intake (thirst)
2 - Hormonal regulation (ADH) - stored in posterior pituitary gland. Released in response to changes in blood osmolarity.
- prevents diuresis
- works directly on renal tubules and collecting ducts, making them more permeable to water and causing water to return to the systemic circulation; when blood is sufficiently diluted ADH release is stopped.
3 - Aldosterone - released by adrenal cortex in response to increased plasma potassium levels.
- acts on distal portion of the renal tubules to increase reabsorption of sodium and secretion and excretion of potassium.
- Because sodium retention leads to water regulation, the release of aldosterone acts as a volume regulator
4 - Renin - enzyme
- responds to decreased renal perfusion secondary to a decrease in extracellular volume.
- produces angiotensin I (causes vasoconstriction)
- renin almost immediately converts angiotensin I to angiotensin II
- causing vasoconstriction and an increase in bloodflow to the kidneys to improve renal perfusion
5 - Fluid output regulation occurs through 4 organs of water loss - Functions/Characteristics of of Lungs
-
Gas Exchange
* Alveoli are the basic unit of gas exchange where lungs and blood exchange Oxygen and CO2.
300 million alveoli in healthy adult lungs.
* Alveoli are surrounded by pulmonary capillaries.
When alveolar surface are is reduced - gas exchange is reduced - Magnesium NL
- 1.2-2.0 mg/dL
- Conditions affecting chest wall movement
-
* Musculoskeletal abnormalities (thoracic, rib cage)
* nervous system diseases
- diseases impairing nervous/muscle control systems
* Trauma
- Ex. Multiple rib fractures
- Chest wall and upper abdominal incisions
* Pain Management
- Ex. High doses of opioids
* Chronic Diseases
- Ex. COPD; Emphysema; Anemia - Osmosis
-
movement of water across a semi-permeable membrane from an area of lower solute to higher solute concentration.
Tries to equalize concentration of ions on each side of the cell membrane - Hydrogen ions affect the activity of excitable membranes and acid-base imbalances are associated with altered function of these membranes
- Functions of Potassium
-
* regulates many metabolic activities
* Necessary for glycogen deposits in liver, skeletal muscle and nerve impulses
* concerned with normal cardiac rhythms because it works on the skeletal muscle and smooth muscle.
* Body does not conserve potassium well
* Any increased urinary output will decrease potassium
* Dietary intake
* Renal secretions - Perfusion =
- the blood flow through the lungs
- Calcium Necessary for -
-
* bone and teeth formation
* blood clotting
* hormone secretions
* cardiac conduction for transmission of nerve impulses for muscle contraction - Functions of Potassium (major ICF cation)
-
* Within cells helps to maintain osmotic pressure, fluid and electrolyte balance, and acid-base balance
* In ECF functions with sodium and calcium to regulate neuromuscular excitability
* Required for conduction of nerve impulses and contraction of skeletal and smooth muscles
* Participates in carb and protein metabolism - Low magnesium levels are treated with
- magnesium IV bolus
- Hypermagnesemia Patho
-
* Increased serum magnesium
* Depressed effects on CNS and Neuromuscular systems, which block transmission of electrical impulses - main symptom HYPOnutremia
- confusion
- Potassium Functions
-
1) Regulation of intracellular osmolarity
2) maintenance of electrical membrane excitability
3) maintenance of plasma acid-base balance
4) regulation of protein synthesis
5) regulation of glucose use and storage
6) Maintenance of action potentials in excitable membranes - Anions (negative)
-
1 - Chloride
2 - Bicarbonate (HCO3-)
3 - Phosphorous - Hypermagnesemia S/S
-
* Serum magnesium >2.5mEq/L
* Skeletal muscle weakness and paralysis
* Cardiac arrhythmias
* Hypotension
* Respiratory insufficiency
* Drowsiness
* Lethargy
* Coma - Calcium NL
- 9-10.5 mEq/mL
- Osmolarity =
- number of milliosmoles in a liter of solution
- treat HYPONUTREMIA with
-
more fluids
saline solution - Sodium Functions
-
* Assists in regulating osmotic pressure, water balance, conduction of electrical impulses in nerves and muscles, electrolyte and acid-base balance
* Influences permeability of cell membranes and assists in movement of substances across cell membranes.
* Participates in many intracellular chemical reactions - Sodium Regulation
- Most abundant cation in the ECF, major contributor to maintaining water balance; regulated by dietary intake and aldosterone secretions
- Diffusion =
- free movement of particles (solute) across a permeable membrane down a concentration gradient
- Potassium NL
- 3.5-5 mEq/mL
- Proteins are the largest source of ?
- buffers
- Phosphorous participates in carbohydrate
- metabolism
- Deep breaths or sighs occur 6 to 10 times per hour
- Active transport =
- use of energy by a cell to move a substance across the cell membrane against a concentration gradient
- Phosphorous promotes
- normal neuromuscular action
- Cough is the cardinal sign of respiratory disease
- The hallmark of metabolic alkalosis is
- an increased bicarbonate level with a rising PaCO2
- Acids are substances that release a _____ when the substance is dissolved in water
- H+
- Hypotonic dehydration involves excessive loss of
- sodium and potassium from the ECF
- Capillaries connect the arterial and venous portions of the circulation
- Hypomagnesemia Patho
-
* Decreased serum magnesium
* Impaired conduction of nerve impulses and muscle contraction - Hyperkalemia S/S
-
* Serum potassium > 5mEq/L
* Muscle weakness
* Possible respiratory insufficiency
* Cardiotoxicity with arrhythmias or cardiac arrest - Hyperchloremic Metabolic Acidosis S/S
-
* Serum chloride >103 mEq/L
* Arterial blood pH <7.35
* Lethargy
* Stupor
* Disorientation
* Coma if acidosis is not treated
* Increased rate and depth of respiration - Functions/Characteristics of the Conduction System
-
* Generates impulses required to initiate the electrical/mechanical chain of events
* All electrical impulses originate within the SA Node (located in the Right Atrium (RA) next to entrance of the Superior Vena Cava (SVC))
* Impulses are initiated at a intrinsic rate of 60-100 beats per minute.
* The resting pace of adults is 60-80 beats per minute
* Electrical impulses are conveyed along the IntraAtrial (IA) pathways to the AV Node.
* The AV node mediates impulse transmission between atrium and ventricles.
* The impulse then travels to the Bundle of His and Purkinje network (fibers)
* EKGs record this electrical activity - The fluid outside of the cells, ECF, contains almost ten times more sodium ions than the fluid inside the cell (ICF)
- Bicarbonate is the primary buffer of the
- ECF
- The ventricles are _____ chambers
- distributing
- Hypokalemia Pathophysiology
-
* Decreased serum K+
* Impaired cardiac conduction
* Decreased strength of myocardial contraction and decreased cardiac output
* Neurologic changes due to impaired conduction of nerve impulses
* Impaired function of skeletal, smooth and cardiac muscle
* Slowed gastric emptying
* Decreased ability of kidneys to concentrate urine and excrete acid
* Impaired carb metabolism and decreased secretion of insulin - Hypocholoremic Metabolic Alkalosis S/S
-
* Serum chloride <95mEq/L; arterial blood pH >7.5
* Paresthesias of face and extremities
* Muscle spasms and tetany
* Slow, shallow respirations
* Dehydration
* Hypotension - Blood functions
-
* to nourish and oxygenate body cells
* protect the body from invading microorganisms
* initiate hemostasis when a blood vessel is injured - Calcium Functions
-
1) Cofactor in blood-clotting cascade
2) Excitable membrane stabilizer
3) Adds strength/density to bones and teeth
4) Essential element in cardiac, skeletal, and smooth muscle contraction
5) Enhances enzyme activity or reactions
6) Increases skeletal muscle contraction
7) Increases cardiac muscle contraction
8) Regulates nerve impulse transmission
9) Assists in blood clotting
10) Provides bone strength and density - The classic respiratory alkalosis profile is
- a reduced bicarbonate level (not usually <15mEq/L) coupled with a very low PaCO2
- Functions of Sodium (major ECF cation)
-
* Assists in regulating osmotic pressure, water balance, conduction of electrical impulses in nerves and muscles, electrolyte and acid-base balance.
* Influences cell membrane permeability
* Participates in many intracellular chemical reactions - If acidosis is respiratory in origin, the effectiveness of respiratory efforts is reduced
- Hyperkalemia Patho
-
* Increased serum potassium
* Impaired conduction of nerve impulses
* Impaired cardiac conduction - The RV sends deoxygenated blood through the pulmonary circulation
- Hyperchloremic Metabolic Acidosis Patho
-
* Increased serum chloride
* In dehydration, kidneys reabsorb water in an attempt to relieve the fluid deficit
* CNS depression
* Increased exhalation of carbon dioxide as a compensatory attempt to restore acid-base balance - Chloride Functions
-
1) Maintenance of plasma acid-base balance
2) Maintenance of plasma electroneutrality
3) Formation of hydrochloric acid - Chronic met. Acidosis may occur with chronic renal failure
- During ventricular diastole,
- the valves act as funnels and facilitate the flow of blood from the atria to the ventricles
- Active transport systems, or pumps, are usually located in the cell membrane and act as gatekeepers to maintain special environments inside cells
- During systole, the valves
- close to prevent the backflow (regurgitation) of blood into the atria
- Cells use active transport to regulate cell volume and to control the ICF concentration of many substances
- Adventitious sounds are additional breath sounds superimposed on normal sounds
- The lungs can usually compensate for acid-base imbalances of _____ origin
- metabolic
-
Hyperkalemia
Pathophysiology -
* Increased serum potassium
* Impaired conduction of nerve impulses and muscle contraction
* Impaired cardiac conduction - Cardiac Lab Values
-
Sodium
Potassium
Hemoglobin
Hematocrit
PaO2 - A unique characteristic of the heart is that each part can generate its own electrical impulse to contract
- Oxygen Transport
-
1) Delivery of oxygen depends on the amount of oxygen entering
* the lungs
* the bloodflow to the lungs
* the tissues
This delivery of oxygen increases Perfusion - High serum sodium levels inhibit aldosterone secretion and directly stimulate the secretion of ADH and ANP. Together these hormones cause
- an increase in kidney excretion of sodium and kidney reabsorption of water
- Ventilation =
- the movement of air between the atmosphere and the alveoli of the lungs
- Low serum levels of sodium inhibit the secretion of ADH and ANP and stimulate aldosterone secretion. Together these actions...
- increase serum sodium concentration by increasing kidney reabsorption of sodium and enhancing kidney loss of water
- Ferrous gluconate (Fergon) is an oral preparation for treating
- iron deficiency anemia
- The kidneys are the third line of defense against fluctuations in pH
- Potassium chloride is the drug of choice for preventing
- or treating hypokalemia because deficiencies of potassium and chloride often occur together
- Ferrous sulfate (Feosol) is the prototype of oral iron preparations and the preparation of choice for prevention or treatment of
- iron deficiency anemia
- Cardiac Index =
- Measure of adequacy of the cardiac output; cardiac index equals cardiac output divided by the client's body surface area (Adult 2.5-4L/min/m3 )
- Hypertonic dehydration occurs when water loss from the ECF is greater than the electrolyte loss
- Hyperventilation is the only mechanism for respiratory alkalosis
- Metabolic Alkalosis
-
* Values indicating alkalosis are increased pH>7.45 and increased HCO3- (>26mEq/L)
* If hypokalemia and hypochloremia are present, KCl will replace both deficits - Stroke Volume =
- Amount of blood ejected from the ventricle with each contraction (50-75mL/contraction)
- When chemical buffers alone cannot prevent changes in body fluid pH, the respiratory system is the second line of defense against changes
- The pulmonic valve separates
- the right ventricle and pulmonary artery
- Hyponatremia Causes
-
* Inadequate intake
* Excessive losses (eg vomiting, GI suction, diarrhea, excessive water enemas, excessive perspiration, burn wounds, and adrenal insufficiency
* Excessive water intake - Decreased renal function promotes retention of
- magnesium and potassium
- Ammonium chloride is contraindicated
- in impaired hepatic function
- The efficiency of the respiratory system depends on
-
* the quality and quantity of air inhaled
* the potency of the airway
* the ability of the lungs to expand and contract
* the ability of O2 and CO2 to cross the alveolar-capillary membrane - Heart rate effects blood flow because of
- interaction between rate and diastolic filling time
- The SL valves prevent blood from flowing back into the ventricles during ventricular diastole
- Aldosterone
-
1) is secreted by the adrenal cortex
2) influences sodium balance by preventing sodium loss
3) sodium exerts osmotic (water-pulling) pressure
4) indirectly regulates water balance - The major cellular protein buffer is ?
-
hemoglobin
- Hyperkalemia causes
-
* Excess intake
* Impaired excretion due to renal insufficiency, oliguria, potassium-saving diuretics, aldosterone deficiency, or adrenocortical deficiency
* Movement of potassium from cells into serum with burns, crusting injures, and acidosis - Bicarbonate is the anion most commonly exchanged for
- chloride
- Hypoventilation is the only mechanism for PCO2 accumulation (respiratory acidosis)
- The tricuspid valve separates the
- RA and RV
- Hypertonic dehydration =
- water loss is greater than electrolyte loss
- The heart provides the mechanism by which oxygenated blood is sent from lungs to body
- There are two semi lunar valves -
- the pulmonic and aortic
- The solvent is
- the water portion of body fluids
- Obligatory urine output =
- minimal volume of urine needed per day to dissolve and excrete toxic waste products (400-600 mL)
- Increases in the rate and depth of respiration are the main causes of resp
- alkalosis
- The right atrium receives deoxygenated blood from the upper part of the body
- Factors Affecting Oxygenation
-
* Any condition that affects CP functioning directly affects the body's ability to meet O2 demands.
1) Decreased O2 carrying capacity
* Hemoglobin carries 97% of oxygen to tissues)
* Anemia
2) Inhalation of Toxic Substances
* Toxic substances (instead of oxygen) bind with the hemoglobin
3) Decreased inspired O2 concentration
* caused by upper or lower airway obstruction
* limits delivery of oxygen to alveoli
4) High altitude
5) Hypovolemia = reduced circulatory blood volume
* usually results from ECF losses
* results from diarrhea
* results from vomiting
6) Increased metabolic rate
* increased O2 demand
ex. - pregnancy
* wound healing
* exercise
* fevers increase tissue needs for O2 -
- CO2 increases
- Resp. rate increases
7) Conditions affecting chest wall movement - Osmolality =
- number of milliosmoles in a kilogram of solution
- The mitral valve separates the
- LA and LV
- The pathologic changes associated with HYPERkalemia are directly related to how rapidly ECF _____ levels increase
- potassium
- Gas Exchange
-
1) Regulation of respiration provides for adequate supply of oxygen to meet metabolic demands
* Neural (CNS) regulators control
- Resp. rate
- Resp. depth
- Resp. rhythm
* Chemical
including regulation of CO2 and H+ ions ...
this, in turn, controls rate and depth of respirations - Facilitated diffusion (facilitated transport) =
- diffusion across a cell membrane that requires the assistance of a transport system or membrane-altering system
- Filtration =
- movement of fluid though a cell or blood vessel membrane because of hydrostatic pressure differences on both sides of the membrane
- Myocardial contractility =
- ability of the heart to squeeze blood from the ventricles and prepare for the next contraction
- Compliance =
- the ability of the lungs to stretch or expand to accommodate incoming air
- The oral mucosa may warm and humidify air but cannot
- filter it
- Nothing functions very well if the body gains or loses 2 liters of blood
- Hypomagnesemia S/S
-
* Serum magnesium < 1.5 mEq/L
* Confusion
* Restlessness
* Irritability
* Vertigo
* Ataxia
* Seizures
* Muscle tremors
* Carpopedal spasm
* Nystagmus
* Generalized spasticity - Oxyhemoglobin is easily reversible so that
- oxygen can enter the blood
- Hyponatremia S/S
-
* Serum sodium <135 mEq/L
* Hypotension and tachycardia
* Oliguria and increased BUN
* Headache
* dizziness
* weakness
* lethargy
* restlessness
* confusion
* delirium
* muscle tremors
* convulsions
* ataxia
* aphasia - Three hormones that help control critical electrolyte balances...
-
1) aldosterone
2) antidiuretic hormone
3) atrial natriuretic peptide - The lungs expand and relax in response to changes in
- pressure relationships
- Hyperkalemia anesthetizes nerve and muscle cells so electrical current cannot be built up to a sufficient level for impulse conduction
- Four Process May Result in Metabolic Acidosis
-
1) overproduction of H+
2) underelimination of H+
3) underproduction of HCO3-
4) overelimination of HCO3- - Respiratory acidosis results from an impairment in any area of respiratory function causing an inadequate exchange of
- O2 and CO2
- Sodium bicarbonate has long been used to treat
- metabolic acidosis
- HYPERNatremia Pathophysiology
-
* Increased serum sodium
* When due to water deficiency - Decreased fluid volume in ECF and ICF (dehydration)
* When due to sodium gain - increases ECF, decreases ICF - Osmosis and filtration act together in capillary fluid dynamics to regulate both ECF and ICF volumes
- The atria are _____ chambers
- recieving
- Hypokalemia Patho
-
* Decreased serum potassium
* Impaired cardiac conduction
* Decreased strength of myocardial contraction and decreased cardiac output
* Neurologic changes due to impaired conduction of nerve impulses
* Impaired function of skeletal, smooth and cardiac muscle
* Slowed gastric emptying
* Decreased GI motility
* Decreased ability of kidneys to concentrate urine and excrete acid
* Impaired carb metabolism - Hypokalemia causes
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* Inadequate (potassium) intake
* Excessive GI losses
* Movement of K+ out of serum and into cells