Patho Workshop 2: Fluid Imbalances

Fluid Imbalances

• Potassium imbalance (3.5-5.0):
  • Function: heart and muscle contraction
  • Hypokalemia (low potassium): causes include vomiting, NG suctioning, wound drainage, malnutrition, and diuretics; manifestations include "low and slow" symptoms such as diarrhea, decreased motility, constipation, paralytic ileus, weakness, muscle twitching, and muscle cramping
  • Hyperkalemia (high potassium): causes include adrenal and kidney disease, respiratory acidosis, and Cushing's; manifestations include "tight and contracted" symptoms such as tall peaked T waves, abdominal cramping, and vomiting
• Sodium imbalance (135-145):
  • Function: blood pressure, blood volume, conduction of nerve impulse, and muscle contraction
  • Hyponatremia (low sodium): causes include too much water or not enough sodium, vomiting, NG tube suctioning, diarrhea, edema, and diuretics; manifestations include "depressed and deflated" symptoms such as hypotension, weak thready pulses, edema, abdominal cramping, nausea, and vomiting
  • Hypernatremia (high sodium): causes include not enough water or too much sodium, heat stroke, excessive sodium intake, kidney failure, and Cushing's; manifestations include "big and bloated" symptoms such as thirst, hypertension, and neuro changes
• Magnesium imbalance (1.5-2.5):
  • Function: helps maintain normal nerve and muscle function
  • Hypomagnesemia (low magnesium): causes include diarrhea, NG suctioning, excessive laxatives, chronic alcoholism, DKA, and diuretics; manifestations include "buck wild" symptoms such as increased neuromuscular activity, shallow respirations, tremors, and lethargy
  • Hypermagnesemia (high magnesium): causes include kidney failure, meds with magnesium, and antacid use; manifestations include "calm and quiet" symptoms such as decreased neuromuscular excitability, decreased reflexes, and muscle paralysis
• Calcium imbalance (9-11):
  • Function: for muscles to move and for nerves to carry messages between the brain and body
  • Hypocalcemia (low calcium): causes include diarrhea, excessive laxatives, rapid blood transfusion, thyroidectomy, and hyperphosphatemia; manifestations include increased neuromuscular excitability, weak heart, decreased neuromuscular excitability, hyperactive bowel sounds, and kidney stones
  • Hypercalcemia (high calcium): causes include thiazide diuretics, excessive antacid use, hypophosphatemia, and bone cancer; manifestations include "slow, moans, groans, and stones" symptoms such as strong heart, decreased neuromuscular excitability, and kidney stones

Acid-Base Imbalances

• pH: 7.35-7.45
• PaCO2: 35-45
• HCO3: 22-26
• Alkalosis: pH > 7.45
• Acidosis: pH < 7.35

Respiratory and Metabolic Acidosis/Alkalosis

• Respiratory acidosis: PaCO2 > 45
• Respiratory alkalosis: PaCO2 < 35
• Metabolic acidosis: HCO3 < 22
• Metabolic alkalosis: HCO3 > 26

GI Manifestations

• Anorexia: loss of appetite
• Nausea: subjective
• Vomiting: forceful expulsion of chyme from the stomach or intestine
• Diarrhea: excessive frequency of stools (loose or watery)
• Constipation: less than normal bowel movements
• Steatorrhea: fatty stools
• Frank blood, occult blood, melena: types of stools
• Bowel obstruction: manifestations include abdominal distention, vomiting, and risk factors such as immobility, surgery, older adults, cancer, and inflammatory bowel disease

Elimination

• Kidneys: responsible for removing waste
• Types of incontinence: oliguria, anuria, pyuria, hematuria, and glycosuria
• UTI: manifestations include burning upon urination, cloudy and foul-smelling urine, and risk factors such as women, poor hygiene, and older adults
• Glomerulonephritis: manifestations include coffee-colored urine, flank or back pain, oliguria, and fatigue
• Urolithiasis: manifestations include intense spasms of pain, vomiting, and risk factors such as diet and diminished fluid intake

Pathophysiology

• Acute renal failure (ARF): reversible, causes include ischemia, inflammation, and nephrotoxins
• Chronic renal failure (CRF): gradual and irreversible, causes include diabetes, hypertension, and nephrotoxins
• Cognition: determined by cerebral cortex and RAS
• Altered level of consciousness (LOC): causes include stroke, brain injury, infection, hypoxia, toxic drug levels, and hypoglycemia
• Brain death: criteria include cessation of brain function, absence of spontaneous respiration, and absence of brain stem reflexes

Neurology

• Neuropathy: damage to peripheral nerves affecting sensation, pain, pressure, and temperature; causes include diabetes, trauma, and peripheral vascular disease
• Dementia: progressive chronic disease, impairing cognitive skills, judgment, and motor coordination; causes include vascular disease, infections, toxins, and genetic disorders
• Seizures: random electrical activity in the brain; causes include epilepsy, and risk factors such as age, genetics, and certain medical conditions

Pain

• Types of pain: somatic, visceral, ischemic, neuropathic, and referred
• PQRST: pain assessment tool

Substance Abuse

• Chronic pattern of substance use: impaired health, causes include trauma, stress, and socio-economic status
• Types of substances: stimulants, depressants, hallucinogens, opioids
• Complications: acute overdose, injury, organ failure, infections

Perfusion

• Flow of blood in the microcirculation to supply oxygen and nutrients to cells
• Risk factors: age, smoking, hypertension, hyperlipidemia, obesity, genetics, atherosclerosis, and diabetes
• Complications: ischemia, infarction, and organ failure

Ischemia vs Infarction

• Ischemia: cell hypoxia and inflammation due to lack of blood flow
• Infarction: cell death due to lack of blood flow

CAD

• Narrowing of coronary arteries: poor perfusion
• Risk factors: age, smoking, hypertension, hyperlipidemia, obesity, genetics, atherosclerosis, and diabetes
• Complications: MI, cardiac arrest, and heart failure

Angina vs MI

• Angina: ischemia (partial blockage)
• MI: infarction (total blockage)

DVT

• Blood clot formation in the leg: causes include immobility, hip or knee surgery, traveling, OC use, and postpartum period
• Complications: pulmonary embolism

HTN

• Increased blood pressure: causes include age, genetics, poor diet, sedentary lifestyle, obesity, smoking, and excessive sodium
• Complications: atheroma formations, aneurysm, stroke, CHF, and chronic renal failure

Cardiac Dysrhythmias

• Electrical problem in the heart: causes include atherosclerosis, hypertension, and cardiomyopathy
• Types of dysrhythmias: atrial fibrillation, atrial flutter, sinus tachycardia, ventricular tachycardia, and ventricular fibrillation