EDAPT: Homeostasis and Elimination

A friend decided to decrease their dietary intake of sodium and is discussing the steps they are taking. Which statement made by the friend indicates they do not understand a low-sodium diet?​

"I'm glad I can still eat sandwiches with bologna."​

What interventions do you expect the healthcare provider to prescribe for your grandmother?

Administer a hypotonic solution and monitor urinary output.

Which individuals are at risk for hypocalcemia? Select all that apply.​

An adolescent living with renal failure​ A person with decreased parathyroid hormone production​ Someone experiencing an increase in serum pH​

Which individual is likely to be experiencing metabolic acidosis?

An older adult who has been vomiting with diarrhea for 26 hours.

Select the common symptom of altered bowel elimination to match each description.​

Anorexia - This occurs before nausea and vomiting, when the body signals that something is not right. ​ Retching - This may precede vomiting and involves the same reflex.​ Nausea - This is an unpleasant sensation stimulated by distention, irritation, or inflammation of the gastrointestinal tract. ​ Vomiting - Also referred to as emesis, this is the forceful emptying of the stomach contents through the mouth.​

Which conditions result in a serum pH of less than 7.35? Select all that apply.

Aspirin overdose Diabetic ketoacidosis Shock Renal failure Respiratory congestion

Which hormones will the body use when there is too much fluid (fluid overload) or too little fluid (dehydration)? Select all that apply.

Atrial natriuretic peptide Antidiuretic hormone Aldosterone

What steps can be taken to prevent alterations in urinary elimination? Select all that apply.​

Avoid caffeine and alcohol​ Eat a well-balanced diet​ Control chronic medical conditions

A client has a serum chloride level of 190 mEq/L. Which foods should the client avoid? Select all that apply.

Black olives ​ Canned corn​ Tomato juice Table salt ​

What are some common reasons for dehydration? Select all that apply.

Bleeding from trauma​ Diarrhea Decreased fluid intake​ Medications (diuretics)​ Vomiting

Which conditions can contribute to the development of respiratory acidosis? Select all that apply.​

Central nervous system (CNS) depression​ Chest wall abnormality​ Atelectasis Respiratory muscle weakness​ Pulmonary edema​​

A client who had been experiencing vomiting and diarrhea for 2 days is feeling well enough to eat. Which foods are the best choice to replace the potassium that has been lost? ​

Cereal with dried apricots

What is the most likely cause of hyperkalemia in an older adult?​

Chronic kidney disease

When dissolved in water or bodily fluids, electrolytes will __________ electrical charges. __________, such as sodium (Na) and magnesium (Mg), are positively charged ions. __________, such as bicarbonate (HCO3) and chloride (Cl), are negatively charged ions. ​

Conduct Cations Anions

You suspect someone may have hypervolemia. Which tests would most accurately support this?​

Daily weight​

How do the kidneys respond to an increase in serum pH (alkalosis)? Select all that apply.

Decrease tubular reabsorption of HCO3- Decrease tubular excretion of H+ ions

What are some signs and symptoms of dehydration? Select all that apply.​

Decreased urine output​ Confusion Fatigue Dry mucosal membranes​

Select the signs or symptoms that are consistent with edema. Jack (preferred pronouns: he, him), a 70-year-old adult male, is in the clinic with difficulty breathing. His triage history states that he has heart failure and had several high-sodium meals over the holidays. Jack's ankles are swollen and he says he gained 5pounds in the past 2 days.

Difficulty breathing Ankles are swollen Gained 5 pounds

Which external signs of severe dehydration would the healthcare provider look for in your 69-year-old grandmother? Select all that apply.

Dizziness Confusion Sunken eyes

Read the case scenario below, and then select all the signs or symptoms that are consistent with a fluid imbalance.​ Chris (preferred pronouns: he, him) is a high school football player who came into the office after practice. He said that he was dizzy and lightheaded. The nurse in the office took his blood pressure and it was low. His pulse rate was elevated. He also had bruising on both arms. The outside temperature during practice was 105 degrees Fahrenheit, and Chris forgot to bring water. He has no medical history, but his father has a history of heart disease and kidney disease.​

Dizzy and lightheaded Blood pressure and it was low Pulse rate was elevated

A high school student has been outside for marching band practice for four hours on a hot, humid afternoon. They have been drinking water to replace fluids lost through sweat. An hour after getting home, the student's caregiver finds them in bed with muscle cramps, lethargy, a headache, and confusion. The student continues to drink water to replace fluid lost during band practice. Which action by the student could have prevented them from becoming hyponatremic?

Drank an isotonic sports drink instead of water​.

An older adult has been feeling unwell for 2 days, experiencing muscle weakness, tingling of the face and tongue, and nausea. Their partner says it is because the older adult uses too much of the new salt substitute, but the older adult thinks the new medication is the cause.​ How could the older adult have best avoided becoming hyperkalemic? Select all that apply. ​

Eat less potassium-rich foods​ Avoiding potassium-based salt substitutes​

Which statements best describe edema? Select all that apply.​

Edema may be classified by the cause​. Not all edema is visible in the body.​ Edema can be classified as generalized or localized​. Edema is an accumulation of excess fluid in the interstitial spaces​. Persistent edema can eventually lead to skin breakdown and delayed wound healing​.

Select the mechanism that best explains the corresponding example.

Electrolytes - Intravenous fluids used by healthcare professionals rely on sodium concentrations to treat conditions of fluid imbalance. Blood pressure - Receptors throughout the body that send signals to the autonomic nervous system to constrict or dilate blood vessels depending on the fluid imbalance it may sense.​ Proteins - Low levels can cause movement of fluid into interstitial areas, causing edema. For example, low levels can cause a water leak from the vascular area into the surrounding tissue, causing edema. Hormones - Renin is converted to angiotensinogen to cause vasoconstriction. It also stimulates production of aldosterone by the adrenal gland, which helps to keep fluid in the vascular system.​

Which environmental sources of potassium should a person avoid who follows a low potassium diet? Select all that apply.​

Fertilizer Home water filters​ Salt substitutes​

In which direction will potassium diffuse through the cell membrane?

From intracellular space to extracellular space.

Chris (preferred pronouns: he, him) is a high school football player who came into the office after practice. He said that he was dizzy and lightheaded. The nurse in the office took his blood pressure and it was low. His pulse rate was elevated. He also had bruising on both arms. The outside temperature during practice was 105 degrees Fahrenheit, and Chris forgot to bring water. He has no medical history, but his father has a history of heart disease and kidney disease.​ Which strategies could have prevented this student's problems? Select all that apply.​

Having water available at the practice Taking frequent rest breaks Offer shaded areas at practice

An individual with hyperkalemia may have alterations in their rate __________ and __________.​

Heart Rhythm

Drag and drop the location of the edema to match the most likely pathophysiologic condition.

Heart failure, blood clot ​ - Lower extremities​ Removal of non- functioning lymph nodes ​ - Upper or lower extremities​ Inflammatory response ​ - Surrounding a wound​ Renal disease - Generalized Liver disease ​- Abdomen

An older adult has been feeling unwell for 2 days, experiencing muscle weakness, tingling of the face and tongue, and nausea. Their partner says it is because the older adult uses too much of the new salt substitute, but the older adult thinks the new medication is the cause.​ Based on the cues provided, the older adult is most likely experiencing __________, which could be confirmed by a __________ test. The pathophysiological process causing the cues is a/an __________ imbalance.​

Hyperkalemia Laboratory Electrolyte

You are visiting someone who is living with chronic kidney disease.​ You know that this disease can cause __________. You want to bring over a meal as the person hasn't been able to cook lately. You know, because of this person's diagnosis, you should cook food that has a __________ amount of __________. You are also aware that you should __________ a salt substitute.

Hyperkalemia Low Potassium Avoid

Based on what you know about tonicity, what type of dehydration will occur in the body if you were to consume salt water from the ocean?

Hypertonic

What type of solution would you use to make this cell "normal?"​

Hypertonic​

Which conditions result in a serum pH of greater than 7.45? Select all that apply.

Hyperventilation Excessive antacid intake Vomiting

Match the description with the type of fluid imbalance.

Hypervolemia - Too much fluid accumulates and/or organs in the body are unable to manage or excrete. Hypovolemia - Blood is lost due to hemorrhage and poor fluid intake. Maldistribution of fluid - Movement of fluid from one compartment to another without a loss of fluid​.

Which conditions can cause metabolic alkalosis? Select all that apply.​

Nasogastric suctioning​ Diuretic therapy​ Mineralocorticoid use​ Excessive use of antacids​ Vomiting

A high school student has been outside for marching band practice for four hours on a hot, humid afternoon. They have been drinking water to replace fluids lost through sweat. An hour after getting home, the student's caregiver finds them in bed with muscle cramps, lethargy, a headache, and confusion. The student continues to drink water to replace fluid lost during band practice. Based on the cues, which body systems are impacted by the student's alteration in health? Select all that apply. ​

Neurological Musculoskeletal

An older adult has been feeling unwell for 2 days, experiencing muscle weakness, tingling of the face and tongue, and nausea. Their partner says it is because the older adult uses too much of the new salt substitute, but the older adult thinks the new medication is the cause.​ Based on the cues, which body systems are impacted by the alteration in serum potassium? Select all that apply. ​

Neurological Musculoskeletal Gastrointestinal

Which clinical manifestation is not associated with hyperkalemia?​

Positive Chvostek's sign​

Which statement best describes hydrostatic pressure?​

Pressure against the wall of a vessel is caused by the force of fluid traveling through a vessel.

Which statement best describes osmotic pressure?​

Pressure is caused by the differences in the concentrations of two solutions.

Which items should be included in the diet of a person who wants to increase their calcium intake? Select all that apply.​

Vitamin D supplement Milk and cheese Green, leafy vegetables Almonds

What occurs during osmosis?

Water moves from an area of lower solute concentration to an area of higher solute concentration.

A high potassium level can lead to which condition(s)? Select all that apply.

Weakness Low heart rate Decreased reflexes Low blood pressure

Other than measuring fluid intake and output, how can fluid changes be accurately measured in the body? Select all that apply.

Weight Urinary frequency

Which risk factors make older adults and children more sensitive to fluid imbalances? Select all that apply.​

Weight and height​ Total body water differences​ Kidney function​

Which are possible signs or symptoms of edema? Select all that apply.

Weight gain Swelling of lower extremities

Interpret the arterial blood gas (ABG) results below.​ Determine if the pH, PaCO2, and HCO3 levels represent acidosis, alkalosis, or are within normal ranges. Drag and drop each result in the appropriate field. pH: 6.99 PaCO2: 76 HCO3-: 22

pH: 6.99 - Acidosis PaCO2: 76 - Acidosis HCO3-: 22 - Normal

Interpret the arterial blood gas (ABG) results below.​ Determine if the pH, PaCO2, and HCO3- levels represent acidosis, alkalosis, or are within normal ranges. Drag and drop each result in the appropriate field. pH: 7.16 PaCO2: 82 HCO3-: 26

pH: 7.16 - Acidosis PaCO2: 82 - Acidosis HCO3-: 26 - Normal

Interpret the arterial blood gas (ABG) results below.​ Determine if the pH, PaCO2, and HCO3 levels represent acidosis, alkalosis, or are within normal ranges. Drag and drop each result in the appropriate field. pH: 7.41 PaCO2: 44 HCO3: 23

pH: 7.41 - Normal PaCO2: 44 - Normal HCO3: 23 - Normal

Interpret the arterial blood gas (ABG) results below.​ Determine if the pH, PaCO2, and HCO3 levels represent acidosis, alkalosis, or are within normal ranges. Drag and drop each result in the appropriate field. pH: 7.5 PaCO2: 38 HCO3: 37

pH: 7.5 - Alkalosis PaCO2: 38 - Normal HCO3: 37 - Alkalosis

Interpret the arterial blood gas (ABG) results listed here. Determine if the pH, PaCO2, and HCO3 levels represent acidosis, alkalosis, or are within normal ranges. Drag and drop each result in the appropriate field. pH: 7.58 PaCO2: 32 mm/Hg HCO3: 24 mEq/L

pH: 7.58 - Alkalosis PaCO2: 32 mm/Hg - Alkalosis HCO3: 24 mEq/L - Normal

Who is at higher risk for complications of diarrhea? Select all that apply.​

A school-aged child living with cystic fibrosis​ A breastfeeding infant with lactose intolerance​ An adolescent with celiac disease​

Select the correct hormones to match the corresponding description.

*Gastrin:* • Found in gastric cells • Increases stomach motility and acid production • Promotes gastric emptying *Cholecystokinin (CCK):* • Found in intestinal mucosal cells • Stimulated by fat and ​amino acids in the duodenum • Inhibits gastric secretion and motility • Fuels pancreatic enzyme secretion • Stimulates ​gallbladder contractions to release bile *Secretin:* • Found in intestinal mucosal cells • Stimulated​ by acidic chyme in the duodenum • Triggers bile and pancreatic ​secretions with bicarbonate content

Identify the signs and symptoms most likely seen with each type of fluid imbalance. Each sign or symptom may be seen in more than one type of fluid imbalance.​

*Hypovolemia:* Dizziness Low blood pressure Oliguria​ *Maldistribution:* Generalized swelling *Hypervolemia:* Weight gain​ Generalized swelling Oliguria​

Categorize the following conditions with which type of fluid imbalance.​

*Hypovolemia:* • Blood loss from external injury​ • Dehydration​ • Extensive burns​ *Maldistribution:* • Anaphylactic reaction​ • Systemic inflammatory response syndrome • Transfusion reaction​ *Hypervolemia:* • Heart failure​ • Liver failure​ • Renal failure​

The table below lists locations where edema can occur. Match the cause and pathology of the disease or injury to the correct location of edema.

*Lower extremities​:* Cause: Heart failure, blood clot Patho: The decreased circulatory pressure caused by a failing heart or vascular blockage leads to increased pressure in the venous system. This intravascular pressure pushes fluid into the interstitial spaces and gravity causes that fluid to settle in the feet and legs.​ *Abdomen:* Cause: Liver disease ​ Patho: As the liver fails, elevated pressure in the portal vein of the liver circulation combined with reductions in protein cause movement of fluid into the abdomen causing ascites (edema).​ *Surrounding a wound​:* Cause: Inflammatory response Patho: The immune system draws fluid in and around an injury to send white blood cells and other immune mediators to fight any type of infection.​ *Upper or lower extremities​:* Cause: Removal or non-functioning lymph nodes​​ Patho: The lymph removes fluid and cells that have reached the end of their usefulness. When these lymph nodes which are located all over our bodies stop functioning or are removed, lymphedema occurs.​ *Generalized:* Cause: ​Renal disease​ Patho: Failure of the kidneys can cause increased generalized edema as the kidneys are not able to eliminate any excess fluid that has already been metabolized.

Identify whether the signs and symptoms below relate to mild/moderate or severe dehydration.

*Mild or Moderate Dehydration:* Thirst Muscle cramps Dry or sticky mouth Dry, cool skin *Severe Dehydration:* Dry, warm skin Feeling dizzy Sunken eyes Fainting Rapid heartbeat

Using the laboratory results, select the name of the electrolyte imbalance from the drop-down menu.​

*Sodium (Na):* Lab Result: 132 mEq/L​ Imbalance: Hyponatremia *Potassium (K):* Lab Result: 5.7 mEq/L​ Imbalance: Hyperkalemia *Chloride (Cl):* Lab Result: 94 mEq/L​ Imbalance: Hypochloremia *Calcium (Ca):* Lab Result: 8.0 mg/dL​ Imbalance: Hypocalcemia

An older adult has been feeling unwell for 2 days, experiencing muscle weakness, tingling of the face and tongue, and nausea. Their partner says it is because the older adult uses too much of the new salt substitute, but the older adult thinks the new medication is the cause.​ For each factor listed, click to specify if the factor is a symptom or a cause of altered potassium.​

*Symptom:* Muscle weakness Nausea Tingling of face and tongue *Cause:* Age of the adult New medication New salt substitute

Match the pH levels with each symptom below.

1. 7.55 2. 7.7 3. 7.4 4. 7.8

Match each type of dehydration to the proper cell.

1. Hypertonic 2. Isotonic 3. Hypotonic

Drag the compartment name to the corresponding location on the image.

1. Interstitial fluid: 15% 2. Intracellular fluid (ICF): 40% 3. Extracellular fluid (ECF): 20% 4. Plasma (intravascular fluid): 4%

What clues (symptoms) would alert you that you are dehydrated?

1. No tears 2. Cracked tongue 3. Dry skin 4. Dry lips 5. Dry mucosa 6. Flaky scalp

Find the following electrolytes on the periodic table: calcium, sodium, potassium, chlorine (chloride), and magnesium.

1. Sodium (Na) 2. Potassium (K) 3. Magnesium (Mg) 4. Calcium (Ca) 5. Chlorine (Cl)

An adult has lost water through sweating while mowing the yard in the middle of a hot summer day. Unfortunately, the person did not keep water nearby to replace what was being lost. Based on this history, which serum sodium level would most likely be found if tested?​

155 mEq per liter​

A person cannot survive if pH drops below __________ or rises to __________ for more than a brief time.

6.8 7.8

Select the signs or symptoms that could be a cause of increased edema. Jack (preferred pronouns: he, him), a 70-year-old adult male, is in the clinic with difficulty breathing. His triage history states that he has heart failure and had several high-sodium meals over the holidays. Jack's ankles are swollen and he says he gained 5pounds in the past 2 days.

70-year-old adult male History states that he has heart failure High-sodium meals

Which statement best describes increased permeability?​

A change in the consistency of a wall or membrane allows more fluid to pass through.

A high school student has been outside for marching band practice for four hours on a hot, humid afternoon. They have been drinking water to replace fluids lost through sweat. An hour after getting home, the student's caregiver finds them in bed with muscle cramps, lethargy, a headache, and confusion. The student continues to drink water to replace fluid lost during band practice. Based on the cues provided, the student is most likely experiencing __________ which could be confirmed by a __________ test.​

Hyponatremia Blood

What type of solution would you use to make this cell "normal?"​

Hypotonic

Chris (preferred pronouns: he, him) is a high school football player who came into the office after practice. He said that he was dizzy and lightheaded. The nurse in the office took his blood pressure and it was low. His pulse rate was elevated. He also had bruising on both arms. The outside temperature during practice was 105 degrees Fahrenheit, and Chris forgot to bring water. He has no medical history, but his father has a history of heart disease and kidney disease.​ Which of the following types of fluid imbalance could this student be experiencing?​

Hypovolemia due to dehydration​

After being out at the beach for hours, an adult suffered from an extensive sunburn covering their back, arms, and legs. Which fluid imbalance is this person most likely experiencing?​

Hypovolemic fluid imbalance​

Chris (preferred pronouns: he, him) is a high school football player who came into the office after practice. He said that he was dizzy and lightheaded. The nurse in the office took his blood pressure and it was low. His pulse rate was elevated. He also had bruising on both arms. The outside temperature during practice was 105 degrees Fahrenheit, and Chris forgot to bring water. He has no medical history, but his father has a history of heart disease and kidney disease.​ The intravascular system is depleted through __________ metabolism and fluid __________ from sweat. This activates baroreceptors, which cause __________ in order to __________ blood pressure. When fluid levels get __________ enough, blood pressure starts to __________ and pulse rate starts to __________. The brain __________ blood, causing dizziness and lightheadedness.​

Increased Loss Vasoconstriction Increase Low Decrease Increase Doesn't get enough

Why are infants and older adults at higher risk of dehydration? Select all that apply.

Infants' inability to vocalize. Both infants and older adults lack fluid reserves in their body. Decreased thirst sensation in older adults.

In a healthy person, most of the potassium in the body is located __________.

Inside the cells

Which statement is the best definition of electrolytes?​

Ions in bodily fluids that regulate metabolic processes​.

What type of solution would you use to keep this cell "normal?"​

Isotonic

Match the symbol of the electrolyte to the chemical compound and function with which it is associated.

K+ - Potassium chloride; Helps regulate heart rhythm​ H+ - Hydrochloric acid; Digestion Na+ - Sodium chloride; Regulates osmotic pressure Ca+ - Calcium chloride; Important for bone regulation Mg+ - Magnesium chloride; Works with muscle and nerves

Which environmental factors directly affect fluid balance? Select all that apply.​

Lack of potable water in a small town. Concentration of bisphenol A in food containers. Regular daily temperature is 120 degrees Fahrenheit.

Which symptoms would an individual with hypokalemia exhibit? Select all that apply.​

Leg cramps​ Anorexia

Which underlying conditions increase the risk of edema? Select all that apply.​

Liver failure​ Chronic kidney disease​ Vascular disease​

Match each cause of edema to its description.​

Lymphatic node dysfunction - If one or more of the lymph nodes are not able to collect these materials, they get caught in the interstitial areas, causing a type of edema called lymphedema. Change in osmotic pressure - This can occur when the concentration of the blood or interstitial fluid changes. The difference in the concentration, or the osmolarity, affects osmotic fluid shifts between compartments, including the cell. Increased vascular permeability - This occurs when chemicals and proteins change the size of the vessel walls to allow fluid to travel into or out of the vascular system. Increased hydrostatic pressure - This occurs when there is a blockage or backup in the vascular system causing increased pressure against the vessel walls and the movement of fluid into interstitial spaces.

From the cues available, select those that provide information about this person's health.​ A high school student has been outside for marching band practice for four hours on a hot, humid afternoon. They have been drinking water to replace fluids lost through sweat. An hour after getting home, the student's caregiver finds them in bed with muscle cramps, lethargy, a headache, and confusion. The student continues to drink water to replace fluid lost during band practice.​

Muscle cramps Headache Confusion Continues to drink water

Jack (preferred pronouns: he, him), a 70-year-old adult male, is in the clinic with difficulty breathing. His triage history states that he has heart failure and had several high-sodium meals over the holidays. Jack's ankles are swollen and he says he gained 5 pounds in the past 2 days. Which strategies can reduce or prevent edema? Select all that apply.

Propping up the legs above the level of the heart. Taking diuretic medication as ordered. Reducing sodium intake

A lack of which of the following can cause an increase in edema?

Protein or albumin

When the serum pH is high or low, the lungs can __________ respond to regulate __________ levels and the __________ can __________ respond to regulate bicarbonate (HCO3) levels.​

Quickly CO2 Kidneys Slowly

Changes in carbon dioxide (CO2) that cause alterations in the serum pH are caused by which mechanism?

Respiratory system

Based on the assessment data, what hypothesis can be made about her underlying condition?

She is dehydrated.

Jack (preferred pronouns: he, him), a 70-year-old adult male, is in the clinic with difficulty breathing. His triage history states that he has heart failure and had several high-sodium meals over the holidays. Jack's ankles are swollen and he says he gained 5 pounds in the past 2 days. Excessive __________ levels in the extracellular fluid promote the accumulation of fluid in the __________ compartment. This happens because of increasing __________ pressure. ​Blood pressure is usually __________, too.

Sodium Interstitial Osmotic Elevated

Which clients are at risk for hypomagnesemia due to preexisting alterations in health? Select all that apply.​

Someone taking a diuretic every day​. A person living with alcohol use disorder​.

Which meal contains the lowest amount of potassium?​ Click the name of the meal to indicate your choice.

Spaghetti with tomato sauce

Which condition may result in tissue edema?

The ingestion of a large amount of salt.

Match the type of dehydration with the correct definition.

The interpretation of the client's lab work indicated they lost fluid and electrolytes equally. - Isotonic The interpretation of the client's lab work indicated they lost more electrolytes than fluid. - Hypotonic The interpretation of the client's lab work indicated they lost more fluid than electrolytes. - Hypertonic

What is the difference in osmotic pressure between the two bottles of cola in the image below?

The osmotic pressure is the same between both bottles.

What alteration is present in a person with hyperkalemia?​

They have too much potassium.

When the osmoreceptors detect a decreased blood volume and increased blood concentration of salt, what function increases in the body?

Thirst

A person with a low magnesium level is most likely to experience which symptoms? Select all that apply.​

Tremors Seizures Tetany

An alteration in serum bicarbonate levels indicates a/n __________ cause of acid-base imbalance.​

Unknown

Which stimulates increased peristalsis and secretions in the digestive tract?

Vagus nerve