Body Fluids Flashcards
Adult female
50% body fluid, less due to adipose tissue
Intracellular compartment
-holds 2/3 of body fluids
Extra cellular compartment
- interstitial fluid(fluid around the cells)
- intravascular fluid(fluid in bloodstream 5 liters)
Age considerations in fluid distributions
- as we age we lose muscle mass=less water/fluids
- elderly increase in fat=decrease fluids
- infants hold more fluid in interstitial spaces than adults
Osmosis
Movement of water from areas of high concentration of water to lower concentrations of water
Capillary filtration and reabsorption
-Movement of fluid through capillary membranes(via hydrostatic pressure) in order to carry water and nutrition into cells, water outside is reabsorption through blood stream
Normal serum osmolarity
270-300 mOs/L
Obligatory urine output
Minimal amount of urine needing to be excreted per 24 hours to avoid accumulation of waste products and possibly causing lethal electrolyte imbalances
400-600ml/24hours
ADH
- released from hypothalamus, and pituitary gland
- ADH is released and causes kidneys to hold water
- released when brain doesn’t sense enough volume in body
Renin angiotensin aldosterone
- aldosterone causes the kidneys to retain sodium(retention in water)
- responds to volume not osmolarity
Atrial natriuretic peptide
- responds to volume
- released when there is too much volume!(stops ADH and aldosterone release)
Thirst
- major driver for controlling osmolarity
- depends on the brain to function
Insensible water loss
Water loss from skin,lungs, and stool
Fluid volume deficit hypovolemia
Hypovolemia is an extra cellular problem caused by decrease of fluid in extra cellular space
-your concentration of electrolytes stays the same just a loss of volume
Third spacing
When fluid moves from the intravascular space to interstitial space.
- response to injury
- ex:bowels, pleural cavity, pericardium
- may occur as a result of increased permeability of the capillary membrane, that allows fluid into interstitial spaces
May lead to hypovolemia shock
Third spacing or Hemorrhage
Ascites
Accumulation of fluid in the peritoneal cavity
Finding with hypovolemia
- changes in LOC
- increased HR,decreased BP
- oliguria(less than 30ml/Hr)
Fluid volume deficit dehydration
- fluid leaving the cells by osmosis to high concentrated areas
- Intracellular problem
Dehydration may be caused by
-npo,tube feeding, inability to obtain water,prolonged diarrhea,prolonged fever, hyperglycemia
Diabetes insipidis
Patient does not make enough ADH, may have output up to 30 liters
S/S of dehydration
- weight loss
- increased HR,decreased BP
- weak thready pulse
- poor skin turgor
- decreased LOC
- dry mucous membranes
- elevated labs (osmolarity>300)(BUN>25)(USG>1.030)(elevated sodium>145)
Palpation BP
- feel for artery
- systolic only
- chart as 80/P
Doppler BP
- only systolic reading
- chart as 80/D
Crystalloids
Solutions that have small particles that pass into the cells quite easily
Isotonic solution
- same as plasma(most friendly solution with osmolarity of 240-340)
- EX: 0.9 NaCL: only solution that can be used in blood transfusion
- ringers solution: largely NaCL but does have same Ca added
- elaborated ringers: isotonic solution with majority of NaCL, has lactate in it for the body to create bicarbonate(good for patients with acidosis)
Dextrose 5% in water… Special case
- considered isotonic while in bag
- when infused in body, the body uses the sugar leaving you with just water and a little glucose(not much of a replacement)
Fluid bolus
- large amount of IV fluid in a short period of time
- purpose: stabilize BP, restore blood volume, maintain kidney function by dumping water into vascular system forcing excretion
Nursing considerations while giving a bolus
- monitor vitals every 15-30 minutes
- monitor IV Site
After we deliver a bolus
- monitor output
- assess heart and lungs for fluid volume excess
Colloids
- aka plasma expanded
- have large molecules that cannot get to interstitial fluid space
- good for hypovolemia
Colloid examples
- Albumin:fluid magnet
- albumin comes in different strengths
Hypotonic crystalloids
- solution contains less than 240 mOs/L
- quickly move through vascular system
Fluid volume excess hypervolemia
An excess of isotonic fluid(water and sodium) in the extra cellular compartment
Causes of hypervolemia
- excessive fluid intake via po/IV
- heart failire(poor cardiac function)
- limited output
- increased sodium intake
Finding present in hypervolemia
- dependent edema(sacrum,butt,legs,feet)
- pulmonary edema
- tachycardia with bounding pulse
- distended hand and neck veins
- BUN & hematocrit below normal
What to do for hypervolemia
- restrict fluids as ordered
- restrict NA
- give diuretics
- give cardio tonics(Digoxin,betablockers)
- digoxin strengthens cardiac contractions and slows the HR
- monitor lungs sounds
- daily weight
- O2 saturation
- fatigue
Fluid volume excess: water intoxication
- a hypotonic extra cellular problem
- too much fluid shifting into cells
Water intoxications causes
- overuse of hypotonic IV solutions
- too may tap water enemas
- too much tap water NG irrigation
- overly dilute baby formula
Syndrome of increased and dangerous hydration
SIADH
- opposite of diabetes insipides
- pituitary gland is releasing too much ADH
- cancer releases a substance in blood stream that mimics ADH
Findings with water intoxication
- ICF more hypertonic than ECF
- pronounced neurological changes with increased ICP
- increased BP,decreased HR
- lab results(osmolarity
How can we help with water intoxication
- restrict water intake
- monitor neurological status
- monitor labs
- daily weights
- provide safe environment
Hypertonic crystalloids
- greater osmolarity than plasma
- greater than 340
-D5/lactated ringers 3-5%NaCL draws fluid from cells
Adult male
60 % body fluid(40 liters)
