CH 4 - Fluid Electrolyte Balance (113) Flashcards
Fluid and electrolyte balance is a ________ process that is crucial for
dynamic, life and homeostasis.
normal pH range
7.35 to 7.45
60% of weight - typical adult consists of
fluid
fluid is made up of
water and electrolytes
Factors that influence the amount of body fluid are
age, gender, and body fat.
younger people have a higher percentage of
body fluid than older people,
men have proportionately more _____ than women
body fluid
obese have less fluid than those who are thin because
fat cells contain little water
Body fluid is located in
two fluid compartments: ICS & ECS
intracellular space (ICS)
fluid inside the cells)
extracellular space (ECS)
fluid outside the cells).
Approximately two thirds of body fluid is intracellular fluid (ICF) and is located primarily in
the skeletal muscle mass;
ECF compartment is further divided into (3)
intravascular, interstitial, transcellular fluid spaces
one third of ______ is in the extracellular fluid (ECF).
Body fluid
intravascular space (IVS)
fluid within the blood vessels
AKA PLASMA
Plasma is made up of
water, along with molecules, electrolytes, and proteins, minus blood cells and platelets.
__ L of the average __ L of blood volume is made up of plasma, which has a___ __ ___
3.5
6
straw-colored appearance.
. SO WHICH PATIENTS WOULD YOU EXPECT TO DEHYDRATE MORE QUICKLY
PREEMIES AND NEWBORNS
THE ELDERLY ESPECIALLY ELDERLY, OBESE WOMEN!
PREEMIES AND NEWBORNS (CAN ALSO
OVER HYDRATE QUICKLY)
EXTRACELLULAR FLUID
(OUTSIDE THE CELLS)
* TRANSPORTS WHAT
NUTRIENTS / WASTES
_________-TO THE CELL AND CARRIES WASTE PRODUCTS AWAY FROM THE CELLS BY MEANS OF THE CAPILLARY BED
TO THE CELL AND CARRIES WASTE PRODUCTS AWAY FROM THE CELLS BY MEANS OF THE CAPILLARY BED
_________TO THE CELL AND CARRIES _______ PRODUCTS AWAY FROM THE CELLS BY MEANS OF THE ________
NUTRIENTS
WASTES
CAPILLARY BED
INTERSTITIAL FLUID
SURROUNDS EACH CELL OF THE BODY, EVEN BONE CELLS
INTRAVASCULAR FLUID
SURROUNDSTHECELLS OF THE BLOOD – MOST OF THE BLOOD VOLUME
WHICH FLUID MAKES UP MOST OF THE BLOOD VOLUME
INTRAVASCULAR FLUID
TRANSCELLULAR FLUID ENCLOSED BY
ENDOTHELIAL MEMBRANE
TRANSCELLULAR FLUID INCLUDES
CEREBROSPINAL
* PERICARDIAL
* PANCREATIC
* PLEURAL
* INTRAOCULAR
* BILIARY
* PERITONEAL
* SYNOVIAL FLUIDS
* BOWEL MUCUS
TRANSCELLULAR FLUID GENERALLY NOT SUBJECTED TO
GAINS AND LOSSES
THIRD SPACE SYNDROME
FLUID SHIFTS FROM THE VASCULAR SPACE INTO AN AREA WHERE IT IS NOT READILY ACCESSIBLE AS EXTRACELLULAR FLUID
EXS OF THIRD SPACING
- EXAMPLES: * ASCITES
- HYDROCEPHALUS
- PLEURAL EFFUSIONS * PERICARDIAL
TRANSCELLULAR
EFFUSIONS
HYDROSTATIC PRESSURE
FORCE OF FLUID PRESSURE IN BLOODSTREAM
OSMOTIC PRESSURE
PRESSUREBYSOLUTESINSOLUTION
ONCOTIC PRESSURE
- “COLLOID PRESSURE”
- PRESSURE DUE TO ALBUMIN IN BLOOD
OSMOLALITY
- CONCENTRATION OF SOLUTES/KG SOLUTION
- OSMOLARITY
- NUMBER OF OSMOLES OF SOLUTE PER LITER OF SOLUTION
HYDROSTATIC PRESSURE SYMBOLIZES
THE Pushing outward force of hydrostatic pressure, pushing water from ECF (capillary) into ICF
Osmotic pressure symbolizes
Pulling force of osmotic (oncotic) pressure, created by sollutes (albumin), which favors fluid movement from the ICF into the ECF (capillary)
MOVEMENT OF FLUID THAT OCCURS AT CAPILLARY BEDS IS THE OUTCOME OF 2 MAJOR OPPOSING FORCES
- HYDROSTATIC PRESSURE
- OSMOTIC PRESSURE
STARLING LAW OF CAPILLARIES EXPLAINS THE
MOVEMENT OF FLUID THAT OCCURS AT CAPILLARY BEDS
LOWER ALBUMIN =
REDUCED OSMOTIC PRESSURE
INCREASED BLOOD VOLUME =
INCREASED HYDROSTATIC PRESSURE
NORMAL PLASMA OSMOLALITY ~
290 MOSM
MOSM MEANS WHAT
?
OSMORECEPTORS
* LOCATED IN
HYPOTHALAMUS
OSMORECEPTORS
* LOCATED IN HYPOTHALAMUS AND STIMULATED BY
BY INCREASED PLASMA CONCENTRATION
OSMORECEPTORS
* LOCATED IN HYPOTHALAMUS AND STIMULATED BY INCREASED PLASMA CONCENTRATION
* INITIATE _______ AND ______
THIRST MECHANISM
ANTIDIURETIC HORMONE (ADH) RELEASE
OSMORECEPTORS
* LOCATED IN HYPOTHALAMUS AND STIMULATED BY INCREASED PLASMA CONCENTRATION
* INITIATE _______ AND ______
THIRST MECHANISM
ANTIDIURETIC HORMONE (ADH) RELEASE
OSMORECEPTORS
* LOCATED IN HYPOTHALAMUS AND STIMULATED BY INCREASED PLASMA CONCENTRATION
* INITIATE _______ AND ______
THIRST MECHANISM
ANTIDIURETIC HORMONE (ADH) RELEASE
ADH (ALSO KNOWN AS
VASOPRESSIN)
ADH (ALSO KNOWN AS VASOPRESSIN)
* SYNTHESIZED BY
HYPOTHALAMUS
ADH (ALSO KNOWN AS VASOPRESSIN)
* SYNTHESIZED BY HYPOTHALAMUS AND RELEASED FROM
POSTERIOR PITUITARY
ADH (ALSO KNOWN AS VASOPRESSIN)
* STIMULATES WHAT IN KIDNEYS
KIDNEY NEPHRON TO REABSORB MORE WATER
RENIN-ANGIOTENSIN- ALDOSTERONE SYSTEM AKA
RAAS
RENIN-ANGIOTENSIN- ALDOSTERONE SYSTEM (RAAS) 4 STEPS
- RENIN RELEASED FROM KIDNEYS
- ANGIOTENSIN I CONVERTED TO ANGIOTENSIN II
- ANGIOTENSIN II (VASOCONSTRICTOR)
- ALDOSTERONE
What happens when Renin is released from the kidneys?
CONVERTS ANGIOTENSINOGEN (FROM LIVER) TO ANGIOTENSIN I
How is angiotensin one converted to angiotensin two and where does it happen?
IN LUNGS BY ANGIOTENSIN-CONVERTING ENZYME (ACE)
What does angiotensin two (vasoconstrictor) activate
ACTIVATES ADRENAL CORTEX TO RELEASE ALDOSTERONE
What does aldosterone do?
INCREASES SODIUM AND WATER REABSORPTION AND POTASSIUM SECRETION BY KIDNEYS
What is the RAAS net EFFect?
Increases blood volume which leads to increasing blood pressure
What activates, the RAAS system
When there is lower circulation or blood pressure sensed by the kidneys
The juxtaglomerular cells in the kidneys detect what
the drop in blood pressure..
The juxtaglomerular cells respond by
secreting the enzyme renin
Which organ secretes renin
Kidneys
Which organ secretes angiotensin I
Liver
Where and how is angiotensin I converted to angiotensin II
In lungs by ACE
What gland does angiotensin II stimulate
Adrenal gland
What does aldosterone do
Increases sodium / water REABSORPTION into bloodstream and causes potassium to be secretes in urine
How does angiotensin II affects the arteries
Stimulates arterial vasoconstriction which raises bp
NATRIURESIS
EXCRETION OF LARGE AMOUNTS OF SODIUM AND WATER
THREE PEPTIDES PROMOTE NATRIURESIS
ATRIAL NATRIURETIC PEPTIDE (ANP)
BRAIN NATRIURETIC PEPTIDE (BNP)
C-TYPE NATRIURETIC PEPTIDE (CNP)
ATRIAL NATRIURETIC PEPTIDE (ANP)
ATRIAL CELLS WHEN ATRIA STRETCHED
BRAIN NATRIURETIC PEPTIDE (BNP)
HEART VENTRICLES AND TO LESSER EXTENT, THE BRAIN
C-TYPE NATRIURETIC PEPTIDE (CNP)
ENDOTHELIAL CELLS OF ARTERIES AND
VENTRICULAR CELLS
ANP
ATRIAL NATRIURETIC PEPTIDE
BNP
BRAIN NATRIURETIC PEPTIDE
CNP
C-TYPE NATRIURETIC PEPTIDE
ASSESSMENT OF FLUID STATUS - 5 ways
- DAILY WEIGHT
- 24-HOUR I & O (INPUT AND OUTPUT)
- VITAL SIGNS SUCH AS HEART RATE AND BLOOD PRESSURE
- ORTHOSTATIC HYPOTENSION MAY DEVELOP IN DEHYDRATION
- ASSESS STATUS OF MUCOUS MEMBRANES, SKIN TURGOR, URINE OUTPUT, EDEMA
How should I & O be recorded
RECORD IN ML
1 OUNCE OF FLUID EQUALS __ ML
30
SEQUESTERED FLUIDS
FLUID ACCUMULATES IN BODY CAVITIES NORMALLY FREE OF FLUIDS
SEQUESTERED FLUIDS examples
THIRD-SPACE ACCUMULATION OR THIRD-SPACING
What areas can third spacing happen
PERICARDIAL SAC, PERITONEAL CAVITY, AND PLEURAL SPACE
