exam 1: fluids (SN) Flashcards
Who is most at risk for fluid imblanaces?
Infants and elderly
FVO for elderly: heart failure and renal failure
FVD for elderly: dehydration and lack of thirst
Why does H2O gradually decrease throughout age?
because muscle mass works to hold water but muscle mass decreases in age
Three factors that mostly influence fluids? How do they work?
Muscle: hold unto water; skin and blood contain the highest amounts of water in the body
-younger people have higher percentage of body fluid than older people (because of muscle mass)
Body Fat: fat repels water
-obese pt have less fluids (less TBW) than those who are leaner; becoming most at risk for fluid imbalance like dehydration
Gender: men have more lean muscle mass than adipose tissues»_space; retain more body fluid than women
Discuss Intracellular Fluid (ICF) and the electrolytes associated
Fluid inside the cell
key electrolyte: potassium as most abundant electrolyte inside the cell
-pulled from outside to inside
(THINK!!!! K+ing Potassium needs to be inside !! not outside !!)
2/3 of fluid in body is almost inside cell; mainly in skeletal muscle cells
ICF is where electrolytes are flowing to
Discuss Extracellular Fluid (ECF) and the electrolytes associated.
Fluid inside bl vessels, skin tissues and spinal cord (CSF)
1/3 of Body Fluid
Explain the associated main organs associated with gaining and losing fluids and what happens.
Kidneys (washing machines!!) : 8oz of urine in 3 hr
doors to body letting fluid out of body in to potty
Renal failure problems: if BUN and CREATINE are HIGH ; if only BUN means DEHYDRATION
Skin: sensible loses/perspirations (visible water and electrolyte losses)
-increases during: fever, heat stroke, thyroid crisis
-sodium, chloride, potassium electrolytes seen in sweat
-burn pt MOST at risk for FVD due to losing water from blister formation
Lungs: cause insensible loses
-monitor pt with respiratory alkalosis: has hyperventilation ‘kussmaul repsirations’
what happens: acid leaving body through carbon dioxide, leaving body in alkaline state
GI Tract: diarrhea and fistulas cause large fluid loses
Define diffusion
solute movement from greater to lesser concentration leading to equalization, occurring through random movement of ions and molecules
-exchange of O2 and CO2
Define osmosis
(wet version of diffusion)
movement of fluid from low to high solute concentration with eventual equalization
Filtration
movement of water and solutes from a higher to a lower hydrostatic pressure
-passage of water and electrolytes ; all about fluid (hydrostatic) pressure from pumping action of heart
Osmolality
concentration of the solution; how heavy and concentrated is it ?
normal bl plasma: 270-300 mOsm/kg
Isotonic Fluids
does not cause any fluid shifts outside of vascular spaces , fluid stays inside the blood vessels ; enough pressure in each side of the membrane
Hypertonic Fluids
osmolality greater than normal (>300 mOsm/L)
-suck fluid out of cell making it super skinny
-solution has osmotic pressure greater than in the body»_space; that excess solution is being pulled out of the cell»_space; into vascular blood vessels spaces
-done to dilute and equalize osmotic pressure from thick hypertonic fluid
Hypotonic Fluids
osmolarity less than normal ( <300 mOsm/L)
-osmotic pressure greater inside body»_space; when infused, fluids out of the blood»_space; into the cell
HYPO- HIPPO- BIG
Manifestations of:
Fluid Volume Overload (FVO)
Fluid Volume Excess (FVE)
Hypervolemia
leads to s/s of edema (see edema card)
high fluid volume = big bulging body
weight gain=water gain»_space; may lead to pulmonary edema and massive fluids in lungs
2-3 lbs in 1d, 5lbs in 7d
cardio: high BP and HTN crisis
140 sys (hypertension) , 180 sys (stroke risk)
aneurysm, increased CVP, bounding pulses, JVD
integ: periorbital edema and pitting edema, pale cool skin
neuromuscular: ALOC due to “mental status changes”, headache (brain swelling»_space; seizures), weakness, paresthesias (pins & needles)
renal and urinary: usually an increase urine output ; however, if there are renal issues, decreased urine output
lab values: LOW when liquidy
-low diluted lab values (hemodilution)
-decreased osmolality (decrease in thickness in blood)
-decreased electrolytes
SODIUM as most critical as severely low amount HYPONATREMIA can lead to severe brain problems/damage
REMEMBER!!
monitor sodium during FVO
GI: increased motility leading to diarrhea (bowel too fast) ; hepatomegaly (enlarged liver) and ascites (abdominal fluid: fluid has no where to go ! go to organs)
respiratory: rapid shallow rate with rales (moist cackles): indicating fluid in lungs
pulmonary edema
urine:
-decreased urine specific gravity
low gravity=low weight
Define edema and its manifestations.
Edema Pitting Points
def: swelling of soft tissues due to excess fluid accumulation
-common and noticeable in lower extremities: fluid pulls when pt is in upright position
0+ : no pitting edema
1+ : 2mm or less (mild edema) - immediate rebound
2+ : 3-4mm (moderate edema)- 15 secs rebound
3+ : 5-6mm (moderately severe edema)- 30 secs rebound
4+ : 8mm or deeper (severe edema)- 1-2 mins rebound
Top 4 causes of edema
- Increased hydrostatic pressure
-high fluid pressure within blood vessels»_space; causes fluid to be pushed out of blood vessel and in to interstitial space
-high bp and pitting edema (worsening)
ex. renal failure, heart failure - Decreased osmotic pressure
-decrease colloid in blood»_space; decrease fluid retention inside blood vessels
-colloid holds water in vascular space (low albumin=low plasma proteins= low Attraction of fluid
fluid leaks out into body cavity) - Increased capillary permeability
edema from fluid leaking out to the blood vessel
caused: severe inflammation or tissue destruction (bacteria-causing infection and burns) - Obstruction of the lymphatic system
-since lymphatic works to clean blood and get rid of any wastes with help of WBC»_space; backup of fluid occurs
cause: cancer or tube blockage or infection (big lymph nodes)
Elaborate on major burns
-can cause massive tissue damage and cellular destruction»_space; widespread systemic inflammation»_space; increases vascular / capillary permeability
“leaky blood vessels that fill up body”
-fluids, electrolytes, and other components spill all over interstitial spaces = low fluid volume intravascularly as they escape and go into tissues»_space; hypovolemic shock
FIRST intervention in first 24 hrs: IV LR solution and IV NS
-are isotonic fluids (since they stay inside veins longer closely resembling human blood )
-increases fluid volume inside fluid vessels»_space; increasing blood pressure
Fluid Volume Deficit (FVD) , causes, and 3 DDDs
Dehydration
-Pt has decrease in fluid
Causes:
-Vomiting & Diarrhea
-Hot body & Sweating: fever, heat stroke, thyroid crisis
-Severe burns: most at risk since a lot of fluids are lost due to blister formation in skin
-urination
DDDs:
DI (diabetic Insipidus): too much urine lost
DKA (diabetic ketoacidosis): increased sugar concentration in blood (hyperglycemia) ; caused by infection ; manifestation: kussumal respiration
Diuretics (furosemide, hydrochlorothiazide): -ide = dr- ied ; drain fluid from body into potty, there is loss of electrolytes (where fluid goes, electrolytes go!!)
Compensation of FVD and Dehydration
-increased thirst
-concentrated urine (body holds unto urine)
-increased HR and Vasoconstriction
THINK !!
make up for decreased fluid volume»_space; the very little amount of blood that there is is being pumped at a faster pace to reach all of the body»_space; to perfuse or oxygenate tissues
^^ called COMPENSATORY MECHANISM
Manifestations of Fluid Volume Deficit
low fluid volume = low body
weight loss = water loss
cardio: low BP can be deadly due to hypovolemic shock (can cause many organs to stop working)
orthostatic hypotension
decreased CVP, weak & thready pulses, flat neck & hand veins, tachycardia
integ: dry skin (poor turgor & tenting); sunken eyes, dry MM, increase body temp
neuromuscular: lethargy to come and weakness
renal & urinary: increase output initially & decreased urine output at end
respiratory: rapid deep rate
GI: decreased motility leading to constipation, diminished bowel sounds (hypoactive bowel sounds)
lab values: appear high when dry
-hemoconcentration of solutes inside blood»_space; almost like paste
-increase osmolality (increased thickness)
-increased hematocrit
-increase electrolytes
Sodium most critical as severely high amount HYPERNATREMIA can lead to risk for brain bleeding (brain shrinkage)
urine:
increased urine specific gravity
high gravity=high weight
-very thick and concentration of urine
Isotonic Solution of IVs
-no fluid shifts; established equilibrium or are equal in concentration = equal osmotic pressure
-human blood is isotonic ; little osmosis occurs when isotonic solutions are infused since they have the same osmolality as body fluids
caution: too much can still cause FVO, so monitor BP
key manifestation: HTN crisis»_space; risk for CVA stroke
LR and IV NS
uses: add fluid inside blood vessel to hydrate body and increase BP when low
-during hypotension, blood transfusions (add volume during bl administration), hemorrhaging, DKA (type 1 disorder) and HHNS (type 2 disorder)
-hyperglycemia»_space; blood very thick»_space; body very dry
Start on isotonic solutions then move to hypotonic fluids
Hypotonic Solutions of IV
-lower concentration of solutes than ICF
-lower osmolarity than body fluids
caution:
solutions should be given slowly to prevent cellular edema and cerebral swelling
not for: ICP (pressure within brain)
manifestation to monitor: cerebral edema
-headache, mental status changes (ALOC), and seizures
1/2 NS
1/4 NS
1/3 NS
D5W 1/4NS (5% dextrose in 0.225 NS)
D5W (5% dextrose in water)
uses: cellular dehydration
-esp hypernatremia (too much sodium that piles up inside bl stream sucking out all of fluid»_space; causing cells to shrink (dehydration))
REMEMBER !! D5W is isotonic IN BAG but hypotonic OUTSIDE
Hypertonic solutions of IV
higher osmolarity than body fluids
-very thick and salty solutions (more solutes and less water)
fluid draw out of cell to make balance causing cell to become dehydrated
caution: give slowly to prevent massive fluid shifts from inside of cell and into blood stream
causing cellular dehydration and FVO
Monitor BP
key manifestation: HTN crisis (risk for CVA stroke)
3% NS
5% NS
D10W
D5W/NS
D5W/ 1/2NS
D5LR
use: hypovolemia, heat related (heat exhaustion), peritonitis, peritoneal dialysis (COMMON)
Homeostasis
body being in harmony and all systems are within a normal range
Therapeutic range
range at which a therapeutic regimen is working its best
Hemoconcentration v Hemodilation
Dehydration
High lab values and Dry body
Overhydration
Low lab values and Liquidy body
