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
