F&E (Exam 3) Flashcards by Isaiah Smith

How much of body weight is water?

-50-60%

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Fluid Compartments:

-Intracellular = 70%

-Extracellular = 30%

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Extracellular space areas

-Interstitial fluid - between cells

-Intravascular fluid - plasma (liquid part of the blood)

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4 Processes that facilitate the movement of fluid and electrolytes

-Diffusion
-Facilitated Diffusion
-Active Transport
-Osmosis

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Osmosis

-Movement of water down a concentration gradient

-Water movement from low to high solute concentation

-From a region of low solute concentration to one of high solute concentration across a semipermeable membrane

(Maintain homostasis)

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When does osmosis stop

-When concentration differences disappear or when hydrostatic pressure builds and opposes further movement

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Diffusion

-Movement of molecules from an area of high concentration to a lower concentration

-Movement stops when the concentration is equal in both areas

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Fluid and Electrolyte Balance

-Water follows electrolytes

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What electrolytes are primarily outside of the cell?

Sodium and Chloride

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What electrolytes are primarily inside the cell

-Potassium, magnesium, phosphate

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Osmosis is

The movement of water across the cell membrane toward the more concentrated solutes

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Osmotic pressure is

The amount of pressure needed to prevent the movement of water across a cell membrane

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Colloids

-Substances that increase colloid osmotic pressure (oncotic pressure)

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What do colloids do?

-Move fluid from interstitial compartment to plasma compartment

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3 Primary colloids:

-Albumin

-Globulin

-Fibrinogen

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How do we measure colloids?

Total Protein level

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Colloid oncotic pressure __________ with age and overall __________

Decreases and Malnutrition

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Hydrostatic Pressure

-Force of fluid in compartment pushing against a cell membrane or vessel wall

-Generated by blood pressure

-At capillary level, major force that pushes water out of the vascular system into interstitial space

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Changes in hydrostatic presssure equates to

Changes in blood pressure

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Oncotic Pressures

-Also called osmotic pressure

-Caused by plasma colloids (large molecules) in solution

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Plasma has LOTS of colloids, interstitial space has little

-Plasma proteins attract water, pulling fluid from tissue space into vascular space

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Hydrostatic pressure is dictated by?

Blood pressure

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Oncotic pressure is dictated by

colloids

Watch the video in the power points

What do electrolytes influence?

-Fluid balance, acid base balance, never impulses, muscle contraction, heart rhythm, and many other cell functions

Because electrolytes function ______________, changes in one electrolyte can affect the ____________ of other electrolytes

collaboratively balance

What are electrolytes?

-Substances that are electrically charged when in a solution

Concentrations of electrolytes depend on

-Electrolyte intake -Electrolyte absorption (small intestines) - Electrolyte distribution (Postive vs negative charges) -Electrolyte excretion (kidney function)

Intracellular electrolytes

-Potassium -Magnesium -Phosphorous

Extracellular electrolytes

-Sodium -Calcium

Positively charge electrolytes

-Cations -Potassium, Sodium, Magnesium, Calcium

Negatively charge electrolytes

-Anions -Phosphorus, chloride, bicarbonate

Sodium Imbalances

- <136 = Hyponatremia - >145 = Hypernatremia

Key point with sodium

-Primary driver of fluid balance. (water follows sodium)

Sodium

Main ECF cation Governs osmolality influences water distribution Activates muscle and nerve cells interstitial and intravascular spaces

Hyponatremia: Causes

GI losses: Diarrhea, vomiting, fistulas, NG suction Renal losses: Diuretics, adrenal insufficiency Skin losses: Burns, wound damage Fasting diest, polydipsia -Excess hypotonic fluid

Sodium is high associated with symptoms related to what?

Our brain

Hyponatremia: Signs and Symptoms

-Confusion and Altered LOC (not enough sodium in cells cause water in go into cells and cause the cells to swell) -Anorexia and muscle weakness -Seizures and coma (Cellular swelling)

Dilution Hyponatremia

-Taking in to much water -Hypervolemia - Increase BP -Increase weight gain -Bounding rapid pulse -Increase urine Sp. gravity

Depletional hyponatremia

-Hypovolemia -Decrease BP and Tach pulse -Weight loss - Decrease urine sp. gravity

Hyponatremia

Too much fluid volume (Dilutional) or Too little sodium (Depletional)

Hyponatremia Treatment

-Sodium Replacement (SLOWLY) -PO/IV -IV normal saline (Depletional) -Fluid Restriction (Dilutional) -Treat underlying problem

What happens if we treat hyponatremia too quickly

-Irreversible neurological or brain damage -Osmotic demylenation syndrome

Dilutional Hyponatremia Treatment

-Restrict fluid causing fluid levels in the body to decrease and sodium concentation will be corrected

Depletional Hyponatremia

IV normal saline

Sodium Bicrobonate

-Used for long term hyponatremia (Acid base issues)

Sodium Bicarbonate: MOA

Dissociates to provide bicrabonate ion which neutralizes ion concentration and raises blood and urinary pH

Sodium Bicarbonate: Indication

Metabolic acidosis

Sodium Bicarbonate: Adverse effects

-Edema, cerebral hemorrhage, hypernatremia, lots of electrolyte abnormalities, metabolic alkalosis, flatulence with PO, tetany, pulmonary edema, heart failure exacerbation

Sodium Bicarbonate: Nursing consideration

-Monitor cardiac , ABG's and electrolytes -If IV, monitor patency thoroughly -Lots of drug interaction if the drug mixing with is diluted with sodium solutions -PO-give 1-3 after or before meals

Sodium Bicarbonate at high concentations

Is a vesicant -Can cause tissue damage -Give via central lines and things to help decrease vesicant

Hypernatremia Causes

-IV fluids, tube feeds, near drowning in salt water -Not enough water intake or to much water loss (Cognitively impaired, diarrhea, high fever, heat stroke)

Hypernatremia: Signs and Symptoms

-Alter LOC/Confusion, seizure, coma -Extreme thirst (hyperosmolatity) -Dry sticky mucous membranes (Water shifting out of cells into extracellular space) (Shrinking brain cells)

Hypernatremia: Treatment

-If H2O is cause then add water -If sodium excess is cause remove sodium

Gradually achieve normal sodium level over a 48 hour period to avoid edema of cerebral cells

-Too quick removal can damage brain cells and be lethal -Physicians order: Infuse NSS @ 50cc/hr x 2hr then @ 75 cc/hr x 4h, then 100cc/hr