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Patho > FE > Flashcards

FE Flashcards

1
Q 
Water content of body
%
lean vs fat
women vs men
age
A

50-60
more in lean than in fat
less in women bc more fat
less in old ppl bc less lean (45-50%)

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2
Q

Body Fluid Compartments

A

Intracellular (2/3) (28 L)

Extracellular (1/3)

  • Interstitial fluid (10 L)
  • plasma (3 L)
  • lymph
  • transcellular fluid (in joints, bt peritoneae, CSF) –> 1 L
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3
Q

Fluid gain/loss

A

1 L = 2.2 lbs = 1 kg

240 ml = 8 oz = 0.5 lb = 0.23 kg

Fasting makes adults lose 1-2 lbs per day –> any extra weight loss is fluid

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4
Q

Main electrolytes for ECF and ICF

A

ECF: sodium! (little K, Ca, Mg) —> Cl (little HCO3, sulfate, PO4)

ICF: K (little Mg and Na) —> PO4 (little HCO3)

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5
Q

Diffusion
Facilitated Diffusion
Active Transport

A
  1. movement of molecules from high to low conc –> no energy
  2. uses prot carrier to pass molecules thru membrane –> high to low conc –> no energy
  3. movement against conc gradient –> needs energy –> Na/K pump
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6
Q

Osmosis
osmotic pressure
osmolality
osmolarity

A
  1. movement of water down conc radient –> no energy
  2. “pull” of water (higher in areas of high solute conc) mOsm
  3. number of milliosmoles per kg of water
  4. mOsm/L of solution
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7
Q

Osmolality

A

Pretty much the same for all body fluid spaces

Normally 280-295 mOsm/kg

High means water deficit

Low means water excess

Plasma osmolality = (2 x Na) + (BUN / 2.8) + (glucose / 18)

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8
Q

hydrostatic pressure

oncotic pressure

A

Force of fluid in compartment pushing against cell membrane or vessel wall (e.g. BP) –> decreases as nears capillaries

(colloidal osmotic pressure) osmotic pressure created by colloids in solution (e.g. albumin) –> 25 mm Hg in plama; 1 mm HG interstitial spaces

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9
Q

Factors affecting fluid movement in capillaries

A
  1. capillary hydrostatic pressure (40 to 10) –> higher at arterial end
  2. plasma oncotic pressure (25)
  3. interstitial hydrostatic pressure (1)
  4. interstitial oncotic pressure (1)
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10
Q

Edema

A

shifts of plasma into interstitial spaces:
high venous hydro pressure,
low plasma oncotic pressure,
high interstitial oncotic prssure

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11
Q

fluid spacing

A

distribution of body water

First spacing: normal ICF and ECF distribution
Second spacing: abnormal accumulation of interstitila fluid
Third spacing: excess fluid in nonfunctional areas bt cells

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12
Q

How much water do we need per day?

What is insensible water loss?

A

2000-3000 ml

invisible vaporization from lungs and skin to regulate body temp (not the same as sweating which includes electrolytes)

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13
Q

Hypothalamic Pituitary fluid regulation

ADH release stimulation

A

Osmoreceptors in Hypothalamus stimulate thirst and release of ADH from post pit
ADH acts on distal tubules and collecting ducts to make them more permeable to water (water excess suppresses ADH)

low BP, nausea, pain, hypoglycemia, hypoxemia

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14
Q

Renal regulation of fluid

A

kidneys filter plasma volume many times a day

reabsorb 99% of filtrate and make 1.5 L of urine a day

fucked up kidneys cause edema, K or PO4 retention, acidosis, etc

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15
Q

Adrenal cortical fluid regulation

A

Glucocorticoids (cortisol) increase serum glucose levels
Mineralocorticoids (aldosterone) enhance Na retention and K excretion
-RAA
-high K
-low Na
-ACTH

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16
Q

Gastrointestinal Regulation of Fluid

A

GI tract secretes 8000 mL of digestive fluid a day
Usually reabsorbs the fluid
Diarrhea and vomitting lead to significant fluid loss (AND ELECTROLYTES)

17
Q

Old people and fluid regulation

A

kidneys change shape which slows glomerular filtration rate, less able to concentrate urine or conserve water

Less renin and aldosterone –> more ADH and ANP

Thin skin = moisture loss

18
Q

Fluid Volume Imbalances

NG suction

A

ECF deficit = hypovolemia
ECF excess = hypervolemia

loss of Na, K, H, and Cl –> low fluid volume and alkalosis

19
Q

cardiac fluid regulation

A

ANP and BNP are made by cardiomyocytes in response to increased atrial pressure and high serum sodium —> antagonists to RAAS and suppress Ald, ADH, and Angio II

20
Q

fluid volume defecit vs dehydration

A

dehydration = loss of pure water

fluid volume defecit (hypovolemia) = loss of body fluid via diarrhea, vomitting, hemorrhage (includes electrolytes)

21
Q

ECF volume deficit causes and manifestations

A

Casues

  • insensible water loss bc fever or heat
  • diabetes insipidus
  • osmotic diuresis
  • hemorrhage
  • GI losses
  • too many diuretics
  • not enough water drunk
  • 3rd space fluid shifts : burns and pancreatitis

Manifestations

  • restless, sleepy, CONFUSION
  • thirsty –> dry mouth
  • cold clammy skin
  • bad capillary refill
  • postural hypotension, high pulse, low pressure
  • little, concentrated pee
  • breathing fast
  • weak, dizzy
  • weightloss
  • seizures, coma HYPOVOLEMIC SHOCK
22
Q

ECF Volume Excess: causes and manifestations

A

Causes:

  • excess isotonic or hypotonic IV fluids
  • heart or renal failure
  • primary polydipsia
  • SIADH
  • Cushing syndrome
  • Too many corticosteroids

Manifestations

  • headache, confusion, lazy
  • edema
  • jugular distension
  • S3 heart sound
  • bounding pulse, high BP and CVP
  • Polyuria
  • dyspnea, crackles, pulmonary edema!!!!!!!!!!!!!!
  • spasms
  • weight gain!!!!!!!!!!!!!!!!!!!!!!!!
  • seizures and coma
23
Q

treating ECF excess and defecit

A

Defecit: 0.9% NaCl or lactated Ringers solution

Excess: diuretics and no sodium and fluid restriction (also paracentesis and pleural effusions)

24
Q

Nurse implementation of fluid balance

A

daily weights
intake and output
-urine specific gravity: over 1.025 is concentrated; less than 1.010 is diluted

Lab findings

  • ECF defecit has high BUN, Na, and hematocrit
  • ECF excess had decreased all of those things

Cariovascular care

Respiratory care

Patient safety

Skin care

25
Q

Cardiovascular care (fluid)

A

ECF excess: bounding pulse, distended jugular, high CVP, high BP, S3 sounds

ECF defecit: high HR, peripheral vasoconstriction. orthostatic hypotension

26
Q

Respiratory Care

A

Pulse oximetry and auscultate lungs

excess = pulmonary edema, shortness of breath, and crackles
defecit = increases RR
27
Q

Fluid defecit and patient safety

A
  • risk of falling
  • muscle weakness
  • if orthostatic hypotension, make them change position slowly
  • put alarm monitors on confused patients
28
Q

skin care

Edema analysis

Good skin care

A

Defecit = low skin turgor (tenting) –> test sternum, abdomen, and ant forearm –> not as relavent in old ppl bc their skin isn’t as elastic
=cold and moist skin
-dry mucous membranes

Edeman assessed with thumb and forefinger over tibia, fibula, sacrum
1+ = slight edema (2 mm indent)
4+ = pitting edema (8 mm indent)

No extreme heat
change positions
elevate edema
don't use too much soap
moisturize
29
Q

Fluid therapy

A

give IVs –> be careful of rate esp heart, renal, or brain problems

defecit: offer drinks every 1-2 hrs –> make bathroom access easy if they’re worried ab nocturia –> help ppl hold containers

Patho (44 decks)

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