Fluid And Electrolytes Part 1

Question 1

The body is always trying to achieve:

Answer 1

Homeostasis

Question 2

Water uses in the body:

Answer 2

• Metabolic transport
• Transport
• Lubricant
• Insulator
• Body temperature

Question 3

How are fluids lost?

Answer 3

• Kidney: Urine output of 1 mL/kg/hr
• Skin loss: sensible due to sweating and insensible due to fever, exercise, and burns.
• Lungs: 300 mL everyday, greater with increased RR.
• GI: Losses due to diarrhea or fistulas.

Question 3

Factors affecting water balance:

Answer 3

• Age
• Sex/ Gender
• Body habitus
• Temperature
• Disease state

Question 4

Approximately 60% of typical adults are fluid, how is this dispersed?

Answer 4

• Intracellular fluid (~40% of body weight/ 28 liters): ⅔ of body fluid, skeletal muscle mass.
• Extracellular fluid (~20% of body weight/14.5 liters):
  - Intravascular (5% / 3.5 liters): Plasma, erythrocytes, leukocytes, thrombocytes.
  - Interstitial (14% / 10 liters): Lymph
  - Transcellular (1% / 1 liter): Cerebrospinal, pericardial, synovial.

Question 5

Osmolarity:
Fewer particles =

Answer 5

Lower osmolarity

Question 6

Osmolarity:
More particles =

Answer 6

Higher osmolarity

Question 7

Normal serum osmolarity:

Answer 7

280-295 mOsm/kg

Question 8

Osmolarity - Isotonic fluid:

Answer 8

Fluid with the same osmolarity.

Question 9

Isotonic fluid examples:

Answer 9

0.9% NaCl and LR

Question 10

Osmolarity - Hypotonic fluid:

Answer 10

Solutes are less concentrated than the cells.

Question 11

Hypotonic fluid examples:

Answer 11

0.45% NaCl

Question 12

Osmolarity- Hypertonic Fluid:

Answer 12

Solutes are more concentrated than the cells.

Question 13

Hypertonic fluid examples:

Answer 13

3% NaCl

Question 14

D5W is considered what kind of fluid?

Answer 14

Both Isotonic and hypotonic crystalloid fluid.

Question 15

Osmosis definition:

Answer 15

Water moves from an area of low solute concentration to an area of high solute concentration.

Question 16

During osmosis water moves across a ______ _______.

Answer 16

Semipermeable membrane.

Question 17

Hydrostatic Pressure:

Answer 17

Exerted on walls of blood vessels.
Blood pressure generated by heart contractions.

Question 18

Osmotic pressure:

Answer 18

Exerted by proteins in plasma.
Proteins (albumin) in plasma attract water, pulling from the tissue spaces into the vascular space.

Question 19

The direction of fluid movement depends on differences in:

Answer 19

Hydrostatic and osmotic pressure.

Question 20

Fluid shift is described as:
Fluid can shift from—

Answer 20

Fluid can shift from plasma spaces to interstitial spaces.

Question 21

First spacing results in:

Answer 21

Normal distribution.

Question 22

Second spacing results in:

Answer 22

Abnormal accumulation of interstitial fluid (edema).

Question 23

Third spacing results in:

Answer 23

Fluid is trapped where it is difficult or impossible to move back into cells or blood vessels (ascites).

Question 24

What is the primary organ for regulating fluid and electrolyte balance by adjusting urine volume?

Answer 24

Kidneys

Question 25

Renal tubules are sites of action for:

Answer 25

ADH (Antidiuretic hormone) and Aldosterone.

Question 26

Osmoreceptrs in the _______ sense changes in the body fluid.

Answer 26

Hypothalamus

Question 27

A fluid deficit causes:

Answer 27

Increased thirst and triggers the release of ADH.

Question 28

Fluid excess causes:

Answer 28

Suppression of the release of ADH.

Question 29

Adrenal Cortical regulation releases hormones to:

Answer 29

Regulate water and electrolytes.

Question 30

During adrenal cortical regulation, glucocorticoids may cause:

Answer 30

Cortisol may cause Na and fluid retention.

Question 31

During adrenal cortical regulation, mineralcorticoids may cause:

Answer 31

Aldosterone causes Na retention and K+ excretion. - Water retention with Na.

Question 32

Clinical application of RAAS:

Answer 32

- Kidneys sense low perfusion and secrete renin. - Renin converts angiotensinogen into angiotensin I. - Angiotensin I then is converted into Angiotensin-converting enzyme (ACE) into angiotensin II. - Angiotensin II: Powerful vasoconstrictor, Stimulates adrenals to release aldosterone.

Question 33

ACE inhibitors disrupt:

Answer 33

The RAAS by reducing the amount of ACE produced.

Question 34

ACE inhibitors cause greater:

Answer 34

Excretion of water and Na in the urine.

Question 35

ACE inhibitors block ________ ________ and thus ______ blood pressure.

Answer 35

Angiotensin II receptors Lowers

Question 36

Fluid imbalances occurs due to:

Answer 36

Disrupts or the normal homeostatic mechanisms.

Question 37

Dehydration is:

Answer 37

Not the same as FVD, loss of water alone, with increased serum sodium levels.

Question 38

Fluid volume deficit (FVD) - Hypovolemia:

Answer 38

May occur alone or in combination with other imbalances. Extracellular fluid loss exceeds the intake ratio of water.

Question 39

Possible causes for FVD:

Answer 39

- Abnormal fluid losses: Vomiting, diarrhea, sweating, and GI suctioning. - Decreased intake: Nausea or lack of access to fluids. - Third-space fluid shifts: due to burns or ascites. - Additional causes: Diabetes insipidus, adrenal insufficiency, hemorrhage, or trauma.

Question 40

Fluid volume excess (FVE) - Hypovolemia:

Answer 40

Isotonic expansion of the ECF is caused by the abnormal retention of water and sodium in approximately the same proportions in which they normally exist in the ECF.

Question 41

Possible causes for FVE:

Answer 41

- Heart failure, renal injury or failure, liver failure (cirrhosis), Excessive intravenous solutions and/or blood transfusions. - Excessive Oral sodium intake, Abnormal retention of fluids and sodium, or Fluid shift increasing intravascular volume (interstitial-to-plasma fluid shift).

Question 42

Colloid fluids:

Answer 42

Stay in vascular space and increase osmotic pressure and pulls fluid into vascular space.

Question 43

Colloid fluid examples:

Answer 43

Human plasma products (albumin, fresh frozen plasma, blood), Semisynthetics (dextran and starches, Hespan).

Question 44

Crystalloid fluids:

Answer 44

A solution (e. Saline) with small molecules, which can move around easily when injected into the body.

Question 45

Colloid fluid examples:

Answer 45

NaCL (0.45%, 0.9%, 3%), LR, D5W.

Question 46

What does pure / sterile water do:

Answer 46

Lyse RBCs, never inject without additives.

Question 47

Hypotonic solutions move water from:

Answer 47

ECF to ICF by osmosis.

Question 48

Isotonic solutions expand:

Answer 48

ECF No net loss or gain from ICF.

Question 49

Hypertonic solutions initially expand and raise:

Answer 49

The osmolarity of ECF.

Question 50

When administering Hypertonic fluids what needs to be monitored?

Answer 50

Frequent monitoring of BP, lung sounds, and serum sodium levels.