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Med Surg Test 3 > Fluid Balance > Flashcards

Fluid Balance Flashcards

1
Q

2 basic functions of fluid

A
  1. Provide transportation of nutrients to cell and waste from cell
  2. Provides medium for chemical reactions
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2
Q

Composition of water in the body

A

Adult male 60%
Adult female 50%
Infants (under 2) 60-80%
Elderly (over 45) 45-55%

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3
Q

Why do females have lower body composition of water than males?

A

females have higher composition of body fat and fat cells contain very little water

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4
Q

Why do the elderly have a lower composition of water?

A

muscle atrophy

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5
Q

How does the body lose fluid?

A

kidneys, GI tract, lungs, skin

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6
Q

How much fluid is lost through the kidneys daily?

A

about 1500 cc daily

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7
Q

How much fluid is lost through the GI tract daily?

A

150-200 cc daily

8-10 liters is secreted but most is reabsorbed

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8
Q

How much fluid is lost through the lungs daily?

A

300-400 cc daily

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9
Q

How much fluid is lost through the skin daily?

A

400-500 cc daily

Sensible & insensible

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10
Q

What is sensible fluid loss through the skin?

A

sweating

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11
Q

What is insensible fluid loss through the skin?

A

evaporation

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12
Q

How do we replenish fluids?

A

liquids & fluids

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13
Q

How much fluid do we need in 24 hours?

A

30 cc/kg

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14
Q

How is food replenished via food?

A

Meats, fruits and veggies contain 60-97% water

Oxidation of carbohydrates, fats or proteins via TCA (Krebs) Cycle–10 cc of water for every 100 calories

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15
Q

Where is the majority of water in children?

A

interstitial space

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16
Q

Do adults of children have a greater metabolic rate?

A

children

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17
Q

daily fluid needs for children

A 
Premature          50-70 ml/kg
Newborn             80-100 ml/kg
Newborn-1 year   150 ml/kg
1-2 years             100 ml/kg
2-4 years               90ml/kg
4-10 years            50-70 ml/kg
> 10 years            40 ml/kg
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18
Q

Volume of fluid in intracellular fluid compartments

A

25 liters

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19
Q

Volume of fluid in extracellular fluid compartments

A

15 liters

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20
Q

3 extracellular fluid compartments

A

interstitial
intravascular
transcellular

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21
Q

What is interstitial fluid?

A

fluid surrounding the cell

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22
Q

Volume of interstitial fluid

A

8 liters

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23
Q

What is intravascular fluid?

A

fluid within blood vessels

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24
Q

Volume of intravascular fluid

A

5-6 liters

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25
Q

What is transcellular fluid?

A

fluid secreted by epithelial cells

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26
Q

examples of transcellular fluid

A

CSF, pericardial fluid, pleural fluid, synovial fluid, intraocular fluid, digestive secretions

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27
Q

Volume of transcellular fluid

A

1 liter

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28
Q

first spacing

A

normal fluid distribution

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29
Q

second spacing

A

interstitial edema

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30
Q

third spacing

A

fluid in areas with little or no fluid normally

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31
Q

examples of third spacing

A

ascites, pleural effusion, pericardial effusion

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32
Q

transport processes that effect movement of water and solutes

A

diffusion
active transport
flitration
osmosis

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33
Q

examples of solutes that move by facilitated diffusion

A

insulin

glucose

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34
Q

example of active transport

A

Na+/K+ pump

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35
Q

what type of transport id dependent on hydrostatic pressure?

A

filtration

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36
Q

Why are diabetics constantly thirsty and frequently urinate?

A

glucose has strong osmotic pull

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37
Q

Osmolarity of water

A

280-294 mOsm/kg

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38
Q

tonicity

A

ability of particles to affect the movement of water

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39
Q

fluid movement in isotonic solutions

A

no net movement

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40
Q

fluid movement in hypotonic solutions

A

fluid moves into cell (cells can burst)

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41
Q

fluid movement in hypertonic solutions

A

fluid moves out of cell (cells can shrivel)

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42
Q

locations of volume receptors (baroreceptors)

A

carotid sinuses, aortic arch, cardiac atria & renal vessles

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43
Q

what type of IV fluids can diffuse through the capillary wall

A

crystalloid solutions

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44
Q

what type of IV fluids cannnot pass through capillary wall

A

colloid solutions

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45
Q

what are colloid solutions used to treat

A

severe deficit or shock

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46
Q

what type of IV fluids increase osmotic pressure in vascular space

A

colloid solutions

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47
Q

what type of IV fluids are plasma or volume expanders

A

colloid solutions

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48
Q

what compartment(s) expand with hypotonic solutions?

A

ECF and ICF

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49
Q

what compartment(s) expand with isotonic solutions

A

ECF only

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50
Q

what tonicity is best for patients with extracellular fluid deficit?

A

isotonic solutions

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51
Q

how do hypertonic solutions work?

A

by raising osmolarity of ECF and expanding it; draw water out of cell into ECF

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52
Q

what is the danger of hypertonic solutions?

A

intravascular fluid volume excess

53
Q

What is tonicity of D5%W?

A

isotonic (278)

54
Q

What is tonicity of D10%W?

A

hypertonic (556)

55
Q

What is tonicity of 0.45% saline?

A

hypotonic (154)

56
Q

What is tonicity of 0.9% saline (NS)?

A

isotonic (308)

57
Q

What is tonicity of 3% NaCl?

A

hypertonic (1026)

58
Q

What is tonicity of D5% 0.225% (D5 1/4)?

A

isotonic (355)

59
Q

What is tonicity of D5% 0.45% (D5 1/2)?

A

hypertonic (432)

60
Q

What is tonicity of D5% 0.9% (D5NS)?

A

hypertonic (586)

61
Q

What is tonicity of Ringer’s Solution?

A

isotonic (309)

62
Q

What is tonicity of Lactated Ringers?

A

isotonic (274)

63
Q

What is Ringer’s Solution?

A

similar to plasma, excess Cl, no Mg, no HCO3

64
Q

What is Lactated Ringers?

A

contains Na K, Cl, Ca, lactate in same proportion as ECF

65
Q

What type of solution is blood?

66
Q

When is whole blood given?

A

emergency situations

67
Q

What is PRBC?

A

red blood cells in 20% plasma

68
Q

What does giving as a split unit mean?

A

giving over 8 hours instead of 4 hours

69
Q

When are platelets given?

A

thrombocytopenia

70
Q

What as the opposite effect of warfarin (coumadin)?

A

fresh frozen plasma

71
Q

What proportion of fresh frozen plasma is given compared to PRBCs?

A

1 unit of FFP per 6 units PRBCs

72
Q

What is fresh frozen plasma?

A

clotting factors

73
Q

What is cryoprecipitate?

A

specialized clotting factors

74
Q

When volume receptors sense change, what 4 things can change?

A

cardiac output
vascular resistance
thirst
renal handling of sodium and water

75
Q

What systems/steroids/hormones regulate fluid?

A 
sympathetic nervous system
renin-angiotensin I/II system
aldosterone
atrial natriuretic factor
antidiuretic hormone
thirst (osmoreceptors)
76
Q

What does aldosterone do?

A

holds onto sodium

77
Q

What does atrial natriuretic factor (ANF) do?

A

reduces blood pressure and circulating volume

inhibits secretion and effects of ADH

78
Q

What do ADH do?

A

hangs onto water

79
Q

What is the earliest symptom of a water deficit?

80
Q

What patient assessments should be done when looking at fluid volume?

A 
history
daily weights (1 kg = 1 L fluid)
integument
mucous membranes
intake and output
vital signs
cardiovascular system (hemodynamic monitoring)
nervous system (mentation)
GI system (anorexia, nausea, constipation, diarrhea, thirst)
Chemistry (H&H, electrolytes)
81
Q

What should normal urine output be?

A

0.5cc/kg/hr

82
Q

how does water affect body temperature?

A

water cools body

83
Q

What is capillary hydrostatic pressure?

A

pressure exerted by fluid inside capillary outward against capillary membrane

84
Q

How does capillary hydrostatic pressure work?

A

filtration

85
Q

What is capillary hydrostatic pressure on arterial end?

86
Q

What is capillary hydrostatic pressure on venous end?

87
Q

What is Interstitial Fluid Pressure?

A

pressure exerted by fluid outside capillary against capillary membrane–about 1 mm Hg

88
Q

What does Interstitial Fluid Pressure do?

A

maintains integrity of interstitial space

89
Q

What is plasma colloidal oncotic pressure?

A

pressure exerted by osmotic pull of proteins inside the blood vessels

90
Q

What does plasma colloidal oncotic pressure do?

A

pulls fluid from interstitial space into blood vessel

91
Q

What is plasma colloidal oncotic pressure on arterial end?

92
Q

What is plasma colloidal oncotic pressure on venous end?

93
Q

What can affect plasma colloidal oncotic pressure?

A

change in the amount of protein in the plasma

94
Q

What is tissue colloidal osmotic pressure?

A

pressure exerted by osmotic pull of proteins in interstitial space–about 1 mm Hg

95
Q

What can affect tissue colloidal osmotic pressure?

A

increase in protein in interstitial space

96
Q

What 2 pressures maintain interstitial space?

A

tissue colloidal osmotic pressure

interstitial fluid pressure

97
Q

Where is the excess fluid in vascular hypervolemia?

A

vascular space

98
Q

Where is the excess fluid when edema occurs?

A

interstitial space

99
Q

Where is the excess fluid in water intoxication?

A

intracellular space

100
Q

Where is the excess fluid in third spacing?

A

transcellular space

101
Q

How does vascular hypervolemia affect blood pressure?

A

increases blood pressure

102
Q

What will the pulse of a patient with vascular hypervolemia?

A

full and bounding

103
Q

What are the clinical findings in a patient with vascular hypervolemia?

A 
increase in blood pressure
full, bounding pulses
distended peripheral veins
increased JVD 
increase in central venous pressure
signs and symptoms of pulmonary edema
104
Q

What interventions should a nurse take with a patient with vascular hypervolemia?

A 
decrease IV to KVO
elevate head of bed with legs in dependent position (decreases venous return)
decrease anxiety
morphine IV (decrease preload and afterload)
diuretics via IV or PO
oxygen via nasal cannula
measure I/O
daily weights
rotating tourniquets (rare)
nitroprusside (dilates blood vessels)
105
Q

Why does morphine decrease preload and afterload?

A

It is a vasodilator

106
Q

What is edema?

A

fluid in interstitial space

107
Q

Where will edema first appear?

A

tissues poorly protected against hydrostatic pressure (ankles, sacrum if bedridden)

108
Q

What causes edema?

A

immobility
injury
obstruction in lymphatic drainage
hypoproteinemia (low protein in blood)

109
Q

What are clinical findings of a patient with edema?

A 
puffy eyelids, bags under eyes
pale, tight, shiny skin
swollen ankles
enlarged abdomen (liver issues)
shoes, rings and belt tight
shortness of breath, dyspnea, moist rales, hoarseness (if lungs are affected)
110
Q

What are nursing interventions for edema?

A

elevate effected body part
promote activity when possible
diuretics (IV or PO)
Fluid restrictions (may have sodium restrictions too)
avoid constrictive clothing
avoid crossing legs or sitting in ways that restrict circulation

111
Q

What cause water intoxication?

A

excess IVs (especially hypotonic solutions)
sterile water for irrigation post-TURP
tap water enema
psychogenic polydipsia (extremely thirsty)

112
Q

What are the clinical findings in a patient with water intoxication?

A

disturbed thought and behavior (apprehension, irritability, restlessness, confusion, lethargy, coma)
decrease in serum electrolytes (hyponatremia)
pulmonary edema
will not usually see visible edema

113
Q

What are nursing interventions for water intoxication?

A

monitor IVs to prevent too much fluid intake
monitor urinary output
assess serum Na+
administer plasma expanders (albumin, mannitol, dextran)
diuretics (increase flow through kidneys)

114
Q

What is third spacing?

A

fluids move into inaccessible spaces and are retained there

115
Q

If there is a drop in blood pressure & increase in pulse without increase in urine output or decrease in body weight, what should you suspect?

A

third spacing

116
Q

What type of fluid excess is know as relative dehydration?

A

third spacing

117
Q

What are some cause of third spacing?

A

intestinal obstruction
cellulitis
crushing injury
vascular occlusions

118
Q

Where are some places third spacing can occur?

A 
pleural space
pericardial space
eye
synovial space
CNS
119
Q

What are treatments for third spacing?

A

IV plasma expanders
crystalloids to support vascular space
mechanical removal of fluid (thoracentesis, paracentesis)

120
Q

What is one reason you should be cautious with third spacing?

A

fluid can move back into intravascular space at any time

121
Q

What are the 3 stages of fluid deficit?

A

simple dehydration
advanced fluid loss
hypovolemic shock

122
Q

What are the signs of simple dehydration?

A

dry skin
loss of skin turgor
weight loss

123
Q

What are the signs of advanced fluid loss?

A

falling blood pressure

weak, thready, rapid pulse

124
Q

What are the signs of hypovolemic shock?

A

signs and symptoms of renal failure

125
Q

What are the clinical findings of fluid deficit?

A

thirst
dry skin and mucous membranes (be concerned if armpits are dry)
hollow, sunken eyes (especially in children)
shrunken wrinkled furrowed tongue (scrotal tongue)
mild temperature elevation
weight loss
orthostatic hypotension with decreased blood pressure and tachycardia
pale, cold extremities (due to peripheral vasoconstriction)
oliguria that progresses to anuria (low urine to no urine)
dark, concentrated urine with high specific gravity
increase in H & H (hemoglobin & hematocrit), Na+, serum osmolarity
apathy, fatigue, stupor, delirium (due to hyperosmolar state affecting CNS)

126
Q

What are nursing interventions for fluid deficit?

A

Give fluids (PO or IV depending on stage)
Monitor IV fluids carefully (do not want to over hydrate)–reverse hypernatremia slowly
I/O
Daily Weight
Scrupulous oral care
adequate nutrition

127
Q

What is an isotonic imbalance?

A

sodium and water increase or decrease together

watch for symptoms of hypovolemia and hypervolemia

128
Q

What is hypotonic imbalance?

A

Too much water or not enough sodium

129
Q

What is hypertonic imbalance

A

Too much sodium or not enough water

Med Surg Test 3 (3 decks)

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