fluid balance Flashcards
What is the focus of Medical/Surgical Nursing?
Protection, promotion & optimization of suffering through the diagnosis and treatment of human responses and advocacy in the care of individuals, families, communities, and populations.
Define Homeostasis.
Defining feature of physiology.
What is the most common fluid and electrolyte disorder in the U.S.?
Dehydration.
What are the two main fluid compartments in the body?
- Intracellular
- Extracellular
What is the difference between interstitial fluid and plasma?
Plasma contains higher concentrations of protein.
List the mechanisms of fluid and electrolyte movement.
- Simple diffusion
- Facilitated transport or diffusion
- Active transport
- Osmosis
- Hydrostatic pressure
- Oncotic or osmotic pressure
What is simple diffusion?
Molecules in constant random motion move from areas of high concentration to lower until net flux is equal.
What is facilitated diffusion?
A process of passive transport aided by membrane proteins.
What is active transport?
Uses energy to move molecules against a concentration gradient, from low to high concentrations.
What is the sodium-potassium pump?
An active transport system that moves sodium out of the cell and potassium into the cell.
What is hydrostatic pressure?
Pressure pushing fluid out of the cell.
What is oncotic pressure?
Pressure keeping fluid in the cell.
Define osmolality.
Measures the number of milliosmoles/kg of water.
What is the normal plasma osmolality range?
Between 275 and 295 mOsm/kg.
What is the role of the hypothalamus in fluid balance?
It acts as the thirst center.
What hormones are involved in fluid balance regulation?
- ADH (Pituitary)
- RAAS (Renal)
- ANP and BNP (Cardiac)
What are insensible losses?
Not visual or measurable losses, for example, through breathing and sweating.
Name three concerns when caring for an older adult experiencing a fluid and electrolyte disorder.
- Decreased body water
- Decreased thirst mechanism
- Increased moisture loss
What are the clinical manifestations of Extracellular Fluid Volume Deficit (ECFVD)?
- Fatigue
- Dizziness
- Dryness
- Weight loss
- Decreased urine output
- Low blood pressure
- Increased heart rate
- Weak and thready pulse
- Dry mucous membranes
- Tenting
What are lab indicators of ECFVD?
- Osmolality above 295 mOsm/kg
- Plasma sodium above 145 mEq/L
- Blood Urea Nitrogen above 25 mg/dl
- Hematocrit above 55%
- Urine specific gravity above 1.030
What is the goal for a patient with fluid volume deficit?
Client will urinate at least 30ml/hr.
What type of fluids are used for IV rehydration?
- Hypotonic
- Isotonic
- Hypertonic
What are isotonic fluids used for?
Fill vascular space.
What is the expected intervention for a client experiencing third spacing?
Identify and treat the cause.
What are the clinical manifestations of Intracellular Fluid Volume Deficit (ICFVD)?
- Thirst
- Oliguria
- CNS changes such as confusion and coma
What causes Extracellular Fluid Volume Excess (ECFVE)?
Fluid overload in the vascular space due to failure to excrete or abnormal retention.
What are the clinical manifestations of ECFVE?
- Swollen
- Bloated
- Short of breath
- High blood pressure
- Bounding pulse
- Low urine output
What are the lab indicators of ECFVE?
- Osmolality less than 275 mOsm/kg
- Sodium less than 135 mEq/L
- Hematocrit less than 45%
- Specific gravity less than 1.010
- Blood Urea Nitrogen less than 8 mg/dl
What is third spacing?
Fluid shift due to tissue injury or protein malnutrition.
What are the clinical manifestations of third spacing?
- Weak pulse
- Hypotension
- Oliguria
- Decreased level of consciousness
What is the outcome management for ICFVE?
- Assess and monitor
- Provide safety
- Fluid restriction
- Sodium administration
What are the indicators of hemodilution in ICFVE?
- Plasma sodium less than 125 meq/l
- Decreased hematocrit
What is the specific gravity of the client?
1.034
What is the blood pressure of the client?
70/50
What is the heart rate of the client?
112
What is the osmolality of the client?
290 mosm/L
What is the serum sodium level of the client?
140
What are two signs of dehydration present in the client?
- Dry mouth
- Poor tissue turgor
What fluid problem might the client have?
D. Extracellular FVD
What condition in a client’s history would be consistent with dehydration?
B. Vomiting
What is the expected treatment for dehydration?
C. provide fluids
What type of IVF may be given if the client’s blood pressure was 70/40?
A. Isotonic
What is the rationale for giving isotonic IVF?
Fills vascular space, rises bp
What is an example of isotonic fluid?
0.9% Normal Saline
What fluid balance problem might a 78 y/o client with CHF have?
A. ECF excess (vascular congested… caused by CHF)
What might be the etiology for fluid volume excess?
A. CHF
What is the expected treatment for fluid volume excess?
A. 2-3 gm Na diet
What is the serum sodium level of the client diagnosed with schizophrenia?
123 meq/L
What fluid balance problem does the client with schizophrenia have?
A. ICF excess
What might be the etiology of intracellular fluid volume excess?
A. Excess ingestion of free water-water intoxication
Which intervention would be appropriate if the client had Intracellular fluid volume excess?
D. Restrict fluids
What are two clinical manifestations of the 86 y/o client with high fever and profuse sweating?
- Body weight decreased
- Dry mucus membranes
What fluid problem might the 86 y/o client have?
D. ECF deficit
What type of IVF should be given if the client has an intracellular fluid volume deficit?
C. 0.45 hypotonic
What is the rationale for administering hypotonic IVF?
To replenish intracellular fluid volume
