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fluid balance Flashcards

1
Q 
how do
age
gender
fat
affect fluid balance (amount of body made up of fluid)
A

inc age-dec boy fluid
men have inc body fluid
overweight people have less fluid % than most people

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2
Q

which parts of the body (tissues have the most water)

A

o Muscle skin and blood have the highest amount of water

o , body fat=less fluid because fat cells contain little water

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3
Q

what percentage body fluids are intra/extracellular

A

Intracellular 30 liters

Extracellular		12 liters
Interstitial		 9 liters
Intravascular	   	  3 liters
Fluid in body spaces	  negligible 
Transcellular spaces
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4
Q

causes of hypervolemia (FVE)

A

o HF, renal failure, cirrhosis of the liver, consumption of excessive amounts of salt
o Increased ingestion (iatrogenic- d/t incorrect IV)
o Increased retention (cardiac disease)
o Decreased excretion (liver and renal failure)

Causes 
Increased ingestion
iatrogenic
Increased retention
Cardiac disease
Decreased excretion
Liver failure
Renal failure
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5
Q

s/s hypervolemia FVE

A 
o	Clinical manifestations result from the expansion of the ECF and include:
 generalized edema, 
distended neck veins, 
pulmonary edema, 
dyspnea, 
cough, 
SOB, 
crackles, 
tachycardia, 
full bounding pulse, 
pulse pressure, 
central venous pressure, 
increased weight, 
increased urine output
Acute weight gain
ascites
CVS symptoms
^BP, ^HR, ^JVP, peripheral  edema
RS symptoms
Pulmonary edema
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6
Q

example of interstitial fluid

A

 Interstitial eg lymph and other fluids that surround the cell

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7
Q

example of transcellular fluid

A

 Transcellular eg CSF, pericardial, synovial, intraocular, pleural

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8
Q

causes of third space fluid shifts

A 
o	Third space fluid shifts can occur in pts w severe liver diseases,
hypocalcemia, 
dec iron intake, 
 alcoholism, 
hypothyroidism, 
malabsorption, 
immobility, burns, 
CA
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9
Q

s/s third spacing

A 
S/S of thrd spacing
o	 Early evi of third space shift is dec in urine output despite adequate intake
o	Inc HR
o	Dec BP
o	Dec central venous pressure
o	Edema
o	Inc body weight
o	Imbalanced I/O
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10
Q

what type of body fluid are elctrolytes meas in

A

plasma

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11
Q

is an anion or a cation positively charged

what is a example of this that is plentiful

A

cation

sodium ions

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12
Q

where is sodium most concentrated

A

in the ECF

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13
Q

major electrolytes in the ICF

A

potassium

phosphate

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14
Q

what is oncotic pressure

A

o Oncotic P is the osmotic P exerted by proteins eg albumin

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15
Q

what is the inc in urine output caused by the excretion of substances such as glucose etc called?

A

o Osmotic diuresis

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16
Q

o Usual daily urine volume in adult is

A

1-2 litres

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17
Q

how much can an adut sweat in an hour in litres

A

1 or more

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18
Q

how can water be insensibly lost from a person

A

perspiration.. Fever and burns inc insensible water loss
o Lungs-approx 300ml of insensible water loss/day
o Gi usually lose 100-200ml daily

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19
Q

what is urine specific gravity

A

o Urine specific gravity meas kidneys ability to excrete or conserve water (its gravity gets compared to water) it is less specifc than urine osmolality. it can be done using a dipstick. inc glucose or protein in urine can cause a falsely elevated specific gravity

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20
Q

how are dehydration and FVD different

A

o Dehydration is NOT the same as FVD; dehydration is loss of water with an increase concentration of Na

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21
Q

how are the kidneys involved in fluid regulation

A

• Kidneys filter 18-L plasma every day and excrete 1-2L fluid
o Role of kidney:
 Regulate ECF volume and osmolarity by selective retention and excretion of body fluids
 Regulation of usual electrolyte levels in ECF by selective electrolyte retention and excretion
 Regulation of pH of the ECF by retention of hydrogen ions
 Excretion of metb wastes and toxic substances

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22
Q

how would a heart w dec CO affect water and electrolyte reg

A

the heart might not circ enough blood to kidneys and not allow for urine formation

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23
Q

how are the lungs involved in fluid balance

A

• Lungs
o Exhale 300mL of water a day
if hyperpnea (abnormally deep respirations) or continuous coughing then loss will inc

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24
Q

which glands are involved in reg of fluid balance. how?

A
  • Hypothalamus: makes ADH, which is stored in the pituitary gland
  • Adrenal Fx: aldosterone secreted by adrenal cortex; sodium (and water) retention, K loss
  • Parathyroid: regulate Ca and phosphate and PTH
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25
Q

for interest: what are osmoreceptors

A

on the surface of hypothalamus. sense changes in sodiu conc. w dehydration they send signal to p. pituitary which rel ADH

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26
Q

creatinine

A

it the end product of muscle metb.
better inicator of kindy fx than BUN
serum creatinine inc when kidney fx dec

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27
Q

what inc and dec HCT

A 
inc:
-dehydration
-polycythemia
dec:
-anemia
-overhydration
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28
Q

what is fuid volume deficit

A

• Fluid Volume Deficit (FVD)/hypovolemia: when loss of ECF volume exceeds the intake of fluid; occurs when h20 and electrolytes are lost in same amounts, so ratio of serum electrolytes remains the same

29
Q

causes of fluid volume deficit

A 
o	Abnormal fluid losses-N+V, diarrhea, GI suctioning, sweating, decreased intake (nausea, lack of access to fluids), third space fluid shifts, movement of fluid from vasculature to other body spaces (edema, ascites), diabetes insipidus, adrenal insufficiency, osmotic diuresis, hemorrhage, coma
Causes 
Reduced intake
Increased losses
Skin 300-500
Resp 600-800
Urine 1400-1800
Bowel 100
30
Q

s/s of hypovolvemia

A 
o	Acute weight loss, 
decreased turgor, 
oliguria, 
concentrated urine, 
orthostatic hypotension, 
weak, rapid heart rate, 
flattened neck veins,
 increased temp, 
thirst, 
decreased of delayed cap refill, 
decreased central venous pressure, 
cool, 
clammy pale skin r/t peripheral vasoconstriction, anorexia, 
nausea, 
lassitude, 
muscle weakness and cramps
Acute weight loss
CVS symptoms
low or postural BP, ^HR
Thirst
Dehydration
Poor tissue turgor, dry mucosa, oliguria
31
Q

lab findings of pt w hypovolemia

A

Lab findings
o Elevated BUN out of proportion to serum creatinine; ratio is greater than 20:1
 Bun elevated bc dehydration or decreased renal perfusion and function
o HCT is greater than normal bc there is decreased plasma volume
o Serum electrolytes changes may exist: K and Na reduced or elevated
o Urine specific gravity is increased in relation to kidneys attempt to conserve water and is decreased w diabetes insipidus

32
Q

if a pt suffers __________ will they be hyper/hypokalemic

  • GI and renal losses
  • adrenal insufficiency
A

gi and renal-hypokalemic

adrenal insuff-hyperkalemia

33
Q

Tx of hypovolemia

A

o ID and treat underlying cause
o Consider usual maintenance requirements
o Fluid replacement: isotonic IV solutions (NS, LR)
 Must be done quickly to prevent renal damage
o Encourage oral fluid intake

34
Q

tx of hypervolemia

A

Identify & treat the cause
Restrict Na+ and fluid diet
Diuretics
Thiazide (ie Hydrochlorothyazide (HTCZ) (mild to moderate FVE) block sodium reabsoprtion in the distal tubule
Loop Diuretics (ie Lasix (Furosemide) (severe FVE) increase loss of water and sodium
Hemodialysis

35
Q

nursing intervetnions hypervolemia (ppt)

A

Detecting is of primary importance!!
Accurate Measuring and Accurate Recording
Assess for edema
Rest
Monitor and teach sodium restrictions
Administer diuretics as ordered and monitor
(frequent) Chest Assessment
Vital signs Q4-6H
Elevate legs when sitting
Position for optimal comfort, circulation and respiration
May require IV Albumin

36
Q

nursing interventions hypovolemia (ppt)

A 
Monitor I&O accurately 
Daily weight
Bowel care prn 
Skin care 
Vital signs
Parenteral Administration 
Monitor for fluid overload when replacing fluids
Provide excellent mouth care 
NV/S to monitor LOC
NOTE: please attend to the gerontological considerations in Day et al.
37
Q

fve is always secondary to

A

o FVE is always secondary to an increase in the total body Na content which, in turn, leads to an increase in total body water

38
Q

lab findings of hypervolemic pt

A

• Diagnostics
o BUN and HCT decline bc of plasma dilution
o CXR- pulmonary congestion

39
Q

bun

A

o BUN:
 Made up of urea (end product of protein metb)
 Normal BUN is 3.6-7.2mmol/L
 Factors increasing BUN: decreased renal fx, GI bleeding, dehydration, increased protein intake, fever, and sepsis
 Factors decreasing BUN: end-stage liver disease, low protein diet, starvation, any condition that results in expanded fluid volume (ie-pregnancy)

40
Q

where can third spacing take place ppt

A 
•	Third Spacing:
o	Peritoneal cavity (ascites)
o	Pleural cavity (pleural effusion)
	Effusion: transudation of fluid into serous cavities
o	Pericardial sac
o	Joint spaces (synovial)
41
Q

how might fluid and electrolyte imbalances present in o adults

A

mnfts may be subtle or atypical
fluid deficit may present as delirium while the first sign in young pt would be thirst

o adults are much more sensitive to changes in fluid and electrolyte imbalance

42
Q

where should skin turgor be monitored for o adults

is this the best indicator of hydration

A

forehead or sternum in older pts

no the skins lost some elasticity. it may be more useful to measure the slowness of filling of the veins int he hands and feet

43
Q

why might an o adult restrict their fluid intake

A

theyre afraid of accidents

44
Q

what could happen w excessive volume of IV fluids to o adult

A

may produce fluid overload and cariac failure d/t dec cardiac reserve and reduced renal fx

45
Q

why do o adults dehydrate so fast

A

dec kidney mass, dec GFR, dec renal blood flow, dec ability to conc urine, dec excretion of potassium, dec of total body fluid

46
Q

when considering a discharge of an o adult what would you assess to see if they can care for themselves w a fluid imbalance

A

functional assessment of ability to det fluid and food needs and to obtain adequate intake. eg can they ambuate, swallow, reach things

47
Q

what would 3% NaCl be used for? 5% NaCl?

A

3% to treat hyponatremia in critical care situations only as only a small amount is nec to have a large effect on sodium levels
5% is to treat symptomatic hyponatremia

48
Q

what are hypotonic IV solns used for.

eg

A

0.45% NaCl

used to treat hypertonic dehydration…

49
Q

what solutions could you use to treat hypovolemia

A

isotonic ones to inc ECF volume: Lactated Ringers (has more electrolytes than 0.9% NaCl.

50
Q

which isotonic solution wouldnt be good when used alone to treat a FVD. why?

A

D5W. it has no electrolytes and dilutes plasma electrolyte conc

51
Q

how would aldosterone affect hypervolemia

A

if it were being chronically stimulated from

  • cirrhosis
  • heart failure
  • nephrotic syndrome
52
Q

what would be prescribed for severe hypervolemia

eg. why?

A

loop diuretic
eg furosemide
they block sodium reabsorbtion int he ascending limb of the loop of Hene where 20-30% of sodium is usually reabsorbed (as opposed to thiazide diuretics which prevents only 5-10% reabsorption)

53
Q

where do thiazide diuretics work?

A

in the distal tubule. they block sodium reabsorption there . where 5-10% of sodium is reabsorbed

54
Q

what can result from the use of diuretics

how can this be addressed

A

electrolyte imbalances. generally hypokalemia unless the drug works in the last distal tubule in which case it can cause hyperkalemia esp if the pt has dec renal fx

take potassium supplement

dec magnesium levels also
maybe hyponatremia

55
Q

eg of a drug that works in the last distal tubule and what electrolyte problem it causes

A

spirinolactone could cause hyperkalemia

56
Q

how would diuresis cause hyponatremia

A

inc ADH trying to address the dec in circulating blood volume

57
Q

whats azotemia

A

inc nitrogen levels in the blood when urea and creatinine arent excreted w FVE d/t dec perfusion by kidneys and dec excretion of wastes

58
Q

what is the optimum daily amount of sodium

A

2000mg

59
Q

when measuring for edema in FVE what ould indicate edema

A

a diff of 1cm at the ankle and 2cm at the calf

60
Q

where are the 4 locations measured to assess for peripheral edema

A

forefoot
smallest and largest circumference of the calf
mid thigh

61
Q

is activity or rest better to treat hypervolemia

A

bed rest promotes diuresis

62
Q

considerations for a hypervolemic pt in bed

A

semi fowlers if theyre SOB

turn and reposition often if they have edema

63
Q

what is the main focus of teaching a pt w FVE

A

about edema. how to recog the S/S

64
Q

what is anasarca

A

severe generalized edema

65
Q

what might a pt w ascites report

A

SOB and a sense of pressure d/t pressure on diaphragm

66
Q

hyponatremia causes

A

Causes
Increased water intake
Reduced water loss
Sodium loss

67
Q

s/s of hyponatremia

A

S/S
Lab findings
Na

68
Q

how would the labs present of a person with hyponatremia

A

look for hemodilution and low sodium

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