Fluid & Electrolytes Part 2 Flashcards by Brina Quintanilla Reyes

What are the 3 fluid tonicity?

Isotonic
Hypertonic
Hypotonic

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What is isotonic?

Has the same osmolality ( the concentration of solutes in the body ) as ECF, No fluid movement occurs

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What is hypertonic?
( more or less concentration ?)

ECF solutes are more concentrated than in cells, water leaves the cells, causing cell shrinkage and possibly cell death

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What is hypotonic?
( more or less concentration ?)

ECF solutes are less concentrated than the cells water moves into the cell and can cause rupture

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Hypertonic short

Fluid leaves the cells and gets smaller

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Hypotonic short

Fluid goes in the cell
Cell gets bigger

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What is osmotic pressure?
(ST, F)

The amount of pressure required to stop osmotic flow of water

( power to pull water through a semi permeable membrane )

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How is osmotic pressure determined by?
(SS,HH)

By the concentration of solutes in solution ; the higher the concentration the higher the pressure
( more pressure in a crowed )

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What starts or stops the movement of fluid?

The pressure

determines the amount of fluid in cell

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What type of solution do we use for hypotonic ?

Normal Saline

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What type of solution do we use for hypertonic?

D50%

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What is hydrostatics pressure?
( generated by what?)
(FC)

Force within a fluid compartment
Blood pressure generated by heart contraction

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What is oncotic pressure caused by

Caused by plasmas colloids in solution

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What is osmotic pressure caused by?

Plasmas proteins

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Fluid movement in capillaries
Amount and direction of movement determined by?
Moves water out of capillaries
(C, IT)

Capillary hydrostatics pressure
Interstitial hydrostatic oressure

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Fluid movement in capillaries
Amount and direction of movement determined by?
Moves fluid into capillaries
(P, IT)

Plasma oncotic pressure
Interstitial oncotic pressure

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What organs or structures in the body contribute to fluid balance and how so?

The kidneys ( controls BP up or down )

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Why isn’t the heart an organ in the body that contribute to the fluid balance?

the heart doesn’t control blood pressures because there are other sensors in the body that want all the perfusion

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What is perfusion?

Organs having enough blood oxygen and fluid, perfect organ condition

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The kidneys will signal the heart to push the blood but what’s actually controlling the blood pressure from up and down is ?

The kidneys

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When the kidneys wants more perfusion they release ?

Renin

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Oncotic pressure is ____ within the ____?

Pulling pressure within the intravascular space

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What is the purpose of oncotic pressure?

To keep the fluid in the intravascular space

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How does the oncotic Pressure keep the fluid in the intravascular space?
(2)

by either holding on to it or pulling it from the interstitial or intracellular spaces

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Hydrostatic pressure is ___within the _____?

Pushing pressure within the intravascular space

Where does the hydrostatic pressure push fluid out and into what?

Pushes it out of the intravascular space into the interstitial or intercellular spaces

How is the hydrostatic pressure influence by? (increase, FOB, v)

By any condition that will increase the amount of force the blood within the intravascular space exerts against the vessel walls

What is the oncotic pressure influenced by, examples and where can it be found?(3)

Large proteins Albumin Intravascular space

If albumin levels are low patients will have fluid ____ out of the vessel into the ______ this is called_____

Fluid leak out of the vessel Into the interstitial space This is called 3rd spacing

Plasma to interstitial fluid shift results in?

Edema

Interstitial fluid to plasmas results in?

Decreases edema

How many fluid spacing are there?

First spacing is?

Normal distribution

Second spacing is ?

Abnormal amount of interstitial fluid (edema)

Third spacing is?

Fluid accumulation in part of body where it is not easily exchanged with ECF

Third spacing is also known as what type of swelling?

Fluffy swelling

In third spacing, does the cell shrink and what type of tonic is it?

Yes it does Hypotonic pressure

Oncotic pressure and hydrostatic pressure working together creates?

Equilibrium

What are the 6 ways to regulation water balance? (A,A,G, M,R, N)

ADH Aldosterone Glucocorticoids Mineralcorticoids RAAS system Nateiuretic peprides

ADH stands for what/means?

Anti diuretic hormone Not urinate

What does diuretic mean?

Pee

What releases ADH?

Hypothalamic pituitary regulation

Fluid deficit stimulates what’s and does what to ADH? ( stimulates as in, what will the patient feel )

Stimulates thirst And releases ADH

When the hypothalamus release ADH what does that cause for the body?

To reabsorb water and not pee

What does fluid excess do to ADH?

Suppresses it

What happens when we suppress ADH?

We excrete water ( we pee )

Average adults produces how much urine daily?

1.5L

Where is the action of ADH and Aldosterone?

Renal tubules ( kidneys )

Adrenal cortical regulations helps with water balance, but what are the 2 groups that help with this? (G,M)

Glucocorticoids Mineralocorticoids

Under glucocorticoids, what is the hormone that helps water balance?

Cortisol

Cortisol is what effect and increases what? (ANTI IN INC SER GL$

Anti inflammatory effect Increases serum glucose

Large doses of cortisol has three what effects?

Glucose elevating & anti inflammatory Sodium retention effects

Mineralcorticoids hormone is?

Aldosterone

Aldosterone is in the what?

Adrenal cortex

Cortisol is also knows as a what hormone ?

Stress

Cortisol is used in steroids and we should be careful with what type of patients and why?

Diabetics because of high glucose increase

What happens to the body when there is a decrease in aldosterone? (RP,DS)

It decreases renal perfusion/sodium delivery to kidneys

When we have decrease aldosterone what do we activate?

Renin-angiotensin-aldosterone-system (RAAS)

What does increase aldosterone do to the body? (Sr,Pe)

Causes sodium retention and potassium excretion

When we have increased aldosterone is water retained with sodium?

Yes

Cardiac regulation of water balance, or natriuretic peptides are what to the RAAS?

Antagonists

What are natriuretic peptides produced in response to? (AP)

They are produced in response to Increase atrial pressure

What is the function of natriuretic peptides?

To suppress secretion of aldosterone, renin, ADH to decrease blood volume & pressure

What does the natriuretic peptides promote?

Excretion of sodium and water

What is the normal intake and output of gi fluid in a day?

2000-3000ml per day

How many literals does the GI tract produce in a day?

8000L

Can diarrhea and vomiting lead to significant fluid and electrolyte loss?

Yes

Is the 8000L that the GI produces mostly reabsorbed?

Yes

How much plasma is in the body?

how much Interstitial fluid is in the body?

10L

How much intracellular fluid is in the body?

28L

What is insensible water loss?

Invisible vaporization from lungs and skin

How much insensible water loss do we lose in a day?

600-900ml

Do we lose electrolytes with normal perspiration?

Do we lose electrolytes with excessive sweating?

Yes

Is the intake and output of the adult fluid going to be the same?

Clinical implications ; nursing management

Gerontologic considerations ( eldery ) What does the elderly lose ability in?

To concentrate urine and conserve water

When elderly lose concentration to urinate and conserve water, what happens to their renal perfusion?

Decreases

What are the other two things that decrease in elders ( other than renal perfusion )?

GFR Cr clearance

Horomonal changes lead to what in the elderly? (2) (D&R,A, I&A,AN )

Decrease in renin and aldosterone Increase in ADH & ANP

Loss of subcutaneous tissue leads to what in the elderly?

Increase loss of moisture

When the elderly have reduced thrist mechanisms, what does that result in?

Decrease fluid intake

When the elderly lose functional and mental statues, it affects their ability to what?

Independent obtain fluids

Fluid and electrolyte imbalances are directly caused by? Examples (3)

Illness and disease ( burns or heart failure ) Therapeutic measures (IV fluid replacement or diuretics)

Who are at the highest of risk to experience body fluid imbalances? Age -2 Gender -1 Body size -1 Environment -1 Lifestyle -1

Infant and elder Female ( more body fat than men ) Fat ( muscle/water fat/no water ) Heat ( sweating ) Exercise,stress,alcohol

What are some more causes of imbalances? (R,C,D,CA,CO,CF,V,D,N,B,M)

Renal disease Cardiovascular disease Diabetes mellitus Cancer COPD Confusion leading to poor fluid intake Vomiting Diarrhea Nasogastric suction Burns Medications (diuretics)

What is another name for extracellular fluid volume deficit ?

Hypovolemia

What is extracellular fluid volume deficit ( hypovolemia )?

Abnormal loss of normal body fluids, poor intake, or Plasma to interstitial fluid shift

Is ECF deficit the same as dehydration and why?

It isn’t Because dehydration is the loss of water without loss of Na(sodium)

What are some clinical manifestations for hypovolemia, EFC deficit ? (r,d, l,c, ph, T, d, w, s, cr)

Restlessness Tachycardia Postural hypotension Skin tutor Capillary refill Confusion Lethargy Drowsiness Weight loss

What is the treatment of hypovolemia? ECF deficit?

Normal saline

What are the physical findings for ECF deficit? ( Dw, st, u, bp, et, I&hp, DM )

Decreased weight Skin tugor Urine output Blood pressure Extremity temperature High pulse Dry mucous membranes

What are the lab findings with FVD ( fluid volume deficit ) hypovolemia ( EFC Defict )? Increase or decrease (H,U,B,S)

Increase Hemoglobin Urine specific gravity BUN Serum sodium

The hemoglobin increase to ____ the hematocrit in the labs results for hypovolemia?

Triple

Nursing interventions for fluid deficit? (f,L,W,U,V,I)

Increase fluids (IV-isotonic) Monitor LOC(level of conscious) Monitor weight Monitor urine output Asses vital signs Monitor I&O

What should we look out for in vital signs for someone who is FVD? Fluid volume deficit?

Blood pressure goes down Heart rate goes up

What is another name for extracellular fluid volume imbalances?

Hypervolemia

What is hypervolemia? EFC imbalances? Interstitial to plasmas or Plasma to interstitial ?

Increase intake of fluids Abnormal rention of fluids or Interstitial to plasma fluid shift

What are clinical manifestations for extracellular fluid volume imbalances ( hypervolemia ) (B, H, D, C, PE, W )

Bounding pulse Hypertension dyspnea Crackles Pulmonary edema Weight gain

What is the treatment to extracellular fluid volume imbalances ( hypervolemia)

Remove fluid without changing electrolyte composition Diuretics Fluid restriction Sodium restriction

Physical findings for FVE ( hypervolemia ) (W,p, BP, c, e, cr, a )

Increased Weight Pulse Blood pressure Confusion Edema Crackles ascites

What is crackles?

Abnormal lung sounds

What are the lab findings for FVE? Hypervolemia? (2)

Decrease in Hct & bun

Nursing interventions for fluid volume excess ( FVE ) R.E.S.T.R.I.C.T

Reduce IV rate Evaluate breathe sounds/respiratory Semi flowers position Treat with O2 & diuretics Reduce fluid/sodium intake Intake and output weights Circulation color and edema Turn and reposition every 2 hours

Nursing diagnosis for hypovolemia?(2) and what is the complication?

Deficient fluid volume Decreased cardiac output Risk for deficient fluid volume Potential complication Hypovolemia shock

What is the nursing diagnosis for hypervolemia and what is the potential complication? (e, I, r, d, a, ) (pe, As)

Excess fluid Impaired gas Risk for skin integrity Disturbed body image Activity intolerance Complication Pulmonary edema, ascites

What are the nursing implantations for intake(how to take it) and output(what comes out)?

Oral, enteral, irrigation ( meds ) Urine, diarrhea, sweat, wound drainage

SG ____=dilute Concentration ____

1.010 1.025

Nursing implementation monitor changes? ( what will you find on the monitor?) (BP.p,j, o)

Blood pressure Force of pulse JVD Orthostatic hypotension

Checking someone weight is important during fluid imbalance because?

You gain weight too much fluid Lose weight too little fluid

Assess respiratory changes for increase ECF? What should you look out for?

Crackles, congestions, edema pulmonary

Assess respiratory changes in decreased ECF? What should you look out for? (H)

Hypoxia (Gasping for air, not enough air in lungs)

Neurological changes for both hypo and hypervolemia?

Pupils response Cerebral edema Decrease perfusion

What should you do for skin turgor care?

Assess temperature, mucous membrane And encourage fluids ( avoid NG tube )