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Nursing Year 2 OSCA > Fluid + Fluid Balance > Flashcards

Fluid + Fluid Balance Flashcards

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1
Q

What does the renal system consist of?

A

2 kidneys
2 ureters
Urinary bladder
Urethra

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2
Q

What is the function of the renal system?

A

Production of varying quantities of urine confusing adjustable quantities of waste allows the body to regulate fluid, electrolyte and pH balances.

Kidneys maintain homeostasis.

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3
Q

What do the kidneys consist of?

A 
Renal capsule
Renal cortex
Renal pyramids
Calyces
Renal pelvis
Ureter
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4
Q

Where are the pyramids in the kidney located?

A

Renal medulla

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5
Q

What is the pathway or urine in the kidneys?

A 
Urine drips from top of each pyramid to:
calyces
pelvis
ureter 
Ureter propels urine to the bladder
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6
Q

What is the main function of the kidneys?

A

To filter blood

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7
Q

What is the body water content?

A

50-60% of total body weight

Females less than males

Decreased in elderly

Higher in babies and infants (75-80%)

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8
Q

What % of body water is intracellular fluid + what electrolytes does it contain?

A

66% of total body water

Potassium, magnesium, phosphate

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9
Q

What % of body water is extracellular fluid + what electrolytes does it contain?

A

33%

Sodium, chloride, bicarbonate

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10
Q

How does the cell membrane allow for the exchange of ions?

A

It is selectively permeable.

Some ions are pumped out of the cell (Na+)

In exchange for other ions entering the cell (K+)

This uses energy from ATP

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11
Q

What is external and internal fluid balance?

A

External - matches input with output from body

Internal - means there is the correct volume of fluids

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12
Q

How is fluid exchanged across membranes?

A

Water distributed by osmosis

This is dependent on the osmotic pressure inside and outside the cells.

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13
Q

What are the most numerous solutes dissolved in body fluids + how does this affect fluid balance?

A

Electrolytes

Fluid balance is dependent on electrolyte balance.

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14
Q

What is an isotonic solution?

A

Same pressure inside and outside the cell

= normal RBC

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15
Q

What is a hypotonic solution?

A

Outside pressure lower than inside pressure

= swollen RBC

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16
Q

What is a hypertonic solution?

A

Inside pressure lower than outside pressure

= shrunken RBC

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17
Q

Why is extracellular fluid osmolality important?

A

It determines whether cells shrink, swell or are normal.

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18
Q

What solutes (and concentrations of these) does extracellular fluid contain?

A 
NA+           140 
Cl-             140
Urea          5
Glucose    5
Others      5

equals = 300 mosmol/l

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19
Q

What is normal saline?

A

An isosmotic solution.

Contains 150 NA+ and 150 Cl-, same osmolarity as ECF.

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20
Q

How does fluid exchange at capillary?

A

Electrolytes and water in ECF exchange freely across capillary wall.

This makes interstitial fluid and plasma very similar.

However plasma pressure slightly higher due to presence of albumin.

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21
Q

Why is the difference in osmotic pressure of the plasma and interstitial fluid helpful?

A

It ensures correct plasma volume and normal fluid exchange between blood and tissue.

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22
Q

What is fluid balance?

A

The same amount of fluid enters the body as leaves the body.

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23
Q

How is water lost through the skin?

A

Sweating

  • affected by environment, physical activity, fever
  • losses of 2-3l/hour can occur
  • risk of dehydration higher in children
24
Q

How is water lost through the lungs?

A

Evaporation

-affected by humidity, altitude, exercise, artificial ventilation.

25
Q

How is much water is lost through faeces?

A

Low levels

2l a day can occur with diarrhoea

GI losses via surgical drain should be noted

26
Q

How much water is lost through urine?

A

Excretion of urea + sodium requires certain amount of water for excretion

High protein/salt diet = increase in urine

Small volume-high alcohol drinks can cause dehydration due to diuretic effect (increase in urine)

27
Q

What are the adult fluid requirements?

18-60, over 60

A

Adults - 30-35ml per kg

18-60 - 35ml/kg

Over 60 - 30ml/kg

28
Q

What are the corrective responses when dehydrated?

A

Increase osmotic pressure stimulates osmoreceptors causing:

Increased thirst
ADH secretion (anti diuretic hormone)
-this tells kidneys to retain water

29
Q

What are the corrective responses when hypovalemic?

A

Thirst + ADH secretion

Drop in blood volume + renal blood flow stimulates renin-angiotensin-aldosterone

Salt and water retained by kidneys

30
Q

What is the correct responses when fluid overloaded?

A

Thirst reduced

Dilute urine produced

Stretch of heart atria releases:
- atrial natriuretic hormone which acts on the kidney and more water and salt is excreted .

31
Q

What can cause disorders of fluid balance + why?

A 
Conditions affecting:
Kidneys
Brain
GI system
Lungs
Skin
Cardiac output

Due to abnormal intake/losses and inadequate/counter productive corrective responses

32
Q

What to assess when checking skin for assessment of fluid status?

A 
Turgor
Mucous membranes
Fontanelle 
Eyes
Dry skin
33
Q

What cardiovascular signs to look for when assessing fluid status?

A

Increased HR
decreased BP
Poor peripheral perfusion
Increased respiratory rate

34
Q

What neurological signs to look for when assessing fluid status?

A 
Conscious level
Irritability
Agitation
Lethargy
Confusion
35
Q

What renal sings to look for when assessing fluid status?

A

Urine output
Colour of urine
Specific gravity of urine
Smell of urine

36
Q

What is dehydration?

A

Insufficient body fluid due to:

Inadequate intake

Excessive loss of fluids

Combination of both

37
Q

How is dehydration calculated?

A

% of dehydration calculated from changes in body weight (litre of water = 1kg)

Mild - <5%
Moderate - 5-10%
Severe - >10%

38
Q

What are the clinical signs of mild dehydration?

A

Thirst
Alert but restless
Normal HR/mild tachycardia
Slow skin retraction

39
Q

What are the clinical signs of moderate dehydration?

A 
\+/- tears
Dry mucous membranes
Low urine output
Thirst
Irritable
Rapid pulse/tachy/rapid resps
Slightly depressed eyes/fontanelle 
Postural hypotension 
Slow skin retraction 
Capillary refill time >2
40
Q

What are the clinical signs of severe dehydration?

A 
No tears
Very dry mucous membranes
Low urine output
Lethargic/sleepy
Severe tachycardia, deep/rapid resps
Severely sunken eyes/fontanelle 
Hypotension 
Very slow skin retraction 
Capillary refill time >3
41
Q

What is the treatment for the three stages of dehydration?

A

Mild - oral rehydration

Moderate - oral and IV rehydration

Severe - accurate IV fluid replacement

42
Q

What is isotonic dehydration?

A

NA+ and h2o lost equally
Loss of plasma or ECF
e.g hemorrhage, burns

May need urgent fluid replacement due to hypovalemia

43
Q

What is hypernatreamic dehydration?

A

High plasma sodium levels, more h2o lost than Na+.

Body fluids more concentrated

Can occur in unconscious patient unable to drink

Water loss shared between ECF + ICF so there is less of a drop in blood volume.

44
Q

What is hyponatraemic dehydration?

A

More Na+ than h2o lost
e.g loss of sodium rich fluid through alimentary canal

Less common

Fluid loss from ECF can cause hypovalemia

45
Q

What are the 5 R’s of IV fluids?

A

Resuscitation

Routine maintenance

Redistribution

Replacement

Reassessment

type + concentration of fluid must be correct for purpose

46
Q

What are the 3 main types of IV fluids?

A

Crystalloids

Colloids

Blood + blood products

47
Q

What are crystalloids and what are examples of these?

A

Clear solutions, move between blood stream and tissues.

Contain no plasma proteins.

Range of types, generally differing strengths of normal saline.

Examples:
0.9% normal saline

5% dextrose

0.45% normal saline + 5% dextrose

48
Q

What are colloids and what are examples of these?

A

Contain solutes that stay in blood because that are too big to pass through capillary walls.

Used to increase blood volume.

Examples:
Human albumin solution (4.5%)

49
Q

What are examples of blood+blood products?

A

Whole blood

Packed cells

Platelets

Fresh frozen plasma

Given for serious haemorrhage or to increase Hb, low platelet count, couagulopathy.

50
Q

What IV therapy is used for resuscitation?

A

500mls 0.9% saline over 15mins (up to 2L can be given)

This rapidly expands blood volume then interstitial fluid more slowly.

There is no fluid shift into cells as it is an isotonic solution.

51
Q

What IV therapy is used in routine maintenance?

A

Sodium chloride 0.18% in 4% glucose with added potassium.

Or

2 bags 5% glucose to 1 bag of 0.9% sodium chloride with added potassium.

Hypotonic solution given to maintain ICF (hydrate cells)
Glucose to prevent ketosis
Potassium to prevent hypokalemia

52
Q

What is redistribution in IV fluid therapy?

A

Excess fluid collects in 3rd spaces (interstitial fluid, peritoneal cavity)

Decrease maintenance fluid to prevent worsening.

In septic shock fluid resuscitation may be needed as much of the fluid given moves into interstitial space

53
Q

What is replacement in IV therapy?

A

Increased maintenance fluids to replace excessive losses from body (sweating, D+V)

Extra electrolyte losses need to be estimated
- blood urine check helps with this, U+E’s

54
Q

What is reassessment in IV fluid therapy?

A

Check U+E’s prior to infusion if appropriate.

Check weight.

Check U+E’s every 24hr minimum while IV fluids are being administered. (If abnormal consider 4-6hrly)

Add supplement if required.

maintain accurate fluid balance charts

55
Q

What effects can excessive isotonic saline have?

A

Circulatory overload is more likely with sodium containing solutions because isotonic solutions stays in ECF boosting blood and interstitial fluid.

Increase in total body sodium.

56
Q

What effects can excessive dextrose solution have?

A

Neurological dysfunction due to hyponatremia
- headache, N+V, lethargy, confusion, drowsiness.

Cause: it is a hypotonic fluid so glucose enters cells and is catabolised leaving free water that dilutes ECF that enters cells by osmosis and caused neurones to swell.

Nursing Year 2 OSCA (7 decks)

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