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N230 exam 1 and 2 > fluid imbalance > Flashcards

fluid imbalance Flashcards

1
Q

Intracellular space/fluid

A

2/3 of water in body
Primarily electrolytes (K,PHOS, MAG)

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2
Q

Extracellular space/fluid

A

Both plasma (in the vessel) and interstitial fluids
Also lymph/transcellular fluids

Primarily electrolytes (NA, CL, HCO3)

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3
Q

What is different about the fluid % in older adults?

A

Lower %

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4
Q

Osmosis

A

Diffusion of water (concentration gradient)

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5
Q

Hydrostatic/osmotic pressures

A

pressure on blood vessel walls/ proteins in the blood(albumin)

The albumin attracts water to prevent it all from leaving

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6
Q

Diffusion

A

Solutes move from higher concentration to lower

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7
Q

How to gain fluids

A

PO mostly
Or IV

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8
Q

How to lose fluid

A

Kidneys (mostly)

Skin loss from sweat, burns, fever

Lungs from breathing, tachypnea

GI tract from stools

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9
Q

Third spacing

A

Fluid outside of the cells and blood vessels.

Due to there being too much fluid in cells

This is how we get edema

Symptoms of low intravascular volume:
tachycardia
hypotension
low urine output
edema

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10
Q

Urine specific gravity (test)

A

Shows how concentrated the urine is

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11
Q

Hematocrit (test)

A

Concentration/percentage of RBC’s

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12
Q

BUN blood urea nitrogen (test)

A

Concentration of urea (waste product) in the blood

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13
Q

***fluid volume deficit AKA hypovolemia

A

low volume in blood vessel

causes:
fluid loss
low intake

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14
Q

***fluid volume deficit
older adults higher risk

A

change related to agine, thirst, response

medication AE (diuretic)

intentional reduce fluid intake (at night to preventing having to pee in the middle of the night)

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15
Q

***Fluid volume deficits
S/S

A

BP decrease
HR increase
Dry mucus membranes
Decreased urine output
Decreased skin turgor
Dizziness
Thirst
Late sign: neuro changes

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16
Q

***Fluid volume deficit
Lab findings

A

Concentration increases:

Increased BUN
Increased Hematocrit
Increased urine osmolality

17
Q

***Fluid volume deficit
Interventions

A

Oral or IV fluid replacement

Be cautious with rate with: older adults, renal disease, heart failure (can cause fluid overload)

Strict I/O

Daily weight

Monitor pulse and BP (want pulse to decrease and bp to increase)

Treat nausea, diarrhea, fever (all cause decrease fluids)

Oral care

18
Q

***Fluid volume excess

A

Causes:
-Excessive intake (rare)
-Excess intravascular fluid
-Heart failure
-Renal failure

19
Q

***Fluid volume excess
S/S

A

Weight gain
JVD distention
Dyspnea/crackles
Edema
Late sign: LOC changes

20
Q

***Fluid volume excess (lab findings)

A

Sodium low <135
BUN low <8
Specific Gravity <1.010
Chest x-ray: pulmonary congestion (can see fluid on x-ray)

21
Q

***Fluid volume excess
Interventions

A

Fluid restriction
Diuretics
Compression stockings if lower edema
Elevate HOB
I/O
Daily weight

Monitor: JVD, Urine output

22
Q

Third spacing

A

Fluid goes into interstitial third space
Fluid not in vessels or cells

Cause:
Liver failure
Burns
Trauma
Severe inflammation/sepsis

23
Q

Third spacing S/S

A

Symptoms of hypovolemia with profound edema

This is due to fluid leaving the vessel and entering the third space causing edema but also s/s of hypovolemia

24
Q

Third spacing treatment

A

Difficult to treat

May need paracentesis

May need administration of albumin (protein that draws the fluid back into the vessel)

Compression stockings for lower edema

25
Q

***Isotonic

A

Tonicity similar to plamsa

Expands ECF (fluid stays in blood vessels)

Used for ECF volume deficit (dehydration from vomiting)

26
Q

***Isotonic fluids

A

0.9% Sodium Chloride (NS)
Lactated ringers (LR) *avoid use in hyperkalemia (contains K), matabolic alkalosis (PH>7.5)

27
Q

***Hypotonic

A

Low osmolality, water moves into the cell
Can lead to excess icf (cellular edema)

Referred to as hippotonic bc cells get big a fat

28
Q

***Hypotonic fluids

A

0.45% NACL (aka 1/2 ns)
D5W

Give these slow (maintenance replacement fluid)

29
Q

***Hypertonic

A

Cells shrink bc vessel draws fluid in
Higher osmolality, draws fluid from cells to ecf (into vessels) very concentrated
*can cause fluid overload in vessels

Used for patients with cerebral edema, hyponatremia

30
Q

***Hypertonic fluids

A

3% NACL
D10W/D15W (10-15% DEXTROSE in water)
*requires frequent monitoring can cause rapid shifts in fluid, cell shrinkage

31
Q

***Main differences in iso, hyper, hypo

A

Isotonic: no change

Hypotonic: cell swells

Hypertonic: cell shrinks

N230 exam 1 and 2 (11 decks)

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