Fluid Imbalance

Question 1

Why is fluid balance important?

Answer 1

To maintain homeostasis (small window for normal balance of electrolytes and fluid

Question 2

What organs of the body regulate fluids?

Answer 2

Kidneys, Heart, Lungs, Pituitary Gland, Adrenal Gland

Question 3

What hormone does the pituitary gland secrete that affects fluid balance?

Answer 3

Antiduretic hormone, which causes the body to retain water

Question 4

What hormone does the adrenal gland secrete that affects fluid balance?

Answer 4

Aldosterone hormone: causes sodium retention, thus water retention

Question 5

What follows Na+?

Answer 5

H20, Cl-

Question 6

Body fluids are intracellular and extraceullar. How many thirds is intracellular?

Answer 6

2/3

Question 7

What 3 fluid compartments are considered to be extracellular?

Answer 7

1. interstitial spaces
2. intravascular
3. fluid body spaces

Question 8

What are the process that fluid can move? (5)

Answer 8

1. Diffusion
2. Osmosis
3. Osmotic Pressure
4. Colloid osmotic pressure
5. Hydrostatic pressure

Question 9

What does tonicity mean?

Answer 9

Measure of the osmotic pressure gradient (hypotonic vs. isotonic v.s hypertonic)

Question 10

What is osmolarity of the following:

1. Isotonic
2. Hypotonic
3. Hypertonic

Answer 10

1. 250-375

2. 375

Question 11

Fluid imbalance can be hypervolemia or hypovolemima. In both of these cases, are the electrolytes inbalance with the fluid?

Answer 11

Yes, Na+ and H20 in same concentration

Question 12

Define hypervolemia

Answer 12

excess fluid volume

Question 13

Define hypovolemia

Answer 13

fluid volume defecit

Question 14

Is hypovolemia the same as being dehydrated? Why or why not?

Answer 14

No. Hypovolemia the fluid and electrolytes are both lost, where as dehydration there is an increase of electrolytes but a decrease of fluid

Question 15

Define 3rd space shift:

Answer 15

Fluid moves into the transcellular spaces, difficult for the fluid to get in and even more difficult for the fluid to et out

Question 16

What would be 3 symptoms of 3rd space shifting?

Answer 16

1. Decrease urine output (d/t fluid accumulating in the transcelluar space)
2. Decreasing BP
3. Swelling in the area where the shift is

Question 17

What are some of the transceullar spaces where fluid can get trapped in a 3rd space shift?

Answer 17

Pleural cavity, peritoneal cavity, pericardial sac, joint spaces

Question 18

What is 3rd space shift to the peritoneal cavity called?

Answer 18

Ascites

Question 19

Define effusions:

What can they contain?

Answer 19

transduction of fluid into serious cavities.

Effusions can contain pus, blood, plasma, proteins and or ECF

Question 20

Who is at risk for developing fluid imbalance?

Answer 20

ALL AGES ACROSS THE LIFESPAN!

Question 21

What factors can cause a fluid imbalance? (4)

Answer 21

1. Vomitting
2. Diahhrea
3. Burns
4. Diuretics

Question 22

What Lab work would you assess for monitoring fluid balance? (6)

Answer 22

1. Serum electrolytes: Na+, K+, Cl-
2. BUN / Creatinine (kidney function tests)
3. Serum Albumin
4. Urine AND serum osmolality
5. Hct
6. Urine specific gravity

Question 23

Why is serum albumin an important diagnostic testing? What condition would cause this to be lowered?

Answer 23

Albumin = most abundant protein in the blood, produced by the liver.
It plays a role in colloid osmotic pressure.
Person w/ liver failure is @ risk for not making enough albumin, therefore decreased colloid osmotic pressure, can lead to fluid shift.

Question 24

What is the normal range for Hct? When would Hct elevate? When would it decrease?

Answer 24

0.4-5.2, elevate = fluid loss, decrease = fluid overload

Question 25

Define Hypervolemia:

Answer 25

Fluid volume in excess

Question 26

What would cause hypervolemia to occur? 3

Answer 26

1. Increase fluid injestion (iatrogenic.. ex. IV bag) 2. Increased fluid retention (cardiac arrest) 3. Decrease fluid excretion (liver/renal failure)

Question 27

What are the S/S of hypervolemia? (4) | number 4 is a diagnostic lab tests.. what would you expect to see?

Answer 27

1. Acute weight gain (ascites) 2. CVS symptoms = increased BP, HR, JVD, peripheral edema 3. RS Symptoms= pulmonary edema 4. Lab findings: Low hct, pulm edema or CxR

Question 28

Treatment for hypervolemia. (4)

Answer 28

1. Identify & Treat the cause 2. Restrict Na+ and fluid in the diet 3. Diueretics (Thiazide, Loop diuretics) 4. Hemodialysis

Question 29

Why restrict the Na+ fluid intake?

Answer 29

Water follows Na+

Question 30

Nursing Interventions for Hypervolemia include:

Answer 30

- Detecting is the primary importance! - Accurate Measuring / recording - Assess for edema - Rest - Monitor and teach Na+ restrictions - Admin. Diuretics - Frequent chest assessment (looking for pulmonary edema) - Vital sings q 4-6 hr - elevate legs when sitting - position for optimal comfort, circulation, respiration - May require IV Albumin (seems super weird to me... that would cause an increase in osmotic pressure which would then increase the pull of more fluids in)

Question 31

Define Hypovolemia:

Answer 31

Fluid voluma deficit

Question 32

What would cause hypovolemia? (2)

Answer 32

1. reduced Intake | 2. Increased losses

Question 33

What could the losses of fluid be through? (4)

Answer 33

1. Skin 2. Resp 3. Urine 4. Bowels

Question 34

What are the S/S of hypoveolmia? (7)

Answer 34

1. Acute weight loss 2. CVS symptoms (low or postural BP, increase HR To compensate for low BP) 3. Thirst 4. Constipation 5. Thready pulse 6. Dehydration (poor turgor, dry mucousa) 7. Lab findings: Increase Hct, Increase serum and urine osmolality

Question 35

What is the treatment for hypovolemia?

Answer 35

1. Identify and treat the cause 2. Consider usual maintenance requirements 3. fluid replacement: isotonic solutions 4. Replace fluid quickly to prevent renal damage 5. Encourage oral fluid intake

Question 36

What are examples of isotonic solutions that could be given to a patient IV with hypovolemia? (2)

Answer 36

1. NS | 2. RL

Question 37

Nursing Interventions for hypovolemia:

Answer 37

- monitor I/O accurately - Daily weight - Bowel care PRN - Skin care - Vital signs q 4-6 hr - Parenteral Admin (monitor for fluid overload when replacing fluids) - Mouth care - NV/S to monitor LOC

Question 38

What are the gerontological considerations for hypovolemia?

Answer 38

Gotta look it up

Question 39

What is the minimum urine output per hour?

Answer 39

30 mls/hr

Question 40

Define hypernatremia: | What causes it?

Answer 40

excessive Na+ | -Increased water loss, reduced water intake, sodium gain

Question 41

What is the importance of Na+?

Answer 41

Plays a large role in water distrubution throughout the body

Question 42

What are S/S of hypernatremia?

Answer 42

- Lab findings: Na> 145 mmol/L - CNS: confusion, change in LOC, change in muscle tone - Thirst - Dehydration

Question 43

Define hyponatremia:

Answer 43

low levels of sodium

Question 44

What causes hyponatremia?

Answer 44

- Increase water intake - Reduced water loss - Sodium loss

Question 45

What are S/S of hyponatremia?

Answer 45

Lab: Na+

Question 46

What is hemodilution?

Answer 46

Decreased concentration (as after hemorrhage) of cells and solids in the blood resulting from gain of fluid—compare hemoconcentration.

Question 47

What is hemodialysis?

Answer 47

Hemodialysis is a therapy that filters waste, removes extra fluid and balances electrolytes (sodium, potassium, bicarbonate, chloride, calcium, magnesium and phosphate).