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NURS120 > Fluid Imbalance lecture > Flashcards

Fluid Imbalance lecture Flashcards

1
Q

1L = ? of water in the body

A

1L = 2.2 lbs

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2
Q

normal plasma osmolality level; number meaning associated with water excess or deficit

A

275-295 mOsm/kg
below -> water excess
above -> water deficit -> solute conc. increase

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3
Q

what are the electrolytes in and outside of the cell?

A

IN: K, PO4, Mg
OUT: Na, Cl, Ca, HCO3

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4
Q

what are some relationship with electrolytes IN and OUT of the cell

A

Na with K
Ca with PO4
INVERSE relationship

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5
Q

what is moving during diffusion

A

solutes move from low to high concentration

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6
Q

what are the electrolytes and molecules that require active transport

A

Na, K, Ca, H, amino acids, and some sugars

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7
Q

what is osmosis

A

water moves from low concentration solutes to high concentration solutes

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8
Q

osmolarity vs. osmolality

A

osmolarity: total solute per unit fluit outside the body; mOsm/L
osmolality: osmatic force per solvent within the vascular system; mOsm/kg

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9
Q

how does estimating serum osmolality work

A

add up all the electrolyte lab numbers;
doesn’t work for someone with abnormal glucose

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10
Q

urine osmolality level

A

100-1300 mOsm/kg

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11
Q

isotonic vs. hypotonic vs. hypertonic

A

isotonic: fluid will remain in vascular space
hypotonic: fluid leaves vascular space into cells (leading to edema)
hypertonic: fluid goes into vascular space from cells

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12
Q

what are the isotonic fluids

A
  • normal saline - 0.9% NaCl
  • lactated ringers
  • D5W
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13
Q

what is normal saline 0.9% NaCl fluid used for

A

Big idea: expands intravascular volume/space
* shock
* hyponatremia, hypocalcemia
* blood transfusions
* increase BP, replace fluids

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14
Q

what is lactated ringers fluid used for

A

Big idea: rehydrating most types of dehydration
* burns
* acute blood loss
* hypovolemia due to 3rd spacing
* lower GI loss - N&V&D

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15
Q

what is D5W used for

A

fluid loss from dehydration
hypernatremia

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16
Q

what is a hypotonic fluid

A

1/2 NS (0.45% NaCl)

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17
Q

what is 1/2 NS (0.45% NaCl) fluid used for

A

water replacement
diabetic ketoacidosis after initial normal saline
hypertonic dehydration
gastric fluid loss (NG, V)

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18
Q

what are the hypertonic fluids

A
  • dextrose 5% in 1/2 normal saline
  • dextrose 5% in normal saline
  • dextrose 5% in lactated ringers
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19
Q

dextrose 5% in 1/2 normal saline usage

A
  • severe dehydration
  • expands plasma volume
  • burns
  • diabetic ketoacidosis after NS and 1/2 NS
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20
Q

dextrose 5% in NS usage

A
  • hypotonic dehydration
  • temp fluid replacement in shock
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21
Q

dextrose 5% in LR usage

A
  • replaces ECF losses - replace electrolytes
  • mild metabolic acidosis
22
Q

what is oncotic pressure

A

the osmotic pressure induced by plasma proteins, mainly albumin

23
Q

causes of elevated venous hydrostatic pressure

A

heart failure
liver failure
fluid volume overload

24
Q

causes of decreased plasma oncotic pressure

A

malnutrition
liver/renal disease

25
Q

causes of elevated interstitial oncotic pressure

A

trauma
burns
inflammation

26
Q

what is first fluid spacing

A

normal distribution of fluid

27
Q

what is second fluid spacing

A

edema

28
Q

what is considered third fluid spacing

A

ascites: fluid accumulation in the abdomin

29
Q

what are the hormones that help maintain balance of fluids

A
  • hypothalamus - ADH
  • adrenal cortex - aldosterone
  • kidneys - renin
  • heart - ANP&BNP
  • GI - oral intake of water & Na insensible water loss
30
Q

function of ANP & BNP

A

released by the atria and ventricles, respectively, to dilate the blood vessels to decrease BP and volume; also promote the kidneys to increase water/Na excretion

31
Q

changes in the elderly

A
  • decreased renin & aldosterone effectiveness
  • increased ADH & ANP (heart issues)
  • more moisture loss through skin
  • thirst center less effective - more likely for hypernatremia
32
Q

what medication is dangerous with hypokalemia

A

digoxin

33
Q

which diuretic is potassium sparing

A

spironolactone

34
Q

dehydration

A
  • serum osmolality & Na conc. increase
  • loss of water ONLY
35
Q

hypovolemia

A
  • solute loss
  • blood loss
  • third space shift
36
Q

causes of dehydration

A
  • less water intake
  • uncontrolled diabetic mellitus (osmotic diuresis)
  • diabetes insipidus (less ADH)
  • overuse of diuretics
37
Q

difference between diabetes insipidus vs. mellitus

A

insipidus: doesn’t produce enough ADH or kidneys ignore signal
mellitus: something wrong with insulin somehwere

38
Q

lab values to look out for due to dehydration

A
  • elevated hematocrit (HCT)
  • elevated serum osmolality - 300 mOsm/kg
  • elevated serum Na - 145 mEq/L
  • urine specific gravity can be below or above depending on cause
39
Q

what fluid to give for dehydration

A

D5 in water, but don’t give too fast and not more than 1 L

40
Q

causes of hypovolemia

A
  • GI losses - NV, diarrhea, suction, fistula drainage
  • hemorrhage - inside and outside trauma
  • third spacing
41
Q

lab value changes in hypovolemia

A
  • normal or high Na levels
  • decreased Hgb & Hct due to blood loss
  • increased BUN & creatinine
  • increased urine specific gravity & serum osmolality
42
Q

hypervolemia vs. water intoxication

A

hypervolemia: excess fluid in extracellular space
water intoxication: excess fluid from extracellular space into intracellular space

43
Q

causes of hypervolemia

A
  • heart failure
  • renal failure
  • increased Na intake
  • increased cortisol secretion (Cushing’s syndrome)
  • long term use of corticosteroids
44
Q

what’s up with pink frothy sputum in hypervolemia

A

pulmonary edema - fluid & small amounts of blood leak from capillaries into the alveoli
WHICH COULD mean pt has CHF WHHHAAAAAT

45
Q

wait why can CHF lead to pulmonary edema

A

heart can’t pump efficiently, blood back up into veins and into the lungs DAMN

46
Q

what are the lab values that indicate hypervolemia

A
  • low HCT
  • low serum K and BUN
  • decreased serum osmolality
  • low oxygen level due to pulmonary edema
47
Q

how is hypervolemia treated

A
  • Na & fluid restriction
  • diuretics
  • pulmonary edema: morphine, nitroglycerine
  • HF: digoxin, oxygen
48
Q

causes of water intoxication

A
  • increased ADH secretion
  • drink lots of water
  • altered thirst mechanism
  • continuous hypo-osmolar IV fluid (1/2NS, D5W)
49
Q

labs for water intoxication

A
  • decreased Na
  • decreased serum osmolality
50
Q

treating water intoxication

A

restrict fluids, NO hypotonic fluid
hypertonic fluids used in close monitoring

NURS120 (38 decks)

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