fluid imbalances Flashcards
1
Q
what is body fluid
A
- water within the body and particles dissolved in it
2
Q
what is total body water (TBW) ?
A
- sum of fluids within all body compartments (all fluid in body)
3
Q
what is extracellular fluid?
A
- fluid outside of the cell
- 1/3 TBW
4
Q
what is interstitial compartment?
A
- between cells and outside of blood vessels
5
Q
what is intravascular compartment?
A
- in the blood vessels
- ex: blood plasma or serum
6
Q
what is intracellular fluid? and how much of it is TBW?
A
- inside the cell
- 2/3 TBW
7
Q
what is the number 1 fluid excretion?
A
- pee or the urinary tract
8
Q
what is urine volume dependent on?
A
- adequate blood pressure to kidneys for proper perfusion
- glomerular filtration rate (GFR)
9
Q
what is the expected GFR?
A
- 1 mk per kg of body weight an hour for an adult
10
Q
what affects fluid excretion?
A
- hormones
11
Q
what hormones effect how much fluid is excreted?
A
- Antidiuretic hormone (ADH)
- Aldosterone
- Also makes you pee less
- Natriuretic peptides (ANP and BNP)
- All connected to the RAAS
12
Q
what does antidiuretic hormone (ADH) ?
A
- makes you pee less, excrete less urine
13
Q
what does aldosterone do?
A
- makes you pee less
- reabsorbed sodium and h20 and excrete potassium
14
Q
what are natriuretic peptides (ANP and BNP)
A
- opposite of aldosterone, helps get rid of urine, but if it’s peptides vs aldosterone, aldosterone always wins, meaning that you don’t pee
15
Q
what is does RAAS stand for?
A
- R = renin
- A = angiotensin
- A = aldosterone
- S = system
16
Q
what does renin do?
A
- hormone secreted by kidney to help regulate blood and pressure by breaking angiotensin into Angiotensin 1
17
Q
what does Angiotensin do?
A
- hormone that helps regulate BP by constricting (narrowing) of blood vessels and triggering water and salt intake
18
Q
what does aldosterone do?
A
- holds onto h2o & na+ excretes potassium so you pee less but when you do pee its heavly concentrated with K+
19
Q
what are the other 4 ways of fluid excretion?
A
- urination
- bowels
- skin = through sweat and insensible perspiration
- lungs = exhalation secretes fluid
20
Q
how do nurses measure fluid imbalances?
A
- through I’s and O’s and BODY WEIGHTS to watch fluids
21
Q
what are examples of abnormal fluid loss?
A
- emesis
- tubes in the GI track or other body cavities
- hemorrhage
- drainage from fistulas, wounds, open skin
- paracentesis
- ascites
22
Q
what is a paracentesis?
A
- pulling fluid out of a drain
23
Q
what is ascites?
A
= fluid build up in abdomen
24
Q
what is fluid homeostasis?
A
- Regulation of fluids and electrolytes
25
what are the 4 general steps of fluid homeostasis?
- fluid intake
- fluid absorption
- fluid distribution
- fluid excretion
26
what is fluid intake triggered by? (intake = thirst)
- thirst is triggered by osmolality of ECF including blood volume, and dry mouth
27
what happens when your body needs/ does retain fluid?
- you get an IV, or drink more
- aldosterone or ADH gets triggered:
- meaning you hold onto fluid
- ADH only holds onto h20
28
what does high & low osmolarity mean in OJ example?
- more pulp
- low osmolarity means less pulp
- homeostats means normal pulp
29
when you have high osmolarity what does your body do?
- high osmolarity means high pulp and you need to drink more to water it down
30
when you have low osmolarity what does your body do?
- you have low pulp and your body pees more
31
where is fluid absorbed and what is it dependent on?
- GI track
- osmotically dependent
32
what primary stimulus for the sensation of thirst declines w/ aging?
- serum osmolarity
- as its the primary sensation for thirst
33
what is the number 1 protein in the blood?
- albumin
34
what does capillary osmotic pressure do?
- pulls h2o in (too much pulp, needs to water it down)
- water drawn IN from interstitial space into capillary
- opposing filtration
35
what does capillary hydrostatic pressure do?
- pushes h2o in
- too much pulp, needs to be watered down
- water moves OUT from capillaries into interstitial space
- favoring filtration
36
what does interstitial hydrostatic pressure do?
- pushes h20 out into the interstitial space
- water moves IN from interstitial space INTO capillary
- opposing filtration
37
what does interstitial osmotic pressure
- pull h20 in
- osmotically attracts water IN from the capillary into the interstitial space
- (favoring filtration)
38
what are two other ways that mean starling forces?
- net filtration
- fluid distribution
39
what does forces favoring filtration mean?
- going to something
40
what does forces opposing filtration mean?
- keep something in
41
what is the def of edema
- excessive accumulation of fluid within interstitial spaces
42
what are starling forces related causes of edema (systemic typically)
- increased capillary hydrostatic pressure
- maybe from heart / kidney failure
- decreased capillary osmotic pressure
- due to low albumin
43
what are some non starling forces related causes of edema? (localized)
- increased capillary membrane permeability
- from wound healing or inflammation
- lymphatic cannel obstruction
- may be due to the removal of lymph nodes
44
what are adverse effects of edema?
- extra distances for nutrients / waste to travel (due to impaired blood flow)
- impaired blood flow
- delayed wound healing
- increased risk of infection and pressure sores
45
what are 2 big clinical variations of localized edema?
- pulmonary edema
- cerebral edema
46
what is pulmonary edema?
- fluid in the lungs due to the heart not working (most the time)
- sounds like crackling sounds or bubbles when listening
- PT may also have pink bubbly sputum
47
what is cerebral edema?
- swelling in brain due to sodium imbalances in neurons causing CNS disturbances
- symptoms: headache, forgetfulness, vision loss, ect (gets worse)
48
what is generalized edema and two examples?
- general swelling of the whole body
- ex: dependent edema (in the legs)
- ex: pitting edema or non-pitting edema (lymphedema)
49
what is the why behind edema?
1. kidney or heart disease
2. decreased lymphatic flow
3. increased capillary hydrostatic pressure (is ALWAYS the reason behind edema)
50
how is edema assessed?
- by pushing down the skin and evaluating the depth 1+ t0 4+
51
what does antidiuretic (ADH) hormone do?
- holds on to H2o only
- dilutes body fluid (the pulp)
52
what does angiotensin do?
- reabsorbs (holds on to) BOTH h20 and NA+ but secretes potassium
- expands extracellular fluid volume (doesn't dilute it)
53
what is the function of atrial natriuretic peptides?
- excrete pee
54
What are the steps of the RAAS system from the kidney POV?
1. drop in BP = drop in fluid volume
2. renin released from the kidney
3. liver releases angiotensinogen 1 & 2
4. stimulating the reabsorption of h20 & NA+ acting directly on blood vessels narrowing to effect attempt to raise BP
55
what stimulates aldosterone release?
- angiotensin II
- actived by decrease of circulating blood volume
- increased concentration of K+ ions in plasma
- decreased fluid excretion (Causes renal tubules to reabsorb sodium & h20, & promotes excretion of K+)
56
what happens when there is decreased secretion of aldosterone released?
- larger urine volume
57
what factors increase release of ADH (antidiuretic hormone)
- increased osmolality (concentration) of extracellular fluid (plasma)
- decreased circulating fluid volume
- pain, nausea, physiological & psychological stressors (if bod`y is stressed = more fluid build up to help w/ immunity)
58
what does ADH do?
- reabsorbs only H20
- decrease urine volume and fluid excretion
- concentrates urine
59
what happens when ADH is decreased?
- large dilute urine volume
- may cause hypernatremia (increased NA+)
60
what is the difference between ADH and aldosterone?
- ADH =
- kidneys reabsorb h20 only
- dilutes body fluids
- Aldosterone =
- kidneys reabsorb water and salt
- expands extracellular fluid volume
61
what is ANP and what does it mean or do?
- ANP is A type natriuretic peptides
- means that there is too much fluid and it needs to be excreted
62
where is ANP secreted from?
- a type naturetic peptides are secreted from the cells in the heart when the atria is stretched
63
what hormone do NP's oppose?
- NP's appose the action of aldosterone but they aren't as strong, so aldosterone will always win
- causing natriuresis (sodium excretion in the urine)
64
when vascular volume is increased & decreased what does that do no NP's
- when vascular volume is increased = NP causes kidneys to excrete less fluid (pee less) opposite effect when vascular volume is decreased (np causes kidneys to excrete less fluid)
65
what is osmolality?
- concentration of molecules per weight of water
66
what is tonicity?
- effective osmolarity of a solution
67
what is a isotonic solution?
- same osmolality (equal amount of fluids and water)
- if in doubt, give isotonic solution
- 0.9 sodium chloride
68
what is a hypotonic solution?
- lower concentration of solutes, more dilute than body fluids
- more water, less pulp, more watery
69
what is a hypertonic solution?
- higher concentration of solutes than body fluids
- more pulp / solutes / particles
- body needs more fluid to go back to homeostats if swelling
- 3% sodium chloride (makes cell shrink) or moves water out of the cell
70
what solution is best for general replenishment?
- isotonic fluid
- o.9% NS
71
what are the 3 other names for isotonic solution?
- 0.9% sodium chloride (NS)
- lactated ringers
- D5W
72
what solution is best for water replacement?
- hypotonic solution
- known as 0.45% NS solution
73
what solution is best for electrolyte REPLACEMENT?
- HYPERtonic
- D10W
- 3% NS
- 25% albumin
74
what is hypovolemia? and what solution should the nurse give?
- volume depletion (low fluid volume in body)
- give isotonic solution (bc everything is low, water and pulp)
75
what is dehydration? and what solution should the nurse give?
- negative water balance
- reduced total body water
- give HYPOTONIC solution (bc osmolarity is elevated, meaning there's more pulp)
76
what fluid should nurses give to a PT with fluid volume excess? and what is it?
- elevated total body water
- give isotonic solution
- the nurse would want to give a slow isotonic drip to make sure the patient stays hydrated and the fluids are measured
77
what is hypotonic hydration? what solution should the nurse administer?
- hypotonic hydration is a positive water balance or water intoxication, too much pulp
- total water body is elevated, too much water in the body, not enough fluids
- nurse should give a hypotonic (reduced h20, more particles) solution (to replace lost other fluids)
78
what is hypovolemia?
- fluid volume deficit & fluid loss
79
How does the body go into hypovolemia?
- removal of fluid from the exocellular compartment
- GI excretion
- renal excretion
- other losses, ex = hemorrhage
- In some instances, fluid is sequestered in a third space in the body, outside the extracellular compartment (ex: fluid is going somewhere lost thats inside the body)
80
what are the clinical manifestations of hypovolemia?
- sudden weight loss
- postural BP decrease w/ increased heart rate (in pt with healthy heart)
- flat neck veins w/ pt in supine
- lightheadedness
- dizziness
- syncope
- oliguria = small volume of concentrated urine (if kidneys are responding normally) (aka = little pee)
- decreased skin turgor
- dryness of mucus membranes (Lips)
- hard stools
- soft sunken eyeballs
- in infants = frontal sunken in (!!!)
81
what are some nursing managements for hypovolemia (fluid volume deficits)
- monitoring I's and O's!!
- lab values for electrolyte
- cardiovascular = hypotension & weak pulses, but fast pulse due to an increase of HR
- raspatory = tissue perfusion and oxygen saturations (trying to breath more)
- neuro = assess orientation, vision, hearing, reflexes, and muscle strength
- daily weights
- oral and skin care = prevent breakdown (fluid gives tissue extra support)
- IV solutions = isotonic (ten monitor)
82
what is hypervolemia?
- fluid volume excess
- amount of extracellular fluid is abnormally increased
- vascular and interstitial areas have too much fluid
83
what is the "why" behind hypervolemia?
- by an addition or retention (retainment) of isotonic saline (salt) sometimes termed saline excess
- excessive secretion of aldosterone (keeps NA & H2O in, takes K out)
- causes the kidneys to retain salt, may lead to heart failure
- excessive intravenous infusion of sodium - containing isotonic solutions
- renal retention of sodium & H20
84
what are the clinical manifestations of hypervolemia
- manifestation of circulatory overload
- bounding pulse = increase of BP (strong)
- neck vein distention in upright position
- crackles in lungs = pulmonary edema due to fluid buildup in the lungs
- dyspnea = shortness of breath
- orthopnea = shortness of breath when lying on back bc pulm edema or heart problems
- sudden weight gain = bc body hands on to more fluid
- edema (any kind)
- if advanced= frothy sputum
- in infant = building frontanel
85
what is hyponatremia?
- serum sodium concentration below the normal limit
- body has low NA and too much water
- extracellular fluid (EFC) is more diluted than normal
86
why does hyponatremia happen?
- factors that produce a relative access of water proportion to salt in extracellular fluid
- 2 causes: causing cell swelling
1. a gain of relatively more water than salt:
- prolonged or excess release of ADH
- water intake that exceeds normal limit
- ex: marathon runners (get neuro issues due to low na)
2. loss of relatively more salt than water
87
what are the clinical manifestations of hyponatremia?
- mild CNS dysfunction: needs more hypertonic solution
- malaise = lack of energy
- nausea & vomiting
- headache
- Severe CNS dysfunction =
- confusion
- lethargy
- seizures
coma
- fatal cerebral herniation (pocket of brain swelling)
88
what is the treatment for hyponatremia?
- hypertonic saline solution (3% NS)
- water intake restriction: dilution hyponatremia (PT not thirsty)
89
what is hypernatremia?
- too much sodium in EFC, not enough water
- ECF is too concentrated
- cells shrivel
90
what is the etiology of hypernatremia?
- gain more salt than water
- excess release of aldosterone
- ex: poorly regulated feeding tubes
- loss of more water than salt
91
what are the clinical manifestations of hypernatremia?
- mild: thirst, oliguria (sever urine reduction), confusion, lethargy
- severe = seizures, coma, death
92
what is the treatment for hypernatremia?
- give PO fluids or isotonic fluids slowly
- potential S/E = cerebral edema secondar to rapid corrective of hypernatremia
93
what is syndrome of inappropriate ADH (SIADH)
- extracellular volume excess
- too large a volume of fluid in the extracellular compartment
94
etiology of SIADH:
- malignant tumors (in the lungs mostly can make ADH be excreted a lot)
- pulmonary TB
- drug induced
95
what are the clinical manifestations of SIADH?
- headache = cerebral edema
- muscle twitching
- weight gain
96
what is diabetes insipidus?
- too much pee, not enough fluid for the body
- extracellular volume deficit
- too much NA
- voiding up too 15 L of pee per day
97
etiology of diabetes insipidus?
- Idiopathic = diseases comes at random for unknown reasons
- surgical/nonsurgical brain trauma !
- Brain tumors !
- Hypophysectomy - pituitary gland removal
98
what are the clinical manifestations of Diabetes insipidus
- excessive urination & drinking
- presents the same as clinical dehydration
