Fluid's Flashcards
What are the major electrolytes of the ICG?
Potassium
Phosphates
What are the major electrolytes of the ECF?
Sodium
Chloride
What is the major force of IV fluid therapy?
Osmosis
What are the 6 main elements that require active transport?
K, Na, H, Fe, Cl, I
What is the key assessment in fluid balance?
Weight
What is the major solute in plasma?
Sodium
Increased BUN is a major indicator of what?
Dehydration
What is Hydrostatic pressure?
Pushing force of fluid against the walls of the space it occupies
What is oncotic pressure?
Where does it occur?
The pulling force of proteins in the vascular space.
In the capillary beds
How much do kidney’s filter a day? This amount is called?
150-180L
The GFR
Water conservation begins after the body loses ______% of body fluids?
1-2%
ADH is also known as ____
Why?
Vasopressin
Because it causes Vasoconstriction
The main goal of ADH is to _____
It does this by_____
Conserve Water
Targeting the Distal tubules of the nephron
ADH release is triggered by what three things? The opposite of these things _____ ADH
Drop in BP
Drop in Blood volume
Rise in Blood osmolarity
Inhibit
ADH is released from the ____
Posterior Hypothalamus
Aldosterones main goal is to____
It does this by _____
Save Sodium and Water
Initates resorption of sodium. Water follows
Aldosterone is released by the ____ in response to the ____system.
Adrenal gland
Renin-angiotensin-aldosteron system
What three things trigger the system that releases aldosterone?
Drop in BP
Drop in Blood volume
Drop in Na and increase in Potassium
Glucocorticoids are released by the ___ their main goal is to ___
Adrenal glands
cause the kidneys to conserve sodium and water
Glucocorticoids are released in response to ___
stress
ANP is relased when ______
The atria of the heart are stretched r/t increased BP or blood volume
The main goal of ANP is to ____
It does this by___ (4things)
Lower BP and Blood Volume
- Vasodilation
- Decreases Aldosterone
- Decreases ADH
- Increases GFR(more urine more water excreted)
When is BNP released?
When the ventricles are stretched r/t increased blood pressure and volume
What is the main goal of BNP
How is this goal achieved? (3 things)
To decrease Blood volume and pressure
- Vasodilation
- Decreased aldosterone
- Causes Diuresis of water and Na
BNP is a key lab for ____
CHF
Small shifts in _____ cause thirst
Serum osmolarity
Receptors that trigger thirst are found in the ____
They can be triggered by as little as ___ mOsm/L change
Hypothalamus
1
When thirst is triggered so are these 2 hormones
ADH and Aldosterone
When you drink water, it takes _____ minutes to be absorbed and distributed
30-60
Water is absorbed in your _____
Colon
What is the minimum fluid intake?
30ml/kg/day
How do you calculate minimum fluid intake?
100 ml/kg for the first 10Kg
50 ml/kg for the next 10Kg
20ml/kg for the remaining Kg’s
Calculate the min. fluid intake of someone weighing 30kg
1000+500+200
1700ml
What is an isotonic FVD
When equal amounts of fluid and solute are lost
What is a Hypotonic FVD?
Plasma osmolarity ____
When more electrolytes are lost than water
Decreases
What is a hypertonic FVD?
Plasma Osmolarity
When more water than electrolytes is lost
Increases
Name some of the 7 general main risk factors for FVD’s
Age, gender, Body fat Acute illness Chronic Illness Environmental Factors Diet and Lifestyle Medications Stress
What are some causes of isotonic fluid volume loss?
- Poor intake
- Excessive Gi fluid loss
- Excessive renal loss
- Excessive skin loss
- Third space loss
What are some causes of hypertonic dehydration
- Poor intake
- Prolonged isotonic loss
- Watery Diarrhea
- Diabetes Insipidus
- Increased solute intake
What are some assesment findings in a FVD?
Thirst Changes in urine volume and concentration Skin turgor Sunken eyes and fontanels Flat neck veins Hypotension Decreased CO Mental status changes Fever Weight loss
Mild FVD = __% of body weight lossed?
2
Moderate FVD = __% of body weight lossed?
5
Severe FVD = __% of body weight lossed?
8 or higher
FVD will should a kidney output of less than ____ and hr and a urine specific gravit of greater than ___
30
1.030
How will FVD effect BP?
It will cause orthostatic Hypotension
What is a normal CVP?
2-8 cm of H2O
What are the 5 types of diagnostic/lab findings that are used to detect FVD?
Direct measurements -ABG -PA lines (CO2 measurements) -CV lines(CVP) HCT&BUN Urine Specific Gravity Urine Osmolarity Plasma Concentration -Osmolarity -Sodium -Glucose
If BUN is increased and creatinine is normal what is the likely reason?
FVD
What are the four types of interventions for FVD?
Which one is the first choice?
Oral replacement First choice
Parenteral replacement
Monitoring during therapy
Medication
What is an example of an Oral replacement Therapy solution?
Pedialyte or Half strength Gatorade
Isotonic Fluids fix _____ FVD
Isotonic
What are the features of Isotonic fluids?
Same osmolarity as plasma
Replaces ECF and electrolytes
They expand volume quickly
No calories
What are the 4 main isotonic solutions?
0.9% NaCl (normal saline solution)
Ringers solution
Lactated ringers solution (LR)
5% dextrose in water
Hypotonic Solutions fix _____ FVD
Hypertonic
What are the features of hypotonic solutions?
Lower osmolarity than Plasma
Prevent/Treat cellular dehydration
Using hypotonic solutions is contraindicated in ____
Why?
Acute Brain injuries
The brain will suck up the solution and swell
What are the frequent assessments required when administering hypotonic solutions?
Why?
VS
LOC
Circulation
Because of the risk of cerebral edema
What are the two main Hypotonic solutions
1/2 NS solution
1/4 NS solution
Hypertonic solutions fix ____ FVD
Hypotonic
What are the features of Hypertonic fluids?
Higher osmolarity than plasma
Require close monitering
Used in limited doses
Require use of infusion pump
What are the 5 main hypertonic fluids?
3% NaCl solution 5% NaCl solution D10W 50% dextrose D51/2NS, D5NS, D5LR, D51/4NS
What is 50% dextrose used for?
DKA
What is a crystaloid solution?
A solution that does not cause a fluid shift
What is a colloid solution?
A solution that causes a fluid shift
What is an Isotonic FVE?
(Hypervolemia and edema)
When there is a proportional gain in fluid and Solute
In an isotonic FVE there is excess in which two fluid compartments?
Vascular and interstitial
What are the 5 main causes of an isotonic FVE?
Renal failure Heart Failure Excess intake High Corticosteroid levels High Aldosterone
A hypotonic FVE is also know as ______
Water intoxication
What are the characteristics of a hypotonic FVE?
More fluid than solute is gained
Serum Osmolality falls
What are some causes of a hypotonic FVE?
Plain water irrigation Hypotonic IV fluids Overzealous plain water intake Diluted formula in infants SIADH Psychogenic Polydipsia Severe prolonged FVE with existing diseases states
What can cause SIADH?
Head/Brain trama
What are some positive assessment findings in FVE?
Bulging Fontanels High CVP JVD Third Spacing Bounding Pulse INcreased BP
What are three examples of third spacing?
Peripheral Edema
Pulmonary Edema
Ascities
What are three signs of pulmonary edema?
Shortness of breath
Crackles
Clear white sputum
What are four main causes of edema?
INcreases capillary Hydrostatic Pressure
Decreases Capillary onconic pressure
Lymphatic Obstruction or removal
Sodium Excess
What causes increased capillary hydrostatic pressure?
Hypertension and hypervolemia
What causes decreased Capillary Onconic Pressure?
Decreased Albumin Injury Inflammation Malnutrition Liver dysfunction
How will weight be affected by FVE?
it will increase
What lab values will suggest a FVE?
Decreased sodium, bun, and HCT
What are some interventions for FVE?
Restrict fluid intake Promote excretions Monitor during therapy Prevent more excess Be alert for acute Pulmonary edema Patient education
What are four things that promote excretion of excess water in a FVE?
Diuretics
hBNP
Digoxin, ACE inhibitors
Protein intake
