Fluid's Flashcards by Bryan Zearfoss

What are the major electrolytes of the ICG?

Potassium

Phosphates

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What are the major electrolytes of the ECF?

Sodium

Chloride

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What is the major force of IV fluid therapy?

Osmosis

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What are the 6 main elements that require active transport?

K, Na, H, Fe, Cl, I

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What is the key assessment in fluid balance?

Weight

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What is the major solute in plasma?

Sodium

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Increased BUN is a major indicator of what?

Dehydration

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What is Hydrostatic pressure?

Pushing force of fluid against the walls of the space it occupies

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What is oncotic pressure?

Where does it occur?

The pulling force of proteins in the vascular space.

In the capillary beds

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How much do kidney’s filter a day? This amount is called?

150-180L

The GFR

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Water conservation begins after the body loses ______% of body fluids?

1-2%

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ADH is also known as ____

Why?

Vasopressin

Because it causes Vasoconstriction

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The main goal of ADH is to _____

It does this by_____

Conserve Water

Targeting the Distal tubules of the nephron

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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

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ADH is released from the ____

Posterior Hypothalamus

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Aldosterones main goal is to____

It does this by _____

Save Sodium and Water

Initates resorption of sodium. Water follows

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Aldosterone is released by the ____ in response to the ____system.

Adrenal gland

Renin-angiotensin-aldosteron system

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What three things trigger the system that releases aldosterone?

Drop in BP
Drop in Blood volume
Drop in Na and increase in Potassium

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Glucocorticoids are released by the ___ their main goal is to ___

Adrenal glands

cause the kidneys to conserve sodium and water

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Glucocorticoids are released in response to ___

stress

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ANP is relased when ______

The atria of the heart are stretched r/t increased BP or blood volume

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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)

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When is BNP released?

When the ventricles are stretched r/t increased blood pressure and volume

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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

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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?

Moderate FVD = __% of body weight lossed?

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