Homeostasis and fluid balance

Question 1

What are the three compartments that hold extracellular fluid

Answer 1

Intravascular, Interstitial (including lymph) and trans cellular (synovial, pleural, CSF)

Question 2

Which fluid compartments are sodium, potassium, and phosphate primarily concentrated in?

Answer 2

Sodium–> extracellular
Potassium and phosphate–> intracellular

Question 3

What types of things does total body fluid consist of?

Answer 3

water, glucose, creatinine, electrolytes, proteins, hormones (made of proteins or steroids (fatty acids) …

Question 4

Which of the three compartments of extracellular fluid make up the least and most amount of the ECF

Answer 4

interstitial–> largest component

transcellular–> smallest component ~ 2%

Question 5

What can pass through the selectivity permeable membrane separating the intravascular from interstitial compartment?

Answer 5

water and solutes, not large plasma proteins

Question 6

What is hydrostatic pressure?

Answer 6

It is the force of intravascular fluid exerted on the blood vessel walls

Question 7

What is the definition of osmosis

Answer 7

Movement of solvent molecules from area of low solute concentration to an area of high solute concentration.

Question 7

What is the defintion of osmotic pressure

Answer 7

It is the pressure that would have to be applied to a solvent to prevent it from moving from a low solute concentration to a high solute concentration. The osmotic pressure is being exerted by solutes to try to pull water towards high concentration

Question 7

What secretes aldosterone and what does this hormone regulate?

Answer 7

Released by the adrenal cortex and it regulates the amount of sodium reabsorbed by the kidneys (h2o follows). Also promotes potassium and hydrogen ion excretion

Question 7

What secretes antidiuretic hormone and what does ADH do?

Answer 7

The posterior pituitary secretes ADH in response to osmoreceptors in the hypothalmus responding to increases in osmolality. adh increases water absorbtion in collecting duct of kidney. Adh can also cause vasoconstriction of arterioles.

Question 7

How do hydrostatic pressure and osmotic pressure differ in arterial vs venous capillary ends. and how does this influence fluid flow?

Answer 7

arterial end –> hydrostatic pressure –> osmotic pressure = fluids and some solutes move out of the capillary
venous end –> osmotic pressure –> hydrostatic pressure = fluids and some solutes move into the capillary

Question 7

What are examples of inputs? Examples of outputs?

Answer 7

oral, IV fluids/meds/blood products, tubes (orogastric, nasogastric, [gastrostomy and jejunostomy–> put in surgically, laparoscopically, percutaneously)

Output
urine, bowel movement (liquid, weighed), emesis, suctioning from tubes, drains (ex. pleural effusions, wounds)

Question 7

What is Hypervolemia? What is hypovolemia?

Answer 7

Hypervolemia is too much fluid (volume) in the intravascular space and Hypovolemia is too little fluid (volume) in the intravascular space

Question 8

What is the definition of Edema?

Answer 8

Too much fluid in the interstitial space. It can be localized or generalized (anasarca)

Question 9

What is third spacing? Is it a fluid loss?

Answer 9

accumulation of trapped extracellular fluid in a transcellular compartment. This is a volume loss (fluid not available to normal physiological processes)

common places: pericardial, peritoneal, joint cavities

pt. will present with low BP

Question 10

Fluid volume deficits can be classified according to serum Na+ concentration. What are the types and describe them? Which type is most frequently seen in hypovolemia?

Answer 10

Isotonic (MOST COMMON IN HYPOVOLEMIA). H2O loss = Na+ loss –> serum Na+ remains i.e, hemorrhage, inadequate intake of fluids

Hypertonic–> loss of H2O is greater then loss of Na+. Thus serum sodium goes up. You will see dilute urine and body will move fluid from intracellular to intravascular compartment causing cell dehydration.
Seen in diarrhea or kidney disease

Hypotonic–> more sodium is lost then water. Thus there is a decrease in serum sodium levels.–> water moves intravascular–> intracellular causing cell swelling.

for example if there is excessive loss of GI fluid loss and only water replacement.

or this can be the case in some diuretics

Question 11

What are the cardiovascular and respiratory findings of hypovolemia (isotonic)

Answer 11

increased thready HR
decrease BP and orthostatic hypotension
decrease peripheral pulses
flat veins
increase respiratory rate and depth of breathing and difficulty breathing

Question 12

What are the Neuromuscular signs of hypovolemia

Answer 12

confusion, lethargy, coma, dizziness, skeletal muscle weakness

Question 13

What are the renal, integumentary, and GI findings of hypovolemia

Answer 13

Renal–> decreased urine output

skin –> thirst, dry mouth, poor skin turgor (tenting)

GI–> decreased bowel sounds, constipation, weight loss

Question 14

What percent of total body weight does fluid account for in Adults, Older Adults and infants

Answer 14

Adults- 60%
Older Adult 55%
Infants - 80%

Question 15

What is often the first sign of hyovolemia in older adults?

Answer 15

confusion- because they have decreased thirst sensation

Question 16

How to assess for and manage hypovolemia as a nurse?

Answer 16

Monitor Ins/Outs
Monitor daily body weight
Monitor moistness of mucus membranes and skin turgor
monitor pulse- pay attention to rate, rhythm and quality

Question 17

What kind of fluids (isotonic, hypotonic, hypertonic), should you use for
isotonic losses?
hypertonic losses?
hypotonic losses?

Answer 17

isotonic losses–> isotonic fluids
hypertonic losses–> hypotonic fluids
hypotonic losses–> hypertonic fluids

Question 18

Ringers lactate is isotonic or hypotonic?

What are some things to beware of before administering ringers?

Answer 18

Isotonic (0.9% normal saline)

-contains potassium–> if pt has high K+ consult physician before administering.
-liver impairment? pt will have challenges metabolizing lactate

Question 19

Someone has a hypertonic loss resulting in an increase in serum sodium levels. This causes movement of fluid from the intracellular compartment to the intravascular compartment. This results in cell dehydration and hyper natremia

What are the types of hypotonic fluids that can be used to treat this conditon and how will they achieve treatment

What do you have to watch out for with these treatments?

Answer 19

1/2 NS
1/3 NS
5% dextrose in water

these have lower sodium than fluids inside cells which will push fluid into the cell.

watch out for hypovolemia–> if give to much

watch out when giving to pt with increased intracranial pressure

beware of giving dextrose solution to diabetics for risk of hyperglycemia

Question 20

What are examples of Hypertonic fluids?

What do they do?

What are they used for

What to monitor for? What to watch out for if you are giving to much?

Answer 20

examples are 5% Normal saline
5% dextrose in water with 1/2 Normal saline
5% dextrose in water with ringers lactate

these will pull fluids out of cells into extraceullar fluid compartments

used in hypovolemia or if there is swelling in extracellular ocmparments

watch out for bounding pulse, distended neck veins, increased BP or crackles on auscultation

Question 21

After replacing fluids (pt. is on IV) what is the expected urine out put

Answer 21

expected–> concentrated- hold onto fluid until volume restored

abnormal–> oliguria (< 30 ml/hr or < 1 mL/Kg/hr)

Question 22

What is the street name for dimenhydrinate?
What is the therapeutic class?
What are the side effects?
What are nursing considerations when giving it?

Answer 22

1. Gravol
2. antiemetic- treat nausea and vomiting
3. dizziness, headache, hyperexcitability (peds), loss of appetite, drowsiness
4. older clients- falls, absorption issues (when given orally) for severe vomiting, can also be given rectally, IM, IV

Question 23

What is the street name for ondansetron?
what is the therapeutic class?
What does it do?
What is the pharmacologic class?
What is the route of administration?
Nursing considerations?

Answer 23

1. zofran
2. antiemetic
3. treat nausea and vomiting
4. 5-HT antagonist- blocks effect of serotonin in CNS
5. oral, IM, IV
6. rapid IV infusion (IV push)- heart dysrhythmias

Question 24

What are the four categories of common lab tests. What are the main components tested in each category?

Answer 24

CBCs –> RBCs (RBC, Hb, Hct, MCV, MCH, MCHC, RDW)
renal–> (Cr, BUN, eGFR)
LFTs–> (alanine transaminase, aspartate aminotransferase)
Lytes–> Na, K, Cl, HCO3

Question 25

examples of why you would you want to test LFTS

Answer 25

liver disease detection
monitor liver disease
assessment of medication effects/can somone tolerate a med with known liver toxicity
eval of weird blood work
eval of unexplained symptoms
preoperative assessment

Question 26

What are the three names for the causes of shock

Answer 26

Hypovolemic
cardiogenic
distributive

(there is also obstructive but it is not in the notes)

Question 27

What are the subtypes of distributive shock?

Answer 27

Neurogenic, anaphylactic, septic

Question 28

What are the three stages of shock and some symptoms in each type

Answer 28

Compensatory–> Normal BP with an increase in heart rate and resp rate
-blood shunting to vital organs
-pale skin
-hypoactive bowel sounds
-decreased Urinary output
-confusion

Progressive–> decrease in blood pressure and decrease in level of consciousness
-mottling of skin

irreversible –> severe and permanent organ damage leading to death

Question 29

What is MAP?
What is the range MAP should be in?
What is MAP a product of?

Answer 29

MAP–> mean arterial pressure .. it is the pressure against your arterial walls

70-100 mm Hg

cardiac output x total peripheral resistance = MAP

Question 30

what is cardiac output a product of?

Answer 30

stroke volume x heart rate

Question 31

How much fluid do you have to lose to go into hypovolemic shock?

What is an example of an external loss? What is an example of an internal fluid loss?

Answer 31

750 ml

external- fluid is lost externally- hemorrhage

internal- fluid shifts (third spacing). ex. ascites

Question 32

Explain frank starlings law?

Answer 32

increased venous return = muscles of heart stretch which increases contractility

Question 33

Nursing treatment of shock

Answer 33

put patient in a position where there feet are slightly elevated, administer IV fluids, medications, and blood products according to physicians orders

-apply oxygen

Question 34

Just like fluid volume deficit could be categorized according to serum sodium concentration. Fluid volume excess or hypervolemia can also be categorized as isotonic, hyper tonic and hypotonic. Explain what each is and what it will cause in the body

Answer 34

Isotonic (most common)–> water and sodium Gain are ~ equivalent. resulting in expansion of extracellular compartments meaning circulatory overload in the intravascular compartment and edema in the intercellular compartment

cause- excessive iv therapy, kidney disease

Hypertonic (rare)–> body has overload of fluid that has sodium in excess. body responds by moving fluid from intracellular compartment to intravascular = cell dehydration
cause–> excessive sodium intake, rapid hypertonic saline infusion

Hypotonic excess–> h20 gain is greater then saline. body moves fluid from intravascular to intracellular= cells swell and generally an excess of fluid in extracellular compartments

*when doing c sections common to fluid overload someone

Question 35

List the cardiovascular, respiratory, neuromuscular, renal, integumentary, and GI fundings of hypervolemia

Answer 35

CV–> increased heart rate that has a bounding pulse, distended veins, high blood pressure

respiratory–> increased respiratory rate, shallow breathing, dyspnea, crackles on auscultation

neuromuscular–> confusion, headache, decreased LOC, coma

renal–> increased urinary output (if the kidneys are compensating)
if there is kidney damage then reduced urinary output

integumentary–> cool, pale skin and putting edema

GI–> increased bowel sounds and motility, diarrhea, weight gain

Question 36

What are some nursing management interventions for someone with hypervolemia?

Answer 36

-monitor Ins/outs to determine retention

-monitor daily body weight - weight gain 1 kg = ~1L of fluid

-monitor vs palpate pulse (rapid? bounding?)
monitor breath sounds– crackles?

-monitor skin- edema (usually beginning in feet)

-pt might be on a fluid restricted diet or sodium restricted diet— educate about this

-monitor electrolyte lab values

-administer meds to correct symptoms

Question 37

What therapeutic class is furosemide? what pharmacy class is it? why is it used? side effects? nursing considerations?

Answer 37

therapeutic class–> diuretic
pharmacy class–> loop diuretic
uses–> mobilize excess fluid and decrease BP
common side effects–> dizziness, headache, hypotension, electrolyte imbalance
nursing considerations–> in older clients consider postal hypotension and electrolyte imbalance, also consider pre-existing kidney function and impact on kidneys

Question 38

When doing lab investigations what molecular compounds are often looked at when assessing renal

Answer 38

creatinine- waste product of creatine phosphate
blood urea nitrogen (BUN)- normal waste product

build up of these = bad kidneys

eGFR

Question 39

Under a typical electrolyte lab investigation which electrolytes are looked at?

Answer 39

sodium, potassium, chloride, bicarbonate

Question 40

98% of Potassium is found in which compartment?

The normal physiological range is ?

it aids in contraction of?

Answer 40

intracellular

3.5-5 mol/L

muscle and heart contraction