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NURS 205 > Lecture 3: Management of Common Fluid Imbalances > Flashcards

Lecture 3: Management of Common Fluid Imbalances Flashcards

1
Q

what % of adult body weight is water

A

60

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2
Q

what are the 2 body fluid compartments

A
  1. extracellular
  2. intracellular
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3
Q

what is extracellular fluid (ECF)

A
  • 1/3 of body water
    1. Intravascular: plasma (5%) (liquid portion of blood)
  • btwn cells: interstitial (15%) and lymph (immune system fluid)
    2. Transcellular fluid (CSF, GI tract, pleural spaces, synovial spaces, peritoneal spaces)
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4
Q

intracellular fluid (ICF)

A
  • 2/3 of body water
  • located within cells
    (40% of body weight)
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5
Q

calculation of fluid gain/loss

A

1 L of H20 weighs 1 Kg
body weight change is a great indicator of fluid loss (ex: daily weights)

if a pt is on a diuretic loses 2kg in 24 hrs they have lost approx 2 L of fluid

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6
Q

what are electrolytes

A
  • molecules dissociate into ions when in water
  • cations: positively charged (Na+,K+,Ca2+, Mg2+)
  • anions: -‘ve charge (bicarbonate, Cl-, phosphate)
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7
Q

measurement of electrolytes

A

mmol/L

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8
Q

mech for controlling fluid and electrolyte movement

A
  • diffusion
  • facilitated diffusion
  • active transport
  • osmosis
  • hydrostatic pressure
  • oncotic pressure
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9
Q

what is diffusion

A

movement of molecules from high to low concentration
- membrane separating the 2 areas must be permeable to diffusing substances
- no ATP

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10
Q

facilitated diffusion

A
  • movement of molecules from high to low concentration
  • no ATP
  • uses specific carrier molecules to accelerate diffusion
  • glucose transport into the cell
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11
Q

active transport

A
  • process in which molecules move against concentration gradient (ex: Na-K pump)
  • external energy required
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12
Q

osmosis

A
  • movement of h2o btwn 2 compartments by membrane permeable to h2o but not solute
  • moves from low to high solute
  • no ATP
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13
Q

osmotic pressure

A

amount of pressure required to stop osmotic flow of water
- determined by concentration of solutes in solution

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14
Q

osmolality

A

concentration of molecules per weight of water

plasma (liquid portion in blood) osmolality is 280-300 mmol/kg

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15
Q

oncotic pressure

A

(colloidal osmotic pressure)
- osmotic pressure exerted by colloids in solution

major collioid in vascular sys contributing to total osmotic pressure is albumin

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16
Q

albumin

A
  • protein made by liver
  • keeps fluid in vascular space
  • albumin is low, fluid leaks out of vascular space
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17
Q

fluids with the same osmolality as the cell interior are ->

A

ISOTONIC, normally the ECF and ICF are isotonic to one another

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18
Q

fluids in which solutes are less concentrated than they are in cells are

A

HYPOTONIC (goes in)

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19
Q

fluids in which the solutes are more concentrated than they are in the cells are

A

HYPERTONIC (goes out)

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20
Q

hydrostatic pressure

A
  • force within fluid compartment
  • major force that pushes water out of vascular sys at capillary level
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21
Q

Fluid shifts

A
  1. plasma -> interstitial fluid shift = EDEMA
    - increased venous hydrostatic pressure
    - decrease in plasma oncotic pressure
    - elevation of interstitial oncotic pressure
  2. interstitial fluid -> plasma
    - fluid drawn into plasma space with increase in plasma osmotic or oncotic pressure
    - increasing the tissue hydrostatic pressure
22
Q

what can help decrease peripheral edema

A

compression socks

23
Q

fluid spacing (1st, 2nd, 3rd)

A

1st: normal distribution of fluid in ICF and ECF
2nd: abnormal accumulation of interstitial fluid (edema)
3rd: fluid accumulation in part of body where it is not easily exchanged w ECF

24
Q

what regulates water balance

A

hypothalamic
pituitary
adrenal cortex
renal
cardiac
gastrointestinal
insensible water loss

25
serum electrolytes: Na
responsible for maintaining osmotic pressure norm: 135-145 mmol/L
26
serum electrolytes: K
component in cardiac function norm: 3.5-5 mmol/L
27
serum electrolytes: Cl
in combo w Na, Cl maintains fluid levels by reg osmotic pressure norm: 95-105 mmol/L
28
serum electrolytes: bicarbonate (HCO3)
major buffer in body, helping to maintain proper blood pH norm: 21-28 mmol/L
29
serum electrolytes: urea nitrogen (BUN)
urea is the waste product resulting from protein metabolism norm: 2.5-6.4 mmol/L (adult)
30
serum electrolytes: creatinine (CR)
waste product when muscle tissue uses energy sources norm: 71-106 umol/L
31
normal intake in adult
fluids - 1200 ml solid food - 1000 ml water from oxidation 300 ml total intake - 2500 ml
32
normal output in adult
- insensible loss (skin and lungs) - 900 ml - in feces - 100 ml - urine - 1500 ml total output: 2500 ml
33
ECF volume imbalances
- commonly occur - accompanied by 1 or more electrolyte imbalanced either have: 1. ECF volume deficit = hypovolemia 2. ECF volume excess = hypervolemia
34
what is hypovolemia
ECF volume deficit - decrease in blood volume - body can compensate, causing kidneys to retain xtra water and Na
35
causes of hypovolemia
- decreased intake - increased loss
36
populations at risk for hypovolemia
- kids: immature kidneys, higher metabolic rate, immature endocrine sys, greater BSA - elderly and disabled: chronic med conditions, decreased thirst response, decreased mobility, med effects
37
how to look for hypovolemia
- neuro changes: weakness, restlessness, agitation, twitching - cardio: increased HR, orthostatic hypotension, weak, thready pulse that is easily obliterated and flattened neck veins - resp change: increased RR - renal: decreased urine output weight loss decreased skin turgor
38
3 types of IV solutions
1. Isotonic solutions (have same effective osmolality as body fluids (close to 285 milliosmoles [mOsm]). An example of an isotonic fluid is 0.9% sodium chloride & lactated ringers 2. A hypotonic solution (has a lower osmolality than body fluids; an example of a hypotonic fluid is 0.45% sodium chloride 3. A hypertonic solution has an effective osmolality greater than that of body fluids; an example of a hypertonic fluid is 3% sodium chloride
39
normal saline
0.9% NaCl - Expands IV volume - Preferred fluid for immediate response - does not change ICF volume - run w blood products; versatile - compatible w most meds
40
lactated ringers
- the solution is isotonic w blood and intended for IV admin
41
D5W
- 5% dextrose - isotonic - 170 cal/L - Free water - Moves into ICF - can cause urinary Na loss - used to replace water losses - does not provide electrolytes
42
cbc
complete blood count 3 categories: 1. leukocytes 2. erythrocytes (hemoglobin [protein compound that bind w o2], and hematocrit [% of RBC]) 3. platelets
43
hemoglobin amount norm
female: 7.4-9.9 mmol/L male: 8.7-11.2 mmol/L
44
low hemoglobin
not enough o2, could be an iron deficiency, **too much fluid in blood because it has diluted the red blood cells**, also that they have lost a lot of blood, anemia, cancer
45
high hemoglobin
to low fluid, if you live at a high altitude, bone marrow disfunction, blood doping,
46
hematocrit levels
female: 0.35-0.47 volume fraction male: 0.42-0.52 volume fraction
47
low hematocrit
fluid volume excess
48
high hematocrit
fluid volume deficit (causes dehydration)
49
ECF volume excess (hypervolemia)
- abnormal increase in blood volume - kidneys to release additional water and sodium causes: increased retention (CHF, chronic liver disease, renal failure), increased intake (rare w adequate renal function, excessive IV administration of fluids sympt: apathy, confusion, pulse not easily obliterated, increased bp, SOB (neuro, cardio, resp)
50
edematous skin
1+ (2mm indentation) to 4+ (pitting, 8mm indentation)

NURS 205 (18 decks)

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