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NURS 205 > Management of Common Fluid Imbalances > Flashcards

Management of Common Fluid Imbalances Flashcards

1
Q

What are the major body fluid compartments?

A

ECF & ICF

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2
Q

Describe the components of extracellular fluid. (3)

A
  • Intravascular: plasma (liquid portion of blood)
  • Between cells: interstitial & lymph (immune system fluid)
  • Transcellular fluid
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3
Q

True or false: 1/3 of the body’s water is ECF.

A

True

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4
Q

True or false: 2/3 of the body’s water is ICF.

A

True

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5
Q

Where is intracellular fluid located?

A

Within cells.

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6
Q

What are the percentages of plasma, interstitial fluid and intercellular fluid?

A
  • Plasma = 5% (3L)
  • Interstitial fluid = 15% (10L)
  • Intracellular fluid = 40% of body weight (25L)
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7
Q

Explain how fluid gain/loss is calculated.

A

1L water=1kg

Ex: pt who is on a diuretic loses 2 kg in 24 hrs. They lost 2L of blood. Cardiac pts must keep fluid balance within a narrow range & daily weighs are often taken.

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8
Q

True or false: Body weight change is an excellent indicator of fluid loss or gain

A

True

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9
Q

What are electrolytes?

A

Substances whose molecules dissociate into ions (charged particles) when placed into water.

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10
Q

What are cations? List some examples. (4)

A

Cations: Positively charged ions

Sodium (Na+)
Potassium (K+)
Calcium (Ca2+)
Magnesium (Mg2+)

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11
Q

What are anions? List some examples. (3)

A

Anions: Negatively charged ions

Bicarbonate (HCO3-)
Chloride (Cl-)
Phosphate (PO4-)

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12
Q

What unit are electrolytes measured in?

A

mmol/L

It’s the weight of the ion in one liter of solution.

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13
Q

What is the composition of electrolytes?

A

ECF (plasma/interstitial)

  • Main cation is Na
  • Main anion is Cl

ICF

  • Main cation is K
  • Main anion is P
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14
Q

What are the mechanisms controlling fluid and electrolyte movement? (6)

A
  • Diffusion
  • Facilitated diffusion
  • Active transport
  • Osmosis
  • Hydrostatic pressure
  • Oncotic pressure
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15
Q

What is diffusion? Provide an example.

A

Diffusion: movement of molecules from high to low concentration.

  • Membrane separating two areas must be permeable to the diffusing substance.
  • Requires no energy
  • Ex: lump of sugar dissolving in water
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16
Q

What is facilitated diffusion? Provide an example.

A

Facilitated diffusion: movement of molecules from high to low concentration without energy.

  • Uses specific carrier molecules to accelerate diffusion
  • Ex: Glucose transport into the cell = Glucose cannot cross through diffusion so it passes across via facilitated diffusion which involves molecules moving through the membrane by passing through channel proteins.
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17
Q

What is active transport? Provide an example.

A

Active transport: process in which molecules move against concentration gradient.

  • External energy is required
  • Ex: sodium–potassium pump
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18
Q

What is osmosis? Provide an example.

A

Osmosis: movement of water between two compartments by a membrane permeable to water but not to solute.

  • Moves from low solute to high solute concentration
  • Requires no energy
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19
Q

What is osmotic pressure?

A

Osmotic pressure: the amount of pressure required to stop the osmotic flow of water.

  • Determined by the concentration of solutes in the solution
  • Can be expressed as fluid osmolarity or fluid osmolality
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20
Q

What is oncotic pressure?

A

Oncotic pressure (colloidal osmotic pressure) is osmotic pressure exerted by colloids in solution.

The major colloid in the vascular system contributing to the total osmotic pressure is albumin.

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21
Q

What is Albumin. What is its importance? What happens if it’s low?

A
  • It’s Protein made by your liver.
  • It helps keep fluid in the vascular space
  • If albumin is low, fluid leaks out of vascular space
  • After surgery, you can administer it. It will prevent fluid from leaking out of the vascular space, thus decreasing edema. It also treats low blood volume (hypovolemia).
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22
Q

What is osmolality? Why is it used?

A

Osmolality: measure of osmotic force that is the concentration of molecules per weight of water
- Measure for evaluating concentration of urine, body fluids and plasma

To understand the water balance of the body:
- Plasma osmolality (280-300 mmol/kg)

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23
Q

Are cells affected by the osmolality of the fluid that surrounds them? Explain.

A
  • Fluids with the same osmolality as the cell interior are ISOTONIC
  • Fluids in which the solutes are less concentrated than they are in the cells are HYPOTONIC.
  • Fluids in which the solutes are more concentrated than they are in the cells are HYPERTONIC
  • Normally the ECF and ICF are isotonic to one another
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24
Q

Describe the effects of water on RBCs.

A

RBC in hypotonic solution = cell swells

RBC in isotonic solution = cell remains the same

RBCs in hypertonic solution = cell shrinks

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25
Q

What is hydrostatic pressure? Provide an example.

A

Hydrostatic pressure: force within a fluid compartment

  • Major force that pushes water out of vascular system at capillary level.
  • Ex: Increased elevation of blood increases the amount of hydrostatic pressure. For instance, the veins and capillaries in our feet have about 100 mm Hg more pressure inside than those at heart level.
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26
Q

Describe what happens when fluid shifts.

A

Plasma -> Interstitial fluid shift = edema

  • Elevation of venous hydrostatic pressure (ex: in heart failure blood pools in capillaries so fluid shifts into ISF).
  • Decrease in plasma oncotic pressure (ex: liver or renal disease).
  • Elevation of interstitial oncotic pressure (ex: burn; proteins leaks out & swelling)

Interstitial fluid -> Plasma

  • Fluid drawn into plasma space with increase in plasma osmotic or oncotic pressure
  • Increasing the tissue hydrostatic pressure
    (ex: compression stockings decrease peripheral edema)
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27
Q

What is fluid spacing?

A

First spacing: normal distribution of fluid in ICF and ECF

Second spacing: abnormal accumulation of interstitial fluid (edema)

Third spacing (third space syndrome): fluid accumulation in part of body where it is not easily exchanged with ECF (increased transcellular fluid)

  • Ex: ascites, burns, pleural effusions, bowel obstructions
  • Ex: Fluid buildup b/w pleural which causes lungs to collapse
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28
Q

What parts of the body are responsible for the regulation of water balance?

A

1) Hypothalamus
2) Pituitary (SIADH
Diabetes Insipidus)
3) Adrenal cortical
4) Renal (primary organ for regulation)
5) Cardiac
6) Gastrointestinal
7) Insensible water loss

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29
Q

How does the hypothalamus regulate water balance?

A
  • Stimulates you to drink & release of anti-diuretic hormone
  • Anti diuretic hormone=retains water
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30
Q

How does the pituitary regulate water balance?

A

SIADH: abnormal antidiuretic hormone (ADH) production
- Ex: brain; fluid overload

Diabetes insipidus: reduction in ADH production

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31
Q

How does the renal regulate water balance?

A

We can go into fluid overload, which may result in us requiring dialysis.

32
Q

How does cardiac regulate water balance?

A

Fluid overload (recognizes an increase)

33
Q

How does the GI tract regulate water balance?

A

Vomiting / diarrhea

34
Q

What’s the name of the cardiac hormone that senses increased fluid volume?

A

Atrial natriuretic factor (ANF)

35
Q

What are the serum electrolytes?

A 
Sodium (Na)
Potassium (K)
Chloride (Cl)
Bicarbonate (HCO3)
Urea nitrogen (BUN)
Creatinine (CR)
36
Q

What is sodium responsible for? What is the normal range?

A

Primarily responsible for maintaining osmotic pressure

Norm (SI units): 135 – 145 mmol/L

37
Q

What is potassium responsible for? What is the normal range?

A

Major component in cardiac function

Norm (SI units): 3.5 - 5.0 mmol/L

38
Q

What is chloride responsible for? What is the normal range?

A

In combination with sodium, chloride maintains fluid levels by regulating osmotic pressure

Norm (SI units): 95 – 105 mmol/L

39
Q

What is bicarbonate responsible for? What is the normal range?

A

Is the major buffer in the body, helping to maintain proper blood pH

Norm (SI units): 21 – 28 mmol/L

40
Q

What is urea nitrogen responsible for? What is the normal range?

A

Urea is the waste product resulting from protein metabolism

Norm (SI units): 2.5 - 6.4 mmol/L (adult)

41
Q

What is creatinine responsible for? What is the normal range?

A

Is a waste product formed when muscle tissue uses energy sources

Norm (SI units): 71- 106 umol/L

42
Q

What are the normal fluid balances in an adult for intake and output?

A 
Intake 
- Fluids: 1200 mL 
- Solid food: 1000 mL 
- Water from oxidation: 300 mL 
= Total intake: 2500 mL 
Output 
- Insensible loss (skin & lungs): 900 mL
- In feces: 100 mL 
- Urine: 1500 mL 
= Total output: 2500 mL
43
Q

What are some subjective and objective data you can gather when assessing fluid and electrolyte (im)balance?

A
  • Urine output
  • Skin turgor (sign of dehydration)
  • Vitals
44
Q

What can ECF volume imbalance result in? (2)

A
  • Hypovolemia: ECF volume deficit (ECFVD)

- Hypervolemia: ECF volume excess (ECFVE)

45
Q

What is hypovolemia?

A

Hypovolemia: an abnormal DECREASE in blood volume

46
Q

Is osmolality affected by hypovolemia?

A

Osmolality is usually unaffected because fluid & solutes are LOST in equal proportion.

47
Q

How does the body deal with hypovolemia?

A

Usually the body can compensate by fine tuning circulating levels of aldosterone, antidiuretic hormone and atrial natriuretic – the hormone produced by the atrial muscle of the heart – causing the kidneys to RETAIN additional water & sodium.

48
Q

What are the causes of hypovolemia?

A

Decreased intake
- Nausea, anorexia, inability to drink, inability to obtain water

Increased loss
- Vomiting, diarrhea, fistula drainage, GI tract suction, excessive sweating, third-space fluid shifts (e.g. burns, intestinal obstruction), overuse of diuretics, hemorrhage

49
Q

What are the populations at risk for hypovolemia?

A

Aging population is at risk (dementia; reduced thirst response = decreased intake; decreased mobility; on more meds-diuretics-; chronic med conditions)

Children: blood goes around body quicker & processed quickly. They need more intake.

50
Q

When inspecting for hypovolemia, what are you looking for and what do you expect to find? (6)

A
  • Neurological changes: Weakness, restlessness, agitation, twitching
  • Cardiovascular changes: increased heart rate, orthostatic hypotension, weak, thready pulse that is easily obliterated & flattened neck veins
  • Respiratory changes: increased respiratory rate due to decreased tissue perfusion
  • Renal: decreased urine output
  • Weight loss
  • Decreased skin turgor, dry mucous membranes
51
Q

What are the different methods of hydrating a patient and when should they be used?

A

Oral (no caffeine or carbonation)

Unrestricted sodium

Isotonic IV fluids (N/S or L/R)

Fluid challenge/bolus may be considered pending the circumstances

52
Q

What are the types of IV solutions? (3)

A

Isotonic solutions

Hypotonic solutions

Hypertonic solutions

53
Q

What are isotonic solutions?

A

Isotonic solutions: have the same effective osmolality as body fluids (close to 285 milliosmoles [mOsm]). An example of an isotonic fluid is 0.9% sodium chloride

54
Q

What are hypotonic solutions?

A

Hypotonic solution: has a lower osmolality than body fluids; an example of a hypotonic fluid is 0.45% sodium chloride

55
Q

What are hypertonic solutions?

A

Hypertonic solution: has an effective osmolality greater than that of body fluids; an example of a hypertonic fluid is 3% sodium chloride

56
Q

What are the most commonly used IV solutions?

A

Normal saline & lactated ringer’s solution

57
Q

What is in NS? What is it used for? Why is it so common to use?

A
  • 0.9%NaCl
  • Expands IV volume (used in ECF volume deficits)
  • Preferred fluid for immediate response
  • Risk for fluid overload is higher (don’t give fluid too fast for ppl w/ heart problems)
  • Does not change ICF volume
  • Blood products
  • Compatible with most medications
58
Q

hat is in LR? What is it used for? Why is it so common to use?

A

Lactated Ringer’s solution is isotonic with blood and intended for IV administration

LR solution is also known as Ringer’s lactate (RL) solution

1L of RL contains:

  • 130 mEq of sodium ion
  • 109 mEq of chloride ion
  • 28 mEq of lactate
  • 4 mEq of potassium ion
  • 1.4 mEq of calcium ion
59
Q

True or false: water goes where saline is.

A

True

60
Q

True or false: if a pt is in an anerobic state, don’t use LR

A

True

61
Q

What is D5W? What is in it? What does it do? What doesn’t it do?

A
  • 5% dextrose in water
  • Isotonic (but physiologically hypotonic)
  • Provides 170 cal/L
  • Free water
  • Moves into ICF
  • May cause urinary sodium loss
  • Used to replace water losses
  • Does not provide electrolytes
62
Q

What do other IV solutions contain?

A

IV solutions with reduced saline concentrations typically have dextrose (glucose) added to maintain a safe osmolality while providing less sodium chloride

  • Ex: dextrose 5% in 0.45% Na Cl
  • Ex: dextrose 3.3% in 0.3% Na Cl (2/3 & 1/3)
63
Q

What is a complete blood count (CBC)?

A

CBC is a blood test that determines how well your body is making blood cells

64
Q

What are the 3 main categories of CBC?

A

Erythrocytes (red blood cells): responsible for delivering oxygen throughout the body. Branch off into hemoglobin and hematocrit.

Hemoglobin: the protein/iron compound on red blood cells that bind with oxygen.

Hematocrit: Percentage of red blood cells in a volume of whole blood.

65
Q

What is the normal range for hemoglobin for females? For males?

A

Female: 7.4-9.9 mmol/L (12-16 g/dL)

Male: 8.7-11.2 mmol/L (14-18 g/dL)

66
Q

What might a low hemoglobin level suggest?

A

Hemorrhage, surgery, cancer, hypervolemia (too much fluid = dilutes erythrocytes)

67
Q

What might a high hemoglobin level suggest?

A

hypovolemia (concentration of RBC= high value), blood doping, bone marrow disfunction

68
Q

What is the normal range for hematocrit for females? For males?

A

Female: 0. 35 – 0.47 volume fraction (35-47%)

Male: 0.42-0.52 volume fraction (42-52%)

69
Q

What might a low hematocrit level suggest?

A

Dilute blood

70
Q

What might a high hematocrit level suggest?

A

Fluid deficit

71
Q

What is hypervolemia?

A

An abnormal INCREASE in blood volume.

72
Q

Is osmolality affected by hypervolemia?

A

Osmolality is usually unaffected because fluid & solutes are GAINED in equal proportion.

73
Q

How does the body deal with hypovolemia?

A

Usually the body can compensate by fine tuning circulating levels of aldosterone, antidiuretic hormone and atrial natriuretic – the hormone produced by the atrial muscle of the heart – causing the kidneys to RELEASE additional water & sodium

74
Q

What are the causes of hypervolemia?

A

Increased retention

  • Congestive heart failure
  • Chronic liver disease with portal hypertension
  • Renal failure

Increased intake

  • Rare with adequate renal function
  • Excessive IV administration of fluids
75
Q

What are the populations at risk for hypervolemia?

A

Elderly patients & patients with impaired renal or cardiovascular function are especially prone to developing hypervolemia

Ex: person has acute renal failure with low urine output > hypervolemia

76
Q

When inspecting for hypovolemia, what are you looking for and what do you expect to find? (3)

A

Neurological changes: Apathy, weakness, confusion

Cardiovascular changes: Pulse is not easily obliterated, increased blood pressure, edema, distended neck veins (jugular venous distention)

Respiratory changes: patient reports shortness of breath, irritated cough & moist crackles heard on auscultation

77
Q

What are some interventions you can use for fluid or electrolyte imbalances? (8)

A

1) Primary cause must be identified & treated
2) Primary treatment: Diuretics & fluid restriction
3) Restriction of sodium intake may also be indicated
4) Measure intake & output
5) Measure daily weights
6) Good skin care
7) Elevation of edematous extremities
8) Monitor patient

NURS 205 (12 decks)

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