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week 1 Flashcards

fluid balance disturbances

1
Q

name the 2 fluid compartments

A

intracellular space (ICF)
extracellular space (ECF)

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2
Q

intracellular fluid makes up ___ of total amount of fluids, mostly in __ ___ ___

A

2/3; skeletal muscle mass

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3
Q

extracellular fluid makes up ___ of total amount of fluid volume

A

1/3

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4
Q

ECF transcellular fluid ____

A

cerebrospinal fluid (CSF), pericardial, synovial, pleural, sweat, digestive, intraocular

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5
Q

what is CVP?

A

central venous pressure

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6
Q

where is CVP measured?

A

Right atrium

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7
Q

ECF fluid shifts into a space that doesn’t contribute to equilibrium

A

third spacing

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8
Q

does 3rd spacing mean fluid volume excess?

A

no

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9
Q

CVP is a ___ ____ indicator

A

fluid volume

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10
Q

low CVP = ___ FV

A

low

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11
Q

high CVP= ___ FV

A

high

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12
Q

define tonicity

A

the ability to make things move

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13
Q

define osmolarity

A

number of milliosmoles per liter of solution;
describes IV fluid due to being out of a liter

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14
Q

define osmolality

A

number of milliosmoles per kg of solvent;
weight

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15
Q

tonicity: isotonic=

A

fluid that has the same proportion of weight of particles and water; perfectly balanced

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16
Q

tonicity: hypotonic=

A

fewer particles, more water (dilute)

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17
Q

tonicity: hypertonic=

A

more particles, less water (concentrated)

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18
Q

hydrostatic pressure uses ___ force

A

pushing

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19
Q

osmotic pressure uses ___ force

A

pulling

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20
Q

first sign of increased hydrostatic pressure is ___

A

edema

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21
Q

fluid is made up of ___ & ____

A

solvent & solutes

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22
Q

diffusion, with or without facilitation, is a ____ transport mechanism

A

passive

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23
Q

name 3 passive transport mechanisms

A

filtration, diffusion, and osmosis

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24
Q

define osmosis

A

movement of water through a semi-permeable membrane; fluid moves not the particle

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25
Q

diffusion moves solutes from ___ concentration to ____ concentration

A

high —> lower

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26
Q

example of facilitated diffusion

A

glucose & insulin

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27
Q

examples of filtration

A

kidneys-urine
pitting edema
capillary exchange

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28
Q

what is sensible fluid loss and give an example

A

loss that can be perceived by the senses and can be measured; urine

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29
Q

what is insensible fluid loss and give an example

A

losses can neither be perceived nor measured directly; sweat, respiratory vapor

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30
Q

Name 5 homeostatic mechanisms

A
  1. baroreceptors
  2. renin-angiotensin-aldosterone system
  3. antidiuretic hormone (ADH)
  4. thirst
  5. Brain natriuretic Peptides (BNP)
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31
Q

in normal conditions, kidneys produce ____ of urine per day

A

1-2 liters

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32
Q

indication of how kidneys are doing

A

GFR glomerular filtration rate

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33
Q

when aldosterone is released

A

sodium and water are retained

34
Q

1 liter of water = ___ body weight

A

1 kg= 2.2 lbs

35
Q

I.E. Isotonic FVD

A

rotavirus, diarrhea, vomiting

36
Q

I.E. Hypotonic FVD

A

excessive sweating

37
Q

I.E. Isotonic FVE

A

CHF

38
Q

I.E. Hypotonic FVE

A

fresh water drowning

39
Q

I.E. Hypertonic FVE

A

salt-water drowning

40
Q

blood mosm/kg water

A

275-295

41
Q

urine mosm/kg water

A

200-800

42
Q

factors increasing osmolality (concentrated status)

A

blood: severe dehydration, water loss, metabolic acidosis, alcoholism, burns, diabetes insipidus
urine: SIADH, fluid volume deficit, CHF, pre-renal failure

43
Q

factors decreased osmolality (dilute status)

A

blood: fluid volume excess, SIADH, over-hydration, hyponatremia
urine: fluid volume excess, diabetes insipidus, acute tubular necrosis

44
Q

Lab Data: Urine specific gravity

A

1.010 to 1.025

45
Q

Lab Data: BUN

A

10-20 mg/dl

46
Q

Lab Data: Creatinine

A

0.7 to 1.4 mg/dl

47
Q

Lab Data: Hematocrit

A

males- 42-52%
females- 35-45%

48
Q

what is urine specific gravity

A

measures kidney’s ability to excrete or conserve water
1.010-1.025

49
Q

what is BUN

A

measurement of the byproduct of protein metabolism: urea
10-20 mg/dl
* increased if dehydrated, renal dysfunction, sepsis
* decreased during starvation, pregnancy, liver disease

50
Q

what is creatinine

A

end product of muscle metabolism
0.7-1.4 mg/dl
* increased when renal function decreases

51
Q

what is hematocrit

A

measures volume percentage of RBCs
males 42-52% females 35-45%
* increased if dehydrated, blood loss
* decreased if overhydrated or anemic

52
Q

Dehydration ____ FVD

A

hypertonic- when water is lost at a more rapid rate than sodium and sodium level is increased

53
Q

Fluid volume deficit #1 risky client

A

GI patients
-burns

54
Q

clinical manifestations of FVD

A

Early s/s decreased urine output
-weight loss, decreased BP, decreased cardiac output, decreased central venous pressure, decreased skin turgor
-increased HR and temperature
-cool, clammy, pale skin

55
Q

clinical manifestations of FVE

A

acute weight gain, edema, ascites,
increased BP, bounding pulses, tachycardia,
muscle weakness, altered LOC

56
Q

FVE diagnostics

A

decreased hemoglobin & hematocrit
decreased urine osmolality
decreased BUN
decreased urine specific gravity

serum osmolality dependent on type:
decreased- hypotonic FVE
increased- hypertonic FVE

57
Q

first choice for acute FVE

A

loop diuretics ex. furosemide

58
Q

IV fluid contraindicated in head injuries

A

hypotonic

59
Q

____ has the same osmolarity as blood plasma

A

isotonic solutions

60
Q

isotonic solutions: no osmotic pressure is created, so fluid remains in the ___

A

ECF

61
Q

Name 2 isotonic solutions

A

Normal Saline (0.9%) & lactated Ringers

62
Q

Use for isotonic solutions

A

-Replace ECF fluid & electrolyte losses; treats FVD w/ abnormal BP
-Expand vascular volume quickly

63
Q

Name 2 hypotonic solutions

A

0.45% saline & 0.225% saline solution

64
Q

Hypotonic solutions cause cells to ___

A

swell

65
Q

with which solutions is water pulled out of the blood vessels into the cells, resulting in decreased vascular volume and increased cell water?

A

hypotonic

66
Q

Uses/contraindications for Hypotonic solutions

A

to prevent & treat cellular dehydration by providing free water to cells or to restore renal functioning
can treat FVD w/ normal BP

contraindication- increased intracranial pressure (ICP) or third spacing, head trauma, stroke

67
Q

Contraindications for hypotonic solutions

A

increased ICP
head trauma
stroke

68
Q

what type of solution pulls fluid from cell to vessel increasing intravascular volume?

A

hypertonic

69
Q

uses for hypertonic solutions

A

-neuro issues (high ICP)
-treats hyponatremia
-limited doses to avoid vascular volume overload (third spacing)
-pulls fluid back into vascular system
-pulls fluid from cells to promote osmotic diuresis

70
Q

1.8%, 3%, and 5% saline

A

hypertonic solutions

71
Q

strong option to block water & sodium reabsorption

A

loop diuretics ex furosemide

72
Q

FVE medical management

A

-diuretics
-dialysis
-nutrition (sodium restriction 250mg/day or less)
-fluid restriction

73
Q

FVE nursing management

A

-assess I/Os
-breath sounds (crackles, SOB, increased RR)
-daily weight (1L=1kg)
-vital signs (increased BP & CVP)
-positioning (elevation)
-skin assessment & measurements
-edema

74
Q

FVD causes

A

vomiting, diarrhea, sweating, third spacing, diabetes insipidus, hemorrhage, osmotic diuresis, burns

75
Q

medical management for FVD

A

severity determines fluid plan
-IV fluid (water and electrolyte solutions)
-oral replacement preferred
-isotonic (1st choice when hypotensive)
—> transition to hypotonic when normotensive

76
Q

safety precautions for FVD

A

fall & seizure precautions

77
Q

Lab values for FVD

A

increased BUN, hematocrit, urine specific gravity

78
Q

Serum osmolality for FVD

A

increased with hypertonic FVD
decreased with hypotonic FVD
normal with isotonic FVD

79
Q

Hypotonic FVE: Fluid shifts from ___ to ____ causing them to ___ and ___

A

ECF to ICF, causing them to swell and burst (possibly)

80
Q

Causes of isotonic FVE

A

heart and renal failure

81
Q

causes of hypotonic FVE

A

fresh water drowning, SIADH (syndrome of inappropriate antidiuretic hormone secretion)

82
Q
A

331 (7 decks)

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