week 1 Flashcards
fluid balance disturbances
name the 2 fluid compartments
intracellular space (ICF)
extracellular space (ECF)
intracellular fluid makes up ___ of total amount of fluids, mostly in __ ___ ___
2/3; skeletal muscle mass
extracellular fluid makes up ___ of total amount of fluid volume
1/3
ECF transcellular fluid ____
cerebrospinal fluid (CSF), pericardial, synovial, pleural, sweat, digestive, intraocular
what is CVP?
central venous pressure
where is CVP measured?
Right atrium
ECF fluid shifts into a space that doesn’t contribute to equilibrium
third spacing
does 3rd spacing mean fluid volume excess?
no
CVP is a ___ ____ indicator
fluid volume
low CVP = ___ FV
low
high CVP= ___ FV
high
define tonicity
the ability to make things move
define osmolarity
number of milliosmoles per liter of solution;
describes IV fluid due to being out of a liter
define osmolality
number of milliosmoles per kg of solvent;
weight
tonicity: isotonic=
fluid that has the same proportion of weight of particles and water; perfectly balanced
tonicity: hypotonic=
fewer particles, more water (dilute)
tonicity: hypertonic=
more particles, less water (concentrated)
hydrostatic pressure uses ___ force
pushing
osmotic pressure uses ___ force
pulling
first sign of increased hydrostatic pressure is ___
edema
fluid is made up of ___ & ____
solvent & solutes
diffusion, with or without facilitation, is a ____ transport mechanism
passive
name 3 passive transport mechanisms
filtration, diffusion, and osmosis
define osmosis
movement of water through a semi-permeable membrane; fluid moves not the particle
diffusion moves solutes from ___ concentration to ____ concentration
high —> lower
example of facilitated diffusion
glucose & insulin
examples of filtration
kidneys-urine
pitting edema
capillary exchange
what is sensible fluid loss and give an example
loss that can be perceived by the senses and can be measured; urine
what is insensible fluid loss and give an example
losses can neither be perceived nor measured directly; sweat, respiratory vapor
Name 5 homeostatic mechanisms
- baroreceptors
- renin-angiotensin-aldosterone system
- antidiuretic hormone (ADH)
- thirst
- Brain natriuretic Peptides (BNP)
in normal conditions, kidneys produce ____ of urine per day
1-2 liters
indication of how kidneys are doing
GFR glomerular filtration rate
when aldosterone is released
sodium and water are retained
1 liter of water = ___ body weight
1 kg= 2.2 lbs
I.E. Isotonic FVD
rotavirus, diarrhea, vomiting
I.E. Hypotonic FVD
excessive sweating
I.E. Isotonic FVE
CHF
I.E. Hypotonic FVE
fresh water drowning
I.E. Hypertonic FVE
salt-water drowning
blood mosm/kg water
275-295
urine mosm/kg water
200-800
factors increasing osmolality (concentrated status)
blood: severe dehydration, water loss, metabolic acidosis, alcoholism, burns, diabetes insipidus
urine: SIADH, fluid volume deficit, CHF, pre-renal failure
factors decreased osmolality (dilute status)
blood: fluid volume excess, SIADH, over-hydration, hyponatremia
urine: fluid volume excess, diabetes insipidus, acute tubular necrosis
Lab Data: Urine specific gravity
1.010 to 1.025
Lab Data: BUN
10-20 mg/dl
Lab Data: Creatinine
0.7 to 1.4 mg/dl
Lab Data: Hematocrit
males- 42-52%
females- 35-45%
what is urine specific gravity
measures kidney’s ability to excrete or conserve water
1.010-1.025
what is BUN
measurement of the byproduct of protein metabolism: urea
10-20 mg/dl
* increased if dehydrated, renal dysfunction, sepsis
* decreased during starvation, pregnancy, liver disease
what is creatinine
end product of muscle metabolism
0.7-1.4 mg/dl
* increased when renal function decreases
what is hematocrit
measures volume percentage of RBCs
males 42-52% females 35-45%
* increased if dehydrated, blood loss
* decreased if overhydrated or anemic
Dehydration ____ FVD
hypertonic- when water is lost at a more rapid rate than sodium and sodium level is increased
Fluid volume deficit #1 risky client
GI patients
-burns
clinical manifestations of FVD
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
clinical manifestations of FVE
acute weight gain, edema, ascites,
increased BP, bounding pulses, tachycardia,
muscle weakness, altered LOC
FVE diagnostics
decreased hemoglobin & hematocrit
decreased urine osmolality
decreased BUN
decreased urine specific gravity
serum osmolality dependent on type:
decreased- hypotonic FVE
increased- hypertonic FVE
first choice for acute FVE
loop diuretics ex. furosemide
IV fluid contraindicated in head injuries
hypotonic
____ has the same osmolarity as blood plasma
isotonic solutions
isotonic solutions: no osmotic pressure is created, so fluid remains in the ___
ECF
Name 2 isotonic solutions
Normal Saline (0.9%) & lactated Ringers
Use for isotonic solutions
-Replace ECF fluid & electrolyte losses; treats FVD w/ abnormal BP
-Expand vascular volume quickly
Name 2 hypotonic solutions
0.45% saline & 0.225% saline solution
Hypotonic solutions cause cells to ___
swell
with which solutions is water pulled out of the blood vessels into the cells, resulting in decreased vascular volume and increased cell water?
hypotonic
Uses/contraindications for Hypotonic solutions
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
Contraindications for hypotonic solutions
increased ICP
head trauma
stroke
what type of solution pulls fluid from cell to vessel increasing intravascular volume?
hypertonic
uses for hypertonic solutions
-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
1.8%, 3%, and 5% saline
hypertonic solutions
strong option to block water & sodium reabsorption
loop diuretics ex furosemide
FVE medical management
-diuretics
-dialysis
-nutrition (sodium restriction 250mg/day or less)
-fluid restriction
FVE nursing management
-assess I/Os
-breath sounds (crackles, SOB, increased RR)
-daily weight (1L=1kg)
-vital signs (increased BP & CVP)
-positioning (elevation)
-skin assessment & measurements
-edema
FVD causes
vomiting, diarrhea, sweating, third spacing, diabetes insipidus, hemorrhage, osmotic diuresis, burns
medical management for FVD
severity determines fluid plan
-IV fluid (water and electrolyte solutions)
-oral replacement preferred
-isotonic (1st choice when hypotensive)
—> transition to hypotonic when normotensive
safety precautions for FVD
fall & seizure precautions
Lab values for FVD
increased BUN, hematocrit, urine specific gravity
Serum osmolality for FVD
increased with hypertonic FVD
decreased with hypotonic FVD
normal with isotonic FVD
Hypotonic FVE: Fluid shifts from ___ to ____ causing them to ___ and ___
ECF to ICF, causing them to swell and burst (possibly)
Causes of isotonic FVE
heart and renal failure
causes of hypotonic FVE
fresh water drowning, SIADH (syndrome of inappropriate antidiuretic hormone secretion)
