Chapter 17 Fluids: Med Surg

Question 1

what does water content vary with?

Answer 1

gender, age, body mass

Question 2

percentage of body weight of water greater in men or women?

Answer 2

men

Question 3

who would have more water content as compared to body weight?

Answer 3

infants 70%-80%

Question 4

intracellular fluid

Answer 4

2/3 of body water and 40% of body weight

Question 5

extracellular fluid

Answer 5

1/3 of body water, consisits of intravascular, interstitial and transcellular spaces

Question 6

intravascular space

Answer 6

1/3 of ECF located here as plasma

Question 7

interstitial space

Answer 7

2/3 of ECF

Question 8

transcellular space

Answer 8

1 L of ECF; CSF, fluid in GI, pleural, synovial, peritoneal fluid

Question 9

why is body water needed?

Answer 9

fluids are in constant motion and transport nutrients, electrolyes, oxygen, regulate temperatures, lubricate joints and membranes, and aids digestion

Question 10

how much does 1 L of fluid weigh?

Answer 10

2.2 kg

Question 11

electrolytes

Answer 11

molecules dissociate (split into ions) when placed in water

Question 12

ions

Answer 12

electrically charged particles

Question 13

cations

Answer 13

positive charged ions

Question 14

anions

Answer 14

negative charged ions

Question 15

valence

Answer 15

electrical charge of an ion

Question 16

ECF cation

Answer 16

sodium

Question 17

ECF anion

Answer 17

chloride

Question 18

ICF cation

Answer 18

potassium

Question 19

ICF anion

Answer 19

phosphate

Question 20

diffusion

Answer 20

movement of molecules from an area of high concentration to one of low concentration; membrane must be permeable; no energy

Question 21

facilitated diffusion

Answer 21

same as diffusion, but some molecules diffuse slowly into the cell and need some help so a carrier molecule accelerates the rate; no energy

Question 22

active transport

Answer 22

molecules move against the concentration gradient, external energy is required; e.g. sodium potassium pump: potassium in and sodium out

Question 23

osmosis

Answer 23

water movement through a semipermeable (favors water not solutes) membrance from an area of low solute concentration to an area of high solute concentration; no external energy, stops when equal

Question 24

osmolality

Answer 24

describes fluids (water balance) inside the body, typically performed to evaluate the concentration of plasma in urine

Question 25

normal plasma osmolality

Answer 25

275-295

Question 26

increased plasma osmolality

Answer 26

concentration is too high or water is too low aka water deficit -> dehydrated

Question 27

decreased plasma osmolality

Answer 27

concentration is too low or water is too high aka water excess

Question 28

major determinant of plasma osmolality

Answer 28

sodium and glucose

Question 29

ECF and ICF are:

Answer 29

isotonic to each other, hence no movement of water occurs and no gain or loss of water occurs although ECF expands e.g. lactated ringers, 0.5% saline

Question 30

if the cell is surrounded by hypotonic fluid:

Answer 30

water moves into the cell and causes it to swell and possibly burst ECF -> ICF e.g. 0.45% saline

Question 31

if the cell is surrounded by hypertonic fluid:

Answer 31

water leaves the cell to dilute the ECF and the cell shrinks and may eventually die ICF -> ECF e.g. 3% saline

Question 32

hydrostatic pressure

Answer 32

force within the fluid compartment, blood pressure generated by the contaction of the heart and pushes water out of the vascular system

Question 33

oncotic pressure

Answer 33

osmotic pressure exerted by colloids in solution, pulls fluid from the tissue space to the vascular space

Question 34

major colloid

Answer 34

protein, which does not dissolve completely since they are too large of molecules

Question 35

what two pressures move water into the capillaries?

Answer 35

plasma oncotic pressure and interstitial hydrostatic pressure

Question 36

what two pressures move water out of the capillaries?

Answer 36

capillary hydrostatic pressure and interstitial oncotic pressure

Question 37

first spacing

Answer 37

normal distribution of fluid in ECF and ICF

Question 38

second spacing

Answer 38

abdnormal accumulation of interstitial fluid (edema)

Question 39

third spacing

Answer 39

fluid accumulates in a portion of the body (transcellular fluid) from which it is not easily exchanged with the rest of the ECF, not functional e.g. ascites, edema with burn, trauma

Question 40

how does the hypothalamus, pituitary, and adrenal cortex respond in water regulation?

Answer 40

the hypothalamus recognizes a fluid deficit and increases plasma osmolality sending osmoreceptors to the posterior pituitary and releasing ADH, which acts in the distal tubules to cause water reabsorption

Question 41

decreased ADH

Answer 41

diabetes insipidus

Question 42

increased ADH

Answer 42

SIADH

Question 43

dextrose solutions

Answer 43

osmolarity changes once dextrose is metabolized

Question 44

at the arterial end of the capillary:

Answer 44

capillary hydrostatic pressures exceeds plasma oncotic pressure, which draws fluid into interstitium (EDEMA)

Question 45

at the venous end of the capillary:

Answer 45

capillary hydrostatic pressure is lower than plasma oncotic pressure and fluid is drawn back into the capillary

Question 46

glucorticoids

Answer 46

cortisol, which has an antiinflammatory effect and increases glucose levels

Question 47

mineralocorticoids

Answer 47

aldosterone, which enhances sodium retention and potassium excretion

Question 48

primary organ that controls f&e balance

Answer 48

kidneys

Question 49

insensible water loss

Answer 49

600-900 mL lost a day, ONLY water, sweating is sensible perspiration and causes f&e loss

Question 50

how do you calculate fluid requirement for a pediatric patient?

Answer 50

convert weight to kg, 100 mL/kg for first 10 kg, 50 mL/kg for second 10 kg, and 20 mL/kg for the remainder of weight. IF ASKED FOR IN ML/HR SIMPLY DIVIDE ANSWER BY 24

Question 51

fluid volume deficit

Answer 51

restless, drowsy, thirst, decreased skin turgot and capilarry refill, increased pulse, decreased urine, increased respirations, weight loss

Question 52

fluid volume excess

Answer 52

headache, edema, venous distention, bounding pulse, increased blood pressure, dyspnea, crackles, muscle spasms, weight gain

Question 53

assess neurologic fx

Answer 53

LOC, pupillary response to light and equality of size, voluntary movement of extremities, degree of muscle strength, reflexes

Question 54

assess skin turgor where?

Answer 54

clavicle!

Question 55

first signs of deficit:

Answer 55

tachycardia, decreased blood pressure, increased respirations

Question 56

late signs of deficit:

Answer 56

hypotension and decreased capillary refill