Conditions of Fluid Imbalance

Question 1

Signs of Pulmonary Edema

Answer 1

• Increase in respiratory rate
• Shortness of breath sensation
• Crackles in auscultation

Question 2

0.9% NaCl
- Name
- Tonicity
- Distribution

Answer 2

Normal Saline
- Isotonic
- All of it goes into ECF

Question 3

How to treat edema
- Underlying Cause

Answer 3

Correct underlying cause
- Fix Heart Failure
- Restrict sodium
–> High amounts of salt may be causing higher amounts of water to build up in the body

Question 4

3% NaCl
- Name
- Tonicity
- Distribution

Answer 4

Hypertonic Saline
- Hypertonic
- Moves water out of ICF
- Moves water into ECF

Used in acute situations

Question 5

What are signs of dehydration in infants (6)

Answer 5

• Dry mouth and tongue
• Lack of tears when crying
• No wet diaper in 3 hour
• Sunken Eyes, Cheeks
• Sunken soft spot on top of head
• Changes in behavior
  Listlessness, Irritable

Question 6

How to treat edema
- Medications

Answer 6

Increase Renal Sodium Excretion
- Diuretics

Loop Diuretics - Very good for heart failure (Furosemide, Ethacrynic Acid)

Thiazide Diuretics
(Hydrochlorothiazide, Chlorthalidone, Metolazone)

Potassium Sparing Diuretics
(Triamterene, Amiloride, Spironolactone)

Question 7

Signs of Edema

Answer 7

• Weight gain (Caused by retaining fluid)
• Increased Jugular Venous Pressure
• Positive hepatojugular reflux (Firm pressure over liver temporarily increases venous return to the heart)
  –> In healthy individual the jugular vein will go away
  –> In edema patients the jugular vein takes a while to go away

Question 8

ECF

Answer 8

1/4 = Intravascular
3/4 = Interstitial

Question 9

How much water should one get in a day?

Answer 9

2000 mL to 3000 mL

Question 10

Function of ECF
- Provide general examples

Answer 10

Important for tissue perfusion
- Delivery of O2 and Nutrients
- Removal of waste

Question 11

Lactated Ringer’s
- Name
- Tonicity
- Distribution

Answer 11

Lactated Ringer’s
- Isotonic
- Almost all of it goes into ECF

Question 12

D5W
- Name
- Tonicity
- Distribution

Answer 12

5% Dextrose
- Hypotonic
- 2/3 into ICF
- 1/3 into ECF

Replenishes Cells

Question 13

How do we treat dehydration

Answer 13

Mild Dehydration = Drink

Dehydration = 0.9% NaCl (Normal Saline)
- Sodium stays in Extracellular Fluid Space
–> Replace Blood Volume
–> Improve Blood Pressure

Question 14

ICF

Answer 14

2/3

Question 15

When assessing patient’s clinical fluid status which fluid do we look at?

Answer 15

ECF (Interstitial Water, Intravascular Water/Blood)
- Serum/Plasma/Blood Volume

Question 16

What is Edema
- Causes

Answer 16

Excess fluid in Extracellular compartment
- Caused by Heart, Kidney, Liver failure
- Occurs in Pregnancy, Malnutrition

Question 17

0.45% NaCl
- Name
- Tonicity
- Distribution

Answer 17

Half Normal Saline
- Hypotonic
- 1/3 into ICF
- 2/3 into ECF

Replenishes Vascular Space

Question 18

What are signs of dehydration (8)

Answer 18

• Dry Mucous Membranes
• Skin Tenting
• Low Urine Output
• Postural Changes:
  High Heart Rate, Low Blood Pressure, Dizzy
• Cool Extremities
• Low Capillary Refill
• Low Cognitive Function
• Sunken Eyes

Question 19

Function of ICF
- Provide example for brain

Answer 19

Important for cellular functions
- Alterations to ICF in brain can lead to significant dysfunction

Question 20

Signs of Pitting Edema

Answer 20

Swelling in feet, ankles, and lower legs
- Patient is retaining water which follows gravity down into the ankles
- Kidneys are not excreting water