EXAM 2 - FLUIDS

Question 1

How much of total body weight is body water?

Answer 1

60%
decreases with age and % of body fat

Question 2

Functions of body fluids

Answer 2

lubricant
metabolism - solvent for chem. reactions
transport of O2, nutrients, chemical messengers
regulates body temperature

Question 3

How much of total body water is extracellular fluid?

Answer 3

33%

Question 4

How much of total body water is intracellular fluid?

Answer 4

66%

Question 5

How much of extracellular fluid is interstitial fluid?

Answer 5

25%

Question 6

How much of extracellular fluid is blood plasma?

Answer 6

8%

Question 7

What is osmolality?

Answer 7

solute concentration in the blood/fluid

Question 8

What is osmosis?

Answer 8

water movement across a semi-permeable membrane from lower concentration to higher concentration
sodium, a solute, is main ion

Question 9

What is diffusion?

Answer 9

movement of particles down a concentration gradient

Question 10

What is active transport?

Answer 10

movement of particles against a concentration gradient, requires energy

Question 11

What is hydrostatic pressure?

Answer 11

water ‘pushing’ pressure

Question 12

What is osmotic pressure?

Answer 12

water ‘pulling’ pressure

Question 13

What is colloidal osmotic pressure (COP)?

Answer 13

albumin - a protein, is the main colloid
large plasma protein that influences water movement
water ‘pulling’ pressure

Question 14

What is filtration?

Answer 14

fluid exits capillary since capillary hydrostatic pressure is greater than blood colloidal osmotic pressure

Question 15

What is no net movement?

Answer 15

capillary hydrostatic pressure = blood colloidal osmotic pressure

Question 16

What is reabsorption?

Answer 16

fluid re-enters capillary since capillary hydrostatic pressure is less than blood colloidal osmotic pressure

Question 17

What contributes to water gain?

Answer 17

food and drink, metabolism

Question 18

What contributes to water loss?

Answer 18

skin, lungs, urine, feces

Question 19

What contributes to insensible water loss?

Answer 19

skin and lungs

Question 20

How does the body tell us we need more intake? (for balance)

Answer 20

increase osmolality
decrease circulating volume
dry mucous membranes
aldosterone
antidiuretic hormone (ADH)

Question 21

How does the body increase output? (for balance)

Answer 21

natriuretic peptides
BNP - brain
ANP - atrial

Question 22

How does aldosterone help us increase fluids?

Answer 22

secreted by adrenal cortex
renal tubules reabsorb Na and H2O
(water follows sodium)
excretes K+

Question 23

How does ADH help us increase fluids?

Answer 23

synthesized in hypothalamus
stored and released from posterior pituitary
released with increase osmolality and decreased circulating volume
effects distal tubule and collecting ducts for water reabsorption, decreased urine, increased concentration of urine

Question 24

How does ANP and BNP help us decrease fluids?

Answer 24

ANP is released from R atrium when heart is stretched - increased circulating volume
BOTH promote fluid excretion
increased Na+ excretion which takes H2O
DIURESIS

Question 25

What is diuresis?

Answer 25

increased production of urine by the kidneys

Question 26

What can increase diuresis?

Answer 26

caffeine, exercise, increased fluid intake, alcohol, medications

Question 27

What are the 4 types of diuretics?

Answer 27

Loop - furosemide Thiazide - hydrochlorothiazide Potassium sparing - spirnolactone osmotic - mannitol

Question 28

What is tonicity?

Answer 28

the osmotic pressure of a solution and how much it influences the movement of water

Question 29

isotonic solution

Answer 29

concentration of stuff equal to intravascular plasma 0.9% saline, lactated ringers, D5W

Question 30

hypotonic solution

Answer 30

concentration of stuff less than plasma, fluid would move out of the vascular space 0.45% saline

Question 31

hypertonic solution

Answer 31

concentration of stuff more than plasma, fluid would move into the vascular space 3% saline, D5W+0.9% saline

Question 32

What are the two major categories of fluid imbalances?

Answer 32

- imbalance of volume, too much or too little - imbalance of concentration, too many or too few

Question 33

What is a volume deficit called?

Answer 33

hypovolemia

Question 34

What is isotonic hypovolemia?

Answer 34

equal decreased water and Na+, too much out, too little in

Question 35

What are the causes of isotonic hypovolemia?

Answer 35

emesis or gastric drainage, diarrhea, burns, hemorrhage, excessive perspiration

Question 36

What causes intravascular hypovolemia?

Answer 36

third spacing - edema or ascites

Question 37

What are some clinical manifestations of hypovolemia?

Answer 37

increased HR, postural hypotension, weight loss, flat neck veins, prolonged cap refill, lightheadedness, oliguria, decreased skin turgor, dry mucous membranes, hard stools, soft, sunken eyeballs, longitudinal furrows in tongue, absence of tears/sweat, sunken fontanel in infants

Question 38

What causes hypervolemia?

Answer 38

excessive infusion of isotonic solution, renal retention of Na and H2O, CHF, cirrhosis, chronic renal failure, increased intake

Question 39

What are some clinical manifestations of hypervolemia?

Answer 39

weight gain, edema, bounding pules, distended jugular vein, crackles, orthopnea, bulging fontanel

Question 40

What are the causes of edema?

Answer 40

- increased capillary hydrostatic pressure - increased interstitial osmotic pressure - decreased capillary osmotic pressure - blockage of lymph drainage (cancer, infection, removed lymph nodes)

Question 41

What can cause increased capillary hydrostatic pressure?

Answer 41

increased blood pressure, vein blockage

Question 42

What can cause increased interstitial osmotic pressure?

Answer 42

increased vascular permeability, leakage of protein into interstitial space which increases the osmotic pressure & contributes to more fluid being lost from inside vessels

Question 43

What can cause decreased capillary osmotic pressure?

Answer 43

decreased plasma proteins/albumin, or loss of plasma proteins causing increased capillary permeability

Question 44

Why would a blockage of lymph drainage cause edema?

Answer 44

the lymphatic circulation carries excess interstitial fluid and protein back to the systemic circulation, it also has a lot of lymphocytes

Question 45

How is increased hydrostatic pressure edema?

Answer 45

interstitial space is elastic and expandable, excess fluid in the interstitial space is edema, there can be a significant increase in ECF BEFORE you see edema

Question 46

How much does 1L of fluid weigh?

Answer 46

1 kg (2.2 lbs)

Question 47

What kind of venous obstructions can cause edema?

Answer 47

thrombophlebitis, hepatic obstruction, tight clothing on extremities, prolonged standing

Question 48

What can Na and H2O retention cause?

Answer 48

CHF and renal failure

Question 49

What is third spacing?

Answer 49

shift of fluid from intravascular space to a space where it can't be used, usually a serous cavity pleural, pericardial, peritoneal protein-rich fluid pulls water into space

Question 50

What are some problems with fluid accumulation and edema?

Answer 50

increased distance for diffusion of nutrients/O2, impaired blood flow, slowed healing, increased risk of infection, pressure sores over bony prominences

Question 51

MOA of loop diuretics

Answer 51

work in loop of Henle to decrease absorption of NA, CL, K, and Ca osmotic gradient, prevents reabsorption of water

Question 52

side effects of loop diuretics

Answer 52

N/V, constipation, diarrhea, hypokalemia, dehydration, tinnitus and hearing impairment