F/E balance Flashcards
(102 cards)
1
Q
constant stability; body fluids are in constant motion transporting nutrients, electrolytes and oxygen to cells while carrying away waste products
A
Homeostasis
2
Q
Primary fluid in the body; most important nutrient
-carries nutrients and waste products
-participates in metabolic reactions, food digestion
-solvent for minerals, vitamins, glucose
-lubricant and cushion for the joints, eyes, spinal cord
-aids in regulation of body temp
-maintains blood volume
60% of an adult’s body weight
A
Water; H2O
3
Q
problem before the kidneys
A
pre-renal
4
Q
30-60 ml/hr
A
normal urine output
5
Q
found in food
-daily need 2000-3000 ml
-1 L of H2o weighs 1 kg
Sudden change in body weight is a great indicator of fluid volume
A
Fluids (H2O) needed
6
Q
liquids (1500 ml/day)
solid foods (800 ml/day)
Metabolism (300 ml/day)
A
Intake Sources of fluids
7
Q
Kidney (1200-1500 ml/day) Skin (500-600 ml/day) Lungs (400 ml/day) GI tract (100-200 ml/day) Drainage from Fistulas/drains, GI suction, salivation
A
Fluid Loss routes
8
Q
oral fluid, tube feedings
parenteral fluid
enemas
retained irrigation fluid
A
Measurable fluid Intake
9
Q
urine
emesis
feces
drainage from body cavities
A
Measurable fluid output
10
Q
Solid foods
Metabolism
A
Non-measurable intake
11
Q
sweating
vaporization through lungs
A
sensible loss
not measurable
12
Q
chemicals dissolved in the body fluid, distribution affects fluid balance.
Regulates by intake, output, acid-base balance, hormones, and cell integrity
A
Electrolytes
13
Q
Major extracellular electrolyte
controls and regulates water balance
A
Sodium
14
Q
Major intracellular electrolyte
Helps maintain intracellular H20 balance
Transmit nerve impulses to muscles and contracts skeletal and smooth muscles
A
Potassium
15
Q
mostly found from food;
kidneys excrete
A
electrolytes
16
Q
135-145 mEq/L
determines whether water is retained, excreted or moved.
imbalance cause neuro problems
A
Sodium Na
17
Q
3.5-5.5
increased with poor kidney function
decreased with excessive urination, diarrhea, vomitting
-imbalances cause cardiac problems
A
Potassium K
18
Q
95-105; important in acid-base balance
-works with sodium to maintain osmotic pressure
increased with poor kidney function
decreased with excessive vomitting/ or diarrhea
A
Chloride Cl
19
Q
9-11 ionized or serum 4.25-5.25
transmission of nerve impulses
heart and muscle contractions, blood clotting, formation of teeth and bone
Requires Vit D for absorption
A
Calcium Ca
20
Q
balance is interwinded with Ca
Major anion of ICF. but found in ECF too.
Bone, skeletal muscle, and nerve tissue.
2.5-4.5 mg/dL
Functioning of muscles, nerves, & RBC’s.
Involved in metabolism of protein, fat and Carbohydrates
absorbed in intestine. all animal products, milk products, legumes, bread,
A
Phosphate PO4
21
Q
6-20
A
BUN
22
Q
0.6-1.3
A
Creatinine
23
Q
42-52% Males
37-47% Females
A
Hematocrit
24
Q
7.35-7.45
A
pH
25
35-45 mmHg
PaCO2
26
75-100% mmHg
PO2
27
24-28mEq/L
HCO3; bicarbonate
28
hematocrit normal is 3x the hemoglobin (10-14 normal)
H, H
29
indicates the H2O balance of the body
-serum osmo is 285-295 mOsm/kg
high is H2O deficit (concentrated)
low is H2O excess (dilute)
Serum Osmolarity
30
500-1200 mOsm/kg
| avg 500-800 mOsm/kg
Urine Osmolarity
31
Together are used to determine what is causing a sodium imbalance.
- solute to h2o ration
- how well the kidneys are working
Serum and Urine Osmolarity
32
K, PO4; intracellular 2/3 body fluids
Na, Cl; extracellular 1/3 body fluids; interstitial (lymph) and transcellular (cerebrospinal, pleural, peritoneal, synovial fluids) and intravascular (blood plasma)
Distribution of body fluids & electrolytes
33
extracellular (33%)
-interstitial 25%
-intravascular (blood plasma) 8%
Intracellular (66%)
body water distribution
34
JG cells
- sense low Na, low volume
- release of renin
- converts angiotensinogen to angiotensin I which converts to angiotensin II
- stimulates release of aldosterone (RAAS)
Kidneys JG cells
35
adrenal cortex
- senses low serum osmo or low Na
- releases aldosterone
- reabsorbs Na into the blood, increases K excretion in the urine
- increases serum osmo
Kidneys Adrenal Cortex
36
senses high serum osmo or high Na
- stimulates thirst
- triggers release of ADH (vasopressin) from posterior pituitary
- retains h2o in the blood
- concentrates urine
- mildly constricts blood vessels
- decreases serum osmo
Hypothalamus
37
senses high volume through stretch receptors in the right atrium
- secretes ANP, BNP
- inhibits ADH
- stops the RAAS
- increases Na excretion through the urine
- dilates blood vessels
- decreases serum osmo
Heart
38
concentrates urine
raises Bp
H2O level down
ADH up
Antidiuretic hormone ADH
39
1st spacing normal
2nd spacing; edema, dehydration
3rd spacing; ascities, burn edema
capillary, interstital pressure changes, fluids shifts from 1 space to another. decreased protein causes 3rd spacing
Fluid spacing
40
fluid trapped and can't be easily exchanged to other spacing.
3rd spacing
41
a solution that has the same osmo as body fluids.
| -normal saline solution, 0.9% sodium chloride, D5W, LR
isotonic
42
keep fluids in the intravascular without causing any fluid compartment shift
crystalloids
43
refers to solutions that have a lower osmo than body fluids.
| 0.045%. 1/2 normal saline; hydrates cells
hypotonic
44
refers to solutions that have a higher osmo than body fluids
3%
D5 1/2 NS
D10W
hypertonic
45
colliods
plasmanate; replace body protein
lipids; IV therapy longer than 5 days
plasma expanders
46
percent of body weight of h2o is decreased
- structure changes in the kidney and decreased renal blood flow
- decreased GFR
- decreased creatinine clearance
- loss of ability to concentrate urine and thus conserve h2o
- decrease in renin and aldosterone
- increase in ADH & ANP
- Loss of subcutaneous tissue
- decrease in thirst mechanism
- musculoskeletal changes
- mental status changes
- incontinence; aging, body changes
* instead of skin turgor, use I & O's and daily weights, mucous membranes
Gerontologic considerations
47
nurtrition, I & O's, insensible losses, use of diuretics/laxatives, weight changes, kidney or endocrine disorders, LOC, mental status, depression, eating disorders, alcohol intake?
History; assessment considerations
48
hydration status, skin turgor, muscous membranes, I & O's
physical assessment considerations
49
electrolyte levels, BUN, glucose, creatinine, pH, HCO3, osmolality, Hgb, Hct, urine dipstick, urine pH, urine specific gravity
Dx tests
50
substances such as lg protein molecules that do not readily dissolve into true solutions
colloids
51
concentrations of solutes in the body fluids is usually expressed in
osmolality
52
the power of a solution to draw h2o across a semipermeable membrane.
osmotic pressure
53
plasma proteins exert an osmotic draw, pulling h2o from the interstitial space into the vascular compartment
*important in maintaining vascular volume.
Colloid Osmotic Pressure or oncotic pressure
54
the continual intermingling of molecules in liquids, gases or solids brought about by the random movement of the molecules.
Diffusion
55
process whereby fluid and solutes move together across a membrane from one compartment to another.; movement from higher pressure to one of lower pressure
filtration
56
the pressure a fluid exerts within a closed system on the walls of its container.
hydrostatic pressure
57
When the hydrostatic pressure is greater than the osmotic pressure, the fluid filters out of the blood vessels; which can lead to swelling of the body tissues (excess fluid trapped)
Edema
58
substances can move cell membranes from a less concentrated solution to a more concentrated one.
- a substance combines with a carrier on the outside surface of the cell membrane, and together they move to the inside surface of the cell membrane.
- requires enzymes and energy is expended.
* Important in maintaining the differences in Na & K ion concentrations of ECF & ICF.
* Sodium Potassium pump; activated, moving sodium from the cells and K into the cells
Active transport
59
primary regulatro of fluid intake; located in the hypothalmus
Stimulating contributors:
-osmotic pressure of body fluids
-vascular volume
-angiotensin (hormone released in response to decreased blood flow to the kidneys)
Thirst mechanism
60
certain fluid losses are required to maintain normal body function. 500 ml must be excreted through kidneys ea. day to eliminate metabolic waste products from the body
- though skin
- respirations
- feces
obligatory losses necessary for temp regulation and elimination of waste products. total 1300 ml/day
61
as kidneys regulate and filter waste, they return electrolytes, ie, K, and Na to blood for use.
-The Cardiovascular and Respiratory systems ensure the body has an adequate O2 to function and use fluids and electrolytes appropriately.
maintaining homeostasis
62
ADH; antidiuretic hormone
RAAS; Renin-angiotension-adosterone system
ANF; atrial natriuretic factor
hormones involved in maintaing homeostasis
63
primary regulator of body fluids and electrolyte balance
-regulate the volume and osmolality of extracellular fluids by regulating water and electrolyte excretion.
135-180 L of plasma/day, 1.5 L of urine excreted
-balance maintained by selective retention and excretion
*play significant role in acid-base balance regulation; excreting hydrogen and retaining HCO3
Kidneys
64
regulates H20 excretion from the kidney, synthesized in the anterior portion of the hypothalamus and acts on the collecting ducts of the nephrons.
-increased serum osmolality rises, hormone produced (collecting ducts become more permeable to h20)
ADH
65
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blood volume
temp
pain
stress
drugs, ie. opiates, barbiturates, and nicotine
```
Factors that affect ADH production
66
specialized receptors in the juxtaglomerular cells of the kidney nephrons respond to changes in renal perfusion.
;blood flow or pressure of kidney decreases, renin is released.
-promoting Na & h20 retention
-restore blood volume (renal perfusion) though Na and h20 retention
Renin-Angiotensin-Aldosterone System RAAS
67
peptide hormone released from cells in the atrium of the heart in response to excess blood volume and stretching of the atrial walls.
- ANF promotes Na wasting and acts as a potent diuretic; reducing vascular volume.
* Inhibits thirst, reducing fluid intake
Atrial Natriuretic Factor
68
- maintaining fluid balance
- contributing to acid-base regulation
- facilitating enzyme reactions
- transmitting neuromuscular reactions
- must be consumed daily
- K & Ca stored in the cells and bones; if serum levels drop, ions shift out of "storage".
Electrolytes
69
promotes enzyme reactions during carbohydrate digestion
Mg
70
present in both ICF & ECF. primary function is regulating acid-base balance, as an essential component of the carbonic acid bicarbonate buffering system.
Extracellular bicarbonate levels regulated by the kidneys.
*produced through metabolic processes in adequate amounts
HCO3
71
fluids constantly being shifted from one compartment to another to compensate a fluid imbalance.
Compensation
72
rapid gains or losses (4-8%) of total body weight indicate moderate to severe fluid volume deficits or excesses
FVD
73
tachycardia
early sign of hypovolemia
74
elevated body temp
dehydration or FVD
75
pulse volume low;
FVD
76
high pulse volume
FVE
77
irregular pulse rate may occur
electrolyte imbalances
78
280-300 mOsm/kg
serum osmolality
79
CBC; H & H
hematocrit measures the volume of whole blood (RBC)
-measure of volume of cells in relation to plasma, it is affected by changes in plasma volume.
increase in Hct; severe dehydration
decrease in Hct severe overload
normal values; 40-54% men and 36-46% women
HCT/ CBC
80
doubling the serum Na and assoc Cl ions are the major determinants of serum osmolality
-measure of the solute concentration of the blood.
Osmolality
81
indicator of urine concentration
| 1.005-1.030
Urine Specific Gravity
82
- sodium chloride
| - potassium chloride
Electrolyte supplement
83
- serum albumin
| - dextran 40
Colloids
84
- furosemide
- hydrochlorothiazide
- spironolactone (Aldactone)
diuretics
85
- 5% dextrose and H20
- normal saline solution
- lactated ringers
- 5% dextrose and 1/2 normal saline
Crystalloids
86
when water and electrolytes are lost or gained in equal proportions so that osmolality of body fluids remain constant.
isotonic imbalance
87
involve the loss/gain of only water, so that the osmolality of the serum is altered
osmolar imbalance
88
FVD
dehydration (hyperosmolar imbalance)
FVE
overhydration (hypoosmolar imbalance)
4 types of imbalances
89
a decrease in intravascular, interstitial, and/or intracellular fluid in the body.
-common, can exist alone or in combo with other electrolyte or acid-base balance issues
FVD; fluid volume deficit
90
refers to loss of fluid alone, often interchangable with FVD
dehydration
91
decrease in circulating blood volume
hypovolemia
92
K lost, Na same, fluid drawn into the vascular compartments from the interstitial spaces as the body attempts to maintain tissue perfusion.
-severe fluid loss can lead to cardiovascular collapse.
isotonic fluid volume deficit
93
hyponatremic dehydration; greater loss of Na than H20. Serum Na below normal levels. Shifts for ECF and ICF to compensate leads to greater ECF dehydration.
Hypotonic dehydration
94
F/E balance
A shift of fluid from the vascular space into an area where it is not available to support normal physiological processes
-Trapped fluid represents a volume loss; unavailable for normal physiological processes.
In abdomen or bowel, or other areas, ie pleural or peritoneal space. or with in soft tissue; burn, trauma
Third spacing
95
Most common cause is excessive loss of GI fluids;
vomitting, diarrhea, or intestinal drainage, intestinal fistulas
-diuretics
renal disorders
endocrine disorders
H20 and Na loss; sweating excessive exercise
hemorrhage
chronic abuse of lax. and enemas
FVD
96
most common type seen in initial period after a burn. fluid leaks into interstitial spaces, causing edema and further FVD; lower urine output
Hypotonic dehydration
97
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darkend urine
decrease urine output
confusion
lethargy
headache
light headedness
sunken eyes
dry mucous membranes
dry axillae
long tongue furrows
postural changes in pulse and blood pressure
```
symptoms of dehydration
98
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hypertension
tachycardia
weak pulse
tachypnea
reduced urine output/concentrated urine with increased sp. gravity
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Decreased cardiac output
99
```
dry, cracked skin
dry mucous membranes
increased hematocrit
poor skin turgor
weightloss
```
inadequate fluid supply to tissues
100
edema
symptoms of FVD
no weight loss
Third spacing
101
```
Bp down
HR up
pulse down
resp normal
jug vein flat
edema rare
skin turgor loose, poor
output low, concentrated
urine sp. gravity high
weight loss
```
FVD
102
```
BP up
HR up
pulse up
Resp crackles, wheezes
jug vein distended
skin turgor taut
output low to normal
urine sp grav. low
weight gain
```
FVE
