fluid and electrolytes 2

Question 1

what happens when fluids shift?

Answer 1

with decreased circulating volume, baroreceptors in the aorta are activated

Question 2

fluids shift also causes

Answer 2

sympathetic nervous system to releases epinephrine and norepinephrine, causing vasoconstriction and an increased heart rate

Question 3

fluid shift makes the kidneys

Answer 3

launch the renin-angiotensin-aldostrone system in response to a lower glomerular filtration rate. RAAS

Question 4

all this happens with the goal

Answer 4

of increasing circulating volume, blood pressure and cardiac output

Question 5

hypothalamic regulation starts

Answer 5

the osmoreceptors in hypothalamus sense fluid deficit or increase
stimulates thirst and antidiuretic hormone (ADH) release and results in increased free water and decreased plasma osmolality

Question 6

stimuli affecting the thirst mechanism

Answer 6

increased plasma osmolality
decreased plasma volume
angiotensin II
angiotensin III
dry pharyngeal mucous membranes
psychological factors

Question 7

the primary regulator of fluid intake is

Answer 7

the thirst mechanism

Question 8

In renal regulation

Answer 8

kidneys are the primary organs for regulating fluid and electrolyte balance
adjusting urine volume
selective reabsorption of water and electrolytes
renal tubules are sites of action of ADH and aldosterone

Question 9

The antidiuretic hormone regulation

Answer 9

regulates water excretion and reabsorption from kidneys
osmolality influences the production of the hormone
other factors that affect the production and release of ADH include:
blood volume
temperature
pain
stress
drugs (opiates, barbiturates, nicotine, NSAIDS)

Question 10

a decrease in urine output

Answer 10

fluid will dilute body fluids

Question 11

renin-angiotensin-aldosterone system

Answer 11

responds to changes in renal perfusion
renin causes conversion of angiotensinogen to angiotensin I, which is converted to angiotensin II causing vasoconstriction and stimulates adrenal glands on top of the kidneys to produce aldosterone.

Question 12

RAAS works to keep the body’s

Answer 12

sodium and water levels at homeostatic levels

Question 13

sympathetic stimulation hypotension decreased sodium delivery to

Answer 13

kidney->renin and angiotensinogen-> A I (by ACE)->A II which goes to adrenal sorted to relate aldosterone to go to renal sodium and fluid retention, same time A II->pituitary-> ADH leading to renal sodium and fluid retention as well as a direct of A II to the renal sodium and fluid retention also-> increased blood volume. A II-.thirst ->increased blood volume, and A II directly to systemic vasoconstriction and cardiac and vascular hypertrophy

Question 14

in cardiac regulation the

Answer 14

atrial natriuretic factor are antagonists to the RAAS
produced by cardiomyocytes in the atrium in response to increased atrial pressure
suppress section of aldosterone, renin, and ADH to decrease blood volume and pressure by acting as a potent diuretic
ANF ia a vasodilator

Question 15

in gastrointestinal regulation

Answer 15

oral intake accounts for most water
small amounts of water are eliminated by gastrointestinal tract in feces
diarrhea and vomiting can lead to significant fluid and electrolyte loss
or NG tube

Question 16

nursing assessment for fluid and electrolyte status is

Answer 16

make sure to obtain a health history
think to ask and look for any chronic cardiac, renal or endocrine diseases
medications
client’s food and fluid intake, fluid output
and a physical assessment

Question 17

during the physical assessment for for fluid and electrolyte status you should

Answer 17

focus on the skin, oral cavity, mucous membranes, the eyes, the cardiovascular, respiratory, and neurological systems and mother function assessment

Question 18

clinical measurements for fluid and electrolyte are

Answer 18

daily weight-first thing in morning with same everything at the same time
VS- for a normal day accurate account
and fluid intake and output

Question 19

diagnostic tests consist of

Answer 19

renal labs: BUN and Creatinine are measures of kidney function
CBC- for hematocrit measures volume of whole blood that is RBC’s
hematocrit is the volume of cells in relation to plasma. affected by changes in plasma volume. normal is between 40%-50%.

Question 20

serum osmolality

Answer 20

measures the solute concentration of the blood. evaluates fluid balance. Normal 280-800 most/kg

Question 21

urine osmolality

Answer 21

measures the solute concentration of the urine, consists of nitrogenous wastes (BUN, creatinine, uric acid). Normal 200-800 most/kg

Question 22

urine specific gravity

Answer 22

indicator of urine concentration. normal 1.005-1.030

Question 23

classification of fluid and electrolyte imbalances are

Answer 23

FVD, FVE, and electrolyte imbalances

Question 24

isotonic imbalances

Answer 24

(water and electrolytes gained or lost in equal proportions) Fluid Volume Excess or Fluid Volume Deficit

Question 25

osmolar imbalances

Answer 25

(loss and gain of water only) dehydration or overhydration.

Question 26

FVD/dehydration-GI fluid loss

Answer 26

excessive fluid loss-hemorrhage, GI suction, intestinal fistulas, vomiting, diarrhea

Question 27

insufficient intake for FVD is

Answer 27

lack of fluid access, oral trauma, swallowing difficulty, altered thirst mechanism

Question 28

FVD-failure of regulatory mechanisms

Answer 28

burns, and kidney failure

Question 29

FVD- pediatric differences

Answer 29

imbalances due to exercise, heat stress, increased respiratory rate, fever

Question 30

FVD-older adults

Answer 30

fewer intracellular reserves leads to rapid dehydration

Question 31

FVD-pregnantcy

Answer 31

can also lead to FVD

Question 32

clinical manifestations of FVD

Answer 32

``` initial symptom may be thirst -hypotension, tachycardia, weak pulse, tachypnea -reduced urine output (oliguria) -dry, cracked skin and dry mucous membranes poor skin turgor weight loss sunken eyeballs may complain of nausea or vomiting ```

Question 33

diagnostic testing for FVD consist of

Answer 33

CBC: hematocrit may be increased/not much fluid on board Urine specific gravity may be elevated, indicating high solute load in the urine serum osmolality: may be increased renal labs such as BUN and creatinine may be elevated indicating renal involvement Seem electrolytes: electrolytes may be normal if the kidneys compensate and regulate electrolyte levels. with profuse diarrhea or vomiting the potassium levels are low, causing muscle weakness and heart rhythm disturbances.

Question 34

FVD/dehydration collaboration

Answer 34

monitor vital signs, I *& O, daily weights, skin turgor mucous membrane, urinary output Urine output less than 30 mL/hr needs to be reported to provider monitor lob values

Question 35

FVD/dehydration clinical therapies

Answer 35

1. oral rehydration- safest and gradual and 30-50% of deficit in first 24 hours 2. intravenous fluids

Question 36

FVD/dehydration nursing diagnoses

Answer 36

deficient fluid volume ineffective peripheral tissue perfusion related to hypovolemia confusion activity intolerance

Question 37

FVD/dehydration implementation

Answer 37

``` accurate intake and output weigh daily vital signs administer fluids as ordered monitor laboratory values monitor level of consciousness reposition every 2 hours institute fall precautions teach prevention of orthostatic hypotension, maintaining fluid intake and prevention of fluid deficit ```

Question 38

FVE/interstitial fluid volume excess (edema)

Answer 38

increased blood hydrostatic pressure (inflammation, local infection, right sided heart failure, venous thrombosis)

Question 39

FVE-decreaded blood osmotic pressure

Answer 39

(albumin-nephrotic syndrome, kwashiorkor, liver disease)

Question 40

FVE-increaded interstitial fluid osmotic pressure

Answer 40

(increased capillary permeability caused by inflammation, toxins, burns, hypersensitivity reactions)

Question 41

FVE-blocked lymphatic drainage

Answer 41

(tumors, goiters, parasites, surgery)

Question 42

over-hydration leads to

Answer 42

``` neurologic cardiovascular respiratory and gastrointestinal problems edema-dependent pitting edema ```

Question 43

FVE is

Answer 43

too much fluid going in with failure to eliminate

Question 44

you can treat FVE by

Answer 44

sodium concentrations being decreased, as well as the osmolality because there is more water than sodium and the hematocrit will be reduced from the dilution of excess water

Question 45

clinical manifestations of FVE

Answer 45

``` weight gain > 5% over short period of time edema (anasarca) full, bounding pulse increase blood pressure distended neck, peripheral veins cough, dyspnea, orthopnea moist crackles and rales i lungs polyuria ascites possible cerebral edema (altered mental status and anxiety) decreased hematocrit and BUN ```

Question 46

diagnostic testing for FVE

Answer 46

CBC: hematocrit may be decreased. serum osmolality may be decreased. specific gravity may be decreased. renal labs, such as BUN and creatinine may be decreased

Question 47

nursing management of fluid volume excess

Answer 47

do frequent respiratory assessments and check his LOC. watch for edema, skill care but cardiovascular checks take priority daily weight fluid restriction measure I & O carefully observation and assessment are need buy the morse because fluid excess can be life threatening always look and assess to be safe

Question 48

FVE-collaboration

Answer 48

diagnostic tests pharmacological therapy (diuretics) fluid management and restriction low sodium diet

Question 49

fluid restriction guidelines

Answer 49

subtract requisite fluids from total daily allowance divide remaining fluid allowance -day shift: 50% of total -evening shift: 25-33% of total -night shift:remainder explain the fluid restriction the client and family members identify preferred fluids and intake pattern of client place allowed amounts of fluid in small glasses (gives perception of a full glass) offer ice chips (when melted, ice chips are approximately half the frozen volume) provide frequent mouth care provide sugarless chewing gum (if allowed) to reduce thirst sensation

Question 50

clinical manifestations etiologies of FVE

Answer 50

congestive heart failure liver cirrhosis adrenal tumor over administration of intravenous fluids

Question 51

clinical therapies of FVE

Answer 51

1. administration of diuretics-loop diuretics which act on the ascending loop of Henle, thiazide-type diuretics which act of the distal convoluted tubule and potassium-sparing diuretics which affect the distal nephron 2. elevate head of bed 3. monitor cardiorespiratory and oxygen saturation 4. administer oxygen 5. daily weights 6. accurate intake/output 7. fluid restriction

Question 52

nursing diagnoses for FVE

Answer 52

``` excess fluid volume risk of impaired skin integrity rick for impaired gas exchange activity intolerance ineffective health maintenance ```

Question 53

implementation of FVE

Answer 53

``` weigh daily maintain intake/output records fluid restrictions oral hygiene every 2 hours teach sodium restriction diet administer medications teach client medication safety reposition every 2 hours-elevate area with edema position in Fowler position monitor labs ```