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Med Surg Test 3 > Fluid Balance > Flashcards

Fluid Balance Flashcards

1
Q

2 basic functions of fluid

A
  1. Provide transportation of nutrients to cell and waste from cell
  2. Provides medium for chemical reactions
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2
Q

Composition of water in the body

A

Adult male 60%
Adult female 50%
Infants (under 2) 60-80%
Elderly (over 45) 45-55%

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3
Q

Why do females have lower body composition of water than males?

A

females have higher composition of body fat and fat cells contain very little water

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4
Q

Why do the elderly have a lower composition of water?

A

muscle atrophy

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5
Q

How does the body lose fluid?

A

kidneys, GI tract, lungs, skin

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6
Q

How much fluid is lost through the kidneys daily?

A

about 1500 cc daily

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7
Q

How much fluid is lost through the GI tract daily?

A

150-200 cc daily

8-10 liters is secreted but most is reabsorbed

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8
Q

How much fluid is lost through the lungs daily?

A

300-400 cc daily

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9
Q

How much fluid is lost through the skin daily?

A

400-500 cc daily

Sensible & insensible

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10
Q

What is sensible fluid loss through the skin?

A

sweating

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11
Q

What is insensible fluid loss through the skin?

A

evaporation

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12
Q

How do we replenish fluids?

A

liquids & fluids

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13
Q

How much fluid do we need in 24 hours?

A

30 cc/kg

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14
Q

How is food replenished via food?

A

Meats, fruits and veggies contain 60-97% water

Oxidation of carbohydrates, fats or proteins via TCA (Krebs) Cycle–10 cc of water for every 100 calories

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15
Q

Where is the majority of water in children?

A

interstitial space

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16
Q

Do adults of children have a greater metabolic rate?

A

children

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17
Q

daily fluid needs for children

A 
Premature          50-70 ml/kg
Newborn             80-100 ml/kg
Newborn-1 year   150 ml/kg
1-2 years             100 ml/kg
2-4 years               90ml/kg
4-10 years            50-70 ml/kg
> 10 years            40 ml/kg
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18
Q

Volume of fluid in intracellular fluid compartments

A

25 liters

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19
Q

Volume of fluid in extracellular fluid compartments

A

15 liters

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20
Q

3 extracellular fluid compartments

A

interstitial
intravascular
transcellular

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21
Q

What is interstitial fluid?

A

fluid surrounding the cell

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22
Q

Volume of interstitial fluid

A

8 liters

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23
Q

What is intravascular fluid?

A

fluid within blood vessels

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24
Q

Volume of intravascular fluid

A

5-6 liters

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25
What is transcellular fluid?
fluid secreted by epithelial cells
26
examples of transcellular fluid
CSF, pericardial fluid, pleural fluid, synovial fluid, intraocular fluid, digestive secretions
27
Volume of transcellular fluid
1 liter
28
first spacing
normal fluid distribution
29
second spacing
interstitial edema
30
third spacing
fluid in areas with little or no fluid normally
31
examples of third spacing
ascites, pleural effusion, pericardial effusion
32
transport processes that effect movement of water and solutes
diffusion active transport flitration osmosis
33
examples of solutes that move by facilitated diffusion
insulin | glucose
34
example of active transport
Na+/K+ pump
35
what type of transport id dependent on hydrostatic pressure?
filtration
36
Why are diabetics constantly thirsty and frequently urinate?
glucose has strong osmotic pull
37
Osmolarity of water
280-294 mOsm/kg
38
tonicity
ability of particles to affect the movement of water
39
fluid movement in isotonic solutions
no net movement
40
fluid movement in hypotonic solutions
fluid moves into cell (cells can burst)
41
fluid movement in hypertonic solutions
fluid moves out of cell (cells can shrivel)
42
locations of volume receptors (baroreceptors)
carotid sinuses, aortic arch, cardiac atria & renal vessles
43
what type of IV fluids can diffuse through the capillary wall
crystalloid solutions
44
what type of IV fluids cannnot pass through capillary wall
colloid solutions
45
what are colloid solutions used to treat
severe deficit or shock
46
what type of IV fluids increase osmotic pressure in vascular space
colloid solutions
47
what type of IV fluids are plasma or volume expanders
colloid solutions
48
what compartment(s) expand with hypotonic solutions?
ECF and ICF
49
what compartment(s) expand with isotonic solutions
ECF only
50
what tonicity is best for patients with extracellular fluid deficit?
isotonic solutions
51
how do hypertonic solutions work?
by raising osmolarity of ECF and expanding it; draw water out of cell into ECF
52
what is the danger of hypertonic solutions?
intravascular fluid volume excess
53
What is tonicity of D5%W?
isotonic (278)
54
What is tonicity of D10%W?
hypertonic (556)
55
What is tonicity of 0.45% saline?
hypotonic (154)
56
What is tonicity of 0.9% saline (NS)?
isotonic (308)
57
What is tonicity of 3% NaCl?
hypertonic (1026)
58
What is tonicity of D5% 0.225% (D5 1/4)?
isotonic (355)
59
What is tonicity of D5% 0.45% (D5 1/2)?
hypertonic (432)
60
What is tonicity of D5% 0.9% (D5NS)?
hypertonic (586)
61
What is tonicity of Ringer's Solution?
isotonic (309)
62
What is tonicity of Lactated Ringers?
isotonic (274)
63
What is Ringer's Solution?
similar to plasma, excess Cl, no Mg, no HCO3
64
What is Lactated Ringers?
contains Na K, Cl, Ca, lactate in same proportion as ECF
65
What type of solution is blood?
colloid
66
When is whole blood given?
emergency situations
67
What is PRBC?
red blood cells in 20% plasma
68
What does giving as a split unit mean?
giving over 8 hours instead of 4 hours
69
When are platelets given?
thrombocytopenia
70
What as the opposite effect of warfarin (coumadin)?
fresh frozen plasma
71
What proportion of fresh frozen plasma is given compared to PRBCs?
1 unit of FFP per 6 units PRBCs
72
What is fresh frozen plasma?
clotting factors
73
What is cryoprecipitate?
specialized clotting factors
74
When volume receptors sense change, what 4 things can change?
cardiac output vascular resistance thirst renal handling of sodium and water
75
What systems/steroids/hormones regulate fluid?
``` sympathetic nervous system renin-angiotensin I/II system aldosterone atrial natriuretic factor antidiuretic hormone thirst (osmoreceptors) ```
76
What does aldosterone do?
holds onto sodium
77
What does atrial natriuretic factor (ANF) do?
reduces blood pressure and circulating volume | inhibits secretion and effects of ADH
78
What do ADH do?
hangs onto water
79
What is the earliest symptom of a water deficit?
thirst
80
What patient assessments should be done when looking at fluid volume?
``` history daily weights (1 kg = 1 L fluid) integument mucous membranes intake and output vital signs cardiovascular system (hemodynamic monitoring) nervous system (mentation) GI system (anorexia, nausea, constipation, diarrhea, thirst) Chemistry (H&H, electrolytes) ```
81
What should normal urine output be?
0.5cc/kg/hr
82
how does water affect body temperature?
water cools body
83
What is capillary hydrostatic pressure?
pressure exerted by fluid inside capillary outward against capillary membrane
84
How does capillary hydrostatic pressure work?
filtration
85
What is capillary hydrostatic pressure on arterial end?
32 mm Hg
86
What is capillary hydrostatic pressure on venous end?
12 mm Hg
87
What is Interstitial Fluid Pressure?
pressure exerted by fluid outside capillary against capillary membrane--about 1 mm Hg
88
What does Interstitial Fluid Pressure do?
maintains integrity of interstitial space
89
What is plasma colloidal oncotic pressure?
pressure exerted by osmotic pull of proteins inside the blood vessels
90
What does plasma colloidal oncotic pressure do?
pulls fluid from interstitial space into blood vessel
91
What is plasma colloidal oncotic pressure on arterial end?
22 mm Hg
92
What is plasma colloidal oncotic pressure on venous end?
22 mm Hg
93
What can affect plasma colloidal oncotic pressure?
change in the amount of protein in the plasma
94
What is tissue colloidal osmotic pressure?
pressure exerted by osmotic pull of proteins in interstitial space--about 1 mm Hg
95
What can affect tissue colloidal osmotic pressure?
increase in protein in interstitial space
96
What 2 pressures maintain interstitial space?
tissue colloidal osmotic pressure | interstitial fluid pressure
97
Where is the excess fluid in vascular hypervolemia?
vascular space
98
Where is the excess fluid when edema occurs?
interstitial space
99
Where is the excess fluid in water intoxication?
intracellular space
100
Where is the excess fluid in third spacing?
transcellular space
101
How does vascular hypervolemia affect blood pressure?
increases blood pressure
102
What will the pulse of a patient with vascular hypervolemia?
full and bounding
103
What are the clinical findings in a patient with vascular hypervolemia?
``` increase in blood pressure full, bounding pulses distended peripheral veins increased JVD increase in central venous pressure signs and symptoms of pulmonary edema ```
104
What interventions should a nurse take with a patient with vascular hypervolemia?
``` decrease IV to KVO elevate head of bed with legs in dependent position (decreases venous return) decrease anxiety morphine IV (decrease preload and afterload) diuretics via IV or PO oxygen via nasal cannula measure I/O daily weights rotating tourniquets (rare) nitroprusside (dilates blood vessels) ```
105
Why does morphine decrease preload and afterload?
It is a vasodilator
106
What is edema?
fluid in interstitial space
107
Where will edema first appear?
tissues poorly protected against hydrostatic pressure (ankles, sacrum if bedridden)
108
What causes edema?
immobility injury obstruction in lymphatic drainage hypoproteinemia (low protein in blood)
109
What are clinical findings of a patient with edema?
``` puffy eyelids, bags under eyes pale, tight, shiny skin swollen ankles enlarged abdomen (liver issues) shoes, rings and belt tight shortness of breath, dyspnea, moist rales, hoarseness (if lungs are affected) ```
110
What are nursing interventions for edema?
elevate effected body part promote activity when possible diuretics (IV or PO) Fluid restrictions (may have sodium restrictions too) avoid constrictive clothing avoid crossing legs or sitting in ways that restrict circulation
111
What cause water intoxication?
excess IVs (especially hypotonic solutions) sterile water for irrigation post-TURP tap water enema psychogenic polydipsia (extremely thirsty)
112
What are the clinical findings in a patient with water intoxication?
disturbed thought and behavior (apprehension, irritability, restlessness, confusion, lethargy, coma) decrease in serum electrolytes (hyponatremia) pulmonary edema will not usually see visible edema
113
What are nursing interventions for water intoxication?
monitor IVs to prevent too much fluid intake monitor urinary output assess serum Na+ administer plasma expanders (albumin, mannitol, dextran) diuretics (increase flow through kidneys)
114
What is third spacing?
fluids move into inaccessible spaces and are retained there
115
If there is a drop in blood pressure & increase in pulse without increase in urine output or decrease in body weight, what should you suspect?
third spacing
116
What type of fluid excess is know as relative dehydration?
third spacing
117
What are some cause of third spacing?
intestinal obstruction cellulitis crushing injury vascular occlusions
118
Where are some places third spacing can occur?
``` pleural space pericardial space eye synovial space CNS ```
119
What are treatments for third spacing?
IV plasma expanders crystalloids to support vascular space mechanical removal of fluid (thoracentesis, paracentesis)
120
What is one reason you should be cautious with third spacing?
fluid can move back into intravascular space at any time
121
What are the 3 stages of fluid deficit?
simple dehydration advanced fluid loss hypovolemic shock
122
What are the signs of simple dehydration?
dry skin loss of skin turgor weight loss
123
What are the signs of advanced fluid loss?
falling blood pressure | weak, thready, rapid pulse
124
What are the signs of hypovolemic shock?
signs and symptoms of renal failure
125
What are the clinical findings of fluid deficit?
thirst dry skin and mucous membranes (be concerned if armpits are dry) hollow, sunken eyes (especially in children) shrunken wrinkled furrowed tongue (scrotal tongue) mild temperature elevation weight loss orthostatic hypotension with decreased blood pressure and tachycardia pale, cold extremities (due to peripheral vasoconstriction) oliguria that progresses to anuria (low urine to no urine) dark, concentrated urine with high specific gravity increase in H & H (hemoglobin & hematocrit), Na+, serum osmolarity apathy, fatigue, stupor, delirium (due to hyperosmolar state affecting CNS)
126
What are nursing interventions for fluid deficit?
Give fluids (PO or IV depending on stage) Monitor IV fluids carefully (do not want to over hydrate)--reverse hypernatremia slowly I/O Daily Weight Scrupulous oral care adequate nutrition
127
What is an isotonic imbalance?
sodium and water increase or decrease together | watch for symptoms of hypovolemia and hypervolemia
128
What is hypotonic imbalance?
Too much water or not enough sodium
129
What is hypertonic imbalance
Too much sodium or not enough water

Med Surg Test 3 (3 decks)

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