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Labs & Diagnostic Collab > Fluid Imbalances (Deficit & Excess) > Flashcards

Fluid Imbalances (Deficit & Excess) Flashcards

1
Q

What is diffusion?

A

the movement of molecules from an area of high concentration to low concentration

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2
Q

What is osmosis?

A

the movement of water “down” a concentration gradient, that is, from a region of low solute concentration to one of high solute concentration, across a semipermeable membrane.

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3
Q

Another name for Colloidal Osmotic Pressure

A

Oncotic Pressure

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4
Q

Albumin is the _______ power.

A

Pulling

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5
Q

What is the result of low Albumin?

A

Fluid will leak into the interstitium and third space because there is no pulling power in the intravascular space

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6
Q

What is Colloidal Osmotic Pressure?

A

the osmotic pressure caused by plasma colloids (large molecules) in solution

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7
Q

What is Albumin?

A

Protein that is a major colloids in the vascular system contributing to osmotic pressure.

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8
Q

What is hydrostatic pressure?

A

the force of fluid in a compartment pushing against a cell membrane or vessel wall.

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9
Q

Hydrostatic pressure is the ______ power.

A

Pushing

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10
Q

An increase in hydrostatic pressure causes a shift of fluids from the __________ space into the _______ space.

(From the Heart failure example– if you have fluid backed up because the heart cannot pump it out as it should)

A

Intravascular, Interstitium

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11
Q

If you have adequate albumin levels, fluid should remain where?

A

Intravascular space

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12
Q

Two types of Fluid Volume Imbalance (FVI)

A

Fluid Volume Excess (FVE)

Fluid Volume Deficit (FVD)

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13
Q

Why would someone have FVE? (Excess) -Causes

A
  • Excess isotonic or hypotonic IV fluids
  • Heart failure (inadequate CO-backed up fluid into interstitium and lungs)
  • Renal failure (inability to void/urinate)
  • Primary polydipsia (drinking excess amounts of water-rare)
  • SIADH (endocrine issue)
  • Cushing syndrome (endocrine issue)
  • Long-term use of corticosteroids (cause fluid retention)
  • TACO (blood transfusion administered too quickly)
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14
Q

Why would someone have FVD (deficit)- Causes

A
  • Increase in insensible water loss or perspiration (high fever, heatstroke)
  • Diabetes insipidus (endocrine)
  • Osmotic diuresis (diuretics that pull excess water out by osmosis–ex: Mannitol(
  • Hemorrhage (internal bleeding)
  • GI losses: vomiting, NG suction, diarrhea, fistula drainage
  • Overuse of diuretics (example: Heart failure Pt)
  • Inadequate fluid intake
  • Third-space fluid shifts: burns, pancreatitis
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15
Q

Too much fluid in the lungs is ________ _________.

A

Pulmonary edema

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16
Q

Too much fluid in the ankles is ______ _______.

A

Peripheral edema

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17
Q

Fluid that collects in an area that serves no purpose and does not belong is called:

a) 2nd Spacing
b) Mitral Spacing
c) 3rd spacing
d) 8th spacing

A

c) 3rd Spacing

examples: Pleural effusion [PE], peritoneum, pericardium

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18
Q

Two most common Med-Surg co-morbidities in adults for FVE (excess)?

A

Heart Failure

Renal Failure

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19
Q

Who has a greater risk for FVE, especially due to heart failure?

A

Elderly/Older adults

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20
Q

Manifestations of Fluid Volume Excess

A
  • Headache, confusion, lethargy
  • Peripheral edema
  • Jugular venous distention
  • S3 heart sound
  • Bounding pulse, ↑ BP, ↑ CVP
  • Polyuria (with normal renal function)
  • Dyspnea, crackles, pulmonary edema
  • Muscle spasms
  • Weight gain
  • Seizures, coma
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21
Q

What part of the body does peripheral edema usually occur? Why?

A

Ankles, because the ankles are a “dependent” part of the body. It is harder for the blood to pump back up to the heart, especially when standing all day.

22
Q

Dependent position is…

A

any area of the body below the level of the heart

23
Q

S3 heart sound is considered what type of sound?

a) clicking
b) gallop
c) no sound
d) skipping

A

b) gallop

d/t overload on the heart

24
Q

With regards to FVE and FVD, is the weight gain/loss due to water or nutrition?

A

Water weight

25
Q

The feeling of thirst is a ____ mechanism

A

protective

26
Q

_____ patients experience a ______ in their thirst mechanism

A

Elderly, decrease

d/t losing the trigger to drink

27
Q

Who is likely to have an increased risk of dehydration?

A

Older adults

28
Q

CO stands for?

A

Cardiac output

29
Q

CO =

A

HR x SV

30
Q

Stroke Volume (SV) is the amount of _____ that is ejected from the ____ ventricle every time it _____.

A

blood
Left
pumps

31
Q

In a FVD patient, their CO will likely reflect: (circle one for each)

increase/decrease in SV

and

increase/decrease in HR

A

decrease = SV

increase = HR
the heart is trying to maintain the CO. if the HR is trending up, find out why!

32
Q

Seizures and coma in both FVE and FVD are likely due to which imbalance?

a) calcium
b) potassium
c) sodium
d) magnesium

A

c) Sodium (discussed further in the Sodium section)

33
Q

Daily monitoring of _____ is key to a patient’s fluid volume status and is the most reliable measure.

A

weight (body)

34
Q

In order to obtain a reliable and consistent measure of body weight, these 3 components must stay the same:

A

Scale
Clothes
Time of day

35
Q

_ & _ are a measure of FV, but are often inconsistent and unreliable

A

I & Os

36
Q

Labs that are monitored because they impact FV: (4)

A

BUN
Na+
Hct
Urine & Serum Osmolality

37
Q

What does the Urine and serum osmolality measure?

A

how concentrated the blood and urine are

38
Q

A patient who is considered hemodiluted (too much fluid) might show what in their lab results for BUN, Na+, Hct?

a) True-low results
b) False-low results
c) False-high results
d) True-high results

A

B) False low lab results

39
Q

A patient who is considered dehydrated (too little fluid) might show what in their lab results for BUN, Na+, Hct?

a) True-low results
b) False-low results
c) False-high results
d) True-high results

A

C) False high lab results

40
Q

Someone who is dehydrated has an increase/decrease in plasma levels (choose one)

A

decrease

41
Q

Nursing Management/Care for FVD patient:

A

1) mild– increase oral hydration
2) severe– replace volume with blood products (ex: PRBC if due to blood loss)
3) severe– replace volume with balance IV solutions (e.g., 0.9% sodium chloride or LR)

42
Q

Nursing Management/Care for FVE patient:

A

May need to restrict fluids, especially those with heart failure, kidney disease, or liver failure

43
Q

Nursing management for FV imbalances (Cardiovascular Risks):

A
  • Monitor VS (watch for trending)
    FVE: bounding
    FVD: faint pulse, Tachycardic, Orthostatic hypotension, amplitude = weak/thready
44
Q

Why is a FVD patient tachycardic?

A

the heart is trying to raise the BP and keep it WNL

45
Q

Nursing Management/Care for FV imbalances (Respiratory risks):

A

FVE: risk for Pulmonary edema

fluid trapped in the aveoli and can cause SOB

46
Q

BP is the _____measure of ____ ____.

A

indirect, Cardiac Output

47
Q

Equation for Cardiac Output

A

CO = HR x SV

48
Q

Nursing management for FV imbalances (Patient Safety Risk):

A
  • Change in LOC

- Orthostatic hypertension (be sure to assist Pt)

49
Q

Nursing management for FV imbalances (Skin Care Risk):

A
  • Dry (FVD)

- Pitting edema (FVE)

50
Q

Nursing management for FV imbalances (Fluid Therapy):

A

Know your patient!

Give fluids if deficient (HCP order dependent)

Restrict fluids if overload (HCP order dependent)

51
Q

What can be delegated to UAP?

A
  • Obtain daily weights and vital signs.
  • Offer frequent oral care.
  • Record accurate intake and output.
  • Perform skin care and frequent position changes.
  • Elevate edematous extremities.
  • Encourage oral fluids as appropriate

Labs & Diagnostic Collab (18 decks)

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