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NURS 205 > Lecture 3: Management of Common Fluid Imbalances > Flashcards

Lecture 3: Management of Common Fluid Imbalances Flashcards

1
Q

what % of adult body weight is water

A

60

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2
Q

what are the 2 body fluid compartments

A
  1. extracellular
  2. intracellular
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3
Q

what is extracellular fluid (ECF)

A
  • 1/3 of body water
    1. Intravascular: plasma (5%) (liquid portion of blood)
  • btwn cells: interstitial (15%) and lymph (immune system fluid)
    2. Transcellular fluid (CSF, GI tract, pleural spaces, synovial spaces, peritoneal spaces)
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4
Q

intracellular fluid (ICF)

A
  • 2/3 of body water
  • located within cells
    (40% of body weight)
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5
Q

calculation of fluid gain/loss

A

1 L of H20 weighs 1 Kg
body weight change is a great indicator of fluid loss (ex: daily weights)

if a pt is on a diuretic loses 2kg in 24 hrs they have lost approx 2 L of fluid

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6
Q

what are electrolytes

A
  • molecules dissociate into ions when in water
  • cations: positively charged (Na+,K+,Ca2+, Mg2+)
  • anions: -‘ve charge (bicarbonate, Cl-, phosphate)
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7
Q

measurement of electrolytes

A

mmol/L

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8
Q

mech for controlling fluid and electrolyte movement

A
  • diffusion
  • facilitated diffusion
  • active transport
  • osmosis
  • hydrostatic pressure
  • oncotic pressure
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9
Q

what is diffusion

A

movement of molecules from high to low concentration
- membrane separating the 2 areas must be permeable to diffusing substances
- no ATP

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10
Q

facilitated diffusion

A
  • movement of molecules from high to low concentration
  • no ATP
  • uses specific carrier molecules to accelerate diffusion
  • glucose transport into the cell
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11
Q

active transport

A
  • process in which molecules move against concentration gradient (ex: Na-K pump)
  • external energy required
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12
Q

osmosis

A
  • movement of h2o btwn 2 compartments by membrane permeable to h2o but not solute
  • moves from low to high solute
  • no ATP
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13
Q

osmotic pressure

A

amount of pressure required to stop osmotic flow of water
- determined by concentration of solutes in solution

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14
Q

osmolality

A

concentration of molecules per weight of water

plasma (liquid portion in blood) osmolality is 280-300 mmol/kg

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15
Q

oncotic pressure

A

(colloidal osmotic pressure)
- osmotic pressure exerted by colloids in solution

major collioid in vascular sys contributing to total osmotic pressure is albumin

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16
Q

albumin

A
  • protein made by liver
  • keeps fluid in vascular space
  • albumin is low, fluid leaks out of vascular space
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17
Q

fluids with the same osmolality as the cell interior are ->

A

ISOTONIC, normally the ECF and ICF are isotonic to one another

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18
Q

fluids in which solutes are less concentrated than they are in cells are

A

HYPOTONIC (goes in)

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19
Q

fluids in which the solutes are more concentrated than they are in the cells are

A

HYPERTONIC (goes out)

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20
Q

hydrostatic pressure

A
  • force within fluid compartment
  • major force that pushes water out of vascular sys at capillary level
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21
Q

Fluid shifts

A
  1. plasma -> interstitial fluid shift = EDEMA
    - increased venous hydrostatic pressure
    - decrease in plasma oncotic pressure
    - elevation of interstitial oncotic pressure
  2. interstitial fluid -> plasma
    - fluid drawn into plasma space with increase in plasma osmotic or oncotic pressure
    - increasing the tissue hydrostatic pressure
22
Q

what can help decrease peripheral edema

A

compression socks

23
Q

fluid spacing (1st, 2nd, 3rd)

A

1st: normal distribution of fluid in ICF and ECF
2nd: abnormal accumulation of interstitial fluid (edema)
3rd: fluid accumulation in part of body where it is not easily exchanged w ECF

24
Q

what regulates water balance

A

hypothalamic
pituitary
adrenal cortex
renal
cardiac
gastrointestinal
insensible water loss

25
Q

serum electrolytes: Na

A

responsible for maintaining osmotic pressure

norm: 135-145 mmol/L

26
Q

serum electrolytes: K

A

component in cardiac function

norm: 3.5-5 mmol/L

27
Q

serum electrolytes: Cl

A

in combo w Na, Cl maintains fluid levels by reg osmotic pressure

norm: 95-105 mmol/L

28
Q

serum electrolytes: bicarbonate (HCO3)

A

major buffer in body, helping to maintain proper blood pH

norm: 21-28 mmol/L

29
Q

serum electrolytes: urea nitrogen (BUN)

A

urea is the waste product resulting from protein metabolism

norm: 2.5-6.4 mmol/L (adult)

30
Q

serum electrolytes: creatinine (CR)

A

waste product when muscle tissue uses energy sources

norm: 71-106 umol/L

31
Q

normal intake in adult

A

fluids - 1200 ml
solid food - 1000 ml
water from oxidation 300 ml

total intake - 2500 ml

32
Q

normal output in adult

A
  • insensible loss (skin and lungs) - 900 ml
  • in feces - 100 ml
  • urine - 1500 ml

total output: 2500 ml

33
Q

ECF volume imbalances

A
  • commonly occur
  • accompanied by 1 or more electrolyte imbalanced

either have:
1. ECF volume deficit = hypovolemia
2. ECF volume excess = hypervolemia

34
Q

what is hypovolemia

A

ECF volume deficit
- decrease in blood volume
- body can compensate, causing kidneys to retain xtra water and Na

35
Q

causes of hypovolemia

A
  • decreased intake
  • increased loss
36
Q

populations at risk for hypovolemia

A
  • kids: immature kidneys, higher metabolic rate, immature endocrine sys, greater BSA
  • elderly and disabled: chronic med conditions, decreased thirst response, decreased mobility, med effects
37
Q

how to look for hypovolemia

A
  • neuro changes: weakness, restlessness, agitation, twitching
  • cardio: increased HR, orthostatic hypotension, weak, thready pulse that is easily obliterated and flattened neck veins
  • resp change: increased RR
  • renal: decreased urine output

weight loss
decreased skin turgor

38
Q

3 types of IV solutions

A
  1. Isotonic solutions (have same effective osmolality as body fluids (close to 285 milliosmoles [mOsm]). An example of an isotonic fluid is 0.9% sodium chloride & lactated ringers
  2. A hypotonic solution (has a lower osmolality than body fluids; an example of a hypotonic fluid is 0.45% sodium chloride
  3. A hypertonic solution has an effective osmolality greater than that of body fluids; an example of a hypertonic fluid is 3% sodium chloride
39
Q

normal saline

A

0.9% NaCl
- Expands IV volume
- Preferred fluid for immediate response
- does not change ICF volume
- run w blood products; versatile
- compatible w most meds

40
Q

lactated ringers

A
  • the solution is isotonic w blood and intended for IV admin
41
Q

D5W

A
  • 5% dextrose
  • isotonic
  • 170 cal/L
  • Free water
  • Moves into ICF
  • can cause urinary Na loss
  • used to replace water losses
  • does not provide electrolytes
42
Q

cbc

A

complete blood count

3 categories:
1. leukocytes
2. erythrocytes (hemoglobin [protein compound that bind w o2], and hematocrit [% of RBC])
3. platelets

43
Q

hemoglobin amount norm

A

female: 7.4-9.9 mmol/L
male: 8.7-11.2 mmol/L

44
Q

low hemoglobin

A

not enough o2, could be an iron deficiency, too much fluid in blood because it has diluted the red blood cells, also that they have lost a lot of blood, anemia, cancer

45
Q

high hemoglobin

A

to low fluid, if you live at a high altitude, bone marrow disfunction, blood doping,

46
Q

hematocrit levels

A

female: 0.35-0.47 volume fraction
male: 0.42-0.52 volume fraction

47
Q

low hematocrit

A

fluid volume excess

48
Q

high hematocrit

A

fluid volume deficit (causes dehydration)

49
Q

ECF volume excess (hypervolemia)

A
  • abnormal increase in blood volume
  • kidneys to release additional water and sodium

causes: increased retention (CHF, chronic liver disease, renal failure), increased intake (rare w adequate renal function, excessive IV administration of fluids

sympt:
apathy, confusion, pulse not easily obliterated, increased bp, SOB
(neuro, cardio, resp)

50
Q

edematous skin

A

1+ (2mm indentation) to 4+ (pitting, 8mm indentation)

NURS 205 (18 decks)

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