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nur 113 > PP - FLUID BALANCE - GADDIS - Jan 17 > Flashcards

PP - FLUID BALANCE - GADDIS - Jan 17 Flashcards

1
Q

BODY FLUID FUNCTION (8)

A

• MAINTAINS BLOOD VOLUME
• REGULATES BODY TEMP
• TRANSPORTS MATERIAL TO AND FROM CELLS
• AQUEOUS MEDIUM FOR CELLULAR METABOLISM
• ASSISTS DIGESTION OF FOOD THROUGH HYDROLYSIS
• SOLVENT - SOLUTES ARE AVAILABLE FOR CELL FUNCTION
• SERVES AS MEDIUM FOR THE EXCRETION OF WASTE
• BODY FLUIDS ARE IN CONSTANT MOTION, MAINTAINING LIVING CONDITIONS FOR BODY CELLS

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2
Q

BODY COMPOSITION

Infants

Adults

Older Adults

A

Infants: 70 - 80 % Water / 20 - 30 % Solids
Adults: 50 - 60 % Water / 40 - 50 % Solids
Older Adults: 45 - 55 % Water / 45 - 55 % Solids

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3
Q

THE AMOUNT OF FLUID IN THE BODY IS AFFECTED BY SEVERAL THINGS

A

Age
Gender
Obesity

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4
Q

How does age effect the amount of fluid in the body

A

• AS WE AGE OUR MUSCLE MASS DECLINES AND THE PROPORTION OF FAT CELLS WITHIN THE BODY INCREASES

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5
Q

MUSCLE CELLS HAS A HIGHER CONTENT OF FLUID THAN

A

FAT CELLS

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6
Q

How does gender effect the amount of fluid in the body

A

WOMEN TYPICALLY HAVE MORE FAT CELLS THAN MEN

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7
Q

Which patients can be expected to dehydrate most quickly

A

Preemies / newborns / older adults

Especially older obese women

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8
Q

Preemies and newborns can dehydrate quickly or this could happen quickly as well

A

Overhydration

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9
Q

BODY FLUID COMPARTMENTS

A

Intracellular
Extracellular

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10
Q

INTRACELLULAR

A

INSIDE THE CELLS

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11
Q

EXTRACELLULAR

A

OUTSIDE THE CELLS

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12
Q

WHAT IS FUNCTION OF ECF

A

TRANSPORTS NUTRIENTS TO THE CELL AND
CARRIES WASTE PRODUCTS AWAY FROM THE CELLS 

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13
Q

HOW DOES ECF TRANSPORT NUTRIENTS / WASTES TO / FROM CELLS

A

BY MEANS OF THE CAPILLARY BED.

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14
Q

ECF (EXTRACELLULAR FLUID) FURTHER DIVIDED (3)

A

• INTERSTITIAL
• INTRAVASCULAR
• TRANSCELLULAR

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15
Q

INTERSTITIAL

A

• SURROUNDS EACH CELL OF THE BODY, EVEN BONE CELLS

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16
Q

• INTRAVASCULAR

A

• SURROUNDS THE CELLS OF THE BLOOD – MOST OF THE BLOOD VOLUME

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17
Q

• TRANS CELLULAR FLUID ENCLOSED BY

A

ENDOTHELIAL MEMBRANE

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18
Q

TRANS CELLULAR INCLUDES (9)

A

• CEREBROSPINAL
• PERICARDIAL
• PANCREATIC
• PLEURAL
• INTRAOCULAR
• BILIARY
• PERITONEAL
• SYNOVIAL FLUIDS • BOWEL MUCUS

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19
Q

WHICH FLUID IS GENERALLY NOT SUBJECTED TO GAINS AND LOSSES

A

TRANSCELLULAR

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20
Q

THIRD SPACE SYNDROME

A

FLUID SHIFTS FROM THE VASCULAR SPACE INTO AN AREA WHERE IT IS NOT READILY ACCESSIBLE AS EXTRACELLULAR FLUID

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21
Q

EX’S OF THIRD SPACE SYNDROME

A

• ASCITES
• HYDROCEPHALUS
• PLEURALEFFUSIONS
• PERICARDIAL TRANSCELLULAR EFFUSIONS ???

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22
Q

HYDROSTATIC PRESSURE

A

HYDROSTATIC PRESSURE

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23
Q

OSMOTIC PRESSURE

A

PRESSURE BY SOLUTES IN SOLUTION

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24
Q

ONCOTIC PRESSURE

A

• “COLLOID PRESSURE”
• PRESSURE DUE TO ALBUMIN IN BLOOD

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25
Q

OSMOLALITY

A

CONCENTRATION OF SOLUTES/KG SOLUTION

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26
Q

OSMOLARITY

A

NUMBER OF OSMOLES OF SOLUTE PER LITER OF SOLUTION

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27
Q

HYDROSTATIC PRESSURE SYMBOLIZES THE

A

PUSHING OUTWARD OF HYDROSTATIC PRESSURE PUSHING H2O FROM ECF (CAPILLARY) INTO ICF

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28
Q

OSMOTIC PRESSURE

A

PULLING FORCE OF OSMOTIC (ONCOTIC) PRESSURE CREATED BY SOLUTES (ALBUMIN), WHICH FAVORS FLUID MOVEMENT FROM ICF INTO ECF (CAPILLARY)

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29
Q

STARLING LAW OF CAPILLARIES EXPLAINS THE MOVEMENT OF

A

FLUID THAT OCCURS AT CAPILLARY BEDS

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30
Q

FLUID THAT OCCURS AT CAPILLARY BEDS OUTCOME OF 2 MAJOR OPPOSING FORCES:

A
  • HYDROSTATIC PRESSURE
  • OSMOTIC PRESSURE
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31
Q

ALTERATIONS IN FORCES CAN LEAD TO

A

EDEMA

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32
Q

EDEMA (2) WAYS

A
  • INCREASED BLOOD VOLUME = INCREASED HYDROSTATIC PRESSURE
  • LOWER ALBUMIN = REDUCED OSMOTIC PRESSURE
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33
Q
  • INCREASED BLOOD VOLUME =
A

INCREASED HYDROSTATIC PRESSURE

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34
Q
  • LOWER ALBUMIN =
A

REDUCED OSMOTIC PRESSURE

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35
Q

NORMAL PLASMA OSMOLALITY ~

A

290 MOSM

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36
Q

MOSM means…

A
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37
Q

OSMORECEPTORS
* LOCATED IN

A

HYPOTHALAMUS

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38
Q

OSMORECEPTORS
* LOCATED IN HYPOTHALAMUS AND STIMULATED BY

A

INCREASED PLASMA CONCENTRATION

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39
Q

THIRST MECHANISM AND ANTIDIURETIC HORMONE (ADH) RELEASE INITIATED BY

A

OSMORECEPTORS

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40
Q

ADH (ALSO KNOWN AS

A

VASOPRESSIN

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41
Q

ADH (ALSO KNOWN AS VASOPRESSIN)
* SYNTHESIZED BY

A

HYPOTHALAMUS

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42
Q

ADH (ALSO KNOWN AS VASOPRESSIN)
* RELEASED FROM

A

POSTERIOR PITUITARY

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43
Q

ADH (ALSO KNOWN AS VASOPRESSIN)
* STIMULATES

A

KIDNEY NEPHRON TO REABSORB MORE WATER

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44
Q

RENIN RELEASED FROM

A

KIDNEYS

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45
Q

ANGIOTENSIN I CONVERTED TO

A

ANGIOTENSIN II

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46
Q

RENIN RELEASED FROM KIDNEYS
CONVERTS

A

ANGIOTENSINOGEN (FROM LIVER) TO ANGIOTENSIN I

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47
Q

WHERE IS ANGI I CONVERTED TO ANGI II AND BY WHAT

A

IN LUNGS BY ANGIOTENSIN-CONVERTING ENZYME (ACE)

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48
Q

ANGIOTENSINOGEN IS FROM

A

LIVER

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49
Q

ANGIOTENSIN II IS A

A

VASOCONSTRICTOR

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50
Q

ANGIOTENSIN II (VASOCONSTRICTOR)
ACTIVATES

A

ADRENAL CORTEX

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51
Q

ANGIOTENSIN II (VASOCONSTRICTOR)
ACTIVATES ADRENAL CORTEX TO RELEASE WHAT

A

ALDOSTERONE

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52
Q

ALDOSTERONE INCREASES

A

SODIUM AND WATER REABSORPTION AND POTASSIUM SECRETION BY KIDNEYS

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53
Q

RAAS

A

RENIN-ANGIOTENSIN- ALDOSTERONE SYSTEM

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54
Q

WHEN DECREASED CIRCULATION / DECREASED BP IS SENSED BY KIDNEYS WHAT HAPPENS

A

KIDNEYS SECRETES RENIN

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55
Q

WHEN KIDNEYS SECRETE RENIN, IT STIMULATES

A

THE LIVER

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56
Q

ANGIOTENSIN II STIMULATES WHICH GLAND

A

OUTER COTEX OF ADRENAL GLAND

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57
Q

WHAT DOES OUTER CORTEX OF ADRENAL GLAND RELEASE

A

ALDOSTERONE

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58
Q

WHAT EFFECT DIOES ALDOSTERONE HAVE ON THE BODY

A

INCREASES SODIUM & WATER REABSORPTION INTO BLOODSTREAM
CAUSES POTASSIUM SECRETION INTO URINE

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59
Q

WHAT IS THE RAAS NET EFFECT

A

INCREASED BLOOD VOLUME & INCREASED BP

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60
Q

ANGIOTENSIN STIMULATES OUTER CORTEX OF ADRENAL GLAND BUT ALSO STIMULATES

A

PERIPHERAL ARTERIAL VASOCONSTRICTION WHICH THEN RAISES BP

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61
Q

NATRIURESIS

A

EXCRETION OF LARGE AMOUNTS OF SODIUM AND WATER

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62
Q

THREE PEPTIDES PROMOTE NATRIURESIS

A
  • ATRIAL NATRIURETIC PEPTIDE (ANP)
  • BRAIN NATRIURETIC PEPTIDE (BNP)
  • C-TYPE NATRIURETIC PEPTIDE (CNP)
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63
Q

ATRIAL NATRIURETIC PEPTIDE (ANP)

A
  • ATRIAL CELLS WHEN ATRIA STRETCHED
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64
Q

RAIN NATRIURETIC PEPTIDE (BNP)

A
  • HEART VENTRICLES AND TO LESSER EXTENT, THE BRAIN
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65
Q

C-TYPE NATRIURETIC PEPTIDE (CNP)

A
  • ENDOTHELIAL CELLS OF ARTERIES AND
    VENTRICULAR CELLS
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66
Q

ASSESSMENT OF FLUID STATUS

A
  • DAILY WEIGHT
  • 24-HOUR I & O (INPUT AND OUTPUT)
  • VITAL SIGNS SUCH AS HEART RATE AND BLOOD PRESSURE
  • ORTHOSTATIC HYPOTENSION MAY DEVELOP IN DEHYDRATION
  • ASSESS STATUS OF MUCOUS MEMBRANES, SKIN TURGOR, URINE OUTPUT, EDEMA
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67
Q

1 OUNCE OF FLUID EQUALS

A

30 mL

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68
Q
  • 24-HOUR I & O (INPUT AND OUTPUT)
  • RECORD IN
A

mL

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69
Q

ORTHOSTATIC HYPOTENSION MAY DEVELOP IN

A

DEHYDRATION

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70
Q

ADD UP THE FOLLOWING INTAKE IN MILLILITERS
* 8 OZ COFFEE
* 6 OZ JUICE
* 1⁄2 CUP JELLO

A

540 mL

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71
Q

TO MAINTAIN, THE GAINS & LOSSES MUST

A

EQUAL

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72
Q

SEQUESTERED FLUIDS

A

FLUID ACCUMULATES IN BODY CAVITIES NORMALLY FREE OF FLUIDS

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73
Q

SEQUESTERED FLUIDS
* FLUID ACCUMULATES IN BODY CAVITIES NORMALLY FREE OF FLUIDS
* AKA:

A

THIRD-SPACE ACCUMULATION OR
THIRD-SPACING PERICARDIAL SAC,
PERITONEAL CAVITY, AND
PLEURAL SPACE

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74
Q

SEQUESTERED FLUIDS ALSO CALLED

A

FLUID CALLED “EFFUSION” doublecheck

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75
Q

FLUID CALLED “EFFUSION” (2) TYPES

A
  • TRANSUDATE: SEROUS FILTRATE OF BLOOD
  • EXUDATE: CONTAINS BLOOD, LYMPH, PROTEINS, PATHOGENS, INFLAMMATORY CELLS
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76
Q

Transudative pleural effusion is caused by

A

fluid leaking into the pleural space. This is from increased pressure in the blood vessels or a low blood protein count. Heart failure is the most common cause

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77
Q

Transudative pleural effusion is caused by fluid leaking into the pleural space. This is from

A

increased pressure in the blood vessels or a low blood protein count. Heart failure is the most common cause

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78
Q

 Exudative effusion is caused by

A

blocked blood vessels or lymph vessels, inflammation, infection, lung injury, or tumors

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79
Q

MAINTAINING THE FLUID BALANCE IN THE BODY IS A BALANCING ACT. WHICH ORGANS ALL WORK o TOGETHER TO MAINTAIN FLUID BALANCE.

A

HEART, KIDNEYS LIVER, ADRENAL AND PITUITARY GLANDS

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80
Q

YOU GAIN AND LOSE ON A

A

DAILY BASIS

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81
Q

THIS DELICATE FLUID BALANCING ACT IS AFFECTED BY

A
  • FLUID VOLUME
  • DISTRIBUTION OF THE FLUIDS IN THE BODY
  • CONCENTRATION OF SOLUTES IN THE FLUID
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82
Q

HOW MUCH WATER IS GAINED ON AVG EACH DAY THROUGH FOOD & DRINK

A

2.2 L

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83
Q

HOW MUCH WATER IS GAINED ON AVG EACH DAY THROUGH METABOLISM

A

0.3 L

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84
Q

TOTAL DAILY INTAKE H2O iS APPROX

A

2.5 L / DAY

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85
Q

(4) WAYS H2O IS LOST

A

SKIN / LUNGS / URINE / FECES

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86
Q

HOW MUCH WATER IS LOST THROUGH SKIN & LUNGS / DAY

A

0.9 L / DAY

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87
Q

WATER LOST EACH DAY THROUGH SKIN & LUNGS IS WHAT TYPE OF LOSS

A

INSENSIBLE LOSSES

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88
Q

HOW MUCH WATER IS LOST THROUGH URINE / DAY

A

1.5 L

89
Q

HOW MUCH WATER IS LOST THROUGH FECES / DAY

A

0.1 L / DAY

90
Q

(2) TYPES WATER LOSSES

A
  • SENSIBLE OR MEASURABLE
  • INSENSIBLE OR NOT MEASURABLE
91
Q
  • SENSIBLE LOSSES ARE
A

MEASURABLE

92
Q

INSENSIBLE LOSSES ARE

A

NOT MEASURABLE

93
Q

INSENSIBLE LOSSES OCCUR THROUGH

A

EVAPORATION

94
Q

EVAPORATION HAPPENS THROUGH

A
  • SKIN
  • LUNGS
95
Q

WHAT FACTORS CAN INCREASES THE INSENSIBLE LOSS

A
  • FEVER
  • RAPID AND/OR DEEP RESPIRATIONS (PAIN, FEVER, ANXIETY, DKA, ETC.)
96
Q

ONE REASON BABIES CAN BECOME DEHYDRATED OR OVER HYDRATED QUICKLY

A

BODY SURFACE AREA IS GREATER IN AN INFANT THAT AN ADULT RELATIVE TO WEIGHT

97
Q

AN EXCHANGE OF FLUID CONTINUOUSLY OCCURS AMONG THE

A

INTRACELLULAR, PLASMA, AND INTERSTITIAL COMPARTMENTS

98
Q

OF THESE THREE SPACES, INTRACELLULAR, PLASMA, AND INTERSTITIAL ONLY THE ——- IS

A

Plasma is DIRECTLY INFLUENCED BY THE INTAKE OR ELIMINATION OF FLUID FROM THE BODY.

99
Q

CHANGES IN THE INTRACELLULAR AND INTERSTITIAL FLUID COMPARTMENTS OCCUR IN RESPONSE TO

A

CHANGES IN THE VOLUME OR CONCENTRATION OF THE PLASMA

100
Q

NORMAL URINARY OUTPUT
* AT LEAST

A

400 ML

101
Q
  • AT LEAST 400 ML OF URINE MUST BE PRODUCED TO EXCRETE THE
A

Daily load of metabolic waste

102
Q

URINARY OUTPUT IDEAL MEASUREMENT:

A

1ML/KG/HR

103
Q

OLIGURIA

A

LESS THAN 400ML OF URINE IN 24 HOURS

104
Q

OLIGURIA:
* SIGNALS RETENTION OF

A

METABOLIC WASTES *5

105
Q

AT RISK MEASUREMENT:

A

0.5ML/KG/HOUR

106
Q
  • ANURIA
A
  • LESS THAN 100 ML URINE IN 24 HOURS
107
Q
  • POLYURIA
A
  • ABNORMALLY LARGE AMOUNT OF URINARY OUTPUT
108
Q
  • FLUID IMBALANCES CAN BE IDENTIFIED EARLY BY
A

ASSESSING YOUR PATIENT BEFORE & DURING IV THERAPY.

109
Q
      • COMPARE AND CONTRAST A PATIENT WHO IS HYPOVOLEMIC AND HYPERVOLEMIC
  • CHOSE 5 ASSESSMENT RESULTS

1. * worksheet on this

A

?vvv
* EXAMPLE: HEMATOCRIT (% OF HGB IN PLASMA) NORMAL IS 3 TIMES THE HEMOGLOBIN IN A NORMOVOLEMIC PATIENT
* IF INCREASED IT MEANS LESS VOLUME (PLASMA), IF DECREASED IT MEANS MORE VOLUME (PLASMA)

110
Q

FLUID IMBALANCES – ASSESSMENT DEFICIT FINDINGS (15)

WIDS MFID FTID PID

A

WEIGHT LOSS
INCREASED HEMATOCRIT
DIMINISHED BLOOD PRESSURE
SUNKEN EYEYES
MENTAL STATUS CHANGES
FAST, THREADY PULSE
INCREASED SERUM ELECTROLYE LRVELS
DRCREASED URINE OUTPUT
FURROWS IN TONGUE
THIRST
INCREASED BUN
DEVREASED SALIVATION
POOR SKIN TURGOR (NOT RELIABLE - ELDERLY)
INCREASED SERUM OSMOLARITY
DRY CRACKED LIPS

111
Q

DEHYDRATION

A

STATE OF DIMINISHED WATER VOLUME IN BODY

112
Q

STATE OF DIMINISHED WATER VOLUME IN BODY IS ALSO KNOWN AS

A

HYPOVOLEMIA

113
Q

IN DEHYDRATION - FLUID MOVES FROM

A

ICF CAUSING CELLS TO SHRINK (CELLULAR DEHYDRATION)

114
Q

RESPONSE TO DEHYDRATION

A
  • OSMORECEPTORS STIMULATE THIRST, ADH RELEASE
  • VASOCONSTRICTION AND INCREASED HR
  • RAAS ACTIVATED
115
Q

DECREASED CIRCULATING BLOOD VOLUME LEADS TO

A

TACHYCARDIA AND HYPOTENSION

paste clarifier

116
Q

DEHYDRATION CAN BE CAUSED BY

A
  • REDUCED FLUID INTAKE
  • REDUCED ADH OR KIDNEYS NOT RESPONSIVE TO ADH
  • BURNS, FEVER, PERSPIRATION
  • OSMOTIC DIURESIS, AS OCCURS WITH ELEVATED BLOOD GLUCOSE LEVELS
  • HYPERNATiREMIA
117
Q

DEHYDRATION STIMULATES WHAT (4) THINGS

A

SIMULATION OSMORECEPTORS IN BRAIN
STIMULATION PERIPHERAL BARORECEPTORS IN BLOOD VESSELS
STIMULATES KIDNEY TO RELEASE RENIN
STIMULATION OF OSMORECEPTORS

118
Q

STIMULATION OF OSMORECEPTORS IN BLOOD VESSELS LEADS TO

A

STIMULATION OF THIRST CENTER IN HYPOTHALAMUS

119
Q

STIMULATION OF BARORECEPTORS IN BLOOD VESSELS LEADS TOPERIPHERAL

A

SNA STIMULATING HEART TO BEAT FASTER
VASOCONSTRICTION OF BLOOD VESSELS

120
Q

STIMULATION OF KIDNEY TO SECRETE RENIN LEADS TO

A

RAAS DIUBLE CHECK THIS

121
Q

RAAS LEADS TO

A

RAISES BP
RAISES BLOOD VOLUME

122
Q

DEHYDRATION STIMULATES OSMORECEPTORS THAT THEN STIMULATES WHAT

A

POSTERIOR PITUITARY GLAND OF BRAIN

123
Q

WHEN POSTERIOR PITUITARY IS STIMULATED WHAT HORMONE IS RELEASED

A

ADH

124
Q

ADH HAS WHAT EFFECT ON THE KIDNEYS

A

INCREASES WATER REABSORPTION AT NEPHRON OF KIDNEY

125
Q

FLUID IMBALANCES – ASSESSMENT EXCESS FINDINGS (14)

A
  • WEIGHT GAIN
  • ELEVATED BLOOD PRESSURE
  • JUGULAR VEIN DISTENTION
  • DYSPNEA
  • BOUNDING PULSE
  • PUFFY EYELIDS
  • MOIST CRACKLES OR RHONCHI
  • EDEMA – GENERALIZED OR
  • PERIORBITAL EDEMA
  • DECREASED HEMATOCRIT
  • DECREASED SERUM ELECTROLYTE LEVELS
  • DECREASED BUN
  • REDUCED SERUM OSMOLARITY
  • SLOW EMPTYING OF HAND VEINS WHEN THE ARM IS RAISED
126
Q

FLUID VOLUME OVERLOAD

A

BLOODSTREAM HAS EXCESSIVE AMOUNT OF WATER

127
Q

ONE OF MOST COMMON CAUSES FLUID VOLUME OVERLOAD

A

IS HEART FAILURE (THROUGH ACTIVATION OF RAAS DUE TO LOW PERFUSION OF KIDNEY)

128
Q

EDEMA DEVELOPS DUE TO

A

HIGH HYDROSTATIC FORCES

129
Q

Transudative pleural effusion is caused by fluid leaking into the pleural space. This is from

A

increased pressure in the blood vessels or a low blood protein count. Heart failure is the most common cause

130
Q

How Is albumin (the most abundant protein in the body) related to edema

A

Proteins in bloodtend to pullwater into blood vessels (acting like a “water magnet”). When level of protein in blood is low, water may leave blood vessels and collect in tissues.

131
Q

Water in the tissues is called

A

“edema”. Critically ill patients develop edema for many reasons. Alow albumin level can cause edema or increase the amount of edema from other causes

132
Q

EDEMA - * EXCESS OF FLUID IN THE

A

ISF AND ICF COMPARTMENTS

133
Q

PRIMARY CAUSES EDEMA

A

ELEVATED HYDROSTATIC PRESSURE
DECREASED OSMOTIC FORCES IN BLOOD
ALTERATIONS IN CAPILLARY PERMEABILITY
SODIUM RETENTION

134
Q

ELEVATED HYDROSTATIC PRESSURE Leads to

A

INCREASED ECF VOLUME AS OCCURS IN HEART FAILURE

135
Q

DECREASED OSMOTIC FORCES IN BLOOD Leads to

A

HYPOALBUMINEMIA

136
Q

HYPOALBUMINEMIA

A

LIVER FAILURE, PROTEIN MALNUTRITION

137
Q

SODIUM RETENTION CAN BE FROM

A
  • DUE TO ILLNESS OR CONSUMPTION OF SALTY FOODS
  • PULLS FLUID FROM ICF INTO ECF
138
Q

ALTERATIONS IN CAPILLARY PERMEABILITY From

A
  • HISTAMINE
  • INFLAMMATION
139
Q

DEPENDENT EDEMA

A
  • LOWER EXTREMITIES
  • VENOUS BLOOD COLLECTS
  • FLUID ACCUMULATES IN
    FEET AND ANKLES
  • TEDS: THROMBOEMBOLIC
140
Q

PITTING EDEMA

A

OCCURS WHEN PRESSURE APPLIED TO SMALL AREA
* INDENTATION PERSISTS AFTER RELEASE OF PRESSURE
* SEVERITY: +1, +2, +3

141
Q

ASSESS YOUR PATIENT FOR DISEASE OR DISORDERS THAT MAY CAUSE DISTURBANCES IN

A

FLUID AND ELECTROLYTE BALANCE

142
Q

Ex’s of DISEASE OR DISORDERS THAT MAY CAUSE DISTURBANCES IN FLUID AND ELECTROLYTE BALANCE

A
  • ULCERATIVE COLITIS
  • DIABETES MELLITUS
  • RENAL FAILURE
143
Q

IDENTIFY MEDICATIONS AND/OR THERAPIES THAT COULD CAUSE DISTURBANCES IN

A

FLUID AND ELECTROLYTE BALANCE

144
Q

Ex’s of MEDICATIONS AND/OR THERAPIES THAT COULD CAUSE DISTURBANCES IN FLUID AND ELECTROLYTE BALANCE

A
  • DIURETICS
  • NG SUCTION
145
Q

TO CORRECT THE IMBALANCE THERE ARE A FEW THINGS WE NEED TO REMEMBER:

A

WHAT ROLE DOES THE IV SOLUTION PLAY?
WHAT EXACTLY IS “OSMOLARITY”?
WHAT DOES A “LOWER SERUM OSMOLARITY” SUGGEST?
WHAT DOES A “HIGHER SERUM OSMOLARITY” SUGGEST?

146
Q

WHAT ROLE DOES THE IV SOLUTION PLAY?

A
  • THE EFFECT THE SOLUTION HAS ON FLUID COMPARTMENTS DEPENDS ON THE SOLUTION’S OSMOLARITY COMPARED WITH THE PATIENT’S SERUM OSMOLARITY
147
Q

WHAT EXACTLY IS “OSMOLARITY”?

A
  • THE CONCENTRATION OF A SOLUTION
148
Q
  • WHAT DOES A “LOWER SERUM OSMOLARITY” SUGGEST?
A
  • SUGGESTS FLUID OVERLOAD
149
Q
  • WHAT DOES A “HIGHER SERUM OSMOLARITY” SUGGEST?
A
  • SUGGESTS HEMOCONCENTRATION OR DEHYDRATION
150
Q

OSMOSIS

A

THE PULLING OF WATER THROUGH A SEMI-PERMEABLE MEMBRANE FROM AREA OF LOWER CONCENTRATION TO AREA OF HIGHER CONCENTRATION IN ORDER TO EQUALIZE CONCENTRATION ON BOTH SIDES.

151
Q

DIFFUSION

A
  • MOVEMENT OF PARTICLES IN A SOLUTION FROM HIGHER CONCENTRATION TO LOWER IN ORDER TO EQUALIZE.
152
Q

DECREASED URINE OUTPUT NOT BALANCED BY DECREASED INTAKE OF SODIUM AND WATER

A
  • OLIGURIA(ACUTEKIDNEYINJURY, ACUTE GLOMERULONEPHRITIS, END STAGERENALDISEASE)
  • ALDOSTERONEEXCESS(CIRRHOSIS, CHRONIC HEART FAILURE, PRIMARY ALDOSTERONISM)
  • HIGHLEVELSOFGLUCOCORTICOIDS (CORTICOSTEROID THERAPY, CUSHING DISEASE)
153
Q

CAUSES THAT DISRUPT FLUID BALANCE

A

ECV DEFICIT (TOO LITTLE EXTRACELLULAR VOLUME)
INCREASED OUTPUT NOT BALANCED BY INCREASED INTAKE OF SODIUM AND WATER
RAPID FLUID SHIFT FROM ECV INTO THIRD SPACE
ECV EXCESS (TO MUCH EXTRACELLULAR VOLUME)
DECREASED URINE OUTPUT NOT BALANCED BY DECREASED INTAKE OF SODIUM AND WATER
INCREASED OUTPUT NOT BALANCED BY INCREASED INTAKE OF WATER
DECREASED OUTPUT NOT BALANCED BY DECREASED INTAKE OF WATER

154
Q

ECV DEFICIT (TOO LITTLE EXTRACELLULAR VOLUME)

A

NORMALOUTPUT BUTDEFICIENT - SODIUM AND WATER

155
Q

INCREASED OUTPUT NOT BALANCED BY INCREASED INTAKE OF SODIUM AND WATER

A
  • VOMITING
  • ACUTE OR CHRONIC DIARRHEA
  • DRAINING GI FISTULAS, GASTRIC SUCTION, INTESTINAL DECOMPRESSION
  • HEMORRHAGE OR BURNS
    OVERUSE OF DIURETICS
156
Q

RAPID FLUID SHIFT FROM ECV INTO THIRD SPACE

A
  • ACUTE INTESTINAL OBSTRUCTION
  • ASCITES THAT DEVELOPS RAPIDLY
157
Q

ECV EXCESS (TO MUCH EXTRACELLULAR VOLUME)

A

OUTPUTLESSTHANEXCESSIVEOR TOORAPIDINTAKEOFSODIUMAND WATER
* EXCESSIVEIVINFUSIONOFSODIUM CONTAINING ISOTONIC SOLUTIONS
* HIGHORALINTAKEOFSALTYFOODS AND WATER WITH RENAL RETENTION OF SODIUM AND WATER
* OVERUSEOFDIURETICS

158
Q

DECREASED URINE OUTPUT NOT BALANCED BY DECREASED INTAKE OF SODIUM AND WATER

A
  • OLIGURIA(ACUTEKIDNEYINJURY, ACUTE GLOMERULONEPHRITIS, END STAGERENALDISEASE)
  • ALDOSTERONEEXCESS(CIRRHOSIS, CHRONIC HEART FAILURE, PRIMARY ALDOSTERONISM)
  • HIGHLEVELSOFGLUCOCORTICOIDS (CORTICOSTEROID THERAPY, CUSHING DISEASE)
159
Q

INCREASED OUTPUT NOT BALANCED BY INCREASED INTAKE OF WATER

A
  • VOMITING OR DIARRHEA WITH REPLACEMENT OF SODIUM BUT NOT ENOUGH WATER
  • DIABETESINSIPIDUS(LACKOF ANTIDIURETIC HORMONE
160
Q

DECREASED OUTPUT NOT BALANCED BY DECREASED INTAKE OF WATER

A
  • EXCESSIVE ANTIDIURETIC HORMONE
161
Q

HYPONATREMIA (BODY FLUIDS TOO DILUTE: OSMOLALITY TOO LOW)

A
  • OUTPUTLESSTHANEXCESSIVEOR TOO RAPID INTAKE OF WATER
  • IVD5WINFUSIONWITHEXCESSRATE OR AMOUNT
  • RAPID ORAL INGESTION OF MASSIVE AMOUNTS OF WATER (CHILD ABUSE, CLUB INITIATION, PSYCHIATRIC DISORDER)
  • OVERUSE OF TAP WATER ENEMAS OR HYPOTONIC IRRIGATING SOLUTIONS
  • MASSIVEREPLACEMENTOFWATER WITHOUT SODIUM DURING VOMITING
162
Q

HYPERNATREMIA (BODY FLUIDS TOO CONCENTRATED: OSMOLALITY TOO HIGH)

A
  • NORMALOUTPUTBUTDEFICIENT INTAKEOFWATER
  • NO ACCESS TO WATER OR INABILITY TO RESPOND TO OR COMMUNICATE THIRST (APHASIA, COMA, INFANT)
  • TUBEFEEDINGWITHOUTADDITIONAL WATER INTAKE)
163
Q

WHEN THE SERUM OSMOLARITY INCREASES OR DECREASES, IV SOLUTIONS MAY BE ORDERED TO

A

HELP MAINTAIN OR RESTORE THE FLUID BALANCE

164
Q

TONICITY

A

AMOUNT OF SOLUTES IN SOLUTION COMPARED WITH THE BLOOD STREAM

165
Q

3 BASIC TYPES OF IV SOLUTIONS:

A

HYPERTONIC
HYPOTONIC
ISOTONIC

166
Q

HYPERTONIC

A

MORE PARTICLES THAN BLOOD (LESS WATER)

167
Q

HYPOTONIC

A
  • FEWER PARTICLES THAN BLOOD (MORE WATER)
168
Q

HYPERTONIC

A
  • DRAWS FLUID INTO THE INTRAVASCULAR COMPARTMENT
    FROM THE CELLS AND THE INTERSTITIAL COMPARTMENTS
169
Q
  • HYPOTONIC:
A
  • CAUSES CELLS TO SWELL (IT SHIFTS THE FLUID OUT OF THE
    INT RAVASCULAR COMPARTMENT)
170
Q
  • ISOTONIC:
A
  • EXPANDS BLOOD VOLUME, PROVIDES NO FREE WATER
171
Q

ABOUT HYPERTONIC:
SOLUTION OSMOLARITY IS HIGHER THAN

A

THE SERUM OSMOLARITY

172
Q

WHEN HYPERTONIC SOLUTIONS ARE INFUSED, THE SOLUTE CONCENTRATION OF SERUM IS

A

INCREASED (↑SERUM OSMOLARITY)

173
Q

WHEN HYPERTONIC SOLUTIONS ARE INFUSED OSMOSIS OCCURS DUE TO

A

THE ↑ IN SERUM OSMOLARITY, NOW HIGHER THAN THE INTERSTITIAL FLUID, TO MAINTAIN EQUAL CONCENTRATIONS ON EITHER SIDE

174
Q

Hypertonic environment

A

The solute concentration is greater outside of the cell. The free water concentration is greater inside the cell. Free water flows out of the cell.

175
Q

What happens when a cell is placed in a hypertonic environment?

A

Free water flows out of the cell

176
Q

What is the indications hypertonic IV fluids?

A

POSTOPERATIVE PATIENTS BECAUSE OF SEVERAL BENEFICIAL EFFECTS, DUE TO THE SHIFT OF FLUID INTO THE BLOOD VESSELS.

177
Q

How old is hypertonic IV fluid benefit postoperative patient .

A

REDUCES RISK OF EDEMA REGULATES URINE OUTPUT STABILIZES BLOOD PRESSURE

178
Q

HYPERTONIC
NOTES OF CONCERN:

A

HYPERTONIC SOLUTIONS EXPAND INTRAVASCULAR COMPARTMENT,
HYPERTONIC SOLUTIONS PULL FLUID FROM THE INTRACELLULAR COMPARTMENTS,
PATIENTS WITH IMPAIRED HEART OR KIDNEY FUNCTION SHOULD NOT BE GIVEN HYPERTONIC SOLUTION

179
Q

HYPERTONIC SOLUTIONS EXPAND INTRAVASCULAR COMPARTMENT, THEREFORE, MONITOR PATIENT CLOSELY FOR

A

HYPERVOLEMIA

180
Q

HYPERTONIC SOLUTIONS PULL FLUID FROM THE INTRACELLULAR COMPARTMENTS, SO PATIENTS WITH CONDITIONS THAT CAUSE CELLULAR DEHYDRATION (E.G., DIABETIC KETOACIDOSIS) SHOULD.

A

NOT BE GIVEN HYPERTONIC SOLUTIONS

181
Q

PATIENTS WITH IMPAIRED HEART OR KIDNEY FUNCTION SHOULD NOT BE GIVEN HYPERTONIC SOLUTION BECAUSE

A

SYSTEM CAN’T HANDLE THE EXTRA FLUID

182
Q

Examples of Hypertonic solutions:

A
  • DEXTROSE 5% IN HALF- NORMAL SALINE
  • DEXTROSE 5% IN NORMAL SALINE
  • DEXTROSE 5% IN LACTATED RINGER’S
  • 3% SODIUM CHLORIDE (ICU/CCU)
  • 25% ALBUMIN
  • 7.5% SODIUM CHLORIDE (DIALYSIS)
  • 3% SODIUM CHLORIDE
  • 25% ALBUMIN
  • 7.5% SODIUM CHLORIDE
183
Q

When thinking about hypertonic solutions, think about large molecules in solutions like glucose

A

DRAWS FLUID FROM THE CELLS AND CAUSES THEM TO “SHRINK” OR ?? Something….

184
Q

ABOUT HYPOTONIC:

A
  • HAS A LOWER SOLUTE CONCENTRATION THAN SERUM
  • FLUID SHIFTS OUT OF BLOOD VESSELS & INTO CELLS & INTERSTITIAL SPACES WHERE CONCENTRATION IS HIGHER
  • HYDRATES THE CELLS WHILE REDUCING THE FLUID IN THE
    46 ????
    CIRCULATORY SYSTEM
185
Q

HYPOTONIC ENVIRONMENT THE SOLUTE CONCENTRATION IS GREATER WHERE

A

INSIDE THE CELL. THE FREE WATER CONCENTRATION IS GREATER OUTSIDE CELL.

186
Q

WHAT HAPPENS TO CELLS IN A HYPOTONIC ENVIRONMENT

A

FREE WATER FLOWS INTO CELLS

187
Q

HYPOTONIC
INDICATIONS:

A
  • WHEN DIURETIC THERAPY DEHYDRATES CELLS
  • CELL DEHYDRATION DUE TO HYPERGLYCEMIC CONDITIONS SUCH AS DIABETIC KETOACIDOSIS (DKA) & HYPERGLYCEMIC HYPEROSMOLAR NONKETOTIC SYNDROME (HHNS). IN THESE CONDITIONS THE HIGH SERUM GLUCOSE LEVELS DRAW FLUID OUT OF THE CELLS.
  • TO PROMOTE WASTE ELIMINATION THROUGH THE KIDNEYS
188
Q

HIGH SERUM GLUCOSE LEVELS DOES WHAT TO CELLS

A

DRAW FLUID OUT OF THE CELLS.

189
Q

EXAMPLES OF HYPOTONIC SOLUTIONS:

A

*0.5% SODIUM CHLORIDE
*0.33% SODIUM CHLORIDE
*0.25% SODIUM CHLORIDE
*DEXTROSE 2.5%
*DEXTROSE 5% IN WATER (TECHNICALLY

190
Q

HYPOTONIC SOLUTIONS DO WHAT TO THE CELLS

A

“FLOOD THE CELLS

191
Q

BECAUSE HYPOTONIC SOLUTIONS “FLOOD THE CELLS”, CERTAIN PATIENTS SHOULD

A

NOT RECEIVE THEM.

192
Q

Which patient should not receive hypotonic IV fluids

A

PATIENTS WITH:
* CEREBRAL EDEMA OR INCREASED INTRACRANIAL PRESSURE,
PATIENTS AT RISK FOR THIRD-SPACE FLUID SHIFTS
* HYPOTENSION AS IT DEPLETES THE CIRCULATING VOLUME

193
Q

Why should patients with cerebral edema or increased intracranial pressure not receive hypotonic IV solutions?

A

DUE TO THE RISK OF CAUSING FURTHER EDEMA AND TISSUE DAMAGE

194
Q
  • PATIENTS AT RISK FOR THIRD-SPACE FLUID SHIFTS
    ARE THOSE WITH
A
  • BURN PATIENTS
  • TRAUMA PATIENTS
  • PATIENTS WITH LOW SERUM PROTEIN LEVELS FROM MALNUTRITION OR LIVER DISEASE
195
Q

ABOUT ISOTONIC:

A
  • HAS SAME SOLUTE CONCENTRATION AS SERUM & OTHER BODY FLUIDS.
  • WHEN INFUSED IT DOES NOT ALTER THE CONCENTRATION OF SERUM, WATER FLOWS IN AND OUT OF THE CELL AT AN EQUAL RATE.
  • SOLUTION BASICALLY “STAYS PUT” WHERE IT’S INFUSED, INSIDE THE BLOOD VESSEL.
196
Q

IN AN ISOTONIC ENVIRONMENT, WHAT HAPPENS TO CELLS

A

WATER FLOWS IN AND OUT OF CELL AT EQUAL RATE

197
Q

IN ANN ISOTONIC ENVIRONMENT WHY DOES WATER FLOW IN AND OUT OF CELL AT AN EQUAL RATE

A

THE SOLUTE CONCENTRATION AND THE FREE WATER CONCENTRATION ARE THE SAME INSIDE AND OUTSIDE THE CELL

198
Q

ISOTONIC INDICATIONS:

A
  • MAINTENANCE OF INTRAVASCULAR VOLUME
  • ACCOMPANIES BLOOD TRANSFUSIONS
  • HYPOTENSION DUE TO HYPOVOLEMIA (REPLACEMENT OF INTRAVASCULAR VOLUME)
199
Q

EXAMPLES ISOTONIC FLUIDS:.

A
  • LACTATED RINGER’S/
  • RINGER’S
  • NORMAL SALINE
  • NORMOSOL
  • DEXTROSE 5% IN WATER (ACTUALLY ISOTONIC ONLY IN THE CONTAINER. WHEN ADMINISTERED, DEXTROSE IS QUICKLY METABOLIZED LEAVING ONLY WATER – A HYPOTONIC FLUID).
  • 5% ALBUMIN
200
Q

DEXTROSE 5% IN WATER IS ONLY ISOTONIC WHEN

A

IN THE CONTAINER..

201
Q

What happens to dextrose?

A

WHEN ADMINISTERED, DEXTROSE IS QUICKLY METABOLLEAVING ONLY WATER – A HYPOTONIC FLUID)

202
Q

ISOTONIC -
NOTES OF CONCERN:

A
  • MONITOR PATIENT CLOSELY FOR FLUID OVERLOAD
  • BECAUSE THE LIVER CONVERTS LACTAToE TO BICARBONATE, LACTATED RINGER’S SHOULD NOT BE GIVEN IF THE PATIENT’S BLOOD PH EXCEEDS 7.5
  • AVOID GIVING D5W TO PATIENTS AT RISK FOR INTRACRANIAL PRESSURE
203
Q

When giving isotonic fluids monitor patients closely for fluid overload due to

A

FLUIDS EXPANDING THE INTRAVASCULAR COMPARTMENT (ESPECIALLY PATIENTS WITH HYPERTENSION OR HEART FAILURE)

204
Q

When giving isotonic fluids AVOID GIVING D5W TO PATIENTS AT RISK FOR INTRACRANIAL PRESSURE AS OT ACTS AS A

A

HYPOTONIC SOLUTION

205
Q

WHAT SHOULD I SEE IF I GIVE MY PATIENT AN ISOTONIC SOLUTION?

A
  • INCREASED UOP
  • INCREASE IN BODY WEIGHT
  • INCREASE IN BP OR MAP
  • DECREASED PULSE
  • IMPROVED SKIN TURGOR, MOIST MUCUS MEMBRANES
206
Q

PREVENTION OF FLUID IMBALANCES THRU THE USE OF

A
  • USE OF IV PUMPS
  • USE OF BURETROL OR SYRINGE PUMP FOR PEDIATRIC PATIENTS
  • MONITOR INTAKE AND OUTPUT
  • MONITOR WEIGHT
  • ASSESS LUNG SOUNDS, HEART TONES, PERIPHERAL
    EDEMA
  • CONSIDER USE OF INTERMITTENT IV WHEN
    55 ?????
207
Q

IV SOLUTIONS FORMS

A

CRYSTALLOIDS
COLLOIDS

208
Q

PREVENTION OF FLUID IMBALANCES THRU THE USE OF

A
  • USE OF IV PUMPS
  • USE OF BURETROL OR SYRINGE PUMP FOR PEDIATRIC PATIENTS
  • MONITOR INTAKE AND OUTPUT
  • MONITOR WEIGHT
  • ASSESS LUNG SOUNDS, HEART TONES, PERIPHERAL
    EDEMA
  • CONSIDER USE OF INTERMITTENT IV WHEN
    55 ????? N
209
Q

CRYSTALLOID IV SOLUTIONS

A

HYPOTONIC
ISOTONIC
HYPERTONIC

210
Q

COLLOID IV SOLUTIONS

A

ALWAYS HYPERTONIC

211
Q

COLLOID IV SOLUTIONS CONTAIN MOLECULES TO LATGE TO

A

PASS THROUGH THE CAPILLARY MEMBRANE

212
Q

CRYSTALLOID SOLUTIONS MOVE HOW

A

FREELY BETWEEN THE CAPILLARY MEMBRANE

213
Q

COLLOIDS CONTAIN

A

PROTEIN OR STARCH MOLECULES

214
Q

IN COLLOIDS, THR PROTEIN OR STARCH MOLECULES REMAIN IN WHAT FORMATION

A

DISTRIBUTED IN THE EXTRACELLULAR SPACE AND DO NOT FORM A “TRUE” SOLUTION.

215
Q

COLLOIDS HAVE WHAT EFFECT ON THE OSMOLARITY WITHIN TH PLASMA

A

INCREASE THE OSMOLARITY WITHIN THE PLASMA SPACE DRAWING FLUID TO INCREASE INTRAVASCULAR VOLUME

216
Q

ONCE COLLOIDS ARE INUSED THEY REMAIN WHERE FOR SEVERAL DAYS

A

THEY REMAIN IN THE VASCULAR SPACE FOR SEVERAL DAYS.

217
Q

COLLOIDS ALSO CALLED

A

PLASMA OR VOLUME EXPANDERS

218
Q

WHITH COLLOIDS MONITOR FOR

A

OVERLOAD

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