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fluid balance
| Question | Answer |
|---|---|
| signs of Hypernatremia | Skin flushed Agitation Low grade fever Thirst SALT or fried Fever, flushed skin Restless Increased fluid retention Edema Decreased urine output, dry mouth |
| signs and symptoms of Hyponatremia | Stupor/coma Anorexia Lethargy Tendon reflexes decreased salt loss Limp muscles Orthostatic hypotension Seizures/headache Stomach cramps |
| causes of hypernatremia | Medications, meals Osmotic diuretics Diabetes insipidus Excessive water loss Low water intake MODEL |
| Arterial blood gases | pH, PaCo2, PaO2, O2 sat, Base (HCo3 -2 to +2) excess |
| arteriole blood gas pH range | 7.35-7.45 Always scale 7.4 |
| arterial blood gas PaCo2 range | 35-45 |
| Electrolytes in blood used most are | Na, K, Cl, Ca, Mg. Phos |
| Na+ range | 135-145mEq/L |
| K+ | 3.5-5 mEq/L |
| Mg2+ | 1.5-2.5 mEq/L |
| Ionized Ca2+ | 4.5-5.5mg/dl |
| Phosphate PO4^3- | 2.8-4.5 mg/dl |
| Arterial bicarbonate HCo3- | 22-26mEq/L |
| Venous bicarbonate HCO3- | 24-30mEq/L |
| physical, behavioral, & enviro effect body's ability to regulate | fluid, electrolyte & acid base balances |
| imbalances result from | illness, altered fluid intake, prolong episodes of vomit, diarrhea |
| Acid base imbalance alter | respiration, metabolism, and cardiovascular, renal and central nervous system function |
| Fluid imbalance is evaluated based on | amount of sodium lost or gained in relationship to water |
| 40% of the fluid in the body resides here, fluid with in cell, is 2/3 of TBW, 25L | ICF intracellular fluid |
| 20% TBW outside the cell is broken into two compartments (actually 3); is 1/3 TBW 15L | ECF extracellular fluid |
| Compartments of extracellular fluid are | intravascular, interstitial, & transcellular |
| is blood plasma arterioles and veins and 1/5th the volume and 15% of the volume of ECF | intravascular IVF fluid |
| 5% ECF fluid that is outside the cell (surrounds the cell) but not in blood plasma/vessels arteries and veins; edema commonly occurs here | interstitial fluid ISF |
| Capillary walls and cells membranes separate | intracellular ICF and extracellular ECF fluid compartments |
| ECF Fluid located in GI tract, cerebral spinal fluid, pleural cavity, synovial, peritoneal, lymph and eyes is considered the third space fluid; w/out we would not exist | transcellular fluid TCF of the ECF. |
| In order for our lung wall to move freely and without pain and in order to breathe our bodies require this fluid around the pleural cavity inside our chest (thoracic) cavity called | transcellular fluid |
| a condition where the fluid around the thoracic cavity is reduced due to inflammation causing organs to rub cant breath | pleurisy |
| fluid moves in 4 ways | osmosis, diffusion, filtration & active transport |
| Fluid distribution for adults 70kg man, woman, elderly, infant & neonate | man 60% TBW b/c more muscle, women 50-55% b/c fat associated w/< water, obese person has less water, elderly 45-55% b/c less muscle, thirst & more fat, infants (neonates) 70-80% because water is based on total surface area and infants ratio is higher |
| in an adult 25% of the extracellular fluid is | blood plasma |
| In an adult 75% of the extracellular fluid is | interstitial fluid |
| Osmosis is the movement of low concentration to a high concentration of | Water ONLY!! |
| Body tries to keep osmolarity balanced in 3 compartments by | shifting fluid or solutes |
| A hypotonic solution eg .45% saline is given to pt it can cause | too much fluid to move from veins into the cells & make them swell |
| A hypertonic solution eg dextrose 5% normal saline D5W NS given to pt it can cause | too much fluid to be pulled from the cells into the blood stream & cells shrink |
| what concentration can pull fluid into a space | osmotic pressure & higher solute concentrations |
| Blood has an osmotic pressure that can keep fluid from leaking out (shifting) out of vascular & intravascular spaces (vessels, arteries & veins) called | colloidal pressure (oncotic) Colloidal osmotic (oncotic pressure is produced by |
| which protein is especially needed to keep fluid from shifting out of intravascular space | albumin proteins |
| solutes (paticles & electrolytes) move from | a high concentration to a low concentration |
| The movement of O2 and CO@ between the aveoli and the capillaries is an example of | diffusion high concentration to a low concentration |
| A left sided heart condition blood is not being pumped forward efficiently on arterial end & blood is coming in from right side venous end causing blood to back up on the venous end b/c low hydrostatic pressure is | CHF congestive heart failure |
| In congestive heart failure what are some of the signs we would see on assessment | if walking edema L. E. , sitting buttocks will have dependent edema ( blood is pulled by gravity down into the lower areas the body) & JVD. answer: dependent edema & JVD |
| forces created by the fluid in vascular space or in the tissues (interstitial space & within the fluid compartments) is called | hydrostatic pressure |
| osmotic pressure keeps the fluids in the cells and is exerted by | colliods (oncotic) which are proteins mostly albumin, proteins hold fluid in the compartments |
| On an assessment how can you tell if someone is malnourished | abdomen distended, turgor tenting, and will not sufficient proteins in the vessel so fluid leaks out there is nothing to keep protein in |
| Portion of TBW(about one third) that is in the space outside the cells. This space includes interstitial fluid (tissue), blood, lymph, bone, & connective tissue water (synovial), & transcellular fluids | extracellular fluid (ECF) |
| Reduction in the serum osmotic pressure makes the patient likely to develop | third spacing of body fluids, with fluid moving from the vascular to the interstitial space, resulting in shock |
| The extracellular compartment includes the interstitial fluid, which is fluid between cells, blood, lymph, bone, connective tissue, water, and transcellular fluid is sometimes called | (sometimes called the third space) |
| accumulation and sequestration of trapped extracellular fluid in an actual or potential body space as a result of disease or injury | third spacing |
| Third space fluid is a trapped fluid that represents | a volume loss and is unavailable for normal physiological processes. |
| Third space fluid may be trapped in body spaces such as the | pericardial, pleural, peritoneal, or joint cavities; the bowel; or the abdomen, or within soft tissues after trauma or burns |
| Assessing the intravascular fluid loss caused by third-spacing is difficult. The loss may not be reflected in | weight changes or intake and output records, and may not become apparent until after organ malfunction occurs |
| Fluid that accumulates & is trapped in part of body not easily exchanged with rest of ECF is considered | third spacing fluid usually caused by burns, cirrhosis |
| what happen to fluid on a burn patient | Fluid is being sucked out of the interstitial & ECf spaces and move into what is called a third space |
| third space fluid that is outside of the stomach and abdomen that is able to move freely | ascites |
| Ascites fluid shift from the vascular system into the abdomen, a form of “third spacing.” As a result, the patient may have | hypovolemia and edema at the same time |
| Massive ascites may cause renal vasoconstriction, triggering the | renin-angiotensin system |
| When doing assessment what will be looking for when a person has ascites | edema w/ burns, septic shock, peritonitis, hepatic liver diseases (cirrhosis) hypovolemia & starvation (malnutrition) a past Hx of, pt just out of suregery |
| A low blood volume that is associated with hypotension is called | hypovolemia |
| 3rd fluid spacing ascites causes | hypovolemia (low blood volume), hypotension (low BP), tachycardia ↑HR, âUrinary Output (renal failure) due to insufficient fluid in vascular space (nothing in nothing out) |
| A patient who just had surgery that has third space fluid ascites may experience fluid overload due to | fluid shifting back into vascular space & they begin to excrete large amounts of fluid |
| A person Can develop fluid overload during recovery after surgery describe and map the flow of fluid after surgery | as fluid shifts back into vascular space: from interstitial---intravascular----to kidneys then excreted |
| What % of TBW is composed of water in average male, female, elderly, infant | male 60%, female50-55%, elderly 45-55%, infant 70-80% |
| What are the 2 primary body fluid compartments? Subcompartments? | intracellular and extracellular; sub compartment of ECF are ISF interstitial, intravascular & transcellular |
| How do fluid & electrolytes shift between compartments? 4 processes | osmosis, diffusion, active transport & filtration |
| The loss of hepatic function contributes to the development of metabolic abnormalities. Hepatic cell damage may lead to these common complications | ascites |
| Active transport keeps _K__higher in ICF & _Na__higher in ECF. On lab tests which electrolyte is higher? Why? | Sodium, Active transport (na, K pump keeps potassium intracellular & sodium extracellular |
| on an assessment, If someone is malnourished, fluid will shift from where to where? Why? What sx may you see? | Edema (there are no proteins colloids that keep the cell membrane intact and fluid is missing, The colloids has shifted from intravascular space to interstitial space b/c so much pressure inside it moves it out to interstitial. Hear crackles in lungs |
| Renin produces angiotensin Ià angiotensin II causes peripheral vasoconstriction increasing BP & redirects blood flow to kidneys What drugs block this effect & control BP? | Ace inhibitors (angiotension converting enzyme inhibitors) block conversion of angiotension 1 from converting to angiotensin 2 allowing BP to stay the same |
| people with CHF have harder time breathing are usually given a class of med to reduce pressure & help them breathe easier this class of drugs are called | diuretics |
| PO2 | 80-100~ |
| arteriole Hco3 | 22-26 |
| oxygen saturation SaO2 | 95-100% |
| Anion gap equation & normal value | 5-11 mEq/L Na + K - (Cl + HCo3) |
| osmolarity | 280-300 |
| Cl | 98-106 |
| Difference between the concentrations of serum cations and anions; determined by measuring the concentrations of sodium cations and chloride and bicarbonate anions. | anion gap |
| anion | neg charged electrolytes |
| cations | positive charged electrolytes |
| Substance or group of substances that can absorb or release hydrogen ions to correct an acid-base imbalance. | buffer |
| Abnormal condition of the kidney caused by the pressure of concentrations of large particles such as protein molecules that will pass through a membrane. | colloid osmotic pressure |
| Procedure in which blood is removed from a donor and stored for a variable period before it is returned to the donor's own circulation. | autologous transfusion |
| Excessive loss of water from the body tissues accompanied by a disturbance of body electrolytes. | dehydration |
| Portion of body fluids composed of the interstitial fluid and blood plasma. | extracellular fluid (ECF) |
| Fluid, cells, or other substances that have been discharged from cells or blood vessels slowly through small pores or breaks in cell membranes. | exudate |
| Inflammation of a vein. | phlebitis |
| Element or compound that, when melted or dissolved in water or other solvent, dissociates into ions and can carry an electrical current. | electrolyte |
| Abnormal condition characterized by increased arterial carbon dioxide concentration, excess carbonic acid, and increased hydrogen ion concentration. | respiratory acidosis |
| Abnormal condition characterized by decreased arterial carbon dioxide concentration and hydrogen ion concentration. | respiratory alkalosis |
Created by:
larue10510