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fluids
fluids, electro, acid base
| question | answer |
|---|---|
| the state of equilibrium in the internal environment of the body, naturally maintained by adaptive responses that promote healthy survival | Homeostasis |
| Approximately two thirds of the body water that is located within cells and is termed | intracellular fluid (ICF); |
| Extracellular fluid (ECF) consists of | interstitial fluid, composed of the fluid in the interstitium (the space between cells) and lymph; the fluid in blood (plasma); and a very small amount of fluid contained within specialized cavities of the body (cerebrospinal fluid, fluid in the gastroint |
| The fluid in the specialized cavities is sometimes referred to as | transcellular fluid. |
| fluid in the interstitium (the space between cells) | interstitial fluid |
| the amount of pressure required to stop the osmotic flow of water | Osmotic pressure |
| measures the osmotic force of solute per unit of weight of solvent.(describe fluids inside the body ) | Osmolality |
| measures the total milliosmoles of solute per unit of total volume of solution.(pertains to fluids outside the body) | Osmolarity |
| _________ is the test typically performed to evaluate the concentration of plasma and urine. | Osmolality |
| _________ is approximately the same in the various body fluid spaces. Determining osmolality is important because it indicates the water balance of the body. | Osmolality |
| Normal plasma osmolality is between ____ and _____. | 275 and 295 mOsm/kg |
| A value greater than 295 mOsm/kg indicates that the concentration of particles is ____ _______ or that the water content is____ ______. | -too great -too little |
| An Osmolality greater than 295? | water deficit. |
| A value less than 275 mOsm/kg indicates what? | too little solute for the amount of water or too much water for the amount of solute. |
| An osmolality less than 275 indicates? | water excess. |
| The major determinants of the plasma osmolality are _______ and _______. | sodium and glucose |
| Osmolality of urine can range from 100 to 1300 mOsm/kg, depending on? | the amount of (ADH) in circulation and the renal response to it. |
| Fluids with the same osmolality as the cell interior are | isotonic. |
| Solutions in which the solutes are less concentrated than the cells | hypotonic (hypoosmolar). |
| Those with solutes more concentrated than cells | hypertonic (hyperosmolar). |
| Normally, the ECF and ICF are _______ to one another;( hence no net movement of water occurs.) | isotonic |
| In the metabolically active cell, there is a constant exchange of substances between the cell and the interstitium, but what does not occur? | no net gain or loss of water |
| If a cell is surrounded by _______ fluid, water moves into the cell, causing it to? | -Hypotonic -swell and possibly to burst. |
| If a cell is surrounded by _______ fluid, water leaves the cell to dilute the ECF, causing the cell to? | Hypertonic - shrink and may eventually die |
| the force within a fluid compartment. | Hydrostatic pressure |
| In the blood vessels, _________ pressure is the blood pressure generated by the contraction of the heart. | Hydrostatic |
| Hydrostatic pressure in the vascular system gradually _______ as the blood moves through the arteries until it is about 40 mm Hg at the arterial end of a capillary. | decreases |
| why does the pressure decrease to about 10 mm Hg at the venous end of the capillary? | Because of the size of the capillary bed and fluid movement into the interstitium |
| is the major force that pushes water out of the vascular system at the capillary level. | Hydrostatic pressure |
| The osmotic pressure exerted by colloids in solution. | Oncotic pressure (colloidal osmotic pressure) |
| The major colloid in the vascular system contributing to the total osmotic pressure is ______ . | protein. |
| Protein molecules attract water, pulling fluid from the _______ space to the ________ space. | -tissue -vascular |
| What prevents proteins from leaving the vascular space through pores in capillary walls? | the large molecular size |
| Under normal conditions, plasma oncotic pressure is approximately? | 25 mm Hg. |
| The amount and direction of movement, between the capillary and the interstitial, are determined by the interaction of what 4 Pressures? | (1) capillary hydrostatic pressure, (2) plasma oncotic pressure, (3) interstitial hydrostatic pressure, and (4) interstitial oncotic pressure. |
| What two pressures cause the movement of water out of the capillaries? | Capillary hydrostatic pressure and interstitial oncotic pressure |
| What 2 pressures cause the movement of fluid into the capillary. | Plasma oncotic pressure and interstitial hydrostatic pressure |
| What happens at the arterial end of the capillary , when capillary hydrostatic pressure exceeds plasma oncotic pressure? | fluid is moved into the interstitium. |
| What happens at the venous end of the capillary, when the capillary hydrostatic pressure is lower than plasma oncotic pressure? | fluid is drawn back into the capillary by the oncotic pressure created by plasma proteins. |
| If capillary or interstitial pressures are altered, fluid may abnormally shift from one compartment to another, resulting in _____ or _______. | edema or dehydration. |
| Accumulation of fluid in the interstitial | edema |
| occurs if venous hydrostatic pressure rises, plasma oncotic pressure decreases, or interstitial oncotic pressure rises. | Edema |
| ______ may also develop if there is an obstruction of lymphatic outflow that causes decreased removal of interstitial fluid. | edema |
| Increasing the pressure at the venous end of the capillary does what? | inhibits fluid movement back into the capillary. |
| Causes of ______ ______ _______ include fluid overload, heart failure, liver failure, obstruction of venous return to the heart (e.g., tourniquets, restrictive clothing, venous thrombosis), and venous insufficiency (e.g., varicose veins). | increased venous pressure |
| Fluid remains in the interstitium if? | the plasma oncotic pressure is too low to draw fluid back into the capillary. |
| Decreased ______ pressure is seen when the plasma protein content is low. | oncotic |
| This can result from excessive protein loss (renal disorders), deficient protein synthesis (liver disease), and deficient protein intake (malnutrition). | Decreased Oncotic pressure (low plasma protein) |
| _______, ______, and __________ can damage capillary walls and allow plasma proteins to accumulate in the interstitium. | Trauma, burns, and inflammation |
| The resultant increased ______ ______ pressure draws fluid into the interstitium and holds it there. | interstitial oncotic |
| Fluid is drawn into the plasma space whenever there is an increase in the_____ ______ or ______ pressure. | plasma osmotic or oncotic pressure. |
| This could happen with administration of colloids, dextran, mannitol, or hypertonic solutions. | the drawing in of fld into plasma spaces |
| Fluid is drawn from the ? | interstitium. |
| In turn, water is drawn from cells via ______, equilibrating the osmolality between ICF and ECF. | osmosis |
| Increasing the tissue ________ pressure is another way of causing a shift of fluid into plasma. | hydrostatic |
| The wearing of _______ or _______ to decrease peripheral edema is a therapeutic application of the effect of fld shift into plasma. | stockings or hose |
| Changes in the osmolality of the ECF alter the ______ of cells. | volume |
| pulls water out of cells until the two compartments have a similar osmolality. | ECF osmolality (water deficit) |
| associated with symptoms that result from cell shrinkage as water is pulled into the vascular system. | Water deficit |
| neurologic symptoms associated w/ water deficit are caused by? | altered CNS function as brain cells shrink. |
| Decreased ECF osmolality (water excess) develops as the result of ______ or _______ of excess water. | gain or retention |
| neurologic symptoms RT water excess are caused by? | brain cells swelling as water shifts into the cells. |
| term sometimes used to describe the distribution of body water. | Fluid spacing |
| describes the normal distribution of fluid in the ICF and ECF compartments. | First spacing |
| refers to an abnormal accumulation of interstitial fluid (i.e., edema). | Second spacing |
| occurs when fluid accumulates in a portion of the body from which it is not easily exchanged with the rest of the ECF. | Third spacing |
| Examples of third spacing are? | ascites, and edema associated with burns. |
| Water balance is maintained via the finely tuned balance of water _____ and _______. | intake and excretion. |
| what is sensed by osmoreceptors in the hypothalamus, which in turn stimulates thirst and ADH release? | A body fluid deficit or increase in plasma osmolality |
| Thirst causes the patient to? | drink water. |
| ______ is synthesized in the hypothalamus and stored in the posterior pituitary, acts in the renal distal and collecting tubules causing water reabsorption. | ADH |
| Thirst and ADH, together result in _______ free water in the body and _______ plasma osmolality. | -increased -decreased |
| If the plasma osmolality is diminished or there is water excess, secretion of ______ is suppressed, resulting in ? | - ADH- urinary excretion of water |
| This is critical because it is the primary protection against the development of hyperosmolality. | An intact thirst mechanism |
| The patient who cannot recognize or act on the sensation of thirst is at risk for ? | fluid deficit and hyperosmolality. |
| The sensitivity of the thirst mechanism __________ in older adults. | -decreases |
| The desire to consume fluids is also affected by ________ and ______ factors not related to fluid balance. | social and psychologic |
| A ___ ______ will cause the patient to drink, even when there is no measurable body water deficit. | dry mouth |
| Water ingestion will equal water loss in the individual who has free access to ? | water, a normal thirst and ADH mechanism, and normally functioning kidneys. |
| Under hypothalamic control, the posterior pituitary releases _____, which regulates water retention by the kidneys. | ADH |
| The distal tubules and collecting ducts in the kidneys respond to _____ by becoming more _______ to water so that water is ________ from the tubular filtrate into the blood and ____ _____ in urine. | - ADH -permeable -reabsorbed -not excreted |
| what will stimulate ADH secretion? | An increase in plasma osmolality or a decrease in circulating blood volume |
| Other factors that stimulate ADH release include? | stress, nausea, nicotine, and morphine. |
| It is common for the postoperative patient to have a _____ serum osmolality after surgery, possibly because of the stress of surgery and narcotic analgesia. | lower |
| The inappropriate ADH causes water retention, which produces a _______ in plasma osmolality below the normal value and a relative ________ in urine osmolality with a decrease in urine volume. | -decrease -increase |
| Reduction in the release or action of ADH produces ? | diabetes insipidus |
| A copious amount of dilute urine is excreted because? | the renal tubules and collecting ducts do not appropriately reabsorb water. |
| While ADH affects only water reabsorption, _________ and __________ secreted by the adrenal cortex help regulate both water and electrolytes. | glucocorticoids and mineralocorticoids |
| These primarily have an antiinflammatory effect and increase serum glucose levels. | glucocorticoids (e.g., cortisol) |
| these enhance sodium retention and potassium excretion. | mineralocorticoids (e.g., aldosterone) |
| When sodium is reabsorbed, water follows as a result of _____ changes. | osmotic |
| the most abundant glucocorticoid? | Cortisol |
| In large doses, _______ has both glucocorticoid (glucose-elevating and antiinflammatory) and mineralocorticoid (sodium-retention) effects. | Cortisol |
| _______ is normally secreted in a diurnal, or circadian, pattern and also in response to increased physical and psychologic stress. | Cortisol |
| is a mineralocorticoid with potent sodium-retaining and potassium-excreting capability. | Aldosterone |
| The secretion of ____________ may be stimulated by decreased renal perfusion or decreased sodium delivery to the distal portion of the renal tubule. | Aldosterone |
| The kidneys respond to the decreased renal perfusion or decreased sodium delivery to the distal portion of the renal tubule by secreting ____ into the plasma. | Renin |
| produced in the liver and normally found in blood? | Angiotensinogen |
| Angiotensinogen is acted on by the renin to form? | angiotensin I, |
| angiotensin I which converts to? | angiotensin II |
| angiotensin II stimulates the _____ ______ to secrete ______. | -adrenal cortex -aldosterone. |
| The primary organs for regulating fluid and electrolyte balance are the? | kidneys. |
| The _______ regulate water balance through adjustments in urine volume. | kidneys |
| urinary excretion of most electrolytes is adjusted so that? | a balance is maintained between overall intake and output. |
| As the filtrate moves through the renal tubules, selective reabsorption of water and electrolytes and secretion of electrolytes result in the production of? | urine that is greatly different in composition and concentration than the plasma. |
| The process of filtration and reabsorption helps maintain? | normal plasma osmolality, electrolyte balance, blood volume, and acid-base balance. |
| The _____ ______ are the site for the actions of ADH and aldosterone. | renal tubules |
| With severely impaired renal function, the kidneys…. | cannot maintain fluid and electrolyte balance. |
| Impaired renal function results in? | edema, potassium and phosphorus retention, acidosis, and other electrolyte imbalances. |
| Natriuretic peptides, including atrial natriuretic peptide (ANP) and β-type natriuretic peptide (BNP), are hormones produced by? | cardiomyocytes. |
| β-type natriuretic peptide (BNP) are natural antagonists to the | renin-angiotensin-aldosterone system (RAAS). |
| Natriuretic peptides are produced in response to | increased atrial pressure (increased volume) and high serum sodium levels. |
| Natriuretic peptides suppress secretion of | aldosterone, renin, and ADH, and the action of angiotensin II |
| Natriuretic peptides (BNP) act on the renal tubules to promote excretion of ______ and _______, resulting in a decrease in blood volume and blood pressure. | sodium and water |
| Daily water intake and output are normally between | 2000 and 3000 ml |
| accounts for most of the water intake. | Oral intake of fluids |
| the GI tract normally secretes approximately 8000 ml of digestive fluids each day that are | reabsorbed. |
| A small amount of the fluid in the GI tract is normally eliminated in feces, but diarrhea and vomiting that prevent GI absorption of secretions and fluids can lead to | significant fluid and electrolyte loss. |
| invisible vaporization from the lungs and skin, assists in regulating body temperature. | Insensible water loss |
| Normally how may ml’s are lost w/Insensible water loss ? | about 600 to 900 ml/day |
| With Insensible water loss no ________ are lost. | electrolytes |
| The amount of water loss is increased by accelerated body metabolism, which occurs with | increased body temperature and exercise. |
| Only _____ is lost by insensible perspiration. | water |
| Excessive sweating (sensible perspiration) caused by fever or high environmental temperatures may lead to | large losses of water and electrolytes. |
| The older adult experiences normal physiologic changes that increase susceptibility to | fluid and electrolyte imbalances. |
| what leads to a decrease in the glomerular filtration rate, decreased creatinine clearance, the loss of the ability to concentrate urine and conserve water, and narrowed limits for the excretion of water, sodium, potassium, and hydrogen ions. | Structural changes to the kidney and a decrease in the renal blood flow |
| Hormonal changes in older adults include a ______ in renin and aldosterone and an ______ in ADH and ANP. | -decrease - increase |
| what leads to increased loss of moisture through the skin and an inability to respond to heat or cold quickly? | Loss of subcutaneous tissue and thinning of the dermis |
| Older adults experience a decrease in the thirst mechanism resulting in | decreased fluid intake despite increases in osmolality and serum sodium level. |
| The frail elderly, especially if ill, are at increased risk of | free-water loss and subsequent development of hypernatremia secondary to impairment of the thirst mechanism and barriers to accessible fluids. |
| To best serve the older adult patient, the health care provider must understand the ________ changes that occur in the elderly. | homeostatic |
| It is important to avoid the pitfalls of ageism, wherein elderly patients’ fluid and electrolyte problems may be inappropriately attributed to the | natural processes of aging. |
| Fluid and electrolyte imbalances occur to some degree in most patients with a major illness or injury because illness disrupts | the normal homeostatic mechanism. |
| Some fluid and electrolyte imbalances are directly caused by | illness or disease (e.g., burns, heart failure). |
| therapeutic measures (e.g., IV fluid replacement, diuretics)can cause or contribute to | fluid and electrolyte imbalances. |
| ECF volume imbalances are typically accompanied by one or more | electrolyte imbalances, particularly changes in the serum sodium level. |
| Fluid volume deficit can occur with | abnormal loss of body fluids (e.g., diarrhea, fistula drainage, hemorrhage, polyuria), inadequate intake, or a plasma-to–interstitial fluid shift. |
| refers to loss of pure water alone without corresponding loss of sodium. | Dehydration |
| The goal of treatment for fluid volume deficit is to | correct the underlying cause and to replace both water and any needed electrolytes. |
| Balanced IV solutions, such as ______ _______ solution, are usually given with FVD. | lactated Ringer's |
| used when rapid volume replacement is indicated. | Isotonic (0.9%) sodium chloride |
| administered when volume loss is due to blood loss. | blood |
| Fluid volume excess may result from | excessive intake of fluids, abnormal retention of fluids (e.g., heart failure, renal failure), or interstitial-to–plasma fluid shift. |
| Although shifts in fluid between the plasma and interstitium do not alter the overall volume of the ECF, these shifts do result in changes in the | intravascular volume. |
| The goal of treatment for fluid volume excess is | removal of fluid without producing abnormal changes in the electrolyte composition or osmolality of ECF. |
| the primary forms of therapy with FVE. | Diuretics and fluid restriction are Restriction of sodium intake may also be indicated. |
| Extracellular fluid volume deficit Nursing diagnosis: | •Deficient fluid volume related to excessive ECF losses or decreased fluid intake •Decreased cardiac output related to excessive ECF losses or decreased fluid intake •Potential complication: hypovolemic shock |
| Extracellular fluid volume excess Nursing Diagnosis: | •Excess fluid volume related to increased water and/or sodium retention •Impaired gas exchange related to water retention leading to pulmonary edema • Risk for impaired skin integrity related to edema •Disturbed body image related to altered body appearan |
| The use of 24-hour intake and output records gives valuable information regarding | fluid and electrolyte problems |
| Specific gravity greater than 1.025 indicate | concentrated urine, |
| Specific gravity of less than 1.010 indicate | dilute urine. |
| Monitoring the patient for cardiovascular changes is necessary to | prevent or detect complications from fluid and electrolyte imbalances. |
| Signs and symptoms of ECF volume excess and deficit are reflected in changes in | blood pressure, pulse force, and jugular venous distention. In fluid volume excess, the pulse is full and bounding. |
| Because of the expanded intravascular volume, the pulse | is not easily obliterated. |
| Increased volume causes | distended neck veins (jugular venous distention) and increased blood pressure. |
| In mild to moderate fluid volume deficit, compensatory mechanisms include | sympathetic nervous system stimulation of the heart and peripheral vasoconstriction. |
| Stimulation of the heart increases _____ ______ and, combined with vasoconstriction, maintains what? | - HR -blood pressure within normal limits. |
| A change in position from lying to sitting or standing may elicit a further increase in heart rate or a decrease in blood pressure | orthostatic hypotension |
| If vasoconstriction and tachycardia provide inadequate compensation, _________ occurs when the patient is _______ . | -hypotension -recumbent |
| can cause a weak, thready pulse that is easily obliterated and flattened neck veins. | Severe fluid volume deficit |
| Severe, untreated fluid deficit will result in | shock. |
| Both fluid excess and fluid deficit affect | respiratory status. |
| ECF excess results in pulmonary congestion and pulmonary edema as increased _________ pressure in the pulmonary vessels forces fluid into the alveoli. | hydrostatic |
| The patient will experience shortness of breath, irritative cough, and moist crackles on auscultation. | ECF Excess |
| The patient with ECF deficit will demonstrate an ________ respiratory rate due to ________ tissue perfusion and resultant hypoxia. | -increased -decreased |
| ECF excess may result in _____ ______ as a result of increased hydrostatic pressure in cerebral vessels. | cerebral edema |
| Alternatively, profound volume depletion may cause an alteration in sensorium secondary to | reduced cerebral tissue perfusion. |
| Assessment of neurologic function includes evaluation of | (1) the level of consciousness, which includes responses to verbal and painful stimuli and the determination of a person's orientation to time, place, and person; (2) pupillary response to light and equality of pupil size; and (3) voluntary movement of th |
| Nursing care focuses on maintaining | patient safety. |
| what provides the easiest measurement of volume status? | Accurate daily weights |
| An accurate weight requires the patient to be weighed | at the same time every day, wearing the same garments, and on the same carefully calibrated scale. |
| Clues to ECF volume deficit and excess can be detected by | inspection of the skin. |
| Skin should be examined for | turgor and mobility. |
| provides more water than electrolytes, diluting the ECF. | A hypotonic solution |
| produces a movement of water from the ECF to the ICF in a hypotonic solution. | Osmosis |
| After osmotic equilibrium has been achieved, the ICF and the ECF have the same ______ , and both compartments have been ______. | Osmolality -expanded. |
| Maintenance fluids are usually hypotonic solutions (e.g., 0.45% NaCl) because | normal daily losses are hypotonic. |
| to maintain normal levels. | Additional electrolytes (e.g., KCl) may be added |
| solutions have the potential to cause cellular swelling, and patients should be monitored for changes in mentation that may indicate cerebral edema. | Hypotonic |
| Although 5% dextrose in water is considered an isotonic solution, the dextrose is quickly metabolized, and the net result is the administration of | free water (hypotonic) with proportionately equal expansion of the ECF and ICF. |
| One liter of a 5% dextrose solution provides __g of dextrose, or 170 calories. | 50 |
| Although this amount of dextrose is not enough to meet caloric requirements, it helps prevent | ketosis associated with starvation. |
| Pure water cannot be administered IV because it would cause | hemolysis of RBCs. |
| Administration of an isotonic solution expands only the | ECF. There is no net loss or gain from the ICF. |
| the ideal fluid replacement for a patient with an ECF volume deficit | isotonic solution |
| Examples of isotonic solutions include | lactated Ringer's solution and 0.9% NaCl. |
| Lactated Ringer's solution contains | sodium, potassium, chloride, calcium, and lactate (the precursor of bicarbonate) in about the same concentrations as those of the ECF. |
| It is contraindicated in the presence of lactic acidosis because of the body's decreased ability to convert lactate to bicarbonate. | Lactated Ringer's solution |
| has a sodium concentration (154 mEq/L) somewhat higher than plasma (135 to 145 mEq/L) and a chloride concentration (154 mEq/L) significantly higher than the plasma chloride level (96 to 106 mEq/L). | Isotonic saline (0.9% NaCl) |
| excessive administration of isotonic NaCl can result in elevated | sodium and chloride levels. |
| may be used when a patient has experienced both fluid and sodium losses or as vascular fluid replacement in hypovolemic shock. | Isotonic saline |
| initially raises the osmolality of ECF and expands it. | hypertonic solution |
| useful in the treatment of hypovolemia and hyponatremia. | hypertonic solution |
| the higher osmotic pressure draws water out of the cells into the ECF. | hypertonic solution |
| Hypertonic solutions (e.g., 3% NaCl) require frequent monitoring of blood pressure, lung sounds, and serum sodium levels and should be used with caution because of the risk for | intravascular fluid volume excess. |
| Although concentrated dextrose and water solutions (10% dextrose or greater) are hypertonic solutions, once the dextrose is metabolized, the net result is | the administration of water. |
| The free water provided by these solutions will ultimately expand | both the ECF and ICF. |
| The primary use of these solutions is in the provision of calories. | hypertonic solution |
| Concentrated dextrose solutions may be combined with amino acid solutions, electrolytes, vitamins, and trace elements to provide | parenteral nutrition |
| Solutions containing 10% dextrose or less may be administered through a | peripheral IV line. |
| Solutions with concentrations greater than __% must be administered through a central line so that there is adequate dilution to prevent? | -10 -shrinkage of RBCs. |
| common additives to the basic IV solutions. | KCl, CaCl, MgSO4, and HCO3− |
| stay in the vascular space and increase the osmotic pressure. | Plasma expanders |
| Plasma expanders include | colloids, dextran, and hetastarch. |
| protein solutions such as plasma, albumin, and commercial plasmas (e.g., Plasmanate). | Colloids |
| Albumin is available in __% and __% solutions. | 5 and 25 |
| The ___% solution has an albumin concentration similar to plasma and will expand the intravascular fluid milliliter for milliliter. | 5% |
| the __% albumin solution is hypertonic and will draw additional fluid from the interstitium. | 25% |
| a complex synthetic sugar. | Dextran |
| why does Dextran remain in the vascular system for a prolonged period but not as long as the colloids? | b/c it metabolizes slowly |
| pulls additional fluid into the intravascular space. | Dextran |
| a synthetic colloid that works similarly to dextran to expand plasma volume. | Hetastarch (Hespan) |
| whole blood or packed RBCs are necessary for a pt who has experienced | blood loss |
| Packed RBCs have the advantage of giving the patient primarily | RBCs; |
| Whole blood, with its additional fluid volume, may cause | circulatory overload. |
| Although packed RBCs have a decreased plasma volume, they will | increase the oncotic pressure and pull fluid into the intravascular space. |
| Loop diuretics may be administered with blood to prevent symptoms of | fluid volume excess in anemic patients who are not volume depleted. |
Created by:
ginger07