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Final Exam level 1

Fluid and Electrolytes

Homeostasis Balance of fluids, electrolytes, acids, and bases that maintain the body.
Two examples of therapeutic measures that can disturb homeostasis Use of diuretics and nasogastric suctioning (unless water and electrolytes are replaced)
The primary body fluid water
The average healthy adult's body weight is approximately what percent of water? 60% (50% in adults over 60 years old due to lower levels of muscle mass)
Who would have a higher percentage of water, a lean client or an obese client? Why? A lean client. Fat tissue is essentially free of water, whereas lean tissue contains a significant amount of water.
Two major departments that contain the body's fluid. Intracellular and extracellular
Where is intracellular fluid (IFC) found? Within the cells of the body
Intracellular fluid accounts for how much of the body's fluid? 2/3
Where is extracellular fluid (EFC) found? Outside the cells
Extracellular fluid accounts for how much of the body fluid 1/3
What are the two main compartments of ECF, and what are the other two? Intravascular and interstitial are the main compartments, but it also includes the Lymph and transcellular fluids.
Intravascular Fluid accounts for how much ECF and where is it found? AKA: plasma fluid. Accounts for 20%. It is found within the vascular system
Interstitial Fluid accounts for how much ECF and where is it found? Accounts for approximately 75%, and it surrounds the cells.
Examples of transcellular fluid. Cerebrospinal, pericardial, pancreatic, pleural, intaocular, biliary, peritoneal, and synovial.
Total body fluid 40 liters
How many liters does cell fluid account for in the body? 25 liters
How many liters does extracellular fluid account for in the body? 15 liters
How many liters does plasma account for in the body? 3 liters
How many liters does interstitial and transcellular fluid account for in the body? 12 liters
What are cations? Positively charged ions ("t" = +)
Give four examples of cations Sodium, potassium, calcium, magnesium
What are anions? Negatively charged ions
Give four examples of anions Chloride, bicarbonate, phosphate, and sulfate
What is the composition of blood? 55% plasma, <1% buffy coat (leukocytes and platelets), 45% red blood cells
Diffusion in terms of of body fluids. Balance of solutes between ICF and ECF. Higher concentration ---> lower concentration.
Osmosis in terms of body fluids. Specific kind of diffusion in which water moves across cell membranes. Water moves toward the higher concentration of solutes in an attempt to equalize the concentrations of both water and solute.
What is osmolality? Measure of the solute concentration of blood. Normal range is 280-300 mEq/L.
Define Isotonic solution and give three examples Has the same osmolality as ECF. Normal saline, 0.9% NaCl or Lactated Ringers, 5% Dextrose in water.
Define Hypertonic solution and give three examples Has higher osmolality than ECF. 3% NaCl, TPN, D50.
Define Hypotonic solution and give two examples Has lower osmolality than ECF. 0.33% NaCl, 0.45% NaCl
What should you look for in a patient receiving a hypertonic solution? Why would this happen? Pulmonary edema. Higher osmolality in the interstitial fluid will pull more water from the extra cellular fluid into the pipes.
What should you look for in a patient receiving a hypotonic solution? Why would this happen? Cerebral edema. Lower osmolality in the interstitial fluid will force water out of the pipes and into the tissues.
Define osmotic pressure The power of a solution to pull water across a semipermiable membrane due to concentration levels. It opposes and balances the force of hydrostatic pressure.
Filtration pressure The pressure that results in the movement of the fluid and solutes out of a compartment and is the difference between the hydrostatic pressure and the osmotic pressure
Filtration Process whereby fluid and solutes move together across a membrane from an area of higher pressure to an area of lower pressure.
Hydrostatic pressure definition Pressure on the walls of a container exerted by a fluid within a closed system. (Container = vessels; Blood = fluid)
What happens when hydrostatic pressure is greater than osmotic pressure in the body? Fluid filters out of blood vessels
Active transport definition Movement of solutes across cell membranes from a less concentrated solution to a more concentrated one using metabolic energy (ATP)
Example of active transport Sodium-potassium pump. Under normal conditions Na is higher in ECF and K is higher in ICF. In order to prevent diffusion, this transport is needed to move and hold these ions against their diffusion gradient.
Primary regulator of fluid intake? Thirst center in the hypothalamus that triggers the thirst mechanism.
What stimuli triggers the the thirst mechanism? Osmotic pressure of body fluids, vascular volume, and the release of agiotensin
Angiotensin A hormone released by the kidneys in response to decreased blood flow
Routs of fluid output Urine, feces, and insensible losses
Average daily fluid intake for an adult Oral fluids - 1,200-1,500 mL, water in foods - 1,000 mL, water as metabolism by-product - 200 mL. TOTAL = 2,400-2,700 mL
Average daily output for an adult Urine - 1,400-1,500 mL, lungs - 350-400 mL, skin - 350-400 mL, sweat - 100 mL, feces - 100-200 mL. TOTAL = 2,300-2,600 mL
Insensible fluid losses Occur through the skin and the lungs. They are usually not noticeable and cannot be measured.
Obligatory losses. Where and why? Required to maintain normal body function. Kidneys must excrete ~500 mL per day to eliminate metabolic waste. Respirations, skin, and feces for temperature regulation and waste elimination.
How kidneys help maintain homeostasis? Primary regulator. Volume and osmolality of ECF are balanced by regulating water and electrolyte excretion. Acid-base regulation by excreting hydrogen and retaining bicarbonate.
Antidiuretic Hormone (ADH) Regulates water excretion from kidneys by acting on the collecting ducts of the nephrons.
What causes ADH to be produced or suppressed Changes in serum osmolality. High osmolality causes collecting ducts to become more permeable to water to absorb more water. Decreased osmolality causes collecting ducts to be less permeable, and urine output increases.
Renin-Angiotensin-Aldosterone System (RAAS) main purpose. Maintain fluid balance by responding to changes in renal perfusion. Net effect of the system is to increase blood volume (and renal perfusion) through sodium and water retention.
How does the RAAS work? (Sequence) Decreased pressure in kidneys --> Release of Renin (causes conversion of angiotensisogen) --> angiotensin I (converted by ACE) --> Angiotensin II --> Stimulates release of Aldosterone
What is ACE and what does it do? Angiotensin Converting Enzyme. Converts angiotensin I into Angiotensin II.
What does angiotensin II do? Acts directly on the nephrons to promote sodium and water retention and stimulates the release of aldosterone.
What does aldosterone do? Promotes sodium retention in the distal nephron.
Atrial Natriuretic Factor (ANF). Where it comes from and why? Released from arium of the heart in response to excess blood volume and stretching of the atrial walls.
What does ANF promote and inhibit? Causes nephrons to waste sodium and acts as a potent diuretic, thus decreasing blood volume. Inhibits thirst, reducing fluid intake.
Electrolyte definition Charged ions capable of conducting electricity, present in all body fluids and fluid compartments.
Four things electrolytes are important for Maintaining fluid balance, contributing to acid-base regulation, facilitating enzyme reactions, transmitting neuromuscular reactions.
Sodium Most abundant cation in ECF. Normal serum levels are 135-145 mEq/L. When reabsorbed, chloride and water follow, thus maintaining ECF volume. High levels in bacon, ham, processed cheese, table salt.
Potassium Major cation in the ICF (125-140 mEq/L). Small amount in ECF (3.5-5 mEq/L). Vital for all muscle activity, acid-base balance, and enzyme reactions. Many fruits and veggies, meat, fish, bananas, avacados, ect..
Calcium Most abundant in the body. 99% stored in bones. 1 % in serum. Vital for neuromuscular funtion (muscle contraction/relaxation, and cardiac function). Normal serum range is 8.5-10.5 mg/dL. Highest levels in milk and milk products.
Magnesium Second most abundant cation. Maintains neuromuscular and cardiac function, aids in production of ATP, and bone strength. Normal ECF level: 1.5-2.5 mEq/L. Richest in cereal grains, nuts, dried fruit, legumes, leafy veggies.
Chloride Major anion of ECF. Functions with Na+ to regulate osmolality and blood volume. Normal is 95-108 mEq/L. Major component of gastric juice. Helps regulate acid-base balance. Found in foods with Na+.
Phosphate Major anion of ICF. Normal is 2.5-4.5 mg/dL. Essential for muscle, nerve, and RBC function. Higher in children due to growth hormone. Absorbed in intestines. Rich in meat, fish, poultry, milk products, and legumes.
Bicarbonate Produced through metabolic process. Generated by kidneys. Primary function is regulating acid-base balance, and is also part of the body's buffering system.
Factors affecting fluid and electrolyte balance Age, sex, body size, environmental temperature, lifestyle
How age affects fluid and electrolyte balance Infants loose more fluid because of immature kidneys, higher respiratory rate. Older adult's thirst response is often diminished, and nephrons become less able to conserve water. These are normal changes that risk dehydration.
How sex affects fluid and electrolyte balance Fat cells contain little or no water. Lean muscle has high water content. Women generally have more body fat than men. Water accounts for ~60% of adult man's weight and ~52% of an adult woman's weigh.
How environmental temperature affects fluid and electrolyte balance Fluid losses through sweating are increased. Both electrolytes and water are lost through sweating. Sports drinks are recommended because they replace both.
How lifestyle affects fluid and electrolyte balance Diet, exercise, stress, and alcohol consumption. See page 1381 for details.
Two basic types of fluid imbalances Isotonic and osmolar
Isotonic imbalance Water and electrolytes are lost or gained in equal proportions. Osmolality remains constant. Isotonic loss or gain (Fluid Volume Deficit or Excess)
Osmolar imbalance Loss or gain of only water. Osmolality is altered. Hyperosmolar loss of water and Hypo-osmolar gain of water (Dehydration and Overhydration)
Isotonic - Fluid Volume Deficit (FVD) Occurs when body loses both water and electrolytes from ECF in similar proportions. A.K.A. hypovolemia because fluid is initially lost from the intravascular compartment.
Third Space Syndrome symptoms Low BP. High HR. Increased thirst. Little urine production. Increased fatigue.
Third space syndrome Causes Isotonic FVD. Fluid shifts from vascular space into an area it is not accessable. This fluid remains in the body but is unavailable for use.
Mild, moderate, and sever weight loss/gain percentages 2% - mild, 5% - moderate, 8% - severe
Isotonic - Fluid Volume Excess (FVE) Occurs when both intravascular and interstitial spaces hace an increased water and sodium content. A.K.A. Hypervolemia. Increased capillary hydrostatic pressure pushes fluid into interstitial space.
What is edema? Excess interstitial fluid. Caused mainly by hydrostatic pressure, serum osmotic pressure, and increased capillary permeability.
What is pitting edema? Leaves a small depression or pit after finger pressure is applied to the swollen area.
Dehydration Hyperosmolar fluid imbalance. Water is lost from the body, leaving excess sodium. Osmolality increases. Water is drawn into the vessels from interstitial space and cells.
Overhydration Hypo-osmolar fluid imbalance. Water is gained in excess of electrolytes. Osmolality decreases. Water is drawn into the cells causing them to swell. A.K.A. water intoxication.
Hyponatremia Sodium deficit. Less than 135 mEq/L. Common electrolyte imbalance. Brain and nervous system affected by cellular edema. Severe (<115 mEq/L can lead to coma).
Hypernatremia Excess sodium. Greater than 145 mEq/L. Cells become dehydrated.
Hypokalemia Potassium deficit. Less than 3.5 mEq/L.
Hyperkalemia Potassium excess. Greater than 5.0 mEq/L. Less common than a potassium deficit but more dangerous. Can lead to cardiac arrest.
Hypocalcemia Calcium deficit. Less than 8.5 mg/dL or 4.5 mEq/L. Can cause tetany with muscle spasms and paresthesias, can lead to seizures. Signs: Chvostek's and Trousseau's signs.
Chvostek's sign Caused by calcium deficit. Contraction of the facial muscles in response to tapping the facial nerve in front of the ear.
Trousseau's sign Caused by calcium deficit. Carpal spasm in response to inflating a blood pressure cuff on the upper arm 20 mmHg greater than systolic pressure for 2-5 minutes.
Hypercalemia Calcium excess. Greater than 10.5 mg/dL or 5.5 mEq/L. Most often occurs when calcium is released from the bones in excess. Prolonged immobilization or malignancy.
Hypomagnesemia Magnesium deficiency. Less than 1.5 mEq/L. More common than magnesium excess. Most common cause is chronic alcoholism.
Hypermagnesemia Magnesium excess. Greater than 2.5 mEq/L. Due to increased intake or decreased excretion, usually from oversupplementation.
Hypophosphatemia Phosphate deficit. Less than 2.5 mEq/L. Phosphate shifts from ECF into cells, or it binds to other substances in the GI tract and is eliminated.
Hyperphosphatemia Phosphate excess. Greater than 4.5 mEq/L. Phosphate shift out of cells into ECF, renal failure, or ingestion of excess phosphate are possible causes.
Hypochloremia Chloride deficit. Less than 95 mEq/L. Excess loss through GI, kidney's or sweating. May experience muscle twitching, tremors, or tetany.
Hyperchloremia Chloride excess. Greater than 108 mEq/L. Excess replacement of sodium chloride or potassium chloride lead to this. May cause weakness, lethargy, dysrhythmias, or coma.
Significance of hematocrit (Hct) lab test for fluid and electrolytes Measures the volume of cells in relationship to plasma and is, therefore, affected by changes in plasma volume. % Increases with dehydration and % decreases with overhydration.
Significance of an osmolality lab test for fluid and electrolytes Measures particles that include sodium ions, glucose, and urea, and is used to evaluate fluid balance. Increase (greater than 300 mEq/L) indicates FVD. Decrease (less than 280 mEq/L) indicates FVE.
Significance of a Urine Specific Gravity lab test for fluid and electrolytes Can be measured quickly and easily by nursing personnel. If it is high (above 1.030) it indicate FVD. HIGH IS DRY! If it is low (below 1.005) it indicates FVE.
What is specific gravity? Urine concentration that correlates with urine osmolality. Normal range is 1.005-1.030 (usually 1.010-1.025)
Urine pH normal levels Averaging about a 6.0, but range from 4.6 to 8.0 is considered normal.
Significance of a urine pH lab test for fluid and electrolytes. Kidneys play a critical role in regulating acid-base balance. This test determines if the kidneys are responding appropriately.
What do the kidneys do to correct metabolic acidosis? Urine pH should decrease because biocarbonate ions should be retained and hydrogen ions should be excreted.
What do the kidneys do to correct metabolic alkalosis? Urine pH should increase because hydrogen ions should be retained and biocarbonate ions should be excreted.
Significance of an Arterial Blood Gasses (ABGs) lab test for fluid and electrolytes. This test is performed to evaluate a client's acid-base balance and oxygenation. One of the six measurements pertains to pH level which involves properly functioning kidneys.
Created by: Jnford15
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