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F&E slide info
fluid & electolyte med surge I (Erin's slides)
| Question | Answer |
|---|---|
| What % of body wt is fluid? | 60% |
| How does age affect % of body fluid? | Elderly have a lower % of body water |
| How does gender affect % of body fluid? | Men have a greater % of body water than women |
| How does body fat affect % of body fluid? | Obese people have lower % of body fluid b/c adipose tissue holds less water |
| What is the major solvent in our body? | Water; a liquid that dissolves other substances |
| Fluid Composition is important b/c? | it is necessary to sustain life; affects cell shape and size; maintains body temp; transports gases & wastes throughout the body; almost every organ in the body plays a vital role in maintaining electrolyte balance. |
| Intracellular space (ICF)= | 2/3 of body fluid; "inside the cell" |
| Extracellular space (ECF)= | Intravascular (inside vessels); "plasma"= liquid part of blood, Interstitial (b/w cells)= fl surrounding cell; Transcellular is fl that does not exist in lg amounts & causes no major fluid shifts,(CSF, pericardial, pleural,digestive, & synovial fluids) |
| Third Space fluid= "Held Prisoner" | fluid lost from ECF (outside the cell); body can't absorb quickly, pee it out or lose it; appear "Puffy" |
| What is the function of Homeostasis? | maintain fluid balance |
| Capillary walls separate what two fluid compartments? | Intracellular (ICF) and Extracellular (ECF); "Act as a Dam" |
| Fluid moves from ________ to _________ and from _________ | intravascular (inside the vessels) to extravascular (outside the vessels) and from intracellular (inside the cells) to extracellular (outside the cells) |
| Fluid regulation is dependent on a balance between? | solutes (electrolytes) and solution (fluid) concentrations |
| Electrolytes are... | Minerals (sometimes called salts)present in all of our body fluids; electrically charged chemicals; + or -; unite in various cojmbinations (i.e. Na+Cl- or normal saline soln) |
| Cations ...(has a "t" with a + in it) | + charge; Na+, K+, Ca++, Mg++, & H+ ions |
| Anions...(has the "A" with a - in it) | - charge; Cl-, HCO3-, SO4-, PO4- |
| Electrolyte concentrations vary from inside the cell(ICF) to outside the cell(ECF); Where are labs drawn from? | ECF (outside the cells) b/c of easier access |
| Na+ is highly concentrated in________and an important _____________? | ECF (outside the cell); regulator of of body fluid volume |
| K+ is highly concentrated in ________? | ICF (inside the cell) |
| In order to keep Na+ levels higher in ECF (outside the cell) and K+ levels higher in ICF (inside the cell) the body must use_____? | Energy to maintain proper concentrations; d/t using the active transport system via Na+/K+ pump |
| Osmosis= Movement of ________ across a semipermeable membrane from ___ ________ concentration to ____ _______ concentration. It is a _______ _________ and does not require ________. | water (fluid) moves from LOW solute (electrolyte) concentration to a HIGH solute (electrolyte) concentration; a passive process and does not require energy. |
| Osmola "L" ity= # of particles of solute in a unit of fluid based on________; hint: "L" = Lb for the abreviation of pound. | # of particles of solute in a unit of fluid based on WEIGHT (mOsm/kg)[wt of the electrolyte, not of the IV bag]; remember |
| Osmolarity= # of particles of solute in a unit of fluid based on ________ | # of particles of solute in a unit of fluid based on VOLUME (mOsm/L); USED TO EVALUATE BLOOD OR URINE |
| What is the ability of solutes to cause an osmotic driving force and promote water movement from one compartment to another to try to maintain balance in the body? | Tonicity |
| Hypotonic solutions= Hypo "LOW" Osmolality; 0.45% NaCl (Normal Saline) | USE(TO INCREASE BP)IN HYPOTENSIVE PATIENTS; "low # of electrolytes as compared to water; In other words= more water and less electrolytes; |
| Isotonic solutions= Normal Osmolality; 0.9% NaCl (Normal Saline) | USED TO INCREASE BLOOD VOLUME (TO INCREASE BP)"Same"= same # of electrolytes and water; won't see huge fluid shifts; DOES NOT ALTER CELL SHAPE OR SIZE; |
| Hypertonic solutions= High; D5NS (5%Dextrose Normal Saline)or D5LR (Lactate Ringer) | USED TO DECREASE EDEMA POST-OPERATIVELY & REGULATES URINE OUTPUT & BP; More electrolytes and less water |
| Why would you give an isotonic solution? | to increase blood volume/BP |
| Why would you give a hypertonic solution? | to decrease edema in post-op pts, regulate urine output, and BP |
| When would you NOT give Normal Saline? | in Hypernatremia |
| Sodium potassium pump... | requires energy |
| Diffusion is a ..."fish downstream" | Passive process; NO ENERGY NEEDED to move solutes or electrolytes across a semipermeable membrane; from HIGH to LOW concentration. |
| F & E Homeostasis uses almost every organ in our body in order to maintain fluid balance to regulate homeostasis...a problem with one...? | A problem in one will affect the other. Kidney; Heart; Lungs; Pituitary glands; Adrenal glands; Parathyroid; Other mechanisms |
| How does the heart affect fluid balance to regulate homeostasis? | Cardiac Output (CO)= the amount of blood pumped by the heart/min |
| How does the heart affect the level of renal perfusion to regulate homeostasis? | CO; affects how much blood or fluid reaches the kidneys. |
| The lungs affect? | insensible fluid loss; and are involved in acid-base balance; (acid= sour; base= bitter) |
| What function does the pituitary gland have in regulating fluid & electrolyte balance to regulate homeostasis? | by the "Thirst Center" located in the hypothalmus |
| What does the hypothalmus produce? | ADH; Anti-Diuretic Hormone |
| What does ADH do? | Prevents peeing to ..."Conserve Water"/retain water; regulates water by acting on the kidneys to ↑ total body H20 reabsorption; ↑'s BP, ↑'s total blood volume |
| How does ADH affect urine? | it is the most significant factor in determining whether excreted urine is concentrated (dark) or dilute (straw color) |
| How does the Adrenal Gland affect fluid & electrolyte balance to regulate homeostasis? | Releases aldosterone |
| What affect does Aldosterone have on fluid & electrolyte balance to regulate homeostasis? | ↑'s Na+ reabsorption and ↑'s/stimulates K+ excretion; Regulates the amount of electrolytes (Na+/K+ levels) in the body, thus, maintains BP & body fluids |
| What affect does the Parathyroid Gland have on fluid & electrolyte balance to regulate homeostasis? | Regulates Ca++ & PO4-; Secretes the Parathyroid Hormone (PTH) |
| PTH causes... | Bone reabsorption (when old bone is broken down it sends Ca++ out into the blood stream); Ca++ absorption from the intestines; Ca++ reabsorption from the renal tubules in the kidneys |
| What happens to the pituitary gland when Na+ ↑'s? | The pituitary releases ADH which stimulates water reabsorption and ↓'s U.O. (urinary output); remember...it keeps you from peeing. |
| How does the Renin-Angiotensin-Aldosterone System stimulate thirst? | causes vasoconstriction which ↑'s arterial perfusion pressure which stimulates thirst |
| The sympathetic nervous system stimulates release of...? | Aldosterone in response to renin |
| Aldosterone regulates...? | volume |
| Renin-Angiotensin-Aldosterone System | regulates BP and water balance; a low BP causes the kidneys to secrete renin, renin stimulates Angio I & Aldosterone which ultimately causes the kidneys to hold onto Na+ and water; ↑'s BP (if BP gets too high need to give ACE inhibitors...-sartans) |
| What do osmoreceptors do? | sense changes in Na+ concentration in our body |
| How does the Atrial Natriuretic Peptide (ANP)affect vessels? | A cardiac hormone; opposite of renin-angiotensin-aldosterone; ANP ↓'s BP,↑'s U.O. ("ANP makes you Pee"); stimulates vasodilation which ↑'s water excretion/U.O. |
| What are Gerontological Considerations? | ↑'d risk of F&E disorders b/c experience changes in F&E's quicker r/t decreased renal, pulmonary (lung), and adrenal function |
| What do you need to assess in geriatric clients to evaluate F&E's? | skin turgor (clavicle or forehead); mental status; ability to swallow (NPO risks); I&O/daily wts; edema (pitting); BUN & Creatinin Clearance; thirst. |
| What does the CC test (Creatinin clearance) measure? | The end product of muscle metabolism. The most definitive way of measuring kidney function [better than BUN (blood urea nitrogen]; but will use BUN & CC to measure kidney function. |
| What are the routes of fluid gain? | Oral, IV, SubQ, Enteral (via gut) |
| What are routes of fluid loss? | Kidneys and insensible losses |
| What is the expected fluid loss per day for the kidneys? | 1500 mL/day of urine (obligatory [need to lose]U.O. is 400-600mL/day) |
| What are insensible losses of fluid? | unmeasureable losses; skin/sweat= 600mL/day; lungs= 300-400mL/day; GI tract= 100-200mL/day |
| What is the term for Fluid Volume Deficit (FVD)? | Hypovolemia (NOT same as dehydration) |
| What is the definition of hypovolemia? or When does hypovolemia occur? | When extracellular fluid losses exceed fluid intake |
| When talking about hypovolemia we talk about a loss of...? | water and electrolytes in the same proportion; an isotonic imbalance. |
| What is dehydration? | loss of fluid; but tends to have a high sodium concentration; (thus, the loss of water is not equal to the loss of electrolytes and cannot be called the same thing as hypovolemia.) |
| Which is worse hypovolemia or dehydration? | hypovolemia |
| What some causes of hypovolemia/isotonic imbalances from the GI system? | vomiting, diarrhea, GI suctioning, GI fistula |
| What some causes of hypovolemia/isotonic imbalances from the renal system? | diuretics, Addison's (↓ Aldosterone), Diabetes Insipidus (↓ ADH), osmotic diuresis |
| What are some insensible causes of hypovolemia/isotonic imbalances? | Fever, sweating, stage III & IV wounds |
| As Hypovolemia worsens the signs/symptoms worsen and can lead to...? | Hypovolemic Shock |
| What is ascites? | Fluid in the abdomen. |
| How do you manage FVD? | Administer fluids: Oral route is preferred; may give isotonic IV fluids 0.9% NS or LR (remember they do not cause huge fluid shifts); this will also increase BP |
| How do you assess response to treatment for FVD? | I&O; Daily wts (most sensitive indicator of fluid changes); VS; Notify the MD of lack of response or worsening of symptoms (SBAR) |
| What pts are at risk for FVD? | Elderly, renal failure, diarrhea, C.diff (pooping q 5 seconds), vomiting. |
| How would you educate a pt with FVD? | If they are able to receive fluids orally, teach to drink some fluids every hour, etc. |
| How do you best assess the adequacy of FVD replacement in a pt. with hypovolemia by monitoring...? | vital signs and daily weights |
| What is hypervolemia? | Expansion of ECF (outside the cell); isotonic imbalance of fluids and electrolytes; circulatory overload |
| How does the body normally compensate for Hypervolemia/too much fluid? | ...your body will try to compensate for fluid overload by fine tuning the circulatory or circulating levels of Aldosterone, ADH & ANP; by altering these levels it causes the kidneys to release additional water and sodium |
| What are the primary Signs/Symptoms of hypervolemia (we are expected to know)? | Rapid wt gain (5#'s in one day); dyspnea, HTN, ↑'d JVD (↑'d time for veins to empty); may develop Pulmonary Edema if they cannot compensate well, the heart can only handle the extra load for so long; therefore, assess early. |
| How do you manage FVE (fluid volume excess)? | Restrict fluid intake; restrict Na+ intake; give diuretics; Positioning: HOB elevated (30 or 45 degrees); elevate extremities (hopefully the body will be able to absorb the fluid) to ↓ edema and prevent skin breakdown by turning every 2h |
| What should you monitor for FVE? | I&O, daily wts, and VS's; notify MD if there is a change in symptoms |
| What pts are at risk for FVE? | Renal fx, Elderly, Heart & liver failure pts (conditions resulting in impaired circulating volume), any condition that presents with ↓'d serum proteins such as Liver fx, malnutrition, Burns, and Nephrotic syndrome (renal fx) |
| Where are electrolytes absorbed? | via GI tract |
| Where are electrolytes excreted? | via Urine |
| What is the #1 ECF cation? | Na+ |
| What does Na+ control/affect? | controls water distribution; and affects muscle contraction/nerve impulse transmission |
| Why is it important to correct sodium imbalances "slowly"? | d/t severe neuro side effects; neurovascular SE's; |
| A loss or gain in Na+= | A loss or gain in water; (Water follows salt) |
| What is considered severe HYPONATREMIA? | < 120 mEq/L; |
| What is a CNS symptom of severe HYPONATREMIA of < 120 mEq/L? | Seizures, caused by H2O moving into the brain cell |
| Na+ is regulated by...? | thirst center in the hypothalmus in the pituitary in the brain |
| What happens when sodium levels become severely low in the blood (< 120 mEq/L) | excess water enters the cells; the cell swells/increases |
| Water toxicity causes...? | HYPONATREMIA |
| Signs and symptoms of hyponatremia depend on...? | How quickly Na+ falls or how long the levels are low, and the amount of extracellular fluid volume. |
| What are the GI symptoms of hyponatremia? | Anorexia, N/V, cramping |
| What are the neurological signs and symptoms of hyponatremia? | HA, lethargy, confusion, SEIZURES (caused by water moving into brain cells...that is why you want to repair the deficit slowly.) |
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