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Fluid Volume
Fluid Volume Imbalances
| Question | Answer |
|---|---|
| How many mL of fluids are gained orally in a day? | 1200mL |
| How many mL of fluids are gained through water in food in a day? | 1000mL |
| How much water as a by-product of food metabolism is gained in a day? | 300mL |
| What is the total amount of fluid gained in a 24 hour period? | 2500mL |
| How much of fluids lost in urine? | 1500mL |
| How much of fluids lost in feces? | 200mL |
| How much of fluids lost in perspiration? | 500mL |
| How much of fluids lost in respiration? | 300mL |
| What is the total amount of fluid lost in a 24 hour period? | 2500mL |
| Should the components of fluids gained and lost per day be approximately equal? | yes |
| What is the average fluid intake and output in 24 hours? | 2500mL |
| What are negatively charged electrolytes? | anions |
| What is the principle cation in plasma? | sodium |
| What is the principle intercellular cation? | potassium |
| Which compartment of body fluids contains the least amount of proteins? | interstitial fluid |
| What is serum osmolality? | twice the amount of serum sodium concentration (approx 140mEq/L) |
| What does a hypertonic solution do to a cell? | shrinks the cell |
| What does a hypotonic solution do to a cell? | swells the cell |
| What does a isotonic solution do to a cell? | no change |
| What kind of solution is 0.9% sodium chloride (normal saline NS)? | isotonic |
| What kind of solution is Lactated Ringer? | isotonic |
| What kind of solution is 5% dextrose in water (d5w)? | isotonic in the bag and changes to hypotonic once infused into body |
| What kind of solution is 0.45% sodium chloride (1/2NS)? | hypotonic |
| What kind of solution is 0.225% sodium chloride (1/4NS)? | hypotonic |
| What kind of solution is D5 NS? | hypertonic |
| What kind of solution is D5 in lactated ringer? | hypertonic |
| What kind of solution is 3% or 5% sodium chloride? | hypertonic |
| What kind of solution is parenteral nutrition (TPN)? | hypertonic |
| What kind of solution is Plasma-Lyte 148? | isotonic |
| How can IV fluids be classified? | crystalloid or colloid |
| What do crystalloid IV solutions contain? | dextrose or electrolytes dissolved in water |
| What kind of solutions can be crystalloids? | hypotonic, hypertonic, or isotonic |
| What do colloid IV solutions contain? | substances that should not diffuse through capillary walls |
| Where do colloids tend to remain? | in the vascular system |
| What can colloids be used to treat? | shock |
| What is the primary regulator of water intake? | thirst |
| What declines with aging that makes older adults vulnerable to dehydration and hyperosmolality? | thirst mechanism |
| What are common causes of fluid volume deficits? | gastrointestinal causes and medications |
| What are some of the most common causes of GI fluid volume deficits? | vomiting, diarrhea, GI suctioning, intestinal fistulas, intestinal drainage |
| What are some of the most common causes of medication fluid volume deficits? | diuretics, chronic abuse of laxatives or enemas, inability to swallow |
| Why does an undetected fever cause a FVD in older adults? | dehydration |
| What are some self care deficits that can cause FVD in older adults? | confused, depressed, tube fed, bed rest, taking meds |
| What are some issues that can lead to FVD in older adults? | No AC, fear of incontinence, physical disabilities, cognitive impairment |
| What are some manifestations of FVD in older adults? | change in mental status, memory, or attention, skin turgor, dry oral mucous membrane, increased tongue furrow, decreased temp, pinched facial expression, tachycardia |
| Where should the nurse assess skin turgor on an older adult? | over the sternum or on inner aspect of thigh |
| Why does 2nd/3rd spacing FVD not lead to loss of weight? | the fluid is still in the body |
| What is a sign of low blood volume (hypovolemia) | orthostatic or postural hypotension |
| Orthostatic or postural hypotension is caused by a drop of how much in their systolic BP when changing to a standing position? | 15mmHg or more |
| FVD heart rate | increases |
| FVE heart rate | increases |
| FVD BP | systolic decreases causing orthostatic hypotension |
| FVE BP | increases |
| FVD urine output | low and concentrated |
| FVE urine output | low or normal |
| FVD weight | loss |
| FVE weight | gain |
| FVD jugular vein distention | flat |
| FVE jugular vein distension | distended |
| FVD serum osmolality (blood concentration) | high |
| FVE serum osmolality (blood concentration) | normal |
| What is considered normal range for urine output per hour in an adult patient? | 30-60mL/hour |
| What indicates inadequate blood flow to the kidneys in an adult patient? | urine output less than 30mL/hour |
| When should you report urine output? | when it is less than 0.5mL/kg/hr for longer than 6 hours |
| What is an example of promoting effective tissue perfusion when experiencing FVD? | turning the patient every 2 hours |
| What is a way to reduce risk for injury when experiencing FVD? | teach patient how to rise slowly in stages |
| Excess extracellular fluid leads to what? | hypervolemia and circulatory overload |
| What does excess interstitial fluid lead to? | edema |
| How can you manage FVE? | limit sodium and water intake, and administer diuretics |
| What does hypervolemia do to your BP? | hypertension |
| What kind of pulse do you have with hypervolemia? | bounding peripheral pulses |
| What heart sounds are associated with hypervolemia? | 3rd heart sound due to volume of blood flow through heart |
| Where is dependent edema found in ambulatory patients? | lower extremities |
| Where should the nurse assess for the presence of dependent edema in a bedridden patient? | sacrum |
| What nursing intervention that monitors fluid balance should be done at the same time each day? | obtaining daily weight |
| How can you decrease dependent edema? | change position frequently, avoid restrictive clothing, avoid crossing legs while sitting, wear support stockings or hose, elevate feet and legs while sitting |
| What are examples of foods high in sodium? | lunch meat, bacon, cheese, dry cereal, canned soup, popcorn, ketchup, pickles |
| Why would a patient be under fluid restrictions and a low-sodium diet? | FVE |
| How often should the nurse reposition the patient to minimize tissue pressure and promote blood flow to the tissues? | at least every 2 hours |
| What might cause pulmonary edema? | FVE |
| What does presence or worsening of crackles and wheezes indicate? | FVE and/or pulmonary edema |
| What position is appropriate for a patient complaining of dyspnea due to pulmonary edema? | fowler's position |
| The nurse may delegate these activities for a patient with FVE | measuring intake and output, obtaining daily weights, and providing oral and skin care |
| Hydrostatic pressure= | PUSH (releases) |
| What happens in hydrostatic pressure? | blood flow coming from arteries to capillaries is narrowed and pushes nutrients out into ISF because of the hydrostatic pressure increasing |
| What factors affect hydrostatic pressure? | BP, blood volume, blood return to the heart, body positioning, impaired venous return, obstruction |
| What kind of obstruction is venous thrombosis? | blood clot |
| What does cellular/interstitial exchange require? | diffusion and active transport |
| What is involved in the cellular/interstitial exchange? | nutrients (amino acids and glucose), gasses (02 and CO2), meds, cellular waste |
| What kinds of cellular waste are there in cellular/interstitial exchange? | nitrogenous: creatinine, uric acid, lactic acid, etc. |
| Plasma Osmotic Pressure= | PULL (reabsorption) |
| What happens in osmotic pressure? | fluid and cellular waste return to the blood vessels |
| What attracts the fluid molecules on plasma osmotic pressure? | plasma proteins |
| What is albumin? | large plasma protein molecule |
| What does albumin do? | creates the pulling pressure that pulls CO2, fluid, and cellular metabolic waste from ISF back into blood |
| Is there more push or pull in a capillary? | push |
| What does having more push than pull in a a capillary mean? | more fluids are pushed out than allowed to be reabsorbed |
| What happens to the extra fluids left in ISF that are not returned through osmotic pressure? | they are returned to the heart by the lymphatic system |
| What does the lymphatic system travel alongside? | blood system |
| What kinds of circulatory systems are there? | blood and lymphatic |
| What kind of system is blood system? | 2 way-closed |
| What kind of pressure in blood system? | high and low |
| What kind of pump does the heart have in blood system? | strong pump |
| What kind of movement is in blood system? | rapid |
| What layer of arteries in blood system? | muscle layer |
| What do veins have in blood system? | valves |
| What kind of system is lymphatic? | 1 way-open |
| What kind of pressure in lymphatic system? | low |
| What kind of movement in lymphatic system? | slow movement, no heart |
| What kind of contractions and movement in lymphatic system? | rhythmic, smooth muscle contractions (intrinsic force) and surrounding muscle and organ movement (extrinsic force) propel lymph through vessel |
| What is lymphatic system involved in? | immunity |
| Are there valves and nodes in lymphatic system? | yes |
| what is capillary permeability? | how easy it is for the blood to leave the vessel |
| what is normal capillary permeability? | single layer of endothelial cells line the blood vessel walls-gaps b/T cells allows small molecules to exist tor enter |
| what is increased capillary permeability? | leaky-allowed gaps to expand-localized and systemic injury, infections, toxins, immune response results in inflammation |
| What happens when there is increased permeability? | localized or systemic loss of fluid from blood vessels |
| What are key elements in the PUSH? | fluid volume and pressure |
| what is key in PULL? | albumin |
| what are nursing interventions in body fluid movement? | gravity and positioning, IV therapy, and medications |
| What can cause edema? | increase in hydrostatic pressure, decrease in osmotic pressure, increase in capillary permeability |
| what causes hydrostatic pressure increases? | heart failure, FVE, renal disease, restriction of venous return |
| what causes osmotic pressure decreases? | hypoalgbuminenemia related to malnutrition, liver disease, etc |
| what causes increased capillary permability? | leaky membrane due to infection, injury, cancer, disease |
| What is third spacing? | a type of FVD-large volume of fluid is not available for cellular exchange or vascular access-not easily returned to vascular system |
| Third spacing locations | interstitial space-tissues, GI tract, peritoneal cavity, pleural space |
| increase in osmolality | concentrated-FVD |
| decrease in osmolality | diluted-FVE |
| increase in hematocrit | concentrated-more RBCs |
| decrease in hematocrit | diluted-less RBCs |
| other lab tests that can indicate fluid status | urine and urine specific osmolality |
| lab values for FVD | increase in osmolality, increase in urine specific gravity, increase in hemoglobin |
| lab values for FVE | decrease in osmolality, decrease in urine specific gravity, decrease in hemoglobin |
| fast IV rates | 150 or higher |
| maintenance IV rates | 100-125 |
| slow (TKO-to keep open) or KVO IV rates | 50 |
| FVD Nursing Care Assessment health history | chronic renal or endocrine disease and other causes of fluid loss |
| FVD priorities of care | promote adequate fluid volume, promote effective tissue perfusion, reduce risk for injury |
| The nurse may delegate these in FVD | measuring fluid intake and output, collecting vital signs, encouraging oral or enteral fluid intake, and skin care |
| FVE nursing care assessment health history | heart failure, renal or endocrine disease, shortness of breath or coughing, difficulty sleeping when laying down |
| what are positively charged electrolytes? | cations |
| FVD nursing care assessment physical assessment | look for causes of FVD-allow older adult to stand for one minute and then recheck BP |
| FVE nursing care assessment physical assessment | edema, crackles or wheezes, dyspnea, cough and sputum, mental status |
| FVE priorities of care | manage FVE, reduce risk for skin breakdown |
| which fluid imbalance causes elevated temp? | FVD |
| which fluid imbalance causes crackles in lungs? | FVE |
| which fluid imbalance causes orthostatic hypotension? | FVD |
| which fluid imbalance do you weight patient daily and turn every 2 hours? | both |
| which fluid imbalance do you restrict fluid of 1500mL/24 hours? | FVE |
| which fluid imbalance do you infuse IV fluid at 150mL/hr rate? | FVD |
| what happens when a patient with 3rd spacing receives albumin? | decrease pulse, increase BP, increase urine output |
| which adverse effect can occur with the administration of albumin? | fluid volume excess |
| severe FVE can lead to a medical emergency called what? | pulmonary edema-frothy pink sputum |
| what assessment should you obtain before infusing albumin so you can monitor the patient for adverse changes in status? | baseline VS including SpO2, listen to baseline lung sounds-breath sounds, urine output-have patient void or empty foley bag prior to infusing albumin |
| hypervolemia causes | HF, excessive sodium or fluid consumption, impaired renal excretion |
| nursing interventions for hypervolemia | low sodium diet, fluid restriction, diuretics, digoxin |
| hypovolemia causes | blood loss, inadequate fluid intake, vomiting, diarrhea |
| nursing interventions for hypovolemia | IV fluids, meds to increase BP, blood transfusion |
| interstitial or third space is what? | nonfunctional area between cells |
| fluid moving from interstitial space after infusing albumin goes where? | into the blood vessel |
Created by:
michellekay
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