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C Exam 4
Fluid & Electrolytes
| Question | Answer |
|---|---|
| What is fluids functions in our body? | Transport nutrients, electrolytes, and oxygen to cells and carry waste products away Helps w/ food digestion A solvent Maintains Blood volume Regulation of body temp A lubricant and cushion for joints, eyes, spinal cord |
| If someone has a healthy weight variation what amount is that? | 1/2 a pound per day |
| What is THE MOST accurate measure of fluid balance in the body? | Daily Weight |
| What is a solvent? | Something dissolved in our body fluids. Ex: electrolytes, minerals, vitamins, and glucose |
| What are the fluid outputs that are immeasurable? | Water lost in solid stool Insensible loss through sweating and water vapor in the lungs Wound drainage |
| What does osmolality measure? | amount of particles in the fluid per kg |
| What does low serum osmolality mean? | less particles, more free water. |
| What does high serum osmolality mean? | Lots of particles, less water. |
| If the urine and serum osmolality are similar what does that mean? | They kidneys are doing their job. |
| How are electrolytes and confusion related? | Imbalances cause a change in cognition. Confusion-Coma |
| What can lead to hypovolemia? | Acute hemorrhage |
| How are fluid and perfusion related? | Fluid loss leads to decreased perfusion |
| What is the daily fluid intake need? | approx 2500 mL |
| What 3 sources of intake does our body have? | oral intake:1200-1500 Water in foods: 1000mL Water from food metabolism: 200mL |
| What are the four primary routes of output? | Drainage(wound vac, GI suction, chest tubes) Emesis Feces Urine |
| 1 Liter of water weighs what? | 1 kg |
| 1 kg is equal to how many pounds? | 2.2 lbs |
| If fluid balance is critical what will be done every hour? | urine outputs to ensure adequate renal function |
| What is an adequate renal output per hour? | greater than 30 mL per hour |
| What is important to note that also effects fluid balance that are not measurable? | Food intake Fever Sweating ↑RR (Tachypnea) Wound drainage |
| How does osmolality work? | Water moves from low to high osmolality |
| What is hemodilution? | Extra water dilutes particles, which results in return to normal concentration |
| What triggers the sensation of thirst? | Decreased extracellular fluid Increased Osmolality |
| Where is the thirst center located? | Hypothalamus of the brain |
| ADH | Study by talking through the diagram |
| What does aldosterone do? | promotes sodium and water retention |
| If there is ↓ blood flow through the kidneys what is secreted? | Renin |
| What does renin do? | Causes conversion of angiotensin to angiotensin I |
| Where is ACE produced? | in the lungs |
| What does ACE stand for? | Angiotensin converting enzyme |
| What does ACE do? | converts angiotensin I to angiotensin II |
| What does angiotensin II do? | promotes vasoconstriction Acts on the nephrons to ↑ sodium and water retention Stimulates release of aldosterone from the renal cortex |
| Where does aldosterone come from? | the renal cortex |
| When there is ↑ volume in the heart, and the muscles stretch what happens? | ANP BNP are released |
| What is ANP? | Atrial Natriuretic Peptide |
| What does ANP do? | ↑Glomerular Filtration Rate ↓Renin & ↓Angiotensin II and Aldosterone which all result increased excretion of water |
| What does BNP do? | causes vasodilation which ↓ BP |
| How much of our total body weight is made up of fluid? | 60%- 42L |
| Besides fluid balance why else are electrolytes important? | Contribute to acid base balance Facilitate enzyme reactions Transmit neuromuscular reactions |
| What is the percent of fluid in the extracellular space? | 33% |
| What is the percent of fluid in the intercellular space? | 67% |
| What is the extracellular space made up of? | Interstitial-80% Plasma-20% |
| What is osmosis? | moves from less concentrated area to a more concentrated area. Dilution affect |
| What is diffusion? | move from area of high concentrated area to less concentrated area. Example: gas exchange in the lungs Think Defuss Demotion- going high to low |
| What is filtration? | fluid and molecules move together across a membrane. Moves from higher pressure to lower pressure. |
| What is first spacing? | normal distribution of fluid in vascular system. Right places in the body. |
| What is second spacing? | S for tiSsue, fluid is pushed out of the vascular system to interstitial space. Hydrostatic pressure (BP) is so high it pushes the fluid out. |
| What is third spacing? | Fluid is trapped in part of body, cavity. All other symptoms suggest they are dehydrated because they are lacking fluid in veins because its in he cavity. |
| What are the cations? | Potassium Sodium Calcium Magnesium |
| What are the Anion? | CAP Chloride Phosphate |
| What electrolytes are in the extracellular fluid? | Extra CCS Chloride Calcium Sodium |
| What electrolytes are in the intercellular fluid? | PPM Potassium Phosphate Magnesium |
| What is potassiums role in the body? | MAN Muscle SCS (skeletal,cardiac,smooth) Acid/Base Balance Nerve impulses(Transmit/ conduct) |
| What foods have potassium? | Melons ABSORB dried PP's |
| What effects potassium levels? | Insulin pH level Aldosterone increases potassium excretion(think about the ACE inhibitors) |
| What is phosphate role in the body? | Think 3 B's Breast( for tissue growth and repair) Bones &teeth Balance of Acid Base |
| What foods have phosphate in it? | PM FML Poultry Meat Fish Milk products Legumes (Beans, peas, lentils) |
| What other electrolyte does phosphate have a relationship with? What is the relationship? | Calcium, an inverse relationship |
| What is magnesium's role in the body? | Nerve transmission & neuromuscular activity Cardiac function Vasodilation Functioning of sodium-k+ pump ** Mellows the muscles ** |
| What foods have magnesium in them? | FML Dried Green nuts & MeatS agrain Fish Milk products Legumes Dried fruit Leafy greens Nuts Meat Seafood Grains |
| What is sodium's role in the body? | Generation and Transmission of nerve impulses |
| What foods have sodium? | BLISS C4 Soda is BS |
| What does BLISS C4 SODA BS stand for? | Bacon Lunch meat Ice cream Shellfish Sausages Crackers(graham) Cheese Cereal Carrots Soda Buttermilk Smoked fish |
| What does Chloride do in the body? | Think water and stomach Maintain water balance, serum osmolality Maintain acid medium for digestion (HCL) |
| What foods have chloride? | same as sodium |
| What is calcium's role in the body? | Think 3 B's Beats (heart + muscle contractions) Blood Bones & teeth |
| What foods have calcium? | DOTS Dairy OJ Tofu Salmon |
| What kind of relationship do sodium and chloride have? | They travel together. |
| What is ascites? | Example of third spacing. Fluid trapped in the abdominal cavity. |
| What can be used to help move fluid out of the cavity back into the ICF? | Albumin, the protein helps pull the fluid back. |
| What are crystalloids? | Isotonic, hypotonic, hypertonic fluids |
| What is an isotonic IV fluid? | I SO perfect, same concentration as blood. 0.9% NS Lactated Ringers D5W (before the dextrose is metabolized) |
| What is a hypotonic fluid? | This is will dilute a high sodium level. 0.45% NS D5W (when the dextrose is metabolized) and only fluid is left. Causes the cell to swell think HIPPO |
| What is a hypertonic fluid? | D5NS D5 1/2 NS D10 Usually used for sugars and not fluid replacement has dextrose molecules (large sugar molecules) which pull fluid into the vascular space. |
| Whats another example of hypertonic fluid? | 3% NS This is used to replenish sodium levels, because where sodium goes water flows it can cause neurological changes. |
| Who can't you use NS with? | heart failure, edema or hypernatremia as it can cause fluid overload. |
| Why are the very young at increased risk for F/E Imbalance? | Immature kidneys More Insensible loss due to higher RR Higher metabolic rate (why they are hungry every 2-4 hrs) 75% of body made of fluid |
| Why are the older at increased risk for F/E Imbalance? | Lost of thirst sensation Kidneys less able to respond to ADH Dependent on someone else to feed them |
| How does glucose effect F/E? | blood glucose is high the body increase UO in attempt to increase glucose excretion |
| What does BUN indicate? | ↑BUN indicate dehydration |
| What is creatinine an indication of? | kidney function |
| What do protien/albumin do for F/E balance? | pull fluid |
| How is hematocrit affected by fluid volume? | ↓Hct can be the result of hemodilution, ↑Hct can be the result of hemoconcentration |
| What does high urine specific gravity indicate? | high levels of particles |
| What does low urine specific gravity indicate? | low levels of particles |
| What is osmolality a measure of? | particles per kg |
| What is osmolaRity a measure of? | particles per liter |
| How do you test urine specific gravity? | must be 24 hour urine collection in the orange tub with ice near the bedside. Discard first collection at time it starts. |
| What is the most accurate measurement of fluid loss? | Weight |
| What vital signs would you anticipate for a pt who has fluid volume deficit? | Decreased BP Increased HR |
| What vital signs would you anticipate for a pt who has fluid volume overload? | Increased BP Increased HR |
| How much weight is to much fluids? | 3 lbs in 2 days or 5 lbs in a week |
| What 2 fluids are used to pull fluid back into the vascular space? | Albumin Dextran 40 |
| When are albumin and dextran 40 used? | used for 3rd spacing and 2nd spacing that's unresponsive to diuretics |
| What should you ALWAYS look at before giving fluids? | sodium lab values |
| What should you watch for when giving a pt hypertonic fluids? | Increased BP Pulmonary congestion Edema Hypernatremia |
| What does excessive sweating indicate? | fluid loss |
| If a pt has fluid overload what kind of sputum would you expect? | pink frothy (pulmonary edema) |
| When should you be concerned about fluid deficit in regards to I & O? | Less than 1000 cc in a day less then 30 cc urine in an hour Pt hasn't voided in 6 hours |
| How much sodium should be consumed in a day? | 2-3 grams |
| What is a normal urine specific gravity? | 1.005-1.030 |
| What three things have the biggest impact on osmolality? | BUN Sodium Glucose |
| 1 Liter of fluid is equal to how many kg's? | 1 |
| Atrial Natriuretic Peptide(ANP) does what to the glomerular filtration rate? | increase the GFR which then decreases renin and angiotensin II and aldosterone. Because we want to stop the retention and excrete the excess fluid |
| Where is the interstitial fluid? | fluid around the cells |
| Where is the intravascular/plasma fluid? | in blood vessels |
| Where is transcellular fluid? | pleural, synovial fluid |
| What is part of the extracellular fluids? | LIIT Lymph Interstitial Intravascular Transcellular |
| If a pt is in acidosis what would there K+ be? | High |
| If a pt is in alkalosis what would there K+ be? | Low |
| If we have high Parathyroid levels what electrolyte would that effect? | Phosphate |
| What part of the brain triggers thirst? | Hypothalamus (think HYdrate) |
| If we have high PTH levels what does that mean? | High excretion of phosphate |
| Low levels of which electrolyte impairs action of PTH? | Magnesium |
| Which electrolyte is excreted in the feces? | think fee CEES= Calcium |
| Calcium is bound to what? | Proteins |
| So pt that have a low protein level would have what kind of calcium level? | low calcium level |
| What helps maintain calcium levels? | regular exercise |
| What is hypovolemia? | lack of fluid in the blood |
| What is hypervolemia? | excess fluid in the blood |
| Which gender is at a greater risk for fluid loss (dehydration)? | Females, because men have more muscle and muscle cells are higher in water. |
Created by:
cberna00
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