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F&E/AB Balance
| Question | Answer |
|---|---|
| third spacing | accumulation of fluid and sequestration of trapped ECF in an actual or potential body space as a result of disease or injury |
| third spacing generally occurs where? | pericardial, pleural, peritoneal or joint cavities; bowel or abdomen or w/in soft tissues after trauma or burns. |
| edema | excess accumulation of fluid in the interstitial space. |
| localized edema | d/t traumatic injury, local inflammation, burns |
| generalized edema (anasarca) | excessive accumulation of fluid in the interstitial space t/o the body and occurs as a result of conditions such as cardiac, renal or liver failure |
| diffusion | solute will spread from an area of HIGHER concentration to an area of LOWER concentration. |
| osmosis | osmotic pressure is the force that draws the solvent from a less concentrated solute through a selectively permeable membrane into a more concentrated solute, thus tending to equalize the concentration of the solvent. |
| filtration | movement of solutes and solvents by hydrostatic pressure. movement from an area of HIGHER pressure to an area of LOWER pressure. |
| hydrostatic pressure | force exerted by the weight of a solution |
| arterial end of capillary | hydrostatic > osmotic, therefore fluids and diffusible solutes move out of the capillary. |
| venous end of capillary | osmotic (pull) > hydrostatic therefore fluids and some solutes move into the capillary. |
| osmolality | # of osmotically active particles per kg of water. it is the concentration of a solution. normal of plasma is 270-300mOsm/kg water. |
| isotonic | same osmolality as body fluids. includes 0.9% NS, D5W, dextrose in 0.225% NS and LR solution. |
| hypotonic | lower osmolality of body fluids - cells swell. include 0.45% NaCl, 0.225% NaCl, 0.33% NaCl |
| hypertonic | higher osmolality of body fluids - cells shrink. include 3% NaCl, 5% NaCl, D10W, 5% dextrose in 0.9% NS or 0.45% NS, D5LR. |
| active transport | needed if an ion needs to move through a membrane from an area of LOWER concentration to an area of HIGHER concentration. moves against concentration and osmotic P. requires ATP! |
| amount of water lost through skin | about 400mL/day |
| average amount of loss by perspiration alone | about 100mL/day |
| water lost through skin/lungs/etc is called? | insensible losses. MUST BE INCLUDED IN OUTPUT. |
| average amount of water lost through lungs | about 350mL/day |
| average amount of water lost through feces | about 150mL/day |
| usual urine output/day | about 1500mL/day |
| urine output should be at least ____mL/hr or ____mL/8 hours | 30mL/hr, 240mL/hr |
| isotonic dehydration | water and dissolved electrolytes are lost in EQUAL PROPORTIONS decreased circulating blood volume and inadequate tissue perfusion known as hypovolemia |
| hypertonic dehydration | amount of solute left is > fluid that is left! results in cellular dehydration and shrinkage |
| hypotonic dehydration | amount of fluid left is > amount of solutes that are left! causes a plasma volume deficit and causes cells to swell. |
| s/s of FVD | thready increased pulse, decreased BP, ^ resp rate/depth, decreased CNS activity, decreased UO, ^ specific gravity, dry skin/mouth, tenting, thirst, diminished bowel sounds |
| lab findings in FVD | increased serum osmolality increased hematocrit increased BUN increased serum Na+ level |
| FVD interventions | provide PO rehydration therapy; IV if severe. generally isotonic dehydration is treated w/ isotonic solutions, hypertonic with HYPOtonic and hypotonic with HYPERtonic. monitor electrolyte values |
| FVE | hypervolemia. only the EC compartment is expanded - there is no shift between EC and IC compartments. causes circulatory overload and interstitial edema |
| hypertonic FVE | caused by excessive Na+ intake |
| hypotonic FVE | known as water intoxication - too much fluid, not enough lytes. all body fluid compartments expand and lyte imbalances occur as a result of dilution. |
| s/s of FVE | bounding increased pulse, ^BP, distended veins, ^CVP, ^RR (shallow), dyspnea, moist crackles, pitting edema in dependent areas, skin pale and cool to the touch, ^GI motility |
| signs of water intoxication | polyuria, diarrhea, nonpitting edema, dysrhythmias, projectile vomiting |
| lab findings in FVE | decreased serum osmolality decreased hematocrit decreased BUN decreased serum Na+ decreased urine specific gravity |
| FVE interventions | monitor CV, resp, NM, renal, integumentary and GI status. diuretics restrict fluid & Na+ intake strict I/O, monitor weight daily monitor lyte values |
| normal Na+; sources | 135-145mEq/L processed foods, bacon, cheese, canned foods (esp soups), lunch meats, soy sauce |
| hyponatremia | serum Na+ <135mEq/L. Na+ imbalances are often associated with fluid volume imbalances. |
| hyponatremia assessment | shallow RR; ineffective mvmts (late) r/t skeletal muscle weakness diminished DTRs HA, personality changes, confusion, seizures, coma ^ GI motility, hyperactive BS, abd cramping, N/D decreased urine specific gravity w/ ^ UO |
| hyponatremia interventions | hypovolemic hyponatremia - IV NaCl hypervolemic hyponatremia - diuretics demeclocycline (Declomycin) if probs with ADH if on Li, monitor levels bc low Na+ levels can potentiate Li toxicity |
| hypernatremia | >145mEq/L |
| hypernatremia assessment | PEdema if hypervolemia is present HR & BP respond to vascular vol status spontaneous muscle twitches; SM weakness, diminished or absent DTRS (late) *ALTERED LOC agitation, confusion; lethargy, stupor, coma decreased UO, dry skin |
| hypervolemia interventions | if cause is d/t inadequate renal excretion if Na+ = diuretics restrict Na+ and fluid intake. monitor lyte levels. |
| normal K+; sources | 3.5-5.0mEq/L avocado, bananas, cantaloupe, carrots, fish, mushrooms, oranges, potatoes, pork, beef, veal, raisins, spinach, strawberries, tomatoes |
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