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Chapter 29: Fluids
Chapter 29: Fluids, Electrolytes, Acid-Base Balances
| Term | Definition |
|---|---|
| Water accounts for what percentage of total body weight | 50% to 70% |
| Typical adult male body weight is made up of | 60% to 65% water |
| Typical older adult body weight is made up of | 50% to 55% water |
| Typical infants and premature infants body weight is made up of | 65% to 80% water |
| Fluid loss interferes with homeostasis and impairs body functions so much that a person can only survive | a few days without water intake |
| 2/3s of body fluids reside | inside individual cells, in the intracellular fluid (ICF) |
| 1/3 of body fluids reside | outside the cells, extracellular fluid (ECF) |
| intracellular fluid (ICF) | fluid within cells |
| extracellular fluid (ECF) | fluid located outside cells |
| sodium chloride | "table salt" |
| if someone takes in too much sodium chloride they will | retain excess water |
| where sodium goes... | water follows |
| found in much higher concentrations inside of cells: | potassium (electrolyte), protein molecules |
| found in much higher concentrations outside of cells: | sodium, chloride, bicarbonate |
| two extracellular areas fluid can be found in | interstitial space, intravascular space |
| interstitial space | areas surrounding and between cells (also called tissue fluid or interstitial fluid) |
| intravascular space | includes the blood vessels & heart, which hold blood |
| plasma | the liquid portion of blood that surrounds and holds blood cells |
| what is the most important to survival: water or food? | water |
| which water compartment contains approximately two-thirds of the body's water content? | |
| what are the two subdivisions within the extracellular compartment? | |
| what follows sodium? | |
| the tissues that form blood vessel walls & cellular membranes are | semipermeable |
| semipermeable means that | they allow passage of some substances but not all |
| a solvent is | a liquid in which solutes/solids are dissolved to make a solution |
| solutes are | solids |
| solutes are dissolved in solvents in order to create a | solution |
| what determines the fluid's osmolality? | the number of solutes present in the solvent |
| osmolality means | concentration |
| which does osmosis move: water or solute? | |
| which does diffusion move: water or solutes? | |
| what are the differences between osmosis and diffusion? | |
| 80% of water entering the first section of the large intestine (cecum) is | absorbed there |
| 1st section of the large intestine | cecum |
| movement of water from the gastrointestinal tract | swallowed - esophagus - stomach - large intestine - cross intestinal wall - capillary wall - enters bloodstream - now apart of plasma - circulated in vessels til reaching capillary beds where nutrients/wastes are exchanged - waste travel to kidneys - pee |
| the goal of all the fluid movement back and forth between water compartments is to | maintain constant relative proportions of fluids and solutes |
| the four main functions of water in the body: | 1) maintain temperature 2) transport electrolytes, minerals, vitamins, waste products 3) protect brain & spinal cord 4) lubricate joints & digestive tract |
| how does water maintain temperature? | |
| how does water transport electrolytes, minerals, vitamins, and wastes? | |
| how does water protect the brain & spinal cord? | |
| how does water lubricate joints & the digestive tract? | |
| the most important factor determining water intake: | thirst |
| which portion of the brain controls thirst? | hypothalamus |
| the hypothalamus receives info from | osmoreceptors |
| osmoreceptors detect | when there is an elevated concentration of solutes in the blood |
| increased concentration of the plasma (osmolality) results in low fluid levels in the blood, which then | stimulates thirst |
| sequence of regulation of body fluids: | elevated concentration of solutes, low fluid levels, is detected by osmoreceptors - they send signal to hypothalamus - hypothalamus triggers thirst sensation |
| average adult needs to consume about (mL) | 1,440 to 1,920 mL of water per day |
| average adult needs to consume about (L) | 1.5 to 2 L each day |
| osmosis | when water moves thru a semipermeable membrane, to equalize concentration of solutes on each side of the membrane |
| diffusion | when molecules move from an area of higher concentration to an area of lower concentration to equalize the amount throughout the area |
| a raisin soaked in a tablespoon in water causes it to plump up as water crosses its skin. this is an example of | osmosis irl |
| when you spray air freshener in one corner of the room, the molecules spread out til it can be smelled throughout the room. this is an example of | diffusion irl |
| if a patient is given an IV solution that is more concentrated than plasma, water from the RBCs will leave the cells and cross the membrane to equalize the concentration, which causes the RBCs to shrivel (crenation). this is an example of | osmosis in the body |
| when you inhale room air (higher in O2 and lower in CO2 than in the capillaries around air sacs in lungs), CO2 molecules move out of the capillaries into air sacs to be exhaled and O2 is drawn into the capillaries | diffusion in the body |
| what are the differences between osmosis and diffusion? | |
| what are the similarities between osmosis and diffusion? | |
| filtration is | when solids are separated from liquids or gases by a barrier that only the liquids and very fine solutes can pass through. examples: coffee grounds & hot water passing thru a filter to make coffee. liver filtering dissolved substances/waste from the blood |
| fatty tissue contains | less water than muscular tissue |
| muscular tissue contains | more water than fatty tissue |
| so more muscular people tend to have a | higher percentage of body weight from water |
| obese people and older adults tend to have a | lower percentage of body fluid due to lack of muscle mass |
| antidiuretic hormone (ADH) and aldosterone | work on kidneys to decrease urine production and increase body fluid level |
| atrial natriuretic factor (ANF) | causes the kidneys to excrete more urine to decrease the body fluid level |
| insensible fluid loss is | that which cannot be directly measured, such as lost during respiration or perspiration |
| normal fluid loss for healthy patients is about | 1 to 3 L per day |
| how does antidiuretic hormone (ADH) regulate fluids and electrolytes? | |
| how does aldosterone regulate fluids and electrolytes? | |
| how does atrial natriuretic factor (ANF) regulate fluids and electrolytes? | |
| which electrolyte does water follow? | |
| hypovolemia | a true fluid volume deficit |
| fluid volume deficit (hypovolemia) | when the patient loses both the fluid and the electrolytes contained in that fluid |
| the most common cause of hypovolemia is | hemorrhage |
| dehydration | when a patient loses only fluids, the remaining electrolytes become more concentrated |
| hemorrhage and dehydration require | different treatments |
| the two reasons for fluid volume deficit (hypovolemia) | 1) prolonged insufficient fluid intake 2) abnormal fluid losses |
| forms of abnormal fluid losses are | bleeding, prolonged tachypnea, excessive sweating (hot climates or extreme amounts of exertion or exercise), fever, diarrhea, vomiting, or excessive urination caused by diuresis |
| common reasons for prolonged insufficient fluid intake | not experiencing thirst (eg. older adults or patients w brain injuries), extreme nausea |
| result in loss of fluid over 24 hours: | urine, insensible respirations, insensible perspiration, gastrointestinal tract |
| result in gain of fluid over 24 hours: | water production created through metabolism of ingested food, oral liquids, water in food |
| volume loss caused by urine (in 24 hours) | 1,200 - 2,100 mL |
| diuretics can cause volume loss (in 24 hours) of up to | 6,000 mL |
| volume loss caused by insensible respirations (in 24 hours) | 200 - 300 mL |
| volume loss caused by insensible perspiration (in 24 hours) | 400 - 600 mL |
| volume loss caused by the gastrointestinal tract (in 24 hours) | 100 - 200 mL |
| volume loss caused by vomiting (in 24 hours) of up to | 6,000 mL |
| volume gain caused by oral liquids (in 24 hours) | 1,000 to 2,000 mL |
| volume gain caused by water in food (in 24 hours) | 800 - 900 mL |
| volume gain caused by water production created by metabolism of ingested foods (in 24 hours) | 100 - 200 mL |
| nursing actions for fluid volume deficit: | replace fluids orally and by IV as ordered monitor electrolyte levels administer antiemetics and antidiarrheal as ordered monitor vitals for low bp, elevated pulse, elevated temp monitor (I&O) void at least every 8 hours provide mouth care |
| persistent urinary output below 30 mL per hour | may indicate renal failure |
| even though a patient who has fluid volume deficit (hypovolemia) needs fluids, rapid infusion may cause | fluid volume excess or overload |
| signs and symptoms of fluid volume deficit | little to no fluid intake or urine output, frquent vomiting or diarrhea, flushed pale hot dry skin, thirst, nausea, cry cracked tongue/lips, elevated heart rate, weak pulse, fever, low bp |
| signs and symptoms of fluid volume deficit in newborns | sunken or depressed fontanels |
| late/severe signs of fluid volume deficit | nonelastic turgor (very late), decreased level of consciousness (severe), confusion (severe) |
| hypervolemia | fluid volume excess |
| what is hypervolemia (fluid volume excess) generally caused by? | retention of sodium and water in ECF |
| causes of hypervolemia | increased intake of dietary sodium, administration of IV fluids containing sodium, or retention of sodium or fluid as a result of a medication or kidney/heart/liver disease |
| who is more susceptible to fluid overload than average adult patients? | infants, small children, frail older adults, patients with heart or renal failure |
| signs and symptoms of hypervolemia | increase respiratory rate, shortness of breath/labored respirations, sudden coughing, jugular vein distention, increased bp/pulse, full bounding pulse, edema, crackles/wheezing in lungs, muffled heartbeat, weight gain, more urine, pink frothy sputum, fear |
| dependent body sites | those that are hanging down or where blood can pool |
| nursing actions for hypervolemia | monitor I&O, diuretics, daily weights, monitor meal trays, patient/family teaching, monitor for elevated bp/pulse/temp, check pulse ox & auscultate breath & heart sounds every 4 hours, check dependent sites for edema |
| electrolytes are | chemical substances that, when dissolved in water, release either their positive or negative electrically charged particles, ions |
| ions | positive or negatively charged particles, released by electrolytes |
| the main two functions of electrolytes are | 1) help transmit electrical impulses thru nerve and muscle fibers 2) maintain balance between the ICF and ECF |
Created by:
hannamalec
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