Fluid Balance 2
Terms
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- Works as solvent for transport
- water
- eliminates wastes through kidney, skin, lungs, and gastrointestinal tract
- water
- Assists with temp regulation
- water
- Lubricant for joints
- water
- comprises 40% of total body weight
- intracellular
- Consists of intravascular fluid opr plasma and interstitial fluid that is between the cells and outsided the blood vessels
- Extracellular
- Large amount of K+, mg+,po4-
- intracellular
- larger amount of Na+, hco3-, cl-, Ca+
- extracellular
-
Spacing of fluids.
1st space= - Normal distribution
-
spacing of fluids
2nd space - abnomal accumulation in interstitial compartment resulting in edema
- what causes increased hydrostatic pressure or decreased colloid osmotic or oncontic pressure in veins?
- edema, 2nd space fluid filling
-
spacing of fluid
accumulation in potential spaces (peritoneum, pancreas, intestines) - 3rd space
- process of water movement through a semipermeable membrane from an area of LOW solute concentrate to an area HIGH solute concentration.
- Osmosis
- The pulling force for water created by numbers of molecules.
- osmotic pressure
- What is normal serum osmolarity
- 280-295mOsm/kg
- normal serum osmolartiy means
- the osmotic pressure of a solution
- Has same osmolarity as blood plasma
- isotonic fluids
- what expands intravascular volume without causing a fluid shift
- isotonic fluids
- Pulls fluids from cells since the solution has more osmotic pressure then the interstitial fluid or intracellular fluid.
- hypertonic fluids
- What moves fluid into cells because intracellular fluid has more pulling power
- hypotonic fluids
- hypertonic and hypotoninc both occure through
- osmosis
- moves fluid into cells because intracellular fluid has more pulling power
- hypotonic fluids
- movement of molecules or solute in a solution across a semipermeable membrane from an area of HIGHER concentrate to an area of LOWER concentration.
- Diffusion
- Stops when concentration is same in both areas.
- Diffusion
- O2 and CO2 diffuse across alveolar capillary membranes
- Diffusion
- The process of water and diffusable substances such as electrolytes move together across semipermeavle membranes in a response to fluid pressure.
- Filtration
- Movement of materials across the membranes and epithelial layers of a cell by jmeans of chemical activity that allows the cell to admit otherwise impermeable molecules against a concentration gradient.
- active transport
- What pulls potassium into cells and sodium out of cells
- Sodium-potassium pump.
- enzymes along with ATP is required for?
- active transport
- Cells absorb what for energy
- glucose
- where is the thirst control center located?
- hypothalamus
- often blunted response in older adults
- thirst center
- What responds to reduction in water
- thirst control center
- Causes kidneys to retain water when the hypothalamus senses low blood volume and increased serum osmolarity.
- ADH
- What gland secretes ADH
- posterior pituitary gland
- these cells of the kidney secrete renin when blood flow to glomerulus drops
- juxtaglomerular cells
- Renin converts what in the liver to angiotensin I.
- Angiotensionogen
- Renin converts angiotensionogen in the liver to ?
- angiotensin I.
- Na+ and water retention, and K+ excretion by kidneys is caused by
- aldosterone
- What attracts water to exert colloid osmotic pressure
- albumin
- decreased colloid will cause water to do what
- leave intravascular compartment (plasma) and go into intersitial spaces. resulting in edema
- what contributes to fluid volume deficit with in intravascular compartments
- albumin
- To maintain water balance, output shoud be within how many cc's of intake?
- 200
- packed red cell volume exxpressed as a percentage of the total blood volume
- hematocrit
- normal hema for men and woman
-
40-54 men
38-47 wom - raise im hema is from
- dehydration or water loss
- hema decreases with
- hemodilution aka... fluids excessively retained.
- test that measuresamount of byproduct of muscle metabolism that is excreted by kidneys.
- serum creatinne
- normal serum creatine is
- .5-1.2mg
- serum creatinine increases with what disease? and decreases with what?
-
kidney disease
muscle atrophy - test of amount of nitrogenous product present in blood as urea
- BUN
- normal BUN test is
- 10-20mg
- Increase in BUn with? and decreased with
- kidney dysfunction and decreaed with malnutrition, water excess, hepatic damage
- Urines degree of concentration is?
- urine specific gravity
- evaluates kidneys abliity to cnserve or excrete water
- urines specific gravity
- normal urine specific gravity level is
- 1.010-1.025
- affected only by the number of particles 50-1400 mOsm.
- Urine osmolatity
- urine output less then 30cc/hr
- Fluid Vol def
- Urine specific gravity of more then 1030, and amber colored is
- Fluid volum Def
- Increased loss from vomitying or diarrhea, fever 2rd space fluid shifts, diuretics can result in
- Fluid V Def
- decreased intake, nausea, anorexia cant drink or swallow, decreased in thirst results in
- fluid vol def
- Signs of FVD
- Dry mucose membranes. decreased saliva, bad skin turgor
- weakness and thirst, are signs of
- FVD
- weak rapid pulse and decreased BP and drop in BP when moving from laying to standing is a sign of
- fvd
- wt loss, slow vein fill, increased HCT and BUN. Clear lungs is a sign of what
- FVD
- nursing care for FVD should be?
-
i and o
turn pt
offer fluids
antiemetics for nausea - Decreased fluid losss in excessive Iv administration,chf, renal failue, chronic liver disease and log term use of steroids are risk factors for what?
- FV Excess
- oliguria and decreased urine SG of less then 1.003 is a sign of
- F V E
- full bounding pulse, increased HR is a sign of
- FVE
- Moist breath sounds (crackles) DOB confusion are signs of
- fve
- distended neck and peripheral veins and slow emptying of hand veins is a sign of what?
- FVE
- Nursing practices for Fluid V Excess would be what?
-
Low sodioum
avoid olives pickles soy sauce bacon sausage cheese
administer diuretics
turn q1h to avoid skin breakdown
encourage rest for diuresis - Contols water balance, primary regulator of ECF vol.
- Sodium (135-145)
- Generatioin and transmisson of nerve impulses Sodium pot pump
- Sodium
-
Sodium is conserved by the___
with what? - Kidneys with aldosterone
- Loss of sodium in Gi fluids, diuretics, adrenal insufficiency is?
- Hyponatremia
- Too much drinking of water without electrolyte replacement is
- hyponatremia
- when excessive adh is secreted what happens?
- SIADH
- characteristics of hyponatremia
-
anorexia, nausia, vomiting
congusion muscle cramps, fingerprinting over sternum sezures - Serum Na below 135 results in
- hyponatermia
- related factors for hypernatremia
-
excessive salt intake in food
increased water loss throuwh sweating heatstroke
drowning in sea
deprivation of water - characteristics for hypernatremia
-
thirst dry tongue, sticky mucous
elevated temp
disorientation hallucinations seizures coma - serum Na above 145 is characteristic of
- hypernatremia
- nursing practices for hypernatremia are
-
offering fluids regularly
monitor i and o
teach what food fluids to avoid