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199 Cards in this Set

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(def)

fluid found within the body cells
intracellular fluid
(def)

fluid that surrounds the cells
interstitial fluid
(def)

plasma; the fluid portion of blood
intravascular fluid
(def)

atoms or group of atoms that carry a positive or negative charge; electrolytes
ions
(def)

fluid loss that is not perceptible to the individual
insensible fluid loss
(def)

fluid found outside the body cells
extracellular fluid
(def)

chemical substances that develop an electric charge and are able to conduct an electric current when placed in water; ions
electrolytes
(def)

the presence of excess interstitial fluid in the body
edema
(def)

the mixing of molecules or ions of two or more substances as a result of random motion
diffusion
(def)

movement of substances across cell membranes against the concentration gradient
active transport
(def)

substances dissolved in a liquid
solutes
(def)

the liquid in which a solute is dissolved
solvent
(def)

a membrane that prevents the passage of some substances but allow the passage of others based on differences in the size, charge, or lipid-solubility of the substance
semipermeable membrane
(def)

pressure exerted by the number of nondiffusible particles in a solution
osmotic pressure
(def)

the concentration of solutes in body fluids
osmolality
(def)

the pressure in a compartment that results in the movement of fluid and substances dissolved in fluid out of the compartment
filtration pressure
(def)

the pressure a liquid exerts on the sides of the container that holds it; also called filtration force
hydrostatic pressure
(def)

a pulling force exerted by colloids that help maintain the water content of blood
colloid osmotic pressure (also known as oncotic pressure)
(def)

a hormone that decreases the production of urine by increasing the reabsorption of water by renal tubules
antidiuretic hormone (ADH)
(def)

an abnormal reduction in blood volume
hypovolemia
(def)

insufficient fluid in the body
dehydration
(def)

passage of a solvent through a semipermeable membrane from an area of lesser solute concentration to one of greater solute concentration
osmosis
(def)

a neuron in the hypothalamus that is sensitive to the relative fluid/solute concentration in the blood plasma and that regulates the secretion of ADH
osmoreceptor
(def)

an excess of sodium in the blood plasma
hypernatremia
(def)

deficiency of sodium in the blood plasma
hyponatremia
(def)

the predominant intracellular cation; helps to regulate neuromuscular excitability and muscle contraction
potassium
(def)

a mineralocorticoid steroid hormone produced by the adrenal cortex with action in the renal tubule to retain sodium, conserve water by reabsorption, and increase urinary excretion of potassium
aldosterone
(def)

a renal proteolytic enzyme, produced by and stored in the juxtaglomerular apparatus; affects the blood pressure by catalyzing the change of angiotensinogen to angiotension I, which is then converted to angiotensin II
renin
(def)

a polypeptide in the blood that causes vasoconstriction, increased BP, and the release of aldosterone from the adrenal cortex
angiotensin
Approximately what % of the average healthy adult's weight is water?
60%
Water is vital to health and normal cellular function, serving as what 7 things?
- a medium for metabolic reactions within cells
- a transporter for nutrients, waste products, and other substances
- a lubricant
- an insulator and shock absorber
- one means of regulating and maintaining body temperature
- a medium for food digestion
- maintains blood volume
Infants have the highest proportion of water, accounting for ___-___% of their body weight.
70-80%
Which type of tissue, muscle or fat, requires more water?
muscle
The body's fluid is divided into what two major compartments?
- intracellular fluid
- extracellular fluid
Intracellular fluid constitutes what % of total body fluid in an adult?
40%

(lecture says 40%, book says 2/3rds)
Extracellular fluid accounts for what % of total body fluid in adults?
20%

(lecture says 20%, book says 1/3rd)
Extracellular fluid is subdivided into what 2 major compartments?
- intravascular fluid (plasma)
- interstitial fluid
Intravascular fluid (plasma) accounts for what percentage of ECF?
25%
Interstitial fluid accounts for what percentage of ECF?
75%
(def)

fluids found in other parts of the body that don't have significant gains or losses
transcellular fluids
What are examples of transcellular fluids? (6)
- cerbrospinal fluid
- pericardial fluid
- pancreatic fluid
- pleural fluid
- intraocular fluid
- synovial fluids
What is "third spacing"?
phenomenon of the trapping of fluid in the interstitial spaces; can be caused by trauma to the capillary membrane, protein imbalance, etc.
What is the "fourth compartment" phenomenon?
fluid where it isn't supposed to be, i.e. an abscess or boil
How are electrolytes measured?
in milliequivalents per liter of water (mEq/L)
What is the major electrolyte outside of the cell?
Sodium (Na+)
What is the major electrolyte inside of the cell?
Potassium (K+)
(def)

a positively charged ion
cation
(def)

a negatively charged ion
anion
What are the principle electrolytes found in extracellular fluid? (3)
- sodium
- chloride
- bicarbonate
Which compartment of ECF is considered protein-rich? What is the most abundant protein found in this compartment?
- Plasma, contains large amounts of albumin
What are the primary electrolytes found in intercellular fluid? (4)
- potassium
- magnesium
- phosphate
- sulfate
Each fluid compartment in the body is separated by what?
a selectively permeable membrane
(def)

movement of molecules/solutes in a solvent moving freely in all directions from an area of high concentration to an area of lower concentration until there is an equal concentration of solutes
diffusion
(def)

movement of solutes from an area of lower concentration to an area of higher concentration; require ATP
active transport
(def)

passive movement of fluid across a membrane from a less concentrated solution to a more concentrated solution
osmosis
When does osmotic pressure develop?
when two solutions of different concentrations are separated by a semipermeable membrane
The osmotic pressure of a solution is called its ________.
osmolality
What is the solvent in the body? What are the solutes?
- water is the solvent
- electrolytes, oxygen, carbon dioxide, glucose, urea, amino acids, and proteins are the solutes
(def)

the total number of dissolved particles per liter of solvent
osmolality
How is osmolality measured/reported?
in osmols or milliosmols per kg (mOsm/kg)
The term _________ may be used to refer to the osmolality of a solution.
tonicity
Solutions given in a clinical setting are defined/termed in what 3 categories?
1. isotonic solution
2. hypertonic solution
3. hypotonic solution
(def)

solution that has the same osmolality as body fluids
isotonic solution
(def)

solution that has a higher osmolality than body fluids
hypertonic solution
(def)

solution that has a lower osmolality than body fluids
hypotonic solution
Isotonic, Hypertonic, or Hypotonic solution?:

Normal Saline, 0.9%
Isotonic
Isotonic, Hypertonic, or Hypotonic solution?:

3% sodium chloride
Hypertonic
Isotonic, Hypertonic, or Hypotonic solution?:

one-half normal saline, 0.45% sodium chloride
Hypotonic
Isotonic, Hypertonic, or Hypotonic solution?:

D5W (Dextrose 5%)
Hypotonic

(Reasoning: Osmolarity of D5W is 252 mOsm/L. The fluid is isotonic when in the container. After administration, the dextrose is quickly metabolized in the body, leaving only water - a hypotonic fluid.)
Isotonic, Hypertonic, or Hypotonic solution?:

Lactated ringer's (LR)
Isotonic
(def)

the osmotic pressure in the blood vessels exerted by colloids (plasma proteins) which holds fluid in the intravascular space
Colloid Osmotic Pressure (Oncotic Pressure)
(def)

a process whereby fluid and solutes move together across a membrane from one compartment to another
filtration
(def)

the pressure in a compartment that results in the movement of fluid and substances dissolved in that fluid out of that compartment
filtration pressure
The ________ pressure of blood is the force exerted by blood against the vascular walls.
hydrostatic pressure
If the hydrostatic pressure of blood is higher than that of the surrounding tissue, why does blood not seep out of the vessels?
because the colloid osmotic/oncotic pressure opposes the hydrostatic pressure and keeps the blood within the vascular compartment
What body system assists with the return of excess fluid back into circulation?
Lymphatic system
How does active transport differ from osmosis and diffusion?
substances are moving to an area of higher concentration AND metabolic energy is expended
Active transport is particularly important in maintaining the differences of what 2 electrolytes?
sodium and potassium
To maintain homeostasis, the body obtains water from what 3 sources?
1. ingested liquids
2. water in food
3. water from metabolic oxygenation
What are 4 sources of water loss in the body?
1. urine
2. intestinal tract
3. lungs
4. skin
What is the primary regulator of fluid intake?
the thirst mechanism
Where is the thirst center located?
in the hypothalamus of the brain
What are 3 examples of stimuli that may trigger the thirst center?
1. increased osmotic pressure
2. low vascular volume
3. the presence of angiotensin (hormone released in response to decreased blood flow to the kidneys)
What is the major avenue of fluid loss in the body?
urine
(def)

fluid loss that occurs through the skin and lungs; usually not noticeable and cannot be measured
insensible loss
What is the primary regulator of body fluids and electrolyte balance?
kidneys
Approximately how many liters of blood is filtered through the kidneys per day? Of this, what amount is excreted?
180 L filtered per day, only 1.5 L of urine is excreted
What hormone regulates water excretion from the kidneys?
ADH (Antidiuretic horomone)
Where is ADH synthesized?
the hypothalamus
What part of the kidney does ADH work on?
the collecting ducts of the nephrons
What is produced when serum osmolarity rises? What action does this have on the body?
- ADH is produced, which causes the collecting ducts of the kidneys to become more permeable to water. This action allows more water to be reabsorbed in the blood.
What happens to ADH when serum osmolarity decreases? What action does this have on the body?
ADH is suppressed, causing the collecting ducts to become less permeable to water, which increases urine output.
In addition to serum osmolality, what are other factors that affect the production and release of ADH?
- blood volume
- temperature
- pain
- stress
- drugs (opiates, barbituates, nicotine)
The receptors located in the juxtaglomerular cells of the kidney nephrons are responsible for activating what system?
the renin-angiotensin-aldosterone system
The activation of the renin-angiotensin-aldosterone system is a response to what?
decreased blood flow/pressure to the kidneys
In the renin-angiotensin-aldosterone system, decreased blood flow to the kidney prompts the kidney to release what?
renin
What does renin do?
prompts the conversion of angiotensinogen to angiotensin I
What converts angiotensin I to angiotensin II?
angiotensin-converting enzyme
What does angiotensin II do?
acts directly on nephrons to promote sodium and water retention AND stimulates the release of aldosterone from the adrenal cortex
What does aldosterone do?
promotes sodium retention in the distal nephron
What is the net effect of the renin-angiotensin-aldosterone system?
restoration of blood volume, thus an increase in blood pressure
(def)

the loss of both water and electrolytes from the ECF in similar proportions, thus the decreased volume of fluid remains isotonic
hypovolemia
(def)

a water loss greater than that of the solutes
hyperosmolar (aka dehydration)
Hypovolemia, of Isotonic loss, generally is a result of what? (3)
- loss of plasma or whole blood (burns, hemmorrhage)
- loss from the GI tract (diarrhea, vomiting, gastric suction, fistula drainage)
- fluid movement into body cavities (third space syndrome)
Hyperosmolarity, or dehydration, is generally a result of what? (3)
- decreased oral intake of fluids (anorexia, nausea, inability to gain access to fluids, inability to swallow)
- loss of water (excessive sweating, fever, diarrhea, polyuria r/t diuretics, diabetes)
- increased solute intake (salt, sugar, protein), the administration of hypertonic fluids, concentrated tube feedings
Marked dehydration is identified as a loss of ___-___% of body weight.
5-8%
Severe dehydration is identified as a loss of > ___% of body weight.
> 8%
Marked or Severe dehydration?:

Weakness, drowsiness, and lightheadedness
marked
Marked or Severe dehydration?:

abnormal thirst
marked
Marked or Severe dehydration?:

weight loss of 3-5 liters
marked
Marked or Severe dehydration?:

dry mucous membranes
marked
Marked or Severe dehydration?:

sluggish skin turgor, dry skin, dry tongue, dry lips
marked
Marked or Severe dehydration?:

low-grade temperature
marked
Marked or Severe dehydration?:

weak, rapid pulse
marked
Marked or Severe dehydration?:

tachypnea
marked
Marked or Severe dehydration?:

orthostatic hypotension
marked
Marked or Severe dehydration?:

slow filling of hand veins
marked
Marked or Severe dehydration?:

sunken, soft eyeballs
marked
Marked or Severe dehydration?:

fluid intake < output
marked
Marked or Severe dehydration?:

decreased urine output
marked
Marked or Severe dehydration?:

weight loss of 5-10 liters
severe
Marked or Severe dehydration?:

skin flushed
severe
Marked or Severe dehydration?:

narrowing pulse pressure
severe
Marked or Severe dehydration?:

decreased systolic BP
severe
Marked or Severe dehydration?:

electrolyte disturbances
severe
Marked or Severe dehydration?:

behavioral changes, like restlessness, irritability, disorientation
severe
Marked or Severe dehydration?:

seizures
severe
Marked or Severe dehydration?:

coma
severe
What type of diagnostic test findings would you expect to see in a person experiencing dehydration?
- increased serum sodium
- increased serum osmolality
- increased Hgb and Hct
- increased BUN
- increased urine specific gravity
What type of nursing interventions would you implement for a patient experiencing dehydration? (8)
- monitor vital signs
- accurate I & O
- force fluids
- daily weights
- skin and mouth care
- provide a safe environment
- monitor diagnostic tests
- document client care
(def)

extracellular fluid volume excess; increased body fluid volume in the interstitial or intravascular space
hypervolemia
(def)

gaining of solutes and water in equal proportion
isotonic excess
What are 2 causes of isotonic excess in the intravascular space?
- excessive fluid and sodium (such as rapid administration of isotonic saline, blood or plasma infusions) (excessive dietary salt intake) (steroid usage)
- decreased function of homeostatic mechanisms (CHF, renal failure, cirrhosis of the liver)
What are 4 causes of isotonic excess in the interstitial space (edema)?
- rise in blood hydrostatic pressure (CHF, interference with venous return)
- damage to capillary walls (tissue injury, allergic reactions, burns)
- decrease in colloid osmotic pressure and plasma proteins (malnutrition, chronic diarrhea, cirrhosis of liver, burns, loss of protein via kidneys)
- obstruction in lymphatic drainage (cancer of lymph system, removal of lymph nodes)
What type of assessment findings would you expect to see in a person experiencing isotonic fluid excess? (11)
- acute weight gain
- distended neck and hand veins
- rapid vital signs
- bounding pulse
- increased blood pressure
- tachypnea
- dyspnea
- constant irritated cough
- periorbital edema
- shiny, taut skin
- pale, cool, moist mucous membranes
(def)

edema that leaves an indention when pressed
pitting edema
(def)

edema associated with gravity
dependent
(def)

non-dependent edema unresponsive to treatment
refractory edema
(def)

severe generalized edema
anasarca
(def)

accumulation of fluid in the peritoneal cavity
ascites
(def)

collection of fluid in the pleural cavity
hydrothorax
(def)

edema where the skin swells so much that fluid cannot be displaced
Brawny edema
What type of diagnostic test results might you see in a person experiencing edema?
- decreased HgB and Hct
- serum albumin < 3.5
- serum sodium WNL
What type of nursing interventions would you implement for a person experiencing extracellular fluid volume excess, or hypervolemia?
- monitor vital signs
- accurate I & O
- daily weight
- restrict fluids
- diuretic therapy
- assess degree of edema
- skin and mouth care
- monitor client's mobility
- low sodium diet
- careful monitoring of IV fluids
- document client care
(def)

increased body fluid volume in relation to sodium
intracellular fluid volume excess, also called overhydration or hypoosmolar imbalance
What are 4 causes of overhydration?
1. administration of D5W
2. overproduction of ADH
3. compulsive polydypsia
4. kidney dysfunction
What are 3 early signs of overhydration (intracellular fluid volume excess)?
- nausea/vomiting
- excessive perspiration
- acute weight gain
What are 3 changes you will see in a person as overhydration progresses?
1. personality changes (apprehension, confusion, irritability)
2. weight gain
3. muscle cramps
What are 3 late signs of overhydration?
1. increased BP
2. bradycardia
3. increased respirations
What type of diagnostic test findings would you see in a person experiencing overhydration?
- serum sodium <125 mEq/L
- serum osmolarity <280 mOsm/kg
What type of nursing interventions would you implement for a person experiencing overhydration? (10)
- monitor vital signs
- accurate I & O
- monitor neurological status
- restrict fluid intake
- osmotic diuretics
- daily weight
- careful monitoring of IV fluids
- monitor diagnostic tests
- provide safe environment
- document client care
Dehydration or Overhydration?:

Low BP
Dehydration
Dehydration or Overhydration?:

High BP
Overhydration
Dehydration or Overhydration?:

Weak Pulse
Dehydration
Dehydration or Overhydration?:

Bounding Pulse
Overhydration
Dehydration or Overhydration?:

Increased heart rate
Dehydration and Overhydration
Dehydration or Overhydration?:

Respiratory rate the same or increased
Both
Dehydration or Overhydration?:

Flat neck veins
dehydration
Dehydration or Overhydration?:

Distended neck veins
overhydration
Dehydration or Overhydration?:

Sunken, dry eyes
dehydration
Dehydration or Overhydration?:

Periorbital edema
overhydration
Dehydration or Overhydration?:

Dry, pale mucous membranes
dehydration
Dehydration or Overhydration?:

Moist mucous membranes
overhydration
Dehydration or Overhydration?:

dry skin
dehydration
Dehydration or Overhydration?:

shiny, taut skin
overhydration
Dehydration or Overhydration?:

increased skin temp; warm/hot
dehydration
Dehydration or Overhydration?:

cool skin
overhydration
Dehydration or Overhydration?:

sluggish, tented skin turgor
dehydration
Dehydration or Overhydration?:

supple skin turgor
overhydration
Dehydration or Overhydration?:

capillary refill > 3 seconds
dehydration
Dehydration or Overhydration?:

capillary refill <3 seconds
overhydration
Dehydration or Overhydration?:

muscle weakness, fatigue
dehydration and overhydration
Dehydration or Overhydration?:

muscle cramping
overhydration
Dehydration or Overhydration?:

drowsy, lightheaded, confused, restless, delirium, disorientation
dehydration
Dehydration or Overhydration?:

headaches, nausea, vomiting, irritability, confusion
overhydration
Dehydration or Overhydration?:

weight loss
dehydration
Dehydration or Overhydration?:

weight gain
overhydration
Dehydration or Overhydration?:

hyperosmolar urine
dehydration
Dehydration or Overhydration?:

hypoosmolar urine
overhydration
Dehydration or Overhydration?:

intake less than output
dehydration
Dehydration or Overhydration?:

intake greater than output
overhydration
Dehydration or Overhydration?:

sodium usually increased
dehydration
Dehydration or Overhydration?:

sodium WNL or slightly low
overhydration
Dehydration or Overhydration?:

serum osmolality increased
dehydration
Dehydration or Overhydration?:

serum osmolality decreased
overhydration
Dehydration or Overhydration?:

hemoglobin and hematocrit increased
dehydration
Dehydration or Overhydration?:

hemoglobin and hematocrit decreased
overhydration
Dehydration or Overhydration?:

bilateral breath sounds clear (unless secondary cause present)
dehydration
Dehydration or Overhydration?:

bilateral breath sounds clear or possibly adventitious
overhydration
Dehydration or Overhydration?:

serum albumin increased or the same
dehydration
Dehydration or Overhydration?:

serum albumin WNL or decreased
overhydration
Dehydration or Overhydration?:

BUN increased
dehydration
Dehydration or Overhydration?:

BUN stays the same
overhydration
Dehydration or Overhydration?:

urine specific gravity increased
dehydration
Dehydration or Overhydration?:

urine specific gravity WNL
overhydration
What type of diet would an overhydrated client likely be on?
low sodium
What type of medication is commonly prescribed to overhydrated clients?
diuretics (loop, osmotic)
Dehydration or Overhydration?:

Force fluids
dehydration
Dehydration or Overhydration?:

restrict fluids
overhydration