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199 Cards in this Set
- Front
- Back
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(def)
fluid found within the body cells |
intracellular fluid
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(def)
fluid that surrounds the cells |
interstitial fluid
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(def)
plasma; the fluid portion of blood |
intravascular fluid
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(def)
atoms or group of atoms that carry a positive or negative charge; electrolytes |
ions
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(def)
fluid loss that is not perceptible to the individual |
insensible fluid loss
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(def)
fluid found outside the body cells |
extracellular fluid
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(def)
chemical substances that develop an electric charge and are able to conduct an electric current when placed in water; ions |
electrolytes
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(def)
the presence of excess interstitial fluid in the body |
edema
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(def)
the mixing of molecules or ions of two or more substances as a result of random motion |
diffusion
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(def)
movement of substances across cell membranes against the concentration gradient |
active transport
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(def)
substances dissolved in a liquid |
solutes
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(def)
the liquid in which a solute is dissolved |
solvent
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(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
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(def)
pressure exerted by the number of nondiffusible particles in a solution |
osmotic pressure
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(def)
the concentration of solutes in body fluids |
osmolality
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(def)
the pressure in a compartment that results in the movement of fluid and substances dissolved in fluid out of the compartment |
filtration pressure
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(def)
the pressure a liquid exerts on the sides of the container that holds it; also called filtration force |
hydrostatic pressure
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(def)
a pulling force exerted by colloids that help maintain the water content of blood |
colloid osmotic pressure (also known as oncotic pressure)
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(def)
a hormone that decreases the production of urine by increasing the reabsorption of water by renal tubules |
antidiuretic hormone (ADH)
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(def)
an abnormal reduction in blood volume |
hypovolemia
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(def)
insufficient fluid in the body |
dehydration
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(def)
passage of a solvent through a semipermeable membrane from an area of lesser solute concentration to one of greater solute concentration |
osmosis
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(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
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(def)
an excess of sodium in the blood plasma |
hypernatremia
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(def)
deficiency of sodium in the blood plasma |
hyponatremia
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(def)
the predominant intracellular cation; helps to regulate neuromuscular excitability and muscle contraction |
potassium
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(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
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(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
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(def)
a polypeptide in the blood that causes vasoconstriction, increased BP, and the release of aldosterone from the adrenal cortex |
angiotensin
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Approximately what % of the average healthy adult's weight is water?
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60%
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Water is vital to health and normal cellular function, serving as what 7 things?
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- 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 |
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Infants have the highest proportion of water, accounting for ___-___% of their body weight.
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70-80%
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Which type of tissue, muscle or fat, requires more water?
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muscle
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The body's fluid is divided into what two major compartments?
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- intracellular fluid
- extracellular fluid |
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Intracellular fluid constitutes what % of total body fluid in an adult?
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40%
(lecture says 40%, book says 2/3rds) |
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Extracellular fluid accounts for what % of total body fluid in adults?
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20%
(lecture says 20%, book says 1/3rd) |
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Extracellular fluid is subdivided into what 2 major compartments?
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- intravascular fluid (plasma)
- interstitial fluid |
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Intravascular fluid (plasma) accounts for what percentage of ECF?
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25%
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Interstitial fluid accounts for what percentage of ECF?
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75%
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(def)
fluids found in other parts of the body that don't have significant gains or losses |
transcellular fluids
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What are examples of transcellular fluids? (6)
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- cerbrospinal fluid
- pericardial fluid - pancreatic fluid - pleural fluid - intraocular fluid - synovial fluids |
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What is "third spacing"?
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phenomenon of the trapping of fluid in the interstitial spaces; can be caused by trauma to the capillary membrane, protein imbalance, etc.
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What is the "fourth compartment" phenomenon?
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fluid where it isn't supposed to be, i.e. an abscess or boil
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How are electrolytes measured?
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in milliequivalents per liter of water (mEq/L)
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What is the major electrolyte outside of the cell?
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Sodium (Na+)
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What is the major electrolyte inside of the cell?
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Potassium (K+)
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(def)
a positively charged ion |
cation
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(def)
a negatively charged ion |
anion
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What are the principle electrolytes found in extracellular fluid? (3)
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- sodium
- chloride - bicarbonate |
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Which compartment of ECF is considered protein-rich? What is the most abundant protein found in this compartment?
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- Plasma, contains large amounts of albumin
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What are the primary electrolytes found in intercellular fluid? (4)
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- potassium
- magnesium - phosphate - sulfate |
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Each fluid compartment in the body is separated by what?
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a selectively permeable membrane
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(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
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(def)
movement of solutes from an area of lower concentration to an area of higher concentration; require ATP |
active transport
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(def)
passive movement of fluid across a membrane from a less concentrated solution to a more concentrated solution |
osmosis
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When does osmotic pressure develop?
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when two solutions of different concentrations are separated by a semipermeable membrane
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The osmotic pressure of a solution is called its ________.
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osmolality
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What is the solvent in the body? What are the solutes?
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- water is the solvent
- electrolytes, oxygen, carbon dioxide, glucose, urea, amino acids, and proteins are the solutes |
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(def)
the total number of dissolved particles per liter of solvent |
osmolality
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How is osmolality measured/reported?
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in osmols or milliosmols per kg (mOsm/kg)
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The term _________ may be used to refer to the osmolality of a solution.
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tonicity
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Solutions given in a clinical setting are defined/termed in what 3 categories?
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1. isotonic solution
2. hypertonic solution 3. hypotonic solution |
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(def)
solution that has the same osmolality as body fluids |
isotonic solution
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(def)
solution that has a higher osmolality than body fluids |
hypertonic solution
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(def)
solution that has a lower osmolality than body fluids |
hypotonic solution
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Isotonic, Hypertonic, or Hypotonic solution?:
Normal Saline, 0.9% |
Isotonic
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Isotonic, Hypertonic, or Hypotonic solution?:
3% sodium chloride |
Hypertonic
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Isotonic, Hypertonic, or Hypotonic solution?:
one-half normal saline, 0.45% sodium chloride |
Hypotonic
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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.) |
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Isotonic, Hypertonic, or Hypotonic solution?:
Lactated ringer's (LR) |
Isotonic
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(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)
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(def)
a process whereby fluid and solutes move together across a membrane from one compartment to another |
filtration
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(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
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The ________ pressure of blood is the force exerted by blood against the vascular walls.
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hydrostatic pressure
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If the hydrostatic pressure of blood is higher than that of the surrounding tissue, why does blood not seep out of the vessels?
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because the colloid osmotic/oncotic pressure opposes the hydrostatic pressure and keeps the blood within the vascular compartment
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What body system assists with the return of excess fluid back into circulation?
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Lymphatic system
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How does active transport differ from osmosis and diffusion?
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substances are moving to an area of higher concentration AND metabolic energy is expended
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Active transport is particularly important in maintaining the differences of what 2 electrolytes?
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sodium and potassium
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To maintain homeostasis, the body obtains water from what 3 sources?
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1. ingested liquids
2. water in food 3. water from metabolic oxygenation |
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What are 4 sources of water loss in the body?
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1. urine
2. intestinal tract 3. lungs 4. skin |
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What is the primary regulator of fluid intake?
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the thirst mechanism
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Where is the thirst center located?
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in the hypothalamus of the brain
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What are 3 examples of stimuli that may trigger the thirst center?
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1. increased osmotic pressure
2. low vascular volume 3. the presence of angiotensin (hormone released in response to decreased blood flow to the kidneys) |
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What is the major avenue of fluid loss in the body?
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urine
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(def)
fluid loss that occurs through the skin and lungs; usually not noticeable and cannot be measured |
insensible loss
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What is the primary regulator of body fluids and electrolyte balance?
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kidneys
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Approximately how many liters of blood is filtered through the kidneys per day? Of this, what amount is excreted?
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180 L filtered per day, only 1.5 L of urine is excreted
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What hormone regulates water excretion from the kidneys?
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ADH (Antidiuretic horomone)
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Where is ADH synthesized?
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the hypothalamus
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What part of the kidney does ADH work on?
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the collecting ducts of the nephrons
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What is produced when serum osmolarity rises? What action does this have on the body?
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- 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.
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What happens to ADH when serum osmolarity decreases? What action does this have on the body?
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ADH is suppressed, causing the collecting ducts to become less permeable to water, which increases urine output.
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In addition to serum osmolality, what are other factors that affect the production and release of ADH?
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- blood volume
- temperature - pain - stress - drugs (opiates, barbituates, nicotine) |
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The receptors located in the juxtaglomerular cells of the kidney nephrons are responsible for activating what system?
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the renin-angiotensin-aldosterone system
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The activation of the renin-angiotensin-aldosterone system is a response to what?
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decreased blood flow/pressure to the kidneys
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In the renin-angiotensin-aldosterone system, decreased blood flow to the kidney prompts the kidney to release what?
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renin
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What does renin do?
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prompts the conversion of angiotensinogen to angiotensin I
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What converts angiotensin I to angiotensin II?
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angiotensin-converting enzyme
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What does angiotensin II do?
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acts directly on nephrons to promote sodium and water retention AND stimulates the release of aldosterone from the adrenal cortex
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What does aldosterone do?
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promotes sodium retention in the distal nephron
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What is the net effect of the renin-angiotensin-aldosterone system?
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restoration of blood volume, thus an increase in blood pressure
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(def)
the loss of both water and electrolytes from the ECF in similar proportions, thus the decreased volume of fluid remains isotonic |
hypovolemia
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(def)
a water loss greater than that of the solutes |
hyperosmolar (aka dehydration)
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Hypovolemia, of Isotonic loss, generally is a result of what? (3)
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- 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) |
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Hyperosmolarity, or dehydration, is generally a result of what? (3)
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- 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 |
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Marked dehydration is identified as a loss of ___-___% of body weight.
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5-8%
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Severe dehydration is identified as a loss of > ___% of body weight.
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> 8%
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Marked or Severe dehydration?:
Weakness, drowsiness, and lightheadedness |
marked
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Marked or Severe dehydration?:
abnormal thirst |
marked
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Marked or Severe dehydration?:
weight loss of 3-5 liters |
marked
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Marked or Severe dehydration?:
dry mucous membranes |
marked
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Marked or Severe dehydration?:
sluggish skin turgor, dry skin, dry tongue, dry lips |
marked
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Marked or Severe dehydration?:
low-grade temperature |
marked
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Marked or Severe dehydration?:
weak, rapid pulse |
marked
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Marked or Severe dehydration?:
tachypnea |
marked
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Marked or Severe dehydration?:
orthostatic hypotension |
marked
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Marked or Severe dehydration?:
slow filling of hand veins |
marked
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Marked or Severe dehydration?:
sunken, soft eyeballs |
marked
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Marked or Severe dehydration?:
fluid intake < output |
marked
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Marked or Severe dehydration?:
decreased urine output |
marked
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Marked or Severe dehydration?:
weight loss of 5-10 liters |
severe
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Marked or Severe dehydration?:
skin flushed |
severe
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Marked or Severe dehydration?:
narrowing pulse pressure |
severe
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Marked or Severe dehydration?:
decreased systolic BP |
severe
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Marked or Severe dehydration?:
electrolyte disturbances |
severe
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Marked or Severe dehydration?:
behavioral changes, like restlessness, irritability, disorientation |
severe
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Marked or Severe dehydration?:
seizures |
severe
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Marked or Severe dehydration?:
coma |
severe
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What type of diagnostic test findings would you expect to see in a person experiencing dehydration?
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- increased serum sodium
- increased serum osmolality - increased Hgb and Hct - increased BUN - increased urine specific gravity |
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What type of nursing interventions would you implement for a patient experiencing dehydration? (8)
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- monitor vital signs
- accurate I & O - force fluids - daily weights - skin and mouth care - provide a safe environment - monitor diagnostic tests - document client care |
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(def)
extracellular fluid volume excess; increased body fluid volume in the interstitial or intravascular space |
hypervolemia
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(def)
gaining of solutes and water in equal proportion |
isotonic excess
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What are 2 causes of isotonic excess in the intravascular space?
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- 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) |
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What are 4 causes of isotonic excess in the interstitial space (edema)?
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- 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) |
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What type of assessment findings would you expect to see in a person experiencing isotonic fluid excess? (11)
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- 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 |
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(def)
edema that leaves an indention when pressed |
pitting edema
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(def)
edema associated with gravity |
dependent
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(def)
non-dependent edema unresponsive to treatment |
refractory edema
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(def)
severe generalized edema |
anasarca
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(def)
accumulation of fluid in the peritoneal cavity |
ascites
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(def)
collection of fluid in the pleural cavity |
hydrothorax
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(def)
edema where the skin swells so much that fluid cannot be displaced |
Brawny edema
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What type of diagnostic test results might you see in a person experiencing edema?
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- decreased HgB and Hct
- serum albumin < 3.5 - serum sodium WNL |
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What type of nursing interventions would you implement for a person experiencing extracellular fluid volume excess, or hypervolemia?
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- 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 |
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(def)
increased body fluid volume in relation to sodium |
intracellular fluid volume excess, also called overhydration or hypoosmolar imbalance
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What are 4 causes of overhydration?
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1. administration of D5W
2. overproduction of ADH 3. compulsive polydypsia 4. kidney dysfunction |
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What are 3 early signs of overhydration (intracellular fluid volume excess)?
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- nausea/vomiting
- excessive perspiration - acute weight gain |
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What are 3 changes you will see in a person as overhydration progresses?
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1. personality changes (apprehension, confusion, irritability)
2. weight gain 3. muscle cramps |
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What are 3 late signs of overhydration?
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1. increased BP
2. bradycardia 3. increased respirations |
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What type of diagnostic test findings would you see in a person experiencing overhydration?
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- serum sodium <125 mEq/L
- serum osmolarity <280 mOsm/kg |
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What type of nursing interventions would you implement for a person experiencing overhydration? (10)
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- 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 |
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Dehydration or Overhydration?:
Low BP |
Dehydration
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Dehydration or Overhydration?:
High BP |
Overhydration
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Dehydration or Overhydration?:
Weak Pulse |
Dehydration
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Dehydration or Overhydration?:
Bounding Pulse |
Overhydration
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Dehydration or Overhydration?:
Increased heart rate |
Dehydration and Overhydration
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Dehydration or Overhydration?:
Respiratory rate the same or increased |
Both
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Dehydration or Overhydration?:
Flat neck veins |
dehydration
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Dehydration or Overhydration?:
Distended neck veins |
overhydration
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Dehydration or Overhydration?:
Sunken, dry eyes |
dehydration
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Dehydration or Overhydration?:
Periorbital edema |
overhydration
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Dehydration or Overhydration?:
Dry, pale mucous membranes |
dehydration
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Dehydration or Overhydration?:
Moist mucous membranes |
overhydration
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Dehydration or Overhydration?:
dry skin |
dehydration
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Dehydration or Overhydration?:
shiny, taut skin |
overhydration
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Dehydration or Overhydration?:
increased skin temp; warm/hot |
dehydration
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Dehydration or Overhydration?:
cool skin |
overhydration
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Dehydration or Overhydration?:
sluggish, tented skin turgor |
dehydration
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Dehydration or Overhydration?:
supple skin turgor |
overhydration
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Dehydration or Overhydration?:
capillary refill > 3 seconds |
dehydration
|
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Dehydration or Overhydration?:
capillary refill <3 seconds |
overhydration
|
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Dehydration or Overhydration?:
muscle weakness, fatigue |
dehydration and overhydration
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Dehydration or Overhydration?:
muscle cramping |
overhydration
|
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Dehydration or Overhydration?:
drowsy, lightheaded, confused, restless, delirium, disorientation |
dehydration
|
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Dehydration or Overhydration?:
headaches, nausea, vomiting, irritability, confusion |
overhydration
|
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Dehydration or Overhydration?:
weight loss |
dehydration
|
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Dehydration or Overhydration?:
weight gain |
overhydration
|
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Dehydration or Overhydration?:
hyperosmolar urine |
dehydration
|
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Dehydration or Overhydration?:
hypoosmolar urine |
overhydration
|
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Dehydration or Overhydration?:
intake less than output |
dehydration
|
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Dehydration or Overhydration?:
intake greater than output |
overhydration
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Dehydration or Overhydration?:
sodium usually increased |
dehydration
|
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Dehydration or Overhydration?:
sodium WNL or slightly low |
overhydration
|
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Dehydration or Overhydration?:
serum osmolality increased |
dehydration
|
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Dehydration or Overhydration?:
serum osmolality decreased |
overhydration
|
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Dehydration or Overhydration?:
hemoglobin and hematocrit increased |
dehydration
|
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Dehydration or Overhydration?:
hemoglobin and hematocrit decreased |
overhydration
|
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Dehydration or Overhydration?:
bilateral breath sounds clear (unless secondary cause present) |
dehydration
|
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Dehydration or Overhydration?:
bilateral breath sounds clear or possibly adventitious |
overhydration
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Dehydration or Overhydration?:
serum albumin increased or the same |
dehydration
|
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Dehydration or Overhydration?:
serum albumin WNL or decreased |
overhydration
|
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Dehydration or Overhydration?:
BUN increased |
dehydration
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Dehydration or Overhydration?:
BUN stays the same |
overhydration
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Dehydration or Overhydration?:
urine specific gravity increased |
dehydration
|
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Dehydration or Overhydration?:
urine specific gravity WNL |
overhydration
|
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What type of diet would an overhydrated client likely be on?
|
low sodium
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What type of medication is commonly prescribed to overhydrated clients?
|
diuretics (loop, osmotic)
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Dehydration or Overhydration?:
Force fluids |
dehydration
|
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Dehydration or Overhydration?:
restrict fluids |
overhydration
|
