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77 Cards in this Set

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What are the types of extracellular fluid in the body?
intravascular fluid
interstitial fluid
Where is transcellular fluid?
around synovial joints

in gi tract

can make up about 1L of fluid
In elderly, why is there a decrease of water in their bodies?
b/c of decrease of muscle mass

increase of fat cells

decrease of thirst mechanism
Too little ECF (extra cellular fluid)
hypovolemia

**remember that ECF is intravascular and interstitial
Too little ICF
dehydration

(just too little ICF FLUID ONLY)
Too much ECF
hypervolemia
Too much ICF
overhydration (remember though this is JUST fluid, not electrolytes)
If you have an isotonic imbalance of fluids, what is out of balance?
both water and electrolytes in equal proportions

examples: FVD, FVE
If you have an osmolar fluid imbalance, what is out of wack?
only loss or excess of water

ex: dehydration, overhydration (water excess)
What are some other names for hypovolemia?
fluid volume deficit (FVD)

isotonic dehydration (remember isotonic is fluid imbalance in proportion with electrolytes
When someone is in shock, what type of fluid problem is it?
FVD
hypovolemia
Patient is losing this if they are hypovolemic.
water and electrolytes in equal amounts
With hypovolemia, which area is fluid initially lost from?
initially lost through intravascular compartment, then it draws from interstitial spaces to try to adapt, finally it starts to draw from the cell
What are the causes of hypovolemia?
gi losses (diarrhea, ng tubes, fistulas)

plasma or whole blood losses (burns or hemorrhage)

decreased oral intake (has to be serious amount)

use of diuretics

fever - diaphoresis

third spacing (body cavity, peritoneal cavity - ascites...body can't recapture it)
What are the manifestations of hypovolemia?
postural hypotension
tachycardia (weak, thready)
rapid wt loss
dry mm
thirst
poor skin turgor
oliguria
slow filling peripheral veins
lethargy
confusion
**neuro changes signal hypoxic
What are the labs that would signal hypovolemia?
increased urine specific gravity (above 1.030)

increased hematocrit
men: 40-54 women 36-46
(amount of space RBC take up in blood. If volume of blood was down, then the RBC would be taking up more space than the fluid)

increased BUN (over 25) b/c renal perfusion is not happening b/c there is not enough water to flow through kidneys)
What are tx for hypovolemia?
fluid replacement IV & ORAL

electrolyte replacement

treat underlying cause

safety (protect from injury secondary to orthostatic hypotension)
What is musculoskeletal problem with FVD?
fatigue
What are neurological problems with FVD?
sensory disturbances
anxiety
restlessness
diminished alertness cognition
coma
What is range for specific gravity of urine?
1.010-1.030
What is normal BUN?
5-25
What is normal creatine?
0.5-1.5
What is normal hematocrit for males and females?
males 40-54

females 36-46
What are the two two types of LOW fluids?
low ECF (hypovolemia) (FVD)

low ICF (dehydration)
What is the problem with dehydration?
low ICF. Water deficit.

Water loss without proportionate loss of electrolytes (particularly sodium)
Where did the water go with dehydration (low ICF)?
water drawn out of the cells and interstitial compartments and moves to the intravascular compartment
What does dehydration eventually cause?
impaired cellular function and circulatory collapse
Dehydration is what type of fluid imbalance?

isotonic or osmotic
osmotic. osmolar dehydration. No loss of electrolytes
What are some causes of dehydration?
diabetic ketoacidosis (sugar in blood draws water???)

decreased response for thirst

diabetes insipidus
(no ADH, so they pee)
What are the manifestations of dehydration?
dry mm
thirst
flushed, dry skin
increased body temperature
irritability
confusion
What are labs that can confirm dehydration?
serum sodium above 145

increased serum osmolality above 295
What is tx for dehydration?
fluid replacement

monitor/manage electrolytes
Why did you not monitor sodium levels with FVD (hypovolemia) but you did with dehydration?
because FVD is isotonic and fluid and electrolytes are lost in equal proportions, but with dehyration, only ICF is lost, so Na levels will rise.
What is the body temperature response to dehydration?
fever
Hypervolemia means what????
too much ECF
Hypervolemia is isotonic or osmotic?
isotonic. Excess water and sodium
What is the outcome of increased ECF?
increased blood volume

circulatory overload

hypervolemia
What are some causes of hypervolumia?
:CHF

:renal failures

:respiratory failure (pulmonary edema)

:cirrhosis of liver (hepatic system failure = retained fluids)

:excessive intake or admin of salty fluids (sodium chloride)

:increased aldosterone and steroid levels
What is dependent edema?

What is refractory edema?
dependent edema: fluid is going to go to gravity: bedrest = sacrum

refractory edema - edema that does not respond to tx
What are manifestations of FVE/hypervolemia?
rapid weight gain

edema

increased BP

rapid bounding pulse

full neck veins

respiratory signs (crackles, dyspnea, tachypnea, orthopnea)
What are labs that may signal FVE?
decreased hematocrit (b/c more fluid makes RBC take up less % of space)

decreased BUN, because lots of fluid is making fluid flow through kidneys and filter and filter and filter
What is tx for FVE/hypervolemia?
fluid restriction

sodium and saline restriction

diuretic therapy

monitor/manage electrolyte changes

safety (protect skin from injury)
What would the sodium restriction be for a patient with FVE?
PO 1000mg restriction a day
What are your safety focuses for these two situations?

FVE:

FVD:
FVE: focus on edematous skin b/c is prone to injury

FVD: focus on safety for falling from orthostatic hypotention
What is the other name for too much intracellular fluid?
hypotonic hydration

over hydration

water intoxication
What is significant to note about overhydration (too much ICF)?
it is a result or complication of another disorder, it does not happen on its own.
What actually increases with overhydration?
increase in ICF without increase in electrolytes
Overhydration (increased ICF) is isotonic or osmotic?
osmotic
What are labs that would signal overhydration (increased ICF)?
decreased serum sodium level below 135

serum osmolality below 280
What are the causes of overhydration?
polydipsia

excessive ADH secretion (SIADH syndrome) can be caused by head trauma, cancer and certain drugs

too rapid infusion of hypotonic IV solutions

excessive us of tap water for NG irrigation
What would you find upon physical examination of patient suffering from overhydration?
decreased LOC
(drowsy, lethargic, confusion, seizures)
convulsions
coma (death)

personality changes
n&V
What is managment of overhydration?
fluid restriction

monitor/manage electrolyte
Who is at risk for fluid problems?
anyone with:

1. inadequate oral intake
2. excessive fluid losses
3. stress
4. chronic illness (renal, heart, respiratory)
5. surgery patient
6. pregnancy
Anytime there is cell damage, there is __________ loss.
potassium
What is more of a risk for an infant?
FVD & dehydration b/c so much of their body is made of water. Greater fluid requirements, greater fluid losses, increased BMR and increased respiratory rate lead to increased insensible water loss. Fluid loss occurs very rapidly.
How much liquid does a toddler/preschooler require every day?
1000-1200ml
Around what % does the FVD or FVE become the category severe"?
around 10% for FVD 8% for FVE
What % of their weight is water?

infants
toddlers
children/adolescent

men
women
over 60
over 85
70-80 infants
60 toddler/preschooler
same as adult when they are 12

52 men
46 women (more adipose)
45 over 65
30-40 over 85
Nursing interventions for FVD and FVE
hydration

nutrition

client teaching
Most IV solutions are _________ which means having the.....
isotonic, which means having the same concentration of solutes (osmolarity) as blood plasma.
An isotonic solution does what to the body?
prevents sudden shifts of fluids and electrolytes in the body.
Hypertonic solutions have a....
greater concentration of solutes than plasma.
IV solutions that are called nutrient solutions contain what?
carbohydrate and water....carb for energy and calories
How many calories does 1 L of 5% dextrose provide?
170
Nutrient solutions can not maintain weight, normal growth or promote healing, but they do this....
prevent dehydration and ketosis
How do Ringer's solutions and LR solutions differn from normal saline?
NS has sodium chloride
R has sodium chloride K & Ca
LR has sodium Cl K Ca & Lactate
What is lactate?
a salt of lactic acid that is metabolized by the liver to form bicarbonate HCO3
What is an example of an alkalizing solution?
LR, used to counteract metabolic acidosis
What is an example of an acidifying solution?
D5W, 0.45 sodium chloride (dextrose in half strength saline), 0.9% (normal saline)
List 3 isotonic IV solutions
normal saline (0.9%)

D5W

LR
List 3 hypotonic IV solutions

(water goes in cell)
0.25% saline

0.45% saline

2.5% dextrose
List 3 hypertonic IV solutions
d5 in 0.45 saline

D5NS (0.9%)

D5LR
Hypertonic IV solution will make water go where?
from cell into blood
What should you monitor for with hypertonic IV admin?
fluid volume excess, circulatory overload, these are volume expanders
Why would you not give hypertonic IV to dehydrated person?
b/c already dehydrated so you would be pulling even more water out of the cell
What does a hypotonic IV solution do to a patient?
pushes water into the cell from the blood, contraindicated in patient with Intracranial pressure b/c of shift of fluid into the brain cells, contraindicated in patient with third spacing b/c will exaggerate it
What does an isotonic solution do the body?
expands the intravascular compartment, so monitor for fluid overload