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77 Cards in this Set
- Front
- Back
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What are the types of extracellular fluid in the body?
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intravascular fluid
interstitial fluid |
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Where is transcellular fluid?
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around synovial joints
in gi tract can make up about 1L of fluid |
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In elderly, why is there a decrease of water in their bodies?
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b/c of decrease of muscle mass
increase of fat cells decrease of thirst mechanism |
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Too little ECF (extra cellular fluid)
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hypovolemia
**remember that ECF is intravascular and interstitial |
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Too little ICF
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dehydration
(just too little ICF FLUID ONLY) |
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Too much ECF
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hypervolemia
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Too much ICF
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overhydration (remember though this is JUST fluid, not electrolytes)
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If you have an isotonic imbalance of fluids, what is out of balance?
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both water and electrolytes in equal proportions
examples: FVD, FVE |
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If you have an osmolar fluid imbalance, what is out of wack?
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only loss or excess of water
ex: dehydration, overhydration (water excess) |
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What are some other names for hypovolemia?
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fluid volume deficit (FVD)
isotonic dehydration (remember isotonic is fluid imbalance in proportion with electrolytes |
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When someone is in shock, what type of fluid problem is it?
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FVD
hypovolemia |
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Patient is losing this if they are hypovolemic.
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water and electrolytes in equal amounts
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With hypovolemia, which area is fluid initially lost from?
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initially lost through intravascular compartment, then it draws from interstitial spaces to try to adapt, finally it starts to draw from the cell
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What are the causes of hypovolemia?
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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) |
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What are the manifestations of hypovolemia?
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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 |
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What are the labs that would signal hypovolemia?
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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) |
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What are tx for hypovolemia?
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fluid replacement IV & ORAL
electrolyte replacement treat underlying cause safety (protect from injury secondary to orthostatic hypotension) |
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What is musculoskeletal problem with FVD?
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fatigue
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What are neurological problems with FVD?
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sensory disturbances
anxiety restlessness diminished alertness cognition coma |
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What is range for specific gravity of urine?
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1.010-1.030
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What is normal BUN?
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5-25
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What is normal creatine?
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0.5-1.5
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What is normal hematocrit for males and females?
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males 40-54
females 36-46 |
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What are the two two types of LOW fluids?
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low ECF (hypovolemia) (FVD)
low ICF (dehydration) |
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What is the problem with dehydration?
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low ICF. Water deficit.
Water loss without proportionate loss of electrolytes (particularly sodium) |
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Where did the water go with dehydration (low ICF)?
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water drawn out of the cells and interstitial compartments and moves to the intravascular compartment
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What does dehydration eventually cause?
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impaired cellular function and circulatory collapse
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Dehydration is what type of fluid imbalance?
isotonic or osmotic |
osmotic. osmolar dehydration. No loss of electrolytes
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What are some causes of dehydration?
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diabetic ketoacidosis (sugar in blood draws water???)
decreased response for thirst diabetes insipidus (no ADH, so they pee) |
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What are the manifestations of dehydration?
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dry mm
thirst flushed, dry skin increased body temperature irritability confusion |
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What are labs that can confirm dehydration?
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serum sodium above 145
increased serum osmolality above 295 |
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What is tx for dehydration?
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fluid replacement
monitor/manage electrolytes |
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Why did you not monitor sodium levels with FVD (hypovolemia) but you did with dehydration?
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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.
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What is the body temperature response to dehydration?
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fever
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Hypervolemia means what????
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too much ECF
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Hypervolemia is isotonic or osmotic?
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isotonic. Excess water and sodium
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What is the outcome of increased ECF?
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increased blood volume
circulatory overload hypervolemia |
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What are some causes of hypervolumia?
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: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 |
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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 |
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What are manifestations of FVE/hypervolemia?
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rapid weight gain
edema increased BP rapid bounding pulse full neck veins respiratory signs (crackles, dyspnea, tachypnea, orthopnea) |
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What are labs that may signal FVE?
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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 |
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What is tx for FVE/hypervolemia?
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fluid restriction
sodium and saline restriction diuretic therapy monitor/manage electrolyte changes safety (protect skin from injury) |
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What would the sodium restriction be for a patient with FVE?
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PO 1000mg restriction a day
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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 |
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What is the other name for too much intracellular fluid?
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hypotonic hydration
over hydration water intoxication |
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What is significant to note about overhydration (too much ICF)?
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it is a result or complication of another disorder, it does not happen on its own.
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What actually increases with overhydration?
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increase in ICF without increase in electrolytes
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Overhydration (increased ICF) is isotonic or osmotic?
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osmotic
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What are labs that would signal overhydration (increased ICF)?
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decreased serum sodium level below 135
serum osmolality below 280 |
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What are the causes of overhydration?
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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 |
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What would you find upon physical examination of patient suffering from overhydration?
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decreased LOC
(drowsy, lethargic, confusion, seizures) convulsions coma (death) personality changes n&V |
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What is managment of overhydration?
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fluid restriction
monitor/manage electrolyte |
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Who is at risk for fluid problems?
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anyone with:
1. inadequate oral intake 2. excessive fluid losses 3. stress 4. chronic illness (renal, heart, respiratory) 5. surgery patient 6. pregnancy |
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Anytime there is cell damage, there is __________ loss.
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potassium
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What is more of a risk for an infant?
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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.
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How much liquid does a toddler/preschooler require every day?
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1000-1200ml
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Around what % does the FVD or FVE become the category severe"?
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around 10% for FVD 8% for FVE
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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 |
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Nursing interventions for FVD and FVE
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hydration
nutrition client teaching |
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Most IV solutions are _________ which means having the.....
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isotonic, which means having the same concentration of solutes (osmolarity) as blood plasma.
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An isotonic solution does what to the body?
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prevents sudden shifts of fluids and electrolytes in the body.
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Hypertonic solutions have a....
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greater concentration of solutes than plasma.
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IV solutions that are called nutrient solutions contain what?
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carbohydrate and water....carb for energy and calories
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How many calories does 1 L of 5% dextrose provide?
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170
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Nutrient solutions can not maintain weight, normal growth or promote healing, but they do this....
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prevent dehydration and ketosis
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How do Ringer's solutions and LR solutions differn from normal saline?
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NS has sodium chloride
R has sodium chloride K & Ca LR has sodium Cl K Ca & Lactate |
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What is lactate?
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a salt of lactic acid that is metabolized by the liver to form bicarbonate HCO3
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What is an example of an alkalizing solution?
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LR, used to counteract metabolic acidosis
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What is an example of an acidifying solution?
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D5W, 0.45 sodium chloride (dextrose in half strength saline), 0.9% (normal saline)
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List 3 isotonic IV solutions
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normal saline (0.9%)
D5W LR |
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List 3 hypotonic IV solutions
(water goes in cell) |
0.25% saline
0.45% saline 2.5% dextrose |
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List 3 hypertonic IV solutions
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d5 in 0.45 saline
D5NS (0.9%) D5LR |
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Hypertonic IV solution will make water go where?
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from cell into blood
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What should you monitor for with hypertonic IV admin?
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fluid volume excess, circulatory overload, these are volume expanders
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Why would you not give hypertonic IV to dehydrated person?
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b/c already dehydrated so you would be pulling even more water out of the cell
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What does a hypotonic IV solution do to a patient?
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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
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What does an isotonic solution do the body?
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expands the intravascular compartment, so monitor for fluid overload
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