Nursing 104 Fluid Volume Managment

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Solid substances dissolved in body fluids, many solutes considered electrolytes

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Solutes

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Solutes that develop an electrical charge when dissolved in water

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Electrolytes

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Other solutes that do not conduct electricity

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Nonelectrolytes

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Body fluids perform several important functions like maintaining ____ volume, __ body temperature, transporting ____ to and from cells, serves as an aqueous medium for cellular metabolism, Assists with ___ of food, serves as a medium for ___ waste.

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blood, regulating, material to and from cells, digestion, excreting

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Fluid volume for a normal adult male is _%, female __% and infant __%

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60, 50, 70

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Women have __ body fluid than men because women have more ___.

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less, fat

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Body fluid contained with in cells also known as cytosol?

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Intracellular fluid

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Intracellular fluid accounts for __% of body weight

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40

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Fluid surrounding the outside of cells?

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extracellular fluid

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ECF carries water, electrolytes, nutrients and o2 to the cells and removes the waste products of cell metabolism

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Info

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ECF accounts for __% of body weight

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20

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What is the name of the ECF that is the fluid surrounding the cells?

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interstitial fluid

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The fluid component of blood?

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plasma, Intravascular fluid

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Fluid trapped in a 3rd compartment?

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Third spacing

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Electrolytes that carry a positive charge?

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cation

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Electrolytes that carry a negative charge are called?

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anions

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The major cations are ?

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Sodium, potassium, calcium and magnesium

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In the ICF, the major cation is?

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Potassium

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In the ECF, the major electrolyte is ?

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Sodium

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Severe electrolyte imbalances can occur if electrolytes move into a compartment they do not normally occupy or are lost from perspiration, rounds, injury and illness

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info

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The movement of fluid and solutes requiring energy?

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Active transport

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The movement of fluids and solutes that require no energy?

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passive transport

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The movement of water across a membrane from an area of less concentrated solution to an area of more concentrated solution.

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osmosis

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The purpose of osmosis is to ___ higher concentration of solutes.

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dilute

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These are solutes that readily dissolve

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Crytalloids

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Larger molecules that do not dissolve readily

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colloids

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The concentration of solutes in body fluid is called?

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Osmolality

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Fluid that is the same osmolality as blood?

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Isotonic

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Solution that has lower osmolality (less solutes) than blood.

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hypotonic solution

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When a hypotonic solution is infused, ____ moves by ____ from the ___ ____ into the ___.

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Water, osmosis, vascular system, cells

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This solution contains a higher concentration of solutes in the blood and is called

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hypertonic solution

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When hypertonic solution is given to a patient, ___ moves by ____ from the ___ into the ___

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water, osmosis, cells, ECF

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A passive process by which molecules of a solute move from an area of higher concentration to an area of lower concentration.

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Diffusion

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The rate of diffusion depends on ___ of molecule, ____ of solution, and ____

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size, concentration, temperature

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The movement of both water and smaller particles from an area of high pressure to low pressure?

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filtration

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The force created by fluid within a closed system; it is responsible for normal circulation of blood.

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Hydrostatic pressure

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An example of filtration is what?

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Arteries have high pressure and it circulates solutes, plasma and blood throughout the body, the body goes though capilaries and filters out only what can fit through the capillaries to feed the its nutrients to certain body parts. Bowmans capsules that are small and then the liver area which can filter larger substances in.

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The power of solution to draw water

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high osmotic pressure.

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True or false: highly concentrated solutions have low osmotic pressure

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False

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the pressure exerted by plasma proteins on the capillary wall.osmotic pressure exerted by colloids in solution.

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oncotic

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this occus when molecules move across cell membranes form an area of low concentration to an area of higher concentration. this requirses energy ATP?

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Active transport

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An example of active transport?

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sodium-potassium pump

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Potassium is the electrolyte highly concentranted in the ?

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ICF

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Sodium is the electrolyte highly concentrated in the ?

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ECF

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we should obtain __% of intake from drinking fluids and __% from food.

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80, 20

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Normal fluid intake and losses in adults ___ mL/day

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2500

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Losses that can be measured are called ___ losses. Examples would be I&O.

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sensible

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Losses of fluid that cannot be measured are called _____ losses. Examples would be sweat, respiration, open wounds, burns

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insensible

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If you have loss of fluid one day, it ___ over time and can get eventually get worst if you don't rehydrate

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accumulates

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The ___ are the principal regulator of fluid and electrolyte balance.

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Kidneys

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The ____ ___ releases what hormone?

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pituitary gland. ADH

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ADH causes kidneys to ____ fluid

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Retain

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____ promotes the reabsorption of sodium and the excretion of potassium in the distal tubules of the kidneys. This hormone is released by the ___ ___. This causes the body to hold onto water.

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aldosterone, adrenal cortex.

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Thyroid hormone affects fluid volume by getting rid of the sodium and water.

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info

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To maintain health, the body must ____ electrolyte losses and intake

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balance

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sodium is a the major cation of ____ and the normal serum level is ___-___ mEq/L

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ECF, 135-145

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Sodium ___ fluid volume. (where salt goes, water goes). Helps maintain blood volume. Interacts with calcium to maintain muscle ___. Stimulates conduction of nerve impulses.

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regulates, contractions

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____ is the major cation in the ICF. Normal Serum level is __-__ mEq/L

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potassium, 3.5-5

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Potassium maintains ICF _____. Regulates conduction of cardiac rhythm.

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Osmolality

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____ is the most abundant of electrolyte in the body. Normal serum level is __-__ mg/dl

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Calcium. 8.5-10.5

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Calcium promotes transmission of mnerve impulses and regulates muscle contractions

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info

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Magnesium normal serum level is __-___ mEq/L

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1.3-2.1

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Magnesium maintains normal intracelular levels of poatssium and is involvedin electrical activign in nerve and muscle membranes

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info

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Only _% of body potassium is found int he extracellular fluid

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2

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This occurs when there is a proportional loss of water and electrolytes from teh ECF

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Fluid volume deficit (hypovolemia)

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The loss of water only

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dehydration

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First symptom of hypovolemia is what?

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thirst

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In Hypovolemia, the heart beats ___, pulse is ___ and Blood pressure is ____

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faster, weak, low

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During hypovolemia water is pulled from the ___ and ___ into the vascular system resulting in dry skin, poor skin turgor, and decreased urine output

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interstitial spaces and ICF

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During hypovolemia our BUN and hematocrit is ____

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elevated

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Edems is the extra fluid with in the the ?

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interstitial fluids

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Hydrogen ions determine ___ balance

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PH

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Pancreatic secretions are ____

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alkaline

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This type of pressure is big molecules that hold water within vascular system

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oncotic

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Defining characteristics of fluid volume deficit?

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High pulse, low BP, Decrease skin turgor, dry mucous membranes, Decrease in capilary refill

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Treatment for isotonic fluid deficit?

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Fluid replacement, measure and evaluate I&O, daily weight, monitor vital signs, skin turgor, and mucous membranes, offer frequent oral care

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Loss of 1lb =___ mL

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500

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Third spacing fluid loss cannot be measured, there is no weight loss but may have weight gain

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info

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Isotonic fluid volume excess is called ____. It involves the retention of __ and ___ in the ECF.

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hypervolemia, NA and water

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The vital signs of a pt with hypervolemia are the opposite of hypovolemia

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BP elevated, pulse is bounding, resiprations are increased and shallow. Neck veins become distended. Skin is pale and cool. Specific gravity is low

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Pitting edema:
Slight indentation, 2mm, normal contours.

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1+

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pitting edema:
Pit is about 4mm last longer than 1 second

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2+

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Pitting edema:
Pit is about 6mm remains for several seconds

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3+

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Pitting edema:
Pit is about 8mm Remains for a prolonged time

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4+

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Isotonic fluid volume excess treatement is __ sodium diet, diuretics and fluid restrictions

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low

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this diuretic acts on the ascending loop pulls out potassium, sodium and water. Example is lasix

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Loop

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pull sodium little potassium and awater. Hydrocloric thiazide

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thiazide diuretic

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pulls out sodium and water. Diazide

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potassium

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Typical american diet contains _ to _ grams of salt a day, we need ____ mg of salt

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2 to 5, 1200

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Hypertonic fluid deficit, cells ____ because of high concentration of solutes in the vascular system

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deflate

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Weight loss, decrease in skin turgor, decrease in moisture of oral cavity, decrease in urinary output, specific gravity, and bun/creatinine, High pulse, low BP

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Isotonic fluid volume deficit

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____ fluid deficit is increasing the osmality of the ECF, in which water moves from the cells into the ecf

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hypertonic

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Hypertonic fluid deficit causes _____ dehydration

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Cellular

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Defining characteristics of this type of deficit:weight loss, weak pulse, hypotension, tachycardia, thirst, changes in mental status.. High sodium levels. high urine specific gravity

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Hypertonic fluid deficit

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Nurisng implications for this type of deficit.
Monitor I&O, monitor lab, obtain daily weight, Administer hypotonic solution, monitor LOC, Frequent oral care

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Hypertonic fluid deficit

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Excess fluid moves from teh extracellular space ton the intracellular space. Water intoxication

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Hypotonic fluid excess

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Fluid requirements
newborn __-__
infant __-___
child ___-____
adolescent ___-___

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50 300
350-550
500-1000
700-14000 ml

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When we measure solute concentrations we measure them in the ___

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blood

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The rapid loss of water and water only

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Dehydration

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What is this diagnosis?
pulse is rapid, respirations rapid, mucus membranes dry, fontanel sunken, eyes -sunken and soft, skin turgor poor Tearing and salivation absent, behavior irritable, lethargic, comatose, convulsions. Body weight loss 5% mild 6-10% moderate. >10% sever3e

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dehydration

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Organs of homeostasis. Adrenal glands secrete ____, Pituitary gland secretes ___ and the parathyroid regulates the __ level

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aldosterone, adh, CA

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Fluids and electrolytes, In relation to water, intracellular contains __ body water, extracellular ___ body water

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3/4, 1/4

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This cation maintains fluid balance

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sodium

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thsi cation contributes the acid-base regulation

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hydrogen

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this cation facilitates enzyme reactions

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Calcium

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this cation is used for neuromuscular reactions

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calcium

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in terms of solutes we always measure the ____ space

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extracellular

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Normal sodium level is __--___

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135-145

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Lack of sodium solution osmality in the body system. Caused by excessive fluid intake.

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hyponatremia

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To much water in the body causing Sodium solution to be dilute excessive sodium loss

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hyponatremia

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Fluid and sodium loss causing dry tissue.

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True hyponatremia

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excessive sodium intake, fluid loss without loss of sodium. This causes cell shrinkage

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hypernatremia

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Dryt tissues, low urine output, tachycardia, neurological changes. These are signs and symptoms of ___-

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hypernatremia

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To help you remember some common s/s of hypernatremia
S
A
L
T

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skin flushed, agitation, low grade fever, thirst

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Potassium has high osmality in the ____

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icf

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Sodium is major cation in the ___

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ecf

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seizureswhen sodium levels reach ___

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120

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Permanent brain damage occurs when levels reach ___

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100

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THis occurs when there is loss of potassium or increased water fluid. Symptoms of hypokalemia is muscle flacidity

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Hypokalemia

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This causes cell wall destruction, increases intake, renal failure. Symptoms, irritable muscles

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hyperkalemia

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Calcium regulates muscle ____/_____

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contraction, relaxation

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Calcium is needed for nerve impulse transmission and coagulation

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info

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Decreased calcium intake, increased phosphate levels, renal disease, acute pancreatitis, hypoparathyroidism

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Hypocalcemia

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Sign is the contraction of facial muscles in the response to a tap over the facial nerve in front of the ear

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Chvosteks sign

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This sign refers to the carpal spasms induced by inflating a blood pressure cuff on the arm

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Trousseaus sign

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Increased intake of pottasium, hyperpapathyroidism, immobilization

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Hypercalcemia

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Magnesium is a Sedative and used for cellular transportation and metabolism, Neuromuscular tone

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info

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causes of this is excessive dietary intake of Ca or Vit D, Gi fluid losses, diuretics, malnutrition, pancreatitis, alcoholism. Low serum levels of magnesium

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hypmagnesemia

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Symptoms are increaaed muscle cell irritability and contractility, low BP, arrythmias, Treatment is magnesium replacement

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Hypomagnesemia

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Seizures
Tetany
Anorexia and arrythmias
Rapid heart rate
Vomiting
Emotional lability
Deep tendon reflexes increases

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Hypomagnesemia

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Causes of this is renal failure, excessive use of magnesium containing products, Diabetic keto acidosis

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Hypermagnesemia