Unit Ii

Front 1

______% of weight in a typical adult is made of fluid. What can affect this percentage?

Back 1

60%
Age-young or old
Gender-male vs. female (men have > muscle)
Body Fat-thin vs. obese

Front 2

Two fluid compartments

Back 2

Intracellular space (fluid inside of the cell)
Extracellular space-(fluid outside of cell)

Front 3

Intracellular space

Back 3

fluid inside of cell, also referred to as ICF, 2/3 of fluid is here.

Front 4

Extracellular space (ECF)

Back 4

Fluid outside of cells, also referred to as ECF, 1/3 of fluid is here.

Front 5

ECF (extracellular space) contains 3 things

Back 5

Intravascular
Interstitial Fluid
Transcellular Space

Front 6

Intravascular

Back 6

inside blood vessels or Plasma

Front 7

Interstitial Fluid

Back 7

Fluid in the tissue spaces (fluid that surrounds the cells)

Front 8

Transcellular space

Back 8

Very small amount of fluid, example is CSF

Front 9

How can your body fluid balance be disrupted?

Back 9

loss of fluid
too much fluid
"third-space" fluid

Front 10

The "path" of how fluids and solutes constantly shift?

Back 10

from cells to interstitial spaces to blood vessels and back again.

Front 11

homeostasis

Back 11

the movement of fluids from one compartment to another to keep things "normal" or level

Front 12

Diffusion

Back 12

type of transport that moves solutes from higher to lower concentrations, eventually both sides equal out. Example is a cup of tea with sugar that dissolves or O2 going into alveoleos then crosses membranes which make RBC

Front 13

Osmosis

Back 13

lets fluids through, water moves from area of low concentration to a higher concentration of particles, stops when both sides are equal. Example: diabetic with high sugar pulls fluid from tissue so that there is equal amounts of sugar and water.

Front 14

The location where there is a critical movement of fluid balance?

Back 14

At the capillary level

Front 15

Capillary Filtration

Back 15

movement of fluids through capillaries, results from blood pushing against walls of capillary, this push creates a pressure

Front 16

Hydrostatic pressure

Back 16

created by fluid pushing against the walls of capillary, forces fluids and solutes through capillary walls. It also creates a filtration process

Front 17

What happens when hydrostatic pressure inside a capillary is > than the pressure in the interstitial space?

Back 17

Fluid and solutes are forced out into those interstitial spaces.

Front 18

What happens when hydrostatic pressure inside a capillary is < pressures in the interstitial spaces?

Back 18

Fluid and solutes move back into the capillary

Front 19

Reabsorption and Albumin prevents what?

Back 19

Too much fluid from leaving capillaries no matter how much hydrostatic pressure is present.

Front 20

As fluid is "filtered" at the capillary what happens to the protein Albumin?

Back 20

Remains behind because it's too large to go through the membrane.

Front 21

Albumin stays behind due to it's size what happens then?

Back 21

Albumin concentration increases as fluid levels decrease. Albumin then acts as a magnets (osmotic pressure) to pull fluid back into the capillary on it's venous side...this process is plasma colloid osmotic pressure (COP)

Front 22

plasma colloid osmotic pressure (COP)

Back 22

a pressure created by albumin left behind creates a osmotic pulling forced created by proteins or plasma. (all on venous side of capillary)

Front 23

Summary: What is the "path of the fluid/filtration in the capillary?

Back 23

Fluid leaves capillary at the arterial end (filtration) by hydrostatic pressure then it bathes interstitial cells with O2 and nutrients, then waste products return to capillary at the venous end where it's reabsorbed by COP (plasma colloid osmotic pressure) and circulated back to the heart...it's that easy!

Front 24

What can we record that is an example of homeostasis?

Back 24

I & O because homeostasis is maintaining balance, intake must equal or almost equal output,

Front 25

Insensible losses? Include examples.

Back 25

Cannot be seen or measured. Skin/sweat
Lungs

Front 26

Sensible losses, include example.

Back 26

Can be measured, GI tract

Front 27

How many ML can your input/output differ to be considered =, and how many days does it take of recording?

Back 27

no more than 500cc difference and it takes 3 days to balance.

Front 28

Oliguria =

Anuria =

Back 28

< 30cc/hr of urine output, also <500cc/day

No urine output

Front 29

How do kidneys play a vital role in regulating fluid volume?

Back 29

-Their role is vital
-regulate ECF (extracellular fluid) volume & osmolarity (concentration)
-regulate electrolyte concentration
-excrete metabolic waste

Front 30

What role does the heart play in regulating fluid volume?

Back 30

-pumping action circulates blood to kidneys and other organs
-results in good renal perfusion

Front 31

What role to your glands play in regulating your fluid volume?

Back 31

Pituitary-anidiuretic hormone (ADH)
Adrenal gland-Aldostrone
Parathyroid-PTH
(Always know your K+ levels)

Front 32

Pituitary gland produces what?

Back 32

ADH (antidiuretic hormone),
-"water-conserving" hormone
-secreted when blood volume decreases or particles in blood increase
-with low volume cells get bigger, it releases ADH and kidneys then hold onto water making volume = as cells get smaller again.

Front 33

Adrenal Gland produces what?

Back 33

-Aldostrone
-promotes Na, chloride, and water reabsorption from renal tubules
-overall increases water in the body
-causes loss of K+

Front 34

Parathyroid Glands

Back 34

-PTH
-regulate calcium and phosphate

Front 35

How do baroreceptors help regulate your fluid volume?

Back 35

-nerve receptors that detect changes in BP
-send signals to CNS

Front 36

Renin-Angiotensin-Aldosterone System

Back 36

-promotes peripheral vasoconstriction and releases of aldosterone
-effect: Na+ & water retention

Front 37

The "path" of renin-angiotensin-aldosterone system

Back 37

renin is secreted in the kidney where it then travels in the blood to the liver.
renin converts angiotensin in the liver to angiotensin I (causes a slight vasoconstriction).
Angiotension I travels to the lungs where it is converted into angiotension II (strong vasoconstritor)
Angiotension II travels to the adrenal gland where it stimulates the production of aldostrone.... whew...got that?

Front 38

Osmoreceptors

Back 38

-on surface of hypothalamus
-sense changes in sodium concentrations
-ADH (antidiuretic hormone) is released

Front 39

If you were stranded on an island with do water, the amount of ADH secreted would most likely?

Back 39

Increase

Front 40

When a person BP drops, the kidneys respond by?

Back 40

secreting renin

Front 41

Hydrostatic pressure, which pushes fluid out of the capillaries, is opposed by colloid osmotic pressure, which involves:

Back 41

the pulling power of albumin to reabsorb water

Front 42

Osmolality

Back 42

measures concentration of solutes in blood
275-300 mosm/kg (blood)

Front 43

BUN

Back 43

measures protein->amino acids->ammonia->absorbed into bloodstream->urea->out in urine
-10-20 mg/dl
-if its too high the kidneys are having problems

Front 44

Creatinine

Back 44

-end product of MUSCLE metabolism
-0.7-1.4mg/dl
-also can indicate kidney problems

Front 45

Hematocit

Back 45

Volume % of RBC's in whole blood (low volume = high HCT)

Front 46

Electrolytes test looks at?

Back 46

Na and K+

Front 47

Urine specific gravity

Back 47

-measures kidney's ability to excrete or conserve water
-1.010-1.025

Front 48

Patients to monitor for I&O?

Back 48

IV's, foley's, GI distress, fluid retention, dehydration, kidney problems, on diuretics, surgical patients, trauma burns, drainage or suction, NPO, fluid restriction, elderly

Front 49

Types of edema

Back 49

pitting
non-pitting
dependent

Front 50

Pitting edema; causes.

Back 50

CHF, HTN, kidney problems

Front 51

Measurement of pitting edema
+1=
+2=
+3=
+4=

Back 51

+1 barely detectable
+2 <5mm indent
+3 5-10mm indent
+4 >10mm indent

Front 52

Dependent Edema

Back 52

Collects in lower or dependent parts (legs, feet, sacrum)

Front 53

Nonpitting edema

Back 53

-local
-short term
-caused by inflammation or traum

Front 54

Sodium (Na+) function

Back 54

-the main ECF cation
-effects fluid balance
-helps regulate acid-base balance

Front 55

Potassium (K+)

Back 55

-major ICF cation
-regulate cell excitability
-too much K+ =v-fib
-too little K+ = irr HB, confusion, constipation

Front 56

Calcium function

Back 56

Muscle contraction, including heart muscle

Front 57

Phosphates function

Back 57

Inverse relationship to calcium
-high calcium, low phosphate

Front 58

Too much extracellular fluid increases what?

Back 58

fluid intake, sodium content....water follows sodium
can lead to circulatory overload

Front 59

Signs/symptoms of fluid volume excess

Back 59

pitting edema, crackles, full bounding pulse, JVD, low Hct & BUN, decreased urine specific gravity <1.003,

Front 60

Fluid volume deficit is

Back 60

loss of ECF > intake , water & electrolytes lost in same proportion, dehydration can lead to FVD

Front 61

Signs/Symptoms and causes of fluid volume deficit

Back 61

insufficient water intake, vomiting, diarrhea, trauma, prolonged sweating, kidney and neuro disorders (DM), thrid spacing

Front 62

What is Third-spacing?

Back 62

fluid shifts from the blood to the 3rd space
-these fluids not available for use
-can lead to kidney failure and shock
-example: ascites

Front 63

Signs of fluid volume deficit

Back 63

-postural hypotension
-weight loss
-dry mucous membrane
-depressed periorbital spaces
-concentrated urine (increase specific gravity >1.030)
-increased lab values (HCT and BUN)

Front 64

What causes fluid shifts of surgical patients in the first 2-5 days?

Back 64

stress from surgery causes, increased aldosterone and glucocorticoids
-increased ADH

Front 65

Results of increased aldosterone, glucocorticoids and ADH from surgery?

Back 65

-decreased weight
-increased blood sugar
-decreased K+
-edema
-decreased urine output
-nonpitting edema
-IV w/ K+in it

Front 66

1 kg of weight gained or loss =

Back 66

1 liter of fluid gained or lost

Front 67

3 main types of IV fluid

Back 67

-isotonic
-hypotonic
-hypertonic

Front 68

Isotonic fluids

Back 68

-close to the same osmolarity as serum (blood)
-contains ~ = #of molecules as serum
-no movement across membrane
-no fluid flow into or out of blood vessels

Front 69

Isotonic fluid uses

Back 69

-hypotension
-hypovolemic patients

Front 70

Isotonic fluid can be harmful for

Back 70

-risk for "fluid overloading" in patients with CHF, HTN
-

Front 71

Examples of Isotonic solution

Back 71

Lactated ringers
normal saline

Front 72

Hypotonic solution

Back 72

-less osmolarity than serum
-dilutes the serum
-fluid shifs from vascular compartment into interstitial fluid compartment
-interstitial fluid compartmentbecomves diluted, fluid ultimately shifts into tissue cells

Front 73

Hypotonic solution is helpful for?

Back 73

-cellulary dehydration-fluid shifts out of blood vessel to the tissue cells
-examples: dry mucous membranes, DKA

Front 74

Hypertonic solution

Back 74

-higher osmolarity than serum
-pulls fluids and electrolytes from the intracellular and interstitial compartments into the intravascular compartment

Front 75

Examples of hypertonic solution

Back 75

D5W.9NaCl
-D5W.45 NaCl
-D5LR

Front 76

Hypertonic solution helps to:

Back 76

-decrease edema
-increase urine output
-stabilize BP

Front 77

Potential complications from Central lines

Back 77

-handout from packet
-circulatory overload
-local infilitration
-thrombophlebitis
-pyrogenic reaction
-anaphylactic reaction