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82 Cards in this Set

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How does being dehydrated affect blood pressure and pulse pressure?
-Systolic blood pressure decreases
-Diastolic blood presssure increases or stays the same
-Pulse pressure narrows and is severe
How does overhydration affect blood pressure and pulse pressure?
-Systolic Blood pressure increases (late sign)
-Diastolic blood pressure decreases
-Pulse pressure widens
How does heart rate (pulse) change due to dehydration?
It Increases.
How does heart rate (pulse) change due to overhydration?
It decreases.
How does pulse amplitude affected by dehydration?
It decrease to a +1
How does pulse amplitude affected by overhydration?
It increases to a +3
How is the respiration rate affected by dehydration?
It increases.
How is the respiration rate affected by overhydration?
It stays the same and a late sign is it increases.
How are the neck veins affected by dehydration?
They are flat.
How are the neck veins affected by overhydration?
They are distended.
How does dehydration affect the eyes?
The eyes have a soft appearance and are sunken.
How does overhydration affect the eyes?
There is periorbital edema.
How does dehydration affect breath sounds?
They are clear.
How does overhydration affect the breath sounds?
They can be clear or have adventitious wet sounds.
How are the mucus membranes affected by dehydration?
They are dry.
How are the mucus membranes affected by overhydration?
They are wet.
How is the skin affected by dehydration?
It is dry.
How is the skin affected by overhydration?
It is moist or can be taut and shiny.
How does dehydration affect skin temperature?
It is warm or hot to the touch.
How does overhydration affect skin temperature?
It is cool to the touch.
What happens to skin turgor in a state of dehydration?
It is sluggish or tenting.
What happens to skin turgor in a state of overhydration?
It is supple.
How does capillary refill change during dehydration?
It is decreased and slower.
How does capillary refill change during overhydration?
It is good < 3 seconds.
How are the muscles affected by dehydration?
There is muscle weakness present.
How are the muscles affect by overhydration?
Muscle cramping.
How is the body affected neurologically by marked and severe dehydration?
Marked- drowsy, lightheaded, and lethargic
Severe- restlessness, irritability, and seizures
How is the body affected neurologically by early and progressive overhydration?
Early- Headache, nausea and vomiting
Progressive- irritability and confusion
How does thirst change during dehydration?
It increases.
How does thirst change during overhydration?
It decreases.
How is weight affected by dehydration?
It decreases.
How is weight affected by overhydration?
It increases.
How is urine output affected by dehydration?
It decreases.
How is urine output affected by overhydration?
It increases.
How does urine concentration change during dehydration?
Its more concentrated.
How does urine concentration change during overhydration?
It is less concentrated.
How does I&O change during dehydration?
I<O
How does I&O change during overhydration?
I>O
How does Na+ values change during dehydration?
They increase.
How does Na+ values change during overhydration?
The decrease.
How does serum osmolality change during dehydration?
It is increased >280
How does serum osmolality change during overhydration?
It is decreased <280
How does hemoglobin and hematocrit change during dehydration?
It is increased.
How does hemoglobin and hematocrit change during overhydration?
It is decreased.
How does the albumin levels change during dehydration?
They are the same or increased.
How does the albumin levels change during overhydration?
They are normal or decreased.
How do the BUN levels change in dehydration?
They increase.
How do the BUN levels change in overhydration?
They are decreased or are in normal range.
How is the urine specific gravity affected by dehydration?
It increases.
How is the urine specific gravity affected by overhydration?
It decreases.
What type of IV fluids would you give a patient if they were dehydrated?
-Isotonic dehydration (hypovolemia)->Isotonic fluids
-Hyperosmolar dehydration->Hypotonic IV fluids
What type of IV fluids would you give a patient if they were overdehydrated?
-No isotonic fluids
-Hyperosmolar overhydration->Hypertonic IV solutions
-Volume expanders->Albumin
What are the nursing interventions that should be done for both dehydration and overhydration?
Take vital signs, monitor I&O, daily weight (same scale, time, and clothes), monitor lab values, skin care, oral care, safe environment, document neurological problems, and monitor IV fluids
What are the nursing interventions that should be done for dehydration?
Force fluids, clear liquids and a regular diet
What are the nursing interventions that should be done for overhydration?
Restrict fluids, low sodium diet, loop diuretic therapy
What are the 3 compartments of body fluids?
-Intracellular (ICF)
-Extracellular (ECF)
-Transcellular
What is the composition of Intracellular fluid and it's compartments?
-Fluid within the cells
-42% of body weight
-Most prevalent cation is K+
-Most prevalent anion is PO4- (phosphate)
What is the composition of Extracellular fluid and it's compartments?
-Fluid in the spaces between cells AKA interstitial fluid
-Most prevalent anion is Cl- (chloride)
-Most prevalent cation is Na+ (sodium)
-It expands and contracts
-2/3 of ECF is interstitium
What is the composition of Transcellular fluid and it's compartments?
-Small, but important fluid compartment
-Approximately 1L
-Includes the fluid in: cerebrospinal fluid, GI tract, pleural spaces, synovial spaces, and peritoneal spaces.
Describe the 2 components in body fluids.
Electrolytes- element that when dissolved can carry an electrical current, cations (+), anions (-), they affect neuromuscular function and acid-base balance
Minerals- ingested compounds, serve as catalysts in nerve response, muscle contraction, and metabolism of nutrients in foods, regulate electrolyte balance
What is diffusion?
Fluids move from an area of higher concentration to an area of lower concentration till even distribution is attained
What is facilitated diffusion?
What is active transport?
Able to move larger molecules and go from a lesser concentration to a greater concentration using energy
What is osmosis?
Movement of pure solvent through a semipermeable membrane from a solution of lower concentration to higher.
What is hydrostatic pressure?
It is the force within a fluid compartment, it's the major force that pushes water out of the vascular system at a capillary level.
What is colloidal oncotic pressure?
Osmotic pressure excerted by the colloids in the solution (colloidal osmotic pressure), protein is a major colloid (Albumin), it draws fluid from the surrounding tissues and extravascular spaces in the blood vessels.
What is filtration pressure?
Water and diffusible substances move together in response to fluid pressure
The amount and direction of fluid movement in capillaries is determined by what?
Capillary hydrostatic pressure, plasma ocotic pressure, Interstitial hydrostatic pressure, Interstitial oncotic pressure
How does Hypothalamic regulation regulate the body's fluid balance?
The osmoreceptors located in the hypothalamus sense a fluid deficit or increase in plasma osmolarity, it stimulates thirst and the release of ADH which results in increased free water and decreased plasma osmolarity
How does pituitary regulation affect the body's fluid balance?
Under control of the hypothalamus it causes the posterior pituitary to release ADH. It can be triggered by stress, nausea, nicotine, and morphine which also stimulate ADH
How does adrenal cortical regulation affect the body's fluid balance?
Adrenal cortex releases hormones to regulate both water and electrolytes: glucocorticoids and mineralcorticoids *Aldosterone is a mineralcorticoid with a potent sodium-retaining and potassium excreting capability
How does renal regulation affect the body's fluid balance?
Kidneys are the primary organs for regulating fluid and electrolyte balance, selective reabsorption of water and electrolytes, excretion of electrolytes occurs here, renal tubules are sites of action of ADH and aldosterone
How does cardiac regulation affect the body's fluid balance?
The heart atria release atrial natriuetic factor (ANF) which stimulates and increase in atrial pressure because of increased blood volume. It targets the blood vessels and kidneys causing vasodilation and an increased excretion of Na+ and water. It effects the plasma volume osmolarity by decreasing plasma volume and increasing osmolarity.
How does gastrointestinal regulation affect the body's fluid balance?
The GI tract accounts for the most of the water intake, and small amounts of water are eliminated by the GI tract in feces
Describe insensible water loss and sensible water loss.
Insensible- invisible vaporization from lungs and skin, approximately 900 mL lost per day, no electrolytes lost
Sensible- excessive sweating, leads to water loss and electrolyte loss
What is the etiology, clinical manifestations, and effects of lab values caused by hypervolemia?
Etiology: may result from excessive intake of fluids, abnormal retention of fluids (CHF), or interstitial-to-plasma shift
S&S: increased circulating volume (HTN), cough, SOB, JVD, bounding pulse, rales or crackles noted on ausculation, feeling of fullness, weight gain, pulmonary edema, pitting edema to extremities, puffy eyelids, tight shiny skin, peripheral edema, restlessness, anxiety, change in LOC
Lab Values: decreased hemoglobin and hematocrit, altered electrolytes
What are the nursing interventions for hypervolemia?
-Monitor location and extent of edema
-Weigh patient daily
-Assess patient
-Observe V/S changes
-Monitor labs
-Neuro checks
-Provide or teach proper diet
-Administer medication
What is the etiology, clinical manifestations, and lab values of hypovolemia?
Etiology: Can occur with loss of normal body fluids (diarrhea, fistula drainage, or plasma-to-interstitial fluid shift)
S&S: decreased urine output, increased urine concentration, oliguria, weakness, sudden wieght loss, decreased venous filling, decreased pulse volume/pressure, increased body temp, decreased skin turgor, dry mucus membranes, dry skin, thirsty
*ORTHOSTATIC HYPOTENSION = HYPOVOLEMIA
**Decreased C/O = Low BP = SHOCK
Lab Values: high urine specific gravity, increased hematocrit, variable serum electrolytes, variable urine volume, increased blood urea nitrogen (BUN), increased osmolality
What are the nursing interventions for hypovolemia?
-Look for causative factors
-Monitor I&O
-Monitor daily weights
-Observe V/S changes
-Assess skin turgor
-Ensure patient safety with position changes
-Administer medication & IVF
What are some contributing factors to fluid and electrolyte imbalances?
-illness and conditons
-interventions and treatment measures
What are the common manefestations of electrolytes imbalances?
-vital sign changes
-cardiac arrhythmias
-gastrointerstinal S/S
-alteration in muscle function
-neurological S/S
-hyperactice or flaccid reflexes
What are the geriactric changes that take place that effect he fluid and electrolyte balance?
-structural changes to the kidney and decreased renal perfusion: decreased glomerular fultration rate and creatinine clearence, lose ability to concentrate urine and conserve water
-hormonal changes: decrease in renin and alderosterone, and increase in ADH and ANP
-body changes: loss of subq tisue and dermis tissue which cause lose of moisture and inability to respond to temperature quickly
-sensory change: decreased thirst mechanism
-musculoskeletal: decresased mobility and stiffness in hands
-mental status changes: confusion, disorientation and decreased memory