AMS1

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Author:
alyn217
ID:
163624
Filename:
AMS1
Updated:
2012-07-29 23:35:05
Tags:
AMS1T2 Fluids
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Description:
Fluid (water) regulation
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  1. Functions of H2O
    • Transports:
    • --Nutrients
    • --Electrolytes
    • --Oxygen
    • --Waste products
    • Lubricates joints & membranes
    • Regulates body temp
    • Medium for digestion
    • 1L water = 1kg or 2.2 lbs.
  2. Water and Cellular compartments
    • Intracellular fluid (ICF)
    • 2/3 of body water
    • Extracellular fluid (ECF)
    • 1/3
    • of body water
    • Intravascular (plasma)
    • Interstitial
    • Transcellular~1 liter
    • Small amount but significant functions
  3. Terms related to fluids to review...
    • Homeostasis
    • Diffusion
    • Facilitated diffusion
    • Active transport
    • Osmosis
    • Hydrostatic pressure
    • Oncotic pressure: albumine is largely responsible for BS oncotic pressure.
    • Tonicity:  Isotonic, hypotonic, hypertonic
  4. Abnormal Fluid Shifts away from blood plasma
    • Alterations in hydrostatic pressures
    • Plasma to interstitial fluid shift = edema
    • --Elevation of hydrostatic pressure
    • --Decrease in plasma oncotic pressure
    • --Elevation of interstitial oncotic pressure
    • --Obstructed lymphatic outflow
    • --Drop in BP
  5. Fluid Shifts/movement into plasma
    • Fluid drawn into plasma space when there is an increase in plasma osmotic or oncotic pressure
    • --Colloids, mannitol, hypertonic solutions
    • Wearing compression stockings has therapeutic effect
    • Increases tissue hydrostatic pressure (^BP)
  6. Fluid Movement Between EC and IC splaces
    • Water Deficit = increased ECF osmolality
    • --Water pulled into vascular system -->crenation of cells
    • --CNS changes common as brain cells shrink

    • Water Excess = decreased ECF osmolality
    • Water pulled into cell -->cellular swelling
    • CNS changes as brain cells swell
  7. Fluid Spacing
    • First spacing : Normal distribution in ICF & ECF
    • Second spacing (some edema): Abnormal accumulation of interstitial fluid
    • Third spacing (pitting edema): Fluid accumulation in part of the body where it is not easily exchanged w/ECF
  8. Brain's regulation of fluid balance
    • Hypothalamus
    • --Osmoreceptors sense fluid deficit or increase in plasma osmolality-->
    • -->^thirst & ADH release-->
    • -->Results in increased intake of free water & decreased plasma osmolality-->
    • ADH suppression &  ^ urine output
    • Pituitary
    • Under hypothalamus control posterior pituitary releases ADH (antidiuretic hormone)
    • --Regulates water retention by renal system
    • --Stress, nausea, nicotine, morphine also stimulate ADH release
    • Adrenal cortex
    • Releases hormones to regulate H2O & e-lytes (gluco & mineralocorticoids)
    • Aldosterone is a mineralocorticoid w/potent Na+ retention & K+ excreting capabilities.

    Pt. with morphine or nicatine patch will retain fluids.
  9. Renal regulation of water balance
    • Kidneys are primary organs for regulating fluid & e-lyte balance
    • Selectively reabsorb & excrete water & e-lytes
    • Renal tubules: site of action of ADH & aldosterone
    • Impaired renal function = ?
    • Nursing considerations for elderly without thirst: give a premarked water container so they know how much they have drunk and how much they should drink.
  10. Heart's regulation of water retension
    • Atrial natriuretic factor (ANF) – released by cardiac atria in response to increased pressure
    • Brain-type natriuretic peptide (BNP) is released by the cardiac ventricles in response to decompensated heart failure (stretch)
    • ANF & BNP-->vasodilation & increased urinary excretion of sodium & water
  11. Regluation of water retension by GI
    • GI tract accounts for most of daily water intake
    • Average intake ~2-3L/day
    • Small amounts of water eliminated by GI tract via feces
  12. What is insensible water loss?
    • Invisible vaporization from lungs & skin
    • Approx 900 mL/day
    • No e-lytes lost
    • Helps regulate body temp
    • Excessive sweating (sensible loss) leads to loss of water & e-lytes
  13. What is hypovolemia?
    • aka Fluid Volume Deficit (FVD)
    • May occur w/loss of normal body fluids
    • Diarrhea
    • Fistula drainage
    • Hemorrhage
    • Decreased intake
    • Plasma-to-interstitial shift
  14. What is hypervolemia?
    • aka Fluid Volume Excess (FVE)
    • May result from
    • Excessive intake
    • Abnormal retention of fluids. Something has gone wrong because normally your body should eliminate it.
    • Interstitial-->plasma shift
  15. what are some clinical manifestations of FVE?
    • Neuro:
    • LOC change secondary to cerebral edema
    • Respiratory:
    • Constant, irritating cough
    • Dyspnea
    • Crackles
    • Cyanosis
    • CV:
    • JVD
    • Hand vein engorgement
    • Bounding pulse
    • Elevated BP
    • Developement of an S3 heart sound.
    • Pitting edema
    • Sacral edema
    • Weight gain
  16. What are some clinical manifestations of FVD
    • Thirst
    • v Skin turgor
    • Mucous membranes
    • Eyeballs
    • ^ Temp
    • ^ HR 
    • v BP
    • v Pulse pressure
    • v Neck veins when supine
    • v Weight
    • v U/O
    • v LOC
    • Orthostatic hypotension
    • Nursing considerations?          
  17. Treatment for ECF Volume Imbalances
    • Hypovolemia:
    • Balanced IV solutions
    • Isotonic NaCl
    • Blood
    • Drink'o'water
    • Hypervolemia:
    • Diuretics
    • Fluid Restriction
    • Dietary Na+ restriction

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