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Functions of H
Lubricates joints & membranes
Regulates body temp
Medium for digestion
1L water = 1kg or 2.2 lbs.
Water and Cellular compartments
Intracellular fluid (ICF)
2/3 of body water
Extracellular fluid (ECF)
of body water
Small amount but significant functions
Terms related to fluids to review...
: albumine is largely responsible for BS oncotic pressure.
Tonicity: Isotonic, hypotonic, hypertonic
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
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)
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
: 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
Brain's regulation of fluid balance
--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
Under hypothalamus control posterior pituitary releases ADH (antidiuretic hormone)
--Regulates water retention by renal system
--Stress, nausea, nicotine, morphine also stimulate ADH release
Releases hormones to regulate H2O & e-lytes (gluco & mineralocorticoids)
is a mineralocorticoid w/potent Na+ retention & K+ excreting capabilities.
Pt. with morphine or nicatine patch will retain fluids.
Renal regulation of water balance
Kidneys are primary organs for regulating fluid & e-lyte balance
Selectively reabsorb & excrete water & e-lytes
: 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.
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
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
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
What is hypovolemia?
aka Fluid Volume Deficit (FVD)
May occur w/loss of normal body fluids
What is hypervolemia?
aka Fluid Volume Excess (FVE)
May result from
Abnormal retention of fluids. Something has gone wrong because normally your body should eliminate it.
what are some clinical manifestations of FVE?
LOC change secondary to cerebral edema
Constant, irritating cough
Hand vein engorgement
Developement of an S
What are some clinical manifestations of FVD
v Skin turgor
v Pulse pressure
v Neck veins when supine
Treatment for ECF Volume Imbalances
Balanced IV solutions
Dietary Na+ restriction
Card Set Information
Fluid (water) regulation
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