Fluid balance.txt

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Michealbledsoe
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Fluid balance.txt
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2013-05-09 18:27:39
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Fluid balance
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  1. What is a cation
    A positively charged electrolyte
  2. What is an anion
    A negatively charged electrolyte
  3. 3 cations
    Sodium, potassium and magnesium
  4. 3 anions
    Chloride, bi-carb and phosphate
  5. What do electrolytes do
    Play a vital role in water distribution necessary for nerve impulses and play a role In acid base imbances
  6. What is Intracellular fluid
    Fluid inside of the cell (35%-40%) of body weight.
  7. What is interstitial fluid
    An extra cellular fluid located in the spaces between the cells
  8. What is intravascular fluid
    "Plasma" fluid contained within the arteries, veins and capillaries
  9. What is the most abundant cation
    Sodium is the most....???? In ECF
  10. What are Extra cellular measurements
    What you see when someone draws a lab
  11. Normal potassium ranges are
    Normal ranges for ??? 3.5 - 4.5
  12. What is the most abundant cation
    Sodium is most abundant
  13. What is most abundant anion
    Chloride is most abundant
  14. What is most abundant cation in ICF
    Potassium is most abundant
  15. What is most abundant anion in ICF
    Phosphate is most abundant
  16. Where is majority of body fluid
    In the cells (intracellular)
  17. What is another name for plasma
    Intravascular compartment is another name for fluid in arteries, veins and capillaries (5%)
  18. What are he two main fluid compartments
    Intracellular and extracellular
  19. Extracellular compartment breaks down to what
    Plasma (interstitial fluid)
  20. What cannot cross cell membrane
    Proteins (what can they not do)
  21. ECF is composed of
    Intravascular and interstitial fluid. (Make up what)
  22. Where is interstitial fluid located
    Located in the space between most of the body's cells (what is located there)
  23. What separates intravascular and interstitial fluid
    Capillary wall separates them
  24. What separates intracellular and extracellular fluid
    Cell membrane separates what
  25. Major intracellular cation is potassium if cells are injured potassium could leak out causing potassium levels to be
    High (these levels will be if cells are injured)
  26. What is diffusion
    Movement of a substance from and area of greater to lesser concentration (solute only)
  27. What is filtration
    Movement of a solute and solvent thru a permeable membrane from greater to lesser pressure (also called hydrostatic pressure)
  28. What is osmosis
    Movement of solvent from lesser to greater solute concentration. solvent movement only
  29. Hydrostatic pressure and osmotic pressure regulates what
    Movement of water between intravascular and interstitial spaces and capillary beds of the body. Hydrostatic pressure at arterial end and osmotic pressure at capillary end
  30. The more osmolarity a fluid has
    The higher the concentration and the more osmotic pull it will have. Water follows salt rule
  31. Where is most hydrostatic pressure located
    By the heart
  32. Protein and sodium act as
    Magnet to pull fluid back into intravascular space (vein)
  33. If person is dehydrated what do the lack
    Albumin (protein)
  34. What is acities
    Third spacing of fluids (out of intravascular space)
  35. Filtration from arteries to veins
    Heart pushes fluid out, (arterial end) protein (albumin) left in, proteins on venous end act as magnet to pull fluid back in (osmotic)
  36. Blood pressure low when
    Fluid is in interstitium cuz it's not available for circulation. (Caught in space between cells)
  37. Interstitial FVE
    •Increased blood hydrostatic pressure (heart pumping to hard pushing fluid into interstitium)

    • •decreased blood colloid pressure (not enough protein to pull fluid into intravascular space)
    • •increased interstitial fluid osmotic pressure
    • • blocked lymphatic drainage (if not removing waste interstitial fluid may over flow and build up) lymph system gets rid of waste.
  38. Third spacing means
    Too much fluid in interstitial space (between cells) and not being pulled back into intravascular space (veins, capillaries and arteries) B/P will be low
  39. More solute outside cell will make cell
    Hypertonic. Cell will shrink cuz water follows solute outside cell
  40. Edema
    Swelling from fluid in interstitial space (3rd spacing)
  41. Leaking proteins from capillaries can cause
    Edema. Protein can leak out and can't pull fluid into intravascular space.
  42. To raise b/p quickly due to loss of fluid from interstitial space use what kind of fluid
    Isotonic (0.9 NS which is also sodium chloride)
  43. If pt is hypovolemic b/p is likely
    Low due to loss fluid volume give isotonic solution
  44. Fluid volume deficit
    Is an extra cellular deficit (interstitium or intravascular)
  45. Hypertonic and hypotonic solutions cause
    Movement between extracellular and intracellular compartment. Either pills fluid in or out
  46. Hypotonic solution
    Will pull fluid into the cell because it has less solutes than plasma. CAUSES CELL SWELLING. NOT GOOD FOR PT W HEAD INJURY
  47. D5W for
    Hyperneutremia. Can be used to bring down high sodium level by dilution. (Isotonic in bag, becomes hypotonic in body) Not for diabetic PTs cuz it contains dextrose
  48. Ringers lactate
    Gets metabolized to bi-carb. Good for metabolic acidosis. Good for blood loss from burns and lower GI fluid loss
  49. Aldosterone is released by and consist of
    Adrenal cortex and is sodium and water
  50. ADH is made in
    Hypothalamus and released by posterior pituitary gland
  51. Hypotonic solutions cause
    Cells to swell. Not good for head injury
  52. Isotonic solution examples
    0.9 NS, D5W, Ringers lactate, D5.2 NS
  53. Hypertonic solution examples
    D10W, D5.9NS, D 5.45NS, D5LR, 3%NaCL (severe hyponeutrimea)
  54. Hypotonic solution ex
    0.45NS and 0.2NS good for cellular dehydration
  55. Hypothalamic thirst center is activated when
    There is a 1-2% decrease in body fluids. Located in brain
  56. ADH causes
    Water reabsorbtion. Keeps u from urinating and losing water
  57. Vasopressin is
    Another name for ADH
  58. Hypovolemia
    Low fluid volume
  59. Hyponeutrimea
    Low sodium volume
  60. Hypernutremia
    High sodium volume
  61. Hypokalemia
    Low potassium
  62. Hyperkalemia
    High potassium
  63. Juxtoglumarilar cells secrete
    Renin from decreased blood flow due to hyperosmolarity which stimulates angiotensin 1 > angiotensin 2 > then causes aldosterone to be released and causes kidneys to retain sodium and water and causes b/p to increase
  64. Aldosterone is triggered by
    Hypovolemia (low fluid volume) hyponutremia (low sodium volume) and hyperkalemia (high potassium)
  65. ANP (atrial natriuretic peptide) released When
    there's too much blood volume From vasodilation. Blood pressure will be too low From excessive water and sodium loss. Shuts off renin angiotensin aldosterone system
  66. FVE
    Excess of fluid in extra cellular compartment (intravascular and interstitial space )
  67. FVE is referred to as what type of disturbance
    Isotonic hyervolemia. Too much fluid in extra cellular compartment
  68. FVD is referred to as what type of disturbance
    Isotonic hypovolemia. Not enough fluid in extra cellular compartment
  69. Osmolarity problems are what type of disturbance
    Hypo or hyper nutremic disturbances. Involves shifts Of sodium from extracellular to intracellular compartments
  70. No shift of fluids from intracellular to extracellular in what type of disturbance
    Isotonic disturbances
  71. How to treat low fluid value with low blood-pressure
    Give isotonic solution such as 0.9 NS
  72. In fluid volume excess extracellular compartment does what
    Expands
  73. How does intravascular fluid affect blood pressure
    It keeps B/P up
  74. Osmolarity problems will cause cells to
    either shrink or swell
  75. Isotonic disturbances only affect
    Extra cellular fluid
  76. Heart failure leads to
    fluid accumulation and pooling
  77. FVE causes
    Heart failure, Cirrhosis (Decreased hepatice profusion, increased venous pressure from protein depletion), renal failure, Adrenal gland disorders, excess 0.9NS administration
  78. FVE signs and symptoms (check lung sounds always)
    Full bounding pulse, distended neck and peripheral veins, cough and dyspnea, orthopnea (difficulty breathing when lying down) tachypnea, crackles, pulmonary edema, ascites, anasarca (general edema) decreased hematocrit
  79. Specific gravity norms (renal concentrating ability)
    • 1.010 - 1.025
    • FVE < (low) specific gravity urine is more dilute
    • FVD > (high) specific gravity urine is more concentrated (dehydration) (lot of particles (sodium)
  80. Hemoglobin norms (within red blood cells)
    Oxygen carrying protein in RBC
    • women 12-14
    • men 13-16
  81. What is normal range for BUN (blood uria nitrogen) tells renal function. Final product of protein metabolism
    • 6-20
    • elevated BUN signals kidney damage
  82. Creatinine (specific indicator of kidney disease) what is the norm
    0.6-1.2 (elderly renal function will decrease)
  83. Hematocrit (percentage of red blood cells in plasma) normal values
    • women 40-48
    • men 42-50
  84. low hematocrit (non anemic person) indicates
    (FVE) hemodilution dilute hydration status
  85. FVE or isotonic hypervolemia (high fluid volume)  results from
    from abnormal retention of sodium and water in same proportion can cause CHF (inability to propel blood foward
  86. Aldosterone is
    sodium and water
  87. ADH is
    Water
  88. Pt with polyuria with FVE would have
    Low BUN (dilute urine)
  89. PT with renal failure would have
    High BUN
  90. 1 liter of fluid is equal to
    2.2lbs
  91. Diluted urine indicates low....
    specific gravity
  92. treatment for FVE
    • momiter VS
    • listen to lung sounds
    • assess for edema
    • asses neck and peripheral vein distention
    • maintain semi-fowlers position
    • fluid restriction
    • sodium restricted diet (avoid processed meat, and fish, canned foods, condiments, snack foods)
    • daily weights
    • diuretics
    • turn pt often for skin break down
    • pulse ox to check o2 sat
  93. characteristic of pitting edema
    edema that doesn't go back to normal after you remove your finger
  94. FVD causes *Isotonic hypovolemia* low fluid volume because fluid is osmotic <lot of particles> (can be dehydration)
    • vomiting (metabolic alkalosis)
    • diarrhea (metabolic acidosis)
    • hemorrhage
    • insufficient intake
    • fever
    • G.I. suctioning
    • intestinal obstruction
  95. orthostatic hypotension
    drop of more than 10 in systolic more than 15 in diastolic
  96. FVD signs and symptoms
    • decreased skin turgor (skin will stay tented when pinched)
    • fontanel will be sunken in in children
    • droopy eyes
    • high specific gravity
    • mucous membranes will be dry
    • dry skin
    • flat neck and hand veins
    • (not enough fluid in extra cellular compartment from dehydration)
  97. FVD treatment
    • weights
    • oral fluids
    • I.V. fluids (0.9 NS) wanna give isotonic solution
    • monitor lab values
    • monitor I&O
    • look for altered mental status
    • moniter values
    • look for orthostatic hypotension
  98. osmolarity disturbances
    shift of fluid in and out of cells (between extracellular and intracellular compartments) sodium disturbances
  99. hyponatremia is
    water excess (lose too much sodium thru sweat or drink too much water) too much water not enough sodium. Sodium levels will reflect disorder. give fluid and electrolytes (Gatorade)
  100. Hypernatremia is
    water deficit (dehydration)
  101. in hyponatremia (water excess) cells do what
    draw fluid in and swell because osmotic pressure is greater in intracellular compartment than extracellular compartment. (more particles/sodium in cell than outside of cell) can be from heart failure, renal failure and cirrhosis
  102. signs and symptoms of hyponatrameia
    • muscle cramps
    • headache
    • altered mental status
    • irratability
    • coma and possible death
  103. treatment for hyponatremia
    • loop diuretics
    • fluid restrictions
    • monitor I&O
    • Daily wts
  104. FVE and FVD (Isotonic disturbances) only involve....
    only involve extra cellular compartment (intravascular and interstitial)
  105. Hypernatremia (water deficit)  is
    water is pulled out of cells causing cells to shrink.
  106. Hypernatremia (water deficit) causes
    • water deprivation
    • dehydration
    • fever
    • hyperventilation
    • excessive perspiration
    • massive burns
    • (elderly most at risk)
  107. signs and symptoms of Hypernatremia (water deficit)
    • Loss of appetite
    • Nausea
    • Vomiting
    • Generalized weakness
    • Excessive fatigue
    • Faintness
    • Excessive thirst
    • Muscle spasms
    • Muscle tremors
    • Swelling Irritability
    • Excessive sleepiness
    • Confusion
    • Seizures
    • Coma
  108. Treatment or hypernatremia
    • use of hypotonic IV solution 0.45 NS
    • skin care
    • oral care
    • reality orientation
    • avoid high sodium foods
  109. Potassium charateristics
    • major CATion in intracellular compartment
    • vital role in cell matabolism
    • 80% excreted by kidneys
    • comes from diet
    • clients on diuretics usually on potassium due to loss of it from excessive urination
  110. Kayaxolate does what to potassium
    Brings potassium level down
  111. Norm potassium range
    • 3.5-5.0 meq
    • Low potassium = muscle weakness
  112. characteristics of sodium
    • controls shift of water
    • regulates extracellular fluid volume
    • necessary for muscle contraction and the transmission of nerve impulses
  113. Sodium values
    • 135-147 meq/L
    • <135 = hyponatremia
    • >147 = hypernatremia
  114. Calcium characteristics
    • sedative action on nerve cells
    • regulates muscle contractions
    • plays a role in blood coagulation
  115. Calcium values
    • 4.3-5.3meq/L
    • <4.3 = hypocalcemia
    • >5.3 = hypercalcemia
  116. Chvosteks sign
    • is one of the signs of tetany seen in hypocalcemia. It refers to an abnormal reaction to the stimulation of the facial nerve. When the facial nerve is tapped at the angle of the jaw the facial muscles on the same side of the face will contract
    • momentarily (typically a twitch of the nose or lips) because of hypocalcemia
  117. Trousseau sign
    Trousseau sign of latent tetany is a medical sign observed in patients with low calcium.[1] This sign may become positive before other gross manifestations of hypocalcemia such as hyperreflexia and tetany, as such it is generally believed to be more sensitive (94%) than the Chvostek sign (29%) for hypocalcemia.
  118. Phosphorus is
    major intracellular anion
  119. phosphorus norms
    • 1.7-2.6
    • < = hypophosphatemia
    • > = hyperphosphatemia
  120. Magnesium is
    important for neuromuscular function
  121. magnesium values
    • 1.5-2.5
    • < = hypomagnesemia
    • >= hypermagnesemia
  122. chloride does what
    controls shift of water
  123. chloride values
    • 100-106
    • < = hypochloremia
    • > = hyperchloremia
  124. SIDAH is
    syndrome of inappropriate ADH from diabetes, can't concentrate urine...lose a lot of water from decrease in ADH
  125. hyperosmolity
    too much solutes in blood so body will require mote water...tells ADH hormone to kick in
  126. more fluid in intravascular compartment means what to blood pressure
    higher blood pressure
  127. what fluid raises blood pressure
    isotonic fluid because it will expand plasma volume (0.9 NS)
  128. Dehydration does what to blood pressure
    lowers it cuz of low protein amount
  129. what solution is always hung when giving blood
    0.9 NS because tonicity is similar to that of plasma
  130. which isotonic solution acts as hypotonic in body
    D5W
  131. which IV solution is used to treat hypernatremia
    D5W
  132. if diabetic and in metabolic acidosis what will potassium be
    high
  133. which solution would you not give to a person with a head injury
    hypotonic solution (0.45NS, 0.2NS or D5W) because it causes cells to swell...not good for head injury or CVA...less tonicity than ECF so it will draw into cell where more sodium lies

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