Fluid and Hemodynamics

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Fluid and Hemodynamics
2011-02-19 17:00:57
fluid hemostatis

chpt 2
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  1. Fluid and Electrolytes
    • Transport gases, nutrients, and wastes.
    • Help generate the electrical activity needed to power body functions.
    • Take part in the transforming of food into energy.
  2. Composition and Compartmental Distribution of Body Fluids
    • Body fluids distributed between intracellular and extracellular compartments.
    • ICF- fluid contained w/in the cells of body.
    • ECF- fluid contained outside the cells including water in interstitial tissue or spaces and bl. vessel.
    • Cell membrane- main barrier to the mov't of substances between the ECF & ICF compartments
  3. Diffusion
    • the mov't of charged or uncharged particles along a concentration [] gradient.
    • all molecules & ions including h2o & dissolved molecules, are in constant random motion.
  4. Osmosis
    • The mov't of H2O across a semipermeable membrane.
    • H2O moves from area of higher concentration of H2O to lower like diffusion.
  5. Tonicity
    • Tension or effect that effective osmotic pressure of a solution w/ impermeable solutes exert on cell size b/c of water mov't across the cell membrane.
    • isotonic, hypotonic, hypertonic.
  6. Compartmental Distribution of Body Fluids
    • Body H2O:
    • 40% of body weight from ICF
    • 20 % of body weight from ECF
    • -Plasma compartment 5% of body wt. Interstitial fluid compartment about 14% of body wt. Transcellular compartment about 1 % of body wt.
  7. Edema
    • Palpable swelling produced by an increase in interstitial volume.
    • Doesn't become evident until interstitial volume has increased by 2.5-3 liters.
  8. Edema from increased capillary filtration pressure
    • Localized is caused by dialation of precapilary sphincters and aterioles that supply that swollen lesion.
    • Generalized- reult of increased vascular volume seen in CHF or Rt. sided heart failure.
  9. Edema from decreased capillary osmotic pressure
    • Plasma proteins exert the osmotic needed to pull fluid back into the capillary from the tissues.
    • Result in inadequate production or abnormal loss of plasma protein mainly albumin.
  10. Edema from increased capillary permeability
    • When capillary pores become enlarged or the integrity of the capillary wall is damaged, capillary permeability is increased.
    • Plasma protein and active particles leak into the interstitial spaces, increasing the tissue collidal osmotic pressure and thereby contributing to the accumulation of interstitial fluid.
  11. Edema from obstruction lymph flow
    • Plasma proteins and other large particles that can't be reabsorbed throgu the pores in the capillary membrane rely on the lymphatic systems for movement back into the circulatory system.
    • Lymphedema- edema due to imparied lymph flow often caused by cancer w/ lymph node involvement, infection and lymph trauma.
  12. More about edema
    • Increases distance for diffusion of O2, nutrients, and wastes.
    • Increased risk of pressure ulcers and can compress bl. vessels.
  13. Pitting Edema
    Exceeds absortive capacity of tissue gel, tissue H2O is mobile and can be translocated w/ pressure
  14. Non- Pitting edema
    reflects on a condition where plasma protein have accumulated in the tissue spaces and coagulated
  15. Hypermia
    • Congestion
    • An unusual amt of bl. in a part increase in quantity of bl. flowing through any part of the body shown by redness of skin
  16. Embolism
    • Sudden obstruction of bl. vessel by debris.
    • Bl. clots, cholesterol containing plaques, masses of bacteria, cancer cells, amniotic fluid, fat from broken bones, and injected substances may lodge in the bl. vessels and ocstruct circulation
  17. Thrombosis
    • Formation or pressure of a bl. clot w/in the vascular system.
    • Clot can occlude vessels, block bl. flow and O2 supply to part of an organ.
    • If detaches, can travel and occlude a vessel at a distance from original site.
  18. Hemorrhage
    • Bl. loss.
    • Episodes of bleeding that last more than a few mintues.
    • Compromise organ or tissue perfusion.
  19. Shock
    • Clinical syndrome marked by inadequateperfusion and oxygenation of cells, tissues, and organs, usually as a result of marginal or markedly lowered bl. pressure.
    • 4 types of shock: cardiogenic, hypovolvemic, Obstructive, and Distributive.
  20. Cardiogenic Shock
    • Heart fails to pump bl. sufficiently enought to meet the body's demands.
    • Decrease in cardiac output, hypotension, hyperfusion, and indications of tissue hypoxia despite an adequate intravascular volume.
  21. Hypovolvemic
    • Dreases bl. volume so that there is inadequate filling of the vascular compartment.
    • From accute bl. loss of 15-20 % of circulating volume.
    • s/s- depend on severity, thirst, increased HR, cool, clammy skin, decreased BP, dec. urine output, change in mental status.
  22. Obstructive Shock
    • Shock from mechanical obstruction of the flow of bl. through the central circulation.
    • Caused by dissecting aortic aneurysm, cardiac tamponade, pneumothorax, atrial myxoma, and evisceration of abdominal contents into thoracic cavity from ruotured diaphragm, pulmonary embolism.
  23. Distributive Shock
    • Vasodialatory shock- loss of bl. vessel tone, enlargement vascular compartment, and displacement of vascular volume away from the heart and central circulation.
    • 2 main causes result in vesssel tone: Decrease in sympathetic control of vasomotor tone, release of extensive vasodialator substances.
  24. 3 Shock states of distributive shock
    • Neurogenic shock- caused by decreased sympathetic control of bl. vessel tone.
    • Anaphylactic shock- immunilogically mediates reaction in which vasodialator substance such as histamine are released.
    • Septic shock- vessel dialates systemic responseto serious problem.
  25. Complications of shock
    • acute lung injury/ acute respiratory distress syndrome.
    • acute renal failure
    • GI complications.
    • disseminated intravascular coagulation.
    • multiple organ dysfunction syndrome.
  26. Hemostasis
    • stoppage of bl. flow.
    • normal process is regulated by complex array of activators and inhobitors that maintain bl. fluidity and prevent bl. from leaving the vascular compartment.
    • normal when seals bl. vessel toprevent bl. loss and hemorrhage.
    • abnormal when it causes inappropriate bl. clotting or when clotting is insufficient to stop the flow of bl. from vascular compartments.
  27. Components of Hemostasis
    • Platelets- platelet production is controlled by thrombopoeitin which are found in liver, kidney, smooth muscle, and bone marrow.
    • Coagulation- use of plasma proteing that are present as inactive procoagluation factors.
    • Endothelium- endothelial cells line vessels that modulated several, and frequently opposite, stages of normal hemostasis.
  28. Clot formation and dissolution
    • Hemostasis 5 stages:
    • vessel spasm, platelet plug formation, bl. coagulation or development of an insoluble fibrin clot, clot retraction, and clot dissolution.
  29. Hemostatic surgical agents/ devices
    • Thermal hemostatic mechanism- ESU, Laser Unit, and Harmonic scapel.
    • Chemical Hemostatic agents- Gel foam, avitene, surgicel or oxycel, and epinephrine.
  30. Hemostatics
    Mechanical hemostatics- clamps, ligatures, clips, spnges, pladgets, bone wax, suction, pressure devices or tourniquets, and drains.