Term
|
Definition
Intracellular Fluid (ICF) - fluid found in the cells (cytoplasm, nucleoplasm) comprises 60% of all body fluids.
Potassium (K+) is the chief cation
Phosphate (PO4-) is the chief anion |
|
|
Term
|
Definition
Extracellular Fluid (ECF) - all fluids found outside the cells, comprises 40% of all body fluids
Sodium (Na+) is the major cation
Chloride (Cl-)is the major anion |
|
|
Term
| What are interstitial fluids? |
|
Definition
| Interstitial Fluid - 80% of ECF is found in localized areas: lymph, cerebrospinal fluid, synovial fluid, aqueous humor and vitreous body of eyes, between serous and visceral membranes, glomerular filtrate of kidneys. |
|
|
Term
|
Definition
| Blood Plasma - 20% of ECF found in circulatory system |
|
|
Term
| How much does water make up of the body? |
|
Definition
| Water is the main component of all body fluids making up 45-75% of the total body weight. |
|
|
Term
| Where is water from in the body? |
|
Definition
Ingested foods and liquids (preformed water)
Metabolic water produced during dehydration synthesis of anabolism. |
|
|
Term
| What are the 2 classes of solutes? |
|
Definition
Electrolytes are inorganic salts, all acids and bases, and some proteins
Nonelectrolytes – examples include glucose, lipids, creatinine, and urea |
|
|
Term
| Which has more osmotic power? |
|
Definition
| Electrolytes. Attract more water |
|
|
Term
| How does the body respond to changes in the ECF? |
|
Definition
| Homeostatic mechanisms. No receptors directly monitor fluid/electrolyte balance. |
|
|
Term
| What does the body respond in changes to? |
|
Definition
| Plasma volume or osmotic concentrations |
|
|
Term
| When does body content of water and electrolyte rise? |
|
Definition
| If intake exceeds outflow |
|
|
Term
|
Definition
Electrolytes are electrically charged ions
Electrolytes dissolve in water and form ions
Electrolytes can conduct electricity |
|
|
Term
|
Definition
| (An ion is an atom or molecule in which the total number of electrons is not equal to the total number of protons, giving the atom a net positive or negative electrical charge.) |
|
|
Term
|
Definition
Dominant extracellur electrolyte
Chief determinant of osmolality
Normal serum level:135-145 mEq/L |
|
|
Term
| What are s/s of HYPOnatremia? |
|
Definition
Deficiency of sodium in the blood
Hypotension
Tachycardia
Muscle weakness |
|
|
Term
| What are s/s of HYPERnatremia? |
|
Definition
Excess sodium in the blood
Hypertension
Muscle twitching
Mental confusion
Coma |
|
|
Term
|
Definition
Dominant intracellular electrolyte
Primary buffer in the cell (A buffer is a solution whose function is to minimize the change in pH when a base or an acid is added to the solution )
Normal serum level: 3.5-5.5 mEq/L |
|
|
Term
| Where is K+ concentrations low? |
|
Definition
|
|
Term
| Potassium ion excretion increases as... |
|
Definition
| ECF concentrations rise. Aldosterone is secreted and pH rises. |
|
|
Term
| Why does potassium retention occur? |
|
Definition
| when pH falls BECAUSE hydrogen ions shift in and out of cells lead to corresponding shifts in potassium in the opposite direction and interferes with activity of excitable cells |
|
|
Term
| What does potassium play a role in? |
|
Definition
Muscle contraction
Nerve impulses
Cell membrane function
Attracting water into the ICF
Imbalances interfere with neuromuscular function and may cause cardiac rhythm disturbances |
|
|
Term
|
Definition
Reduced dietary intake
Poor absorption by the body
Vomiting and/or diarrhea
Renal disease
Medications (typically diuretics) |
|
|
Term
| What are the s/s of HYPOkalemia? |
|
Definition
Malaise
Skeletal muscle weakness
Decreased reflexes
Hypotension
Vomiting
Excessive thirst
Cardiac arrhythmias and cardiac arrest
Flattened T wave
U wave |
|
|
Term
| What are the causes of HYPERkalemia? |
|
Definition
Serum level above 5.3
Chronic or acute renal failure
Burns
Crush injuries
Excessive use of Potassium salts |
|
|
Term
| What are the s/s of HYPERkalemia? |
|
Definition
Excess potassium in the blood
Cardiac arrhythmias and cardiac arrest
Elevated T wave
Muscle weakness
ECG Changes
Irritability
Nausea
Diarrhea
Oliguria (100 – 400 ml urine output/24 hours)
Weakness and paralysis |
|
|
Term
| How does excess potassium effect the heart? |
|
Definition
| It can cause cardiac arrhythmias and cardiac arrest. An elevated T wave will be present in an electrocardiogram of a person with hyperkalemia. Muscle weakness is also a symptom of hyperkalemia. |
|
|
Term
| What are the ECG changes with HYPERkalemia? |
|
Definition
Peaked T wave
Wide QRS complex
Flat P wave
Lead into sine wave appearance |
|
|
Term
| How do you treat hyperkalemia? |
|
Definition
IV administration of glucose and insulin helps lower serum Potassium levels.
Sodium Bicarbonate also causes potassium to shift into the cells. |
|
|
Term
|
Definition
Activates many enzymes
50% is insoluble in bone
45% is intracellular
5% is extracellular |
|
|
Term
| What are the s/s of HYPOmagnesium? |
|
Definition
Flat T wave
ST interval depression
Prolonged QT interval – may lead to Torsade de Pointes
Tremors
Diarrhea
Hyperactive deep reflexes Confusion/Hallucinations
Seizures
Dysrhythmias |
|
|
Term
| What causes HYPOmagnesium? |
|
Definition
Alcoholism
Malabsorption
Starvation
Diarrhea
Diuresis |
|
|
Term
| What causes HYPERmagnesemia? |
|
Definition
Not common
Occurs with chronic renal insufficiency
Treatment is hemodialysis |
|
|
Term
| What are the symptoms of HYPERmagnesemia? |
|
Definition
Peaked T wave
Bradycardia
CNS Depression
Areflexia
Sedation
Respiratory paralysis |
|
|
Term
|
Definition
Essential for
Neuromuscular transmission
Growth and ossification of bones
Muscle contraction
Excreted through urine, feces, and perspiration
Most is in bones and teeth
Involved in
Blood clotting
Nerve impulse
Muscle contraction |
|
|
Term
| What are the causes of HYPOcalcemia? |
|
Definition
Renal insufficiency
Decreased intake or malabsorption of Calcium
Deficiency in or inability to activate Vitamin D |
|
|
Term
| What are the s/s of HYPOcalcemia? |
|
Definition
Tetany (cramps/convulsions in wrists and ankles)
Weak heart muscle
Increased clotting time
Prolonged QT interval – may lead to Torsade de Pointes
Abnormal behavior
Chvostek's sign (facial twitching)
Paresthesia |
|
|
Term
| What causes HYPERcalcemia? |
|
Definition
Neoplasms (tumors)
Excessive administration of Vitamin D |
|
|
Term
| What are the S/S of HYPERcalcemia? |
|
Definition
Kidney stones
Bone pain
Cardiac arrhythmias
Shortened QT interval
Hypotonicity of muscles (decreased muscle tone)
Renal stones
Altered mental status |
|
|
Term
| How do you treat HYPERcalcemia? |
|
Definition
Usually aimed at underlying disease and hydration
Severe hypercalcemia may be treated with forced diuresis |
|
|
Term
|
Definition
energy metabolism
genetic coding
cell function
bone formation
Normal serum level: 2.5-4.5 mg/dL |
|
|
Term
| What are the causes of HYPOphosphatemia? |
|
Definition
Alcoholism
Hyperalimentation without phosphate
Chronic ingestion of antacids
Post stomach surgery
If you are lacking in Vitamin-D (which is needed to absorb phosphate) |
|
|
Term
| What are the s/s of HYPOphosphatemia/ |
|
Definition
Respiratory difficulty
Confusion
Irritability
Coma. |
|
|
Term
| What are the causes of HYPERphosphatemia? |
|
Definition
Severe infections
Kidney failure
Thyroid failure
Parathyroid Failure
Often associated with hypocalcemia or hypomagnesemia or too much Vitamin D
Cell destruction - from chemotherapy, when the tumor cells die at a fast rate. This can cause tumor lysis syndrome. |
|
|
Term
| What are the s/s of HYPERphosphatemia? |
|
Definition
Elevated blood phosphate level
There are no symptoms of hyperphosphatemia. |
|
|
Term
| How do you treat HYPERphosphatemia? |
|
Definition
Calcium Carbonate tablets
Aluminum hydroxide (can cause aluminum toxicity. |
|
|
Term
|
Definition
| is a form of passive transport (no energy required) in which substances flow from an area of high concentration to an area of low concentration. |
|
|
Term
|
Definition
| diffusion of water across a semipermeable membrane. The semipermeable membrane is necessary for osmosis because it restricts the movement of certain solutes, allowing the solvent to pass through. Water generally moves freely through semipermeable membranes. |
|
|
Term
| What governs the rate of diffusion of substances? |
|
Definition
1. The greater the concentration differences, the higher the rate of diffusion.
2. The higher the temperature, the greater the rate of diffusion.
3. The lighter the molecule, the greater the rate of diffusion.
4. The faster molecules move, the greater the rate of diffusion. |
|
|
Term
|
Definition
| the passage of materials through a membrane by a physical force such as gravity. In the body filtration is also achieved by means of a physical pump, the heart, which effects the rate of filtration by effecting the pressure of the blood through the blood vessels. |
|
|
Term
| What is active transport? |
|
Definition
| movement of ions or molecules across a cell membrane in the direction opposite that of diffusion, that is, from an area of lower concentration to one of higher concentration. Active transport requires the assistance of a type of protein called a carrier protein, using energy supplied by ATP. |
|
|
Term
|
Definition
| means that the cell’s environment has a NaCl concentration equal to the NaCl concentration that the cell has. In other words, the cell’s environment has a NaCl concentration equal to 0.85 %. If cells are placed in an isotonic solution, there will be equal movement of water in and out of the cell. |
|
|
Term
|
Definition
| means that the cell’s environment contains a higher concentration of NaCl than the cell itself has. In other words, the cell’s environment has a NaCl concentration greater than 0.85 %. If cells are placed in a hypertonic solution, there will be a net movement of water (osmosis) out of the cell which will cause the cell to shrink or crenate. Why would this happen? |
|
|
Term
|
Definition
| means that the cell’s environment contains a lower concentration of NaCl than the cell itself has. In other words, the cell’s environment has a NaCl concentration less than 0.85%. If cells are placed in a hypotonic solution, there will be a net movement of water (osmosis) into the cell. The cells will swell and possibly burst -- bursting is described as hemolysis in red blood cells. Why would this happen? |
|
|
Term
| What is fluid intake primarily through? |
|
Definition
|
|
Term
| What is IOM recommendation? |
|
Definition
| 2700 mL/day women, 3500 mL/day men |
|
|
Term
| What is fluid intake regulated by? |
|
Definition
THIRST!
Change in plasma osmolality
Hypothalamus |
|
|
Term
|
Definition
Urine: 1500 mL/day
Skin: perspiration
Lungs: exhalation
Feces: 100–200 mL/day |
|
|
Term
| What are the hormones involved in hormonal regulation? |
|
Definition
Antidiuretic hormone (ADH)
Renin-angiotensin system
Aldosterone
Thyroid hormone
Brain naturetic factor |
|
|
Term
| What is fluid volume deficit? |
|
Definition
Hypovolemia
Dehydration
Dry skin, mucous membranes
Nonelastic skin turgor
Decreased urine output and blood pressure (hypotension); increased heart rate (tachycardia); rise in temperature
Weight loss |
|
|
Term
| What is fluid volume excess? |
|
Definition
Hypervolemia
Overhydration
Elevated blood pressure, bounding pulse
Pale, cool skin
Edema/ascites
Crackles |
|
|
Term
| What are the major electrolytes? |
|
Definition
|
|
Term
|
Definition
| Compound that contains H+ IONS |
|
|
Term
|
Definition
| Compound that ACCEPTS H+ ions |
|
|
Term
| What is acid/base reflected in? |
|
Definition
|
|
Term
| What is the pH range for blood? How is it measured? |
|
Definition
|
|
Term
| How is acid/base regulated? |
|
Definition
Buffer systems
respiratory systems
renal mechanisms |
|
|
Term
|
Definition
Serum pH BELOW 7.35
Respiratory acidosis - high PCO2
Metabolic acidosis - low HCO3 |
|
|
Term
|
Definition
Serum pH ABOVE 7.45
Respiratory alkalosis - low PCO2
Metabolic alkalosis - high HCO3 |
|
|
Term
| How do you assess for fluid balance? |
|
Definition
- Head to toe physical assessment
- Vital signs
- Daily weight
- Fluid I/O
- Lab results |
|
|
Term
| What nursing interventions are involved in fluid balance? |
|
Definition
Dietary teaching
Oral electrolyte supplements
Limiting or facilitating oral fluid intake
Parenteral replacement of fluids and/or electrolytes |
|
|
Term
| What are the 3 types of environments of the body? |
|
Definition
Isotonic
Hypertonic
Hypotonic |
|
|
Term
| What is the main fxn of the kidneys? |
|
Definition
| to filter our blood and remove waste as urine. Both kidneys do the same job. Blood is taken to the kidneys by the renal artery and when it is cleaned, it is returned to the heart by the renal vein. The urine is taken to the bladder by the ureters. |
|
|
Term
|
Definition
. Each nephron has a capsule (bowman’s capsule) that is in direct contact with a capillary bed known as the glomerulus. The glomerulus is the site of filtration.
The capillaries in the glomerulus drain into more arterioles that continue to help blood get filtered along the nephron before returning to the renal vein. |
|
|
Term
| Where does reabsorption take place in the kidneys? |
|
Definition
| Reabsorption takes place between the nephron tubule and the second capillary bed. |
|
|
Term
| When is water balance inhibited? |
|
Definition
|
|
Term
| What are the 2 types of feedback? |
|
Definition
Negative feedback involves constantly adjusting to correct and abnormal situation.
Example – production of ADH returns water balance to normal, ADH production stops
Positive feedback involves processes that must be completed quickly and the production of some hormone triggers the production of more
Example – production of chemical clotting agents at the site of a cut will trigger the production of more clotting agents to rapidly clot and minimize blood loss |
|
|
Term
| What is deficient fluid volume? |
|
Definition
| Decreased intravascular, interstitial, and/or intracellular fluid (refers to dehydration, water loss alone without change in sodium level) |
|
|
Term
| What are defining characteristics of deficient fluid volume? |
|
Definition
Decreased urine output;
increased urine concentration;
weakness;
sudden weight loss (except in third-spacing);
decreased venous filling;
increased body temperature;
decreased pulse volume/pressure;
change in mental state;
elevated hematocrit; because plasma is lost
decreased skin/tongue turgor;
dry skin/mucous membranes;
thirst;
increased pulse rate;
decreased blood pressure |
|
|
Term
| What are related factors to deficient fluid volume? |
|
Definition
Active fluid volume loss;
failure of regulatory mechanisms |
|
|
Term
| What are the characteristics of stage one hypovolemic shock? |
|
Definition
Up to 15% blood volume loss (750 mL)
Compensated by constriction of vascular bed
Blood pressure maintained
Normal respiratory rate
Pallor of the skin
Normal mental status to slight anxiety
Normal capillary refill
Normal urine output |
|
|
Term
| What are the characteristics of stage 2 hypovolemic shock? |
|
Definition
15–30% blood volume loss (750–1500 mL)
Cardiac output cannot be maintained by arterial constriction
Tachycardia >100 bpm
Increased respiratory rate
Systolic blood pressure maintained
Increased diastolic blood pressure
Narrow pulse pressure (gap between the systolic and diastolic pressure)
Sweating from sympathetic nervous system stimulation
Mildly anxious/Restless
Delayed capillary refill
Urine output of 20-30 milliliters/hour |
|
|
Term
| What are the characteristics of stage 3 hypovolemic shock? |
|
Definition
30–40% blood volume loss (1500–2000 mL)
Systolic BP falls to 100 mmHg or less
Classic signs of hypovolemic shock
Marked tachycardia (increased heart rate) >120 bpm
Marked tachypnea (increased rate of respiration) >30 bpm
Alteration in mental status (confusion, anxiety, agitation)
Sweating with cool, pale skin
Delayed capillary refill
Urine output of approximately 20 milliliters/hour |
|
|
Term
| What are the characteristics of stage 4 hypovolemic shock? |
|
Definition
Loss greater than 40% (>2000 mL) Extreme tachycardia (>140) with weak pulse
Pronounced tachypnea
Significantly decreased systolic blood pressure of 70 mmHg or less
Decreased level of consciousness, lethargy, coma
Skin is sweaty, cool, and extremely pale (moribund)
Absent capillary refill
Negligible urine output |
|
|
Term
| What do you do when treating hypovolemic shock? |
|
Definition
, further workup depends on the probable cause of the hypovolemia, as well as on the stability of the patient's condition.
Initial laboratory studies should include analysis of the CBC, electrolyte levels (eg, Na, K, Cl, HCO3, BUN, creatinine, glucose levels), prothrombin time, activated partial thromboplastin time, ABGs, urinalysis (in patients with trauma), and a urine pregnancy test. Blood should be typed and cross-matched. |
|
|
Term
| What is the work up for a patient with hypovolemic shock? |
|
Definition
| The workup for the patient with trauma and signs and symptoms of hypovolemia is directed toward finding the source of blood loss. |
|
|
Term
| What does an atraumatic patient with hypovolemic shock require? |
|
Definition
| ultrasonography examination in the ED if an abdominal aortic aneurysm is suspected. If GI bleeding is suspected, a nasogastric tube should be placed, and gastric lavage should be performed. An upright chest radiograph should be obtained if a perforated ulcer is a possibility |
|
|
Term
| What happens if a person with hypov. shock is pregnant? |
|
Definition
| surgical consultation and the consideration of bedside pelvic ultrasonography should be immediately performed in the ED. Hypovolemic shock secondary to an ectopic pregnancy is common. |
|
|
Term
| If thoracic dissection is suspected b/c of the mechanism and initial chest radiographic findings, what does the work up involve? |
|
Definition
| may include transesophageal echocardiography, aortography, or CT scanning of the chest. |
|
|
Term
| If a traumatic abdominal injury is suspected, what happens next? |
|
Definition
| a focused abdominal sonography for trauma (FAST) ultrasonography examination may be performed in the stable or unstable patient. If long-bone fractures are suspected, radiographs should be obtained. |
|
|
Term
| What do you do if hypovolemic shock is caused by a medication? |
|
Definition
| the administration of antidotes may be appropriate but should be carefully monitored to avoid shock or the emergence of other pre-existing conditions. |
|
|
Term
| When is fluid replacement beneficial in hypovolemia? |
|
Definition
| stage 2, and is necessary in stage 3 and 4. For a patient presenting with hypovolemic shock in hospital the following investigations would be carried out: |
|
|
Term
| What blood tests are performed on hypovolemic patients? |
|
Definition
| U+Es/Chem7, FBC, Glucose, Cross-match |
|
|
Term
| What diagnostic tests are performed to diagnose hypovolemia? |
|
Definition
Central Venous Line/Blood Pressure
Arterial line/Arterial Blood Gases
Urine output measurements (via urinary catheter)
Blood pressure
SpO2 Oxygen saturations |
|
|
Term
| What are the basic interventions of hypovolemia? |
|
Definition
IV access
Oxygen as required
Surgical repair at sites of hemorrhage
Inotrope therapy (Dopamine, Noradrenaline) which increase the contractility of the heart muscle
Fresh frozen plasma/whole blood |
|
|
Term
| How do you determine effectiveness of treatment in hypovolemia? |
|
Definition
Maintains urine output >1300 ml/day (or at least 30 ml/hr)
Maintains normal blood pressure, pulse, and body temperature
Maintains elastic skin turgor; moist tongue and mucous membranes; and orientation to person, place, time
Explains measures that can be taken to treat or prevent fluid volume loss
Describes symptoms that indicate the need to consult with health care provider |
|
|
Term
| Why would you need to monitor for the existence of factors causing deficient fluid volume (e.g., gastrointestinal losses, difficulty maintaining oral intake, fever, uncontrolled type II diabetes, diuretic therapy)? |
|
Definition
| Early identification of risk factors and early intervention can decrease the occurrence and severity of complications from deficient fluid volume. The gastrointestinal system is a common site of abnormal fluid loss |
|
|
Term
| Why do you need to watch for early signs of hypovolemia, including weakness, muscle cramps, and postural hypotension.? |
|
Definition
| Late signs include oliguria; abdominal or chest pain; cyanosis; cold, clammy skin; and confusion |
|
|
Term
| Why do you need to monitor total fluid intake and output every 8 hours (or every hour for the unstable client)? |
|
Definition
| A urine output of <30 ml/hr is insufficient for normal renal function and indicates hypovolemia or onset of renal damage |
|
|
Term
| Why do you need to watch trends in output for 3 days; include all routes of intake and output and note color and specific gravity of urine? |
|
Definition
| Monitoring for trends for 2 to 3 days gives a more valid picture of the client's hydration status than monitoring for a shorter period. Dark-colored urine with increasing specific gravity reflects increased urine concentration. |
|
|
Term
| Why do you need to monitor daily weight for sudden decreases, especially in the presence of decreasing urine output or active fluid loss. Weigh client on same scale with same type of clothing at same time of day, preferably before breakfast? |
|
Definition
| Body weight changes reflect changes in body fluid volume. A 1-pound weight loss reflects a fluid loss of about 500 cc |
|
|
Term
| Why do you need to monitor vital signs of clients with deficient fluid volume every 15 minutes to 1 hour for the unstable client (every 4 hours for the stable client). Observe for decreased pulse pressure first, then hypotension, tachycardia, decreased pulse volume, and increased or decreased body temperature? |
|
Definition
| A decreased pulse pressure is an earlier indicator of shock than is the systolic blood pressure (Mikhail, 1999). Decreased intravascular volume results in hypotension and decreased tissue oxygenation. The temperature will be decreased as a result of decreased metabolism, or it may be increased if there is infection or hypernatremia present |
|
|
Term
| Why do you need to check orthostatic blood pressures with client lying, sitting, and standing? |
|
Definition
| A 15 mm Hg drop when upright or an increase of 15 beats/minute in the pulse rate are seen with deficient fluid volume |
|
|
Term
| Why do you need to monitor for inelastic skin turgor, thirst, dry tongue and mucous membranes, longitudinal tongue furrows, speech difficulty, dry skin, sunken eyeballs, weakness (especially of upper body), and confusion.? |
|
Definition
| Tongue dryness, longitudinal tongue furrows, dryness of the mucous membranes of the mouth, upper body muscle weakness, thirst, confusion, speech difficulty, and sunkenness of eyes are symptoms of deficient fluid volume |
|
|
Term
| Why do you need to provide frequent oral hygiene, at least twice a day (if mouth is dry and painful, provide hourly while awake).? |
|
Definition
| Oral hygiene decreases unpleasant tastes in the mouth and allows the client to respond to the sensation of thirst. |
|
|
Term
| Why do you need to provide fresh water and oral fluids preferred by client (distribute over 24 hours [e.g., 1200 ml on days, 800 ml on evenings, and 200 ml on nights]); provide prescribed diet; offer snacks (e.g., frequent drinks, fresh fruits, fruit juice); instruct significant other to assist client with feedings as appropriate.? |
|
Definition
| The oral route is preferred for maintaining fluid balance (Metheny, 2000). Distributing the intake over the entire 24 hour period and providing snacks and preferred beverages increases the likelihood that the client will maintain the prescribed oral intake. |
|
|
Term
| Why do you need to provide free water with tube feedings as appropriate (50 to 100 ml every 4 hours)? |
|
Definition
| This provides water for replacement of intravascular or intracellular volume as necessary. Tube feeding has been found to increase the risk for dehydration |
|
|
Term
| Why do you need to institute measures to rest the bowel when client is vomiting or has diarrhea (e.g., restrict food or fluid intake when appropriate, decrease intake of milk products). Hydrate client with ordered IV solutions if prescribed? |
|
Definition
| The most common cause of deficient fluid volume is gastrointestinal loss of fluid. At times it is preferable to allow the gastrointestinal system to rest before resuming oral intake. Hydration should be maintained. (See care plan for Diarrhea or Nausea.) |
|
|
Term
| Why do you need to provide oral replacement therapy as ordered with a glucose-electrolyte solution when client has acute diarrhea or nausea/vomiting. Provide small, frequent quantities of slightly chilled solutions? |
|
Definition
| Maintenance of oral intake stabilizes the ability of the intestines to digest and absorb nutrients; glucose-electrolyte solutions increase net fluid absorption while correcting deficient fluid volume (Cohen et al, 1995). |
|
|
Term
| Why do you need to administer antidiarrheals and antiemetics as appropriate? |
|
Definition
| The gastrointestinal tract is a common site for fluid loss. The goal is to stop the loss that results from vomiting or diarrhea. |
|
|
Term
| Why do you need to , maintain patent IV access, set an appropriate IV infusion flow rate, and administer at a constant flow rate as ordered.? |
|
Definition
| Isotonic IV fluids such as 0.9% N/S or lactated ringers allow replacement of intravascular volume |
|
|
Term
| Why do you need to assist with ambulation if client has postural hypotension? |
|
Definition
| Postural hypotension can cause dizziness, which places the client at higher risk for injury. |
|
|
Term
| Why do you need to promote skin integrity (e.g., monitor areas for breakdown, ensure frequent weight shifts, prevent shearing, promote adequate nutrition)? |
|
Definition
| Deficient fluid volume decreases tissue oxygenation, which makes the skin more vulnerable to breakdown. |
|
|
Term
| Why do you need to monitor elderly for dizziness associated with hypovolemia? |
|
Definition
| The elderly are predisposed to deficient fluid volume because of decreased fluid in body, decreased thirst sensation, and decreased ability to concentrate urine |
|
|
Term
| How much of the adult body is made of water? |
|
Definition
|
|
Term
| How much of a infant's body is made of water? |
|
Definition
70-80%
More prone to fluid/electorlyte imbalance |
|
|
Term
| How much of the older adult's body is made of water? |
|
Definition
45-50%
Less fluid reserve during periods of illness |
|
|
Term
| What is fluid volume deficit? |
|
Definition
| Dehydration or the loss of fluids/electrolytes due to vomiting, dia, excessive sweating, fever, nasogastric suction |
|
|
Term
| What is fluid volume excess? |
|
Definition
| A condition of fluid overload or retention. The body retains H2O and sodium |
|
|
Term
| What are the functions of water? |
|
Definition
1.) Transporting nutrients to cells and waste from them
2.) Transporting hormones, enxymes, blood platelets, and RBC/WBC
3.) Facilitating cellular metabolism and proper cellular chemical fxn
4.) Acting as a solvent for electrolytes and nonelectrolytes
5.) Solvent
6.) Maintain temperature
7.) Facilatating digestion and promoting elimnation
8.) Acting as a tissue lubricant |
|
|
Term
| What is the difference between a cation and anion? |
|
Definition
Cation - positive charged ions
Anion - negatively charged ions |
|
|
Term
|
Definition
| Liquids that hold a substance in solution |
|
|
Term
|
Definition
| substances dissolved in a solution |
|
|
Term
| How are electrolytes regulated? |
|
Definition
Water distribution
Acid-base balance
Neuromuscular excitability |
|
|
Term
| What are the fxns of sodium? |
|
Definition
Regulates volume of body fluids
Maintains water balance
Regulates ECF
Influences ICF
Generation and transmission of nerve impulses
Sodium-Potassium pump |
|
|
Term
| What are the fxns of potassium? |
|
Definition
Regulates cellular enzyme activity and water content
Transmission of nerve and muscle impulses
Metabolism of proteins and carbohydrates
Regulation of acid-base balance by cellular exchange with H+ |
|
|
Term
| What are the fxns of calcium? |
|
Definition
Nerve impulse transmission and blood clotting
Catalyst for muscle contraction
Thickness and strength of of cell membranes |
|
|
Term
| What are the fxns of magnesium? |
|
Definition
Metabolism of carbohydrates and proteins
Vital enzyme actions
Protein and DNA synthesis
Maintaining intracellular levels of Potassium
Maintain electrical activity in nervous tissue and muscle tissue membranes |
|
|
Term
| What are the fxns of chloride? |
|
Definition
Works with sodium to maintain osmotic pressure of blood
Regulates acid-base balance
Buffering action during O2/CO2 exchange
Production of Hydrochloric acid in digestion |
|
|
Term
| What are the fxns of bicarbonate? |
|
Definition
| Essential for acid base balance. Works with carbonic acid to make up the body’s acid base buffer system |
|
|
Term
| What are the fxns of phosphate? |
|
Definition
Maintains body’s acid-base balance
Cell division and transmission of heredity
Chemical reactions use of Vit B, CHO metabolism, nerve and muscle action |
|
|
Term
|
Definition
Anion
ICF
Excreted in the kidney |
|
|
Term
|
Definition
Anion
Facilitates diffusion to and from capillaries |
|
|
Term
| What is filtration influenced by? |
|
Definition
Colloid osmotic pressure
Hydrostatic pressure |
|
|
Term
| What are the sources for water? |
|
Definition
-Ingested liquids
-Food
-Metabolism |
|
|
Term
| Where is insensible water lost? |
|
Definition
-Kidneys (urine)
-GI tract (poop)
-Skin (sweat) |
|
|
Term
|
Definition
| Hypovolemia — deficiency in amount of water and electrolytes in ECF with near normal water/electrolyte proportions |
|
|
Term
|
Definition
| decreased volume of water and electrolyte change |
|
|
Term
| What is third-space fluid shift? |
|
Definition
| distributional shift of body fluids into potential body spaces |
|
|
Term
|
Definition
| excessive retention of water and sodium in ECF |
|
|
Term
|
Definition
| above normal amounts of water in extracellular spaces |
|
|
Term
|
Definition
| excessive ECF accumulates in tissue spaces |
|
|
Term
| What is interstitial to plasma shift? |
|
Definition
| movement of fluid from space surrounding cells to blood |
|
|
Term
| What are nursing diagnoses related to imbalance? |
|
Definition
Excess fluid volume
Deficient fluid volume
Risk for imbalanced fluid volume |
|
|
Term
| What are expected outcomes related to imbalance? |
|
Definition
Maintain approximate fluid intake and output balance (2500mL intake and output over 3 days)
Maintain urine specific gravity within normal range (1.010 to 1.025)
Practice self-care behaviors to promote balance |
|
|
Term
| How do you implement planning for fluid imbalance? |
|
Definition
Dietary modifications
Modifications of fluid intake
Medication administration
IV therapy
Blood and blood products replacement
TPN |
|
|
Term
| What medications are used in fluid imbalance? |
|
Definition
Mineral-electrolyte preparations
Diuretics
Intravenous therapy |
|
|
Term
| What IV therapy is used for fluid imbalance? |
|
Definition
Vascular access devices
Peripheral venous catheters
Midline peripheral catheter
Central venous access devices
Implanted ports |
|
|
Term
| How do you know which vein to use? |
|
Definition
Accessibility of a vein
Condition of vein
Type of fluid to be infused
Anticipated duration of infusion |
|
|
Term
| What is the normal daily urine volume in adults? |
|
Definition
|
|
Term
|
Definition
- True Solution
- Capable of passing through a semipermeable membrane |
|
|
Term
|
Definition
Solutions that DO NOT dissolve.
Not true solutions
Increase intravascular colloid osmotic pressure |
|
|
Term
| What are the 4 main types of IV fluid? |
|
Definition
- Resuscitation Fluid
- Maintenance fluid
- Replacement fluid
- Totale parenteral fluid |
|
|
Term
| What are examples of 3 hypotonic solutions? |
|
Definition
1.) 0.45% NaCl
2.) 5% Dextrose Water
3.) 0.2% NaCl |
|
|
Term
| What are examples of isotonic solution? |
|
Definition
1.) Ringer's Lactate
2.) Blood Components
3.) 0.9% NaCl |
|
|
Term
| What are the mechanisms of homeostasis in the body? |
|
Definition
- Kidneys
- Cardiovas. system
- Lungs
- Adrenal Glands
- Thyroid gland
- Parathyroid gland
- Gastrointestinal tract
- Nervous system |
|
|
Term
| How do the adrenal glands maintain homeostasis? |
|
Definition
| secrete aldosterone helps body to retain sodium, chloride and water and excrete potassium. |
|
|
Term
| How does the thyroid maintain homeostasis? |
|
Definition
throxine increases blood flow in the body to increase glomerular filtration in the kidney
Parathyroid hormone regulates ca++ in the ECF |
|
|
Term
| How does the nervous system maintain homeostasis? |
|
Definition
| osmoreceptors are sensitive to changes in ECF and send messages to approp spot to maintain homeostasis. Thalmus gland to stimulate thirst, pituitary gland to release or inhibit ADH for fluid regulation. |
|
|
Term
| What is the carbonic acid-sodium bicarbonate system? |
|
Definition
| Sodium bicarb/carbonic acid buffers up to 90% most significant in the system. Exist n body in a 20:1 ration of HCO3- tp H2CO3 |
|
|
Term
| What is the phosphate buffer system? |
|
Definition
| Phosphate buffer in ICF converts sodium phosphate base to sodium phosphate acid in the kidneys |
|
|
Term
| What is the protein buffer system? |
|
Definition
| Protein and hemoglobin in plasma can combine with free h+ ions to act as buffer |
|
|
Term
| For the patient with hyperkalemia related to decreased renal excretion secondary to potassium conserving diuretic therapy” an appropriate expected outcome would be which of the following? |
|
Definition
| ECG will show no cardiac arrhythmias within 48 hours after removing salt substitutes, coffee, tea and other K+ rich foods from the diet |
|
|
Term
| Which of the following nursing diagnoses would you expect to find based on the effects of fluid and electrolyte imbalance on human functioning? |
|
Definition
| Altered thought processes related to cerebral edema, including mental confusion and disorientation |
|
|
Term
| A nurse who diagnoses a patient as having “fluid volume excess” related to compromised regulatory mechanisms (kidneys) may have been alerted by which of the following symptoms? |
|
Definition
|
|
Term
| Pumping uphill would describe which of the following means or transporting materials to and from intercellular compartments? |
|
Definition
|
|
