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Nurs. In. Test 1
Fluids and Electrolytes
71
Nursing
Undergraduate 2
08/22/2013

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Term
During studying, be sure to thing of how you would...
Definition
assess, monitor, and teach
Term
Homeostasis
Definition
Balance.
Movement of water in the body is continuous in order to achieve homeostasis
Term
Balance depends on
Definition
The Patient
(Amount of Body water)
Varies with age, body mass and gender
Term
Infants
Definition
70-80% of body weight
Term
Adults
Definition
50-60%
Term
Older adult
Definition
45-55%
Term
Lean vs. Obese
Definition
Lean (More body water)
The muscle has more water contained in it
Term
Male vs. Female
Definition
Male has more water.
More lean muscle.
Term
Who is most at risk for fluid\electrolyte imbalances.
Definition
Infants and Older adults
Term
Balance depends on other factors
Definition
I's and O's-intake-ingested (liquid, food), Parenteral (IV Fluids)
Output (Sensible and Insensible)
Term
Sensible output**
Definition
Can sometimes be measured and we can see it.
Term
Insensible Loss
Definition
Cannot see our body losing fluid-not visible respiration respiration vapors.
Term
Metabolic Oxidation
Definition
Breaking down the food you eat
Term
Will output and intake always be equal?
Definition
NO
Term
Balance is also affected by
Definition
regulatory glands and hormones
Term
Adrenals
Definition
Aldosterone (mineral corticoid)
Glucocorticoids
Term
Aldosterone
Definition
Causes body to reabsorb water and sodium\excretion of potassium.
Term
What happens when you give someone a steroid?
Definition
They retain fluids\may result in Edema
Term
Hypothalamus-Pituitary
Definition
Antidiurectic Hormone (ADH)
Term
ADH
Definition
prevents diuresis, retains fluid
Term
Reasons to retain fluid (the body)
Definition
Low sodium
Surgery
Trauma
Burns
People in Pain
NPO
Blood Loss
Term
Thyroid
Definition
Thyroxine
Term
Thyroxine (what does it do to hb, blood flow, output)
Definition
affects the metabolic rate. Increases HB, blood flow, and output
Term
Look at stress signals chart (page 4 in first section of notes!)
Definition
Term
Two special problems of ADH (Diseases of the pituitary gland)
Definition
Diabetes insipidus (ADH deficiency)
Syndrome of inappropriate antidiuretic hormone (SIADH)
Term
Not holding onto enough fluids
Definition
Leads to dehydration
Term
Diabetes Insipidus
Definition
ADH deficiency
Polyuria (excessive urination)
Dehydration
Term
Syndrome of inappropriate antidiuretic hormone (SIADH)
Definition
ADH excess
Water retained-dilution: Holding onto too much fluid dilutes everything (especially sodium)
Term
Balance depends on plasma proteins
Definition
Plasma Proteins\albumin, Glucose, Atrial Natriuretic Peptide (ANP)
Term
Plasma proteins\albumin
Definition
Provides oncotic pressure in the vascular space (Helps hold fluid in vasular space)
Term
Vascular space
Definition
Where plasma is
Term
Not enough albumin
Definition
Fluid leaks out and patient develops edema
Term
Pt. at risk for low albumin
Definition
-Esp. Post Op, blood loss, liver disease, anemia, malnutrition
Term
Glucose
Definition
High particle to water ration results in diuresis.
Term
Atrial natriutretic peptide (ANP)
Definition
Compensatory to ADH and Aldosterone
Response to increase intravascular volume
Causes diuresis
It's released when the vessels in the heart become gorged
Term
Intracellular Fluid (ICF)
Definition
40% of body weight or 70% of body fluid. We can't measure what's in our cell, but we can measure vascular
Term
Interstitial fluid
Definition
surrounds the cell
Term
Extracellular fluid (ECF)
Definition
20% of body weight or 30% of body fluid
Intravascular fluids or plasma
Interstitial fluid (surrounds tissue cells, Third Space*)
Term
Plasma
Interstitial
Intracellular (%)
Definition
5%, 15%, 40%
Term
Osmolarity
Definition
Whats in the bag (Fluids)
Term
Osmolality
Definition
What's in the body
Term
Isotonic
Definition
balanced
Term
Isotonic
Definition
balanced
Term
Hypertonic
Definition
shrinks (solutes more than plasma)
Term
Hypotonic
Definition
Swells (Solutes less than plasma)
Term
Isotonic
Definition
(275-295 mOsm\L)
Concentration is similar to plasma
Helps expand circular volume.
Prevents dehydration, supports BP, used in surgery, maintenance of fluids
Indication-hypovolemia
Term
Hypertonic
Definition
(> or = to 295)
Fluid shifts from ICF to interstitial space to intravascular space. (Prevents from going into the cell)
Indications-intravascular dehydration
Reduce post op edema
Term
Hypotonic
Definition
Closely monitor
(< or = 275)
Fluid shifts from intravascular space to ICF
Indications-Cellular dehydration (Not because of dehydration, but because they're diabetic)
This is not common
Closely Monitor
Term
Plasma Expanders
Definition
Stay in vascular space and increase osmotic pressure
Packed RBCs, Albumin, Plasma
Term
Serum Osmolality
Definition
2885-295 mOsm\kg
Term
Hemoglobin
Definition
14-18 g\dL males
12-16 g\dL female
Term
Hematocrit
Definition
41-53% males, 36%-46% females,
Fluid balance increase if dehydrated
Term
Serum Sodium
Definition
135-145
Term
Blood urea Nitrogen (BUN)
Definition
Shows concentration (fluid balance)
7-18mg\dL
Increased in older adults
Shows liver and kidney function
Term
Serum creatinine
Definition
0.6-1.2 mg\dL
Decreases with age
Term
Albumin
Definition
3.4-5.0
Term
Fluid Volume Deficit (FVD)
Related to
Definition
N\V\D, actual fluid loss, some parts of the body may not be function properly
Term
Dehydration (Hypovolemia)
Common risk factors (Causes)
Definition
Burns, Trauma, malnutrition, overuse of diuretics and laxatives, diabetes insipidous, heat stroke, NPO, Hemorrhage, NG Suctioning, Wounds, Alcohol (acts as a diuretic)
Term
Dehydration (hypovolemia)
Clinical Manifestations
Definition
increase HR, Respiratory, Urine grav.
Decrease in BP, urine output, skin turgor, cap refill
Dry membrans, skin looks pale cool and clammy, flat veins, possible fever, weight loss, confusion, lethargic
Term
Dehydration (Hypovolemia)
Outcomes
Definition
Monitor output\cardiac labs
adequate I's and O's
Increased strength
Reverse of cray vitals
Daily weights
Term
Intervention for Weights
Definition
Same scale, same time of day, have them consistently void before
Term
Third space shift (third spacing)
Definition
Shift from vascular to spaces where fluid cannot be used
Term
third spacing (What places can fluids not be used?)
Definition
Interstitial, pericardium, bowel, plueral, peritoneal, joint
Term
Causes of third space
Definition
Hypoalbuminemia, tissue trauma, ascites, acute bowel obstruction, peritonitis, pleural effusion (lungs), Pancreatitis
Term
Third Space S&S
Definition
Edema, Pitting (Non-pitting)
Wheezing, crackles, Vascular dehydration (You still have fluid but it isn't in the vascular)
Term
third space interventions
Definition
I&O's, weights, abdominal girth, lung sounds, edema
Term
Fluid Volume excess (overhydration)
Risk Factors (Causes)
Definition
Poorly controlled IV therapy
renal failure
long term steriod treatment
SIADH
Water intoxication
Congestive HF
Postop
Term
Fluid Volume excess (overhydration)
Clinical Manifestations
Definition
Pulse bounding, increase in BP, HR, weight gain, urine output, there is wheezing, crackles, distension, headache, diluted urine, Polyuria, full veins, shortness of breath (dyspnea)
Term
Fluid Volume excess (overhydration)
LABS
Definition
Decrease in NA, USG, Serum osmolality, HCT, BUN
Term
Hypovolemia Labs
Definition
Increase in Na, USG, Serum osmolality, Hct, BUN
Term
Fluid Volume excess (overhydration)
Outcomes
Definition
Monitor I's and O's, daily weights, watch IV fluids, diet (sodium), Check labs, listen to lungs, monitor effects of diuretic then watch\monitor loss of potassium, stable output, clear lung sounds,
**slow infusion for elderly and infants
Careful monitoring IV fluids with cardiac and renal patients
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