Term
|
Definition
Fluids within cells
~2/3 of total body water
28 L |
|
|
Term
|
Definition
= Fluid outside of cells
~1/3 of total body water
Three divisions:
– Interstitial
– Intravascular
– Transcellular
14 L |
|
|
Term
|
Definition
| Sodium, Potassium, Calcium, Magnesium |
|
|
Term
|
Definition
| chloride, bicarbonate, sulfate |
|
|
Term
|
Definition
| Compounds that separate into ions when they are dissolved in water |
|
|
Term
|
Definition
| A fluid with the same concentration of nonpermeant particles as normal blood is called isotonic. Isotonic solutions have the same osmolarity as blood, similar to normal saline (0.9% sodium chloride). |
|
|
Term
| What is hypotonic and hypertonic in comparison to blood? |
|
Definition
| A hypotonic solution is more dilute than blood, and a hypertonic solution is more concentrated than normal blood. |
|
|
Term
|
Definition
| A hypotonic solution such as 0.45% sodium chloride moves fluids into cells, causing them to enlarge |
|
|
Term
|
Definition
| A hypertonic solution such as 3% sodium chloride pulls fluid from cells, causing them to shrink. |
|
|
Term
| What is active transport? |
|
Definition
| Movement of ions against osmotic pressure to an area of higher pressure; requires energy |
|
|
Term
|
Definition
| Passive movement of electrolytes or other particles down the concentration gradient (from higher to lower concentration) |
|
|
Term
|
Definition
| Movement of water (or other solute) from an area of lesser to one of greater concentration |
|
|
Term
|
Definition
| Movement across a membrane, under pressure, from higher to lower pressure |
|
|
Term
|
Definition
| Hydrostatic pressure is the force of the fluid pressing outward against a surface. In the process of filtration, hydrostatic pressure differences determine the movement of water. With increased hydrostatic pressure on the venous side of the capillary bed, edema will occur. |
|
|
Term
| What is osmotic pressure? |
|
Definition
| exerts osmotic pressure, an inward-pulling force caused by particles in the fluid. |
|
|
Term
| How does capillary filtration work? |
|
Definition
| At the arterial end of a normal capillary, capillary hydrostatic pressure is strongest, and fluid moves from the capillary into the interstitial area, bringing nutrients to cells. At the venous end, capillary hydrostatic pressure is weaker, and the colloid osmotic pressure of the blood is stronger. Thus fluid moves into the capillary at the venous end, removing waste products from cellular metabolism. Lymph vessels remove any extra fluid and proteins that have leaked into the interstitial fluid. |
|
|
Term
| What does fluid balance consist of? |
|
Definition
Fluid intake and absorption
Fluid distribution
Fluid output |
|
|
Term
|
Definition
| Drinking, eating, thirst and habit. |
|
|
Term
| How is fluid primarily obtained? |
|
Definition
| Fluid intake occurs orally through drinking but also through eating because most foods contain some water. Food metabolism creates additional water. Average fluid intake from these routes for healthy adults is about 2300 mL, although it varies widely. Other routes of fluid intake include IV, rectal (e.g., enemas), and irrigation of body cavities that can absorb fluid. Although you might think that the major regulator of oral fluid intake is thirst, habit and social reasons actually account for most fluid intake. |
|
|
Term
|
Definition
| Thirst, the conscious desire for water, is an important regulator of fluid intake when plasma osmolality increases (osmoreceptor-mediated thirst) or blood volume decreases (baroreceptor-mediated thirst and angiotensin II– and III–mediated thirst). |
|
|
Term
| How does fluid distribution between ECF and intracellular compartments occur? |
|
Definition
|
|
Term
| How does fluid distribution between blood vessels and ECF occur? |
|
Definition
|
|
Term
| Where is the thirst mechanism located? |
|
Definition
|
|
Term
| What causes the sensation of thirst? |
|
Definition
- Increased plasma osmolality
- Decreased plasma volume
- Angiotensin II
- Angiotensin III
- Dry pharyngeal mucus membranes
- Psychological factors |
|
|
Term
| How is fluid normally output? |
|
Definition
| Normally via skin, lungs, GI tract, kidneys |
|
|
Term
| How is fluid abnormally output? |
|
Definition
| Abnormally via vomiting, wound drainage, hemorrhage |
|
|
Term
| What influences fluid output? |
|
Definition
Antidiuretic hormone (ADH)
Renin-angiotensin-aldosterone system (RAAS)
Atrial natriuretic peptides (ANPs) |
|
|
Term
|
Definition
| ADH regulates the osmolality of body fluids by influencing how much water is excreted in urine |
|
|
Term
|
Definition
| The RAAS regulates ECF volume by influencing how much sodium and water is excreted in urine. |
|
|
Term
|
Definition
| Atrial natriuretic peptide (ANP) also regulates ECF volume by influencing how much sodium and water is excreted in urine. |
|
|
Term
| Where is ADH released from? |
|
Definition
|
|
Term
| Where is Aldosterone released from? |
|
Definition
|
|
Term
| Where is ANP released from? |
|
Definition
|
|
Term
|
Definition
Extracellular fluid volume (ECV) deficit
Hypovolemia means decreased vascular volume and often is used when discussing ECV deficit. |
|
|
Term
|
Definition
|
|
Term
| What does hypernatremia lead to? |
|
Definition
| Water deficit -> HYPERtonic |
|
|
Term
| What does hyponatremia lead to? |
|
Definition
| Water excess -> HYPOtonic |
|
|
Term
| What is clinical dehydration? |
|
Definition
| ECV deficit AND hypernatremia. |
|
|
Term
| Plasma concentrations of K+, Ca2+, Mg+, and phosphate (Pi) are very ____ compared with their concentrations in cells and bone. |
|
Definition
|
|
Term
| How are electrolytes balanced? |
|
Definition
-Intake & Absorption
-Distribution
-Output |
|
|
Term
| How is electrolyte output maintained? |
|
Definition
| Electrolyte output occurs through normal excretion in urine, feces, and sweat. Output also occurs through vomiting, drainage tubes, and fistulas. When electrolyte output increases, electrolyte intake must increase to maintain electrolyte balance. Similarly, if electrolyte output decreases, as with oliguria, electrolyte intake must also decrease to maintain balance. |
|
|
Term
|
Definition
| is abnormally low potassium concentration in the blood |
|
|
Term
|
Definition
| . Common causes of hypokalemia from increased potassium output include diarrhea, repeated vomiting, and use of potassium-wasting diuretics |
|
|
Term
| What are the symptoms of hypokalemia? |
|
Definition
| Hypokalemia causes muscle weakness, which becomes life threatening if it includes respiratory muscles and potentially life-threatening cardiac dysrhythmias. |
|
|
Term
|
Definition
| abnormally high potassium ion concentration in the blood. |
|
|
Term
| What causes hyperkalemia? |
|
Definition
| People who have oliguria (decreased urine output) are at high risk of hyperkalemia from the resultant decreased potassium output unless their potassium intake also decreases substantially |
|
|
Term
| What are the symptoms of hyperkalemia? |
|
Definition
| Hyperkalemia can cause muscle weakness, potentially life-threatening cardiac dysrhythmias, and cardiac arrest. |
|
|
Term
|
Definition
| Hypocalcemia is abnormally low calcium concentration in the blood |
|
|
Term
| What causes hypocalcemia? |
|
Definition
| Factors that cause too much ionized calcium to shift to bound forms cause symptomatic ionized hypocalcemia. People who have acute pancreatitis frequently develop hypocalcemia because calcium binds to undigested fat in their feces and is excreted. |
|
|
Term
| What are the symptoms of hypocalcemia? |
|
Definition
| Hypocalcemia increases neuromuscular excitability, which is the basis for its signs and symptoms. |
|
|
Term
|
Definition
| Hypercalcemia is abnormally high calcium concentration in the blood. |
|
|
Term
| What causes hypercalcemia? |
|
Definition
| shift of calcium from bones into the ECF, and decreased calcium output. Patients with cancer often develop hypercalcemia |
|
|
Term
| What are the symptoms of hypercalcemia? |
|
Definition
| Hypercalcemia decreases neuromuscular excitability, the basis for its other signs and symptoms, the most common of which is lethargy. |
|
|
Term
|
Definition
| abnormally low magnesium concentration in the blood |
|
|
Term
| What causes hypomagnesemia? |
|
Definition
| decreased magnesium intake and absorption, shift of plasma magnesium to its inactive bound form, and increased magnesium output |
|
|
Term
| What are the symptoms of hypomagnesemia? |
|
Definition
| Signs and symptoms are similar to those of hypocalcemia because hypomagnesemia also increases neuromuscular excitability. |
|
|
Term
|
Definition
| Abnormally high magnesium conc in the blood |
|
|
Term
| What causes hypermagnesemia? |
|
Definition
| End-stage renal disease causes hypermagnesemia unless the person decreases magnesium intake to match the decreased output |
|
|
Term
| What are the symptoms of hypermagnesemia? |
|
Definition
| Signs and symptoms are caused by decreased neuromuscular excitability, with lethargy and decreased deep tendon reflexes being most common. |
|
|
Term
|
Definition
|
|
Term
|
Definition
| The H+ that acids release |
|
|
Term
| What is the degree of acidity reported as? |
|
Definition
|
|
Term
| What is the pH range of blood? |
|
Definition
|
|
Term
| What are the metabolic acids? |
|
Definition
|
|
Term
| What do the lungs excrete? |
|
Definition
|
|
Term
| What do the kidneys excrete? |
|
Definition
|
|
Term
| How does the lung excrete carbonic acid? |
|
Definition
|
|
Term
| How does the kidney excrete metabolic acids? |
|
Definition
| They secrete H+ into the renal tubular fluid, putting HCO3− back into the blood at the same time. If too many H+ ions are present in the blood, renal cells move more H+ ions into the renal tubules for excretion, retaining more HCO3− in the process. If too few H+ ions are present in the blood, renal cells secrete fewer H+ ions. |
|
|
Term
| The body’s fluid and electrolyte balance is maintained partially by hormonal regulation. You will express an understanding of this mechanism in which of the following statements? |
|
Definition
| D. The pituitary gland secretes antidiuretic hormones |
|
|
Term
| What does respiratory acidosis arise from? |
|
Definition
| Hypoventilation. The lungs are unable to secrete enough CO2 which causes a decrease in pH (more acidic) |
|
|
Term
| What does respiratory alkalosis arise from? |
|
Definition
Arises from alveolar hyperventilation
Lungs excrete too much CO2
Deficit of carbonic acid in the blood increases pH. |
|
|
Term
| How do the kidneys compensate for respiratory acidosis? |
|
Definition
| . The kidneys compensate by increasing excretion of metabolic acids in the urine, which increases blood bicarbonate. |
|
|
Term
| How do they kidneys compensate for respiratory alkalosis? |
|
Definition
| They don't. There isn't enough time. |
|
|
Term
| WHat does metabolic acidosis arise from? |
|
Definition
Arises from increase in metabolic acid or decrease in base (bicarbonate)
Kidneys unable to excrete enough metabolic acids, which accumulate in the blood
Results in decreased level of consciousness |
|
|
Term
| What does metabolic alkalosis arise from? |
|
Definition
Arises from direct increase in base (bicarbonate) or decrease in metabolic acid
Results in increased blood bicarbonate |
|
|
Term
| How do the lungs compensate from metabolic acidosis? |
|
Definition
| Compensatory hyperventilation begins in a few minutes and removes carbonic acid from the body. This process does not correct the problem, but it helps limit the pH decrease |
|
|
Term
| How do the lungs compensate for metabolic alkalosis? |
|
Definition
| The respiratory compensation for metabolic alkalosis is hypoventilation. The decreased rate and depth of respiration allow carbonic acid to increase in the blood, as can be seen by an increased PaCO2. |
|
|
Term
| What should you consider when assessing for fluid balance? |
|
Definition
Age: very young and old at risk
Environment: excessively hot?
Dietary intake: fluids, salt, foods rich in potassium, calcium, and magnesium
Lifestyle: alcohol intake history
Medications: include over-the-counter (OTC) and herbal, in addition to prescription medications |
|
|
Term
| What should you consider when assessing medical history for fluid imbalance? |
|
Definition
Recent surgery (physiological stress)
Gastrointestinal output
Acute illness or trauma
Respiratory disorders
Burns
Trauma
Chronic illness
Cancer
Heart failure
Oliguric renal disease |
|
|
Term
| What should be looked at lab wise when considering fluid imbalance? |
|
Definition
|
|
Term
| What nursing diagnoses are related to fluid/electrolyte/acid-base imbalance? |
|
Definition
• Decreased cardiac output
Impaired oral mucous membrane
Impaired skin integrity
Risk for injury
Acute confusion
Risk for electrolyte imbalance
Deficient fluid volume
Deficient knowledge regarding disease management
Excess fluid volume
Ineffective tissue perfusion
Impaired gas exchange |
|
|
Term
| What do central lines do? |
|
Definition
| Central venous lines deliver intravenous fluid into the superior vena cava near the heart. (CVAD, Central venous access device.) |
|
|
Term
| What are IV solutions considered? |
|
Definition
|
|
Term
|
Definition
| Vascular access devices (VADs) are catheters or infusion ports designed for repeated access to the vascular system. Peripheral catheters are for short-term use (e.g., fluid restoration after surgery and short-term antibiotic administration). |
|
|
Term
| What does hypotonic solution do to the body's cells? |
|
Definition
| Hypotonic solutions have an effective osmolality less than body fluids, thus decreasing osmolality by diluting body fluids and moving water into cells. |
|
|
Term
| What does hypertonic solution do to the body's cells? |
|
Definition
| Hypertonic solutions have an effective osmolality greater than body fluids. If they are hypertonic sodium-containing solutions, they increase osmolality rapidly and pull water out of cells, causing them to shrivel. |
|
|
Term
| What are the complications of IV therapy? |
|
Definition
| Fluid overload, infiltration, extravasation, phlebitis, local infection, bleeding at the infusion site |
|
|
Term
| What is blood component therapy? |
|
Definition
| IV administration of whole blood or blood component |
|
|
Term
| What is an autologous transfusion? |
|
Definition
| Autologous transfusion (autotransfusion) is the collection and reinfusion of a patient’s own blood. Blood for an autologous transfusion most commonly is obtained by preoperative donation up to 6 weeks before a scheduled surgery. Autologous transfusions are safer for patients because they decrease the risk of mismatched blood and exposure to bloodborne infectious agents. |
|
|
Term
| What 3 things should be verified before giving a blood transfusion? |
|
Definition
| that blood components delivered are the ones that were ordered; that blood delivered to the patient is compatible with the blood type listed in the medical record; and that the right patient receives the blood. |
|
|
Term
| What is a transfusion rxn? |
|
Definition
| A transfusion reaction is an immune system reaction to the transfusion that ranges from a mild response to severe anaphylactic shock or acute intravascular hemolysis, both of which are life threatening. |
|
|
