FE

Question 1

Water content of body
%
lean vs fat
women vs men
age

Answer 1

50-60
more in lean than in fat
less in women bc more fat
less in old ppl bc less lean (45-50%)

Question 2

Body Fluid Compartments

Answer 2

Intracellular (2/3) (28 L)

Extracellular (1/3)

• Interstitial fluid (10 L)
• plasma (3 L)
• lymph
• transcellular fluid (in joints, bt peritoneae, CSF) –> 1 L

Question 3

Fluid gain/loss

Answer 3

1 L = 2.2 lbs = 1 kg

240 ml = 8 oz = 0.5 lb = 0.23 kg

Fasting makes adults lose 1-2 lbs per day –> any extra weight loss is fluid

Question 4

Main electrolytes for ECF and ICF

Answer 4

ECF: sodium! (little K, Ca, Mg) —> Cl (little HCO3, sulfate, PO4)

ICF: K (little Mg and Na) —> PO4 (little HCO3)

Question 5

Diffusion
Facilitated Diffusion
Active Transport

Answer 5

1. movement of molecules from high to low conc –> no energy
2. uses prot carrier to pass molecules thru membrane –> high to low conc –> no energy
3. movement against conc gradient –> needs energy –> Na/K pump

Question 6

Osmosis
osmotic pressure
osmolality
osmolarity

Answer 6

1. movement of water down conc radient –> no energy
2. “pull” of water (higher in areas of high solute conc) mOsm
3. number of milliosmoles per kg of water
4. mOsm/L of solution

Question 7

Osmolality

Answer 7

Pretty much the same for all body fluid spaces

Normally 280-295 mOsm/kg

High means water deficit

Low means water excess

Plasma osmolality = (2 x Na) + (BUN / 2.8) + (glucose / 18)

Question 8

hydrostatic pressure

oncotic pressure

Answer 8

Force of fluid in compartment pushing against cell membrane or vessel wall (e.g. BP) –> decreases as nears capillaries

(colloidal osmotic pressure) osmotic pressure created by colloids in solution (e.g. albumin) –> 25 mm Hg in plama; 1 mm HG interstitial spaces

Question 9

Factors affecting fluid movement in capillaries

Answer 9

1. capillary hydrostatic pressure (40 to 10) –> higher at arterial end
2. plasma oncotic pressure (25)
3. interstitial hydrostatic pressure (1)
4. interstitial oncotic pressure (1)

Question 10

Edema

Answer 10

shifts of plasma into interstitial spaces:
high venous hydro pressure,
low plasma oncotic pressure,
high interstitial oncotic prssure

Question 11

fluid spacing

Answer 11

distribution of body water

First spacing: normal ICF and ECF distribution
Second spacing: abnormal accumulation of interstitila fluid
Third spacing: excess fluid in nonfunctional areas bt cells

Question 12

How much water do we need per day?

What is insensible water loss?

Answer 12

2000-3000 ml

invisible vaporization from lungs and skin to regulate body temp (not the same as sweating which includes electrolytes)

Question 13

Hypothalamic Pituitary fluid regulation

ADH release stimulation

Answer 13

Osmoreceptors in Hypothalamus stimulate thirst and release of ADH from post pit
ADH acts on distal tubules and collecting ducts to make them more permeable to water (water excess suppresses ADH)

low BP, nausea, pain, hypoglycemia, hypoxemia

Question 14

Renal regulation of fluid

Answer 14

kidneys filter plasma volume many times a day

reabsorb 99% of filtrate and make 1.5 L of urine a day

fucked up kidneys cause edema, K or PO4 retention, acidosis, etc

Question 15

Adrenal cortical fluid regulation

Answer 15

Glucocorticoids (cortisol) increase serum glucose levels
Mineralocorticoids (aldosterone) enhance Na retention and K excretion
-RAA
-high K
-low Na
-ACTH

Question 16

Gastrointestinal Regulation of Fluid

Answer 16

GI tract secretes 8000 mL of digestive fluid a day
Usually reabsorbs the fluid
Diarrhea and vomitting lead to significant fluid loss (AND ELECTROLYTES)

Question 17

Old people and fluid regulation

Answer 17

kidneys change shape which slows glomerular filtration rate, less able to concentrate urine or conserve water

Less renin and aldosterone –> more ADH and ANP

Thin skin = moisture loss

Question 18

Fluid Volume Imbalances

NG suction

Answer 18

ECF deficit = hypovolemia
ECF excess = hypervolemia

loss of Na, K, H, and Cl –> low fluid volume and alkalosis

Question 19

cardiac fluid regulation

Answer 19

ANP and BNP are made by cardiomyocytes in response to increased atrial pressure and high serum sodium —> antagonists to RAAS and suppress Ald, ADH, and Angio II

Question 20

fluid volume defecit vs dehydration

Answer 20

dehydration = loss of pure water

fluid volume defecit (hypovolemia) = loss of body fluid via diarrhea, vomitting, hemorrhage (includes electrolytes)

Question 21

ECF volume deficit causes and manifestations

Answer 21

Casues

• insensible water loss bc fever or heat
• diabetes insipidus
• osmotic diuresis
• hemorrhage
• GI losses
• too many diuretics
• not enough water drunk
• 3rd space fluid shifts : burns and pancreatitis

Manifestations

• restless, sleepy, CONFUSION
• thirsty –> dry mouth
• cold clammy skin
• bad capillary refill
• postural hypotension, high pulse, low pressure
• little, concentrated pee
• breathing fast
• weak, dizzy
• weightloss
• seizures, coma HYPOVOLEMIC SHOCK

Question 22

ECF Volume Excess: causes and manifestations

Answer 22

Causes:

• excess isotonic or hypotonic IV fluids
• heart or renal failure
• primary polydipsia
• SIADH
• Cushing syndrome
• Too many corticosteroids

Manifestations

• headache, confusion, lazy
• edema
• jugular distension
• S3 heart sound
• bounding pulse, high BP and CVP
• Polyuria
• dyspnea, crackles, pulmonary edema!!!!!!!!!!!!!!
• spasms
• weight gain!!!!!!!!!!!!!!!!!!!!!!!!
• seizures and coma

Question 23

treating ECF excess and defecit

Answer 23

Defecit: 0.9% NaCl or lactated Ringers solution

Excess: diuretics and no sodium and fluid restriction (also paracentesis and pleural effusions)

Question 24

Nurse implementation of fluid balance

Answer 24

daily weights
intake and output
-urine specific gravity: over 1.025 is concentrated; less than 1.010 is diluted

Lab findings

• ECF defecit has high BUN, Na, and hematocrit
• ECF excess had decreased all of those things

Cariovascular care

Respiratory care

Patient safety

Skin care

Question 25

Cardiovascular care (fluid)

Answer 25

ECF excess: bounding pulse, distended jugular, high CVP, high BP, S3 sounds ECF defecit: high HR, peripheral vasoconstriction. orthostatic hypotension

Question 26

Respiratory Care

Answer 26

Pulse oximetry and auscultate lungs ``` excess = pulmonary edema, shortness of breath, and crackles defecit = increases RR ```

Question 27

Fluid defecit and patient safety

Answer 27

- risk of falling - muscle weakness - if orthostatic hypotension, make them change position slowly - put alarm monitors on confused patients

Question 28

skin care Edema analysis Good skin care

Answer 28

Defecit = low skin turgor (tenting) --> test sternum, abdomen, and ant forearm --> not as relavent in old ppl bc their skin isn't as elastic =cold and moist skin -dry mucous membranes Edeman assessed with thumb and forefinger over tibia, fibula, sacrum 1+ = slight edema (2 mm indent) 4+ = pitting edema (8 mm indent) ``` No extreme heat change positions elevate edema don't use too much soap moisturize ```

Question 29

Fluid therapy

Answer 29

give IVs --> be careful of rate esp heart, renal, or brain problems defecit: offer drinks every 1-2 hrs --> make bathroom access easy if they're worried ab nocturia --> help ppl hold containers