fluid balance Flashcards

hypovolemic shock
Terms Definitions
hypertonic solution
cell shrinks
*Seen in vascular hyperemia
effect of hypocalcemia
increase excitability
Water Loss
Via excretion, respiration, evaporation, & defacation
Where is the thirst center?
Edema (types)
Localized, Generalized, Dependent (gravity causes "pooling" in feet) Pitting vs. NonPitting (Dependent Edema=more interstitial fluid - tissue swells and when pressure is applied, water shifts to the sides - pitting)
% of water extracellular (tissue)
Signals Governing Thirst
Increased plasma osmolality, hypovolemia, dryness of throat and mouth
Hydrostatic pressure
Pressure exerted by a liquid
What is ECF in lymphatic vessels?
Neonates and babies are ____% water
fever is an
insensible loss of water
respiratory alkalosis=
CO2 goes down - hyperventilations
Edema (Etiology)
ELEVATED Hydrostatic pressure pushes fluid to interstitial spaces (Salt/Water retention/CHF, venous congestion) DECREASED Osmotic & Oncotic pressure (Serum protein decreased, Liver disease) INCREASE in capillary permeability caused by injury (Inflammation - allows permeability so nutrients can leak to tissue, burns, allergic reaction) BLOCKED lymph drainage (tumor, lymphectomy) - irreversible
Movement of molecules(solutes) in a liquid across a permeable membrane from an area of high concentration to an area of lower concentration to maintain equality of osmolality (Same concentration on either side of membrane). *Allows a lot of material to cross until concentration is equal
thirst stimulants
•increased Na+ •decreased plasma volume •dry mucous membranes •low K+ •increased plasma osmolarity •angio-tension (vasoconstriction of blood vessels)
abnormal accumulation of interstitial fluid (edema)
second spacing
name two intracellular buffers
phosphate and hemoglobin
average daily liquid intake and average daily amount eliminated by the kidneys
Respiratory ALKALosis causes
hyperventilation (due to anxiety), depletion of carbonic acid, excess artificial ventilation, injury to respiratory center (resulting in hyperventilation)
High sodium levels (above 145 mM)
- Normal Na levels 136- 145 mM
Altered LOC
A manifestation of FVE causing patients to become lathargic & possibly slip into a coma.
acute water balance disorders can markedly affect
ADH levels
weak bases...
ionize less complestely and release fewer OH+
Fluid Balance Assessment
HISTORY:of swelling or dehydration, kidney or cardiac problems. WEIGHT: on diuretic? Kidney problems? (weigh every day) I&O BALANCE: Should balance w/in 24 hrs. SKIN TURGOR & MOISTURE; EDEMA; BREATH SOUNDS:Crackles reveal fluid in lungs - overhydration. VITAL SIGNS: Increase in fluid will increase BP, Dehydration lowers BP. JVD: will show if overhydrated. LOC:Over & Dehydration wlil alter conciousness (swelling of brain cells) - Anxiety, confusion
dehydration risk
fluid intake requires an alert state.... infants, olderadults unable to perceive thirst, & those with neurological problems are at a risk for dehydration
How are balances maintained?
I&O of water, electrolytes
in blood vessels, blood pressure generated by the contraction of the heart is what kind of pressure
hydrostatic pressure
TBW for an adult male
60 % intracellular
amount of extracellular fluid that is plasma (intravascular)
Metabolic ALKALosis causes
Overuse of antacids (sodium bicarb), excessive vomiting, excessive aldosterone (leading to increased Na+ reabsorption & increased H+ secretion)
What is dehydration?
Total body water ↓, osmolarity rises
- lack of drinking water, diabetes, profuse sweating, diuretics
-affects all fluid compartments
--Infants more vulnerable
SIADH is what?
Over-secretion of ADH from the pituitary gland
ADH (antidiuretic hormone)
regulates the body's retention of water (it's released when the body is dehydrated and causes the kidneys to conserve water thus concentrating the urine, and reducing urine volume.
we need to make sure that diabetics have access to
diabetes mellitus aka
"sugar diabetes" or " sweet diabetes"
strong bases...
ionize more copletely and release more OH+
Fluid Balance - Labs
HCT, Lytes; Serum OsmolaLity (Norm:275-295); Ua Specific Gravity (Norm:1.010-1.030)
Mg2+ regulation
50-60% in bone *necessary for enzyme activities, neurochem activities & muscle excitability *regulated by dietary intake/renal excretion
amount of pressure required to stop osmotic flow of water; determined by concentration of solutes in solution
osmotic pressure
effect of high aldosterone on potassium
will decrease potassium
What is the average amount of fluid lost through the skin?
hormones are...
chemicals that exert effect on target tissues using the bld
ABG Normal Ranges
pH 7.35-7.45, pCO2 35-45, HCO3 22-27 mEq/L
Medical Management of FVE
Limiting Na+ and water intake, administration of diuretics, & restriction of Na+ in the diet. *When giving diuretics client excretes everything and will likely be put on k+ pills or drugs.
Medical Management of FVD
Oral fluid replacement (liter for liter), daily weight, IV replacement of fluids.
What else can cause overhydration?
AIDs, malignant tumor, meds, anesthesia, barbiturates, and head injury
What type of fluids exists?
Isotonic, Hypotonic, and Hypertonic solutions
water and elecrolyte balance are
interdependent (body fluid tone depends on both)
ADH & Aldosterone
BOTH result in FLUID RETENTION BY KIDNEYS. (ADH =water saved by reapsorption into renal tubes) vs. (Aldosterone =Na/water saved by kidneys) BOTH: Increase fluid & RAISE BP.
ringers solution
iv solution that contains Na, K, and Ca
ATP muscles solutes from an area of lower concentration to an area of higher concentration
Active transport
how to correct hypervolemia
Treat cause, diurese, fluid limit, sodium restrition, diailysis, dilate peripheral blood vessels
What is Hypotonic hydration?
More water than Na retained or ingested
(ECF hypotonic)
Labs to Monitor with FVE
Serum electrolytes Na+ and Osmolality, Serum Hematocrit Levels decrease, Urine Specific Gravity decrease, BUN decrease & Serum Protein may decrease.
What is ANF do?
Increases Na+ excretion via a trigger by increased kpa on cardiac walls
ECF: Intravascular Fluid
Fluid or plasma - liquid part of blood
respiratory acidosis =
CO2 goes up - unsuccessful exchange of gasses
the higher the osmolality of a solution what happens
greater its pulling power
hypotonic iv fluids
type to solution that has a lower osmolality than normal plasma
Pituitary gland what does the posterior gland do
excretes ADH which controls concentration of body fluids. --------- it also excretes oxytocin (uterus and mammary glands.
How does Hypovolemia differ from dehydration?
Hypovolemia is characterized by Na depletion where as dehydration is defined as excessive loss of body water
What is 3rd space syndrome?
Shift of fluid from vascular space into a place not accessible
causes of neurogenic (central) diabetes insipidus
decreased secretion of ADH due to traumatic (accidental or surgery), malignancy (metastatic), infections (meningitis), vascular (cardiac arrest), psychobiologic (anorexia nervosa), toxic (carbon monoxide)
What are some effects of fluid imbalance on the body?
altered respiration & metabolism altered cardiovascular, renal & CNS function
Total Body Water (TBW)
amount of water in the body expressed as % of body weight
What happens when aldosterone forces more sodium into the blood stream?
the blood volume increases because water follows sodium
Mechanism of fluid movement http://www.tvdsb.on.ca/westmin/science/sbi3a1/Cells/Osmosis.htm
Osmosis - movement of fluid across semi-permeable membrane from an area of less concentration of particles to more concentration of particles. Pull exerted by particles is osmolarity of a solution. Fluid is "pulled toward" area of more particles
Labs to monitor with FVD
Serum lytes Na+ and K+ levels, Serum Hematocrit levels increase, Increase in Urine Specific Gravity = 1.010 - 1.030
Increase in Serum Osmolality.
What are the nursing responsibilities of a Lasix pt?
Assess fluid status regularly with wt, I&O, skin turgor, edema, lung sounds, and watch BP
Monitor K levels for hypokalemia
Assess for An/N/V muscle cramps, paresthesia and confusion
What is Active Transport?
uses ATP to move solutes from an area of low concetnration to an area of high concentration.
Fluid Volume Excess (FVE) (& why?)
Hypervolemia / Over Hydration / Edema ETIOLOGY: Excessive Na intake (PO or IV) COMPROMISED SYSTEM: H20 retention could = renal insufficiency, CHF, Cirrhosis COMPENSATION: Decrease of ADH & Aldosterone (if you have ample Na, you don't need the Albumin)MANIFESTATIONS: Weight Gain (fluid); Moist Crackles, (Dyspnea, Cough), Headache (agitatino, confusion) Hypertension, VS increase (pulse, resp), JVD
serum Na dangerously low, less than 115mg/dL
clinical indication for use with hypertonic saline; used with great caution and limited doses need to be on an iv infusion pump
40% or about 28 liters
amount of a person’s weight made up of intracellular fluid
Goals for client with FVD or FVE
ID client at risk, Correct underlying cause, & Correct the existing deficits.
Where is the fluid in 3rd space syndrome?
interstitial space as edema, bowel, inflamed tissue, and peritoneal/pleaural cavities
what happens with excess glucose in blood
dehydration, pulls water out of cells into vascular tree
Hypovolemia is a fluid balance problem. Define
Hypovolemia -- Too little fluid in the vascular space, Causes - Loss of body fluids: duiresis, NG, Vomiting, Diarrhea, Ostomy losses, bleeding, fever, Bowel Obstruction, third spacing.
of the 40 liters of water in the body, about two thirds is __ and one third is __
two thirds: intracellular fluid
one third: extracellular fluid
(we are cellular so most of our fluid is IN cells)
What amount of urine indicates renal failure?
less than 20mL per hour or 500mL per day
excessive urination
hypotonic solution
cell swells
Parasympatheic signals
= watery saliva
hyperkalemia causes H+ to
Water Replacement
Via ingestion and metabolism
Urine hourly output equation
0.5mL/kg(pt weight)/hour
Anti-diuretic Hormone: CONTROLS: Water balance MADE IN: Posterior Pituitary. RELEASED: Serum osmolaLity increases (especially Na) OR when blood volume DROPS. **CAUSES WATER TO BE REABSORBED BY RENAL TUBES (decreased urination) / INCREASES FLUID LEVELS** this will result in INCREASED BP. "When osmolaLity of plasma is high, ADH will kick in to hold onto sodium and thus fluid to diute plasma" **SAVES WATER**
Contains more solute concentration than another
Young Women TBW
50% of body weight
Accumulation of fluid within the peritoneal cavity due to increased hydrostatic pressure within the portal venous system
ADH response
Dehydration→ ↑ blood osmolarity→ ADH→ Stimulates thirst center→ reduces salivation, dry mouth→ sense of thirst→ ingestion of water→ cools and moistens mouth and distends stomach and intestines (Short term)→ rehydrates blood (long term)
What is severe hypovolemia called?
hypovolemic shock
thirst center is located in the
respiratory alkalosis develops as a result of
Sodium (Na+)
NORMAL VALUES: 135-145 mEq/L FUNCTION:Major cation of ECF / Maintains osmolaLity & H20 volume / generation & transmission of nerve impulses / Regulation of acid-base balance (ACTS AS ALKALINE BUFFER TO CONTROL ACIDITY)
-water & substances move TOGETHER across membrane in response to fluid pressure --move from high pressure to low pressure ex: increased hydrostatic pressure on venous side of capillary beds (during CHF) causes water movement OUT of cells and to interstitial space (edema)
is ECF or ICF more stable
maintenance fluid that provides some free water to cells and calories, provides less free water and more EC water
A liquid with equal solute concentration as another
Metabolic ACIDosis causes
Severe diarrhea, renal disease, untreated diabetes mellitus (leading to DKA), overuse of aspirin
↓ BP by causing vasoconstriction ; excreting Na and water in urine
→ reducing Blood volume
A manifestation of FVD causing low urine output, usually less that 500 mL/day or 30 mL/hr.
drugs that decrease ADH secretion
ethanol, norepinephrine, glucocorticoids
Strong acids...
ionize more completely and release more H+
Second Spacing
Fluid in interstitial spaces. RESULT: Edema. **This fluid can still "communicate" w/ the circulation.**
Percentage of Total Body Weight
*Newborn=75-80%, *Infant=70%, *Child=65%, *Adult=60%, *Elderly=45% - FLUID COMPARTMENTS: ICF=2/3 ECF=1/3 (Interstitial=80%; Intravascular=20% Other fluids in cerebrospinal and synovial fluid) - One Liter of water weighs 1 kg (2.2lb)
(PO4)3- regulation
=phosphate (buffer anion in ICF) *inversely related to calcium (1 incr, other decr) *regulated by dietary intake, renal excretion, intestional absorption, PTH *involved in neuromusc function, carbohydrate metabolism, bone maintance
hormone that decreases calcium in the blood
amount of extracellular fluid that is interstitial
SNS neurotransmitters include
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Respiratory ACIDosis s/s
headache (r/t dilation of cerebral blood vessels/increase in CSF mmHg), tachycardia, & arrhythmias
What is ECF?
Extracellular Fluid fills the narrow spaces between cells of tissues known as interstitial fluid; ECF differs depending on where it occurs in the body
If Decreased Cardiac Output
Administer 02 and monitor vitals.
How can you organize general edema?
more uniform distribution
severe pain, nausea, trauma, surgery all
increase ADH secretion
mechanisms that replace lost water (solvent) and electrolytes (solutes) and excrete excesses maintain
body fluid "tone"
Alkalosis - Metabolic
>26 ETIOLOGY: Anything that causes loss of K or gain in HC03 (Vomiting/gastric suction; Adrenal impairment; Excessive use of antacids/baking soda) *MANIFESTATIONS:ABGs: Increase pH & HC03; Dizziness/Irritable/Nervous/Confused; Tachycardia; Decreased respiratory rate/depth; Tremors/tetany/tingling
systems involved in fluid output
kidneys, lungs, skin, GI
this develops from gain or retention of excess of water
water excess
hormone that increases calcium in the blood
parathyroid hormone
hypovolemia compensation
Aldosterone "hold the salt, hold the water!" 1) secreted by the adrenal cortex, Causes sodium to be reabsorbed by the kidnesy and potassiuym to be ecxcreted. 3) Triggered by low BP and Renin/angiotensin system
Total Body Water (TBW) Varies With:
Age, Gender, & Adiposity
FVE or Hypervolemia
Occurs when the body retains both water and sodium in equal proportions. Always secondary to an increase in total body Na+ content which leads to an increase in total body water. Because both water and NA+ are retained, serum Na+ concentration remain normal. *Water follows Na+.
What are the GI S/S of FVD?
dry furrowed tongue
acute weight loss
How much fluid intake daily is taken through drinking?
1200-1500 mL
What is Diffusion?
form of passive transport (no energy required) that moves solutes from an area of higher concentration to an area of lower concentration, resulting in equal distributionof solutes between 2 areas.
Events of excess water intake
1. extracellular fluid becomes osmotically less concentrated 2. this change stimulates osmoreceptors in the hypothalamus 3. the posterior pituitary gland decreases ADH release 4. renal tubules decrease water reabsorption 5. urine output incresases and excess water is excreted
Fluid Volume Excess - NDX
*Altered Tissue Perfusion r/t edema(immobilization) *Risk for impaired skin integrity r/t edema(splitting) *Body Image Disturbance r/t altered appearance s/t edema *Risk for Injury r/t altered LOC & seizures s/t abnormal CNS function PC(potential complication): Risk for pulmonary edema (3rd spacing in lungs) or ascites (3rd spacing in belly)
hypotonic fluids
water is pulled out of vessels into the cells, resulting in decreased vascular volume and increased cell water
Active transport
ATP is utilized to move solutes from an area of lower concentration to an area of higher concentration
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What is metabolic water ?
by-product of aerobic metabolism and dehydration synthesis (remove water from an amino acid)
Extracellular Fluid (ECF)
Found outside the cells and is approx. 1/3 of total body fluid.
What are the CV S/S of FVD?
hyperthermia (nonfunctioning radiator in car)
thready pulse
tachycardia and tachypnea
cap refill diminished
What is Hypotonic Solution?
has a lower solute concentration than another solution. Fluid will shift from hypotonic soluion area to area of higher concentration.
If pH varies far from normal pH...
enzyme systems stop functioning
fluid volume overload increases pressure in vascular tree causing what
increasing BP, increased risk for pulmonary edema
Thirst mechanism comes from which part of the brain
hypothalamus, which produces antidiuretic hormone to retain fluid
Mechanisms of fluid movement: Active Transport
Movement of particles against concentration gradient (i.e. sodium-potassium pump) Requires energy.
What are the fluid compartments?
65% ICF
35% ECF
-25% tissue fluid
-8% blood plasma
-2% transcellular fluid(CSF, Synovial fluid, pericardial, peritoneal, pleural)
What 4 ways can body fluids move?
osmosis, diffusion, filtration, and active transport
How does the body maintain fluid balance?
Kidneys, Hormones and Thirst Mechanism
4 methods of fluid movement:
1- osmosis 2- diffusion 3- filtration 4- active transport
What is the normal range for serum osmalality?
275 to 295 mOsm/kg
Hypertonic > 340/liter. Hypertonic solutions include..
D5/.45 Na Cl, D5/.9NaCl = Normal Saline, D10W or D20W (nutrition)
FVD Third Spacing Shift
No actual loss of total body water but the water is unavailable for use causing edema and FVD.
What are the resp S/S for hypervolemia?
pulmonary edema, dyspnea and SOB, orthopnea, moist crackles,
What affects changes in amount of fluid lost?
Humidity levels, respiratory rate and depth, tachypnea (more) bradypnea (less) and Fever.
Fluid imbalance is based on....
amount of Na+ lost or gained in relation to water
Two conditions that would cause the amount of ANP released by the atria to increase
Chronic renal failure and heart failure
What is an isotonic loss of water?
equal loss of fluid and electrolytes, known as hypovolemia
Water evaporation from skin is related to BSA so why are little babies at a higher risk for fluid loss than grown people?
because their BSA relative to their weight is higher when compared to adults
Osmolarity - Pressure of # of particles in a solution
Blood osmolarity = about 300 mOsm/l, Isotonic Solution = 300, Hypotonic = <270, Hypertonic = > 300
what is the fluid movement in an isotonic situation?
fluid volume of the body expands WITHOUT causing a fluid shift (btwn compartments)
4 components of O2 deliver
1) PO2 - amt of O2 in the bld, 2) Cardiac Output - amt of bld per min circulating, 3) RBCs to carry the oxygen, 4) Tissue metabolism
low potassium
Bleeding to death
ADH is known as
effect of hypokalemia
hyperpolarization (paralysis)
Respiratory ACIDosis dx value
pCO2 >45
What organ controls thirst?
the hypothalamus
AN-ions, - Cl-, HCO3-, SO4-
Reduces dieresis, increases water retention, comes from the hypothalamus and stored in the posterior pituitary gland
Metabolic ALKALosis dx value
HCO3 > 27
*Difficulty in breathing that occurs when lying down & is relieved upon changing to an upright position (as in congestive heart failure) (MP),
*Seen in left sided heart failure
A manifestation of FVD causing increased heart rate.
1/4 of ECF is ______
vascular fluid
Extracellular Fluid
Fluid found outside the cells
Na+ and K+ are regulated by
Ca deficit in blood (<4.5)or(<9) ETIOLOGY: Poor intake of Ca or Vitamin D; Malabsorption from GI; Parathyroid disease; Renal Failure *MANIFESTATIONS: Fatigue, depression, hyperactive reflexes (twitching); Tetany,Cardiac dysrhythmias
Extracellular Fluid includes ALL fluid outside a cell 3 types: interstitial, intravascular, transcellular
water moves through a semipermeable membrane from an area of lower concentration to an area of higher concentration until concentrations are equalized on both sides of the membrane
with hypotonic solutions water always goes where
fluid loss that can be measured
Hyperemia (vascular)
*An increased blood flow through dilated arteries, arterioles, & capillary beds,
*When associated with inflammation, hyperemia is followed by localized edema resulting from increased vascular permeability
What are Aquaporins?
Integral membrane proteins that function as water channels
Actual FVD
A decrease in total body water.
What are early S/S of hypovolemia/FVD?
orthostatic hypotension
diabetes insipidus aka
"water diabetes" or "tasteless diabetes"
a severe electrolyte definiency may cause...
salt cravings
Decreased Na+ in the blood (<135) ETIOLOGY: Excessive water intake (diluted Na so it has no osmotic force); Excessive Na loss (Diaphoresis, Hyperglycemia, Diuretics, hemorrhage, vomiting, diarrhea) *MANIFESTATIONS: Confusion, drowsiness, Heartbeat altered, Hypotension, tachycardia, cold clammy skin, diarrhea
Arterial Blood Gas
(ABG) Measures Hydrogen Ion concentration - SAMPLE is drawn from arteries, not veins. TEST: performed to evaluate the pt's acid-base balance (USE MEAN, NOT RANGE) and oxygenation (02 Saturation = 95-100% - compare w/ pulse ox)
hypotonic osmolarity
solution has LOWER osmotic pressure than blood plasma ex: 0.45% NaCl
osmotic pressure exerted by colloids in solution (colloidal osmotic pressure); protein molecules attract water, pulling fluid from the tissue space to the vascular space
oncotic pressure
causes of metabolic acidosis
hyperkalemia, diarrhea, ketoacidosis, low bicarbonate
the amount of blood filtered by nephrons in a minute
the amount of a premature infant’s body weight that is water
hypervolemia compensation
Neurohormonal systems... dec ADH leads to water excretion (aldosterone) - Atrial and B-Type Natriurtic Peptide (anp;BNP) release causes vessel dilation and fluid excretion - Endothelin - dec secretion causes vasodilation
Respiratory ALKALosis s/s
Numbness and tingling (parasthesia) in the fingers and lips, increased neuromuscular irritability in CNS/PNS
What is Hypovolemia?
Total body water decreases, osmolarity normal
-Hemorrhage, severe burns, chronic vomiting or diarrhea
Concentrated Urine
A manifestation of FVD causing a darker urine appearance.
How much should fluid output be daily?
2300-2600 mL
symptomatic thirst
stops once the body is replenished (e.g. in diabetics, vomiting and diarrhea)
What is an example of Hypotonic Solution?
half-normal saline
Osmotic Pressure
(a solution's OsmolaLity) The FORCE w/ which a SOLVENT(water) passess through a semipermeable membrane. MEASURED by determining the hydrostatic pressure that must be opposed to the osmotic force to bring the passage to a "standstill." CONTROLLED by proteins which maintin fluid balance in the body:(Albumin in the blood stream) (K regulates ICF balance & NA regualtes ECF balance). **The more solutes, the greater "Pulling Power" of water**
Balance of fluid and lytes are the same (Loss of Na AND water) CELLS: don't shink OR swell. Most alterations are Isontonic (Dehydration is depletion, but equal & balanced)
isotonic osmolarity
-solution has SAME osmolarity as blood plasma --concentration of solutions is EQUAL on either side of cellular membrane ex:normal saline, 0.9% NaCl
this is associated with symptoms that result from cell shrinkage as water is pulled into vascular system
water deficit
What is the average daily amount of fluid lost trough the intestines?
Solutes move from an area of higher concentration to an area of lower concentration
Dehydration occurs when the body's fluid intake is not sufficient to meet the body's fluid needs. Name the 3 types of dehydration...
Isotonic, Hypertonic, Hypotonic
What is Cutaneous transpiration?
Water your body constantly gives off
Decreased Venous Filling
A manifestation of FVD causing a decrease amount of vein filling.
What are the S/S of shock?
cool clammy skin
pale skin
decreased turgor
dry mucous membranes and skin
How can you organize local edema?
site, organ, or ascites
What % of body weight is fluid for males?
osmolality (osmolarity)
is the measure of the number of dissolved solute particles in solution
Insensible Losses
Fluid losses from the skin and lungs. Can't be measured or seen.
two major types of acidosis are
respiratory and metabolic acidosis
Alkalosis - Respiratory
<35 ETIOLOGY: Anything that causes a decrease in C02 (Hyperventilation/anxiety; CNS disease/Fever/Mechanical ventilation) *MANIFESTATIONS:ABGs: Increase pH & decrease PC02; Light-headed/dizziness/numbness/tingling/difficulty concentrating/blurred vision
Lab Findings for fluid balance
hemoglobin, urine (color, amount, odor)
Two things that angiotensin II does
peripheral vasoconstriction and stimulate adrenal glands to produce aldosterone
What are the thirst mechanisms?
- Stimulation of thirst center
- Inhibition of salivation
What is the role of Renin-angiotensin system?
Controls secretion of aldosterone
Renin→ angiotensinogen→ angiotensin I→ angiotensin II→ stimulates adrenal glands to secrete aldosterone
______ is the first place to see fluid shifts
vascular system
What 3rd spacing risk factors are there for hypovolemia?
peritonitis, ascites, burns, intestinal obstrux.
What is Isotonic Solution?
has the same solute concentration as another solution.
electrolytes of greatest importance to cellular functions
sodium, potassium, calcium, magnesium, chloride, sulfate, phosphate, bicarbonate and hydrogen ions
ACE Inhibitors
Rx that will stop the process of water retention by Aldosterone. PREVENTS: Water retention & increased BP. (Diurectic --> Lowers BP)
where atrial natriuretic peptide is made
right atrium of the heart
What causes the release of ANP?
Increased pressure in the artia
Causes of Endrocrine disorders
Excess or deficiency of a specific hormone. - Primary problem - problem in th egland itself. Secondary problem - excess or deficient feedback from pituitary
Concerns for Pediatric FVD
Second most common group for FVD due to high metabolic rate. Percentage of body fluid 80% greater than adults. Weigh diapers (1mL of fluid=30 grams). Admin Pedialite or juices with electrolytes. IV has to be controlled by pump (no drip).
What can cause a chronic stimulus in the kidneys to conserve H2O and Na+ leading to hypervolemia?
heart failure, cirrhosis, glucosteroids, and increased aldo
what two major factors regulate the movement of water and electrolytes from one fluid compartment to another
Hydrostatic pressure (BP) (for perfusion)
Osmotic pressure
(again related to perfusion)
amount and direction of movement of fluid in capillaries determined by what
capillary hydrostatic pressure, plasma oncotic pressure, interstitial hydrostatic pressure, interstitial oncotic pressure
What happens to urine when ADH is working?
It becomes more concentrated
Nrsing assessment and interventions for hypervolemia include
1) monitor pt (esp respiratory distress) 2) Restrict fluids, 3) Administer meds, 4) wt., I&Os, 02 sats, electrolytes, & serum osmolarity daily and monitor trends in lab test results.
What are some routes of water loss?
urine, feces, expired breath, sweat, cutaneous transpiration
What other losses can lead to hypovolemia?
hemorrhage, and high drainage from wounds
How does the thirst mechanism maintain fluid balance?
it is regulated by hypothalamus, stimulated by increase in extracellular fluid and drying of mucous membranes, causes person to drink fluids which are absorbed by iintenstines, moved to bloodstream and distributed between compartments.
Why are fluid, electrolyte, & acid-base balances in the body important?
they maintain health and function of all systems
Describe the steps in the rennin-angiotensin-aldosterone system
low pressure in the glomerulus causes the juxtaglomerular cells to secrete renin; renin goes to the liver and converts angiotensinogen into angiotensin 1; in the lungs 1 become 2; 2 causes vasoconstriction and release of adolsterone.
What are the causes of Isotonic dehydration....
inadequate intake of fluids and solutes, 2) fluid shifts between compartments, 3) excessive losses of fluids.
What are the nursing implications for FVE?
Monitor weight, VS, I&O, edema and breath sounds, restrict fluid and Na+ intake
How do the Kidneys maintain fluid balance?
Nephrons filter blood and form urine. If body needs more fluid - nephron retain or reabsorb water and electroltyes. If body needs Less water - tubules absorb less causing water and electrolytes to be excreted. Kidneys secrete renin.
Two things that activate renin secretion
1) low blood flow to kidneys 2) reduced sodium content in the blood reaching the kidneys
What are 2 sources of water gain?
1. Preformed water - ingested in food and drink
2. Metabolic water - by product of aerobic metabolism and dehydration synthesis
Where does fluid go if a hypertonic solution is placed on one side of a semi-permeable membrane?
It is drawn into the hypertonic solution.
Which type of dehydration is the most common....
Isotonic. It is due to loss of plasma vol. , loss of fluid from ECF, plasma osmolarity remains normal, ICF vol remains normal, Leads to hypovolemia,
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