Week 4 Altered Fluid @ Electrolytes + BEG IV management

What is Hemostasis?

The correct balance of all systems in the body

Keeping body in regulated limites

Do Geriatric population have a low or high body water %

Lower, meaning they are more suseptible to fluid/ Electrolyte imabalnces

What are examples of Intracellular Fluid (ICF)

Leukocytes, RBC, Platelets

What are examples of Extracellular fluids

Interstitial

Intravascular

Transcellular

Does Intracullular fluid make up 2/3 of the body fluid

Yes

Does Extracellular Fluid make up 1/3 of the bodies fluid?

Yes

What is the interstitial fluid of ECF?

Fluid located Between spaces between cells and lymph

What is intravascular fluid of the ECF?

All blood

• Blood Plasa

• Blood components (WBC, RBC

What type of ECF is Blood?

Intravascular

What is Transcellular fluid of the ECF?

Fluids in special locations surrounded by epitheial membrands

• Cerebrospinal fluid

• GI fluids

• Joint Fluids

• Pleural

• Peritoneal

• Intraocular

• Pericardial

What are electrolytes

Minerals that carry a charge when dissolved in water.

What are the common electrolytes in ICF fluid (Salty Banana)

K+

Phosphate PO4 -3

What are the comon electrolytes in ECF

NaCL

What charge are Cations

Positive

What charges are Anions

Negative

What is the unit for concentration of electrolytes?

Milliequivalents

(mEq)/L

What is Diffusion?

Movement of molecules across a permable membrane from high to low concetration

Movement stops when both sides have the same concentration

What is Facilitated diffusion

The use of carrier molecules to be able to move molecules from high to low

Passive

What is osmosis?

Water moving down the concentration gradient (Refering to concentration of water)

Moving from low solute to high solute

Does osmosis require energy

no

What is Osmotic Pressure?

The amount of pressure it takes to stop osmosis from naturally happening

What is osmolarity?

The total particles per liter of solution

What is Osmolality?

Total partciles per kilogram of water

Whats the difference betweem osmolarity and osmolality?

Osmolarity: total particles per liter of solution (IV bags)

Osmolality: Total particles per kilogram of water (Labs)

What are the normal values for normal plasma osmolality?

280-295 mOsm/kgs this

What does a value >295 mean for plasma osmolality? What happens

High Osmolality: Water Low, Solutes high

Water is pulled from surrounding cells causing cell shrinkage and cell drhydration

Blood pressure briefly increases

What does a value <280 mean for plasma osmolality?

Low osmolarity: High Water, Low solute

Water is pushed from plasma to surrouding cells causing swelling.

What is hydrostatic pressure.

Pressure built inside vessel that causes water to be pushed outside of the vessel into interstitial space

Whats the difference between hydrostatic pressure and osmotic pressure?

Hydrostatic pressure pushes water out of the vessels

Osmosis brings water into the vessels via albumin

What is the % of human cells

0.9% salt concetration

What do Isotonic fluids do to cells? What concentration are they

Cell remains the same due to equal solute concentration

0.9% NS, Lactated Ringers

What do hypotonic fluids do to cells? What concentration are they?

Cells swell because of osmosis leading fluid from low to high

Solute of solution is less than cell solute

Anything less than 0.9%

What do hypertonic fluids do to cells? What Concentration are they?

Causes water from cells to leave, Cells shrink

Solution has higher solute concentration compared to cells

Higher than 0.9%

Is hydrostatic pressure built from blood pressure

Yes,

What happens in the arterial end vs the venous end

Arterial end: New highly pressurized blood arrives increase the hydrostatic pressure causing water to leak out to surrounding tissue

Venous end: Water comes back to the vessel due to decrease hydrostic pressure

What are the causes of Edema?

Plasma moving from vessels to interstial space

Elevated venous hydrostatic pressure (its usally low to get water back in)

Decreased Plasma Oncotic Pressure (can’t keep water in)

Elevation of interstial oncotic pressure

What organ produces albumin

The liver

What ist he usual cause for decrease onotic pressure

Lack of albumin

Can burns cause damage to capillary walks increasing capillary permeability allowing proteins and albumin to leak to interstitial spaces

Yes

What is first spacing for fluids.

Fluids are where they are supposed to be in the ECF and the ICF

What is second spacing?

Abnormal accumulation of fluid in interstitial space

• Edema

What is Third spacing?

Fluid gets trapped in areas where is it impossible/difficult to remove back to its normal area

• Ascites

• Pleural effusion

Usually have to surgicaly drainded

How does the hypothalamic pituitary regulation work for water balance

Osmoreceptors in the hypothalamus detect fluid imbalances

If low: Stimulate Thirst, release ADH

If high: Stop ADH

What is Syndrome of inappropriate antidiuretic hormone secretion (SIADH)?

The body releases excess amounts of ADH causing severe fluid retention

Is it true that the kidneys are the primary organs for regulating fluid balance, electrolyte levels, and urine volume?

Yes

What does aldosterone do?

Increases Reabsorbation of Na: allowing water to be retained

Excretes K+

How does stress affect fluid and electrolyte balance?

Activates ADH

increase Water reabsoption

Activates aldosterone

Increase cortisol

What do Natriuretic peptides do?

Serve as antagnoist to the RAAS system to decrease blood volume and pressure to stop Heart from being overstretched

Made by heart

How is most water introduced to the body

Orally

Is it true that small amounts of water are eliminated by the GI tract in feces

Yes, most of water gets reabsorbed

Why does diarrhea and vomited lead to significant fluid and electrolyte loss?

Because of the consistancy itself, and being the GI system has not finished it’s job therefore stools are not fully formed

How many ml of digestive fluid is secreted by the GI tract?

8,000 ml

Geriatric populations suffer from

Structural changes in kidney that affect the ability to conserve water

Hormone changes causing renin, aldosterone decrease

Increase in ADH and ANP

Decreased Thirst sensation

What does skin turgor test for?

Hydration status:

Normal Finding: Skin goes back into in 2 seconds

Abnormal (tenting): Skin stays folded due to lack of water

For older adutls why is skin turgor a cautious test?

Can give false result due to loss of tissue elasticity leading to false results

What does Hypovolemia mean?

It is a fluid volume deficit (FVD)

What is Hypovolemia caused by

Abnormal loss of body fluids, inadequate fluid intake, or plasma or interstitial fluid shift

Loss of both water and electrolytes

What is dehydration

Loss of pure water only

No loss of electrolytes

What are health history items that could indicate fluid imalances?

Kidney, Heart, Gi , Respiratory issues

Body weight flucuations

Dialysis

Activity level

What are some causes for a fluid volume deficit?

Vomiting, Diarrhea, Hemorrhage

Polyuria

3rd space shifts

What are some causes of hypervolemia

Excess fluid intake

Abnormal fluid retention

Interstitial to plasma fluid shift

What is a common clinical manifestation of hypervolemia?

Weight Gain

What are some nursing issues that can hpapen when theres hypervolemia?

Impaired gas exchange

Impaired tissue integrity

Activity intolerance

What are some nursing actions to manage fluid imblanaces

Daily weights

Monitor Intake and Output

What is the number for concentrated urine specific gravity

>1.025

What is the number for diluted urine specific gravity?

<1.010

What are some cardiac signs of hypervolemia?

Increase Pulses

Jugular Vein Distention

Presence of S3 heart sound

What are some cardiac signs of hypovolemia

Early sign: Increase Pulse

Late: decrease urine output

What pressure increases that acuses fluid build up in the alveoli?

Hydrostatic

What are the nursing problems of low BP

Blurred vision

Loss of concentration

Dizziness

Nausea

What are nursing interventions for low BP

Evidence Base Fall risk protocol

Monitor for orthostatic changes

Bed Alaram

Assess LOC, Gait, Muscle Strength

What labs would you expect for someone who is hypovolemic?

Elevated BUN, Sodium, Hematocri

High olmolality for plasma (>295) and urine test

What labs would you expect for someone who is hypervolemic

Decreased BUN, Sodium, hematocrit

Decreased plasma (<275) and urine osmolality

Elevated BNP (Natriuretic Peptide)

What is sodium mainly used for in the body

Regulate Fluid Balance

Transmit nerve signals

Muscle Contractions

Regulating acid base balance

Is it true that when sodium changes happen, plasma osmolality also changes

Yes

What are some clinical manifestations of Hypernatremia?

Thirstiness

Any manifestations of low BP

Symtoms associated with Fluid Volume Deficiencies

What are the usual causes of Hypernatremia? What population is at risk

Inadequate water intake

Confused paitents are at risk as well as older

What are some treatments for hypernatermia?

Replace fluid orally or IV with isotonic or hypotonic fluids

Use sodium free IV fluids and promote sodium excretion with diuretics