Page 1: Homeostasis & Elimination

Page 2: Fluid Imbalances

Page 3: The Role of Body Fluids

• More than half of the body is composed of water.

  • Water acts as a transport mechanism for gases, nutrients, and waste.

  • Protects organs and bones from external trauma.

• Homeostasis: The body regulates fluid movement between compartments using pressure, electrolytes, and hormones.

Page 4: Body Fluid Compartments

• Intracellular Fluid (ICF):

  • Constitutes two-thirds of the body’s fluid; found within cells.

• Extracellular Fluid (ECF):

  • Comprises one-third of the body’s fluid, existing outside the cells.

  • Interstitial Fluid: Located outside cells and the vascular system.

  • Intravascular Fluid: Found within blood vessels.

• Fluid Imbalance:

  • Refers to fluids shifting from one compartment to another, leading to excess fluid or fluid deficit.

• Fluid movement mechanisms include hydrostatic pressure and osmotic pressure.

Page 5: Mechanisms of Fluid Movement

• Hydrostatic Pressure:

  • Exerted pressure that pushes fluid from one compartment to another.

  • Example: Higher pressure in blood vessels pushes fluid to areas with lower pressure.

• Osmotic Pressure:

  • PULLS fluid from areas of higher concentration to lower concentration.

• Osmolarity:

  • Describes concentration or number of particles in a fluid, crucial for determining osmotic pressure.

Page 6: Response to Fluid Imbalance

• Hyperosmolar State:

  • High sodium concentration in extracellular fluid (ECF), leading to dehydration.

  • Body conserves water and secretes more sodium, resulting in lower urine volume and higher urine concentration.

• Hypo-osmolar State:

  • Low sodium concentration in ECF, excess water leads to fluid overload.

  • Body increases sodium conservation and water secretion, resulting in higher urine volume and lower urine concentration.

Page 7: Factors Affecting Fluid Movement

• Electrolytes:

  • Regulate fluid levels; for instance, sodium in the renal system adjusts fluid transfer between urinary and vascular systems.

• Blood Pressure:

  • Receptors send signals to the autonomic nervous system to adjust constriction or dilation based on fluid balance.

• Proteins:

  • Attract water to maintain fluid balance; low protein levels can cause fluid to move into interstitial spaces (leading to edema).

• Hormones:

  • Control fluid pressure and can attract fluid; examples include renin and angiotensinogen.

Page 8: Hormones Impacting Fluid Levels

• Antidiuretic Hormone (ADH):

  • Promotes water reabsorption in kidneys.

• Aldosterone:

  • Signals kidneys to reabsorb sodium and water.

• Atrial Natriuretic Peptide (ANP) & B-type Natriuretic Peptide (BNP):

  • Secreted by the heart to help maintain fluid levels.

Page 9: Types of Fluid Imbalance

• Hypovolemia:

  • Results from blood loss or dehydration (plasma reduction).

• Maldistribution:

  • Movement of fluid between compartments without overall loss; can be due to immune responses or hormone deficits (e.g., allergic reactions).

• Hypervolemia:

  • Excess fluid accumulation where organs cannot effectively manage or excrete it; example: myocardial infarction leads to fluid back up in the venous system.

Page 10: Signs, Symptoms, and Treatments of Fluid Imbalances

• Hypervolemia:

  • Signs/Symptoms: Edema, lightheadedness, low blood pressure, increased respiratory rate.

  • Causes: Heart failure, liver failure, renal failure.

• Hypovolemia:

  • Signs/Symptoms: Dizziness, syncope, weight gain/loss, high heart rate, oliguria/anuria.

  • Causes: Blood loss, dehydration, gastrointestinal bleed, burns, medications.

  • Treatment for Hypervolemia: Diuretics or dialysis.

  • Treatment for Hypovolemia: Administer fluids, blood products, or albumin.

Page 11: Diagnostic Testing for Fluid Imbalance

• Vital signs monitoring.

• Lab tests such as:

  • Electrolytes, kidney function (Creatinine & BUN), liver enzymes.

  • Urinalysis, urine specific gravity, BNP levels.

• Monitoring intake and output (I&O) and weight changes (notify for 3-5 lbs gain in 1-2 days).

Page 12: Age & Environmental Impacts on Fluid Imbalances

• Children:

  • Decreased fluid volume, sensitive to imbalances, require quick treatment of hypovolemia.

• Older Adults:

  • Less active kidneys and vascular compromise leading to slower compensatory responses.

• Environmental Factors:

  • Climate, available resources, and chemical exposures.

Page 13: Dehydration

• A condition where the body lacks sufficient water.

  • Occurs due to inadequate intake, excessive loss, or both.

  • Risk factors: Disease, injury, limited access to water; high predisposition in elderly and children.

Page 14: Causes and Effects of Dehydration

• Causes of Dehydration:

  • Loss of water via skin, gastrointestinal tract, kidneys; inadequate intake; blood loss; third spacing (fluid shifts).

  • Contributing conditions: Diarrhea, medications, increased metabolic rate.

Page 15: Cellular Changes Due to Dehydration

• Tonicity: Concentration of solutes in relation to fluid affects the movement of fluid (osmosis).

• Dehydration causes fluid to shift compartments and changes tonicity, leading to cell swelling or lysis.

Page 16: Cellular Changes in Fluid Movement

• Water moves into cells when solute concentration is higher inside, causing swelling.

• Water moves out when solute concentration is lower inside, leading to cell shrinkage.

• When water movement is equal, solute concentration inside the cell matches the outside concentration.

Page 17: Causes of Dehydration

• Loss of fluid from skin, GI tract, or kidneys.

• Decreased or inadequate fluid intake, blood loss, fluid shifting (third-spacing), medications, or increased metabolic rates.

Page 18: Signs & Symptoms of Dehydration

• Mild to Moderate Signs:

  • Thirst, dry mouth, darker urine, dry skin, headache, muscle cramps, bad breath.

• Severe Signs:

  • Little to no urination, very dark urine, dizziness, rapid heartbeat, sunken eyes, lethargy, confusion, fainting.

Page 19: Dehydration Effects & Water Intake

• Compensations for fluid loss include increased ADH & aldosterone levels, leading to concentrated urine.

• Staying hydrated is crucial; hydration sources include fruits, vegetables, liquids, and food with high water content.

Page 20: Age-Related Differences in Dehydration

• Infants:

  • Cannot communicate needs, prone to dehydration, rapid fluid loss due to high surface area/volume ratio.

• Adults:

  • Can communicate needs but may neglect hydration due to busy schedules.

• Older Adults:

  • Sometimes forget to drink, can get cold easily due to fat loss, dependent on caregivers for hydration.

Page 21: Rehydration Strategies

• Determine the degree of dehydration to guide rehydration.

• Use oral rehydration solutions for mild to moderate cases, providing 50-100 mL/kg over several hours.

• For severe dehydration in children, intravenous fluids may be necessary, while maintaining nutrition with breastfeeding/solid foods as tolerated.

Page 22: Improving Hydration & Treatment

• Ensure fluid accessibility and provide foods/lifestyles that encourage fluid intake (e.g., fruits/veggies, easy drinking tools for older adults).

• Treatment involves oral liquids, high-water-content foods, and possibly IV fluids (hypertonic, isotonic, hypotonic).

Page 23: Edema

• Refers to the excess accumulation of fluid in interstitial spaces.

Page 24: Types of Edema

• Generalized Edema:

  • Excess fluid accumulation throughout the body.

• Localized Edema:

  • Confined to specific areas (arms, legs, abdomen).

• Ascites:

  • Edema in the abdomen due to liver failure.

• Persistent edema may cause skin breakdown and hinder wound healing.

Page 25: Causes of Edema

• Increased Vascular Permeability:

  • Altered vessel structure allows excess fluid movement; observed during immune responses.

• Increased Hydrostatic Pressure:

  • Resulting from vascular obstructions, leading to fluid movement into interstitial spaces.

• Osmotic Pressure Changes:

  • Concentration changes affecting fluid shifts occur with protein/albumin loss.

• Lymphatic Dysfunction:

  • Impaired lymphatic system can lead to accumulation of materials resulting in lymphedema.

Page 26: Locations of Edema

• Lower Extremities:

  • Commonly seen in heart failure or blood clots.

• Abdomen:

  • Often due to liver disease.

• Surrounding Wounds:

  • Inflammatory responses attract fluid to injuries for healing.

• Generalized Edema:

  • Can be caused by renal diseases leading to systemic issues.

Page 27: Causes of Edema Recap

• Key Factors: Tumor, heart failure, kidney disease, venous thrombosis, hypoproteinemia, pregnancy, malnutrition, sepsis.

Page 28: Signs & Symptoms of Edema

• Extent of fluid retention characterized by:

  • Localized swelling, weight gain, pale/red skin.

  • Potentially leads to pulmonary congestion with respiratory complications.

Page 29: Edema Diagnosis & Treatment

• Diagnostics include:

  • Physical assessments and vital signs, laboratory testing (CBC, electrolytes).

  • Imaging if necessary (ULS, CT).

• Treatment Focus:

  • Identify and correct underlying causes, manage fluid balance with medications, increase direct area pressure (compression stockings), dietary adjustments.

Page 30: Age & Environmental Impact on Edema

• Aging Factors:

  • Older adults frequently experience edema due to reduced renal function, loss of vascular elasticity, and hormonal changes.

• Environmental Factors:

  • Climate variations, dietary salt intake, and physical activity impact fluid retention.

Page 31: Electrolyte Imbalances

• Overview of necessary minerals (Mg, Ca, Na, K).

Page 32: Electrolytes' Functions

• Electrolytes:

  • Charged minerals vital in:

  • Regulating chemical reactions, balancing fluid systems, and supporting homeostasis by managing osmotic pressure.

Page 33: Strong Electrolytes in the Body

• Identification of main electrolytes and their conductive properties when dissolved in bodily fluids.

• Functions include fluid balance, pH regulation, and electrical signaling in muscles/nerves.

Page 34: Lifestyle & Age Effects on Electrolytes

• Aging can cause calcium deficiencies; infants may suffer chloride deficiencies affecting development.

• Lifestyle factors, such as alcohol intake and medication use, impact electrolyte levels.

Page 35: Study Tips for Electrolytes

• Include normal values, main functions, and key manifestations related to imbalances (both hyper and hypo).

• Use mnemonic devices for recall of signs/symptoms.

Page 36: Sodium's Role and Dietary Sources

• Importance:

  • Muscle contraction, nerve conduction, and maintaining fluid balance.

• High Sodium Foods: Pickles, olives, processed meats, canned foods, and bread.

• Mechanism: Sodium's movement dictates water retention and excretion.

Page 37: Sodium Imbalances: Hyponatremia & Hypernatremia

• Hyponatremia: Low sodium levels; leads to fluid shifts into cells, potentially causing confusion and weakness.

• Hypernatremia: High sodium levels; leads to dehydration signs including agitation and elevated blood pressure.

  • Lab testing varies based on symptoms.

Page 38: Promoting Normal Sodium Levels

• Suggestions include balanced diet, adequate hydration, isotonic drink consumption during fluid loss, and monitoring sodium intake.

Page 39: Calcium Overview

• Functions: Bone/teeth formation, muscle contraction, impulse transmission, and blood clotting.

  • Interplay with vitamin D and necessity for proper absorption noted.

• High Calcium Foods: Include dairy products, leafy greens, and almonds.

Page 40: Calcium Imbalances: Hypocalcemia & Hypercalcemia

• Hypocalcemia: Arises from disorders like hypoparathyroidism or malabsorption; causes muscle spasms and tetany.

• Hypercalcemia: Can result from neoplasms and hyperparathyroidism, leading to decreased neuromuscular activity and potential arrhythmias.

Page 41: Maintaining Normal Calcium Levels

• Emphasizes dietary management, sun exposure for vitamin D, and adherence to prescribed medications.

Page 42: Functions of Magnesium

• Vital for energy production, DNA/protein synthesis, and nerve function; closely tied to heart function.

• Sources of Magnesium: Nuts, seeds, beans.

Page 43: Magnesium Imbalances: Hypomagnesemia & Hypermagnesemia

• Disruptions in magnesium levels can lead to increased cardiac irritability or depressed neuromuscular conduction.

Page 44: Effects of Magnesium Deficiency

• Symptoms reflect systemic unrest, including tiredness, anxiety, gastrointestinal issues, and muscle cramps.

Page 45: Strategies for Normal Magnesium Levels

• Importance of balanced diets rich in green vegetables and adequate hydration is emphasized along with medication adherence.

Page 46: Chloride Functions & Sources

• Acts as a buffer for maintaining acid-base balance, osmotic pressure regulation, and contributing to gastric function.

• Chloride-Rich Foods: Include table salt and various processed foods.

Page 47: Chloride Imbalances: Hypochloremia & Hyperchloremia

• Generally, chloride levels correlate with sodium changes; signs of imbalances noted.

Page 48: Potassium Overview

• Essential as a major intracellular cation, vital for multiple bodily functions including nerve, muscle, and fluid balance.

Page 49: Potassium Transport

• Explains movement within cells via active/passive transport mechanisms ensuring the balance of sodium and potassium across membranes.

Page 50: Potassium Imbalances: Hypokalemia & Hyperkalemia

• Hypokalemia: Can lead to intense muscle weakness and arrhythmias; monitoring advised.

• Hyperkalemia: Risk of life-threatening cardiac complications necessitates urgent attention.

Page 51: Promoting Healthy Potassium Levels

• Strategies for low potassium levels include dietary management, while high levels may necessitate restriction or use of potassium-rich substitutes.

Page 52: Potassium-Rich Foods

• Specific foods promoting potassium intake—tomatoes, bananas, avocados, potatoes, and leafy greens listed as beneficial.

Page 53: Potassium and Aging

• Age factors affecting potassium levels; infants and older adults particularly susceptible to imbalances based on body physiology.

Page 54: Acid-Base Imbalances Overview

• Introduces pH scale, with designations for acidic, neutral, and basic substances, accompanied by physiological pH specifics.

Page 55: Acidosis Explained

• Refers to decreased serum pH resulting in CNS depression; detailed breakdown of potential origins provided.

Page 56: Causes & Symptoms of Acidosis

• Includes comprehensive causes for respiratory and metabolic acidosis along with symptomatology affecting various bodily systems.

Page 57: Alkalosis Defined

• Overview of increased pH conditions, correlating causes that lead to hyperventilation or metabolic shifts.

Page 58: Causes & Symptoms of Alkalosis

• Clarification of respiratory/metabolic factors contributing to state alteration, along with observable symptoms listed per system.

Page 59: Comparative Review of Acid-Base Disorders

• Presenting simultaneous comparisons of causes and symptoms of both acidosis and alkalosis as well as diagnostic insights.

Page 60: Measuring pH & Compensation Mechanisms

• Essential lab values for monitoring homeostasis in acid-base balance and various compensatory mechanisms are outlined with relevance.

Page 61: Compensation Strategies

• Covers the body's method of addressing pH imbalances through buffering systems, respiratory regulation, and renal function adaptations.

Page 62: Practice Problems and Solutions

• Engaging in practical assessments to reinforce understanding of fluid, electrolyte, and acid-base balance.

Page 63: Elimination Overview

• Introduction to the significance of bowel and urinary functions in maintaining homeostasis.

Page 64: Bowel Elimination Function

• Description of the digestive system's components and their roles in breakdown, absorption, and waste elimination with neural regulation emphasized.

Page 65: Digestive Hormones

• Overview of key hormones influencing gastric and intestinal motility, secretion, and overall digestive efficiency.

Page 66: Lifespan and Elimination Changes

• Describes developmental changes in elimination processes from infancy through older adulthood, alongside pregnancy impacts.

Page 67: Risk Factors and Symptoms of Altered Bowel Elimination

• Highlights factors such as dietary habits and medications that lead to altered bowel habits, with corresponding symptoms like nausea and vomiting.

Page 68: Fecal Incontinence

• Addresses risk factors and causes of fecal incontinence, encompassing treatments and complications.

Page 69: Types and Causes of Diarrhea

• Differentiates between osmotic, small-volume, steatorrhea, and bloody diarrhea including common causative factors for each type.

Page 70: Diarrhea Symptoms, Complications & Treatment

• Outline of symptoms indicating dehydration, along with treatment recommendations based on the specific underlying causes.

Page 71: Diagnostics for Diarrhea

• Comprehensive diagnostic strategies, including imaging options and laboratory analyses to pinpoint causes of diarrhea.

Page 72: Prevention Strategies for Diarrhea

• Emphasizes primary and secondary prevention methods including adequate hydration and screening measures.

Page 73: Excretory System Overview

• Summarizes the anatomy involved in urinary elimination within the context of the excretory system.

Page 74: Risk Factors for Altered Urinary Elimination

• Comprehensive list of factors that may respectively increase the risk for urinary incontinence.

Page 75: Types of Urinary Incontinence

• Classifies urinary incontinence types along with specific causes and distinguishing factors for each type.

Page 76: Symptoms of Incontinence

• Describes observable signs of incontinence that affect daily life and personal comfort levels.

Page 77: Treatment & Management of Incontinence

• Treatment options to manage urinary incontinence and patient self-care strategies outlined.

Page 78: Urinary Retention Causes

• Explains causes leading to acute and chronic urinary retention alongside treatment strategies.

Page 79: Urinary Tract Infection (UTI) Overview

• Describes types of UTIs, principal symptoms, and treatment options.

Page 80: Renal Disorders Description

• Provides insight on inflammatory and obstructive disorders of the renal system with related symptoms and management strategies.

Page 81: Urinary Diagnostic Testing

• Overview of laboratory testing relevant for assessing renal function and detecting abnormalities in urinary health.

Page 82: Treatment & Prevention of Urinary Alterations

• Focuses on maintaining hydration, dietary considerations, and preventive measures to promote urinary health.

Page 83: Bowel Obstruction Overview

• Examines gastrointestinal anatomy and how obstructions can occur, affecting waste elimination.

Page 84: Types of Bowel Obstruction

• Differentiates between mechanical and functional obstructions, elaborating on their causes and implications.

Page 85: Diagnosis & Treatment of Bowel Obstruction

• Highlights the diagnostic approaches and management options necessary for treating bowel obstructions effectively.

Page 86: Renal Insufficiency Overview

• Discusses chronic kidney disease progression and its impact on overall health alongside risk factors.

Page 87: Pathophysiology of Renal Insufficiency

• Outlines mechanisms leading to kidney function deterioration and related systemic effects.

Page 88: Stages of Chronic Kidney Disease

• Stages classified based on the estimated glomerular filtration rate (eGFR), outlining implications at each level.

Page 89: Signs & Symptoms of Renal Insufficiency

• Lists common signs suggesting renal impairment, emphasizing the necessity of early detection.

Page 90: Causes & Diagnostics for Renal Insufficiency

• Comprehensive look at causes leading to renal insufficiency and recommended diagnostic procedures.

Page 91: Acute Kidney Injury Overview

• Definition and categorization of acute kidney injury with respective causes identified.

Page 92: Electrolytes and Renal Insufficiency

• Explains changes occurring in electrolyte levels as a result of renal insufficiency with clinical significance.

Page 93: Preventive Strategies for Renal Insufficiency

• Suggests lifestyle modifications and clinical interventions aimed at preventing renal complications.

Page 94: Functions of the Liver

• Overview of liver functions including detoxification, balancing glucose, and notable risk factors for liver disease.

Page 95: Liver Disease Overview

• Describes the spectrum of liver disease consequences based on cellular dysfunction.

Page 96: Liver Failure Symptoms

• Symptoms conveyed may mimic other conditions making early diagnosis challenging.

Page 97: Laboratory Testing for Liver Disease

• Key laboratory markers used to diagnose liver disease and monitor progression.

Page 98: Phases of Hepatitis

• Clarifies symptoms occurring in various phases of hepatitis progression.

Page 99: Hepatitis Disease Characteristics

• Classification of viral hepatitis and modes of transmission outlined.

Page 100: Liver Disease Risk & Prevention

• Lifestyle adjustments and preventive measures necessary to combat liver disease manifestations.

Page 101: Liver Cirrhosis Explanation

• Final consequences of ongoing liver cell damage leading to cirrhosis, the associated symptoms, and management options described.