Fluid and Electrolytes Miscellaneous

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homeostasis

Maintaining relatively constant conditions and internal balance. Basically, health.

intracellular fluid

fluid within a cell

within

Most of the body's fluids are found ______ the cell.

extracellular fluid

fluid outside the cell
- includes intravascular and interstitial fluid

intravascular fluid

Fluid in blood vessels in the form of plasma or serum
- part of extracellular fluid

interstitial fluid

Fluid surrounding cells, including lymph
- part of extracellular fluid

water

_____ makes up the largest portion of body weight.

transcellular fluid

Fluid separated from other fluids by a cellular barrier and consists of cerebrospinal, pleural, gastrointestinal, intraocular, peritoneal, and synovial fluids.

1

Transcellular fluid is less than __% of the body's fluids.

decreases

percentage of body water _________ with age.

elderly, obese, babies

Who is most at risk for fluid imbalances?

functions of water

- transportation of nutrients, electrolytes, and oxygen to the cells
- excretion of waste products
- regulation of body temperature
- lubrication of joints and membranes
- medium for food digestion

electrolyte

Substance that develops an electrical charge when dissolved in water

ion

a particle that is electrically charged (positive or negative)

solute

substance that is dissolved

muscle contraction, nerve impulses

positive and negative charges are essential for ______ ___________ and _____ ________.

cation

a positively charged ion

anion

a negatively charged ion

anions

Chloride, bicarbonate, and phosphate are examples of ______.

cations

Sodium, potassium, calcium, and magnesium are examples of _______.

sodium (Na)

most abundant electrolyte, primary electrolyte in extracellular fluid, cation

functions of sodium (Na)

- major role in regulating body fluid volumes
- muscular activity
- nerve impulse conduction
- acid-base balance
- effects serum osmolality

potassium (K)

found mainly in the intracellular fluid, the major intracellular cation

functions of potassium (K)

- skeletal and smooth muscle contractions
- especially important in the heart
- important in maintaining fluid osmolarity and volume within the cell
- essential for normal membrane excitability - a critical factor in transmitting nerve impulses
- needed for protein synthesis, for the synthesis and breakdown of glycogen, and to maintain plasma acid-base balance

chloride (Cl)

an extracellular anion that is usually bound with other ions, especially sodium or potassium

functions of chloride (Cl)

- regulate osmotic pressure between fluid compartments
- assist in regulating acid-base balance

Calcium (Ca)

Cation that is usually combined with phosphorous to form the mineral salts of the bones and teeth, ingested through the diet and absorbed through the intestine
- 99% concentrated in the bones and teeth
- 1% in the extracellular fluid

functions of calcium (Ca)

- promotes transmission of nerve impulses
- helps regulate muscle contraction and relaxation

Magnesium (Mg)

a cation found in bone (50% - 60%), intracellular fluid (39%-49%), and extracellular fluid (1%)

functions of magnesium (Mg)

- plays a role in the metabolism of carbohydrates and proteins
- storage and use of intracellular energy
- neural transmission
- important in heart, nerve, and muscle function

nonelectrolytes

Solutes that do not carry an electrical charge

examples of nonelectrolytes

- urea
- protein
- glucose
- creatinine
- bilirubin
- oxygen
- carbon dioxide

selectively permeable membranes

Allow only certain molecules to pass through
- separate fluid compartments and control movement of water and certain solutes
- maintain unique composition of each compartment of the body while allowing transport of nutrients and wastes to and from cells
- kind of like a collander or fish net, straining system

osmosis, diffusion, filtration, active transport

The four primary ways fluids and electrolytes shift or transport between compartments include: _______, _________, __________, and ______ _________.

osmosis

Movement of water across a membrane from an area of lower concentration to an area of high concentration

osmotic pressure

pressure that must be applied to prevent osmotic movement across a selectively permeable membrane

diffusion

process by which molecules tend to move from an area where they are more concentrated to an area where they are less concentrated
- like osmosis, only with solutes instead of water and goes from high concentration to low concentration
- the warmer the temp, the faster the movement

active transport

carrier proteins transport substances from and area of lower concentration to an area of equal or greater concentration
- requires expenditure of energy (uses ATP)

filtration

transfer of water and solutes through a membrane from an area of high pressure to an area of low pressure

osmolality

concentration of solution determined by number of dissolved particles per kg of water
- reflects hydration status
- measured by serum and urine
- solutes measured: mainly urea (BUN), glucose, and sodium
- basically just means concentration
- when you see osmolality or osmolarity just think "concentration" :)

osmolarity

concentration of a solution determined by the number of dissolved particles per liter of a solution
- usually talking about IV fluids whereas osmolality is usually referring to the pt's serum
- pretty much the same thing as osmolality

hydrostatic pressure

push power
- moving fluid out of an artery in the capillary bed

oncotic pressure

pull power
- moving fluid into a vein in the capillary bed

kidney filtration

- blood plasma entering the kidney via the renal artery is delivered to the glomerulus
- about 20% of plasma is filtered into the glomerular capsule
- most remaining plasma leaves the kidney through the renal vein
- filtrate then moves through the tubules where it is transformed into urine by tubular reabsorption and secretion

tubular reabsorption (kidneys)

Process by which most of the glomerular filtrate is returned to circulation
- water and selected solutes move from the tubules into the capillaries
- wast products remain in tubules for excretion, whereas most water and sodium is reabsorbed into the blood stream
- adjusts volume and composition of the filtrate; prevents excessive fluid loss through kidneys

tubular secretion (kidneys)

The last phase in the work of the kidneys in which the filtrate is transformed into urine
- various substances: drugs, hydrogen ions, potassium ions, creatinine, and histamine pass from the blood into the tubules
- process eliminates some excess substances to maintain fluid and electrolyte balance as well as metabolic waste products

equal

In healthy adults, 24-hour fluid I&O should be approximately _____.

1-2, 1

The usual adult urine volume is between __-__ liters per day or __ ml/kg of body weight per hour.

300-400

We lose approximately ___-___ml of water through evaporation in the lungs every day.

100-200

We lose approximately ___-___ml of water daily in the GI tract.

insensible loss

The loss of water not noticeable by a person, such as through evaporation from the skin and exhalation from the lungs during breathing.
- unmeasurable water loss

sensible loss

water losses that are measurable, such as urinary output and wound drainage

30, 55-65, 25, 65

Unless contraindicated, fluid requirements for older adults, based on ideal body weight, are __ml/kg for ages __-__ and __ml/kg for __ years and older.

medical conditions effecting water balance

- fever
- burns
- diarrhea, vomiting
- NG suction
- wound drainage
- mechanical ventilation
- uncontrolled diabetes, diabetes insipidus

health history

determines if patient has conditions that contribute to fluid or electrolyte imbalances

"red flag" assessment findings

complaints of fatigue, palpitations, dizziness, edema, muscle weakness or cramps, dyspnea, and confusion may be associated with fluid imbalances.

2.2, 1

One liter of water is equal to __.__lbs or __kg.

minimally

respirations are _________ effected by electrolyte changes.

volume

BP is directly related to blood ______.

weight

______ is one of the best ways to assess fluid imbalance.

urine

_____ characteristics also give clues to fluid balance.
- clear, pale in a healthy person suggests the excretion of excess water, whereas darker, concentrated indicates the kidneys are retaining water

dehydration

Dry, flushed skin can mean?

shock

Pale, cool, clammy skin can mean severe fluid volume deficit that occurs with _____.

excess

Moist, edematous tissue is seen with ______ fluid volume.

fluid volume deficit

Soft eyeballs and sunken eyes may indicate what?

fluid volume excess

Puffy eyelids and fuller cheeks suggest what?

sternum, thighs, forehead

Skin turgor is measured by pinching the skin over the _______, the inner aspects of the ______, or the ________.

fluid volume excess

Edema (especially pitting) is an indication of what?

longitudinal, deficit, smaller, red, swollen

In well person, the tongue has one ____________ furrow. Fluid volume _______ causes addition longitudinal furrows, and the tongue is _______. Sodium excess causes the tongue to appear ___ and _______.

deficit, mouth breathing

A dry mouth may be the result of fluid volume _______ or _____ _________.

deficit, excess

appearance of the jugular veins in the neck and the veins in the hands can suggest either a fluid volume _______ or ______.

measurable intake

- oral fluids
- parenteral fluids
- enemas
- irrigation fluids

non-measurable intake

- solid foods

measurable output (sensible loss)

- urine
- feces
- drainage from body cavities

non-measurable output (insensible loss)

- perspiration
- vaporization through lungs

isotonic

normal Na and serum osmolality

hypotonic

decreased Na and serum osmolality

hypertonic

increased Na and serum osmolality

2200-2700

Normal fluid intake is about ____-____ml/day.

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