Water in the body varies with what three factors? Age, body fat, sex

What percent of the body is water? 60% Where are body fluids located? Intracellular, extracellular What is extracellular subdivided into? Interstitial and

intravascular Who has higher fluid content? Infants 70 to 80%, more

vulnerable to fluid deficit Why do elderly have decrease fluid content? Decreased mean

body mass Name the three types of transport? Define? Diffusion-

movement of gas/liquid molecules from a area of higher concentration to lesser thru a selective permeable membrane (CO2 & O2, perspiration, sweat glands). Osmosis – passage of a solvent thru a membrane from a solution of lesser solute to one of greater solute (venous/capillary). Filtration- fluids flow from an area of greater pressure across a membrane to an area of low pressure (hydrostatic-arterial capillary bed to interstitial)

What organs maintains fluid composition? Kidneys, lungs, heart, adrenal glands, parathyroid glands, hypothalamus

What is the rule of gains and losses? Input is = to output What are other ways fluids are regulated by the body? Thirst,

output by kidney-skin-lungs-GI tract, regulation – cellular NA/K+ pump-capillary level-kidney filtration, Hormonal – Pituitary-hypothalmus-adrenal-parathyroid glands, BP controls, osmolality, lymphatics.

What should be included in an assessment with a patient with fluid and electrolyte imbalances? Significant history that would be an indication (disease, medications, diet, adequate I&O’s, abnormal loss of fluid or intake), inspection of face (pinched look, sunken eyes)-thirst changes- decreased tearing and salivation-tongue turgor-JVD-appearance and temperature of skin- edema- pulmonary edema- neuromuscular irritability ( Chvostek’s sign/Trousseau’s sign) – other (changes in sensation, behavior, energy)

What hemodynamic signs should you monitor? Body temperature, Pulse, respirations, BP, CVP, Pulmonary Artery Pressures, Pulmonary wedge pressures, urine specific gravity (1.003-1.035), I&O, body weight

What labs should you monitor? Anion Gap (metabolic acidosis), lactate (tissue hyperperfusion), Albumin (fluid shift to interstitial/edema), BUN (reduced renal blood flow), Creatinine (renal disease), HCT (RBC in Plasma), Glucose (increase diuresis/fvd), serum osmolality (280to 295 serum NA concentration), Ammonia (decreased K+-alkalosis), phosphate (intracellular ion/calcium relationship), carbon dioxide (total bicarbonate and carbonic acid in venous blood), K+ (acid based), NA (bodies H2O status), CA (pH, cellular), Magnesium (intracellular), Chloride (excessive saline, alkalosis)

What maintenance fluids contain undissolved particles, such as protein, sugar, and starch molecules too big to pass thru capillary walls? Colloids draw fluids from interstitial & intracellular spaces to increase intravascular volume. Used for volume expansion when crystalloids are inadequate to treat hypovolemic shock, hemorrhage or third spacing. Example- Albumin 5% (isotonic) or 25% concentration

What does whole blood contain? RBC,WBC, Platelets, Plasma Must be given with in 24 hours, degrades with storage. Treat blood loss

Whole blood is broken down into what types of units? RBC’s (increase RBC mass and oxygen carrying capacity possibly causing fluid overload), Platelets, FFP

How fast should RBC’s be transfused? Infuse over 1-2 hours no more than 4, need a 20 gauge needle, consent, monitor for reaction, monitor patients with poor ejection fraction closely for fluid overload, may give diuretic in between units, type and cross match will be drawn prior, to be checked with another RN.

What is Fresh Frozen Plasma give? Used for clotting factors contains albumins, globulins, antibodies, & other plasma proteins.

Name colloids that are pharmaceutical plasma expanders? Hespan –volume expanding, Hetastarch – treat intravascular

volume loss, Dextran – increase intravascular volume, Mannitol- increase plasma volume producing osmotic diuresis treating ICP

What solutions closely mimic the bodies extracellullar fluid? Crystalloid. Expand both extracellular fluid volume.

How do you measure fluid volume status? Tonicity/osmolality (controls fluid between compartments) - measures number of solutes in a solution – move from lower concentration to higher concentration of solutes

What fluids have the same tonicity as plasma (ECF)? Isotonic - .9ns, D5W, LR for fluid loss due to vomiting & diarrhea, waiting for blood, expand circulating volume. Watch for excess.

What types of fluids help restore hemeostasis? Hypotonic - .45%, lower concentration of particles than plasma to treat patient in hyperosmolality state. Has less salt more H20 for patients who have NA restriction, to much can cause intravascular depletion, hyptension, cellular edema and tissue damage. Hypertonic – concentrated D5W or 3%or 5% NACl, greater tonicity than fluid in the extracellular compartment, use in extreme caution, treat hypoosmolality, high in sodium concentration, treat patients to correct hypoglycemia or provide calories. Draws fluids from intracellular to extracellar compartments causing cells to shrink relieving cellular edema. Increase risk of volulme overload. Monitor BS/ urine output, electrolytes.

What are nursing interventions fro patients receiving fluids? Meticulous I&O’s, DW, monitor lab values discussed earlier, acid-base, serum lactate, vital sign trends, skin integrity, warm solution to prevent hypthermia

What are complications a patient may have? Volume overload, electrolyte disturbances, coagulopathy, heart failure, pulmonary edema, interstitial edema, allergic reaction

Assessment- History- dietary intake, elimination (diarrhea, urine output),

medications OTC/prescribed, weight changes, heat exposure, thirst or excessive drinking, disorders (diabetes, renal, Cushing, Addison, cardiac), changes in mental status.

Physical- Hydration- Normal SG 1,015, moist mucus membranes/eyes, alert, = I & O, good skin turgor. Assess skin turgor, dryness (eyes, nose, mucus membranes), accurate I & O, weight changes, behavioral and neurological changes (excites neurological function), wound drainage, gastric or intestinal drainage, blood loss, drainage of body secretions, neuromuscular (muscle tone, strength, movement, coordination, tremors), GI peristalsis, cardiac changes, changes from baseline assessment.

Psychosocial- depressed, eating disorders, alcohol & drug abuse.

Diagnostic- (memorize lab results, you will be expected to know them for all your exams)

Electrolytes K+ 3.5 to 5.5 meq/l, magnesium 1.5-2.5 meq/l, NA 135-145 meq/l, Ca+ 9-11 total, Ca+ ionized 4.5-5.5mg/dl, phosphorus 2.8-4.5mg/dl Potassium imbalance life threatening.

BUN 10-30mg/dl measurement of liver and kidney function.

Creatinine 0.20- 1.0 mg/dl (measurement of renal excretion only, better test of renal function)

Glucose- fasting 70-120

Osmolality 275-295, indicates concentration of solutes in a in blood and urine. Used to measure fluid.

Hgb and HCT Male-13.5-18/40-54 Female 12-16/38-47

Urine pH and specific gravity- 4-8/1.003-1.030