Fluid, Electrolyte, Acid Base Balance (Chapter 39)

Functions of Water in the Body

* Act as a solvent for electrolytes and non electrolytes. * Help maintain normal body temperature. * Facilitate digestion and promote elimination. * Act as a tissue lubrican.

Lab Studies to Assess for Imbalances

* Complete blood count. * Serum electrolytes, blood urea nitrogen, and creatinine levels. * Urine pH and specific gravity. * Arterial blood gases.

Two Compartments of Fluid in the Body

* Intracellular fluid (ICF): fluid within cells [70%). * Extracellular fluid (ECF): fluid outside cells [30%) Includes intravascular and interstitial fluids

Osmolarity of a Solution

* Isotonic: same concentration of particles as plasma. * Hypertonic: greater concentration of particles than plasma. * Hypotonic: lesser concentration of particles than plasma.

Primary Organs of Homeostasis

* Kidneys normally filter 170 L of plasma and excrete 15 L of urine. * The cardiovascular system pumps and carries nutrients and water in body.

Primary Organs of Homeostasis

* Lungs regulate oxygen and carbon dioxide levels of the blood. * Adrenal glands help the body conserve sodium, save chloride and water, and excrete potassium. * The pituitary gland stores and releases ADH.

Magnesium

* Magnesium: metabolism of carbohydrates and proteins, vital actions involving enzymes. * Chloride: maintains osmotic pressure in blood, produces hydrochloric acid

Parameters of Assessment

* Nursing history and physical assessment. * Fluid intake and output. * Daily weights. * Laboratory studies.

Primary Organs of Homeostasis

* Parathyroid glands regulate the level of calcium in ECF. * The GI tract absorbs water and nutrients that enter the body through this route.

Sodium

* Sodium: controls and regulates volume of body fluids * Potassium: chief regulator of cellular enzyme activity and water content. * Calcium: nerve impulse, blood clotting, muscle contraction, B12 absorption.

Fluid Balance

* Solvents: liquids that hold a substance in solution (water) Solutes: substances dissolved in a solution (electrolytes * and nonelectrolytes)

Primary Organs of Homeostasis

* The thyroid gland increases the blood flow in the body and increases renal circulation. * The nervous system inhibits and stimulates mechanisms influencing fluid balance.

Functions of Water in the Body

* Transport nutrients to cells and wastes from cells. * Transport hormones, enzymes, blood platelets, and red and white blood cells. * Facilitate cellular metabolism and proper cellular chemical functioning.

What are the subdivisions of extracellular fluid? Which ones are the two *main compartments?

*Intravascular or plasma (within the vascular system) *Interstitial Lymph Transcellular

Implementing

-Dietary modifications. -Modifications of fluid intake. -Medication administration. -IV therapy. -Blood and blood products replacement. -TPN. -Allaying patient anxiety as needed. -Appropriate patient and family teaching.

Risks for Balance Disturbances

-clients who are confused or unable to communicate needs -vomiting, diarrhea, NG suction -tissue trauma (burns, hemorrhage) -Impaired cardiac function -decreased blood flow to kidneys -medications -chronic disease (diabetes, COPD)

Examples of transcellular fluid are: (Select all that apply) 1. CSF & synovial fluid 2. pericardial 3. pancreatic 4. pleural 5. saliva 6. peritoneal 7. gastric juices

1, 2, 3, 4, 6,

FVD occurs as a result of: (select all that apply) 1. abnormal losses through skin, GI tract, kidney 2. decreased intake of fluid 3. bleeding 4. low blood pressure 5. movement of fluid into a third space

1, 2, 3, 5

Water is used for which of the following? Select all that apply. 1. as a lubricant 2. as an insulator 3. as a shock absorber 4. to hydrolyze foreign invaders 5. to maintain/regulate body temperature

1, 2, 3, 5 (I made #4 up)

Specific causes of FVE include: (select all that apply) 1. excessive intake of NaCl 2. administering sodium containing infusions too rapidly, particularly to clients with impaired regulatory mechanisms 3. lack of exercise 4. heart/renal failure 5. cirrhosis of the liver

1, 2, 4, 5

Sodium functions in which of the following? Select all that apply: 1. Regulating ECF volume and distribution 2. Maintaining blood volume 3. Intracellular metabolism 4. HCl production 5. Transmitting nerve impulses and contracting muscles

1, 4, 5

The average adult takes in ____mL of water in foods each day.

1,000

The average daily oral fluid intake for an adult is _____ to _____ mL.

1,200 to 1,500

Urine contributes____ to ____mL of fluid output on average for an adult.

1,400, 1,500

3 buffer systems

1. carbonic acid-sodium bicarbonate buffer system 2. phospate buffer system 3. the protein buffer system

Homeostatic regulators of hydrogen ions

1. chemical buffer systems 2. respiratory mechanisms 3. renal mechanisms

_____ of total body fluid is found outside the cells and is called ______ ______.

1/3, extracellular fluid (ECF)

Adults can lose ____mL of fluid in the form of sweat and lose ____ to _____ in their feces.

100; 100 to 200

Normal sodium levels are ____ to ____ mEq/L.

135 to 145

Electrolytes are important for: (Select all that apply) 1. regulating edema 2. maintaining fluid balance 3. facilitating enzyme reactions 4. transmitting neuromuscular reactions 5. suppressing ADH

2, 3, 4

Intracellular fluid contains which of the following? Select all that apply. 1. proteins 2. oxygen 3. glucose 4. electrolytes 5. fatty acids

2, 3, 4

Which of the following contribute to fluid regulation in the body? Select all that apply. 1. Liver 2. Kidneys 3. Cardiovascular system 4. Gastrointestinal system 5. Pancreas 6. Lungs

2, 3, 4 (pg 1454)

Approximately ___% of ECF is _______, found within the vascular system.

20, plasma

____mL of fluid is contributed to the adult's average daily fluid intake as a by-product of food metabolism.

200

The normal serum osmolality is ___ - ____ mOsm/Kg

280 to 300

The following substances move easily across cell and capillary membranes: (Select all that apply) 1. glucose 2. proteins 3. ions 4. oxygen 5. CO2

3, 4, 5 (glucose and proteins are large molecules and have difficulty moving across membranes)

Which of the following apply to ANF? Select all that apply. 1. it is released from the liver 2. it is released in response to decreased blood volume. 3. It promotes sodium wasting 4. it acts as a diuretic 5. it decreases blood volume 6. it inhibits thirst

3, 4, 5, 6 (ANF is released from cells from the atrium of the heart in response to EXCESS blood volume.)

An adult loses ____ to ____mL of fluid from each the lungs and from the skin.

350, 400

Total body fluid

50-60% of body weight in normal adult

Approximately ____% of the average healthy adult's weight is water.

60

The normal pH of arterial blood is:

7.35-7.45

Interstitial fluids account for approximately ___% of the ECF.

75

Overhydration

: above-normal amounts of water in extracellular spaces

Hypervolemia

: excessive retention of water and sodium in ECF

Filtration

: passage of fluid through a permeable membrane from the area of higher to lower pressure

Diffusion

: tendency of solutes to move freely throughout a solvent ("downhill")

Where is a PICC line placed

A nurse places a PICC line into a large vein in your arm and guides the catheter up into the main vein near your heart where blood flows quickly. The nurse sutures (stitches) the PICC line in place and covers the site with a sterile bandage. An x-ray is done to make sure that the catheter is in the right place.

Buffer

A substance that prevents body fluids from becoming overly acidity or alkaline

Acid-base imbalances occur

Acid-base imbalances occur when the carbonic acid or bicarbonate levels become disproportionate. When there is a single primary cause, these disturbances are known as respiratory acidosis or alkalosis and metabolic acidosis or alkalosis.

The movement of solutes across cell membranes from a less concentrated solution to a more concentrated solution is referred to as _____ _____.

Active transport

Factors affecting fluid, electrolyte, acid-base balance in the body.

Age Sex/Body size environmental temperature Lifestyle

infant

An infant has considerably more body fluid and ECF than an adult; more prone to fluid volume deficits

The regulatory mechanism of this electrolyte includes: -redistribution between bones and ECF -parathyroid hormone and calcitrol increase serum levels of this electrolyte; calcitonin decreases serum levels

Ca2+ (calcium)

Ca++

Calcium

Central venous access

Central venous access devices provide access for a variety of IV fluids, medications, blood products, and TPN solutions and allow a means for hemodynamic monitoring and blood sampling.

Of the three ways the body maintains a normal pH, which is the fastest system?

Chemical Buffers

The regulatory mechanism of this electrolyte includes: -excreted and reabsorbed along with sodium in the kidneys -aldosterone increases reabsorption of this electrolyte with sodium

Cl- (chloride)

Examples of anions

Cl-, HCO3-, PO4-

Hypotonic solution

Decrease osmotic pressure which moves fluid into the cell causing the cell to swell, put fluid into the cell -Used for those with a hypertonic fluid imbalance such as those when a patient has a loss of intracellular fluid -Cellular replacement given over time -0.45 NS, 0.33 NS -Used with diabetes insidious, diabetic ketoacidosis and in children

A fluid deficit would do what to blood pressure?

Decrease systolic BP, postural hypotention

Nursing Diagnoses Related to Fluid Imbalances

Deficient Fluid Volume Excess Fluid Volume Risk for Imbalanced Fluid Volume Risk for Deficient Fluid Volume

______ is a hyperosmolar fluid imbalance that leaves the client with excess sodium.

Dehydration

The movement of a solute, gas, or substance in a solution across a semi-permeable membrane from and area of higher concentration to an area of lower concentration resulting in even distribution of the solute is called _____.

Diffusion

When hydrostatic pressure is greater than osmotic pressure, fluid filters into the blood vessels. T/F

FALSE---fluid filters out of blood vessels into interstitial space

Angiotensin II acts directly on the nephron to promote sodium and water excretion. T/F

FALSE. It promotes sodium and water RETENTION.

Interstitial fluid is protein rich and contains large amounts of albumin. T/F

False---it's plasma. IF contains little or no protein

Biliary and intraocular fluids are considered interstitial fluids. T/F

False--they are considered transcellular fluids

The thirst center is located in the cerebral cortex. T/F

False. It's located in the hypothalamus

Under normal conditions, sodium concentrations are higher in the the ICF than in the ECF. T/F

False. Potassium concentrations are higher in the ICF under normal conditions

Collecting ducts become less permeable when ADH is released. T/F

False. They become more permeable when ADH is released, allowing more water to be reabsorbed into the blood.)

The ICF is the transport system that carries oxygen and nutrients to, and waste products from, body cells.

False. its the ECF.

Interstital fluid

Fluid between the cells (surrounding the cells)

____ ____ ____ occurs when he body retains both water and sodium in similar proportions to normal ECF.

Fluid volume excess (FVE)

women and obese people

Gender and amount of fat cells affect body water; women and obese people have less body water

The regulatory mechanism of this electrolyte includes: -excretion and reabsorption by the kidneys -regeneration by the kidneys

HCO3- (bicarbonate)

Which of the following is a strong acid, releasing more hydrogen ions in solution and, thus, lowering the pH more than the others?

HCl

Variations in Fluid Content. Healthy person

Healthy person: total body water is 50% to 60% of body weight

The delicate balance of fluids, electrolytes, acids, and bases that depends on many physiological processes that regulate fluid intake and output.

Homeostasis

______ _______ is the pressure exerted by a fluid within a closed system on the walls of the container in which it is contained.

Hydrostatic pressure

The overall body response to stress is to (increase/decrease) blood volume.

Increase

Hypertonic solution

Increase osmotic pressure pulls fluid out from the cells causing them to shrink -Use cautioulsl because your pulling fluid out into the vascular space which could lead to pulmonary edema -D10W, D5 in 0.9% NS, D5 0.45% NS, D5 in LR

The loss of fluid through the skin and lungs are referred to as _____ _____ _____.

Insensible fluid losses

This fluid surrounds the cells.

Interstitial fluid

____ fluid is found within the cells of the body and constitutes approximately ____ of the total body fluid in adults.

Intracellular fluid, 2/3

_____ imbalances occur when water and electrolytes are lost or gained in equal proportions, and osmolality of body fluids remains constant.

Isotonic

Osmolarity of a Solution

Isotonic. Hypertonic. Hypotonic.

The regulatory mechanism of this electrolyte includes: -renal excretion -aldosterone increases excretion of this electrolyte -movement into and out of cells -Insulin helps move this into cells; tissue damage and acidosis shift this out of cells and into ECF

K+ (potassium)

Mg++

Magnesium

Expected Outcomes

Maintain approximate fluid intake and output balance (2,500-mL intake and output over 3 days).

Urinary specific gravity (SG) is a measure of the concentration of solutes in the urine. It measures the ratio of urine density compared with water density and provides information on the kidney's ability to concentrate urine. A urinary specific gravity measurement is a routine part of urinalysis

Maintain urine specific gravity within normal range (1,010-1,025).

Major electrolytes in the ECF

Major electrolytes in the ECF include sodium, chloride, calcium, and bicarbonate.

Major electrolytes in the ICF

Major electrolytes in the ICF include potassium, phosphorus, and magnesium

_____ energy is expended during active transport.

Metabolic

Metabolic

Metabolic acidosis: proportionate deficit of bicarbonate in ECF. Metabolic alkalosis: primary excess of bicarbonate in ECF.

Vomiting (with a loss of HCl acid from the stomach) will cause which type of acid/base disturbance? What would be the compensation?

Metabolic alkalosis; decreased respiration

The regulatory mechanism of this electrolyte includes: -conservation and excretion by kidneys -intestinal absorption increased by Vit D and parathyroid hormone

Mg2+ (magnesium)

The regulatory mechanism of this electrolyte includes: -renal reabsorption or excretion -aldosterone increases the absorption of this electrolyte in collecting duct of nephron

Na+ (sodium)

Examples of cations

Na+, K+, Ca++, Mg++

Anion

Negative charge -Chloride, bicarbonate, phosphate

When pH is low in the plasma, the kidney uses three mechanisms to restore pH. The first mechanism is reabsorption of filtered bicarbonate. What are the other two mechanisms?

New bicarbonate ions are generated and hydrogen ions are secreted.

Metabolic acidosis

Occur when carbonic acid or bicarbonate levels become disproportionate

Alkalosis

Occurs when there is a lack of H ions or gain of base ions and the pH exceeds 7.45

The concentration of solutes in body fluids is usually expressed as ________.

Osmolality

_____ imbalances involve the loss of gain of only water so that osmolality of serum is altered.

Osmolar

The movement of water across cell membranes from less concentration of solute to more concentration of solute in efforts to equalize the concentration of solutions is called______.

Osmosis

_____ _____ opposes and balances the force of hydrostatic pressure.

Osmotic pressure

_____ is a hypo-osmolar fluid imbalance that occurs when water is gained in excess of electrolytes, resulting in love serum osmolality and low serum sodium levels.

Overhydration

The regulatory mechanism of this electrolyte includes: -excretion and reabsorbed along with sodium in the kidneys -parathyroid hormone decreases serum levels my increasing renal excretion -reciprocal relations hips calcium; increasing serum calcium decreases levels of this electrolyte

PO4- (phosphate)

Trancellular

Pleural (lungs), CSF, intraocular (eyes), synovial fluid (joints) periotoneal (abdomen)

The primary cations present in ICF are ____ and ____.

Potassium and Magnesium

Active transport

Process that requires energy for the movement of substances through a cell membrane, agains the concentration gradient from area of lesser solute concentration to an area of higher solute concentration -Requires ATP (energy)

Respiratory acidosis

Respiratory acidosis: primary excess of carbonic acid in ECF. Respiratory alkalosis: primary deficit of carbonic acid in ECF.

Emphysema can lead to which acid/base disturbance? What would be the compensation?

Respiratory acidosis; kidneys will retain more HCO3 and excrete H+

Severe anxiety would cause which type of acid/base disturbance? What would be the compensation?

Respiratory alkalosis; excrete HCO3

Capillary filtration

Results from the force of blood pushing against the walls of the capillaries

Isotonic solution

Same as body fluid and same concentration of particles as plasma; used for extracellular volume replacement -givent to dehydrated patients or vomiting patients to replace volume -Most common solution -LR, 0.9% NS, and D5W

Major Electrolyte

Sodium. Potassium. Calcium. Magnesium. Chloride. Bicarbonate. Phosphate.

Base

Substance that can accept or trap H+ ions, such as bicarbonate ion

Electrolytes

Substances that are capable of breaking into particles called ions

Diffusion

Th tendency of solutes to move freely throughout a solvent from an area of higher to an area of lower concentration -Oxygen and carbondioxide exchange in the lungs use diffusion

Question: The nursing instructor is explaining how the respiratory system is involved in hydrogen ion regulation to maintain normal pH. The instructor places the steps in order once the CO2 in the blood has increased resulting in increased respirations to eliminate CO2. 1 pH becomes more alkaline 2 Decreased respirations 3 H2CO3 level in the blood decreases 4 Carbonic acid formed 5 Carbon dioxide retention 6 Blood level of CO2 decreases

The Correct Order: H2CO3 level in the blood decreases pH becomes more alkaline Blood level of CO2 decreases Decreased respirations Carbon dioxide retention Carbonic acid formed When respirations are increased, the H2CO3 level begins to decrease, causing the pH to become more alkaline. When the blood level of CO2 decreases, respirations slow, resulting in CO2 retention and the formation of carbonic acid, signaling stabilization of the pH balance.

How long can a PICC line stay in place

The PICC line can stay in your arm for as long as 12 months, although the average length is usually about 6 months, depending on your treatment requirements

Acidosis

The condition characterized by and excess of H ions or loss of base ions in the ECF in which the pH falls below 7.35

dehydration

The loss of our deprivation of water form the body

Hydrostatic pressure

The pressure that the fluid exerts on the walls of its container.

Hydrostatic pressure

The pushing force, force solutes out into intersitiial space

Aldosterone promotes sodium retention at the distal nephron. T/F

True

Gastric and intestinal secretions contain electrolytes. T/F

True

Osmotic pressure of body fluids, vascular volume, and angiotensin are all stimuli that trigger the thirst center. T/F

True

Plasma and IF, the two primary components of ECF, contain essentially the same electrolytes and solutes, with the exception of protein. T/F

True

The kidneys play a role in both electrolyte balance and acid base balance. T/F

True (Electrolyte balance is maintained by selective retention and excretion by kidneys; they also excrete H+ and retain bicarbonate.) pg 1455

A physician has asked the nurse to use microdrip tubing to administer a prescribed dosage of IV solution to a client. What is the standard drop factor of microdrip tubing? a) 60 drops/mL b) 30 drops/mL c) 120 drops/mL d) 90 drops/mL

a) 60 drops/mL Microdrip tubing, regardless of manufacturer, delivers a standard volume of 60 drops/mL. Macrodrip tubing manufacturers, however, have not been consistent in designing the size of the opening. Therefore, the nurse must read the package label to determine the drop factor (number of drops/mL)

The oncoming nurse is assigned to the following patients. Which patient should the nurse assess first? a) A newly admitted 88-year-old with a two-day history of vomiting and loose stools b) A 60-year-old who is 3 days post-myocardial infarction and has been stable c) A 20-year-old, 2 days post-operative open appendectomy who refuses to ambulate today d) A 47-year-old who had a colon resection yesterday and is complaining of pain

a) A newly admitted 88-yr old with a two day history of vomiting and loose stool

Which nursing diagnosis would the nurse make based on the effects of fluid and electrolyte imbalance on human functioning? a) Acute Confusion related to cerebral edema b) Constipation related to immobility c) Risk for Infection related to inadequate personal hygiene d) Pain related to surgical incision

a) Acute confusion related to cerebral edema

The nurse is caring for a male client who has a diagnosis of heart failure. Today's laboratory results show a serum potassium of 3.2 mEq/L. For what complications should the nurse be aware, related to the potassium level? a) Cardiac dysrhythmias b) Fluid volume excess c) Tetany d) Pulmonary embolus

a) Cardiac dysrhythmias

The nurse is caring for elderly patients in a long-term care facility. What age-related alteration should the nurse consider when planning care for these patients? a) Cardiac volume intolerance b) An increased sense of thirst c) Increased renal blood flow d) Increase in nephrons in the kidneys

a) Cardiac volume intolerance The elderly patient is more likely to experience cardiac volume intolerance related to the heart having less efficient pumping ability. The elderly typically experience a decreased sense of thirst, loss of nephrons, and decreased renal blood flow.

A client is taking a diuretic such as furosemide. When implementing client education, what information should be included? a) Decreased potassium levels b) Decreased oxygen levels c) Increased potassium levels d) Increased sodium levels

a) Decreased potassium levels Many diuretics such as furosemide are potassium wasting; hence, potassium levels are measured to detect hypokalemia.

A nurse is measuring intake and output for a patient who has congestive heart failure. What does not need to be recorded? a) Fruit consumption b) Frozen fluids c) Parenteral fluids d) Sips of water

a) Fruit Consumption Any water consumption must be recorded in order to closely monitor a patient who has congestive heart failure. Many of these patients are on fluid restrictions. Sips of water, parenteral fluids, and frozen fluids count as fluid intake. The amount of water in fruits cannot be measured.

Endurance athletes who exercise for long periods of time and consume only water may experience a sodium deficit in their extracellular fluid. What is this electrolyte imbalance known as? a) Hyponatremia b) Hyperkalemia c) Hypokalemia d) Hypernatremia

a) Hyponatremia Hyponatremia refers to a sodium deficit in the extracellular fluid caused by a loss of sodium or a gain of water. Hypernatremia refers to a surplus of sodium in the ECF. Hypokalemia refers to a potassium deficit in the ECF. Hyperkalemia refers to a potassium surplus in the ECF.

A young man has developed gastric esophageal reflux disease. He is treating it with antacids. Which acid-base imbalance is he at risk for developing? a) Metabolic alkalosis b) Respiratory acidosis c) Metabolic acidosis d) Respiratory alkalosis

a) Metabolic Alkalosis Endocrine disorders and ingestion of large amounts of antacids cause metabolic alkalosis.

A nurse monitoring a client's IV infusion auscultates the client's lung sounds and finds crackles in the bases of lungs that were previously clear. What would be the appropriate intervention in this situation? a) Notify the primary care provider immediately for possible fluid overload. b) No intervention is necessary as this is a normal finding with IV infusion. c) Check all clamps on the tubing and check tubing for any kinking. d) Notify the primary care provider immediately because these are signs of speed shock.

a)Notify primary care provider immediately for possible fluid overload

A patient with type AB blood has experienced a precipitous drop in his hemoglobin levels due to a gastrointestinal bleed and now requires a blood transfusion. Which of the following blood types may this patient safely receive? Select all that apply. a) A b) O c) AB d) B

a, b, c, d

What signs of complications and their probable causes may occur when administering an IV solution to a patient? (Select all that apply.) a) Swelling, pain, coolness, or pallor at the insertion site may indicate infiltration of the IV. b) Engorged neck veins, increased blood pressure, and dyspnea occur when a thrombus is present. c) Bleeding at the site when the IV is discontinued indicates an infection is present. d) A pounding headache, fainting, rapid pulse rate, increased blood pressure, chills, back pains, and dyspnea occur when an air embolus is present. e) Redness, swelling, heat, and pain at the site may indicate phlebitis. f) Local or systemic manifestations may indicate an infection is present at the site.

a, e, f

Which actions would a nurse perform after selecting a site and palpating accessible veins in order to start an IV infusion? (Select all that apply.) a) Advance the needle or catheter into the vein. A sensation of "give" can be felt when the needle enters the vein. b) Enter the skin gently with the catheter held by the hub in the non-dominant hand, bevel side down, at a 10- to 30-degree angle. c) Clean the entry site with saline, followed by an alcohol swab according to agency policy. d) Place the dominant hand about 4 inches below the entry site to hold the skin taut against the vein. e) When blood returns through the lumen of the needle or the flashback chamber of the catheter, advance device into the vein until the hub is at the venipuncture site. f) Release the tourniquet, quickly remove the protective cap from the IV tubing, and attach the tubing to the catheter or needle.

a, e, f

People who drink heavy amounts of alcohol are also at risk for _____ associated with breakdown of fat tissue.

acidosis

Angiotensin II stimulates what hormone to be released from the adrenal cortex?

aldosterone

central venous catheter

also called a central line, is a long, thin, flexible tube used to give medicines, fluids, nutrients, or blood products over a long period of time, usually several weeks or more. A catheter is often inserted in the arm or chest through the skin into a large vein.

ACE converts ______ to _______

angiotensin I to angiotensin II

What is ACE?

angiotensin converting enzyme

Renin converts _______ to _________.

angiotensin to angiotensin I

Ions that carry a negative charge are called _____.

anions

Solvents

are liquids that hold a substance in solution

Solutes

are substances that are dissolved in a solution

A nurse is measuring the intake and output of a patient who is dehydrated. What is the average adult daily fluid intake in milliliters that the nurse would use as a comparison? a) 2,300 mL b) 2,600 mL c) 1,800 mL d) 1,500 mL

b) 2600 mL The average adult daily fluid source is: 1,300 mL from ingested water, 1,000 mL from ingested food, and 300 mL from metabolic oxidation, totaling 2,600 mL fluid.

A nurse is calculating the output of a client with renal failure and takes into account all modes of fluid loss. When addressing the client's insensible fluid loss, which amount would the nurse anticipate as the usual average? a) 200 mL/day b) 300 to 400 mL/day c) 100 to 200 mL/day d) 1500 mL/day

b) 300 to 400 ml/day

Which fluid should be administered slowly to prevent circulatory overload? a) 0.45% NaCl b) 5% NaCl c) 0.9% NaCl d) Dextrose 5%

b) 5% NaCl When a hypertonic solution is infused, it raises serum osmolarity, pulling fluid from the cells and the interstitial tissues into the vascular space. Examples of hypertonic solutions include 3% (NaCl) and 5% saline (NaCl).

When caring for a client who is on intravenous therapy, the nurse observes that the client has developed redness, warmth, and discomfort along the vein. Which of the following interventions should the nurse perform for this complication? a) Elevate the client's head. b) Apply a warm compress. c) Position the client on the left side. d) Apply antiseptic and a dressing.

b) Apply a warm compress Prolonged use of the same vein can cause phlebitis; the nurse should apply a warm compress after restarting the IV. The nurse need not elevate the client's head, position the client on the left side, or apply antiseptic and a dressing. The client's head is elevated if the client exhibits symptoms of circulatory overload. The client is positioned on the left side if exhibiting signs of air embolism. The nurse applies antiseptic and a dressing to an IV site in the event of an infection.

A home care nurse is teaching a client and family about the importance of a balanced diet. The nurse determines that the education was successful when the client identifies which of the following as a rich source of potassium? a) Processed meat b) Apricots c) Dairy products d) Bread products

b) Apricots

A client loses consciousness after strenuous exercise and needs to be admitted to a health care facility. The client is diagnosed with dehydration. The nurse knows that the client needs restoration of which of the following? a) Interstitial fluid b) Electrolytes c) Non-electrolytes d) Colloid solution

b) Electrolytes

Which solution is a crystalloid solution that has the same osmotic pressure as that found within the cells of the body and is used to expand the intravascular volume? a) Colloid b) Isotonic c) Hypertonic d) Hypotonic

b) Isotonic fluids Isotonic fluids have an osmolarity of 250-375 mOsm/L, which is the same osmotic pressure as that found within the cell.

The nurse writes a nursing diagnosis for a patient of "Fluid Volume: Excess." What risk factor would the nurse assess in this patient? a) Excessive use of laxatives b) Renal failure c) Diaphoresis d) Increased cardiac output

b) Renal Failure Excess fluid volume may result from increased fluid intake or from decreased excretion, such as occurs with progressive renal disease. Excessive use of laxatives, diaphoresis, and increased cardiac output may lead to a fluid volume deficit.

HCO3-

bicarbonate

A home care nurse is visiting a client with renal failure who is on fluid restriction. The client tells the nurse, "I get thirsty very often. What might help?" Which of the following would the nurse include as a suggestion for this client? a) Eat crackers and bread. b) Use regular gum and hard candy. c) Avoid salty or excessively sweet fluids. d) Use an alcohol-based mouthwash to moisten your mouth.

c) Avoid salty or excessively sweet fluids

Major control over the extracellular concentration of potassium within the human body is exerted by: a) albumin. b) testosterone. c) aldosterone. d) progesterone.

c) aldosterone Aldosterone exerts major control over the extracellular concentration of potassium. It also enhances renal secretion of potassium.

Regular weight bearing exercise has a benefit on the balance of which electrolyte?

calcium

Heavy alcohol consumption increases the risk of low amounts of what 3 electrolytes?

calcium, magnesium, phosphate

Ions that carry a positive charge are called _____.

cations

Milliequivalents refers to the capacity of _____ to combine with _____ to form ________.

cations; anions; molecules

In dehydration, serum osmolality and serum sodium levels increase, drawing water into the vascular compartment from the interstitial space and cells, resulting in _____ dehydration.

cellular

Cl-

chloride

When sodium is absorbed from the kidney tubules, ___ and ____ are absorbed with it.

chloride, water

ADH regulates water excretion from the kidneys by acting upon the ______ ______ of the nephrons.

collecting ducts

Cell and capillary membranes are _____ permeable to water and _____ permeable to solutes.

completely; selectively

A physician orders an infusion of 250 mL of NS in 100 minutes. The set is 20 gtt/mL. What is the flow rate? a) 40 gtt/min b) 30 gtt/min c) 20 gtt/min d) 50 gtt/min

d) 50 gtt/min

A client who is admitted to the health care facility has been diagnosed with cerebral edema. Which of the following intravenous solutions needs to be administered to this client? a) Hypotonic solution b) Isotonic solution c) Colloid solution d) Hypertonic solution

d) Hypertonic solution Hypertonic solutions are used in extreme cases when it is necessary to reduce cerebral edema or to expand the circulatory volume rapidly because it is more concentrated than body fluid and draws cellular and interstitial water into the intravascular compartment. Hypotonic solutions are administered to clients with fluid losses in excess of fluid intake, such as those who have diarrhea or vomiting. Isotonic solution is generally administered to maintain fluid balance in clients who may not be able to eat or drink for a short period. Colloid solutions are used to replace circulating blood volume because the suspended molecules pull fluid from other compartments. However, these solutions are not related to clients with cerebral edema.

A nurse needs to select a venipuncture site to administer a prescribed amount of IV fluid to a client. The nurse looks for a large vein when using a needle with a large gauge. Which of the following reasons explains the nurse's action? a) To avoid restriction of mobility b) To reduce the potential for blood clots c) To prevent pain and discomfort d) To prevent compromising circulation

d) To prevent compromising circulation

The pulse amplitude is (increased/decreased) with fluid deficit and (increased/decreased) with fluid excess.

decreased, increased

When hydrogen ion concentration decreases, acidity __________, and pH __________.

decreases; increases

How does fluid excess and deficit affect respirations?

deficit: normal excess: moist crackles/wheezes

Active transport moves and holds Na+ and K+ against their ______ ______.

diffusion gradients

The jugular vein becomes _____ with fluid excess.

distended

Dependent _____ is evident with a fluid excess.

edema

Chemical substances that develop and electric charge and are able to conduct and electric current when place in water

electrolytes

Sports drinks are recommended with strenuous activity because they replace both ____ and ____.

electrolytes and water

How does fluid excess and deficit affect specific gravity?

excess--low deficit--high

Edema

excessive ECF accumulates in tissue spaces

In ______, fluid and solutes move together across a membrane from one compartment to another (from area of high pressure to area of low pressure).

filtration

The pressure that results in the movement of fluid and solutes out of a compartment is called ______ ________.

filtration pressure

When the body loses both water and electrolytes form the ECF in similar proportions, it is referred to as a ____ _____ _____ .

fluid volume deficit

Infants and growing children have a (greater/lesser) fluid turnover than adults and they loose (more/less) through their kidneys.

greater; more

When two solution of different concentrations are separated by a semipermeable membrane, the solution with a (higher/lower) solute concentration exerts a higher osmotic pressure and pulls water across the membrane.

higher

Filtration pressure is the difference between _____ pressure and ______ pressure

hydrostatic, osmotic

FVE is also called ______ because blood volume increases.

hypervolemia

FVD (fluid volume deficit) is often called ______ because fluid is initially lost from the intravascular compartment.

hypovolemia

How would a fluid excess affect blood pressure

increase

Heart rate (increases/decreases) with fluid deficit, and (increases/decreases) with fluid excess.

increases, increases

The sodium potassium pump maintains the concentration of ____ in the ECF & ICF

ions

peripherally inserted central catheter (PICC or PIC line)

is a form of intravenous access that can be used for a prolonged period of time (e.g. for long chemotherapy regimens, extended antibiotic therapy, or total parenteral nutrition

Colloid osmotic pressure

is a form of osmotic pressure exerted by proteins, notably albumin, in a blood vessel's plasma (blood/liquid) that usually tends to pull water into the circulatory system.

Extracellular fluid (ECF)

is all the fluid outside of the cells, accounting for about 30% of the total body water or 20% of the adults body weight -Interstitial -Transcellular -intravascular

ICF provides a medium for the ______ processes of cells.

metabolic

Water serves as a medium for _____ reactions within cells.

metabolic

A loss of bicarbonate due to diarrhea can lead to a ____________ (name the acid/base disturbance) with ____________ (metabolic or respiratory) compensation.

metabolic acidosis; respiratory

The unit of measurement for electrolytes is called _________.

milliequivialents (mEq)

People with a higher percentage of lean muscle retain (more/less) water than those with a higher percentage of body fat.

more

Interstitial-to-plasma shift:

movement of fluid from space surrounding cells to blood

The power of a solution to pull water across a semipermeable membrane is referred to as _____ _____.

osmotic pressure

Cellular metabolism generates CO2, which is eliminated by the lungs. If respiration decreases, what will happen to the pH of the blood?

pH decreases

PO4-

phosphate

The primary anions present in ICF are ____ and ______.

phosphate and sulfate

Cation

positive charge -sodium, potassium, calcium, hydrogen, magnesium ions

Seriously malnourished people have decreased serum _____ levels and may develop edema because serum osmotic pressure is reduced.

protein

Colloid omotic pressur

pulling fores or reabsorption of fluid back into the capillaries

If blood flow or pressure to the kidney decreases, ____ is released.

renin

Active transport

requires energy for movement of substances through the cell membrane from the lesser solute concentration to the higher solute concentration

FVE is always secondary to an increase in ____ content in the body, which leads to an increase in total body water.

sodium

The 3 principal electrolytes in the ECF are:

sodium, chloride, and bicarbonate

Na+, K+

sodium, potassium

Acid

substance containing H+ that can bet liberated or released such as carbonic acid

SO42-

sulfate

SIADH

syndrome of inappropriate antidiuretic hormone (too much ADH???)

Intravascular fluid

the fluid in the blood vessels (blood plasma)

Intracellular fluid (ICF)

the fluid within cells, constituting for about 70% of total body water of 40% of adults body weight

When fluid shifts from the vascular space into an area where it is not readily accessible as ECF, it is called _____ _____ _____.

third space syndrome (third spacing)

In older adults, the ____ response is diminished. They also have impaired ____ function that contributes to fluid imbalance.

thirst; renal

Output may be low or normal with fluid excess. T/F

true

Water serves as a transporter for nutrients and waste products. T/F

true

Overhydration often occurs when both fluid and electrolytes are lost, but only _____ is replaced (i.e., excessive sweating.)

water

osmosis

water (solvent) passes from area of lesser solute concentration and more water to areas with greater solute concentration and lesser water

Osmosis:

water passes from an area of lesser solute concentration to greater concentration until equilibrium is established